Tranexamic acid (TXA) is an antifibrinolytic agent that has been shown to decrease blood loss and transfusion rates after knee and hip arthroplasty, however with only limited evidence to support its use in shoulder arthroplasty. Therefore, we performed a systematic review and meta-analysis to evaluate the clinical usefulness of tranexamic acid for shoulder arthroplasty. A thorough literature search was conducted across four electronic databases (PubMed, Cochrane Library, Web of Science, Scopus) from inception through to 1 December 2021. The mean difference (MD), odds ratio (OR) or relative risk (RR) and 95% confidence interval (CI) were used to estimate pooled results from studies. Total of 10 studies comprising of 993 patients met the inclusion criteria and were included in the analysis. Blood volume loss in the TXA and non-TXA group was 0.66 ± 0.52 vs. 0.834 ± 0.592 L (MD= −0.15; 95%CI: −0.23 to −0.07; p < 0.001). Change of hemoglobin levels were 2.2 ± 1.0 for TXA group compared to 2.7 ± 1.1 for non-TXA group (MD= −0.51; 95%CI: −0.57 to −0.44; p < 0.001) and hematocrit change was 6.1 ± 2.7% vs. 7.9 ± 3.1%, respectively; (MD= −1.43; 95%CI: −2.27 to −0.59; p < 0.001). Tranexamic acid use for shoulder arthroplasty reduces blood volume loss during and after surgery and reduces drain output and hematocrit change.
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Recreational diving is becoming an increasingly popular physical activity around the world. The vast majority of people who practice scuba diving are amateurs, often being treated for a number of chronic diseases and having cardiovascular burdens. Due to the high prevalence of diabetes mellitus in the world population and the potential for dangerous complications during diving, there is a need for unified recommendations for safe diving with this condition. Current guidelines from international diving associations are not entirely consistent. This review presents the positions of international diving associations concerning the requirements for diving with diabetes, the scope of diving and recommended management of life-threatening conditions during the dive.
Cardiovascular diseases such as coronary artery disease, hypertension, and diabetes are some of the most common conditions among the population. An ever-increasing number of recreational divers forces us to consider the impact on unprepared diving patients with cardiovascular diseases, in whom profound changes occur during the dive. People in at-risk groups should have a medical check-up before diving to minimise the risk of possible complications.
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