Liposynovitis prepatellaris in a child (Hoffa’s syndrome): Lessons from MRI

AbstractBackgroundLiposynovitis prepatellaris (Hoffa’s syndrome) is a rare condition in children and rarely discussed in the literature. Hoffa’s syndrome can lead to an obscure anterior knee pain resulting from impingement and inflammation of the infrapatellar fat pad.Aim of the workThe aim of this case report is to increase awareness among rheumatologists about this condition among children to avoid erroneous diagnosis of juvenile idiopathic arthritis (JIA) and unnecessary treatment with disease-modifying antirheumatic drugs (DMARDs).Case reportIn this report we presented a 12year-old child with this condition who presented with chronic pain and intermittent swelling involving his right knee. The patient was wrongly diagnosed as a case of JIA and wrongly treated with DMARDs for three years duration. The report will shed light on the characteristic MRI features of this condition and the value to order MRI in such atypical presentation.ConclusionHoffa’s syndrome can present with chronic arthropathy in children that can mimic mono-articular JIA presentation and eventually unnecessary treatment with DMARDs. MRI is generally very helpful from the diagnostic point of view, it clearly depicts Hoffa’s infrapatellar fat pad entrapment and its findings may suggest Hoffa’s syndrome

Testing short-term over/ underreaction hypothesis: empirical evidence from the Egyptian stock exchange

The overreaction hypothesis, as postulated by De Bondt and Thaler (1985) dictates that “stocks that have performed poorly in the past (loser stocks) tend to outperform stocks that have performed well in the past (winner stocks) (DeBondt, et al., 1985). On the other hand, the under-reaction hypothesis argues that stock\u27s return shows momentum, whereby winner stocks continue to exhibit high returns in future periods, reflecting tendency of investors to under-weigh the extent of new information. The aim of this thesis is to investigate whether short-term overreaction or under-reaction appears in the Egyptian Exchange (EGX) over the period of January 1998 to December 2013, making this the first attempt to test these market anomalies in an Arab stock market. The thesis surveys the overreaction/under-reaction literature focusing on the differences in methodologies and results across the various sample markets and timeframes. The thesis compares two standard methodologies in the literature, that of Ali et al (2011) and Clare & Thomas (1995), to test the overreaction/under-reaction hypothesis over various holding periods ranging from one week to 52 weeks. The analysis reveals that while short-term overreaction doesn\u27t exist in the Egyptian Exchange, there is statistically significant evidence of under-reaction for the holding periods of one to four weeks. This motivates further tests to establish the profitability of utilizing this evidence of under-reaction by applying a momentum strategy that invests in winner stocks. The results show that while a momentum strategy can provide significant abnormal returns of up to 0.885% over a holding period of four weeks, when trading costs are taken into account, the profitability of the momentum strategy becomes insignificant. The thesis further analyzes whether size of the company can explain the evidence of under-reaction. This is done on the basis of creating portfolios with large and small capitalization stocks. For large capitalization stocks, an under-reaction that is statistically significant over holding periods from 1 to 3 weeks is found. The overall result for this thesis suggests that while evidence of under-reaction appears for Egyptian listed stocks, this is concentrated in large firms. Investor, however, cannot profit from this market anomaly by applying a momentum strategy since after taking into account trading costs involved in trading Egyptian stocks, the profitability of this strategy diminishes

Chaos Theory and Literature from an Existentialist Perspective

Yasser Khamees Ragab Aman proposes in his article Chaos Theory and Literature from an Existentialist Perspective that in literature the relation, principles, and processes of chaos and order can be analyzed from an existentialist perspective. Chaos lies at the heart of nothingness and order is the appearance of the achievement it tries to realize, temporary it may seem. Aman argues that with the application of chaos theory to works of literature may yield new insight and applies in his paper aspects of chaos theory reading three literary works which represent three different literatures and cultures, namely Arabic, English, and French. Through a comparative textual interpretation of Sartre\u27s Nausea (La Nausée), Lawrence\u27s Sons and Lovers, and Al Hakim\u27s The People of the Cave (Ahl Al-Kahf), Aman\u27s analysis suggests that despite cultural differences literature -- as a primary representation of culture -- shows important similarities and thus suggests the principles and processes of chaos and order as universal systemic characteristics

Antisynthetase Syndrome Complicating the Course of Established Case with Rheumatoid Arthritis:A Rare and Under-recognized Overlapping Disease

A 52-year-old male patient developed RA in March 2009 at the age of 43, with symmetric polyarthritis and active synovitis affecting hands, knees, ankles and both feet without symptoms or signs suggestive of extra-articular features. Laboratory investigations showed negative RF and positive anti-CCP antibodies, negative ANA, negative anti-dsDNA antibodies; the X-rays of both hands showed typical erosive changes in RA and fulfilled the new ACR/EULAR (2010) criteria of RA. The patient achieved remission on a combination of DMARDs. He did well until January 2017 when he developed acute onset of progressive chest pain, dyspnea, and acute respiratory failure. High-resolution CT of the lung showed extensive areas of ground glass veiling, and interstitial subpleural infiltrates were found consistent with aggressive interstitial lung disease (ILD). Autoantibodies against extractable nuclear antigens were screened and showed positive results for anti-RO and anti-Jo1 autoantibodies. The positive anti-Jo1was an expression of anti-synthetase syndrome complicating the RA course and explained the rapidly aggressive course of ILD

Cam versus pincer femoroacetabular impingement. Which type is associated with more hip structural damage?:An exploratory cross-sectional study

Background: Femoroacetabular impingement (FAI) occurs as a conflict between the proximal femur and the acetabular rim. The purpose of this study was to evaluate MRI findings and look for correlations with pain intensity and duration in each type of FAI separately in an attempt to identify which type is associated with more structural damage. Methods: Forty-four patients (78 hips) diagnosed with either cam or pincer FAI were consecutively recruited in a prospective cohort study. None of our patients had evidence of osteoarthritis (OA) on the initial plain radiography. All patients had contrast-enhanced MRI and CT scans of the hips. All patients filled in a visual analogue scale (VAS) for pain. Results: The frequency of bone marrow edema (BME) was 37% in cam FAI and 20.8% in pincer FAI. In cam FAI, BME positively correlated with pain severity as measured by VAS (P<0.0001), cartilage degradation (P=0.001), pseudocysts (P<0.0001), hip effusion (P=0.013) and reactive synovitis (P<0.0001). However, in pincer FAI, BME only correlated with pain severity (P=0.004) and duration (P=0.011) and did not correlate with other MRI signs of structural hip damage. Conclusions: In cam FAI, BME of the femoral head and neck on MRI positively correlated with chondral damage and synovitis, but not in pincer FAI. This correlation suggests that cam FAI might be associated with a worse long-term prognosis. This finding might have an impact on clinical practice and decision making as it would encourage surgeons to intervene early in cases of cam FAI, thus preventing the possible development of irreversible, established hip OA