Diagnóstico de infecciones asociadas a artroplastias / Recommendations for the diagnosis of prosthetic joint infections

Resumen La infección de prótesis articulares es la más temida de las complicaciones en estas cirugías. Su diagnóstico continúa siendo un gran desafío, debido a su presentación poco evidente y solapada, exigiendo una alta sospecha clínica para que el mismo pueda ser realizado en forma oportuna. El presente documento representa una revisión actualizada de las evidencias y recomendaciones existentes, con el objeto de proveer una herramienta que permita a los profesionales seguir un curso de acción basado en los conocimientos actuales y recursos disponibles, según la opinión de los miembros de la Comisión de Infecciones Osteoarticulares de la Sociedad Argentina de Infectología (SADI).

Abstract Prosthetic joint infection is the most feared complication of implant surgeries. Its diagnosis continues to be a challenge since its clinical presentation is usually not very evident and overlapping. A high clinical suspicion is needed to make a timely diagnosis. This document represents an updated review of the existing evidence and recommendations, in order to provide a tool that allows professionals to follow a course of action based on current knowledge and available resources, according to the opinion of the members of the Commission of Osteoarticular Infections from the Argentinean Society of Infectious Diseases (SADI).

[Recommendations for the diagnosis of prosthetic joint infections]. / Diagnóstico de infecciones asociadas a artroplastias.

Prosthetic joint infection is the most feared complication of implant surgeries. Its diagnosis continues to be a challenge since its clinical presentation is usually not very evident and overlapping. A high clinical suspicion is needed to make a timely diagnosis. This document represents an updated review of the existing evidence and recommendations, in order to provide a tool that allows professionals to follow a course of action based on current knowledge and available resources, according to the opinion of the members of the Commission of Osteoarticular Infections from the Argentinean Society of Infectious Diseases (SADI).

La infección de prótesis articulares es la más temida de las complicaciones en estas cirugías. Su diagnóstico continúa siendo un gran desafío, debido a su presentación poco evidente y solapada, exigiendo una alta sospecha clínica para que el mismo pueda ser realizado en forma oportuna. El presente documento representa una revisión actualizada de las evidencias y recomendaciones existentes, con el objeto de proveer una herramienta que permita a los profesionales seguir un curso de acción basado en los conocimientos actuales y recursos disponibles, según la opinión de los miembros de la Comisión de Infecciones Osteoarticulares de la Sociedad Argentina de Infectología (SADI).

Estrés laboral en docentes de un Centro Educativo rural en Pasto / WORK STRESS IN TEACHERS OF A RURAL EDUCATIONAL CENTER OF PASTO

La comprensión y el estudio del estrés laboral se ha constituido en una de las prioridades a nivel mundial; específicamente para la Psicología de la Salud Ocupacional (PSO), ya que ha impactado la salud (física, psicológica y social) ante las exigencias laborales percibidas como desbordantes, en los recursos de afrontamiento y la oportunidad de desarrollar procesos investigativos en contexto rural, del cual se ha evidenciado una baja incidencia de estudios articulados al estrés laboral. Este estudio tiene como objetivo caracterizar los estresores organizacionales y las consecuencias psicológicas en docentes del área rural de San Juan de Pasto, a partir de un estudio mixto secuencial explicativo, de diseño muestral tipo censo. En cuanto a la fase cuantitativa, se aplicó la escala para la evaluación de estrés laboral EEEL y para la fase cualitativa se implementó la técnica de grupo focal. En los resultados, se encontró que el 80% de los docentes puntuaron en los niveles alto de estrés, así como también los factores de entorno de trabajo y condiciones de trabajo. Desde la triangulación de los resultados, se caracterizan los estresores laborales del Centro Educativo Municipal, en estresores organizacionales y estresores extra-laborales (resultado emergente). Se concluyó que los procesos de identificación de estresores organizacionales en instituciones rurales permiten la construcción de procesos de prevención, intervención y seguimiento contextualizado a las dinámicas del centro educativo, así como también la oportunidad de escenarios de promoción de la salud mental laboral.

The understanding and study of work stress has become one of the priorities worldwide; specificallyfor the Occupational Health Psychology, as it has impacted the health (physical, psychological and social) in the face of work demands perceived as overwhelming, in coping resources and the opportunity to develop investigative processes in a rural context, in which a low incidence of studies related to work stress has been evidenced. This study aims to characterize organizational stressors and psychological consequences in teachers in the rural area of San Juan de Pasto. From a mixed sequential explanatory study, with a census-type sample design. Regarding thequantitative phase, the Scale for the Evaluation of Work Stress was applied and for the qualitative phase the focus group technique was implemented. In this regard, from the total scores, 80% of the teachers scored on the levels of high stress and stress, as well as the factors of work environment and working conditions. From the triangulation of the results, the work stressors of the Municipal Education Center, organizational stressors and extra-work stressors (emergent result) are characterized. Concluding that the processes of identification of organizational stressors in rural institutions allow the construction of prevention, inter vention and contextualized monitoring processes to the dynamics of the educational center, as well as the opportunity of scenarios for the promotion of occupational mental health.

Treatment as prevention in resource-limited settings: is it feasible to maintain HIV viral load suppression over time?

INTRODUCTION: Recently, there has been increasing interest in the role of "treatment as prevention" (TasP). Some of the questions regarding TasP strategies arise from the perceived difficulties in achieving and maintaining viral load (VL) suppression over time and the risk of emergence of viral resistance that could compromise future treatment options. This study was conducted to assess these questions in a resource-limited setting. METHODOLOGY: We performed a retrospective observational study of HIV-infected patients diagnosed in the pre-HAART era on follow-up at a private center from Buenos Aires, Argentina. Socio-demographic, clinical, and laboratory data were extracted from clinical charts. Analyses were performed to test for potential associations of selected variables with current virologic failure or use of third-line drugs. RESULTS: Of 619 patients on follow-up, 82 (13.2%) were diagnosed in the pre-HAART era. At the time of our study, 79 (96.3%) patients were on HAART, with a median duration of 14 years (IQR 12-15) of therapy, and exposure to mono or dual nucleoside reverse transcriptase inhibitors regimens in 47.8% of cases. Sixty-nine patients (87.3%) had undetectable VL, 37 (46.8%) never presented virologic failure, and 19 (24.1%) experienced only one failure. Thirteen patients (16.5%) were receiving third-line ART regimens, with an average of 2.7-fold more virologic failures than those on first- or second-line regimens (p = 0.007). CONCLUSIONS: Maintaining viral load suppression over time in resource-limited-settings is feasible.