Tratamiento quirúrgico de la fractura de acetábulo con luxación posterior de cadera: análisis retrospectivo de 20 casos

Entre 1985 y 1990 fueron intervenidos en nuestro servicio 20 pacientes con fractura acetabular y luxación posterior de cadera, con edades desde 22 a 53 años, 18 (90%) eran varones. Los accidentes de tráfico fueron la causa de 18 (90%) de las lesiones. Diez (50%) presentaron lesiones asociadas de importancia. Se estudió su evolución con un seguimiento medio de 5 años (rango de 3.5 a 8.1). La fractura de pared posterior ha sido la que con mayor frecuencia se ha asociado a la luxación (50%), seguida de la transversa y de pared posterior (30%). Hemos obtenido 14 (70%) resultados satisfactorios; 2 pacientes precisaron artroplastia total a los 3 años. No se observó peor evolución en los casos de mayor edad, pero sí en aquéllos que fueron intervenidos pasadas las 3 semanas del accidente. Se comentan aspectos de la evaluación preoperatoria.Between 1985 and 1990, 20 patients aged from 22 to 53 years with fracture of the acetabulum and posterior dislocation of the femoral head were treated surgically. Eighteen (90%) were male. Eighteen (90%) of the fractures were sustained in a motor-vehicle accident. Ten (50%) patients had multiple associated injuries. The average duration of the follow-up period was 5 years (range from 3.5 to 8.1). Ten (50%) of the dislocations were associated with posterior wall fracture. We observed 14 (70%) satisfactory results; 2 patients needed a THA 3 years later. Best results were achieved with early treatment. Aspects of the preoperative evaluation are commented

Cotilos roscado y atornillado recubiertos de hidroxiapatita: estudio comparativo

Se estudian 122 cotilos recubiertos de hidroxiapatita, 45 roscados y 77 atornillados, con un seguimiento medio de 3,8 años. La valoración clínica se hizo según el protocolo de Johnston comparando el estado previo y el actual, obteniendo un 93 % de excelentes y buenos resultados en los cotilos roscados y un 83 % con los atornillados. El cotilo roscado ofreció mejores puntuaciones en las necrosis avasculares (p<0,01) y artrosis primarias (p<0,05). El resultado clínico fue mejor en la artrosis primaria que en los recambios (p<0,05) y las artropatías inflamatorias (p<0,01). No se evidenciaron aflojamientos, encontrándose como única diferencia la posición más horizontal de los implantes roscados. En el sexo masculino fue más frecuente la aparición de calcificaciones periarticulares. Se produjeron un 7% de luxaciones que se asociaron a la mayor altura del cotilo sobre la lágrima y a la menor longitud del cuello femoral por encima del trocánter menor.One hundred twenty two hidroxyapatite-coated acetabular implants, 45 threaded and 77 fixed with screws, were reviewed. The average follow-up period was 3.8 years. The results have been very encouraging, obtaining 93% of excellent and good results with threaded cups and 83 % when fixed with screws. Threaded cups had better scores for avascular necrosis (p<0.01) and primary osteoarthrosis (p<0.05). The worse results were achieved for patients with revisions and inflamatory diseases. No evidence of loosening was found. The placement of threaded cups was more horizontal. Male sex was associated with developing of heterotopic ossification. There were 7% of dislocations associated with a longes distance from the teardrop and as shorter length of the calcar from the lesser trochanter

Valor del seguimiento densitométrico en la evaluación de una prótesis total de cadera

En este estudio se ha revisado la evolución clínica, radiográfica y densitométrica de 30 Prótesis Totales de Cadera modelo Bihapro, con recubrimiento de Hidroxiapatita. Se han presentado complicaciones clínicas en 3 casos (10%). La evolución ha sido de incremento de la densidad alrededor de la prótesis en el 97% de los casos. El aumento medio de densidad fue de 1 a 1,3 (cociente hueso periprotésico/hueso normal) en el cotilo y de 1,4 a 1,5 en la zona metafisaria (áreas 1 y 7 de Gruen) del fémur. Los resultados clínicos, radiográficos y densitométricos (Sistema CADIA) han sido coincidentes en el 97% de los casos.In this study we have reviewed the clinical, radiographical and densitometric follow-up of 30 Bihapro® total hip hydroxyapatite-coated arthroplasties. There were complications in 3 cases (10%). Densitometric results showed an increase of bone density around the prosthesis in 97% of cases. The average increase in bone denstiy (periprosthetic/normal bone ratio) varied from 1 to 1.3 in the acetabulum and from 1.4 to 1.5 in the metaphysial area of the femur (Gruen's zones 1 and 7). Clinical, radiographical and densitometric results (CADIA System) exhibited a foot correlation in 97% of cases

Artroplastia total de cadera bihapro® primeros resultados

Se analizan en este trabajo 150 artroplastias totales implantadas en tres hospitales con un seguimiento de 3 a 15 meses. En todos los casos se utilizó el modelo Bihapro® fabricado en aleación de Titanio y vástago recubierto de hidroxiapatita en su porción proximal. La edad de los pacientes osciló entre los 29 y 76 años con una media de 61. Aunque el periodo de revisión es corto, los autores señalan por una parte la buena evolución clínica con escasa presencia de dolor en el muslo y por otra, en cuanto a los hallazgos radiográficos, la excelente integración ósea acetabular con áreas de osteocondensación y trabéculas en la zona metafísaria femoral.In this report we review 150 total hip arthroplasties performed in three hospitals with a follow-up of 3 to 15 months. In all cases were used the Bihapro® model made of Titanium alloy with a hidroxiapatite coated femoral component in its proximal region. The age of the patients varies from 29 to 76 years, with an average of 61 years. Although the follow-up period is short the authors show both a good clinical evolution with little thigh pain and an excelent acetabular bone integration with areas of osteocondensation and trabeculae in the femoral metaphyseal area

Sociodemographic changes and trends in the rates of new perinatal HIV diagnoses and transmission in Spain from 1997 to 2015

Background There are not enough nationwide studies on perinatal HIV transmission in connection with a combination of antiretroviral treatments in Spain. Our objectives were to study sociodemographic changes and trends in the rates of HIV diagnoses and perinatal transmission in Spain from 1997 to 2015. Methods A retrospective study using data from Spanish Paediatric HIV Network (CoRISpe) and Spanish Minimum Basic Data Set (MDBS) was performed. HIV- diagnosed children between 1997 and 2015 were selected. Sociodemographic, clinical and immunovirological data of HIV-infected children and their mothers were studied in four calendar periods (P1: 1997-2000; P2: 2001-2005; P3: 2006-2010; P4: 2011-2015). Rates of perinatal HIV diagnoses and transmission from 1997 to 2015 were calculated. Results A total of 532 HIV-infected children were included in this study. Of these children, 406 were Spanish (76.3%) and 126 immigrants (23.7%). A decrease in the number of HIV diagnoses, 203 (38.2%) children in the first (P1), 149 (28%) in the second (P2), 130 (24.4%) in the third (P3) and 50 (9.4%) in the fourth (P4) calendar periods was studied. The same decrease in the Spanish HIV-infected children (P1, 174 (46.6%), P2, 115 (30.8%), P3, 65 (17.4%) and P4, 19 (5.1%)) was monitored. However, an increase in the number of HIV diagnoses by sexual contact (P1: 0%; P2: 1.3%; P3: 4.6%; P4: 16%) was observed. The rates of new perinatal HIV diagnoses and perinatal transmission in Spanish children decreased from 0.167 to 0.005 per 100,000 inhabitants and 11.4% to 0.4% between 1997 and 2015, respectively. Conclusions A decline of perinatal HIV diagnoses and transmission was observed. However, an increase of teen-agers HIV diagnoses with sexual infection was studied. Public awareness campaigns directed to teen-agers are advisable to prevent HIV infection by sexual contact

Clinical Outcomes of a Zika Virus Mother-Child Pair Cohort in Spain

BACKGROUND: Zika virus (ZIKV) infection has been associated with congenital microcephaly and other neurodevelopmental abnormalities. There is little published research on the effect of maternal ZIKV infection in a non-endemic European region. We aimed to describe the outcomes of pregnant travelers diagnosed as ZIKV-infected in Spain, and their exposed children. METHODS: This prospective observational cohort study of nine referral hospitals enrolled pregnant women (PW) who travelled to endemic areas during their pregnancy or the two previous months, or those whose sexual partners visited endemic areas in the previous 6 months. Infants of ZIKV-infected mothers were followed for about two years. RESULTS: ZIKV infection was diagnosed in 163 PW; 112 (70%) were asymptomatic and 24 (14.7%) were confirmed cases. Among 143 infants, 14 (9.8%) had adverse outcomes during follow-up; three had a congenital Zika syndrome (CZS), and 11 other potential Zika-related outcomes. The overall incidence of CZS was 2.1% (95%CI: 0.4-6.0%), but among infants born to ZIKV-confirmed mothers, this increased to 15.8% (95%CI: 3.4-39.6%). CONCLUSIONS: A nearly 10% overall risk of neurologic and hearing adverse outcomes was found in ZIKV-exposed children born to a ZIKV-infected traveler PW. Longer-term follow-up of these children is needed to assess whether there are any later-onset manifestations

Neurocognition and quality of life after reinitiating antiretroviral therapy in children randomized to planned treatment interruption

Objective: Understanding the effects of antiretroviral treatment (ART) interruption on neurocognition and quality of life (QoL) are important for managing unplanned interruptions and planned interruptions in HIV cure research. Design: Children previously randomized to continuous (continuous ART, n=41) vs. planned treatment interruption (PTI, n=47) in the Pediatric European Network for Treatment of AIDS (PENTA) 11 study were enrolled. At study end, PTI children resumed ART. At 1 and 2 years following study end, children were assessed by the coding, symbol search and digit span subtests of Wechsler Intelligence Scale for Children (6-16 years old) or Wechsler Adult Intelligence Scale ( 6517 years old) and by Pediatrics QoL questionnaires for physical and psychological QoL. Transformed scaled scores for neurocognition and mean standardized scores for QoL were compared between arms by t-test and Mann-Whitney U test, respectively. Scores indicating clinical concern were compared (&lt;7 for neurocognition and &lt;70 for QoL tests). Results: Characteristics were similar between arms with a median age of 12.6 years, CD4 + of 830 cells/\u3bcl and HIV RNA of 1.7 log 10 copies/ml. The median cumulative ART exposure was 9.6 in continuous ART vs. 7.7 years in PTI (P=0.02). PTI children had a median of 12 months off ART and had resumed ART for 25.2 months at time of first assessment. Neurocognitive scores were similar between arms for all tests. Physical and psychological QoL scores were no different. About 40% had low neurocognitive and QoL scores indicating clinical concern. Conclusion: No differences in information processing speed, sustained attention, short-term memory and QoL functioning were observed between children previously randomized to continuous ART vs. PTI in the PENTA 11 trial

Choice of the initial antiretroviral treatment for HIV-positive individuals in the era of integrase inhibitors

BACKGROUND: We aimed to describe the most frequently prescribed initial antiretroviral therapy (ART) regimens in recent years in HIV-positive persons in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) and to investigate factors associated with the choice of each regimen. METHODS: We analyzed initial ART regimens prescribed in adults participating in CoRIS from 2014 to 2017. Only regimens prescribed in >5% of patients were considered. We used multivariable multinomial regression to estimate Relative Risk Ratios (RRRs) for the association between sociodemographic and clinical characteristics and the choice of the initial regimen. RESULTS: Among 2874 participants, abacavir(ABC)/lamivudine(3TC)/dolutegavir(DTG) was the most frequently prescribed regimen (32.1%), followed by tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/elvitegravir(EVG)/cobicistat(COBI) (14.9%), TDF/FTC/rilpivirine (RPV) (14.0%), tenofovir alafenamide (TAF)/FTC/EVG/COBI (13.7%), TDF/FTC+DTG (10.0%), TDF/FTC+darunavir/ritonavir or darunavir/cobicistat (bDRV) (9.8%) and TDF/FTC+raltegravir (RAL) (5.6%). Compared with ABC/3TC/DTG, starting TDF/FTC/RPV was less likely in patients with CD4100.000 copies/mL. TDF/FTC+DTG was more frequent in those with CD4100.000 copies/mL. TDF/FTC+RAL and TDF/FTC+bDRV were also more frequent among patients with CD4<200 cells//muL and with transmission categories other than men who have sex with men. Compared with ABC/3TC/DTG, the prescription of other initial ART regimens decreased from 2014-2015 to 2016-2017 with the exception of TDF/FTC+DTG. Differences in the choice of the initial ART regimen were observed by hospitals' location. CONCLUSIONS: The choice of initial ART regimens is consistent with Spanish guidelines' recommendations, but is also clearly influenced by physician's perception based on patient's clinical and sociodemographic variables and by the prescribing hospital location