SURVIVAL OF NONAGENARIAN PATIENTS WITH HIP FRACTURES: A COHORT STUDY

ABSTRACT Objective: The objective of this study was to assess survival and factors that may influence survival in nonagenarians with hip fracture. Methods: We retrospectively analyzed 134 nonagenarian patients admitted for hip fractures over a period of 9 years, and reviewed medical records and survival data from the National Population Register. The analysis included demographic data, ASA score, surgical delay, type of treatment, and mortality. Results: Mean patient age was 92.53 years (range 90-103 years). Of the total, 35.8% of the fractures involved the femoral neck and 64.2% were in the trochanteric region. Overall mortality was 18.7% at 30 days, and 9% at one year. Mean survival for the entire sample was 683±78.1 days, with a median of 339 days; survival in men and women was 595±136.8 days and 734±94.6 days, respectively. We found that type of fracture (p=0.026) and ASA score (p=0.004) were the main factors influencing survival. Kaplan-Meier survival analysis indicated that patients with extracapsular fractures treated by internal fixation had a better survival rate (p=0.047). There was no significant differences between sexes (p = 0.102) or diagnosis (p = 0.537) Conclusion: Although nonagenarian patients have numerous comorbidities, surgical treatment using internal fixation seems superior to a conservative approach. Level of Evidence III, Retrospective Comparative Study.

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Operational experience of the Dutch helicopter emergency medical services (HEMS) during the initial phase of the COVID-19 pandemic: jeopardy on the prehospital care system?

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01569-w ◽

2021 ◽

Author(s):

Quinten G. H. Rikken ◽

Sarah Mikdad ◽

Mathijs T. Carvalho Mota ◽

Marcel A. De Leeuw ◽

Patrick Schober ◽

...

Keyword(s):

The Netherlands ◽

Initial Phase ◽

Prehospital Care ◽

Operational Experience ◽

Level Of Evidence ◽

Historical Cohort ◽

Significant Difference ◽

One Year ◽

Retrospective Comparative Study ◽

Global And Local

Abstract Purpose The SARS-CoV-2 virus has disrupted global and local medical supply chains. To combat the spread of the virus and prevent an uncontrolled outbreak with limited resources, national lockdown protocols have taken effect in the Netherlands since March 13th, 2020. The aim of this study was to describe the incidence, type and characteristics of HEMS and HEMS-ambulance ‘Lifeliner 1’ dispatches during the initial phase of the COVID-19 pandemic compared to the same period one year prior. Methods A retrospective review of all HEMS and HEMS-ambulance ‘Lifeliner 1’ dispatches was performed from the start of Dutch nationwide lockdown orders from March 13th until May 13th, 2020 and the corresponding period one year prior. Dispatch-, operational-, patient-, injury-, and on-site treatment characteristics were extracted for analysis. In addition, the rate of COVID-19 positively tested HEMS personnel and the time physicians were unable to take call was described. Results During the initial phase of the COVID-19 pandemic, the HEMS and HEMS-ambulance was requested in 528 cases. One year prior, a total of 620 requests were received. The HEMS (helicopter and ambulance) was cancelled after deployment in 56.4% of the COVID-19 cohort and 50.7% of the historical cohort (P = 0.05). Incident location type did not differ between the two cohorts, specifically, there was no significant difference in the number of injuries that occurred at home in pandemic versus non-pandemic circumstances. Besides a decrease in the number of falls, the distribution of mechanisms of injury remained similar during the COVID-19 study period. There was no difference in self-inflicted injuries observed. Prehospital interventions remained similar during the COVID-19 pandemic compared to one year prior. Specifically, prehospital intubation did not differ between the two cohorts. The rate of COVID-19 positively tested HEMS personnel was 23.1%. Physicians who tested positive were unable to take call for a mean of 25 days (range 8–53). Conclusion A decrease in the number of deployments and increase in the number of cancelled missions was observed during the COVID-19 study period. No major differences in operational- and injury characteristics were found for HEMS and HEMS-ambulance dispatches between the initial phase of the COVID-19 pandemic in the Netherlands and the same period one year prior. These findings highlight the importance of continued operability of the HEMS, even during pandemic circumstances. Level of evidence III, retrospective comparative study.

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Are Sicker Patients Less Likely to Improve after Ankle Fusion?

Foot & Ankle Orthopaedics ◽

10.1177/2473011419s00252 ◽

2019 ◽

Vol 4 (4) ◽

pp. 2473011419S0025

Author(s):

Jessica M. Kohring ◽

Jeffrey R. Houck ◽

Sam Flemister ◽

John P. Ketz ◽

Irvin Oh ◽

...

Keyword(s):

Physical Function ◽

Demographic Data ◽

Ankle Arthrodesis ◽

Routine Care ◽

Computerized Adaptive Test ◽

Asa Score ◽

Ankle Fusion ◽

Patient Reported ◽

One Year ◽

The Impact

Category: Ankle Arthritis Introduction/Purpose: The influence of pre-existing medical conditions on post-operative patient reported outcomes are important to consider when selecting and preparing a patient for surgery. The purpose of this study was to determine the impact of medical comorbidities on post-operative physical function and pain in patients undergoing ankle arthrodesis. Methods: This was a Global IRB approved retrospective review of 88 consecutive ankle arthrodesis procedures performed from May 2015 to March 2018. Patient reported physical function (PF) and pain interference (PI) were measured as part of the routine care via the PROMIS PF and PI computerized adaptive test. A chart review was performed to determine the Charlson Comorbidities Index (CCI), ASA scores, and demographic data. A multivariate analysis predicting pre- and post-operative PROMIS PF based on PI, ASA score, and CCI was performed. Spearman correlations for CCI, ASA, pre- and post-operative PROMIS T- scores for PF and PI were calculated. Results: The ASA score and CCI were not associated with pre-operative PI, although the CCI was predictive of pre-operative physical function (p=0.06), indicating that patients with a higher CCI had lower pre-operative PF. Pre-operative PF and ASA were the best individual predictors of physical function at 6 months post-operatively (r=0.51). At 6 months after undergoing ankle arthrodesis, there was no correlation between CCI and post-operative PROMIS PF and PI outcome T-scores (r=0.02, r=-0.06, respectively), this continued at 1 year post-operatively (r=-0.17, r=0.04, respectively). Demographic data, ASA, CCI, and mean PROMIS T-scores are included in Table 1. Conclusion: Sicker patients (ASA score=3) and those with lower pre-operative function recovered more slowly as indicated by lower physical function at 6 months and obtained less physical function benefit from ankle fusion than healthier patients at one year. The results of this study can assist surgeons with risk stratification and educating patients about surgical expectations as pre- operative physical function and ASA score appear to influence post-operative physical function after undergoing ankle arthrodesis.

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Pediatric Focal Segmental Glomerulosclerosis: Favorable Transplantation Outcome With Plasma Exchange

10.21203/rs.3.rs-806062/v1 ◽

2021 ◽

Author(s):

Fatina I Fadel ◽

Hafez M Bazaraa ◽

Mohamed A Abdel Mawla ◽

Doaa M Salah

Keyword(s):

Plasma Exchange ◽

Focal Segmental Glomerulosclerosis ◽

Survival Data ◽

Early Recurrence ◽

Transplant Recipients ◽

Kidney Transplant Recipients ◽

Segmental Glomerulosclerosis ◽

Kaplan Meier ◽

One Year

Abstract Background: Although kidney transplantation (KT) is the treatment of choice for pediatric kidney failure (KF); concerns for recurrence in cases of focal segmental glomerulosclerosis (FSGS) are still present. This study aimed to investigate the outcome of KT in children with KF secondary to FSGS, with implementation of preemptive perioperative plasma exchange (PE) for non-genetically proven patients.Methods: Forty FSGS pediatric kidney transplant recipients were studied. Of them: 12 patients (30%) had genetically proven NPHS2 mutations/familial and 28 (70%) were sporadic FSGS patients. Sporadic patients electively received 6 preoperative PE sessions. Recurrence of proteinuria was managed with PE and Rituximab (RTX). Kaplan-Meier curves were used to analyze graft and recurrence free survival data.Results: The mean follow-up duration after KT was 3.8 ± 2.86 years. Recurrence of proteinuria was encountered early postoperative in 11 patients (27.5%) and late (1.6 and 2.9 years after KT) in 2 patients (5%). Proteinuria was less in patients underwent native nephrectomy than others immediately postoperative and at assessment (p= 0.002 & 0.0031 respectively). One-year graft and patient survival was 93.8% with a mean 1-year serum creatinine of 0.67 ± 0.25 mg/dl. Three graft losses (7.5%) were due to chronic rejection 3.3, 3.75 and 4.17 years after KT and 2 patients' mortality (5%) occurred early postoperative (first 2 weeks) due to infection.Conclusion: FSGS transplanted children have favorable outcomes with perioperative PE for non-genetically proven cases. Early recurrence after KT can be successfully managed with PE and RTX.

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Distal Metatarsal Segmental Shortening for the Treatment of Chronic Metatarsophalangeal Dislocation of Lesser Toes

Foot & Ankle International ◽

10.1177/1071100720961086 ◽

2020 ◽

pp. 107110072096108

Author(s):

Tzu-Cheng Yang ◽

Yun-Hsuan Tzeng ◽

Chien-Shun Wang ◽

Ming-Chau Chang ◽

Chao-Ching Chiang

Keyword(s):

Demographic Data ◽

Level Of Evidence ◽

Radiographic Measurements ◽

Group I ◽

Significant Difference ◽

Scale Scores ◽

Group Ii ◽

American Orthopaedic ◽

Retrospective Comparative Study ◽

Mtp Joints

Background: This retrospective study aimed to describe the techniques and results of distal metatarsal segmental shortening (DMSS) for the treatment of chronic irreducible metatarsophalangeal (MTP) dislocation of lesser toes. Methods: We retrospectively reviewed patients who underwent DMSS for chronic dislocation of MTP joints of lesser toes between January 2010 and December 2017 with follow-up of at least 24 months. Demographic data, radiographic measurements, functional outcomes, and complications were analyzed. Furthermore, the results of patients with short segment of shortening (group I, <10 mm) were compared to those with long segment of shortening (group II, ≥10 mm). A total of 43 MTP joints of 30 patients with an average age of 70.4 years were included. Results: Union was observed in 42 metatarsals (97.7%). Mean American Orthopaedic Foot & Ankle Society scale scores improved significantly from 42.2 (range, 15-65) preoperatively to 79.1 (range, 52-90) ( P < .001). Mean visual analog scale pain score improved significantly from 5.0 (range, 1-9) preoperatively to 1.8 (range, 0-6) ( P < .001). Complications included 1 nonunion, 1 osteonecrosis, 3 metatarsal angulation, 4 recurrent instability, 4 symptomatic osteoarthritis, 3 transfer metatarsalgia, and 1 floating toe. Group I included 23 MTP joints and group II included 20 MTP joints. There was no significant difference in clinical outcomes and complications between the 2 groups. Conclusion: DMSS was a reliable procedure for the treatment of chronic irreducible dislocated MTP joint of lesser toes. It provided satisfactory surgical outcomes and a low rate of postoperative complications, regardless of length of metatarsal shortening. Level of Evidence: Level III, retrospective comparative study.

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Are inflatable play structures really safe for our children?

Journal of Children s Orthopaedics ◽

10.1302/1863-2548.12.170191 ◽

2018 ◽

Vol 12 (3) ◽

pp. 282-287 ◽

Cited By ~ 2

Author(s):

L. Corominas ◽

A. Fernandez-Ansorena ◽

P. Martinez-Cepas ◽

J. Sanpera ◽

A. Obieta

Keyword(s):

Risk Factors ◽

Prospective Study ◽

Demographic Data ◽

Anatomical Location ◽

Level Of Evidence ◽

Adult Supervision ◽

Female Children ◽

One Year ◽

A Prospective Study ◽

And Control

PurposeThe frequency of injuries sustained while playing on inflatable toys such as bouncy castles have rapidly increased. These supposedly safe structures are likely unsafe. The objective of this review was to investigate the risk that these attractions represent and the necessary measures to minimize risk of accidents.MethodsWe conducted a prospective study of 114 patients over a period of one year (2015 to 2016). Demographic data collected included: age, gender, anatomical location and side of involvement as well as supervision of the child whilst on the bouncy castle. The extracted data include mechanism of injury and risk factors, i.e. lack of supervision of the child, amounts of users jumping at the same time.ResultsThe injuries were slightly more frequent in male than female children; 2:1 up to six years of age. From the age of ten to 14 years the ration evened to 1:1, the higher incidence in female children was between the ages of six to eight years. The most common injuries were to the humerus, followed by the distal radius. Only 28% of the parents said they were supervising while the child was jumping.ConclusionInjuries associated with inflatable bouncers have increased over time. The main risk factors: were lack of effective adult supervision and the shared use by an excessive number of participants of different ages and weights. These considerations lead to the conclusion that there is a necessity to enhance child health surveillance and to consider limiting bouncer usage to children over the age of six years, to prevent and control injuries and to minimize their consequences.Level of EvidenceII - prospective study

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Hematopoietic Stem Cell Transplantation (HSCT) Using Plasma Depleted Umbilical Cord Blood (UCB) That Were Not Red Cell Depleted.

Blood ◽

10.1182/blood.v108.11.5231.5231 ◽

2006 ◽

Vol 108 (11) ◽

pp. 5231-5231

Author(s):

Robert Chow ◽

Patrick Tan ◽

Tang-Her Jaing ◽

Joseph Rosenthal ◽

Auayporn Nademanee ◽

...

Keyword(s):

Stem Cell ◽

Survival Data ◽

Chronic Gvhd ◽

Cell Loss ◽

Red Cell ◽

Racially Diverse ◽

Hematopoietic Stem ◽

Kaplan Meier ◽

Transplant Center ◽

One Year

Abstract UCB is an attractive source for HSCT; however, limiting cell dose has hampered its widespread use. The red cell depletion (RCD) techniques that are widely used incur significant nucleated cell loss after processing; therefore, to minimize cell loss and still reduce volume during processing, a technique was devised to deplete plasma (PD) but not red blood cells. A large racially diverse inventory of over 25,000 PD UCB is available on stem cell registries. Of the 265 PD UCB transplanted into 240 patients up to May 2006, an updated retrospective audited analysis of all 205 patients with engraftment and/or survival data was performed. The characteristics for the patients were: median age 8.8 yo, range 0.3–59, 76 ≥16 yo (32%); median weight 29 kg, range 5–137, 84 ≥50kg (35%); male 59%; median # HLA ABDR matches 4.0; median pre-freeze TNC dose 5.31 × 107/kg (n=229); transplant center reported median post-thaw TNC dose 4.92 × 107/kg (n=112); median pre-freeze CD34 dose 1.7 × 105/kg; malignant indications 71%; transplants outside U.S. 39%; double transplant 23%; and non-myeloablative 15%. For all engrafted patients, the median time to engraftment for ANC 500 (n=192), platelet 20K (n=174) and 50K (n=169) were 22.0 days (range 7–64), 49.5 days (range 12–181), and 63.5 days (range 21–374) respectively. Kaplan-Meier estimates of engraftment of ANC500, platelet 20K and 50K engraftment were 88±3%, 82±4% and 76±4% respectively. The incidence of grade III–IV acute GVHD and extensive chronic GVHD were 13% and 14% respectively. One-year relapse rate was 23±4% for all patients (n=190), and TRM was 29±3% (n=203) at 1 year. With a median follow-up of 178 days (range 4–1402 days) for the surviving patients, the Kaplan-Meier estimates of 1-year OS (n=203) and DFS (n=190) are 59±4% and 54±4% respectively for all patients. These results demonstrate that HSCT using PD UCB can be performed safely and effectively.

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ALLOGENEIC PLATELET-RICH PLASMA FOR ROTATOR CUFF REPAIR

Acta Ortopédica Brasileira ◽

10.1590/1413-785220172501163417 ◽

2017 ◽

Vol 25 (1) ◽

pp. 38-43 ◽

Cited By ~ 4

Author(s):

CHRIS HYUNCHUL JO ◽

JI SUN SHIN ◽

SEUNG YEON LEE ◽

SUE SHIN

Keyword(s):

Rotator Cuff ◽

Rotator Cuff Repair ◽

Platelet Rich Plasma ◽

Level Of Evidence ◽

Cross Sectional ◽

Significant Difference ◽

One Year ◽

Arthroscopic Rotator Cuff ◽

Retrospective Comparative Study ◽

Cuff Repair

ABSTRACT Objective: To investigate the safety and efficacy of allogeneic platelet-rich plasma (PRP) in rotator cuff repair . Methods: Seventeen patients with a full-thickness rotator cuff tear were included. Ten patients underwent arthroscopic rotator cuff repair with allogeneic, and seven patients with autologous PRP. Three PRP gels in a volume 3 ml each were applied between the torn end and the greater tuberosity. Clinical outcomes were assessed preoperatively and at a minimum of 2 years after surgery. Structural outcomes were evaluated with the presence of retear and the change of the cross-sectional area (ACT) of the supraspinatus . Results: Allogeneic PRP did not cause any adverse events during the follow-up period. There was no significant difference in the clinical outcome measures between the two groups (all p > 0.05). The retear rate was 33.3% and 25.0% in the allogeneic group and autologous group, respectively (p = 0.764). The change between the one-year postoperative and immediately postoperative ACT was not also significantly different between the two groups (p = 0.373) . Conclusion: Allogeneic PRP in arthroscopic rotator cuff did not cause any local or general complications and that has the efficacy comparable to autologous PRP with respect to the clinical and structural outcomes. Level of Evidence III, Retrospective Comparative Study.

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Weight gain and menstrual abnormalities between users of Depo-provera and Noristerat

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20192131 ◽

2019 ◽

Vol 8 (6) ◽

pp. 2226

Author(s):

Yusuf Abisowo Oshodi ◽

Joy Oyinyechi Agbara ◽

Olamide O. Ade fashola ◽

Fatimat Motunrayo Akinlusi ◽

Haleema Folasade Olalere ◽

...

Keyword(s):

Weight Gain ◽

Contraceptive Method ◽

Demographic Data ◽

Unwanted Pregnancy ◽

Hormonal Contraceptive ◽

Other Information ◽

Menstrual Pattern ◽

One Year ◽

Long Acting ◽

Retrospective Comparative Study

Background: Progesterone only injectable contraceptive provides long acting contraception against unwanted pregnancy. Alterations in menstrual pattern are a well known side effect of this effective contraceptive method. Objective of this study was to compare the weight gain and pattern of menstrual abnormalities in users of Depot Medroxyprogesterone Acetate (DMPA) and Norethisterone Enanthate (Noristerat) in LASUTH.Methods: Retrospective comparative study conducted over a 3year period (January 2013 to December 2015) and involving 237 subjects who used injectable hormonal contraceptive (either DMPA or Noristerat). Case records of all the subjects were retrieved and information obtained on socio-demographic data, parity, previous contraceptive method and reason for discontinuation within one year of usage. Other information including subjects’ weight, menstrual cycle length and pattern, and side effects were collected at 3, 6 and 12 months for DMPA group and 2, 4 and 12 months interval for Noristerat group. Data obtained were analyzed using statistical packages for social sciences (version 19).Results: The combined mean age was 34.15±1.36 years. The mean weight at commencement was 68.16kg for DMPA and 66.61kg for Noristerat users while after a year, it significantly increased to 71.27kg for DMPA and 69.07kg for Noristerat users (P<0.05). No change in menstrual pattern was noted in 10% of DMPA and 7% of Noristerat users while 60% of DMPA and 57% of Noristerat had amenorrhoea by the end one year period. Five percent each of DMPA and Noristerat users perceived weight gain as problem significant enough to discontinue both methods respectively. Overall, 24% of DMPA and 19.1% of Noristerat users discontinued use after one year.Conclusions: There were significant weight gain between users of DMPA and Noristerat which was not considered a problem. Amenorrhoea was the commonest menstrual abnormality responsible for discontinuation of either method.

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An Analysis of Dental Implants Survival and Success

Revista de Chimie ◽

10.37358/rc.18.9.6554 ◽

2018 ◽

Vol 69 (9) ◽

pp. 2465-2466

Author(s):

Iustin Olariu ◽

Roxana Radu ◽

Teodora Olariu ◽

Andrada Christine Serafim ◽

Ramona Amina Popovici ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Medical History ◽

Retrospective Cohort Study ◽

Odds Ratio ◽

Retrospective Cohort ◽

Demographic Data ◽

Kaplan Meier ◽

Number Of Patients ◽

Health Related

Osseointegration of a dental implant may encounter a variety of problems caused by various factors, as prior health-related problems, patients� habits and the technique of the implant inserting. Retrospective cohort study of 70 patients who received implants between January 2011- April 2016 in one dental unit, with Kaplan-Meier method to calculate the probability of implants�s survival at 60 months. The analysis included demographic data, age, gender, medical history, behavior risk factors, type and location of the implant. For this cohort the implants�survival for the first 6 months was 92.86% compared to the number of patients and 97.56% compared to the number of total implants performed, with a cumulative failure rate of 2.43% after 60 months. Failures were focused exclusively on posterior mandible implants, on the percentage of 6.17%, odds ratio (OR) for these failures being 16.76 (P = 0.05) compared with other localisations of implants, exclusively in men with median age of 42 years.

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Is It Definitely Clear That Long-Term Survival after Breast Cancer Surgery Is Not Affected by Anaesthetics?

Cancers ◽

10.3390/cancers13143390 ◽

2021 ◽

Vol 13 (14) ◽

pp. 3390

Author(s):

Mats Enlund

Keyword(s):

Breast Cancer ◽

Survival Data ◽

Retrospective Studies ◽

Breast Cancer Surgery ◽

Breast Cancer Patients ◽

Term Survival ◽

Long Term Survival ◽

Significant Difference ◽

One Year

Retrospective studies indicate that cancer survival may be affected by the anaesthetic technique. Propofol seems to be a better choice than volatile anaesthetics, such as sevoflurane. The first two retrospective studies suggested better long-term survival with propofol, but not for breast cancer. Subsequent retrospective studies from Asia indicated the same. When data from seven Swedish hospitals were analysed, including 6305 breast cancer patients, different analyses gave different results, from a non-significant difference in survival to a remarkably large difference in favour of propofol, an illustration of the innate weakness in the retrospective design. The largest randomised clinical trial, registered on clinicaltrial.gov, with survival as an outcome is the Cancer and Anesthesia study. Patients are here randomised to propofol or sevoflurane. The inclusion of patients with breast cancer was completed in autumn 2017. Delayed by the pandemic, one-year survival data for the cohort were presented in November 2020. Due to the extremely good short-term survival for breast cancer, one-year survival is of less interest for this disease. As the inclusions took almost five years, there was also a trend to observe. Unsurprisingly, no difference was found in one-year survival between the two groups, and the trend indicated no difference either.

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