Abstract
Aims
Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in ...associations between various heart disease subtypes and in-hospital mortality.
Methods and results
We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66–75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02–1.15; P = 0.12 (corrected for multiple testing). Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10–1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20–1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients.
Conclusion
Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.
Graphical Abstract
Graphical Abstract
After multivariable adjustment, the strongest association was found for heart failure and in-hospital mortality (aRR 1.19, 95% CI 1.10–1.30; P < 0.018 and in particular for severe (NYHA class III/IV) heart failure (aRR 1.41, 95% CI 1.20–1.64; P < 0.018). For the other heart disease subtypes, including ischaemic heart disease, no significant associations with in-hospital mortality were found after correction for multiple testing. BMI = body mass index; NYHA = New York Heart Association; PAD = peripheral arterial disease. *Significant after correcting for multiple testing.
Hemostasis in neurosurgery is of utmost importance. Bleeding management is one of the crucial steps of each neurosurgical procedure. Several strategies, namely thermal, mechanical, electric, and ...chemical, have been advocated to face blood loss within the surgical field. Over time, countless hemostatic agents and devices have been proposed. Furthermore, the ever-growing recent technological innovation has made available several novel and interesting tools. Pursuant to their impact on surgical practice, we perceived the imperative to update our previous disclosure paper. Therefore, we reviewed the literature and analyzed technical data sheets of each product in order to provide an updated and comprehensive overview in regard to chemical properties, mechanisms of action, use, complications, tricks, and pitfalls of topical hemostatic agents.
Age and comorbidities increase COVID-19 related in-hospital mortality risk, but the extent by which comorbidities mediate the impact of age remains unknown.
In this multicenter retrospective cohort ...study with data from 45 Dutch hospitals, 4806 proven COVID-19 patients hospitalized in Dutch hospitals (between February and July 2020) from the CAPACITY-COVID registry were included (age 6958-77years, 64% men). The primary outcome was defined as a combination of in-hospital mortality or discharge with palliative care. Logistic regression analysis was performed to analyze the associations between sex, age, and comorbidities with the primary outcome. The effect of comorbidities on the relation of age with the primary outcome was evaluated using mediation analysis.
In-hospital COVID-19 related mortality occurred in 1108 (23%) patients, 836 (76%) were aged ≥70 years (70+). Both age 70+ and female sex were univariably associated with outcome (odds ratio OR4.68, 95%confidence interval 4.02-5.45, OR0.680.59-0.79, respectively;both p< 0.001). All comorbidities were univariably associated with outcome (p<0.001), and all but dyslipidemia remained significant after adjustment for age70+ and sex. The impact of comorbidities was attenuated after age-spline adjustment, only leaving female sex, diabetes mellitus (DM), chronic kidney disease (CKD), and chronic pulmonary obstructive disease (COPD) significantly associated (female OR0.650.55-0.75, DM OR1.471.26-1.72, CKD OR1.611.32-1.97, COPD OR1.301.07-1.59). Pre-existing comorbidities in older patients negligibly (<6% in all comorbidities) mediated the association between higher age and outcome.
Age is the main determinant of COVID-19 related in-hospital mortality, with negligible mediation effect of pre-existing comorbidities.
CAPACITY-COVID ( NCT04325412 ).
This study aimed at evaluating short- and long-term effects of housing beef cattle on deep litter (DL) or concrete fully slatted floor (FS) on their welfare. Animal-based measures of the Welfare ...Quality® assessment protocol for cattle were used to assess health status and behaviour of bulls. The assessment was carried out in a large commercial farm on 15 batches of bulls (4 DL and 11 FS) 1 month after their receiving day (short-term) and on 12 batches (three DL and nine FS) the week before slaughter (long-term). Signs of better comfort on deep litter in terms of shorter lying down durations (5.1±0.5 v. 6.5±0.4 s; P<0.05) and lower risk of hairless patches (odds ratio=0.09; 95% confidence interval=0.01 to 0.68; P<0.05) were already observed after 1 month. Heavy bulls after a long-term housing on FS showed a higher prevalence of bursitis, hairless patches and lesions/swellings than animals on DL. Bulls on fully slatted floor were at higher risk of early culling (odds ratio=6.44; 95% confidence interval=1.57 to 26.37; P<0.01), mainly due to musculoskeletal system pathologies/lameness. Deep litter proved to be a valid alternative to slatted floor, making animals more confident to interact with powerful movements such as mounting at the end of the finishing period. A negative aspect of the deep litter was the poor cleanliness of the bulls. Compared with the fully slatted floor, there were higher odds ratios for dirty bulls at both, the short- (odds ratio=25.09; 95% confidence interval=8.96 to 70.22; P<0.001) and the long-term housing (odds ratio=276.13; 95% confidence interval=98.21 to 776.38; P<0.001). In order to improve health and welfare of beef cattle finished at a heavy weight, deep litter systems are a promising alternative to fully slatted floors. However, proper management of deep litter is necessary to maintain satisfactory cleanliness of the bulls.
Abstract Acute traumatic central cord syndrome (ATCCS) is the most common type of incomplete spinal cord injury, characterized by predominant upper extremity weakness, and less severe sensory and ...bladder dysfunction. ATCCS is thought to result from post-traumatic centro-medullary hemorrhage and edema, or, as more recently proposed, from a Wallerian degeneration, as a consequence of spinal cord pinching in a narrowed canal. Magnetic Resonance Imaging is the method of choice for diagnosis, showing a typical intramedullary hypersignal on T2 sequences. Non-surgical treatment relies on external cervical immobilization, maintenance of a sufficient systolic blood pressure, and early rehabilitation, and should be reserved for patients suffering from mild ATCCS. Surgical management of ATCCS consists of posterior, anterior or combined approaches, in order to achieve spinal cord decompression, with or without stabilization. The benefits of early surgical decompression in the setting of ATCCS remain controversial due to the lack of clinical randomized trials; recent studies suggest that early surgery (less than 72 hours after trauma) appears to be safe and effective, especially for patients with evidence of focal anatomical cord compression.
Anterior odontoid screw fixation is a valid surgical option for unstable odontoid fractures, as type II Anderson D’Alonzo fractures. Grauer further divided type II fractures in subtypes according to ...the fracture line, providing recommendations for implementation of screw fixation techniques.
Primary endpoint of our study is to evaluate the postoperative results of minimally invasive odontoid screw insertion in terms of outcome, fusion rate and stability of cranio-cervical junction. Secondary endpoint was to investigate the influence of age or fractures’ features on outcome and fusion rate.
We report the clinical and radiological features of 32 patients harbouring unstable type II fractures operated by a minimally invasive odontoid screw insertion technique. All patients underwent a high resolution multiplanar CT in order to assess fracture features according to Grauer's classification; the integrity of ligaments was investigated by MRI. In addition, a preoperative neurological performance (modified Rankin Scale, mRS) was evaluated for patients either directly or interviewing their families. Follow-up at one, three and six months and 1 year have been performed (averaging 13.5 months) by cervical CT (fusion rate and stability) and mRS update. In order to investigate the influence of age on postoperative neurological performance, two groups (≤50 yrs, 9 pts/>50 yrs, 23 pts) were separately considered and analysed. Overall, we observed no surgery related complications. We also analysed the fusion rate and its correlation with patient age and Grauer's subtype of fracture.
At last available clinical follow-up, the preoperative performance was preserved (mRS 0/1: 24, 75%; mRS 2–4: 9, 15%) although with slight reduction of intact patients (mRS 0: 22 vs. 19; 71.8 vs. 59.3%). Younger patients (≤50 yrs) fared significantly better than older ones, achieving a good clinical outcome (mRS 0/1) in 100% vs. 69.5% (9/9 vs. 16/23 pts). Statistical analysis showed a fair correlation between age and outcome. Other factors such as sex and Grauer's type did not influence significantly the clinical outcome. Nine patients did not complete a full radiological follow-up and were therefore excluded from analysis of radiological outcome. Among the remaining 23 patients, only 25% of those who were followed three months or less showed fusion; conversely, all patients who have been examined from 6 to 48 months fused. Among the non-union patients, two underwent a second surgery by posterior approach.
In our recent experience, the minimally invasive AOSF proved safe and effective in treating odontoid peg fractures. Selection based on Grauer's type is mandatory to achieve best results. While in the elderly, an anterior approach is well accepted as the first choice treatment, we recommend that this option should be offered as a suitable alternative to Halo or orthosis also in younger patients since it provides prompt, excellent clinical outcome and high fusion rate especially in this age group.
Anterior odontoid screw fixation is a valid surgical option for unstable odontoid fractures, as type II Anderson D'Alonzo fractures. Grauer further divided type II fractures in subtypes according to ...the fracture line, providing recommendations for implementation of screw fixation techniques.
Primary endpoint of our study is to evaluate the postoperative results of minimally invasive odontoid screw insertion in terms of outcome, fusion rate and stability of cranio-cervical junction. Secondary endpoint was to investigate the influence of age or fractures' features on outcome and fusion rate.
We report the clinical and radiological features of 32 patients harbouring unstable type II fractures operated by a minimally invasive odontoid screw insertion technique. All patients underwent a high resolution multiplanar CT in order to assess fracture features according to Grauer's classification; the integrity of ligaments was investigated by MRI. In addition, a preoperative neurological performance (modified Rankin Scale, mRS) was evaluated for patients either directly or interviewing their families. Follow-up at one, three and six months and 1 year have been performed (averaging 13.5 months) by cervical CT (fusion rate and stability) and mRS update. In order to investigate the influence of age on postoperative neurological performance, two groups (≤50 yrs, 9 pts/>50 yrs, 23 pts) were separately considered and analysed. Overall, we observed no surgery related complications. We also analysed the fusion rate and its correlation with patient age and Grauer's subtype of fracture.
At last available clinical follow-up, the preoperative performance was preserved (mRS 0/1: 24, 75%; mRS 2-4: 9, 15%) although with slight reduction of intact patients (mRS 0: 22 vs. 19; 71.8 vs. 59.3%). Younger patients (≤50 yrs) fared significantly better than older ones, achieving a good clinical outcome (mRS 0/1) in 100% vs. 69.5% (9/9 vs. 16/23 pts). Statistical analysis showed a fair correlation between age and outcome. Other factors such as sex and Grauer's type did not influence significantly the clinical outcome. Nine patients did not complete a full radiological follow-up and were therefore excluded from analysis of radiological outcome. Among the remaining 23 patients, only 25% of those who were followed three months or less showed fusion; conversely, all patients who have been examined from 6 to 48 months fused. Among the non-union patients, two underwent a second surgery by posterior approach.
In our recent experience, the minimally invasive AOSF proved safe and effective in treating odontoid peg fractures. Selection based on Grauer's type is mandatory to achieve best results. While in the elderly, an anterior approach is well accepted as the first choice treatment, we recommend that this option should be offered as a suitable alternative to Halo or orthosis also in younger patients since it provides prompt, excellent clinical outcome and high fusion rate especially in this age group.
Purpose
C1-C2 instability or painful osteoarthritis are recognised indications for posterior atlanto-axial fixation. In the traditional trans-articular C1-C2 screw fixation, up to 20% of patients ...cannot have safe placement of bilateral screws in the event of a medially located vertebral artery and a straight screw trajectory in the sagittal plane. The more recently developed C1-C2 fixation technique with individual C1 lateral mass screws and converging C2 pars screws can be employed in case of a medially located vertebral artery and has comparable biomechanical strength. This is a prospective observational study to investigate the advantages, the safety, and the drawbacks of posterior atlanto-axial fixation with polyaxial C1 lateral mass screws and C2 pars screws.
Methods
Twelve consecutive patients with C1-2 instability (
n
= 11) and painful osteoarthritis (
n
= 1) underwent a posterior atlanto-axial fixation with polyaxial C1 lateral mass screws and C2 pars screws. The average follow-up was 16 months and all patients reached the 12-month follow-up.
Findings
No hardware failure occurred in any of the patients. Correct screw placement and construct stability was found in all 12 patients (100%) at 6 and 12 months after surgery. Mean neck pain on a visual analogue scale (VAS) was 2.1 at 6 months and 2.0 at 12 months. Only transient complications were observed: one patient presented with progressive intestinal herniation through the iliac crest scar; one suffered from severe pain at the posterior iliac crest for 3 months and three patients complained of annoying pain/dysaesthesia in the C2 dermatome for 3–6 months after surgery.
Conclusion
This study confirms that posterior atlanto-axial fixation with polyaxial C1 lateral mass screws and C2 pars screws is a safe and effective surgical option in the treatment of atlanto-axial instability or painful osteoarthritis.
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