Mapping of Dietary Interventions Beneficial in the Prevention of Secondary Health Conditions in Spinal Cord Injured Population: A Systematic Review.

OBJECTIVES: Individuals with spinal cord injury are at risk of secondary health conditions (SHC) that develop as a consequence of autonomic dysfunction, prolonged oxidative stress and inflammation, and physical inactivity coupled with inadequate energy and nutritional intake. SHC can be debilitating and even life-threatening, and its prevention remains one of the major challenges in the continuum of medical care of aging SCI population. An unhealthy diet is a major driver of inflammation, oxidative stress, and unfavourable metabolic status and may be a practical preventive target to tackle increased SHC risk post-injury. AIMS: To provide a catalogue of dietary interventions beneficial in prevention of SHC among individuals with SCI by conducting a systematic review of the literature on dietary interventions and dietary supplementation in promoting health and well-being after the injury. In addition, we aimed to provide a summary of observational studies exploring the association between habitual diet (macro- and micronutrients intake and dietary patterns) and health patterns following the injury. METHOD: This review was registered at PROSPERO (University of York) with registration number CRD42022373773. Four medical databases (EMBASE.com, MEDLINE [Ovid], Cochrane CENTRAL, and Web of Science Core Collection) and Google Scholar were searched from inception until 11th July 2022. Studies were included if they were clinical trials or observational studies conducted in adult individuals with SCI and provided information of interest. Based on strength of the study design and risk of bias assessment (using the NIH tool), we classified studies from Level 1 (most reliable studies) to Level 4 (least reliable studies). RESULTS: Of 12,313 unique citations, 47 articles (based on 43 original studies) comprising 32 interventional (22 RCTs, 3 NRCT, and 7 pre-post studies) and 11 observational studies (2 cohort studies, 2 case-control, 1 post-intervention follow-up study, and 6 cross-sectional studies) were included in the present systematic review. Twenty studies (46.5%) were classified as Level 1 or 2, indicating high/moderate methodological quality. Based on those studies, dietary strategies including high protein diet, intermittent fasting, balanced diet in combination with physical conditioning and electrical stimulation, and dietary supplementation including alpha-lipoic acid, creatine, vitamin D, and cranberry-derived supplements and probiotics were mapped as the most promising in prevention of SHC among individuals with SCI. CONCLUSIONS: To develop timely and effective preventive strategies targeting major SHC (e.g., cardiometabolic diseases, urinary tract infections) in SCI, further research is warranted to confirm the effectiveness of dietary strategies/interventions identified through the current systematic review of the literature.

Pre-procedural image-guided versus non-image-guided ventricular tachycardia ablation-a review.

BACKGROUND: Magnetic resonance imaging and computed tomography in patients with ventricular tachycardia (VT) after myocardial infarction (MI) helps to delineate scar from healthy tissue. Image-guided VT ablation has not yet been studied on a large scale. OBJECTIVE: The aim of the meta-analysis was to compare the long-term outcome of image-guided VT ablation with a conventional approach for VT after MI. METHODS: Eight electronic bibliographic databases were searched to identify all relevant studies from 2012 until 2018. The search for scientific literature was performed for studies that described the outcome of VT ablation in patients with an ischaemic substrate. The outcome of image-guided ablation was compared with the outcome of conventional ablations. RESULTS: Of the 2990 citations reviewed for eligibility, 38 articles-enrolling a total of 7748 patients-were included into the meta-analysis. Five articles included patients with image-guided ablation. VT-free survival was 82% [74-90] in the image-guided VT ablation versus 59% [54-64] in the conventional ablation group (p < 0.001) during a mean follow-up of 35 months. Overall survival was 94% [90-98] in the image-guided versus 82% [76-88] in the conventional VT ablation group (p < 0.001). CONCLUSIONS: Image-guided VT ablation in ischaemic VT was associated with a significant benefit in VT-free and overall survival as compared with conventional VT ablation. Visualising myocardial scar facilitates substrate-guided ablation procedures, pre-procedurally and by integrating imaging during the procedure, and may consequently improve long-term outcome.

[Fixation of the tuberculum in multifragment fractures of the proximal humerus treated with hemiarthroplasty].

Hemiarthroplasty is an effective treatment for multifragmentary fractures of the proximal humerus. Purpose of this study was to compare 2 different methods of tuberosity dislocations,which is one of the primary reasons for successful posttraumatic arthroplasty. Between 2006 and 2008, 29 patients with multifragmentary fractures of the proximal humerus underwent hemiarthroplasty of the shoulder. Mean gae was 69y., while mean postoperative follow up was 27 months. We evaluated two different techiques of tuberosity fixation after anatomic reattachment on humeri: (A) intertuberosity suture stabilization around the prothesis, and their suture to the humeri and (B) direct intertuberosity suture and their suture to the humeri Postoperartive Constant score averaged 71 points. Reason for failure of the operative treatment was primary due to the postoperative tuberosity migration It was noted in all patients of group 2 and in 2 patients of group 1. Intertuberosity stabilization using sutures arpund the prothesis and tuberosity fixation to the humeri was proofed to be optimal method, because it decreased strain and mobility of tuberosities, maximize stability of the hemiarthroplasty and facilitate postoperative rehabilitation.

[Intramedullary fixation and proximal femoral fractures: diversity in use through case reports].

Proximal femoral fractures, including intertrochanetric and subtrochanteric with diaphiseal propagation represent a significant challenge in orthopedic surgery, especially in older population. Retrospective analysis of patients, after the application of "Bi Nail (Bioimpianti Inc.) intramedullary nail for fractures and pathological conditions of proximal femur, was done at the Department of Adult Orthopedics, Institute of Orthopedic surgery Banjica, during the three year period. We present patients with complex fractures and pathological conditions (metastasis and pseudoarthrosis) of proximal femur; most of the fractures were result of effects of low energy, and the most common pathological fracture is due to metastasis of breast cancer. The analysis included the technical characteristics and duration of surgery, intraoperative and postoperative complications as well as the coalescence time of fracture healing and postoperative quality of life after rehabilitation. We believe that the described surgical method, although technically demanding, with a variable length duration of surgery and treatment of high risk elderly patients, provides stable fracture fixation with early rehabilitation to improve the quality of life.

Unusual position of bone tunnels in failed ACL reconstruction.

INTRODUCTION: Surgery of ACL deficient knees is very frequent nowadays due to advanced surgical techniques, sophisticated implants and large number of surgeons. Therefore, the number of revisions for various reasons is growing up. There are several well known reasons for failed surgery This paper reported a case of revision surgery in a patient with previously done and failed reconstruction of ACL. CASE OUTLINE: Reviewing the clinical findings and X rays we found out peculiar position of the transplant and tunnels as a cause of the failure. We haven't found such complication reported in literature therefore we decided to report the case. CONCLUSION: Variety of implants and instruments can ease the surgery but basic anatomical knowledge of position and relations of the knee ligaments are essential for good surgical outcome.

[Biochemical and antropometric monitoring of growth in preterm infants].

Enriched human milk may stimulate gain weight in preterm infants during neonatal period. Aim is biochemical assessment of preterm infants, feed by mother's milk fortificated with special domestic formula (pre)Impamil during the first month of life. 80 preterm infants (45 male and 35 female), up to 36 weeks of gestation. BW less than 2500 g, which started enteral intake in the first three day of life. Total volume intake was in range from 70 ml/kg first day, to 170-200 ml/kg, after 10th day of life. Mother's milk fortification was prepared as 5% mixture solution of (pre)Impamil. The dynamics of biochemical analyses started on the first day of study and was repeated once weekly. We analysed levels of: total protein, albumin, prealbumin, transferin, urea, Ca ionised, P and alkaline phosphatase using standard biochemical methods. Statistical analyses completed by ANOVA test, one factorial analyses of variance. During monitoring total protein level increased in the second week of life (p < 0.03), as well as albumin (p < 0.03). Prealbumin level increased, as well as transferin (p-NS). Initial level of ionised fraction of Ca was significantly lower (p < 0.03) at the beginning of the study, compared to the rest. Serum level of P increased, as well as level of alkaline phosphatase at the end of first and second week (p < 0.01). Conclusion is that biochemical parameters as level of protein and albumin are important at the assessement growth in preterm infants on special feeding regimes.

[Successfull extirpation of femoral pseudotumour in a patient with severe haemophilia A and an inhibitor to factor VIII]. / Uspesno hirursko uklanjenje femurskog pseudotumora kod odraslog bolesnika s teskom hemofilijom A i inhibitorom na faktor VIII.

The article deals with a successfull extirpation of femoral pseudotumour in a 53-year-old patient with severe haemophilia A (F VIII: C less than 1%) and an inhibitor to factor VIII. Such case is the first one reported in Yugoslavia. A combination of ultrasonography, computed axial tomography, angiography and Tc-99m labelled red blood cell scintigraphy was used for precise diagnosis of the pseudotumour. Preoperative preparation consisted of 50 units/kg of concentrate of F VIII (Hemate P) and 50 units/kg of activated prothrombine complex concentrate (FEIBA). A pseudotumour, 15 cm in diameter, was extirpated, as well as a few dauther cysts. F VIII concentrate was used for postoperative supportive therapy. On the 5-th postoperative day the patient prematurely rose from his bed and the "secondary bleeding" had to be treated with F VIII concentrate. The success of complex operations in haemophiliacs is possible only in big centres which can provide the best diagnostic procedures, trained surgeon teams, and modern and various supportive therapy.

[Open injuries of the knee]. / Otvorene povrede kolena.

The authors discuss the therapeutic approach to 9 cases with open injuries of the knee which they have encountered during the past 5 years. All patients were hospitalized in a state of serious traumatic shock and all had multiple injuries. All 5 cases were operated on within 2--3 hours of the injury. The authors used the following postulates in treating this type of trauma: prevention of traumatic shock, early meticulous primary surgical treatment of the wound, closure of the joint with the drainage of the synovial cavity and periarticular space, strict immobilization, reinacting the extensor mechanism, fixation of the condylar fragment and the administration of antibiotics. The surgical treatment was restricted to only the minimal, patelectomy (3 cases) sec. McLaughlin, and in one case the medial condyle was fixed to the femur. Postoperative infection was not noted. All five patients returned to full working capacity and exhibited only minimal loss of extension at the knee.