Musculoskeletal Brucellosis in Adults in the United Arab Emirates: A Retrospective Study

Introduction: Brucellosis is a zoonotic infection caused by the aerobic Gram-negative bacteria coccobacilli, and is considered a public health problem in the Mediterranean region and Arabian Peninsula. This paper studied the clinical characteristics of musculoskeletal brucellosis and the outcomes of treatment in Al Ain City, United Arab Emirates. Method: A retrospective chart review study was conducted at Tawam Hospital over seven years: January 2009–January 2016. Risk factors for brucellosis, musculoskeletal (MSK) manifestations, duration of Brucella infection (acute, subacute, chronic), and treatment were studied. Results: A total of 99 patients were diagnosed with brucellosis during the study period; the mean age was 44 years, the majority were males (71%), and the male to female ratio was 3:1. The most common risk factor for Brucella infection in the cohort was drinking raw milk (43.4%). Fever was the most common presenting symptoms (93%), followed by arthralgia, fatigue, and loss of appetite in 35, 21, and 14%, respectively. The clinical manifestations of brucellosis in the cohort were MSK involvement (30%), hepatitis (17%), epididymo-orchitis (2%), and endocarditis (1%). Thirty percent of patients (n=30) had MSK-specific symptoms and only one-third (n=10) had confirmatory positive radiographic findings. The majority of patients had lumbar and sacroiliac joint involvement. Most of the patients received antibiotics for a 4–8-week duration and the overall relapse rate of Brucella infection was 10%. Conclusion: This study demonstrates that MSK involvement is a common manifestation in brucellosis, occurring in one-third of the cases. The index of suspicion should be high in brucellosis-endemic countries for early recognition and treatment.

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Arthritis in children with LRBA deficiency – case report and literature review

Pediatric Rheumatology ◽

10.1186/s12969-019-0388-4 ◽

2019 ◽

Vol 17 (1) ◽

Cited By ~ 1

Author(s):

Rotem Semo Oz ◽

Melissa S. Tesher

Keyword(s):

Case Report ◽

Literature Review ◽

Rheumatic Disease ◽

Case Reports ◽

Clinical Manifestations ◽

Immune Dysregulation ◽

Joint Involvement ◽

Female Ratio ◽

Minimal Data ◽

Lrba Deficiency

Abstract Background Lipopolysaccharide (LPS)-responsive and beige like anchor (LRBA) deficiency is categorized as a subtype of common variable immune deficiency (CVID). A growing number of case reports and cohorts reveal a broad spectrum of clinical manifestations and variable phenotype expression, including immune dysregulation, enteropathy and recurrent infections. The association between rheumatic disease and CVID generally has been well established, arthritis has been less frequently reported and minimal data regarding its clinical features and characteristic in LRBA deficiency has been published. This case report and literature review evaluates the characteristics and features of arthritis in LRBA deficiency patients. Case presentation and review results Herein, we describe a unique case of LRBA deficiency first presented with poly articular arthritis. Alongside the report, a literature review focusing on LRBA deficiency, rheumatic disease and arthritis has been conducted. We reviewed 43 publications. Among these, 7 patients were identified with arthritis. Age of first presentation was six weeks to 3 years. Male to female ratio was 4/3. Two patients were diagnosed with polyarticular Juvenile idiopathic arthritis (JIA) and three with oligoarticular JIA. Each patient was found to have different genomic mutation. The treatment was diverse and included corticosteroids, cyclosporine, methotrexate, adalidumab and abatacept. Conclusion Joint involvement is variable in LRBA deficiency, hence it should always be kept in mind as a differential diagnosis for a patient with combination of juvenile arthritis and clinically atypical immune dysregulation and / or immunodeficiency.

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COVID-19 in Hospitalized Adults With HIV

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa327 ◽

2020 ◽

Vol 7 (8) ◽

Cited By ~ 1

Author(s):

Kate Stoeckle ◽

Carrie D Johnston ◽

Deanna P Jannat-Khah ◽

Samuel C Williams ◽

Tanya M Ellman ◽

...

Keyword(s):

Clinical Characteristics ◽

Invasive Mechanical Ventilation ◽

Clinical Manifestations ◽

Supplemental Oxygen ◽

Control Group ◽

Electronic Health Record Data ◽

Duration Of Symptoms ◽

Radiographic Findings ◽

Presenting Symptoms ◽

And Control

Abstract Background The spread of SARS-CoV-2 and the COVID-19 pandemic have caused significant morbidity and mortality worldwide. The clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 and HIV co-infection remain uncertain. Methods We conducted a matched retrospective cohort study of adults hospitalized with a COVID-19 illness in New York City between March 3, 2020, and May 15, 2020. We matched 30 people with HIV (PWH) with 90 control group patients without HIV based on age, sex, and race/ethnicity. Using electronic health record data, we compared demographic characteristics, clinical characteristics, and clinical outcomes between PWH and control patients. Results In our study, the median age (interquartile range) was 60.5 (56.6–70.0) years, 20% were female, 30% were black, 27% were white, and 24% were of Hispanic/Latino/ethnicity. There were no significant differences between PWH and control patients in presenting symptoms, duration of symptoms before hospitalization, laboratory markers, or radiographic findings on chest x-ray. More patients without HIV required a higher level of supplemental oxygen on presentation than PWH. There were no differences in the need for invasive mechanical ventilation during hospitalization, length of stay, or in-hospital mortality. Conclusions The clinical manifestations and outcomes of COVID-19 among patients with SARS-CoV-2 and HIV co-infection were not significantly different than patients without HIV co-infection. However, PWH were hospitalized with less severe hypoxemia, a finding that warrants further investigation.

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Cerebral Venous Thrombosis Associated with COVID-19 Infection: An Observational, Multicenter Study

Cerebrovascular Diseases Extra ◽

10.1159/000516641 ◽

2021 ◽

pp. 55-60

Author(s):

Sajid Hameed ◽

Mohammad Wasay ◽

Bashir A. Soomro ◽

Ossama Mansour ◽

Foad Abd-allah ◽

...

Keyword(s):

Venous Thrombosis ◽

Scale Score ◽

United Arab Emirates ◽

Cerebral Venous Thrombosis ◽

Imaging Finding ◽

Elevated Serum ◽

Cerebrovascular Diseases ◽

Modified Rankin Scale ◽

Female Ratio ◽

Presenting Symptoms

Background and Purpose: Coronavirus disease 2019 (COVID-19) has an increased propensity for systemic hypercoagulability and thromboembolism. An association with cerebrovascular diseases, especially cerebral venous thrombosis (CVT), has been reported among these patients. The objective of the present study was to identify risk factors for CVT as well as its presentation and outcome in COVID-19 patients. Methods: This is a multicenter and multinational observational study. Ten centers in 4 countries (Pakistan, Egypt, Singapore, and the United Arab Emirates) participated in this study. The study included patients (aged >18 years) with symptomatic CVT and recent COVID-19 infection. Results: Twenty patients (70% men) were included. Their mean age was 42.4 years, with a male-to-female ratio of 2.3:1. Headache (85%) and seizures (65%) were the common presenting symptoms, with a mean admission Glasgow Coma Scale (GCS) score of 13. CVT was the presenting feature in 13 cases (65%), while 7 patients (35%) developed CVT while being treated for COVID-19 infection. Respiratory symptoms were absent in 45% of the patients. The most common imaging finding was infarction (65%), followed by hemorrhage (20%). The superior sagittal sinus (65%) was the most common site of thrombosis. Acute inflammatory markers were raised, including elevated serum D-dimer (87.5%), erythrocyte sedimentation rate (69%), and C-reactive protein (47%) levels. Homocysteine was elevated in half of the tested cases. The mortality rate was 20% (4 patients). A good functional outcome was seen in the surviving patients, with a mean modified Rankin Scale score at discharge of 1.3. Nine patients (45%) had a modified Rankin Scale score of 0–1 at discharge. Conclusion: COVID-19-related CVT is more common among males at older ages when compared to previously reported non-COVID-19-related CVT cases. CVT should be suspected in COVID-19 patients presenting with headache or seizures. Mortality is high, but functional neurological outcome is good among survivors.

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Screening household members of shepherds in brucellosis endemic areas in China and reporting follow-up results of asymptomatic infections

10.21203/rs.3.rs-30753/v1 ◽

2020 ◽

Author(s):

Jing Hu ◽

Huixin Yang ◽

Xiangyi Zhang ◽

Siwen Zhang ◽

Taijun Wang ◽

...

Keyword(s):

Clinical Manifestations ◽

Asymptomatic Infection ◽

Female Ratio ◽

Brucella Infection ◽

Male Female Ratio ◽

History Of ◽

Household Members ◽

Asymptomatic Infections ◽

Endemic Areas

Abstract Background: Brucellosis is a zoonotic infectious disease caused by brucella, patients often show obvious clinical manifestation, however, many cases of asymptomatic brucella infection were reported. Previous scholars have described or screened the asymptomatic infection, but little attention has been paid to the results. This research focused on the short-term results in patients with asymptomatic brucella infectionMethods: 595 household members of shepherds in brucellosis endemic areas were included, all of them have questionnaires and laboratory tests. Based on inclusion and exclusion criteria for the cohort, 15 asymptomatic infections were included and followed-up for 18months.Results: Among 595 subjects, 34(5.7%) were asymptomatic infections, 460(77.3%) were healthy, 58patients (9.7%) were diagnosed as brucellosis, 13(2.2%) suspected cases, 19(3.2%) cured cases and 11(1.8%) unclear diagnosis. Among 15 asymptomatic infections, the median age was 34 [12, 50] years, there were 40%cases <18 years old and the male-female ratio was 1.5:1, 60% cases were farmers and herdsmen, 11(73.3%) cases had a history of possible exposure to brucella. Average follow-up time was 10.47 ± 8.47 months. A total of 7 asymptomatic infections developed into brucellosis, of which five patients turned in the first month of follow-up, one patient in the second month, and one minor case turned in the seventh month. Remaining asymptomatic infections showed negative outcomes after 7 months of follow-up, among them, SAT titer decreased in two cases, no changes in SAT titer and clinical manifestations in six cases.Conclusions: Continued exposure to brucella may be a major risk factor for asymptomatic infection turn to brucellosis.

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Pediatric appendicitis- five year experience at tertiary care pediatric surgery department: a cohort study

International Surgery Journal ◽

10.18203/2349-2902.isj20202383 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1793

Author(s):

Manisha Albal ◽

Prasad Y. Bansod ◽

Deep Mashru

Keyword(s):

Cohort Study ◽

Acute Appendicitis ◽

Early Recognition ◽

Pediatric Population ◽

Iliac Fossa ◽

Tertiary Care ◽

Complication Rates ◽

Age Group ◽

Female Ratio ◽

Presenting Symptoms

Background: Acute appendicitis is one of the most common abdominal surgical condition in pediatric population. It accounts for 1-8% of children presenting in pediatric surgical emergency. The aim of this study was to evaluate pediatric appendectomy in our department.Methods: It was a hospital based prospective cohort study spanning over a period of 5 years, where all diagnosed cases of pediatric appendicitis were enrolled. Demographic profile, clinical features and operative findings were analyzed. Patients were kept on regular follow-up and complications were noted.Results: During the study period 146 patients were enrolled for the study. Male: female ratio was 1:1. Maximum patients belonged to age group of 11-15 years (42%). Pain in abdomen and fever were the most common presenting symptoms. Tenderness in right iliac fossa was the most common clinical sign (89.72%) and inflamed appendix was the most common operative finding in the study (83.91%).Conclusions: The diagnosis of acute appendicitis is based on clinical examination. Atypical symptoms may lead to delay in the diagnosis and management. Imaging and lab investigations are supportive. Early recognition of symptoms, access to healthcare facility with a surgeon can significantly reduce the morbidity and complication rates in pediatric age group.

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Severe Thrombocytopenic Purpura in a Child with Brucellosis: Case Presentation and Review of the Literature

Case Reports in Infectious Diseases ◽

10.1155/2017/3416857 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Alexandros Makis ◽

Aikaterini Perogiannaki ◽

Nikolaos Chaliasos

Keyword(s):

Antimicrobial Agents ◽

Brucella Melitensis ◽

Clinical Manifestations ◽

Public Health Problem ◽

Severe Thrombocytopenia ◽

Thrombocytopenic Purpura ◽

Hematological Disorders ◽

Presenting Symptoms ◽

Mediterranean Countries ◽

Significant Public Health

Brucellosis is still endemic and a significant public health problem in many Mediterranean countries, including Greece. It is a multisystemic disease with a broad spectrum of clinical manifestations including hematological disorders, such as anemia, pancytopenia, leucopenia, and thrombocytopenia. Thrombocytopenia is usually moderate and attributed to bone marrow suppression or hypersplenism. Rarely, autoimmune stimulation can cause severe thrombocytopenia with clinically significant hemorrhagic manifestations. We present the case of a girl with severe thrombocytopenic purpura as one of the presenting symptoms of Brucella melitensis infection. Treatment with intravenous immunoglobulin and the appropriate antimicrobial agents promptly resolved the thrombocyte counts. A review of similar published cases is also presented.

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Clinical manifestations of acute asthma in children at the Department of Child Health Cipto Mangunkusumo Hospital

Paediatrica Indonesiana ◽

10.14238/pi43.4.2003.132-5 ◽

2016 ◽

Vol 43 (4) ◽

pp. 132

Author(s):

Kadek Ayu Lestari ◽

Imam Budiman ◽

Sudigdo Sastroasmoro

Keyword(s):

Child Health ◽

Acute Asthma ◽

Early Recognition ◽

Clinical Manifestations ◽

Cross Sectional Study ◽

Cross Sectional ◽

Female Ratio ◽

Asthma Attack ◽

Pediatric Pulmonology ◽

Asthma In Children

Background Acute asthma is an asthma attack or worsening ofasthma manifestation and pulmonary function. Severe asthma at-tack might be prevented by early recognition of the attack and ap-propriate therapy. Clinical manifestations of asthma in children varywidely, so does the assessment of the attack that is often not accu-rately defined by doctors. This leads to delayed and inadequatetreatment of the attack.Objective This study aimed to know the clinical manifestationsof acute asthma in children at the Department of Child Health, Medi-cal School University of Indonesia/Cipto Mangunkusumo Hospi-tal.Methods This was a descriptive, cross sectional study, conductedat the emergency room (ER), the Pediatric Pulmonology Outpa-tient Clinic, and the Pediatric Outpatient Clinic. Subjects were asth-matics who were having attack and aged 2-18 year-old. Data ofage, sex, pulse rate, respiratory rate, duration of attack, expiratory,and inspiratory effort signs were obtained by history and physicalexamination followed by the assessment of attack severity.Results Subjects consisted of 92 children, mostly obtained fromthe ER (40%), with male to female ratio of 1.5:1 and average ageof 5.8 years old. Most of the subjects had mild attack (83%) andduration of attack of less than 24 hours (56%). Most subjects (70%)only had signs of increased expiratory effort, in which all of themhad mild attack. The rest of the subjects showed the combinationof inspiratory and expiratory efforts; 12 patients with mild attack,15 with moderate attack, and 1 with severe attack.Conclusion Patients who only showed expiratory effort usuallyhad mild attack. Patients showing expiratory and inspiratory ef-forts usually had mild or moderate attack. Treatment should betailored to the degree of attack

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Multiple Myeloma or Brucellosis: A Case Report

Infectious Disorders - Drug Targets ◽

10.2174/1871526519666190307123047 ◽

2020 ◽

Vol 20 (1) ◽

pp. 102-105 ◽

Cited By ~ 1

Author(s):

Hossein A. Rahdar ◽

Mansoor Kodori ◽

Mohamad R. Salehi ◽

Mahsa Doomanlou ◽

Morteza Karami-Zarandi ◽

...

Keyword(s):

Multiple Myeloma ◽

Brucella Melitensis ◽

Severe Disease ◽

Correct Diagnosis ◽

Clinical Manifestations ◽

Bone Marrow Aspiration ◽

Major Health Problem ◽

Brucella Infection ◽

Wide Range ◽

Parental Treatment

Background: Brucellosis, a major health problem in developing countries, is a multisystem infection with a broad spectrum of clinical manifestations. Hematological complications, ranging from an intravascular coagulopathy to mild homeostasis disorders (such as gammopathy), have been reported in brucella infection. These signs and symptoms may lead to misdiagnosis of brucellosis with other hematological diseases. Case: A 65-year-old male whose occupation was shepherding was referred to our hospital as a known case of multiple myeloma with continuous fever, muscle weakness, and night sweating after taking 2 courses of chemotherapy. The laboratory diagnosis of multiple myeloma had been based on the observation of a high percent of plasma cells in the bone marrow aspiration. At follow- up, the result of patient's fever workup, with 2 sets of blood cultures, was positive for Brucella melitensis. Isolated brucella was confirmed as B. melitensis by 16S rRNA sequencing. Brucellosis serologic test was performed by agglutination test and positive results were obtained. The patient was discharged with the cessation of fever and general improvement after the end of the parental treatment phase of brucella bacteremia. Conclusions: Brucella infection may cause a severe disease, mimicking a primary hematological disease, which could complicate the correct diagnosis. In brucellosis cases, due to the wide range of symptoms, in addition to cultivation and serological methods, molecular methods should also be used to prevent inappropriate diagnosis and additional costs.

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Possible role of Unani Pharmacology in COVID-19 – a narrative review

Reviews on Environmental Health ◽

10.1515/reveh-2020-0106 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Md Anzar Alam ◽

Mohd Abdul Gani ◽

G. Shama ◽

Ghulamuddin Sofi ◽

Mohd Aleemuddin Quamri

Keyword(s):

Clinical Manifestations ◽

Public Health Problem ◽

World Health ◽

Santalum Album ◽

Boswellia Serrata ◽

Unani Medicine ◽

Significant Public Health Problem ◽

Significant Public Health ◽

Novel Coronavirus ◽

Health Organization

AbstractAccording to the World Health Organization (WHO), viral diseases continue to rise, and pose a significant public health problem. Novel coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2. The pathogenesis and clinical manifestations of COVID-19 is close to Amraz-e-Wabai (epidemic diseases) which was described by Hippocrates, Galen, Aristotle, Razes, Haly Abbas, Avicenna, Jurjani etc. Presently, there is no specific or challenging treatment available for COVID-19. Renowned Unani Scholars recommended during epidemic situation to stay at home, and fumigate the shelters with aromatics herbs like Ood kham (Aquilaria agallocha Roxb.), Kundur (Boswellia serrata Roxb), Kafoor (Cinnamomum camphora L.), Sandal (Santalum album L), Hing (Ferula foetida L.) etc. Use of specific Unani formulations are claimed effective for the management of such epidemic or pandemic situation like antidotes (Tiryaqe Wabai, Tiryaqe Arba, Tiryaqe Azam, Gile Armani), Herbal Decoction (Joshandah), along with Sharbate Khaksi, Habbe Bukhar, Sharbate Zanjabeel, Khamira Marwareed, Jawarish Jalinus, and Sirka (vinegar). Such drugs are claimed for use as antioxidant, immunomodulatory, cardiotonic, and general tonic actions. The study enumerates the literature regarding management of epidemics in Unani medicine and attempts to look the same in the perspective of COVID-19 prevention and management.

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LINC-28. EPIDEMIOLOGICAL CHARACTERISTICS AND SURVIVAL OUTCOMES OF CHILDREN WITH MEDULLOBLASTOMA TREATED AT THE NATIONAL CANCER INSTITUTE (INCA) IN RIO DE JANEIRO, BRAZIL

Neuro-Oncology ◽

10.1093/neuonc/noaa222.462 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii383-iii384

Author(s):

Gabriela Oigman ◽

Diana Osorio ◽

Joseph Stanek ◽

Jonathan Finlay ◽

Denizar Vianna ◽

...

Keyword(s):

High Risk ◽

Maternal Education ◽

Survival Outcomes ◽

Middle Income ◽

Female Ratio ◽

High Risk Patients ◽

Presenting Symptoms ◽

Risk Patients ◽

Epidemiological Characteristics ◽

Standard Risk

Abstract BACKGROUND Medulloblastoma (MB), the most malignant brain tumor of childhood has survival outcomes exceeding 80% for standard risk and 60% for high risk patients in high-income countries (HIC). These results have not been replicated in low-to-middle income countries (LMIC), where 80% of children with cancer live. Brazil is an upper-middle income country according to World Bank, with features of LMIC and HIC. METHODS We conducted a retrospective review of 126 children (0–18 years) diagnosed with MB from 1997 to 2016 at INCA. Data on patients, disease characteristics and treatment information were retrieved from the charts and summarized descriptively; overall survival (OS) and event-free survival (EFS) were calculated using the Kaplan-Meier Method. RESULTS The male/female ratio was 1.42 and the median age at diagnosis was 7.9 years. Headache (79%) and nausea/vomiting (75%) were the most common presenting symptoms. The median time from onset of symptoms to surgery was 50 days. The OS for standard-risk patients was 69% and 53% for high-risk patients. Patients initiating radiation therapy within 42 days after surgery (70.6% versus 59.6% p=0.016) experienced better OS. Forty-five patients (35%) had metastatic disease at admission. Lower maternal education correlated with lower OS (71.3% versus 49% p=0.025). Patients who lived >40km from INCA fared better (OS= 68.2% versus 51.1% p=0.032). Almost 20% of families lived below the Brazilian minimum wage. CONCLUSIONS These findings suggest that socioeconomic factors, education, early diagnosis and continuous data collection, besides oncological treatment must be adressed to improve the survival of children with MB.

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