Bedside Ultrasound for Early Diagnosis of Necrotizing Enterocolitis: A Pilot Study.

OBJECTIVE: This study aimed to assess whether bedside ultrasound (BUS) as the first imaging modality allows an earlier diagnosis of necrotizing enterocolitis (NEC) compared with abdominal radiography. STUDY DESIGN: A before-after controlled study in preterm infants with suspected NEC. The intervention group (October 2019-October 2021) received BUS as the first imaging modality and was managed accordingly to BUS findings. The control group (October 2015-September 2019) received radiography as the first imaging modality. The main outcome was NEC confirmation at the time of initial imaging. Secondary outcomes included time to diagnosis, laboratory data, and treatment requirements. RESULTS: Thirty-five episodes of suspected NEC with 14 (40%) confirmed NEC cases and 49 episodes of suspected NEC with 22 (44.9%) confirmed NEC cases were included in the intervention and control groups, respectively. In the intervention group, 11 of 14 (78.6%) NEC cases were confirmed at initial evaluation compared with 5 of 22 (22.7%) in the control group (p = 0.001). Infants in the intervention group developed thrombocytopenia and coagulopathy less frequently, were exposed to less radiation, and required less days of parenteral nutrition compared with the control group (p < 0.05). CONCLUSION: The use of BUS as the first imaging modality allowed an earlier diagnosis and timely treatment of NEC compared with abdominal radiography.Key Points · This is the first study that has assessed the role of BUS as the first imaging modality in NEC.. · BUS improves early diagnosis of NEC compared with abdominal radiography.. · BUS shortens time to NEC confirmation and treatment initiation which may reduce clinical severity of the NEC episode..

Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study.

OBJECTIVES: The impact of inflammatory rheumatic diseases on COVID-19 severity is poorly known. Here, we compare the outcomes of a cohort of patients with rheumatic diseases with a matched control cohort to identify potential risk factors for severe illness. METHODS: In this comparative cohort study, we identified hospital PCR+COVID-19 rheumatic patients with chronic inflammatory arthritis (IA) or connective tissue diseases (CTDs). Non-rheumatic controls were randomly sampled 1:1 and matched by age, sex and PCR date. The main outcome was severe COVID-19, defined as death, invasive ventilation, intensive care unit admission or serious complications. We assessed the association between the outcome and the potential prognostic variables, adjusted by COVID-19 treatment, using logistic regression. RESULTS: The cohorts were composed of 456 rheumatic and non-rheumatic patients, in equal numbers. Mean age was 63 (IQR 53-78) years and male sex 41% in both cohorts. Rheumatic diseases were IA (60%) and CTD (40%). Most patients (74%) had been hospitalised, and the risk of severe COVID-19 was 31.6% in the rheumatic and 28.1% in the non-rheumatic cohort. Ageing, male sex and previous comorbidity (obesity, diabetes, hypertension, cardiovascular or lung disease) increased the risk in the rheumatic cohort by bivariate analysis. In logistic regression analysis, independent factors associated with severe COVID-19 were increased age (OR 4.83; 95% CI 2.78 to 8.36), male sex (1.93; CI 1.21 to 3.07) and having a CTD (OR 1.82; CI 1.00 to 3.30). CONCLUSION: In hospitalised patients with chronic inflammatory rheumatic diseases, having a CTD but not IA nor previous immunosuppressive therapies was associated with severe COVID-19.

Prevalence of hospital PCR-confirmed COVID-19 cases in patients with chronic inflammatory and autoimmune rheumatic diseases.

BACKGROUND: The susceptibility of patients with rheumatic diseases and the risks or benefits of immunosuppressive therapies for COVID-19 are unknown. METHODS: We performed a retrospective study with patients under follow-up in rheumatology departments from seven hospitals in Spain. We matched updated databases of rheumatology patients with severe acute respiratory syndrome coronavirus 2-positive PCR tests performed in the hospital to the same reference populations. Rates of PCR+ confirmed COVID-19 were compared among groups. RESULTS: Patients with chronic inflammatory diseases had 1.32-fold higher prevalence of hospital PCR+ COVID-19 than the reference population (0.76% vs 0.58%). Patients with systemic autoimmune or immune-mediated disease (AI/IMID) showed a significant increase, whereas patients with inflammatory arthritis (IA) or systemic lupus erythematosus did not. COVID-19 cases in some but not all diagnostic groups had older ages than cases in the reference population. Patients with IA on targeted-synthetic or biological disease-modifying antirheumatic drugs (DMARDs), but not those on conventional-synthetic DMARDs, had a greater prevalence despite a similar age distribution. CONCLUSION: Patients with AI/IMID show a variable risk of hospital-diagnosed COVID-19. Interplay of ageing, therapies and disease-specific factors seem to contribute. These data provide a basis to improve preventive recommendations to rheumatic patients and to analyse the specific factors involved in COVID-19 susceptibility.

Clasificación de Neer. Variabilidad interobservador / Interobserver Variability Of Neer Classification

Introducción Hacer objetiva la variabilidad interobservador al evaluar una fractura de húmero proximal utilizando la clasificación de Neer y establecer su utilidad diagnóstica y terapéutica. Materiales y Métodos Formulario digital con 20 casos elegidos al azar de fracturas de húmero proximal, de un mismo hospital entre 2010 y 2014. Cada caso incluyó: edad, sexo, lateralidad y dos proyecciones radiográficas. Evaluado de forma anónima por Traumatólogos, con y sin práctica habitual en cirugía del hombro, de hospitales nacionales e internacionales, indicando estadío de Neer y opción terapéutica adecuada. Se estableció la variabilidad interobservador entre grupos y comparando a todos por igual, calculando el índice de Kappa de Fleiss e interpretándolo según los criterios de Landis y Koch. Resultados 40 respuestas de Traumatólogos, 15 con práctica habitual de cirugía de hombro y 25 no. El índice Kappa de Fleiss medio fue 0,173 en el grupo de Traumatólogos con práctica habitual en cirugía de hombro. Siendo 0,176 en el grupo sin práctica habitual. Al evaluarlos conjuntamente, 0,184. Existe gran variabilidad interobservador en la indicación terapéutica y dentro de la indicación quirúrgica. Discusión El grado de acuerdo obtenido, según los criterios de Landis y Koch, ha sido pobre en todos los grupos en lo que a estadío se refiere y débil en lo referente al tratamiento, no influyendo la experiencia del Traumatólogo. Sería necesaria una clasificación más reproducible ya que la clasificación de Neer presenta la suficiente variabilidad interobservador como para aceptarla como único medio en la toma de decisiones.

Background To study inter-observer variability by evaluating a fracture of the proximal humerus using Neer's classification and to establish its diagnostic and therapeutic utility. Methods A computerised form was used with 20 randomly selected cases of fractures of the proximal humerus, from the same hospital between 2010 and 2014. Each case included: age, gender, laterality, and two radiographic projections. They were anonymously evaluated by Traumatologists, for whom shoulder surgery was routine practice or not, from national and international hospitals. They indicated Neer stage and an appropriate therapeutic option. Interobserver variability was established between groups, and comparing all of them equally, calculating Fleap's Kappa index and interpreting it according to the Landis and Koch criteria. Results A total of 40 responses were obtained from the Traumatologists, 15 of them were shoulder surgery was usual practice and 25 where it was not. The mean Fleap Kappa index was 0.173 in the Traumatologists group were shoulder surgery was usual practice, being 0.176 in the group were it was not usual practice. The overall index was 0.184. There is wide interobserver variability in the therapeutic indication, as well as within the surgical indication. Discussion The level of agreement obtained, according to the criteria of Landis and Koch, was poor in all groups in terms of stage, and weak in terms of treatment. The experience of the Traumatologist had no influence. A more reproducible classification may be necessary since Neer's classification has sufficient interobserver variability to accept it as the sole means of decision making.

Estudio comparativo entre clavo endomedular y tratamiento conservador en fracturas de húmero proximal de 2 y 3 fragmentos / Comparative study between intramedullary nailing and conservative treatment in proximal humerus fractures of 2 and 3 fragments

Introducción Hacer objetivas las diferencias relativas a funcionalidad y calidad de vida entre pacientes con fracturas de húmero proximal de 2 y 3 fragmentos tratados de forma conservadora y mediante enclavado endomedular. Materiales y Métodos Estudio descriptivo-retrospectivo realizado en un mismo centro hospitalario entre junio de 2010 y mayo de 2014. Se incluyeron pacientes con fractura de húmero proximal de 2 y 3 fragmentos, excluyendo los menores de 60 años. Se evaluó la movilidad, test de Constant y ASES. El análisis estadístico se realizó con el programa SPSS. Resultados 71 pacientes seleccionados; 43 presentaban fractura de 2 fragmentos y 28 de 3. Mediante enclavado endomedular fueron tratados 15, con una media de edad de 76,7 años, y 38 recibieron tratamiento conservador, con una edad media de 79,8 años; en ambos grupos el número de mujeres fue mayor. Las puntuaciones de los cuestionarios Constant y ASES fueron superiores en el grupo que recibió tratamiento conservador, al igual que su grado de satisfacción y mejor movilidad y funcionalidad. Discusión En las fracturas de 2 y 3 fragmentos el tratamiento conservador es utilizado en gran parte de los casos. La edad no es un factor influyente a la hora de decantarse por una u otra opción terapéutica. La mayoría de los pacientes están satisfechos con el tratamiento recibido. En los test de Constant y ASES obtienen mejor resultado los pacientes tratados de forma conservadora. La abducción y la flexión son ligeramente superiores en pacientes que recibieron tratamiento conservador.

Background To study the differences related to functionality and quality of life between patients with proximal humerus fractures of 2 and 3 fragments treated conservatively and by using intramedullary nailing. Material and Methods Descriptive-retrospective study was conducted in the same hospital between June 2010 and May 2014. Patients with proximal humerus fractures of 2 and 3 fragments were included. Patients under 60 years were excluded. Mobility was evaluated, using the Constant and ASES (American Shoulder and Elbow Surgeons) test. Statistical analysis was performed using the SPSS program. Results Of the 71 selected patients, 43 had a 2 fragments fracture, and 28 had a 3 fragment fracture Intramedullary nailing was used to treat 15 cases (with a mean age of 76.7 years), and 38 (mean age 79.8 years) received conservative treatment. The number of women was higher in both groups. The scores of the Constant and ASES questionnaires were higher in the group that received conservative treatment. They also had a higher level of satisfaction and better mobility and functionality. Discussion In fractures of 2 and 3 fragments conservative treatment is used in a large majority of the cases. Age is not an influential factor when opting for one or another therapeutic option. Most patients are satisfied with the treatment received. Patients treated conservatively obtain better results in the Constant and ASES tests. Abduction and flexion are slightly higher in patients that received conservative treatment.

The Fourth Extensor Compartment Artery Vascularized Bone Graft of the Distal Radius for CMC Fusion in the Treatment of Carpal Boss: A Case Report.

BACKGROUND: Carpometacarpal joints can be affected by traumatic or degenerative pathology. Although different techniques have been described to treat these conditions, most authors agree that arthrodesis is an effective treatment modality. Vascularized bone grafts of the distal radius have been used to treat carpal conditions, such as scaphoid nonunion or Kiënbock disease, and they have been shown to have several advantages over nonvascularized bone grafts. METHODS: We report a case of a carpal boss in a female patient treated with an arthrodesis of the second and third carpometacarpal joints by using the fourth extensor compartment artery vascularized bone graft. RESULTS: At 6 weeks postoperative bone union was achieved. At 2 years follow-up the patient was able to perform daily life activities without pain. CONCLUSIONS: The fourth ECA VBG with reverse blood flow from the dorsal intercarpal arch allowed the graft to reach the CMC. A solid fusion was obtained at 6 weeks due to the biological advantage of the VBG.

Extracto acuoso de Escoba amarga. Estudio preliminar de sus propiedades / Aqueous extract of Parthenium hysterophorus. Preliminary study of its properties

Se realiza el estudio físico-químico preliminar de un extracto acuoso de Escoba Amarga con el propósito de lograr una materia prima útil para formular fitofármacos, se da como resultado presencia de saponinas, lactonas, aminoácidos y polisacáridos. Con el extracto obtenido se desarrollan 2 formulaciones: un champú y una loción que combinados se aplican en perros afectados con escabiosis, lográndose notables mejorías y en ningún caso reacciones adversas (AU)

Extracto acuoso de Escoba amarga: estudio preliminar de sus propiedades / Aqueous extract of Parthenium hysterophorus: preliminary study of its properties

Se realiza el estudio físico-químico preliminar de un extracto acuoso de Escoba Amarga con el propósito de lograr una materia prima útil para formular fitofármacos, se da como resultado presencia de saponinas, lactonas, aminoácidos y polisacáridos. Con el extracto obtenido se desarrollan 2 formulaciones: un champú y una loción que combinados se aplican en perros afectados con escabiosis, lográndose notables mejorías y en ningún caso reacciones adversas

Extracto acuoso de Calendula officinalis. Estudio preliminar de sus propiedades/30 / Aqueous extract from Calendula officinalis. Preliminary study of its properties/30

Se aborda el estudio preliminar de un extracto acuoso de Calendula officinalis Lin. comprobándose la presencia de saponinas, polisacáridos, flavonoides, taninos y aminoácidos. El estudio farmacológico realizado reporta propiedades antimicóticas y pasado un año de elaborado el extracto, las características físico-químicas no presentan cambios significativos. Los resultados obtenidos con este extracto sugieren continuar profundizando en el estudio físico-químico y farmacológico, con la finalidad de fijar los límites de calidad y emplearlo como materia prima en la formulación de fitofármacos (AU)

Extracto acuoso de Calendula officinalis: estudio preliminar de sus propiedades/30 / Aqueous extract from Calendula officinalis: preliminary study of its properties/30

Se aborda el estudio preliminar de un extracto acuoso de Calendula officinalis Lin. comprobándose la presencia de saponinas, polisacáridos, flavonoides, taninos y aminoácidos. El estudio farmacológico realizado reporta propiedades antimicóticas y pasado un año de elaborado el extracto, las características físico-químicas no presentan cambios significativos. Los resultados obtenidos con este extracto sugieren continuar profundizando en el estudio físico-químico y farmacológico, con la finalidad de fijar los límites de calidad y emplearlo como materia prima en la formulación de fitofármacos