Is a Parry Fracture—An Isolated Fracture of the Ulnar Shaft—Associated with the Probability of Abuse in Children between 2 and 16 Years Old?

A parry fracture is an isolated fracture of the ulnar shaft. It occurs when the ulna receives the full force of an impact when the forearm is raised to protect the face. The aim of this study is to assess a possible association between a parry fracture and the probability of abuse in children. In this retrospective, observational, multicenter study, we identified patients between 2 and 16 years old who had been treated for an isolated ulnar shaft fracture. Patient characteristics were registered, anonymized radiographs were rated, and charts were screened for referral to a child protective team. A total of 36 patients were analyzed. As no referrals were registered during follow-up, the primary outcome was changed to a perpendicular force as trauma mechanism. Univariable regression analysis and independent t-test both showed no significant association between patient factors or radiographic classification, and the reported trauma mechanism. We were unable to determine an association between a parry fracture and the probability of abuse. Since trauma mechanism does have a biomechanical effect on the fracture type, we would advise that a very clear reconstruction (and documentation) of the trauma mechanism should be established when a parry fracture is identified on radiographs.

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Durability and Failure Types of S2-Alar-Iliac Screws: An Analysis of 312 Consecutive Screws

Operative Neurosurgery ◽

10.1093/ons/opaa251 ◽

2020 ◽

Vol 20 (1) ◽

pp. 91-97

Author(s):

Seung-Jae Hyun ◽

Jong-myung Jung ◽

Ki-Jeong Kim ◽

Tae-Ahn Jahng

Keyword(s):

Clinical Outcomes ◽

Screw Fixation ◽

Patient Characteristics ◽

Shaft Fracture ◽

Consecutive Series ◽

Computed Tomographic ◽

Spinopelvic Fixation ◽

Iliac Screws ◽

Failure Types

Abstract BACKGROUND S2-alar-iliac (S2AI) screws improve stability across the lumbosacral junction in spinopelvic fixation procedures by crossing the cortical surfaces of the sacroiliac joint (SIJ), thereby increasing the biomechanical strength of the instrumentation. OBJECTIVE To investigate the durability and failure types of S2AI screws after spinopelvic reconstruction surgery. METHODS A single-center, single-surgeon consecutive series of patients who underwent spinopelvic fixation using bilateral S2AI screws with a ≥1-yr follow-up and at least 1 postoperative computed tomographic scan were retrospectively reviewed. Patient characteristics, radiographic parameters, operative data, clinical outcomes, and complications were analyzed. RESULTS In total, 312 S2AI screws in 156 patients were evaluated (mean follow-up, 26.1 mo; range 12-71 mo). There were no significant differences in screw diameter, length, or insertion angle between right-side and left-side screws. Visual analogue scale scores for back pain, ambulatory status, and Oswestry Disability Index scores significantly improved. A total of 10 patients (3.2%) experienced SIJ pain after S2AI screw installation. SIJ pain improved in 8 of them following SIJ block. In total, 7 screws (2.2%) showed partial periscrew lucency. Set screw dislodgement occurred in 7 screws (2.2%). Screw fracture occurred in 6 screws (1.9%): 5 neck fractures and 1 shaft fracture. A total of 5 patients (1.6%) underwent revision surgery for S2AI screw failure. Distal device (L4-pelvis region) breakage occurred in 5 patients. CONCLUSION The radiographic and clinical outcomes of S2AI screw fixation were acceptable. However, S2AI screw fixation has several drawbacks, including screw fracture and dislodgement of the set screw. SIJ irritation symptoms after S2AI screw fixation occurred with considerable frequency.

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Clozapine Re-Challenge and Initiation Despite Neutropenia and Outcomes from 14 Patients

10.21203/rs.2.16940/v1 ◽

2019 ◽

Author(s):

Edward Silva ◽

Melanie Higgins ◽

Barbara Hammer ◽

Paul Stephenson

Keyword(s):

Risk Mitigation ◽

Case Series ◽

Patient Characteristics ◽

Mitigation Strategies ◽

Treatment Resistant ◽

Serious Adverse Events ◽

The Face ◽

Risk Mitigation Strategies ◽

Male Patients

Abstract Objective: Clozapine remains the most effective intervention for treatment resistant schizophrenia. But its use is limited because of the risk of neutropenia and agranulocytosis. In the absence of effective alternatives its use after blood dyscrasias is possible. Methods: A case series of 14 male patients with treatment resistant schizophrenia treated with clozapine despite previous episodes of neutropenia between 2006 and 2015 is presented. Data were collected during 2015 and 2019. Using routinely collected clinical data we describe the patient characteristics, causes of neutropenia, the strategies used and outcomes. Results: Previous neutropaenia was due to varying aetiologies: benign ethnic neutropaenia; clozapine induced; other medication; autoimmune. A range of risk mitigation strategies were used to prevent neutropaenia on clozapine rechallenge: G-CSF; lithium; watch and wait. There were no serious adverse events associated with clozapine or risk mitigation treatments. At follow up during 2019, half of the original 14 patients had improved sufficiently to transfer to conditions of lesser security. Conclusion: With careful planning and monitoring, taking into account what is known about neutrophil biology, clozapine can be successfully reinitiated following CIN or in the face of preexisting neutropenia resulting in significant benefits for patients.

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Evaluation of Complications and Weight Outcomes in Pediatric Cerebral Palsy Patients With Gastrostomy Tubes

The American Surgeon ◽

10.1177/00031348211034753 ◽

2021 ◽

pp. 000313482110347

Author(s):

Jihane Jadi ◽

Sudipta Hyder ◽

Nidia P. Rodriguez Ormaza ◽

Emma Twer ◽

Michael Phillips ◽

...

Keyword(s):

Cerebral Palsy ◽

Primary Outcome ◽

Patient Characteristics ◽

Tube Placement ◽

Severe Malnutrition ◽

Bivariate Analysis ◽

Z Score ◽

Feeding Difficulties ◽

Weight Outcomes

Background Feeding difficulties are common in children with cerebral palsy (CP). The goal of this study was to examine pediatric CP patients undergoing gastrostomy tube (G tube) placement and assess the association between patient characteristics and weight after 3 months, 6 months, and 1 year. Methods This was a retrospective study of all pediatric patients with CP who received a G tube placement between April 2014 and December 2017 at a single institution. Bivariate analysis was used to examine association between patient characteristics and the primary outcome of improvement in weight Z score at 3, 6, and 12 months. Results Of 63 patients who received a G tube, 81% had an increase in Z score at 3 months, 44% at 6 months, and 64% at 12 months. By 12 months, factors associated with a positive Z score change included moderate and severe malnutrition, lack of prior G tube, and fewer comorbidities. The majority (69.8%) of patients experienced complications. Seven (11%) patients died, with only 1 death related to G tube placement. Discussion The use of G tubes in CP patients resulted in an increase in an improvement in nutritional status for the majority of patients over the course of a year. Although most complications were minor, patients had a high complication rate and frequently visited the emergency department, highlighting the need for standardized education and follow-up among this patient population.

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Antiretroviral Treatment-Associated Labia Majora Lipohypertrophy: A Rare Case and Plastic Surgical Treatment Options

Journal of Clinical and Health Sciences ◽

10.24191/jchs.v2i1.5877 ◽

2017 ◽

Vol 2 (1) ◽

pp. 43

Author(s):

Akmal Hisham ◽

Devananthan Ilenghoven ◽

Wan Syazli Wan Ahmad Kamal ◽

Salina Ibrahim ◽

Shah Jumaat Mohd Yussof

Keyword(s):

Highly Active Antiretroviral Therapy ◽

Daily Living ◽

Treatment Options ◽

Hiv Positive ◽

Highly Active ◽

Labia Majora ◽

The Face ◽

Central Fat

The emergence of highly active antiretroviral therapy (HAART) has revolutionized the prognosis of HIV-infected patients. However, the extended use of HAART is associated with a disfiguring complication termed lipodystrophy, a disorder of body fat maldistribution causing peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). Lipoatrophy commonly affects the face, legs, buttocks and arm, whilst lipohypertrophy frequently favours the abdomen, breast and dorsocervical region. To our knowledge, we present only the second documented case in the literature of a labia majora lipohypertrophy in a HIV-positive patient receiving long-term HAART. The severity of labial abnormality caused significant physical and functional morbidities. Labiaplasty with dermolipectomy of the labia majora and excisional lipectomy of the mons pubis was successfully performed. At a 6-month follow-up, patient had no recurrence with resolution of symptoms and resumption of normal activities of daily living (ADL).

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The impact of statin therapy after surgical or endovascular treatment of cerebral aneurysms

Journal of Neurosurgery ◽

10.3171/2019.3.jns183500 ◽

2020 ◽

Vol 133 (1) ◽

pp. 182-189

Author(s):

Tae-Jin Song ◽

Seung-Hun Oh ◽

Jinkwon Kim

Keyword(s):

Statin Therapy ◽

Coil Embolization ◽

Primary Outcome ◽

Cox Regression ◽

Cerebral Aneurysms ◽

Time Dependent ◽

Lipid Lowering ◽

Surgical Clipping ◽

The Impact

OBJECTIVECerebral aneurysms represent the most common cause of spontaneous subarachnoid hemorrhage. Statins are lipid-lowering agents that may expert multiple pleiotropic vascular protective effects. The authors hypothesized that statin therapy after coil embolization or surgical clipping of cerebral aneurysms might improve clinical outcomes.METHODSThis was a retrospective cohort study using the National Health Insurance Service–National Sample Cohort Database in Korea. Patients who underwent coil embolization or surgical clipping for cerebral aneurysm between 2002 and 2013 were included. Based on prescription claims, the authors calculated the proportion of days covered (PDC) by statins during follow-up as a marker of statin therapy. The primary outcome was a composite of the development of stroke, myocardial infarction, and all-cause death. Multivariate time-dependent Cox regression analyses were performed.RESULTSA total of 1381 patients who underwent coil embolization (n = 542) or surgical clipping (n = 839) of cerebral aneurysms were included in this study. During the mean (± SD) follow-up period of 3.83 ± 3.35 years, 335 (24.3%) patients experienced the primary outcome. Adjustments were performed for sex, age (as a continuous variable), treatment modality, aneurysm rupture status (ruptured or unruptured aneurysm), hypertension, diabetes mellitus, household income level, and prior history of ischemic stroke or intracerebral hemorrhage as time-independent variables and statin therapy during follow-up as a time-dependent variable. Consistent statin therapy (PDC > 80%) was significantly associated with a lower risk of the primary outcome (adjusted hazard ratio 0.34, 95% CI 0.14–0.85).CONCLUSIONSConsistent statin therapy was significantly associated with better prognosis after coil embolization or surgical clipping of cerebral aneurysms.

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Awareness of Pregnant Women for COVID-19 Infection

Tropical Health and Medical Research ◽

10.35916/thmr.v0i0.28 ◽

2020 ◽

Author(s):

Erhan Okuyan ◽

Emre Gunakan ◽

Sertaç Esin

Keyword(s):

Pregnant Women ◽

Respiratory Diseases ◽

Prospective Observational Study ◽

Information Source ◽

Home Birth ◽

Patient Characteristics ◽

Emotional Status ◽

Prevention Method ◽

And Behavior

Covid outbreak has been getting worse and spread affected all over the world. Pregnant patients are also vulnerable to respiratory diseases. We aimed to evaluate the awareness, emotional status, and behavior of pregnant during the COVID outbreak. This study's main benefit is to analyze the knowledge and understanding of pregnant women about the pandemic and draw attention to the prevention issues that need improvement. This research is a prospective observational study that 199 patients subjected to a questionnaire including 29 questions about patient characteristics, pregnancy information, knowledge about COVID19-infection, behavioral and emotional changes. 130 (65.3) of the patients stated an above-average knowledge level. Television was the most frequent information source (75.4%, n:150) and was the only information source for 90 (45.1%) of the patients. Sixty-nine patients used more than one information source. More than one prevention method uses by 149 (75%) of the patients. Washing hands (n:183, 92.0%) and cleaning the house (n:122, 61.3%) were the most preferred methods. Only 55 (27.6%) of the patients used a mask for prevention. 88(44.2%) of the patients stated that they preferred a shorter hospital stay, and 75 (37.7%) of the patients indicated that they postponed or avoided the pregnancy follow-up visits due to the COVID-19 issue. Pregnant women seem to be aware and stressed of COVID-19, but knowledge of what to do seems insufficient. Patients informed of risks of COVID infection, unplanned hospital admission, and chances of avoiding necessary visits and home birth demands.

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Cerebrospinal Fluid Shunt-Associated Surgical Site Infection With Three- Versus Twelve-Month Follow-Up in Canadian Hospitals

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.679 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s157-s157

Author(s):

Kelly Baekyung Choi ◽

John Conly ◽

Blanda Chow ◽

Joanne Embree ◽

Bonita Lee ◽

...

Keyword(s):

Surgical Site Infection ◽

Age Distribution ◽

Patient Characteristics ◽

Csf Shunt ◽

Surveillance Program ◽

Site Infection ◽

Infection Surveillance ◽

Surgical Manipulation ◽

National Systems

Background: Surgical site infection (SSI) after cerebrospinal fluids (CSF) shunt surgery is thought to be acquired intraoperatively. Biomaterial-associated infection can present up to 1 year after surgery, but many national systems have shortened follow-up to 90 days. We compared 3- versus 12-month follow-up periods to determine the nature of case ascertainment in the 2 periods. Methods: Participants of any age with placement of an internal CSF shunt or revision surgical manipulation of an existing internal shunt identified in the Canadian Nosocomial Infection Surveillance Program (CNISP) participating hospitals between 2006 and 2018 were eligible. We excluded patients with external shunting devices or culture-positive CSF at the time of surgery. Patients were followed for 12 months after surgery for the primary outcome of a CSF infection with a positive CSF culture by review of laboratory and health records. Patients were categorized as adult (aged ≥18 years) or pediatric (aged < 18 years). The infection rate was expressed as the number of CSF shunt-associated infections divided by the number of shunt surgeries per 100 procedures. Results: In total, 325 patients (53% female) met inclusion criteria in 14 hospitals from 7 provinces were identified. Overall, 46.1% of surgeries were shunt revisions and 90.3% of shunts were ventriculoperitoneal. For pediatric patients, the median age was 0.7 years (IQR, 0.2–7.0). For adult patients, the median age was 47.9 years (IQR, 29.6–64.6). The SSI rates per 100 procedures were 3.69 for adults and 3.65 for pediatrics. The overall SSI rates per 100 procedures at 3 and 12 months were 2.74 (n = 265) and 3.48 (n = 323), respectively. By 3 months (90 days), 82% of infection cases were identified (Fig. 1). The median time from procedure to SSI detection was 30 days (IQR, 10–65). No difference was found in the microbiology of the shunt infections at 3- and 12-month follow-ups. The most common pathogens were coagulase-negative Staphylococcus (43.6 %), followed by S. aureus (24.8 %) and Propionibacterium spp (6.5 %). No differences in age distribution, gender, surgery type (new or revision), shunt type, or infecting organisms were observed when 3- and 12-month periods were compared. Conclusions: CSF-SSI surveillance for 3 versus 12 months would capture 82.0% (95% CI, 77.5–86.0) of cases, with no significant differences in the patient characteristics, surgery types, or pathogens. A 3-month follow-up can reduce resources and allow for more timely reporting of infection rates.Funding: NoneDisclosures: None

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Real-World Outcomes of Ivacaftor Treatment in People with Cystic Fibrosis: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10071527 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1527

Author(s):

Jamie Duckers ◽

Beth Lesher ◽

Teja Thorat ◽

Eleanor Lucas ◽

Lisa J. McGarry ◽

...

Keyword(s):

Systematic Review ◽

Cystic Fibrosis ◽

Real World ◽

Safety Profile ◽

Clinical Trial Data ◽

Patient Characteristics ◽

Healthcare Resource Utilization ◽

Patient Reported ◽

Clinical Benefits

Cystic fibrosis (CF) is a rare, progressive, multi-organ genetic disease. Ivacaftor, a small-molecule CF transmembrane conductance regulator modulator, was the first medication to treat the underlying cause of CF. Since its approval, real-world clinical experience on the use of ivacaftor has been documented in large registries and smaller studies. Here, we systematically review data from real-world observational studies of ivacaftor treatment in people with CF (pwCF). Searches of MEDLINE and Embase identified 368 publications reporting real-world studies that enrolled six or more pwCF treated with ivacaftor published between January 2012 and September 2019. Overall, 75 publications providing data from 57 unique studies met inclusion criteria and were reviewed. Studies reporting within-group change for pwCF treated with ivacaftor consistently showed improvements in lung function, nutritional parameters, and patient-reported respiratory and sino-nasal symptoms. Benefits were evident as early as 1 month following ivacaftor initiation and were sustained over long-term follow-up. Decreases in pulmonary exacerbations, Pseudomonas aeruginosa prevalence, and healthcare resource utilization also were reported for up to 66 months following ivacaftor initiation. In studies comparing ivacaftor treatment to modulator untreated comparator groups, clinical benefits similarly were reported as were decreases in mortality, organ-transplantation, and CF-related complications. The safety profile of ivacaftor observed in these real-world studies was consistent with the well-established safety profile based on clinical trial data. Our systematic review of real-world studies shows ivacaftor treatment in pwCF results in highly consistent and sustained clinical benefit in both pulmonary and non-pulmonary outcomes across various geographies, study designs, patient characteristics, and follow-up durations, confirming and expanding upon evidence from clinical trials.

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Progression of cerebral infarction before and after thrombectomy is modified by prehospital pathways

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-017155 ◽

2021 ◽

pp. neurintsurg-2020-017155

Author(s):

Alexander M Kollikowski ◽

Franziska Cattus ◽

Julia Haag ◽

Jörn Feick ◽

Alexander G März ◽

...

Keyword(s):

Patient Characteristics ◽

Large Vessel ◽

Stroke Severity ◽

Large Vessel Occlusion ◽

Time Intervals ◽

Vessel Occlusion ◽

Before And After ◽

Transferred Patients ◽

Stroke Center

BackgroundEvidence of the consequences of different prehospital pathways before mechanical thrombectomy (MT) in large vessel occlusion stroke is inconclusive. The aim of this study was to investigate the infarct extent and progression before and after MT in directly admitted (mothership) versus transferred (drip and ship) patients using the Alberta Stroke Program Early CT Score (ASPECTS).MethodsASPECTS of 535 consecutive large vessel occlusion stroke patients eligible for MT between 2015 to 2019 were retrospectively analyzed for differences in the extent of baseline, post-referral, and post-recanalization infarction between the mothership and drip and ship pathways. Time intervals and transport distances of both pathways were analyzed. Multiple linear regression was used to examine the association between infarct progression (baseline to post-recanalization ASPECTS decline), patient characteristics, and logistic key figures.ResultsASPECTS declined during transfer (9 (8–10) vs 7 (6-9), p<0.0001), resulting in lower ASPECTS at stroke center presentation (mothership 9 (7–10) vs drip and ship 7 (6–9), p<0.0001) and on follow-up imaging (mothership 7 (4–8) vs drip and ship 6 (3–7), p=0.001) compared with mothership patients. Infarct progression was significantly higher in transferred patients (points lost, mothership 2 (0–3) vs drip and ship 3 (2–6), p<0.0001). After multivariable adjustment, only interfacility transfer, preinterventional clinical stroke severity, the degree of angiographic recanalization, and the duration of the thrombectomy procedure remained predictors of infarct progression (R2=0.209, p<0.0001).ConclusionsInfarct progression and postinterventional infarct extent, as assessed by ASPECTS, varied between the drip and ship and mothership pathway, leading to more pronounced infarction in transferred patients. ASPECTS may serve as a radiological measure to monitor the benefit or harm of different prehospital pathways for MT.

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Comparative study of intracranial access in thrombectomy using next generation 0.088 inch guide catheter technology

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017341 ◽

2021 ◽

pp. neurintsurg-2021-017341

Author(s):

Devin V Bageac ◽

Blake S Gershon ◽

Jan Vargas ◽

Maxim Mokin ◽

Zeguang Ren ◽

...

Keyword(s):

Primary Outcome ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Control Group ◽

Anterior Circulation ◽

Guide Catheter ◽

Catheter Failure ◽

Catheter Technology ◽

Intracranial Vasculature

BackgroundMost conventional 0.088 inch guide catheters cannot safely navigate intracranial vasculature. The objective of this study is to evaluate the safety of stroke thrombectomy using a novel 0.088 inch guide catheter designed for intracranial navigation.MethodsThis is a multicenter retrospective study, which included patients over 18 years old who underwent thrombectomy for anterior circulation large vessel occlusions. Technical outcomes for patients treated using the TracStar Large Distal Platform (TracStar LDP) or earlier generation TRX LDP were compared with a matched cohort of patients treated with other commonly used guide catheters. The primary outcome measure was device-related complications. Secondary outcome measures included guide catheter failure and time between groin puncture and clot engagement.ResultsEach study arm included 45 patients. The TracStar group was non-inferior to the control group with regard to device-related complications (6.8% vs 8.9%), and the average time to clot engagement was 8.89 min shorter (14.29 vs 23.18 min; p=0.0017). There were no statistically significant differences with regard to other technical outcomes, including time to recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2B). The TracStar was successfully advanced into the intracranial internal carotid artery in 33 cases (73.33%); in three cases (6.67%), it was swapped for an alternate catheter. Successful reperfusion (mTICI 2B-3) was achieved in 95.56% of cases. Ninety-day follow-up data were available for 86.67% of patients, among whom 46.15% had an modified Rankin Score of 0–2%, and 10.26% were deceased.ConclusionsTracstar LDP is safe for use during stroke thrombectomy and was associated with decreased time to clot engagement. Intracranial access was regularly achieved.

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