Unsafe workout: a weak and painful shoulder in a professional volleyball player.

A 29-year-old professional volleyball player started complaining of a dull ache in the right lateral base of the neck. This pain arose during a preseasonal athletic training intense session. After 3 days, he presented deficiency of right scapula adduction, limitation of scapula elevation, right shoulder weakness and local mild pain. He had asymmetrical neckline with drooping of the affected shoulder, lateral displacement and minimal winging of the right scapula. After 1 week, hypothrophy of superior trapezius appeared. An electromyography of right upper limb showed a denervation in the upper, middle and lower components of the right trapezius muscle, due to axonotmesis of spinal accessory nerve (SAN). A subsequent MRI was consistent with muscular suffering caused by early denervation. This case shows idiopathic SAN palsy, likely secondary to an inappropriate use of a weight-lifting machine, where the athlete recovered after an adequate rest and rehabilitation period.

Immunoglobulin M indirect-fluorescent antibody test for the diagnosis of acute toxoplasmosis during pregnancy in the avidity era: A 14-year experience at the Tuscany Reference Center for Infectious Diseases in Pregnancy, Florence, Italy.

AIM: The aim of this study was to evaluate immunoglobulin M indirect-fluorescent antibody test (IgM IFAT) for the diagnosis of acute or chronic Toxoplasma infection in pregnancy. METHODS: Pregnant women with suspected acute toxoplasmosis referred to the Tuscany Reference Center for Infectious Diseases in Pregnancy during the period 1998-2012 were retrospectively enrolled. All women were tested with a panel of serological tests, including enzyme-linked immunosorbent assay for IgG avidity and IgM IFAT. On the basis of anamnestic, clinical, and serological criteria, pregnant women were classified into three groups: recently infected (RI), latently infected (LI), and doubtful latently infected (DLI). Patients classified as DLI were excluded from the analysis. The association between IgM IFAT (positive or negative) and the diagnosis of infection (acute or chronic) was assessed. Positive predictive value and negative predictive value of the IgM IFAT were calculated. RESULTS: A total of 810 pregnant women were enrolled in the study: 302 in the RI group and 508 in the LI group. Fifty-two women classified as DLI were excluded. IgM IFAT was positive in 172 out of 302 (56.9%) pregnant women in the RI group and in 29 out of 508 (5.7%) in the LI group. The positive predictive value and negative predictive value of IgM IFAT in predicting RI was 85.6% and 78.6%, respectively. CONCLUSION: IgM IFAT has reasonable sensitivity and specificity in diagnosing recent infection and, mostly in case of borderline avidity test, could be considered as a further aid for an accurate diagnosis of acute toxoplasmosis in pregnancy.

Syphilis in pregnancy in Tuscany, description of a case series from a global health perspective.

OBJECTIVE: To estimate the epidemiological impact of syphilis in pregnancy and congenital syphilis in Tuscany and to better delineate their determinants in this region. METHODS: Features of pregnant women with syphilis attending the Tuscany Reference Center for Infectious Diseases in Pregnancy between 2000 and 2010 and their infants were retrospectively reviewed. RESULTS: One hundred and eighty-seven pregnancies were observed. The number of pregnancies evaluated increased steadily from 24 in 2000-2002 to 70 in 2009-2010. The majority of women were Italian (20.32%) and East European (44.39%). Eight cases of congenital syphilis were diagnosed (5.60% of pregnancies with known outcome). Italian women had more often an early stage of syphilis (11.76 vs. 1.34%; p = 0.016), an rapid plasma regain (RPR) title ≥ 1:8 (15.79 vs. 5.37%; p = 0.041) and a partner with positive test (60.00 vs. 21.69%; p < 0.001) compared with migrant women. Migrant women received treatment after the first trimester more often compared with Italian ones (40.94 vs. 18.42%; p = 0.013). CONCLUSIONS: Syphilis in pregnancy is emerging in Tuscany. Italian and migrant women with syphilis show two different "risk patterns" of vertical transmission. An additional screening test for syphilis in the third trimester and educational campaigns about maternal and sexual health could be effective in combating congenital syphilis in Italy.