HIV IN ORTHOPAEDICS - DNB Orthopaedics MS Orthopedics MRCS Exam GUIDE -

DNB Orthopaedics  MS Orthopedics  MRCS Exam GUIDE -

Orthopaedic Guidance for DNB Orthopaedics,MS Orthopaedics and Mrcs exams.Cme courses for orthopaedic surgeons.Davangere notes,solved question papers.DNB Ortho,MS Ortho MRCS,Exam Guide videos and notes 9087747888


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Friday 6 April 2018



  • Transmission of disease to surgeon from patient
    • chance of transmission by needle prick or surgical instrument injury is 0.3%
    • screen all patients – window period – take universal barrier precaution for all patients
    • contamination occurs – immediate cleaning under running water
    • post exposure prophylaxis
      • start within 2hrs
      • 2 reverse transcriptase inhibitors (Zidovudine and Lamivudine) and a protease inhibitor (Indinavir) – for 4 wks
      • Zidovudine – 250 mg – BD
      • Lamivudine – 150mg – BD
      • Indinavir – 800mg – TDS
      • baseline HIV test to be done immediately
      • repeat test after 12 wks to determine seroconversion
      • hepatitis prophylaxis should also be initiated

  • Transmission of disease from infected surgeon to non infected patient
    • chance is very rare
  • Trauma and HIV patients
    • Polytrauma
      • such patients more susceptible to acute lung injury / RDS – secondary infection
    • Closed #
      • problems are – wound infection after ORIF – late sepsis around implant – delay/ non union of # - unfavorable functional outcome
      • important determinants after ORIF are – CD 4 cell count – level of aseptic methods – soft tissue handling
      • Staph aureus most common pathogen
      • others are fungal and slow growing mycobacterial
      • aseptic precautions and I gen cephalosporins
    • Compound #
      • high risk of infection occurrence (42%)
      • early debridement, prophylaxis, antibiotics and rigid external fixators
  • Musculoskeletal syndromes in HIV infected patients
    • MC musculoskeletal syndromes seen in HIV infected are
      • manifestations of drug toxicity
      • reactive arthritis – foot and ankle mainly
      • infective arthritis – mc in I/v drug abusers and hemophiliacs – staph aureus and staph pneumoniae
      • osteomyelitis
      • myositis
      • tendinitis – achilles tendon, anterior and posterior tibial tendons commonly
      • bursitis
    • HIV infection alters the clinical presentation, severity and course of disease
    • osteomyelitis can occur primarily but mc by extension of septic arthritis – total joint prosthesis increases chance of infection as immuno suppression progresses
    • most common complaint is myositis
      • idiopathic myositis
      • polymyositis secondary to zidovudine toxicity
      • pyomyositis
    • in idiopathic and polymyositis
      • pain, muscle weakness, raised CPK
      • muscle biopsy : myofibril necrosis, associated inflammation
    • in pyomyositis
      • staph aureus – solitary or multiple abscess within the muscle
      • pain, localized swelling, erythema
      • treatment – aspiration, systemic antibiotics
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