Clinical Outcomes In Majority Research Articles

Arm Sling Versus Figure of Eight for Treating Midshaft Clavicle Fracture in Adults – A Systematic Review

Introduction: The clavicle is a long, dual-curved bone that forms the only direct link between the axial and appendicular skeletons. Clavicle fracture is the most frequent trauma of the scapular girdle, and involves the midshaft. Although the proportion managed operatively has increased in recent years, the majority (80%) occur at the midshaft are treated non-operatively. Conservative treatments (including figure of eight and arm sling) has a high union rate and good clinical outcome in majority of cases, but very few randomized studies have compared the two. Therefore, a systematic review is needed to compare between arm sling and figure of eight bandage for treat the midshaft clavicle fracture in adults. The author hopes that this systematic review can be the consideration for the better treatment in closed clavicle fracture in adults. Method: The following strategy was used terms on several journals of comparison between arm sling with figure of eight bandage for threatening midshaft clavicle fracture in adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform the comprehensive data collection. The authors used 5 years publication date and English language to select an appropriate journal. Result: The result is presented by comparison between arm sling and figure of egiht for the treatment outcomes. The author identified 11 relevant articles about comparison between arm sling and figure of eight to treat midshaft clavicle fracture in adults. The total number of patients was 3064 samples. The articles compare about the level of pain by VAS score, level of shortening and mean time of union. Conclusion: The arm sling has better advantages for non-operative treatment to midshaft clavicle fracture in adults than figure of eight bandage. It shows from the level of pain, level of shortening and mean time of union. The arm sling treatment has less level of pain, less level of shortening and less mean time of union than figure of eight bandage.

Arm Sling Versus Figure of Eight for Treating Midshaft Clavicle Fracture in Adults – A Systematic Review

Introduction: The clavicle is a long, dual-curved bone that forms the only direct link between the axial and appendicular skeletons. Clavicle fracture is the most frequent trauma of the scapular girdle, and involves the midshaft. Although the proportion managed operatively has increased in recent years, the majority (80%) occur at the midshaft are treated non-operatively. Conservative treatments (including figure of eight and arm sling) has a high union rate and good clinical outcome in majority of cases, but very few randomized studies have compared the two. Therefore, a systematic review is needed to compare between arm sling and figure of eight bandage for treat the midshaft clavicle fracture in adults. The author hopes that this systematic review can be the consideration for the better treatment in closed clavicle fracture in adults. Method: The following strategy was used terms on several journals of comparison between arm sling with figure of eight bandage for threatening midshaft clavicle fracture in adults. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform the comprehensive data collection. The authors used 5 years publication date and English language to select an appropriate journal. Result: The result is presented by comparison between arm sling and figure of egiht for the treatment outcomes. The author identified 11 relevant articles about comparison between arm sling and figure of eight to treat midshaft clavicle fracture in adults. The total number of patients was 3064 samples. The articles compare about the level of pain by VAS score, level of shortening and mean time of union. Conclusion: The arm sling has better advantages for non-operative treatment to midshaft clavicle fracture in adults than figure of eight bandage. It shows from the level of pain, level of shortening and mean time of union. The arm sling treatment has less level of pain, less level of shortening and less mean time of union than figure of eight bandage.

Early arthritis clinic is effective for rheumatoid and psoriatic arthritides.

Early arthritis clinics (EACs) have been well established since 1980s. Most of the data for their effectiveness comes from rheumatoid arthritis (RA) management and is largely limited to process outcomes. There is little evidence that such clinics improve clinical outcomes particularly for psoriatic arthritis (PsA). We examined whether EACs provide better outcomes irrespective of final arthritis diagnosis. A 52-week prospective observational study of all inflammatory arthritis patients presenting to early arthritis service at our secondary care hospital in 2016 was undertaken. A protocolised approach to the early initiation of therapy (within 3weeks) and 6-weekly review of treatment outcomes was embedded irrespective of the arthritis diagnosis. Statistical analysis was undertaken using Mann-Whitney U test for disease activity scores to ascertain the significance of outcomes. Of 1884 patients referred, 482 (25.5%) were triaged into EACs based on set criteria. 159 (64.3%) had RA, 55 (22%) with PsA and 33 had other inflammatory arthritides. Mean DAS28 for RA at first visit was 4.65 (0.6-8.0). Treating to target achieved DAS28 remission for 84 (53.5%) and low disease activity (LDA) for a further 44 (34%). Median time to achieve remission or LDA was 20weeks (0-52weeks). Mean tender (TJ) and swollen joint (SJ) counts for PsA at first visit were 8.2 (1-35) and 3.5 (0-14), respectively [n = 55]. The patient (PtGA) and physician (PhGA) global assessments mean were 3.0 and 2.9 (1-5). Target [TJ and SJ ≤ 2] was achieved for 38 patients (69%) and good PsARC response for a further four (7%). Median time to achieve the target or good response was 22weeks (0-48weeks). Final TJ and SJ mean was significantly better at 1.2 (0-4) and 0.3 (0-2) [p < 0.0001] with similar improvement in PtGA [mean 1.8 (1-4)] and PhGA [mean 1.6 (1-3)]. Dedicated EACs help achieve good clinical outcomes in majority of patients with RA and PsA. Nearly 80% of our cohort attained the target or good disease response in less than 6months. This was despite a significant delay in patients presenting to their GPs and moderately high disease activity.

Impact of CYP2D6 polymorphisms on endoxifen concentrations and breast cancer outcomes.

We investigated the impact of germline CYP2D6 genotyping done using the non-tumor specimen on endoxifen concentrations and/or clinical outcomes in breast cancer (BC) patients treated with tamoxifen in published studies. We evaluated published data from 13 001 patients in 29 studies. Mean±s.d. endoxifen concentrations were significantly lower in poor metabolizers (PM) versus extensive metabolizers (EM) (8.8±7.2 versus 22.3±11.8 ng ml-1; P<0.05). The PM status did not influence clinical outcomes in majority of the studies. However, only one study followed the Gaedigk activity scoring for phenotypic assignments, which predicted recurrence-free survival in CYP2D6 poor metabolizers. In two independent studies with 1676 patients, low endoxifen concentrations predicted poor BC-free survival. From our review of published data we found that standardization of CYP2D6 genotype-phenotype classification is needed in order to ensure effective evaluation of associations between CYP2D6 polymorphisms and endoxifen concentrations and BC outcomes. Universal implementation of this standardization classification system should be a priority among researchers and laboratories. Furthermore, additional clinical research is warranted to determine whether patients with CYP2D6 PM phenotypes or low endoxifen levels will have better clinical outcomes with increased tamoxifen dosing compared to standard dosing.

Prognostic role of intratumoral IL-17A expression by immunohistochemistry in solid tumors: a meta-analysis

IL-17A is an important proinflammatory cytokine which is frequently elevated in tumor microenvironment. However, the role of intratumoral IL-17A in solid tumors remains controversial. Herein, we conducted a meta-analysis to assess the prognostic impact of intratumoral IL-17A in patients with solid tumor. PubMed and EBSCO were searched to identify the studies evaluating the associations between intratumoral IL-17A measured by immunohistochemistry (IHC) and overall survival (OS) and disease-free survival (DFS) in solid tumors. A total of 2972 patients with solid tumor from 21 published studies were incorporated into this meta-analysis. We found that high level of intratumoral IL-17A was significantly associated with worse 3-year, 5-year OS and 1-year, 3-year DFS, but not with 1-year OS or 5-year DFS in solid tumors. In addition, in stratified analyses by cancer types, IL-17A overexpression was significantly associated with worse OS in hepatic carcinoma, but with improved OS in esophageal squamous cell carcinoma (ESCC). Furthermore, high IL-17A expression positively correlated with advanced TNM stage. In conclusion, High expression of intratumoral IL-17A leads to an unfavorable clinical outcome in majority of solid tumors, implicating IL-17A is a valuable biomarker for prognostic prediction of human solid malignances and targeting it may have a potential for effective treatment.

UNSTABLE FRACTURE OF THORACOLUMBAR SPINE;

Objectives: To evaluate the functional outcome of unstable thoracolumbarfractures fixed with pedicular screws and rods. Study Design: Descriptive case series. Setting:Department of Orthopedics and Spine surgery Ghurki Trust Teaching Hospital Lahore. Period:February 2013 to October 2015. Material &amp; Methods: Patients of either gender or all ageswith thoracolumbar fractures fulfilling the inclusion criteria were fixed with pedicular screwsand rods under general anesthesia. Post operatively patients were reviewed monthly for oneyear and results were analyzed according to modified McNab criteria as excellent, good, fairand poor at final follow up. Results: A total of 281 patients including 193(68.68%) males and88(31.32%) females with mean age 28.32 years (range 18 to 60 years) were included in ourstudy. Majority (91 patients) had fractures of L1 followed by L2 (73 patients) fracture and D12(67 patients) fracture. Pre operatively 95(33.81%) were neurologically graded as Frankle gradeD,73 (25.98%) grade C while 49(17.44%) were graded as Frankle grade E.Post operatively finalfollow up at one year yielded excellent clinical outcome in majority (91.46%,n=257) while goodand fair outcomes were reported in 6.41%(18 patients), and 2.14%(6 patients) respectivelyaccording to modified McNab criteria. No post op neurological detoriation, mortality or othermajor complication was reported in the study. Conclusion: Pedicular screw and rod fixationfor unstable thoracolumbar fractures gave excellent functional results in majority of patient as itreduces complications of recumbency and helps in early mobilization. We recommend it as afirst line treatment for such fractures.

Terrible triad of the elbow: is it still a troublesome injury?

Terrible triad injury (TTI), one of the main patterns of complex elbow instability, is difficult to treat and yields conflicting surgical results. We analyzed prospectively a series of patient affected by TTI and treated according to the current diagnostic and surgical protocols to investigate whether their application allow to obtain more predictable outcomes. We analyzed 26 patients with a mean age of 52 years. Preoperative X-rays and CT were performed; all patients were operated by the same elbow surgeon and underwent the same surgical and rehabilitation treatment. Final functional outcome was assessed by the Mayo Elbow Performance Score (MEPS), Quick-Disability of the Arm Shoulder and Hand-score (Q-DASH) and the modified-American Shoulder and Elbow Surgeons score (m-Ases). A radiographic evaluation was also performed. Mean follow-up was 31 months. At final evaluation, mean flexion, extension, supination and pronation were 137°, 10°, 77° and 79°, respectively; mean MEPS, m-ASES and Q-DASH scores were respectively 96, 91 and 8 points. Complications observed after first surgery were: elbow stiffness in 5 cases, mild posterolateral instability in 3 cases, chronic subluxation in 1 case. Radiographic evaluation showed secondary arthritis in 9 cases, symptomatic HO in 3 cases and late hardware displacement in 2 cases. Six out of 26 patient underwent reoperation with final satisfactory results. The current diagnostic and therapeutic protocols allow obtaining satisfactory clinical outcomes in majority of cases but a high number of major and minor unpredictable complications persist yet. In this series, low compliance, obesity, and extensive soft elbow tissue damage caused by high-energy trauma represented negative prognostic factors unrelated to surgery. On the other hand, the strict application of current algorithms by an expert elbow surgeon appears to improve clinical results by reducing the influence of other avoidable negative prognostic factors well known in current literature, such as the incomplete recognition of injuries, delayed treatment, inadequate treatment of bony and ligamentous injuries, prolonged immobilization and, last but not least, the surgeon's inexperience. Level IV, Case series, Treatment study.