Prasugrel or Clopidogrel in Patients with Acute Coronary Syndromes at High Thrombotic Risk
PROMETHEUS compared Prasugrel and Clopidogrel in ACS patients having PCI. ACS patients should take P2Y12 inhibitors in addition to aspirin.The best antithrombotic therapy should be altered based on the patient's thrombotic and hemorrhagic risk due to complications. Prasugrel, unlike Clopidogrel, reduced the risk of ischemia events in both high and low-to-moderate thrombotic risk patients.
Short-term Pulse Pressure Variability Linked to cardiovascular death among normotensive adults
Short-term systolic & diastolic blood pressure variability is linked to worse CVD outcomes, especially with established CVD risk factors. But data on short-term pulse pressure variability and mortality are scarce. The study monitored 6,340 normotensive adults (20+) for an average of 22.3 yrs. According to NHANES data, 2 visit pulse pressure variability is associated with cardiovascular death.
Arrhythmia and cardiomyopathy in Heritable Thoracic Aortic Disease
The study indicated that patients with an ACTA2 mutation had no myocardial dysfunction or arrhythmia. Patients with FBN1 and LDS gene variants had myocardial dysfunction. In patients with HTAD, myocardial dysfunction and arrhythmia are rare features. They occur predominantly in patients with a variant in FBN1 and LDS genes, but were not seen in patients carrying a variant in the ACTA2 gene.
Clinical Outcomes in COVID-19 Patients with In-hospital Cardiac Arrest
The study showed that critically sick patients with COVID-19 had high rate of cardiac arrest & poor effects in those who received CPR. A non-shockable initial rhythm designates that non-cardiac reasons might be playing a major role. These include acute respiratory insufficiency, severe sepsis, or multiorgan failure. These data should inform end-of-life care discussions.
Cardiovascular Protection by Combination of Finerenone and Empagliflozin
Non-steroidal MR antagonism with Finerenone and SGLT2 inhibition with Empagliflozin provide cardiovascular protection in preclinical hypertensive-induced cardiorenal disorder. Combination of these 2 modes of action at low dosages showed effectual decrease in blood pressure, cardiac lesions and mortality specifying a strong prospective for combined clinical usage in cardiorenal patient populations
Prevalence of Risk Factors for Adverse Spinopelvic Mobility in Total Hip Arthroplasty
The aim of this study was to identify spinopelvic risk variables relevant to hip arthroplasty surgeons, as well patient risk factors for pathologic spinopelvic movement and anterior dislocation. In this study, 46% of patients had spinopelvic disease. Adverse spinopelvic mobility is found in half of THA patients with no specific risk factor, highlighting need to screen all patients preoperatively.
Multimodal Analgesic Management for Lumbar Decompression Surgery in the Ambulatory Setting
Largest ASC study examined lumbar decompression operations with no specific 23-hour surveillance (499 patients). It was found that lumbar decompression surgery can be performed in an ASC with proper patient selection, surgical technique, and multimodal analgesia. This treatment is safe in the ASC setting due to its low VAS and low postoperative complications.
Acute vs. Delaying Reverse Total Shoulder Arthroplasty Treatment of Proximal Humeral Fracture
This study aims to understand how the time of RTSA treatment influences results by comparing the revision rate, surgical and medical complications, and costs between acute and delayed RTSA. Delayed RTSA for proximal humeral fractures causes more 1-year revisions and dislocations than acute RTSA. Delaying RTSA may lead to more surgery and worse outcomes.
Higher Preoperative NarxCare Scores Linked to Adverse Outcomes After Primary Total Hip Arthroplasty
The study aimed to identify a preoperative NCS threshold for poor outcomes, a link between preoperative NCS and LOS, discharge disposition, 90-day readmission, and reoperation rates following initial THA. Higher NCS was linked to longer LOS, 90-day readmission, & reduced probabilities of home release. NCS of 300 may be utilised to identify people at risk for THA complications.
Fragility Fracture of the Upper Extremity and Foot or Ankle Should Be Considered Sentinel Events
This study aimed to examine patient demographics, bone disease severity, prior fracture frequency, and osteoporosis treatment frequency by anatomic location of fragility fracture. Fragility fractures of the foot/ankle occur in people with less severe metabolic bone disease and should be referred for bone health evaluation.
Periprosthetic Femur Fracture Risk: Influenced by Stem Choice, Not Surgical Approach
This study's goal is to assess the 90-day relative risk of PFF based on method and stem type. PFF is a prevalent cause of failure after total hip arthroplasty (THA). Based on their single-center experience, collared stems and fit-and-fill stems lower the risk of periprosthetic fracture within 90 days. A female's age and BMI below 25 increase PFF risk. No anaesthesia reduced fracture rates.
Association between Femoral Stem Type and the Risk of Aseptic Revision following Hemiarthroplasty
In the treatment of displaced femoral neck fractures in the elderly, uncemented hemiarthroplasty had higher risk of aseptic revision than cemented hemiarthroplasty. Aseptic revision risk was assessed with three uncemented hemiarthroplasty stem designs. Uncemented stem designs have higher incidence of aseptic revision than cemented fixation.
Knee Arthroscopy Prior to Revision TKA linked with Increased Revision for Stiffness
The study aimed to evaluate the impact of knee arthroscopy on outcomes of subsequent TKA revision surgery. This cohort matched analysis found patients who had prior knee arthroscopy were likely to need revision TKA than individuals who received revision TKA without prior knee arthroscopy. Patients who had prior knee arthroscopy within 6 months had a higher risk of needing revision.
Continuous Passive Motion vs. Physical Therapy after Arthroscopic Release of Elbow Contracture
Following surgical contracture release, CPM was faster & better than PT in postoperative elbow rehabilitation. This was reflected in improved 6-week & 3-month ROM, as well as a reduced median time to attain their primary post-operative goal & improved 1-year ROM. These findings suggest more contractures benefit with CPM as they regained maximal recovery at 1 year.
Long Cervical Fusions: Are Multiple Segmental Plates Less Likely to Fail than a Single Long Plate?
Multilevel anterior cervical discectomy & fusion (ACDF) is commonly used for neuro-compressive pathology. Separated segmental anterior fixation maintains its stiffness effectively at caudal aspect of the construct than long single plate fixation.The validated model of biochemical performances of cervical spine fixation will enhance ability to optimize constructs & reduce risk of fractures.
Non-Narcotic Total Joint Arthroplasty Using an Alternative to Opioids Multimodal Pain Protocol
An opioid-free, multimodal pain management pathway is safe and effective for TJA patients and does not affect length of stay, 90-day complication rates, ED visits, or readmission rates. To properly understand how to adopt an opioid-free approach in total joint arthroplasty, future research will need to include randomised trials.
Arthroscopic Latarjet: In Vitro Evidence to Avoid Complications with the Trans-Pec Medial Portal
To avoid difficulties in the arthroscopic Bankart-Bristow-Latarjet surgery, the medial trans-pec major (East) portal can be used safely. To palpable tip of coracoid process, portal placement should be 45-50 mm distal and 30-35 mm medial. The portal medial to the coracoid gives excellent surgical access without compromising critical neurovascular pathways.
Safety Profile of Recombinant Human Bone Morphogenetic Protein 2 in Spinal Fusion Surgery
The session described use of recombinant human bone morphogenetic protein (rhBMP) in spinal fusion but remained controversial. The prior observational studies have shown conflicting conclusions regarding rhBMP safety and effectivenes. This large observational study states that rhBMP is found to be safe and effective as compared to non-BMP usage in spinal fusion with low infections.
Scoliosis Team & Standardized Surgery Improve Adolescent Idiopathic Scoliosis Surgery Outcomes
A retrospective review showed that standardization of the perioperative approach for AIS correction with a dedicated team significantly reduced blood loss, surgical time, and length of stay. These results were seen as the team continued to refine the protocol and its reproducibility is demonstrated by its capacity to enhance perioperative outcomes across multiple institutions.
The Incidence of Osteochondral Lesions after Ankle Fractures: A Systematic Review
In the study, OCLs were found in up to 45% of patients suffering from an ankle fracture at 3 years of follow up after initial trauma. The talus was found to be the location with the highest incidence of posttraumatic OCLs. Rotational type ankle fractures reported a higher percentage of OCLs compared to other ankle fracture types.
