Hamed Yazdanshenas

Pain in Community-Dwelling Elderly African Americans

Objective: This study examines the type, severity, and correlates of pain among underserved elderly African Americans. Method: This cross-sectional study includes 400 non-institutionalized underserved aged African Americans, recruited from 16 African American churches located in South Los Angeles. Results: Two thirds of our participants reported a level of pain of 5 or higher (on a scale of 0-10) for at least one of the pain items. Participants with severe level of pain showed a higher level of insomnia, depression, and deficiency in activity of daily living as well as a lower level of memory function and quality of physical and mental health. Also, level of pain is a statistically significant correlate of office-based physician visits and emergency department admission. Conclusion: Our findings encourage multidisciplinary and interdisciplinary interventions to include pharmacotherapy, psychological support, and physical rehabilitation, specifically on neuropathic pain among aged African Americans with multiple chronic conditions.

Double acetabular wall—a misleading point for hip arthroplasty: an anatomical, radiological, clinical study

PurposeDespite the great attention focused on cup positioning in primary total hip arthroplasty (PTHA), it is surprising to find so few studies that have dealt with cup placement. A common thwarting problem for correct cup placement during PTHA is the existence of osteophytes, which obscure the anatomical landmarks. In this study we aimed to evaluate the morphology of acetabular osteophyte formation in patients with osteoarthritis.MethodWe evaluated 276 patients with hip complaints, using plain X-rays and CT scans.ResultsOf these patients, 57 underwent surgery. We developed a staging system for central osteophytes in hip osteoarthritis based on the radiographic and anatomical findings of our patients.ConclusionWe recommend routine use of CT scans for patients scheduled for PTHA in order to assess the stage of osteophyte before surgery and, thus, reduce the risk of failure resulting from the interrupted acetabular landmarks.

Inappropriate Medication Use Among Underserved Elderly African Americans.

Objective: The goal of this study is to identify correlates and the prevalence of potentially inappropriate medication (PIM) use among underserved elderly African Americans. Method: This cross-sectional study recruited 400 elderly African Americans living in South Los Angeles, and used structured, face-to-face surveys. These elicited data pertaining to the type, frequency, dosage, and indications of all medications used by participants. Results: Seventy percent of participants engaged in PIM use and used at least one medication that was classified as “Avoid” (27%) and “Use Conditionally” (43%) through Beers Criteria. Significant correlations emerged between PIM use and the number of autonomic and central nervous system, neurological and psychotherapeutic medications, medication duplications, and drug–drug interactions. Discussion: Our findings point to the need for multidisciplinary team programs of health care providers that include primary and specialist physicians, pharmacists, nurses, and social workers. Together, they can improve health outcomes, enhance the quality of life, and reduce morbidity and mortality due to inappropriate medication use.

Patellar tendon donor-site healing during six and twelve months after Anterior Cruciate Ligament Reconstruction.

BACKGROUND Bone-Patellar Tendon-Bone Graft is one of the most acceptable methods of treatment for Anterior Cruciate Ligament rupture (ACL). This study evaluates the recovery process of the graft donor site. METHODS This study evaluates the graft donor site recovery in 23 patients with ACL reconstruction, 6 and 12 months after the patellar tendon graft surgery. RESULTS In 70 percent of the cases, the healing process was completed after 6 months and the remaining 30 percent recovered after 12 months. CONCLUSION Time is an important factor in the recovery process of the patellar tendon for reconstruction of the ACL.

Prognostic determinants and treatment outcomes analysis of osteosarcoma and Ewing sarcoma of the spine

BACKGROUND CONTEXT Osteosarcoma (OGS) and Ewing sarcoma (EWS) are the two classic primary malignant bone tumors. Due to the rarity of these tumors, evidence on demographics, survival determinants, and treatment outcomes for primary disease of the spine are limited and derived from small case series. PURPOSE To use population-level data to determine the epidemiology and prognostic indicators in patients with OGS and EWS of the osseous spine. STUDY DESIGN/SETTING Large-scale retrospective study. PATIENT SAMPLE Patients diagnosed with OGS and EWS of the spine in the Surveillance, Epidemiology, and End Results (SEER) registry from 1973 to 2012. OUTCOME MEASURES Overall survival (OS) and disease-specific survival (DSS). METHODS Two separate queries of the SEER registry were performed to identify patients with OGS and EWS of the osseous spine from 1973-2012. Study variables included age, sex, race, year of diagnosis, tumor size, extent of disease (EOD), and treatment with surgery and/or radiation therapy. Primary outcome was defined as OS and DSS in months. Univariate survival analysis was performed using the Kaplan-Meier method and the log-rank test. Multivariate analysis was performed using Cox proportional hazards regression models. RESULTS The search identified 648 patients with primary OGS and 736 patients with primary EWS of the spine from 1973 to 2012. Mean age at diagnosis was 48.1 and 19.9 years for OGS and EWS, respectively, with OGS showing a bimodal distribution. The median OS and DSS were 1.3 and 1.7 years, respectively, for OGS, with OGS in Pagets disease having worse OS (0.7 years) relative to the mean (log-rank p=.006). The median OS and DSS for EWS were 3.9 and 4.3 years, respectively. Multivariate cox regression analysis showed that age (OS p<.001, DSS p<.001), decade of diagnosis (OS p=.049), surgical resection (OS p<.001, DSS p<.001), and EOD (OS p<.001, DSS p<.001) were independent positive prognostic indicators for spinal OGS; radiation therapy predicted worse OS (hazard ratio [HR] 1.48, confidence interval [CI] 1.05-2.10, p=.027) and DSS (HR 1.74, CI 1.13-2.66, p=.012) for OGS. For EWS, age (OS p<.001, DSS p<.001), surgical resection (OS p=.030, DSS p=.046), tumor size (OS p<.001, DSS p<.001), and EOD (OS p<.001, DSS p<.001) were independent determinants of improved survival; radiation therapy trended toward improved survival but did not achieve statistical significance for both OS (HR 0.76, CI 0.54-1.07, p=.113) and DSS (0.76, CI 0.54, 1.08, p=.126). CONCLUSIONS Age, surgical resection, and EOD are key survival determinants for both OGS and EWS of the spine. Radiation therapy may be associated with worse outcomes in patients with OGS, and is of potential benefit in EWS. Overall prognosis has improved in patients with OGS of the spine over the last four decades.

Chondrosarcoma of the Osseous Spine: An Analysis of Epidemiology, Patient Outcomes, and Prognostic Factors Using the Seer Registry From 1973 to 2012

Study Design. Retrospective analysis. Objective. To determine the epidemiology and prognostic indicators in patients with chondrosarcoma of the osseous spine. Summary of Background Data. Chondrosarcoma of the spine is rare, with limited data on its epidemiology, clinicopathologic features, and treatment outcomes. Therapy centers on complete en bloc resection with radiotherapy reserved for subtotal resection or advanced disease. Methods. The Surveillance, Epidemiology, and End Results Registry was queried for patients with chondrosarcoma of the osseous spine from 1973 to 2012. Study variables included age, sex, race, year of diagnosis, size, grade, extent of disease, and treatment modality. Results. The search identified 973 cases of spinal chondrosarcoma. Mean age at diagnosis was 51.6 years, and 627% of patients were males. Surgical resection and radiotherapy were performed in 75.2% and 21.3% of cases, respectively. Kaplan-Meier analysis demonstrated overall survival (OS) and disease-specific survival (DSS) of 53% and 64%, respectively, at 5 years. Multivariate Cox regression analysis showed that age (OS, P < 0.001; DSS, P = 0.007), grade (OS, P < 0.001; DSS, P < 0.001), surgical resection (OS, P < 0.001; DSS, P < 0.001), and extent of disease (OS, P < 0.001; DSS, P < 0.001) were independent survival determinants; tumor size was an independent predictor of OS (P = 0.006). For confined disease, age (P = 0.013), decade of diagnosis (P = 0.023), and surgery (P = 0.017) were independent determinants of OS. For locally invasive disease, grade (OS, P < 0.001; DSS, P = 0.003), surgery (OS, P = 0.013; DSS, P = 0.046), and size (OS, P = 0.001, DSS, P = 0.002) were independent determinants of OS and DSS. Radiotherapy was an independent indicator of worse OS for both confined (P = 0.004) and locally invasive disease (P = 0.002). For metastatic disease, grade (OS, P = 0.021; DSS, P = 0.012) and surgery (OS, P = 0.007; DSS, P = 0.004) were survival determinants for both OS and DSS, whereas radiotherapy predicted improved OS (P = 0.039). Conclusion. Surgical resection confers survival benefit in patients with chondrosarcoma of the spine independent of extent of disease. Radiotherapy improves survival in patients with metastatic disease and worsens outcomes in patients with confined and locally invasive disease. Level of Evidence: 4

Pain Treatment of Underserved Older African Americans.

Older African Americans who experience pain are especially at high risk of underassessment and undertreatment. This study examined patterns and correlates of pain medication use: severity of pain, medical conditions, and access to care. African Americans aged 65 and older were recruited from 16 churches located in south Los Angeles (N = 400). Structured face‐to‐face interviews and visual inspection of each participants medications were conducted. More than 39% of participants were aged 75 and older, and 65% were female. Forty‐seven percent used at least one type of pain medication. The frequency of pain medication use according to pharmaceutical class was nonopioid, 33%; opioid, 12%; adjuvant, 9%; and other drug, 8%. Seventy‐seven percent of nonopioids were nonsteroidal anti‐inflammatory drugs (NSAIDs), which 25% of participants with hypertension, 28% with stroke, 26% with kidney disease, and 28% with gastrointestinal problems used. Ninety‐eight percent of participants who used NSAIDs, 98% experienced potentially inappropriate medication (PIM) use, 69% experienced drug duplication, and 65% experienced drug–drug interactions. This study suggests severe mismanagement of pain in underserved older African Americans, particularly those with comorbidity, multiple providers, and limited access to health care. The use of pain medication was associated with drug–drug interactions, drug duplication, and PIM use. The data show that many participants with severe pain are not taking pain medication or experience PIM use. One in four participants was taking NSAIDs, which can cause serious side effects in older African Americans with multiple chronic conditions.

A new method for tibial torsion measurement by computerized tomography.

BACKGROUND Computerized tomography (CT) is the gold standard technique for tibial torsion assessment. This study compared two methods of tibial torsion assessment and proposed a new method, which could be of value in cases of abnormal fibular changes. METHODS The CT-scanograms of 60 participants were assessed by using two different techniques, differed in determination of the distal tibial axis. RESULTS The interobserver reliability was 0.861 and 0.863 in the first and second methods, respectively. The intraobserver reliability in both measurement methods was 0.868. CONCLUSIONS We proposed a reliable method, independent of the fibular midpoint, in assessment of tibial torsion by CT.

Epidemiology of musculoskeletal injury in the California film and motion picture industry.

Abstract Introduction: Musculoskeletal injury exerts a significant burden on US industry. The purpose of this study was to investigate the frequency and characteristics of musculoskeletal injuries in the California (CA) film and motion picture (FMP) industry which may result in unforeseen morbidity and mortality. Methods: We reviewed the workers’ compensation (WC) claims database of the Workers’ Compensation Insurance Rating Bureau of California (WCIRB) and employment statistics through the US Bureau of Labor Statistics (BLS). We analyzed the frequency, type, body part affected, and cause of musculoskeletal injuries. Results: From 2003 to 2009, there were 3505 WC claims of which 94.4% were musculoskeletal. In the CA FMP industry, the most common injuries were strains (38.4%), sprains (12.2%), and fractures (11.7%). The most common sites of isolated injury were the knee (18.9%), lower back (15.0%), and ankle (8.6%). Isolated musculoskeletal spine injuries represented 19.3% of all injuries. The most common causes of injury were work-directed activity (36.0%) and falls (25.5%). Conclusion: We present the first report on the unique profile of musculoskeletal injury claims in the FMP industry. This data provides direction for improvement of workplace safety.

Long-term safety and efficacy of human bone morphogenetic protein (HBMP) in the treatment of resistant non-unions and failed arthrodesis

The bone morphogenetic protein (BMP) has emerged as a suitable alternative to autogenous cancellous bone grafting and despite current knowledge about its mechanism; few studies provide evidence about the long-term safety of BMP. The aim of this investigation is to determine if BMP implantation is a safe and effective agent in a long-term setting for the treatment of patients with resistant non-unions and failed arthrodesis. This study is a retrospective case series study that was conducted on 55 patients who had received BMP. Collected data included all related surgical history, and clinical and X-ray data both pre-operatively and post-operatively. All patients were scheduled for follow-up evaluations at one week and 1, 3, 6, and 12 months post-operatively. Seven patients (13%) experienced adverse events related to their surgery with hBMP. Six patients (11%) experienced persistent non-union; five of these underwent further revision surgery. One patient (2%) developed an infected non-union. No patients experienced tumor induction, allergic reaction to hBMP. The remaining 48 patients achieved osseous union within six months of hBMP implantation. This study differs from previous studies that the use of hBMP is a safe and efficacious treatment method for resistant non-unions and failed arthrodesis in the long-term setting.