Magnetic Resonance Imaging and 99Tc WBC-SPECT/CT Scanning in Differential Diagnosis between Osteomyelitis and Charcot Neuroarthropathy: A Case Series.

BACKGROUND: Distinguishing between Charcot Neuroarthropathy (CN), osteomyelitis (OM), and CN complicated with superimposed OM in diabetic patients is crucial for the treatment choice. Given that current diagnostic methods lack specificity, advanced techniques, e.g., magnetic resonance imaging (MRI) and 99mTc-HMPAO-WBC Single Photon Emission Computed Tomography (SPECT/CT), are needed. This study addresses the challenges in distinguishing OM and CN. METHODS: We included diabetic patients with CN and soft tissue ulceration. MRI and 99mTc-HMPAO-WBC SPECT/CT were used for the diagnosis. The patients were classified into three probability levels for OM (i.e., Definite, Probable, and Unlikely) according to the Consensus Criteria for Diabetic Foot Osteomyelitis (CC-DFO). RESULTS: Eight patients met the eligibility criteria. MRI, supported by SPECT-CT and CC-DFO, showed consistency with the OM diagnosis in three cases. The key diagnostic features included the location of signal abnormalities and secondary features such as skin ulcers, sinus tracts, and abscesses. Notably, cases with inconclusive MRI were clarified by SPECT/CT, emphasizing its efficacy in challenging scenarios. CONCLUSIONS: The primary objective of this study was to compare the results of MRI and 99mTc-HMPAO-WBC SPECT/CT with the CC-DFO score in the diabetic foot with CN and suspected OM. Advanced imaging offers a complementary approach to distinguish between CN and OM. This can help delineate the limits of the disease for presurgical planning. While MRI is valuable, 99mTc-HMPAO-WBC SPECT/CT provides additional clarity, especially in challenging cases or when metallic implants affect MRI accuracy.

COVID-19 pandemic interim Foundation Year 1 post and confidence in core skills and competencies: a longitudinal survey.

OBJECTIVES: The interim Foundation Year 1 (FiY1) post was created in response to the COVID-19 pandemic to help bolster the workforce and manage increased clinical pressures. This study aimed to assess the impact of the FiY1 post on medical graduates' self-reported confidence in common tasks, core skills, competencies and procedures prior to starting FY1, as a measure of increasing preparedness for practice. SETTING: A longitudinal survey was performed at a tertiary teaching hospital in the South East of England. FiY1 posts ran from June to July 2020. PARTICIPANTS: Questionnaires were sent to 122 medical graduates from a single medical school (recipients included FiY1s and non-FiY1s) and to 69 FiY1s at a single Teaching Hospital NHS Trust, irrespective of medical school attended. Initial and follow-up questionnaires had 86 and 62 respondents, respectively. Of these, 39 graduates were matched; 26 were FiY1s and 13 non-FiY1s. The 39 matched results were analysed. PRIMARY OUTCOME MEASURES: Confidence levels in common FY1 tasks, core procedures and competencies were gathered before and after the FiY1 post through online questionnaires. Change in confidence comparing FiY1s and non-FiY1s was measured and analysed using linear regression. RESULTS: On a 5-point scale, the FiY1 post increased overall confidence in starting FY1 by 0.62 (95% CI 0.072 to 1.167, p=0.028). The FiY1 post increased confidence in performing venepuncture by 0.32 (95% CI 0.011 to 0.920, p=0.045), performing intravenous cannulation by 0.48 (95% CI 0.030 to 1.294, p=0.041) and recognising, assessing and initiating the management of the acutely ill patient by 0.32 (95% CI 0.030 to 1.301, p=0.041). CONCLUSIONS: The COVID-19 pandemic FiY1 post improved confidence in core skills and competencies. These findings may help guide future educational interventions in conjunction with further larger scale studies, ultimately aiding to bridge the transition gap between being a medical student and a doctor.

Endovascular treatment of diabetic peripheral arterial disease in older and oldest old patients: a retrospective study.

BACKGROUND: Peripheral arterial disease (PAD) is frequent among older diabetic patients, but the evidence about endovascular revascularization is very limited. METHOD: We retrospectively analyzed data collected from 120 diabetic patients consecutively admitted to a Diabetic Foot Clinic, including 64 patients aged 65-79 years and 56 patients aged 80 or more. RESULTS: Percutaneous transluminal angioplasty (PTA) was followed by technical success in 82.5% of older patients and 62.5% of oldest old ones (p = 0.05). No significant difference was observed in regards to complete re-epithelization (76.6 vs 76.8%, p = 0.820), recurrent stenosis (26.6 vs 19.6%, p = 0.371), intra- or post-procedure complications (21.9 vs 10.7%, p = 0.102), and amputations (12.5 vs 5.4%, p = 0.176). DISCUSSION: Our findings suggest that older and oldest old patients with diabetic foot and critical ischemia could be effectively and safely treated with PTA.

The Italian version of the Response Evaluation Measure-71.

OBJECTIVE: The aim of the present study was to analyze the psychometric properties of the Italian version of the Response Evaluation Measure (REM-71), a 71-item self-report measure previously developed for the assessment of defenses in adults and adolescents. The authors also examined the differences in the use of defenses based on sex and age (early adolescence, late adolescence, and early adulthood), and the association between defenses, psychosocial health, and psychologic distress in a large community sample. METHOD: The Italian version of REM-71 was obtained through back-translation and administered to 1648 (1020 female subjects, mean age = 19.5 years, SD = +/-5.77) community subjects, aged between 13 and 68 years, voluntarily recruited among high school and university students in Milan, Italy, and the surrounding area. All subjects completed a self-report measure to assess demographic variables and satisfaction with life. A subsample (n = 1197) completed the Italian version of the Symptom Checklist-90-Revised to assess symptoms of psychologic distress. RESULTS: Results were highly consistent with those obtained in the original English version of the REM-71 and included satisfactory internal consistency of the measure. Factor analyses yielded 2 principal factors that showed overall stability across age and sex subgroups. Factor 1 and factor 2 defenses were significantly correlated, in line with theoretical expectations, with positive and negative aspects of various domains of life. CONCLUSIONS: Results provide further support for the structure and validity of the REM-71 as a useful instrument for the assessment of defenses in adolescents and adults and suggest no major cross-cultural differences in the organization of these defenses.

Changes in body composition and insulin sensitivity in severely obese subjects after laparoscopic adjustable silicone gastric banding (LASGB).

BACKGROUND: Laparoscopic adjustable silicone gastric banding (LASGB) is a viable therapeutic approach to achieve stable body weight reduction in severe obesity. The aim of this study was to evaluate body composition and metabolic features in morbidly obese patients before and after LASGB. MATERIAL/METHODS: There were 15 severely obese patients (Ob) (M/F: 4/11; mean age: 32.5 +/- 3.8 years) and 16 age-and sex-matched healthy lean controls (C) (M/F: 4/12; mean age: 39.5 +/- 2 years). Body mass index (BMI), waist circumference, waist-to-hip ratio, blood pressure, lipid profile, serum glucose and insulin during OGTT, and HOMA-IR were evaluated in all subjects. Body composition and fat distribution were measured using dual energy X-ray absorptiometry (DEXA). Patients were assessed before and six months after LASGB. RESULTS: The obese subjects showed several metabolic alterations. There were also positive correlations between waist, fat mass (FM), and HOMA-IR at baseline. After LASGB, mean BMI fell from 42.2 kg/m2 to 33.2 kg/m2; waist circumference and abdominal FM% decreased significantly. FM% declined, whereas FFM% increased. The ratio of FM loss to FFM loss was 3.7:1. Serum glucose and insulin levels during OGTT diminished slightly after weight loss and triglyceride levels fell dramatically. After LASGB, fasting insulin and HOMA-IR declined. RESULTS: LASGB induced a significant improvement in insulin sensitivity and a redistribution of body composition with a relative increase of FFM.

Overexpression of the renin-angiotensin system in human visceral adipose tissue in normal and overweight subjects.

To evaluate the expression of the renin-angiotensin system (RAS) genes in visceral (VAT) and subcutaneous adipose tissue (SAT) in normotensive subjects with different body mass index (BMI). Adipose tissue was obtained from 22 normotensive (12 normal weight and 10 overweight) patients during surgery for colecystectomy. Angiotensinogen (AGT), angiotensin II receptor type 1 (AT1), angiotensin converting enzyme (ACE) mRNA, and protein levels were measured by reverse transcriptase-polymerase chain reaction and Western blot analysis, respectively. The AGT mRNA and AT1 receptor mRNA levels were significantly higher in VAT than in SAT; AGT mRNA levels were higher, although not significantly, in overweight subjects in both SAT and VAT. There was no significant difference in ACE gene expression in the two tissues, and no expression of angiotensin II receptor type 2 (AT2). Finally, we failed to find mRNA for the renin gene in adipose tissue. The presence of AGT and ATI receptor in SAT and VAT was confirmed by Western blot analysis. Our study demonstrates the presence--and different levels of expression--of the various components of the RAS system (AGT, ATI, and ACE) in human SAT and VAT, and highlights the different role and regulation of the system in the two tissues. Its high expression in VAT suggests that its regulation and function are involved in all conditions where visceral adiposity is present.