Sharri Junadi Mortensen

Background The aim of the study was to investigate the combination of cell-free fetal hemoglobin (cfHbF), total cell-free hemoglobin (tcfHb), cell-free fetal DNA (cffDNA), Pregnancy Associated Plasma Protein A (PAPP-A) and maternal obstetric history as potential markers in first and second trimester, for prediction of preeclampsia (PE) in asymptomatic pregnant women. Methods This was a retrospective case-control study of 589 pregnant women (560 in the control group and 29 with PE in the case group). We used routine blood samples used in screening for chromosomal anomalies and rhesus immunization to analyze the levels of cfHbF, tcfHb, and PAPP-A in gestational weeks 8-14 and levels of cfHbF, tcfHb, and cffDNA in gestational weeks 23-28. Results In first-trimester samples, there was no statistically significant difference between controls, mild PE, and severe PE regarding levels of PAPP-A, cfHbF, tcfHb or cfHbF/tcfHb ratio. In second trimester samples, cfHbF and cffDNA levels were significantly higher in PE cases than in controls. The odds ratio (OR) for developing PE was 4.28 (95%CI: 1.85-9.89) given a cfHbF>90th centile (p90th centile (p<0.001). When adjusting for BMI and previous history of PE in a logistic regression analysis, only cffDNA and BMI remained statistically significant (p< 0.001). Conclusion We found a significant association between PE and high levels of cfHbF and cffDNA in second- trimester samples, but no statistically significant difference in first-trimester samples were observed.

Background: With the worsening opioid epidemic in America, more patients are developing found down extremity compartment syndrome (FDECS). The purpose of this study was to describe this patient population, including their presenting symptoms, laboratory test results, and clinical outcomes. Methods: We performed a 2-center retrospective review of adult patients who developed FDECS secondary to substance use from January 2006 to December 2019. Patients were managed operatively or nonoperatively at the surgeon’s discretion. Data on patient demographic characteristics, laboratory values, hospital course, and clinical outcomes were collected from electronic medical records. Results: In this study, 91 patients were included: 85 patients were managed operatively, and 6 patients were managed nonoperatively. Most patients were male, and the mean patient age (and standard deviation) was 37 ± 11 years. Opioids were the most common substance used. Patients managed operatively underwent a mean of 4 ± 3 surgical procedures, 44% received a skin graft, 25% developed a wound infection, and 11% underwent limb amputation. Patients managed nonoperatively did not undergo a subsequent fasciotomy or amputation. At a mean follow-up of 2.3 years, persistent weakness (66%), pain (78%), persistent sensory deficits (53%), and contractures (18%) were common. Conclusions: Patients who develop FDECS secondary to substance use have high surgical complication rates and poor clinical outcomes. We found high rates of wound infection, revision surgical procedures, and amputation, often leaving young adults with lifelong disability. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

» Acupuncture after total knee arthroplasty (TKA) may decrease the incidence of postoperative nausea and vomiting (PONV). » Acupuncture did not decrease visual analog scale (VAS) scores in the 0 to 48-hour interval but did decrease VAS scores at >48 hours after TKA. » The heterogeneity of the studies prevented meta-analysis of opioid use with acupuncture after TKA; a systematic review demonstrated mixed results. » Additional studies are needed to investigate opioid reduction with acupuncture after TKA.

Introduction Among the various hip fracture predictors explored to date, modifiable risk factors warrant special consideration, since they present promising targets for preventative measures. This systematic review and meta-analysis aims to assess various modifiable risk factors. Material and methods We searched four online databases in September 2017. We included studies that reported on modifiable lifestyle risk factors for sustaining fragility hip fractures. The quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS). The inclusion criteria consisted of (1) adult patients with osteoporotic hip fracture, (2) original study, (3) availability of full text articles in English, and (4) report of a modifiable lifestyle risk factor. Results Thirty-five studies, containing 1,508,366 subjects in total, were included in this study. The modifiable risk factors that were significantly associated with an increased risk of hip fracture were the following: weight < 58 kg (128 lbs) (pooled OR 4.01, 95% CI 1.62–9.90), underweight body mass index (BMI) (< 18.5) (pooled OR 2.83, 95% CI 1.82–4.39), consumption of ≥ 3 cups of coffee daily (pooled OR 2.27, 95% CI 1.04–4.97), inactivity (pooled OR 2.14, 95% CI 1.21–3.77), weight loss (pooled OR 1.88, 95% CI 1.32–2.68), consumption of ≥ 27 g (approx. > 2 standard drinks) alcohol per day (pooled OR 1.54, 95% CI 1.12–2.13), and being a current smoker (pooled OR 1.50, 95% CI 1.22–1.85). Conversely, two factors were significantly associated with a decreased risk of hip fracture: obese BMI (> 30) (pooled OR 0.58, 95% CI 0.34–0.99) and habitual tea drinking (pooled OR 0.72, 95% CI 0.66–0.80). Conclusion Modifiable factors may be utilized clinically to provide more effective lifestyle interventions for at risk populations. We found that low weight and underweight BMI carried the highest risk, followed by high coffee consumption, inactivity, weight loss, and high daily alcohol consumption.

Objective: To characterize the patient population with substance-related found-down extremity compartment syndrome (FDECS) and report on their treatment and outcome. Data Source: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Articles in English language were identified by searching 3 online databases, EMBASE, PubMed Publisher, and Cochrane Central, in September 2019. Study Selection: Studies involving substance-related FDECS were included. Exclusion criteria were as follows: patient age <18 years, not original studies, no full text available, technical reports, traumatic acute extremity compartment syndrome, chronic exertional compartment syndrome, and vascular acute extremity compartment syndrome. Data Extraction: There were 61 studies included with 166 cases of FDECS. Two investigators screened and extracted data independently according to a standardized template. Disagreements were addressed by an attempt to reach a consensus, and involvement of a third reviewer. Studies were quality assessed with “Quality Assessment tool for Case Series Studies.” Data Synthesis: Descriptive statistics were reported using Excel. Conclusion: Substance-related FDECS is often occurring in young adults. Data from this review found that most of the patients were already diagnosed with substance use disorders and/or psychiatric disorders. There should be a high index of suspicion of FDECS in patients presenting after prolonged immobilization. Level of Evidence: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Background: Acute compartment syndrome (ACS) is a devastating condition, further aggravated by delayed diagnosis. Since ACS is a clinical diagnosis, identification of risk factors for individual patients may help with earlier detection. This study aims to identify the risk factors associated with the development of ACS of the extremities. Methods: We performed a systematic review and meta-analysis of studies with adult patients at risk for and with traumatic ACS of the extremity. Non-traumatic, chronic exertional, vascular and abdominal compartment syndrome were excluded. Technical reports, biomechanical studies, abstracts, studies of non-human subjects, non-English studies, and studies with less than five subjects were excluded. Meta-analysis was performed on a subset of studies including a control group. We addressed cases of substantial heterogeneity among the studies with subgroup analysis, and whenever heterogeneity remained significant, we employed random effect meta-analysis for the data pooling. The study protocol has been registered in PROSPERO (ID = CRD42019126603). Results: There were 19 studies with 48,887 patients investigating risk factors of traumatic ACS. Of these, there were 1,716 patients with the diagnosis of traumatic ACS. Fourteen studies (46,300 controls and 1,358 ACS patients) qualified for meta-analysis. Male to female ratio was 5.5 with an average age of 36 years. Factors that were significantly associated with the development of ACS were: age 18-64 (OR: 1.34, 95% CI: 1.07-1.68), male (OR: 2.18, 95% CI: 1.53-3.10), gunshot wound with fracture and vascular injury (OR: 12.5, 95% CI: 5.69-27.46), combined forefoot and midfoot injury (OR: 3.3, 95% CI: 2.39-4.57), injury severity score (ISS) 0-9 (OR: 1.58, 95% CI: 1.27-1.97), OTA/AO type C fractures (OR: 2.75, 95% CI: 1.04-7.28), vascular injury (OR: 9.05, 95% CI: 6.69-12.26), and high-energy trauma (OR: 3.10, 95% CI: 1.60-5.82). Factors such as tibia fracture and crush injury were reported but were not included in quantitative analysis, due to lack of control groups and/or only one study qualifying for meta-analysis. Conclusion: This study reports on the current significant risk factors for developing traumatic ACS. The most common risk factors included age, sex, gunshot wound with a vascular injury, OTA/AO fracture type C and high-energy trauma.

Fragility hip fractures and their associated morbidity and mortality pose a global healthcare problem. Several pharmaceutical products have been postulated to alter bone architecture and contribute to fragility hip fractures. We searched four electronic databases from inception to September 2017. Inclusion criteria were the following: (1) adult patients with fragility hip fractures, (2) full text in English, (3) minimum one-year follow-up, and (4) reporting of at least one risk factor. To minimize heterogeneity among the studies, we performed subgroup analyses. Whenever heterogeneity remained significant, we employed random effect meta-analysis for data pooling. Thirty-eight studies were included, containing 1,244,155 subjects and 188,966 cases of fragility hip fractures. Following medications were significantly associated with fragility hip fractures: Antidepressants (OR 2.07, 95% CI 1.98–2.17), antiparkinsonian drugs (OR 2.21, 95% CI 1.15–4.24), antipsychotic drugs (OR 2.0, 95% CI 1.50–2.66), anxiolytic drugs (OR 1.44, 95% CI 1.19–1.75), benzodiazepines (OR 1.84, 95% CI 1.26–2.69), sedatives (OR 1.33, 95% CI 1.14–1.54), systemic corticosteroids (OR 1.65, 95% CI 1.37–1.99), H₂ antagonists (OR 1.21, 95% CI 1.18–1.24), proton pump inhibitors (OR 1.41, 95% CI 1.16–1.71), and thyroid hormone (OR 1.29, 95% CI 1.13–1.47). Hormone replacement therapy with estrogen (HRT) was associated with decreased risk of hip fracture (OR 0.80, 95% CI 0.65–0.98). There are several medications associated with sustaining a fragility hip fracture. Medical interventions should be considered for patients on these medications, including information about osteoporosis and fracture prevention.

Purpose Acute compartment syndrome (ACS) is often difficult to diagnose in pediatric patients due to their erratic symptomatology. Therefore, it is of paramount importance to identify at-risk patients to facilitate a prompt diagnosis. This study aims to identify risk factors for the development of ACS in the pediatric population. Methods We included studies comprised of pediatric patients with traumatic ACS. We excluded studies evaluating compartment syndrome secondary to exertion, vascular insult, abdominal processes, burns, and snake bites. Heterogeneity was addressed by subgroup analysis, and whenever it remained significant, we utilized a random-effects meta-analysis for data pooling. The protocol has been registered at PROSPERO (ID = CRD42019126603). Results We included nine studies with 380,411 patients, of which 1144 patients were diagnosed with traumatic ACS. The average age was 10 years old, and 67% of patients were male. Factors that were significantly associated with ACS were: open radius/ulna fractures (OR 3.56 CI 1.52–8.33, p = 0.003), high-energy trauma (OR 3.51 CI 1.71–7.21, p = 0.001), humerus fractures occurring concurrently with forearm fractures (OR 3.49 CI 1.87–6.52, p < 0.001), open tibia fractures (OR 2.29 CI 1.47–3.55, p < 0.001), and male gender (OR 2.06 CI 1.70–2.51, p < 0.001). Conclusion In the present study, open fractures, high-energy trauma, concurrent humerus and forearm fractures, and male gender significantly increased the risk of developing ACS in the pediatric population. Clinicians should raise their suspicion for ACS when one or multiple of these factors are present in the right clinical context. Type of study Systematic review and meta-analysis. Level of evidence III.

This study aims to describe infectious complications in both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) patients with sustained return of spontaneous circulation (ROSC) and to compare differences in antimicrobial treatment and outcomes between the two groups. This was a retrospective, single-center, observational study. Adult patients (≥ 18 years) with OHCA or IHCA who had sustained ROSC between December 2007 to March 2015 were included. Blood, urine, sputum, and other fluid cultures, as well as radiologic imaging, were obtained at the discretion of the treating clinical teams. 275 IHCA and 318 OHCA patients were included in the analysis. We found evidence of infection in 181 IHCA and 168 OHCA patients. Significant differences were found between the IHCA and OHCA group in terms of initial rhythm, duration of arrest (10 min vs. 20, p = < 0.001), targeted temperature management (30% vs. 73%, p = < 0.001), and post-arrest infection rates (66% vs 53%, p = 0.001). 95% of IHCA and 82% of OHCA patients received antimicrobial treatment in the post-cardiac arrest period. The source of infection in both groups was largely respiratory, followed by urinary. Gram-positive cocci and gram-negative rods were the most common organisms identified among subjects with culture-proven bacteremia. Infections in the post-arrest period were common in both OHCA and IHCA. We found significantly more infections in IHCA compared to OHCA patients. The most common infection category was respiratory and the most common organism isolated from sputum cultures was Staphylococcus aureus coagulase-positive. The incidence of culture-positive bacteremia was similar in both OHCA and IHCA cohorts but overall lower than previously reported.