scholarly journals Bracing in clubfoot: do we know enough?

2019 ◽  
Vol 13 (3) ◽  
pp. 258-264 ◽  
Author(s):  
C. Alves
Keyword(s):  
Randomized Clinical Trials ◽  
Current Knowledge ◽  
Healthcare Providers ◽  
Ponseti Method ◽  
Level Of Evidence ◽  
Achilles Tenotomy ◽  
Advantages And Disadvantages ◽  
Serial Casting ◽  
Custom Made ◽  
The Individual

Purpose The Ponseti method is widely used in clubfoot treatment. Long-term follow-up shows high patient satisfaction and excellent functional outcomes. Clubfoot tendency to relapse is a problem yet to solve. Given the importance of bracing in relapse prevention, we ought to discuss current knowledge and controversies about bracing. Methods We describe types of braces used, with its advantages and disadvantages, suggesting bracing schedules and duration. We identify bracing problems and pinpoint strategies to promote adherence to bracing. Results When treating a clubfoot by the Ponseti method, the corrected foot should be held in an abducted and dorsiflexed position, in a foot abduction brace (FAB), with two shoes connected by a bar. The brace is applied after the clubfoot has been completely corrected by manipulation, serial casting and possibly Achilles tenotomy. Bracing is recommended until four to five years of age and needs to be fitted to the individual patient, based on age, associated relapse rate and timing when correction was finished. Parental non-adherence to FAB use can affect 34% to 61% of children and results in five- to 17-fold higher odds of relapse. In patients who have recurrent adherence problems, a unilateral lower leg custom-made orthosis can be considered as a salvage option. Healthcare providers must communicate with patients regarding brace wearing, set proper expectations and ensure accurate use. Conclusion Bracing is essential for preventing clubfoot relapse. Daily duration and length of bracing required to prevent recurrence is still unknown. Prospective randomized clinical trials may bring important data that will influence clinicians’ and families’ choices regarding bracing. Level of Evidence V

scholarly journals Effectiveness of achillotomy in children with arthrogryposis

2019 ◽  
Vol 7 (2) ◽  
pp. 51-60
Author(s):  
Svetlana I. Trofimova ◽  
Denis V. Derevianko ◽  
Evgeniia A. Kochenova ◽  
Ekaterina V. Petrova
Keyword(s):  
Open Surgery ◽  
Ponseti Method ◽  
Lateral View ◽  
Neutral Position ◽  
X Ray ◽  
Achilles Tenotomy ◽  
Serial Casting ◽  
Equinus Contracture ◽  
The Mean ◽  
Equinus Deformity

Introduction. Ponseti method is a widespread treatment for clubfoot in children with arthrogryposis. Closed subcutaneous achillotomy in these patients could not completely rectify the equinus deformity due to tissue rigidity which often leads to reconsideration of the tenotomy principles. Aim. This study aimed to formulate the anticipating criteria to assess the effectiveness of achillotomy in order to develop a different achillotomy approach for children with arthrogryposis. Materials and methods. This study retrospectively analyzed closed subcutaneous achillotomy in 28 patients (56 feet) with arthrogryposis. The mean age of the patients was 5.4 months (range 2–8 months). The children were subdivided into two groups according to the residual equinus deformity after the completion of Ponseti serial casting. All patients were physically and radiographically examined. Results and discussion. The first group included 12 patients (24 feet), which achieved foot neutral position or dorsiflexion ≥5° after achillotomy. The second group consisted of 16 patients (32 feet) with residual equinus after achillotomy who required surgery. X-ray images showed that the patients in the second group had significantly wider tibiocalcaneal angle and smaller talocalcaneal angle in lateral view (р < 0.01). The correction values of the equinus deformity after achillotomy in the children with arthrogryposis were greatly limited: 27° (20°–30°) and 19° (10°–30°) in the first and second groups, respectively. Conclusion. Closed subcutaneous achillotomy for effective equinus elimination during clubfoot treatment by Ponseti method should be performed only after complete correction at the level of tarsal joints. X-ray examination of the feet is recommended for the children with arthrogryposis in order to evaluate the talocalcaneal divergence and heel position more comprehensively. Furthermore, the values of tibiocalcaneal and talocalcaneal angles in lateral view prior to achillotomy are essential prognostic factors of its effectiveness. Moreover, the severity of equinus contracture should be considered prior to achillotomy. Achilles tenotomy is inappropriate if equinus deformity exceeds 30°. In such cases, open surgery should be considered.

scholarly journals HIIT, RESISTANCE TRAINING, AND RISK FACTORS IN ADOLESCENTS: A SYSTEMATIC REVIEW

2020 ◽  
Vol 26 (6) ◽  
pp. 558-564
Author(s):  
Waynne Ferreira de Faria ◽  
Filipe Rodrigues Mendonça ◽  
Rui Gonçalves Marques Elias ◽  
Raphael Gonçalves de Oliveira ◽  
Antonio Stabelini Neto
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Resistance Training ◽  
Physical Exercise ◽  
Cardiometabolic Risk ◽  
Randomized Clinical Trials ◽  
Current Knowledge ◽  
Cardiometabolic Risk Factors ◽  
Fat Percentage ◽  
Level Of Evidence

ABSTRACT It has been shown that combined physical exercise is an efficient non-pharmacological approach in the context of public health, since it has demonstrated satisfactory results in the prevention, treatment and control of various morbidities. Therefore, it is essential to systematize current knowledge to enable professionals involved in the prescription of physical exercise to do so based on evidence. Thus, the objective of this study was to perform a systematic review of randomized clinical trials to verify changes in cardiometabolic risk factors induced by high-intensity interval training (HIIT) and resistance training (RT) in adolescents. The systematic search was performed in the following databases: Pubmed, ScienceDirect, Cochrane, LILACS and Scielo. Initially 933 studies were identified, then two researchers eliminated duplications and manuscripts that did not meet the eligibility criteria. Thus, two articles were included that met these criteria: a randomized clinical trial conducted with adolescents (10 to 19 years) of both sexes, an intervention lasting for at least four weeks, which prescribed HIIT and RT in the same session or not, and evaluation of at least one cardiometabolic risk factor. The results demonstrated that eight to 12 weeks of HIIT and RT without nutritional intervention were effective in significantly reducing waist circumference and body fat percentage. However, data pertinent to the efficacy of this combination on risk of developing type 2 diabetes mellitus and arterial hypertension are controversial. In view of the above, it is ascertained from the included studies that the combination of HIIT and RT has the potential to reduce cardiometabolic risk factors in adolescents; therefore, further studies should be conducted to determine the effectiveness of this prescription of physical exercise. Level of Evidence II; Systematic review of Level II or Level I Studies with discrepant results.

scholarly journals Ponseti method for treatment of idiopathic congenital talipes equinovarus at tertiary care center in India

2021 ◽  
Author(s):  
Maruti B. Lingayat ◽  
Sourabh S. Dhamale ◽  
Gaurav B. Mate
Keyword(s):  
Low Income ◽  
Care Center ◽  
Tertiary Care ◽  
Ponseti Method ◽  
Success Rates ◽  
Congenital Talipes Equinovarus ◽  
Achilles Tenotomy ◽  
Serial Casting ◽  
Foot Biomechanics ◽  
Talipes Equinovarus

<p class="abstract"><strong>Background:</strong> Different treatment methods were tried with variable success rates but Ponseti method of serial casting and manipulation stood apart due to better understanding of foot biomechanics and became accepted choice of treatment worldwide.</p><p class="abstract"><strong>Methods:</strong> 50 patients were enrolled in the study out of which 40 were available for final follow-up. We studied 40 cases during October 2018 to December 2020 at Government Medical College, Aurangabad. Out of 40 cases 31 were male and 9 were female. 25 were unilateral and 15 were bilateral. All cases were idiopathic. 4 inches Plaster of Paris (POP) bandages were cut into half and such 2 inches POP bandages were used for casting. Tenotomies were performed under controlled environment of Operation Theater with general anaesthesia. Number 12 surgical blade was used. Dennis-Browne splint was used for maintenance of correction.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of total 55 feet studied, 10 feet (18.18%) required tendo Achilles tenotomy and 45 feet (81.82%) were treated with casting alone. There were 8 cases of relapses (20%). All relapsed cases were treated with repeat casting as per Ponseti protocol and none of them required repeat tenotomy. Complications related to plaster were minimal and there were no incidence of rocker bottom deformity.</p><p class="abstract"><strong>Conclusions:</strong> We conclude that in a low income developing country like India where case load is very high; Ponseti method is effective, inexpensive form of treatment with minimal complications. Need for extensive soft tissue procedures vastly reduced with this method.</p>

scholarly journals Sleep related painful erection: an algorithm for evaluation and management

2019 ◽  
Vol 29 (1) ◽  
Author(s):  
Maher Abdessater ◽  
Anthony Kanbar ◽  
Ahmed S. Zugail ◽  
Abdalla Al hammadi ◽  
Bertrand Guillonneau ◽  
...  
Keyword(s):  
Side Effects ◽  
Randomized Clinical Trials ◽  
Current Knowledge ◽  
Case Reports ◽  
Treatment Success ◽  
Treatment Decision ◽  
Rare Condition ◽  
Level Of Evidence ◽  
Phosphodiesterase Type 5 Inhibitors ◽  
Pubmed Database

Abstract Background Sleep related painful erection (SRPE) is a rare parasomnia consisting of nocturnal penile tumescence accompanied by pain that awakens the individual. Normal non-painful erections are experienced when awake. No penile anatomic abnormalities are present. No conclusive randomized clinical trial is present in the literature about the management of this rare condition. The aim of this article is to review the current knowledge about the management of SRPE and to suggest an algorithm to help physicians evaluate and manage SRPE. Material and methods A literature review was conducted through PubMed database using the terms: sleep, pain, painful, penile, and erection. The reference lists of the articles were also reviewed. The search returned 23 references that were published between 1987 and 2019. Results were presented in a descriptive manner. Results Treatment decision for now is based on reports of the treatment success, the sustainability of remission, the tolerability by the patients and the potential side effects of each medication. From data available in literature, Baclofen is the mostly used medication with a tolerable profile of adverse effects. Phosphodiesterase type 5 inhibitors are considered potential treatments and are already widely used and tolerated for other indications, but so far only 2 successful trials have been reported for SRPE. Cinitapride is very promising, but only one case was studied and no side effects were reported. Clozapine can be very dangerous although highly effective. Conclusion Based on the limited number of treatment trials and reported cases, the low level of evidence and the lack of randomized clinical trials, no treatment consensus for SRPE can be reached. We suggested a useful tool for clinicians: an algorithm for the management of SRPE to facilitate their access to the literature without exhaustive return to case reports and series upon each case faced.

scholarly journals Ponseti Casting for Severe Club Foot Deformity: Are Clinical Outcomes Promising?

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Mohammad Hallaj-Moghaddam ◽  
Ali Moradi ◽  
Mohammad Hosein Ebrahimzadeh ◽  
Seyed Reza Habibzadeh Shojaie
Keyword(s):  
Club Foot ◽  
Ponseti Method ◽  
Foot Deformity ◽  
Achilles Tenotomy ◽  
Serial Casting ◽  
Before And After ◽  
The Mean ◽  
A Prospective Study ◽  
Demographic Features

Between 2007 and 2010, a prospective study was done on 85 patients with severe idiopathic nonsyndromic clubfeet, in our center. Demographic features, severity of the deformity before and after serial casting according to Diméglio classification, and complications were assessed. The mean age of the patients was 8 days and 69% were male. The mean follow-up period was 26 months. The average number of castings used to correct the deformity was 5.7 times (range: 4 to 8). Tenotomy was performed in 76 (89.4%) of the feet. In all patients, plantigrade foot was achieved. Tenotomy occurred more in patients with higher Diméglio scores. Although patients who underwent Achilles tenotomy began to walk later than those who did not (13±7.2versus9.2±18), it was not significant (P=0.06). Relapse rate, at the end of follow-up, was 27.1%. Diméglio score before casting was16±3.4and at the end of follow-up it was1.6±6.2. The patients with bilateral clubfeet had inferior final outcome compared to those with unilateral clubfoot. Eighty percent of parents’ were completely satisfied with their child's gait and foot appearance (94.1%). Ponseti method of manipulation and casting is a valuable technique in severe club foot as well as in common types.

Early Radiographic Changes in the Lateral Talocalcaneal Angle Following Achilles Tenotomy in Children With Idiopathic Clubfoot

2019 ◽  
Vol 41 (3) ◽  
pp. 350-355
Author(s):  
Jingchun Li ◽  
Yuanzhong Liu ◽  
Yiqiang Li ◽  
Zhe Yuan ◽  
Hongwen Xu ◽  
...  
Keyword(s):  
Correlation Coefficients ◽  
Ponseti Method ◽  
Idiopathic Clubfoot ◽  
Neutral Position ◽  
Level Of Evidence ◽  
Positive Correlation ◽  
Achilles Tenotomy ◽  
Severity Of The Disease ◽  
The Relationship ◽  
Radiographic Changes

Background: Percutaneous Achilles tenotomy (PAT) is an important component of the Ponseti method and is performed in 85% to 90% of patients. However, there is a lack of objective data assessing early radiographic changes in children undergoing PAT. Methods: Forty-nine patients with idiopathic clubfoot treated by Ponseti casting were prospectively enrolled between October 2017 and October 2018. Preoperative and postoperative ankle dorsiflexion (pre-ADFmax, post-ADFmax) and lateral talocalcaneal angle (pre-LTCAmax, post-LTCAmax) values with the ankle in maximal dorsiflexion as well as postoperative LTCA values with the ankle in the neutral position (post-LTCAneutral) were measured. The relationship between the preoperative and postoperative ADF and LTCA values was studied using Pearson or Spearman correlation coefficients. Forty-nine patients (72 feet) were included; the mean age at initial treatment was 32.2 ± 24.1 days. Results: Post-LTCAmax improved significantly from 18.6 ± 9.2 degrees to 25.1 ± 10.5 degrees ( P < .0001). Pre-ADF and pre-LTCAmax showed a positive correlation in both the less than 28-day group ( r = 0.42; P = .015) and the Dimeglio III group ( r = 0.29; P = .035). However, post-ADF and post-LTCAmax showed a positive correlation in the Dimeglio III group ( r = 0.30; P = .028). The degree of improvement in post-LCTAmax in the Dimeglio III group was similar to that in the Dimeglio IV group ( P = .28). Conclusion: The LTCA increased immediately after PAT in clubfoot, although the improvement seemed to be unrelated to the severity of the disease. PAT led to an increase in both ADF and the LTCA, and it contributed to the improvements in subtalar joint motion and alignment. Level of Evidence: Level III, comparative study.

scholarly journals Percutaneous heel cord release for clubfoot: a retrospective, multicentre cost analysis

2018 ◽  
Vol 12 (3) ◽  
pp. 273-278 ◽  
Author(s):  
B. Hedrick ◽  
F. K. Gettys ◽  
S. Richards ◽  
R. D. Muchow ◽  
C.-H. Jo ◽  
...  
Keyword(s):  
Operating Room ◽  
Outpatient Clinic ◽  
Perioperative Complications ◽  
Ponseti Method ◽  
Hospital Charges ◽  
Idiopathic Clubfoot ◽  
Achilles Tenotomy ◽  
Event Time ◽  
Serial Casting ◽  
Total Event

Purpose The Ponseti method of treatment is the standard of care for idiopathic clubfoot. Following serial casting, percutaneous tendo-Achilles tenotomy (TAT) is performed to correct residual equinus. This procedure can be performed in either the outpatient clinic or the operating room. The purpose of this study was to evaluate the expense of this procedure by examining hospital charges in both settings. Methods We retrospectively reviewed charts of 382 idiopathic clubfoot patients with a mean age of 2.4 months (0.6 to 26.6) treated with the Ponseti method at three institutions. Patients were divided into three groups depending on the setting for the TAT procedure: 140 patients in the outpatient clinic (CL), 219 in the operating room with discharge following the procedure (OR) and 23 in the operating room with admission to hospital for observation (OR+). Medical records were reviewed to analyze age, deformity, perioperative complications and specific time spent in each setting. Hospital charges for all three groups were standardized to one institution’s charge structure. Results Charges among the three groups undergoing TAT (CL, OR, OR+) were found to be significantly different ($3840.60 versus $7962.30 versus $9110.00, respectively; p ≤ 0.001), and remained significant when separating unilateral and bilateral deformities (p < 0.001). There were nine total perioperative complications (six returns to the ER and three unexpected admissions to the hospital): five (2.3%) in the OR group, four (17.4%) in the OR+ group and none in the CL group. The OR+ group statistically had a higher rate of complications compared with the other two groups (p = 0.006). The total event time of the CL group was significantly shorter compared with the OR and OR+ groups (129.1, 171.7 and 1571.6 minutes respectively; p < 0.001). Conclusion Hospital charges and total event time were significantly less when percutaneous TAT was performed in the outpatient clinic compared with the operating room. In addition, performing the procedure in clinic was associated with the lowest rate of complications. Level of Evidence Therapeutic, Level III

Multidisciplinary management of vascular access for haemodialysis: from the preparation of the initial access to the treatment of stenosis and thrombosis

VASA ◽  
2011 ◽  
Vol 40 (3) ◽  
pp. 188-198 ◽  
Author(s):  
Reinhold ◽  
Haage ◽  
Hollenbeck ◽  
Mickley ◽  
Ranft
Keyword(s):  
Vascular Access ◽  
Central Venous ◽  
Advantages And Disadvantages ◽  
Multidisciplinary Study ◽  
First Results ◽  
Lower Complication ◽  
Lower Complication Rate ◽  
Access Problems ◽  
Arteriovenous Grafts ◽  
The Individual

In February 2008 a multidisciplinary study group was established in Germany to improve the treatment of patients with potential vascular access problems. As one of the first results of their work interdisciplinary recommendations for the management of vascular access were provided, from the creation of the initial access to the treatment of complications. As a rule the wrist arteriovenous fistula (AVF) is the access of choice due to its lower complication rate when compared to other types of access. The AVF should be created 3 months prior to the expected start of haemodialysis to allow for sufficient maturation. Second and third choice accesses are arteriovenous grafts (AVG) and central venous catheters (CVC). Ultrasound is a reliable tool for vessel selection before access creation, and also for the diagnosis of complications in AVF and grafts. Access stenosis and thrombosis can be treated surgically and interventionally. The comparison of both methods reveals advantages and disadvantages for each. The therapeutic decision should be based on the individual patients’ constitution, and also on the availability and experience of the involved specialists.

ADMINISTRATION MODELS IN THE SYSTEM OF FORENSIC EXAMINATION INSTITUTIONS FROM THE POSITION OF SCIENTIFIC MANAGEMENT

2016 ◽  
Vol 16 ◽  
pp. 179-184
Author(s):  
S. V. Kudryashova
Keyword(s):  
Scientific Management ◽  
Competing Values ◽  
State Institutions ◽  
Advantages And Disadvantages ◽  
Forensic Examination ◽  
Forensic Institutions ◽  
The Individual

The individual forensic activity in comparison with the activity of forensic experts of specialized state institutions is considered, the main advantages and disadvantages are determined. The directions of development of specialized state and non-state forensic institutions are presented in accordance with R. Quinn's competing values model.

Wykorzystanie mediów społecznościowych w komunikacji z klientem na przykładzie firm sektora piwowarskiego

2015 ◽  
pp. 161-176 ◽  
Author(s):  
Piotr Szamrowski ◽  
Adam Pawlewicz
Keyword(s):  
Social Media ◽  
Public Relations ◽  
Small Enterprises ◽  
Brewing Industry ◽  
Video Sharing ◽  
Advantages And Disadvantages ◽  
Media Platform ◽  
The Individual ◽  
Media Channels ◽  
Regional Character

The main objective of this paper is to identify the platforms and social media tools utilized by the brewing industry in communication with the stakeholders, mainly with potential clients. In addition, the study sought to determine the nature of the published content, identify those responsible for their management, and present the advantages and disadvantages of their conduct in communication and creating the image of the company. The results indicate that only 25% of the surveyed companies do not use social media in PR. This applies only to small enterprises, with regional character. All the major brewing companies in their public relations activities use at least one type of social media, focusing in most cases on social networking (Facebook) and Video Sharing (YouTube). In addition, some of the largest brands included in the individual equity groups have their own social media channels used to communicate with the stakeholders. General promotion of company products and, what is very important, creating a dialogue with social media platform community, were seen as the most important benefits of using social media.

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