Prescreening For Osteoporosis With Forearm Bone Densitometry In Health Examination Population

Background: Early detection and timely prophylaxis can retard the progression of osteoporosis. The purpose of this study was to determine the usefulness of peripheral Dual Energy X-ray Absorptiometry(DXA) for osteoporosis screening. We utilized AKDX-09W-I, a domestic brand instrument to perform peripheral DXA. Briefly, we acquired bone mineral density (BMD) data from manufacturer-supplied density-gradient phantoms and 30 volunteers to investigate its accuracy and precision, then we measured BMD from 150 volunteers using both AKDX (left forearm) and Hologic Discovery Wi (left forearm, left hip and L1 - L4 vertebrae) simultaneously. Correlation analysis of BMD results from two instruments was assessed by simple linear regression, the Receiver Operating Characteristic (ROC) curves and Areas Under the Curves (AUCs) were evaluated for the diagnostic value of left forearm BMD from AKDX in detecting osteoporosis.Results: In vitro precision errors of AKDX BMD were 0.40%, 0.20%, 0.19%, respectively, on low-, medium-, and high-density phantom; in vivo precision was 1.65%. Positive correlation was observed between AKDX BMD and Hologic BMD at the forearm (r = 0.670), L1–L4 (r = 0.430, femoral neck (r = 0.449), and total hip (r = 0.559). With Hologic DXA T-score as the gold standard, the sensitivity of AKDX T-score < -1 for identifying suboptimal bone health was 63.0% and 76.1%, respectively, at the distal one-third radius and at any site, and the specificity was 73.9% and 90.0%, respectively; the AUCs were 0.708 and 0.879. The sensitivity of AKDX T-score ≤ -2.5 for identifying osteoporosis at the distal one-third radius and at any site was 76.9% and70.4%, respectively, and the specificity was 80.4% and 78.0%, respectively; the AUCs were 0.823 and 0.778.Conclusions: Peripheral DXA appears to be a reliable tool for prescreening for osteoporosis.

NICOLAU SYNDROME IN A CHILD FOLLOWING IV CLINDAMYCIN INJECTION-DECODING THE PURPLE PUZZLER

Nicolau syndrome is a rare complication of intramuscular injections caused by various drugs that present with intense pain and induration at the injection site. It is characterized by local aseptic skin necrosis and rarely, muscle necrosis on the injection site. It has rarely been reported to occur after intramuscular injections of anti-inammatory drugs, corticosteroids, local anesthetics, penicillin and interferon. Our literature review revealed no cases of Nicolau syndrome following intravenous (IV) clindamycin injections. Herein, we report a case of Nicolau syndrome that occurred after IV clindamycin injection in the left forearm of a 1.5-year child, that was notable because of the uniqueness of the syndrome coupled with the fact that it has not previously been reported after intravenous clindamycin injection.

Itch evoked by the rubber hand illusion

It has been well-established that expectancies can influence itch intensity. It remains to be established whether psychological processes can lead to non-itchy input being perceived as itchy. The current study aimed to investigate whether healthy individuals perceive non-itchy tactile stimulation (rubbing) as itchy when having the illusion that an itch stimulus is applied (using the rubber hand illusion; RHI). Moreover, it was investigated whether this effect depended on psychological characteristics, including expectancies. In 36 healthy female volunteers, ownership over the rubber arm was induced in a standard RHI setup. After assessing the itch-inducing properties of merely rubbing, baseline itch was evoked by rubbing cowhage spicules (pruritogenic tropical bean particles) onto the left forearm. Cowhage was kept on the arm for some minutes (follow-up phase). Similarly, cowhage was subsequently applied onto the rubber arm, while the participant’s concealed right arm was simultaneously rubbed without cowhage. Mean (mean=0.8, SD=1.1) and peak itch (mean=1.3, SD=1.4) significantly differed from zero (t=5.74, p&lt;0.001 and t=6.89, p&lt;0.001, respectively). Expectations did not mediate the effect, but self-reported attention to itch (PVAQ-itch) was positively associated with itch during follow-up. Low levels of itch were induced using the RHI paradigm, demonstrating the role of psychological factors in itch perception.

Rickettsia burneti and Brucella melitensis co-infection: a case report and literature review

Rickettsia is the pathogen of Q fever, Brucella ovis is the pathogen of brucellosis, and both of them are Gram-negative bacteria which are parasitic in cells. The mixed infection of rickettsia and Brucella ovis is rarely reported in clinic. Early diagnosis and treatment are of great significance to the treatment and prognosis of brucellosis and Q fever. Here, we report a case of co-infection Rickettsia burneti and Brucella melitensis. The patient is a 49-year-old sheepherder, who was hospitalized with left forearm trauma. Three days after admission, the patient developed fever of 39.0°C, accompanied by sweating, fatigue, poor appetite and headache. Indirect immunofluorescence (IFA) was used to detect Rickettsia burneti IgM. After 72 hours of blood culture incubation, bacterial growth was detected in aerobic bottles, Gram-negative bacilli were found in culture medium smear, the colony was identified as Brucella melitensis by mass spectrometry. Patients were treated with doxycycline (100 mg bid, po) and rifampicin (600 mg qd, po) for 4 weeks. After treatment, the symptoms disappeared quickly, and there was no sign of recurrence or chronic infection. Q fever and Brucella may exist in high-risk practitioners, so we should routinely detect these two pathogens to prevent missed diagnosis.

Studi Keluhan Musculoskeletal Disorder (MSDs) di UD. Berkah Alam Tahun 2021

The rapid progress in the industrial sector has an important role in growing the economy. Without the industrial sector, growth in developing countries will be slower than in previous years. UD. Berkah Alam is one of the informal industrial sectors that focuses on coconut management. The types of jobs available at UD. The blessings of Nature are the pacak part, the scrap part, the daily part and the copra part. This type of work has a risk of musculoskeletal disorders. The study was conducted with the aim of knowing the prevalence of complaints of Musculoskeletal Disorders (MSDs) in each work section. The method used is a survey using a nordic body map using a questionnaire. The results showed that 59% of all workers experienced complaints of pain or pain, especially in the musculoskeletal system. Workers who experience complaints on the musculoskeletal system are highest in the copra (100%). Complaints of disorders experienced by workers of the right shoulder, left shoulder, buttocks, buttocks, right forearm and left forearm.

Eccrine Nevus in the Forearm of a 16-Year-Old Presenting as Unilateral Hyperhidrosis: A Clinicopathological Correlation Paradigm

A case of a purely eccrine nevus in an adolescent patient presenting with focal hyperhidrosis on an area comprising the left forearm and the dorsal aspect of the left hand is described. No clinically evident lesions were identifiable. Dermatopathologic findings were subtle, showing only a slight increase in the number of eccrine glands. Clinicopathological correlation was paramount to achieve the diagnosis.

Posterior Interosseous Fascicular Constriction Within the Radial Nerve in a Diabetic Patient With Bilateral Neuralgic Amyotrophy: A Case Report

Background: Neuralgic amyotrophy (NA) is an acute, monophasic, painful inflammatory dysimmune focal, or multifocal mononeuropathy. The lesion in NA is not always restricted to the brachial plexus but also involves individual nerves or branches. The prognosis of NA is less favorable than previously assumed, but the reasons for poor recovery remain unknown. Nerve constriction may be one of the causes of poor prognosis in NA.Case Presentation: Herein, we described a 54-year-old male with a history of type 2 diabetes in whom bilateral neuralgic amyotrophy developed with constriction of the posterior interosseous fascicle within the radial nerve. The patient experienced sudden-onset severe pain in both shoulders followed, 2 days later, by weakness in bilateral shoulders and the left forearm extensors over the subsequent month. The left forearm extensors were more severely affected than both shoulder girdle muscles. He noted a 7-kg weight loss for 1 month before pain onset. After diagnosing diabetic NA based on the clinical symptoms, imaging, and electrophysiological studies, treatment with systemic steroids improved pain and weakness in both shoulder muscles. Weakness in the left forearm extensors persisted after 1 month of steroid treatment. Follow-up ultrasound revealed constriction of the posterior interosseous fascicle within the main trunk of the left radial nerve at the elbow. Surgical exploration at 6 months after onset identified fascicle constriction, for which neurolysis was performed. Weakness in the extensors of the wrist and fingers did not improve during the 16-month follow-up.Conclusion: A single constriction of the fascicle within a peripheral nerve may often be under-recognized if NA presents with variable degrees of weakness in bilateral upper limbs. Furthermore, fascicular constriction without edema of the parent nerve may be easily missed on the initial ultrasound. A lack of early recognition of nerve constriction and delay in surgical intervention can result in unfavorable outcomes. The physician should consider the possibility of the fascicular constriction when evaluating patients suspected of brachial NA with significant weakness in the distal upper limb compared to the proximal weakness or weakness of the distal upper limb that does not improve over time.

Human gnathostomiasis in Sri Lanka: An underreported disease?

Highlight A healthy young man from Sri Lanka, currently living in Switzerland, consulted at the University Hospital of Geneva with a history of painful erythema and swelling of the left forearm. Laboratory tests showed a slight eosinophilia. Western blot serology for Gnathostoma spp, inconclusive at presentation, became positive two weeks later.

Subcutaneous Aspergillus nodule with cutaneous Enterococcus infection

ABSTRACT An 87-year-old woman presented with a subcutaneous nodule with overlying black and yellow scales on the surface located on the left forearm. Enterococcus faecalis grew up in bacterial culture using specimen from skin surface scale. And Aspergillus fumigatus was detected in the subcutaneous tissue culture. When suspecting a deep infection, not only the surface part but also the deeper part must be cultured, because we may mislead about the identity of the infectious organism only bacterial culture form skin surface.

Patient-Specific Guided Osteotomy to Correct a Symptomatic Malunion of the Left Forearm

We present a case report of a 12-year old female with a midshaft forearm fracture. Initial conservative treatment with a cast failed, resulting in a malunion. The malunion resulted in functional impairment for which surgery was indicated. A corrective osteotomy was planned using 3D analyses of the preoperative CT-scan. Subsequently, patient-specific guides were printed and used during the procedure to precisely correct the malunion. Three months after surgery, the radiographs showed full consolidation and the patient was pain-free with full range of motion and comparable strength in both forearms. The current case report shows that a corrective osteotomy with patient-specific guides based on preoperative 3D analyses can help surgeons to plan and precisely correct complex malunions resulting in improved functional outcomes.