ABSTRACT
Background: COVID-19 trials took <1 year to identify therapies reducing death in >30,000 patients but the Australian Placental Transfusion Study took >12 years to show that delaying cord clamping reduced death or major disability (cerebral palsy, severe visual loss, deafness, or cognitive delay) in 1,531 preterm infants. What can this teach us? Further, as composite outcomes of death or major disability can be inconclusive if each is unequally affected (as in the NeOProM Collaboration1) 2 important aims are (i) global co-operation (https://www.alphacollaboration.com/) to identify core Participant-Intervention-Comparator-Outcome questions for trials assessing mortality, a key outcome, and (ii) to answer those questions in much larger, faster trials. Such trials will also yield much more precise estimates of disability in survivors than was previously typical - a major benefit. Method: To inform these aims we compared enrolment in 2 COVID-19 trials and in 10 trials by IMPACT collaborators with samples >1,500 in high- or low-or-middle-income countries (HIC/LMIC). Results: The COVID-19 trials took 3-9 months, enrolling 13 - 219 per-site-per-year. Perinatal trials took 16-86 months, enrolling 5 - 1,700 per site per year. Trials in pregnant women or LMIC (n = 53,092) enrolled 5 times more than trials in newborns or restricted to HIC (n = 9,014). (Table) Conclusions: Greater international collaboration could resolve questions of shared relevance and priority more rapidly. Megatrials addressing mortality may benefit from highly streamlined processes for enrolment and minimal data collection, e.g., RECOVERY's one-page outcome form.
ABSTRACT
Background: Hip fracture is a common injury in elder population. Generally, this condition requires urgent diagnosis and prompt surgical treatment, to reduce postoperative mortality, morbidity, and improve functional outcome. Outcome of surgical treatment by better techniques and improved anesthesia methods has changed the prognosis of the geriatric injury. Case report: A 79 Y/F with history of CAD, HTN and DM admitted with history of fall. Radiograph suggested right # N/F and left radius. History of CABG 7 years back, taking oral drugs;ecospirin, carvedilol, cidmus, eplerenone, nitroglycerin and atorvastatin. Investigation, RBS was 180mgm/dl, Hb1Ac was 7.12% and CRP was 131.48mgm/l. ECG showed LVH, complete LBB and sinus rhythm. 2D Echo - IHD, RWMA and akinetic basal infero-septum, post wall and mid basal segments of inferior wall. Paradoxical movement of the septum due to LBB. Concentric LVH and EF of 40%. Patient tested negative for COVID-19 (RT-PCR). NT pro BNP was 957 pg/ml. Preoperatively, LMWH was started. Patient was given G.A. Standard monitoring included - 5 lead ECG, SpO2, ETCO2, NIBP, urine output and gas monitoring. Anaesthesia was given with i/v fentanyl, i/v etomidate and cisatracurium. After endotracheal intubation, anaesthesia was maintained with oxygen, nitrous oxide and sevoflurane, DHS screw fixation with closed reduction of radius was done. Anaesthesia was reversed with i/v myopyrollate and extubated. Patient was haemodynamically stable throughout the procedure and tolerated anaesthesia well. Post-operatively, the patient recovery was good. Conclusion: The femoral neck fracture in a patient with recent myocardial infarction involves a difficult decision and a multidisciplinary collaboration. Although rare, this combined pathology is difficult to manage and still has no consensus on when to wait, how long to wait until surgery and whether to operate or to treat functionally these particular patients.