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Abstract Acute Compartment Syndrome (ACS) is one of the most devastating orthopedic conditions, affecting any of the body’s many compartments, which, if sufficiently severe, may result in disability and amputation. Currently, intra-compartmental pressure measurements serve as the gold standard for diagnosing ACS. Diagnosing limbs at risk for ACS before irreversible damage to muscle and nerve is critical. Standard approaches for diagnosing impending compartment syndrome include clinical evaluation of the limb, such as assessment for “tightness” of the overlying skin, reduced pulses distally, and degree of pain, none of which are specific or sensitive. We have proposed a novel method to detect ACS via electrical impedance myography (EIM), where a weak, high-frequency alternating current is passed between one pair of electrodes through a region of tissue, and the resulting surface voltages are measured via a second pair. We evaluated the ability of EIM to detect early muscle ischemia in an established murine model of compression-induced muscle injury, where we collected resistance, reactance, and their dimensionless product, defined as Relative Injury Index (RII) during the study. Our model generated reproducible hypoxia, confirmed by Hypoxyprobe™ staining of endothelial regions within the muscle. Under conditions of ischemia, we demonstrated a reproducible, stable, and significant escalation in resistance, reactance, and RII values, compared to uninjured control limbs. These data make a reasonable argument for additional investigations into using EIM for the early recognition of muscle hypoperfusion and ischemia. However, these findings must be considered preliminary steps, requiring further pre-clinical and clinical validation.

Background Type 2 Diabetes Mellitus (T2DM) is a highly prevalent disease worldwide and in Colombia, representing one of the main causes of death and placing a considerable burden on healthcare systems. 13 classes of drugs are approved for the treatment of T2DM, with Glucagon-like Peptide-1 (GLP-1) receptor agonists being a first-line treatment option for patients with or at high risk of certain cardiovascular diseases and chronic kidney disease. The objective of this study is to conduct a short-term cost-effectiveness analysis of once-weekly semaglutide versus once-weekly dulaglutide in Colombian adults with T2DM, from a third-party payer perspective. Methods Numbers needed to treat were calculated for different single and composite endpoints of the SUSTAIN 7 trial, annual costs for once weekly semaglutide 1.0 mg and dulaglutide 1.5 mg were extracted from the public SISMED database. With these inputs a cost of control model was developed, to obtain the annual cost of bringing one T2DM patient to relevant clinical outcomes by using semaglutide or dulaglutide. Results Semaglutide was considered cost-effective compared to dulaglutide across all pre-specified endpoints, even in the different scenarios evaluated in the sensitivity analyses, and in a particularly pronounced manner for weight loss outcomes. Semaglutide at a dose of 1.0 mg once-weekly was cost-effective compared to dulaglutide 1.5 mg across all outcomes in the short-term, making it an appropriate first-line choice in the treatment of T2DM when deciding between these two GLP-1 receptor agonists. Conclusions This is the first short-term cost-effectiveness study of semaglutide and dulaglutide in T2DM Colombian patients. Our modeled results suggest that once-weekly semaglutide represents a cost-effective option for treating individuals with T2DM in Colombia who are not achieving glycaemia control with metformin, and it would be expected to improve HbA1C, promote greater weight loss and reduce costs from a third-payer perspective compared with treatment with dulaglutide.

Background Type 2 Diabetes Mellitus (T2DM) is a highly prevalent disease worldwide and in Colombia, representing one of the main causes of death and placing a considerable burden on healthcare systems. 13 classes of drugs are approved for the treatment of T2DM, with Glucagon-like Peptide-1 (GLP-1) receptor agonists being a first-line treatment option for patients with or at high risk of certain cardiovascular diseases and chronic kidney disease. The objective of this study is to conduct a short-term cost-effectiveness analysis of once-weekly semaglutide versus once-weekly dulaglutide in Colombian adults with T2DM, from a third-party payer perspective. Methods Numbers needed to treat were calculated for different single and composite endpoints of the SUSTAIN 7 trial, annual costs for once weekly semaglutide 1.0 mg and dulaglutide 1.5 mg were extracted from the public SISMED database. With these inputs a cost of control model was developed, to obtain the annual cost of bringing one T2DM patient to relevant clinical outcomes by using semaglutide or dulaglutide. Results Semaglutide was considered cost-effective compared to dulaglutide across all pre-specified endpoints, even in the different scenarios evaluated in the sensitivity analyses, and in a particularly pronounced manner for weight loss outcomes. Semaglutide at a dose of 1.0 mg once-weekly was cost-effective compared to dulaglutide 1.5 mg across all outcomes in the short-term, making it an appropriate first-line choice in the treatment of T2DM when deciding between these two GLP-1 receptor agonists. Conclusions This is the first short-term cost-effectiveness study of semaglutide and dulaglutide in T2DM Colombian patients. Our modeled results suggest that once-weekly semaglutide represents a cost-effective option for treating individuals with T2DM in Colombia who are not achieving glycaemia control with metformin, and it would be expected to improve HbA1C, promote greater weight loss and reduce costs from a third-payer perspective compared with treatment with dulaglutide.

Background: Type 2 Diabetes Mellitus (T2DM) is a highly prevalent disease worldwide and in Colombia, representing one of the main causes of death and placing a considerable burden on healthcare systems. 13 classes of drugs are approved for the treatment of T2DM, with Glucagon-like Peptide-1 (GLP-1) receptor agonists being a first-line treatment option for patients with or at high risk of certain cardiovascular diseases and chronic kidney disease. The objective of this study is to conduct a short-term cost-effectiveness analysis of once-weekly semaglutide versus once-weekly dulaglutide in Colombian adults with T2DM, from a third-party payer perspective. Methods: Numbers needed to treat were calculated for different single and composite endpoints of the SUSTAIN 7 trial, annual costs for once weekly semaglutide 1.0 mg and dulaglutide 1.5 mg were extracted from the public SISMED database. With these inputs a cost of control model was developed, to obtain the annual cost of bringing one T2DM patient to relevant clinical outcomes by using semaglutide or dulaglutide. Results: Semaglutide was considered cost-effective compared to dulaglutide across all pre-specified endpoints, even in the different scenarios evaluated in the sensitivity analyses, and in a particularly pronounced manner for weight loss outcomes. Semaglutide at a dose of 1.0 mg once-weekly was cost-effective compared to dulaglutide 1.5 mg across all outcomes in the short-term, making it an appropriate first-line choice in the treatment of T2DM when deciding between these two GLP-1 receptor agonists. Conclusions: This is the first short-term cost-effectiveness study of semaglutide and dulaglutide in T2DM Colombian patients. Our modeled results suggest that once-weekly semaglutide represents a cost-effective option for treating individuals with T2DM in Colombia who are not achieving glycaemia control with metformin, and it would be expected to improve HbA1C, promote greater weight loss and reduce costs from a third-payer perspective compared with treatment with dulaglutide.

Introducción: El enfisema pulmonar sin obstrucción al flujo aéreo es uno de los espectros clínicos sobre los cuales se puede manifestar la enfermedad pulmonar obstructiva crónica. Objetivo: Comparar pacientes con enfisema pulmonar en tomografía computarizada con y sin obstrucción al flujo aéreo por espirometría. Métodos: Estudio de corte transversal en sujetos mayores de 40 años quienes fueron llevados a espirometría y tomografía de tórax en un centro médico especializado entre los años 2018 a 2020. Se realizó un análisis descriptivo resumiendo las variables cualitativas en frecuencias y porcentajes, y las variables cuantitativas en promedio y desviación estándar si su distribución era normal, y mediana y rango intercuartílico si su distribución no era normal. Resultados: Los sujetos sin enfisema con alteración obstructiva presentaban una mayor exposición al humo de leña con el 62,5 % y menor a tabaquismo con el 29,2 %. La capacidad vital forzada fue menor en los sujetos con enfisema sin alteración obstructiva cuando se comparó con los sujetos que no presentaba enfisema y las pruebas de función pulmonar eran normales, la relación volumen espiratorio forzado en el primer segundo/capacidad vital forzada fue similar en estos últimos 2 grupos. Conclusión: Sujetos con enfisema sin alteración obstructiva espirométrica tienen un antecedente frecuente de tabaquismo, alta frecuencia de disnea y menor frecuencia de tos cuando se compara con pacientes con alteración obstructiva en la función pulmonar, la capacidad vital forzada de los sujetos con enfisema sin obstrucción es menor a la de los sujetos sin enfisema ni obstrucción.

Resumen:Se analizó un resultado con alteración cromosómica tomado de una base de datos conformada por un total de 4755 muestras de líquido amniótico extraídos mediante amniocentesis con indicación de su médico tratante, riesgo sérico y edad materna avanzada. En este reporte se presenta la detección de un mosaico de trisomía 21 en liquido amniótico, mediante la técnica de Banda G donde se analizaron 20 metafases. Los resultados obtenidos documentan una composición cromosómica 47, XY+21 y 46, XY con una relación 9:11 respecto a las metafases analizadas confirmándose así el diagnostico del Sindrome de Down secundario a mosaico.

This systematic review aimed to reevaluate the available evidence of the use of biologics as treatment candidates for the treatment of severe and advanced COVID-19 disease; what are the rationale for their use, which are the most studied, and what kind of efficacy measures are described? A search through Cochrane, Embase, Pubmed, Medline, medrxiv.org, and Google scholar was performed on the use of biologic interventions in COVID-19/SARS-CoV-2 infection, viral pneumonia, and sepsis, until 11 January 2022. Throughout the research, we identified 4821 records, of which 90 were selected for qualitative analysis. Amongst the results, we identified five popular targets of use: IL6 and IL1 inhibitors, interferons, mesenchymal stem cells treatment, and anti-spike antibodies. None of them offered conclusive evidence of their efficacy with consistency and statistical significance except for some studies with anti-spike antibodies; however, Il6 and IL1 inhibitors as well as interferons show encouraging data in terms of increased survival and favorable clinical course that require further studies with better methodology standardization.

Therapeutic drug monitoring (TDM) and continuous infusion strategies are effective interventions in clinical practice, but these practices are still largely unknown in Colombia, especially in the critical care setting. This study aims to describe the practices involved in the administration and TDM of β-lactams and vancomycin reported by specialists in critical care in Colombia and to explore the factors that are related to the use of extended infusion. An online nationwide survey was applied to 153 specialists, who were selected randomly. A descriptive, bivariate analysis and a logistic regression model were undertaken. In total, 88.9% of the specialists reported TDM availability and 21.57% reported access to results within 6 h. TDM was available mainly for vancomycin. We found that 85.62% of the intensivists had some type of institutional protocol; however, only 39.22% had a complete and socialized protocol. The odds of preferring extended infusions among those who did not have institutional protocols were 80% lower than those with complete protocols, OR 0.2 (95% CI: 0.06−0.61). The most important perceived barriers to performing continuous infusions and TDM were the lack of training and technologies. This pioneering study in Colombia could impact the quality of care and outcomes of critically ill patients in relation to the threat of antimicrobial resistance.

Drug monitoring is one strategy of antibiotic stewardship to face antimicrobial resistance. This strategy could have a determinant role in critically ill patients treated with carbapenems to overcome pharmacokinetic variability, reduce the risk of subtherapeutic dosage or toxicity, and reduce the risks inherent to treatment. However, the effectiveness of therapeutic drug monitoring (TDM) is unknown. This paper aims to identify TDM effectiveness in critically ill patients treated with carbapenems. English and ClinicalTrials.gov databases were searched to identify relevant studies evaluating carbapenem TDM. Randomized controlled trials (RCTs) and comparative cohort studies were selected for inclusion if they compared carbapenem TDM to standard care in adult critically ill or sepsis/septic shock patients. The primary outcome was mortality. Secondary outcomes included morbidity, clinical cure, microbiological eradication, antimicrobial resistance, drug-related side effects, and achievement of target plasma concentrations. Overall, performing carbapenem TDM was not associated with a decrease in mortality. However, it could be evidence for a relationship with clinical cure as well as target attainment. Some studies found favorable outcomes related to clinical and microbiological responses, such as lower procalcitonin levels at the end of the monitored therapy compared to standard care. For the primary and secondary outcomes analyzed, strong evidence was not identified, which could be due to the size, risk of bias, and design of selected studies.

Category: Ankle, Trauma Introduction/Purpose: Ankle syndesmotic injuries are a significant source of morbidity and require anatomic reduction to optimize outcomes. Although a previous study concluded that maximal dorsiflexion during syndesmotic fixation was not required, methodologic weaknesses existed and several studies have demonstrated improved ankle dorsiflexion after removal of syndesmotic screws. The purposes of the current investigation are: To assess the effect of syndesmotic screw fixation on ankle dorsiflexion utilizing a controlled load and instrumentation allowing for precise measurement of ankle dorsiflexion. To assess the effect of anterior & posterior syndesmotic malreduction after syndesmotic screw fixation on ankle dorsiflexion. Methods: Fifteen cadaveric leg specimens were utilized for the study. Ankle dorsiflexion was measured utilizing a precise micro- sensor system after application of a consistent load in the intact state, after compression fixation with a syndesmotic screw and after anterior & posterior malreduction of the syndesmosis. Results: Following screw compression of the nondisplaced syndesmosis, dorsiflexion ROM was 99.7±0.87% (mean ± standard error) of baseline ankle ROM. Anterior and posterior displacement of the syndesmosis resulted in dorsiflexion ROM that was 99.1±1.75% and 98.6±1.56% of baseline ankle ROM, respectively. One-way ANOVA was performed showing no statistical significance between groups (p-value =0.88). Two-way ANOVA comparing the groups with respect to both the reduction condition (intact, anatomic reduction, anterior displacement, posterior displacement) and the displacement order (anterior first, posterior first) did not demonstrate a statistically significant effect (p-value= 0.99). Conclusion: Maximal dorsiflexion of the ankle is not required prior to syndesmotic fixation. Anterior or posterior syndesmotic malreduction following syndesmotic screw fixation has no effect on ankle dorsiflexion thus poor patient outcomes after syndesmotic malreduction does not appear to be the result of loss of dorsiflexion due to mechanical block.

Category: Ankle, Basic Sciences/Biologics, Hindfoot, Biomechanics Introduction/Purpose: Orthotics are commonly prescribed by orthopaedic surgeons to address the hindfoot and midfoot deformity resulting from posterior tibial tendon dysfunction. The public however will often purchase over the counter orthotics for generalized complaints of foot pain that is not associated with any significant deformity or foot pathology. The mechanical axis of the lower limb may be altered in patients who use orthotics despite a normal foot alignment. We hypothesize that patients with normal alignment who use orthotics may adversely change ankle and subtalar joint orientation and load distribution. Methods: Five fresh frozen lower limb cadaveric specimens without known skeletal condition were used. The femoral head was potted with PMMA and TekScan pressure sensors were inserted into the ankle and subtalar joint. The specimens were placed on a custom jig, which allowed for load cell modulated loading of the leg; 75 lb load (half body weight) was applied at the femoral head while the foot was supported against a fixed plate keeping the ankle in neutral position. Testing was achieved by placing an orthotic under the medial half of the plantar talonavicular joint level. Mean pressure (MP), peak pressure (PP), contact area (CA), and center of force (COF) were measured in both the ankle and subtalar joints under three conditions; barefoot (BASE), with a 1.5 cm (ORT1) and 3 cm (ORT2) height orthotic. Each condition was tested three times per specimen. Displacement of COF was calculated relative to its location at baseline. Results: The MP, PP and CA showed a constant decrease from BASE to ORT1 and ORT2. Despite this relation, the only comparison that was significantly different was that between peak pressure values of the baseline and ORT2 conditions of the subtalar joint. The average displacement of COF from BASE was 0.14 mm and 0.42 mm medially, and 0.26 mm and 0.46 mm posteriorly at the ankle joint with ORT1 and ORT2 respectively. The average displacement of COF from BASE was 0.03 mm laterally and 0.08 mm posteriorly with ORT1, and 0.2 mm medially and 0.46 mm posteriorly with ORT2 at the subtalar joint. Conclusion: Foot deformities have an impact on the articular forces in the lower limb. Our results agree with previous studies about the role of foot deformity on the distribution of body weight forces and its consequences across the ankle and subtalar joint. Our novel study also demonstrates that orthotics and orthotics of varying sizes can change the mean pressure, peak pressure, contact area center of force in the ankle and subtalar joint. This study proves the feasibility of its design for studying intra-articular pressure changes in a lower limb cadaveric model with simulated weight bearing.