Talalgies avec paresthésies au niveau du bord médial du pied

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KNEE OSTEOARTHRITIS AND PLATELET-RICH PLASMA TREATMENT : HOW TO IMPROVE THE EFFICIENCY ?

peer reviewedIntroduction/Background The management of chondral disease is challenging. New studies have focused on modern therapeutic methods that stimulate cartilage healing process and improve the damage, including the use of platelet-rich plasma (PRP). PRP is prepared from autologous blood by centrifugation to obtain a highly concentrated sample of platelets. Due to the mixed results from controlled studies, the clinical efficacy of PRP in the treatment of knee OA is unclear with shortcomings in the current literature. Material and Method A comparison of the outcomes of randomized controlled trials (RCTs) included in the 3 most recent and high-quality meta-analyses to classify the different studies in 2 groups (bad responders group (BRG) and very good responders group (VGRG)). The minimal clinically important improvement (MCII) was defined to help determining whether an observed difference is clinically important. We used MCII values to classify the different studies in 2 groups depending on the outcomes: BRG 2xMCII. Results From the 19 RCTs analyzed, 7 trials were included in the VGRG and 4 in the BRG. In VGRG, 1 or 2 injections were performed in 4/7 trials, time between injections was 2 to 3 weeks in 4/5 studies with many injections, volume injected varied from 2.5 to 8 mL, and single spinning technique was used in 5/7 studies. PRP classification was Mishra 4B and PAWP2Bβ in 5/7 studies. The use of PRP with leukocytes is only found in the BRG. Conclusion Our study helped identify features of PRP recommended for knee OA treatment, such as the use of a single spinning technique, a platelet concentration lower than 5 times the baseline (from 3 to 4), and avoiding leukocytes and erythrocytes. We recommend leveraging this information about PRP for future studies

Double-Layered Patella (DLP) in Multiple Epiphyseal Dysplasia (MED)

Double-layered patella (DLP) is a rare form of bipartite patella, pathognomonic for a certain type of chondrodysplasia, named multiple epiphyseal dysplasia (MED). This patellar deformity may be asymptomatic, but it may also cause several complaints, including anterior knee pain and severe maltracking of the patella. We present the case of a young man with recurrent anterior knee pain, mainly provoked by movement, who was already known to have MED

Accidental intradural injection during attempted epidural block -A case report-

Several cases of accidental subdural injection have been reported, but only few of them are known to be accidental intradural injection during epidural block. Therefore we would like to report our experience of accidental intradural injection. A 68-year-old female was referred to our pain clinic due to severe metastatic spinal pain. We performed a diagnostic epidural injection at T9/10 interspace under the C-arm guided X-ray view. Unlike the usual process of block, onset was delayed and sensory dermatomes were irregular range. We found out a dense collection of localized radio-opaque contrast media on the reviewed X-ray findings. These are characteristic of intradural injection and clearly different from the narrow wispy bands of contrast in the subdural space

Intelektualna ometenost u visokom obrazovanju - samoprocena potreba za obukom univerzitetskih nastavnika

Introduction. The inclusion of students with disabilities in higher education is a fundamental right recognised by the legal system since its recognition in the United Nations Convention on the Rights of Persons with Disabilities. However, the measures adopted by European countries to promote their incorporation are not always accompanied by parallel training actions that provide university professors with the necessary knowledge to incorporate people with intellectual disabilities into the classroom with the same guarantees and opportunities as people without intellectual disabilities. Objective. This paper aims to provide specific data on the self-perceived training needs of university teaching staff and thus lay the foundations for a specific training programme. Methods. A cross-sectional study was carried out by means of a survey designed to collect the teachers' perceptions of their own competences and the effectiveness of their knowledge, as well as the importance they attached to some aspects of intellectual disability. The survey was administered to teachers in Serbia, the Netherlands, Portugal, Italy and Spain, with a total sample of 1009 teachers. Results. The results obtained showed that the perception of self-perceived competence in educational skills is dependent on three main factors: previous specific training, teaching experience with people with intellectual disabilities and own personal experiences. Conclusion. The present study demonstrated the concern and need of the teaching staff to obtain specific training on people with intellectual disabilities in higher education.Uvod: Inkluzija studenata sa ometenošću u visokom obrazovanju je fundamentalno pravo koje prepoznaje pravni sistem od usvajanja Konvencije Ujedinjenih nacija o pravima osoba sa ometenošću. Međutim, mere koje su preduzele evropske zemlje u promovisanju tih prava nisu uvek praćene obukama koje bi univerzitetskim nastavnicima obezbedile neophodna znanja za uključivanje osoba sa intelektualnom ometenošću u nastavu sa istim garancijama i mogućnostima koje se nude osobama tipičnog razvoja. Cilj: Cilj ovog istraživanja je da utvrdi potrebe za obukom na osnovu vlastite percepcije univerzitetskog nastavnog osoblja i da na taj način postavi temelje specifčnog programa obuke. Metode: Sprovedeno je transferzalno istraživanje pomoću upitnika kojim su prikupljeni podaci o vlastitoj proceni nastavnika u pogledu kompetencija i efektivnosti njihovog znanja, kao i o značaju koji oni pridaju pojedinim aspektima intelektualne ometenosti. Ispitivanje je izvršeno na uzorku od 1009 nastavnika iz Srbije, Holandije, Portugalije, Italije i Španije. Rezultati: Dobijeni rezultati pokazuju da je samoprocena kompetencija u edukativnim veštinama zavisna od tri glavna činioca: specifčnog treninga u prošlosti, iskustva u podučavanju osoba sa intelektualnom ometenošću i ličnih iskustava, Zaključak: Dobijeni rezultati ukazuju na potrebu za specifčnom obukom nastavnog osoblja u oblasti rada sa osobama sa intelektualnom ometenošću u visokom obrazovanju

Intensive insulin therapy in mixed medical/surgical intensive care units.Benefit vs. harm

Intensywne leczenie insuliną (IIT) poprawia rokowanie u pacjentów w stanie krytycznym długotrwale leczonych na oddziale intensywnej terapii (ICU), natomiast dotychczas nie określono potencjalnych zagrożeń i optymalnego stężenia glikemii. Aby wyjaśnić te wątpliwości, wykorzystano odpowiednią populację dwóch randomizowanych, kontrolowanych badań klinicznych. Niezależnie od ilości glukozy podawanej drogą parenteralną, IIT zmniejszało śmiertelność z 23,6% do 20,4% w grupie intention to treat (n = 2748; p = 0,04) oraz z 37,9% do 30,1% w grupie pacjentów leczonych długotrwale (n = 1389; p = 0,002); nie stwierdzono natomiast istotnej statystycznie różnicy wśród osób leczonych krótkotrwale (8,9% vs. 10,4%; n = 1359; p = 0,4). W porównaniu z glikemią 110-150 mg/dl śmiertelność była znacznie wyższa przy glikemii powyżej 150 mg/dl [wskaźnik ryzyka: 1,38% (95% CI: 1,10-1,75); p = 0,007] i niższa przy glikemii poniżej 110 mg/dl [0,77 (0,61-0,96); p = 0,02]. Jedynie u chorych na cukrzycę (n = 407) nie wykazano poprawy śmiertelności po IIT. Zapobieganie uszkodzeniu nerek i polineuropatia stanów krytycznych stwarzają konieczność utrzymywania stężenia glukozy w ciągu dnia ściśle poniżej 110 mg/dl, co z kolei wiąże się z najwyższym ryzykiem hipoglikemii. W okresie 24 godzin po hipoglikemii zmarło 3 pacjentów leczonych konwencjonalnie i 1 leczony intensywną insulinoterapią (p = 0,0004), bez różnicy w ogólnej śmiertelności szpitalnej. U pacjentów wypisanych z oddziału intensywnej terapii, u których obserwowano hipoglikemię, nie występowały nowe problemy neurologiczne. Stwierdzono, że IIT zmniejsza śmiertelność u wszystkich pacjentów na oddziałach intensywnej terapii zarówno chirurgicznych, jak i internistycznych, z wyjątkiem chorych na cukrzycę, nie powodując istotnych zagrożeń. Docelowe wartości glikemii poniżej 110 mg/dl okazały się najbardziej korzystne w odniesieniu do śmiertelności, ale wiązały się również z największym ryzykiem hipoglikemii.Intensive insulin therapy (IIT) improves the outcome of prolonged critically ill patients, but concerns remain regarding potential harm and the optimal blood glucose level. These questions were addressed using the pooled dataset of two randomized controlled trials. Independent of parenteral glucose load, IIT reduced mortality from 23.6% to 20.4% in the intention-to-treat group (n = 2,748; p = 0.04) and from 37.9% to 30.1% among long stayers (n = = 1.389; p = 0.002), with no difference among short stayers (8.9% vs. 10.4%; n = 1,359; p = 0.4). Compared with blood glucose of 110&#8211;150 mg/dl, mortality was higher with blood glucose > 150 mg/dl [odds ratio 1.38 (95% CI 1.10-1.75); p = 0.007] and lower with < 110 mg/dl [0.77 (0.61-0.96); p = 0.02]. Only patients with diabetes (n = 407) showed no survival benefit of IIT. Prevention of kidney injury and critical illness polyneuropathy required blood glucose strictly < 110 mg/day, but this level carried the highest risk of hypoglycemia. Within 24 h of hypoglycemia, three patients in the conventional and one in the IIT group died (p = 0.0004) without difference in hospital mortality. No new neurological problems occurred in survivors who experienced hypoglycemia in intensive care units (ICUs). We conclude that IIT reduces mortality of all medical/surgical ICU patients, except those with a prior history of diabetes, and does not cause harm. A blood glucose target < 110 mg/day was most effective but also carried the highest risk of hypoglycemia