Differential Diagnosis between Child Abuse and Infantile Cortical Hyperostosis: A Case Report and Literature Review

Child abuse is a major public health problem that can lead to critical consequences for the child and family. However, early identification of abuse may be difficult. An 8-month-old boy presented with extensive periosteal reaction in both upper and lower long bones. There was no specific history of injury. Caffey disease was initially considered as the diagnosis because the patient displayed fever and hyperostosis of multiple bones with elevated erythrocyte sedimentation rates and C-reactive protein and alkaline phosphatase levels. However, we suspected child abuse based on the clinical and radiological features. We eventually found out that the child had been injured through child abuse and were able to treat him. We report this case because child abuse cases may be confused with Caffey disease. This case report can, therefore, help distinguish between Caffey disease and child abuse.

Unusual etiology of stroke in young adults: think of Takayasu’s arteritis

Takayasu arteritis is an uncommon inflammatory disease of vessels that preferentially affects the aorta and its major branches. It can be a potential cause of stroke in young adults. Current study included 7 patients aged between 18 to 48 years. Each patient had varying presentations of stroke with Takayasu’s arteritis along with other neurological symptoms. Four of the 7 patients presented with ischemic strokes, one with hemorrhagic stroke, one with TIAs and one with syncopal attacks. All the patients had elevated erythrocyte sedimentation rates. Five of the seven patients were treated with steroids and methotrexate. Two were treated with azathioprine and steroids. Antiplatelets were given for those patients who had strokes and TIAs. Our cases demonstrate that Takayasu arteritis can present with varying presentations including stroke. Thus, it is important to consider Takayasu’s arteritis as an unusual etiology of stroke especially in young adults.

Effect of Anti-Rheumatic Treatment on the Periodontal Condition of Rheumatoid Arthritis Patients

Periodontitis, a bacterial-induced infection of the supporting soft and hard tissues of the teeth (the periodontium), is common in patients with rheumatoid arthritis (RA). As RA and periodontitis underlie common inflammatory pathways, targeting the progression of RA might mediate both periodontitis and RA. On the other hand, patients with RA on immunosuppressive medication have an increased risk of infection. Therefore, the objective of this longitudinal observation study was to assess the effect of methotrexate (MTX) and anti-tumor necrosis factor-α (anti-TNF, etanercept) treatment on the periodontal condition of RA patients. Overall, 14 dentate treatment-naive RA patients starting with MTX and 12 dentate RA patients starting with anti-TNF therapy in addition to MTX were included. Follow-up was scheduled matching the routine protocol for the respective treatments. Prior to the anti-rheumatic treatment with MTX or the anti-TNF therapy in addition to MTX, and during follow-up, i.e., 2 months for MTX, and 3 and 6 months for the anti-TNF therapy in addition to MTX, the periodontal inflamed surface area (PISA) was measured. The efficacy of the anti-rheumatic treatment was assessed by determining the change in RA disease activity (DAS28-ESR). Furthermore, the erythrocyte sedimentation rates were determined and the levels of C-reactive protein, IgM-rheumatoid factor, anti-cyclic citrullinated protein antibodies, and antibodies to the periodontal pathogen Porphyromonas gingivalis, were measured. Subgingival sampling and microbiological characterization of the subgingival microflora was done at baseline. MTX or anti-TNF treatment did not result in an improvement of the periodontal condition, while both treatments significantly improved DAS28 scores (both p < 0.01), and reduced C-reactive protein levels and erythrocyte sedimentation rates (both p < 0.05). It is concluded that anti-rheumatic treatment (MTX and anti-TNF) has negligible influence on the periodontal condition of RA patients.

Novel Coronavirus Disease 2019 (COVID-19) Pneumonia Progression Course in 17 Discharged Patients: Comparison of Clinical and Thin-Section Computed Tomography Features During Recovery

Background Our objective was to retrospectively analyze the evolution of clinical features and thin-section computed tomography (CT) imaging of novel coronavirus disease 2019 (COVID-19) pneumonia in 17 discharged patients. Methods Serial thin-section CT scans of 17 discharged patients with COVID-19 were obtained during recovery. Longitudinal changes of clinical parameters and a CT pattern were documented in all patients during the 4 weeks after admission. A CT score was used to evaluate the extent of the disease. Results There were marked improvements of fever, lymphocyte counts, C-reactive proteins, and erythrocyte sedimentation rates within the first 2 weeks after admission. However, the mean CT score rapidly increased from the first to the third week, with a top score of 8.2 obtained in the second week. During the first week, the main CT pattern was ground-glass opacities (GGO; 76.5%). The frequency of GGO (52.9%) decreased in the second week. Consolidation and mixed patterns (47.0%) were noted in the second week. Thereafter, consolidations generally dissipated into GGO, and the frequency of GGO increased in the third week (76.5%) and fourth week (71.4%). Opacities were mainly located in the peripheral (76.5%) and subpleural (47.1%) zones of the lungs; they presented as focal (35.3%) or multifocal (29.4%) in the first week and became more diffuse in the second (47.1%) and third weeks (58.8%), then showed a reduced extent in fourth week (50%). Conclusions The progression course of the CT pattern was later than the progression of the clinical parameters within the first 2 weeks after admission; however, there were synchronized improvements in both the clinical and radiologic features in the fourth week.

GENERAL IMMUNOLOGICAL REACTIVITY OF PATIENT’S ORGANISM WITH CHRONIC HEPATITIS С

Introduction: Nowadays, the number of chronic carriers of hepatitis C virus (HCV) is considered to be from around 150 to 500 million by the most of infectionists and epidemiologists. Being one of the most dangerous diseases of the liver of viral etiology hepatitis C increases annually. The aim: To determine the level of general immunological reactivity of patients with chronic hepatitis C. Materials and methods: This study does not contradict the principles of the Helsinki Declaration (2013), the European Convention on Human Rights and Biomedicine. A clinical and laboratory examination of 31 patients with chronic hepatitis C was conducted during 2014-2015 on the basis of the infectious department of Chernivtsi Regional Clinical Results: The initial condition of clinical and laboratory examination of patients with chronic hepatitis C is normally considered to be a clinical examination of each patient and first of all hemograms where absolute and relative number of major populations of immunocompetent cells, platelets, erythrocytes and erythrocyte sedimentation rates (ESR) were determined. Conclusions: General immunological reactivity in patients with chronic hepatitis C increased to 30,07% and the factors activation and mechanisms of nonspecific anti-infection protection decreased that create a condition for prolonged persistence of hepatitis C virus and the progression of a chronic infectious process in patients’ organism.

HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN ADULTS: LOW INCIDENCE OF PRIMARY NEOPLASM AS A TRIGGER IN A CASE SERIES FROM TURKEY

This study aimed to investigate the clinical and laboratory features and outcomes of Turkish patients with Hemophagocytic Lymphohistiocytosis. The medical records of 26 HLH adult patients (≥ 16 years of age) were retrospectively analyzed. Gender, age, the duration of fever, time to diagnosis, etiology and laboratory data were extracted from the records. The mean age was 38 ± 18 years, and 15 (58%) patients were female. A total of nine cases had infectious diseases, four cases had rheumatologic diseases, three cases had hematological malignancies while nine cases could not be obtained a definitive diagnosis. The median time to detection of HLH was 20 days (IQR: 8-30 d). Of the 25 patients, 11 (44%) died. The erythrocyte sedimentation rates of the surviving and non-surviving patients were 39 ± 22 mm/h and 15 ± 13 mm/h, respectively. When a long-lasting fever is complicated by bicytopenia or pancytopenia (especially), clinicians must promptly consider the possibility of HLH syndrome to improve patients’ prognosis