Efficacy of Ibuprofen after Total Hip Arthroplasty to Prevent Heterotopic Ossification: Systematic Review and Meta-Analysis / Eficácia do ibuprofeno após artroplastia total de quadril para prevenção de ossificação heterotópica: Revisão sistemática e metanálise

Abstract The objective of this study was to conduct a systematic review and meta-analysis of relevant randomized control trials (RCTs) to determine the role of ibuprofen, as well as the optimum dose and duration of therapy, in preventing the incidence of heterotopic ossification (HO) after primary total hip arthroplasty (THA). A literature search was performed using the PubMed/MEDLINE and Cochrane Library databases for RCTs that compared the use of ibuprofen versus placebo as prophylaxis for HO in patients after THA. The main outcomes for this study were overall occurrence of HO, occurrence according to the Brooker classification, and gastrointestinal complications. A total of 27 potential articles were identified from the database. Eventually, four trials with 1,153 patients were included in the final analysis. When compared with placebo, the use of ibuprofen is associated with a reduction in the incidence of HO at the 3- and 12-month follow-up appointments, as well as the incidence of Brooker II and III HO (p < 0.05). However, there was no significant difference between the ibuprofen and placebo groups in terms of treatment discontinuation due to gastrointestinal complications or the incidence of Brooker I and IV HO (p > 0.05). The existing data indicates that ibuprofen is safe and efficacious in reducing the total incidence of HO along with Brooker II and III HO at follow-up. However, due to the small number of studies, the conclusions are limited; therefore, more high-quality clinical trials are required to develop guidelines for optimal dose and duration of therapy.

Resumo O objetivo deste estudo foi realizar uma revisão sistemática e metanálise de estudos clínicos randomizados (ECRs) relevantes para determinar o papel do ibuprofeno, sua dose ideal, e a duração do tratamento na prevenção de ossificação heterotópica (OH) após a artroplastia total primária do quadril (ATQ). Uma pesquisa bibliográfica foi feita nos bancos de dados PubMed/MEDLINE e Cochrane Library para a obtenção de ECRs quecomparassem ouso de ibuprofeno edeplacebo como profilaxiaparaOHem pacientes submetidos à ATQ. Os principais desfechos deste estudo foram ocorrência geral de OH, classificação de Brooker da OH, e complicações gastrintestinais. No total, 27 artigos foram identificados nos bancos de dados e 4 estudos, com 1.153 pacientes, foram incluídos na análise final. Em comparação ao placebo, o uso de ibuprofeno reduziu a incidência de OH aos 3 e 12 meses de acompanhamento e a incidência de OH Brooker II e III (p < 0,05). No entanto, não houve diferença significativa entre os grupos que receberam ibuprofeno e placebo em termos de interrupção do tratamento devido a complicações gastrintestinais ou da incidência de OH Brooker I e IV (p > 0,05). Os dados existentes indicam que o ibuprofeno é seguro e eficaz na redução da incidência total de OH e de OH Brooker II e III durante o acompanhamento. No entanto, as conclusões são limitadas devido ao pequeno número de estudos; logo, mais estudos clínicos de alta qualidade são necessários para o desenvolvimento de diretrizes em relação à dose e duração ideal da terapia.

The levels of inflammatory biomarkers in hemodialysis and peritoneal dialysis patients.

OBJECTIVE: In this study, we aimed to determine fibroblast growth factor 23, soluble alpha klotho, osteocalcin, indoxyl sulphate, sclerostin, Procollagen 1 N Terminal Propeptide, and beta-CrossLaps levels in hemodialysis and peritoneal dialysis patients, and to compare the levels of these markers among hemodialysis and peritoneal dialysis patients, as well as healthy individuals. METHODS: The study included 30 hemodialysis and 23 peritoneal dialysis patients who were followed-up for at least six months at the Sakarya University Hospital, besides 30 healthy volunteers. RESULTS: The participants were divided into three groups with similar characteristics in terms of age, gender and body mass index. Fibroblast growth factor 23, soluble alpha klotho, indoxyl sulphate, beta-CrossLaps, and Procollagen 1 N Terminal Propeptide levels were significantly higher in patients of both the hemodialysis and peritoneal dialysis groups than in the healthy volunteers' group. There was no difference in levels of these molecules between hemodialysis and peritoneal dialysis groups. CONCLUSIONS: Fibroblast growth factor 23, sclerostin, indoxyl sulphate, beta-CrossLaps, and Paclitaxel-induced neuropathic pain levels were higher in patients of both groups as inflammatory markers. In our study, we found higher soluble alpha klotho levels in patients of both groups than in the healthy volunteers' group, suggesting that blood soluble alpha klotho levels may not correlate with renal klotho levels.

Evaluation of cardiac parameters between survivors and nonsurvivors of COVID-19 patients.

OBJECTIVE: The present study compares the cardiac parameters of the survivor and nonsurvivor patients with COVID-19 infection. METHODS: This study was conducted in 379 patients diagnosed with COVID-19 disease. Information of 21 nonsurvivor and 358 survivor patients with COVID-19 was obtained from the hospital information management system and analyzed retrospectively. Relationship between cardiac parameters in patients categorized into the mortal and immortal groups was investigated. RESULTS: Of the total 379 patients involved in this study, 155 (40.9%) were females and 224 (59.1%) were males. No statistically significant difference in mortality was found between females and males (p=0.249). The total median age was 70, the median age in the nonsurvivor group was 74 (35-89), and it was 69.5 (18-96) in the survivor group (p=0.249). The median values of high-sensitivity troponin (hs-Tn), creatine kinase MB form, and especially myoglobin in the survivor and nonsurvivor groups were 25/64.9 (p=0.028), 18/23 (p=0.02), and 105.5/322.4 (p<0.001), and the difference was statistically significant. Comparing mortality, while there was 1 (0.7%) nonsurvivor out of 134 patients in the service unit, there were 20 (8.2%) nonsurvivors out of 245 patients in the intensive care unit. This difference was statistically significant (p=0.003). The cutoff value of myoglobin, which may pose a risk of mortality, was found to be 191.4 µg/L, while it was 45.7 ng/l for hs-Tn and 60.1 U/L for creatine kinase MB. CONCLUSIONS: Advanced age and increased levels of high-sensitivity troponin, creatine kinase MB, and myoglobin were found to be associated with mortality.

Evaluation of cardiac parameters between survivors and nonsurvivors of COVID-19 patients

SUMMARY OBJECTIVE: The present study compares the cardiac parameters of the survivor and nonsurvivor patients with COVID-19 infection. METHODS: This study was conducted in 379 patients diagnosed with COVID-19 disease. Information of 21 nonsurvivor and 358 survivor patients with COVID-19 was obtained from the hospital information management system and analyzed retrospectively. Relationship between cardiac parameters in patients categorized into the mortal and immortal groups was investigated. RESULTS: Of the total 379 patients involved in this study, 155 (40.9%) were females and 224 (59.1%) were males. No statistically significant difference in mortality was found between females and males (p=0.249). The total median age was 70, the median age in the nonsurvivor group was 74 (35-89), and it was 69.5 (18-96) in the survivor group (p=0.249). The median values of high-sensitivity troponin (hs-Tn), creatine kinase MB form, and especially myoglobin in the survivor and nonsurvivor groups were 25/64.9 (p=0.028), 18/23 (p=0.02), and 105.5/322.4 (p<0.001), and the difference was statistically significant. Comparing mortality, while there was 1 (0.7%) nonsurvivor out of 134 patients in the service unit, there were 20 (8.2%) nonsurvivors out of 245 patients in the intensive care unit. This difference was statistically significant (p=0.003). The cutoff value of myoglobin, which may pose a risk of mortality, was found to be 191.4 µg/L, while it was 45.7 ng/l for hs-Tn and 60.1 U/L for creatine kinase MB. CONCLUSIONS: Advanced age and increased levels of high-sensitivity troponin, creatine kinase MB, and myoglobin were found to be associated with mortality.

Is the COVID-19 disease associated with de novo nephritic syndrome?

INTRODUCTION: This study aims to determine the incidence of de novo nephritic syndrome (NS) in COVID-19 patients and identify its associated factors. METHODS: All ward patients with COVID-19 pneumonia were investigated. After determining the inclusion and exclusion criteria, the study population was identified. The urine dipstick test and urine protein creatinine ratio (UPCR) measurements were performed. Patients with de novo NS findings, nasopharyngeal swab, and urine RT-PCR tests were performed simultaneously. RESULTS: This descriptive cross-sectional study was conducted with 21 patients with COVID-19. The mean age of the patients was 42.2±8.8 years, and 71.4% of them were male. The mean duration of follow-up was 28.4±9.3 days. The urine RT-PCR test was positive in one patient (4.8%). Improvements were observed in hematuria by 71.4%, and proteinuria by 85.7% at the end of the follow-up. A significant decrease in the measured UPCR was found in comparison to the baseline(P=0.000). Also, improvements were recorded in the complete blood counts, inflammatory parameters, ferritin, and coagulation tests, compared to the baseline. There was a positive correlation between baseline UPCR and ferritin, and a negative correlation between baseline UPCR and sodium values. CONCLUSION: COVID-19-induced de novo nephritic syndrome may occur mainly due to tubulointerstitial involvement and often results in spontaneous remission. However, why these findings were not present in all patients who had no comorbidities is not clear.

The effect of abo and rh blood group antigens on admission to intensive care unit and mortality in patients with COVID-19 infection.

AIM: The aim of this study is to analyze the prognostic significance of ABO and Rh blood group antigens along with various parameters in patients followed-up with the diagnosis of COVID-19. METHODS: We evaluated 397 patients who were follow-up and treated due to COVID-19 infections. The ages, genders, chronic diseases, ABO and Rh blood group antigens, admission rates to Intensive Care Units (ICU), and mortality rates of the patients were analyzed. FINDINGS: The mean age of the 397 patients with COVID-19 was 47±17 years. In the blood group analysis of the patients, A Rh-positive (A +) was the most frequently seen blood type (176 patients, 44.3%) followed by O Rh-positive (0 +) (109 patients, 27,5%); 38 patients were Rh negative (Rh -) (9,6%). 53 of the patients (13,4%) were followed in ICU and 29 patients died (7,3%). Neither mortality nor admission to ICU was seen for Rh - group. The comparison of Rh groups concerning the need for ICU admission revealed a significantly high rate of ICU admission in the Rh + group (p=0,011), while no significant relationship was found between mortality and Rh antigen (p=0,069). CONCLUSION: The most frequently seen blood type among COVID-19 patients was A +. The Rh + blood group was found in all cases who were admitted to ICU and had a death outcome. The Rh + blood group was found in a significantly high number of patients who were admitted to ICU, while no significant relationship was found between mortality and Rh blood group.

The effects of favipiravir on hematological parameters of covid-19 patients.

INTRODUCTION: This study aims to evaluate changes in hematological parameters after the follow-up of patients who received treatment with favipiravir due to COVID-19 infections. METHODS: Sixty-two cases receiving favipiravir treatment for at least five days due to COVID-19 infection were evaluated retrospectively. Parameters including age, gender, nasopharyngeal swab positivity, and chronic diseases were analyzed. Hematologic parameters were analyzed before and after the treatment. RESULTS: The mean age of the patients receiving treatment with favipiravir was 63.7±12.3 years. Nasopharyngeal swab positivity was detected in 67.7%. The most common comorbid conditions detected in patients were hypertension in 25 cases (40.3%) and diabetes in 16 cases (25.8%). In the statistical analysis of the hematological parameters before and after treatment with favipiravir, WBC, PT-PTT-INR levels were found to be unaffected; the mean RBC was found to have decreased from 4.33 ± 0.58 M/uL to 4.16 ± 0.54 M/uL (p:0.003); the median hemoglobin level was found to have decreased from 12.3 g/dl to 11.9 g/dl (p:0.041); the hematocrit level decreased from 38.1% ± 4.8 to 36.9% ± 4.2 (p:0.026); the median neutrophil count decreased from 4.57 K/uL to 3.85 K/uL (p:0.001); the mean lymphocyte count increased from 1.22 ± 0.53 K/uL to 1.84 ± 1.19 K/uL (p:0.000); and the mean platelet count increased from 244.1 ± 85.1 K/uL to 281.9 ± 103.3 K/uL (p:0.005). CONCLUSION: We concluded that the pathological effect of treatment with favipiravir on the hematologic system was the suppression in the erythrocyte series, and there were no adverse effects in other hematologic parameters.

Is the COVID-19 disease associated with de novo nephritic syndrome?

SUMMARY INTRODUCTION: This study aims to determine the incidence of de novo nephritic syndrome (NS) in COVID-19 patients and identify its associated factors. METHODS: All ward patients with COVID-19 pneumonia were investigated. After determining the inclusion and exclusion criteria, the study population was identified. The urine dipstick test and urine protein creatinine ratio (UPCR) measurements were performed. Patients with de novo NS findings, nasopharyngeal swab, and urine RT-PCR tests were performed simultaneously RESULTS: This descriptive cross-sectional study was conducted with 21 patients with COVID-19. The mean age of the patients was 42.2±8.8 years, and 71.4% of them were male. The mean duration of follow-up was 28.4±9.3 days. The urine RT-PCR test was positive in one patient (4.8%). Improvements were observed in hematuria by 71.4%, and proteinuria by 85.7% at the end of the follow-up. A significant decrease in the measured UPCR was found in comparison to the baseline(P=0.000). Also, improvements were recorded in the complete blood counts, inflammatory parameters, ferritin, and coagulation tests, compared to the baseline. There was a positive correlation between baseline UPCR and ferritin, and a negative correlation between baseline UPCR and sodium values CONCLUSION: COVID-19-induced de novo nephritic syndrome may occur mainly due to tubulointerstitial involvement and often results in spontaneous remission. However, why these findings were not present in all patients who had no comorbidities is not clear.

RESUMO INTRODUÇÃO: Este estudo tem como objetivo determinar a incidência da síndrome nefrítica de novo (SN) em pacientes com COVID-19 e identificar os fatores associados. MÉTODOS: Todos os pacientes da enfermaria com pneumonia por COVID-19 foram investigados. Após a determinação dos critérios de inclusão e exclusão, a população do estudo foi identificada. Foram realizadas medições do teste da vareta da urina e da razão da creatinina das proteínas na urina (UPCR). RESULTADOS: Este estudo transversal descritivo foi realizado com 21 pacientes com COVID-19. A idade média dos pacientes foi de 42,2±8,8 anos e 71,4% dos pacientes eram do sexo masculino. A duração média do seguimento foi de 28,4±9,3 dias. O teste de RT-PCR na urina foi positivo em um paciente (4,8%). Houve melhorias observadas na hematúria em 71,4% e na proteinúria em 85,7% no final do acompanhamento. E uma diminuição significativa na UPCR medida em comparação à linha de base (p=0,000). Além disso, foram registradas melhorias nas contagens sanguíneas completas, nos parâmetros inflamatórios, nos testes de ferritina e de coagulação, comparados aos valores basais. Houve correlação positiva entre UPCR basal e ferritina, e correlação negativa entre os valores basais de UPCR e sódio. CONCLUSÃO: A síndrome nefrítica de novo induzida por COVID-19 pode ocorrer principalmente devido ao envolvimento túbulo-intersticial e frequentemente resulta em remissão espontânea. No entanto, a questão de por que esses achados não se apresentaram em todos os pacientes que não apresentavam condição comórbida não é clara.

The effects of favipiravir on hematological parameters of covid-19 patients

SUMMARY INTRODUCTION This study aims to evaluate changes in hematological parameters after the follow-up of patients who received treatment with favipiravir due to COVID-19 infections. METHODS Sixty-two cases receiving favipiravir treatment for at least five days due to COVID-19 infection were evaluated retrospectively. Parameters including age, gender, nasopharyngeal swab positivity, and chronic diseases were analyzed. Hematologic parameters were analyzed before and after the treatment. RESULTS The mean age of the patients receiving treatment with favipiravir was 63.7±12.3 years. Nasopharyngeal swab positivity was detected in 67.7%. The most common comorbid conditions detected in patients were hypertension in 25 cases (40.3%) and diabetes in 16 cases (25.8%). In the statistical analysis of the hematological parameters before and after treatment with favipiravir, WBC, PT-PTT-INR levels were found to be unaffected; the mean RBC was found to have decreased from 4.33 ± 0.58 M/uL to 4.16 ± 0.54 M/uL (p:0.003); the median hemoglobin level was found to have decreased from 12.3 g/dl to 11.9 g/dl (p:0.041); the hematocrit level decreased from 38.1% ± 4.8 to 36.9% ± 4.2 (p:0.026); the median neutrophil count decreased from 4.57 K/uL to 3.85 K/uL (p:0.001); the mean lymphocyte count increased from 1.22 ± 0.53 K/uL to 1.84 ± 1.19 K/uL (p:0.000); and the mean platelet count increased from 244.1 ± 85.1 K/uL to 281.9 ± 103.3 K/uL (p:0.005). CONCLUSION We concluded that the pathological effect of treatment with favipiravir on the hematologic system was the suppression in the erythrocyte series, and there were no adverse effects in other hematologic parameters.

RESUMO INTRODUÇÃO Este estudo tem como objetivo avaliar as alterações nos parâmetros hematológicos após o acompanhamento de pacientes que receberam tratamento com favipiravir devido à infecção por Covid-19. MÉTODOS Sessenta e dois casos em tratamento com favipiravir por pelo menos cinco dias devido à infecção por Covid-19 foram avaliados retrospectivamente. Parâmetros como idade, sexo, positividade do swab nasofaríngeo e doenças crônicas foram analisados. Os parâmetros hematológicos foram analisados antes e após o tratamento. RESULTADOS A idade média dos pacientes que receberam tratamento com favipiravir foi de 63,7±12,3 anos. A positividade do swab nasofaríngeo foi detectada em 67,7%. As condições comórbidas mais comuns detectadas nos pacientes foram hipertensão em 25 casos (40,3%) e diabetes em 16 casos (25,8%). Na análise estatística dos parâmetros hematológicos antes e após o tratamento com favipiravir, os níveis de leucócitos, PT-PTT-INR não foram afetados. Verificou-se que o RBC médio diminuiu de 4,33±0,58 M/uL para 4,16±0,54 M/uL (p=0,003); o nível médio de hemoglobina foi reduzido de 12,3 g/dl para 11,9 g/dl (p=0,041); o nível de hematócrito diminuiu de 38,1%±4,8 para 36,9%±4,2 (p=0,026); a contagem mediana de neutrófilos diminuiu de 4,57 K/uL para 3,85 K/uL (p=0,001); a contagem média de linfócitos aumentou de 1,22±0,53 K/uL para 1,84±1,19 K/uL (p=0,000); a contagem média de plaquetas aumentou de 244,1±85,1 K/uL para 281,9±103,3 K/uL (p=0,005). CONCLUSÃO Concluiu-se que o efeito patológico do tratamento com favipiravir no sistema hematológico foi a supressão na série eritrocitária e que não houve efeitos adversos em outros parâmetros hematológicos.

The effect of abo and rh blood group antigens on admission to intensive care unit and mortality in patients with COVID-19 infection

SUMMARY AIM The aim of this study is to analyze the prognostic significance of ABO and Rh blood group antigens along with various parameters in patients followed-up with the diagnosis of COVID-19. METHODS We evaluated 397 patients who were follow-up and treated due to COVID-19 infections. The ages, genders, chronic diseases, ABO and Rh blood group antigens, admission rates to Intensive Care Units (ICU), and mortality rates of the patients were analyzed. FINDINGS The mean age of the 397 patients with COVID-19 was 47±17 years. In the blood group analysis of the patients, A Rh-positive (A +) was the most frequently seen blood type (176 patients, 44.3%) followed by O Rh-positive (0 +) (109 patients, 27,5%); 38 patients were Rh negative (Rh -) (9,6%). 53 of the patients (13,4%) were followed in ICU and 29 patients died (7,3%). Neither mortality nor admission to ICU was seen for Rh - group. The comparison of Rh groups concerning the need for ICU admission revealed a significantly high rate of ICU admission in the Rh + group (p=0,011), while no significant relationship was found between mortality and Rh antigen (p=0,069). CONCLUSION The most frequently seen blood type among COVID-19 patients was A +. The Rh + blood group was found in all cases who were admitted to ICU and had a death outcome. The Rh + blood group was found in a significantly high number of patients who were admitted to ICU, while no significant relationship was found between mortality and Rh blood group.

RESUMO OBJETIVO O objetivo deste estudo é analisar o significado prognóstico dos antígenos do grupo sanguíneo ABO e Rh, juntamente com vários parâmetros em pacientes acompanhados com o diagnóstico de COVID-19. MÉTODOS Foram avaliados 397 pacientes que foram acompanhados e tratados devido à infecção por COVID-19. Foram analisadas as idades, gêneros, doenças crônicas, antígenos do grupo sanguíneo ABO e Rh, taxas de internação em unidades de terapia intensiva (UTI) e taxas de mortalidade dos pacientes. A idade média de 397 pacientes com COVID foi de 47 ± 17 anos. Na análise do grupo sanguíneo dos pacientes, A Rh positivo (A +) foi o tipo sanguíneo mais frequentemente observado (176 dos pacientes, 44,3%), seguido pelo O Rh positivo (0 +) (109 dos pacientes, 27,5%) 38 dos pacientes eram Rh negativos (Rh -) (9,6%). 53 dos pacientes (13,4%) foram acompanhados em UTI e 29 faleceram (7,3%). Não houve mortalidade nem admissão na UTI para o grupo Rh. A comparação dos grupos Rh quanto à necessidade de admissão na UTI revelou uma taxa significativamente alta de admissão na UTI no grupo Rh + (p = 0,011), enquanto não foi encontrada relação significativa entre mortalidade e antígeno Rh (p = 0,069). CONCLUSÃO O tipo sanguíneo mais frequentemente observado foi o A + entre os pacientes com COVID-19. O grupo sanguíneo Rh + foi encontrado em todos os casos admitidos na UTI e com evolução mortal. O grupo sanguíneo Rh + foi encontrado em um número significativamente alto de pacientes internados na UTI, enquanto nenhuma relação significativa foi encontrada entre a mortalidade e o grupo sanguíneo Rh.

Morphogenesis of Kidney in Crossbred Pig (Sus scrofa) Foetii / Morfogénesis del Riñon en Fetos de Cerdos Híbridos (Sus scrofa)

Twenty five numbers of crossbred pig foetii were selected based on their crown-rump length and subsequently divided into 5 age groups consisting of 5 animals in each group viz. group I (41-55 days), group II (56-70 days), group III (71-85 days), group IV (86-100 days) and groupV (101-114 days). No renal pelvis was evident in group I in all the kidneys under study. From group II onwards, the renal pelvis was distinct and extensive with a well developed ureter that originated from the middle of the pelvis in both the kidneys.

Se selecionaron 25 fetos de cerdos híbridos basándose en la longitud céfalocaudal y luego fueron separados en 5 grupos etarios de 5 animales cada uno: Grupo I (41-55 días), grupo II (56-70 días), grupo III (71-85 días), grupo IV (86-100 días) y grupo V (101-114 días). No se encontraron pelvis renales en el grupo I, en ninguno de los ríñones en estudio. Desde el grupo II en adelante, la pelvis renal era claramente visible y grande, con un uréter bien desarrollado, que se originaba desde el centro de la pelvis, en ambos ríñones.