Short-term outcome of total knee replacement in a patient with hemophilia: A case report and review of literature.

BACKGROUND: Hemophilia A is a rare inherited bleeding disorder caused by mutations in the factor VIII gene. This clotting factor plays an intrinsic role in the blood coagulation pathway. Patients with hemophilia may develop orthopedic manifestations such as hemarthrosis, but multiple malunion of fractures over the knee is rare and difficult to treat. CASE SUMMARY: We report a patient with hemophilia A who developed severe knee osteoarthritis along with fracture malunion and nonunion. Total knee replacement was performed using a custom-made modular hinged knee prosthesis (cemented) equipped with extended distal and proximal stems. At 3 years' follow-up, the patient exhibited excellent clinical function and remained satisfied with the surgical outcome. Surgical intervention was accompanied by rigorous coagulation factor replacement. CONCLUSION: This case highlights various unique scenarios specific to individuals with hemophilia and fracture deformity.

Building-Related Symptoms among Office Employees Associated with Indoor Carbon Dioxide and Total Volatile Organic Compounds.

This study investigated whether sick building syndrome (SBS) complaints among office workers were associated with the indoor air quality. With informed consent, 417 employees in 87 office rooms of eight high-rise buildings completed a self-reported questionnaire for symptoms experienced at work during the past month. Carbon dioxide (CO2), temperature, humidity and total volatile organic compounds (TVOCs) in each office were simultaneously measured for eight office hours using portable monitors. Time-averaged workday difference between the indoor and the outdoor CO2 concentrations (dCO2) was calculated as a surrogate measure of ventilation efficiency for each office unit. The prevalence rates of SBS were 22.5% for eye syndrome, 15.3% for upper respiratory and 25.4% for non-specific syndromes. Tiredness (20.9%), difficulty in concentrating (14.6%), eye dryness (18.7%) were also common complaints. The generalized estimating equations multivariate logistic regression analyses showed that adjusted odds ratios (aORs) and 95% confidence interval (CI) per 100 ppm increase in dCO2 were significantly associated with dry throat (1.10, 95% CI=(1.00-1.22)), tiredness (1.16, 95% CI=(1.04-1.29)) and dizziness (1.22, 95% CI=(1.08-1.37)). The ORs for per 100 ppb increases in TVOCs were also associated with upper respiratory symptoms (1.06, 95% CI=(1.04-1.07)), dry throat (1.06, 95% CI=(1.03-1.09)) and irritability (1.02, 95% CI=(1.01-1.04)). In conclusion, the association between some SBS symptoms and the exposure to CO2 and total VOCs are moderate but may be independently significant.

Oxidative DNA damage estimated by urinary 8-hydroxydeoxyguanosine and indoor air pollution among non-smoking office employees.

This study investigated whether urinary 8-hydroxydeoxyguanosine (8-OHdG), a biomarker of oxidative stress, was associated with indoor air quality for non-smokers in high-rise building offices. With informed consents, urine samples from 344 non-smoking employees in 86 offices were collected to determine 8-OHdG concentrations. The concentrations of carbon dioxide (CO(2)) and total volatile organic compounds (TVOCs) in each office and outside of the building were simultaneously measured for eight office hours. The average workday difference between indoor and outdoor CO(2) concentrations (dCO(2)) was used as a surrogate measure of the ventilation efficiency for each office unit. The CO(2) levels in the offices ranged 467-2810ppm with a mean of 1170ppm, or 2.7 times higher than that in the outside air. The average urinary 8-OHdG levels among employees increased from 3.10 micro g/g creatinine, for those at the lowest tertile levels of both dCO(2) and TVOCs, to 6.27 micro g/g creatinine, for those at the highest tertile levels. Multivariate logistic regression analysis showed that the risk of having the urinary 8-OHdG level of greater than the median, 4.53 micro g/g creatinine, for participants was increased significantly at the highest tertile dCO(2) level of >680ppm (odds ratio (OR)=3.37, 95% confidence interval (CI)=1.20-9.46). The effect was significant at the middle tertile TVOCs level of 114-360ppb (OR=2.62, 95% CI=1.43-4.79), but not at the highest tertile. Inadequate ventilation in office increases the risk of building-related oxidative stress in non-smoking employees.

Oxidative stress associated with indoor air pollution and sick building syndrome-related symptoms among office workers in Taiwan.

This study investigated whether sick building syndrome (SBS) complaints and indoor air pollution for office workers are associated with oxidative stress indicated by urinary 8-hydroxydeoxyguanosine (8-OHdG). With informed consent, 389 employees in 87 government offices of 8 high-rise buildings in Taipei city completed self-reported questionnaires on SBS complaints at work in the past month. Urinary 8-OHdG was determined for each study participant and on-site air pollutants were measured for each office in both indoor and outdoor air. The results showed that urinary 8-OHdG had significant associations with volatile organic compounds and carbon dioxide levels in offices, and with urinary cotinine levels. The mean urinary 8-OHdG level was also significantly higher in participants with SBS symptoms than in those without such complaints (6.16 vs. 5.45 mug/g creatinine, p = .047). The mean 8-OHdG increased as the number of SBS symptoms increased. The multivariate logistic regression analyses showed that the adjusted odds ratios (OR) in relation to micrograms per gram creatinine increase in 8-OHdG were statistically significant for eye dryness (1.12), upper respiratory syndrome (1.17) with particularly nose itching (1.25), sneezing (1.51), dry throat (1.21), skin dryness (1.31), and dizziness (1.19). This study indicates that the 8-OHdG level was significantly associated with SBS complaints after controlling for air pollution and smoking. Whether the 8-OHdG can be used as an effective predictor for SBS symptoms deserves further study.