Recurrent Achilles Tendon Rupture in Multiple Sites as a Primary Manifestation of Systemic Lupus Erythematosus in a 32-Year-Old Patient: A Case Report.

The Achilles tendon is vital for walking and running, but it's also the most frequently ruptured tendon. Ruptures often occur without direct trauma and present with acute posterior ankle/heel pain. Various factors like age, biomechanical properties, degeneration, and mechanical factors influence susceptibility to rupture. Mechanisms of injury vary, including weight-bearing forefoot pushing off and sudden dorsiflexion of the ankle. Management goals focus on minimizing morbidity, swift recovery, and preventing complications through tailored interventions. Systemic lupus erythematosus (SLE) can also contribute to tendon rupture, especially with prolonged corticosteroid use. A 32-year-old female presented to the ER after injuring her left foot during a basketball game. She was diagnosed with an Achilles tendon rupture and underwent surgery to repair it. However, she experienced delayed wound closure and needed a skin graft. Two months later, she suffered another rupture in a different location, requiring a tendon transfer surgery. She was finally diagnosed with SLE after tests by the Rheumatology Department. Treatment commenced, and she began rehabilitation four weeks post-surgery. Surgical management of ruptured Achilles tendon involves techniques like open repair, percutaneous repair, mini-open repair, and augmentative repair. Open repair involves a direct approach with a posteromedial incision to align tendon stumps using various stitching techniques. Conservative treatment involves immobilization and non-weight-bearing for at least four weeks post surgery. For rare cases of Achilles tendon rupture caused by lupus, treatment focuses on managing the underlying disease with medications like hydroxychloroquine and glucocorticosteroids. Comprehensive evaluation, including musculoskeletal assessment, is crucial for lupus patients. SLE needs to be considered as a potential cause, especially in cases of recurrent ruptures or additional musculoskeletal symptoms. Surgical management should be tailored to individual patient needs, while also considering surgeon proficiency and preferences.

[Concordance between the Work Capability Index and the Years of Surviving Disability Estimated using the PoRT-9LSQ methodology]. / Concordancia entre el Índice de Capacidad Laboral y los Años de Discapacidad Sobrevenida Estimados mediante metodología PoRT-9LSQ.

OBJECTIVE: To analyze the association between lifestyles and health risk factors that can lead to prematurely leaving work, with the expected Years Lived with Disability (AYLD) in a working population, and to calculate the correlation between the Work Ability Index (WAI) and the Work Ability Score (WAS), and then both of these with the AYLD and its economic cost. METHODS: A cross-sectional study in a sample of workers who underwent a health examination. The information was collected using the ICL and WAS questionnaires, applying the PoRT-9LSQ methodology. Linear regression and analysis of variance (ANOVA) were used to analyze the association between the risk factors and AYLD. The correlation between WAI and WAS was analyzed using the intraclass correlation coefficient (ICC), and then between each of these the AYLD and its economic cost using adjusted linear regression.  Results: A total of 590 workers were included. Factors that most influenced the average AYLD were a sedentary lifestyle, poor diet, and overweight/obesity, with statistically significant differences according to sex, shift, and occupation (p<0.05). An ICC of 93.0%  was found between ICL and WAS, a good/excellent rating. The adjusted linear regression between ICL and ADSE was 7.982-0.136xICL (p<0.05), and was similar for WAS.  Conclusions: The WAI is useful for predicting AYLD in the working population. This can facilitate decisionmaking by health personnel to identify vulnerable people, encouraging changes in lifestyle and self-care.

OBJETIVO: Analizar la asociación entre los estilos de vida y factores de riesgo para la salud que pueden suponer un abandono prematuro del trabajo, con los años de discapacidad sobrevenida estimados (ADSE) en población laboral, y calcular la correlación entre el Índice de Capacidad Laboral (ICL) y el Work Ability Score (WAS), y ambos con los ADSE y su coste económico. Métodos: Estudio transversal en una muestra de trabajadores a los que se realizó un examen de salud. La información se recogió mediante los cuestionarios ICL y WAS, y la metodología PoRT-9LSQ. Se realizó un análisis de la asociación entre los factores de riesgo analizados y los ADSE mediante regresión lineal y análisis de la varianza (ANOVA). Se analizó la correlación entre ICL y WAS usando el coeficiente de correlación intraclase (CCI), y con los ADSE y su coste económico mediante regresión lineal ajustada.  Resultados: Se incluyeron 590 trabajadores. Los factores que más influyeron en la media de ADSE fueron el sedentarismo, la mala alimentación y el sobrepeso/obesidad, con diferencias estadísticamente significativas según sexo, turno y ocupación (p<0,05). El CCI entre ICL y WAS fue del 93,0% para una valoración excelente/buena. La regresión lineal ajustada entre ICL y los ADSE fue de 7,982-0,136xICL (p<0,05), siendo similar para el WAS.  Conclusiones: El ICL se ha mostrado útil para la predictibilidad de los ADSE en población laboral, lo que facilitará la toma de decisiones del personal sanitario para identificar personas vulnerables favoreciendo cambios en los estilos de vida y el autocuidado.

Concordancia entre el Índice de Capacidad Laboral y los Años de Discapacidad Sobrevenida Estimados mediante metodología PoRT-9LSQ / Concordance between the Work Capability Index and the Years of Surviving Disability Estimated using the PoRT-9LSQ methodology

Objetivo: Analizar la asociación entre los estilos de vida y factores de riesgo para la salud que pueden suponer un abandono prematuro del trabajo, con los años de discapacidad sobrevenida estimados (ADSE) en población laboral, y calcular la correlación entre el Índice de Capacidad Laboral (ICL) y el Work Ability Score (WAS), y ambos con los ADSE y su coste económico.Métodos: Estudio transversal en una muestra de trabajadores a los que se realizó un exa-men de salud. La información se recogió mediante los cuestionarios ICL y WAS, y la meto-dología PoRT-9LSQ. Se realizó un análisis de la asociación entre los factores de riesgo ana-lizados y los ADSE mediante regresión lineal y análisis de la varianza (ANOVA). Se analizó la correlación entre ICL y WAS usando el coeficiente de correlación intraclase (CCI), y con los ADSE y su coste económico mediante regresión lineal ajustada. Resultados: Se incluyeron 590 trabajadores. Los factores que más influyeron en la media de ADSE fueron el sedentarismo, la mala alimentación y el sobrepeso/obesidad, con dife-rencias estadísticamente significativas según sexo, turno y ocupación (p<0,05). El CCI entre ICL y WAS fue del 93,0% para una valoración excelente/buena. La regresión lineal ajustada entre ICL y los ADSE fue de 7,982-0,136xICL (p<0,05), siendo similar para el WAS. Conclusiones: El ICL se ha mostrado útil para la predictibilidad de los ADSE en población la-boral, lo que facilitará la toma de decisiones del personal sanitario para identificar personas vulnerables favoreciendo cambios en los estilos de vida y el autocuidado (AU)

Objetivo: Analizar la asociación entre los estilos de vida y factores de riesgo para la salud que pueden suponer un abandono prematuro del trabajo, con los años de discapacidad sobrevenida estimados (ADSE) en población laboral, y calcular la correlación entre el Índice de Capacidad Laboral (ICL) y el Work Ability Score (WAS), y ambos con los ADSE y su coste económico.Métodos: Estudio transversal en una muestra de trabajadores a los que se realizó un exa-men de salud. La información se recogió mediante los cuestionarios ICL y WAS, y la meto-dología PoRT-9LSQ. Se realizó un análisis de la asociación entre los factores de riesgo ana-lizados y los ADSE mediante regresión lineal y análisis de la varianza (ANOVA). Se analizó la correlación entre ICL y WAS usando el coeficiente de correlación intraclase (CCI), y con los ADSE y su coste económico mediante regresión lineal ajustada. Resultados: Se incluyeron 590 trabajadores. Los factores que más influyeron en la media de ADSE fueron el sedentarismo, la mala alimentación y el sobrepeso/obesidad, con dife-rencias estadísticamente significativas según sexo, turno y ocupación (p<0,05). El CCI entre ICL y WAS fue del 93,0% para una valoración excelente/buena. La regresión lineal ajustada entre ICL y los ADSE fue de 7,982-0,136xICL (p<0,05), siendo similar para el WAS. Conclusiones: El ICL se ha mostrado útil para la predictibilidad de los ADSE en población la-boral, lo que facilitará la toma de decisiones del personal sanitario para identificar personas vulnerables favoreciendo cambios en los estilos de vida y el autocuidado Conclusions: The WAI is useful for predicting AYLD in the working population. This can facilitate decisionmaking by health personnel to identify vulnerable people, encouraging changes in lifestyle and self-care (AU)

Molecular tools for the characterization of seizure susceptibility in genetic rodent models of epilepsy.

Epilepsy is a chronic neurological disorder characterized by abnormal neuronal activity that arises from imbalances between excitatory and inhibitory synapses, which are highly correlated to functional and structural changes in specific brain regions. The difference between the normal and the epileptic brain may harbor genetic alterations, gene expression changes, and/or protein alterations in the epileptogenic nucleus. It is becoming increasingly clear that such differences contribute to the development of distinct epilepsy phenotypes. The current major challenges in epilepsy research include understanding the disease progression and clarifying epilepsy classifications by searching for novel molecular biomarkers. Thus, the application of molecular techniques to carry out comprehensive studies at deoxyribonucleic acid, messenger ribonucleic acid, and protein levels is of utmost importance to elucidate molecular dysregulations in the epileptic brain. The present review focused on the great diversity of technical approaches available and new research methodology, which are already being used to study molecular alterations underlying epilepsy. We have grouped the different techniques according to each step in the flow of information from DNA to RNA to proteins, and illustrated with specific examples in animal models of epilepsy, some of which are our own. Separately and collectively, the genomic and proteomic techniques, each with its own strengths and limitations, provide valuable information on molecular mechanisms underlying seizure susceptibility and regulation of neuronal excitability. Determining the molecular differences between genetic rodent models of epilepsy and their wild-type counterparts might be a key in determining mechanisms of seizure susceptibility and epileptogenesis as well as the discovery and development of novel antiepileptic agents. This article is part of the Special Issue "NEWroscience 2018".

Effects of fondaparinux on wound drainage after total hip and knee arthroplasty.

BACKGROUND: The purpose of this investigation was to determine the effects of fondaparinux on postoperative wound drainage, length of hospital stay (LOS) and rate of surgical site infection in total joint patients. METHODS: 117 patients undergoing total joint arthroplasty treated with fondaparinux for venous thromboembolism (VTE) prophylaxis were prospectively studied. RESULTS: The average time to a dry wound was 3.4 days, with an average LOS of 3.77 days. Perioperative complications included 2 cases each of superficial cellulitis, deep vein thrombosis, and pulmonary embolism; there were no cases of deep infection. Multi-variate analysis showed increased patient BMI increased LOS (p = 0.0169). CONCLUSION: Fondaparinux is an effective drug for VTE prophylaxis in total joint arthroplasty with wound drainage and LOS comparable to historical controls of enoxaparin, warfarin, and rivaroxaban.

Relationship between deep vein thrombosis and pulmonary embolism following THA and TKA.

Patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) are at risk for venous thromboembolisms, including deep vein thrombosis and pulmonary embolism. Most deep vein thromboses are asymptomatic, but they can lead to long-term morbidity to the same extent as symptomatic events. The risk of complications of venous thromboembolisms depends on the location of thrombi; potential long-term complications include recurrent venous thromboembolism, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension. Risk of recurrence persists for several years after the initial event. Approximately 20% of recurrent events are pulmonary embolisms, and approximately half of those are fatal. The causal relationship between deep vein thrombosis and pulmonary embolism remains controversial. Some consider them distinct clinical entities, while others have found asymptomatic distal deep vein thrombosis to be associated with elevated risk of developing pulmonary embolism. Unique coagulation factors may be associated with orthopedic surgery patients that differentiate them from patients undergoing other types of surgery. Symptomatic and asymptomatic deep vein thrombosis can lead to the development of recurrent venous thromboembolism, pulmonary embolism, postthrombotic syndrome, and chronic thromboembolic pulmonary hypertension, all of which are associated with reduced quality of life and increased health care expenditures. Thromboprophylaxis is therefore important in patients undergoing THA or TKA. However, traditional anticoagulants are not ideal, particularly for long-term use. Orthopedic surgeons should be aware of the causes and potential sequelae of venous thromboembolism and of the new thromboprophylactic agents that can help prevent it.

Computer-assisted navigation of total knee arthroplasty for osteoarthritis in a patient with severe posttraumatic femoral deformity.

In the setting of extraarticular deformities of the knee, total knee arthroplasty (TKA) is difficult, as anatomical abnormalities obstruct identification of alignment landmarks and may preclude the use of traditional instrumentation. The long-term clinical value of computer assistance for TKA is a point of ongoing controversy. Few reports describe the use of computer-assisted orthopedic surgery as a method to decrease alignment outliers in TKA with associated posttraumatic deformities. In this report, a 70-year-old woman who had a severe distal femoral deformity from a previous open fracture underwent computer-assisted TKA for osteoarthritis. The use of a computer-assisted navigation system achieved a high degree of accuracy relative to the desired target alignment and led to improved function in a patient in which standard instrumentation was not feasible.

Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006.

BACKGROUND: This study was proposed to investigate the changes in the utilization of knee arthroscopy in an ambulatory setting over the past decade in the United States as well as its implications. METHODS: The National Survey of Ambulatory Surgery, last carried out in 1996, was conducted again in 2006 by the Centers for Disease Control and Prevention. We analyzed the cases with procedure coding indicative of knee arthroscopy or anterior cruciate ligament reconstruction. To produce estimates for all arthroscopic procedures on the knee in an ambulatory setting in the United States for each year, we performed a design-based statistical analysis. RESULTS: The number of arthroscopic procedures on the knee increased 49% between 1996 and 2006. While the number of arthroscopic procedures for knee injury had dramatically increased, arthroscopic procedures for knee osteoarthritis had decreased. In 1996, knee arthroscopies performed in freestanding ambulatory surgery centers comprised only 15% of all orthopaedic procedures, but the proportion increased to 51% in 2006. There was a large increase in knee arthroscopy among middle-aged patients regardless of sex. In 2006, >99% of arthroscopic procedures on the knee were in an outpatient setting. Approximately 984,607 arthroscopic procedures on the knee (95% confidence interval, 895,999 to 1,073,215) were performed in an outpatient setting in 2006. Among those, 127,446 procedures (95% confidence interval, 95,124 to 159,768) were for anterior cruciate ligament reconstruction. Nearly 500,000 arthroscopic procedures were performed for medial or lateral meniscal tears. CONCLUSIONS: This study revealed that the knee arthroscopy rate in the United States was more than twofold higher than in England or Ontario, Canada, in 2006. Our study found that nearly half of the knee arthroscopic procedures were performed for meniscal tears. Meniscal damage, detected by magnetic resonance imaging, is commonly assumed to be the source of pain and symptoms. Further study is imperative to better define the symptoms, physical findings, and radiographic findings that are predictive of successful arthroscopic treatment.