bluuebunny/crossref_metadata_2025 huggingface dataset:
P035 Hip involvement in Tunisian Juvenile Idiopathic Arthritis patients
Authors: Yasmine Makhlouf , Triki Wafa , Maatallah Kaouther , Ferjani Hanene , Ben Nessib Dorra , Kaffel Dhia , Hamdi Wafa
Published: November 2021

Background

Juvenile idiopathic arthritis (JIA) is characterized by a widely variable clinical course and outcome. If uncontrolled, joint damage may occur. In this context, coxitis is a feared complication. The aim of our study was to determine the prevalence and patterns of hip involvement in Tunisian JIA patients.

Methods

A retrospective study including children with JIA according to the International League of Associations for Rheumatology (ILAR)) was conducted between 2012and 2021. Sociodemographic data as well as disease characteristics were collected. Laboratory markers including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were recorded. Hip involvement was assessed clinical exam and imaging (standard radiograph, ultrasound or magnetic resonance imaging (MRI)). We compared these parameters between the two groups: G1: presence of coxitis and G2: absence of coxitis.

Results

The study included 40 patients with a male predominance: sex ratio was 1.6. The mean age was 11.1 years-old [3–16]. The mean age at onset of the disease was 18.1 years old [8–30]. The distribution of the different subsets was as follows: polyarticular with rheumatoid factor (n = 1), polyarticular without rheumatoid factor (n = 2), enthesitis-related arthritis (n = 29), oligoarthritis (n = 7), psoriatic arthritis (n = 1). Extra-articular manifestations were found in 21.2% of cases: ocular (n = 4), pulmonary (n = 2) and cardiovascular (n = 1). The mean ESR and CRP was 30.9 mm/h [2–90] and 15.8 mg/l [1–70] respectively. A high ESR or CRP were found in 67% of cases. Hip involvement concerned 70% of the patients and was bilateral in 67.9% of them. Hip radiographs were normal in 50% of cases. Ultrasound was performed in 9 patients and revealed a positive Doppler synovitis (n = 2), a negative Doppler synovitis (n = 7) and joint effusion (n = 2). MRI was performed in 20% of cases and revealed synovitis (67%) and joint effusion (33%). Overall, 79.3% of patients had medical treatment combining NSAIDs and rehabilitation, 39% of the patients had had local infiltration with Hexatrione and only two patients had hip replacement. Hip involvement was not correlated with age at onset (P = 0.2), subtype (P = 0.8), sex (P = 0.7), extraarticular manifestations (P = 0.4). Similarly, there was no correlation between the presence of coxitis and ESR (P = 0.07) as well as CRP (P = 0.5).

Conclusion

Our study showed that hip involvement is frequent among Tunisian patients with JIA. Although not correlated with disease characteristics, hip involvement should be assessed frequently and carefully.
P038 Let’s look at coxitis features in enthesitis-related arthritis population
Authors: Yasmine Makhlouf , Ferjani Hanene , Maatallah Kaouther , Triki Wafa , Ben Nessib Dorra , Kaffel Dhia , Hamdi Wafa
Published: November 2021

Background

Enthesitis-related arthritis (ERA) is a defined juvenile idiopathic arthritis subtypes, which presents with enthesitis, arthritis and axial skeleton involvement. ∼20–50% of JIA patients have hip involvement within 1–6 years of diagnosis onset [1]. The frequency of coxitis in ERA category is not recognized. The aim of this study was to assess coxitis features and its management in ERA population.

Methods

A retrospective study including children with ERA according to the International League of Associations for Rheumatology (ILAR). Data recorded included sociodemographic features, disease characteristics (disease duration, extra-articular manifestations, and presence of HLAB27) as well as treatment modalities. Regarding coxitis, we collected radiographs, ultrasound (US) and magnetic resonance imaging (MRI) of the hip when performed. Coxitis was defined by clinical (limited range of motion) and/or radiographic findings (destruction, synovitis, bone marrow oedema).

Results

The study included 51 patients with ERA. There was a male predominance (78.4%). The mean age of onset of the disease was 12.2 years [6–16]. The mean current age was 24.3 years old [9–59]. A family history of spondyloarthritis was found in 26.8% of cases. A positive HLAB27 was reported in 85.7% of cases. The distribution of extra-articular manifestations (37.5%) was as follows: ocular (n = 8), cardiovascular (n = 2), gastrointestinal (n = 1), pulmonary (n = 4). A peripheral onset was found in 39% and a peripheral and axial onset was reported in 42% of patients. Hip involvement was found in 78.4% of the patients and revealed the disease in 43% of cases. The mean delay between disease onset and coxitis was 4.5 years [0–34]. Coxitis was bilateral and destructive in 82.5% and 51% of cases respectively. The most limited range of motion was the internal rotation (68%), followed by hip flexion (48%) and the external rotation (43.2%). In patients with normal hip radiography (n = 8), US or MRI depicted early changes in 75% of cases. Hip replacement was noted in ten patients and was bilateral in 70% of cases. Regarding treatment modalities, NSAIDs and csDMARD (MTX n = 14, SLZ n = 8, biologics n = 2) were prescribed in 76.4% and 52% respectively. Most of the patients had physical therapy (88%) and 23.5% of them had intra-articular corticoid injection. Twenty-six percent of the patients had hip replacement.

Conclusion

Our study showed a high prevalence of coxitis among ERA patients. There is a need to further optimize therapeutic strategies for such patients.
P039 Evolutionary course of Juvenile Idiopathic Arthritis
Authors: Mechid F , Bahaz N , Remilaoui A , Zehraoui F H , Benaziez R , Dahou-Makhloufi C
Published: November 2021

Background

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of rare conditions that begin before the age of 16. Seven categories have been defined by the International League of Associations for Rheumatology (ILAR) classification. The aim of our work is to describe the demographic, clinical, and radiological characteristics and therapeutic of patients with JIA.

Materials and methods

A retrospective, descriptive study of patients followed for AIJ in the rheumatology department of Mohamed LamineDebaghine during a period of 15 years (2005–2020). Patients were included if satisfied ILAR criteria.

Results

Ten patients with JIA were included, 5 of whom were females. The mean age of onset was 9.20 ± 3.15 (range: 5–14 years). The subtypes were as follows: 4 patients had RF-negative polyarthritis, one case had RF-positive polyarthritis, one with systemic arthritis form, 2 cases of oligoarthritis, 1 case of psoriatic arthritis, and enthesitis-related arthritis. Three children have coxitis. ACPA was positive in one case and antinuclear antibodies were negative. Eight patients have developed osteoarticular destruction. Pulmonary involvement was noted in a patient who had RF-positive polyarthritis.

Corticosteroid therapy was prescribed in 9 patients, 5 of whom developed complications related to steroids, including growth retardation, which was observed in 3 cases. Nine JIA patients received methotrexate. The use of etanercept and IL-1 inhibitors were required in 7 and 1 cases, respectively. Corticosteroid infiltrations were performed in 9 patients. Total hip replacement was indicated in 3 patients.

Conclusion

Through our study, we note a predominance of the polyarticular form. Osteoarticular destruction seems to be frequent, particularly in the hip. The use of biotherapy and the total hip prosthesis proved the severity of juvenile idiopathic arthritis in our patients.
P051 Juvenile Behcet's disease
Authors: Cherfi R , Mahieddine N , Mammeri K , Touri S , Sadaoui F , Kirouani B , Kedji L
Published: November 2021

Background

Behçet's disease is a rare systemic vasculitis in children. The most frequent manifestations are orogenitalaphthosis and uveitis. Neurological, digestive, vascular, joint, and skin involvement are possible. We aimed to describe the clinical, diagnostic criteria, and therapeutic features of pediatric-onset Behcet's disease

Methods

Study carried out based on files collected over 12 years (2007–2018) concerning patients under the age of 15 hospitalized in the pediatric department of CHU de Blida for Behcet disease

Results

For 12 years (2007–2018), we hospitalized five children for various reasons and whose diagnosis of Behcet's disease was retained. These are 03 boys (2 of the theme are brothers) and 02 girls. The average age at admission was 13.5 years (12–15 years), and the average duration of follow-up is 4.2 years (15 months-8 years).

The mean age of onset of first symptoms was 11 years, and the meantime to diagnosis was 2 years (12 months-3 years)

The main diagnostic criteria were: mouth ulcers in five patients (100%), genital ulcers in three patients (60%), ophthalmic manifestations in two patients (40%): one had bilateral uveitis, and the other had papillitis, the pathergy test was positive in 3 patients (60%).

The other manifestations were as follows: polyarthralgia in 3 patients (60%), family history in one patient (20%). Neurological manifestations were present in 3 patients (60%): one child presented two episodes of aseptic meningitis and thrombosis deep cerebral venous; one child with diffuse cerebral demyelination lesions, and the third with HIC syndrome and massive lateral sinus thrombosis.

Three children have a vascular involvement (60%): pulmonary embolism with thrombosis of the superior vena cava (20%), bilateral thrombosis of the jugular veins (20%), and thrombosis of the right ventricle complicated by pulmonary embolism (20%)

Initial symptoms included recurrent aphthous stomatitis (100%), arthralgia (60%), prolonged fever (20%), behavioral disturbances and dysarthria (20%), weight loss (40%), and headache (60 %).

The histocompatibility antigen (HLAB 51) was found in 2 children (40%). The treatment included corticosteroids for all patients (3 boluses of 1 g/m2/day of methylprednisolone then relayed by prednisone 1 mg/kg/day), azathioprine 2.5 mg/kg/day in 5 children (100%), and colchicine for 2 patients only one patient had received anticoagulant therapy (LMWH followed by VKA) Relapses were observed in a single patient (20%) and mortality in one patient (20%.)

Conclusion

Behcet's disease is a rare disease whose diagnosis remains difficult in children. However, early diagnosis and aggressive treatment are mandatory to avoid complications and functional sequelae.
P064 Henoch-Schonlein Purpura: experience of a general pediatric center
Authors: Belamri D J , Boustil I , Zoubir S , Chériet Bensoltane H , Bouchair N
Published: November 2021

Background

Henoch-Schonlein purpura (HSP) is the most classic dysimmune vasculitis in children, related to an abnormal response of an immature immune system following an external antigen attack. Digestive involvement in HSP conditions the immediate vital prognosis and severe renal failure conditions the long-term functional prognosis. The Objective is to identify the epidemiological, clinical, disease course and therapeutic particularities of patients with HSP with a review of the literature.

Material and method

The authors reported the results of a retrospective study of cases of patients with HSP hospitalized and treated in the 02 pediatric departments of the wilaya of Annaba in Algeria (Clinique Sainte Thérèse, Annaba hospital university center and EHS El Bouni) over a period of 02 years. Information was obtained from hospital records.

Results

24 cases of HSP were identified with a sex ratio of 1.4 (14 boys and 10 girls) and a hospital incidence of 1.66%. The average age was 6.6 years. Half of patients was hospitalized during the autumn-winter period, 67% of whom had an ENT infection before their hospitalizations. 17% of cases have personal history of HSP (the oldest was 5 years ago and the most recent 10 days before hospitalization). 7 patients underwent surgeries prior to hospitalization. Skin lesions were found in all patients. Joint, digestive and renal involvement were recorded in 50%, 80% and 25% respectively. Gastrointestinal bleeding has been observed in one patient. Only 1 patient with renal impairment progressed to chronic renal failure and only 1 patient had confirmed hypertension. A rare association with viral hepatitis A has been noted in one patient.

Conclusion

HSP remains a benign condition, easy to recognize clinically. Its immediate prognosis depends on the digestive complications and its long-term on nephropathy which may expose to the risk of chronic renal failure.
P067 Bone manifestations of Haematological Malignancies
Authors: Mzabi Anis , Fakhfakh Rym , Ben Hassine Imen , Anoun Jihed , Karmani Monia , Ben Fredj Fatma , Laouani Chadia
Published: November 2021

Background

Bone manifestations complicate many haematological malignancies and usually reflect a progression of the disease, affecting the prognosis (1). Because of the diversity of imaging appearances and clinical behavior of this spectrum of disease, diagnosis can be challenging. The Objectives is to describe the characteristics of bone manifestations in hematologic malignancies.

Methods

A retrospective descriptive study reviewing the medical records of all patients with hematologic malignancies, hospitalized in an internal medicine department.

Results

Among 70 patients, 39 men and 31 women were enrolled. The mean age was 55 years (15–83 years). Bone manifestations were related to multiple myeloma (28 cases), Hodgkin's disease (16 cases), non-Hodgkin's lymphoma (13 cases), chronic leukaemia (6 cases), acute leukaemia (5 cases) and Waldenström's disease (2 cases). The clinical presentation was dominated by: an alteration of the general condition (45 cases), peripheral lymphadenopathy (28 cases), hepato-splenomegaly (22 cases), diffuse bone pain (21 cases), back pain (16 cases) and night sweats (13 cases). The complete blood count found cytopenia in 47 cases. Patients presented a biologic inflammatory syndrome (58 cases), kidney failure (23 cases) and hypercalcemia (13 cases). Osteolytic lesions were objectified in 13 cases and vertebral collapse in 4 cases. A myelogram was performed in 40 cases, a lymph node biopsy in 25 cases, a bone marrow biopsy (6 cases) and a bone biopsy in 4 patients. The treatment was based on chemotherapy +/- radiotherapy. Therapeutic abstention was indicated in some patients.

Conclusion

Multiple myeloma and Hodgkin’s disease have shown the most bone manifestations. Knowledge of the different characteristics of hematological malignancies is essential to enable early diagnosis and appropriate treatment.
P069 Assessment of diagnostic delay for hip disorders in the pediatric population
Authors: Ines Cherif , Triki Wafa , Hassen Affes , Ferjani Hanene , Maatallah Kaouther , Ben Nessib Dorra , Kaffel Dhia , Wafa Hamdi
Published: November 2021

Background

Hip disorders are highly common among pediatric patients. The diagnosis is based primarily on the clinical findings, the context and the personal and family history of the child. It is in most cases steered by the biological and imaging findings. The latter are usually derived from radiographs, ultrasound imaging and, in some cases, MRI. The main purpose of this study is to evaluate assess the diagnostic delay for hip disorders in the pediatric population.

Methods

We conducted a retrospective study including pediatric patients from the rheumatology and the orthopedics department, who consulted or were referred to orthopeadics for a suspected hip disorder.

For all patients, we collected the following data: age, clinical findings, imaging findings, the number of consultations in general medicine or emergency medicine and the number of consultations in orthopedics department before the diagnosis is made, the final retained diagnosis and, ultimately, the diagnostic delay since onset of symptoms and first consultation.

Results

We included 81 children (48 boys and 33 girls) with a mean age of 9.9 years old [1.5–16]. Sixty-two patients were symptomatic at admission. The pain was located in the hip in 55.5% of patients (n = 45), in the groin in 7.4% of patients (n = 6) and in the knee in 12.34% of patients (n = 10). One child reported unilateral buttock pain. The other reasons for consultation were limping in 3.7% of cases (n = 3), deformity of the lower limb in 1.23% of cases (n = 1), a crying baby in 1.23% of cases (n = 1) and swelling of the knee in 1.23% of cases (n = 1). On clinical examination, 58 patients had a limitation of the hip motion. Twenty-nine percent of the children had a biological inflammatory syndrome at admission. In total, over one hundred and seventy-one imaging examinations were performed in order to adjust the diagnosis; among them, 7 CT pelvic scan and 23 MRI.

The different retained diagnoses of hip involvement are summarized in Table 1.

The mean number of consultations in general medicine or emergency medicine before the diagnosis is made was 0,58 ranging from 0 to 2. The mean diagnostic delay since the onset of symptoms was 9,12 months ranging from 3 days to 13 years. The mean diagnostic delay since the first medical check -up was 3,5 months ranging from 0 to 10 years.

Conclusion

Our study showed that the patient lost an average of 9 months from symptom onset to retaining the final diagnosis. The hip being a prognosis joint, this delay could alter the child's future functional abilities.
P070 Evaluation of the perception of pediatric rheumatology by pediatric residents: results of a national survey
Authors: Hadef Djohra , Benaldjia Hanene , Saidani Feryal , Mechtaoui Nesrine
Published: November 2021

Background

Pediatric Rheumatology (PR) is a young specialty that has not yet gained momentum in Algeria. The aim of this study is the assessment of the perception of PR by pediatric residents in Algeria and the current practice of this young sub-specialty in our country.

Methods

Descriptive cross-sectional study evaluating the perception of PR by pediatric residents was created on Google forms and distributed via email and Facebook to be taken as a self-administered online survey.

The survey is composed of three parts: socio-demographic characteristics of the participant, current practice of PR and perspectives of PR training.

Results

Seventy-seven residents responded to the online questionnaire, with an average age of 30.40 ± 3.13 years and 65% of participants being female. Participation included different regions of Algeria (Batna, Annaba, Setif, Constantine, Algiers and Oran) and different levels of training (from the first year to the fifth year of residency)

Ninety-two percent (92%) of participants had managed PR consultations, with a frequency of once a week in 75.3% of cases and twice a week in 15.6% of cases. In 81% of cases, it was not the initial presentation. The patients were mainly referred by a general practitioner or a general pediatrician. The Management of these patients was provided by a general pediatrician in 69.4% of cases and only in 37.7% by a specialized pediatrician. In 71.4% of cases, there was no pediatric rheumatologist in the establishment where the resident was being trained.

The level of knowledge in PR was admitted to be poor by 59.7% of the respondents. Seventy-five percent of the residents wanted to have rotations dedicated to this sub-specialty during their training. Seventy percent thought that PR is equally as important to know as the other subspecialties in pediatrics (pediatric endocrinology, pediatric pneumology ...). Interest in further PR training was expressed by 80.5% of participants, given the chance.

Conclusion

This survey reinforces the perception that PR training needs to be improved in Algeria, especially as the number of PR consultations is on the rise.

The creation of specialized training in PR is becoming a necessity.
P075 Contribution of biothérapy in pediatric rheumatology: tolérance and efficacy
Authors: Messadi W , Salmi A , Cherif N
Published: November 2021

Background

Biotherapy result of spectacular advances in genetics and research in molecular and cellular biology, has considerably improved the management of rheumatic and autoinflammatory diseases in children. The Objective is to assess the efficacy and tolerance of biotherapy in pediatrics

Methods

A retro-prospective study was carried out in the Pediatric Department B at the pediatric rheumatology consultation, university hospital center. An operating sheet was drawn up including epidemiological, clinical, paraclinical and therapeutic data of the cases diagnosed as well as their evolution on biotherapy.

Results

26 children received treatment with biotherapy. 73% presented with JIA (54% systemic, 19% polyarticular with positive RF, 19% severe uveitis, and 4% familial Mediterranean fever. 4% behçet disease

The mean time to start biotherapy was 12 months [2–48]. There is a clear clinical and biological improvement for 93% of patients. Etanercept was effective in polyarticular-progressive JIA, Adalimumab in oligoarthritis with severe uveitis, Tocilizumab in systemic forms of JIA and Anakinra in familial Mediterranean fever resistant to colchicine and systemic arthritis.

The adverse reactions noted were: one case of tuberculosis, hepatic cytolysis in 4 cases, and one case of psoriasis.

Conclusion

The introduction of biotherapy in pediatric has considerably improved the management of inflammatory rheumatic diseases and transformed the prognosis of these chronic diseases. The maintenance of the good response to treatment and the good tolerance of biotherapy must be evaluated prospectively over the long term.
P076 SARS-COV-2 infection in two patients with juvenile lupus
Authors: Hanane Toumi , Tiaaza Faid , Asmaa Sakhi , Kenza Bouayed
Published: November 2021

Background

The new SARS-COV-2 pandemic affects both children and adults, with a low pediatric percentage of < 1%. The severity and death rate of this disease are lower in this age range. The pediatric populations who are most likely to develop severe COVID 19 are those with particularly immunosuppressive comorbidities. Juvenile systemic lupus erythematosus “jSLE” which represents the prototype of autoimmune diseases, constitutes a predisposing ground for severe viral infections, related to immune dysfunction; linked on one hand to the disease, and on the other hand to the numerous immunosuppressive treatments prescribed. In this context, a great risk was incurred by patients with jSLE. The aim of this work is to assess the severity of COVID 19 infection in our patients with jSLE

Methods and results

Among 20 cases of jSLE hospitalized during the year 2020, we report 2 medical cases report of patients aged 9 and 8, respectively, followed-up in our tertiary care unit for jLES based on the criteria of the Systemic Lupus International Collaborating Clinics “SLICC 2012” and the American College of Rheumatology “ACR 2019”, and who developed a cough, progressing dyspnea and feverish. The Covid 19 was confirmed by a positive PCR for SARS-COV-2. The chest X-ray showed a systematized right cavity in 1 case. Thoracic CT showed foci of alveolar condensation systematized with air bronchogram sign extended to > 25%, associated with bilateral subpleural ground glass areas centrally and peripherally compatible with moderate pneumonia type COVID 19 in one case. The patients were in flare of their lupus disease, proven by the consumption of the C3 and C4 fractions of the complement.

They were treated according to the national COVID 19 infection management plan comprising azithromycin at a dose of 20 mg/kg/day on D1 then 10 mg/kg/day for 6 days, increasing the doses of hydroxychloroquine, associated with vitamin therapy (vitamin C, Zinc, vitamin D), the evolution was favorable after 7 days of treatment.

Conclusion

Reassuringly, several studies have shown that the clinical course of covid 19 in SLE does not appear to be more severe than in the general population. The hydroxychloroquine prescribed routinely in patients with SLE does not protect against covid 19, but may prevent the occurrence of severe forms.
P080 Acroosteolysis: a rare complication or a co-occurrence with Juvenile Idiopathic Arthritis?
Authors: Yasmine Makhlouf , Saoussen Miladi , Alia Fazaa , Mariem Sellami , Leila Souabni , Kmar Ouenniche , Selma Kassab , Selma Chekili , Ben Abdelghani Kawther , Ahmed Laatar
Published: November 2021

Background

Acroosteolysis refers to a destructive process involving the distal phalanges of the fingers and toes that may extend to metacarpals or metatarsals. Rarely idiopathic, the diagnosis of primary acroosteolysis requires ruling out other causes. Juvenile idiopathic arthritis is an exceptional aetiology of acroosteolysis occurring mainly in psoriatic arthritis. Here by a case of juvenile idiopathic arthritis associated with acroosteolysis of the toes.

Methods

A 13-year-old girl with no past medical history, presented to our department of rheumatology with oligoarthritis affecting both wrists and knees. She had no familiar history of psoriasis nor rheumatic diseases. She described a dull ache and recurring swelling of knees evolving for >6 years associated with a macular rash of the chest without fever. On examination, the knees were swollen with a limited range of motion of < 90°. Examination of the spine and sacroiliac joints was unremarkable. There was no deformity, no dysmorphic syndrome nor ligamentous hyper laxity. The mucocutaneous examination was normal. Similarly, there was no hepatosplenomegaly or swollen lymph nodes. Laboratory investigations showed high acute phase reactants and normal blood count. Rheumatoid factor, anti-cyclic citrullinated peptide antibodies and antinuclear antibodies were also negative. Besides, she was negative for HLAB-27. Ophthalmic examination did not show any sequelae of uveitis.

Results

Plain radiograph of the feet revealed bone resorption of the second and fifth distal phalanges without signs of reconstruction. Other secondary causes of acroosteolysis were ruled out. The diagnosis of oligoarticular juvenile idiopathic arthritis was made. In view of the involvement of the distal phalanges, the phenotype of psoriatic arthritis was probable. The patient was initially treated with non-steroidal anti-inflammatory drugs as well as intraarticular injections of corticosteroids in knees. As the flares persisted, she was put on Methotrexate at a dosage of 15 mg per week with marked clinical improvement.

Conclusion

Our case illustrates a possible occurrence of acroosteolysis of the feet in the field of an active juvenile idiopathic arthritis. It is important to rule out other causes and make a rapid diagnosis in order to ensure appropriate management decisions.
P092 Infantile osteopetrosis: a case report Traduction en Anglais
Authors: Sakhi A , Scholastique R , Moussali N , Bouayed K
Published: November 2021

Background

Infantile osteopetrosis is a rare genetic disorder characterized by increased bone density due to defective osteoclastic resorption.

Case report

We report the case of a 6 years old girl, born of a consanguineous marriage, hospitalized in our department for bone deformations and visual disturbances. On clinical examination, there was conjunctival pallor, thoracic deformity, genu-valgum and dentigenesis disorder as well as nystagmus and severe loss of visual acuity. The complete blood count showed regenerative normochromic normocytic anaemia as well as thrombocytopenia. Assessment for infectious disorders was negative. The skeletal X-ray revealed diffuse osteocondensation of the skeleton. The CT scan of the rock bones of cranial bases revealed bilateral segmental stenosis of the facial canal with densification of the ossicular chain and thickening of the stapes. Cranio-orbital MRI revealed bilateral optic duct stenosis with atrophy of the optic nerves and chiasma. The diagnosis of osteopetrosis was retained according to this set of clinical and radiological arguments. Unfortunately, the genetic study could not be performed. Histocompatible bone marrow transplant may be curative but was not available for our patient. Genetic counseling was offered for the family as well as dental and orthopedic care.

Conclusion

Infantile osteopetrosis is a rare but serious pathology that can have severe functional repercussion and even be life-threatening, requiring early diagnosis and management.
Inequality
Authors: Galbraith James
                    K.
Published: November 2021

Over the past
thirty years, the issue of economic inequality has emerged from the backwaters
of economics to claim center stage in the political discourse of America and
beyond a change prompted by a troubling fact: numerous measures of income
inequality, especially in the United States in the last quarter of the twentieth
century, have risen sharply in recent years. Even so, many people remain
confused about what, exactly, politicians and media persons mean when they
discuss inequality. What does “economic inequality ” mean? How is it measured?
Why should we care? Why did inequality rise in the United States? Is rising
inequality an inevitable feature of capitalism? What should we do about it?
Inequality: What Everyone Needs to Know takes up these questions and more in
plain and clear language, bringing to life one of the great economic and
political debates of our age. Inequality expert James K. Galbraith has compiled
the latest economic research on inequality and explains his findings in a way
that everyone can understand. He offers a comprehensive introduction to the
study of economic inequality, including its philosophical and theoretical
origins, the variety of concepts in wide use, empirical measures and their
advantages and disadvantages, competing modern theories of the causes and
effects of rising inequality in the United States and worldwide, and a range of
policy measures. This latest addition to the popular What Everyone Needs to Know
series from Oxford University Press will tell you everything you need to know to
make informed opinions on this significant issue.
Prevention and control of HIV/AIDS in China: lessons from the past three decades
Authors: Xu Jun-Jie , Han Meng-Jie , Jiang Yong-Jun , Ding Hai-Bo , Li Xi , Han Xiao-Xu , Lv Fan , Chen Qing-Feng , Zhang Zi-Ning , Cui Hua-Lu , Geng Wen-Qing , Zhang Jing , Wang Qi , Kang Jing , Li Xiao-Lin , Sun Hong , Fu Ya-Jing , An Ming-Hui , Hu Qing-Hai , Chu Zhen-Xing , Liu Ying-Jie , Shang Hong
Published: November 2021

In the past 37 years, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) has undergone various major transmission routes in China, with the world most complex co-circulating HIV-1 subtypes, even the prevalence is still low. In response to the first epidemic outbreak of HIV in injecting drug users and the second one by illegal commercial blood collection, China issued the Anti-Drug Law and launched the Blood Donation Act and nationwide nucleic acid testing, which has avoided 98,232 to 211,200 estimated infections and almost ended the blood product-related infection. China has been providing free antiretroviral therapy (ART) since 2003, which covered >80% of the identified patients and achieved a viral suppression rate of 91%. To bend the curve of increasing the disease burden of HIV and finally end the epidemic, China should consider constraining HIV spread through sexual transmission, narrowing the gaps in identifying HIV cases, and the long-term effectiveness and safety of ART in the future.
Clinical Observation of Corneal Endothelial Plaques With Fungal and Bacterial Keratitis by Anterior Segment Optical Coherence Tomography and In Vivo Confocal Microscopy
Authors: Jin Xin , Jin Hao , Shi Yan , Zhang Nan , Zhang Hong
Published: November 2021

Purpose:

Endothelial plaque is an important sign of fungal keratitis and is related to diagnosis, surgical indications, and prognosis. However, bacterial keratitis sometimes involves fibrin formation on the back corneal surface, similar to endothelial plaques. Because corneal infiltration interferes with precise observation of the posterior corneal plaque, distinguishing pathogens with a slitlamp is difficult. We hope to assist clinicians in early diagnosis and timely treatment by observing the connection state of endothelial plaques and the corneal endothelium through anterior segment optical coherence tomography (AS-OCT) and the different forms of endothelial plaques in infectious keratopathy through in vivo confocal microscopy (IVCM).

Methods:

We analyzed 52 patients in the Eye Hospital of the First Affiliated Hospital of Harbin Medical University who were clearly diagnosed with fungal or bacterial keratitis with endothelial plaques. All patients underwent AS-OCT and IVCM on admission.

Results:

According to the smear, IVCM, or fungal and bacterial culture results, the patients were diagnosed with fungal (28 patients) or bacterial keratitis (24 patients). AS-OCT in 25 patients diagnosed with fungal keratitis revealed that the corneal endothelium–endothelial plaque boundary was unclear and wavy, and 24 patients had unclear cell boundaries and a large number of compactly distributed inflammatory cells in the endothelial layer according to IVCM. AS-OCT in 23 patients diagnosed with bacterial keratitis revealed clear corneal endothelium–endothelial plaque boundaries, and insufficient endothelial cell boundaries with a large number of visible and scattered inflammatory cell structures were observed through IVCM in 22 patients.

Conclusions:

Corneal endothelial plaque detection by AS-OCT and IVCM can be used for early diagnosis of infectious keratitis.
High Viral Load in Upper Respiratory Specimens of Persons With SARS-CoV-2 Infection in a Northern Italian Area
Authors: Valent Francesca , Mazzilis Giada , Doimo Anna , Marzinotto Stefania , Bulfoni Michela , Moretti Valentina , Tullio Annarita , Curcio Francesco , Pipan Corrado
Published: November 2021

Background

An assessment of viral load in biologic specimens of subjects with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may have important implications for public health planning. The aim of this study was to estimate the prevalence of high viral load in upper respiratory specimens of patients with SARS-CoV-2 infection during the first Italian wave (spring) and at the beginning of the second wave (summer) of the COVID-19 epidemic, through the measurement of cycle threshold (Ct) values from real-time reverse transcription-polymerase chain reaction tests conducted at the University Hospital of Udine, Italy, serving 530,000 inhabitants.

Methods

We compared the prevalence of high viral load, defined as Ct ≤ 20 at the first positive test result, in 262 subjects from the spring and 453 from the summer period. Logistic regression was used to account for potential confounding due to sex, age, and severity of infection.

Results

In the spring, 9.2% of subjects had Ct ≤ 20 versus 21.4% in the summer. After adjusting for confounders, the likelihood of having high viral load was 2.9 times higher in the summer than in the spring (95% confidence interval, 1.7–5.0).

Conclusions

In this Italian area, more COVID-19 patients had high viral load in the spring epidemic wave than at the beginning of the second, during the summer. Cycle threshold values may represent useful information to monitor viral load at a population level in subjects with SARS-CoV-2 infection.
Difluprednate 0.05% twice a day vs prednisolone acetate 1% 4 times a day for cataract postsurgical inflammation treatment: noninferiority trial
Authors: Valvecchia Gerardo , Kaufer Robert , Ferroni Carlos , Zaldívar Roger , Masseroni Manuela , Idiart Cecilia , Ferroni Valeria , Marino Flavia , Nuñez Myriam , del Papa Melina , Passerini María Silvia
Published: November 2021

Purpose:

To establish whether difluprednate 0.05% nanoemulsion (DIFL) twice a day is as effective as prednisolone acetate 1% + phenylephrine hydrochloride 0.12% suspension (PRED) 4 times a day for postsurgical inflammation treatment.

Setting:

4 private Argentine ophthalmological centers.

Design:

Noninferiority, prospective, multicenter, double-blind, randomized, parallel-group, comparative trial.

Methods:

A total of 259 patients who underwent phacoemulsification randomly received DIFL or PRED, starting the day before surgery and continuing for 28 days. The primary endpoint was central corneal thickness. Noninferior anti-inflammatory efficacy was considered if the difference of corneal thickness between baseline and day 4 did not differ beyond 17 μm between treatments. Secondary endpoints were cell and flare, corrected distance visual acuity (CDVA), endothelial cell count, optical coherence tomography (OCT) central macular thickness, and intraocular pressure. All outcomes were evaluated at baseline and day 1, 4, and 28 postoperatively.

Results:

225 patients finished the study. The difference in corneal thickness at baseline and day 4 did not differ beyond 17 μm between treatments (95% CI −2.78 μm to 14.84 μm), with no statistically significant difference (P = .523). No statistically significant differences were found between groups in total anterior chamber clearance at any study timepoint (P > .05). Moreover, no statistically significant differences were reported between treatments in CDVA (P = .455), endothelial cell count (P = .811), OCT central macular thickness (P = .869), and intraocular pressure outcome (P = .316).

Conclusions:

Difluprednate administered twice a day was at least as effective as prednisolone acetate administered 4 times a day for inflammatory treatment after cataract surgery.
Sofosbuvir-based antiviral therapy provided highly treatment efficacy, safety, and good tolerability for Taiwanese chronic hepatitis C patients with decompensated cirrhosis
Authors: Su Pin-Shuo , Wu Sih-Hsien , Chu Chi-Jen , Su Chien-Wei , Lin Chung-Chi , Lee Shou-Dong , Wang Yuan-Jen , Lee Fa-Yauh , Huang Yi-Hsiang , Hou Ming-Chih
Published: November 2021

Background:

For patients with hepatitis C virus (HCV)-related decompensated cirrhosis, poor prognosis was documented due to the development of portal hypertension-related complications and hepatocellular carcinoma. Sofosbuvir-based direct-acting antiviral agents (DAAs) has revolutionized the treatment landscape of HCV, particularly in this subpopulation. To date, real-world efficacy, tolerability, and safety profiles for Taiwanese HCV-related decompensated cirrhosis treated by DAAs have not been reported.

Methods:

Between December 2015 and June 2020, 50 consecutive HCV-related Child-Turcotte-Pugh (CTP) classes B or C cirrhotics treated by sofosbuvir-based DAAs (with daclatasvir: 7, with ledipasvir: 32, with velpatasvir: 10, with ledipasvir then shifted to velpatasvir: 1) were enrolled. Forty-seven (94%) patients used DAAs in combination with low-dose ribavirin. SVR12 was defined by undetectable HCV RNA (<15 IU/mL) at treatment end and 12 weeks after the completion of therapy.

Results:

The mean age of the enrolled patients was 68.1 ± 11.2 years, 18% of the patients were CTP class C, and the baseline HCV RNA level was 5.42 ± 1.2 log10 IU/mL. The genotype distribution was as follows: 1a: 3; 1b: 34; 2: 9; 6: 3; and one patient with an unclassified HCV genotype. After DAAs treatment, the rates of undetectable HCV RNA at week 4 and at the end of the treatment were 88.9% and 98.0%, respectively. Subjective adverse events were reported by 42.0% of the patients, but they were generally mild and could be relieved by medications. One patient did not finish therapy due to sepsis with multiple organ dysfunction. The overall SVR12 rate was 96.0% (CTP class B: 97.6%, CTP class C: 88.9%). A significant improvement in hepatic functional reserve was noted after successful antiviral therapy.

Conclusion:

For patients with HCV-related decompensated cirrhosis, which has been considered a contraindication for interferon-based therapy, sofosbuvir-based all-oral DAAs provided high treatment efficacy, acceptable safety, and good tolerability.
Subacromial Injections of Low- or High-Molecular-Weight Hyaluronate Versus Physical Therapy for Shoulder Tendinopathy: A Randomized Triple-Blind Controlled Trial
Authors: Esmaily Hadi , Mohebbi Rezvaneh , Rezasoltani Zahra , Kasaiyan Seyedalireza , Dadarkhah Afsaneh , Mir Mahshad
Published: November 2021

Objective:

Shoulder tendinopathy is a prevalent and debilitating problem. We compared the effects of subacromial high- or low-molecular-weight hyaluronate injection with physical therapy (PT) in shoulder tendinopathy.

Design:

A triple-blinded randomized controlled trial.

Setting:

We conducted the trial in an outpatient clinic at a teaching hospital.

Participants:

In total, 79 patients with shoulder tendinopathy were randomly allocated to high- (n = 27) or low-molecular-weight (n = 28) hyaluronate or PT (n = 24) groups.

Interventions:

We administered a 20-mg injection of high- or low-molecular-weight hyaluronate. For PT, we prescribed 10 sessions of physiotherapy and exercise.

Outcome Measures:

The primary outcome was shoulder pain and the secondary outcomes included Disability of the Arm Shoulder and Hand score, shoulder range of movement and QoL. We measured the outcomes at baseline, 1, and 3 months of treatment, and assessed shoulder pain at the sixth month postintervention.

Results:

The interventions were all clinically beneficial in the management of tendinopathy for high- (n = 25) and low-molecular-weight (n = 24) hyaluronate and PT (n = 19) groups (all P < 0.05). However, between-group analyses indicated that hyaluronate preparations were more effective in controlling pain, decreasing disability, increasing range of motion, and improving the quality of life (all P < 0.05). The pain and subjective feeling of rigidity at the injection area (P = 0.012) were less prominent for low-molecular-weight hyaluronate.

Conclusion:

High- or low-molecular-weight hyaluronate is more effective than PT in the treatment of shoulder tendinopathy. The clinical benefits of hyaluronate last for at least 3 months, and the pain alleviation sustains partially for 6 months. Shoulder injection of low-molecular-weight hyaluronate is more tolerable to the patient than high-molecular-weight hyaluronate.
Correction of Traumatic Transverse Mandibular Widening With Interdental Wiring
Authors: Lee Cameron C. , Be Austin , Hajibandeh Jeffrey T.
Published: November 2021

Mandibular symphysis fractures pose several technical challenges for the craniomaxillofacial surgeon. One classic challenge is restoration of the transverse dimension when the mandible is widened secondary to splaying of the lingual cortex. Failure to diagnose or correct this problem can result in widening of the lower facial third, inadequate fracture reduction, and/or a malocclusion. Surgeons have traditionally utilized techniques such as manual pressure to the rami or lingual splint application to address transverse defects intraoperatively. However, these methods may be inadequate in situations with significant widening, such as in the case of concomitant subcondylar fractures. More recently, virtual surgical planning and custom hardware have been utilized to address mandibular widening, though this method also has various shortcomings. In this technical note, the authors present a simple technique using interdental wiring to precisely control mandibular width intraoperatively. The technique is cost effective, does not require an assistant, and can be used in conjunction with any of the above methods. The authors also present a case of secondary reconstruction in which use of this technique was necessary given a large degree of mandibular widening not amenable to reduction and fixation with manual pressure alone.
A Mathematical Model for Stability Analysis of Covid like Epidemic/Endemic/Pandemic
Authors: Awasthi A.K. , Kumar Sanjeev , Garov Arun Kumar
Published: November 2021

The transmission and spread of infectious disease like Covid-19 occurs through horizontal and vertical mode. The causative pathogens for such kind of disease may be bacterium, protozoa, virus or toxin. The infectious diseases like AIDS, SARS, MARS, Polio Plague, Bubonic Plague and Covid-19 have destroyed the social and economic structure of world population. The world scientific community adopts different mechanisms to model and analyse the population dynamics of infectious disease outbreaks. Mathematical Modelling is the most effective tool to take the informed decision about the containment, control and eradication of the pandemic. The main focus of Government and public health authorities is to design the strategy in destabilising the spread and impact of the infections. A series of models-SIR, SEIR, SEIRD, SEAIHCRD, SAUQAR has been under study to combat the Covid-19 since its inception. An effort has been made to design the model based on reproduction number, endemic equilibrium and disease-free equilibrium to curtail the impact of Covid-19 through stability analysis methods-Hurwitz stability criteria, Lyapunov Method and Linear Stability Analysis.
Chromosome breaks in breast cancers occur near herpes tumor virus sequences and explain why the cancer comes back
Authors: Friedenson Bernard
Published: November 2021

Breast cancer has a relentless tendency to come back after treatment. Analyses of public data from about 2100 breast cancers produce a model that explains this recurrence and implicates variants of Epstein-Barr viruses (EBV or Human Herpes Virus 4). These viruses cause chromosome breaks. Broken chromosome pieces rejoin abnormally, sometimes including two centromeres. Two centromeres on the same chromosome interfere with cell division. Each centromere gets pulled toward a different pole. This mechanical stress shatters chromosomes. Shattered chromosome fragments rejoin arbitrarily, but showers of mutations accompany their rejoining. In this way, a single break can destabilize the entire genome. The breast cancer phenotype is not fixed and constantly creates new cancer driver genes. The phenotype becomes independent of the original virus and its dosage. Cancer comes back because treatment does not explicitly target the underlying breakage-rejoining cycles or the contributing virus.

The following data support this model. EBV causes chromosome breaks, and breast cancer chromosomes often have two centromeres. Breast cancer breakpoints on all chromosomes aggregate around the same positions as breakpoints in cancers definitively associated with EBV infection (nasopharyngeal cancer and endemic Burkitt’s lymphoma). Rejoined boundaries of highly fragmented chromosomes characteristic of breakage fusion cycles cluster around viral sequences. There is presumptive evidence of past infection. Human EBV sequences distribute like retrovirus transposons near dense piRNA clusters at a critical MHC-immune response region of chromosome 6. Other viruses strongly resemble endogenous transposons which piRNAs inactivate by methylation and cleavage. Remnants of exogenous EBV variants sit close to inactive transposons in piRNA sandwiches. The arrangement grossly resembles bacterial CRISPR and adds a layer of DNA protection to the immune system. Breast cancers target this protection with chromosome breaks and mutations and have a distinctive methylation signature nearby. Finally, areas near EBV docking sites can have increased numbers of breaks.

Graphical Abstract