Cytomegalovirus urinary excretion and long term outcome in children with congenital cytomegalovirus infection. Congenital CMV Longitudinal Study Group

BACKGROUND: Cytomegalovirus (CMV) is the most frequent cause of congenital infection, and both symptomatic and asymptomatic infants may have long term sequelae. Children with congenital CMV infection are chronically infected and excrete CMV in the urine for prolonged periods. However, the effect of prolonged viral replication on the long term outcome of these children is unknown. OBJECTIVE: To determine whether duration of CMV excretion is associated with outcome at 6 years of life in symptomatic and asymptomatic congenitally infected children. METHODS: Longitudinal cohort study. Children congenitally infected with CMV were identified at birth and followed prospectively in a study of long term effects of congenital CMV infection. The relationship between duration of CMV urinary excretion and growth, neurodevelopment and presence and progression of sensorineural hearing loss (SNHL) at 6 years of age was determined. RESULTS: There was no significant difference in the duration of viral urinary excretion between children born with asymptomatic (median, 4.55 years) and symptomatic (median, 2.97 years) congenital CMV infection (P = 0.11). Furthermore there was no association between long term growth or cognitive outcome and duration of viral excretion. However, a significantly greater proportion of children who excreted CMV for <4 years had SNHL and progressive SNHL compared with children with CMV excretion >4 years (P = 0.019, P = 0.009, respectively). CONCLUSIONS: Children congenitally infected with CMV are chronically infected for years, but the duration of CMV urinary excretion is not associated with abnormalities of growth, or neurodevelopmental deficits. However, SNHL and progressive SNHL were associated with a shorter duration of CMV excretion.     

Treatment of adhesive capsulitis with intra-articular hyaluronate: A systematic review

Sodium hyaluronate injection into the glenohumeral joint is a treatment option in the management of adhesive capsulitis of the shoulder. We hypothesized that a systematic review would demonstrate that intra-articular sodium hyaluronate injections would result in significant improvements in passive range-of-motion, shoulder and general clinical outcome measures, and pain scales at short- and mid-term follow-up. Multiple medical databases were searched for levels I-IV evidence with a priori defined specific inclusion and exclusion study criteria. Clinical outcome measures used included Constant score, VAS pain scores, Cho functional scores, JOA scores, and range-of-motion measurements. Seven studies were included (four Level I and three Level IV; 292 subjects, 297 shoulders). Mean subject age was 59.1 years and mean pre-treatment duration of symptoms was 7.3 months. 140 subjects underwent one or multiple hyaluronate injections (120 glenohumeral joint; 20 subacromial bursa). Clinical follow-up was mean 9.0 weeks. Sodium hyaluronate injection into the glenohumeral joint has significantly improved shoulder range-of-motion, constant scores, and pain at short-term follow-up following treatment of adhesive capsulitis. Isolated intra-articular hyaluronate injection has significantly better constant scores than control. Isolated intra-articular hyaluronate injection has equivalent clinical outcomes and range-of-motion compared to intra-articular corticosteroid injection. Intra-articular hyaluronate injection was safe, with no reported complications within the studies in this review. Sodium hyaluronate injection into the glenohumeral joint is a safe, effective treatment in the management of adhesive capsulitis of the shoulder. Short-term evidence indicates that clinical outcomes are better than control and equivalent to intra-articular corticosteroid injection.