Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline.

BACKGROUND: Penetrating gluteal injuries (PGIs) are an increasingly common presentation to major trauma centers (MTCs) in the UK and especially in London. PGIs can be associated with mortality and significant morbidity. There is a paucity of consistent guidance on how best to investigate and manage these patients. METHODS: A retrospective cohort study was performed by interrogating prospectively collected patient records for PGI presenting to a level 1 MTC in London between 2017 and 2019. RESULTS: There were 125 presentations with PGI, accounting for 6.86% of all penetrating injuries. Of these, 95.2% (119) were male, with a median age of 21 (IQR 18-29), and 20.80% (26) were under 18. Compared with the 3 years prior to this study, the number of PGI increased by 87%. The absolute risk (AR) of injury to a significant structure was 27.20%; the most frequently injured structure was a blood vessel (17.60%), followed by the rectum (4.80%) and the urethra (1.60%). The AR by anatomic quadrant of injury was highest in the lower inner quadrant (56%) and lowest in the upper outer quadrant (14%). CT scanning had an overall sensitivity of 50% and specificity of 92.38% in identifying rectal injury. DISCUSSION: The anatomic quadrant of injury can be helpful in stratifying risk of rectal and urethral injuries when assessing a patient in the emergency department. Given the low sensitivity in identifying rectal injury on initial CT, this data supports assesing any patients considered at high risk of rectal injury with an examination under general anesthetic with or without rigid sigmoidoscopy. The pathway has created a clear tool that optimizes investigation and treatment, minimizing the likelihood of missed injury or unnecessary use of resources. It therefore represents a potential pathway other centers receiving a similar trauma burden could consider adopting. LEVEL OF EVIDENCE: 2b.

Nitrogen fertilizer decreases survival and reproduction of female locusts by increasing plant protein to carbohydrate ratio.

Nitrogen limitation theory predicts that terrestrial plants should benefit from nitrogen inputs and that herbivores should benefit from subsequent higher plant protein contents. While this pattern has generally been supported, some herbivorous insects have shown preference and higher performance on low protein (p), high carbohydrate (c) diets as juveniles. However, little is known about the effects on reproduction in adults. Using nitrogen fertilizer, we demonstrate that high plant p:c has negative effects on Senegalese locust (Orthoptera: Oedaeleus senegalensis) reproduction and survival in an agroecological setting. For this, we measured p:c in millet plants Pennisetum glaucum that received two levels of fertilizer (high and moderate) and a control, then we caged locusts on these plants for 2 weeks. In the laboratory, we gave locusts the choice between untreated millet leaves and leaves that received one of the two fertilization treatment. We found that fertilization increased p:c ratio in a concentration-dependent fashion. We counted the number of locusts alive over the course of 2 weeks and showed that fewer females survived on fertilized plants than on control plants. Females that ate plants from the high fertilization treatment laid lighter eggs. Finally, we showed that female locusts prefer unfertilized plants to plants with a high p:c. We hypothesize that this pattern will apply broadly to species that have extensive carbohydrate needs, such as long-distance migrators. Because many ecological studies focus primarily on nitrogen or protein, and fail to consider carbohydrates, this study has important implications for how ecologists consider nutrient limitation of primary consumers in ecosystems globally.

Asociación entre Escala de Alvarado y diagnóstico de apendicitis aguda complicada y no complicada según anatomía patológica en el Centro Médico Naval / Association between Alvarado Score and acute appendicitis diagnosis complicated and uncomplicated as pathology in the Naval Medical Center

OBJETIVO: Determinar la asociación entre la Escala de Alvarado y diagnóstico de apendicitis aguda complicada y no complicada según anatomía patológica en el Centro Médico Naval. MATERIAL Y MÉTODO: Se trató de un estudio no experimental de tipo transversal y retrospectivo con enfoque cualitativo. Se revisaron las historias clínicas y reportes operatorios de todos los pacientes que ingresaron por emergencia del citado hospital con diagnóstico clínico de apendicitis aguda entre Enero y Marzo 2011. RESULTADOS: Se estudiaron 116 pacientes que fueron intervenidos de apendicectomías. Hubo 76 hombres (65.5%) y 40 mujeres (34.5%), la edad promedio fue de 34 años, la media del tiempo de enfermedad fue de 21 horas. La variable de la escala de Alvarado que estuvo presente en el 100% de los pacientes fue el dolor en fosa iliaca derecha (FID), seguido de migración. Se encontró que la apendicitis aguda complicada obtuvo 0.99 más puntos que la apendicitis aguda no complicada. Un puntaje ≥ 7 en la escala de Alvarado arrojo una sensibilidad del 71.15% y especificidad de 56.67% para clasificar apendicitis aguda complicada y no complicada, con un porcentaje de correctamente clasificados del 63.39 %. Así mismo, la curva ROC, demostró que el área bajo la curva fue de 0.68. CONCLUSIONES: Se demostró que existe asociación entre Escala de Alvarado y diagnóstico de apendicitis aguda complicada y no complicada, según anatomía patológica. Además, se demostró que a mayor puntaje en la Escala de Alvarado, mayor es el grado de afectación apendicular.

OBJETIVE: To determine the association between AlvaradoÆs scale and diagnosis of complicated and uncomplicated acute appendicitis for anatomy pathology at Naval Medical Center. MATERIALS AND METHOD: This study was non experimental, cross-sectional and retrospective qualitative approach. We reviewed medical records and surgery reports of all emergency patients admitted in the same hospital with clinical diagnosis of acute appendicitis between January and March 2011. RESULTS: A total of 116 patients underwent appendectomy. There were 76 men (65.5%) and 40 women (34.5%). The average age was 34 years old. Mean disease duration was 21 hours. Under Alvarado scoring system, the variable which was present at 100 % of our population was the right iliac fossa pain, followed by migration. We found that complicated acute appendicitis was 0.99 more points than uncomplicated acute appendicitis. A ≥7 score in AlvaradoÆ scale threw a sensitivity of 71.15 % and 56.67 % specificity for classifying complicated and no complicated acute appendicitis, with a rate of 63.39 of correctly classified. Finally, ROC curve showed that the area under the curve was 0.68. CONCLUSIONS: We demonstrated that association between AlvaradoÆs scale and diagnosis of complicated and uncomplicated acute appendicitis for anatomy pathology at Naval Medical Center exists. Besides the higher the score on AlvaradoÆs scale, the greater the degree of appendix involvement.