Aspectos epidemiológicos, manejo clínico y resultados a corto plazo en pacientes mayores diagnosticados de insuficiencia cardiaca aguda en urgencias en España: resultados del estudio EDEN-34 / Epidemiological aspects, clinical management and short-term outcomes in elderly patients diagnosed with acute heart failure in the emergency department in Spain: results of the EDEN-34 study

Objetivo: Estimar la incidencia de diagnóstico de insuficiencia cardiaca aguda (ICA) en pacientes mayores en los servicios de urgencias (SU), la confirmación diagnóstica de la ICA en pacientes hospitalizados y los eventos adversos a corto plazo. Método: Se incluyeron a todos los pacientes de ≥65 años atendidos en 52 SU españoles durante una semana y se seleccionaron los diagnosticados de ICA. En los hospitalizados se recogieron los diagnosticados de ICA al alta. Como eventos adversos, se recogió la mortalidad intrahospitalaria y a 30 días, y evento adverso combinado (muerte u hospitalización) a 30 días posalta. Se calcularon las odds ratio (OR) ajustadas de las características demográficas, de estado basal y a la llegada al SU asociadas con mortalidad y evento adverso posalta a 30 días. Resultados: Se incluyeron 1.155 pacientes con ICA (incidencia anual: 26,5 por 1.000 habitantes ≥65 años, IC95%: 25,0-28,1). En el 86%, el diagnóstico de ICA constaba al alta. La mortalidad global a 30 días fue del 10,7%, la intrahospitalaria del 7,9% y el evento combinado posalta del 15,6%. La mortalidad intrahospitalaria y a 30 días se asoció con hipotensión arterial (OR ajustada: 74,0, IC95%: 5,39-1.015.; y 42,6, 3,74-485, respectivamente) e hipoxemia (2,14, 1,27-3,61; y 1,87, 1,19-2,93) a la llegada a urgencias y con precisar ayuda en la deambulación (2,24, 1,04-4,83; y 2,48, 1,27-4,86) y la edad (por cada incremento de 10 años; 1,54, 1,04-2,29, y 1,60, 1,13-2,28). Conclusiones: La ICA es un diagnóstico frecuente en los pacientes mayores que consultan en los SU. El deterioro funcional, la edad, la hipotensión e hipoxemia son los factores que más se asocian a mortalidad.(AU)

Objective: To estimate the incidence of acute heart failure (AHF) diagnosis in elderly patients in emergency departments (ED), diagnostic confirmation in hospitalized patients, and short-term adverse events. Methods: All patients aged ≥65 years attended in 52 Spanish EDs during 1 week were included and those diagnosed with AHF were selected. In hospitalized patients, those diagnosed with AHF at discharge were collected. As adverse events, in-hospital and 30-day mortality, and combined adverse event (death or hospitalization) at 30 days post-discharge were collected. Adjusted odds ratios (OR) for association of demographic variables, baseline status and constants at ED arrival with mortality and 30-day post-discharge adverse event were calculated. Results: We included 1,155 patients with AHF (annual incidence: 26.5 per 1000 inhabitants ≥65 years, 95%CI: 25.0-28.1). In 86% the diagnosis of AHF was known at discharge. Overall 30-day mortality was 10.7% and in-hospital mortality was 7.9%, and the combined event in 15.6%. In-hospital and 30-day mortality was associated with arterial hypotension (adjusted OR: 74.0, 95%CI: 5.39-1015. and 42.6, 3.74-485, respectively and hypoxemia (2.14, 1.27-3.61; and 1.87, 1.19-2.93) on arrival at the ED and requiring assistance with ambulation (2.24, 1.04-4.83; and 2.48, 1.27-4.86) and age (per 10-year increment; 1.54, 1.04-2.29; and 1.60, 1.13-2.28). The combined post-discharge adverse event was not associated with any characteristic. Conclusions: AHF is a frequent diagnosis in elderly patients consulting in the ED. The functional impairment, age, hypotension and hypoxemia are the factors most associated with mortality.(AU)

TisB protein is the single molecular determinant underlying multiple downstream effects of ofloxacin in Escherichia coli.

Bactericidal antibiotics can cause metabolic perturbations that contribute to antibiotic-induced lethality. The molecular mechanism underlying these downstream effects remains unknown. Here, we show that ofloxacin, a fluoroquinolone that poisons DNA gyrase, induces a cascade of metabolic changes that are dependent on an active SOS response. We identified the SOS-regulated TisB protein as the unique molecular determinant responsible for cytoplasmic condensation, proton motive force dissipation, loss of pH homeostasis, and H2O2 accumulation in Escherichia coli cells treated with high doses of ofloxacin. However, TisB is not required for high doses of ofloxacin to interfere with the function of DNA gyrase or the resulting rapid inhibition of DNA replication and lethal DNA damage. Overall, the study sheds light on the molecular mechanisms by which ofloxacin affects bacterial cells and highlights the role of the TisB protein in mediating these effects.

Caja de herramientas para el abordaje integral del uso de sustancias psicoactivas (SPA)

La caja de herramientas para el abordaje integral del uso de sustancias psicoactivas, es un espacio dedicado a aquellas personas que de manera personal han estado o están expuestos al consumo de sustancias psicoactivas (SPA), igualmente, se dirige aquellas personas de la comunidad, familias, colegios, universidades, barrios y grupos sociales que requieran de herramientas prácticas que aporten a la mitigación y prevención de consumo de SPA en su círculo social.

Bienestar para todos PYPAPS: Promoción y Prevención en Atención Primaria en Salud

Este es un espacio pensado en ti y tu comunidad, tiene contenido fácil de leer y comprender para hacer de la información una herramienta, en la que tú y yo, seamos partícipes de la creación de comunidades y personas saludables. Está enfocado en seis poblaciones de interés nacional: Grupos Étnicos, Grupos Etarios, Víctimas de Conflicto Armado, Género, Orientación e Identidad Sexual y Personas con Discapacidad.

Ruta del Paciente en urgencias para una gestión clínica efectiva

Esta herramienta virtual permite desarrollar un proceso de autogestión y planeación de la oferta de servicios para la atención de urgencias y encontrará todas las variables que pueden llegar a modificar el resultado de la calidad de la atención.

Mapa de Evidências - Estratégias em programas e políticas de alimentação e nutrição

O Mapa apresenta uma visão geral das evidências sobre os efeitos de ações e estratégias para promover a nutrição e a alimentação saudável nas diretrizes previstas na Política Nacional de Alimentação e Nutrição (PNAN). A partir de uma ampla busca bibliográfica para as nove diretrizes da PNAN e “Programas e Políticas de Nutrição e Alimentação”, foram incluídas 101 revisões sistemáticas (RS). O mapa representa graficamente 640 associações entre 82 tipos de intervenções distribuídos em 5 categorias e 119 desfechos distribuídos em 8 categorias, com o efeito reportado para cada associação: positivo, potencialmente positivo, inconclusivo, sem efeito ou negativo. Principais Achados: ● As RS abordaram cinco, das nove diretrizes da PNAN: Organização da Atenção Nutricional; Promoção da Alimentação Adequada e Saudável; Qualificação da Força de Trabalho; Controle e Regulação dos Alimentos; e Cooperação e articulação para a Segurança Alimentar e Nutricional. ● As 82 intervenções analisadas nas revisões foram categorizadas em: Atenção Nutricional, Alimentação Saudável, Força de Trabalho, Controle e Regulação, Segurança Alimentar. ● Os 119 desfechos foram distribuídos em oito categorias: Aleitamento materno; Educação e conhecimento; Hábito alimentar; Indicador de Saúde; Problema de Saúde; Qualidade dos alimentos; Segurança alimentar; Venda e publicidade.

Epidemiological aspects, clinical management and short-term outcomes in elderly patients diagnosed with acute heart failure in the emergency department in Spain: results of the EDEN-34 study.

OBJECTIVE: To estimate the incidence of acute heart failure (AHF) diagnosis in elderly patients in emergency departments (ED), diagnostic confirmation in hospitalized patients, and short-term adverse events. METHODS: All patients aged ≥65 years attended in 52 Spanish EDs during 1 week were included and those diagnosed with AHF were selected. In hospitalized patients, those diagnosed with AHF at discharge were collected. As adverse events, in-hospital and 30-day mortality, and combined adverse event (death or hospitalization) at 30 days post-discharge were collected. Adjusted odds ratios (OR) for association of demographic variables, baseline status and constants at ED arrival with mortality and 30-day post-discharge adverse event were calculated. RESULTS: We included 1,155 patients with AHF (annual incidence: 26.5 per 1000 inhabitants ≥65 years, 95% CI: 25.0-28.1). In 86% the diagnosis of AHF was known at discharge. Overall 30-day mortality was 10.7% and in-hospital mortality was 7.9%, and the combined event in 15.6%. In-hospital and 30-day mortality was associated with arterial hypotension (adjusted OR: 74.0, 95% CI: 5.39-1015. and 42.6, 3.74-485, respectively and hypoxemia (2.14, 1.27-3.61; and 1.87, 1.19-2.93) on arrival at the ED and requiring assistance with ambulation (2.24, 1.04-4.83; and 2.48, 1.27-4.86) and age (per 10-year increment; 1.54, 1.04-2.29; and 1.60, 1.13-2.28). The combined post-discharge adverse event was not associated with any characteristic. CONCLUSIONS: AHF is a frequent diagnosis in elderly patients consulting in the ED. The functional impairment, age, hypotension and hypoxemia are the factors most associated with mortality.

An archaeobotanical and stable isotope approach to changing agricultural practices in the NW Mediterranean region around 4000 BC.

It has recently been observed, that a change in the crop spectrum happened during the so-called Middle Neolithic in France at ca. 4000 BC. An agricultural system based on free-threshing cereals (naked wheat and naked barley) seems to shift to one based on glume wheats. This is a major change for traditional farmers and this paper aims to shed light on its possible causes. Here we describe the results of new investigations in a key area for the understanding of this process: the NW Mediterranean arch, where free-threshing cereals are the main cultivars since ca. 5100 BC. New data confirm that the shift towards glume wheats is also observed in some sites of the NE of the Iberian Peninsula and that among the glume wheats that spread at ca. 4000 BC we should not only consider emmer and einkorn but also Timopheevi's wheat. Stable isotope analyses indicate no major decrease in soil fertility or alterations in local precipitation regimes. The agricultural change may be the result of a combination of the spread of damaging pests for free-threshing cereals and presumably new networks being developed with the North-eastern part of Italy and the Balkans.

Mapa de evidências Doença de Chagas: Diagnóstico, Tratamento e Análise de risco

O mapa apresenta uma visão geral das evidências sobre as formas de diagnóstico, de tratamento e de aspectos relacionados ao risco de transmissão da doença de Chagas, bem como do desenvolvimento da cardiopatia chagásica. A partir de uma ampla busca bibliográfica foram incluídos no mapa 43 estudos que foram avaliados, caracterizados e categorizados no mapa. No mapa estão representadas graficamente 82 associações entre 29 intervenções e 29 desfechos para doença de Chagas, com indicação do efeito reportado nos estudos.

Evidence Map on effectiveness of Medicinal Cannabis

This map provides an overview of the evidence regarding interventions related to medicinal cannabis from 194 review studies. These studies evaluated the effects of 18 types of cannabis-based interventions for 71 health outcomes with the most common population with mental/neurological disorders and individuals experiencing pain. The map graphically presents 489 associations that link the effects of 18 types of cannabis interventions to at least one of the 71 health outcomes. Interventions were grouped into 4 types: Synthetic cannabinoids, Isolated phytocannabinoid, THC and CBD formulations, and other cannabis-based formulations. Outcomes were grouped into 9 categories: Well-being and quality of life, Diseases of the Nervous System, Pain, Physiological Phenomena and Metabolism, Psychological and Behavioral Indicators, Other Pathological Conditions, Signs and Symptoms, Mental Disorders, and Other Outcomes. For each association, the intervention's effect on the outcome was reported. For most associations, a positive effect or potentially positive effect was reported.

Mapa de Evidências Arboviroses: estratégias de prevenção e controle

O mapa apresenta uma visão geral das evidências sobre os efeitos das estratégias de prevenção e controle para arboviroses. Foram incluídos no mapa 45 estudos de revisão, que foram avaliados e caracterizados por um grupo de pesquisadores do Centro de Inteligência em Agravos Tropicais Emergentes e Negligenciados (CIATEN) e da Universidade Federal do Piauí (UFPI). No mapa estão representadas graficamente 164 associações entre 64 intervenções e 26 desfechos para prevenção e controle das Arboviroses, com indicação do efeito reportado nos estudos. A intervenção mais avaliada foi a vacina contra a dengue com 14 associações, para as quais foi reportado efeito positivo ou potencialmente em 10 associações. Os desfechos mais avaliados foram: redução de casos de dengue, eliminação do Aedes aegypti e redução da população de mosquitos. Um dos efeitos positivos apresentados foi relacionado principalmente à vacina contra dengue destacando como desfecho principal a redução de casos de dengue; e eliminação de criadouros para eliminação do Aedes aegypti e redução da população de mosquitos, adultos e larvas.

Mapa de evidências Chikungunya: prevenção, controle, diagnóstico e tratamento

O mapa apresenta uma visão geral das evidências sobre as formas de prevenção e controle dos vetores responsáveis pela transmissão da Chikungunya, bem como os diferentes tipos de diagnóstico e tratamento para Chikungunya. A partir de uma ampla busca bibliográfica foram incluídos no mapa 61 estudos (28 revisões sistemáticas, 17 ensaios clínicos controlados, 8 revisões narrativas, 5 estudos metanálises, 3 revisões integrativas), que foram avaliados, caracterizados e categorizados no mapa. No mapa estão representadas graficamente 154 associações entre 74 intervenções e 44 desfechos para Chikungunya, com indicação do efeito reportado nos estudos.

Mapa de Evidências da Teleodontologia

O mapa apresenta uma visão geral das evidências acerca da Teleodontologia aplicada à saúde e educação, a partir de 44 estudos de revisão sistemática. O mapa representa a evidência que analisou o efeito de 39 diferentes intervenções em Teleodontologia organizados em 7 grupos: e-Learning e Teleducação; Teleconsulta e Teleatendimento; Telemonitoramento; Telediagnóstico; Teletriagem; TICs e Intervenções combinadas – para pelo menos um dos 64 desfechos em saúde e educação. Estes desfechos, por sua vez, foram organizados em 8 grupos: Acurácia do Diagnóstico; Educação e Formação; Comportamento Usuário com as TICs; Prática Clínica; Desfechos Centrados no Paciente; Desfechos Clínicos; Gestão de Serviços em Saúde e Acesso aos Serviços de Saúde.

Mapa de Evidências sobre a efetividade da Cannabis Medicinal

O mapa apresenta uma visão geral das evidências de 194 revisões sistemáticas sobre intervenções relacionadas à Cannabis medicinal, que avaliaram o efeito de 18 tipos de intervenções à base de Cannabis para 71 desfechos de saúde. As intervenções foram agrupadas em 4 tipos: Canabinoides sintéticos, Fitocanabinoide isolado, Formulações de THC e CBD, e outras formulações a base de Cannabis. Os desfechos foram agrupados em 9 grupos: Bem-estar e qualidade de vida, Doenças do Sistema Nervoso, Dor, Indicadores Fisiológicos e Metabólicos, Indicadores Psicológicos e Comportamentais, Condições Patológicas, Sinais e Sintomas, Transtornos Mentais, e outros Desfechos. Para cada uma das associações foi reportado o efeito da intervenção para o desfecho, onde para a maioria foi reportado efeito positivo ou potencialmente positivo. O efeito foi inconclusivo para 99 associações, sem efeito para 84 associações. O efeito potencial negativo foi reportado para 18 associações, e negativo para 9 associações. Analisando-se apenas as revisões de alto nível de qualidade (34), foi reportado efeito positivo para os desfechos: segurança do paciente, alívio da dor, dor neuropática, insônia, qualidade do sono, convulsões, epilepsia, transtornos de ansiedade e transtornos cognitivos. E, o efeito potencial positivo foi reportado para os desfechos: dor crônica, dor oncológica, dor neuropática, espasticidade muscular, esclerose múltipla, sintomas de abstinência de drogas, incontinência urinária, noctúria, anorexia, saúde em geral, função física, condicionamento físico, para segurança do paciente, alívio da dor, dor neuropática e qualidade do sono.

Enhanced in vivo absorption and biodistribution of curcumin loaded into emulsions with high medium-chain triglyceride content.

The health benefits of curcumin have been demonstrated by several clinical studies, but its low bioavailability compromises its functionality. In this regard, emulsions have proven to be effective encapsulation systems for curcumin. Nevertheless, emulsions with a high oil content (50%) may offer some advantages due to the large amount of compound they can incorporate. Therefore, the aim of this work was to study the pharmacokinetics and biodistribution of curcumin when carried in optimized emulsions containing 50% MCT oil and a plant-based emulsifier (soybean lecithin) at 2 h or 4 h post-oral administration to rats. The most stable emulsion was obtained using 50% of oil and a surfactant-oil-ratio 0.1, through a microfluidization process. After the oral administration of the systems (150 mg curcumin/kg body weight), curcumin glucuronide was the main compound present in plasma (AUC0-t = 1556.3 ng·h·ml-1), especially at 2-4 h post-administration. The total curcuminoid bioavailability was increased by 10.6-fold when rats were fed with the curcumin emulsion rather than with a control suspension. Moreover, rats fed with the emulsion showed the highest accumulation of free curcuminoids, which present the highest biological activity, in the liver (129 ng curcumin/g tissue) and brown adipose tissue (193 ng curcumin/g tissue). The obtained results are of great interest since the presence of curcumin in the brown adipose tissue has been shown to play a relevant role in the prevention of obesity and its related metabolic disorders.

Structure and Electronic Properties of Large Oligomeric Heterometallic 3d/CeIV Polyoxometalates.

Merging the rich chemistry of Ce(IV) polyoxometalates (POMs) with that of 3d polyanions remains a challenge due to the strong competition between these highly oxophilic lanthanide cations and 3d metallic ions for coordination to lacunary molecular metal oxides. We report herein the characterization of an unprecedented water stable hexameric CeIV/CoII POM (Ce12Co6) made of two {(SiW9)2Ce6} units connected to a {(SiW10)2Co6(PO4)2} core. In addition, the pentameric CeIV/NiII compound Ce6Ni8, where two {PW9Ni3W} and a {PW10Ni2} fragments are grafted on a {(PW9)2Ce6} moiety, has been obtained. Magnetic studies of Ce6Ni8 revealed ferromagnetic interactions between the NiII centers constituting the {Ni3PW10} fragments, in agreement with the geometry of such a trinuclear cluster. Related insoluble barium salts of Ce12Co6 and Ce6Ni8 were also prepared, allowing their solid-state electrochemical investigations and showing in particular that in Ce12Co6, both the cobalt, cerium, and silicotungstate moieties are electroactive. Finally, photophysical studies demonstrate the formation of long-lived reduced POMs photosensitized by [Ru(bpy)3]2+, suggesting that Ce12Co6 and Ce6Ni8 could be used as efficient reservoirs of reduction equivalents for photocatalytic reactions.

¿Recomendar la frecuencia de administración de medicamentos en la prescripción electrónica mejora su adecuación? Estudio antes-después / Does recommending the dosing frequency in the electronic prescription improve its adequacy? Before and after study

Objetivo: Analizar si informar la frecuencia de administración (FA) en el módulo de prescripción de la estación clínica de atención primaria (ECAP) del Institut Català de la Salut (ICS) mejora la adecuación de la FA de las prescripciones. Diseño: Estudio de adecuación antes-después con control no equivalente de prescripciones sin cambios en la FA. El periodo de estudio incluye desde el 1 de septiembre de 2019 hasta el 29 de febrero de 2020.Emplazamiento: Ámbito de atención primaria. Participantes: Se incluyen las prescripciones de los medicamentos con una única FA adecuada o mayoritariamente adecuada realizadas por los médicos de familia del ICS durante el periodo de estudio.IntervenciónRecomendar la FA adecuada en el módulo de prescripción. Mediciones principales: Adecuación definida como la coincidencia entre la FA prescrita y la FA adecuada. Resultados: Tras la intervención se produjo un aumento del 22,75% de prescripciones con FA adecuada. El mayor aumento se dio en los medicamentos del sistema genitourinario y hormonas sexuales. En términos absolutos, el grupo de antiinfecciosos es el que obtuvo más prescripciones con FA adecuada entre los dos periodos. Conclusiones: La intervención aumentó la adecuación en la FA de las prescripciones, lo que supone una mejora en la seguridad y en la eficacia de los tratamientos. Se evidencia que el diseño y la implantación de mejoras en los sistemas de prescripción electrónica contribuye a aumentar la calidad de la prescripción.(AU)

Objective: To assess whether reporting the dosing frequency into the prescription module of the Institut Català de la Salut (ICS) primary care electronic clinical workstation improves the dosing frequency's adequacy of the prescriptions. Design: Before and after study with non-equivalent control of prescriptions without any change in the dosing frequency. The study periods includes from September 1st, 2019 to February 29th, 2020.Location: Primary care setting. Participants: Prescriptions issued by ICS General Practitioner, during the study period of those medicines which indications have a single appropriate dosing frequency or mostly appropriate, are included.Intervention: Recommendation of the appropriate dosing frequency in the prescription module. Main measurements: Adequacy defined as the coincidence between the prescribed dosing frequency and the appropriate dosing frequency. Results: After the intervention there was a 22.75% increase in prescriptions with adequate dosing frequency. The largest increase occurred in the medicines for the genitourinary system and sex hormones. In absolute terms, the group of anti infective for systemic use is the one that obtained more prescriptions with an adequate dosing frequency between the two periods. Conclusions: The intervention increased the dosing frequency's adequacy leading to improvements in the safety and effectiveness of the treatments. It is evident that the design and implementation of improvements in electronic prescription systems contributes to increasing the quality of the prescription.(AU)

Etnicidad y Salud / Ethnicity and Health

Información de referencia en Etninicidad y Salud en la región del America Latina y el Caribe alineada a la Política sobre Etnicidad y Salud (29.a Conferencia Sanitaria Panamericana).

Insights into molar-incisor hypomineralisation in past populations: A call to anthropologists.

OBJECTIVE: Molar incisor hypomineralisation (MIH) is a developmental defect of enamel affecting the first permanent molars and often the incisors and affecting approximately 13% of the current population worldwide. Here, we aim to highlight potential differential diagnoses of MIH in archaeological collections (taphonomic discoloration, amelogenesis imperfecta, fluorosis, rachitic teeth, etc.). METHODS: Causative factors of dental discolourations are identified through a literature review. RESULTS: In an archaeological context, the sediments contained in the burial soil can lead to tooth discoloration. Taphonomic staining of the dentition may have a similar appearance to enamel hypomineralisation, and thus is a confounding factor that has the potential to cause miscalculation of the true prevalence of MIH within archaeological collections. Some rare medieval cases are reported in the modern literature but without microanalysis, misdiagnosis is possible. The aetiological factors of MIH are unknown but probably follow the multifactorial model involving systemic medical and genetic factors. CONCLUSIONS: Systematic detection and diagnosis of MIH during anthropological studies is therefore of great interest. SIGNIFICANCE: The hypotheses that only contemporary agents are causative factors of MIH could be refuted by the discovery of individuals living before medication or pollutants. The identification of MIH in a group of individuals also provides information regarding the health status of a population and reflects stress occurring during the period of mineralisation of the first permanent molars after secretion of the enamel matrix. LIMITATIONS: Taphonomic alterations of archaeological remains prevent MIH diagnosis. SUGGESTIONS FOR FUTURE RESEARCH: MIH diagnosis can be difficult in archaeological series and further non-destructive methods (microtomography, elemental analyses, etc.) are required.

Rib Plating Outcomes in Elderly Trauma Patients With Multiple Rib Fractures: A Community Hospital Experience.

Rib fractures in the elderly are one of the most common injuries in trauma patients admitted to the hospital, accounting for over 350,000 patients annually in the United States. Rib plating has been shown to be most beneficial among certain populations. Early surgical intervention is important to utilize approaches that limit the use of pain medications. This is a retrospective data analysis to determine the efficacy of rib plating in elderly trauma patients with rib fractures. A total of 253 patients were seen with rib fractures, 63% were male and 37% were female. The mean age is 64 ± 18.5 years. Of these patients analyzed, 76% had an associated comorbid condition. A majority of patients (95%) presented to the emergency department (ED) with mild GCS range (13-15). Moderate GCS range (9-12) was 4%, and 3% of patients were with severe GCS (3-8.) The mean ISS was 10. The overall mortality rate was 4.5%. Patients were divided into 2 groups: group I consisted of patients who received open reduction and fixation of the fractured ribs, and group II was patients managed conservatively without surgery. Statistical analyses using Student's t-test and Chi-square test were performed. Institutional Review Board approval was obtained for this study. Rib plating in elderly trauma patients with multiple rib fractures has shown to be beneficial in terms of mortality. Furthermore, geriatric patients with comorbidities will benefit from early open reduction and fixation of rib fractures, though a larger study is needed to establish clearer criteria for rib plating.