Low Mortality of Orthopedic Trauma Patients With Asymptomatic COVID-19: A Level I Trauma Center Pandemic Experience.

Background: Early (2020) reports on mortality in patients with coronavirus disease 2019 (COVID-19) who underwent orthopedic surgery ranged from 20.5% to 56%, but these studies included elderly patients with multiple comorbidities. The mortality rate for younger and asymptomatic COVID-19-positive patients undergoing orthopedic surgery after high-energy trauma is underreported. The purpose of this study was to compare the 30-day mortality of asymptomatic COVID-19-positive patients and COVID-19-negative patients surgically treated for orthopedic trauma at a Level I trauma center during the coronavirus pandemic. A secondary objective was to compare the patients' postoperative hospital course and length of stay. Methods: This study is a single-center retrospective review of all patients who underwent an orthopedic surgical procedure at a Level I trauma center during a 3-month period early in the COVID-19 pandemic. All patients received a preoperative nasopharyngeal swab to determine COVID-19 infection status. Preoperative demographic variables, perioperative and postoperative mortality within 30 days, length of stay, and intensive care unit days were compared between COVID-19-positive and COVID-19-negative patients. Results: Of the 471 total patients, 13 were COVID-19-positive and 458 were COVID-19-negative prior to surgery. The average age of all patients was 40.5 ± 19.8 years. The mortality rate in the COVID-19-positive group was 0% vs 0.7% in the COVID-19-negative group, with no significant difference between groups (P=0.77). The COVID-19-positive group vs the COVID-19-negative group had no significant difference in hospital length of stay (7.4 days vs 4.4 days, respectively, P=0.12). Conclusion: Asymptomatic COVID-19-positive orthopedic trauma patients treated with surgery at a Level I trauma center in a 3-month period during the COVID-19 pandemic had a 0% mortality rate, and we found no differences between COVID-19-positive and COVID-19-negative patients with respect to mortality and hospital length of stay.

Case report: unique failure of a Synthes TFNA fenestrated lag screw in a peritrochanteric nonunion.

Background: Intertrochanteric femur fractures are a common orthopaedic injury that are often treated surgically. Cephalomedullary nails (CMN) are frequently the implant of choice for intertrochanteric femur fractures, resulting in low complication rates. Implant failure is a rare but reported complication. Common locations of failure include the proximal nail aperture, distal screw holes, and implant shaft. In this case report, we describe a CMN failure pattern through fenestrated cephalic screw holes. Case: A 70-year-old female sustained an OTA 31A-2.2 peritrochanteric fracture during a motor vehicle collision. She was treated the following day with a Synthes Trochanteric Fixation Nail-Advanced CMN utilizing a fenestrated cephalic screw. There were no intraoperative complications. She was made non-weight bearing for 8 weeks after the procedure due to ipsilateral foot fractures. At 6 months follow-up she was noted to have a delayed union. 11 months postoperatively she suffered a ground level fall and the cephalic lag screw failed through its fenestrations, resulting in varus collapse of her fracture at the femoral neck. The patient then underwent nail extraction and salvage total hip arthroplasty. Conclusion: Cephalomedullary nail implant failure is presented with implant fracture propagation through a fenestrated cephalic screw. Cephalomedullary lag screw failure is rare and can be difficult to manage. It is important to monitor new implants for unique failure mechanisms.

Propentdyopent: the scaffold of a heme metabolite as an electron reservoir in transition metal complexes.

The dipyrrin-1,9-dione scaffold of heme metabolite propendyopent coordinates late transition metals (Co, Ni, Cu, and Zn) forming homoleptic, pseudo-tetrahedral complexes. Electrochemical and spectroscopic studies reveal that the monoanionic, bidentate ligands behave as electron reservoirs as the complexes reversibly host one or two ligand-based radicals.

Digitalis-like factor and digoxin-like immunoreactive factor in diabetic women with preeclampsia, transient hypertension of pregnancy, and normotensive pregnancy.

An endogenous sodium pump inhibitor, or digitalis-like factor (DLF), has been postulated to mediate essential hypertension. It may also play a role in preeclampsia. However, studies of this factor in hypertensive pregnancy have not provided consistent findings. Part of this may be due to the absence of subclassification of pregnant women with pregnancy-induced hypertension (PIH) when assessing these parameters. In this study we explored serum DLF and digoxin-like immunoreactive factor (DLIF) in insulin-dependent diabetic (IDDM) women with normotensive pregnancies or PIH, comparing them to each other and to nondiabetic pregnant women. Our results demonstrated that nondiabetic women with preeclampsia (PE, PIH with proteinuria) had significantly increased serum DLF and DLIF compared to normotensive pregnant women (NL BP). Women with transient hypertension of pregnancy (THP, PIH without proteinuria) had intermediate values (DLF. NL BP: 3.3 +/- 0.6, THP: 4.8 +/- 1.1, PE: 7.6 +/- 1.3% inhibition [Na,K]-ATPase, P < .05 ANOVA; DLIF. NL BP: 0.22 +/- 0.02, THP: 0.28 +/- 0.03, PE: 0.35 +/- 0.02 ng digoxin equivalents/mL, P < .05 ANOVA). Pregnant normotensive IDDM women had significantly higher serum DLF and DLIF activity than their nondiabetic counterparts (DLF. non-IDDM NL BP: 3.3 +/- 0.6 v IDDM NL BP: 8.8 +/- 1.2% inhibition [Na,K]-ATPase, P = .0008; DLIF. non-IDDM NL BP: 0.22 +/- 0.02 v IDDM NL BP: 0.31 +/- 0.02 ng digoxin equivalents/mL, P = .005).(ABSTRACT TRUNCATED AT 250 WORDS)

Characteristics of antibiotic-resistant Escherichia coli in the rectum of healthy school-children.

During a 3-year period, 771 rectal swabs were taken from abacteriuric school-children. Out of 709 E. coli strains, each isolated from one faecal specimen, 102 were found to be resistant to one or more antibacterial agents, and 607 to be fully sensitive. Another 204 resistant strains were found by selection for antibiotic resistance. The antibiotic-sensitive and the resistant strains were found to be two somewhat different populations, distinguished by a different distribution of O antigen types. Also, the K1 antigen was more common among the sensitive than among the resistant strains. Resistant strains that were not O typable were very seldom haemolytic.

Evaluation of the accuracy of reporting residents' operative experience.

To study the accuracy of residents' operative experience reports, operations were monitored for 6 months. Independent scores for participation (on a scale from 0 to 10) and rating for credit "as surgeon" were obtained from attending surgeons and residents. There was extremely close agreement on acceptance of credit (n = 1,049 of 1,139; p less than 0.00001); where disparity existed, it was predominant in the first two postgraduate years (62% of 90 cases). There was also significant correlation between scores (p less than 0.001). When analyzed in low- (0-3.0), intermediate- (3.5-6.0), and high-score (6.5-10) groups, there was significantly better correlation in the low- and high-score groups (p less than 0.000000001). Sixty-five percent of procedures in the intermediate group were performed by first or second postgraduate year residents; these residents performed 493 (43%) of all procedures. The overall reporting accuracy appeared excellent. Counseling and monitoring may be required at the junior levels.

Long-term treatment with pivmecillinam in patients with recurrent bacteriuria.

Thirty out-patients with chronic recurrent urinary tract infections, who had failed to respond to 10 days treatment with either pivmecillinam and/or amoxycillin, received a 3-month course of pivmecillinam at a dose of 200 mg, three times daily. Twenty-seven patients had bacteriuria due to Enterobacteriaceae, mainly Escherichia coli, sensitive to mecillinam in vitro. Pivmecillinam eradicated all the initial urinary pathogens. Reinfections occurred during treatment in three patients, who remained asymptomatic. Four subjects complained of gastro-intestinal side-effects, and therapy was withdrawn in three instances. Another three patients described unusual adverse events towards the end of the course of treatment, described as an odd sensation in the body and a desire for salt. The sensation disappeared a few days after the end of treatment. Treatment with pivmecillinam had no adverse effect on haematopoietic, hepatic or renal function.

Immunoproliferative small intestinal disease in Basenji dogs: morphologic observations.

Eleven Basenjis with chronic diarrhea were evaluated for pathologic changes. Light microscopic and ultrastructural changes were characterized by lymphoplasmacytic infiltration of the lamina propria of the intestine and stomach and by evidence of degranulation of mast cells in close association with immunocytes. Other changes included hyperplasia of the thyroid parafollicular cells, thyroid follicular atrophy, epidermal atrophy, and ulceration of the pinna. Similarities of the condition in Basenjis and immunoproliferative small intestinal disease and Menetrier's disease in persons are presented.

Untreated asymptomatic bacteriuria in girls: II--Effect of phenoxymethylpenicillin and erythromycin given for intercurrent infections.

OBJECTIVE: To investigate the effects of phenoxymethylpenicillin and erythromycin on urinary isolates from patients with untreated asymptomatic bacteriuria. DESIGN: Retrospective study of subgroup of patients from cohort followed up till the end of 1986. SETTING: Outpatient clinic for children with urinary tract infections. PATIENTS: 51 Girls aged under 15 with untreated asymptomatic bacteriuria. INTERVENTIONS: Before 1982 intercurrent infections (mostly tonsillitis or otitis) were treated with phenoxymethylpenicillin; after 1982 erythromycin treatment was preferred. END POINTS: Change of bacterial strain in urinary tract and symptomatic recurrences of disease. MEASUREMENTS AND MAIN RESULTS: Bacteria identified by serotype and electrophoretic type and compared before and after antibiotic treatment. Bacteriuria eradicated and replaced by new strains in most patients treated with phenoxymethylpenicillin, leading to symptomatic recurrences in about 15%. Conversely, patients given erythromycin rarely showed change in bacteriuria and none suffered symptomatic recurrence. CONCLUSIONS: In girls with untreated asymptomatic bacteriuria the use of phenoxymethylpenicillin for intercurrent infections may lead to a change of urinary bacteria and leave them at substantial risk of acute pyelonephritis. With erythromycin this risk is small (2/20 courses in this series).

High-throughput identification of putative receptors for cancer-binding peptides using biopanning and microarray analysis.

Phage-display peptide biopanning has been successfully used to identify cancer-targeting peptides in multiple models. For cancer-binding peptides, identification of the peptide receptor is necessary to demonstrate the mechanism of action and to further optimize specificity and target binding. The process of receptor identification can be slow and some peptides may turn out to bind ubiquitous proteins not suitable for further drug development. In this report, we describe a high-throughput method for screening a large number of peptides in parallel to identify peptide receptors, which we have termed "reverse biopanning." Peptides can then be selected for further development based on their receptor. To demonstrate this method, we screened a library of 39 peptides previously identified in our laboratory to bind specifically to cancers after irradiation. The reverse biopanning process identified 2 peptides, RKFLMTTRYSRV and KTAKKNVFFCSV, as candidate ligands for the protein tax interacting protein 1 (TIP-1), a protein previously identified in our laboratory to be expressed in tumors and upregulated after exposure to ionizing radiation. We used computational modeling as the initial method for rapid validation of peptide-TIP-1 binding. Pseudo-binding energies were calculated to be -360.645 kcal mol(-1), -487.239 kcal mol(-1), and -595.328 kcal mol(-1) for HVGGSSV, TTRYSRV, and NVFFCSV respectively, suggesting that the peptides would have at least similar, if not stronger, binding to TIP-1 compared to the known TIP-1 binding peptide HVGGSSV. We validated peptide binding in vitro using electrophoretic mobility shift assay, which showed strong binding of RKFLMTTRYSRV and the truncated form TTRYSRV. This method allows for the identification of many peptide receptors and subsequent selection of peptides for further drug development based on the peptide receptor.

Level diagnosis of symptomatic urinary tract infections in childhood.

As no method for localization of urinary tract infection has been shown to be absolutely reliable, six procedures have been carried out simultaneously in 25 girls with acute symptomatic infections and the reliability of each method assessed. While clinical diagnosis of pyelonephritis or cystitis correlated well with the overall results of the battery of tests, the reliability of individual tests varied. Highest reliability was obtained with CRP determinations followed by antibody titration, sedimentation rate, and renal concentrating capacity. In the bladder washout test only 8 of the 14 patients with pyelonephritis had findings clearly indicating high infection. Intermittent or inadequate discharge of bacteria from the renal parenchyma is suggested as the major source for this inaccuracy. In fact, half of the 42 final washout specimens from girls with acute pyelonephritis contained less than 1000 bacteria per ml, indicating that low numbers of organisms in ureteric urine is common in childhood pyelonephritis.