[Incidence of dislocation and relationship with the surgical approach in a historic cohort of 1,738 hips of the National Register of Uruguay]. / Incidencia de luxación y relación con el abordaje en una cohorte histórica de 1,738 caderas del Registro Nacional de Uruguay.

INTRODUCTION: In Uruguay, all replacements have been registered by law since 1980. Instability is the second cause of revision in hip replacements. OBJECTIVE: To know the incidence of instability, and its relationship with the surgical approach. MATERIAL AND METHODS: Observational and analytical study of a historical cohort of 1,738 hip replacements conducted in 2014. Random sample stratified according to the surgical approach: posterior (AP) and anterolateral (AAL). All patients who had suffered any dislocation were identified, their incidence was estimated and bivariate and multivariate tests were performed, to identify factors related, associated with the patient, to the surgeon (surgical approach and experience), to the environment, and to the implant. RESULTS: 633 patients, minimum follow-up of three years and 16 patients with dislocation, with an incidence of 1.95% (95% CI: 1.14-3.31) in general, 1.4% (95% CI: 0.64-3.03) in AAL and 4.9% (95% CI: 2.67-8.83) in AP (p = 0.009, RR = 3.35). Factors associated with dislocation were: a) AP with an OR of 6.18 (CI 95%: 1.99-19.26); b) patient from the private health subsector with an OR of 13.74 (95% CI: 1.87-101.15); c) antecedent of hypothyroidism with an OR of 3.51 (IC 95%: 1.09-11.29); d) osteoarthritis secondary to inflammatory arthritis and dysplasia with an OR of 5.24 (CI 95%: 1.16-23.66); e) surgical center number three with an OR of 8.80 (CI 95%: 1.50-51.51). CONCLUSIONS: The incidence of early dislocation was within the usual ranges. Posterior surgical approach with increased risk of instability from preoperative risk factors.

INTRODUCCIÓN: En Uruguay se registran por ley todas las artroplastías desde 1980. La inestabilidad es la segunda causa de revisión en artroplastías de cadera. OBJETIVO: Conocer la incidencia de inestabilidad y su relación con el abordaje. MATERIAL Y MÉTODOS: Estudio observacional y analítico de una cohorte histórica de 1,738 artroplastías de cadera efectuadas en 2014. Muestra aleatoria estratificada según la vía de abordaje: abordaje posterior (AP) y anterolateral (AAL). Se identificaron todos los pacientes que habían sufrido alguna luxación, se estimó su incidencia y se realizó análisis bivariado y multivariado para identificar los factores relacionados asociados al paciente, al cirujano (abordaje y experiencia), al medio y al implante. RESULTADOS: 633 pacientes, seguimiento mínimo de tres años y 16 pacientes con luxación, con una incidencia de 1.95% (IC 95%: 1.14-3.31) en general, 1.4% (IC 95%: 0.64-3.03) en AAL y 4.9% (IC 95%: 2.67-8.83) en AP (p = 0.009, RR = 3.35). Los factores asociados con luxación fueron: a) AP con un OR de 6.18 (IC 95%: 1.99-19.26); b) paciente procedente del subsector de salud privado con un OR de 13.74 (IC 95%: 1.87-101.15); c) antecedente de hipotiroidismo con un OR de 3.51 (IC 95%: 1.09-11.29); d) artrosis secundarias a artritis inflamatorias y displasia con un OR de 5.24 (IC 95%: 1.16-23.66); e) centro quirúrgico número tres con un OR de 8.80 (IC 95%: 1.50-51.51). CONCLUSIONES: La incidencia de luxación temprana estuvo dentro de los rangos habituales. El AP con mayor riesgo de inestabilidad por factores de riesgo preoperatorios.

Resultados a largo plazo de artroplastia de cadera en pacientes en diálisis por insuficiencia renal crónica. Mortalidad y supervivencia del implante en el Registro Nacional de Uruguay desde el año 2000 / Long-term results of hip arthroplasty in patients on dialysis for chronic renal failure. Mortality and implant survival in the National Registry of Uruguay since 2000

Objetivo: Evaluar la incidencia de mortalidad, revisión y valoración funcional en la artroplastia de cadera en pacientes dializados en Uruguay. Métodos: Se realizó un estudio observacional analítico de una cohorte histórica de artroplastias de cadera en pacientes con enfermedad renal crónica tratados con hemodiálisis o diálisis peritoneal entre el 1/1/2000 y el 31/12/2013; análisis de supervivencia mediante el método de Kaplan-Meier. Se realizó además, la evaluación funcional y radiológica de los pacientes vivos. Ciento cuarenta y una artroplastias de cadera, 42 por artrosis (29,8%) y 99 por fracturas (70,2%), edad 72,3 (DE: 12,1) años (18,9-93,1), 72 mujeres (51,1%) y 69 varones (48,9%), 75 artroplastias izquierdas (53,2%) y 66 derechas (46,8%). Predominó el abordaje anterolateral (115, 81,6%) respecto al posterolateral (26, 18,4%). Resultados: La mortalidad a los 30, 180 días, uno y 5 años en pacientes diagnosticados por artrosis fue del 2,4, 7,1, 9,5 y 47,6%, respectivamente, y en pacientes con fractura del 7,1, 18,2, 29,3 y 82,6%, respectivamente. Se realizaron 5 revisiones protésicas, 3 por luxación recidivante, una por aflojamiento aséptico y una artroplastia resección por infección. Doce pacientes estaban vivos al último control, la puntuación media según la escala de Merle D́Aubigne-Postel fue 6,4 en el preoperatorio y 11 al final del seguimiento. El índice de Barthel promedio en el seguimiento fue 72,8. Discusión: La mortalidad a mediano y largo plazo de estos pacientes fue muy alta, mucho mayor que la observada en los pacientes sometidos al mismo procedimiento que no están en diálisis. La revisión es excepcional, y la evaluación funcional de los pocos pacientes vivos muestra malos resultados clínico-radiológicos

Objective: To evaluate the incidence of mortality, revision and functional assessment after hip arthroplasty in dialysis patients in Uruguay. Methods: An observational analytical study of a historical cohort of hip arthroplasties was performed on patients with chronic kidney disease treated with haemodialysis or peritoneal dialysis between 1/1/2000-31/12/2013; survival analysis using the Kaplan-Meier method. Functional and radiological evaluation of the live patients was also carried out. One hundred and forty-one hip arthroplasties, 42 for osteoarthritis (29.8%) and 99 for fractures (70.2%), age 72.3 (SD: 12.1) years (18.9-93.1), 72 women (51.1%) and 69 men (48.9%), 75 left arthroplasties (53.2%) and 66 right (46.8%). The anterolateral approach (115, 81.6%) predominated over the posterolateral approach (26, 18.4%). Results: Mortality at 30, 180 days, 1 and 5 years of patients diagnosed with osteoarthritis was 2.4, 7.1, 9.5 and 47.6%, respectively, and of patients with fracture it was 7.1, 18.2, 29.3 and 82.6%. Five prosthetic revisions were performed, 3 due to recurrent dislocation, one due to aseptic loosening, and one resection arthroplasty due to infection. Twelve patients were alive at the last control, the average score according to the scale of Merle D'Aubigne-Postel was 6.4 preoperatively, and 11 at the end of the follow-up. The average Barthel index at follow-up was 72.8. Discussion: The mortality in the medium and long term of these patients was very high, much higher than that observed in patients undergoing the same procedure not on dialysis. The review is exceptional, and the functional evaluation of the few living patients shows poor clinical-radiological results

Long-term results of hip arthroplasty in patients on dialysis for chronic renal failure. Mortality and implant survival in the National Registry of Uruguay since 2000. / Resultados a largo plazo de artroplastia de cadera en pacientes en diálisis por insuficiencia renal crónica. Mortalidad y supervivencia del implante en el Registro Nacional de Uruguay desde el año 2000.

OBJECTIVE: To evaluate the incidence of mortality, revision and functional assessment after hip arthroplasty in dialysis patients in Uruguay. METHODS: An observational analytical study of a historical cohort of hip arthroplasties was performed on patients with chronic kidney disease treated with haemodialysis or peritoneal dialysis between 1/1/2000-31/12/2013; survival analysis using the Kaplan-Meier method. Functional and radiological evaluation of the live patients was also carried out. One hundred and forty-one hip arthroplasties, 42 for osteoarthritis (29.8%) and 99 for fractures (70.2%), age 72.3 (SD: 12.1) years (18.9-93.1), 72 women (51.1%) and 69 men (48.9%), 75 left arthroplasties (53.2%) and 66 right (46.8%). The anterolateral approach (115, 81.6%) predominated over the posterolateral approach (26, 18.4%). RESULTS: Mortality at 30, 180 days, 1 and 5 years of patients diagnosed with osteoarthritis was 2.4, 7.1, 9.5 and 47.6%, respectively, and of patients with fracture it was 7.1, 18.2, 29.3 and 82.6%. Five prosthetic revisions were performed, 3 due to recurrent dislocation, one due to aseptic loosening, and one resection arthroplasty due to infection. Twelve patients were alive at the last control, the average score according to the scale of Merle D'Aubigne-Postel was 6.4 preoperatively, and 11 at the end of the follow-up. The average Barthel index at follow-up was 72.8. DISCUSSION: The mortality in the medium and long term of these patients was very high, much higher than that observed in patients undergoing the same procedure not on dialysis. The review is exceptional, and the functional evaluation of the few living patients shows poor clinical-radiological results.

Emergence of KPC-producing Klebsiella pneumoniae in Uruguay: infection control and molecular characterization.

We describe the first outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP), the infection control measures adopted and the shift in resistance patterns of isolates during antibiotic treatment. The ST258 KPC-KP strain exhibited a multiresistant antibiotic phenotype including co-resistance to gentamycin, colistin and tigecycline intermediate susceptibility. Isolates before and after treatment had different behaviour concerning their antibiotic susceptibility and the population analysis profile study. A progressive increase in the aminoglycosides (acquiring amicacin resistance) and ß-lactam MICs, and a decreased susceptibility to fosfomycin was observed throughout the administration of combined antimicrobial regimens including meropenem. A high meropenem resistance KPC-KP homogeneous population (MIC 256 Jg/mL), could arise from the meropenem heterogeneous low-level resistance KPC-KP population (MIC 8 Jg/mL), by the selective pressure of the prolonged meropenem therapy. The kpc gene was inserted in a Tn4401 isoform a, and no transconjugants were detected. The core measures adopted were successful to prevent evolution towards resistance dissemination.

Neumonía asociada a la ventilación mecánica: ¿antibioterapia empírica o específica? / Ventilator-associated pneumonia: empirical or specific antibiotic therapy?

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Latin american experience with two low-dose oral contraceptives containing 30 microg ethinylestradiol/75 microg gestodene and 20 microg ethinylestradiol/150 microg desogestrel.

The objective of this study was to compare cycle control, efficacy and tolerance of an oral contraceptive containing 20 microg ethinylestradiol and 150 microg desogestrel with a preparation containing 30 microg ethinylestradiol combined with 75 microg gestodene. This study involved 342 women and 4104 cycles use in Argentina, Brazil, Chile, and Mexico. Contraceptive efficacy was good with both formulations. Two pregnancies occurred in the desogestrel group but were not due to method failure. With respect to cycle control, the incidence of intermenstrual bleeding was higher during the first 3 cycles in the desogestrel group; it was significant (p <0.01) during the first 3 days of the cycle for a normal or heavy bleeding only in the Mexican group. Amenorrhea was not reported for any group, but the incidence of dysmenorrhea was significantly higher (p <0.01) in the Brazilian desogestrel group (13.8%) and was significantly lower (p <0.01) in the Mexican gestodene group (8.5%). Adverse events were similar in all the countries with headache, breast tension, and nausea, the most frequently reported symptoms. The range of mean increase in body weight varied from 0.2 kg in the Argentine group to 2.6 kg in the Chilean group (95% confidence limit, +/- 2.51) in the gestodene group, and 0.2 kg in the Argentine group to 2.5 kg in Brazilian group (95% confidence limit, +/- 2.36) in the desogestrel group. Fifteen women discontinued because of headache, but there were no significant differences between the groups regarding discontinuation for this and other medical or non-medical reasons. Both oral contraceptive preparations are reliable and well tolerated, and both have favorable effects on control cycle.

Carcinoma primario de duodeno

Se estudiaron lesiones neoplásicas relacionadas con el carcinoma del intestino delgado. Hemos conciderado documentar esta lesión por su importancia. Se muestran los aspectos de la obstrucción mediante la clínica, endoscopia, biopsia y radiología. Se analizaron origen,síntomas y todo lo relacionado con el carcinoma intestinal, así como las mejores terapias

Serum lipid variations in women on copper intrauterine devices, triphasic oral contraceptives and monthly injectable contraceptives.

This is a longitudinal, prospective, comparative controlled study. Patient selection excluded smokers, overweighed, hypertensive, and aged greater than 34 years. 168 women were distributed by random list into four groups: A) fitted with inert IUD (control); B) with Nova T (Cu-IUD); C) received triphasic gestodene (OC); and D) monthly norethisterone enanthate 50 mg + estradiol valerate 5 mg (injectable). Serum lipid patterns were assessed at the beginning of contraceptive use and at 1, 6 and 12 months. The results of the Cu-IUD group did not show any difference with the control group. The OC group showed an increase of HDL and a significant lowering of LDL cholesterol at 6 months but this reverted by 12 months. On the other hand, in the injectable group, a sharp decrease of total lipids, total cholesterol and LDL was observed from the first month, lasting throughout 12 months, yielding significant difference with controls and also with pre-treatment values. In sum, the monthly injectable showed quite favorable patterns that would deserve further study, especially in view of the scarcity of hitherto available information concerning this formulation.