scholarly journals Periprosthetic osseointegration fractures are infrequent and management is familiar

2020 ◽  
Vol 102-B (2) ◽  
pp. 162-169 ◽  
Author(s):  
Jason S. Hoellwarth ◽  
Kevin Tetsworth ◽  
John Kendrew ◽  
Norbert Venantius Kang ◽  
Oscar van Waes ◽  
...  
Keyword(s):  
Bone Density ◽  
Medical Records ◽  
Risk Of Fracture ◽  
Prosthetic Limb ◽  
Press Fit ◽  
Prosthetic Limbs ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Femoral Implants ◽  
Lower Limb Amputees

Aims Osseointegrated prosthetic limbs allow better mobility than socket-mounted prosthetics for lower limb amputees. Fractures, however, can occur in the residual limb, but they have rarely been reported. Approximately 2% to 3% of amputees with socket-mounted prostheses may fracture within five years. This is the first study which directly addresses the risks and management of periprosthetic osseointegration fractures in amputees. Methods A retrospective review identified 518 osseointegration procedures which were undertaken in 458 patients between 2010 and 2018 for whom complete medical records were available. Potential risk factors including time since amputation, age at osseointegration, bone density, weight, uni/bilateral implantation and sex were evaluated with multiple logistic regression. The mechanism of injury, technique and implant that was used for fixation of the fracture, pre-osseointegration and post fracture mobility (assessed using the K-level) and the time that the prosthesis was worn for in hours/day were also assessed. Results There were 22 periprosthetic fractures; they occurred exclusively in the femur: two in the femoral neck, 14 intertrochanteric and six subtrochanteric, representing 4.2% of 518 osseointegration operations and 6.3% of 347 femoral implants. The vast majority (19/22, 86.4%) occurred within 2 cm of the proximal tip of the implant and after a fall. No fractures occurred spontaneously. Fixation most commonly involved dynamic hip screws (10) and reconstruction plates (9). No osseointegration implants required removal, the K-level was not reduced after fixation of the fracture in any patient, and all retained a K-level of ≥ 2. All fractures united, 21 out of 22 patients (95.5%) wear their osseointegration-mounted prosthetic limb longer daily than when using a socket, with 18 out of 22 (81.8%) reporting using it for ≥ 16 hours daily. Regression analysis identified a 3.89-fold increased risk of fracture for females (p = 0.007) and a 1.02-fold increased risk of fracture per kg above a mean of 80.4 kg (p = 0.046). No increased risk was identified for bilateral implants (p = 0.083), time from amputation to osseointegration (p = 0.974), age at osseointegration (p = 0.331), or bone density (g/cm2, p = 0.560; T-score, p = 0.247; Z-score, p = 0.312). Conclusion The risks and sequelae of periprosthetic fracture after press-fit osseointegration for amputation should not deter patients or clinicians from considering this procedure. Females and heavier patients are likely to have an increased risk of fracture. Age, years since amputation, and bone density do not appear influential. Cite this article: Bone Joint J 2020;102-B(2):162–169.

scholarly journals Pharmacologic treatment and SUDEP risk

Neurology ◽  
2020 ◽  
Vol 95 (18) ◽  
pp. e2509-e2518 ◽  
Author(s):  
Olafur Sveinsson ◽  
Tomas Andersson ◽  
Peter Mattsson ◽  
Sofia Carlsson ◽  
Torbjörn Tomson
Keyword(s):  
Medical Records ◽  
Case Control Study ◽  
Unexpected Death ◽  
Increased Risk ◽  
National Patient ◽  
Potential Risk Factors ◽  
Clonic Seizures ◽  
Reduce Risk ◽  
Control Study ◽  
Reduced Risk

ObjectiveWe conducted a nationwide case–control study in Sweden to test the hypothesis that antiepileptic drugs (AEDs) mono- or polytherapy, adherence, antidepressants, neuroleptics, β-blockers, and statins are associated with sudden unexpected death in epilepsy (SUDEP) risk.MethodsIncluded were 255 SUDEP cases and 1,148 matched controls. Information on clinical factors and medications came from medical records and the National Patient and Prescription Registers. The association between SUDEP and medications was assessed by odds ratios (ORs) with 95% confidence intervals (CIs) adjusted for potential risk factors including type of epilepsy, living conditions, comorbidity, and frequency of generalized tonic-clonic seizures (GTCS).ResultsPolytherapy, especially taking 3 or more AEDs, was associated with a substantially reduced risk of SUDEP (OR 0.31, 95% CI 0.14–0.67). Combinations including lamotrigine (OR 0.55, 95% CI 0.31–0.97), valproic acid (OR 0.53, 95% CI 0.29–0.98), and levetiracetam (OR 0.49, 95% CI 0.27–0.90) were associated with reduced risk. No specific AED was associated with increased risk. Regarding monotherapy, although numbers were limited, the lowest SUDEP risk was seen in users of levetiracetam (0.10, 95% CI 0.02–0.61). Having nonadherence mentioned in the medical record was associated with an OR of 2.75 (95% CI 1.58–4.78). Statin use was associated with a reduced SUDEP risk (OR 0.34, 95% CI 0.11–0.99) but selective serotonin reuptake inhibitor use was not.ConclusionThese results provide support for the importance of medication adherence and intensified AED treatment for patients with poorly controlled GTCS in the effort to reduce SUDEP risk and suggest that comedication with statins may reduce risk.

Clinical use of bisphosphonates in the UK

2001 ◽  
Vol 7 (2) ◽  
pp. 75-79 ◽  
Author(s):  
RM Francis
Keyword(s):  
Bone Density ◽  
Vertebral Fractures ◽  
Bone Pain ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Skeletal Deformity ◽  
Risk Of Fracture ◽  
Advantages And Disadvantages ◽  
Increased Risk ◽  
Minimal Trauma

Bisphosphonates are synthetic analogues of naturally occurring pyrophosphate, but contain a P-C-P bond in the middle of the molecule instead of a P-O-P bond. The addition of different side chains allows many structural variations, producing bisphosphonates with a range of potencies and properties. Bisphosphonates are poorly absorbed from the bowel, but once absorbed they localise to the skeleton, where they inhibit the recruitment and function of osteoclasts. This provides a rationale for their use in the management of patients with bone diseases. Osteoporosis is characterised by a reduction in bone density, associated with skeletal fragility and an increased risk of fracture after minimal trauma. Bisphosphonates decrease bone resorption and formation, but because of the transient uncoupling of these processes, there is an increase in bone density of 5-10%. Cyclical etidronate, alendronate and risedronate decrease the incidence of further vertebral fractures, but only alendronate and risedronate have been shown to reduce the risk of hip and other non-vertebral fractures. Paget's disease is a focal disorder of bone remodelling, associated with bone pain, skeletal deformity and increased risk of fracture. Specific treatment is directed at suppressing the overactivity of osteoclasts, thereby decreasing bone turnover. Tiludronate, risedronate and iv pamidronate reduce the activity of Paget's more effectively than etidronate. Although bisphosphonates decrease bone pain and reduce the activity of Paget's disease, there is currently no evidence that any treatment will prevent skeletal deformity, fractures or other complications of the condition. The choice of bisphosphonate for the treatment of osteoporosis and Paget's disease will depend on the potential advantages and disadvantages in the individual patient.

scholarly journals Comparative study of the in-hospital case-fatality rate of leptospirosis between pediatric and adult patients of different age groups

2004 ◽  
Vol 46 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Antonio Alberto Lopes ◽  
Everaldo Costa ◽  
Yara Aragão Costa ◽  
Edilson Sacramento ◽  
Antonio Ralph Ribeiro de Oliveira Junior ◽  
...  
Keyword(s):  
Medical Records ◽  
Case Fatality Rate ◽  
Age Groups ◽  
Case Fatality ◽  
Fatality Rate ◽  
Duration Of Symptoms ◽  
Hospital Case ◽  
Risk Of Death ◽  
Increased Risk ◽  
Potential Risk Factors

The main objective was to compare the in-hospital case-fatality rate of leptospirosis between pediatric (< 19 years) and adult (>19 years) patients, taking into account gender, renal function, duration of symptoms and jaundice. Medical records of 1016 patients were reviewed. Comparative analysis was restricted to 840 patients (100 pediatric, 740 adults) with recorded information on the variables included in the analysis. Among these patients 81.7% were male and 91.5% were icteric. The case-fatality rate of leptospirosis was 14.4%. The odds of death adjusted for gender, jaundice, duration of symptoms, serum urea and serum creatinine were almost four times higher for the adult than for the pediatric group (odds ratio (OR) = 3.94; 95% confidence interval = 1.19-13.03, p = 0.029). Among adults, increased age was also significantly and independently associated with increased risk of death (p < 0.01). Older patients were also more often treated by dialysis. In conclusion, the data suggest that the in-hospital case fatality rate of leptospirosis is higher for adults than for children and adolescents, even after taking into account the effects of several potential risk factors of death. Among adults, older age was also strongly and independently associated with higher risk of death.

scholarly journals Correlation between Potential Risk Factors and Pulmonary Embolism in Sarcoidosis Patients Timely Treated

2021 ◽  
Vol 10 (11) ◽  
pp. 2462
Author(s):  
Barbara Ruaro ◽  
Paola Confalonieri ◽  
Mario Santagiuliana ◽  
Barbara Wade ◽  
Elisa Baratella ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pulmonary Embolism ◽  
Potential Risk ◽  
Smoking Habit ◽  
Age At Diagnosis ◽  
Antiphospholipid Antibody ◽  
Increased Risk ◽  
Significant Difference ◽  
Antibody Positivity ◽  
Potential Risk Factors

Background. Some studies with inconclusive results have reported a link between sarcoidosis and an increased risk of pulmonary embolism (PE). This study aimed at assessing a possible correlation between potential risk factors and PE in sarcoidosis patients. Methods. A total of 256 sarcoidosis patients (84 males and 172 females; mean age at diagnosis 49 ± 13) were enrolled after giving written informed consent. Clinical evaluations, laboratory and radiology tests were performed to evaluate the presence of pulmonary embolism. Results. Fifteen sarcoidosis patients with PE (4 males and 11 females; mean age at diagnosis 50 ± 11), diagnosed by lung scintigraphy and 241 sarcoidosis patients without PE (80 males and 161 females; mean age at diagnosis 47 ± 13), were observed. There was a statistically significant increase of the presence of antiphospholipid antibodies in the sarcoidosis group with pulmonary embolism. There was no statistically significant difference between the two groups as to smoking habit, obesity or hereditary thrombophilia frequency (p > 0.05, respectively). Conclusions. This study demonstrates a significant correlation between the presence of antiphospholipid antibody positivity and the pulmonary embolism events in our sarcoidosis patients. Furthermore, we propose screening for these antibodies and monitoring, aimed at timely treatment.

Post-Bariatric Abdominoplasty: Analysis of 406 Cases With Focus on Risk Factors and Complications

2020 ◽  
Vol 41 (1) ◽  
pp. 59-71 ◽  
Author(s):  
Torsten Schlosshauer ◽  
Marcus Kiehlmann ◽  
Diana Jung ◽  
Robert Sader ◽  
Ulrich M Rieger
Keyword(s):  
Risk Factors ◽  
Wound Healing ◽  
Surgical Technique ◽  
Significant Risk ◽  
Level Of Evidence ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Wound Healing Problems ◽  
Bariatric Patients

Abstract Background Post-bariatric patients present a surgical challenge within abdominoplasty because of residual obesity and major comorbidities. In this study, we analyzed complications following abdominoplasty in post-bariatric patients and evaluated potential risk factors associated with these complications. Objectives The authors sought to determine the complications and risk factors following abdominoplasty in post-bariatric patients. Methods A retrospective study of patients who underwent abdominoplasty was performed from January 2009 to December 2018 at our institution. Variables analyzed were sex, age, body mass index (BMI), smoking, surgical technique, operative time, resection weight, drain output, and complications. Results A total of 406 patients were included in this study (320 female and 86 male) with a mean age of 44.4 years and a BMI of 30.6 kg/m2. Abdominoplasty techniques consisted of traditional (64.3%), fleur-de-lis technique (27.3%), and panniculectomy without umbilical displacement (8.4%). Overall complications recorded were 41.9%, the majority of these being wound-healing problems (32%). Minor and major complications were found in 29.1% and 12.8% of patients, respectively. A BMI value of ≥30 kg/m2 was associated with an increased risk for wound-healing problems (P = 0.001). The frequency of total complications was significantly related to age (P = 0.007), BMI (P = 0.004), and resection weight (P = 0.001). Abdominoplasty technique tended to influence total complications. Conclusions This study demonstrates in a fairly large sample of post-bariatric patients (n = 406) that abdominoplasty alone can be performed safely, with an acceptable complication rate. Age, BMI, and resection weight are shown to be significant risk factors for total complications. The role of surgical technique needs to be evaluated further. Level of Evidence: 4

scholarly journals Gender Differences in Psychosocial Outcomes of Hair Loss Resulting from Childhood Irradiation for Tinea Capitis

2021 ◽  
Vol 18 (15) ◽  
pp. 7825
Author(s):  
Liat Hoffer ◽  
Netta Achdut ◽  
Shifra Shvarts ◽  
Dorit Segal-Engelchin
Keyword(s):  
Gender Differences ◽  
Hair Loss ◽  
Medical Records ◽  
Tinea Capitis ◽  
Psychosocial Outcomes ◽  
Self Esteem ◽  
Psychosocial Needs ◽  
Increased Risk ◽  
Physical Health Problems ◽  
Physical Bullying

Recent studies have linked hair loss due to childhood irradiation for tinea capitis, a fungal infection of the scalp, to adverse psychosocial and health outcomes in women. However, no study to date has examined gender differences in the outcomes of this type of hair loss. The current study aimed to investigate gender differences in health and psychosocial outcomes of hair loss resulting from childhood irradiation for tinea capitis, and to identify the risk factors associated with depression in both men and women. Medical records held at the archives of the Israel National Center for Compensation of Scalp Ringworm Victims were retrospectively reviewed for 217 women and 105 men who received maximum disability compensation due to severe hair loss resulting from irradiation for tinea capitis. We found that women were at increased risk of developing psychosocial symptoms, including depression. Gender emerged as a significant predictor of depression, distinct from other predictors, such as marital status, age at radiation, exposure to verbal and physical bullying, low self-esteem, social anxiety, and physical health problems. Thus, the psychosocial needs of patients, particularly female patients, who were irradiated for tinea capitis during childhood need to be taken into account by the healthcare professionals treating them.

scholarly journals Prevalence and burden of chronic bronchitis symptoms: results from the BOLD study

2017 ◽  
Vol 50 (5) ◽  
pp. 1700621 ◽  
Author(s):  
Filip Mejza ◽  
Louisa Gnatiuc ◽  
A. Sonia Buist ◽  
William M. Vollmer ◽  
Bernd Lamprecht ◽  
...  
Keyword(s):  
Lung Function ◽  
Lung Disease ◽  
Chronic Bronchitis ◽  
Airflow Obstruction ◽  
Population Based ◽  
Normal Lung ◽  
Increased Risk ◽  
Potential Risk Factors ◽  
Definition Of ◽  
Disease Study

We studied the prevalence, burden and potential risk factors for chronic bronchitis symptoms in the Burden of Obstructive Lung Disease study.Representative population-based samples of adults aged ≥40 years were selected in participating sites. Participants completed questionnaires and spirometry. Chronic bronchitis symptoms were defined as chronic cough and phlegm on most days for ≥3 months each year for ≥2 years.Data from 24 855 subjects from 33 sites in 29 countries were analysed. There were significant differences in the prevalence of self-reported symptoms meeting our definition of chronic bronchitis across sites, from 10.8% in Lexington (KY, USA), to 0% in Ile-Ife (Nigeria) and Blantyre (Malawi). Older age, less education, current smoking, occupational exposure to fumes, self-reported diagnosis of asthma or lung cancer and family history of chronic lung disease were all associated with increased risk of chronic bronchitis. Chronic bronchitis symptoms were associated with worse lung function, more dyspnoea, increased risk of respiratory exacerbations and reduced quality of life, independent of the presence of other lung diseases.The prevalence of chronic bronchitis symptoms varied widely across the studied sites. Chronic bronchitis symptoms were associated with significant burden both in individuals with chronic airflow obstruction and those with normal lung function.

Preterm Pulmonary Hemorrhage Is Associated with Multiple Births but Not with Intracytoplasmic Sperm Injection: A Cohort Study on Medical Records

2018 ◽  
Vol 35 (11) ◽  
pp. 1087-1092
Author(s):  
Stefanie Stierling ◽  
Ralf-Dieter Hilgers ◽  
Sonja Trepels-Kottek ◽  
Konrad Heimann ◽  
Thorsten Orlikowsky ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Gestational Age ◽  
Intracytoplasmic Sperm Injection ◽  
Medical Records ◽  
Ductus Arteriosus ◽  
Pulmonary Hemorrhage ◽  
Multiple Births ◽  
Preterm Neonates ◽  
Increased Risk

Objective Pulmonary hemorrhage (PH) is a severe complication in preterm neonates. This study aims to identify risk factors and comorbidities of PH. Study Design A single-center cohort study on medical records including all preterm neonates of <30 weeks' gestational age was conducted in the neonatal intensive care unit of Universitätsklinikum Aachen, Germany. The occurrence of PH served as a primary end point. Gestational age, birthweight, sex, multiple births, intracytoplasmic sperm injection (ICSI), intubation, surfactant, antenatal steroids, intraventricular hemorrhage (IVH), amniotic infection syndrome, and persistent ductus arteriosus were studied as risk factors. Results In this study, 344 preterm neonates were included, of whom 36 suffered from PH (10.5%). The mean time of the first occurrence was the third day of life (standard deviation [SD]: 1.2). On average, the patients suffered from 1.5 incidents (SD: 0.8) of PH, of whom 50% were severe. Preterm neonates born as multiples (95% confidence interval [CI]: 3.1, 26.9) and those who suffered from IVH (95% CI: 2.7, 18.9) had a significantly increased risk of PH. ICSI was not an independent risk factor. Conclusion PH is significantly associated with IVH and multiple births but not with ICSI. The identification of patients at risk allows to apply prophylactic strategies of ventilation and pharmacological treatment.

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