Use of Ultrasound-Guided Platelet-Rich Plasma in the Treatment of Carpometacarpal Osteoarthritis.

Introduction: Osteoarthritis (OA) is the most common form of arthritis and can severely affect function and quality of life. Platelet-rich plasma (PRP) is derived from a patient's own blood and has potential as an adjunct to treat OA. However, research has been limited for small joints such as the carpometacarpal (CMC) joint. Clinical Findings: A 65-year-old Caucasian male complained of bilateral wrist and neck pain after a motor vehicle accident. His initial exam noted swelling, tenderness and pain with movement at the bilateral thumb CMC joints and anatomic snuffboxes. However, there was no strength, range of motion or tactile deficits during examination. Outcomes: He was found to have moderate to severe OA bilaterally in his left and right CMC joints seen on computed tomography and magnetic resonance imaging. The patient was initially treated with ultrasound (US)-guided steroid injections but did not experience significant improvement. After careful discussion, the patient chose to undergo US-guided injection of PRP into both joints. Follow-up at six weeks after PRP injection revealed that there was functional improvement in both joints as well as objective improvement via the Mayo Wrist Score survey. Conclusion: US-guided PRP injection can be used as an alternative modality to treat OA of the CMC joints when approaches such as conservative therapy and steroid injections have failed. PRP has not been as well studied as other interventions such as corticosteroid injections, but it may offer less long-term adverse effects and be considered a potential alternative or adjuvant to current treatment modalities.

Tuberculoid Leprosy Masquerading as Erythema Induratum.

Introduction: Erythema Induratum (EI) is a relatively rare dermatologic disorder affecting subcutaneous fat tissue, which is often associated with Mycobacterium tuberculosis. This report details the presentation, diagnosis and management in a 70-year-old female who presented with a painful erythematous annular rash at the clinic. The rash was later diagnosed as EI associated with Mycobacterium leprae, one rarely seen in literature. Discussion: EI is a rare form of panniculitis that typically presents as a recurrent grouping of tender nodules and plaques on the posterior aspect of the lower legs. Although EI is considered idiopathic in most cases, it can be associated with M. leprae. Given the atypical presentation of a rash, a biopsy was done. It showed epithelioid granulomatous dermatitis with lobar panniculitis. A DNA polymerase chain reaction (PCR) was also sent and revealed the presence of M. leprae. Treatment of EI without association with M. leprae includes potassium iodide, non-steroidal anti-inflammatory drugs (NSAIDs), rest, elevation, compression and, in severe cases, systemic immunosupressives. If tuberculoid leprosy is confirmed, the attending physician is encouraged to consult the infectious disease department as treatment varies with presentation. Conclusions: This case details the diagnosis and management involved in a case of tuberculoid leprosy masquerading as EI. Management of the EI involved NSAIDs and potassium iodide. The leprosy was treated with dapsone and rifampin in conjunction with an infectious disease consultation. Our case highlights the importance of relying on a strong clinical suspicion based on a patient's social history in order to diagnose rare entities accurately.

A Rare Presentation of Bilateral Bochdaleck Congenital Diaphragmatic Hernia, a Case Study.

Introduction: Congential diaphragmatic hernias (CDH) are a rare process that have a prevalence of 1-4 cases per 10,000 live births, and of these, bilateral Bochdalek congenital diaphragmatic hernias are even rarer entities that occur in about 1% of cases. This finding is rarely documented in literature. This paper offers a detailed methodical timeline documentation of the events that occurred after delivery and includes how to approach the diagnosis and management of such a rare and volatile condition. Presentation: The neonate was born at 35 weeks and 6 days gestation. Unfortunately, despite intensive cardiopulmonary resuscitation efforts, the neonate expired within less than one hour after delivery. Diagnosis of a bilateral diaphragmatic Bochdalek hernia was confirmed during the autopsy report and was evidenced by chest x-rays and clinical course. The autopsy revealed pulmonary aplasia/hypoplasia with weight being 12.8% of normal lung weight. Hepatomegaly, splenomegaly, nephromegaly and abdominal contents were in the bilateral pleural cavities. Conclusion: This case report can be used to guide health care practitioners who come across neonates presenting with possible signs and symptoms of a rare but severe case of bilateral CDH. Management with enhanced prenatal care and hospital resources is needed to improve the chances of successful resuscitation in a neonate that presents with bilateral CDH.

The role of select subtype polymorphisms on HIV-1 protease conformational sampling and dynamics.

HIV-1 protease is an essential enzyme for viral particle maturation and is a target in the fight against HIV-1 infection worldwide. Several natural polymorphisms are also associated with drug resistance. Here, we utilized both pulsed electron double resonance, also called double electron-electron resonance, and NMR (15)N relaxation measurements to characterize equilibrium conformational sampling and backbone dynamics of an HIV-1 protease construct containing four specific natural polymorphisms commonly found in subtypes A, F, and CRF_01 A/E. Results show enhanced backbone dynamics, particularly in the flap region, and the persistence of a novel conformational ensemble that we hypothesize is an alternative flap orientation of a curled open state or an asymmetric configuration when interacting with inhibitors.