Dalbavancin for treating prosthetic joint infections caused by Gram-positive bacteria: A proposal for a low dose strategy. A retrospective cohort study.

OBJECTIVE: Gram-positive bacteria are the leading cause of prosthetic joint infection (PJI). Dalbavancin is a lipoglycopeptide with remarkable pharmacokinetic properties and high bactericidal activity against most Gram-positive bacteria. Although clear evidence regarding its effectiveness in bone and joint infections lacks, recent studies suggest a promising role of dalbavancin in PJI. METHODS: From June 1st 2016 to May 1st 2018, all patients diagnosed of PJI and treated with DAL alone or in combination with other drugs were retrospectively evaluated. Dalbavancin susceptibility of every isolate was studied following CLSI criteria. The primary objective was to assess the clinical efficacy and tolerability of the drug in patients with PJI. A cost-analysis was performed following the DALBUSE study methodology. RESULTS: Sixteen patients were treated with dalbavancin, eight with total hip arthroplasty infection (THAi) and eight with total knee arthroplasty infection (TKAi). Staphylococcus spp. and Enterococcus spp. were the microorganisms involved. No major side effects were detected. Infection resolved in 12 patients. In 2 patients the treatment failed, and another patient died due to unrelated causes. One patient is currently being treated for hematogenous-spread knee infection secondary to prosthetic aortic arch endocarditis. After discontinuation of dalbavancin, and excluding patients who died or with clinical failure, the median follow up of the cohort was 503 days (interquartile range IQR, 434.5 to 567 days). We calculate that US$ 264,769 were saved. CONCLUSIONS: This study suggests that dalbavancin treatment for PJI caused by Gram-positive bacteria is a safe and effective option that reduces hospital stay and costs. Future reports are needed to confirm these findings.

Osteocondromas del extremo proximal del húmero. Manejo diagnóstico y terapéutico / Osteochondromas of the Proximal Humerus. Diagnostic and Therapeutic Management

Objetivo: 1) Recordar la epidemiología y semiología de los osteocondromas del extremo proximal del húmero (EPH); 2) determinar las indicaciones de su tratamiento y 3) hacer recomendaciones relativas al tratamiento quirúrgico en ese asiento. Material y método: Estudio retrospectivo observacional y longitudinal de 20 osteocondromas solitarios y 12 múltiples del EPH. Se analizaron las características epidemiológicas, clínicas y de imagen de los pacientes de la serie, y los resultados del tratamiento, con un tiempo medio de seguimiento de los casos intervenidos de 45 meses. Resultados: Los osteocondromas solitarios correspondieron a 11 hombres (55%) y 9 mujeres (45%), con una edad media de 21 años. Doce (60%) fueron intervenidos a una edad media de 23 años por ser sintomáticos o, en un caso, por sospecharse malignización. Dos casos solitarios no intervenidos pudieron haber involucionado espontáneamente. Las formas múltiples ocurrieron en 11 hombres (92%) y una mujer (8%) y 3 fueron intervenidos. No hubo complicaciones ni recidivas y el resultado funcional fue excelente en todos los pacientes. Discusión: Los osteocondromas del EPH son relativamente frecuentes, aunque la mayoría de las publicaciones son de casos clínicos aislados o de series cortas. Conclusiones: Los osteocondromas del EPH no difieren de los de otra localización. Los casos sintomáticos y en los que se sospecha malignización serían intervenidos, aquellos mejor con el crecimiento finalizado. El tratamiento quirúrgico se resume en la planificación del abordaje mediante TC o RM, resección en bloque extraperióstica y una eventual reconstrucción ósea, idealmente con homoinjerto

Objective: 1) To recall the epidemiology and signs of osteochondromas of the proximal humerus (OPH); 2) determine treatment indications; 3) and make recommendations for surgical treatment. Methods: Retrospective, observational and longitudinal study of 20 solitary and 12 multiple osteochondromas of the proximal humerus. We analyzed the epidemiological, clinical and imaging characteristics and treatment results with an average time of follow-up of the operated cases of 45 months.Results: Eleven (55%) males and 9(45%) females with an average age of 21 years presented solitary osteochondromas. Twelve (60%) cases were operated on at a mean age of 23 years because they were symptomatic or, in one case, malignancy was suspected. Two solitary osteochondromas could have spontaneously regressed. Multiple osteochondromas were found in 11(92%) males and one (8%) female of whom 3required surgery. There were no complications or recurrences. Functional outcome was excellent in all patients. Discussion: Osteochondromas of the proximal humerus are relatively common, although most publications are case reports or short series. Conclusions: Osteochondromas of the proximal humerus do not differ from those in other locations. Symptomatic cases and those in which malignancy is suspected would be operated, the former preferably at the end of growth. The surgical treatment is summarized in planning the approach, using CT and/or MRI, extraperiosteal en bloc resection, and eventual bone reconstruction, ideally with allograft

Osteochondromas of the Proximal Humerus. Diagnostic and Therapeutic Management. / Osteocondromas del extremo proximal del húmero. Manejo diagnóstico y terapéutico.

OBJECTIVE: 1) To recall the epidemiology and signs of osteochondromas of the proximal humerus (OPH); 2) determine treatment indications; 3) and make recommendations for surgical treatment. METHODS: Retrospective, observational and longitudinal study of 20 solitary and 12 multiple osteochondromas of the proximal humerus. We analyzed the epidemiological, clinical and imaging characteristics and treatment results with an average time of follow-up of the operated cases of 45 months. RESULTS: Eleven (55%) males and 9(45%) females with an average age of 21 years presented solitary osteochondromas. Twelve (60%) cases were operated on at a mean age of 23 years because they were symptomatic or, in one case, malignancy was suspected. Two solitary osteochondromas could have spontaneously regressed. Multiple osteochondromas were found in 11(92%) males and one (8%) female of whom 3required surgery. There were no complications or recurrences. Functional outcome was excellent in all patients. DISCUSSION: Osteochondromas of the proximal humerus are relatively common, although most publications are case reports or short series. CONCLUSIONS: Osteochondromas of the proximal humerus do not differ from those in other locations. Symptomatic cases and those in which malignancy is suspected would be operated, the former preferably at the end of growth. The surgical treatment is summarized in planning the approach, using CT and/or MRI, extraperiosteal en bloc resection, and eventual bone reconstruction, ideally with allograft.

Análisis de la postura sedente en una población escolar a través de un cuestionario y su posible influencia en las algias vertebrales / Analysis of seated position in a school population through a questionnaire and its possible influence on vertebral pains

Objetivos: a través de este estudio, se pretende conocer cuáles son los hábitos posturales y conocimientos ergonómicos sobre las diferentes formas que utilizan los adolescentes a la hora de sentarse. Además se pretenden establecer relaciones entre las diferentes posiciones adoptadas (de atención, de escritura y de descanso) y la aparición de dolores de espalda. Material y método: desarrollo y aplicación de un cuestionario dirigido a una población de 700 adolescentes (n = 700) Y realizado en cinco centros de Educación Secundaria Obligatoria de Ponferrada, Toreno y Cacabelos (pertenecientes a la provincia de León). Resultados: se obtienen datos sobre las posiciones más utilizadas por los escolares en tres situaciones: posición de atención (explicación del profesor), posición de escritura (tomar apuntes) y posición de descanso (tiempo de ocio sentados en sus casas). Asimismo, se comprueba el elevado número de horas que pasan en posición sedente a lo largo del día y si las diferentes posiciones adoptadas tienen alguna influencia en el padecimiento de algias vertebrales. Conclusiones: el número de horas que los alumnos pasan en posición sedente provoca el incremento de desequilibrios musculares. Este factor, unido a un mobiliario mal adaptado ya la adopción de posturas incorrectas, puede incrementar el número de algias vertebrales padecidas a lo largo de sus vidas

Objedives: Through this study, it is intended to know which are the postural habits and ergonomic knowledge on the different ways that the adolescents adopt when sitting down. It also seeks to settle down relationships among the different adopted positions (of attention, of writing and of rest) and the appearance of back pain Material and method: We developed and applied a questionnaire directed to a population of 700 adolescents (n = 700) and carried out in five Compulsory Secondary Education schools in Ponferrada, Toreno and Cacabelos (belonging to the province of León). Results: Data are obtained on the positions more often adopted by the students in three situations: position of attention (the teacher's explanation), writing position (taking notes) and position of rest (time of leisure sitting down in their houses). Also it is pro ven the high number of hours that they spend in seated position along the day and if the different adopted positions ha ve any influence in the suffering of vertebral pains. Conclusions: The number of hours which students spend in seated position causes the increment of muscular imbalances. This factor together to a not well adapted furniture and to the adoption of incorrect postures can in crease the number of vertebral pains suffered along their lives