Challenging definitions and diagnostic approaches for ancient rare diseases: The case of poliomyelitis

A depiction of poliomyelitis in a 17th -century Piedmontese fresco?

INTRODUCTION

A potential representation of poliomyelitis is investigated in an Italian artwork.

MATERIALS AND METHODS

A 17th century Piedmontese fresco is analyzed by combining historico-medical, palaeopathological and clinical approaches. Alternative diagnoses are considered.

RESULTS, DISCUSSION AND CONCLUSIONS

The man appearing in the fresco holding a crutch is characterized by an atrophic left leg reminiscent of poliomyelitic atrophic. Other congenital anomalies or cerebrovascular causes appear less likely. A reflection on the difficulty of retrospectively diagnosis poliomyelitis is offered.

Forgotten and found: A case of childhood rickets in the 19th-century settler village of Heuvelton, New York

OBJECTIVE

To evaluate pathological lesions suggesting the presence of rickets and to place the diagnosis into bioarchaeological and historical context.

MATERIALS

The remains of a 3-year ± 12-month-old child discovered during a rescue excavation in Heuvelton, New York.

METHODS

We examined the individual macroscopically and conducted a differential diagnosis following established protocols in the palaeopathological literature.

RESULTS

Bony change on the orbits, mandible, ribs, clavicles, left scapula, humerii, radii, ulnae, femora, tibiae, fibulae (e.g., porosity, diaphyseal thickening, flaring, bowing), and dental lesions were recorded.

CONCLUSIONS

We demonstrate that the child likely presented with vitamin D deficiency rickets during crawling and as they learned to walk.

SIGNIFICANCE

This example offers an important contribution to the bioarchaeological literature, as few cases of rickets have been recorded in rural North America using updated diagnostic criteria and little is known of the health and lifeways of early settlers in 19th-century upstate New York.

LIMITATIONS

It is not possible to ascertain the precise aetiology of this child's rachitic state and to compare this individual with others in the population.

SUGGESTIONS FOR FURTHER RESEARCH

Examination (and re-assessment) of other North and South American skeletal assemblages for signs of vitamin D deficiency rickets following current bioarchaeological standards.

Insights in paediatric virology during the COVID-19 era (Review)

The present article provides an overview of the key messages of the topics discussed at the '7th Workshop on Paediatric Virology', which was organised virtually on December 20, 2021 by the Institute of Paediatric Virology, located on the Island of Euboea in Greece. The workshop's plenary lectures were on: i) viral pandemics and epidemics in the ancient Mediterranean; ii) the impact of obesity on the outcome of viral infections in children and adolescents; and iii) COVID-19 and artificial intelligence. Despite the scarcity of evidence from fossils and remnants, viruses have been recognised as significant causes of several epidemics in the ancient Mediterranean. Paediatric obesity, a modifiable critical health risk factor, has been shown to impact on the development, progression and severity of viral infections. Thus, the prevention of paediatric obesity should be included in formulating public health policies and decision-making strategies against emerging global viral threats. During the current COVID-19 pandemic, artificial intelligence has been used to facilitate the identification, monitoring and prevention of SARS-CoV-2. In the future, it will play a fundamental role in the surveillance of epidemic-prone infectious diseases, in the repurposing of older therapies and in the design of novel therapeutic agents against viral infections. The collaboration between different medical specialties and other diverse scientific fields, including archaeology, history, epidemiology, nutritional technologies, mathematics, computer technology, engineering, medical law and ethics is essential for the successful management of paediatric viral infections. The current COVID-19 pandemic has underscored this need, which should be further encouraged in modern medical education.

Madelung-type deformity in a female individual from the Merovingian Period in Central Germany: A rare finding or a rare disease?

OBJECTIVE

This paper presents a probable case of Madelung-type deformity of the right lower arm in an individual from the Merovingian burial ground (7th and 8 th century CE) from Gotha-Boilstädt (Germany).

MATERIALS

A female individual with an age-at-death of 40-50 years was investigated.

METHODS

Macroscopic, osteometric and radiographic analyses were performed using standard methods.

RESULTS

The individual exhibits an unusual case of dysmelia of the right upper extremity. The shoulder and upper arm displayed gracile muscle attachment marks and less robustness compared to the left side. The ulna was shortened and distorted and the radius was severely deformed.

CONCLUSIONS

The results indicate that the individual might have been affected by a unilateral Madelung-type deformity. The severity of this case is greater than that reported in the clinical literature.

SIGNIFICANCE

This study places an ancient rare disease into archaeological and paleopathological contexts, allowing for the evaluation of the term "ancient rare disease." It also highlights the importance of reporting rigorously diagnosed cases in order to raise our level of awareness of the incidence and course of this rare condition in the past.

LIMITATIONS

The diagnosis cannot be stated with certainty, and only a handful of possible diagnoses can be offered. Congenital and acquired etiologies must be considered, especially when compared with clinical cases where severity of conditions may be modified by medical intervention.

SUGGESTIONS FOR FURTHER RESEARCH

Genetic analysis might be helpful in the determination of the etiology of the observed Madelung-type deformity.