Bone Tenderness Research Articles

The Incidence of Primary Malignant Bone Tumour at the University College Hospital, Ibadan, Oyo State, Nigeria, from 2007 to 2022: A Current Update

Abstract Background: Bone tumours constitute about 0.5% of documented cancer incidence. A previous study conducted in our hospital showed an incidence of 0.53% for primary malignant bone tumour (PMBT). Some of the predisposing factors to the development of these bone tumours include trauma, irradiation, foreign bodies, and genetic malfunctioning or mutation. They present symptoms, such as bone pain, swelling and tenderness of the affected bone, and weight loss, and in some cases, the first presentation may be a pathological fracture through the bone tumour. The last review of primary malignant bone tumours carried out in our centre was in September 2007; therefore, this study is designed to provide an update on the current pattern of these tumours. Aims and Objectives: The aim and objectives of this study are to provide an update on the current pattern of primary malignant bone tumours. To determine their relative frequencies, age and sex distributions, anatomical sites of occurrence as well as the histological types of the tumours. Materials and Methods: This is a retrospective hospital-based study to re-evaluate the incidence of primary malignant bone tumour at the University College Hospital, Ibadan, Oyo State, Nigeria. The histopathology records of patients with primary malignant bone tumours were reviewed through the Cancer Registry of the University College Hospital, Ibadan from January 2007 to December 2022. The information retrieved from the Cancer Registry records includes the age of the patient, the sex, the histological type of tumour, and the bone involved. The data retrieved were analysed using version 23 of the Statistical Package for the Social Sciences. Results: The results revealed that data from 170 patients with primary malignant bone tumours were reviewed within the study period. In all, there were 93 males and 77 females with a male-to-female ratio of 1.2:1. However, 145 patients had complete records and were reviewed. Primary malignant bone tumours occurred more in the second and third decades of life, and the most common primary malignant bone tumour was osteosarcoma. Conclusion: This study concludes that the annual average occurrence of primary malignant bone tumour seems to be on the increase when compared with previous studies with a higher preponderance in the male gender with osteosarcoma being the most common PMBT. The younger age group, especially teenagers and young adults within the second and third decades of life are the most affected.

Osseous Stress Injuries: Treatment Algorithms and Return to Play.

Osseous stress injuries are common in athletes. Specifically, lower extremity injuries are prevalent in running athletes and upper extremity injuries are prevalent in throwing athletes. Such injuries are suspected when there is focal bone tenderness and increased pain with the inciting activity. In elite athletes, osseous stress injuries are a relatively common culprit in lost play time. Thus rapid diagnosis and treatment is imperative to expedite return to play (RTP). The radiologist's role in these cases is not only for diagnosis, but also to grade the injury, which has implications in determining a treatment regimen. The high sensitivity and specificity of magnetic resonance imaging is thus the preferred imaging modality. This article discusses common osseous stress injuries, the imaging findings, and how different treatment regimens affect RTP.

Demographic and clinical characteristics of acute myeloid leukaemia diagnosed and treated at the tertiary level in Afghanistan.

A retrospective case series design was conducted to elucidate the demographic features of acute myeloid leukaemia in Afghanistan. This study was conducted at Jamhuriat Hospital and French Medical Institute for Mothers and Children, Kabul, Afghanistan. A total of 203 patients with AML diagnosed and managed at Jamhuriat Hospital from 1 March 2018 to 31 March 2020, were included in the current study. The median age at diagnosis was 27 years. Housewives represented the largest subset of patients from an occupational point of view constituting 37.44% of the total sample population and 81.72% of the female population, followed by 20.69% patients who were students of which 14.77% were male and 5.91% were female, and 17.24% were farmers, which constituted 31.81% of the male population. Similarly, 69.95% of individuals presented with infection, 57.14% presented with bone tenderness, 46.3% presented with bleeding tendencies, 55.66% had hepatomegaly and/or splenomegaly, and 27.58% of patients had lymphadenopathy. Considering the chemotherapeutic regime,64.53% of the individuals received standard 7 + 3 (cytarabine + daunorubicin) induction regimen, 10.68% of those received 5 + 2 re-induction chemotherapy (cytarabine + daunorubicin). 10.84% who were diagnosed with acute promyelocytic leukaemia received all-trans-retinoic acid + arsenic trioxide, while 5.42% of patients defaulted chemotherapy. High prevalence was noted in young individuals. Similarly, a high proportion of patients were constituted by housewives.

Tenofovir-induced hypophosphatemic osteomalacia: how do bone mineral density, trabecular bone score and proximal hip geometry change with treatment?

Tenofovir-induced osteomalacia secondary to proximal renal tubular dysfunction is not an uncommon complication known to occur. A 46-year-old woman was referred for the evaluation of osteoporosis which was diagnosed elsewhere. She had polyarthralgia, bony pains and proximal muscle weakness of 1 year duration. She was diagnosed to have HIV infection and was on antiretroviral therapy that consisted of tenofovir, lamivudine and efavirenz for the past 12 years. She had attained menopause 5 years back. On examination, she had bone tenderness, proximal myopathy and painful restriction of movement of her lower limbs. Investigations showed features of renal tubular acidosis, hypophosphatemia and raised alkaline phosphatase that were suggestive of osteomalacia. X-ray of the pelvis showed diffuse osteopenia and an MRI of the pelvis done showed multiple insufficiency fractures involving the head of femur on both sides. Following this, her tenofovir-based regimen was changed to abacavir, efavirenz and lamivudine with addition of neutral phosphate supplements and calcitriol. On follow-up after 6 months, she had significant improvement in her symptoms as well as in the bone mineral density at the lumbar spine (33.2%), femoral neck (27.6%), trabecular bone score (13.2%) and reduction in the buckling ratio at the narrow neck (6.3%), inter-trochanteric region (34%) and femoral shaft (28.8%). Tenofovir-induced osteomalacia is encountered in individuals on prolonged treatment with tenofovir. Treatment consists of changing to a non-tenofovir-based regimen, as well as supplementation of phosphate and calcitriol. Treatment results in remarkable improvement in symptoms and most densitometric indices. Tenofovir is a nucleotide reverse transcriptase inhibitor (NRTI) and is a major drug in the treatment of retroviral and hepatitis B infections. Tenofovir-related hypophosphatemic osteomalacia is related to proximal tubulopathy and is not an uncommon occurrence. Treatment mandates changing to a non-tenofovir-based regimen with supplementation of neutral phosphate and calcitriol. Treatment results in a significant improvement in bone mineral density, trabecular bone score and hip geometric parameters.

Immune cytopenia: an uncommon presentation of a common disease tuberculosis - a case series and literature review

Various haematological abnormalities such as anaemia, leucocytosis, and pancytopenia are described in patients with tuberculosis. These often occur due to non-immunologic mechanisms. Here, we present a series of three paediatric cases with immune–mediated thrombocytopenia or haemolytic anaemia, in the setting of mycobacterial infection. This is an unusual presentation with only a few published paediatric case-reports. This is a case-series study from a tertiary hospital in North India. Medical records of three paediatric patients with immune cytopenia (IC), which was confirmed to be caused by Mycobacterium tuberculosis were reviewed. We also performed a literature search for previously reported cases of IC in children caused by tuberculosis. Three previously healthy children, between 5 to 11 years of age, presented with epistaxis, generalised petechiae, pallor and lymphadenopathy. There was no hepatosplenomegaly or bone tenderness. Laboratory investigations and bone marrow aspiration suggested megakaryocytic thrombocytopenia in all the three patients. Additionally, the first two cases had Coomb’s positive haemolytic anaemia. None of them showed a sustained clinical and haematological response to platelet transfusions and steroid therapy. Further work-up revealed histopathological, radiological and microbiological evidence of tuberculosis. The diagnosis of immune cytopenia secondary to tuberculosis was thus established. Anti-tubercular treatment (ATT) was started. All patients gradually demonstrated clinical and haematological improvement within four weeks of ATT. Follow-up at 1 year showed complete recovery in each case. Tuberculosis should be included in the etiological investigation of autoimmune cytopenia in childhood, especially in countries with high TB burden, since they respond to anti-tubercular drugs alone with a favourable outcome.

Osteitis Fibrosa Cystica; A Forgotten Manifestation of Secondary Hyperparathyroidism Due to End-Stage Renal Disease: A Case Report

IntroductionOsteitis fibrosa cystica is a rare complication of secondary hyperparathyroidism. Even though it is thought to be a disease of the past, it still continues to be seen in this modern era in the setting of undiagnosed or untreated chronic kidney disease.Case PresentationA 26-year-old married Ethiopian women presented with 4 year history of progressive proximal weakness of extremities and diffuse bone pain. Physical examination revealed diffuse bone tenderness and features consistent with myopathy. Blood work up showed raised creatinine, markedly elevated PTH, borderline low calcium, and vitamin D in severe deficiency range. X-Ray findings were consistent with classical skeletal lesion of severe secondary hyperparathyroidism.ConclusionOsteitis fibrosa cystica is a rare but still frequent complication of secondary hyperparathyroidism, which may be the initial presentation of chronic kidney disease. This case report emphasizes the importance of considering secondary hyperparathyroidism in patients presenting with weakness and bone pain to allow for early diagnosis, treatment, and improvement of overall prognosis.

Perception of Rickets Disease Among Parents in Al-Baha Province, Saudi Arabia

IntroductionRickets involves the softening of bones in children and osteopenia with disordered calcification, leading to a higher proportion of osteoid tissue prior to epiphyseal closure in children. Rickets is common in the Middle East, Africa, and Asia. The peak age of prevalence is 3–18 months. Signs include bone tenderness, easy fracture, early bone deformity, delayed closure of fontanelles, and softening of skull bones (craniotabes).ObjectiveThis study assesses knowledge in the AlBaha region about rickets’ clinical presentation, causes, complications, and prevention, as well recommendations to educate the community.MethodsIn this descriptive cross-sectional study, a questionnaire was administered to people in the AlBaha region to assess knowledge related to rickets in children. The sample size was calculated using calculator.net, and the Statistical Package for Social Sciences (SPSS) version 2 was used for analyses with P < 0.05 used for significance.ResultsOf the 692 participants, only 5% reported rickets in their children, but the majority (99%) had heard about rickets. Participants’ knowledge of rickets’ complications was highest for spinal vertebral deformities and lowest for skin deformities. 55% of the participants thought there was no need to stop breast-feeding once rickets is diagnosed, 62% preferred to add fortified milk to the diet, 67% thought that a suitable duration for sunlight exposure is 10 to 15 minutes per day, and 46% thought that sunrise and sunset are suitable times for sun exposure. Preventive measures were believed to depend on having enough exposure to sunlight (77% of participants) and eating vitamin-D rich foods (63%). The majority believed that failure to grow is the most obvious symptom, inadequate milk is the main cause, and exclusive breast-feeding is a major risk factor.ConclusionMost people have heard about rickets, but knowledge about complications and prevention varies.

The Importance of Vitamin D in Long-Term Care Residents

The Importance of Vitamin D in Long-Term Care Residents

Abstract 36: Clinical Profiles and 1-Year Survival of Children with Acute Lymphoblastic Leukemia at Mbarara Regional Referral Hospital Cancer Unit

Abstract Purpose: Acute lymphoblastic leukemia (ALL) is the commonest childhood cancer globally and mimics common childhood conditions, creating diagnostic challenges. We described the baseline feature at diagnosis and established 1-year overall survival. Methods: In a retrospective cohort study, medical records of children &amp;lt;16 years of age diagnosed with ALL between 1st June 2016 and 31st May 2020 were reviewed. The frequencies and proportions of symptoms, signs, laboratory findings and treatment outcomes were extracted and described. 1-year overall survival was estimated using Kaplan Meier curves. Research and Ethics Committee of Mbarara University of Science and Technology provided ethics approval. Results: Fifty one (51) children had been diagnosed with ALL at MRRH. They presented with fever, 44 (86.3%), weight loss 34(66.7%), cough 28(54.9%), bleeding tendencies 21(41.2%), limb pains 20(39.4%), and abdominal distension 8(15.7%). The signs were pallor, 44(86.3%), lymphadenopathy 39(76.5%), hepatosplenomegaly 37(72.5%), pyrexia 18(35.3%), bone tenderness 12(23.5%) and petieche 11(21.6%). Thirty (58.8%) children had leukocytosis (WBC&amp;gt;12 × 109/L), 15(29.4%) had WBC&amp;gt;50,000 and all children had anemia (Hb&amp;lt;11.0g/dl) at admission, 32 (62.7%) had severe anemia (Hb &amp;lt;7.0g/dl). Forty eight (94.1%) children had thrombocytopenia (&amp;lt;150.0 × 109/L), 32(62.7%) had severe thrombocytopenia (&amp;lt;50 × 109/L). 1-year overall survival was 63.6% (95%CI (49.8-77.5). Conclusion: Children with ALL present with non-specific clinical features that can mimic other illnesses and 1-year overall survival was low at MRRH. Children with a combination of fever, pallor, bleeding; and leukocytosis, anemia and thrombocytopenia should be actively investigated for acute lymphoblastic leukemia for early treatment initiation. Citation Format: Stella Zalwango, Peters Kalubi, Barnabas Atwiine. Clinical Profiles and 1-Year Survival of Children with Acute Lymphoblastic Leukemia at Mbarara Regional Referral Hospital Cancer Unit [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 36.

Frequency of Vitamin D Deficiency with Non-Specific Musculoskeletal Symptoms in Female Patients

Objective: To determine frequency of vitamin D deficiency in female patients presenting with non-specific musculoskeletal symptoms.Study Design: Descriptive cross sectional.Place and Duration of Study: The study was conducted in Medical Outpatient Department (OPD), Combined Military Hospital (CMH) Quetta from 30th November 2018 to 30th May 2019.Materials and Methods: A total of 150 female patients with nonspecific musculoskeletal symptoms were included. Patients on vitamin D supplements, osteopenia, osteoporosis, chronic kidney disease, neuropathies, cancers, diabetes mellitus, iron and Vitamin B12 deficiency were excluded. Data including gender, age and presence of bone pain, muscle aches, bone tenderness and fracture was collected. SPSS v 17 was used for data analysis. Chi-square test was applied to test for associations, p value less than 0.05 was taken as significant.Results: The mean age was 37.20 + 13.30 years. Mean Vitamin D levels were 14.89 + 7.76 ng/ml with range from 3.10 to 35.67ng/ml. Participants with vitamin D3 &lt; 10 ng/ml were 24% (n=36), &lt; 20 ng/ml were 54% (n= 81), &lt;30 ng/ml were 12 % (n=18) and only 10 % (n= 15) had optimal Vitamin D3 levels. Among the study population 82% (n=123) had bone pains, 88.6% (n=33) had muscle aches and weakness, 72.66% (n=109) had bone tenderness while only 4% (n=6) had fractures. There was a statistically significant association between symptoms and vitamin D3 deficiency with p value &lt;0.001.Conclusion: This study showed that vitamin D deficiency is prevalent in our female populationand it presents with nonspecific musculoskeletal symptoms.

Instant orthopnea and pseudo-cardiac dilatation due to anterior mediastinal tumor.

A 45-year-old woman presented with instant orthopnea and enlarged cardiomediastinal silhouette in her chest radiograph. Although anterior mediastinal tumor can be misdiagnosed as heart failure due to orthopnea with enlarged cardiomediastinal silhouette, "instant orthopnea" may be a useful sign to distinguish these conditions.

Study on Diagnostic Evaluation of Pancytopenic Patients

Introduction: Pancytopenia is a common hematological problem with an extensive differential diagnosis and is a challenging problem to the treating physician. Bone marrow aspiration and biopsy is an important diagnostic test for patient management. The objective of this study is to find out the incidence various causes of pancytopenia in patients attending to the Enam medical college hospital in savar.&#x0D; Materials and Methods: This prospective observational study was done in the department of haematology, Enam Medical College Hospital (EMCH) from July 2012 to June 2019.&#x0D; Results: In our study out of 66 patients, 36 (54.55%) were male, 30 (45.45%) were female and male to female ratio were 1.2:1.Generalized weakness 47 (71.21%) and fever 23 (34.85%) were the most common presenting symptoms followed by bleeding 17 (25.76%), weight loss 6 (12.12%), bodyache 6 (9.09%). Most common clinical findings were anemia 57 (86.36%) and bone tenderness 22 (33.33%). Other physical findings were purpura/brusing 13 (19.70%), splenomegaly 10 (15.15%), lymphadenopathy 4 (6.06%) and hepatomegaly 3 (4.55%). Hematological malignancy 29 (43.94%) and hypoplastic marrow 26 (39.39%) were the most common bone marrow finding of pancytopenic patients followed by megaloblastic anaemia 4 (6.06%), leishmaniasias 5 (7.58), and erythroid hyperplasia 2 (3.03%). Acute myeloid leukaemia was the common haematological malignancy 16 (24.24%), others were acute lymphoblastic leukaemia 5 (7.58%). Myelodysplastic syndrome 3 (4.55%), multiple myeloma 4 (6.06%), chronic myelogenous leukaemia in blastic crisis 1 (1.52%).&#x0D; Conclusion: So we concluded that complete workup is essential for all cases of pancytopenia to find out the treatable cases and to reduce the motality and morbidity in serious diseases.&#x0D; Medicine Today 2020 Vol.32(1): 58-61

MON-497 Adult Onset Hypophosphatasia: Before and After Treatment with Asfotase Alfa

Hypophosphatasia is a rare inherited bone disease resulting from mutations in the gene encoding tissue-nonspecific alkaline phosphatase (TNSALP), an enzyme predominant in skeleton, liver, kidney and teeth. Diminished TNSALP activity causes accumulation of substrates that inhibit bone mineralization resulting in debilitating pain, fractures and low alkaline phosphatase (ALP) levels. In 2015 the FDA approved asfotase alfa, a bone-targeted recombinant TNSALP used for enzyme replacement therapy. We present a case of hypophosphatasia treated with asfotase alfa resulting in improvements in whole body scan and pedometer step counts. In 2014, a 52-year-old female with chronic pain presented with over 30 years of bony pain, poor balance, falls, fractures and life-long dental disease. Physical exam displayed tenderness of long bones and waddling gait. Blood work was remarkable for low ALP at 11 U/L (normal 35-120 U/L) and low bone-specific ALP of 3 ug/L (normal 7.0-22.4 ug/L). Vitamin B6 level was >2000 nmol/L (normal 20.0-125.0 nmol/L). Calcium level was 9.8 mg/dL (normal 8.5-10.1 mg/dL). Serum phosphorus was elevated at 5.2 mg/dL (normal 2.3-4.6 mg/dL). Intact parathyroid hormone level was elevated at 114.1 pg/mL (normal 18.5-88.0 pg/mL), with known diagnosis of chronic kidney disease, GFR 27 mL/min. Her 24-hour urine calcium, serum protein electrophoresis, celiac test, thyroid studies and vitamin D level were normal. N-telopeptide was elevated at 25.9 nM (normal 6.2 to 19.0 nM). SPECT whole body scan demonstrated increased uptake with multiple fractures of the axial skeleton and proximal femurs; consistent with oncogenic osteomalacia. Fibroblast growth factor 23 and indium 111 octreotide scan showed no evidence of malignancy. DEXA scan showed osteopenia of the hip and forearm. She was diagnosed with adult-onset hypophosphatasia. Initially, due to lack of options, she was treated with denosumab. After three injections, she developed a new atypical femur fracture requiring surgical rod placement; denosumab was discontinued. In 2017, she was started on asfotase alfa with significant improvements in balance, endurance, and bone pain. Prior to treatment, the patient required narcotic oral pain medicine, fentanyl patch and an assistive device to walk 3000 steps daily; after treatment, she is walking over 10,000 steps daily without any pain pharmacotherapy. Repeat whole body scan showed less focal uptake overall, consistent with healing fractures. This case highlights clinical proof of improvement after treatment with asfotase alfa based on increased daily step count and healing fractures on whole body scans. Asfotase alfa is a newly approved therapy for hypophosphatasia and therefore long-term outcomes are not yet available, however short term patient reported subjective findings and clinical data are reassuring for successful treatment.

A Clinical and Laboratory Profile of Multiple Myeloma

Background: Myeloma, the most common malignant disease of bone, is incurable and occurring with increasing frequency in elderly population. Typical clinical features are weakness, fatigability, bone pain, anemia, renal insufficiency and hypercalcemia. Incidental discovery on comprehensive laboratory panels is common. Serum or urine protein electrophoresis or immunofixation and bone marrow aspirate analysis help the diagnosis of multiple myeloma.Objective: The aim of this study was to define and evaluate the clinico-laboratory features of newly diagnosed adult multiple myeloma (MM) patients in the context of Bangladesh.Materials and Methods: This study was carried out in two centers, from October 2005 to January 2010 in Bangabandhu Sheikh Mujib Medical University (BSMMU) and July 2012 to June 2017 in Enam Medical College and Hospital (EMCH). Thirty two diagnosed valid cases of multiple myeloma were included in this study. Clinical history, physical and relevant laboratory findings were carefully recorded and analyzed.Results: In this study among 32 patients, 29 were males and 3 were females with mean age 51.94 ± 10.09 years. The common complaints were bone pain, weakness and fatigue. The common clinical findings were bone tenderness, pallor and high ESR (ESR of all the study patients was more than 100 mm in 1st hour). Hemoglobin level was &lt;8.5 gm/dL in 13 patients, serum creatinine ≥2 mg/dL in seven patients, serum albumin &lt;30 mg/L in 14 patients and serum β2 microglobulin &gt;5.5 mg/L in 15 patients. Three patients were hypercalcemic. Lytic lesions were the most common radiological finding in the study.Conclusion: This study showed that multiple myeloma is a disease of the middle and elderly aged population with male preponderance, with high male female ratio. Multivenued studies are needed to view the real picture of multiple myeloma in the context of Bangladesh.J Enam Med Col 2018; 8(3): 159-164

Vitamin D deficiency is associated with tibial bone pain and tenderness. A possible contributive role.

Vitamin D deficiency is associated with osteomalacia and a variety of musculoskeletal pain. This study aimed to determine the association of vitamin D deficiency with tibial bone pain and tenderness. Patients with leg pain, defined as local pain and tenderness over tibial bones for ≥6weeks were consecutively selected. Secondary causes of pain were excluded by appropriate clinical, radiological and laboratory examinations. Serum 25-hydroxyvitamin D (25-OHD) was assessed by enzyme-linked immunosorbent assay method and levels <20ng/mL were considered as deficiency. Age- and sex-matched subjects without leg pain served as controls. Multiple logistic regression analysis was used to determine associations. One hundred and eighteen patients and 114 controls aged 46.8±14.8 and 44.6±14.1years, respectively (P=0.93) were analyzed. Mean 25-OHD level was significantly lower (P=0.001) and the prevalence of 25-OHD deficiency was significantly higher in the patients as compared with the controls (75.4% vs. 23.6%), odds ratio (OR)=9.54 (95% CI, 5.22-17.45, P=0.001). There was a negative dose-response relationship between serum 25-OHD and tibial bone pain by OR=17.33 (95% CI, 6.48-46.3) in subjects with 25-OHD<10ng/mL, and OR=14.7 (95% CI, 6.35-34.6) in serum 25-OHD levels at 10-19.9ng/mL, and OR=2.58 (95% CI, 1.08-6.1) in those with 25-OHD at 20-29.9ng/mL as compared with 25-OHD≥30ng/mL. After controlling for demographic and biochemical factors, the association reached a stronger level of 19.8 (6.9-56.3) in subjects with serum 25-OHD<10ng/mL and 14.4 (5.8-34.6) in those with serum 25-OHD at levels of 10-19.9ng/mL and 1.85 (0.73-4.6) in 20-29ng/mL. These findings indicate a possible contributive role for serum 25-OHD deficiency in the development of pain and tenderness over the tibial bone.

Vitamin D Deficiency in Patients With Chronic Tension-Type Headache: A Case-Control Study.

To see the interrelation between chronic tension-type headache (CTTH) and serum vitamin D levels. Several studies have suggested an association between chronic pain and vitamin D deficiency. Anecdotal evidence suggests that vitamin D deficiency may be associated with tension-type headache and migraine. This case-control study was carried out to examine the association between CTTH and serum 25-hydroxy vitamin (25(OH) D) levels. One hundred consecutive adult (>18 years) patients with CTTH and 100 matched healthy controls were enrolled. The serum 25(OH) D levels were significantly lower in CTTH patients than in the controls (14.7 vs 27.4 ng/mL). The prevalence of vitamin D deficiency (serum 25 (OH) D < 20 ng/mL) was greater in patients with CTTH (71% vs 25%). CTTH patients had a significantly high prevalence of musculoskeletal pain (79% vs 57%), muscle weakness (29%vs 10%), muscle tenderness score (7.5 vs 1.9), and bone tenderness score (3.0 vs 0.8) in comparison to controls. CTTH patients with vitamin D deficient group (<20 ng/mL) had a higher prevalence of musculoskeletal pain (58% vs 31%), muscle weakness (38%vs 7%), muscle and bone tenderness score, associated fatigue (44% vs 17%) and more prolonged course (15.5 months vs 11.2 months). A strong positive correlation was noted between serum vitamin D levels and total muscle tenderness score (R2 = 0. 7365) and total bone tenderness score (R2 = 0. 6293). Decreased serum 25(OHD) concentration was associated with CTTH. Intervention studies are required to find out if supplementation of vitamin D is effective in patients with CTTH.

Lower pain and higher muscular strength in immigrant women with vitamin D deficiency following vitamin D treatment

ABSTRACTBackground: Vitamin D deficiency is common among immigrants in the Nordic region. It may lead to osteomalacia with severe musculoskeletal pain. There are reports that vitamin D deficiency without osteomalacia may lead to pain but little is known of the effect of treatment.Objective: To investigate whether a moderate dose of cholecalciferol and calcium improves strength and pain in a group of vitamin D deficient women.Design: Twentyfive immigrant women with vitamin D deficiency diagnosed during pregnancy were treated postpartum with a daily dose of 1,600 IU cholecalciferol and 1,000 mg of calcium. They were examined at the start of treatment and again after 3 months of treatement and the results were statistically compared. Setting: Southern parts of Stockholm.Main outcome measures: Serum 25-hydroyvitamin D (25(OH)D), serum-parathyroid hormone (PTH), pain measured by a visual analogue scale (VAS), musculoskeletal strength by performance on a chair stand test (seconds), and bone tenderness by pressure algometer (kilo-Pascal).Results: Following the treatment, the 21 women attending had lowered cm in VAS, improved musculoskeletal strength, - and 25(OH)D levels were normalized.Conclusions: A moderate dose of vitamin D normalized l vitamin D levels, improved muscular strength and reduced pain in this group of vitamin D deficient immigrant women.

Pengaruh Tekanan Pemasakan dan Penggunaan Rak Penyusun Terhadap Mutu dan Kekerasan Tulang Ayam Presto

Problems encountered in the production of chicken presto is bones which it is rapidly destroyed while cooking spices still does not penetrate properly into the meat and rancidity is still felt. The purpose of this study was to determine the effect of vapor pressure cooking and the influence of position rack storage of raw chicken in aoutoclave on quality and tenderness of chicken bones of chicken presto. The study consisted of two phases, namely the production of chicken presto, and storage for 8 weeks. Steam pressure treatment used were 10, 15 and 20 psi. These treatment were conducted with rack storage (shelf dividers) and without rack storage (stacked as usual). Tests were conducted on the product organoleptic and bone hardness test. Presto chicken products with the highest organoleptic acceptance is the treatment T2, which was the process of cooking presto with a pressure of 15 psi and processed without the use rack storage. Rack storage did not affect the organoleptic score increase on the product. Organoleptic test results showed presto chicken products accepted by the panelists with the average value of A between 3.3 to 3.6. The bone hardness test shows hardness values varying between 22.44 gf / mm to 60,46 gf / mm

Musculuskeletal system involvement in hemodialysis patients

Objective: Musculoskeletal problems remain among the main limitations of the quality of life of patients undergoing hemodialysis. This study was designed to evaluate the musculoskeletal system involvement in hemodialysis patients. Methods: This study was carried out on the all of the hemodialysis patients of Khatam-al Anbia Hospital, Zahedan, Iran. All patients underwent a precide physical examination. Venous blood samples were obtained for the measurement of calcium, phosphorous, alkaline phosphatase, and parathyroid hormone. An x-ray of the hand was taken from each patient. Results: Thirty seven (37) patients completed the study. The most common symptoms were: carpopedal spasm 54.0%, symptoms of carpal tunnel syndrome 24.2%, arthralgia 21.6%, and bone pain 13.5%. The most common clinical findings were: a positive Phalen test 32.4%, muscle weakness 40.5%, bone deformity 21.6%, and bone tenderness 18.9%. The most common abnormal laboratory tests were: hypocalcemia 51.4%, hyperphosphatemia 43.2%, increased alkaline phosphatase 75.6%, and raised Parathyroid hormone 81.0%. Conclusion: Musculoskeletal involvement is common in our hemodialysis patients.

A Rare Case of Clavicle Osteomyelitis in a Child and Literature Review

Acute clavicle osteomyelitis in children is rare representing <3% of osteomyelitis cases. We treated a 12-year-old boy who presented with acute pain in the right clavicle and high fever for 4 days. MRI showed abnormal signal in the right clavicle with periosteal reaction. Staphylococcus aureus isolated from blood was susceptible to methicillin, clindamycin, and macrolides. Clindamycin was given intravenously for 3 wks and orally for another 3 wks with no recurrence. We reviewed clavicle osteomyelitis cases in children searching PubMed English literature. From a total of 89 studies retrieved, only 6 fulfilled the criteria and were analyzed. Sixteen patients (56% female) were included with a median age of 9 yrs (range 2 wks–16 yrs). Osteomyelitis was hematogenous in most cases, with S. aureus being the most frequent cause, isolated from either blood or tissue. Symptoms included fever, swelling, and localized bone tenderness. Antimicrobial therapy lasted for 4–12 weeks (median 7.5). Three patients required drainage or curettage. Recurrence occurred in 1/16 cases (6.2%) and persistence of symptoms occurred to 2/16 cases (12.5%) reported before 90s with unknown antimicrobial susceptibility of the pathogen. Acute clavicle osteomyelitis mainly affects older children and has generally good prognosis. Staphylococcus aureus is most commonly implicated and surgery may be needed.