Impact of Syndesmotic Screw Removal on Quality of Life, Mobility, and Daily Living Activities in Patients Post Distal Tibiofibular Diastasis Repair

Background and Objectives: While numerous studies have been conducted on syndesmotic screw management following distal tibiofibular diastasis repair, a clear consensus remains unclear. This research aims to evaluate whether the postoperative removal of syndesmotic screws leads to improved patient outcomes, specifically in quality of life, mobility, and daily living activities, and whether it offers a cost-effective solution. Materials and Methods: Patients with a history of unimalleolar or bimalleolar ankle fractures, classified according to the Danis-Weber and Lauge-Hansen systems, were included. Comprehensive evaluations were made via standardized questionnaires like the SF-36 Health Survey, HADS, and WHOQOL-BREF, distributed approximately 2 months post surgery. A total of 93 patients underwent syndesmotic screw removal while 51 retained the screws (conservative approach). Results: Patients who underwent screw removal reported superior satisfaction in mobility, with a score of 7.8, compared to 6.7 in the conservative approach (p = 0.018). Similarly, their ability to perform daily activities scored 8.1, higher than the 6.5 from the conservative cohort (p < 0.001). Pain levels were also more favorable in the screw removal group, with a score of 5.3 against 6.8 in the conservative group (p = 0.003). On the SF-36 physical domain, the screw removal group achieved a mean score of 55.9 versus 53.3 for the conservative group (p = 0.027). Notably, the HADS anxiety subscale highlighted reduced anxiety levels in the screw removal cohort with a mean score of 5.8 against 7.3 in the conservative group (p = 0.006). However, overall quality of life and recommendations to others showed no significant difference between the groups. Conclusions: Syndesmotic screw removal postoperatively leads to marked improvements in patients' mobility, daily activity abilities, and reduced postoperative pain and anxiety levels. However, overall quality of life was similar between the two approaches. The findings offer valuable insights for orthopedic decision making and patient-centered care concerning the management of syndesmotic screws after distal tibiofibular diastasis repair.

Avoiding the Removal of Syndesmotic Screws after Distal Tibiofibular Diastasis Repair: A Benefit or a Drawback?

There is still no general agreement about the most effective form of syndesmosis fixation with syndesmotic screws for patients affected by ankle fractures that are accompanied by syndesmotic injuries. In the same manner, no consensus has been reached yet on whether or not the tibiofibular syndesmotic screw is more beneficial if removed or not, as well as the exact timing of removal if this proves superiority. The purpose of this research was to verify whether or not removing syndesmotic screws reduces the risk of developing a diastasis and compare outcomes in patients whose syndesmotic screw was or was not removed at all. A retrospective observational study was carried out to cover a period of five years and a computed sample size of almost 300 cases. Patients were included in the current study if their history was positive for ankle fracture with distal tibiofibular diastasis repair with syndesmotic screws. Loss of reduction was more frequent after screw removal (8.5% vs. 2.1%), although the quality of reduction was generally excellent in both groups. The mean AOFAS score was significantly better in patients who had their tibiofibular screw removed (92.6 vs. 88.4), but the tibiofibular clear space and incisura fibularis depth widened more following the second intervention (3.8 mm vs. 3.6 mm, and, respectively, 4.3 vs. 4.1). Lastly, the same patients with tibiofibular screw removal had a significantly higher cost of total interventions and more days of medical leave (21 vs. 15 days on average). It seems that a strong conclusion in favor of removing or not removing syndesmotic screws after distal tibiofibular diastasis repair cannot be given. However, several radiographic findings lean toward the benefit of those patients whose tibiofibular screws were not removed, although mobility was notably better after the screw was removed. Furthermore, treatment expenses are greatly lowered if a subsequent operation for screw removal is avoided, as well as if individuals who have a single surgery take a shorter medical leave.

COVID-19 Pandemic Effects on Cervical Cancer Diagnosis and Management: A Population-Based Study in Romania

The Pap test plays a significant role worldwide in the early diagnosis of and high curability rates for cervical cancer. However, the coronavirus disease 2019 (COVID-19) pandemic necessitated the use of multiple drastic measures to stop the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, limiting women’s access to essential invasive and non-invasive investigations for cervical cancer diagnosis. Therefore, we aimed to determine the impact the COVID-19 pandemic had on cancer diagnosis and management in western Romania. A retrospective study design allowed us to compare the last 24 months of the pre-pandemic period with the first 24 months of the COVID-19 pandemic to determine the change in volume of cervical screening tests, the number of newly diagnosed cases and their severity, and the access to cancer care. A drastic 75.5% decrease in the volume of tests was observed in April 2020 during the first lockdown, after which the volume of cases decreased by up to 36.1% in December 2021. The total volume loss of tests during the first 24 months of the pandemic was 49.9%. The percentage of late-stage cervical cancers (III–IV) rose by 17%, while the number of newly diagnosed cancers in our outpatient clinic was significantly lower than the baseline, with a 45% drop. The access to cancer care was negatively influenced, with 9.2% more patients waiting longer to receive test results over four weeks, while taking longer to seek cancer care after diagnosis (6.4 months vs. 4.1 months pre-pandemic) and missing significantly more appointments. The COVID-19 pandemic had a significantly negative impact on cervical cancer diagnosis and management during the first 24 months compared with the same period before the pandemic. Although the numbers are now recovering, there is still a big gap, meaning that many cervical cancer cases were potentially missed. We recommend further interventions to reduce the gap between the pre-pandemic and pandemic period.

Using the NYHA Classification as Forecasting Tool for Hospital Readmission and Mortality in Heart Failure Patients with COVID-19

During the COVID-19 pandemic, it was observed that patients with heart disease are more likely to be hospitalized and develop severe COVID-19. Cardiac disease takes the top position among patient comorbidities, heart failure (HF) prevalence reaching almost 5% in the general population older than 35 years in Romania. This retrospective study aimed to determine the potential use of the NYHA classification for HF in hospitalized patients with COVID-19 as prognostic tool for in-hospital mortality, length of hospitalization, and probability of rehospitalization for HF decompensation. We observed that patients with advanced HF had a history of significantly more comorbid conditions that are associated with worse disease outcomes than the rest of patients classified as NYHA I and II. However, regardless of existing diseases, NYHA III, and, especially, NYHA IV, patients were at greatest risk for mortality following SARS-CoV-2 infection. They required significantly longer durations of hospitalization, ICU admission for mechanical ventilation, and developed multiple severe complications. NYHA IV patients required a median duration of 20 days of hospitalization, and their in-hospital mortality was as high as 47.8%. Cardiac biomarkers were significantly altered in patients with SARS-CoV-2 and advanced HF. Although the study sample was small, all patients with NYHA IV who recovered from COVID-19 required a rehospitalization in the following month, and 65.2% of the patients at initial presentation died during the next six months. The most significant risk factor for mortality was the development of severe in-hospital complications (OR = 4.38), while ICU admission was the strongest predictor for rehospitalization (OR = 5.19). Our result highlights that HF patients continue to be vulnerable post SARS-CoV-2 infection. Physicians and policymakers should consider this population’s high likelihood of hospital readmissions when making discharge, hospital capacity planning, and post-discharge patient monitoring choices.

Determinants of COVID-19 Vaccination Hesitancy among Romanian Pregnant Women

Universal COVID-19 immunization is seen as a critical approach for limiting the spread of SARS-CoV-2 and reducing the danger of new variations emerging in the general population, especially in pregnant women. The literature and accessible research data indicate that vaccination intentions vary greatly by country, with Romania ranking among the European nations with the lowest vaccination rates. Thus, we aimed to investigate the prevalence and extent of COVID-19 vaccine hesitancy among pregnant women in Romania and the factors influencing their decision. A cross-sectional study was conducted on pregnant women referred to the Obstetrics and Gynecology Clinic of the Timisoara Municipal Emergency Hospital in Romania. Participants were asked to complete the validated VAX scale about vaccine hesitancy and to report their willingness to receive a COVID-19 vaccine and their reasons for hesitancy. The group of 184 pregnant women who completed the survey recorded significantly more hesitant respondents than the non-pregnant group with 161 respondents (52.2% vs. 40.3%). They had significantly higher average scores in all VAX scale subsections, while 78.1% of them gave credits to social media for their COVID-19 vaccination decision, compared with 63.0% of non-pregnant women. The independent risk factors for hesitancy were determined as not being afraid of COVID-19 OR = 1.89, below-average income OR = 2.06, trusting social media rumors OR = 2.38, not believing in SARS-CoV-2 existence OR = 2.67, and being a vaccination non-believer OR = 3.15. We advocate for pregnant women to get vaccinated against COVID-19 and for the development of targeted campaigns to address the factors of hesitation. This research emphasizes the critical need for delivering the COVID-19 immunization to the whole community, including pregnant women who may have vaccine-related concerns.