Early Versus Late Intramedullary Nailing for Traumatic Femur Fracture Management: Meta-Analysis

INTRODUCTION: There is no consensus yet on the impact of timing of femur fracture (FF) internal fixation on the patient outcomes. This meta-analysis was conducted to evaluate the contemporary data in patients with traumatic FF undergoing intramedullary nail fixation (IMN). METHODS: English language literature was searched with publication limits set from 1994 to 2016 using PubMed, Scopus, MEDLINE (OVID), EMBASE (OVID), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). Studies included randomized controlled trials (RCTs), prospective observational or retrospective cohort studies, and case-control studies comparing early versus late femoral shaft fractures IMN fixation. Variable times were used across studies to distinguish between early and late IMN, but 24 h was the most frequently used cutoff. The quality assessment of the reviewed studies was performed with two instruments. Observational studies were assessed with the Newcastle-Ottawa Quality Assessment Scale. RCTs were assessed with the Cochrane Risk of Bias Tool. RESULTS: We have searched 1151 references. Screening of titles and abstracts eliminated 1098 references. We retrieved 53 articles for full-text screening, 15 of which met study eligibility criteria. CONCLUSIONS: This meta-analysis addresses the utility of IMN in patients with FF based on the current evidence; however, the modality and timing to intervene remain controversial. While we find large pooled effects in favor of early IMN, for reasons discussed, we have little confidence in the effect estimate. Moreover, the available data do not fill all the gaps in this regard; therefore, a tailored algorithm for management of FF would be of value especially in polytrauma patients

An Overview Of Status Post Splenectomy, Role Of Nursing, Paramedics, Psychologist And Clinical Laboratory Teams

People who have had their spleen removed through elective or non-elective splenectomy are at a significant risk of developing serious infections. Overwhelming postsplenectomy infection (OPSI) is a series of events characterized by a fast advance from infection to severe sepsis. Postsplenectomy infection is a critical medical situation that requires immediate attention. It is highly advisable to promptly administer antibiotics upon the initial indication of infection. Typically, in adults, the progression of the disease takes many days but can accelerate within a few hours from the first indication of fever to the development of widespread pneumonia, widespread blood clotting, bleeding and tissue death in the adrenal glands, and tissue death in the kidney tubules. The paramedics play a vital role in evaluating patients with critical conditions before they reach the hospital and implementing effective measures. Similarly, the nursing and clinical laboratory staff have a crucial role in properly managing these cases. Lastly, psychologists play an important role in providing support to patients and their families after a spleenectomy

Correction to: Early versus late intramedullary nailing for traumatic femur fracture management: meta-analysis

Following the publication of this article [1], the authors reported that they had submitted an incorrect version of Figs. 2, 3 and 4

Early versus late intramedullary nailing for traumatic femur fracture management: meta-analysis

Abstract Introduction There is no consensus yet on the impact of timing of femur fracture (FF) internal fixation on the patient outcomes. This meta-analysis was conducted to evaluate the contemporary data in patients with traumatic FF undergoing intramedullary nail fixation (IMN). Methods English language literature was searched with publication limits set from 1994 to 2016 using PubMed, Scopus, MEDLINE (OVID), EMBASE (OVID), Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL). Studies included randomized controlled trials (RCTs), prospective observational or retrospective cohort studies, and case-control studies comparing early versus late femoral shaft fractures IMN fixation. Variable times were used across studies to distinguish between early and late IMN, but 24 h was the most frequently used cutoff. The quality assessment of the reviewed studies was performed with two instruments. Observational studies were assessed with the Newcastle-Ottawa Quality Assessment Scale. RCTs were assessed with the Cochrane Risk of Bias Tool. Results We have searched 1151 references. Screening of titles and abstracts eliminated 1098 references. We retrieved 53 articles for full-text screening, 15 of which met study eligibility criteria. Conclusions This meta-analysis addresses the utility of IMN in patients with FF based on the current evidence; however, the modality and timing to intervene remain controversial. While we find large pooled effects in favor of early IMN, for reasons discussed, we have little confidence in the effect estimate. Moreover, the available data do not fill all the gaps in this regard; therefore, a tailored algorithm for management of FF would be of value especially in polytrauma patients

Žafran (Crocus sativus L.) kot zaščita pred poškodbami organov in hematološkimi spremembami pri podganah zaradi aflatoksina B1

Saffron is well-known for its anti-apoptotic, anti-inflammatory, and antioxidant properties. Saffron\u27s nutritional and medicinal properties support its numerous uses as a flavouring and herbal remedy. This study investigated the protective efficacy of saffron administration against aflatoxin B1 (AFB1)-induced toxicity in adult male Wistar albino rats during an experimental period of 21 days. Aflatoxin B1 (AFB1) is a common mycotoxin of soils and foodstuffs. Thirty-two rats were divided into four groups (Control group, AFB1 group, Saffron group, and AFB1+ Saffron group), and their body weights were measured on days 1, 7, 14, and 21. Blood samples were collected on the 21st day for haematological and biochemical studies (testosterone, kidney and liver function tests, and oxidative stress markers). Tissue samples from testes, liver, and kidney were subjected to histological examinations. The results depicted a significant decrease in the body weights after 7, 14, and 21 days of Saffron, AFB1, and AFB1+ Saffron treatments in comparison to control. Haematological investigations showed that basophils, platelets, monocytes, lymphocytes, and eosinophils greatly increased compared to the control group, whereas neutrophils and eosinophils dramatically decreased. There was a significant rise in the serum levels of uric acid, creatinine, aspartate transaminase, alkaline phosphatase, nitric oxide, and malondialdehyde. Contrarily, testosterone levels notably reduced in AFB1-administered rats as compared to controls. AFB1 group exhibited several histological modifications in testes, liver, and kidney tissues. Oxidative stress biomarkers, testosterone, kidney and liver functions, and haematological parameters of the AFB1+ Saffron group remained similar to the control group. Kidney and liver tissues of Saffron-treated rats also displayed normal structure similar to the control group, which confirmed its protective efficacy against AFB1-induced toxicity. Saffron\u27s bioactive components and antioxidant and pharmacological properties might have contributed to its promising anti-AFB1-toxicity potential.Žafran je znan po svojih anti-apoptotičnih, protivnetnih in antioksidativnih lastnostih. Prehranske in zdravilne lastnosti žafrana podpirajo njegovo številno uporabo kot začimbe in zeliščnega zdravila. V tej študiji je bila raziskana zaščitna učinkovitost žafrana pred delovanjem aflatoksina B1 (AFB1), pri odraslih samcih podgan Wistar albino v poskusnem obdobju 21 dni. Aflatoksin B1 (AFB1) je pogost mikotoksin v tleh in živilih. V poskusu smo 32 podgan razdelili v štiri skupine (kontrolna skupina, skupina z AFB1, skupina z žafranom in skupina z AFB1 + žafran). Njihovo rast smo spremljali preko telesne teže 1., 7., 14. in 21. dan. Ob zaključku poskus smo 21. dan odvzeli vzorce za hematološke in biokemične analize (testosteron, testi delovanja ledvic in jeter ter markerji oksidativnega stresa). Vzorci tkiva semenčic, jeter in ledvic so bili predmet histoloških preiskav. Rezultati so pokazali znatno zmanjšanje telesne teže po 7, 14 in 21 dneh zdravljenja z žafranom, AFB1 in AFB1+ žafranom v primerjavi s kontrolo. Hematološke preiskave so pokazale, da so se bazofili, trombociti, monociti, limfociti in eozinofili močno povečali v primerjavi s kontrolno skupino, medtem ko so se nevtrofilci in eozinofilci močno zmanjšali. V serumu so se znatno povečale vrednosti sečne kisline, kreatinina, aspartatne transaminaze, alkalne fosfataze, dušikovega oksida in malondialdehida. Nasprotno pa se je raven testosterona pri podganah, ki so prejemale AFB1, v primerjavi s kontrolami opazno zmanjšala. Pri skupini z AFB1 so se pokazale številne histološke spremembe v testisih, jetrih in ledvicah. Biomarkerji oksidativnega stresa, testosteron, delovanje ledvic in jeter ter hematološki parametri skupine z AFB1+ žafranom so ostali podobni kontrolni skupini. Tudi ledvična in jetrna tkiva podgan, zdravljenih z žafranom, so imela normalno strukturo, podobno kontrolni skupini, kar je potrdilo njegovo zaščitno učinkovitost pred toksičnostjo, povzročeno z AFB1. Bioaktivne sestavine žafrana ter njegove antioksidativne in farmakološke lastnosti so morda prispevale k njegovemu obetavnemu potencialu proti toksičnosti AFB1