Archive for December 1, 2016

Boletín sobre HIV/SIDA en la Argentina Nº 33 DICIEMBRE 2016

Ministerio de Salud de la Argentina – 102 páginas

INDICE

  1. Presentación 6
  2. Consideraciones metodológicas 8
  3. VIH y sida en Argentina 10
  4. Resumen de indicadores sobre la situación y respuesta al VIH en la Argentina 12
  5. Vigilancia de casos de infección por VIH 13
  6. Diagnóstico oportuno y tardío de la infección por VIH 24
  7. Transmisión perinatal del VIH y sífilis congénita en la Argentina 28
  8. Mortalidad por sida en provincias de la Argentina en el período 2004-2014 33
  9. Experiencias piloto de implementación del test rápido de VIH en el primer nivel de atención 37
  10. VIH y comunicación: estrategias para la prevención
  11. Jóvenes con diagnóstico reciente de VIH en el Área Metropolitana de Buenos Aires 44
  12. Prevalencia de mutaciones por resistencia en personas que comienzan el tratamiento antirretroviral
  13. Estado actual del tratamiento de la hepatitis C en la Argentina 54
  14. Algunas acciones implementadas por la Dirección de Sida y ETS en 2015 58
  1. Anexo
  2. Catálogo de materiales 87

PDF

http://www.msal.gob.ar/images/stories/bes/graficos/0000000918cnt-2016-11-30_boletin-vih-sida-2016.pdf

 

 

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December 1, 2016 at 9:28 am

Severely Obese Patients Have a Higher Risk of Infection After Direct Anterior Approach Total Hip Arthroplasty

Journal of Arthroplasty September 2016 V.31 N.9 P.162–165

Richard L. Purcell, Nancy L. Parks, Jeanine M. Gargiulo, William G. Hamilton

Background

The orthopedic literature documents that obesity can place patients at increased risk for complications. This is the first study to document the increased risk of infection in obese patients after direct anterior approach (DAA) primary total hip arthroplasty (THA).

Methods

We retrospectively evaluated 1621 consecutive primary THAs performed with a DAA. Patients were stratified by body mass index <35 kg/m2 (group 1) or ≥35 kg/m2 (group 2). Rates of postoperative infection requiring revision, superficial wound dehiscence, return to the operating room, and total wound complications were compared. There were 1417 cases in group 1 and 204 in group 2.

Results

Five cases in each group had a deep infection, resulting in a significantly higher rate in group 2 (0.35% vs 2.5%, P = .0044, relative risk = 7.1). Superficial wound dehiscence was diagnosed in 13 (0.92%) THA in group 1 and 4 (1.96%) in group 2 (P = .256). The all-cause reoperation rate was 0.92% and 3.43% in each group, respectively (P = .008). The total rate of all studied complications was 1.27% compared to 4.41% (P = .0040, relative risk = 3.5).

Conclusion

This is the first study to report on significantly increased rates of postoperative infection requiring revision in patients with body mass index ≥35 kg/m2 after anterior approach hip arthroplasty. We believe it is the combination of immune dysfunction and proximity of the anterior incision to the inguinal crease and genitalia with overlying abdominal pannus that contributes to this risk. Further studies comparing other surgical approaches in obese patients are needed to determine if this complication is truly attributable to the DAA alone.

PDF

http://www.arthroplastyjournal.org/article/S0883-5403(16)00326-0/pdf

December 1, 2016 at 8:26 am

Risk of Reinfection After Treatment of Infected Total Knee Arthroplasty

Journal of Arthroplasty September 2016 V.31 N.9 P.156–161

Adam R. Cochran, Kevin L. Ong, Edmund Lau, Michael A. Mont, Arthur L. Malkani

Background

The purpose of this study was to determine the incidence of subsequent reinfections after initial treatment of an infected total knee arthroplasty, identify risk factors leading to reinfection, and compare results among the varying treatment modalities.

Methods

A total of 1,493,924 primary TKA patients were identified from the Medicare data between October 1, 2005, and December 31, 2011. Patients who encountered periprosthetic joint infection (PJI) after TKA were identified using International Classification of Diseases, Ninth Revision, Clinical Modification code 996.66. The risk of subsequent PJI was stratified based on the first-line treatment and compared between the various first-line treatment groups.

Results

A total of 16,622 patients (1.1%) were diagnosed with PJI. The Kaplan-Meier risk of PJI was 0.77% at 1 year and 1.58% at 6 years. Age (P < .001), Charlson score (P < .001), hospital control (P < .001), race (P = .036), census region (P = .031), gender (P < .001) were identified as risk factors for PJI. Of the PJI patients, 20.8% (n = 2806) were treated with incision and drainage (I&D), 15.9% (n = 2150) treated with I&D and liner exchange, 22.7% (n = 3069) treated with 1-stage revision, 39.7% (n = 5364) treated with 2-stage revision, and 0.98% (n = 132) treated with amputation. After first-line treatment, 26% of patients with PJI had a subsequent PJI. Patients undergoing I&D as a first-line treatment had the highest risk of reinfection, with risks of 28.2% at 1 year and 43.2% at 6 years. One-stage revision patients had 33.9% greater adjusted risk of reinfection than 2-stage revision patients (P < .001).

Conclusion

Two-stage reimplantation, despite 19% recurrence, had the highest success rate. Given the higher failure rates of I&D and single-stage revisions, guidelines need to be established for their specific indications.

PDF

http://www.arthroplastyjournal.org/article/S0883-5403(16)00304-1/pdf

December 1, 2016 at 8:23 am


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