1.Effects of local infiltration of analgesia and tranexamic acid in total knee replacements: safety and efficacy in reducing blood loss and comparability to intra-articular tranexamic acid.
Harish SIVASUBRAMANIAN ; Cheryl Marise Peilin TAN ; Lushun WANG
Singapore medical journal 2024;65(1):16-22
INTRODUCTION:
The use of periarticular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) TXA have not been well explored in the literature. This retrospective cohort study aimed to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate postoperative pain relief and functional outcomes in patients after unilateral primary total knee arthroplasty (TKA).
METHODS:
A total of 63 patients underwent TKA, and they were divided into the IA TXA delivery group ( n = 42) and PA TXA delivery group ( n = 21). All patients were administered 1 g of TXA. They also received pericapsular infiltration consisting of 0.5 mL of adrenaline, 0.4 mL of morphine, 1 g of vancomycin, 1 mL of ketorolac and 15 mL of ropivacaine. Outcomes for blood loss and surrogate markers for immediate functional recovery were measured.
RESULTS:
Of the 63 patients, 54% were female and 46% male. The mean drop in postoperative haemoglobin levels in the PA and IA groups was 2.0 g/dL and 1.6 g/dL, respectively, and this was not statistically significant ( P = 0.10). The mean haematocrit drop in the PA and IA groups was 6.1% and 5.3%, respectively, and this was also not statistically significant ( P = 0.58). The postoperative day (POD) 1 and discharge day flexion angles, POD 1 and POD 2 visual analogue scale (VAS) scores, gait distance on discharge and length of hospitalisation stay were largely similar in the two groups.
CONCLUSION
Our study showed that both IA and PA TXA with analgesic components were equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.
Humans
;
Male
;
Female
;
Tranexamic Acid/adverse effects*
;
Arthroplasty, Replacement, Knee/adverse effects*
;
Antifibrinolytic Agents/adverse effects*
;
Retrospective Studies
;
Postoperative Hemorrhage
;
Blood Loss, Surgical/prevention & control*
;
Administration, Intravenous
;
Analgesia
;
Analgesics/therapeutic use*
;
Pain, Postoperative/drug therapy*
;
Injections, Intra-Articular
2.Expert consensus on fundus photograph-based cardiovascular risk assessment using artificial intelligence technology.
Chinese Journal of Internal Medicine 2024;63(1):28-34
Cardiovascular risk assessment is a basic tenet of the prevention of cardiovascular disease. Conventional risk assessment models require measurements of blood pressure, blood lipids, and other health-related information prior to assessment of risk via regression models. Compared with traditional approaches, fundus photograph-based cardiovascular risk assessment using artificial intelligence (AI) technology is novel, and has the advantages of immediacy, non-invasiveness, easy performance, and low cost. The Health Risk Assessment and Control Committee of the Chinese Preventive Medicine Association, in collaboration with the Chinese Society of Cardiology and the Society of Health Examination, invited multi-disciplinary experts to form a panel to develop the present consensus, which includes relevant theories, progress in research, and requirements for AI model development, as well as applicable scenarios, applicable subjects, assessment processes, and other issues associated with applying AI technology to assess cardiovascular risk based on fundus photographs. A consensus was reached after multiple careful discussions on the relevant research, and the needs of the health management industry in China and abroad, in order to guide the development and promotion of this new technology.
Humans
;
Cardiovascular Diseases/prevention & control*
;
Artificial Intelligence
;
Consensus
;
Risk Factors
;
Heart Disease Risk Factors
4.Comparison of the inward leakage rate between N95 filtering facepiece respirators and modified surgical masks during the COVID-19 pandemic.
Kazunari ONISHI ; Masanori NOJIMA
Environmental Health and Preventive Medicine 2024;29():8-8
BACKGROUND:
Owing to shortage of surgical and N95 filtering facepiece respirators (FFRs) during the COVID-2019 pandemic, various masks were developed to prevent infection. This study aimed to examine the inward leakage rate (ILR) of sealed face masks and modified surgical masks using a quantitative fit test and compared it with the ILR of unmodified N95 FFRs.
METHODS:
We conducted paired comparisons of ILRs of bent nose-fit wire masks, double masks, and N95 FFRs from October to December 2021. To measure the protective effectiveness of masks, participants wore masks, and the number of particles outside and inside the mask were measured. The ILR was based on the percentage of particles entering the mask using a fit tester.
RESULTS:
We enrolled 54 participants (20 men and 34 women) in this study. The median ILR for surgical masks without and with a W-shaped bend in the nose-fit wire were 96.44% and 50.82%, respectively. The nose-fit wire adjustment reduced the ILR of surgical masks by a mean of 28.57%, which was significantly lower than the ILR without adjustment (P < 0.001). For double masks, with surgical or polyurethane masks on top of the W-shaped mask, the ILR did not differ significantly from that of N95. Although the filtration performance of double surgical masks matched that of N95 masks, their ILR was notably higher, indicating that double masks do not provide equivalent protection.
CONCLUSIONS
Wearing N95 masks alone is effective in many cases. However, surgical mask modifications do not guarantee consistent effectiveness. Properly selected, sealed masks with a good fit overcome leakage, emphasizing their crucial role. Without evidence, mask-wearing may lead to unexpected infections. Education based on quantitative data is crucial for preventing adverse outcomes.
Male
;
Humans
;
Female
;
N95 Respirators
;
COVID-19/epidemiology*
;
Masks
;
Pandemics/prevention & control*
;
Respiratory Protective Devices
;
Materials Testing
;
Equipment Design
;
Occupational Exposure/prevention & control*
10.Evaluating the clinical endpoint of antibiotic prophylaxis for cirrhosis patients complicated with upper gastrointestinal bleeding: An updated systematic review and meta-analysis
Putu Itta Sandi Lesmana Dewi ; Kadek Mercu Narapati Pamungkas ; Ni Luh Putu Yunia Dewi ; Ni Nyoman Gita Kharisma Dewi ; Dwijo Anargha Sindhughosa ; I Ketut Mariadi
Acta Medica Philippina 2024;58(Early Access 2024):1-10
Background and Objective:
Antibiotic prophylaxis is used to prevent bacterial infections and rebleeding in cirrhosis patients with upper gastrointestinal bleeding (UGIB). However, the effects of various antibiotics on patients with UGIB are still being considered. This study aims to evaluate the effect of antibiotic prophylaxis on cirrhosis patients with UGIB.
Methods:
The studies were searched through databases of PubMed, ScienceDirect, Wiley Online Library, and CENTRAL from 2013 to 2023. We used Revman 5.4 to perform a meta-analysis. I2 statistics measured the heterogeneity test. The odds ratio (OR) and 95% confidence interval (CI) were used to assess the effect of antibiotic prophylaxis.
Results:
Twelve studies involving 14,825 cirrhosis patients were included in this study. Based on the meta-analysis, antibiotic prophylaxis significantly lowered the bacterial infection rate (OR: 0.29, 95%CI: 0.10 to 0.84, P = 0.02), and the incidence of serious adverse events (SAE) (OR: 0.50, 95%CI: 0.28 to 0.88, P = 0.02) in cirrhosis patients with UGIB.
Conclusions
Administration of antibiotics demonstrated a significant reduction in bacterial infection rates and SAEs. Broad-spectrum non-absorbable antibiotics can be used in cirrhosis patients with UGIB. The appropriate use of antibiotics is important to prevent resistance.
Antibiotic
;
Anti-Bacterial Agents
;
prophylaxis
;
prevention &
;
control
;
Cirrhosis
;
Fibrosis
Result Analysis
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