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Introduction: The Gamma 3 nail is widely used for AO31A1-3 fractures. The aim of this study was to compare outcomes in patients with 31A2 fractures treated with two lengths of Gamma3 nail. Material:A prospective study of 104 non-pathological 31A2 fractures treated January 2012-January 2014. 14 patients were eliminated due to inadequate follow up. Mean follow-up was 18 months (range 12-36). Average age was 81 years (range 50-99), 78% of the patients were female. We studied two groups: Long Gamma3 Nail (LGN) and Short Gamma3 Nail (SGN). Preoperative variables included: age, medical pathologies, gait, anesthetic risk, associated fractures, hemoglobin and hematocrit values. Postoperatively, we evaluated: functional and radiographic results, quality of life, hemoglobin concentration, hematocrit, transfusion, gait and pain. Intraoperative and postoperative complications were recorded: malunion, nonunion, infection rates, cut-outs and periprosthetic fractures. Results:We obtained a correct reduction in 73% of cases. We found two intraoperative complications (greater trochanteric fractures) in two LGN cases. 38% of the patients with LGN presented nail tip impaction upon the distal anterior femoral cortex, associated with anterior knee pain. Blood loss was statistically different between groups but neither clinical outcomes nor quality of life presented any differences. Conclusion:Our results with these two sizes of the Gamma3 Nail in 31A2 fractures showed no overall differences in clinical outcomes and complication rates. Despite this, the LGN presented a statistically significant higher decrease of the postoperative hematocrit and more transfused blood concentrates. We therefore recommend the use of locked SGN to treat the 31A2 fractures.

Background Coronavirus disease 2019 (COVID-19) has been a pandemic that is still very prevalent. Patients with Inflammatory Bowel Disease (IBD) represent a special population considering their already altered immune system and their exposure to several immunosuppressive therapies. We pretend to study the impact of COVID-19 on IBD patients in our community, Castilla-La Mancha (a region in central Spain). Methods Retrospective observational study using an artificial intelligence with natural language processing capability, the SAVANA manager, we analyzed data from 1 808 010 patients with Electronic Medical Records (EMR) within the public health system of Castilla-La Mancha from March 1st 2020 to January 1st 2021. Data on demographic characteristics, hospitalization, ICU admission and mortality were collected. We compared COVID outcomes between IBD and non-IBD patients. We compared COVID outcomes in IBD patients according to their treatment (comparing each treatment group to those IBD patients with no treatment); we considered: immunomodulators (azathioprine, mercaptopurine, methotrexate), antiTNF alone or combined with immunomodulator, vedolizumab, ustekinumab and tofacitinib; mesalazine and corticosteroids were not analyzed. Results 2 243 patients with IBD suffered COVID-19, compared to COVID-19 cases without IBD there were less females, they suffered more arterial hypertension, diabetes mellitus, dyslipidemia, obesity, or tabacco use (TABLE 1). And yet, despite these being proven risk factors for worse outcomes for COVID-19, no differences were appreciated in hospitalization rate, ICU admission, or mortality between those with or without IBD (TABLE 2). COVID-19 was more frequent in IBD patients (32.59 vs 13.28%). Comparing IBD patients with COVID-19 according to their treatments (TABLE 3), vedolizumab is the only treatment with a higher risk for COVID-19 infection, however the hospitalization risk for vedolizumab is lower than for those without it. Immunomodulators do also have a lower hospitalization risk both alone or in combination with antiTNF, no differences were found for antiTNF monotherapy, ustekinumab or tofacitinib. ICU rate and mortality are no different between treatments, except for tofacitinib (0.00% ICU rate, 10.00% mortality), however the small number of patients using this treatment may bias this result. Conclusion COVID-19 in IBD patients is no different in hospitalization, ICU admission or mortality compared to non-IBD population. IBD patients exposed to immunomodulators and vedolizumab have less hospitalization risk than those not exposed, no differences were found for antiTNF alone or ustekinumab. The impact of tofacitinib in COVID outcomes requires further investigation.

IntroductionEndoscopic submucosal dissection (ESD) is an advanced endoscopic procedure that has enabled en-bloc resection in lesions of any size. Moreover, ESD is a suitable technique for achieving curative resection in fibrotic and difficult polyps, with recurrence rates lower than endoscopic mucosal resection (EMR) [1]. However, in western countries, ESD is not a widely used because of the long learning curve [2], high risk of adverse events (AEs), and amount of time necessary to perform ESD (an average of 54 to 116 minutes per procedure) [3]. Avoidance of inappropriate visualization of the submucosal plane becomes crucial to perform the procedure safely because it can result in inadvertent cutting of blood vessels or the muscular layer. The reason for this drawback of the ESD procedure is that it is done entirely through a single endoscope port, unlike conventional and laparoscopic surgery. To overcome this issue, several traction techniques have been developed [4]. One of them -Magnetic anchor guided-ESD (MG-ESD) -is an attractive alternative, since it poses several advantages compared to other trac-