Aging and burn: a five-year retrospective study in a major burn centre in Portugal

Aging is an important factor contributing decisively to the clinical outcome of burn patients. The aim of this study was to assess the characteristics of patients admitted to a Burn Unit and determine the impact of aging on mortality. A retrospective analysis of patients successively admitted to a major burn centre in Portugal from 1/1/2012 to 31/12/2016 was conducted. They were divided into 2 groups: "elderly" (≥65 years) and "non-elderly" (<65 years). A total of 736 patients were included, 324 of them classified as elderly with a mean age of 78.12±7.14 years. Most of the patients in the elderly group were female (59.6%), in contrast to the non-elderly group (35%; p<0.001). The elderly patients had a higher mean length of hospital stay (20.14±18.46 days; p=0.011). Most of the burns were caused by fire (58.3%) and scalding (36.1%) and mainly after home accidents. Elderly patients showed a higher mean of burn severity index (7.26; p<0.001) and 6.8% needed an amputation. Mortality rate was significantly higher in the elderly group (11.7%; p=0.001). Age (p<0.001; OR=1.169), a higher total burn surface area (p<0.001; OR=1.081), full-thickness burns (p=0.005; OR=11.985) and the need for mechanical ventilation (p<0.001; OR=16.856) were associated with a higher mortality risk and reached statistical significance after multivariate analysis. The functional and vital prognosis of patients admitted to a burn centre is affected by multiple factors. This study showed that age, higher TBSA, full-thickness burns and need for mechanical ventilation seem to increase the risk of mortality.

Factors that Influence Mycobacterium bovis Infection in Red Deer and Wild Boar in an Epidemiological Risk Area for Tuberculosis of Game Species in Portugal

Bovine tuberculosis (bTB) is a worldwide zoonotic disease of domestic and wild animals. Eradication has proved elusive in those countries with intensive national programmes but with ongoing transmission between wildlife and cattle. In Portugal, a high-risk area for bTB was defined and specific measures implemented to assess and minimize the risk from wildlife. Data from the 2011 to 2014 hunting seasons for red deer (Cervus elaphus) and wild boar (Sus scrofa) were analysed with bovine demographic and bTB information to assess factors that determined the occurrence and distribution of bTB in both species. The likelihood of bTB-like lesions in wild boar was positively associated with density of red deer, wild boar and cattle, while for red deer, only their density and age were significant factors. The likelihood of Mycobacterium bovis isolation in wild boar was associated with density of cattle and red deer and also with the anatomical location of lesions, while for red deer, none of the variables tested were statistically significant. Our results suggest that, in the study area, the role of red deer and wild boar may be different from the one previously suggested by other authors for the Iberian Peninsula, as red deer may be the driving force behind M. bovis transmission to wild boar. These findings may assist the official services and game managing bodies for the management of hunting zones, what could also impact the success of the bTB eradication programme.

A population-based analysis of the post-fracture care gap 1996-2008: the situation is not improving

The post-fracture care gap has not narrowed in recent years. Following an initial improvement, rates of medication initiation have actually declined.

INTRODUCTION

The current study characterizes temporal changes in post-fracture bone mineral density (BMD) testing or osteoporosis treatment initiation from 1996/1997 to 2007/2008.

METHODS

A population-based administrative data repository for Manitoba, Canada was accessed to identify non-traumatic fractures in individuals aged 50 years and older. Outcomes included BMD testing or dispensation of an osteoporosis medication in the 12 months following the fracture.

RESULTS

Thirty thousand nine hundred and twenty (30,920) fracture events met the inclusion criteria; 15,670 affected major osteoporotic fracture sites. Based on either BMD testing or treatment initiation, intervention rates reached a maximum of only 15.5% in 2003/2004, compared with 6.3% in 1996/1997, and 13.2% in 2007/2008 (p-for-trend < 0.001). Post-fracture BMD testing increased from 0.7% in 1996/1997 to 8.9% 2007/2008 (p-for-trend < 0.001). Osteoporosis medication use increased from 6.1% in 1996/1997 to 12.3% in 2001/2002 and then progressively declined to 5.9% by 2007/2008 (p-for-trend = 0.025). Similar trends were observed when only major osteoporotic fractures were included. The initiation of BMD testing or medication varied according to age, gender, geographic region, and income.

CONCLUSION

Despite increased attention to gaps in osteoporosis management post-fracture in the last 10 years, the situation has not improved: in 2007/20008, fewer than 20% of untreated individuals with a low-trauma fracture received intervention. Novel strategies are required to disseminate and implement best practices at the point of care to reduce the risk of recurrent fractures.

Mortality rates after incident non-traumatic fractures in older men and women

Non-traumatic fractures at typical osteoporotic sites are associated with increased mortality across all age groups, particularly in men. Furthermore, in certain age subgroups of women and men, this rate remained elevated beyond 5 years for fractures of the hip, vertebrae, humerus, and other sites.

INTRODUCTION

Increased mortality rates have been documented following non-traumatic hip, vertebral, and shoulder fractures. However, data are lacking as to the duration of excess mortality and whether there is increased mortality following fractures at other sites. We determined mortality up to 15 years following incident fractures at typical osteoporotic sites.

METHODS

Using healthcare databases for the Province of Manitoba, Canada, we identified individuals 50 years and older with an incident non-traumatic fracture between 1986 and 2007. Each fracture case was matched to three fracture-free controls. Generalized linear models were used to test for trends in mortality and to estimate the relative risk for cases after adjusting for co-morbidity and living arrangements.

RESULTS

During the study period, we identified 21,067 incident fractures in men followed by 10,724 (50.1%) deaths and 49,197 incident fractures in women followed by 22,018 deaths (44.8%). Seventy-six percent of the fractures were at sites other than the hip and vertebrae. After adjustment for age, number of co-morbidities, and level of dependence in living arrangements, the risk of death in cases, relative to controls, was increased in both sexes for hip, vertebral, humerus, wrist (in men only), and other fracture sites. Post-fracture mortality was higher in men than women. Relative mortality was the highest in the younger age groups across the spectrum of fracture sites.

CONCLUSIONS

Fractures at typical osteoporotic sites are associated with increased mortality across all age groups, particularly in men. Better understanding of factors associated with increased post-fracture mortality should inform the development of management strategies.

Secular decreases in fracture rates 1986-2006 for Manitoba, Canada: a population-based analysis

SUMMARY

We examined trends in fracture rates over 20 years in the Province of Manitoba, Canada. Hip fractures, major low-trauma fractures, and high-trauma fractures declined significantly from 1986 to 2006.

INTRODUCTION

Secular decreases in hip fracture rates have been reported in some countries. Whether this phenomenon applies to other fracture sites is not well described.

METHODS

We used 20 years of data from the Population Health Research Data Repository for the Province of Manitoba, Canada. Age-adjusted fracture rates were calculated for men and women age 50 years and older 1986-2006 according to fracture site and mechanism (presence/absence of external injury codes). Generalized linear models with generalized estimating equations were used to derive adjusted annual rates and test for linear change in men and women.

RESULTS

Major low-trauma fractures (hip, forearm, spine, and humerus) showed a significant annual linear decline in women (-1.2% [95% CI, -0.7% to -1.8%]) and in men (-0.4% [95% CI, -0.7% to -0.2%]). Hip fracture showed a significant annual decline for both sexes, while forearm and humerus fractures showed a significant decline only in women. The only fracture category that did not show a significant annual decline in either sex was the spine. The observed annual reduction in high-trauma fractures was even larger and did not show a sex difference (-1.8% [95% CI, -2.8% to -0.7%]).

CONCLUSION

We observed a decrease in both low-trauma and high-trauma fracture rates over the study period. This decline was apparent in years prior to widespread osteoporosis testing or availability of modern pharmacotherapy.

Release of hydrocortisone from a cream matrix: dependency of release on suspension concentration and measurement of solubility and diffusivity

The principal object of the present research was to investigate the sensitivity of drug release from a semisolid system to the manner of its preparation and to the concentration of drug placed within it. Established theory indicated that release should be concentration dependent, with the specific dependency determined by whether the drug in the system is fully in solution or is present substantially as suspended matter. To purposefully explore these relatively untested performance expectations, the total amount of drug in the formula was varied from a low concentration of 0.25% to a high concentration of 3%. Conditions were established such that drug release conformed to release from a semi-infinite medium into a receptor sink. At every concentration, release profiles were well reproduced in replicate samples and, where multiple lots of a kind were employed, from lot to identical lot. In all cases square root of time release kinetics were observed. Moreover and without exception, the square root of time release rate from run to run was directly proportional to the square root of the total concentration of hydrocortisone placed in the formulations. The amount released per square root of time per square root of total concentration was nearly identical from run to run irrespective of total concentration. The overall behavior fit theoretical expectations for suspensions having only a small fraction of the drug they contain in solution. That this condition prevailed even at the lowest 0.25% hydrocortisone strength was proven by independently measuring hydrocortisone's solubility (0.02%). Measurement of solubility permitted estimation of the effective diffusivity of the drug through the cream (2 x 10(-7) cm2/s).