Khawaja Muhammad Usman-Joint Dysplasia-(Pakistan)

The second round of treatment:

Name: Khawaja Muhammad Usman
Sex: Male
Nationality: Pakistani
Age: 3
Diagnosis: 1. Joint dysplasia 2. Microcytic hypochromic anemia
Date of Admission: August 19th, 2016
Treatment hospital/period: Wu Medical Center/14days

Before treatment:
Khawaja was a full-term normal delivery baby, during his mother’s pregnancy, there were no abnormalities. When he was 1 month old, his mother found the fingers on his left hand were bent, the fingers could be opened, his right hand fingers were better. He was taken to their local hospital but was not treated. When he was 3 months old, his condition became worse. His mother took him to the hospital again but was untreated. In June, 2015, his left hand middle finger was unable to be opened, so he was taken to the hospital and had a B-type ultrasound done. The result showed: there was effusion in his knees, ankles and wrists. The plain film radiography showed: the right hip joint was at an angle of 23 degrees, the left hip joint was at an angle of 26 degrees. HLA-B27 was negative. Rheumatoid factor was normal. ANA: titre was normal. He was diagnosed with joint dysplasia, suspicion of rheumatic disease. His hands were bent, especially his left hand, his knees had eversion, and there was effusion in his knees, ankles and wrists. He was taken to our hospital 8 months ago, after the treatment, his fingers had improved, and there was no effusion in his knees. His weight and height were normal. Khawaja was taken to our hospital again to have a chance at a better life.
His diet and sleep were good, his urination routine and bowel movements were good.

Admission PE:
Bp: 113/85mmHg; Hr: 90/min; Ht108.5cm, Wt25Kg.  Khawaja has a normal and well-nourished build. His skin and mucosa had no yellow stains, bleeding spots or ecchymosis. The thyroid gland was not swollen. The lips had no cyanosis. There was no pharyngeal congestion. The tonsils were not swollen. The respiratory sounds in the lungs were clear, without dry or moist rales heard. His heart rhythm was regular and strong, without obvious murmur in the valves. The abdomen was soft without pressing pain. His legs were not swollen. The spine is normally developed. His fingers on both hands had malformation. The middle finger, index finger on the left hand could not be stretched passively, especially the middle finger. The right hand was in a slightly better condition. The bilateral knee joints had mild eversion malformation. It was hard for Khawaja to bend his knees without joint pain. Sometimes he felt pain when he bent his toes, he could not finish the movement of bending his knees while jumping, squatting and rising, crossing his legs, his knees were introverted when he walked, his gait was slightly abnormal when he walked and ran. The blood test showed microcytic hypochromic anemia (mild anemia).

Nervous System Examination:
Khawaja was conscious and in good spirits. He spoke normally. His memory and orientation abilities were normal. His eyeballs moved flexibly. The diameter of both pupils was 3.0mms, and both pupils were equal in size and round. The pupils reacted normally to light stimulus and there was no nystagmus. The forehead wrinkle pattern and nasolabial groove were symmetrical. The tongue was centered.. The muscle tone of all four limbs was normal. The muscle strength of all four limbs was at level 5, the gripping power of both hands was level 5-, and the tendon reflex could be elicited normally. He could not cooperate with the coordination examination. The palm-jaw reflex was negative. The pathological sign of the lower limbs was negative. The meningeal irritation sign was negative.

Treatment:
After the admission, Khawaja was diagnosed with 1. Joint dysplasia; 2.Microcytic hypochromic anemia (mild anemia). He received 3 neural stem cell injections and 3 mesenchymal stem cell injections to allow his bone joints and tissues to grow again, repair the damaged cells, nourish the nerves, improve circulation and adjust the anemia. This was accompanied with appropriate rehabilitation training.

Post-treatment:
After 14 days of treatment, Khawaja’s condition was stable. His fingers were not as malformed. His fingers could move better. The bending movement of the knee-joints was more flexible than before. The pain in the finger-joints and knee-joints were noticeably relieved.

The first round of treatment:

Name:Khawaja Muhammad Usman
Sex: Male
Country:Pakistan
Age:2 Years 5 months
Diagnosis:1. Joint Dysplasia  2. Microcytic hypochromic anemia (moderate anemia)
Date of Admission: December 7th, 2015
Treatment Hospital/period:Wu Medical Center/15 days

Before treatment:
Khawaja Muhammad Usman is born with full-term normal delivery. There was no abnormity during his mother’s pregnancy. One month after he was born, his mother found that his left curled abnormally. Three months after he was born, the curled condition became worse. However, local hospital did not give any treatment. In June 2015, he did ultrasonic examination and X-ray in the hospital in Dubai as his middle finger of left hand could not be opened passively. Ultrasonic examination: knee-joints, ankle joints, wrist joints effusion. X-ray: right acetabulum angle: 23°; left acetabulum angle: 36°. He was suspicious for rheumatic disease. He has no history of trauma or blood transfusion.
One month after he was born, he had one vesicle at each of his wrists and ankles. He recovered after he had antibiotics. He had no other medical history. He had no history of blood transfusion, traumatic surgery or food allergy.

Admission PE:
Bp: 92/56mmHg;Hr: 108/min; Ht 97cm, Wt 18.5Kg. He has a normal and well-nourished figure. His skin and mucosa had no yellow stain, bleeding point or ecchymosis. His weasand is in the middle and thyroids have no swollen. His lips had no cyanosis. The pharyngeal had no congestion. His tonsil had no swollen. The respiratory sound in lungs was clear, without dry or moist rales heard.His heart rhythm was regular and strong, withoutobvious murmur in the valves. The abdomen was soft without pressing pain or masses. The shifting dullness was negative. His legs had no swollen. The spine is normally developed. His fingers of both hands have malformation. The middle finger, index finger and ring finger of left hand cannot be stretched passively especially middle finger. The right hand has a slightly better condition. The middle finger and ring finger cannot be stretched passively. The bilateral knee joints have mild swollen and eversion with a sense of friction. The feet have internal rotation.

Nervous System Examination:
Khawaja was conscious and in a good spirit. He speaks normally. His memory and orientation abilities are normal. His eyeballs move flexibly. The diameter of both pupils was 3.0mms, and both pupils were equal in size and round. The pupilsreacted normally to light stimulus and he had no nystagmus. The forehead wrinkle and nasolabial groove are symmetrical. The tongue is in the middle. The muscle tone of limbs is normal. The muscle strength of limbs is level 5 and the tendon reflex can be normally elicited. He could not cooperate with coordination examination. The palm-jaw reflex is negative. The pathological sign is negative. The meningeal irritation sign is negative.

Treatment:
After his admission, he was diagnosed with 1. Joint dysplasia; 2.Microcytic hypochromic anemia (moderate anemia) in accordance with the combination of his symptoms, physical signs and lab test. He was given treatment to nourish nerves, improve circulation and adjust anemia. This is accompanied with appropriate rehabilitation training.

Post-treatment:
After treatment, patient is more cooperative in his rehabilitation training. The movement of fingers especially left hand is more flexible than before. The left hand is able to open a big angle. The friction and eversion of knee joints have been alleviated. The internal rotation of knee joints has alleviated. He performs better at balance beam training. The condition of anemia has improved.  Patient’s treatment has completed and the discharge has been approved.

 E-mails:

Date:2016-4-5

Hello doctor! (Patient file 151203)
Hope you are well . You have asked about khawaja so he is very well gained 2 kg and also his increased height can b seen but I have not measured.
His right hand is completely cleared and all fingers are in order and about his left hand , his rings finger is now recovered and  his index finger and middle is very much recovered ... he can stretch his index finger by a little more force to open by himself.
I have consult a doctor for iron and and HB level but unfortunately it was not the right mdcn for him . I'm also attaching his mdcn pictures and new reports with this mail .but from last fifteen days his imprment seems to b stopped and also a little reverse like he have to use alot more force to open index finger or his middle finger seem to be a little stiff . It is may b bacause of his HB level but you better know the reason.  I started medication from here for HB and iron and I have to wait until a month to see the results but it doesn't work. Now I have another appointment of a hematology specialist in this week if he can help me otherwise i have to ask you for help to improve HB And Iron level .
His medication is regular and proper as was recommended and rehabilitation is not so regular because sometimes he is fed up and as you have seen him in hospital he is not instusted either and even unhappy with it.
One thing more according to his new reports should I stop the medicine that were recommend for three months and those are RISPRIDONE, BROMOCRIPTINE and DUOWEIPIAN. These medicines are for stem cell .
One thing more I want to inform you that almost 15 days back he had a minor intestinal infection  which was recovered with in 3 days.

Date:2016-5-6

Hello doctor. 
(patient file 121503)Hope you are doing well!. By the grace of God  khawaja usman is very well and have a very prominent improvement.
His left hand fingers are not completely recovered yet but it is getting better with time. And about his hip joint and knees are also not recovered completely... his height weight and appetite is all good
For iron and HB level I have started a medicine recommend by the specialist. I will attach the pictures of medicine.
The medicine he will need future after these six months , I have not got their attachment with your mail kindly send me that again.
Thank you for all your corporation and help.