scholarly journals Timing of Bisphosphonate Initiation After Fracture: What Does the Data Really Say?

2020 ◽  
Vol 11 ◽  
pp. 215145932098036
Author(s):  
David W. Barton ◽  
C. Taylor Smith ◽  
Amit S. Piple ◽  
Sterling A. Moskal ◽  
Jonathan J. Carmouche
Keyword(s):  
Fracture Healing ◽  
Clinical Studies ◽  
Osteoporosis Treatment ◽  
The Body ◽  
Non Union ◽  
Increased Risk ◽  
Level I ◽  
Timing Of Initiation ◽  
The Impact ◽  
Published Research

Introduction: Osteoporosis is often not clinically recognized until after a fracture occurs. Individuals who have 1 fracture are at increased risk of future fractures. Prompt initiation of osteoporosis treatment following fracture is critical to reducing the rate of future fractures. Antiresorptives are the most widely used class of medications for the prevention and treatment of osteoporosis. Many providers are hesitant to initiate antiresorptives in the acute post-fracture period. Concerns include interference with bone remodeling necessary for successful fracture healing, which would cause increased rates of non-union, malunion, and refracture. While such concerns should not extend to anabolic medications, physicians may also hesitate to initiate anabolic osteoporosis therapies due to high cost and/or lack of familiarity. This article aims to briefly review the available data and present a digestible narrative summary to familiarize practicing orthopaedic surgeons with the essential details of the published research on this topic. Results: The results of 20 clinical studies and key pre-clinical studies related to the effect of anti-resorptive medications for osteoporosis on fracture healing are summarized in the body of this narrative review. Discussion & Conclusions: While few level I studies have examined the impact of timing of initiation of osteoporosis medications in the acute post-fracture period, the few that have been published do not support these concerns. Specifically, data from level I clinical trials indicate that initiating bisphosphonates as early as 2 weeks post-fracture does not increase rates of non-union or malunion. By reviewing the available data, we hope to give clinicians the confidence to initiate osteoporosis treatment promptly post-fracture.

scholarly journals Impact of COVID-19 on People with Disabilities

2021 ◽  
Vol 3 (2) ◽  
pp. 1-6
Author(s):  
Smriti Pant ◽  
Saugat Koirala ◽  
Madhusudan Subedi
Keyword(s):  
Online News ◽  
The Body ◽  
Narrative Review ◽  
The Poor ◽  
Increased Risk ◽  
The World ◽  
People With Disability ◽  
The Disabled ◽  
Mainstream Society ◽  
The Impact

Any condition of the body or mind that makes it more difficult for the person with the condition to do certain activities and interact with the world around them is known as a disability. Despite the various efforts being done to ensure their rights and equity of the disabled, they still suffer more during various crises like conflicts, natural disasters and pandemics. The purpose of this narrative review is to access the impact that the COVID-19 pandemic has had on People with disability (PWD). For writing this narrative review, Google, Google Scholar, Pub Med and online news portals were searched by using various combination of the following terminologies; “Disability”, “Differently “Disabled”, “Disable”, “People with Disability”, “PWD” “Impact”, “COVID-19”, “Corona Pandemic”, “Challenges”, “Issues”, “Policies”, “Social”, and “increased risk”. The pandemic has created many challenges for people with disability. They not have greater risk of contracting COVID-19, but also have problems accessing health services. It has also had various social impacts like problems related to education, employment as well as discrimination. The COVID pandemic has exposed gaps in the health system that make the poor, marginalized and disabled population more vulnerable to neglect and mistreatment. Proper implementation and monitoring of policies should be done to ensure that PWD feel included and respected. It is important to continually integrate PWD into the mainstream society while minimizing their risks of contracting COVID-19. The caretakers should use the necessary PPE when attending to their needs.

scholarly journals The Impact of Obesity and Adiposity on Mortality Risk in Older Adults: A Ten-year Survival Analysis

2021 ◽  
Author(s):  
Letícia Almeida Nogueira Moura ◽  
Valéria Pagotto ◽  
Cristina Camargo Pereira ◽  
Rômulo Roosevelt da Silva Filho ◽  
César de Oliveira ◽  
...  
Keyword(s):  
Older Adults ◽  
Survival Analysis ◽  
Mortality Risk ◽  
Cancer Mortality ◽  
Cox Regression ◽  
Clinical History ◽  
The Body ◽  
Increased Risk ◽  
Multifrequency Bioimpedance ◽  
The Impact

Abstract There are not much information about the impact of obesity on all-cause, cardiovascular and cancer mortality in older adults. We have investigated the impact of obesity and adiposity on all-cause, cardiovascular and cancer mortality, in older adults after a 10-year follow-up. Prospective cohort study has been carried out with individuals ≥ 60 years. Sociodemographic characteristics, lifestyle, clinical history, laboratory tests and anthropometric data were collected. Adiposity was defined as tertiles of the percentage of body fat assessed by multifrequency bioimpedance. For obesity, three classifications were considered using the body mass index (BMI) as follows: ≥ 25.0 kg/m² in men and ≥ 26.6 kg/m² in women, ≥ 27.0 kg/m² and ≥ 30.0 kg/m². The BMI ≥ 30.0 kg/m² was associated a reduction in the all-cause mortality risk in non-ajusted Cox regression (HR: 0.65; 95% CI: 0.43 - 0.97) and in the Kaplan-Meier curves (p = 0.032). However, in multivariate Cox regression none of the diagnostic criteria for obesity and adiposity were significantly associated with all-cause, cardiovascular or cancer mortality. This 10-year survival analysis has showed that obesity and adiposity were not associated with an increased risk of all-cause, cardiovascular or cancer mortality in the older adults.

Abdominal Hollow Viscus Injuries are Associated with Spine and Neurologic Infections after Penetrating Spinal Cord Injuries

2014 ◽  
Vol 80 (10) ◽  
pp. 966-969 ◽  
Author(s):  
Alexander C. Schwed ◽  
David S. Plurad ◽  
Scott Bricker ◽  
Angela Neville ◽  
Fred Bongard ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Multivariate Analysis ◽  
Injury Severity ◽  
Spinal Cord Injuries ◽  
Infectious Complications ◽  
Injury Patterns ◽  
Hollow Viscus ◽  
Increased Risk ◽  
Level I ◽  
The Impact

Penetrating spinal cord injuries are rare but potentially devastating injuries that are associated with significant morbidity. The objective of this study was to assess the impact of abdominal hollow viscus injuries (HVIs) on neurologic and spinal infectious complications in patients sustaining penetrating spinal cord injuries. We performed a 13-year retrospective review of a Level I trauma center database. Variables analyzed included demographics, injury patterns and severity, spine operations, and outcomes. Spine and neurologic infections (SNIs) were defined as para-spinal or spinal abscess, osteomyelitis, and meningitis. Multivariate analysis was performed to identify factors associated with SNI. Of 137 patients, there were 126 males (92%) with a mean age of 27 ± 10 years. Eight patients (6%) underwent operative stabilization of their spine. Fifteen patients (11%) developed SNI. There was a higher incidence of SNI among patients with abdominal HVI compared with those without (eight [26%] vs six [6%], P < 0.001). On multivariate analysis, after controlling for injury severity, solid abdominal injury and HVI, vascular injury, and spine operation, abdominal HVIs were independently associated with an increased risk for SNI (odds ratio, 6.88; 95% confidence interval, 2.14 to 22.09; P = 0.001). Further studies are required to determine the optimal management strategy to prevent and successfully treat these infections.

scholarly journals The Effects of Psychological and Environmental Stress on Micronutrient Concentrations in the Body: A Review of the Evidence

2019 ◽  
Author(s):  
Adrian L Lopresti
Keyword(s):  
Environmental Stress ◽  
The Body ◽  
Environmental Stressors ◽  
Mental Function ◽  
Increased Risk ◽  
Physical Diseases ◽  
Different Populations ◽  
Nutrient Changes ◽  
Calcium Iron ◽  
The Impact

ABSTRACT Stress is the nonspecific response of the body to any demand for change. Excess or chronic psychological or environmental stress is associated with an increased risk of mental and physical diseases, with several mechanisms theorized to be associated with its detrimental effects. One underappreciated potential mechanism relates to the effects of psychological and environmental stress on micronutrient concentrations. Micronutrients (vitamins and minerals) are essential for optimal physical and mental function, with deficiencies associated with an array of diseases. In this article, animal and human studies investigating the effects of various psychological and environmental stressors on micronutrient concentrations are reviewed. In particular, the effects of psychological stress, sleep deprivation, and physical exercise on micronutrient concentrations and micronutrient excretion are summarized. Micronutrients identified in this review include magnesium, zinc, calcium, iron, and niacin. Overall, the bulk of evidence suggests stress can affect micronutrient concentrations, often leading to micronutrient depletion. However, before definitive conclusions about the effects of stress can be made, the impact of different stressors, stress severity, and acute versus chronic stress on micronutrient concentrations requires investigation. Moreover, the impact of stress on micronutrients in different populations varying in age, gender, and premorbid health status and the durability of changes after a stressor is resolved require examination. The medical, physical, and psychological implications of nutrient changes caused by a stressor also remain to be determined.

scholarly journals Motorcycle-related trauma: effects of age and site of injuries on mortality. A single-center, retrospective study.

2020 ◽  
Author(s):  
Stefano Granieri ◽  
Elisa Reitano ◽  
Francesca Bindi ◽  
Federica Renzi ◽  
Fabrizio Sammartano ◽  
...  
Keyword(s):  
Trauma Center ◽  
Injury Severity ◽  
Age Groups ◽  
Mortality Rates ◽  
Rank Test ◽  
Younger Patients ◽  
Risk Of Death ◽  
Increased Risk ◽  
Level I ◽  
The Impact

Abstract BackgroundMotorcyclists are often victims of road traffic incidents. Though elderly patients seem to have worse survival outcomes and sustain more severe injuries than younger patients, concordance in the literature for this does not exist. The aim of the study is to evaluate the impact of age and injury severity on the mortality of patients undergoing motorcycle trauma. MethodsData of 1725 patients consecutively admitted to our Trauma Center were selected from 2002 to 2016 and retrospectively analyzed. The sample was divided into three age groups: ≤ 17 years, 18-54 years and ≥ 55 years. Mortality rates were analyzed for the overall population and patients with Injury Severity Score (ISS) ≥ 25. Differences in survival among age groups were evaluated with Log-Rank test and multivariate logistic regression models were created to identify independent predictors of mortality.ResultsA lower survival rate was detected in patients older than 55 years (83,6% vs 94,7%; p = 0.049) and in those sustaining critical injuries (ISS ≥ 25, 61% vs 83% p = 0.021). Age (p =0,027; OR: 1,03), ISS (p <0,001; OR: 1,09), Revised Trauma Score (RTS) (p <0,001; OR: 0,47) resulted independent predictors of death. Multivariate analysis identified head (p <0,001; OR: 2,04), chest (p <0,001; OR: 1,54), abdominal (p <0,001; OR: 1,37) and pelvic (p =0,014; OR: 1,26) injuries as independent risk factors related to mortality as well. Compared to the theoretical probability of survival, patients of all age groups showed a survival advantage when managed at a level I Trauma Center.ConclusionsWe detected anatomical injury distributions and mortality rates among three age groups. Patients aging more than 55 years had an increased risk of death, with a prevalence of severe chest injuries, while younger patients sustained more severe head trauma. Age represented an independent predictor of death. Management of these patients at a Level I Trauma Center may lead to improved outcomes.

scholarly journals Genetic and biochemical aspects of formation of professional chronic dust bronchitis

2019 ◽  
pp. 342-347
Author(s):  
A. S. Kazitskaya ◽  
N. I. Panev ◽  
T. K. Yadykina ◽  
O. N. Gulyaeva ◽  
N. A. Evseeva
Keyword(s):  
Respiratory System ◽  
Coal Industry ◽  
Main Group ◽  
The Body ◽  
Control Group ◽  
Immunological Parameters ◽  
Actual Problem ◽  
Functional Parameters ◽  
Increased Risk ◽  
The Impact

Introduction. Th e actual problem of modern occupational health is the study of the role of exogenous and endogenous factors in the development of occupational pathology of the bronchopulmonary system. То identify groups at increased risk of developing a dusty pathology of the bronchopulmonary system, it is necessary to conduct a comprehensive study of clinical and genetic factors, as well as to determine the most signifi cant diagnostic markers of the development of this pathology.The aim of the study was to study the genetic status of a set of biochemical and molecular genetic markers, as well as biochemical parameters of blood and respiratory function in coal industry workers with chronic dust bronchitis and persons of the control group.Materials and methods. 115 workers of coal mines from the South of Kuzbass aged from 39 to 58 years were examined in the Clinic of the Institute. Among them — 71 people with a previously established diagnosis of chronic dust bronchitis (the main group) and 44 people of the control group of persons working in the same sanitary conditions, but not having this pathology. A complex of clinical, biochemical and genetic methods of research was used in the study, and functional parameters of the bronchopulmonary system were evaluated. Statistical processing of the results was carried out using IBM SPSS Statistics 22 soft ware. Results. Statistically signifi cant diff erences between biochemical (increase in the concentration of ceruloplasmin and α–1antitrypsin) and immunological parameters (increase in the total number of leukocytes and ESR, increase in the concentration of IgG) in miners with chronic dust bronchitis and coal industry workers without this pathology were revealed. The dependence of the functional changes of the respiratory system with the development of professional pathology is determined. Th e persons of the main group showed a statistically signifi cant decrease in functional parameters (forced exhalation per second and lung capacity), increased respiratory failure. A predisposition to the development of dust bronchitis in the owners of the HP 1–1 genotype and resistance to the formation of this pathology in persons with the HP 2–2 genotype were found. Th e study of GSTT 1 deletion polymorphism revealed that carriers of the GSTT 1 «+» variant are most susceptible to the development of chronic dust bronchitis, and owners of the GSTT 1 variant are» resistant to its formation. Th ere was a positive аssociation with the development of dust bronchitis of the holders of the MM phenotype (MN).Conclusions. When working in similar conditions, some workers have a deviation of biochemical and immunological parameters fr om the norm, as well as a violation of the respiratory system, while others have no changes. Th e response of the body to the impact of certain external adverse factors may be due to genetic predisposition or resistance to the development of the disease. 

scholarly journals Effects of Ionizing Radiation and their Potential Risk on the Brain: A Review

2019 ◽  
Vol 19 (3&4) ◽  
pp. 120
Author(s):  
Ghofrane Cherkaoui Salhi ◽  
Houda Filali
Keyword(s):  
Ionizing Radiation ◽  
Potential Risk ◽  
Clinical Studies ◽  
The Body ◽  
The Impact ◽  
The Brain

The brain is considered as one of the most radioresistant organ in the body. However, more and more studies start to question this resistance. The aim of this paper is to briefly review the current available data regarding the impact of ionizing radiation on the brain with a focus on epidemiological/clinical studies.

scholarly journals Administration of Human Non-Diabetic Mesenchymal Stromal Cells to a Murine Model of Diabetic Fracture Repair: A Pilot Study

Cells ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 1394
Author(s):  
Luke Watson ◽  
Xi Zhe Chen ◽  
Aideen E. Ryan ◽  
Áine Fleming ◽  
Aoife Carbin ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Pilot Study ◽  
Fracture Healing ◽  
Mesenchymal Stromal Cells ◽  
Stromal Cells ◽  
Flexural Modulus ◽  
Human Mscs ◽  
Mineral Density ◽  
Non Union ◽  
Increased Risk

Individuals living with type 1 diabetes mellitus may experience an increased risk of long bone fracture. These fractures are often slow to heal, resulting in delayed reunion or non-union. It is reasonable to theorize that the underlying cause of these diabetes-associated osteopathies is faulty repair dynamics as a result of compromised bone marrow progenitor cell function. Here it was hypothesized that the administration of non-diabetic, human adult bone marrow-derived mesenchymal stromal cells (MSCs) would enhance diabetic fracture healing. Human MSCs were locally introduced to femur fractures in streptozotocin-induced diabetic mice, and the quality of de novo bone was assessed eight weeks later. Biodistribution analysis demonstrated that the cells remained in situ for three days following administration. Bone bridging was evident in all animals. However, a large reparative callus was retained, indicating non-union. µCT analysis elucidated comparable callus dimensions, bone mineral density, bone volume/total volume, and volume of mature bone in all groups that received cells as compared to the saline-treated controls. Four-point bending evaluation of flexural strength, flexural modulus, and total energy to re-fracture did not indicate a statistically significant change as a result of cellular administration. An ex vivo lymphocytic proliferation recall assay indicated that the xenogeneic administration of human cells did not result in an immune response by the murine recipient. Due to this dataset, the administration of non-diabetic bone marrow-derived MSCs did not support fracture healing in this pilot study.

The Impact of Methamphetamine Use on Trauma Patients at a Level I Trauma Center: A 10-Year Retrospective Review

2018 ◽  
Vol 84 (3) ◽  
pp. 428-432 ◽  
Author(s):  
Gregory R. Stroh ◽  
Fanglong Dong ◽  
Elizabeth Ablah ◽  
Jeanette G. Ward ◽  
James M. Haan
Keyword(s):  
Retrospective Review ◽  
Trauma Center ◽  
Traumatic Injury ◽  
Hospital Length Of Stay ◽  
Drug Screen ◽  
Trauma Patients ◽  
Urine Drug Screen ◽  
Increased Risk ◽  
Level I ◽  
The Impact

The effects of methamphetamines (MAs) on trauma patient outcomes have been evaluated, but with discordant results. The purpose of this study was to identify hospital outcomes associated with MA use after traumatic injury. Retrospective review of adult trauma patients admitted to an American College of Surgeons verified–Level I trauma center who received a urine drug screen (UDS) between January 1, 2004 and December 31, 2013. Logistic regression analysis was used to identify factors associated with mortality. Patients with a negative UDS were used as controls. Among the 2321 patients included, 75.1 per cent were male, 81.9 per cent were white, and the average age was 39. Patients were grouped by UDS results (negative, MA only, other drug plus MA, or other drug without MA). A positive drug screen result of other drug without MA demonstrated a significantly lower risk for mortality, but longer intensive care unit and hospital length of stay, as well as increased ventilator days than negative results. Results of MA only did not alter the risk of mortality. These findings suggest that patients who test positive for MAs are not at an increased risk of in-hospital mortality when compared with patients having a negative drug screen.

scholarly journals Obesity and risk of end-stage renal disease in patients with chronic kidney disease: a cohort study

2018 ◽  
Vol 108 (5) ◽  
pp. 1145-1153 ◽  
Author(s):  
Ting-Yun Lin ◽  
Jia-Sin Liu ◽  
Szu-Chun Hung
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
The Body ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Impact

ABSTRACT Background Obesity is a risk factor for de novo chronic kidney disease (CKD) in the general population. Obesity has been increasingly prevalent in patients with CKD and may lead to further progression of pre-existing CKD. However, whether obesity is associated with the development of end-stage renal disease (ESRD) in patients with CKD is not well understood. Objective We investigated the impact of obesity on ESRD (needing chronic dialysis treatment or pre-emptive renal transplantation) or all-cause mortality in patients with moderate to advanced CKD. Design A total of 322 patients with stages 3–5 CKD who were not yet on dialysis were prospectively followed for a median of 4.9 y. Obesity was defined by body mass index (BMI, in kg/m2) ≥30 or body fat percentage (BF%) >25% in men and >35% in women. BF% was assessed with the use of the Body Composition Monitor, a multifrequency bioimpedance spectroscopy device. Results In total, 100 participants progressed to ESRD and 39 participants died. Obesity, whether defined by BMI or BF%, was not associated with a significantly increased risk of ESRD in Cox proportional hazards models that adjusted for age, sex, diabetes mellitus, cardiovascular disease, estimated glomerular filtration rate, urine protein:creatinine ratio, high-sensitivity C-reactive protein, and use of renin-angiotensin-aldosterone system inhibitors or statins, accounting for the competing risk for mortality (subdistribution HR: 1.15; 95% CI: 0.62, 2.14 for BMI-defined obesity and subdistribution HR: 0.84, 95% CI: 0.54, 1.29 for BF%-defined obesity, respectively). Results were similar when BMI and BF% were analyzed as continuous or time-dependent variables. Whereas higher BMI was protective, higher BF% appeared to be associated with increased all-cause mortality. Conclusions Obesity did not confer an increased risk of ESRD in patients with moderate to advanced CKD. This trial was registered at http://www.clinicaltrials.gov as NCT03285074.

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