Long-Term Outcomes of Nonsurgical Treatment of Thumb Carpometacarpal Osteoarthritis: A Cohort Study.

BACKGROUND: Although nonsurgical treatment of thumb carpometacarpal (CMC-1) osteoarthritis (OA) provides short-term improvement, the durability of these effects beyond 1 year is unknown. In this study, we investigated patient-reported pain and limitations in activities of daily living (ADL) at >5 years following nonsurgical treatment (i.e., exercise therapy and use of an orthosis) for CMC-1 OA. We hypothesized that pain and limitations in ADL would not worsen after 12 months. Secondary outcomes were satisfaction with treatment results and health-related quality of life at >5 years of follow-up and the rate of conversion to surgery. METHODS: This was a multicenter, prospective cohort study using 2 overlapping samples. The change in the Michigan Hand Outcomes Questionnaire (MHQ) subscales of pain and ADL between 12 months and >5 years was the primary outcome as measured in the first sample (n = 170), which consisted of patients who did not undergo conversion to surgery. Additional measurement time points included baseline and 3 months. We evaluated conversion to surgery in a second sample, which included all patients who responded to the invitation for this follow-up study (n = 217). RESULTS: At a median follow-up of 6.6 years (range, 5.1 to 8.7 years), the score on the MHQ pain subscale did not differ significantly from that at 12 months. The score on the MHQ ADL improved by 4.4 points (95% confidence interval [CI],1.5 to 7.2) compared with 12 months, but this was not clinically relevant. At >5 years, 5% of the patients rated their satisfaction as "poor," 14% as "moderate," 26% as "fair," 39% as "good," and 16% as "excellent." The median EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) index score was 0.852 (range, 0.135 to 1). The rate of conversion to surgery was 22% (95% CI,16.4% to 27.7%) at a median follow-up of 7 years (range, 5.5 to 9.0 years). CONCLUSIONS: We found positive outcomes at >5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or of limitations in ADL after 12 months. Our findings support nonsurgical treatment as the first treatment choice and suggest that treatment effects are sustainable. LEVEL OF EVIDENCE: Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.

Secondary syphilis presenting as leukocytoclastic vasculitis in a 61-year-old man.

Cutaneous lesions of secondary syphilis are highly infectious and can mimic many skin disorders, making the diagnosis more difficult. They typically present as generalized, nonpruritic erythematous-to-copper-colored macules and papules, characteristically involving palms and soles. In 80% of patients the rash develops insidiously. However, rare forms of secondary syphilis present as rapidly progressive papulopustular lesions. These forms of syphilis are usually associated with human immunodeficiency virus infection and immunosuppression. We report a case of secondary syphilis presenting with an acute, rapidly progressive purpuric eruption mimicking leukocytoclastic vasculitis. A 61-year-old man presented with a 6-day history of nonpruritic rash on his chest and lower extremities associated with fatigue, sore throat, and night sweats. Examination revealed purpuric papules, extending from the dorsal feet to the hips; mucosal surfaces were not involved. A diagnosis of cutaneous small-vessel vasculitis was favored with possible triggers of IgA vasculitis. Initial work-up showed acute kidney injury and microscopic hematuria. Renal biopsy showed IgA nephropathy with mesangioproliferative glomerulonephritis. The patient's rash progressed to cover almost his entire body sparing palms and soles. Skin biopsy showed heavy perivascular lymphoplasmacytic infiltrate, capillary endothelial cell swelling, and sparse perivascular neutrophilic nuclear dust. Spirochetal stain highlighted scattered epidermal and dermal organisms.

The Narrative Macrostructure Production of Spanish-English Bilingual Preschoolers: Within-and Cross-Language Relations.

Despite the importance of understanding the narrative abilities of bilingual children, minimal research has focused on Spanish-English bilingual preschoolers. Therefore, this study examined the cross-language macrostructure and within-language microstructure relations in the English and Spanish narratives of bilingual preschoolers and examined whether language dominance impacted these relations. Narratives were elicited from 200 preschool-aged children of Latino heritage. Microstructure measures included the Number of Different Words, Mean Length of Utterance in Words, and Subordination Index. The Narrative Scoring Scheme measured macrostructure (Heilmann, Miller, Nockerts, & Dunaway, 2010). Using standardized language testing of expressive vocabulary and sentence comprehension, the children were classified into two groups: balanced dominance and Spanish dominant. Results revealed that English macrostructure and Spanish macrostructure were not related after controlling for microstructure measures within languages. Children's microstructure abilities in each language were strongly related to their macrostructure abilities within that language. Dominance did not moderate these relations. Consistent with previous research on school-age children, vocabulary was a unique predictor of macrostructure production. This study highlights the additional importance of utterance length within both languages to macrostructure during the preschool years. The absence of unique cross-language macrostructure relations and the absence of dominance group moderation may have been due to the immaturity of the children's narratives.

Effects of Home Language, Oral Language Skills, and Cross-Linguistic Phonological Abilities on Whole-Word Proximity in Spanish-English-Speaking Children.

Purpose This study examined language use and language ability factors that predict phonological whole-word proximity in young Spanish-English-speaking children. Method Participants were 199 Latino children aged 3;0-6;6 (years;months) and their mothers. Children's speech sound production in English and Spanish was assessed using the Bilingual Phonological Assessment ( Miccio & Hammer, 2006 ). Vocabulary and story retell abilities were assessed using the Woodcock-Muñoz Language Survey-Revised ( Woodcock, Muñoz-Sandoval, Ruef, & Alvarado, 2005 ), and information regarding the children's exposure to and use of English and Spanish was collected by means of a parent survey. Hierarchical regression analyses were used to determine the degree to which exposure to and use of each language in the home, oral language abilities, and phonological proficiency as measured by the proportion of whole-word proximity (PWP; Ingram, 2002 ) in the other language were able to predict the PWP scores in English and Spanish. Results A large portion of the variance in English and Spanish PWP scores ( R 2 = .66 and .51, respectively) was predicted by the language children use when communicating with their mothers, children's vocabulary scores, and children's PWP scores in the other language. Conclusion Language use, vocabulary, and phonological whole-word proximity in the other language are significant factors in predicting bilingual children's whole-word proximity in English and Spanish. Children's phonological abilities in one language are highly predictive of those same abilities in the other, suggesting underlying shared phonological skills across languages.

Disseminated methicillin-susceptible Staphylococcus aureus infection.

INTRODUCTION: When clinicians think about Staphylococcus aureus bacteria, what comes to the mind of most is the dreaded methicillin-resistant form. However, clinicians should not forget the methicillin-susceptible type, which is just as virulent. CASE PRESENTATION: The authors present the case of a 20-year-old woman who was admitted with septic shock and multi-organ failure and was found to have disseminated methicillin-susceptible Staphylococcus aureus (MSSA) infection. The patient had persistent blood cultures positive for MSSA. A transesophageal echocardiogram showed a 1.1 cm vegetation in the mitral valve, and the patient had bilateral pleural effusions that grew MSSA. An MRI of the brain showed multiple areas consistent with infarctions thought to be secondary to septic emboli. The patient underwent a mitral valve replacement and was treated with a prolonged course of parenteral nafcillin. DISCUSSION: This case illustrates a severe clinical presentation and management of MSSA infections.

Predicting Spanish-English bilingual children's language abilities.

PURPOSE: In this study, the authors investigated factors that affect bilingual children's vocabulary and story recall abilities in their 2 languages. METHOD: Participants included 191 Latino families and their children, who averaged 59 months of age. Data on parental characteristics and children's exposure to and usage of Spanish and English were collected. The authors assessed children's Spanish and English vocabulary and story recall abilities using subtests of the Woodcock-Muñoz Language Survey-Revised ( Woodcock, Muñoz-Sandoval, Ruef, & Alvarado, 2005). RESULTS: Sizeable percentages of variation in children's English (R2 = .61) and Spanish (R2 = .55) vocabulary scores were explained by children's exposure to, and usage of, each language and maternal characteristics. Similarly, variations in children's story recall scores in English (R2 = .38) and Spanish (R2 = .19) were also explained by the factors considered in this investigation. However, the authors found that different sets of factors in each category affected children's vocabulary and story recall abilities in each language. CONCLUSIONS: Children's exposure to and usage of their two languages as well as maternal characteristics play significant roles in bilingual individuals' language development. The results highlight the importance of gathering detailed sociolinguistic information about bilingual children when these children are involved in research and when they enter the educational system.

Assessing the Phonological Skills of Bilingual Children From Preschool Through Kindergarten: Developmental Progression and Cross-Language Transfer.

The developmental progression hypothesis for phonological awareness states that children perform better on lower level tasks; and has mainly been addressed in the literature with children beginning at age 5. In addition, there has been limited amount of research done regarding the performance of dual language learners on phonological awareness tasks under the age of 5. There is a need for a valid measure of phonological awareness for bilingual preschool children at an earlier age. This article addresses three purposes: 1) developing a reliable measure of phonological awareness for bilingual preschool children, 2) testing the developmental progression hypothesis in both English and Spanish, and 3) comparing longitudinal performance across language on the measure. Two hundred and forty-one Spanish-English bilingual children were assessed on the author-developed Phonological Awareness Test at three time points (mean age of 4.58; mean age of 4.96; mean age of 5.94). Findings indicate differences in developmental progression by language as well as shifts in performance across language as children go through school. The children in this study transition from a language specific model of phonological awareness to a more skill specific model of phonological awareness as they progress through school.

Dual language and literacy development of Spanish-speaking preschool children.

This article describes oral language and early literacy skills in Spanish and English for a sample of 319 bilingual children in Massachusetts and Maryland (ECS) and a comparison group of 144 monolingual Spanish-speaking children in Puerto Rico (PRC). Children were assessed as they entered and exited pre-kindergarten programs. Data collection included four subtests of the Woodcock Language Proficiency Battery and a researcher-developed phonological awareness task. Results show that, on average, children in the ECS sample performed below average in both English and Spanish when compared to monolingual norms and, despite some early literacy and oral language gains during their pre-kindergarten year, continue to lag behind monolingual children of the same age. Children in the ECS sample performed better in the early literacy tasks than in the oral language tasks in both English and Spanish. On average, the PRC sample scored significantly better than the ECS sample in Spanish oral language skills, but lower in phonological awareness skills. Educational implications and directions for future research are discussed.