Kyphosis types of the spine cervical-thoracic junction

Introduction. The strengthening of thoracic kyphosis and forward head posture is one of the urgent problems of modern man. Such changes are most often detected for elderly and senile people. However, today these features are also detected for young people. Digital radiography can objectively assess the position of the cervical and thoracic vertebrae. However, the criteria for reliably registering the position of the vertebrae of the cervicalthoracic junction have not yet been developed.The aim of the study — to develop a method for assessing the position of the vertebrae of the cervical-thoracic junction according to digital radiographs; to develop a typology of the vertebra positions of the cervical-thoracic junction; to study the frequency of vertebral position types for the cervical-thoracic junction for different age groups.Materials and methods. Spine X-ray images in the sagittal plane for 141 adult patients with dorsopathies were studied. The selection of patients was random and there were four age groups: 32 persons aged 21 to 45, 32 persons aged 46 to 59, 50 persons aged 60 to 74 and 21 persons aged 75 to 88 year-old. The study was conducted on PC screen, without the patient′s presence. A single digital X-ray image of the spine for each patient in the sagittal plane was obtained. On the combined digital radiograph, the occipital vertical was drawn along all parts of the spine, starting from the external hillock of the occipital bone downwards, and the anteroposterior CV–TV axes of the vertebrae (r axes) were applied. At the points of intersection of the axes with the occipital vertical, the perpendiculars to the axis were restored, and the angles between the perpendiculars and the vertical — the angles of the anteroposterior axes of the vertebrae (r angles) — were measured. Statistical analysis was performed using the MS Offi ce Excel 2007 and Statistica 12 software packages.Results. It was found that the values of the anteroposterior axe angles r of CVII–TIII vertebrae can serve as criteria for determining the spatial position of the cervical-thoracic junction vertebrae. There are 4 types of the shape of the cervical-thoracic junction. Type I is a straightened kyphosis («giraffe neck»); type II is physiological («harmonious»); type III — enhanced kyphosis («bear withers»); type IV–hyperkyphosis («buffalo hump»). Types III and IV are accompanied by a forward displacement of the head. Straightened cervical-thoracic junction kyphosis — type I — was diagnosed in 21 (15 %) people, 52 (37 %) patients were assigned to type II, another 48 (34 %) patients had type III, and 20 (14 %) patients had type IV cervical-thoracic junction kyphosis. In young patients aged 21 to 45, as well as in middle-aged patients aged 46 to 59, the most common type was the harmonious type II of cervical-thoracic junction, in elderly patients aged 60 to 74 — type III and close to it in frequency was type III. In elderly patients aged 75 to 88, the IV type of the position of the vertebrae of the cervical-thoracic junction prevailed in frequency.Conclusion. The proposed diagnostic method allows to register the type of the vertebra positions in cervicalthoracic junction for each patient. Four position types of the cervical-thoracic junction vertebrae were determined: straightened kyphosis «giraffe neck», physiological kyphosis «harmonious», enhanced kyphosis «bear withers» and hyperkyphosis «buffalo hump». Increased kyphosis and hyperkyphosis are accompanied by a forward head posture.

Antiretroviral therapy associated lipodystrophy; learning from the past.

Background: With the introduction of effective antiretroviral therapy (ART), descriptions of body shape abnormalities, such as central fat accumulation and peripheral fat loss emerged among persons living with human immunodeficiency virus (HIV). We aimed to determine the prevalence of lipodystrophy and associated risk factors among patients on ART at Orotta National Referral Hospital (ONRH), Asmara, Eritrea. Methods: A single center, retrospective study was conducted at the ONRH, reviewing records of HIV-infected patients commenced on ART between January 2007 and December 2012. Results: Records of 250 eligible patients were reviewed. Most were female (59.2%, n=148) with a median age of 35 (IQR-20-63) years. Forty-three (17.2%) participants had body fat abnormalities. 42 (97.6%) had lipoatrophy and 1 (2.4%) buffalo hump. Of the 43 patients with lipodystrophy 34 (79%) were on Stavudine (d4T)/Lamivudine (3TC)/Nevirapine (NVP) regimen, 6 (14%) on Zidovudine (AZT)/3TC/NVP, 2 (4.7%) on d4T/3TC/Efavirenz (EFV) and 1(2.3%) on AZT, 3TC, EFV. EFV- based regimen was significantly associated with lipodystrophy (p< 0.01). Conclusion: We report a high prevalence of lipodystrophy. Four drug regimens were incriminated in the development of lipodystrophy. EFV-based regimen was significantly associated with the lipodystrophy.

Recalibrating Rodinian rifting in the northwestern United States

A lack of precise age constraints for Neoproterozoic strata in the northwestern United States (Washington State), including the Buffalo Hump Formation (BHF), has resulted in conflicting interpretations of Rodinia amalgamation and breakup processes. Previous detrital zircon (DZ) studies identified a youngest ca. 1.1 Ga DZ age population in the BHF, interpreted to reflect mostly first-cycle sourcing of unidentified but proximal magmatic rocks intruded during the amalgamation of Rodinia at ca. 1.0 Ga. Alternatively, the ca. 1.1 Ga DZ population has been suggested to represent a distal source with deposition occurring during the early phases of Rodinia rifting, more than 250 m.y. after zircon crystallization. We combined conventional laser-ablation split-stream analyses of U-Pb/Lu-Hf isotopes in zircon with a method of rapid (8 s per spot) U-Pb analysis to evaluate these opposing models. Our study of ~2000 DZ grains from the BHF identified for the first time a minor (~1%) yet significant ca. 760 Ma population, which constrains the maximum depositional age. This new geochronology implies that the BHF records early rift deposition during the breakup of Rodinia and correlates with sedimentary rocks found in other late Tonian basins of southwestern Laurentia.

Between the supercontinents: Mesoproterozoic Deer Trail Group, an intermediate age unit between the Mesoproterozoic Belt–Purcell Supergroup and the Neoproterozoic Windermere Supergroup in northeastern Washington, USA

Mesoproterozoic and Neoproterozoic basins in western North America record the evolving position of the Laurentian craton within two supercontinents during their growth and dismemberment: Columbia (Nuna) and Rodinia. The western-most exposures of the Columbia rift-related Belt–Purcell Supergroup are preserved in northeastern Washington, structurally overlain by the Deer Trail Group and depositionally overlying the Neoproterozoic Windermere Supergroup. It has been disputed whether the Deer Trail Group is correlative with the Belt–Purcell Supergroup, or younger. To help resolve the uncertain correlation of these units and their bearing on supercontinent evolution, we characterized the detrital zircon age populations of units from the Deer Trail Group, the Windermere Supergroup, and the Belt–Purcell Supergroup in northeastern Washington. These data show that the western part of the Columbia supercontinent (now located in Australia and eastern Antarctica) remained attached to western Laurentia and continued to supply 1600–1500 Ma detrital zircon grains to the Belt–Purcell Supergroup until after ca. 1391 Ma. The Deer Trail Group is younger than the Belt–Purcell strata, with the basal unit younger than ca. 1362 Ma and a middle unit younger than ca. 1300 Ma. The Deer Trail Group has a pre-Grenville-age provenance from the southwestern USA and possibly east Antarctica. The Buffalo Hump Formation is younger than the Deer Trail Group, with Grenville-age (ca. 1112 Ma) detrital zircon grains and a detrital zircon signature like that of the overlying Neoproterozoic Windermere Supergroup. We interpret the Deer Trail Group to have been deposited during the rift-demise of supercontinent Columbia and before the Grenville-age assembly of the supercontinent Rodinia.

Case Report on Steroid Induced Cushing Syndrome

Glucocorticoids are the effective steroid drugs which reduce the inflammation & most commonly glucocorticoids are used in diseases such as asthma, allergic diseases such as psoriasis, eczema and rheumatoid arthritis. Long term effect of corticosteroids leads to the symptoms of moon face, buffalo hump, pink stretch marks, and weight gain. In this we are going to report a case of 30 yrs female patient with representing the long term use of corticosteroids; Prednisolone leads to cushing syndrome. Eventually she was treated with oral hypoglycemics and diuretics and the use of steroid had stopped temporarily and the dose of prednisolone was tapered. Keywords: glucocorticoids, prednisolone, Cushing syndrome

A Stratified Approach for Cushing’s Syndrome Diagnosis

Cushing&rsquo;s syndrome is an endocrine disorder broadly renowned as a diagnostic challenge. From the initial clinical presentation up to the identification of the underlying etiology, it is necessary to adhere to a logical and stratified plan of action, directed to the correlation of signs and symptoms to the physiopathology of the syndrome, in order to accurately establish a diagnosis and adequate treatment. From stages as early as the patient&rsquo;s first clinical evaluation, the physician should be specially attentive of a constellation of clinical signs which strongly suggest the diagnosis of Cushing&rsquo;s syndrome, such as the presence of a &ldquo;moon face&rdquo;, a &ldquo;buffalo hump&rdquo;, cutaneous atrophy, proximal muscle weakness and purplish cutaneous striae, among others. Based off these findings, laboratory analyses are necessary for the detection of hypercortisolism. According to these results, and if physiologic causes are ruled out, pathologic hypercortisolism is confirmed. Lastly, a complex array of diagnostic tests must be navigated to identify the primary origin of the disorder. Thus, the diagnosis of Cushing&rsquo;s syndrome requires a logically structured algorithm of action, constructed off its pathophysiologic implications, in order to optimize time, resources and the interdisciplinary workgroup required for its consecution, and offer patients the possibility of a better quality of life. It is also important to highlight the need for a stratified approach in patients with metabolic disturbance given that medical professionals may simply treat the patient for obesity not recognizing the presence of the complicating condition Cushing&rsquo;s syndrome.

Iatrogenic Cushing Syndrome due to Application of Potent Topical Corticosteroid: A Case Report

Corticosteroids are over the counter and cheaper drugs available in every medical stores in Nepal. Iatrogenic Cushing syndrome due to topical steroids application is a very rare phenomenon in adults.A 32 year female from Janakpur presented with complaints of swelling of face, weight gain, excessive facial hair and fatigue since two years that gradually increased over last one year. She had a past medical history of on and off application of multiple potent topical corticosteroids for disseminated Tinea infection. She was obese with moon facies, buffalo hump and multiple striae over her abdomen. Her blood pressure was raised and her blood sugar was in pre-diabetic range. Laboratory studies were consistent with iatrogenic Cushing syndrome. Patient recovered after discontinuation of topical corticosteroids and treatment with antifungals.Although iatrogenic Cushing syndrome following application of topical corticosteroid is a rare phenomenon in adults, this can happen in a setup like ours where corticosteroids are prescribed as over the counters and patients have very little knowledge about their use. Therefore, we emphasize that patients and pharmacist should be well educated about the consequences of their prolong application and their side effects