Venous thromboembolism (VTE) developing after ankle sprain. Comparison with VTE after knee arthroplasty.

BACKGROUND: Venous thromboembolism (VTE) is a critical complication after non-major trauma or surgery. While the risk and severity of VTE following major orthopedic surgery is well-documented, there is significant knowledge gap regarding, non-major trauma such as ankle sprains. METHODS: We analyzed data from the RIETE registry to assess the clinical characteristics, VTE prophylaxis usage, and outcomes in patients with VTE following ankle sprain versus those post elective knee arthroplasty. We aimed to assess the risk and severity of VTE in a population traditionally considered at lower risk. Risk stratification was performed using the TRiP(cast) score. RESULTS: Among 1,250 patients with VTE, those with ankle sprain (n = 459) were much younger than those post knee arthroplasty (n = 791), less often female, had fewer comorbidities, and received VTE prophylaxis less often (27% vs. 93 %). During anticoagulation, 26 patients developed recurrent VTE, 31 had major bleeding, and 12 died (fatal PE 3, fatal bleeding 2). There were no differences between the two groups in the rates of VTE recurrences (rate ratio (RR): 1.65; 95%CI: 0.69-3.88) or death (RR: 1.12; 95%CI: 0.33-3.46), but patients with VTE after ankle sprain had a lower rate of major bleeding (RR: 0.39; 95%CI: 0.13-0.99). CONCLUSIONS: Ankle sprain patients are often undertreated for VTE prophylaxis and have similar severity of VTE than those undergoing elective knee surgery, indicating the need for a more customized approach to VTE management.

Characteristics, treatment patterns and outcomes of patients presenting with venous thromboembolic events after knee arthroscopy in the RIETE Registry.

Knee arthroscopy is the most common orthopedic procedure worldwide. While incidence of post-arthroscopy venous thromboembolic events (VTE) is low, treatment patterns and patient outcomes have not been described. Patients from the "Registro Informatizado Enfermedad TromboEmbolica" who had confirmed post-arthroscopy VTE were compared to patients with provoked, post bone-fracture, and to patients with unprovoked VTE. Baseline characteristics, presenting signs and symptoms, treatment and outcomes including recurrent VTE, bleeds or death were compared. A total of 101 patients with post-arthroscopy VTE and 19,218 patients with unprovoked VTE were identified. Post-arthroscopy patients were younger (49.5 vs. 66 years, P < 0.0001) and had less history of VTE [5.9% vs. 20%, OR 0.26 (0.11-0.59)]. Among patients with isolated DVT, there were fewer proximal DVT in the post-arthroscopy group [40% vs. 86%, OR 0.11 (0.06-0.19)]. Treatment duration was shorter in the post-arthroscopy group (174 ± 140 vs. 311 ± 340 days, P < 0.0001) and more often with DOAC [OR 3.67 (1.95-6.89)]. Recurrent VTE occurred in 6.18 (1.96-14.9) and 11.9 (11.0-12.8) per 100 patient years [HR 0.52 (0.16-1.26)] after treatment in the post-arthroscopy and unprovoked groups, respectively. Recurrent VTE occurred in 5.17 (1.31-14.1) per 100 patient years in a separate post bone-fracture group (n = 147), also not statistically different than the post-arthroscopy recurrence rate. After anticoagulation cessation, some patients post-knee arthroscopy develop VTE. While our small sample size precludes drawing firm conclusions, this signal should warrant further research into the optimal treatment duration for these patients, as some patients may be at increased risk for long-term recurrence.

Artritis séptica tras ligamentoplastia artroscópica de la rodilla: análisis retrospectivo de casos / Septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee: retrospective case review

INTRODUCCIÓN: La rotura de los ligamentos cruzados de la rodilla es frecuente y se repara mediante ligamentoplastia artroscópica. Entre sus complicaciones está la artritis séptica. El objetivo de este trabajo es describir las características clínicas y microbiológicas de esta entidad. MÉTODOS: Revisión retrospectiva de casos de artritis séptica tras ligamentoplastia de rodilla ocurridos en una institución durante los años 2000-2015. Según los días transcurridos desde la ligamentoplastia, la infección se consideró aguda (< 14 días), subaguda (> 14 días y < 30 días) o tardía (> 30 días). Se realizó un análisis descriptivo y comparativo, estratificado según el tipo de infección y microorganismo causante. RESULTADOS: Se intervinieron 3.219 pacientes; 30 (0,9%) desarrollaron artritis séptica. Diecisiete (57%) infecciones fueron agudas, 12 (40%) subagudas y una tardía. Los microorganismos causantes fueron Staphylococcus coagulasa-negativos (n = 13; 43%), Staphylococcus aureus (n = 12; 40%), otros cocos grampositivos (n = 3; 10%) y bacilos gramnegativos (n = 2; 7%). Se realizó desbridamiento artroscópico en todos los casos; en ninguno fue necesario retirar la plastia. Los pacientes recibieron tratamiento antibiótico durante una mediana de 23,5 días (rango, 14 - 78 días); todas las infecciones se curaron. No se evidenciaron diferencias significativas en ninguna de las variables analizadas entre el tipo de infección o el microorganismo responsable. CONCLUSIONES: La artritis séptica es una complicación poco frecuente de la ligamentoplastia de rodilla. Se manifiesta generalmente dentro de las 4 semanas después de la cirugía y está causada por Staphylococcus. El tratamiento consiste en desbridamiento artroscópico precoz (pudiendo no ser necesario retirar la plastia) y antibioterapia

INTRODUCTION: Rupture of cruciate ligaments of the knee is a common injury that is repaired by arthroscopic reconstruction, which can give rise to septic arthritis. The objective of this article is to describe the clinical and microbiological aspects of this entity. METHODS: Retrospective review of cases of septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee that occurred at a single institution from 2000-2015. According to time elapsed from surgery, infections were classified as acute (< 14 days), subacute (> 14 days and < 30 days), and late (> 30 days). A descriptive and comparative analysis stratified by type of infection and causative microorganism was performed. RESULTS: 3,219 patients underwent arthroscopic reconstruction of cruciate ligaments of the knee and 30 (0.9%) developed septic arthritis. Seventeen (57%) were acute infections and 12 (40%) subacute; there was one late infection. The causative microorganisms were coagulase-negative Staphylococci (n = 13; 43%), Staphylococcus aureus (n = 12; 40%), other grampositive cocci (n = 3; 10%), and gramnegative bacilli (n = 2; 7%). All patients underwent arthroscopic debridement; no grafts were removed. All patients received antibiotic therapy for a median of 23.5 days (range: 14 - 78 days); all infections were cured. No significant differences were found in any of the variables analysed among the infection type or the causative microorganism. CONCLUSIONS: Septic arthritis after arthroscopic reconstruction of cruciate ligaments of the knee is uncommon. It generally presents within 4 weeks of surgery and is caused by Staphylococci. Its treatment consists of arthroscopic debridement (without necessarily removing the graft) and antibiotic therapy

Septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee: retrospective case review. / Artritis séptica tras ligamentoplastia artroscópica de la rodilla: análisis retrospectivo de casos.

INTRODUCTION: Rupture of cruciate ligaments of the knee is a common injury that is repaired by arthroscopic reconstruction, which can give rise to septic arthritis. The objective of this article is to describe the clinical and microbiological aspects of this entity. METHODS: Retrospective review of cases of septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee that occurred at a single institution from 2000-2015. According to time elapsed from surgery, infections were classified as acute (< 14 days), subacute (> 14 days and<30 days), and late (> 30 days). A descriptive and comparative analysis stratified by type of infection and causative microorganism was performed. RESULTS: 3,219 patients underwent arthroscopic reconstruction of cruciate ligaments of the knee and 30 (0.9%) developed septic arthritis. Seventeen (57%) were acute infections and 12 (40%) subacute; there was one late infection. The causative microorganisms were coagulase-negative Staphylococci (n=13; 43%), Staphylococcus aureus (n=12; 40%), other grampositive cocci (n=3; 10%), and gramnegative bacilli (n=2; 7%). All patients underwent arthroscopic debridement; no grafts were removed. All patients received antibiotic therapy for a median of 23.5 days (range: 14 - 78 days); all infections were cured. No significant differences were found in any of the variables analysed among the infection type or the causative microorganism. CONCLUSIONS: Septic arthritis after arthroscopic reconstruction of cruciate ligaments of the knee is uncommon. It generally presents within 4 weeks of surgery and is caused by Staphylococci. Its treatment consists of arthroscopic debridement (without necessarily removing the graft) and antibiotic therapy.

Análisis crítico de un proyecto de investigación sobre trastornos musculoesqueléticos: lumbalgia: determinación de contingencia en una MATEPSS / Critical analysis a research Project on musculo-skeletal disorders: Low bank pain contingency asessment at one matepss

El objetivo es valorar un estudio realizado sobre la lumbalgia, su determinación de contingencia, es decir, si su origen es de etiología laboral o extralaboral, y determinar la magnitud de la lumbalgia como contingencia profesional en los trabajadores atendidos en la MATEPSS, en el año 2007, en tres provincias (Lleida, Girona y Tarragona). Se realiza un análisis del estudio descriptivo, retrospectivo y transversal. Mide variables de manera independiente, los porcentajes de casos que cursaron baja, el grupo profesional, la edad, el sexo, el mecanismo lesional, los casos derivados al sistema público de salud, así como las pruebas complementarias de imagen más frecuentes. Su utilidad está dirigida a una población similar a la estudiada. Presenta limitaciones en cuanto a la estimación de la causalidad, y del riesgo, así como la asociación entre El objetivo es valorar un estudio realizado sobre la lumbalgia, su determinación de contingencia, es decir, si su origen es de etiología laboral o extralaboral, y determinar la magnitud de la lumbalgia como contingencia profesional en los trabajadores atendidos en la MATEPSS, en el año 2007, en tres provincias (Lleida, Girona y Tarragona). Se realiza un análisis del estudio descriptivo, retrospectivo y transversal. Mide variables de manera independiente, los porcentajes de casos que cursaron baja, el grupo profesional, la edad, el sexo, el mecanismo lesional, los casos derivados al sistema público de salud, así como las pruebas complementarias de imagen más frecuentes. Su utilidad está dirigida a una población similar a la estudiada. Presenta limitaciones en cuanto a la estimación de la causalidad, y del riesgo, así como la asociación entre (AU)

The aim of the present work is to assess a study on low back pain and its contingency findings (that is, whether its origin is occupational or non-occupational), and to assess the importance of low back pain as an occupational contingency among workers seen in the year 2007 at one MATEPSS encompassing three northern Spanish provinces, namely Lérida, Gerona and Tarragona.The study analyzed was descriptive, retrospective and cross-sectional and considered, as independent variables, the percentages of cases granted sick leave, the occupational groups concerned, the age, the gender, the causative mechanism, the percentage of cases referred to the Public Health Care System, and the most commonly applied complementary image examinations. It is concluded that the study might be useful as a reference for a population similar to the studied one; it evidences limitations in the areas of causality, risk andinter-variables association estimation. Conflicts of interest may arise, though, in fact, they did not do so in this case. The results might lead to the postulation of hypotheses that might then be verified and expanded (AU)

Traumatismos menores de la extremidad inferior, enfermedad tromboembólica venosa y trombofilia / Minor trauma of the lower limbs, venous throum-boemblic disease and thrombophilia

En los pacientes con traumatismos menores de la extremidad inferior no se recomienda instaurar tromboprofilaxis de forma sistemática. Se revisaron las características clínicas y la presencia de trombofilia en estos casos. Método: Estudio retrospectivo de casos de enfermedad tromboembólica venosa tras traumatismos menores de la extremidad inferior. Resultados: Entre marzo de 2001 y marzo de 2006, se diagnosticaron 21 casos de enfermedad tromboembólica venosa tras traumatismos menores de la extremidad inferior. Veinte pacientes presentaron trombosis venosa profunda (TVP); hubo dos casos de tromboembolismo pulmonar. En 10 (71%) de los 14 pacientes que participaron en el estudio de trombofilia se encontraron alteraciones. Conclusiones: Los traumatismos menores de la extremidad inferior constituyen un factor de riesgo para el desarrollo de enfermedad tromboembólica venosa. En este tipo de traumatismos debe considerarse la posibilidad de instaurar tromboprofilaxis. El diagnóstico de trombofilia debe de tenerse en cuenta cuando se desarrolla enfermedad tromboembólica venosa tras traumatismos menores de la extremidad inferior (AU)

Background: In patients with minor trauma of the lower limbs, no systematic thrombopeophylaxis is recommended. We have reviewed the clinical features and the presence of thrombophilia in such cases. Method: Retrospective study of cases of venous thromboembolic disease after minor trauma of the lower limbs. Results: Twenty-one cases of venous thromboembolic disease following minor trauma to the lower limbs were diagnosed between March 2001 and March 2006. Twenty patients had deep venous thrombosis, with two cases of pulmonary embolism. Some abnormality was detected in 10 (71%) of the 14 patients participating in the thrombophilia study. Conclusions: Minor trauma to the lower limbs represents a risk factor for the development of venous thromboembolic disease. The possibility to initiate thromboprophylaxis should therefore be considered in this setting. Thrombophilia should be considered and ruled out when venous thromboembolic disease develops following minor trauma to the lower limbs (AU)

Síncope en el medio laboral: neurocisticercosis. A propósito de un caso / Syncope in the labour environment: neurocysticerosis. About a clinical case

Hombre de 40 años, sin antecedentes de interés, procedente de Ecuador, que reside en España desde hace 6 años y trabaja en almacenajede ultracongelados. Acude a urgencias del hospital denuestra mutua por pérdida de conocimiento, de aproximadamente10 minutos, con recuperación espontánea, sin traumatismo previo,ni pródromos, ni relajación de esfínteres. Refiere cefalea holocraneal tras episodio. En la exploración destaca bradipsiquia y desorientación parcial en tiempo. Las pruebas complementarias resultan normales y el TAC craneal muestra imágenes de fino granuladoperiventricular, lesiones quísticas con contenido cálcico intraparenquimatosasque exigen descartar eurocisticercosis. El trabajadores remitido a su hospital para completar estudio y tratamiento. Laneurocisticercosis está causada por la infección del SNC por el cisticercodel helminto intestinal Taenia solium, la parasitosis másfrecuente del SNC y primera causa de epilepsia en países endémicos.En España la prevalencia ha aumentado, debido a la poblacióninmigrante. La sintomatología es variable: crisis comiciales, cefalea,signos cerebelosos, psiquiátricos, neuroftalmológicos, síncopes conmovimientos de la cabeza. El diagnóstico se basa en epidemiología, clínica, inmunodiagnóstico y neuroimagen. El tratamiento médicode primera elección es antiparasitarios (albendazol) y medicación sintomática (esteroides, anticomiciales...). Los casos de HTIC grave requieren cirugía. Unas medidas higiénicas básicas serían la mejor prevención (AU)

We report the case of a 40-year-old man, with no significant pastmedical history, from Ecuador, who lives in Spain for 6 years andworks in frozen storage. He arrived at our hospital emergency roomfor a 10 minute-loss of consciousness, spontaneously recovered, without previous trauma, prodromos, or loss of bladder or bowels control. He reffered holocranial headache afterwards. Neurologicalexamination shows bradypsychia and disorientation to time. Theadditional tests are normal and the brain CT reveals fine granulatedcalcified periventricular lesions, suggesting neurocysticercosis. Theworker was sent to his hospital to complete the study and treatment.The neurocysticercosis is caused by a CNS infection by thecysticercus of the intestinal worm Taenia solium, which is the mostcommon CNS parasitic infection and a leading cause of epilepsy inendemic countries. In Spain the prevalence has increased becauseof the immigrant population. The symptoms are variable: convulsions,headache, cerebellar signs, psychiatric, neuroophtalmologicalssymptoms, and syncope with head movements. The diagnosisis based on epidemiological, clinical, immunological and neuroimaging findings. The first medical treatment choice is antiparasitic (albendazole) and symptomatic medications (steroids, anticonvulsivants...). Some cases of serious intracranial hypertension require surgery. Basic hygiene measures can be the best prevention (AU)

Insulin and HOMA in Spanish prepubertal children: relationship with lipid profile.

OBJECTIVE: The effects of insulin or insulin resistance on the lipid profile seem to change with age. The aim of this study was to analyze insulin levels and an insulin resistance index and to investigate the relationship between these and the lipid profile in a population-based sample of Spanish prepubertal children. METHODS: 1048 (524 boys and 524 girls) randomly selected prepubertal children were studied. Children were 6 to 8 years old with a mean age of 6.7. Plasma lipid, FFA and insulin levels were measured. The homeostatic model assessment (HOMA) was calculated as an indicator of insulin resistance. RESULTS: When analyzing percentile values of insulin, HOMA and FFA by sex, we observed that girls had significantly higher insulin concentrations than boys (except at the 10th percentile) and significantly higher FFA (except at the 90th percentile) with no significant differences between sexes for HOMA. Multivariate regression analyses showed that insulin was positively associated with glucose, triglycerides and apoB in boys but not in girls, and negatively associated with FFA in both genders. CONCLUSIONS: We report here data about the distribution of insulin in the Spanish prepubertal population. The higher levels of insulin in prepubertal girls could indicate that girls start to be more insulin resistant than boys at this age, although other manifestations of insulin resistance are not yet detectable.

Obesity in Spanish schoolchildren: relationship with lipid profile and insulin resistance.

This article reports cross-sectional data from a total of 1048 children, 6 to 8 years of age, categorized by presence or absence of obesity, who participated in a voluntary survey of cardiovascular risk factors in Spain over the period of 1998 to 2000, to establish the relationship between obesity and its metabolic consequences at this age. The prevalence of obesity and overweight were 9.4% and 15.7%, respectively, in boys and 10.5% and 18.0%, respectively, in girls. We observed that, in both sexes, obese children had higher triglycerides and lower high-density lipoprotein-cholesterol levels than non-obese children. No differences were found in plasma glucose or low-density lipoprotein-cholesterol levels between normal and obese children. However, we observed that insulin levels and the homeostasis model assessment for insulin resistance were significantly (p<0.001) higher in obese children of both sexes but that free fatty acid levels were lower in obese children than in nonobese children, with a statistical significance in girls (0.72+/-0.30 vs. 0.61+/-0.16 mEq/liter). In summary, our survey found some metabolic consequences of obesity similar to those found in adults (elevated triglycerides, insulin, and the homeostasis model assessment for insulin resistance, and lower high-density lipoprotein-cholesterol). However, other features (glucose, total cholesterol, low-density lipoprotein-cholesterol, and free fatty acid levels) were found to behave differently, indicating that the association of obesity with risk factors seems to change as the children age and may depend on the chronology of sexual maturation.