The use of erythromycin and colistin-loaded cement in total knee arthroplasty does not reduce the incidence of infection: a prospective randomized study in 3000 knees.

BACKGROUND: The use of antibiotic-loaded cement is believed to prevent infection in primary total knee arthroplasty, but there is a lack of randomized studies to support this concept. The aim of this study was to evaluate the use of an antibiotic-loaded cement to reduce the infection rate in primary total knee arthroplasty. METHODS: This is a prospective randomized study with 2948 cemented total knee arthroplasties, in which bone cement without antibiotic was used in 1465 knees (the control group) and a bone cement loaded with erythromycin and colistin was used in 1483 knees (the study group). All patients received the same systemic prophylactic antibiotics. The patients were followed for a minimum of twelve months. The rate of infection was analyzed according to the criteria of the Centers for Disease Control and Prevention. RESULTS: The rate of deep infection (1.4% in the control group and 1.35% in the study group; p = 0.96) and the rate of superficial infection (1.2% and 1.8%, respectively; p = 0.53) were similar in both groups. The factors related to a higher rate of deep infection in a multivariate analysis were male sex and an operating time of >125 minutes. CONCLUSIONS: The use of erythromycin and colistin-loaded bone cement in total knee arthroplasty did not lead to a decrease in the rate of infection when systemic prophylactic antibiotics were used, a finding that suggests that the use of antibiotic-loaded bone cement would not be indicated in the general population. Further research is needed to assess whether its use is recommended for patients with a higher risk of infection.

Impact of different patterns of nonadherence on the outcome of highly active antiretroviral therapy in patients with long-term follow-up.

OBJECTIVES: The aim of the study was to evaluate the impact of different patterns of nonadherence on treatment outcomes in patients with long-term follow-up. METHODS: This cohort study included patients who began highly active antiretroviral therapy during 1996-1999, with the last follow-up in 2007. Adherence was evaluated every 2 months by monitoring of pharmacy refills and by using self-reports. Patients were considered nonadherent at a specific visit when less than 90% of the prescribed drugs had been taken. Adherence was categorized as follows. (A) Continuous adherence: a patient had to be adherent in all of the evaluations throughout the period of follow-up. (B) Treatment interruption: drugs were not taken for more than 3 days, for any reason. Treatment failure was defined as viral load >500 HIV-1 RNA copies/mL or death. Cox proportional risk models were used to calculate adjusted relative hazards (ARHs) of treatment failure. RESULTS: A total of 540 patients were included in the study, with a median follow-up of 8.3 years. Only 32.78% of patients achieved and maintained continuous adherence, and 42.78% of patients had treatment interruptions. Noncontinuous adherence [ARH 1.48; 95% confidence interval (CI) 1.02-2.14] and treatment interruptions (ARH 1.39; 95% CI 1.04-1.85) were associated with treatment failure for the overall cohort; however, for patients with more than 3 years of follow-up, only treatment interruptions were independently associated with treatment failure. CONCLUSIONS: Only one-third of patients managed to achieve continuous adherence, and almost half of the patients had treatment interruptions, which have a particularly marked effect on treatment outcomes over the long term.

[Prevalence of cardiovascular risk factors in HIV-infected patients]. / Prevalencia de factores de riesgo cardiovascular en pacientes con infección por el VIH.

INTRODUCTION: To determine the prevalence of cardiovascular risk factors in human immunodeficiency virus (HIV)-infected patients. PATIENTS AND METHOD: A cross-sectional study was performed with HIV-infected patients aged 20 or over managed at the outpatient Infectious Disease Unit during 2003. Clinical and epidemiological characteristics of HIV infection and cardiovascular risk factors were evaluated. RESULTS: The final 760 patients included in the study had a mean of 1.5 cardiovascular risk factors, with smoking being the most prevalent (66.8%; CI 95%: 63.4-70.2). The cardiovascular risk factor of age and gender was present in 26.4% (CI 95%: 23.3-29.7) of patients and family history of premature coronary heart disease in 14.3% (CI 95%: 11.8-16.9). The prevalence of hypertension and diabetes mellitus was 13.2% (CI 95%: 10.8-15.8) and 4.3% (CI 95%: 3.0-6.0), respectively. High density lipoprotein (HDL) cholesterol concentration under 40 mg/dl was found in 29.3% (CI 95%: 26.1-32.7) and above 60 mg/dl in 16.3% (CI 95%: 13.8-19.1). Twenty-five patients (3.3%; CI 95%: 2.1-4.8) had suffered overt cardiovascular disease. CONCLUSION: Smoking and HDL cholesterol were the main cardiovascular risk factors in this HIV-infected cohort.

Prevalencia de factores de riesgo cardiovascular en pacientes con infección por el VIH / Prevalence of cardiovascular risk factors in HIV-infected patients

Introducción. Determinar la prevalencia de los factores de riesgo cardiovascular en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Pacientes y método. Estudio transversal en pacientes de 20 años o mayores con infección por el VIH durante el año 2003 en la consulta externa del Servicio de Medicina Interna y Enfermedades Infecciosas del Hospital del Mar de Barcelona. Se evaluaron las características clínico-epidemiológicas de la infección por el VIH y los factores de riesgo cardiovascular. Resultados. Los 760 pacientes incluidos en el estudio presentaban una media de 1,5 factores de riesgo cardiovascular, siendo el consumo de cigarrillos el más prevalente (66,8%; intervalo de confianza [IC] 95%: 63,4-70,2). La edad y el sexo como factor de riesgo cardiovascular estuvo presente en el 26,4% (IC 95%: 23,3-29,7) de los pacientes y los antecedentes familiares de cardiopatía isquémica precoz en el 14,3% (IC 95%: 11,8-16,9). La prevalencia de hipertensión y de diabetes mellitus fue del 13,2% (IC 95%: 10,8-15,8) y 4,3% (IC 95%: 3,0-6,0), respectivamente. En el 29,3% (IC 95%: 26,1-32,7) se detectó una concentración de colesterol de las lipoproteínas de alta densidad (c-HDL) inferior a 40 mg/dl y superior a 60 mg/dl en el 16,3% (IC 95%:13,8-19,1). Veinticinco pacientes (3,3%; IC 95%: 2,1-4,8) habían presentado enfermedad cardiovascular sintomática. Conclusión. El tabaquismo y el c-HDL destacan como los principales factores de riesgo cardiovascular en esta cohorte de pacientes con infección por el VIH

Introduction. To determine the prevalence of cardiovascular risk factors in human immunodeficiency virus (HIV)-infected patients. Patients and method. A cross-sectional study was performed with HIV-infected patients aged 20 or over managed at the outpatient Infectious Disease Unit during 2003. Clinical and epidemiological characteristics of HIV infection and cardiovascular risk factors were evaluated. Results. The final 760 patients included in the study had a mean of 1.5 cardiovascular risk factors, with smoking being the most prevalent (66.8%; CI 95%: 63.4-70.2). The cardiovascular risk factor of age and gender was present in 26.4% (CI 95%: 23.3-29.7) of patients and family history of premature coronary heart disease in 14.3% (CI 95%: 11.8-16.9). The prevalence of hypertension and diabetes mellitus was 13.2% (CI 95%: 10.8-15.8) and 4.3% (CI 95%: 3.0-6.0), respectively. High density lipoprotein (HDL) cholesterol concentration under 40 mg/dl was found in 29.3% (CI 95%: 26.1-32.7) and above 60 mg/dl in 16.3% (CI 95%: 13.8-19.1). Twenty-five patients (3.3%; CI 95%: 2.1-4.8) had suffered overt cardiovascular disease. Conclusion. Smoking and HDL cholesterol were the main cardiovascular risk factors in this HIV-infected cohort

Síndrome metabólico en pacientes con lipodistrofia infectados por el VIH / Metabolic syndrome among HIV-infected patients with lipodystrophy

Introducción. La lipodistrofia en los pacientes con infección por el virus de la inmunodeficiencia humana (VIH) puede contemplarse como un factor predisponente al desarrollo del síndrome metabólico. Por dicho motivo en el presente estudio se ha evaluado la prevalencia de síndrome metabólico en estos pacientes según el tipo de lipodistrofia y los posibles factores relacionados. Pacientes y métodos. Estudio transversal que incluyó a los pacientes mayores de 20 años, con infección por el VIH y anomalías en la distribución de la grasa corporal atendidos en la consulta externa del Servicio de Medicina Interna y Enfermedades Infecciosas del Hospital del Mar de Barcelona, durante el año 2003. La identificación del síndrome metabólico se estableció según los criterios del Panel III del National Cholesterol Education Program. La lipodistrofía se evaluó por exploración física y se clasificó en lipoatrofia, lipohipertrofia y formas mixtas. Resultados. El 99% de los 260 pacientes incluidos recibía tratamiento antirretroviral. La prevalencia de síndrome metabólico fue del 23,5%. Según el patrón de lipodistrofia, la prevalencia fue del 15,1% en los pacientes con lipoatrofia aislada y del 35,2% en los que presentaban lipoacúmulo. El índice de masa corporal (odds ratio [OR]: 1,22; intervalo de confianza [IC] del 95%, 1,1-1,36) fue el único factor que se asoció de forma independiente y significativa con la presencia de síndrome metabólico en los pacientes con lipodistrofia. Conclusiones. La presencia de lipoacúmulo duplica la prevalencia de síndrome metabólico en los pacientes infectados por el VIH con lipodistrofia. Dado que el índice de masa corporal es el principal predictor del riesgo de aparición de síndrome metabólico en estos pacientes, deben enfatizarse las medidas dirigidas a cambiar los estilos de vida (AU)

Introduction. Lipodystrophy in HIV-infected patients may be a predisposing factor for metabolic syndrome. The aim of the present study was to assess the prevalence of metabolic syndrome among HIV-infected patients with lipodystrophy and to analyze the possible associated factors. Patients and methods. A cross-sectional study was performed in HIV-infected patients aged 20 years old and older with lipodystrophy managed at the Internal Medicine and Infectious Diseases Outpatient Unit of Hospital del Mar in Barcelona (Spain), in 2003. The National Cholesterol Education Program-APT III criteria for the identification of metabolic syndrome were used. Lipodystrophy was evaluated by clinical examination and classified as lipoatrophy, lipohypertrophy and mixed forms. Results. Ninety-nine percent of the 260 patients included were on antiretroviral therapy. The prevalence of metabolic syndrome was 23.5%. Based on the lipodystrophy pattern, the prevalence ranged from 15.1% in patients with isolated lipoatrophy to 35.2% in those with lipoaccumulation pattern. The only independent factor associated with the presence of metabolic syndrome among patients with lipodystrophy was body mass index (OR: 1.22; 95% CI, 1.1-1.36). Conclusions. The presence of lipoaccumulation doubles the prevalence of metabolic syndrome in HIV-infected patients with lipodystrophy. Since body mass index was the main independent predictor of metabolic syndrome in the present study, interventions aimed at lifestyle changes should be prioritized in these patients (AU)

Otitis media serosa bilateral como primera manifestación de una poliangeítis microscópica / Bilateral otitis media as presentation form of microscopic polyangiitis

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