No abstract

We report on three cases with congenital brachymetatarsia, one with bilateral affectation, together with the results of a lengthening of the short metatarsal bones by progressive axial distraction using an external minifixator. The method proved to be easy to implement, permitting immediate functionality of the ankle and early load bearing. The immediate results (cosmetic) and later findings (functional) were excellent in all three cases.

Fourteen critically ill patients underwent percutaneous drainage of abdominal abscesses. All 14 had one or more relative contraindications to external drainage procedure: (a) multiloculated abscesses; (b) multiple abscesses; (c) abscesses that form fistulae to surrounding organs; (d) abscesses containing viscous fluid, debris, or necrotic material. A total of 32 cavities was drained, usually using a multiple trocar/catheter system. Biplane computed tomography demonstrated a safe drainage route in all patients. In those patients in whom the contents of the abscess were too viscous to permit drainage, the contents were liquefied with acetylcysteine. Nine of the 14 patients (64%) recovered completely following the drainage procedure.

BackgroundDolutegravir (DTG) plus lamivudine (3TC) has proven highly efficacious as a switching strategy in virologically suppressed people with HIV (PWH). As this strategy was introduced relatively recently, real‐world, long‐term durability studies are lacking.MethodsWe performed a retrospective review of treatment‐experienced patients who started DTG + 3TC in a cohort of PWH. HIV‐RNA <50 copies/mL was analysed at 144 weeks in an intention‐to‐treat (ITT) analysis (missing = failure) and a per‐protocol (PP) analysis (patients with missing data or changes for reasons other than virological failure were excluded).ResultsThe study population comprised 358 PWH (19% women). Median age and time with HIV infection were 51.7 and 13.4 years, respectively. The median number of previous antiretroviral combinations was three. Previous virological failure was reported in 27.1% of patients, and the M184V resistance mutation was detected in 17 patients. At 144 weeks, the percentage of individuals with HIV‐RNA <50 copies/mL was 77.4% (277/358) in the ITT analysis and 95.5% (277/290) in the PP analysis. A total of 68 participants were excluded from the PP analysis (data missing, 25, discontinuation due to toxicity, 19; other, 16; death, 8). Two people with virological failure selected resistance‐associated mutations (M184V and M184V + R263K). HIV‐RNA remained undetectable in 17 patients with a previous history of the M184V mutation.ConclusionOur results confirm the real‐world, long‐term efficacy, tolerability and high genetic barrier of DTG + 3TC in treatment‐experienced PWH. Although scarce, mutations causing resistance to nucleosides and integrase can emerge.