Nivel de cumplimiento vía telemática de cuestionarios relacionados con la calidad de vida en artroplastia total de rodilla / Level of response to telematic questionnaires on health related quality of life on total knee replacement

Objetivo. La realización y obtención de cuestionarios de calidad de vida relacionada con la salud por el paciente y el profesional es complicada. Actualmente, disponemos de herramientas informáticas para recoger esta información. Nuestro objetivo fue evaluar la capacidad de los pacientes intervenidos de prótesis total de rodilla para rellenar cuestionarios de calidad de vida relacionada con la salud, utilizando una plataforma telemática. Material y métodos. Fueron incluidos 98 pacientes consecutivos intervenidos de artroplastia total de rodilla. A los que aceptaron participar en el estudio se les solicitó responder, en una página web, a 2 cuestionarios de calidad de vida relacionada con la salud (SF8 y WOMAC reducido) y 3 preguntas adicionales de opinión sobre dichos cuestionarios. Resultados. Noventa y ocho pacientes (45 hombres y 53 mujeres), con una media de edad de 72,7 años. Catorce no aceptaron participar por no disponer de acceso a Internet. De los 84 pacientes que aceptaron, el 50% entró en la página web, de los cuales solamente 36 contestaron correctamente a todas las preguntas. De estos, el 80% fue ayudado por un familiar o amigo y el 22% refirió dificultades para acceder a Internet. Conclusión. La utilización de sistemas telemáticos para responder a cuestionarios de calidad de vida debe ser usada de forma cautelosa, especialmente en población de edad avanzada. Probablemente, la población a la que va dirigida no está preparada para utilizar este tipo de tecnología. Por ello, antes de diseñar cuestionarios telemáticos debemos asegurarnos de si serán debidamente cumplimentados (AU)

Questionnaires measuring health-related quality of life are difficult to perform and obtain for patients and professionals. Computerised tools are now available to collect this information. The objective of this study was to assess the ability of patients undergoing total knee replacement to fill in health-related quality-of-life questionnaires using a telematic platform. Material and methods. Ninety eight consecutive patients undergoing total knee arthroplasty were included. Participants were given an access code to enter the website where they had to respond to 2 questionnaires (SF8 and the reduced WOMAC), and 3 additional questions about the difficulty in completing the questionnaires. Results. A total of 98 patients agreed to participate: 45 males and 53 females (mean age 72.7 years). Fourteen did not agree to participate due to lack of internet access. Of the final 84 participants, 50% entered the website, and only 36 answered all questions correctly. Of the patients who answered the questionnaire, 80% were helped by a relative or friend, and 22% reported difficulty accessing internet. Conclusion. The use of telematic systems to respond to health-related quality of life questionnaires should be used cautiously, especially in elderly population. It is likely that the population they are directed at is not prepared to use this type of technology. Therefore, before designing telematics questionnaires it must be ensured that they are completed properly (AU)

Level of response to telematic questionnaires on Health Related Quality of Life on total knee replacement.

UNLABELLED: Questionnaires measuring health-related quality of life are difficult to perform and obtain for patients and professionals. Computerised tools are now available to collect this information. The objective of this study was to assess the ability of patients undergoing total knee replacement to fill in health-related quality-of-life questionnaires using a telematic platform. MATERIAL AND METHODS: Ninety eight consecutive patients undergoing total knee arthroplasty were included. Participants were given an access code to enter the website where they had to respond to 2 questionnaires (SF8 and the reduced WOMAC), and 3 additional questions about the difficulty in completing the questionnaires. RESULTS: A total of 98 patients agreed to participate: 45 males and 53 females (mean age 72.7 years). Fourteen did not agree to participate due to lack of internet access. Of the final 84 participants, 50% entered the website, and only 36 answered all questions correctly. Of the patients who answered the questionnaire, 80% were helped by a relative or friend, and 22% reported difficulty accessing internet. CONCLUSION: The use of telematic systems to respond to health-related quality of life questionnaires should be used cautiously, especially in elderly population. It is likely that the population they are directed at is not prepared to use this type of technology. Therefore, before designing telematics questionnaires it must be ensured that they are completed properly.

[Tranexamic acid in orthopedic surgery]. / Ácido tranexámico en cirugía ortopédica.

Perioperative bleeding may require blood transfusions, which are sometimes not without complications and risks, with the subsequent increase in health care costs. Among other prevention methods, treatment with tranexamic acid (ATX) has shown to be effective in reducing surgical blood loss, especially in the immediate postoperative period. In this regard, studies evaluating ATX in orthopedic surgery show that it is effective and safe when administered intravenously or intra-articularly. The usual evaluated intravenous doses range between 10mg/Kg and 20mg/kg or a fixed dose of 1g to 2g; while intra-articularly, it varies between 250 mg and 3g. ATX, as an anti-fibrinolytic has a potential thrombotic effect, thus it is contraindicated in those patients at risk or with a history of thrombosis. Its topical administration may be safer, but studies are needed to confirm this.

Estudio observacional para evaluar en el tiempo el sangrado por los drenajes de una cohorte prospectiva de pacientes intervenidos de fractura pertrocantérica de fémur / A prospective observational study to evaluate the blood loss in a cohort of patients with pertrochanteric femoral fracture

Objetivo: Evaluar la cantidad del sangrado por los drenajes en las fracturas pertrocantéricas de fémur en el tiempo, durante el postoperatorio inmediato, para saber el momento más apropiado para retirarlos. Pacientes y métodos: Estudio descriptivo, longitudinal y unicéntrico de una cohorte prospectiva de pacientes consecutivos intervenidos de fractura pertrocantérica de fémur, tratada con una osteosíntesis con tornillo y placa deslizante. Se incluyeron 100 pacientes, con edad media de 86 (DE: 8) años; el 74% fueron mujeres. En 96 casos se colocó un drenaje profundo y en 17 superficial. La variable principal fue el sangrado postoperatorio de los drenajes que se recogieron horariamente durante las tres primeras horas del postoperatorio, a las 24 y 48 horas antes de retirarlos. Resultados: El sangrado medio intraoperatorio fue de 278,1 (DE: 148,2) mL y el sangrado total medio postoperatorio de 76,2 (DE: 83,4) mL. El 74% de los pacientes sangraron durante las primeras 24 horas y el 52% lo hicieron hasta las 48 horas. Requirieron transfusión sanguínea perioperatoria 68 pacientes. Conclusión: El sangrado postoperatorio de los pacientes con fractura pertrocantérica de fémur es bajo. Tan solo unos pocos pacientes se beneficiarían del uso de drenajes, por lo que cabría evaluar el riesgo-beneficio de no utilizarlos (AU)

Objective: To evaluate the blood loss intraoperatively and through the drainages during the postoperative procedure of pertrochanteric femoral fractures, in order to know when is appropriated time to take them out. Patients and methods: A descriptive, longitudinal and unicenter study of a prospective and consecutive cohort of patients with pertrochanteric femoral fracture treated with a Dynamic Hip Screw. 100 patients were included, with a mean age 86 (DE: 8) years old; 74% were women. Deep drainages were inserted in 96 and superficial drainages in 17 cases. The principal outcome was the blood loss collected through the drainages during the first three hours of the postoperative, at 24 hours and at 48 hours. Results: The mean intraoperative blood loss was 278.1 (SD: 148.2) mL, and the mean blood loss through the drainages during the postoperative period was 76,2 (SD: 83.4) mL. Within the first postoperative 24 hours, 74% of the patients had blood losses whereas 52% did so within 48 hours. Sixty eight patients required blood transfusion. Conclusion: The main postoperative blood loss in the pertrochanteric fracture is small. A few patients can take benefit of drainages, therefore if we not use them, it would be advisable to perform a risk-benefit analysis (AU)

Pseudoaneurisma poplíteo como complicación de la artroplastia total de rodilla. Revisión y actualización bibliográfica a propósito de un caso / Popliteal pseudoaneurysm as a complication in total knee replacement. Presentation of a case and an updated literature review

Las complicaciones vasculares después de cirugía protésica de rodilla son poco frecuentes. Dentro de este grupo, el pseudoaneurisma de la arteria poplítea es todavía más raro, habiéndose reportado en la literatura unos pocos casos. Presentamos el caso de una mujer de 80 años con el diagnóstico de gonartrosis izquierda por genu varo que fue intervenida de prótesis total de rodilla y que en el postoperatorio tardío previo al alta, presentó un pseudoaneurisma de la arteria poplítea que fue tratado satisfactoriamente mediante un stent intravascular por abordaje inguinal (AU)

Vascular complications are rare after total knee arthroplasty, and popliteal pseudoaneurysms are even more so. There are few cases reported in the literature. We present a case of an 80 year-old woman with osteoarthritis of the left knee, secondary to Genu varum, who was treated with total knee arthroplasty. On the discharge day after surgery, the patient suffered a popliteal pseudoaneurysm that was successfully treated with an intravascular stent introduced by an inguinal approach (AU)

[Popliteal pseudoaneurysm as a complication in total knee replacement. Presentation of a case and an updated literature review]. / Pseudoaneurisma poplíteo como complicación de la artroplastia total de rodilla. Revisión y actualización bibliográfica a propósito de un caso.

Vascular complications are rare after total knee arthroplasty, and popliteal pseudoaneurysms are even more so. There are few cases reported in the literature. We present a case of an 80 year-old woman with osteoarthritis of the left knee, secondary to Genu varum, who was treated with total knee arthroplasty. On the discharge day after surgery, the patient suffered a popliteal pseudoaneurysm that was successfully treated with an intravascular stent introduced by an inguinal approach.

Comparison between exclusively school teacher-based and mixed school teacher and healthcare provider-based programme on basic cardiopulmonary resuscitation for secondary schools.

OBJECTIVE: To compare two teaching methodologies for PROCES (a basic cardiopulmonary resuscitation (b-CPR) programme for secondary school students): one exclusively performed by school teachers (study group) and another by a mixed team of school teachers and healthcare providers (control group). METHODS: According to their preferences, teachers chose either method and students were consequently assigned to the control or study group. All participants took a 10 multiple-choice question exam regarding b-CPR skills twice: immediately after PROCES and one year later. Eight or more correct answers was considered satisfactory learning. Results between groups were compared. Associations between satisfactory learning and some student characteristics were analysed. RESULTS: Immediately after PROCES, 442 students (219 in the study group and 223 in the control group) took the exam. The percentage of satisfactory learning was not different: 67.1% in the study group and 64.6% in the control group. Immediate satisfactory learning was related to the absence of pending subjects in the control (odds ratio (OR) 2.31, 95% CI 1.16 to 4.64) and study (OR 5.87, 95% CI 1.22 to 28.20) groups. One year later, a greater percentage of retention of b-CRP skills was detected in the study group (57.1% vs 40.6%; p = 0.01). The absence of any pending subject (OR 6.86, 95% CI 1.83 to 25.66) was independently associated with better retention in the study group, but not the control group. CONCLUSIONS: Secondary school teachers, previously trained in b-CPR, can teach these skills effectively to 14-16-year-old students using PROCES. The retention of b-CPR skills is greater with this methodology compared with a more standardised programme.

A cyclic disulfide peptide reproduces in solution the main structural features of a native antigenic site of foot-and-mouth disease virus.

A cyclic disulfide peptide corresponding to the G-H loop sequence 134-155 [replacement Tyr136 and Arg153 with Cys] of the capsid protein VP1 of foot-and-mouth disease virus (FMDV) isolate C-S8c1 was examined by proton 2D-NMR spectroscopy in water and in 25% HFIP/water. In water, NMR data supported the presence of a non-canonical turn in the central, conserved cell adhesion RGD motif and suggested the presence of a nascent helix in the C-terminal part, stabilized and slightly extended upon addition of 25% HFIP, a secondary structure stabilizing cosolvent. The formation of the C-terminal helix was evidenced by combined analysis of NOE connectivities, H alpha chemical shifts, 3JNH-H alpha coupling constants and amide temperature coefficients. Surprisingly, these global structural features of the cyclic peptide in solution show similarities to previous X-ray structure analysis of (a) a shortened linear peptide complexed with a antivirus antibody and (b) the G-H loop represented on the chemical reduced viral surface of a different serotype. Thus, even in entirely different biological environments the cyclic peptide reflect similar structural features, reinforcing the concept that this viral loop behaves as an independent structural and functional unit.

A large-scale evaluation of peptide vaccines against foot-and-mouth disease: lack of solid protection in cattle and isolation of escape mutants.

A large-scale vaccination experiment involving a total of 138 cattle was carried out to evaluate the potential of synthetic peptides as vaccines against foot-and-mouth disease. Four types of peptides representing sequences of foot-and-mouth disease virus (FMDV) C3 Argentina 85 were tested: A, which includes the G-H loop of capsid protein VP1 (site A); AT, in which a T-cell epitope has been added to site A; AC, composed of site A and the carboxy-terminal region of VP1 (site C); and ACT, in which the three previous capsid motifs are colinearly represented. Induction of neutralizing antibodies, lymphoproliferation in response to viral antigens, and protection against challenge with homologous infectious virus were examined. None of the tested peptides, at several doses and vaccination schedules, afforded protection above 40%. Protection showed limited correlation with serum neutralization activity and lymphoproliferation in response to whole virus. In 12 of 29 lesions from vaccinated cattle that were challenged with homologous virus, mutant FMDVs with amino acid substitutions at antigenic site A were identified. This finding suggests the rapid generation and selection of FMDV antigenic variants in vivo. In contrast with previous studies, this large-scale vaccination experiment with an important FMDV host reveals considerable difficulties for vaccines based on synthetic peptides to achieve the required levels of efficacy. Possible modifications of the vaccine formulations to increase protective activity are discussed.

Non-additive effects of multiple amino acid substitutions on antigen-antibody recognition.

Synthetic peptides have been used to mimic the main antigenic site of foot-and-mouth disease virus (FMDV) of serotype C and of several variant isolates. This region includes multiple continuous B cell epitopes. The effect of single amino acid replacements, individually or in combination, on antigen specificity has been evaluated using monoclonal antibodies. Quantitative enzyme immunodot assays have shown that both additive and non-additive effects of multiple replacements occur in continuous B cell epitopes, with regard to antibody recognition. Antigenically critical single replacements may be compensated by other, non-critical replacements. Thus, the role of a single amino acid on antibody recognition depends on the sequence context in the antigenic domain. The non-additive effects of multiple replacements may modulate the extent of antigenic diversification of highly variable RNA viruses, and keep viruses confined within antigenic groups by precluding linear antigenic divergence.

Studies on antigenic variability of C strains of foot-and-mouth disease virus by means of synthetic peptides and monoclonal antibodies.

Peptides representing the sequence of the immunodominant loop of foot-and-mouth disease virus strain C-S8 (YTASARGDLAHLTTTHARHLP, residues 136-156 of VP1) and of several variant viruses have been prepared by solid phase methods. In addition, five peptides with single-residue replacements at Leu147 (Ile, Nle, Val, Ala, Gly) have been synthesized. Tosyl and dinitrophenyl protections for histidine have been compared, the latter being found to give better synthetic products. The peptides have been tested in an immunodot assay against a panel of monoclonal antibodies directed towards the VP1 loop. Immunochemical results are discussed on the basis of the mobility of the region reproduced by the peptides and the nature of the side chain of residue 147.