- Multidisciplinary dentistry for transitional care patients. [Journal Article]
- QIQuintessence Int 2018; 49(10):855-861
- A growing patient population is adolescents and young adults who have had one or more serious medical problems and are aging into adulthood. This group of patients has unique medical needs, which has...
A growing patient population is adolescents and young adults who have had one or more serious medical problems and are aging into adulthood. This group of patients has unique medical needs, which has resulted in the development of a specialized area of medicine: transitional care medicine. The case reviews of two of these patients are described. Patient 1 was a 23-year-old man with hereditary pancreatitis. His genetic condition resulted in the need for pancreatic splenectomy and removal of part of his small bowel, resulting in insulin-dependent diabetes and malnutrition. These complex clinical issues and the challenges of chronic pain were further complicated by severe anxiety disorder and substance abuse. He presented to the University of Rochester Medical Center's Complex Care Center (CCC), an interdisciplinary clinic that provides care for adults with pediatric onset conditions, staffed with both dentists and physicians, with acute pain from a grossly decayed premolar tooth. His blood glucose measured > 500 mg/dL and he was experiencing an acute episode of anxiety. With the expertise and experience of center staff his care needs could be met. Patient 2 was a 32-year-old woman with chronic juvenile rheumatoid arthritis, drug-associated lupus, and mental health problems including depression. This condition requires her to be managed with broad spectrum immunosuppression to prevent joint inflammation that results in significant joint destruction and bone loss. She presented to the CCC with an abscessed molar tooth, which prevented her from receiving her required immunotherapy, IV tocilizamab. While monitored by on-site physicians, a center dentist could safely proceed with the extraction. These cases illustrate that, as the population of transitional care patients grows, general dentists can learn to work on-site with physicians and allied health per-sonnel to meet the need.
- Arthroscopic repair of glenoid rim fractures: a ligamentotaxis surgical technique. [Journal Article]
- MSMusculoskelet Surg 2018; 102(Suppl 1):41-48
- CONCLUSIONS: Acute antero-inferior glenoid rim fractures are uncommon but they are increasing in over 55 years population (frequently associated with cuff tear). Correct classification and treatment are necessary to achieve good results. The X-ray assessment includes the Neer's trauma series and the CT study with PICO measurement of glenoid fragment size. Wrong treatment can lead to chronic instability, degenerative joint disease and poor results. The arthroscopic repair with ligamentotaxis is a good solution and permits the treatment of the associated rotator cuff tear. Arthroscopic technique imposes a long learning curve. CT can be used to confirm the anatomic reduction and the healing of the fracture but since it uses X-rays it must be reserved to comminuted fractures.
- Trans-Chalcone Attenuates Pain and Inflammation in Experimental Acute Gout Arthritis in Mice. [Journal Article]
- FPFront Pharmacol 2018; 9:1123
- Gouty arthritis is characterized by an intense inflammatory response to monosodium urate crystals (MSU), which induces severe pain and reduction in the life quality of patients. Trans-Chalcone (1,3-d...
Gouty arthritis is characterized by an intense inflammatory response to monosodium urate crystals (MSU), which induces severe pain and reduction in the life quality of patients. Trans-Chalcone (1,3-diphenyl-2-propen-1-one) is a flavonoid precursor presenting biological activities such as anti-inflammatory and antioxidant proprieties. Thus, the aim of this work was to evaluate the protective effects of trans-Chalcone in experimental gout arthritis in mice. Mice were treated with trans-Chalcone (3, 10, or 30 mg/kg, per oral) or vehicle (Tween 80 20% plus saline) 30 min before intra-articular injection of MSU (100 μg/knee joint, intra-articular). We observed that trans-Chalcone inhibited MSU-induced mechanical hyperalgesia, edema, and leukocyte recruitment (total leukocytes, neutrophils, and mononuclear cells) in a dose-dependent manner. Trans-Chalcone also decreased inflammatory cell recruitment as observed in Hematoxylin and Eosin (HE) staining and the intensity of fluorescence of LysM-eGFP+ cells in the confocal microscopy. Trans-Chalcone reduced MSU-induced oxidative stress as observed by an increase in the antioxidant defense [Glutathione (GSH), Ferric Reducing (FRAP), and 2,2'-Azinobis-3-ethylbenzothiazoline 6-sulfonic acid (ABTS assays)] and reduction in reactive oxygen and nitrogen species production [superoxide anion (NBT assay) and nitrite (NO assay)]. Furthermore, it reduced in vivo MSU-induced interleukin-1β (IL-1β), Tumor necrosis factor-α (TNF-α), and IL-6 production, and increased Transforming growth factor-β (TGF-β) production. Importantly, trans-Chalcone reduced nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) activation and thereby the mRNA expression of the inflammasome components Nlrp3 (cryopyrin), Asc (apoptosis-associated speck-like protein containing a CARD), Pro-caspase-1 and Pro-IL-1β. In vitro, trans-Chalcone reduced the MSU-induced release of IL-1β in lipopolysaccharide (LPS)-primed macrophages. Therefore, the pharmacological effects of trans-Chalcone indicate its therapeutic potential as an analgesic and anti-inflammatory flavonoid for the treatment of gout.
- Spontaneous Septic Arthritis of Canine Elbows: Twenty-One Cases. [Journal Article]
- VCVet Comp Orthop Traumatol 2018; 31(6):488-493
- CONCLUSIONS: Septic arthritis, even in the absence of pyrexia, should be considered as a major differential diagnosis in middle aged, large breed dogs, with pre-existing elbow arthritis, that suffer an acute onset lameness, with elbow joint effusion and discomfort. Antibiotic therapy alone was effective for treatment with high initial response rates. Chronic lameness post-treatment was common, and a high rate of recurrence was seen with 3/12 dogs suffering more than one episode.
- Fibromodulin: Structure, Physiological Functions, and an Emphasis on its Potential Clinical Applications in Various Diseases. [Journal Article]
- JCJ Coll Physicians Surg Pak 2018; 28(10):783-790
- Fibromodulin (FMOD) is one of the small leucine-rich proteoglycans. A search of the literature did not reveal any paper that specifically reviews the potential clinical applications of FMOD in the ma...
Fibromodulin (FMOD) is one of the small leucine-rich proteoglycans. A search of the literature did not reveal any paper that specifically reviews the potential clinical applications of FMOD in the management of human diseases. First, the structure and physiological functions of FMOD were reviewed. Then its potential clinical applications in various diseases including diseases of the skin, tendons, joints, intervertebral discs, blood vessels, teeth, uterus, bone and kidney were reviewed. FMOD is able to switch the adult response to skin wounding to the desired fetal response of scarless healing. Lowered levels of FMOD would be desirable in the management of tendinopathy, uterine fibroids, tumors resistant to radiotherapy, glioblastomas, small-cell lung cancer, and primary liver/lung fibrosis. In contrast, increased levels of FMOD would be desirable in the management of acute tendon injuries, osteoarthritis, rheumatoid arthritis, temporo-mandibular disease, joint laxity, intervertebral disc disease, neo-intimal hyperplasia of vein grafts, teeth caries, periodontal disease, endometrial atrophy, osteoporosis and diabetic nephropathy. Furthermore, FMOD may be used as a prognostic marker of cerebrovascular events in patients undergoing carotid endarterectomy and a marker for prostatic cancer. Finally, the use of FMOD in the treatment of symptomatic endometrial atrophy should be explored in women who are unable to use the standard estrogen management for endometrial atrophy. The review concluded that clinical trials in humans should be initiated to investigate the potential therapeutic effects of FMOD.
- [Improved early diagnostics of rheumatic diseases : Monocentric experiences with an open rheumatological specialist consultation]. [Review]
- ZRZ Rheumatol 2018; 77(9):844-849
- CONCLUSIONS: Through this open rheumatological outpatient consultation a low threshold opportunity for the early diagnosis of rheumatologic diseases could be established. The diagnostic delay for many rheumatological diseases could be considerably shortened. Cooperation with rheumatologists in private practice guaranteed the subsequent specialized rheumatological care of the identified patients in the early stages of their illness.
- Arthritis in sarcoidosis: A multicentric study from India. [Journal Article]
- IJInt J Rheum Dis 2018; 21(9):1728-1733
- CONCLUSIONS: Acute oligoarthritis was the commonest presentation with the ankle being the most commonly affected joint. Upper limb joint (predominantly distal) and knee involvement were more common as reported in our largest series worldwide of chronic sarcoid arthritis in adults. Hilar adenopathy and erythema nodosum were common extra-articular features in both acute and chronic sarcoid arthritis. A limitation of the study was the retrospective nature of the analysis.
- Efficacy and tolerance of anakinra in acute calcium pyrophosphate crystal arthritis: a retrospective study of 33 cases. [Journal Article]
- CRClin Rheumatol 2018 Aug 25
- Calcium pyrophosphate (CPP) deposition is a frequent joint disease with increased prevalence in older people in whom treatment of acute CPP arthritis with conventional therapies such as colchicine or...
Calcium pyrophosphate (CPP) deposition is a frequent joint disease with increased prevalence in older people in whom treatment of acute CPP arthritis with conventional therapies such as colchicine or non-steroidal anti-inflammatory drugs could be contraindicated or not used at an optimal dose. As recommended in gout, anakinra might represent an alternative treatment for arthritis. We aimed to analyze the efficacy and safety of anakinra in acute CPP arthritis in a large reported series. We retrospectively included all patients receiving anakinra for acute CPP arthritis between January 2011 and 2017. The following data were collected before and 4 days after the first anakinra injection: swollen joint count (SJC), tender joint count (TJC), pain score on a visual analog scale (VAS, 0-100 mm), and C-reactive protein (CRP) level. A good response was defined according the evaluation of the physician. We included 33 patients (24 women; mean age 79.2 ± 12.8 years). The number of good responders was 27 (81.8%). At day 4, patients showed decreased mean VAS pain score (from 64.8 ± 26.5 to 21.2 ± 19.7 mm, p < 0.0001), TJC (5.8 ± 5.0 to 1.0 ± 1.0, p < 0.0001), SJC (3.9 ± 2.7 to 0.9 ± 1.0, p < 0.0001), and CRP level (116.1 ± 71.6 to 26.0 ± 23.1 mg/l, p < 0.0001). Anakinra was well tolerated, without skin complications. Only one patient had pneumonitis that was resolved with oral antibacterial agents. Anakinra could be a relevant alternative for managing acute CPP arthritis when conventional therapies are ineffective or contraindicated.
- Spine surgery in patients with ankylosing spondylitis. [Journal Article]
- RARev Assoc Med Bras (1992) 2018; 64(4):379-383
- CONCLUSIONS: the majority of our clinical and laboratories findings were discrepant with the medical literature. These differences may be secondary to regional characteristics or by the fact that our population included only those patients who underwent spinal surgery.
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- Correlation Between Tumor Necrosis Factor-α Levels, Free Fatty Acid Levels, and Soluble Vascular Cell Adhesion Molecule-1 Levels in Rheumatoid Arthritis Patients. [Journal Article]
- OROpen Rheumatol J 2018; 12:86-93
- CONCLUSIONS: (1) There was no correlation between TNF-α levels and VCAM-1 levels in RA patients; (2) There was no correlation between TNF-α levels and FFA levels in RA patients; (3) There was a negative correlation between FFA levels and VCAM-1 levels in RA patients.