The Effect of Local Tranexamic Acid Administration on Blood Loss and Transfusion in Total Knee Arthroplasty: A Retrospective Study.

Objectives: The standard surgical method for primary gonarthrosis in advanced stages is total knee arthroplasty (TKA), despite the risk of bleeding that requires transfusion. Blood transfusions are potentially dangerous. The aim of this study was to determine whether there is a statistical difference in the amount of bleeding and the need for transfusion between patients who received and did not receive perioperative local tranexamic acid in TKA. Methods: The hospital data system was used to access the data of patients who underwent TKA in our clinic between January 2015 and January 2022 with a diagnosis of gonarthrosis. Patients who underwent TKA and had gonarthrosis as the primary diagnosis were included in the study. They were separated into two groups: A control group (Group C) and a group that received perioperative local tranexamic acid (Group LTXA). The amount of bleeding was compared by taking into account patients' hemogram follow-ups, the amount of blood from their drains, and their transfusion needs during the postoperative period. Results: The findings demonstrated that TKA patients who received local tranexamic acid administration experienced a significant decrease in perioperative blood loss and needed lesser transfusions. Conclusion: The findings of our investigation are consistent with other studies and are in favor of the usage of TXA in TKA. To validate our findings and establish the ideal TXA dosage and administration method in TKA, additional research is required.

The Use of Ilizarov Method at the Lower Extremity Deformity Management.

Objectives: Complications are common in the treatment of lower extremity congenital or acquired deformities by Ilizarov method. The results to be obtained vary in specific patient groups. In this study, deformities who developed before the age of 16 were compared with those developed after this age regardless of the type of aetiology, in terms of results obtained, treatment durations and complications encountered. Methods: 53 bone deformities with an average of 9.5 (7.5-18) years of follow-up treated by the same surgeon were divided into 2 groups according to the age of deformity onset. Demographics and deformity characteristics of patients were defined, treatment times, bone healing indexes, consolidation/correction rates, problems encountered and results obtained were compared retrospectively. The results were compared with ASAMI functional and bone scoring. Complications were rated according to Paley and relative risk increases between groups were calculated. Results: 26 of the patients were men and 22 were women. The average age was 26.47 (7-57). The mean deformity was 23.98° (7-60) and the mean shortness in 39 patients was 38.65 (10-110)mm. Mechanical axis deviation was corrected in 83% of patients. The Lengthening index was 54.13days/cm in the development group and 63.69 days/cm in adults. Consolidation/correction rate was 2.54 in developmental age and 2.4 (p=0.698) in adults. The risk increased by 1.02 times in terms of problems encountered, 2 for obstacles, 3 times in complications and 1.34 times in total difficulties per case, according to Paley. The duration of stay in the fixator was higher in developmental group (p=0.023). ASAMI functional (p=0.000148) and anatomical (p=0.000242) scores were better in the adult group. Conclusion: Congenital or acquired deformities in the lower extremity can be treated with satisfactory results by Ilizarov method. The development of deformity at an early age makes treatment difficult. Although the bone healing index is lower in this group of patients, which usually has a higher amount of shortness, the treatment is usually longer than that of adult deformities; complications are more frequent and serious. Functional and anatomical results are more unsuccessful.

Frequency And Factors Associated With Adverse Reactions After Administration of Inactivated COVID-19 Vaccine Among Health Workers.

BACKGROUND: The 2019 coronavirus (COVID-19) has precipitated a significant public health crisis. Our study aimed to evaluate the prevalence and risk factors associated with adverse reactions to the inactivated CoronaVac vaccine. METHODS: The study involved voluntary health workers who received CoronaVac vaccine. We documented the sociodemographic information of 2,019 participants who volunteered for our study. Of these, 1,964 and 1,702 participants were interviewed by phone 1 month after the first and second dose, respectively, during which they were queried about any adverse reactions. RESULTS: Within the first week after the first dose, adverse reactions were observed in 856 (43.3%) participants, with 133 (6.7%) experiencing them during the second week, and 96 (4.9%) people at the end of the first month. For the second dose, 276 individuals (16.2%) reported adverse reactions. The prevalence of both local and systemic adverse events ranged from 9.5-11.2% overall. Fatigue was the most common adverse reaction overall, while pain at the injection site was the most frequent local adverse reaction. CONCLUSIONS: The evaluation of both systemic and local side effects revealed no significant adverse reactions to the inactivated CoronaVac vaccine (Sinovac Life Sciences, Beijing, China). Our study found that the incidence of systemic and local adverse responses to the CoronaVac vaccination was lower than the rates reported in studies involving the recombinant adenovirus type-5, BNT162b1, and ChAdOx1nCoV-19 COVID-19 vaccines, all of which underwent the World Health Organization LULUC/PQ evaluation process.

Deformity correction and limb lengthening with externally controlled motorized extendable intramedullary nails: Comparison of 2 different nails.

OBJECTIVE: The aim of this study was to assess and compare the clinical, radiological, and functional results of patients treated with FITBONE or PRECICE nails due to deformity and length discrepancy in their lower extremities. METHODS: This retrospective cohort study included 41 patients with length discrepancy and deformity in their lower extremities, who underwent limb lengthening surgery with either FITBONE (group F) or PRECICE (group P) nails between 2010 and 2020. The mean postoperative follow-up period was 15.95 ± 4.75 months in group F (20 patients) and 20.48 ± 7.57 months in group P (21 patients). Lower extremity mechanical and anatomical axes were measured on x-rays preoperatively and at the end of treatment. Consolidation and distraction indexes were also calculated to assess bone healing. Lower Extremity Functional Scale test was used to evaluate functional outcomes and quality of life. RESULTS: Neither of the treatment methods caused deviations in the mechanical axes and femoral distal angles (P > .05). No statistically significant difference in consolidation and distraction indexes was found between the groups (P > .05). Postoperative complications were seen in 3 of the patients in group F and 4 of the patients from group P. There was no significant difference in Lower Extremity Functional Scale scores between groups (P = .425). CONCLUSION: This study has demonstrated that treatment with both the FITBONE and PRECICE nails resulted in improved physical and emotional functional outcomes. Both nails had similar radiographic results, complication rates, high patient compliance, and good cosmesis. LEVEL OF EVIDENCE: Level III, Therapeutic Study.

Traditional versus magnetically controlled growing rods in early onset scoliosis surgical treatment.

PURPOSE: Growing rod surgeries are common methods in the treatment of early onset scoliosis. Magnetic growing rod (MGR) surgery, in particular, has become more widespread in the last 10 years. The aim of this study was to compare the effects of traditional and magnetically controlled growing rod techniques on efficacy, safety, spinal growth, and lung development. METHODS: A retrospective analysis was made of 24 TGR and 17 MGR patients. Inclusion criteria were patients aged < 10 years, curvature > 40° or a progression of > 10° in the 4-6 month follow-up for curves between 25 and 40°. RESULTS: There were 9 males and 15 females in the TGR cohort and 7 males and 10 females in the MGR cohort. The mean age at first surgery was 6.1 years and 7.1 years, respectively. Major curve Cobb angles of TGR were preop. 51.5°, postop. 21.4° and 18.1° at the final follow-up. In the MGR cohort, these values were 60.4°, 41.8°, and 36.4°, respectively. The mean T1-S1 lengthening velocity was calculated as 1.12 cm/year (0.9318 mm/month) in the TGR group and 1.27 cm/year (1.0571 mm/month) in the MGR group. In the TGR cohort, a total of 99 procedures were performed as 24 initial surgeries and 75 additional procedures (5 lengthening during unplanned surgery due to complications; 4 revision, 1 debridement). In the MRG cohort, a total of 25 surgical procedures were performed as 17 initial surgeries and 7 additional procedures (3 debridements, 5 revisions). CONCLUSION: The results of this study showed that the TGR system provided better correction in the coronal plane and was superior in kyphosis restoration than the MGR system. Both methods were successful in lengthening, but complication rates were slightly higher in the MGR cohort. The most common complication was the pullout of the proximal anchors, and this was more common in the MGR. Both TGR and MGR were found to be effective treatments. Lengthening without surgery is a significant advantage of the MGR system, but it has a high revision rate, and Cobb angle correction was found to be less effective than with TGR.

An interesting finding: What is the relation between aortic enlargement and COVID-19?

BACKGROUND: We aim to compare the diameters of ascending aorta in COVID-19 patients and COVID-19-free individuals referred to our pandemic hospital. METHODS: The medical records and thorax tomographies of patients admitted to the "pandemic central" state hospital with symptoms of COVID-19 were observed between April 2020 and May 2020 in this case-control study. The first group consisted of patients diagnosed with COVID-19, and the second group consisted of patients without the disease. The diameter of the ascending aorta is measured via tomography and compared to each other. The most causative risk factors for aortic enlargements underwent a multivariate regression analysis. RESULTS: Charts of 156 patients (104 COVID-19 positives, 52 COVID-19 negatives) were reviewed. There was a statistical difference (p: .01) between the mean aortic diameter of COVID-19 patients (39 mm) and COVID-free patients (32.5 mm) even though comorbid factors and patient characteristics were similar in the two groups at the time of hospital admission. The regression analysis result demonstrates that COVID-19 (leading factor), age, and coronary artery disease were the most significant factors associated with increasing aortic dimensions. (p: .001, B: 5.3/, p: .02, B: 3.36/, p: .002, B: 0.13/, R square: 40.2%). CONCLUSION: This study shows that the mean aortic diameter of COVID-19 patients is larger than non-COVID-19 patients with similar comorbidities referred to a pandemic hospital. COVID-19, age, and coronary artery disease are the most influential factors that affect the aortic diameter, and the COVID-19 was the leading factor.

The Effects of Smoking in Patients in the Intensive Care Unit During the COVID-19 Pandemic.

Objectives: In this study, we aimed to see the effects of smoking prevalence, the length of stay regarding the usage of cigarettes, and the effects on the mortality of COVID-19 in our Intensive Care Unit (ICU). Methods: This is a retrospective single-centered study that was done in the ICU on patients with COVID-19 between 16th of March and 16th of May in 2020. The demographic data, comorbidity status, the units they were accepted from, clinical symptoms, respiratory support, prevalence of smoking, length of stay in the ICU, and mortalities of the patients were recorded. There were two groups: Smoker and non-smoker. There were 1100 COVID-19 patients and 150 of these were treated in ICU unit. 95 patient's data were accessed. Statistical analyses were performed with the Scientific Package for the Social Science (version 21.0; SPSS Inc.). Results: There were 69.4% non-smoker and 35.8% smoker, and 5.3% of the smoker did smoke before (Table 1). The average age of the patients in smoker group was less than nonsmoker. The incidence of chronic obstructive pulmonary disease was higher in smokers (Table 2). The most common symptom was cough and it was 82% in nonsmoker group and 76.5% in smoker group (Table 3). In both groups, respiratory support was provided by IMV (Table 4). There was no relationship between two groups according to age (p=0.044) and gender of patients (p:0.062) (Table 2). The length of ICU stay was 7.6 days for smoking patients in the ICU and 9.3 days for non-users. While the mortality was 52.9% for smokers, it was 39.3% for non-smokers. No statistical correlation was found between smoking status, length of stay in ICU, and survival (Fig. 1). Smoking is blamed among the factors that cause this aggressive process, which can progress to respiratory failure and result in mortality in COVID-19 disease. Conclusion: Some studies also claim that smoking can be protective. There is still no clarity on this issue. It was concluded that smoking has no effect on the duration of ICU stay and mortality in patients treated in the ICU with respiratory failure due to COVID-19 pneumonia.

Favipiravir Experience in COVID-19 Patients at a Tertiary Center Intensive Care Unit.

Objectives: The aim of this study was to compare intensive care unit (ICU) and overall hospital mortality in patients treated with favipiravir and lopinavir-ritonavir for COVID-19. Methods: Data were collected retrospectively between March 10 and May 10, 2020, from patients' records admitted to ICU due to COVID-19. Laboratory data, clinical characteristics, ICU and hospital mortality, ICU and hospital length of stay were compared in patients treated with favipiravir and lopinavir-ritonavir. Results: A total of 100 patients' data were investigated. Favipiravir was used as the treatment for 85% of patients, with the rest treated with lopinavir-ritonavir. Clinical and laboratory data of both antiviral treatment groups were similar. Length of hospital stay was 16 (9-24) days with favipiravir and 8.5 (5-12.5) days with lopinavir-ritonavir (p=0.002). Length of ICU stay for favipiravir and lopinavir-ritonavir groups were 8 (5-15) days and 4 (3-9) days, respectively (p=0.011). ICU mortality was 65.9% for the favipiravir and 80% for lopinavir-ritonavir (p=0.002). Hospital mortality for favipiravir and lopinavir-ritonavir was 67.1% and 80%, respectively (p=0.001). Conclusion: The mortality in patients treated with favipiravir was less than patients treated with lopinavir-ritonavir. Favipiravir needs more attention and trials for its effect to be confirmed.

Treatment with Buttress Plate Technique for Symptomatic Ulnar Styloid Base Nonunion.

Background Surgical treatment options for symptomatic ulnar styloid base nonunion can be divided into two groups: styloid excision and styloid fixation methods. Styloid fixation is commonly performed using tension band wiring or distal ulna hook plate. However, these methods are more suitable for large styloids than small ones. For this reason, fixation of small styloids still remains a problem. Purpose To present the surgical details and results of patients operated using the buttress plate technique, due to the symptomatic ulnar styloid base nonunion. Patients and Methods In this study, 11 patients who underwent surgery for symptomatic ulnar styloid base nonunion using buttress plate technique were evaluated retrospectively. The patients were evaluated with the help of forearm and wrist range of motion, grip strength, disabilities of the arm, shoulder, and hand (DASH) score and visual analogue pain score. Results The mean follow-up period was 15 months (range: 13-21 months). Union was achieved in 10 patients. At the final follow-up, the forearm supination and pronation active range of motions were significantly higher than those in the preoperative period, the visual analogue pain score mean value was 0.7 (range: 0-5), and the DASH score mean value was 7 (range: 1-32). Conclusion We conclude that good results can be achieved with the buttress plate technique in patients with both large and small fragmented ulnar styloid base nonunions and no distal radioulnar joint instability. Level of Evidence This is a Level IV, therapeutic study.

The Effect of Diabetes Mellitus on Mortality in Patients Hospitalized Intensive Care Unit in Covid-19 Pandemic.

Backgorund and aim: There are many studies on the effects of Diabetes Mellitus on the clinical course in COVID-19 patients. Factors that increase the risk of contracting COVID-19 disease and increase disease progression have been caused, and diabetes mellitus is one of them. We aimed to evaluate the incidence of Diabetes Mellitus in patients treated in the intensive care unit in respiratory failure due to COVID-19 pneumonia, and the effect of Diabetes Mellitus on the length of stay in intensive care and mortality. METHODS: Our study is a single-center retrospective study. The study includes patients hospitalized in our COVID intensive care unit between March 16, 2019, and May 16, 2020 Patients over 18 years of age with and without a history of Diabetes Mellitus were compared in 2 groups. Demographic data of the patients, length of stay in the intensive care unit, respiratory support methods, presence of other comorbid diseases, effects of Diabetes Mellitus to mortality in ICU were recorded. RESULTS: The information of 150 patients was obtained in the COVID-19 intensive care units of our hospital. Diabetes Mellitus was detected in 49 of the patients hospitalized in intensive care. 34.7% of these patients were female and 65.3% were male. There was no significant difference in survival in both groups (p = 0.942). The BMI of the patients with Diabetes Mellitus was 27.07 ± 2.55, significantly higher (p = 0.005). Intensive care stay periods were similar in both groups. The presence of hypertension was significantly higher in those with Diabetes Mellitus (p = 0.000). There was no statistically significant difference between respiratory support methods. CONCLUSIONS: Diabetes Mellitus did not affect the duration of stay in the intensive care unit and mortality in patients who were followed up and treated in the intensive care unit due to COVID-19 pneumonia.