Prospective study of maturation and injury in elite handball academy. Could ‘maturational status’ be a risk factor for injury incidence in different handball team categories?

The objective of this study is to describe the relationship between injury incidence (IL) and maturity in male elite handball's player (HbP). Prospective study during two seasons, evaluating the sports injuries, maturity status and exposure time in hours in 133 young handball's players, under the UEFA methodology model for epidemiological studies. We discuss the maturity stage with different parameters, the Tanner's stage, puberty stages, peak high velocity, testicular volume, and the bone age. Finally, 190 injuries for a total of 34.222 h of exposure were registered. The average total Injury Incidence (IIn) by categories was 5,6 injury/1000 h of exposure. Injury Incidence during competition: 21,8 injuries/1000 hs and in training: 3,1 injuries/1000 hs without statistically significant between IIn, chronological age and different maturity stage by ANOVA. The multivariate statistical analysis registers tendency associations between IIn in competition for category (P = 0,07), and the IIn in training for Tanner stage (P = 0,091) and puberty (P = 0,021). In conclusion: there is not a significant difference in total IIn by ages categories in handball players but there is statistically significance tendency respect to some maturity parameters under a multivariate analysis. This last result must be considered when planning training seasons and strategies for injury prevention in the context of the formative handball. (AU)

Aluminum blood concentration in adult patients: effect of multichamber-bag versus hospital-compounded parenteral nutrition / Concentración sanguínea de aluminio en pacientes adultos: efecto de la nutrición parenteral tricameral frente a la nutrición parenteral elaborada en el hospital

Background: the administration of aluminum-contaminated parenteral nutrition (PN) leads to an accumulation of aluminum. The aim of this study was to assess blood aluminum concentrations (BACs) of inpatients receiving multichamber-bag (MCB) PN compared to those receiving compounded PN. Methods: available BACs were retrospectively gathered from patient charts of adult inpatients receiving PN from 2015 to 2020, and compared depending on the type of PN administered. Long-term PN patients, defined as ≥ 20 days of PN, receiving at least > 10 days of compounded PN, were compared to long-term patients receiving only MCB. Results: a total of 160 BACs were available from 110 patients. No differences were found according to type of PN (mean BAC: 3.11 ± 2.75 for MCB versus 3.58 ± 2.08 µg/L for compounded PN). Baseline total bilirubin, surgery and days with PN were related to higher BACs (coefficient: 0.30 [95 % CI, 0.18-0.42], 1.29 [95 % CI, 0.52-2.07], and 0.06 [95 % CI: 0.01-0.11], respectively). Regarding long-term PN, patients receiving only MCB (n = 21) showed lower BACs compared to the compounded PN (n = 17) [2.99 ± 1.55 versus 4.35 ± 2.17 µg/L, respectively; p < 0.05]. Conclusions: although there were no differences in BAC according to type of PN administered, in long-term PN, MCB PN was associated with lower BACs as compared to compounded PN. (AU)

Antecedentes: la administración de nutrición parenteral (NP) contaminada con aluminio conduce a su acumulación. El objetivo de este estudio fue evaluar las concentraciones de aluminio en sangre (CAS) en pacientes hospitalizados que recibieron NP elaboradas en el hospital o bolsas tricamerales. Métodos: se recogieron retrospectivamente las CAS disponibles de los pacientes hospitalizados con NP durante el período entre 2015 y 2020, comparándose los valores en función del tipo de NP administrada. Se comparan igualmente los valores de pacientes de larga duración, definida como ≥ 20 días de NP, que recibieron al menos > 10 días de NP elaborada frente aquellos de larga duración que recibieron solo NP tricameral. Resultados: se incluyeron un total de 160 CAS de 110 pacientes. No se encontraron diferencias con respecto al tipo de NP (CAS media: 3,11 ± 2,75 para la tricameral frente a 3,58 ± 2,08 µg/L para la elaborada). La bilirrubina total basal, la cirugía y los días con NP se relacionaron con un mayor valor de CAS (coeficiente: 0,30 [IC 95 %: 0,18-0,42], 1,29 [IC 95 %: 0,52-2,07] y 0,06 [IC 95 %: 0,01-0,11], respectivamente). En la NP a largo plazo, los pacientes que recibieron solo NP tricameral (n = 21) mostraron una CAS menor en comparación con el grupo que recibió al menos 10 NP elaboradas (n = 17) [2,99 ± 1,55 versus 4,35 ± 2,17 µg/L, respectivamente; p < 0,05]. Conclusiones: aunque no hubo diferencias de CAS con respecto al tipo de NP administrada, en la NP a largo plazo, la administración de NP tricameral se asoció con CAS menores en comparación con la NP elaborada. (AU)

Aluminum blood concentration in adult patients: effect of multichamber-bag versus hospital-compounded parenteral nutrition.

Introduction: Background: the administration of aluminum-contaminated parenteral nutrition (PN) leads to an accumulation of aluminum. The aim of this study was to assess blood aluminum concentrations (BACs) of inpatients receiving multichamber-bag (MCB) PN compared to those receiving compounded PN. Methods: available BACs were retrospectively gathered from patient charts of adult inpatients receiving PN from 2015 to 2020, and compared depending on the type of PN administered. Long-term PN patients, defined as ≥ 20 days of PN, receiving at least > 10 days of compounded PN, were compared to long-term patients receiving only MCB. Results: a total of 160 BACs were available from 110 patients. No differences were found according to type of PN (mean BAC: 3.11 ± 2.75 for MCB versus 3.58 ± 2.08 µg/L for compounded PN). Baseline total bilirubin, surgery and days with PN were related to higher BACs (coefficient: 0.30 [95 % CI, 0.18-0.42], 1.29 [95 % CI, 0.52-2.07], and 0.06 [95 % CI: 0.01-0.11], respectively). Regarding long-term PN, patients receiving only MCB (n = 21) showed lower BACs compared to the compounded PN (n = 17) [2.99 ± 1.55 versus 4.35 ± 2.17 µg/L, respectively; p < 0.05]. Conclusions: although there were no differences in BAC according to type of PN administered, in long-term PN, MCB PN was associated with lower BACs as compared to compounded PN.

Introducción: Antecedentes: la administración de nutrición parenteral (NP) contaminada con aluminio conduce a su acumulación. El objetivo de este estudio fue evaluar las concentraciones de aluminio en sangre (CAS) en pacientes hospitalizados que recibieron NP elaboradas en el hospital o bolsas tricamerales. Métodos: se recogieron retrospectivamente las CAS disponibles de los pacientes hospitalizados con NP durante el período entre 2015 y 2020, comparándose los valores en función del tipo de NP administrada. Se comparan igualmente los valores de pacientes de larga duración, definida como ≥ 20 días de NP, que recibieron al menos > 10 días de NP elaborada frente aquellos de larga duración que recibieron solo NP tricameral. Resultados: se incluyeron un total de 160 CAS de 110 pacientes. No se encontraron diferencias con respecto al tipo de NP (CAS media: 3,11 ± 2,75 para la tricameral frente a 3,58 ± 2,08 µg/L para la elaborada). La bilirrubina total basal, la cirugía y los días con NP se relacionaron con un mayor valor de CAS (coeficiente: 0,30 [IC 95 %: 0,18-0,42], 1,29 [IC 95 %: 0,52-2,07] y 0,06 [IC 95 %: 0,01-0,11], respectivamente). En la NP a largo plazo, los pacientes que recibieron solo NP tricameral (n = 21) mostraron una CAS menor en comparación con el grupo que recibió al menos 10 NP elaboradas (n = 17) [2,99 ± 1,55 versus 4,35 ± 2,17 µg/L, respectivamente; p < 0,05]. Conclusiones: aunque no hubo diferencias de CAS con respecto al tipo de NP administrada, en la NP a largo plazo, la administración de NP tricameral se asoció con CAS menores en comparación con la NP elaborada.

Use and Outcomes of Triple Antithrombotic Therapy with Non-Vitamin K Antagonists in Patients with Atrial Fibrillation Undergoing Percutaneous Coronary Intervention.

BACKGROUND: Triple antithrombotic therapy (TT) is recommended for patients with nonvalvular atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). However, there is a lack of comparative data in a real-world clinical setting between non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonists (VKA). The aim of this study was to compare the safety and efficacy of TT with NOAC or VKA after PCI in patients with AF at 1-year of follow-up. MATERIALS AND METHODS: This was an observational retrospective study in 2 tertiary care hospitals during 2013-2016. Patients with indication for anticoagulation due to AF from an initial registry of 5,269 patients undergoing PCI were identified. Safety primary endpoint was the occurrence of major bleeding events as defined by Bleeding Academic Consortium (BARC ≥ 3). The primary efficacy endpoint was defined as major adverse cardiovascular events (MACE). RESULTS: A total of 187 consecutive patients on TT were identified: 45.4% of were discharged on NOAC and 54.6% on VKA. Patients who received VKA presented more comorbidities and had a higher bleeding risk than those who received NOACs. Major bleeding events occurred in 17 patients (9%), with a higher rate in the VKA group (3.5% vs. 13% confidence interval, 0.19-0.86, P = 0.02). There were no differences in the rates of major adverse cardiovascular events, stroke or net clinical benefit. CONCLUSIONS: In this real-world study, patients with AF undergoing PCI treated on NOAC-based TT showed lower bleeding rates than those on VKA, with a lower rate of major bleeding events, while efficacy was similar between groups.

Epidemiología lesional del balonmano de elite: estudio retrospectivo en equipos profesional y formativo de un mismo club / Epidemiology of injuries in elite handball: Retrospective study in professional and academy handball team

Objetivo: Evaluar la incidencia y el patrón lesional en el balonmano de elite. Método: Estudio retrospectivo y transversal de 496 jugadores, de 29 equipos (divididos por categorías según edad y nivel), durante 5 temporadas (2007-2012), de un club del sur de Europa. El equipo médico evaluó las lesiones y el tiempo de exposición por equipos. Se siguieron los criterios epidemiológicos según consenso UEFA y codificación OSICS-10. Resultados: Se registraron 557 lesiones con 117.723 h de exposición totales. La incidencia lesional media de los equipos fue: 4,9 lesiones/1.000 h de exposición. Para el equipo Senior A (Profesional) fue de 4,3 (DE 1,8); Senior B, 3,4 (DE 1,6); Juvenil, 5,6 (DE 1,4); Cadete A, 5,5 (DE 2,5); Cadete B, 5,7 (DE 3,2), e Infantil, 4,9 (DE 1,9). No hubo diferencias estadísticamente significativas entre ellos, aunque los seniors tuvieron la mayor cantidad de horas de exposición (p < 0,001).Las localizaciones más frecuentes fueron tobillo (18,1%), rodilla (15,3%), muslo (12,9%) y región lumbar (10,6%). Las estructuras afectadas con más frecuencia fueron la lesión ligamentosa (27,3%) y la lesión «muscular por mecanismo indirecto» (20,5%). Esta última más en el Senior A, y la lesión ligamentosa en las categorías inferiores, aunque no se registraron diferencias significativas entre categorías. Conclusión: El patrón y la incidencia lesional en el balonmano de elite es uniforme entre los equipos de diferentes categorías, con pequeñas diferencias que deberán tenerse en cuenta para optimizar los programas de prevención en cada categoría del balonmano formativo de elite

Objective: To evaluate the injury incidence and pattern of injuries in elite handball by different ages. Method: A retrospective, cross sectional study, was conducted over 5 seasons (2007-2012), analyzing a total of 496 players, 29 teams (from different categories separated by age and performance level) of the same club in southern Europe. The same medical team has assessed the injuries and exposure time by teams. Epidemiological criteria according to UEFA and consensus OSICS-10 diagnostic coding were followed. Results: A total of 57 injuries were recorded during 117,723 hours of total exposure. There was a mean team injury incidence of 4.9 injuries/1000 hours of total exposure. For the Senior A (Professional Senior) it was was 4.3 (SD 1.8), Senior B (Amateur 18-28 years) 3.4 (SD 1.6), Youth (U-18 year) 5.6 (SD 1.4), Cadete A (U-16 year) 5.5 (SD 2.5), Cadete B (U-15 year) 5.7 (SD 3.2) and Infantil (U-14 year) 4.9 (SD 1.9). There were no statistically significant differences between categories, although seniors teams had more hours of exposure compared to other teams (P < 0.001). The most frequently affected sites were ankle (18.1%), knee (15.3%), thigh (12.9%) and lumbar region (10.6%). The most common type of injury to all teams was the sprain (27.3%) and non-traumatic muscle injury (20.5%). Muscle injuries were more common at Senior A (Professional) level, but in lower level teams it was the sprain, although there is no significant differences between them. Conclusion: The pattern and incidence of injury in elite handball is uniform between teams from different categories at the same club; with a few differences between each other that you should take this into account to optimize a preventions programs in each category of elite handball training