Early mobilization after total hip or knee arthroplasty: a substudy of the POWER.2 study.

BACKGROUND: Early mobilization after surgery is a cornerstone of the Enhanced Recovery After Surgery (ERAS) programs in total hip arthroplasty (THA) or total knee arthroplasty (TKA). Our goal was to determine the time to mobilization after this surgery and the factors associated with early mobilization. METHODS: This was a predefined substudy of the POWER.2 study, a prospective cohort study conducted in patients undergoing THA and TKA at 131 Spanish hospitals. The primary outcome was the time until mobilization after surgery as well as determining those perioperative factors associated with early mobilization after surgery. RESULTS: A total of 6093 patients were included. The median time to achieve mobilization after the end of the surgery was 24.áhours [16.Çô30]. 4,222 (69.3%) patients moved in .ëñ 24.áhours after surgery. Local anesthesia [OR.á=.á0.80 (95% confidence interval [CI]: 0.72.Çô0.90); p.á=.á0.001], surgery performed in a self-declared ERAS center [OR = 0.57 (95% CI: 0.55.Çô0.60); p.á<.á0.001], mean adherence to ERAS items [OR.á=.á0.93 (95% CI: 0.92.Çô0.93); p.á<.á0.001], and preoperative hemoglobin [OR.á=.á0.97 (95% CI: 0.96.Çô0.98); p.á<.á0.001] were associated with shorter time to mobilization. CONCLUSIONS: Most THA and TKA patients mobilize in the first postoperative day, early time to mobilization was associated with the compliance with ERAS protocols, preoperative hemoglobin, and local anesthesia, and with the absence of a urinary catheter, surgical drains, epidural analgesia, and postoperative complications. The perioperative elements that are associated with early mobilization are mostly modifiable, so there is room for improvement.

Eficacia de un programa de tratamiento conservador de la incontinencia urinaria de esfuerzo. Cumplimiento y modificación de los parámetros evaluados a corto y medio plazo / No disponible

Objetivo Evaluar el resultado de un programa de reeducación de la musculatura del suelo pélvico (MSP) en una población de mujeres con incontinencia urinaria de esfuerzo (IUE) diagnosticada mediante estudio urodinámico. Método Estudio prospectivo de 144 mujeres diagnosticadas urodinámicamente de IUE, con indicación de tratamiento conservador mediante ejercicios de contracción de la MSP, biofeedback y electroterapia, asociado a un programa de educación terapéutica (ET). Se incluyeron mujeres tratadas en un periodo de tres años, con un seguimiento mínimo de un año. Los parámetros evaluados fueron: capacidad contráctil de la MSP, cuantificación de la pérdida de orina (test de la compresa), el número de absorbentes de protección, el cuestionario de calidad de vida International Consultation Incontinence Questionnaire (ICIQ-IU-SF) y una escala de percepción subjetiva de mejoría-curación. Se valoró también el cumplimiento en la realización del programa pautado de ejercicios al finalizar el tratamiento y en los controles evolutivos. Resultados De las 144 pacientes que realizaron el tratamiento, 96 completaron el seguimiento mínimo de 12 meses. Al finalizar el tratamiento se observó un cambio en los síntomas y en la afectación de la vida diaria, que se objetivó en el valor del ICIQ-IU-SF que indicaba una mejoría (puntuación menor que al inicio) en el 73% de las pacientes. Un 19% manifestaba no tener IUE y sólo un 8% seguía igual. En el seguimiento, a partir de los 12 meses, se observó que el porcentaje de pacientes con mejoría del ICIQ-IU-SF era menor que al inicio (53%), un 16%seguía sin síntomas de IU y el 31% manifestaba que sus síntomas permanecían igual que antes del tratamiento. En cuanto a la percepción subjetiva de las pacientes, a los 12 meses, el 80% presentó mejoría, el (..) (AU)

SUMMARY Aim To assess the outcome of a pelvic floor muscles (PFM) rehabilitation program in a women population with stress urinary incontinence (UI) diagnosed by urodynamic study. Method Prospective study of 144 women diagnosed urodynamically for stress UI, with conservative treatment indication through MSP contraction exercises, biofeedback and electrotherapy, associated to a therapeutic education program (ET). We included women treated during a three years period, with a minimum one-year follow-up. The evaluated parameters were: the MSP contractile ability, loss of urine quantification (pad test), number of absorbent needed, the International Consultation Incontinence Questionnaire (ICIQ-IU-SF) quality of life questionnaire and a self-perception scale improvement-healing. It was also assessed the performance in carrying out the program of exercises scheduled at the end of treatment and evolutive controls. Results From 144 patients who carried out the treatment, 96 completed the minimum 12 months follow-up period. At the end of the treatment it was observed a change in symptoms and in the disruption of daily life, showed by the value of the IU-SF-ICIQ, which indicated an improvement(score lower than at the beginning) in 73% of the patients, 19% expressed no UI and only 8% remained unchanged. The followup, from 12 months, showed that the percentage of patients with improvement of ICIQ-IU-SF was lower than at the beginning (53%),followed by 16% without symptoms of UI and 31% reported that their symptoms remained the same as before treatment. As for the subjective perception of patients at 12 months, 80% referred improvement, 18% related no (..) (AU)

Human immunodeficiency virus infection and nutritional status in female drug addicts undergoing detoxification: anthropometric and immunologic assessments.

To clarify the interrelations among drug abuse, malnutrition, and immunosuppression, the effects of human immunodeficiency virus (HIV) infection on the nutritional status of 17 noninfected and 19 HIV-infected asymptomatic female drug addicts undergoing detoxification were evaluated by measuring anthropometric and immunologic indexes. Anthropometric measurements were normal in both groups as a result of weight gain (approximately 10 kg) in every patient after the detoxification period. Leukocyte and lymphocyte values and CD2 lymphocyte subset counts were also similar in both groups. CD4 counts (P = 0.04) and the ratio of CD4 to CD8 cells (P = 0.6 x 10(-4)) were lower whereas CD8 counts (P = 0.003) were higher in the HIV-infected than in the noninfected group. Responses to a delayed-hypersensitivity skin test were below normal in both groups but significantly more so in the HIV-positive group (P = 0.05). CD19 counts were lower (P = 0.02) and values for serum immunoglobulins G and M were higher (51% and 37%, respectively) in the HIV-infected females than in the noninfected women. These results may suggest that despite anthropometric recovery, the HIV-infected women had depleted immune function, resulting not only from HIV infection but also from the subclinical malnutrition triggered by previous drug addiction.

Effects of human immunodeficiency virus infection and detoxification time on anthropometric measurements and dietary intake of male drug addicts.

Anthropometric measurements and dietary intakes of male drug addicts (n = 62), infected (n = 23) or not infected (n = 39) with human immunodeficiency virus (HIV), who underwent two phases of detoxification (P1:15 d to 1 mo and P2: 5-6 mo) were assessed. Body weight, weight gain during detoxification, height, body mass index, and ideal body weight were measured. A prospective food-record questionnaire was compiled and energy and nutrient contents of ingested food were determined. Food intakes were compared with dietary recommendations for the Spanish population. At the time of the study, all patients had substantial weight gains, mostly in P1. Nutrient consumption was lower in P2 (energy, protein, and lipids) and in groups not infected with HIV. In P2, lipid intake was higher in the HIV-positive than in the HIV-negative group (P < 0.05, Student's t test). Moreover, an interactive effect of HIV by phase was shown for lipid intake (P = 0.04, two-way analysis of variance). Magnesium, folate, and vitamin E intakes were lower than recommended in nearly all patients. Energy, zinc, riboflavin, and vitamin B-6 intakes were lower than recommended or were borderline. HIV infection did not have a negative effect on anthropometric measurements or on nutrient intakes. The anthropometric assessment may suggest an adequate recovery of the indexes measured in all patients, which principally took place during P1. Measurement of nutrient intakes showed certain imbalances and deficits that should be corrected.

[Chemical composition of 6 unconventional plants from Oaxaca State, Mexico, as potential resources for animal feed]. / Estudio de la composición química de 6 plantas no convencionales del Estado de Oaxaca, México, como recursos potenciales en la alimentación animal.

Characteristics and distribution of six plants are described. The chemical composition and in vitro digestibility of leaf and stem of Polymnia maculata, Trigonospermum annuum, Buddleia parviflora Kunt, Canna indica L, Gnaphalium oxyphyllum y Saurauia scabrida Hensl., selected for farmers information, were analysed as a potential resources in animal feeding. The results in dry matter: Crude protein (%): Go and Ss 10.9, Bp 16.7, Pm 11.7 and Ta 11.3. Cell wall (%): Go 54.1, Ss 52.3, Ci 54.4, Bp 68.3, Pm 27.8 and Ta 30.9. Lignin (%): Go and Ss 16.6, Ci 15.5, Bp 10.4, Pm 10.6 and Ta 13.3. IN vitro dry matter digestibility (%): Go 55.1, Ss 37.6, Ci 55.4, Bp 46.5, Pm 82.4 and Ta 81.4. Calcium and phosphorus (mg/100g) respectively: Go 1095 and 379, Ss 1132 and 387, Ci 600 and 421, Bp 800 and 855, Pm 1146 and 421 and Ta 905 and 480. Tannic acid (mg/100g): Go 1450, Ss 1480, Bp 575, Ci 518, Pm 3329 and Ta 2760. Trypsin inhibitor (UIT/g): Go 22264, Ss 29720, Bp 755, Ci 4228, Pm 931 and Ta 4412. Hemagglutinins were detected in Pm and Ta. Alkaloids were detected as scarce in Bp, Ci and Pm, moderate in Ta. Saponins and Cyanogenic glucosides were not detected. It is concluded that Pm and Ta could be considered as a forage for ruminants; Go, Bp and Ci as a complement; recommended the voluntary intake, in vivo digestibility and weight increase trials.

Nutritional status assessment of HIV-positive drug addicts.

Since human immunodeficiency virus (HIV) is known to lead to modifications of immune function and interrelationships among malnutrition, anergy and drug addiction have been shown, the aim of this work was to assess the nutritional status of 36 male heroin addicts under a period of detoxication (3 months). They were divided into two groups: (1) HIV negative (n = 20) and (2) HIV positive (n = 16); heights, weights and serum albumin concentration were measured and immune function was tested, using delayed hypersensitivity skin tests containing 7 antigens. No significant differences in anthropometric measurements were found between both groups, but anthropometric improvement was shown in every patient after the detoxication period. Serum albumin, often used as a classical index of malnutrition, remained within the normal values in both groups. The whole response to skin tests was depressed in both groups and no significant differences were shown between them. Therefore, these results might suggest that in spite of the apparent anthropometric recovery and the normal values of albumin, a subclinical malnutrition was indicated by the depressed immune function, which was more noticeable in the HIV-positive group.