We report a rare case of heparin-induced thrombocytopenia with thrombosis (HITT) following treatment for May–Thurner syndrome complicated by deep vein thrombosis (DVT), which resulted in venous stent thrombosis. A 27-year-old male with acute left lower-limb DVT successfully underwent thrombolysis and stenting for May–Thurner syndrome. However, the patient developed recurrent thrombosis and thrombocytopenia 3 days post-procedure. HITT was confirmed by a positive antiplatelet factor 4-heparin antibody test. After discontinuing heparin, the patient was successfully treated with fondaparinux, followed by repeat thrombectomy and thrombolysis, and then transitioned to warfarin. This is the second reported case of venous stent thrombosis due to HITT in May–Thurner syndrome. This case underscores the importance of early recognition and prompt management of HITT using alternative anticoagulants like fondaparinux to prevent complications such as venous limb gangrene. Further randomized controlled trials are required to evaluate the safety and efficacy of fondaparinux in HITT.

We report a rare case of heparin-induced thrombocytopenia with thrombosis (HITT) following treatment for May–Thurner syndrome complicated by deep vein thrombosis (DVT), which resulted in venous stent thrombosis. A 27-year-old male with acute left lower-limb DVT successfully underwent thrombolysis and stenting for May–Thurner syndrome. However, the patient developed recurrent thrombosis and thrombocytopenia 3 days post-procedure. HITT was confirmed by a positive antiplatelet factor 4-heparin antibody test. After discontinuing heparin, the patient was successfully treated with fondaparinux, followed by repeat thrombectomy and thrombolysis, and then transitioned to warfarin. This is the second reported case of venous stent thrombosis due to HITT in May–Thurner syndrome. This case underscores the importance of early recognition and prompt management of HITT using alternative anticoagulants like fondaparinux to prevent complications such as venous limb gangrene. Further randomized controlled trials are required to evaluate the safety and efficacy of fondaparinux in HITT.

We report a rare case of heparin-induced thrombocytopenia with thrombosis (HITT) following treatment for May–Thurner syndrome complicated by deep vein thrombosis (DVT), which resulted in venous stent thrombosis. A 27-year-old male with acute left lower-limb DVT successfully underwent thrombolysis and stenting for May–Thurner syndrome. However, the patient developed recurrent thrombosis and thrombocytopenia 3 days post-procedure. HITT was confirmed by a positive antiplatelet factor 4-heparin antibody test. After discontinuing heparin, the patient was successfully treated with fondaparinux, followed by repeat thrombectomy and thrombolysis, and then transitioned to warfarin. This is the second reported case of venous stent thrombosis due to HITT in May–Thurner syndrome. This case underscores the importance of early recognition and prompt management of HITT using alternative anticoagulants like fondaparinux to prevent complications such as venous limb gangrene. Further randomized controlled trials are required to evaluate the safety and efficacy of fondaparinux in HITT.

We report a rare case of heparin-induced thrombocytopenia with thrombosis (HITT) following treatment for May–Thurner syndrome complicated by deep vein thrombosis (DVT), which resulted in venous stent thrombosis. A 27-year-old male with acute left lower-limb DVT successfully underwent thrombolysis and stenting for May–Thurner syndrome. However, the patient developed recurrent thrombosis and thrombocytopenia 3 days post-procedure. HITT was confirmed by a positive antiplatelet factor 4-heparin antibody test. After discontinuing heparin, the patient was successfully treated with fondaparinux, followed by repeat thrombectomy and thrombolysis, and then transitioned to warfarin. This is the second reported case of venous stent thrombosis due to HITT in May–Thurner syndrome. This case underscores the importance of early recognition and prompt management of HITT using alternative anticoagulants like fondaparinux to prevent complications such as venous limb gangrene. Further randomized controlled trials are required to evaluate the safety and efficacy of fondaparinux in HITT.

We report a rare case of heparin-induced thrombocytopenia with thrombosis (HITT) following treatment for May–Thurner syndrome complicated by deep vein thrombosis (DVT), which resulted in venous stent thrombosis. A 27-year-old male with acute left lower-limb DVT successfully underwent thrombolysis and stenting for May–Thurner syndrome. However, the patient developed recurrent thrombosis and thrombocytopenia 3 days post-procedure. HITT was confirmed by a positive antiplatelet factor 4-heparin antibody test. After discontinuing heparin, the patient was successfully treated with fondaparinux, followed by repeat thrombectomy and thrombolysis, and then transitioned to warfarin. This is the second reported case of venous stent thrombosis due to HITT in May–Thurner syndrome. This case underscores the importance of early recognition and prompt management of HITT using alternative anticoagulants like fondaparinux to prevent complications such as venous limb gangrene. Further randomized controlled trials are required to evaluate the safety and efficacy of fondaparinux in HITT.

BACKGROUND/AIMS: Pyomyositis is an infective condition with primary involvement of the skeletal muscles. There is sparse recent literature on patients with pyomyositis. METHODS: This study was carried out at emergency services of a tertiary care center located in subtropical area of Indian subcontinent. RESULTS: Sixty-two patients of primary pyomyositis formed the study cohort. Mean age of occurrence was 29.9 ± 14.8 years. There were 54 men. Twelve patients had underlying medical diseases. Muscle pain was seen in all 62 patients. Forty-eight patients (77.4%) had the fever. Most common site of involvement was thigh muscles (n = 29, 46.8%). Forty-nine patients (79%) presented in the suppurative stage of illness. Patients with comorbidities were older (age: median 36 years [interquartile range (IQR), 25 to 47] vs. 24 years [IQR, 16 to 35], p = 0.024), had higher culture positivity with gram-negative organisms (8/9 [88.89%] vs. 6/29 [20.69%], p = 0.001). Importantly, higher number of these patients received inappropriate antibiotics initially. Patients with positive pus culture result had higher complication rate (32/38 [84.21%] vs. 10/18 [55.56%], p = 0.044). Six patients (9.7%) had in-hospital mortality. Lower first-day serum albumin, initial inappropriate antibiotic therapy, and advanced form of the disease at presentation were associated with increased in-hospital mortality. CONCLUSIONS: Primary pyomyositis is not an uncommon disease entity. Patients with comorbidities were more likely to receive initial inappropriate antibiotic therapy. Patients with positive pus culture report had the higher rate of complications. Lower first-day serum albumin, initial inappropriate antibiotic therapy and advanced form of the disease at presentation were associated with increased in-hospital mortality.
Anti-Bacterial Agents ; Cohort Studies ; Comorbidity ; Emergencies ; Fever ; Hospital Mortality ; Humans ; India* ; Male ; Muscle, Skeletal ; Muscles ; Myalgia ; Outcome Assessment (Health Care)* ; Pyomyositis* ; Serum Albumin ; Suppuration ; Tertiary Care Centers ; Thigh

No abstract available.
Research Report*

PURPOSE: Cigarette smoking is a major risk factor in periodontal diseases. The pathogenesis of periodontal diseases may be affected by alterations of the inflammatory response by smoke. Nitric oxide (NO) is a gaseous, colorless, highly reactive, short-lived free radical with a pivotal role in the regulation of various physiological and pathological mechanisms in the body. It is important in host defense and homeostasis, on the one hand, whereas, on the other hand, it modulates the inflammatory response in periodontitis, leading to harmful effects. The aim of this study was to assess the levels of NO in both the serum and saliva of smokers and nonsmokers having chronic periodontitis and to compare them with periodontally healthy controls. METHODS: Sixty subjects participated in the study and were divided into three groups: group I, healthy nonsmoking subjects; group II, nonsmoking patients with chronic periodontitis; group III, smoking patients with chronic periodontitis. Each group consisted of twenty subjects. The biochemical estimation of NO in the collected serum and in the saliva was performed using the Griess colorimetric reaction. RESULTS: The results showed that the mean value of the salivary and serum NO was greater in group II than in group I, and also greater in group III than in group II. CONCLUSIONS: NO appears to play an important and rather complex role in the immuno-inflammatory process and in the remodeling and maintenance of osseous structures. It is therefore logical that modulation of this mediator has potential for the treatment of a number of inflammatory conditions including periodontal disease.
Chronic Periodontitis* ; Colorimetry ; Homeostasis ; Humans ; Nitric Oxide* ; Periodontal Diseases ; Periodontitis ; Risk Factors ; Saliva ; Smoke ; Smoking

Multicentric reticulohistiocytosis (MRH) is a rare systemic disease, which commonly manifests as muco-cutaneous papulonodules and inflammatory erosive polyarthropathy. In this research, we report the clinical manifestations and management of a rare case of MRH with destructive arthropathy of bilateral hip joints and arthritis mutilans presenting with characteristic deformities. Disabling hip arthropathy that occurs secondary to MRH can be successfully managed with bilateral total hip arthroplasty (THA). Osteopenia and acetabular bone defects must be anticipated during THA. This case is reported due to its rare occurrence and because little literature has been published regarding THA in such patients.
*Arthroplasty, Replacement, Hip ; Fingers/pathology ; Hip/pathology/radiography/surgery ; *Histiocytosis, Non-Langerhans-Cell ; Humans ; Skin/pathology ; Toes/pathology

INTRODUCTIONRheumatoid arthritis (RA) patients taking disease-modifying antirheumatic drugs (DMARDs) may experience treatment failure due to adverse effects or a lack of efficacy/resistance. The purpose of this study was to evaluate the prescription patterns, the incidence and reasons for failure, and the time to treatment failure of DMARDs in RA patients.

METHODSThe medical records of patients visiting the Rheumatology Clinic were scrutinised retrospectively in order to extract the relevant data, including demographics, clinical and laboratory investigations and drug usage, for analysis.

RESULTSMore than 60% of the 474 eligible patients were started on a combination of DMARDs. Hydroxychloroquine (HCQ) (79.7%) and methotrexate (MTX) (55.6%) were the most common DMARDs prescribed initially. There was a significant difference in survival times among the various treatment groups (p ≤ 0.001). Adverse effect was the main reason for treatment failure of sulfasalazine (SSZ) (88.9%) and MTX (75%), while addition or substitution DMARDs was more common for those taking HCQ (72.2%). Adverse event was reported as the most significant predictor of treatment failure. The most commonly reported adverse effects were bone marrow suppression and hepatotoxicity.

CONCLUSIONA combination of DMARDs was used to initiate therapy in more than 60% of RA patients, with HCQ and MTX being prescribed most frequently. Adverse effects accounted mainly for treatment failures with MTX and SSZ, while lack of efficacy was responsible for major treatment failures with HCQ.

Adult ; Antirheumatic Agents ; adverse effects ; therapeutic use ; Arthritis, Rheumatoid ; drug therapy ; Drug Therapy, Combination ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Retrospective Studies ; Treatment Failure