Site specific differences in vBMD and geometry in postmenopausal women with primary hyperparathyroidism.

PURPOSE: Primary Hyperparathyroidism (PHPT) is associated with catabolic effects at both trabecular and cortical bone. Mechanical loading is one of the most important natural anabolic stimuli for bone at all ages. The present study was designed to assess the impact of PHPT on vBMD and bone geometry using peripheral quantitative computed tomography (pQCT) at the radius and tibia, sites with similar structural characteristics, but subject to different loading conditions. METHODS: We evaluated the impact of PHPT on bone, by comparing the z-scores of volumetric Bone Mineral Density (vBMD) and indices of bone geometry simultaneously at the tibia and the radius by pQCT, skeletal sites with similar structure, but subject to different loading conditions. Forty-one postmenopausal women with PHPT and 79 controls, comprised the study group. RESULTS: At both trabecular and cortical sites, vBMD and bone geometry indices were significantly lower in patients compared with controls. In patients with PHPT, apart from a lower z-score for total vBMD (p = 0.01) at the radius, there was no other difference between the radius and the tibia at the trabecular sites. On the contrary, at cortical sites, the z-scores of cortical bone mineral content (p = 0.02), cortical vBMD (p = 0.01) and cortical cross-sectional area (p = 0.05) were significantly lower at the radius compared with the tibia, indicating that cortical bone at the weight bearing tibia might be less affected by the catabolic actions of continuous parathyroid hormone (PTH) exposure. PTH levels were positively associated with the difference in z-scores of cort BMD (r = 0.439, p < 0.01) indicating that in more severe cases, as expressed by higher PTH levels, the deleterious effects at the non-weight bearing radius might be accentuated. CONCLUSION: We found that in postmenopausal women with PHPT, both trabecular and cortical bone are adversely affected. However, at the weight bearing tibia as compared with the radius, the deleterious effects, especially on cortical bone, seem to be attenuated. TRIAL REGISTRATION NUMBER: NCT05426512, 21/06/2022, "retrospectively registered".

Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine.

Point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. It has many uses in daily clinical practice, including improved diagnostic timeliness and accuracy, and providing information about a patient's prognosis and follow-up. It has been integrated into numerous specialities, but remains relatively undefined in internal medicine training programs. Ultrasonography is a useful tool in the standard clinical practice of internists in numerous clinical scenarios (Emergency Department, hospital ward, general and specific consultations, and home care). Although POCUS has been recently included in the European curriculum of internal medicine, there are differences between European internists in its use, ranging from not at all to well structured educational programs. The use of POCUS needs to be widespread in internal medicine departments, and to accomplish this we must encourage structured training. This document details the consensus-based recommendations by the European Federation of Internal Medicine (EFIM) Ultrasound working group. We establish POCUS core competencies and clinical settings for internists in a symptom-based approach. We also propose training requirements, providing a framework for training programs at a national level.

LOCAL USE OF GRANULOCYTE-MACROPHAGES COLONY STIMULATING FACTOR IN TREATMENT OF CHRONIC DIABETIC NEUROPATHIC ULCER (CASE REVIEW).

One of the main causes of amputations in patients with Diabetes Mellitus patients is a chronic diabetic foot ulcer. The authors present a clinical case and discussion of a successful use of Granulocyte-Macrophages Colony Stimulating Factor (GM-CSF) treatment for the promotion of healing of a chronic diabetic foot ulcer. A 65 year-old woman was admitted to the Diabetes Center with complaints of a deep non-healing chronic foot ulcer for the last 18 months. At the examination a 5 cm ulcer on the plantar surface of the right foot was revealed. The patient had a 15-year history of Diabetes Mellitus type 2, complicated by neuropathy (peripheral and autonomic), retinopathy, nephropathy and Charcot joints in both legs and the right 4th toe had been amputation. She also had a history of heart failure. Healing of the ulcer could not be achieved with prior administered treatment. The decision was made to use GM-CSF treatment option in the area of the ulcer. Patient received local intradermal injections of GM-CSF (400 mcg twice a week) into the ulcerated foot for the duration of two months. The ulcer healed completely after one year of treatment with GM-CSF. Osteomyelitis was ruled out by scintigraphy. The patient did not develop any clinical side-effects or peripheral blood cell count abnormalities to the treatment. GM-CSF is a safe and effective treatment for chronic non-healing diabetic foot ulcers.