Human Herpesvirus 8-Positive Multicentric Castleman Disease in an Immunocompetent Patient: A Diagnostic Challenge

We present a clinical case of a 79-year-old male admitted to inpatient care for longstanding asthenia and respiratory symptoms. Associated features were polyserositis, multiple enlarged lymphatic nodules, acute kidney injury, and heart failure. The patient's recent medical history revealed SARS-CoV-2 vaccination a week prior and an upper respiratory tract infection. The laboratory results from thoracentesis were compatible with a transudate, with no immunological stain. Epstein-Barr virus polymerase chain reaction (PCR) was positive. The thoracic, abdominal, and pelvic CT scans revealed multiple enlarged lymphatic nodules, worsening the pre-existent polyserositis and hepatosplenomegaly. The patient began to show signs of neurologic symptoms and deterioration of the global health status. An enlarged lymphatic nodule was excised and the pathology showed human herpesvirus 8 multicentric Castleman disease. The disease evolved rapidly into hematological dysfunction and blood transfusions were necessary. Even though the patient was started on high-dose rituximab therapy combined with etoposide, the disease evolved into multiorgan dysfunction with a fatal outcome.

The clinical outcome of physiotherapy after reversed shoulder arthroplasty: a systematic review

PURPOSE

The purpose of this systematic review was to analyze the current literature on the clinical outcomes of physiotherapy (PT) program after reversed total shoulder arthroplasty (rTSA) and to summarize the improvements in this population.

METHODS

A search was performed in four databases (MEDLINE, Embase, PubMed, Google Scholar) from its inception to 30 April 2020. Data were extracted to describe the study design and rehab programs. The quality of evidence was assessed as high, moderate, and low-level according to the Evaluation of Quality of an Intervention Study critical appraisal criteria.

RESULTS

There were 22 eligible studies including two randomized controlled trials, four prospective cohort studies, 10 retrospective reviews, five case-series, and one case-control study, with the sample sizes ranging from 9 to 474 patients followed for 1-10 years. All studies indicated substantial improvement in patients after PT program in terms of functional outcomes and forward flexion.

CONCLUSIONS

High-quality RCTs are required to provide more conclusive results. We identified substantial variation in the post-operative PT programs except for the progressive mobilization strategy and the common management following surgery to increase the soft tissue healing within 4-6 weeks.Implications for RehabilitationThe reverse shoulder arthroplasty (rTSA) has been widely utilized for patients with rotator cuff arthropathy, primary arthritis, and proximal fractures.A successful outcome of rTSA is not only depending on the surgical management, but also depended on physiotherapy (PT) programs.Our systematic review concluded that a 12-week PT program starting with immobilization for 4-6 weeks, followed by 3-4 phases PT exercises including PROM, AAROM, AROM, and strength training was recommended as common management for patients received rTSA.Due to the huge variation in the included studies, the evidence of PT protocol in our study was not sufficient to summarize the better clinical practice suggestions regarding rTSA rehabilitation.

Psychometric Properties of the Patient-Specific Functional Scale in Patients with Low Back Pathology: A Systematic Review and Meta-Analysis

Purpose: This systematic review and meta-analysis identifies, critically appraises, synthesizes, and meta-analyses the reported psychometric properties of the Patient-Specific Functional Scale (PSFS) in patients with low back pain or pathology. Method: The MEDLINE, Embase, PubMed, and Google Scholar databases were searched from their inception to September 2019. We included prospective measurement studies that reported on the psychometric properties (reliability, validity, responsiveness) of the PSFS in people with low back pain or pathology. We followed the COnsensus-based Standards for the selection of health Measurement INstruments 2018 guideline for systematic reviews. We performed both quantitative and qualitative syntheses in which the results were summarized on the basis of the reported measurement properties and study quality. Results: Ten eligible studies were included. The pooled PSFS reliability measure was excellent (intra-class correlation coefficient = 0.89; 95% CI: 0.75, 0.95). Validity measures displayed correlations that ranged from -0.47 to 0.69 when compared with other patient-reported outcome measures (PROMs) or other tests. Eight studies had assessed the responsiveness of the PSFS. Effect sizes reported were large (≥ 0.91). Conclusions: The PSFS is a reliable, valid, and responsive PROM for patients with low back pain or pathology.

Effects of changes in micro-weather conditions on structural features, total protein and carbohydrate content in leaves of the Atlantic rain forest tree golden trumpet (Tabebuia chrysotricha)

Golden trumpet, Tabebuia chrysotricha, is a native tree from the Brazilian Atlantic rain forest, with a broad latitudinal distribution. In this study, we investigated the potential effects of short-term changes in micro-weather conditions on structural features, and total protein and carbohydrate content of golden trumpet leaves, using structural and histochemical approaches. Leaves were harvested in four different micro-weather conditions: 1. Afternoon, after a hot, sunny day; 2. at dawn, after a previously hot, sunny day; 3. at noon, of a hot, sunny day; and 4. at noon, of a cold, cloudy day. Leaflets exposed to low light irradiance showed flattened chloroplasts, uniformly distributed within the cells, throughout the palisade parenchyma. Conversely, leaflets exposed to high light irradiance presented flattened and rounded chloroplasts, in the upper and lower palisade parenchyma cells, respectively. The strongest protein staining was found for leaves harvested at the coldest period, whereas the weakest protein staining was found for leaves harvested after a hot, sunny day. The largest and most numerous starch grains were found for leaves harvested in the afternoon, after a hot, sunny day. Conversely, the smallest and less numerous starch grains were found for leaves harvested at dawn. Analysis of the data reported herein suggests that the leaflet responses to transient changes in micro-weather conditions are likely to contribute to the golden trumpet successful establishment in the broad latitudinal distribution in which the species is found.

The posterior condylar offset ratio and femoral anatomy in anterior versus posterior referencing total knee arthroplasty

BACKGROUND

The preservation of joint anatomy is one of the key issues in total knee arthroplasty. The effect of the prosthesis' referencing system, relative to femoral anatomy, remains unknown. It was sought to determine if femoral anatomy, following total knee arthroplasty is better maintained using either anterior referencing or posterior referencing prosthesis. The posterior condylar offset ratio (PCOR) was employed for preoperative and postoperative radiographic comparison of femoral condyles. It was hypothesized that posterior referencing prosthesis would better restore condylar morphology.

METHODS

Sixty-six patients undergoing a total knee arthroplasty with anterior referenced Zimmer(®) NexGen(®) LPS prosthesis and ninety-one with posterior referenced Tornier(®) HLS Noetos(®) were divided into two groups according to the prosthetic model used and retrospectively compared. PCOR was calculated as the quotient of the distance between the posterior condylar border and the tangent to the posterior cortex of the femoral diaphysis, and the distance between the posterior condylar border and the tangent to the anterior cortex of the femoral diaphysis. PCOR was determined preoperatively and postoperatively and compared within each group and between both groups.

RESULTS

An increase in the PCOR (P<0.0001) following surgery was observed in both anterior referencing and posterior referencing models. No difference was noted when the postoperative PCOR was compared between both groups (P=0.61).

CONCLUSION

Both anterior and posterior referencing prosthesis lead to a similar increase of the PCOR following total knee arthroplasty.

LEVEL OF EVIDENCE

Level IV.