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RMD Open Jul 2024To identify multimorbidity trajectories over 20 years among incident osteoarthritis (OA) individuals and OA-free matched references.
OBJECTIVES
To identify multimorbidity trajectories over 20 years among incident osteoarthritis (OA) individuals and OA-free matched references.
METHODS
Cohort study using prospectively collected healthcare data from the Skåne region, Sweden (~1.4 million residents). We extracted diagnoses for OA and 67 common chronic conditions. We included individuals aged 40+ years on 31 December 2007, with incident OA between 2008 and 2009. We selected references without OA, matched on birth year, sex, and year of death or moving outside the region. We employed group-based trajectory modelling to capture morbidity count trajectories from 1998 to 2019. Individuals without any comorbidity were included as a reference group but were not included in the model.
RESULTS
We identified 9846 OA cases (mean age: 65.9 (SD 11.7), female: 58%) and 9846 matched references. Among both cases and references, 1296 individuals did not develop chronic conditions (no-chronic-condition class). We identified four classes. At the study outset, all classes exhibited a low average number of chronic conditions (≤1). Class 1 had the slowest progression towards multimorbidity, which increased progressively in each class. Class 1 had the lowest count of chronic conditions at the end of the follow-up (mean: 2.9 (SD 1.7)), while class 4 had the highest (9.6 (2.6)). The presence of OA was associated with a 1.29 (1.12, 1.48) adjusted relative risk of belonging to class 1 up to 2.45 (2.12, 2.83) for class 4.
CONCLUSIONS
Our findings suggest that individuals with OA face an almost threefold higher risk of developing severe multimorbidity.
Topics: Humans; Female; Male; Osteoarthritis; Aged; Sweden; Middle Aged; Multimorbidity; Adult; Morbidity; Incidence; Chronic Disease; Prospective Studies; Comorbidity
PubMed: 38955511
DOI: 10.1136/rmdopen-2024-004164 -
BMJ Open Jul 2024To understand commonalities and differences in injured patient experiences of accessing and receiving quality injury care across three lower-income and middle-income...
OBJECTIVES
To understand commonalities and differences in injured patient experiences of accessing and receiving quality injury care across three lower-income and middle-income countries.
DESIGN
A qualitative interview study. The interviews were audiorecorded, transcribed and thematically analysed.
SETTING
Urban and rural settings in Ghana, South Africa and Rwanda.
PARTICIPANTS
59 patients with musculoskeletal injuries.
RESULTS
We found five common barriers and six common facilitators to injured patient experiences of accessing and receiving high-quality injury care. The barriers encompassed issues such as service and treatment availability, transportation challenges, apathetic care, individual financial scarcity and inadequate health insurance coverage, alongside low health literacy and information provision. Facilitators included effective information giving and informed consent practices, access to health insurance, improved health literacy, empathetic and responsive care, comprehensive multidisciplinary management and discharge planning, as well as both informal and formal transportation options including ambulance services. These barriers and facilitators were prevalent and shared across at least two countries but demonstrated intercountry and intracountry (between urbanity and rurality) variation in thematic frequency.
CONCLUSION
There are universal factors influencing patient experiences of accessing and receiving care, independent of the context or healthcare system. It is important to recognise and understand these barriers and facilitators to inform policy decisions and develop transferable interventions aimed at enhancing the quality of injury care in sub-Saharan African nations.
Topics: Humans; Health Services Accessibility; Qualitative Research; Female; Male; Adult; Middle Aged; Quality of Health Care; Wounds and Injuries; Rwanda; Young Adult; Ghana; South Africa; Adolescent; Africa South of the Sahara; Aged; Rural Population; Interviews as Topic
PubMed: 38955369
DOI: 10.1136/bmjopen-2023-082098 -
Bone & Joint Open Jul 2024Shoulder arthroplasty is effective in the management of end-stage glenohumeral joint arthritis. However, it is major surgery and patients must balance multiple factors...
AIMS
Shoulder arthroplasty is effective in the management of end-stage glenohumeral joint arthritis. However, it is major surgery and patients must balance multiple factors when considering the procedure. An understanding of patients' decision-making processes may facilitate greater support of those considering shoulder arthroplasty and inform the outcomes of future research.
METHODS
Participants were recruited from waiting lists of three consultant upper limb surgeons across two NHS hospitals. Semi-structured interviews were conducted with 12 participants who were awaiting elective shoulder arthroplasty. Transcribed interviews were analyzed using a grounded theory approach. Systematic coding was performed; initial codes were categorized and further developed into summary narratives through a process of discussion and refinement. Data collection and analyses continued until thematic saturation was reached.
RESULTS
Two overall categories emerged: the motivations to consider surgery, and the information participants used to inform their decision-making. Motivations were, broadly, the relief of pain and the opportunity to get on with life and regain independence. When participants' symptoms and restrictions prevented them enjoying life to a sufficient extent, this provided the motivation to proceed with surgery. Younger participants tended to focus on maintaining employment and recreational activities, and older patients were eager to make the most of their remaining lifetime. Participants gathered information from a range of sources and were keen to optimize their recovery where possible. An important factor for participants was whether they trusted their surgeon and were prepared to delegate responsibility for elements of their care.
CONCLUSION
Relief of pain and the opportunity to get on with life were the primary reasons to undergo shoulder arthroplasty. Participants highlighted the importance of the patient-surgeon relationship and the need for accurate information in an accessible format which is relevant to people of different ages and functional demands.
PubMed: 38955355
DOI: 10.1302/2633-1462.57.BJO-2024-0009.R1 -
Bone & Joint Research Jul 2024The antidiabetic agent metformin inhibits fibrosis in various organs. This study aims to elucidate the effects of hyperglycaemia and metformin on knee joint capsule...
AIMS
The antidiabetic agent metformin inhibits fibrosis in various organs. This study aims to elucidate the effects of hyperglycaemia and metformin on knee joint capsule fibrosis in mice.
METHODS
Eight-week-old wild-type (WT) and type 2 diabetic (db/db) mice were divided into four groups without or with metformin treatment (WT met(-/+), Db met(-/+)). Mice received daily intraperitoneal administration of metformin and were killed at 12 and 14 weeks of age. Fibrosis morphology and its related genes and proteins were evaluated. Fibroblasts were extracted from the capsules of 14-week-old mice, and the expression of fibrosis-related genes in response to glucose and metformin was evaluated in vitro.
RESULTS
The expression of all fibrosis-related genes was higher in Db met(-) than in WT met(-) and was suppressed by metformin. Increased levels of fibrosis-related genes, posterior capsule thickness, and collagen density were observed in the capsules of db/db mice compared with those in WT mice; these effects were suppressed by metformin. Glucose addition increased fibrosis-related gene expression in both groups of mice in vitro. When glucose was added, metformin inhibited the expression of fibrosis-related genes other than cellular communication network factor 2 () in WT mouse cells.
CONCLUSION
Hyperglycaemia promotes fibrosis in the mouse knee joint capsule, which is inhibited by metformin. These findings can help inform the development of novel strategies for treating knee joint capsule fibrosis.
PubMed: 38955349
DOI: 10.1302/2046-3758.137.BJR-2023-0384.R1 -
International Journal of Surgery Case... Jun 2024The ulnar's nerve compression at the Guyon's canal is not a frequent entity add to it that vascular lesions are rarely involved as a causative agent of this syndrome.
INTRODUCTION AND IMPORTANCE
The ulnar's nerve compression at the Guyon's canal is not a frequent entity add to it that vascular lesions are rarely involved as a causative agent of this syndrome.
CASE PRESENTATION
We report a case of a young male patient admitted in our department for a Guyon's canal syndrome due to an aneurysm of the ulnar artery and underwent a surgical decompression. Post-operative course was uneventful and the patient was satisfied with the result.
CLINICAL DISCUSSION
Many etiologies are involved in the Guyon's canal syndrome and these etiologies can be arranged into groups. Previous treatment attempts, the duration and severity of the symptoms and the underlying etiology dictate the treatment options. Adjacent vascular enlargement is not a usual cause of Guyon's canal compression and a few case reports were reported in the literature. Surgical treatment by opening and releasing the roof of Guyon's canal and removing the aneurysm helped to achieve good outcome in most reports.
CONCLUSION
Guyon's canal syndrome is less frequent than both cubital tunnel syndrome or carpal tunnel syndrome and many causative agents have been described. Vascular lesions are not the usual cause of compressing the ulnar nerve at the wrist and through this case we spotlighted this entity as another possible etiology requiring an adequate treatment for a better outcome.
PubMed: 38954970
DOI: 10.1016/j.ijscr.2024.109978 -
International Journal of Surgery Case... Jun 2024Meniscal root tears are defined as soft-tissue and/or osseous injuries that rip or avulse within one centimeter of the meniscal insertion to the tibial plateau. These...
INTRODUCTION AND IMPORTANCE
Meniscal root tears are defined as soft-tissue and/or osseous injuries that rip or avulse within one centimeter of the meniscal insertion to the tibial plateau. These injuries impact around 100,000 patients a year and make up 10 % to 21 % of all meniscal tears. Meniscal extrusion frequently happens when there are root rips, and the transmission of circumferential hoop loads is hampered.
CASE PRESENTATION
We present one case of a 28-year-old male who complained of pain and stiffness in his left knee since 2 years after undergoing ACL reconstruction using a hamstring autograft. His examination revealed joint line tenderness on both the medial and lateral sides of the left knee. Further investigations involving X-ray and MRI established the diagnosis of both medial and lateral meniscal root tears, which were surgically managed using the transtibial pullout technique.
DISCUSSION
The biomechanical implications of meniscal root tears, such as loss of hoop forces and increased tibiofemoral contact pressures, underscore the importance of timely diagnosis and management. The literature advocates surgical treatment for managing root tears, as leaving them without surgical intervention can lead to functional outcomes similar to those of total meniscectomy.
CONCLUSION
This case report presents both menisci posterior root tears with an intact ACL graft which is unique in that they commonly tear in conjuction with ACL. These kind of injuries necessitates prompt diagnosis and surgical intervention to protect the knee from early arthritic changes.
PubMed: 38954967
DOI: 10.1016/j.ijscr.2024.109971 -
International Journal of Surgery Case... Jun 2024Traumatic pelvic fractures are complex injuries often associated with significant morbidity and mortality. Among the complications of pelvic trauma, rupture of the...
INTRODUCTION AND IMPORTANCE
Traumatic pelvic fractures are complex injuries often associated with significant morbidity and mortality. Among the complications of pelvic trauma, rupture of the ovarian vein represents a rare yet potentially life-threatening event. Prompt recognition and appropriate management are essential to mitigate the risk of hemorrhage and associated complications.
CASE PRESENTATION
We present a case of a 70-year-old woman who sustained a traumatic pelvic fracture following a skiing accident, resulting in rupture of the left ovarian vein. The patient came with the ambulance in the emergency room with lower abdominal tenderness, pelvic pain, but no signs of hemorrhagic shock. Imaging studies confirmed the diagnosis of a pelvic fracture with venous leakage of the left ovarian vein.
CLINICAL DISCUSSION
This review synthesizes recent insights into the diagnosis, management, and complications associated with pelvic fractures, with an emphasis on optimizing patient outcomes through a multidisciplinary approach. The analysis incorporates findings from key studies, including those by Wong and Bucknill, Ma Y et al., and Tullington and Blecker, which advocate for the use of advanced diagnostic tools like CT scans and systematic evaluation processes. These studies underline the necessity of precise classification systems such as the Tile classification to guide treatment and predict outcomes.
CONCLUSION
Management of traumatic pelvic fractures with associated vascular injuries requires a multidisciplinary approach involving trauma surgeons, interventional radiologists, and critical care specialists. Early recognition, accurate diagnosis, and timely intervention are paramount in optimizing outcomes and reducing the risk of mortality. This case underscores the importance of prompt intervention and highlights the challenges associated with traumatic pelvic fractures and rupture of the ovarian vein. Further research is warranted to enhance our understanding of optimal management strategies and improve outcomes for patients with these complex injuries.
PubMed: 38954965
DOI: 10.1016/j.ijscr.2024.109894 -
International Journal of Surgery Case... Jun 2024Chondrosarcomas are the third most frequent malignant bone tumors. With pelvic bones being their most common primary location, diagnosis and treatment of these tumors is...
INTRODUCTION AND IMPORTANCE
Chondrosarcomas are the third most frequent malignant bone tumors. With pelvic bones being their most common primary location, diagnosis and treatment of these tumors is especially challenging due to the diverse clinical manifestations and involvement of critical anatomic structures. We present the case of a grade III pelvic chondrosarcoma of the left iliopubic branch managed through a multidisciplinary approach.
CASE PRESENTATION
A 26-year-old male patient presented with a 1-year history of a mass in the left iliopubic branch. The imaging findings suggested chondrosarcoma and showed extrinsic compression of pelvic structures causing right hydronephrosis, marked elongation and tortuosity of the sigmoid colon, and anterior and superior displacement of the bladder. Following multidisciplinary meeting it was decided to perform a left hemicolectomy, colostomy, and internal hemipelvectomy in the 1-2-3 left zones, with resection of the intrapelvic and intra-abdominal tumor, and preservation of the left lower extremity. The patient presented two episodes of intestinal obstruction, which resolved with medical management. Was discharged without presenting further complications.
CLINICAL DISCUSSION
Chondrosarcomas management demands a methodical approach. Appropriate surgical strategy requires individualization according to the characteristics of the lesion and the degree of involvement of surrounding structures. Complete resection of the tumor and preservation of the lower extremity function are critical achievements.
CONCLUSION
This case underscores the effective management of a challenging tumor such as pelvic chondrosarcoma. The multidisciplinary approach and collaboration of several specialties was crucial to reach an appropriate surgical strategy.
PubMed: 38954964
DOI: 10.1016/j.ijscr.2024.109860 -
Journal of Osteopathic Medicine Jul 2024Orthopaedic surgery has become increasingly competitive over the years, with the COVID-19 pandemic creating additional challenges for applicants and programs. To promote...
CONTEXT
Orthopaedic surgery has become increasingly competitive over the years, with the COVID-19 pandemic creating additional challenges for applicants and programs. To promote an equitable match experience, the American Orthopaedic Association (AOA) introduced a formal preference signaling (PS) system into the 2022-2023 application cycle. PS allows applicants to indicate their heightened interest in specific programs, which improves the likelihood of receiving an interview and ultimately matching at their desired residency program.
OBJECTIVES
The objective of this anonymous survey is to assess applicants' opinions and perspectives toward PS in orthopaedic surgery prior to the 2022-2023 match results. Additionally, we sought to evaluate the signaling strategies being utilized by applicants.
METHODS
An anonymous 22-question survey was distributed to applicants of an orthopaedic surgery residency program (34.2 % response rate). Responses were collected after the application submission deadline but before the match lists and results were available. This survey included questions germane to demographics, signal utilization, signaling reasons and strategies, and opinions toward PS. Descriptive statistics were calculated utilizing R (version 4.2.1) and RStudio.
RESULTS
Most respondents (96.1 %) participated in PS, and 96.7 % utilized all 30 signals. Signaling encouraged 24.2 % of applicants to apply to fewer programs. In accordance with guidelines, 83.2 % of respondents signaled each away rotation program; however, only 53 % signaled their home program. Applicants commonly signaled 1-10 "reach" and "safety" programs each. and were the most important reasons for signaling, whereas was the least. A program's social presence and virtual interview option did not influence many applicants' decisions for signaling. Most applicants believe that the COVID-19 pandemic and pass/fail licensure examinations influenced PS adoption. Sixty-seven of 149 respondents (45 %) claimed that applicants and programs benefit equally from PS, while 41 % believe programs benefit more. Nearly half (40.94 %) knew or about PS.
CONCLUSIONS
During the inaugural introduction of PS in orthopaedic surgery, nearly every applicant utilized all 30 signals, prioritizing factors like family proximity and perceived operative experience over program prestige. This shift reflects the importance of geographic location and presumed training quality. Despite unfamiliarity toward PS, personalized signaling strategies were implemented, accompanied by a slight decrease in application volumes. The 30 allotted signals in orthopaedic surgery may serve as an informal application cap due to the necessity of signaling a program for an interview invite. However, improved educational efforts are needed to enhance the understanding and maximize the benefits of PS for both applicants and programs.
PubMed: 38954485
DOI: 10.1515/jom-2023-0127 -
Journal of Cellular and Molecular... Jul 2024Both osteoporosis and tendinopathy are widely prevalent disorders, encountered in diverse medical contexts. Whilst each condition has distinct pathophysiological... (Review)
Review
Both osteoporosis and tendinopathy are widely prevalent disorders, encountered in diverse medical contexts. Whilst each condition has distinct pathophysiological characteristics, they share several risk factors and underlying causes. Notably, oxidative stress emerges as a crucial intersecting factor, playing a pivotal role in the onset and progression of both diseases. This imbalance arises from a dysregulation in generating and neutralising reactive oxygen species (ROS), leading to an abnormal oxidative environment. Elevated levels of ROS can induce multiple cellular disruptions, such as cytotoxicity, apoptosis activation and reduced cell function, contributing to tissue deterioration and weakening the structural integrity of bones and tendons. Antioxidants are substances that can prevent or slow down the oxidation process, including Vitamin C, melatonin, resveratrol, anthocyanins and so on, demonstrating potential in treating these overlapping disorders. This comprehensive review aims to elucidate the complex role of oxidative stress within the interlinked pathways of these comorbid conditions. By integrating contemporary research and empirical findings, our objective is to outline new conceptual models and innovative treatment strategies for effectively managing these prevalent diseases. This review underscores the importance of further in-depth research to validate the efficacy of antioxidants and traditional Chinese medicine in treatment plans, as well as to explore targeted interventions focused on oxidative stress as promising areas for future medical advancements.
Topics: Humans; Oxidative Stress; Osteoporosis; Antioxidants; Tendinopathy; Reactive Oxygen Species; Animals
PubMed: 38953556
DOI: 10.1111/jcmm.18508