1. In this prospective randomized controlled study, pain scores for the topical tranexamic acid (TXA) group on the first day after total hip arthroplasty (THA) were significantly lower than the intravenous (IV) group.
2. Those enlisted to receive topical TXA were additionally observed to use lesser amounts of tramadol on days 1 and 2 postoperatively.
3. There was no significant difference in total blood loss or adverse events between the two groups.
Evidence Rating Level: 1 (Excellent)
The possibility of opioid dependence post-operatively should always be a consideration for healthcare providers. Of particular concern is the rate of opioid dependence following total hip arthroplasties. Thus, control of postoperative pain should be of importance. While perioperative TXA has been widely studied in the context of blood loss prevention, few studies have elucidated its effects on early postoperative pain. To further investigate this, researchers conducted a prospective randomized controlled study in which patients undergoing THA were divided into either a topical TXA group (n = 79) or an intravenous group (n = 82), administered perioperatively. Visual analogue scale (VAS) scores were used to assess postoperative pain at one, two, and three days post-THA. On the first day after surgery, the topical TXA group had significantly lower hip pain scores (3.54 ± 0.46 vs. 3.84 ± 0.39, p <0.001), CRP, IL-6, and ESR levels (Ps ≤ 0.001). These differences were no longer statistically significant on days 2 and 3 post-THA (Ps ≥ 0.05). The doses of tramadol used differed significantly between the two groups on postoperative days 1 and 2 (P = 0.037 and P = 0.039, respectively), but not on day 3. With respect to blood loss, there were no significant differences in hemoglobin levels (12.22 ± 4.05 g/L vs. 17.07 ± 4.04 g/L, P = 0.824) or calculated blood loss (640.60 ± 188.12 ml vs. 634.20 ± 187.85 ml, P = 0.827) between the two groups. There was also no significant difference in the rate of postoperative complications between the groups. Overall, this study demonstrates that overall opioid consumption in the early stages after THA may be decreased with the use of topical TXA perioperatively. It also demonstrated that TXA could potentially affect the local inflammatory response on the first day after surgery. Additional studies into the effects of topical TXA perioperatively should be conducted to further this hypothesis.Â
1. In this cohort study, individuals with Type 1 diabetes (T1D) had consistently higher brain age values than their non-diabetic counterparts, averaging to approximately 6 years older, and were additionally observed to score lower on measures of cognitive performance for psychomotor and mental efficiency.Â
2. Alzheimer’s Disease (AD) related atrophy and neurodegeneration were comparable between the two groups when measured by magnetic resonance imaging (MRI).Â
Evidence Rating Level: 2 (Good)
The literature has established some modest structural and functional changes that occur in the brains of those with T1D, including declines in memory performance, mental efficiency tests, and smaller gray matter volumes. Using MRI-derived signatures and novel machine learning methods to identify spatial patterns of brain atrophy, researchers are now able to differentiate brain aging from neurodegenerative processes. In this cohort study, 416 participants with T1D from the Epidemiology of Diabetes Interventions and Complications (EDIC) study (median diabetes duration 37 years) agreed to take part in this ancillary study, as did 99 controls without T1D. Cognitive protocols included a battery of psychomotor, mental efficiency, immediate recall, and delayed recall tests which are sensitive in detecting normal aging versus mild cognitive impairment. Across the entire actual age range, EDIC participants had consistently higher predicted age values compared to controls, who showed no evidence of premature brain aging. However, there was no greater atrophy in regions typically affected in AD. Brain regions most affected by atrophy in EDIC participants included the putamen, thalamus, superior frontal gyrus, middle frontal gyrus, and superior temporal gyrus. Among EDIC participants, greater brain aging was associated with lower psychomotor and mental efficiency (P < .001). The results of this study support the hypothesis that morphology of the brain is associated with accelerated aging in those with a longstanding history of T1D. Based on this study, T1D is not associated with significantly decreased brain reserve in regions that are susceptible to AD-related neurodegeneration at this age. A potential weakness of the study is the lack of generalizability of results due to racial homogeneity of the study population (predominantly non-Hispanic White), as well as a mean age of 60, which is younger than the typical emergence of AD-related symptoms. Patients in the control group also differed significantly from the EDIC group in higher educational attainment (P = .02), which could have potentially confounded potential results related to brain atrophy and aging. This study should be repeated where possible in diverse and older populations to explicate the results further. Nonetheless, findings suggest an association between advanced brain age as well as cognitive decline with Type 1 diabetes, possibly representing an underrecognized risk factor in the development of early dementia.Â
1. This noninferiority trial found that at 12 weeks, hematologic responses to 200 mg ferrous fumarate thrice weekly (TIW) were not significantly different than the TID iron treatment group for iron deficiency anemia (IDA) by week 12 of treatment.Â
Evidence Rating Level: 1 (Excellent)
IDA is a relatively common condition affecting patients’ quality of life. If non-inferior, a TIW treatment regimen would be more cost-effective, reduce pill burdens, and could potentially lend to a lower incidence of adverse events associated with ferrous fumarate use (e.g., metallic taste, epigastric discomfort, constipation, nausea). Therefore, this noninferiority trial sought to evaluate the effectiveness of lower dose regimens on IDA. A total of 64 patients were randomized either to the TID (n = 32) or TIW arms (n = 32) at enrollment, and by week 12, there remained 27 and 26 participants in each arm, respectively. At week 4, the hemoglobin (Hb) level in the TID arm was significantly higher than the TIW arm (9.9 vs. 10.8 g/dL, respectively, p = 0.040), but by week 12, there was no longer a significant difference between either arm (11.9 vs. 12.4 g/dL, p = 0.188). While the TID group may have seen a faster result, the difference was short-lasting. The primary endpoint of an increase in Hb of ≥ 3 g/dL was achieved by both groups without a significant difference (p > 0.05). In terms of secondary outcomes, although the mean Hb in the TID group (12.4 g/dL) was higher than in the TIW group (11.9 g/dL) by week 12, the mean Hb was not significantly different between the groups (< 0.9 g/dL). All participants from both arms recovered from anemic symptoms (fatigue, dyspnea on exertion, dizziness, sore tongue, taste disturbance, and pica) by week 12 as well. From a hematological standpoint, the transferrin saturations and serum ferritin levels between both groups were no different by week 12 (64.3% vs. 73.1%, p = 0.430). Compliance by week 12 was 95.4% in the TIW arm, and 92.0% in the TID arms. There was a relatively high attrition rate (17%) with only 64 participants to begin with, which may be interpreted as a potential limitation of this study. However, results are promising and should be further elucidated as the potential for less frequent dosing with ferrous fumarate may provide a cost-effective solution that decreases the frequency of common adverse effects associated with the supplement.
1. In this cross-sectional, longitudinal study, power and speed scores measured during the sit-to-stand motion were predictive of frailty in older adults with cardiometabolic disease.Â
Evidence Rating Level: 2 (Good)
Frailty, characterized by decreased physiologic reserve, increased vulnerability to stressors, and a high risk for adverse health outcomes, is an important concept linked to life expectancy and well-being in older adults. With the largest proportion of the population entering older adulthood in the coming years (≥ 65), it is crucial that we focus on the prevention and early detection of frailty. This is especially important in those struggling with metabolic and cardiovascular diseases (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation, ischemic heart disease, heart failure). The ground reaction force (GRF) during sit-to-stand movements is measured using a motor function analyzer and calculates for power (maximum GFR/body weight), speed (rate of force development), and balance (lateral load sway). In this cross-sectional, longitudinal study, researchers sought to examine associations between measurements of GRF and scores for frailty in this subpopulation. The study analysis included 319 outpatients aged 65 or older with cardiometabolic diseases who were screened for frailty using the modified Cardiovascular Health Study (mCHS) scale and Kihon Checklist (KCL). Analyses demonstrated that scores for power and speed with GRF were predictive of frailty using the mCHS criteria and KCL criteria at baseline. An increase in power, speed, and total GRF scores decreased the incidence of KCL-defined frailty by 44%, 23%, and 35%, respectively (ps < .05). Similarly, mCHS and KCL defined frailty-free survival was significantly lower in patients with lower power and speed scores (p < .01 and p = .028, respectively). In fact, a 0.1-point increase in power or 1-point increase in speed reduced mCHS-defined frailty risk by 55% and 28%, respectively. The balance score was not associated with either criteria’s definition of frailty. Overall, the results of this study demonstrate that GRF may be a convenient and useful tool in determining frailty risk in resource-scarce or clinical settings.Â
1. This double-blind, crossover, single-center randomized clinical trial found that Tinnitus Functional Index (TFI) and tinnitus loudness level scores were significantly decreased in those receiving bisensory stimulation.Â
Evidence Rating Level: 1 (Excellent)
Somatic tinnitus, which is tinnitus where the affected person can manipulate the volume, pitch, or tonal quality of their tinnitus by performing head or neck movements, comprises most cases of tinnitus. While the etiology of tinnitus is not fully understood, animal models have demonstrated the potential importance of dorsal cochlear nucleus circuitry changes in the development of this condition. A working hypothesis is that bisensory (including both auditory and somatosensory) stimuli can reverse altered neural patterns to reduce tinnitus, as demonstrated in a pilot study which saw tinnitus reduction in those who receiving bisensory stimulation. In this double-blinded, crossover, single-center randomized clinical trial, participants were randomized to receive 30 minutes per day of bisensory treatment (n = 49) or 30 minutes per day of auditory-only treatment (n = 50). Both groups were treated for 6 weeks followed by a 6-week washout phase. The TFI score was used as a primary measure for improvement in the groups (a higher TFI score indicates a higher effect of tinnitus on quality of life), and the Tinnitus Handicap Inventory (THI) was used as an endpoint measurement. While both the treatment and control groups saw improvements in TFI scores during the initial treatment phase, there was a significantly greater improvement in the bisensory treatment group (P < .01). The bisensory stimulation resulted in significant, cumulative, and lasting decreases in the primary endpoints of TFI score and tinnitus loudness level, as well as the end point of THI (Ps < .05). These clinically significant decreases in TFI score (> 13 points) and THI score (> 5 points) continued beyond treatment and into the washout phase. The results of this study corroborate and further bolster the results of the previous pilot study. The addition of 2 extra weeks of treatment in this study (6 weeks versus 4 weeks in the pilot study) lent itself to lasting results through the washout phase.Â
Image: PD
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