Addition of the apical oblique projection increases the detection of acute traumatic shoulder abnormalities in adults

Purpose Plain radiographic evaluation of acute shoulder trauma in adults requires a minimum of two projections, commonly the anteroposterior (AP) and lateral scapular projections, with additional projections taken for diagnosis. The aim of this retrospective study was to determine whether the addition of the apical oblique (AO) projection to the AP and lateral scapular projections increases the number and/or alters the types of abnormalities detected in the examination of acute shoulder trauma. Methods Examinations of 56 adults who had undergone three-projection (AP, lateral scapular, AO) radiographic shoulder examination for acute trauma were allocated into two-projection (AP, lateral scapular) and three-projection cases and assessed by a radiologist. The differences in number and types of abnormalities between the two-projection and three-projection cases were quantified using the one-tailed t test and chi-square goodness-of-fit test, respectively. Results Test-retest reliability was moderate (intra-class correlation coefficient [95%CI], 0.56 [0.15 to 0.80]) for number, and almost perfect (kappa [95%CI], 0.94 [0.85 to 1.00]) for types, of abnormalities detected. There was a significant increase in the number of abnormalities detected across all three-projection versus two-projection cases (difference in means [95%CI], 0.20 [0.01 to 0.39]) and for fractures (difference in means [95%CI], 0.30 [0.11 to 0.49]), but no difference in the types of abnormalities detected (χ 2 = 4.7, p = 0.19). Conclusion This study suggests that adding the AO projection to two-projection examination of acute shoulder trauma increases the number of abnormalities detected; this has potential implications for patient management. Further research investigating differences in types of abnormalities detected between two-projection and three-projection cases is warranted

Outcomes of elective liver surgery worldwide: a global, prospective, multicenter, cross-sectional study

Background: The outcomes of liver surgery worldwide remain unknown. The true population-based outcomes are likely different to those vastly reported that reflect the activity of highly specialized academic centers. The aim of this study was to measure the true worldwide practice of liver surgery and associated outcomes by recruiting from centers across the globe. The geographic distribution of liver surgery activity and complexity was also evaluated to further understand variations in outcomes. Methods: LiverGroup.org was an international, prospective, multicenter, cross-sectional study following the Global Surgery Collaborative Snapshot Research approach with a 3-month prospective, consecutive patient enrollment within January–December 2019. Each patient was followed up for 90 days postoperatively. All patients undergoing liver surgery at their respective centers were eligible for study inclusion. Basic demographics, patient and operation characteristics were collected. Morbidity was recorded according to the Clavien–Dindo Classification of Surgical Complications. Country-based and hospital-based data were collected, including the Human Development Index (HDI). (NCT03768141). Results: A total of 2159 patients were included from six continents. Surgery was performed for cancer in 1785 (83%) patients. Of all patients, 912 (42%) experienced a postoperative complication of any severity, while the major complication rate was 16% (341/2159). The overall 90-day mortality rate after liver surgery was 3.8% (82/2,159). The overall failure to rescue rate was 11% (82/ 722) ranging from 5 to 35% among the higher and lower HDI groups, respectively. Conclusions: This is the first to our knowledge global surgery study specifically designed and conducted for specialized liver surgery. The authors identified failure to rescue as a significant potentially modifiable factor for mortality after liver surgery, mostly related to lower Human Development Index countries. Members of the LiverGroup.org network could now work together to develop quality improvement collaboratives

Effects of Postprandial Blood Pressure on Gait Parameters in Older People

Postprandial hypotension (PPH), a fall in systolic blood pressure (SBP) within 2 h of a meal, may detrimentally affect gait parameters and increase the falls risk in older people. We aimed to determine the effects of postprandial SBP on heart rate (HR), gait speed, and stride length, double-support time and swing time variability in older subjects with and without PPH. Twenty-nine subjects were studied on three days: glucose (“G”), water and walk (“WW”), glucose and walk (“GW”). Subjects consumed a glucose drink on “G” and “GW” and water on “WW”. The “G” day determined which subjects had PPH. On “WW” and “GW” gait was analyzed. Sixteen subjects demonstrated PPH. In this group, there were significant changes in gait speed (p = 0.040) on “WW” and double-support time variability (p = 0.027) on “GW”. The area under the curve for the change in gait parameters from baseline was not significant on any study day. Among subjects without PPH, SBP increased on “WW” (p < 0.005) and all gait parameters remained unchanged on all study days. These findings suggest that by changing gait parameters, PPH may contribute to an increased falls risk in the older person with PPH

Cinquenta (50) anos da Lei 4.320/1964 : Desafios e perspectivas para a contabilidade pública brasileira

Faz uma retrospectiva da Contabilidade Pública no Brasil, tendo como referência a Lei 4.320, de 1964

Optimizing Dolutegravir Initiation in Neonates Using Population Pharmacokinetic Modeling and Simulation

BackgroundA knowledge gap exists for dolutegravir (DTG) pharmacokinetics and safety during the first 4 weeks of life, preventing safe and effective DTG use in neonates.SettingPopulation pharmacokinetic modeling and simulation were used to assess newborn DTG dosing requirements during the first few days of life as a function of maternal DTG dosing history before delivery.MethodsDTG PK data were obtained from pregnant women and infants enrolled in the International Maternal Pediatric Adolescent AIDS Clinical Trials Network P1026S study. Maternal and neonate population pharmacokinetic models were separately developed. Monte Carlo simulations were performed to simulate neonatal concentrations after 2 doses of DTG after birth for infants born to mothers either receiving or not receiving DTG before delivery.ResultsIn DTG-naïve infants, a 5-mg DTG dose at birth with a second dose after 48 hours maintained median concentrations above the lower bound of the target range (0.77 μg/mL) and below the upper bound of the target range (7.34 μg/mL representing 2-fold above the adult Cmax value). In DTG-exposed infants, a 5-mg DTG dose at 24 hours after birth with a second dose after 48 hours maintained median concentrations within or nearly within the target range, even if the last maternal DTG dose was taken as soon as 6 hours or as long as 24 hours before delivery.ConclusionsNewborn DTG dosing requirements during the first few days of life depend on maternal DTG dosing history before delivery. These results may help the design of future clinical studies of DTG in the neonatal population