Screening of MRSA colonization in patients undergoing total joint arthroplasty.

BACKGROUND: Periprosthetic infection is commonly caused by Staphylococcus aureus and, if resistant to methicillin (MRSA), is associated with increase in severity and costs to patient and healthcare systems. MRSA colonizes 1-5% of the population, therefore using a screening and decolonisation protocol the risk of periprosthetic infection could be reduced. The objective of our study is to report the results of a preoperative MRSA screening and management protocol utilised at our hospital. METHODS: All patients undergoing a total joint arthroplasty at our hospital were preoperatively screened for MRSA colonization with swab samples of five different locations. Exposure to risk factors were investigated in colonised patients and they were treated for 5 days prior surgery with nasal mupirocin, chlorhexidine sponges and oral tablets. RESULTS: During the 48 months of the study, MRSA colonisation was identified in 22 (1.01%) of 2188 patients operated. The culture was positive only in the nasal swab in 55 patients. In five patients the nasal culture was negative, but they had another positive swab culture (three in the groin and two perianal). None of the patients reported a history of recent antibiotic treatment or hospitalization. CONCLUSION: At our institution, the prevalence of MRSA colonisation is 1.01% in patients undergoing hip and knee arthroplasty. Interestingly, our screening protocol included samples from five different anatomic locations, and it is important to highlight that we found patients with negative nares culture and positive cultures in other locations. Therefore, the number of carriers may be underdiagnosed if only nasal samples are obtained. LEVEL OF EVIDENCE: IV.

La artroplastia invertida de hombro ante defectos óseos glenoideos / Reverse shoulder arthroplasty due to glenoid bone defects

Objetivo. La artroplastia invertida se está convirtiendo en una herramienta útil para afecciones muy variadas en el hombro. Un defecto óseo importante de la glena puede afectar a la fijación del componente glenoideo. El propósito de nuestro estudio es evaluar a medio plazo los resultados de la artroplastia invertida de hombro asociados a una glenoplastia. Material y métodos. Se realizó un estudio retrospectivo de 5 pacientes de nuestro hospital con defectos glenoideos de distinta etiología que fueron tratados mediante artroplastia invertida de hombro asociada a glenoplastia. Resultados. El seguimiento mínimo de estos pacientes fue de un año (con una media de 30,4 meses). Todos los injertos estaban radiológicamente integrados, sin observarse signos de resorción o necrosis. A los 12 meses el test de Constant era de 66,75 de media y el EVA medio era de 1. Discusión. La glenoplastia es una intervención de alta demanda técnica que consigue restaurar el remanente óseo en pacientes con defectos estructurales, permitiendo así implantar una artroplastia invertida. De esa forma podemos mejorar la función y la clínica en pacientes con diversas afecciones glenohumerales, proporcionándoles una solución (AU)

Objective. Reverse shoulder arthroplasty is becoming a useful tool for many diseases of the shoulder. Any severe glenoid bone defect may affect the fixing of the glenoid component. The aim of this paper is to evaluate the medium-term outcomes of reverse shoulder arthroplasty associated with a glenoplasty. Materials and methods. A retrospective study was conducted on 5 patients from our hospital, selected due to glenoid defects of different etiology. All of them where treated with reverse shoulder arthroplasty associated with glenoplasty with bone graft. Results. The minimum follow-up was one year (mean 30.4 months). All grafts were radiologically integrated, with no signs of resorption or necrosis being observed. At 12 months, the Constant score was 66.75 and the mean EVA score was 1. Discussion. Glenoplasty surgery is technically demanding for restoring original bone size in patients with glenoid structural defects, enabling a reverse shoulder arthroplasty to be implanted. Thus improving both the function and clinical outcomes in selected patients with glenohumeral pathology and providing them with a solution (AU)

Preeclampsia: Long-term effects on pediatric disability.

BACKGROUND: Preeclampsia affects up to 10% of pregnancies worldwide and is one of the main causes of fetal morbidity and mortality. Although it has been linked to developmental delay, its long-term effects on neurologic development in children have yet to be sufficiently quantified. OBJECTIVES: To evaluate whether preeclampsia's severity and its obstetric management correlate to the degree of disability in these infants. MATERIALS AND METHOD: This is an observational and descriptive study performed on a population of 96 women who were diagnosed with preeclampsia at Hospital General Universitario Gregorio Marañón between 2007 and 2014, and their 111 children. To evaluate the mother, we gathered data pertaining to her medical history, renal function markers, and medical management of the preeclampsia. To assess the children, we collected fetal growth measurements, acute fetal distress markers and main diagnoses at birth. We used the Pediatric Evaluation of Disability Inventory in its computerized adaptive test version (PEDI-CAT) to study performance in the relevant areas, and the TNO-AZL Preschool children Quality of Life (TAPQOL) to estimate health-related quality of life. RESULTS: PEDI-CAT percentiles were consistently lower in the social/cognitive domain than in other areas. Lower social/cognitive percentiles were associated to both lower maternal IgG levels and presence of necrotizing enterocolitis during the neonatal period. CONCLUSIONS: A connection between preeclampsia and poor social/cognitive outcomes exists that warrants further research.

Reverse shoulder arthroplasty due to glenoid bone defects. / La artroplastia invertida de hombro ante defectos óseos glenoideos.

OBJECTIVE: Reverse shoulder arthroplasty is becoming a useful tool for many diseases of the shoulder. Any severe glenoid bone defect may affect the fixing of the glenoid component. The aim of this paper is to evaluate the medium-term outcomes of reverse shoulder arthroplasty associated with a glenoplasty. MATERIALS AND METHODS: A retrospective study was conducted on 5 patients from our hospital, selected due to glenoid defects of different etiology. All of them where treated with reverse shoulder arthroplasty associated with glenoplasty with bone graft. RESULTS: The minimum follow-up was one year (mean 30.4 months). All grafts were radiologically integrated, with no signs of resorption or necrosis being observed. At 12 months, the Constant score was 66.75 and the mean EVA score was 1. DISCUSSION: Glenoplasty surgery is technically demanding for restoring original bone size in patients with glenoid structural defects, enabling a reverse shoulder arthroplasty to be implanted. Thus improving both the function and clinical outcomes in selected patients with glenohumeral pathology and providing them with a solution.

Compact étendue-preserving light-mixing optics.

We present a compact freeform optic, called "Freeform Shell-Mixer", which, when placed on top of a multicolor light source (particularly, a multi-chip LED), turns it into a virtual source in which colors are uniformly mixed. The optic, compatible with injection molding, makes use of étendue-conserving Köhler integration to provide homogeneous mixing of light. Its minimal size (just 2x larger than the source) makes the concept compatible with many luminaries, as ray tracing models show. Simulations indicate that the Freeform Shell-Mixer can reach efficiencies above 95% and both the size of the virtual source and its emission pattern are very similar to the ones of the original source, so the correct performance of the luminaire is secured.

Guía SECOT-GEIOS en osteoporosis y fractura por fragilidad. Actualización / SECOT-GEIOS guidelines in osteoporosis and fragility fracture. An update

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Using the small alignment index chaos indicator to characterize the vibrational dynamics of a molecular system: LiNC-LiCN.

A study of the dynamical characteristics of the phase space corresponding to the vibrations of the LiNC-LiCN molecule using an analysis based on the small alignment index (SALI) is presented. SALI is a good indicator of chaos that can easily determine whether a given trajectory is regular or chaotic regardless of the dimensionality of the system, and can also provide a wealth of dynamical information when conveniently implemented. In two-dimensional (2D) systems SALI maps are computed as 2D phase space representations, where the SALI asymptotic values are represented in color scale. We show here how these maps provide full information on the dynamical phase space structure of the LiNC-LiCN system, even quantifying numerically the volume of the different zones of chaos and regularity as a function of the molecule excitation energy.

A randomized control trial of a psychosocial intervention for caregivers of allogeneic hematopoietic stem cell transplant patients: effects on distress.

Caregivers of patients receiving allogeneic hematopoietic stem cell transplants (allo-HSCT) serve a pivotal role in patient care but experience high stress, anxiety and depression as a result. We theorized that stress management adapted for allo-HSCT caregivers would reduce distress compared with treatment as usual (TAU). Of 267 consecutive caregivers of allo-HSCT patients approached, 148 (mean=53.5 years, 75.7% female) were randomized to either psychosocial intervention (i=74) or TAU (n=74). Eight one-on-one stress management sessions delivered across the 100-day post-transplant period focused on understanding stress, changing role(s) as caregiver, cognitive behavioral stress management, pacing respiration and identifying social support. Primary outcomes included perceived stress (psychological) and salivary cortisol awakening response (CAR) (physiological). Randomized groups were not statistically different at baseline. Mixed models analysis of covariance (intent-to-treat) showed that intervention was associated with significantly lower caregiver stress 3 months post transplant (mean=20.0, 95% confidence interval (95% CI)=17.9-22.0) compared with TAU (mean=23.0, 95% CI=21.0-25.0) with an effect size (ES) of 0.39 (P=0.039). Secondary psychological outcomes, including depression and anxiety, were significantly reduced with ESs of 0.46 and 0.66, respectively. Caregiver CAR did not differ from non-caregiving controls at baseline and was unchanged by intervention. Despite significant caregiving burden, this psychosocial intervention significantly mitigated distress in allo-HSCT caregivers.

Free kappa light chains in cerebrospinal fluid as a biomarker to assess risk conversion to multiple sclerosis.

BACKGROUND: Multiple sclerosis (MS) initiates with a first attack or clinically isolated syndrome (CIS). The importance of an early treatment in MS leads to the search, as soon as possible, for novel biomarkers which can predict conversion from CIS to MS. OBJECTIVE: The purpose of this study was to assess the predictive value of the kappa index ([Formula: see text] index), using kappa free light light chains ([Formula: see text]FLCs) in cerebrospinal fluid (CSF), for the conversion of CIS patients to MS, and compare its accuracy with other parameters used in clinical practice. METHODS: FLC levels were analysed in CSF from 176 patients: 70 as control group, 77 CIS, and 29 relapsing-remitting MS. FLC levels were quantified by nephelometry. RESULTS: [Formula: see text] Index sensitivity and specificity (93.1%; 95.7%) was higher than those from the immunoglobulin G (IgG) index (75.9%; 94.3%), and lower than those from oligoclonal IgG bands (OCGBs) (96.5%; 98.6%). The optimal cut-off for [Formula: see text] index was 10.62. Most of the CIS patients with [Formula: see text] index >10.62 presented OCGBs, IgG index >0.56 and fulfilled magnetic resonance imaging (MRI) criteria. CONCLUSION: CIS patients above [Formula: see text] index cut-off of 10.62 present 7.34-fold risk of conversion to MS than CIS below this value. The [Formula: see text] index correlated with positive OCGBs, IgG index above 0.56 and MRI criteria.

Integrating mental health services into a general hospital in Puerto Rico.

The prevalence of mental health problems in the general population should be carefully considered. The literature has reported a high co-morbidity of medical and mental illnesses; therefore, collaborative efforts incorporating psychological services into medical settings are imperative. In Puerto Rico, this is not a regular practice in general hospitals. Improving access to mental health services is a challenge and requires the creation of new venues within the healthcare system. This paper describes the theoretical framework, mission, and objectives of the Clinical Psychology Services Program (CPSP) implemented at Damas Hospital in Puerto Rico. From December 2002 to December 2010, a total of 13,580 visits were made to inpatients in diverse clinical units of the hospital; 61% of all inpatients evaluated met the criteria for at least one mental health disorder based on the DSM-IV-TR. The CPSP's outcomes highlight the acceptance and relevance of incorporating mental health services and clinical psychologists into general hospitals.

Reconstrucción de defecto troclear lateral traumático con autoinjerto de cabeza radial / Reconstruction of a traumatic lateral trochlear defect with a radial head autograft

Objetivo. Presentar el resultado de la reparación de un defecto troclear severo en el codo mediante un autoinjerto óseo con la cabeza radial ipsilateral, como una alternativa a la artroplastia total. Caso clínico. Presentamos el caso de un paciente, que sufrió una fractura abierta de codo con pérdida ósea importante en la región humeral distal, y que precisó tras la estabilización inicial una cirugía de reconstrucción mediante autoinjerto ipsilateral de cabeza radial. Discusión. Las fracturas abiertas de codo son infrecuentes. Cuando existe un defecto troclear severo, las alternativas quirúrgicas son la artroplastia total de codo, con unos resultados a corto y medio plazo que parecen ser insuficientes, o la artrodesis. Creemos que la reconstrucción del defecto empleando un autoinjerto de cabeza radial homolateral es una alternativa más funcional que los otros procedimientos descritos. Conclusión. La reconstrucción con cabeza radial ipsilateral de los defectos trocleares laterales es una técnica, que al contrario que la artrodesis, conserva la funcionalidad sin los inconvenientes de la artroplastia total de codo (AU)

Objective. To report the result of a severe articular defect secondary to a complex open fracture of the distal humerus, using the ipsilateral radial head as a bone autograft for the trochclear region as an alternative to total arthroplasty. Case report. We describe a patient who suffered an open fracture of the elbow with bone loss in the distal humeral region and, after the initial stabilisation surgery, needed a reconstruction with an ipsilateral radial head autograft. Discussion. Open fractures of elbow are rare. When there is a severe trochlear defect, surgical options are total elbow arthroplasty, where the short and medium term results appear to be insufficient, or elbow arthrodesis. We believe that reconstruction of the defect using an ipsilateral radial head autograft is a more functional alternative than the other procedures described. Conclusion. Radial head reconstruction with ipsilateral lateral trochlear defects is a technique that, unlike fusion, preserves functionality without the problems of total elbow arthroplasty (AU)

Oral and intranasal steroid treatments improve nasal patency and paradoxically increase nasal nitric oxide in patients with severe nasal polyposis.

INTRODUCTION: Recently, we demonstrated that acoustic rhinometry (AR) measurements correlated with nasal cavity volumes in patients with nasal polyposis (NP). The aim of the present study was to evaluate whether AR and nasal nitric oxide (nNO) are useful methods in monitoring and follow-up of medical treatment of NP. MATERIAL AND METHODS: Patients with severe nasal polyps were randomized into two groups after a 4-week steroid washout period (w0): a treatment group received oral prednisone for 2 weeks (w2) and intranasal budesonide for 12 weeks (w12) while the control group received no steroid treatment. Nasal volume (Vol 0-6), minimum cross-sectional area (mCSA), nNO, peak nasal inspiratory flow (PNIF), nasal obstruction, and smell loss were evaluated. RESULTS: At w2, the treatment group showed a significant increase of vol 0-6 compared to w0 and the control group. The mCSA area also increased compared to w0 and the control group. At w12, the improvement in vol 0-6 and mCSA was maintained after intranasal steroids compared to w0. At w2, the treatment group showed a paradoxical increase of nNO compared to w0 and the control group. At w12, this increase was maintained by intranasal steroids. CONCLUSION: Both oral and intranasal steroid treatments improve nasal patency and paradoxically increase nNO, by opening the ostiomeatal complex. This suggests that AR and nNO are useful methods in the monitoring and follow-up of patients with NP.

Aspectos de interés para el cirujano ortopédico y traumatólogo sobre la vitamina D / Aspects of interest on vitamin D for the traumatologist and orthopaedic surgeon

La deficiencia (insuficiencia o deficiencia) de vitamina D es un problema clínico especialmente prevalente en ancianos con fracturas de baja energía, sobre todo de cadera, aunque también se ha relacionado con fracturas de estrés y de alta energía. Son muchas las evidencias que apoyan la necesidad de mantener unos niveles adecuados de vitamina D en sangre para reducir el número de fracturas por fragilidad, favorecer la consolidación de las mismas, mejorar la función neuromuscular de los pacientes, evitar las caídas, prevenir las infecciones quirúrgicas o mejorar la duración de las artroplastias. Sin embargo, no es habitual que el cirujano ortopédico y traumatólogo considere determinar los valores de vitamina D en este tipo de pacientes e instaurar el tratamiento adecuado. Se recomienda mantener niveles superiores a 30-40ng/ml (75-100nmol/l) de vitamina D y la ingesta, en casi todos los casos, de 800 a 1.000UI/día de vitamina D para alcanzar estos niveles (AU)

Vitamin D deficiency or insufficiency is a clinical problem particularly prevalent in elderly patients with low-energy fractures, particularly hip fractures, but has also been associated with stress fractures and high energy fractures. There is much evidence that supports the need to maintain adequate levels of vitamin D in the blood in order to; reduce the number of fragility fractures, furthering the consolidation of these, improve neuromuscular function of patients, prevent falls, prevent surgical infections, or improve the length of arthroplasties. However, it is rare for the orthopaedic surgeon to request the values of vitamin D in these patients and give the appropriate treatment It is recommended to maintain levels higher than 30-40ng/ml (75-100nmol/l) and increase vitamin D intake, in almost all cases, from 800 to 1,000IU/day to achieve these levels (AU)

[Aspects of interest on vitamin D for the traumatologist and orthopaedic surgeon]. / Aspectos de interés para el cirujano ortopédico y traumatólogo sobre la vitamina D.

Vitamin D deficiency or insufficiency is a clinical problem particularly prevalent in elderly patients with low-energy fractures, particularly hip fractures, but has also been associated with stress fractures and high energy fractures. There is much evidence that supports the need to maintain adequate levels of vitamin D in the blood in order to; reduce the number of fragility fractures, furthering the consolidation of these, improve neuromuscular function of patients, prevent falls, prevent surgical infections, or improve the length of arthroplasties. However, it is rare for the orthopaedic surgeon to request the values of vitamin D in these patients and give the appropriate treatment It is recommended to maintain levels higher than 30-40ng/ml (75-100nmol/l) and increase vitamin D intake, in almost all cases, from 800 to 1,000IU/day to achieve these levels.

[Reconstruction of a traumatic lateral trochlear defect with a radial head autograft]. / Reconstrucción de defecto troclear lateral traumático con autoinjerto de cabeza radial.

OBJECTIVE: To report the result of a severe articular defect secondary to a complex open fracture of the distal humerus, using the ipsilateral radial head as a bone autograft for the trochclear region as an alternative to total arthroplasty. CASE REPORT: We describe a patient who suffered an open fracture of the elbow with bone loss in the distal humeral region and, after the initial stabilisation surgery, needed a reconstruction with an ipsilateral radial head autograft. DISCUSSION: Open fractures of elbow are rare. When there is a severe trochlear defect, surgical options are total elbow arthroplasty, where the short and medium term results appear to be insufficient, or elbow arthrodesis. We believe that reconstruction of the defect using an ipsilateral radial head autograft is a more functional alternative than the other procedures described. CONCLUSION: Radial head reconstruction with ipsilateral lateral trochlear defects is a technique that, unlike fusion, preserves functionality without the problems of total elbow arthroplasty.

Impacto de la práctica en un modelo de entrenamiento: en la adquisición de habilidades para la exploración laparoscópica de la vía biliar / Impact of the practice in a laparoscopy common bile duct exploration training model: in the acquisition of surgical skills

Determinar el impacto de la práctica en un modelo de entrenamiento inanimado en la adquisición de habilidades para la exploración laparoscópica de la vía biliar. Se trata de un estudio prospectivo, comparativo, controlado, donde se incluyen dos grupos constituidos por cuatro individuos con similar entrenamiento y experiencia en cirugía laparoscópica avanzada. Ambos grupos (A y B) fueron evaluados mediante el uso del modelo, en cuatro tareas inserción de cateter para colanglografía, manejo de la cesta helicoidal, colocación del tubo en "t" de Kehr, uso del coledocoscopio. El grupo en estudio (A) acudió a 10 sesiones de entrenamiento en el modelo en un lapso de dos semanas, posterior a lo cual se realizó una nueva comparación con el grupo control, que no había realizado práctica alguna. La evaluación inicial de ambos grupos no mostró diferencias significativas. Luego de las sesiones de entrenamiento el grupo en estudio (A) mostró mejoría significativa en todas las tareas realizadas cuando se comparó con la evaluación inicial y con el grupo control (B), dejando en evidencia el positivo impacto del entrenamiento en la adquisición de habilidades. La práctica de pasos fundamentales para el exploración laparoscópica de la vía biliar en el modelo inanimado diseñado por los autores conduce a una mejoría en las habilidades del equipo quirúrgico y probablemente a un mejor desempeño en el quirófano.

To determine the impact of the practice in a laparoscopic common bile duct exploration training model in the acquisition of surgical skills. A prospective, comparative, controlled study with two groups, each constituted by four individuals with similar training and experience in advanced laparoscopic surgery the study group (A) had 10 training sessions with the model in a two week period. Both groups (A and B) were evaluated prior and after the practice, with the use of the training model in four tasks: insertion of a cholangiography catheter, management of a helicoidal basket, insertion of "t" tube and use of a choledochoscope. The initial evaluation of both groups did not show any significant differences. After the training sessions, the study group (A) showed a significant improvement in all the tasks when compared with the initial evaluation and the control group (B). This demostrates the positive impact of the practice on the acquisition of skills. Practice of the basic steps of laparoscopic exploration of the common bile duct in the inanimate model designed by the autors results in a significant improvement in the skills of the surgical ream and might eventually result in a better performance in the operating room.

Alteraciones olfativas como diagnóstico precoz de la poliposis nasosinusal incipiente / Smell disorders as early diagnosis in the early stage of Sinonasal Polyposis

Introducción: La creciente demanda de atención sobre la patología del olfato, junto con la persistente presencia de la poliposis nasosinusal, ha abierto la necesidad de tratar dichas patologías a niveles muy tempranos. Objetivos: Demostrar primero que los estadios incipientes de la poliposis nasosinusal son detectables por olfatometría antes que por imagen radiológica; segundo, tal detección se halla vinculada a la ausencia de ocupación del espacio «extrameatal» (donde se halla la hendidura olfativa). Métodos: Estudio basado en los datos obtenidos a partir de un grupo (n=121) de pacientes con poliposis nasosinusal de grado 0 o grado 1, libres de alergias, tríada de ASA y asma, sometidos a estudio fibroendoscópico, olfatometría (par craneal I y V) y TAC nasosinusal, comparándose el resultado con un grupo control (n=120). Resultados: Se confirmaron valores significativos (p<0,05) de afectación de los nervios olfatorio y trigémino, en los pacientes con grado 0 y grado 1 de poliposis. Conclusiones: La presencia de alteraciones olfativas con ausencia de ocupación del espacio «extrameatal» (poliposis grado 1 o grado 2), acompañado de TAC nasosinusal con inicio de ocupación etmoidal, debería ser interpretado como inicio de poliposis nasosinusal (AU)

Introduction: The increasing demand for attention to olfactory disorders, along with the persistent presence of sinonasal polyposis, has opened the need to treat these pathologies in very early stages. Objectives: To demonstrate that incipient stages in sinonasal polyposis are detectable by olfactometry before radiological images, and that this detection is linked with a non-blocked area around the nasal meatus (where the olfactory cleft is located). Methods: This study is based on data obtained from a sinonasal polyposis (degree 0 or 1) patient group (n=121) without allergies or asthma backgrounds. The patients underwent both fibroscopic and olfactometry explorations (first and fifth cranial nerve) and computed axial tomography (CT) assessment. The results were compared with the control group (n=120). Results: Significant values (p<0.05) of affectation were found in decreasing olfactory levels (olfactory and trigeminal nerves) in patients with degree 0 or 1 polyposis. Conclusion: Olfactory disorders linked to a non-blocked area around the nasal meatus (degree 1 or 2 polyposis), together with sinonasal CT scans showing beginnings of ethmoidal inflammation, should be interpreted as incipient sinonasal polyposis (AU)