Enteroviruses as a possible cause of hypertension,dilated cardiomyopathy (DCM) and hypertensive heart failure (HHF) in South western Nigeria

Background

Human enteroviruses have long been associated with various diseases of man resulting into a wide range of acute symptoms involving the cardiac and skeletal muscles, central nervous system, pancreas, skin and mucous membranes.

Objective

To assess the role of enteroviruses in the etiology of hypertension, DCM and HHF.

Methods

We obtained stool specimens from 70 subjects comprising 65 patients and 5 controls and isolation was carried out on RD, L20B, HEp-2C and Vero cell lines and identified by neutralization with standard antisera (RIVM). Thirty-six enteroviruses were isolated and identified to be Coxsackieviruses-B5, A9, Echoviruses 1, 6, 7, 9, 11, 12, 22, 30 and Poliovirus type 1 and 3.

Results

Three most frequently occurring enterovirus serotypes which constitute 60.0% of the 30 NPEV typed and 50.0% of all the isolates were Echoviruses, Coxsackie-B5-virus and Coxsackievirus-A9. Echoviruses constituted 50.0% of all the serotypes while Coxsackieviruses-B5 and A9 accounts for the 27.8 % and 5.6% respectively. Enteroviral isolation rate was higher in age groups 51 years and above. The percentage of study subjects who had Coxsackie-B5-viruses and echoviruses was significantly (P<0.05) higher in cases of hypertension, HHF and DCM than in control subjects. Coxackie-B5-virus, Echovirus-6 and Echovirus-11 were found in both study locations.

Conclusion

The findings of this study showed that Enteroviruses may likely be involved in the etiology of hypertension, DCM and HHF. Further studies would therefore be necessary for the prevention and control of these diseases.     

Complications of Total Knee Arthroplasty: Standardized List and Definitions of The Knee Society

Background

Despite the importance of complications in evaluating patient outcomes after TKA, definitions of TKA complications are not standardized. Different investigators report different complications with different definitions when reporting outcomes of TKA.

Questions/purposes

We developed a standardized list and definitions of complications and adverse events associated with TKA.

Methods

In 2009, The Knee Society appointed a TKA Complications Workgroup that surveyed the orthopaedic literature and proposed a list of TKA complications and adverse events with definitions. An expert opinion survey of members of The Knee Society was used to test the applicability and reasonableness of the proposed TKA complications. For each complication, members of The Knee Society were asked “Do you agree with the inclusion of this complication as among the minimum necessary for reporting outcomes of knee arthroplasty?” and “Do you agree with this definition?”

Results

One hundred two clinical members (100%) of The Knee Society responded to the survey. All proposed complications and definitions were endorsed by the members, and 678 suggestions were incorporated into the final work product. The 22 TKA complications and adverse events include bleeding, wound complication, thromboembolic disease, neural deficit, vascular injury, medial collateral ligament injury, instability, malalignment, stiffness, deep joint infection, fracture, extensor mechanism disruption, patellofemoral dislocation, tibiofemoral dislocation, bearing surface wear, osteolysis, implant loosening, implant fracture/tibial insert dissociation, reoperation, revision, readmission, and death.

Conclusions

We identified 22 complications and adverse events that we believe are important for reporting outcomes of TKA. Acceptance and utilization of these standardized TKA complications may improve evaluation and reporting of TKA outcomes.     

Economic impact of total hip arthroplasty

Since the first successful total hip arthroplasty (THA) 28 years ago, this procedure has enabled millions of people to walk without pain. The overall incidence of THA has more than tripled in the last five years, now exceeding 196,000 cases annually. The direct and indirect costs of THA exceed $4.9 billion annually. Though the economic benefits of THA offset this figure by $1.85 billion, the costs nevertheless have a significant impact on the health care system. Although THA is expensive, the excellent long-term results make it well worth the expense.     

Total Knee Arthroplasty Wound Complication Treatment Algorithm: Current Soft Tissue Coverage Options

Background

Wound complications associated with soft tissue defects following total knee arthroplasty present challenges for the orthopedic surgeon. The scale of early complications include less morbid problems, such as quickly resolving drainage and small superficial eschars, to persistent drainage and full-thickness tissue necrosis, which may require advanced soft tissue coverage.

The benefit of radiologically-guided steroid injections for trapeziometacarpal osteoarthritis

INTRODUCTION

Osteoarthritis of the trapeziometacarpal joint (TMJ) is a common condition causing significant disability. Conservative treatments include intra-articular steroid injections.

PATIENTS AND METHODS

This clinical, observational study prospectively reviewed the longevity of benefit of steroid injections into the TMJ. Eighty-three patients were recruited with a median age of 62 years and injected with steroid and local anaesthetic under radioscopic guidance. They were followed up until the analgesic effects ceased with a questionnaire including visual analogue scores.

RESULTS

Two-thirds of patients were improved at 2 months, with nearly half having a 3-month improvement. One in six patients had a 6-month benefit, with some patients still improved 2 years after injection. Previously injected patients had a reduced duration of benefit compared to their previous injection. Severity of osteoarthritis did not affect the injection efficacy.

CONCLUSIONS

Based on this study, we recommend steroid injections in all degrees of TMJ osteoarthritis.     

川芎根茎挥发油化学成分的研究

用毛细管气相色谱和色谱—质谱—计算机联用系统对川芎根茎挥发油的化学成分进行了研究。从50m×0.25mm键合甲基硅氧烷弹性石英毛细管色谱柱中分离出180个峰,用保留指数测定,标准品叠加和质谱测定三种方法初步鉴定出40个成分。其主要成分是藁本内酯(58.00%)、3-丁叉苯酞(5.29%)和香桧烯(6.08%)等。