Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Whole-genome sequencing reveals host factors underlying critical COVID-19

Critical COVID-19 is caused by immune-mediated inflammatory lung injury. Host genetic variation influences the development of illness requiring critical care1 or hospitalization2,3,4 after infection with SARS-CoV-2. The GenOMICC (Genetics of Mortality in Critical Care) study enables the comparison of genomes from individuals who are critically ill with those of population controls to find underlying disease mechanisms. Here we use whole-genome sequencing in 7,491 critically ill individuals compared with 48,400 controls to discover and replicate 23 independent variants that significantly predispose to critical COVID-19. We identify 16 new independent associations, including variants within genes that are involved in interferon signalling (IL10RB and PLSCR1), leucocyte differentiation (BCL11A) and blood-type antigen secretor status (FUT2). Using transcriptome-wide association and colocalization to infer the effect of gene expression on disease severity, we find evidence that implicates multiple genes—including reduced expression of a membrane flippase (ATP11A), and increased expression of a mucin (MUC1)—in critical disease. Mendelian randomization provides evidence in support of causal roles for myeloid cell adhesion molecules (SELE, ICAM5 and CD209) and the coagulation factor F8, all of which are potentially druggable targets. Our results are broadly consistent with a multi-component model of COVID-19 pathophysiology, in which at least two distinct mechanisms can predispose to life-threatening disease: failure to control viral replication; or an enhanced tendency towards pulmonary inflammation and intravascular coagulation. We show that comparison between cases of critical illness and population controls is highly efficient for the detection of therapeutically relevant mechanisms of disease

Headache

It is hoped that the attached table will supplement the optometrist's clinical assessment and help to identify the type and probable cause of many headaches

Newer Approaches to Glaucoma Management

Traditional drug treatment of glau­coma tends to produce sequential periods of overdose and underdose. Methods of avoiding this pulsed sequence are becoming available. The aim is to achieve zero order kinetics instead of first order kinetics. The result should be smoother control of intraocular pressure with a smaller dose of drug. Laser treatments are replacing some of the older surgical procedures for treating glaucoma. No current treatment modality is totally successful and free of problems for all patients

Ophthalmic Preparations of Interest to Optometrists

This paper is essentially a tabulated listing of nearly 200 ophthalmic preparations. It Is too lengthy to publish in one issue of the CJO, so it will be presented In parts

The Development of B-Adrenergic Blocking Drugs for Management of Primary Open-­Angle Glaucoma

In the last few years, there has been a marked increase in the number of drugs available for the management of open-angle glaucoma. The development of these newer ophthalmic drugs has been prompted by a desire to make available, to the public, products that display max­imum efficacy (with respect to the glau­coma) but minimal side effects on the body generally or on the health of the eye or on vision. The major development has been in a set of drugs active on {B-adren­ergic receptors (the B-blockers"). While many of these newer drugs are, as yet, available only in Europe or Japan, in 1986, three new ophthalmic B-blockers became available in the English-speaking world. It is our intent in this article to review why there has been this major expansion in the number of drugs avai­lable to manage glaucoma or ocular hypertension..