Complications of Bone Plating Following Different Facial Bones Fractures

The Aim of our study was to evaluate the complication of bone plating fixation used for treatment of multiple type of facial fracture, reconstruction procedure and bone graft in maxillofacial trauma. This prospective study was performed on 42 patients to evaluates complications of the bone plates had been used in fixation of multiple facial fractures, between October 2013 and March 2015, The age of the patients ranged from 17 – 65 years The mean age of the patients was (31.7± 9.4) years. There were 31 males and 11 females, with male to female ratio (2.81:1), patients were followed up for minimum 6 months. Seventy-one plates were inserted over 17 months. Among the 42 patients there were 45 fracture sites, 26 (57.8%) were mandibular fractures, 15 (33.3%) were ZMC fractures, and four (8.9%) were maxillary; it is worth mentioning that some patients had fracture at more than one site. Complications due to fracture fixation with bone plating were 33 represented 46.5% of the total 71 plates inserted, which included Infection/wound dehiscence 15 (21.1%), Discomfort/ palpability 9 (12.7%), Plate exposure 4 (5.6%), hardware failure (broken plate & loosening screw) 1 (1.4%), Cold/heat intolerance 3 (4.2%) and Pain (TMJ) account for one plate (1.4%). According to this study, there will be a need for hardware removal in a portion of patients treated with metallic osteosynthesis devices. This study states that the infection is most common reason for plate removal, followed by discomfort due to cold/heat climate, particularly in those facial regions that provide only thin soft tissue cover over the plate

Avaliação da ocorrência de anticorpos anti-Toxoplasma gondii, em soros de caprinos do estado de São Paulo, e associação com variáveis epidemiológicas, problemas reprodutivos e riscos à saúde pública Occurrence of anti-Toxoplasma gondii antibodies in goat sera in the state of São Paulo, and its association with epidemiological variables, reproductive problems and risks on public health

Objetivando avaliar a ocorrência de anticorpos anti-Toxoplasma gondii, em caprinos leiteiros do estado de São Paulo, e verificar possíveis associações com idade, sexo, presença de gatos, problemas reprodutivos e potenciais riscos à saúde pública, foram considerados soros de 923 caprinos, de ambos os sexos e idade acima de três meses, provenientes de 17 propriedades de diferentes municípios. Para o diagnóstico, utilizou-se a reação de imunofluorescência indireta (RIFIe"16) e, também, um inquérito sobre saúde, a fim de se coletarem informações epidemiológicas e de esfera reprodutiva de todos os capris. Os resultados foram discutidos no nível de 5% de significância. Do total das 17 propriedades, foram diagnosticados 15 focos de T. gondii, com positividade entre 2,70% e 81,25%. Não foram verificadas associações entre freqüência de soropositividade e sexo dos animais nem ocorrência de falhas reprodutivas, nos capris. Constatou-se influência positiva na taxa de anticorpos anti-T. gondii pelo aumento da idade dos caprinos e presença de gatos, nos capris. Além de a enfermidade encontrar-se amplamente difundida no estado de São Paulo, o risco eminente de transmissão de T. gondii à saúde pública também deve ser considerado, uma vez que se encontraram focos onde se comercializavam produtos "in natura", como leite e carne.<br>The study evaluated the anti-Toxplasma gondii antibodies occurrence in dairy goats in São Paulo State, and also verified likely associations with age, sex, presence of cats, occurrence of reproductive problems, and potential risks to public health. Serum was obtained from 923 animals of both sex, over three months of age from 17 properties in different cities. For the diagnosis, the indirect immunofluorescence reaction (RIFIe"16) and a questionnaire about health to collect epidemiological information and the reproductive cycle of every goat were used. Among all properties, 15 foci of T. gondii were diagnosed with seropositivity ranging from 2.70% to 81.25%. Neither association between the frequency of seropositivity and the sex of animals nor occurrence of reproduction failure of goats was identified. There was positive influence of anti-T. gondii antibody rate due to the older age of the animals and the presence of cats in pens. The risk of transmitting T. gondii to the public health must be considered, once in some properties where the positive serology was verified natural, products such as milk and/or meat are commercialized. Results were discussed at 5% level of significance

Cumulative radiation dose incurred during the management of complex pleural space infection.

BACKGROUND: Complex pleural space infections are commonly managed with antibiotics, pleural drainage, intrapleural fibrinolytic therapy, and surgery. These strategies often utilize radiographic imaging during management, however little data is available on cumulative radiation exposure received during inpatient management. We aimed to identify the type and quantity of radiographic studies along with the resultant radiation exposure during the management of complex pleural space infections. METHODS: Retrospective review of community network healthcare system from January 2015 to July 2018. Patients were identified through billing databases as receiving intrapleural fibrinolytic therapy and/or surgical intervention. Patient demographics, clinical outcomes, and inpatient radiographic imaging was collected to calculate cumulative effective dose. RESULTS: A total of 566 patients were identified with 7275 total radiographic studies performed and a median cumulative effective dose of 16.9 (IQR 9.9-26.3) mSv. Multivariable linear regression analysis revealed computed tomography use was associated with increased cumulative dose, whereas increased age was associated with lower cumulative dose. Over 74% of patients received more than 10 mSv, with 7.4% receiving more than 40 mSv. CONCLUSIONS: The number of radiographic studies and overall cumulative effective dose in patients hospitalized for complex pleural space infection was high with the median cumulative effective dose \u3e 5 times normal yearly exposure. Ionizing radiation and modern radiology techniques have revolutionized medical care, but are likely not without risk. Additional study is warranted to identify the frequency and imaging type needed during complex pleural space infection management, attempting to keep ionizing radiation exposure as low as reasonably possible

Effect of Intrapleural Fibrinolytic Therapy vs Surgery for Complicated Pleural Infections: A Randomized Clinical Trial.

IMPORTANCE: There is a paucity of high-quality prospective randomized clinical trials comparing intrapleural fibrinolytic therapy (IPFT) with surgical decortication in patients with complicated pleural infections. OBJECTIVE: To assess the feasibility, safety, and efficacy of an algorithm comparing tissue plasminogen activator plus deoxyribonuclease therapy with surgical decortication in patients with complicated pleural infections. DESIGN, SETTING, AND PARTICIPANTS: This parallel pilot randomized clinical trial was performed at a single urban community-based center from March 1, 2019, to December 31, 2021, with follow-up for 90 days. Seventy-four individuals were screened and 48 were excluded. Twenty-six patients 18 years or older with clinical pleural infection and positive findings of pleural fluid analysis were included. Of these, 20 patients underwent randomized selection (10 in each group), and 6 were observed. INTERVENTIONS: Intrapleural tissue plasminogen activator plus deoxyribonuclease therapy vs surgical decortication. MAIN OUTCOMES AND MEASURES: Primary outcomes were the percentage of patients enrolled to study completion and multidisciplinary adherence. Secondary outcomes included the number of patients with and the reason for inadequate screening, screening to enrollment failures, time to accrual of 20 patients or the number accrued at 1 year, and clinical data. RESULTS: Twenty-six patients were enrolled, 10 were randomized to each group, and 6 were observed. There was 100% enrollment to study completion in each treatment group, no protocol deviations, 2 minor protocol amendments, and no screening to enrollment failures. It took 32 months to enroll 26 patients. The 20 randomized patients had a median age of 57 (IQR, 46-65) years, were predominantly men (15 [75%]), and had a median RAPID (Renal, Age, Purulence, Infection Source, and Dietary Factors) score of 2 (IQR, 1-3). Treatment failure occurred in 1 patient and 2 crossover treatments occurred, all of which were in the IPFT group. Intraprocedure and postprocedure complications were similar between the groups. There were no reoperations or in-hospital deaths. Median duration of chest tube use was comparable in the IPFT (5 [IQR, 4-8] days) and surgery (4 [IQR, 3-5] days) groups (P = .21). Median hospital stay tended to be longer in the IPFT (11 [IQR, 4-18] days) vs surgery (5 [IQR, 4-6] days) groups, although the difference as not significantly different (P = .08). There were no 30-day readmissions or 30- or 90-day deaths. CONCLUSIONS AND RELEVANCE: In this pilot randomized clinical trial, the study algorithm was feasible, safe, and efficacious. This provides evidence to move forward with a multicenter randomized clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03873766