Introduction Humanimmunodeciencyvirus(HIV)associated tuberculosis(TB)remainsamajorglobalpublichealth challenge. By the end of 2009, an estimated 33.3 millionpeoplewerelivingwithHIV,thevastmajority in sub-Saharan Africa and Asia. An estimated 2.6 million individuals had become newly infected with HIV and 1.8 million had died of AIDS in that year alone 1 .TBisthemostcommonopportunisticinfection (OI)amongHIV-infectedindividuals,andco-infected individuals are at high risk of death 2,3 .Theestimates oftheglobalburdenofdiseasecausedbyTBin2009 Review Article Diagnosis&treatmentoftuberculosisinHIVco-infectedpatients C.Padmapriyadarsini,G.Narendran&SoumyaSwaminathan National Institute for Research in Tuberculosis (Indian Council of Medical Research), Chennai, India ReceivedOctober31,2011 Human immunodeciency virus (HIV) associated tuberculosis (TB) remains a major global public health challenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to challenges in both the diagnosis and treatment of tuberculosis. Further, there has been an increase in rates of drug resistant tuberculosis, including multi-drug (MDR-TB) and extensively drug resistant TB (XDRTB), which are difcult to treat and contribute to increased mortality. Because of the poor performance of sputum smear microscopy in HIV-infected patients, newer diagnostic tests are urgently required that are not only sensitive and specic but easy to use in remote and resource-constrained settings. The treatment of co-infected patients requires antituberculosis and antiretroviral drugs to be administered concomitantly; challenges include pill burden and patient compliance, drug interactions, overlapping toxic effects, and immune reconstitution inammatory syndrome. Also important questions about the duration and schedule of anti-TB drug regimens and timing of antiretroviral therapy remain unanswered. From a programmatic point of view, screening of all HIV-infected persons for TB and vice- versa requires good co-ordination and communication between the TB and AIDS control programmes. Linkage of co-infected patients to antiretroviral treatment centres is critical if early mortality is to be prevented. We present here an overview of existing diagnostic strategies, new tests in the pipeline and recommendations for treatment of patients with HIV-TB dual infection. Key words Co-infection-diagnosis-drugresistance-HIV-IRIS-treatment-tuberculosis wereasfollows:9.4millionincidentcases(range8.9- 9.9 million), 1.3million deaths amongHIV-negative TB patients (range 1.2-1.5 million) and 0.38 million deaths among HIV-positiveTB patients (range 0.32- 0.45million).MostTBcaseswereintheSouth-East Asia, African and Western Pacic regions (35, 30 and 20%, respectively).Anestimated 11-13 per cent of incident cases were HIV-positive 4 . TB may occur atanystageofHIVdiseaseandisfrequentlytherst recognizedpresentationofunderlyingHIVinfection 5,6 . AscomparedtopeoplewithoutHIV,peoplelivingwith HIV(PLWH)havea20-foldhigherriskofdeveloping 850 IndianJMedRes134,December2011,pp850-865 TB 7 and the risk continues to increase as CD4 cell countsprogressivelydecline 5 . AsaresultofWHO’s3by5campaign,>6million HIV-infected individuals in resource limited settings havehadaccesstoantiretroviraltherapy(ART)since 2004 8 ,thoughthisisstillfarshortoftheactualneed. AlthoughART can reduce the incidence of TB both at the individual and population level, M I N D S & H E A R T S: A Specialist Clinic for Autism Spectrum Conditions Autism Spectrum Conditions: Diagnosis and Treatment, Basic Workshop – Melbourne, VIC, Australia Thursday 14th & Friday 15th March 2013, 9.00am – 4.30pm Presented by: Professor Tony Attwood & Dr Michelle Garnett Professor Tony Attwood is a world expert and leading authority on Asperger’s Syndrome (AS) and autism Tony is a clinical psychologist who has specialised in autism spectrum conditions since he qualified as a clinical psychologist in England in 1975 His book “Asperger's Syndrome – A Guide for Parents and Professionals” has sold over 350,000 copies and has been translated into over twenty languages He has worked with over 6,000 individuals of all ages with Asperger's syndrome or an Autism Spectrum Condition His latest book “The Complete Guide to Asperger's Syndrome” was published in October 2006 Dr Michelle Garnett is the Founder of Minds & Hearts, a specialist clinic in Brisbane for children and adults who have an autism spectrum condition (ASC) Both are internationally known presenters, having presented together around Australia, New Zealand and Europe for numerous Universities, Societies, Colleges, Schools and Support Networks Tony and Michelle are clinical psychologists who together have over 50 years of experience in helping people with autism spectrum conditions They are warm, inspiring engaging and knowledgeable presenters Event endorsed for workshop requirement for entry to the APS/Medicare Autism and Pervasive Developmental Disorders (PDD) Identified Practitioners List The purpose of this workshop is to prepare health professionals to recognise and appropriately refer, assess or treat autism spectrum conditions (ASC) Subtypes of ASC are described and defined according to DSM-IV-TR and DSM-V A critical review of the available screening devices and diagnostic tools is presented, with recommendations as to the strongest tools to use Participants will learn about the prevalence of ASC, and its aetiology Guidance will be given as how to structure and conduct a diagnostic assessment with particular consideration given to autistic disorder, Asperger’s syndrome, early screening and diagnosis, and school-aged children A video-taped demonstration by Professor Tony Attwood will illustrate a diagnostic interview with a primary-aged child Differential diagnoses and co-morbid conditions will be presented and explained Treatment will focus on early intervention models for autism, family therapy, cognitive behaviour therapy and Social Stories VENUE: Rydges on Swanston, 701 Swanston Street, Carlton, VIC REGISTER ONLINE: www.mindsandhearts.net or TELEPHONE: (07) 3844 9466 or Complete the Registration Form below Most of the books and resources described in our seminars are available from Resources at Hand book store www.resourcesathand.com.au REGISTRATION FORM – ASC: BASIC OR ADVANCED WORKSHOP or BOTH – MELBOURNE 2013 TAX INVOICE ABN: 51 128 736 103 Please complete form and send to Minds & Hearts, P O Box 5675, West End QLD, 4101, OR Fax (07) 3844 9533 Payment can be made via Credit Card (except Diners Club & Amex), Cheque or Money Order Please make cheques or money orders payable to Minds & Hearts Name(s): _ Address: _ Phone: Mobile: _ Email: _ I WOULD LIKE TO ATTEND: (Please circle) ASC: BASIC WORKSHOP th OR ASC: ADVANCED WORKSHOP OR BOTH th Basic Workshop - Thurs 14 & Fri 15 March 2013 th th Advanced Workshop – Thurs 25 & Fri 26 July 2013 9.00am to 4.30pm Rydges on Swanston, 701 Swanston Street, Carlton, VIC One Workshop Both Workshops Regular th Early Bird (before 15 February for Basic Workshop only or both th workshops; before 25 June for Advanced Workshop only) $660 $1210 $630 $1100 Full time Student $590 $1010 Registration includes welcome tea and coffee, morning tea and a light lunch If you are a full-time student requiring a discount please also send in a photocopy of your Student ID Card Prices include GST For cancellations: Up to 14 days notice payment will be refunded, minus a $50 administrative fee At less than days notice there will be a refund of 50% of the fee Attendance is fully transferable PAYMENT METHOD (Please circle): CHEQUE MONEY ORDER AMOUNT: $ _ CREDIT CARD CREDIT CARD DETAILS: Name on card: MASTERCARD VISA BANKCARD Credit Card Number: _ _ Expiry Date: / _ Signature: Receipts will be posted or emailed out and attendance certificates will be mailed on request OSTEOARTHRITIS – DIAGNOSIS, TREATMENT AND SURGERY Edited by Qian Chen Osteoarthritis – Diagnosis, Treatment and Surgery Edited by Qian Chen Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Vana Persen Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Osteoarthritis – Diagnosis, Treatment and Surgery, Edited by Qian Chen p. cm. 978-953-51-0168-0 Contents Preface IX Part 1 General Treatment of OA 1 Chapter 1 Long-Term Treatment of Osteoarthritis Pain: Achieving a Balance Between Efficacy and Tolerability for a Successful Chronic Therapy 3 Mila Etropolski Chapter 2 Characterization of Live and Experimentally Degenerated Hyaline Cartilage with Thermal Analysis 27 Gellért Sohár, Piroska Szabó-Révész, Kálmán Tóth and Zoltán Aigner Chapter 3 Topical and Regional Treatment for Osteoarthritis 47 Leena Patel and Charles Mackworth-Young Chapter 4 Intra-Articular Injections for the Treatment of Osteoarthritis: Focus on the Clinical Use of Several Regimens 67 Dong Rak Kwon and Gi Young Park Chapter 5 Hyaluronic Acid in the Treatment of Osteoarthritis: What is New 101 Michele Abate and Vincenzo Salini Chapter 6 Gene Therapy for Human Osteoarthritis 123 Magali Cucchiarini and Henning Madry Part 2 Alternative Treatment of OA 141 Chapter 7 Peloidotherapy in Osteoarthritis-Modulation of Oxidative Stress 143 Viorica Marin, Olga Surdu, Daniela Profir and Sibel Demirgian Chapter 8 Ginger and Osteoarthritis 157 Tessa Therkleson VI Contents Part 3 OA in Upper Extremity (Hand, Wrist, Shoulder, and Elbow) 169 Chapter 9 Osteoarthritis of the Wrist 171 Nimit Patel, Glenn Russo and Craig Rodner Chapter 10 Osteoarthritis of the Trapeziometacarpal Joint (TMJ): A Review of the Literature 203 Oliver Boughton and Hugh Mackenzie Chapter 11 Low Level Laser Therapy in the Treatment of Temporomandibular Joint Arthritis: Questions and Answers 211 Marini Ida [...]... to be in shock is aortic dissection until proved otherwise Reference Pretre R et al: Aortic dissection Lancet 19 97;349 :14 61 [PMID: 94 613 34] 1 Copyright 2002 The McGraw-Hill Companies, Inc Click Here for Terms of Use 2 Essentials of Diagnosis & Treatment Pulmonary Stenosis 1 I Essentials of Diagnosis • A congenital disorder causing symptoms only when transpulmonary valve gradient is > 50 mm Hg • Exertional... septal defect Ann Thorac Surg 2000;69 :14 96 [PMID: 10 8 818 29] 1 6 Essentials of Diagnosis & Treatment Patent Ductus Arteriosus 1 I Essentials of Diagnosis • Caused by failure of closure of embryonic ductus arteriosus with continuous blood flow from aorta to pulmonary artery • Symptoms are those of left ventricular failure or pulmonary hypertension; many complaint-free • Widened pulse pressure, a loud... at both the aortic area and the apex, with no murmur at the left lower sternal border Reference Otto CM: Timing of aortic valve surgery Heart 2000;84: 211 [PMID: 10 908267] 1 10 Essentials of Diagnosis & Treatment Aortic Regurgitation 1 I Essentials of Diagnosis • Causes include congenital bicuspid valve, endocarditis, rheumatic heart disease, Marfan’s syndrome, aortic dissection, ankylosing spondylitis,... associated with tricuspid stenosis Reference Blaustein AS et al: Tricuspid valve disease Clinical evaluation, physiopathology, and management Cardiol Clin 19 98 ;16 :5 51 [PMID: 9742330] 1 12 Essentials of Diagnosis & Treatment Tricuspid Regurgitation 1 I Essentials of Diagnosis • Causes include infective endocarditis, right ventricular heart failure, carcinoid syndrome, systemic lupus erythematosus, and Ebstein’s... aggressive anticoagulation is being contemplated Reference Ambrose JA et al: Unstable angina: current concepts of pathogenesis and treatment Arch Intern Med 2000 ;16 0:25 [PMID: 10 632302] 1 16 Essentials of Diagnosis & Treatment Acute Myocardial Infarction 1 I Essentials of Diagnosis • Prolonged (> 30 minutes) chest pain, associated with shortness of breath, nausea, left arm or neck pain, and diaphoresis;... is more commonly multifocal atrial tachycardia than atrial fibrillation Reference McCord J et al: Multifocal atrial tachycardia Chest 19 98 ;11 3:203 [PMID: 94405 91] 1 20 Essentials of Diagnosis & Treatment Paroxysmal Supraventricular Tachycardia (PSVT) 1 I Essentials of Diagnosis • A group of arrhythmias including supraventricular reentrant tachycardia (over 90% of cases), automatic atrial tachycardia,... hypertrophy: evaluate for treatment • Prognosis for those with mild disease is good I Pearl Flushing with the murmur as described raises the issue of carcinoid syndrome Reference Gibbs JL: Interventional catheterisation Opening up I: the ventricular outflow tracts and great arteries Heart 2000;83 :11 1 [PMID: 10 618 3 51] Chapter 1 Cardiovascular Diseases 3 Aortic Coarctation I Essentials of Diagnosis • Elevated... beta-hemolytic streptococcal infections until age 25 and for infective endocarditis for lifetime I Pearl Occasional patients have hoarseness due to recurrent laryngeal nerve compression between aorta and pulmonary artery Reference Bruce CJ et al: Clinical assessment and management of mitral stenosis Cardiol Clin 19 98 ;16 :375 [PMID: 9742320] 1 8 Essentials of Diagnosis & Treatment Mitral Regurgitation 1. .. failure is caused by leftsided failure Reference Waller BF et al: Pathology of tricuspid valve stenosis and pure tricuspid regurgitation Part II Clin Cardiol 19 95 ;18 :16 7 [PMID: 7743689] Chapter 1 Cardiovascular Diseases Bronchiolitis Obliterans With Organizing Pneumonia (BOOP) ■ Essentials of Diagnosis • Bronchiolitis obliterans in adults—also called cryptogenic orga- nizing pneumonia—may follow infections (eg, mycoplasma, viral infection), may be due to toxic fume inhalation or associated with connective tissue disease or organ transplantation, may com- plicate local lung lesions, or may be idiopathic • Usually characterized by abrupt onset of flu-like symptoms, including dry cough, dyspnea, fever, and weight loss • Dry crackles and wheezing by auscultation; clubbing rare • Restrictive abnormalities with pulmonary function studies; hy- poxemia • Chest radiograph typically shows patchy alveolar infiltrates bilaterally • Open or thoracoscopic lung biopsy necessary for precise diagnosis ■ Differential Diagnosis • Idiopathic pulmonary fibrosis • AIDS-related lung infections • Congestive heart failure • Mycobacterial or fungal infection • Severe pneumonia due to bacteria, fungi, or tuberculosis ■ Treatment • Corticosteroids effective in two-thirds of cases • Relapse common after short (< 6 months) steroid courses ■ Pearl One of the “new” diseases; consider this when there is untimely reso- lution of an infiltrate in what you thought was a community-acquired pneumonia. Reference Epler GR: Bronchiolitis obliterans organizing pneumonia. Arch Intern Med 2001;161:158. [PMID: 11176728] 40 Essentials of Diagnosis & Treatment 2 Solitary Pulmonary Nodule ■ Essentials of Diagnosis • A round or oval circumscribed lesion less than 5 cm in diameter surrounded by normal lung tissue • Twenty-five percent of cases of bronchogenic carcinoma present as such; the 5-year survival rate so detected is 50% • Factors favoring benign lesion: age under 35 years, asymptoma- tic status, size under 2 cm, diffuse calcification, smooth margins, and satellite lesions • Factors suggesting malignancy: age over 45 years, symptoms, size greater than 2 cm, lack of calcification, indistinct margins, smoking history • Skin tests, serologies, cytology rarely helpful • Comparison with old chest radiographs essential; follow-up with serial radiographs or CT scans often helpful; CT scan may reveal benign-appearing calcifications • Positron emission tomography (PET) scans are a newly emerg- ing diagnostic modality ■ Differential Diagnosis • Benign causes: granuloma (eg, tuberculosis or fungal infection), arteriovenous malformation, pseudotumor, fat pad, hamartoma • Malignant causes: primary, metastatic malignancy ■ Treatment • Options include fine-needle aspiration (FNA), surgical resection, or radiographic follow-up over 2 years; negative FNA does not exclude malignancy due to high false-negative rate, unless a spe- cific benign diagnosis is made • Thoracic CT scan (with thin cuts through nodule) to look for benign-appearing calcifications and evaluate mediastinum for lymphadenopathy • With high-risk clinical or radiographic features, surgical resection is recommended • In low-risk or intermediate-risk cases, close radiographic follow- up may be justified ■ Pearl In calcified pulmonary nodules, the first digit of the patient’s Social Security number (always present on VA studies) suggests the specific infectious cause. Reference Ost D et al: Evaluation and management of the solitary pulmonary nodule. Am J Respir Crit Care Med 2000;162(3 Part 1):782. [PMID: 10988081] Chapter 2 Pulmonary Diseases 41 2 Asthma ■ Essentials of Diagnosis • Episodic wheezing, colds; chronic dyspnea or tightness in the chest; can present as cough • Some attacks triggered by cold air or exercise • Prolonged expiratory time, wheezing; if severe, pulsus paradoxus and cyanosis • Peripheral eosinophilia common; mucus casts, eosinophils, and Charcot-Leyden crystals in sputum • Obstructive pattern by spirometry supports diagnosis, though may be normal between attacks • With methacholine challenge, Systemic Lupus Erythematosus ■ Essentials of Diagnosis • Predominantly in young women • Multisystem inflammatory autoimmune disorder with periods of exacerbation and remission • Four or more of the following 11 criteria must be present: malar (“butterfly”) rash, discoid rash, photosensitivity, oral ulcers, ar- thritis, serositis, renal disease, neurologic disease, hematologic disorders, positive antinuclear antibody (ANA), and immuno- logic abnormalities (eg, antibody to native double stranded DNA or to Sm, or false-positive serologic test for syphilis) • Also associated with fever, myositis, alopecia, myocarditis, peri- carditis, vasculitis, lymphadenopathy, conjunctivitis, anti- phospholipid antibodies with hypercoagulability and miscarriages, thrombocytopenia, glomerulonephritis (focal, membranoprolifer- ative, or membranous), sicca complex • Syndrome may be drug-induced (eg, procainamide, hydra- lazine), in which case brain and kidney usually spared ■ Differential Diagnosis • Rheumatoid arthritis • Vasculitis • Sjögren’s syndrome • Systemic sclerosis • Endocarditis • Lymphoma • Glomerulonephritis due to other cause ■ Treatment • Mild disease (ie, arthralgias with dermatologic findings) often responds to hydroxychloroquine and COX-2 inhibitors or NSAIDs • Moderate disease activity (ie, refractory to antimalarials): corticos- teroids and azathioprine, methotrexate, or mycophenolate mofetil • Corticosteroids and cyclophosphamide for lupus cerebritis and lupus nephritis • Withdraw offending agent if drug-induced lupus suspected • Avoid sun exposure ■ Pearl The classic malar rash of SLE spares the nasolabial folds. Reference Strand V: New therapies for systemic lupus erythematosus. Rheum Dis Clin North Am 2000;26:389. [PMID: 10768219] 148 Essentials of Diagnosis & Treatment 6 Systemic Sclerosis (Scleroderma) ■ Essentials of Diagnosis • Diffuse systemic sclerosis in 20% of patients with generalized fibrotic changes of the skin and internal organ systems • Raynaud’s phenomenon typical; may be associated with intesti- nal hypomotility, pulmonary fibrosis, myocarditis, pericarditis, hypertension and renal failure, acral ulceration • Limited disease (80% of patients) or CREST syndrome (calci- nosis cutis, Raynaud’s phenomenon, esophageal hypomotility, sclerodactyly, and telangiectasia): skin tightening limited to the distal extremities and feet, with lower risk of renal disease, later onset of pulmonary hypertension and biliary cirrhosis, and an overall better prognosis • ANA frequently useful in systemic sclerosis; anticentromere anti- body positive in 1% of patients with diffuse scleroderma and 50% of those with CREST syndrome; antitopoisomerase I (Scl-70) in one-third of patients with diffuse systemic sclerosis and 20% of those with CREST syndrome, and a poor prognostic factor ■ Differential Diagnosis • Eosinophilic fasciitis • Overlap syndromes with scleroderma • Graft-versus-host disease • Amyloidosis • Morphea • Raynaud’s disease • Cryoglobulinemia ■ Treatment • Angiotensin-converting enzyme blockers to treat hypertensive crisis occasionally seen in patients with systemic sclerosis • Corticosteroids not helpful; penicillamine may be • Warm clothing, smoking cessation, and extended-release calcium channel blockers for Raynaud’s phenomenon; intravenous ilo- prost may be helpful for digital ulcers • H 2 receptor antagonists or omeprazole for esophageal reflux ■ Pearl Malabsorption in systemic sclerosis is due not to intestinal fibrosis but to bacterial overgrowth from hypomotility. Reference Clements PJ: Systemic sclerosis (scleroderma) and related disorders: clinical aspects. Baillieres Best Pract Res Clin Rheumatol 2000;14:1. [PMID: 10882211] Chapter 6 Rheumatologic & Autoimmune Disorders 149 6 Overlap Syndromes (Mixed Connective Tissue Disease & Undifferentiated Connective Tissue Syndrome) ■ Essentials of Diagnosis • Clinical features of more than one ... WOULD LIKE TO ATTEND: (Please circle) ASC: BASIC WORKSHOP th OR ASC: ADVANCED WORKSHOP OR BOTH th Basic Workshop - Thurs 14 & Fri 15 March 2013 th th Advanced Workshop – Thurs 25 & Fri 26 July 2013... REGISTRATION FORM – ASC: BASIC OR ADVANCED WORKSHOP or BOTH – MELBOURNE 2013 TAX INVOICE ABN: 51 128 736 103 Please complete form and send to Minds & Hearts,... Street, Carlton, VIC One Workshop Both Workshops Regular th Early Bird (before 15 February for Basic Workshop only or both th workshops; before 25 June for Advanced Workshop only) $660 $1210