Anesthesia for intra-articular corticosteroid injections in juvenile idiopathic arthritis: A survey of pediatric rheumatologists

<p>Abstract</p> <p>Objective</p> <p>To determine the methods of anesthesia currently being used by pediatric rheumatologists when performing intra-articular corticosteroid injections (IACI).</p> <p>Study design</p> <p>A questionnaire was emailed to all members of the Childhood Arthritis & Rheumatology Research Alliance, a pediatric rheumatology research network in North America. The questionnaire consisted of 11 questions ranging from procedure technique, treatments prescribed for topical anesthesia and oral analgesia, and factors that might affect procedural pain.</p> <p>Results</p> <p>Seventy-four of 161 physicians (46%) responded to the questionnaire. On average, each physician injected 33 children (median 25, range 1-160) and 43 joints (median 30, range 1-150) yearly. Local anesthesia was used in children on average ≥ 8 years (range 2-16 years), with general anesthesia being more frequently used for younger children. All respondents used local anesthesia. The most commonly used methods of local anesthesia were EMLA^®cream plus subcutaneous lidocaine (58.8%), ethyl chloride spray only (39.7%), EMLA^®cream only (33.8%), subcutaneous lidocaine only (25%), and lidocaine iontophoresis only (11.8%). Buffering of the lidocaine was routinely done only 7.4% of the time.</p> <p>Conclusion</p> <p>Although pediatric rheumatologists in North America perform IACI on a large number of patients each year, a wide variety of methods are used to deliver local anesthesia with no accepted standard of care. More studies are needed to determine the optimal method of local anesthesia delivery to minimize pain associated with IACI.</p

The Continuing Use of Problematic Sexual Stereotypes in Judicial Decision-Making

This article examines the continuing use of problematic sexual stereotypes at appellate level in the English and Welsh legal system. Using five cases as illustrations, it argues that, notwithstanding professional training and guidance on sexual equality matters, certain senior judges in this jurisdiction still at least sometimes openly employ crude and problematic sexual stereotypes in their judgments or fail to deal appropriately with the use of these stereotypes by trial judges. The central point is that there is still a significant problem with the open use of crude sexual stereotypes in legal reasoning at a senior level in this jurisdiction, despite the pressure on all members of the legal system to appear to be ‘politically correct’

An adolescent with both Wegener's Granulomatosis and chronic blastomycosis

We report a case of Wegener's Granulomatosis (WG) associated with blastomycosis. This appears to be the first case report of WG co-existing with a tissue proven blastomycosis infection. The temporal correlation of the two conditions suggests that blastomycosis infection (and therefore possibly other fungal infections), may trigger the systemic granulomatous vasculitis in a predisposed individual; a provocative supposition warranting further study

Integrating Blue: How do we make Nationally Determined Contributions work for both blue carbon and local coastal communities?

Blue Carbon Ecosystems (BCEs) help mitigate and adapt to climate change but their integration into policy, such as Nationally Determined Contributions (NDCs), remains underdeveloped. Most BCE conservation requires community engagement, hence community-scale projects must be nested within the implementation of NDCs without compromising livelihoods or social justice. Thirty-three experts, drawn from academia, project development and policy, each developed ten key questions for consideration on how to achieve this. These questions were distilled into ten themes, ranked in order of importance, giving three broad categories of people, policy & finance, and science & technology. Critical considerations for success include the need for genuine participation by communities, inclusive project governance, integration of local work into national policies and practices, sustaining livelihoods and income (for example through the voluntary carbon market and/or national Payment for Ecosystem Services and other types of financial compensation schemes) and simplification of carbon accounting and verification methodologies to lower barriers to entry

Rheumatology: 16. Diagnosing musculoskeletal pain in children Clinical basics

The case A 7-year-old girl has a 2-month history of a mildly swollen and slightly painful knee, which her parents believe was caused by a fall at school. There is no other relevant history. Examination reveals a small swelling of the knee, with a small flexion contracture, loss of full flexion and some discomfort at the end of the range of motion. The results of the rest of the examination are normal. A complete blood count and the erythrocyte sedimentation rate are normal. A test for rheumatoid factor is negative, and an antinuclear antibody test is positive at a low titre (1:40). The child is referred to a pediatric rheumatologist with a provisional diagnosis of juvenile rheumatoid arthritis, although the referring physician is concerned about a possible injury to the knee caused by the fall. M usculoskeletal pains in children are common, affecting 10%-20% of schoolchildren. 1 In a recent school-based survey of adolescents in British Columbia, musculoskeletal pains were the second most common problem (after acne), and over 5% of these adolescents had limb pain of such severity that they believed that they had arthritis. 2 Most of these pains are not the result of a serious underlying disease, although they can be a cause of significant morbidity. However, some children with musculoskeletal pains will have conditions that are either life-threatening or potentially crippling. The variety and relative frequencies of musculoskeletal conditions seen by pediatric rheumatologists have recently been documented