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- Bravo, L, et al.
(author)
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- 2021
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swepub:Mat__t
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- Tabiri, S, et al.
(author)
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- 2021
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swepub:Mat__t
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- Glasbey, JC, et al.
(author)
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- 2021
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- Khatri, C, et al.
(author)
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Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study
- 2021
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In: BMJ open. - : BMJ. - 2044-6055. ; 11:11, s. e050830-
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Journal article (peer-reviewed)abstract
- Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.SettingProspective, international, multicentre, observational cohort study.ParticipantsPatients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.ResultsThis study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).ConclusionsPatients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration numberNCT04323644
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- Natiello, Mario A., et al.
(author)
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Modelling population dynamics based on experimental trials with genetically modified (RIDL) mosquitoes
- 2020
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In: Ecological Modelling. - : Elsevier BV. - 0304-3800. ; 424
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Journal article (peer-reviewed)abstract
- Recently, the RIDL-SIT technology has been field-tested for control of Aedes aegypti. The technique consists of releasing genetically modified mosquitoes carrying a “lethal gene”. In 2016 the World Health Organization (WHO) and the Pan-American Health Organization (PAHO) recommended to their constituent countries to test the new technologies proposed to control Aedes aegypti populations. However, issues concerning effectiveness and ecological impact have not been thoroughly studied so far. In order to study these issues, we develop an ecological model. It presents interdependent dynamics of mosquito populations and food in a homogeneous setting. Mosquito populations are described in a stochastic compartmental setup, in terms of reaction norms depending on the available food in the environment. The development of the model allows us to indicate some critical biological knowledge that is missing and could (should) be produced. Hybridisation levels, release numbers during and after intervention and population recovery time after the intervention as a function of intervention duration and target are calculated under different hypotheses with regard to the fitness of hybrids and compared with two field studies of actual interventions. This minimal model should serve as a basis for detailed models when the necessary information to construct them is produced. For the time being, the model shows that nature will not clean non-lethal introgressed genes.
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