Factors associated with poor self-reported function and quality of life in patients with end-stage knee or hip osteoarthritis immediately prior to total joint arthroplasty.

INTRODUCTION: The aim was to evaluate patients' perception of function and physical and mental dimensions of health-related quality of life (HRQoL) in patients with end-stage knee or hip osteoarthritis (OA) immediately prior to surgery and to identify the factors associated with the outcomes. MATERIAL AND METHODS: The study included 200 patients with end-stage OA (100 knee OA and 100 hip OA patients). Self-reported physical function was assessed using the Oxford Knee Score or Oxford Hip Score. Physical and mental dimensions of HRQoL were assessed using the physical and mental component summary scores of the 36-Item Short-Form Health Survey. Multivariate linear regression analysis was used to identify the sociodemographic, clinical and psychological factors associated with self-reported function and physical and mental dimensions of HRQoL. RESULTS: End-stage knee or hip OA patients had poor function and physical dimension of HRQoL, while the mental dimension of HRQoL was not impaired. In knee OA, pain, flexion range of motion (ROM), catastrophizing, and anxiety were significantly associated with self-reported function (explained 56% of the variance), whereas catastrophizing explained 10% of the variance of the physical dimension of HRQoL. In hip OA, flexion ROM, catastrophizing and being employed were significantly associated with self-reported function (explained 44% of the variance), whereas catastrophizing and flexion ROM explained 34% of the variance of the physical dimension of HRQoL. CONCLUSIONS: Many investigated factors were associated with poor self-reported function and HRQoL in knee and hip OA. However, the most important factors for both knee and hip OA were catastrophizing and flexion ROM.

Pain, Physical Function, Radiographic Features, and Quality of Life in Knee Osteoarthritis Agricultural Workers Living in Rural Population.

Background: The aim of this study was to analyse the relationship between the clinical manifestations, disease severity based on radiography images, functional activity level, and quality of life in patients with knee osteoarthritis in a rural population living in Serbian enclaves in Kosovo, as well as to determine the correlation between the WOMAC and the EQ-5D questionnaire in this population. Method: The cross-sectional study was conducted at the Internal Medicine Clinic, Clinical Hospital Center Pristina-Gracanica, located in Laplje Selo from February to December 2013. One hundred patients with confirmed (American College of Rheumatology criteria) knee osteoarthritis completed the EQ-5D and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires, rated pain on a visual analogue scale (VAS), and underwent knee radiographic examinations. Result: Most patients were obese with moderate radiographic changes according to the Kellgeren-Lawrence scale and suffered from very severe pain according to the VAS scale. The duration of disease significantly correlated with the WOMAC scores, VAS score, and all of the scores on the EQ-5D, except for mobility. The age of participants showed a similar correlation with the same variables. The patients with higher Kellgren-Lawrence scores (3-4) were significantly older, with a significantly higher body mass index (BMI) and longer duration of disease than patients with lower scores (1-2). Significantly higher VAS, pain/discomfort EQ-5D, and WOMAC pain and function scores were also recorded among patients with more significant radiological changes. The correlations between WOMAC and EQ-5D were satisfactory. Conclusion: The severity of clinical manifestations and radiographic area changes may affect functional ability and the quality of life in knee OA patients living in rural areas, which requires adequate treatment and physical therapy.

The effectiveness of group Otago exercise program on physical function in nursing home residents older than 65years: A randomized controlled trial.

AIM: To examine whether the 6-months group-based Otago exercise program is more effective than usual care on physical function and functional independence in nursing home residents older than 65 years. METHODS: An observer-blind randomized controlled study included 77 independently walking, cognitively unimpaired residents aged 78.4±7.6years, of which 66.2% were female. Physical function was assessed at baseline, after 3 and 6months of the Otago exercise program by three performance tests: Berg Balance Scale (BBS), Timed Up and Go (TUG) and Chair Rising Test (CRT), and functional independence by the motor Functional Independence Measure (mFIM). RESULTS: Significant within participant effects of time in EG for BBS, TUG and CRT (p<0.001) and for mFIM (p=0.010) were found. Between participant effects of groups on BBS, TUG, CRT and mFIM values were not significant. Changes in values of performed three tests regarding physical function were significantly different in EG and CG (p<0.001), as well as for functional independence test (mFIM) (p=0.019). In EG the values got better, while in CG values worsened. Effect sizes of change in the EG were higher for BBS, TUG and CRT compared to mFIM. CONCLUSION: The Otago exercise program was shown as effective in improving balance, functional mobility, lower limbs muscle strength and functional independence, indicating that it could help in slowing of disability progression.

Predictors of Quality of Life Improvement after 2 Years of Coronary Artery Bypass Surgery.

PURPOSE: The aim was to examine the predictors of improvement of quality of life after 2 years of coronary artery bypass grafting (CABG). METHODS: In all, 208 patients who underwent the elective CABG at the Institute for Cardiovascular Diseases Dedinje in Belgrade were contacted and examined 2 years after the surgery. All patients completed Nottingham Health Profile Questionnaire part one. RESULTS: Two years after CABG, quality of life (QOL) in patients was significantly improved in all sections compared to preoperative period. Independent predictors of QOL improvement after 2 years of CABG were found to be serious angina under sections of physical mobility [p = 0.003, odds ratio (OR) = 1.76, 95% confidence interval (CI) 1.21-2.55], energy (p = 0.01, OR = 1.63, 95% CI: 1.11-2.38), sleep (p = 0.005, OR = 1.65, 95% CI: 1.16-2.35), pain (p <0.001, OR = 2.43, 95% CI: 1.57-3.77), absence of hereditary load in energy section (p = 0.002, OR = 0.35, 95% CI: 0.18-0.68), male sex in the sleep section (p = 0.03, OR = 0.43, 95% CI: 0.20-0.93), and absence of diabetes in pain section (p = 0.006, OR = 0.27, 95% CI: 0.10-0.68). CONCLUSION: Predictors of improvement of QOL after 2 years of CABG are serious angina, absence of hereditary load, male sex, and absence of diabetes.

Xanthine Oxidase Activity in Type 2 Diabetes Mellitus Patients with and without Diabetic Peripheral Neuropathy.

This study investigated the relationship between serum xanthine oxidase (XOD) activity and the occurrence of diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM) patients. Serum XOD activity, ischemia-modified albumin (IMA), uric acid (UA), albumin, glycated hemoglobin (HbA1c), advanced glycation end products (AGE), total free thiols, atherogenic index of plasma (AIP), and body mass index (BMI) were measured in 80 T2DM patients (29 with and 51 without DPN), and 30 nondiabetic control subjects. Duration of diabetes, hypertension, medication, and microalbuminuria was recorded. Serum XOD activities in controls, non-DPN, and DPN were 5.7 ± 2.4 U/L, 20.3 ± 8.6 U/L, and 27.5 ± 10.6 U/L (p < 0.01), respectively. XOD activity was directly correlated to IMA, UA, BMI, HbA1c, and AGE, while inversely correlated to serum total free thiols. A multivariable logistic regression model, which included duration of diabetes, hypertension, AIP, HbA1c, UA, and XOD activity, revealed HbA1c [OR = 1.03 (1.00-1.05); p = 0.034] and XOD activity [OR = 1.07 (1.00-1.14); p = 0.036] as independent predictors of DPN. Serum XOD activity was well correlated to several other risk factors. These results indicate the role of XOD in the development of DPN among T2DM patients.

Sequential analysis of oxidative stress markers and vitamin C status in acute bacterial osteomyelitis.

In bacterial bone infections, excessively formed oxidants may result in local and systemic oxidative stress. Vitamin C is the major extracellular nonenzymatic antioxidant, also implicated in bone cells metabolism and viability. The physiological functions of vitamin C largely depend on its redox status. We sequentially assessed oxidative stress markers, hydroperoxides and malondialdehyde (MDA), total antioxidant activity (AOA), total vitamin C, ascorbic acid (Asc), and oxidized/reduced vitamin C ratio in 137 patients with acute osteomyelitis (OM). Compared to 52 healthy controls, in OM group baseline serum hydroperoxides, MDA and oxidized/reduced vitamin C ratio were higher whilst Asc and AOA were lower (P < 0.05, resp.). On the other side, total vitamin C levels in patients and controls were similar (P > 0.05), thereby suggesting a relative rather than absolute vitamin C deficiency in OM. During the follow-up, oxidative stress markers, AOA, and oxidizedreduced vitamin C ratio were gradually returned to normal, while there was no apparent change of total vitamin C concentrations. Persistently high values of oxidized/reduced vitamin C ratio and serum MDA were found in subacute OM. In conclusion, acute OM was associated with enhanced systemic oxidative stress and the shift of vitamin C redox status towards oxidized forms.

[Stability and quality of osteosynthesis in treatment of tibial pylon fractures with dynamic external fixation typ Mitkovic].

UNLABELLED: The study included 35 patients with fractures of distal tibia treated at the department of orthopedics HC K. Mitrovica and the Orthopedic clinic in CHC of Nis by a dynamic external fixator fixation of ancle. Ovadia-Beals score was used to assess the quality and repositioning and to assess the stability assessment made osteosynthesis. The final functional result of treatment the patient was determined based on the AOFAS score. Deviations for postoperative talocrural angle for extraarticular fractures was approximately 6 degrees (excellent result). Student's T-test showed statistically significant difference (t = 1.693 p < 0.05) before and after surgery in favor of a postoperative series in the analysis of articular fractures by Ovadia-Beals score, and that means much better anatomical conditions for healing. Student's T-test were not found statistically significant differences in postoperative radiographic parameters in postoperative series and series before removing fixator for the extraarticular and intra-articular fractures, for extraarticular fractures (t = 1.440, p > 0.05), and intrarticular fractures, (t = 1.234, p > 0.05), which is a remarkable result and describes the remarkable stability of the fracture zone by this method. Distribution of complications: soft-tissue complications of 11.4%, healing in a bad position of 5.7%, nonunions 3%, infection 6%. Distribution of functional results according to AOFAS score: excellent 27.2%, good 40%, satisfactory 11.4% 11.4% bad. Pearson's test (r = - 0.6002) has been shown that the weight of the fracture is correlated with the AOFAS score, or the level of the outcome of treatment decreases with the increase cominution of fracture zone. CONCLUSIONS: The lack of clear protocols in the literature; the method of dynamic external fixator fixation provides optimal biochemical conditions for the healing of these injuries; the final functional outcome of this series and the distribution and number of complications corresponding to the current data in the literature.