Two-stage Total Knee Arthroplasty for Treatment of Surgical Failure of Septic Arthritis in Degenerative Knee Joints.

BACKGROUND: The ultimate goal of the treatment of infectious knee arthritis is to protect the articular cartilage from adverse effects of infection. Treatment, however, is not always hundred percent successful and has a 12% failure rate. Persistent infection is more likely to happen in elderly patients and those with underlying joint diseases, particularly osteoarthritis. Eradication of infection and restoration of function in the involved joint usually are not possible by conventional treatment strategies. There are few case series reporting two-stage primary knee arthroplasty as the salvage treatment of the septic degenerative knee joint; however, the treatment protocol remains to be elucidated. METHODS: Based on a proposed approach, patients with failure of common interventions for treatment of septic knee arthritis and underlying joint degeneration were treated by two-stage TKA and intervening antibiotic loaded static cement spacer. Suppressive antibiotic therapy was not prescribed after the second stage. RESULTS: Complete infection eradication was achieved with mean follow up of 26 months. All cases were balanced with primary total knee prosthesis. The knee scores and final range of motions were comparable to other studies. CONCLUSION: The two-stage total knee replacement technique is a good option for management of failure of previous surgical treatment in patients with septic arthritis and concomitant joint degeneration. Our proposed approach enabled us to use primary prosthesis in all of our patients with no need for suppressive antibiotic therapy.

Reduction in incidence of type 2 diabetes by lifestyle intervention in a middle eastern community.

BACKGROUND: Very few studies have used community-based interventions for primary prevention of Type 2 diabetes, and the direct effect of such interventions on diabetes incidence is relatively unknown. PURPOSE: This study aims to assess the effect of lifestyle modification on risk factors for noncommunicable diseases (NCDs) and the development of Type 2 diabetes at the community level. DESIGN: A cluster-controlled trial was conducted. SETTING/PARTICIPANTS: In all, 3098 and 5114 individuals in intervention and control groups, respectively (mean age=43 years), recruited from District 13 of Tehran, Iran, participated in the baseline examination in 1999-2001. Among these individuals, a total of 1754 and 2993 individuals in the intervention and control groups, respectively (58%), completed a follow-up examination in 2002-2005. INTERVENTION: The study intervention involved improvement in diet, increase in the level of physical activity, and reduction in cigarette smoking through educational interviews, lectures, and publications. MAIN OUTCOME MEASURES: Incident Type 2 diabetes was measured by fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG) and change in NCD risk factors. RESULTS: The mean follow-up time was 3.6 years. The incidence of diabetes in the control and intervention groups was 12.2 and 8.2 per 1000 person-years, respectively, with a relative risk reduction of 65% (95% CI=30%, 83%, p<0.003). The adjusted difference in mean change of risk factors between the intervention and control groups was significant for weight (-0.5 kg in men); BMI (-0.18 kg/m(2) in men); waist circumference (-1.0 cm in women); systolic and diastolic blood pressure (-1.1 and -0.6 mmHg, respectively, in women); FPG (-2.1 and -2.3 mg/dL in men and women); 2hPG (-4.6 mg/dL in women); total cholesterol (-2.8 mg/dL in women); triglycerides (-7.6 and -5.2 mg/dL in men and women); and high-density lipoprotein cholesterol (1.1 mg/dL in women; all p<0.05). CONCLUSIONS: Lifestyle intervention resulted in a significant decrease in the incidence of Type 2 diabetes and better control of NCD risk factors in a population-based setting. ISRCTN TRIAL REGISTRATION #: ISRCTN52588395.

Temporal changes in anthropometric parameters and lipid profile according to body mass index among an adult Iranian urban population.

AIMS: To examine changes in anthropometric parameters and lipid profiles over a period of 3.6 years in an Iranian adult population according to body mass index (BMI) groups. METHODS: Between 1998 and 2001 (phase 1) and 2002 and 2005 (phase 2), 5,618 nondiabetic Iranian adults aged > or =20 years were examined. Analysis of covariance was used to delineate trends in anthropometric parameters as well as total and low- and high-density lipoprotein cholesterol (TC, LDL-C and HDL-C, respectively) across BMI groups. RESULTS: Although BMI increased in women, this increase was not significant in obese persons. Among the men, however, a significant increase in BMI was observed only in lean persons. Waist circumference (WC) increased across all BMI groups in both sexes. A significant decrease was observed in TC [men: -0.83 mmol/l, 95% confidence interval (CI) -1.27 to -0.40; women: -0.78 mmol/l, CI -0.97 to -0.60] and LDL-C (men: -0.63 mmol/l, CI -1.13 to -0.13; women: -0.51 mmol/l, CI -0.78 to -0.24). A significant decrease in mean HDL-C was observed only among men (-0.09 mmol/l, CI -0.13 to -0.04), with no difference among BMI groups (p = 0.3). There were no significant decreases in TC/HDL-C and LDL-C/HDL-C ratios in men or women. CONCLUSIONS: Despite an increase in WC, favorable trends were observed in TC and LDL-C levels. The favorable trend in TC levels was counterbalanced by changes in HDL-C, as reflected by the absence of a significant decrease in TC/HDL-C or LDL-C/HDL-C.

High prevalence of undiagnosed diabetes and abnormal glucose tolerance in the Iranian urban population: Tehran Lipid and Glucose Study.

BACKGROUND: To estimate the prevalence of diagnosed and undiagnosed diabetes mellitus, impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and combined IFG/IGT in a large urban Iranian population aged > or = 20 years. METHODS: The study population included 9,489 participants of the Tehran Lipid and Glucose Study with full relevant clinical data. Age-standardized prevalence of diabetes and glucose intolerance categories were reported according to the 2003 American Diabetes Association definitions. Age-adjusted logistic regression models were used to estimate the numbers needed to screen (NNTS) to find one person with undiagnosed diabetes. RESULTS: The prevalence of diagnosed and undiagnosed diabetes, isolated IFG, isolated IGT, and combined IFG/IGT were 8.1%, 5.1%, 8.7%, 5.4% and 4.0% in men and 10%, 4.7%, 6.3%, 7.6%, and 4.5% in women respectively. Participants with undiagnosed diabetes had higher age, body mass index (BMI), waist circumference, systolic and diastolic blood pressures, triglycerides (all p values <0.001) and lower HDL-cholesterol (only in women, p < 0.01) compared to normoglycemic subjects. Undiagnosed diabetes was associated with family history of diabetes, increased BMI (> or = 25 kg/m2), abdominal obesity, hypertriglyceridemia, hypertension and low HDL-cholesterol levels. Among men, a combination of increased BMI, hypertension, and family history of diabetes led to a NNTS of 1.6 (95% CI: 1.57-1.71) and among women a combination of family history of diabetes and abdominal obesity, yielded a NNTS of 2.2 (95% CI: 2.1-2.4). CONCLUSION: In conclusion, about one third of Tehranian adults had disturbed glucose tolerance or diabetes. One- third of total cases with diabetes were undiagnosed. Screening individuals with BMI > or = 25 kg/m2 (men), hypertension (men), abdominal obesity (women) and family history of diabetes may be more efficient.