Septic Malleolar Bursitis in a Patient with an Ankle Electronic Monitoring Device: A Case Report

Introduction: Septic malleolar bursitis is a rare cause of ankle pain and swelling. It has been described in certain occupational and recreational activities that involve tight-fitting boots, such as figure skating. Court-ordered electronic monitoring devices are often worn on the ankle. It is not known whether these devices are a risk factor for the development of malleolar bursitis. Case report: We describe a 41-year-old male under house arrest with an electronic monitoring device on his right ankle who presented to our emergency department with several days of progressive pain and swelling over the medial malleolus. Point-of-care ultrasound revealed a thick-walled cystic structure consistent with medial malleolar bursitis. Bursal aspiration was performed. Fluid culture yielded Staphylococcus aureus. Discussion: Emergency physicians regularly see patients with ankle pain and swelling and must consider a comprehensive differential diagnosis. Septic malleolar bursitis is an uncommon but important cause of ankle pain and swelling that requires prompt diagnosis and intervention. Point-of-care ultrasonography may aid in the diagnosis. Additionally, emergency physicians should be aware of potential complications related to electronic monitoring devices

Septic Malleolar Bursitis in a Patient with an Ankle Electronic Monitoring Device: A Case Report

Introduction: Septic malleolar bursitis is a rare cause of ankle pain and swelling. It has been described in certain occupational and recreational activities that involve tight-fitting boots, such as figure skating. Court-ordered electronic monitoring devices are often worn on the ankle. It is not known whether these devices are a risk factor for the development of malleolar bursitis.Case Report: We describe a 41-year-old male under house arrest with an electronic monitoring device on his right ankle who presented to our emergency department with several days of progressive pain and swelling over the medial malleolus. Point-of-care ultrasound revealed a thick-walled cystic structure consistent with medial malleolar bursitis. Bursal aspiration was performed. Fluid culture yielded Staphylococcus aureus.Discussion: Emergency physicians regularly see patients with ankle pain and swelling and must consider a comprehensive differential diagnosis. Septic malleolar bursitis is an uncommon but important cause of ankle pain and swelling that requires prompt diagnosis and intervention. Point-of-care ultrasonography may aid in the diagnosis. Additionally, emergency physicians should be aware of potential complications related to electronic monitoring devices

A Tablet-Based Tool for Accurate Measurement of Hand Proprioception After Stroke

Background and Purpose: Proprioceptive deficits in the hand are common following stroke, but current clinical measurement techniques are too imprecise to detect subtle impairments or small changes. We developed a tablet-based tool to measure static hand proprioception using an adaptive staircase procedure. Methods: In 16 individuals with chronic stroke and age-matched controls, we quantified proprioception at the metacarpophalangeal joint of the index finger using 3 methods: the tablet task, a custom passive movement direction discrimination test (PMDD), and a manual assessment similar to the Fugl-Meyer (F-M) proprioception subsection. Results: The tablet-based measure and the PMDD both identified impaired proprioception in the affected hand relative to the unaffected hand (P = 0.024 and 0.028), and relative to the control group (P = 0.040 and 0.032), while manual assessment did not. The PMDD had a ceiling effect as movement excursions greater than 15^ were not biomechanically feasible. The tablet-based measure and the PMDD detected impaired proprioception in 56% to 75%, and the F-M in only 29%, of patients. PMDD and tablet-based measures were both correlated with primary tactile sensation, but not manual dexterity. Discussion and Conclusions: Both the tablet-based tool and the custom PMDD performed better than manual assessment. The PMDD may be useful when the deficit is mild or assessment of dynamic proprioception is desired. As the tablet-based measure does not have the ceiling effect that is associated with the PMDD, it may be useful with any level of proprioceptive impairment, and may be preferable if testing or clinician training time needs to be minimized, or pain or spasticity is present

CYP2C9*2 is associated with indomethacin treatment failure for patent ductus arteriosus

Aims: To identify clinical andgenetic factors associated with indomethacin treatment failure in preterm neonates with patent ductus arteriosus (PDA). Patients & Methods: This is a multicenter cohort study of 144 preterm infants (22-32 weeks gestational age) at three centers who received at least one treatment course of indomethacin for PDA. Indomethacin failure was defined as requiring subsequent surgical intervention. Results: In multivariate analysis, gestational age (AOR 0.76, 95% CI 0.60-0.96), surfactant use (AOR 9.77, 95% CI 1.15-83.26), and CYP2C9*2 (AOR 3.74; 95% CI 1.34-10.44) were each associated with indomethacin failure. Conclusion: Age, surfactant use, and CYP2C9*2 influence indomethacin treatment outcome in preterm infants with PDA. This combination of clinical and genetic factors may facilitate targeted indomethacin use for PDA