Tuberculosis Arthritis Genu Sinistra with Drug-Induced Liver Injury, COVID 19 Confirmed

Background. Tuberculosis is still a significant health problem, especially in developing countries. Although pulmonary tuberculosis is the most common form of the disease, extrapulmonary tuberculosis also contributes significantly to morbidity and mortality. 10-15% of extrapulmonary cases are due to tuberculous arthritis. The following is a case report of a 36-year-old woman with a diagnosis of genu Sinistra tuberculosis arthritis and drug-induced hepatotoxic injury due to OAT. Case presentation. A woman, 36 years old, Muslim, addresses Banyuasin. The patient is a housewife, treated at Dr. Moh Hoesin General Hospital since October 11, 2021. The main complaint in the form of pain in the left knee has been getting worse since 1 week before being admitted to the hospital. 4 months before admission the hospital, the patient complained of left knee pain, the pain felt like being stabbed, coming and going, especially when walking. In this patient, there was a complaint of nausea that was felt in the pit of the stomach. The results of laboratory examinations showed an increase in the transaminase enzyme and hyperuricemia, so it was suspected that the patient had DILI due to OAT drugs. Hepatocyte death in DILI can occur through two processes, namely processes mediated by apoptosis or necrosis. In apoptosis, cell shrinkage and fragmentation occur into small pieces with the cell membrane intact. These fragments are cleared by phagocytosis and generally do not stimulate the host immune response. Conclusion. A patient diagnosed with arthritis tuberculosis genu Sinistra with Drug-Induced Liver Injury and Confirmed COVID 19.

The impact of skeletal muscle disuse on distinct echo intensity bands: A retrospective analysis

Echo intensity (EI) is a novel tool for assessing muscle quality. EI has traditionally been reported as the mean of the pixel histogram, with 0 and 255 arbitrary units (A.U.) representing excellent and poor muscle quality, respectively. Recent work conducted in youth and younger and older adults suggested that analyzing specific EI bands, rather than the mean, may provide unique insights into the effectiveness of exercise and rehabilitation interventions. As our previous work showed deterioration of muscle quality after knee joint immobilization, we sought to investigate whether the increase in EI following disuse was limited to specific EI bands. Thirteen females (age = 21 yrs) underwent two weeks of left knee immobilization and ambulated via crutches. B-mode ultrasonography was utilized to obtain images of the immobilized vastus lateralis. The percentage of the total number of pixels within bands of 0–50, 51–100, 101–150, 151–200, and 201–255 A.U. was examined before and after immobilization. We also sought to determine if further subdividing the histogram into 25 A.U. bands (i.e., 0–25, 26–50, etc.) would be a more sensitive methodological approach. Immobilization resulted in a decrease in the percentage of pixels within the 0–50 A.U. band (-3.11 ± 3.98%), but an increase in the 101–150 A.U. (2.94 ± 2.64%) and 151–200 A.U. (0.93 ± 1.42%) bands. Analyses of variance on the change scores indicated that these differences were large and significant (%EI0-50 vs. %EI101-150: p < .001, d = 1.243); %EI0-50 vs. %EI151-200: p = .043, d = 0.831). The effect size for the %EI51-100 versus %EI101-150 comparison was medium/large (d = 0.762), but not statistically significant (p = .085). Further analysis of the 25 A.U. bands indicated that the percentage of pixels within the 25–50 A.U. band decreased (-2.97 ± 3.64%), whereas the 101–125 (1.62 ± 1.47%) and 126–150 A.U. (1.18 ± 1.07%) bands increased. Comparison of the 50 A.U. and 25 A.U. band methods found that 25 A.U. bands offer little additional insight. Though studies are needed to ascertain the factors that may influence specific bands, changes in EI during muscle disuse are not homogeneous across the pixel histogram. We encourage investigators to think critically about the robustness of data obtained from EI histograms, rather than simply reporting the EImean value, in muscle quality research.

Synovial chondromatosis combine with synovial tuberculosis of knee joint: a case report

Backgroud Synovial chondromatosis is a rare synovial-derived metaplasia disease that comes from the formation of cartilage nodules within the synovial connective tissue of the joint. Knee tuberculosis is a disease caused mostly by the pulmonary tuberculosis and a few by tuberculosis of the digestive tract and lymphatic. tube. Case presentation Herein we report a 3-year-old child admitted by intermittent swelling of left knee joint with lameness for half a year, the patient received surgical treatment. The loose bodies filled in the joint cavity was taken out and the degenerative synovium was excised. Biopsy confirmed as synovial chondromatosis combined with synovial tuberculosis of knee joint. After 6 months follow-ups, knee swelling and claudication get totally recovered and the gait of patient recover back to normal. Conclusion Careful investigation of children with knee pain is recommended to avoid misdiagnosis, Synovial chondromatosis combine with tuberculosis should be considered a differential diagnosis in a child with knee pain.

Patellar MACI With Tibial Tubercle Osteotomy

Background: Chondral pathology is frequently encountered during knee arthroscopies with a prevalence rate of 63% to 66%. Prior studies have demonstrated that unaddressed or excised fragments result in poor knee function and arthritis. As a result, chondral-related procedures have increased in popularity, and now more than 200,000 procedures are performed annually. Indications: We present a case of an active 32-year-old woman, prior collegiate basketball player, with persistent left knee pain noted to have a full-thickness patellar articular cartilage defect and maltracking. Technique: A patellar autologous matrix-induced chondrocyte is implanted with a concomitant tibial tubercle osteotomy (TTO) and lateral retinacular lengthening. Results: At 9 weeks, the patient had no knee pain with full range of motion symmetric to the contralateral side while slowly progressing with quadriceps strengthening. Discussion/Conclusion: Successful outcomes addressing large patellar chondral defects and maltracking can be achieved with matrix autologous chondrocyte implantation and concomitant TTO with lateral retinacular lengthening.

Reactivation of Coccidioides immitis in a Prosthetic Knee after Initiation of Chemotherapy

Coccidioides is an endemic fungus in the Southwestern United States and Central and South America. Coccidioidomycosis primary infections are typically of the lung with an asymptomatic or self-limiting course. Some infections disseminate to other parts of the body and a few can remain latent for many years. Reactivation of latent fungal disease can occur following an insult to the host immune system. Here, we describe a case of a 76-year-old Caucasian male patient who moved from California to Wisconsin with a history of coccidioidomycosis infection of the left knee that reactivated decades later in his prosthetic knee shortly after being initiated on ibrutinib (Imbruvica), a Bruton tyrosine kinase (BTK) inhibitor, for chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL). There have been some case reports regarding coccidioidomycosis infections after initiating ibrutinib therapy but none with a 50 year latency period before reactivation. Readers will learn the immunological effects of ibrutinib on the hosts’ innate and adaptive immunity and its role in putting the host at risk for invasive fungal infections. We also review the literature and data on treatment regimens and recommendations based on current guidelines.

Arthroscopic Management of Synovial Chondromatosis of the Knee Joint

Synovial Chondromatosis is a rare and it is a benign condition characterized by multiple cartilaginous nodules in synovial facet spaces. Synovial Chondromatosis affects most commonly the knee joint. This is a case report of a 30-year-old male patient presented with pain and swelling over the left knee joint. On evaluation MRI shows loose bodies, for which he underwent, arthroscopic exploration. Viscous fluid and loose bodies were identified and showed synovial hyperemia. Synovial debridement was done and loose bodies were removed and sent to histopathological examination. The result signify that arthroscopy is efficient method both in diagnostic as well as therapeutic management of synovial chondromatosis.

Biocompatible Hydrogel for Intra-Articular Implantation Comprising Cationic and Anionic Polymers of Natural Origin: In Vivo Evaluation in a Rabbit Model

We describe the functional capability of a cross-linked hydrogel composed of sulfated glycosaminoglycans and a cationic cellulose by conducting trials on experimental animal models using intra-articular implants to treat an articular disease called osteoarthritis. Forty-eight mature New Zealand white rabbits were divided into three experimental groups: A, B, and C. Group A and B underwent unilateral anterior cruciate ligament transection (ACLT) of the right knee. Subsequently, both knees of group A were treated with the injectable formulation under study. Meanwhile, group B was treated with sterile PBS (placebo). The animals of group C were surgically operated in both knees: Commercial hyaluronic acid (HA) was implanted in the left knee, and the formulation under study was implanted in the right knee. After implantation, all specimens underwent several evaluations at 3, 6, and 12 months postoperatively. At 6 months, no significant differences were detected between the right and left knees of the different groups. However, significant differences were observed between both knees at 12 months in group C, with less cartilage damage in the right knees implanted with our hydrogel. Therefore, in vivo studies have demonstrated hydrogel safety, superior permanence, and less cartilage damage for long-term follow up 12 months after implantation for the formulation under study compared with commercial HA.

Does treadmill workstation use affect user’s kinematic gait symmetry?

The effects of treadmill workstation use on kinematic gait symmetry and computer work performance remain unclear. The purpose of this pilot study was to analyze the effects of treadmill workstation use on lower body motion symmetry while performing a typing task when compared to overground and treadmill walking. The lower body motion of ten healthy adults (6 males and 4 females) was recorded by a motion capture system. Hip, knee, and ankle joint rotations were computed and compared for each condition. Despite comparable lower body kinematic gait asymmetries across conditions, asymmetric knee flexion motions at early gait cycle were only found in treadmill workstation users (left knee significantly more flexed than the right one). This demonstrates that the interaction between walking and another task is dependent on the task cognitive content. Our findings suggest that lower body kinematic gait symmetry may be influenced by the use of treadmill workstations.

Yersinia enterocolitica Prosthetic Joint Septic Arthritis Successfully Treated with Ceftriaxone

Yersinia enterocolitica is a Gram-negative coccobacillus that is known to cause gastroenteritis and symptoms mimicking appendicitis or terminal ileitis. It is also one of the culprit infections implicated in causing reactive arthritis. Rarely, it can cause musculoskeletal infections including osteomyelitis, septic arthritis, and discitis. We describe the case of a 70-year-old female with multiple comorbidities who presented with left knee pain and swelling after recent gastroenteritis. She was found to have Yersinia enterocolitica septic arthritis in her left knee prosthetic joint. The patient underwent an exchange of her prosthetic material and was successfully treated with a six-week course of ceftriaxone. Our article aims to highlight a rare manifestation of Yersinia enterocolitica infection and to point out an important differential for reactive arthritis after Yersinia enterocolitica infection.

Ultrasonographic evaluation of femoral cartilage thickness in patients with familial Mediterranean fever

Objectives: This study aims to determine femoral cartilage thickness using ultrasonography in familial Mediterranean fever (FMF). Patients and methods: A total of 45 patients (16 males, 29 females; mean age: 38.5±9.1 years; range, 24 to 49 years) with the diagnosis of FMF and 31 healthy individuals (6 males, 25 females; mean age: 37.0±8.7 years; range, 25 to 47 years) between January 2016 and July 2016 were included in this study. Clinical data and demographic characteristics of the patients were recorded. All FMF cases in the study were in remission with colchicine treatment. The thickness of femoral cartilage in both knees were evaluated using ultrasonography. Three measurements (mid-point) were taken from both knees (at the medial/lateral femoral condyles and intercondylar area). Results: Ultrasonographical measurements revealed that cartilage measurements of FMF patients were significantly thinner at both the medial/lateral femoral condyles and intercondylar area on the right knee and at the medial/lateral femoral condyles on the left knee (p<0.001). The cartilage measurements in FMF patients were significantly thinner at the intercondylar area on left knee, compared to those in controls (p=0.023). Conclusion: Our study showed decreased femoral cartilage thickness in FMF patients. These findings indicate that even if these patients do not have an attack, they may have subacute and chronic arthritis in their joints, and their femoral cartilage thickness can be affected.