Fractura por fatiga atípica de la cabeza femoral sobre deslizamiento epifisario crónico

Presentamos el caso de un paciente joven con fractura de estrés desplazada cuyo trazo se localiza a nivel de la antigua placa físaria de la cabeza femoral. La imagen radiográfica era claramente de fractura de estrés, posiblemente sobre una secuela de epifisiolisis crónica de cabeza femoral. La cadera contralateral era normal y se descartó un cierre tardío de fisis por hipotiroidismo. Por el desplazamiento de la fractura y tiempo de evolución se trató mediante artroplastia total de sustitución no cementada. El estudio anatomopatológico informó de fractura de características de fractura de estrés con necrosis de la cabeza femoral. La evolución postoperatoria fue satisfactoria y el paciente se incorporó a su trabajo.We present a case report of a young patient with a displaced stress fracture, which fracture pattern is placed over the old femoral head growth plate (femoral head physis). The x-ray showed a clear image of a stress fracture, possibly on a sequel of chronic slipped capital femoral epiphysis. The contralateral hip was normal and a delayed closure of physis due to hypothyroidism was ruled out. Due to the fracture displacement and the evolution time it was treated with uncemented total hip arthroplasty. The anatomopathologic study showed characteristics of stress fracture and femoral neck necrosis. The postoperatory result was excellent and the patient returned to work

La fijación externa en el tratamiento de las fracturas de extremidad distal de radio: Revisión de 83 casos

Se presenta un estudio retrospectivo de 83 casos de fractura de extremidad distal de radio tratadas con fijación externa, exclusivamente o asociada a otros métodos de tratamiento, con un seguimiento medio de 15 meses. Se han revisado las indicaciones y se han valorado los resultados mediante el protocolo de evaluación clínica propuesto por Gartland y Werley, modificado por Sarmiento; y la evaluación radiológica según los criterios de Linström, ampliados por Van Der Linden y Ericsson. Se obtuvieron resultados excelentes en 9 casos, buenos en 44 casos, regulares en 24 y malos en 6 casos. La complicación más frecuente hallada fue la osteopenia difusa del carpo (50%) y la causa más común de discapacidad residual, la articulación radiocubital distal. De los resultados concluimos que la fijación externa es un método correcto para el tratamiento de las fracturas de extremidad distal de radio, aunque son necesarias en algunos casos otras técnicas añadidas para conseguir una aceptable congruencia articular y minimizar la cifra de resultados inaceptables.Retrospective study on 83 cases of distal radius fractures in treatment with external fixation, exclusively or associated with other treatment methods, with an average follow-up of 45 months. Indications have been revised and results have been valued through the medical record of clinical evaluation proposed by Gartland and Werley, modified by Sarmiento, and the radiological evaluation accordinf to Linström's criterions, amplified by Van Der Linden and Ericson. Excellent results have been obtained in 9 cases, good ones in 44 cases, not bad ones in 24 cases, bad ones in 6 cases. The most frequent complication found was the carpus wide osteopeny (50%) and the most common cause of residual discapacity, the distal radioulnar joint. We conclude, from the results, that the external fixation is a correct method for the treatment of distal radius fractures, although other added techniques are necessary, in some cases, in order to achieve an acceptable articular congruity and minimize the number of unacceptable results

The global impact of the COVID-19 pandemic on the management and course of chronic urticaria

Introduction: The COVID-19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown. Aim: To understand how CU patients are affected by the COVID-19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID-19. Materials and Methods: Our cross-sectional, international, questionnaire-based, multicenter UCARE COVID-CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences. Results: The COVID-19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID-19 patient care, which negatively impacted on the care of urticaria patients. The rate of face-to-face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID-19, but COVID-19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID-19. Conclusions: The COVID-19 pandemic brings major changes and challenges for CU patients and their physicians. The long-term consequences of these changes, especially the increased use of remote consultations, require careful evaluation

Fate of free and modified Alternaria mycotoxins during the production of apple concentrates

Mouldy core is a frequent apple fungal disease, mainly caused by toxigenic Alternaria species. Mouldy core is hardly detected in pre-selection procedures when the apples are destined for industrialization, and to date no information is available on the fate of Alternaria toxins during apple concentrate production. Therefore, we evaluated the effect of this process on the natural contamination levels of 10 Alternaria metabolites: alternariol (AOH), alternariol monomethyl ether (AME), altenuene (ALT), tenuazonic acid (TeA), tentoxin (TEN), altertoxin-I (ATX-I), alternariol 3-sulfate (AOH-3-S), alternariol 3-glucoside (AOH-3-G), alternariol monomethyl ether 3-sulfate (AME-3-S), and alternariol monomethyl ether 3-glucoside (AME-3-G). Six stages (grinding, turbos, decanter muds, pre-concentration, concentrate and rejection) of five independent Red Delicious and one of Granny Smith apple concentrate processes were sampled. Four out of the six processes included clarification, while two did not. The Granny Smith raw material was the least contaminated one, both in quality and quantity of Alternaria mycotoxins. Quantifiable levels of AOH, AME, TeA and TEN, were observed in the ground apples of the Red Delicious processes. Regarding the modified mycotoxins, only AME-3-S was present in the raw material; nevertheless, AOH-3-S and AOH-3-G were detected along the process. ALT, ATX-I, and AME-3-G were not detected at any stage. Clear and cloudy processes showed similar variations on mycotoxin quantities until the clarification step, in which all the mycotoxins analysed underwent a significant reduction to non-quantifiable levels. Only TeA remained at detectable levels in one of the clarified final products. The concentration in the final cloudy product increased with respect to the raw material for AOH (301%), AME (221%), TEN (872%) and TeA (1024%). This is the first report of AOH-3-S and AME-3-S in apple-by-products. The clarification stage in apple concentrate production has a relevant role in reducing Alternaria toxins to safe levels in the final products. A major risk might be associated with cloudy apple-by-products.Fil: Pavicich, Maria Agustina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Micología y Botánica. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Micología y Botánica; Argentina. University of Ghent; BélgicaFil: De Boevre, Marthe. University of Ghent; BélgicaFil: Vidal, Arnau. University of Ghent; BélgicaFil: Iturmendi, Facundo. Universidad Nacional de Río Negro; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Mikula, Hannes. Institute of Applied Synthetic Chemistry; AustriaFil: Warth, Benedikt. Universidad de Viena; AustriaFil: Marko, Doris. Universidad de Viena; AustriaFil: De Saeger, Sarah. University of Ghent; BélgicaFil: Patriarca, Andrea Rosana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Micología y Botánica. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Micología y Botánica; Argentin

Efficacy and safety of ligelizumab in adults and adolescents with chronic spontaneous urticaria: results of two phase 3 randomised controlled trials

Background: Many patients with chronic spontaneous urticaria (CSU) do not achieve complete control of their symptoms with current available treatments. In a dose-finding phase 2b study, ligelizumab improved urticaria symptoms in patients with H1-antihistamine (H1-AH) refractory CSU. Here, we report the efficacy and safety outcomes from two ligelizumab phase 3 studies. Methods: PEARL-1 and PEARL-2 were identically designed randomised, double-blind, active-controlled and placebo-controlled parallel-group studies. Patients aged 12 years or older with moderate-to-severe H1-AH refractory CSU were recruited from 347 sites in 46 countries and randomly allocated in a 3:3:3:1 ratio via Interactive Response Technology to 72 mg ligelizumab, 120 mg ligelizumab, 300 mg omalizumab, or placebo, dosed every 4 weeks, for 52 weeks. Patients allocated to placebo received 120 mg ligelizumab from week 24. The primary endpoint was change-from-baseline (CFB) in weekly Urticaria Activity Score (UAS7) at week 12, and was analysed in all eligible adult patients according to the treatment assigned at random allocation. Safety was assessed throughout the study in all patients who received at least one dose of the study drug. The studies were registered with ClinicalTrials.gov, NCT03580369 (PEARL-1) and NCT03580356 (PEARL-2). Both trials are now complete. Findings: Between Oct 17, 2018, and Oct 26, 2021, 2057 adult patients were randomly allocated across both studies (72 mg ligelizumab n=614; 120 mg ligelizumab n=616; 300 mg omalizumab n=618, and placebo n=209). A total of 1480 (72%) of 2057 were female, and 577 (28%) of 2057 were male. Mean UAS7 at baseline across study groups ranged from 29·37 to 31·10. At week 12, estimated treatment differences in mean CFB-UAS7 were as follows: for 72 mg ligelizumab versus placebo, –8·0 (95% CI –10·6 to –5·4; PEARL-1), –10·0 (–12·6 to –7·4; PEARL-2); 72 mg ligelizumab versus omalizumab 0·7 (–1·2 to 2·5; PEARL-1), 0·4 (–1·4 to 2·2; PEARL-2); 120 mg ligelizumab versus placebo –8·0 (–10·5 to –5·4; PEARL-1), –11·1 (–13·7 to –8·5; PEARL-2); 120 mg ligelizumab versus omalizumab 0·7 (–1·1 to 2·5; PEARL-1), –0·7 (–2·5 to 1·1; PEARL-2). Both doses of ligelizumab were superior to placebo (p<0·0001), but not to omalizumab, in both studies. No new safety signals were identified for ligelizumab or omalizumab. Interpretation: In the phase 3 PEARL studies, ligelizumab demonstrated superior efficacy versus placebo but not versus omalizumab. The safety profile of ligelizumab was consistent with previous studies. Funding: Novartis Pharma

Definition, aims, and implementation of GA 2 LEN/HAEi angioedema centers of reference and excellence

This document summarizes the aims of GA2 LEN/HAEi Angioedema Centers of Reference and Excellence (ACAREs) and elaborates the requirements that ACAREs must fulfill to become certified. It also provides (see Appendix S1) background information on GA2LEN and HAEi, including HAEi member organizations and regional patient advocates, on why we need an Angioedema Center of Reference and Excellence (ACARE) program and network, and on the accreditation and certification process, governance and funding, and on the interaction with other GA2LEN networks of centers of reference and excellence. The protocols, aims, requirements, and provisions related to becoming a certified CARE are based on (a) the experience of the GA2LEN UCARE network and (b) input from angioedema patients, general practitioners, and angioedema specialists