ABSTRACT
Aim: The aim of this paper is to review the pathophysiology, risk factors, prevention and treatment of osteoporosis in persons with hemophilia (PWH). Study Design and Methodology: In a search of PubMed up to September 24, 2013 using as keywords "osteoporosis" and "hemophilia" the author found 61 references, of which only the 22 focused on the aim of this study were revised. Results: Prevention of osteoporosis in PWH is crucial. Risk factors are lack of hematological prophylaxis and development of an inhibitor (antibody) against the deficient coagulation factor, lack of exercise due to chronic pain and loss of joint function (hemophilic arthropathy), low body mass index and abnormal liver function because of viral infection (HIV, HCV). It has not been demonstrated that hemophilia has any effect on osteoclast development and/or osteoblast loss. Hemophilia does not impair mineral Ca/P/K mobilizations and metabolisms. Hemophilia does not have any general effects on the endocrine system. Substitution treatment with clotting factors does not interfere with the treatment of osteoporosis. Conclusion: Continuous primary hematological prophylaxis and rehabilitation and exercise are paramount in PWH. PWH over the age of 50 should have routine screening for detection of osteoporosis. In PWH prevention should encourage good habits (such as a diet adequate in calcium and vitamin D) and discourage harmful habits (such as tobacco, alcohol and immobilization). Osteoporosis is multi-facial. Osteoporosis ought to be promptly treated regardless of the underlying cause.
ABSTRACT
Fractures of the femoral shaft are mostly the result of high-energy accidents that also cause multiple trauma injuries, in particular ipsilateral knee and hip injuries. The purpose of this study was to investigate the incidence of injuries associated with femoral shaft fractures and how many of them were undetected. We studied 148 patients [150 femoral shaft fractures] with an average age of 52 [range: 18-97]. Femoral shaft fractures were treated with antegrade intramedullary nailing in 118 cases [78.7%], and with open reduction and internal fixation in 32 cases [21.3%]. Unlocked reamed intramedullary nailing was performed in Winquist type I and type II fractures, while statically locked unreamed intramedullary nailing was carried out in Winquist type III and type IV fractures. There were 70 patients with associated injuries [46.4%]. The associated injuries went undetected in 18 out of 70 patients [25.5%]. Six femoral nonunions [4%] occurred in patients under 70 years of age [high-energy accidents] treated by open reduction and internal fixation. Injuries associated with femoral shaft fractures were very frequent [46.4%] in our series, with 25.5% undetected. Open reduction and internal fixation was a poor prognostic factor of nonunion in these fractures
ABSTRACT
Se compararon 4 métodos coproparasitológicos para determinar la prevalencia de Strongyloides stercoralis. Se analizaron 100 muestras fecales de individuos con edades comprendidas entre 1 y 50 años, de la comunidad de San Juan de Macarapana, municipio Sucre estado Sucre, Venezuela; encontrándose una prevalencia del 24 por ciento, correspondiente al diagnóstico por el cultivo de heces en placas de agar, mientras que por el método directo, el método de Ritchie modificado y el método de Baermann modificado se detectó la presencia de Strongyloides stercoralis en un 13,5 y 16 por cineto de las muestras, respectivamente. El grupo etario más afectado fue el de los niños menores de 10 años (83,33 por ciento), de los cuales el 80 por ciento pertenecían al sexo masculino. En conclusión, el cultivo de heces en placas de agar fue el más sensible para el diagnóstico de Strongyloides stercoralis, y permitió clasificar a San Juan de Macarapana como un área hiperendémica (>5 por ciento) de estrongiloidiasis.