Cecilia Fieiras

Franco JV, et al. World J Mens Health. 2024 Jan;42:e11. https://doi.org/10.5534/wjmh.230222

Objetivo: Comparar los resultados clínicos y las complicaciones de una serie consecutiva de pacientes con fracturas de húmero proximal tratados con prótesis invertida de hombro y con consolidación anatómica de las tuberosidades o sin ella. Materiales y Métodos: Se evaluó a 113 pacientes >65 años con fractura de húmero proximal tratados con prótesis invertida de hombro. Setenta presentaron consolidación anatómica de las tuberosidades y 43, ausencia de consolidación. Se evaluó el rango de movilidad, y se utilizaron los puntajes de Constant-Murley, ASES, SANE y la escala analógica visual. Se documentaron todas las complicaciones y las reoperaciones. Resultados: El seguimiento promedio fue de 56 meses (rango 24-96) y la edad media era de 73 años (rango65-83). La elevación activa y la rotación interna medias posoperatorias fueron de 131° (± 14) y 27° (± 5), respectivamente. La rotación externa posoperatoria media en abducción y aducción fue de 27° (± 1) y 15° (± 6), respectivamente. La escala analógica visual promedio posoperatoria fue de 1,7 (± 0,8). Los puntajes ASES, de Constant-Murley y SANE promedio fueron de 76 (± 6), 62 (± 11) y 74% (± 7), respectivamente. La elevación anterior, la rotación externa y los puntajes funcionales promedio finales ASES y de Constant-Murley fueron significativamente mejores en el grupo con consolidación de las tuberosidades. Conclusiones: En pacientes >65 años con fractura de húmero proximal tratados con prótesis invertida de hombro tanto la movilidad posoperatoria, como los puntajes funcionales fueron significativamente mejores en los pacientes con consolidación anatómica de las tuberosidades.

Purpose Total hip arthroplasty (THA) is a successful treatment for hip osteoarthritis secondary to hip dysplasia. However, the reported rate of complications following THA in the settings of neuromuscular diseases is high. This systematic review aimed to analyze the indications, functional outcomes and surgical failures of primary THA in cerebral palsy (CP) patients. Methods MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were searched, and all clinical studies focusing on THA in patients with CP from inception through March 2020 were included. The methodological quality was assessed with Guo et al.’s quality appraisal checklist for case series and case–control studies, while cohort and prospective studies were evaluated with a modified version of the Downs and Black’s quality assessment checklist. Results The initial search returned 69 studies out of which 15, including 2732 THAs, met the inclusion criteria. The most frequent indication for THA was dislocated painful hip for which previous non-operative treatment had failed. Complications presented in 10 to 45% of cases. The most frequently reported complication was dislocation (1–20%), followed by component loosening (0.74–20%). Aseptic component loosening was the most frequent cause of revision surgery, followed by dislocation and periprosthetic fracture. Mean implant survival at ten years was 84% (range 81–86%). Conclusion The available literature suggests that although THA is a beneficial procedure in CP patients, it has a higher rate of complications and worse implant survival than the general population.

Objectives To assess the effectiveness and safety of risperidone and aripiprazole in children with autism spectrum disorder (ASD). Design and setting Overview of systematic reviews (SRs). Search methods In October 2021, we searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, PsycInfo and Epistemonikos placing no restrictions on language or date of publication. Participants Children aged 12 years or less with ASD. Interventions Risperidone and aripiprazole with no dosage restrictions. Data collection and analysis We rated the methodological quality of the included SRs using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). We reported the Grading of Recommendations, Assessment, Development and Evaluation certainty of the evidence according to the analysis conducted by the authors of the included SRs. Main outcomes measured A multidisciplinary group of experts agreed on analysing nine critical outcomes evolving core and non-core ASD symptoms. Patient and public involvement Organisations of parents of children with ASD were involved during part of the process, participating in external revision of the final version of the report for the Chilean Ministry of Health with no additional comments (ID 757-22-L120 DIPRECE, Ministry of Health, Chile). The organisations involved were: Fundación Unión Autismo y Neurodiversidad, Federación Nacional de Autismo, Vocería Autismo del Sur, and Vocería Autismo del Norte. Results We identified 22 SRs within the scope of this overview, of which 16 were of critically low confidence according to AMSTAR 2 and were excluded from the analysis. Both aripiprazole and risperidone were effective for reducing autism symptoms severity, repetitive behaviours, inappropriate language, social withdrawal and behavioural problems compared with placebo. The certainty of the evidence for most outcomes was moderate. Risperidone and aripiprazole are associated with metabolic and neurological adverse events. Follow-up was short termed. Conclusions We found that aripiprazole and risperidone probably reduce symptom severity at short-term follow-up but may also cause adverse events. High-quality and updated SRs and larger randomised controlled trials with longer term follow-up are needed on this topic. Overview protocol PROSPERO CRD42020206535.

Trivisonno LF, et al. Investig Clin Urol. 2021 Sep;62(5):520-534. https://doi.org/10.4111/icu.20210254