Nevin Manimala

Acta Chir Orthop Traumatol Cech. 2022;89(5):349-352.

ABSTRACT

PURPOSE OF THE STUDY Minimal and limited access techniques are gaining increasing interest for the treatment of displaced intra-articular calcaneal fractures. The ideal treatment method is however still debated and largely based on individual case factors and surgeon experience. Aim of this study was thus to compare the treatment characteristics and radiographic correction potential of a locking nail system with a sinus tarsi approach to plate fixation via an extended lateral approach. MATERIAL AND METHODS We retrospectively reviewed 39 cases of patients with calcaneal fractures that received primary fracture treatment for displaced intra-articular calcaneal fractures between July 2017 and March 2020. Patient characteristics, time to surgery, time to discharge, OR time and the correction achieved were analyzed and comparative statistics performed. RESULTS In total 19 patients treated with the locking nail and 20 patients treated with plate fixation were analyzed. Patient age and fracture severity according to the Sanders classification were comparable between the groups. Overall surgical time, as well as the achieved reduction was equal between both groups. Time to surgery, as well as time from surgery to discharge was significantly shorter in the locking nail group. 2 additional soft tissue procedures were necessary in the extended lateral approach group. DISCUSSION AND CONCLUSIONS The results with the locking calcaneus nail and sinus tarsi approach suggest, that similar treatment results can be achieved as with plate osteosynthesis and an extended lateral approach. Soft tissue management, as well as pre- and postoperative timing and discharge management can be improved with the nail. Further controlled trials comparing the longterm outcome between the treatment options are needed. Key words: calcaneus fracture, sinus tarsi approach, calcaneal nail, C-Nail.

PMID:36322035

Acta Chir Orthop Traumatol Cech. 2022;89(5):339-343.

ABSTRACT

PURPOSE OF THE STUDY Many physicians believe that loco-regional anaesthesia and analgesia improve the postoperative course of patients indicated for total hip arthroplasty compared to general anaesthesia. However, there are many patients who refuse subarachnoid or epidural anaesthesia, or have contraindications or conditions making the use of such techniques impossible. An alternative option is the combination of general anaesthesia and a peripheral nerve blockade. The aim of this prospective randomized open-label clinical trial was to compare the efficacy and quality of postoperative analgesia between fascia iliaca block combined with general anaesthesia (GA) and subarachnoid anaesthesia with morphine and bupivacaine (SAB). MATERIAL AND METHODS After having obtained the ethics committee approval and the patients consent, a prospective, open-label, randomized trial was conducted in patients referred for total hip arthroplasty (THR). The GA group was administered ultrasound-guided fascia iliaca block with 40 ml of 0.25% bupivacaine solution after the induction of general anaesthesia. In the SAB group, subarachnoid blockade was performed with a mixture of 3 ml of 0.5% bupivacaine with 0.150 mg morphine prepared in the hospital pharmacy. Right after surgery the patients were taken to the ICU for 24 hours, after which they were transferred to a general ward. In addition to vital signs monitoring, pain intensity using a 0-10 numeric rating scale (NRS), first morphine administration at NRS >4, total morphine consumption and potential adverse effects were observed over the period of 72 hours. RESULTS There was no statistical difference between the GA (14 persons) and the SAB (14 persons) group in demographic parameters, time to first morphine administration (10 hrs vs. 19 hrs, p=0.10), number of persons with no need for morphine after surgery (5 vs. 7), tingling sensation (1 vs. 0) or numbness of the limb (0 vs. 1). There was no difference in cardiorespiratory parameters or side effects of therapy. In neither case was there respiratory depression or delayed rehabilitation. No patient developed delirium after surgery, and no patient reported dissatisfaction with pain management. DISCUSSION The fascia iliaca block and subarachnoid anaesthesia using local anaesthetic with opioid addition have been repeatedly published for patients after total hip arthroplasty, but this study is unique by comparing the two methods. The study added a new piece of knowledge to the findings of several recent meta-analyses on the comparable outcomes of general and subarachnoid anaesthesia for hip replacement in the perioperative period. CONCLUSIONS If subarachnoid anaesthesia cannot be used in hip arthroplasty, general anaesthesia with fascia iliaca block provides comparable analgesia and quality of postoperative course. Key words: total hip arthroplasty, general anaesthesia, fascia iliaca block, subarachnoid anaesthesia, postoperative analgesia, postoperative course.

PMID:36322033

Lab Med. 2022 Nov 2:lmac120. doi: 10.1093/labmed/lmac120. Online ahead of print.

ABSTRACT

OBJECTIVE: Presence of autoantibodies against troponin I (cTnI) or T (cTnT) has been reported to interfere with troponin assays. However, the extent of the interference with the measurement has not been explored sufficiently. The aims of this study were to examine the frequencies of autoantibodies against troponin I and troponin T and how much these antibodies would affect the measurement.

METHODS: The study comprised 52 subjects who visited Hokkaido University Hospital with suspected ischemic heart diseases. To evaluate the presence of autoantibodies, we calculated the recoveries of cTnI or cTnT after immunoglobulin G depletion, and the distributions of peaks reactive with cTnI or cTnT by high-performance liquid chromatography were examined.

RESULTS: Autoantibodies against cTnI and cTnT were identified in 8 subjects (15.4%) and 1 subject (1.9%), respectively. Although the greatest difference between cTnI and cTnT was 32-fold, the distributions of cTnI-to-cTnT ratios in groups with and without anti-cTnI were not statistically different.

CONCLUSION: Autoantibodies against cTnI were more frequent by several fold than those against cTnT. Their presence did not significantly expand the discrepancy between cTnI and cTnT assays.

PMID:36322014 | DOI:10.1093/labmed/lmac120

J Feline Med Surg. 2022 Nov 2:1098612X221121920. doi: 10.1177/1098612X221121920. Online ahead of print.

ABSTRACT

OBJECTIVES: The aims of this study were to determine owners’ perception of their cats’ quality of life (QoL), and whether there is a correlation with weight-loss variables, as well as to identify the main difficulties owners encounter during controlled weight loss in their obese cats.

METHODS: The study was carried out as an e-questionnaire survey addressed to owners of cats starting a weight-loss programme. The e-questionnaire was provided at a single time point after the conclusion of the study (24 weeks).

RESULTS: Nineteen completed questionnaires were included. Eighteen cats had a lower weight at the end of the weight-loss period, two of which had successfully reached their target weight. Mean weight loss was 13.84% body weight at a rate of 0.53% weight loss/week. Although the perceived QoL was not correlated with weight-loss variables (P >0.05), it increased over time, even in cats that did not reach their target weight, and was statistically correlated with increased activity (r = 0.73; P <0.01), mobility (r = 0.78; P <0.01) and play time (r = 0.61; P <0.01). The main difficulties encountered by owners were not giving (32%) or permitting the cat to eat extra food (26%). The main presumed difficulty for the cat was having its food decreased over time (53%). Most owners considered their cats happy (42%) and quite happy (53%) during the study, and no statistically significant correlations were found between the weight loss, food-seeking behaviour and stress parameters (P >0.05).

CONCLUSIONS AND RELEVANCE: Although several difficulties were encountered throughout the study, increased QoL and energy levels in their cats were noticed by owners. A positive perspective on weight-loss programmes is important to keep owners motivated and achieve the target weight in their cats. Furthermore, this survey provides insights into the perceived difficulties of weight-loss regimens in cats.

PMID:36322004 | DOI:10.1177/1098612X221121920

Pain Med. 2022 Nov 2:pnac166. doi: 10.1093/pm/pnac166. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the analgesic efficacy of quadratus lumborum block (QLB) in adults undergoing nephrectomy.

DESIGN: Systematic review and meta-analysis.

PATIENTS: Adult patients (≥ 18 years) received nephrectomy under general anesthesia.

METHODS: We searched PubMed, Embase, the Cochrane Library, and Web of Science on January 10, 2022, including randomized controlled trials (RCTs) that evaluated the analgesic efficacy of QLB for patients undergoing nephrectomy.

RESULTS: A total of 12 RCTs (N = 821 patients) were included in the study. Compared with the non-block, single-shot QLB reduced the postoperative opioid consumption (mean difference [MD], -8.37 mg intravenous morphine equivalent; 95% CI, -12.19 to -4.54 mg) and pain scores at 2 h, 6 h, 12 h, and 24 h at rest and during movement after nephrectomy. Single-shot QLB also prolonged the time to first analgesic request (MD, 6.44 h; 95% CI, 2.23 to 10.65 h), and shortened the length of hospital stay (MD, -0.32 d; 95% CI, -0.55 to -0.09 d) and decreased the incidence of postoperative nausea and vomiting (risk ratio, 0.48; 95% CI, 0.36 to 0.65). Compared with continuous epidural anesthesia, repeated QLB may provide comparable postoperative analgesic benefits.

CONCLUSIONS: Single-shot QLB provided a statistically significant, but clinically-small improvement in postoperative analgesia and recovery for patients undergoing nephrectomy. The QLB would be beneficial as part of multimodal analgesia. Future research may need to determine which approach of QLB is superior for postoperative analgesia after nephrectomy.

PMID:36321993 | DOI:10.1093/pm/pnac166

AJR Am J Roentgenol. 2022 Nov 2. doi: 10.2214/AJR.22.28402. Online ahead of print.

ABSTRACT

Background: FDG PET/CT has limited diagnostic performance for peritoneal metastasis. The 68Ga-fibroblast activation protein inhibitor (68Ga-FAPI) targets tumor stroma, leading to high accumulation across cancer types. Objective: To conduct a meta-analysis to compare the diagnostic performance of 68Ga-FAPI PET/CT and FDG PET/CT in detecting PM based on studies providing head-to-head comparisons between the two tests. Evidence Acquisition: PubMed, Embase, and Cochrane Library databases were searched through July 2022 to identify studies reporting head-to-head comparison of 68Ga-FAPI PET/CT and FDG PET/CT for detection of PM. Reference standard was classified as histopathology in all patients, or as combination of histopathology, clinical, imaging, laboratory, and follow-up information (i.e., multidisciplinary reference standard). Random-effects statistical model was applied to conduct a meta-analysis of tests’ diagnostic performances in patient-based and lesion-based analyses. QUADAS-2 and QUADAS-C tools were used to assess study quality. Evidence Synthesis: Eleven studies were included; patient-based analysis comprised nine studies with 340 patients, and lesion-based analysis comprised four studies with 222 lesions. Pooled sensitivity of 68Ga-FAPI PET/CT was significantly higher than that of FDG PET/CT in patient-based analysis [98.2% (95% CI: 96.1-100.0%) vs 55.9% (95% CI: 33.9-77.9%)] and lesion-based analysis [99.9% (95% CI: 99.5-100.0%) vs 27.3% (95% CI: 11.2-43.4%)]. Eight studies were rated as high risk of bias in the reference standard domain because the multidisciplinary reference standard was not sufficiently explained and may have included one of the two index tests, which would have artificially increased sensitivity. Specificity was reported in three studies as 100.0% for both tests; these studies were considered at uncertain risk of bias in the patient selection domain because patients with benign peritoneal conditions may have been excluded, resulting in underestimation of potential false-positive results. Conclusion: Current evidence suggests excellent sensitivity of 68Ga-FAPI PET/CT for the detection of PM, in comparison to poorer sensitivity of FDG PET/CT. However, most included studies had high risk of bias, with need for further studies that could more convincingly characterize true- and false-positive results. Clinical Impact: The use of 68Ga-FAPI PET/CT may offer substantially improved sensitivity compared with FDG PET/CT for the evaluation of PM, facilitating surgical candidate selection and planning.

PMID:36321984 | DOI:10.2214/AJR.22.28402

Laeknabladid. 2022 Nov;108(11):495-500. doi: 10.17992/lbl.2022.11.715.

ABSTRACT

BACKGROUND: Transient Global Amnesia (TGA) is a benign syndrome characterized by sudden anterograde memory loss, that resolves spontaneously within 24 hours. TGA appears without other focal neurological symptoms. The aim of this study was to study TGA in the greater Reykjavik-area.

METHODS: We retrospectively analysed the medical history of patients with a diagnosis of TGA (ICD-10 G45.4) at the University Hospital in Iceland in 2010-2021. Medical records were reviewed, and information about year and age at diagnosis, sex, symptoms, precipitating events, imaging results and risk factors were collected. Statistical processing was performed with Excel and Rstudio.

RESULTS: Overall, 348 attacks of TGA were identified with a mean frequency of 29 attacks/year, where 9.9% had an earlier history of TGA. The mean age was 64.1, with 50% of subjects between 58-70 years old. The sex distribution was equal (49.9% female). Possible precipitating events were found in 53.7% of cases, with physical activity being the most common one (24.4%), followed by sudden temperature change and emotional stress. In 96% of patients a computerized tomography was performed (no sign of acute changes were found), and magnetic resonance imaging (MRI) in 36.2% of cases. MRI showed restricted diffusion in the hippocampal area in 10.3% of cases.

DISCUSSION: TGA is not a rare but a benign syndrome. Our findings regarding age, sex distribution and precipitating events were in accordance with other studies. TGA is thought to result from a temporary hippocampal dysfunction supported by the clinical presentation and MRI findings. The cause of TGA is however still unknown.

PMID:36321932 | DOI:10.17992/lbl.2022.11.715

Fam Pract. 2022 Nov 2:cmac122. doi: 10.1093/fampra/cmac122. Online ahead of print.

ABSTRACT

OBJECTIVE: To explore consultation patterns, management practices, and costs of foot, ankle, and leg problems in Australian primary care.

STUDY DESIGN: We analyzed data from the Bettering the Evaluation and Care of Health program, April 2000 to March 2016. Foot, ankle, and leg problems were identified using the International Classification of Primary Care, Version 2 PLUS terminology. Data were summarized using descriptive statistics examining general practitioner (GP) and patient characteristics associated with a foot, ankle, or leg problem being managed. Cost to government was estimated by extracting fees for GP consultations, diagnostic imaging, and pathology services from the Medicare Benefits Schedule (MBS) database. Costs for prescription-only medicines were extracted from the Pharmaceutical Benefits Schedule and for nonprescribed medications, large banner discount pharmacy prices were used.

RESULTS: GPs recorded 1,568,100 patient encounters, at which 50,877 foot, ankle, or leg problems were managed at a rate of 3.24 (95% confidence intervals [CIs] 3.21-3.28) per 100 encounters. The management rate of foot, ankle, or leg problems was higher for certain patient characteristics (older, having a health care card, socioeconomically disadvantaged, non-Indigenous, and being English speaking) and GP characteristics (male sex, older age, and Australian graduate). The most frequently used management practice was the use of medications. The average cost (Australian dollars) per encounter was A$52, with the total annual cost estimated at A$256m.

CONCLUSIONS: Foot, ankle, and leg problems are frequently managed by GPs, and the costs associated with their management represent a substantial economic impact in Australian primary care.

PMID:36321909 | DOI:10.1093/fampra/cmac122

Global Spine J. 2022 Nov 2:21925682221138261. doi: 10.1177/21925682221138261. Online ahead of print.

ABSTRACT

STUDY DESIGN: Diagnostic accuracy study.

OBJECTIVES: Previous studies have reported the clinical application of the Vertebral Bone Quality (VBQ) scores for assessing bone density in operative lumbar spine patients. We aim to explore whether the method could be modified and applicable for patients undergoing cervical spine surgery.

METHODS: Adult patients receiving cervical spine surgery for degenerative diseases between September 2020 and March 2022 with non-contrast T1-weighted MRI and DEXA were included. Correlation between cervical VBQ scores and DEXA T-scores was analyzed using Pearson’s correlation. Student’s t test was used to present the discrepancy between the VBQ of patients with normal bone density (T ≥ -1.0) and patients with osteopenia/osteoporosis (T < -1.0). Statistical significance was set at P < .05.

RESULTS: Eighty-three patients (20 patients with T ≥ -1.0 vs 63 patients with T < -1.0 ) were included. Significant difference was found between the cervical VBQ between groups (2.99 ± .79 vs 3.80 ± .81, P < .001). Interclass correlation coefficient for inter-rater reliability was .82 (95% CI: .70-.93) and .91(95% CI: .84-.97) for intra-rater reliability. The area under the ROC curve was .78 (95% CI: .65-.90). The DEXA T-score of the femoral neck, total hip and the lowest DEXA T-score were found to be significantly correlated with the cervical VBQ score according to Pearson correlation analysis (P < .001).

CONCLUSIONS: This is the first study to apply the VBQ method to assess the bone density in preoperative cervical spine patients. Cervical VBQ scores were significantly correlated with DEXA T-score. With an overall accuracy of .78, the radiation-free and cost-effective method could be a potential tool for screening patients with osteopenia and osteoporosis before surgery.

PMID:36321883 | DOI:10.1177/21925682221138261

J Med Entomol. 2022 Nov 2:tjac166. doi: 10.1093/jme/tjac166. Online ahead of print.

ABSTRACT

Tick-borne diseases (TBDs) pose a significant risk to humans and represent one of the major factors influencing readiness within the United States’ military worldwide. Additionally, ticks and TBDs constitute major animal health problems leading to economic losses at multiple levels affecting low- and middle-income countries the hardest. Tick control is frequently hampered by issues ranging from acaricide resistance to lack of data on tick distribution and infection rates. We conducted a cross-sectional study to assess tick species distribution, host use, and rickettsial pathogen infection rate of ticks in different areas of the Uganda Cattle Corridor. We identified 4,425 hard ticks (Ixodida: Ixodidae) comprised of seven species by morphological characters with 3,315 ticks collected from four locations during the dry season and 1,110 ticks from one location during the wet season. Rickettsial pathogen prevalence was assessed in ticks collected from two districts to determine the minimum infection rate compared across seasons, village location, and tick species. We found statistically significant differences in the abundance and distribution of tick species among districts in the dry season, host animal species, and the proportion of rickettsial positive pools between villages. Seasonality, village location, and tick species do not affect the minimum infection rate of rickettsial pathogens of ticks in Uganda, but village location affects the proportion of positive tick pools. These results indicate geographical and seasonal differences among pathogen-harboring ticks contributing to our understanding of the current distribution of ticks and TBDs in Uganda.

PMID:36321534 | DOI:10.1093/jme/tjac166