The use of a tumor necrosis factor inhibitor-adalimumab-in the management of arthritis in an adolescent with HIV: A case report.

Human immunodeficiency virus (HIV) infection is associated with a myriad of musculoskeletal manifestations. Inflammatory arthritis has been described in association with HIV in both adults and children. Biologic disease-modifying anti-rheumatic drugs, particularly tumor necrosis factor inhibitors (TNFi), have been reported to manage inflammatory arthritis in adults with HIV when conventional therapy fails to control arthritis. In this report, we describe the management of arthritis and enthesitis in a 12-year-old adolescent male with HIV using the TNFi adalimumab. At the time of presentation, the patient was on highly active antiretroviral therapy for 1 year. His viral load was <40 copies/mL, and the CD4+ T-cell count was 1280 cells/mm3 . He had a positive antinuclear antibody and HLA-B27. Rheumatoid factor was negative. After screening for hepatitis B and C and latent tuberculosis, the patient was started on adalimumab. This report describes the successful control of recalcitrant arthritis and enthesitis in a pediatric patient with HIV infection using adalimumab.

Parental Knowledge and Awareness of Childhood Urinary Tract Infections: A Cross Sectional Survey.

Background: Parent's misconceptions or lack of knowledge about childhood urinary tract infections (UTIs) can negatively impact their children's health. Therefore, the present study aimed to determine the childhood urinary tract infections awareness and understanding among parents in Saudi Arabia. Patients and Methods: An online validated cross-sectional survey of parents in Saudi Arabia was conducted from August to September 2021. Study participants who met the inclusion criteria were selected using a convenience sampling technique. A questionnaire with two domains was used to assess parental awareness of childhood urinary tract infection symptoms, complications, treatment, prevention, epidemiology, and diagnosis. The total childhood urinary tract infections awareness scores were classified into three categories: low awareness, moderate awareness, and high awareness. Descriptive statistics were used to determine the data distribution. A chi-square test was used to evaluate the relationship between parental awareness about urinary tract infections in children and other variables. Statistical significance was established at 0.05. Results: Of the 1688 parents who completed the survey, 1289 (76.4%) were female, 1581 (93.7%) were married, and 1161 (68.8) had a university degree. Parent's total awareness scores were high; however, individual domain scores indicate a moderate level of knowledge. Statistically significant relationship were observed between total awareness and gender, occupation, and level of educational level ((P=0.004, P=0.001, P=0.007, respectively). Another statistically significant relationship was noted between the history of urinary tract infections and awareness of disease prevention (P=0.009). Conclusion: In Saudi Arabia, parental knowledge about childhood urinary tract infections is moderate to high. However, future studies are needed to investigate gender, educational, and occupational variations in childhood UTI knowledge among parents in Saudi Arabia.

Orbital Swelling and Ptosis as an Initial Presentation of Childhood Acute Lymphoblastic Leukaemia: A Case Report and Review of the Literature.

We are reporting the case of a 3-year-old-girl who initially presented with unilateral eyelid swelling and ptosis. A diagnosis of acute lymphoblastic leukaemia (ALL) was eventually made based on an orbital incisional biopsy and a bone marrow examination. Historically, orbital involvement had been linked to myeloid leukaemia; however, in lymphoid leukaemia, they are increasingly being implicated and had been reported as the sole presentation of the disease. These findings stress the importance of conducting ophthalmologic assessments in cases diagnosed with ALL in order to prevent delays in proper assessment and treatment. Management options in orbital disease are fortunately not significantly different than well-established treatment protocols.

A Case of a Non-Radiographic Axial Spondyloarthritis in a 14-Year-Old Girl Presenting with Muscle Weakness and Hyperthyroidism.

Juvenile spondyloarthritis (SpA) affects patients below the age of 16 and mainly presents with peripheral involvement. Many atypical clinical presentations were reported in the adult SpA, but not in the juvenile group. We report a case of non-radiographic axial SpA in a 14-year-old girl presented atypically with muscle weakness and hyperthyroidism. She had sacroiliitis evident by magnetic resonance imaging (MRI) with negative HLA-B27. Muscle biopsy showed fasciitis. She responded well to adalimumab and thyroid functions returned to normal values.