WFH Guidelines for the Management of Hemophilia, 3rd edition Srivastava, Alok; Santagostino, Elena; Dougall, Alison ...
Haemophilia : the official journal of the World Federation of Hemophilia,
August 2020, 2020-08-00, 20200801, 2020-08-01, Letnik:
26, Številka:
S6
Journal Article
A survey of the American Association of Hip and Knee Surgeons (AAHKS) reported that 95% of respondents attempted to modify risk factors prior to arthroplasty. This study investigated Indian ...arthroplasty surgeons’ approach to patients who have modifiable risk factors.
The AAHKS survey tool was adapted for Indian surgeons and distributed to the membership of the Indian Society of Hip and Knee Surgeons and Indian Arthroplasty Association via a Survey Monkey. A total of 92 survey responses were received, representing a response rate of 12%.
Overall, 87% of respondents restricted access to arthroplasty surgery for patients who have modifiable risk factors, but only 51% of respondents reported delays or restricted treatment because of risk factors. Respondents reported that financial implications were more likely to delay or restrict treatment in 97% and social/family reasons in 66%. Poor diabetic control (81%), previous infection (57%), and malnutrition/hypoalbuminemia (47%) were the most frequent modifiable risk factors. There were 82% of surgeons reporting that the patient’s socioeconomic status influenced treatment including: 71% of patients who have low socioeconomic status, 57% who do not have insurance, and 45% who have limited social supports. Most surgeons (92%) reported that funding influenced the type of care provided and the choice of implants.
Over 97% of Indian arthroplasty surgeons thought socioeconomic factors impaired access to orthopaedic treatment. Only half the surgeons restricted access for comorbidities and these were more often related to infection risks and diabetes. These findings contrast dramatically to the practice patterns of American AAHKS members.
Treatment in hemophilia is designed to reduce bleed frequency, minimize joint damage, and maximize functional independence and quality of life. Therefore, success of a factor replacement protocol is ...usually gauged by its ability to produce near "normal joints"-without any significant pathology. The most commonly used outcome measurement tools are based on the radiological and clinical assessment of joint arthropathy. To improve the sensitivity to early changes, the clinical scores have been refined, and imaging based on magnetic resonance imaging and ultrasonography has been initiated. Although these scores are useful in assessing the structure and function of a joint, they do not consider the impact of arthropathy on overall musculoskeletal function. They are also not capable of assessing the efficacy of interventions on functional independence, participation in life activities, and quality of life. The development of functional scores such as the Functional Independence Score for Hemophilia, the pediatric Hemophilia Activities List, and some quality of life measurement tools have helped provide a more comprehensive assessment of health. This article describes the psychometric properties and limitations of the various clinimetric tools that are used to assess musculoskeletal outcome in hemophilia and suggests an algorithm for their use in clinical practice.
Objective: The aim of this study is to characterise the clinical and microbiological profile of adult patients treated at our orthopaedic unit with septic arthritic between 2006 and 2017. Materials ...and Methods: A total of 70 patients who were admitted with a diagnosis of septic arthritis between 2006 and 2017 were included in the study. The patients’ clinical and epidemiological characteristics were surveyed; microbiological profile and the complications relating to the patients’ treatment were identified. Results: Septic arthritis was more common among males (83%). About 75% of the patients presented with a history of fever. The knee was the most commonly affected joint (71%), followed by the hip. While C-reactive protein was found to be consistently >75, total blood white blood cell (WBC) counts were found not to be reflective of the presence of infection with a mean WBC count of only 13,561/cu.mm, and Gram stain examination had a poor sensitivity of 47%. Among the co-morbidities, the most prevalent association was with diabetes mellitus. The infectious agent most frequently isolated was Staphylococcus aureus (42.85%). The antibiotic sensitivity pattern has evolved since the early years, with resistant strains becoming increasingly prevalent. Unusually, high incidence of streptococci was noted (30%), contrary to the published literature. One-third of the patients had multi-resistant organisms. Septic arthritis left 70% of the patients with a significant residual disability at 6 months follow-up and had 4.25% mortality. Conclusion: Changing sensitivity patterns of microbes in septic arthritis point to a need for reconsidering empirical antibiotic therapy. Joint damage following infection can lead to significant disability.
Background: Knowledge of the local microbiological epidemiology helps in formulating protocols for appropriate treatment of hip infections. The aim of this study was to profile the organisms cultured ...from infected hips. Methods: The microbiological profile and sensitivity pattern of organisms in eighty infected hips were reviewed. Results: Infection was secondary to arthroplasty in 35, fracture surgery in 34 and primary septic arthritis in 11. Twenty percent of the infections were polymicrobial, whereas the rest were monomicrobial. Fifty-five percent were Gram-positive, of which 45% were Staphylococcus species (36% methicillin-sensitive Staphylococcus aureus, 20% methicillin-resistant S. aureus, and 44% coagulase sensitive Staphylococcal species). All Staphylococcus species were sensitive to vancomycin, but 20% of Enterococcus species were resistant to vancomycin. One-third of the Enterococcus species and 2% of Staphylococcus species were resistant to teicoplanin. Escherichia coli (n = 10) and Pseudomonas sp. (n = 13) were the most common Gram-negative organism. Although 18% of the Gram-negative organisms were carbapenem resistant, all were sensitive to colistin. Conclusion:Staphylococcus sp. was the most common pathogen found in hip infections. However, the high incidence of Gram-negative infection requires that prophylactic antibiotics cover these organisms as well. The high resistance to first-line antibiotics should be taken into consideration while making protocols. The knowledge of the microbial profile is especially important when considering arthroplasty for arthritis secondary to hip infections.
An uncommon cause of polyarthralgia Soumya, Sudarsanababu; Cherian, Kripa; Gupta, Riddhi ...
Journal of family medicine and primary care,
05/2019, Letnik:
8, Številka:
5
Journal Article
Recenzirano
Odprti dostop
Tumour induced osteomalacia (TIO) is a paraneoplastic syndrome characterized by renal phosphate wasting and hypophosphatemic osteomalacia, caused by FGF-23 (Fibroblast growth factor-23) producing ...mesenchymal tumours. Here, we report the case of a 40 year old lady referred by her family physician for multiple joint pains of 2 years duration. There was no evidence of inflammatory arthritis. Biochemical investigations revealed low phosphorus, with raised alkaline phosphatase and high levels of FGF-23. As a TIO was considered likely, functional imaging with a DOTATATE PET scan was done, which revealed a DOTA avid lesion in the right foot. Following surgical excision of the tumour, there was significant relief in symptoms and gradual recovery of phosphate to normal levels. It is relevant and important for family physicians as in subjects with symptom like polyarthralgia, a simple measurement of analytes like phosphate, calcium and alkaline phosphatase in primary care setting will help to arrive at a cause and referral for further evaluation as this condition is potentially treatable.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Background
Schatzker type V and VI tibial fractures are complex injuries, usually treated with open reduction and internal fixation (ORIF) using dual plates or ring fixators. ORIF has the advantage ...of not requiring pin tract care, but has a higher infection rate, especially in open fractures. We have combined the advantages of these two methods to treat these difficult fractures.
Materials and Methods
Ten Schatzker type V and 11 Schatzker type VI fractures were treated between 2006 and 2010. ORIF with dual plates was performed, only if there was marked articular displacement (> 2 mm) in a closed fracture. All other fractures including open fractures and closed fractures with soft tissue compromise or minimal articular displacement were treated with ring fixators. The outcomes were analyzed and documented using the Honkonen and Jarvinen subjective, clinical, functional, and radiological criteria and the Western Ontario and McM aster Universities Arthritis Index (WOMAC).
Results
Nine closed fractures with marked articular displacement (> 2 mm) were treated with dual plates. Eight closed fractures with minimal articular displacement (< 2 mm) and poor skin condition and four open fractures were treated with ring fixators. The mean follow-up period was 2 ½ years. The mean postoperative knee flexion was 128°. All patients could walk, jump, and climb steps. 90% could squat, though only 50% could duck walk properly. Radiologically, 85% had a plateau tilt of less than 5°, 92% had an articular step of less than 2 mm, and a residual articular widening of less than 5 mm. There were no major infections. Two patients had minor pin tract infections and two requested that their plates be removed subsequently.
Conclusion
The protocol used to treat Schatzker type V and VI tibial plateau fractures has had excellent results and we suggest that all open fractures be treated with ring fixators and that ORIF should be done only for closed fractures with marked displacement.
Treatment of hemophilia aims to minimize structural damage to joints and maximize patients' functional independence and quality of life. From an orthopedic perspective, treatment efficacy can be ...judged by quantifying the extent of musculoskeletal damage. Joint scores--both clinical and radiologic--have traditionally been measured in patients with hemophilia. However, such scores may lack the sensitivity to detect early changes in the hemophilic joint, and this has prompted the development of more sensitive measures. In addition, scores based on the status of individual joints do not consider the impact of arthropathy on overall musculoskeletal function. It would prove valuable to understand the implications of small differences in clinical/radiologic scores in terms of overall musculoskeletal function and patients' quality of life. The development of functional scores such as the Functional Independence Score for Haemophilia (FISH) and the Haemophilia Activities List (HAL), along with the quality-of-life (QoL) measurement tools, have helped to provide a more comprehensive assessment of health in hemophilia. Such improved understanding should assist with the development of contextually relevant guidelines for the management of hemophilia.
Abstract Introduction Epidemiologic data on the incidence of venous thromboembolism (VTE) in Indian population vary widely. Most studies show that the incidence of VTE is lower in Asian patients than ...in Western population. Screening tools to identify high-risk patients should enable us to reduce this complication. Methods The incidence of VTE in 101 patients who underwent knee or hip arthroplasty, or surgery for hip fractures, without chemoprophylaxis for deep vein thrombosis (DVT) was documented. Diagnosis of DVT was made with Duplex ultrasonography. We also assessed the usefulness of pre-operative assessment of the hypercoagulable status of the patient in predicting the occurrence of VTE, using the Thrombelastography (TEG) test. Results The incidence of DVT in the study population was 7%. Six of the 7 patients who developed DVT had surgery for hip fractures, while one had knee replacement. The thrombus was above the knee joint level in 6 of the 7 patients. Pre-operative TEG was positive in only one of the 7 patients, but was positive in 37 of the remaining 94 patients. Conclusion Incidence of DVT in the study population is sufficiently high to recommend some form of prophylaxis to prevent VTE following hip and knee surgery. Pre-operative assessment of the patients’ coagulation status with Thrombelastography does not predict the risk of VTE. The use of other lab parameters that could help in selective chemoprophylaxis needs to be explored.
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