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OBJECTIVES: The primary objective of this systematic review was to evaluate pain relief and shoulder functional outcome following reverse shoulder arthroplasty for three- and four-part proximal humerus fractures in patients over the age of 60 years. The secondary objective was to assess the clinical end radiological complications following this procedure for this indication. METHODS: Studies were identified using a MEDLINE search for relevant articles on 20th May 2019. The key terms 'reverse shoulder arthroplasty' and 'proximal humerus fracture' were used. RESULTS: Five retrospective case-series fully met the eligibility criteria. No randomized controlled trials or meta-analyses were found. All of the studies agreed that reverse shoulder arthroplasty was able to offer good pain relief, function end range of forward flexion (FF), and abduction (Abd.). Restrictions in shoulder rotation have to be fully addressed. The rate of major complications, reduction in functional outcome, and development of scapular notching with time was a concern. CONCLUSIONS: Reverse shoulder arthroplasty for comminuted proximal humerus fractures has increased over the past several years, yet the published data evaluating the surgical outcome is limited. Large well-designed prospective randomized controlled trials are needed for comparing the various treatment options, in order to ensure that these patients receive the best treatment available.
RESUMO
Introduction Smoking is the leading cause of lung cancer around the world. In a developing country like Pakistan with low levels of literacy and general awareness about adverse effects of smoking, doctors play a pivotal role in educating the masses about its harmful consequences and providing support for smoking cessation. However, their efficacy is affected if they smoke themselves, and oftentimes the habits cultivated during educational recourse are carried into the professional careers. The aim of this study was to document the prevalence of smoking among final year medical students of Lahore, Pakistan, and the factors associated with it. Methodology Study approval was obtained from Combined Military Hospital (CMH) Lahore Medical College, Ethics Review Committee. A cross-sectional survey was carried out in four medical colleges and hospitals of Lahore, Pakistan. A questionnaire consisting of 14 questions related to basic demographics and smoking was used after being pilot tested on 20 students of CMH. The overall response rate was 74.89%. Data was collected from 337 respondents, of which 38 forms were discarded and 299 forms were analyzed by SPSS V21. Results Among the 299 respondents, there were 128 males (42.81%) and 171 females (57.19%) with 32 (10.70%) smokers. Male students reported smoking (n = 27, 21.09%) more than their female counterparts (n = 5, 0.02%). The mean age of participants was 23.01 years. Students having an active smoker at home had statistically significant positive correlations with current smoking status and the number of cigarettes smoked per day. Students with household smoking contacts were also more likely to smoke if they belonged to the male gender. Conclusion Prevalence of smoking in medical students is lower than in the general population but still considerable in the male students. There is a need to target this particular population with interactive counseling sessions, education campaigns, and anti-smoking rules to decrease smoking among them and through them in the society.
