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Mosaffa F, Taheri M, Manafi Rasi A, Samadpour H, Memary E, Mirkheshti A. Comparison of pericapsular nerve group (PENG) block with fascia iliaca compartment block (FICB) for pain control in hip fractures: A double-blind prospective randomized controlled clinical trial. Orthop Traumatol Surg Res 2022; 108:103135. [PMID: 34715388 DOI: 10.1016/j.otsr.2021.103135] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 08/17/2021] [Accepted: 09/14/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Fascia iliaca compartment block (FICB) is a common regional analgesic strategy in hip fracture surgery but, recently it has been suggested that FICB may not provide enough analgesia. Pericapsular nerve group block (PENG) is a novel method for hip analgesia which its efficacy is not well established yet. The aim of this study was to the effect of the PENG block in the control of the hip fracture pain as well as to compare the effectiveness of the PENG compared with FICB. HYPOTHESIS The hypothesis of this study was that the PENG block could be a good alternative to the FICB in hip fracture analgesia. MATERIALS AND METHODS This randomized controlled clinical trial was conducted in the Imam- Hossein Hospital, Tehran, Iran; between 2018 and 2019. Hip fracture patients were randomly divided into two groups; Group A (n=22) received FICB and Group B (n=30) received PENG block. RESULTS There was no significant difference between VAS score before blocks procedure between two groups (p=0.37). After 15minutes of blocks and after 12hours of post-surgery, VAS score significantly reduced in the PENG block group compared with the FICB group (p=0.031; p=0.021, respectively). The first time of the analgesic consumption after surgery was significantly longer in the PENG block compared with the FCIB (p=0.007). Compared with the FICB group, the total dose of morphine consumption during 24hours significantly reduced in the PENG block (p=0.008). CONCLUSION PENG block is a good method in hip fractures analgesia and provides better analgesia than FICB. However, further studies with larger sample sizes are required to validate the efficacy and superiority of the PENG blocks over conventional techniques. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Faramarz Mosaffa
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdad Taheri
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Manafi Rasi
- Department of Orthopedics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Samadpour
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Memary
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Mirkheshti
- Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Kim SJ, Anh NH, Diem NC, Park S, Cho YH, Long NP, Hwang IG, Lim J, Kwon SW. Effects of β-Cryptoxanthin on Improvement in Osteoporosis Risk: A Systematic Review and Meta-Analysis of Observational Studies. Foods 2021; 10:foods10020296. [PMID: 33540706 PMCID: PMC7913073 DOI: 10.3390/foods10020296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/27/2021] [Accepted: 01/28/2021] [Indexed: 11/16/2022] Open
Abstract
Many studies have analyzed the effects of β-cryptoxanthin (BCX) on osteoporosis and bone health. This systematic review and meta-analysis aimed at providing quantitative evidence for the effects of BCX on osteoporosis. Publications were selected and retrieved from three databases and carefully screened to evaluate their eligibility. Data from the final 15 eligible studies were extracted and uniformly summarized. Among the 15 studies, seven including 100,496 individuals provided information for the meta-analysis. A random effects model was applied to integrate the odds ratio (OR) to compare the risk of osteoporosis and osteoporosis-related complications between the groups with high and low intake of BCX. A high intake of BCX was significantly correlated with a reduced risk of osteoporosis (OR = 0.79, 95% confidence interval (CI) 0.70–0.90, p = 0.0002). The results remained significant when patients were stratified into male and female subgroups as well as Western and Asian cohorts. A high intake of BCX was also negatively associated with the incidence of hip fracture (OR = 0.71, 95% CI 0.54–0.94, p = 0.02). The results indicate that BCX intake potentially reduces the risk of osteoporosis and hip fracture. Further longitudinal studies are needed to validate the causality of current findings.
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Affiliation(s)
- Sun Jo Kim
- College of Pharmacy, Seoul National University, Seoul 08826, Korea; (S.J.K.); (N.H.A.)
| | - Nguyen Hoang Anh
- College of Pharmacy, Seoul National University, Seoul 08826, Korea; (S.J.K.); (N.H.A.)
| | - Nguyen Co Diem
- School of Medicine, Vietnam National University, Ho Chi Minh City 70000, Vietnam;
| | - Seongoh Park
- Department of Statistics, Sungshin Women’s University, Seoul 02844, Korea;
| | - Young Hyun Cho
- Department of Statistics, Seoul National University, Seoul 08826, Korea; (Y.H.C.); (J.L.)
| | - Nguyen Phuoc Long
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Korea;
| | - In Guk Hwang
- Researcher, Department of Agrofood Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Korea;
| | - Johan Lim
- Department of Statistics, Seoul National University, Seoul 08826, Korea; (Y.H.C.); (J.L.)
| | - Sung Won Kwon
- College of Pharmacy, Seoul National University, Seoul 08826, Korea; (S.J.K.); (N.H.A.)
- Research Institute of Pharmaceutical Sciences, Seoul National University, Seoul 08826, Korea;
- Correspondence:
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Lumjeaksuwan M, Patcharasopit S, Seksanpanit C, Sritharo N, Aeampuck A, Wittayachamnankul B. The trend of emergency department visits among the elderly in Thailand. WHO South East Asia J Public Health 2021; 10:25-28. [PMID: 35046154 DOI: 10.4103/who-seajph.who-seajph_67_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Emergency department (ED) usage by older adults tends to be a major health issue due to increase in aging population and their health fragility. Currently, there is no study comparing ED data of older adults with those of younger population in Southeast Asia. The aim of this study was to explore the epidemiologic data of elderly who visited the ED from 2016 to 2018 and compare them with data from younger group. Data on ED visits from 2016 to 2018 were extracted from the electronic medical database. Descriptive statistics were used for analyzing the collected data and compared with the data of the age group of 15-59 years. A total of 27,871 elderly patients were found eligible and included. The mean age was 72.69 years (95% confidence interval 72.6-72.8). Patients aged 60-69 years have the highest ED visits rate (45.4%). From the total visits, 58.06% were discharged from ED, while 40.82% were admitted to hospital with 11.22% death rate after the admission. The most diagnosed condition was injury, poisoning, or other consequence from an external cause, with a head injury as the leading cause (20.74%). Compared with patients aged 15-59 years, elderly patients had a higher visit rate per 1000 population (21.99 vs. 30.91; P < 0.001), more admissions (15% vs. 40.8%; P < 0.001), and more re-visits within 7 days (1.81% vs. 4.07%; P < 0.001). These results showed that older adult patients tend to have higher ED visits rate, ED re-visits rate, and admissions rate compared to younger age groups.
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Affiliation(s)
- Methasit Lumjeaksuwan
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Suparada Patcharasopit
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Chanatip Seksanpanit
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Natchaya Sritharo
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichat Aeampuck
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Borwon Wittayachamnankul
- Department of Emergency Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Manetti S, Turchetti G, Fusco F. Determining the cost-effectiveness requirements of an exoskeleton preventing second hip fractures using value of information. BMC Health Serv Res 2020; 20:955. [PMID: 33059683 PMCID: PMC7565816 DOI: 10.1186/s12913-020-05768-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 09/28/2020] [Indexed: 11/20/2022] Open
Abstract
Background Falls may lead to hip fractures, which have a detrimental effect on the prognosis of patients as well as a considerable impact on healthcare expenditures. Since a secondary hip fracture (SHF) may lead to even higher costs than primary fractures, the development of innovative services is crucial to limit falls and curb costs in high-risk patients. An early economic evaluation assessed which patients with a second hip fracture could benefit most from an exoskeleton preventing falls and whether its development is feasible. Methods The life-course of hip fractured patients presenting with dementia or cardiovascular diseases was simulated using a Markov model relying on the United Kingdom administrative data and complemented by published literature. A group of experts provided the exoskeleton parameters. Secondary analyses included a threshold analysis to identify the exoskeleton requirements (e.g. minimum impact of the exoskeleton on patients’ quality of life) leading to a reimbursable incremental cost-effectiveness ratio. Similarly, the uncertainty around these requirements was modelled by varying their standard errors and represented alongside population Expected Value of Perfect Information (EVPI). Results Our base-case found the exoskeleton cost-effective when providing a statistically significant reduction in SHF risk. The secondary analyses identified 286 cost-effective combinations of the exoskeleton requirements. The uncertainty around these requirements was explored producing further 22,880 scenarios, which showed that this significant reduction in SHF risk was not necessary to support the exoskeleton adoption in clinical practice. Conversely, a significant improvement in women quality of life was crucial to obtain an acceptable population EVPI regardless of the cost of the exoskeleton. Conclusions Our study identified the exoskeleton requisites to be cost-effective and the value of future research. Decision-makers could use our analyses to assess not only whether the exoskeleton could be cost-effective but also how much further research and development of the exoskeleton is worth to be pursued.
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Affiliation(s)
- Stefania Manetti
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy.,Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, UK
| | | | - Francesco Fusco
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK. .,Centre for Health Economics, University of York, Heslington, York, UK. .,Department of Public Health & Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, UK.
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Abstract
Spain is considered the healthiest nation in the world, due to lifepromoting aspects such as good diet, care facilities and a favourable family environment. However, although increased life expectancy is an indicator of development, it may have a negative impact on the other two variables of health service efficiency, namely health expenditure per capita and its relative weight in Gross Domestic Product.
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Cano JR, Crespo PV, Cruz E, Rivas-Ruiz F, Sánchez-Quevedo MC, Guerado E, Campos A. Is the bone tissue of the femoral neck demineralised in patients with hip fracture? Injury 2020; 51 Suppl 1:S4-S11. [PMID: 32143855 DOI: 10.1016/j.injury.2020.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 02/08/2020] [Indexed: 02/02/2023]
Abstract
The aim of this study is to establish the falsifiability of the "osteoporotic hypothesis" for hip fracture, according to which the bone density and mineral composition of bone tissue in patients with hip fracture is poorer than when no such fracture is present, and that this circumstance is relevant to the occurrence of a fracture. The study population consisted of forty patients treated with arthroplasty. Twenty patients with femoral neck fracture and another twenty with hip osteoarthritis received the same diagnostic protocol and the same antibiotic, anaesthetic, surgical and antithrombotic prophylaxis. Levels of calcium (Ca), phosphorus (P) and vitamin D in blood, amongst other values, were determined, and five samples of bone tissue from the proximal femoral metaphysis were obtained and characterised by optical microscopy and microanalytical analysis. No statistically significant differences were observed between the two groups with respect to the trabecular number, area or thickness, or inter-trabecular distance. However, there were differences in the length of the trabeculae, which was greater in the patients with hip osteoarthritis (p = 0.002), but not when the groups were compared by gender. When compared by age, a greater inter-trabecular distance was observed in the patients aged over 75 years (p = 0.036) but there were no differences in the remaining parameters. Serum levels of Ca (p = 0.03), P (p < 0.01) and vitamin D (p < 0.01) were lower in the fracture group. In the quantitative microanalytical analysis, no significant differences were observed in bone levels of Ca or P or in the Ca/P index, nor was there any correlation between serum and levels of bone Ca or P (Ca-0.197:p = 0.314;P-0.274:p = 0.158).Multiple linear regression revealed no correlation between the diagnoses, vitamin D and bone levels of Ca or P. Despite the reduced serum levels of Ca and P in the patients with hip fracture, no correlation was observed with bone levels of Ca and P,which were similar in both groups. There were differences in the organic bone structure, in terms of length and inter-trabecular distance. For patients with osteoporosis, treatment should be aimed at increasing the synthesis of bone trabeculae to reinforce their structure. Nevertheless, no such treatment can prevent falls, and therefore no reduction in hip fractures amongst this population can be assured.
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Affiliation(s)
- J R Cano
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Marbella, Málaga, Spain.
| | - P V Crespo
- Tissue Engineering Group, Department of Histology, University of Granada, Granada, Spain
| | - E Cruz
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Marbella, Málaga, Spain
| | - F Rivas-Ruiz
- Research Support Unit, Hospital Universitario Costa del Sol, REDIDDEC, Marbella, (Spain)
| | - M C Sánchez-Quevedo
- Tissue Engineering Group, Department of Histology, University of Granada, Granada, Spain
| | - E Guerado
- Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Costa del Sol, University of Málaga, Marbella, Málaga, Spain
| | - A Campos
- Tissue Engineering Group, Department of Histology, University of Granada, Granada, Spain
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Al-algawy AAH, Baiee HA, Hasan S, Jassim I, Razaq M, Kamel F, Ali A, Khudhair E. Risk Factors Associated With Hip Fractures among Adult People in Babylon City, Iraq. Open Access Maced J Med Sci 2019; 7:3608-3614. [PMID: 32010385 PMCID: PMC6986518 DOI: 10.3889/oamjms.2019.734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/24/2019] [Accepted: 08/25/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The fractures of hip joint considered as a serious problem in public health in the medical and socioeconomic issues, the incidence of the fracture neck femur is significantly increased with the increment of general population life span. AIM The goal of this study is to highlight and focus on the most important risk factor for the hip fractures in our Babylon society, and to improve our understanding of the medical and social aspects of these predisposing factors. PATIENTS AND METHODS A case-control study of older adults (above 60 years old). The study was done on tow samples. First, one consisting of 75 cases those having fracture neck femur considered as cases, and second sample as a control group, consisting of 150 people as a healthy control group having no fracture. A pre-tested questionnaire was prepared to collect data from both samples; the questionnaire included demographic data and information about potential risk factors of hip fracture. RESULTS Most of the people in the study samples in both groups were, married women, housekeepers, illiterate and from urban dwellers. There was highly significant association between case-control groups regarding, Continuous using of medication such as cortisone which was found to be a potential risk factor of hip fracture (Unadjusted OR = 3.636), low income was positively associated risk factor of hip fracture in this study (OR = 2.377), low milk intake, low sun exposure, tobacco smoking were positively associated with this health problem (OR = 1.794), while physical exercise was protective factor (OR = 0.489). CONCLUSION The highest risk factors associated with increased occurrence of hip fracture were using cortisone, Osteoporosis, tobacco smoking, consuming soft drinks, and less exposure to sunlight.
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Affiliation(s)
| | | | - Sahar Hasan
- College of Nursing, University of Babylon, Hillah, Iraq
| | - Ismail Jassim
- College of Nursing, University of Babylon, Hillah, Iraq
| | - Maryam Razaq
- Students at College of Nursing, University of Babylon, Hillah, Iraq
| | - Fatma Kamel
- Students at College of Nursing, University of Babylon, Hillah, Iraq
| | - Athraa Ali
- Students at College of Nursing, University of Babylon, Hillah, Iraq
| | - Eitaa Khudhair
- Students at College of Nursing, University of Babylon, Hillah, Iraq
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Abstract
INTRODUCTION Approximately half of all hip fractures are intertrochanteric femur fractures. This video demonstrates the technique of repair of an unstable intertrochanteric hip fracture using a cephalomedullary device. METHODS The patient is an 88-year-old woman presenting with an intertrochanteric hip fracture secondary to a low-energy injury. The patient was indicated for surgery due to the unstable nature of the fracture. RESULTS This video demonstrates the cephalomedullary nailing technique for the repair of an unstable intertrochanteric hip fracture after a low-energy injury. Anatomical reduction and stable fixation were obtained with this technique. CONCLUSIONS The case demonstrates a cephalomedullary technique of intertrochanteric fracture fixation using a cephalomedullary nail. The technique has significant advantages including minimal intraoperative blood loss, shorter operative times, potential for more biological healing with a load-sharing device, and low infection rate.
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