Short-term Pain Outcomes in Robotic versus Manual Total Hip Arthroplasty

Background: Four-hundred-fifty-thousand patients annually undergo total hip arthroplasty (THA) in the United States. THA has been shown to alleviate pain, restore function, and improve quality of life. Manual implant postoperative complications have led to a need for more advanced technology. Robotic assisted THA has the potential for greater accuracy in component positioning compared to manual. Comparing robotic and manual THA, significant differences have been shown in hip-specific functional outcomes, component positioning, complications, and patient-centered outcomes. The effects of these techniques on differences from baseline pain have yet to be investigated. Methods: A retrospective review of the Berkshire Medical Center electronic medical record system identified 70 patients undergoing THA between March 1, 2020 to October 31, 2021 with preoperative diagnosis of osteoarthritis or degenerative joint disease of the hip. Patients were admitted for at least one day postoperatively with documented preoperative and POD1 vital signs, POD1 pain scores, and LOS were included. The primary objective was to identify differences in postoperative day 1 (POD1) pain scores between robotic and manual THA. The secondary objective was to identify differences in length of stay (LOS) and preoperative versus postoperative vital signs (blood pressure, heart rate) between groups. Results: A statistically significant difference was identified for postoperative pain scores indicating significantly lower pain scores in patients undergoing manual THA in comparison to robotic (3.0 versus 5.0; P = 0.01). No significant differences were identified for systolic blood pressure (P = 0.46), diastolic blood pressure (P = 0.43), heart rate (p = 0.93), or LOS (P = 0.35). Discussion: Previous studies have demonstrated decreases in postoperative pain, LOS, and costs in patients undergoing robotic versus manual THA. The results of our study were not consistent with these studies which may be due to small sample size, quantity of anesthetic used, and surgeon differences. THA performed via robotic technique demonstrated a statistically significant increase in postoperative pain outcomes when compared to manual. There may be a lack of clinical difference in postoperative pain scores between groups and no differences were identified for vital signs or LOS

Comparison of Pregnancy Complication Rates: Does Opioid Agonist Pharmacotherapy Make A Difference?

Background: Over the past decade, the prevalence of opioid use disorder (OUD) in pregnant patients has increased by 131% with an associated increase in pregnancy complications. Opioid agonist pharmacotherapy (OAP) with methadone or buprenorphine is recommended by ACOG for the management of OUD. The objectives of our study are to compare the incidence of pregnancy complications among patients who at the time of their delivery used OAP, OAP plus any additional substance (OAP+), illicit or prescribed opioids, and no opioids. Methods: We conducted a retrospective cohort study at Berkshire Medical Center in Pittsfield, MA, between January 1, 2018, through December 31, 2020, to compare the incidence of nine pregnancy complications in patients who at the time of their delivery were using OAP, OAP+, illicit or prescribed opioids, and no opioids. The data was analyzed with Chi-squared tests and a Bonferroni correction of the p-value was used to adjust for comparison of the rates. The significance level used was p ≤ 0.025. Results: There were 1979 deliveries during the 3-year study period with a total complication incidence of 23%. The complication incidence was 11% for OAP, 15% for OAP+, 42% for illicit or prescribed opioids, and 24% for no opioids. The incidence of complications in the OAP group was significantly lower than the incidence in the no opioids group (11% vs 24%, p = 0.01). There was no significant difference in the comparisons between other groups. Discussion: Our study investigated nine pregnancy complications; no other single study included all of these complications. Patients who used OAP had a significantly lower incidence of pregnancy complications compared to those who used no opioids. A multisite cohort study showed a low incidence of placental abruption in patients using methadone (3%), which was a similar outcome to the MOTHER study (2.3%) and our study (1.4%). The results of this research could assist providers in counseling their patients on the use of OAP in pregnancy

STAT3 Activation in Skeletal Muscle Links Muscle Wasting and the Acute Phase Response in Cancer Cachexia

Cachexia, or weight loss despite adequate nutrition, significantly impairs quality of life and response to therapy in cancer patients. In cancer patients, skeletal muscle wasting, weight loss and mortality are all positively associated with increased serum cytokines, particularly Interleukin-6 (IL-6), and the presence of the acute phase response. Acute phase proteins, including fibrinogen and serum amyloid A (SAA) are synthesized by hepatocytes in response to IL-6 as part of the innate immune response. To gain insight into the relationships among these observations, we studied mice with moderate and severe Colon-26 (C26)-carcinoma cachexia.Moderate and severe C26 cachexia was associated with high serum IL-6 and IL-6 family cytokines and highly similar patterns of skeletal muscle gene expression. The top canonical pathways up-regulated in both were the complement/coagulation cascade, proteasome, MAPK signaling, and the IL-6 and STAT3 pathways. Cachexia was associated with increased muscle pY705-STAT3 and increased STAT3 localization in myonuclei. STAT3 target genes, including SOCS3 mRNA and acute phase response proteins, were highly induced in cachectic muscle. IL-6 treatment and STAT3 activation both also induced fibrinogen in cultured C2C12 myotubes. Quantitation of muscle versus liver fibrinogen and SAA protein levels indicates that muscle contributes a large fraction of serum acute phase proteins in cancer.These results suggest that the STAT3 transcriptome is a major mechanism for wasting in cancer. Through IL-6/STAT3 activation, skeletal muscle is induced to synthesize acute phase proteins, thus establishing a molecular link between the observations of high IL-6, increased acute phase response proteins and muscle wasting in cancer. These results suggest a mechanism by which STAT3 might causally influence muscle wasting by altering the profile of genes expressed and translated in muscle such that amino acids liberated by increased proteolysis in cachexia are synthesized into acute phase proteins and exported into the blood

Hemoglobin As A Predictor For COVID-19 Disease Severity

Background: The dilemma of who is at highest risk for COVID-19 severe disease and death persists. Hemoglobin levels may be an indicator of COVID-19 disease severity. There is inconsistent data on Emergency Department (ED) hemoglobin levels and severity of disease. Our objective was to examine if COVID-19 patients presenting with abnormal hemoglobin levels have an increased risk of severe disease and in-hospital mortality. Methods: We conducted a retrospective cohort study at Berkshire Medical Center in Pittsfield, MA to investigate the relationship of COVID-19 disease severity with hemoglobin level. Inclusion criteria consisted of ED patients over 18 years with a COVID-19 diagnosis from July 1, 2021, to November 1, 2021. Exclusion criteria consisted of duplicate visits and patients without a hemoglobin value recorded. Patients with anemia were stratified by severity. Disposition categories from most to least severe were: ICU/PCU, medical floor, or discharge from ED. In-hospital mortality was recorded. Backward linear regression followed by z-tests were used for each abnormal hemoglobin category versus normal hemoglobin category. Results: The four-month period included 341 ED visits coded for COVID-19. After excluding 113 visits, 228 were eligible for analysis. There were 132 discharged from the ED, 64 admitted to the medical floor, 32 to ICU/PCU, and 19 deaths. Backwards linear regression showed hemoglobin category was a significant predictor of hospital disposition (p \u3c 0.0001) and mortality (p = 0.07). Z-test showed a significant difference in disposition for normal hemoglobin versus mild anemia (z = 2.1927, p = 0.03) and normal hemoglobin versus moderate/severe anemia (z = 3.6225, p = 0 0003). Z-test showed a significant difference in death for normal hemoglobin versus moderate/severe anemia (z = 3.2949, p = 0.001). Normal hemoglobin versus elevated hemoglobin had no significant difference for disposition (z = 0.356, p = 0.72) or death (z = 1.786, p = 0.07). Discussion: Abnormal hemoglobin is associated with severity of disease and death COVID-19 patients. Increasingly severe anemia is more associated with severity of disease and death. Elevated hemoglobin is not associated with severity of disease or death

Disease Severity in COVID-19 Breakthrough Cases

Background Vaccine breakthrough is a phenomenon wherein vaccinated individuals become infected with disease despite adequate protection. During this study period, the Centers for Disease Control (CDC) reported 66.6% of US people have been fully vaccinated. Any measures to improve trust would increase vaccination rates. This study aims to understand vaccine breakthrough cases in COVID-19 by comparing their severity to unvaccinated cases. Our objective is to compare disease severity based on the worst initial vital signs (temperature, respiratory rate, oxygen saturation), length of stay (LOS), and age between vaccinated and unvaccinated COVID-19 cases. Methods We conducted a retrospective cohort study at Berkshire Medical Center between July 15, 2021, through October 31, 2021. IRB exemption was obtained. Patient records were reviewed for vaccination status, age, vital signs, and LOS. We used forward and backward logistic regressions to determine significant variables and odds ratios to quantify the association between them. We then computed two-sample t-tests to compare the variables between vaccinated and unvaccinated groups. Results There were 151 vaccinated and 141 unvaccinated COVID-19 cases. Using a forward logistic regression model, we found significant associations between vaccination status, age (p\u3c0.005), and max Temp (p\u3c0.005). Using a backward logistic regression model, we found significant associations between vaccination status, age (p\u3c0.005), max Temp (p\u3c0.005), and min SpO2 (p\u3c0.031). Odds ratios were 1.0725 (age), 0.6608 (max Temp), and 1.0873 (min SpO2). Two-sample t-tests showed significant differences in age and max Temp between vaccinated and unvaccinated groups while no significant differences were found in LOS, max RR, and min SpO2. Discussion Our results suggest that vaccination may lead to milder disease even against virulent strains such as the Delta variant. These findings were similar to another study during the Alpha variant peak that demonstrated that vaccinated patients had less disease severity. Vaccination was associated with a 7.25% higher likelihood of being older, a 66.08% lower likelihood of having a higher temperature, and an 8.73% higher likelihood of having lower SpO2. There were significant differences in age and max Temp between vaccinated and unvaccinated groups indicating that vaccination may be associated with less disease severity even in an older population