Outcomes of early treatment of radial dysplasia Nguyen, Phi Duong; Light, Terry Richard; Mai, Tuong Trong
Journal of clinical orthopaedics and trauma,
March 2024, 2024-Mar, 2024-03-00, 20240301, Volume:
50
Journal Article
Peer reviewed
Open access
Radial dysplasia, also termed radial club hand is an abnormality along the longitudinal axis of the hand characterized by hypoplasia or aplasia of radial structures. Surgery that centralize the wrist ...on the distal end of the ulna gives quite good results in terms of anatomical recovery but affecting range of motion of the wrist and fingers, limbs length. We conducted this study to evaluate the outcome of serial casting followed by centralization at our institution.
We conducted a prospective study involving 20 pediatric patients with 25 limbs affected by Bayne Types III and IV radial dysplasia, with an average follow-up period of 4.2 years. Each limb underwent progressive soft tissue stretching via serial casting, followed by centralization. Clinical and radio-graphic data were collected at surgery and during follow-up assessments.
The study achieved an average correction of 60° in radial deviation, with a decrease in wrist range of motion from 79° to 28° over the follow-up period. Finger mobility showed increased stiffness. Ulnar length recovery reached 57% of the normal contra-lateral side. Final results, based on the Bayne and Klug criteria, revealed that 24 out of 25 hands (96%) exhibited good or satisfactory outcomes.
Early intervention employing gradual corrective casting followed by centralization is an effective treatment for radial dysplasia in children, consistently resulting in good or satisfactory outcomes. However, this approach entails a trade-off with reduced wrist and finger range of motion and potential implications for limb growth.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract The article investigates the controversies that emerge with the production of the CoronaVac vaccine, the first Covid-19 vaccine available in Brazil, on June 11th, 2020. Based on ...Actor-Network Theory, this study is inspired by virtual ethnography. We thus privilege digital documents from government agencies and medical entities, specialized publications, publications in Facebook groups, and the writing of a virtual field diary. Our investigation ends with the approval of the CoronaVac and Oxford/AstraZeneca vaccines by the National Health Surveillance Agency (Anvisa). We identify the construction of factoids by groups that were critical of social distancing measures, basing themselves on the use of purportedly scientific arguments. The alliances established between doctors and the federal government through the Ministry of Health challenged the vaccine as a technoscientific artifact, and advocated for drugs that were part of the so-called "early treatment" as the "cure" for the pandemic in Brazil.
Resumo O artigo investiga as controvérsias que emergem com a notícia do início da produção da primeira vacina contra a Covid-19 no Brasil, a CoronaVac, em 11 de junho de 2020. Apoiando-se na perspectiva da Teoria Ator-Rede, realiza-se um estudo com inspiração na etnografia virtual. Assim, privilegiam-se documentos digitais de órgãos governamentais e entidades médicas, matérias jornalísticas, publicações em grupos da rede social Facebook e escrita de diário de campo virtual. A investigação é finalizada com a aprovação das vacinas CoronaVac e Oxford-AstraZeneca pela Agência Nacional de Vigilância Sanitária. O estudo identifica a construção de factóides por grupos críticos ao distanciamento social, tendo como base o acionamento de argumentos pretensamente científicos. Identifica-se que as alianças estabelecidas entre médicos e o governo federal por meio do Ministério da Saúde procuraram desestabilizar a vacina, enquanto artefato tecnocientífico, performando medicamentos do chamado “tratamento precoce” como a “cura” para a pandemia no Brasil.
Abstract Background In the EDITA trial, patients with systemic sclerosis (SSc) and mild pulmonary vascular disease (PVD) treated with ambrisentan had a significant decline of pulmonary vascular ...resistance (PVR) but not of mean pulmonary arterial pressure (mPAP) vs. placebo after six months. The EDITA-ON study aimed to assess long-term effects of open label therapy with ambrisentan vs. no pulmonary arterial hypertension (PAH) therapy. Methods Patients who participated in the EDITA study and received regular follow-up were included in EDITA-ON. Clinical, echocardiographic, laboratory, exercise and hemodynamic parameters during follow-up were analysed. The primary endpoint was to assess whether continued treatment with ambrisentan vs. no treatment prevented the development of PAH according to the new definition. Results Of 38 SSc patients included in the EDITA study four were lost to follow-up. Of the 34 remaining patients (age 55 ± 11 years, 82.1% female subjects), 19 received ambrisentan after termination of the blinded phase, 15 received no PAH medication. The mean follow-up time was 2.59 ± 1.47 years, during which 29 patients underwent right heart catheterization. There was a significant improvement of mPAP in catheterised patients receiving ambrisentan vs. no PAH treatment (-1.53 ± 2.53 vs. 1.91 ± 2.98 mmHg, p = 0.003). In patients without PAH treatment 6/12 patients had PAH vs. 1/17 of patients receiving ambrisentan ( p < 0.0001). Conclusion In SSc patients with early PVD, the development of PAH and/or deterioration was less frequent among patients receiving ambrisentan, indicating that early treatment and close follow-up could be beneficial in this high-risk group. Future trials in this field are needed to confirm these results.
Background: Repurposed drugs with host-directed antiviral and immunomodulatory properties have shown promise in the treatment of COVID-19, but few trials have studied combinations of these agents. ...The aim of this trial was to assess the effectiveness of affordable, widely available, repurposed drugs used in combination for treatment of COVID-19, which may be particularly relevant to low-resource countries. Methods: We conducted an open-label, randomized, outpatient, controlled trial in Thailand from October 1, 2021, to June 21, 2022, to assess whether early treatment within 48-h of symptoms onset with combinations of fluvoxamine, bromhexine, cyproheptadine, and niclosamide, given to adults with confirmed mild SARS-CoV-2 infection, can prevent 28-day clinical deterioration compared to standard care. Participants were randomly assigned to receive treatment with fluvoxamine alone, fluvoxamine + bromhexine, fluvoxamine + cyproheptadine, niclosamide + bromhexine, or standard care. The primary outcome measured was clinical deterioration within 9, 14, or 28 days using a 6-point ordinal scale. This trial is registered with ClinicalTrials.gov (NCT05087381). Findings: Among 1900 recruited, a total of 995 participants completed the trial. No participants had clinical deterioration by day 9, 14, or 28 days among those treated with fluvoxamine plus bromhexine (0%), fluvoxamine plus cyproheptadine (0%), or niclosamide plus bromhexine (0%). Nine participants (5.6%) in the fluvoxamine arm had clinical deterioration by day 28, requiring low-flow oxygen. In contrast, most standard care arm participants had clinical deterioration by 9, 14, and 28 days. By day 9, 32.7% (110) of patients in the standard care arm had been hospitalized without requiring supplemental oxygen but needing ongoing medical care. By day 28, this percentage increased to 37.5% (21). Additionally, 20.8% (70) of patients in the standard care arm required low-flow oxygen by day 9, and 12.5% (16) needed non-invasive or mechanical ventilation by day 28. All treated groups significantly differed from the standard care group by days 9, 14, and 28 (p < 0.0001). Also, by day 28, the three 2-drug treatments were significantly better than the fluvoxamine arm (p < 0.0001). No deaths occurred in any study group. Compared to standard care, participants treated with the combination agents had significantly decreased viral loads as early as day 3 of treatment (p < 0.0001), decreased levels of serum cytokines interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and interleukin-1 beta (IL-1β) as early as day 5 of treatment, and interleukin-8 (IL-8) by day 7 of treatment (p < 0.0001) and lower incidence of post-acute sequelae of COVID-19 (PASC) symptoms (p < 0.0001). 23 serious adverse events occurred in the standard care arm, while only 1 serious adverse event was reported in the fluvoxamine arm, and zero serious adverse events occurred in the other arms. Interpretation: Early treatment with these combinations among outpatients diagnosed with COVID-19 was associated with lower likelihood of clinical deterioration, and with significant and rapid reduction in the viral load and serum cytokines, and with lower burden of PASC symptoms. When started very soon after symptom onset, these repurposed drugs have high potential to prevent clinical deterioration and death in vaccinated and unvaccinated COVID-19 patients. Funding: Ped Thai Su Phai (Thai Ducks Fighting Danger) social giver group.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Colorectal cancer is a common malignant tumor in China. At present, the incidence rate and the mortality rate of colorectal cancer in China are on the rise. Among all malignant tumors in China, the ...incidence rate of colorectal cancer ranks second, and the mortality rate ranks fourth. It has become a public health problem that seriously threatens our health. A large number of studies and practice have shown that colorectal cancer screening, early diagnosis and treatment are effective measures to reduce the mortality rate of colorectal cancer in the population. Since 2013, Shanghai has continued to carry out community colorectal cancer screening, which greatly extends the survival period of colorectal cancer patients by early detection of precancerous lesions, reducing the risk of disease, early diagnosis of colorectal cancer and timely treatment. At the same time, the standardized diagnosis and treatment level of major hospitals in Shanghai is relatively high, and the 5-year survival rate of colorectal cancer patients is also relatively high, even exceeding that of the developed countries in Europe and America. However, due to regional differences and uneven economic development, most regions in China have not yet carried out colorectal cancer-related prevention and treatment projects. At the same time, due to the lack of clinical service capacity of primary hospitals, the low early diagnosis and early treatment rates have become a bottleneck restricting the further improvement of the prognosis of colorectal cancer patients in China. In response to the current situation of insufficient clinical service capabilities in primary hospitals in terms of colorectal cancer-related knowledge, risk prevention knowledge, common screening methods, standardized diagnosis, treatment knowledge, etc., the Colorectal Cancer Special Committee of Shanghai Anti-Cancer Association organized colorectal cancer diagnosis and treatment experts from major hospitals in Shanghai to jointly compile the “Shanghai plan for early screening, diagnosis and treatment of colorectal cancer (2023 edition)”. The plan introduced the epidemiology of colorectal cancer, risk factors and protective factors of colorectal cancer, precancerous lesions of colorectal cancer and early colorectal cancer, screening of colorectal cancer, diagnosis of early colorectal cancer and treatment of early colorectal cancer, and provided relevant suggestions for clinical reference. The protocol aimed to standardize the screening, early diagnosis and early treatment practice of colorectal cancer, and improve the prevention and treatment of colorectal cancer in China. Early screening, diagnosis and treatment of colorectal cancer are keys to improving patient survival rates and prognosis. Currently, although there are various screening methods for colorectal cancer, there are still problems of insufficient sensitivity and specificity. At the same time, in many hospitals across the country, there are also problems of standardization in the diagnosis and treatment of colorectal cancer. Therefore, in the future, in addition to developing more efficient screening methods, improving the accuracy of early diagnosis and exploring safer and more effective treatment methods, the prevention and treatment of colorectal cancer also requires providing assistance to primary hospitals in diagnosis and treatment, emphasizing the standardization of colorectal cancer diagnosis and treatment, improving the diagnosis and treatment level of primary doctors, enhancing the diagnosis and treatment abilityies of primary hospitals and finally strengthening public health education to improve public awareness of colorectal cancer and prevention.
While early medical treatment has proven effective in MS, early-phase MS rehabilitation has not gained much attention in MS research and clinical practice. Exercise therapy is one of the most ...promising treatment strategies in MS rehabilitation. Here, we provide a topical review investigating when exercise therapy is initiated in existing MS studies, showing that exercise is initiated at a rather late disease stage, where it predominantly serves as a symptomatic treatment. Recent findings in MS suggest that exercise may have neuroprotective and disease-modifying effects. Such findings along with the findings from medical trials that an early-stage “window of opportunity” exists leads to the proposal that early exercise therapy should be an increased focus in research and clinical practice for persons with MS. A further perspective relates to other rehabilitation interventions that are also initiated at a later disease stage, as these may also take advantage of an early-phase approach.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
Background:
Potential supplemental disease-modifying and neuroprotective treatment strategies are warranted in multiple sclerosis (MS). Exercise is a promising non-pharmacological approach, and an ...uninvestigated ‘window of opportunity’ exists early in the disease course.
Objective:
To investigate the effect of early exercise on relapse rate, global brain atrophy and secondary magnetic resonance imaging (MRI) outcomes.
Methods:
This randomized controlled trial (n = 84, disease duration <2 years) included 48 weeks of supervised aerobic exercise or control condition. Population-based control data (Danish MS Registry) was included (n = 850, disease duration <2 years). Relapse rates were obtained from medical records, and patients underwent structural and diffusion-kurtosis MRI at baseline, 24 and 48 weeks.
Results:
No between-group differences were observed for primary outcomes, relapse rate (incidence-rate-ratio exercise relative to control: (0.49 (0.15; 1.66), p = 0.25) and global brain atrophy rate (−0.04 (−0.48; 0.40)%, p = 0.87), or secondary measures of lesion load. Aerobic fitness increased in favour of the exercise group. Microstructural integrity was higher in four of eight a priori defined motor-related tracts and nuclei in the exercise group compared with the control (thalamus, corticospinal tract, globus pallidus, cingulate gyrus) at 48 weeks.
Conclusion:
Early supervised aerobic exercise did not reduce relapse rate or global brain atrophy, but does positively affect the microstructural integrity of important motor-related tracts and nuclei.
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NUK, OILJ, SAZU, UKNU, UL, UM, UPUK
The antiviral drug favipiravir has been shown to have in vitro antiviral activity against severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2). In this study, we investigated the clinical ...benefits and initiation of favipiravir treatment in patients with non-severe coronavirus-disease-2019 (COVID-19).
This study was a single-center retrospective cohort study. Receiver operating characteristic curves were drawn to calculate the area under the curve, and the optimal cut-off values for the time to initiate favipiravir treatment were calculated to predict defervescence within seven days. Univariate and multivariate Cox regression analyses were performed to identify potential influencing factors of defervescence. This was defined as a body temperature of less than 37 °C for at least 2 days.
Data from 41 patients were used for the efficacy assessment. The days from the onset of fever to defervescence showed a positive correlation with the duration from the onset of fever to initiation of favipiravir treatment (r = 0.548, P < 0.001). The optimal cut-off value was the administration of favipiravir on day 4. Patients were assigned to two groups based on the optimal cut-off value from onset to initiation of favipiravir treatment: early treatment group (within 4-days) and late treatment group (more than 4-days). In the multivariate analysis, when adjusted for age, sex, and days from onset to initiation of favipiravir treatment, the significant factors were male sex and days of initiation of the favipiravir treatment.
We recommend that if favipiravir is to be used for treatment, it should be initiated as early as possible.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Depression is the greatest estimated cause of disability among people of working age. Preventing dropouts from depression treatment in the early stages of outpatient psychiatric care is important in ...avoiding poor outcomes. Since the long waiting time between appointment and consultation was one of the factors for dropout in previous studies, this study aimed to determine the early dropout rate and identify factors associated with early treatment discontinuation in depressed patients in a psychiatric outpatient practice, where immediate access to treatment is available. Of 563 participants, 184 (32.7%) stopped treatment within 1 month, which was as high as previous findings. Logistic regression analysis confirmed that younger age, ICD-10 F4 diagnosis, and lower attention-deficit/hyperactivity disorder (ADHD)-related characteristics predicted earlier treatment discontinuation. The current study suggests that immediate access to treatment might not significantly affect the rate of treatment discontinuation within 1 month for working-age depressed patients. Given the high rate of early treatment discontinuation, explaining the importance of continuing treatment might be necessary at the first visit, especially for patients with younger age, ICD-10 F4 diagnosis, and fewer complaints suggestive of ADHD.
•Of the 563 working-age outpatients with depression treated without delay, 32.7% discontinued treatment within 1 month.•Younger age, ICD-10 F4 diagnosis, and fewer complaints suggestive of ADHD predicted earlier treatment discontinuation.•Explaining the importance of continuing treatment might be necessary at the first visit, especially for these patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
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