Role of Sodium-Glucose Co-Transporter-2 Inhibitor During Anthracycline Use: An Updated Review.

The coalescence of anthracycline-induced cardiotoxicity and the evolving role of sodium-glucose co-transporter-2 (SGLT-2) inhibitors in oncology and cardiology has prompted a comprehensive review of their mechanisms, clinical implications, and future directions. Anthracyclines, potent chemotherapeutic agents, have been integral in cancer treatment, yet their potential for cardiac harm necessitates careful monitoring and management. We explore the multifactorial nature of anthracycline-induced cardiotoxicity, encompassing diverse patient populations, cumulative doses, and interplay with other treatments. While advancements in imaging and biomarker assessments aid in early detection, the lack of standardized criteria poses challenges. The emergent role of SGLT-2 inhibitors, initially developed for diabetes management, presents a novel avenue for cardioprotection. Beyond glycemic control, these inhibitors exhibit pleiotropic effects, including enhanced diuresis, anti-inflammatory actions, and modulation of energy sources. Consequently, SGLT-2 inhibitors are being investigated for their potential to mitigate cardiotoxic effects, promising an innovative approach in cardio-oncology. Despite these advancements, limitations in data interpretation and patient-specific considerations persist. The future of anthracycline-induced cardiotoxicity research lies in predictive biomarkers, precision medicine, multidisciplinary collaboration, and tailored treatment regimens. By navigating these challenges and harnessing emerging strategies, we aim to optimize cancer treatment efficacy while safeguarding cardiovascular health, ultimately paving the way for a new era of personalized and comprehensive oncologic care.

Reamed compared with unreamed nailing of tibial shaft fractures: Does the initial method of nail insertion influence outcome in patients requiring reoperations?

BACKGROUND: Patients with a tibial shaft fracture experiencing their first postoperative complication following treatment with intramedullary nails may be at greater risk of subsequent complications than the whole population. We aimed to determine whether the initial method of nail insertion influences outcome in patients with a tibial shaft fracture requiring multiple reoperations. METHODS: Using the Study to Prospectively Evaluate Reamed Intramedullary Nails in Tibial Shaft Fractures trial data, we categorized patients as those not requiring reoperation, those requiring a single reoperation and those requiring multiple reoperations, and we compared them by nail insertion technique (reamed v. unreamed) and fracture type (open v. closed). We then determined the number of patients whose first reoperation was in response to infection, and we compared other clinical outcomes between the reamed and unreamed groups. RESULTS: Among 1226 patients included in this analysis, 175 (14.27%) experienced a single reoperation and 44 patients (3.59%) underwent multiple reoperations. Nail insertion techniques (reamed v. unreamed) did not play a role in the need to perform multiple reoperations. Seventy-five percent of patients requiring multiple reoperations had open tibial shaft fractures. An equal number of these were reamed and unreamed insertions. The majority of patients had their course complicated by infection and almost 50% of patients whose first reoperation was for infection required more than 2 reoperations for management. The rest required multiple procedures for nonunion or bone loss. CONCLUSION: Our findings corroborate those of other studies, in which open fracture type rather than nail insertion technique was found to be the cause of morbidity following intramedullary nailing of tibial fractures. CLINICAL TRIAL REGISTRATION: www. CLINICALTRIALS: gov, no. NCT00038129.

The presentation delay and differences of symptoms manifestation in Myocardial Infarction patients with and without Diabetes: a cross-sectional study.

Patients with diabetes have a higher risk of coronary artery disease (CAD). This study aims to evaluate the effect of diabetes on the symptoms and the delay it causes in seeking medical treatment. Methodology: This cross-sectional study was conducted from 1 January 2021 to 30 June 2022, in three major tertiary care hospitals in Karachi, Pakistan. Patients falling in the inclusion criteria included those who were diagnosed with ST-elevation myocardial infarction (STEMI) or Non-ST-elevation myocardial infarction (NSTEMI) and those that were clinically stable and answered the questions within 48 h of admission to the hospital with or without the help of their family members. The association of the demographic variables, symptoms, presentation delay, and distance from the hospital was determined between the diabetics and the nondiabetics using the χ 2-test. A P-value of less than 0.05 was considered significant. Results: Among the patients with diabetes, 147 (90.7%) were smokers, 148 (91.4%) had a history of hypertension, 102 (63.0%) had a history of ischemic heart disease, and 96 (59.3%) patient's family history is significant for CAD. The higher educational level, smoking, hypertension, history of ischemic heart disease, and family history of CAD were found to be significantly related to diabetes with a P-value of less than 0.05. Patients with diabetes did not believe they have myocardial infarction was the most common cause of delay. Conclusion: The findings of our study conclude that diabetes significantly causes a delay in myocardial infarction patients seeking medical help as compared to nondiabetics.

Should we worry about periacetabular interference gaps in hip resurfacing?

BACKGROUND: Press-fit acetabular component seating in hip resurfacing can be challenging as a strong interference fit is required. It has not been established whether reducing the acetabular underream minimizes incomplete component seating or leads to increased acetabular loosening. QUESTIONS/PURPOSES: We examined (1) the incidence and natural history of postoperative interference gaps in hip resurfacing and (2) whether reduction of the acetabular underream from 2 mm to 1 mm reduces the incidence of periacetabular interference gaps. METHODS: Of 327 Birmingham Hip™ Resurfacings (Smith & Nephew Inc, Memphis, TN, USA) performed by a single surgeon from 2005 to 2010, we evaluated 306 hips with a minimum 1-year radiographic followup. Postoperative periacetabular interference gaps were monitored for radiographic gap resolution at latest followup. The frequency of incomplete component seating was compared between acetabula prepared with 1- and 2-mm underream techniques. Minimum followup was 1 year (mean, 2.7 years; range, 1-6 years). RESULTS: Fifty-one percent of the postoperative radiographs demonstrated the presence of a periacetabular interference gap. At latest followup, 96% of these gaps were no longer visible. We observed a reduction in the number of interference gaps identified when acetabular preparation changed from a 2-mm underream (63%) to a 1-mm underream (39%). There were no revisions due to acetabular failure. CONCLUSIONS: Periacetabular interference gaps were common in this series but not associated with acetabular component failure. The use of a 1-mm underream is sufficient for adequate short-term press-fit fixation of the acetabular component in Birmingham Hip™ Resurfacing arthroplasty. LEVEL OF EVIDENCE: Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

Analysis of needle versus open biopsy for the diagnosis of advanced stage pediatric neuroblastoma.

BACKGROUND: Adequate tissue biopsy is necessary for the appropriate diagnosis and risk stratification of pediatric neuroblastoma (NB). We compared the quality and adequacy of biopsy tissue and complication rates in children with NB who underwent open (OBX) and image-guided needle biopsy (NBX) at our center. METHODS: We retrospectively reviewed all patients diagnosed with stage III and IV NB from September 2001 to August 2004. The 24 patients were divided into two groups: those in whom the diagnosis was initiated using NBX, and those diagnosed using OBX. In addition to demographic data, we collected data pertaining to sufficiency of biopsy tissue for biology studies including: Shimada Classification, MYC-N amplification, and DNA index analysis and complications associated with the procedure. Chi-Square and Student's t-test were used to analyze the categorical and continuous variables, respectively. RESULTS: Of 24 patients, 11 underwent NBX, and 13 patients underwent OBX. Eighteen patients had stage IV disease, 5 patients had stage III disease, and 1 stage IVS. Ten major complications occurred in four NBX patients and six OBX patients. There was no difference in days of narcotic use, time to DAT, or hospital stay between the two groups. Ten patients (seven NBX and three OBX, P = 0.045) had tissue that was insufficient for biology studies. Three of the seven NBX patients underwent a second biopsy for clarification of risk group. CONCLUSIONS: This study demonstrated that more than half of patients undergoing NBX for NB had insufficient tissue for complete histological and molecular classification and that the incidence of procedural complications between NBX and OBX are similar.

Cervical cancer screening among South Asian women in Canada: the role of education and acculturation.

Cervical cancer screening by Papanicolaou (Pap) smear lowers the incidence and provides early detection of cervical cancer and is a preventative health care measure that should be available on a regular basis to all women at risk. As the population of ethnic women increases, it is important to assess whether these women are aware of and are utilizing this health service. A self-administered questionnaire was completed by 124 South Asian women, aged 18 to 60 years. Sixty-two South Asian students were selected from a university setting and 62 Tamil women were selected from a community center for South Asian women. This study examined the knowledge and use of Pap smears in South Asian women in Canada, and whether their level of acculturation or formal education influenced whether they know about and receive Pap smears. Low level of knowledge about the Pap test and a low prevalence of Pap testing behaviour was significantly correlated (p < 0.001) with a low level of formal education, education taking place outside of Canada, and a low index of acculturation. South Asian students were significantly more acculturated than Tamil women (p < 0.001). In conclusion, there was a low level of knowledge and prevalence of cervical cancer screening among South Asian women. This study highlights the need for educational interventions in Canada directed to ethnic women especially from South Asia.