Chronic foot pain resulting from bunion hallux valgus deformity is a common complaint in family medicine, sport medicine and orthopedics practices especially in females. It is a deformity in metatarsophalangeal joint of big toe because of laxity of joint capsule and ligaments resulting in failure of stabilization of the affected joint. High heels, tight and narrow tiptoe box pointed shoes are potential apparent causes of this pathology. Initial treatment remains conservative with large toe box shoes, pain control medicines and surgery as a last choice. When indicated, surgical treatment is controversial because of the greater than 100 described surgical procedures and a historically high prevalence of recurrence. Platelet rich plasma (PRP) is an autologous treatment and pain management method came out in last twenty years, now it is so popular in orthopaedic, rheumatology and sport medicine practices because of it’s effectiveness and cheapness and safety. The authors reported and managed chronic pain by PRP local injections for four cases complaining from long standing bunion hallux valgus deformity and pain.
Objective: To evaluate the efficacy of exercise and intra-articular ozonized platelet rich plasma (IA-OPRP) injections as management for sever grad IV knee osteoarthritis (KOA). Methods: Over 18-month period (January 1, 2018– July 31, 2019), 33 patients (21 females and 12 males) with 58 grade IV osteoarthritic knees were retrospectively studied. Severity of KOA was assessed according to the clinical features and Kellgren &Lawrencegrading scale. All patients underwent 8-weeks simple exercises followed by 4 sessions of IA-OPRP.OPRP was prepared by centrifuging patients’ own blood and activated by passing 1 ml of ozone for each 1 ml of platelet rich plasma. A questionnaire was used to categorize the pain severity into mild, moderate, and severe and the response to therapy was graded as excellent, good, fair, and poor. Results: The mean age was 63.7 years. The top co-morbid condition were overweight and obesity (n=28, 84.8%) whereas diabetes and hypertension ranked second (n=15 each, 45.4%). All patients had severe pain of grad IV knee OA. Overall, exercise and four IA-OPRP injections yielded good-excellent results in (72.4%) of the treated joints (p˂0.01) with no significant sex-related difference in pain response (p>0.01). Conclusion: Exercise and IA-OPRP seems to be a safe, effective and cheap method for relieving the chronic pain of severeknee OA.
Objectives: The anterior cruciate ligament (ACL) is one of the most common injured knee ligaments and it is one of the most frequent injuries seen in orthopedic practice Methods: This is a retrospective study of 20 patients (14 female and 6 male) with ACL tear managed by intra articular activated PRP injection in the first author private clinic in Kirkuk over 2 years period (August 1, 2017–July 31, 2019). A detailed history was taken according to a questionnaire and a complete physical and radiological (MRI) examination was done. A sample of patient’s own blood was used to prepare PRP by a process of two repeated centrifugation. Longevity resources EXT50 Ozone Generator with oxygen tank and CGA870 Oxygen Regulator were used for activation of PRP. The clinical notes were reviewed to ascertain the clinical presentations and response of patients to PRP therapy. Results: The mean age was 55±10.38years. The age groups affected with ACL were 50-59 and 60-69 years (n: 7, 35%) for each, while (n:5,25%) from age group 40-49 years and (n: 1, 5%) was from age group 20-29. Although 19 patient (95%) have at least one co-morbid condition, all the patient (n:20, 100%) show good response.7 patient (35%) received three doses of PRP and 13 patient (65%) received four doses to get good response. Conclusion: Even though PRP and Ozone are not expensive therapies, they seem to be safe and effective in pain management of ACL tear.
Objective This study is designed to assess the polypharmacy use by elderly patients having multimorbidity in Kirkuk, Iraq Methodology. This descriptive cross sectional study conducted over one year period (1 January-31 December, 2017) with 105 adults (75 females and 30 males) aged ≥65 years, who attended outpatient clinic of the Geriatric Medicine Department in Azadi Teaching Hospital in Kirkuk Province in Iraq. Patients with ≥2 considered as multimorbidity subjects and patients taking >5 medications considered as polypharmacy subjects. Data were collected directly from the patients by face-to-face interview technique Results The mean age was 70.49±3.88 years. The most common diseases were Hypertension and diabetes mellitus (n: 105, 100%). It was determined that (n: 95, 90.5%) of patients aged 65 to 74 years and (n: 10, 9.5%) of patients aged 75 to 82 years had multimorbidity, the difference between the two age groups was statistically significant. The mean number of drugs used by participants was 7.3±1.1 drug/ day, the highest polypharmacy was 6,7 and 8 drugs per day (n: 31, 29.52%), (n: 30, 28.57%) and (n: 30, 28.57%) respectively. There was a statistical significant increase in polypharmacy with the increase in the multimorbidity. Conclusion The prevalence of polypharmacyin multimorbid elderly patients was very high.
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