Harefuah
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Osteoarthritis is the most common joint disorder in the world and its incidence is rising. In Western populations it is one of the most frequent causes of pain, loss of function and disability in adults. The estimated lifetime risk for knee osteoarthritis is approximately 40% in men and 47% in women. ⋯ The American College of Rheumatology (ACR) has recommended using the following criteria for the diagnosis of knee osteoarthritis: chronic knee pain (lasting for more than 6 weeks) and at least three of the following: • Age over 50 years old. • Morning knee stiffness lasting up to 30 minutes. • Crepitus with active motion • Tenderness on bony palpation • Thickening or growth of the bones • No local heat on palpation Treatment of osteoarthritis involves alleviating pain, attempting to rectify mechanical misalignment, and identifying and addressing manifestations of joint instability. The American Academy of Orthopedic Surgeons (AAOS) has conducted a systematic review of the current scientific and clinical research and has issued clinical practice guidelines containing fifteen recommendations for the treatment of osteoarthritis of the knee, and include only less invasive alternatives to total or partial knee arthroplasty. This review presents the background, diagnosis, treatment and a summary of the AAOS guidelines regarding "Treatment of Osteoarthritis of the Knee".
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Primary headaches are one of the most common disorders of childhood, with migraine and tension type headaches (TTHs) being the most frequent ones. In spite of their prevalence, there is paucity of knowledge regarding the underlying pathophysiological mechanisms that cause headaches and regarding the unique aspects of headaches in children and adolescents. ⋯ Most of our current knowledge regarding primary headaches in children and adolescents is driven from extrapolations from studies that were conducted with adult patients. Therefore, it needs to be validated for the different age groups. Migraines may be diagnosed effectively based on the 2nd edition of the International Classification of Headache Disorders (ICHD-II), however, TTH is diagnosed mainly by the absence of features found in other headache types. Treatment strategies for primary headaches vary according to patient's age, family structure, culture and beliefs, headache diagnosis, and based on the disability the headache imposes on the patient's daily living. It was shown that a multidisciplinary approach, that includes continuing counseling, education, and reassurance, in combination with pharmacological and non-pharmacological treatment, is an effective strategy for children and adolescents suffering from primary headaches. Further studies are needed to enrich our knowledge about the pathophysiological mechanisms that cause headaches in children and adolescents and to develop efficient strategies to alleviate their burden.
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The last decades have seen a marked increase in the number of immunocompromised patients. These patients are at higher risk for severe outcomes from infections, many of which are vaccine-preventable diseases. However, such complex cases raise several important issues of concern: 1. ⋯ Do clinicians have sufficient or updated information concerning the safety, efficacy and contraindications to vaccination of such at-risk patients? 6. Which vaccines can be safely administered to immunocompromised travelers to tropical destinations? The answers to those questions are multifaceted, and data on safety, immunogenicity, and efficacy of vaccines for immunocompromised populations are limited. This article summarizes the current recommendations for immunizations in immunocompromised patients, indications and potential adverse effects.
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Patient positioning during surgery can have profound short and long term implications for the patient. Each position carries some degree of risk to the patient, which is magnified in prolonged operations, surgeries performed under general anesthesia and when position manipulations are required in order to gain best surgical access. ⋯ It is also important that these complications are diagnosed promptly and managed appropriately in the post-operative period. The purpose of the following review is to summarize the positioning-related complications, in particular peripheral nerve injuries, and emphasize correct positioning recommendations and preventive measures.
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Nausea and vomiting of pregnancy (NVP) is the most prevalent medical condition during gestation. Approximately 85% of pregnant women suffer from some degree of this condition, while hyperemesis gravidarum (HG), the most severe form, affects up to 2% of women. Although being the leading cause for hospitalization during pregnancy, NVP has received little attention from the medical community. ⋯ Various studies have demonstrated the effectiveness and safety of antiemetic therapy in pregnancy. However, fear of teratogenicity and lack of clinical guidelines lead to trial and error NVP management. We present an updated algorithm for the management of NVP.