UPDATE ON MEDICAL TREATMENT OF OSTEOARTHRITIS

2014 ◽  
pp. 5-11
Author(s):  
Tam Vo ◽  
Thi Hong Van Le
Keyword(s):  
Key Words ◽  
Weight Management ◽  
Joint Replacement ◽  
Nutritional Supplements ◽  
Management Plan ◽  
Joint Involvement ◽  
Narcotic Analgesics ◽  
Key Words Osteoarthritis ◽  
Low Toxicity ◽  
Disease Modifying

The management plan should be individualized. Nonpharmacologic treatments of osteoarthritis (OA) include education, weight management and appropriate exercise which may delay disease progression, reduce symtoms, and improve fuction. Nutritional supplements such as glucosamine and chondroitin sulfate have been studied in OA, may benefit some patients, and have low toxicity. Pharmacologic approaches to treatment include non-narcotic analgesics such as acetaminophen and nonsteroid anti-imflammatory drugs (NSAIDs). Intra-articular injection of glucocorticoids or hyaluronic may be useful for isolated joint involvement. Surgical joint replacement, especially at the hip and knee, can reduce pain and improve function in appropriate candidates. Investigation continues into potential disease-modifying interventions in OA. Key words: osteoarthritis

Weight Loss and Dietary Interventions for Hidradenitis Suppurativa: A Systematic Review

2019 ◽  
Vol 24 (1) ◽  
pp. 64-72 ◽  
Author(s):  
Arunima Sivanand ◽  
Wayne P. Gulliver ◽  
Chitmandeep K. Josan ◽  
Raed Alhusayen ◽  
Patrick J. Fleming
Keyword(s):  
Systematic Review ◽  
Weight Loss ◽  
Hidradenitis Suppurativa ◽  
Nutritional Supplements ◽  
Management Plan ◽  
Primary Objective ◽  
Inflammatory Disorder ◽  
Dietary Interventions ◽  
Zinc Gluconate ◽  
Excess Skin

Hidradenitis suppurativa (HS) is a common inflammatory disorder characterized by recurrent, painful, and malodorous abscesses and nodules predominantly in skin folds. HS is associated with substantial morbidity and poor quality of life. There are no curative therapies, and the only approved biologic drug has variable efficacy and requires high doses, making adjunct treatments crucial. An important risk factor for disease severity is obesity. Our primary objective was to conduct a systematic review examining weight loss and dietary interventions, in HS. Our secondary objective was to examine nutritional supplements in HS.A systematic literature search was conducted using Medline, EMBASE, and the Cochrane Database. We included all study types in adults (>18 years), with a minimum sample size of 5, examining the effects of any dietary or weight loss intervention on HS severity. Two authors screened n = 1279 articles of which 9 met inclusion criteria. All included studies were observational and all interventions were associated with various measures of decreased HS severity. Patient-controlled weight loss and bariatric surgery were associated with HS regression, though a subset of patients with significant increase in panniculi experienced exacerbations and required excision of excess skin. Diets demonstrating benefit eliminated dairy and brewer’s yeast. Nutritional supplements including zinc gluconate, vitamin D, and riboflavin had a suppressive, rather than curative, effect on HS lesions in single studies. Overall, the reviewed interventions show promise as potential adjunct treatments in a HS management plan. Prospective randomized controlled trials should validate these findings.

scholarly journals Do Morbidly Obese (BMI >40) Patients Have Increased Healing Complications Post Orthopedic Total Knee Replacement (TKA)?: A Narrative Review of Recent Literature

2020 ◽  
pp. 1-5
Author(s):  
Edwin McCray ◽  
◽  
Donald Maharty ◽  
Harshit Terala ◽  
◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Total Knee Replacement ◽  
Weight Management ◽  
Joint Replacement ◽  
Recent Literature ◽  
Morbidly Obese ◽  
Obesity Epidemic ◽  
Orthopedic Surgeons ◽  
Younger Age ◽  
Total Knee

Introduction: Faced with the looming obesity epidemic, orthopedic surgeons are finding an increase in demand and popularity of joint replacement surgeries, particularly those of the knee. Equally alarming is the younger age and higher BMI at which patients are electing to have the procedure performed, despite attempts at weight management and other interventions. Along with the innumerable comorbidities associated with obesity it is proving to be a challenge for orthopedic surgeons especially in terms of postoperative complications for patients at an elevated BMI.

Weight Management and Weight Loss Strategies of Professional Jockeys

2002 ◽  
Vol 12 (1) ◽  
pp. 1-13 ◽  
Author(s):  
Jan M. Moore ◽  
Anna F. Timperio ◽  
David A. Crawford ◽  
Cate M. Burns ◽  
David Cameron-Smith
Keyword(s):  
Weight Loss ◽  
Body Weight ◽  
Weight Management ◽  
Weight Control ◽  
Response Rate ◽  
Management Strategies ◽  
Management Plan ◽  
Rapid Weight Loss ◽  
Additional Weight ◽  
The Impact

Jockeys are required to maintain very low body weight and precise weight control during competition. This study examined the weight loss and weight management strategies of professional horseracing jockeys in the state of Victoria, Australia. An anonymous, self-completed questionnaire was administered (55% response rate, n=116). Almost half (43%) reported that maintaining riding weight was difficult or very difficult, with 75% routinely skipping meals. In preparation for racing, 60% reported that they typically required additional weight loss, with 81% restricting food intake in the 24 hours prior to racing. Additionally, sauna-induced sweating (29%) and diuretics (22%) were frequently employed to further aid in weight loss prior to racing. These rapid weight loss methods did not differ between the 51% of jockeys who followed a weight management plan compared to those who did not. The impact of these extreme weight loss practices on riding performance and health remains unknown.

Observe and Accept: A Pathways Approach to Multiple Sclerosis

Biofeedback ◽  
2019 ◽  
Vol 47 (3) ◽  
pp. 71-78
Author(s):  
Donald Moss
Keyword(s):  
Multiple Sclerosis ◽  
Complementary Therapies ◽  
Nutritional Supplements ◽  
Biofeedback Training ◽  
Depression And Anxiety ◽  
Blurred Vision ◽  
Mindfulness Skills ◽  
The Central Nervous System ◽  
Disease Modifying ◽  
Disease Modifying Agents

Multiple sclerosis (MS) is a chronic disease, marked by demyelination of the central nervous system and a wide variety of symptoms, including blurred vision, muscle weakness, and impaired motor control, most of which occur in a remitting and relapsing pattern. In many cases the illness is progressive with severe disability. Current treatments combine interventions to manage the current episode and disease-modifying agents to reduce the risk of further episodes. The treatments for MS are only partially effective, and patients often face a confusing and frightening progression of their illness, despite treatment. Many patients utilize complementary therapies, especially dietary changes, nutritional supplements, and relaxation skills. This article presents the case narrative of a 36-year-old woman who was referred for depression and anxiety accompanying a 3-year period of recurring MS episodes. She combined many complementary therapies along with the medical management of her illness, and benefitted especially from mindfulness skills and biofeedback training.

The burns management pathway II: receiving and initially managing a patient with burns

2019 ◽  
pp. 43-52
Author(s):  
Kayvan Shokrollahi ◽  
Susie Yao
Keyword(s):  
Nutritional Supplements ◽  
Management Plan ◽  
Associated Injuries ◽  
Vein Thrombosis ◽  
Standard Management ◽  
Theatre Staff ◽  
Secondary Survey ◽  
Specialist Nurses ◽  
Anaesthetic Assessment ◽  
Deep Vein

The burns multidisciplinary team includes surgeons, specialist nurses, anaesthetic and critical care specialists, operating theatre staff, physiotherapists, occupational therapist, play specialists, clinical psychologists and dieticians, with input from other specialties (eg. microbiology). Burns units receive referrals from primary and secondary care, usually by telephone. Referral proformas help to document these calls and any information provided about patients, their burns and associated injuries, the treatments provided and their planned transfer. The clinician accepting the patient for transfer must ensure that there is an available ward or ICU bed, as required, prior to arranging transfer. Care should be taken to minimize the risk of a patient deteriorating during transfer. Fluid resuscitation and patient warming should continue during a prompt transfer by an ambulance team with the appropriate equipment and expertise, along with a medical escort if required. Upon arrival, the patient should be formally and systematically assessed (including an ATLS primary and secondary survey and anaesthetic assessment if indicated) and any remaining investigations undertaken. The burn wounds should be cleaned, photographed, swabbed and dressed, and any resuscitation fluids recalculated and prescribed. Appropriate medications and adjuncts should be prescribed including tetanus, deep vein thrombosis and stress ulceration prophylaxis, analgesia, usual medications, and nutritional supplements along with enteral or parenteral feeds. An admission proforma helps junior medical staff to ensure that all required information is collected and all components of the standard management plan are instituted.

The antifungal strobilurins and their possible ecological role

1995 ◽  
Vol 73 (S1) ◽  
pp. 940-945 ◽  
Author(s):  
T. Anke
Keyword(s):  
Antifungal Activity ◽  
Key Words ◽  
Phytopathogenic Fungi ◽  
Ecological Role ◽  
Natural Substrate ◽  
Lead Compounds ◽  
Low Toxicity ◽  
Respiration Inhibitors ◽  
Nutrient Resources ◽  
High Antifungal Activity

The strobilurins and the closely related oudemansins are new respiration inhibitors, binding to the Qp centre of cytochrome b. Their high antifungal activity against phytopathogenic fungi and their low toxicity towards mammals make them attractive lead compounds for the synthesis of agricultural fungicides. The strobilurins have been isolated from a great number of Basidiomycetes belonging to the genera Strobilurus, Oudemansiella, Xerula, Hydropus, Mycena, Filoboletus, Crepidotus, and Cyphellopsis as well as one Ascomycete, Bolinea lutea. Strobilurin-producing species occur in Europe, the Americas, Africa, and Australia. Most of the producing fungi grow on wood. Since under sterile conditions strobilurin production could be detected in the natural substrate it appears that the strobilurins play a role in securing nutrient resources for the producers from competing fungi. Key words: strobilurins, oudemansins, antibiotics, antifungal, Basidiomycetes.

scholarly journals 817 Activated osteoarthritis following immune checkpoint inhibitor treatment: an observational study

2021 ◽  
Vol 9 (Suppl 3) ◽  
pp. A854-A854
Author(s):  
Pankti Reid ◽  
David Liew ◽  
Rajshi Akruwala ◽  
Anne Bass ◽  
Karmela Chan
Keyword(s):  
Adverse Events ◽  
Observational Study ◽  
Immune Checkpoint ◽  
Inflammatory Arthritis ◽  
Immune Checkpoint Inhibitor ◽  
Checkpoint Inhibitor ◽  
Joint Involvement ◽  
Inflammatory Drugs ◽  
Disease Modifying ◽  
Anti Inflammatory

BackgroundImmune checkpoint inhibitors (ICIs) have revolutionized cancer therapy but can result in toxicities, known as immune-related adverse events (irAEs), due to a hyperactivated immune system. ICI-related inflammatory arthritis has been described in literature, but herewith we introduce and characterize post-ICI activated osteoarthritis (ICI-aOA).MethodsWe conducted a multi-center, retrospective, observational study of patients with cancer treated with ICIs and diagnosed with ICI-aOA by a rheumatologist. ICI-aOA was defined by (1) an increase in non-inflammatory joint pain after ICI initiation, (2) in joints characteristically affected by osteoarthritis and (3) lack of inflammation on exam. Cases were graded using the CTCAE (Common Terminology Criteria for Adverse Events) V6.0 rubric for arthralgia. RECIST (Response evaluation criteria in solid tumors) V.1.1 (v.4.03) guidelines determined tumor response. Results were analyzed using Chi-squared tests of association and multivariate logistic regression.ResultsThirty-six patients had ICI-aOA with mean age at time of rheumatology presentation of 66 years (51–81yrs). Most patients had metastatic melanoma (10/36, 28%) and had received a PD1/PDL1 inhibitor monotherapy (31/36, 86%) with 5/36 (14%) combination therapy. Large joint involvement (hip/knee) was noted in 53% (19/36), small joints of hand 25% (9/36), and spine 14% (5/36). Two-thirds (24/36) suffered multiple joint involvement. Three of 36 (8%) had CTCAE grade 3, 14 (39%) grade 2 and 19 (53%) grade 1 manifestations. Symptom onset ranged from six days to 33.8 months with median of 5.2 months after ICI initiation; 5 patients suffered ICI-aOA after ICI cessation (0.6, 3.5, 4.4, 7.3 and 15.4 months after ICI cessation) (figure 1). Most common form of therapy was intra-articular corticosteroid injections only (15/36, 42%) followed by NSAIDs only (7/36, 20%) (figure 2). Twenty patients (56%) experienced other irAEs, with rheumatic and dermatologic being the most common. All three patients with high-grade ICI-aOA also had another irAE diagnosis at some point after ICI initiation.ConclusionsICI-aOA should be recognized as an adverse event of ICI immunotherapy. Early referral to a rheumatologist can facilitate the distinction between ICI induced inflammatory arthritis from post-ICI mechanical arthropathy, the latter of which can be managed with local therapy that will not compromise ICI efficacy.Ethics ApprovalCollection of patient data was approved by local Institutional Review Boards at respective institutions: Hospital for Special Surgery in New York (HSS IRB # 2017–1898), University of Chicago in Chicago, Illinois (IRB150837) and Austin Health in Melbourne, Victoria, Australia (HREC/18/Austin/102).Abstract 817 Figure 1Incidence of ICI-aOA (activated osteoarthritis after immune-checkpoint inhibitor) ranged from the first month after ICI initiation up until month 22 after ICI initiation, with most cases occurring in the first 6 months after start of ICI. Five of 36 patients experienced ICI-aOA after ICI cessation (0.6, 3.5, 4.4, 7.3 and 15.4 months after ICI cessation), corresponding to presentation after ICI initiation as follows: 2.0, 9.6, 19.1, 8.7 and 16.1 months after ICI initiation, respectively (as denoted in darker color). ICI: Immune-checkpoint inhibitor, NSAIDs: Non-steroidal anti-inflammatory drugs, DMARDs: Disease modifying anti-rheumatic drugsAbstract 817 Figure 2Therapeutic option most used was local or intra-articular corticosteroid therapy, followed by conservative management with physical therapy only then NSAIDs. Most patients experienced improvement in signs and symptoms with treatment. ICI: Immune-checkpoint inhibitor, NSAIDs: Non-steroidal anti-inflammatory drugs, DMARDs: Disease modifying anti-rheumatic drugs

scholarly journals Lok Vanaki - a recent innovative approach for managing private forestry in Madhya Pradesh, India

1970 ◽  
Vol 15 (2) ◽  
pp. 24-27
Author(s):  
A.K. Bhattacharya ◽  
Bijendra Basnyat
Keyword(s):  
Key Words ◽  
State Government ◽  
Unemployment Rate ◽  
Management Plan ◽  
Madhya Pradesh ◽  
Innovative Approach ◽  
Scientific Management ◽  
Political Commitment ◽  
Private Forestry ◽  
Implementation Status

This paper highlights on Lok Vanaki (private forestry) scheme, an innovative and decentralized approach for managing private forestry of Madhya Pradesh (MP) and examines on policy provisions, implementation status and explore on issues associated with its implementation. This scheme was launched in Madhya Pradesh in April 1999 for promoting multi-tier scientific management of neglected and degrading forests on private holdings. The State Government has taken adequate measures to provide sufficient legal support to the whole initiative. Lok vanaki has not only helped on conservation and development of private forestry but also in socio-economic upliftment of people. It has also contributed in reducing the unemployment rate of the country concept through the charter foresters, who are fully authorized for preparation, implementation and monitoring of the plan. Efforts are underway to make the programme successful through political commitment. Key words: Private forestry, Forest acts, Management plan, MP, India. Banko Janakari Vol.15(2) 2005 pp24-27

Creating an effective weight management plan

2013 ◽  
Vol 11 (11) ◽  
pp. 561-566
Author(s):  
Debbie Cook
Keyword(s):  
Weight Management ◽  
Management Plan

OARSI/OMERACT Criteria of Being Considered a Candidate for Total Joint Replacement in Knee/Hip Osteoarthritis as an Endpoint in Clinical Trials Evaluating Potential Disease Modifying Osteoarthritic Drugs

2009 ◽  
Vol 36 (9) ◽  
pp. 2097-2099 ◽  
Author(s):  
MAXIME DOUGADOS ◽  
GILLIAN HAWKER ◽  
STEFAN LOHMANDER ◽  
AILEEN M. DAVIS ◽  
PAUL DIEPPE ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Task Force ◽  
Joint Space Width ◽  
Hip Osteoarthritis ◽  
Joint Space ◽  
Systematic Research ◽  
Disease Modifying ◽  
Space Width

Objective.A disease-modifying osteoarthritic drug (DMOAD) should interfere with the cartilage breakdown observed and improve symptoms or prevent deterioration of the patient’s clinical condition. We propose a composite index including structural and symptomatic variables of osteoarthritis (OA) as criteria for being considered a candidate for total joint replacement as an endpoint in clinical trials evaluating potential DMOAD.Methods.An OARSI/OMERACT task force conducted this study in 3 steps: (1) The 3 main domains — pain, function, structure — were revisited; (2) For each of the domains a “non-acceptable state” and a “relevant” progression for their structure were defined; and (3) a set of criteria was proposed combining the information from these 3 domains.Results.A questionnaire was elaborated for the domains “pain” and “function.” Systematic research of the literature and evaluation of different databases concluded that the domain “structure” should be evaluated by radiological joint space width in millimeters. An unacceptable radiographic progression was defined as a change in the joint space width over the measurement error. An international, cross-sectional study is proposing a definition of a “nonacceptable symptom state.”Conclusion.The objective of the ongoing OARSI/OMERACT initiative is to propose criteria for being considered a candidate for total joint replacement to be used as an endpoint in clinical trials evaluating potential DMOAD. The preliminary steps of this initiative have been completed.

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