Septic arthritis in a tertiary care hospital

To study the epidemiological features of septic arthritis in the adult population and to identify the risk factors for mortality in septic arthritis. A five year reterospective study was performed on cases with septic arthritis admitted in our hospital between January 1999 and December 2004. Patients were identified according to ICD codes, 711.00. Data was recorded on a standardized data sheet and analyzed by SPSS 11.5 software. A total of 116 patients were identified, 69 were male [59.5%] and 47 female [40.55%]. Mean age of patients was 49.22 years. The most common presenting clinical features were joint swelling [99.1%] and fever [60.3%], Knee joint was the most common joint involved [65.5%] followed by hip [11.2%]. Gram stains of synovial fluid was done in 67.2% of cases out of which 22.4% had positive stains. Staphylococcus aureus was the most common organism isolated from blood as well as synovial fluid [18.8%]. Mean haemoglobin was 10.83gm/dl and 57.8% of patients had total leukocyte count less than 11,000/cumm. Platelet count was greater than 150,000/cumm in 90.5% patients. Hypertension, renal failure, chronic liver disease and elevated ESR were identified as some of the potential risk factors for higher mortality in a cohort with septic arthritis. Septic arthritis is associated with significant morbidity and mortality. These results highlight the importance of obtaining cultures before starting any treatment

Proteinuria: The primary care approach

Proteinuria is a common finding on urinalysis and can occur in several conditions, ranging from benign to serious disorders. It is important to distinguish benign forms of proteinuria from proteinuria due to disorders which can cause permanent damage to the kidney or even death, if not diagnosed and treated appropriately. In renal insufficiency proteinuria is not only a marker of renal disease but it also predicts those patients at greatest risk for the development of chronic and progressive renal insufficiency. This effect of proteinuria on the progression of renal disease is independent of other risk factors. Abnormal increase in the urinary protein has also been linked to increased cardiovascular disease. It is therefore clear that proteinuria can be a serious manifestation of several diseases and methodical approach is required for appropriate management of patients with proteinuria

MRSA Septic Polyarthritis: a case report and review of literature

A 45-year-old male patient with history of hypertension and diabetes mellitus was admitted to the hospital because of increasing erythema and swelling of left elbow, bilateral wrist, right knee and right ankle joints of two weeks duration. He had undergone amputation of his left big toe two months prior to presentation, which was complicated by wound infection and poor healing. He had been treated with multiple courses of empiric oral and intravenous antibiotics to control the local infection. On examination, the patient's temperature was 102 F, pulse rate was 90 beats per minute, and blood pressure was 160/90 mm Hg and respiratory rate 20 per minute. There was significant tenderness, swelling and erythema of both wrists. Left knee and ankle appeared markedly swollen and tender with severe limitation of movement. Left big toe wound looked infected with purulent drainage. Synovial fluid aspirate from right wrist and knee showed numerous pus cells and gram-positive cocci on Gram stain. The culture grew S. aureus resistant to methicillin but sensitive to vancomycin, teicoplanin, chloramphenicol and fusidic acid. Three consecutive blood cultures also grew colonies of S. aureus. Therefore the diagnosis of MRSA septic polyathritis was made