Stress fractures, a common overuse injury in physically active individuals, present a significant challenge for athletes and military personnel. Patients who sustain stress fractures have demanding training regimes where periods of rest and immobilisation have unacceptable negative consequences on sports goals and finances. Aside from being an overuse injury, there are various contributing risk factors that put certain individuals at risk of a stress fracture. The main two being nutritional deficiencies and hormonal variations, which have significant effects on bone metabolism and turnover. Historically, treatment of stress fractures focused on conservative strategies such as rest and immobilisation. Calcium and vitamin D deficiencies have been closely linked to stress fractures and so over time supplementation has also played a role in treatment. With the introduction of biologics into orthopaedics, newer treatment strategies have been applied to accelerate fracture healing and perhaps improve fracture callus quality. If such therapies can reduce time spent away from sport and activity, it would be ideal for treating stress fractures. This article aims to offer insights into the evolving landscape of stress fracture management. It investigates the pre-clinical evidence and available published clinical applications. Though fracture healing is well understood, the role of biologics for fracture healing is still indeterminate. Available literature for the use of biologic therapies in stress fractures are restricted and most reports have used biologics as a supplement to surgical fixation in subjects in studies that lack control groups. Randomised control trials have been proposed and registered by a few groups, with results awaited. Assessing individuals for risk factors, addressing hormonal imbalances and nutritional deficiencies seems like an effective approach to addressing the burden of stress fractures. We await better designed trials and studies to accurately determine the clinical benefit of adding biologics to the management of these injuries.

2021-10-01·Journal of Minimal Access Surgery4区 · 医学

An Obesity and Metabolic Surgery Society of India survey of 1307 patients

4区 · 医学

ArticleOA

作者: Tantia, Om ; Padmakumar, R ; Shah, Neha ; Narwaria, Mahendra ; Kaushal, Anshuman ; Palaniappan, Raj ; Pal Rajput, Ram Raksha ; Leo, Jayanth ; Baig, Sarfaraz J ; Shivaram, H V ; Prasad, Arun ; Patolia, Sanjay ; Chikkachanappa, Mahesh ; Bhasker, Aparna Govil ; Khaitan, Manish ; Patel, Parag ; Dukkipati, Nandkishore ; Perungo, T ; Aggarwal, Sandeep ; Shrivastava, Rajesh ; Sethi, Daksh ; Wadhawan, Randeep ; Rajkumar, Anirudh ; Bindal, Vivek ; Saggu, Sukhvinder Singh ; Hareendran, Deepak Thampi ; Singh, Rahul ; Parikh, Chirag ; Bharucha, Manoj ; Garg, Rohit ; Kular, Kuldeepak ; Dhorepatil, Shrihari ; Ismail, Mohamed ; Motwani, Manish ; Jammu, Gurvinder Singh ; Ugale, Surendra ; Bedi, Digvijay ; Goel, Ramen ; Soni, Vandana ; Goel, Deep ; Shah, Shashank ; Kumar, Amardeep

Background:Although safe practice guidelines were issued by the Obesity and Metabolic Surgery Society of India (OSSI) in the end of May 2020, surgeons have been in a dilemma about risk of subjecting patients to hospitalisation and bariatric surgery. This survey was conducted with the objective to evaluate the risk of coronavirus disease-19 (COVID-19) infection in peri- and post-operative period after bariatric and metabolic surgery (BMS).Methods:A survey with OSSI members was conducted from 20 July 2020 to 31 August 2020 in accordance with EQUATOR guidelines. Google Form was circulated to all surgeon members through E-mail and WhatsApp™. In the second phase, clinical details were captured from surgeons who reported positive cases.Results:One thousand three hundred and seven BMS were reported from 1 January 2020 to 15 July 2020. Seventy-eight per cent were performed prior to 31 March 2020 and 276 were performed after 1 April 2020. Of these, 13 (0.99%) patients were reported positive for COVID-19 in the post-operative period. All suffered from a mild disease and there was no mortality. Eighty-seven positive cases were reported from patients who underwent BMS prior to 31 December 2019. Of these, 82.7% of patients had mild disease, 13.7% of patients had moderate symptoms and four patients succumbed to COVID-19.Conclusion:BMS may be considered as a safe treatment option for patients suffering from clinically severe obesity during the COVID-19 pandemic. Due care must be taken to protect patients and healthcare workers and all procedures must be conducted in line with the safe practice guidelines.

2021-10-01·Transplantation Proceedings4区 · 医学

Is Early COVID-19 in Kidney Transplant Recipients Concerning Enough to Halt Transplantation? A Multicenter Comparative Analysis from India

4区 · 医学

Article

作者: Sil, Keshab ; Anand, Urmila ; Raju, Sree Bhushan ; Chauhan, Sanshriti ; Siddini, Vishwanath ; Krishna, Amresh ; Kute, Vivek B ; Das, Pratik ; Patel, Himanshu V ; Meshram, Hari Shankar ; Patel, Ansy H ; Sahay, Manisha ; Pathak, Vivek ; Mishra, Vineet ; Abraham, Abi ; Hegde, Umapati ; Bahadur, M M ; Chaudhury, Arpita Ray

BACKGROUNDLimited data exist on the incidence and outcome of early coronavirus disease 2019 (COVID-19) in kidney transplantation recipients (KTR).METHODSA retrospective multicenter research study was conducted across 12 centers in India. We explored the symptomatology, demographic, laboratory findings, and outcome of COVID-19 within 30 days of transplantation. The outcome was compared with the overall KTR and waitlisted patients acquiring COVID-19.RESULTSThe incidence of early COVID-19 was 2.6% (n = 22) for the cumulative 838 renal transplants performed since nationwide lockdown in March 2020 until May 2021. Overall, 1049 KTR were diagnosed with COVID-19 and 2% of those had early COVID-19. The median age of the early COVID-19 cohort was 43 (31-46) years. COVID-19 severity ranged from asymptomatic (18.2%), mild (59.1%), moderate (9.1%), and severe (13.6%). Among clinical symptoms, dyspnea and anosmia were frequent, and in laboratory parameters, neutrophil lymphocyte ratio, high-sensitivity C-reactive protein, and D-dimer were higher in patients requiring oxygen. The mortality in early COVID-19 was not higher than overall KTR (4.5% vs 8.5%; P = 1). COVID-19 severity (23.9% vs 15.7%; P = .0001) and mortality (15.5% vs 8.5%; P = .001) among waitlisted patients (n = 1703) were higher compared with overall KTR.CONCLUSIONSWe report higher burden of COVID-19 in waitlisted patients compared with KTR and a favorable outcome in early COVID-19 in KTR. Our report will help the transplant physicians in dealing with the ongoing dilemma of halting or resuming transplantation in the COVID-19 era.

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