ORCID Profile
0000-0002-6316-5289
Current Organisation
Lyell McEwin Hospital
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Publisher: Springer Science and Business Media LLC
Date: 03-03-2022
DOI: 10.1007/S00068-022-01919-W
Abstract: Early weight bearing (EWB) is often recommended after intramedullary nailing of tibial shaft fractures, however, the risks and benefits have not been critically evaluated in a systematic review or meta-analysis. Therefore, the aims of this study were to perform a systematic review and meta-analysis comparing EWB and delayed weight-bearing (DWB) after intramedullary nailing of tibial shaft fractures and assess the relationship between weight-bearing, fracture union and healing. This review included studies comparing the effects of EWB, defined as weight-bearing before 6 weeks, and DWB on fracture union and healing. PubMed, Embase, CINAHL, and the Cochrane Library were searched from inception to 9 May 2021. Risk of bias was assessed using the Down’s and Black Checklist and Cochrane Risk of Bias Tool 2.0. Data were synthesised in a meta-analysis, as well as narrative and tabular synthesis. Eight studies were included for data extraction and meta-analysis. The analysis produced mixed results and found a significant decrease in mean union time (−2.41 weeks, 95% confidence interval: −4.77, −0.05) with EWB and a significant Odd’s Ratio (OR) for complications with DWB (OR: 2.93, 95% CI: 1.40, 6.16). There was no significant difference in rates of delayed union, non-union, re-operation and malunion. The included studies were of moderate risk of bias and demonstrated shorter union time and fewer complications with EWB. However, current evidence is minimal and has significant limitations. The role of EWB in high-risk patients is yet to be examined. Further well-designed, randomised studies are required on the topic.
Publisher: Wiley
Date: 19-12-2023
DOI: 10.1111/ANS.18210
Publisher: Informa UK Limited
Date: 24-04-2023
Publisher: Springer Science and Business Media LLC
Date: 19-02-2021
Publisher: Wiley
Date: 28-01-2022
DOI: 10.1111/ANS.17490
Publisher: Wiley
Date: 23-04-2023
DOI: 10.1111/ANS.18470
Abstract: KRAS and BRAF testing is currently recommended in metastatic colorectal cancer. There is evidence that KRAS and BRAF mutation status may act as a prognostic biomarker in patients with non‐metastatic colorectal cancer. Data is limited on whether KRAS and BRAF mutation status impacts recurrence and mortality in patients with non‐metastatic colorectal cancer. A retrospective cohort study was conducted in a tertiary hospital examining outcomes in patients who had KRAS and BRAF testing for colorectal cancer in 2017. Primary outcomes were all‐cause mortality and recurrence. Multivariable analysis for both outcomes, used cause specific Cox proportional hazards models with KRAS/BRAF status as exposure. For time to recurrence, a sensitivity analysis was performed with a weighted Fine‐Grey model with death as a competing risk. KRAS mutation status was not associated with all‐cause mortality (average Hazard Ratio (aHR) = 0.78, 95% CI 0.28–2.21) or recurrence (aHR = 0.96, 95% CI 0.32–2.86). BRAF mutation status was not associated with time to all‐cause mortality (aHR = 3.06, 95% CI 0.79–11.8) or recurrence (aHR = 0.94, 95% CI 0.13–6.57). Increased risk of recurrence was significantly associated with large bowel obstruction (aHR = 2.73, 95% CI 1.16–6.45) and anaemia (aHR = 3.39, 95% CI 1.06–10.8) at time of surgery. This study did not demonstrate an association between KRAS and BRAF mutations and all‐cause mortality or recurrence. A significantly increased risk of cancer recurrence was found in patients with large bowel obstruction and in patients with anaemia at time of surgery. Anaemia should be promptly investigated and corrected prior to colorectal cancer surgery.
No related grants have been discovered for Mohamed Zaafer Afzal.