The purpose of this retrospective study was to identify opioid prescribing practices, determine the number of morphine milliequivalents (MMEs) prescribed by orthopaedic/nonorthopaedic members to ...narcotic naive and previously exposed patients, and provide narcotic prescribing recommendations.
Patients older than 18 years with an isolated femur fracture sustained between 2013 and 2015 were identified using the CPT code 27506. Prescribing information was obtained from the State Controlled Substance Monitoring Database. Descriptive analysis of MMEs was then performed. Outliers and patients without prescriptions from orthopaedic providers were excluded to eliminate skewing of data. Mean and standard deviations were then calculated for patients without a history of opiates prescribed within 1 year of injury and for patients with a history of opiates prescribed within 1 year before the injury.
Forty-five percent (40/88) of patients were opiate exposed at the time of injury. Previously exposed patients received 1491 MMEs (SD, 1044; median, 1350; range, 210-5140) and nonexposed patients received 1363 MMEs (SD, 977.2; median, 1260; range, 105-4935) from orthopaedic providers (P = 0.1473). Nonorthopedists prescribed 530 MMEs (SD, 780.7; median, 140; range, 0-3515) to previously exposed patients and 175 MMEs (SD, 393; median, 140; range, 0-1890) to patients without exposure (P < 0.0001).
Patients with prior exposure are more likely to be prescribed more opiates after femoral shaft fracture treatment. We recommend a protocol of prescribing half the mean of MMEs currently prescribed by orthopedists equating to 47 (711 MMEs) pills of oxycodone 10 mg in up to 3 prescriptions.
•The first synthesis of 1,2,3-triazolyl Difenoconazole analogues is reported.•Some 1,2,3-triazolyl Difenoconazole analogues displayed a selective activity against MRSA comparable to Gentamicin ...standard.•Biological activity is related to a conformation adopted by 5‑chloro-2-(2,4-dichloro-phenoxy)-phenol core.•Inhibition activity is probably related to the conjugation of non-covalent interactions in whole system.
An efficient synthesis of novel difenoconazole analogues is described. The synthetic route involves a Friedel-Crafts acylation on triclosan molecule followed by a sequential azide formation/CuAAC reaction in a single synthetic operation leading to 1-(2‑chloro-5-(2,4-dichlorophenoxy)-4-hydroxyphenyl)-2-(4-(1-hydroxycyclohexyl)-1,2,3-triazol-1-yl)ethan-1-one derivatives in 50–96% yields. Synthesized 1,2,3-triazoles were evaluated for activity against diverse strains including bacterial strains of Staphylococcus aureus ATCC 29213, Escherichia coli ATCC 700891 and fungal strain Candida albicans ATCC 90028. A 1,2,3-triazole derivative bearing a CH(OH)CH3 group displayed a selective activity against Methicillin-resistant Staphylococcus aureus (MRSA) comparable to Gentamicin standard. This selectivity can be attributed to a conformation adopted by 5‑chloro-2-(2,4-dichloro-phenoxy)-phenol core enabling non-covalent interactions presenting a higher activity based on Fukui function on triazole ring.
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Arterial hypertension represents one of the main comorbidities observed in patients with heart failure (HF) and one of the main risk factors for its development. Despite this, studies assessing this ...hypertensive etiology are scarce in Latin America. Our objective was to analyze the prevalence of HF of hypertensive etiology and evaluate its prognosis in patients enrolled in the Colombian Heart Failure Registry (RECOLFACA by its Spanish acronym).
RECOLFACA recruited adult patients diagnosed with HF in 60 centers in Colombia between 2017 and 2019. The primary outcome was all-cause mortality. A Cox proportional hazards regression model was used to assess factors associated with primary outcomes in patients with hypertensive HF. A p value <0.05 was considered significant. All statistical tests were two-tailed.
Out of the total number of patients evaluated in RECOLFACA (n = 2,514), 804 had a diagnosis of HF with hypertensive etiology (31.9%). These patients were less frequently males and had a significantly older age and lower prevalence of comorbidities than those with HF of other etiologies. Additionally, patients with hypertensive HF had a higher prevalence of HF with preserved ejection fraction (HFpEF) (34.1% vs. 28.3%; p = 0.004). Finally, type 2 diabetes mellitus, chronic obstructive pulmonary disease diagnosis, and NYHA class IV were classified as independent mortality risk factors.
Hypertensive HF represents about one-third of the total number of patients with HF in RECOLFACA. Compared with HF of other etiologies, it presents a differential clinical profile - older age and a higher prevalence of HFpEF. RECOLFACA has become a useful tool to characterize patients with HF in Colombia, with which it has been possible to carry out a more specific search and reach the diagnosis of this pathology in our population, and it has served as an example to stimulate registries of patients with HF in other countries in the region.
Since early 2020, different studies have shown an increased prevalence of COVID-19 and poorer prognosis in older adults with cardiovascular comorbidities. This study aimed to assess the impact of ...heart failure (HF) on cardiovascular complications, intensive care unit (ICU) admissions, and in-hospital mortality in patients hospitalized with COVID-19. The CARDIO COVID 19-20 registry includes 3260 hospitalized patients with a COVID-19 serological diagnosis between May 2020 and June 2021 from Latin American countries. A history of HF was identified in 182 patients (5.6%). In patients with and without previous HF, the incidence of supraventricular arrhythmia was 16.5% vs. 6.3%, respectively (
= 0.001), and that of acute coronary syndrome was 7.1% vs. 2.7%, respectively (
= 0.001). Patients with a history of HF had higher rates of ICU admission (61.5% vs. 53.1%, respectively;
= 0.031) and in-hospital mortality (41.8% vs. 24.5%, respectively;
= 0.001) than patients without HF. Cardiovascular mortality at discharge (42.1% vs. 18.5%, respectively;
< 0.001) and at 30 days post-discharge (66.7% vs. 18.0%, respectively) was higher for patients with a history of HF than for patients without HF. In patients hospitalized with COVID-19, previous history of HF was associated with a more severe cardiovascular profile, with increased risk of cardiovascular complications, and poor in-hospital and 30-day outcomes.
•High-volume institutions were found to be the primary driver of variability in management of bilateral femur fractures.•There is considerable variation amongst institutions in timing of definitive ...surgery for bilateral femur fractures.•ISS is a direct influencer in timing of definitive surgery for bilateral femur fractures.
The purpose of our study was to evaluate the factors that influence the timing of definitive fixation in the management of bilateral femoral shaft fractures and the outcomes for patients with these injuries.
Patients with bilateral femur fractures treated between 1998 to 2019 at ten level-1 trauma centers were retrospectively reviewed. Patients were grouped into early or delayed fixation, which was defined as definitive fixation of both femurs within or greater than 24 hours from injury, respectively. Statistical analysis included reversed logistic odds regression to predict which variable(s) was most likely to determine timing to definitive fixation. The outcomes included age, sex, high-volume institution, ISS, GCS, admission lactate, and admission base deficit.
Three hundred twenty-eight patients were included; 164 patients were included in the early fixation group and 164 patients in the delayed fixation group. Patients managed with delayed fixation had a higher Injury Severity Score (26.8 vs 22.4; p<0.01), higher admission lactate (4.4 and 3.0; p<0.01), and a lower Glasgow Coma Scale (10.7 vs 13; p<0.01). High-volume institution was the most reliable influencer for time to definitive fixation, successfully determining 78.6% of patients, followed by admission lactate, 64.4%. When all variables were evaluated in conjunction, high-volume institution remained the strongest contributor (X2 statistic: institution: 45.6, ISS: 8.83, lactate: 6.77, GCS: 0.94).
In this study, high-volume institution was the strongest predictor of timing to definitive fixation in patients with bilateral femur fractures. This study demonstrates an opportunity to create a standardized care pathway for patients with these injuries.
Level III
Chronic Chagas cardiomyopathy (CCM) represents a relevant origin of Heart Failure (HF) in countries where the disease is endemic. CCM exhibits distinct myocardial involvement and is associated with a ...poorer prognosis compared to different HF etiologies. The aim is to explain the features and prognosis of individuals with HF resultant to CCM registered in the Colombian Registry of Heart Failure (RECOLFACA). RECOLFACA registry enrolled 2528 adult patients with HF. A comparison was made between patients diagnosed with CCM and those diagnosed with other etiologies of HF. 88 patients (3.5%) present CCM diagnosis. The individuals diagnosed with both HF and CCM were notably younger in age, had less comorbidities, poorer functional class, and significantly inferior ejection fraction. Finally, the presence of CCM diagnosis was linked to a substantially elevated mortality risk throughout the follow-up period (HR 2.01;95% CI 1.01-4.00) according to a multivariate model adjusted. CCM represents an important etiology of HF in Colombia, drawing attention to a distinct clinical profile and a higher risk of mortality compared to other HF etiologies.
Casamassima-Morton-Nance syndrome (CMNS) is a rare pathology with few reports in the literature. CMNS, Jarcho-Levine syndrome and the Lavy-Moseley syndrome must be considered among the differential ...diagnoses on those patients with vertebral and costal arch segmentation deficiencies.
We report a case of a 13-year-old girl without a history of consanguinity presenting to the spine clinic with cervicalgia and was found to have altered segmentation of her spine and costal arcs as well as a Chiari type I malformation.
CMNS is a rare condition with few reported cases in the literature. Due to the associated conditions patients have a short life span. In this report, we present the case of a 13-year-old girl with CMNS, CC junction abnormalities, and Chiari type I malformation.
This is a case report of foreign body ingestion in a suicide attempt resulting in gastric perforation and phlegmon formation during a subsequent 6 month period that eventually required surgical ...intervention. The patient had a prolonged course because she did not report a history of foreign body ingestion and the initial evaluating physicians had no suspicion about possible foreign body ingestion and may have missed important findings on physical examination. Gastric perforation by a foreign object may have a slow course rather than presenting acute abdomen. The realization of a proper physical examination in the emergency department is key to an accurate diagnosis.
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