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Cureus May 2023Gout is a common inflammatory arthritis caused by increased uric acid crystals in and around various joints, mainly the big toe in adults. It happens due to the increase...
Gout is a common inflammatory arthritis caused by increased uric acid crystals in and around various joints, mainly the big toe in adults. It happens due to the increase of urate or uric acid levels either because of increased production or decreased excretion from the body. Uric acid is the final product of purine metabolism, and many patients with hyperuricemia may remain asymptomatic. We present a case of a 46-year-old male who presented to the ambulatory care unit with the clinical features of acute pharyngitis and left toe pain for the past three days. On further questioning, he added that he had pain in the left lumber region and left side of the toe for the past few months. He also had a known case of type 2 diabetes mellitus, hypertension, and gastritis, for which he has been taking the thiazide diuretic, angiotensin-converting enzyme (ACE) inhibitors, metformin, sitagliptin, aspirin, and atorvastatin. Laboratory tests showed elevated uric acid along with raised inflammatory markers. As a result, he was referred to the specialist for arthrocentesis in order to confirm the diagnosis, and the thiazide diuretic was replaced with calcium channel blockers. He also suffered from nonalcoholic steatohepatitis (NASH) based on his ultrasound abdomen. On the follow-up visit, his symptoms had resolved, and his uric acid level had normalized.
PubMed: 37378123
DOI: 10.7759/cureus.39207 -
Hip & Pelvis Jun 2023The aim of this review is to conduct an analysis of existing literature on outcomes of application of various methods of joint decompression in management of septic... (Review)
Review
The aim of this review is to conduct an analysis of existing literature on outcomes of application of various methods of joint decompression in management of septic arthritis of the hip in children. A search of literature in PubMed, Embase, and Google Scholar was conducted for identification of studies reporting on the outcomes of intervention for septic arthritis of the hip in children. Of the 17 articles selected, four were comparative studies; two of these were randomized controlled trials while the rest were single arm studies. Statistical difference was observed between the proportion of excellent clinical and radiological outcomes in arthrotomy (90%, 95% confidence interval [CI] 81-98%; 89%, 95% CI 80-98%), arthroscopy (95%, 95% CI 91-100%; 95%, 95% CI 90-99%), and arthrocentesis (98%, 95% CI 97-100%; 99%, 95% CI 97-100%), respectively. The highest overall rate of additional unplanned procedures was observed in the arthrocentesis group (24/207, 11.6%). Patients who underwent arthrocentesis had a statistically greater chance of excellent clinical and radiological outcomes, although the highest level of need for additional unplanned surgical intervention was observed in the arthrocentesis group, followed by the arthroscopy group and the arthrotomy group. Future conduct of a prospective multicentric study focusing on the developed and developing world, along with acquisition of data. such as delay of treatment and severity of disease will enable assessment of the efficacy of one technique over the other by surgeons worldwide.
PubMed: 37323550
DOI: 10.5371/hp.2023.35.2.73 -
National Journal of Maxillofacial... 2023Various techniques have been used to treat internal temporomandibular joint derangements (TMJ ID), with arthrocentesis one of the most successful in reducing symptoms...
INTRODUCTION
Various techniques have been used to treat internal temporomandibular joint derangements (TMJ ID), with arthrocentesis one of the most successful in reducing symptoms and promoting function. In cases of TMJ ID, this research study compares and evaluates the efficacy of arthrocentesis with injections of corticosteroids (CS) or hyaluronic acid (HA).
METHODS
This prospective randomized, non-blinded study involving 91 patients with symptoms of TMJ ID treated by arthrocentesis followed by intra articular injection of 1 ml of either corticosteroid (group A) or HA (group B) . Maximum mouth opening, lateral excursive movements, TMJ pain at rest and during function, masticatory efficiency, pre-treatment functional TMJ limitation and subjective judgment of efficacy of treatment were assessed with millimeter scale. All the parameters measured before the procedure and further followed at 1 week, 1 month, 3 month and 6 month post-procedure.
RESULTS
Maximum mouth opening post procedure improved significantly in Group B at follow up visits ( < 0.05). Subjects in group B showed significant reduction in pain at rest ( = 0.001) at 1 week and 1 month follow up & increased masticatory efficiency at 6 months ( = 0.042) as compared to that of group A subjects.
CONCLUSION
Injection of HA post-TMJ arthrocentesis is found be comparatively more effective method of treating TMD IDs with resultant decrease in pain & improved functionality of the jaw. TMJ arthrocentesis along with injection of HA could serve as a possible alternative to treat chronic TMJ pain sufferers who are unresponsive to conservative medical therapies.
PubMed: 37273422
DOI: 10.4103/njms.njms_8_22 -
Cureus Apr 2023Gout is a common inflammatory arthropathy that presents as acute monoarthritis, most commonly of the first metatarsophalangeal (MTP) joint. Chronic polyarticular...
Gout is a common inflammatory arthropathy that presents as acute monoarthritis, most commonly of the first metatarsophalangeal (MTP) joint. Chronic polyarticular involvement may lead to confusion with other inflammatory arthropathies, including rheumatoid arthritis (RA). A thorough history, physical examination, synovial fluid analysis, and imaging are keys to establishing a correct diagnosis. Although a synovial fluid analysis remains the gold standard, the affected joints may be difficult to access by arthrocentesis. In cases where a large monosodium urate (MSU) crystal deposition is in the soft tissues - the ligaments, bursae, and tendons, it becomes a clinical impossibility. In such cases, dual-energy computed tomography (DECT) can assist in differentiating gout from other inflammatory arthropathies, including RA. Additionally, DECT can perform quantitative analysis of tophaceous deposits and, therefore, assess response to treatment.
PubMed: 37252479
DOI: 10.7759/cureus.38247 -
Medicina (Kaunas, Lithuania) May 2023Emergency department (ED) overcrowding is a public health crisis that affects patient care quality. Space management in the ED can affect patient flow dynamics and...
Emergency department (ED) overcrowding is a public health crisis that affects patient care quality. Space management in the ED can affect patient flow dynamics and clinical practice. We proposed a novel design of the "emergency procedure zone" (EPZ). The purpose of the EPZ was to provide an isolated area for clinical practice and procedure teaching, to ensure a secure area with adequate equipment and monitors, and safeguard patient privacy and safety. This study aimed to analyze the impact of the EPZ on procedural practice and patient flow dynamics. This study was conducted at the ED of a tertiary teaching hospital in Taiwan. Data were collected from 1 March 2019 to 31 August 2020 (pre-EPZ period) and from 1 November 2020 to 30 April 2022 (post-EPZ period). Statistical analyses were performed using IBM SPSS Statistics software. This study focused on the number of procedures and length of stay in the emergency department (LOS-ED). Variables were analyzed using the chi-square test and Mann-Whitney U test. Statistical significance was defined as < 0.05. There were 137,141 (pre-EPZ period) and 118,386 (post-EPZ period) ED visits recorded during this period. The post-EPZ period showed a significant increase in central venous catheter insertion, chest tube or pigtail placement, arthrocentesis, lumbar puncture, and incision and drainage procedures ( < 0.001). For patients who were directly discharged from the ED, the post-EPZ period also had a higher percentage of ultrasound studies performed in the ED and a shorter LOS-ED for patients who were directly discharged from the ED ( < 0.001). The establishment of an EPZ in the ED has a positive impact on procedural efficiency. The EPZ improved diagnosis and disposition efficiency, shortened the length of stay, and provided benefits such as improved management, patient privacy, and teaching opportunities.
Topics: Humans; Retrospective Studies; Length of Stay; Emergency Service, Hospital; Time Factors; Hospitals, Teaching
PubMed: 37241133
DOI: 10.3390/medicina59050901 -
Journal of General Internal Medicine Oct 2023Lack of experienced faculty to supervise internal medicine (IM) residents is a significant barrier to establishing a medical procedure service (MPS).
BACKGROUND
Lack of experienced faculty to supervise internal medicine (IM) residents is a significant barrier to establishing a medical procedure service (MPS).
AIM
Describe the development and 10-year outcomes of an MPS led by IM chief residents.
SETTING
University-based IM residency program affiliated with a county and Veterans Affairs hospital.
PARTICIPANTS
Categorical IM interns (n=320) and 4-year IM chief residents (n=48) from 2011 to 2022.
PROGRAM DESCRIPTION
The MPS operated on weekdays, 8 am-5 pm. After training and sign-off by the MPS director, chief residents trained and supervised interns in ultrasound-guided procedures during a 4-week rotation.
PROGRAM EVALUATION
From 2011 to 2022, our MPS received 5967 consults and 4465 (75%) procedures were attempted. Overall procedure success, complication, and major complication rates were 94%, 2.6%, and 0.6%, respectively. Success and complication rates for paracentesis (n=2285) were 99% and 1.1%, respectively; 99% and 4.2% for thoracentesis (n=1167); 76% and 4.5% for lumbar puncture (n=883); 83% and 1.2% for knee arthrocentesis (n=85); and 76% and 0% for central venous catheterization (n=45). The rotation was rated 4.6 out of 5 for overall learning quality.
DISCUSSION
A chief resident-led MPS is a practical and safe approach for IM residency programs to establish an MPS when experienced attending physicians are unavailable.
Topics: Humans; Internship and Residency; Clinical Competence; Education, Medical, Graduate; Paracentesis; Spinal Puncture; Internal Medicine
PubMed: 37237120
DOI: 10.1007/s11606-023-08234-z -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... May 2023To investigate the relationship between trace elements in synovial fluid and cartilage and severity of knee osteoarthritis (KOA).
OBJECTIVE
To investigate the relationship between trace elements in synovial fluid and cartilage and severity of knee osteoarthritis (KOA).
METHODS
Patients with KOA who underwent knee arthrocentesis or total knee arthroplasty (TKA) were recruited based on inclusion criteria between June 2021 and December 2021. Synovial fluid samples were obtained during knee arthrocentesis and TKA, and participants were divided into the mild group (grading Ⅰ/Ⅱ) and the severe group (grading Ⅲ/Ⅳ) according to the Kellgren-Lawrence grading (K-L grading). Cartilage samples with different degrees of wear were collected during the TKA from the same patient and were divided into mild wear (0-1 point) and severe wear (2-4 points) groups based on the Pelletier score. The contents of copper (Cu), zinc (Zn), and manganese (Mn) in synovial fluid and cartilage were evaluated by inductively coupled plasma mass spectrometry, and the differences between groups were compared.
RESULTS
A total of 33 synovial fluid samples were collected, including 19 specimens from 14 patients who underwent knee arthrocentesis of mild group, with 5 bilateral sides knee arthrocentesis in them, and 14 specimens from 14 TKA patients of severe group. The patients were significantly younger in the mild group than in the severe group ( <0.05), but there was no significant difference in gender or body mass index between the two groups ( >0.05). Nineteen pairs of cartilage samples with mild and severe wear were collected from severe KOA patients (K-L grading Ⅲ and Ⅳ), including 9 males and 10 females, with an average age of 70.4 years (range, 58-80 years). The body mass index ranged from 21.2 to 30.7 kg/m , with an average of 25.6 kg/m . The content of Zn in synovial fluid and cartilage from KOA patients was the highest, followed by Cu, and Mn was the lowest. The Cu content in synovial fluid was significantly higher in the severe group than in the mild group ( <0.05), and in the severe wear group than in the mild wear group ( <0.05). There was no significant difference in Zn and Mn content between the two groups ( >0.05).
CONCLUSION
The Cu content increases with the severity of cartilage wear in patients with KOA.
Topics: Male; Female; Humans; Aged; Osteoarthritis, Knee; Synovial Fluid; Trace Elements; Knee Joint; Cartilage, Articular; Zinc
PubMed: 37190836
DOI: 10.7507/1002-1892.202302008 -
Annals of the Rheumatic Diseases Aug 2023'Invasive pannus' is a pathological hallmark of rheumatoid arthritis (RA). This study aimed to investigate secretome profile of synovial fibroblasts of patients with RA...
OBJECTIVES
'Invasive pannus' is a pathological hallmark of rheumatoid arthritis (RA). This study aimed to investigate secretome profile of synovial fibroblasts of patients with RA (RA-FLSs), a major cell type comprising the invasive pannus.
METHODS
Secreted proteins from RA-FLSs were first identified using liquid chromatography-tandem mass spectrometry analysis. Ultrasonography was performed for affected joints to define synovitis severity at the time of arthrocentesis. Expression levels of myosin heavy chain 9 (MYH9) in RA-FLSs and synovial tissues were determined by ELISA, western blot analysis and immunostaining. A humanised synovitis model was induced in immuno-deficient mice.
RESULTS
We first identified 843 proteins secreted from RA-FLSs; 48.5% of the secretome was associated with pannus-driven pathologies. Parallel reaction monitoring analysis of the secretome facilitated discovery of 16 key proteins related to 'invasive pannus', including MYH9, in the synovial fluids, which represented synovial pathology based on ultrasonography and inflammatory activity in the joints. Particularly, MYH9, a key protein in actin-based cell motility, showed a strong correlation with fibroblastic activity in the transcriptome profile of RA synovia. Moreover, MYH9 expression was elevated in cultured RA-FLSs and RA synovium, and its secretion was induced by interleukin-1β, tumour necrosis factor α, toll-like receptor ligation and endoplasmic reticulum stimuli. Functional experiments demonstrated that MYH9 promoted migration and invasion of RA-FLSs in vitro and in a humanised synovitis model, which was substantially inhibited by blebbistatin, a specific MYH9 inhibitor.
CONCLUSIONS
This study provides a comprehensive resource of the RA-FLS-derived secretome and suggests that MYH9 represents a promising target for retarding abnormal migration and invasion of RA-FLSs.
Topics: Animals; Mice; Synoviocytes; Secretome; Synovial Membrane; Arthritis, Rheumatoid; Cell Movement; Synovitis; Fibroblasts; Cells, Cultured; Cell Proliferation
PubMed: 37188496
DOI: 10.1136/ard-2022-223625 -
Journal of Orthopaedic Case Reports Mar 2023Septic arthritis (SA) is a rare clinical entity that can lead to significant morbidity and mortality. Recent years have seen a rise in minimally invasive surgical...
INTRODUCTION
Septic arthritis (SA) is a rare clinical entity that can lead to significant morbidity and mortality. Recent years have seen a rise in minimally invasive surgical therapy for the treatment of benign prostatic hyperplasia, including prostatic urethral lift. We report a case of bilateral simultaneous SA of the knees, following a prostatic urethral lift procedure. SA following a urologic procedure has not previously been reported.
CASE REPORT
A 79-year-old male presented to the Emergency Department through an ambulance with bilateral knee pain with associated fever and chills. Two weeks before presentation, he had undergone a prostatic urethral lift, cystoscopy, and Foley catheter placement. The examination was remarkable for bilateral knee effusions. Arthrocentesis was performed, and the synovial fluid analysis was consistent with a diagnosis of SA.
CONCLUSION
This case emphasizes the need for frontline clinicians to consider SA in patients presenting with joint pain as a rare complication of prostatic instrumentation.
PubMed: 37187818
DOI: 10.13107/jocr.2023.v13.i03.3588