Therapeutics and Clinical Risk Management最新文献

Purpose: Total knee arthroplasty (TKA) is widely used as a treatment for knee osteoarthritis. Few studies have analysed the factors affecting the squatting ability of patients after TKA. The purpose of this study was to comprehensively analyse the factors affecting squatting ability after TKA and to determine which ones are important.

Patients and methods: Three hundred primary TKA cases with a minimum 3-year follow-up were retrospectively analysed. All patients received a conventional posterior-stabilized TKA implant and underwent a standard perioperative care pathway. The patients were divided into two groups according to the squatting position and knee flexion angle while weight-bearing (Group I - inability to squat group, Group II - ability to squat group). Demographic, operative, and clinical data were collected. Radiographic assessment included joint line elevation, patellar position, posterior condylar offset (PCO), etc. Statistical analysis of the effect of all the above factors on squatting ability was performed.

Results: The preoperative range of motion and joint line of Group I were 82.9±12.6 and 3.24±1.07, respectively, and those of Group II were 107±9.6 and 1.83±0.89 respectively. The univariate analysis showed that age, prosthesis size, preoperative ROM and joint line position were correlated with squatting ability. But in the final multivariate analysis, joint line position and preoperative ROM were independent influencing factors that affected squatting ability after TKA (p value < 0.01).

Conclusion: Preoperative ROM and joint line position were independent influencing factors affecting squatting ability after TKA. Patients should be counseled accordingly and be made to understand these factors. To ensure that patients can squat postoperatively, we should improve surgical techniques to control joint line elevation.

Chronic kidney disease (CKD) is recognized as a leading public health problem and causes numerous health complications. One of the most common and burdensome dermatological symptoms affecting patients undergoing dialysis is CKD-associated pruritus (CKD-aP). This condition not only has a negative impact on sleep, mood, daily activities, and quality of life but also increases the mortality risk of hemodialyzed patients. Despite that, this condition is greatly underestimated in clinical practice. Due to the complex and still not fully understood etiopathogenesis of CKD-aP, the choice of an effective therapy remains a challenge for clinicians. Most common therapeutic algorithms use topical treatment, phototherapy, and various systemic approaches. This review aimed to summarize most recent theories about the pathogenesis, clinical features, and treatment of CKD-aP.

Background: As an inflammation-based marker, red cell distribution width to platelet ratio (RPR) has been verified to be associated with disease severity and outcome in many clinical settings. We designed this study to evaluate the prognostic value of RPR in patients with traumatic brain injury (TBI).

Methods: A total of 420 patients admitted with TBI were included in this study. Laboratory and clinical data were collected from an electronic medical record system. Univariate and multivariate logistic regression analyses were sequentially performed to discover risk factors of in-hospital mortality. Receiver operating characteristic (ROC) curves were drawn to confirm the predictive value of different markers including RPR in training set and testing set.

Results: Non-survivors had higher level of RPR than survivors (P<0.001). Logistic regression analysis showed that RPR was significantly associated with mortality even after adjusting for confounding factors (P<0.001). The area under the ROC curve (AUC) value of Glasgow Coma Scale (GCS) for predicting mortality was 0.761 and 0775 in training set and testing set, respectively. And the constructed predictive model incorporating RPR had the highest AUC value of 0.858 and 0.884 in training set and testing set.

Conclusion: RPR is significantly associated with mortality in TBI patients. Utilizing RPR to construct a predictive model is valuable to evaluate prognosis of TBI patients.

Purpose: This study evaluated the utility of a ruler for reconstructed article positioning.

Methods: Forty-seven patients with unilateral microtia were selected from August 2020 to September 2021.

Results: The linear distance from the highest point of the reconstructed auricle to the central axis of the nose was not significantly different from the distance from the highest point of the normal contralateral auricle to the central axis of the nose (P>0.05). The distance from the lowest point of the reconstructed auricle to the central axis of the nose was not significantly different from the distance from the lowest point of the normal auricle to the central axis of the nose (P>0.05). The linear distance from the highest to the lowest point of the reconstructed auricle was not significantly different from the distance from the highest to the lowest point of the normal auricle (P>0.05). These results indicate that the reconstructed auricle was symmetrical to the contralateral ear.

Conclusion: The positioning ruler evaluated in this study is simple, easy to use, accurate, and non-invasive.

Thyroid eye disease (TED; also known as thyroid-associated ophthalmopathy) is an autoimmune condition with disabling and disfiguring consequences. Teprotumumab is the first and only medication approved by the United States Food and Drug Administration for the treatment of TED. We review the efficacy and safety of teprotumumab in TED, highlighting results from the 2 randomized, double-masked, placebo-controlled trials. Post-approval case reports of teprotumumab use in patients with compressive optic neuropathy (CON) and inactive TED were similarly favorable to those from the trials. The preliminarily results of teprotumumab for CON and inactive TED should be investigated in formal clinical trials. Teprotumumab should be avoided in pregnancy. Evidence also suggests that teprotumumab may exacerbate pre-existing inflammatory bowel disease, worsen hyperglycemia, and be associated with hearing impairment. Patients at risk for these adverse events need to be closely monitored with baseline and periodic assessments.

Purpose: Uncomplicated urinary tract infections (uUTIs) are one of the main reasons for emergency department (ED) visits. Many antibiotics can be used for uUTI treatment. Currently, no data concerning uUTIs and cost-effectiveness have been reported in Saudi Arabia. This study aimed to investigate antibiotic and cost-effectiveness of beta-lactams, fluoroquinolones, and nitrofurantoin as first-line uUTI treatment.

Patients and methods: This study was a retrospective cohort based on a five-arm comparative outcome analysis. A cost-effectiveness analysis and comparative group of uUTI treatments in the ED at King Abdulaziz Medical City (KAMC) in Saudi Arabia over a three-month follow-up period was done. The patient group consisted of those presenting to the ED with uUTIs who were treated initially with one of five antibiotics: (1) amoxicillin/clavulanic acid, (2) cefuroxime, (3) ciprofloxacin, (4) nitrofurantoin, or (5) norfloxacin. The main outcomes were effectiveness in terms of cure rates, symptom-free days (SFDs), and estimations of cost-effectiveness among this group.

Results: A total of 865 adult patients who presented with uUTIs were enrolled. Most patients (89.5%) completely recovered, whereas 10.5% of patients were readmitted to the ED with recurrent infections. Effectiveness in terms of the highest cure rate was observed with nitrofurantoin and amoxicillin/clavulanic acid (93.2% and 92.2%, respectively) followed by norfloxacin, cefuroxime, and ciprofloxacin; no significant differences in cure rates were found among these antibiotics. Antibiotic effectiveness in terms of SFDs showed that nitrofurantoin produced the longest SFD period (76 days) followed by amoxicillin/clavulanic acid (69 days). A cost-effectiveness analysis in terms of uUTI cure rates and number of SFDs indicated that nitrofurantoin presented the highest cost-effectiveness followed by amoxicillin/clavulanic acid, norfloxacin, ciprofloxacin, and cefuroxime.

Conclusion: A comparison of five antibiotics for uUTI treatment did not yield clinically significant differences in cure rates. Nitrofurantoin was more cost-effective than the other antibiotics.

Objective: We aimed to demonstrate the methods of treatment for coxa vara with modular total hip arthroplasty (THA) and evaluate clinical and radiographic outcomes, and further survivorship at the midterm follow-up.

Methods: We retrospectively reviewed 33 patients (42 hips) who underwent modular THA for coxa vara deformity from May 2008 to December 2019. The clinical and radiographic results, including Harris Hip Score (HHS), leg length discrepancy (LLD), greater trochanteric height, femoral offset, abductor lever arm, stem alignment and limp, and complications, were evaluated.

Results: The follow-up time was mean 69.9±43.7 months. Clinically, the HHS improved significantly (p<0.001) on average from 42.90±14.44 points to 89.54±4.75 points. The mean LLD decreased from 33.3±19.4 mm to 5.0±5.8 mm (p<0.001), and 27 patients (82%) thought that total equality of the lower limbs was obtained. Patients demonstrated diminished or no limping in 88% (29/33) of hips and a significant improvement of biomechanics. At the final follow-up, all stems of hips were in clinical neutral alignment and the prostheses survivorship rates for all-causes revisions was 97.6%.

Conclusion: Modular THA is a valuable alternative to render favorable outcomes for treatment of osteoarthritis secondary to severe coxa vara.

Introduction: Though chloroquine derivatives are used in the treatment of coronavirus disease 2019 (COVID-19) in many countries worldwide, doubts remain about the safety and efficacy of these drugs, especially in African communities where published data are scarce.

Methods: We conducted an observational prospective cohort study from April 24 to September 03, 2020, in Burkina Faso to assess (as primary outcome) the clinical, biological, and cardiac (electrocardiographic) safety of chloroquine or hydroxychloroquine plus azithromycin administered to COVID-19 patients. The main secondary outcomes were all-cause mortality and median time of viral clearance.

Results: A total of 153 patients were enrolled and followed for 21 days. Among patients who took at least one dose of chloroquine or hydroxychloroquine (90.1% [138/153]), few clinical adverse events were reported and were mainly rash/pruritus, diarrhea, chest pain, and palpitations. No statistically significant increase in hepatic, renal, and hematological parameters or electrolyte disorders were reported. However, there was a significant increase in the QTc value without exceeding 500ms, especially in those who received chloroquine phosphate. Three adverse events of special interest classified as serious (known from chloroquine derivatives) were recorded namely pruritus, paresthesia, and drowsiness. One case of death occurred. The average onset of SARS-CoV-2 PCR negativity was estimated at 7.0 (95% CI: 5.0-10.0) days.

Conclusion: Hydroxychloroquine appeared to be well tolerated in treated COVID-19 patients in Burkina Faso. In the absence of a robust methodological approach that could generate a high level of scientific evidence, our results could at least contribute to guide health decisions that should be made based on different sources of scientific evidence including those from our study.

Purpose: Previous research on incremental hemodialysis transition has mainly focused on one or two benefits or prognoses. We aimed to conduct a comprehensive analysis by investigating whether incremental hemodialysis was simultaneously associated with adequate dialysis therapy, stable complication indicators, long-lasting arteriovenous vascular access, and long-lasting preservation of residual kidney function (RKF) without increasing mortality or hospitalization.

Patients and methods: Incident hemodialysis patients from Huashan Hospital in Shanghai, China, over the period of 2012 to 2019, were enrolled and followed every three months until death or the time of censoring. Changes in complication indicators from baseline to all post-baseline visits were analyzed by mixed-effects models. The outcomes of RKF loss, arteriovenous vascular access complications, and the composite of all-cause mortality and cardiovascular events were compared between incremental and conventional hemodialysis by Cox proportional hazards model.

Results: Of the 113 patients enrolled in the study, 45 underwent incremental and 68 conventional hemodialysis. There were no significant differences in the changes from baseline to post-baseline visits in complication indicators between the two groups. Incremental hemodialysis reduced the risks of RKF loss (HR, 0.33; 95% CI, 0.14-0.82), de novo arteriovenous access complication (HR, 0.26; 95% CI, 0.08-0.82), and recurrent arteriovenous access complications under the Andersen-Gill (AG) model (HR, 0.27; 95% CI, 0.10-0.74) and the Prentice, Williams and Peterson Total Time (PWP-TT) model (HR, 0.31; 95% CI, 0.12-0.80). There were no significant differences in all-cause hospitalization or the composite outcome between groups.

Conclusion: Incremental hemodialysis is an effective dialysis transition strategy that preserves RKF and arteriovenous access without affecting dialysis adequacy, patient stability, hospitalization risk and mortality risk. Randomized controlled trials are warranted.