Decreased PTH levels and higher levels of glycemia independently contribute to lower bone turnover in elderly nursing home patients with type 2 DM. Despite higher bone mass and lower bone turnover, hip fracture risk is comparable with women without DM.
In 2014, sepsis-like illness affected 9 full-term newborns in 1 hospital in Austria. Although results of initial microbiological testing were negative, electron microscopy identified picornavirus. Archived serum samples and feces obtained after discharge were positive by PCR for human parechovirus 3. This infection should be included in differential diagnoses of sepsis-like illness in newborns.
Context: Absolute fracture risk in nursing home patients is the highest among the communities studied. Screening for high-risk patients in such an environment is usually difficult. Objective:The objective was to investigate whether quantitative bone ultrasound measurements and/or markers of bone turnover/ metabolism help in predicting which patients will incur hip or nonvertebral fractures.Design, Setting, and Participants: In this prospective study, mobile teams enrolled 1664 female patients from 95 nursing homes in Austria. Main Outcome Measures:Calcaneal stiffness (n ϭ 1117), radial speed of sound (SOS) (n ϭ 1332), and phalangeal SOS (n ϭ 1498) measurements were performed at baseline. Serum samples (n ϭ 960) were analyzed for serum calcium and phosphate, 25 hydroxyvitamin D, PTH, osteocalcin, C-terminal telopeptide crosslinks, and osteoprotegerin (OPG). Patients were prospectively followed for hip and other nonvertebral fractures for 2 yr.Results: A total of 117 hip fractures and 269 nonvertebral fractures developed during a mean observation period of 2 yr. Prevalence of vitamin D deficiency and secondary hyperparathyroidism was high. A history of a past fracture was significantly associated with a hazard ratio (HR) of 1.47 (95% confidence interval, 1.01-2.15) and 1.65 (1.26 -2.16) for the development of hip and nonvertebral fractures, respectively. Cox regression analysis revealed a multivariate adjusted elevation in both hip [HR 1.30 (1.12-1.43)] and nonvertebral [HR 1.14 (1.02-1.25)] fracture risk for each SD decrease in calcaneal stiffness. Patients in the lowest quartile for calcaneal stiffness Z-score had 2.5 and 1.2 times higher rates of hip and nonvertebral fractures when compared with patients in the highest quartile. Fracture rates were not statistically associated with baseline radial or phalangeal SOS measurements or with serum osteocalcin, C-terminal telopeptide crosslinks, and OPG concentrations. When adjusted for bone mass, higher serum OPG levels were associated with fewer hip as well as nonvertebral fractures Conclusion:Calcaneal stiffness measurements proved to be useful in predicting hip fractures and to a lesser extent nonvertebral fractures in nursing home residents. Radial and phalangeal bone ultrasound measurements and baseline markers of bone turnover, however, were not indicative of future fracture risk in this population.
Acanthamoeba is the causative agent of granulomatous amebic encephalitis, a rare and usually fatal disease. We report a child with acute lymphoblastic leukemia who developed brain abscesses caused by Acanthamoeba during induction therapy. Multimodal antimicrobial chemotherapy and hyperbaric oxygen therapy resulted in complete resolution of symptoms and of pathology as seen by magnetic resonance imaging. CASE REPORTA 25-month-old boy was treated at our institution for acute lymphoblastic leukemia (ALL). The induction therapy consisted of prednisone, dexamethasone, vincristine, daunorubicin, l-asparaginase, methotrexate, cyclophosphamide, and mercaptopurine. Infection prophylaxis included oral amphotericin B and trimethoprim-sulfamethoxazole (4 mg/kg of body weight/day 4 days/week). Complete remission of ALL was achieved by day 15 of ALL treatment.Forty-three days after the diagnosis was established and therapy started, the boy developed fever followed by an increase of C-reactive protein (CRP) (maximum, 87.8 mg/liter [normal range, 0 to 8 mg/liter]). Therapy with meropenem and liposomal amphotericin B resulted in defervescence. The patient suffered from mild headache, and 5 days later he experienced left-sided hemiparesis and a second elevation of CRP level (maximum, 37 mg/dl). No other symptoms besides fever and hemiparesis were noted.Magnetic resonance imaging (MRI) revealed multifocal lesions up to 20 mm in diameter, partially necrotic as seen by increased contrast medium enhancement, and extended edema. The largest lesion was located in the right front parietal lobe. The morphology of these lesions was indicative for abscess formations (Fig. 1).Analysis of the initially acquired cerebrospinal fluid (CSF) showed 0 erythrocytes/l, 2 leukocytes/l, increased protein (62 mg/dl), normal glucose, and no bacteria. An extensive diagnostic workup on fungi, bacteria, and parasites known to cause brain abscesses in children (7) revealed positive PCR results for Acanthamoeba 2 days after the first signs of hemiparesis. An Acanthamoeba-specific PCR amplifying a fragment of the 18S ribosomal DNA (rDNA) was performed using the primers JDP1 and JDP2 (12) and Acanthamoeba strain ATCC PRA-105, genotype T4, as a positive control. For genotyping, amplicons were sequenced using a 310 ABI Prism automated sequencer (Applied Biosystems, Langen, Germany), and the genotype was assessed with the model assumption of a Ͻ5% sequence dissimilarity within one genotype (3). Further specification revealed Acanthamoeba group II, genotype T4, known to be the predominant type that causes granulomatous amebic encephalitis (GAE) in humans (13).Cultures and PCR of the CSF were negative for fungi and bacteria. The results of Acanthamoeba PCR of nasal and respiratory discharge and sputum were negative.ALL therapy was stopped on treatment day 44, and empirical antimicrobial therapy was initiated, consisting of meropenem, teicoplanin, fosfomycin, metronidazole, and liposomal amphotericin B. Hyperbaric oxygen therapy (HBO) was started empirically for its...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.