Conservative Treatment In Patients Research Articles

Views about the clinical, diagnostic and comprehensive treatment of plantar fasciitis: a review

INTRODUCTION. One of the problems in modern podiatry is plantar fasciitis. According to population studies, more than two million patients are treated for plantar fasciitis each year in the United States, 1 in 10 people will develop heel pain during their lifetime, and 1 % of visits to podiatrists are related to heel pain. Plantar fasciitis occurs in approximately 10 % of the general population, with 83 % of these patients being active working adults between the ages of 25 and 65. The high prevalence of plantar fasciitis in the population necessitates the search and development of new and effective methods for its recognition and treatment. AIM. Generalization of literature data on the mechanisms of development of plantar fasciitis, methods of diagnosis and treatment. MATERIALS AND METHODS. The databases PubMed, Scopus and the electronic scientific library eLIBRARY were searched for articles using the keywords: “plantar fasciitis”, “plantar fasciosis”, “heel pain”, “heel spur”. Search depth — 10 years. Publications related to the diagnosis and treatment of PF were selected. During the study, 40 publications were selected, the content of which, to one degree or another, corresponded to the purpose of this study. RESULTS AND DISCUSSION. Pain syndrome in the area of the heel bone is the main reason for seeking medical care in patients with plantar fasciitis. Currently, there are several approaches to the treatment of plantar fasciitis: conservative and surgical treatment. Conservative treatment is represented by methods of manual therapy, physical therapy, and physical therapy. Surgical methods include various variants of resection of the bony outgrowth of the calcaneal region and other interventions. CONCLUSION. Treatment of plantar fasciitis requires a multidisciplinary approach to treatment, as no single treatment method is universal. Conservative treatment of patients with plantar fasciitis should be comprehensive. Due to the high prevalence of plantar fasciitis in the population, the introduction of new treatment techniques and the development and use of a unified patient management tactic can improve patient outcomes and quality of life. Among other surgical methods, the use of RFD has a positive effect in patients with PF refractory to conservative therapy and is the least invasive method among surgical methods.

Synovial fluid monocyte-to-lymphocyte ratio in knee osteoarthritis patients predicts patient response to conservative treatment: a retrospective cohort study

BackgroundBiomarkers that predict the treatment response in patients with knee osteoarthritis are scarce. This study aimed to investigate the potential role of synovial fluid cell counts and their ratios as biomarkers of primary knee osteoarthritis.MethodsThis retrospective study investigated 96 consecutive knee osteoarthritis patients with knee effusion who underwent joint fluid aspiration analysis and received concomitant intra-articular corticosteroid injections and blood tests. The monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR) were calculated. After 6 months of treatment, patients were divided into two groups: the responder group showing symptom resolution, defined by a visual analog scale (VAS) score of ≤ 3, without additional treatment, and the non-responder group showing residual symptoms, defined by a VAS score of > 3 and requiring further intervention, such as additional medication, repeated injections, or surgical treatment. Unpaired t-tests and univariate and multivariate logistic regression analyses were conducted between the two groups to predict treatment response after conservative treatment. The predictive value was calculated using the area under the receiver operating characteristic curve, and the optimal cutoff value was determined.ResultsSynovial fluid MLR was significantly higher in the non-responder group compared to the responder group (1.86 ± 1.64 vs. 1.11 ± 1.37, respectively; p = 0.02). After accounting for confounding variables, odds ratio of non-responder due to increased MLR were 1.63 (95% confidence interval: 1.11–2.39). The optimal MLR cutoff value for predicting patient response to conservative treatment was 0.941.ConclusionsMLR may be a potential biomarker for predicting the response to conservative treatment in patients with primary knee osteoarthritis.

SurLym trial: study protocol for a multicentre pragmatic randomised controlled trial on the added value of reconstructive lymphatic surgery to decongestive lymphatic therapy for the treatment of lymphoedema

IntroductionLymphoedema is a chronic condition caused by lymphatic insufficiency. It leads to swelling of the limb/midline region and an increased risk of infection. Lymphoedema is often associated with mental and...

Improvement of Postoperative Quality of Life in Patients Over 80 Years Old With Thoracic Spinal Stenosis.

A retrospective comparative study was conducted to analyze the outcome of surgical and conservative treatment for patients over 80 years old with thoracic spinal stenosis (TSS). To evaluate the safety and efficiency of posterior spinal cord decompression surgery for over 80-year-old patients with TSS. Concerned about the risk of surgery, over 80-year-old patients with TSS are usually treated conservatively, which often leads to a decline in quality of life. So far as we know, no study demonstrates the risk and benefit of spine surgery for these patients. Over 80 years of age who underwent dorsal decompression surgery or conservative treatment due to TSS between January 2010 and November 2020 were analyzed. Sixty-four patients who completed follow-up PROM (patient-reported outcome measure) data were collected, including the mJOA (modified Japanese Orthopedic Association score) scoring system, VAS (visual analogue scale), questionnaire-based assessment of the ODI (Oswestry disability index), BI (Barthel index), and SF-36v2 (Short Form-36v2) Health Survey. The clinical characteristics, preoperative and postoperative imaging findings, operative records, complications, and individual outcomes were analyzed. Of the 64 patients, 38 underwent posterior decompression, pedicle screw fixation, and posterolateral fusion; another 26 chose conservative treatment. The baseline characteristics of the TSS patients in 2 groups show no significant differences. The clinical symptoms and imaging outcomes showed a significant improvement in the surgical group compared with the nonsurgical group, according to mJOA, VAS, ODI, BI, and SF-36v2. Cerebrospinal fluid leakage occurred in 6 patients, and transient neurological impairment occurred in 2 patients. Posterior decompression surgery for over 80-year-old patients with TSS is a safe and effective treatment, it has a good clinical outcome as well as an acceptable complication rate. However, there were no obvious improvements in quality of life or pain with conservative treatment.

Comparison between Invasive Intervention and Conservative Treatment in Patients with In-Hospital Myocardial Infarctions: Results from the Regional Myocardial Infarction Registry of Saxony-Anhalt (RHESA) Study.

Background/Objectives: In-hospital myocardial infarctions (AMIs) are less often treated with invasive intervention, compared to out-of-hospital AMIs. We aimed to identify the determinants of invasive intervention in patients with in-hospital AMIs and assess its association with mortality, compared to conservative treatment. Methods: This was a cross-sectional study of in-hospital AMIs in The Regional Myocardial Infarction Registry of Saxony-Anhalt. Patients' characteristics and outcomes were compared based on the treatment strategy (invasive intervention vs. conservative treatment). Logistic regression was performed to assess the determinants of invasive intervention (vs. conservative treatment) and its association with 30-day mortality. Results: Nearly 67% of the patients (259/386) received invasive intervention, and the rest were treated conservatively. Those who were treated with an invasive intervention were younger and had a lower proportion of chronic heart failure than those treated conservatively. Age > 75 years compared to younger patients, pre-existing heart failure, and higher heart rate upon presentation were associated with lower odds of receiving invasive intervention. Hypertension (OR = 2.86, 95% CI [1.45-5.62]) and STEMI vs. NSTEMI (1.96, [1.10-3.68]) were associated with higher odds of invasive intervention. The adjusted odds of 30-day mortality were lower with invasive intervention compared to conservative treatment (0.25, [0.10-0.67]). Conclusions: One-third of the patients with in-hospital AMIs received conservative treatment. Younger age, absence of heart failure, lower heart rate, hypertension, and STEMI were determinants of invasive intervention usage. Invasive intervention had lower odds of 30-day mortality, but longitudinal studies are still needed to assess the efficacy of conservative vs. invasive strategies in in-hospital AMIs.

Comparison of Conservative and Surgical Treatment in Patients with Legg-Calve-Perthes Disease

Objectives: The overall main purpose of this study is to add some knowledge on the treatment of LCPD, with a main focus on the comparison between conservative and surgical treatments of Legg-Calve-Perthes Disease (LCPD). And a brief overview of the complications of these treatments. Methods: A retrospective cohort method was used in this study. A total number of 53 patients were registered with LCPD, at the first affiliated hospital of Xinjiang Medical University. Out of these 53 patients, 39 patients were included in this study, rest of 14 patients couldn’t be included due to missed data or loss of contact. For the comparison of results, a modified form of the Harris Hip Score (HHS) was used for the clinical assessment of hip function. Radiographs were also used for the evaluation. The radiological assessment was made by the use of CE and CCD angles. The main classification system, which was used for the evaluation, staging, and prognosis of hip function, was Stulberg’s classification. Statistical analysis was done by using the SPSS 23.0 version. A simple t-test was used for data analysis. Results: The clinical results supported our hypothesis that surgical treatment is a better choice of treatment than conservative treatment in patients with LCPD. However, the statistical data from radiographic assessment showed no significant difference between conservative and surgical treatment in patients with LCPD. The statistical data showed that both conservative and surgical treatment had significant p-values (<0.05) when compared results at the final follow-up check with that before starting treatment. So conservative treatment can be used as an alternative to surgical treatment in patients with Legg-Calve-Perthes Disease. Conclusion: From the statistical analysis of data, we concluded that there is no significant difference between outcomes of conservative and surgical treatment in patients with Legg-Calve-Perthes Disease (LCPD). So conservative treatment can be ........

Factors determining the short-term clinical outcomes of conservative treatment in patients with supraspinatus tear

IntroductionTo identify factors influencing the better and worse changes in the Western Ontario Rotator Cuff Index of patients undergoing conservative treatment for supraspinatus tendon tear. MethodsThe study included 30 patients with supraspinatus tendon tear who underwent conservative treatment. The average duration of intervention was 35.4 days. The Western Ontario Rotator Cuff Index, shoulder range of motion, isometric muscle strength, supraspinatus tendon thickness, thickness of the supraspinatus, infraspinatus, and teres minor muscles, and acromiohumeral interval were assessed before and after the intervention. In the statistical analyses, change in the Western Ontario Rotator Cuff Index was the dependent variable, and the amount of change in each measurement variable before and after the intervention was the independent variable. ResultsThe average Western Ontario Rotator Cuff Index improved from 1067 at pre-treatment to 997 at post-treatment, but without a significant difference (p = 0.29). A multiple regression analysis revealed that supraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption had a significant effect on the change in the Western Ontario Rotator Cuff Index (R2 = 0.44, p < 0.01). ConclusionSupraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption were important factors for the Western Ontario Rotator Cuff Index score in the early stages of conservative treatment for patients with supraspinatus tendon tear.

Subacromial Impingement Syndrome. A Retrospective Analysis of Long-Term Outcomes of Surgical and Conservative Treatment

INTRODUCTION. Subacromial impingement syndrome (SAIS) is one of the most common reasons that makes patients seek treatment for shoulder pain.&#x0D; PURPOSE. To assess the effectiveness of surgical and conservative treatment of patients with subacromial impingement syndrome.&#x0D; MATERIALS AND METHODS. The clinical results of 48 patients with SAIS stage 1, 2 according to Neer, divided into 3 groups, were analyzed: 1) conservative group without rotator cuff tears (16 patients), 2) conservative group with partial rotator cuff tears (16 patients); 3) surgical group (16 patients). The patients of the conservative groups were treated according to the rehabilitation protocol including myofascial release techniques, physiotherapy, manual therapy, exercises. The patients of the surgical group underwent an arthroscopic subacromial decompression. The follow-up period was at least 24 months. The clinical condition of the patients was assessed using ASES, VAS scales and SANE questionnaire.&#x0D; RESULTS. The study did not reveal a statistically significant difference of the surgical and conservative treatment groups according to VAS and ASES. There was a statistically significant difference in the results of the SANE questionnaire (p = 0.008) with better results in the conservative groups. Longer rehabilitation was noted in patients of the surgical group.&#x0D; DISCUSSION. Ketola et al. compared clinical results of surgical group of patients who underwent the subacromial decompression and the conservative group who performed the exercises. There was no statistically significant difference found in VAS level results, subjective shoulder function assessment. Paavola et al. have not found statistically significant difference in VAS scale results between surgical group, group of diagnostic arthroscopy and conservative group of patients with rotator cuff tendinopathy.&#x0D; CONCLUSION. The conservative treatment of subacromial impingement syndrome with physiotherapy and manual therapy let achieve good and excellent results.

Arthroscopic capsular release is more effective in pain relief than conservative treatment in patients with frozen shoulder

BackgroundFrozen shoulder is a common medical condition, but the ideal therapeutic method is yet to be determined. Our aim was to analyze the pain-relieving effect of different treatment options used for the management of this disease.MethodsMedical records of 59 patients (22 male, 37 female, average age: 55.5 years ±9.9) with early stage primary frozen shoulder were evaluated, their demographic data, physical examination, concomitant diseases and treatment specific data were registered. Life quality and the level of pain were assessed using the Oxford Shoulder Score (OSS) and Numeric Rating Scale (NRS). Different treatment modalities and their effect on pain relief were recorded. Any existing correlation between life quality, pain and demographic data, concomitant diseases or the therapeutic method used was investigated.ResultsThe level of pain measured on NRS improved from 7.9 ± 1.6 to 1.9 ± 2.2. The most effective therapeutic method in terms of pain relief was surgery, followed by physiotherapy and intraarticular steroid injection (NRS score after treatment: 2 - p < 0.0001; 3.3 - p < 0.0001; 4.9 - p < 0.0001, respectively). Non-steroidal anti-inflammatory drugs (NSAIDs) did not reduce pain significantly. OSS improved from 24 to 43.6 and was not affected by the investigated variables, time to recovery was not influenced by the demographic data, the type of treatment or concomitant diseases.ConclusionsArthroscopic capsular release, physiotherapy and intraarticular steroid injection outperformed physical therapy and NSAID treatment in terms of pain relief. Despite of slight but persistent post-therapeutic pain found in half of the cases, treatment was considered satisfactory by the patients. Nor patient specific neither therapy specific data had a significant effect on the course of the disease.

Evaluating the implementation of personalised outcomes forecasts to optimise supervised exercise therapy in patients with intermittent claudication in the Netherlands: a multimethods study

BackgroundTo support the optimisation of supervised exercise therapy (SET) in patients with intermittent claudication, we developed personalised outcomes forecasts (POFs), which visualise estimated walking distance and quality of life for...

The 6 month interim analysis of a randomized controlled trial assessing the quality of life in patients with breast cancer related lymphedema undergoing lymphaticovenous anastomosis vs. conservative therapy

Breast cancer related lymphedema (BCRL) is a chronic condition with a detrimental impact on psychosocial and physical well-being. Lymphaticovenous anastomosis has shown promising results in alleviating physical symptoms and increasing quality of life in patients with BCRL. The aim of the study is to evaluate the effect on health related quality of life (HrQol) after LVA surgery versus conservative treatment in patients with BCRL. The study is a prospective, multicenter randomized controlled trial. Adult women with unilateral BCRL, with early stage lymphedema and viable lymphatic vessels were included. The primary outcome measure was HrQol measured by the lymphedema functioning disability and health (Lymph-ICF) questionnaire. The secondary outcomes were volume difference measured by the water displacement method; the Upper Extremity Lymphedema (UEL) index; and daily use of the compression garments after 3 and 6 months. For this interim analysis 46 patients per group were included. There was a significant improvement in the domains in physical and mental function in the Lymph-ICF questionnaire in the LVA group after 6 months, (− 16.46 ± 18.5, p < 0.05, − 10.12 ± 29.5, p < 0.05 respectively). However, there was no statistical difference in the total score of the Lymph-ICF after 6 months in both groups (LVA-group; − 8.57 ± 22.6, p > 0.05, CDT-group; − 2.65 ± 18.2, p < 0.05). Furthermore, there was no significant volume reduction in both groups (LVA-group: 20.04 ± 196.40, p = 0.497, CDT: 33.98 ± 189.87, p = 0.236). In the LVA group, 41% partially of completely stopped wearing the compression garments after six months whereas in the CDT group 0% discontinued to use of compression garments. LVA resulted in improvement of the domains physical and mental function of the Lymph-ICF. Limb volume did not significantly improve after 6 months. However, around 42% could completely or partially stopped with the use of compression garments in the LVA group. The current results are promising, however longer follow up is required to assess long term effect of LVA for secondary lymphedema. Clinical Trial Registration: NCT02790021 registered on 03/06/2016

The predictive role of computed tomography with oral contrast in the successful management of adhesive small bowel obstruction

Background Adhesive small bowel obstruction (SBO) stands out as one of the most frequent and clinically significant complications following abdominal surgery. The present study aimed to investigate the role of computed tomography (CT) with oral contrast media in guiding treatment and predicting the success of conservative treatment in patients presenting with adhesive SBO. Patients and methods This is a prospective study that was conducted on adult patients who were clinically and radiologically proven to have SBO and had a history of at least one previous abdominal surgical intervention. The included patients underwent CT examination of the abdomen and pelvis with oral contrast. Patients who had the oral contrast seen reaching the right colon were admitted and completed conservative management. Surgical intervention was indicated in patients who showed failure of treatment with oral contrast. Results This study included 70 patients, of whom 29 (41.4%) had contrast in the right colon during CT examination after the first oral contrast administration. The remaining patients (n=41, 58.6%) indicated a second oral contrast CT study after 24 h. Sixteen (22.9%) patients had nonresolving obstructions and underwent surgical intervention. Overall, 52 (74.3%) patients were successfully treated with oral contrast studies, with no subsequent morbidity. Significant predictors for surgical intervention were a history of more than one previous surgical intervention (OR=6.08, CI: 1.75–21.14, P=0.005) and nonpassage of contrast to the right colon in the CT study (OR=0.099, CI: 0.029–0.341, P&lt;0.001). Conclusion This study highlights the clinical relevance of CT with oral contrast studies in guiding management. A history of multiple previous surgeries and nonpassage of the oral contrast to the right colon emerged as a significant predictor for surgical intervention.

Сравнительная оценка эффективности эмболизации ветвей подколенной артерии и комплексного консервативного лечения при остеоартрите коленного сустава

Osteoarthritis of the knee joint is a common condition that often leads to pain and impaired joint function. Embolization of branches of the popliteal artery is an innovative treatment method for osteoarthritis, however, its effectiveness and comparison with complex conservative treatment in cases where surgical intervention is not possible require further investigation. Objective is to evaluate and compare the short-term, medium-term, and long-term outcomes of embolization of branches of the popliteal artery and complex conservative treatment in patients with stage III knee osteoarthritis. The study included patients with stage III knee osteoarthritis according to the Kellgren–Lawrence scale who were unable to undergo surgical intervention for various reasons. Two treatment methods were offered to them: embolization of branches of the popliteal artery and complex conservative treatment. Patients were divided into two groups. The results were assessed using the visual analog scale (VAS) and the WOMAC questionnaire, which considers the joint's functional status and the patient's quality of life. The study significantly reduced VAS scores and WOMAC questionnaire scores in both groups. In the group treated with embolization of branches of the popliteal artery compared to complex conservative treatment, pain relief occurred in a shorter period, and the pain remission period was longer. The results suggest the potential effectiveness of embolization of branches of the popliteal artery in treating knee osteoarthritis. For patients with severe osteoarthritis where surgical treatment is not possible, both treatment methods demonstrated good results when applied meticulously and monitored, with embolization of branches of the popliteal artery being more effective in relieving pain. Further research is needed to confirm these findings and determine optimal treatment strategies. Based on a 2-year observation period, for patients with severe intractable pain caused by stage III knee osteoarthritis according to K–L, embolization of branches of the popliteal artery is a more effective treatment method in pain relief, improving quality of life and social activity compared to conservative complex.

Treatment of a Patient With Closed Liver Injury Using Interventional Methods:&#x0D; a Case Study

Background. Mechanical injury occupies a leading position among the causes of mortality in the working-age population. Diagnosis and treatment of isolated and combined abdominal traumas accompanied by bleeding appear to be a specific challenge. Due to difficulties in diagnosis and treatment, they are characterized by frequent complications and an increased mortality rate.Currently, there is no uniform tactics for diagnosing and treating patients with liver damage. In Russia and globally, new approaches are being actively introduced for the treatment of patients with closed liver traumas using minimally invasive techniques.The aim of study was to present a clinical case of a patient with a closed liver injury treated using interventional methods, such as angiography and embolization.Materials and methods. According to conventional techniques, the patient had to undergo laparotomy with complex manipulations to stop intra-abdominal bleeding from a ruptured liver, which would inevitably worsen her condition in the context of a presenting severe injury.Multiple studies reported that the number of postoperative complications after laparotomy is up to 41%, and in case of combined trauma 10-35% of complications can be one of the causes of death [6, 7, 8]. In order to avoid more traumatic treatment approaches, we applied tactics using minimally invasive high-tech diagnostic and treatment options.Results. To stop intra-abdominal bleeding from a liver rupture, which was previously diagnosed during multislice computed tomography (MSCT) with intravenous contrast, using interventional options, selective embolization of the segmental branch of the right hepatic artery was performed with an adhesive composition. The post-traumatic period proceeded without complications; in 14 days after the injury, the patient was discharged in satisfactory condition.Conclusion. Minimally invasive and conservative treatment of patients with closed abdominal traumas using interventional radiology can be successfully applied in specialized trauma centers.

Reproductive outcomes after conservative treatment in early and advanced stage MOGCTs

BackgroundMalignant ovarian germ cell tumors usually occur in young women. The standard of care is fertility sparing surgery and comprehensive surgical staging followed by adjuvant chemotherapy with BEP (bleomycin, etoposide, cisplatin) if needed. The aim of this study was to analyze the reproductive outcomes after conservative treatment in patients diagnosed, treated and followed up in MITO (Multicenter Italian Trials in Ovarian Cancer) centers. MethodsA questionnaire concerning gynecological symptoms, reproductive outcomes and fertility treatment was administered to 164 MOGCTs survivors. Data regarding patients deceased were collected from MITO-9 database. There were 114 patients diagnosed at reproductive age between 1983 and 2019 included. Results109 patients answered the questionnaire and 5 patients decesased were included (median age 24.9 years). 78.1% were stage I,4.4% stage II, 14.9% stage III and 2.6% stage IV. 57.9% received chemotherapy, the mean number of cycles was 4.1. Median time to menstrual recovery after BEP was of 5.6 months range, only 1 case of premature ovarian failure was reported. Among the 114 patients 38 (33.3%) attempted to become pregnant, 29/38 (76.3%) got pregnant with a total of 44 conceptions. 40.9% received chemotherapy and 22.9% did not (p 0.048). Pregnancy desire was the only predictive factor associated with live births among women who attempted pregnancy after treatment. ConclusionsAs MOGCTs affect women of child-bearing age, fertility preservation represents a major treatment issue. Our results are consistent with the available evidence, confirming that adjuvant chemotherapy for MOGCT does not impact the reproductive function and fertility.

Diagnostic Relevance of Electromyographic Values and their Role in Forecasting the Conservative Treatment in Patients with Carpal Tunnel Syndrome

Summary. Instrumental investigation and electromyography (EMG), one of the most widespread and informative of its methods, still remains widely used for differentiated diagnostics with any other disorder, compressive-ishemic focal neuropathy (CIFN) of the median nerve (MN) ) at the level of the carpal tunnel (CT) diagnosis verification and determination of the severity of damage to the MN. The clinical diagnosis of this pathologyis better know as carpal tunnel syndrome (CTS). Objective: To study the diagnostic relevance of electromyographic values in the Ukrainian population of CTS patients and their role in forecasting the efficiency of conservative treatment of this disorder.&#x0D; Materials and methods: 128 patients (204 extremities) with the clinical signs of CTS, who formed the Main Group (MG) underwent electromyography (EMG). The mean age of the patients was 58.2±12.5 years old; among them were 105 (82 %) women and 23 (18 %) men; 77 persons with a bilateral and 51 with a unilateral process. The control group (CG) included 30 volunteers (54 extremities) without any claims and signs of neurological symptoms. The mean age was 45.1±7.8 years old; among them were 23 (77.6%) women and 7 (23,3%) men. To determine the EMG predictors of the effectiveness of clinical outcomes after paraneural corticosteroid injection (PCI) 58 extremities MG were examined.For the EMG examination, we used the «Viking Quest» machine by Nicollet, the USA. Applying relevant methods, we investigated the following: median motor distal latency (DMLm) and CMAP of M. abductor pollicis brevis (APB); median sensory distal onset (MOL-D2), median sensory distal peak latency (MPL-D2), median SNAP amplitude digit 2, median sensory conduction velocity between wrist and digit 2 (mSNCV); difference in median sensory onset latency (digit 1) (MSL-D1) to radial sensory onset latency (digit 1) (RSL-D1) – MD1-RD1; difference in median nerve distal motor latency (2nd lumbrical)to the ulnar nerve distal motor latency (2nd interossei) – 2LI-DML; interrelation of the amplitudes of CMAP APB obtained by the stimulation of the MN on the level of the lower third of forearm to the amplitude of CMAP APB – on the level of the lower third of a palm (wrist to palm amplitude ratio); the sensory ulnar nerve conduction velocity (uSNCV).&#x0D; Results: The analysis of mean values of the core EMG values has demonstrated the significant differences between MG and CG, with different directions of changes, typical of the CTS. Relying on the data collected while studying people from the CG (the discovered referential and abnormal values) and the ROC analysis, we have established the sensitivity and specificity of EMG values: DMLm – 73.5% and 96.3%; MPL-D2 – 81.9% and 100%; mSNCV– 93.9% and 100%; MD1-RD1 – 62.5% and 100%; MSL-D1– 83.3% and 96.9%; 2LI-DML – 88.2% and 100%, respectively (AUC=0,91-0.96). Based on the results of the ROC analysis, determined that the most prognostically significant EMG predictor of clinical outcome after PCI was median SNAP amplitude digit 2 (sensitivity 90,9% and specificity 92%, AUC=0,95.&#x0D; Conclusions: The EMG is the objective and informative method to diagnose CIFN of the MN at the level of the CT, severity of nerve damage in CTS patients and predicting of clinical outcome after PCI.

Laparoscopic exploration versus conservative treatment in stable blunt abdominal trauma patients

Background: Laparoscopy is now a standard procedure in general surgery, and as technique and equipment advance, more complicated procedures are being carried out using this minimally invasive approach. With less patient morbidity, postoperative complications, and recovery time than open procedures, laparoscopic surgery aims to offer equal or better visualisation. Numerous laparoscopic procedures, such as cholecystectomy, gastroesophageal reflux procedures, and diagnostic laparoscopy, have demonstrably achieved this goal. Despite the advantages of laparoscopy in the trauma population, its complexity and potential hemodynamic instability due to intra-abdominal injury typically prevent its use. This cutting-edge technology may help carefully chosen trauma patients. According to estimates, 10% of all deaths worldwide were due to trauma. Methods: This prospective study included 29 patients with history of blunt abdominal trauma and vitally stable following initial resuscitation admitted to Casualty and Emergency Unit, ainshams university hospitals and Elzhor Hospital port said, during the period from June 2022 to December 2022. Results: The patients in study were 21 males (82 % of total) 10 males in (LE) representing approximately 77 % and 11 males in conservative group representing approximately (87 %), and 8 females (18 % of total) 2 females in (LE) and 6 in conservative group. As Regarding the hospital stay, in this study, the patients managed by (LE) had shorter hospital stay in relation to those managed conservatively, as the patients results revealed that the overall hospital stay for (LE) was significantly shorter, with an average of 5.69 ± 1.887 days. In this study, the group that benefit the most from shortening the hospital stay was the patients with haemoperitonium with no definite injuries, followed by patients with splenic injuries, while differences in hospital stay in patients with hepatic injuries were not significant. All patients had access to follow-up information for three months after discharge. There were no infective or late hemorrhagic complications observed. Conclusion: Laparoscopic exploration was found to be most beneficial in patients with blunt abdominal trauma who had a CT scan that revealed haemoperitonium but no organ injuries., and to less extent in cases with splenic injuries, while there was no significant data favoring (LE) on conservative treatment in patients with hepatic injuries.

Early surgery versus conservative treatment in patients with traumatic intracerebral hematoma: a CENTER-TBI study

PurposeEvidence regarding the effect of surgery in traumatic intracerebral hematoma (t-ICH) is limited and relies on the STITCH(Trauma) trial. This study is aimed at comparing the effectiveness of early surgery to conservative treatment in patients with a t-ICH.MethodsIn a prospective cohort, we included patients with a large t-ICH (< 48 h of injury). Primary outcome was the Glasgow Outcome Scale Extended (GOSE) at 6 months, analyzed with multivariable proportional odds logistic regression. Subgroups included injury severity and isolated vs. non-isolated t-ICH.ResultsA total of 367 patients with a large t-ICH were included, of whom 160 received early surgery and 207 received conservative treatment. Patients receiving early surgery were younger (median age 54 vs. 58 years) and more severely injured (median Glasgow Coma Scale 7 vs. 10) compared to those treated conservatively. In the overall cohort, early surgery was not associated with better functional outcome (adjusted odds ratio (AOR) 1.1, (95% CI, 0.6–1.7)) compared to conservative treatment. Early surgery was associated with better outcome for patients with moderate TBI and isolated t-ICH (AOR 1.5 (95% CI, 1.1–2.0); P value for interaction 0.71, and AOR 1.8 (95% CI, 1.3–2.5); P value for interaction 0.004). Conversely, in mild TBI and those with a smaller t-ICH (< 33 cc), conservative treatment was associated with better outcome (AOR 0.6 (95% CI, 0.4–0.9); P value for interaction 0.71, and AOR 0.8 (95% CI, 0.5–1.0); P value for interaction 0.32).ConclusionsEarly surgery in t-ICH might benefit those with moderate TBI and isolated t-ICH, comparable with results of the STITCH(Trauma) trial.

Shoulder &amp; Elbow

The August 2023 Shoulder &amp; Elbow Roundup360 looks at: Motor control or strengthening exercises for rotator cuff-related shoulder pain? A multi-arm randomized controlled trial; Does the choice of antibiotic prophylaxis influence reoperation rate in primary shoulder arthroplasty?; Common shoulder injuries in sport: grading the evidence; The use of medial support screw was associated with axillary nerve injury after plate fixation of proximal humeral fracture using a minimally invasive deltoid-splitting approach; MRI predicts outcomes of conservative treatment in patients with lateral epicondylitis; Association between surgeon volume and patient outcomes after elective shoulder arthroplasty; Arthroscopic decompression of calcific tendinitis without cuff repair; Functional outcome after nonoperative management of minimally displaced greater tuberosity fractures and predictors of poorer patient experience.

Implementing lifestyle-related treatment modalities in osteoarthritis care: Identification of implementation strategies using the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change matching tool.

Despite recommendations in international clinical guidelines, lifestyle-related treatment modalities (LRTMs) are currently underutilised in the conservative treatment of patients with hip and/or knee osteoarthritis. This study aimed to identify implementation strategies in order to address barriers to implementing LRTMs from the perspective of healthcare professionals (HCPs). The Consolidated Framework for Implementation Research (CFIR)-Expert Recommendations for Implementing Change (ERIC) Implementation Strategy Matching Tool was applied. First, previously identified influencing factors among primary and secondary HCPs were mapped onto the corresponding CFIR constructs/subconstructs by two researchers. Second, the CFIR-based barriers relevant for all HCPs were entered into the tool. Third, the CFIR-based barriers specific to one or more subgroups of HCPs served as additional input for the tool. Finally, a selection of ERIC implementation strategies was made based on the tool's output. Fourteen implementation strategies were selected. The strategy most endorsed by the tool was 'build a coalition'. Eight of the selected strategies belonged to the ERIC cluster 'develop stakeholder interrelationships'. Other strategies were part of the clusters 'use evaluative and iterative strategies' (n=3), 'utilise financial strategies' (n=2), and 'engage consumers' (n=1). The findings emphasise the importance of an interdisciplinary approach when addressing the implementation of LRTMs in osteoarthritis care. The final selection of implementation strategies forms the basis for a tailored implementation plan. Future work should focus on further operationalising the implementation strategies and evaluating the effectiveness of the resulting implementation plan.