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Cureus May 2022Resorbable collagen has been utilized to treat wounds, close graft, and tooth extraction sites, and enhance recovery. Collagen-based membranes are also used as barriers... (Review)
Review
Resorbable collagen has been utilized to treat wounds, close graft, and tooth extraction sites, and enhance recovery. Collagen-based membranes are also used as barriers in periodontal and implant therapy to limit epithelial migration and allow cells with the regenerative capacity to fill the problem area. This systematic review was carried out to analyze the studies focusing on collagen structure, synthesis, and its applications. A detailed and extensive search was performed with the help of the keywords "collagen structure", "collagen synthesis" and "collagen applications". There was extensive literature search in reliable and authentic databases like PubMed, Scopus, Web of Sciences, Ovidsp, and Cochrane library to obtain papers focusing on collagen structure, synthesis, and applications. During the systematic review, data were obtained concerning the following parameters. Type of study, nature of aim of the study, size of the sample in the study, gender and age of the subjects included in the study, prevalence of skin diseases where collagen was used for treatment, dose of collagen used, form in which collagen was used, the origin of collagen used, analysis of different variables, structure, and synthesis of collagen. Twenty-two studies were included in this systematic review. The studies discussed the structure, synthesis, and applications of collagen in treatment. In studies focusing on the application of collagen supplements, most of the study subjects were females (68.3%). The study subjects included both healthy and unhealthy subjects. The study subjects were divided into two categories. One category was the intervention group, while another group was the placebo group. Collagen was administered in hydrolysate form (90%) in some studies, bovine form (2.3%), and porcine form (3.4%) in other studies. Collagen supplementation was found to provide better results in both healthy and unhealthy effects in improving the health of skin, cornea, bone, periodontium, face, etc. It can be concluded that collagen is an integral part of the body. The application of collagen supplements can be pretty effective in maintaining the proper health of several important structures of the body like skin, face, cornea, nails, periodontium, etc. Thus, a detailed study of the molecular structure of collagen and genes associated with each type of collagen is essential for further research and treatment of collagen-associated disorders.
PubMed: 35702467
DOI: 10.7759/cureus.24856 -
Strategies in Trauma and Limb... 2022Circular frame fixation remains a key tool in the armamentarium of the limb reconstruction surgeon. One of the key drawbacks is the onset of pin-site infection (PSI). As... (Review)
Review
INTRODUCTION
Circular frame fixation remains a key tool in the armamentarium of the limb reconstruction surgeon. One of the key drawbacks is the onset of pin-site infection (PSI). As a result of limited evidence and consensus of PSI prevention, a wide variation in practice remains.
AIM
The principal aim of this review is to synthesise primary research concerning all aspects of treatment regarded as relevant to PSI in frame constructs.
MATERIALS AND METHODS
Comparative studies until week 26, 2021, were included in the trial. Studies were included that concerned patients undergoing management of a musculoskeletal condition in which pin-site care is necessary for over 4 weeks.
RESULTS
Eighteen studies over a 13-year period were captured using the search strategy. Sulphadiazine and hydrogen peroxide cleansing was found to reduce PSI, with the use of low-energy fine wires and hydroxyapatite (HA)-coated pins also associated with lower infection rate. The remainder of studies found no significant improvement across interventions.
CONCLUSION
There is no superiority between weekly and daily care. Low-energy pin-insertion technique had lower rates of infection. Sulphadiazine has positive results as a pin-care solution, but more research is necessary to determine the most effective care regime. Current literature is limited by absence of established definitions and by a lack of studies addressing all aspects of care relevant to PSI.
HOW TO CITE THIS ARTICLE
Shields DW, Iliadis AD, Kelly E, . Pin-site Infection: A Systematic Review of Prevention Strategies. Strategies Trauma Limb Reconstr 2022;17(2):93-104.
PubMed: 35990183
DOI: 10.5005/jp-journals-10080-1562 -
Journal of Spine Surgery (Hong Kong) Mar 2018We conducted a thorough review of the literature to examine the risks and complications associated with the use of Gardner-Wells Tongs (GWT). Twenty-three articles were... (Review)
Review
We conducted a thorough review of the literature to examine the risks and complications associated with the use of Gardner-Wells Tongs (GWT). Twenty-three articles were included in this review for final analysis. One article reported a 37.5% (6/16) incidence rate of minor complications with the usage of GWTs, which included pin loosening, asymmetrical pin positioning, and superficial infections. Various cases reported more serious yet rare complications, including perforation of the skull, brain abscesses, and neurovascular damage. Overall, the complication rate is low, and often associated with only minor and transient complications, which can be easily managed. Therefore, we conclude that GWT are safe and effective, with only rare, more serious complications reported in the literature.
PubMed: 29732432
DOI: 10.21037/jss.2018.03.03 -
CNS Drugs Sep 2023Although one of the major presentations of vestibular migraine is dizziness with/without unsteady gait, it is still classified as one of the migraine categories.... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Although one of the major presentations of vestibular migraine is dizziness with/without unsteady gait, it is still classified as one of the migraine categories. However, in contrast to ordinary migraine, vestibular migraine patients have distinct characteristics, and the detailed treatment strategy for vestibular migraine is different and more challenging than ordinary migraine treatment. Currently, there is no conclusive evidence regarding its management, including vestibular migraine prophylaxis.
AIM
The objective of this current network meta-analysis (NMA) was to compare the efficacy and acceptability of individual treatment strategies in patients with vestibular migraine.
METHODS
The PubMed, Embase, ScienceDirect, ProQuest, Web of Science, ClinicalKey, Cochrane Central, and ClinicalTrials.gov databases were systematically searched for randomized controlled trials (RCTs), with a final literature search date of 30 December 2022. Patients diagnosed with vestibular migraine were included. The PICO of the current study included (1) patients with vestibular migraine; (2) intervention: any active pharmacologic or non-pharmacologic intervention; (3) comparator: placebo-control, active control, or waiting list; and (4) outcome: changes in migraine frequency or severity. This NMA of RCTs of vestibular migraine treatment was conducted using a frequentist model. We arranged inconsistency and similarity tests to re-examine the assumption of NMA, and also conducted a subgroup analysis focusing on RCTs of pharmacological treatment for vestibular migraine management. The primary outcome was changes in the frequency of vestibular migraines, while the secondary outcomes were changes in vestibular migraine severity and acceptability. Acceptability was set as the dropout rate, which was defined as the participant leaving the study before the end of the trial for any reason. Two authors independently evaluated the risk of bias for each domain using the Cochrane risk-of-bias tool.
RESULTS
Seven randomized controlled trials (N = 828, mean age 37.6 years, 78.4% female) and seven active regimens were included. We determined that only valproic acid (standardized mean difference [SMD] -1.61, 95% confidence interval [CI] -2.69, -0.54), propranolol (SMD -1.36, 95% CI -2.55, -0.17), and venlafaxine (SMD -1.25, 95% CI -2.32, -0.18) were significantly associated with better improvement in vestibular migraine frequency than the placebo/control groups. Furthermore, among all the investigated pharmacologic/non-pharmacologic treatments, valproic acid yielded the greatest decrease in vestibular migraine frequency among all the interventions. In addition, most pharmacologic/non-pharmacologic treatments were associated with similar acceptability (i.e. dropout rate) as those of the placebo/control groups.
CONCLUSIONS
The current study provides evidence that only valproic acid, propranolol, and venlafaxine might be associated with beneficial efficacy in vestibular migraine treatment.
TRIAL REGISTRATION
CRD42023388343.
Topics: Adult; Female; Humans; Male; Migraine Disorders; Network Meta-Analysis; Propranolol; Valproic Acid; Venlafaxine Hydrochloride
PubMed: 37676473
DOI: 10.1007/s40263-023-01037-0 -
Health Promotion Perspectives 2021Several studies assessed the level of knowledge and general public behavior on human immunodeficiency virus/acquired immuno-deficiency syndrome (HIV/AIDS) in India.... (Review)
Review
Several studies assessed the level of knowledge and general public behavior on human immunodeficiency virus/acquired immuno-deficiency syndrome (HIV/AIDS) in India. However, comprehensive scrutiny of literature is essential for any decision-making process. Our objective was to perform a systematic review and meta-analysis to examine the level of knowledge and attitude towards HIV/AIDS in India. A systematic search using Medical Subject Headings (MeSH) and free terms was conducted in PubMed/Medline, Scopus, Embase, and Google Scholar databases to investigate the level of knowledge and attitude of HIV/AIDS in India population. Cross-sectional studies published in English from January 2010 to November 2020 were included. The identified articles were screened in multiple levels of title, abstract and full-text and final studies that met the inclusion criteria were retrieved and included in the study. The methodological quality was assessed using the Joanna Briggs Institute's checklist for cross-sectional studies. Estimates with corresponding 95% confidence intervals (CIs) for each domain were pooled to examine the level of knowledge and attitude towards HIV/AIDS in India. A total of 47 studies (n= 307 501) were identified, and 43 studies were included in the meta-analysis. The overall level of knowledge about HIV/AIDS was 75% (95% CI: 69-80%; I2 = 99.8%), and a higher level of knowledge was observed among female sex workers (FSWs) 89% (95% CI: 77-100%, I2 = 99.5%) than students (77%, 95% CI: 67-87%, I2 = 99.6%) and the general population (70%, 95% CI: 62-79%, I2 = 99.2%), respectively. However, HIV/AIDS attitude was suboptimal (60%, 95% CI: 51-69%, I2 = 99.2%). Students (58%, 95% CI: 38-77%, I2 = 99.7%), people living with HIV/AIDS (57%, 95% CI: 44-71%, I2 = 92.7%), the general population (71%, 95% CI: 62-80%, I2 = 94.5%), and healthcare workers (HCWs) (74%, 95% CI: 63-84%, I2 = 0.0%) had a positive attitude towards HIV/AIDS. The methodological quality of included studies was "moderate" according to Joanna Briggs Institute's checklist. Funnel plots are asymmetry and the Egger's regression test and Begg's rank test identified risk of publication bias. The level of knowledge was 75%, and 40% had a negative attitude. This information would help formulate appropriate policies by various departments, ministries and educational institutions to incorporate in their training, capacity building and advocacy programs. Improving the knowledge and changing the attitudes among the Indian population remains crucial for the success of India's HIV/AIDS response.
PubMed: 34195038
DOI: 10.34172/hpp.2021.19 -
BMC Musculoskeletal Disorders Nov 2023Ilizarov method has become one of primary methods for treating bone defects. Currently, there is growing trend in the application of modified Ilizarov methods (e.g.,... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ilizarov method has become one of primary methods for treating bone defects. Currently, there is growing trend in the application of modified Ilizarov methods (e.g., applying unilateral external fixators or with flap tissue) and its combined methods (e.g., Ilizarov method with antibiotic spacer or internal fixation) to manage bone defects. However, there is a lack of studies with systematical evaluation of the clinical effects of these evolving methods. This study aimed to conduct a systematic review and meta-analysis for overall evaluating the clinical effects on long bone defects of lower extremity in Ilizarov methods and its combined methods.
METHODS
Studies were identified in three electronic databases (Pubmed, Embase and Cochrane Library) from the earliest indexing year through November 01, 2022, and relevant data were extracted subsequently. The total number of participants, number of participants with bone unions, bone result or functional result, and related complications including pin infection, pin loosening, pain, refracture, limb discrepancy, malalignment, joint stiffness, recurrent infection, and amputation were extracted in this study. Then, union rate (defined as the proportion of patients who achieved bone unions) and specific complication incidence rate (defined as the proportion of patients who experienced specific complication) were pooled estimated respectively. Relative risk (RR) was used for comparing the clinical effects among various Ilizarov technique.
RESULTS
Sixty-eight case series studies, 29 comparative studies, and 3 randomized clinical trials were finally included. The union rate of Ilizarov methods was 99.29% (95% CI: 98.67% ~ 99.86%) in tibial defects and 98.81% (95% CI: 98.81% ~ 100.00%) in femoral defects. The union rate of Ilizarov method with antibiotic spacer and intramedullary nail in tibial defects was 99.58% (95% CI: 98.05% ~ 100.00%) and 95.02% (95% CI: 87.28% ~ 100.00%), respectively. Compared to the Ilizarov methods, the union rate of the Ilizarov method with antibiotic spacer in tibial defects increased slightly (RR = 1.02, 95% CI: 1.01 ~ 1.04). Meanwhile, compared to Ilizarov methods, we found lower excellent rate in bone result in Ilizarov method with antibiotic spacer, with the moderate to high heterogeneity. Compared to the Ilizarov method, lower rate of pin infection, higher rate of recurrent infection and amputation were observed in Ilizarov method with intramedullary nail, however, the findings about the comparison of pin infection and recurrent infection between the two groups were presented with high degree of statistical heterogeneity.
CONCLUSION
Our study confirmed the reliable treatment of Ilizarov methods and its combined technique on long bone defects, and founded there were significant differences on some complications rate between Ilizarov methods and its combined technique. However, the findings need to be confirmed by further studies.
Topics: Humans; Ilizarov Technique; Reinfection; Treatment Outcome; Tibia; External Fixators; Lower Extremity; Anti-Bacterial Agents; Retrospective Studies; Tibial Fractures
PubMed: 37968675
DOI: 10.1186/s12891-023-07001-9 -
International Journal of Surgery... Oct 2015Intramedullary nails (IM nails) now include dedicated fibular nails for lateral malleolus fractures. This study reviewed nail versus plate for fixation of unstable ankle... (Comparative Study)
Comparative Study Review
INTRODUCTION
Intramedullary nails (IM nails) now include dedicated fibular nails for lateral malleolus fractures. This study reviewed nail versus plate for fixation of unstable ankle fractures.
DESIGN
Systematic review and meta-analysis of published reports.
RESULTS
Four studies met the inclusion criteria, including 375 patients. Two included studies were randomised-control studies and two were non-randomised case series. The implants investigated included: Knowles Pins, Fibular Nails, Rush Rods and Inyo Nails. The overall risk of bias was high. Pooled data showed a statistically significant lower risk of wound infection (RR 0.10; 95% CI 0.02 to 0.44), symptomatic hardware (RR 0.14; 95% CI 0.05 to 0.35) and removal of hardware (RR 0.57; 95% CI 0.39 to 0.81) with intramedullary nail fixation.
CONCLUSIONS
There is a paucity of literature upon which to draw reliable conclusions. There was a high risk of bias towards favourable outcomes for the nail group. It would appear that intramedullary nail fixation of distal fibular fractures can outperform conventional fixation with plate and screws. There is a need for adequately powered, scientific trials.
Topics: Ankle Fractures; Bone Nails; Bone Plates; Fracture Fixation, Internal; Humans
PubMed: 26255000
DOI: 10.1016/j.ijsu.2015.07.697 -
Injury Apr 2023Intramedullary nailing (IMN) is a general treatment for intertrochanteric hip fractures. The computer-assisted orthopaedics system (CAOS), ADAPT system (Stryker, NJ),... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Intramedullary nailing (IMN) is a general treatment for intertrochanteric hip fractures. The computer-assisted orthopaedics system (CAOS), ADAPT system (Stryker, NJ), has been developed to facilitate lag screw insertion. When compared to the conventional freehand method, the efficacy of CAOS has not been clearly clarified. Therefore, we conducted this systematic review and meta-analysis to answer: does the CAOS performed better than freehand method in IMN.
MATERIALS AND METHODS
Studies published up to January 2023 were searched in the PubMed, Embase, Web of Science and Cochrane Library databases with predetermined key words. Comparative clinical studies between CAOS (ADAPT system) and freehand method were included. The primary outcomes of interest were the tip-apex-distance (TAD) and positions of lag screw. Fluoroscopy use, operation duration and intraoperative/postoperative complications were also extracted. A meta-analysis was performed for pooled analysis.
RESULTS
There were seven studies with 326 fractures in CAOS group and 325 fractures in Freehand group. All studies included presented high qualities. The CAOS group showed a statistically smaller TAD than Freehand group (weighted mean difference = -3.24 mm; 95% confidence interval [CI] -5.10 to -1.37 mm; p = 0.0007) and a better lag screw position (83/92 [90.2%] VS 64/92 [69.6%]; RR = 1.3; 95% CI 1.12 to 1.51; p = 0.0007). The operative time and radiation use revealed no difference between two groups.
CONCLUSIONS
The current evidence indicated that ADAPT system could help to perform a more accurate lag screw than freehand manipulation while the operative time and radiation time was not reduced as expectations on such new technique. Long-term follow-up studies are appealed.
Topics: Humans; Orthopedics; Hip Fractures; Bone Screws; Fracture Fixation, Intramedullary; Computers; Treatment Outcome; Bone Nails
PubMed: 36759309
DOI: 10.1016/j.injury.2023.02.011 -
Journal of Orthopaedic Surgery and... Jun 2018The objective of this meta-analysis was to illustrate the clinical outcomes and safety of two different managements for supracondylar humeral fractures in children. (Review)
Review
BACKGROUND
The objective of this meta-analysis was to illustrate the clinical outcomes and safety of two different managements for supracondylar humeral fractures in children.
METHODS
In January 2018, a systematic computer-based search was conducted in PubMed, EMBASE, Web of Science, Cochrane Database of Systematic Reviews, and Google database. Data on patients prepared for two different managements for supracondylar humeral fractures in children were retrieved. The primary endpoint was the cosmetic and clinical outcomes based on the criteria of Flynn, ulnar nerve injury, and the occurrence of infection. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.
RESULTS
Six clinical studies with 581 patients were ultimately included in the meta-analysis. There was no significant difference between the closed reduction and percutaneous cross-pinning, and open reduction and internal fixation in terms of the cosmetic and clinical outcomes based on the criteria of Flynn, ulnar nerve injury, and the occurrence of infection (P > 0.05).
CONCLUSIONS
Closed reduction and percutaneous pinning, and open reduction and internal fixation of supracondylar humeral fractures in children result in similar construct stability and functional outcome. More high quality randomized controlled trials are needed to identify this conclusion.
Topics: Bone Nails; Child; Fracture Fixation, Internal; Humans; Humeral Fractures; Prospective Studies; Retrospective Studies; Treatment Outcome
PubMed: 29880019
DOI: 10.1186/s13018-018-0806-1 -
Knee Surgery, Sports Traumatology,... Mar 2023The purpose of this systematic review is to describe the complications and downsides of robotic systems in total knee arthroplasty (TKA). (Review)
Review
PURPOSE
The purpose of this systematic review is to describe the complications and downsides of robotic systems in total knee arthroplasty (TKA).
METHODS
A comprehensive search according to the PRISMA guidelines was performed across PubMed, MEDLINE, Cochrane Central Register of Controlled Trials, Scopus, and Google Scholar from inception until December 2021. All articles of any study design directly reporting on complications and downsides of the robotic system in TKA were considered for inclusion. Risk of bias assessment was performed for all included studies using the Cochrane risk of bias and MINORS score.
RESULTS
A total of 21 studies were included, consisting of 4 randomized controlled trials, 7 prospective studies and 10 retrospective studies. Complications of the robotic system were pin-hole fracture, pin-related infection, iatrogenic soft tissue and bony injury, and excessive blood loss. While, downsides were longer operative duration, higher intraoperative cost, learning curve and aborting a robotic TKA due to different reasons. Iatrogenic injuries were more common in the active robotic system and abortion of the robotic TKA was reported only with active robotic TKA.
CONCLUSION
Robotic TKA is associated with certain advantages and disadvantages. Therefore, surgeons need to be familiar with the system to use it effectively. Widespread adoption of the robotic system should always be evidence-based.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Arthroplasty, Replacement, Knee; Knee Joint; Robotic Surgical Procedures; Prospective Studies; Retrospective Studies; Iatrogenic Disease; Osteoarthritis, Knee
PubMed: 35716186
DOI: 10.1007/s00167-022-07031-1