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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Septic arthritis is a joint disease that can affect one or more joints in patients of any age&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">1</span></a> It is considered a medical emergency<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">2</span></a> and&#44; despite the new diagnostic techniques&#44; the morbidity has changed little over the last 25 years&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a> In Europe&#44; the incidence is estimated to range between 2 and 6 cases per 100<span class="elsevierStyleHsp" style=""></span>000 population<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">4</span></a>&#59; this number can be multiplied by 10 among individuals with osteoarthritis or rheumatoid arthritis&#44;<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">5</span></a> those with a joint replacement&#44; older persons&#44; alcoholics&#44; diabetics&#44; immunocompromised patients&#44; individuals with skin ulcers&#44; those treated with intraarticular corticosteroids or synthetic materials<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a> and in indigenous populations&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The organisms that cause septic arthritis differ from one part of the world to another&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a> In the majority of the countries of Europe and North America&#44; a greater frequency of staphylococci and streptococci has been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">9</span></a> Gram-negative bacteria may be associated with septic arthritis in up to 20&#37; of the cases&#44; mainly when immunosuppression&#44; cancer&#44; diabetes or cirrhosis is involved&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a> The diagnosis of septic arthritis is suspected on the basis of the clinical picture &#40;joint pain&#44; functional limitation and body temperature &#62;38&#46;5<span class="elsevierStyleHsp" style=""></span>&#176;C&#41; and is confirmed by means of the gold standard&#44; that is&#44; a positive joint fluid culture&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">In Mexico and the rest of Latin America&#44; few studies have focused on septic arthritis from the perspective of comparing the major known risk factors to enable the application of this knowledge to similar geographic regions&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> compares the microorganisms and clinical factors that have been associated with them in some of these studies&#46; For the purpose of describing the medical history&#44; clinical characteristics and microorganisms involved in a group of adults with and without a diagnosis of septic arthritis&#44; we carried out a prospective comparative study in a tertiary care center in Mexico&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Materials and Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Study Population</span><p id="par0020" class="elsevierStylePara elsevierViewall">A cross-sectional&#44; descriptive analysis was conducted to study 96 adults of both sexes with suspected septic arthritis&#44; recruited among patients seeking care in a hospital-based orthopedic outpatient clinic&#44; who presented with some clinical sign of pain&#44; inflammation&#44; reddening&#44; increased warmth or reduced mobility in one or more joints&#46; The study was carried out in a tertiary care center in northeastern Mexico between January 2010 and December 2012&#46; Authorization was granted by the research ethics committee of the hospital prior to the initiation of the study&#46; All the patients provided their written informed consent before enrolling in the study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Participant Recruitment</span><p id="par0025" class="elsevierStylePara elsevierViewall">Arthrocentesis and synovial fluid culture were performed in every case&#46; Patients whose synovial fluid was considered to be contaminated or whose clinical data were incomplete were excluded&#44; as were those who did not choose to participate in the study&#46; The septic arthritis group consisted of 49 individuals whose clinical picture included at least two of the following symptoms in one or more joints&#58; increased sensitivity&#44; pain&#44; erythema or functional limitation&#44; and who were carriers of a bacterial agent isolated in culture&#46; The comparison group was made up of 47 individuals with a similar clinical picture and with a leukocyte count in synovial fluid lower than 50<span class="elsevierStyleHsp" style=""></span>000&#47;mm<span class="elsevierStyleSup">3</span>&#44; as well as absence of microorganisms in the synovial fluid&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Measurements and Case Reviews</span><p id="par0030" class="elsevierStylePara elsevierViewall">We designed a tool that comprised more than 40 variables which we obtained from the medical records and personal interviews with our patients&#46; They included demographic data relative to hospital admission and discharge&#44; known risk factors for septic arthritis &#40;injuries&#44; comorbidities and use of corticosteroids&#44; among others&#41;&#44; possible origin of the infection and clinical symptoms&#46; During the clinical evaluation&#44; synovial fluid was collected from the affected joint&#44; and was analyzed by means of Gram stain and bacterial culture&#46; The causative agent was defined as that which was reported in the results of the culture and was classified as gram-positive or gram-negative&#46; Finally&#44; the clinical and laboratory data were compared and included in the final analysis&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Declaration of Ethical Principals</span><p id="par0035" class="elsevierStylePara elsevierViewall">The study was approved by the hospital research ethics committee and we followed the research protocols established by the institution in which the study was carried out with regard to gaining access to the clinical data of the patients&#46; All of the information was obtained for the only purpose of its analysis and subsequent publication in scientific media&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical Analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">The categorical variables were expressed in terms of frequency distribution and percentages&#44; and measures of central tendency &#40;mean&#41; and variability &#40;standard deviation&#41; were used for the continuous variables&#46; The categorical variables were compared by means of Pearson&#39;s chi-square &#40;<span class="elsevierStyleItalic">&#967;</span><span class="elsevierStyleSup">2</span>&#41; and Fisher&#39;s test&#44; when the expected frequencies were less than 5&#46; Odds ratio &#40;OR&#41;&#44; estimated from 2<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2 contingency tables&#44; was utilized to identify those variables associated with septic arthritis&#46; The variables that proved to have a <span class="elsevierStyleItalic">P</span> value &#60;&#46;200 were included in a binary logistic regression model&#46; Of all the variables analyzed&#44; those with the highest <span class="elsevierStyleItalic">P</span> value were excluded from the model&#44; and logistic regression analysis was again carried out using the remaining variables&#46; This process was repeated successively&#44; and was completed when all the variables utilized in the model proved to be significant &#40;<span class="elsevierStyleItalic">P</span>&#60;&#46;05&#41;&#46; The results were expressed as OR with 95&#37; confidence intervals &#40;CI&#41;&#46; The consistency of the model was evaluated on the basis of the area under the receiver operating characteristic &#40;ROC&#41; curve&#44; and the assumptions of the model were tested by means of the calculation of residues&#46; The statistical analysis was performed using version 19 of the SPSS<span class="elsevierStyleSup">&#174;</span> statistical software package for Windows &#40;SPSS&#44; Chicago&#44; IL&#44; United States&#41;&#46; A <span class="elsevierStyleItalic">P</span> value less than or equal to &#46;05 was considered to indicate statistical significance&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Sociodemographic and Clinical Characteristics of the Sample</span><p id="par0045" class="elsevierStylePara elsevierViewall">The study group consisted of 96 individuals with a mean age of 46&#46;83<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>16&#46;68 years &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;36&#41;&#46; The diagnosis of septic arthritis was confirmed in 49 patients &#40;51&#37;&#41;&#44; whose mean age was 48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19 years&#46; In contrast&#44; those individuals without septic arthritis were relatively younger&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The incidence of septic arthritis was higher among the men &#40;69&#37;&#41;&#44; in contrast to the women&#44; in whom the prevalence observed was significantly lower &#40;31&#37;&#41;&#46; A history of joint disease &#40;injury&#44; previous surgery&#41; was recorded in 59&#37; of the patients with septic arthritis and was associated with significant risk &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>1&#46;51&#59; 95&#37; CI&#44; 1&#46;00&#8211;2&#46;26&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;04&#41;&#46; It is important to point out that there was clear evidence of a history of some joint injury that could explain the development of infection in only two cases &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>1&#46;29&#59; 95&#37; CI&#44; 0&#46;43&#8211;3&#46;84&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;67&#41;&#46; In all&#44; 39&#37; of the patients had a history of some type of rheumatic disease&#58; osteoarthritis&#44; ankylosing spondylitis or rheumatoid arthritis&#46; We observed no significant association between any of these conditions and a higher risk for septic arthritis&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">The use of corticosteroids was positively associated with the risk of developing septic arthritis &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>2&#46;84&#59; 95&#37; CI&#44; 1&#46;01&#8211;7&#46;95&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;01&#41;&#46; In contrast&#44; no significant association was observed for a history of diabetes mellitus&#44; tobacco use&#44; alcohol consumption&#44; intravenous drug use&#44; peripheral vascular disease or the presence of cancer&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">With regard to the localization of the septic arthritis&#44; in most cases&#44; a single joint was involved &#40;96&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;02&#41;&#44; there being an evident higher risk in these patients &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>3&#46;04&#59; 95&#37; CI&#44; 0&#46;85&#8211;10&#46;80&#41;&#46; Knees were the most frequently affected joints &#40;61&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;06&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The clinical signs associated with septic arthritis included&#58; swelling &#40;57&#37;&#59; OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>1&#46;65&#59; 95&#37; CI&#44; 1&#46;14&#8211;2&#46;37&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;01&#93;&#44; pain &#40;59&#37;&#59; OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>1&#46;95&#59; 95&#37; CI&#44; 1&#46;39&#8211;2&#46;75&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;001&#93; and functional limitation &#40;51&#37;&#59; OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>1&#46;81&#59; 95&#37; CI&#44; 1&#46;24&#8211;2&#46;64&#93;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;002&#41;&#46; Other manifestations that indicated a diagnosis of septic arthritis but were not statistically significant were&#58; hyperemia &#40;35&#37;&#59; OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>1&#46;35&#59; 95&#37; CI&#44; 0&#46;92&#8211;1&#46;99&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;14&#41;&#44; increased local warmth &#40;45&#37;&#59; OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>1&#46;17&#59; 95&#37; CI&#44; 0&#46;79&#8211;1&#46;74&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;41&#41; and fever &#40;20&#37;&#59; OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>1&#46;23&#59; 95&#37; CI&#44; 0&#46;66&#8211;2&#46;26&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;47&#41;&#46; The general characteristics and age ranges of the study participants with and without septic arthritis are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Clinical Laboratory Tests of Synovial Fluid</span><p id="par0070" class="elsevierStylePara elsevierViewall">Gram staining was performed in 49 cases&#59; of these&#44; 78&#37; were gram-positive &#40;95&#37; CI&#44; 65&#8211;91&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; The study of the synovial fluid identified staphylococcus as the most frequently isolated microorganism &#40;65&#37; of the cases&#59; 95&#37; CI&#44; 48&#8211;82&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; Among the cocci isolated in culture&#44; those most frequently found were <span class="elsevierStyleItalic">Staphylococcus aureus</span> &#40;<span class="elsevierStyleItalic">S&#46; aureus</span>&#41; &#40;44&#37;&#59; 95&#37; CI&#44; 27&#8211;61&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41; and <span class="elsevierStyleItalic">Staphylococcus epidermidis</span> &#40;50&#37;&#59; 95&#37; CI&#44; 33&#8211;67&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; Gram-negative bacteria were identified in few cases &#40;22&#37;&#41;&#46; Among those isolated were <span class="elsevierStyleItalic">Salmonella</span> sp&#46; &#40;4&#37;&#59; 95&#37; CI&#44; &#8722;23 to 31&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;258&#41; and <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> &#40;4&#37;&#59; 95&#37; CI&#44; &#8722;23 to 31&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;258&#41;&#46; Other bacteria isolated either alone or in combination with those mentioned above included&#58; <span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span>&#44; <span class="elsevierStyleItalic">Enterococcus faecalis</span>&#44; <span class="elsevierStyleItalic">Escherichia coli</span>&#44; <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&#44; <span class="elsevierStyleItalic">Actinomyces</span> sp&#46; and <span class="elsevierStyleItalic">Chryseobacterium indologenes</span>&#46; None of our patients had septic arthritis due to <span class="elsevierStyleItalic">Neisseria gonorrhoeae&#46;</span> The results of the bacteriological analysis of the joint fluid collected from the patients with septic arthritis are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Binary Logistic Regression Analysis</span><p id="par0075" class="elsevierStylePara elsevierViewall">Binary logistic regression analysis was performed in those variables in which the initial univariate analysis demonstrated some significant association with the diagnosis of septic arthritis&#46; Thus&#44; from the statistical point of view&#44; the final model identified the presence of previous joint disease &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>2&#46;33&#59; 95&#37; CI&#44; 1&#46;03&#8211;5&#46;29&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;04&#41; and osteoarthritis &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>25&#46;04&#59; 95&#37; CI&#44; 1&#46;30&#8211;481&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;03&#41; as risk factors for the development of septic arthritis&#46; Among the background features described&#44; the use of corticosteroids persisted as a risk factor for the development of septic arthritis &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>5&#46;25&#59; 95&#37; CI&#44; 1&#46;37&#8211;20&#46;06&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;01&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Likewise&#44; the involvement in the disease of a single joint &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>3&#46;21&#59; 95&#37; CI&#44; 0&#46;53&#8211;19&#46;31&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;02&#41; was associated with the diagnosis of septic arthritis&#46; Finally&#44; with respect to the clinical signs&#44; the presence of pain &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>5&#46;79&#59; 95&#37; CI&#44; 1&#46;95&#8211;17&#46;20&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;002&#41; and functional limitation &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>8&#46;54&#59; 95&#37; CI&#44; 1&#46;01&#8211;72&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;04&#41; were shown to be predictors associated with the diagnosis of septic arthritis&#46; In contrast&#44; swelling &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>13&#46;16&#59; 95&#37; CI&#44; 0&#46;87&#8211;198&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;06&#41; was associated with borderline risk&#46; The results of the binary logistic regression analysis in relation to the clinical signs&#44; comorbidities and location of the septic arthritis can be found in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Discussion</span><p id="par0085" class="elsevierStylePara elsevierViewall">For the purpose of describing the clinical characteristics&#44; microorganisms involved and comorbidities in a group of adults with septic arthritis&#44; we reviewed the cases of acute arthritis in a tertiary care center in northeastern Mexico&#46; A total of 96 patients in whom septic arthritis was suspected were studied&#46; Ultimately&#44; 49 cases were confirmed and were included as cases that were positive for septic arthritis&#44; and the remainder&#44; as a comparison group&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">At the present time&#44; it is increasingly common to find cases of polyarticular septic arthritis associated with rheumatoid arthritis&#44; chronic diseases&#44; antimicrobial resistance&#44; aging or immunosuppression&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">3&#44;11</span></a> However&#44; similar to the findings reported by other authors&#44;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">12</span></a> the majority of the cases in this study involved a single joint&#44; with the knee occupying first place&#46; A number of hypotheses have been proposed to explain this fact&#59; however&#44; the one most widely accepted is associated with hematogenous spread or the proximity of bacteria that penetrate the articular fluid because of the absence of a basement membrane in the synovial tissue following a knee injury or lesion&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">13</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Among the clinical and epidemiological factors associated with the development of bacterial septic arthritis&#44; we mentioned age&#44; as up to 40&#37; of the cases occur in adults over the age of 60 years&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a> Among the risk factors that increase the probability of diagnosing an acute joint inflammation such as septic arthritis&#44; those that are always included are age&#44; history of diabetes mellitus&#44; rheumatoid arthritis&#44; recent joint surgery&#44; joint replacement &#40;synthetic material&#41; and skin infection&#44; among others&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">15</span></a></p><p id="par0100" class="elsevierStylePara elsevierViewall">Although gender has been reported to be a factor of higher risk for certain specific types of septic arthritis&#44; this aspect cannot be generalized&#46; The majority of the individuals with septic arthritis in this study were men&#44; a finding similar to those reported in previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">Another important factor in the development of septic arthritis is a history of an underlying rheumatic disease &#40;lupus&#44; osteoarthritis&#44; rheumatoid arthritis or gout&#41;&#44; principally in cases of polyarticular arthritis&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">17</span></a> In our study group&#44; 13&#37; of the cases were associated with osteoarthritis and 20&#37; with rheumatoid arthritis&#46; Binary logistic regression analysis revealed a statistically significant association for the presence of osteoarthritis&#46; It has been pointed out that osteoarthritis&#44; together with injuries&#44;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">18</span></a> are a frequent cause of septic arthritis in patients over the age of 50 years&#44;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">19</span></a> and more so if they are associated with the presence of autoimmune diseases&#44;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">20</span></a> drug use and corticosteroids&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">18</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">Among the background features&#44; the use of corticosteroids has been shown to be an important risk factor for the development of septic arthritis&#46; We should not overlook the fact that the use of corticosteroids was established in previous studies and our patients were no exception&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">21</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The etiology and clinical characteristics of septic arthritis are not easy to study&#44; especially because it is difficult to establish an accurate bacteriological diagnosis in a large number of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">22</span></a> The culture of the joint fluid is the gold standard for the diagnosis of infectious arthritis&#44; with a sensitivity that ranges from 75&#37; to 97&#37;&#46;<a class="elsevierStyleCrossRefs" href="#bib0305"><span class="elsevierStyleSup">23&#8211;25</span></a> In this respect&#44; the microbiological pattern of septic arthritis has not changed much&#44; and in recent decades&#44; the majority of the researchers continue to highlight <span class="elsevierStyleItalic">S&#46; aureus</span> and <span class="elsevierStyleItalic">Streptococcus</span> as the major causative agents&#44;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">3&#44;16</span></a> mainly because bacterial colonization is favored when there is tissue damage&#44; which exposes the synovial membrane to contamination&#46;<a class="elsevierStyleCrossRefs" href="#bib0320"><span class="elsevierStyleSup">26&#44;27</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In most hospitals&#44; the evaluation of an inflamed joint can be carried out in a simple manner&#44; with the examination of the synovial fluid&#44; looking for crystals and bacteria&#44; using a Gram stain&#44; which has a sensitivity of nearly 60&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">28</span></a> In this study&#44; 78&#37; of the participants had a positive Gram stain which pointed to the diagnosis and made it possible to start antibiotic therapy in a timely fashion&#46; This is the policy in the center in which we work&#44; committed to the Mexican Guidelines for the Prevention&#44; Diagnosis and Treatment of Acute Septic Arthritis in Children and Adults &#40;IMSS-368-10&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">29</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">As reported by other authors&#44; staphylococci and streptococci were the infectious agents most frequently isolated&#46;<a class="elsevierStyleCrossRef" href="#bib0340"><span class="elsevierStyleSup">30</span></a> There was little presence of gram-negative bacteria&#44; as agents of that type were detected in only four cases&#46; There was a notable absence of cases of gonococcal arthritis&#44; in contrast to the situation reported in North America and Australia&#44; where it is a common cause of septic arthritis in young adults&#46;<a class="elsevierStyleCrossRefs" href="#bib0300"><span class="elsevierStyleSup">22&#44;23</span></a> In contrast&#44; in European countries&#44; the incidence is very low&#44; similar to the findings in our series&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> As a possible explanation for this circumstance&#44; Hook et al&#46; proposed the existence of variations in the capacity of <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> to cause joint damage in different geographical regions of the world&#44; a hypothesis that has not yet been confirmed by any study&#46;<a class="elsevierStyleCrossRefs" href="#bib0270"><span class="elsevierStyleSup">16&#44;22&#44;31</span></a> Recently&#44; Oppegaard et al&#46;<a class="elsevierStyleCrossRef" href="#bib0350"><span class="elsevierStyleSup">32</span></a> have reported the high specificity &#40;98&#37;&#41; of CD64 and procalcitonin for the diagnosis of infectious diseases&#44; including septic arthritis&#46; As yet we have no experience in this regard in our setting and the possibility of including these diagnostic tests among others that could be utilized for the analysis of septic arthritis remains open&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">A detailed clinical history and well performed physical examination are sufficient to awaken the suspicion of septic arthritis within the first 3 days of onset of symptoms in the majority of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">33</span></a> In this respect&#44; swelling&#44; the presence of pain and functional limitation were the most prevalent clinical signs in our population and&#44; in the logistic regression model&#44; were clinical manifestations that enabled us to reach the diagnosis&#46; Eder et al&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a> and&#44; somewhat later&#44; Margaretten et al&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a> reported pain to be a consistent symptom in up to 85&#37; of the patients with septic arthritis&#46; However&#44; the individual differences in pain threshold can influence the final diagnosis&#46; This was made clearer in a study performed by Burgos-Vargas et al&#46; in 1210 patients with septic arthritis in which the objective was to predict the diagnosis of septic arthritis using a multivariate analysis that included pain &#40;scored according to a visual analog scale&#41;&#44; functional disability and the use of nonsteroidal anti-inflammatory drugs&#46; At the end of the study&#44; the diagnosis was based on a pain score of 5&#46;2 or higher out of 10 possible points &#40;maximum pain&#41;<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">34</span></a>&#59; thus&#44; the authors conclude that&#44; during the clinical evaluation of a painful&#44; inflamed joint&#44; a thorough analysis of all the signs in the inflamed joint would point toward the diagnosis and make it possible to rule out other possible causes of nonseptic arthritis&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Functional limitation continues to be a relevant clinical sign in septic arthritis&#46; Our study found a prevalence of 51&#37;&#59; previous studies report values that range from 10&#37; to 73&#37;&#44; in which the patient characteristics&#44; type of bacterium&#44; a correct and timely diagnosis and the treatment received had a direct influence on its development&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">16</span></a> Logistic regression analysis revealed a significant increase in the risk for swelling and functional limitation as important factors in the diagnosis of septic arthritis&#46; This information agrees with the idea that the finding of a swollen&#44; inflamed&#44; reddened and overly warm joint is reason enough to include septic arthritis in the differential diagnosis of a joint disease&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">3</span></a> In our results&#44; we observed no significant differences for the increase in the local temperature or hyperthermia&#44; a fact that could be more due to the samples size of our study population than to a lack of statistical association&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">In the case of fever&#44; Margaretten et al&#46; report that it has a low sensitivity &#40;57&#37;&#41; for the diagnosis of septic arthritis<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a>&#59; consequently&#44; it is considered to be a symptom of low specificity for the majority of conditions involving joints&#46;<a class="elsevierStyleCrossRefs" href="#bib0365"><span class="elsevierStyleSup">35&#8211;37</span></a></p><p id="par0145" class="elsevierStylePara elsevierViewall">Finally&#44; synovial biopsy is known to be of no use in the diagnosis of acute bacterial arthritis&#59; however&#44; when an unclear diagnosis is suspected&#44; it is common for the physician to perform a biopsy in cases of chronicity of the inflammatory signs&#44; and in agreement with the clinical history of the patient in cases of amyloidosis&#44; sarcoidosis or suspected metastatic tumors&#46;<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a> In our center&#44; it is performed only in patients who do not respond to medical treatment&#44; when there is some doubt concerning the diagnosis or chronicity of the clinical picture&#44; as we mentioned above&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">This study has a number of limitations&#58; it was carried out in a single center&#44; the sample size&#44; the cross-sectional &#40;but not prospective&#41; design&#44; the fact that it was not possible to perform a cytological analysis of the synovial fluid in every case&#44; an analysis was not done with additional tests for other diseases associated with septic arthritis in the group of individuals with negative bacterial culture&#44; it was not possible to carry out a follow-up of the treatment and of the complications because many patients were lost to follow-up in our center when they returned to the municipalities from which they had been referred&#46; However&#44; the exclusion of synovial fluids considered to be contaminated and the methodology utilized allow us to suppose that the number of cases studied is representative of the region and that the findings can be applied to other areas or hospitals in which the population is similar&#46; Moreover&#44; it lends support to the results of previous studies in terms of the risk factors and clinical characteristics of septic arthritis&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">In conclusion&#44; as has been reported by other researchers&#44; the most common clinical presentation of septic arthritis continues to be monoarthritis of the knee&#44; associated with gram-positive bacteria&#44; in which evidence of an inflamed&#44; reddened and overly warm joint is reason enough to consider this diagnosis&#46; Additional prospective studies will be required to further evaluate the course&#44; treatment and complications of septic arthritis in Mexican patients&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Ethical Disclosures</span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Protection of human and animal subjects</span><p id="par0160" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Confidentiality of data</span><p id="par0165" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their work center on the publication of patient data&#46;</p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Right to privacy and informed consent</span><p id="par0170" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Conflicts of Interest</span><p id="par0175" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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          "titulo" => "Abstract"
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          "titulo" => "Resumen"
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              "titulo" => "Study Population"
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              "titulo" => "Participant Recruitment"
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              "titulo" => "Measurements and Case Reviews"
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              "titulo" => "Sociodemographic and Clinical Characteristics of the Sample"
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              "titulo" => "Clinical Laboratory Tests of Synovial Fluid"
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              "titulo" => "Binary Logistic Regression Analysis"
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              "titulo" => "Confidentiality of data"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2014-04-03"
    "fechaAceptado" => "2015-02-20"
    "PalabrasClave" => array:2 [
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          "clase" => "keyword"
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            0 => "Arthritis"
            1 => "Septic"
            2 => "Joints"
            3 => "Synovial fluid"
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          "palabras" => array:4 [
            0 => "Artritis"
            1 => "S&#233;ptico"
            2 => "Articulaciones"
            3 => "L&#237;quido sinovial"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To describe the history&#44; clinical features and microorganisms involved in a group of adult subjects with and without septic arthritis &#40;SA&#41; at a tertiary care in Mexico&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A cross-sectional descriptive study was conducted on 96 adults with clinical suspicion of AS in one or more joints&#46; In all cases synovial fluid arthrocentesis and culture was performed&#46; The comparison group subjects were culture negative&#46; A descriptive statistical analysis and binary logistic regression model was performed between the variables associated with the development of AS&#46; A value of <span class="elsevierStyleItalic">P</span>&#8804;&#46;05 was significant&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A total of 49 out of 96 subjects had a positive culture&#44; mostly of the monoarticular type &#40;96&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;02&#41;&#46; The knee was the most common site &#40;61&#37;&#59; <span class="elsevierStyleItalic">P</span>&#61;&#46;06&#41; and pain was the main clinical manifestation &#40;59&#37;&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;001&#41;&#46; Staphylococcus was the most common etiological agent &#40;65&#37;&#59; <span class="elsevierStyleItalic">P</span>&#60;&#46;001&#41;&#46; The risk factors revealed in the final regression model were SA the history of joint disease &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>25&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;03&#41; and volume increase &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>13&#46;16&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;06&#41;&#46; Functional limitation &#40;OR<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>8&#46;54&#59; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleMonospace">&#61;</span>&#46;04&#41; showed a significant risk among borderline for SA&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Our results are consistent with previous studies&#44; and can be generalized to geographical areas with similar clinical features to those observed in this study&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
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          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Describir los antecedentes&#44; caracter&#237;sticas cl&#237;nicas y microorganismos implicados en un grupo de sujetos adultos con y sin artritis s&#233;ptica &#40;AS&#41; en un centro de tercer nivel de atenci&#243;n en M&#233;xico&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Dise&#241;o descriptivo&#44; de tipo transversal anal&#237;tico en 96 adultos con sospecha cl&#237;nica de AS en una o m&#225;s articulaciones&#46; En todos los casos se realiz&#243; artrocentesis y cultivo de l&#237;quido sinovial&#46; El grupo de comparaci&#243;n fueron sujetos con cultivo negativo&#46; Un an&#225;lisis con estad&#237;stica descriptiva y un modelo con regresi&#243;n log&#237;stica binaria se realiz&#243; entre las variables asociadas al desarrollo de AS&#46; Un valor de p&#8804;0&#44;05 fue significativo&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Un total de 49&#47;96 sujetos tuvieron cultivo positivo&#44; la mayor&#237;a del tipo monoarticular &#40;96&#37;&#59; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;02&#41;&#44; principalmente la rodilla &#40;61&#37;&#59; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;06&#41;&#46; Las manifestaciones cl&#237;nicas incluyeron&#58; aumento de volumen &#40;57&#37;&#59; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;01&#41;&#44; dolor &#40;59&#37;&#59; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;001&#41; y limitaci&#243;n de la funci&#243;n &#40;51&#37;&#59; p<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; El estafilococo fue el agente etiol&#243;gico m&#225;s com&#250;n &#40;65&#37;&#59; p&#60;0&#44;001&#41;&#46; El modelo de regresi&#243;n final revel&#243; como factores de riesgo para AS el antecedente de enfermedad articular &#40;RM<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>2&#44;33&#41;&#44; osteoartritis &#40;RM<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>25&#44;04&#41; y uso de corticoides &#40;RM<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>5&#44;25&#41;&#46; Cl&#237;nicamente&#44; el aumento de volumen &#40;RM<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>13&#44;16&#41;&#44; el dolor &#40;RM<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>5&#44;79&#41; y la limitaci&#243;n funcional &#40;RM<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleMonospace">&#61;</span><span class="elsevierStyleHsp" style=""></span>8&#44;54&#41; se mostraron con un riesgo entre lim&#237;trofe y significativo para AS&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Nuestros resultados son congruentes con estudios previos y pueden generalizarse a zonas geogr&#225;ficas con caracter&#237;sticas cl&#237;nicas similares a las observadas en este estudio&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0035">Please cite this article as&#58; Ornelas-Aguirre JM&#46; Artritis s&#233;ptica en un centro de adultos de tercer nivel de atenci&#243;n&#46; Reumatol Clin&#46; 2016&#59;12&#58;27&#8211;33&#46;</p>"
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">HIV&#44; human immunodeficiency virus&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Authors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Country&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; of participants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Microorganisms isolated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Associated clinical factors&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">G&#243;mez-Rodr&#237;guez et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">S&#46; aureus</span>&#44; <span class="elsevierStyleItalic">Streptococcus</span>&#44; <span class="elsevierStyleItalic">Pseudomonas</span>&#44; <span class="elsevierStyleItalic">Salmonella</span> sp&#46;&#44; <span class="elsevierStyleItalic">Serratia</span> sp&#46;&#44; <span class="elsevierStyleItalic">Enterobacter</span>&#44; <span class="elsevierStyleItalic">Escherichia coli</span>&#44; <span class="elsevierStyleItalic">Proteus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Senility&#8226;<span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&#8226;<span class="elsevierStyleHsp" style=""></span>Malignant neoplasms&#8226;<span class="elsevierStyleHsp" style=""></span>Chemotherapy&#8226;<span class="elsevierStyleHsp" style=""></span>Alcoholism&#8226;<span class="elsevierStyleHsp" style=""></span>Rheumatoid arthritis&#8226;<span class="elsevierStyleHsp" style=""></span>Liver cirrhosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Mateo-Soria et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2009&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Spain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">S&#46; aureus</span>&#44; <span class="elsevierStyleItalic">S&#46; agalactiae</span>&#44; <span class="elsevierStyleItalic">S&#46; dysgalactiae</span>&#44; <span class="elsevierStyleItalic">S&#46; pneumoniae</span>&#44; <span class="elsevierStyleItalic">E&#46; epidermidis</span>&#44; <span class="elsevierStyleItalic">N&#46; gonorrhoeae</span>&#44; <span class="elsevierStyleItalic">E&#46; coli</span>&#44; <span class="elsevierStyleItalic">Salmonella</span>&#44; <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&#44; <span class="elsevierStyleItalic">Citrobacter freundii</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Rheumatoid arthritis&#8226;<span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&#8226;<span class="elsevierStyleHsp" style=""></span>Gout&#8226;<span class="elsevierStyleHsp" style=""></span>Liver cirrhosis&#8226;<span class="elsevierStyleHsp" style=""></span>Chronic kidney disease&#8226;<span class="elsevierStyleHsp" style=""></span>Intravenous drug use&#8226;<span class="elsevierStyleHsp" style=""></span>Hepatitis B and C infection&#8226;<span class="elsevierStyleHsp" style=""></span>HIV<span class="elsevierStyleSup">&#43;</span>&#8226;<span class="elsevierStyleHsp" style=""></span>Cancer&#8226;<span class="elsevierStyleHsp" style=""></span>Joint replacement&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Reyes-Llerena et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2000&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Cuba&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">S&#46; aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Senility&#8226;<span class="elsevierStyleHsp" style=""></span>Distant spread&#8226;<span class="elsevierStyleHsp" style=""></span>Arthroscopy&#8226;<span class="elsevierStyleHsp" style=""></span>Open surgery&#8226;<span class="elsevierStyleHsp" style=""></span>Needle aspiration of synovial effusions&#8226;<span class="elsevierStyleHsp" style=""></span>Intraarticular steroid injection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Medina-Rodr&#237;guez et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1995&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mexico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">S&#46; aureus</span>&#44; <span class="elsevierStyleItalic">Salmonella</span>&#44; <span class="elsevierStyleItalic">E&#46; coli</span>&#44; <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&#44; <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&#44; <span class="elsevierStyleItalic">S&#46; pneumoniae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&#8226;<span class="elsevierStyleHsp" style=""></span>Rheumatoid arthritis&#8226;<span class="elsevierStyleHsp" style=""></span>Cancer&#8226;<span class="elsevierStyleHsp" style=""></span>Immunosuppression&#8226;<span class="elsevierStyleHsp" style=""></span>Lupus erythematosus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Sada-D&#237;a et al&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1983&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mexico&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">S&#46; aureus</span>&#44; <span class="elsevierStyleItalic">Salmonella</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8226;<span class="elsevierStyleHsp" style=""></span>Immunosuppression&#8226;<span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&#8226;<span class="elsevierStyleHsp" style=""></span>Cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Comparison of Microorganisms Isolated and Associated Clinical Factors in Studies of Septic Arthritis in Mexico&#44; Cuba and Spain&#46;</p>"
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        "etiqueta" => "Table 2"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">&#37;&#44; percentage&#59; CI&#44; confidence interval&#59; No&#46;&#44; number of patients&#59; OR&#44; odds ratio&#59; SD&#44; standard deviation&#46;</p>"
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                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Septic arthritisNo&#46; &#40;&#37;&#41;n&#61;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without septic arthritisNo&#46; &#40;&#37;&#41;n&#61;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Age in years</span> &#40;&#956;<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Gender</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Men&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;69&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;83&#8211;2&#46;02&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Women&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">History</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Previous joint disease<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;1&#46;00&#8211;2&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Joint injury&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;43&#8211;3&#46;84&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Osteoarthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;13&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;71&#8211;2&#46;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ankylosing spondylitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;45&#8211;15&#46;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Rheumatoid arthritis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;52&#8211;1&#46;43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;34&#8211;1&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tobacco use&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">18 &#40;38&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;89&#8211;2&#46;49&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Alcoholism&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;24&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;71&#8211;1&#46;83&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Drug use&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;25&#8211;4&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Corticosteroid use&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;1&#46;01&#8211;7&#46;95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Peripheral vascular disease&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">14 &#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;17&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;77&#8211;3&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;37&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;06&#8211;2&#46;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Location</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Monoarticular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47 &#40;96&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;85&#8211;10&#46;80&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Polyarticular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;09&#8211;1&#46;16&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Knee&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">37 &#40;79&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;68&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;47&#8211;0&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;06&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Thigh&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;26&#8211;2&#46;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;67&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="6" align="left" valign="top"><span class="elsevierStyleItalic">Clinical signs</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Swelling&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;81&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;1&#46;14&#8211;2&#46;37&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Local warmth&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;45&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;53&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;79&#8211;1&#46;74&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pain&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">29 &#40;59&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;89&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;1&#46;39&#8211;2&#46;75&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Hyperemia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;92&#8211;1&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Functional limitation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;51&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;21&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;1&#46;24&#8211;2&#46;64&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Fever&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;15&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;23&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;0&#46;66&#8211;2&#46;26&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">&#37;&#44; percentage&#59; CI&#44; confidence interval&#59; No&#46;&#44; number of patients&#59; OR&#44; odds ratio&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">n&#61;49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">&#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Gram stain</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;78&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;65 to 91&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;22&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;&#8722;2 to 46&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Bacteria</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Staphylococcus</span> species&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;65&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;48 to 82&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">S&#46; aureus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">14 &#40;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;27 to 61&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">S&#46; epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;33 to 67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#60;&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">S&#46; saprophyticus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;&#8722;3 to 9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;333&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">S&#46; pyogenes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;&#8722;3 to 9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;333&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Streptococcus</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;&#8722;19 to 35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;064&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">S&#46; epidermidis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;1 to 99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">S&#46; agalactiae</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;&#8722;17 to 67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">S&#46; pyogenes</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;25&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;&#8722;17 to 67&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;042&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Salmonella</span> sp&#46;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;&#8722;23 to 31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;258&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Pseudomonas aeruginosa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#40;&#8722;23 to 31&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;258&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;19&#41;&nbsp;\t\t\t\t\t\t\n
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            1 => array:3 [
              "identificador" => "tblfn0020"
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              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Includes&#58; <span class="elsevierStyleItalic">Stenotrophomonas maltophilia</span>&#44; <span class="elsevierStyleItalic">Enterococcus faecalis</span>&#44; <span class="elsevierStyleItalic">Escherichia coli</span>&#44; <span class="elsevierStyleItalic">Klebsiella pneumoniae</span>&#44; <span class="elsevierStyleItalic">Actinomyces</span> sp&#46; and <span class="elsevierStyleItalic">Chryseobacterium indologenes</span>&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Bacteriologic Analysis of Joint Fluid of Patients With Septic Arthritis&#46;</p>"
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;03&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;06&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;93&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;06&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10&#46;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&#46;79&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&#46;89&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&#46;54&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">&#46;04&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Results of the Adjusted Analysis of the Characteristics Observed in Patients With and Without Septic Arthritis Using Binary Logistic Regression&#46;</p>"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Approach to septic arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;L&#46; Horowitz"
                            1 => "E&#46; Katzap"
                            2 => "S&#46; Horowitz"
                            3 => "M&#46;L&#46; Barilla-LaBarca"
                          ]
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                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Am Fam Physician"
                        "fecha" => "2011"
                        "volumen" => "84"
                        "paginaInicial" => "653"
                        "paginaFinal" => "660"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21916390"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
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              "identificador" => "bib0200"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Septic arthritis in rheumatology&#58; review of 5 cases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46;D&#46; Muhayidina"
                            1 => "M&#46;S&#46; Said"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4021/jocmr2009.08.1254"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Med Res"
                        "fecha" => "2009"
                        "volumen" => "1"
                        "paginaInicial" => "173"
                        "paginaFinal" => "177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22493652"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Of bugs and joints the relationship between infection and joints"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;R&#46; Espinoza"
                            1 => "I&#46; Garc&#237;a-Valladares"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.reuma.2012.06.008"
                      "Revista" => array:6 [
                        "tituloSerie" => "Reumatol Clin"
                        "fecha" => "2013"
                        "volumen" => "9"
                        "paginaInicial" => "229"
                        "paginaFinal" => "238"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22944142"
                            "web" => "Medline"
                          ]
                        ]
                      ]
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                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence and sources of native and prosthetic joint infection&#58; a community based prospective survey"
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                          "etal" => false
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