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(A) La RM inicial reveló edema metafisario y diafisario en la tibia derecha (flecha). No se aisló ningún patógeno y la enfermedad se clasificó como osteomielitis bacteriana sin etiología microbiológica identificada. (B) A los 5 meses, tuvo un episodio similar en la extremidad inferior izquierda, y la RM reveló edema metafisario y diafisario en la tibia izquierda (flecha), llevando al diagnóstico de OMCR. (C-E) Niña de 11 años que presentó dolor y signos de inflamación local en la extremidad inferior derecha con elevación leve de la VSG (24<span class="elsevierStyleHsp" style=""></span>mm/h) y la PCR (3<span class="elsevierStyleHsp" style=""></span>mg/L). Antecedente de dolor de espalda de un año de duración. La RMCE en secuencia STIR <span class="elsevierStyleItalic">(short tau inversion recovery)</span> reveló múltiples focos de edema óseo: en la metáfisis tibial (flechas en C), en el cuerpo vertebral de T7 (flecha en D), y la pared posterior del acetábulo (flecha en E). (F-K) Adolescente varón de 14 años que presentó dolor y signos de inflamación local en la extremidad inferior izquierda y elevación leve de la VSG (80<span class="elsevierStyleHsp" style=""></span>mm/h) y la PCR (3<span class="elsevierStyleHsp" style=""></span>mg/L). (F) La radiografía anteroposterior inicial mostró una lesión lítica excéntrica adyacente a la fisis al nivel de la metáfisis de la tibia distal (flecha), con reacción perióstica discontinua (cabeza de flecha). (G) Cinco meses después, el tamaño de la lesión había disminuido (flecha) y la reacción perióstica era continua (cabeza de flecha). (H) A los 2 años, la lesión se había resuelto, con esclerosis ósea residual mínima (flecha). (I) RM al diagnóstico con visualización de una lesión transfisaria: hipointensa en secuencias T1 (flecha) e (J) hiperintensa en secuencias T2 (flecha). (K) Realce intenso de la lesión ósea y los tejidos blandos circundantes (flecha).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Raquel Lisbona, Melania Martínez-Morillo, María Méndez, Damian García-Perdomo, Ricard Pérez-Andrés" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Raquel" "apellidos" => "Lisbona" ] 1 => array:2 [ "nombre" => "Melania" "apellidos" => "Martínez-Morillo" ] 2 => array:2 [ "nombre" => "María" "apellidos" => "Méndez" ] 3 => array:2 [ "nombre" => "Damian" "apellidos" => "García-Perdomo" ] 4 => array:2 [ "nombre" => "Ricard" "apellidos" => "Pérez-Andrés" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287923001060" "doi" => "10.1016/j.anpede.2023.03.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287923001060?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403323000887?idApp=UINPBA00005H" "url" => "/16954033/0000009800000006/v1_202306021130/S1695403323000887/v1_202306021130/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287923001072" "issn" => "23412879" "doi" => "10.1016/j.anpede.2023.05.002" "estado" => "S300" "fechaPublicacion" => "2023-06-01" "aid" => "3445" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2023;98:472-4" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Serious systemic toxicity after application of topical lidocaine" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "472" "paginaFinal" => "474" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Toxicidad sistémica grave tras la aplicación de lidocaína tópica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1276 "Ancho" => 2175 "Tamanyo" => 145119 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Evolution of the serum levels of lidocaine.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">*The therapeutic range given in the literature is of 1.5–5<span class="elsevierStyleHsp" style=""></span>μg/mL.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Piotr Z. 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0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Melania" "apellidos" => "Martínez-Morillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "María" "apellidos" => "Méndez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Damian" "apellidos" => "García-Perdomo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Ricard" "apellidos" => "Pérez-Andrés" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Sección de Radiología Musculoesquelética, Hospital Germans Trias i Pujol, Badalona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Germans Trias i Pujol, Badalona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Pediatría, Hospital Germans Trias i Pujol, Badalona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Osteomielitis crónica multifocal recurrente: claves para el diagnóstico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1776 "Ancho" => 3341 "Tamanyo" => 424885 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Boy aged 2 years who presented with pain and signs of local inflammation in the right lower extremity with mild elevation of the ESR (34 mm/h) y la CPR (4 mg/L). (A) The initial MRI detected metaphyseal and diaphyseal oedema in the right tibia (arrow). A pathogen was not isolated, and the disease was classified as bacterial osteomyelitis of unknown aetiology. (B) Five months later, he had a similar episode in the left lower extremity, and the MRI scan revealed metaphyseal and diaphyseal oedema in the left tibia (arrow), leading to diagnosis of CRMO. (C–E) Girl aged 11 years who presented with pain and local inflammatory signs in the right lower extremity with mild elevation of the ESR (24 mm/h) and CPR level (3 mg/L). History of back pain of one year’s duration. The short tau inversion recovery (STIR) whole body MRI images revealed multiple foci of bony oedema: in the tibial metaphysis (arrows in C), in the body of T7 (arrow in D), and in the posterior wall acetabulum (arrow in E). (F–K) Male adolescent aged 14 years who presented with pain and signs of local inflammation in the left lower extremity and mild elevation of the ESR (80 mm/h) and CPR (3 mg/L). (F) The initial anteroposterior radiograph detected an eccentric lytic lesion adjacent to the physis at the level of the metaphysis of the distal tibia (arrow), with a discontinuous periosteal reaction (arrowhead). (G) Five months later, the lesion had decreased in size (arrow) and the periosteal reaction was continuous (arrowhead). (H) Two years later, the lesion had resolved with minimum residual bone sclerosis (arrow). (I) MRI at diagnosis with visualization of a transphyseal lesion: hypointense in T1-weighted images (arrow) and (J) hyperintense in T2-weighted images (arrow). (K) Intense enhancement of the bony lesion and surrounding soft tissues (arrow).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present 6 cases of chronic recurrent multifocal osteomyelitis (CRMO) in a cohort of children and adolescents; the clinical and demographic characteristics of the cases are summarised in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, and radiological images can be found in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. The patients presented with insidious bone or joint pain associated with local swelling, warmth and tenderness at the affected site and functional impairment.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">One of the patients had nail pitting secondary to psoriasis, which was diagnosed before CRMO. Another patient had fever of up to 39 °C. The rest did not present with constitutional symptoms, with a mean temperature at diagnosis of 37.1 °C.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Four patients had multifocal disease and 2 unifocal disease. Four experienced recurrences at the original site and 1 at a different site (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, A and B), and one did not experience recurrence.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In every case, the results of laboratory tests at diagnosis were normal, with the exception of mild elevation of the erythrocyte sedimentation rate (ESR) and C-reactive protein (CPR), with mean values of 72 mm/h and 21 mg/L, respectively.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The initial radiographs were also normal in every case but one, in which a radiographic pattern indicative of aggressive disease was identified at the distal tibial metaphysis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, F–K).</p><p id="par0030" class="elsevierStylePara elsevierViewall">All patients underwent a bone biopsy guided by computed tomography (CT) and a magnetic resonance imaging (MRI) scan of the involved regions. The findings ruled out infectious or malignant disease in every case and evinced mild inflammatory changes in the bone marrow. Four patients also underwent a whole body MRI scan (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, C–E), which evinced vertebral involvement in all and vertebral collapse in 3.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Three patients received an initial diagnosis of bacterial osteomyelitis of unknown aetiology and empiric antibiotherapy until CRMO was diagnosed. In 3 patients, treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) achieved remission, while another 3 required second-line treatment: 2 with pamidronate and 1 with etanercept.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Chronic recurrent multifocal osteomyelitis is an autoinflammatory disease of bone that develops in children and adolescents.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Comorbidities such as psoriasis, palmar plantar pustulosis, inflammatory bowel disease or inflammatory arthritis may cooccur or precede the diagnosis of CRMO.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In this case series, one patient presented with nail pitting. Clinically, CRMO is characterised by insidious bone or joint pain in at least one site, with focal swelling, warmth and tenderness, and may cause functional impairment. At onset, the bone changes may be limited to a single location, or there may be multiple foci. Although our series did not include any patients with clavicular involvement, most previous studies agree that clavicular osteomyelitis is suggestive of CRMO.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Symptoms may recur or remit, and fewer than 5% of affected patients have constitutional symptoms, like weight loss or fever.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In agreement with the previous literature, the laboratory values at diagnosis of CRMO were normal or there was mild elevation of the ESR and CPR levels.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">There are no universally accepted criteria for the diagnosis of CRMO, although some have been proposed (Bristol criteria, Jansson criteria),<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> and it continues to be a diagnosis of exclusion, chiefly through ruling out malignant disease and infection.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Plain radiography is frequently the initial imaging modality used in the diagnosis of CRMO in the early stages, but it usually does not detect specific pathological features. When present, they tend to be focal metaphyseal lytic lesions,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> which was the case in only one of our patients (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Magnetic resonance imaging is particularly sensitive, even in the early stages, and frequently detects the presence of asymptomatic bony oedema and soft tissue changes.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">If the disease is multifocal, unifocal with involvement of the clavicle or recurrent, CRMO should be suspected, and whole-body MRI is the gold standard of diagnosis. Whole-body MRI can detect multifocal involvement and is useful for the assessment of disease activity and to identify potential skeletal complications, such as vertebral fractures or bony deformities due to premature physeal closure.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In our series, half the patients experienced vertebral collapse during the course of disease. This highlights the importance of appropriate diagnosis, treatment and follow-up in these patients. Lastly, several studies show that at present, a bone biopsy is performed in 70%–80% of patients,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> particularly in those with unifocal involvement and atypical location of disease, early onset (age <2 years) or atypical response to treatment.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However, in our case series, a biopsy was performed in every patient to rule out alternative diagnoses. In children presenting with unifocal pain, the differential diagnosis is broad, and CRMO should be considered when biopsy findings and blood culture results rule out infection and malignant disease.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1776 "Ancho" => 3341 "Tamanyo" => 424885 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A and B) Boy aged 2 years who presented with pain and signs of local inflammation in the right lower extremity with mild elevation of the ESR (34 mm/h) y la CPR (4 mg/L). (A) The initial MRI detected metaphyseal and diaphyseal oedema in the right tibia (arrow). A pathogen was not isolated, and the disease was classified as bacterial osteomyelitis of unknown aetiology. (B) Five months later, he had a similar episode in the left lower extremity, and the MRI scan revealed metaphyseal and diaphyseal oedema in the left tibia (arrow), leading to diagnosis of CRMO. (C–E) Girl aged 11 years who presented with pain and local inflammatory signs in the right lower extremity with mild elevation of the ESR (24 mm/h) and CPR level (3 mg/L). History of back pain of one year’s duration. The short tau inversion recovery (STIR) whole body MRI images revealed multiple foci of bony oedema: in the tibial metaphysis (arrows in C), in the body of T7 (arrow in D), and in the posterior wall acetabulum (arrow in E). (F–K) Male adolescent aged 14 years who presented with pain and signs of local inflammation in the left lower extremity and mild elevation of the ESR (80 mm/h) and CPR (3 mg/L). (F) The initial anteroposterior radiograph detected an eccentric lytic lesion adjacent to the physis at the level of the metaphysis of the distal tibia (arrow), with a discontinuous periosteal reaction (arrowhead). (G) Five months later, the lesion had decreased in size (arrow) and the periosteal reaction was continuous (arrowhead). (H) Two years later, the lesion had resolved with minimum residual bone sclerosis (arrow). (I) MRI at diagnosis with visualization of a transphyseal lesion: hypointense in T1-weighted images (arrow) and (J) hyperintense in T2-weighted images (arrow). (K) Intense enhancement of the bony lesion and surrounding soft tissues (arrow).</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">CPR, C-reactive protein; ESR, erythrocyte sedimentation rate; F, female; M, male; NSAID, nonsteroidal anti-inflammatory drug.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age/sex \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">ESR (mm/h) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CPR<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>(mg/L) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Temperature (°C) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Cutaneous manifestations \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Presentation \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of episodes \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Initial X-ray \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Treatment \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Biopsy \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Vertebral collapse \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35.9 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Nail pitting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multifocal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NSAID \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multifocal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NSAID + pamidronate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">100 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37.5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multifocal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NSAID \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Multifocal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Lytic lesion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NSAID + etanercept \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Yes \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9/F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">115 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">37 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unifocal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NSAID + pamidronate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2/M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unifocal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Normal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NSAID \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3185603.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peak CPR value during the episode.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Characteristics of the cohort.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "When local bone pain is just the tip of the iceberg—a case report of three patients with chronic multifocal recurrent osteomyelitis and some red flags to help make the diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Wobma" 1 => "D. Jaramillo" 2 => "L. Imundo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3389/fped.2019.00407" "Revista" => array:5 [ "tituloSerie" => "Front Pediatr" "fecha" => "2019" "volumen" => "7" "paginaInicial" => "407" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31681708" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The many faces of pediatric chronic recurrent multifocal osteomyelitis (CRMO): a practical location- and case-based approach to differentiate CRMO from its mimics" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.J. Menashe" 1 => "H. Aboughalia" 2 => "Y. Zhao" 3 => "A.V. Ngo" 4 => "J.P. Otjen" 5 => "M.M. Thapa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/jmri.27299" "Revista" => array:6 [ "tituloSerie" => "J Magn Reson Imaging" "fecha" => "2021" "volumen" => "54" "paginaInicial" => "391" "paginaFinal" => "400" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32841445" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic nonbacterial osteomyelitis in children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Koryllou" 1 => "M. Mejbri" 2 => "K. Theodoropoulou" 3 => "M. Hofer" 4 => "R. Carlomagno" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/children8070551" "Revista" => array:5 [ "tituloSerie" => "Children (Basel)" "fecha" => "2021" "volumen" => "8" "paginaInicial" => "551" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34202154" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chronic recurrent multifocal osteomyelitis (CRMO) — advancing the diagnosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.R. Roderick" 1 => "R. Shah" 2 => "V. Rogers" 3 => "A. Finn" 4 => "A.V. Ramanan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s12969-016-0109-1" "Revista" => array:5 [ "tituloSerie" => "Pediatr Rheumatol Online J" "fecha" => "2016" "volumen" => "14" "paginaInicial" => "47" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27576444" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Classification of non-bacterial osteitis: retrospective study of clinical, immunological and genetic aspects in 89 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Jansson" 1 => "E.D. Renner" 2 => "J. Ramser" 3 => "A. Mayer" 4 => "M. Haban" 5 => "A. Meindl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rheumatology (Oxford)" "fecha" => "2007" "volumen" => "46" "paginaInicial" => "154" "paginaFinal" => "160" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000009800000006/v1_202306061300/S2341287923001060/v1_202306061300/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009800000006/v1_202306061300/S2341287923001060/v1_202306061300/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287923001060?idApp=UINPBA00005H" ]
Year/Month | Html | Total | |
---|---|---|---|
2024 November | 7 | 12 | 19 |
2024 October | 86 | 43 | 129 |
2024 September | 72 | 30 | 102 |
2024 August | 69 | 50 | 119 |
2024 July | 63 | 31 | 94 |
2024 June | 59 | 47 | 106 |
2024 May | 69 | 47 | 116 |
2024 April | 49 | 34 | 83 |
2024 March | 53 | 16 | 69 |
2024 February | 98 | 34 | 132 |
2024 January | 76 | 33 | 109 |
2023 December | 75 | 26 | 101 |
2023 November | 91 | 37 | 128 |
2023 October | 78 | 44 | 122 |
2023 September | 81 | 44 | 125 |
2023 August | 60 | 23 | 83 |
2023 July | 34 | 26 | 60 |
2023 June | 116 | 44 | 160 |
2023 May | 38 | 11 | 49 |