Tubercular osteomyelitis of calcaneum in an immunocompetent adult.

Tuberculosis (TB) affecting calcaneum is relatively rare in immunocompetent adults. Due to its nonspecific presentation and the absence of constitutional symptoms of TB, diagnosis is often delayed. The authors present a case of TB of calcaneum in a young male. A 20-year-old male presented with persistent pain and mild swelling of the right heel for 6 months. Upon evaluation with radiographs, a lytic lesion was noted in the posteromedial aspect of the right calcaneum. Magnetic resonance imaging was done and was reported as subacute osteomyelitis with Brodie's abscess. An open biopsy was performed and the obtained tissue was sent for histopathological examination. Histopathology showed features suggestive of Koch's etiology. All the microbiological investigations, including polymerase chain reaction for TB were negative. The patient was started on antitubercular therapy (ATT) based on weight. After 4 months of ATT, the patient developed multiple discharging sinuses over a previous open biopsy scar for which repeat debridement was done. After 12 months of ATT, the patient was asymptomatic, and radiologically, the lesion was healed. Early diagnosis and treatment with ATT will prevent massive destruction and collapse of the calcaneal body and further spread into the subtalar joint. Repeated debridements may be needed in case of nonhealing discharging sinuses to decrease the local infection load.

Flexor tenosynovitis of the wrist with carpal tunnel syndrome.

Tubercular tenosynovitis of the wrist with carpal tunnel syndrome (CTS) is a rare occurrence. The authors present a case of tubercular flexor tenosynovitis of the wrist with CTS. A 60-year-old female presented with complaints of swelling in the volar aspect of the right wrist with numbness of the first three fingers for the past 6 months. Clinical and radiological diagnosis of chronic flexor tenosynovitis with median nerve compression neuropathy was made. The patient was operated with carpal tunnel release and total tenosynovectomy. Histopathology showed features suggestive of Koch's etiology. The patient was started with antitubercular therapy (ATT) and followed up regularly. Carpal tunnel symptoms subsided immediately after surgery and there was no recurrence of swelling at the last follow-up. Carpal tunnel release and tenosynovectomy should be performed at the earliest possible and followed up with ATT for better outcomes in tubercular tenosynovitis of the wrist with CTS.

Campanacci Grade III Giant Cell Tumors of Distal End Radius Treated With Wide Excision and Reconstruction: A Retrospective Case Series.

Introduction Campanacci Grade III Giant Cell tumors of the distal radius are difficult to manage as they are associated with a high recurrence rate. Wide excision of the distal radius and reconstruction with an ipsilateral proximal fibula or ulnar translocation reduces the recurrence rate significantly and gives acceptable function to the hand and wrist. Methods and materials This was a retrospective study of eight patients with Campanacci grade III giant cell tumors of distal radius treated with wide excision of distal radius followed by reconstruction at our institute. Four cases were operated on with ulnar translocation and four cases were operated on with ipsilateral proximal fibula grafting after wide excision of the distal radius. Patients were studied for the Musculoskeletal Tumor Society (MSTS) score and visual analogue scale (VAS) score for pain at one year, recurrence, and complications. Results The mean MSTS score of the total series was 24.75 ± 1.6. The mean VAS score for the total series was 1.62 ± 0.4. Of the eight cases, two cases had a recurrence, one patient had persistent wrist paint, and two patients had wrist subluxation. Conclusion Wide excision of the distal radius followed by reconstruction with a proximal fibula or ulnar translocation is a good option to avoid repeated surgeries in patients with Campanacci grade III giant cell tumors of the distal radius and achieve acceptable functional results for the wrist and hand.

Parsonage-Turner Syndrome Following Covishield (AstraZeneca ChAdOx1 nCoV-19) Vaccination: A Case Report.

Parsonage-Turner Syndrome (PTS) is a rare neurological disorder involving brachial plexus and periscapular muscles following viral infection, surgery, and vaccination. We hereby describe the first case of PTS from India following Covishield (AstraZeneca ChAdOx1 nCoV-19) COVID-19 vaccination. A 21-year-old healthy male presented to us with complaints of pain and weakness in the right shoulder five weeks after Covishield vaccination on the contralateral deltoid. There was no history of injury or constitutional symptoms. On examination, hyperalgesia over the area innervated by the axillary nerve and wasting of the deltoid, supra, and infraspinatus muscles were noted. An MRI scan of the shoulder, cervical spine, and brachial plexus neurogram were normal. Decreased motor amplitude in right axillary and musculocutaneous nerve was recorded in the nerve conduction study (NCS). High titers of SARS-COV-2 IgG neutralizing antibodies were noted after a single dose of vaccination and SARS CoV-2 IgM antibodies were negative. Having been diagnosed with post-vaccination PTS, the right shoulder was splinted and an intravenous injection of 1g methylprednisolone was administered for three days followed by oral steroids for three weeks. NCS and electromyography at 10 weeks showed insignificant differences between the two sides suggesting early neurological recovery. Currently, the patient is being followed up regularly for complete neurological recovery. PTS is a known side effect of vaccination. We report the index case of PTS following the administration of Covishield vaccination from India to aid in early diagnosis and management, further evaluation, and public health safety.

Daily Saline Nasal Douching for Chronic Allergic Rhinosinusitis: An Autobiographical Case Report.

Chronic allergic rhinosinusitis is a debilitating condition in a group of susceptible individuals with multifactorial etiology. I present my case of suffering from chronic allergic rhinosinusitis for 25 years treated with multiple drugs and surgeries with no relief. Adjunctive daily saline nasal douching has provided significant relief for three years to date. Genetic susceptibility with defective ciliary clearance, mucosal metaplasia with increased goblet cells secreting thick and inspissated mucus blocking the normal drainage, and stasis of secretions with inadequate mucosal immunity predisposes to polymicrobial infections, including fungal infections, antimicrobial resistance, and recurrent episodes of rhinosinusitis. Medical and surgical strategies often fail to manage this condition appropriately in a few cases. Adjunctive daily saline nasal douching is a safe and effective alternative to manage the debilitating symptoms of chronic allergic rhinosinusitis.

Hypovitaminosis D in patients with osteoporotic hip fractures.

BACKGROUND: Inadequate serum vitamin D levels are associated with secondary hyperparathyroidism, increased bone turnover, bone loss and increased fracture risk. Vitamin D is well recognized to be suboptimal in older patients when compared to age-matched controls. There are no published studies on the prevalence of hypovitaminosis D in Indian population with fragility fractures around the hip associated with osteoporosis and comminution at the fracture site. AIM: To investigate the prevalence of hypovitaminosis D in patients admitted with osteoporotic hip fractures and associated fracture site comminution in a South Indian Institute. MATERIAL & METHODS: A prospective cross sectional study was conducted on 100 patients admitted with osteoporotic hip fracture. Measurement of serum 25-hydroxy vitamin D was done and the same was correlated with the degree of osteoporosis using Singh's index and fracture site comminution. RESULTS: Out of 100 patients studied, 92% had hypovitaminosis D with mean vitamin D level of 16.08 ±â€¯5.95 ng/dl (65% vitamin D deficiency with mean 13.16 ±â€¯4.24 ng/dl and 27% vitamin D insufficiency with mean 23.11 ±â€¯2.62 ng/dl) and 94% had osteoporosis with Singh's index grade 3 or less. Out of the 36 patients with fracture site comminution 34 patients (94%) had hypovitaminosis D and 33 patients (91.6%) had osteoporosis. Statistical significance was established for all the variables. CONCLUSION: Significant association was found between hypovitaminosis D, osteoporosis and fracture site comminution. High prevalence of hypovitaminosis D in patients presenting with hip fractures and fracture site comminution implicates the necessity for proper evaluation and effective supplementation of vitamin D in elderly patients along with anti-osteoporotic regimens for effective prevention and appropriate management of osteoporotic hip fractures.

Clinical and Genetic Analysis of Fibrodysplasia Ossificans Progressiva: A Case Report and Literature Review.

Fibrodysplasia ossificans progressiva (FOP) is a rare genetic disorder characterized by congenital malformation of the great toes and disabling heterotopic ossification in specific anatomic locations with a world wide prevalence of 1 in 2 million population. Nearly 90% of patients with FOP are misdiagnosed and mismanaged. We present a case of a four-year-old boy brought by his parents with the complaints of stiffness of right shoulder, neck and multiple swellings over the upper back noted over the past 4 months. On examination bilateral symmetrical hallux valgus with microdactyly of great toes and multiple bony hard swellings on both the scapulae were noted. Skeletal survey revealed all the classical features of FOP. Mutation of the ACVR1gene on genetic analysis confirmed the diagnosis of FOP. Invasive surgical procedures including biopsy and manipulations for stiff joints were avoided as they strikingly end up in rapid progression of FOP. Congenital hallux valgus with short great toe in a child should be considered as an early diagnostic tool for FOP even before the onset of mass lesions. Genetic analysis for mutation of ACVR1gene is confirmatory. Prevention of injury, medical management of acute painful flare-ups and rehabilitation are the mainstay of treatment.