Effects of extended oral antibiotic prophylaxis on surgical site infections after instrumented spinal fusion: a cohort study of 901 patients with a minimum follow-up of 1 year.

BACKGROUND AND PURPOSE: We aimed to determine whether an extended oral antibiotic prophylaxis protocol may reduce the rate of surgical site infection (SSI) in patients undergoing instrumented spinal fusion. PATIENTS AND METHODS: This retrospective cohort study comprise 901 consecutive patients subjected to spinal fusion between September 2011 and December 2018 with a minimum 1-year follow-up. 368 patients operated on between September 2011 and August 2014 were administered standard intravenous prophylaxis. 533 patients operated on between September 2014 and December 2018 were administered an extended protocol with 500 mg of oral cefuroxime axetil every 12 hours (clindamycin or levofloxacin in allergic individuals) until the removal of sutures. SSI was defined following the Centers for Disease Control and Prevention criteria. The association between risk factors and the incidence of SSI was evaluated by odds ratio (OR) with a multiple logistic regression model. RESULTS: The bivariate analysis showed a statistically significant association between SSI and the type of prophylaxis used ("extended"' = 1.7% vs. "standard" = 6.2%, p= 0.001), with a lower proportion of superficial SSIs with the extended regimen (0.8% vs. 4.1%, p = 0.001). The multiple logistic regression model showed an OR = 0.25 (95% confidence interval [CI] 0.10-0.53) for extended prophylaxis and an OR = 3.5 (CI 1.3-8.1) for non-beta-lactams antibiotics. CONCLUSION: Extended antibiotic prophylaxis seems to be associated with a reduction in the incidence of superficial SSI in instrumented spine surgery.

Is Mexico's population hesitant towards COVID-19 vaccines? A 2021 survey on different levels of hesitancy and its determinants.

Vaccine hesitancy is a well-known phenomenon whereby individuals in a population reject or delay being vaccinated despite having access to vaccine services. This phenomenon is especially problematic in the current context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) pandemic because vaccine hesitancy can decrease vaccination rates. In Mexico, vaccine hesitancy has been less thoroughly studied than in other countries such as the United States despite its importance and the potential impact of overlooking the problem. Understanding and effectively tackling this problem requires a more in-depth analysis of the defining characteristics of vaccination hesitancy. For this purpose, the World Health Organization's (WHO) Vaccine Hesitancy Determinants Matrix (VHDM in this study) is highly useful. In the present study, a digital survey was conducted using Google Forms to assess the level of vaccine hesitancy in the Mexican population and the vaccine determinants of the VHDM model associated with the respondents' different levels of vaccine hesitancy. The sample consisted of 1,195 people divided into four levels of vaccine hesitancy based on their answers. Tests for association were performed, identifying an association between some determinants of the VHDM model and the levels of vaccine hesitancy. Based on the analysis of the survey results, areas of opportunity for addressing COVID-19 vaccine hesitancy in Mexico were found and discussed; these included the importance of studying vaccine hesitancy as a complex and changing gradient, the high connectivity of people with high level of vaccine hesitancy to networks of people with vaccine hesitancy, the relatively high trust in physicians at all levels of vaccine hesitancy, the low trust in government authorities at high and moderate levels of vaccine hesitancy, and the strong association of the fear of suffering side effects and knowing people who have suffered them with the level of vaccine hesitancy.

Factores biológicos, socioambientales y clínico radiológicos asociados a neumonía adquirida en la comunidad en menores de 5 años en un hospital público del Perú

Introducción: La neumonía adquirida en la comunidad (NAC) es una patología inflamatoria que daña la vía respiratoria baja, generalmente de etiología infecciosa. Afecta el parénquima pulmonar, lo cual produce alteración en la hematosis alveolar y ocasiona hipoxemia progresiva. Objetivo: Determinar cómo los factores biológicos, socioambientales, clínico radiológicos y analíticos se asocian al desarrollo de NAC en menores de 5 años hospitalizados en un hospital público del Perú durante 2019. Materiales y métodos: Estudio observacional, retrospectivo, analítico, tipo casos y controles. El tamaño muestral se realizó mediante muestreo aleatorio simple, no pareado, y se obtuvieron 71 casos y 71 controles en el Servicio de Pediatría del Hospital San José durante 2019. Resultados: El sexo masculino predominó en los pacientes con NAC (54.9 %); pero no hubo asociación significativa entre este sexo y NAC (OR: 1.67 IC: 0.86-3.23, p: 0.13). Los resultados estadísticamente significativos asociados a NAC fueron lactancia materna no efectiva (OR: 6.85, IC 95 %: 3.18-14.75) y antecedente de enfermedades respiratorias (OR: 5.41, IC 95 %: 2.58-11.34). Conclusiones: Los factores biológicos, lactancia materna no efectiva y antecedente de enfermedades respiratorias se encuentran asociados a NAC en menores de 5 años.

Introduction: Community Acquired Pneumonia (CAP) is an inflammatory pathology that damages the lower respiratory tract, usually of infectious etiology. It affects the pulmonary parenchyma producing alteration in alveolar hematosis, causing progressive hypoxemia. Objective: To determine how biological, socio-environmental, clinical radiological and analytical factors are associated with the development of CAP in children under 5 years of age hospitalized in a Public Hospital in Peru during 2019. Materials and methods: Observational, retrospective, analytical, case-control study. The sample size was made by simple, untied random sampling, obtaining 71 cases and 71 controls in the Pediatrics Service of the San José Hospital during 2019. Results: The male sex predominated in patients with CAP (54.9%); but there was no significant association between this sex and NAC (OR: 1.67 CI: 0.86-3.23, p: 0.13). The statistically significant results associated with CAP were ineffective breastfeeding (OR: 6.85, 95 % CI: 3.18-14.75) and history of respiratory diseases (OR: 5.41, 95 % CI: 2.58-11.34). Conclusions: Biological factors, ineffective breastfeeding and history of respiratory diseases are associated with CAP in children under 5 years.

Refractive and aberrometric outcomes of intracorneal ring segments for keratoconus: mechanical versus femtosecond-assisted procedures.

OBJECTIVE: To compare visual, refractive, and corneal aberrometric outcomes in keratoconic eyes implanted with intracorneal ring segments (ICRS) implantation using either a mechanical or a femtosecond laser-assisted procedure. DESIGN: Retrospective, consecutive case series. PARTICIPANTS: A total of 146 consecutive eyes of 106 patients with the diagnosis of keratoconus (68 unilateral and 39 bilateral) were included. Two groups were created according to the surgical technique used for corneal tunnelization: Mechanical group (mechanical tunnelization, 63 eyes) and Femtosecond group (femtosecond laser-assisted tunnelization, 83 eyes). Intracorneal ring segments implantation was indicated because of the existence of reduced best spectacle-corrected visual acuity (BSCVA) or contact lens intolerance. METHODS: Intracorneal ring segments implantations were performed by 6 surgeons following the same protocol except for the incision location. A total of 55 eyes were implanted with Intacs (Addition Technology, Inc, Fremont, CA) and 8 eyes were implanted with KeraRings (Mediphacos, Belo Horizonte, Brazil) in the Mechanical group, and 25 eyes were implanted with Intacs and 58 eyes were implanted with KeraRings in the Femtosecond group. Mean follow-up was 10.66+/-8.20 months, ranging from 1 month to 24 months. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), BSCVA, refraction, keratometry, and root mean square (RMS) for different kinds of corneal aberrations. RESULTS: By reporting only for statistically significant changes, UCVA improved in both groups at 6 months (P< or =0.02) and BSCVA improved in the Femtosecond group (P<0.01). The refraction improved in both groups at 6 months (P< or =0.02). The cornea on average was flatter in both groups at 6 months (P<0.01). Root mean square astigmatism was reduced in the Femtosecond group (P = 0.03), but there was an increase in some higher-order aberrations (P = 0.03). Significant differences were found between the 2 groups for eyes implanted with Intacs for primary spherical aberration, coma, and other higher-order aberrations, favoring the Femtosecond group (P< or =0.01). A significant negative correlation was found between the preoperative corneal aberrations and the postoperative BSCVA in the Mechanical group (r>0.63, P< or =0.04). CONCLUSIONS: Intracorneal ring segments implantation using both mechanical and femtosecond laser-assisted procedures provide similar visual and refractive outcomes. A more limited aberrometric correction is observed for eyes with mechanical implantation. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.