Outpatient parenteral antimicrobial therapy (OPAT) from an emergency model applied during the COVID-19 pandemic to standard of care: Preliminary lessons from our experience.

OBJECTIVES: We wish to report on our experience of OPAT during the first two years of the COVID19 outbreak. PATIENTS AND METHODS: We recorded data on all patients treated in the OPAT regimen in 2020 and 2021 and compared overall trends, use of carbapenems and saved days of hospitalization. RESULTS: The OPAT model enabled us to ensure the administration of first choice antibiotic therapy to 239 patients with an increase of 21.3% from 2020 to 2021 (108 vs 131). Applying this model, we also recorded a reduction in the use of carbapenems from 33% in 2020 to 26% in 2021 and a total of 3041 recovery days saved in 2021.The clinical cure rate reached 94%. Few adverse events occurred (35/239; 14.6%), and they did not require hospitalization. CONCLUSION: OPAT is a safe, efficacious, and cost-effective model that functioned effectively during the COVID-19 crisis and could become the standard of care for the treatment of selected patients.

Nutritional assessment of an Italian population of elderly hip fracture patients: a comparison between sexes and types of fractures.

Malnutrition is highly prevalent in elderly patients with hip fractures (HF) (intracapsular and extracapsular). Many factors influence the patterns of HF, but the role of nutrition is not yet clear. In this investigation, an analysis of the body compositions of geriatric patients with HF was conducted, to identify differences in the nutritional status between male and female patients with intra- and extra-capsular HF. The nutritional assessment of patients was performed using three different techniques: anthropometrics measurement, plicometry, and bioimpedance analysis. The most prevalent type of fracture in females was the extracapsular type, while the intracapsular type is more common in males. Males showed a lower BMI, fat percentage and a greater length of hospital stay (LOS). Patients with intracapsular fractures are more malnourished compared with patients with extracapsular fractures. Males with HF have a higher prevalence of intracapsular fractures compared to women and stayed in hospital longer.

O'nil Anteversa® mini-plate for stable hip fracture: first experience considerations and outcomes.

Hip fractures are associated with a 20% one-year mortality and a 50% loss of function. Over 700,000 deaths are estimated to occur annually worldwide following hip fractures. Concern exist regarding which is the best implant for extracapsular fractures fixation. For a correct positioning of the cephalic screw, a new plate (O'Nil Anteversa® mini-plate, Intrauma, Torino, Italy) with a fixed 8°of anteversion in the axial plane was developed. A total of 22 patients with an intertrochanteric fracture underwent surgery with Anteversa® mini-plate between October 2016 and April 2017. Data collected included patients' age at surgery, gender, fracture type, operative side, surgeon, type of implant, TAD, CalTAD and TADCalTAD. All patients underwent clinical and radiographic evaluations according to the AO Surgery Reference classification. The mean TAD, CalTAD and TADcalTAD for the entire population of study were, respectively, 20.18±7.5 mm, 20.45±7.25 mm, and 40.62±14.44 mm. The mean TAD, CalTAD and TADcalTAD of those patients who experienced mobilisation of the cephalic screw were, respectively, 20.26±5.87 mm, 19.53±5.47 mm, and 39.8±11.16 mm. Three patients experienced mobilisation of the cephalic screw, and none of these had a TAD greater than 25 mm, a CalTAD greater of 25mm or a TADcalTAD greater than 50 mm. This type of device meets the essential requirements for a correct treatment of intertrochanteric fractures in elderly patients. However, the excessive need of attention in each step, and the consequent increased time of surgery, could be seen as a limitation for its use.

Genetics in orthopaedic practice.

DNA holds genetic information in the nucleus of eukaryotic cells; and has three different functions: replication, storage of hereditary information, and regulation of cell division. Most studies described the association of single nucleotide polymorphism (SNP) to common orthopaedics diseases and the susceptibility to develop musculoskeletal injuries. Several mutations are associated with osteoporosis, musculoskeletal ailments and other musculoskeletal deformity and conditions. Several strategies, including gene therapy and tissue engineering with mesenchymal stem cells (MSC), have been proposed to enhance healing of musculoskeletal tissues. Furthermore, a recent technique has revolutionized gene editing: clustered regulatory interspaced short palindromic repeat (CRISPR) technology is characterized by simplicity in target design, affordability, versatility, and high efficiency, but needs more studies to become the preferred platform for genome editing. Predictive genomics DNA profiling allows to understand which genetic advantage, if any, may be exploited, and why a given rehabilitation protocol can be more effective in some individual than others. In conclusion, a better understanding of the genetic influence on the function of the musculoskeletal system and healing of its ailments is needed to plan and develop patient specific management strategies.

Surgery within 48 hours in hip fractures in elderly patients exerts a positive effect on post-operative hyponatremia.

This study investigated the prevalence of hyponatremia during the hospital stay, in a cohort of elderly patients with hip fractures who underwent surgery within 48 h from admission. Records data were retrieved from the database of the San Giovanni di Dio e Ruggi d'Aragona Hospital of Salerno, Italy. All elderly patients (≥65 years old) with a documented hip fracture that underwent surgery within 48 h from admission, between 2016 and 2018, were included and divided in 4 subgroups according to their sex and type of fracture. Serum sodium concentration were monitored during the hospital stay and collected at admission, before surgery, after surgery and at discharge. The overall prevalence of hyponatremia was 23.99% (n=71/295), (24.3%, n=57/234 for female patients and 22.9%, n=14/61 for male patients). The percentage of hyponatremic patients with an intracapsular hip fracture was 27.17% (n=25/92), and 22.66% (n=46/203) in patients with an extracapsular hip fracture. The highest value of mean serum sodium concentration (139.2 mmol/L±4.4 SD) was found at the hospital discharge phase, and the lowest value (138.4 mmol/L±4.3 SD) was found during the pre-surgery phase. The lowest mean value of serum sodium was found before surgery, while the highest was after surgery. This could suggest that the early operative treatment and the accurate in-hospital monitoring are effective to treat or prevent this condition.

Overuse injuries in sport: a comprehensive overview.

BACKGROUND: The absence of a single, identifiable traumatic cause has been traditionally used as a definition for a causative factor of overuse injury. Excessive loading, insufficient recovery, and underpreparedness can increase injury risk by exposing athletes to relatively large changes in load. The musculoskeletal system, if subjected to excessive stress, can suffer from various types of overuse injuries which may affect the bone, muscles, tendons, and ligaments. METHODS: We performed a search (up to March 2018) in the PubMed and Scopus electronic databases to identify the available scientific articles about the pathophysiology and the incidence of overuse sport injuries. For the purposes of our review, we used several combinations of the following keywords: overuse, injury, tendon, tendinopathy, stress fracture, stress reaction, and juvenile osteochondritis dissecans. RESULTS: Overuse tendinopathy induces in the tendon pain and swelling with associated decreased tolerance to exercise and various types of tendon degeneration. Poor training technique and a variety of risk factors may predispose athletes to stress reactions that may be interpreted as possible precursors of stress fractures. A frequent cause of pain in adolescents is juvenile osteochondritis dissecans (JOCD), which is characterized by delamination and localized necrosis of the subchondral bone, with or without the involvement of articular cartilage. The purpose of this compressive review is to give an overview of overuse injuries in sport by describing the theoretical foundations of these conditions that may predispose to the development of tendinopathy, stress fractures, stress reactions, and juvenile osteochondritis dissecans and the implication that these pathologies may have in their management. CONCLUSIONS: Further research is required to improve our knowledge on tendon and bone healing, enabling specific treatment strategies to be developed for the management of overuse injuries.

Molecular characterization of lactic acid populations associated with wine spoilage.

We have investigated the prevalence of spoilage lactic acid bacteria (LAB) in table wines produced in the Apulia region. The occurrence of LAB was evaluated in wines produced with low sulphur dioxide doses and not supplemented with selected malolactic starters such as Oenococcus oeni. About 150 strains were isolated from wine must and a molecular characterization was performed using PCR-based techniques. Most of the strains analysed belonged to Lactobacillus plantarum species. However, some of the strains were identified as Pediococcus damnosus and Leuconostoc sp. The amplified fragments of Pediococcus damnosus were cloned and sequenced. The coding sequence was highly homologous to that of the ropy plasmid confirming that the isolated strain was a ropy(+) Pediococcus damnosus. In all the samples analysed, the final must pH value reached was relatively high (from 3.78 to 3.90). The high pH values had probably negatively influenced (counteracted) the activity of sulphur dioxide added, allowing proliferation of spoilage wine microorganisms.

Fate of Escherichia coli O157:H7 during the manufacture of Mozzarella cheese.

AIMS: The fate of Escherichia coli O157:H7 was investigated during the manufacture of Mozzarella cheese. METHODS AND RESULTS: The Mozzarella cheese was made from unpasteurized milk which was inoculated to contain ca 10(5) cfu ml(-1)E. coli O157:H7. Two different heating temperatures (70 and 80 degrees C), commonly used during curd stretching, were investigated to determine their effects on the viability of E. coli O157:H7 in Mozzarella cheese. Stretching at 80 degrees C for 5 min resulted in the loss of culturability of E. coli O157:H7 strains, whereas stretching at 70 degrees C reduced the number of culturable E. coli O157:H7 by a factor of 10. CONCLUSIONS: The results show that stretching curd at 80 degrees C for 5 min is effective in controlling E. coli O157:H7 during the production of Mozzarella cheese. Brining and storage at 4 degrees C for 12 h was less effective than the stretching. SIGNIFICANCE AND IMPACT OF THE STUDY: Mozzarella cheese should be free of E. coli O157:H7 only if temperatures higher than or equal to 80 degrees C are used during milk processing.

Characterization of Lactobacillus plantarum from wine must by PCR species-specific and RAPD-PCR.

AIMS: Physiological and molecular analysis such as PCR species-specific and randomly amplified polymorphic PCR (RAPD-PCR) have been used for typing of Lactobacillus plantarum strains from typical wine must. METHODS AND RESULTS: Phenotypic tests such as API 50CH and evaluation of D-L-lactate production from glucose were used to perform a preliminary characterization of lactobacilli. Furthermore, 18 strains of lactobacilli were analyzed by PCR species-specific oligonucleotides based on short sequences of the recA gene. CONCLUSIONS: Four strains were identified as belonging to the L. plantarum species and were further analysed by RAPD-PCR. The RAPD-PCR profiles were similar in all strains that had positive results for species-specific PCR, suggesting that the four L. plantarum strains were closely related. SIGNIFICANCE AND IMPACT OF THE STUDY: Using PCR species-specific as a preliminary screening test and then RAPD-PCR can be as considered the most reliable method of performing a rapid and correct typing of L. plantarum from wine must.

How to avoid common overhead allocation mistakes.

Paying for overhead in a physician practice can be tricky, especially when it comes to figuring out who pays for what. Examine some common overhead allocation errors and learn how to fix them.

Preparation and functional characterization of thylakoids from Arabidopsis thaliana.

A protocol for the isolation of functional thylakoids from Arabidopsis thaliana leaves was developed. The critical factor in obtaining active, coupled and stable preparation is the inclusion of EDTA and EGTA in the grinding buffer. Preparations were characterized with respect to the whole or partial electron transport chain, ATP/NADPH, ATP/O(2) and PS II/chlorophyll ratios. Sensitivity to a light-chill photoinhibitory treatment was also determined by evaluating the decrease in both maximal photochemical efficiency (Fv/Fm) and in electron transport rate.

Understanding financial statements.

In his premier column for The Physician Executive, David Tarantino takes a look at those critical "financials" that can make or break a business. If you're considering a career move, you need to know the financial condition of future employers. Learn how to read the statements and glean valuable information from the numbers.

The role of fine-needle aspiration biopsy and flow cytometry in the evaluation of persistent neck adenopathy.

BACKGROUND: The role of fine-needle aspiration biopsy (FNAB) and flow cytometry (FCM) in the evaluation of persistent neck adenopathy has not been completely defined. METHODS: All patients who underwent FNAB of an abnormal lymph node from 1990 to 1997 were identified, and the results of FNAB and FCM were correlated with histology or clinical follow-up. RESULTS: FNAB was performed on 133 patients with an abnormal lymph node in the neck. FNAB was malignant in 82 (62%), atypical in 13 (10%), benign in 27 (20%), and nondiagnostic in 11 (8%) patients. FNAB was compared with histologic results in 114 (86%) or with the results of clinical follow-up (average 17 months) in 12 patients (9%). Seven patients (5%) were lost to follow-up. Lymphoma and metastatic carcinoma were diagnosed in 25 (19%) and 76 (57%) patients, respectively. Sensitivity of FNAB and FCM was 96% and 100%, respectively, and specificity was 58% and 100%, respectively. Patients with Hodgkin's lymphoma accounted for 80% of false negative FCM results. FCM was nondiagnostic in 3 of 34 patients (9%). Definitive subclassification of lymphoma was accomplished in only 3 of 17 (18%) patients in whom FCM was performed. CONCLUSIONS: FNAB is reliable in identifying metastatic disease, non-Hodgkin's lymphoma, and reactive lymphadenopathy in the neck. FNAB and FCM still have a limited role in definitive diagnosis of Hodgkin's lymphoma and classification of non-Hodgkin's lymphoma, underscoring the importance of excisional biopsy.

Anesthetic considerations in chest trauma.

At the R. Adams Cowley Shock Trauma Center, participation of anesthesiologists in the care of thoracic trauma victims begins with the initial assessment of patients on arrival by helicopter or ambulance. It continues with management of the airway, stabilization of hemodynamics, intraoperative management, patient care in the PACU and critical care setting, and acute pain management. By using a team approach involving anesthesia, surgery, and critical care, the care of trauma victims with thoracic injury continues to be enhanced.

Can intraoperative prebypass arteriography substitute for the preoperative arteriogram?

Preoperative contrast arteriography is presently considered a requirement when planning infrainguinal arterial reconstructions in patients with limb-threatening ischemia. We reviewed the clinical data from 22 infrainguinal bypasses done in 20 patients to see if appropriate decisions concerning operability and the nature of the operation could be made from the physical examination and noninvasive data supplemented by a limited intraoperative on-table prebypass arteriogram. The presence of a normal femoral pulse with either a normal thigh pulse volume tracing or a normal high-thigh index assured adequate inflow to the groin level. The presence of an arterial Doppler signal at the ankle level, heard with a hand held Doppler, confirmed the presence of patent outflow vessels for the distal anastomosis. The exact site of the distal anastomosis could be determined with the on-table prebypass arteriogram. In patients with limb-threatening ischemia due to occlusive disease limited to the infrainguinal arterial tree, an appropriate operative bypass may be performed without the aid of the preoperative arteriogram.