Non-surgical treatment of aseptic olecranon bursitis: A systematic review

OBJECTIVE

Olecranon bursitis (OB), characterized by inflammation and fluid collection in the olecranon bursa is a commonly encountered out-patient condition. The data is heterogeneous regarding a stepwise and standardized approach to aseptic OB treatment and the efficacy of intra-bursal corticosteroid injections (CSI). The objective of this review is to systematically evaluate the non-surgical treatment options for aseptic OB.

METHODS

This systematic review was conducted in accordance with PRISMA recommendations. The English and non-English literature search was performed in 5 medical databases to identify studies evaluating the treatment of OB. All included studies were evaluated for risk of bias (RoB) using the revised Cochrane RoB tool for randomized control trials (RCTs) and the Newcastle-Ottawa Scale (NOS) for case-control and cohort studies.

RESULTS

For the final analyses, 2 RCTs and 2 observational studies were included. The RoB for the RCTs was high and both failed to demonstrate a significant difference in terms of the resolution of OB and bursal tenderness among various invasive and non-invasive treatment options. Corticosteroid injection (CSI) was associated with a significant decline in the duration of symptoms. However, it was associated with a higher number of complications including bursal infection and skin atrophy.

CONCLUSION

Based on the available data, it appears that the clinical resolution of aseptic OB can occur with conservative methods if implemented earlier in the disease course. Although CSI is more effective than other treatments, it should be reserved for refractory cases because of a higher complication rate.

Impact of colchicine on mortality and morbidity in COVID-19: a systematic review

INTRODUCTION

Colchicine, because of its anti-inflammatory and possible anti-viral properties, has been proposed as potential therapeutic option for COVID-19. The role of colchicine to mitigate "cytokine storm" and to decrease the severity and mortality associated with COVID-19 has been evaluated in many studies.

OBJECTIVE

To evaluate the role of colchicine on morbidity and mortality in COVID-19 patients.

METHODS

This systematic review was conducted in accordance with the PRISMA recommendations. The literature search was conducted in 6 medical databases from inception to February 17, 2021 to identify studies evaluating colchicine as a therapeutic agent in COVID-19. All included studies were evaluated for risk of bias (ROB) using the Revised Cochrane ROB tool for randomised controlled trials (RCTs) and Newcastle-Ottawa Scale (NOS) for case-control and cohort studies.

RESULTS

Four RCTs and four observational studies were included in the final analysis. One study evaluated colchicine in outpatients, while all others evaluated inpatient use of colchicine. There was significant variability in treatment protocols for colchicine and standard of care in all studies. A statistically significant decrease in all-cause mortality was observed in three observational studies. The risk of mechanical ventilation was significantly reduced only in one observational study. Length of hospitalisation was significantly reduced in two RCTs. Risk for hospitalisation was not significantly decreased in the study evaluating colchicine in outpatients. Very few studies had low risk of bias.

CONCLUSION

Based on the available data, colchicine shall not be recommended to treat COVID-19. Further high-quality and multi-center RCTs are required to assess the meaningful impact of this drug in COVID-19.KEY MESSAGESColchicine, an anti-inflammatory agent has demonstrated anti-viral properties in in-vitro studies by degrading the microtubules, as well as by inhibiting the production of pro-inflammatory cytokines.Colchicine has been studied as a potential therapeutic option for COVID-19, with variable results.Until further research can establish the efficacy of colchicine in COVID-19, the use of colchicine in COVID-19 shall be restricted to clinical trials.

STARplasty for reconstruction of the burned web space: introduction of an alternative technique for the correction of dorsal neosyndactyly

INTRODUCTION

Significant hand burns frequently result in dorsal neosyndactyly, despite appropriate wound care, excision/grafting, and occupational therapy. Patients often develop limited abduction, tethered flexion/extension, intrinsic tightness, and inversion of the web space. We present a new technique for neosyndactyly release: the STARplasty (Syndactyly Treatment After Release), named after the appearance of the reconstructed web.

METHODS

We performed a retrospective review of 25 patients who underwent 66 web space reconstructions by a single surgeon, from January 2002 to December 2003. The STARplasty was developed prior to the study period, with the following goals: to use local tissue, negate the need for a skin graft, and permit early range of motion. Combined with longitudinal, transverse, and oblique releases, STARplasty uses a single volar flap, harvested from each sidewall of both proximal phalanges, with 30-degree corners. STARplasty simultaneously deepens and widens the web space while correcting the angle of inclination.

RESULTS

Sixteen patients (mean age: 34 years; range: 3-62 years) underwent a total of 33 STARplasties, an average of 37 months after burn injury. Mean area resurfaced per web was 5.2 cm, which contrasts with the 33 non-STARplasty reconstructions, which were used to resurface a mean area of 19.4 cm (P < 0.05) and included 5-flap z-plasties (17), full-thickness skin graft (10), 2-flap z-plasties (3), and advancement flaps (3). No complications occurred in the STARplasty group, including infection, flap loss, dehiscence, nerve injury, or recurrent contracture. All patients had improved function (mean follow-up: 6.7 months; range: 1-18 months).

CONCLUSIONS

STARplasty is a new, safe, and efficacious technique to correct dorsal neosyndactyly and reconstruct the web space after burn injury.

Biochemical screening for inherited metabolic disorders in the mentally retarded

A biochemical screening programme for the detection of inherited metabolic disease was carried out on urine and blood samples from inmates of the Alexandra Institute for the mentally retarded, Cape Town. Of the 1087 patients screened, positive results for phenylketonuria were obtained in 3, for cystinuria in 2 and for Hartnup disease in 1. The overall frequency of metabolic disorders was 0,6%. It is evident that genetic metabolic disease as detected by current screening procedures makes only a small contribution to the overall burden of mental retardation.

Immunoglobulin E in chronic middle ear effusions

A total of 61 middle ear effusions and matched sera obtained from patients suffering from chronic otitis media with effusions (OME) was examined for IgE and other immunoglobulins to see if a reaginic antibody is involved in OME. The IgE levels were determined by the Phadebas IgE radioimmunoassay test. Excluding one patient who had extremely high IgE as a result of parasitosis, there were only three cases which showed marginally increased serum IgE levels. Elevated IgE levels in sera and/or in effusions were unrelated to a history of allergy. The mucoid effusions had significantly higher effusion levels than the levels in corresponding sera (p less than .0005). Fourteen percent of the cases examined showed effusion IgE levels five times or more higher than serum levels. Biopsy specimens of these patients showed numerous degranulating mast cells. Only two specimens showed eosinophilic infiltration. It is suggested that the IgE is produced locally by the mucosa in mucoid-type effusions and may have been involved in mast cell degranulation. However, this study cannot confirm the allergic nature of the OME.