Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study

AbstractWe aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, multicentre, observational study of GN-PJI diagnosed from 2003 through to 2010 in 16 Spanish hospitals. We define failure as persistence or reappearance of the inflammatory joint signs during follow-up, leading to unplanned surgery or repeat debridement >30 days from the index surgery related death, or suppressive antimicrobial therapy. Parameters predicting failure were analysed with a Cox regression model. A total of 242 patients (33% men; median age 76 years, interquartile range (IQR) 68–81) with 242 episodes of GN-PJI were studied. The implants included 150 (62%) hip, 85 (35%) knee, five (2%) shoulder and two (1%) elbow prostheses. There were 189 (78%) acute infections. Causative microorganisms were Enterobacteriaceae in 78%, Pseudomonas spp. in 20%, and other gram-negative bacilli in 2%. Overall, 19% of isolates were ciprofloxacin resistant. DAIR was used in 174 (72%) cases, with an overall success rate of 68%, which increased to 79% after a median of 25 months' follow-up in ciprofloxacin-susceptible GN-PJIs treated with ciprofloxacin. Ciprofloxacin treatment exhibited an independent protective effect (adjusted hazard ratio (aHR) 0.23; 95% CI, 0.13–0.40; p <0.001), whereas chronic renal impairment predicted failure (aHR, 2.56; 95% CI, 1.14–5.77; p 0.0232). Our results confirm a 79% success rate in ciprofloxacin-susceptible GN-PJI treated with debridement, ciprofloxacin and implant retention. New therapeutic strategies are needed for ciprofloxacin-resistant PJI

Transient Changes in Bacterioplankton Communities Induced by the Submarine Volcanic Eruption of El Hierro (Canary Islands)

Postprint4,411

Exomorfología y anatomía de órganos vegetativos aéreos en especies de Flourensia DC. (Asteraceae) con importancia fitoquímica

El género Flourensia DC. es americano y comprende 32 especies. Son arbustos resinosos utilizados en medicina popular; poseen un potencial valor económico, por lo que, en algunas especies representantes, se han caracterizado sus compuestos químicos y determinado algunos posibles usos. En el presente trabajo, se estudió la exomorfología y anatomía de órganos vegetativos de F. hirta S. F. Blake, F. leptopoda S. F. Blake, F. niederleinii S. F. Blake y F. tortuosa Griseb., especies endémicas del centro de Argentina. Se observó que todas son similares en cuanto a la anatomía de hoja y tallo. En cuanto al estudio de la epidermis foliar, se concluye que es posible diferenciar las especies teniendo en cuenta la frecuencia estomática y la presencia de tricomas. Finalmente, las diferencias más notables se encontraron en la exomorfología foliar ya que se observó una gran variación en cuanto a la forma de las hojas y tamaño de las láminas y pecíolos. Con respecto a las estructuras secretoras, se encontraron tricomas y conductos secretores esquizógenos en las hojas y los tallos de todas las especies, las cuales serían responsables de la producción y secreción de las resinas.The genus Flourensia DC. is American and comprises 32 species. They are resiniferous shrubs used in folk medicine. As they have potential economic value, its chemical compounds have been characterized and some possible uses identified. In this work, the exomorphology and anatomy of vegetative organs of F. hirta S. F. Blake, F. leptopoda S. F. Blake, F. niederleinii S. F. Blake and F. tortuosa Griseb., endemic species from central Argentina, have been studied. All species are similar in leaf and stem anatomy. Regarding the epidermis, it is possible to differentiate the species according to the stomatal frequency and the presence of trichomes. Finally, the most remarkable differences were found in leaf exomorphology, since there was a large variation in shape and size of blades and petioles. Concerning the secretory structures, trichomes and secretory ducts were found in the leaves and stems of all species, which would be responsible for the production and secretion of the resins

7th Drug hypersensitivity meeting: part two

No abstract availabl

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Enteric methane mitigation strategies for ruminant livestock systems in the Latin America and Caribbean region: a meta-analysis.

Latin America and Caribbean (LAC) is a developing region characterized for its importance for global food security, producing 23 and 11% of the global beef and milk production, respectively. The region?s ruminant livestock sector however, is under scrutiny on environmental grounds due to its large contribution to enteric methane (CH4) emissions and influence on global climate change. Thus, the identification of effective CH4 mitigation strategies which do not compromise animal performance is urgently needed, especially in context of the Sustainable Development Goals (SDG) defined in the Paris Agreement of the United Nations. Therefore, the objectives of the current study were to: 1) collate a database of individual sheep, beef and dairy cattle records from enteric CH4 emission studies conducted in the LAC region, and 2) perform a meta-analysis to identify feasible enteric CH4 mitigation strategies, which do not compromise animal performance. After outlier?s removal, 2745 animal records (65% of the original data) from 103 studies were retained (from 2011 to 2021) in the LAC database. Potential mitigation strategies were classified into three main categories (i.e., animal breeding, dietary, and rumen manipulation) and up to three subcategories, totaling 34 evaluated strategies. A random effects model weighted by inverse variance was used (Comprehensive Meta-Analysis V3.3.070). Six strategies decreased at least one enteric CH4 metric and simultaneously increased milk yield (MY; dairy cattle) or average daily gain (ADG; beef cattle and sheep). The breed composition F1 Holstein × Gyr decreased CH4 emission per MY (CH4IMilk) while increasing MY by 99%. Adequate strategies of grazing management under continuous and rotational stocking decreased CH4 emission per ADG (CH4IGain) by 22 and 35%, while increasing ADG by 22 and 71%, respectively. Increased dietary protein concentration, and increased concentrate level through cottonseed meal inclusion, decreased CH4IMilk and CH4IGain by 10 and 20% and increased MY and ADG by 12 and 31%, respectively. Lastly, increased feeding level decreased CH4IGain by 37%, while increasing ADG by 171%. The identified effective mitigation strategies can be adopted by livestock producers according to their specific needs and aid LAC countries in achieving SDG as defined in the Paris Agreement

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified