[Non traumatic lesions of the foot, calluses and nails: socioeconomic impact of an unexplored issue]. / Lésions non traumatiques du pied, cors et ongles: impact socio-écono- mique d'un problème méconnu.

Up to 20% of the general population, especially women and old people, suffer from non traumatic lesions of the foot. These lesions have repercussions on a person's health and wellbeing. Nevertheless, the clinical examination of the foot rarely forms part of routine medical consultations. Using questionnaires and individual interviews, this pilot study investigated the foot problems of 96 patients attending a podiatrist's practice, as well as the level of communication between the patients and their doctor. 85% of the participants said they never talked about calluses and nails with their doctor. The results were confirmed by fifteen individual interviews. Clinicians have an important role to play in the early detection of these lesions, allowing an efficient management of this issue.

Spatiotemporal patterns of reinfestation by Triatoma guasayana (Hemiptera: Reduviidae) in a rural community of northwestern Argentina.

Triatoma guasayana (Wygodzinsky & Abalos) is a secondary vector of Trypanosoma cruzi (Chagas), the etiologic agent of Chagas disease, in the Chaco region of Argentina, Bolivia, and Paraguay. The spatial distribution of T. guasayana in a rural community in northwestern Argentina is described and analyzed using very high spatial resolution satellite imagery, geographic information systems, and spatial statistics. Since a 1992 residual spraying with insecticides of all houses, site-specific domestic and peridomestic reinfestations by triatomine bugs were monitored using various methods semiannually from 1993 to 2002. The reinfestation by T. guasayana started with finding of only adult bugs in a few sites. Bug abundance was significantly clustered and predominantly peridomestic in the southern and northern extremes of the community. The identified source of reinfestation in the northern cluster was a colonized wood pile, whereas no potential peridomestic source was found for the southern cluster. The spatial distribution of T. guasayana was positively associated with the abundance and spatial distribution of goats. Active dispersal from the hypothesized source and the surrounding sylvatic environment, and passive transport of bugs in wood piles seems to be the most likely mechanisms underlying the observed spatial pattern of T. guasayana. The absence of domestic colonization indicates that, to date, there is no trend toward increased local domiciliation of T. guasayana. The clustering zones can be considered "hot spots" where bug invasion from other sources is expected to be higher and where eventually, introduction of sylvatic T. cruzi to suitable hosts may occur.

Role of fibronectin in staphylococcal adhesion to metallic surfaces used as models of orthopaedic devices.

Staphylococcal infection of various prosthetic and internal fixation devices is a major complication associated with orthopaedic surgery. This study investigated the role of the host protein fibronectin in promoting adhesion of Staphylococcus aureus and Staphylococcus epidermidis to metallic surfaces representing materials used for orthopaedic devices. Pure human fibronectin was adsorbed in vitro onto coverslips (0.8 x 0.8 cm) of stainless steel, pure titanium, or titanium-aluminum-niobium alloy. In vitro bacterial adhesion was promoted more strongly by the metallic surfaces coated with fibronectin than by albumin-coated controls for two strains of S. aureus and one strain of S. epidermidis. Furthermore, with the fibronectin-coated coverslips, bacterial adhesion to titanium alloy was significantly greater than adhesion to stainless steel. Adhesion of the three staphylococcal strains was promoted more strongly by coverslips explanted from the subcutaneous space of guinea pigs and tested under similar conditions than by albumin-coated controls. Incubation of either in vitro fibronectin-coated or explanted metallic coverslips with anti-fibronectin antibodies produced a significant decrease in staphylococcal adhesion. These results suggest that the presence of fibronectin on the surface of implanted metallic devices is an important determinant of colonization of orthopaedic biomaterials by staphylococci.

Calcification of the tibialis posterior tendon: a case report and literature review.

The tibialis posterior muscle and tendon are subject to a number of pathological conditions and injuries that have recently received much attention in the literature. Because of its function as a main stabilizer of the subtalar complex against hindfoot valgus and forefoot pronation, the mechanical demand on the posterior tibial tendon is high. Problems with dislocation, tenosynovitis, rupture, and laceration have all been described with this tendon. In this report, we present a case of dysfunction of the posterior tibial tendon associated with chronic tendinitis and intratendinous calcifications. After removal of the calcifications, the patient became asymptomatic and returned to work. Proposed etiologies of these calcifications are discussed.

[Talar neck fracture: 9-year follow-up of 40 cases]. / Fractures du col de l'astragale: 40 cas revus au recul moyen de 9 ans.

PURPOSE OF THE STUDY: Complication rate is high after talar neck fractures. Avascular osteonecrosis and post-traumatic joint degeneration could be avoided by proper management. We analyzed long-term outcome in a series of 40 talar neck fractures treated in our unit from 1979 to 1995. MATERIAL AND METHODS: Mean follow-up was 9 years. Orthopedic and surgical management by Hawkins classification group was, respectively, type I=10 (7 and 3), type II=17 (3 and 14), type III=11 (1 and 10) and type IV=2 (both surgery). Two patients had bilateral fractures and 7 fractures were open. Among the 29 fractures treated surgically, the anteromedial approach was used for open reduction and fixation for 18. A dual approach was needed for 1 patient with a type III fracture. Fixation was achieved with cancelous screws for 17/29 fractures including 3 fluted screw fixations, cortical screws for 9, K-wires for 2 and staples for 1. RESULTS: According to the AOFAS classification, mean function score at last follow-up was 94.4/100 for type I, 78.5 for type II, 69.5 for type III, and 57.5 for type IV. Signs of osteoarthritis were observed in 68% of the cases with clinical expression in 9 out of 10 cases. DISCUSSION: The results show that conservative treatment is indicated for type I fractures while open reduction and fixation should be used for types II, III, and IV. Subsequent joint degeneration was correlated with the type of fracture and clearly influenced functional outcome. In our long-term follow-up, we only had two cases of osteonecrosis which finally necessitated arthrodesis. This low rate would be related to the fact that most of the patients were able to avoid weight bearing for several months.

Dietary supplementation in elderly patients with fractured neck of the femur.

59 elderly patients (mean age 82) with femoral neck fractures were randomised into two groups. 27 patients received daily an oral nutrition supplement (250 ml, 20 g protein, 254 kcal) for a mean of 32 days; 32 patients acted as controls. On admission most patients had nutritional deficiencies. Despite being offered adequate quantities, nutritional requirements were not met during the hospital stay. Clinical outcome was significantly better in the supplemented group (56% favourable course vs 13% in controls) during the stay in the convalescent hospital. The rates of complications and deaths were also significantly lower in supplemented patients (44% vs 87%). 6 months after the fracture the rates of complications and mortality were significantly lower in supplemented patients (40% vs 74%). The median duration of hospital stay was significantly shorter in the supplemented group (24 vs 40 days). Thus the clinical outcome of elderly patients with femoral neck fracture can be improved by once daily dietary oral supplementation.

Evaluation of the age-adjusted incidence of hip fractures between urban and rural areas: the difference is not related to the prevalence of institutions for the elderly.

As many as 40% of hip fractures occur in institutions for the elderly. Several studies have demonstrated a higher age-adjusted incidence of hip fractures in urban areas compared with rural areas. To assess whether this difference could be due to a preferential location of institutions for the elderly in urban areas, we compared the incidence of hip fractures over a 5-year period in urban versus rural areas, as defined according to the population density (urban > 15 inhabitants/ha2). We then determined the age-adjusted incidence of hip fractures in institutional-dwelling elderly and home-dwelling elderly. Hip fracture incidence was 100.0/100,000 (150.5 in women and 43.8 in men) in urban areas, and 71.0/100,000 (107.2 in women and 32.8 in men) in rural areas (p<0.001). When only those patients living in their own homes were analyzed, the incidence was 66.7/100000 (94.6 in women and 35.7 in men) in urban regions and 36.8/100,000 (49.6 in women and 23.4 in men) in rural areas (p<0.001), a difference of even greater magnitude than when both home-dwelling and institutional-dwelling residents were considered together. In a logistic regression model including age class, gender, urban or rural areas and institutionalization for inhabitants 65 years of age and older, urban residents have a 31% significantly (p<0.001) higher incidence of hip fracture compared with rural residents; women have a 79% significantly (p<0.001) higher incidence of hip fracture compared with men; and institutional-dwelling elderly have a 351% significantly (p<0.001) higher incidence of hip fracture compared with home-dwelling elderly. These results confirm the existence of a higher age-adjusted incidence of hip fractures in urban compared with rural areas. Since this difference is increased when patients living at home were analyzed separately, it indicates that the difference between urban and rural areas is not due to a preferential urban location of institutions for the elderly.

Is time since hip fracture influencing the discrimination between fractured and nonfractured subjects as assessed at the calcaneum by three technologically different quantitative ultrasound devices?

Because quantitative ultrasound (QUS) instruments from different manufacturers have significant technical differences, it is difficult to assess whether all of them can discriminate similarly between osteoporotic fractures and age-matched controls. Thus, to avoid any bias, reliable comparative assessment of the QUS devices should be carried out on the same population. Few studies have fulfilled this condition. Another source of variability in cross-sectional studies in which fractured and nonfractured subjects are compared is the time since osteoporotic fracture. Our study evaluated the ability of three calcaneal QUS devices to discriminate patients with osteoporotic hip fracture from control subjects, using the same population. In addition, a subset of patients was re-measured about 9 months after the hip replacement surgery to check how the time since fracture affects the discriminatory ability of the different QUS devices. Fifty postmenopausal hip-fractured patients and 46 postmenopausal age-matched controls were included in this study and measured on three QUS devices, as well as 50 young healthy controls to calculate the T-score. Odds ratio results showed that a decrease in UBIS trade mark BUA of 1 SD was associated with a significant increase in fracture risk (odds ratio adjusted = 2.30) comparable with Sahara broadband ultrasound attenuation (BUA) (OR adj. = 2.30), and Achilles BUA (OR adj. = 3.5). However, given the large overlap between the 95% intervals of each OR and for the areas under ROC curves, no significant difference was found between them. In the subset of 15 hip-fractured subjects, no significant differences were found between ultrasound parameters of the first visit and 9 months after except for the heel width (soft tissue variation). Odds ratio and areas under the curve (AUC) tend to increase from visit 1 to 2 for the BUA and decrease substantially for the SOS for all but the Lunar Achilles+. Nonsignificant correlation was found between the absolute difference of the ultrasound parameters measured at the two visits and the time since fracture, except for the Sahara SOS (r = 0.45; P < 0.04). In conclusion, no significant differences between QUS technologies were observed in their positive and significant ability to discriminate hip-fractured patient from controls. However, this statement is shadowed when taking into account the time since fracture which seems to negatively influence results obtained on dry versus wet QUS systems. As a result, it is advisable that such parameters would be taken into account when designing a study aimed to demonstrate the discriminatory ability of heel ultrasound between normal and hip-fractured patients.

Effectiveness of residual spraying of peridomestic ecotopes with deltamethrin and permethrin on Triatoma infestans in rural western Argentina: a district-wide randomized trial.

OBJECTIVE: To compare the effectiveness of a single residual spraying of pyrethroids on the occurrence and abundance of Triatoma infestans in peridomestic ecotopes in rural La Rioja. METHODS: A total of 667 (32.8%) peridomestic sites positive for T. infestans in May 1999 were randomly assigned to treatment within each village, sprayed in December 1999, and reinspected in December 2000. Treatments included 2.5% suspension concentrate (SC) deltamethrin in water at 25 mg active ingredient (a.i.)/m(2) applied with: (a) manual compression sprayers (standard treatment) or (b) power sprayers; (c) 1.5% emulsifiable concentrate (EC) deltamethrin at 25 mg a.i./m(2); and (d) 10% EC cis-permethrin at 170 mg a.i./m(2). EC pyrethroids were diluted in soybean oil and applied with power sprayers. All habitations were sprayed with the standard treatment. FINDINGS: The prevalence of T. infestans 1-year post-spraying was significantly lower in sites treated with SC deltamethrin applied with manual (24%) or power sprayers (31%) than in sites treated with EC deltamethrin (40%) or EC permethrin (53%). The relative odds of infestation and catch of T. infestans 1-year post-spraying significantly increased with the use of EC pyrethroids, the abundance of bugs per site before spraying, total surface, and host numbers. All insecticides had poor residual effects on wooden posts. CONCLUSION: Most of the infestations probably originated from triatomines that survived exposure to insecticides at each site. Despite the standard treatment proving to be the most effective, the current tactics and procedures fail to eliminate peridomestic populations of T. infestans in semiarid rural areas and need to be revised.

El papel del peridomicilio en la eliminacion de Triatoma infestants de comunidades rurales argentinas / The role of the peridomiciliary area in the elimination of Triatoma infestans in rural Argentine communities

El objetivo del estudio fue identificar el origen y estudiar la dinamica de la reinfestacion por Triatoma infestans ocurrida despues de rociar con deltametrina el domicilio y peridomicilio de 94 casas de tres comunidades rurales del noroeste argentino. La efectividad del rociamiento se evaluo inmediatamente despues y al segundo mes de rociar las viviendas. Ademas, se detectaron y rociaron 5 focos residuales peridomiciliarios y 3 preexistentes que no habian sido rociados.Para monitorizar la reinfestacion, se colocaron biosensores en los domicilios, se solicito a cada familia que capturase triatominos y los guardara en bolsas de plastico, y se buscaron triatominos en domicilios y peridomicilios usando un aereosol para desalojar a los insectos de sus refugios. Solo se realizaron rociamientos selectivos donde se encontro alguna colonia de T. infestns. Durante 30 meses de seguimiento, el porcentaje de casas donde se capturo algun T. infestans oscilo entre 3 por ciento y 9 por ciento. En 6 casas se capturaron T. infestans en mas de una evaluacion. El numero de peridomicilios infestados (19) fue el doble que el de domicilios (9). Solo se detectaron colonias de T. infestans en peridomicilios. La cifra de T. infestans capturados en peridomicilios fue seis veces mas alta que las de los domicilios. Las gallinas fueron el hospedador mas frecuente asociado con los focos peridomiciliarios. El peridomicilio constituyo el origen y la principal fuente de reinfestacion. Para reducir la velocidad de reinfestacion y la frecuencia de rociamientos es preciso combinar medidas de manejo ambiental y control quimico en los peridomicilios: reducir los refugios para triatominos; restringir la cria de aves a estructuras no colonizables por triatominos; aplicar un insecticida menos desagradable por agentes climaticos o realizar un segundo rociamiento de 6 a 12 meses despues del primero, y emplear un dispositivo para detectar tempranamente la presencia de T. infestans en peridomicilios

Trypanosoma cruzi infection in Triatoma infestans and other triatomines : long-term effects of a control program in rural northwestern Argentina

The prevalence of Trypanosoma cruzi infection in Triatoma infestans, Triatoma guasayana, and Triatoma sordida was evaluated in Amamá and other neighboring rural villages in northwestern Argentina for five years after massive spraying with deltamethrin in 1992 and selective sprays thereafter. Local residents and expert staff collected triatomines in domiciliary and peridomestic sites. During 1993-1997, the prevalence of T.cruzi was 2.4 per cent in 664 T. infestans, 0,7 per cent in 268 T.guasayana, and 0.2 per cent in 832 T.sordida. T.cruzi infection was more frequently detected in adult bugs and in triatomines collected at domiciliary sites. The infected T.guasayana and T.sordida were nymphs and adults, respectively, captured at peridomestic sites. The prevalence of T.cruzi infection in T.infestans decreased from 7.7 per cent to 1.5 per cent during the surveillance period, although that change was not statistically significant. Comparison of T.infestans infection rates before the control program and during surveillance showed a highly significant decrease from 49 per cent to 4.6 per cent in bedrooms, as well as a fall from 6 per cent to 1.8 per cent in peridomestic sites. Because of its infection with T.cruzi and frequent invasion of domiciliary areas and attacks on humans and dogs, T. guasayana appeared implicated as a putative secondary vector of T.cruzi in domestic and peridomestic sites during the surveillance period.T. sordida was the most abundat species, but it was strongly associated with chickens and showed little tendency to invade bedrooms

El papel del peridomicilio en la eliminacion de Triatoma infestants de comunidades rurales argentinas / The role of the peridomiciliary area in the elimination of Triatoma infestans in rural Argentine communities

El objetivo del estudio fue identificar el origen y estudiar la dinamica de la reinfestacion por Triatoma infestans ocurrida despues de rociar con deltametrina el domicilio y peridomicilio de 94 casas de tres comunidades rurales del noroeste argentino. La efectividad del rociamiento se evaluo inmediatamente despues y al segundo mes de rociar las viviendas. Ademas, se detectaron y rociaron 5 focos residuales peridomiciliarios y 3 preexistentes que no habian sido rociados.Para monitorizar la reinfestacion, se colocaron biosensores en los domicilios, se solicito a cada familia que capturase triatominos y los guardara en bolsas de plastico, y se buscaron triatominos en domicilios y peridomicilios usando un aereosol para desalojar a los insectos de sus refugios. Solo se realizaron rociamientos selectivos donde se encontro alguna colonia de T. infestns. Durante 30 meses de seguimiento, el porcentaje de casas donde se capturo algun T. infestans oscilo entre 3 por ciento y 9 por ciento. En 6 casas se capturaron T. infestans en mas de una evaluacion. El numero de peridomicilios infestados (19) fue el doble que el de domicilios (9). Solo se detectaron colonias de T. infestans en peridomicilios. La cifra de T. infestans capturados en peridomicilios fue seis veces mas alta que las de los domicilios. Las gallinas fueron el hospedador mas frecuente asociado con los focos peridomiciliarios. El peridomicilio constituyo el origen y la principal fuente de reinfestacion. Para reducir la velocidad de reinfestacion y la frecuencia de rociamientos es preciso combinar medidas de manejo ambiental y control quimico en los peridomicilios: reducir los refugios para triatominos; restringir la cria de aves a estructuras no colonizables por triatominos; aplicar un insecticida menos desagradable por agentes climaticos o realizar un segundo rociamiento de 6 a 12 meses despues del primero, y emplear un dispositivo para detectar tempranamente la presencia de T. infestans en peridomicilios

Se publica en ingles en el Bull. PAHO. Vol. 30(3), 1996

Trypanosoma cruzi infection in Triatoma infestans and other triatomines: long-term effects of a control program in rural northwestern Argentina / Infección por Trypanosoma cruzi en Triatoma infestans y otros triatómidos: efectos a largo plazo de un programa de control en una zona rural del noroeste de Argentina

The prevalence of Trypanosoma cruzi infection in Triatoma infestans, Triatoma guasayana, and Triatoma sordida was evaluated in Amamá and other neighboring rural villages in northwestern Argentina for five years after massive spraying with deltamethrin in 1992 and selective sprays thereafter. Local residents and expert staff collected triatomines in domiciliary and peridomestic sites. During 1993-1997, the prevalence of T.cruzi was 2.4 per cent in 664 T. infestans, 0,7 per cent in 268 T.guasayana, and 0.2 per cent in 832 T.sordida. T.cruzi infection was more frequently detected in adult bugs and in triatomines collected at domiciliary sites. The infected T.guasayana and T.sordida were nymphs and adults, respectively, captured at peridomestic sites. The prevalence of T.cruzi infection in T.infestans decreased from 7.7 per cent to 1.5 per cent during the surveillance period, although that change was not statistically significant. Comparison of T.infestans infection rates before the control program and during surveillance showed a highly significant decrease from 49 per cent to 4.6 per cent in bedrooms, as well as a fall from 6 per cent to 1.8 per cent in peridomestic sites. Because of its infection with T.cruzi and frequent invasion of domiciliary areas and attacks on humans and dogs, T. guasayana appeared implicated as a putative secondary vector of T.cruzi in domestic and peridomestic sites during the surveillance period.T. sordida was the most abundat species, but it was strongly associated with chickens and showed little tendency to invade bedrooms

Durante los cinco años posteriores a una fumigación masiva con deltametrina realizada en 1992 y seguida de fumigaciones selectivas, se investigó la prevalencia de la infección por Trypanosoma cruzi en Triatoma infestans, Triatoma guasayana y Triatoma sordida en Amamá y otras poblaciones rurales vecinas del noroeste de Argentina. Los triatómidos fueron recogidos en los domicilios y en el área peridoméstica por los propios residentes y por personal experto. Durante el quinquenio 1993­1997, la prevalencia de T. cruzi fue de 2,4% en 664 T. infestans, de 0,7% en 268 T. guasayana y de 0,2% en 832 T. sordida. La infección por T. cruzi se detectó con mayor frecuencia en las chinches adultas y en los triatómidos recogidos en los domicilios. T. guasayana y T. sordida fueron, respectivamente, ninfas y adultos recogidos en el área peridoméstica. Durante el período de vigilancia, la prevalencia de la infección por T. cruzi en T. infestans disminuyó de 7,7% en 1993 a 1,5% en 1997, aunque este cambio no fue estadísticamente significativo. La comparación de las tasas de infección de T. infestans antes del programa de control (1992) y durante el período de vigilancia (1993­1997) reveló una disminución altamente significativa, de 49% a 4,6%, en los dormitorios y también en las áreas peridomésticas (de 6% a 1,8%). Debido a su infección por T. cruzi y a su frecuente invasión de las áreas domésticas con ataques a los humanos y a los perros, T. guasayana parecía estar implicado como vector secundario de T. cruzi en las áreas domésticas y peridomésticas durante el período de vigilancia. T. sordida fue la especie más abundante, pero estaba estrechamente asociada a los pollos y mostró escasa tendencia a invadir los dormitorios

Triatoma infestans (Klug) / Triatoma infestans (Klug)

Resume información disponible sobre Triatoma infestans, respecto a: taxonomía; distribución geográfica, aspectos ecológicos generales; hábitats y especies asociadas (domiciliario, peridomiciliario y silvestres); infecciones por Trypanosoma cruzi y otros flagelados; alimentación y defecación; ciclo de vida, teratología, mutaciones e hibridaciones; enemigos naturales (predadores, parásitos y patógenos), control biológico; dispersión y movilidad