Emergency hip disarticulations for severe necrotising fasciitis of the lower limb: a series of rare cases from a rural district general hospital

2021 ◽  
Vol 103 (7) ◽  
pp. e223-e226
Author(s):  
SM Korambayil ◽  
S Iyer ◽  
DJ Williams
Keyword(s):  
Lower Limb ◽  
Functional Outcomes ◽  
District General Hospital ◽  
Necrotising Fasciitis ◽  
First Line ◽  
Life Saving ◽  
Lower Limb Pain ◽  
Discharge From Hospital ◽  
Flap Closure ◽  
Hindquarter Amputation

Hip disarticulation is the removal of the entire lower limb through the hip joint by detaching the femur from the acetabulum. This major ablative procedure is rarely performed for infection but may be required in severe necrotising fasciitis. We present a single centre retrospective review of all cases of emergency hip disarticulations in patients with necrotising fasciitis between 2010 and 2020. All five patients included in the review presented with acute lower limb pain and sepsis. Three patients had comorbidities predisposing them to necrotising fasciitis. Three were deemed to be high risk and two were at intermediate risk of developing necrotising fasciitis. There were two deaths in the postoperative period. Of the three survivors, two required revision surgery for a completion hindquarter amputation and one for flap closure. All three survivors had good functional outcomes after discharge from hospital. Despite its associated morbidity, emergency amputation of the entire lower limb is a life-saving treatment in cases of rapidly progressing necrotising fasciitis and should be considered as a first-line option in managing this condition.

Risk Factor Of Substitution ARV First Line People Living With HIV/AIDS In General Hospital Buleleng Bali

2020 ◽  
Vol 9 (1) ◽  
pp. 190-197
Author(s):  
Luh Putu Desy Puspaningrat ◽  
Gusti Putu Candra ◽  
Putu Dian Prima Kusuma Dewi ◽  
I Made Sundayana ◽  
Indrie Lutfiana
Keyword(s):  
Risk Factor ◽  
General Hospital ◽  
Medical Records ◽  
Secondary Data ◽  
District General Hospital ◽  
People Living With Hiv ◽  
First Line ◽  
The Past ◽  
Factor Substitution ◽  
Living With Hiv

Substitution is still a threat to the failure of ARV therapy so that no matter how small it must be noted and monitored in ARV therapy. The aims  was analysis risk factor substitution ARV first line in therapy ARV. This study was an analytic longitudinal study with retrospective secondary data analysis in a cohort of patients receiving ARV therapy at the District General Hospital of Buleleng District for the period of 2006-2015 and secondary data from medical records of PLHA patients receiving ART.  Result in this study that the percentage of first-line ARV substitution events is 9.88% (119/1204) who received ARV therapy for the past 11 years. Risk factors that increase the risk of substitution in ARV therapy patients are zidovudine (aOR 4.29 CI 1.31 -2.65 p 0.01), nevirapine (aOR1.86 CI 2.15 - 8.59 p 0.01) and functional working status (aOR 1.46 CI 1.13 - 1.98 p 0.01). 

scholarly journals COVID-19: Nutrition and functional outcomes for critical care survivors in a 400- bedded district general hospital in North London

2021 ◽  
pp. 175114372110254
Author(s):  
Rachel Catlow ◽  
Charlotte Cheeseman ◽  
Helen Newman
Keyword(s):  
Critical Care ◽  
General Hospital ◽  
Health Professionals ◽  
Functional Outcomes ◽  
Critical Care Unit ◽  
Workforce Planning ◽  
District General Hospital ◽  
Allied Health Professionals ◽  
Novel Coronavirus ◽  
Rehabilitation Needs

Novel coronavirus disease (COVID-19) has resulted in huge numbers of critically ill patients. This study describes the inpatient recovery and rehabilitation needs of patients admitted with COVID-19 to the critical care unit of a 400 bedded general hospital in London, United Kingdom. The rehabilitation needs of our sample were considerable. It is recommended that the increase demand on allied health professionals capacity demonstrated is considered in future COVID-19-related workforce-planning.

scholarly journals Ipsilateral Motor Pathways and Transcallosal Inhibition During Lower Limb Movement After Stroke

2021 ◽  
pp. 154596832199904
Author(s):  
Brice T. Cleland ◽  
Sangeetha Madhavan
Keyword(s):  
Lower Limb ◽  
Functional Outcomes ◽  
Motor Pathways ◽  
Movement Accuracy ◽  
Transcallosal Inhibition ◽  
Paretic Limb ◽  
Bilateral Lower Limb ◽  
Ankle Movement ◽  
Lower Limb Movement ◽  
Clinical Measures

Background Stroke rehabilitation may be improved with a better understanding of the contribution of ipsilateral motor pathways to the paretic limb and alterations in transcallosal inhibition. Few studies have evaluated these factors during dynamic, bilateral lower limb movements, and it is unclear whether they relate to functional outcomes. Objective Determine if lower limb ipsilateral excitability and transcallosal inhibition after stroke depend on target limb, task, or number of limbs involved, and whether these factors are related to clinical measures. Methods In 29 individuals with stroke, ipsilateral and contralateral responses to transcranial magnetic stimulation were measured in the paretic and nonparetic tibialis anterior during dynamic (unilateral or bilateral ankle dorsiflexion/plantarflexion) and isometric (unilateral dorsiflexion) conditions. Relative ipsilateral excitability and transcallosal inhibition were assessed. Fugl-Meyer, ankle movement accuracy, and walking characteristics were assessed. Results Relative ipsilateral excitability was greater during dynamic than isometric conditions in the paretic limb ( P ≤ .02) and greater in the paretic than the nonparetic limb during dynamic conditions ( P ≤ .004). Transcallosal inhibition was greater in the ipsilesional than contralesional hemisphere ( P = .002) and during dynamic than isometric conditions ( P = .03). Greater ipsilesional transcallosal inhibition was correlated with better ankle movement accuracy ( R2 = 0.18, P = .04). Greater contralateral excitability to the nonparetic limb was correlated with improved walking symmetry ( R2 = 0.19, P = .03). Conclusions Ipsilateral pathways have increased excitability to the paretic limb, particularly during dynamic tasks. Transcallosal inhibition is greater in the ipsilesional than contralesional hemisphere and during dynamic than isometric tasks. Ipsilateral pathways and transcallosal inhibition may influence walking asymmetry and ankle movement accuracy.

Incapacitating lower limb pain syndrome in cord blood stem cell transplant recipients with calcineurin inhibitor

2004 ◽  
Vol 10 (4) ◽  
pp. 204-206 ◽  
Author(s):  
Aiko Kida ◽  
Kazuteru Ohashi ◽  
Takeshi Kobayashii ◽  
Miwa Sakai ◽  
Takuya Yamashita ◽  
...  
Keyword(s):  
Stem Cell ◽  
Lower Limb ◽  
Calcineurin Inhibitor ◽  
Stem Cell Transplant ◽  
Pain Syndrome ◽  
Cell Transplant ◽  
Transplant Recipients ◽  
Limb Pain ◽  
Cord Blood Stem Cell ◽  
Lower Limb Pain

scholarly journals The transplanted patient who suffered from excruciating lower limb pain and developed nodular skin lesions

1999 ◽  
Vol 14 (12) ◽  
pp. 2947-2949 ◽  
Author(s):  
Minh-Truc Vo-cong ◽  
Alexandre Persu ◽  
Liliane Marot ◽  
Eric Goffin
Keyword(s):  
Lower Limb ◽  
Skin Lesions ◽  
Limb Pain ◽  
Lower Limb Pain

scholarly journals Effectiveness of Exercise Therapy and its Variations in Lower Limb Osteoarthritis: A Literature Review

2014 ◽  
Vol 48 (4) ◽  
pp. 190-196 ◽  
Author(s):  
Himmat S Dhillon
Keyword(s):  
Literature Review ◽  
Strength Training ◽  
Exercise Therapy ◽  
Lower Limb ◽  
Functional Outcomes ◽  
Tai Chi ◽  
Weight Bearing ◽  
Functional Limitation ◽  
Joint Disorder ◽  
The Common

ABSTRACT Osteoarthritis is an irreversible, progressive, degenerative joint disorder of multifactorial etiology that commonly affects weight-bearing joints and leads to pain, loss of movement and functional limitation. Exercise therapy has been shown to be beneficial in osteoarthritis, in terms of decreased pain, improved motion and improved functional outcomes. This review aims to look at some of the common as well as newer modalities of exercise therapy for osteoarthritis (OA), such as strength, training, stretching, agility training, aquatic exercises, Tai Chi and combinations of these modalities. How to cite this article Dhillon HS, Sharma M, Sharma S. Effectiveness of Exercise Therapy and its Variations in Lower Limb Osteoarthritis: A Literature Review. J Postgrad Med Edu Res 2014;48(4):190-196.

scholarly journals An oral combined contraceptive user with elevated D-dimer post COVID-19: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nada A. Alyousefi
Keyword(s):  
Emergency Room ◽  
Lower Limb ◽  
Varicose Veins ◽  
Hormonal Contraception ◽  
Oral Contraception ◽  
Contraceptive User ◽  
Lower Limb Pain ◽  
The Right ◽  
D Dimer ◽  
Ethinyl Oestradiol

Abstract Background This case discusses the challenges created by COVID-19 (coronavirus disease 2019) in the area of hormonal contraception, highlighting the contraception knowledge gap for women in their post COVID-19 period, especially if they had high D-dimer levels. Case presentation This case involves a thirty-eight-year-old woman taking combined oral contraception (desogestrel/ethinyl oestradiol tablets) with a history of varicose veins. She recovered from a COVID-19 infection in November 2020. She presented to the emergency room with right lower-limb pain below the knee and progressive swelling for five days in February 2021. Physical examination of the lower limb showed mild swelling and tenderness of the right leg compared to the left leg. D-Dimer was elevated (1.06 mcg/mL FEU). COVID-19 screening was negative. A Doppler scan to exclude DVT was performed considering the clinical picture and high D-dimer level. There was no evidence of DVT in the right limb. She was reassured and discharged with instructions on when to visit the emergency room. The D-dimer had decreased to 0.53 mcg/mL FEU in March 2021. She booked an appointment with family medicine clinics because she was concerned about the continuation of combined oral contraception (desogestrel/ethinyl oestradiol tablets) with high D-dimer and risk of thrombosis. The follow-up D-dimer level in May 2021 was normal (0.4 mcg/mL FEU). The patient preferred to continue taking oral contraception. Conclusion An evidence-based consensus is needed to guide clinicians in providing contraception counselling for such patients.

Audit of new long-stay patients in a district general hospital

1994 ◽  
Vol 11 (1) ◽  
pp. 42-43 ◽  
Author(s):  
Mathew Kurian ◽  
Shobha George ◽  
Clive G Ballard ◽  
Ramalingam NC Mohan ◽  
Stuart Cumella
Keyword(s):  
General Hospital ◽  
Antisocial Behaviour ◽  
District General Hospital ◽  
Primary Diagnosis ◽  
Psychiatric Ward ◽  
Psychiatric Unit ◽  
Prolonged Stay ◽  
Diagnosis Of Dementia ◽  
Rehabilitation Facilities ◽  
Discharge From Hospital

AbstractObjective: To describe the characteristics of “new” long-stay patients in a district general hospital psychiatric unit. Method: A “new” long-stay patient was defined as a patient aged 18 or more who on the census date had been in a district general hospital psychiatric ward for longer than six months but less than six years. There was no upper age limit but patients with a primary diagnosis of dementia were excluded from the study. Information about each patient was obtained from medical and nursing cases notes. Patients were interviewed by one interviewer to determine their views on discharge from hospital. All the members of the multi-disciplinary team were interviewed by one interviewer to obtain their judgements about future accommodation needs of the patients. Results: “New” long-stay patients are typically single in their mid-forties with no supportive relatives. Most have a primary diagnosis of schizophrenia. They have a long psychiatric history and the majority had been in hospital between 6 months and three years. The principle reasons for prolonged stay were persistence of active psychotic symptomatology, schizophrenic defect state, poor social skills and antisocial behaviour. Conclusion: A group of “new” long-stay patients have accumulated in Wolverhampton district general hospital psychiatric unit, despite modern methods of treatment and the availability of a good range of rehabilitation facilities. They are a diverse group including patients with a severe schizophrenic disorders, affective disorders, personality disorders and organic disorders. Ideally, if these patients are to be placed in the community, rather than remaining as inpatients, then placement would need to be in specialised facilities like hospital hostels.

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