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Journal of Personalized Medicine Jul 2023Septic arthritis (SA) in children is an acute inflammatory disease of the joints. If not treated promptly, it could become a surgical emergency. The incidence of the... (Review)
Review
BACKGROUND
Septic arthritis (SA) in children is an acute inflammatory disease of the joints. If not treated promptly, it could become a surgical emergency. The incidence of the disease in children in Europe is approximately 2-7 per 100,000 children. The aim of this systematic review was to investigate which of these treatments-arthrocentesis, arthrotomy, and arthroscopy-provides better results in children and when to use them.
METHODS
Three independent authors conducted a systematic review of PubMed, ScienceDirect, and MEDLINE databases to assess studies with any level of evidence that reported the surgical outcome of SA. Two senior investigators evaluated and approved each stage's findings.
RESULTS
A total of 488 articles were found. After screening, we chose 24 articles that were suitable for full-text reading based on the inclusion and exclusion criteria. The results of our analysis showed that there are no numerically significant differences reported in the literature on clinical and radiographic outcomes by surgical technique.
CONCLUSIONS
We developed an algorithm that could be used if septic arthritis is suspected. Based on our results, the surgical technique to be used will depend on the operator who will perform it.
PubMed: 37511710
DOI: 10.3390/jpm13071097 -
Zeitschrift Fur Rheumatologie Apr 2024The German Society for Rheumatology, through its campaign Rheuma2025, aims to improve student teaching in order to ensure patient care for rheumatological patients in...
BACKGROUND
The German Society for Rheumatology, through its campaign Rheuma2025, aims to improve student teaching in order to ensure patient care for rheumatological patients in the future.
OBJECTIVE
To assess whether a combination of traditional and innovative educational methods provide both an improvement in the quality of teaching and an increase in the attractiveness of rheumatology as a discipline.
MATERIAL AND METHODS
Establishment of the teaching concept "Rheuma (be-)greifen" consisting of five modules on patient history taking with acting patients, musculoskeletal ultrasound, arthrocentesis, 3D printing of pathological joints and virtual reality applications based on real patient cases in the curricular teaching of medical students.
RESULTS
The evaluation of the teaching concept with 93 students of medicine showed a consistently high acceptance of all modules, which were rated as very effective or rather effective. Direct patient-related modules, such as history taking with acting patients, musculoskeletal ultrasound and arthrocentesis, received even higher acceptance than the visualization methods utilizing 3D printing and virtual reality.
CONCLUSION
Innovative teaching methods can help to improve the acceptance of teaching in the field of rheumatology, especially when combined with classical teaching contents.
Topics: Humans; Students, Medical; Rheumatology; Ultrasonography; Teaching
PubMed: 37505294
DOI: 10.1007/s00393-023-01391-w -
International Journal of Surgery Case... Aug 2023This is the first report of subcutaneous emphysema of the thigh as a complication after total knee arthroplasty (TKA).
INTRODUCTION AND IMPORTANCE OF THE CASE
This is the first report of subcutaneous emphysema of the thigh as a complication after total knee arthroplasty (TKA).
PRESENTATION OF CASE
A 78-year-old female patient with valgus knee arthropathy underwent TKA. Two days postoperatively, the patient experienced left thigh swelling and pain, and subcutaneous emphysema was detected upon palpation. Although the skin tone was comparable to the other side, the left thigh was tender and firm. The surgical wound did not exhibit erythema. Computed tomography imaging revealed emphysema in the subcutaneous and intermuscular regions of the left thigh. Gram stain and culture tests from arthrocentesis were negative, and blood culture results were also negative. As there was no fever or disturbance of consciousness, and the LRINEC score was 1, supportive care was provided to the patient. At 5 days postoperatively, there was an observable improvement in the emphysema, and by day 9 postoperatively, the emphysema had fully resolved.
CLINICAL DISCUSSION
There is a lack of documented cases reporting extensive subcutaneous emphysema of the thigh following TKA, suggesting it to be an exceedingly rare complication. In this case, we conducted a thorough investigation to assess the potential association of infection. Subsequently, the symptoms were successfully alleviated with supportive care without antibiotics.
CONCLUSION
The occurrence of subcutaneous emphysema in the thigh was identified as a postoperative complication following TKA. Blood tests, culture tests and LRINEC score can be valuable tools for differentiation.
PubMed: 37453324
DOI: 10.1016/j.ijscr.2023.108466 -
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 -
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