Aging and effect of antiretroviral therapy on bone mass could increase the risk of femoral neck fractures (FNF) in HIV patient. The aim of this study was specifically to determine whether ...intracapsular FNF in HIV-positive patients are more prone to short-term post-operative complications than similar fractures occurring in HIV-negative patients.
A group of 25 HIV-positive patients with intracapsular FNF were enrolled and matched to HIV-negative patient with similar fractures according to gender, age, a modified Charlson Comorbidity Index (CCI), fracture classification, surgical treatment and time interval between fracture event and surgery. For each group, length of stay, surgical time, early clinical outcomes and short-term surgical and medical complications were compared to determine the impact on the early outcome.
At the time of the fracture occurrence, 56% of HIV-positive patients were on antiretroviral therapy and 12% started with therapy in the perioperative period. At three months follow-up, there were no statistically significant differences between the two study groups in length of stay, Harris hip score and total number of early complications. However, a statistically significant increase in urinary tract infections and longer surgical time using hip sliding screw fixation were seen in the HIV-positive group. The poorest post-operative result was seen in a patient who failed to adequately adhere to the HIV therapy protocol.
This study failed to show any statistically significant increase in short-term complications or worse clinical outcomes for intracapsular FNF in HIV-positive patients compared to HIV-negative patients to recommend their treatment in dedicated centres.
The objective of this prospective double-blind clinical trial was to compare clinical outcomes of indirect pulp capping restorative protocols on permanent teeth over a 12-month period.
Deep carious ...lesions in permanent teeth (90) were randomly assigned to three indirect pulp capping protocols (n=30: TheraCal LC, Dycal, and no liner). All teeth were restored with resin composite. The outcome measures were pain (VAS scale) and success rate (pulp vitality based on percussion, palpation, cold test, and radiographic findings), collected at screening, intervention, and 24-hour, 7-day, 3-month, 6-month, and 12-month follow-up visits.
There was no statistically significant difference in tooth sensitivity among the three indirect pulp capping protocols nor in success rates among the restorative protocols after 1 year of follow-up (p>0.1).The respective success rates, as defined by the tooth remaining vital, after 1 year were: 96.2% for TheraCal LC, 100% for Dycal, and 100% for no liner.
After 12-month evaluation, the success rate of indirect pulp capping therapy on permanent teeth was not affected by the pulp capping restorative protocol.
Background:
Despite the considerable research efforts being made to learn more about COVID-19, little is known about the presence of SARS-CoV-2 genetic material in biological fluids other than ...respiratory droplets, blood, and feces
1,2
. In particular, little is known about the presence of SARS-CoV-2 in the joints either
post mortem
3
or
in vivo
4
. To the best of our knowledge, only Lopéz-Gonzalez
et al.
5
have published a description of acute arthritides occurring during hospitalisation due to COVID-19, and they did not find any SARS-CoV-2 genetic material in the patients’ synovial fluid samples.
Objectives:
The aim of this
post mortem
study was to assess the presence of SARS-CoV-2 RNA in the knee synovial fluid, synovial tissue, and bone tissue of COVID-19 patients in order to discover whether the joint is a possible route of transmission during orthopaedic surgical procedures, and clarify the possible role of SARS-CoV-2 as a directly arthritogenic virus.
Methods:
Post mortem
synovial fluid, synovial tissue and bone tissue samples were collected from the knees of five patients who died of COVID-19 in our hospital between September and October 2020, and analysed for the presence of SARS-CoV-2 using a commercial real-time polymerase chain reaction (RT-PCR) panel. Quantitative RT-PCR was used to test
post mortem
nasopharyngeal swabs of all of the patients.
Results:
No SARS-CoV-2 RNA was detected in any of the knee samples, despite the positivity of the throat swab.
Conclusion:
Our findings indicate that SARS-CoV-2 was not detected in knee synovial fluid, synovial membrane or bone. Therefore, our results suggest that all healthcare professionals performing surgical procedures on the joints of COVID-19 patients are exposed to a risk of contagion due to exposure to respiratory droplets, blood and body fluids, but not to direct exposure to joint- or bone-related tissues. Furthermore, given that some case reports of arthritis in COVID-19 patients
5-8
show that it is possible that COVID-19 patients display viral-mediated arthralgias and arthritis, the absence of the virus in the knee highlighted by our study suggests that it is unlikely that SARS-CoV-2 has a direct inflammatory action on the joint, but it could induce an inflammation-related reaction, manifesting as a reactive arthritis
9
.
References:
1Cheng ZJ, Shan J. 2019 Novel coronavirus: where we are and what we know.
Infection
. 2020;(0123456789):1-9. doi:10.1007/s15010-020-01401-y
2Chen Y, Chen L, Deng Q, et al. The Presence of SARS-CoV-2 RNA in Feces of COVID-19 Patients.
J Med Virol
. April 2020. doi:10.1002/jmv.25825
3Maiese A, Manetti AC, La Russa R, et al. Autopsy findings in COVID-19-related deaths: a literature review.
Forensic Sci Med Pathol
. 2020. doi:10.1007/s12024-020-00310-8
4Baldanti F, Novazzi F, Cassaniti I, Piralla A, Di A, Bruno R. Detection of the SARS-CoV-2 in different biologic specimens from positive patients with COVID-19, in Northern Italy.
Authorea
. 2020. doi:10.22541/au.159724509.93056098
5López-González M-C, Peral-Garrido ML, Calabuig I, et al. Case series of acute arthritis during COVID-19 admission.
Ann Rheum Dis
. 2020;0(0):annrheumdis-2020-217914. doi:10.1136/annrheumdis-2020-217914
6Parisi S, Borrelli R, Bianchi S, Fusaro E. Viral arthritis and COVID-19.
Lancet Rheumatol
. 2020;2(11):e655-e657. doi:10.1016/S2665-9913(20)30348-9
7Alivernini S, Cingolani A, Gessi M, et al. Comparative analysis of synovial inflammation after SARS-CoV-2 infection.
Ann Rheum Dis
. 2020;0(0):2-3. doi:10.1136/annrheumdis-2020-218315
8Talarico R, Stagnaro C, Ferro F, Carli L, Mosca M. Symmetric peripheral polyarthritis developed during SARS-CoV-2 infection.
Lancet Rheumatol
. 2020;2(9):e518-e519. doi:10.1016/S2665-9913(20)30216-2
9Di Carlo M, Tardella M, Salaffi F. Can SARS-CoV-2 induce reactive arthritis?
Clin Exp Rheumatol
. 2020;In press.
Acknowledgements:
We would like to thank the clinical staff of the Pathology Unit for their collaboration in performing the autopsies.
Disclosure of Interests:
None declared
Abstract Introduction The aim of this paper is to present our experience with femoral press-fit fixation in anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft. ...Methods The patient population was randomly placed in two groups: group A (58 patients), who underwent femoral screw fixation; group B (62 patients), who underwent femoral press-fit fixation. Results At last follow-up 9.2% of patients were lost; 28% of patients in group A and 64% of patients in group B had excellent International Knee Documentation Committee score (grade A); 66% of patients in group A and 32% of patients in group B had good International Knee Documentation Committee scores (grade B). The difference was statistically significant (p < 0.05). Conclusions Femoral press-fit fixation of bone- patellar tendon- bone autograft provides stable fixation at low cost, it ensures unlimited bone-to-bone healing and high primary stability, avoiding the disadvantages of hardware and the need for removal in case of revision.
Background
Osteoarthritis (OA) of the knee, whether primary or post-traumatic, does not always involve all three compartments (tibiofemoral medial and lateral and the patellofemoral ones). ...Bicompartmental knee arthroplasty (BKA) was proposed as a good alternative to total knee arthroplasty when two of the three knee compartments were affected.
Materials and methods
We performed a retrospective comparative study collecting all BKAs performed between March 2010 and January 2016. During this period, we treated 27 patients with BKA for medial or lateral and patellofemoral OA. Seven of them were lost to follow-up and were not included in the study. Group A (BKA group) was compared to a homogeneous group of 20 patients who underwent TKA during the same period (group B).
Results
Patients treated with TKA were younger than those treated with BKA (mean age 65 vs. 67.2;
p
= 0.2149). BKA resulted in longer mean operating time (87 vs. 82.4 min;
p
= 0.2983), less blood loss (413 vs. 458 ml;
p
= 0.0052) but higher blood transfusion rate (12 vs. 10%). Medium follow-up was 34 months for BKA group and 38 months for TKA group. No statistically significant differences were found in KSS score between the two groups (KSS score 92.3 for BKA, 94.5 for TKA;
p
= 0.5221; KSS function was 87.2 for BKA and 89.2 for TKA;
p
= 0.4985).
Conclusion
The most important finding of the present study was that although BKA seemed to be theoretically more favorable in terms of functional recovery and blood loss, patients of group A had lower KSS score and higher transfusion rate than those of group B. Our data confirm that BKA could be proposed as an alternative to TKA, especially in young and high-demanding patients.
We report constraints on cosmological parameters from the angular power spectrum of a cosmic microwave background (CMB) gravitational lensing potential map created using temperature data from 2500 ...deg2 of South Pole Telescope (SPT) data supplemented with data from Planck in the same sky region, with the statistical power in the combined map primarily from the SPT data. We fit the lensing power spectrum to a model including cold dark matter and a cosmological constant ( ), and to models with single-parameter extensions to . We find constraints that are comparable to and consistent with those found using the full-sky Planck CMB lensing data, e.g., = 0.598 0.024 from the lensing data alone with weak priors placed on other parameters. Combining with primary CMB data, we explore single-parameter extensions to . We find or < 0.70 eV at 95% confidence, in good agreement with results including the lensing potential as measured by Planck. We include two parameters that scale the effect of lensing on the CMB: , which scales the lensing power spectrum in both the lens reconstruction power and in the smearing of the acoustic peaks, and , which scales only the amplitude of the lensing reconstruction power spectrum. We find × = 1.01 0.08 for the lensing map made from combined SPT and Planck data, indicating that the amount of lensing is in excellent agreement with expectations from the observed CMB angular power spectrum when not including the information from smearing of the acoustic peaks.
The delayed transition from gavage-to-nipple feeding is one of the most significant factors that may prolong hospital length of stay (LOS). Osteopathic manipulative treatment (OMT) has been ...demonstrated to be effective regarding LOS reduction, but no investigations have documented its clinical validity for attaining oral feeding.
To assess OMT utility regarding the timing of oral feeding in healthy preterm infants.
Preliminary propensity score-matched retrospective cohort study.
Data were extrapolated from the neonatal intensive care unit (NICU) of Del Ponte Hospital in Varese, Italy, during the period between March 2012 and December 2013.
Two propensity score-matched groups of healthy preterm infants aged 28+0 to 33+6 were compared, observing those supported with OMT until hospital discharge and control subjects.
Days from birth to the attainment of oral feeding was the primary endpoint. Body weight, body length, head circumference and LOS were considered as secondary endpoints.
Seventy premature infants were included in the study as the control group (n = 35; body weight (BW) = 1457.9 ± 316.2 g; gestational age (GA) = 31.5 ± 1.73 wk) and the osteopathic group (n = 35; BW = 1509.6 ± 250.8 g; GA = 31.8 ± 1.64 wk). The two groups had analogous characteristics at study entry. In this cohort, we observed a significant reduction in TOF (-5.00 days; p = 0.042) in the osteopathic group with a greater effect in very low birth weight infants.
These data demonstrate the utility and potential efficacy of OMT for the attainment of oral feeding. Further adequately powered clinical trials are recommended.
Introduction
The authors performed a matched paired study between two groups: bi-unicompartmental (Bi-UKR) versus total knee replacements (TKR) for the treatment of isolated bicompartmental ...tibio-femoral knee arthritis with an asymptomatic patello-femoral joint. The Authors believe that Bi-UKR could achieve comparable outcomes than TKR, but with a real less invasive surgery and maintaining a higher joint function.
Materials and methods
A total of 22 patients with bicompartmental tibio-femoral knee arthritis, who underwent Bi-UKR between January 1999 and March 2003, were included in the study (group A). In all the knees the arthritic changes were graded according to the classification of Älback. All patients had an asymptomatic patello-femoral joint. All patients had a varus deformity lower than 8°, a body-mass index lower than 34, no clinical evidence of ACL laxity or flexion deformity and a preoperative range of motion of a least 110°. At a minimum follow-up of 48 months, every single patient in group A was matched with a patient who had undergone a computer assisted TKR between August 1999 and September 2002 (group B). In the Bi-UKR group, in two cases we registered intraoperatively the avulsion of the treated tibial spines, requiring intra-operative internal fixation and without adverse effects on the final outcome. Statistical analysis of the results was performed.
Results
At a minimum follow-up of 48 months there were no statistical significant differences in the surgical time while the hospital stay was statistically longer in TKR group. No statistically significant difference was seen for the Knee Society, Functional and GIUM scores between the two groups. Statistically significant better WOMAC Function and Stiffness indexes were registered for the Bi-UKR group. TKR implants were statistically better aligned with all the implants positioned within 4° of an ideal hip–knee–ankle (HKA) angle of 180°.
Conclusions
The results of this 48 months follow-up study suggest that Bi-UKR is a viable option for bicompartmental tibio-femoral arthritis at least as well as TKR but maintaining a higher level of function.
The purpose of this study was to compare the results and complications of tibial lengthening over an intramedullary nail with treatment using the traditional Ilizarov method.
In this matched case ...study, 16 adult patients underwent 19 tibial lengthening over nails (LON) procedures. For the matched case group, 17 patients who underwent 19 Ilizarov tibial lengthenings were retrospectively matched to the LON group.
The mean external fixation time for the LON group was 2.6 months and for the matched case group was 7.6 months. The mean lengthening amounts for the LON and the matched case groups were 5.2 cm and 4.9 cm, respectively. The radiographic consolidation time in the LON group was 6.6 months and in the matched case group 7.6 months. Using a clinical and radiographic outcome score that was designed for this study, the outcome was determined to be excellent in 17 and good in two patients for the LON group. The outcome was excellent in 14 and good in five patients in the matched case group. The LON group had increased blood loss and increased cost. The LON group had four deep infections; the matched case group did not have any deep infections.
The outcomes in the LON group were comparable with the outcomes in the matched case group. The LON group had a shorter external fixation time but experienced increased blood loss, increased cost, and four cases of deep infection. The advantage of reducing external fixation treatment time may outweigh these disadvantages in patients who have a healthy soft-tissue envelope.Cite this article: J. E. Herzenberg. Tibial lengthening over intramedullary nails: A matched case comparison with Ilizarov tibial lengthening. Bone Joint Res 2016;5:1-10. doi: 10.1302/2046-3758.51.2000577.
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