172 Septic Arthritis of the Wrist: Audit of Management and Awareness of National Guidelines Amongst Orthopaedic Surgeons in a District General Hospital

Aim

Septic arthritis (SA) of the wrist is relatively uncommon and, in contrast to SA of large joints, can safely be managed with serial aspiration to dryness rather than traditional open surgical drainage. This is supported by BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. We conducted an audit of management of suspected wrist SA patients and surveyed awareness of relevant guidelines amongst orthopaedic surgeons.

Method

Electronic records of patients referred as suspected wrist SA to the orthopaedic department over a six-month period (August 2020 to February 2021) were retrospectively reviewed. Data analysis included demographics, diagnosis, management, and treatment outcome.

In addition, knowledge of wrist SA management amongst orthopaedic medical staff was determined via a multiple-choice questionnaire.

Results

11 patients were identified (5M:6F, age range 62–91).

6/11 patients underwent wrist aspiration though only one patient had a positive gram stain.

No patients underwent serial aspiration as advocated by national guidelines.

2/11 patients underwent formal surgical washout in theatre.

15 orthopaedic doctors were surveyed (8 Junior Doctors, 4 Registrars, 3 Consultants). 2/15 were aware of national guidelines. 11/15 chose joint aspiration as an initial investigation. 2/15 considered repeated joint aspiration to dryness as definitive management.

Conclusions

This audit highlighted low compliance with national guidelines when managing wrist SA, although this did not adversely affect patient outcomes. We demonstrated lack of awareness of relevant guidelines amongst orthopaedic surgeons. We propose relevant teaching and incorporation of national guidelines into Trust policy.

Clinical progress and advanced research of red blood cells based drug delivery system

Red blood cells (RBCs) are biocompatible carriers that can be employed to deliver different bioactive substances. In the past few decades, many strategies have been developed to encapsulate or attach drugs to RBCs. Osmotic-based encapsulation methods have been industrialized recently, and some encapsulated RBC formulations have reached the clinical stage for treating tumors and neurological diseases. Inspired by the intrinsic properties of intact RBCs, some advanced delivery strategies have also been proposed. These delivery systems combine RBCs with other novel systems to further exploit and expand the application of RBCs. This review summarizes the clinical progress of drugs encapsulated into intact RBCs, focusing on the loading and clinical trials. It also introduces the latest advanced research based on developing prospects and limitations of intact RBCs drug delivery system (DDS), hoping to provide a reference for related research fields and further application potential of intact RBCs based drug delivery system.

Exposing rodents to a combination of tobacco smoke and lipopolysaccharide results in an exaggerated inflammatory response in the lung

BACKGROUND AND PURPOSE

Acute exacerbations of chronic obstructive pulmonary disease (COPD), which are often associated with respiratory infections, are defined as a worsening of symptoms that require a change in medication. Exacerbations are characterized by a reduction in lung function, quality of life and are associated with increased pro-inflammatory mediators in the lung. Our aim was to develop an animal model to mimic aspects of this exaggerated inflammatory response by combining key etiological factors, tobacco smoke (TS) and bacterial lipopolysaccharide (LPS).

EXPERIMENTAL APPROACH

Rats were exposed to TS for 30 min twice a day for 2 days. On day 3 animals were exposed to LPS for 30 min followed by exposure to TS 5 h later. Inflammation, mucus and lung function were assessed 24 h after LPS.

KEY RESULTS

Neutrophils, mucus, oedema and cytotoxicity in lung and/or bronchoalveolar lavage was increased in animals exposed to combined LPS and TS, compared with either stimulus alone. Lung function was impaired in animals exposed to combined LPS and TS. Inflammatory cells, oedema and mucus were unaffected by pretreatment with the corticosteroid, budesonide, but were reduced by the phosphodiesterase 4 selective inhibitor roflumilast. Additionally, lung function was improved by roflumilast.

CONCLUSIONS AND IMPLICATIONS

We have established an in vivo model mimicking characteristic features of acute exacerbations of COPD including lung function decline and increased lung inflammation. This model may be useful to investigate molecular and cellular mechanisms underlying such exacerbations, to identify new targets and to discover novel therapeutic agents.

Clinical spectrum of systemic lupus erythematosus at the Aga Khan University Hospital

BACKGROUND

Systemic lupus erythematosus is a disease of unknown etiology, which at onest may involve only one organ system or be multisystemic. The aim of our study is to determine the clinical presentation of SLE patients presenting to AKUH to establish whether guidelines laid down about this disease are in agreement with our experience.

METHODS

A retrospective log review was carried out at AKUH, based on data obtained from 165 files of individuals admitted to the hospital over a period of 12 years with a confirmed diagnosis of SLE.

RESULTS

From the sample size of 165, 143 (86.7%) were females and 22 (13.3%) males. The mean age of diagnosis was 30.9 years. Frequency of symptomatology was observed to be in the following order: systemic 78.8%, musculoskeletal 63% and hematological 60.6%. Oninvestigation ANA levels were positive in 112 patients.

CONCLUSION

Our result lead us to conclude that the classification set forth by the American Rheumatological Association is applicable to patients presenting with SLE in our setting.

Communicating information about sore throats and rheumatic fever to South Auckland high-school students

AIMS

The present study examined the effectiveness of three modes of communication designed to increase high school students' knowledge about throat infections and rheumatic fever in a high risk area.

METHODS

The study was part of an evaluation of a rheumatic fever prevention programme that has established 27 school-based 'sore throat' clinics in South Auckland. The rationale for the clinics was explained to students through: assemblies conducted by public health nurses, written information sheets and classroom lessons. The effectiveness of each communication mode was assessed by comparing the knowledge of students from eight classes at an intervention school with eight classes at a control school before and after the intervention school students received the teaching.

RESULTS

Students at the intervention school showed a significant improvement in knowledge compared to students at the control school. The assembly presentations by health professionals were more effective in informing students than information sheets or classroom lessons.

CONCLUSIONS

This study suggests that presentations by health professionals are an effective method of teaching basic health information to students in these South Auckand secondary schools. Classroom teachers need to be provided with appropriate resources, if they are to provide effective instruction. Written information sheets should not be relied on.

Dissecting obesogenic environments: the development and application of a framework for identifying and prioritizing environmental interventions for obesity

BACKGROUND

The "obesogenicity" of modern environments is fueling the obesity pandemic. We describe a framework, known as ANGELO (analysis grid for environments linked to obesity), which is a conceptual model for understanding the obesogenicity of environments and a practical tool for prioritizing environmental elements for research and intervention.

METHODS

Development of the ANGELO framework. The basic framework is a 2 x 4 grid which dissects the environment into environmental size (micro and macro) by type: physical (what is available), economic (what are the costs), political (what are the "rules"), and sociocultural (what are the attitudes and beliefs). Within this grid, the elements which influence food intake and physical activity are characterized as obesogenic or "leptogenic" (promoting leanness).

RESULTS

Application of the ANGELO framework. The ANGELO framework has been piloted at the population level (island communities) to prioritize the settings/sectors for intervention and at the setting level (fast food outlets) to prioritize research needs and interventions. Environmental elements were prioritized by rating their validity (evidence of impact), relevance (to the local context), and potential changeability.

CONCLUSIONS

The ANGELO framework appears to be a flexible and robust instrument for the needs analysis and problem identification stages of reducing the obesogenicity of modern environments.