Osteomyelitis in a General Pediatric Ward

INTRODUCTION: Pediatric acute osteomyelitis (AO) is a serious condition and a challenging diagnosis. It mainly affects previously healthy individuals and Staphylococcus aureus is the leading causative agent. The objective of this study was to characterize all pediatric AO cases admitted to a second-level hospital during a six-year period.METHODS: Retrospective single-center study, including all children under 18 years-old with a primary diagnosis of AO. Descriptive statistics analysis was performed.RESULTS: Ten cases were identified, 60% males. The median age was 6.7 years. Previous trauma was referred by five. Affected locations were foot (n=3), tibia (n=3), femur (n=2), sacrum (n=1) and hand (n=1). All presented with local pain and limping or inability to walk (except one case with hand involvement). Four patients had fever and inflammatory signs, namely erythema and edema, were reported by four. At admission, nine had elevated inflammatory markers and six out of eight had normal radiographs. Magnetic resonance imaging confirmed the diagnosis in seven. Blood cultures were positive for Staphylococcus aureus (n=3) and Streptococcus pyogenes (n=1). Salmonella enteritidis was isolated from pus (n=1) and there was one presumed Kingella kingae AO defined as a positive polymerase chain reaction test from an oropharyngeal swab. The average duration of parenteral and oral antibiotherapy was 14.7 days 3.9 weeks, respectively. The antibiotic of choice was flucloxacillin. Two patients developed local complications.DISCUSSION: An unspecific and subacute clinical and radiological presentation together with low positive blood culture rates difficults timely diagnosis and management. An early empirical parenteral antibiotherapy is mandatory, followed by an oral regimen for at least four weeks.

An evaluation of contralateral hand involvement in the operation of the Delft Self-Grasping Hand, an adjustable passive prosthesis

The Delft Self-Grasping Hand is an adjustable passive prosthesis operated using the concept of tenodesis (where opening and closing of the hand is mechanically linked to the flexion and extension of the wrist). As a purely mechanical device that does not require harnessing, the Self-Grasping Hand offers a promising alternative to current prostheses. However, the contralateral hand is almost always required to operate the mechanism to release a grasp and is sometimes also used to help form the grasp; hence limiting the time it is available for other purposes. In this study we quantified the amount of time the contralateral hand was occupied with operating the Self-Grasping Hand, classified as either direct or indirect interaction, and investigated how these periods changed with practice. We studied 10 anatomically intact participants learning to use the Self-Grasping Hand fitted to a prosthesis simulator. The learning process involved 10 repeats of a feasible subset of the tasks in the Southampton Hand Assessment Procedure (SHAP). Video footage was analysed, and the time that the contralateral hand was engaged in grasping or releasing was calculated. Functionality scores increased for all participants, plateauing at an Index of Functionality of 33.5 after 5 SHAP attempts. Contralateral hand involvement reduced significantly from 6.47 (first 3 attempts) to 4.68 seconds (last three attempts), but as a proportion of total task time remained relatively steady (increasing from 29% to 32%). For 9/10 participants most of this time was supporting the initiation of grasps rather than releases. The reliance on direct or indirect interactions between the contralateral hand and the prosthesis varied between participants but appeared to remain relatively unchanged with practice. Future studies should consider evaluating the impact of reliance on the contralateral limb in day-to-day life and development of suitable training methods.

Is justice grounded? How expertise shapes conceptual representation of institutional concepts

Using abstract concepts is a hallmark of human cognition. While multiple kinds of abstract concepts exist, they so far have been conceived as a unitary kind in opposition to concrete ones. Here, we focus on Institutional concepts, like justice or norm, investigating their fine-grained differences with respect to other kinds of abstract and concrete concepts, and exploring whether their representation varies according to individual proficiency. Specifically, we asked experts and non-experts in the legal field to evaluate four kinds of concepts (i.e., institutional, theoretical, food, artefact) on 16 dimensions: abstractness-concreteness; imageability; contextual availability; familiarity; age of acquisition; modality of acquisition; social valence; social metacognition; arousal; valence; interoception; metacognition; perceptual modality strength; body-object interaction; mouth and hand involvement. Results showed that Institutional concepts rely more than other categories on linguistic/social and inner experiences and are primarily characterized by positive valence. In addition, a more subtle characterization of the institutional domain emerged: Pure-institutional concepts (e.g., parliament) were perceived as more similar to technical tools, while Meta-institutional concepts (e.g., validity) were characterized mainly by abstract components. Importantly, for what concerns individual proficiency, we found that the level of expertise affects conceptual representation. Only law-experts associated Institutional concepts with exteroceptive and emotional experiences, showing also a more grounded and situated representation of the two types of institutional concepts. Overall, our finding highlights the richness and flexibility of abstract concepts and suggests that they differ in the degree of embodiment and grounding. Implications of the results for current theories of conceptual representation and social institutions are discussed.

Rare Genetic Variant of Distal Myopathy with Posterior Leg and Anterior Hand Involvement: Case Report

Distal myopathies are a heterogeneous group of genetic muscle disorders characterized by weakness of distal muscle groups of the upper and lower extremities. The various types of distal myopathies can be clinically differentiated based on age at onset, pattern of muscle involvement, disease severity, and the mode of inheritance. We described a case of slowly progressive muscle weakness that involved one of the patients’ hand and posterior leg muscles. Her genetic study showed a rare variant that likely contributed to distal myopathy with posterior leg and anterior hand involvement (distal actin-binding domain [ABD]-filaminopathy). The disease is due to mutations on the actin-binding domain of the FLNC gene that encodes filamin C. This variant has been described only in one Italian family. This rare variant will expand our knowledge about the rare phenotype of distal myopathy with posterior leg and anterior hand involvement.

Tuberculosis of lunate as an isolated intraosseous osteolytic lesion in an adult: a diagnostic challenge

In an endemic zone of tuberculosis (TB), osseous involvement is a relatively common presentation. Spine and long bones are the the most common nidus of TB. Smaller bones and joints are relatively less involved. Thorough clinical examination and history of typical constitutional symptoms like weight loss, fever and loss of appetite are the diagnostic aids for initiating early treatment. Wrist and hand involvement is a rare occurrence and often presents atypically without any obvious symptoms or signs. This results in delayed diagnosis and worse outcome. TB of lunate without articular involvement is a very rare subset and we present such an isolated case of TB involving the lunate, without any typical symptoms, with the patient complaining of vague pain without any restriction of joint mobility. TB was diagnosed with the aid of radiology, haematology and histopathology. 18 months of multidrug antitubercular treatment was given, to which the patient responded well.