The effect of gender on response to antithyroid drugs and risk of relapse after discontinuation of the antithyroid drugs in patients with Graves’ hyperthyroidism: a multicentre study

Introduction: The outcome of medical treatment in patients with Graves’ disease (GD) is generally difficult to predict. In this study, we examined the hypothesis that gender may affect the outcome of treatment with antithyroid drugs (ATDs). Material and methods: This is a retrospective multicentre study including 717 (514 female and 203 male) patients with the first episode of GD treated for at least 12 months. Patients were classified as relapse, poorly controlled (several episodes of hyperthyroidism followed by euthyroidism and rarely hypothyroidism, occurring after titration of ATDs), and remission. Results: During the mean follow-up time of 26.75 ± 21.25 months (between 1 and 120 months), 269 (37.5%), 176 (24.5%), and 272 (37.9%) patients experienced a relapse, a poorly controlled disease, and remained in remission, respectively. During the follow-up time, 223 (43.4%) of the female and only 49 (24%) of the male patients remained in remission. Relapse and poorly controlled disease (non-remitting GD) were more common in male compared to female patients with GD (hazard ratio 1.26, 95% CI: 1.03–1.53, p = 0.025). Graves’ disease in male patients tended to relapse earlier, and male patients tended to have larger goiter sizes at diagnosis as well. The smoking habit wasalso significantly more frequent in males compared to female patients with GD. Conclusion: Male patients with GD have a markedly higher frequency of relapse and poorly controlled disease, as compared to female patients. Larger goiter sizes and higher frequency of smoking may contribute to the higher frequency of relapse and poorly controlled disease in male patients.

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Results of rehabilitation programs on pain and functionality in patients with total hip arthroplasty due to developmental dysplasia of the hip

Amaç: Total kalça artroplastisi (THA) cerrahisi kalçanın gelişimsel displazisine (DDH) bağlı koksartroz tedavisinde uygun bir seçenektir. 1) Gerekli olmayan hastalarla birlikte kısalma osteotomisi yapılması gereken hastaların sonuçlarını değerlendirmek ve 2) THA ile tedavi edilen DDH hastaları için postoperatif rehabilitasyon programı tanımlamak. Tasarım: 2011-2016 yılları arasında 240 hasta DDH'ye sekonder koksartroz ameliyat etti. Bu hastalar arasında; Çalışmaya dahil edilme kriterlerini karşılayan 182 hasta (256 kalça) çalışmaya alındı. Hastalar iki gruba ayrıldı: proksimal femur kısalma osteotomilerine (PFO) ihtiyaç duymayan gruplar (Grup 1) ve PFO gerektiren gruplar (Grup 2). Her iki grup için de, deneyimli bir fizyoterapistin gözetiminde uygulanan postoperatif bir rehabilitasyon programı tanımladık. Ve ilerlemeleri postoperatif 3 ay boyunca iki haftada bir kontrollerle kontrol edildi. Hastalar ağrı için Visual Analog Scala (VAS), yürüme için Trendelenburg testi, Harris Kalça Skoru (HHS) ve SF-12 Sağlık Anketi fonksiyonelliği için ameliyat öncesi, 3. ayın sonundaki, 1 yıl sonunda değerlendirildi. Bulgular: Grup 1'de 137, Grup 2'de 45 hasta vardı. Grup 1'de ortalama yaş 47.10 ± 12.92 yıl ve Grup 2'de 46.33 ± 10.70 yıl idi. Ağrı ve fonksiyon özellikle ilk üç ayda düzeldi ve daha sonra Bundan sonra kararlı. Sonuç: Rehabilitasyon programlarıyla birlikte her iki grubun uzun dönem sonuçlarına baktığımızda, ağrı ve işlevsellik üzerinde olumlu bir ilerleme kaydedildi. Bu rehabilitasyon programı, THA ile tedavi edilen DDH hastalarının hasta- lığı hakkında literatürde en son ve en detay- lıdır. Rehabilitasyon uygulamalarının artacağını ve çalışmalarımıza edebiyata katkıda bulunacağımızı düşünüyoruz

Effects of ischemic compression and instrument-assisted soft tissue mobilization techniques in trigger point therapy in patients with rotator cuff pathology: randomized controlled study

Purpose To compare the ischaemic compression (IC) and instrument-assisted soft tissue mobilization (IASTM) in the treatment of MTrPs in addition to standard rehabilitation program in patients with rotator cuff tears. Methods Participants with rotator cuff tears were included the study (n = 46). Patients were randomly divided into two groups; which were Group 1 (IC + standard rehabilitation program (n = 23)), and Group 2 (IASTM + standard rehabilitation program (n = 23)) groups. Pain were assessed by visual analog scale (VAS). Range of motion (ROM) was assessed by a universal goniometer. Active MTrPs were assessed according to the Travel and Simons criteria. Pressure pain threshold (PPT) were assessed by a digital algometer. Function were evaluated by the Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH) and American Shoulder and Elbow Surgeons Standardised Shoulder Assessment (ASES) Form. Anxiety and depression were evaluated by the Hospital Anxiety and Depression (HAD) scale. Satisfaction was assessed by the Global Rating of Change scale after 6 weeks treatment. Results After the treatment, pain, ROM and the DASH, ASES, HAD scores improved in both groups (p < 0.05). The active MTrPs of 2 muscles, PPT of 4 muscles and DASH in Group 1 significantly improved compared to Group 2 (p < 0.05). Conclusion Although patients with low functionality accumulated in the IC group, the IC is more effective than the IASTM in increasing the PPT and functional improvement according to the results of the DASH score