Harefuah
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Osteoarthritis is the most common joint disorder in the world and its incidence is rising. In Western populations it is one of the most frequent causes of pain, loss of function and disability in adults. The estimated lifetime risk for knee osteoarthritis is approximately 40% in men and 47% in women. ⋯ The American College of Rheumatology (ACR) has recommended using the following criteria for the diagnosis of knee osteoarthritis: chronic knee pain (lasting for more than 6 weeks) and at least three of the following: • Age over 50 years old. • Morning knee stiffness lasting up to 30 minutes. • Crepitus with active motion • Tenderness on bony palpation • Thickening or growth of the bones • No local heat on palpation Treatment of osteoarthritis involves alleviating pain, attempting to rectify mechanical misalignment, and identifying and addressing manifestations of joint instability. The American Academy of Orthopedic Surgeons (AAOS) has conducted a systematic review of the current scientific and clinical research and has issued clinical practice guidelines containing fifteen recommendations for the treatment of osteoarthritis of the knee, and include only less invasive alternatives to total or partial knee arthroplasty. This review presents the background, diagnosis, treatment and a summary of the AAOS guidelines regarding "Treatment of Osteoarthritis of the Knee".
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Early removal of burn eschar is a cornerstone of burn care. The most commonly practiced eschar removal technique for deep burns in modern burn care is surgical debridement but this technique is associated with surgical burden and leads to unnecessary excision of viable tissue. ⋯ We believe early enzymatic debridement will lead to better care for burn victims and perhaps, even to a paradigm shift in the treatment of burns.
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Case Reports
[ALLEN-MASTERS SYNDROME AS A CAUSE FOR CHRONIC PELVIC PAIN: DIAGNOSIS, TREATMENT AND LONG TERM FOLLOW-UP].
Chronic pelvic pain is one of the main causes for repeated ambulatory and hospital visits. The main findings on exploratory laparoscopy performed for these complaints are endometriosis and adhesions, while in more than 50% of cases, no cause for the pain is found. In 1955, Allen and Masters reported pain associated with traumatic labor. ⋯ In 1997, von Theobald showed that it could be conducted by laparoscopy with long term follow-up. We report 3 cases of women diagnosed with Allen-Masters Syndrome, the surgical treatment performed and the long follow-up of these patients. We also discuss the ways to diagnose the syndrome and the preferred modality of treatment.
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Comparative Study
[MEDICATIONS DEPRESCRIBING IN ELDERLY NURSING HOME RESIDENTS].
Polypharmacy, inappropriate prescribing and adverse drug reactions are frequent and important among elderly nursing home residents. Few clinical trials have evaluated systematic withdrawal of medications in nursing homes. ⋯ A controlled deprescribing intervention in nursing homes was feasible and acceptable to participants. Such interventions should be further evaluated in larger randomized controlled trials.
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The cannabis plant has been known to humanity for centuries as a remedy for pain, diarrhea and inflammation. Current research is inspecting the use of cannabis for many diseases, including multiple sclerosis, epilepsy, dystonia, and chronic pain. ⋯ Controlled clinical studies investigating the therapeutic potential of cannabis are few and small, whereas pressure for expanding cannabis use is increasing. Currently, as long as cannabis is classified as an illicit drug and until further controlled studies are performed, the use of medical cannabis should be limited to patients who failed conventional better established treatment.