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Reikersdorfer KN, Singh A, Young JD, Batty MB, Steele AE, Yuen LC, Momtaz DA, Weissert JN, Liu DS, Hogue GD. The Troubling Rise of Scurvy: A Review and National Analysis of Incidence, Associated Risk Factors, and Clinical Manifestations. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202407000-00012. [PMID: 39018570 PMCID: PMC11251681 DOI: 10.5435/jaaosglobal-d-24-00162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 05/06/2024] [Indexed: 07/19/2024]
Abstract
INTRODUCTION In the era of modern medicine, scurvy has been thought of as a rare disease of ancient times because of improved emphasis on diet and nutrition; however, isolated case reports are plentiful. This investigation presents a comprehensive review of scurvy, including an analysis on its rising incidence, with specific focus on its orthopaedic manifestations and commonly associated diagnoses. METHODS This comprehensive review includes a retrospective analysis of 19,413,465 pediatric patients in the National Inpatient Sample database from 2016 through 2020. Patients with scurvy were identified by the ICD-10 code, and an estimated incidence of scurvy in the inpatient pediatric population was calculated. Concurrent diagnoses, musculoskeletal reports, and demographic variables were collected from patient records. Comparisons were made using analysis of variance or chi-square with Kendall tau, where appropriate. RESULTS The incidence of scurvy increased over the study period, from 8.2 per 100,000 in 2016 to 26.7 per 100,000 in 2020. Patients with scurvy were more likely to be younger (P < 0.001), male (P = 0.010), in the lowest income quartile (P = 0.013), and obese (P < 0.001). A majority (64.2%) had a concomitant diagnosis of autism spectrum disorder. Common presenting musculoskeletal reports included difficulty walking, knee pain, and lower limb deformity. Burden of disease of scurvy was markedly greater than that of the average inpatient population, with these patients experiencing greater total charges and longer hospital stays. CONCLUSION Clinicians should be aware of the increasing incidence of scurvy in modern medicine. In cases of vague musculoskeletal reports without clear etiology, a diagnosis of scurvy should be considered, particularly if risk factors are present. TRIAL REGISTRATION NUMBER NA.
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Affiliation(s)
- Kristen N. Reikersdorfer
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Aaron Singh
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Jason D. Young
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Miles B. Batty
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Amy E. Steele
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Leslie C. Yuen
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - David A. Momtaz
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Joleen N. Weissert
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - David S. Liu
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
| | - Grant D. Hogue
- From the Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA (Ms. Reikersdorfer, Dr. Young, Dr. Batty, Dr. Steele, Dr. Yuen, Dr. Liu, and Dr. Hogue) Department of Orthopaedics, UT Health San Antonio, San Antonio, TX (Mr. Singh, and Dr. Momtaz); and the Department of Pediatrics, Boston Children's Hospital, Boston, MA (Dr. Weissert)
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Kassa HL, Singh S, Douglas-Jones M, Schermbrucker G, De Lange J, Phoya F, Butters C, Hlela C, Coetzee A, Banderker E, Webb K. Scurvy masquerading as IgA vasculitis. Pediatr Rheumatol Online J 2024; 22:56. [PMID: 38760753 PMCID: PMC11102241 DOI: 10.1186/s12969-024-00992-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Vitamin C deficiency, or scurvy, is rare but poses risks for children with poor diets, limited resources, or malabsorption issues. It may also be common in children with restrictive or selective dietary habits in children with global developmental delay, autism spectrum disorder, and physical disabilities. Symptoms include fatigue, irritability, joint and muscle pain, joint swellings, edema, swollen gums, easy bruising, and delayed wound healing. Early recognition and prompt intervention are essential to prevent the progression of symptomatic vitamin C deficiency in children. CASE PRESENTATION We present a case of a 13-year-old boy with developmental delay secondary to Lennox Gastaut syndrome referred for suspected recurrent, severe, and atypical IgA vasculitis. He presented with irritability, loss of appetite, petechial and ecchymotic lower limb lesions, unilateral gum swelling, severe arthritis, peripheral oedema, severe weight loss, anaemia, and raised inflammatory markers. Multiple investigations were performed before the diagnosis of scurvy was made. A surgical finding of friable gingival tissue with multiple loose teeth, a skin biopsy with follicular hyperkeratosis and extravasated perifollicular red blood cells, and a typical X-ray finding led to the diagnosis of scurvy. CONCLUSION Scurvy should be given careful consideration as a differential diagnosis in patients presenting with musculoskeletal issues, mucocutaneous complaints, and constitutional symptoms such as malaise, asthenia, irritability, and loss of appetite. A focused and detailed dietary history looking for a lack of good sources of vitamin C can be an easy indicator of this differential. Imaging studies revealing the typical features can also help make the diagnosis. Pathology of the skin revealing pathognomonic features can add to the certainty of the diagnosis. In the absence of all else, the rapid response to treatment with an appropriate dose of vitamin C has a diagnostic and therapeutic role.
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Affiliation(s)
- Hanna L Kassa
- Department of Pediatric Rheumatology, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa.
| | - S Singh
- National Health Laboratory Service, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - M Douglas-Jones
- Department of Maxillofacial and Oral Surgery, Groote Schuur and Red Cross Children's Hospital, University of the Western Cape, Cape Town, South Africa
| | | | - J De Lange
- Department of Maxillofacial and Oral Surgery, Groote Schuur and Red Cross Children's Hospital, University of the Western Cape, Cape Town, South Africa
| | - Frank Phoya
- Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Claire Butters
- Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Carol Hlela
- Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Ashton Coetzee
- Department of Paediatric Nephrology, Red Cross Childrens Hospital, University of Cape Town, Cape Town, South Africa
| | - Ebrahim Banderker
- Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Kate Webb
- Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
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Noor Emilia EM, Said AH. Case report: A Boy with an inability to walk; do not forget about scurvy. MALAYSIAN FAMILY PHYSICIAN : THE OFFICIAL JOURNAL OF THE ACADEMY OF FAMILY PHYSICIANS OF MALAYSIA 2024; 19:31. [PMID: 38855399 PMCID: PMC11162535 DOI: 10.51866/cr.590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Scurvy, a condition caused by vitamin C deficiency, is characterized by a syndrome of multisystem disorder due to defective collagen production and antioxidative function. This condition is infrequent in this modern era; thus, it is often not within the list of differential diagnoses. The broad clinical picture is generally overlooked as other systemic illnesses, resulting in an extensive investigation that delays the diagnosis. Herein, we report a case of an 8-year-old boy with underlying autism spectrum disorder who presented with lower limb pain and other constitutional symptoms. Examination revealed multiple hyperpigmented scars over the upper and lower limbs and gingival hyperpigmentation. With history of picky eating habits and clinical symptoms supported by radiographic findings, scurvy was suspected and subsequently confirmed based on a low level of ascorbic acid. With vitamin C supplementation and proper nutritional support, the patient recovered well.
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Affiliation(s)
- Emira Mansor Noor Emilia
- MBBCh, Department of Family Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar InderaMahkota, Kuantan, Pahang, Malaysia.
| | - Abdul Hadi Said
- MD, MMed Family Medicine, Department of Family Medicine, International Islamic University Malaysia, Jalan Sultan Ahmad Shah, Bandar InderaMahkota, Kuantan, Pahang, Malaysia
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Alhalabi R, Nasrallah B, Rahman R, Muad H, Qureshi A. Chronic Recurrent Multifocal Osteomyelitis Mimicking Scurvy in a Child: A Case Report. Cureus 2023; 15:e38880. [PMID: 37313111 PMCID: PMC10259692 DOI: 10.7759/cureus.38880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
Scurvy is a rare clinical syndrome resulting from prolonged vitamin C deficiency and is uncommon in the Gulf area. It can present with non-specific symptoms, making diagnosis and treatment challenging. In pediatric patients, symptoms may include weight loss, lethargy, low-grade fever, anemia of varying degrees, easy bruising or bleeding, joint and muscle pain, and poor wound healing. Despite advances in healthcare in many Gulf countries, nutritional deficiencies can still occur in certain populations. Therefore, it is important for pediatricians, orthopedists, rheumatologists, and radiologists to consider scurvy in the evaluation of children with low-grade, multisystemic involvement. We report a case of a six-year-old boy who presented to the emergency department (ED) multiple times with progressive right (RT) leg pain. The clinical picture and imaging findings suggested chronic recurrent multifocal osteomyelitis (CRMO). Despite symptom progression, scurvy was ultimately diagnosed and treatment with vitamin C led to rapid resolution of his symptoms. This case highlights the importance of considering scurvy in the differential diagnosis of children with multisystemic involvement, especially in regions where nutritional deficiencies may be more prevalent.
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Affiliation(s)
- Rawan Alhalabi
- Department of Pediatrics, American Hospital Dubai, Dubai, ARE
| | - Basil Nasrallah
- Department of Pediatrics, American Hospital Dubai, Dubai, ARE
| | - Rizviya Rahman
- Department of Pediatrics, American Hospital Dubai, Dubai, ARE
| | - Hussein Muad
- Department of Pediatrics, American Hospital Dubai, Dubai, ARE
| | - Assad Qureshi
- Department of Orthopaedic Surgery, American Hospital Dubai, Dubai, ARE
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Elouali A, El Haddar Z, Bouabdella Y, Rkain M, Babakhouya A. A Case of Scurvy in a Child: An Uncommon but Important Diagnosis to Consider. Cureus 2023; 15:e39369. [PMID: 37362528 PMCID: PMC10285571 DOI: 10.7759/cureus.39369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2023] [Indexed: 06/28/2023] Open
Abstract
Scurvy is a rare disease resulting from a prolonged ascorbic acid deficiency. It commonly affects individuals with low incomes and limited access to fresh fruits and vegetables. The diagnosis of scurvy can be challenging for clinicians due to the non-specific symptoms, resulting in extensive investigations and a delayed diagnosis. We report the case of a 14-year-old girl who presented with symptoms of pallor, bone pain, inability to walk, petechiae, ecchymosis of the lower limbs, irritability, and swollen, bleeding gums. Initially, the symptoms raised suspicions of hematopoietic malignancies, such as leukemia, and the patient underwent a series of invasive diagnostic exams before arriving at the correct diagnosis. Following a detailed dietary anamnesis with the parents, it became evident that the patient had a limited intake of fresh fruits and vegetables. A vitamin C blood test confirmed the diagnosis of scurvy. The prompt resolution of the clinical symptoms after the administration of vitamin C provided further confirmation of the diagnosis. This case highlights the importance of considering a patient's medical history and symptoms rigorously to avoid unnecessary, expensive, and invasive medical procedures, as well as to prevent potential misdiagnosis.
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Affiliation(s)
- Aziza Elouali
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| | - Zohair El Haddar
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| | - Yasser Bouabdella
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| | - Maria Rkain
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
| | - Abdeladim Babakhouya
- Pediatrics, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, MAR
- Pediatrics, Mohammed VI University Hospital, Oujda, MAR
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6
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Emamian A, Abugroun I, Laningham F, Fernández KS. When bone pain and bleeding mean more than leukemia: The case of nutritional deficiencies. Pediatr Blood Cancer 2023; 70:e30272. [PMID: 36912401 DOI: 10.1002/pbc.30272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 03/14/2023]
Affiliation(s)
- Anahita Emamian
- Valley Children's Pediatric Residency Program, Stanford Medicine, Madera, California, USA
| | - Isra Abugroun
- Division of Pediatric Endocrinology, Valley Children's Healthcare, Madera, California, USA
| | - Fred Laningham
- Department of Radiology, Valley Children's Healthcare, Madera, California, USA
| | - Karen S Fernández
- Division of Hematology/Oncology, Cancer and Blood Disorders Center, Stanford Medicine, Valley Children's Healthcare, Madera, California, USA
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7
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Nwayyir HA, Mutasher EM, Alabid OM, Jabbar MA, Abdulraheem Al-Kawaz WH, Alidrisi HA, Alabbood M, Chabek M, AlZubaidi M, Al-Khazrajy LA, Abd Alhaleem IS, Al-Hilfi ADA, Ali FM, AlBayati A, Al Saffar HB, Khazaal FAK. Recommendations for the prevention and management of obesity in the Iraqi population. Postgrad Med 2023:1-15. [PMID: 36803631 DOI: 10.1080/00325481.2023.2172914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Obesity is a chronic metabolic disease that has become one of the leading causes of disability and death in the world, affecting not only adults but also children and adolescents. In Iraq, one third of the adult population is overweight and another third obese. Clinical diagnosis is accomplished by measuring body mass index (BMI) and waist circumference (a marker for intra-visceral fat and higher metabolic and cardiovascular disease risk). A complex interaction between behavioral, social (rapid urbanization), environmental and genetic factors underlies the etiology of the disease. Treatment options for obesity may include a multicomponent approach, involving dietary changes to reduce calorie intake, an increase in physical activity, behavioral modification, pharmacotherapy and bariatric surgery. The purpose for these recommendations is to develop a management plan and standards of care that are relevant to the Iraqi population and that can prevent/manage obesity and obesity-related complications, for the promotion of a healthy community.
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Affiliation(s)
- Hussein Ali Nwayyir
- University of Basra, College of Medicine, Department of Endocrinology, Faiha Specialized Diabetes, Endocrine and Metabolism Centre, Iraq
| | - Esraa Majid Mutasher
- Department of Pediatric Endocrinology, Children Welfare Teaching Hospital, Medical City Complex, Iraq
| | | | | | | | | | - Majid Alabbood
- Department of Endocrinology, Almawani Hospital, Basra, Iraq
| | - Muhammed Chabek
- Consultant Obstetrics and Gynecology, Private Practice, Iraq
| | - Munib AlZubaidi
- Department of paediatrics, University of Baghdad College of Medicine, Iraq
| | - Lujain Anwar Al-Khazrajy
- Department of Family medicine, Consultant Family Physician, Al-Kindy College of Medicine, University of Baghdad, Iraq
| | | | | | | | - Ali AlBayati
- Department of Endocrinology Consultant Endocrinology, Professor of medicine, Babylon medical college, Iraq
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8
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Allen H, Barnthouse NC, Chan BY. Periosteal Pathologic Conditions: Imaging Findings and Pathophysiology. Radiographics 2023; 43:e220120. [DOI: 10.1148/rg.220120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Hailey Allen
- From the Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Nicholas C. Barnthouse
- From the Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
| | - Brian Y. Chan
- From the Department of Radiology and Imaging Sciences, University of Utah School of Medicine, 30 North 1900 East #1A071, Salt Lake City, UT 84132-2140
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Ding TG, Goh F, Hayman R. Easily missed, easily treatable: A case of non-weight bearing, an MRI and scurvy. J Paediatr Child Health 2023; 59:395-397. [PMID: 36464998 DOI: 10.1111/jpc.16299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 11/12/2022] [Accepted: 11/15/2022] [Indexed: 12/07/2022]
Affiliation(s)
- Thomas G Ding
- Department of Paediatric, Kidz First Hospital, Te Whatu Ora, Auckland, New Zealand
| | - Fern Goh
- Radiology Department, Middlemore Hospital, Te Whatu Ora, Auckland, New Zealand
| | - Rebecca Hayman
- Department of Paediatric, Kidz First Hospital, Te Whatu Ora, Auckland, New Zealand
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Bertrand V, Millardet E, Bouchereau J, Dhenin C, Bruel H. Suspicion of Munchausen syndrome by proxy with a child's presentation of undernutrition, scurvy, and an apparent Avoidant Restrictive Food Intake Disorder. Eat Weight Disord 2022; 27:3815-3820. [PMID: 36565378 DOI: 10.1007/s40519-022-01520-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/10/2022] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Avoidant Restrictive Food Intake Disorder (ARFID) was recently characterized in the DSM-5 classification. Potential differential diagnoses remain poorly reported in the literature. Our purpose was to present a possible Munchausen syndrome by proxy with undernutrition and scurvy, presenting as ARFID in a child. METHODS We describe here a case of an 8-year-old boy who presented with severe undernutrition (BMI = 11.4) and scurvy leading to joint pains. The boy had had a very selective diet since early childhood, and his condition required hospitalization and enteral refeeding. Because of his specific eating behaviour, an ARFID was initially suspected. However, observation of the mother-child relationship, analysis of the child's eating behaviour, and retrospective analysis of his personal history suggested that this was not a true ARFID, and that the selective eating behaviour had probably been induced by the mother over many years, who probably maintained a low variety diet. CONCLUSION Munchausen syndrome by proxy is a difficult differential diagnosis, which may also affect patients with ARFID symptoms, which may also present in the affected child as apparent ARFID. LEVEL OF EVIDENCE Level V, descriptive study.
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Affiliation(s)
- Valérie Bertrand
- Paediatric Unit, Le Havre Hospital, BP 24, 76083, Le Havre Cedex, France.
- INSERM U1073, UNIROUEN, Normandie University, Rouen, France.
| | - Ekatarina Millardet
- Child Radiology Unit, Le Havre Hospital, BP 24, 76083, Le Havre Cedex, France
| | - Juliette Bouchereau
- Reference Center for Inborn Error of Metabolism, Department of Paediatrics, Necker Hospital, Assistance Publique-Hôpitaux de Paris, G2M Network, MetabERN, Paris, France
| | - Caroline Dhenin
- Paediatric Unit, Le Havre Hospital, BP 24, 76083, Le Havre Cedex, France
| | - Henri Bruel
- Paediatric Unit, Le Havre Hospital, BP 24, 76083, Le Havre Cedex, France
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Gupta J, Sharma P, Sharma R, Choudhary R, Bhandari A, Sitaraman S. Children with Inability to Walk: Don't Forget to Rule Out Scurvy. Indian J Pediatr 2022; 89:932. [PMID: 35821553 DOI: 10.1007/s12098-022-04301-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Juhi Gupta
- Department of Pediatrics, SMS Medical College, Jaipur, Rajasthan, 302004, India.
| | - Pooja Sharma
- Department of Pediatrics, SMS Medical College, Jaipur, Rajasthan, 302004, India
| | - Rahul Sharma
- Department of Radiodiagnosis, SMS Medical College, Jaipur, Rajasthan, India
| | - Richa Choudhary
- Department of Pediatrics, SMS Medical College, Jaipur, Rajasthan, 302004, India
| | - Anu Bhandari
- Department of Radiodiagnosis, SMS Medical College, Jaipur, Rajasthan, India
| | - Sadasivan Sitaraman
- Department of Pediatrics, SMS Medical College, Jaipur, Rajasthan, 302004, India
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Abuabara L, Werner-Masters K, Paucar-Caceres A. Daily food planning for families under Covid-19: combining Analytic Hierarchy Processes and Linear Optimisation. Health Syst (Basingstoke) 2022; 11:232-250. [PMID: 36147555 PMCID: PMC9487970 DOI: 10.1080/20476965.2022.2080006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In many households, preparation of food in normal times proves to be problematic, particularly when parents endeavour to keep their children on a balanced diet. The COVID-19 pandemic has further exacerbated this problem imposing the requirement of social distancing, which led to disruptions in the food supply chain and multiplication of responsibilities faced by families with children. The present study revisits the standard “Diet Problem” to address these challenges and to develop a participatory approach to provide a diversified weekly meal plan that is easy and fun but simultaneously complies with the unique requirements of each participant. This is done by providing a novel framework, which combines linear optimisation with the Parsimonious Analytic Hierarchy Process, a method for individual choices. This novel approach to participatory modelling is tested within two young family settings in Brazil. The model produced through this contemporary framework provides a weekly menu that best meets expectations of the members of a young family in the context of the COVID-19 pandemic.
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Affiliation(s)
- Leila Abuabara
- Universidade Federal de São Paulo (UNIFESP) - Instituto Tecnológico de Aeronáutica (ITA), São José dos Campos, Bolsista Capes, SP, Brasil
| | - Katarzyna Werner-Masters
- Manchester Metropolitan University - All Saints Campus, Manchester, United Kingdom of Great Britain and Northern Ireland
| | - Alberto Paucar-Caceres
- Manchester Metropolitan University - All Saints Campus, Manchester, United Kingdom of Great Britain and Northern Ireland
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13
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Clayton JA, Slain KN, Shein SL, Cheifetz IM. High Flow Nasal Cannula in the Pediatric Intensive Care Unit. Expert Rev Respir Med 2022; 16:409-417. [PMID: 35240901 DOI: 10.1080/17476348.2022.2049761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The use of high flow nasal cannula (HFNC) has become widely used in pediatric intensive care units (PICUs) throughout the world. The rapid adoption has outpaced the number of studies evaluating the safety and efficacy in a variety of pediatric diseases/conditions. AREAS COVERED This scoping review begins with the definition and mechanisms of action of HFNC and then follows with a review of the literature focused on studies performed on critically ill children cared for in the PICU. The Pubmed database was searched with a pediatric filter from the time period 2000 to 2021. EXPERT OPINION The rapid adoption of HFNC in PICUs has largely been driven by changes in institutional practices and small observational studies. There is a lack of adequately powered studies evaluating patient-centered outcomes, such as intubation rates, mortality, PICU and hospital length of stay. Given the wide variability in flow rates and clinical indications, more research is needed to better define effective flow rates for different disease states as well as markers of treatment success and failure. One particular entity that is poorly studied is the use of HFNC in those at risk for developing pediatric acute respiratory distress syndrome (PARDS).
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Affiliation(s)
- Jason A Clayton
- Division of Pediatric Critical Care Medicine, Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Katherine N Slain
- Division of Pediatric Critical Care Medicine, Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Steven L Shein
- Division of Pediatric Critical Care Medicine, Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Ira M Cheifetz
- Division of Pediatric Cardiac Critical Care Medicine, Rainbow Babies & Children's Hospital, Cleveland, Ohio
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Trapani S, Rubino C, Indolfi G, Lionetti P. A Narrative Review on Pediatric Scurvy: The Last Twenty Years. Nutrients 2022; 14:nu14030684. [PMID: 35277043 PMCID: PMC8840722 DOI: 10.3390/nu14030684] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 02/04/2023] Open
Abstract
Scurvy is a well-known clinical condition caused by vitamin C deficiency. Although considered a rare disease in high-income countries, it has been recently increasingly reported in children, especially in those with abnormal dietary habits, mental or physical disabilities. We performed an extensive review of the literature analyzing studies published in the last 20 years focusing on clinical features, differential diagnosis and diagnostic delay. Fifteen articles were selected, collectively reporting a total of 166 children. Because of the wide clinical spectrum (musculoskeletal complaints and/or mucocutaneous lesions or systemic symptoms), scurvy can mimic several conditions, including autoimmune diseases, infections, and neoplasia. In addition, frequent findings such as normal nutritional status, anemia or elevated inflammatory markers may guide clinicians towards the abovementioned misdiagnoses. Scurvy should be considered in patients presenting with musculoskeletal complaints, not only in those with risk factors but also in healthy children. A focused dietary history and a careful physical examination, assessing other signs of vitamin C deficiency, are mandatory in these patients. When suspected, the dosage of serum vitamin C is the diagnostic gold standard; furthermore, imaging studies, performed by an expert radiologist, can reveal the typical features of scurvy. Only early diagnosis can avoid unnecessary investigations and potentially fatal complications of the disease.
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Affiliation(s)
- Sandra Trapani
- Pediatric Unit, Department of Health Sciences, Meyer Children’s University Hospital, University of Florence, Viale Pieraccini 24, 50137 Florence, Italy
- Correspondence: ; Tel.: +39-055-5662480
| | - Chiara Rubino
- Pediatric Unit, Meyer Children’s University Hospital, Viale Pieraccini 24, 50137 Florence, Italy;
| | - Giuseppe Indolfi
- Pediatric Unit, Department of NEUROFARBA, Meyer Children’s University Hospital, University of Florence, Viale Pieraccini 24, 50137 Florence, Italy;
| | - Paolo Lionetti
- Gastroenterology Unit, Department of NEUROFARBA, Meyer Children’s University Hospital, University of Florence, Viale Pieraccini 24, 50137 Florence, Italy;
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15
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Iamopas O, Ratanachu-Ek S, Kaewnimee S. Scurvy in children - A neglected disease? Pediatr Int 2022; 64:e15324. [PMID: 36331236 DOI: 10.1111/ped.15324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 07/30/2022] [Accepted: 08/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The incidences of pediatric scurvy has decreased substantially, particularly in developed countries, but there are still reports of it from developing countries. Unusual manifestations have led to delays in diagnosis and treatment. Nevertheless, there are few publications regarding misdiagnosis of scurvy. The objective is to determine dietary factors, clinical manifestations, laboratory and radiologic findings, treatment, and outcomes of scurvy cases. The occurrence of misdiagnosis and its associated factors are also explored. METHOD The medical records of 0-18 year-old children from 2003 to 2016, diagnosed with scurvy, were included and reviewed. Clinical data, and data regarding feeding history, nutritional status, laboratory and radiologic findings, and misdiagnosis were collected. Univariate and logistic regression analysis were used for identification of the independent associated factors. RESULTS The study consisted of 106 children. The boys-to-girls ratio was 2.2:1, and their mean age was 44.65 months ± 30.50 months. The common manifestations were refusal to walk, tenderness, and swelling at the lower extremities. Four participants had unusual manifestations including proptosis and scalp hematoma. Low serum vitamin C level and abnormal radiologic findings were detected in most patients. All of them fully recovered after receiving vitamin C supplementation. Misdiagnosis was identified in 74 cases (69%). Logistic regression analysis revealed that temperature higher than or equal to 38 °C, participants aged 3 years or below, and swelling at lower extremities were independently associated with misdiagnosis (adjusted OR 5.91, 3.78, and 3.56 respectively). CONCLUSIONS Scurvy still exists, and misdiagnosis often occurs. Taking a careful medical history and conducting a physical examination are still the best way to diagnose scurvy.
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Affiliation(s)
- Orawan Iamopas
- Division of Nutrition, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.,College of Medicine, Rangsit University, Mueang Pathum Thani, Thailand
| | - Suntaree Ratanachu-Ek
- Division of Nutrition, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.,College of Medicine, Rangsit University, Mueang Pathum Thani, Thailand
| | - Suranat Kaewnimee
- Division of Nutrition, Department of Pediatrics, Queen Sirikit National Institute of Child Health, Bangkok, Thailand.,College of Medicine, Rangsit University, Mueang Pathum Thani, Thailand
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16
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Rubino C, Mastrangelo G, Bartolini E, Indolfi G, Trapani S. The Pitfall in Differential Diagnosis of Musculoskeletal Symptoms in Children: A Case Series of Pediatric Scurvy. J Clin Rheumatol 2021; 27:S362-S367. [PMID: 32897996 DOI: 10.1097/rhu.0000000000001562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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El-Sobky T, Mahmoud S. Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills. EFORT Open Rev 2021; 6:584-592. [PMID: 34377550 PMCID: PMC8335954 DOI: 10.1302/2058-5241.6.200155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis.A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management.Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician's clinical judgment.Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve.The growing body of evidence on 'high-risk' children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets.Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis.Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155.
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Affiliation(s)
- Tamer El-Sobky
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shady Mahmoud
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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18
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Musa H, Ismail II, Abdul Rashid NH. Paediatric scurvy: frequently misdiagnosed. Paediatr Int Child Health 2021; 41:158-161. [PMID: 32937094 DOI: 10.1080/20469047.2020.1816285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Paediatric scurvy is uncommon in the modern age but cases have been reported in children with neurodevelopmental issues and restricted dietary habits. The broad clinical picture is frequently overlooked as primarily other systemic diseases are considered first leading to extensive investigations and delay in diagnosis. A 4-year-old boy with autism and bilateral lower limb pain and refusal to walk is reported. His restricted diet and radiographic findings were highly suggestive of scurvy which was confirmed by the extremely low levels of ascorbic acid. Treatment with ascorbic acid replenishment and maintenance resulted in remarkable improvement. This case highlights the importance of a high index of suspicion in at-risk children so as to avoid unnecessary invasive investigations and procedures.
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Affiliation(s)
- Husna Musa
- Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.,Department of Paediatrics, Serdang Hospital, Ministry of Health, Serdang, Malaysia
| | - Imma Isniza Ismail
- Department of Orthopaedics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Nurul Hazwani Abdul Rashid
- Department of Paediatrics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia.,Department of Paediatrics, Serdang Hospital, Ministry of Health, Serdang, Malaysia
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19
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Pereira TDSF, Pantuzzo ES, Costa FPD, Lemos APV, Martins PDS, Kakehasi F, Silva AASD, Detomi L, Rodrigues KEDS, Travassos DV, Silva TA. Red-purple gingival enlargements in a pediatric patient. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 132:619-625. [PMID: 34031001 DOI: 10.1016/j.oooo.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 02/13/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Thaís Dos Santos Fontes Pereira
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Erika Soares Pantuzzo
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas. Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fernanda Pereira Delgado Costa
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas. Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ana Paula Vilaça Lemos
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas. Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Priscila de Souza Martins
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas. Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Fabiana Kakehasi
- Department of Pediatrics, Medicine Faculty, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Letícia Detomi
- Department of Pediatrics, Medicine Faculty, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Karla Emília de Sá Rodrigues
- Department of Pediatrics, Medicine Faculty, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Denise Vieira Travassos
- Multiprofessional Integrated Residency in Health, Hospital das Clínicas. Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Department of Social and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Tarcília Aparecida Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil; Multiprofessional Integrated Residency in Health, Hospital das Clínicas. Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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20
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O'Donnell L, Hill EC, Anderson ASA, Edgar HJH. Cribra orbitalia and porotic hyperostosis are associated with respiratory infections in a contemporary mortality sample from New Mexico. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 173:721-733. [PMID: 32869279 DOI: 10.1002/ajpa.24131] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/23/2020] [Accepted: 08/04/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Cribra orbitalia (CO) and porotic hyperostosis (PH) are porous cranial lesions (PCLs) classically associated with iron-deficiency anemia in bioarchaeological contexts. However, recent studies indicate a need to reassess the interpretation of PCLs. This study addresses the potential health correlates of PCLs in a contemporary sample by examining relationships between the known cause of death (COD) and PCL presence/absence. METHODS This study includes a sample of 461 juvenile individuals (6 months to 15 years of age) who underwent examination at the University of New Mexico's Office of the Medical Investigator between 2011 and 2019. The information available for each individual includes their sex, age at death, and their COD and manner of death. RESULTS Odds ratio of having CO (OR = 3.92, p < .01) or PH (OR = 2.86, p = .02) lesions are increased in individuals with respiratory infections. Individuals with heart conditions have increased odds of having CO (OR = 3.52, p = .03) lesions, but not PH. CONCLUSION Individuals with respiratory infection are more likely to have CO and/or PH. CO appears to have a greater range of health correlates than PH does, as indicated by the heart condition results. However, individuals with congenital heart defects are at higher risk for respiratory infections, so bony alterations in cases of heart conditions may be due to respiratory illness. Since respiratory infection remains a leading cause of mortality today, CO and PH in bioarchaeological contexts should be considered as potential indicators of respiratory infections in the past.
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Affiliation(s)
- Lexi O'Donnell
- Department of Sociology and Anthropology, University of Mississippi, Oxford, Mississippi, USA
| | - Ethan C Hill
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Heather J H Edgar
- Department of Anthropology, University of New Mexico, Albuquerque, New Mexico, USA.,Office of the Medical Investigator, University of New Mexico, Albuquerque, New Mexico, USA
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21
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Menashe SJ, Aboughalia H, Zhao Y, Ngo AV, Otjen JP, Thapa MM, Iyer RS. The Many Faces of Pediatric Chronic Recurrent Multifocal Osteomyelitis (CRMO): A Practical Location- and Case-Based Approach to Differentiate CRMO From Its Mimics. J Magn Reson Imaging 2020; 54:391-400. [PMID: 32841445 DOI: 10.1002/jmri.27299] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/08/2020] [Accepted: 07/08/2020] [Indexed: 12/12/2022] Open
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is an autoinflammatory bone disease of childhood and adolescence characterized by episodic bone pain. Diagnosis relies heavily on whole-body MRI and is made by excluding a wide variety of other disorders with overlapping imaging features, depending on location, marrow distribution, and the presence or absence of multifocality. We present an overview of the clinical and imaging features of CRMO and, through various clinical scenarios, provide tips for tailoring the differential diagnosis based on location and distribution of encountered abnormalities. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Sarah J Menashe
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Hassan Aboughalia
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Yongdong Zhao
- Department of Rheumatology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Anh-Vu Ngo
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeffrey P Otjen
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mahesh M Thapa
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
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