Pathological Weight Loss Research Articles

Anti-obesity Drugs for the Treatment of Binge Eating Disorder: Opportunities and Challenges.

Binge eating disorder (BED) is the most prevalent form of disordered eating, frequently associated with obesity. Both these conditions along with sharing overeating behaviour features can lead to substantial burden of disease and premature mortality. With limited specific evidence available on pharmacotherapy, since lisdexamfetamine is approved only in some countries, new drugs are urgently needed to provide physicians with efficacious prescribing choices when treating BED. Although unique mechanisms underlie psychopathological features of binge eating, including impulsivity, compulsivity, and emotional reactivity, anti-obesity drugs might represent an option for both weight management and symptom reduction in people with BED. The aim of this review is thus to provide a summary of available evidence on the efficacy of anti-obesity drugs for BED. After comprehensively searching for relevant studies in PubMed and the Cochrane Library, as well as for unpublished results in ClinicalTrials.gov, we included 14 clinical trials. Despite the limited sample size and the methodological variability, evidence from available studies suggests that most anti-obesity drugs, namely phentermine/topiramate, naltrexone/bupropion, liraglutide and semaglutide, though not orlistat, might variously achieve improvements for both body weight and severity and frequency of binge episodes. Findings from ongoing clinical trials are likely to provide further insight into the possible role of anti-obesity drugs for treating BED. Since these agents can hold the potential to be misused potentiating dietary restriction and pathological weight loss, it is crucial to promote responsible prescribing practices.

Risk Factors for Readmission Following Surgical Decompression for Spinal Epidural Abscesses: An Analysis of 4595 Patients.

Retrospective cohort study. The study aimed to (1) compare baseline demographics of patients undergoing surgery for SEA who were/were not readmitted; (2) identify risk factors for 90-day readmissions; and (3) quantify 90-day episode-of-care health care costs. Spinal epidural abscess (SEA), while rare, occurring ~2.5-5.1/10,000 admissions, may lead to permanent neurologic deficits and mortality. Definitive treatment often involves surgical intervention via decompression. A search of the PearlDiver database from 2010 to 2021 for patients undergoing decompression for SEA identified 4595 patients. Cohorts were identified through the International Classification of Disease, Ninth Revision (ICD-9), ICD-10, and Current Procedural Terminology codes. Baseline demographics of patients who were/were not readmitted within 90 days following decompression were aggregated/compared, identifying factors associated with readmission. Using Bonferroni correction, a P -value<0.001 was considered statistically significant. Readmission within 90 days of surgical decompression occurred in 36.1% (1659/4595) of patients. While age/gender were not associated with readmission rate, alcohol use disorder, arrhythmia, chronic kidney disease, ischemic heart disease, and obesity were associated with readmission. Readmission risk factors included fluid/electrolyte abnormalities, obesity, paralysis, tobacco use, and pathologic weight loss ( P <0.0001). Mean same-day total costs ($17,920 vs. $8204, P <0.001) and mean 90-day costs ($46,050 vs. $15,200, P <0.001) were significantly higher in the readmission group. A substantial proportion of patients (36.1%) are readmitted within 90 days following surgical decompression for SEA. The top 5 risk factors in descending order are fluid/electrolyte abnormalities, pathologic weight loss, tobacco use, pre-existing paralysis, and obesity. This study highlights areas for perioperative medical optimization that may reduce health care utilization.

Comparison of patient demographics and patient-specific risk factors for readmissions following open reduction and internal fixation for acetabular fractures.

Acetabular fractures are highly complex injuries often resulting from high-energy trauma. The gold standard treatment for these injuries has become open reduction internal fixation (ORIF). The purpose of this study is to further this understanding and investigate how (1) patient demographics and (2) patient-specific risk factors affect 90-day readmission rates. A retrospective, nationwide query of private insurance database from January 1st, 2010 to October 31st, 2020 was performed using ICD-9, ICD-10, and CPT codes. Patients who underwent acetabular ORIF and were readmitted within 90days following index procedure were included, patients who were not readmitted served as controls. Patients were divided by demographics and specific risk factors associated with readmission. The query yielded a total of 3942 patients. Age and sex were found to be non-significant contributing risk factors to 90-day readmissions. Data also showed that statistically significant comorbidities included arrhythmia, cerebrovascular disease, coagulopathy, fluid and electrolyte abnormalities, and pathologic weight loss. This study illustrated how several patient-specific risk factors may contribute to increased 90-day readmission risk following acetabular ORIF. A heightened awareness of these comorbidities in patients requiring acetabular ORIF is required to improve patient outcomes and minimize rates of readmission. Further investigation is needed to improve patient outcomes, and increase awareness of potential post-operative complications in these higher-risk patient populations.

The Impact of Nutritional Therapy in the Management of Overweight/Obese PCOS Patient Candidates for IVF.

Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder, and it has two main pathological aspects: reproductive and metabolic. Overweight/obesity is a risk factor in terms of adverse effects during hormone stimulation, a reduced response to ovulation induction regimens, reduced success of IVF, and an increased risk of obstetric complications. To resolve this vicious cycle of pathological events, weight loss and lifestyle modifications are promising strategies. Among these possible approaches, the consumption of a very-low-calorie ketogenic diet (VLCKD) or Mediterranean diet (MD) represents a valid option. In our study, 84 obese/overweight PCOS patients were recruited to evaluate the effects induced by the VLCKD and MD on weight, hormonal, and metabolic parameters. BMI decreased significantly among the VLKCD patients compared to the MD patients (both presenting p values < 0.0001 at 90 and 120 days), and a significant reduction in body circumference was observed. At the same time, HOMA index values statistically decreased for the VLCKD patients compared to those on the MD (p value < 0.001 at 90 days and p value < 0.05 at 120 days), and this phenomenon was also observed for AFC at 90 and 120 days (both p values < 0.001) and AMH at 90 days (p value < 0.05). Interestingly, the ovarian hyperstimulation syndrome (OHSS) incidence was statistically lower in the VLKCD patients compared to the MD patients (p < 0.001). We state that these dietary regimes may improve anthropometric parameters (such as BMI) and women's reproductive health, restore menstrual regularity, and reduce the risk of OHSS. Regarding the different nutritional therapies, the results suggest that the VLCKD is an optimal choice for entry into IVF, especially in terms of the time range in which these results are achieved.

Long-term aspirin administration suppresses inflammation in diabetic cystopathy.

Diabetic cystopathy (DCP) is one of the most common and troublesome urologic complications of diabetes mellitus, characterized by chronic low-grade inflammatory response. However, the correlation between inflammation and disease progression remains ambiguous and effective drugs interventions remain deficient. Herein, during 12-week study, 48 male Sprague-Dawley rats were randomly assigned to four groups: negative control (NC), NC treated with aspirin (NC+Aspirin), DCP, and DCP treated with aspirin (DCP+Aspirin). Type 1 diabetes mellitus was established by intraperitoneal injection of streptozotocin (65 mg/kg). After 2 weeks modeling, the rats in treatment groups received daily oral aspirin (100 mg/kg/d). After 10 weeks of treatment, aspirin ameliorated pathological weight loss and bladder weight increase in diabetic rats, accompanied by a 16.5% decrease in blood glucose concentrations. H&E, Masson, immunohistochemistry and transmission electron microscopy revealed that a dilated bladder with thickened detrusor smooth muscle (DSM) layer, inflammatory infiltration, fibrosis and ultrastructural damage were observed in diabetic rats, which were obviously ameliorated by aspirin. The dynamic investigations at 4, 7 and 10 weeks revealed inflammation gradually increased as the disease progresses. After 10 weeks of treatment, the expression of TNF-α, IL-1β, IL-6, and NF-κB has been decreased to 78%, 39.7%, 44.1%, 33.3% at mRNA level and 67.6%, 76.7%, 71.4%, 67.1% at protein level, respectively (DCP+Aspirin vs. DCP, p < 0.01). Aspirin partially restored the increased expression of inflammatory mediators in bladder DSM of diabetic rats. The study provided insight into long-term medication therapies, indicating that aspirin might serve as a potential strategy for DCP treatment.

Rapid, automated, and experimenter-free touchscreen testing reveals reciprocal interactions between cognitive flexibility and activity-based anorexia in female rats.

Anorexia nervosa has among the highest mortality rates of any psychiatric disorder and is characterized by cognitive inflexibility that persists after weight recovery and contributes to the chronic nature of the condition. What remains unknown is whether cognitive inflexibility predisposes individuals to anorexia nervosa, a question that is difficult to address in human studies. Our previous work using the most well-established animal model of anorexia nervosa, known as activity-based anorexia (ABA) identified a neurobiological link between cognitive inflexibility and susceptibility to pathological weight loss in female rats. However, testing flexible learning prior to exposure to ABA in the same animals has been thus far impossible due to the length of training required and the necessity of daily handling, which can itself influence the development of ABA. Here, we describe experiments that validate and optimize the first fully-automated and experimenter-free touchscreen cognitive testing system for rats and use this novel system to examine the reciprocal links between reversal learning (an assay of cognitive flexibility) and weight loss in the ABA model. First, we show substantially reduced testing time and increased throughput compared to conventional touchscreen testing methods because animals engage in test sessions at their own direction and can complete multiple sessions per day without experimenter involvement. We also show that, contrary to expectations, cognitive inflexibility measured by this reversal learning task does not predispose rats to pathological weight loss in ABA. Instead, rats that were predisposed to weight loss in ABA were more quickly able to learn this reversal task prior to ABA exposure. Intriguingly, we show reciprocal links between ABA exposure and cognitive flexibility, with ABA-exposed (but weight-recovered) rats performing much worse than ABA naïve rats on the reversal learning task, an impairment that did not occur to the same extent in rats exposed to food restriction conditions alone. On the other hand, animals that had been trained on reversal learning were better able to resist weight loss upon subsequent exposure to the ABA model. We also uncovered some stable behavioral differences between ABA susceptible versus resistant rats during touchscreen test sessions using machine learning tools that highlight possible predictors of anorectic phenotypes. These findings shed new light on the relationship between cognitive inflexibility and pathological weight loss and provide targets for future studies using the ABA model to investigate potential novel pharmacotherapies for anorexia nervosa.

Neonatal outcomes and long-term neurodevelopmental evaluations of hospitalized early term infants: prospective case-control study.

It was intended to compare early term babies to term babies by reviewing short-term issues and long-term neurodevelopmental evaluations. It was planned as a prospective case-control study. Of the 4263 infants admitted to the neonatal intensive care unit, 109 infants born at early term by elective cesarean section and hospitalized within the first 10 postnatal days were included in the study. As the control group, 109 babies born at term were enrolled. Nutrition status of infants, reasons for hospitalization in the first postnatal week were recorded. When the babies were 18-24 months old, an appointment was made for neurodevelopmental evaluation. In the early term group, the time of breastfeeding was later than the control group, with a statistically significant difference. Similarly, breastfeeding difficulty, need for formula in the first week postpartum and hospitalization were found to be significantly higher in the early term group. Considering the short-term results; pathological weight loss, hyperbilirubinemia requiring phototherapy and feeding difficulties were statistically significantly higher in the early term group. Neurodevelopmental delay did not statistically differ across the groups, but the early term group's MDI and PDI scores were found to be statistically lower than those of the term group. Early term infants are thought to be like term infants in many ways. Although these babies are similar to term babies, they are still physiologically immature. The short and long-term negative consequences of early term birth are obvious, non-medical elective early term births should be prevented.

Risk factors for the development of a peri-prosthetic joint infection up to 2 Years following primary reverse shoulder arthroplasty

BackgroundReverse shoulder arthroplasty (RSA) has become commonly used to treat glenohumeral osteoarthritis (GHOA), of which complications such as peri-prosthetic joint infections (PJIs) may develop. The objective of this study was to compare patient demographics of those who did and did not develop PJIs within 2 years after primary RSA for GHOA and identify risk factors for this sequela. MethodsA nationwide database was queried from 2005 to 2014 for Medicare patients treated with primary RSA (International Classification of Disease (ICD-9) procedural code 81.88) for GHOA. Patients who developed PJIs within 2-years of primary RSA defined the study group, whereas those who were devoid of infections represented the comparison group. Our study consisted of 51,824 patients, of which 879 (1.69%) developed a PJI. Patient demographics comprising the Elixhauser comorbidity index (ECI) were compared using Chi-Square analyses. Multivariable logistic regression models were used to compute the odds-ratios (OR) of patient-specific factors associated with acquiring a PJI within 2 years after RSA. P values less than 0.002 were significant. ResultsPatients developing a PJI had higher mean ECI (8 vs. 6; p < 0.0001). The greatest risk factors for developing PJIs within 2-years following RSA were male sex (OR: 2.10, 95%CI: 1.81–2.43, p < 0.0001), pathologic weight loss (OR: 1.78, 95%CI: 1.45–2.17, p < 0.0001), iron deficiency anemia (OR: 1.75, 95%CI: 1.49–2.06, p < 0.0001), morbid obesity (OR: 1.52, 95%CI: 1.21–1.88, p = 0.0001), rheumatoid arthritis (OR: 1.32, 95%CI: 1.13–1.54, p = 0.0003), arrhythmias (OR: 1.26, 95%CI 1.09–1.46, p = 0.001), and depressive disorders (OR: 1.23, 95%CI 1.06–1.43, p = 0.001). ConclusionsThe greatest risk factors for PJIs within 2 years of primary RSA included male sex; additional modifiable risk factors included iron deficiency anemia, pathologic weight loss, and obesity. Preoperative screening can help to identify modifiable risk factors and alter management for high-risk patients to potentially minimize PJIs.

Influence of early maternal separation on susceptibility to the activity-based anorexia model in male and female Sprague Dawley rats

A principal animal paradigm employed in Anorexia Nervosa (AN) study is the activity-based anorexia (ABA) model. The model's efficacy in recapitulating the core features of AN in humans allows for the study of the parameters involved in the disorder. The current study examined the susceptibility to the ABA protocol in the presence of a significant stressor (maternal separation) in male and female Sprague Dawley rats. More importantly, we analysed the sex-differences on activity levels during different periods of the ABA protocol to determine the period(s) influencing the most pathological weight loss. Both components of the ABA protocol contributed to the subjects’ bodyweight loss. Stress in the first two weeks of development conferred a protective effect in males. Time spent and activity levels on the running wheel were higher in females compared to males. Hyperactivity in ABA subjects was observed during the food-anticipatory activity (FAA) and postprandial activity in males and during the FAA and nocturnal activity periods in females. This study aids in understanding the effect of intensity of activity during specific periods on the pathological weight loss in ABA rats. These observations are informative for therapies aimed at ameliorating body mass index in AN patients.

Multi index evaluation method of pathological weight loss effect of aerobic exercise based on telemedicine monitoring

INTRODUCTION: Pathological obesity seriously endangers human health. OBJECTIVES: A multi index evaluation method of pathological weight loss effect of aerobic exercise based on telemedicine monitoring is proposed to evaluate the pathological weight loss effect of aerobic exercise by using telemedicine monitoring system. METHODS: According to the indexes of aerobic exercise affecting weight loss effect, a multi index evaluation system of pathological weight loss effect of aerobic exercise was established. The medical sensor of the telemedicine monitoring system is used to collect the index data in the multi index evaluation system of pathological obese personnel. The medical sensor uses the wireless node to transmit the collected data to the remote monitoring center. The evaluation module of the remote monitoring center uses the collected data and selects the fuzzy comprehensive evaluation method to evaluate the pathological weight loss effect of aerobic exercise. RESULTS: The experimental results show that this method can effectively use the telemedicine monitoring system to collect the physiological parameters of pathological obese people, and use the parameter collection results to evaluate the effect of aerobic exercise on pathological weight loss. CONCLUSION: The proposed methods can provide basis for human aerobic exercise pathological weight loss.

How Can Animal Models Inform the Understanding of Cognitive Inflexibility in Patients with Anorexia Nervosa?

Deficits in cognitive flexibility are consistently seen in patients with anorexia nervosa (AN). This type of cognitive impairment is thought to be associated with the persistence of AN because it leads to deeply ingrained patterns of thought and behaviour that are highly resistant to change. Neurobiological drivers of cognitive inflexibility have some commonalities with the abnormal brain functional outcomes described in patients with AN, including disrupted prefrontal cortical function, and dysregulated dopamine and serotonin neurotransmitter systems. The activity-based anorexia (ABA) model recapitulates the key features of AN in human patients, including rapid weight loss caused by self-starvation and hyperactivity, supporting its application in investigating the cognitive and neurobiological causes of pathological weight loss. The aim of this review is to describe the relationship between AN, neural function and cognitive flexibility in human patients, and to highlight how new techniques in behavioural neuroscience can improve the utility of animal models of AN to inform the development of novel therapeutics.

In pursuit of biomarkers for predicting susceptibility to activity-based anorexia in adolescent female rats.

ObjectiveIdentifying risk factors that contribute to the development of anorexia nervosa (AN) is critical for the implementation of early intervention strategies. Anxiety, obsessive–compulsive behavior, and immune dysfunction may be involved in the development of AN; however, their direct influence on susceptibility to the condition remains unclear. Here, we used the activity‐based anorexia (ABA) model to examine whether activity, anxiety‐like behavior, compulsive behavior, and circulating immune markers predict the subsequent development of pathological weight loss.MethodFemale Sprague–Dawley rats (n = 44) underwent behavioral testing before exposure to ABA conditions after which they were separated into susceptible and resistant subpopulations. Blood was sampled before behavioral testing and after recovery from ABA to screen for proinflammatory cytokines.ResultsRats that were vulnerable to pathological weight loss differed significantly from resistant rats on all key ABA parameters. While the primary measures of anxiety‐like or compulsive behavior were not shown to predict vulnerability to ABA, increased locomotion and anxiety‐like behavior were both associated with the extent of weight loss in susceptible but not resistant animals. Moreover, the change in expression of proinflammatory markers IL‐4 and IL‐6 evoked by ABA was associated with discrete vulnerability factors. Intriguingly, behavior related to risk assessment was shown to predict vulnerability to ABA.DiscussionWe did not find undisputable behavioral or immune predictors of susceptibility to pathological weight loss in the ABA rat model. Future research should examine the role of cognition in the development of ABA, dysfunction of which may represent an endophenotype linking anorectic, anxiety‐like and compulsive behavior.Public SignificanceAnorexia nervosa (AN) has among the highest mortality rates of all psychiatric disorders and treatment options remain limited in their efficacy. Understanding what types of risk factors contribute to the development of AN is essential for implementing early intervention strategies. This study describes how some of the most common psychological features of AN could be used to predict susceptibility to pathological weight loss in a well‐established animal model.

The Use of the "Early Weight Loss Nomograms" as Compared to a Standard Weight Loss Percentage Protocol Will Decrease Postnatal Formula Supplementation.

Introduction: We compared the number of babies who needed formula supplementation, based on the "Early Weight Loss Nomograms," with the hypothetical outcomes that would have occurred in the same cohort if they had been managed according to a "weight loss percentage" protocol. Subjects and Methods: This study included 308 newborns. Supplemental formula was provided to babies whose weight loss was more than the 95th percentile according to the "Early Weight Loss Nomograms." Pathological weight loss was defined as when a weight loss was >5% at the 24th hour or >8% at the 48th hour. The number of babies who would have needed formula supplementation according to those two strategies were compared. Results: The mean postnatal first-second day weight losses for vaginal and cesarean deliveries were 3.06% versus 4.7% and 4.5%, versus 5.8%, respectively, and were significantly higher for babies born by cesarean section (p = 0.001). We found that 89.4% of vaginal deliveries and 89.2% of babies born by cesarean section were exclusively breastfed when the nomograms were in use. If the daily weight loss strategy would be applied instead of the nomograms to the study cohort, the rate of exclusive breastfeeding would be significantly lower for babies born by cesarean section (64.2% versus 89.2%) (p = 0.001). Conclusions: The use of the Early Weight Loss Nomograms will decrease the rate of formula supplementation.

The potential role of stimulants in treating eating disorders.

Many individuals with eating disorders remain symptomatic after a course of psychotherapy and pharmacotherapy; therefore, the development of innovative treatments is essential. To learn more about the current evidence for treating eating disorders with stimulants, we searched for original articles and reviews published up to April 29, 2021 in PubMed and MEDLINE using the following search terms: eating disorders, anorexia, bulimia, binge eating, stimulants, amphetamine, lisdexamfetamine, methylphenidate, and phentermine. We propose that stimulant medications represent a novel avenue for future research based on the following: (a) the relationship between eating disorders and attention deficit/hyperactivity disorder (ADHD); (b) a neurobiological rationale; and (c) the current (but limited) evidence for stimulants as treatments for some eating disorders. Despite the possible benefits of such medications, there are also risks to consider such as medication misuse, adverse cardiovascular events, and reduction of appetite and pathological weight loss. With those risks in mind, we propose several directions for future research including: (a) randomized controlled trials to study stimulant treatment in those with bulimia nervosa (with guidance on strategies to mitigate risk); (b) examining stimulant treatment in conjunction with psychotherapy; (c) investigating the impact of stimulants on "loss of control" eating in youth with ADHD; and (d) exploring relevant neurobiological mechanisms. We also propose specific directions for exploring mediators and moderators in future clinical trials. Although this line of investigation may be viewed as controversial by some in the field, we believe that the topic warrants careful consideration for future research.

Comparison study of patient demographics and risk factors for infections following primary total hip arthroplasty for femoral neck fractures.

While studies have shown favorable outcomes in the treatment of femoral neck fractures with the utilization of total hip arthroplasty (THA), adverse events, such as infections, can still occur. Therefore, the aims of this study were to 1) compare baseline demographics and 2) identify risk factors associated with developing either surgical site infections (SSIs) or peri-prosthetic joint infections (PJIs). A retrospective analysis of patients who underwent primary THA for femoral neck fractures were queried from the Medicare database. The inclusion criteria consisted of patients developing SSIs within 90days or PJIs within 3years following the index procedure. The query yielded 2502 patients who developed infections in the form of either SSIs (n = 987) or PJIs (n = 1515) out of 57,191 patients treated for femoral neck fractures with primary THA. Primary endpoints were to compare baseline demographic profiles and determine risk factors associated with developing infections. Multivariate binomial logistic regression analyses were performed to determine the odds (OR) of developing infections. A p value less than 0.001 was considered to be statistically significant. Patients who developed either infections were found to be significantly different when compared to patients who did not develop infections. SSI (10 vs. 8, p < 0.0001) and PJI (9 vs. 5, p < 0.0001) patients both had significantly higher mean Elixhauser Comorbidity Index (ECI) scores compared to their counterparts. The regression model found the greatest risks for developing SSIs included hypertension (OR 1.63, p = 0.001), pathologic weight loss (OR 1.58, p < 0.0001), and iron deficiency anemia (IDA) (OR 1.48, p < 0.0001), whereas IDA (OR 2.14, p < 0.0001), pathologic weight loss (OR 1.75, p < 0.0001), and rheumatoid arthritis (OR 1.57, p < 0.0001) increased the odds for PJIs. This study can be utilized by orthopedic surgeons and other healthcare professionals to adequately educate these patients of the complications which may occur following their surgery.

Causes, risk factors, and costs associated with ninety-day readmissions following primary total hip arthroplasty for femoral neck fractures

IntroductionRisk factors associated with primary THA readmissions have not yet been thoroughly analyzed when stratified by underlying indication. Given that a majority of THAs are done electively in the context of osteoarthritis (OA), it remains to be explored whether or not THAs performed non-electively in the trauma setting have different readmission patterns. Therefore, the aims of this study were to identify: 1) causes of readmissions; 2) patient-related risk-factors for readmissions; and 3) costs associated with the reasons for readmissions. Materials and methodsPatients who sustained a femoral neck fracture and underwent primary THA from 2005 to 2014 were identified. Those subsequently readmitted within 90-days following the procedure comprised the study cohort whereas those not readmitted served as the comparison cohort. Primary outcomes included identifying causes of readmissions, identifying patient-related risk-factors associated with readmissions and determining healthcare expenditures associated with the different readmission etiologies. A regression analysis was used to calculate the odds (OR) for readmissions. A p-value less than 0.01 was considered to be statistically significant. ResultsThe regression model demonstrated the greatest patient-related risk factors included: electrolyte and fluid disorders (OR: 1.80, p < 0.0001), morbid obesity (OR: 1.60, p < 0.0001), pathologic weight loss (OR: 1.58, p < 0.0001), congestive heart failure (OR: 1.41, p < 0.0001), were the leading risk factors for readmissions. Pulmonary-related causes ($42,357.71) of readmission were the leading driver of costs of care. ConclusionOrthopaedic surgeons should identify and optimize pre-operative management of patient-related risk factors that increase readmissions following primary THA for femoral neck fractures. Additionally, pulmonary-related causes of readmission lead to the highest costs of care. Level of EvidenceIII.

Comparison study of patient demographics and risk factors for infections following primary total elbow arthroplasty

BackgroundInfections are a feared complication following primary total elbow arthroplasty (TEA). Studies comparing baseline demographic profiles and identifying risk factors associated with developing surgical site infections (SSIs) or peri-prosthetic joint infections (PJIs), following primary TEA are limited. This study was therefore aimed to: (1) compare patient demographics; and (2) identify patient-related risk factors for the development of infections following a primary TEA. MethodsPatients who underwent primary TEA from January 1, 2005 to March 31, 2014 were identified in an administrative claims database. The study group consisted of all patients who developed either SSIs within 90-days or PJIs within 2-years following the index procedure, respectively. A total of 23,134 primary TEAs were identified between 2005 and 2014, of which 757 (3.3%) were coded as being infected. Primary outcomes that were assessed included comparing baseline patient demographics and identifying patient-related risk factors for developing PJIs. Pearson's chi-square analyses were used to compare study group demographics to their counterparts. Welch's t-test was used to compare mean Elixhauser-Comorbidity Index scores between the cohorts. Multivariate binomial logistics regression was used to calculate odds-ratios (OR) for patient-related risk factors. A P value less than .05 was considered statistically significant. ResultsPatients who developed infections were significantly different compared to their counterparts with respect to the variables analyzed. Patients developing infections were found to have a higher prevalence of comorbidities as measured by mean Elixhauser-Comorbidity Index scores in patients who developed SSIs (7 vs. 5, P < .0001) or PJIs (7 vs. 5, P < .0001) compared to their respective counterparts. The greatest risk factors for SSIs within 90-days following primary TEA were rheumatoid arthritis (OR: 1.80, P < .0001), being male (OR: 1.53, P = .009), and depressive disorders (OR: 1.52, P = .004), whereas iron deficiency anemia (OR: 2.04, P < .0001), rheumatoid arthritis (OR: 1.78, P < .0001), and pathologic weight loss (OR: 1.73, P < .0001) were associated with an increased odd of PJIs. ConclusionThis study demonstrated statistically significant differences between patients who developed and did not develop infections following primary TEA and identified a myriad of risk factors associated with these adverse events. The results from this study can help identify high risk patients by orthopedic surgeon in order to potentially mitigate the incidence of either SSIs or PJIs in patients undergoing TEA. Level of EvidenceLevel III; Database Study, Retrospective Case-Control Prognosis Study

Comparison study of patient demographics and patient-related risk factors for peri-prosthetic joint infections following primary total shoulder arthroplasty

BackgroundWhile studies have demonstrated favorable outcomes in utilization of primary total shoulder arthroplasty (TSA) for the treatment of glenohumeral osteoarthritis (OA), adverse events such as infections can still occur. Periprosthetic joint infections (PJIs) are associated with worse outcomes and patient morbidity. The purpose of this study was to: (1) compare patient demographics amongst TSA patients with and without PJIs following primary TSA; and (2) identify patient-related risk factors for PJIs following primary TSA. MethodsPatients undergoing primary TSA for the treatment of glenohumeral OA were identified using the Mariner administrative claims database by CPT code 23,472. Laterality modifiers were utilized to ensure PJIs were developing in the correct laterality as those patients undergoing primary TSA. Inclusion for the study group consisted of patients who developed PJIs within 2-years after the index procedure, whereas patients who did not develop PJIs served as the comparison cohort. Primary outcomes analyzed included patient demographics and patient-related risk factors for PJIs following primary TSA. A stepwise backwards elimination multivariate binomial logistic regression analyses was performed to determine the odds (OR) of PJIs in patients undergoing primary TSA. A P value less than .05 was considered statistically significant. ResultsThe query yielded 15,396 patients who underwent primary TSA for glenohumeral OA, of which 191 patients developed PJIs and 15,205 did not develop PJIs. The study found statistically significant differences amongst patients who did and did not develop PJIs following primary TSA with respect to age, sex, and presence of comorbid conditions. Risk factors associated with developing PJIs following primary TSA included: pathologic weight loss (OR: 2.06, P < .0001), obesity (OR: 1.56, P = .0001), male sex (OR: 1.52, P = .007), and peripheral vascular disease (OR: 1.46, P = .022). ConclusionAs the number of primary TSAs for the treatment of glenohumeral OA increase worldwide, identifying modifiable risk-factors to reduce the incidence of infection is critical. The study found various modifiable and non-modifiable risk factors associated with developing PJIs following primary TSA. This study is valuable to orthopedists in order to identify and risk-stratify patients with regard to PJI in the setting of primary TSA for OA. Level of EvidenceLevel III; Case-Control Study

Comparison of Patient Demographics and Patient-Related Risk Factors for Infections After Primary Total Hip Arthroplasty for Acetabular Fractures.

In the proper age group, there is evidence that total hip arthroplasty (THA) has superior outcomes for the treatment of acetabular fractures compared with open reduction and internal fixation. Studies comparing patient demographics and identifying risk factors for either surgical site infections (SSIs) or periprosthetic joint infections (PJIs) are limited. Therefore, the purpose of this study was to (1) compare baseline demographics of patients who did and did not develop infections and (2) identify risk factors associated with developing either SSIs or PJIs. A retrospective study from 2005 to 2014 was done using a nationwide claims database. The inclusion criteria consisted of patients sustaining an acetabular fracture and treated with THA who developed either SSIs or PJIs within 90 days or 2 years, respectively, whereas patients not developing infections served as control subjects. The final study yielded 13,059 patients within the study (n = 988) and control cohort (n = 12,071). Baseline demographics were compared. A multivariate regression model calculated the odds ratio (OR) associated with development of infections. P value less than 0.002 was considered statistically significant. The study demonstrated significant differences among the cohorts regarding baseline demographics. The greatest risk factors for SSIs within 90 days were morbid obesity (OR: 1.84, P < 0.0001), pathologic weight loss (OR: 1.64, P < 0.0001), and iron deficiency anemia (OR: 1.59, P = 0.001). An increased risk of PJIs was associated with iron deficiency anemia (OR: 1.97, P < 0.0001), pathologic weight loss (OR: 1.72, P < 0.0001), and morbid obesity (OR: 1.70, P = 0.0001). This study found notable differences between baseline demographics of the cohorts and a myriad of risk factors associated with developing infections after THA for acetabular fractures. This study provides insight into orthopaedic surgeons and other healthcare professionals on the need of properly educating these high-risk patients of the potential consequences which they may encounter after their procedure. Level III.

Extensive pulmonary metastases in young boy with primary cardiac angiosarcoma: a case report.

BackgroundMalignant primary cardiac neoplasms are rare and primary cardiac angiosarcoma is the most common and aggressive subtype. It most commonly presents in middle-aged males and due to its non-specific clinical presentation, the diagnosis is often delayed until advanced disease is already present. Clinical presentation is determined by manifestations of local infiltration or metastatic disease and making an early diagnosis is extremely challenging.Case summaryA 15-year-old previously healthy boy was admitted to the emergency department with a history of pathological weight loss and functional decline. The patient was found to have a left-sided pneumothorax as well as bilateral diffusely spread pulmonary nodules on plain chest radiograph. Computed tomography chest confirmed widespread pulmonary metastases and a right atrial filling defect. Echocardiography revealed a right atrial tumour and transvenous endomyocardial biopsy of the tumour was done under fluoroscopic and echocardiographic guidance. A diagnosis of primary cardiac angiosarcoma was made. The patient demised shortly after presentation.DiscussionPrimary cardiac angiosarcoma is rare and even more so in patients as young as the case described. The diagnostic process poses several challenges to the clinician, of which the obtaining of a histological sample is one. This case report demonstrates aspects both unique and typical of this rare disease. It also describes an effective option for obtaining tissue for a histological diagnosis in patients whose clinical condition may not allow biopsy under general anaesthesia.