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1.
Orthop Traumatol Surg Res ; 108(7): 103053, 2022 11.
Artículo en Inglés | MEDLINE | ID: mdl-34530129

RESUMEN

INTRODUCTION: Several surgical techniques have been proposed for the treatment of patellar fractures. The aim of this study is to compare the clinical efficacy and complication rates of treatment using suture tape circumferential cerclage (STCC) and metallic wire circumferential cerclage (MWCC) for the surgical treatment of displaced transverse patellar fractures (TPFs). HYPOTHESIS: The hypothesis is that the use of the suture tape would be associated with a significantly lower rate of re-operation than metallic cerclage but no differences in other clinical outcomes. PATIENTS AND METHODS: A retrospective comparative analysis of the clinical outcomes of consecutive patients undergoing fixation of TPFs with either MWCC or STCC between January 2017 and December 2018 was undertaken. All patients underwent evaluation with standardised radiographs at one, three, and six months after surgery to determine rates of union, non-union, loss of fixation and malunion. All patients underwent a final clinical evaluation at 18 months postoperatively to evaluate clinical scores and complications. RESULTS: A total of 26 patients were included in the study. Thirteen patients underwent STCC and 13 underwent MWCC. There were no complications in the STCC group. In the MWCC group, one patient underwent hardware removal at 2 months postoperatively due to painful prominence. There was no significant difference in re-operation rates between the STCC and MWCC groups (p=1). There were no cases of non-union, malunion or loss of fixation throughout the series. At the final clinical follow-up of 18months, there were no significant differences in KSS, KOOS or Böstman scores between the groups. CONCLUSION: No significant differences were identified when comparing the clinical outcomes of fixation of AO/OTA 34C1/2 fractures with suture tape or metallic cerclage fixation concerning re-operation rates, union rates, loss of fixation and functional outcome measures. These results cannot be extrapolated to more complex injury patterns or surgical techniques in which prominence of implanted material is more likely. LEVEL OF EVIDENCE: III.


Asunto(s)
Fracturas Óseas , Traumatismos de la Rodilla , Humanos , Rótula/diagnóstico por imagen , Rótula/cirugía , Rótula/lesiones , Estudios Retrospectivos , Fijación Interna de Fracturas/métodos , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/cirugía , Hilos Ortopédicos , Suturas , Resultado del Tratamiento
2.
Eur Radiol ; 31(4): 1999-2012, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33033861

RESUMEN

OBJECTIVES: To evaluate the inter-rater agreement of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) and to determine the value of initial CXR along with demographic, clinical, and laboratory data at emergency department (ED) presentation for predicting mortality and the need for ventilatory support. METHODS: A total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1-13, 2020) were retrospectively included. Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation. Two scoring systems (Brixia score and percentage of lung involvement) were applied. Inter-rater agreement was assessed by weighted Cohen's kappa (κ) or intraclass correlation coefficient (ICC). Predictors of death and respiratory support were identified by logistic or Poisson regression. RESULTS: GGO admixed with consolidation (n = 235, 69%) was the most common CXR finding. The inter-rater agreement was almost perfect for type of parenchymal opacity (κ = 0.90), Brixia score (ICC = 0.91), and percentage of lung involvement (ICC = 0.95). The Brixia score (OR: 1.19; 95% CI: 1.06, 1.34; p = 0.003), age (OR: 1.16; 95% CI: 1.11, 1.22; p < 0.001), PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.98, 1; p = 0.002), and cardiovascular diseases (OR: 3.21; 95% CI: 1.28, 8.39; p = 0.014) predicted death. Percentage of lung involvement (OR: 1.02; 95% CI: 1.01, 1.03; p = 0.001) and PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.99, 1.00; p < 0.001) were significant predictors of the need for ventilatory support. CONCLUSIONS: CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO2/FiO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support. KEY POINTS: • Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia. • The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO2/FIO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.


Asunto(s)
COVID-19 , Servicio de Urgencia en Hospital , Humanos , Pulmón , Radiografía Torácica , Estudios Retrospectivos , SARS-CoV-2 , Rayos X
3.
EClinicalMedicine ; 24: 100419, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-32766538

RESUMEN

BACKGROUND: Novel Coronavirus SARS-CoV-2 pandemic is spreading around the world. At the end of February, the outburst of the pandemic has hit hard on northern Italian's hospitals. As of today, no data have been published regarding the severity of respiratory failure of patients presenting to the Emergency Departments. Moreover, the outcome the patients forced to undergo Continuous Positive Airway Pressure (CPAP) or Non-Invasive Positive Pressure Ventilation (NIPPV) due to lack of Intensive Care resources is unknown. "Papa Giovanni XXIII" hospital (HPG23) of Bergamo is one of the largest hospitals in the Country, with an Emergency Department (ED) managing over 100,000 patients per year. METHODS: This is a retrospective observational study based on chart review of patients presenting to the Emergency Department of HPG23 from 29/02/2020 to 10/03/2020 with a clinical condition highly suspicious for COVID-19 infection. Registration of admission rates, severity of respiratory failure (ARDS classification), need of respiratory support, SARS-CoV-2 PCR test and outcome of patients treated with a ventilatory support were registered on 10th of May 2020. FINDINGS: From 29/02 to 10/03 611 patients with a suspected diagnosis of COVID-19 infection were evaluated in our ED; 320 (52%) met the criteria for hospital admission and 99 (31%) needed to be immediately started on ventilatory support (81% CPAP, 7% NIPPV, 12% Invasive Mechanical Ventilation). Eighty-five (86%) of the 99 patients needing a ventilatory support eventually had SARS-CoV-2 infection confirmed by PCR test on nasal-pharyngeal swab. Their median PO2/FiO2 ratio was 128 (IQR 85-168), with 23 patients (29.5%) classified as severe ARDS. Mortality rate as of 10th of May was 76.5%, ranging from 44.4% within patients <60 years old to 85% within those older than 60 years (p = 0.001). NIPPV/CPAP failure occurred in 91.5% of patients. INTERPRETATION: The population of patients suspected for COVID-19 infection presenting at our ED showed a very high rate of severe respiratory failure, with urgent need of a large amount of intensive care resources. Mortality rates of critically ill patients with confirmed COVID-19 (76.5%) are similar to previously reported studies with similar population. CPAP/NIPPV could be a valid strategy to treat severely hypoxic patients that cannot be intubated in the ED due to lack of intensive care resources. FUNDING: No funds were received for this research project.

4.
Pediatr Emerg Med Pract ; 17(5): 1-24, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-32286766

RESUMEN

The novel coronavirus, SARS-CoV-2, and its infection, COVID-19, has quickly become a worldwide threat to health, travel, and commerce. It is essential for emergency clinicians to learn as much as possible about this pandemic to manage the unprecedented burdens on healthcare providers and hospital systems. This review analyzes information from worldwide research and experience on the epidemiology, prevention, and treatment of COVID-19, and offers links to the most reliable and trustworthy resources to help equip healthcare professionals in managing this public health challenge. As the pandemic sweeps the United States, lessons learned from early centers of infection, notably New York and Northern Italy, can help localities to prepare.


Asunto(s)
Defensa Civil , Infecciones por Coronavirus , Servicio de Urgencia en Hospital , Recursos en Salud , Pandemias , Neumonía Viral , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/terapia , Humanos , Italia , New York , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/terapia , Salud Pública , SARS-CoV-2
5.
Emerg Med Pract ; 22(5 Suppl): CD1-CD2, 2020 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-32297727

RESUMEN

The Brescia-COVID respiratory severity scale/algorithm is a stepwise management approach to COVID-19 patients based on clinical severity. The BCRSS was rapidly developed in Brescia, Italy, during that nation's COVID-19 crisis. The scale has not been validated or tested in other populations. The BCRSS uses patient examination features along with the need for escalating levels of respiratory support (NIV, intubation, proning) to suggest treatment recommendations. The scale simplifies the clinical summary of a patient's status, and allows clinicians to compare patients to one another and to track the trend of a patient's level of respiratory severity over time.


Asunto(s)
Algoritmos , Infecciones por Coronavirus , Sistemas de Apoyo a Decisiones Clínicas , Pulmón , Pandemias , Neumonía Viral , Índice de Severidad de la Enfermedad , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Servicio de Urgencia en Hospital , Humanos , Pulmón/patología , Pulmón/fisiopatología , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Respiración , Medición de Riesgo , SARS-CoV-2
6.
Emerg Med Pract ; 22(5): 1-28, 2020 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-32207910

RESUMEN

The novel coronavirus, COVID-19, has quickly become a worldwide threat to health, travel, and commerce. This overview analyzes the best information from the early research, including epidemiologic and demographic features from SARS-CoV-1 and MERS-CoV viruses; lessons learned from the experience of an emergency physician in Northern Italy, where the outbreak has devastated the healthcare system; evidence on transmission and prevention through safe use of PPE; evidence and advice on SARS-CoV-2 testing and co-infection; management options; airway management options; steps for rapid sequence intubation in the ED and managing disaster ventilation; and information on managing pediatric and pregnant patients.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Servicio de Urgencia en Hospital , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Equipo de Protección Personal , Neumonía Viral , Adulto , Manejo de la Vía Aérea , Betacoronavirus/genética , Betacoronavirus/patogenicidad , COVID-19 , Niño , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Planificación en Desastres , Femenino , Humanos , Hidroxietilrutósido , Control de Infecciones/métodos , Intubación/métodos , Italia/epidemiología , Masculino , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Neumonía Viral/transmisión , Embarazo , Complicaciones Infecciosas del Embarazo , Respiración Artificial , SARS-CoV-2
8.
Knee ; 24(4): 705-710, 2017 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-28522238

RESUMEN

BACKGROUND: To compare in an animal model the biomechanical properties of four coupled fixation devices currently used in ACL reconstruction. Three out of four devices used a full tibial tunnel with an interference screw, while the other one system used a tibial socket and an adjustable loop suspension device. The null hypothesis is that there are no biomechanical differences between all the techniques tested. METHODS: Thirty two femur-graft-tibia complexes were mounted on a tensile machine using bovine digital extensor tendons, porcine knees and four different fixation device combinations: After a preconditioning with a tensile load of 90N for five minutes, 1000cycles between 0 and 150N were applied to the complex before the final pulled to failure. Stiffness and strength were evaluated at the final pullout, as was the displacement (slippage) at one, 100, 500, and 1000cycles. RESULTS: The multiple mean comparison led to a significant difference for the case of stiffness, with worse results in group C compared to group A (p=0.037). Conversely, no differences were found in UFL and slippage between all groups (p>0.05). CONCLUSION: All the tested systems demonstrated in an animal model sufficient properties for a safe postoperative rehabilitation both for strength and for stiffness and slippage under cyclic loading.


Asunto(s)
Reconstrucción del Ligamento Cruzado Anterior/métodos , Ligamento Cruzado Anterior/cirugía , Animales , Reconstrucción del Ligamento Cruzado Anterior/efectos adversos , Reconstrucción del Ligamento Cruzado Anterior/instrumentación , Fenómenos Biomecánicos , Tornillos Óseos , Bovinos , Modelos Animales de Enfermedad , Falla de Equipo/estadística & datos numéricos , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Porcinos , Tendones , Tibia/cirugía
10.
Emerg Med Clin North Am ; 34(4): 811-835, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27741990

RESUMEN

The definition of a transient ischemic attack (TIA) has evolved over the past decade from a clinical diagnosis to a tissue-based definition based on neuroimaging results. TIA shares the same pathophysiology as stroke, which occurs in up to 5% of patients within 48 hours of the TIA and 10% within 90 days. This rate is decreasing, likely due to improved diagnostic and management strategies. Decision support scores have been developed to risk stratify patients, which include clinical and radiological elements. Antiplatelet and anticoagulant therapy, as well as carotid endarterectomy/stenting have been shown to reduce the stroke occurrence after TIA.


Asunto(s)
Servicio de Urgencia en Hospital , Ataque Isquémico Transitorio/diagnóstico , Encéfalo/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Humanos , Ataque Isquémico Transitorio/diagnóstico por imagen , Ataque Isquémico Transitorio/terapia , Imagen por Resonancia Magnética , Neuroimagen , Accidente Cerebrovascular/diagnóstico
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