Skeletal immaturity, rostral sparing, and disparate hip morphologies as biomechanical causes for Legg-Calvé-Perthes’ disease

Legg-Calvé-Perthes' (Perthes') disease is a developmental disease of the hip joint that may result in numerous short and long term problems. The etiology of the disease remains largely unknown, but the mechanism is believed to be vascular and/or biomechanical in nature. There are several anatomical characteristics that tend to be prevalent in children with Perthes' disease, namely: skeletal immaturity, reduced height, and rostral sparing. We present an overview of the literature, summarizing the current understanding of the pathogenesis, particularly related to how the formation of the vasculature to the femoral epiphysis places children aged 5–8 at a higher risk for Perthes' disease, how skeletal immaturity and rostral sparing could increase the probability of developing Perthes' disease, and how animal models have aided our understanding of the disease. In doing so, we also explore why Perthes' disease is correlated to latitude, with populations at higher latitudes having higher incidence rates than populations closer to the Equator. Finally, we present five hypotheses detailing how Perthes' disease could have a biomechanical cause. Clin. Anat. 29:759–772, 2016. © 2016 Wiley Periodicals, Inc

Cleidocranial dysplasia and RUNX2-clinical phenotype-genotype correlation

Runt-related transcription factor 2 (RUNX2/Cbfa1) is the main regulatory gene controlling skeletal development and morphogenesis in vertebrates. It is located on chromosome 6p21 and has two functional isoforms (type I and type II) under control of two alternate promoters (P1 and P2). Mutations within RUNX2 are linked to Cleidocranial dysplasia syndrome (CCD) in humans. CCD is an autosomal skeletal disorder characterized by several features such as delayed closure of fontanels, dental abnormalities and hypoplastic clavicles. Here, we summarize recent knowledge about RUNX2 function, mutations and their phenotypic consequences in patients.status: publishe

Psoriatic arthritis – classification, diagnostic and clinical aspects

From 5% to 40% patients with psoriatic skin lesions develop psoriatic arthritis, but 15% to 30% of patients with psoriasis suffer from undiagnosed psoriatic arthritis. The key role in development o-f psoriasis is played by T-lymphocytes and release of proinflammatory cytokines, interferon and adhesive proteins. Infection may exert an influence on psoriasis vulgaris and psoriatic arthritis development. The presence of antibodies against the antigens of Yersinia spp., Campylobacter spp. and Chlamydia trachomatis was more frequently observed in the serum of patients with psoriatic arthritis. Diagnosis of psoriatic arthritis may be based on CASPAR criteria. Diagnostic imaging (CT, MRI, USG) are routine diagnostic procedures in psoriatic arthritis. Several sub-types of psoriatic arthritis have been identified. Questionnaires to identify early stages of the disease have been constructed. Genetic factors, cigarette smoking, alcohol abuse, infections, stress and environmental factors may affect clinical course and results of treatment of psoriasis vulgaris and psoriatic arthritis. In severe cases, the disease may lead to disability

Antimicrobial resistance of <I>Enterobacteriaceae</I> in bloodstream infections in hospitalized patients in southern Poland

Aim: The aim of this study was to highlight antimicrobial resistance among Enterobacteriaceae isolated from bloodstream infections in hospitals in southern Poland. Materials and Methods: The present study includes laboratory-confirmed secondary bloodstream infections (LC-BSIs), in the years 2015–2018, in hospitalized adult patients (≥18). Episodes of BSIs were defined according to the strictly described guidelines. Antimicrobial susceptibility testing was performed with the automated system and the disc diffusion method. Extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriaceae were detected using the double-disc synergy test. Results: Between 2015 and 2018, 356 episodes of secondary BSIs in 997 patients aged 21–96 years were documented in a prospective study, including 134 (37.6%) ESBL-producing Enterobacteriaceae. Escherichia coli was the predominant pathogen in internal medicine (37.6%) and surgery units (46.8%); in intensive care units (ICUs), Klebsiella pneumoniae was isolated more frequently (33.3%). Enterobacteriaceae were highly resistant to most antimicrobial agents. K. pneumoniae isolates had a higher level of resistance than E. coli, regardless of the unit. Conclusions: The increase in AMR and the widespread distribution of ESBL-producing Enterobacteriaceae in Polish hospitals can be related to the lack of or inappropriate antibiotic treatment