8 research outputs found
Comparing Intensive and Conventional Therapy: A Meta-Analysis of Postoperative Physical Outcomes After Total Knee Replacement.
No full textOsteoarthritis (OA) is a common degenerative joint disease causing cartilage damage, bone erosion, and chronic pain, often leading to disability. Total knee arthroplasty (TKA) is frequently performed to relieve OA symptoms. Conventional therapy training (CTT) is the standard intervention, whether preoperative or postoperative. We assume that intensive therapy training (ITT) may have higher effects in some aspects. The study aims to evaluate the impact of postoperative CTT versus ITT on various physical measures and questionnaires over different follow-up periods. Our systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Cochrane guidelines, searching until June 2024. We assessed the risk of bias using the Cochrane Risk of Bias 2 (ROB 2) tool. Data were analyzed using Review Manager 5.4 (Cochrane Collaboration, London, UK), with mean differences (MD) and 95% confidence intervals (CI), and heterogeneity was assessed via P-value and I2 tests. The study consisted of 1087 patients. In the first month of follow-up, ITT did not significantly reduce pain on the visual analog scale (VAS) compared to CTT, with similar results at three and 12 months (overall MD = -0.38, 95% CI = -1.56 to 0.8, P = 0.53). For Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, ITT showed significant improvement within the first week and at one month (MD = -14.60 and MD = -3.11, respectively), but not at later follow-ups. In range of motion (ROM) flexion, ITT significantly improved outcomes in the first week (MD = 8.60, P = 0.001), but showed no significant differences at one and three months. No other outcomes showed any significant difference, and both results in ITT and CTT were similar. In TKA rehabilitation, ITT provides early benefits, particularly in improving ROM flexion and WOMAC scores during the initial postoperative week. However, ITT does not show significant advantages over CTT in terms of walking distance, quadriceps strength, ROM extension, or pain reduction throughout various follow-up periods. While ITT offers slight early gains, it does not present long-term benefits over CTT. Incorporating preoperative training into the postoperative regimen may be beneficial. We recommend that high-intensity exercises may not be necessary, as they yield similar results to conventional methods. However, further research is needed to explore both early and long-term outcomes that are not fully addressed in current studies
Exploring the Association Between COVID-19 and Avascular Necrosis: A Systematic Review
No full textAvascular necrosis (AVN) has emerged as an extrapulmonary complication associated with COVID-19 and corticosteroids. This review aims to evaluate the association between COVID-19 infection, corticosteroid use, and the development of AVN. We conducted a systematic review following the PRISMA guidelines, searching five databases until May 30, 2024. We included cohort and case series studies involving COVID-19 patients who developed AVN. The risk of bias was assessed using the Newcastle-Ottawa Scale (NOS). A total of 13 studies, comprising nine case series and four cohort studies, were included. These studies involved 795 patients with a mean age of 46.1 years and a male predominance (66%). The cumulative dose of corticosteroids varied, with an average of 1,462.9 mg. The duration between COVID-19 infection and initial AVN symptoms ranged from 2 to 62 weeks. The most commonly affected bones were the hip and femoral head. The visual analog scale (VAS) score improved with the treatment, and the cases showed improvements. A significant association was found between COVID-19, corticosteroid use, and AVN development. Clinicians should exercise caution when prescribing corticosteroids and monitor for early signs of AVN. Further research is needed to elucidate the pathophysiological mechanisms and explore alternative treatments to mitigate the risk of AVN
The risk of developing acute myeloid leukemia in patients with Ewing sarcoma and trend analysis: a SEER-based study
No full textBackgroundEwing sarcoma (ES) is a neoplasm of neuroectodermal origin arising from bone or soft tissue. The annual incidence of ES is 2.93 per 1, 000, 000. Acute myeloid leukemia (AML) is one of the most described second malignancies as a complication of primary cancer therapy. There is a lack of recent studies elaborating on the incidence rates of such complications. So, the aim was to quantify the risk of developing AML as a second primary malignancy (SPM) in ES patients and to provide an updated evidence to the literature.MethodsWe extracted the data from the Surveillance, Epidemiology and End Results (SEER) program statistical analysis software package (SEER*Stat, version 8.4.1.2). We used an MP-SIR session to identify patients diagnosed with AML as an SPM after ES as a first primary malignancy between 2000 and 2020. We assessed the SIR as Observed/Expected(O/E) and Excess Absolute Risk (EAR) per 10, 000 with a 95% confidence interval (CI) and statistical significance at 0.05.ResultsA total of 2631 patients with ES were recorded in the SEER database, with a median follow-up of 120 + months. Patients with ES had an increased risk of developing AML with an O/E of 145.98 (P < 0.05, EAR = 21.79). Gender played a role in AL development; both males (O/E = 52.94, P < 0.05, 95% CI: 31.87-82.670) and females (O/E = 105.62, P < 0.05) had a high risk of AL SPM. About 35 patients developed acute non-lymphocytic leukemia with an O/E 130.92 (P < 0.05, 95% CI: 91.19-182.08, EAR 21.77). There was a significantly increased risk of developing SPMs in different sites among ES patients (O/E = 5.85, P < 0.05).ConclusionPatients treated for a primary ES have a significant risk of developing AML, among other second primary malignancies. Thus, we recommend screening for AML from 2 to 11 months after the diagnosis of ES for early detection and better management outcomes
Correction: Epidemiology and outcomes of early-onset AKI in COVID-19-related ARDS in comparison with non-COVID-19-related ARDS: insights from two prospective global cohort studies (Critical Care, (2023), 27, 1, (3), 10.1186/s13054-022-04294-5)
No full textFollowing publication of the original article [1], the authors identified that the collaborating authors part of the collaborating author group CCCC Consortium was missing. The collaborating author group is available and included as Additional file 1 in this article
Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries
No full textBackground: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have
improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of
this study was to evaluate the outcomes following pancreatic surgery worldwide.
Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing
pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of
surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.
Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 per cent of
patients (2901 of 4223). Major complication rates (Clavien–Dindo grade at least IIIa) were 24, 18, and 27 per cent, and mortality rates
were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality
rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per
cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 per cent; however, it was 41 per cent in low-to-middle- compared
with 19 per cent in very high-HDI countries.
Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe
complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to
address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic
surgery (NCT04652271; ISRCTN95140761)
Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries
No full textBackground: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)
Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries.
No full textAbstractBackground: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 per cent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 per cent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 per cent; however, it was 41 per cent in low-to-middle- compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761).</div
