Onset Of Osteomyelitis Research Articles

Association of Sodium-Glucose Cotransporter 2 Inhibitors with Osteomyelitis and Other Lower Limb Safety Outcomes in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

Our aim was to evaluate osteomyelitis and other major lower limb safety outcomes (i.e., peripheral artery disease or PAD, ulcers, atraumatic fractures, amputations, symmetric polyneuropathy, and infections) in patients affected by type 2 diabetes mellitus (T2DM) and treated with sodium-glucose cotransporter 2 inhibitors (SGLT2-is). We thus performed a systematic review and meta-analysis of randomised controlled trials (RCTs) comparing SGLT2-is at approved doses for T2DM with a placebo or standard of care. MEDLINE, Embase, and Cochrane CENTRAL were searched through August 2022. Separate intention-to-treat analyses were implemented for each molecule to calculate Mantel-Haenszel risk ratios (RRMH) with 95% confidence intervals (CIs) through a random-effects model. We processed data from 42 RCTs for a total of 29,491 and 23,052 patients, respectively assigned to SGLT2-i and comparator groups. SGLT2-is showed a pooled neutral effect on osteomyelitis, PAD, fractures, and symmetric polyneuropathy, whereas slightly deleterious sway on ulcers (RRMH 1.39 [1.01-1.91]), amputations (RRMH 1.27 [1.04-1.55]), and infections (RRMH 1.20 [1.02-1.40]). In conclusion, SGLT2-is appear to not significantly interfere with the onset of osteomyelitis, PAD, lower limb fractures, or symmetric polyneuropathy, even though the number of these events proved consistently higher in the investigational groups; otherwise, local ulcers, amputations, and overall infections may be favoured by their employment. This study is registered with the Open Science Framework (OSF).

POST-MANDIBULAR FRACTURE OSTEOMYELITIS:

Osteomyelitis represents an inflammatory entity of the bone tissue with spinal cord involvement. Its etiology is multifactorial, presenting difficult diagnosis and complex treatment, being the prognosis, in most cases, unpredictable. Therefore, it is an inflammation of the medullary spaces caused by the decrease of the blood supply, leading to an ischemia and subsequent necrosis of the bone tissue. Although odontogenic infections are the most commonly involved in the onset of osteomyelitis, other situations also play a relevant role, such as: periodontal diseases, exodontia, and facial trauma. Treatment included combination of antibiotic therapy and surgical procedures. Although correct antibiotic therapy plays an important role in the success of the treatment, the surgical procedure is essential for the removal of the cause and possible bone sequestration formed by the infectious process. The objective of this work is to perform a review of the literature on Osteomyelitis and present two cases of Chronic Suppurative Osteomyelitis that emerged as a complication of mandible fracture. We observed that OSC caused after fracture of face presents clinical characteristics similar to those from odontogenic infection and that the treatment of choice is similar.

PREMORBIDITY IN ACUTE INFLAMMATION OF THE MAXILLOFACIAL AREA IN CHILDREN

Current state-of-the-art technologies facilitate studying the role of internal and external factors at a higher organ-specific level, and the broad and systematic provision of treatment and prevention care for child population of all age groups differs favorably from the routine visit to a doctor, if necessary. Apparently, the above methodological approach enables establishing different responses of the body to damaging factors in each case.
 Methods and Material. 537 case histories of children with acute purulent odontogenic and neodontogenic inflammation of the maxillofacial area have been thoroughly studied. Only medical histories of in-patients have been selected.
 Results and Discussion. The analysis of premorbid state of 240 patients with acute purulent lymphadenitis has shown that the onset of the diseases was triggered by the experienced ARVI in 89 patients (37%) and in 37 cases (15%) inflammation of the lymph nodes coincided with manifestations of acute pathology of the ENT organs; in 34 (14%) cases it was combined with acute inflammation of the bronchopulmonary system, in 23 (10%) cases with disorder of the gastrointestinal tract (GIT), in 13 (6%) cases it was provoked by acute periodontitis and exacerbation of chronic periodontitis in temporary and permanent molars of the mandible.
 Concomitant chronic somatic diseases were detected in 122 patients (51%). They most often occurred in toddlers, preschoolers and school-aged children and related, in most cases, to the respiratory tract and ENT organs.
 Precursors of adenophlegmon in 150 patients were ARVI (45 children (30%)); acute inflammation and exacerbation of chronic ENT processes (21 children (14%)); pathological changes in the bronchopulmonary system (19 children (13%)); gastrointestinal disorders (15 children (10%)); acute periodontitis and exacerbation of chronic periodontitis in temporary molars (20 children (13%)), permanent molars (6 (4%)); acute inflammation of the oral mucosa (5 children (3%)); pyoderma (4 children (3%)). In 15 children (10%) the provoking factor for the development of adenophlegmon failed to be established.
 Concomitant chronic somatic pathology was diagnosed in 100 children out of 150 (66.7%), and combination of two chronic diseases was found in 6 children (6%). Most often, the chronic course of somatic pathology was established in preschoolers, less frequently in toddlers and school-aged children, and infrequently during breastfeeding.
 In acute odontogenic osteomyelitis, the source of infection was temporary molars in all toddlers and preschoolers, as well as in 12 school-aged children (18%). In total, the onset of osteomyelitis was triggered by temporary teeth in 67 cases (46%). Notably, 35 cases (52%) were related to the first molar and 32 (48%) cases to the second molar. Complicated dental caries in permanent second premolars caused osteomyelitis in 2 (14%) adult children only. Permanent molars caused the development of purulent process in 78 cases (53%).
 The analysis of the premorbid state has revealed that the onset of osteomyelitis was preceded by: ARVI (42 children (29%)); general hypothermia (37 (25%)), inflammation of the ENT organs (21 children (14%)) and bronchopulmonary system (15 (10 %)); exacerbation of chronic gastrointestinal diseases (8 children (5%)) and in 24 children (16%) a provoking factor failed to be established.
 Concomitant chronic diseases of organs and systems were found in 90 children (61.2%) out of 147 with acute odontogenic osteomyelitis of the mandible. The combination of their two nosological forms was noted in 3 children (3%).
 In conclusion, the establishment of certain adverse factors, or the presence of somatic diseases in children necessitates the formation of a risk group, especially when it comes to the existence of odontogenic foci of inflammation. Timely establishment of factors that can be influenced enables control over them through preventive measures, including routine dental check-ups.

Clinical and panoramic radiographic features of osteomyelitis of the jaw: A comparison between antiresorptive medication-related and medication-unrelated conditions.

PurposeThis study was performed to analyze the clinical and imaging features of contemporary osteomyelitis (OM) and to investigate differences in these features on panoramic radiography according to patients' history of use of medication affecting bone metabolism.Materials and MethodsThe records of 364 patients (241 female and 123 male, average age 66.8±14.9 years) with OM were retrospectively reviewed. Panoramic imaging features were analyzed and compared between patients with medication-related OM (m-OM) and those with conventional, medication-unrelated OM (c-OM).ResultsThe age of onset of OM tended to be high, with the largest number of patients experiencing onset in their 70s. The 2 most frequent presumed causes were antiresorptive medication use (44.2%) and odontogenic origin (34.6%). On panoramic radiographs, a mix of osteolysis and sclerosis was the most common lesion pattern observed (68.6%). Sequestrum, extraction socket, and periosteal new bone formation were found in 143 (42.1%), 79 (23.2%), and 24 (7.1%) cases, respectively. The m-OM group exhibited sequestrum and extraction socket more frequently and displayed significantly higher mandibular cortical index values than the c-OM group.ConclusionWe observed some differences in imaging features as shown on panoramic radiography according to the history of antiresorptive medication use. This study may help elucidate the predictive imaging features of medication-related osteonecrosis of the jaw.

An Update on Osteomyelitis Treatment in a Pycnodysostosis Patient

The aims of the present study were to discuss the demographic distribution and clinical characteristics of patients with pycnodysostosis (PYCD) and the onset of osteomyelitis and its treatment using a literature review. The authors also report on an update of treatment of mandibular osteomyelitis in a patient with PYCD using a buccal fat pad (BFP) as a free graft. The study was carried out in 2 steps. In the first step, an electronic search was undertaken in PubMed in March 2018, with 17 articles being included. In the second step, the authors present a case of mandibular osteomyelitis in a 30-year-old woman with PYCD treated by sequestrectomy and a BFP as a free graft (follow-up, 24months). Twenty-one cases of osteomyelitis of the jaws in patients with PYCD were included. Dental extraction, mandibular fracture, and 1 case of facial trauma represented the causes of mandibular osteomyelitis. Treatments included resection associated with antibiotics and sequestrectomy alone or associated with antibiotics. Despite the good results of the present case, further studies using the BFP as an adjuvant for jaw osteomyelitis are necessary to elucidate its clinical efficiency and safety.

Diagnosis and treatment of pediatric chronic osteomyelitis in developing countries: prospective study of 96 patients treated in Kenya

The authors carried out a prospective study on 96 patients they treated in Kenya for chronic osteomyelitis from 2000 to 2009. All the patients received orthopedic surgery and antibiotic therapy, when possible based on the antibiotic sensitivity test. Among the 90 patients with at least 12months' follow-up, 11 had osteomyelitis relapse (12.2%) and recovery rate was therefore 87.8% with no resulting disability. Risk factors for osteomyelitis relapse were investigated and previous treatment with beta-lactamines, predisposing to onset of methycillin-resistant Staphylococcus aureus (MRSA) infections (P=0.03, OR=5.74), and onset of osteomyelitis in the metaepiphyseal region (P<0.0001) resulted statistically significant. Aim of the study was to evaluate the validity of our treatment of chronic osteomyelitis in Kenya on the basis of outcome.

Rapid manifestation of cervical vertebral osteomyelitis

Within 10 days after cystoscopy causing urosepsis this patient developed persistant neckpain as initial symptom of vertebral osteomyelitis. E. coli was isolated from urine, blood cultures and later from bone biopsy. Antibiotic treatment did not stop the progress of the disease. A transverse spinal cord syndrome occurred due to a pathological fracture of C5 and C6 and operative decompression was necessary. The rapid onset of osteomyelitis was impressive. For effective treatment of bacterial osteomyelitis a bone biopsy is sometimes unavoidable and indicated.

Neonatal Hematogenous Osteomyelitis

The findings in 40 infants with neonatal osteomyelitis were examined to evaluate factors that may predict the development of sequelae. On follow-up at 1-11 years of age, 16 children were found to have moderate (six) and severe (10) sequelae. Thirteen of these 16 children were among the 21 infants who had perinatal risk factors. On the other hand, there were only three handicapped infants in the group of 19 who had no risk factors. The high-risk infants were, on the average, younger at onset of osteomyelitis than the previously healthy babies. No differences were found between those two groups that could be ascribed to the causative organisms. Fifty-five osteomyelitic sites involving the large joints were diagnosed. Growth disturbance was evident in 20 of 36 nonoperated foci and four of 19 operated foci. To achieve the best result, the joint and abscess should be drained, and this should be supplemented by drainage of the metaphysis.

The role of trauma in the occurrence of hematogenous osteomyelitis in children

There is still no full agreement on the question of the role of trauma in the occurrence of endogenous bone infections. While some authors consider trauma to be a significant factor in the onset of osteomyelitis, others do not attach particular importance to it.