Efficacy and Safety of Bioactive Glass S53P4 as a Treatment for Diabetic Foot Osteomyelitis.

Osteomyelitis represents a challenging condition in the diabetic foot with an associated high risk of major amputation. S53P4 Bioactive Glass (BG) has bacterial inhibiting properties on the market and indicated to be used in osteomyelitis. The objective of the study was to test the efficacy and safety of BG in treating diabetic foot osteomyelitis. This was an observational, retrospective, single-centre study involving subjects with diabetes affected by osteomyelitis of the foot who underwent surgical debridement from 01/2016 to 10/2018. Overall, 44 diabetic patients (14 [31.8%] female, aged 68.0 ± 10.2 years, diabetes duration 26.8 ± 11.9 years) were studied: 22 (50%) treated with surgical debridement and a local application of BG; 22 (50%) treated by means of surgical debridement. The primary outcome was the osteomyelitis resolution. Revascularization was performed before surgical procedure in 31 (70.5%) of patients. Systemic antibiotics were used in both groups. The osteomyelitis resolution rate was significantly higher in subjects treated with BG than in subjects treated with traditional procedure (18 [90%] vs 13 [61.9%], respectively p = .03). The odds of BG to reach osteomyelitis resolution was 5.54 times greater than for traditional treatment (odds ratio 5.54, 95% confidence interval 1.10-30.5). The use of BG was associated with an 81% lower probability to need additional antibiotic therapy compared to subjects treated with traditional procedure (odds ratio 0.19, 95% confidence interval 0.04-0.87). The debridement of osteomyelitis followed by application of BG could be an effective and safe option in the treatment of osteomyelitis of the diabetic foot.

Effectiveness, Safety, and Acceptance of an Interim Orthosis in Patients with Diabetes in the Immediate Postoperative Chopart Surgery.

Chopart amputation is the consequence of severe diabetes-related foot complications. A new interim orthosis allowing the patient a greater degree of mobility after Chopart surgery than currently used systems is now available. The aim of this study was to evaluate the effectiveness of the new orthosis compared with traditional treatment. Safety and level of patient acceptance of the device were also investigated. We performed a retrospective case-control observational study involving people with diabetes who underwent Chopart amputation between January 2016 and January 2018. The sample of subjects treated with the innovative orthosis was compared with consecutive patients, who were treated with traditional management. The main study outcomes include major amputation occurrence, ulcer recurrence, healing time, and patient acceptance of the orthosis. Patient satisfaction was evaluated using the Italian validated version of the Orthotic Prosthetic User's Survey (OPUS) questionnaire. Overall, 27 subjects were enrolled using the new device (mean age 68.7 ± 8.4 years, 70.4% males, mean diabetes duration 22.7 ± 15 years). Clinical baseline characteristics were comparable between the cases and the controls. There was no difference between the groups in the healed wound rate (81.5% vs 80.0% for cases and the control group, respectively, P = .53). The ulcer recurrence rate was higher in the control group compared with subjects using the new orthosis (62.5% vs 24.0%, respectively, P = .04). The use of the innovative orthosis was associated with an 81% lower probability to have ulcer recurrence (odds ratio 0.19, 95% confidence interval 0.04-1.04). No between groups difference was detected for a major amputation rate. The wound healing time was faster for cases compared with controls (160.4 ± 114.1 vs 256.5 ± 112.9 days, P = .05). No adverse events related to the use of the new orthosis were recorded. Patient acceptance of the new orthosis was high. This orthosis can be recommended as an efficient, safe, and well-accepted device after Chopart amputation.

Pretransplant positivity for circulating thyroid antibodies and graft survival in patients undergoing kidney transplant.

BACKGROUND: Thyroid disturbances are common in kidney graft recipients and they may influence graft function. CXC chemokine ligand 10 plays a role in both autoimmune thyroiditis and graft rejection. Thyroid antibody (Ab) positivity has been regarded as a marker of imbalance of the immune system. AIM: To relate pretransplant positivity for antithyroperoxidase (TPO) Ab and antithyroglobulin (Tg) Ab with kidney graft outcome. METHODS: Pretransplant thyroid antibodies were measured in 211 kidney graft recipients. RESULTS: The 5-year death-censored graft survival rate was 91.5%. Pretransplant circulating Tg Ab and TPO Ab were detected in 12 (5.7%) and 13 (6.2%) patients, respectively. Lifetime analysis showed similar 5-year graft survival rates in patients negative or positive for Tg Ab and TPO Ab (91.5 vs. 91.7% for Tg Ab and 91.9 vs. 84.6% for TPO Ab). However, patients with pretransplant positivity for TPO Ab showed a significantly lower 5-year graft survival when early graft loss (12 months after transplant) was excluded (84.6 and 96.8% for TPO Ab+ and TPO Ab- patients, respectively; p < 0.05). Occurrence of acute rejection and chronic allograft nephropathy was unrelated to thyroid Ab positivity. Serum CXC chemokine ligand 10 levels were similar independent of Tg Ab and TPO Ab positivity. CONCLUSION: Pretransplant positivity for TPO Ab may affect long-term graft survival in kidney graft recipients independent of occurrence of acute rejections and chronic allograft nephropathy.

Graves'-like orbitopathy in a patient with chronic autoimmune pancreatitis.

BACKGROUND: Graves' orbitopathy is an inflammatory orbital disease that represents the commonest extrathyroidal manifestation of Graves' disease. Autoimmune pancreatitis (AIP) is a rare inflammatory disease characterized by prominent lymphocytic infiltration and fibrosis of the pancreas causing organ dysfunction. SUMMARY: This report provides the first clinical description of severe Graves'-like orbitopathy occurring in association with AIP. Although there was no clear evidence of autoimmune thyroid disease or dysfunction in our patient, the clinical course of his orbitopathy was related to that of AIP, the relapses of orbital inflammation being temporally coincident. CONCLUSIONS: Our data suggest that shared autoantigens between the pancreas and the orbit might be responsible for the unusual disorder observed in our patient.

The post partum period and the onset of Graves' disease: an overestimated risk factor.

OBJECTIVE: Aggravation of autoimmune diseases due to a rebound reaction to the pregnancy-associated immune changes is common during the post partum (PP) period. Previous studies demonstrated that up to 45% of women developing Graves' disease (GD) in the childbearing age had a PP onset of disease. Thus, the PP period was identified as a major risk factor for GD onset. DESIGN: The aim of this study was to evaluate the role of the PP period as a risk factor for GD occurrence. METHODS: The reproductive histories of 291 consecutive GD patients (165 patients in the childbearing age and 126 in the non-childbearing age) were retrospectively collected. RESULTS: The rate of PP onset of GD in all patients with at least one successful pregnancy was 9.8 and 20.0% when only patients in the childbearing age were considered. In the entire cohort of GD women, independent of their age and parity status (i.e., the number of successful pregnancies), the rate of PP onset of GD was 7.2%. The relative frequencies of the rate of PP onset of GD were similar in relation with increasing parity. The rates of false negative (nulliparous) and false positive (parous non-childbearing+childbearing with a non-PP onset of GD) were estimated. The positive predictive value of the PP period for the onset of GD was less than 10%. CONCLUSIONS: The results of the current study would not support a role for the PP period as a major risk factor for de novo occurrence of GD.