Septic Arthritis and Multifocal Osteomyelitis Caused by Capnocytophaga Canimorsus: A Case Report

Capnocytophaga; Osteomyelitis; Septic arthritisCapnocitofaga; Osteomielitis; Artritis sépticaCapnocytophaga; Osteomielitis; Artritis sèpticaMicrobiological diagnosis of chronic osteoarticular infections remains a major challenge, particularly when the clinical presentation is atypical and the pathogen is uncommon. In this unique case, Capnocytophaga canimorsus, a microorganism belonging to the oral microbiota of some domestic animals, caused septic arthritis and multifocal osteomyelitis in the long bone of a 43-year-old immunocompetent man. The patient was treated with two-stage surgery and local and systemic antibiotic therapy, and had a successful recovery. C. canimorsus should be considered as a possible etiological agent in patients with osteoarticular pathology and a history of exposure to domestic animals

Sequential repeated tibial tubercle osteotomy in a two-stage exchange strategy: a superior approach to treating a chronically infected knee arthroplasty?

Periprosthetic joint infection; Tibial tubercle osteotomy; Two-stage revision arthroplastyInfecció articular periprotèsica; Osteotomia del tubercle tibial; Artroplàstia de revisió en dues etapesInfección articular periprotésica; Osteotomía del tubérculo tibial; Artroplastia de revisión en dos tiemposPurpose Surgical approach can impact the reliability of the debridement after a chronic total knee periprosthetic joint infection (PJI), a factor of utmost importance to eradicate the infection. The most adequate knee surgical approach in cases of PJI is a matter of debate. The purpose of this study was to determine the influence of performing a tibial tubercle osteotomy (TTO) in a two-stage exchange protocol for knee PJI treatment. Methods Retrospective cohort study examining patients managed with two-stage arthroplasty due to chronic knee PJI (2010–2019). Performance and timing of the TTO were collected. Primary end-point was infection control with a minimum FU of 12 months and according to internationally accepted criteria. Correlation between TTO timing and reinfection rate was reviewed. Results Fifty-two cases were finally included. Overall success (average follow-up: 46.2 months) was 90.4%. Treatment success was significantly higher among cases addressed using TTO during the second stage (97.1% vs. 76.5%, p value 0.03). Only 4.8% of the patients relapsed after performing a sequential repeated TTO, that is, during both first and second stages, compared to 23.1% cases in which TTO was not done (p value 0.28). No complications were observed among patients in the TTO group with a significant decrease in soft tissue necrosis (p: 0.052). Conclusion Sequential repeated tibial tubercle osteotomy during a two-stage strategy is a reasonable option and offers high rates of infection control in complex cases of knee PJI with a low rate of complications.Open Access Funding provided by Universitat Autònoma de Barcelona

Sequential repeated tibial tubercle osteotomy in a two-stage exchange strategy : a superior approach to treating a chronically infected knee arthroplasty?

Surgical approach can impact the reliability of the debridement after a chronic total knee periprosthetic joint infection (PJI), a factor of utmost importance to eradicate the infection. The most adequate knee surgical approach in cases of PJI is a matter of debate. The purpose of this study was to determine the influence of performing a tibial tubercle osteotomy (TTO) in a two-stage exchange protocol for knee PJI treatment. Retrospective cohort study examining patients managed with two-stage arthroplasty due to chronic knee PJI (2010-2019). Performance and timing of the TTO were collected. Primary end-point was infection control with a minimum FU of 12 months and according to internationally accepted criteria. Correlation between TTO timing and reinfection rate was reviewed. Fifty-two cases were finally included. Overall success (average follow-up: 46.2 months) was 90.4%. Treatment success was significantly higher among cases addressed using TTO during the second stage (97.1% vs. 76.5%, pvalue 0.03). Only 4.8% of the patients relapsed after performing a sequential repeated TTO, that is, during both first and second stages, compared to 23.1% cases in which TTO was not done (p value 0.28). No complications were observed among patients in the TTO group with a significant decrease in soft tissue necrosis (p: 0.052). Sequential repeated tibial tubercle osteotomy during a two-stage strategy is a reasonable option and offers high rates of infection control in complex cases of knee PJI with a low rate of complications

Three-stage limb salvage in tibial fracture related infection with composite bone and soft-tissue defect

Altres ajuts: Acord transformatiu CRUE-CSICIntroduction: Managing critical-sized tibial defects is one of the most complex challenges orthopedic surgeons face. This is even more problematic in the presence of infection and soft-tissue loss. The purpose of this study is to describe a comprehensive three-stage surgical protocol for the reconstruction of infected tibial injuries with combined bone defects and soft-tissue loss, and report the clinical outcomes. Materials and methods: A retrospective study at a specialized limb reconstruction center identified all patients with infected tibial injuries with bone and soft-tissue loss from 2010 through 2018. Thirty-one patients were included. All cases were treated using a three-stage protocol: (1) infected limb damage control; (2) soft-tissue coverage with a vascularized or local flap; (3) definitive bone reconstruction using distraction osteogenesis principles with external fixation. Primary outcomes: limb salvage rate and infection eradication. Secondary outcomes: patient functional outcomes and satisfaction. Results: Patients in this series of chronically infected tibias had been operated upon 3.4 times on average before starting our limb salvage protocol. The mean soft-tissue and bone defect sizes were 124 cm (6-600) and 5.4 cm (1-23), respectively. A free flap was performed in 67.7% (21/31) of the cases; bone transport was the selected bone-reconstructive option in 51.7% (15/31). Local flap failure rate was 30% (3/10), with 9.5% for free flaps (2/21). Limb salvage rate was 93.5% (29/31), with infection eradicated in all salvaged limbs. ASAMI bone score: 100% good/excellent. Mean VAS score was 1.0, and ASAMI functional score was good/excellent in 86% of cases. Return-to-work rate was 83%; 86% were "very satisfied" with the treatment outcome. Conclusion: A three-stage surgical approach to treat chronically infected tibial injuries with combined bone and soft-tissue defects yields high rates of infection eradication and successful limb salvage, with favorable functional outcomes and patient satisfaction

Should all patients with a culture-negative periprosthetic joint infection be treated with antibiotics?:A multicentre observational study

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

Pedagogía Ignaciana 5. Reflexiones para un modelo educativo universitario ignaciano

Obra que reúne las ponencias presentadas en el Seminario Internacional sobre el Modelo Ignaciano Universitario, realizado en el Instituto Tecnológico y de Estudios Superiores de Occidente, del 16 al 18 de febrero de 1998. Allí se abordaron cuestiones sobre la tradición educativa de los jesuitas, los elementos esenciales de un modelo universitario de inspiración ignaciana y su praxis.ITESO, A.C

Biopsia percutánea de la interfase protésica : técnica para el aislamiento preoperatorio del microorganismo patógeno en casos de infección periprotésica crónica con aspirado articular "seco"

El objetivo de este estudio es determinar la valía diagnóstica de una biopsia de interfase protésica (BIP) preoperatoria para aislar la bacteria en casos de infección periprotésica crónica con aspirado articular "seco". Para ello se realizó una revisión retrospectiva de 24 pacientes. Los resultados de los cultivos de la BIP se compararon con los resultados de los cultivos de las muestras intraoperatorias. La sensibilidad fue de un 88,2%, la especificidad del 100%, el valor predictivo positivo del 100% y el valor predictivo negativo del 77,9%. La eficacia global fue del 91,6%. La BIP resultó una prueba efectiva.L'objectiu d'aquest estudi és determinar la vàlua diagnòstica d'una biòpsia d'interfase protèsica (BIP) preoperatòria per aïllar el bacteri en casos d'infecció periprotésica crònica amb aspirat articular "sec". Per a això es va realitzar una revisió retrospectiva de 24 pacients. Els resultats dels cultius de la BIP es van comparar amb els resultats dels cultius de les mostres intraoperatòries. La sensibilitat va ser d'un 88,2% l'especificitat del 100%, el valor predictiu positiu del 100% i el valor predictiu negatiu del 77,9%. L'eficàcia global va ser del 91,6%. La BIP va resultar una prova efectiva

Tensiones y transiciones en las relaciones internacionales

Este libro reúne 12 textos en torno a la realidad internacional con­temporánea, que se presentan a modo de reflexiones, investigacio­nes empíricas y análisis conceptuales, elaborados por académicos y egresados de la Licenciatura de Relaciones Internacionales del ITESO, en el marco de la celebración del 20 aniversario de esta espe­cialidad, que nació en 1997 con el fin de formar profesionales capa­ces de analizar el panorama mundial y de establecer puentes entre las esferas local, nacional y global, para contribuir a la construcción de una sociedad más justa y equitativa. Dividida en cuatro apartados, esta obra busca mostrar una radio­grafía del complicado entramado que enfrentan las relaciones inter­nacionales en el dinámico y desafiante entorno mundial, lo que le convierte en un material de consulta de interés para todo estudiante y profesional en la materia, así como para todo aquel lector que busque conocer mejor los elementos, el funcionamiento, las interac­ciones y transiciones de las estructuras que rigen al mundo.ITESO, A.C

TRY plant trait database – enhanced coverage and open access

Plant traits - the morphological, anatomical, physiological, biochemical and phenological characteristics of plants - determine how plants respond to environmental factors, affect other trophic levels, and influence ecosystem properties and their benefits and detriments to people. Plant trait data thus represent the basis for a vast area of research spanning from evolutionary biology, community and functional ecology, to biodiversity conservation, ecosystem and landscape management, restoration, biogeography and earth system modelling. Since its foundation in 2007, the TRY database of plant traits has grown continuously. It now provides unprecedented data coverage under an open access data policy and is the main plant trait database used by the research community worldwide. Increasingly, the TRY database also supports new frontiers of trait‐based plant research, including the identification of data gaps and the subsequent mobilization or measurement of new data. To support this development, in this article we evaluate the extent of the trait data compiled in TRY and analyse emerging patterns of data coverage and representativeness. Best species coverage is achieved for categorical traits - almost complete coverage for ‘plant growth form’. However, most traits relevant for ecology and vegetation modelling are characterized by continuous intraspecific variation and trait–environmental relationships. These traits have to be measured on individual plants in their respective environment. Despite unprecedented data coverage, we observe a humbling lack of completeness and representativeness of these continuous traits in many aspects. We, therefore, conclude that reducing data gaps and biases in the TRY database remains a key challenge and requires a coordinated approach to data mobilization and trait measurements. This can only be achieved in collaboration with other initiatives

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research