Simulation of risk of tuberculosis infection in healthcare workers in hospitals of an intermediate incidence country.

We simulated the frequency of tuberculosis infection in healthcare workers in order to classify the risk of TB transmission for nine hospitals in Medellín, Colombia. We used a risk assessment approach to estimate the average number of infections in three risk groups of a cohort of 1082 workers exposed to potentially infectious patients over 10- and 20-day periods. The risk level of the hospitals was classified according to TB prevalence: two of the hospitals were ranked as being of very high priority, six as high priority and one as low priority. Consistent results were obtained when the simulation was validated in two hospitals by studying 408 healthcare workers using interferon gamma release assays and tuberculin skin testing. The latent infection prevalence using laboratory tests was 41% [95% confidence interval (CI) 34·3-47·7] and 44% (95% CI 36·4-51·0) in those hospitals, and in the simulation, it was 40·7% (95% CI 32·3-49·0) and 36% (95% CI 27·9-44·0), respectively. Simulation of risk may be useful as a tool to classify local and regional hospitals according to their risk of nosocomial TB transmission, and to facilitate the design of hospital infection control plans.

[Hemilithotomy position for intramedullary nailing of the femur and compartment syndrome of the healthy leg]. / La position d'hémilithotomie pour l'enclouage du fémur et le syndrome des loges du membre sain.

The well leg compartment Syndrome following long procedures in the dorsal lithotomy or hemi-lithotomy position is a rare complication. Its diagnosis is usually late and the neurological deficit are often permanent. We report two cases of femoral nailing complicated by Compartment Syndrome of the contralateral leg. We review the published literature on 40 cases which suggests a clear relationship between these positions, the duration of the intervention and the degree of leg elevation. Given the potentially severe sequel, prevention is a must and a high degree of suspicion is the key to an early diagnosis. A modified hemi-lithotomy position is proposed. That avoids extreme elevation of the leg and diminishes the hip and knee flexion required while allowing adequate fluoroscopy.