Tag: nevin manimala

Acta Chir Orthop Traumatol Cech. 2022;89(1):48-52.

ABSTRACT

PURPOSE OF THE STUDY Hemoglobin (Hb) levels tend to decrease in patients after hip fractures. There are several factors that is responsible for this decrease in Hb levels. The primary aim in this study was to evaluate the risk factors of blood loss in patients with IFF and to determine the limits that may require allogeneic blood transfusion (ABT), and the secondary aim was to prevent unnecessary blood crossing outside these limits. MATERIAL AND METHODS 119 patients with intertrochanteric femur fracture (IFF) were included in the study. The patients were divided into two groups according to the use of ABT in the postoperative period. Age, gender, fracture side, height, weight, body mass index (BMI), American Society of Anesthesiologist (ASA) score, preoperative hemoglobin (Hb) level, platelet (Plt) number, International Normalized Ratio (INR), prothrombin time (PT), activated partial thromboplastin time (aPTT) values, comorbid diseases, history of drug use, whether ABT was applied in the preoperative period or not, and the postoperative 1st day Hb levels were evaluated from the medical records. A p value below than 0.05 was accepted as statistically significant. RESULTS Advanced age [odds ratio (OR) 1.069, 95% confidence interval (CI) 0.372-3.202], unstable fracture type [OR 0.258, 95% CI 0.496-6.632], and hemoglobin level <11 g / dL [OR 5.574, 95% GA 0.312-65.278 was found to be an independent predictive risk factor for allogeneic blood transfusion requirement in the postoperative period. DISCUSSION There are several factors that is responsible for decrease in Hb levels in patients after hip fractures. The most important and most likely cause of these is the fracture itself. Other reasons are stated as type of fracture, time elapsed until the surgical treatment, preferred implants for treatment, advanced age, mean preoperative Hb value and anticoagulant drug usage in literature. Although the preoperative blood loss due to trauma is inevitable, unnecessary aggressive and/or inadequate treatments can be avoided if patients with higher bleeding risk and complication rate can be detected. CONCLUSIONS Advanced age, unstable fracture pattern and low preoperative Hb values should be considered as risk factors for the postoperative ABT requirements for patients with IFF. Key words: intertrochanteric femur fracture, allogenic blood transfusion, blood loss hemoglobin level.

PMID:35247244

Acta Chir Orthop Traumatol Cech. 2022;89(1):37-42.

ABSTRACT

PURPOSE OF THE STUDY The study analyses a cohort of patients with surgically treated ankle fractures who developed complete distal tibiofibular synostoses. It focuses on their occurrence and association with the extent of tibiotalar dislocation of the ankle joint on the trauma X-ray and its relation to the choice of surgery. MATERIAL AND METHODS The cohort of a total of 824 patients with type B and C fractures according to Weber classification was followed up for 9 years. The cohort consisted of 403 (48.9%) men and 421 (51.1%) women. The exclusion criteria included associated talus fractures, calcaneus fractures and fractures of the other bones of the foot. The studied data were obtained retrospectively from medical documentation and by evaluation of trauma X-rays and X-rays obtained during the postoperative checks. The ankle fractures were classified based on the Weber classification and the basic epidemiologic data (age and gender), type of fracture and extent of tibiotalar dislocation of ankle fractures on the trauma X-ray were evaluated. Posttraumatic ankle dislocation was divided into tibiotalar dislocation > 10 mm, tibiotalar dislocation < 10 mm and the group with regular ankle joint. When evaluating the treatment method, the cohort was divided into three groups: Group 1 with one-stage osteosynthesis, Group 2 with temporary K-wire transfixation or external fixation and subsequent secondary conversion to internal osteosynthesis, and Group 3 with definitive transfixation or external fixation of the ankle. The results were statistically evaluated using the Pearson s chi-square test, or the Fisher s exact test for low frequencies. A multivariant logistic regression model was created to identify statistically significant factors contributing to the development of synostosis. The results with the p-value < 0.05 were considered statistically significant. RESULTS In the whole cohort, the synostosis of distal tibiofibular joint was observed in a total of 131 (15.9%) patients. In men it was in 85 (21.1%) cases and in women in 46 (10.9%) cases, which was statistically significant (p < 0.0001). There was a statistically significant difference (p = 0.0020) between the mean age in the group of patients with synostosis (54.4 years) and the mean age in the group of patients without synostosis (49.1 years). Complete distal tibiofibular synostoses were found in 78 (12.7%) fractures classified as type B according to the Weber classification and in 53 (25.5%) type C fractures. When taking into account the gender, synostoses occurred more frequently in men in both types of fractures classified based on the Weber classification, only in type C fractures no statistical significance was established (p = 0.3026). Various size of posttraumatic tibiotalar dislocation was present in both types of fractures. The group with less severe type B ankle fractures showed a statistically significant dominance of synostosis development in cases with large tibiotalar dislocation of more than 10 mm (p<0.0001). In the group with type C fractures different results were obtained. The highest frequency of cases with synostosis was reported in the group with dislocation smaller than 10 mm (p = 0.0698). In the entire cohort, 615 (74.6%) one-stage osteosyntheses were performed and synostoses developed in 77 (12.5%) cases. In 165 (20.0%) patients, transfixation with K-wires or external fixation with subsequent conversion to secondary osteosynthesis were used and synostoses were identified in 50 (30.3%) cases (p < 0.0001). The open fractures showed an insignificantly smaller number of synostoses than the closed fractures (p = 0.5902). DISCUSSION Posttraumatic distal tibiofibular synostoses have varied morphology. A number of studies confirmed that they do not affect much the functional status of the ankle, even despite their extensive finding in the area of syndesmosis is evident on the Xray. Etiologically, a certain role in their development is reported to be played by posttraumatic hematoma in case of damage to deep soft and bony structures of the ankle. CONCLUSIONS A higher occurrence of synostoses was observed in male population, older age patients and also in type C fractures according to the Weber classification. Larger tibiotalar dislocation showed statistical significance in the development of synostoses in type B fractures according to the Weber classification, whereas in type C fractures it was not the main factor contributing to the development of synostosis. In cases where one-staged osteosynthesis was performed, the occurrence of synostoses was statistically significantly lower than in secondary osteosynthesis after temporary stabilisation. Key words: ankle fracture, distal tibiofibular synostosis, ankle joint dislocation, Weber classification, acute surgery, delayed surgery.

PMID:35247242

J Magn Reson Imaging. 2022 Mar 5. doi: 10.1002/jmri.28110. Online ahead of print.

ABSTRACT

BACKGROUND: Structural lesion evaluation in axial spondyloarthropathy (SpA) can improve accuracy of diagnosis. However, structural lesions (bone erosions) are difficult to be assessed using conventional MRI compared to computed tomography (CT).

PURPOSE: To evaluate the diagnostic performance of ultrashort echo time (UTE) for detecting bone erosion in axial SpA compared to T1WI and three-dimensional double-echo steady-state (3D DESS) imaging using CT as the reference standard.

STUDY TYPE: Retrospective.

POPULATION: Fourteen patients (eight females, 57.1%) and 14 healthy controls (seven females, 50.0%) who underwent sacroiliac (SI) joint MRI and CT.

FIELD STRENGTH/SEQUENCE: 3 T; TSE T1WI, 3D DESS, 2D UTE.

ASSESSMENT: The bilateral SI joints were assessed for bone erosion. Three observers scored bone erosion for all three sequences of MRI. CT was used as the gold standard. Diagnostic confidence in axial SpA was measured based on a four-point confidence score.

STATISTICAL TESTS: Correlation of erosion scores between CT and MRI were evaluated using Spearman’s correlation test. Sensitivity, specificity, and positive-negative predictive values were calculated. Confidence scores were compared using the Wilcoxon sum rank test. Statistical significance was set at P < 0.05.

RESULTS: Compared with erosion scores of CT, the correlation coefficients for each MRI sequence showed significant low-to-high positive correlations (0.39-0.72). UTE imaging showed the highest correlation coefficients for all observers (0.70, 0.72, and 0.67, respectively). The specificity of UTE imaging was equal or higher than those of T1WI and 3D DESS for all observers (0.86 vs. 0.71 vs. 0.57; 0.93 vs. 0.71 vs. 0.57; 0.79 vs. 0.79 vs. 0.43). All observers had the highest confidence in interpreting UTE imaging for detecting bone erosion among the three sequences (3.5, 3.4, and 3.3 for UTE; 3.1, 3.0, and 2.6 for T1WI; and 3.2, 2.7, and 2.4 for DESS).

DATA CONCLUSION: UTE imaging can detect bone erosions in patients with axial SpA and show higher specificity than conventional T1WI and 3D DESS.

EVIDENCE LEVEL: 4 TECHNICAL EFFICACY: Stage 2.

PMID:35247216 | DOI:10.1002/jmri.28110

Ther Apher Dial. 2022 Mar 5. doi: 10.1111/1744-9987.13829. Online ahead of print.

ABSTRACT

Systemic vascular syndromes (SV) include a variety of, and numerous diseases. In 2012, the International CHAPEL HILL Consensus Conference (CHCC2012) led to a major reorganization of the classification of vasculitis, and this is still in wide use today. Although the results of plasmapheresis for individual diseases have been sometimes shown, there are few systematic reviews that discuss the effects along with vasculitis classification. Therefore, we will discuss the efficacy and the latest evidence for each vasculitis according to the CHCC 2012 classification in this review. This review provides a comprehensive overview of the estimation of plasmapheresis in each of the vasculitides, with a particular focus on small vasculitides, which have recently discussed frequently. For some time now, plasma exchange therapy (PEX) has been frequently used and is expected to be effective in some diseases, most of which are included in small vessel vasculitides. In particular, data showing efficacy have been accumulated for immune complex vasculitis, and the recommendation seems to be high. For instance, anti-GBM nephritis, concomitant use of PEX is essential and strongly recommended. On the other hand, for ANCA-related vasculitis among small vessel vasculitis, RCTs have recently shown negative results. In particular, the PEXIVAS trial statistically showed that PEX has no potential to reduce the mortality and renal death in AAV, but the ASFA, ACR, and KDIGO guidelines following this trial all regard PEX as salvage therapy or selective treatment for severe cases. As plasmapheresis is often performed in combination with other therapies, it is difficult to evaluate to clarify its efficacy on its own, and this predisposition may be pronounced in vasculitis, a rare disease. Although statistically significant differences are not apparent, the diseases that show a trend toward efficacy may possibly include treatment-sensitive subgroups. Further analysis is expected in the future. This article is protected by copyright. All rights reserved.

PMID:35247230 | DOI:10.1111/1744-9987.13829

Indian J Gastroenterol. 2022 Mar 5. doi: 10.1007/s12664-021-01216-1. Online ahead of print.

ABSTRACT

INTRODUCTION: Sensorineural hearing loss (SNHL) has been reported in association with inflammatory bowel disease (IBD). However, SNHL as an extraintestinal manifestation of IBD is frequently underreported. In the present study, we compared the prevalence and severity of SNHL among patients with IBD-ulcerative colitis (IBD-UC) in remission with controls to find out any association between SNHL and IBD-UC in remission compared to controls.

METHODS: This single-center hospital-based prospective observational study included outdoor patients with IBD-UC in remission and healthy age- and sex-matched controls. Eligible patients and healthy participants were subjected to a battery of audiological tests (otoscopy, tympanometry and pure tone audiometry [PTN]) after thorough systemic and ear, nose and throat (ENT) examination.

RESULTS: A total of 100 patients were enrolled in the study: 50 in IBD-UC in the remission group and 50 in the control group. None of the demographic variables (age, gender, residence and habits) were significantly different between the two groups. Otoscopy and tympanometry were normal in all patients and controls. The difference between the two groups in respect to frequency and severity of SNHL on PTA and in respect to unilateral and bilateral distribution of the hearing loss was not statistically significant.

CONCLUSION: There is no statistically significant difference in frequency and severity of SNHL between patients with ulcerative colitis in remission and healthy age- and sex-matched controls.

PMID:35247189 | DOI:10.1007/s12664-021-01216-1

Environ Sci Pollut Res Int. 2022 Mar 5. doi: 10.1007/s11356-022-19145-7. Online ahead of print.

ABSTRACT

To effectively investigate the characteristics, source analysis, and chemical conversions of volatile organic compounds (VOCs) pollution in a typical petrochemical area, 81 VOC species from nine sampling sites were collected from 1st January to 31th December 2019 in Jinshan District. Results showed the concentration of VOCs was 51.63 ± 36.05 ppbv, and VOCs were dominated by alkane (40.10%) and alkenes (39.91%). The temporal variations of VOCs showed that the highest average VOC concentration appeared in July, and the lowest concentration of VOCs was in February. The concentration of VOCs was mainly connected with industrial processes and was transported to other areas through the downwind direction. Six PMF-derived sources including petrochemical industry, solvent utilization, vehicle exhaust, fuel evaporation, combustion, and other industry processes, contributing 37.08%, 16.74%, 16.69%, 14.99%, 9.53%, and 4.97%, respectively. Meanwhile, an anthropogenic VOC emission inventory was established by emission factors and the activity statistics for 2019, results indicated that the total emission of VOCs was estimated as 6.22 kt, petrochemical industry was the most important contributor of human-produced VOCs. The L_OH concentration was 396.12 ppbv via OH radical loss rate method, and the OFP was 210.44 ppbv based on the MIR factor. Alkenes and aromatics were the important components of O₃ formation. This study provides effective information for corresponding governments to establish VOCs contamination control directives.

PMID:35247176 | DOI:10.1007/s11356-022-19145-7

Environ Sci Pollut Res Int. 2022 Mar 5. doi: 10.1007/s11356-022-19499-y. Online ahead of print.

ABSTRACT

Diabetes is one of the most comprehensive metabolic disorders and is spread across the globe. The data from IDF Diabetes Atlas and National Diabetes Statistics mentions that the number of patients with diabetes is increasing at an exponential rate which is challenging the current therapeutics used for the management of diabetes. However, current therapies used for the treatment may provide symptomatic relief but lack in preventing the progression of the disease and thereby limiting the treatment of diabetes-associated complications. A thorough review and analysis were conducted using various databases including EMBASE, MEDLINE, and Google Scholar to extract the available information on challenges faced by current therapies which have triggered the development of novel molecules or drugs. From the analysis, it was analyzed that transforming growth factor βs (TGF-βs) have been shown to exhibit pleiotropic activity and are responsible for maintaining homeostasis and its overexpression is convoluted in the pathogenesis of various disorders. Therefore, developing drugs that block TGF-β signaling may provide therapeutic benefits. This extensive review concluded that drugs targeting TGF-β signaling pathway and its subsequent blockade have shown promising results and hold the potential to become drugs of choice in the management of diabetes and associated complications.

PMID:35247177 | DOI:10.1007/s11356-022-19499-y

Arch Osteoporos. 2022 Mar 5;17(1):40. doi: 10.1007/s11657-022-01088-8.

ABSTRACT

We performed a cross-sectional study in 212 PLHIV under antiretroviral therapy. Bone mass was compromised in 36.5% of relatively young sample and associated with hypogonadism, older age, higher PTH levels, and metabolic syndrome. Hypovitaminosis D was present in 85%, especially those on NNRTI.

PURPOSE: Previous studies have reported an increased prevalence of bone demineralization among people living with the human immunodeficiency virus (PLHIV). We aimed to assess bone mineral density (BMD), vitamin D levels, and associated risk factors in Brazilian PLHIV.

METHODS: Cross-sectional study with 212 patients in a specialized assistance service. Clinical and demographic information were registered. Laboratory tests were performed, and BMD was measured at the lumbar spine, total hip/femoral neck, and forearm by dual-energy X-ray absorptiometry. Participants were classified into “with low bone mass (wLBM)” and “without low bone mass (woLBM).” Those wLBM encompasses osteoporosis, osteopenia, and below the expected range for age as recommended by the World Health Organization.

RESULTS: One hundred and eighty-seven patients were included. Median age was 46.3 years (interquartile range (IQR) 40-52) and duration of HAART exposure was 11.2 years (IQR 7-15). Plasma viral load was undetectable in 79%. Hypovitaminosis D (< 30 ng/mL) was present in 85% and LBM in 36.5%. Men wLBM were more likely to have testosterone deficiency and had higher PTH levels than those woLBM. LBM in women was associated with older age, menopause, and metabolic syndrome.

CONCLUSION: This study showed a high frequency of LBM in a relatively young sample, and suggests a detrimental effect of hypogonadism, older age, higher PTH levels, and metabolic syndrome. Hypovitaminosis D was frequent, especially those on non-nucleoside reverse transcriptase inhibitor, higher body mass index, and abdominal circumference.

PMID:35247128 | DOI:10.1007/s11657-022-01088-8

Neurosurg Rev. 2022 Mar 5. doi: 10.1007/s10143-022-01765-9. Online ahead of print.

ABSTRACT

Cystatin C (CysC) has been found to be associated with hemorrhagic and ischemic stroke in many studies. However, the association between CysC level and the risk of delayed cerebral ischemia after endovascular treatment of aneurysmal subarachnoid hemorrhage has been reported rarely. Our study was proposed to explore this association. Consecutive patients from June 2015 to February 2021 in this single-center retrospective study were selected. Univariate and multivariate analyses were used to identify potential prognostic risk factors for delayed cerebral ischemia, and the stability of the association was demonstrated by several statistical methods, such as subgroup analysis, interaction testing, generalized linear models, and propensity score matching. A total of 424 patients were included in the analysis. Cystatin C was independently associated with delayed cerebral ischemia. The independent effects of CysC on delayed cerebral ischemia were shown in generalized linear models with a logit link, and the results were relatively stable in crude, partial, and full models with ORs (95% CIs) for delayed cerebral ischemia. Subgroup analysis showed no significant subgroup differences in the effect of CysC on delayed cerebral ischemia. There was also no interaction effect between CysC and other confounders. Patients in the high CysC group had a higher risk of delayed cerebral ischemia than those in the low CysC group before and after propensity score matching. CysC level could be an independent predictor for the risk of delayed cerebral ischemia after endovascular treatment of aneurysmal subarachnoid hemorrhage.

PMID:35247129 | DOI:10.1007/s10143-022-01765-9

Int Ophthalmol. 2022 Mar 5. doi: 10.1007/s10792-022-02246-0. Online ahead of print.

ABSTRACT

PURPOSE: To secondary statistical analysis of the Pentacam or Corvis ST parameters from literatures, and to obtain more sensitive diagnostic parameters for clinical keratoconus (CKC) and forme fruste keratoconus (FFKC), respectively.

METHODS: The parameters and the corresponding area of ROC curve (AUC) in previous studies were extracted and screened to obtain the database of CKC (Data-CKC) and FFKC (Data-FFKC), respectively. Two different importance evaluation methods (%IncMSE and IncNodePurity) of random forest were used to preliminary select the important parameters. Then, based on the partial dependency analysis, the sensitive diagnostic parameters that had promotion to the diagnostic performance were obtained. Data-FFKC was analyzed in the same way. Finally, a diagnostic test meta-analysis on the sensitive parameter of interest was conducted to verify the reliability of the above analysis methods.

RESULTS: There were 88 parameters with 766 records in Data-CKC, 57 parameters with 346 records in Data-FFKC. Based on two importance evaluation methods, 60 important parameters were obtained, of which 20 were further screened as sensitive parameters of keratoconus, and most of these parameters were related to the thinnest point of cornea. The stiffness parameter at first applanation (SPA1) was the only Corvis ST output parameter sensitive to FFKC except the Tomographic and Biomechanical Index and the Corvis Biomechanical Parameter (CBI). A total of 4 records were included in the meta-analysis of diagnostic tests on SPA1. The results showed that there was threshold effect, but no significant heterogeneity (I² = 33%), and the area under the SROC curve was 0.87 (95% CI, 0.84-0.90).

CONCLUSIONS: For the diagnosis of FFKC, the sensitivity of SPA1 is not inferior to the well-known CBI, and may be the earliest Corvis ST output parameter to reflect the changes of corneal biomechanics during keratoconus progression. The elevation parameters based on the typical position of the thinnest point of corneal thickness are of great significance for the diagnosis of keratoconus.

PMID:35247116 | DOI:10.1007/s10792-022-02246-0