Does vitamin D deficiency affect functional outcomes in hip fracture patients? A meta-analysis of cohort studies.

BACKGROUND: Vitamin D deficiency is common in patients with hip fractures and may negatively affect functional recovery and quality of life (QOL). OBJECTIVE: This study aimed to conduct a meta-analysis to quantify the effects of vitamin D deficiency on physical function and quality of life after hip fractures. METHODS: The PubMed, EMBASE, Scopus, and Cochrane Library databases were searched for relevant studies. The inclusion criteria were hip fracture, comparison between vitamin D deficiency and normal vitamin D levels in patients with hip fracture, and functional outcome as the primary outcome. The exclusion criteria were case reports, reviews, duplicates, studies with a high risk of bias, and non-comparable or missing data. Two independent reviewers selected studies, extracted data, assessed bias, and performed meta-analyses using the Review Manager. Heterogeneity and publication bias were also assessed. Two independent reviewers selected the studies, extracted data, and assessed the risk of bias. We performed a meta-analysis using Review Manager and assessed heterogeneity and publication bias. RESULTS: Seven studies with 1,972 patients were included. Vitamin D deficiency was defined as a 25(OH)D level < 20 ng/mL. There were no significant differences in the ability to walk (OR 0.68, 95% CI 0.31-1.53, I2 = 69%) or length of hospital stay (MD 2.27 days, 95% CI - 2.47 to 7.01, I2 = 93%) between patients with and without vitamin D deficiency. However, patients with vitamin D deficiency had significantly worse functional ability and quality of life (SMD - 1.50, 95% CI - 2.88 to - 0.12, I2 = 96%). CONCLUSIONS: Despite the limitations of this study, such as small sample size, heterogeneous outcome assessments, and variable vitamin D measurement techniques, the results demonstrated that screening for vitamin D status and optimizing levels through supplementation could facilitate rehabilitation, promote lifestyle changes, aid in the recovery of independence, and help reduce long-term burdens.

The Impact of Hypoalbuminemia on Postoperative Complications in Patients Undergoing Shoulder Arthroplasty: A Meta-Analysis.

OBJECTIVES: The objective of this meta-analysis was to investigate the association between hypoalbuminemia and postoperative complications in patients undergoing shoulder arthroplasty. METHODS: This meta-analysis study was registered in PROSPERO (CRD42023442466) and adhered to the PRISMA guidelines. Studies focused on shoulder arthroplasty that compared hypoalbuminemia and normal albumin levels were included. A systematic literature search was conducted in PubMed, EMBASE, Scopus, and the Cochrane Collaboration database. Seven comparative studies were included, and odds ratios with a 95% confidence interval were calculated for the dichotomous variables. A fixed-effect model was used when there was no statistical evidence of heterogeneity, and a random-effect model was used when significant heterogeneity was observed. Review Manager 5.4 software was used for data analysis. RESULTS: The meta-analysis included a total of 20,290 patients from seven studies. Hypoalbuminemia was significantly associated with a higher risk of readmissions (OR 2.92, 95%CI 1.74 to 4.91), reoperations (OR 3.23, 95%CI 1.98 to 5.27), an increase in hospital stay duration (MD 1.59, 95%CI 0.86 to 2.32), and complications such as death (OR 5.75, 95% CI 2.98 to 11.08; studies = 4), thromboembolic events (OR 2.43, 95% CI 1.46 to 4.06; studies = 4), cardiac events (OR 2.78, 95% CI 1.07 to 7.24; studies = 3), pulmonary infections (OR 3.09, 95% CI 1.54 to 6.20; studies = 3), systemic infections (OR 2.19, 95% CI 1.51 to 3.16; studies = 3), and transfusions (OR 3.16, 95% CI 2.23 to 4.48; studies = 2). However, there was no significant association between hypoalbuminemia and renal complications, surgical site infections, urinary tract infections, wound problems, or cardiovascular events. CONCLUSION: This meta-analysis provides strong evidence that hypoalbuminemia is associated with a higher risk of postoperative complications in patients undergoing shoulder arthroplasty.

Role of acute social stress in the rewarding effects of MDMA in adolescent mice.

Drug use among adolescents is a serious problem in our society, as some individuals develop dependence and addiction. MDMA/Esctasy is one of the most typically used substances by this age group. It is well known that environmental factors can alter the rewarding properties of drugs and the propensity to drug-related disorders. In this sense, exposure to social stress induces long-term effects in mice, enhancing the rewarding effects of MDMA in the conditioned place preference (CPP) paradigm. On the other hand, previous research has not provided conclusive results regarding the short-term effects of social defeat on MDMA reward in adolescent animals, probably due to the use of very low or very high doses. Thus, in the present study, we set out to evaluate whether exposure to social defeat immediately before each conditioning session with an intermediate dose of MDMA (2.25 mg/kg) modulates the rewarding effect of this drug in adolescent animals. Our results indicate that both control and socially defeated mice acquired CPP, but only stressed mice showed reinstatement. These findings indicate that social defeat induces an increase in the rewarding effect of MDMA, suggesting that this type of stress is a potential factor in the development of MDMA addiction.

Blockade of nitric oxide signalling promotes resilience to the effects of social defeat stress on the conditioned rewarding properties of MDMA in mice.

MDMA abuse continues being a serious problem in our society. Environmental factors, such as stress, increase the vulnerability of individuals to develop drug abuse and we have observed that exposure to social defeat (SD) stress alters the sensitivity of mice to the rewarding effects of MDMA in the conditioned place preference (CPP) paradigm. In the present study, we evaluated the role of the nitric oxide (NO) pathway in the effects of SD on the rewarding properties of MDMA. Three groups of mice were treated with an inhibitor of NO synthesis, 7-nitroindazole (0, 7.25 and 12.5 mg/kg), before each exposure to SD and place conditioning with MDMA (1.25 mg/kg) on PND 54, 56, 58, and 60. One control group was not exposed to SD before place conditioning. In addition, we studied the effects of SD on the levels of nitrites in the striatum, hippocampus and frontal cortex. Our results showed that the low dose of 7-nitroindazole blocked the effects of SD on the rewarding properties of MDMA. Moreover, SD exposure increased the nitrites in the prefrontal cortex and hippocampus. These results demonstrated the role of NO signalling in the effects of SD stress in mice and suggested that the inhibition of NO synthesis may confer resilience to the effects of social stress on the rewarding properties of MDMA. The manipulation of the NO signalling pathway could be a useful target for the treatment of MDMA-dependent subjects who experienced high levels of stress.

Prefrontal symptomatology in People with Amyotrophic lateral Sclerosis: Clinical Utility and Psychometric Properties of Prefrontal Symptoms Inventory (PSI)

The Amyotrophic Lateral Sclerosis (ALS) is a multisystemic disorder. It is considered a neuromuscular disease but also involves cognitive (executive functions, social cognition, attention, memory and language), emotional or behavior changes in over 50% of the reported cases and to of frontotemporal diagnosis lobar degeneration of behavioral variant in up to 15% of the cases. For this reason, the presence of cognitive and motivational problems was analysed in a Spanish sample of ALS patients through the prefrontal symptoms inventory (PSI) to determine applicability in this disease STI. A sample of 31 patients with a potential ALS or definitive diagnostic criteria according to El Escorial was used. Obtained results ISP were compared with a sample of 31 healthy people in the same proportions of gender, age and education level. Obtained results showed a not significant difference between the two populations in the motivational factor problems, related to the depression symptomatology frequently associated with ALS. A significant positive correlation between age at diagnosis and the scale of the motivational problems was observed, with a not significant trend related to problems in the executive control and in social the behavior control and with the age at diagnosis, in the same sense with age at diagnosis. Therefore, it can be concluded that, despite the results obtained, emotional and behavioral deficits in ALS patients and symptoms related to frontotemporal dementia (among others, anosognosia or lack of consciousness symptoms) could have interfered in patient perception about their symptomatology