T2DM patients who have been on metformin therapy is found to benefit from the drug in that metformin is associated with a threefold decrease in mortality due to COVID-19. The exact mechanism behind this beneficial effect is unknown but it could be attributed to the anti-inflammatory and anti-thrombotic effects of the drug. A mortality rate of 11 percent was observed among metformin users as opposed to the 23 percent among nonusers, pointing to the possibility of a protective effect the drug might impart to diabetic patients.
The meta-analysis carried out by Suetonia C Palmer et al. aimed to determine the effect of sodium-glucose cotransporter-2 (SGLT-2) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists in patients with type 2 diabetes. The study included an analysis of 764 randomised control trials and found that both classes of drugs lowered all cause mortality, cardiovascular mortality, non-fatal myocardial infarction, and kidney failure. SGLT-2 inhibitors were found to reduce mortality and hospital admission for heart failure whereas GLP-1 receptor agonists reduced non-fatal stroke.
Morika Suzuki et al. report the case of a 55-year-old man who presented with fever and dysuria. Subsequent to his hospital admission he showed urinary retention and later on developed involuntary movements of the extremities, nuchal rigidity, hyperreflexia of the deep tendon reflexes, and pathological reflexes in the bilateral lower extremities. Lumbar puncture revealed elevated cerebrospinal pressure, protein count and cell count with dominant mononuclear cells. Based on the findings a diagnosis of urinary retention due to meningitis-retention syndrome (MRS) with aseptic meningitis was made. A positive polymerase chain reaction test for Epstein–Barr virus led to the identification of EBV reactivation as the cause of MRS.
Fergus W Hamilton et al. conducted a cohort study to determine whether lymphopenia in patients who develop pneumonia is associated with an increased risk of death. The study, that included 40,909 participants aged >50 years with pneumonia, found that low lymphocyte count is associated with an increase in short- and long-term mortality, indicating that lymphopenia is an independent predictor of mortality in primary care pneumonia.
Adopting an aggressive treatment strategy that comprises upfront cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy may be beneficial for certain older women with ovarian cancer. Researchers have found a long median overall survival of 69.2 months for women aged younger than 65 years and 69.3 months for those aged 65 years or older with upfront cytoreductive surgery plus HIPEC. The median progression-free survival was also found to be longer in women who underwent this treatment.
According to a randomized trial that included more than 160 patients, patients with knee osteoarthritis who wear stable supportive shoes for 6 months have greater average reductions in knee pain when walking, compared with patients who wear flat flexible shoes. Abnormal knee joint loading has been implicated in the pathogenesis of knee OA. Guidelines recommend that patients wear appropriate footwear, but research has not established which shoes are best.
A new proof-of-concept study suggests that a single injection of denosumab (Prolia, Amgen), frequently used to treat osteoporosis, may reduce the need for revision surgery in patients with symptomatic osteolysis following total hip arthroplasty. Aseptic loosening is the result of wear-induced osteolysis caused by the prosthetic hip and is a major contributor to the need for revision surgery in many parts of the world.
Results of a published study suggest that patients with shoulder impingement syndrome who underwent arthroscopic subacromial decompression had no clinically relevant improvements at 5-year follow-up compared with diagnostic arthroscopy or exercise therapy. Researchers randomly assigned 210 patients 35 to 65 years of age who had symptoms consistent with shoulder impingement syndrome for more than 3 months to undergo either exercise therapy or surgery.
Ilene Tisnovsky et.al. conducted a study to propose a gunshot wound-related hip injury algorithm and improve patient outcomes. The researchers concluded that various therapeutic strategies have been used for the management of gunshot wound-related hip injuries but further prospective studies are necessary to determine the optimal therapeutic modality.
Pauline Besonhe et.al. presented a case of a newborn in which surgery was necessary to free both fingers and toes from constrictive bands responsible for ischemia. In the absence of surgery, the constrictive bands can lead to amputation (pseudoainhum). The purpose of this case report is to expose the management and the role of an orthopaedic surgeon in the treatment of a collodion baby.