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Pregnancy-associated osteoporosis: a UK case series and literature review

Hardcastle SA, Yahya F, Bhalla AK

Osteoporos Int, 2019 May;30(5):939-948.
PMID: 30671611 DOI: 10.1007/s00198-019-04842-w

Mini Abstract: Pregnancy-associated osteoporosis (PAO) is a rare syndrome affecting women during late pregnancy and the early postpartum period. We set out to review the clinical features of ten cases of PAO from a single UK centre. Patients had attended the Royal National Hospital for Rheumatic Diseases, Bath (RNHRD) between January 2000 and June 2016. The principal criterion for inclusion was the occurrence of low trauma fractures either during pregnancy or the immediate post-partum period. Data were obtained from retrospective review of medical notes. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (Hologic ®Discovery system) at the lumbar spine and hip. Data pertaining to the pregnancy, as well as type and duration of treatment received, were reviewed. All ten cases presented with vertebral fractures. In four patients, no risk factors for fracture other than pregnancy or breastfeeding could be identified. Four patients were found to have vitamin D insufficiency at the time of diagnosis, and a further two patients had received treatment with low molecular weight heparin (LMWH). In one case, further investigation led to a diagnosis of osteogenesis imperfecta (OI) confirmed on genetic testing. In terms of treatment, eight out of the ten patients in this series received a bisphosphonate, most commonly risedronate due to its relatively short skeletal retention time. Clinicians should be aware of PAO, a rare but recognised complication of pregnancy. The condition should be especially considered in women presenting with new onset back pain in pregnancy or the postpartum period.

Matched MeSH terms: Back Pain/etiology
Fulltext Association of psychological distress and work psychosocial factors with self-reported musculoskeletal pain among secondary school teachers in Malaysia

Zamri EN, Moy FM, Hoe VC

PLoS One, 2017;12(2):e0172195.
PMID: 28234933 DOI: 10.1371/journal.pone.0172195

BACKGROUND: Musculoskeletal pain is common among teachers. Work-related psychosocial factors are found to be associated with the development of musculoskeletal pain, however psychological distress may also play an important role.
OBJECTIVES: To assess the prevalence of self-reported low back pain (LBP), and neck and/or shoulder pain (NSP) among secondary school teachers; and to evaluate the association of LBP and NSP with psychological distress and work-related psychosocial factors.
METHODS: This was a cross-sectional study conducted among teachers in the state of Penang, Malaysia. The participants were recruited via a two stage sampling method. Information on demographic, psychological distress, work-related psychosocial factors, and musculoskeletal pain (LBP and NSP) in the past 12 months was collected using a self-administered questionnaire. Poisson regression was used to estimate the prevalence ratio (PR) for the associations between psychological distress and work-related psychosocial factors with LBP and NSP.
RESULTS: The prevalence of self-reported LBP and NSP among 1482 teachers in the past 12 months was 48.0% (95% Confidence Interval (CI) 45.2%, 50.9%) and 60.1% (95% CI 57.4%, 62.9%) respectively. From the multivariate analysis, self-reported LBP was associated with teachers who reported severe to extremely severe depression (PR: 1.71, 95% CI 1.25, 2.32), severe to extremely severe anxiety (1.46, 95% CI 1.22, 1.75), high psychological job demand (1.29, 95% CI 1.06, 1.57), low skill discretion (1.28, 95% CI 1.13, 1.47) and poorer mental health (0.98, 95% CI 0.97, 0.99). Self-reported NSP was associated with mild to moderate anxiety (1.18, 95% CI 1.06, 1.33), severe to extremely severe anxiety (1.25, 95% CI 1.09, 1.43), low supervisory support (1.13, 95% CI 1.03, 1.25) and poorer mental health (0.98, 95% CI 0.97, 0.99).
CONCLUSIONS: Self-reported LBP and NSP were common among secondary school teachers. Interventions targeting psychological distress and work-related psychosocial characteristics may reduce musculoskeletal pain among school teachers.

Matched MeSH terms: Low Back Pain
Fulltext A Good Short-term Outcome in Delayed Decompression of Cauda Equina Syndrome in Klebsiella pneumoniae Spinal Epidural Abscess: A Case Report

Hanifah J, Joehaimey J, Yusof MI

Malays Orthop J, 2017 Jul;11(2):85-88.
PMID: 29021888 MyJurnal DOI: 10.5704/MOJ.1707.018

Spinal epidural abscess is a severe, generally pyogenic, infection of the epidural space of spinal cord or cauda equina. The swelling caused by the abscess leads to compression or vascular disruption of neurological structures that requires urgent surgical decompression to avoid significant permanent disability. We share a rare case of Klebsiella pneumoniae spinal epidural abscess secondary to haematogenous spread of previous lung infection that presented late at our centre with cauda equina syndrome that showed good short-term outcome in delayed decompression. A 50-year old female presented with one-week history of persistent low back pain with progressively worsening bilateral lower limb weakness for seven days and urinary retention associated with saddle anesthesia of 2-day duration. Magnetic resonance imaging with contrast of the lumbo-sacral region showed an intramuscular collection of abscess at left gluteus maximus and left multifidus muscle with a L3-L5 posteriorly placed extradural lesion enhancing peripherally on contrast, suggestive of epidural abscess that compressed the cauda equina. The pus was drained using the posterior lumbar approach. Tissue and pus culture revealed Klebsiella pneumoniae, suggestive of bacterial infection. The patient made immediate improvement of muscle power over bilateral lower limbs postoperative followed by ability to control micturition and defecation the 4th post-operative day. A good short-term outcome in delayed decompression of cauda equine syndrome is extremely rare. Aggressive surgical decompression combined with antibiotic therapy led to good short-term outcome in this patient despite delayed decompression of more than 48 hours.

Matched MeSH terms: Low Back Pain
Effects of two ergonomic improvements in brazing coils of air-handler units

Loo HS, Yeow PH

Appl Ergon, 2015 Nov;51:383-91.
PMID: 26154237 DOI: 10.1016/j.apergo.2015.06.007

The research aims to address the physically loading task and quality and productivity problems in the brazing of coils of air-handler units. Eight operators participated in two intervention studies conducted in a factory in Malaysia to compare the status quo brazing with (1) the use of a new twin-brazing torch that replaced the single-brazing gun and (2) brazing in a sitting position. The outcome measures are related to quality, productivity, monetary costs, body postures and symptoms. After baseline, Interventions I and II were applied for 3 months respectively. The results show a 58.9% quality improvement, 140% productivity increase and 113 times ROI. There was also a reduction in poor work postures e.g. in the raising of the arms and shoulders; bending, twisting and extending of the neck; and bending of left and right wrists, and the back. This research can be replicated in other factories that share similar processes.

Matched MeSH terms: Back