Lupus syndrome with neutropenia following minocycline therapy - a case report

An 18-year-old patient is described who presented with febrile neutropenia and hepatitis caused by minocycline therapy. This rare complication of minocycline-induced lupus syndrome is discussed here.     

Lupus nephritis: an update

Lupus nephritis (LN) is an inflammatory condition of the kidneys that encompasses various patterns of renal disease including glomerular and tubulointerstitial pathology. It is a major predictor of poor prognosis in patients with systemic lupus erythematosus (SLE). Genetic factors, including several predisposing loci, and environmental factors, such as EBV and ultraviolet light, have been implicated in the pathogenesis. It carries a high morbidity and mortality if left untreated. Renal biopsy findings are utilized to guide treatment. Optimizing risk factors such as proteinuria and hypertension with renin-angiotensin receptor blockade is crucial. Immunosuppressive therapy is recommended for patients with focal or diffuse proliferative lupus nephritis (Class III or IV) disease, and certain patients with membranous LN (Class V) disease. Over the past decade, immunosuppressive therapies have significantly improved long-term outcomes, but the optimal therapy for LN remains to be elucidated. Cyclophosphamide-based regimens, given concomitantly with corticosteroids, have improved survival significantly. Even though many patients achieve remission, the risk of relapse remains considerably high. Other treatments include hydroxychloroquine, mycofenolate mofetil, and biologic therapies such as Belimumab, Rituximab, and Abatacept. In this paper, we provide a review of LN, including pathogenesis, classification, and clinical manifestations. We will focus, though, on discussion of the established as well as emerging therapies for patients with proliferative and membranous lupus nephritis.     

Venous thromboembolism in patients with heart failure: in-hospital and chronic use of anti-coagulants for prevention

Heart failure (HF) is a common clinical syndrome characterized by high morbidity and frequent hospitalizations. HF is an independent and major risk factor for venous thromboembolism (VTE) and VTE occurring in patients with HF carries a worse prognosis. The present review will focus on short and long term role of anti-coagulants in prevention of venous thrombosis in HF patients. We will also be discussing the recently investigated and patented anti-coagulants which could have a role in this specific population.     

The association between clubfoot and developmental dysplasia of the hip

The association between idiopathic congenital talipes equinovarus (CTEV) and developmental dysplasia of the hip is uncertain. We present an observational cohort study spanning 6.5 years of selective ultrasound screening of hips in clubfoot. From 119 babies with CTEV there were nine cases of hip dysplasia, in seven individuals. This suggests that 1 in 17 babies with CTEV will have underlying hip dysplasia. This study supports selective ultrasound screening of hips in infants with CTEV.     

Experience of an isolated use of low-intensity pulsed ultrasound therapy on fracture healing in established non-unions: a prospective case series

Fracture non-unions are responsible for approximately 5% of cases, with low expectation of spontaneous healing thereafter. The fractures that heal without complications can take months to heal completely. An ultrasound, typically at low intensities (0.5–50 mW/cm²), serves a diagnostic purpose, whereas at higher intensities (0.2–100 W/cm²), its role becomes more therapeutic by generating heat energy. Low-intensity pulsed ultrasound (LIPUS) is frequently used to stimulate or to accelerate fracture healing. We present a prospective review of fracture non-unions treated with low-intensity pulsed ultrasound (LIPUS). We enrolled 66 patients during August 2016 and December 2018, 38 males and 28 females; age range 19–85 years (average 49.2 years). All these patients were followed up to minimum 6 months. The average time of referral post-treatment for fractures was 8.2 months (range 6–18 months). Four patients were excluded due to various reasons. 39 out of 62 fractures showed successful healing with symptom improvement and callus formation with 67% success rate. In this case series, we noted LIPUS therapy failure in the post-ORIF scaphoid fracture and post-ankle joint fusion non-union. We did not observe any influence of a medical condition such as diabetes mellitus, osteoporosis or personal habits like smoking. The LIPUS therapy appears to have influence on bone healing, depending on the onset of therapy, fracture type and the approach to fracture care. In this case series, the compliant group showed 67% successful outcome.