The use of hip injection (HI) in the treatment of osteoarthritis (OA) has gained wide popularity. The relatively low cost, fast and simple method of pain relief are amongst its many advantages. Over time, the content of the injection has also evolved from local anesthetic (LA) agents to corticosteroids (CSs), hyaluronic acid (HA) and platelet-rich plasma (PRP). [1] The scope of use of injections in the hip region has grown from traditional aspiration to therapeutic injections. The two main substances used in recent Hip injection (HI) for osteoarthritis (OA) are in vogue nowadays. Corticosteroids (CSs) and hyaluronic acid (HA) gel are the two most common agents injected into the hip. Off late, platelet-rich plasma (PRP), mesenchymal stem cell (MSC), bone marrow aspirate concentrate (BMAC), local anesthetic (LA) agents, non-steroidal anti-inflammatory drugs (NSAIDs) and their different combinations have also been injected in hips to provide desired pain relief. However, there is a group of clinicians who vary of these injections. A search of the literature was performed on PubMed, Cochrane Library, and DOAJ using the keywords "hip osteoarthritis injection". Data were analyzed and compiled. Intraarticular CSs are effective in providing the desired pain relief in OA hip, but repeated injections should be avoided and the interval between HI and hip arthroplasty must be kept for more than three months. Methylprednisolone or triamcinolone are combined with 1% lidocaine or 0.5% bupivacaine. Chondrotoxic effects of LA is a concern. Although national guidelines do not favor the use of HA for hip OA, numerous publications have favored its usage for a moderate grade of OA. The PRP, MSC, and BMAC are treatment options with great potential; however, currently, the evidence is conflicting on their role in hip OA. There is always a risk of septic arthritis, particularly when aseptic precautions are not followed, and clinicians must vary of this complication.
Purpose:We aimed to develop a method for quantitative assessment of wound healing in ulcerated diabetic feet.Methods: High-frequency ultrasound (HFU) images of 30 wounds were acquired in a controlled environment on post-debridement days 7, 14, 21, and 28. Meaningful features portraying changes in structure and intensity of echoes during healing were extracted from the images, their relevance and discriminatory power being verified by analysis of variance. Relative analysis of tissue healing was conducted by developing a features-based healing function, optimised using the pattern-search method. Its performance was investigated through leave-one-out cross-validation technique and reconfirmed using principal component analysis. Results:The constructed healing function could depict tissue changes during healing with 87.8% accuracy. The first principal component derived from the extracted features demonstrated similar pattern to the constructed healing function, accounting for 86.3% of the data variance. Conclusion:The developed wound analysis technique could be a viable tool in quantitative assessment of diabetic foot ulcers during healing. K E Y W O R D Sdermatologic sonography, diabetic foot ulcer, healing function, high-frequency ultrasound imaging, image processing, pattern search optimisation, wound healing assessment | INTRODUCTIONDiabetic foot ulcers (DFUs) are the most common foot problem (80%) among diabetics, with a prevalence of 4-10% in the general diabetic population; this is higher (5-10%) in older and lower (1.5-3.5%) in younger patients.1 Wound assessment at regular intervals helps clinicians to evaluate the effectiveness of a particular treatment strategy and change it if necessary; however, developing a reproducible quantitative method to monitor and predict the healing rate has proven to be a convoluted task. Improvements in ultrasound instrumentation and advances in portable high-frequency ultrasound (HFU) skin scanners (>20 MHz) during the last two decades have expanded their applications as cost-effective and non-invasive tools in diagnostic dermatology, including for the measurement of skin thickness, the evaluation of the efficacy of drugs, the differentiation of dermal burns, the assessment of skin tumours, the visualisation of the skin structure as well as dimensional changes deep within the tissues, the measurement of the skin's mechanical properties and the monitoring of
Chronic liver disease (CLD) is the commonest ailment affecting the hepatobiliary system. Six significant pathologies related to CLD include hepatic osteodystrophy (HO), increased infection susceptibility, sarcopenia, osteonecrosis of the femoral head (OFH), increased risk of periprosthetic complications and fracture. Hepatic osteodystrophy, which comprises osteopenia, osteoporosis, and osteomalacia, refers to alterations in bone mineral metabolism found in patients with CLD. The HO prevalence ranges from 13 to 95%. Low complement levels, poor opsonization capacity, portosystemic shunting, decreased albumin levels, and impaired reticuloendothelial system make the cirrhotic patients more susceptible to developing infectious diseases. Septic arthritis, osteomyelitis, prosthetic joint infection, and cellulitis were common types of CLD-associated infectious conditions. The incidence of septic arthritis is 1.5 to 2-fold higher in patients with cirrhosis. Sarcopenia, also known as muscle wasting, is one of the frequently overlooked manifestations of CLD. Sarcopenia has been shown to be independent predictor of longer mechanical ventilation, hospital stay, and 12-month mortality of post-transplantation. Alcohol and steroid abuse commonly associated with CLD are the two most important contributory factors for non-traumatic osteonecrosis. However, many studies have identified cirrhosis alone to be an independent cause of atraumatic osteonecrosis. The risk of developing OFH in cirrhosis patients increases by 2.4 folds and the need for total hip arthroplasty increases by 10 folds. Liver disease has been associated with worse outcomes and higher costs after arthroplasty. Cirrhosis is a risk factor for arthroplasty complications and is associated with a prolonged hospital stay, higher costs, readmission rates, and increased mortality after arthroplasty. Greater physician awareness of risk factors associated with musculoskeletal complications of CLD patients would yield earlier interventions, lower healthcare costs, and better overall clinical outcomes for this group of patients.
Bone fractures have a high degree of severity. This is usually a result of the physical trauma of diseases that affect bone tissues, such as osteoporosis. Due to its highly vascular nature, the bone is in a constant state of remodeling. Although those of younger ages possess bones with high regenerative potential, the impact of a disrupted vasculature can severely affect the recovery process and cause osteonecrosis. This is commonly seen in the neck of femur, scaphoid, and talus bone. In recent years, mesenchymal stem cell (MSC) therapy has been used to aid in the regeneration of afflicted bone. However, the cut-off in blood supply due to bone fractures can lead to hypoxia-induced changes in engrafted MSCs. Researchers have designed several oxygen-generating biomaterials and yielded varying degrees of success in enhancing tissue salvage and preserving cellular metabolism under ischemia. These can be utilized to further improve stem cell therapy for bone repair. In this review, we touch on the pathophysiology of these bone fractures and review the application of oxygen-generating biomaterials to further enhance MSC-mediated repair of fractures in the three aforementioned parts of the bone.
Chapter 1 Introduction 1 Chapter 2 Capacity building exposure of health care providers for adolescent friendly health service delivery Chapter 3 Provider perspectives on the provision of sexual and reproductive health information, counselling and services to adolescents and youth Chapter 4 Provider interaction with adolescents and youth Chapter 5 Provider perspectives on barriers to providing services to adolescents and youth Chapter 6 Summary and recommendations References Authors List of investigators iv This study has benefited immeasurably from the inputs of many. We are extremely grateful to the John D. and Catherine T. MacArthur Foundation for their financial support which made this study possible.
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