Diagnostic Utility of Synovial Fluid Cell Counts and CRP in Pediatric Knee Arthritis: A 10-Year Monocentric, Retrospective Study

BACKGROUND Orthopedic surgeons often use the intra-articular white blood counts (WBCs) and the percentage of polymorphonuclear cells (PMN) in the diagnosis of an acute swollen and painful knee joint in children. Today, there is no established threshold for the synovial WBC, and their differentiation, as indicative of native joint knee bacterial arthritis. We determine the sensitivity and specificity of synovial WBCs and PMN percentages in the prediction of a community-acquired, acute bacterial native joint septic arthritis (SA) in the pediatric population. METHODS A retrospective study on healthy children 0-16 years of age who underwent knee joint aspiration for a community-acquired, acute irritable knee effusion in our tertiary-care children's hospital between May 2009 and April 2019 was conducted. We divided the study population into two groups according to the detection of bacterial arthritis in the synovial fluid (bacterial arthritis versus its absence) and compared the intra-articular leukocyte and C-reactive protein (CRP) levels. RESULTS Overall, we found a statistically significant difference regarding the total CRP (p = 0.017), leukocyte or PMN counts (p ≤ 0.001 in favor of a bacterial arthritis). In contrast, the percentage of the neutrophils was not determinant for the later confirmation of bacterial pathogens, and we were unable to establish diagnostically determining minimal thresholds of the intra-articular CRP and leukocyte levels. CONCLUSIONS This pilot study suggests that either the leukocyte or PMN counts may be associated with a bacterial origin of knee arthritis in children. We plan a larger prospective interventional study in the future to confirm these findings including the investigation of other joint aspirate biomarkers

Amelioration Du Systeme De Management De Qualite Via Une Contribution A La Mise En Place D’un Systeme De Management De Securite Dans Une Societe Multinationale Au Maroc

Managing staff security has become a global requirement and challenge. Moroccan companies are obliged to guarantee the safety of their personnel through a security management system. The implementation of the SMS (Safety Management System) has now become a regulatory requirement. This article presents a study carried out in a multinational company, a production and packaging unit for fresh fruits and vegetables, with a view to setting up an SMS, in an approach aimed at improving the quality system of the company

Comparing neuromotor functions in 45- and 65-year-old adults with 18-year-old adolescents

Aim: This cross-sectional analysis investigates how neuromotor functions of two independent cohorts of approximately 45- and 65-year-old individuals are different from 18-year-old adolescents using the Zurich Neuromotor Assessment-2 (ZNA-2). Methods: A total of 186 individuals of the Zurich Longitudinal Studies (ZLS) born in the 1950s (mean age 65.1 years, SD = 1.2 year, range of ages 59.0–67.5 years, n = 151, 82 males) and 1970s (mean age 43.6 years, SD = 1.3 year, range of ages 40.8–46.6 years, n = 35, 16 males) were tested with the ZNA-2 on 14 motor tasks combined in 5 motor components: fine motor, pure motor, balance, gross motor, and associated movements. Motor performance measures were converted into standard deviation scores (SDSs) using the normative data for 18-year-old individuals as reference. Results: The motor performance of the 45-year-old individuals was remarkably similar to that of the 18-year-olds (SDS from −0.22 to 0.25) apart from associated movements (−0.49 SDS). The 65-year-olds showed lower performance than the 18-year-olds in all components of the ZNA-2, with the smallest difference observed for associated movements (−0.67 SDS) and the largest for gross motor skills (−2.29 SDS). Higher body mass index (BMI) was associated with better performance on gross motor skills for 45-year-olds but with worse performance for 65-year-olds. More educational years had positive effects on gross motor skills for both ages. Interpretation: With the exception of associated movements, neuromotor functions as measured with the ZNA-2 are very similar in 45- and 18-year-olds. In contrast, at age 65 years, all neuromotor components show significantly lower function than the norm population at 18 years. Some evidence was found for the last-in-first-out hypothesis: the functions that developed later during adolescence, associated movements and gross motor skills, were the most vulnerable to age-related decline

Perioperative Course and Socioeconomic Status Predict Long-Term Neurodevelopment Better Than Perioperative Conventional Neuroimaging in Children with Congenital Heart Disease

OBJECTIVE The objective of the study was to compare the use of neonatal conventional brain magnetic resonance imaging (MRI) with that of clinical factors and socioeconomic status (SES) to predict long-term neurodevelopment in children with severe congenital heart disease (CHD). STUDY DESIGN In this prospective cohort study, perioperative MRIs were acquired in 57 term-born infants with CHD undergoing cardiopulmonary bypass surgery during their first year of life. Total brain volume (TBV) was measured using an automated method. Brain injury severity (BIS) was assessed by an established scoring system. The neurodevelopmental outcome was assessed at 6 years using standardized test batteries. A multiple linear regression model was used for cognitive and motor outcomes with postoperative TBV, perioperative BIS, CHD complexity, length of hospital stay, and SES as covariates. RESULTS CHD diagnoses included univentricular heart defect (n = 15), transposition of the great arteries (n = 33), and acyanotic CHD (n = 9). Perioperative moderate-to-severe brain injury was detected in 15 (26%) patients. The total IQ was similar to test norms (P = .11), whereas the total motor score (P < .001) was lower. Neither postoperative TBV nor perioperative BIS predicted the total IQ, but SES (P < .001) and longer hospital stay (P = .004) did. No factor predicted the motor outcome. CONCLUSION Although the predictive value of neonatal conventional MRIs for long-term neurodevelopment is low, duration of hospital stay and SES better predict the outcome in this CHD sample. These findings should be considered in initiating early therapeutic support

Secular trends in physical growth, biological maturation, and intelligence in children and adolescents born between 1978 and 1993

IntroductionHuman physical growth, biological maturation, and intelligence have been documented as increasing for over 100 years. Comparing the timing of secular trends in these characteristics could provide insight into what underlies them. However, they have not been examined in parallel in the same cohort during different developmental phases. Thus, the aim of this study was to examine secular trends in body height, weight, and head circumference, biological maturation, and intelligence by assessing these traits concurrently at four points during development: the ages of 4, 9, 14, and 18 years.MethodsData derived from growth measures, bone age as an indicator of biological maturation, and full-scale intelligence tests were drawn from 236 participants of the Zurich Longitudinal Studies born between 1978 and 1993. In addition, birth weight was analyzed as an indicator of prenatal conditions.ResultsSecular trends for height and weight at 4 years were positive (0.35 SD increase per decade for height and an insignificant 0.27 SD increase per decade for weight) and remained similar at 9 and 14 years (height: 0.46 SD and 0.38 SD increase per decade; weight: 0.51 SD and 0.51 SD increase per decade, respectively) as well as for weight at age 18 years (0.36 SD increase per decade). In contrast, the secular trend in height was no longer evident at age 18 years (0.09 SD increase per decade). Secular trends for biological maturation at 14 years were similar to those of height and weight (0.54 SD increase per decade). At 18 years, the trend was non-significant (0.38 SD increase per decade). For intelligence, a positive secular trend was found at 4 years (0.54 SD increase per decade). In contrast, negative secular trends were observed at 9 years (0.54 SD decrease per decade) and 14 years (0.60 SD decrease per decade). No secular trend was observed at any of the four ages for head circumference (0.01, 0.24, 0.17, and − 0.04 SD increase per decade, respectively) and birth weight (0.01 SD decrease per decade).DiscussionThe different patterns of changes in physical growth, biological maturation, and intelligence between 1978 and 1993 indicate that distinct mechanisms underlie these secular trends

Secular trends in motor performance in Swiss children and adolescents from 1983 to 2018

Introduction: Environmental changes, including globalization, urbanization, social and cultural changes in society, and exposure to modern digital technology undoubtedly have an impact on children's activity and lifestyle behavior. In fact, marked reductions in children's physical activity levels have been reported over the years and sedentary behavior has increased around the world. The question arises whether these environmental changes had an impact on general motor performance in children and adolescents. The study aimed to investigate secular trends of motor performance in Swiss children and adolescents, aged between 7 and 18 years, over a period of 35 years from 1983 to 2018. Methods: Longitudinal data on the five motor components of the Zurich Neuromotor Assessment (ZNA) - pure motor (PM), fine motor (FM), dynamic balance (DB), static balance (SB), and contralateral associated movements (CAM) - were pooled with cross-sectional data on PM and FM from eight ZNA studies between 1983 and 2018. Regression models were used to estimate the effect of the year of birth on motor performance and body mass index (BMI) measurements. Models were adjusted for age, sex, and socioeconomic status. Results: The secular trend estimates in standard deviation scores (SDS) per 10 years were - 0.06 [-0.33; 0.22, 95% Confidence Interval] for PM, -0.11 [-0.41; 0.20] for FM, -0.38 [-0.66; -0.09] for DB (-0.42 when controlled for BMI), -0.21 [-0.47; 0.06] for SB, and - 0.01 [-0.32; 0.31] for CAM. The mean change in BMI data was positive with 0.30 SDS [0.07; 0.53] over 10 years. Discussion: Despite substantial societal changes since the 1980s, motor performance has remained relatively stable across generations. No secular trend was found in FM, PM, SB, and CAM over a period of 35 years. A secular trend in DB was present independent of the secular trend in body mass index

Prophylaxis of Experimental Endocarditis With Antiplatelet and Antithrombin Agents: A Role for Long-term Prevention of Infective Endocarditis in Humans?

Background. Infective endocarditis (IE) mostly occurs after spontaneous low-grade bacteremia. Thus, IE cannot be prevented by circumstantial antibiotic prophylaxis. Platelet activation following bacterial-fibrinogen interaction or thrombin-mediated fibrinogen-fibrin polymerization is a critical step in vegetation formation. We tested the efficacy of antiplatelet and antithrombin to prevent experimental IE. Methods. A rat model of experimental IE following prolonged low-grade bacteremia mimicking smoldering bacteremia in humans was used. Prophylaxis with antiplatelets (aspirin, ticlopidine [alone or in combination], eptifibatide, or abciximab) or anticoagulants (antithrombin dabigatran etexilate or anti-vitamin K acenocoumarol) was started 2 days before inoculation with Streptococcus gordonii or Staphylococcus aureus. Valve infection was assessed 24 hours later. Results. Aspirin plus ticlopidine, as well as abciximab, protected 45%-88% of animals against S. gordonii and S. aureus IE (P < .05). Dabigatran etexilate protected 75% of rats against IE due to S. aureus (P < .005) but failed to protect against S. gordonii (<30% protection). Acenocoumarol was ineffective. Conclusions. Antiplatelet and direct antithrombin agents may be useful in the prophylaxis of IE in humans. In particular, the potential dual benefit of dabigatran etexilate might be reconsidered for patients with prosthetic valves, who require life-long anticoagulation and in whom S. aureus IE is associated with high mortalit

Secular trends in motor performance in Swiss children and adolescents from 1983 to 2018

IntroductionEnvironmental changes, including globalization, urbanization, social and cultural changes in society, and exposure to modern digital technology undoubtedly have an impact on children’s activity and lifestyle behavior. In fact, marked reductions in children’s physical activity levels have been reported over the years and sedentary behavior has increased around the world. The question arises whether these environmental changes had an impact on general motor performance in children and adolescents. The study aimed to investigate secular trends of motor performance in Swiss children and adolescents, aged between 7 and 18 years, over a period of 35 years from 1983 to 2018.MethodsLongitudinal data on the five motor components of the Zurich Neuromotor Assessment (ZNA) – pure motor (PM), fine motor (FM), dynamic balance (DB), static balance (SB), and contralateral associated movements (CAM) – were pooled with cross-sectional data on PM and FM from eight ZNA studies between 1983 and 2018. Regression models were used to estimate the effect of the year of birth on motor performance and body mass index (BMI) measurements. Models were adjusted for age, sex, and socioeconomic status.ResultsThe secular trend estimates in standard deviation scores (SDS) per 10 years were − 0.06 [−0.33; 0.22, 95% Confidence Interval] for PM, −0.11 [−0.41; 0.20] for FM, −0.38 [−0.66; −0.09] for DB (−0.42 when controlled for BMI), −0.21 [−0.47; 0.06] for SB, and − 0.01 [−0.32; 0.31] for CAM. The mean change in BMI data was positive with 0.30 SDS [0.07; 0.53] over 10 years.DiscussionDespite substantial societal changes since the 1980s, motor performance has remained relatively stable across generations. No secular trend was found in FM, PM, SB, and CAM over a period of 35 years. A secular trend in DB was present independent of the secular trend in body mass index

Comparing neuromotor functions in 45- and 65-year-old adults with 18-year-old adolescents

AimThis cross-sectional analysis investigates how neuromotor functions of two independent cohorts of approximately 45- and 65-year-old individuals are different from 18-year-old adolescents using the Zurich Neuromotor Assessment-2 (ZNA-2).MethodsA total of 186 individuals of the Zurich Longitudinal Studies (ZLS) born in the 1950s (mean age 65.1 years, SD = 1.2 year, range of ages 59.0–67.5 years, n = 151, 82 males) and 1970s (mean age 43.6 years, SD = 1.3 year, range of ages 40.8–46.6 years, n = 35, 16 males) were tested with the ZNA-2 on 14 motor tasks combined in 5 motor components: fine motor, pure motor, balance, gross motor, and associated movements. Motor performance measures were converted into standard deviation scores (SDSs) using the normative data for 18-year-old individuals as reference.ResultsThe motor performance of the 45-year-old individuals was remarkably similar to that of the 18-year-olds (SDS from −0.22 to 0.25) apart from associated movements (−0.49 SDS). The 65-year-olds showed lower performance than the 18-year-olds in all components of the ZNA-2, with the smallest difference observed for associated movements (−0.67 SDS) and the largest for gross motor skills (−2.29 SDS). Higher body mass index (BMI) was associated with better performance on gross motor skills for 45-year-olds but with worse performance for 65-year-olds. More educational years had positive effects on gross motor skills for both ages.InterpretationWith the exception of associated movements, neuromotor functions as measured with the ZNA-2 are very similar in 45- and 18-year-olds. In contrast, at age 65 years, all neuromotor components show significantly lower function than the norm population at 18 years. Some evidence was found for the last-in-first-out hypothesis: the functions that developed later during adolescence, associated movements and gross motor skills, were the most vulnerable to age-related decline