Clinical Applications of Virtual Reality in Musculoskeletal Rehabilitation: A Scoping Review.

(1) Background: VR is based on a virtual world that creates sounds effects and videos that replace the real environment. Arising literature shows VR efficacy in the field of neurological rehabilitation (NR) and that its use is also taking a place in musculoskeletal rehabilitation (MSR), as a treatment of various disorders that cause disability and chronic pain. (2) Aim: We discuss the role of VR in MSR, presenting its use and development on acute and chronic musculoskeletal disorders, based on the most recent literature. (3) Design and Methods: Literature searches were conducted in the databases Pubmed and Medline up to 30 September 2023. The PRISMA-Scr Checklist was followed. (4) Results: A total of 51 records were included. The analysed studies were conducted within a variety of populations, musculoskeletal disorders, settings, and VR technologies. Only a few studies could statistically affirm the efficacy of VR in MSR, as mentioned for the rehabilitation of the upper limb. Nevertheless, the observed trend is an improvement of the global perceived effect compared to traditional rehabilitation. (5) Conclusion: VR allows for the personalisation of treatment with an adaptable treatment platform, which may improve the participation of the patient and increase acceptability and adherence to long-term rehabilitation programs. We provide recommendations and suggestions for future research and use of VR in musculoskeletal rehabilitation.

Multisystem Inflammatory Syndrome Following SARS-CoV-2 Vaccination in Two Children.

This report presents 2 pediatric cases of multisystem inflammatory syndrome in children and adults (MIS-C/A) post severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination (MIS-V). Both children presented with MIS-V within 6 weeks of receiving their first and only dose of Pfizer-BioNTech's SARS-CoV-2 vaccine. The first patient had symptoms of MIS-C/A with peri-myocarditis and shock, and the second 1 had classic Kawasaki disease features. Both responded well to intravenous immunoglobulins and/or systemic corticosteroids. Both children were positive only for SARS-2-CoV antispike (S) (and not for antinucleocapsid [NC]) antibodies consistent with a postvaccine, and not a postinfection, event. Surveillance for rare adverse events following immunization should continue, especially now that SARS-CoV-2 vaccination is approved in the 5 to 11 year age group that has had the highest risk of developing MIS-C post SARS-CoV-2 infection. Our patients did not receive any further SARS-CoV-2 vaccines. Our report highlights the importance of measuring differentiating antibodies (anti-S and anti-NC) that can be used within a specific timeframe to help determine if a patient has MIS-V post vaccine (only anti-S present), or MIS-C/A post SARS-CoV-2 infection (both anti-S and anti-NC present).

[Sports dermatology]. / Dans la peau des sportif·ve·s: dermatologie du sport.

Athlete's skin is under great stress and its integrity is essential. Knowledge and prevention of sports-related dermatoses are fundamental to athlete's the management. Hereby we review common sport-related affections classified by their etiologies (traumatic, infectious, inflammatory and environmental dermatoses).

La peau est soumise à des contraintes importantes lors des activités sportives et son intégrité est essentielle mais souvent banalisée. La connaissance et la prévention des dermatoses liées aux différents sports sont fondamentales pour une prise en charge optimale. Cet article rappelle les diverses dermatoses liées au sport classées par étiologies (traumatiques, infectieuses, inflammatoires et liées à l'environnement).

[Plantar fasciitis: update 2021]. / Aponévropathie plantaire : mise au point 2021.

Plantar heel pain affects 4 to 9% of the population and is a common reason for consultation. Plantar fasciitis is the most frequent cause. Its diagnosis is essentially clinical, possibly supported initially by combination of X-ray/ultrasound. Ultrasound is the modality of choice to confirm the diagnosis. The prognosis is favorable, but the evolution can be long. Its management should be structured in a progressive manner, based on therapeutic education and physical measures. These simple measures have the highest level of evidence of effectiveness and should be implemented before proposing, sometimes too early, second-line therapies.

Les talalgies plantaires touchent 4 à 9 % de la population et sont un motif fréquent de consultation en médecine générale et en médecine du sport. L'aponévropathie plantaire en est la cause la plus fréquente. Son diagnostic est essentiellement clinique, éventuellement complété en première intention par le couple radiographie/échographie. Cette dernière est l'examen de choix permettant de confirmer le diagnostic. De pronostic favorable, sa durée d'évolution peut être longue. Sa prise en charge doit être structurée de façon progressive en s'appuyant sur l'éducation thérapeutique et des mesures physiques. Ces mesures simples montrent le niveau de preuve d'efficacité le plus élevé et doivent impérativement être mises en place avant de proposer, parfois trop précocement, des thérapeutiques de seconde intention.

Complex regional pain syndrome of the residual limb in a transtibial lower-limb amputee: diagnosis and treatment.

We present the unusual case of complex regional pain syndrome (CRPS) of the residual limb in a 54-year-old woman with transtibial lower-limb amputation. Intractable pain developed 14 months after amputation, followed by successful rehabilitation. Anamnesis and clinical findings included sensory symptoms, vasomotor symptoms and signs, and oedema. The Budapest criteria for a diagnosis of CRPS were met. After infusions of bisphosphonates during a 5-week inpatient interdisciplinary rehabilitation programme, the pain decreased. Clinicians should suspect CRPS in case of chronic or recurrent residual limb pain. The Budapest criteria seem applicable even if interpretation of symptoms and findings can be complicated in vascular polymorbid lower-limb amputation. Bisphosphonates, proposed as first-line pharmacological treatment, can be useful.

Multisystem inflammatory syndrome in children and adults (MIS-C/A): Case definition & guidelines for data collection, analysis, and presentation of immunization safety data.

This is a Brighton Collaboration Case Definition of the term "Multisystem Inflammatory Syndrome in Children and Adults (MIS-C/A)" to be utilized in the evaluation of adverse events following immunization. The case definition was developed by topic experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of vaccines for SARS-CoV-2. The format of the Brighton Collaboration was followed, including an exhaustive review of the literature, to develop a consensus definition and defined levels of certainty. The document underwent peer review by the Brighton Collaboration Network and by selected expert external reviewers prior to submission. The comments of the reviewers were taken into consideration and edits incorporated into this final manuscript.

Impact of quadrivalent HPV vaccine dose spacing on immunologic response in women living with HIV.

HPV vaccination schedules have changed as evidence has supported reduced dosing and extended intervals. Women living with HIV (WLWH) represent an important population with no data on alternative dosing. Girls and WLWH received quadrivalent HPV (qHPV) vaccine in a pan-Canadian study of immunogenicity and efficacy. Serology was performed at months 0/2/7/12/18/24. Medical and sexual history was collected throughout. Linear regression was used to determine if spacing of doses was associated with peak antibody titer. Multivariable analyses demonstrated significant relationships between peak antibody titer and time to blood draw post last vaccine dose, naivety to the relevant HPV type, and HIV viral load for all qHPV types. There was a significant relationship between peak HPV16/18 antibody titer and age. Taking age, time to serology, CD4 cell count, CD4 nadir, HIV viral load, and HPV naivety into account, spacing of the three qHPV vaccine doses did not significantly impact peak antibody titers.

Cross-cultural adaptation and measurement properties of the French version of the Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R).

BACKGROUND: The Trinity Amputation and Prosthesis Experience Scales-Revised (TAPES-R) is a self-administered questionnaire to measure multidimensional adjustment to a prosthetic limb. Our aim was to assess the validity and reliability of the French version of the TAPES-R (TAPES-R-F). MATERIALS AND METHODS: The cross-cultural adaptation was performed according to the recommendations. Factor analysis and Rasch analysis were also performed to allow comparison with the original English version. Construct validity was assessed by measuring the correlations between TAPES-R-F subscores and quality of life, pain, body image satisfaction, anxiety and depression. Internal consistency was measured with Cronbach's α. The standard error of measurement, smallest detectable change, Bland and Altman limits of agreement, and intraclass correlation were the measures of agreement and reliability. RESULTS: No major difficulties were encountered throughout the trans-cultural adaptation process. The final version of the TAPES-R-F was well accepted and understood by the patients. According to the factor analysis, the satisfaction scale should be treated as a one-dimensional construct when used by French-speaking people and should not be separated into two separate subscales, functional and aesthetic, as is the case in the original English version. Our study confirmed that there is a strong relationship between biopsychosocial factors and adjustment to amputation. Cronbach's α > 0.8 for all the subscales. Reliability was good to excellent for all the subscales (ICCs between 0.61 and 0.89). The smallest detectable changes were 0.7, 0.8, 1.3, 0.4, and 1.8 (general adjustment, social adjustment, adjustment to limitation, activity restriction, and global satisfaction with the prosthesis). CONCLUSIONS: The TAPES-R-F is a valid and reliable instrument to assess multidimensional adjustment of French-speaking lower limb amputees. This questionnaire can be used for both clinical assessment and research purposes.

Pregnancies Among the First Generation of Survivors of Perinatal HIV Infection.

OBJECTIVE: Little is known about pregnancy outcomes among women who have acquired human immunodeficiency virus (HIV) through perinatal infection and survived into adulthood. The objectives of this study were to describe pregnancy outcomes among women with perinatal HIV infection (PHIV) in Canada and to identify potential challenges in the prevention of perinatal HIV transmission in this population. METHODS: A retrospective review of all pregnancies among women with PHIV who were previously followed as children at two tertiary care centres in Montréal, Québec, was conducted. Data were extracted from pediatric and obstetrical records. RESULTS: There were 21 pregnancies among 11 women, and 18 of these pregnancies were unintentional. Mean age at first pregnancy was 19.5 years (range 15-29 years). At the first prenatal visit, 79% had a detectable viral load, 36% were immunosuppressed (CD4 T cell count <200 mm3), and only 36% were receiving antiretroviral therapy (ART). At the time of delivery, although all were prescribed ART, 50% of these women still had a detectable viral load, and 36% remained immunosuppressed. All of the women harboured mutations conferring drug resistance to zidovudine and lamivudine, and the majority (73%) were also resistant to nevirapine. None of the infants were HIV infected, although all received prophylaxis with agents to which their mother's virus was resistant. CONCLUSION: Unplanned pregnancies, difficulties with adherence to ART, and drug resistance were identified challenges in the management of pregnancies among women with PHIV. This study highlights a gap in the reproductive counselling of adolescents with PHIV and the need for close follow-up and adherence support during pregnancy in this population.

Challenges to achieving and maintaining viral suppression among children living with HIV.

OBJECTIVES: The objective of this study was to determine the time to, and durability of, viral suppression, among Canadian children living with HIV after initiation of combination antiretroviral therapy (cART). DESIGN: Prospective, multicenter Canadian cohort study (Early Pediatric Initiation Canada Child Cure Cohort), using both prospective and retrospectively collected data. METHODS: Kaplan-Meir survival estimates with Cox regression were used to determine the time to and risk factors for viral suppression, defined as two consecutive undetectable viral loads (<50 copies/ml) at least 30 days apart after initiation of cART. RESULTS: A total of 228 children were enrolled between December 2014 and December 2018. The time to viral suppression was significantly shorter among children initiating cART after 5 ≤ 5 vs. years or less of age [adjusted hazard ratio (aHR) 1.57, 95% confidence interval (CI) 1.13-2.20], among those born after 2010 vs. prior (aHR 1.71, 95% CI 1.04-2.79), and among those without child protection services involvement (aHR 1.44, 95% CI 1.03-2.01). Overall, 27% of children had a viral rebound within 3 years of achieving viral suppression; the risk of viral rebound was significantly lower among children initiating cART after 5 vs. 5 years or less of age [adjusted odds ratio (aOR): 0.32, 95% CI 0.13-0.81], those whose families had not received social assistance (aOR 0.16, 95% CI 0.06-0.46), and females vs. males (aOR 0.51, 95% CI 0.26-0.99). CONCLUSION: Only 73% of the children in the Early Pediatric Initiation Canada Child Cure Cohort had maintained viral suppression 3 years after it was first achieved. Age at cART initiation, and socioeconomic factors were predictors of both time to viral suppression and risk of viral rebound in this cohort.

Transcultural adaptation and validation of a French version of the Prosthetic Limb Users Survey of Mobility 12-item Short-Form (PLUS-M/FC-12) in active amputees.

BACKGROUND: The PLUS-M 12-item Short-Form is a self-questionnaire that assesses the perceived capacity of lower limb amputees (LLAs) to perform a number of daily-life activities. Its psychometric properties are excellent (intraclass correlation coefficient [ICC]>0.9, fast administration and scoring, normative data available), and it can be used in clinical practice or for research purposes. OBJECTIVE: We aimed to develop a French version of this questionnaire and to assess its psychometric properties. METHODS: We followed international recommendations for translation and cross-cultural validation of questionnaires. In total, 52 LLAs (age 53±16, 40 males, 28/12/12 transtibial/Gritti-Stokes/transfemoral, 20/28/4 ischemic/traumatic/other) participated. Criterion and construct validities were assessed with the Pearson correlation coefficient (PCC) between the PLUS-M 12-item Short-Form and other constructs (Prosthetic-Profile-of-the-Amputee-Locomotor Capabilities Index, Activities-specific Balance Confidence scale, 2-min walking test and Timed Up and Go test), internal consistency with the Cronbach α and reliability with the ICC in 46 individuals who completed the questionnaire twice in a 7-day interval. RESULTS: The mean (SD) PLUS-M 12-item Short-Form T-score was 56.1 (7.8; range 40.3 to 71.4). Construct and criterion validity, internal consistency and reliability ranged from low to excellent (r=0.43 to 0.84, P<10-2 to 0.002; Cronbach α=0.90, ICC=0.89 [0.81-0.94]). We found no floor or ceiling effect. CONCLUSIONS: The French version of the PLUS-M 12-item Short-Form has good to excellent psychometric properties, comparable to those of the original version. Its use could definitely be proposed for both clinical and research purposes, once its validation is completed by assessing other psychometric qualities, especially sensitivity to change.

[The acute management of muscle injuries in 2018]. / Prise en charge des lésions musculaires aiguës en 2018.

Acute muscle lesions are frequent conditions in sports traumato-logy. Intrinsic traumatic mechanism (excessive stretch) is more prevalent that extrinsic mechanism (direct shock or lacerations). The diagnosis is generally based on the injury mechanism description together with the clinical examination. The ultrasonography is helpful in order to evaluate the severity of the lesion and the time to sports resumption. The initial management is based on the POLICE acronym: Protection, Optimal loading, Ice, Compression, and Elevation. For high grade muscle lesions, patients might benefit from either ultrasound-guided hematoma evacuation or surgical repair. Non-steroid anti-inflammatory drugs should be avoided within the first days. The rehabilitation should begin 48h after the trauma, whatever the severity of the lesion.

Les lésions musculaires sont fréquentes en traumatologie sportive. Le mécanisme traumatique est plus fréquemment intrinsèque (par élongation) qu'extrinsèque (par choc direct ou lacération). Le diagnostic se fait sur la base de la description du mécanisme lésionnel et de l'examen clinique. L'estimation de la gravité et des délais de reprise est aidée par les examens d'imagerie, comme l'échographie. La prise en charge immédiate se base sur le protocole POLICE (Protection, Optimal loading, Ice, Compression, Elevation). Les anti-inflammatoires non stéroïdiens sont à proscrire. Les lésions de haut grade peuvent bénéficier d'une ponction-évacuation d'hématome, voire d'une réparation chirurgicale. Il est recommandé de débuter une rééducation adaptée dès 48 heures après le traumatisme, quelle que soit la sévérité de la lésion initiale.

Immunogenicity and Safety of the Quadrivalent Human Papillomavirus Vaccine in Girls Living With HIV.

We evaluated quadrivalent human papillomavirus vaccine seroresponses among 35 girls living with HIV (9-13 years of ages) and compared with data on girls without HIV, as part of a subgroup analysis. The quadrivalent human papillomavirus vaccine was safe and well tolerated. However, antibody response was significantly lower in girls living with HIV relative to girls without HIV. HIV virologic suppression predicted better antibody response.

[« My joints are cracking, is it serious doctor ? ¼ A review about sounds produced by joints]. / « Mes articulations craquent, c'est grave docteur ? ¼ Les bruits articulaires en question.

The sounds produced by joints are a common source of questioning for doctors and their patients. Two major types are identified : cracks and crepitus. Few investigations have been carried out on these manifestations, while they potentially have clinical implications, especially for patellar crepitus in patellofemoral osteoarthrosis, and may generate anxiety. Knuckle cracking appears to be caused by the sudden and temporary occurrence of an intra-articular gaseous cavity, called tribonucleation. Other researches on these sounds are focused on the knees and their links with osteoarthritis, as well as on the spine. Many questions still arise but it seems important to talk about it with patients without trivializing them.

Les bruits produits par les articulations sont une source de questionnements pour les médecins et leurs patients. Deux principaux types sont identifiés, les craquements et les grincements. Peu d'investigations ont été réalisées sur ces manifestations fréquentes alors qu'elles présentent potentiellement une implication clinique, notamment pour les grincements patellaires dans l'arthrose fémoro-patellaire, et qu'elles peuvent générer de l'anxiété. Les craquements des doigts semblent être provoqués par l'apparition soudaine et temporaire d'une cavité gazeuse intra-articulaire, appelée tribonucléation. Les autres recherches sur ces bruits se portent principalement sur les genoux et leurs liens avec l'arthrose, ainsi que sur le rachis. De nombreuses questions subsistent, mais il est nécessaire d'en parler avec les patients sans les banaliser.

HIV viral suppression results in higher antibody responses in HIV-positive women vaccinated with the quadrivalent human papillomavirus vaccine.

OBJECTIVE: To evaluate the immunogenicity and safety of the quadrivalent HPV (qHPV) vaccine in HIV-positive women over 24months. DESIGN: Between November 2008 and December 2012, 372 women aged 15 and older were enrolled from 14 Canadian HIV outpatient clinics in an open label cohort study. The qHPV vaccine (0.5mL) was administered intramuscularly at months 0, 2 and 6. The primary study endpoint was seroconversion to any of the HPV types targeted by the qHPV vaccine. Antibody levels were measured at 0, 2, 7, 12, 18, and 24months. Adverse events were recorded throughout. RESULTS: Of 372 participants enrolled, 310 (83%) received at least one dose of the qHPV vaccine and 277 (74%) received all three doses. Ninety-five percent (293/308) were seronegative for at least one vaccine type at baseline. The median age was 38years (IQR 32-45, range 15-66), 36% were white, 44% black and 13% were of Indigenous origin. Seventy-two percent of participants had a suppressed HIV viral load (VL<40c/ml) at baseline, with a median CD4 count of 510cells/mm(3) (376-695). Month 7 HPV type-specific seroconversion rates were 99.0%, 98.7%, 98.1% and 93.6% for HPV types 6, 11, 16 and 18 respectively in the per-protocol population. Participants with suppressed HIV VL at first vaccine had a 1.74-3.05fold higher peak antibody response compared to those without (p from 0.006 to <0.0001). CONCLUSIONS: This study is the first to examine the qHPV vaccine in HIV-positive women out to 24months and the first to include HIV-positive women through to age 66. The qHPV vaccine was well tolerated, and highly immunogenic. As women with suppressed viral load had higher antibody responses, planning HPV vaccination to occur when persons are virologically suppressed would be optimal for maximizing immune response. Findings provide strong evidence that older HIV-positive women can still benefit from HPV vaccination. CLINICAL TRIAL REGISTRATION: http://www.isrctn.com/ISRCTN33674451.

Macroscopic deciduosis in pregnancy is finally a common entity.

OBJECTIVE: The primary aim of our study was to determine the prevalence of macroscopic deciduosis Found randomly in Cesarean sections and the secondary objective to determine the association with any obstetrical complications or adverse effects. METHODS: This is a unicenter prospective study from 01/08/2011 to 01/02/2014. During the study period 307 consecutive Cesarean sections were performed with 31 biopsy proven cases of macroscopic deciduosis in the ovary, uterine and fallopian tube serosa. RESULTS: The mean age of the patients was 31.2 ± 5.4 years (range 13-43), the mean Body Mass Index was 26.3 ± 5.8 (range 15-48)kg/m(2), the mean term of Cesarean was 270 ± 25 days, and the mean fetal weight was 3094 ± 809 g. The majority of patients were Caucasian (n=175, 57.0%). Patients with deciduosis had a greater BMI (28.4 ± 5.3 kg/m(2) vs 25.7 ± 5.8 kg/m(2), p<0.05). The presence of pain was more frequent in the deciduosis group (10.1%, OR 5.78, 95%, CI [2.41-13.87], p<0.001). CONCLUSION: Deciduosis is a benign lesion during pregnancy that is not correlated with obstetrical complications. Our study has shown that this physiological phenomenon is more frequent that originally thought, being present in 10% of the Cesarean sections, and is associated with abdominal pain during pregnancy.