Antonio Herrera

Perioperative intravenous iron, with or without erythropoietin, plus restrictive transfusion protocol reduce the need for allogeneic blood after knee replacement surgery

BACKGROUND:  Unilateral total knee replacement (TKR) results in a substantial blood loss and 30 to 50 percent of patients receive allogeneic blood transfusion (ABT). Therefore, the effectiveness of a restrictive transfusion trigger (hemoglobin [Hb] level < 8 g/dL) plus stimulation of erythropoiesis was evaluated, with or without blood salvage, for reducing ABT in TKR patients.

Salmonella incidence and distribution of serotypes throughout processing in a Spanish poultry slaughterhouse

A survey of contamination with Salmonella spp. was done at 11 sampling sites in a poultry slaughter establishment in Spain for a total of 192 samples. Samples included fecal material, utensils, water, and poultry carcasses and livers at several stages of processing. Salmonella incidence rates increased from 30% in fecal material collected from incoming birds to 60% in air-chilled carcasses and 80% in cold-stored livers, indicating that cross-contamination occurred. The rate of incidence of Salmonella organisms on carcasses averaged 56.7% through post-picking to post-air chilling and reached a maximum of 70% on carcasses at the post-spray wash site. Poultry livers were more heavily contaminated with salmonellae, as 55% and 80% samples after evisceration and cold storage, respectively, were positive for those pathogenic bacteria. From a total of 112 strains isolated, 87 (77.6%) were S. enteritidis , 7 (6.2%) Salmonella serotype 4,5,12:b:-(II), and 6 (5.4%) Salmonella serotype 4,12:b:-(II), and the remaining 12 strains were equally distributed among S. typhimurium . S. virchow , and S. blockley (3.6% each). Serotypes isolated from feces were later detected in matched carcasses and livers indicating a cross-contamination of carcasses by endogenous microflora in bird feces. The incidence of Salmonella serotype 4,5, 12:b:-(II) and that of S. typhimurium were significantly higher (P < 0.05) in samples obtained prior to evisceration than in those collected after that particular step. The situation with S. enteritidis was quite the reverse, since this serotype was more frequently detected in samples taken after the evisceration step (P < 0.01).

Epidemiology of osteoporotic hip fractures in Spain

We conducted a multicentre study, divided into a retrospective and a prospective portion. The retrospective study evaluated osteoporotic hip fractures that occurred during 2002. The prospective study evaluated osteoporotic hip fractures that occurred during May 2003. The study was conducted in 77 hospitals in Spain and comprised patients 60 years of age and over. In the retrospective study we registered 13,195 hip fractures. Of the patients, 74% were women and 26% were men. The mean age was 80.7±8.4 years. The average incidence was 6.94±0.44 hip fractures per 1,000 inhabitants/year (95% CI, 6.07–7.82). In the prospective study, we registered 1,399 hip fractures. This represents a monthly incidence of 0.60±0.04 hip fractures per 1,000 inhabitants/year (95% CI, 0.51–0.69). Of the subjects, 74% were women and 26% were men. The mean age was 81.4±8.1 years. Using these data, we calculated the average annual prevalence in 2003 to be 7.20 fractures per 1,000 inhabitants. Thirty-three percent had previously suffered a hip fracture. Prior to the fracture, only 18% had received medical treatment for osteoporosis. After discharge from the hospital, only 26% were receiving pharmacological treatment for osteoporosis.RésuméNous avons conduit une étude multicentrique, divisée en une portion rétrospective et une portion prospective. L’étude rétrospective a étudiée les fractures de la hanche ostéoporotique qui se sont produites pendant l’année 2002. L’étude prospective transversale a évalué les fractures de la hanche ostéoporotique qui se sont produites pendant le mois de mai 2003. L’étude a été conduite dans 77 hôpitaux en Espagne et a inclus des patients de 60 ans et plus. Dans l’étude rétrospective nous avons enregistré 13195 fractures de la hanche. 74% étaient des femmes et 26% des hommes. L’âge moyen était 80,7±8,4 années. La fréquence moyenne était 6,94±0,44 fractures de la hanche par 1000 habitants/année (95% CI, 6,07–7,82). Dans l’étude prospective, nous avons enregistré 1399 fractures de la hanche. Cela représente une fréquence mensuelle de 0,60±0,04 fractures par 1000 habitants (95% CI, 0,51–0,69). 74% étaient des femmes et 26% des hommes. L’âge moyen était 81,4±8,1 ans. Utilisant ces données, nous avons calculé la prévalence annuelle moyenne en 2003 qui est de 7,20 fractures pour 1000 habitants. 33% avaient souffert d’une fracture de la hanche précédemment. Avant la fracture, seulement 18% avaient reçu un traitement médical contre l’ostéoporose. Après l’hospitalisation , seulement 26% avaient un traitement contre l’ostéoporose.

Quality evaluation of Spanish rosemary (Rosmarinus officinalis) honey

The qualities of 27 samples of rosemary (Rosmarinus officinalis L.) honey from Aragon (Spain) was evaluated. Most samples showed a proper maturity considering the low moisture content. The low electrical conductivity and ash content were typical of pale honeys. Optical rotation was mostly levorotatory except for four samples with high sucrose content. Since the hydroxymethyl-furfural content was low and the diastase activity was high, a good freshness was estimated. The total acidity (below 40 meq/kg) indicated absence of undesirable fermentation; additionally the mean pH around 3·70 is usual in this kind of honey. The fructose/glucose ratio was 1·17 ± 0·01 and sucrose content averaged 1·97 ± 0·27%. The analysis of sediment showed a very low honeydew indication which explains the low trisaccharide content found in the samples by GC-FID quantitation.

Physicochemical attributes and pollen spectrum of some unifloral Spanish honeys

In the present work a total of 19 unifloral Spanish honeys were studied and botanically typified: willow (Salix sp.), sainfoin (Onobrychis viciifolia Scop.), chickweed (Hypecoum sp.), crucifer (Brassica type), fruiter (Prunus sp.), thyme (Thymus sp.), blueweed (Echium sp.), spike lavender (Lavandula latifolia Med.), French lavender (Lavandula stoechas L.), and vetch (Vicia sativa L.). Unifloral honeys were considered as such whenever the dominant pollen was found at over 45% of total pollen, except for lavender and thyme types of honey where a finding above 15% of Lavandula or Thymus pollen, respectively, was enough to typify them. All samples were organoleptically examined and the following determinations were carried out: moisture, optical rotation, electrical conductivity, ash, hydroxymethylfurfural, diastase activity, pH, acidity (free, lactone, and total) and carbohydrate composition. These samples were found to meet all major national and international honey specifications.

Predictive factors for cutting-out in femoral intramedullary nailing

BACKGROUND Femoral intramedullary nailing is currently one of the most frequent surgical treatments for extracapsular hip-fracture fixation. Cutting-out of the lag screw is the main complication of this technique, but only few studies have approached the cutting-out focussed on femoral nailing. The aim of this study was to confirm in patients treated with intramedullary nailing not only with regard to previous reports about the association of cutting-out with technical factors, but also with regard to clinical factors not previously studied. METHODS Case-control study of all patients sustaining a cut-out of the femoral nail was carried out and a control sample was randomly selected among all extracapsular hip-fracture patients during the study period (2005-2008). All clinical and technical variables were collected from medical records. Orthopaedic Trauma Association (AO/OTA) fracture classification, Singh Osteoporosis Index of the contralateral hip and the American Society of Anaesthesiology (ASA) criteria for preoperative clinical status were used. Statistical assessment included bivariant analysis and multivariant logistic regression analysis. RESULTS A total of 916 hip-fracture cases were treated in the study period: 33 of them (3.6%) were identified as suffering cutting-out, and 315 controls fulfilling inclusion criteria were also recruited. No statistical differences were found in age, sex or other socio-demographic variables between the two groups. Bivariant analysis showed significant differences between groups in technical variables (tip-apex distance, suboptimal placement of lag screw, fracture diastasis, inadequate fixation quality and distal static locking) and in clinical variables (osteoporosis severity, right hip affected, better previous ability for walking and better preoperative ASA status). Multivariant logistic regression analysis showed significant association only for tip-apex distance and inadequate fixation quality. Differences in distal static locking were close to statistical significance. CONCLUSIONS The strongest predictor of cutting-out in femoral nailing is tip-apex distance. This study suggests that distal static locking and other clinical conditions play an important role in this fixation failure.

Seven to 10 years followup of an anatomic hip prosthesis: an international study.

Hypothetically, hydroxyapatite-coated anatomic-shaped femoral stems and hemispheric acetabular cups should improve biologic fixation of the implant and strength transmission to the bone, improving unsatisfactory results of the first cementless hip prosthesis focused on the stress-shielding phenomenon at the femur and failure of the threaded acetabular cups. A consecutive series of 312 patients who had primary Anatomique Benoist Giraud hip prostheses unilaterally implanted were followed up. We analyzed the clinical and radiographic results and report the outcomes 7–10 years after implantation. Two hundred thirty-two patients were assessed at 7–10 years. The survival rate for the implant was 96.8%; 77.2% of patients had no pain, 72.4% maintained total mobility, and 62.9% were able to walk without restrictions. However, radiologic assessment shows that problems improved but did not disappear. More than 55% of femurs had signs of proximal stress-shielding develop. More important, substantial polyethylene wear was observed in at least 62% of the acetabular inserts at 7–10 years followup.

The treatment of proximal humerus nonunions in older patients with reverse shoulder arthroplasty

INTRODUCTION Experience with treating proximal humeral nonunions with reverse total shoulder arthroplasty is limited. We report our results. PATIENTS Eighteen patients with proximal humeral atrophic nonunion were treated with reverse total shoulder prosthesis. There were 12 women and 6 men, with a mean age of 78.8 years (range, 75-84 years). The mean follow up after reverse arthroplasty was 28 months (range, 24-32 months). Extensive proximal humeral bone loss that was found in six cases was treated adding a proximal humeral allograft. A long humeral stem was always used. RESULTS The mean Constant score increased from 26% preoperatively to 55% postoperatively (p <0.0001). The average anterior elevation increased from 35° to 90° (p<0.0001), abduction from 35° to 85° (p<0.0001), external rotation from 15° to 30° (p <0.0001) and internal rotation from 25° to 55° (p <0.0001). The average subjective shoulder score increased from 10% preoperatively to 50% postoperatively (p <0.0001). All but 4 patients would undergo the same procedure again if faced with the same problem. Eight patients were very satisfied, 6 satisfied and 4 unhappy with the operation. We had one case of transitory axillary nerve palsy and two cases of infection. Two prosthetic dislocations occurred; they were successfully treated by revision with a larger polyethylene glenosphere of 44 mm. CONCLUSIONS Reverse total shoulder arthroplasty improves function and motion in patients with proximal humeral fracture sequelae. However, the rate of dislocation is high.

Chemical composition and antimicrobial activity of essential oils of Thymus algeriensis, Eucalyptus globulus and Rosmarinus officinalis from Morocco

BACKGROUND The present study reports on the antimicrobial activity and chemical composition of the essential oils (EOs) of Thymus algeriensis, Eucalyptus globulus and Rosmarinus officinalis from Morocco. RESULTS The composition of these species was analysed by GC-MS, and 65 components were identified. Eucalyptus globulus EO showed a great similarity with EOs from other regions, with 1,8-cineole (79.85%) the major component. Also rich in this constituent was Rosmarinus officinalis (43.99%). However, the chemical profile of Thymus algeriensis was rather different, and for the first time such a high content of borneol (23.48%) has been described in this EO. The antimicrobial activity of these species has also been studied against seven pathogenic and spoiling bacteria of significant importance. According to the results, Thymus algeriensis showed the best bacteriostatic and bactericidal effect, followed by Eucalyptus globulus and Rosmarinus officinalis. CONCLUSIONS As far as we know this is the first time that minimum inhibitory and bactericidal concentration values have been reported for Eucalyptus globulus EO. Our data support the possible use of this EO as well as Thymus algeriensis EO, as potential natural agents in preservatives for food and pharmaceutical products.

High Prevalence of Multiple Resistance to Antibiotics in 144 Listeria Isolates from Spanish Dairy and Meat Products

The resistance to 12 commonly used antimicrobial agents of 144 foodborne isolates belonging to the genus Listeria (23 L. monocytogenes , 54 L. innocua , 66 L. seeligeri , and 1 L. welshimeri ) was tested by using the agar disc-diffusion assay. The Listeria strains were isolated from dairy products (different varieties of unripened fresh and bacteria-ripened hard cheeses made from ewes, cows, and goats milk) and meat products ( longaniza , a type of pork sausage). A total of 84 (93%) and 54 (100%) Listeria strains isolated from cheese and pork sausage, respectively, were resistant to multiple antimicrobial agents. More than 80% of the Listeria strains of both food origins were found to be susceptible to penicillin G and ampicillin, whereas the proportion of isolates resistant to the cephalosporins cefotaxime and cefoxitin was nearly 100%. The prevalence of resistance was much higher for isolates from pork sausage (73.8% on average) than for isolates from cheese (20.9%). This marked difference was statistically significant (P < 0.05; chi-square test) for all antibiotics except ampicillin, cefotaxime, and cefoxitin. The strains of the foodborne pathogen L. monocytogenes isolated from cheese were all susceptible to 9 of the 12 antimicrobial agents evaluated. In contrast, more than 80% of the L. monocytogenes strains isolated from pork sausage exhibited resistance to cefotaxime, cefoxitin, tobramycin, amikacin, chloramphenicol, tetracycline, and erythromycin. The appearance of substantial resistance to antibiotics in foodborne Listeria isolates suggests the need for more prudent use of antibiotics by farmers, veterinarians, and physicians.