Antibiotic therapy in penetrating abdominal trauma with gastrointestinal lesion: randomized clinical trial with two therapeutics schemes

BACKGROUND: To compare the effectiveness of two antibiotics schemes in victims of penetrating abdominal trauma with gastrointenstinal lesions. METHOD: In this prospective and randomized trial, victims of penetrating abdominal trauma with gastrointestinal lesions were distributed into two groups: peroperative cefoxitin only (Group 1) and five days treatment with gentamicin associated to metronidazol (Group 2). The groups were stratified in three levels, in agreement with the Abdominal Trauma Index (ATI). End points were infectious complications at surgical and non surgical sites. Additional trauma scores and data regarding the mechanism of trauma, treatment interval, incidence of shock at the admission, transfused blood volume, surgical time and trans-operative data were collected. RESULTS: Both groups were similar and perfectly comparable, demonstrating that there was no difference in the effectiveness between the antibiotic schemes. CONCLUSIONS: For victims of penetrating abdominal trauma with gastrointestinal lesions, the use of the restricted peroperative cefoxitin scheme is valid.OBJETIVO: Comparar a eficácia de dois esquemas terapêuticos de antibióticos em vítimas de trauma penetrante de abdome com lesão gastrintestinal. MÉTODO: O estudo selecionou de forma prospectiva e randomizada, vítimas de trauma abdominal penetrante com lesão gastrintestinal, dividindo-os em dois grupos, conforme o esquema terapêutico: cefoxitina perioperatória exclusivamente (Grupo 1) e associação de gentamicina e metronidazol por cinco dias (Grupo 2). Os grupos foram estratificados em três níveis de acordo com o Abdominal Trauma Index (ATI) e os desfechos analisados foram complicações infecciosas em nível de sitio cirúrgico e não cirúrgico. Escores de trauma e diversas variáveis foram coletadas, como mecanismo e intervalo trauma - tratamento, choque à admissão, volume transfundido, tempo cirúrgico e lesões de cólon. RESULTADOS: Ambos os grupos foram semelhantes e perfeitamente comparáveis, demonstrando não haver diferença na eficácia entre os esquemas antibióticos. CONCLUSÃO: Para vítimas de trauma abdominal penetrante com lesão gastrintestinal, o uso de cefoxitina restrito ao perioperatório é perfeitamente válido.27728

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta

Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes

Multi-messenger Observations of a Binary Neutron Star Merger

International audienceOn 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of $\sim 1.7\,{\rm{s}}$ with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg(2) at a luminosity distance of ${40}_{-8}^{+8}$ Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 $\,{M}_{\odot }$. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at $\sim 40\,{\rm{Mpc}}$) less than 11 hours after the merger by the One-Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ∼10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position $\sim 9$ and $\sim 16$ days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC 4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta