Local Swelling Research Articles

Subcutaneous furosemide in heart failure: a systematic review.

Intravenous loop diuretics are the primary treatment for congestion in patients with decompensated heart failure (HF). Furosemide is the most commonly used loop diuretic and is licensed for administration either orally, intramuscularly or intravenously but not subcutaneously. Recently developed, pH-neutral, concentrated, 'skin-friendly' preparations of furosemide have been developed which allow subcutaneous administration. In this systematic review, we summarize and critically appraise the current evidence for subcutaneous furosemide in patients with HF. The electronic databases MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov registry were searched up to 31 December 2023. Of the 17 studies identified, 5 were randomised controlled trials (RCTs), 2 were non-randomised controlled studies, 3 were prospective observational cohort studies, and 7 were retrospective observational studies.All RCTs utilised novel pH-neutral, subcutaneous preparations of furosemide. Bioavailability of novel subcutaneous preparations were similar to intravenous furosemide 10mg/ml: 99.7% for an 8mg/ml preparation and 112% for a 30mg/ml preparation. Natriuresis and diuresis were also similar with novel subcutaneous and conventional intravenous furosemide. Adverse events of novel preparations included infusion site pain or discomfort, localised skin erythema and minimal swelling. All studies of conventional subcutaneous furosemide were non-randomised with very limited data re bioavailability or diuretic and natriuretic effect. Conventional subcutaneous furosemide was associated with substantial skin irritation (affecting 3-23% of patients), and skin infections requiring treatment with antibiotics (3-17%). Novel, pH-neutral preparations of subcutaneous furosemide achieved similar diuresis, natriuresis, and bioavailability to intravenous furosemide, and were well tolerated. Novel preparations may be a treatment option for patients with HF.

Improved injection site reactions after switching from adalimumab reference to adalimumab biosimilar LBAL for ulcerative colitis: A case report.

Adalimumab (ADA) is an antitumor necrosis factor agent that is used for the treatment of inflammatory bowel disease. However, its cost has resulted in varying degrees of restricted access across global healthcare economies. Biosimilars are agents that contain a similar version of the active substance of an already approved original biologic agent and are intended to be used for the same indication as the reference product. In general, biosimilars follow the originator; therefore, information on its efficacy and safety had been few. Some studies have reported on replacement of the originator with a biosimilar of the same efficacy because of medical reasons. A 15-year-old girl with steroid-dependent ulcerative colitis that relapsed after vedolizumab was treated with ADA reference. Six weeks after starting ADA reference, her gastrointestinal symptoms had completely resolved, however, immediately after the eighth dose of ADA reference, redness, swelling, and pruritus were noted at the injection site on the left thigh. Allergic reaction caused by the ADA reference. ADA reference was changed to ADA biosimilar LBAL. ADA biosimilar LBAL was continued without any symptoms, such as local swelling, redness, or itching. In addition, there was no deterioration of gastrointestinal symptoms. We showed the efficacy and safety of ADA biosimilar LBAL as an alternative to ADA reference, which caused injection site reactions. Changing from ADA reference to ADA biosimilar because of adverse events may be an option that needs careful observation, considering that the originator and the biosimilar are not exactly the same.

Inhibition of LPS-induced inflammatory response in RAW264.7 cells by natural Chlorogenic acid isomers involved with AKR1B1 inhibition

Inflammation is the physiological response of the immune system to injury or infection, typically manifested by local tissue congestion, swelling, heat, and pain. Prolonged or excessive inflammation can lead to tissue damage and the development of many diseases. The anti-inflammatory effects of natural ingredients have been extensively researched and confirmed. This study investigated the effects of Chlorogenic acid (CGA) isomers —— 3-Caffeolyquninic acid (3-CQA), 4-Caffeolyquninic acid (4-CQA), and 5-Caffeolyquninic acid (5-CQA) —— on the inflammatory response and oxidative stress reaction induced by LPS in RAW264.7 cells. Overall, 3-CQA exhibited the most significant reduction in levels of TNF-α, IL-6, NO, and ROS. 4-CQA showed superior inhibition of TNF-α compared to 5-CQA (p < 0.05), while no significant difference in other parameters. We further used DARTS and CETSA to demonstrate that CGA isomers have stable affinity with AKR1B1. As a positive control, the AKR1B1 antagonist epalrestat exhibited similar effects to the CGA isomers. 3-CQA having the smallest half-inhibitory concentration (IC50) for AKR1B1, while 4-CQA and 5-CQA have similar values. AutoDock simulations of the docking conformations revealed minimal differences in the average binding energies of the CGA isomers. The main differences were that VAL47 formed a hydrogen bond with 3-CQA, whereas GLN49 formed hydrogen bonds with 4-CQA and 5-CQA. Additionally, the number of hydrophobic bonds involving PHE122 and LEU300 varies. Our conclusion is that differences in non-covalent interactions result in the varying inhibitory abilities of CGA isomers on AKR1B1, which further affect the anti-inflammatory and antioxidant effects of CGA isomers.

Clinical Profile of Snakebite: A Cross-sectional Study In A Upazila (Subdistrict) Health Complex, Bangladesh

Background:Snakebite remains a significant public health concern in many regions of Bangladesh, particularly in southern Chattogram. The Non communicable Disease Control (NCDC) program under DGHS has put tremendous efforts and motivation toward the healthcare provider at Upazilla level to treat cases of snakebite successfully. This study provides a comprehensive analysis of snakebite cases, focusing on the epidemiological patterns, clinical profiles and management observed at Lohagara Upazilla Health Complex. Method: Through a cross-sectional study, analysis of the records of past two years of admitted patients was done which elucidates the demographic characteristics, clinical presentations, and management outcomes of snakebite envenoming in the southern Chattogram community. Result: A total of 202 cases of snakebite were treated successfully, among which 63.9% were male (n=129) and 36.1% were female (n=73). The mean age was approximately 32 years (±17.40) and most were in the age group of 11-20 years (52, 25.74%). 26 (13%) cases developed local envenoming by green-pit viper bite, whereas 6 (2.9%) developed systemic envenoming with neurotoxicity alone and only 1 (0.5%) had features of both neurotoxicity and local swelling. The majority of cases had a short hospital stay, with 171 (84.7%) cases discharged after one day. Maximum patients (55.5%) reached the hospital within one hour of bite. In 53.46% of cases, the species of snakes could not be identified. Conclusion: These findings indicate the need for targeted public health interventions focusing on education and first-aid training, as well as improved pre-hospital care practices to better address snakebite incidents. J Bangladesh Coll Phys Surg 2024; 42: 305-311

Exceptional Rarity Unveiled: Isolated Fungal Osteomyelitis of Great Toe by Fusarium Solani-Unprecedented Presentation and Exquisite Management Insights

Fungal osteomyelitis is a rare but significant condition, often associated with immunocompromised states or severe systemic illnesses. This condition involves fungal pathogens, primarily Aspergillus, Candida, and Mucor species. Among these, Aspergillus is the most commonly implicated, especially in cases of vertebral osteomyelitis, although fungal infections involving bones like the distal phalanx of the toe are rare. In particular, Fusarium solani, though less frequently reported, has gained recognition for its role in causing localized osteomyelitis in both immunocompetent and immunocompromised patients. A case involving a 57-year-old male with no significant history of immunosuppression is presented. The patient developed localized pain and swelling in the left toe following a minor traumatic injury. Initial radiographic imaging revealed bone erosion, leading to a diagnosis of osteomyelitis. Cultures from bone biopsy identified Fusarium solani as the causative pathogen. This is noteworthy as the fungus, though commonly found in soil, water, and plants, rarely infects bone structures. The patient was treated with a combination of antifungal therapy, including voriconazole and surgical debridement. The rarity of Fusarium solani osteomyelitis and its unusual presentation in an immunocompetent host adds to the complexity of diagnosing fungal infections in osteomyelitis. Treatment typically involves a multidisciplinary approach that combines both medical and surgical interventions. The case highlights the importance of considering fungal pathogens, even in unusual clinical settings, especially when initial treatments fail to provide resolution. Early diagnosis and targeted therapy can improve outcomes, particularly in cases involving uncommon fungal pathogens such as Fusarium solani. This report emphasizes the need for awareness of fungal osteomyelitis in immunocompetent individuals and underscores the critical role of fungal cultures and imaging studies in guiding management.

Exploring Hemophilic Pseudotumors: A Comprehensive Case Series

Introduction: This case series investigates four hemophilic pseudotumors, which are rare but significant complications of hemophilia. All patients presented with localized swelling and pain, with imaging revealing mass-like lesions that mimicked tumors. Treatment involved a combination of surgical intervention and factor replacement therapy. The findings underscore the importance of diagnostic vigilance and highlight the necessity of a multimodal approach to manage these challenging cases effectively. Aim(s): The major aim of this study is to highlight the prevalence of hemophilic complications like pseudotumors in India. Along with this, this series also aims to shed some light on the multi-disciplinary approach required to manage these complications of Hemophilia. Study Design: Case series. Methods and Materials: 4 cases were followed at a tertiary care centre who presented with various complaints but were each linked by hemophilic pseudotumor. It takes into account the management approach in each case. Conclusion: Early detection of compressive symptoms in hemophilic pseudotumors is crucial for accurate surgical planning. Recent hemorrhages should be managed conservatively, while chronic cases with pain and pressure symptoms often require surgery. Surgical intervention, though complex, is essential and should involve a multidisciplinary approach to prevent morbidity and mortality.

Clinical features of chronic tibial osteomyelitis: a single-center retrospective study of 282 cases in Xinjiang, China.

Chronic osteomyelitis is a highly prevalent and severe orthopaedic complication, representing a critical unresolved issue. The clinical symptoms of osteomyelitis are influenced by various factors, including geography, lifestyle, and pre-existing medical conditions.This study aims to provide theoretical basis for treatment and prevention of osteomyelitis by investigating and analyzing clinical features and pathogen distribution among 282 patients with chronic tibial osteomyelitis in xinjiang. A total of 282 patients with chronic tibial osteomyelitis from January 1, 2012 to January 1, 2022 in the First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed. All data were collected from electronic medical record (EMR) system including demographics, etiology, risk factors, osteomyelitis location and clinical classification. Farmers, students, unemployed and retirees accounted for a relatively large proportion of the 282 patients. There were 233 males and 49 females with a gender ratio of 4.75:1. The average age was 40.21 ± 15.68 years and was mainly concentrated in 41-50 years, specifically, the mean age of females was slightly older than that of males. Education level was mostly primary and secondary school education, and illiteracy. Risk factors of chronic tibial osteomyelitis included history of smoking and drinking, history of multiple repeated surgeries, and impaired immunity. Frequent clinical symptoms were in the order of pain, local swelling, pus discharge and skin ulceration. Among all inflammatory markers, proportion of positive results were 30.85%, 59.93% and 53.90% for white blood cell (WBC), erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), respectively. Positive rate of pathogenic microorganism culture was low and the three most common bacteria were Staphylococcus aureus (S. aureus), Pseudomonas aeruginosa (P. aeruginosa) and Escherichia coli (E. coli). The most frequent site of infection was middle tibia. According to Cierny-Mader osteomyelitis classification, the most common types were type IIIA, IVA and IIA. Number of visits due to chronic osteomyelitis increased year by year, with young and middle-aged male farmers and low education level as the main groups. Smoking and drinking were two considerable risk factors that should be attached to a great importance. No significant increase was found in inflammatory markers and lower positive rate of pathogenic microorganism culture was observed. Multi-drug resistant bacteria were common and S. aureus remained the most frequent pathogen. Elevated ESR had certain diagnostic value for osteomyelitis. Type III and type IV osteomyelitis accounted for a large proportion which posed great challenges for clinical diagnosis and treatment.

Safety Evaluation of the Novel Cocktail of Monoclonal Antibodies for Postexposure Prophylaxis in Category III Animal Exposures

Abstract Introduction: Rabies monoclonal antibody (mAb) is a life-saving immune-biological for postexposure prophylaxis (PEP) in all Category III animal exposures. A novel cocktail of mAbs derived using recombinant DNA technology is presently available for usage. The WHO recommends monitoring the clinical use and outcomes of mAb products. Methods: An open-label, postmarketing study was conducted at the anti-rabies clinic in the southern part of India. PEP was provided to all the study participants per the national guidelines. All the subjects were assessed for any adverse events (AEs) following PEP up to 35 days; if any, were treated free of cost at the study center. Results: The present study included 309 subjects across all age groups, 59.2% were adults, 33.3% of children, and 7.5% elderly. Majority of the patients were exposed to dogs (89.6%) and most of them had lacerations (86.3%) in different parts of their body. A total of 19 (6.2%) AEs were reported. All the AEs were local reactions, namely pain (2.6%), erythema (1.4%), tenderness (1%), induration (0.6%), and swelling (0.6%). All reported AEs were mild (Grade 1 severity) and resolved completely with symptomatic treatment. Conclusion: The novel cocktail of mAbs was safe for PEP in Category III animal exposures across all the age groups and supports its continued and improved usage for Universal Health Coverage to prevent rabies.

Etiology, Recent Advances, and Clinical Trials Data for the Treatment of Angioedema: A Review.

Angioedema is a health issue that affects parts of the body like the upper pulmonary and gastric pathways and is identified by abrupt, nonpitting enlargement of the skin, mucous membranes, or both. The swelling usually lasts a few hours to 72 hours and may appear as non-puritic, subcutaneous, or submucosal organ edema. It is characterized by localized swelling brought on by the release of histamine. Itching is rare, and usual areas of appearance include the hands, feet, face, and genitalia, with periorbital swelling being the most often. The main objective of this review article is to study in brief the classifications, etiology, pathophysiology, and clinical trial data by describing the recent advancement in the treatment of angioedema. Various research articles obtained from different journals indexed under Scopus and SCI were used to prepare the review article and for illustrative work software such as Biorender and Microsoft Word was used. Histamine-- mediated angioedema, linked to allergic reactions, coexists with urticaria. Bradykinin-mediated angioedema, exemplified by hereditary angioedema and acquired forms, lacks urticaria. Idiopathic angioedema, with uncertain etiology. Imitated angioedema results from non-IgE-mediated reactions, often induced by medications. It is a complicated medical condition with a variety of causes and mechanisms. Over time, outcomes for patients have been greatly improved by a growing understanding of its etiology, pathophysiology, and available treatments. The field of medical treatment for this difficult problem is always changing, and this is partly due to clinical trials.

Radiographic differences in deep fascial space infections versus localized acute apical abscesses: A cone-beam computed tomographic-based observational study

ABSTRACT Aim: The objective of this study was to evaluate anatomical differences and patterns of bone loss in patients with acute apical abscess (AAA) clinically presenting as a localized swelling or with concomitant fascial space involvement (FSI) using cone-beam computed tomographic (CBCT) imaging. Materials and Methods: Thirty CBCT images of AAA cases presenting with fascial space involvement (FSI) and 31 cases of localized acute apical abscess (LAAA) were evaluated. Factors that were recorded included the presence/absence of cortical disruption, the distance of the involved tooth apex to the buccal and lingual/palatal cortex, the length of the anatomic root/s of the involved tooth, and the volume of the endodontic lesions. Results: The median for the volume of the lesions was 138 mm3 for the FSI group and 154 mm3 for the LAAA group (P &gt; 0.05). Radiographic evidence of cortical disruption was seen in 26.7% of the cases with FSI and 41.9% of the cases with LAAA (P &gt; 0.05). The mean for the distance of the apex to the buccal cortex was the only statistically significant difference between the two groups and was 4.2 mm for the FSI group and 3 mm for the LAAA group (P &lt; 0.05). Conclusions: CBCT assessment showed root apices associated with fascial space involvement tended to be more confined in cancellous bone. Although a significant difference between the two conditions was found, the inflammatory process is complex, and CBCT assessment alone cannot predict AAA remaining as a localized swelling versus spreading to fascial spaces.

Spontaneous rectus sheath hematoma as a differential diagnosis for localized abdominal swelling in chronic liver disease: A rare case report.

Spontaneous rectus sheath hematoma is a rare complication in chronic liver disease patients. Early clinical suspicion with prompt radiological evaluation is crucial for accurate diagnosis and timely management. Spontaneous rectus sheath hematoma can present as an acute abdomen in the emergency department. The rupture of the upper and lower epigastric arteries and their branches is the main cause of hematoma formation. Hepatic dysfunction can affect the clotting process, increasing the risk of hematoma development. Computed tomography is the preferred diagnostic tool. Most hematomas can be managed conservatively, with only a few requiring minimal intervention or surgical management. We report an uncommon instance of spontaneous rectus sheath hematoma in a patient with chronic liver disease presenting with painful abdominal distention, mimicking a hernia and initially posing a diagnostic challenge. The rectus sheath hematoma was definitively diagnosed through clinical and radiological evaluation and subsequently evacuated with successful outcomes.

Ocular sequelae following snakebite envenomation

Abstract We report the case of a 33-year-old male patient who developed ophthalmoplegic symptoms following a viper snakebite. The patient presented with complaints of ptosis, blurred vision, and diplopia following a snakebite on his left lower limb. Clinical examinations revealed signs of envenomation, including local swelling and tenderness, alongside ocular manifestations such as limited extraocular movements and alternating exotropia. Blood investigations showed elevated white blood cell count and urinary abnormalities. The objective of this case report is to present the characteristic findings and management of this rare manifestation of a viper snakebite.

Etiology, Diagnosis, and Treatment Strategy of Dental Therapy-related Subcutaneous Emphysema

Subcutaneous emphysema (SE) is defined as localized tissue swelling caused by gas entering subcutaneous tissue through a tissue gap. Although SE is usually a nonfatal and self-limiting disease, in severe cases, the gas may spread to the neck, mediastinum, and chest, leading to mediastinal emphysema and other serious complications. This article aims to explore the etiology, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, and treatment strategy of SE related to dental therapy, to provide some reference for dentists.

Biophysical aspects of migrasome organelle formation and their diverse cellular functions.

The transient cellular organelles known as migrasomes, which form during cell migration along retraction fibers, have emerged as a crutial factor in various fundamental cellular processes and pathologies. These membrane vesicles originate from local membrane swellings, encapsulate specific cytoplasmic content, and are eventually released to the extracellular environment or taken up by recipient cells. Migrasome biogenesis entails a sequential membrane remodeling process involving a complex interplay between various molecular factors such as tetraspanin proteins, and mechanical properties like membrane tension and bending rigidity. In this review, we summarize recent studies exploring the mechanism of migrasome formation. We emphasize how physical forces, together with molecular factors, shape migrasome biogenesis, and detail the involvement of migrasomes in various cellular processes and pathologies. A comprehensive understanding of the exact mechanism underlying migrasome formation and the identification of key molecules involved hold promise for advancing their therapeutic and diagnostic applications.

Is Aggressive Surgery Always Necessary for Suspected Early-Onset Surgical Site Infection after Lumbar Surgery? A 10-Year Retrospective Analysis.

Surgical site infection (SSI) after spinal surgery is still a persistent worldwide health concern as it is a worrying and devastating complication. The number of samples in previous studies is limited and the role of conservative antibiotic therapy has not been established. This study aims to evaluate the clinical efficacy and feasibility of empirical antibiotic treatment for suspected early-onset deep spinal SSI. We conducted a retrospective study to identify all cases with suspected early-onset deep SSI after lumbar instrumented surgery between January 2009 and December 2018. We evaluated the potential risks for antibiotic treatment, examined the antibiotic treatment failure rate, and applied logistic regression analysis to assess the risk factors for empirical antibiotic treatment failure. Over the past 10 years, 45 patients matched the inclusion criteria. The success rate of antibiotic treatment was 62.2% (28/45). Of the 17 patients who failed antibiotic treatment, 16 were cured after a debridement intervention and the remaining one required removal of the internal fixation before recovery. On univariate analysis, risk factors for antibiotic treatment failure included age, increasing or persisting back pain, wound dehiscence, localized swelling, and time to SSI (cut-off: 10 days). Multivariate analysis revealed that infection occurring 10 days after primary surgery and wound dehiscence were independent risk factors for antibiotic treatment failure. Appropriate antibiotic treatment is an alternative strategy for suspected early-onset deep SSI after lumbar instrumented surgery. Antibiotic treatment for suspected SSI occurring within 10 days after primary surgery may improve the success rate of antibiotic intervention. Patients with wound dehiscence have a significantly higher likelihood of requiring surgical intervention.

Incision and drainage as mainstay therapy in antibioma: A case report

Antibioma is a chronic sterile, tough fibrous abscess formed commonly due to prolonged and inappropriate use of antibiotics for infections, without facilitating proper drainage of the pus. It is a localized swelling which is painless, smooth, non-tender and firm on palpation. It is only after the abscess has been incised, the body defence mechanism and antibiotic can eradicate the infection by releasing pressure, increasing blood circulation and oxygen to the anaerobic environment. Here, a rare case of antibioma in the neck of an 8 year old male child who had undergone extraction of an offending tooth to eradicate the infection. However, inadequate drainage of the abscess and lack of proper postoperative follow-up led to persistence of residual infection.

JOLT: A Noninvasive Solution for the Correction of the Jowl.

Sagging and loss of elasticity of the facial skin and tissues leads to jowling and an aged appearance. Jowling is a common reason for aesthetic surgical consultations. Prospective open-label study of the JOLT (jowl lifting) technique using hyaluronic acid (HA) fillers in healthy women 40-65 years of age with Fitzpatrick skin phototypes II-IV (n = 8). To be eligible, patients had jowling grade 2-3 on the jowl appearance scale as assessed by both the physician and patient. Treatment was administered at the baseline visit and consisted of an average of 6 mL of HA filler, 3 mL per side. Efficacy was assessed at baseline, week 4, and week 12. Assessment measures included the jawline rating scale (JRS) and a five-point global aesthetic improvement scale performed by two independent observers. Success was defined as an improvement of 1-2 grades on JRS. The mean JRS was improved from 2.75 at baseline to 1.53 at 90 days, which was considered a significant improvement. Mean global aesthetic improvement scale scores at 90 days were 1.44 ± 0.66 (range 1-3), indicating a "very much improved" appearance compared with baseline on both investigator and subject ratings. The procedure was well tolerated by all patients. Injection-related side effects (bruising and localized swelling) resolved spontaneously within 1 week of treatment. No other adverse events were reported. The JOLT technique effectively uses HA fillers to lift and tighten the lower face/neck and camouflage the remaining jowl, diminishing marionette lines, defining the mandibular border, and improving jowl sagging.

Application of retaining the vessels around the orbicularis oculi muscle in blepharoplasty.

To investigate the effect of retaining the vessels around the orbicularis oculi muscle on reducing local swelling after blepharoplasty. A total of 309 patients undergoing blepharoplasty (total incision) were observed and randomly assigned to three groups; (A) conventional operation; (B) preservation of deep vessels; (C) preservation of anterior vessels of orbicularis oculi muscle. The groups were compared based on intraoperative blood loss, operation time, swelling, satisfaction, and complications. Among the 309 patients, 39 were lost to follow-up. c Additionally, A had the shortest operation time, followed by C with slightly longer duration. On the 7th day, 15th day, and 1 month after surgery, both B and C demonstrated significantly lower levels of swelling compared to A. Moreover, patient satisfaction was higher in B and C than in A. Retaining either superficial or deep veins of the orbicularis oculi muscle can effectively reduce short-term postoperative swelling. However, when retaining the superficial central group of this muscle during surgery, it is crucial to strictly control the amount of surrounding tissue around vessels.

The effects of hyperbaric oxygen therapy on snake-bite-associated wounds in dogs.

To assess the effect of hyperbaric oxygen therapy (HBOT) on Crotalinae envenomation-induced wound swelling and severity and pain in dogs, and to describe the safety and complications of HBOT. Prospective, randomized, controlled, blinded study (2017-2021). University teaching hospital, private veterinary practice. Thirty-six client-owned dogs presenting within 24hours of a confirmed or suspected naturally occurring Crotalinae snake bite injury were enrolled between 2017 and 2021. In addition to the standard of care treatment, dogs received 2 interventions with either HBOT (n=19) or control (n=16) within 24hours of hospital admission. Dogs receiving HBOT were pressurized over 15 minutes (1psi/min), maintained at a target pressure of 2 atmosphere absolute (ATA) for 30 minutes, and decompressed over 15 minutes. Control dogs received 1 ATA for 1hour. Local wound swelling, wound severity score, and pain score were assessed at admission, before and after each intervention, and at hospital discharge. There was no significant difference in wound swelling (P=0.414), severity score (P=1.000), or pain score (P=0.689) between HBOT and control groups. Pain decreased significantly over time regardless of the study intervention (P<0.001). There were no major adverse effects associated with either study intervention. HBOT did not significantly alter the short-term recovery from Crotalinae envenomation in this study population. However, the study might be underpowered to detect a significant treatment effect.

Clinical Characteristics and Management of Children and Adolescents Hospitalized With Pyomyositis.

Pyomyositis, a bacterial muscle infection, is an important differential diagnosis in children and adolescents with musculoskeletal pain. In contrast to tropical regions, it is rarely recognized in temperate countries, but incidence is increasing and major studies are missing. This retrospective multicenter study included patients <18 years of age hospitalized with pyomyositis in 11 Swiss children's hospitals between January 2010 and December 2022. Cases were identified by ICD-10 code (Myositis; M60-M60.9), and data was extracted from electronic hospital records. Of 331 patients identified, 102 fulfilled the case definition. Patient age at presentation ranged from 2 weeks to 17 years (median 8 years). The majority had no underlying illness and all presented with fever and localized pain. At the respective site of pyomyositis, 100 (98%) had impaired movement and 39 (38%) presented with local swelling. Pelvic (57%) and leg (28%) muscles were mostly affected. Blood or tissue cultures were obtained in 94 (92%) and 59 (57%) patients, respectively. Of those, 55 (58%) blood and 52 (88%) tissue cultures were positive, mainly for Staphylococcus aureus (35 and 19, respectively) and Streptococcus pyogene s (12 and 15, respectively). All patients received antibiotic treatment during hospitalization for a median of 10 days (interquartile range: 7-17), followed by outpatient treatment for a further median of 16 days (interquartile range: 11-22) in 95 (93%) patients. Fifty-nine (57%) patients required surgery. Pyomyositis is a challenging diagnosis that requires a high level of awareness. Blood and/or tissue cultures revealed S. aureus and S. pyogenes as the predominant causative agents.