Far Proximal and Far Distal Tibial Fractures: Management with Intramedullary Nails

Operative treatment of tibial fractures located at the proximal metaphyseal-epiphyseal and distal metaphyseal-epiphyseal areas, including those with articular extensions, is a technical challenge. Common methods for surgical management include plates (locking and nonlocking), external fixation devices, and intramedullary nails. All these methods have shown satisfactory results in terms of quality of reduction and clinical and radiological outcomes. The authors present some technical methods and strategies that have been useful for the surgical approach, reduction, and fixation of these lesions with the use of locked nails

Management of Distal Femoral Fractures

Operative treatment of distal femoral fractures has evolved significantly in tems of strategy and implants available for fracture fixation. Major advances include improvements in fixation devices, as well as the understanding of the pathomechanics of fixation failures. As the complexity of the fracture increases, and in conjunction with considerations of the general status and functionality of the patient, judicious planning, surgical approach and choice of implants can be undertaken, in order to obtain optimal functional restoration. This goes along tightly with the capability of a given construct to withstand deforming forces, while early mobilization and weight bearing take splace, and ultimately bone healing occurs. Minimizing the risk of complications, such as hardware failure and nonunion, depend closely on proper planning and execution. Factors inherent to the patient and the fracture itself are beyond the surgeon’s control. But taking these in mind, allows the surgeon to select properly the timing, surgical approach and choice of implant—or combination of implants—, best suited for a given patient

Myocardial injury determination improves risk stratification and predicts mortality in COVID-19 patients

Background: Despite being associated with worse prognosis in patients with COVID-19, systematic determination of myocardial injury is not recommended. The aim of the study was to study the effect of myocardial injury assessment on risk stratification of COVID-19 patients.Methods: Seven hundred seven consecutive adult patients admitted to a large tertiary hospital with confirmed COVID-19 were included. Demographic data, comorbidities, laboratory results and clinical outcomes were recorded. Charlson comorbidity index (CCI) was calculated in order to quantify the degree of comorbidities. Independent association of cardiac troponin I (cTnI) increase with outcomes was evaluated by multivariate regression analyses and area under curve. In addition, propensity-score matching was performed to assemble a cohort of patients with similar baseline characteristics.Results: In the matched cohort (mean age 66.76 ± 15.7 years, 37.3% females), cTnI increase above the upper limit was present in 20.9% of the population and was associated with worse clinical outcomes, including all-cause mortality within 30 days (45.1% vs. 23.2%; p = 0.005). The addition of cTnI to a multivariate prediction model showed a significant improvement in the area under the time-dependent receiver operating characteristic curve (0.775 vs. 0.756, DC-statistic = 0.019; 95% confidence interval 0.001–0.037). Use of renin–angiotensin–aldosterone system inhibitors was not associated with mortality after adjusting by baseline risk factors.Conclusions: Myocardial injury is independently associated with adverse outcomes irrespective of baseline comorbidities and its addition to multivariate regression models significantly improves their performance in predicting mortality. The determination of myocardial injury biomarkers on hospital admission and its combination with CCI can classify patients in three risk groups (high, intermediate and low) with a clearly distinct 30-day mortality

Genetic parameter estimations of new traits of morphological quality on gilthead seabream (Sparus aurata) by using IMAFISH_ML software

In this study, a total of 18 novel productive traits, three related to carcass [cNiT] and fifteen related to morphometric [mNiT]), were measured in gilthead seabream (Sparus aurata) using Non-invasive Technologies (NiT) as implemented in IMAFISH_ML (MatLab script). Their potential to be used in industrial breeding programs were evaluated in 2348 offspring reared under different production systems (estuarine ponds, oceanic cage, inland tank) at harvest. All animals were photographed, and digitally measured and main genetic parameters were estimated. Heritability for growth traits was medium (0.25–0.37) whereas for NiT traits medium-high (0.24–0.61). In general, genetic correlations between mNiT, cNiT and growth and traits were high and positive. Image analysis artifacts such as fin unfold or shades, that may interfere in the precision of some digital measurements, were discarded as a major bias factor since heritability of NiT traits after correcting them were no significantly different from original ones. Indirect selection of growth traits through NiT traits produced a better predicted response than directly measuring Body Weight (13–23%), demonstrating that this methodological approach is highly cost-effective in terms of accuracy and data processing time.Versión del edito

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Efecto del cruzamiento en terneros de vacas comerciales en un sistema de pastoreo en Jamundí, Valle del Cauca, Colombia

24 P.En el presente estudio se realizó una comparación de desempeño de diversos cruces en un hato comercial de ganado de carne con 190 vacas que presentaron 838 partos. Para comparar los efectos de cruzamiento en el intervalo entre partos, los animales se agruparon en 4 grupos en base a su composición racial. El desempeño productivo fue evaluado en el peso al destete de las crías para 10 composiciones raciales las cuales son : 100% Brahman, 1/2 Limousin-1/2 Brahman,1/2 Braunvieh-1/2 Brahman, 1/2 Romangnola-1/2 Brahman, 1/2 Simmental-1/2 Brahman, 1/2 Charolais-1/2 Brahman, 1/2 Lucerna-1/2 Brahman,3/4 Brahman-1/4 Simmental, 3/4 Romagnola-1/4 Brahman, ¾ Brahman-1/4 Romagnola. Este desempeño se evaluó con peso al destete, peso ajustado a 205 días, peso ajustado por número de parto a los 205 días, peso ajustado por sexo y parto a 205 días. El estudio se realizó en la Hacienda La Novillera, Jamundí, Valle del Cauca, Colombia. Todos los terneros fueron pesados al momento de ser destetados y con estos datos se aplicaron tres fórmulas para medir mejor el desempeño de los cruces brindando como resultado el mejor desempeño al destete que lo obtuvo el cruce 3/4 Romagnola-1/4 Brahman (P≤0.05) y en los otros cruces no se obtuvo una diferencia con (P>0.05). En la comparación del peso ajustado a 205 días todos los cruces no difieren entre sí (P>0.05), excepto 1/2 Limousin-1/2 Brahman que presentó 11 kg más que el cruce de 100% Brahman. En la comparación de peso ajustado por número de parto a los 205 días, en relación a el Brahman seis de los cruces no difieren entre sí, excepto los cruces 1/2 Lucerna- 1/2 Brahman que presentó un desempeño 16 kg menos al cruce 100% Brahman. Los cruce 1/2 Brahman-1/2 Charolais y 1/2 Brahman-1/2 Simmental obtuvieron un desempeño de 7 kg menos que el cruce 100% Brahman y entre estos tres cruces no hubo una diferencia (P>0.05), en el peso ajustado por número de parto y sexo a 205 días, 8 de los cruces no difieren entre sí, excepto los cruces 1/2 Lucerna-1/2 Brahman ya que obtuvo un menor desempeño con 24 kg menos que el cruce 100% Brahman, el cruce 1/2 Charolais-1/2 Brahman obtuvo un menor desempeño con 14 kg menos que el cruce 100% Brahman y entre estos dos cruces no hubo una diferencia (P>0.05). En la comparación de intervalo entre parto se mostró un mejor desempeño con los cruces 1/2 Charolais-1/2 Brahman ,1/2 Romagnola-1/2 Brahman y 1/2 Simmental-1/2 Brahman en comparación a la raza Brahman pura