Curēus
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Objectives Nonunions of tibial shaft fractures have profound implications on patient quality of life and are associated with physical and mental suffering. Radiographic Union Score for Tibia Fractures (RUST) may serve as an important prognostic tool for identifying patients at a high risk of nonunion. Design We used data from the Study to Prospectively Evaluate Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT) and Fluid Lavage of Open Wounds (FLOW) trials to explore the association of three-month RUST scores with nonunion in patients with tibial shaft fractures treated with intramedullary nailing. We performed a retrospective cohort study nested within two multi-center, randomized controlled trials. ⋯ Conclusion A third of patients with tibial shaft fractures who have failed to heal by three months will show nonunion at one year. Open fractures and lower three-month RUST scores are strongly associated with a higher risk of nonunion at one year. Further research is needed to establish whether prognosis in this high-risk group can be modified.
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Background Increasing concerns about depression and burnout in residents have led to a recent focus on assessing "non-cognitive" traits in residents and residency applicants. One attribute that has received significant attention is grit, defined as trait-level perseverance and passion for long-term goals. With an objective measure available, an important question is under what circumstances of administration is that measure reliable and accurate. The goal of this study was to ascertain whether internal medicine residents and their faculty mentors were congruent in their ratings of resident grit, or if not, how the ratings differed. Methods Subjects were internal medicine residents (N=42) at a community-based university-affiliated hospital internal medicine residency program. Near the end of the academic year 2019, residents completed the GRIT-S (short form). ⋯ These results further the understanding of the role of grit and raise important questions about how assessments might be used to assure validity. Further areas of inquiry into this potentially important characteristic are suggested.
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Background Surgical site infections (SSIs) and surgical site occurrences (SSOs) are frequent post-operative complications that are dependent on the presence of different risk factors. The use of closed incision negative pressure therapy (ciNPT) is considered a measure by the WHO guidelines for prevention of SSIs. The prevention of SSOs is an extremely important issue in the ventral hernia repair (VHR) surgical field. ⋯ Fever was reported in 28.6% of patients in the ciNPT group vs 54.5% in the control group (p = 0.0006; RR (95% CI) 0.52 (0.35 - 0.79); OR (95% CI) 0.33 (0.18 - 0.63)); leukocytosis affected 21.4% of patients treated with ciNPT vs 45.4% of patients in the control group (p = 0.001; RR (95% CI) 0.47 (0.29 - 0.77); OR 0.33 (0.16 - 0.65)). ciNPT patients had shorter hospitalization stay than control group (3 ± 1.37 vs 6 ± 2.39; p < 0.00001). The cost-effectiveness deterministic analysis estimated that if the ciNPT is routinely adopted, the reduction of total costs would be €166'944.00 for 100 patients. Conclusions This study demonstrates that ciNPT use in high-risk populations following VHR with synthetic mesh positioning is associated with positive clinical and economic outcomes.
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A 74-year-old male was admitted to the Intensive Care Unit (ICU) at State University of New York (SUNY) Downstate Medical Center following acute respiratory failure secondary to coronavirus disease 2019 (COVID-19) viral pneumonia. The patient had significant comorbidities, including a history of lung and esophageal cancer status-post resection, cerebrovascular accident with neurological deficits, diabetes mellitus, hypertension, and peripheral vascular disease. The patient was in septic shock and respiratory failure on admission requiring intubation and mechanical ventilation. Computed tomography (CT) of the chest showed patchy bilateral opacities suspicious for viral pneumonia and the COVID-19 sputum sample sent to the New York Department of Health returned positive. This patient's comorbidities, along with his age, placed him in the highest risk of mortality for COVID-19. The patient was managed pharmacologically with hydroxychloroquine and azithromycin. By Day 5 of his admission, he improved significantly and was extubated and downgraded from the ICU to the medical floor, pending discharge. This case report provides anecdotal evidence for the effectiveness of the hydroxychloroquine and azithromycin combination currently being used across the nation to manage COVID-19, pending development of a definitive vaccine or antiviral treatment.
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Case Reports
A Rare and Challenging Presentation of Empyema Necessitans/Necessitasis Leading to Brachial Plexopathy.
Empyema necessitasis (EN) also referred to as empyema necessitans (EN) is a rare complication of empyema that can involve soft tissues outside the pleural cavity and can lead to brachial plexus injury. Although, brachial plexus injury most commonly occurs as a result of trauma, inflammation, or malignancies, but it has been rarely seen in EN. We are reporting a rare and challenging case of empyema necessitasis (EN) causing impingement of brachial plexus in a 42-year-old, type 2 diabetic patient, who initially presented to the hospital with left-sided pleuritic chest pain and acute onset of left upper limb weakness. ⋯ Our objective is to emphasize on the prompt management with close follow-up in EN, which can present with life-threatening complications as seen in our case. Any delay can compromise the patient's health. As per our limited knowledge, this case has not been reported in the literature.