Functional Outcome In Patients Research Articles

General versus Brachial Plexus Block Anesthesia in Pain Management after Internal Fixation in Patients with Distal Radius Fracture: A Randomized Controlled Trial.

Distal radius fractures (DRFs) are very common injuries associated with aging, and the number of fractures is increasing with the increase in the elderly population. General anesthesia or brachial plexus block (BPB) is required for fracture fixation, and acute postoperative pain control is necessary after operation. Early pain control can improve patient satisfaction and functional outcomes. In this study, we report the clinical differences in postoperative pain, according to the method of anesthesia (general anesthesia versus brachial plexus block). Volar plating was used to treat 72 patients older than 60 years who had comminuted DRF. Patients were randomized to either group A (36 patients), who underwent general anesthesia, or group B (36 patients), who underwent BPB. We compared these two groups prospectively for acute postoperative pain using a visual analog scale (VAS) at 2, 4, 6, 12, and 24 h after surgery. The VAS scores of each group were: 6.8 ± 2.5 in general anesthesia and 0.5 ± 2.3 in BPB at 2 h, postoperatively; 6.5 ± 2.4 in general anesthesia and 0.5 ± 2.4 in BPB anesthesia at 4 h, postoperatively; 5.2 ± 2.4 in general anesthesia and 1.5 ± 2.4 in BPB anesthesia at 6 h, postoperatively; 4.5 ± 2.5 in general anesthesia and 3.4 ± 2.7 in BPB anesthesia at 12 h, postoperatively; and 3.5 ± 2.5 in general anesthesia and 3.2 ± 2.7 in BPB anesthesia at 24 h, postoperatively. DRF patients with BPB anesthesia showed a lower VAS score than those subjected to general anesthesia in early postoperative period. As a result, the effect of BPB anesthesia on acute pain management after surgery was excellent, which resulted in a lower pain score compared with general anesthesia in DRF patients undergoing volar plating.

Autologous stem cell transplantation improves cardiopulmonary exercise testing outcomes in systemic sclerosis patients.

Autologous haematopoietic stem cell transplantation (AHSCT) is a disease-modifying treatment for patients with severe SSc. Here, we aimed at assessing cardiopulmonary function outcomes of SSc patients after AHSCT. Twenty-seven SSc adult patients treated with AHSCT were included in this retrospective study. Most had the diffuse cutaneous subset (93%) and pulmonary involvement (85%). Before and 12 months after AHSCT, patients underwent cardiopulmonary exercise testing, transthoracic echocardiography, pulmonary function test with diffusing capacity for carbon monoxide (DLCO), 6-min walk test (6MWT) and quality of life evaluations. After AHSCT, the peak VO2 increased from 954 to 1029 ml/min (P = 0.02), the percentage of predicted peak VO2 increased from 48.9 to 53.5 m (P = 0.01), and the distance measured by the 6MWT increased from 445 to 502 m (P = 0.01), compared with baseline. Improvements in peak VO2 correlated positively with improvements in 6MWT distance, and negatively with a decrease in resting heart rate. At baseline, patients with DLCO >70% had higher peak VO2 values than those with DLCO <70% (P = 0.04), but after AHSCT all patients showed improved VO2 values, regardless of baseline DLCO levels. Increases in VO2 levels after AHSCT positively correlated with increases in the physical component scores of the Short Form-36 quality of life questionnaire (r = 0.70; P = 0.0003). AHSCT improves the aerobic capacity of SSc patients probably reflecting combined increments in lungs, skeletal muscle and cardiac function.

Characterization of primary fibular bone tumors and post-surgical clinical and functional outcomes.

Objectives In this study, we present the characterization of tumors located in the fibula, which is a rare site for tumors, and the clinical and functional results of patients with fibular tumors that we operated in our clinic.Patients and methods Between February 2008 and December 2018, a total of 104 patients (58 males, 46 females; mean age: 26±18 years; range, 3 to 78 years) who were operated for tumor located in the fibula were retrospectively analyzed. Demographic data, histopathological diagnosis, tumor localization, surgical method and postoperative complications, metastases, follow-up time, and functional results of the patients were recorded. The fibula was divided into three groups as proximal, diaphysis and distal one-third.Results The mean follow-up was 56±25.3 (range, 24 to 108) months. Eighty (76.9%), seven (6.7%) and 17 (16.3%) patients were located proximal, diaphysis and distal to the fibula, respectively. The number of patients with malignant tumors located in the fibula was 26 (25%), the tumor was benign in 54 (51.9%) patients and 24 (23%) tumors were borderline. The most common tumor localized to the fibula was osteochondroma with 28 (26.9%) patients. The most common malignant tumors located in the fibula were Ewing sarcoma and osteosarcoma in 11 patients each. The most common surgical method was curettage in 44 (42.3%) patients. Distant organ metastases were present in 18 (17.3%) patients. The Musculoskeleteal Tumor Society score of 17 patients who underwent resection of the proximal fibula were 87%.Conclusion Fibula is a rare location for tumors and fibula tumors tend to be located more proximal. Tumors located in the fibula have good functional outcomes after surgery.

Arthrodesis for Carpometacarpal Joint Arthritis: A Systematic Review.

This study reviews the patient demographics, functional outcomes, and complications of trapeziometacarpal arthrodesis as a treatment for arthritis of the first carpometacarpal joint. A literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed and Google Scholar. Articles located by the search were independently assessed by title, abstract, or full article review for inclusion or exclusion. Demographic, outcome, and complication data from included articles were extracted, compiled, and analyzed. Frequency-weighted means and proportions were generated. In total, 21 articles met inclusion and exclusion criteria accounting for 802 patients and 914 thumbs. Average age at time of surgery was 55.4 years, and mean follow-up time was 72.7 months. Arthrodesis techniques include Kirschner-wire fixation (51.3%), plate fixation (24.6%), screw fixation (9.8%), tension band technique (7.1%), staple fixation (7.0%), and none (<0.1%). Mean preoperative Disabilities of the Arm, Shoulder and Hand score was 58 and 25.4 postoperatively (∆ = -32.6 points). Mean preoperative visual analogue scale score was 6.8 and 1.9 postoperatively (∆ = -4.9 points). Mean preoperative grip strength was 15.7 kg, and 23.0 kg postoperatively (∆ = +7.3 kg). In all, 48.7% of thumbs had complications, 15.1% of which were major, while 33.6% were minor. The most common major complication was symptomatic hardware (8.6%) requiring return to the operating room, and the most common minor complications were peritrapezial arthritis (8.5%) and nonunion (8.4%). Arthrodesis for arthritis of the trapeziometacarpal joint is associated with good functional outcomes and low to moderate patient-reported disability and pain scores, but a high complication rate. IV.

Across the Myeloablative Spectrum: Hematopoietic Cell Transplant Conditioning Regimens for Pediatric Patients with Sickle Cell Disease.

One out of every five hundred African American children in the United States has sickle cell disease (SCD). While multiple disease-modifying therapies are available, hematopoietic cell transplantation (HCT) remains the only curative option for children with SCD. HLA-matched sibling HCT has demonstrated excellent efficacy, but its availability remains limited; alternative donor strategies are increasingly explored. While Busulfan-Cyclophosphamide has become the most widespread conditioning regimen employed in HCT for pediatric SCD, many other regimens have been examined. This review explores different conditioning regimens across the intensity spectrum: from myeloablative to non-myeloablative. We describe survival and organ function outcomes in pediatric SCD patients who have received HCT and discuss the strengths and weaknesses of the various conditioning intensities. Finally, we posit novel directions in allogeneic HCT for SCD.

MRI whole-lesion texture analysis on ADC maps for the prognostic assessment of ischemic stroke

BackgroundThis study aims is to explore whether it is feasible to use magnetic resonance texture analysis (MRTA) in order to distinguish favorable from unfavorable function outcomes and determine the prognostic factors associated with favorable outcomes of stroke.MethodsThe retrospective study included 103 consecutive patients who confirmed unilateral anterior circulation subacute ischemic stroke by computed tomography angiography between January 2018 and September 2019. Patients were divided into favorable outcome (modified Rankin scale, mRS ≤ 2) and unfavorable outcome (mRS > 2) groups according to mRS scores at day 90. Two radiologists manually segmented the infarction lesions based on diffusion-weighted imaging and transferred the images to corresponding apparent diffusion coefficient (ADC) maps in order to extract texture features. The prediction models including clinical characteristics and texture features were built using multiple logistic regression. A univariate analysis was conducted to assess the performance of the mean ADC value of the infarction lesion. A Delong’s test was used to compare the predictive performance of models through the receiver operating characteristic curve.ResultsThe mean ADC performance was moderate [AUC = 0.60, 95% confidence interval (CI) 0.49–0.71]. The texture feature model of the ADC map (tADC), contained seven texture features, and presented good prediction performance (AUC = 0.83, 95%CI 0.75–0.91). The energy obtained after wavelet transform, and the kurtosis and skewness obtained after Laplacian of Gaussian transformation were identified as independent prognostic factors for the favorable stroke outcomes. In addition, the combination of the tADC model and clinical characteristics (hypertension, diabetes mellitus, smoking, and atrial fibrillation) exhibited a subtly better performance (AUC = 0.86, 95%CI 0.79–0.93; P > 0.05, Delong’s).ConclusionThe models based on MRTA on ADC maps are useful to evaluate the clinical function outcomes in patients with unilateral anterior circulation ischemic stroke. Energy obtained after wavelet transform, kurtosis obtained after Laplacian of Gaussian transform, and skewness obtained after Laplacian of Gaussian transform were identified as independent prognostic factors for favorable stroke outcomes.

Comparison of postoperative functional results in holmium laser enucleation of the prostate, green laser photovaporization of the prostate and transurethral resection of the prostate in the treatment of obstructive prostatic hyperplasia

Objective: To compare the functional results in patients undergoing transurethral resection of the prostate (TURP), photovaporization of the prostate with GreenLight ® laser (FTV) and prostate enucleation with Holmium laser (HOLEP), for the treatment of benign prostatic obstruction at the Central Military Hospital. Material and methods: The international index of prostate symptomatology questionnaire (IPSS), Uroflowmetry (Qmax), pre and post void ultrasonography (PVR) were applied to patients undergoing TURP, VTF and HOLEP pre and postoperatory from January 2018 to March 2019. Shapiro-Wilks tests were analyzed for quantitative variables; parametric behavioral data were analyzed with ANOVA tests, and non-parametric data were analyzed with Mann-Whitney and Kruskal-Wallis U tests. GraphPad PRISM v7.0 statistical package was used. Results: 46 patients underwent to TURP, 62 to HOLEP and 17 to VFT were evaluated, removing those who did not achieve complete postoperative follow-up; describing the demographic characteristics, the most frequent comorbidities and the parameters evaluated preoperatively. At follow-up, HOLEP was slightly better than FTV or TURP; without finding statistical significance between the groups, observing an important improvement in the reference values of IPSS, Qmax and PVR after surgery in all populations. Conclusions: No superiority of any technique was proven in short-term postoperative functional results, so we propose to perform long-term studies, considering adding trans and postoperative parameters in order to demonstrate superiority of these techniques.

Early Results of Cementless Hip Joint Arthroplasty with the Straight Zweymller Stem.

Total cementless hip joint arthroplasty is a method commonly used in the treatment of advanced hip osteoarthritis. The aim of this paper is to present the early results of hip joint arthroplasty with the straight Zweymller stem. The study enrolled 117 patients (64 women and 53 men) who underwent a total of 123 hip joint arthroplasties with the straight Zweymller stem. The mean age of the patients at surgery was 60.8 years (range: 26-81 years). The mean follow-up period was 7.7 years (range: 5-12.6 years). Pre-operative Merle dAubigne-Postel scores (modified by Charnley) of the study group were poor in all patients. Mean post-operative improvement was 6.3 points. The outcomes were classified as excellent in 42 cases (34.15%), good in 56 cases (45.53%), satisfactory in 14 (11.38%) and poor in 11 cases. Poor results were always associated with implant loosening. Heterotopic ossification was noted in 8 cases (6.5%). According to the Kaplan-Meier estimator, 5-year survival probability was 91.1% for the whole implant and 95.1% for the stem alone. 1. Our follow-up data (from a mean follow-up period of more than 7 years) indicate that the straight Zweymller stem affords excellent clinical and functional results in patients operated on for advanced hip osteoarthritis. 2. In patients correctly qualified for this procedure, with good surgical technique and in the absence of complications, the risk of aseptic loosening is minimal. 3. As only medium-term follow-up data are available, there may be more cases of loosening (mainly of the acetabular cup) over time, indicating a need of regular long-term follow-up.

Treatment of displaced intra-articular calcaneal fractures: A single-center experience study with 20 years follow-up

IntroductionThis study was conducted to identify the patient characteristics, classification, treatment, complications, and functional outcomes of operatively treated displaced intra-articular calcaneal fractures (DIACFs) in a level-I trauma center over a 20-year period. MethodsPatients with a DIACF classified as Sanders ≥2 and operatively treated with percutaneous reduction and screw fixation (PSF) or open reduction and internal fixation (ORIF) between 1998 and 2017 were identified. Pre- and postoperative radiological assessments were performed. Functional outcomes were evaluated using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the Maryland Foot Score (MFS). General health and patient satisfaction were assessed using the Short Form-36 Health Survey (SF-36) and the visual analog scale (VAS). ResultsIn total, 120 patients with a DIACF that were operatively treated with PSF or ORIF. Of these patients, 72 with a total of 80 DIACFs completed the questionnaires (60%). The average follow-up was 130 months. Mean scores for PSF and ORIF were 74 and 75 for AOFAS, 78 and 78 for MFS, 68 and 61 for SF–36, and 7.7 and 7.5 for VAS, respectively. An infection was the most common complication associated with ORIF (31%), and hardware removal (58%) was the most common complication in patients treated with PSF. Overall, 36 patients (68%) were able to return to work after a median time 6 months (IQR, 3–7) and 6 months (IQR, 3,25–6,75) for PSF and ORIF treated, respectively ConclusionThis long-term follow-up study reviews ORIF using ELA and PSF in the treatment of DIACFs. This study shows that both treatments are capable of restoring the Böhler angle and yield relatively good long-term functional outcomes. Differences in complication rates were apparent, infectious problems are inherent to ORIF using ELA, and hardware removal is associated with PSF.

Comparison of Enterprise stent 2 with 1 in assisting coiling of ruptured aneurysms: a real-world study.

Aim: To investigate the effectiveness and safety of the Enterprise 2 (E2) stent versus the Enterprise 1 (E1) stent in treating ruptured intracranial aneurysms (RIAs) in China. Materials & methods: The authors conducted an electronic medical record analysis for patients with RIAs who underwent E1/E2 deployment. The main outcomes were immediate complete occlusion (ICO), patient functional outcomes, complications and aneurysm recurrence. Results: Stent deployment was successful in all patients (E2: 90; E1: 270). ICO and patients with good functional outcomes at discharge were similar between E2 and E1 (80.0% vs 75.1% and 78.7% vs 81.1%, respectively). The E2 group had a significantly lower complication rate compared with the E1 group (7.8% vs 16.4%; odds ratio: 0.36; 95% CI: 0.15-0.91; p=0.031). By 6 months post-discharge, the two groups had comparable patient functional outcomes and aneurysm recurrence (E2 vs E1: 80.2% vs 81.9% and 13.3% vs 14.9%). Conclusion: Compared with the E1 stent, the E2 stent had similar effectiveness but a lower complication risk in treating RIAs.

The results of treatment of patients with tandem occlusions in the acute period of ischemic stroke

Objective – to evaluate the efficacy and safety of endovascular treatment in patients with acute ischemic stroke due to tandem occlusions.Materials and methods. The results of the examination and treatment of 237 patients with acute ischemic stroke due to large vessel occlusion who underwent endovascular reperfusion were analyzed. Tandem occlusions (internal carotid ‒ middle cerebral artery) were diagnosed in 65 (27.4 %) cases. Patient age ranged from 29 to 84 years (mean age ‒ 64.8 years). Men predominated among the patients (46 (70.8 %)). Among patients with ischemic stroke due to tandem occlusion, 29 (44.6 %) were diagnosed with atherothrombotic stroke subtype, 27 (41.5 %) had cardioembolic. In 9 (13.9 %) cases the cause of thrombosis was spontaneous dissection of the wall of the internal carotid artery. To assess collateral blood flow, the ACG scale proposed by the American Society for Interventional and Therapeutic Radiology was used. The quality of reperfusion was assessed using the eTICI scale. Analysis of the functional results of patients after 90 days from the onset of the disease was carried out according to the modified Rankine scale (mSR).Results. According to our study, a good angiographic result (eTICI 2b-3) was achieved in 54 (83.1 %) patients. Intraoperative complications were registered in 8 (12.3 %) cases. An analysis of the dependence of the quality of reperfusion on the severity of collateral compensation of a thrombosed artery showed that in patients with developed (ACG 3-4) collaterals (35 (53.8 %)) good reperfusion was achieved in 33 (94.3 %) cases, in patients with mild (ACG 0-2) collateral compensation (30 (46.2 %)) the quality of eTICI 2b-3 reperfusion was achieved only in 21 (70.0 %) cases. It was found that out of 40 (61.5 %) patients with tandem occlusion, in whom arterial puncture was performed within 6 hours after the onset of neurological symptoms, 15 (37.5 %) had 0-2 points for mSR after 90 days. When puncturing the artery later than 6 hours (25 (38.5 %) cases), a good result after 90 days was registered only in 7 (28.0 %) patients. Analysis of the influence of collaterals on the dynamics of changes according to multislice computed tomography revealed that patients with well-defined collaterals (35 (53.8 %) cases) during the control examination had ASPECTS scores from 1 to 9 points (average ‒ 5.3 points). Patients with mild collaterals (30 (46.2 %) observations)) on the ASPECTS scale during the control examination had from 0 to 6 points (average ‒ 2.2 points). During the first day or at the time of discharge, a statistically significant decrease in neurological deficit was observed in the group with successful restoration of cerebral blood flow findings.Conclusions. Many factors influence the clinical efficacy of endovascular reperfusion techniques: hypoperfusion area and area of brain damage according to computed tomography during hospitalization, quality of endovascular reperfusion, time from the onset of the disease, collateral compensation of the thrombosed artery basin, complications during surgery. Well-defined collaterals are a predictor of positive dynamics after successful endovascular reperfusion.

Impact of dysphagia and its severity on long-term survival and swallowing function outcomes in patients with idiopathic inflammatory myopathies other than inclusion body myositis.

To investigate the impact of dysphagia on long-term survival and swallowing function outcomes in patients with idiopathic inflammatory myopathy other than inclusion body myositis. We retrospectively evaluated consecutive patients with idiopathic inflammatory myopathy other than inclusion body myositis to investigate the impact of dysphagia and its severity assessed using the Food Intake LEVEL Scale on survival and swallowing function outcomes. Time-to-event analyses were used, including Kaplan-Meier curves with log-rank (trend) test, cumulative incidence with Gray's test, and Cox proportional hazards models. Of the 254 patients, 26 were dysphagic, including eight severe (Food Intake LEVEL Scale [FILS] score 2, 3) and six most severe (FILS score 1) cases; 210 were non-dysphagic, and 18 were indeterminate cases. During the 5 years after myositis diagnosis, 15 (57.7%) dysphagic and 31 (14.8%) non-dysphagic patients died, and dysphagic patients had significantly shorter survival. However, multivariate analysis showed that shorter survival was significantly associated with baseline age-adjusted Charlson Comorbidity Index (hazard ratio [HR] 1.57, 95% confidence interval [CI] 1.36-1.82]), but not with dysphagia (HR 1.46, 95% CI 0.69-3.10). Dysphagia severity was significantly associated with delayed recovery of dysphagia. In 20 non-severe or severe dysphagic cases, 19 restored swallowing function within 1 year. The most severe cases had a significantly higher cumulative probability of death before recovery from dysphagia than severe cases. The poor survival of dysphagic myositis patients was largely confounded by advanced age and comorbid malignancies. However, patients with the most severe dysphagia had a significantly worse swallowing function and survival prognosis than those with milder dysphagia.

Generalized joint hypermobility does not influence 1-year patient satisfaction or functional outcome after ACL reconstruction

PurposeThe purpose of this study was to evaluate whether generalized joint hypermobility (GJH) influences postoperative results, including return to sport, patientreported outcomes, functional performance (hop tests), muscular strength, and the occurrence of ACL re-injury, in patients 1 year after anterior cruciate ligament (ACL) reconstruction.MethodsData was extracted from a regional rehabilitation-specific registry containing information on patients with ACL injury. Patients between the ages of 16–50 years previously undergoing ACL reconstruction with available 1 year follow-up data were eligible for inclusion. Generalized joint hypermobility was assessed using the Beighton score (BS). Patients were examined one year postoperatively in terms of return to sport, patient-reported outcome, hop tests, muscular strength and the occurrence of reinjury. For purpose of analysis, patients were allocated into two groups, depending on the existence of GJH. The KOOS subscale of sports and recreation was considered the primary outcome. Analyses were performed both dichotomously and by using adjusted logistic regression, to consider potential confounders.ResultsA total of 356 patients (41% males) were included, of which 76 (24% male) were categorized as having GJH. Patients with GJH had an inferior limb symmetry index preoperatively in terms of knee extension (mean 81.6 [SD 16.4] vs. 91.4 [SD 15.9], p = 0.02) and flexion strength (mean 91.9 vs. 99.1, p = 0.047) compared to patients without GJH. There was no difference between the groups in terms of the primary outcome, nor in any of the other postoperative outcomes. Nine patients (11.8%) in the group with GJH suffered ACL re-injury, compared with 13 patients (4.6%) in the control group (n.s.).ConclusionOne year after ACL reconstruction the existence of GJH did not affect postoperative patient satisfaction, strength or functional outcome. No conclusive statements can be made regarding the influence of GJH on the risk of ACL re-injury in this particular study.Level of evidenceLevel II.

Клинические случаи факоэмульсификации катаракты у пациентов с крайними степенями аметропий

Purpose. To evaluate the features of the phacoemulsification technique with IOL implantation and clinical and functional results in patients with extreme eyeball length. Material and methods. There were 2 patients under observation: a 70-year-old patient with a diagnosis of OU: Complicated cataract. High myopia. Amblyopia moderate. Primary open-angle glaucoma 2A. Visual acuity at admission vis OD = 0.001 n.c.; vis OS = 0.04 sph +2.00 D cyl –2.50 D ax 105° = 0.1. The second patient, aged 65, was diagnosed with OU: Complicated cataract. Hyperopia of a high degree. Amblyopia moderate. Primary open-angle glaucoma 1A, operated. Visual acuity at admission OD = 0.01 sph +11.00 D cyl +1.50 D ax 110° = 0.2; OS = 0.01 sph +11.00 D cyl +1.00 D ax 105 = 0.1. Both patients underwent phacoemulsification with Asphina IOL implantation (Carl Zeiss Meditec AG, Germany): the right eye of patient N 1 and the left eye of patient N 2. Results. A month after the operation, the uncorrected visual acuity in the first patient was Vis OD = 0.15. In the second patient, a month after the operation, visual acuity was Vis OS = 0.04 sph (+) 11.0 D = 0.2. Both patients are subjectively satisfied with the obtained visual functions. Conclusion. Thus, this clinical case demonstrates a very successful implementation of cataract phacoemulsification with IOL implantation in patients with extreme eyeball length. Keywords: microphthalmos, high myopia, high degree ametropia, complicated cataract, cataract phacoemulsification.

Minimally Invasive Reconstruction of the Medial Collateral Ligament of the Knee.

This study describes a minimally invasive technique for the reconstruction of the medial collateral ligament (MCL) and posterior oblique ligament (POL) through minimal incisions on the tibial and femoral sides of the ligament using the modified Bosworth technique. This study included 19 consecutive patients who presented with chronic grade III injury; the mean age was 29.6 years (standard deviation ± 7.5 years, range 19-43 years), and five patients (26.3%) had no associated injuries. Ten patients (52.6%) had associated anterior cruciate ligament (ACL) injury and four patients (21.1%) had associated posterior cruciate ligament (PCL) injury. All patients were assessed 18 months postoperatively regarding functional outcome using the Lysholm score and medial joint space opening. There was a statistically significant improvement in the patient functional outcome as the Lysholm score improved from 55.39 ± 6.9 to 89.42 ± 6.4 at 18 months postoperatively. (P< 0.001). At the end of the follow-up, 16 cases had grade 1 medial laxity, 3 cases with grade II laxity, and no patients with grade III medial laxity. Minimally invasive MCL reconstruction with modified Bosworth technique gives very good results regarding the functional outcome and residual medial laxity of the knee.

A Prospective Study Comparing the Efficacy of Local Injection of Platelet-Rich Plasma (PRP) vs Methylprednisolone in Plantar Fasciitis

IntroductionPlantar fasciitis is a common musculoskeletal problem in Orthopaedic practice. Heel pain caused due to plantar fasciitis, if persistent, can cause distress to the patient, so the correct intervention at the right time is needed. Plantar fasciitis is also common in the rural population.ObjectivesTo compare the efficacy of local injection of platelet-rich plasma (PRP) and corticosteroid (CS) (methylprednisolone) in patients with chronic plantar fasciitis, and to evaluate the safety, side effect and complications of two different modalities of treatment.Materials and methodsThe study period was between August 2018 and September 2020. After obtaining proper written consent, 110 patients, who were above the age of 18 years and suffering from plantar fasciitis for more than three months, were included in the study. The patient characteristics including gender, age, weight, history of heel pain, duration of symptoms and types of prior treatment were noted. All the 110 patients were subjected to four parameter assessments before administration of the PRP/CS injections. Out of the 110 patients, 55 patients received PRP injection and 55 received CS - 2 ml (40 mg) methylprednisolone with 2 ml of sterile water injections. Post administration of injections, the patients' clinical, radiological, subjective and functional outcomes were assessed at the first, third and sixth month by using the Visual Analog Scale (VAS), Foot and Ankle Outcome Instrument Core Scale (FAI), Roles and Maudsley Scores (RMS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale and ultrasonogram of plantar fascia thickness.DiscussionIn this study, 110 patients were screened and evaluated. Out of these 110 patients, five patients who received PRP and five who received CS were lost for follow-up. Out of the 110 patients, 59 were females and 41 were males. The majority of the patients were in the BMI range of 18.5 to 24.9, with a mean BMI of 23.6. Comparing the results in both the groups reflected an improvement in the group of patients who received PRP injections. Two patients had post-operative complications (superficial infection) in the PRP injection group, while 10 patients had post-procedure complications (five patients developed superficial infections, three patients developed skin depigmentation, and two patients had atrophy of fat pad) in the corticosteroid injections (CSI) group. Infections subsided in all the patients as observed during subsequent follow-up.ConclusionThis study shows that PRP administration is a good method of managing patients suffering from chronic plantar fasciitis, presenting with some discomfort following activity, with more than three months of symptoms and with a VAS score of more than 6 and plantar fascia thickness of 5 mm and failed conservative management. This is evidenced by a comparison of AOFAS, FAI score and thickness of plantar fascia using an ultrasonogram before and after the procedure. This study reflects better treatment outcomes with PRP injection compared to local steroid infiltration. This is the largest series of cases studied compared to other previously available studies in the literature. PRP injections may thus be used as a superior alternative to the already available treatments for chronic heel pain.

Efficacy and Safety of Triiodothyronine Treatment in Cardiac Surgery or Cardiovascular Diseases: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: Low levels of the active thyroid hormone triiodothyronine (T3) in cardiac patients are associated with worse outcomes. The aim of this analysis was to assess if T3 treatment is beneficial and safe in patients undergoing cardiac surgery or those with cardiovascular diseases in whom there is observed or expected reduction in serum T3 levels. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed as per the PRISMA guidelines. Pubmed, EMBASE, and Web of Science databases were searched for RCTs published between January 1, 1960 and March 30, 2022 that evaluated the effects of T3 therapy in patients undergoing cardiac surgery or with cardiovascular diseases. The primary outcomes were measures of cardiac function. Weighted mean difference (MD) or relative risk was calculated using a random effects model. PROSPERO registration number CRD42020211966. Results: Of the 3181 full-text articles screened, 34 studies with 2547 participants (number ranging between 13 and 223, mean ages between 0.5 and 73 years, mean percentage of women between 7% and 64%) were included. In 12 RCTs with 1093 adults undergoing cardiac surgery T3 therapy was associated with improvement in cardiac index (MD [95% confidence interval], 0.24 [0.08 to 0.40] L/min/m2, I2 = 74%). The quality of evidence was high to moderate. In 3 RCTs with 188 children undergoing cardiac surgery, 3 RCTs with 131 adult cardiac donors, 3 RCTs with 83 adult patients with heart failure, and 2 RCTs with 89 adults with acute myocardial infarction, T3 therapy did not improve cardiac index or left ventricular function; the quality of evidence ranged from high (pediatric cardiac surgery) to low (other groups). No detrimental effect of T3 therapy was observed on heart rate, risk of in-hospital atrial fibrillation, or mortality. Conclusions: Short-term T3 therapy is safe and trials in adults undergoing cardiac surgical procedures to evaluate longer term clinical endpoints are required. Current data do not support the routine use of T3 therapy in children undergoing cardiac surgery or in cardiac donors. Adequately designed trials are required to determine if T3 therapy improves cardiac function and clinical outcomes in patients with heart failure or acute myocardial infarction.

Penetrating spinal cord injury: a systematic review and meta-analysis of clinical features and treatment outcomes.

To systematically review the literature on penetrating spinal cord injury (PSCI) and evaluate current management strategies, their impact on patient functional outcomes, and treatment complications. PubMed, Scopus, and Cochrane were searched based on the Preferred Reporting Items for Systematic-Reviews and Meta-Analyses (PRISMA) guidelines to include studies on penetrating spinal cord injury (PSCI). We included 10 articles comprising 1754 cases of PSCI. Mean age was 19.2 years (range, 16-70), and most patients were male (89.9%). Missile spinal cord injury (MSCI) was the most common type, affecting 1623 patients (92.6%), while non-missile spinal cord injury (NMSCI) accounted for only 131 cases (7.4%). Gunshots were the most common cause of MSCI, representing 87.2%, while knife stabs were the most common cause of NMSCI, representing 72.5%. A total of 425 patients (28.0%) underwent surgical intervention, and 1094 (72.0%) underwent conservative management. The conservative group had a higher rate of complete spine cord injury compared with the surgical group (61.5% vs. 49.2; p < 0.001). Although surgery yielded a higher score improvement rate compared with the conservative management (41.5% vs. 20.5%, p < 0.001), neither treatment strategy displayed superiority in improving neurological outcomes for neither complete SCIs (OR:0.7, 95% CI, 0.3-1.64; I2 = 44%, p = 0.13) nor for incomplete SCIs (OR:1.15, 95% CI, 0.64-2,06; I2 = 40%, p = 0.12). Surgical and conservative management strategies proved to be equally effective on PSCI, irrespective of injury severity. Therefore, tailored treatment strategies for each patient and careful surgical selection is advised.

Severe functional impairment increases the risk of major morbidity and mortality in older patients after digestive tract surgery: a retrospective cohort study.

The relationship between the severity of impairment in basic activities of daily living (ADLs) function and postoperative outcomes in older surgical patients remains unclear. This study aimed to clarify the association between the severity of preoperative functional impairment and the composite postoperative outcome of major morbidity and mortality in older patients undergoing digestive tract surgery. This was a retrospective cohort study. We collected perioperative data of older patients (age ≥ 65years) who underwent digestive tract surgery in our institution. The severity of functional impairment was assessed using the Barthel Index scale before surgery. The major morbidity and mortality were defined as Clavien-Dindo grade III or greater postoperative complications during hospital stay. The association between the severity of functional impairment and the major morbidity and mortality was assessed using a multivariable logistic regression model. 131 of 1076 patients (12.2%) developed major morbidity and mortality. After controlling for confounding factors, high Barthel Index scores were correlated with decreased risk of major morbidity and mortality (OR 0.986, 95% CI 0.976-0.997, P = 0.011); preoperative severe (OR 2.862, 95% CI 1.172-6.989, P = 0.021), but not mild or moderate (OR 1.019, 95% CI 0.602-1.726, P = 0.943) functional impairment was independently associated with an increased risk of major morbidity and mortality, when compared with independent functional status. Preoperative severe functional impairment in basic ADLs was independently associated with a higher risk of major postoperative morbidity and mortality in older patients undergoing digestive tract surgery.

The association between self-efficacy on function and pain outcomes among patients with chronic low back pain managed using the McKenzie approach: a prospective cohort study

ABSTRACT Introduction Self-efficacy is a determinant of function and pain outcomes in patients with chronic low back pain receiving physiotherapy. The McKenzie approach is an effective intervention for patients with back pain that may affect self-efficacy. Study aims were to determine if, among patients with back pain being managed by McKenzie-credentialed physiotherapists: intake self-efficacy is correlated with intake function and pain; intake self-efficacy is associated with changes in function and pain during treatment; self-efficacy improves during treatment; and improvements in self-efficacy during treatment are associated with improvements in function and pain at discharge. Methods Two-hundred-eighty-two subjects with chronic low back pain seen by McKenzie-credentialed clinicians provided data on self-efficacy, function and pain at intake and discharge. Results Self-efficacy was correlated with function and pain at intake; however, intake self-efficacy was not associated with function or pain outcomes. Self-efficacy increased during treatment. This increase was associated with improvements in function and pain at discharge. Conclusion While intake self-efficacy was associated with function and pain when initiating physiotherapy, it did not result in improved treatment outcomes. Specific interventions may be necessary to improve self-efficacy. The increases in self-efficacy observed during treatment were associated with improvements in function and pain outcomes at discharge.