Daily Med Bites - 21/05/2025

Dear reader, I’m sorry for yesterday’s newsletter, because of some technical issues it was not scheduled correctly.

Here are the summaries of some of the latest papers from PubMed.

Photon-counting CT:

• Source: Photon-counting CT offers superior diagnostic capabilities for cardiac imaging, including better resolution and tissue characterization, which can reduce the need for invasive procedures like coronary angiography and MRI.

• Source: The study demonstrates that photon-counting detector CT can effectively evaluate coronary artery calcification at radiation doses comparable to those of a chest radiography, enabling opportunistic screening while significantly reducing patient exposure.

• Source: The key takeaway is that photon counting detector CT offers superior imaging capabilities, especially in pediatric settings, through improved resolution, reduced radiation dose, and enhanced spectral imaging options, leading to better diagnostic outcomes and new research opportunities.

• Source: The study demonstrates that photon-counting CT can accurately measure extracellular volume in cardiac amyloidosis patients, comparable to cardiac MRI, and also assess coronary artery disease.

• Source: Brass and lead bullets can be differentiated using photon-counting CT, enabling noninvasive bullet characterization.

• Source: Different breath-holding techniques affect scanning length and radiation dose in coronary CT angiography, with some methods reducing radiation exposure while maintaining image quality.

Hip Fractures:

• Source: Surgical timing significantly affects in-hospital mortality rates for hip fractures in older adults, with acute events and chronic comorbidities playing crucial roles in patient outcomes.

• Source: The take-home message is that hip fractures significantly worsen health outcomes for older adults with cognitive impairment or dementia, increasing risks of subsequent falls, hospitalization, institutionalisation, and mortality, while also diminishing quality of life and functional status.

• Source: The take-home message of this paper is that anticoagulation therapy in elderly hip fracture patients affects surgical timing and outcomes, highlighting the need for optimized management strategies in an Orthogeriatric Clinical Care Center.

• Source: Frailty, as measured by the Clinical Frailty Scale, significantly impacts mortality, surgical timing, and length of hospital stay in patients with hip fractures.

• Source: Identifying key factors influencing anti-fracture therapy decisions in older patients with fragility fractures through a multidimensional geriatric assessment can improve outcomes in Fracture Liaison Services (FLS) programs.

• Source: Recovery of ambulation after surgery for complete pathological femoral fractures in older adults is a prognostic factor and associated with postoperative chemotherapy, while shorter preoperative waiting times are linked to better recovery outcomes. Prompt surgical intervention should be considered for patients developing CF due to femoral metastasis.

• Source: High ASA score, volume and number of transfusions are risk factors for mortality within 6 months after intertrochanteric fracture surgery in Chinese geriatric patients, while advanced age and severe complications become significant risk factors beyond 6 months.

• Source: Polypharmacy in older patients with intertrochanteric fractures is associated with lower 1-year survival and increased postoperative complications following surgical treatment.

• Source: The take-home message of this paper is that incorporating inflammatory biomarkers at admission, when used in conjunction with the Nottingham Hip Fracture Score (NHFS), can enhance the prediction of post-operative outcomes for patients with hip fractures.

• Source: The APACHE II score predicts postoperative complications in hip fracture patients over 65 better than ASA Score and CCI, but specific orthopaedic scoring systems are more accurate.

• Source: A nomogram was developed to predict postoperative new-onset constipation in elderly patients with hip fractures, identifying ten risk factors and demonstrating good discriminative ability.

• Source: The key takeaway from this paper is that it identifies specific risk factors for subsequent fractures within two years of an initial fracture in individuals aged 50 and older, distinguishing these factors from those associated with falls.

• Source: Changes in health-related quality of life after hip fractures vary across different domains, and certain factors are associated with resilience in maintaining HRQoL.

• Source: Mid-term outcomes show no significant difference in implant survival, complications, or functional performance between “fix and replace” and ORIF for acetabular fractures in elderly patients, suggesting both methods are viable options.

• Source: COVID-19 significantly increased mortality rates for patients with proximal femoral fractures, affecting both those who tested positive and those who tested negative for the virus.

• Source: Education and household income influence patient-reported outcomes after hip fractures, with higher socioeconomic position correlating with better health-related quality of life, less pain, and greater satisfaction following fracture.

• Source: The take-home message of this paper is that it identifies racial and ethnic disparities in 1-year and 5-year mortality rates following major osteoporotic fractures in postmenopausal women, highlighting the need for targeted interventions.

• Source: The study demonstrates that eHealth-based prehabilitation programs like HIPPER are effective and user-friendly for older adults preparing for total hip replacement surgery, improving their surgical readiness and experience while offering potential cost savings for the healthcare system.

• Source: Lymphocyte subset abnormalities can effectively detect early-stage postoperative pneumonia in older patients following hip fracture surgery.

• Source: The take-home message is that a subacute transverse diaphyseal femoral fracture can occur in an otherwise healthy elderly individual without apparent risk factors, highlighting the need for careful evaluation beyond initial diagnoses like osteoarthritis.

• Source: ASA, SORT, and ACCI scores are useful in predicting ICU admission requirements for elderly patients undergoing hip surgery.

• Source: The main finding of this paper is that delaying surgery beyond 24 hours after an ankle fracture increases the risk of postoperative wound complications.

• Source: The use of a cemented polished taper-slip (PTS) stem in anterior approach total hip replacement may reduce the risk of periprosthetic fractures.

• Source: Postoperative adjuvant chemotherapy in older adults aged ≥80 years with LAGC improves survival outcomes compared to surgery alone.

• Source: The study highlights that incorporating factors such as fall frequency, Social Vulnerability Index (SVI), and race into the Fracture Risk Assessment Tool (FRAX) improves its predictive accuracy for fall-induced hip fractures, suggesting a need to refine FRAX to better account for these variables.

That’s enough for today, see you tomorrow!

As always, these extremely reduced summaries may be incomplete or inexact in some aspects. Make sure to always read the papers of interest.

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