Diagnosing osteomyelitis in the diabetic foot: a pilot study to examine the sensitivity and specificity of Tc(99m) white blood cell-labelled single photon emission computed tomography/computed tomography.

Diabetic foot ulceration poses a significant threat of osteomyelitis (OM) and subsequent amputation. The diagnosis of OM via imaging studies is difficult as radiographic findings do not present immediately and advanced imaging studies may be contraindicated or unavailable. A novel diagnostic tool has been developed which synthesises technetium-99 white blood cell-labelled single-photon emission computed tomography and computed tomography (Tc(99m) WBC labelled-SPECT/CT) imaging, effectively enhancing anatomic detail. The aim of this pilot study was to determine the validity and reliability of this novel imaging technique in patients with diabetic foot ulcers in a Veterans Affairs healthcare facility. A retrospective review was performed on consecutive patients who met the inclusion criteria (n = 14) and underwent Tc(99m) WBC-labelled SPECT/CT for suspected OM. Histopathologic analysis of bone specimen (when available) and International Working Group on the Diabetic Foot consensus criteria were used as a reference standard. The sensitivity and specificity of Tc(99m) WBC-labelled SPECT/CT were 87·50% [confidence interval (CI): 64·58-110·42%] and 71·43% (CI: 37·96-104·90%), respectively. Negative predictive value (NPV) and positive predictive value (PPV) were 83·33% (CI: 53·51-113·15%) and 77·78% (CI: 50·62-104·94%), respectively, with a likelihood ratio (LR) of 3·063 and an accuracy of 80%. These findings suggest Tc(99m) WBC-labelled SPECT/CT can be useful in imaging OM in patients with diabetic foot ulcers.

Polaridad predominante en pacientes bipolares tipo I. Estudio en una población aislada con alta prevalencia de trastornos de ánimo / Predominant polarity in type-I bipolar patients. Study in an isolated population with a high prevalence of mood disorders

Introducción: Estudios recientes han demostrado que la descripción de la polaridad predominante tiene efectos en la detección temprana y el inicio oportuno del tratamiento en los pacientes con trastorno afectivo bipolar (TAB). Metodología: Estudio descriptivo de corte transversal en 101 pacientes con TAB procedentes de una muestra poblacional genéticamente aislada de la región colombiana de Antioquia. Resultados: El estudio abarcó una población de 101 pacientes con diagnóstico de TAB tipo I, de los cuales 57,4% cumplieron criterios de polaridad maniaca (PM), 10,1% presentaron polaridad depresiva (PD) y 25,7% fueron clasificados con polaridad indefinida (PI). En comparación con los otros, los pacientes con PM tienen menor nivel educativo y menor edad de inicio y hay más solteros que en los otros grupos. La mayor prevalencia de suicidio se dio dentro del grupo de PM. El grupo de PM presentó un mayor consumo de cannabinoides y cocaína. Dentro del grupo de PD se registró una fuerte tendencia al consumo de cigarrillo y alcohol. Respecto a los fármacos consumidos a lo largo de la vida por los pacientes que conforman el estudio, los antipsicóti-cos fueron el grupo más usado, seguido por el litio y los anticonvulsivantes. Hay un elevado porcentaje de pacientes con PM que usaron antidepresivos a lo largo de su vida. Conclusiones: La polaridad del primer episodio de la enfermedad parece ser un parámetro de pronóstico válido en cuanto a la polaridad de los episodios subsiguientes; por lo tanto funciona de forma indirecta como predictor del curso de la enfermedad...

Introduction: Recent studies have shown that the predominant description of polarity has effects upon early detection and the timely beginning of treatment in patients with bipolar affective disorder (BAD). Methodology:Cross sectional cut and descriptive study in 101 BAD patients coming from a genetically isolated population from the Colombian Region of Antioquia. Results: The study covered a population of 101 patients with type-I BAD diagnosis, out of which 57,4% met the criteria for maniac polarity (MP), 10,1% exhibited depressive polarity (DP) and 25,7% were classified with Indefinite Polarity (IP). In comparison, MP patients have a lower education level and less starting age, including a greater number of single people. The MP group showed the greatest prevalence of suicide and greater use of cannabinoids and cocaine. Within the DP group there was a strong tendency to cigarette and alcohol consumption. With respect to pharmaceutical drugs consumed by the study patients during their lives, antipsychotics were the most widely used group, followed by lithium and anticonvulsivants. There is high percentage of MP patients who have used antidepressants during their lives. Conclusion: The polarity of the first episode of the disease seems to be a valid predictive parameter concerning the polarity of subsequent episodes; therefore, it works indirectly as a valid predictor of the disease’s course...

[Predominant polarity in type-I bipolar patients: Study in an isolated population with a high prevalence of mood disorders]. / Polaridad predominante en pacientes bipolares tipo I: Estudio en una población aislada con alta prevalencia de trastornos de ánimo.

INTRODUCTION: Recent studies have shown that the predominant description of polarity has effects upon early detection and the timely beginning of treatment in patients with bipolar affective disorder (BAD). METHODOLOGY: Cross sectional cut and descriptive study in 101 BAD patients coming from a genetically isolated population from the Colombian Region of Antioquia. RESULTS: The study covered a population of 101 patients with type-I BAD diagnosis, out of which 57,4% met the criteria for maniac polarity (MP), 10,1% exhibited depressive polarity (DP) and 25,7% were classified with Indefinite Polarity (IP). In comparison, MP patients have a lower education level and less starting age, including a greater number of single people. The MP group showed the greatest prevalence of suicide and greater use of cannabinoids and cocaine. Within the DP group there was a strong tendency to cigarette and alcohol consumption. With respect to pharmaceutical drugs consumed by the study patients during their lives, antipsychotics were the most widely used group, followed by lithium and anti-convulsivants. There is high percentage of MP patients who have used antidepressants during their lives. CONCLUSION: The polarity of the first episode of the disease seems to be a valid predictive parameter concerning the polarity of subsequent episodes; therefore, it works indirectly as a valid predictor of the disease's course.