Modificación del líquido sinovial en diferentes afecciones articulares de la rodilla / Changes in synovial fluid in different knee-joint diseases

Objetivo. Analizar las modificaciones del líquido sinovial (LS) en las afecciones articulares más frecuentes de la rodilla y establecer una relación en función de su concentración. Material y métodos. Se analizaron 62 muestras de LS de rodillas con afección meniscal (32), rotura del ligamento cruzado anterior (LCA) (17) y lesión condral aislada (13). De cada muestra se realizó un estudio cuantitativo y cualitativo de las citocinas (IL-1, IL-2, IL-6, IL-10, TNF-alfa) y factores de crecimiento (IGF-1, TGF-Beta). Resultados. En la lesión del LCA, el ambiente del LS fue predominantemente anabólico e inflamatorio, con niveles elevados de IL1, IL6, significativos de TGF-Beta (p=0,02 y p=0,004), IL-10 (p=0,046 y p=0,047) y significativamente disminuidos de TNF-alfa (p=0,02 y p=0,004). En la afección condral y meniscal, predominó un ambiente catabólico, con elevación significativa del TNF-alfa y disminución significativa del TGF-Beta (p=0,02 y p=0,004). Las diferencias fueron mayores en el caso de la lesión condral aislada. Conclusión. Los cambios observados señalan que en la lesión articular, además de la alteración biomecánica, el LS influye negativamente en la homeostasis articular, variando su composición según el tipo de afección (AU)

Objective. To analyse the changes in synovial fluid (SF) in the most common knees joint diseases, and to establish a relationship according to its concentration. Material and methods. A total of 62 synovial fluids were analysed from knees with, meniscus disease (32), anterior cruciate ligament (ACL) (17) and isolated chondral injury (13). A quantitative and quality study was performed on each sample, which included cytokines IL-1, IL-2, IL-6, IL-10, TNF-alfa and growth factors, IGF-1 and TGF-Beta). Results. The SF environment in the ACL injury was mainly anabolic and inflammatory, with increased levels of IL1, IL6, significant levels of TGF-Beta (P=.02 and P=.004), IL-10 (P=.046 and P=.047) and significantly decreased levels of TNF-alfa (P=.02 and P=.004). There was mainly a catabolic environment in chondral and meniscal disease, with a significant increase in TNF-alfa and a significant decrease in TGF-Beta (P=.02 and P=.004). The differences were greater in the case of isolated chondral injury. Conclusion. The changes observed show that, as well as the biomechanical changes, the SF has a negative effect on joint homeostasis, it composition varying depending on the type of pathology (AU)

[Changes in synovial fluid in different knee-joint diseases]. / Modificación del líquido sinovial en diferentes afecciones articulares de la rodilla.

OBJECTIVE: To analyse the changes in synovial fluid (SF) in the most common knees joint diseases, and to establish a relationship according to its concentration. MATERIAL AND METHODS: A total of 62 synovial fluids were analysed from knees with, meniscus disease (32), anterior cruciate ligament (ACL) (17) and isolated chondral injury (13). A quantitative and quality study was performed on each sample, which included cytokines IL-1, IL-2, IL-6, IL-10, TNF-α, and growth factors, IGF-1 and TGF-ß). RESULTS: The SF environment in the ACL injury was mainly anabolic and inflammatory, with increased levels of IL1, IL6, significant levels of TGF-ß (P=.02 and P=.004), IL-10 (P=.046 and P=.047) and significantly decreased levels of TNF-α (P=.02 and P=.004). There was mainly a catabolic environment in chondral and meniscal disease, with a significant increase in TNF-α and a significant decrease in TGF-ß (P=.02 and P=.004). The differences were greater in the case of isolated chondral injury. CONCLUSION: The changes observed show that, as well as the biomechanical changes, the SF has a negative effect on joint homeostasis, it composition varying depending on the type of pathology.

Too fast, too soon to call it "probiotic".

Probiotics (bacteria or yeasts) were defined by the Food Agricultural Organization (FAO) and the World Health Organization (WHO) joint report as live microorganisms which when administered in adequate amounts (in food or as a dietary supplement) confer a health benefit on the host. The best-demonstrated potential clinical benefits of probiotic agents, specifically in the pediatric population, are in the prevention and management of acute diarrhea, antibiotic associated diarrhea, and evidence is mounting on their potential benefits in atopic disease, inflammatory bowel conditions, and necrotizing enterocolitis. Their beneficial effects seem to be strain specific, thus, pooling data from different strains may result in misleading conclusions. Because there was no international consensus on methodology to assess efficiency and safety of probiotics, in 2001 the FAO/WHO undertook work to compile and evaluate the scientific evidence on functional and safety aspects of probiotics. International criteria have been developed to formulate unequivocal criteria for probiotic bacterial strains and products that contain them. More recently, the European Food Safety Authority (EFSA) highlighted as critical factors for probiotic health claim submissions genetic typing, internationally recognised naming protocols and evidence of consistency in the final product.

Paraplejia por contusión lumbar / Paraplegia due to low back strain

Un traumatismo dorsal, en una columna afectada por espondilitis anquilosante (EA), debe tratarse inicialmente por defecto como una fractura y el paciente se considerará potencialmente inestable hasta que se normalicen todas las pruebas complementarias. Se expone un caso de contusión lumbar en un paciente con historia conocida de EA, que sufre un deterioro neurológico tardío y paraplejia de miembros inferiores. En este artículo queremos enfatizar el manejo inicial y las complicaciones derivadas de la enfermedad, que todo médico en la puerta de urgencias debe conocer (AU)

Dorsal injury in a spine affected by ankylosing spondylitis (AS) must be treated initially by default as a fracture and the patient will be considered potentially unstable until all supplemental investigations show normal results. We report a case of low back strain in a patient with known history of AS, suffering late neurological impairment and paraplegia of the lower limbs. This article intends to highlight the initial management and complications resulting of the disease that any physician at the emergency room should know (AU)

[Use and abuse of intravenous catheters in conventional hospital wards]. / Uso y abuso de los catéteres intravenosos en las plantas de hospitalizacion convencional.

BACKGROUND: Information regarding the use intravenous catheters (IVC) in conventional hospital units and its consequence in terms of intravenous catéter-related bacteremia (ICRB) is scarce. OBJECTIVES: To evaluate the use of IVC in patients admitted in conventional wards of a general hospital and to measure IVCRB incidence in such patients. METHODS: We evaluated during one week IVC use in adult patients admitted in 12 de Octubre Hospital and we calculated la incidence density of ICRB. RESULTS: We evaluated the clinical charts of 731 patients (284 from medical wards and 447 from surgical wards), of which 338 (46.2%) had a peripheral VC inserted and 63 (8.6%) a central IVC. Central IVC had been inserted for a mean time 11.5 days globally (CI 95% 5.57-17.42), being 28.3 in medical wards and 8.32 days in surgical wards (p = 0.2). In 27.7 % of the patients with IVC intravenous antimicrobials was the only reason for the use of such catheters in spite of adequate oral tolerance in 30 % of the patients with central IVC an specific note explaining the reason for implanting such catheter was lacking in the clinical chart. IVCRB was detected in 12/401 patients (3%). The incidence density of IVCRB in central IVC was 8.28 per 1000 catheter-days. CONCLUSIONS: There are some aspects that could be clearly improved regarding the prevention of IVCRB, mostly in the indications, the excess of time those catheters are kept implanted and in the lost chances for catheter withdrawal when switch-therapy could be performed.

Uso y abuso de los catéteres intravenosos en las plantas de hospitalizacion convencional / Use and abuse of intravenous catheters in convetntional hospitals wards

Antecedentes: Existe escasa información acerca del uso de catéteres venosos (CVs) en unidades de hospitalización convencionales y la incidencia bacteriemia relacionada con catéteres venosos (BRCV) en dichas unidades. Objetivos: Evaluar el uso de catéteres venosos (CVs) en pacientes ingresados en plantas convencionales de un hospital general y las consecuencias en términos de BRCV. Métodos: Se evaluó durante una semana el uso de catéteres venosos y la densidad de incidencia de BRCV en pacientes adultos ingresados en los servicios de hospitalización del hospital 12 de Octubre de Madrid. Resultados: Se analizaron las historias clínicas de 731 pacientes (284 en servicios médicos y 447 en servicios quirúrgicos), de los cuales 338 (46,2%) eran portadores en ese momento de un CV periférico y 63 (8,6%) de un CV central. La media de días de colocación de un CV central fue globalmente de 11,5 (IC 95% 5,57-17,42), 28,3 en los servicios médicos días y 8,32 en los servicios quirúrgicos (p = 0,2). En el 27,7% de los pacientes con CVs la única indicación para el uso de un CV fue la administración intravenosa de antibióticos a pesar de que el paciente toleraba por vía oral y en un 30% de las ocasiones no había ninguna especificación en la historia que permitiera aclarar cuál era la indicación para la colocación del CV. Se detectó BRCV en 12/401 pacientes (3%). La densidad de incidencia de BRC en CV centrales fue de 8,28 por cada 1.000 días de catéter. Conclusiones: Existen claros aspectos que deben mejorarse en cuanto a la prevención de la BRC, fundamentalmente respecto al ajuste de las indicaciones, el tiempo que permanecen los catéteres centrales implantados y, sobre todo, en cuanto a las oportunidades perdidas de retirar el catéter secuenciando la medicación a vía oral

Background: Information regarding the use intravenous catheters (IVC) in conventional hospital units and its consequence in terms of intravenous catéter-related bacteremia (ICRB) is scarce. Objectives: To evaluate the use of IVC in patients admitted in conventional wards of a general hospital and to measure IVCRB incidence in such patients. Methods: We evaluated during one week IVC use in adult patients admitted in 12 de Octubre Hospital and we calculated la incidence densitity of ICRB. Results: We evaluated the clinical charts of 731 patients (284 from medical wards and 447 from surgical wards), of which 338 (46.2%) had a peripheral VC inserted and 63 (8.6%) a central IVC. Central IVC had been inserted for a mean time 11.5 days globally (CI 95% 5.57-17.42), being 28.3 in medical wards and 8.32 days in surgical wards (p=0.2). In 27.7 % of the patients with IVC intravenous antimicrobials was the only reason for the use of such catheters in spite of adequate oral tolerance in 30 % of the patients with central IVC an specific note explaining the reason for implanting such catheter was lacking in the clinical chart. IVCRB was detected in 12/401 patients (3%). The incidence density of IVCRB in central IVC was 8.28 per 1000 catheter-days. Conclusions: There are some aspects that could be clearly improved regarding the prevention of IVCRB, mostly in the indications, the excess of time those catheters are kept implanted and in the lost chances for catheter withdrawal when switch-therapy could be performed

[Comparison of two 27-G-caliber needles for spinal anesthesia. Study of 1,555 patients]. / Comparación de dos agujas de calibre 27G para anestesia raquídea. Estudio sobre 1.555 pacientes.

OBJECTIVES: The purpose of this study was to compare two 27-gauge anesthesia needles with different points (a Whitacre-type point and a Quincke-type point) and to assess the incidences of postdural puncture headache (PDPH), puncture difficulty and failed anesthesia. MATERIAL AND METHODS: This prospective, randomized and double-blind trial enrolled 1,555 patients receiving spinal anesthesia for lower abdominal surgery. No age limits were established. A 27-gauge Whitacre-point needle was used in group I (n = 748) and a 27-gauge Quincke-point needle was used in group II (n = 774). RESULTS: The incidences of PDPH were significantly different in groups I (0.53%) and II (1.85%) (p < 0.01). Puncture was easy in 84.89% of the procedures in group I and in 78.81% in group II (p < 0.01). The number of cases in which a puncture could not be accomplished was similar in the two groups (2.41% in group I and 2.07% in group II). The number of failed anesthetic procedures was also similar (0.96% in group I and 1.45% in group II). CONCLUSIONS: When a 27-gauge Whitacre-point needle is used, fewer cases of PDPH develop and the puncture is easier to accomplish than when a Quincke-point needle is used. The number of failed anesthetic procedures is similar with both needles. Whitacre-point 27-gauge needles are preferable to Quincke-point 27-gauge needles.

Comparación de dos agujas de calibre 27G para anestesia raquídea. Estudio sobre 1.555 pacientes / Comparison of two 27-gauge needles for spinal anesthesia in 1.555 patients

OBJETIVOS: El propósito de este estudio es comparar dos agujas de anestesia espinal del mismo calibre (27G) y distinta punta (tipo Whitacrey tipo Quincke) y evaluar la incidencia de cefalea postpunción dura l (CPPD ), la dificultad de la punción y las anestesias fallidas . MATERIAL Y MÉTODOS: Estudio prospectivo, aleatorio y ciego sobre 1.555 pacientes sometidos a anestesia subaracnoidea para cirugía infraumbilical. No se establecieron límites de edad. Se dividieron en dos grupos según el tipo de aguja: Grupo I (27G con punta tipo Whitacre; n=748) y Grupo II (27G con punta tipo Quincke; n=774). RESULTADOS: La incidencia de CPPD fue del 0,53 por ciento en el Grupo I y del 1,85 por ciento en el Grupo II, diferencia estadísticamente significativa (p<0,01). En el Grupo I se registraron un 84,89 por ciento de punciones fáciles frente a un 78,81 por ciento en el Grupo II (p<0,01). No hubo diferencia significativa en cuanto a las punciones imposibles (Grupo I: 2,41 por ciento y Grupo II: 2,07 por ciento) ni en las anestesias fallidas (0,96 por ciento en el Grupo I y 1,45 por ciento en el Grupo II). CONCLUSIONES: Las agujas de calibre 27G con punta tipo Whitacre producen menos CPPD, la punción es más fácil y hay un número semejante de anestesias fallidas que con las de punta tipo Quinc ke. En el calibre 27G, las agujas con punta tipo Whitacre son preferibles a las de punta tipo Quincke (AU)