Orthopedic Manifestations of Abuse

Intimate partner violence and elder abuse are common in the United States but often remain undetected. The incidence of these forms of abuse is difficult to quantify, but those with a history of abuse are at risk of chronic health conditions. Physicians are in a unique position of triaging trauma patients and differentiating unintentional from abusive trauma in patients. Certain orthopedic injuries, in particular, may be related to abuse, which may trigger clinical suspicion and lead to further workup or intervention. By increasing awareness, through physician education and increased screening, earlier detection of abuse may prevent more serious injuries and consequences. Therefore, this review evaluates current literature regarding the orthopedic manifestations of abuse in hopes of increasing physician awareness.     

Lower limb deformity following proximal tibia physeal injury: long-term follow-up

Background  

Proximal tibial physeal injuries are quite rare, but their complications can be of great importance. The purpose of this study was to evaluate the effect of this injury on the axis and length of a child’s limb.     

Tpl2 ablation promotes intestinal inflammation and tumorigenesis in Apcmin mice by inhibiting IL-10 secretion and regulatory T-cell generation

To address the role of Tpl2, a MAP3K8 that regulates innate/adaptive immunity and inflammation, in intestinal tumorigenesis, we crossed a Tpl2 KO allele into the Apc(min/+) genetic background. Here, we show that Apc(min/+)/Tpl2(-/-) mice exhibit a fivefold increase in the number of intestinal adenomas. Bone marrow transplantation experiments revealed that the enhancement of polyposis was partially hematopoietic cell-driven. Consistent with this observation, Tpl2 ablation promoted intestinal inflammation. IL-10 levels and regulatory T-cell numbers were lower in the intestines of Tpl2(-/-) mice, independent of Apc and polyp status, suggesting that they were responsible for the initiation of the enhancement of tumorigenesis caused by the ablation of Tpl2. The low IL-10 levels correlated with defects in mTOR activation and Stat3 phosphorylation in Toll-like receptor-stimulated macrophages and with a defect in inducible regulatory T-cell generation and function. Both polyp numbers and inflammation increased progressively with time. The rate of increase of both, however, was more rapid in Apc(min/+)/Tpl2(-/-) mice, suggesting that the positive feedback initiated by inflammatory signals originating in developing polyps is more robust in these mice. This may be because these mice have a higher intestinal polyp burden as a result of the enhancement of tumor initiation.     

Pregnancy and homozygous beta thalassaemia major

Nine pregnant women with homozygous β-thalassaemia major followed a strict transfusion regimen to maintain their haemoglobin level > 10g/dl. One pregnancy was terminated because of concern about desferrioxamine teratogenicity and another ended in miscarriage at 11 weeks. All other women were delivered by elective caesarean section between 37 and 38 weeks. There were no obstetric complications or perinatal deaths.     

Familial unilateral deafness and delayed endolymphatic hydrops

Delayed endolymphatic hydrops (DEH) is a unique disorder characterized by fluctuating otologic symptoms in the setting of preexisting unilateral deafness. The symptoms include aural fullness, fluctuating hearing, and/or episodes of vertigo similar to those observed in Meniere disease and may occur ipsilateral or contralateral to the previously deafened ear. In most reported cases, the unilateral deafness has been a profound sensorineural hearing loss with a sudden onset that has been variously attributed to bacterial or viral labyrinthitis, acoustic or cranial trauma, otosclerosis, and congenital CMV infection. Familial occurrence of the syndrome has not previously been reported in the literature. In this report, we describe two possible familial instances of delayed DEH. These patients raise the possibility that genetic factors may sometimes be the cause of this unusual syndrome.     

Use of Glasgow Benefit Inventory (GBI) in Meniere's disease managed with intratympanic dexamethasone perfusion: Quality of life assessment

Objective

To evaluate patients’ quality of life following intratympanic dexamethasone perfusion in management of Meniere's disease (MD).

Methods

This is a retrospective study in a tertiary referral center that uses the Glasgow Benefit Inventory (GBI). Intratympanic perfusion of 24 mg/ml of dexamethasone was administered after failure to respond to previous management with diuretics and low-salt diet. GBI questionnaires were collected and analyzed in a 12 months follow-up of participating patients.

Results

Thirty patients (20 women and 10 men, aged 28-85 years) with MD underwent intratympanic dexamethasone perfusion and were assessed with the assistance of GBI questionnaire. Follow-up ranged from 12 to 48 months (mean 30 months). Audiometric results were also available in all of them. In the short term (4 weeks post-perfusion) 6 patients demonstrated a greater than 10 dB improvement in PTA, and 6 patients had an increase in SDS of at least 15%, while in the long-term (12 months post-perfusion) the number of patients in the respective groups decreased to 5 and 2. With regards to the GBI responses, 9 patients (50%) expressed an overall benefit, while 6 (33%) expressed no benefit and 3 patients (17%) complained of negative effect after the intervention.

Conclusion

The mean GBI score indicates substantial improvement in patients’ overall quality of life following intratympanic dexamethasone perfusion, which was also confirmed by the audiometric results.     

Comorbid major depression in obsessive-compulsive disorder patients

Although major depressive disorder (MDD) has been consistently considered the most frequent complication of obsessive-compulsive disorder (OCD), little is known about the clinical characteristics of patients with both disorders. This study assessed 815 Brazilian OCD patients using a comprehensive psychiatric evaluation. Clinical and demographic variables, including OCD symptom dimensions, were compared among OCD patients with and without MDD. Our findings showed that prevalence rates of current MDD (32%) and lifetime MDD (67.5%) were similar for both sexes in this study. In addition, patients with comorbid MDD had higher severity scores of OCD symptoms. There was no preferential association of MDD with any particular OCD symptom dimension. This study supports the notion that depressed OCD patients present more severe general psychopathology.     

Homocysteine and metalloprotease-3 and -9 in patients with ascending aorta aneurysms

Introduction

Matrix metalloprotease (MMP) activity is increased in ascending and abdominal aortic aneurysms. Elevated plasma homocysteine (Hc) levels have been reported in patients with abdominal aneurysms. However, there are no published reports correlating, Hc and MMP levels in patients with ascending aortic aneurysms (AAAs).

Materials and Methods

This study attempts to determine whether serum or tissue Hc in patients undergoing surgery for AAAs is associated with aneurysm diameter, circulating and tissue levels of MMP-3 and MMP-9 assessed by Enzyme-linked immunosorbent assay (ELISA) and their mRNA tissue expression assessed by real-time PCR. Twenty-seven patients were recruited in the study.

Results

Forty-three percent of the patients had abnormal Hc serum levels (> 35.9 μmol/L). Circulating MMP-3 (6.44 ± 4.20 ng/mL) and MMP-9 levels (134 ± 11.4 ng/mL) were elevated compared to healthy controls (p < 0.001). Positive correlations were observed between circulating MMP-9, tissue MMP-3 and MMP-9 concentrations with serum Hc (r = 0.773, p = 0.011; r = 0.461, p = 0.014; r = 0.526, p = 0.024, respectively). MMP-9 mRNA was expressed in 21% of the aneurysms. No MMP-3 mRNA expression was detected in the studied specimens. A negative correlation between tissue Hc and aneurysm diameter was detected. No associations of serum Hc, MMP-3 and MMP-9 levels in both serum and tissue with aneurysm diameter were noted.

Conclusion

Our results suggest that Hc, even in patients with mild hyperhomocysteinaemia, is involved in the pathophysiology of AAA, through the regulation of MMP-3 and MMP-9 activity.