scholarly journals Treatment of aseptic osteonecrosis of the talus. A draft of clinical guidelines

2021 ◽  
Vol 27 (2) ◽  
pp. 153-162
Author(s):  
A.N. Torgashin ◽  
◽  
A.K. Mursalov ◽  
S.S. Rodionova ◽  
N.V. Zagorodniy ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
Treatment Options ◽  
Medical Professional ◽  
Diagnosis And Treatment ◽  
Disease Stage ◽  
Cochrane Library ◽  
Level Of Evidence ◽  
Non Profit ◽  
Clinical Recommendations ◽  
Aseptic Osteonecrosis

Clinical guidelines are an algorithm adapted for use in our country, based on the works systematized by the level of evidence, reflecting current approaches to the diagnosis and treatment of aseptic bone necrosis (osteonecrosis) of various localizations. Purpose of the study Creation of an algorithm for diagnosis and treatment of osteonecrosis based on the assessment of the evidence level of literature data. Material and methods The Guidelines are a systematized algorithm based on the level of evidence for the management of patients with osteonecrosis, reflecting current approaches to diagnosis, treatment and rehabilitation, which are based on literature data and the authors' own experience. Electronic databases of Medline, Embase, Web of Science, and Cochrane Library platforms were searched for related sources. Preference was given to the works with high levels of evidence. References to information sources are given in the order of their appearance in the text. The search depth was 50 years due to the availability of systematic literature reviews in the framework of previous international clinical guidelines. When specific medical procedures related to the diagnosis, conservative or surgical treatment of osteonecrosis were included in the clinical recommendations, their level of evidence was reliability, the appropriateness of their use, taking into account the unified scale for assessing the quality of evidence and the strength of the recommendations for application of medical technologies GRADE. Results The Guidelines reflect aspects of clinical, instrumental and laboratory examination of patients with osteonecrosis, treatment options depending on the location of the process and disease stage. Conclusion Clinical recommendations on the medical assistance to patients with aseptic osteonecrosis have been compiled according to the requirements imposed on clinical recommendations developed by medical professional non-profit institutions

scholarly journals Hereditary Hemorrhagic Telangiectasia: Systemic Therapies, Guidelines, and an Evolving Standard of Care

Blood ◽  
2020 ◽  
Author(s):  
Hanny Al-Samkari
Keyword(s):  
Hereditary Hemorrhagic Telangiectasia ◽  
Standard Treatment ◽  
Treatment Options ◽  
Standard Of Care ◽  
Diagnosis And Treatment ◽  
International Guidelines ◽  
Clinical Recommendations ◽  
Antiangiogenic Therapies ◽  
Systemic Therapies ◽  
Second International

Hereditary hemorrhagic telangiectasia (HHT) management is evolving due to the emergence and development of antiangiogenic therapies to eliminate bleeding telangiectasias and achieve hemostasis. This is reflected in recent clinical recommendations published in the Second International Guidelines for the Diagnosis and Treatment of HHT, in which systemic therapies including antiangiogenics and antifibrinolytics are now recommended as standard treatment options for bleeding. This review highlights the new recommendations especially relevant to hematologists in managing bleeding, anticoagulation, and anemia in patients with HHT.

scholarly journals Thrower’s Exostosis of the Shoulder: A Systematic Review With a Novel Classification

2020 ◽  
Vol 8 (7) ◽  
pp. 232596712093210
Author(s):  
Michael T. Freehill ◽  
Sandeep Mannava ◽  
Laurence D. Higgins ◽  
Alexandre Lädermann ◽  
Austin V. Stone
Keyword(s):  
Systematic Review ◽  
Classification System ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Return To Sport ◽  
Current Treatment ◽  
Operative Intervention ◽  
Diagnosis And Treatment ◽  
Level Of Evidence ◽  
Anatomic Locations

Background: A variety of thrower’s exostoses are grouped under the term Bennett lesion, which makes understanding diagnosis and treatment difficult. Purpose: To identify all types of reported thrower’s and overhead athlete’s exostoses and categorize them into a classification system to allow a morphology-based classification. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of all articles pertaining to Bennett lesions and thrower’s exostosis was performed. The classification and treatments were evaluated to describe the types, proposed causes, diagnosis, and treatment options. Results: A total of 27 studies were included in the systematic review. The anatomic locations referenced in the study demonstrated posteroinferior, posterior, and posterosuperior glenoid lesions. Aggregate radiographic data demonstrated 158 of 306 patients (52%) with a thrower’s exostosis of any type and location. Of these 158 patients with a radiographic lesion, 119 (75%) patients were symptomatic. The locations were posteroinferior in 110 patients (70%), directly posterior in 2 patients (1.3%), posterosuperior in 44 patients (28%), and unknown in 2 patients (1.3%). Avulsed lesions were present in 9 (5.7%) posteroinferior lesions, 0 direct posterior lesions, and 2 (1.3%) posterosuperior lesions. Treatment plans included both nonoperative and operative strategies, but operative intervention was more commonly reported for detached lesions. After operative intervention, only 61% of reported athletes returned to preinjury performance. Conclusion: Based on a comprehensive review of the literature, we identified several anatomic locations for a thrower’s exostosis beyond the classic Bennett lesion. We categorized the reported exostoses into a new classification system for description of location and type (subperiosteal or free fragment) of the thrower’s exostosis, which may be used to study future treatments. Current treatment strategies recommend that surgical treatment of thrower’s exostosis is considered only after exhausting nonoperative management because reported return to sport is variable after surgery. The effectiveness of excision or repair for both subperiosteal and detached lesions has not been established.

scholarly journals Thyrotoxicosis. Clinical guidelines for diagnosis and treatment. Part ІІ

2020 ◽  
Vol 28 (3) ◽  
pp. 273-286
Author(s):  
N. S. Pidchenko ◽  
L. Ya. Vasylyev ◽  
G. V. Grushka ◽  
O. M. Astapieva ◽  
A. S. Savchenko
Keyword(s):  
Clinical Guidelines ◽  
Clinical Manifestations ◽  
Diagnosis And Treatment ◽  
Cochrane Library ◽  
American Thyroid Association ◽  
Endocrine Society ◽  
Appropriate Treatment ◽  
Thyrotoxic Crisis ◽  
Medical Radiology ◽  
The Cochrane Library

Background. Recently they have reported an increased rate of thyrotoxicosis, which is characterized by polyetiology, a variety of clinical manifestations and potential treatment. Appropriate treatment requires an accurate diagnosis and depends on the comorbidities and preferences of the patient. Purpose. To highlight the key points of clinical guidelines for diagnosis and treatment of thyrotpxicosis provided by the American Thyroid Association and the American Association of Clinical Endocrinologists, US Endocrine Society dealing with diagnosis and treatment of thyroid diseases as well as the local clinical protocols of SO «Grigoriev Institute for Medical Radiology and Oncology of the National Academy of Medical Sciences of Ukraine». Materials and methods. Based on the search of contributions in the electronic databases over the last 5 years, which are included in the Cochrane Library, PUBMED and MEDLINE databases. Clinical guidelines are based on expert consensus and assessing the significance according to the international guidelines for thyrotoxicosis. Results and discussion. The paper deals with up-to-date guidelines on diagnosis, management and treatment of patients with different forms of thyrotoxicosis. It presents a detailed strategy for those patients depending on etiology of the disease. The therapeutic approaches to treating Graves’ disease, autoimmune ophthalmopathy, thyrotoxic crisis, gravidae as well as the peculiarities of treating patients with subclinical hyperthyroidism and iodine-induced thyrotoxicosis have been substantiated. Conclusions. The treatment of thyrotoxicosis remains a challenging issue of modern internal medicine. Despite the existing numerous clinically proven protocols for the treatment of this pathology, the comorbid background of patients complicates following them. The implementation of the provided protocol elements will make it possible to introduce the principles of a customized approach in thyrotoxicosis patients.

scholarly journals Rigorous Assessment of Guidelines on COVID-19-Related Thrombotic or Thromboembolic Disease: Implications for Clinical Practice of Prevention, Diagnosis, and Treatment

2021 ◽  
Vol 2021 ◽  
pp. 1-14
Author(s):  
Jingyi Liang ◽  
Zhufeng Wang ◽  
Jiaxing Xie ◽  
Hanwen Liang ◽  
Jiamin Liang ◽  
...  
Keyword(s):  
International Organizations ◽  
Web Of Science ◽  
Thromboembolic Disease ◽  
Diagnosis And Treatment ◽  
Cochrane Library ◽  
High Quality ◽  
Agree Ii ◽  
Clinical Recommendations ◽  
Current Guidelines

Purpose. Severe COVID-19 patients were prone to develop venous thromboembolism. Unfortunately, to date, there is no evidence of any effective medications for thromboembolism in COVID-19. The management of the disease relies on symptomatic and supportive treatments, giving rise to a variety of guidelines. However, the quality of methodology and clinical recommendations remains unknown. Materials and Methods. We searched Medline, Cochrane Library, Web of Science, websites of international organizations and medical societies, and gray literature databases. Four well-trained appraisers independently evaluated the quality of eligible guidelines and extracted recommendations using well-recognized guideline appraisal tools. Furthermore, recommendations were extracted and reclassified according to a composite grading system. Results. The search identified 23 guidelines that offered 108 recommendations. Guidelines scored average on AGREE II criteria, with Scope and Purpose and Clarity of Presentation highest. Only five (22%) guidelines provided high-quality recommendations. The existed clinical recommendations were inconsistent in terms of prophylaxis, diagnosis, and treatment of thromboembolic disease to some extent. Conclusion. Current guidelines for COVID-19 thromboembolism are generally of low quality, and clinical recommendations on thromboembolism are principally supported by insufficient evidence. There is still an urgent need for more well-designed clinical trials as evidence to prevent adverse events and improve prognosis during COVID-19 treatment.

scholarly journals The Treatment and Outcomes of Medial Malleolar Stress Fractures

2014 ◽  
Vol 6 (6) ◽  
pp. 527-530 ◽  
Author(s):  
Val Irion ◽  
Timothy L. Miller ◽  
Christopher C. Kaeding
Keyword(s):  
Stress Fracture ◽  
Treatment Options ◽  
Case Series ◽  
Return To Sport ◽  
Stress Fractures ◽  
Return To Play ◽  
Cochrane Library ◽  
Medial Malleolus ◽  
Retrospective Case ◽  
Level Of Evidence

Context: The medial malleolus is considered a high-risk stress fracture and can be debilitating to the highly active or athletic populations. A range of treatment methods have been described with varying outcomes. Currently, there is no gold standard treatment option with optimal results described. Objective: A systematic search of the literature to determine treatment options and outcomes in medial malleolus stress fractures. Data Sources: OVID/Medline, EMBASE, and the Cochrane Library from 1950 to September 2013. Study Selection: Included studies mentioned treatment and outcomes of medial malleolus stress fractures. Study Design: Systematic review. Level of Evidence: Level 4. Data Extraction: The searches used combinations of the terms stress fracture, medial malleolus, management, and treatment. Two authors independently reviewed the selected articles and created individual tables, which were later compiled into a master table for final analysis. Results: Six retrospective case series were identified (n = 31 patients). Eighty percent (25/31) of patients were men, with an average age of 24.5 years. Ninety percent (28/31) of patients were at least involved in recreational athletics. All patients were able to return to sport. Complications were seen in both groups ranging from minor stiffness to nonunion requiring open reduction internal fixation. Conclusion: Nonoperative and operative interventions have proven to be successful with regard to healing and return to play for medial malleolar stress fractures in the recreational and competitive athlete. However, early operative intervention can possibly create a higher likelihood of early healing, decrease in symptoms, and return to play.

scholarly journals Do Culture-Negative Periprosthetic Joint Infections Have a Worse Outcome Than Culture-Positive Periprosthetic Joint Infections? A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Marie Reisener ◽  
Carsten Perka
Keyword(s):  
Systematic Review ◽  
Treatment Strategies ◽  
Diagnosis And Treatment ◽  
Cochrane Library ◽  
Two Stage ◽  
Level Of Evidence ◽  
Clinical Issue ◽  
Joint Infections ◽  
Culture Positive ◽  
Culture Negative

Background. Culture-negative periprosthetic joint infections (CN PJI) have not been well studied, and due to the lack of consensus on PJI, especially with culture-negative infections, there are considerable uncertainties. Due to the challenging clinical issue of CN PJI the aim of this systematic review is to describe incidence, diagnosis, and treatment outcomes based on the current literature on CN PJI.Hypothesis.The review is designed to assess the formal hypothesis that CN PJI of the hip and knee have a poorer outcome when compared with culture-positive ones.Study Design.It is systematic review with level of evidence 3.Methods.EMBASE, MEDLINE, and the Cochrane Library were searched electronically in January 2018. All studies regarding CN PJI of the hip or knee published in English or German with a minimum of 10 patients were included. Afterwards, the authors performed a descriptive analysis of diagnosis and treatment outcome.Result.Eight studies were identified that met the inclusion criteria. The incidence of CN PJI in the hip or knee ranged from 7% to 42 %. The included studies were pooled to give an overall incidence rate estimate of 11 % [95% confidence interval (CI): 10-12] based on a random-effects model. The most common surgical intervention was the two-stage revision of prosthesis with 283 patients. Postoperatively, the majority of patients received vancomycin as the antibiotic treatment, alone or in combination with other antibiotics. The rate of succesfully treated infections varied from 85% to 95 % in all included studies. The two-stage exchange arthroplasty had the best outcome, based on the infection-free survival rate of 95%, five years after treatment.Conclusions.We conclude that CN PJI have the same or even better results than culture-positive infections. Nonetheless, a standardized diagnostic protocol and evidence-based treatment strategies for CN PJI should be implemented for further studies.

scholarly journals Thyrotoxicosis. Clinical recommendations for diagnosis and treatment Part І

2020 ◽  
Vol 28 (2) ◽  
pp. 154-163
Author(s):  
N. S. Pidchenko
Keyword(s):  
Internal Medicine ◽  
Clinical Guidelines ◽  
American Association ◽  
Clinical Manifestations ◽  
Diagnosis And Treatment ◽  
Cochrane Library ◽  
Clinical Protocols ◽  
Appropriate Treatment ◽  
Key Points ◽  
The Cochrane Library

Background. Currently submitted an increased rate of thyrotoxicosis, which is characterized by polyetiology, a variety of clinical manifestations and potential treatments. Appropriate treatment requires an accurate diag­nosis and depends on the comorbidities and preferences of the patient. The aim of the study was to consider the pathogenesis, clinical picture and di­agnosis of thyrotoxicosis. Purpose. To highlight the key points of clinical guidelines on thyrotoxi­cosis diagnosis and treatment provided by the American Thyroid Associa­tion and the American Association of Clinical Endocrinologists, US En­docrine Society dealing with diagnosis and treatment of thyroid diseases as well as the local clinical protocols of SO «Grigoriev Institute for Med­ical Radiology and Oncology of the National Academy of Medical Sci­ences of Ukraine». Materials and methods. Based on the research in the electronic databases of last 5 years publications, which are included in the Cochrane Library, PUBMED and MEDLINE databases. Clinical guidelines are based on expert consensus and assessing the significance according to the interna­tional guideline of thyrotoxicosis. Conclusions. Thyrotoxicosis treatment remains a challenging is­sue of modern internal medicine. Despite the existing numerous clini­cally proven protocols for the treatment of this pathology, the comorbid background of patients complicates following them. The implementa­tion of the provided protocol elements will make it possible to introduce the principles of a customized approach in thyrotoxicosis patients.

scholarly journals Estimation of Direct Melanoma-related Costs by Disease Stage and by Phase of Diagnosis and Treatment According to Clinical Guidelines

2018 ◽  
Vol 98 (2) ◽  
pp. 218-224 ◽  
Author(s):  
A Buja ◽  
G Sartor ◽  
M Scioni ◽  
A Vecchiato ◽  
M Bolzan ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
Diagnosis And Treatment ◽  
Disease Stage

scholarly journals Draft of the clinical recommendations for diagnosis and treatment of hypothyroidism

2021 ◽  
Vol 17 (1) ◽  
pp. 4-13
Author(s):  
V. V. Fadeev ◽  
T. B. Morgunova ◽  
G. A. Melnichenko ◽  
I. I. Dedov
Keyword(s):  
Pregnant Women ◽  
Autoimmune Thyroiditis ◽  
Clinical Guidelines ◽  
Radioactive Iodine ◽  
Primary Hypothyroidism ◽  
Diagnosis And Treatment ◽  
Clinical Recommendations ◽  
Chronic Autoimmune Thyroiditis ◽  
Endocrine Diseases

Hypothyroidism is one of the most common endocrine diseases. More than 99% of all cases of hypothyroidism in adults are due to primary hypothyroidism. Most often, hypothyroidism develops because of chronic autoimmune thyroiditis, as well as after medical manipulations (iatrogenic hypothyroidism) — postoperative or as a result of therapy with radioactive iodine. The article presents a draft of clinical guidelines for the diagnosis and treatment of hypothyroidism in different groups of patients, including pregnant women.

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