Local Inflammatory Signs Research Articles

Treatment of fractures of the main phalanx of the fingers in children

BACKGROUND: Fractures of the bones of the hand and wrist account for 25% of all fractures in children, whereas the phalanges are the most common localization of these injuries and account for 15%30% of all fractures of the upper limb. To fix fractures of the neck of the middle and main phalanx of the fingers, traumatologists resort to retrograde osteosynthesis with a spoke, which in all cases passes through the articular surface of the distal fragment, thereby blocking the joint adjacent to the fracture. This significantly complicated postoperative rehabilitation to restore movements.
 AIM: This study aimed to comparatively analyze the results of extra-articular osteosynthesis of fractures of the distal metaphysis of the main phalanx of childrens fingers.
 MATERIALS AND METHODS: A prospective cohort study included 52 children with fractures of the main phalanx of the fingers. The study cohort of children was divided into two groups. The main group included 29 children who underwent osteosynthesis of the distal fragment of the phalanx with spokes according to the authors method without passing them through the distal or proximal interphalangeal joint. The comparison group included 23 children who, during osteosynthesis, had spokes carried out retrogradely, through the articular surface of the distal phalanx fragment. The total volume of the restored active movements in the proximal interphalangeal joint was compared after 3, 6, and 12 weeks from the moment of surgery, including local signs of inflammation in the needle insertion site after 3 and 7 days from the moment of surgery.
 RESULTS: In the main group, signs of inflammation were found only in 10% of the cases, whereas in the comparison group, more serious signs were observed, such as the release of exudate along the spokes in two cases on day 3. The average values of the amplitude of movements at week 3 in the main group are more than two times higher than the average values of the comparison group, 12.06 and 5.56, respectively. The volume of movements in the main group was restored more than two times more efficiently, and in several patients, by week 12, it was restored to 100 of the total volume of active movements in the joint (p 0.05).
 CONCLUSIONS: The authors method of extra-articular and antegrade osteosynthesis of the fractures of the neck of the main phalanges in children made it possible to achieve better functional results in comparison with the standard method.

Acute kidney injury in snake bite patients

Background: In India, large proportion of snake bites occur when people are working barefoot in fields or while walking at night. Objectives: To study i) clinical profile of renal involvement in snake bite patients. ii) in-hospital outcome of acute kidney injury in snake bite patients Methodology: Patients are classified into three stages of acute kidney injury proposed by Acute Kidney Injury Network which defines AKI as an abrupt increase in serum creatinine concentration of ≥0.3 mg/dl from baseline, a percentage increase in the serum creatinine concentration ≥50% or oliguria of 0.5 ml/kg/hr >6 hours. Results: Mean age of patients was 43.8±12.63 years. Male to female ratio was 1.63:1 with male preponderance. Mean interval between snakebite and presentation to hospital was 15.37 hours. All snake bites were inflicted to lower limbs and 48% of snake bites were due to Viper as identified by patients. 98% patients presented with local signs of inflammation. 52% patients presented with coagulation abnormality and 60% with decreased urine output which were associated with increase severity of AKI and need for haemodialysis in 12% of patients.Conclusion: Common manifestations of poisonous snake bite include cellulitis, abnormal Coagulation profile and decreased urine output.

Chronic recurrent multifocal osteomyelitis, a rare disease. Case report

Introduction: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare inflammatory bone disease usually observed in children and adolescents. It is caused by an imbalance between proinflammatory and anti-inflammatory factors. To establish its diagnosis, it is necessary to integrate clinical and laboratory elements that are typically aimed at ruling out other conditions, constituting a diagnosis of exclusion. Treatment is based on non-steroidal anti-inflammatory drugs and other drugs in specific cases. Case presentation: A 16-year-old female patient with a 1-year history of joint pain, especially in the knees, accompanied by signs of local inflammation was admitted to the emergency department of a quaternary care hospital due to a fever >38.5°, odynophagia, asthenia, and adynamia over the last two days. The patient underwent multiple extension studies, including laboratory, imaging and histopathological tests, which ruled out various etiologic causes. She received empirical antibiotic treatment without remission of symptoms, so a diagnosis of CRMO was finally established and outpatient treatment with non-steroidal anti-inflammatory drugs and corticosteroids was indicated, obtaining a favorable response. Conclusions: CRMO should be considered in children and adolescents with bone pain and a poorly defined clinical history with non-specific laboratory, imaging and histopathological findings. To date, little is known about CRMO, so it is necessary to carry out research and expand the knowledge related to this disease.

Maxillary Sinus Osteoma as a Support for Dental Implant Associated to Sinus Augmentation Procedure: A Case Report and Literature Review

Background: Maxillary sinus augmentation is a method extensively used to restore sufficient bone volume in the posterior maxilla to allow for the placement of fixtures. The purpose of the present case report was to describe a rare case of sinus osteoma used for implant support and to review the relevant literature. Materials and Methods: A 58-year-old man with a radiopaque intrasinusal lesion was referred for rehabilitation of the maxilla. The lesion was probably an osteoma and involved the nasal wall of the maxillary sinus. After discussing the options with the patient, he agreed to maintain the lesion and a sinus augmentation with a bone graft. A part of the osteoma was partially removed for histological analysis while avoiding perforation or tearing of the schneiderian membrane. After six months, 6 implants (Bone System Implant, Milano, Italy) were placed in the maxilla, two of which were inserted in the osteoma. Results: The two implants placed in the osteoma were perfectly osseointegrated. The graft material appeared well-integrated with no local signs of inflammation. No postoperative events or symptoms were reported after the surgery stages and at a 6-month follow-up. Regarding the two implants placed in the osteoma: article selection identified 9 case reports, 2 case series, and 1 retrospective study for a total of 58 subjects, 35 males and 25 females. The patients’ ages were heterogeneous and ranged between 12 and 79 years old. Conclusions: In the present case, we decided to leave the osteoma because it was asymptomatic and used as dental implant support. The effectiveness of the present investigation can provide useful guidance for surgeons and dentists in the management of similar clinical situations.

Morphofunctional rearrangement of the wall of the small intestine of rats against the background of experimental diabetes mellitus, stress and their combination

Peculiarities of morphofunctional changes of the wall of the small intestine in experimental animals during the development of streptozotocin diabetes mellitus, against the background of chronic immobilization stress and under the combined effects of these pathological conditions were studied. Objective – to evaluate the features of morphofunctional reconstruction of the small intestine of rats in experimental streptozotocin diabetes mellitus under chronic stress. Methods. Experimental adult rats were modeled for absolute insulin deficiency by intraperitoneal administration of streptozotocin at a dose of 7 mg per 100 grams of body weight. To simulate stress, the animals were subjected to daily rigid immobilization in special cages for 6 hours at different time intervals. In order to study the combined effects of these pathological factors, the animals were immobilized from the 14th day of diabetes mellitus. The material was taken 28 and 56 days after the start of the experiment. Results. During the development of experimental diabetes mellitus in the small intestinal wall of experimental animals, there is a predominance of enteropathy due to dystrophic changes in the intestinal wall. Focal signs of enteritis predominated during the 56-day simulation of chronic stress. With the combined effect of these pathological conditions on the 28th day of the experiment, focal signs of enteritis and enteropathy were observed, which progressed to 56 days of the experiment.Conclusions. On samples from the small intestine wall, stained with hematoxylin and eosin, in rats with experimental diabetes mellitus, mucosal atrophy was noted, which was manifested by shortening of the villi and an increase in the depth of the crypts. Against the background of chronic stress on the 28th day, the wall of the small intestine retained the normal histologic structure, with local signs of inflammation, but on the 56th day, there was significant leukocyte infiltration of the mucous membrane and submucosal layer, increased eosinophils, lymphocytes and histiocytes. In rats with diabetes on the background of stress, structural changes in the intestinal wall were characterized by the greatest polymorphism.

Role of magnetic resonance imaging in the pre‐surgical planning of perianal hidradenitis suppurativa, complicated by anal fistulae: A case report and review of the literature

Hidradenitis Suppurativa (HS) is a chronic inflammatory disease of the skin starting from the apocrine glands and mainly involving the axilla, perineum and perianal area. It is clinically defined by the onset of painful subcutaneous nodularities, associated with signs of local inflammation, whose progression proceeds towards the definition of true subcutaneous abscess collections from which fistulous pathways branch off. These lesions result in severe fibro-cicatricial deformities. The diagnosis of HS, which is basically clinical, is followed, due to the recurrent/relapsed nature of the disease, by a difficult therapeutic management, which makes use of different treatments depending on the severity of the pathological picture, ranging from topical or systemic medical therapy to surgical excision. Imaging examinations, although not specific enough in the diagnosis of HS, are essential to define the loco-regional extension of the disease and to exclude possible alternative diagnoses. In particular, MRI plays a key role in the study of HS with anogenital localization, both for the recognition of lesions in the active phase and for the assessment of the local extension of the disease, in particular in adequately demonstrating the entire course of the fistulas and the relationships with the neighboring anatomical structures. This allows the optimization of its treatment, in order to reduce disease recurrence. The case presented by us describes the MRI characteristics in a rare case of HS, complicated by anal fistulae.

A false alarm: Pacemaker pocket pseudo-infection.

A 87-year-old man had a dual-chamber pacemaker for almost 10 years implanted for symptomatic sinus node disease. Subsequently, he underwent device replacement in our department because of battery depletion. Nineteen months after the last procedure, he presented to a district hospital because he noticed a diffuse redness over the pacemaker area. Shortly after, he was transferred to our center with a presumed diagnosis of “pacemaker pocket infection.” On inspection, there was an obvious redness over the pacemaker pocket area extending to half of the left hemithorax (Figure 1 Panel A). The erythema was warm on palpation but there was no tenderness. Of note, the patient was afebrile in good clinical condition. His past medical history was significant for hypertension and hyperlipidemia treated with perindopril, amlodipine, and atorvastatin. The laboratory examinations were all within normal limits, apart from the C-reactive protein (CRP) levels (initial value: 90 mg/L; normal value <8 mg/L). No specific site of injury, irritation, insect bite, or sting was evident over the pacemaker area. Given that a pacemaker pocket infection was suspected, he was placed on intravenous antibiotic treatment with ampicillin/sulbactam and clindamycin while an extraction procedure was scheduled. A transesophageal echocardiogram the following day did not reveal any abnormality. The blood cultures taken before the antibiotics institution were negative. Remarkably, the patient responded dramatically to the treatment and on the fifth day of hospitalization, the erythema disappeared (Figure 1B) while the CRP levels almost normalized (10 mg/L). Although the initial working diagnosis was a pocket infection, the possibility of a superficial infection caused by an involuntary irritation or minor injury was also considered. The patient was discharged home on the 8th day after admission and continued the same antibiotic treatment orally for another 7 days. During follow-up at 1, 6, and 12 months, the patient remained well without any relapse. The final diagnosis made by our team was local cellulitis that responded to antibiotic treatment and was confirmed by an internist with a special interest in infectious diseases. Cardiac implantable electronic device (CIED) infection represents a devastating complication leading to significant morbidity and mortality.1, 2 Current recommendations advocate a therapeutic approach consisting of complete removal of the system and antimicrobial therapy.2 Although most CIED infections occur within 1 year from the index procedure, a significant proportion of patients develop infections later.1, 3 The early recognition and management of CIED infections is important in terms of morbidity and mortality. The clinical presentation of our patient along with the elevated CRP was suspected of pocket infection, although 19 months had been elapsed since the generator replacement. Notably, we have reported a case series of patients with skin lesions that mimic pocket infection.4 These conditions include local cellulitis after CIED implantation, spontaneous bruising, herpes zoster, contact dermatitis because of the prolonged postoperative application of povidone-iodine.4 However, most conditions that may be misinterpreted as CIED pocket infection are neoplastic (malignant tumors).4 Moreover, titanium, nickel, or other pacemaker compounds may very rarely provoke allergic reactions including contact dermatitis.4 Our patient suffered localized diffuse cellulitis without any obvious cause (local injury, sting, or bite). Clinicians should be aware of conditions mimicking CIED pocket infection. Many of these entities can be treated conservatively without any meaningful complications. Inadvertent CIED extraction may have a negative impact on patient's clinical outcomes. Although CIED pseudo-infection is rare, a rapid and dramatic improvement of the local inflammatory signs after antibiotic treatment during the first few days may portend a benign outcome. However, the diagnosis of pseudo-infection would be certain only if complete remission will remain and no signs of infection recur after cessation of antibiotic treatment. Authors declare no conflict of interets for this article. The patient has given signed consent for publication of his medical case anonymously and without showing his face.

Cerebrospinal Fluid Shunt Infections in Children: Do Hematologic and Cerebrospinal Fluid White Cells Examinations Correlate With the Type of Infection?

Cerebrospinal fluid (CSF) shunt infections in children represent an increasing problem in clinical practice. However, comprehensive clinical, laboratory and microbiologic data are scarce in pediatric age. We conducted a 10-year retrospective study to (1) analyze clinical, laboratory and microbiologic parameters associated with infections in children; (2) analyze results according to the type of catheter (medicated or not), type of infection (first or relapses), type of hydrocephalus (acquired and congenital), presence or not of bacteriemia; (3) describe antibiotic susceptibilities and their evolution during the study period. Eighty-seven children with shunt infection and 61 children with mechanical shunt malfunction were enrolled. Fever, vomit, leukocytosis and elevated C-reactive protein were more frequent in the infected group (P < 0.001), while neurologic symptoms developed more frequently in the noninfected group (10.3% vs. 27.87%; P = 0.006). Local signs of inflammation and abdomen distension were similarly reported in the 2 groups. Children with medicated shunts had lower cell count in the CSF (12/mm3) compared with those with nonmedicated shunts (380/mm3; P < 0.0001). Gram-negative bacteria were more common in the not-medicated catheters (90.91% vs. 50% of cultures; P = 0.04). Gram-negative bacteria were identified in 50.67% of CSF cultures, Gram-positive bacteria in 53.33% and fungi were observed in 5.33%. Sixteen children (18.4%) had also a positive blood culture. Enterococci isolation was associated with relapsed infections (37.50% vs. 15.25%; P = 0.05). Our study shows that the diagnosis and management of children with shunt infections are challenging. Prospective studies with a comprehensive approach focusing on patient, medical, microbiologic and surgical risk factors for first infection are urgently needed.

Cystic Degeneration of an Atypical Adventitial Bursitis: Case Report and Literature Review

Adventitial (adventitious) bursae occur as a pathological condition in areas between soft tissues and bone where abnormal friction arises due to professional, traumatic, or sport activity. An atypical localization of an adventitial bursa was noticed on the ulnar margin of the distal forearm in a woman with a mild bone misalignment, as a professional disorder. The clinical presentation was one of subcutaneous mass with mild pain and no local signs of inflammation. A 1-year follow-up visit noted the degeneration of the bursa into a cystic lesion, as proved with a grayscale sonogram, using a 14 MHz linear transducer. This was an unexpected chronic evolution. A quick literature search found either resolution or a chronic course with complications as fibrosis, infection, and ulceration of adventitial bursitis.

Floating gallbladder in exomphalos minor an exceptional condition that should be considered, a case report.

BackgroundThe exomphalos minor or small omphalocele is a defect of the abdominal wall smaller than 5 cm, located in the umbilical cord. It presents a sac containing intra-abdominal organs, mainly the small intestine. The main surgical objective is to repair the defected wall, preserving the intra-abdominal structures inside the sac. A floating gallbladder is unusual in this pathology; however, it must be removed when that occurs due to the risk of torsion, inflammation, and volvulus.Presentation of caseWe present the case of a 7-day-old patient who comes to the emergency room with an abdominal mass. The physical examination shows minor exomphalos with local signs of inflammation. Genetic, chromosomal, and imaging studies are solicited. The abdominal ultrasonography report shows the absence of the gallbladder in the liver. The patient requires surgical correction of abdominal wall defect. The gallbladder is found inside the sac of defect that does not have a hepatic fixation; a cholecystectomy is performed. The patient presents a satisfactory postoperative evolution and is discharged.ConclusionsThe exomphalos minor is a malformation of the abdominal wall. It needs surgical treatment; this must be done carefully, preserving the intra-abdominal organs inside the sac as much as possible. The gallbladder without hepatic fixation, elongated meso, or suspended by its pedicle is unusual in pediatric age, and they present a higher risk of torsion, inflammation, and necrosis. For this reason, cholecystectomy is indicated. A minor exomphalos has a better prognosis when the defect is small. It is not associated with malformations or associated structural alterations.

The Diagnosis and Treatment of Acute Cholecystitis

Acute cholecystitis (AC), defined as inflammation of the gallbladder, is mainly caused by gallstones. Over 90% of AC results from obstruction of the cystic duct by stones or sludge, which subsequently increases the intraluminal pressure within the gallbladder and, in conjunction with the presence of bile supersaturated with cholesterol, activates an acute inflammatory cascade. Clinical features play an important role in the diagnosis of AC. The Tokyo Guidelines 2018 for acute cholecystitis designates the presence of local inflammatory signs and systemic inflammatory signs for a suspected diagnosis. It requires confirmation by radiological imaging along with these two factors for a definitive diagnosis. Thanks to less invasiveness, easy availability, ease of use, and cost-effectiveness, ultrasound (US) is usually accepted as the first choice in suspicious AC patients. A meta-analysis comparing methods of diagnosis for AC reported that the US has 81% of sensitivity and 83% of specificity. Abdominal computed tomography is recommended for diagnosing emphysematous or gangrenous cholecystitis. Meanwhile, acute acalculous cholecystitis (AAC) is a life-threatening disease mainly in severely ill patients. It usually affects the patients hospitalized for multiple trauma, burns, cardiopulmonary bypass surgery, long-term total parenteral nutrition or sepsis. The diagnosis of AAC is quite challenging and requires a high index of suspicion. Currently, cholecystectomy is the treatment of choice for AC, although the optimal time for surgery is still controversial. Due to high morbidity and mortality in high surgical risk groups, percutaneous gallbladder drainage can be a safe and feasible alternative to cholecystectomy, particularly for patients unfit for the surgery.

Infective endocarditis in cardiac implantable electronic devices (pacemakers): Experience of the rhythmology department in Mohammed V military instruction hospital

Infective endocarditis (IE) remains a highly mortal disease, yet the diagnosis often is missed or made only late in the disease course. Its development on cardiac implantable electronic devices (CIEDs), such as a pacemakers, may be difficult to treat without explanting the cardiac stimulation system. Our objective is to study the frequency of infective endocarditis (IE) on cardiac implantable electronic devices (CIEDs), and to determine the predisposing factors in order to prevent them. We conducted a retrospective and descriptive study of patients who received CIEDs implantation in the rhythmology department of Mohammed V military instruction hospital in Rabat from February 2013 to January 2017. We included patients who experienced endocarditis on these devices. We collected data regarding the indication, the implantation procedure, and the diagnostic, therapeutic and progression characteristics of this endocarditis. Of the 395 patients implanted, twelve (3%) had an IE. The infection concerned ten patients with primary implantation and two patients after generator replacement. Eight patients (67%) were male, the mean age was 66 years and three patients had a type 2 diabetes (17%). Local inflammatory signs were the most frequent evocative symptom in our series, they were observed in seven patients (60%). Biological assessment and blood cultures were conclusive in only half of the cases. Extraction of infected material was performed by traction in ten patients and by laser extraction in the other two ( Fig. 1 ). Infective endocarditis on cardiac implantable electronic devices mainly affects young male patients with diabetes. Clinical suspicion was mainly based on local inflammatory signs. Biological and bacteriological tests were often inconclusive requiring multimodality imaging approach. The best prevention remains a strict asepsis during implantation.

P097 Diagnostic dilemma of acquired non-traumatic spinal deformation: Pott's disease; histiocytosis or psoriatic rheumatism? About a case

Abstract Background Non-traumatic acquired spinal deformities represent a separate entity within the axial pathologies in children. Their causes are variable (neurological, muscular, infectious, especially Pott's disease, inflammatory or tumoral). The etiological diagnosis can be clinically oriented by pain, medical history, especially rheumatic. The contribution of the CT scan is crucial, as it localizes the lesion, specifies its nature, but above all it helps the histological diagnosis by guided biopsies. Our case illustrates the difficulties in diagnosing the aetiology of spinal acquired deformity in a girl with a multi-evocative context. Observation A 14 years-old girl complains for a few months of a dorso-lumbar spinal pain and a vicious attitude. Her medical history includes femoral thrombophlebitis and psoriasis. She had no trauma or fever. Clinically, the general state is preserved, with no local inflammatory signs, a kyphotic attitude with an analgesic lumbar support was noted. The rest of the locomotor exam was normal. CT scan shows cancellous body geodes with a double mirror. Discussion Acquired spinal deformities are always secondary to general disease. The fever may point to bacterial infections, especially tuberculosis (Pott's disease), but also non-infectious causes such as a rheumatic disease. For our patient, psoriasis argues for the latter possibility. However, the rarity of isolated disco-vertebral involvement and the severity of the lytic lesions are against this diagnosis. The histopathological exam showed an eosinophilic granuloma, confirming the histiocytosis X diagnosis. The cortico-response strengthen the diagnosis. The course was marked by the bone remodeling with the posture correction. Conclusion A clinical, radiological, and histological analysis allow the etiological orientation in front of acquired spinal deformity.

Medical-Grade Honey as an Alternative Treatment for Antibiotics in Non-Healing Wounds-A Prospective Case Series.

Non-healing wounds are usually colonised by various types of bacteria. An alternative to antibiotic treatment in patients with infected wounds with local signs of inflammation may be medical-grade honey (MGH), which favourably affects the healing process with its antimicrobial, antioxidant, anti-inflammatory, and immunomodulatory properties. The objective of this study was to evaluate the effect of MGH therapy on the healing process of non-healing wounds of various aetiologies and different wound colonisations. Prospective, observation–intervention case studies (n = 9) of patients with wounds of various aetiologies (venous leg ulcers, diabetic foot ulcers, surgical wound dehiscence) are presented. All wounds were treated with MGH and the healing trajectory was rigorously and objectively monitored. In all cases, pain, odour, and exudation were quickly resolved, which led to an improvement in the quality of life of patients. Despite the proven bacterial microflora in wounds, antibiotic treatment was not necessary. The effects of MGH alleviated the signs of local infection until their complete elimination. In eight out of nine cases, the non-healing wound was completely healed. MGH has antimicrobial, anti-inflammatory, and antioxidant effects in wounds of various aetiologies and forms an effective alternative for the use of antibiotics for treating locally infected wounds.

Pseudo-Chilblains in a COVID-19 Patient

The aim of this case is to describe an example of cutaneous manifestations caused by COVID-19 infection, helping to better understand the disease and support an early clinical suspicion. This case addresses a 36-year-old patient with COVID-19 infection, symptomatic, with mild complaints. Seven days after the start of the clinic, she exhibited dermatological lesions in the acral areas bilaterally on her hands. The presence of erythematous-violet papules/vesicles was found in the dorsal extensor zones of the fingers, with local inflammatory signs, skin rash, flushing, edema, local burning sensation, itching and pain. Pseudo-chilblains were assumed as diagnostic hypotheses. She underwent symptomatic treatment, having achieved complete resolution at 10 days, with no subsequent sequelae.Attention should be paid to the fact that COVID-19 may present only with cutaneous manifestations, therefore these may serve as an indicator of the disease in suspected cases.

A spacer infection by Candida albicans secondary to a Staphylococcus capitis prosthetic joint infection: a case report

BackgroundProsthetic joint infection (PJI) is one of the most feared complications following total arthroplasty surgeries. Gram-positive bacteria are the most common microorganisms implicated in PJIs, while infections mediated by fungi only account for 1% of cases. When dealing with PJIs, a two-stage revision arthroplasty is widely used. Briefly, a spacer is introduced until re-implantation of the definitive prosthesis to provide skeleton stabilization while delivering antibiotics in the site of the infection. Sometimes, antimicrobial therapy may fail, but the isolation of a second microorganism from the spacer is uncommon and even less frequent that of a yeast.Case presentationHere is described a case of a 75-year-old woman who underwent two-stage revision surgery of the left hip prosthesis secondary to a Staphylococcus capitis infection, whose spacer was found to be infected by Candida albicans at a later time. Briefly, the patient underwent revision surgery of the hip prosthesis for a suspected PJI. After the debridement of the infected tissue, an antibiotic-loaded spacer was implanted. The microbiological analysis of the periprosthetic tissues and the implant depicted a S. capitis infection that was treated according to the antimicrobial susceptibility profile of the clinical isolate. Three months later, the patient was admitted to the emergency room due to local inflammatory signs. Synovial fluid was sent to the laboratory for culture. No evidence of S. capitis was detected, however, a yeast was identified as Candida albicans. Fifteen days later, the patient was hospitalized for the removal of the infected spacer. Microbiological cultures confirmed the results of the synovial fluid analysis. According to the susceptibility profile, the patient was treated with fluconazole (400 mg/day) for 6 months. Seven months later, the patient underwent second-stage surgery. The microbiological tests on the spacer were all negative. After 12 months of follow-up, the patient has fully recovered and no radiological signs of infection have been detected.ConclusionsGiven the exceptionality of this complication, it is important to report these events to better understand the clinical outcomes after the selected therapeutic options to prevent and forestall the development of either bacterial or fungal spacer infections.

Non-axial osteoarticular tuberculosis in the paediatric age

Introduction and objectivesOsteoarticular tuberculosis, caused by a member of the Mycobacterium genus, represents approximately 10% of the total extrapulmonary tuberculosis in pediatric patients. Its low prevalence and nonspecific clinical presentation lead to a late diagnosis and elevated risk of sequelae. Patients and methodsThis retrospective study included seven pediatric patients with non-vertebral osteoarticular tuberculosis diagnosed between 2006 and 2019. The patients were classified in accordance with the radiographic criteria of Kerri and Martini. ResultsThe mean patient age was 7,4 years (median, 5 years; range, 2–16 years). The mean follow-up time was 18,5 months (range, 10–32 months). The mean diagnostic delay was 4,7 months (range, 1–8 months). The locations were femoral head osteoarthritis (two patients) and proximal humerus osteomyelitis, talus dome osteoarthritis, distal clavicle osteoarthritis, proximal ulna epiphysis osteoarthritis, and tibiotalar arthritis along with subtalar gland (one patient each). The clinical findings were lameness (four patients), localized pain (two patients), functional impotence, constitutional syndrome (asthenia, anorexia, and involuntary loss of >5% of total body weight) (two patients), local inflammatory signs (one patient), and fever (one patient). One patient was asymptomatic and received a diagnosis during pulmonary radiological analysis. Medical treatment with four drugs was performed in all patients; five patients required surgical treatment for abscess drainage, three of them open drainage, and two with laparoscopic drainage. ConclusionsThe final results were satisfactory, such that 71% of patients recovered joint balance but with radiological sequelae in 57,1% patients. Good prognosis, according to our results, depends on younger age and early diagnosis with early medical or surgical treatments.

A Prospective Study on the Efficacy of Two Different Phlebotonic Therapies as a Bridge to Surgery in Patients with Advanced Hemorrhoidal Disease.

The aims of this study were to evaluate the efficacy of two different phlebotonic therapies, preoperatively administered in advanced hemorrhoidal disease (HD) patients with recommendation for surgery, and to assess patient satisfaction after treatment. In this prospective observational study, 100 patients were preoperatively treated either with micronized purified flavonoid fraction (group A) or sublingual nano-emulsion flavonoid (group B). HD symptoms, local inflammation signs and patients’ satisfaction were evaluated at baseline visit (T0), after 4 weeks of therapy (T1) and 8 weeks after its discontinuation (T2). In group A, a significant improvement for all HD symptoms and inflammation signs was observed after therapy (T1), followed by a reduction of efficacy in T2, except for itching and edema. In group B, therapy had a significant benefit on symptoms and local inflammation at T1, which persisted after its discontinuation for all symptoms, and edematous hemorrhoids. In both groups, the satisfaction rate was “good” in 60% of patients and patients were statistically significant more satisfied at T1 compared with T2 (p = 0.0001). No adverse events were recorded. Preoperative treatment was safe and useful to optimize patients’ clinical condition prior to surgery.

Strong Antimicrobial Effects of Xanthohumol and Beta-Acids from Hops against Clostridioides difficile Infection In Vivo.

Clostridioides (C.) difficile is an important causative pathogen of nosocomial gastrointestinal infections in humans with an increasing incidence, morbidity, and mortality. The available treatment options against this pathogen are limited. The standard antibiotics are expensive, can promote emerging resistance, and the recurrence rate of the infection is high. Therefore, there is an urgent need for new approaches to meet these challenges. One of the possible treatment alternatives is to use compounds available in commonly used plants. In this study, purified extracts isolated from hops—alpha and beta acids and xanthohumol—were tested in vivo for their inhibitory effect against C. difficile. A rat model of the peroral intestinal infection by C. difficile has been developed. The results show that both xanthohumol and beta acids from hops exert a notable antimicrobial effect in the C. difficile infection. The xanthohumol application showed the most pronounced antimicrobial effect together with an improvement of local inflammatory signs in the large intestine. Thus, the hops compounds represent promising antimicrobial agents for the treatment of intestinal infections caused by C. difficile.

Venous Thromboembolic Diseases: Epidemiological, Clinical, Para clinical, Therapeutic and Evolutionary Aspects: Retrospective Study over a Period of 7.5 Years about 112 Cases collected in the Internal Medicine and Cardiology Department of Lnth

Introduction: venous thromboembolism (VTE) is a real public health problem in the world due to its frequency and severity since the mortality from an untreated thromboembolic episode is around 30%. Because of its chronic and disabling complications (post-thrombotic disease and chronic thromboembolic pulmonary hypertension), it is responsible for a deterioration in the quality of life of patients. Objective: The aim of this work was to contribute to the study of the epidemiological , clinical, Para clinical, therapeutic and evolutive aspects of venous thromboembolism disease in the internal medicine and cardiology department of the Amirou Boubacar Diallo National Hospital. Patients and Methods: It's a prospective study from July 1st, 2019 to June 30th, 2020 and retrospective from January 1st, 2013 to June 30th, 2019 (7 years and 6 months) about 112 patients with whom the diagnostic of deep venous thrombosis (DVT ) and / or pulmonary embolism (PE) had been done. Results: In our study, the prevalence of venous thromboembolism has been estimated at 3.9% of hospitalized patients with cardiovascular diseases. There was a female predominance (sex ratio 1.38). The average age of patients was 52 years. Teabed-rest prolonged was the frequent risk factor (66%). The clinical symptomatology was dominated by oedema of the lower limb (83.3%) and pain in limb palpation (82.1%) in case of DVT, the dyspnea (23.02%) and thoracic pain (11.6%) in case of PE. The attack of the left lower limb prevailed (45.5%). The sinus tachycardia (25.9%) was the predominant electrical sign at the ECG. Through the Doppler of the lower limbs, the popliteal and femoral veins were the most involved with 22.3% and 17.8% respectively. According to the chest angio-CT, the left pulmonary artery was obstructed in 100% of case. The treatment was essentially made of low molecular weight heparins (90.1%) replaced quickly by vitamin k antagonist (began the first day of the heparin therapy) and / or of unfractionated heparin (9%). The most common complication was PE due to DVT and the overall mortality was 12.5%. Conclusion: VTE is pathology in young adults and elderly characterized by the formation of a clot in a vein responsible for the obstruction of the latter causing local inflammatory signs and / or its pulmonary migration which could be fatal. The prevention and treatment of VTE are based on anticoagulants.