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Background: Atraumatic limping is a frequent cause of consultation in Pediatric Emergency Departments (PED) and often represents a challenge for pediatricians for its variability in etiology ranging from benign causes to potential crippling conditions. The aims of this research are to illustrate the clinical features of acute limping children (LC) and to identify the possible red flags that could help to make a diagnosis of severe pathologies. Methods: We carried out a retrospective study about non-traumatic limping children referred to the PED of Bambino Gesù Children's Hospital over a 2-year period. We divided the cohort into three groups based on the patient's age: toddlers, children and adolescents. We considered crippling conditions: oncologic etiologies, bone or neurological infections, epiphysiolysis, Perthes disease, Guillain Barrè syndrome and non-accidental injuries. Results: We analyzed 485 patients. At clinical evaluation, 19.5% of the patients presented at least one sign and/or symptom of red flags. Crippling conditions (6.2% of the total population) showed red flags in 36.7%. Transient synovitis of the hip was the most frequent diagnosis. We found crippling conditions in 30 patients, mostly represented by toddlers. Conclusions: Our data suggest that toddlers and patients presenting red flags should be evaluated with particular suspicion because they have an increased risk of underlying severe conditions. [ABSTRACT FROM AUTHOR]

Hip pain in a child can pose a diagnostic conundrum. In most cases, the cause of a painful hip is often attributed to trauma, but a number of these cases will be atraumatic. The main entities to consider are inflammatory, infective and neoplastic causes. Pathologies such as avascular necrosis and slipped upper femoral epiphysis can also present in a similar manner. A detailed history and clinical examination are crucial in narrowing down the differential diagnosis. In addition, understanding the most appropriate imaging modalities and the characteristic radiological findings is key in ensuring timely treatment and management. This article reviews the various disease processes in children who present with hip pain and outlines the most appropriate assessment and imaging modalities that will aid diagnosis. [ABSTRACT FROM AUTHOR]

Scurvy results from a deficiency of ascorbic acid. This disease first appeared in children during the 19th century with the emergence of new dietary habits; in particular, heating milk that leads to a loss of ascorbic acid. Even though scurvy has become a rare condition in western countries, many cases are still reported in pediatric patients, especially in those who lack proper nutrition due to neurological or psychiatric illnesses. Symptoms include bleeding and swollen gums, loosening of teeth, bone abnormalities, arthralgia, delayed wound healing, anemia, petechiae, and purpura. Bone lesions are mainly irregularities of long bones metaphyses. We report the case of a five-yearold boy who presented with arthralgia and limb deformation (genu valgum). The patient was investigated for vitamin deficiencies to exclude rickets. The radiologic investigations revealed metaphyseal signs compatible with scurvy. During the hospitalization, the patient was observed to have abnormal eating patterns and the scurvy was attributed to malnutrition. Although the occurrence of scurvy is rare, it remains essential to detect this disease in children at risk of developing vitamin deficiencies. Without targeted treatment, the complications of scurvy can be serious and potentially fatal. [ABSTRACT FROM AUTHOR]

Objectives: Low health literacy is both pervasive in the United States and a substantial barrier to satisfactory patient care and the appropriate utilization of healthcare resources. This prospective study aims to evaluate the factors that contribute to limited musculoskeletal literacy in patients who undergo shoulder arthroplasty. Methods: Ninety patients undergoing shoulder replacement surgery completed demographics and Literacy in Musculoskeletal Problems (LiMP) surveys. Scores of less than six were considered indicative of limited musculoskeletal literacy. Results: The overall percentage of participants with limited musculoskeletal literacy was 38.8%. Multivariable logistic regression analysis with multiple imputation modeling demonstrated a significant positive relationship between patient income and adequate LiMP scores (p = 0.009) with an odds ratio of 1.15 (CI: 1.04; 1.28) while level of education (p = 0.173) and patient ethnicity (p = 0.830) among other patient characteristics did not have a significant relationship with LiMP scores. Conclusion: In patients undergoing shoulder replacement surgery, low income was the only variable found to be predictive of limited musculoskeletal health literacy scores. Therefore, when discussing the risks and benefits of shoulder arthroplasty, orthopaedic surgeons should be cognizant of the possibility that any given patient may not meet the threshold of adequate musculoskeletal literacy. [ABSTRACT FROM AUTHOR]

Copyright of Health Bulletin / Zdravstveni Glasnik is the property of Faculty of Health Studies, University of Mostar and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The limping child is a common presentation to paediatric services. In most instances the cause is benign with few, if any, investigations required. There is, however, always that concern that the limping child may have an underlying limb-threatening or life-threatening disease. This poses a challenge to clinicians, who must find that balance between correctly identifying disease early and avoiding the risks and harms of overinvestigation. In this article we discuss the diagnostic approach to the limping child and present a structure for assessment, investigation and risk management. [ABSTRACT FROM AUTHOR]

Copyright of Rigakuryoho Kagaku is the property of International Press Editing Center Incorporation and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Determination of the hematological profile quail is a necessity because this species is characterized by an intense metabolism. Any nutritional imbalance is reflected on metabolism influencing their health and production. Research has shown that the hemoleucogram is different depending on age and gender. Thus, the red grouts had an increase of 0.77x106 mm³ in quail chicks of one day, reaching 21 days at 1.72 x 106 mm³. In adults, the variation limits were between 4.22 x 106 mm³ in males and 3.31 x 106 mm³ in females. The same evolution occurred in white blood cells, which were 1 day of 10.2 thousand mm3, reaching 21 days at 16.3 thousand mm³. In adults, they were between 24.5 thousand mm3 in males and 26 thousand mm³ in females. Changes related to age and sex also recorded the amount of hemoglobin and hematocrit. Leukocyte values, excluding eosinophils, were 0.8% for the two sexes. Lymphocytes, 26% in males and 25% in females, and neutrophils were 70.8% in males and 70.5% in females. Hematological research has shown that quail blood has a high oxygenation capacity and remarkable lymphocyte character. [ABSTRACT FROM AUTHOR]

Limb ischemia reperfusion (I/R) injury is associated with serious local and systemic effects. Reperfusion may augment tissue injury in excess of that produced by ischemia alone. The hippocampus has been reported to be vulnerable to I/R injury. Alpha lipoic acid (ALA) is an endogenous antioxidant with a powerful antioxidative, anti-inflammatory, and antiapoptotic properties. We studied the probable restorative effect of ALA on limb I/R-induced structural damage of rat hippocampus. Forty adult male albino rats were divided equally into four groups: group I (sham); group II (I/R-1 day) has undergone bilateral femoral arteries occlusion (3 h), then reperfusion for 1 day; group III (I/R-7 days) has undergone reperfusion for seven days; group IV (I/R-ALA) has undergone I/R as group III and received an intraperitoneal injection of ALA (100 mg/kg) for 7 days. I/R groups revealed degenerative changes in the pyramidal neuronal perikarya of CA3 field in the form of dark-stained cytoplasm, dilated RER cisternae, mitochondrial alterations, and dense bodies’ accumulation. Their dendrites showed disorganized microtubules. Astrogliosis is featured by an increased number and increased immunoreactivity of astrocytes for glial fibrillary acid protein. Morphometric data revealed significant reduction of light neurons, surface area of neurons, and thickness of the CA3 layer. Most blood capillaries exhibited narrow lumen and irregular basal lamina. ALA ameliorated the neuronal damage. Pyramidal neurons revealed preservation of normal structure. Significant increase in the thickness of pyramidal layer in CA3 field and surface area and number of light neurons was observed but astrogliosis persisted. Limb I/R had a deleterious remote effect on the hippocampus aggravated with longer period of reperfusion. This work may encourage the use of ALA in the critical clinical settings with I/R injury. [ABSTRACT FROM PUBLISHER]

Acute limp in a child presents a diagnostic conundrum and can result from a variety of causes. The underlying etiology is often referable to the hip, but the spine, abdomen, pelvis, or knee can be alternatively implicated. An adequate clinical history and satisfactory physical examination are often difficult in younger children. Consequently, there is disproportionate reliance on imaging to arrive at the correct diagnosis. The potential for rapid clinical deterioration and long-term sequelae is a risk with some of the conditions presenting with acute hip (septic hip, osteomyelitis). This review article describes the imaging appearance of common etiologies for acute limp in the ambulatory preschool (1-5 years) and school-age child (5-12 years). The ultimate goal is to familiarize the interpreting radiologist with the imaging appearance of specific clinical entities that lead to acute limp while providing a readily accessible resource on how to image the patient most appropriately and judiciously. [ABSTRACT FROM AUTHOR]

Children with musculoskeletal symptoms are commonly seen by general practitioners (GPs). Those that present with atraumatic limp pose a particular diagnostic challenge. Although uncommon, Perthes disease (PD) is an important cause of atraumatic limp in children and may result in debilitating consequences if missed. We put forward a case of delayed diagnosis of PD in a child, thus highlighting the need for a greater index of suspicion among GPs in approaching any child with a limp. [ABSTRACT FROM AUTHOR]

Purpose: Hip pain with limping is a common presentation in childhood. The most common diagnosis in young children is transient synovitis of the hip (TSH), a benign and self-limiting condition. In our clinical practice, we observed eosinophilia in children presenting with irritable hip more commonly than would otherwise be expected. The aims of this study were to assess the prevalence of eosinophilia in children with TSH, and to evaluate the clinical outcomes of this sub-group of patients. Methods: This study retrospectively examined the data of all paediatric patients admitted to Christchurch Public Hospital, Christchurch, New Zealand. TSH cases were compared with age- and sex-matched controls. Results: A total of 103 patients were included. Compared with controls, TSH patients had significantly higher eosinophil counts (303 ± 236 vs. 380 ± 337 cells/μL, respectively, p = 0.049). Fourteen patients (15.6 %) had eosinophilia, with a mean eosinophil count of 986 (±321) cells/µL. Children who had eosinophilia did not differ from the rest of the sample in their age (mean 4.6 vs. 4.4 years, p = 0.74) or ethnicity (85.7 vs. 85.5 % European, p = 0.99). Eosinophilic children were not more likely to be atopic (i.e. have history of allergic rhinitis, asthma and/or eczema) than non-eosinophilic children (21.4 vs. 10.5 %, p = 0.37). There was a shorter hospital stay in eosinophilic children (mean 16.3 ± 6 h) than in non-eosinophilic children (mean 21.5 ± 18.8 h), although this was not statistically significant ( p = 0.058). Conclusions: To the authors' knowledge, this is the first study to explore the relationship between TSH and eosinophilia. We found a sizeable minority (15.6 %) of children with TSH to have eosinophilia. While the difference in hospital stay was not statistically significant, a correlation between peripheral eosinophilia and length of hospital stay of TSH patients is possible. Whether this correlation is clinically meaningful remains to be answered. Level of evidence: Retrospective prognostic study; level II. [ABSTRACT FROM AUTHOR]

Purpose: Approximately 33% of Americans have inadequate health literacy, which is associated with decreased medical knowledge, increased hospitalization and use of emergency care, and worse control of diseases. In this study, the Literacy in Musculoskeletal Problems (LiMP) questionnaire was used to evaluate the prevalence of limited musculoskeletal literacy in patients presenting to the emergency department (ED) with foot and ankle-related complaints, as these individuals may be at increased risk for inferior outcomes.Methods: In this cross-sectional study, individuals ≥18 years of age presenting with foot and ankle-related complaints to the ED were invited to participate. Participants completed a demographic survey and the LiMP questionnaire, with scores ≥6 indicative of adequate musculoskeletal literacy. The prevalence of adequate health literacy and the influence of demographic parameters was assessed. P values <.05 were considered significant.Results: The mean LiMP score was 5 ± 2.06. Limited musculoskeletal health literacy was seen in 32% of participants (18/56). Although gender (male), a current or prior employment in a health care field, and having previously seen a physician for a musculoskeletal complaint correlated with higher literacy rates, these values did not reach statistical significance (P > .05). However, Caucasians and those with higher levels of education (equal to or more than college) were significantly more likely to possess adequate literacy (P = .008, P = .04, respectively).Conclusions: Approximately one third of patients presenting to the ED with foot and ankle-related complaints have limited musculoskeletal literacy and may lack the necessary skills required for making informed decisions regarding their care. This is concerning and has tremendous socioeconomic implications, as more than 23 000 people per day require medical care for ankle sprains in the United States, with average treatment costs for this injury in the ED setting estimated at $1498. Identification of those most at risk is thus crucial and will facilitate the development of interventions geared toward those most vulnerable.Levels Of Evidence: Prognostic, Level IV study. [ABSTRACT FROM AUTHOR]

Background: Lobosphaera incisa, formerly known as Myrmecia incisa and then Parietochloris incisa, is an oleaginous unicellular green alga belonging to the class Trebouxiophyceae (Chlorophyta). It is the richest known plant source of arachidonic acid, an ω-6 poly-unsaturated fatty acid valued by the pharmaceutical and baby-food industries. It is therefore an organism of high biotechnological interest, and we recently reported the sequence of its chloroplast genome. Results: We now report the complete sequence of the mitochondrial genome of L. incisa from high-throughput Illumina short-read sequencing. The circular chromosome of 69,997 bp is predicted to encode a total of 64 genes, some harboring specific self-splicing group I and group II introns. Overall, the gene content is highly similar to that of the mitochondrial genomes of other Trebouxiophyceae, with 34 protein-coding, 3 rRNA, and 27 tRNA genes. Genes are distributed in two clusters located on different DNA strands, a bipartite arrangement that suggests expression from two divergent promoters yielding polycistronic primary transcripts. The L. incisa mitochondrial genome contains families of intergenic dispersed DNA repeat sequences that are not shared with other known mitochondrial genomes of Trebouxiophyceae. The most peculiar feature of the genome is a repetitive palindromic repeat, the LIMP (L. Incisa Mitochondrial Palindrome), found 19 times in the genome. It is formed by repetitions of an AACCA pentanucleotide, followed by an invariant 7-nt loop and a complementary repeat of the TGGTT motif. Analysis of the genome sequencing reads indicates that the LIMP can be a substrate for large-scale genomic rearrangements. We speculate that LIMPs can act as origins of replication. Deep sequencing of the L. incisa transcriptome also suggests that the LIMPs with long stems are sites of transcript processing. The genome also contains five copies of a related palindromic repeat, the HyLIMP, with a 10-nt motif related to that of the LIMP. Conclusions: The mitochondrial genome of L. incisa encodes a unique type of repetitive palindromic repeat sequence, the LIMP, which can mediate genome rearrangements and play a role in mitochondrial gene expression. Experimental studies are needed to confirm and further characterize the functional role(s) of the LIMP. [ABSTRACT FROM AUTHOR]

This report describes a case of hind limb lameness associated with intra-abdominal torsion of a neoplastic testicle in a dog. An 11-year-old, male, bilaterally cryptorchid dog was referred for third degree lameness in the left hind limb. An orthopaedic and radiographic examination did not reveal any alteration in the limb, whereas transabdominal palpation and ultrasonography showed the presence of retained gonads. The surgical procedure revealed a left testicular torsion adherent to the viscera and peritoneum in the ventral-caudal part of the abdomen. A few days after a bilateral orchiectomy, the lameness was completely resolved. Histopathological investigations allowed diagnosis of intestitial (Sertoli) cell tumours in both testicles. One of the two testes was twisted. Sertolioma often affects undescended testicles and causes additional clinical changes, due to estrogenic steroidogenesis. The hyper-oestrogenism is characterised by alopecia, feminisation, prostatic alteration and haematological disorders. However, in this case these clinical signs were not present. The aim of this case report is to highlight the correlation of the disease and the onset of limp, which is similar to what has been reported in human medicine in patients affected by meralgia paresthetica. [ABSTRACT FROM AUTHOR]

Scurvy is a well-known clinical condition caused by vitamin C deficiency. Although considered a rare disease in high-income countries, it has been recently increasingly reported in children, especially in those with abnormal dietary habits, mental or physical disabilities. We performed an extensive review of the literature analyzing studies published in the last 20 years focusing on clinical features, differential diagnosis and diagnostic delay. Fifteen articles were selected, collectively reporting a total of 166 children. Because of the wide clinical spectrum (musculoskeletal complaints and/or mucocutaneous lesions or systemic symptoms), scurvy can mimic several conditions, including autoimmune diseases, infections, and neoplasia. In addition, frequent findings such as normal nutritional status, anemia or elevated inflammatory markers may guide clinicians towards the abovementioned misdiagnoses. Scurvy should be considered in patients presenting with musculoskeletal complaints, not only in those with risk factors but also in healthy children. A focused dietary history and a careful physical examination, assessing other signs of vitamin C deficiency, are mandatory in these patients. When suspected, the dosage of serum vitamin C is the diagnostic gold standard; furthermore, imaging studies, performed by an expert radiologist, can reveal the typical features of scurvy. Only early diagnosis can avoid unnecessary investigations and potentially fatal complications of the disease. [ABSTRACT FROM AUTHOR]

A 25-year-old Arab woman, reported to our endocrinology clinic one month post-partum presenting with back pain and a limp that started during the seventh month of pregnancy. Upon examination, she was found to have a full range of motion and no tenderness in the hip joint or lower back. The pain was aggravated by walking. She had a limping gait with a lean to her right side. She had low calcium, low hemoglobin, high parathyroid hormone and high alkaline phosphatase levels. X-rays of her hip and lumbosacral areas were normal. Her spinal magnetic resonance imaging findings were also normal. A bone mineral density (BMD) study revealed severe osteoporosis with a lumbar spine T-score of -4.6 and femoral neck T-scores of -4.1 (left) and -3.9 (right). A celiac disease work-up included tests for anti-endomysial antibodies and anti-tissue transglutaminase antibodies, which were positive, and the results of an endoscopy and biopsy confirmed the diagnosis of celiac disease. Gluten-free diet with calcium and vitamin D supplementation resulted in the complete resolution of her symptoms and a normal gait. The patient returned to normal calcium and parathyroid hormone levels and experienced a significant improvement in her BMD to normal. Celiac disease may initially presents during pregnancy result in severe osteoporosis that causes significant pain and disability. [ABSTRACT FROM AUTHOR]

Objectives: To examine the utility of clinical findings, laboratory markers and X-ray radiographs (X-ray) in the assessment of children presenting with an acute non-traumatic limp. Methods: A retrospective review of all children who received hip X-rays over a 2 year period in the Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand. Children were identified from the radiology database and clinical notes reviewed. Children aged 0–12 years old were included if the limp was acute (less than 2 weeks of duration) with no history of trauma. X-rays were reported by a consultant paediatric radiologist. Univariate and multivariate analysis was performed to determine predictors of osteomyelitis and septic arthritis. Receiver operator curves were used to assess the optimum cut-off points for C reactive protein (CRP), erythrocyte sedimentation rate (ESR) and white cell count (WCC). Results: A total of 350 patients were enrolled. There were 21 (6%) abnormal X-rays . Fever, non-weight bearing, raised white cell count, raised erythrocyte sedimentation rate and raised CRP were all associated with increased risk of septic hip or osteomyelitis. The optimum inflammatory marker cut-off was a CRP of 12 with a sensitivity of 87% and specificity of 91%. Conclusion: In acute non-traumatic limp, X-rays of the hips diagnose slipped upper femoral epiphysis, as such they should be routinely used from the age of 9 years upwards. Below this age they are of little value. Inflammatory markers have utility in risk-stratifying children and selecting a group in whom to proceed with definitive tests to exclude osteomyelitis or septic hip. Children with a short history and minimal symptoms can be managed with appropriate follow up and no investigations. [ABSTRACT FROM AUTHOR]

The acutely limping child presents a significant diagnostic challenge. The purpose of this study was to create a clinically useful algorithm to allow exclusion of ‘musculoskeletal sepsis’ as a differential diagnosis in the child presenting with limp. Data were collected on all 286 limping children admitted to our centre over a 3-year-period. Using logistic regression analysis, the predictive model was constructed, to exclude infection. Duration of symptoms, constitutional symptoms, temperature, white cell count and ESR were significantly different in children with musculoskeletal infection ( P < 0.05). Multivariate analysis demonstrated that when all three variables of duration of symptoms >1, <5 days; temperature >37.0°C; and ESR >35 mm/h were present, the predicted probability of infection was 0.66, falling to 0.01 when none were present. This multivariate model enables us to rule out musculoskeletal infection with 99% certainty in limping children with none of these three presenting variables. [ABSTRACT FROM AUTHOR]

A limp suggests an underlying pathology causing the abnormal gait pattern. There is a long list of possible causes. The challenge for the physician is to identify the cause and act accordingly. The purpose of this article is to instruct on the assessment of a child with a limp. [ABSTRACT FROM AUTHOR]

The principal causes in children of a non-acute painful hip are Perthes disease and synovitis (irritable hip). The 99mTc methylene diphosphonate (MDP) bone scan appearances in Perthes disease are well-known; in synovitis, the hip may show a diffuse increase in activity or may be normal. The significance of bone scintigraphy in the clinical setting of non-acute hip symptoms with normal skeletal radiography has been evaluated in 36 symptomatic children. The mean duration of symptoms prior to scan was 3 months (range 1 week-17 months). On the basis of final diagnosis, established by clinical findings, bone scan, X-ray and follow-up, the children were divided into two groups: synovitis or Perthes disease. Of the 33 scans in the 32 children with synovitis, 18 were normal and 15 showed diffusely increased activity on the painful side. All four patients with Perthes disease had focal femoral head abnormalities in the painful hip. Of the 18 children with normal scans, none went on to develop a skeletal disorder. In children with hip pain of over 1 week's duration, the main value of the bone scan is the early detection of Perthes disease. Diffuse increased activity on the painful side suggests synovitis. A normal scan virtually excludes significant skeletal abnormality. [ABSTRACT FROM AUTHOR]

Introduction: Neuroblastoma is a rare condition which usually presents with an abdominal mass. It is a malignant tumour of sympathetic nervous tissue and the second most common solid tumour of childhood. We are reporting this rare case of neuroblastoma presenting with a limp. There is one other report of a similar case in English literature. This 3-year-old boy presented with a 10-day history of a limp. There was no history of trauma and the movements of the hips and knees were normal. His inflammatory markers were mildly raised and ultrasound and X-rays of the hips were normal. Magnetic resonance imaging showed infiltrative lesions in the left femur as well as other parts of the skeleton. Bone marrow biopsy in a regional paediatric centre confirmed a diagnosis of neuroblastoma and he is now in a regional chemotherapy trial. This case highlights the rare orthopaedic presentation of this childhood malignancy. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 4 year-old female with right leg pain and limp for 2 days who was taken to the Emergency Department. After the negative findings of her physical examination, no laboratory studies were obtained but a radiograph of the pelvis and hips. The article discusses limp, trauma, and transient synovitis.

The article describes the case of a three-year-old Japanese boy who underwent an early diagnosis of scurvy based on radiology and dietary history. Topics covered include how a radiograph of the boy's knee showed distal femoral metaphyseal thickening of the provisional zones of calcification which is the so-called white line of Frankel and how scurvy can lead to irritability, petechiae, and dermatological problems.

Copyright of Reumatología Clínica is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)