The use of erythromycin and colistin-loaded cement in total knee arthroplasty does not reduce the incidence of infection: a prospective randomized study in 3000 knees.

BACKGROUND: The use of antibiotic-loaded cement is believed to prevent infection in primary total knee arthroplasty, but there is a lack of randomized studies to support this concept. The aim of this study was to evaluate the use of an antibiotic-loaded cement to reduce the infection rate in primary total knee arthroplasty. METHODS: This is a prospective randomized study with 2948 cemented total knee arthroplasties, in which bone cement without antibiotic was used in 1465 knees (the control group) and a bone cement loaded with erythromycin and colistin was used in 1483 knees (the study group). All patients received the same systemic prophylactic antibiotics. The patients were followed for a minimum of twelve months. The rate of infection was analyzed according to the criteria of the Centers for Disease Control and Prevention. RESULTS: The rate of deep infection (1.4% in the control group and 1.35% in the study group; p = 0.96) and the rate of superficial infection (1.2% and 1.8%, respectively; p = 0.53) were similar in both groups. The factors related to a higher rate of deep infection in a multivariate analysis were male sex and an operating time of >125 minutes. CONCLUSIONS: The use of erythromycin and colistin-loaded bone cement in total knee arthroplasty did not lead to a decrease in the rate of infection when systemic prophylactic antibiotics were used, a finding that suggests that the use of antibiotic-loaded bone cement would not be indicated in the general population. Further research is needed to assess whether its use is recommended for patients with a higher risk of infection.

Association between red meat consumption and metabolic syndrome in a Mediterranean population at high cardiovascular risk: cross-sectional and 1-year follow-up assessment.

BACKGROUND AND AIMS: Little is known about the role that red meat and processed red meat (RM) consumption plays in the development of the metabolic syndrome (MetS). The aim was to assess the relationship between RM consumption and the prevalence or incidence of the MetS and its components in a Mediterranean population at high risk of cardiovascular disease. METHODS AND RESULTS: Cross-sectional analyses were carried out at baseline and at 1-year follow-up and longitudinal analysis were conducted in a cohort of individuals at high risk of cardiovascular disease from the PREDIMED study. A 137-item validated semi-quantitative food frequency questionnaire, anthropometric measurements, blood pressure, fasting plasma glucose and lipid profile were evaluated both at baseline and after 1-year follow-up. The MetS was defined in accordance with the updated ATP III criteria. Subjects in the upper quartile of RM consumption were more likely to meet the criteria for the MetS at baseline (OR, 2.3; 95% CI, 1.4-3.9; P-trend = 0.001) and after 1-year follow-up (OR, 2.2; 95% CI, 1.3-3.7; P-trend = 0.034) compared with those in the quartile of reference, even after adjusting for potential confounders. The longitudinal analyses showed that individuals in the fourth quartile of RM consumption had an increased risk of MetS (OR, 2.7; 95% CI, 1.1-6.8; P-trend = 0.009) or central obesity incidence (OR, 8.1; 95% CI, 1.4-46.0; P-trend = 0.077) at the end of the follow-up compared to the lowest quartile. CONCLUSIONS: Higher RM consumption is associated with a significantly higher prevalence and incidence of MetS and central obesity in individuals at high risk of cardiovascular disease.

Impact of different patterns of nonadherence on the outcome of highly active antiretroviral therapy in patients with long-term follow-up.

OBJECTIVES: The aim of the study was to evaluate the impact of different patterns of nonadherence on treatment outcomes in patients with long-term follow-up. METHODS: This cohort study included patients who began highly active antiretroviral therapy during 1996-1999, with the last follow-up in 2007. Adherence was evaluated every 2 months by monitoring of pharmacy refills and by using self-reports. Patients were considered nonadherent at a specific visit when less than 90% of the prescribed drugs had been taken. Adherence was categorized as follows. (A) Continuous adherence: a patient had to be adherent in all of the evaluations throughout the period of follow-up. (B) Treatment interruption: drugs were not taken for more than 3 days, for any reason. Treatment failure was defined as viral load >500 HIV-1 RNA copies/mL or death. Cox proportional risk models were used to calculate adjusted relative hazards (ARHs) of treatment failure. RESULTS: A total of 540 patients were included in the study, with a median follow-up of 8.3 years. Only 32.78% of patients achieved and maintained continuous adherence, and 42.78% of patients had treatment interruptions. Noncontinuous adherence [ARH 1.48; 95% confidence interval (CI) 1.02-2.14] and treatment interruptions (ARH 1.39; 95% CI 1.04-1.85) were associated with treatment failure for the overall cohort; however, for patients with more than 3 years of follow-up, only treatment interruptions were independently associated with treatment failure. CONCLUSIONS: Only one-third of patients managed to achieve continuous adherence, and almost half of the patients had treatment interruptions, which have a particularly marked effect on treatment outcomes over the long term.

[Prevalence of cardiovascular risk factors in HIV-infected patients]. / Prevalencia de factores de riesgo cardiovascular en pacientes con infección por el VIH.

INTRODUCTION: To determine the prevalence of cardiovascular risk factors in human immunodeficiency virus (HIV)-infected patients. PATIENTS AND METHOD: A cross-sectional study was performed with HIV-infected patients aged 20 or over managed at the outpatient Infectious Disease Unit during 2003. Clinical and epidemiological characteristics of HIV infection and cardiovascular risk factors were evaluated. RESULTS: The final 760 patients included in the study had a mean of 1.5 cardiovascular risk factors, with smoking being the most prevalent (66.8%; CI 95%: 63.4-70.2). The cardiovascular risk factor of age and gender was present in 26.4% (CI 95%: 23.3-29.7) of patients and family history of premature coronary heart disease in 14.3% (CI 95%: 11.8-16.9). The prevalence of hypertension and diabetes mellitus was 13.2% (CI 95%: 10.8-15.8) and 4.3% (CI 95%: 3.0-6.0), respectively. High density lipoprotein (HDL) cholesterol concentration under 40 mg/dl was found in 29.3% (CI 95%: 26.1-32.7) and above 60 mg/dl in 16.3% (CI 95%: 13.8-19.1). Twenty-five patients (3.3%; CI 95%: 2.1-4.8) had suffered overt cardiovascular disease. CONCLUSION: Smoking and HDL cholesterol were the main cardiovascular risk factors in this HIV-infected cohort.

Prevalencia de factores de riesgo cardiovascular en pacientes con infección por el VIH / Prevalence of cardiovascular risk factors in HIV-infected patients

Introducción. Determinar la prevalencia de los factores de riesgo cardiovascular en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Pacientes y método. Estudio transversal en pacientes de 20 años o mayores con infección por el VIH durante el año 2003 en la consulta externa del Servicio de Medicina Interna y Enfermedades Infecciosas del Hospital del Mar de Barcelona. Se evaluaron las características clínico-epidemiológicas de la infección por el VIH y los factores de riesgo cardiovascular. Resultados. Los 760 pacientes incluidos en el estudio presentaban una media de 1,5 factores de riesgo cardiovascular, siendo el consumo de cigarrillos el más prevalente (66,8%; intervalo de confianza [IC] 95%: 63,4-70,2). La edad y el sexo como factor de riesgo cardiovascular estuvo presente en el 26,4% (IC 95%: 23,3-29,7) de los pacientes y los antecedentes familiares de cardiopatía isquémica precoz en el 14,3% (IC 95%: 11,8-16,9). La prevalencia de hipertensión y de diabetes mellitus fue del 13,2% (IC 95%: 10,8-15,8) y 4,3% (IC 95%: 3,0-6,0), respectivamente. En el 29,3% (IC 95%: 26,1-32,7) se detectó una concentración de colesterol de las lipoproteínas de alta densidad (c-HDL) inferior a 40 mg/dl y superior a 60 mg/dl en el 16,3% (IC 95%:13,8-19,1). Veinticinco pacientes (3,3%; IC 95%: 2,1-4,8) habían presentado enfermedad cardiovascular sintomática. Conclusión. El tabaquismo y el c-HDL destacan como los principales factores de riesgo cardiovascular en esta cohorte de pacientes con infección por el VIH

Introduction. To determine the prevalence of cardiovascular risk factors in human immunodeficiency virus (HIV)-infected patients. Patients and method. A cross-sectional study was performed with HIV-infected patients aged 20 or over managed at the outpatient Infectious Disease Unit during 2003. Clinical and epidemiological characteristics of HIV infection and cardiovascular risk factors were evaluated. Results. The final 760 patients included in the study had a mean of 1.5 cardiovascular risk factors, with smoking being the most prevalent (66.8%; CI 95%: 63.4-70.2). The cardiovascular risk factor of age and gender was present in 26.4% (CI 95%: 23.3-29.7) of patients and family history of premature coronary heart disease in 14.3% (CI 95%: 11.8-16.9). The prevalence of hypertension and diabetes mellitus was 13.2% (CI 95%: 10.8-15.8) and 4.3% (CI 95%: 3.0-6.0), respectively. High density lipoprotein (HDL) cholesterol concentration under 40 mg/dl was found in 29.3% (CI 95%: 26.1-32.7) and above 60 mg/dl in 16.3% (CI 95%: 13.8-19.1). Twenty-five patients (3.3%; CI 95%: 2.1-4.8) had suffered overt cardiovascular disease. Conclusion. Smoking and HDL cholesterol were the main cardiovascular risk factors in this HIV-infected cohort

Síndrome metabólico en pacientes con lipodistrofia infectados por el VIH / Metabolic syndrome among HIV-infected patients with lipodystrophy

Introducción. La lipodistrofia en los pacientes con infección por el virus de la inmunodeficiencia humana (VIH) puede contemplarse como un factor predisponente al desarrollo del síndrome metabólico. Por dicho motivo en el presente estudio se ha evaluado la prevalencia de síndrome metabólico en estos pacientes según el tipo de lipodistrofia y los posibles factores relacionados. Pacientes y métodos. Estudio transversal que incluyó a los pacientes mayores de 20 años, con infección por el VIH y anomalías en la distribución de la grasa corporal atendidos en la consulta externa del Servicio de Medicina Interna y Enfermedades Infecciosas del Hospital del Mar de Barcelona, durante el año 2003. La identificación del síndrome metabólico se estableció según los criterios del Panel III del National Cholesterol Education Program. La lipodistrofía se evaluó por exploración física y se clasificó en lipoatrofia, lipohipertrofia y formas mixtas. Resultados. El 99% de los 260 pacientes incluidos recibía tratamiento antirretroviral. La prevalencia de síndrome metabólico fue del 23,5%. Según el patrón de lipodistrofia, la prevalencia fue del 15,1% en los pacientes con lipoatrofia aislada y del 35,2% en los que presentaban lipoacúmulo. El índice de masa corporal (odds ratio [OR]: 1,22; intervalo de confianza [IC] del 95%, 1,1-1,36) fue el único factor que se asoció de forma independiente y significativa con la presencia de síndrome metabólico en los pacientes con lipodistrofia. Conclusiones. La presencia de lipoacúmulo duplica la prevalencia de síndrome metabólico en los pacientes infectados por el VIH con lipodistrofia. Dado que el índice de masa corporal es el principal predictor del riesgo de aparición de síndrome metabólico en estos pacientes, deben enfatizarse las medidas dirigidas a cambiar los estilos de vida (AU)

Introduction. Lipodystrophy in HIV-infected patients may be a predisposing factor for metabolic syndrome. The aim of the present study was to assess the prevalence of metabolic syndrome among HIV-infected patients with lipodystrophy and to analyze the possible associated factors. Patients and methods. A cross-sectional study was performed in HIV-infected patients aged 20 years old and older with lipodystrophy managed at the Internal Medicine and Infectious Diseases Outpatient Unit of Hospital del Mar in Barcelona (Spain), in 2003. The National Cholesterol Education Program-APT III criteria for the identification of metabolic syndrome were used. Lipodystrophy was evaluated by clinical examination and classified as lipoatrophy, lipohypertrophy and mixed forms. Results. Ninety-nine percent of the 260 patients included were on antiretroviral therapy. The prevalence of metabolic syndrome was 23.5%. Based on the lipodystrophy pattern, the prevalence ranged from 15.1% in patients with isolated lipoatrophy to 35.2% in those with lipoaccumulation pattern. The only independent factor associated with the presence of metabolic syndrome among patients with lipodystrophy was body mass index (OR: 1.22; 95% CI, 1.1-1.36). Conclusions. The presence of lipoaccumulation doubles the prevalence of metabolic syndrome in HIV-infected patients with lipodystrophy. Since body mass index was the main independent predictor of metabolic syndrome in the present study, interventions aimed at lifestyle changes should be prioritized in these patients (AU)

Otitis media serosa bilateral como primera manifestación de una poliangeítis microscópica / Bilateral otitis media as presentation form of microscopic polyangiitis

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[Cardiovascular disease in HIV-infected patients on highly active antiretroviral therapy]. / Enfermedad cardiovascular sintomática en pacientes infectados por el virus de la inmunodeficiencia humana que reciben tratamiento antirretroviral de gran actividad.

BACKGROUND AND OBJECTIVE: Our goal was to assess the main characteristics of cardiovascular disease in HIV-infected patients on highly active antiretroviral therapy (HAART). PATIENTS AND METHOD: Retrospective analysis of the clinico-epidemiological characteristics of 16 HIV-infected patients treated with HAART who had suffered a cardiovascular event from a 1,459 patients' cohort. RESULTS: Clinical presentation of cardiovascular disease was an acute coronary syndrome in 12 cases, ischemic stroke in 2 and peripheral vascular disease in 2. Patients included in the study had a mean of 3.2 cardiovascular risk factors, smoking and low HDL levels being the more prevalent risk factors. Eight (50%, 95% CI, 25-75%) patients fulfilled the criteria of metabolic syndrome. The mean CD4 count was 548 x 10(6)/l. CONCLUSIONS: HIV-infected patients on HAART ha-ve a high cardiovascular risk. A strict management of modifiable risk factors must be warranted in these patients.

[Surgical treatment of atrial fibrillation and coronary artery bypass without the use of extracorporeal circulation: case report]. / Tratamiento quirúrgico de fibrilación auricular y bypass aortocoronario sin circulación extracorpórea: caso clínico.

A 71-year-old man presented stable angina due to severe coronariophaty and chronic atrial fibrillation. A radial approach for atrial fibrillation and three coronary artery bypass grafts were performed without cardiopulmonary bypass. The procedure for the arrhythmia ablation was done epicardially with a multipolar radiofrequency catheter. Intraoperatively, the patient regained normal sinus rhythm, with an uneventful postoperative course. Postoperative echocardiography demonstrated the presence of an atrial A wave.

[Partial left atriectomy in the treatment of atrial fibrillation associated with mitral valve disease]. / Auriculectomía parcial izquierda en el tratamiento de la fibrilación auricular por valvulopatía mitral.

BACKGROUND: Atrial fibrillation is frequently observed under conditions associated with atrial dilatation. Atrial size is a factor related to the genesis and maintenance of atrial fibrillation. Predictive parameters of persistence of atrial fibrillation after maze procedure are atrial size and long duration of atrial fibrillation. The aim of this study was to investigate the effects of surgical left atrial reduction in chronic atrial fibrillation by mitral valvulopathy. PATIENTS AND METHOD: nineteen patients with chronic atrial fibrillation and dilated left atrium undergoing mitral valve procedures were included in this prospective study: group I with left atrial reduction (10 patients) and group II including control (9 patients). Both groups were with similar preoperative characteristics. RESULTS: At the mean follow-up of 12 months, all the patients in group II had chronic atrial fibrillation, and 7 patients in group I showed in atrial rhythm (p < 0.003). The patients in whom atrial fibrillation continued after surgery showed left atrial area of 33.8 +/- 12.3 cm2 and a volume of 98.5 +/- 53.9 ml; and the patients with normal rhythm had a left atrial area of 24.5 +/- 5.3 cm2 and a volume 60.3 +/- 21.2 ml. CONCLUSIONS: Preliminary results indicate that surgical left atrial reduction in patients with chronic atrial fibrillation may be a mechanism implicated in the elimination of arrhythmia after surgery.

[Employment of St. Jude "silzone" valve in the surgical treatment of early prosthetic valve endocarditis: a preliminary case report and review of the literature]. / Empleo de la válvula St. Jude "Silzone" en el tratamiento quirúrgico de la endocarditis valvular protésica temprana: caso clínico preliminar y revisión de la bibliografía.

Prosthetic valve endocarditis remains as one of the most life-threatening complication of valve replacement surgery. Homografts are the valve of choice with a lower early risk of endocarditis than other valve substitutes, however they are not always available. Recently a new prosthesis has been introduced with a silver-coated sewing cuff (St. Jude Medical with Silzone coating). Silver is an antimicrobial agent that has been proven to reduce bacterial colonization. We present the case of a 48-year-old man with an early prosthetic valve endocarditis which affected an aortic stentless prosthesis. He was successfully treated with a silver-coated prosthesis. Indications for surgery and the use of this prosthesis as a valuable option in this disease entity are discussed. Although the present patient is an isolated case, the interest of this article is the encouraging result obtained with this new prosthesis for this serious complication. Moreover, the clinical experience is reduced with only a few reports in the literature.

Effect of SO2 on control of breathing in anesthetized cats.

In seven anesthetized tracheotomized cats we studied the acute respiratory effects of SO2 inhalation at different steady-state levels of arterial CO2 tension (Paco2). During room air breathing, SO2 (0.05%) addition caused a progressive reduction in tidal volume (VT) and increases in both respiratory frequency (f) and pulmonary resistance (RL). Atropine sulfate abolished the bronchoconstriction response to SO2 and thus permitted the study of the influence of SO2 on VT and f in the absence of constricted airways. Despite marked reductions in the VT VS. PaCO2 relationships with SO2 exposure after atropine, the relationship between pulmonary ventilation (VE) and PaCO2 was not signifcantly altered. This was the case since SO2 caused solely a reduction in inspiratory duration (Ti), affecting neither the mean rate of rise of inspiratory activity (i.e., VT/Ti) nor the relationship between Ti and breath duration. Thus, airways irritation with SO2 produced rapid, shallow breathing characterized by a shortening of inspiratory and total respiratory cycle times with no change in the rate of development of inspiratory activity. The findings suggest an influence exclusively concerned with the timing of inspiration. Perhaps premature onset of inspiratory activity accounts for the observed effects.