Cuidados para el manejo seguro de los pacientes con espondilitis infecciosa / Care measures for the safe management of patients with infectious spondylitis

Objetivo: identificar los principales cuidados de Enfermería de los pacientes que han sido diagnosticados de una espondilitis infecciosa para prevenir sus posibles complicaciones. Metodo: se realizó una revisión narrativa a través de las bases de datos: Pubmed, CINAHL, Cochrane Library Plus y Cuiden, con los términos libres: infectious spondylitis, spondylodiscitis, vertebral osteomielitis AND care; espondilitis infecciosa, espondilodiscitis, osteomielitis vertebral. Limitados en idioma: inglés o español, pacientes adultos y publicados entre 2008 y 2018. Resultados: de un total de 138 artículos encontrados en la búsqueda finalmente se seleccionaron 18. Los cuidados identificados fueron: vigilancia de síntomas inespecíficos como el dolor de espalda en pacientes de riesgo (edad avanzada, inmunodeprimidos, usuarios de drogas por vía parenteral, portadores de catéter central), manipulación estéril de catéteres de hemodiálisis, realización de hemocultivos, vigilancia del dolor y manejo del mismo con utilización de corsés ortopédicos, mantener reposo absoluto las dos primeras semanas de tratamiento antibiótico, vigilancia de complicaciones neurológicas (sintomatología neurológica), meningitis o endocarditis, controlar la evolución de la sintomatología y vigilancia de la fiebre. Conclusión: conocer la evolución de esta enfermedad y puntos clave de su tratamiento desde el enfoque enfermero ayuda a adecuar los cuidados, a evitar las complicaciones o a saberlas identificar de manera precoz antes de que sean irreversibles

Objective: to identify the main Nursing care measures for patients diagnosed with infectious spondylitis, in order to prevent its potential complications. Method: a narrative review was conducted through the following databases: Pubmed, CINAHL, Cochrane Library Plus and Cuiden, using the free terms: Infectious spondylitis, spondylodiscitis, vertebral osteomyelitis AND care; "espondilitis infecciosa", "espondilodiscitis", "osteomielitis vertebral". Language limitations: English or Spanish; adult patients, and published between 2008 and 2018. Results: out of the 138 articles in total retrieved in the search, 18 were finally selected. The care measures identified were: watching for unspecific symptoms such as back pain in patients at risk (advanced age, immunosuppressed, parenteral drug users, carriers of a central catheter), sterile handling of hemodialysis catheters, conducting blood cultures, watching for pain and its management through the use of back braces, maintaining complete rest during the first two weeks of antibiotic treatment, watching for neurological complications (neurological symptomatology), meningitis or endocarditis, watching the evolution of symptomatology, and watching for high temperature. Conclusion: to understand the evolution of this disease and the key points for its treatment from a nursing approach will help to adapt care measures, to prevent complications, or to detect them earlier before they become irreversible

Vaccination of breeder hens with a polyvalent killed vaccine for pathogenic Enterococcus cecorum does not protect offspring from enterococcal spondylitis.

Pathogenic strains of Enterococcus cecorum cause symmetrical paralysis in broilers due to infection of the free thoracic vertebra. The disease caused by pathogenic E. cecorum, known as enterococcal spondylitis or "kinky-back" continues to be responsible for significant losses to the broiler industry worldwide. In outbreaks of pathogenic E. cecorum, gut colonization and sepsis occur in the first three weeks-of-life. Since maternal antibodies are present during this period, we postulated that vaccination of breeders with a polyvalent killed vaccine would protect chicks from challenge. To test this hypothesis, representative isolates from seven genotype groups of pathogenic E. cecorum circulating in the US were chosen to produce adjuvanted killed vaccines (bacterins) and given to broiler-breeder hens. No single strain produced high titres of antibodies to all other strains; however, the combination of serologic reactivity of pathogenic isolates (designated SA3 and SA7) was sufficient to react with all genotypes. Vaccination of commercial broiler-breeder hens with a bacterin composed of SA3 and SA7 did not have any adverse effects. Vaccinated hens developed E. cecorum specific antibodies; however, no significant difference in survival was observed in infected embryos from hens in vaccine or adjuvant only groups. Chicks from vaccinated hens also failed to resist homologous or heterologous challenge during experimental infection. In a macrophage killing assay, pathogenic E. cecorum were found to evade opsinophagocytosis with elicited antibodies. These data suggest that pathogenic strains of E. cecorum possess virulence mechanisms that confound antibody-mediated opsinophagocytosis, complicating vaccine development for this pathogen of broilers.

Prevention of new osteitis on magnetic resonance imaging in patients with early axial spondyloarthritis during 3 years of continuous treatment with etanercept: data of the ESTHER trial.

OBJECTIVE: The aim of this study was to assess the degree of fluctuation of osteitis on MRI during long-term treatment with etanercept (ETN) in patients with early axial SpA (axSpA) with active inflammation (osteitis) on whole-body MRI in the spine and/or the SI joints at baseline. METHODS: We analysed MRI data from 328 SI joint quadrants and 943 spine vertebral units (VUs) in terms of osteitis in the pooled data set of 41 patients who were treated with ETN for 3 consecutive years. Scoring was performed by two blinded radiologists at baseline, year 2 and year 3. RESULTS: Through years 2 and 3, osteitis on MRI resolved completely in 56 of 144 (38.9%) SI joint quadrants and in 20 of 40 (50%) VUs affected at baseline, while persistent osteitis was found in 24 of 144 (16.7%) SI joint quadrants and in 8 of 40 (20.0%) spine VUs. The development of new osteitis in sites that were free of osteitis at baseline only occurred in 2 of 131 (1.5%) SI joint quadrants and in 3 of 862 (0.4%) spine VUs in both year 2 and year 3. CONCLUSION: There was a consistently small amount of osteitis on MRI in patients with early axSpA compared with baseline values, and only a very low rate of new-onset osteitis was found during 3 years of continuous treatment with ETN. TRIAL REGISTRATION: www.clinicaltrials.gov, NCT00844142.

Cervical spine instability in rheumatoid arthritis.

Rheumatoid arthritis (RA) is the most common inflammatory disease of the cervical spine (CS). After hands and feet, CS is the most commonly involved segment, being present in more than half of the patients with RA. Especially in the CS, RA may cause degeneration of ligaments, leading to laxity, instability and subluxation of the vertebral bodies. This is often asymptomatic or symptoms are erroneously attributed to peripheral manifestations. Otherwise, this may cause compression of spinal cord (SC) and medulla oblongata leading to severe neurologic deficits and even sudden death. Owing to its potentially debilitating and life-threatening sequelae, inevitable progression once neurologic deficits occur and the poor medical condition of afflicted patients, CS involvement remains a priority in the diagnosis and its treatment will remain a challenge. The surgical approach aims a solid fixation of the upper cervical spine, giving stability, preventing neurologic deterioration and injury to the SC, leading to improved neurologic function, vascular integrity and maintenance of sagittal balance. The recent advances in surgical techniques, complete understanding of the anatomy and precise preoperative evaluation led to safer and more effective procedures that have decreased complication rates. Based on the fact that when a patient becomes myelopathic the rate of long-term mortality increases and the chance of neurologic recovery decreases, many authors agree that early surgical intervention, before the onset of neurologic deficits, gives a more satisfactory outcome. However, the timing when a prophylactic stabilization should occur is poorly defined, and so, patients with radiographic instability but without evidence of neurologic deficit are still the most difficult to manage.

[Tuberculous spondylitis of vertebra with fracture, paraparesis and pleural empyema complications--case report].

INTRODUCTION: Spine tuberculosis is caused by Micobacterium tuberculosis. It is localized in the vertebral body or intervertebral disc. Its diagnosis is often delayed because of nonspecific symptoms and neglected presence of tuberculosis, which leads to serious complications. CASE REPORT: This paper presents a case of tuberculous spondylitis, which was complicated with the fracture of vertebra, paraparesis of lower extremities and pleural empyema. The treatment with antituberculous drugs started after the fracture of 10th and 11th thoracic vertebras. The therapy brought some improvement but paraparesis of lower extremities remained. In the further course of disease, inflammatory process affected the pleura. Antibiotic and antitubercular therapy with puncture of pleura were not very effective. Operation was performed on December 20th 2011: Thoracotomia lat. dex. Decorticatio pulmonum lat.dex. Seven months after surgery, the patient was without symptoms. CONCLUSION: Tuberculous spondylitis occurs relatively frequently in clinical practice. Early diagnosis and adequate therapy of this disease can prevent the occurrence of its serious complications.

Capacitive coupling reduces instrumentation-related infection in rabbit spines: a pilot study.

BACKGROUND: Postoperative spine infections cause considerable morbidity. Patients are subjected to long-term antibiotic regimens and may require further surgery. Delivery of electric current through instrumentation can detach biofilm, allowing better antibiotic penetration and assisting in eradicating infection. QUESTION/PURPOSES: We asked (1) whether capacitive coupling treatment in combination with a single dose of antibiotics would reduce infection rates when compared with antibiotics alone in a rabbit spine infection model, (2) whether it would decrease the overall bacterial burden, and (3) whether there was a time-dependent response based on days treated with capacitive coupling. METHODS: Thirty rabbits were subjected to a well-established spine infection model with a single dose of intravenously administered systemic ceftriaxone (20 mg/kg of body weight) prophylaxis. Two noncontiguous rods were implanted inside dead space defects at L3 and L6 challenged with 10(6) colony-forming units of Staphylococcus aureus. Rabbits were randomly treated with a capacitive coupling or control device. Instrumentation and soft tissue bacterial growth were assessed after 7 days. RESULTS: Sites treated with capacitive coupling showed a decrease in the incidence of positive culture: 36% versus 81% in the control group. We observed no difference in the soft tissue's infectious burden. Overall bacterial load was not decreased with capacitive coupling. CONCLUSIONS: Capacitive coupling in conjunction with antibiotics reduced the instrumentation-related infection rate compared with antibiotics alone. CLINICAL RELEVANCE: Capacitive coupling noninvasively delivers an alternating current that may detach biofilm from instrumentation. Treatment of infection may be successful without removal of instrumentation, allowing for improved stability and overall decreased morbidity.

Neonatal capsaicin pretreatment suppresses intramedullary inflammation in adjuvant-induced spondylitis.

In order to investigate the proposed involvement of neuropeptides in musculoskeletal inflammation we pretreated rats, in an adjuvant spondylitis model, with capsaicin, a neurotoxin. Immunohistochemistry showed that administration of capsaicin to newborn rats depleted irreversibly the neuropeptide, substance P. Elimination of capsaicin-sensitive fibres by the neonatal injection of capsaicin did not suppress the peridiscitis of rats in which adjuvant spondylitis was induced at 7 weeks of age. However, elimination of capsaicin-sensitive fibres did suppress the inflammation usually seen in the bone marrow. We speculate that this intramedullary inflammation is normally induced or sustained by capsaicin-sensitive fibres.

[Primary disability in patients with tuberculous spondylitis and the ways for its decrease]. / Pervichnaia invalidnost' u bol'nykh tuberkuleznym spondilitom i puti ee snizheniia.

Causes responsible for invalidity were analysed in 167 patients with a circumscribed form of tuberculous spondylitis. The causes were divided into 4 groups: diagnostic errors; errors in treatment; prognostic errors (late indications to surgical treatment); organizational errors. Heightening of the quality of early diagnosis of tuberculous spondylitis at a primary application to a medical institution and timely high-quality specific therapy in the antituberculous institutions will contribute to an increase in treatment effectiveness and invalidity reduction.

[The methodological aspects of primary prevention in spinal osteochondrosis]. / Metodologicheskie aspekty pervichnoi profilaktiki osteokhondroza pozvonochnika.

The paper presents the conception of primary prophylaxis of a prevalent disease--spinal osteochondrosis. The conception rests primarily on the main spinal functions and implies training of nonspecific resistance mechanisms under the conditions of present-day mode of life.