Incidence of Corrective Procedures After Nonoperatively Managed Distal Radius Fractures in the Elderly.

Although the majority distal radius fractures in the elderly are initially managed nonoperatively, the true incidence of subsequent corrective surgery is unknown. The purpose of this study was to determine the incidence and predictors of corrective surgery after conservative management. METHODS: ICD-9 and Current Procedural Terminology codes were queried from the Medicare 5% sample to select patients aged 65 years and older undergoing nonsurgical treatment of distal radius fractures with a minimum 5-year follow-up. Rates of subsequent ipsilateral wrist surgery were correlated against patient age, sex, geographic region, and initial closed reduction. RESULTS: Five thousand eighty patients with a mean age of 78.3 years were included. Fifty-five patients (1.1%) had undergone subsequent wrist surgery at a median time of 182 days after injury. The youngest cohort (65 to 69 years) had a significantly higher operation rate (1.9%, P = 0.007) than the oldest cohort (80+ years) (0.5%, P = 0.004). There was no notable difference in corrective procedures between sex, geographic region, and initial closed reduction. DISCUSSION: Once surgical intervention is deemed unnecessary per standard guidelines, the data support successful nonsurgical management in a large majority of patients but highlight a small subset of younger patients who remain at increased risk of requiring additional surgery.

Novel Bumped Kinase Inhibitors Are Safe and Effective Therapeutics in the Calf Clinical Model for Cryptosporidiosis.

Cryptosporidiosis, caused by the apicomplexan parasite Cryptosporidium parvum, is a diarrheal disease that has produced a large global burden in mortality and morbidity in humans and livestock. There are currently no consistently effective parasite-specific pharmaceuticals available for this disease. Bumped kinase inhibitors (BKIs) specific for parasite calcium-dependent protein kinases (CDPKs) have been shown to reduce infection in several parasites having medical and veterinary importance, including Toxoplasma gondii, Plasmodium falciparum, and C. parvum In the present study, BKIs were screened for efficacy against C. parvum infection in the neonatal mouse model. Three BKIs were then selected for safety and clinical efficacy evaluation in the calf model for cryptosporidiosis. Significant BKI treatment effects were observed for virtually all clinical and parasitological scoring parameters, including diarrhea severity, oocyst shedding, and overall health. These results provide proof of concept for BKIs as therapeutic drug leads in an animal model for human cryptosporidiosis.

Cryptosporidium avium n. sp. (Apicomplexa: Cryptosporidiidae) in birds.

The morphological, biological, and molecular characteristics of Cryptosporidium avian genotype V are described, and the species name Cryptosporidium avium is proposed to reflect its specificity for birds under natural and experimental conditions. Oocysts of C. avium measured 5.30-6.90 µm (mean = 6.26 µm) × 4.30-5.50 µm (mean = 4.86 µm) with a length to width ratio of 1.29 (1.14-1.47). Oocysts of C. avium obtained from four naturally infected red-crowned parakeets (Cyanoramphus novaezealandiae) were infectious for 6-month-old budgerigars (Melopsittacus undulatus) and hens (Gallus gallus f. domestica). The prepatent periods in both susceptible bird species was 11 days postinfection (DPI). The infection intensity of C. avium in budgerigars and hens was low, with a maximum intensity of 5000 oocysts per gram of feces. Oocysts of C. avium were microscopically detected at only 12-16 DPI in hens and 12 DPI in budgerigars, while PCR analyses revealed the presence of specific DNA in fecal samples from 11 to 30 DPI (the conclusion of the experiment). Cryptosporidium avium was not infectious for 8-week-old SCID and BALB/c mice (Mus musculus). Naturally or experimentally infected birds showed no clinical signs of cryptosporidiosis, and no pathology was detected. Developmental stages of C. avium were detected in the ileum and cecum using scanning electron microscopy. Phylogenetic analyses based on small subunit rRNA, actin, and heat shock protein 70 gene sequences revealed that C. avium is genetically distinct from previously described Cryptosporidium species.