The effects of antiepileptic drugs on bone health: A systematic review.

PURPOSE: Epilepsy may be treated with antiepileptic drugs (AEDs), which have been reported to decrease bone mineral density (BMD). Current data is conflicting and variable, and little is known with regard to how duration of AED use or specific AEDs, such as CYP-450 enzyme-inducing (EIAEDs) versus non-enzyme inducing (NEIAEDs) drugs affect BMD. We sought to systematically review BMD changes due to AED use to identify trends in reporting. METHODS: A literature search via Medline (PubMed), EMBASE, and Cochrane databases was performed. Peer-reviewed articles were identified that reported on BMD measurements in conjunction with AEDs. RESULTS: Twenty-six studies met inclusion criteria. Long-term therapy was shown across multiple, well-controlled studies to have the most significant BMD loss. Carbamazepine had the most frequent reporting of unfavorable effects on bone health and Lamotrigine seemed to show the most bone-protective qualities. Serum biochemical markers of bone turnover did not significantly correlate with measured BMD changes. CONCLUSION: The present study provides evidence that long-term AED therapy is the most significant risk factor for BMD loss. Furthermore, there was little compelling evidence to support that EIAEDs, as a class, were more harmful to bone than NEIAEDs, which has been previously suggested in multiple studies. Early clinical concern for significant loss of BMD may not be warranted as lower BMD was less likely to be observed during the initial years of AED therapy. Furthermore, serum markers of bone turnover are not clinically reliable in assessing BMD changes in patients taking AEDs.

Characterizing Hand Infections in an Underserved Population: The Role of Diabetic Status in Antibiotic Choice and Infection Location.

Introduction Patients with diabetes mellitus (DM) in underserved communities are at greater risk for hand infections. We aimed to describe the features of hand infections presenting to an urban hospital via laboratories, microbiology, and antibiotic choice with respect to diabetic status. Materials and Methods Patients presenting with any hand infection were reviewed and stratified by DM status and infection location. Labs, culture results, antibiotic regimens, and significant predictors of laboratories or infection location were analyzed. Results Fifty-three patients were included: DM ( n = 24), no-DM ( n = 24), and unknown status ( n = 5). Culture rates were comparable between all groups. Mean erythrocyte sedimentation rate (ESR) was significantly higher in DM (76.19 vs. 51.33); mean white blood cell count (WBC) and C-reactive protein (CRP) were comparable. Diabetics had higher odds of increased ESR (odds ratio [OR] = 1.03). Diabetics received vancomycin/piperacillin/tazobactam (VAN/PTZ) significantly more often (52% vs. 8%). Providers treated DM with VAN/PTZ or any VAN-containing regimen more often than with any other regimen. Proximal infections had significantly higher mean CRP (136.9 vs. 50.5) and WBC (5.19 vs. 3.9) and higher CRP (OR = 1.02). Conclusion This study highlights the need for systematic criteria to better risk- stratify patients for appropriate antibiotic treatment. It may not be appropriate to treat both groups differently, as overly aggressive antibiotic selection may contribute to drug-resistance development.

The trends in robotic-assisted knee arthroplasty: A statewide database study.

OBJECTIVE: Recent technological advancements have led to the utilization of robotic-assisted knee arthroplasty (raKA) in the operating room. METHODS: All patients who underwent knee arthroplasty from 2009 to 2013 in NYS SPARCS were reviewed. raKAs and non-raKAs were compared for utilization and institutional trends. RESULTS: Robotic-assistance increased by 500%. 80% of raKAs were performed in teaching hospitals. The trend increase was greater in teaching hospitals. Blood transfusion rates differed between raKA and non-raKA (6.6% vs. 10.9%, p < 0.001). CONCLUSION: raKA utilization increased in NYS, moreso within teaching hospitals. raKA transfusion rates were lower but higher in teaching hospitals, potentially related to learning curve.

Adolescent Idiopathic Scoliosis Care in an Underserved Inner-City Population: Screening, Bracing, and Patient- and Parent-Reported Outcomes.

STUDY DESIGN: Retrospective review of a prospectively collected database. OBJECTIVES: This preliminary investigation sought to identify the quality of care adolescent idiopathic scoliosis (AIS) patients from our large, underserved community had received before presenting at this institution's clinic. SUMMARY OF BACKGROUND DATA: AIS affects 1% to 4% of children between ages 10 and 16. Barriers to health care for patients in underserved populations have not been well studied. METHODS: Patients who visited a single surgeon's clinic for primary AIS between June 2016 and January 2017 were enrolled. Patients had 36-inch full-spine radiographs and completed a survey of demographics, prior AIS care received (screening, bracing, etc), socioeconomic parameters, and patient-reported outcomes (PROs; Scoliosis Research Society [SRS]-30 Questionnaire and Body Image Disturbance Questionnaire [BIDQ]). Parametric and nonparametric analyses were used and percentages and mean/median values were reported. RESULTS: 47 patients (age: 15 ± 3 years; 82.7% female) were included. Overall, 25.5% of patients reported a family history of scoliosis, and 42.6% had no prior knowledge of scoliosis. Per Scoliosis Research Society (SRS) recommendations, 15 patients required observation (main Cobb angle: <25°), 22 patients were eligible for bracing (25°-45°), and 10 patients were surgical candidates (>45°). In addition, 21.3% of all patients were never screened for scoliosis; of these, 50% had a main scoliosis curve >25°. Seventy percent of surgical candidates never wore a brace, and 59.3% of screened patients who were eligible for bracing were not braced at initial presentation. Patients who were left unbraced when eligible exhibited worse BIDQ scores (1.7 vs. 1.4, p < .05). CONCLUSIONS: One of five children in our population was never screened for scoliosis, and nearly three of five children did not receive optimal care as recommended by SRS. AIS patients in our inner-city populations are potentially at risk of continuing to experience a significant disadvantage in health care access. LEVEL OF EVIDENCE: Level IV case series.

Epidemiology and Trends of Weightlifting-Related Sprains and Strains that Presented to Emergency Departments in the United States.

Despite potential health benefits of weightlifting and physical activity, individuals can suffer from a number of musculoskeletal injuries. This study aimed to: (i) compare incidence and annual trends of different weightlifting injury types presenting to emergency departments in the United States and (ii) identify frequency and annual trends of weightlifting-related sprains and strains to each body part. The National Electronic Injury Surveillance System was queried to identify all weightlifting-related injuries from 2010-2016. Incidence and annual trends of various types of weightlifting-related injuries were compared during the study period. Furthermore, frequency and annual trends of weightlifting-related sprains and strains to different body parts were assessed. The weighted estimated annual incidence of weightlifting-related injuries significantly increased from 86,910 in 2010 to 109,961 in 2016 (R2 = 3.382; p = 0.01). The most common weightlifting-related sprains and strains involved the lower trunk (29.4%), shoulder (22.6%), upper trunk (17.3%), neck (6.5%), upper arm (5.6%), wrist (4.8%), knee (3.4%), and elbow (2.6%). There was a significant increase in the frequency and trends of sprains and strains that involved the lower trunk (R2 = 0.631; p = 0.033). Weightlifting-related injuries have increased, of which sprains and strains were the most common. Additionally, the most commonly affected body part was the lower trunk. Further studies are needed to determine the etiologies of weightlifting-related lower trunk sprains/strains. This study may be beneficial to weightlifters, highlighting common injury types, thereby allowing them to take preventative measures.

A Systematic Review of All Smart Phone Applications Specifically Aimed for Use as a Scoliosis Screening Tool.

The scoliometer is an inclinometer commonly used in scoliosis screening. The device is used during an Adam's forward bend test, in which a patient bends forward at the hips to measure deformity of the rib cage and spinal column. If a sufficient angle of rotation is measured, then the appropriate referrals and x-rays can be made and taken. This ubiquitous screening tool allows for a quick and simple scoliosis screening and is a mainstay of scoliosis management. With the advent and rapid improvement of smart phone technology, many scoliometer applications have become readily accessible. Our study was designed to test the accuracy, precision, and calibration of several scoliometer applications available on both the Apple iPhone and Samsung Galaxy platforms. Application cost was also analyzed to assess the plausibility of using a smartphone scoliometer application in place of a traditional scoliometer in a traditional scoliosis screening. Our data show that available smart phone applications can be used effectively and that, in a controlled environment, some applications performed better than a traditional scoliometer. Application price was not correlated with effectiveness; the cost-free application performed better than the for-purchase application.

Shoulder Lesion in a 69 Year Old Woman.

Milwaukee Shoulder Syndrome (MSS) is a painful progressive arthropathy in which hydroxyapatite crystal deposition in synovial tissue induces lysosomal release of collagenase and neutral proteases. These enzymes are destructive to periarticular tissue, including the synovium, articular cartilage, rotator cuff muscles, and the intrasynovial cortical bone. MSS predominantly occurring in women (90%) over the age of 70 years of age with a clinical history marked by recurrent joint effusions and pain, which classically worsens at night. Our patient is a 69-year-old woman who presented with progressive shoulder pain, most prominent at night, with limited range of motion and swelling; intermittent discharge; and intermittent neck pain that radiated to her right upper extremity. Her medical history was notable for invasive carcinoma of the right breast treated with mastectomy and radiation. She was also treated with radiation therapy for right shoulder pain and a lucent right shoulder lesion presumed to be metastatic breast cancer. The remainder of her medical history consists of hypertension, diabetes mellitus, hyperlipidemia, and uneventful bilateral total knee arthroplasties. At presentation, she denied constitutional symptoms. Based on the patient's history and physical exam the differential diagnosis included primary and metastatic malignancy, radiation induced sarcoma and necrosis, infection, Charcot disease, and crystal arthropathies. Physical exam, laboratory findings, and imaging studies led us to the diagnosis of MSS.