Pain management following simultaneous bilateral total knee arthroplasty: genicular nerve blockade versus periarticular injection

The aim of the present study was to investigate whether the analgesic solution prepared for periarticular injection (PAI) could be utilized as a genicular nerve blockade (GNB) agent in bilateral knee arthroplasty, and to assess the pain control efficacy of this approach in comparison with PAI. This was a retrospective cohort in which patients undergoing simultaneous bilateral total knee arthroplasty (TKA) were evaluated. Thirty patients were enrolled. The standard PAI was used for one knee, while the PAI solution was applied in the form of GNB to the other. Visual Analog Scale (VAS) pain scores were measured and recorded separately for each knee, at rest (static) and during exercise (dynamic). Active range of joint motion (JRM) for both knee joints was measured preoperatively, at postoperatively. Compared to the PAI group, the GNB group had lower VAS scores at 2 and 8 hours (p = 0.030 and p < 0.001, respectively). The GNB group also had lower dynamic VAS scores at 2, 8, and 24 hours (p = 0.009, p <0.001 and p<0.001, respectively). Static and dynamic VAS measurements did not demonstrate any differences between groups (GNB vs. PAI) at 48 hours and 30 days (p>0.05). When the reduction in VAS scores was assessed, we found that the decrease in both scores was significantly greater in the PAI group compared to the GNB group (p<0.001, for both). There were no significant differences between the groups with regard to drainage volume, complications and JRM (p>0.05). GNB was found to be more effective for pain control throughout the first postoperative day in patients who underwent simultaneous bilateral TKA.

Optimization of anastomotic technique and gastric conduit perfusion with hyperspectral imaging and machine learning in an experimental model for minimally invasive esophagectomy

INTRODUCTION

Esophagectomy is the mainstay of esophageal cancer treatment, but anastomotic insufficiency related morbidity and mortality remain challenging for patient outcome. Therefore, the objective of this work was to optimize anastomotic technique and gastric conduit perfusion with hyperspectral imaging (HSI) for total minimally invasive esophagectomy (MIE) with linear stapled anastomosis.

MATERIAL AND METHODS

A live porcine model (n = 58) for MIE was used with gastric conduit formation and simulation of linear stapled side-to-side esophagogastrostomy. Four main experimental groups differed in stapling length (3 vs. 6 cm) and simulation of anastomotic position on the conduit (cranial vs. caudal). Tissue oxygenation around the anastomotic simulation site was evaluated using HSI and was validated with histopathology.

RESULTS

The tissue oxygenation (ΔStO₂) after the anastomotic simulation remained constant only for the short stapler in caudal position (-0.4 ± 4.4%, n.s.) while it was impaired markedly in the other groups (short-cranial: -15.6 ± 11.5%, p = 0.0002; long-cranial: -20.4 ± 7.6%, p = 0.0126; long-caudal: -16.1 ± 9.4%, p < 0.0001). Tissue samples from avascular stomach as measured by HSI showed correspondent eosinophilic pre-necrotic changes in 35.7 ± 9.7% of the surface area.

CONCLUSION

Tissue oxygenation at the site of anastomotic simulation of the gastric conduit during MIE is influenced by stapling technique. Optimal oxygenation was achieved with a short stapler (3 cm) and sufficient distance of the simulated anastomosis to the cranial end of the gastric conduit. HSI tissue deoxygenation corresponded to histopathologic necrotic tissue changes. The experimental model with HSI and ML allow for systematic optimization of gastric conduit perfusion and anastomotic technique while clinical translation will have to be proven.

AB1175 EFFECTS OF THE COVID-19 DISEASE ON AXIAL SPONDYLOARTHRITIS DISEASE FLARE

Background

Rheumatological disease flares may be seen after many infections. However, our knowledge for the post-COVID axial spondyloarthritis (SpA) flares and its related factors is limited.

Objectives

We aimed to evaluate disease activity and factors that may be associated with disease activity in axial SpA patients in post-COVID period.

Methods

We retrospectively assessed the axial SpA patients who have had COVID-19 disease confirmed by a positive SARS-CoV-2 polymerized chain reaction (PCR) test result. Demographics, comorbid diseases, active medical treatments for SpA and information regarding COVID-19 clinical courses were collected from medical records. PCR positive patients were reached via telephone and Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scored for pre- and post-COVID SpA symptoms. An increase of ≥2 points in the BASDAI score was defined as flare, and SpA groups with and without flare were compared. Factors predicting SpA flare were also analyzed by the logistic regression analysis.

Results

A total of 48 axial SpA patients were included in our study, 65% of them male and the mean±SD age was 42.3±8.6 years. Post-COVID SpA flare was seen in 38% patients. Demographic, clinical, medical features of the SpA patients and COVID-19 disease severity were similar between Flare and No flare groups. In comparison of the COVID-19 symptoms, although most of the COVID-19 related symptoms were similar between two groups, the frequency of the back pain and diarrhea were higher in the Flare group than No flare group. But in multivariate analysis, only history of the inflammatory bowel disease had an increased risk for post-COVID SpA flare (Table 1).

Table 1.

Results from adjusted logistic regression model of the spondyloarthritis flare

VariablesEnter MethodBackward:Conditional MethodOR95% CIpOR95% CIpSmoking0.1250.013-1.2330.075Multimorbidity0.2440.047-1.2560.091Inflammatory bowel disease33.2211.236-892.7200.03734.3821.571-752.4620.025Fever1.5820.334-7.4860.563Arthralgia3.4380.233-50.6300.368Back pain1.0540.080-13.8950.968

OR: Odds ratio, CI: Confidence Interval

Conclusion

The presence of inflammatory bowel disease statistically significant related post-COVID SpA flares. In addition, diarrhea and back pain symptoms in COVID-19 disease may be stimulating factors for SpA flares but we found no effect of rheumatological therapies.

Disclosure of Interests

None declared

AB1142 EFFECTS OF SULFASALAZINE USED IN AXIAL SPONDYLOARTHRITIS ON COVID-19 OUTCOMES: REAL-LIFE DATA FROM A SINGLE CENTER

Background

Compared to biologic-agents, little is known about effects of sulfasalazine used for axial spondyloarthritis(AxSpA) on COVID-19 outcomes.

Objectives

So, we aimed to understand the impact of sulfasalazine on COVID-19 in AxSpA patients.

Methods

This was a retrospective study from a single center which included 2344 AxSpA patients. We analyzed 219 of 406 confirmed COVID-19 patients from March 2020 to July 2021. The primary outcome was COVID-19 severity in terms of COVID-19 pneumonia, hospitalization rate and length of hospitalization. Analyses were stratified according to use of sulfasalazine and/or biologic-agents.

Results

Most of the patients were male(59%) with a mean age of 45.0 years. Peripheral arthritis was present in 35% and uveitis in 15%. In total, sulfasalazine was used in 42% and biologic-agent in 42%. COVID-19 pneumonia detected in 16%, hospitalization required in 14% and median(IQR) duration of hospitalization was 10(8) days. Two patients died due to COVID-19. The sulfasalazine users had higher age, more frequent COVID-19 pneumonia, hospitalization and longer hospitalization. After biologic-agent users were excluded, the sulfasalazine group had again longer hospitalization. When patients regrouped as sulfasalazine monotherapy, sulfasalazine+biologic and biologic monotherapy, in pairwise comparisons, sulfasalazine monotherapy group had a higher frequency of COVID-19 pneumonia than biologic monotherapy group(p=0.008).

Conclusion

Although sulfasalazine seemed to be related with increased rates of COVID-19 pneumonia and hospitalization, this impact diminished after exclusion of biologic-agent users. Sulfasalazine monotherapy and sulfasalazine+biologic therapy might be associated with development of COVID-19 pneumonia, compared to biologic monotherapy. Our results imply sulfasalazine may be related with worse disease course AxSpA patients with COVID-19.

Disclosure of Interests

None declared

AB0157 PREVALENCE OF SARCOPENIA AND CLINICAL IMPLICATIONS IN NEWLY DIAGNOSED RHEUMATOID ARTHRITIS PATIENTS

Background:

The aim of this study is to determine the frequency of sarcopenia at the time of diagnosis in RA patients, evaluate the effects of sarcopenia on RA disease activity, prognosis and examine the factors that may be associated with sarcopenia.

Objectives:

To determine the frequency of sarcopenia at the time of diagnosis in rheumatoid arthritis (RA) patients, assessing disease activity and factors that may be associated with sarcopenia and observe effects of treatment on sarcopenia.

Methods:

A prospective study was conducted on RA patients with newly diagnosed. Patients were evaluated twice, at the time of diagnosis and three months after the initiation of treatment. Demographic data, anthropometric measurements, disease activity scores and sarcopenia status were recorded. Sarcopenia was evaluated with grip strength and bioelectric impedance. The results were also compared with healthy volunteers.

Results:

Hand grip strength (p<0.001), skeletal muscle mass (p=0.009) and skeletal muscle mass index (p=0.032) were found to be reduced in RA patients compared to the control group. The frequency of sarcopenia in RA at onset of diagnosis was found to be 31.5%. There was a significant decrease in the rate of sarcopenia after three months of treatment (31.5% versus 8.7%; p=0.046).

Conclusion:

Sarcopenia was found in approximately one third of the patients with newly diagnosed RA in our study. With treatment, sarcopenia improved significantly. RA patients should be evaluated in terms of sarcopenia besides evaluating joint and extra-articular findings at the time of diagnosis. Early detection and treatment planning may improve the quality of life.

Figure 1.

Distribution of skeletal muscle mass index (SMMI) and prevalence of sarcopenia in RA and control groups

Table 1.

Demographics, clinical features, anthropometric measurements and disease activity scores of sarcopenic and non-sarcopenic RA patients

RA without sarcopenian=37RA with sarcopenian=17pAge, mean (SD), years47,3 (12,8)58,0 (16)0,011*Gender, female, n (%)27 (73)9 (52,9)0,215Marital status, married, n (%)34 (91,9)13 (76,5)0,258Tobacco consumption, n (%) Active smoker10 (27)5 (29,4)0,086 Ex-smoker8 (21,6)8 (47,1) Never smoker19 (51,4)4 (23,5)Alcohol consumption, n (%) Active drinker2 (5,4)2 (11,8)0,244 Ex-drinker0 (0,0)1 (5,9) Never drinker35 (94,6)14 (82,4)Occupation, n (%) Worker15 (40,5)12 (70,6)0,060Height, mean (SD), meter1,6 (0,1)1,6 (0,1)0,664Weight, mean (SD), kg80,6 (17,7)65,3 (8,6)<0,001*BMI, mean (SD), kg/m231,4 (7,3)24,9 (3,2)<0,001*Obese, n (%)20 (54,1)2 (11,8)0,006*Waist circumference, mean (SD), cm97,1 (14,2)89,3 (12,8)0,058Hip circumference, mean (SD), cm108,1 (12,7)96,6 (5,1)0,001*Calf circumference, mean (SD), cm35,4 (5,1)29,6 (4,0)<0,001*Triceps skin thickness, median (min-max), mm22 (8-36)15 (6-31)0,022*Loss of muscle strength, n (%) Right10 (27,0)9 (52,9)0,076 Left12 (32,4)10 (58,8)0,081Dominant hand, right, n (%)33 (89,2)13 (76,5)0,418SMM, mean (SD)25,1 (5,8)21,9 (4,7)0,049*SMMI, mean (SD)9,6 (1,5)8,2 (1,2)<0,001*DAS 28 - CRP, median (min-max)4,4 (1,7-6,5)4,4 (2,4-6,3)0,860SDAI, median (min-max)36,1 (8,8-113)31,1 (17,1-113)0,668CDAI, median (min-max)23 (0-48)23 (6-39)0,993PrGA, median (min-max)6 (0-9)5 (2-10)0,627PtGA, median (min-max)8 (0-10)7 (4-10)0,666Presence of morning stiffness, n (%)32 (86,5)14 (82,4)0,999Swollen joint count, median (min-max)2 (0-10)4 (0-9)0,423Tender joint count, median (min-max)6 (0-20)7 (0-18)0,911

Disclosure of Interests:

None declared

AB0314 SEMAPHORIN 3A LEVELS IN LUPUS WITH AND WITHOUT SECONDARY ANTIPHOSPHOLIPID ANTIBODY SYNDROME AND RENAL INVOLVEMENT

Background:

In this study, we aimed to evaluate sema3A levels in SLE patients with and without renal involvementor secondary antiphospholipid antibody syndrome (APS), to further elucidate the contribution ofsema3A in etiopathogenesis these conditions

Objectives:

Aim of this study is to evaluate sema3A levels in systemic lupus erythematosus patients (SLE) with and without renal involvement and secondary antiphospholipid antibody syndrome (APS).

Methods:

SLE patients were grouped according to presence of secondary APS or renal involvement. The control group consisted of age-matched, non-smoker, healthy volunteers. Sema3A levels were compared among groups. All SLE patients were regrouped according to presence of thrombotic events, miscarriages and proteinuria and sema3A levels were investigated. Finally, sema3A levels of all SLE patients as a single group were compared to controls.

Results:

The mean sema3A values were 16.16±2.84 ng/dL in the control group, 11.28±5.23 ng/dL in SLE patients without nephritis and APS, 9.05±5.65 ng/dL in SLE with APS group, and 8.53±5.11 ng/dL in lupus nephritis group. When all three patient groups were examined as a single group, mean sema3A value was significantly lower than that of the control group. Sema3A was reduced in SLE patients with thromboembolism and/or miscarriage.

Conclusion:

Sema3A levels were lower in all patient groups compared to the control group. Moreover, the reduced sema3A levels in patients with a history of thromboembolism and/or miscarriage suggests that sema3A may play an important role in the pathogenesis of vasculopathy

Table 1.

Comparison of sema3A levels between SLE patient groups and control subjects

Patient groupsGroup A (N=20)Group B (N=20)Group C (N=19)Control (N=19)pSema3A, ng/dL, mean ± SD9.05 ± 5.6511.28 ± 5.238.53 ± 5.1116.16 ± 2.84Group A vscontrol<0.001Group B vscontrol<0.001Group C vscontrol<0.001Group A vs B = 0.203Group A vs C = 0.766Group B vs C = 0.106All patients (N=59)Control (N=19)<0.0019.64 ± 5.3816.16 ± 2.84Patients with thrombotic events and/or miscarriages (N=31)Patients without thrombotic events and/or miscarriages (N=48)0.0329.96 ± 5.1112.33 ± 5.84Patients with proteinuria and/or thrombotic events and/or miscarriages (N=45)Patients without proteinuria and/or thrombotic events and/or miscarriages (N=34)<0.0019.05 ± 5.0914.91± 4.50

Disclosure of Interests:

None declared

Association between blood pressure, inflammation and spirometry parameters in chronic obstructive pulmonary disease

BACKGROUND/AIMS

Many systems including the cardiovascular system (ischemic heart diseases, heart failure, and hypertension) may act as comorbidities that can be seen during the course of chronic obstructive pulmonary disease (COPD). Comorbidities affect the severity and prognosis of COPD negatively. Nearly 25% of patients with COPD die due to cardiovascular diseases. In this study, we aimed to evaluate the relationship between the blood pressure, inflammation, hypoxia, hypercapnia, and the severity of airway obstruction.

METHODS

We included 75 COPD patients in the study with 45 control cases. We evaluated age, sex, body mass index, smoking history, C-reactive protein levels, 24-hour ambulatory blood pressure Holter monitoring, arterial blood gas, and respiratory function tests of the patient and the control groups.

RESULTS

In COPD patients, the night time systolic, diastolic blood pressures and pulse per minute and the mean blood pressures readings were significantly elevated compared to the control group (p < 0.05). In the correlation analysis, night time systolic pressure was associated with all the parameters except forced expiratory volume in 1 second (FEV1%). Diastolic blood pressure was associated with pH and HCO3 levels. The mean night time, day time pulse pressures and 24- hour pulse per minute values were also associated with all the parameters except FEV1%.

CONCLUSION

In this study we found that parameters of systolic and diastolic blood pressures and pulse pressures were significantly elevated in COPD patients compared to the control groups. Blood pressure was associated blood gas parameters and inflammation parameters in COPD patients. This, in turn, may cause understanding of the pathophysiology of COPD and its complications.

Use of tolvaptan in patients hospitalized for worsening chronic heart failure with severe hyponatremia: The initial experience at a single-center in Turkey

OBJECTIVE

The aim of the present study was to assess the efficacy and safety of tolvaptan for severe hyponatremia (SH) in hypervolemic heart failure (HF) patients within daily clinical practice.

METHODS

We restrospectively reviewed our database on tolvaptan as an add-on treatment in hypervolemic patients admitted to our clinic due to deterioration of HF and having hyponatremia resistant to standard therapy. Severe hyponatremia was defined as serum sodium concentration ≤125 mEq/L. The database included demographic, clinical, laboratory, and echocardiographic findings on admission, and numerous outcome measures for oral tolvaptan treatment were used to assess its efficacy and safety.

RESULTS

The study group consisted of 56 hypervolemic HF patients with severe hyponatremia (25 female and 31 male) with mean age of 66 years. All patients received a single dose of tolvaptan 15 mg daily for an average of 3.2 days due to severe hyponatremia. Sodium and potassium concentrations, fluid intake, and urine volume increased (p<0.0001, p=0.037, p<0.0001, and p<0.0001, respectively), whereas furosemide dosage, body weight, heart rate, systolic and diastolic blood pressure, and New York Heart Association class decreased significantly in response to tolvaptan treatment, without a rise in serum creatinine or urea concentrations (p<0.0001, p<0.0001, p=0.001, p<0.049, p<0.009 ve p=0.001, respectively).

CONCLUSION

In this retrospective, single-centered study conducted in a small group of Turkish patients, short-term treatment with low-dose tolvaptan added to standard therapy of hypervolemic HF patients with severe hyponatremia was well tolerated with a low rate of major side effects and was effective in correcting severe hyponatremia.

Association of monocyte to HDL cholesterol level with contrast induced nephropathy in STEMI patients treated with primary PCI

Background:

Contrast induced nephropathy (CIN) has been proven to be a clinical condition related to adverse cardiovascular outcomes. In recent studies, the monocyte to high density lipoprotein ratio (MHR) has been postulated as a novel parameter associated with adverse renal and cardiovascular outcomes. In this study we investigated the association of MHR with CIN in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).

Methods:

Consecutive STEMI patients treated with primary PCI were prospectively recruited. Subjects were categorized into two groups; as patients who developed CIN (CIN+) and patients who did not develop CIN (CIN–) during hospitalization. CIN was defined as either a 25% increase in serum creatinine from baseline or 44.20 µmol/L increase in absolute value, within 72 h of intravenous contrast administration.

Results:

A total number of 209 patients were included in the study. Thirty-two patients developed CIN (15.3%). In the CIN (+) patients, monocytes were higher [1.02 (0.83–1.39) vs. 0.69 (0.53–0.90) 109/L, p<0.01] and HDL cholesterol levels were lower [0.88 (0.78–1.01) vs. 0.98 (0.88–1.14) mmol/L, p<0.01]. In addition, MHR was significantly higher in the CIN (+) group [1.16 (0.89–2.16) vs. 0.72 (0.53–0.95) 109/mmol, p<0.01]. In multivariate logistic regression analysis, MHR, Mehran score, AGEF score and CV/eGFR were independently correlated with CIN.

Conclusions:

Higher MHR levels may predict CIN development after primary PCI in STEMI patients.

Smoking and gingivitis: focus on inducible nitric oxide synthase, nitric oxide and basic fibroblast growth factor

BACKGROUND

Periodontal disease pathogenesis has been associated with smoking. Gingivitis is a mild and reversible form of periodontal disease and it tends to progress to periodontitis only in susceptible individuals. In the present study, we aimed to examine the impact of smoking on host responses in gingivitis and to evaluate and compare the inducible nitric oxide synthase (iNOS) activity in gingival tissue and NO and basic fibroblast growth factor (bFGF) levels in the gingival crevicular fluid of patients with gingivitis and healthy individuals.

MATERIAL AND METHODS

Forty-one participants were assigned to the gingivitis-smoker (n = 13), gingivitis (n = 13), healthy-smoker (n = 7) and healthy groups (n = 8). Clinical indices were recorded; gingival biopsy and gingival crevicular fluid samples were obtained from papillary regions. iNOS expression was evaluated by immunohistochemical staining. The immunoreactive cells were semiquantitatively assessed. For the quantitative determination of nitrite and nitrate in gingival crevicular fluid, the NO assay kit was used. The amount of bFGF in gingival crevicular fluid was determined by enzyme-linked immunosorbent assay.

RESULTS

The gingivitis-smoker group demonstrated a stronger iNOS expression than the non-smoker gingivitis group. iNOS expression intensity was lower in the non-smoker healthy group compared to that in healthy-smokers. No significant gingival crevicular fluid NO and bFGF level changes were observed between groups. Among patients with gingivitis, a positive correlation was detected between gingival crevicular fluid NO and bFGF levels (r = 0.806, p = 0.001).

CONCLUSIONS

Our data suggest that smoking has significant effects on iNOS expression but not on gingival crevicular fluid NO or bFGF levels in healthy and patients with gingivitis. However, our results suggest that bFGF might be involved in the regulation of NO production via iNOS.

Long-term outcomes of pericardiectomy for constrictive pericarditis

Background

Constrictive pericarditis is a rare and disabling disease that can result in chronic fibrous thickening of the pericardium. The purpose of this study was to evaluate the long-term outcomes following treatment of constrictive pericarditis by pericardiectomy.

Methods

Between September 1992 and May 2014, 47 patients who underwent pericardiectomy for constrictive pericarditis were retrospectively examined. Demographic, pre-, intra- and postoperative data and long-term outcomes were analyzed.

Results

Thirty of the patients were male, the mean age was 45.8 ± 16.7. Aetiology of constrictive pericarditis was tuberculosis in 22 (46.8 %) patients, idiopathic in 15 (31.9 %), malignancy in 3 (6.4 %), prior cardiac surgery in 2 (4.3 %), non-tuberculosis bacterial infections in 2 (4.3 %), radiotherapy in 1 (2.1 %), uraemia in 1 (2.1 %) and post-traumatic in 1 (2.1 %). The surgical approach was achieved via a median sternotomy in all patients except only 1 patient. The mean operative time was 156.4 ± 45.7 min. Improvement in functional status in 80 % of patients’ at least one New York Heart Association (NYHA) functional class was observed. In-hospital mortality rate was 2.1 % (1 of 47 patients). The cause of death was pneumonia leading to progressive respiratory failure. The late mortality rate was 23.4 % (11 of 47 patients). The mean follow-up time was 61.2 ± 66 months. The actuarial survival rates were 91 %, 85 % and 81 % at 1, 5 and 10 years, respectively. Recurrence requiring a repeat pericardiectomy was developed in no patient during follow-up.

Conclusion

Pericardiectomy is associated with high morbidity and mortality rates. Cases with neoplastic diseases, diminished cardiac output, cases in need of reoperation are expected to have high mortality rates and less chance of functional recovery.

A calvarial acute subdural hematoma migrating into the spinal canal in a young male

It is not common for an acute subdural hematoma (SDH) in the supratentorial region to show rapid resolution or migration during the clinical course. In this report, we present a rare case where the SDH in the supratentorial region was observed to rapidly migrate into the lumbar spinal canal, leading to severe radiculopathy. A 20-year-old male patient was admitted to the emergency department with severe headache after head trauma. The patient's overall condition was good, whereas his Glasgow Coma Scale score was 15 and blood pressure was normal. He had vomited 3 times after the onset of pain. No stiff neck was found, and the computed tomography showed an ASDH over the outer layer of the right hemisphere, causing a 7- to 8-mm shift. During the follow-up, the headache regressed and eventually resolved after 12 hours; however, another severe pain occurred in the lumbar region and in both legs. The pain worsened over time, progressing to sciatica in both legs. Acute SDH associated with a minor head trauma may migrate from the supratentorial compartment into the spinal canal by the help of elastic cerebral tissues in young adults and children.