Bone and Joint Health

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Overview

As we progress through adulthood, bone resorption occurs at a rate faster than bone formation. This results in a gradual fail in bone mass as we age.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Rickets and Osteomalacia

Rickets is a condition that results from a delay in deposition of bone mineral (especially calcium and phosphate) for bone growth. This is a result of poor vitamin D, and is characterised by skeletal deformities such as bowed legs.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Osteoporosis

Excessive loss of bone tissue leads to osteoporosis, a condition that is characterised by bone fragility and increased risk of bone fracture. Osteoporosis may lead to mobility problems and even death.[/vc_column_text][vc_empty_space height=”10vh”][vc_single_image image=”4185″ img_size=”medium”][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Factors affecting bone strength

  • Oestrogen
  • Physical Activity
  • Diet

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Oestrogen

Plays an important role in women to protect bones. Thus, irregular or loss of menstrual periods can be detrimental to bones because after menopause, oestrogen is no longer produced, which eventually causing increased bone loss compared to men of same age.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Physical activity

Especially weight bearing activity, is of critical importance in building and maintaining strong bones. Engaging with regular physical activity has many benefits for people of all ages. Being overweight can be associated with osteoarthritis. Therefore, weight loss and regular physical activity can relieve symptoms.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Diet

Important in both childhood development of strong bones and in adulthood maintenance of the bones. A number of nutrients are required but is is a lack of vitamin D in particular that is associated with rickets in children. Diet and nutrient status are important factors in formation of healthy bones, particularly calcium, vitamin.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Calcium + Vitamin D

Calcium intake is particularly important during childhood, adolescence and adulthood for bones development. Vitamin D assists in the absorption of calcium from food. Some vitamin D is acquired from the diet but for most people the major source is through synthesis in skin that is exposed to sunlight.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_single_image image=”4189″ img_size=”800×1000″ alignment=”center”][vc_empty_space height=”10vh”][/vc_column][/vc_row]

Brush Up On Your Dental Care

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Boils

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Overview

Folliculitis is a superficial inflammation of the hair follicle caused by injury, chemical irritation, or infection. Furuncles (abscess or boil) and carbuncles occur when folliculitis extends from the hair shaft to deeper tissues.

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Epidemiology and Etiology

Age of onset
Children, adolescents, and young adults.

Sex
More common in boys.

Etiology
Most commonly MSSA. Community acquired MRSA becoming more common. Outbreaks of P. aeruginosa infections are associated with inadequately chlorinated pools, hot tubs, etc.

Predisposing factors

  • Chronic S. aureus carrier state (nares, axillae, perineum, vagina).
  • Diabetes Mellitus.
  • Obesity.
  • Poor hygiene.
  • Immunocompromised.
  • Hyper-IgE syndrome (Job’s syndrome).
  • Corticosteroid use.

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Pathogenesis

Folliculitis, furuncles, and carbuncles represent a continuum of severity of S. aureus infection. Portal of entry: Hair follicle, break in the integrity of skin. MRSA infections often have high morbidity due to delay in administration of effective antibiotic. Control or eradication of carrier state treats / prevents folliculitis, furuncle, and carbuncle formation.

Infectious causes:

  • S. aureus (most common).
  • Streptococcus species.
  • Mixed bacteria infection.

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Risk factors of Folliculitis

Local Trauma

  • Abrasions.
  • Surgical wounds or draining abscess.
  • Shaving.

 

Aggravates S. Aureus Folliculitis

  • Exposure to occlusive dressing.
  • Tar.
  • Adhesive plaster.
  • Plastic occlusive dressing.

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Furuncles

Usually occur in areas of friction or perspiration. Lesion is usually a firm, tender, red nodule that becomes more painful and may drain pus.

  • Known as abscess or boils.
  • Usually start as folliculitis.
  • Deep folliculitis – spread to deeper tissue

 

Walled off nodule of purulent infection:

  • Painful.
  • Firm or fluctuant.
  • Fever is uncommon.
  • Can be at any site.
  • Most often in areas of friction.

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Carbuncles

  • Broad, swollen, erythematous, deep, and painful masses, usually on the back of the neck.
  • Patient with diabetes especially susceptible.
  • Commonly associated with constitutional symptoms such as fever and chills.
  • Bacteremia and spread are a risk.
  • Uncommon in children

 

Carbuncle involves a coalition of furuncles:

  • Deeper, more extensive involvement
  • Require greater degree of debridement

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Management

  • Antimicrobial treatment usually not necessary for smaller boils.
  • Warm saline compresses to promote drainage.
  • Incision and drainage may be required, especially for carbuncles.
  • Topical antibiotics.
  • Mupirocin (Bactroban) cream or ointment.
  • Fucidin cream or ointment.
  • Erythromycin 2% solution.
  • Clindamycin Solution.
  • To be applied two to three times a day for 7 to 10 days.
  • Only applicable for smaller boils.
  • Systemic antibiotics.
  • Cloxacillin (covers methicillin-sensitive S. aureus [MSSA] and S. pyogenes):
    – Adults: 250–500 mg orally every 6 hours.
    – Pediatrics: 25–50 mg/kg orally divided into four doses.
  • Cephalexin (covers MSSA and S. pyogenes)
    – Adults: 250–500 mg orally every 6 hours.
    – Pediatrics: 25–50 mg/kg orally divided into four doses.
  • Clindamycin (covers MSSA, some CA-MRSA, and S. pyogenes)
    – Adults: 300–600 mg orally every 6–8 hours.
    – Pediatrics: 10–30 mg/kg/day orally divided into three or four doses.
    – Is an oral option for CA-MRSA, but is cross-resistant with erythromycin.
  • Antimicrobial treatment should be for 7–10 days.

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Surgery

Incision and drainage are often adequate for treatment of abcesses, furuncles or carbuncles.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

Recurrent Furunculosis

Usually related to persistent s. aureus in the nares, perineum, and body folds.

Topical Therapy 

Shower with povidone iodine soap. Apply mupirocin ointment daily to the inside of nares and other sites of s.aureus carriage.

Systemic Therapy

Appropriate antibiotic treatment is continued until all lesions have resolved. Secondary prophylaxis may be given once a day for many months.

Carrier State

Rifampicin: 600mg PO for 7 to 10 days for eradication of carrier state.[/vc_column_text][vc_empty_space height=”10vh”][/vc_column][/vc_row][vc_row][vc_column][vc_column_text]

References

  • Stevens DL, Bisno AL, Chambers HF, et al. Prac­tice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005;41:1371–406.
  • Liu C, Bayer A, Cosgrove E, et al. Clinical prac­tice guidelines by the Infectious Diseases Society of America for treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis 2011;52:1–38.
  • Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med 1996;334:240–5.
  • Tennvall GR, Apelqvist J, Eneroth M. Costs of deep foot infections in patients with diabetes mel­litus. Pharmacoeconomics 2000;18:225–38.
  • Fitzpatrick’s. Color Atlas and Synopsis of Clinical Dermatology 5th edition. McGraw Hill New York 2005. Pg 586 – 560.

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BMI

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