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1.
BMJ Case Rep ; 14(1)2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33495189

RESUMO

We report an extremely rare case of adult Langerhans cell histiocytosis (LCH) in a patient with papillary thyroid carcinoma (PTC) and Castleman disease (CD). A 46-year-old man visited our hospital with anaemia; systemic imaging showed an abdominal and a left thyroid mass. Biopsy confirmed CD for the abdominal mass and PTC for the thyroid mass. Two months after, he presented with headache and a right parietal lump. Brain CT and enhanced MRI revealed an osteolytic mass with enhancement in the right parietal skull. Surgical removal and biopsy confirmed the diagnosis of skull LCH. The BRAF mutation was positive on PTC and negative on CD and LCH. We conducted surgical resection only for PTC and LCH; surgical resection with siltuximab for multicentric CD. At the 25-month follow-up, there was no recurrence or progression. We may consider of syndromic nature of these diseases to establish a treatment strategy.


Assuntos
Doenças Ósseas/diagnóstico por imagem , Hiperplasia do Linfonodo Gigante/diagnóstico por imagem , Histiocitose de Células de Langerhans/diagnóstico por imagem , Câncer Papilífero da Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Anticorpos Monoclonais/uso terapêutico , Antineoplásicos/uso terapêutico , Doenças Ósseas/complicações , Doenças Ósseas/patologia , Doenças Ósseas/cirurgia , Hiperplasia do Linfonodo Gigante/complicações , Hiperplasia do Linfonodo Gigante/tratamento farmacológico , Hiperplasia do Linfonodo Gigante/patologia , Histiocitose de Células de Langerhans/complicações , Histiocitose de Células de Langerhans/patologia , Histiocitose de Células de Langerhans/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Crânio , Câncer Papilífero da Tireoide/complicações , Câncer Papilífero da Tireoide/patologia , Câncer Papilífero da Tireoide/cirurgia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Tomografia Computadorizada por Raios X
2.
Orphanet J Rare Dis ; 15(1): 228, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32867855

RESUMO

During the COVID-19 outbreak, the European Reference Network on Rare Bone Diseases (ERN BOND) coordination team and Italian rare bone diseases healthcare professionals created the "COVID-19 Helpline for Rare Bone Diseases" in an attempt to provide high-quality information and expertise on rare bone diseases remotely to patients and healthcare professionals. The present position statement describes the key characteristics of the Helpline initiative, along with the main aspects and topics that recurrently emerged as central for rare bone diseases patients and professionals. The main topics highlighted are general recommendations, pulmonary complications, drug treatment, trauma, pregnancy, children and elderly people, and patient associations role. The successful experience of the "COVID-19 Helpline for Rare Bone Diseases" launched in Italy could serve as a primer of gold-standard remote care for rare bone diseases for the other European countries and globally. Furthermore, similar COVID-19 helplines could be considered and applied for other rare diseases in order to implement remote patients' care.


Assuntos
Betacoronavirus , Doenças Ósseas/complicações , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Doenças Raras/complicações , Consulta Remota/normas , Idoso , Algoritmos , Doenças Ósseas/terapia , Criança , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Feminino , Humanos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Gravidez , Doenças Raras/terapia , Ferimentos e Lesões
3.
J S Afr Vet Assoc ; 91(0): e1-e4, 2020 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-32129635

RESUMO

A feather cyst in the cervical region which, through complications of inward growth, resulted in compression of the cervical spinal cord of a Lohmann Brown layer is described. It is postulated that expansion of the cyst exerted pressure on the adjacent cervical vertebra and through bone lysis created an opening through which the cyst protruded, thereby exerting pressure on the spinal cord. The affected spinal cord segment was reduced to a fifth of its normal diameter. The bird most likely died of starvation because of limb and neck paralysis and disorientation. Although the cause of the feather cyst was not conclusively identified, moulting and trauma could have triggered its formation and subsequent growth.


Assuntos
Doenças Ósseas/veterinária , Vértebras Cervicais/patologia , Galinhas , Cistos/veterinária , Doenças das Aves Domésticas , Compressão da Medula Espinal/veterinária , Animais , Doenças Ósseas/complicações , Doenças Ósseas/etiologia , Doenças Ósseas/patologia , Cistos/complicações , Cistos/etiologia , Cistos/patologia , Plumas , Feminino , Doenças das Aves Domésticas/etiologia , Doenças das Aves Domésticas/patologia , Compressão da Medula Espinal/patologia
4.
Clin Chim Acta ; 501: 186-197, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31770508

RESUMO

Vitamin Ddeficiency is frequently present in patients affected by chronic kidney disease (CKD). Experimental studies demonstrated that Vitamin D may play a role in the pathophysiology of diseases beyond mineral bone disorders in CKD (CKD-MBD). Unfortunately, the lack of large and interventional studies focused on the so called "non-classic" effects of 25(OH) Vitamin D supplementation in CKD patients, doesn't permit to conclude definitely about the beneficial effects of this supplementation in clinical practice. In conclusion, treatment of nutritional vitamin D deficiency in CKD may play a central role in both bone homeostasis and cardiovascular outcomes, but there is not clear evidence to support one formulation of nutritional vitamin D over another in CKD.


Assuntos
Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/tratamento farmacológico , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/sangue , Vitamina D/uso terapêutico , Doenças Ósseas/sangue , Doenças Ósseas/complicações , Doenças Ósseas/tratamento farmacológico , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/tratamento farmacológico , Suplementos Nutricionais , Humanos , Insuficiência Renal Crônica/sangue , Vitamina D/administração & dosagem , Deficiência de Vitamina D/sangue
5.
Dis Markers ; 2019: 1814304, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687048

RESUMO

Chronic kidney disease (CKD) is an irreversible loss of kidney function, and it represents a major global public health burden due to both its prevalence and its continuously increasing incidence. Mineral bone disorders (MBDs) constitute a hallmark of CKD, and alongside cardiovascular complications, they underlie a poor prognosis for these patients. Thus, our study focused on novel CKD biomarker patterns and their impact on the clinical staging of the disease. As a first testing approach, the relative expression levels of 105 proteins were assessed by the Proteome Profiler Cytokine Array Kit for pooled CKD stage 2-4 serum samples to establish an overall view regarding the proteins involved in CKD pathogenesis. Among the molecules that displayed significant dysregulation in the CKD stages, we further explored the involvement of Dickkopf-related protein 1 (Dkk-1), a recognised inhibitor of the Wnt signalling pathway, and its crosstalk with 1,25OH2D3 (calcitriol) as new players in renal bone and vascular disease. The serum levels of these two molecules were quantified by an ELISA (76 samples), and the results reveal decreasing circulating levels of Dkk-1 and calcitriol in advanced CKD stages, with their circulating expression showing a downward trend as the CKD develops. In the next step, we analysed the inflammation and MBD biomarkers' expression in CKD (by xMAP array). Our results show that the molecules involved in orchestrating the inflammatory response, interleukin-6 (IL-6) and tumour necrosis factor alpha (TNFα), as well as the mineral biomarkers osteoprotegerin (OPG), osteocalcin (OC), osteopontin (OPN), and fibroblast growth factor 23 (FGF-23), correlate with Dkk-1 and calcitriol, raising the possibility of them being potential useful CKD biomarkers. These results reveal the impact of different biomarker patterns in CKD staging and severity, thus opening up novel approaches to be explored in CKD clinical management.


Assuntos
Biomarcadores/sangue , Inflamação/patologia , Insuficiência Renal Crônica/diagnóstico , Idoso , Algoritmos , Densidade Óssea , Doenças Ósseas/complicações , Doenças Ósseas/diagnóstico , Calcitriol/sangue , Estudos Transversais , Feminino , Fatores de Crescimento de Fibroblastos/sangue , Humanos , Peptídeos e Proteínas de Sinalização Intercelular/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Osteocalcina/sangue , Osteopontina/sangue , Osteoprotegerina/sangue , Fenótipo , Prognóstico , Proteoma , Insuficiência Renal Crônica/sangue , Insuficiência Renal Crônica/complicações , Fator de Necrose Tumoral alfa/sangue , Via de Sinalização Wnt
6.
PLoS One ; 14(10): e0222225, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622347

RESUMO

BACKGROUND: HIV-positive patients are facing age-and disease-related comorbidities. Since gender differences in viro-immunological, clinical and therapeutic features have been described, aim of this analysis was to explore such differences in elderly HIV-positive females compared to males coming from the same cohort. DESIGN: Cross-sectional study. SETTING: Ten Infectious Diseases Center participating to a new multicenter Italian geriatric Cohort aiming at describing health transition over time in HIV-positive individuals. PARTICIPANTS: HIV-positive patients aged ≥65 years old. MEASUREMENTS: We recorded clinical, viro-immunological and therapeutical data. RESULTS: We included 210 women (17%) out of 1237 patients. Compared to males, elderly females were less likely to present a HIV-RNA <50 copies/mL (74.3% vs. 81.8%, OR 0.64, 95%CI 0.44-0.93); they showed higher CD4+/CD8+ ratio (p = 0.016). Combined antiretroviral therapy (cART) strategies were similar between genders (p>0.05), although women were less likely to be treated with protease Inhibitors (PIs) (p = 0.05); specifically, in triple-drug regimens females received less PIs (28% vs 38% p = 0.022) and more integrase inhibitors (30% vs. 20% p = 0.012). Bone disease was more common in females (p<0.001) while males presented more frequently cardiovascular disease (CVD) (p<0.001). In females with bone disease, PIs and boosted regimens (38% vs. 53.7% p = 0.026 and 30.4 vs 44.0% p = 0.048 respectively) were prescribed less frequently. Polypharmacy was common and similar in both genders (20% vs. 22.8%, p = >0.05). A higher use of lipid-lowering drugs (20.5% vs. 14.8%, p = 0.04) was observed in females and yet they were less likely to receive anti-thrombotic agents (18.6% vs. 26.3%, p = 0.019) even when CVD was recorded (57.1% vs. 83.1%, p = 0.018). In multivariate analysis, we found that female gender was independently associated with a higher CD4+/CD8+ ratio but not with virological suppression. CONCLUSIONS: Elderly HIV-positive women display a worse virologic response despite a better immune reconstitution compared to males. The burden of comorbidities as well as the medications received (including cART) may slightly differ according to gender. Our data suggest that more efforts and focused interventions are needed in this population.


Assuntos
Doenças Ósseas/epidemiologia , Linfócitos T CD4-Positivos/efeitos dos fármacos , Infecções por HIV/epidemiologia , HIV-1/efeitos dos fármacos , Idoso , Idoso de 80 Anos ou mais , Fármacos Anti-HIV/administração & dosagem , Doenças Ósseas/complicações , Doenças Ósseas/patologia , Doenças Ósseas/virologia , Linfócitos T CD4-Positivos/virologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/patologia , Doenças Cardiovasculares/virologia , Estudos de Coortes , Quimioterapia Combinada , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Soropositividade para HIV/sangue , Soropositividade para HIV/virologia , HIV-1/patogenicidade , Humanos , Masculino , RNA Viral/genética , Caracteres Sexuais , Carga Viral/efeitos dos fármacos
7.
Int J Mol Sci ; 20(17)2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31480433

RESUMO

Osteoporosis is a frequently observed complication in patients with chronic liver disease, particularly liver cirrhosis and cholestatic liver diseases. In addition, osteoporosis is critical in patients receiving a liver transplant. Nevertheless, few studies have evaluated bone diseases in patients with more frequently observed chronic liver disease, such as chronic viral hepatitis, nonalcoholic fatty liver disease and alcoholic liver disease. Osteoporosis is a disease caused by an imbalance in the activities of osteoblasts and osteoclasts. Over the last few decades, many advances have improved our knowledge of the pathogenesis of osteoporosis. Importantly, activated immune cells affect the progression of osteoporosis, and chronic inflammation may exert an additional effect on the existing pathophysiology of osteoporosis. The microbiota of the intestinal tract may also affect the progression of bone loss in patients with chronic liver disease. Recently, studies regarding the effects of chronic inflammation on dysbiosis in bone diseases have been conducted. However, mechanisms underlying osteoporosis in patients with chronic liver disease are complex and precise mechanisms remain unknown. The following special considerations in patients with chronic liver disease are reviewed: bone diseases in patients who underwent a liver transplant, the association between chronic hepatitis B virus infection treatment and bone diseases, the association between sarcopenia and bone diseases in patients with chronic liver disease, and the association between chronic liver disease and avascular necrosis of the hip. Few guidelines are currently available for the management of low bone mineral density or bone diseases in patients with chronic liver disease. Due to increased life expectancy and therapeutic advances in chronic liver disease, the importance of managing osteoporosis and other bone diseases in patients with chronic liver disease is expected to increase. Consequently, specific guidelines need to be established in the near future.


Assuntos
Doenças Ósseas/complicações , Hepatopatias/complicações , Animais , Doenças Ósseas/patologia , Doenças Ósseas/terapia , Doença Crônica , Gerenciamento Clínico , Humanos , Hepatopatias/patologia , Hepatopatias/terapia , Transplante de Fígado
8.
JBJS Case Connect ; 9(3): e0391, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31365360

RESUMO

CASE: Focal periphyseal edema (FOPE) zones have only recently been described as a cause of joint pain in adolescence. The literature is limited to a few case reports and radiologic studies describing this symptomatic physeal pathology. This series describes 3 adolescent patients with magnetic resonance imaging (MRI) confirmed FOPE zones of the distal femur. Repeat MRI of 2 of the 3 patients showed improvement yet incomplete resolution of the bone edema, corresponding with persistent knee pain. CONCLUSIONS: FOPE zones usually improve with conservative treatment, but may be a cause of persistent knee pain in adolescents.


Assuntos
Artralgia/etiologia , Doenças Ósseas/complicações , Edema/complicações , Articulação do Joelho/diagnóstico por imagem , Adolescente , Artralgia/diagnóstico por imagem , Doenças Ósseas/diagnóstico por imagem , Edema/diagnóstico por imagem , Feminino , Humanos , Radiografia
9.
J Bone Miner Res ; 34(6): 996-1013, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31233632

RESUMO

Gaucher disease (GD) is a rare, genetic lysosomal disorder leading to lipid accumulation and dysfunction in multiple organs. Involvement of the skeleton is one of the most prevalent aspects of GD and a major cause of pain, disability, and reduced quality of life. Uniform recommendations for contemporary evaluation and management are needed. To develop practical clinical recommendations, an international group of experienced physicians conducted a comprehensive review of 20 years' of the literature, defining terms according to pathophysiological understanding and pointing out best practice and unmet needs related to the skeletal features of this disorder. Abnormalities of bone modeling, reduced bone density, bone infarction, and plasma cell dyscrasias accompany the displacement of healthy adipocytes in adult marrow. Exposure to excess bioactive glycosphingolipids appears to affect hematopoiesis and the balance of osteoblast and osteoclast numbers and activity. Imbalance between bone formation and breakdown induces disordered trabecular and cortical bone modeling, cortical bone thinning, fragility fractures, and osteolytic lesions. Regular assessment of bone mineral density, marrow infiltration, the axial skeleton and searching for potential malignancy are recommended. MRI is valuable for monitoring skeletal involvement: It provides semiquantitative assessment of marrow infiltration and the degree of bone infarction. When MRI is not available, monitoring of painful acute bone crises and osteonecrosis by plain X-ray has limited value. In adult patients, we recommend DXA of the lumbar spine and left and right hips, with careful protocols designed to exclude focal disease; serial follow-up should be done using the same standardized instrument. Skeletal health may be improved by common measures, including adequate calcium and vitamin D and management of pain and orthopedic complications. Prompt initiation of specific therapy for GD is crucial to optimizing outcomes and preventing irreversible skeletal complications. Investing in safe, clinically useful, and better predictive methods for determining bone integrity and fracture risk remains a need. © 2019 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.


Assuntos
Osso e Ossos/fisiopatologia , Doença de Gaucher/fisiopatologia , Padrões de Prática Médica , Doenças Ósseas/complicações , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/fisiopatologia , Medula Óssea/patologia , Medula Óssea/fisiopatologia , Remodelação Óssea , Osso e Ossos/diagnóstico por imagem , Doença de Gaucher/complicações , Doença de Gaucher/diagnóstico , Doença de Gaucher/terapia , Humanos
10.
World Neurosurg ; 128: 14-17, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31054339

RESUMO

BACKGROUND: An epidermoid cyst arising from diploic space in the skull can cause an intracranial mass effect with compression of the underlying venous sinuses. CASE DESCRIPTION: A 66-year-old woman came to us with a persistent headache and unsteadiness. Computed tomography demonstrated an occipital bone cystic lesion with an intracranial mass effect overlying the torcular herophili, with high-intensity findings in diffusion-weighted magnetic resonance imaging. Cerebral angiogram demonstrated obstruction of the torcular herophili with development of diploic venous drainage. The patient underwent removal of the lesion and a cranioplasty procedure. The diagnosis was torcular epidermoid cyst. The postoperative course was uneventful, and the symptoms were resolved. CONCLUSIONS: Development of diploic venous drainage contributed to avoidance of critical intracranial hypertension during slow growth of a torcular epidermoid cyst.


Assuntos
Doenças Ósseas/complicações , Transtornos Cerebrovasculares/etiologia , Cavidades Cranianas , Cisto Epidérmico/complicações , Idoso , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/patologia , Doenças Ósseas/cirurgia , Transtornos Cerebrovasculares/diagnóstico por imagem , Transtornos Cerebrovasculares/cirurgia , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Cavidades Cranianas/patologia , Cisto Epidérmico/diagnóstico por imagem , Cisto Epidérmico/patologia , Cisto Epidérmico/cirurgia , Feminino , Humanos , Hipertensão Intracraniana/etiologia , Osso Occipital
11.
J Investig Med High Impact Case Rep ; 7: 2324709619836139, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30938179

RESUMO

INTRODUCTION: Sarcoidosis is a systemic granulomatous inflammatory disease that can involve almost any organ system in the human body. It most frequently presents with pulmonary infiltrates, hilar lymphadenopathy, and skin lesions. Clinical and subclinical involvement of other organ systems is not uncommon. However, the simultaneous development of clinically apparent multisystem sarcoidosis is very rare. CASE DESCRIPTION: This 44-year-old Caucasian man presented to an outpatient clinic with a 2-month history of fatigue, night sweats, weight loss, loss of appetite, and mild abdominal discomfort. Initial laboratory finding showed elevated liver enzymes. Imaging studies revealed cirrhotic liver with steatosis, few enhancing hepatic masses, and multiple enlarged periaortic and portocaval lymph nodes. Liver biopsy revealed scattered necrotizing granulomatous hepatitis. Positron emission tomography scan showed extensive hepatic uptake, diffuse lymphadenopathy, as well as numerous fluorodeoxyglucose-avid osseous lesions. After extensive workup to rule out malignancy and infectious etiologies, a diagnosis of diffuse multi-organ sarcoidosis was made. He was ultimately treated with methotrexate and steroids, resulting in marked improvement in symptoms and liver function, with stable disease on repeat imaging. CONCLUSION: Diffuse multi-organ sarcoidosis is often associated with widespread lymphadenopathy and osseous lesions, which appear indistinguishable from malignancy on imaging. The angiotensin converting enzyme levels and inflammatory markers may be normal. Clinicians should be aware of the possibility of diffuse systemic sarcoidosis in any patient with a remote sarcoidosis history and the simultaneous development of multi-organ-related symptoms.


Assuntos
Doenças Ósseas/patologia , Granuloma/patologia , Hepatopatias/patologia , Linfadenopatia/patologia , Sarcoidose Pulmonar/patologia , Adulto , Biópsia , Doenças Ósseas/complicações , Granuloma/complicações , Humanos , Hepatopatias/complicações , Linfadenopatia/complicações , Masculino , Especificidade de Órgãos , Tomografia por Emissão de Pósitrons , Sarcoidose Pulmonar/complicações
12.
J Int Neuropsychol Soc ; 25(3): 336-342, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30729910

RESUMO

This study, reports for the first time, the neuropsychological profile of a child with Hamamy syndrome-a rare genetic disorder with only five published cases (Buget, Canbolat, Akgul, & Kucukay, 2015). The patient was seen for a neuropsychological evaluation at ages 6 and 7, at the American University of Beirut Medical Center. Procedures included an extended clinical interview with the parent, behavioral observations, formal tests, and a series of parental rating scales. Patient was found to have relatively spared nonverbal intelligence, borderline-impaired language, and clinically impaired verbal reasoning, attention, and motor coordination. Additionally, he showed clinically significant concerns with behavioral regulation, metacognition, attention-deficit, and hyperactivity/impulsivity. The patient was diagnosed with a DSM-V Language Disorder, Speech Sound Disorder, and Attention Deficit/Hyperactivity Disorder, combined presentation, in the context of low-average intelligence. At follow-up, the neuropsychological profile was consistent, albeit improvement was noted following pharmacotherapy. This is the first published report that describes the neuropsychological functions of Hamamy syndrome. We make recommendations for early identification of cognitive strengths and weaknesses, and interventions to address them. Future research should evaluate additional functions such as memory and social/emotional development. (JINS, 2019, 25, 336-342).


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Doenças Ósseas/complicações , Hipertelorismo/complicações , Deficiência Intelectual/complicações , Inteligência/fisiologia , Transtornos da Linguagem/fisiopatologia , Miopia/complicações , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Criança , Humanos , Transtornos da Linguagem/etiologia , Masculino , Distúrbios da Fala/etiologia , Distúrbios da Fala/fisiopatologia
14.
Clin Imaging ; 54: 15-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30500454

RESUMO

Differentiation of bone infarct from osteomyelitis is one of the most challenging issues in the evaluation of acute bone pain in sickle cell patients. The imaging modalities that are currently being used for assessment of bone marrow in this population have several limitations. We present a case of an 18-year-old male with a history of sickle cell disease, who was transferred to our emergency department with progressively severe headache and jaw pain for one-week. Initial evaluation was concerning for osteomyelitis and epidural abscess formation. Due to the lack of response to the current antibiotic treatment, he was transferred to our institution. On further review of the images, atypical DWI findings that were identified in the early phase of presentation helped to differentiate bone infarct from osteomyelitis. Radiologists should be aware of this phenomenon, as it can help in the differentiation between these two pathologies and can affect the patient's management overall.


Assuntos
Anemia Falciforme/complicações , Doenças Ósseas/diagnóstico , Osso e Ossos/patologia , Adolescente , Antibacterianos , Doenças Ósseas/complicações , Doenças Ósseas/patologia , Medula Óssea , Humanos , Masculino , Osteomielite/diagnóstico , Osteomielite/patologia
15.
Clin Infect Dis ; 69(8): 1370-1376, 2019 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-30590451

RESUMO

BACKGROUND: We characterized associations between frailty and incident cardiovascular disease (CVD), diabetes mellitus (DM), bone disease, and mortality within a cohort of aging persons with human immunodeficiency virus (PWH). METHODS: Participants underwent frailty evaluations using the Fried frailty assessment (baseline and annually). Frailty was defined as having ≥3 frailty criteria. Clinical outcomes of mortality, CVD events, DM, and bone disease events were recorded throughout the study period (baseline to most recent study or clinic visit, or date of clinical outcome, whichever came first). Poisson regression models were used to evaluate associations between baseline frailty, change in frailty score over 48 weeks, and each clinical outcome. RESULTS: Among 821 men and 195 women (median age 51 years), 62 (6%) were frail at baseline. Frailty scores increased by ≥1 component among 194 participants (19%) from baseline to 48 weeks. Baseline frailty was associated with an increased risk of incident CVD and DM, with a trend toward a significant association with bone events. Among frailty components, slow gait speed was associated with incident DM and borderline associated with incident CVD. An increase in frailty from baseline to week 48 was associated with mortality but not with the other clinical outcomes. CONCLUSIONS: Baseline frailty was associated with multiple adverse health outcomes (incident CVD, DM, and bone disease), while increase in frailty score was associated with mortality among PWH engaged in care. Incorporation of frailty assessments into the care of PWH may assist in improvement of functional status and risk stratification for age-related chronic diseases.


Assuntos
Doenças Ósseas/epidemiologia , Doenças Cardiovasculares/epidemiologia , Diabetes Mellitus/epidemiologia , Fragilidade , Infecções por HIV/complicações , Adulto , Fatores Etários , Envelhecimento , Doenças Ósseas/complicações , Doenças Cardiovasculares/complicações , Doença Crônica , Estudos de Coortes , Demografia , Complicações do Diabetes/epidemiologia , Feminino , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Medição de Risco , Fatores de Risco
16.
World Neurosurg ; 123: 165-167, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30476663

RESUMO

BACKGROUND: Cranial pneumatization in humans is normally confined to the paranasal sinuses and the petrous and mastoid parts of the temporal bones. CASE DESCRIPTION: We present a case of left-sided fractures of the occipital condyle and lateral mass of the atlas in the setting of extensive craniocervical pneumatization but in the absence of trauma, with a resulting unilateral hypoglossal nerve palsy. CONCLUSIONS: We discussed the possible etiology of this rare disease, its management, and prognosis.


Assuntos
Doenças Ósseas/complicações , Atlas Cervical/lesões , Fraturas Espontâneas/complicações , Doenças Ósseas/diagnóstico por imagem , Atlas Cervical/diagnóstico por imagem , Fraturas Espontâneas/diagnóstico por imagem , Humanos , Doenças do Nervo Hipoglosso/diagnóstico por imagem , Doenças do Nervo Hipoglosso/etiologia , Masculino , Pessoa de Meia-Idade , Osso Occipital
17.
Enferm Infecc Microbiol Clin ; 37(6): 373-379, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30389268

RESUMO

BACKGROUND: The life expectancy of HIV-infected individuals has dramatically improved with potent antiretroviral therapies. However, organ-specific toxicities of some antiretrovirals and persistent inflammation and immune activation due to residual virus replication account for a high burden of age-associated comorbidities in the HIV population. METHODS: The prevalence of overt cardiovascular, renal and bone diseases as well as their major risk factors were cross-sectionally examined during the year 2014 in the VACH cohort, a large nationwide population of HIV-infected individuals in Spain. RESULTS: A total of 10,897 HIV-infected patients were examined. Seventy-one point four percent were male and the mean age was 48 years. Mean time since HIV diagnosis was 15.8 years and mean time on antiretroviral therapy was 13.1 years. The proportion of patients with undetectable viral load was 87.1%, whereas 65.7% had CD4 counts>500 cells/mm3. Overall, cardiovascular, renal and bone disease were recorded in 4.7%, 5.9% and 2.8%, respectively. The prevalence of major risk factors was as follows: smoking 51.3%, alcohol abuse 7.8%, overweight/obesity 42.2%, diabetes 19.9%, dyslipidaemia 72.6%, hypertension 25.6%, and osteoporosis 11.1%. In the subset of patients older than 55 years-old (18%), all figures for overt disease and their major risk factors were significantly greater. CONCLUSION: Major age-related medical conditions and most of their risk factors are highly prevalent in HIV-infected individuals on long-term antiretroviral therapy in Spain. Preventive actions, including careful selection of antiretroviral agents, should be prioritized in the ageing HIV population.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Doenças Ósseas/complicações , Doenças Ósseas/epidemiologia , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Nefropatias/complicações , Nefropatias/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Espanha
18.
Foot Ankle Spec ; 12(4): 311-315, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30129378

RESUMO

BACKGROUND: Multiple ankle pathologies have been found to coexist with chronic lateral ankle ligament instability, but their prevalence varies widely in the literature. The purpose of this study is to reexamine the prevalence of these associated pathologies and to determine their impact on reoperation rate. METHODS: We retrospectively reviewed 382 cases of lateral ankle ligament repair/reconstruction between June 2006 and November 2016. Patient charts and radiograph reports were examined for the presence of any associated foot and ankle pathologies as well as clinical course. The effect of copathologies on reoperation rate was examined using binary logistic regression and the χ2 test. RESULTS: We included a total of 99 cases. Copathologies included peroneal pathology (75/99, 75.8%), ankle impingement (40/99, 40.4%), and osteochondral lesion of the talus (17/99, 17.2%); 36.4% (36/99) had a low-lying muscle belly of peroneus brevis. The total reoperation rate was 12/92 (13.1%). It was lower in cases with peroneal pathology (8.7% vs 27.5%, P = .032). CONCLUSION: Peroneal pathology, ankle impingement, and osteochondral lesions were the most common associated copathologies in surgical patients with chronic lateral ankle ligament instability. The presence of peroneal pathology may lead to fewer reoperations, possibly as a result of a more comprehensive first-time surgical approach. Level of Evidence: Level III: Retrospective cohort.


Assuntos
Doenças Ósseas/complicações , Doenças Ósseas/epidemiologia , Fíbula , Instabilidade Articular/complicações , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Doenças Musculares/complicações , Doenças Musculares/epidemiologia , Adulto , Tornozelo , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético , Procedimentos Ortopédicos , Prevalência , Procedimentos Cirúrgicos Reconstrutivos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Tálus , Fatores de Tempo , Adulto Jovem
19.
BMJ Case Rep ; 20182018 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-30232074

RESUMO

Reported is the case of a 79-year-old woman initially diagnosed with periorbital abscess on the background of a recent upper respiratory tract infection. Unexpectedly, intraoperative findings were that of a haematoma rather than an abscess. Subperiosteal orbital haematoma (SOH) is an extremely rare complication of rhinosinusitis. In contrast to the more common periorbital abscess, it is seldom listed as a complication of sinusitis. A review of reported cases suggests an older patient demographic are affected by SOH in contrast to periorbital abscess which typically affects paediatric patients. Given current demographic trends toward an older patient population with multiple comorbidities, failure to consider SOH as a differential will have important implications on preoperative workup, perioperative care and final outcome for patients. We present this case as a reminder of a rare but important complication of a common disease.


Assuntos
Sinusite Frontal/complicações , Hematoma/diagnóstico por imagem , Órbita/patologia , Administração Intravenosa , Idoso , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Doenças Ósseas/complicações , Doenças Ósseas/microbiologia , Doenças Ósseas/patologia , Drenagem/métodos , Feminino , Hematoma/tratamento farmacológico , Hematoma/microbiologia , Hematoma/cirurgia , Humanos , Órbita/irrigação sanguínea , Doenças Orbitárias/etiologia , Doenças Orbitárias/patologia , Propionibacterium acnes/isolamento & purificação , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
20.
Atherosclerosis ; 278: 49-59, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30253289

RESUMO

Mineral bone disease (MBD) is a common complication of chronic kidney disease (CKD) characterized by disruption of normal mineral homeostasis within the body. One or more of the following may occur: hypocalcemia, hyperphosphatemia, secondary hyperparathyroidism (SHPT), decreased vitamin D and vascular calcification (VC). The greater the decrease in renal function, the worse the progression of CKD-MBD. These abnormalities may lead to bone loss, osteoporosis and fractures. CKD-MBD is a major contributor to the high morbidity and mortality among patients with CKD. Another well-known complication of CKD is cardiovascular disease (CVD) caused by increased atherosclerosis and VC. CVD is the leading cause of morbidity and mortality in CKD patients. VC is linked to reduced arterial compliance that may lead to widened pulse pressure and impaired cardiovascular function. VC is a strong predicator of cardiovascular mortality among patients with CKD. Elevated phosphorus levels and increased calcium-phosphorus product promote VC. Controlling mineral disturbances such as hyperphosphatemia and SHPT is still considered among the current strategies for treatment of VC in CKD through restriction of calcium based phosphate binders in hyperphosphatemic patients across all severities of CKD along with dietary phosphate restriction and use of calciminetics. Additionally, Vitamin D insufficiency is common in CKD and dialysis patients. The causes are multifactorial and a serious consequence is SHPT. Vitamin D compounds remain the first-line therapy for prevention and treatment of SHPT in CKD. Vitamin D may also have atheroprotective effects on the arterial wall, but clinical studies do not show clear evidence of reduced cardiovascular mortality with vitamin D administration. This review discusses the issues surrounding CKD-MBD, cardiovascular disease and approaches to treatment.


Assuntos
Aterosclerose/complicações , Densidade Óssea , Doenças Ósseas/complicações , Cálcio/metabolismo , Insuficiência Renal Crônica/complicações , Calcificação Vascular/complicações , Animais , Aterosclerose/patologia , Doenças Ósseas/patologia , Osso e Ossos/patologia , Cardiotônicos/farmacologia , Ensaios Clínicos como Assunto , Homeostase , Humanos , Hiperparatireoidismo Secundário/complicações , Hiperparatireoidismo Secundário/patologia , Hiperfosfatemia/complicações , Hiperfosfatemia/patologia , Rim/fisiopatologia , Fosfatos/metabolismo , Diálise Renal , Insuficiência Renal Crônica/patologia , Sevelamer/farmacologia , Calcificação Vascular/patologia , Vitamina D/farmacologia
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