RESUMO
AIMS: To investigate the frequency and the factors associated with urinary incontinence (UI) in a sample of middle-aged and older women with lower limb osteoarthritis (OA). METHODS: Women aged 50 years or older with clinical hip/knee OA diagnoses were recruited for this cross-sectional study. Self-reported UI and type, sociodemographic characteristics, medical conditions, physical activity level, anthropometric and body composition measurements, muscle strength, and physical function were assessed. Uni and multivariable logistic regression were used to investigate the factors associated with UI. RESULTS: Among 100 middle-aged and older women (mean 67.27 ± 8.77 SD years), 67% reported UI. In the UI group, 33% reported stress UI, 36% reported urgency UI, and 31% reported mixed UI. In the univariate analysis, age, level of physical activity, pulmonary disease, number of medications, body mass index (BMI), number of deliveries, and activity limitation were significantly associated with UI. In the multivariable analysis, older age (60-69 years OR: 4.91, 95% CI: 1.25-19.36; ≥70 years OR: 8.06, 95% CI: 1.96-33.22), compared to 50-59 years, morbid obesity (OR: 14.10, 95% CI: 1.36-146.48), compared to BMI < 30 kg/m2 , and activity limitation (OR: 5.31, 95% CI: 1.61-17.54), assessed as short physical performance battery ≤8, remained significantly associated with UI. CONCLUSIONS: UI was highly frequent among middle-aged and older women with hip/knee OA. Older age, activity limitation, and morbid obesity were independently associated with UI. Interventions targeting physical function and weight management must be considered to prevent and treat UI in this population.
Assuntos
Obesidade Mórbida , Osteoartrite do Quadril , Osteoartrite do Joelho , Incontinência Urinária por Estresse , Incontinência Urinária , Pessoa de Meia-Idade , Humanos , Feminino , Idoso , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/epidemiologia , Estudos Transversais , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/epidemiologia , Obesidade Mórbida/complicações , Pacientes Ambulatoriais , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia , Fatores de Risco , Incontinência Urinária por Estresse/complicações , PrevalênciaRESUMO
PURPOSE: To present the preliminary results of a cohort of 13 patients with hip osteoarthritis (OA) and great trochanteric pain syndrome (GTPS) refractory to conservative management or physical therapy and no indication for surgery treated with embolization of the lateral femoral circumflex artery. MATERIAL AND METHODS: This is a single-center prospective cohort from July 2019 to September 2020. Visual analogue scale (VAS) and Western Ontario and MacMaster Universities (WOMAC) were used to compare the symptoms before and after 6-month follow-up. Technical success was considered when at least one artery responsible for the hyperemic synovium was embolized. Complications and adverse events were noted. RESULTS: In total, 13 patients were included; mean age was 62.4 (± 11.0) years. 10 (76.9%) patients were treated for GTPS and 3 (23.1%) for hip OA. Nine patients were treated with imipenem/cilastatin (I/C) alone. Microsphere 100-300 µm and I/C were combined in 4 patients. The WOMAC Index had a statistically significant decrease in the total from 77 to 27 points (p = 0.001). Pain, rigidity and physical activity have also significantly reduced (19 to 5, p = 0.001; 6 to 2, p = 0.002 and 53 to 22, p = 0.001, respectively). VAS score had a significant decrease (10 to 2, p = 0.002). Two patients present posterior tight numbness, spontaneously improved within 30 days. CONCLUSION: In this cohort, lateral femoral circumflex artery embolization was a safe and effective treatment for patients with hip pain due to OA and GTPS.
Assuntos
Bursite , Osteoartrite do Quadril , Osteoartrite do Joelho , Humanos , Pessoa de Meia-Idade , Osteoartrite do Quadril/complicações , Estudos Prospectivos , Seguimentos , Bursite/complicações , Dor/complicações , Resultado do Tratamento , Artérias , Osteoartrite do Joelho/complicaçõesRESUMO
Total hip arthroplasty is a successful procedure with high rates of functional satisfaction and pain relief. A large number of patients with bilateral hip pathology will require both hip joint replacement, from there born the inquietude to knowing benefits and disadvantage of bilateral simultaneous hip arthroplasty. We present a female patient case who developed bilateral hip osteoarthritis secondary to development dysplasia of the hip which was surgically managed with bilateral arthroplasty at one time. We show a follow-up report of the case and a review of the literature to know the main advantages of this new current of hip arthroplasty in patients with bilateral hip pathology
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia , Artroplastia de Quadril/métodos , Radiografia , Osteoartrite do Quadril/complicações , Osteoartrite do Quadril/terapiaRESUMO
The aim of this study was to evaluate the efficacy and safety of the intra-articular (IA) injection of botulinum toxin type A (BoNT/A) to the management of chronic pain in dogs. In a randomized, controlled, double-blinded study sixteen dogs with osteoarthritis secondary to hip dysplasia were distributed into two groups: 25 IU BoNT/A (BoNT) or saline solution (Control) was administered IA in each affected joint. All dogs received oral supplements (90 days) and carprofen (15 days). The dogs were assessed by a veterinarian on five occasions and the owner completed an assessment form at the same time (baseline to 90 days). The data were analyzed using unpaired-t test, Fisher's exact test, analysis of variance and the Tukey's test (P<0.05). There were no differences between groups in the veterinarian and owner assessments. Lower scores were observed in both groups during 90 days after IA therapy in the owner assessments (P<0.001). Compared with baseline, the Vet score was lower from 15-90 days after IA injection in the BoNT group, and at 15 and 30 days in the Control group (P<0.001). Both treatments were safe and reduced the clinical signs associated with hip osteoarthritis. However, IA BoNT/A (25 IU) did not provide better pain relief than the control treatment.
Assuntos
Toxinas Botulínicas Tipo A/uso terapêutico , Doenças do Cão/tratamento farmacológico , Displasia Pélvica Canina/complicações , Osteoartrite do Quadril/veterinária , Manejo da Dor/veterinária , Dor/veterinária , Animais , Cães , Método Duplo-Cego , Feminino , Injeções Intra-Articulares , Masculino , Fármacos Neuromusculares/uso terapêutico , Osteoartrite do Quadril/complicações , Dor/tratamento farmacológico , Dor/etiologia , Distribuição AleatóriaRESUMO
BACKGROUND: Advanced osteoarthritis and total joint replacement (TJR) recovery are painful experiences and often prompt opioid use in developed countries. Physicians participating in the philanthropic medical mission Operation Walk Boston (OpWalk) to the Dominican Republic have observed that Dominican patients require substantially less opioid medication following TJR than US patients. We conducted a qualitative study to investigate approaches to pain management and expectations for postoperative recovery in patients with advanced arthritis undergoing TJR in the Dominican Republic. METHODS: We interviewed 20 patients before TJR about their pain coping mechanisms and expectations for postoperative pain management and recovery. Interviews were conducted in Spanish, translated, and analyzed in English using content analysis. RESULTS: Patients reported modest use of pain medications and limited knowledge of opioids, and many relied on non-pharmacologic therapies and family support to cope with pain. They held strong religious beliefs that offered them strength to cope with chronic arthritis pain and prepare for acute pain following surgery. Patients exhibited a great deal of trust in powerful others, expecting God and doctors to cure their pain through surgery. CONCLUSION: We note the importance of understanding a patient's individual pain coping mechanisms and identifying strategies to support these coping behaviors in pain management. Such an approach has the potential to reduce the burden of chronic arthritis pain while limiting reliance on opioids, particularly for patients who do not traditionally utilize powerful analgesics.
Assuntos
Artroplastia do Joelho/efeitos adversos , Dor Crônica/terapia , Osteoartrite do Quadril/complicações , Osteoartrite do Joelho/complicações , Manejo da Dor/métodos , Dor Pós-Operatória/terapia , Adaptação Psicológica , Adulto , Idoso , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico , Artroplastia de Quadril , República Dominicana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/psicologia , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/psicologia , Osteoartrite do Joelho/cirurgia , Período Pós-Operatório , Pesquisa Qualitativa , Religião , Adulto JovemRESUMO
ABSTRACTBACKGROUND AND OBJECTIVE: To compare the therapeutic effects of ketamine alone or ketamine plus propofol on analgesia, sedation, recovery time, side effects in premedicated children with midazolam-ketamine-atropin who are prepared circumcision operation.METHODS: 60 American Society of Anaesthesiologists physical status I-II children, aged between 3 and 9 years, undergoing circumcision operations under sedation were recruited according to a randomize and double-blind institutional review board-approved protocol. Patients were randomized into two groups via sealed envelope assignment. Both groups were administered a mixture of midazolam 0.05 mg/kg + ketamine 3 mg/kg + atropine 0.02 mg/kg intramuscularly in the presence of parents in the pre-operative holding area. Patients were induced with propofol-ketamine in Group I or ketamine alone in Group II.RESULTS: In the between-group comparisons, age, weight, initial systolic blood pressure, a difference in terms of the initial pulse rate was observed (p > 0.050). Initial diastolic blood pressure and subsequent serial measurements of 5, 10, 15, 20th min, systolic blood pressure, diastolic blood pressure and pulse rate in ketamine group were significantly higher (p < 0.050).CONCLUSION: Propofol-ketamine (Ketofol) provided better sedation quality and hemodynamy than ketamine alone in pediatric circumcision operations. We did not observe significant complications during sedation in these two groups. Therefore, ketofol appears to be an effective and safe sedation method for circumcision operation.
RESUMOJUSTIFICATIVA E OBJETIVO: Comparar os efeitos terapêuticos da cetamina isolada ou combinação de cetamina-propofol em analgesia, sedação, tempo de recuperação e efeitos colaterais em crianças pré-medicadas com midazolam-cetamina-atropina programadas para procedimentos de circuncisão.MÉTODOS: 60 crianças, estado físico ASA I-II (de acordo com a classificação da Sociedade Americana de Anestesiologistas), com idades entre três e nove anos, submetidas a procedimentos de circuncisão sob sedação, foram recrutadas de acordo com um protocolo de randomização duplo-cego aprovado pelo Conselho de Revisão Institucional. Os pacientes foram randomizados e alocados em dois grupos com o uso do método de envelopes lacrados. Ambos os grupos receberam uma mistura de midazolam 0,05 mg kg-1 + cetamina 3 mg kg-1 + atropina 0,02 mg kg-1 por via intramuscular, na presença dos pais na área de intervenções pré-operatórias. A indução foi realizada com propofol-cetamina no Grupo I ou cetamina isolada no Grupo II.RESULTADOS: Nas comparações entre os grupos foram observadas a idade, o peso, a pressão arterial sistólica inicial e a diferença em relação à taxa de pulso inicial (p > 0,050). A pressão arterial diastólica inicial e as mensurações seriadas subsequentes nos minutos 5, 10, 15 e 20 da pressão arterial sistólica, pressão arterial diastólica e taxa de pulso do grupo cetamina foram significativamente maiores (p < 0,050).CONCLUSÃO: Cetamina-propofol (cetofol) proporcionou melhor qualidade de sedação e estabilidade hemodinâmica que cetamina isolada em cirurgias pediátricas de circuncisão. Não foram observadas complicações significativas durante a sedação nos dois grupos. Portanto, cetofol parece ser um método de sedação eficaz e seguro para procedimentos de circuncisão.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Cistos Ósseos , Cabeça do Fêmur , Colo do Fêmur , Articulação do Quadril , Osteoartrite do Quadril , Osteófito , Cistos Ósseos/etiologia , Imageamento Tridimensional , Osteoartrite do Quadril/complicações , Osteófito/etiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios XRESUMO
OBJETIVO: Caracterizar e comparar idosos comunitários com osteoartrite (OA) de joelhos e/ou quadris, com enfoque na síndrome da fragilidade. MéTODO: Estudo transversal com avaliação de características sociodemográficas, comorbidades, medicamentos, depressão, antropometria, quedas, dor, rigidez, função, fragilidade e avaliação subjetiva da saúde em idosos com OA de joelhos e/ou quadris a partir de subamostra do estudo sobre fragilidade em idosos brasileiros (FIBRA). RESULTADOS: A amostra final foi composta de 58 idosos (74 ± 5,50 anos), como segue: 17 (29,31%) não frágeis, 28 (48,28%) pré-frágeis e 13 (22,41%) frágeis. O número de medicamentos foi maior no grupo frágil em comparação ao não frágil (7,00 ± 2,00 e 4,00 ± 2,00, respectivamente; P = 0,001). O Índice de Massa Corporal foi menor nos idosos não frágeis em comparação aos pré-frágeis e frágeis (média de 27,00 ± 4,50 kg/m², 30,00 ± 4,00 kg/m² e 34,00 ± 8,00 kg/m², respectivamente; P = 0,018). Depressão foi mais prevalente no grupo frágil. Em relação à saúde comparada ao ano anterior, houve diferença: 64,3% dos pré-frágeis e 46,2% dos frágeis acreditavam que sua saúde piorou; entre os não frágeis, 52,9% consideraram que a saúde permaneceu igual (P = 0,016). Quanto ao nível de atividade em relação ao ano anterior, pré-frágeis e frágeis relataram que houve piora (P = 0,010). Quanto à função e à autoeficácia para quedas, os frágeis mostraram-se piores que os demais (P = 0,023 e 0,017, respectivamente). Os outros itens avaliados não apresentaram diferenças significativas entre os grupos. CONCLUSÃO: Idosos com OA e fragilidade usam maior número de medicamentos, são mais obesos e mais deprimidos, têm pior percepção da saúde e do nível de atividade em relação ao ano anterior e pior autoeficácia para quedas e para função física.
OBJECTIVE: To characterize and compare community-dwelling elderly with knee and/or hip osteoarthritis (OA), focusing on the frailty syndrome. METHOD: Cross-sectional study of the elderly with knee and/or hip OA, using a subsample from the study of frailty in the Brazilian elderly (FIBRA), assessing the following: sociodemographic characteristics, comorbidity, medications, depression, anthropomorphic data, falls, pain, stiffness, physical function, and frailty. The subjective assessment of health was also performed. RESULTS: The final sample comprised 58 elderly (mean age, 74 ± 5.5 years) as follows: 17 (29.31%) non-frail, 28 (48.28%) pre-frail, and 13 (22.41%) frail. The frail elderly received more medications than the non-frail ones (7.00 ± 2.00 and 4.00 ± 2.00, respectively; P = 0.001). The mean Body Mass Index was lower in the non-frail elderly as compared with those of the pre-frail and frail ones (27.00 ± 4.50 kg/m², 30.00 ± 4.00 kg/m², and 34.00 ± 8.00 kg/m², respectively; P = 0.018). Depression was more prevalent in the frail group. Compared to the previous year, there was a difference in the health status of the groups as follows: 64.3% of the pre-frail elderly and 46.2% of the frail ones believed their health deteriorated, and 52.9% of the non-frail elderly considered that their health status remained unchanged (P = 0.016). When comparing the current physical activity levels with those of the previous year, the pre-frail and frail elderly reported a worsening (P = 0.010). Regarding physical function and fall-related self-efficacy, the frail elderly were worse than the others (P = 0.023 and 0.017, respectively). There were no significant differences between the groups for the remaining items analyzed. CONCLUSION: The elderly with OA and frailty use more medications, are more obese and depressed, have a poorer perception of their own health and of their level of activity as compared with that of the previous year, have a worse fall-related self-efficacy, and worse physical function.
Assuntos
Idoso , Feminino , Humanos , Masculino , Idoso Fragilizado , Osteoartrite do Quadril/complicações , Osteoartrite do Joelho/complicações , Estudos Transversais , Avaliação Geriátrica , Características de Residência , SíndromeRESUMO
OBJECTIVE: To characterize and compare community-dwelling elderly with knee and/or hip osteoarthritis (OA), focusing on the frailty syndrome. METHOD: Cross-sectional study of the elderly with knee and/or hip OA, using a subsample from the study of frailty in the Brazilian elderly (FIBRA), assessing the following: sociodemographic characteristics, comorbidity, medications, depression, anthropomorphic data, falls, pain, stiffness, physical function, and frailty. The subjective assessment of health was also performed. RESULTS: The final sample comprised 58 elderly (mean age, 74 ± 5.5 years) as follows: 17 (29.31%) non-frail, 28 (48.28%) pre-frail, and 13 (22.41%) frail. The frail elderly received more medications than the non-frail ones (7.00 ± 2.00 and 4.00 ± 2.00, respectively; P = 0.001). The mean Body Mass Index was lower in the non-frail elderly as compared with those of the pre-frail and frail ones (27.00 ± 4.50 kg/m², 30.00 ± 4.00 kg/m², and 34.00 ± 8.00 kg/m², respectively; P = 0.018). Depression was more prevalent in the frail group. Compared to the previous year, there was a difference in the health status of the groups as follows: 64.3% of the pre-frail elderly and 46.2% of the frail ones believed their health deteriorated, and 52.9% of the non-frail elderly considered that their health status remained unchanged (P = 0.016). When comparing the current physical activity levels with those of the previous year, the pre-frail and frail elderly reported a worsening (P = 0.010). Regarding physical function and fall-related self-efficacy, the frail elderly were worse than the others (P = 0.023 and 0.017, respectively). There were no significant differences between the groups for the remaining items analyzed. CONCLUSION: The elderly with OA and frailty use more medications, are more obese and depressed, have a poorer perception of their own health and of their level of activity as compared with that of the previous year, have a worse fall-related self-efficacy, and worse physical function.
Assuntos
Idoso Fragilizado , Osteoartrite do Quadril/complicações , Osteoartrite do Joelho/complicações , Idoso , Estudos Transversais , Feminino , Avaliação Geriátrica , Humanos , Masculino , Características de Residência , SíndromeRESUMO
El pinzamiento femoroacetabular es reconocido hoy como una de las principales causas de coxalgia en el adulto joven y corresponde a la primera causa de artrosis la cuarta y sexta década de la vida. El pinzamiento se produce debido a una incongruencia entre el acetábulo y la cabeza femoral; el origen de ésta puede ser principalmente de la porción femoral, tipo CAM, y/o de origen acetabular tipo PINCER. Es un fenómeno dinámico y progresivo en el tiempo, cuyo tratamiento es básicamente quirúrgico, a través de cirugía artroscópica, teniendo como objetivo la restitución de la anatomía normal de la cadera. Los resultados a mediano y largo plazo están en directa relación con el daño articular al momento de la cirugía, teniendo los mejores resultados en pacientes jóvenes y sin artrosis.
Hip impingement syndrome or femoro-acetabular impingement (F Al) is a well known cause of hip pain in the young-adult group, and it is also the main cause of arthritis among people in their forties to sixties. F Al is caused by an offset between the femoral head and acetabulum. This deformity may be mainly present on the femoral side: CAM type, and/or in the acetabular side: PINCER type. It is a dynamic and progressive concern that can be treated with arthroscopic surgery. The main goal of surgery is to restore the normal shape of the hip joint. Mid to long-term results for this procedure depend on age and joint status at the moment of the surgery. Younger, non arthritic patients respond better.
Assuntos
Humanos , Adulto , Acetábulo/cirurgia , Acetábulo , Artropatias/cirurgia , Artropatias , Osteoartrite do Quadril/cirurgia , Osteoartrite do Quadril , Artroscopia , Articulação do Quadril/cirurgia , Articulação do Quadril , Artropatias/complicações , Dor/etiologia , Osteoartrite do Quadril/complicaçõesRESUMO
Se presenta una serie de 20 casos operados con prótesis de Wagner, 8 por coxartrosis con otra prótesis primaria y fractura sobre la prótesis y 12 por fractura tratada con osteosíntesis primaria fallida, habiendo obtenido en todos buen resultado como tratamiento definitivo a la complicación previa. Sólo hubo un caso de luxación de la prótesis de Wagner, tratado mediante manipulación cerrada. El resultado general fue satisfactorio gracias a la longitud del vástago femoral que va de 190 a 305 milímetros