Obturator externus abscess in a 9-year-old child: A case report and literature review.

Obturator pyomyositis is a rare condition in children. Diagnosis is often delayed because of its rarity, and the vagaries of its presentation cause it to be easily be missed. Physicians should therefore familiarize themselves with this condition and consider it as a possible differential diagnosis in patients presenting with an acutely painful hip. Inflammatory syndrome is also frequent among sufferers and the MRI is a very sensitive diagnostic tool for obturator pyomyositis. Additionally, joint fluid aspirations and blood cultures are also useful in identifying the pathogen. The appropriate antibiotic therapy provides a rapid regression of symptoms during the early stage of pyomyositis. In cases of MRI-confirmed abscess, surgical treatment is indicated. Our report focuses on a case of obturator pyomyositis in a 9-year-old boy. The child was febrile for 5 days and could only manage to walk a few steps. His hip range of motion was restricted in all directions. In addition, the patient had presented pain and swelling of his right elbow for a day, with a restriction of motion in the joint. There was a clear inflammatory syndrome. A diagnosis of hip and elbow septic arthritis was suspected, and the child underwent joint aspiration of the both cited joints. The aspiration of the elbow returned pus. Conversely, no effusion was found in the hip aspiration. The administration of empiric intravenous antibiotherapy was started. An MRI revealed an osteomyelitis of the ischio-pubic area associated with a subperiosteal abscess. Subsequently, 3 days after elbow arthrotomy, a surgical treatment was performed on the patient's right hip in order to evacuate the subperiosteal abscess and muscular collection because of the persistence of the patient's symptoms and inflammatory syndrome despite susceptible intravenous antibiotics. Postsurgery the patient showed steady improvement. Such cases demonstrate how diagnosis can be difficult because pelvic pyomyositis is often mistaken for more common pathologies such as septic arthritis, osteomyelitis, or appendicitis. This may delay the diagnosis or refer misdiagnosis. We discuss this rare infection in light of the literature with particular reference to its incidence, clinical features, bacteriological etiology, biological, and radiological presentation, and above all, its treatment

Swiss recommendations on perioperative antimicrobial prophylaxis in children

Infection following surgical procedures leads to significant morbidity and mortality in all age groups. Sterile techniques, antibiotic prophylaxis and improved postoperative wound care have contributed to the decline of surgical site infections since the early days of surgery. Recommendations on the use of perioperative antimicrobial prophylaxis exist for adults, but are rare for the paediatric population. Here, we provide a standardised approach to the effective use of antimicrobial agents for the prevention of surgical site infections in children contributing to a targeted and rational perioperative use of antibiotics in Switzerland

Decongestion improving right heart function ameliorates prognosis after an acute heart failure episode.

The prognostic role of decongestion-related change of cardiac morphology and in particular right heart function has not been investigated comprehensively in AHF patients. This prospective observational single-centre study included consecutive patients hospitalized for treatment of AHF with reduced, mildly-reduced or preserved left ventricular ejection fraction (LVEF). Comprehensive transthoracic echocardiography at admission and discharge assessed decongestion-related change of cardiac function and morphology. The combined endpoint of 1 year all-cause mortality and cardiovascular rehospitalization explored the prognostic importance of decongestion-related change. The 176 study participants were 83 years old [74-87] and 54% were men. Fifty one (29%) had rLVEF, 65 (37%) mrLVEF, and 60 (34%) pLVEF. The proportion of de novo or worsening chronic HF was not different between LVEF groups. HF aetiology and cardiovascular risk factors were equally distributed across all groups except for a higher BMI in the pLVEF group. Decongestion equally reduced body weight, heart rate, systolic and diastolic blood pressure, tricuspid regurgitation gradient, and inferior vena cava diameter across all groups (P < 0.004 for all). Decongestion-related increase in TAPSE independent of the LVEF was associated with improvement of right-ventricular-pulmonary artery coupling and a lower incidence of the combined outcome in the Cox proportional hazard risk analysis (unadjusted HR 0.50 95% CI 0.33-0.78, P = 0.002; adjusted HR 0.46 95% CI: 0.33-0.78, P = 0.001). Decongestion-related increase in TAPSE and recovery of RV/pulmonary artery coupling was observed across all LVEF groups and associated with a risk reduction for the combined endpoint highlighting the important prognostic role of right heart recovery after an AHF episode

Viral suppression and retention in HIV care during the postpartum period among women living with HIV: a longitudinal multicenter cohort study.

BACKGROUND Low rates of postnatal retention in HIV care and viral suppression have been reported in women living with HIV (WLWH) despite viral suppression at delivery. At the same time, postpartum follow-up is of crucial importance in light of the increasing support offered in many resource-rich countries including Switzerland to WLWH choosing to breastfeed their infant, if optimal scenario criteria are met. METHODS We longitudinally investigated retention in HIV care, viral suppression, and infant follow-up in a prospective multicentre HIV cohort study of WLWH in the optimal scenario who had a live birth between January 2000 and December 2018. Risk factors for adverse outcomes in the first year postpartum were assessed using logistic and proportional hazard models. FINDINGS Overall, WLWH were retained in HIV care for at least six months after 94.2% of the deliveries (694/737). Late start of combination antiretroviral therapy (cART) during the third trimester was found to be the main risk factor for failure of retention in HIV care (crude odds ratio [OR] 3.91; 95% confidence interval [CI], 1.50-10.22; p = 0.005). Among mothers on cART until at least one year after delivery, 4.4% (26/591) experienced viral failure, with illicit drugs use being the most important risk factor (hazard ratio [HR], 13.2; 95% CI, 2.35-73.6; p = 0.003). The main risk factors for not following the recommendations regarding infant follow-up was maternal depression (OR, 3.52; 95% CI, 1.18-10.52; p = 0.024). INTERPRETATION Although the results are reassuring, several modifiable risk factors for adverse postpartum outcome, such as late treatment initiation and depression, were identified. These factors should be addressed in HIV care of all WLWH, especially those opting to breastfeed in resource-rich countries. FUNDING This study has been financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant #201369), by SHCS project 850 and by the SHCS research foundation

Summation of visual attributes in auditory‐visual crossmodal

Crossmodal correspondences are a feature of human perception in which two or more sensory dimensions are linked together; for example, high‐pitched noises may be more readily linked with small objects than large objects. However, no study yet has systematically examined the interaction between different visual‐auditory crossmodal correspondences. We investigated how the visual dimensions of luminance, saturation, size and vertical position can influence decisions when matching particular visual stimuli with high‐pitched or low‐pitched auditory stimuli. For multi‐dimensional stimuli, we found a general pattern of summation of individual crossmodal correspondences, with some exceptions that may be explained by Garner interference. These findings have applications for the design of sensory substitution systems, which convert information from one sensory modality to another

Viral suppression and retention in HIV care during the postpartum period among women living with HIV: a longitudinal multicenter cohort study

BACKGROUND: Low rates of postnatal retention in HIV care and viral suppression have been reported in women living with HIV (WLWH) despite viral suppression at delivery. At the same time, postpartum follow-up is of crucial importance in light of the increasing support offered in many resource-rich countries including Switzerland to WLWH choosing to breastfeed their infant, if optimal scenario criteria are met. METHODS: We longitudinally investigated retention in HIV care, viral suppression, and infant follow-up in a prospective multicentre HIV cohort study of WLWH in the optimal scenario who had a live birth between January 2000 and December 2018. Risk factors for adverse outcomes in the first year postpartum were assessed using logistic and proportional hazard models. FINDINGS: Overall, WLWH were retained in HIV care for at least six months after 94.2% of the deliveries (694/737). Late start of combination antiretroviral therapy (cART) during the third trimester was found to be the main risk factor for failure of retention in HIV care (crude odds ratio [OR] 3.91; 95% confidence interval [CI], 1.50-10.22; p = 0.005). Among mothers on cART until at least one year after delivery, 4.4% (26/591) experienced viral failure, with illicit drugs use being the most important risk factor (hazard ratio [HR], 13.2; 95% CI, 2.35-73.6; p = 0.003). The main risk factors for not following the recommendations regarding infant follow-up was maternal depression (OR, 3.52; 95% CI, 1.18-10.52; p = 0.024). INTERPRETATION: Although the results are reassuring, several modifiable risk factors for adverse postpartum outcome, such as late treatment initiation and depression, were identified. These factors should be addressed in HIV care of all WLWH, especially those opting to breastfeed in resource-rich countries. FUNDING: This study has been financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant #201369), by SHCS project 850 and by the SHCS research foundation