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1.
Medicine (Baltimore) ; 99(4): e18789, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977870

RESUMO

Clinical features of extremity fractures (EFs) in patients presenting with traumatic spinal fractures (TSFs) and spinal cord injury (SCI) have not been investigated. To investigate the clinical features and risk factors for EFs in patients presenting with TSFs and SCI.Data from 1392 patients presenting with TSFs and SCI in our hospitals between 2001 and 2010 were retrospectively reviewed, among which 165 patients (129 males and 36 females, 37.5 ±â€Š10.6 years old) presented with EFs. The clinical features of EFs have been investigated.The frequencies of upper limb fractures were significantly higher in the motor vehicle collisions (MVCs) group than in the high-fall group (P = .012) and the struck-by-object group (P = .002). The frequencies of lower limb fractures were significantly higher in the struck-by-object group (P = .019) and the high-fall group (P = .011) than the MVCs group. Univariate logistic regression analysis show that being in the 19 to 39 age group (P = .001), having a lumbar spinal fracture (P < .001) and experiencing a high fall (P < .001) were risk factors for EFs. Multivariate logistic regression analysis showed that we should focus on the factors that having a lumbar spinal fracture and experiencing a high fall.High fall and MVCs were the most common aetiologies for EFs. Having a lumbar spinal fracture and experiencing a high fall were significant risk factors for EFs. We should make early diagnoses and initiate timely treatment according to different patterns of extremity fractures in patients with TSFs and SCI.


Assuntos
Fraturas Ósseas/epidemiologia , Extremidade Inferior/lesões , Fraturas da Coluna Vertebral/epidemiologia , Extremidade Superior/lesões , Acidentes/estatística & dados numéricos , Adulto , Fatores Etários , Feminino , Fraturas Ósseas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fraturas da Coluna Vertebral/etiologia
2.
BMJ ; 368: l7057, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996343

RESUMO

OBJECTIVE: To study the impact of maternal smoking during pregnancy on fractures in offspring during different developmental stages of life. DESIGN: National register based birth cohort study with a sibling comparison design. SETTING: Sweden. PARTICIPANTS: 1 680 307 people born in Sweden between 1983 and 2000 to women who smoked (n=377 367, 22.5%) and did not smoke (n=1 302 940) in early pregnancy. Follow-up was until 31 December 2014. MAIN OUTCOME MEASURE: Fractures by attained age up to 32 years. RESULTS: During a median follow-up of 21.1 years, 377 970 fractures were observed (the overall incidence rate for fracture standardised by calendar year of birth was 11.8 per 1000 person years). The association between maternal smoking during pregnancy and risk of fracture in offspring differed by attained age. Maternal smoking was associated with a higher rate of fractures in offspring before 1 year of age in the entire cohort (birth year standardised fracture rates in those exposed and unexposed to maternal smoking were 1.59 and 1.28 per 1000 person years, respectively). After adjustment for potential confounders the hazard ratio for maternal smoking compared with no smoking was 1.27 (95% confidence interval 1.12 to 1.45). This association followed a dose dependent pattern (compared with no smoking, hazard ratios for 1-9 cigarettes/day and ≥10 cigarettes/day were 1.20 (95% confidence interval 1.03 to 1.39) and 1.41 (1.18 to 1.69), respectively) and persisted in within-sibship comparisons although with wider confidence intervals (compared with no smoking, 1.58 (1.01 to 2.46)). Maternal smoking during pregnancy was also associated with an increased fracture incidence in offspring from age 5 to 32 years in whole cohort analyses, but these associations did not follow a dose dependent gradient. In within-sibship analyses, which controls for confounding by measured and unmeasured shared familial factors, corresponding point estimates were all close to null. Maternal smoking was not associated with risk of fracture in offspring between the ages of 1 and 5 years in any of the models. CONCLUSION: Prenatal exposure to maternal smoking is associated with an increased rate of fracture during the first year of life but does not seem to have a long lasting biological influence on fractures later in childhood and up to early adulthood.


Assuntos
Fraturas Ósseas , Gestantes/psicologia , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Fumar , Adulto , Fatores Etários , Criança , Correlação de Dados , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Humanos , Lactente , Masculino , Gravidez , Sistema de Registros/estatística & dados numéricos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Suécia/epidemiologia
3.
Praxis (Bern 1994) ; 109(1): 19-22, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910768

RESUMO

OsteoLaus: Right to Exist and First Results Abstract. The OsteoLaus cohort included 1475 women aged 50 to 80 years between 2010 and 2012, and since followed every 2.5 years. The main goal is to better define osteoporosis and the prediction of fracture risk. Using the multiple data available in CoLaus/PsycoLaus, many analyses are being conducted to better understand the relationship between bone health and chronic disease.


Assuntos
Fraturas Ósseas , Osteoporose , Idoso , Idoso de 80 Anos ou mais , Osso e Ossos , Estudos de Coortes , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/epidemiologia , Fatores de Risco
4.
Int J Radiat Oncol Biol Phys ; 106(3): 485-492, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31610251

RESUMO

PURPOSE: Older patients undergoing radiation therapy (RT) for pelvic malignancies are at increased risk for pelvic fracture, which is associated with significant morbidity and mortality. RT techniques such as brachytherapy or intensity modulated RT (IMRT) allow for more conformal dose distributions, but it is not known whether the risk for pelvic fracture varies by RT modality. METHODS AND MATERIALS: This observational cohort study involved 28,354 patients ≥65 years old, treated with RT for pelvic malignancies. We evaluated the relative risk of pelvic fracture by type of RT when accounting for baseline factors. To test for nonspecific effects, we also evaluated risk of nonpelvic fractures in the same population. RESULTS: The 5-year incidence of pelvic fractures was 12.7% (95% confidence interval [CI], 11.6%-13.8%), 11.8% (10.8%-12.8%), and 3.7% (3.4%-4.0%) for patients with gastrointestinal, gynecologic, and prostate cancer, respectively. On multivariable analysis, being treated with IMRT (hazard ratio, 0.85; 95% CI, 0.73-0.99) or brachytherapy therapy alone (hazard ratio, 0.43; 95% CI, 0.34-0.54) was associated with a reduced hazard for pelvic fractures compared with 3D conformal radiation therapy in female patients. In contrast, there was no association with RT modality and the hazard for nonpelvic fractures among females. There was no significant association between pelvic fractures and IMRT or brachytherapy for male patients. White race, advanced age, and higher comorbidity were associated with an increased hazard for pelvic fracture. CONCLUSIONS: IMRT and brachytherapy were associated with a reduced risk of pelvic fractures in older women undergoing RT for pelvic malignancies. Pelvic insufficiency fracture risk should be considered when treating with pelvic RT.


Assuntos
Braquiterapia/efeitos adversos , Fraturas Ósseas/etiologia , Ossos Pélvicos/lesões , Neoplasias Pélvicas/radioterapia , Radioterapia Conformacional/efeitos adversos , Fatores Etários , Idoso , Estudos de Coortes , Intervalos de Confiança , Grupo com Ancestrais do Continente Europeu , Feminino , Fraturas Ósseas/epidemiologia , Neoplasias Gastrointestinais/radioterapia , Neoplasias dos Genitais Femininos/radioterapia , Humanos , Incidência , Masculino , Ossos Pélvicos/efeitos da radiação , Neoplasias da Próstata/radioterapia , Radioterapia de Intensidade Modulada/efeitos adversos , Análise de Regressão , Risco , Fatores Sexuais
5.
Int J Radiat Oncol Biol Phys ; 106(3): 475-484, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31580930

RESUMO

PURPOSE: To estimate the overall rate, symptomatic proportion, and most common sites of pelvic insufficiency fracture (PIF) after external beam radiation therapy for gynecologic cancers based on posttreatment computed tomography, magnetic resonance imaging, positron emission tomography, or bone scintigraphy. METHODS AND MATERIALS: A systematic search of databases (PubMed and EMBASE) was performed (CRD42019125679). The pooled summary of overall PIF and the proportion of symptomatic cases were calculated using the random-effects model weighted by the inverse variance. A multivariate meta-regression was performed to evaluate potential sources of heterogeneity regarding PIF fractures. RESULTS: Twenty-one studies met the inclusion criteria (total 3929 patients). Five hundred four patients developed PIF, translating to an overall rate of 14% (95% confidence interval, 10%-18%, based on 21 studies). Among these cases with PIF, the proportion of symptomatic patients was 61% (95% confidence interval, 52%-69%, based on 14 studies). The total number of PIFs was 704 (mean, 1.72 PIFs per each patient to develop PIF, based on 14 studies). More recent series (P = .0074) and the use of intensity modulated radiation therapy (P = .0299) were associated with lower fracture rates. The most common fracture sites were sacroiliac joint (39.7%), body of the sacrum (33.9%), pubis (13%), lumbar vertebra (7%), iliac bone (2.8%), acetabulum (2.1%), and femoral head/neck (1.5%). The median time to fracture was 7.1 to 19 months after radiation therapy. CONCLUSIONS: The incidence of PIF after radiation therapy for gynecologic cancers is high (14%), with the majority affecting the sacral bone or joint (73.6%), although this risk appears to be lower with intensity modulated radiation therapy. Posttreatment bone surveillance is warranted in this population because nearly 40% of patients were asymptomatic at the time of PIF diagnosis.


Assuntos
Fraturas Ósseas/epidemiologia , Fraturas Espontâneas/epidemiologia , Neoplasias dos Genitais Femininos/radioterapia , Ossos Pélvicos/lesões , Intervalos de Confiança , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Humanos , Ossos Pélvicos/efeitos da radiação , Radioterapia de Intensidade Modulada , Análise de Regressão
6.
Acta Neurol Scand ; 141(1): 47-55, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31550049

RESUMO

OBJECTIVES: To estimate the incidence of fractures, possibly caused by falls, in patients aged 65 and older with first episode of stroke, and to estimate the incidence of fracture types for this group of patients. Another objective was to investigate stroke severity and marital status, as risk factors for fractures. MATERIALS AND METHODS: A large retrospective dataset of 116 519 patients with first episode of stroke was extracted from the Danish Stroke Registry between January 2003 and December 2017. The occurrence of fractures was identified in the Danish National Patient Registry. A univariate analysis was conducted and a multivariate analysis was conducted to determine the relationship between stroke severity and fractures, and marital status and fractures, adjusting for multiple confounders. Cox regression with time-varying covariates was used, taking time-dependent variables into account. RESULTS: The incidence rate of fractures post-stroke was 41.07 per 1000 person-years between 2003 and 2017 in Denmark. A total of 15 872 (14.86%) sustained a fracture and the mean time at risk until outcome was 3.67 years post-stroke. Femur fracture was the most common fracture type. Mild, moderate, severe, and unknown stroke severity are associated with fractures after stroke compared to very severe stroke, and living alone at the time of stroke is associated with fractures after stroke compared to living with someone. CONCLUSIONS: The incidence rate of fractures in Denmark was 41.07 per 1000 person-years. Moreover, mild, moderate, and severe stroke severity, and living alone at the time of stroke were found to be risk factors for fracture.


Assuntos
Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Acidente Vascular Cerebral/complicações , Acidentes por Quedas , Idoso , Idoso de 80 Anos ou mais , Dinamarca/epidemiologia , Feminino , Humanos , Incidência , Masculino , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco
7.
Emerg Med Clin North Am ; 38(1): 61-79, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757255

RESUMO

Injury patterns of the hand and wrist can be complex and challenging for the emergency physician to diagnose and treat. The ability of the hand to perform delicate maneuvers requires a very intricate interplay of bones, ligaments, and tendons. Unfortunately, due to the omnipresence of the hand, the hand and wrist are commonly injured. These injuries can be debilitating if not treated correctly and can be both time-consuming and fraught with medicolegal risk. This article provides the necessary knowledge to diagnose and treat common hand and wrist injuries encountered in the emergency department.


Assuntos
Gerenciamento Clínico , Emergências , Fraturas Ósseas , Traumatismos da Mão , Procedimentos Ortopédicos/métodos , Radiografia , Traumatismos do Punho , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/terapia , Saúde Global , Traumatismos da Mão/diagnóstico , Traumatismos da Mão/epidemiologia , Traumatismos da Mão/terapia , Humanos , Incidência , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/epidemiologia , Traumatismos do Punho/terapia
8.
PLoS Med ; 16(12): e1002986, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31790400

RESUMO

BACKGROUND: Puberty is a critical period for bone mass accrual, and late puberty in boys is associated with reduced bone mass in adult men. The role of variations in pubertal timing within the normal range for adult fracture risk in men is, however, unknown. We, therefore, assessed the association between age at peak height velocity (PHV), an objective measure of pubertal timing, and fracture risk in adult men. METHODS AND FINDINGS: In the BMI Epidemiology Study Gothenburg, 31,971 Swedish men born between January 1, 1945, and December 31, 1961, with detailed growth data (height and weight) available from centrally archived school healthcare records and the conscription register were followed until December 31, 2016. Age at PHV was calculated according to a modified infancy-childhood-puberty model, and fracture information was retrieved from the Swedish National Patient Register. The mean ± SD age at PHV was 14.1 ± 1.1 years. In total, 5,872 men (18.4%) sustained at least 1 fracture after 20 years of age and 5,731 men (17.9%) sustained a non-vertebral fracture after 20 years of age during a mean ± SD follow-up of 37.3 ± 11.7 years. Cox proportional hazards models adjusted for birth year and country of origin revealed that age at PHV was associated with the risk of any fracture and non-vertebral fracture. Participants with age at PHV in the highest tertile (after 14.5 years of age) were at greater risk of any fracture (hazard ratio [HR] 1.15, 95% confidence interval [CI] 1.08-1.22, P < 0.001) and non-vertebral fracture (HR 1.16, 95% CI 1.09-1.24, P < 0.001) compared with those with age at PHV in the lowest tertile (at 13.6 years of age or younger). Additional adjustments for birthweight, childhood BMI, adult educational level, and young adult height did not attenuate the associations between age at PHV and adult fracture risk. Limitations of this study include the inability to adjust for important risk factors for fracture, inadequate power to assess the relation between pubertal timing and specific fracture types, and the limited generalizability to other populations. CONCLUSIONS: In this study, we observed that late pubertal timing was associated with increased adult fracture risk in men. These findings suggest that information on pubertal timing might aid in the identification of those men at greatest risk of fracture.


Assuntos
Peso Corporal/fisiologia , Fraturas Ósseas/epidemiologia , Maturidade Sexual/fisiologia , Adolescente , Adulto , Estatura/fisiologia , Índice de Massa Corporal , Criança , Estudos de Coortes , Feminino , Humanos , Masculino , Risco , Suécia , Adulto Jovem
9.
West J Emerg Med ; 20(6): 857-864, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31738712

RESUMO

INTRODUCTION: Musculoskeletal injuries (MSI) comprise a large portion of the trauma burden in low- and middle-income countries (LMIC). Rwanda recently launched its first emergency medicine training program (EMTP) at the University Teaching Hospital-Kigali (UTH-K), which may help to treat such injuries; yet no current epidemiological data is available on MSI in Rwanda. METHODS: We conducted this pre-post study during two data collection periods at the UTH-K from November 2012 to July 2016. Data collection for MSI is limited and thus is specific to fractures. We included all patients with open, closed, or mixed fractures, hereafter referred to as MSI. Gathered information included demographics and outcomes including death, traumatic complications, and length of hospital stay, before and after the implementation of the EMTP. RESULTS: We collected data from 3609 patients. Of those records, 691 patients were treated for fractures, and 674 of them had sufficient EMTP data measured for inclusion in the analysis of results (279 from pre-EMTP and 375 from post-EMTP). Patient demographics demonstrate that a majority of MSI cases are male (71.6% male vs 28.4% female) and young (64.3% below 35 years of age). Among mechanisms of injury, major causes included road traffic accidents (48.1%), falls (34.2%), and assault (6.0%). There was also an observed association between EMTP and trends of the three primary outcomes: a reduction of death in the emergency department (ED) from those with MSI by 89.9%, from 2.51% to 0.25% (p = 0.0077); a reduction in traumatic complications for MSI patients by 71.7%, from 3.58% to 1.01% (p = 0.0211); and a reduction in duration of stay in the ED among those with MSI by 52.7% or 2.81 days on average, from 5.33 to 2.52 days (p = 0.0437). CONCLUSION: This study reveals the current epidemiology of MSI morbidity and mortality for a major Rwandan teaching hospital and the potential impacts of EM training implementation among those with MSI. Residency training programs such as EMTP appear capable of reducing mortality, complications, and ED length of stay among those with MSI caused by fractures. Such findings underscore the efficacy and importance of investments in educating the next generation of health professionals to combat prevalent MSI within their communities.


Assuntos
Medicina de Emergência/educação , Fraturas Ósseas/terapia , Internato e Residência , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Hospitais de Ensino/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Ruanda/epidemiologia , Resultado do Tratamento
10.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31767715

RESUMO

OBJECTIVES: To investigate nonpowder firearm injuries treated in US emergency departments among children <18 years old. METHODS: National Electronic Injury Surveillance System data from 1990 through 2016 were analyzed. RESULTS: An estimated 364 133 (95% confidence interval 314 540-413 727) children <18 years old were treated in US emergency departments for injuries related to nonpowder firearms from 1990 to 2016, averaging 13 486 children annually. From 1990 to 2016, the number and rate of nonpowder firearm injuries decreased by 47.8% (P < .001) and 54.5% (P < .001), respectively. Most injuries occurred among 6- to 12-year-olds (47.4%) and 13- to 17-year-olds (47.0%). Boys accounted for 87.1% of injured children, the most common diagnosis was foreign body (46.3%), and 7.1% of children were admitted. BB guns accounted for 80.8% of injuries, followed by pellet guns (15.5%), paintball guns (3.0%), and airsoft guns (0.6%). The rate of eye injuries increased by 30.3% during the study period. Eye injuries accounted for 14.8% of all injuries and the most common diagnoses were corneal abrasion (35.1%), hyphema (12.5%), globe rupture (10.4%), and foreign body (8.6%). CONCLUSIONS: Although the number and rate of nonpowder firearm injuries declined during the study period, nonpowder firearms remain a frequent and important source of preventable and often serious injury to children. The severity and increasing rate of eye injuries related to nonpowder firearms is especially concerning. Increased prevention efforts are needed in the form of stricter and more consistent safety legislation at the state level, as well as child and parental education regarding proper supervision, firearm handling, and use of protective eyewear.


Assuntos
Serviço Hospitalar de Emergência , Ferimentos por Arma de Fogo/epidemiologia , Adolescente , Criança , Pré-Escolar , Contusões/epidemiologia , Traumatismos Oculares/epidemiologia , Feminino , Armas de Fogo/legislação & jurisprudência , Corpos Estranhos/epidemiologia , Fraturas Ósseas/epidemiologia , Humanos , Lacerações/epidemiologia , Masculino , Estudos Retrospectivos , Estados Unidos/epidemiologia , Ferimentos por Arma de Fogo/prevenção & controle , Ferimentos por Arma de Fogo/terapia
11.
Am Surg ; 85(10): 1089-1093, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657300

RESUMO

Older adults undergoing nonelective surgery are at risk for geriatric events (GEs: delirium, dehydration, falls/fractures, failure to thrive, and pressure ulcers), but the impact of GEs on postoperative outcomes is unclear. Using the 2013 to 2014 National Inpatient Sample, we analyzed nonelective hospital admissions for five common operations (laparoscopic cholecystectomy, colectomy, soft tissue debridement, small bowel resection, and laparoscopic appendectomy) in older adults (aged ≥65 years) and a younger referent group (aged 55-64 years). Nationally weighted descriptive statistics were generated for GEs. Logistic regression controlling for patient, procedure, and hospital characteristics estimated the association of 1) age with GEs and 2) GEs with outcomes. Of 471,325 overall admissions, 64.7 per cent were aged ≥65 years. The rate of any GE in older adults was 26.9 per cent; GEs varied by age and procedure (P < 0.001). After adjustment, the probability of any GE increased with age category (P < 0.001); having any GE was associated with higher probability of all outcomes (P < 0.001): mortality (4.5% vs 0.8%), postoperative complications (61.7% vs 24.9%), prolonged length of stay (24.3% vs 7.9%), and skilled nursing facility discharge (46.6% vs 10.3%). In addition, there was a dose-response relationship between GEs and negative outcomes. GEs are prevalent in the nonelective surgery setting and associated with worse clinical outcomes. Quality improvement efforts should focus on addressing GEs.


Assuntos
Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Colectomia/efeitos adversos , Desbridamento/efeitos adversos , Intestino Delgado/cirurgia , Complicações Pós-Operatórias/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Fatores Etários , Idoso , Apendicectomia/estatística & dados numéricos , Colecistectomia Laparoscópica/estatística & dados numéricos , Colectomia/estatística & dados numéricos , Desbridamento/estatística & dados numéricos , Desidratação/epidemiologia , Desidratação/etiologia , Delírio/epidemiologia , Delírio/etiologia , Insuficiência de Crescimento/epidemiologia , Insuficiência de Crescimento/etiologia , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Lesão por Pressão/epidemiologia , Lesão por Pressão/etiologia , Instituições de Cuidados Especializados de Enfermagem/estatística & dados numéricos , Resultado do Tratamento
12.
Tidsskr Nor Laegeforen ; 139(12)2019 09 10.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-31502796

RESUMO

BACKGROUND: It is a policy objective to increase the percentage of journeys made by bicycle in Norway from the current 5 % to 10 %. Kristiansand is one of the most active cities in Norway in terms of cycling. We wished to identify the extent of injuries among cyclists admitted to the hospital. MATERIAL AND METHOD: We reviewed the medical records of patients with cycling-related injuries who were admitted to Sørlandet Hospital, Kristiansand in the period 1 January 2012 to 31 December 2015. Patient, accident, injury and treatment characteristics were recorded, as well as any sequelae after 12 months. RESULTS: Altogether 224 adults and 53 children (<16 years) were registered with cycling-related injuries, most of which (n=192, 69 %) were mild/moderate. Very severe and critical injuries were recorded in 6 (11 %) children and 22 (10 %) adults. Fractures (n=179, 65 %) and minor head injuries (n= 78, 28 %) dominated the injury panorama. Surgical treatment was undertaken in 107 (48 %) adults and 19 (36 %) children. A total of 12 (4 %) patients were transferred to the trauma centre at Oslo University Hospital Ullevål. Four adults had significant sequelae after 12 months, all related to severe head/neck injury. INTERPRETATION: A considerable proportion of serious and complex injuries require that the national guidelines for use of a trauma team be followed. Systematic and ongoing registration of cyclists' injuries in the form of a national registry could help increase our insight into the circumstances surrounding accidents and the extent of injuries related to these.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Ciclismo/lesões , Adolescente , Adulto , Ciclismo/estatística & dados numéricos , Criança , Traumatismos Craniocerebrais/epidemiologia , Serviços Médicos de Emergência , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Tempo de Internação , Masculino , Registros Médicos , Pessoa de Meia-Idade , Noruega/epidemiologia , Estações do Ano , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Fatores de Tempo , Transporte de Pacientes , Índices de Gravidade do Trauma
13.
Transplant Proc ; 51(8): 2704-2709, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31477421

RESUMO

BACKGROUND: There is a high risk of fracture after kidney transplantation (KT). Recipients of KT are susceptible to persistent hyperparathyroidism and other disorders of bone and mineral metabolism. However, the risk factors for fractures after KT remain uncertain. The aim of the present study was to investigate the risk factors for fracture after KT. METHODS: A total of 941 recipients of KT were enrolled from a multicenter observational cohort study in Korea from 2012 to 2016. The biochemical markers were measured at the time of KT, then annually for 5 years following KT. All fracture events were recorded. A Cox proportional hazards analysis was performed to calculate hazard ratios (HR) for the association of risk factors with fractures. RESULTS: Twenty-two fractures had occurred in 20 patients during the study period. Baseline and serial changes of mineral and bone biochemical markers were similar between fracture and nonfracture patient groups. Among the total study population, 104 patients were diagnosed with osteoporosis and 422 patients were diagnosed with osteopenia in a pretransplant bone mineral density test. In a multivariate Cox analysis, pretransplant osteoporosis (HR = 11.76; 95% confidence interval [CI], 2.28-60.69; P = .003) and pretransplant osteopenia (HR = 5.21; 95% CI, 1.15-23.57; P = .032) were independent risk factors for fracture in recipients of KT. CONCLUSIONS: Pretransplant osteoporosis and osteopenia were independent risk factors for fracture after KT. More careful monitoring of bone mineral density before and after KT might be beneficial to predict the risk for fracture after KT.


Assuntos
Doenças Ósseas Metabólicas/complicações , Fraturas Ósseas/etiologia , Transplante de Rim , Osteoporose/complicações , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Doenças Ósseas Metabólicas/epidemiologia , Estudos de Coortes , Feminino , Fraturas Ósseas/epidemiologia , Humanos , Transplante de Rim/efeitos adversos , Masculino , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Modelos de Riscos Proporcionais , República da Coreia , Fatores de Risco
14.
Bull Soc Pathol Exot ; 112(2): 71-78, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31478620

RESUMO

Spondylodiscitis is a common but potentially serious form of extra-pulmonary tuberculosis. Very few descriptions are known from Tunisia. We have conducted a retrospective study including 60 cases of spinal tuberculosis, performed over a period of 20 years (1996-2016). The diagnosis was retained on bacteriological, radiological and anatomopathologic evidence. Sixty cases including 31 women and 29 men of spinal tuberculosis were involved. The mean age was 54.4 ±â€…21.3 years. The delay from onset to diagnosis was 6 months (1-14). Lumbar region was the most common infection site (68%). The magnetic resonance imaging has confirmed spinal infection in all cases. The percutaneous image guided spinal biopsy was conclusive in 24/42 cases (57.1%). All patients were put under anti-tuberculosis treatment with total treatment duration of 14 months. Fourteen patients underwent surgical act. The outcome was favorable in 42 cases (7%). Advanced age ≥ 65 years (P = 0.026), radiological evidence of spinal cord compression (P = 0.033) or abscess (P = 0.024), hyperleucocytosis higher than 11,500 elements/mm3 (0.031), or fractures on bone imaging (P = 0.018) and vertebral deformity (P < 0.001) were strongly linked to a bad outcome. Early diagnosis and treatment onset may ensure better outcomes and reduce neurological complications and vertebral deformity.


Assuntos
Discite/diagnóstico , Discite/epidemiologia , Tuberculose da Coluna Vertebral/diagnóstico , Tuberculose da Coluna Vertebral/epidemiologia , Adulto , Idoso , Antituberculosos/uso terapêutico , Estudos de Coortes , Discite/tratamento farmacológico , Discite/microbiologia , Feminino , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/microbiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Tuberculose da Coluna Vertebral/tratamento farmacológico , Tunísia/epidemiologia
15.
BMJ ; 366: l4892, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31481394

RESUMO

OBJECTIVE: To explore whether thyroid stimulating hormone (TSH) concentration in patients with a diagnosis of hypothyroidism is associated with increased all cause mortality and a higher risk of cardiovascular disease and fractures. DESIGN: Retrospective cohort study. SETTING: The Health Improvement Network (THIN), a database of electronic patient records from UK primary care. PARTICIPANTS: Adult patients with incident hypothyroidism from 1 January 1995 to 31 December 2017. EXPOSURE: TSH concentration in patients with hypothyroidism. MAIN OUTCOME MEASURES: Ischaemic heart disease, heart failure, stroke/transient ischaemic attack, atrial fibrillation, any fractures, fragility fractures, and mortality. Longitudinal TSH measurements from diagnosis to outcomes, study end, or loss to follow-up were collected. An extended Cox proportional hazards model with TSH considered as a time varying covariate was fitted for each outcome. RESULTS: 162 369 patients with hypothyroidism and 863 072 TSH measurements were included in the analysis. Compared with the reference TSH category (2-2.5 mIU/L), risk of ischaemic heart disease and heart failure increased at high TSH concentrations (>10 mIU/L) (hazard ratio 1.18 (95% confidence interval 1.02 to 1.38; P=0.03) and 1.42 (1.21 to 1.67; P<0.001), respectively). A protective effect for heart failure was seen at low TSH concentrations (hazard ratio 0.79 (0.64 to 0.99; P=0.04) for TSH <0.1 mIU/L and 0.76 (0.62 to 0.92; P=0.006) for 0.1-0.4 mIU/L). Increased mortality was observed in both the lowest and highest TSH categories (hazard ratio 1.18 (1.08 to 1.28; P<0.001), 1.29 (1.22 to 1.36; P<0.001), and 2.21 (2.07 to 2.36; P<0.001) for TSH <0.1 mIU/L, 4-10 mIU/L, and >10 mIU/L. An increase in the risk of fragility fractures was observed in patients in the highest TSH category (>10 mIU/L) (hazard ratio 1.15 (1.01 to 1.31; P=0.03)). CONCLUSIONS: In patients with a diagnosis of hypothyroidism, no evidence was found to suggest a clinically meaningful difference in the pattern of long term health outcomes (all cause mortality, atrial fibrillation, ischaemic heart disease, heart failure, stroke/transient ischaemic attack, fractures) when TSH concentrations were within recommended normal limits. Evidence was found for adverse health outcomes when TSH concentration is outside this range, particularly above the upper reference value.


Assuntos
Doenças Cardiovasculares/epidemiologia , Fraturas Ósseas/epidemiologia , Hipotireoidismo/tratamento farmacológico , Tireotropina/sangue , Tiroxina/administração & dosagem , Adulto , Idoso , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Feminino , Fraturas Ósseas/etiologia , Fraturas Ósseas/prevenção & controle , Humanos , Hipotireoidismo/sangue , Hipotireoidismo/complicações , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Glândula Tireoide/metabolismo , Tireotropina/metabolismo , Tireotropina/normas
16.
J Korean Med Sci ; 34(35): e224, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31496139

RESUMO

BACKGROUND: There have been equivocal results in studies of the effects of dipeptidyl peptidase-4 inhibitors (DPP-4i) on fractures. In this study, we analyzed the effect of DPP-4i on bone fracture risk in a Korean population. METHODS: We extracted subjects (n = 11,164) aged 50 years or older from the National Health Insurance Service-National Sample Cohort 2.0 from 2009 to 2014. Our control group included subjects without diabetes (n = 5,582), and our treatment groups with diabetes included DPP-4i users (n = 1,410) and DPP-4i non-users (n = 4,172). The primary endpoint was the incidence of a composite outcome consisting of osteoporosis diagnosis, osteoporotic fractures, vertebral fractures, non-vertebral fractures, and femoral fractures. The secondary endpoint was the incidence of each individual component of the composite outcome. Survival analysis was performed with adjustment for age, gender, diabetes complications severity index, Charlson comorbidity index, hypertension medication, and dyslipidemia treatment. RESULTS: The incidence of the composite outcome per 1,000 person-years was 0.089 in DPP-4i users, 0.099 in DPP-4i non-users, and 0.095 in controls. There was no significant difference in fracture risk between DPP-4i users and DPP-4i non-users or controls after the adjustments (P > 0.05). The incidences of osteoporosis diagnosis, osteoporotic fractures, vertebral fractures, non-vertebral fractures, and femoral fractures were not significantly different between DPP-4i users and non-users. The results of subgroup analyses by gender and age were consistent. CONCLUSION: DPP-4i had no significant effect on the risk of fractures in a Korean population.


Assuntos
Inibidores da Dipeptidil Peptidase IV/efeitos adversos , Fraturas Ósseas/diagnóstico , Hipoglicemiantes/efeitos adversos , Idoso , Estudos de Coortes , Bases de Dados Factuais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Inibidores da Dipeptidil Peptidase IV/uso terapêutico , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Humanos , Hipoglicemiantes/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico , Osteoporose/epidemiologia , Osteoporose/etiologia , República da Coreia/epidemiologia , Fatores de Risco
17.
Ulus Travma Acil Cerrahi Derg ; 25(5): 489-496, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31475332

RESUMO

BACKGROUND: In most respects, the vast majority of pelvic injuries is not of a life-threatening status, but co-presence of other injuries needs to be diagnosed. This study aims to evaluate associated pelvic and extra-pelvic visceral organ injuries of the patients with closed pelvic fractures. METHODS: This retrospective study was conducted with 471 adult patients who had been admitted to our Emergency Service with the diagnosis of pelvic fractures. Type of fractures, accompanying visceral organ injuries, the demographic data, type of operation, mortality rates were recorded and analysed statistically. RESULTS: The rate of operations carried out by the general surgery clinic or other surgical clinics in each type of fracture according to AO classification did not differ (p=0.118). In patients with A2, A3 and B1 types of fractures, the operation rate of general surgery clinic did not show a significant difference. However, most of the patients who had extrapelvic surgery were in the mild severity pelvic trauma, such as AO A2 and A3. A total of 31 patients were ex-patients, 17 of whom had AO-A2 type of fractures. The findings showed that there was a significant difference between abdominal ultrasonography outcome that was normal and non-orthopedic surgery types (p<0.001). There was no significant difference between the types of surgery performed and Abdominal CT outcome, which was normal (p=0.215). CONCLUSION: In the management of patients with pelvic fractures irrespective of its type or grade, the findings suggests that greater attention should be paid to not to overlook the associated injuries. Early blood and imaging tests are encouraged after the patient's hemodynamic status is stabilized.


Assuntos
Traumatismos Abdominais , Fraturas Ósseas , Ossos Pélvicos/lesões , Traumatismos Abdominais/complicações , Traumatismos Abdominais/epidemiologia , Fraturas Ósseas/complicações , Fraturas Ósseas/epidemiologia , Humanos , Estudos Retrospectivos
18.
Eur J Endocrinol ; 181(5): 509-517, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31484162

RESUMO

Introduction: The role of vitamin D on bone microarchitecture and fragility is not clear. Objective: To investigate whether vitamin D deficiency (25(OH)D <20 ng/mL) increases cortical bone loss and the severity of fractures. Design: Cross-sectional study of 287 elderly women with at least one prevalent low-impact fracture. Methods: Biochemistry, X-rays to identify vertebral fractures (VFs) and to confirm non-vertebral fractures (NonVFs), and high-resolution peripheral quantitative computed tomography (HR-pQCT) to evaluate bone microstructure. Results: Serum 25(OH)D levels were associated with body mass index (BMI: r = -0.161, P = 0.006), PTH (r = -0.165; P = 0.005), CTX (r = -0.119; P = 0.043) and vBMD at cortical bone (Dcomp: r = 0.132; P = 0.033) and entire bone (D100: r = 0.162 P = 0.009) at the distal radius, but not at the tibia. Age and PTH levels were potential confounding variables, but in the multiple linear regressions only BMI (95% CI: 0.11-4.16; P < 0.01), 25(OH)D (95% CI: -0.007 to 1.70; P = 0.05) and CTX (95% CI: -149.04 to 21.80; P < 0.01) predicted Dcomp, while BMI (95% CI: 1.13-4.18; P < 0.01) and 25(OH)D (95% CI: 0.24-1.52; P < 0.01) predicted D100. NonVFs predominated in patients with 25(OH)D <20 ng/mL (P = 0.013). Logistic regression analysis showed a decrease in the likelihood of presenting grade 2-3 VFs/NonVFs for every increase in 25(OH)D (OR = 0.962, 95% CI: 0.940-0.984; P = 0.001), BMI (OR = 0.932, 95% CI: 0.885-0.981; P = 0.007) and D100 at radius (OR = 0.994, 95% CI: 0.990-0.998; P = 0.005). Conclusion: In elderly patients with prevalent fractures, vitamin D deficiency was associated with cortical bone loss and severity of fractures.


Assuntos
Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Osteoporose/epidemiologia , Osteoporose/etiologia , Deficiência de Vitamina D/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/etiologia , Hormônio Paratireóideo/sangue , Fraturas da Coluna Vertebral/epidemiologia , Fraturas da Coluna Vertebral/etiologia
19.
BMC Musculoskelet Disord ; 20(1): 404, 2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31484522

RESUMO

BACKGROUND: Areal bone mineral density (aBMD) estimated by dual-energy X-ray absorptiometry (DXA) is used to estimate peak bone mass, define osteoporosis and predict fracture. However, as aBMD is calculated as bone mineral content (BMC) divided by the scanned area, aBMD displays an inverse relationship with bone size. In a skeleton that is increasing in size, this is a problem, as bone size is an independent factor that determines bone strength. It could therefore be questioned whether peak aBMD is the period with greatest bone strength, a period that in the hip then would occur in ages 16-19. The aim of this study was to evaluate whether there are changes in bone size in men after age 18 that may influence peak bone strength. Another aim was to provide updated normative DXA data. METHODS: We scanned left femoral neck by DXA in a cross-sectional study with a population-based selection of 1052 men aged 18-28, and then registered bone mineral content (BMC, gram), aBMD (gram/cm2) and bone area (cm2) in each one-year age group. We performed analyses of variance (ANOVA) to evaluate whether there were differences in these traits between the age groups. We then used Pearson's correlation analyses to test for trends with ageing after peak bone mass was reached. RESULTS: We found the highest absolute femoral neck aBMD at age 19, with statistically significant differences between the one-year age groups in BMC, aBMD, and bone area (all p < 0.05). From peak bone mass onwards (n = 962), there are negative correlations between age and BMC (r = - 0.07; p < 0.05) and age and aBMD (r = - 0.12; p < 0.001), and positive correlation between age and bone area (r = 0.06; p < 0.05). CONCLUSION: As femoral neck bone size in young adult men becomes larger after peak bone mass, it could be questioned whether DXA estimated peak aBMD correlates with peak bone strength. We infer that aBMD must be interpreted with care in individuals with a growing skeleton, since skeletal strength may then increase, in spite of decreasing aBMD. This should be taken into account when performing DXA measurements in these ages.


Assuntos
Absorciometria de Fóton , Envelhecimento/fisiologia , Densidade Óssea/fisiologia , Colo do Fêmur/diagnóstico por imagem , Adolescente , Adulto , Fatores Etários , Análise de Variância , Estudos Transversais , Estudos de Viabilidade , Colo do Fêmur/crescimento & desenvolvimento , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/etiologia , Humanos , Incidência , Masculino , Osteoporose/complicações , Osteoporose/diagnóstico , Medição de Risco/métodos , Suécia/epidemiologia , Adulto Jovem
20.
J Manag Care Spec Pharm ; 25(10): 1089-1095, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31556816

RESUMO

Decision tree and Markov models have been the most commonly used modeling methods in health economic evaluations. Both methods are known for their limitations. Discrete-event simulation (DES), an event-driven model in continuous time at the patient level, is a relatively new method in health economic evaluations that addresses some limitations of the common modeling techniques. Specifically, with the advent of personalized medicine, conventional methods for value assessment that are based on population-level measures might not be appropriate. The best treatment would depend on patient characteristics and clinical profiles. Value assessment of health interventions can vary substantially and may lead to different health decision making due to patient heterogeneity. As such, modeling at the patient level is an appropriate approach for value assessment of health interventions. The DES model has several advantages, such as flexibility, ability to reflect patient heterogeneity, increased precision, and better characterization of modeling uncertainty, that may be preferred to decision tree and Markov models. In addition, with increasing health care spending and drug prices, it is important to quantify value of available treatment options for women with postmenopausal osteoporosis (PMO). The purpose of this Viewpoints article was to describe and demonstrate an application of a DES model to evaluate the cost-effectiveness of the current treatment guidelines for women with PMO. In particular, the DES model indicated that the optimal treatment at the common willingness-to-pay thresholds between $100,000 per quality-adjusted life-year (QALY) and $150,000 per QALY was denosumab. Analysis of patient heterogeneity in terms of low, medium, high, and very high risk of fractures resulted in a similar conclusion. DISCLOSURES: Funding for this study was received through the PhRMA Foundation Value Assessment Challenge Award. The author has no conflicts of interest to declare.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Análise Custo-Benefício , Fraturas Ósseas/prevenção & controle , Modelos Econômicos , Osteoporose Pós-Menopausa/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Árvores de Decisões , Custos de Medicamentos , Feminino , Fraturas Ósseas/economia , Fraturas Ósseas/epidemiologia , Humanos , Cadeias de Markov , Osteoporose Pós-Menopausa/economia , Osteoporose Pós-Menopausa/genética , Guias de Prática Clínica como Assunto , Medicina de Precisão/economia , Medicina de Precisão/normas , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco
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