Multiple level spondylodiscitis with presacral abscess in spinal brucellosis: a rare presentation
A 56-year-old male farmer in India presented with lower back pain and weakness in his legs for 9 weeks. MRI revealed multi-level infective spondylodiscitis and a prevertebral sacral abscess. Blood culture grew Brucella melitensis after 8 days. Treatment was modified to a 12-month triple antibiotic therapy. Spinal brucellosis should be considered for those with back pain in endemic areas, as timely diagnosis and appropriate treatment is important.
Evidence Based Practice in Medical Imaging- Ankylosing SpondylitisNoor Farahuda
This presentation is about evidence-based practice in medical imaging for a particular disease, which is the Ankylosing Spondylitis. It is actually focusing on the imaging modalities that have been used for diagnose the disease and the appearances of the disease on the image of the modalities.
Hydatid cyst, caused by echinococcus granulosa, can produce tissue cyst everywhere in body. Skeletal cystic lesion is rare specially in long bones like femur and because of its unusual presentation, its diagnosis may easily be missed, unless be kept in mind. Hydatid disease is a parasitic infestation of the humans that can practically affect any part of the body. It commonly affects liver, lung and muscles. Bone hydatid is less common occurring in only 0.5–2% of cases and humans act as an intermediate host. In the patient evaluated by us, the plain x-ray showed multiple osteolytic lesions along the lower one third of the femur and the upper end of tibia.
Multiple Giant Cell Tumours of Tendon Sheath of Thumb: A Rare Case Reportiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Evidence Based Practice in Medical Imaging- Ankylosing SpondylitisNoor Farahuda
This presentation is about evidence-based practice in medical imaging for a particular disease, which is the Ankylosing Spondylitis. It is actually focusing on the imaging modalities that have been used for diagnose the disease and the appearances of the disease on the image of the modalities.
Hydatid cyst, caused by echinococcus granulosa, can produce tissue cyst everywhere in body. Skeletal cystic lesion is rare specially in long bones like femur and because of its unusual presentation, its diagnosis may easily be missed, unless be kept in mind. Hydatid disease is a parasitic infestation of the humans that can practically affect any part of the body. It commonly affects liver, lung and muscles. Bone hydatid is less common occurring in only 0.5–2% of cases and humans act as an intermediate host. In the patient evaluated by us, the plain x-ray showed multiple osteolytic lesions along the lower one third of the femur and the upper end of tibia.
Multiple Giant Cell Tumours of Tendon Sheath of Thumb: A Rare Case Reportiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Multiple atraumatic osteoporotic vertebral fractures: Unusual cause of pain i...Apollo Hospitals
Secondary osteoporosis may not be detected early, and thus the condition remains clinically silent until the patient presents with multiple atraumatic compression fractures. It is devastating for a young patient to develop multiple vertebral fractures in view of the associated morbidity and mortality. To decrease the risk of additional fractures and preserve the quality of life in these patients, interventions should be initiated early. Hence, it is important to consider multiple osteoporotic vertebral fractures as a complication in any patient on prolonged steroid therapy.
Lecture ipsilateral noninstrumented psf with ULBDSpiro Antoniades
Treatment of spinal stenosis in the elderly with a minimally invasive approach of ipsilateral ULBD unilateral laminectomy bilateral decompression with BMP bone morphogenic protein in the posterior lateral space.
Traditionally, obtaining tissue diagnosis from the Temporomandibular Joint (TMJ) has required invasive open techniques. In this case-series, the authors demonstrate a minimally invasive technique using arthroscopy to diagnose and treat Pigmented Villonodular Synovitis (PVNS) and pseudogout of the TMJ, followed by a review of the literature.
Osteoid osteoma is among the commonest bone tumors, primarily affecting young subjects. Often localized in the diaphysis cortex of long bones, the disease has a well-described symptomatology and imagery of choice for diagnosis. When in a different location, the diagnosis is less evident. We describe a case herein of an intra-articular osteoid osteoma of the hip misdiagnosed as a femoro-acetabular impingement and treated by means of hip arthroscopy.
Multiple atraumatic osteoporotic vertebral fractures: Unusual cause of pain i...Apollo Hospitals
Secondary osteoporosis may not be detected early, and thus the condition remains clinically silent until the patient presents with multiple atraumatic compression fractures. It is devastating for a young patient to develop multiple vertebral fractures in view of the associated morbidity and mortality. To decrease the risk of additional fractures and preserve the quality of life in these patients, interventions should be initiated early. Hence, it is important to consider multiple osteoporotic vertebral fractures as a complication in any patient on prolonged steroid therapy.
Lecture ipsilateral noninstrumented psf with ULBDSpiro Antoniades
Treatment of spinal stenosis in the elderly with a minimally invasive approach of ipsilateral ULBD unilateral laminectomy bilateral decompression with BMP bone morphogenic protein in the posterior lateral space.
Traditionally, obtaining tissue diagnosis from the Temporomandibular Joint (TMJ) has required invasive open techniques. In this case-series, the authors demonstrate a minimally invasive technique using arthroscopy to diagnose and treat Pigmented Villonodular Synovitis (PVNS) and pseudogout of the TMJ, followed by a review of the literature.
Osteoid osteoma is among the commonest bone tumors, primarily affecting young subjects. Often localized in the diaphysis cortex of long bones, the disease has a well-described symptomatology and imagery of choice for diagnosis. When in a different location, the diagnosis is less evident. We describe a case herein of an intra-articular osteoid osteoma of the hip misdiagnosed as a femoro-acetabular impingement and treated by means of hip arthroscopy.
A Large Intra-Articular Ossicle in the Knee Joint-A Rare Occurrence_Crimson P...CrimsonPublishersAICS
A Large Intra-Articular Ossicle in the Knee Joint-A Rare Occurrence by Lokesh Rana, Dinesh Sood, Raman Chauhan, Roshni Shukla, Pooja Gurnal SR and Himanshu Nautiyal in Advancements in Case Studies
Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome is a genetic disorder caused by
mutation in the Proteoglyacn PRG4 gene on chromosome 1. The syndrome is characterized by congenital or early onset camptodactyly and childhood-onset of non-inflammatory arthropathy, coxa vara deformity,or other dysplasia associated with progressive hip disease and non-inflammatory pericardial effusion. It has an autosomal recessive mode of inheritance and the causative gene is located on chromosome band 1q25-31.
— Superior orbital fissure syndrome (SOFS) is a rare disease. So when a case of this came at Aravind Eye Institute, a detailed case report was prepared to publish. A 56 years old male patient, a known case of prostatic malignancy with skeletal metastasis presented with ptosis, exotropia, diminished pupillary reflex and limitations in extraocular movements of left eye. MRI brain revealed diffuse skull base and leptomeningeal metastasis. Whole body CT scan showed metastasis in ribs, scapula and in pelvic bones. He was diagnosed to have superior orbital fissure syndrome due to metastatic prostatic malignancy and was offered steroids and radiotherapy.
Giant osteoid osteoma of tibial shaft: A rare case reportApollo Hospitals
Giant osteoid osteoma of the tibial shaft is a rare entity.
Though this tumor is seen commonly in axial skeleton, so far
no conclusive report has been published on its periosteal
involvement of tibial shaft diaphysis.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. 170 International Journal of Medicine
Fig. 1:MRI Lumbosacral Spine Showing Spondylodiscitis, Paravertebral Contrast Enhancement and Presacral Abscess on Different Sections.
Legend to figure 1: A, MRI Lumbosacral spine showing con-
trast uptake at T12-L1 level (white arrow- right side) and at
L5-S1 level with presacral collection (white arrow- left side);
B, presacral collection on T2 imaging (black arrow); C, presa-
cral collection on T1 imaging (white arrow); D, post-contrast
imaging transverse section at L1 level showing spondylodisci-
tis (white arrow); E, Coronal section on post contrast imaging
showing paravertebral enhancement and Schmorl's nodes
(Vertical arrow).
CSF analysis was deferred due to multiple level involvement in
lumbar region. Standard tube agglutination showed insignificant
titre of antibodies to Brucella. Tests for tuberculosis yielded nega-
tive results. Empirical intravenous coverage, including ceftriax-
one, metronidazole and gentamicin with oral doxycycline was
started. Anti-tuberculous drugs were added considering endemici-
ty of tuberculosis in India. Since pyogenic abscess was consid-
ered, steroids were not initiated. After eight days, blood culture
grew Brucella melitensis. Now, treatment was revised to a twelve
month triple therapy with rifampicin, doxycycline and double
strength cotrimoxazole.
3. Discussion
Early in the course of spinal brucellosis, osteoporosis of affected
vertebral body and erosion of the anterior-superior endplate occurs
followed by narrowing of joint space. Focal anterior or diffuse
disc collapse is seen. Posterior elements are rarely involved. Dis-
tinctive MR features include moderately abnormal paraspinal soft
tissue without abscess formation, intact vertebral architecture de-
spite diffuse vertebral osteomyelitis and lack of gibbus deformity
(Kim & Cho 2008).Table 1 shows differentiating MRI features
between brucellosis and tuberculosis (Beeching& Corbel 2015).
Table 1: Difference between Radiological Features of Spinal Brucellosis
and Spinal Tuberculosis
Brucellosis Tuberculosis
Site Lumbar and others Dorsolumbar
Vertebrae
Multiple or contigu-
ous
Contiguous
Discitis Late Early
Body Intact till late Morphology lost early
Canalcompression Rare Common
Epiphysitis Anterosuperior
General: upper and lower
disc region, cen-
tral,subperiosteal
Osteophyte Anterolateral Uncommon
Deformity
Wedging uncom-
mon
Anterior wedging with gib-
bus
Recovery
Sclerosis of whole
vertebral body
Variable
Paravertebral
abscess
Small, well local-
ized
Common and discrete
Psoas abscess Rare More likely
Slow growing bacteria and intermittent bacteremia decrease the
yield of blood culture. Notwithstanding, growth of Brucella organ-
isms in culture of blood, bone marrow or involved tissue is diag-
nostic (Kim & Cho 2008). Differential diagnosis includes tubercu-
3. International Journal of Medicine 171
lous spondylitis, salmonella spondylitis, other pyogenic spondyli-
tis, disc herniation, and vertebral metastases (Nas et al. 2001).
WHO recommends first line combination therapy for spinal
brucellosis with tetracycline/doxycycline for 6 weeks with an
aminoglycoside (preferably streptomycin for 7-10 days). Combi-
nation of rifampin and doxycycline for 8 weeks is an alternative
therapy. Fluoroquinolones have good penetration and achieve
good tissue concentrations, which may lead to better outcomes.
Fluoroquinolone and rifampicin combination is as effective as
doxycycline and rifampin. However, specific guidelines regarding
antibiotic regimens and duration of treatment for neuro brucellosis
are still lacking. Surgical intervention is indicated in spinal insta-
bility, cord compression, radiculopathy, cauda equine syndrome,
and severe weakness of the muscles due to extradural inflammato-
ry mass. Epidural and paravertebral abscesses may be given a trial
of antibiotics. In case of no response or neurological deterioration
percutaneous drainage of epidural abscess can be performed (Alp
&Doganay 2008).
Our case was unique due to multilevel spondylodiscitis,
prevertebral sacral abscess and isolation of Brucella from blood
culture. Involvement of posterior vertebral elements, as seen in
this case, is uncommon. To conclude, MRI finding of spondy-
lodiscitis in endemic areas should prompt a differential diagnosis
and evaluation for brucellosis. This is vital considering the poten-
tial treatability of the condition.
References
[1] Alp E, Doganay M. Current therapeutic strategy in spinal brucello-
sis. Int Jr of Infectious Dis. 2008 Nov 30; 12(6):573-7.
https://doi.org/10.1016/j.ijid.2008.03.014.
[2] Tur BS, Suldur N, Ataman S, Ozturk EA, Bingol A, Atay MB. Bru-
cellar spondylitis: a rare cause of spinal cord compression. Spinal
Cord.2004 May 1;42(5):321-
4.https://doi.org/10.1038/sj.sc.3101571.
[3] Kim DH, Cho YD. A case of spondylodiscitis with spinal epidural
abscess due to Brucella. Journal of Korean Neurosurgical Society.
2008 Jan 1; 43(1):37-40. https://doi.org/10.3340/jkns.2008.43.1.37.
[4] Beeching NJ, Corbel MJ. Brucellosis. In: Loscalzo J, Kasper D,
Hauser S, Fauci A, Jameson J, Longo D, eds. Harrison's Principles
of Internal Medicine 19th Edition. New York: McGraw Hill; 2015.
p. 1066-1069
[5] Nas K, Gür A, Kemaloglu MS, Geyik MF, Cevik R, Büke Y, Ceviz
A, Sarac AJ, Aksu Y. Management of spinal brucellosis and out-
come of rehabilitation. Spinal Cord. 2001 Apr 1; 39(4):223-
7.https://doi.org/10.1038/sj.sc.3101145.