RESUMO
Introduction: Patients visiting for Knee Arthroplasty have often been treated at neighborhood clinics and bonesetters. India floated world's largest publicly funded national health insurance program -AB-PMJAY covering Knee Arthroplasty. AB-PMJAY's data for Arthroplasty has not been published. Methods: A Prospective study from Jan 2016- Jan 2023 on females undergoing TKA. Age, DEXA Score, Walking Ability, KSS, 10MWT, SF36 Scores, Funding Pattern before and after AB-PMJAY, Time to Approval, Time to discharge, Time to Query reply and Rejection Rates were documented. Results: 790 patients (91.86%) received treatment previously. 650 (78.54%) patients lived with family & 32 patients lost to follow-up. 37.67% & 62.32% patients had Grade. 3 & 4 osteoarthritis respectively. Commonest comorbidity was Vitamin D deficiency followed by Menopause and Hypertension. Post-treatment Vitamin D deficiency reduced from 68.59% to 2.17% at 3 months. Post-surgery, Functional Scores improved significantly at 1st and 6th month. VAS dropped significantly from 7.8 to 3.6 at 1st month follow up. At 6 months, 81.52% patients were independent outdoor walkers compared to 9.42% (baseline). Average hospital stay-54 hours and Return to work- 42 days. Central health scheme beneficiaries rose significantly from 12% (pre-PMJAY) to 42% (post-PMJAY). With AB-PMJAY, no rejection for surgical procedures, Time to surgery approval was 16 hours (mean) and Time to Discharge was 8 hours (mean). Time to reply was 6 hours (mean). Conclusion: Evident rise in patients getting TKA done through AB-PMJAY. TKA has become an affordable and achievable target for financially deprived patients, post regulation of knee implant prices & AB-PMJAY.
RESUMO
Introduction: Venous malformations are rare lesions of unknown etiology, with a reported incidence of 0.8-1%. Patients with inexorable growth and expansion of vascular malformations, or" have an unpredictable clinical course and a wide range of presenting symptoms. Often, they are erroneously diagnosed and inadequately treated due to their rarity and lack of expertise among clinicians. To author's information this is the first report of diffuse venous malformations with multiple phleboliths involving various compartments of the upper extremity in children. Case Report: The uthors discuss the clinical presentation, evaluation, and treatment over 8 months of slow-flow venous malformations with phleboliths in an11-year-old girl presenting with multiple painful swellings throughout her right upper extremity. The right upper extremity had multiple swellings over the right hand, forearm, arm, and shoulder region involving multiple compartments. The digital swellings had bluish discoloration, indicating a vascular nature. Blood tests revealed a raised D-dimer level (2.42 mg/L). Radiographs, Ultrasound, Magnetic resonance imaging, and CT angiography suggested a slow-flow venous malformation. The excisional biopsy confirmed the diagnosis. Ultrasound-guided Sclerotherapy with the Sclerotherapy with Adjunctive Stasis of Efflux Technique was performed for other lesions. Sodium Tetradecyl Sulfate (60 mg/2 mL; 0.5mL) was used in each lesion. Post-intervention, at 6 months follow-up, cosmetic appearance improved drastically, with the hands benefitted most. Parents were satisfied with overall outcome. Sclerotherapy was stopped after 4 cycles. Conclusion: Ultrasound-guided sclerotherapy is effective in treating venous malformations. The ideal result is seen after 4-5 sittings. Sclerotherapy must be performed in the operating theatre under sedation or appropriate anesthesia with resuscitation equipment at the ready disposal. Excision is reserved for bigger superficial lesions.
