Chronic nonbacterial osteomyelitis in children: a multicentre Belgian cohort of 30 children

BackgroundTo evaluate clinical characteristics, imaging findings, therapeutic approach and outcome of paediatric patients with Chronic Non-Bacterial Osteomyelitis (CNO). MethodsRetrospective review of 30 children diagnosed with CNO at two tertiary care centres in Belgium. Imaging data were evaluated by blinded paediatric radiologists. ResultsMean age at onset was 10.3 years and mean age at diagnosis was 11.7 years. Bone pain was the leading symptom (29/30 patients). Out of 180 symptomatic lesions, 131 were confirmed on MRI as hyperintense geographic lesions on STIR images at the metaphysis and epiphysis adjacent to growth plates of tubular bones. The most common sites of involvement were the lower limbs, spine, sternoclavicular joint and humerus. For nearly half of the patients (14/30) monotherapy with NSAIDs was sufficient to obtain remission. The remaining 16 patients received second-line therapy: bisphosphonates (n=15/30), disease-modifying antirheumatic drugs (n=7/30), etanercept (n=4/30) and tocilizumab (n=1/30). 26/30 Patients reached remission after a mean time of 37.6 months. The prognosis was worse for patients with spinal involvement, resulting in more long-term sequelae. ConclusionsWe present a multicentre paediatric cohort of 30 CNO patients. A typical pattern of bone involvement could be found on MRI. NSAIDs were administered as first-line treatment. Second-line strategies included bisphosphonates, corticosteroids, methotrexate, etanercept and tocilizumab. Trial registrationRetrospectively registered.

First-Person Perspective of Alice in Wonderland Like Visual Perceptions Presented Primary as Microsomatognosia as Leading Symptom of a 24 Years-Old Student From Chile

AIWS is a disorientating form of seizures that affect in peculiar visual perception. AIWS is a neurological form of seizures that can affect the brain, especially the temporoparietal junction and visual pathways leading to impaired and bizarre visual perceptions. The origin of AIWS is yet not known exactly. Cases of migraines, brain tumors, depression episodes, epilepsy, delirium, psychotropic drugs, ischemic stroke, EBV, mycoplasma and malaria infections correlate like seizures with AIWS are published before.

LONG-TERM RESULTS AFTER VIDEO ENDOSCOPIC MYOTOMY BY HELLER WITH FUNDOPLICATION BY DOR IN PATIENTS WITH 2-4 STAGES OF ACHALASIA

Relevance. Treatment of achalasia of the cardia (AС) is currently palliative, aimed at reducing the manifestation of clinical symptoms of the disease. Together with instrumental methods of examination of esophageal function, the Eckardt scale and the GIGLI questionnaire are convenient and simple tools for evaluating results in the long-term postoperative period.The aim of the study was to evaluate the long-term results of surgical treatment of patients with 2-4 stages of AС, after laparoscopic Нeller myotomy with anterior hemiesophagofundoplication by Dor to the results of special methods of esophageal examination and patient questionnaires using the Eckardt scale and the GIGLI questionnaire.Materials and methods. The work included the results of examinations of 103 patients who underwent video laparoscopic Нeller myotomy, with anterior hemiesophagofundoplication by Dor. The period of examination in the postoperative period was from 3 to 7 years. The results of X-ray examination of the esophagus and stomach, manometry of the esophageal and esophageal-gastric junction before and after surgery were studied , and patients were also surveyed according to the Eckardt scale and the GIGLI questionnaire.Results. The analysis of the results of instrumental methods of studying the function of the esophagus in the pre – and postoperative periods showed that the given manometry of the esophagus and esophageal-gastric junction, X-ray of the esophagus and stomach significantly improved in the postoperative period in patients with all stages of the disease. The results of patients of 4th stage AC compared with the results of 2nd and 3rd stages patients were worse(p<0,05).The leading symptom of AK-dysphagia in the long-term postoperative period decreased in all the studied patients, the results were better in patients with stage 2, worse in patients with stage 4 of AK (p<0,05).The leading symptom of AK-dysphagia in the long-term postoperative period decreased in all the studied patients, the 2nd stage patients results were better, 4th stage patients results were worse (p<0,05).Conclusions. After video-endoscopic Нeller myotomy with fundoplication by Dor, the indicators of esophageal manometry and esophageal and stomach radiography significantly improve, the results of the Eckardt scale and GIGLI questionnaire survey of patients show a significant decrease in the severity of clinical manifestations of AC in the balls. This method of surgical treatment can be recommended already at the 2nd stage of AC and as an organpreserving operation for 4th stage.

Variant Transthyretin Amyloidosis (ATTRv) in Hungary: First Data on Epidemiology and Clinical Features

Background: Variant transthyretin amyloidosis (ATTRv) is an autosomal dominant inherited disease, where the mutation of the transthyretin gene (TTR) results in the deposition of pathogenic protein fibrils in various tissues. The mutation type influences the clinical course. Until now, no data were available on the genotype, phenotype, and prevalence of Hungarian ATTRv patients. The aim of our study was to assess the prevalence, regional distribution, genotypes, and phenotypes of Hungarian patients with ATTRv. Methods: With the collaboration of Hungarian regional and university centers, we identified patients diagnosed with ATTRv. We also searched prior publications for case studies of Hungarian ATTRv patients. Results: 40 individuals in 23 families with ATTRv were identified within the borders of Hungary. At the time of the diagnosis, 24 of them were symptomatic. The two most common mutations were ATTRHis88Arg (nine families) and ATTRIle107Val (8 families). ATTRVal30Met was demonstrated in 2 families, and ATTRVal122del, ATTRPhe33Leu, ATTRIle84Ser, and ATTRAsp18Gly in one family each. The median age of the symptomatic patients at the time of clinical diagnosis was 65 years. The most common clinically significant organ involvement was restrictive cardiomyopathy, found in 24 patients. Polyneuropathy was diagnosed in 20 patients. A total of 19 patients showed a mixed phenotype. The leading symptom was heart failure in 8 cases (3 of them had only cardiac symptoms), polyneuropathy in 11 cases (all of them also had cardiac symptoms), and equally severe cardiac and neuropathy symptoms were present in 3 cases. Out of 24 symptomatic patients, 10 received targeted pharmacological therapy. The follow-up period ranged from 1 to 195 months. At the time of the retrospective analysis, 12 patients had already died, and 1 patient underwent heart transplantation. Conclusions: As TTR genotype influences the phenotype and clinical course of ATTRv, it is important to know the regional data. In Hungary, ATTRHis88Arg and ATTRIle107Val are the most common mutations in ATTRv, both presenting with mixed phenotype, but the median age at the time of the diagnosis is 9 years lower in patients with ATTRHis88Arg than in patients with ATTRIle107Val.

Using Autoplasma in Treatment of Secondary Arthrosis, Developed from Dislocation of TMJ Disc

22 patients diseased with secondary arthrosis, developed from dislocation of TMJ disc, were observed by the authors of the article. Between these patients were 17 females and 5 males. The age of patients was from 21 to 60 years. In the clinical case, the leading symptom was constant or periodical pain, located at the injured joint, limitation of mandibular movement, aggravation of pain while moving jaw and was attached with clicking in joint. In the complex treatment of this problematical disease, successfully and for the first time was used autoplasmolifting. Authors injected autoplasma once in 5-6 days, 6 injections on one course of treatment. After noted treatment, 18 patients all the symptoms were released, 4 patients condition got better there was slight pain left, while moving jaw. In 1 patient's case, the neuralgia of III branch of the trigeminal nerve was diagnosed and he received suitable treatment. In 3 cases there was necessary to include orthopedic/orthodontic treatment.

Effects of realistic e-learning cases on students’ learning motivation during COVID-19

Background Keeping up motivation to learn when socially isolated during a pandemic can be challenging. In medical schools, the COVID-19 pandemic required a complete switch to e-learning without any direct patient contact despite early reports showing that medical students preferred face-to-face teaching in clinical setting. We designed close to real-life patient e-learning modules to transmit competency-based learning contents to medical students and evaluated their responses about their experience. Methods Weekly e-learning cases covering a 10-week leading symptom-based curriculum were designed by a team of medical students and physicians. The internal medicine curriculum (HeiCuMed) at the Heidelberg University Medical School is a mandatory part of clinical medical education in the 6th or 7th semester. Case-design was based on routine patient encounters and covered different clinical settings: preclinical emergency medicine, in-patient and out-patient care and follow-up. Individual cases were evaluated online immediately after finishing the respective case. The whole module was assessed at the end of the semester. Free-text answers were analyzed with MaxQDa following Mayring`s principles of qualitative content analyses. Results N = 198 students (57.6% female, 42.4% male) participated and 1252 individual case evaluations (between 49.5% and 82.5% per case) and 51 end-of-term evaluations (25.8% of students) were collected. Students highly appreciated the offer to apply their clinical knowledge in presented patient cases. Aspects of clinical context, interactivity, game-like interface and embedded learning opportunities of the cases motivated students to engage with the asynchronously presented learning materials and work through the cases. Conclusions Solving and interpreting e-learning cases close to real-life settings promoted students’ motivation during the COVID-19 pandemic and may partially have compensated for missing bedside teaching opportunities.

IDENTIFICATION OF PATIENTS WITH "INTESTINAL FORM" WITH NEW CORONAVIRAL INFECTION IN PATIENTS WITH A SURGICAL PROFILE AT THE LEVEL OF THE ADMISSION UNIT OF A MULTIDISCIPLINE HOSPITAL

В статье рассматриваются некоторые особенности выявления больных с «кишечной формой» новой коронавирусной инфекцией у пациентов хирургического профиля на уровне приемного отделения многопрофильного стационара. Данная тематика является весьма актуальной, так как после начала пандемии Covid-19 в 2020 году, было выявлено несколько отличающихся течением, форм заболевания, одной из которых и стала, так называемая «кишечная форма». Большой интерес обусловлен тем, что при данном виде течения патологического процесса практически отсутствуют характерные для Covid-19 симптомы - болезнь, зачастую, маскируется под клинику «острого живота», в виду чего в ряде случаев диагностика ложиться на плечи врачей хирургического профиля. Данная работа стала результатом попытки выявить основные закономерности развития и особенности «течения» у пациентов данной патологии, с выявлением основных клинических симптомов, которые могли бы своевременно помочь с адекватной дифференциальной диагностикой. Объектами исследования послужило 150 пациентов, мужчин и женщин, в возрасте от 19 до 79 лет, мужчин (n=91) и женщин (n=59). Все больные были разделены на 3 группы по 50 человек. В первую группу вошли больные, у которых была выявлена одна из существующих острых хирургических патологий. Вторую группу составили пациенты, у которых была диагностирована «кишечная форма» новой коронавирусной инфекции. В третью группу вошли пациенты, которые ранее уже перенесли Covid-19. В основу исследования лег подробное изучение всех жалоб пациентов. Так были установлены определенные различия между рядом жалоб у пациентов различных групп. Однако ведущим симптомом, заставившем всех больных обратиться в стационар, был болевой синдром. В дальнейшем в работе проведен комплексный анализ боли, ее характер и особенности локализации в зависимости от группы. Важной частью исследования стало также изучение общего анализа крови и биохимического анализа крови, с выделением основных показателей, способных оказать помощь в дифференциальной диагностике. В завершении исследования проводилось изучение данных УЗИ и методов специфической диагностики новой коронавирусной инфекции, позволяющих получить первичные данные о процессе формирования иммунитета после перенесенного Covid-19. Статья интересна прежде всего врачам, занимающимся первичным приемом пациентов в стационарах и поликлиниках The article discusses some of the features of identifying patients with "intestinal form" of new coronavirus infection in surgical patients at the level of the admission department of a multidisciplinary hospital. This topic is very relevant, since after the start of the Covid-19 pandemic in 2020, several different forms of the disease were identified, one of which became the so-called "intestinal form". The great interest is due to the fact that with this type of pathological process, there are practically no symptoms characteristic of Covid-19 - the disease is often disguised as an acute abdomen clinic, which means that in some cases, the diagnosis falls on the shoulders of surgical doctors. This work was the result of an attempt to identify the main patterns of development and features of the "course" in patients with this pathology, with the identification of the main clinical symptoms that could promptly help with adequate differential diagnosis. The objects of the study were 150 patients, men and women, aged 19 to 79, men (n = 91) and women (n = 59). All patients were divided into 3 groups of 50 people each. The first group included patients who had one of the existing acute surgical pathologies. The second group consisted of patients who were diagnosed with the "intestinal form" of a new coronavirus infection. The third group included patients who had previously suffered from Covid-19. The study was based on a detailed study of all patient complaints. Thus, certain differences were established between a number of complaints in patients of different groups. However, the leading symptom that made all patients go to the hospital was pain syndrome. In the future, a comprehensive analysis of pain, its nature and localization characteristics depending on the group was carried out. An important part of the study was also the study of a general blood test and a biochemical blood test, with the identification of the main indicators that can help in differential diagnosis. At the end of the study, the study of ultrasound data and methods of specific diagnostics of a new coronavirus infection was carried out, which make it possible to obtain primary data on the formation of immunity after the transferred Covid-19. The article is of interest primarily to doctors engaged in the primary admission of patients in hospitals and clinics

Negative myoclonus as the leading symptom in acute cefepime neurotoxicity

An 86-year-old woman was diagnosed with hospital-acquired pneumonia with Pseudomonas aeruginosa and treated with cefepime adjusted to her renal clearance. After 4 days, she developed acute-onset negative myoclonus without signs of altered mental status. After ruling out an acute intracranial haemorrhagic or ischaemic stroke as well as other metabolic and endocrine causes of negative myoclonus, the antibiotic was switched to piperacillin/tazobactam due to a suspicion of cefepime neurotoxicity. The patient improved within 24 hours and her symptoms fully resolved within 4 days. These observations suggest a link of the negative myoclonus to acute cefepime neurotoxicity, which may occur without or with minimal alteration of mental status, thus extending its spectrum of clinical presentation.

Headache secondary to cerebrovascular disease

Objectives To discuss headache secondary to cerebrovascular disease. Background Headache is an important symptom in cerebrovascular diseases. In some conditions, headache is the leading symptom. Migraine is associated with an increased risk of stroke. Methods The authors undertook a literature search for the terms “headache” and “cerebrovascular diseases”. Results We report studies on headache in subarachnoidal hemorrhage, intracerebral hemorrhage, ischemic stroke, TIA, basilar artery thrombosis, cervical artery dissection, cerebellar stroke, arteritis and cerebral sinus venous thrombosis. In addition, we discuss migraine and stroke and thunderclap headache. Conclusions Headache is a leading symptom in many cerebrovascular diseases. Headache in combination with focal neurological deficits requires immediate diagnosis and treatment.