Clinical characteristics and outcomes of chronic nonbacterial osteomyelitis in children: a multicenter case series

Abstract Objective The aim of this study was to evaluate demographic, clinical, laboratory, imaging, histopathology characteristics, and treatment responses of children with Chronic nonbacterial osteomyelitis (CNO). Methods Retrospective multi-center case series study of pediatric patients diagnosed with CNO treated at five tertiary centers in south China. Results Totally there were 18 patients diagnosed as CNO between 2014 and 2020. The median age of onset was 9.2 years (range 3.7–13.1) and 55.6% were female. Median delay in diagnosis was 10.9 months (range 1.0–72.0). The most frequent presenting symptoms were bone pain (100%) and fever (44.4%). Most patients had more than one lesion (median of 5, range 1–7). Most frequently affected bones were tibiofibula (88.9%) and femur (77.8%). The MRI characteristics mainly presented as bone edema and hyperintensity in bone marrow. Bone biopsy was conducted in 11 patients (61.1%) with inflammatory cells infiltration manifested as chronic osteomyelitis, and none showed bacterial infection or tumor. In treatment, non-steroid anti-inflamatory drugs (NSAIDs) is used as the first-line drug followed by steriods, methotexate (MTX), salazosulfadimidine (SASP), Bisphosphonates and TNF-α inhibitor. Two refractory cases received combination therapy with Bisphosphonates and TNF-α inhibitor, and achieved good therapeutic effect. Conclusions The present study described a multicenter series of CNO from south China and highlighted the clinical features, laboratory tests, imaging characteristics and treatment outcomes. Increasing awareness of this disease is important to decrease time to diagnosis, improve access to treatment, and reduce complications.

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Clinical Characteristics and Outcomes of Chronic Nonbacterial Osteomyelitis in Children: A Multicenter Case Series

10.21203/rs.3.rs-595799/v1 ◽

2021 ◽

Author(s):

Le Ma ◽

Haimei Liu ◽

Hanyun Tang ◽

Zhiyong Zhang ◽

Lixia Zou ◽

...

Keyword(s):

South China ◽

Age Of Onset ◽

Bone Biopsy ◽

Case Series ◽

Presenting Symptoms ◽

Imaging Characteristics ◽

Case Series Study ◽

Tnf Α ◽

Bone Edema ◽

Chronic Nonbacterial Osteomyelitis

Abstract Objective The study was to evaluate demographic, clinical, laboratory, imaging, histopathology characteristics, and treatment responses of children with Chronic nonbacterial osteomyelitis (CNO). Methods Retrospective multi-center case series study of pediatric patients diagnosed with CNO treated at five tertiary centers in south China. Results Totally there were 18 patients diagnosed as CNO between 2014 and 2020. The median age of onset was 9.2 years (range 3.7-13.1) and 55.6% were female. Median delay in diagnosis was 10.9 months (range 1.0-72.0). The most frequent presenting symptoms were bone pain (100%) and fever (44.4%). Most patients had more than one lesion (median of 5, range 1-7). Most frequently affected bones were tibiofibula(88.9%) and femur (77.8%). The MRI characteristics mainly presented as bone edema and Hyperintensity in bone marrow. Bone biopsy was conducted in 11 patients (61.1%) with inflammatory cells infiltration manifested as chronic osteomyelitis, and none showed bacterial infection or tumor. In treatment, non-steroid anti-inflamatory drugs (NSAIDs) is used as the first-line drug followed by steriods, methotexate(MTX), salazosulfadimidine (SASP), Bisphosphonates and TNF-α inhibitor. Two refractory cases received combination therapy with Bisphosphonates and TNF-α inhibitor, and achieved good therapeutic effect. Conclusions The present study described a multicenter series of CNO from south China and highlighted the clinical features, laboratory tests, imaging characteristics and treatment outcomes. Increasing awareness of this disease is important to decrease time to diagnosis, improve access to treatment, and reduce complications.

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Tracheo-bronchial foreign bodies: our experience at a tertiary care hospital

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20161848 ◽

2016 ◽

Author(s):

Shashidhar S. Suligavi ◽

Mallikarjun N. Patil ◽

S. S. Doddamani ◽

Chandrashekarayya S. Hiremath ◽

Afshan Fathima

Keyword(s):

Foreign Body ◽

Early Diagnosis ◽

Foreign Bodies ◽

Tertiary Care ◽

Case Series ◽

Team Work ◽

Care Hospital ◽

Retrospective Case ◽

Presenting Symptoms ◽

Case Series Study

Background:Tracheo- bronchial foreign bodies have always posed a challenge to the ENT surgeon as they present with varied symptomatology ranging from a simple cough and fever to more grave respiratory distress. It requires a strong suspicion, early diagnosis and timely intervention to reduce the overall morbidity and mortality .This study was undertaken to highlight our experiences in handling cases of tracheo- bronchial foreign bodies (FB) at our setup.Methods:It is a retrospective case series study conducted in S. Nijalingappa Medical College between January 2011 and January 2015. Results:Most commonly affected were children between 1year to 3years of age. Chronic cough and wheeze were the commonest presenting symptoms. Vegetative foreign body was found to be the commonest variety of foreign body. The mortality rate in our study was 4.7% (n=3).Conclusions:A good clinical acumen, team work, early diagnosis and timely intervention are all needed to reduce the overall mortality and morbidity associated with tracheo- bronchial foreign bodies.

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Clinical Features of Type B Insulin Resistance in Japanese Patients: Case Report and Survey-Based Case Series Study

Journal of Diabetes Research ◽

10.1155/2020/4359787 ◽

2020 ◽

Vol 2020 ◽

pp. 1-11 ◽

Cited By ~ 1

Author(s):

Yusuke Hirota ◽

Hirotsugu Suwanai ◽

Toshimasa Yamauchi ◽

Takashi Kadowaki

Keyword(s):

Insulin Resistance ◽

Autoimmune Diseases ◽

Lupus Erythematosus ◽

Age Of Onset ◽

Cold Treatment ◽

Case Series ◽

Japanese Patients ◽

Type B ◽

Case Series Study ◽

Series Study

Type B insulin resistance (TBIR) is an extremely rare disease characterized by marked hyperglycemia and insulin resistance and often coexists with autoimmune diseases. The characteristics, symptoms, blood glucose patterns, comorbidities, and treatments of TBIR all vary and are not defined. In this study, we described a case of TBIR that developed 6 months after DPP-4 inhibitor administration and immediately after the patient caught a cold. Treatment using prednisolone and insulin-like growth factor-1 was effective. We also conducted an observational survey-based case series study in a Japanese cohort comprising 21 cases. The average age of onset of TBIR was 62.3±14.8 (17–84) years, and 61.9% of subjects were male. The majority of patients (90.4%) were 50 years old and over. During the study period, there was a high percentage (85.7%) of episodes of hypoglycemia, which was the trigger for diagnosis in more than 50% of cases. Glycemic patterns included 7 cases of hyperglycemia (33.3%), 10 cases of hypoglycemia (47.6%), and 4 cases of both hyperglycemia and hypoglycemia (19.1%). In the hypoglycemic group, 90.0% of patients were male. Furthermore, 71.4% of cases were antinuclear antibody positive, and 81.0% of cases were complicated with autoimmune disease. Systemic lupus erythematosus (38.1%) and Sjögren’s syndrome (23.8%) were relatively common as coexisting autoimmune diseases. Treatment was based on prednisolone use, which was used in 88.9% of patients. On the other hand, the effect of IGF-1 was limited. Overall, the prognosis of TBIR was good.

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Serial changes in the aqueous IL-10 level after intravitreal methotrexate injection as an indicator of primary vitreoretinal lymphoma recurrence

Scientific Reports ◽

10.1038/s41598-020-73111-2 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Young Gun Park ◽

Woo-Kyung Park ◽

Rae-Young Kim ◽

Mirinae Kim ◽

Young-Hoon Park

Keyword(s):

Case Series ◽

Disease Recurrence ◽

Rapid Reduction ◽

Primary Vitreoretinal Lymphoma ◽

Case Series Study ◽

Tnf Α ◽

Vitreoretinal Lymphoma ◽

Series Study ◽

Necrosis Factor

Abstract Primary vitreoretinal lymphoma (PVRL) often masquerades as other uveitic diseases. We investigated the aqueous cytokine level changes and the effects of intraocular methotrexate (MTX) in patients with PVRL. In this retrospective consecutive case-series study, we reviewed the records of 14 consecutive patients with PVRL treated between 2018 and 2020. The concentrations of interleukin (IL)-2, IL-6, IL-10, IL-12, IL-17, interferon (IFN)-γ, and tumor necrosis factor (TNF)-α were determined at baseline and several time points after intravitreal MTX injections during follow-up. Markedly elevated IL-10 levels and a higher IL-10/IL-6 ratio were found in patients with PVRL. The aqueous levels of IL-10, IL-12, and TNF-α, and the IL-10/IL-6 ratio significantly decreased at 1 month after intravitreal MTX therapy onset compared with the baseline values (P = 0.001, 0.002, 0.001, and 0.001, respectively). The mean duration to normalized IL-10 levels was 1.17 ± 0.4 months. Where serially recorded IL-10 levels were available, regular intravitreal MTX treatment was associated with rapid reduction in IL-10 levels, while elevated IL-10 level was associated with disease recurrence. Elevated IL-10 levels and high IL-10/IL-6 ratio may aid in the diagnosis of PVRL. Aqueous IL-10 level monitoring can help assess the therapeutic response and indicate disease recurrence.

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Isolated Shear Fracture of the Metatarsal Head in Lesser Toes Treated With ORIF: Case Series

Foot & Ankle International ◽

10.1177/1071100720952794 ◽

2020 ◽

pp. 107110072095279

Author(s):

Ying Li ◽

Wenjing Li ◽

Shaoliang Li ◽

Yan Wang ◽

Shengsheng Guan ◽

...

Keyword(s):

Shear Fracture ◽

Case Series ◽

Metatarsal Head ◽

Ct Scans ◽

Activity Levels ◽

Retrospective Case ◽

Level Of Evidence ◽

Imaging Characteristics ◽

Case Series Study

Background: Isolated shear fractures of a metatarsal head in the lesser toes are rare in clinical practice. We report the clinical and imaging characteristics, and treatment results, of these fractures. Methods: A retrospective consecutive case-series study was performed on 7 patients with symptomatic isolated shear fracture of a metatarsal head in the lesser toes who were operatively treated using open reduction and internal fixation (ORIF). Radiographs and computed tomographic (CT) scans of the patients were analyzed. The American Orthopaedic Foot & Ankle Society–lesser metatarsophalangeal-interphalangeal (AOFAS-LMI) score, visual analog scale (VAS) score, and passive dorsiflexion range of motion (ROM) of the metatarsophalangeal (MTP) joint were determined preoperatively and at final follow-up. Postoperative complications were also recorded. Results: There were 5 males and 2 females, with a mean age of 21 years (range, 16-36) at the time of surgery. Four fractures occurred at the fourth metatarsal. There were 3 chronic cases, 1 was not diagnosed initially; the other 2 failed conservative treatment. The main symptom of the chronic fractures was limited dorsiflexion at the MTP joint. Preoperative radiographs and CT scans revealed dorsal displacement of the fragment without dislocation of the MTP joint. At the final follow-up (mean, 17.4 months; range 9-27), the AOFAS-LMI scores had improved from 70.6 (range, 59-79) preoperatively to 93.3 (range, 92-100) ( P = .001). VAS scores showed a decrease in pain from 4.0 to 0.0 ( P = .016). Mean passive dorsiflexion ROM of the MTP joint improved significantly from 8.6 degrees preoperatively to 35.7 degrees at final follow-up ( P < .001). All patients returned to their respective preinjury activity levels. Conclusion: Patients with an acute or chronic isolated shear fracture of a metatarsal head in the lesser toes treated by ORIF achieved good short-term clinical and radiologic outcomes. Level of Evidence: Level IV, retrospective case series.

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Amebic Liver Abscess

Sultan Qaboos University Medical Journal [SQUMJ] ◽

10.18295/squmj.6.2021.083 ◽

2021 ◽

Author(s):

Nenad Pandak ◽

Sirous Golchinheydari ◽

Asmaa S Mahdi ◽

Ali Al Majrafi ◽

Stephen S Deenadayalan ◽

...

Keyword(s):

Liver Abscess ◽

Case Series ◽

Amebic Liver Abscess ◽

Royal Hospital ◽

Imaging Characteristics ◽

Case Series Study ◽

Patient Database ◽

History Of ◽

Travel Abroad ◽

Series Study

Objective: Amebic liver abscess (ALA) is endemic to many areas of the world. In this study we sought to investigate the epidemiology, presentation, laboratory tests and imaging characteristics related to ALA in Oman and ultimately determine whether ALA is native to Oman or is it imported from abroad. Methods: This case series study was conducted at Royal Hospital Muscat, Oman. Patient data was extracted from the Royal Hospital patient database and included patients older than 13 years of age, discharged with the discharge diagnosis of ALA from January 2013 to December 2017. Results: 22 patients were included in the study. The results showed 18 Omani patients and 4 expatriates. Only two Omanis had history of travel abroad. 15 patients were male and 7 females. The average age was 45.2. The most common presentation was abdominal pain seen in 17 patients. Fever was seen in 13 patients. Alanine transferase was found to be elevated in 13 patients. 90% of patients had no symptomatic infections prior to developing ALA. Conclusion: The data suggests that ALA is endemic to Oman given the higher number of local patients and the lack of travel abroad in this population. As the number of treated ALA patients is rather small, it can be concluded that the occurrence of ALA is much lower in Oman as compared to other endemic areas. The majority of patients had no prior symptomatic infections and thus a method of control would be to screen and prevent amebic spread. Keywords: Amebic liver abscess, Amebiasis, liver abscess, Entamoeba histolytica, Royal Hospital, Oman

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P.098 Evaluation and surgical management of pelvic peripheral nerve sheath tumors: the University of Toronto experience and review of literature

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.182 ◽

2017 ◽

Vol 44 (S2) ◽

pp. S38-S38

Author(s):

S Wang ◽

Z Merali ◽

F Pirouzmand

Keyword(s):

Peripheral Nerve ◽

English Language ◽

Case Series ◽

Tumor Location ◽

Presenting Symptoms ◽

Nerve Sheath Tumors ◽

Peripheral Nerve Sheath Tumors ◽

Nerve Sheath ◽

Imaging Characteristics ◽

Surgical Technical

Background: Pelvic peripheral nerve sheath tumors (PNST), which includes neurofibroma, schwannoma, and MPNST, are rare tumors located in the retroperitoneum. Methods: The case records of a prospectively maintained database at Sunnybrook Health Sciences Center (SHSC) were reviewed to identify patients with pelvic PNST, managed between 2006 - 2016. Medical records were retrospectively reviewed for patient demographics, presentation, tumor location, symptoms, imaging characteristics, management, and outcome. The surgical technical caveats were described. An English language literature review was performed to describe previously published experiences. Results: The series consisted of 7 patients, ranging from 22 - 74 years of age at presentation. These lesions tend to be large at the time of diagnosis, and presenting symptoms include abdominal, flank, or back pain, as well as leg edema or hydronephrosis from local compression. Most patients in this cohort were managed surgically with midline abdominal transperitoneal exposures. Lastly, 5 tumors were benign schwannomas managed with gross total resection or debulking, while 2 patients had MPNSTs managed with biopsy followed by adjuvant chemoradiation therapy. Conclusions: In this case series, we describe the characteristics, evaluation, and management of 7 patients with pelvic PNST at a major healthcare institution in Toronto, Canada, highlighting the technical aspects of managing this rare and challenging entity.

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Juvenile open angle glaucoma –A case series study

Indian Journal of Clinical and Experimental Ophthalmology ◽

10.18231/j.ijceo.2021.089 ◽

2021 ◽

Vol 7 (2) ◽

pp. 448-451

Author(s):

Shams Mohammed Noman

Keyword(s):

Visual Acuity ◽

Intraocular Pressure ◽

Age Of Onset ◽

Open Angle Glaucoma ◽

Clinical Manifestations ◽

Case Series ◽

Open Angle ◽

Case Series Study ◽

Pre Treatment ◽

Field Defects

Juvenile open angle glaucoma is a rare form of glaucoma that differs from primary open angle glaucoma in its age of onset and magnitude of intraocular pressure.Juvenile open angle glaucoma has its onset between 3-40 years of age with relatively high intraocular pressure. For the documentation and describe clinical manifestations management and outcome of management of the patients diagnosed as Juvenile open-angle glaucoma at the glaucoma department, CEITC, Chittagong, Bangladesh. This is a hospital based prospective observational case series review. 20 patients who were diagnosed as Juvenile open-angle glaucoma from November 2010 to December 2011 were included in this study.Patient particulars history with main causes of hospital presentations were recorded. Ophthalmic examinations and management given were documented. Similar relevant details were recorded for different follow-up periods. 40 eyes of 20 patients were included in this study. There were 16 male and 4 female. All cases were bilateral. Age more than 18yrs. (18-35) in 16 patients and below 18yrs. (5-18) in 4 patients. 15 patients came from rural area and 5 patients from urban. Pretreatment average IOP in the both eyes was 32±3mmhg, which was 15±1mmhg after treatment. 24 of 40 eyes were presented with advance field defects. 85% (17 patients) had myopic refractive error. In 18eyes pre treatment presenting visual acuity was <6/60 and >6/60 in the rest of the eyes. Visual acuity was improved after treatment. In 21 patients (53%) IOP was controlled with 2-3 medications. In 19 eyes (48%) IOP was controlled with filtration surgery. As Juvenile open-angle glaucoma presented with high IOP and advance field defect, early diagnosis, appropriate investigations and medical or surgical management is mandatory to stabilize IOP and to prevent progression of field defects.

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Clinical characteristics and outcomes in women and men hospitalized for coronavirus disease 2019 in New Orleans

Biology of Sex Differences ◽

10.1186/s13293-021-00359-2 ◽

2021 ◽

Vol 12 (1) ◽

Cited By ~ 2

Author(s):

Yilin Yoshida ◽

Scott A. Gillet ◽

Margo I. Brown ◽

Yuanhao Zu ◽

Sarah M. Wilson ◽

...

Keyword(s):

New Orleans ◽

Gender Equity ◽

Clinical Characteristics ◽

Invasive Mechanical Ventilation ◽

Tertiary Care ◽

Case Series ◽

Hospital Death ◽

Chronic Obstructive ◽

Presenting Symptoms ◽

Case Series Study

Abstract Objectives Determine if sex differences exist in clinical characteristics and outcomes of adults hospitalized for coronavirus disease 2019 (COVID-19) in a US healthcare system. Design Case series study. Setting and participants Sequentially hospitalized adults admitted for COVID-19 at two tertiary care academic hospitals in New Orleans, LA, between 27 February and 15 July 2020. Measures and outcomes Measures included demographics, comorbidities, presenting symptoms, and laboratory results. Outcomes included intensive care unit admission (ICU), invasive mechanical ventilation (IMV), and in-hospital death. Results We included 776 patients (median age 60.5 years; 61.4% women, 75% non-Hispanic Black). Rates of ICU, IMV, and death were similar in both sexes. In women versus men, obesity (63.8 vs 41.6%, P < 0.0001), hypertension (77.6 vs 70.1%, P = 0.02), diabetes (38.2 vs 31.8%, P = 0.06), chronic obstructive pulmonary disease (COPD, 22.1 vs 15.1%, P = 0.015), and asthma (14.3 vs 6.9%, P = 0.001) were more prevalent. More women exhibited dyspnea (61.2 vs 53.7%, P = 0.04), fatigue (35.7 vs 28.5%, P = 0.03), and digestive symptoms (39.3 vs 32.8%, P = 0.06) than men. Obesity was associated with IMV at a lower BMI (> 35) in women, but the magnitude of the effect of morbid obesity (BMI ≥ 40) was similar in both sexes. COPD was associated with ICU (adjusted OR (aOR), 2.6; 95%CI, 1.5–4.3) and IMV (aOR, 1.8; 95%CI, 1.2–3.1) in women only. Diabetes (aOR, 2.6; 95%CI, 1.2–2.9), chronic kidney disease (aOR, 2.2; 95%CI, 1.3–5.2), elevated neutrophil-to-lymphocyte ratio (aOR, 2.5; 95%CI, 1.4–4.3), and elevated ferritin (aOR, 3.6; 95%CI, 1.7–7.3) were independent predictors of death in women only. In contrast, elevated D-dimer was an independent predictor of ICU (aOR, 7.3; 95%CI, 2.7–19.5), IMV (aOR, 6.5; 95%CI, 2.1–20.4), and death (aOR, 4.5; 95%CI, 1.2–16.4) in men only. Conclusions This study highlights sex disparities in clinical determinants of severe outcomes in COVID-19 patients that may inform management and prevention strategies to ensure gender equity.

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Force Plate Analysis of Dogs with Bilateral Hip Dysplasia Treated with a Unilateral Triple Pelvic Osteotomy: A Long-term Review of Cases

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.1055/s-0038-1632616 ◽

1998 ◽

Vol 11 (02) ◽

pp. 85-93 ◽

Cited By ~ 10

Author(s):

Joanne R. Cockshutt ◽

H. Dobson ◽

C. W. Miller ◽

D. L. Holmberg ◽

Connie L. Taves ◽

...

Keyword(s):

Gait Analysis ◽

Hip Dysplasia ◽

Weight Bearing ◽

Force Plate ◽

Case Series ◽

Pelvic Osteotomy ◽

Vertical Force ◽

Long Term Outcome ◽

Case Series Study

SummaryA retrospective case series study was done to determine the long-term outcome of operations upon dogs treated for canine hip dysplasia by means of a triple pelvic osteotomy (TPO). Twentyfour dogs with bilateral hip dysplasia, that received a unilateral TPO between January 1988 and June 1995, were re-examined at the Ontario Veterinary College. The assessment included physical, orthopedic and lameness examinations, standard blood work, pelvic radiographs and force plate gait analysis. They were compared to bilaterally dysplastic dogs that had not been treated, and also to normal dogs. Force plate data analysis demonstrated a significant increase in peak vertical force (PVF) and mean vertical force over stance (MVF) in the limb that underwent surgical correction by means of a TPO, when compared to the unoperated hip. It was determined that performing a unilateral TPO on a young dysplastic dog resulted in greater forces and weight bearing being projected through the TPO corrected limb when compared to the unoperated limb.Dogs with bilateral hip dysplasia treated with a unilateral triple pelvic osteotomy (TPO) were assessed by force plate gait analysis, radiographs and orthopedic examination. There was a significant increase in hip Norberg angles over time, although degenerative changes did progress. Limbs that had been operated upon had significantly greater peak and mean ground reaction forces than limbs that had not received an operation.

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