Atherosclerotic disease is increased in recent-onset rheumatoid arthritis: a critical role for inflammation
Arthritis Research & Therapy
ORIGINAL ARTICLE: RA patients have increased mortality and morbidity as a result of cardiovascular and cerebro-vascular disease. However, it is neither clear how early accelerated atherosclerosis begins in RA, nor how soon risk factors must be rigorously controlled. Furthermore, given the strong relationship of vascular disease to RA mortality and of inflammation to the accelerated atherosclerosis associated with RA, it is important to evaluate indices which could serially and non- invasively quantify atherosclerotic disease in RA patients. Carotid intima-media thickness (cIMT) and plaque, measured by ultrasound, correlate closely with direct measurement of local and systemic atherosclerotic burden. To investigate the presence of sub-clinical atherosclerosis in the early stages of RA, cIMT and plaque were measured using carotid duplex scanning in 40 RA patients with disease duration of less than 12 months and 40 control subjects matched for age, sex and established cardiovascular risk factors. Patients with RA had significantly higher average cIMT values and more plaque than the control group (cIMT 0.64 +/- 0.13 mm vs. 0.58 +/- 0.09 mm respectively, p = 0.03). In RA patients, cIMT was predicted by age and C-reactive protein (CRP) level at first presentation to the clinic (R2 = 0.64). CRP was associated with age of disease onset and history of smoking. Since inflammation has been shown to predate onset of clinical RA, the accelerated atherogenic process related to inflammation may precede RA symptom onset.
Peripheral Arterial Disease Study (PERART): Prevalence and predictive values of asymptomatic peripheral arterial occlusive disease related to cardiovascular morbidity and mortality
BMC Public Health
ORIGINAL ARTICLE:The early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index (AAI) is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease) The aim of the PERART study (PERipheral ARTerial disease) is to determine the prevalence of peripheral arterial disease (both silent and symptomatic) in a general population of both sexes and determine its predictive value related to morbimortality (cohort study). Methods and design This cross-over, cohort study consists of 2 phases: firstly a descriptive, transversal cross-over study to determine the prevalence of peripheral arterial disease, and secondly, a cohort study to evaluate the predictive value of AAI in relation to cardiovascular morbimortality. From September 2006 to June 2007, total of 3,010 patients over the age of 50 years will be randomly selected from a population adscribed to 24 healthcare centres in the province of Barcelona (Spain). The diagnostic criteria of peripheral arterial disease will be considered as an AAI < 0.09, determined by portable Doppler (8 Mhz probe) measured twice by trained personnel. Cardiovascular risk will be calculated with the Framingham-Wilson tables, with Framingham calibrated by the REGICOR and SCORE groups. The subjects included will be evaluated every 6 months by telephone interview and the clinical history and death registries will be reviewed. The appearance of the following cardiovascular events will be considered as variables of response: transitory ischaemic accident, ictus, angina, myocardial infarction, symptomatic abdominal aneurysm and vascular mortality.
Hypoxanthine-guanine phosphoribosyltransferase (HPRT) deficiency: Lesch-Nyhan Syndrome
Orphanet Journal of Rare Diseases
ORIGINAL ARTICLE: Deficiency of hypoxanthine-guanine phosphoribosyltransferase (HPRT) activity is an inborn error of purine metabolism associated with uric acid overproduction and a continuum spectrum of neurological manifestations depending on the degree of the enzymatic deficiency. The prevalence is estimated at 1/380,000 live births in Canada, and 1/235,000 live births in Spain. Uric acid overproduction is present in all HPRT-deficient patients and is associated with lithiasis and gout. Neurological manifestations include severe action dystonia, choreoathetosis, ballismus, cognitive and attention deficit, and self-injurious behaviour. The most severe forms are known as Lesch-Nyhan syndrome (patients are normal at birth and diagnosis can be accomplished when psychomotor delay becomes apparent). Partial HPRT-deficient patients present these symptoms with a different intensity, and in the least severe forms symptoms may be unapparent. Megaloblastic anaemia is also associated with the disease. Inheritance of HPRT deficiency is X-linked recessive, thus males are generally affected and heterozygous female are carriers (usually asymptomatic). Human HPRT is encoded by a single structural gene on the long arm of the X chromosome at Xq26. To date, more than 300 disease-associated mutations in the HPRT1 gene have been identified. The diagnosis is based on clinical and biochemical findings (hyperuricemia and hyperuricosuria associated with psychomotor delay), and enzymatic (HPRT activity determination in haemolysate, intact erythrocytes or fibroblasts) and molecular tests. Molecular diagnosis allows faster and more accurate carrier and prenatal diagnosis. Prenatal diagnosis can be performed with amniotic cells obtained by amniocentesis at about 15-18 weeks’ gestation, or chorionic villus cells obtained at about 10-12 weeks’ gestation. Uric acid overproduction can be managed by allopurinol treatment. Doses must be carefully adjusted to avoid xanthine lithiasis. The lack of precise understanding of the neurological dysfunction has precluded development of useful therapies. Spasticity, when present, and dystonia can be managed with benzodiazepines and gamma-aminobutyric acid inhibitors such as baclofen. Physical rehabilitation, including management of dysarthria and dysphagia, special devices to enable hand control, appropriate walking aids, and a programme of posture management to prevent deformities are recommended. Self-injurious behaviour must be managed by a combination of physical restraints, behavioural and pharmaceutical treatments.
Podiatry Today ENews
Podiatry Today
Current Concepts In Ankle Arthroscopy
By Catherine Cheung, DPM
Ankle arthroscopy is a minimally invasive technique that can foster improved visualization for surgeons and better outcomes for patients. Accordingly, this author emphasizes appropriate pre-op planning, key technique tips and other pertinent insights
Do Runners Get What They Pay For With Expensive Shoes?
By Brian McCurdy, Senior Editor
When choosing a pair of running shoes, consumers have a wide range of choices with a number of models available in different price ranges. Does buying a more expensive running shoe necessarily translate into getting a better quality shoe? A recent study suggests there may not be that much difference in cushioning between inexpensive and more expensive shoes.
Understanding The Benefits Of Electrical Bone Stimulation
By Glenn Weinraub, DPM, FACFAS
In order to address nonunions and delayed bone healing, this author offers an overview of electrical bone stimulation, insights on key studies and pertinent case studies.
Current Insights On Custom And Prefabricated Foot Orthoses
Guest Clinical Editor: Scott Spencer, DPM
In this month’s “Orthotics Q&A” column, the panelists offer their perspectives on assessing patients as candidates for custom orthoses, share insights on the possible role of over-the-counter (OTC) devices and discuss future possibilities in orthotic therapy.
Continuing Education: How To Address Lower Extremity Tendon Injuries
Healing wounds with silver is a tried and true practice, and a new product makes silver use simpler.
The Foot Blog News
TheFootBlog.org
December 2007:
- Woman Born With Feet Facing Backwards Insists She Is Not Disabled
- Girl takes first steps since feet severed on thrill ride
- The misery of painful feet
- The University Of Miami Is Enrolling Patients With Chronic Diabetic Foot Ulcers For MATRIX Clinical Trial
- Monitoring Skin Temperature can reduce the risk of diabetic foot ulceration
- Oculus fills up clinical trial for foot ulcer treatment
- Common Foot Problems – And What Can Be Done For Relief
Podiatry Related Abstracts
Entrez Pub Med, Wiley Interscience, Ingenta Connect, Blackwell Synergy and more . . .
CT of the Foot: Selected Inflammatory Arthridites. Journal of Assisted Computerized Tomography
Correction of heel strike in a hindfoot stump not adequate for weightbearing following Chopart amputation : Tibiocalcaneal arthrodesis and intramedullary nailing Unfallchirurg.
The Role of Hemodynamic Measurements in the Management of Venous and Ischemic Ulcers Int J of Lower Ext Wounds
Orthopaedic * Radiology * Pathology Conference: Ankle Pain in a 31-year-old Man CORR
Tibial Wedge Osteotomy for Osteochondral Transplantation in Talar Lesions Int J Sports Med
Ankle-brachial index and hemostatic markers in the Atherosclerosis Risk in Communities (ARIC) study cohort Vascular Medicine
Gout, have we met before? No, not like this J Gen Int Med
Calcaneal Osteomyelitis Caused by Exophiala jeanselmei in an Immunocompetent Child JBJS
ORIGINAL ARTICLE: In the last few decades significant advances have occurred in the diagnosis and therapy of bone and soft tissue sarcomas of the extrimities, which has made it possible to avoid amputations and conserve the limb in many cases. But careful case selection has to be done and consideration has to be given to the influence of adjuant modalities needed in the management.This article reviews the various aspects of limb salvage in extrimity sarcomas including the methods of reconstruction in deatil. Problems of reconstruction in a growing child is also dealt with separately. “Amputation is the most merciful of surgeries when indicated but the meanest option when other alternatives exist”. Till not very long ago amputation was considered the only option to achieve local control in malignant bone and soft tissue tumors of the extremity. The last few decades have seen rapid strides in surgery with function preserving alternatives for local control in these lesions becoming the norm without compromising on overall disease survival. The advent of better imaging modalities, more effective chemotherapy, improved radiotherapy techniques, a better understanding of anatomy with continuous refinement in surgical techniques and advances in prosthesis design and materials have all played a part in achieving this goal. Limb salvage is currently possible in a large majority of malignant bone and soft tissue tumors of the extremity. It requires a well coordinated multidisciplinary approach involving varied specialties. The objectives of extremity reconstruction after oncologic resection include providing skeletal stability where necessary, adequate wound coverage to allow subsequent adjuvant therapy, preservation of functional capability and optimizing the aesthetic outcome. 
ORIGINAL ARTICLE:Diabetes is a serious worldwide public health problem. People with diabetes need to take special care of their feet because of loss of sensation in the feet. Therefore, developing health educational programs for diabetic foot care and disability prevention are important issues. The purpose of this study was to determine the effect of educational program based on health belief model (HBM) on diabetic foot care of the type 2 diabetes patients. 
ORIGINAL ARTICLE: Diabetes Mellitus constitutes one of the most important public health problems due to its high prevalence and enormous social and economic consequences. Diabetic foot ulcers are one of the chronic complications of diabetes mellitus and constitute the most important cause of non-traumatic amputation of inferior limbs. It is estimated that 15% of diabetic population will develop an ulcer sometime in their life. Although novel therapies have been proposed, there is no effective treatment for this pathology. Naturally produced nitric oxide participates in the wound healing process by stimulating the synthesis of collagen, triggering the release of chemotactic cytokines, increasing blood vessels permeability, promoting angiogenic activity, stimulating the release of epidermical growth factors, and by interfering with the bacterial mitochondrial respiratory chain. Topically administered nitric oxide has demonstrated to be effective and safe for the treatment of chronic ulcers secondary to cutaneous leishmaniasis. However, due to their unstable nitric oxide release, the topical donors needed to be applied frequently, diminishing the adherence to the treatment. This difficulty has led to the development of a multilayer polymeric transdermal patch produced by electrospinning technique that guarantees a constant nitric oxide release. The main objective of this study is to evaluate the effectiveness and safety of this novel nitric oxide releasing wound dressing for the treatment of diabetic foot ulcers. Methods and Design. A double-blind, placebo-controlled clinical trial, including 100 diabetic patients was designed. At the time of enrollment, a complete medical evaluation and laboratory tests will be performed, and those patients who meet the inclusion criteria randomly assigned to one of two groups. During 90 days group 1 will receive active patches and group 2 placebo patches. The patients will be seen by the research group at least every two weeks until the healing of the ulcer or the end of the treatment. During each visit the healing process of the ulcer, the patient’s health status and the presence of adverse events will be assessed. Should the effectiveness of the patches be demonstrated an alternative treatment would then be available to patients. Trial registration: NCT00428727. 
ORIGINAL ARTICLE:While various researchers have implicated the equinus deformity as a major deforming force in a host of foot and ankle pathologies, the exact definition of equinus remains unclear.1-4 However, Root states that “the minimal range of ankle joint dorsiflexion that is necessary for normal locomotion is 10 degrees.”5 Subsequent studies report that the ankle joint range of motion for asymptomatic patients ranges from 0 to 13.1 degrees with the knee extended and from 5 to 22.3 degrees with the knee flexed.6-9 The implication from these studies and other papers is that with a decrease in the range of motion at the ankle joint, it is more likely that pathologies will develop. Although other soft tissue and bony constraints may restrict ankle joint range of motion, the Achilles tendon appears to play the dominant role for this limitation. 
Original article: Delivering and documenting evidence-based treatment to all Department of Veterans Affairs (VA) foot ulcer patients has wide appeal. However, primary and secondary care medical centers where 52% of these patients receive care are at a disadvantage given the frequent absence of trained specialists to manage diabetic foot ulcers. A retrospective review of diabetic foot ulcer patient records and a provider survey were conducted to document the foot ulcer problem and to assess practitioner needs. Results showed of the 125 persons with foot ulcers identified through administrative data, only, 21% of diabetic foot patients were correctly coded. Chronic Care and Microsystem models were used to prepare a tailored intervention in a VA primary care medical center. The site Principal Investigators, a multidisciplinary site wound care team, and study investigators jointly implemented a diabetic foot ulcer program. Intervention components include wound care team education and training, standardized good wound care practices based on strong scientific evidence, and a wound care template embedded in the electronic medical record to facilitate data collection, clinical decision making, patient ordering, and coding. A strategy for delivering offloading pressure devices, regular case management support, and 24/7 emergency assistance also was developed. It took 9 months to implement the model. Patients were enrolled and followed for 1 year. Process and outcome evaluations are on-going. KEYWORDS: diabetes, foot ulcer, systems of care, electronic medical records, wound care. This article is adapted from a presentation at the conference Evidence-based Practice in Wound Care, held in Cleveland, Ohio, September 2006 (organized by Case Western Reserve University School of Medicine). 
