We report a case of spinal tuberculosis with concomitant presence of tuberculosis psoas abscesses. A 27 yearold male patient presented with 10month history of lower back pain and a recently appeared, increasing in size, gluteal mass. Patient appeared with low-grade fever and mildly elevated inflammation markers. Magnetic resonance imaging (MRI) revealed the two psoas abscesses and spondylitis of T12-L1 vertebrae. Drainage of the largest abscess was performed, samples were cultured and PCR for mycobacterium tuberculosis was performed. After the positive result from PCR and exclusion of concomitant tuberculosis of other organs the patient was treated with isoniazid, rifampicin, ethambutol and pyrazinamide and the use of spinal orthotics for stabilization of the spine. Culture results confirmed the diagnosis of spinal tuberculosis. Patient was followed up during the year he received the treatment and remained asymptomatic with improvement of imaging findings. Pott’s disease accounts for a small percentage of all tuberculosis cases, while skeletal tuberculosis accounts for almost half of extra-pulmonary tuberculosis. Among spinal tuberculosis patients only a 5% suffers from concomitant psoas abscesses. Since skeletal tuberculosis has an insidious clinical course and can lead to serious disability if undiagnosed, high clinical suspicion by the physician is essential for early diagnosis and management

Prosthetic joint infection is a rare but severe complication of arthroplasties, quite challenging to diagnose, especially when the pathogenic microorganisms are difficult to isolate. Granulicatella, a nutritionally deficient microorganism, is a normal component of the oral flora which under specific circumstances may be pathogenic. We report a prosthetic knee joint infection by Granulicatella adiacens, 8 years after total arthroplasty, on 76-a yearold woman. Laboratory diagnosis was achieved via a novel combined technique, using the pioneering sonication method on the implant and inoculation of the sonication fluid in a pediatric blood culture bottle (sonication fluid vial culture). This technique requires further investigation since its promising results appear to open a new direction in diagnosis of prosthetic joint infections

We report the case of a 31-year-old, previously healthy woman, with bilateral hip pain six months after ovarian stimulation for oocytes retrieval. Plain radiographs of both hips as well as clinical examination at that time, which were performed at a different hospital, showed normal findings. Three months later, however, the patient presented to our department with progressive hip pain. MRI examinations were performed on both hips and revealed bilateral osteonecrosis of the femoral head (Ficat I). Conservative treatment was recommended but the patient failed to complete the suggested clinical reevaluations during this conservative management period and reappeared 17 months after her last visit to our department. At that time, radiographs revealed remarkable collapse of both femoral heads. Consequently, cementless ceramic - ceramic total hip arthroplasty was performed, first on the right hip and three months later on the left.

Juvenile dermatomyositis (JDM) is a relatively rare, multi-systemic autoimmune disease, which combines inflammatory myopathy, characteristic cutaneous findings and symptoms of other organ systems. In JDM the basic characteristic is the skin and muscle vasculitis, although the first sign of JDM is usually a skin rash in a V-shaped pattern that may be red and patchy, with typically red or purplish color on the eyelids (“heliotrope” rash), cheeks, or both. The medications used for the relief of symptoms of dermatomyositis are corticosteroids, cyclosporine, intravenous immunoglobulin, cyclophosphamide, methotrexate, and biological agents. Evidence shows that children with low-activity dermatomyositis should be able to safely perform aerobic exercise and resistance- based exercise regimes to reduce disease activity and improve circulation in the resting phase, but also during exercise. Until now, both pharmaceutical therapy and physiotherapy have been proven the best way to treat the disease so that patients achieve complete remission without disease-related complications or any use of steroids.

Pseudohypoparathyroidism (PHP) is a heterogeneous inherited disease characterized by unresponsiveness to parathyroid hormone (PTH) in its target organs. The constant finding in patients with PHP is hypocalcemia and hyperphosphatemia with elevated serum PTH levels. Several distinct entities cluster this disorder. PHP type 1 differs from PHP type 2 in that there is a reduced urinary cAMP excretion in response to administration of PTH. Here we report a young female with PHP at late-onset, yet to be differentiated between type 1b and type 2 due to economic struggles that most of our patients face now days. Despite the circumstances the patient was put on treatment since diagnosis with improvement of all biochemical parameters and amelioration of symptomatology. Further diagnostic testing will be held as soon as possible to meet the definitive diagnosis.

Ankylosing spondylitis (AS) is an inflammatory rheumatic disorder that burdens predominantly the spine and sacroiliac joints. The exact factors that define the development and evolution of the AS remain unclear. The ambiguity around the therapeutic treatment of vitamin D, regarding its immunomodulatory and anti-inflammatory effects in the development of the AS, provides an attractive field of investigation. The connection of the disease with intestinal gut microbiota is well documented, allowing for investigating the role of nutrition, including prebiotics and probiotics, on well-being and functionality of people with AS. The beneficial effect of low starch diet and the anti-inflammatory effect of the Mediterranean diet are landmarks in the development of AS. Additionally, it can be argued that the progression of the disease was compounded, among the Inuit population of Alaska, by the change in their nutrition that was rich in omega-3 polyunsaturated fatty acids and low carbohydrate, to a “Western-Diet” that is high in carbohydrate (sugar and starch) and saturated fat. This review investigates the relationship between diet and disease progression, as well as identifies a dietary pattern that could improve the well-being of people with AS. Finally, this review investigates the therapeutic effect of vitamin D supplementation in the disease progress.

Background: It is known that humans live under the strong influence of light/dark cycles associated with the day/night changes created by the 24-hour rotation of the earth. Yet, it is possible that the circadian rhythm could be disrupted from the presence of a disease and/or changes in body homeostasis. The aim of the present study was to search for an association in patients with adrenal adenomas between cortisol circadian rhythm and osteopathies. Materials and Methods: Twenty eight patients with a history of adenoma, osteopathy or both participated. Patients were tested for routine biochemical factors as well as cortisol levels at 8 a.m., 1 p.m., 5 p.m. and 11 p.m., as well as ACTH and urine cortisol. Results: Significant differences were observed in SGOT levels Free-T₄, FSH and K⁺ in subjects with and without any history of osteopenia or osteoporosis manifesting lower levels as compared to subjects with a history of osteopenia or osteoporosis. At the same time cortisol remained similar among all patient groups. Discussion: Although there is no conclusive evidence, cortisol levels appear to remain untouched by the disease states and thus it appears that circadian rhythms are regulated through an alternative circuitry.

The fractures of the lesser tuberosity of the humerus commonly present with fracture of the head of the humerus and/or posterior dislocation of the shoulder. We report a case of a 58 year old female that sustained an isolated avulsion fracture of the lesser tuberosity following a fall which is extremely rare. Furthermore, the tendon of the biceps was not displaced and subsequently conservative rehabilitation management was followed with excellent results.

Camurati-Engelmann disease (CED) is a rare autosomal dominant disease characterized by heavily thickened long bones, pelvis and skull. Deafness is a common finding, due to the compression of nerves and blood vessels by thickened skull bones, and is usually difficult to manage. Herein, we report a young female diagnosed with CED since her adolescence, with gradual deterioration of hearing of mixed type, where conservative medical treatment proved ineffective, confirming the key role of early decompressive surgery in such cases.

Objective: Zygomaticomaxillary complex (ZMC) fractures represent a common type of facial fractures, sometimes associated with defects of the orbital floor that may escape diagnosis, unless investigated intraoperatively following open reduction. The aim of the study was to determine the frequency of orbital floor defects among cases of ZMC fractures treated with open reduction in our Department and to share our experience in the diagnostic and therapeutic approach of such defects. Patients and methods: The files of all patients, treated in our Department for ZMC fractures from January 2010 to October 2014 were retrieved and reviewed retrospectively. Specific related data were registered and submitted to thorough analysis. Results: Based on our findings a considerable percentage (34.1%) of the patients with ZMC fractures demonstrated considerable defects of the orbital floor; these were diagnosed through intraoperative exploration of the orbital floor following open reduction of the fractures and appropriately treated. Conclusions: Orbital floor defects associated with ZMC fractures may remain undiagnosed and therefore untreated, unless routine exploration of the orbital floor is performed following open reduction of the fractures. This could result in severe morbidity, including enofthalmos, restricted ocular mobility and impaired visual acuity.

The antinuclear antibody (ANA) testing is an indispensable diagnostic tool for the management of systemic autoimmune rheumatic diseases (SARD). From the initial discovery of ANA identification until today there has been considerable technical progress in ANA testing and standardisation which has allow the development of commercial ANA assay kits that are widespread used in clinical and research practice. In this mini-review we explore the history and recent advancements in ANA testing and provide guidelines to the laboratory interpretation and clinical assessment of ANA results.

Objective: the investigation of the relationship between different basic biochemical parameters of bone metabolism in galactosaemia patients. Methods: Study participants included twenty two patients with an average age 7.97±5.1 years, early diagnosed by newborn screening and dietary treated. Serum biochemical factors including calcium, phosphate, magnesium, alkaline phosphatase (ALP), creatinine, albumin, lipidaemic factors, vitamin-D, hemoglobin and ferritin were determined during a routine biochemical physical examination. Z-BMI, Z-Wt and Z-Ht were estimated for the assessment of normal or delayed growth. Results: Estimated biochemical variables did not demonstrate significant differences between patient groups (e.g. males-females, galactosaemia subtypes). Creatinine manifested lower values whereas ALP manifested highest values as compared to reference ranges. Significant differences were observed with respect to BMI estimates as well as Vitamin D vs. age, body weight vs. height in females. Vitamin D was negatively correlated to creatinine and HDL. Calcium was negatively correlated to creatinine, in all patients. Conclusion: These findings suggest that there is a place for periodic monitoring of basic biochemical bone profile in galactosaemic patients, in order to detect early subtle changes in bone metabolism.