Clinical, Biochemical and Radiological Factors Affecting the Prognosis of Neurological Deficit Improvement in Spinal Tuberculosis Patients at Hospitals of Sabah

The incidence of spinal tuberculosis is highest in developing nations. We aimed to analysethe clinical, biochemical, and radiological parameters in spinal tuberculosis patients withsignificant neurological impairment in relation to their functional outcome. This cross-sectional study involved 224 patients who had been presented to three hospitals in Sabah from July 2017 to June 2018, with significant neurological impairment fulfilling the inclusion criteria were enrolled. Diagnosis of spinal tuberculosis was determined by clinical and radiological factors and confirmed with histopathology, micro bacteriology, and immunoassay. Patients with significant neurology received standard treatment protocol according to the middle pathway regime, anti-tuberculosis for the first three weeks, and were subjected to surgery if there was no improvement. Age, duration of symptoms, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white cell count (WCC), thoracolumbar spine involvement, and presence of soft tissue collection were evaluated. Modified Barthel Index (MBI) was used to assess the functional outcome. After a year, 146 patients (65.1%) had good functional outcomes and 78 patients had no significant improvement. On univariate analysis, there were no significant correlations between functional outcome and age (p>0.45); duration of symptoms (p>0.68); CRP (p>0.76); WCC (p>0.99); and presence of soft tissue collection (p>0.21).. High ESR (p<0.008) and thoracolumbar lesions were associated with poor functional outcomes (p<0.033). Higher ESR values and thoracolumbar lesions were associated with poor prognostic factors functional outcome in spinal tuberculosis patients.

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Necrotizing soft tissue infections of perianal and perineal region - still lethal infection

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh151217005s ◽

2017 ◽

Vol 145 (1-2) ◽

pp. 32-37

Author(s):

Goran Stanojevic ◽

Milica Nestorovic ◽

Branko Brankovic ◽

Miodrag Stojanovic ◽

Milan Radojkovic ◽

...

Keyword(s):

Risk Factors ◽

Soft Tissue ◽

Soft Tissue Infection ◽

Univariate Analysis ◽

Tissue Infection ◽

Fatality Rate ◽

Duration Of Symptoms ◽

Necrotizing Soft Tissue Infection ◽

Stoma Creation ◽

Perineal Region

Introduction/Objective. Necrotizing soft tissue infection is a life-threatening condition, characterized by widely spread necrosis of the skin, subcutaneous adipose tissue, fascia, and muscle. This study aimed to determine the risk factors associated with lethality due to necrotizing soft tissue infection of perianal and perineal region, for all patients surgically treated at a tertiary referral hospital. Methods. A retrospective review of 38 patients with necrotizing soft tissue infection of the perianal and perineal region, in the period between January 2007 and December 2014, was performed. We reviewed sex and age of the patients, the presence of known risk factors (diabetes mellitus, obesity, alcoholism), localization of necrotizing soft tissue infection, duration of symptoms, length of hospitalization, the number of necessary operations done, the performance of the stoma, and the outcome. We used logistic regression to identify the predictors of lethal outcome in a univariate analysis with estimated odds ratios and 95% confidence intervals. Results. There was a significantly higher fatality rate in the group of patients over 60 years of age (p < 0.05), with more than 10 days from the onset of symptoms to the treatment (p < 0.05), with a perianal localization (p < 0.05), and stoma creation (p < 0.05). The overall fatality rate was 18.4%. Conclusion. Patients? age, time passed between the onset of the symptoms and the initiation of the treatment, perianal localization, and stoma creation were related to higher lethality risk.

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The Radiological and Functional Outcomes of Pelvic Fractures Treated by External Fixator

10.53350/pjmhs2115103458 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3458-3459

Author(s):

Husain Bux ◽

Imamud din ◽

Nazia Azeem

Keyword(s):

Functional Outcome ◽

Pelvic Fracture ◽

External Fixator ◽

Functional Outcomes ◽

Case Series ◽

Pelvic Fractures ◽

X Rays ◽

Radiological Outcome ◽

Duration Of Symptoms ◽

Satisfactory Outcome

Objective: To determine the radiological and functional outcomes of pelvic fracture’s patients treated by external fixator. Methods: A case series was done at orthopaedics unit of Jinnah Postgraduate Medical Center in Karachi from January to July 2013. All patients with either gender age range from 20 to 50 years pelvic fracture of type A2 or B of less than 1 week duration were enrolled in this study. Patients were given spinal anaesthesia and the A.O external fixator was applied. Patients were followed for 3 months for final outcome. To assess the radiological outcome X-Rays pelvis AP view was done and for functional outcome was assessed in terms of severity of pain using Visual Analogue Score. The presence of acceptable radiological and functional outcome was taken as a satisfactory outcome as per operational definition. Results: Mean age of the patients was 36.39±7.89 years, duration of symptoms 3.58±1.01 days, weight 67.70±7.67Kg, Height 1.56±0.058-meter, average BMI 23.36±4.05 Kg/m2. There were 65 (67%) males and 32(33%) females. Acceptable radiological outcome was found in 89 (91.80%) patients while acceptable functional outcome was found in 76 (78.40%) patients. A satisfactory outcome was found in 73(75.30%) patients. Conclusion: Radiological and functional outcome in patients with pelvic fractures treated by external fixator was found to be acceptable in most of the patients. Keywords: Pelvic Fracture, satisfactory outcome, radiological and functional outcomes, external fixator

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A Rare Case of Spinal Leprosy Mimicking Spinal Tuberculosis

International Journal of Human and Health Sciences (IJHHS) ◽

10.31344/ijhhs.v0i0.151 ◽

2019 ◽

pp. 33

Author(s):

K Thuraikumar ◽

V Naveen ◽

Mustaqim A ◽

Arieff AA ◽

K Shri ◽

...

Keyword(s):

Back Pain ◽

Soft Tissue ◽

Histopathological Examination ◽

Posterior Instrumentation ◽

Spinal Tuberculosis ◽

Previous History ◽

Skin Lesions ◽

Titanium Implants ◽

Paravertebral Abscess ◽

History Of

Introduction: Spinal tuberculosis is the most common manifestation of extrapulmonar y tuberculosis. A combination of leprosy and tuberculosis is a rare entity.Case report: A 44-year-old male patient working as a laborer presented to our hospital with complaints of severe back pain and swelling over the back, difficulty in walking, associated with constitutional symptoms. On admission, he was febrile and had leukocytosis. Initial spine X-ray showed end plate destruction and increase in soft tissue shadow at the level of T8-T9. CT spine revealed thoracic paravertebral collection extending from T7 to T9 levels, suggest ive of tuberculous spondylitis with cold abscess. Patient refused a transpedicular biopsy and was started on anti-tubercular therapy. Two weeks after commencement of treatment, he developed worsening back pain and weakness of the lower extremities. MRI spine showed a paravertebral abscess and posterior soft tissue edema involving level of T7 to T11. Patient underwent a posterior decompression, debridement and posterior instrumentation. He was discharged well, there was improvement of his lower limb power. Upon clinic review, he complained of multiple hyperpigmented, painless, nonpruritic skin lesions over the trunk and back. No previous history of eczema, psoriasis and Tinea corporis. Given the history of allergy, initial impression was hypersensitivity reaction towards the titanium implants, and he was started on anti-histamines. However, there was no improvements seen. Histopathological examination of skin lesions revealed presence of granuloma within the dermis layer, composed of epitheloid, histiocytes, lymphocytes and plasma cells. Wade-Fite stain for Mycobacterium leprae is positive. Slit skin smear shows multibacillary leprosy. Patient was started on multidrug therapy (rifampicin, clofazimine and dapsone) for 1 year. He has recovered well.International Journal of Human and Health Sciences Supplementary Issue: 2019 Page: 33

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Multivariate ordered logistic regression analysis of the postoperative effect of symptomatic discoid lateral meniscus

Archives of Orthopaedic and Trauma Surgery ◽

10.1007/s00402-021-03821-3 ◽

2021 ◽

Author(s):

Shun-Jie Yang ◽

Jian Li ◽

Yang Xue ◽

Zhong Zhang ◽

Gang Chen

Keyword(s):

Logistic Regression ◽

Age Of Onset ◽

Univariate Analysis ◽

Arthroscopic Surgery ◽

Lateral Meniscus ◽

Postoperative Outcomes ◽

Discoid Lateral Meniscus ◽

Work Intensity ◽

Duration Of Symptoms ◽

Ordered Logistic Regression

Abstract Introduction The postoperative effect of arthroscopy in the treatment of symptomatic discoid lateral meniscus (DLM) varies greatly among individuals. Therefore, this study aims to investigate the factors affecting the postoperative outcomes of symptomatic DLM. Materials and methods According to the inclusion and exclusion criteria, patients with symptomatic single-knee DLM who underwent arthroscopic surgery at our hospital from 9/2008 to 9/2015 were included. Retrospectively collected 16 factors probably affecting postoperative outcomes. The Ikeuchi grade system was used to evaluate the knee joint function. Univariate analysis was performed by Kruskal–Wallis rank-sum test or Mann–Whitney U test, and multivariate analysis by ordered logistic regression. P < 0.05 was considered statistically significant. Results A sum of 502 patients was included, including 353 females (70.3%) and 149 males (29.7%). Difference between preoperative and postoperative Ikeuchi grade was statistically significant (P < 0.001). Female was bad to obtain a good Ikeuchi grade (P = 0.009, OR 0.458). Outerbridge grade (P = 0.018, OR 0.638) was negatively correlated with Ikeuchi grade. BMI (P = 0.001, OR 0.875) and work intensity (P = 0.020, OR 0.611) were inversely correlated with Ikeuchi grade. Age of onset (P < 0.001, OR 0.956) and symptoms duration (P < 0.001, OR 0.988) were negatively correlated with Ikeuchi grade. Besides, compared to total meniscectomy, meniscoplasty with a repair was an unfavourable factor for Ikeuchi grade (P = 0.044, OR 0.245). Conclusions With the increase of BMI, work intensity, age of onset, duration of symptoms, and the severity of cartilage lesion, the postoperative results become worse. Moreover, female and meniscoplasty with repair are risk factors for the postoperative outcomes.

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Impella CP Implantation during Cardiopulmonary Resuscitation for Cardiac Arrest: A Multicenter Experience

Journal of Clinical Medicine ◽

10.3390/jcm10020339 ◽

2021 ◽

Vol 10 (2) ◽

pp. 339

Author(s):

Vassili Panagides ◽

Henrik Vase ◽

Sachin P. Shah ◽

Mir B. Basir ◽

Julien Mancini ◽

...

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Cardiopulmonary Resuscitation ◽

Univariate Analysis ◽

Cerebral Performance Category ◽

Neurological Impairment ◽

Left Ventricular ◽

Circulatory Support ◽

Factors Associated ◽

Analysis Survival

Background: Impella CP is a left ventricular pump which may serve as a circulatory support during cardiopulmonary resuscitation (CPR) for cardiac arrest (CA). Nevertheless, the survival rate and factors associated with survival in patients undergoing Impella insertion during CPR for CA are unknown. Methods: We performed a retrospective multicenter international registry of patients undergoing Impella insertion during on-going CPR for in- or out-of-hospital CA. We recorded immediate and 30-day survival with and without neurologic impairment using the cerebral performance category score and evaluated the factors associated with survival. Results: Thirty-five patients had an Impella CP implanted during CPR for CA. Refractory ventricular arrhythmias were the most frequent initial rhythm (65.7%). In total, 65.7% of patients immediately survived. At 30 days, 45.7% of patients were still alive. The 30-day survival rate without neurological impairment was 37.1%. In univariate analysis, survival was associated with both an age < 75 years and a time from arrest to CPR ≤ 5 min (p = 0.035 and p = 0.008, respectively). Conclusions: In our multicenter registry, Impella CP insertion during ongoing CPR for CA was associated with a 37.1% rate of 30-day survival without neurological impairment. The factors associated with survival were a young age and a time from arrest to CPR ≤ 5 min.

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Scaphoid Nonunion Is a Disabling Problem in a Military Population

Hand ◽

10.1177/15589447211003177 ◽

2021 ◽

pp. 155894472110031

Author(s):

Nicholas H. Lake ◽

Rafae Khan ◽

Kyle W. Mombell ◽

Mary Fergus ◽

Dominic Gomez-Leonardelli

Keyword(s):

Functional Outcome ◽

Military Service ◽

Functional Outcomes ◽

High Rate ◽

Scaphoid Nonunion ◽

Military Population ◽

Outcome Scores ◽

The Mean ◽

Return To Duty

Background Scaphoid nonunion can occur in up to 55% of displaced scaphoid fractures. Long-term functional outcomes of this injury are lacking. In addition, no study has published rate of return to active military service after this injury. Our goal was to educate providers and patients on expected functional outcomes and return to duty after treatment of scaphoid nonunion. Methods We conducted a retrospective review of patients who underwent scaphoid nonunion repair at our institution from 2008 to 2017. The primary outcome measures were union rates, return to duty rates, and functional outcome scores obtained by telephone call. A total of 144 patients were included and 40 responded to our call for long-term follow-up. Results A total of 72% of patients achieved union after surgery, 18% required revision surgery, and 74% of patients were able to return to full duty after surgery. However, this number progressively decreased at 1, 2, and 5 years after surgery. At an average of 5.9 years after surgery, the mean Quick Disabilities of the Arm, Shoulder, and Hand (qDASH) score was 23.9. The mean qDASH for patients who achieved union (21.9) was significantly lower than those with persistent nonunion (29.2) ( P = .0115). Conclusion Scaphoid nonunion is a difficult problem in the military. We found a high rate of persistent nonunion often requiring revision to partial or full wrist arthrodesis. In addition, our long-term functional outcome scores demonstrate significant disability after this injury, even when union is achieved. This information can help us better counsel our patients and set expectations after treatment of this injury.

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SOFT TISSUE CAM IMPINGEMENT IN ADOLESCENTS: MRI REVEALS IMPINGEMENT LESIONS UNDERAPPRECIATED ON X-RAY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00063 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0006

Author(s):

Benjamin L. Johnson ◽

Hamza Alizai ◽

Montanez Ben ◽

K. John Wagner ◽

Tyler Youngman ◽

...

Keyword(s):

Soft Tissue ◽

Femoral Head ◽

Plain Radiograph ◽

Alpha Angle ◽

Duration Of Symptoms ◽

X Ray ◽

Insidious Onset ◽

Adolescent Patients ◽

Cam Impingement ◽

Soft Impingement

Background: The presence of femoroacetabular impingement (FAI) in adolescents has been established. However, the existence of a non-ossified CAM lesion in adolescent femoracetabular impingement (FAI) is not well described. Hypthesis/Purpose: The purpose of this study is to evaluate the presence of a non-ossified or soft CAM lesion in adolescent patients with FAI. Methods: A review of a prospective cohort of patients with symptomatic FAI in an institutional registry was performed. Subjects were included if they had an MRI and lateral x-ray of the hip (45o Dunn, Cross Table, or frog) at a baseline visit. On MRI, evaluation of the anterolateral femoral head was evaluated using radial, coronal, sagittal, or axial oblique sequences. When a soft CAM lesion was identified (all found between 2-5 o’clock), an alpha angle was performed on MRI and plain radiograph. The cohort of soft CAM lesions was reviewed and differences between radiographic and MRI alpha angles were assessed using a paired T-Test. Results: Thirty-one (9.3%) of 332 hips (mean age 16.4 yrs, range 13.66-19.59 yrs; 83.9% F) were identified with a soft impinging lesion at the femoral head-neck junction on MRI. The most common primary sport was track & field (4), the average duration of symptoms was 92.4 weeks and a majority with insidious onset (77.4%). The average alpha angle on MRI was greater than on x-ray [63.53 ± 7.94o vs 51.25 ± 7.92o; p<0.05]. All subjects with soft CAM lesions demonstrated soft tissue consistent with extension of the physis (n=1),thickening of the peri-chondral ring (n=22), or thickening of the periosteum (n=8). Twenty-two of these patients (71%) with soft impingement underwent hip preservation surgery (n=13 labral repairs) with improvements in clinical outcome. Conclusion: In adolescent patients with symptomatic hip impingement, MRI may be useful to identify soft CAM lesions (non-ossified) that are under-represented on x-ray.

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Early versus late decompressive craniectomy in traumatic brain injury: A retrospective comparative case study

Trauma ◽

10.1177/1460408620935766 ◽

2020 ◽

pp. 146040862093576

Author(s):

Nida Fatima ◽

Mujeeb-Ur-Rehman ◽

Samia Shaukat ◽

Ashfaq Shuaib ◽

Ali Raza ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Regression Analysis ◽

Brain Injury ◽

Functional Outcome ◽

Decompressive Craniectomy ◽

Univariate Analysis ◽

Timing Of Surgery ◽

Comparative Case Study ◽

Outcome Parameters ◽

Good Functional Outcome

Objectives Decompressive craniectomy is a last-tier therapy in the treatment of raised intracranial pressure after traumatic brain injury. We report the association of demographic, radiographic, and injury characteristics with outcome parameters in early (<24 h) and late (≥24 h) decompressive craniectomy following traumatic brain injury. Methods We retrospectively identified 204 patients (158 (early decompressive craniectomy) and 46 (late decompressive craniectomy)), with a median age of 34 years (range 2–78 years) between 2015 and 2018. The primary endpoint was Glasgow Outcome Scale Extended (GOSE) at 60 days, while secondary endpoints included Glasgow Coma Score (GCS) at discharge, mortality at 30 days, and length of hospital stay. Regression analysis was used to assess the independent predictive variables of functional outcome. Results With a clinical follow-up of 60 days, the good functional outcome (GOSE = 5–8) was 73.5% versus 74.1% (p = 0.75) in early and late decompressive craniectomy, respectively. GCS ≥ 9 at discharge was 82.2% versus 91.3% (p = 0.21), mortality at 30 days was 10.8% versus 8.7% (p = 0.39), and length of stay in the hospital was 21 days versus 28 days (p = 0.20), respectively, in early and late decompressive craniectomy groups. Univariate analysis identified that GCS at admission (0.07 (0.32–0.18; < 0.05)) and indication for decompressive craniectomy (3.7 (1.3–11.01; 0.01)) are significantly associated with good functional outcome. Multivariate regression analysis revealed that GCS at admission (<9/≥9) (0.07 (0.03–0.16; <0.05)) and indication for decompressive craniectomy (extradural alone/ other hematoma) (1.75 (1.09–3.25; 0.02)) were significant independent predictors of good functional outcome irrespective of the timing of surgery. Conclusions Our results corroborate that the timing of surgery does not affect the outcome parameters. Furthermore, GCS ≥ 9 and/or extra dural hematoma are associated with relatively good clinical outcome after decompressive craniectomy.

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Outcome and Toxicity of an Ifosfamide-Based Soft Tissue Sarcoma Treatment Protocol in Children. The Importance of Local Therapy

Sarcoma ◽

10.1080/13577149877939 ◽

1998 ◽

Vol 2 (3-4) ◽

pp. 171-177

Author(s):

S. Murray Yule ◽

Roderick Skinner ◽

Martin W. English ◽

Mike Cole ◽

Andrew D. J. Pearson ◽

...

Keyword(s):

Soft Tissue ◽

Soft Tissue Sarcoma ◽

Primary Tumour ◽

Treatment Protocol ◽

Disease Free Survival ◽

Local Therapy ◽

Complete Response ◽

One Year ◽

Sarcoma Treatment

Background.Although the survival of children with soft tissue sarcoma (STS) has improved considerably, the outcome of patients with metastatic disease, and those with primary tumours of the extremities or parameningeal sites remains disappointing. We describe the clinical outcome of an ifosfamide-based regimen with local therapy directed only to children who failed to achieve a complete response to initial chemotherapy.Patients and Methods.Twenty-one children with STS (16 rhabdomyosarcoma) who presented with unresectable tumours were treated with five courses of ifosfamide (9 g/m2) and etoposide (600 mg/m2). Patients who did not achieve a complete response then received local therapy. Chemotherapy with ifosfamide combined with etoposide, vincristine (1.5 mg/m2and doxorubicin (60 mg/m2) or vincristine and actinomycin D (1.5 mg/m2) was continued for one year.Results and Discussion.Objective responses to five courses of ifosfamide and etoposide were seen in all patients. Disease free survival (DFS) at a median follow up of 59 months was 57% (95% CI 29–75%). The DFS of children who received local therapy was 89% compared with 33% in those who received chemotherapy alone (p=0.027). Locoregional recurrences did not occur in children who received radiotherapy to the site of the primary tumour. Ifosfamide-based chemotherapy does not reduce the incidence of loco-regional recurrence in children who do not receive local therapy.

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Functional Outcome in Sarcomas Treated With Limb-Salvage Surgery or Amputation

Sarcoma ◽

10.1080/13577149878118 ◽

1998 ◽

Vol 2 (1) ◽

pp. 19-23 ◽

Cited By ~ 20

Author(s):

Rikke Johansen ◽

Ole S. Nielsen ◽

Johnny Keller

Keyword(s):

Functional Outcome ◽

Limb Salvage ◽

Salvage Surgery ◽

Univariate Analysis ◽

Soft Tissue Sarcomas ◽

Post Treatment ◽

Limb Salvage Surgery ◽

Functional Evaluation ◽

Functional Scores

Purpose.In all patients treated at the Centre for Bone and Soft Tissue Sarcomas of Aarhus the functional outcome is prospectively evaluated by use of the Enneking system for the functional evaluation after surgical treatment of tumours of the musculoskeletal system. This system has been accepted by the Musculoskeletal Tumour Society and the International Symposium on Limb Salvage.Patients/methods.In the present study the functional outcome after limb-salvage surgery (89 patients) and amputation (58 patients) was compared. In the limb-salvage group the treatment was surgery alone in 50% and surgery combined with either radiotherapy in 39% or chemotherapy in 11%. Inclusion criteria were: Deep seated extremity sarcomas, age >14 years, more than 1 year post-treatment follow-up time and alive at the end of the study. Median age was 49 years (range 14–88 years). Median tumour diameter was 8 cm (range 1–20 cm), median follow-up time was 4.8 years (range 1–11 years). Wilcoxon andχ2-tests were used for statistical analyses.Results.The two groups were comparable according to age, sex, size of tumour, type of tumour, location of tumour, as well as post-treatment follow-up time. The functional scores were significantly higher after limb-salvage surgery as compared to amputation, the median scores being 85 and 47, respectively (p<0.001). A similar difference was observed if the Enneking scores were subdivided into general health-related scores and extremity-related scores. No association was found between functional scores and the following factors by use of univariate analysis: size of tumour, radiation therapy, localization of tumour and surgical margin.Discussion.We conclude that this study indicates that limb-salvage surgery is associated with a better functional outcome than that observed after amputation. However, whether this also indicates a difference in quality of life needs further studies.

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