Epidemiology of clubfoot in Sweden from 2016 to 2019: A national register study

Background This study aimed to estimate the birth prevalence of children born with isolated or non-isolated clubfoot in Sweden using a national clubfoot register. Secondarily we aimed to describe the clubfoot population with respect to sex, laterality, severity of deformity, comorbidity and geographic location. Methods A national register, the Swedish Pediatric Orthopedic Quality register, was used to extract data on newborn children with clubfoot. To calculate the birth prevalence of children with isolated or non-isolated clubfoot between 1st of January 2016 and 31st of December 2019, we used official reports of the total number of Swedish live births from the Swedish Board of Statistics. The Pirani score and predefined signs of atypical clubfoot were used to classify clubfoot severity at birth. Results In total 612 children with clubfoot were identified. Of these, 564 were children with isolated clubfoot, generating a birth prevalence of 1.24/1000 live births (95% confidence interval 1.15–1.35). About 8% were children with non-isolated clubfoot, increasing the birth prevalence to 1.35/1000 live births (95% confidence interval 1.25–1.46). Of the children with isolated clubfoot, 74% were boys and 47% had bilateral involvement. The children with non-isolated clubfoot had more severe foot deformities at birth and a greater proportion of clubfeet with atypical signs compared with children with isolated clubfoot. Conclusion We have established the birth prevalence of children born with isolated or non-isolated clubfoot in Sweden based on data from a national register. Moreover, we have estimated the number of children born with atypical clubfeet in instances of both isolated and non-isolated clubfoot. These numbers may serve as a baseline for expected birth prevalence when planning clubfoot treatment and when evaluating time trends of children born with clubfoot.

Bilateral frontal intracranial xanthoma associated with type II hyperlipidemia in a 42-year-old woman: illustrative case

BACKGROUND Xanthoma is a granulomatous lesion that develops from leakage of circulating serum lipoprotein into the surrounding tissue. An isolated intracranial xanthoma is rarely reported and usually misdiagnosed. Intracranial xanthoma is also rarely found in patients with hyperlipidemia. To the best of the authors’ knowledge, no previous studies and literature have reported bilateral involvement of intracranial xanthoma in the frontal lobe. OBSERVATIONS The authors reported an unusual case of bilateral involvement of intracranial xanthoma in the frontal lobe with associated type II hyperlipidemia in a 42-year-old woman. Macroscopically, the tumor had an appearance of greyish-yellow color with a brittle, solid consistency. Histopathological examination revealed numerous lipid-laden macrophages surrounded by a cystic, necrotic, partially hemorrhagic area, with some parts consisting of hemosiderophages and proliferative capillary blood vessels. The histopathological findings indicated the characteristics of xanthoma. LESSONS Bilateral frontal intracranial xanthoma with associated type II hyperlipidemia is an unusual finding. Despite its rarity and wide variety of radiological presentations, it should be considered one of the differential diagnoses of lesions that develop intracranially and intraaxially. Confirmation with histopathological examination is needed to exclude from other differential diagnoses.

Predictors of COVID-19 Infection: A Prevalence Study of Hospitalized Patients

Aim. To find the predictors of coronavirus disease 2019 (COVID-19) in hospitalized patients. Methods. A prevalence study compared the characteristics of COVID-19 patients with non-COVID-19 patients from January 19, 2020, to February 18, 2020, during the COVID-19 outbreak. Laboratory test results and pulmonary chest imaging of confirmed COVID-19 and non-COVID-19 patients were collected by retrieving medical records in our center. Results. 96 COVID-19 patients and 122 non-COVID-19 patients were enrolled in this study. COVID-19 patients were older (53 vs. 39; P < 0.001) and had higher body mass index (BMI) than non-COVID-19 group (24.21 ± 3.51 vs. 23.00 ± 3.27, P = 0.011); however, differences in gender were not observed between the two groups. Logistic regression analysis showed that exposure history (OR: 23.34, P < 0.001), rhinorrhea (odds radio (OR): 0.12, P = 0.006), alanine aminotransferase (ALT) (OR: 1.03, P = 0.049), lactate dehydrogenase (LDH) (OR: 1.01, P = 0.020), lymphocyte (OR: 0.27, P = 0.007), and bilateral involvement on chest CT imaging (OR: 23.01, P < 0.001) were independent risk factors for COVID-19. Moreover, bilateral involvement on chest CT imaging (AUC = 0.904, P < 0.001) had significantly higher AUC than others in predicting COVID-19. Conclusions. Exposure history, elevated ALT and LDH, absence of rhinorrhea, lymphopenia, and bilateral involvement on chest CT imaging provide robust evidence for the diagnosis of COVID-19, especially in resource-limited conditions where nucleic acid detection is not readily available.

Osteonecrosis Development Post Covid-19 Infection

The COVID19 pandemic, originating in China, has spread across the world, with serious proportions in populations and public health. Systemic lesions in those infected generate cascading changes affecting different organs. Osteonecrosis is a bone pathology, of different etiologies, common throughout the world, which directs the hip to a disabling condition. Furthermore, there is a polygenic and multifactorial interaction in its pathophysiology. The objective of this paper is to present the first series of cases of osteonecrosis of the femoral head after infection by SARS-CoV-2 and to discuss the possible pathological mechanisms. This is a sample with a male majority with a mean age of 43.5 years, bilateral involvement of the hip sin 100% of cases, mean time between infection and onset of symptoms was 132.8 days. About 33% had osteonecrosis of the femoral head after a mild infection, 66% were moderate or severe cases that used corticosteroid therapy with a minimum dose of 40mg/day of dexamethasone for an average time of 14.6 days. We believe that the association of hypercoagulability mechanisms inherent to COVID-19, direct cell infection and instituted cortico therapy may be responsible for the high incidence of osteonecrosis in the post-covid syndrome.

CASE REPORT OF IDIOPATHIC BILATERAL ORBITAL MYOSITIS

Orbital myositis is an inflammatory disease affecting extraocular muscles. Mostly unilateral and rarely bilateral orbital involvement is seen. Bilateral involvement is a secondary table to systemic diseases and recurrence can be seen. Diagnosis is made by clinical, examination and imaging. Increased density of extraocular muscles and increased muscle mass should be seen in computed tomography or magnetic resonance imaging. The basis of the diagnosis is exclusion and the differential diagnosis needs to be done well. Steroids and other immunosuppressive agents may be used in the treatment. Patients respond dramatically to steroid treatment. While short-term steroid treatment may be sufficient in idiopathic patients, orbital myositis secondary to systemic disease requires longer-term and non-steroid immunosuppressive treatments. Here, a case of idiopathic orbital myositis with bilateral involvement is presented as it is a rare condition.

The Effects of Endometriosis on Ovarian Functions

Infertility is a main manifestation of endometriosis, though the exact pathogenesis of endometriosis-associated infertility remains unclear. Compromised ovarian functions may be one of the causes of endometriosis related infertility. The ovarian function can be classified into three basic elements, (1) production of ovarian hormones, (2) maintenance of follicular development until ovulation, and (3) reservoir of dormant oocytes (ovarian reserve). The effects of endometriosis on ovarian hormone production and follicular development are inconclusive. Ovarian endometrioma is common phonotype of endometriosis. Development of endometrioma per se may affect ovarian reserve. Surgery for endometriomas further diminish ovarian reserve, especially women with bilateral involvement. Early intervention with surgery and/or medical treatment may be beneficial, though firm evidence is lacking. When surgery is chosen in women at reproductive age, specific techniques that spare ovarian function should be considered.

Lung adenocarcinoma characterized by multiple thromboemboli was misdiagnosed as primary anti-phospholipid syndrome: A case report

Giant Cell Arteritis (GCA) is an immune-mediated vasculitis of large- and medium-sized vessels. Stroke happens in 3% to 7% of the cases, and identifying GCA properly is important because potentially curative treatment exists. We present a case of an 83-year-old woman, in whom suspected GCA was revealed by stroke caused by Vertebral Artery (VA) inflammation. The uncommon stroke localization and the ultrasound findings suggested vasculitic etiology of lesions. 18-Fluorodeoxyglucose-Positron Emission Tomography (18-FDG-PET) confirmed inflamed VA walls. Patient was treated with oral steroids and antiplatelet therapy, with improvement of clinical and ultrasonographic status. In our patient clinical diagnosis of GCA was challenging due to limited classical symptoms. Arguments in favor of arteritis were the symmetric and bilateral involvement of the VA, the sonographic halo sign and atypical stroke localization. Keywords: Adenocarcinoma; Antibodies; Antiphospholipid; Antiphospholipid Syndrome; Lung neoplasms; Venous thrombosis

Krukenberg tumor in a young female arising from a primary adenocarcinoma of stomach: a case report

Krukenberg tumor is a malignancy of ovary that metastasizes from a primary site. Krukenberg tumors are uncommon and account for less than 2% of all ovarian tumors. It is usually a bilateral involvement of ovaries from the metastatic deposit from adenocarcinoma of the stomach. Krukenberg tumors mostly occur after 40 years. Metastatic ovarian tumors in young age are very rare. Here, we reported a very rare case of bilateral Krukenberg tumors of the ovaries arising from a primary adenocarcinoma of the stomach in a 20 year old Indian female.

Bilateral Septic Hip Epiphyseal Detachment in Children: A Case Report and Review of the Literature

Background: Diagnosed and treated fairly early, children’s septic arthritis of the hip has few or no complications. Septic epiphyseal detachment of the hip in children is a rare complication due to delayed treatment. Unilateral forms have been reported, but bilateral involvement has never been described in the literature. Case presentation: We report the case of an 8-year-old girl who presented with hip pain associated fever and diminished lower limb movements, approximately 4 months after the onset of symptoms. The diagnosis of bilateral septic epiphyseal detachment of the hips was made and computerized tomography (CT) scan revealed osteonecrosis of both femoral heads. The necrotic epiphyses required removal in order to control the infection. Conclusion: This report highlights the importance of early diagnosis of septic arthritis of the hip in the neonatal period. Any delay in presentation, diagnosis or management can result in irrecoverable sequelae for the developing hip and seriously impact long-term function. Keywords: Septic arthritis, Bilateral, Epiphysis detachment, Hip, Ablation.