scholarly journals Role of asymptomatic bacteriuria on early periprosthetic joint infection after Hip Hemiarthroplasty. BARIFER randomized clinical trial.

2021 ◽  
Author(s):  
Dolors Rodriguez-Pardo ◽  
María Dolores Del Toro ◽  
Laura Guio Carrión ◽  
Rosa Escudero ◽  
Marta Fernández-Sampedro ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Outcome ◽  
Joint Infection ◽  
Asymptomatic Bacteriuria ◽  
Open Label ◽  
Hip Hemiarthroplasty ◽  
Joint Infections ◽  
Fosfomycin Trometamol

Abstract Purpose: To evaluate preoperative asymptomatic bacteriuria (ASB) treatment on the reduction of early-periprosthetic joint infections (early-PJIs) after hip hemiarthroplasty (HHA) for fracture.Methods: Open-label, multicentre RCT comparing 3gr of fosfomycin-trometamol with non-treatment. A parallel follow-up cohort without ASB was established. Primary outcome: early-PJI within 3 months after HHA. Results: 594 patients enrolled (mean age 84.3years); 152(25%) with ASB (77 treated with fosfomycin and 75 controls) and 442(75%) without. ASB was not a predictor of early-PJI (OR:1.06[95%CI:0.33-3.38], p=0,9228) and its treatment did not modify early-PJI incidence (OR:1.03[95%CI:0.15-7.10], p=0.9787). Conclusions: Neither preoperative ASB nor its treatment were risk factors of early-PJI after HHA. Trial Registration: Eudra CT 2016-001108-47

Should all patients with a culture-negative periprosthetic joint infection be treated with antibiotics?

2022 ◽  
Vol 104-B (1) ◽  
pp. 183-188
Author(s):  
Maxime van Sloten ◽  
Joan Gómez-Junyent ◽  
Tristan Ferry ◽  
Nicolò Rossi ◽  
Sabine Petersdorf ◽  
...  
Keyword(s):  
Primary Outcome ◽  
Joint Infection ◽  
Recurrent Infection ◽  
Molecular Techniques ◽  
Secondary Outcome ◽  
International Consensus ◽  
Joint Infections ◽  
Causative Microorganism ◽  
Culture Negative

Aims The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld. Methods A multicentre observational study was undertaken: 1,553 acute and 1,556 chronic PJIs, diagnosed between 2013 and 2018, were retrospectively analyzed. Culture-negative PJIs were diagnosed according to the Muskuloskeletal Infection Society (MSIS), International Consensus Meeting (ICM), and European Bone and Joint Society (EBJIS) definitions. The primary outcome was recurrent infection, and the secondary outcome was removal of the prosthetic components for any indication, both during a follow-up period of two years. Results None of the acute PJIs and 70 of the chronic PJIs (4.7%) were culture-negative; a total of 36 culture-negative PJIs (51%) were treated with antibiotics, particularly those with histological signs of infection. After two years of follow-up, no recurrent infections occurred in patients in whom antibiotics were withheld. The requirement for removal of the components for any indication during follow-up was not significantly different in those who received antibiotics compared with those in whom antibiotics were withheld (7.1% vs 2.9%; p = 0.431). Conclusion When adequate methods of culture are used, the incidence of culture-negative PJIs is low. In patients with culture-negative PJI, antibiotic treatment can probably be withheld if there are no histological signs of infection. In all other patients, diagnostic efforts should be made to identify the causative microorganism by means of serology or molecular techniques. Cite this article: Bone Joint J 2022;104-B(1):183–188.

Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽  
2016 ◽  
Vol 37 (2) ◽  
pp. 130-139 ◽  
Author(s):  
Danica W. Y. Liu ◽  
A. Kate Fairweather-Schmidt ◽  
Richard Burns ◽  
Rachel M. Roberts ◽  
Kaarin J. Anstey
Keyword(s):  
Risk Factors ◽  
Well Being ◽  
Current Status ◽  
Psychological Resilience ◽  
Cross Sectional ◽  
Life Project ◽  
Resilience Factors ◽  
First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

scholarly journals Periprosthetic Joint Infection Prophylaxis in the Elderly after Hip Hemiarthroplasty in Proximal Femur Fractures: Insights and Challenges

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 429
Author(s):  
Dolors Rodríguez-Pardo ◽  
Laura Escolà-Vergé ◽  
Júlia Sellarès-Nadal ◽  
Pablo S. Corona ◽  
Benito Almirante ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Antimicrobial Prophylaxis ◽  
Joint Infection ◽  
Asymptomatic Bacteriuria ◽  
Infection Prophylaxis ◽  
Beta Lactam ◽  
Hip Hemiarthroplasty ◽  
Femur Fractures ◽  
Published Evidence ◽  
Prophylactic Measures

We review antibiotic and other prophylactic measures to prevent periprosthetic joint infection (PJI) after hip hemiarthroplasty (HHA) surgery in proximal femoral fractures (PFFs). In the absence of specific guidelines, those applied to these individuals are general prophylaxis guidelines. Cefazolin is the most widely used agent and is replaced by clindamycin or a glycopeptide in beta-lactam allergies. A personalized antibiotic scheme may be considered when colonization by a multidrug-resistant microorganism (MDRO) is suspected. Particularly in methicillin-resistant Staphylococcus aureus (MRSA) colonization or a high prevalence of MRSA-caused PJIs a glycopeptide with cefazolin is recommended. Strategies such as cutaneous decolonization of MDROs, mainly MRSA, or preoperative asymptomatic bacteriuria treatment have also been addressed with debatable results. Some areas of research are early detection protocols in MDRO colonizations by polymerase-chain-reaction (PCR), the use of alternative antimicrobial prophylaxis, and antibiotic-impregnated bone cement in HHA. Given that published evidence addressing PJI prophylactic strategies in PFFs requiring HHA is scarce, PJIs can be reduced by combining different prevention strategies after identifying individuals who will benefit from personalized prophylaxis.

Predictors of Recurrence, Progression, and Retreatment in Basilar Tip Aneurysms: A Location-Controlled Analysis

2018 ◽  
Vol 16 (4) ◽  
pp. 435-444 ◽  
Author(s):  
Isaac Josh Abecassis ◽  
Rajeev D Sen ◽  
Jason Barber ◽  
Rakshith Shetty ◽  
Cory M Kelly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Primary Outcome ◽  
Hazard Ratio ◽  
Anterior Communicating Artery ◽  
Multivariate Modeling ◽  
Ruptured Aneurysms ◽  
Endovascular Interventions ◽  
Kaplan Meier ◽  
Event Rates

Abstract BACKGROUND Endovascular treatment of intracranial aneurysms is associated with higher rates of recurrence and retreatment, though contemporary rates and risk factors for basilar tip aneurysms (BTAs) are less well-described. OBJECTIVE To characterize progression, retreatement, and retreated progression of BTAs treated with microsurgical or endovascular interventions. METHODS We retrospectively reviewed records for 141 consecutive BTA patients. We included 158 anterior communicating artery (ACoA) and 118 middle cerebral artery (MCA) aneurysms as controls. Univariate and multivariate analyses were used to calculate rates of progression (recurrence of previously obliterated aneurysms and progression of known residual aneurysm dome or neck), retreatment, and retreated progression. Kaplan–Meier analysis was used to characterize 24-mo event rates for primary outcome prediction. RESULTS Of 141 BTA patients, 62.4% were ruptured and 37.6% were unruptured. Average radiographical follow-up was 33 mo. Among ruptured aneurysms treated with clipping, there were 2 rehemorrhages due to recurrence (6.1%), and none in any other cohorts. Overall rates of progression (28.9%), retreatment (28.9%), and retreated progression (24.7%) were not significantly different between surgical and endovascular subgroups, though ruptured aneurysms had higher event rates. Multivariate modeling confirmed rupture status (P = .003, hazard ratio = 0.14) and aneurysm dome width (P = .005, hazard ratio = 1.23) as independent predictors of progression requiring retreatment. In a separate multivariate analysis with ACoA and MCA aneurysms, basilar tip location was an independent predictor of progression, retreatment, and retreated progression. CONCLUSION BTAs have higher rates of progression and retreated progression than other aneurysm locations, independent of treatment modality. Rupture status and dome width are risk factors for progression requiring retreatment.

scholarly journals Poor outcome of octogenarians admitted to ICU due to periprosthetic joint infections: a retrospective cohort study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Emre Yilmaz ◽  
Alexandra Poell ◽  
Hinnerk Baecker ◽  
Sven Frieler ◽  
Christian Waydhas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Joint Infection ◽  
Invasive Ventilation ◽  
Very Elderly ◽  
Saps Ii ◽  
Poor Outcome ◽  
Joint Infections ◽  
Saps Ii Score ◽  
The Mean

Abstract Background Even though surgical techniques and implants have evolved, periprosthetic joint infection (PJI) remains a serious complication leading to poor postoperative outcome and a high mortality. The literature is lacking in studies reporting the mortality of very elderly patients with periprosthetic joint infections, especially in cases when an intensive care unit (ICU) treatment was necessary. We therefore present the first study analyzing patients with an age 80 and higher suffering from a periprosthetic joint infection who had to be admitted to the ICU. Methods All patients aged 80 and higher who suffered from a PJI (acute and chronic) after THR or TKR and who have been admitted to the ICU have been included in this retrospective, observational, single-center study. Results A total of 57 patients met the inclusion criteria. The cohort consisted of 24 males and 33 females with a mean age of 84.49 (± 4.0) years. The mean SAPS II score was 27.05 (± 15.7), the mean CCI was 3.35 (± 2.28) and the most patient had an ASA score of 3 or higher. The PJI was located at the hip in 71.9% or at the knee in 24.6%. Two patients (3.5%) suffered from a PJI at both locations. Sixteen patients did not survive the ICU stay. Non-survivors showed significantly higher CCI (4.94 vs. 2.73; p = 0.02), higher SAPS II score (34.06 vs. 24.32; p = 0.03), significant more patients who underwent an invasive ventilation (132.7 vs. 28.1; p = 0.006) and significantly more patients who needed RRT (4.9% vs. 50%; p < 0.001). In multivariate analysis, RRT (odds ratio (OR) 15.4, CI 1.69–140.85; p = 0.015), invasive ventilation (OR 9.6, CI 1.28–71.9; p = 0.028) and CCI (OR 1.5, CI 1.004–2.12; p = 0.048) were independent risk factors for mortality. Conclusion Very elderly patients with PJI who needs to be admitted to the ICU are at risk to suffer from a poor outcome. Several risk factors including a chronic infection, high SAPS II Score, high CCI, invasive ventilation and RRT might be associated with a poor outcome.

scholarly journals Evaluating the use of benzodiazepines following recent bereavement

2001 ◽  
Vol 178 (1) ◽  
pp. 36-41 ◽  
Author(s):  
James Warner ◽  
Chris Metcalfe ◽  
Michael King
Keyword(s):  
Primary Outcome ◽  
Outcome Measure ◽  
Primary Outcome Measure ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Negative Effect ◽  
Controlled Evaluation ◽  
Current Advice

BackgroundThere is no evidence to support current advice not to use benzodiazepines after bereavement.AimsTo determine the role of benzodiazepines in the management of bereavement.MethodWe conducted a randomised, double-blind, placebo-controlled evaluation of the use of diazepam after recent bereavement. Participants were randomised to either 2 mg diazepam or identically packaged placebo up to three times daily. The primary outcome measure was the Bereavement Phenomenology Questionnaire.ResultsThirty subjects were randomised. No evidence was found of an effect of benzodiazepines on the course of the first 6 months of bereavement (estimated mean difference of combined follow-up assessments=0.3 in favour of placebo; 95% CI –6.2 to +6.7).ConclusionWe found no evidence of a positive or negative effect of benzodiazepines on the course of bereavement.

scholarly journals Risk Factors for Obesity at Age 3 in Alaskan Children, Including the Role of Beverage Consumption: Results from Alaska PRAMS 2005-2006 and Its Three-Year Follow-Up Survey, CUBS, 2008-2009

PLoS ONE ◽  
2015 ◽  
Vol 10 (3) ◽  
pp. e0118711 ◽  
Author(s):  
Janet M. Wojcicki ◽  
Margaret B. Young ◽  
Katherine A. Perham-Hester ◽  
Peter de Schweinitz ◽  
Bradford D. Gessner
Keyword(s):  
Risk Factors ◽  
Beverage Consumption

scholarly journals Role of Anti-oxidants in the Treatment of Vitiligo

2019 ◽  
Vol 17 (1) ◽  
pp. 49-57
Author(s):  
Amit Kumar ◽  
Sudha Agrawal ◽  
Tapan Kumar Dhali ◽  
Shankar Kumr Majhi
Keyword(s):  
Oxidative Stress ◽  
Placebo Group ◽  
Vitamin E ◽  
Primary Outcome ◽  
Antioxidant Supplementation ◽  
Significant Difference ◽  
Anti Oxidant ◽  
And Oxidative Stress

Introduction: The role of free radicals and oxidative damage in the pathophysiology of vitiligo has been documented in recent studies. Antioxidant supplementation has been reported to be useful in the treatment of vitiligo. Objective: To evaluate the role of oral antioxidants supplementation therapy in the treatment of vitiligo by assessing the onset of repigmentation and oxidative stress. Materials and Methods: A total of 80 cases of vitiligo randomized into two groups: antioxidant and placebo comprising 40 patients each and were followed up for 8 weeks for the assessment of onset of repigmentation of vitiliginous lesions as primary outcome.  The activities of Malondialdehyde (MDA), Vitamin C, and Vitamin E in serum and of Catalase (CAT) in erythrocytes of patients at baseline and at end of eight weeks were also assessed by using the spectrophotometric assay. Results: The onset of repigmentation was noted significantly earlier among the anti-oxidant group as compared to the placebo group (p=0.015). At the baseline, between the two groups, no significant difference was found in the different biochemical parameters. However, at the end of 2 months the level of MDA (p<0.001) was found to be significantly lower and that of Vitamin E (p<0.001) and CAT (p=0.005) was significantly higher among the anti-oxidants group as compared to the placebo group. Conclusion: Antioxidant supplementation carried a better response in terms of early onset of repigmentation and significant decrease in the oxidative stress, in the short follow up of two months.

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