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Transient Primary Bone Marrow Edema Syndrome - A Synthesis
Nissim Ohana,
Dimitri Sheinis,
Daniel Benharroch
Issue:
Volume 7, Issue 2, March 2019
Pages:
27-32
Received:
4 March 2019
Accepted:
4 April 2019
Published:
15 May 2019
Abstract: A complex and often confusing nomenclature is currently used for relatively rare syndromes characterized by sudden onset of joint pain in the lower limbs, absence of trauma, bone marrow edema and its resolution, both confirmed by the MRI, as well as a self-limiting course. These include transient osteoporosis of the hip (TOH), of the knee (TOK), of the foot and ankle and transient bone marrow edema syndrome. Our purpose was to review the literature in order to substantiate the hypothesis that these apparently different conditions may be synthesized into a single disease entity, termed transient primary bone marrow edema syndrome (TPBMES). Of a total of 546 patients scrutinized, 342 had TOH, 105 had TOH of pregnancy, and 49, mainly females, showed transient foot-and-ankle osteoporosis. TPBMES occurred also with systemic osteoporosis or in a migratory pattern. The six proposed subsets of TPBMES have in common a MRI-based diagnosis and remission, as well as a self-limiting course. Thus, the hypothesis of a single disease entity is sustainable. We conclude that the education of the medical profession regarding this rare disease should expand. The causes of the prolonged symptoms seen in the systemic osteoporosis and migratory subsets warrant further studies. The efficiency of our suggested modality of management should be validated in a large cohort.
Abstract: A complex and often confusing nomenclature is currently used for relatively rare syndromes characterized by sudden onset of joint pain in the lower limbs, absence of trauma, bone marrow edema and its resolution, both confirmed by the MRI, as well as a self-limiting course. These include transient osteoporosis of the hip (TOH), of the knee (TOK), of...
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Chiari Network – Just an Innocent Bystander or Can Have Serious Impact on Clinical Outcomes
Anum Asif,
Nauman Farooq,
Tayebah Mumtaz
Issue:
Volume 7, Issue 2, March 2019
Pages:
33-35
Received:
4 March 2019
Accepted:
14 May 2019
Published:
30 May 2019
Abstract: Chiari network, a remnant of sinus venosus is often incidentally diagnosed on routine echocardiograms. Chiari network occurs due to incomplete resorption of right valve of sinus venosus. It is often noticed as fenestrated membranous structure or reticular network like structure in the valve of inferior vena cava and coronary sinus. The structure was first described by Von Rokitansky in 1875 and gained its name after pathologist Hans Chiari in 1897 when he described the structure in 11 cadavers. There are inconsistencies in the exact prevalence of this structure and has been reported in literature from 2-13.6%. Most of this data is available from cadaveric or autopsied hearts. These structures are usually considered as benign congenital malformations but literature has reported various cases which have resulted in medical complications including endocarditis, thromboembolism or procedural difficulties. These structures can also mimic right atrial pathologies or thrombus creating a diagnostic challenge. It is important that clinicians are aware of these since misdiagnosis can have significant effect on clinical course and outcomes of the patients. The possibility of the presence of these congenital remnants should be kept in mind during clinical decision making. We present two clinical scenarios with incidental diagnosis of Chiari network and its effect on the clinical course of these patients.
Abstract: Chiari network, a remnant of sinus venosus is often incidentally diagnosed on routine echocardiograms. Chiari network occurs due to incomplete resorption of right valve of sinus venosus. It is often noticed as fenestrated membranous structure or reticular network like structure in the valve of inferior vena cava and coronary sinus. The structure wa...
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Frequency and Risk Factors Association of Fall Among the Idiopathic Parkinson’s Patients in Jashore, Bangladesh
Goutam Kumar Acherjya,
Mohammad Ali,
Mostofa Kamal,
Rajashish Chakkraborty,
Md Anwar Shahadat,
AV Srinivashan
Issue:
Volume 7, Issue 2, March 2019
Pages:
36-40
Received:
28 March 2019
Accepted:
5 May 2019
Published:
30 May 2019
Abstract: Parkinson’s disease is the second most common neuro degenerative disease worldwide. Fall is common scenario in our day to day clinical practice among the older people but it is more common among the Parkinson’s people. The study was conducted to assess the frequency of fall and to ascertain the risk association among the idiopathic Parkinson’s patients. This observational study was conducted from July to December, 2018 in the district of Jashore, Bangladesh. Both the male and female clinically diagnosed as idiopathic Parkinson’s disease without taking antiparkinsonian medication were recruited in the study. Those having Parkinson’s disease due to stroke or secondary causes, orthostatic hypotension, taking anti parkinsonian drugs and the drugs may mimicking Parkinson’s disease were excluded from the study. A total 111 patients were analyzed of which 69.4% (N=77) male and 30.6% (N=34) female with the mean age of our participants was 66±10 years. The event of fall among the idiopathic Parkinson’s patients was 36.9% in the last one year where single, two and three or more episodes of fall were 20.7%, 3.6% and 12.6% respectively. No significant difference observed between faller and non-fallers among different demographic characteristics including age (p: 0.091) sex (p: 0.058) educational level (p: 0.235), occupational status (p: 0.220) and residency (p: 0.547). Experience of fall found more in high BMI (p: 0.037), hypertensive (p: 0.018), diabetic (p: 0.009) and in patients receiving multiple medications (p: 0.011). But duration of Parkinsonism (p: 0.835) does not increase fall. Based on this study, we have found that there is high frequency of fall among the idiopathic Parkinson’s patients. So, earlier identification and potential strategies to remove the risk factors may prevent falls and falls related events, thus finally reducing the morbidity and mortality in the Parkinson’s patients.
Abstract: Parkinson’s disease is the second most common neuro degenerative disease worldwide. Fall is common scenario in our day to day clinical practice among the older people but it is more common among the Parkinson’s people. The study was conducted to assess the frequency of fall and to ascertain the risk association among the idiopathic Parkinson’s pati...
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Ear Nose and Throat (ENT) Manifestations in Granulomatosis with Polyangiitis in Patients from Saudi Arabia
Abdurhman Saud Al Arfaj,
Najma Khalil
Issue:
Volume 7, Issue 2, March 2019
Pages:
41-45
Received:
7 April 2019
Accepted:
16 May 2019
Published:
4 June 2019
Abstract: Granulomatosis with polyangiitis (GPA) frequently affects ear, nose and throat (ENT) at disease onset. Our aim was to report on our experience with the ENT manifestations in GPA patients, therapy and outcome. A retrospective study of GPA patients was performed who followed up in Rheumatology clinics at King Khalid University hospital, Riyadh during the period 1990-2016. Demographics, different ENT manifestations, laboratory and diagnostic features, therapy and outcome of GPA patients were retrieved from their medical charts. ENT involvement was observed in 15 (65.2%) of the 23 GPA cases identified. Otologic symptoms were noted in 3 (13.0%), nose and sinus symptoms in 13 (56.5%) and throat symptoms in 3 (13.0%) GPA patients. Epistaxis (39.1%) was the most prevalent nose and sinus symptom followed by sinusitis (30.4%), otitis media and hearing loss were the frequent otologic symptoms, oral ulcers and hoarseness of voice constituted frequent throat symptoms in GPA patients. Of the 15 ENT-GPA patients, 9 were males and 6 were females (male: female; 1.5: 1). Their mean age at disease onset was 33.8 ± 18.3 (range 11-57) years and mean duration of disease was 10.1 ± 5.9 (range 1-20) years. ANCA was positive in 93.3% ENT-GPA patients, 73.3% had c-ANCA and 20.0% had p-ANCA. Infections were noted in 33.3% ENT-GPA patients that included pneumonia, septicemia, esophageal candidiasis, bacterial meningitis and herpes zoster. All patients received oral prednisolone, 60.0% received intravenous cyclophosphamide, 20.0% refractory cases received rituximab doses, and the disease outcome was good. Comparison of ENT- GPA with non- ENT GPA cohort showed that 26.7% ENT-GPA patients had renal involvement compared to 87.5% non ENT-GPA patients (p = 0.009). Our study showed that the frequency of ENT symptoms in our GPA patients was less compared to other studies, and the disease outcome was good. Renal involvement was significantly less frequent in ENT-GPA cohort compared to non ENT-GPA cohort.
Abstract: Granulomatosis with polyangiitis (GPA) frequently affects ear, nose and throat (ENT) at disease onset. Our aim was to report on our experience with the ENT manifestations in GPA patients, therapy and outcome. A retrospective study of GPA patients was performed who followed up in Rheumatology clinics at King Khalid University hospital, Riyadh during...
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Significance of G Test [(1-3)-β-D-Glucan Assay] in the Diagnosis and Guidance of Clinical Medication of Invasive Fungal Infection
Lianfang Xue,
Suishan Qiu,
Guangchao Yu,
Qin-Ai Zhu,
Shasha Li,
Hui Liu,
Yuping Wang,
Fengtian Ouyang,
Wenyu Gong
Issue:
Volume 7, Issue 2, March 2019
Pages:
46-50
Received:
13 April 2019
Accepted:
21 May 2019
Published:
11 June 2019
Abstract: Objective: G test [(1-3) -β-D-glucan assay] was a novel texting method for invasive fungal infection (IFI). The study evaluated the diagnostic value of G test for IFI by comparing G test with fungal culture method，and analyze the guiding significance of G test and fungal culture in clinical medication. Methods: 373 inpatients with suspected IFI in the first affiliated hospital of Jinan university from January to December 2017 were retrospectively analyzed. G test and fungal culture results were collected, and their positive rate, sensitivity, specificity, positive and negative predictive values were calculated. The value and rationality of G test for clinical diagnosis of IFI was evaluated by taking the relief and cure of infection symptoms of patients as clinical effective criteria. Results: Among 373 suspected IFI patients, the positive rate of G experiment was 39.95%, higher than that of fungus culture (28.95%, P<0.001). The positive rate of combined G test and fungal culture was 43.70%. To evaluate the consistency of G test with fungal culture method, κ value was 0.596 (P<0.001). When positive fungal culture was used as the criterion for the diagnosis of IFI, the sensitivity, specificity, positive predictive value and negative predictive value of G test for the diagnosis of IFI were 87.04%, 79.25%, 63.09% and 93.75%, respectively. All 373 patients with IFI received antifungal therapy, and the effective rate of the both methods positive group was 72.34%, higher than 42.86% in the only fungal culture positive group (P=0.033) and 30.48% in the both methods negative group (P<0.001). The effective rate of the only G test positive group was 58.18%, higher than that of the both methods negative group (30.48%, P<0.001). There was no significant difference in the therapeutic efficiency between the only G test positive group and the only fungal culture positive group (P=0.303). Conclusion: G test was an effective diagnostic method of IFI, and combined with fungal culture could improve its positive rate and have a higher guiding value for clinical medication.
Abstract: Objective: G test [(1-3) -β-D-glucan assay] was a novel texting method for invasive fungal infection (IFI). The study evaluated the diagnostic value of G test for IFI by comparing G test with fungal culture method，and analyze the guiding significance of G test and fungal culture in clinical medication. Methods: 373 inpatients with suspected IFI in ...
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