Reactive arthritis: update 2018.

At this time, reactive arthritis (ReA) is considered to be part of the spectrum of the spondyloarthritis, previously known as Reiter's syndrome, and refers to an infection induced systemic illness, characterized by a sterile synovitis occurring in a genetically predisposed individual, secondary to an infection localized in a distant organ/system, but also accompanied with multiple extra articular manifestations.

Guía dietética para pacientes con hiperuricemia y gota agar / Dietary guide for patients with hyperuricaemia and drop agar

Gota proviene del latin Gutta es un término acuñado en el siglo V que significa exceso o derrame de flema por exceso de vino, comida y sexo. Llamada "Rey de las enfermedades yenfermedad de reyes" fue uno de los primeros desordenes reumáticos en ser reconocidos como entidad clínic a. Es la artritis por deposito de microcri s tales más común debida a desequilibrio en el metabolismo de las purinas que conlleva a hiperuricemia y el depósito de cristales de urato monosódico, caracterizada por ser de inicio monoarticular, que a fecta con mayor frecuencia la primera articulación metatarso de pie y que progresa en su forma crónica a poliarticular, asociada a destrucción progresiva y a la formación de tofos, falla renal y enfermedad cardiovascular. Predomina sexo masculino, su pr evalencia se calcula de 0.08% a nivel mundial, aumentando la frecuencia de sus ataques con el alto contenido de carnes, mariscos, cervezas y bebidas espirituosas. El objetivo de la presente revisión bibliográfica es proporcionar una guía dietética para lo s médicos enfatizando y destacando su contenido de purinas en alimentos de uso cotidiano en la población guatemalteca, para obtener un mejor control de la artritis gotosa y disminuir la frecuencia de sus ataques ...(AU)

Gota comes from Latin Gutta is a term coined in the fifth century that means excess or spill of phlegm for excess wine, food and sex. Called "King of diseases and disease of kings" was one of the first rheumatic disorders to be recognized as a clinical entity. Arthritis is the most common microcritical deposit due to imbalance in the metabolism of purines that leads to hyperuricemia and the deposition of monosodium urate crystals, characterized by monoarticular initiation, which most often occurs with the first metatarsal joint. standing up and progressing in its form chronic to polyarticular, associated with progressive destruction and the formation of tophi, renal failure and cardiovascular disease. Male sex predominates, its pr evance is estimated at 0.08% worldwide, increasing the frequency of its attacks with the high content of meats, seafood, beers and spirits. The aim of this bibliographical review is to provide a dietary guide for physicians emphasizing and highlighting their content of purines in foods of daily use in the Guatemalan population, to obtain a better control of gouty arthritis and to reduce the frequency of their attacks. .. (AU)

Prior exposure to acrolein accelerates pulmonary inflammation in influenza A-infected mice.

The combustion product acrolein contributes to several smoke-related health disorders, but whether this immunomodulatory toxicant alters pulmonary susceptibility to viruses has received little attention. To study the effects of prior acrolein dosing on the severity of influenza A viral infection, male BALB/c mice received acrolein (1mg/kg) or saline (control) via oropharyngeal aspiration either 4- or 7-days prior to intranasal inoculation with either influenza A/PR/8/34 virus or vehicle. At 0, 2, 4 and 7 days post-inoculation, lung samples were assessed for histological changes while pulmonary inflammation was monitored by estimating immune cell numbers and cytokine levels in bronchoalveolar lavage fluid (BALF). After viral challenge, animals that were exposed to acrolein 4 days previously experienced greater weight loss and exhibited an accelerated inflammatory response at 2 days after viral inoculation. Thus compared to saline-pretreated, virus-challenged controls, BALF recovered from these mice contained higher numbers of macrophages and neutrophils in addition to increased levels of several inflammatory cytokines, including IL-1α, IL-1ß, IL-6, TNF, IFN-γ, KC, and MCP-1. The acrolein-induced increase in viral susceptibility was suppressed by the carbonyl scavenger bisulphite. These findings suggest acute acrolein intoxication "primes" the lung to mount an accelerated immune response to inhaled viruses.

Prevalencia de enteroparásitos en embarazadas de la maternidad “Dr. Armando Castillo Plaza” en Maracaibo Venezuela / Prevalence of enteroparasitism in pregnant women at the “Dr. Armando Castillo Plaza” maternity center Maracaibo Venezuela

Para determinar la prevalencia de parásitos intestinales en gestantes con edades comprendidas entre 14 y 43 años de la Maternidad Dr. Armando Castillo Plaza del Municipio Maracaibo, Venezuela; se analizaron 120 muestras fecales, a las cuales se les practicó métodos coproparasitológicos mediante examen al fresco con SSF y coloraciones temporales de lugol y nair, técnicas de concentración de formol - éter, coloración de Kinyoun para el diagnóstico de coccidios intestinales y técnica de recuento de huevos (Kato-Katz) para determinar la severidad de las Geohelmintiasis. Se encontró una prevalencia de infestación parasitaria en un 65,9 por ciento y el grupo etario más afectado fue el de 23 a 31 años (48,1 por ciento). Las principales especies parasitarias encontradas fueron B. hominis (48,3 por ciento), E. nana (25 por ciento), E. coli, complejo E. histolytica/E. dispar (13,3 por ciento), T. trichiura (4,2 por ciento). A. lumbricoides (3,3 por ciento), S. stercoralis (1,6 por ciento), Ancylostomideos y Taenia sp. (0,8 por ciento). No se detectó la presencia de coccidios intestinales. El análisis estadístico de Ji cuadrado (X2) no mostró significancia entre las variables parasitismo - edad gestacional, parasitismo -grupo etario, parasitismo - anemia. La población de gestantes estudiadas es susceptible a las infestaciones por parasitosis intestinales.

For to determine the prevalence of intestinal parasites in pregnant women between 14 and 43 years old at Dr. Armando Castillo Plaza maternity center in Maracaibo Municipality. 120 stool samples were obtained and analyzed by copro-parasitical methods such as fresh test with saline solution and lugol, and concentration techniques with formaldehyde - eter (Ritchie); Kinyoun coloration for the diagnosis of intestinal coccidios. Kato Katz method was performed demonstrating the geohelminthiasis severity. Parasite infestation prevalence was found in 65.9 percent and the most affected age group was the one between 23 and 31 years (48.1 percent), with protozoal predominance (86 percent) over helminth (14 percent). The principal parasitical species found were B. hominis (48.3 percent), E. nana (25 percent), E. coli, E. histolytica / E. dispar complex (13.3 percent), T. trichiura (4.2 percent), A. lumbricoides (3.3 percent), S. stercoralis (1.6 percent), Ancylostomideos, Taenia sp. (0.8 percent). No intestinal coccidios were found in any of the analysis did not demostrate any significance between the variables parasitism - group by age, parasitism - pregnancy state and parasitism - anemia. The studied pregnant population is susceptible to be infested by intestinal parasites

Luxación recidivante de prótesis total de cadera / Recurrent dislocation in total hip replacement

Más del 50% de los casos de caderas inestables se pueden resolver mediante la reducción cerrada de la luxación. Un intento sistemático para entender la causa de la inestabilidad, normalmente suele conducir a un tratamiento eficaz del problema cuando hace falta cirugía. Los componentes constreñidos o de retención han mejorado las posibilidades de resolver los problemas difíciles de inestabilidad, pero los efectos negativos potenciales de estos componentes deben tenerse también en cuenta. Los implantes tripolares, cuyos resultados clínicos en la literatura son muy alentadores, ocupan un lugar de elección en el arsenal terapéutico de la inestabilidad protética

Over 50% of unstable hip cases can be solved by carrying out a closed reduction of the dislocation. A systematic attempt to understand the cause of the instability, normally results in an efficient treatment of the condition in cases where surgery is required. Constrained ­ also known as retentive ­ components have enhanced the possibilities of addressing difficult instability problems, although the potential negative effects of these implants also need to be considered. Tripolar implants, whose clinical results are very encouraging according to the literature, should occupy a prominent place among the therapeutic options available for prosthetic instability

[Giant atherosclerotic aneurysm. A case report]. / Aneurisma aterosclerótico gigante. Presentación de un caso.

INTRODUCTION: Intracraneal aneurysms are frequent in medical practice, most of them never produce symptoms, that is why occasionally, they are not diagnosed before death. Sacular is the most frequent aneurysm, and atherosclerotic aneurysm is rare. CASE REPORT: In this article we present the case of a 75 year old woman who has been suffering from high blood pressure and coronary artery disease since more than 20 years and in the last four months she had been complaining of dysphagia and dysartria. She was taken to the hospital because 24 hours ago mild headache started accompanied by vertigo, nausea and vomiting. On neurological exam we found sleepiness, dysartria, and right braguio crural hemiparesis, therefore we decided admitt her, but after 48 hours left braquio crural hemiparesis was added and later respiratory sepsis appeared. The patient died due to an acute respiratory failure. CONCLUSION: Necropsy revealed a huge atherosclerotic intracraneal aneurysm (31 mm) located on basilar artery. The case has been discussed and images were shown.

Aneurisma aterosclerótico gigante. Presentación de un caso / Giant atherosclerotic aneurysm. A case report

Introducción. Los aneurismas intracraneales son frecuentes en la práctica médica. Muchos de ellos no producen manifestaciones clínicas, por lo que, en ocasiones, no se diagnostican en vida. El sacular es el tipo más frecuente y el aterosclerótico es uno de los más raros. Caso clínico. En este artículo presentamos el caso de una paciente blanca, mujer, de 75 años de edad, que padecía de hipertensión arterial y cardiopatía isquémica crónica desde hacía más de 20 años, y que en los últimos cuatro meses se había quejado de disfagia y disartria. Ingresó en el hospital 24 horas después de haberse iniciado un cuadro de cefalea moderada, acompañada de vértigo, náuseas y vómitos. En el examen neurológico se constató somnolencia, disartria y una hemiparesia braquiocrural derecha, por lo que se decidió su ingreso; pero pasadas 48 horas se añadió una hemiparesia braquiocrural izquierda y posteriormente apareció sepsis respiratoria, que desencadenó una insuficiencia respiratoria aguda y la llevó a la muerte. Conclusión. El estudio necrópsico demostró la presencia de un aneurisma intracraneal aterosclerótico gigante (31 mm) de la arteria basilar. Se discute el caso y se presentan las imágenes (AU)

Introduction. Intracraneal aneurysms are frequent in medical practice, most of them never produce symptoms, that is why occasionally, they are not diagnosed before death. Sacular is the most frequent aneurysm, and atherosclerotic aneurysm is rare. Case report. In this article we present the case of a 75 year-old woman who has been suffering from high blood pressure and coronary artery disease since more than 20 years and in the last four months she had been complaining of dysphagia and dysartria. She was taken to the hospital because 24 hours ago mild headache started accompanied by vertigo, nausea and vomiting. On neurological exam we found sleepiness, dysartria, and right braguio-crural hemiparesis, therefore we decided admitt her, but after 48 hours left braquio-crural hemiparesis was added and later respiratory sepsis appeared. The patient died due to an acute respiratory failure. Conclusion. Necropsy revealed a huge atherosclerotic intracraneal aneurysm (31 mm) located on basilar artery. The case has been discussed and images were shown (AU)

Infected total hip arthroplasty--the value of intraoperative histology.

Intraoperative histology showed a sensitivity of 100% and a specificity of 98%. These results were better than those observed for the other tests evaluated. Our data provide evidence that intraoperative histology is useful tool in the diagnosis of infected total hip arthroplasty.

Alcohol consumption and mortality. I. Characteristics of drinking groups.

AIMS: This is the first of a set of three papers evaluating drinking status and mortality risk. Analyses of multiple studies describe associations of drinking patterns with characteristics hypothesized to confound the relationships between drinking status and mortality. Characteristics which both significantly differentiate drinking groups and are consistent across studies would suggest that mortality studies not controlling for them may be compromised. DESIGN AND PARTICIPANTS: Associations are evaluated from the raw data of 10 general population studies which contained mortality data. Long-term abstainers are compared to former drinkers, long-term abstainers and former drinkers are compared to light drinkers (by quantity, frequency and volume in separate analyses) and moderate to heavy drinkers are compared to light drinkers. Tetrachoric correlation coefficients assess statistical significance; meta-analysis determines if associations are homogeneous across studies. MEASUREMENTS: Measures of alcohol consumption are quantity, frequency and volume; long-term abstainers are differentiated from former drinkers. Multiple measures of health, social position, social integration and mental health characteristics are evaluated. FINDINGS: Across studies, adult male former drinkers are consistently more likely to be heavier smokers, depressed, unemployed, lower SES and to have used marijuana than long-term abstainers. Adult female former drinkers are consistently more likely to be heavier smokers, in poorer health, not religious, and unmarried than long-term abstainers. Both types of abstainers tend to be of lower SES than light drinkers and report poorer health (not consistent). Female abstainers are more likely to be of normal or overweight than light drinkers. CONCLUSIONS: Characteristics of two groups of abstainers, other than their non-use of alcohol, may confound the associations found between drinking and mortality risk.

Alcohol consumption and mortality. II. Studies of male populations.

AIMS: This is the second of a set of three papers evaluating drinking status and mortality risk. Analysis of eight general population surveys of men evaluated all-cause mortality rates by drinking pattern. DESIGN AND PARTICIPANTS: Raw data from three studies of youth and five studies of adults were evaluated. Logistic regression models controlled for confounding characteristics. Meta-analysis combined study results. MEASUREMENTS: Drinking pattern was alternatively defined by quantity, frequency and volume of drinking. Final models included drinking pattern (as well as abstinence in the youth models and long-term abstainers and former drinkers in adult models), age and other confounding variables. Models also evaluated interactions of age and, respectively, long-term abstinence and former drinking. FINDINGS: No evidence was found for the hypothesis that abstinence is associated with greater mortality risk than light drinking. In the youth samples, abstainers had a lower risk of dying than those drinking less than 15 times per month. One study of the adult samples showed a significant age by former drinker interaction; this did not alter the lack of association of former drinking with mortality risk or the homogeneity of results across studies for this finding. The most consistent finding was the association of heavy drinking with mortality among youth. Among adults, drinking 43 or more drinks per month and drinking 21 or more times per month were associated with increased mortality risk. Quantity per occasion was not significantly associated with mortality risk among adults. CONCLUSIONS: That frequent drinking was related to mortality risk, whereas heavier quantity was unrelated, is inconsistent with the belief that daily consumption of a few glasses of wine has salutary effects. Empirically, however, this pattern tends to be unusual. Findings were homogeneous across studies lending generalizability to results.

Alcohol consumption and mortality. III. Studies of female populations.

AIMS: This is the third of a set of three papers evaluating drinking status and mortality risk. Analysis of three general population surveys of women evaluated all-cause mortality rates by drinking pattern. DESIGN AND PARTICIPANTS: Raw data from three studies of adult women were evaluated. Logistic regression models controlled for confounding characteristics. Meta-analysis combined study results. MEASUREMENTS: Drinking pattern was alternatively defined by quantity, frequency and volume of drinking. Final models included drinking pattern (including long-term abstainers and former drinkers) as well as age and other confounding variables. Models also evaluated interactions of age and, respectively, long-term abstinence and former drinking. FINDINGS: In models in which age was controlled, odds of death for long-term abstainers and former drinkers (defined by volume or quantity) were greater than those for light drinkers; odds of death for moderate and heavy drinkers (defined by quantity) were greater than those for light drinkers. When other psychosocial attributes were controlled, odds of death were similar for abstainers and light drinkers. When other psychosocial attributes were controlled, odds of death for heavy drinkers (defined by volume and quantity) were greater than those for light drinkers. When interactions of age and the two forms of abstinence were introduced, one study showed a significant effect of age and former drinking. CONCLUSIONS: Results were consistent with the hypothesis that characteristics of abstainers other than their non-use of alcohol may account for their higher mortality risk. With the exception of former drinkers compared to light drinkers, when interactions were introduced into models (for measures of quantity and frequency) findings were homogeneous across studies, lending generalizability to results.

Determinants of life-course variation in the frequency of alcohol consumption: meta-analysis of studies from the collaborative alcohol-related longitudinal project.

OBJECTIVE: This report evaluates the relative contribution of predictors of change in the frequency of alcohol consumption among drinkers, based on the quantitative synthesis of data from 27 longitudinal studies of the general population. The analysis has two objectives: (1) to evaluate the impact of selected demographic characteristics on the magnitude and trajectory of change in drinking across multiple samples, and (2) to assess the influence of methodological characteristics on the consistency of results across studies. METHOD: Raw data from studies including two serial measures of the frequency of alcohol consumption are analyzed. Fixed, random and mixed effects models for meta-analysis are used to pool measures across observations and model the influence of predictors on variability between results. RESULTS: Gender-based variation in the patterning of change is present across all observations, but concentrated in early periods of the life course. Age displays significant predictive effects across all observations, but statistically uniform results are obtained for subjects aged 30 and over. The national origin of study predicts larger amounts of variation than do other demographic predictors in the models. Significant effects are observed for several methodological characteristics of studies. Variation among effect estimates is associated with differences between samples in the interval between first and final measurements, the date of first measurement (a proxy for the historical context of the sample), the percentage retention of subjects between measurements and the time frame of the original alcohol measure. CONCLUSIONS: Based on the synthesis of data from multiple longitudinal samples, this study (1) characterizes normative developmental patterning in the frequency of alcohol consumption and demonstrates the varying effects of demographic factors across the life-course: (2) indicates the key influence of cultural and historical context on the establishment of drinking patterns; and (3) confirms the impact of methodological differences on variation in the results of studies.

Aggregate-level predictors of the prevalence of selected drinking patterns in multiple studies: a research synthesis from the Collaborative Alcohol-Related Longitudinal Project.

This paper examines the prevalence of two "at-risk" alcohol drinking patterns (infrequent heavy drinking and frequent heavy drinking) within age/gender groups in multiple general population studies. When heterogeneity in findings across studies is found, we test the hypotheses that suicide, divorce, unemployment rates, and the per capita consumption of alcohol in each country are associated with the prevalence of these drinking patterns. These analyses should inform the literature on the relationships between societal factors and the prevalence of persons in different societies and periods in history that drink at these levels.

Gender differences for the risk of alcohol-related problems in multiple national contexts.

The primary research question asked is: After holding alcohol consumption constant, will men and women be at equal risk for a variety of alcohol-related problems? Since women are actually at a higher blood alcohol content at the same consumption levels, a physiological argument would suggest that women are at equal or greater risk for alcohol problems than men. However, variation in societal norms surrounding gender roles and/or societal-level stress may mediate the experience of men and women, regardless of the differences in physiology. Ten cross-sectional general population studies are used. Analyses control for individual-level variables (age, quantity, and frequency of drinking) and societal-level variables (proportion of women in the work force and female suicide rate) that might confound these relationships; cross-study homogeneity is examined.

[Hip prosthesis infection: diagnostic approach and treatment of 27 cases]. / Infección de prótesis de cadera: aproximación diagnóstica y tratamiento de 27 episodios.

BACKGROUND: Preoperative diagnosis of hip prosthesis infection (HPI) is difficult. There is no therapeutic option which is completely effective and without risk. The aim of this study was to evaluate a diagnostic approach and therapeutic strategy in a group of patients with HPI. PATIENTS AND METHODS: A retrospective study of 27 episodes of HPI diagnosed by anatomopathologic and/or microbiologic examination of surgical samples was performed. RESULTS: Twenty-three patients with 27 episodes of HPI out of a total of 24 hip prosthesis (HP) were treated. The infection was early in 15 episodes. The etiologic agents were plasmocoagulase negative staphylococcus (NSP) in 11 cases, P. aeruginosa in 8, S. aureus in 5, Enterococcus sp. in 2 and miscellaneous in the remaining cases. In 2 cases the infection was polymycrobial. Following a mean follow period of 22.6 +/- 15.2 months, 13 out of the 14 patients in whom the prosthesis was withdrawn were cured (in 4 a second prosthesis was implanted), one out of 6 in those in whom the prosthesis remained in situ following debridement, and 2 out of 3 episodes in whom reimplantation was performed over time. The withdrawal of the prosthesis was significantly greater than debridement in the treatment of early infection (p < 0.001). The total mean length of postoperative antibiotherapy was 48.2 +/- 17 days. No differences were observed in the oral versus parenteral treatment (p = 0.22), and nor was prognosis worse in those treated for less than 42 days. CONCLUSIONS: The authors' experience suggests that attempts to save a hip prosthesis in early infection usually fail. In addition to prosthesis withdrawal or implantation of another prosthesis, six weeks of postoperative antibiotic therapy, which may be oral route, appear to be sufficient.

Relationships of measures of alcohol consumption with alcohol-related problems in multiple studies: a research synthesis from the collaborative alcohol-related longitudinal project.

Two measures of alcohol consumption were used to predict groups of alcohol problems in 21 general population studies from 11 countries to determine (a) if quantity of drinking per occasion or frequency of drinking per month constituted significant "risk" for alcohol problems, having controlled for each as well as individual-level and aggregate-level variables which might confound these relationships and (b) if these associations were homogeneous across studies. A two-tiered analysis assessed these relationships within each study by modeling age, sex, quantity per occasion and frequency per month as predictors of alcohol problems. Meta-analysis combined test statistics to determine if they were homogeneous across studies. The meta-analysis was repeated, blocking for per capita consumption of alcohol (a trait of nations thought to measure drinking norms) and the female rate of suicide (a trait of nations thought to measure societal-level stress). When only individual-level variables were controlled (age and sex), both quantity and frequency were risk factors for each drinking problem. However, except in the case of the association of quantity with alcohol treatment, the magnitude of these risks were heterogeneous across studies. When blocking for the societal-level traits, each had more relevance for some, but not all, of the relationships between consumption and problems. Particularly striking was the well-documented finding that per capita consumption of alcohol significantly distinguished the relationships of frequency of drinking and health problems (while the female suicide rate did not) and the previously undocumented finding that the female suicide rate significantly distinguished the relationships of both quantity and frequency with treatment (while the per capita consumption of alcohol did not). These findings suggest that the impact of norms and the impact of societal stress in groups have different but significant consequences for the relationships of consumption to problems.

Societal-level predictors of groups' drinking patterns: a research synthesis from the Collaborative Alcohol-Related Longitudinal Project.

OBJECTIVES: Period effects of per capita consumption of alcohol and divorce rates are assessed for change in quantity and frequency among age/sex groups in multiple longitudinal studies. METHODS: Twenty-five studies of quantity and 29 studies of frequency are used. Studies are from 15 nations and cover periods of 1 to 21 years. Models predict the standardized mean difference for quantity and frequency based on period effects and group-level and methodological variables. RESULTS: When both the period effects of per capita consumption and the divorce rate are considered, the divorce rate significantly predicts change in quantity and frequency. An increase in the divorce rate is associated with a stronger decrease in frequency among younger people; men are more likely than women to decrease their frequency of drinking when divorce rates rise. CONCLUSIONS: Multiple societal-level factors should be considered critical in influencing the drinking patterns of groups. These results suggest that an increase in the divorce rate is associated with more "dry" social contexts, characterized possibly by drinking patterns of a more "volitive" nature (i.e., heavier quantity per occasion and less frequent drinking).

The fertility incentive of land tenure in Mexico.

PIP: Ejidos are communal holding groups of redistributed land expropriated (generally without compensation) from large private landowners during Mexico's post-1910 land reform. The model in this study of the "ejidal" system's influence on fertility differs from DeVany and Sanchez in providing more current data and including the following more detailed variables: the land area of ejidos and the number of ejidos, the need for children, male income, female income share, and social security coverage. The data pertains to states rather than municipalities. DeVany and Sanchez found that the ejidal system encouraged fertility, because having more children helped an ejido family retain land rights, increased its chances of gaining additional productive land, and gave it increased political power. Children also provided a means of intergenerational transfer of resources. The estimation results of this study revealed that the total proportion of land held as ejidos had a positive, significant effect on fertility. The ratio of ejidos to total number of farms was negative and significant. There was support for the hypothesis that the impact of ejidos land holdings and area was diminished when ejidos were dominant in the state. Fertility declined with the increase in unpaid workers per hectare of land. Elasticity functions were small: 0.075 on ejidal land, -0.222 on ejidal farms, and -0.045 on workers. A positive significant demographic effect on fertility was illiteracy. Infant mortality and female income share each had a negative, significant effect on fertility. Insignificant variables were male income, social security coverage, and the dummy for northern states. There have been changes in the Mexican ejidal system. These changes and the availability of farm labor are expected to reduce urban and rural fertility differentials.^ieng