RESUMO
This study aims to provide an updated review comparing the complication rates and clinical outcomes of intramedullary nails and locking plates (LPs) in displaced proximal humerus fracture (PHF) management. We performed a systematic review of the Cochrane Central Register of Controlled Trials, Clinical Trials Registry, EMBASE, and PubMed. Studies with level III evidence or higher comparing intramedullary nails and LPs used for internal fixation of displaced PHFs were included. The Methodological Index for Nonrandomized Studies (MINORS) criteria and Cochrane Handbook for Systematic Reviews of Interventions 5.2.0 were used to assess the risk of bias. Our meta-analysis included a comparison of method-related complications, pain scores, range of motion (ROM), and functional scores. A total of 13 comparative studies were included: five randomized controlled trials, three prospective cohort studies, and five retrospective cohort studies. The total number of patients included was 1,253 (677 in the LP group and 576 in the intramedullary nail group). Superior Constant-Murley scores and external rotation ROM were found in the LP group during the early postoperative period. However, long-term functional scores and complication rates were comparable between the two groups. We conclude that intramedullary nailing and LP fixation are both equally effective for the treatment of displaced PHFs. Neither treatment appears superior at this time, and more large-scale randomized controlled trials should be conducted to further evaluate the potential benefit of LPs in the early postoperative period.
RESUMO
Background Individuals with longstanding type 2 diabetes mellitus (T2DM) have a significantly higher risk for infection caused by immune dysfunction, resulting in sepsis continuum (sepsis, severe sepsis, and septic shock) if not adequately addressed. In sepsis, organ dysfunction occurs because the host's response to infection is impaired, more so in severe sepsis. In septic shock, persistent hypotension happens, requiring vasopressors despite aggressive fluid management. The internal medicine (IM) ward plays a critical part in managing patients with sepsis. However, the prevalence of sepsis has been investigated extensively in an intensive care unit (ICU) setting instead of the IM ward. This study aimed to determine the prevalence rates of sepsis, severe sepsis, and septic shock in patients with T2DM admitted at an IM ward in Samoa. Methods This retrospective hospital record-based study was conducted over four months on 100 patients with T2DM admitted to the IM ward within the sepsis continuum. Participants were selected by convenience sampling, and the diagnosis was determined from the admission notes. Results The prevalence rates of sepsis, severe sepsis, and septic shock in patients with T2DM admitted to the IM ward were 80%, 12%, and 8%, respectively. Conclusion The most frequent presentation in individuals with T2DM who are within the sepsis continuum upon admission to the IM ward was sepsis, followed by severe sepsis and septic shock.
RESUMO
BACKGROUND: Diabetes mellitus is one of the leading chronic conditions worldwide. One of its most debilitating complications is diabetic foot ulcers (DFUs), which appear to have an increased incidence in the Pacific Islands. However, this report has not been studied extensively in Samoa. Nevertheless, DFUs may be prevented through strict glycemic control by hemoglobin A1c (HbA1c) level monitoring. OBJECTIVE: This study aimed to identify a specific cutoff point for HbA1C to reduce the occurrence of DFUs in patients with type 2 diabetes mellitus (T2DM) admitted to an internal medicine ward in Samoa. Increased HbA1c levels are hypothesized to be strongly associated with DFU development. METHODS: A retrospective unmatched case-control study examined 100 patients with T2DM (50 patients with DFUs [case] and 50 patients without DFUs [control]) over four months. Participants were selected by convenience sampling. RESULTS: The HbA1c results were available in 32 cases and 29 controls. The receiver operating characteristic curve showed that the area under the curve was 51% (95% CI, 36%-66%; standard error, 0.075; P = 0.8966), and no cutoff point could be established. CONCLUSION: The HbA1c is not an ideal test to readily predict DFUs in patients with T2DM.
