The Impact of External Fixation of Femoral Fractures on Mortality and Morbidity in Polytrauma Patients

Polytrauma represents one of the most challenging aspects of modern medicine, due to its high mortality and morbidity, affecting especially young, active patients. Therefore, research is nowadays directed towards optimising the treatment for these patients, which is extremely difficult, as polytrauma is characterized by a complicated pathophysiology with intricate pathways, potentially generating local and general complications and requiring a multidisciplinary approach. An essential issue for these patients is a careful monitoring algorithm, able to determine an appropriate therapeutic response in due time, so objective, measurable and reproducible elements able to do this have been sought. Since biochemical markers have these properties, and the most important pathogenic element in polytrauma is the Systemic Inflammatory Response Syndrome (SIRS), the authors of this paper evaluate the predictive value of inflammatory markers in order to improve the monitoring algorithm of these patients. The results of this prospective study demonstrate some statistically significant correlations, such as those between lactate (at admission and 24 hours later) and mortality, as well as between IL-6 and early systemic complications, which are of great value because they can concentrate the efforts of the multidisciplinary team and save the life of the poytrauma patient.

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Key Aspects of Assessing Effectiveness and Efficiency of Implementation of the Federal Clean Air Project on the Example of the Comprehensive Emission Reduction Action Plan in Nizhny Tagil

ЗДОРОВЬЕ НАСЕЛЕНИЯ И СРЕДА ОБИТАНИЯ - ЗНиСО / PUBLIC HEALTH AND LIFE ENVIRONMENT ◽

10.35627/2219-5238/2020-330-9-48-60 ◽

2020 ◽

pp. 48-60

Author(s):

SV Yarushin ◽

DV Kuzmin ◽

AA Shevchik ◽

TM Tsepilova ◽

VB Gurvich ◽

...

Keyword(s):

Emission Reduction ◽

Action Plan ◽

Local Population ◽

Ambient Air ◽

Ambient Air Pollution ◽

Mortality And Morbidity ◽

Industrial Enterprises ◽

Clean Air ◽

Effectiveness And Efficiency ◽

The Impact

Introduction: Key issues of assessing effectiveness and economic efficiency of implementing the Federal Clean Air Project by public health criteria are considered based on the example of the Comprehensive Emission Reduction Action Plan realized in the city of Nizhny Tagil, Sverdlovsk Region. Materials and methods: We elaborated method approaches and reviewed practical aspects of evaluating measures taken in 2018–2019 at key urban industrial enterprises accounting for 95 % of stationary source emissions. Results: Summary calculations of ambient air pollution and carcinogenic and non-carcinogenic inhalation health risks including residual risks, evaluation of the impact of air quality on urban mortality and morbidity rates, economic assessment of prevented morbidity and premature mortality cases have enabled us not only to estimate health effects but also to develop guidelines for development and implementation of actions aimed at enhancing effectiveness and efficiency of industrial emission reduction in terms of health promotion of the local population. Conclusions: We substantiate proposals for the necessity and sufficiency of taking remedial actions ensuring achievement of acceptable health risk levels as targets of the Comprehensive Emission Reduction Action Plan in Nizhny Tagil until 2024 and beyond.

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Association between Intraoperative Blood Transfusion and Mortality and Morbidity in Patients Undergoing Noncardiac Surgery

Anesthesiology ◽

10.1097/aln.0b013e3182054d06 ◽

2011 ◽

Vol 114 (2) ◽

pp. 283-292 ◽

Cited By ~ 312

Author(s):

Laurent G. Glance ◽

Andrew W. Dick ◽

Dana B. Mukamel ◽

Fergal J. Fleming ◽

Raymond A. Zollo ◽

...

Keyword(s):

Blood Transfusion ◽

Noncardiac Surgery ◽

Pulmonary Complications ◽

Wound Complications ◽

Severe Anemia ◽

Thromboembolic Complications ◽

Mortality And Morbidity ◽

Risk Of Death ◽

Increased Risk ◽

The Impact

Background The impact of intraoperative erythrocyte transfusion on outcomes of anemic patients undergoing noncardiac surgery has not been well characterized. The objective of this study was to examine the association between blood transfusion and mortality and morbidity in patients with severe anemia (hematocrit less than 30%) who are exposed to one or two units of erythrocytes intraoperatively. Methods This was a retrospective analysis of the association of blood transfusion and 30-day mortality and 30-day morbidity in 10,100 patients undergoing general, vascular, or orthopedic surgery. We estimated separate multivariate logistic regression models for 30-day mortality and for 30-day complications. Results Intraoperative blood transfusion was associated with an increased risk of death (odds ratio [OR], 1.29; 95% CI, 1.03-1.62). Patients receiving an intraoperative transfusion were more likely to have pulmonary, septic, wound, or thromboembolic complications, compared with patients not receiving an intraoperative transfusion. Compared with patients who were not transfused, patients receiving one or two units of erythrocytes were more likely to have pulmonary complications (OR, 1.76; 95% CI, 1.48-2.09), sepsis (OR, 1.43; 95% CI, 1.21-1.68), thromboembolic complications (OR, 1.77; 95% CI, 1.32-2.38), and wound complications (OR, 1.87; 95% CI, 1.47-2.37). Conclusions Intraoperative blood transfusion is associated with a higher risk of mortality and morbidity in surgical patients with severe anemia. It is unknown whether this association is due to the adverse effects of blood transfusion or is, instead, the result of increased blood loss in the patients receiving blood.

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Detection of diarrhoea associated rotavirus and co-infection with diarrhoeagenic pathogens in the Littoral region of Cameroon using ELISA, RT-PCR and Luminex xTAG GPP assays

BMC Infectious Diseases ◽

10.1186/s12879-021-06318-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Rahinatou N. Ghapoutsa ◽

Maurice Boda ◽

Rashi Gautam ◽

Valantine Ngum Ndze ◽

Akongnwi E. Mugyia ◽

...

Keyword(s):

Demographic Data ◽

Laboratory Diagnosis ◽

Epidemiological Studies ◽

Sub Saharan Africa ◽

Rt Pcr ◽

Mortality And Morbidity ◽

Vaccine Introduction ◽

Littoral Region ◽

Rotavirus Vaccines ◽

The Impact

Abstract Background Despite the global roll-out of rotavirus vaccines (RotaTeq/Rotarix / ROTAVAC/Rotasiil), mortality and morbidity due to group A rotavirus (RVA) remains high in sub-Saharan Africa, causing 104,000 deaths and 600,000 hospitalizations yearly. In Cameroon, Rotarix™ was introduced in March 2014, but, routine laboratory diagnosis of rotavirus infection is not yet a common practice, and vaccine effectiveness studies to determine the impact of vaccine introduction have not been done. Thus, studies examining RVA prevalence post vaccine introduction are needed. The study aim was to determine RVA prevalence in severe diarrhoea cases in Littoral region, Cameroon and investigate the role of other diarrheagenic pathogens in RVA-positive cases. Methods We carried out a study among hospitalized children < 5 years of age, presenting with acute gastroenteritis in selected hospitals of the Littoral region of Cameroon, from May 2015 to April 2016. Diarrheic stool samples and socio-demographic data including immunization and breastfeeding status were collected from these participating children. Samples were screened by ELISA (ProSpecT™ Rotavirus) for detection of RVA antigen and by gel-based RT-PCR for detection of the VP6 gene. Co-infection was assessed by multiplexed molecular detection of diarrheal pathogens using the Luminex xTAG GPP assay. Results The ELISA assay detected RVA antigen in 54.6% (71/130) of specimens, with 45, positive by VP6 RT-PCR and 54, positive using Luminex xTAG GPP. Luminex GPP was able to detect all 45 VP6 RT-PCR positive samples. Co-infections were found in 63.0% (34/54) of Luminex positive RVA infections, with Shigella (35.3%; 12/34) and ETEC (29.4%; 10/34) detected frequently. Of the 71 ELISA positive RVA cases, 57.8% (41/71) were fully vaccinated, receiving two doses of Rotarix. Conclusion This study provides insight on RVA prevalence in Cameroon, which could be useful for post-vaccine epidemiological studies, highlights higher than expected RVA prevalence in vaccinated children hospitalized for diarrhoea and provides the trend of RVA co-infection with other enteric pathogens. RVA genotyping is needed to determine circulating rotavirus genotypes in Cameroon, including those causing disease in vaccinated children.

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European registry of type A aortic dissection (ERTAAD) - rationale, design and definition criteria

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01536-5 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Fausto Biancari ◽

Giovanni Mariscalco ◽

Hakeem Yusuff ◽

Geoffrey Tsang ◽

Suvitesh Luthra ◽

...

Keyword(s):

Adverse Events ◽

Aortic Dissection ◽

Treatment Strategies ◽

Kidney Injury ◽

Type A ◽

Salvage Procedure ◽

Type A Aortic Dissection ◽

Mortality And Morbidity ◽

Link Type ◽

The Impact

Abstract Background Acute Stanford type A aortic dissection (TAAD) is a life-threatening condition. Surgery is usually performed as a salvage procedure and is associated with significant postoperative early mortality and morbidity. Understanding the patient’s conditions and treatment strategies which are associated with these adverse events is essential for an appropriate management of acute TAAD. Methods Nineteen centers of cardiac surgery from seven European countries have collaborated to create a multicentre observational registry (ERTAAD), which will enroll consecutive patients who underwent surgery for acute TAAD from January 2005 to March 2021. Analysis of the impact of patient’s comorbidities, conditions at referral, surgical strategies and perioperative treatment on the early and late adverse events will be performed. The investigators have developed a classification of the urgency of the procedure based on the severity of preoperative hemodynamic conditions and malperfusion secondary to acute TAAD. The primary clinical outcomes will be in-hospital mortality, late mortality and reoperations on the aorta. Secondary outcomes will be stroke, acute kidney injury, surgical site infection, reoperation for bleeding, blood transfusion and length of stay in the intensive care unit. Discussion The analysis of this multicentre registry will allow conclusive results on the prognostic importance of critical preoperative conditions and the value of different treatment strategies to reduce the risk of early adverse events after surgery for acute TAAD. This registry is expected to provide insights into the long-term durability of different strategies of surgical repair for TAAD. Trial registration ClinicalTrials.gov Identifier: NCT04831073.

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910. A Comprehensive, One Year, Hospital-Wide Snapshot of All Serious Infectious Complications in People Who Inject Drugs

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1098 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S489-S490

Author(s):

John T Henderson ◽

Evelyn Villacorta Cari ◽

Nicole Leedy ◽

Alice Thornton ◽

Donna R Burgess ◽

...

Keyword(s):

Multivariable Analysis ◽

Vertebral Osteomyelitis ◽

The United States ◽

Infectious Complications ◽

Data Set ◽

Cumulative Impact ◽

Mortality And Morbidity ◽

Icu Admission ◽

Risk Of Death ◽

The Impact

Abstract Background There has been a dramatic rise in IV drug use (IVDU) and its associated mortality and morbidity, however, the scope of this effect has not been described. Kentucky is at the epicenter of this epidemic and is an ideal place to better understand the health complications of IVDU in order to improve outcomes. Methods All adult in-patient admissions to University of Kentucky hospitals in 2018 with an Infectious Diseases (ID) consult and an ICD 9/10 code associated with IVDU underwent thorough retrospective chart review. Demographic, descriptive, and outcome data were collected and analyzed by standard statistical analysis. Results 390 patients (467 visits) met study criteria. The top illicit substances used were methamphetamine (37.2%), heroin (38.2%), and cocaine (10.3%). While only 4.1% of tested patients were HIV+, 74.2% were HCV antibody positive. Endocarditis (41.1%), vertebral osteomyelitis (20.8%), bacteremia without endocarditis (14.1%), abscess (12.4%), and septic arthritis (10.4%) were the most common infectious complications. The in-patient death rate was 3.0%, and 32.2% of patients were readmitted within the study period. The average length of stay was 26 days. In multivariable analysis, infectious endocarditis was associated with a statistically significant increase in risk of death, ICU admission, and hospital readmission. Although not statistically significant, trends toward mortality and ICU admission were identified for patients with prior endocarditis and methadone was correlated with decreased risk of readmission and ICU stay. FIGURE 1: Reported Substances Used FIGURE 2: Comorbidities FIGURE 3: Types of Severe Infectious Complications Conclusion We report on a novel, comprehensive perspective on the serious infectious complications of IVDU in an attempt to measure its cumulative impact in an unbiased way. This preliminary analysis of a much larger dataset (2008-2019) reveals some sobering statistics about the impact of IVDU in the United States. While it confirms the well accepted mortality and morbidity associated with infective endocarditis and bacteremia, there is a significant unrecognized impact of other infectious etiologies. Additional analysis of this data set will be aimed at identifying key predictive factors in poor outcomes in hopes of mitigating them. Disclosures All Authors: No reported disclosures

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Fracture fixation strategy and specific muscle tissue availability of neutrophilic granulocytes following mono- and polytrauma: intramedullary nailing vs. external fixation of femoral fractures

European Journal of Medical Research ◽

10.1186/s40001-020-00461-y ◽

2020 ◽

Vol 25 (1) ◽

Author(s):

Johannes Greven ◽

Klemens Horst ◽

Zhi Qiao ◽

Felix Marius Bläsius ◽

Ümit Mert ◽

...

Keyword(s):

Clinical Practice ◽

External Fixation ◽

Intramedullary Nailing ◽

Muscle Tissue ◽

Femur Fracture ◽

Femoral Fractures ◽

Pig Model ◽

Minor Role ◽

Neutrophil Granulocytes ◽

Concomitant Injuries

Abstract Background In the stabilization of femoral fractures in mono- and polytrauma, clinical practice has shown better care through intramedullary nailing. However, the reason why this is the case is not fully understood. In addition to concomitant injuries, the immunological aspect is increasingly coming to the fore. Neutrophil granulocytes (PMNL), in particular next to other immunological cell types, seem to be associated with the fracture healing processes. For this reason, the early phase after fracture (up to 72 h after trauma) near the fracture zone in muscle tissue was investigated in a pig model. Material and methods A mono- and polytrauma pig model (sole femur fracture or blunt thoracic trauma, hemorrhagic shock, liver laceration, and femur fracture) was used to demonstrate the immunological situation through muscle biopsies and their analysis by histology and qRT-PCR during a 72 h follow-up phase. Two stabilization methods were used (intramedullary nail vs. external fixator) and compared with a nontraumatized sham group. Results Monotrauma shows higher PMNL numbers in muscle tissue compared with polytrauma (15.52 ± 5.39 mono vs. 8.23 ± 3.36 poly; p = 0.013), regardless of the treatment strategy. In contrast, polytrauma shows a longer lasting invasion of PMNL (24 h vs. 72 h). At 24 h in the case of monotrauma, the fracture treated with external fixation shows more PMNL than the fracture treated with intramedullary nailing (p = 0.026). This difference cannot be determined in polytrauma probably caused by a generalized immune response. Both monotrauma and polytrauma show a delayed PMNL increase in the muscle tissue of the uninjured side. The use of intramedullary nailing in monotrauma resulted in a significant increase in IL-6 (2 h after trauma) and IL-8 (24 and 48 h after trauma) transcription. Conclusion The reduction of PMNL invasion into the nearby muscle tissue of a monotrauma femur fracture stabilized by intramedullary nailing supports the advantages found in everyday clinical practice and therefore underlines the usage of nailing. For the polytrauma situation, the fixation seems to play a minor role, possibly due to a generalized immune reaction.

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