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| 13. |
- Khatri, C, et al.
(författare)
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Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study
- 2021
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 11:11, s. e050830-
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Tidskriftsartikel (refereegranskat)abstract
- Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.SettingProspective, international, multicentre, observational cohort study.ParticipantsPatients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.ResultsThis study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).ConclusionsPatients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration numberNCT04323644
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| 14. |
- Nordström, Anna, 1973-
(författare)
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Bone mass and physical activity
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Abstract Weak and osteoporotic bones in old age are an increasing cause of mortality and painful physical impairment of the elderly, especially in the western world. Bone mineral accrual during childhood and adolescence is thought to play a vital role in preventing osteoporosis. Identifying and optimizing the factors influencing peak bone mass is thus important for the prevention of osteoporosis and related fractures. A main aim of this thesis was to investigate the potential effects of various types of weight-bearing physical activity on bone accretion in young males just out of puberty. The results from our subgroups of athletes consisting of badminton, ice hockey, and soccer players suggest that weight-bearing physical activity gives rise to regional specific bone response that is determined by the degree of impact of the activity in areas subject to mechanical loading (papers I–IV). In summary, the bone is sensitive to loading after puberty in males, and important bone mass gains can be achieved by proper amount and type of exercise. Another aim of this thesis was to studythe effect of detraining on weight-bearing and non-weight-bearing bone in a cohort of adolescent males who participated in ice hockey and soccer training. Our results indicate that exercise-induced bone mineral density benefits decline, predominantly in weight-bearing bones, after retirement from an active sports career (papers II–IV). High bone density stemming from physical loading might be at least partly preserved even by reduced physical activity at nonweight-bearing sites after about three years of reduced activity (III, IV). A final aim was to follow prospectively the development of BMD during years of reduced activity in former male athletes, and evaluate whether exercise during adolescence could be associated with fewer fractures in old age. We found fewer fragility fractures in a cohort of 400 former athletes compared to in 800 age-matched controls. Thus, high bone density stemming from previous weight-bearing physical activity may reduce the risk of sustaining fragility fractures in the elderly. Key words: physical activity, peak bone mineral density, males.
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| 20. |
- Bravo, L, et al.
(författare)
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- 2021
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swepub:Mat__t
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