The association between diabetes status and postoperative complications for patients receiving ACL reconstruction

PURPOSE

It is well established that diabetes is associated with complications following surgical procedures across the wide array of surgical subspecialties. The evidence on the effect of diabetes on postoperative outcomes following anterior cruciate ligament (ACL) reconstruction (ACLR), however, is not as robust, and findings have not been consistent. It was hypothesized that patients with diabetes are at increased risk of complications and a higher rate of hospital admission following ACLR.

METHODS

The National Surgical Quality Improvement Program database was queried for patients undergoing ACL reconstruction from 2006 to 2019. Two patient cohorts were defined in this retrospective study: patients with diabetes and patients without diabetes. The various patient demographics, medical comorbidities, and postoperative outcomes were compared between the two groups, with the use of bivariate and multivariate analyses.

RESULTS

Of 9,576 patients who underwent ACL reconstruction, 9,443 patients (98.6%) did not have diabetes, whereas 133 patients (1.4%) had diabetes. Following adjustment on multivariate analyses, compared to non-diabetic patients, those with diabetes had an increased risk of admission to the hospital within thirty days of the surgery (OR 2.14; p = 0.002).

CONCLUSION

Patients with diabetes have a significantly higher risk of being admitted to the hospital compared to those without the disease. Clinicians should be aware of diabetic patients who undergo ACLR to ensure appropriate pre- and postoperative care to minimize complications in this patient population.

Synergistic Effects of Multiple Factors Involved in COVID-19-dependent Muscle Loss

The COVID-19 pandemic caused by the novel SARS-CoV-2 coronavirus is an ongoing pandemic causing severe health crisis worldwide. Recovered COVID-19 patients go through several long-term side effects such as fatigue, headaches, dizziness, weight loss, and muscle loss among others. Our study sought to determine the molecular mechanisms behind muscle loss in COVID-19 patients. We hypothesized that multiple factors such as cytokine storm and therapeutic drugs (glucocorticoid and antiviral drugs) might be involved in muscle loss. Using the Gene Expression Omnibus database, we identified several studies that performed RNA sequencing on skeletal muscles with the treatment of cytokine, glucocorticoid, and antiviral drugs. Our study identified cytokines, such as IL-1b, and IL-6, associated with altered regulation of several genes involved in the myogenic processes, including Ttn, Cxxc5, Malat1, and Foxo1. We also observed that glucocorticoid altered the expression of Foxo1, Lcn2, Slc39a14, and Cdkn1a. Finally, we found out that the antiviral (RNA-dependent RNA polymerase inhibitor) drug regulates the expression of some of the muscle-related genes (Txnip, Ccnd1, Hdac9, and Fbxo32). Based on our findings, we hypothesize that the cytokine storm, glucocorticoids, and antiviral drugs might be synergistically involved in COVID-19-dependent muscle loss.

Tryptophan-Kynurenine Pathway in COVID-19-Dependent Musculoskeletal Pathology: A Minireview

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), affecting multiple organ systems, including the respiratory tract and lungs. Several studies have reported that the tryptophan-kynurenine pathway is altered in COVID-19 patients. The tryptophan-kynurenine pathway plays a vital role in regulating inflammation, metabolism, immune responses, and musculoskeletal system biology. In this minireview, we surmise the effects of the kynurenine pathway in COVID-19 patients and how this pathway might impact muscle and bone biology.

Rofecoxib, a specific cyclooxygenase-2 inhibitor, in primary dysmenorrhea: a randomized controlled trial

OBJECTIVE

To determine whether rofecoxib is effective for treating primary dysmenorrhea and whether cyclooxygenase-2 is involved in the pathophysiology of primary dysmenorrhea.

METHODS

A double-masked, randomized, placebo and active-comparator-controlled clinical trial including 127 subjects with histories of primary dysmenorrhea was conducted in an outpatient clinical research center. Subjects were randomly assigned to placebo, rofecoxib 25 or 50 mg followed by 25 mg every 24 hours as needed, or naproxen sodium 550 mg every 12 hours as needed for up to 3 days. Subjects took all four treatments in a balanced, complete-block, crossover design. Measurements included self-administered questionnaires of analgesic efficacy, spontaneous reports of adverse experiences, physical examinations, and laboratory safety tests.

RESULTS

Rofecoxib 25 and 50 mg provided analgesic efficacy greater than placebo (P < or = .006) for the primary endpoint of total pain relief over the first 8 hours. For other efficacy endpoints (sum of the pain intensity difference over the first 8 hours, subject's global evaluation, peak pain relief, peak pain intensity difference, and time to remedication) both doses of rofecoxib were better than placebo (P < or = .006) and were not distinguishable from naproxen sodium for all efficacy endpoints. All treatments were well tolerated.

CONCLUSION

Rofecoxib effectively treated primary dysmenorrhea, and cyclooxygenase-2-derived prostanoids play a role in the pathophysiology of primary dysmenorrhea.