Progressive Weakness and Rash

A 47-year-old man with hypercholesterolemia sought care for a 4-month history of progressive, proximal upper limb weakness and myalgia, followed by dysphagia, difficulty climbing stairs, and facial rash. Discontinuation of atorvastatin was of no benefit. Neurologic examination showed moderate weakness of the neck flexor muscles, shoulder girdle muscles, and finger extensors, and mild weakness of hip flexor and ankle dorsiflexor muscles. He had a heliotrope rash and Gottron sign. Serum testing showed an increased creatine kinase level. Needle electromyography showed myopathic changes with fibrillation potentials in proximal and axial muscles. Biopsy of the deltoid demonstrated a perifascicular pathologic process, including muscle fiber atrophy, and perivascular inflammatory exudate in the perimysium. Immunocytochemical studies showed patchy loss of intramuscular capillaries, some of which had complement (C5b9) deposition, and sarcoplasmic expression of myxovirus resistance protein A, mainly in the perifascicular regions. Immunologic testing was positive for autoantibodies to nuclear matrix protein 2 and negative for 3-hydroxy-3-methylglutaryl–coenzyme A reductase antibodies. Video swallow studies showed oropharyngeal dysphagia. Pulmonary function tests indicated mildly decreased maximal respiratory pressures but normal diffusing lung capacity for carbon monoxide. The findings were consistent with a diagnosis of dermatomyositis. The patient was started on oral prednisone and azathioprine, after checking for adequate thiopurine methyltransferase activity. Liver function tests and complete blood cell count with differential were assessed to monitor for potential azathioprine toxicity. Intravenous immunoglobulin was given. Follow-up examination revealed mild weakness of the shoulder girdle muscles after immunotherapy, and normal strength and creatine kinase value while on azathioprine monotherapy. Dermatomyositis is an idiopathic inflammatory myopathy. Idiopathic inflammatory myopathy is a group of autoimmune muscle diseases that includes dermatomyositis, polymyositis, inclusion body myositis, immune-mediated necrotizing myopathy, and overlap myositis, including antisynthetase syndrome.

Out-of-Frame Mutations in ACTN2 Last Exon Cause a Dominant Distal Myopathy With Facial Weakness

Background and ObjectivesTo clinically, genetically, and histopathologically characterize patients presenting with an unusual combination of distal myopathy and facial weakness, without involvement of upper limb or shoulder girdle muscles.MethodsTwo families with a novel form of actininopathy were identified. Patients had been followed up over 10 years. Their molecular genetic diagnosis was not clear after extensive investigations, including analysis of candidate genes and FSHD1-related D4Z4 repeats.ResultsPatients shared a similar clinical phenotype and a common pattern of muscle involvement. They presented with a very slowly progressive myopathy involving anterior lower leg and facial muscles. Muscle MRI finding showed complete fat replacement of anterolateral compartment muscles of the lower legs with variable involvement of soleus and gastrocnemius but sparing thigh muscles. Muscle biopsy showed internalized nuclei, myofibrillar disorganization, and rimmed vacuoles. High-throughput sequencing identified in each proband a heterozygous single nucleotide deletion (c.2558del and c.2567del) in the last exon of the ACTN2 gene. The deletions are predicted to lead to a novel but unstructured slightly extended C-terminal amino acid sequence.DiscussionOur findings indicate an unusual form of actininopathy with specific molecular and clinical features. Actininopathy should be considered in the differential diagnosis of distal myopathy combined with facial weakness.

Injuries, Suffered by Nurses, Changing Patients’ Position

As recently as 20 years ago, the International Labor Organization has drawn the attention to the nurses’ working conditions, nursing and health. Nursing is one of the professions, mostly exposed to the risk of experiencing back injuries. One of the main precautions to prevent nurses' back injuries is the use of technical aids and the work environment provision with ergonomic means. There must be a lot and diverse devices in the workplace available for nurses to protect them from injuries [1]. The European Agency for Safety and Health at Work identifies several groups of risk factors that affect the health of nurses. They are work-related risks (monotonous movements, use of physical force, an uncomfortable body position), patient-related risks (a heavy patient, immobility, etc.), environment-related risks (slippery work surfaces, limited area, etc.), and other risks (lack of knowledge, inappropriate clothing and footwear, etc.) [2]. The aim of the research was to analyze the injuries experienced by nurses in changing the situation of patients. A quantitative survey was conducted, providing the questionnaires; its participants were nurses, working in Utena City health care institutions. The nurses usually experience various types of sprains of back, lumbar and shoulder girdle muscles. Injuries, suffered by nurses, are related to the lack of additional facilitators and knowledge on how to lift a patient in a correct manner.

Electromyographic Evaluation of the Shoulder Muscle after a Fatiguing Isokinetic Protocol in Recreational Overhead Athletes

The goal of our study was to examine the muscle activity of the shoulder girdle after isokinetic fatigue, which may simulate muscle activities commonly occurring during specific sport-related activities in recreational overhead asymptomatic athletes. We hypothesized that exercise-induced fatigue, reported after isokinetic protocols, may cause a decrease in the median frequency (MF) of the upper trapezius (UT), infraspinatus (IS), and deltoid muscles. Twenty-four male overhead volleyball (n = 8), handball (n = 8), and tennis (n = 8) athletes participated in this study. All subjects were without shoulder injury history. The surface electromyography (SEMG) was collected on the right (dominant) side of the shoulder girdle muscles in the following order: UT, IS and anterior (DA), and posterior deltoideus (DP). The fatigue protocol consisted of three sets of 32 maximum isokinetic concentric contractions while performing shoulder internal and external rotation at an isokinetic speed of 120 o/s. The resultant difference in median frequency (ΔMF) values consistently dropped after the fatiguing tasks across all recorded muscles, in terms of the initial MF (MFINI = 65.1 ± 1.1 Hz) and final MF (MFFIN = 57.9 ± 0.9 Hz), and the main effect of time was significant (F(1,22) = 43.15, p < 0.001). MF values decreased mostly for IS (ΔMFIS = −9.9 ± 1.6 Hz) and DP (ΔMFPD = −9.5 ± 1.9 Hz) muscles, while DA and UT showed smaller changes (ΔMFDA = −6.9 ± 1.5 Hz) and (ΔMFUT = −3.2 ± 1.3 Hz). The results of our study show a meaningful contribution in determining increased fatigue of the shoulder girdle muscles during repeated isokinetic internal-external rotation protocols. We have also demonstrated a significant decrease in MF in all examined muscles, especially IS and DA.

Piomiosite del cingolo scapolare con focolai polmonari multipli e sepsi da MRSA

The paper describes the case of a 14-year-old girl with intense right shoulder pain and severe signs of local and systemic inflammation. Magnetic resonance imaging revealed a pyomyositis of right shoulder girdle muscles. Blood culture was found positive for methicillin-resistant Staphylococcus aureus (MRSA) and the chest computed tomography scan revealed nodular infiltrates in both pulmonary fields resulting from septic embolism. A prolonged antibiotic therapy according to antibiogram allowed the complete recovery. Pyomyositis is a deep pyogenic infection of the skeletal muscle tissue and is most commonly caused by Staphylococcus aureus species. In the described case, repetitive trauma due to karate may have caused the initial muscle cell damage with subsequent haematoma, which subsequently becomes colonised by bacteria during a transient bacteraemia. There is an increasing prevalence of pyomyositis in temperate climates and in the last few years MRSA has emerged as a pathogen within the community (CA-MRSA) also in healthy people. An early diagnosis is important to avoid local and systemic complications.

STRENGTH ABILITIES IN SPORTS SWIMMING A SYSTEMATIC REVIEW

Strength training is an important part of the preparation of competitive athletes. The subject of interest of the scientists connected of sports swimming was the level of strength ability of the competitors practising this sport and the influence of this ability on the final sports result. The purpose of this review is to describe and consider the impact of strength training of the shoulder muscles in sports swimming. A literature review was conducted in Embase, Medline PubMed, DOAJ, EBSCO and Google databases. Basic search terms are: training in sports swimming, strength tests, evaluation of muscle properties, rotation of the arm, strength measurement methods. Results: 235 results were found and 148 professional publications were selected and analysed. A thorough review of scientific publications indicates that strength parameters of the shoulder girdle muscles played a very important role on the sports performance of swimmers. The programmes combining swim training with 'on land' strength improvement or electrical stimulation are more effective than swim training alone. Significant fatigue of the rotator muscles can impair shoulder stability and result in injury. Increased strength in the internal rotation movement may result pathological conditions of the shoulder.

Ergonomic and Biomechanical Analysis of the Manioc Root Harvest: Case Report

The aim of this case report was to evaluate the risks of musculoskeletal injuries from manual extraction of manioc roots in a Brazilian family farming production. It was used a lumbar extension isometric dynamometry, electromyography and infrared thermography of the surface at the back of the worker and the whole collection of data was made in loco. The results showed an increased temperature on the surface of the left lower back (+0.6 ℃), the values of isometric strength upon lumbar extension (143 ± 2.66 Kgf) and electromyography alteration in the muscles. The questionnaires indicate that the individual complains of discomfort along all of the back of his torso. The activity of manioc manual extraction can generate an overload on the lumbar and shoulder girdle muscles. It can affect the individual productive state.

Fulminant immune-mediated necrotising myopathy (IMNM) mimicking myocardial infarction with non-obstructive coronary arteries (MINOCA)

A 74-year-old man, with inflammatory arthritis, recently commenced on adalimumab, presented with a 4-week history of left-sided chest pain, malaise and shortness of breath. Admission ECG showed age-indeterminate left bundle branch block. Troponin T was 4444 ng/L (normal range <15 ng/L) and acute coronary syndrome treatment was commenced. Catheter angiogram revealed mild-burden non-obstructive coronary disease. Cardiac magnetic resonance (CMR) was performed to refine the differential diagnosis and demonstrated no myocardial oedema or late gadolinium enhancement. Extracardiac review highlighted oedema and enhancement of the left shoulder girdle muscles consistent with acute myositis. Creatine kinase was subsequently measured and significantly elevated at 7386 IU/L (normal range 30–200 IU/L in men). Electrophoresis clarified that this was of predominantly skeletal muscle origin. Myositis protocol MRI revealed florid skeletal muscle oedema. The MR findings, together with positive anti-Scl-70 antibodies, suggested fulminant immune-mediated necrotising myopathy presenting as a rare mimic of myocardial infarction with non-obstructive coronary arteries, diagnosed by careful extracardiac CMR review.