Ceftaroline for Central Nervous System Infections: Case Report of a Young Infant, and Scoping Review.

BACKGROUND: Managing health care acquired and device-associated intracranial infections in young children can be challenging given adverse antibiotic side effects and difficulties in achieving adequate central nervous system (CNS) antibiotic concentrations. Ceftaroline is a cephalosporin with a favorable safety profile and activity against methicillin-resistant Staphylococci and several Gram-negative organisms. Published data on the use of ceftaroline for CNS infections in children and adults are limited. METHODS: We describe a 2-month-old infant with ventriculo-subgaleal shunt-associated methicillin-resistant Staphylococcus epidermidis ventriculitis, which was successfully treated with ceftaroline, in addition to vancomycin and rifampin. We conducted a scoping review of English-language literature retrieved from PubMed, EMBASE and Web of Science that assessed the use of ceftaroline for CNS infections. RESULTS: We identified 22 articles for inclusion in our review, which described 92 unique patients, of whom 2 were <21 years old. Ceftaroline was commonly used in conjunction with other antibiotics to treat infections caused by Staphylococcus aureus, coagulase-negative Staphylococci and Streptococcus pneumoniae. Most case reports described clinical success with ceftaroline, though small case series and cohort studies yielded mixed efficacy assessments. Adverse effects attributed to ceftaroline were rare and included reversible myelosuppression, eosinophilia, hepatotoxicity and nephrotoxicity. Pharmacokinetic/pharmacodynamic studies suggested similar CNS penetration through inflamed meninges as other beta lactam antibiotics. CONCLUSIONS: We identified a growing body of published evidence supporting the use of ceftaroline in combination with other agents for the treatment of CNS infections. In absence of clinical trials, additional real-world data are needed to define the efficacy and safety of ceftaroline for children and adults with CNS infections.

Persistent post-discharge symptoms after COVID-19 in rheumatic and musculoskeletal diseases.

OBJECTIVES: We aimed to describe persistent symptoms and sequelae in patients with rheumatic and musculoskeletal diseases (RMD) after admission owing to coronavirus disease 2019 (COVID-19), assessing the role of autoimmune rheumatic diseases (ARDs) compared with non-autoimmune rheumatic and musculoskeletal diseases (NARDs) on persistent symptoms and sequelae. METHODS: We performed an observational study including RMD patients who attended a rheumatology clinic in Madrid and required admission owing to COVID-19 (between March and May 2020) and survived. The study began at discharge and ran until October 2020. Main outcomes were persistence of symptoms and sequelae related to COVID-19. The independent variable was the RMD group (ARD and NARD). Covariates included sociodemographics, clinical and treatment data. We ran a multivariate logistic regression model to assess the risk of the main outcomes by RMD group. RESULTS: We included 105 patients, of whom 51.5% had ARD and 68.57% reported at least one persistent symptom. The most frequent symptoms were dyspnoea, fatigue and chest pain. Sequelae were recorded in 31 patients. These included lung damage in 10.4% of patients, lymphopenia in 10%, a central retinal vein occlusion and an optic neuritis. Two patients died. Eleven patients required re-admission owing to COVID-19 problems (16.7% ARD vs 3.9% NARD; P = 0.053). No statistically significant differences were found between RMD groups in the final models. CONCLUSION: Many RMD patients have persistent symptoms, as in other populations. Lung damage is the most frequent sequela. Compared with NARD, ARD does not seem to differ in terms of persistent symptoms or consequences, although ARD might have more re-admissions owing to COVID-19.

Evaluation of biomechanical gait parameters of patients with Cerebral Palsy at three different levels of gait assistance using the CPWalker.

BACKGROUND: Cerebral Palsy (CP) is the most common cause of permanent serious physical disability in childhood. Although many platforms have been developed, so far there are still not precise guidelines for the rehabilitation of the population with CP. The CPWalker is a robotic platform for the rehabilitation of children with CP, through which they can start experiencing autonomous locomotion in the rehabilitation environment. It allows the possibility of free movement and includes physical and cognitive interfaces into the therapy. The main objective of this work is to evaluate the effects of the CPWalker-based rehabilitation intervention in children with CP by comparing different gait parameters before, during and after the use of the platform. FINDINGS: The evaluation was divided in three stages where the gait parameters and symmetry indexes of eight subjects with CP were evaluated. In the first stage patients walked only with the help they receive normally in daily life. During the second stage they walked with the CPWalker and finally, in the third stage, they repeated their gait without the platform. In all stages they wore an inertial G-Sensor Ⓡ while walking through the hospital facilities. The results showed statistical significant differences in several spatio-temporal parameters, pelvic angles and general gait cycle parameters, with and without the use of the robotic device. For the eight patients: cadence, speed and stride length presented similar values when comparing before and after the therapy. However, they decreased during the intervention (both means and standard deviations). No significant differences were found in the symmetry indexes with the use of the platform. In spite of this, a reduction in the pelvic angles ranges and propulsion was observed. CONCLUSIONS: The effect of using the device was analyzed for spatio-temporal parameters, pelvic girdle angles and general gait cycle parameters. Among the eighteen initial parameters, seven presented a statistical significant difference when comparing stage 2 of the intervention with stages 1 and 3. Those changes showed the potential of the CPWalker to improve muscular strength and gait patterns of the patients with CP in the long term and to provide useful information for the design of the future generations of rehabilitation robotic devices.