General Information about Drospirenone

Drospirenone is an artificial form of progesterone, a hormone produced in the body by the ovaries. It belongs to a category of progestins often recognized as spironolactone derivatives, which implies it has an identical structure to the medicine spironolactone generally used to deal with hypertension and fluid retention. Unlike different progestins, drospirenone has anti-mineralocorticoid and anti-androgenic properties, meaning it blocks the effects of male hormones on the physique.

Furthermore, drospirenone has been discovered to have a lower risk of venous thromboembolism (VTE) in comparability with different progestins. VTE is a situation the place blood clots form within the veins, which may be life-threatening in the event that they journey to the lungs. This decreased danger has made drospirenone a most popular selection for ladies who have a historical past of blood clots or are thought-about at high threat for VTE.

It accommodates each an estrogen (ethinyl estradiol) and a progestin (drospirenone) that work together to prevent ovulation, thicken cervical mucus, and thin the liner of the uterus. One of the primary active components in Yasmin, drospirenone, is a relatively newer progestin that has gained popularity in latest times because of its distinctive properties and potential well being benefits.

In addition to its effects on PMS and androgen-driven circumstances, drospirenone has additionally been linked to potential cardiovascular advantages. Studies have shown that it could have a positive impact on blood stress and lipid ranges, lowering the risk of heart illness and stroke. This is especially related for girls who may have pre-existing cardiovascular risk components, such as hypertension or elevated cholesterol levels.

Aside from its potential well being benefits, drospirenone can additionally be recognized for its contraceptive effectiveness. When taken as directed, it is estimated to have a failure price of lower than 1%. This is corresponding to other extremely efficient types of contraception, similar to intrauterine units (IUDs) and contraceptive implants.

In conclusion, drospirenone is a novel progestin that offers a quantity of benefits to women. Not solely does it effectively forestall pregnancy, however it also has potential well being advantages and may improve symptoms of PMS and androgen-driven situations. For women considering a birth control choice, it could be very important focus on the potential advantages and risks with their healthcare supplier to determine if drospirenone is the best selection for them.

It is essential to notice that drospirenone, like all forms of birth control, does not defend against sexually transmitted infections (STIs). Women should at all times use condoms in addition to hormonal contraception to scale back their threat of STIs.

Like any treatment, there are potential side effects related to the use of drospirenone. The most typical ones embrace breast tenderness and recognizing or breakthrough bleeding. Some women may also experience temper modifications, complications, or changes in their menstrual cycle. These side effects are usually gentle and tend to enhance with continued use. However, if they become bothersome or persistent, it is essential to converse with a healthcare provider.

This distinctive mechanism of motion makes drospirenone a most well-liked progestin for many girls. It is usually prescribed for individuals who experience symptoms of premenstrual syndrome (PMS), such as bloating, breast tenderness, and temper modifications. As drospirenone blocks the effects of male hormones, it could additionally help improve pimples and hirsutism (excessive hair growth) in some girls.

Overall tolerability and analgesic activity of intraarticular sodium hyaluronate in the treatment of knee osteoarthritis. The results of arthroscopic lavage and debridement of osteoarthritic knees based on the severity of degeneration: a 4 to 6year symptomatic followup. It most commonly involves the knee joint (75% cases) but has been reported in the ankle (dome of talus), elbow (capitellum), femoral head and wrist. Within the knee the most common site is the posterolateral portion of the medial condyle of the femur. Most cases are unilateral but bilateral involvement has been described in up to 33% cases in juvenile form. Osteochondritis dissecans must be differentiated from chon dral separation, chondral flap, osteochondral fracture, osteonecrosis, accessory centers of ossification and hereditary epiphyseal dysplasia. Fairbanks has postulated that repetitive impingement of the tibial spine on the medial condyle is responsible for the common lesion. Osteochondritis is also more common in athletes and high impact sporting population. Similarly an association between lateral femoral condyle osteochondritis and lateral discoid meniscus has been reported. Another view suggests vascular insufficiency as a factor but that has been largely refused as histological studies have found only necrosis and no evidence of infarction. It has also been postulated that defects of ossification may also lead to this condition. This theory may explain the lesions occurring in other parts of the joint apart from the medial femoral condyle. Patients with a hereditary condition called multiple epiphyseal dysplasia have been quoted to be predisposed to osteochondritis but literature is divided on this matter. Juvenile osteochondritis occurs in adolescence and is rare before the age of 10 years. OsteOchOndritis dissecans Of Knee Juvenile osteochondritis responds well to conservative treatment whereas the adult form generally needs intervention. In the later stages the pain increases in severity with localized tenderness over the medial femoral condyle. Physical Examination There may be an effusion with diffuse tenderness on the femoral condyles in the earlier stages. Patients with lesion on the lateral aspect of the medial femoral condyle may walk with the leg externally rotated to avoid abutment. In such patients if the knee is slowly extended from 90° flexion with the tibia internally rotated there may be sharp pain at approximately 30° flexion, which is relieved by external rotation. It gives excellent anatomical details, and helps in assessment of stability of the lesion, viability and breaks in the overlying cartilage and differentiation from other similar conditions. De Smet and colleagues have proposed four criteria for insta bility in adults (Box 1). Tunnel view is essentially an anteroposterior view of the knee taken in 30­50° of flexion to visualize the lesion on the posterolateral region of the condyle. Radiographs are not sensitive and do not give any information on the stability of the lesion or the status of the overlying cartilage. Cahill and Berg have given a classification based on the site of the lesion on anteroposterior and lateral radiographs. Treatment the treatment modality depends on the age of the patient, size, situation and stability of the lesion. Both modalities have given good results in the specific subset of patients with reported rate of healing from 50­75%. Box 2: Arthroscopic classification of osteochondritic lesions · · · · Type I:Cartilageintact. Internal fixation is an option for larger stable lesions in weightbearing regions with a good subchondral bone stock, partially detached lesions and detached lesions less than 2­3 cm2. Special care should be taken to bury the fixation devices below the level of articular cartilage. If needed the bed of lesion can be freshened and cancellous bone grafting done to replace the bone stock and promote healing. Restorative techniques include marrow stimulation with microfracture, autologous osteochondral autograft or allograft or autologous chondrocyte implantation. These techniques are used for detached lesions greater than 2­3 cm2 not amenable to fixation, lesions without sufficient subchondral bone and cases which have failed conservative or fixation techniques. This is applicable in smaller defects in low demand patients without loss of subchondral bone. Autologous Osteochondral Grafting It involves debriding nonviable cartilage with subchondral bone and replacing the same with osteochondral graft harvested from a nonarticulating portion of the knee preferably from the lateral trochlea. Pegs of osteochondral graft can also be used to fix large lesions, which are unstable and not detached. This method is limited by the amount of graft that can be harvested but it does not involve risk of disease transmission. Various studies have shown good results with reformation of hyaline like cartilage. Drilling could be extra articular or through the joint cartilage (transarticular); the former being preferred. For unstable but nondetached lesions some form of fixation is needed in the form of screws, bioabsorbable devices or bone pegs. The only disadvantage of screws is the need for a second surgery for implant removal.

It is well accepted that better the level of general fitness, lesser are the incidences, recurrences of low back pain and shorter is the recovery period. Information about the lifestyle provides useful information about any physical or emotional stressors which may be a source of pain and which may influence the recovery process. The sequence of evaluation is: (a) Rule out non-spinal pathology; (b) Exclude the presence of serious spinal pathology; (c) Confirm or rule out neural involvement. This at times proves to be too simplified an approach and clinician may have to modify, devise his own ways of evaluating the patient. The European groups recommend doing assessment for psychosocial factors and reviewing them in detail if there is no improvement. Also most of these cases come with a history of failed attempts by multiple clinicians in treating them. We therefore, give significant emphasis on knowing these contributing psychosomatic possibilities right at the time of primary evaluation rather than after failure of any primary regime. Clinical Evaluation However, history alone does not have a high sensitivity and high specificity for the cause of radiculopathy and ankylosing spondylitis. Careful observation of the patient to note the spinal curvatures, pelvic obliquity, lower limb shortening and posture is necessary. The lumbar lordosis should appear as a smooth and gentle curve and there should be a smooth transition at the thoraco lumbar junction. Assessing the patient in entirety in terms of his movement, its quality, his willingness to move independently, and gait pattern, can provide some important clues. The multiple muscles surrounding the spine can go in reflex spasm as a need to immobilize the painful spinal segments. Observing this spasm over a period and noting the changes gives information about the resolution of interior pathology. Wasting or hypertrophy of erector spinae muscles indicate disuse during chronic suffering or overuse as in instabilities. Some are very simple while others are complex both for the patient and the evaluator. The patients mark on the line at the point that they feel represents their perception of their current state. The older patients with cognitive impairments may find it difficult to complete it and may need supervision during completion to minimize error. It cannot be used for comparing across a group of individuals at a given point of time. The patient suffering from chronic pain is asked to notate front and back body outlines, using intensity showing marking signs like circles, arrows, lines, etc. Useful for a quick assessment, it can demonstrate whether the patient is demonstrating symptoms consistent with the organic lesion, and whether he is amplifying pain levels. The self-completed questionnaire contains questions regarding: Pain intensity, abilities of lifting, self-care, walking, sitting, standing and sexual function, social life, sleep quality and ability to travel. Each of the above functions are scored on a scale of 0­5, where zero is the least disability while 5 is the most severe disability. The scores of all questions are summed and then multiplied by 2 to obtain the index (range 0­100). Careful assessment by an experienced clinician will help in locating the source of pain. These tests may even need to be repeated if the symptomatology changes significantly and if surgical management is being considered. Neural Evaluation: Nerve Stretch Tests In the lumbar spine, the dura, the nerve root sleeves and nerve roots are pain sensitive, mobile structures. Pain arising from these structures may be caused by ischemia, inflammation, excessive stretch, with or without associated compression. A chronically compressed or stretched non-inflamed root generally produces paresthesia rather than pain (Van den Hoogen). While performing these tests, many other soft tissue structures get stretched and patient may complain of stretch pain arising from them. We feel that, these tests must not be considered as positive unless they reproduce the neural symptoms presented by the patient. Functional Evaluation Observe the patient from all sides actively performing flexion, extension, rotation and side bending to both sides while standing. Examine the patient lying down and repeat passively all these movements by the non-loaded spine to differentiate the movements from those done by the loaded spine. Also is noted the type of pain produced and whether active, passive and/or restricted movements are provoking it. Most maneuvers used in physical examination are likely to stress several structures simultaneously, especially the discs, muscles, facet joints, etc. Thus, the buttock pain could be because of L4­5 disc or L4­5 facet, sacroiliac joint, hip joint or the muscles of the buttock like gluteus maximus or the pyriformis. The clinical evaluation must include upper spine examination, systemic examination and distal vascularity examination. He also found that for Indian patients, inclusion of question related to weight lifting and sexual function needs to be reviewed. We (Author 1) had studied tightness of hamstrings in 1982 in 176 normal and back pain subjects (35 school children, 22 medical students and 119 back pain sufferers). We found a good correlation between the tight shortened hamstrings and chronic, recurrent low back pain. Continuation of the study over next 15 years showed non back pain, tight hamstring children growing into back pain prone adults. The tight hamstrings subjects have difficulty in stooping forwards, right-angled sitting, sitting cross-legged and squatting plantigrade.

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The lesser tuberosity and subscapularis are retracted medially, and the greater tuberosity is retracted laterally and superiorly. This will allow visualization of the articular segment, which is usually devoid of any soft-tissue attachments and is easily removed. Since it contributes to anterosuperior stability, the coracoacromial ligament should be identified and preserved. Step 7: Suture Placement Drill two holes through the wall of the humeral shaft medial to the biceps groove for lesser tuberosity attachment. Then drill another Shoulder replacement in proximal humeruS Fracture two holes through the shaft lateral to the biceps groove for greater tuberosity attachment. Care should be taken that the knot should not be at fracture site of tuberosities. When using an uncemented prosthesis, one can avoid the knots to allow the sutures to slide and hence tighten the knots more effectively. The cement is injected into the canal and the prosthesis is inserted in the proper position and maintained in that "trial" position until the cement has hardened. The position should then be confirmed and the head should be impacted into place, making sure that the morse taper is dry and free of any debris. Proper reattachment and secure fixation will enhance the probability of a successful outcome in terms of range of motion and overall function; therefore, careful attention must be given to the technical aspects of this portion of the procedure. The principles of tuberosity fixation are: · Placement of vertical sutures to bring the tuberosities into a position below the prosthetic articular surface and into contact with the humeral shaft. With Ethibond 5#, first vertical sutures should be placed in supraspinatus and infraspinatus portion of cuff as mattress fashion. After we are done with vertical sutures, the most important part is to pass horizontal (cerclage) sutures. If the tuberosity repair is tenuous then avoid rotational movements post operatively. Step 11: Suture Tying One may need to enhance healing of tuberosities by placing bone graft at fracture site. The sequence of tying is as follows: Vertical sutures from supraspinatus and infraspinatus are tied with sutures of shaft (lateral to bicipital groove), followed by suturing of vertical suture from subscapularis to sutures of shaft (medial to bicipital groove). Pendulum, elbow range of motion exercises, and scapula sets are allowed from very next day. At third week, active assisted exercise (forward flexion and abduction) with stick is allowed, and strictly no rotation is allowed. Two patients (one 70 years male and another 64 years lady) had disengagement of the humeral head prosthesis in immediate postoperative and were re-operated with same prosthesis fixed back again immediately. We believe the good results of shoulder replacements are directly proportional to the rotator cuff quality and also the healing of the tuberosities. Trauma patients are usually younger than the arthritis patients and are likely to have better prevalent cuff function. Studies have also demonstrated that acute reconstruction (less than 4 weeks after the injury) results in better functional outcomes because of the ease of tuberosity reconstruction. We have had two postoperative infections so far leading to removal of prosthesis in one of them. Conclusion Primary hemiarthroplasty has been shown to be effective in providing good pain relief and function. Tuberosity union and positioning as well as height and retroversion are critical factors for successful outcome after hemiarthroplasty. Before we go into details of role of reverse shoulder arthroplasty in proximal humerus fracture, it is mandatory to understand prevalence of rotator cuff tear. The prevalence correlated with age and was 13% in patients aged 50­59 years, 20% in patients between the ages of 60 and 69 years, 31% between the ages of 70 and 79 years, and 51% in individuals older than age 80 years. In reverse shoulder replacement for fractures, usually an extensile approach such as deltopectoral is preferred. Although fixation of tuberosities is controversial, there is some evidence to suggest that restoration of tuberosities will provide bone stock which will prevent aseptic loosening and also it will help in achieving external rotation Next the humeral head is removed preserving the tuberosities, and the shaft is reamed in a standard manner, similar to hemiarthroplasty. After the trial prosthesis is in its place, the glenoid is prepared and implanted with a 10­15° inferior tilt. Indication Displaced three part or four part fracture of proximal humerus in elderly (older than 70 years) who cannot participate in rehabilitation program or with pre-existing rotator cuff arthropathy. Demographics Our preference is to offer a reverse shoulder replacement after 75 years age. Most surgeons prefer not to start active supervised physio and allow the patient to self-rehabilitate themselves. In such cases, if the ranges remain poor at 3 months, we do offer them a supervised deltoid strengthening program with elastic bands. Postoperative Management the postoperative care is only marginally different from a hemiarthroplasty. We allow patients to lift a cup of tea after surgery and avoid major movement at the shoulder. Reported complications include dislocation, tuberosity nonunion, nerve injury, infection, reflex sympathetic dystrophy, scapular notching, proximal bone resorption, and glenoid loosening. The Shoulder, Rupture of the Supraspinatus Tendon and Other Lesions in or about the Subacromial Bursa. Hemiarthroplasty of the shoulder after four-part fracture of the humeral head: a longterm analysis of 34 cases.