The effect of pre-operative carbohydrate loading in femur fracture: a randomized controlled trial.

BACKGROUND: Femur fracture is a major burden among elderly people, leading patients to be bedridden for a long time in the hospital. The body is more likely to be in a catabolic state as a result of the prolonged fasting period required for surgery, leading to an increase in insulin resistance. Pre-operative carbohydrate loading has been shown to improve postoperative outcomes in several countries. The study aimed to evaluate the effect of pre-operative carbohydrate loading in femur fracture surgery. METHODS: This study was single-center, hospital-based, open-label, parallel-group randomized controlled trial conducted between August 2020 and November 2021. A total of 66 participants, aged 50 years and above having femur fractures planned for surgery were included in this study and assigned to the control (n = 33) and study (n = 33) groups through computer-generated random numbers. The control group was kept fasting from midnight to the next morning as in existence while the study group was intervened with carbohydrate loading according to the Enhanced Recovery After Surgery (ERAS) protocol. The pre-operative nutritional status was identified and the postoperative outcomes were measured using the Visual Analogue Score (VAS), Cumulative Ambulatory Score (CAS), and Modified Barthel Index (MBI) scoring systems. Statistical analyses were performed using the Chi-square test and the Student's two-sample t-test to compare the outcomes between the two groups. RESULTS: All the participants completed the study. There was a significant reduction in the average postoperative pain in the carbohydrate loading group (VAS: 4.8 (SD ± 1.8), 95% CI: 4.7-5.4) as compared to the control group (VAS: 6.1 (SD ± 2.1), 95% CI: 5.3-6.8). The average CAS showed a significant improvement in regaining the mobility function of participants in the study group (CAS: 8.1 (SD ± 2.8), 95% CI: 7.1-9.1) than that of the control group (CAS: 6.8 (SD ± 2.8), 95% CI: 5.8-7.8). The mean MBI score of the participants at the time of discharge from the hospital was higher in the study group (MBI:13.1 (SD ± 2.3), 95% CI: 12.2-13.9) compared to the control group (MBI: 11.8 (SD ± 3.1), 95% CI:10.6-12.9). Similarly, the length of hospital stay after surgery had decreased in the study group than in the control group. CONCLUSIONS: The uptake of carbohydrate loading showed reduced post-operative pain, enhanced functional mobility, and decreased length of hospital stay. This study warrants larger trials to show the effect of pre-operative carbohydrate loading in a clinical setting. TRIAL REGISTRATION: NCT04838366, first registered on 09/042021 ( https://clinicaltrials.gov/ct2/show/NCT04838366 ).

Incidental diagnosis of paragonimiasis after histopathological examination of cholecystectomy specimen in Nepal: A case report.

INTRODUCTION: Paragonimiasis or lung fluke disease is a typical food-borne parasitic zoonosis caused by infection with Paragonimus species. The Paragonimus is a trematode that mainly infects the lungs of humans after eating an infected raw or undercooked crab or crayfish. CASE PRESENTATION: Herein we report a case of peritoneal Paragonimiasis in the gallbladder of a 58-year-old female from Rukum district of Nepal. It was an incidental diagnosis following routine histopathological examination of the cholecystectomy specimen. She presented with the symptoms of abdominal pain, fever, cough, and had a history of consumption of partially cooked river crabs. She responded well to praziquantel and improved thereafter. CLINICAL DISCUSSION: Ectopic paragonimiasis is a rare disease and it presents with few clinical symptoms so it is significantly difficult to make a diagnosis and treat the patients. Even if a sputum test and biopsy are performed, the ova or body of Paragonimus parasites may not be detectable due to insufficient amount of specimens. Therefore, thorough history taking should be given importance. The dietary history of partially cooked crab or crayfish should indicate towards a high suspicion of Paragonimiasis. Any such indication should be immediately confirmed, which in our case was done by routine histopathological examination of the cholecystectomy specimen. CONCLUSION: We report the case of a patient with peritoneal paragonimiasis in the gallbladder. Ectopic paragonimiasis is hard to diagnose due to an ignorance of, misdiagnosis, and the rarity of this disease. Thus, thorough history-taking and clinical suspicion of parasitic infection is essential.

Acotiamide and Functional Dyspepsia: A Systematic Review and Meta-Analysis.

Functional dyspepsia is a common gastrointestinal disorder characterized by postprandial fullness or early satiety and epigastric burning or pain in the absence of organic disease. Acotiamide is a novel prokinetic motility drug being used in functional dyspepsia. Databases like PubMed, PubMed Central, Embase, and Scopus were searched for studies comparing the use of acotiamide and placebo for people with functional dyspepsia. Quantitative synthesis was performed using RevMan 5.4 (Cochrane, London, United Kingdom). The improvement in symptoms of functional dyspepsia after treatment was higher in people treated with acotiamide than placebo, although not statistically significant (OR, 1.48; 95% CI, 0.93 to 2.35; n = 1697; I2 = 59%). Among the commonly reported adverse effects, namely, raised in serum prolactin (OR 1.02, 95% CI 0.64 to 1.61; n = 1709; I2 = 44%), raised in alanine transaminase (OR 1.27, 95% CI 0.70 to 2.33; n = 1709; I2 = 0%), and raised in serum bilirubin (OR, 0.98; 95% CI, 0.52 to 1.87; I2 = 0%) did not differ between two groups. Acotiamide seems to be a promising agent in functional dyspepsia. However, further larger studies are needed to evaluate the role of acotiamide in functional dyspepsia.