Comparing Intraoperative Blood Loss in Cemented, Uncemented, and Hybrid Total Hip Replacement for Neck of Femur Fractures.

Background As the aging population increases, osteoporotic neck of femur fracture cases will continue to rise. Although hemiarthroplasty or half hip replacement is the treatment of choice in a majority of patients, a small but definite cohort of patients would need a total hip replacement. In these elderly patients who often have comorbidities, the use of cement to fix the prosthesis is often quoted as beneficial in view of perceived lower blood loss compared to uncemented fixation of the prosthesis. However, the cementation of the implant in itself has inherent problems. This study examined three modalities of fixation of a prosthesis for total hip replacement in the neck of femur fractures, namely, cemented, hybrid, and uncemented, and compared their relative intraoperative blood loss. Methodology This is a retrospective study with a follow-up of two years. Patients who presented to a level 1 trauma center in an inner city metropolitan with neck of femur fractures and were treated by total hip replacement were included in the study. Intraoperative blood loss was calculated using Nadler's formula. Results There was no statistical difference in intraoperative blood loss in either of the three groups of patients, namely, cemented, hybrid, or uncemented total hip replacement for neck of femur fractures. Conclusions Intraoperative blood loss should not influence the modality of prosthesis fixation for total hip replacement in neck of femur fractures.

Community integration, self-esteem, and perceived stigma in a Nigerian sample with epilepsy.

OBJECTIVE: The objective of the study was to investigate the levels, interrelationships, and associated factors of community integration (CI), perceived stigma (PS), and self-esteem in people living with epilepsy (PWE) in Anambra and Enugu States of south-east Nigeria. METHODS: This was a cross-sectional survey involving 70 consenting adults living with epilepsy consecutively recruited from three purposively sampled specialized clinics in Anambra State. The Reintegration to Normal Living Index, the Epilepsy Stigma Scale, and the Rosenberg Self-Esteem Scale were used to estimate CI, PS, and self-esteem, respectively among the participants. Data were analyzed at 0.05 level of significance. RESULTS: The mean age of the participants (28.6% females) was 34.91 ±â€¯16.21 years. The participants had moderate PS score (43.54 ±â€¯14.20), poor self-esteem score (17.63 ±â€¯6.12), and mild-to-moderately restricted CI score (67.83 ±â€¯24.72). Participants' PS, CI, and self-esteem significantly correlated with one another (p < 0.05) with PS and self-esteem being significant predictors of CI. Participants' PS had a significant correlation with their age at onset of epilepsy, while their self-esteem and CI significantly correlated with their seizure episodes (p < 0.05). Participants' PS and CI were significantly different across different categories of their occupational and educational statuses. Perceived stigma also varied across participants' marital status with divorced participants having the worst score (p < 0.05). CONCLUSION: People living with epilepsy had moderate PS, poor self-esteem, and mild-to-moderate CI, which correlated significantly with one another. Results suggest the possibility of using CI as an outcome for assessing the effectiveness of stigma and self-esteem interventions during epilepsy rehabilitation.

Prognostic review and time-to-event data meta-analysis of low skeletal muscle mass in patients with peripheral arterial disease of the lower limbs undergoing revascularization.

INTRODUCTION: The relationship between low skeletal muscle mass, a surrogate of sarcopenia, and postoperative morbidity and mortality is currently being explored, with a hope to develop its role as a prognostic factor in preoperative risk stratification. Recent evidence suggests a link between low skeletal muscle mass and outcomes of lower limb revascularization in peripheral arterial disease (PAD). EVIDENCE ACQUISITION: A review of the literature was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed a meta-analysis for peri-interventional mortality using the odds ratio (OR) and associated 95% confidence interval (CI). For late outcomes, we conducted a time-to-event data meta-analysis using the inverse-variance method and reported the result as summary hazard ratio (HR) and associated 95% CI. We applied the random-effects models of meta-analysis. EVIDENCE SYNTHESIS: Six observational cohort studies were eligible for quantitative synthesis. In the outcome of peri-interventional mortality, we found no significant difference between patients with low skeletal muscle mass and those without (OR 1.84, 95% CI: 0.40-8.43, P=0.43). Meta-analysis of four studies found no significant difference in overall survival between patients with and without low skeletal muscle mass (HR 1.77, 95% CI: 0.58-5.39, P=0.32). Patients without low skeletal muscle mass were found to have a significantly longer amputation-free survival (HR 2.75, 95% CI: 1.82-4.15, P<0.00001), and a trend towards higher rates of limb salvage (HR 2.42, 95% CI: 0.87-6.80, P=0.09) than those with low skeletal muscle mass. CONCLUSIONS: Low muscle mass is closely associated with worse disease progression following revascularization demonstrated through lower amputation-free survival and limb salvage. More research is needed to further evaluate its prognostic value in PAD.