Expert Review of Molecular Diagnostics, Jun 21, 2021
INTRODUCTION Prosthetic Joint Infections can be challenging to eradicate and are associated with ... more INTRODUCTION Prosthetic Joint Infections can be challenging to eradicate and are associated with high morbidity and mortality. Current microbiology culture methods can be associated with a high false-negative rate of up to 50%. Early and accurate diagnosis is crucial for effective treatment, and negative results have been associated with a greater rate of reoperation. AREAS COVERED There has been increasing investigation of the use of next- generation sequencing technology such as the use of metagenomic shotgun sequencing to help identify causative organisms and decrease the uncertainty around culture-negative infections. The clinical importance of the organisms detected and their management, however, requires further study. The polymerase chain reaction has shown promise, but in recent years multiple studies have reported similar or lower sensitivity for bacteria detection in PJI when compared to traditional culture. Furthermore, issues such as high cost and complexity of sample preparation and data analysis are to be addressed before it can move further towards routine clinical practice. . EXPERT OPINION Metagenomic NGS has shown results that inspire cautious optimism - both in culture-positive and culture-negative cases of joint infection. Refinement of technique could revolutionize the way PJI is diagnosed, managed, and drastically improve outcomes from this currently devastating complication.
Introduction: Slipped capital femoral epiphysis (SCFE) is a rather uncommon fracture, occurring u... more Introduction: Slipped capital femoral epiphysis (SCFE) is a rather uncommon fracture, occurring usually in adolescence, during a period of rapid growth. Various pathogenetic risk factors contributing to its development have been identified. We present the case of a 10-month-old male infant who developed SCFE in his left hip following an epileptic seizure. To the best of our knowledge, this is the first such case report in the English literature. Case Report: A 10-month-old male infant, with a known medical history of epileptic encephalopathy, was referred to the accident and emergency department of our hospital. The parents of the youngster reported inability of the child to move his left lower limb and inconsolable crying following several epileptic seizures. A radiograph revealed the existence of SCFE in the left hip. The fracture was reduced (with gentle closed traction under general anesthesia) and a hip spicacast was applied. It was removed at 8 weeks. Physical examination at t...
Introduction: Hip pain in children and adolescents may become a diagnostic challenge. A wide rang... more Introduction: Hip pain in children and adolescents may become a diagnostic challenge. A wide range of causes must be considered in the deferential diagnosis. Ischiofemoral impingement (IFI) is a pathological condition defined by hip pain associated with narrowing of the ischiofemoral (IF) space. We report the case of an adolescent patient with non-traumatic quadratus femoris (QF) tear secondary to an occult IFI syndrome. To the best of our knowledge, this is the first such case reported in the literature. Case Report: A 15-year-old girl reported persisting hip pain for a month following increased physical activity. The symptoms had started a couple of days following a weekend of increased activity due to her participating in a dancing contest. Physical examination and imaging studies (standard anterior pelvis radiograph and MRI-scan) failed to reveal any pathology apart from an area of diffused edema in the IF space. Standard hematology and biochemistry laboratory tests were all wit...
Aim of this study was to investigate the potential influence of Critical Shoulder Angle (CSA) as ... more Aim of this study was to investigate the potential influence of Critical Shoulder Angle (CSA) as a predisposing factor for the development of degenerative full-thickness rotator cuff tears (DRCT) or primary glenohumeral osteoarthritis (PGOA). A systematic review of the Pubmed, Scopus, Mendeley, ScienceDirect and the Cochrane Central Register of Controlled Trials online databases was performed for literature regarding CSA and its association with DRCT and PGOA. In order to evaluate solely the relationship between CSA as a predisposing factor for the development of the aforementioned degenerative shoulder diseases (DSDs), we precluded any study in which traumatic cases were not clearly excluded. Our search strategy identified 289 studies in total, nine of which were eligible for inclusion based on our pre-established criteria. Quality assessment contacted using the Newcastle Ottawa Scale for case-control studies. There were a total of 998 patients with DRCT and 285 patients with PGOA....
Intraneural ganglion cysts are benign soft-tissue masses located in the epineurium of peripheral ... more Intraneural ganglion cysts are benign soft-tissue masses located in the epineurium of peripheral nerves. They originate from nearby joint connections via articular branches. Traumatic events seem to play a role in their pathogenesis as well. Clinical manifestations include pain over the area of the cyst, palpable tender mass, hypoesthesia, and muscle weakness depending on the affected nerve. Our case highlights an uncommon clinical manifestation of this entity with acute foot drop, as the primary symptom, without any previous traumatic event, enriching by this way the current diagnostic thinking process of clinical physicians. We report a case of a 42-year-old military officer who presented to our emergency department with acute foot drop that appeared during a march. Initially, the common peroneal palsy was misdiagnosed as L5-S1 disc herniation, but investigation with lumbar MRI scan led to rejection of our primary diagnosis. After performing EMG of the lower extremity and knee MRI...
INTRODUCTION Prosthetic Joint Infections can be challenging to eradicate and are associated with ... more INTRODUCTION Prosthetic Joint Infections can be challenging to eradicate and are associated with high morbidity and mortality. Current microbiology culture methods can be associated with a high false-negative rate of up to 50%. Early and accurate diagnosis is crucial for effective treatment, and negative results have been associated with a greater rate of reoperation. AREAS COVERED There has been increasing investigation of the use of next- generation sequencing technology such as the use of metagenomic shotgun sequencing to help identify causative organisms and decrease the uncertainty around culture-negative infections. The clinical importance of the organisms detected and their management, however, requires further study. The polymerase chain reaction has shown promise, but in recent years multiple studies have reported similar or lower sensitivity for bacteria detection in PJI when compared to traditional culture. Furthermore, issues such as high cost and complexity of sample preparation and data analysis are to be addressed before it can move further towards routine clinical practice. . EXPERT OPINION Metagenomic NGS has shown results that inspire cautious optimism - both in culture-positive and culture-negative cases of joint infection. Refinement of technique could revolutionize the way PJI is diagnosed, managed, and drastically improve outcomes from this currently devastating complication.
Expert Review of Molecular Diagnostics, Jun 21, 2021
INTRODUCTION Prosthetic Joint Infections can be challenging to eradicate and are associated with ... more INTRODUCTION Prosthetic Joint Infections can be challenging to eradicate and are associated with high morbidity and mortality. Current microbiology culture methods can be associated with a high false-negative rate of up to 50%. Early and accurate diagnosis is crucial for effective treatment, and negative results have been associated with a greater rate of reoperation. AREAS COVERED There has been increasing investigation of the use of next- generation sequencing technology such as the use of metagenomic shotgun sequencing to help identify causative organisms and decrease the uncertainty around culture-negative infections. The clinical importance of the organisms detected and their management, however, requires further study. The polymerase chain reaction has shown promise, but in recent years multiple studies have reported similar or lower sensitivity for bacteria detection in PJI when compared to traditional culture. Furthermore, issues such as high cost and complexity of sample preparation and data analysis are to be addressed before it can move further towards routine clinical practice. . EXPERT OPINION Metagenomic NGS has shown results that inspire cautious optimism - both in culture-positive and culture-negative cases of joint infection. Refinement of technique could revolutionize the way PJI is diagnosed, managed, and drastically improve outcomes from this currently devastating complication.
Introduction: Slipped capital femoral epiphysis (SCFE) is a rather uncommon fracture, occurring u... more Introduction: Slipped capital femoral epiphysis (SCFE) is a rather uncommon fracture, occurring usually in adolescence, during a period of rapid growth. Various pathogenetic risk factors contributing to its development have been identified. We present the case of a 10-month-old male infant who developed SCFE in his left hip following an epileptic seizure. To the best of our knowledge, this is the first such case report in the English literature. Case Report: A 10-month-old male infant, with a known medical history of epileptic encephalopathy, was referred to the accident and emergency department of our hospital. The parents of the youngster reported inability of the child to move his left lower limb and inconsolable crying following several epileptic seizures. A radiograph revealed the existence of SCFE in the left hip. The fracture was reduced (with gentle closed traction under general anesthesia) and a hip spicacast was applied. It was removed at 8 weeks. Physical examination at t...
Introduction: Hip pain in children and adolescents may become a diagnostic challenge. A wide rang... more Introduction: Hip pain in children and adolescents may become a diagnostic challenge. A wide range of causes must be considered in the deferential diagnosis. Ischiofemoral impingement (IFI) is a pathological condition defined by hip pain associated with narrowing of the ischiofemoral (IF) space. We report the case of an adolescent patient with non-traumatic quadratus femoris (QF) tear secondary to an occult IFI syndrome. To the best of our knowledge, this is the first such case reported in the literature. Case Report: A 15-year-old girl reported persisting hip pain for a month following increased physical activity. The symptoms had started a couple of days following a weekend of increased activity due to her participating in a dancing contest. Physical examination and imaging studies (standard anterior pelvis radiograph and MRI-scan) failed to reveal any pathology apart from an area of diffused edema in the IF space. Standard hematology and biochemistry laboratory tests were all wit...
Aim of this study was to investigate the potential influence of Critical Shoulder Angle (CSA) as ... more Aim of this study was to investigate the potential influence of Critical Shoulder Angle (CSA) as a predisposing factor for the development of degenerative full-thickness rotator cuff tears (DRCT) or primary glenohumeral osteoarthritis (PGOA). A systematic review of the Pubmed, Scopus, Mendeley, ScienceDirect and the Cochrane Central Register of Controlled Trials online databases was performed for literature regarding CSA and its association with DRCT and PGOA. In order to evaluate solely the relationship between CSA as a predisposing factor for the development of the aforementioned degenerative shoulder diseases (DSDs), we precluded any study in which traumatic cases were not clearly excluded. Our search strategy identified 289 studies in total, nine of which were eligible for inclusion based on our pre-established criteria. Quality assessment contacted using the Newcastle Ottawa Scale for case-control studies. There were a total of 998 patients with DRCT and 285 patients with PGOA....
Intraneural ganglion cysts are benign soft-tissue masses located in the epineurium of peripheral ... more Intraneural ganglion cysts are benign soft-tissue masses located in the epineurium of peripheral nerves. They originate from nearby joint connections via articular branches. Traumatic events seem to play a role in their pathogenesis as well. Clinical manifestations include pain over the area of the cyst, palpable tender mass, hypoesthesia, and muscle weakness depending on the affected nerve. Our case highlights an uncommon clinical manifestation of this entity with acute foot drop, as the primary symptom, without any previous traumatic event, enriching by this way the current diagnostic thinking process of clinical physicians. We report a case of a 42-year-old military officer who presented to our emergency department with acute foot drop that appeared during a march. Initially, the common peroneal palsy was misdiagnosed as L5-S1 disc herniation, but investigation with lumbar MRI scan led to rejection of our primary diagnosis. After performing EMG of the lower extremity and knee MRI...
INTRODUCTION Prosthetic Joint Infections can be challenging to eradicate and are associated with ... more INTRODUCTION Prosthetic Joint Infections can be challenging to eradicate and are associated with high morbidity and mortality. Current microbiology culture methods can be associated with a high false-negative rate of up to 50%. Early and accurate diagnosis is crucial for effective treatment, and negative results have been associated with a greater rate of reoperation. AREAS COVERED There has been increasing investigation of the use of next- generation sequencing technology such as the use of metagenomic shotgun sequencing to help identify causative organisms and decrease the uncertainty around culture-negative infections. The clinical importance of the organisms detected and their management, however, requires further study. The polymerase chain reaction has shown promise, but in recent years multiple studies have reported similar or lower sensitivity for bacteria detection in PJI when compared to traditional culture. Furthermore, issues such as high cost and complexity of sample preparation and data analysis are to be addressed before it can move further towards routine clinical practice. . EXPERT OPINION Metagenomic NGS has shown results that inspire cautious optimism - both in culture-positive and culture-negative cases of joint infection. Refinement of technique could revolutionize the way PJI is diagnosed, managed, and drastically improve outcomes from this currently devastating complication.
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