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Author : Conrad Daugaard | Published On : 18 Apr 2025

Cervical radiculopathy is a common clinical condition with an annual incidence of 85/10,000. Refractory cases with positive disco-vertebral imaging findings are routinely referred to the Neurosurgeon for evaluation and treatment. In the absence of a clearcut compressive etiology, other rarer but surgically curable causes must be considered before recommending conservative management. We discuss the case of an otherwise active, healthy patient with an invalidating, refractory, relapsing nuchal pain and cervical radiculopathy. Only careful and state-of-the-art neuroimaging led to the correct diagnosis an osteoid osteoma of the right C6 lamina was diagnosed and microsurgically resected allowing complete recovery and cure. The clinical features of these rare tumors in this unusual location are reviewed. The case is relevant for multifold reasons it draws attention to rare conditions which can mimic radicular compression; emphasizes the need for a careful evaluation and appreciation of specific clinical symptoms and signs associated with non-compressive radiculopathies; prompts planning of a state of the art imaging workup, in order to rule out such an elusive tumor. All these measures minimize the risk of overlooking the present and other rare pathologies, sparing patients a long path of time-consuming, frustrating and cost-ineffective studies and treatment modalities.Background Tocilizumab, an interleukin-6 (IL-6) receptor antagonist, has been used in patients with coronavirus disease 2019 (COVID-19) as an anti-cytokine agent. IL-6 also plays a complex role in hemostasis and thrombosis. We observed a transient elevation of D-dimer in our patients who received tocilizumab, which triggered this study. Methods A retrospective hospital-based cohort analysis of patients with confirmed COVID-19 who received tocilizumab during the study period of March 15, 2020, to May 20, 2020, was conducted. We retrieved demographic, clinical, and laboratory data, and patients who were receiving therapeutic anticoagulation therapy prior to tocilizumab administration were excluded. Descriptive analysis was performed, and the cause of death and trends of D-dimer and inflammatory markers were studied. Results Out of the 436 confirmed COVID-19 patients admitted during the study period, 24 met the inclusion criteria. Their median age was 47.5 years. They were 18 males and 6 females; 15 patients survived and nine expired. Of the group that survived, 12 received therapeutic anticoagulation. Of the seven patients who did not receive therapeutic anticoagulation, four expired (one from sepsis and three probably from thromboembolic complications) compared to five deaths in the 17 patients who received therapeutic anticoagulation (four from sepsis and one possibly from thromboembolic complications). Conclusions The interplay between IL-6, IL-6 receptor antagonist, and venous thromboembolism is complex. We observed a transient elevation of D-dimer in COVID-19 patients who received tocilizumab, and a trend toward increased death secondary to thromboembolism. This observation is novel and highlights the potential thrombophilic side effects of tocilizumab.
In March 2020, the World Health Organization declared the severe acute respiratory syndrome (SARS) (coronavirus disease, COVID-19) outbreak as a pandemic.In response to the rising number of coronavirus cases in the United Kingdom, the British Orthopaedic Association (BOA) issued a series of emergency guidelines for the management of trauma and orthopedic patients during the pandemic.In line with this guidance, the orthopedic team at the Worcestershire Royal Hospital set up a 'one-stop-shop' minor injuries unit (MIU). This seven-day service provided a direct pathway to the trauma clinic for ambulatory patients who would usually be managed in the emergency department (ED), intending to reduce both the pressure on the ED and the need for further follow-up appointments. The aim of this project was to evaluate the service provided to patientsand to inform our practice during the next stages of the pandemic and beyond.

Data were collected retrospectively from a clinic database, dictated letters, and scanned patMIU instead, relieving pressure on the ED. The lessons learned allowed us to plan for the 'second peak' in COVID-19 cases and will inform ongoing practice as we work to recover elective services.
We delivered a seven-day minor injuries service in which the majority of patients received definitive management at first attendance, reducing the demand for fracture clinic appointments. Some 700 patients who would have been treated in the ED were seen in the MIU instead, relieving pressure on the ED. The lessons learned allowed us to plan for the 'second peak' in COVID-19 cases and will inform ongoing practice as we work to recover elective services.Edwards syndrome, or trisomy 18, is an uncommonly encountered aneuploidy in which multiple organs are affected and have compromised function. Only 13% of neonates born with Edwards syndrome survive beyond their first year of life. In this paper, we report the case of a 16-year-old girl with non-mosaic (with meiotic non-disjunction) Edwards syndrome who survived long beyond the expected life span of less than two years. learn more She was diagnosed by karyotyping at the age of one month with complete trisomy 18. She had global developmental delay, a diaphragmatic hernia, recurrent chest infections, juvenile idiopathic scoliosis of the thoracolumbar region, neurogenic bladder, fecaloma, bilateral exposure keratopathy, and failure to thrive.Marginal zone lymphoma (MZL) is a relatively uncommon subtype of non-Hodgkin lymphoma consisting of extranodal, nodal, and splenic MZL. Mucosa-associated lymphoma constitutes the majority of extranodal MZL including but not limited to the stomach, lung, salivary gland, ocular adnexa, skin, and thyroid. Depending on the site of origin, maltoma may present with different symptoms. Here we present a patient who presented to the pulmonary clinic for further evaluation of a right middle lobe consolidation. She was treated with a course of antibiotics empirically with no interval change in imaging. She underwent bronchoscopy with biopsy. Pathology was remarkable for extensive lymphoid infiltrates consisting of mixed B and T lymphocytes. Positron emission tomography (PET) CT demonstrated mild uniform uptake in consolidation with no evidence of PET avid distant metastasis. CT-guided biopsy was consistent with extranodal marginal zone lymphoma. She underwent right middle lobectomy with no complications. As mentioned in our case, bronchoscopy is usually nondiagnostic and a lung biopsy is needed in pulmonary maltoma.