Epidemiological aspects of facial trauma in a third level hospital in Mexico

Background: Facial trauma is common in early adulthood and may require complex surgery and even high mortality. Methods: Retrospective, cross-sectional study at the Hospital General de México during the period from January 2018 to December 2021. Patients with a diagnosis of fracture of the facial region, who had a complete clinical record, of any age, were included. Patients who did not comply with the treatment in the hospital unit, with incomplete clinical records, were excluded. Through non-probability sampling, a sample of 156 patients was formed. The descriptive data analysis was carried out by calculating frequencies and percentages for the qualitative variables. For the quantitative variables, measures of central tendency and dispersion were calculated according to the distribution of the variables (mean and standard deviation). for variables with normal distribution and median with interquartile range for variables with non-normal distribution). Results: 156 patients were included, the male sex predominated (89.7%), the age group from 21 to 30 years (35.3%), the injury mechanism of aggression by a third party (54.5%). Facial fractures occurred in the following descending order: orbit (64.7%), zygoma (41.7% n=65), mandibular (23.1% n=36), nasal (22.4% n=35), maxilla (21.8% n=34), NOE (4.5% n=7), Le Fort (3.8% n=6), and palate (3.8% n=6). Within orbital fractures, the most frequently affected region was the orbital floor (42.3%). The patients with orbital fracture were mostly men (88.1% versus 11.9%). The highest frequency of these fractures was between the ages of 21 and 30 (38.6%). Surgical treatment of fractures in general was established in 44.9%, performing open reduction and internal fixation of fractures in 41.0%. Conclusions: The most frequent facial fractures are: orbit, zygoma, and mandibular; they mainly affect the male sex in the second decade of life, they are produced mainly by aggressions to third parties. The management of facial fractures is predominantly surgical, through open reduction and internal fixation

Practice Patterns and Outcomes of Intravitreal Anti-VEGF Injection for Retinopathy of Prematurity

To report practice patterns of intravitreal injections of anti-VEGF for retinopathy of prematurity (ROP) and outcomes data with a focus on retreatments and complications. Multicenter, international, retrospective, consecutive series. Patients with ROP treated with anti-VEGF injections from 2007 to 2021. Twenfty-three sites (16 United States [US] and 7 non-US) participated. Data collected included demographics, birth characteristics, examination findings, and methods of injections. Comparisons between US and non-US sites were made. Primary outcomes included number and types of retreatments as well as complications. Secondary outcomes included specifics of the injection protocols, including types of medication, doses, distance from limbus, use of antibiotics, and quadrants where injections were delivered. A total of 1677 eyes of 918 patients (43% female, 57% male) were included. Mean gestational age was 25.7 weeks (range, 21.2–41.5 weeks), and mean birth weight was 787 g (range, 300–2700 g). Overall, a 30-gauge needle was most commonly used (51%), and the quadrant injected was most frequently the inferior-temporal (51.3%). The distance from the limbus ranged from 0.75 to 2 mm, with 1 mm being the most common (65%). Bevacizumab was the most common anti-VEGF (71.4%), with a dose of 0.625 mg in 64% of cases. Overall, 604 (36%) eyes required retreatment. Of those, 79.8% were retreated with laser alone, 10.6% with anti-VEGF injection alone, and 9.6% with combined laser and injection. Complications after anti-VEGF injections occurred in 15 (0.9%) eyes, and no cases of endophthalmitis were reported. Patients in the United States had lower birth weights and gestational ages (665.6 g and 24.5 weeks, respectively) compared with non-US patients (912.7 g and 26.9 weeks, respectively) (P < 0.0001). Retreatment with reinjection and laser was significantly more common in the US compared with the non-US group (8.5% vs. 4.7% [P = 0.0016] and 55% vs. 7.2% [P < 0.001], respectively). There was no difference in the incidence of complications between the 2 geographic subgroups. Anti-VEGF injections for ROP were safe and well tolerated despite a variance in practice patterns. Infants with ROP receiving injections in the US tended to be younger and smaller, and they were treated earlier with more retreatments than non-US neonates with ROP

Comparison in Retreatments between Bevacizumab and Ranibizumab Intravitreal Injections for Retinopathy of Prematurity

To compare the types and dosages of anti-vascular endothelial growth factors (VEGFs) to ascertain whether specific dosages or types of injection were associated with retreatment in clinical practice in the United States. Multicenter, retrospective, consecutive series. Patients with retinopathy of prematurity (ROP) treated with anti-VEGF injections from 2007 to 2021. Sixteen sites from the United States participated. Data collected included demographics, birth characteristics, examination findings, type and dose of anti-VEGF treatment, retreatment rates, and time to retreatment. Comparisons of retreatment rates between bevacizumab and ranibizumab intravitreal injections were made. Relative rate of retreatment between varying types of anti-VEGF therapy, including bevacizumab and ranibizumab, and the various dosages used for each. Data from 873 eyes of 661 patients (61% male and 39% female) were collected. After exclusion of 40 eyes treated with laser before anti-VEGF injection and 266 eyes re-treated with laser at or beyond 8 weeks after the initial anti-VEGF treatment, 567 eyes of 307 patients (63% male and 37% female) remained and were included in the primary analysis. There was no difference between the no retreatment and retreatment groups in terms of birthweight, gestational age, age at first injection, ROP stages, or number of involved clock hours. The retreatment group had a larger percentage of aggressive ROP (34% vs. 18%, P < 0.001) and greater percentage of zone 1 ROP (49 vs. 34%, P = 0.001) than the no retreatment group. Ranibizumab use was associated with a higher rate of retreatment than bevacizumab use (58% vs. 37%, P < 0.001), whereas the rate of retreatment was not associated with a specific dose of ranibizumab (R2 = 0.67, P = 0.32). Meanwhile, lower doses of bevacizumab were associated with higher rates of retreatment compared with the higher doses (R2 = 0.84, P = 0.01). There was a dose-specific trend with higher doses trending toward lower retreatments for bevacizumab. In a multicenter study of ROP patients initially treated with anti-VEGF therapy, ranibizumab and lower-dose bevacizumab use were associated with an increased rate of retreatment when compared with higher-dose bevacizumab. Proprietary or commercial disclosure may be found after the references. This multicenter retrospective study of 567 eyes with retinopathy of prematurity showed that ranibizumab and lower-dose bevacizumab use were associated with an increased rate of re-treatment when compared with higher-dose bevacizumab