Association of tramadol use with risk of hip fractures in patients with osteoarthritis: A systematic review and meta-analysis of observational studies.

OBJECTIVE: Many studies have reported conflicting results for the use of tramadol with the risk of fractures, especially hip fractures. This systematic review and meta-analysis study aimed to evaluate the association of tramadol use versus codeine use with the risk of hip fracture for the first time. METHODS: PubMed, Scopus, Google Scholar, and Web of Science databases were searched with specific keywords to find studies that examined the association of tramadol use with hip fracture risk in patients with osteoarthritis up to May 2023. The risk of hip fracture secondary to tramadol versus codeine use was estimated based on age and sex. This systematic review was conducted based on the PRISMA checklist. Heterogeneity between studies was evaluated using Cochran's Q and I2 tests. Egger's test was used to check publication bias. The Newcastle-Ottawa Checklist (NOS) was used to assess the quality of the studies. FINDINGS: Ten studies with 1,939,293 participants were reviewed. The majority of participants were female. Based on the study evaluation checklist, most studies were of good quality. Tramadol use significantly increases the overall risk of hip fracture. (HR: 1.32, 95% CI: 1.14, 1.51, P: 0.001, I2:19.3%) Tramadol use significantly increases the risk of hip fracture in men (HR: 1.48, 95% CI: 1.24, 1.73, P: 0.001 I2:35%) and age ≤65 years (HR: 1.63, 95% CI: 1.45, 1.80, P: 0.001, I2:0%). CONCLUSION: The use of tramadol significantly increases the risk of hip fracture. This increased risk of hip fracture was greater in males younger than 65 years.

Diagnostic test accuracy of machine learning algorithms for the detection intracranial hemorrhage: a systematic review and meta-analysis study.

BACKGROUND: This systematic review and meta-analysis were conducted to objectively evaluate the evidence of machine learning (ML) in the patient diagnosis of Intracranial Hemorrhage (ICH) on computed tomography (CT) scans. METHODS: Until May 2023, systematic searches were conducted in ISI Web of Science, PubMed, Scopus, Cochrane Library, IEEE Xplore Digital Library, CINAHL, Science Direct, PROSPERO, and EMBASE for studies that evaluated the diagnostic precision of ML model-assisted ICH detection. Patients with and without ICH as the target condition who were receiving CT-Scan were eligible for the research, which used ML algorithms based on radiologists' reports as the gold reference standard. For meta-analysis, pooled sensitivities, specificities, and a summary receiver operating characteristics curve (SROC) were used. RESULTS: At last, after screening the title, abstract, and full paper, twenty-six retrospective and three prospective, and two retrospective/prospective studies were included. The overall (Diagnostic Test Accuracy) DTA of retrospective studies with a pooled sensitivity was 0.917 (95% CI 0.88-0.943, I2 = 99%). The pooled specificity was 0.945 (95% CI 0.918-0.964, I2 = 100%). The pooled diagnostic odds ratio (DOR) was 219.47 (95% CI 104.78-459.66, I2 = 100%). These results were significant for the specificity of the different network architecture models (p-value = 0.0289). However, the results for sensitivity (p-value = 0.6417) and DOR (p-value = 0.2187) were not significant. The ResNet algorithm has higher pooled specificity than other algorithms with 0.935 (95% CI 0.854-0.973, I2 = 93%). CONCLUSION: This meta-analysis on DTA of ML algorithms for detecting ICH by assessing non-contrast CT-Scans shows the ML has an acceptable performance in diagnosing ICH. Using ResNet in ICH detection remains promising prediction was improved via training in an Architecture Learning Network (ALN).

Impaction Grafting Is Sufficient to Address Acetabular Deficiency During Total Hip Arthroplasty of Most Dysplastic Hips With Over 30% Bone Defect.

BACKGROUND: Addressing acetabular deficiency during arthroplasty of dysplastic hips is challenging. We assessed outcomes of a protocol for choosing either impaction or structural graft for this purpose. METHODS: This retrospective study included 59 patients (71 hips) with a dysplastic hip and over 30% uncoverage that underwent cementless total hip arthroplasty. Morselized impaction grafting was performed for hips where initial stability of the acetabular cup was achieved. In others, a shelf graft was inserted before implantation of the acetabular cup. Outcomes were assessed at a minimum follow-up of 4 years. RESULTS: Fifty-seven (80.3%) hips underwent impaction grafting and 14 (19.7%) received a structural graft. Mean age at surgery was 48.1 ± 13.5 (18-68) years for impaction and 48.6 ± 14 (24-70) years for shelf grafts. Mean increase in Harris Hip Score was 51.5 ± 9.3 and 50 ± 11.2 for the impaction and structural groups, respectively, at a mean follow-up of 92 (49-136) months (P = .6). Heterotopic ossification occurred in 16 patients in the impaction group vs none in the structural group (P = .004). Radiologically, mean percentages of cup coverage provided by the graft were 47.8 ± 10.9% and 48.9 ± 13.3% in the impaction and structural groups, respectively (P = .75). All but one of shelf grafts united to host bone and all impaction grafts incorporated. There was one case of cup loosening in the structural graft group. CONCLUSION: Most dysplastic acetabula with over 30% defect can be addressed using a cementless cup and impaction grafting, with good results in the midterm. In about 20% of cases, initial press-fit is not attainable and structural support-like shelf graft becomes necessary. LEVEL OF EVIDENCE: IV.

Serum Level of Galectin-3 in Early Detection of Acute Pancreatitis.

BACKGROUND Acute pancreatitis (AP) is a common cause of hospital admissions. Diagnosing AP in patients presenting to emergency departments remains a challenge for physicians. Thus, we aimed to evaluate the diagnostic accuracy of galectin-3 to find a new and effective method for detecting AP. METHODS In this prospective cross-sectional study, 43 patients with a manifestation of AP were enrolled. The serum levels of galectin-3 were measured at admission and 48 hours later and compared between the groups of patients with and without AP. RESULTS Serum levels of galectin-3 at admission and after 48 hours were significantly higher in AP cases compared with non-AP individuals. The area under the curve (AUC) for galectin-3 was 73.1%, which revealed a good accuracy in predicting the AP diagnosis. CONCLUSION Serum levels of galectin-3 at admission and after 48 hours were significantly higher in AP cases, and their diagnostic value was acceptable in the detection of AP.

The Diagnostic Value of Neuron-Specific Enolase in Children with Mild Blunt Trauma Requiring Cranial CT Scan.

BACKGROUND: The present study was conducted to investigate the relationship between serum levels of enolase and pathological findings obtained from CT scans of the brain in children with mild blunt brain trauma and help with a more accurate diagnosis of brain injuries. METHODS: The present observational study was conducted on children presenting with head traumas to the emergency department (ED) of Golestan Hospital in Ahvaz, Iran in 2016. A venous blood sample was immediately taken by the ward nurse from all the eligible patients within 6 hrs of the incident after obtaining their information, performing initial examinations and their initial stabilization. Laboratory serum levels and the corresponding interpretations of CT scans of the brain were collected, recorded and then evaluated and analyzed. RESULTS: A total of 62 children with mild blunt brain trauma were included in the study. A significant difference was observed between the positive CT scan group (2.7±9.74 µg/L) and the negative group (4.23±1.33 µg/L) in terms of serum levels of enolase (P<0.0001). The area under the receiver operating characteristic (ROC) curve was 0.992 for serum levels of enolase in diagnosing brain lesions caused by mild head traumas. Moreover, with a cut-off point of 6.97 µg/L, brain lesions could be detected with a sensitivity of 93.55% and a specificity of 100%. CONCLUSION: Serum levels of enolase were found to be higher in patients with brain injuries. This highly accurate diagnostic biomarker can be recommended for estimating the presence of brain lesions associated with mild head traumas in infants.

Characteristics of S100B and Neuron Specific Enolase in Differentiating Acute Vertigo Cases with Central Cause; a Diagnostic Accuracy Study.

INTRODUCTION: Differentiating central vertigo from peripheral ones poses a challenge to specialists. The present study aimed to examine the potential screening value of S100B and neuron-specific enolase (NSE) in this regard. METHODS: This prospective cross-sectional study recruited adult acute vertigo patients with suspected central causes visiting the emergency department (ED) in the first six hours since the onset of symptoms. The screening performance characteristics of S100B and NSE biomarkers in differentiating central vertigo cases were measured considering brain magnetic resonance imaging (MRI) as the reference test. RESULTS: 85 cases who met the criteria were enrolled to the study (82.3% female). The MRI of 21 (24.7%) cases had abnormal findings. The two groups were the same in terms of age, sex, and vital signs. Patients with abnormal brain MRI had significantly higher levels of S100B (p < 0.001) and NSE (p < 0.001). S100B and NSE had area under the receiver operating characteristic (ROC) curve of 90.3 (95% CI: 80.7 - 99.8) and 96.9 (95% CI: 93.7 - 100.0) in differentiating the central causes of acute vertigo, respectively. At the cut-off point of above 119.68 pg/l, S100b had sensitivity of 90.00% (95% CI: 78.83 -95.86) and specificity of 92.00% (95% CI: 72.49 - 98.60). The sensitivity and specificity of NSE at the cut-off point of above 18.12 ng/ml were 100.00% (95% CI: 93.14 - 100.00) and 89.47% (95% CI: 65.46 - 98.15), respectively. CONCLUSION: The serum levels of S100B and NSE were significantly higher in patients with central vertigo, and could therefore be considered as accurate tools in screening acute vertigo cases with central causes in ED.

Comparing intranasal ketamine with intravenous fentanyl in reducing pain in patients with renal colic: A double-blind randomized clinical trial.

BACKGROUND: Kidney stones are a fairly common problem that manifests itself as symptoms of acute abdominal and flank pains in patients presenting to emergency departments. OBJECTIVE: The present study was conducted to compare the analgesic effect of intravenous fentanyl with that of intranasal ketamine in renal colic patients. METHODS: One mg/kg of intranasal ketamine was administered in the first group, and one µg/kg of intravenous fentanyl in the second group. The pain severity was measured in the patients in terms of a visual analogue scale (VAS) score at the beginning of the study and at minutes 5, 15 and 30, and the medication side-effects were evaluated and recorded. RESULTS: A total of 130 patients were ultimately assessed in two groups of 65. In the ketamine group, the mean severity of pain was 8.72 ±â€¯1.52 at the beginning of the study (P < 0.001), 5.5 ±â€¯2.97 at minute 5 (P < 0.001), 3.38 ±â€¯3.35 at minute 15 (P = 0.004) and 2.53 ±â€¯3.41 at minute 30 (P = 0.449). In the fentanyl group, this severity was 9.66 ±â€¯88.8 in the beginning of the study (P < 0.001), 7.27 ±â€¯1.37 at minute 5 (P < 0.001), 4.61 ±â€¯1.5 at minute 15 (P = 0.004) and 1.24 ±â€¯1.25 at minute 30 (P = 0.449). The general prevalence of the medication side-effects was 10 (15.4%) in the ketamine group and 1 (1.5%) in the fentanyl group (P = 0.009). CONCLUSIONS: Ketamine was found to be less effective than fentanyl in controlling renal colic-induced pain, and to be associated with a higher prevalence of side-effects; nevertheless, ketamine can be effective in controlling this pain in conjunction with other medications.

Comparing Intradermal Sterile Water with Intravenous Morphine in Reducing Pain in Patients with Renal Colic: A Double-Blind Randomized Clinical Trial.

OBJECTIVE: The present study was conducted to investigate the effect of intradermal administration of sterile water compared to intravenous morphine on patients with renal colic. METHODS: This double-blind, randomized clinical trial study was conducted in 2017 to compare the therapeutic effects of intradermal sterile water with those of intravenous morphine on patients with renal colic presenting to the emergency departments (ED) of Imam Khomeini and Golestan Hospitals in Ahvaz, Iran. The first group received 0.5 ml of intradermal sterile water, and the second group 0.1mg/kg of intravenous morphine plus 0.5 ml of intradermal sterile water in the most painful area or the center of the painful area in the flank. The pain severity was measured using a visual analogue scale (VAS), and the medication side-effects were recorded at the beginning of the study and minutes 15, 30,45 and 60. RESULTS: A total of 94 patients were studied in two groups. The mean severity of pain was 2.97 ± 1.51 in the sterile water group and 2.34 ± 1.89 in the morphine group at minute 30 (P=0.042), 2.58 ± 1.43 in the sterile water group and 1 ± 1.23 in the morphine group at minute 45 (P<0.001), and 1.89 ± 1.7 in the sterile water group and 0.52 ± 0.79 in the morphine group at minute 60 (P<0.001). CONCLUSION: Morphine reduces pain faster and more effectively than intradermal sterile water; nevertheless, treatment with intradermal sterile water can be used as an appropriate surrogate or adjunct therapy for pain control, particularly in special patients or in case of medication scarcity.

Intravenous Tranexamic Acid for Brain Contusion with Intraparenchymal Hemorrhage: Randomized, Double-Blind, Placebo-Controlled Trial.

INTRODUCTION: Controlling of secondary traumatic brain injuries (TBI) is necessary due to its salient effect on the improvement of patients with TBI and the final outcomes within early hours of trauma onset. This study aims to investigate the effect of intravenous tranexamic acid (TAX) administration on decreased hemorrhage during surgery. METHODS: This double-blind, randomized, and placebo-controlled trial was conducted on patients referring to the emergency department (ED) with IPH due to brain contusion within 8 h of injury onset. The patients were evaluated by receiving TXA and 0.9% normal saline as a placebo. The following evaluation and estimations were performed: intracranial hemorrhage volume after surgery using brain CT-scan; hemoglobin (Hb) volume before, immediately after, and six hours after surgery; and the severity of TBI based on Glasgow Coma Score (GCS). RESULTS: 40 patients with 55.02 ± 18.64 years old diagnosed with a contusion and intraparenchymal hemorrhage. Although the (Mean ± SD) hemorrhage during surgery in patients receiving TXA (784.21 ± 304.162) was lower than the placebo group (805.26 ± 300.876), no significant difference was observed between two groups (P=0.83). The (Mean ± SD) Hb volume reduction immediately during surgery (0.07 ± 0.001 and 0.23 ± 0.02) and six hours after surgery (0.04 ± 0.008 and 0.12 ± 0.006) was also lower in TXA group but had no significant difference (P = 0.89 and P = 0.97, respectively). CONCLUSION: Using TXA may reduce the hemorrhage in patients with TBI, but this effect, as in this study, was not statistically significant and it is suggested that a clinical trial with a larger population is employed for further investigation.

Efficacy of nebulized fentanyl and low dose ketamine for pain control of patients with long bone fractures: A randomized, double-blind, clinical trial.

INTRODUCTION: Fentanyl is a lipid soluble, highly potent opioid. The lipid solubility of fentanyl makes it an ideal opioid to be administrated by inhalation. The current study compared ketamine infusion and nebulized fentanyl in bone fracture pain relief. METHODS: In this double-blind, randomized clinical trial, patients aged 18 to 55 years who were admitted to the emergency department (ED) with limb fracture were recruited. A total of 127 patients were included in the study, 51.1% (65) of whom were male and 48.9% (62) of whom were female. The patients were divided equally into two groups: Group I received 100 cm3 IV infusion of normal saline and 4 µg/kg of 50 µg/ml nebulized fentanyl; Group II received 0.4 mg/kg ketamine in 10 min and 5 cm3 nebulized normal saline. Pain was assessed using a visual analog scale just before treatment and 5, 10, 15, 30, and 60 min post-treatment. RESULTS: Before intervention, the pain scores of both groups showed no significant difference. However, log linear analysis in both groups showed a significantly decrement during the follow up (60 min) (p < 0.0001). Multiple comparison analysis showed that pain scores were significantly higher in the patients of Group I. Moreover, patients in Group I required additional treatment. CONCLUSION: Ketamine can be used as an alternative non-invasive treatment to successfully relieve pain in patients with limb fractures.

Percutaneous Versus Open Hamstring Lengthening in Spastic Diplegic Cerebral Palsy.

BACKGROUND: Open hamstring lengthening (oHSL) is commonly performed to decrease knee contracture and improve gait and posture for children with spastic diplegia. Furthermore, percutaneous hamstring lengthening (pHSL) is also gaining popularity as an alternative to the open approach. This study aimed to compare the results of pHSL versus oHSL and to determine the efficacy and safety of the percutaneous approach. METHODS: This retrospective included 54 patients (108 knees) with spastic diplegia operated for flexed knee gait with either open or percutaneous HSL. The mean age of the participants at the time of surgery was 10.3±1.7 years (age range: 5-25 years) for the open and 8.5±1.5 years (age range: 7-23 years) for the percutaneous group. Overall, 29 and 25 children were subjected to oHSL and pHSL, respectively. RESULTS: The mean durations of follow-up were 19.1 months (range: 12-49 months) and 18.3 months (range: 14-45 months) for oHSL and pHSL groups, respectively. In the open group, the mean of preoperative popliteal angle decreased from 64.3±3.6 to 28.4±4.3 (P<0.001), and in the percutaneous group from 63.8±2.7 to 29.5±2.3 (P<0.001). The obtained results revealed no significant differences between the two approaches leading to a similar improvement among the investigated patients (P=0.83). Although the Gross Motor Function Class Score improved significantly within each group (P<0.001); this improvement was insignificant between the groups (P=0.88). The mean of hospital stay for the percutaneous group was 1.6 days (range:1-3 days) compared to 3.6 days (range: 2-6 days) for the open group, which indicated a significant difference (P=0.001). The mean values of total cost were $333 and $473 in the percutaneous group and open group (P=0.001), respectively. There was no significant difference between the groups regarding the complication rate (P=0.85). CONCLUSION: Percutaneous HSL is a safe, easy, rapid, and brief procedure that is as effective as the open technique for children with spastic diplegia in a short period of time. However, it is essential to examine the effects of this approach during longer follow-ups to generalize the findings of the current study.

Intravenous Tranexamic Acid for Subdural and Epidural Intracranial Hemorrhage: Randomized, Double-Blind, Placebo-Controlled Trial.

BACKGROUND: Recovery of patients with traumatic brain injury largely depends on the reduction in secondary brain damage. The present study aims at investigating the effect of Tranexamic Acid (TXA) administration within the first hours of brain trauma in the emergency department (ED). METHODS: This randomized, double-blind, placebo-controlled clinical trial was carried out in patients with subdural and epidural hemorrhage. Patients with any type of bleeding were assigned into two groups of TXA and 0.9% normal saline as placebo. The rate of intracranial hemorrhage after surgery was assessed by CT-scan and amount of hemoglobin (Hb) was measured immediately before surgery and after 6 hours of surgery. RESULTS: A total of 80 participants were randomly assigned into four groups of 20 people. There was a significant difference in the mean of intraoperative bleeding during surgery in patients receiving TXA and placebo in both SDH (Subdural hematoma) and EDH (Epidural Hemorrhage) groups (P= 0.012). The Hb drop amount had no significant difference with placebo (P< 0.0001). No complications were observed in any of the intervention and control groups during the study as well. CONCLUSION: The use of TXA may reduce bleeding, however, based on the results of this study, such effect was not statistically significant in controlling the epidural and subdural hemorrhage, but clinical trials with a higher sample size are suggested for further investigation in this regard.

Plant genetic resources for food and agriculture: opportunities and challenges emerging from the science and information technology revolution.

Contents Summary 1407 I. Introduction 1408 II. Technological advances and their utility for gene banks and breeding, and longer-term contributions to SDGs 1408 III. The challenges that must be overcome to realise emerging R&D opportunities 1410 IV. Renewed governance structures for PGR (and related big data) 1413 V. Access and benefit sharing and big data 1416 VI. Conclusion 1417 Acknowledgements 1417 ORCID 1417 References 1417 SUMMARY: Over the last decade, there has been an ongoing revolution in the exploration, manipulation and synthesis of biological systems, through the development of new technologies that generate, analyse and exploit big data. Users of Plant Genetic Resources (PGR) can potentially leverage these capacities to significantly increase the efficiency and effectiveness of their efforts to conserve, discover and utilise novel qualities in PGR, and help achieve the Sustainable Development Goals (SDGs). This review advances the discussion on these emerging opportunities and discusses how taking advantage of them will require data integration and synthesis across disciplinary, organisational and international boundaries, and the formation of multi-disciplinary, international partnerships. We explore some of the institutional and policy challenges that these efforts will face, particularly how these new technologies may influence the structure and role of research for sustainable development, ownership of resources, and access and benefit sharing. We discuss potential responses to political and institutional challenges, ranging from options for enhanced structure and governance of research discovery platforms to internationally brokered benefit-sharing agreements, and identify a set of broad principles that could guide the global community as it seeks or considers solutions.

Sublingual Buprenorphine Efficacy in Renal Colic Pain Relief: A Randomized Placebo-Controlled Clinical Trial.

INTRODUCTION: This study was designed to compare the analgesic efficacy of sublingual (SL) buprenorphine and intravenous (IV) ketorolac for renal colic pain relief. METHODS: The present study was carried out as a double-blind, double-dummy randomized clinical trial in patients diagnosed with acute renal colic attending the emergency department. The study subjects were 63 patients with confirmed renal stones. The subjects were randomly divided into two groups. One group, which included 32 patients, received SL buprenorphine tablets (2 mg) with an IV placebo, and another group, including 31 patients, received ketorolac tromethamine (30 mg) with a SL placebo. After medication, the pain of subjects was measured by a standard visual pain analogous scale (VPAS) in minutes 0, 20, 40, and 60 of study. Also, probable adverse effects were recorded. RESULTS: In 28.1% of patients in the buprenorphine group, the mean pain score decreased from 9.2 to 5.9, 2.8, and 1.5 after 20, 40, and 60 min, respectively, as determined by VPAS. Also, in 38.7% of patients in the ketorolac group, the mean pain score decreased from 9.1 to 5.5, 3.0, and 1.6 after 20, 40, and 60 min, respectively, as determined by VPAS. The two groups did not significantly differ for pain reduction at 20, 40, and 60 min (P value = 0.16, 0.34, and 0.3, respectively). No adverse effects were seen in the ketorolac group, but vomiting (18.8%), nausea (18.8%), and dizziness (21.9%) were detected in the buprenorphine group. CONCLUSIONS: We found no difference between SL buprenorphine and intravenous ketorolac in renal colic pain relief but more adverse effects in the buprenorphine group. Trial Registration Iranian Registry of Clinical trials identifier, IRCT2015041421773N1.

Evaluation of emergency medical technicians intermediate prediction about their transported patients final disposition in emergency department of Imam Khomeini Hospital.

This was a prospective cross-sectional study of consecutive transported patients by emergency medical service (EMS) to a referral hospital. The goal of this study was the evaluation of emergency medical technician intermediate prediction about their transported patients disposition in Emergency Department of Imam Khomeini Hospital. 2950 patients were transported to this hospital, Questionnaires were submitted in 300 of consecutive patient transports and completed data were obtained and available upon arrival at hospital for 267 of these cases. Emergency medical technicians intermediate (EMT-I) were asked to predict whether the transported patient would require admission to the hospital, and if so, what will be their prediction of patient actual disposition. Their predictions were compared with emergency specialist physicians. EMT-I predicted that 208 (78%) transports would lead to admission to the hospital, after actual disposition, 232 (%87) patients became admitted. The sensitivity of predicting any admission was 65%, with positive predictive value (PPV) of 39% and specificity of 86% with negative predictive value (NPV) of 94%. The sensitivity of predicting trauma patients (56.2% of total patients) was 55% with PPV of 38%, specificity of 86% and for Non-trauma patients' sensitivity was 80% with PPV of 40% and specificity of 82%. EMT-I in our emergency medical system have very limited ability in prediction of admission and disposition in transported patients and their prediction were better in Non-trauma patients. So in our EMS, the pre-hospital diversion and necessity of transporting policies should not be based on EMS personnel disposition.