Factores asociados con rigidez de las articulaciones del hombro y la cadera en adultos mayores / Factors associated with stiffness of the shoulder and hips joints in the elderly

Introducción: mantener el nivel adecuado de flexibilidad en la edad adulta es importante para realizar las actividades básicas de la vida diaria; sin embargo, esta puede verse afectada negativamente por distintos factores, como el sedentarismo, la artrosis, la diabetes y el estado emocional. Objetivo: analizar la prevalencia de la rigidez en las articulaciones del hombro y coxofemoral, con factores asociados en los adultos mayores de la ciudad de Cuenca, Ecuador. Metodología: estudio analítico transversal con una muestra de 160 adultos mayores de las residencias geriátricas de la ciudad de Cuenca, Ecuador. La información se recolectó aplicando dos tests que valoran la flexibilidad, incluidos en la batería Senior fitness test (SFT): el Back scratch (TBS) y el test Chair sit and reach (TCSAR), para valorar el grado de rigidez de las articulaciones del hombro y coxofemoral. El nivel de actividad física se evaluó utilizando el test Rapid Assessment of Physical Activity (RAPA), y se utilizaron el test Yesavege para valorar el grado de depresión y la historia clínica de cada paciente, para conocer antecedentes de diabetes mellitus o artrosis. Se analizaron los datos con el programa SPSS versión 20.0®, por medio de medidas de frecuencia, dispersión, análisis bivariado (OR, IC, valor P). Resultados: se evidenció la inactividad física como factor de riesgo importante para padecer rigidez de articulación del hombro p=0,023, articulación coxofemoral p<0,001; además, la artrosis como factor de riesgo para rigidez en miembros superiores. La pre-valencia de rigidez articular fue de 40,6% en miembros inferiores y el 70,6%en los miembros superiores. Conclusión: los hallazgos de esta investigación corroboran que la inactividad física pue-de llevar a la pérdida progresiva de la flexibilidad en adultos mayores, con disminución en el rango de movimiento articular y limitación funcional. (AU)

Introduction: maintaining the appropriate level of flexibility in adulthood is important to carry out the basic activities of daily life; however, this can be negatively affected by different factors, such as a sedentary lifestyle, osteoarthritis, diabetes and emotional state. Objective: to analyze the prevalence of stiffness in the shoulder and coxofemoral joints, with associated factors in older adults in the city of Cuenca, Ecuador. Methodology: cross-sectional analytical study with a sample of 160 older adults from nursing homes in the city of Cuenca. The information was collected by applying two tests that assess flexibility, included in the senior fitness test (SFT) battery: the back scratch (TBS) and the chair sit and reach test (TCSAR), to assess the degree of stiffness of the knee joint. shoulder and coxofemoral. The level of physical activity was evaluated using the Rapid Assessment of Physical Activity (RAPA) test, the Yesavege test was used to assess the degree of depression and the clinical history of each patient to determine a history of diabetes mellitus or osteoarthritis. The data were analyzed with the SPSS version 20.0 program, through measures of frequency, dispersion, and bivariate analysis (OR, CI, P value). Results: physical inactivity was evidenced as an important risk factor for shoulder joint stiffness p=0.023, coxofemoral joint p=<0.001; in addition, osteoarthritis as a risk factor for stiffness in the upper limbs. The prevalence of joint stiffness was 40.6% in the lower limbs and 70.6% in the upper limbs. Conclusion: the findings of this research corroborate that physical inactivity can lead to progressive loss of flexibility in older adults, with decreased range of joint movement and functional limitation. (AU)

Effect of chemokines CXCL9 and CXCL10 on bone erosion in patients with rheumatoid arthritis / 北京大学学报(医学版)

OBJECTIVE@#To detect the serum level of soluble chemokines CXCL9 and CXCL10 in patients with rheumatoid arthritis (RA), and to analyze their correlation with bone erosion, as well as the clinical significance in RA.@*METHODS@#In the study, 105 cases of RA patients, 90 osteoarthritis (OA) patients and 25 healthy controls in Peking University People's Hospital were included. All the clinical information of the patients was collected, and the serum CXCL9 and CXCL10 levels of both patients and healthy controls were measured by enzyme-linked immune sorbent assay (ELISA). CXCL9 and CXCL10 levels among different groups were compared. The correlation between serum levels with clinical/laboratory parameters and the occurrence of bone erosion in RA were analyzed. Independent sample t test, Chi square test, Mann-Whitney U test, Spearman's rank correlation and Logistic regression were used for statistical analysis.@*RESULTS@#The levels of CXCL9 and CXCL10 were significantly higher in the RA patients [250.02 (126.98, 484.29) ng/L, 108.43 (55.16, 197.17) ng/L] than in the OA patients [165.05 (75.89, 266.37) ng/L, 69.00 (33.25, 104.74) ng/L] and the health controls [79.47 (38.22, 140.63) ng/L, 55.44 (18.76, 95.86) ng/L] (all P < 0.01). Spearman's correlation analysis showed that the level of serum CXCL9 was positively correlated with swollen joints (SJC), rheumatoid factor (RF) and disease activity score 28 (DAS28) (r=0.302, 0.285, 0.289; P=0.009, 0.015, 0.013). The level of serum CXCL10 was positively correlated with tender joints (TJC), SJC, C-reactive protein (CRP), immunoglobulin (Ig) A, IgM, RF, anti-cyclic citrullinated peptide antibody (ACPA), and DAS28 (r=0.339, 0.402, 0.269, 0.266, 0.345, 0.570, 0.540, 0.364; P=0.010, 0.002, 0.043, 0.045, 0.009, < 0.001, < 0.001, 0.006). Serum CXCL9 and CXCL10 levels in the RA patients with bone erosion were extremely higher than those without bone erosion [306.84 (234.02, 460.55) ng/L vs. 149.90 (75.88, 257.72) ng/L, 153.74 (89.50, 209.59) ng/L vs. 54.53 (26.30, 83.69) ng/L, respectively] (all P < 0.01). Logistic regression analysis showed that disease duration, DAS28 and serum level of CXCL9 were correlated with bone erosion in the RA patients (P < 0.05).@*CONCLUSION@#Serum levels of CXCL9 and CXCL10 were remarkably elevated in patients with RA, and correlated with disease activities and occurrence of bone erosion. Chemokines CXCL9 and CXCL10 might be involved in the pathogenesis and bone destruction in RA.

Open versus laparoscopic appendicectomy in acute appendicitis: results of a district general hospital

Background:Despite multiple studies comparing the two methods, the real advantages of laparoscopic appendicectomy (LA) compared to open appendicectomy (OA) are still unclear. Purpose of the current study was to compare the results between the two techniques in a district general hospital.Methods:The electronic records of all patients who underwent OA or LA in a one year period were reviewed retrospectively. The comparative data points assessed included age, gender, overall complications, length of stay and Clavien-Dindo Classification of Surgical Complications, including the rates of the main types of complications. Results:300 patients were included in the study. 166 patients underwent OA and 134 patients LA. Postoperative complications were documented in 26 patients (8.7%). LA was employed predominantly in female patients (p = 0.004) and in older patients (p = 0.0015) and was associated with significantly more negative appendicectomies than OA (p = 0.002). No statistically significant difference was noted with regards to the length of hospital stay (p = 0.577), overall postoperative morbidity (p = 0.543) and grading of complications (p = 0.460). Finally, following comparison of the incidence of specific types of complications, only wound infections were significantly different, in favour of LA.Conclusions:LA is safe and effective, however, besides the lower incidence of wound sepsis, demonstrates no clear advantage over OA. The selection between OA and LA should thus be tailored to the clinical scenario and the surgeon's preference

Determinants of quality of life in Paget's disease of bone / Determinantes da qualidade de vida na doença de Paget óssea

Abstract Objective: To evaluate the parameters associated with quality of life in patients with Paget's disease of bone. Methods: Patients with Paget's disease of bone were evaluated with SF-36 and WHOQOL-bref questionnaires. Patients with other diseases that could cause significant impairment of their quality of life were excluded. We searched for correlations between the results and: age, time from diagnosis, type of involvement, pain related to Paget's disease of bone, limitation to daily activities, deformities, bone specific alkaline phosphatase, the extent of involvement and treatment. Results: Fifty patients were included. Results of the SF-36 total score and its domains, physical and mental health, were significantly correlated with bone pain and deformities. Marital status was significantly correlated with the SF-36 total score and Mental Health Domain. BAP levels and disease extension were significantly correlated to SF-36 Physical Health Domain. After multivariate analysis, the only parameters that remained significantly associated with the SF-36 total score and to its Mental Health and Physical Health Domains were pain and marital status.The WHOQOL-bref total score was significantly associated with pain, physical impairment and deformities. WHOQOL-bref Domain 1 (physical) score was significantly associated with marital status, pain and deformities, while Domain 2 (psychological) score was associated with marital status, physical impairment and kind of involvement. After multivariate analysis, the presence of pain, deformities, and marital status were significantly associated with results of the WHOQOL-bref total score and its Domain 1. WHOQOL-bref domain 2 results were significantly predicted by pain and marital status. Conclusion: The main disease-related factor associated with SF-36 results in Paget's disease of bone patients was bone pain, while bone pain and deformities were associated with WHOQOL-bref.

Resumo Objetivo: Avaliar os parâmetros associados à qualidade de vida em pacientes com doença de Paget óssea (DPO). Métodos: Avaliaram-se pacientes com DPO com os questionários SF-36 e WHOQOL-bref. Excluíram-se pacientes com outras doenças que pudessem causar comprometimento significativo da qualidade de vida. Buscou-se por correlações entre os resultados e idade, tempo de diagnóstico, tipo de envolvimento, dor relacionada com a DPO, limitação às atividades diárias, deformidades, fosfatase alcalina específica do osso, extensão do envolvimento e tratamento. Resultados: Incluíram-se 50 pacientes. Os resultados da pontuação total do SF-36 e seus domínios, saúde física e saúde mental, se correlacionaram significativamente com a dor óssea e deformidades. O estado civil se correlacionou significativamente com a pontuação total do SF-36 e com seu domínio saúde mental. Os níveis de BAP e a extensão da doença se correlacionaram significativamente com o domínio saúde física do SF-36. Depois da análise multivariada, os únicos parâmetros que permaneceram significativamente associados à pontuação total do SF-36 e aos seus domínios saúde mental e saúde física foram a dor e o estado civil. A pontuação total do WHOQOL-bref esteve significativamente associada à dor, ao comprometimento físico e a deformidades. O escore do Domínio 1 (físico) do WHOQOL-bref esteve significativamente associado ao estado civil, dor e deformidades, enquanto o Domínio 2 (psicológico) esteve associado ao estado civil, comprometimento físico e tipo de envolvimento. Depois da análise multivariada, a presença de dor, deformidades e estado civil esteve significativamente associada à pontuação total do WHOQOL-bref e à pontuação do seu Domínio 1. Os resultados do WHOQOL-bref 2 foram significativamente preditos pela dor e pelo estado civil. Conclusão: O principal fator associado aos escores do SF-36 foi a dor óssea, enquanto a dor óssea e as deformidades estiveram associadas ao WHOQOL-bref.

Revisión de artroplastia total de cadera: epidemiologia en base a 10 años de experiencia / Review total hip arthroplasty: epidemiology based on 10 years of experience

A medida que la prevalencia de la artrosis aumenta, en una población cada vez más longeva y con una expectativa de vida mayor, el número de artroplastias totales de cadera, aumenta proporcionalmente. Cuando las principales complicaciones de un remplazo total de cadera ocurren como son el aflojamiento mecánico, la infección y la inestabilidad, la artroplastia de revisión se erige como la principal alternativa de solución. El propósito del siguiente estudio fue determinar el número de revisiones de artroplastias de cadera realizadas en un período de 10 años, principales características demográficas de la población, causas de revisión, así como las principales complicaciones del procedimiento. Se realizó una revisión retrospectiva que incluían 121 pacientes sometidos a revisión de artroplastia de cadera, la mayoría de pacientes del sexo femenino con 65,29%. El promedio de edad fue de 65,09 años. La revisión de ambos componentes se realizó en 71,07% de los casos. La causa de revisión más común fue el aflojamiento aséptico en el 52,07% de los pacientes. La principal complicación fue la infección superficial. Es evidente que la artroplastia de revisión de cadera es un procedimiento cada vez más frecuente, por lo que es necesario identificar las principales causas de la misma, a fin de realizar las correcciones necesarias a la hora del remplazo primario para minimizar dichas fallas(AU)

As the prevalence of osteoarthritis increases by an increasingly aging population and longer life expectancy, the number of total hip replacements increased proportionally. When the major complications of total hip replacement occur as are the mechanical loosening, infection and inestability, revision arthroplasty stands as the main alternative solution. The purpose of this study was to determine the number of revisions of hip replacements performed over a period of 10 years, major demographic characteristics of the population, causes of revision and major complications of the procedure. A retrospective review that included 121 patients undergoing revision hip arthroplasty was performed; most female patients were reported with 65.29%. The average age was 65.09 years. The revision of both components was performed in 71.07% of cases. The most common cause of revision was aseptic loosening in 52.07% of patients. The main complication was superficial infection. Obviously the revision hip arthroplasty is an increasingly common procedure, so it is necessary to identify the main causes of it, to make the necessary corrections when the primary replacement to minimize such failures(AU)

Effect of Preexisting Musculoskeletal Diseases on the 1-Year Incidence of Fall-related Injuries / 예방의학회지

OBJECTIVES: People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea. METHODS: We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group. RESULTS: The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08). CONCLUSIONS: One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.

Infección osteoarticular por Kingella kingae en niños. Descripción de casos clínicos / Kingella kingae osteoarticular infections in children. Description of clinical cases

Kingella kingae es un bacilo gram negativo colonizador habitual del tracto respiratorio superior de niños menores de 5 años. En ocasiones puede originar infecciones sistémicas con especial afinidad por el sistema osteoarticular. Su baja expresividad clínica, la discreta alteración de los parámetros infecciosos y las dificultades en su aislamiento hacen que, a menudo, pueda ser subdiagnosticada. El aislamiento de Kingella kingae en dos niños con infecciones osteoarticulares en el intervalo de un año en la Asociación Española y la ausencia de casos notificados a nivel nacional hacen necesaria esta comunicación con una actualización del tema

Intervencionismo musculoesquelético en cuidados paliativos / Musculoskeletal interventionism on palliatives cares

El presente estudio descriptivo da cuenta de resultados en aplicación de intervencionismo para alivio del dolor musculoesquelético en enfermos con diagnóstico de cáncer terminal, pero que se mantienen activos, e ingresados a Unidad de Alivio del Dolor y Cuidados Paliativos del Hospital del Salvador en Santiago de Chile, entre los meses de julio del 2010 a marzo del 2011. Los principales diagnósticos causantes de dolor musculoesquelético fueron síndrome miofascial, artrosis y ambos diagnósticos combinados. Las técnicas usadas fueron infiltración de punto gatillo, infiltración intra-articular, o ambas. Los resultados mostraron disminución estadísticamente significativa en la intensidad del dolor en forma global en escala numérica, así como al analizar según tipo de intervención por separado. La media de duración del efecto fue de un mes en el caso de infiltración de puntos gatillo. Este tiempo podría constituir una ventana analgésica en pacientes con sobrevida limitada y controlaría el alza de analgésicos. Cuando el DME está presente, el uso de terapia intervencionista para DME podría ser una herramienta útil en Cuidados Paliativos, pero se requieren mayores estudios con mejor diseño estadístico para poder obtener conclusiones con mayor nivel de seguridad.

This descriptive study gives an account of results of interventionism implementation to the relief of musculoskeletal pain in patients that were diagnosed with terminal cancer; but have retained activity level, which are given they state of health at the Unit Pain Relief And Palliative Care at Hospital del Salvador in Santiago, Chile between the months of July 2010 to March 2011. The main causes of musculoskeletal pain diagnoses were Myofascial pain syndrome, arthritis and both combined conditions. The techniques used were trigger point infiltration, intra-articular joint infiltration or both together. The results showed statistical significant decrease in pain intensity on a numerical scale global, as well as the analysis by the type of separately intervention. The mean duration of effect was about a month in the case of infiltration of trigger points, this time window could be a survival analgesic in patients with limited and control the rise of analgesics. When the DME is present, the use of interventional therapy for DMA could be useful tool in palliative care, but require larger studies with better statistical design in order to draw conclusions with greater security.

Correlação de fadiga com dor e incapacidade na artrite reumatoide e na osteoartrite, respectivamente / Correlation of fatigue with pain and disability in rheumatoid arthritis and osteoarthritis, respectively

OBJETIVO: Investigar a correlação de fadiga com dor em pacientes com artrite reumatoide e de fadiga com incapacidade em pacientes com osteoartrite. MÉTODOS: Foram avaliados 20 pacientes com artrite reumatoide e 20 com osteoartrite. Fadiga foi avaliada com escala visual analógica e questionário de avaliação multidimensional de fadiga. Utilizou-se a escala visual analógica para avaliar dor e para a avaliação global da doença pelo paciente. Incapacidade foi avaliada pelo questionário de avaliação de saúde. Idade, gênero, duração da doença, escolaridade, renda mensal, uso de drogas antirreumáticas e comorbidades foram obtidos. A análise estatística incluiu teste exato de Fisher, Shapiro-Wilk, Kruskal-Wallis e Spearman. O nível de significância foi de 0,05. RESULTADOS: A fadiga mostrou-se significativamente aumentada na osteoartrite em comparação à artrite reumatoide quando se utilizou o questionário de avaliação multidimensional de fadiga (P < 0,05). Dor correlacionou-se com fadiga ao se utilizar a escala visual analógica ou o questionário de avaliação multidimensional de fadiga em artrite reumatoide (r = 0,46; P < 0,05). O questionário de avaliação de saúde foi associado à fadiga por escala visual analógica em osteoartrite (r = 0,54; P < 0,05). Avaliação global da doença pelo paciente correlacionou-se com fadiga pela escala visual analógica (r = 0,44; P < 0,003). Todas as pacientes eram mulheres, predominantemente idosas, com médias de idade semelhantes, longa duração de doença e baixa renda. CONCLUSÃO: Nossos resultados confirmam que em pacientes com artrite reumatoide a fadiga correlaciona-se com dor, enquanto em pacientes com osteoartrite ela associa-se à incapacidade. Portanto, fadiga tem diferentes correlatos em osteoartrite e artrite reumatoide. Sugerimos que incapacidade, e não dor, seja o correlato da fadiga em pacientes com osteoartrite.

OBJECTIVE: To investigate the correlation of fatigue with pain in rheumatoid arthritis patients and with disability in osteoarthritis patients. METHODS: Twenty patients with rheumatoid arthritis and 20 patients with osteoarthritis were evaluated. The degree of fatigue was evaluated with a visual analogue scale and the Multidimensional Assessment of Fatigue. Pain was evaluated with a visual analogue scale as well as Patient Global Assessment. For disability evaluation, the Health Assessment Questionnaire was performed. Age, gender, disease duration, education, income, antirheumatic drugs used and comorbidity were also obtained. Statistical analysis included Fisher exact, Shapiro-Wilk, Kruskal-Wallis and Spearman tests. The significance level was 0.05. RESULTS: Fatigue was more significantly increased in patients with osteoarthritis than in patients with rheumatoid arthritis when evaluated with Multidimensional Assessment of Fatigue (P < 0.05). Pain was found to correlate with fatigue evaluated with visual analogue scale or Multidimensional Assessment of Fatigue in patients with rheumatoid arthritis (r = 0.46; P < 0.05). Health Assessment Questionnaire was associated with fatigue visual analogue scale in patients with osteoarthritis (r = 0.54; P < 0.05). Patient Global Assessment correlates with fatigue visual analogue scale (r = 0.44; P < 0.003). Patients were similar in both groups: all females, similar mean age, with long disease duration and low income. CONCLUSION: Our results corroborate that fatigue in rheumatoid arthritis patients correlates with the degree of pain, while in osteoarthritis patients it is associated with disability. Therefore, we found that fatigue has different correlates in osteoarthritis and rheumatoid arthritis, and we suggest that disability, not pain, is a correlate of fatigue in osteoarthritis patients.

Comorbidades em pacientes com osteoartrite: frequência e impacto na dor e na função física / Comorbidities in patients with osteoarthritis: frequency and impact on pain and physical function

INTRODUÇÃO: Uma vez que a prevalência da osteoartrite (OA) aumenta com o envelhecimento, é comum a coexistência de outras doenças crônicas. OBJETIVOS: Avaliar a frequência de comorbidades em pacientes com OA e mensurar o impacto destas na dor e a função física nesses pacientes. MÉTODOS: Estudo transversal em pacientes portadores de OA do ambulatório de reumatologia do IMIP. A dor foi mensurada pela Escala Visual Analógica (EVA) e a função física pelos índices de Lequesne e SACRAH. Foi realizado um screening para depressão, além de aferição de medidas antropométricas, pressão arterial, dosagem da glicemia de jejum e perfil lipídico. RESULTADOS: Foram estudados 91 pacientes, com média de idade de 59,3 anos, sendo 91,4 por cento do sexo feminino. A frequência de síndrome metabólica foi de 54,9 por cento. Hipertensão arterial sistêmica ocorreu em 75,8 por cento dos casos, dislipidemia em 52,6 por cento e obesidade em 57,1 por cento. O screening para depressão foi positivo em 61,3 por cento dos pacientes. Quando comparamos individualmente os componentes da síndrome metabólica, observamos que pacientes com hipertensão apresentavam maiores escores no SACRAH com diferença estatisticamente significante (P = 0,035). Para as outras variáveis, não foram demonstradas diferenças entre os escores Lequesne, SACRAH e EVA. CONCLUSÃO: Foi observada uma alta frequência de depressão, síndrome metabólica e de seus componentes isoladamente nesse grupo de pacientes com OA, podendo haver impacto da presença destes na dor e na função física desses pacientes. Tais resultados demonstraram a necessidade de investigação e tratamento dessas comorbidades em pacientes com OA.

INTRODUCTION: As the prevalence of osteoarthritis (OA) increases with age, the coexistence of other chronic diseases is common. OBJECTIVES: To evaluate the frequency of comorbidities in OA patients and to measure their impact on pain and physical function of those patients. METHODS: Cross-sectional study in OA patients of a public rheumatology clinic. Pain was measured by use of the Visual Analogue Scale (VAS) and physical function by use of the Lequesne's and SACRAH indices. A screening for depression was performed, as were the following measurements: anthropometric data; blood pressure; fasting glycemia; and lipid profile. RESULTS: The study assessed 91 patients (mean age 59.3 years; 91.4 percent female). The metabolic syndrome frequency was 54.9 percent. Hypertension occurred in 75.8 percent of the patients, dyslipidemia in 52.6 percent, and obesity in 57.1 percent. The screening for depression was positive in 61.3 percent of patients. When comparing the metabolic syndrome components individually, patients with hypertension had higher SACRAH scores, with statistically significant differences (P = 0.035). For the other variables, no differences among the Lequesne's, SACRAH and VAS scores were observed. CONCLUSION: This group of OA patients showed a high frequency of depression, metabolic syndrome and its components in isolation, which can impact the pain and physical function of those patients. Such results showed the need for investigating and treating those comorbidities in OA patients.

Osteoarthritis in the neonate: risk factors and outcome

OBJECTIVES: The aim of this study was to identify the clinical, radiological, and bacteriological features, risk factors, and outcome of neonates with bone and joint infections. STUDY DESIGN: Observational, retrospective, and analytical study of 77 patients less than 2 months of age, admitted to a tertiary neonatal intensive care unit (NICU) with the diagnosis of bone or joint infection, based on clinical, radiological, and microbiological criteria. RESULTS: Seventy-seven patients with 99 acute osteoarthritis foci in a 16 year period were included in the study. Risk factors for infection could be identified in 69 percent of the patients. The hip was the most frequent. Staphylococcus aureus was the main isolated microorganism. Twenty-nine infants (38 percent) had sequelae. Hip involvement, culture positive, and Staphylococcus aureus isolation were risk factors associated with sequelae. CONCLUSION: Osteoarticular infection is unusual in the neonate; however it is associated with an elevated incidence of sequelae. This mandates for a high degree of suspicion to diagnose this potentially disabling entity.

Osteoartrose e atividade física / Osteoarthritis and physical activity

A atividade física desempenha papel importante no tratamento da coadjuvante da osteoartose.Intervenções com programas de exercícios mostraram impacto no tratamento da osteoartose de joelho em idosos.A inatividade física com osteoartose traz fraqueza,hipotrofia muscular,descondicionamento físico e dor,levando o indivíduo à incapacidade física em um ciclo vicioso.Atividade física é qualquer movimento do corpo com gasto energético maior que o repouso e exercício é uma forma mais elaborada dessa atividade,incluindo intensidade,frequência e duração.

Osteoartrite / Osteoarthritis

A osteoartrite (OA) é uma desordem articular que leva ao envolvimento global da articulação (osso subcondral, ligamentos, cápsula articular, membrana sinovial e músculos periarticulares). Os desfechos clínicos e patológicos de uma variedade de eventos biológicos e mecânicos levam à falência estrutural e funcional das articulações sinoviais. É a doença articular mais prevalente e é a principal causa de dor e desabilidade em indivíduos idosos. As alterações radiográficas são praticamente universais após os 60 anos de idade, mas as queixas clínicas ocorrem em torno de 20% dos pacientes. O diagnóstico é dado pelas queixas clínicas, os achados no exame físico e as alterações radiográficas. O tratamento atual é dividido em medidas não farmacológicas e farmacológicas.

Uso del fibroscopio en el manejo de la vía aérea de la espondiloartritis anquilopoyética: reporte de un caso / Use of the fiberscope in the management of the airway of the ankylopoietic spondylarthritis: a case report

La espodilitis anquilopoyética se caracteriza por brotes leves o moderados de espondilitis activa que alternan con períodos de inactivación total o casi total de la enfermedad con incapacidad. Se presenta el caso de una paciente sometida a artroplastia total de cadera derecha, ya que su enfermedad provocó una artrosis degenerativa de dicha cadera con incapacidad para la marcha. Por los test predictivos realizados por el personal experimentado durante el manejo de la vía aérea en el momento de la intubación a través del fibroscopio fue catalogada como vía aérea difícil.

The ankylopoietic spondylitis is characterized for mild or moderate outbreaks of active spondylitis that alternate with total or almost total periods of inactivación of the disease with incapacity. A case of a patient submitted to a total arthroplasty of the right hip is presented, since this disease caused to her a degenerative arthrosis of the said hip with incapacity for the march. Due to the predictable tests carried out by the experienced personnel during the management of the airway at the intubation moment through the fiberscope was catalogued as a difficult one.

Efectividad del tratamiento rehabilitador del síndrome cervical doloroso en pacientes que asistieron a consulta externa del Hospital Aldo Chavarría en el período de abril del 2007- a enero del 2008 / Effectiveness of rehabilitative treatment of cervical pain syndrome in patients who attended outpatient clinics of the Hospital Aldo Chavarria in the period April 2007 - January 2008

El dolor cervical, asociado o no a otros síntomas, es uno de los motivos más comunes de consulta en un departamento de Medicina Física y de Rehabilitación. Se realizó un estudio descriptivo, prospectivo, longitudinal y no probabilistico para evaluar la efectividad del tratamiento rehabilitador del síndrome cervical doloroso a través de la aplicación de la escala del dolor de Borg en pacientes que asistieron a consulta externa del Hospital Atdo Chavarría en el período de abril del 2007 a enero del 2008. De estos pacientes 65 fueron varones y 85 fueron mujeres. Las patologías que se encontraron frecuentes en el sexo masculino son las siguientes: 29 casos de contractura muscular, 26 casos de osteoartrosis cervical y 10 casos de radiculopatia cervical más osteoartrosis cervical. En el sexo femenino las patologías que se encontraron frecuentes fueron : 37 casos de contractura muscular, 23 casos de osteoartrosis cervical y 25 casos de radiculopatía cervical más osteoartrosis. Entre los síntomas del aparato locomotor relacionados con cervicalgia independientemente del sexo se hallá que había dolor irradiado a 1 ó 2 miembros superiores en 68 de los casos estudiados y parestesias en 1 6 2 miembros superiores en 63 de los casos. Había dolor lumbar en 15 de los casos y dolor dorsal en 5 de los pacientes. El síntoma dolor fue evaluado antes y después del tratamiento mediante la escala del dolor de Borg. Los cortes evaluativos se hicieron cada 5 sesiones de tratamiento siendo la número 15 la final. Se obtuvieron los siguientes resultados: al inicio del tratamiento se ubicaron en el nivel 6 a 11(7.3%) de los pacientes, en el nivel 7 a 52 (34%) de los pacientes, en el nivel 8 a 48 (32%) de los pacientes, en el nivel 9 a 23(15%) d elos pacientes y en el nivel 10 a16(10.6%) de los pacientes. El tratamiento rehabilitador fue efectivo para el 55.3% de lo pacientes que disminuyeron su dolor a nivel 0. Un 26 disminuyó el dolor al nivel 1 y el 13.3% refieren un dolor constante...

Pseudoartrosis atrófica infectada y acortamiento de pierna / Atrophic infected pserdoarthrosis and leg shortening: a clinical case

Se presenta el caso clínico de un paciente de 34 años con diagnóstico de pseudoartrosis atrófica infectada y acortamiento de pierna o pseudoartrosis tipo II (Paley), como complicación de fractura expuesta grado III-B (Gustilo)debida al traumatismo de alta energía. El caso representa un desafío para el ortopedista debido a pérdida ósea (10cm), acortamiento (7 cm), infección (Staphylococcus aureus), piel atrófica (11 cirugías previas) y rigidez articular parcial (rodilla-tobillo). Se realizó tratamiento según el método de Ilizarov con tutor circular híbrido que al ser multiplanar, logra la corrección simultánea del defecto, del acortamiento y de la infección ósea, por lo que se presenta como alternativa para el tratamiento de fracturas de pierna por mecanismo de alta energía.

The Effects of Aromatherapy on Pain, Depression, and Life Satisfaction of Arthritis Patients / 간호학회지

PURPOSE: The purpose of this study was to investigate the effect of aromatherapy on pain, depression, and feelings of satisfaction in life of arthritis patients. METHOD: This study used a quasi-experimental design with a non-equivalent control group, pre-and post-test. The sample consisted of 40 patients, enrolled in the Rheumatics Center, Kangnam St. Mary's Hospital, South Korea. The essential oils used were lavender, marjoram, eucalyptus, rosemary, and peppermint blended in proportions of 2:1:2:1:1. They were mixed with a carrier oil composed of almond (45%), apricot(45%), and jojoba oil(10%) and they were diluted to 1.5% after blending. The data were analyzed using an 2-test, Fisher's exact test, t-test and paired t-test. RESULT: Aromatherapy significantly decreased both the pain score and the depression score of the experimental group compared with the control group. However, aromatherapy didn't increase the feeling of satisfaction in life of the experimental group compared with the control group. CONCLUSION: The result of this study clearly shows that aromatherapy has major effects on decreasing pain and depression levels. Based on our experiment's findings, we suggest that aromatherapy can be a useful nursing intervention for arthritis patients.