Metabolic abnormalities associated with potent antiretroviral regimens including PI may revert at least partially, whereas the suppression achieved may be preserved at least at mid-term after replacing PI by nevirapine.

Routine administration of TA during total knee arthroplasty to patients without history of thromboembolic disease is associated with a 67% reduction in RBC transfusions and, in those transfused, with a reduction in the number of units administered. TA treatment was not associated with an increase in thromboembolic complications. Transfusion costs are significantly reduced.

No abstract

One-hundred seventy-two consecutive adult patients with salmonella bacteremia documented by at least one positive blood culture were prospectively evaluated over a 10-year period. Salmonella enteritidis was isolated in 121 cases (70.3%), Salmonella typhimurium in 29 (16.9%), and other Salmonella species in 22 (12.8%). Twenty-seven patients (15.7%) developed septic metastasis; 21 patients (12.2%) died of bacteremia, and 24 (16.7%) of the 144 patients who survived had at least one relapse. A logistic regression analysis selected three variables as independently influencing outcome: septic shock (P = .005), coma (P = .029), and immunosuppression (P = .04). By means of the same statistical analysis, leukopenia (a white blood cell count of < 4 x 10(9)/L) was identified as an independent risk factor for relapse (P < .0001). The possibility of salmonella bacteremia must be considered when immunosuppressed patients have fever and no obvious source of infection. Treatment with a drug active against Salmonella species is essential in this population. Patients with leukopenia should be considered as recipients of prophylaxis for relapse.

The purpose of this study was to evaluate the short-term results after performing a total knee arthroplasty (TKA) using two surgical approaches: the subvastus approach (SV) and the conventional parapatellar approach. It was hypothesized that the SV approach would achieve the best short-term benefits. This is a randomized prospective and double-blind study that includes 104 patients. Evaluations were carried out preoperatively, when discharged (5 days) at one, three, and 12 postoperative months. The SV group showed significantly better range of movement and quadriceps extensor force when discharged. Statistically significant differences were found that showed a distinct improvement in favour of the SV group at one month in terms of extensor force and according to the Barthel Index. No significant difference was found between the two groups at the 12 month evaluation. It was concluded that the SV approach offers superior short-term clinical and functional results and it was shown that this approach also offers a significant advantage to the patient in the immediate postoperative period, although these differences tend to disappear over time following TKA. We strongly recommend the SV approach in the majority of TKA.

Background Although the health-related quality of life (HRQL) for patients who are obese seems to improve after TKA, the magnitude of improvement and the associated factors remain controversial. We previously found body mass index was not associated with changes in HRQL after TKA. Questions/purposes The purposes of this secondary analysis were to determine which patient characteristics and surgical factors were associated with worse health status after TKA in patients who are severe or morbidly obese. Methods We assessed 60 patients (53 females; mean age, 70 years) 12 months after surgery. The mean number of comorbidities was 2.5. Mean lower limb anthropometric index scores were: suprapatellar, 1.6; infrapatellar, 2; and suprapatellar/infrapatellar, 1.2. Intraoperative difficulty (IOD) was Grade 0, 40%; Grade 1, 48%; and Grade 2, 12%. Ten patients (17%) had complications. We measured HRQL using the disease-specific WOMAC questionnaire. Patient characteristics (sociodemographic variables, BMI, comorbidity, lower limb anthropometry) and surgical factors (IOD, complications, postoperative medical data) were collected. Associations between WOMAC dimension scores at 12 months and patient characteristics and surgical factors were analyzed using linear regression models. Results Factors associated with worse WOMAC dimension scores in patients who were obese included the number of comorbidities, an infrapatellar index percentile less than 75, IOD Grade 2, and the number of complications after discharge. Conclusions For patients with knee osteoarthritis who were severe or morbidly obese, various lower limb anthropometric features, degree of IOD, and postoperative complications negatively influenced postoperative WOMAC scores. Level of EvidenceLevel II Prognostic Study. See Guidelines for a complete description of levels of evidence.

TT proximalization osteotomy provides satisfactory results in improving a lack of flexion and pain in patella baja post-TKR.

Identification of inexpensive and technically simple immunological tests useful in predicting the progression to AIDS in human immunodeficiency virus (HIV)-infected patients would be especially welcome in developing countries, in which 80% of the HIV-infected patients reside and health budgets are low. In the current study, we evaluated CD4 ؉ and total lymphocyte counts and the concentrations in serum of ␤ 2-microglobulin, p24 antigen, and immunoglobulin A (IgA) as predictors of disease progression in 74 Panamanian HIV-positive patients and 50 HIV-negative healthy individuals. Total lymphocyte and CD4 ؉-cell counts for AIDS patients (1,451 ؎ 811 cells/l, P < 0.001, and 238 ؎ 392 cells/l, P < 0.0001, respectively) and asymptomatic patients (2,393 ؎ 664 cells/l, P > 0.05, and 784 ؎ 475 cells/l, P < 0.001, respectively) were lower than those observed for healthy subjects (2,596 ؎ 631 cells/l and 1,120 ؎ 296 cells/l, respectively). The levels of ␤ 2-microglobulin and IgA in serum were significantly elevated in patients with AIDS (5.7 ؎ 3.6 mg/liter, P < 0.0001, and 541 ؎ 265 mg/dl, P < 0.0001, respectively) and asymptomatic infected subjects (3.4 ؎ 2.1 mg/liter, P ‫؍‬ 0.001, and 436 ؎ 216 mg/dl, P < 0.0001, respectively) compared with the levels in healthy subjects (2.2 ؎ 0.7 mg/liter and 204 ؎ 113 mg/dl, respectively). Nonstatistically significant differences (P > 0.05) for concentrations of p24 antigen between asymptomatic infected patients (29 ؎ 13 pg/ml) and AIDS patients (40 ؎ 23 pg/ml) were observed. Total lymphocyte counts of 1,750 cells/l or less, CD4 counts of 200 cells/l or less, ␤ 2-microglobulin concentrations in serum of 4 mg/liter or higher, concentrations of IgA in serum of 450 mg/dl or higher, and the presence in serum of p24 antigen were correlated with elevated risks for developing AIDS. Monitoring both total lymphocytes and ␤ 2-microglobulin identified 91% of the AIDS patients; these assays may allow reductions in the annual number of CD4 ؉-cell evaluations and the costs associated with monitoring the immune status of HIV-positive patients.