Management o an exposed fracture in Primary Health Attention. A propos of a case.

Se presenta un caso de fractura expuesta de tibia, asistido inicialmente en su área de salud y remitido a la atención secundaria por evolución tórpida. Se realiza valoración adecuada tomándose conducta consecuente y se establecen pautas en el tratamiento. Se llega a la conclusión que la atención inmediata con enfoque multidisciplinario garantiza una adecuada evolución del paciente, lográndose así una pronta recuperación e incorporación a la vida social y demostrándose la importancia del adecuado manejo de  esta lesión traumática en la atención primaria.It is presented a case of an exposed tibial fracture first assisted in a Primary Health Attention and then transferred to Secondary Health Attention because of torpid evolution. It was made an adequate valoration taking consequent conduct, and there were established standard treatment. It was concluded that immediate attention with multidisciplinary approach guarantees an adequate patient evolution, obtaining a fast recuperation, and incorporation to social life, demonstrating the importance of an adequate management in this traumatic lesion in Primary Health Attention

Fractura de tobillo tratado con placa Sherman modificada. A propósito de un caso

There were presented the results in the surgical treatment of a patient with left bimalleolar and ankle´s fracture, to whom there was applied a modified Sherman plate, used as stability plates for the forearms fractures, completely useless now days. But it was reduced  and, was very useful for that kind of fracture, because its holes allowed the application of cortical screws of 3.5 mm and 4.5 mm It was obtained a good result and there were also shown the postoperatives radiologiesSe presentan los resultados en el tratamiento quirúrgico de un paciente portador de una fractura de tobillo bimaleolar izquierdo, al cual se le colocó placa Sherman modificada. Utilizada como placa de estabilización para fracturas del antebrazo  y hoy día en completo desuso. La misma se redujo por corte y fue muy útil para este tipo de fractura, pues sus orificios permiten la utilización de tornillos corticales de 3,5 mm y 4,5 mm respectivamente. Se obtuvo buen resultado y se  muestran en este trabajo radiologías postoperatorias del mismo

Desorption of furfural from bimetallic Pt-Fe oxides/alumina catalysts

In this work, the desorption of furfural, which is a competitive intermediate during the production of biofuel and valuable aromatic compounds, was studied using pure alumina, as well as alumina impregnated with iron and platinum oxides both individually and in combination, using thermogravimetric analysis (TGA). The bimetallic sample exhibited the lowest desorption percentage for furfural. High-resolution transmission electron microscopy (HRTEM) imaging revealed the intimate connection between the iron and platinum oxide species on the alumina support. The mechanism of furfural desorption from the Pt-Fe/Al2O3 0.5%-0.5% sample was determined using physisorbed furfural instead of chemisorbed furfural; this mechanism involved the oxidation of the C=O group on furfural by the catalyst. The oxide nanoparticles on γ-Al2O3 support helped to stabilize the furfural molecule on the surface

Thermocatalytic degradation of lignin monomer coniferyl aldehyde by aluminum–boron oxide catalysts

Two aluminum–boron oxide catalysts were produced via a sol–gel method at pH 3 and 4 during the solution mixing step of the synthesis, these materials were employed in thermocatalytic degradation of coniferyl aldehyde (CA), which was used as a probe molecule of the lignin polymeric molecule and is comprised of the repetitive monomers coniferyl, sinapyl, and paracoumaryl. The two synthesized catalysts were mostly amorphous and mesoporous, aiding in permeability and percolation of CA. A commercial catalyst was compared (Pt/alumina at 1 wt%) with both catalysts synthesized in this work by kinetic tests by varying the CA concentration and inlet temperature. Under the same reaction conditions, the commercial catalyst showed higher activity than the aluminum–boron oxide catalysts, but the synthetic catalysts presented a wider variety of organic products than the commercial catalyst. In particular, two high-value products, isomers of eugenol and isoeugenol, were yielded in higher percentages. The experimental reaction rate data was fit to a Langmuir–Hinshelwood model, and kinetic parameters were analyzed, revealing how the adsorbed CA molecules on the catalytic surface had higher mobility with the synthesized catalyst compared with the commercial catalyst, the value of $\Delta S_{\mathrm{ads}}^{0}$ for the synthetic catalysts were $-$5.48 and $-$4.31 J/mol-K and for the commercial catalyst $-$37.17 J/mol-K

Thermocatalytic degradation of lignin monomer coniferyl aldehyde by aluminum–boron oxide catalysts

Two aluminum–boron oxide catalysts were produced via a sol–gel method at pH 3 and 4 during the solution mixing step of the synthesis, these materials were employed in thermocatalytic degradation of coniferyl aldehyde (CA), which was used as a probe molecule of the lignin polymeric molecule and is comprised of the repetitive monomers coniferyl, sinapyl, and paracoumaryl. The two synthesized catalysts were mostly amorphous and mesoporous, aiding in permeability and percolation of CA. A commercial catalyst was compared (Pt/alumina at 1 wt%) with both catalysts synthesized in this work by kinetic tests by varying the CA concentration and inlet temperature. Under the same reaction conditions, the commercial catalyst showed higher activity than the aluminum–boron oxide catalysts, but the synthetic catalysts presented a wider variety of organic products than the commercial catalyst. In particular, two high-value products, isomers of eugenol and isoeugenol, were yielded in higher percentages. The experimental reaction rate data was fit to a Langmuir–Hinshelwood model, and kinetic parameters were analyzed, revealing how the adsorbed CA molecules on the catalytic surface had higher mobility with the synthesized catalyst compared with the commercial catalyst, the value of $\Delta S_{\mathrm{ads}}^{0}$ for the synthetic catalysts were $-$5.48 and $-$4.31 J/mol-K and for the commercial catalyst $-$37.17 J/mol-K

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Durvalumab Plus Carboplatin/Paclitaxel Followed by Maintenance Durvalumab With or Without Olaparib as First-Line Treatment for Advanced Endometrial Cancer: The Phase III DUO-E Trial

PURPOSE Immunotherapy and chemotherapy combinations have shown activity in endometrial cancer, with greater benefit in mismatch repair (MMR)-deficient (dMMR) than MMR-proficient (pMMR) disease. Adding a poly(ADP-ribose) polymerase inhibitor may improve outcomes, especially in pMMR disease. METHODS This phase III, global, double-blind, placebo-controlled trial randomly assigned eligible patients with newly diagnosed advanced or recurrent endometrial cancer 1:1:1 to: carboplatin/paclitaxel plus durvalumab placebo followed by placebo maintenance (control arm); carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib placebo (durvalumab arm); or carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab plus olaparib (durvalumab + olaparib arm). The primary end points were progression-free survival (PFS) in the durvalumab arm versus control and the durvalumab + olaparib arm versus control. RESULTS Seven hundred eighteen patients were randomly assigned. In the intention-to-treat population, statistically significant PFS benefit was observed in the durvalumab (hazard ratio [HR], 0.71 [95% CI, 0.57 to 0.89]; P = .003) and durvalumab + olaparib arms (HR, 0.55 [95% CI, 0.43 to 0.69]; P < .0001) versus control. Prespecified, exploratory subgroup analyses showed PFS benefit in dMMR (HR [durvalumab v control], 0.42 [95% CI, 0.22 to 0.80]; HR [durvalumab + olaparib v control], 0.41 [95% CI, 0.21 to 0.75]) and pMMR subgroups (HR [durvalumab v control], 0.77 [95% CI, 0.60 to 0.97]; HR [durvalumab + olaparib v control] 0.57; [95% CI, 0.44 to 0.73]); and in PD-L1-positive subgroups (HR [durvalumab v control], 0.63 [95% CI, 0.48 to 0.83]; HR [durvalumab + olaparib v control], 0.42 [95% CI, 0.31 to 0.57]). Interim overall survival results (maturity approximately 28%) were supportive of the primary outcomes (durvalumab v control: HR, 0.77 [95% CI, 0.56 to 1.07]; P = .120; durvalumab + olaparib v control: HR, 0.59 [95% CI, 0.42 to 0.83]; P = .003). The safety profiles of the experimental arms were generally consistent with individual agents. CONCLUSION Carboplatin/paclitaxel plus durvalumab followed by maintenance durvalumab with or without olaparib demonstrated a statistically significant and clinically meaningful PFS benefit in patients with advanced or recurrent endometrial cancer

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe