The effect of 2-butyl-cyanoacrylate adhesive in osteotomies and bone grafts in rabbits: macroscopic and radiographic characteristics

OBJECTIVE: To evaluate the effect of butyl-2-cyanoacrylate tissue adhesive in osteotomies and bone grafts, with regard to macroscopic and radiographic characteristics. METHODS: Forty-eight rabbits were used, randomly divided into four groups of 12 animals, with observation periods of two, four, eight and 16 weeks. Both thoracic limbs were operated in each animal and two osteotomies were performed in each of the radii, withdrawing a bone fragment (bone graft) of 1 cm in length. On one side, the bone graft was then replaced and a drop of adhesive was applied to each of the osteotomies. On the other side, the same procedure was performed without applying the adhesive. The rejection level for the nullity hypothesis was set at 0.05% or 5%. RESULTS: Blue marks were present in all the surgical specimens in which adhesive was applied. From the fourth week onwards, there was absence of movement of the bone grafts with adhesive and control. In group A, in the proximal osteotomies with adhesive, there was less deviation of the bone graft (p = 0.02). In group C, the union (p = 0.03) and the integration of the bone graft (p = 0.02) were better in the proximal osteotomies with adhesive. CONCLUSIONS: The adhesive was not completely metabolized within 16 weeks. There was clinical consolidation of the osteotomies within four weeks. The adhesive stabilized the bone graft within the first weeks and did not interfere with the consolidation of the osteotomies, or the integration of the bone graft in radiographic observations.OBJETIVO: Avaliar o efeito do adesivo tecidual butil-2-cianoacrilato em osteotomias e enxerto ósseo (EO), sob o aspecto macroscópico e radiográfico. MÉTODOS: Foram utilizados 48 coelhos, divididos aleatoriamente em quatro grupos de 12 animais, com períodos de observação de duas, quatro, oito e 16 semanas. Foram operados os dois membros torácicos de cada animal e realizadas duas osteotomias em cada um dos rádios, com a retirada de um fragmento ósseo (EO) de 1cm de comprimento. De um lado foi recolocado o EO no local e aplicada uma gota do adesivo em cada uma das osteotomias. No outro lado, foi realizado o mesmo procedimento sem a aplicação do adesivo. Fixou-se em 0,05 ou 5% o nível de rejeição da hipótese de nulidade. RESULTADOS: Presença de marcas azuis em todas as peças cirúrgicas em que foi utilizado o adesivo. A partir da quarta semana, ausência de movimento dos EO com adesivo e controle. No grupo A, nas osteotomias proximais com adesivo, ocorreu menos desvio do EO (p = 0,02). No grupo C, a união (p = 0,03) e a integração do EO (p = 0,02) foram melhores nas osteotomias proximais com adesivo. CONCLUSÕES: O adesivo não foi totalmente metabolizado com 16 semanas. Há consolidação clínica das osteotomias em quatro semanas. O adesivo estabilizou o EO nas primeiras semanas e não interferiu na consolidação das osteotomias, assim como na integração dos EO a observação radiográfica.UNIVÁS FACIMPAUNIFESP Departamento de OrtopediaUNIFESP, Depto. de OrtopediaSciEL

The effect of autologous costal perichondrium graft with butyl-2-cyanoacrylate in provoked injury in the articular cartilage of rabbit s knee

The purpose of this study was to verify the effect of the perichondrium graft with butyl-2-cyanoacrylate in provoked injury in the articular cartilage of rabbit`s knee. Male adult animals were used, divided in 2 groups, called Group A and Group B, with 17 animals each. The Group A animals were reoperated in 4 weeks and the Group B animals in 8 weeks. A 2 cm fragment was taken out from the 7th costal cartilage from which the perichondrium was removed. Two osteo-cartilaginous cylinders were taken out from each medialis condyles of the femurs in the same animal. The articular cartilage of the cylinder was replaced in one side by the perichondrium with a thin layer of sticking-tissue in its external face and only the articular cartilage was removed from the other side. The cylinders were replaced in the femurs. Macroscopically, in Group A, most of the injuries which received the perichondrium were found completely covered with tissue and all the lesions without perichondrium were only partilly covered. In Group B, no macroscopic significant difference in the covering of the injuries was found. Statistically, There was no microscopical significant difference between the injuries with and without perichondrium of the Group A and Group B and neither groups A and B.A finalidade desse estudo foi verificar o efeito do enxerto autólogo de pericôndrio com butil-2-cianoacrilato em lesão provocada na cartilagem articular do joelho de coelhos. Foram utilizados animais machos, adultos, divididos em 2 grupos, denominados de Grupo A e de Grupo B, de 17 animais cada um. Os animais do Grupo A foram reoperados com 4 semanas e os do Grupo B com 8 semanas. Foi retirado um fragmento de 2 cm da 7ª cartilagem costal esquerda do qual se descolou o pericôndrio. Retiraram-se dois cilindros ósseo-cartilaginosos, um de cada côndilo femural medial do mesmo animal. De um lado a cartilagem articular do cilindro foi substituida por pericôndrio com um fina camada do adesivo tecidual na sua face externa e do outro lado só foi retirada a cartilagem articular. Os cilindros foram recolocados nos fêmures. Macroscopicamente, no Grupo A, encontrou-se a maioria das lesões com pericôndrio recobertas totalmente com tecido e todas as lesões sem pericôndrio recobertas parcialmente. No Grupo B, não se encontrou diferença macroscópica significante entre a cobertura total e parcial com tecido, das lesões. Estatisticamente, não houve diferença microscópica significante entre as lesões com pericôndrio e sem pericôndrio do Grupo A e do Grupo B e nem entre os Grupos A e B.Faculdade de Ciências Médicas de Pouso AlegreUniversidade Federal de São Paulo (UNIFESP)UNIFESPSciEL

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death