Hip Displacement in Cerebral Palsy: The Role of Surveillance

IntroductionHip displacement is common in cerebral palsy (CP) and is related to the severity of neurological and functional impairment. It is a silent, but progressive disease, and can result in significant morbidity and decreased quality of life, if left untreated. The pathophysiology of hip displacement in CP is a combination of hip flexor-adductor muscle spasticity, abductor muscle weakness, and delayed weight-bearing, resulting in proximal femoral deformities and progressive acetabular dysplasia. Due to a lack of symptoms in the early stages of hip displacement, the diagnosis is easily missed. Awareness of this condition and regular surveillance by clinical examination and serial radiographs of the hips are the key to early diagnosis and treatment.Hip surveillance programmesSeveral population-based studies from around the world have demonstrated that universal hip surveillance in children with CP allows early detection of hip displacement and appropriate early intervention, with a resultant decrease in painful dislocations. Global hip surveillance models are based upon the patients’ age, functional level determined by the Gross Motor Function Classification system (GMFCS), gait classification, standardized clinical exam, and radiographic indices such as the migration percentage (MP), as critical indicators of progressive hip displacement.ConclusionDespite 25 years of evidence showing the efficacy of established hip surveillance programmes, there is poor awareness among healthcare professionals in India about the importance of regular hip surveillance in children with CP. There is a need for professional organizations to develop evidence-based guidelines for hip surveillance which are relevant to the Indian context.     

The pathophysiology and therapy of menopausal symptoms

Menopause is generally experienced as a biopsychosocial process involving physiological changes, and influenced by a wide range of psychological, social and cultural factors. The loss of ovarian oestrogen production may cause debilitating symptoms, including hot flushes, night sweats, sleep disturbance, vaginal dryness, dyspareunia, bladder dysfunction, loss of libido, and mood changes. Experience of the menopause transition varies widely between individuals, depending on the age of onset, personal health and wellbeing, social context, environment and culture.Hormone Replacement Therapy (HRT) remains the most effective treatment for the management of vasomotor symptoms and vaginal dryness, but has no proven role in the treatment of chronic diseases of ageing. Treatment should be individualized, and for most healthy women aged 50–59 years the risks of HRT are low. An understanding of the pathophysiology of menopausal symptoms and the risks and benefits of both hormonal and non-hormonal treatments assists in the individual management of patients.     

Is routine extubation overnight safe in cardiac surgery patients?

Objectives

Expedient extubation after cardiac surgery has been associated with improved outcomes, leading to postoperative extubation frequently during overnight hours. However, recent evidence in a mixed medical-surgical intensive care unit population demonstrated worse outcomes with overnight extubation. This study investigated the impact of overnight extubation in a statewide, multicenter Society of Thoracic Surgeons database.