Revisión de revisiones sistemáticas de factores pronóstico para infección protésica / Overview of systematic reviews of risk factors for prosthetic joint infection

Introducción: La infección protésica es una de las complicaciones más graves en cirugía ortopédica, por lo que es importante detectar factores relacionados con su aparición. Las revisiones sistemáticas (RS) pronósticas detectan y evalúan factores relacionados con enfermedades, lo que permite una mejor predicción de los riesgos y la implementación de medidas preventivas. Aunque estas RS pronósticas son cada vez más frecuentes, su campo metodológico presenta algunas lagunas de conocimiento. Objetivo: Realizar una revisión de RS de factores pronósticos para infección protésica y describir la evidencia sintetizada. Secundariamente, evaluar el riesgo de sesgo y la calidad metodológica. Material y métodos: Búsqueda bibliográfica en 4bases de datos (en mayo de 2021) para identificar RS pronósticas que evaluaran factores pronósticos para infección protésica. Evaluamos el riesgo de sesgo mediante ROBIS y la calidad metodológica con la herramienta modificada AMSTAR-2. Se realizó un estudio de solapamiento entre RS. Resultados: Incluimos 23 RS que valoraban 15 factores asociados con la infección protésica; de ellos, 13 mostraron asociación significativa. Los más estudiados fueron obesidad, corticoides intraarticulares, tabaquismo y glucemia elevada. El solapamiento entre RS fue elevado para obesidad y muy alto para corticoides intraarticulares, tabaquismo y glucemia elevada. El riesgo de sesgo fue considerado bajo en 8 RS (34,7%), pero la herramienta de evaluación metodológica demostró una baja calidad en general. Conclusiones: La identificación de factores procedimentales modificables ofrecen mejores resultados a los pacientes. Sin embargo, muchas RS son redundantes. La evidencia en factores pronósticos en cirugía ortopédica es débil debido al alto riesgo de sesgo y a la calidad metodológica limitada.(AU)

Background: Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SR) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SR are increasingly frequent, their methodological field presents some knowledge gaps. Purpose: To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. Material and methods: We conducted a bibliographic search in 4databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. Results: Twenty-three SR were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. Conclusions: Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SR are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.(AU)

[Translated article] Overview of systematic reviews of risk factors for prosthetic joint infection / Revisión de revisiones sistemáticas de factores pronóstico para infección protésica

Introducción: La infección protésica es una de las complicaciones más graves en cirugía ortopédica, por lo que es importante detectar factores relacionados con su aparición. Las revisiones sistemáticas (RS) pronósticas detectan y evalúan factores relacionados con enfermedades, lo que permite una mejor predicción de los riesgos y la implementación de medidas preventivas. Aunque estas RS pronósticas son cada vez más frecuentes, su campo metodológico presenta algunas lagunas de conocimiento. Objetivo: Realizar una revisión de RS de factores pronósticos para infección protésica y describir la evidencia sintetizada. Secundariamente, evaluar el riesgo de sesgo y la calidad metodológica. Material y métodos: Búsqueda bibliográfica en 4bases de datos (en mayo de 2021) para identificar RS pronósticas que evaluaran factores pronósticos para infección protésica. Evaluamos el riesgo de sesgo mediante ROBIS y la calidad metodológica con la herramienta modificada AMSTAR-2. Se realizó un estudio de solapamiento entre RS. Resultados: Incluimos 23 RS que valoraban 15 factores asociados con la infección protésica; de ellos, 13 mostraron asociación significativa. Los más estudiados fueron obesidad, corticoides intraarticulares, tabaquismo y glucemia elevada. El solapamiento entre RS fue elevado para obesidad y muy alto para corticoides intraarticulares, tabaquismo y glucemia elevada. El riesgo de sesgo fue considerado bajo en 8 RS (34,7%), pero la herramienta de evaluación metodológica demostró una baja calidad en general. Conclusiones: La identificación de factores procedimentales modificables ofrecen mejores resultados a los pacientes. Sin embargo, muchas RS son redundantes. La evidencia en factores pronósticos en cirugía ortopédica es débil debido al alto riesgo de sesgo y a la calidad metodológica limitada.(AU)

Background: Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SR) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SR are increasingly frequent, their methodological field presents some knowledge gaps. Purpose: To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. Material and methods: We conducted a bibliographic search in 4databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. Results: Twenty-three SR were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. Conclusions: Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SR are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.(AU)

Real-world EGFR testing practices for non-small-cell lung cancer by thoracic pathology laboratories across Europe.

BACKGROUND: Testing for epidermal growth factor receptor (EGFR) mutations is an essential recommendation in guidelines for metastatic non-squamous non-small-cell lung cancer, and is considered mandatory in European countries. However, in practice, challenges are often faced when carrying out routine biomarker testing, including access to testing, inadequate tissue samples and long turnaround times (TATs). MATERIALS AND METHODS: To evaluate the real-world EGFR testing practices of European pathology laboratories, an online survey was set up and validated by the Pulmonary Pathology Working Group of the European Society of Pathology and distributed to 64 expert testing laboratories. The retrospective survey focussed on laboratory organisation and daily EGFR testing practice of pathologists and molecular biologists between 2018 and 2021. RESULTS: TATs varied greatly both between and within countries. These discrepancies may be partly due to reflex testing practices, as 20.8% of laboratories carried out EGFR testing only at the request of the clinician. Many laboratories across Europe still favour single-test sequencing as a primary method of EGFR mutation identification; 32.7% indicated that they only used targeted techniques and 45.1% used single-gene testing followed by next-generation sequencing (NGS), depending on the case. Reported testing rates were consistent over time with no significant decrease in the number of EGFR tests carried out in 2020, despite the increased pressure faced by testing facilities during the COVID-19 pandemic. ISO 15189 accreditation was reported by 42.0% of molecular biology laboratories for single-test sequencing, and by 42.3% for NGS. 92.5% of laboratories indicated they regularly participate in an external quality assessment scheme. CONCLUSIONS: These results highlight the strong heterogeneity of EGFR testing that still occurs within thoracic pathology and molecular biology laboratories across Europe. Even among expert testing facilities there is variability in testing capabilities, TAT, reflex testing practice and laboratory accreditation, stressing the need to harmonise reimbursement technologies and decision-making algorithms in Europe.

Transcriptomics reveals a distinct metabolic profile in T cells from severe allergic asthmatic patients.

The reasons behind the onset and continuation of chronic inflammation in individuals with severe allergies are still not understood. Earlier findings indicated that there is a connection between severe allergic inflammation, systemic metabolic alterations and impairment of regulatory functions. Here, we aimed to identify transcriptomic alterations in T cells associated with the degree of severity in allergic asthmatic patients. T cells were isolated from severe (n = 7) and mild (n = 9) allergic asthmatic patients, and control (non-allergic, non-asthmatic healthy) subjects (n = 8) to perform RNA analysis by Affymetrix gene expression. Compromised biological pathways in the severe phenotype were identified using significant transcripts. T cells' transcriptome of severe allergic asthmatic patients was distinct from that of mild and control subjects. A higher count of differentially expressed genes (DEGs) was observed in the group of individuals with severe allergic asthma vs. control (4,924 genes) and vs. mild (4,232 genes) groups. Mild group also had 1,102 DEGs vs. controls. Pathway analysis revealed alterations in metabolism and immune response in the severe phenotype. Severe allergic asthmatic patients presented downregulation in genes related to oxidative phosphorylation, fatty acid oxidation and glycolysis together with increased expression of genes coding inflammatory cytokines (e.g. IL-19, IL-23A and IL-31). Moreover, the downregulation of genes involved in TGFß pathway together with a decreased tendency on the percentage of T regulatory cell (CD4 + CD25+), suggest a compromised regulatory function in severe allergic asthmatic patients. This study demonstrates a transcriptional downregulation of metabolic and cell signalling pathways in T cells of severe allergic asthmatic patients associated with diminished regulatory T cell function. These findings support a link between energy metabolism of T cells and allergic asthmatic inflammation.

[Translated article] Overview of systematic reviews of risk factors for prosthetic joint infection.

BACKGROUND: Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SRs) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SRs are increasingly frequent, their methodological field presents some knowledge gaps. PURPOSE: To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. MATERIAL AND METHODS: We conducted a bibliographic search in 4 databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. RESULTS: Twenty-three SRs were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8 SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. CONCLUSIONS: Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SRs are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.

Overview of systematic reviews of risk factors for prosthetic joint infection. / Revisión de revisiones sistemáticas de factores pronóstico para infección protésica.

BACKGROUND: Prosthetic joint infection is one of the most serious complications in orthopedics. Prognostic systematic reviews (SR) detecting and assessing factors related to prosthetic joint infection, allow better prediction of risk and implementation of preventive measures. Although prognostic SR are increasingly frequent, their methodological field presents some knowledge gaps. PURPOSE: To carry out an overview of SR assessing risk factors for prosthetic joint infection, describing and synthesizing their evidence. Secondarily, to assess the risk of bias and methodological quality. MATERIAL AND METHODS: We conducted a bibliographic search in 4databases (May 2021) to identify prognostic SR evaluating any risk factor for prosthetic joint infection. We evaluated risk of bias with the ROBIS tool, and methodological quality with a modified AMSTAR-2 tool. We computed the overlap degree study between included SR. RESULTS: Twenty-three SR were included, studying 15 factors for prosthetic joint infection, of which, 13 had significant association. The most frequently studied risk factors were obesity, intra-articular corticosteroids, smoking and uncontrolled diabetes. Overlapping between SR was high for obesity and very high for intra-articular corticoid injection, smoking and uncontrolled diabetes. Risk of bias was considered low in 8SRs (34.7%). The modified AMSTAR-2 tool showed important methodological gaps. CONCLUSIONS: Identification of procedural-modifiable factors, such as intra-articular corticoids use, can give patients better results. Overlapping between SR was very high, meaning that some SR are redundant. The evidence on risk factors for prosthetic joint infection is weak due to high risk of bias and limited methodological quality.

Minimally invasive surgery for pediatric dumbbell neuroblastoma: systematic literature review and report of a single-stage neurosurgical and thoracoscopic approach

IntroductionTraditional surgical strategies for dumbbell neuroblastoma entail, among others, high risk of spinal deformity. Less invasive procedures might reduce these sequelae, however, there is small evidence comparing different strategies. Indications of minimally invasive surgery in neuroblastoma are still developing. Our aim is to identify and analyze different surgical approaches described in the recent literature and to suggest a minimally invasive option.MethodsA systematic review of the literature was conducted in PubMed (Jan 2000–Dec 2021) to identify reports describing surgical resection of dumbbell neuroblastoma in children, according to the PRISMA guidelines. Only full-text articles were included.Results7 articles met the inclusion criteria which, added to the present case, represent a total of 43 patients. All were retrospective studies, most of them small series. Tumor location was mostly thoracic. Most of combined approaches were performed in two stages. Spinal deformity after surgery was reported in 3 patients. Minimally invasive approach was described in only one paper, with no reported cases of its use in a single-stage combined surgery. We also report, to our knowledge, the first single-stage posterior neurosurgical approach combined with thoracoscopy for resection of a dumbbell neuroblastoma in an infant.ConclusionSurgical resection of dumbbell neuroblastomas is challenging. There is no consensus on best surgical approach. Dumbbell tumors should not be considered a contraindication for minimally invasive surgery. A single stage and minimally invasive strategy is proposed.

Estudio de viabilidad de la ecografía abdominal con dispositivos portátiles en atención domiciliaria / Feasibility study of abdominal ultrasound using hand-held devices in homecare services

Antecedentes y objetivos:La miniaturización y portabilidad de dispositivos de ecografía permite al médico de familia aplicarlos en ámbitos como el domicilio del paciente. El presente estudio pretende demostrar que la realización de la ecografía abdominal en el domicilio de pacientes frágiles es factible, permite reducir la demora en la atención y reduce la incertidumbre diagnóstica.Pacientes y métodos:Estudio de casos y controles. Se estudió una muestra de 59 pacientes: 30 casos y 29 controles. Se realizó un análisis descriptivo del grupo casos y se comparó la variable demora entre ambos grupos.Resultados:Se observó una reducción relevante y significativa en la demora entre la ecografía practicada en atención domiciliaria y la realizada en el hospital, de hasta 10 veces menor. El 73,4% de los pacientes solo precisó control clínico por su médico de referencia. En aquellos pacientes que precisaron otras pruebas complementarias o derivación, el diagnóstico definitivo presentó una concordancia total con los resultados de la ecografía realizada al domicilio.Conclusiones:La implementación de la ecografía en atención domiciliaria es asequible y aporta beneficios clínicos relevantes para el paciente e incrementa la capacidad resolutiva del profesional. (AU)

Background and objectives:The miniaturisation and portability of ultrasound devices allow the family doctor to apply them in areas such as the patient's home. The present study aims to prove that performing an abdominal ultrasound in the home of frail patients is feasible, decreases the delay in care, and reduces diagnostic uncertainty.Patients and methods:Case-control study. A sample of 59 patients was studied: 30 cases and 29 controls. A descriptive analysis of the case group was carried out and the delay variable was compared between both groups.Results:A relevant and significant reduction, up to 10 times lower, was observed in the delay between the ultrasound performed in homecare compared those performed in the hospital. Of the patients, 73.4% only required clinical follow-up by their physician. In those patients who required other complementary tests or referrals, the definitive diagnosis was in complete agreement with the results of the ultrasound performed in homecare.Conclusions:The implementation of ultrasound in homecare services is feasible and provides relevant clinical benefits for the patient and increases the resolution capacity of the professional.

[Feasibility study of abdominal ultrasound using hand-held devices in homecare services]. / Estudio de viabilidad de la ecografía abdominal con dispositivos portátiles en atención domiciliaria.

BACKGROUND AND OBJECTIVES: The miniaturisation and portability of ultrasound devices allow the family doctor to apply them in areas such as the patient's home. The present study aims to prove that performing an abdominal ultrasound in the home of frail patients is feasible, decreases the delay in care, and reduces diagnostic uncertainty. PATIENTS AND METHODS: Case-control study. A sample of 59 patients was studied: 30 cases and 29 controls. A descriptive analysis of the case group was carried out and the delay variable was compared between both groups. RESULTS: A relevant and significant reduction, up to 10 times lower, was observed in the delay between the ultrasound performed in homecare compared those performed in the hospital. Of the patients, 73.4% only required clinical follow-up by their physician. In those patients who required other complementary tests or referrals, the definitive diagnosis was in complete agreement with the results of the ultrasound performed in homecare. CONCLUSIONS: The implementation of ultrasound in homecare services is feasible and provides relevant clinical benefits for the patient and increases the resolution capacity of the professional.

Effect of probiotic Lactiplantibacillus plantarum and chestnut flour (Castanea sativa mill) on microbiological and physicochemical characteristics of dry-cured sausages during storage.

The effect of chestnut flour (Castanea sativa Mill) on L. plantarum viability and physicochemical characteristics in a dry-cured sausage (Longaniza de Pascua) during storage is discussed. Four batches were prepared: CL with 3% chestnut flour added; CPL with 3% chestnut flour and 8.5 log CFU/g L. plantarum added; PL with 8.5 log CFU/g L. plantarum added and L, the batch control. The sausages were stored at 4 °C and 20 °C, and vacuum packed for 43 d. L. plantarum viability was affected by storage time (P < 0.001). However, higher L. plantarum counts at the final of storage were reached due to chestnut flour addition (P < 0.001). At room storage, chestnut flour caused a higher increase in TBARS values (P = 0.022). Nevertheless, all lipid oxidation treatments were in the range of accepted values at the sensory detection level. In conclusion, Longaniza de Pascua can be kept at 4 °C or 20 °C for 43 d without causing any rancidity problems.

Minimally invasive surgery for pediatric dumbbell neuroblastoma: systematic literature review and report of a single-stage neurosurgical and thoracoscopic approach.

INTRODUCTION: Traditional surgical strategies for dumbbell neuroblastoma entail, among others, high risk of spinal deformity. Less invasive procedures might reduce these sequelae, however, there is small evidence comparing different strategies. Indications of minimally invasive surgery in neuroblastoma are still developing. Our aim is to identify and analyze different surgical approaches described in the recent literature and to suggest a minimally invasive option. METHODS: A systematic review of the literature was conducted in PubMed (Jan 2000-Dec 2021) to identify reports describing surgical resection of dumbbell neuroblastoma in children, according to the PRISMA guidelines. Only full-text articles were included. RESULTS: 7 articles met the inclusion criteria which, added to the present case, represent a total of 43 patients. All were retrospective studies, most of them small series. Tumor location was mostly thoracic. Most of combined approaches were performed in two stages. Spinal deformity after surgery was reported in 3 patients. Minimally invasive approach was described in only one paper, with no reported cases of its use in a single-stage combined surgery. We also report, to our knowledge, the first single-stage posterior neurosurgical approach combined with thoracoscopy for resection of a dumbbell neuroblastoma in an infant. CONCLUSION: Surgical resection of dumbbell neuroblastomas is challenging. There is no consensus on best surgical approach. Dumbbell tumors should not be considered a contraindication for minimally invasive surgery. A single stage and minimally invasive strategy is proposed.

Clinical and molecular practice of European thoracic pathology laboratories during the COVID-19 pandemic. The past and the near future.

BACKGROUND: This study evaluated the consequences in Europe of the COVID-19 outbreak on pathology laboratories orientated toward the diagnosis of thoracic diseases. MATERIALS AND METHODS: A survey was sent to 71 pathology laboratories from 21 European countries. The questionnaire requested information concerning the organization of biosafety, the clinical and molecular pathology, the biobanking, the workload, the associated research into COVID-19, and the organization of education and training during the COVID-19 crisis, from 15 March to 31 May 2020, compared with the same period in 2019. RESULTS: Questionnaires were returned from 53/71 (75%) laboratories from 18 European countries. The biosafety procedures were heterogeneous. The workload in clinical and molecular pathology decreased dramatically by 31% (range, 3%-55%) and 26% (range, 7%-62%), respectively. According to the professional category, between 28% and 41% of the staff members were not present in the laboratories but did teleworking. A total of 70% of the laboratories developed virtual meetings for the training of residents and junior pathologists. During the period of study, none of the staff members with confirmed COVID-19 became infected as a result of handling samples. CONCLUSIONS: The COVID-19 pandemic has had a strong impact on most of the European pathology laboratories included in this study. Urgent implementation of several changes to the organization of most of these laboratories, notably to better harmonize biosafety procedures, was noted at the onset of the pandemic and maintained in the event of a new wave of infection occurring in Europe.

Arthrotomy debridement of arthrostic septic arthritis of the knee is more effective than arthroscopic debridement and delays the need for prosthesis despite progression. / El desbridamiento por artrotomía de la artritis séptica de rodilla artrósica es más eficaz que el artroscópico y retrasa la necesidad de prótesis a pesar de la progresión de la artrosis.

BACKGROUND AND OBJECTIVE: 40%-50% of this septic arthritis occurs in the knee, despite rapid medical surgical treatment, 24%-50% will have a poor clinical outcome. It is not clear which debridement technique, by arthrotomy or arthroscopy, is more effective in controlling infection, or whether or not previous osteoarthritis worsens the outcome. The objective of this study on septic arthritis of the osteoarthritic knee was to analyse which surgical debridement technique, arthroscopy or arthrotomy, is more effective, the clinical and radiographic outcomes of the patients, and how many go on to require a TKR after the infection has healed. MATERIAL AND METHODS: A retrospective study was performed in 27 patients with native septic arthritis of the knee. Eighteen were men and the mean age was 64.8 years (30-89years). Fifteen patients were debrided by arthrotomy and 12 by arthroscopy. The effectiveness of debridement in controlling infection, the radiographic progression of the osteoarthritis on the Ahlbäch scale, the need for subsequent replacement, and pain and functional status were analysed using the VAS and WOMAC scales at 52.8±11.2-month follow-up. RESULTS: The infection was controlled in 93% and 92% of the patients, 13% and 42% required 2 or more surgeries for infection control, 18% and 44.4% showed progression of arthritis in the arthrotomy and arthroscopy groups, respectively. One patient in each group required a knee replacement. The VAS score was superior in the arthrotomy group and there were no differences in WOMAC score. CONCLUSION: Debridement by arthrotomy in the emergency department by non-sub-specialist knee surgeons is more effective than arthroscopic debridement in controlling septic arthritis of the knee. Surgical debridement of septic arthritis in knees with previous osteoarthritis enabled control of the infection with no pain despite the progression of the osteoarthritis.

Validez de las escalas KLIC y CRIME80 en la predicción del fracaso en la infección aguda tardía tratada mediante desbridamiento y retención de implantes / Validity of the KLIC and CRIME80 scores in predicting failure in late acute infection treated by debridement and implant retention

En las infecciones protésicas es muy importante realizar un tratamiento correcto con el que podamos asegurar una mayor tasa de éxito. Si bien es cierto que el desbridamiento con retención de implante (DAIR) es una cirugía muy utilizada en infecciones agudas y agudas tardías, se sabe que los pacientes que no logran el éxito en este tipo de cirugías presentan mayor riesgo de fracaso en cirugías posteriores. Es por ello que es importante encontrar una escala que nos permita predecir el riesgo de fracaso de DAIR. Así nacieron la escala KLIC y CRIME80 para infecciones agudas e infecciones agudas tardías, respectivamente. Con este estudio hemos analizado la validez de ambas escalas en infecciones periprotésicas de rodilla agudas tardías y se ha observado que el KLIC no tiene valor predictivo para este tipo de infecciones, pero sí la escala CRIME80

It is very important to treat prosthetic infections correctly in order to ensure a higher success rate. Debridement with implant retention (DAIR) is widely used in acute and late infections, however patients who fail after this surgery are known to have a higher risk of failure in subsequent surgeries. Therefore, it is important to find a scale that enables us to predict the risk of DAIR failure. Hence the KLIC and CRIME80 scores for acute and late acute infections, respectively. This study analysed the validity of both scores in acute late periprosthetic knee infections. We observed that the KLIC score has no predictive value for this type of infection, but the CRIME80 score does

Validity of the KLIC and CRIME80 scores in predicting failure in late acute infection treated by debridement and implant retention. / Validez de las escalas KLIC y CRIME80 en la predicción del fracaso en la infección aguda tardía tratada mediante desbridamiento y retención de implantes.

It is very important to treat prosthetic infections correctly in order to ensure a higher success rate. Debridement with implant retention (DAIR) is widely used in acute and late infections, however patients who fail after this surgery are known to have a higher risk of failure in subsequent surgeries. Therefore, it is important to find a scale that enables us to predict the risk of DAIR failure. Hence the KLIC and CRIME80 scores for acute and late acute infections, respectively. This study analysed the validity of both scores in acute late periprosthetic knee infections. We observed that the KLIC score has no predictive value for this type of infection, but the CRIME80 score does.

Quality Standards for Allergen Immunotherapy Clinics in Spain: Consensus Document.

BACKGROUND AND OBJECTIVE: Allergen immunotherapy clinics (AITCs) in Spain differ widely in terms of structure, organization, resources, and portfolio of services. Therefore, it is essential to unify treatment criteria and define quality standards for the most complex AITCs. Objective: To establish a series of recommendations that make it possible to guarantee quality and safety in the administration of immunotherapy and define quality standards for the most complex AITCs. METHODS: This project began with an online survey of 65 allergy departments/units throughout Spain in 2013. Next, a 2-phase consensus process was carried out. In the first phase, 10 experts defined and agreed on the standards using the RAND/UCLA Appropriateness method; in the second, the agreements were validated by means of a 2-round Delphi consultation with 84 experts. RESULTS: Consensus was reached on minimum safety and quality criteria in the administration of allergen immunotherapy, and 2 levels of highly complex AITCs were defined: accredited AITCs and accredited AITCs with excellence. Consensus was also reached on quality standards and accreditation criteria for both levels. CONCLUSIONS: This project is pioneering in terms of its purpose (the definition of quality standards for AITCs) and of the use of structured participation techniques (combination of the RAND/UCLA and Delphi methods). It enabled the design of minimum standards for quality and safety in administering AIT, as well as quality criteria for accreditation of AITCs supported by a broad panel of experts from the Spanish Society of Allergology and Clinical Immunology.

Quality standards for allergen immunotherapy clinics in Spain: consensus document

BACKGROUND: Allergen immunotherapy clinics (AITCs) in Spain differ widely in terms of structure, organization, resources, and portfolio of services. Therefore, it is essential to unify treatment criteria and define quality standards for the most complex AITCs. OBJECTIVE: To establish a series of recommendations that make it possible to guarantee quality and safety in the administration of immunotherapy and define quality standards for the most complex AITCs. METHODS: This project began with an online survey of 65 allergy departments/units throughout Spain in 2013. Next, a 2-phase consensus process was carried out. In the first phase, 10 experts defined and agreed on the standards using the RAND/UCLA Appropriateness method; in the second, the agreements were validated by means of a 2-round Delphi consultation with 84 experts. RESULTS: Consensus was reached on minimum safety and quality criteria in the administration of allergen immunotherapy, and 2 levels of highly complex AITCs were defined: accredited AITCs and accredited AITCs with excellence. Consensus was also reached on quality standards and accreditation criteria for both levels. CONCLUSIONS: This project is pioneering in terms of its purpose (the definition of quality standards for AITCs) and of the use of structured participation techniques (combination of the RAND/UCLA and Delphi methods). It enabled the design of minimum standards for quality and safety in administering AIT, as well as quality criteria for accreditation of AITCs supported by a broad panel of experts from the Spanish Society of Allergology and Clinical Immunology

ANTECEDENTES: Las unidades de inmunoterapia (UIT) en España son muy diferentes en cuanto a estructura, organización, recursos y cartera de servicios. Por ello, resulta esencial homogeneizar criterios de actuación y definir estándares de calidad para las UIT de mayor complejidad. OBJETIVO: Establecer recomendaciones que permitan garantizar la calidad y seguridad en la administración de la inmunoterapia y definir estándares de calidad para las UIT de mayor complejidad. MÉTODOS: Proyecto iniciado (año 2013) con una encuesta on-line a 65 servicios o unidades de alergología de toda España. Posteriormente, se desarrolló un proceso de consenso en dos fases. En la primera, diez expertos definieron y consensuaron los estándares mediante el método RAND/UCLA; en la segunda, los acuerdos se validaron mediante una consulta Delphi a dos rondas con 84 expertos. RESULTADOS: Se consensuaron criterios mínimos de seguridad y calidad en la administración de inmunoterapia con alérgenos (ITA) y se definieron dos niveles de UIT de mayor complejidad: las UIT acreditadas (UITA) y las UIT acreditadas con excelencia (UITAE), consensuándose también los estándares de calidad y criterios de acreditación para ambos niveles. CONCLUSIONES: Proyecto pionero en su objetivo - definición de estándares de calidad de UIT- y en el empleo de técnicas de participación estructuradas -combinación de los métodos RAND/UCLA y Delphi-. El resultado es la definición de unos mínimos de calidad y seguridad para administrar ITA, y un conjunto de criterios de calidad para la acreditación de las UIT que cuenta con el respaldo de un amplio panel de expertos de la SEAIC

Effect of a training programme on blood culture contamination rate in critical care. / Efecto de una acción formativa en cuidados intensivos sobre la tasa de contaminación de hemocultivos.

Blood culture contamination can occur from extraction to processing; its rate should not exceed 3%. OBJECTIVE: To evaluate the impact of a training programme on the rate of contaminated blood cultures after the implementation of sample extraction recommendations based on the best evidence. METHOD: Prospective before-after study in a polyvalent intensive care unit with 18 beds. Two phases were established (January-June 2012, October 2012-October 2015) with a training period between them. Main recommendations: sterile technique, surgical mask, double skin disinfection (70° alcohol and 2% alcoholic chlorhexidine), 70° alcohol disinfection of culture flasks and injection of samples without changing needles. Including all blood cultures of patients with extraction request. VARIABLES: demographic, severity, pathology, reason for admission, stay and results of blood cultures (negative, positive and contaminated). Basic descriptive statistics: mean (standard deviation), median (interquartile range) and percentage (95% confidence interval). Calculated contamination rates per 100 blood cultures extracted. Bivariate analysis between periods. RESULTS: Four hundred and eight patients were included. Eight hundred and forty-one blood cultures were taken, 33 of which were contaminated. In the demographic variables, severity, diagnosis and stay of patients with contaminated samples, no differences were observed from those with uncontaminated samples. Pre-training vs post-training contamination rates: 14 vs 5.6 per 100 blood cultures extracted (P=.00003). CONCLUSION: An evidence-based training programme reduced the contamination of samples. It is necessary to continue working on the planning of activities and care to improve the detection of pollutants and prevent contamination of samples.

Artritis tuberculosa sobre prótesis de rodilla: descripción de un caso y revisión de la literatura / Tuberculous prosthetic knee joint infection: a case report and literature review

Introducción. La infección protésica tardía se presenta a partir del segundo mes tras la cirugía en el contexto de una diseminación hematógena desde otro foco. La infección protésica por micobacterias es una complicación rara cuyo manejo clínico no está estandarizado. Caso. Paciente de 77 años sin antecedentes personales de interés salvo diabetes y un recambio protésico de rodilla derecha por gonartrosis tres años antes. Acude a urgencias del hospital por un cuadro de unos 6 meses de evolución de intenso dolor en rodilla derecha de tipo mecánico con signos inflamatorios pero sin fiebre asociada. A los 5 días de su reingreso y presentando empeoramiento clínico se informa del crecimiento de Mycobacterium tuberculosis en la primera muestra de aspirado de rodilla y se instaura tratamiento antituberculoso durante 9 meses. Las imágenes de resonancia magnética nuclear confirmaron también el diagnóstico de espondilitis tuberculosa en el contexto clínico de la paciente. Tras la intervención quirúrgica se seguía aislando en el cultivo de las muestras intraoperatorias M. tuberculosis y por ello la paciente recibió de nuevo otra tanda de 9 meses con antituberculosos. La evolución al año de seguimiento fue aceptable, aunque unos meses después la paciente falleció por causas cardiovasculares. En la revisión bibliográfica se encontraron 15 publicaciones con un total de 17 casos clínicos en los últimos 25 años de infección protésica por M. tuberculosis. Conclusión. La artritis protésica tuberculosa, aunque es una presentación infrecuente, debe tenerse presente, especialmente en aquellos pacientes con condiciones predisponentes y con antecedentes de infección tuberculosa (AU)

Introduction. Prosthetic late infection occurs in the second month after surgery in the context of haematogenous spread from another source. Prosthetic mycobacterial infection is a rare complication whose clinical management is not standardized. Case. Patient of 77 years with no personal history except for diabetes and a prosthetic replacement of right knee with osteoarthritis three years ago. Patient goes to hospital emergency box for 6 months pain in the right knee with mechanical inflammatory signs but no fever associated. After their return within 5 days and clinical worsening is reporting growth of Mycobacterium tuberculosis in knee aspirate and antitubercular treatment is established for 9 months. Nuclear magnetic resonance imaging studies also confirmed the diagnosis of tuberculosis spondylitis in the clinical context of the patients. After surgery, M. tuberculosis was again isolated from intraoperative samples and therefore the patient received another batch of treatment for 9 months. After a year of monitoring, the development was acceptable but few months later, the patient died for cardiovascular causes. In the literature review, 15 publications with a total of 17 clinical cases of prosthetic infection by M. tuberculosis were found from 1980 to 2014. Conclusion. Prosthetic tuberculous arthritis, although it is a rare presentation, it should be noted, especially in patients with predisposing conditions with a history of tuberculosis infection (AU)

[Tuberculous prosthetic knee joint infection: a case report and literature review]. / Artritis tuberculosa sobre prótesis de rodilla: descripción de un caso y revisión de la literatura.

OBJECTIVE: Prosthetic late infection occurs in the second month after surgery in the context of haematogenous spread from another source. Prosthetic mycobacterial infection is a rare complication whose clinical management is not standardized. CASE: Patient of 77 years with no personal history except for diabetes and a prosthetic replacement of right knee with osteoarthritis three years ago. Patient goes to hospital emergency box for 6 months pain in the right knee with mechanical inflammatory signs but no fever associated. After their return within 5 days and clinical worsening is reporting growth of Mycobacterium tuberculosis in knee aspirate and antitubercular treatment is established for 9 months. Nuclear magnetic resonance imaging studies also confirmed the diagnosis of tuberculosis spondylitis in the clinical context of the patients. After surgery, M. tuberculosis was again isolated from intraoperative samples and therefore the patient received another batch of treatment for 9 months. After a year of monitoring, the development was acceptable but few months later, the patient died for cardiovascular causes. In the literature review, 15 publications with a total of 17 clinical cases of prosthetic infection by M. tuberculosis were found from 1980 to 2014. CONCLUSIONS: Prosthetic tuberculous arthritis, although it is a rare presentation, it should be noted, especially in patients with predisposing conditions with a history of tuberculosis infection.