Scaphoid Cysts: Literature Review of Etiology, Treatment, and Prognosis.

Background: Cystic lesions of the carpal bones are rare entities that are infrequently reported in the literature. Scaphoid intraosseous cystic lesions represent a rare subset of carpal bone cysts. This review aims to summarize the available evidence on the evaluation and treatment of scaphoid cystic lesions to help guide clinical management. Methods: Systematic electronic searches were performed using PubMed, Ovid, and Embase databases. Studies included were graded for their risk of bias. Pooled descriptive statistics were performed on incidence, etiology, physical exam findings, treatment, and follow-up. Results: A total of 38 patients representing 41 scaphoid cystic lesions were pooled from 27 articles. Patients presented with wrist pain without fracture (n = 27), pathological fracture (n = 9), swelling only (n = 1), or were asymptomatic (n = 4). Cystic lesions of the scaphoid were initially revealed on imaging with radiographs alone (n = 22), radiographs in combination with computed tomography (CT) (n = 10) or magnetic resonance imaging (n = 6), CT alone (n = 1), or using all 3 modalities (n = 2). Intraosseous ganglia were identified most frequently (n = 31), followed by "bone cyst-like pathological change" (n = 3), unicameral bone cysts (n = 2), aneurysmal bone cysts (n = 2), primary hydatid cysts (n = 2), and cystic like changes post fall (n = 1). Treatment modalities included curettage and bone graft (n = 39) or below-elbow cast (n = 2). On follow-up (average of 21.3 months; n = 40), all patients improved clinically after treatment and were found to have full wrist range of motion without pain (n = 31), slightly reduced grip strength (n = 3), limited range of motion (n = 2), or persistent mild discomfort (n = 2). Conclusions: Scaphoid cystic lesions are most commonly intraosseous ganglia, but can include other etiologies as well. The main presenting symptom is radial wrist pain that usually resolves after treatment. The presence of intracarpal cystic lesions should be considered in the differential diagnosis of wrist pain.

Risky sexual behavior, knowledge of sexually transmitted infections and treatment utilization among a vulnerable population in Rawalpindi, Pakistan.

As a part of a second generation surveillance, we investigated the sociodemographics, risky sexual behavior, knowledge of HIV and sexually transmitted infections (STIs) and treatment seeking behavior among a vulnerable population. A cross-sectional study preceded by mapping, was conducted in Rawalpindi, Pakistan during 2005. Subjects were recruited through snowball, time location cluster and cluster sampling techniques. Behavioral interviews were conducted with 203 female sex workers (FSWs), 101 male sex workers (MSWs), 101 Hijras (transgender men) and 200 injecting drug users (IDUs), who were deemed a vulnerable population for STIs. Among this population 136 (67%) FSWs were illiterate, 145 (71.4%) were married and entertained on average 23 clients per month. Consistent condom use during one month was reported by 34 (17%) FSWs. One hundred thirty-three (66%) FSWs had a knowledge of STIs, 69 (34%) suffered from STIs. MSWs and Hijras had the youngest average ages at 24.4 (+/- 6.8), 25.8 (+/- 5.9) and started sexual activity even at age 14.7, and 13.9 years, respectively. Consistent condom usage was as low as 3 (3.1%) and 4 (4%) among MSWs and Hijras. IDUs had lowest monthly income of US$ 69 (+/- 41) and had a predominant migratory pattern. Fifty (25.2%) IDUs shared a needle with the last injection. Though knowledge of STIs was lowest among IDUs, 61 (30.7%), however, all utilized the public health facility for their treatment. Difference between knowledge of STIs and educational levels among IDUs and Hijras were found to be statistically significant (p=0.015 and p=0.04, respectively). The present study indicates the knowledge of HIV/STIs is high among the vulnerable population but condom usage is very low.