History Of Ulcer Research Articles

A case of neuro-Behcet's disease complicated with intra-cardiac thrombosis

Intra-cardiac thrombus is an unusual and rare complication of Behcet’s (BD) with poor prognosis. A 32-year-old man with a history of mouth and genital ulcers since 12 years ago was admitted to the neurology ward with complaints of headache and fever. Two years ago, the patient suffered from hydrocephalus due to cerebral vein thrombosis and a cerebral shunt was implanted for him. The patient was diagnosed with BD and was treated with glucocorticoids and cytotoxic drugs. During current hospitalization, with the diagnosis of shunt infection, the patient was treated with broad-spectrum antibiotics and the shunt was removed. On the 10th day of hospitalization, he developed cough and palpitation without dyspnea. Echocardiography showed a 2.5 × 4.7 mm mass in the right ventricle, tricuspid regurgitation and pulmonary arterial pressure of 32 mmHg. On computed tomography of the chest, the lung parenchyma was normal, but extension of the thrombus into the main pulmonary artery was reported.

Recurrent oral and nasopharyngeal ulcers, facial erythema, vesicles and scars in an older woman.

A 71-year-old woman presented with a 30-year history of recurrent fever, fatigue, oral and nasopharyngeal ulcers, facial oedematous erythema and vesicles that ulcerated and healed by forming scars.

Real-world risk of bleeding events in patients with chronic lymphocytic leukemia or small lymphocytic lymphoma (CLL/SLL) treated with BTKi.

7052 Background: Bruton tyrosine kinase inhibitors (BTKis) are effective treatments for various B-cell malignancies including CLL/SLL but are known to be associated with increased bleeding risk. Current evidence indicating this association has largely been demonstrated in clinical trial research. However, bleeding risk in real-world CLL/SLL patients, who are often sicker with more comorbidities requiring anticoagulant (AC) or antiplatelet (AP) use is not well described. This study aimed to assess the prevalence of AC/AP use and explore risk factors for bleeding among real-world CLL/SLL patients receiving BTKi therapies. Methods: We conducted a retrospective cohort study using the claims-linked Premier PINC AI Healthcare Database of patients aged ≥18 years with a diagnosis of CLL/SLL from July 1, 2016 to March 31, 2022. Patients were followed from first BTKi prescription fill (index date) to earliest of BTKi discontinuation, death, or end of the study period. Patient comorbidities, treatments, and bleeding events were assessed using diagnosis and procedure codes and prescription claims. Multivariable-adjusted risk for bleeding events was assessed with Cox proportional-hazards regression. Results: Among 2091 patients with CLL/SLL receiving BTKi therapies, mean age was 65.7 years, 61.8% were men, and 77.7% were White. BTKi treatments included ibrutinib (86.3%), acalabrutinib (13.1%), and zanubrutinib (<1%). Overall, 4.3% of patients switched BTKis during follow-up; 615 (29.4%) had AC/AP use at any time during the study period, of whom 411 (66.8%) started after BTKi initiation. Bleeding events occurred in 526 (25.2%) patients during a mean BTKi exposure of 14.2 months, with an incidence of 26.6 per 100 person-years (PYs) overall, and 37.2 and 22.0 per 100 PYs in patients with and without any prescription AC/AP use, respectively. The proportion of patients with fatal bleeding was <0.3%. In adjusted models, risk of first bleeding event was higher for AC use (HR [95% CI] 2.33 [1.83–2.98]), age ≥65 years (1.32 [1.14–1.53]), women (1.28 [1.10–1.48]), and history (during 90 days prior to BTKi start) of bleeding (2.27 [1.87–2.76]), ulcers (2.21 [1.06–4.63]) or myocardial infarction (MI) (1.74 [1.31–2.33]) (all P≤0.05). Prescription AP use, race/ethnicity, and history of chronic kidney disease or thrombocytopenia were not statistically significant. Conclusions: In this large real-world study of bleeding risk in patients receiving BTKis, bleeding events occurred in 26.6 per 100 patients per year, with higher risk in AC users, women, and patients with history of bleeding, ulcers, or MI. However, the risk of fatal bleeding was low.

Association of Smoking with progression from low-risk to high-risk intraductal papillary mucinous neoplasms and pancreatic cancer

BackgroundFactors associated with the risk of pancreatic adenocarcinoma (PDAC) may play a role in the development and progression of Intraductal Papillary Mucinous Neoplasms (IPMNs). However, data are limited. AimTo compare exposome factors in three groups of patients with “high or low-risk” IPMNs, as assessed at diagnosis and during a 24-months follow-up, and with PDAC. MethodsPatients were matched (same sex, age ±5) 1:1. Exposure variables were compared across groups using Kruskal-Wallis, ANOVA, or Chi-square tests with Bonferroni correction. ResultsA total of 151 patients were enrolled in each of the three groups (453 overall). The proportion of current smokers was progressively higher in “low-risk”, “high-risk” IPMNs and PDAC patients (8.1 %, 11.2 %, 23.3 %; p = 0.0002). The three groups did not differ in terms of ever or heavy smoking, BMI, history of diabetes, cancer, cholecystectomy or chronic pancreatitis, use of statins or aspirin, and family history of cancer. A history of peptic ulcer was more common in PDAC (7.2 %) than in either “low-risk” (2.0 %) or “high-risk” (2.6%) IPMNs (p = 0.02, not significant after Bonferroni correction). ConclusionActive smoking seems associated with the progression of IPMNs to malignancy, and cessation of active smoking might be advised in patients with IPMN.

Stomach Cancer Prediction Model (SCoPM): An approach to risk stratification in a diverse U.S. population.

Population-based screening for gastric cancer (GC) in low prevalence nations is not recommended. The objective of this study was to develop a risk-prediction model to identify high-risk patients who could potentially benefit from targeted screening in a racial/ethnically diverse regional US population. We performed a retrospective cohort study from Kaiser Permanente Southern California from January 2008-June 2018 among individuals age ≥50 years. Patients with prior GC or follow-up <30 days were excluded. Censoring occurred at GC, death, age 85 years, disenrollment, end of 5-year follow-up, or study conclusion. Cross-validated LASSO regression models were developed to identify the strongest of 20 candidate predictors (clinical, demographic, and laboratory parameters). Records from 12 of the medical service areas were used for training/initial validation while records from a separate medical service area were used for testing. 1,844,643 individuals formed the study cohort (1,555,392 training and validation, 289,251 testing). Mean age was 61.9 years with 53.3% female. GC incidence was 2.1 (95% CI 2.0-2.2) cases per 10,000 person-years (pyr). Higher incidence was seen with family history: 4.8/10,000 pyr, history of gastric ulcer: 5.3/10,000 pyr, H. pylori: 3.6/10,000 pyr and anemia: 5.3/10,000 pyr. The final model included age, gender, race/ethnicity, smoking, proton-pump inhibitor, family history of gastric cancer, history of gastric ulcer, H. pylori infection, and baseline hemoglobin. The means and standard deviations (SD) of c-index in validation and testing datasets were 0.75 (SD 0.03) and 0.76 (SD 0.02), respectively. This prediction model may serve as an aid for pre-endoscopic assessment of GC risk for identification of a high-risk population that could benefit from targeted screening.

Management of bilateral lower eyelid entropion in a black Angus bull by temporary tacking and modified Hotz Celsus

AbstractThe objective was to evaluate the progression and management of eyelid tacking sutures before permanent eyelid surgical correction. A 1‐year‐old Aberdeen black Angus bull presented with a 1‐month history of bilateral corneal ulcers. Ophthalmic examination revealed an infected stromal corneal ulcer on the left eye and bilateral lower eyelid entropion. Lower eyelid tacking sutures were placed bilaterally to allow corneal healing, prevent recurrent corneal ulceration and allow resolution of concurrent moist dermatitis. Approximately 2 weeks after eyelid tacking, permanent entropion repair using a modified Hotz Celsus technique was performed on both lower eyelids. This report details the successful treatment of bilateral lower eyelid entropion in a bull using temporary tacking sutures to stabilise corneal and eyelid disease before permanent eyelid surgical correction.

Temporal changes in toe-brachial index results in haemodialysis patients.

Toe brachial index (TBI), the ratio of toe pressure to systolic blood pressure (SBP), helps predict peripheral arterial disease. In patients with kidney failure this may be performed during haemodialysis for convenience. Until recently there has been little evaluation of the impact of haemodialysis in limb and systemic perfusion on these values. We aimed to determine if the values of TBI would change during and after dialysis compared to pre-dialysis assessments. Using a repeated measures study, TBIs and toe pressures were measured using the Hadeco Smartop Vascular Ultrasound Doppler in 31 patients undergoing haemodialysis. TBI assessments were completed pre-dialysis and compared to values obtained at 1 hour, 2 hours, 3 hours, and post-dialysis to monitor change in TBI results. Comparison of values for each patient were tested for differences using paired t-tests. Linear mixed-effects models were used to test for the effect of patient and clinical factors on change in outcome measures. Mean TBI decreased from pre-dialysis at 1 hour (0.72 to 0.63, p = 0.01) and remained lower at 2 hours and 3 hours, before returning to pre-dialysis levels at post-dialysis. Mean systolic blood pressure also declined during dialysis. Mean TBI results were lower in those with a history of lower limb ulceration and in females. Sixteen patients (51.6%) had a normal TBI at baseline, 14 (45.2%) had a mildly low TBI, and one (3.2%) had a severely low TBI. Between baseline and 1 h, five patient's results moved from normal to mildly abnormal and one from mildly abnormal to severely abnormal. As haemodialysis concluded (post-dialysis) there were 17 (56.7%) 'normal' TBIs, with no severely abnormal TBIs (p = 0.73). 0.30). TBI and toe pressures are impacted significantly by dialysis. TBI and toe pressure assessments should be conducted before haemodialysis begins, or between dialysis sessions to avoid variability.

A Multi-Faceted Digital Health Solution for Monitoring and Managing Diabetic Foot Ulcer Risk: A Case Series.

Diabetic foot ulcers (DFU) are a devastating complication of diabetes. There are numerous challenges with preventing diabetic foot complications and barriers to achieving the care processes suggested in established foot care guidelines. Multi-faceted digital health solutions, which combine multimodal sensing, patient-facing biofeedback, and remote patient monitoring (RPM), show promise in improving our ability to understand, prevent, and manage DFUs. Patients with a history of diabetic plantar foot ulcers were enrolled in a prospective cohort study and equipped with custom sensory insoles to track plantar pressure, plantar temperature, step count, and adherence data. Sensory insole data enabled patient-facing biofeedback to cue active plantar offloading in response to sustained high plantar pressures, and RPM assessments in response to data trends of concern in plantar pressure, plantar temperature, or sensory insole adherence. Three non-consecutive case participants that ultimately presented with pre-ulcerative lesions (a callus and/or erythematous area on the plantar surface of the foot) during the study were selected for this case series. Across three illustrative patients, continuous plantar pressure monitoring demonstrated promise for empowering both the patient and provider with information for data-driven management of pressure offloading treatments. Multi-faceted digital health solutions can naturally enable and reinforce the integrative foot care guidelines. Multi-modal sensing across multiple physiologic domains supports the monitoring of foot health at various stages along the DFU pathogenesis pathway. Furthermore, digital health solutions equipped with remote patient monitoring unlock new opportunities for personalizing treatments, providing periodic self-care reinforcement, and encouraging patient engagement-key tools for improving patient adherence to their diabetic foot care plan.

The Use of Negative Pressure Wound Therapy (NPWT) as a Dressing for Split Thickness Skin Graft for Bilateral Chronic Venous Leg Ulcer

Background: Chronic ulcer is a type of wound, which persists for at least 3 months. One of the causes of chronic ulcer is deep vein thrombosis (DVT). Chronic ulcers require very high maintenance costs and can negatively impact the patient’s quality of life and mental health. Case Illustration: A 40-year-old man came to the hospital with a history of chronic ulcer on both legs, which first appeared 3 years ago. The Patient had undergone treatment at a public outpatient clinic and hospital, unfortunately the wound did not heal. The patient continued to change the bandage independently and did not go to the doctor for wound control. Upon doppler ultrasound, a sign of deep vein thrombosis (DVT) was observed. Negative Pressure Wound therapy (NPWT) was used for wound bed preparation, Split Thickness Skin Graft (STSG) on the left foot was used as a dressing, while conventional dressing was chosen for the right foot. The graft take on the left foot with NPWT was 95%, while the one on the right foot with conventional dressing was 90%. Discussion: Negative pressure wound therapy (NPWT) is a closed system that applies negative pressure through continuous or intermittent suction. NPWT can be used in wound bed preparation to reduce biofilm. NNPWT helps in the removal of exudates from the wound, thus preventing the build-up of serous fluids and blood, reducing the growth of bacteria at the base of the wound, which helps tissue growth after split thickness skin graft (STSG). Conclusion: NPWT stimulates better healing after surgery. The left leg, which used NPWT after STSG had faster healing time and better aesthetic result by promoting graft take. The graft take on the left leg (with NPWT) was higher compared to the right leg.

Knowledge on the Risk Factors for Diabetic Foot Syndrome and Self-Foot Care Practices among Diabetic Patients at Muhimbili National Hospital in Dar es Salaam, Tanzania: A Cross-Sectional Study.

Background: Evidence indicates diabetic patients have more than 15 times increased risk of non-traumatic foot disabilities. Patients' knowledge of the potential risk factors and self-care practices anticipate better self-management. Objective: This study aimed to assess patients’ knowledge of the risk factors for diabetic foot syndromes and reported self-foot care practices at Muhimbili National Hospital. Methods: A hospital-based quantitative cross-sectional study design was conducted in June and December 2022. A random sampling technique was applied to recruit 140 diabetic patients at an outpatient clinic. The Guided Interview questionnaire was used to obtain data. Data were analyzed using SPSS version 25. Result: The reported history of foot ulceration was 42(30%). Participants did not identify Smoking 106 (78.4%), foot soring/fungus 101(72.1%), and toenail ingrowth 96(68.3%) as potential contributors/risks for foot ulceration. Participants 93(66.4%) had an Inadequate knowledge score on the risk factors for Diabetic Foot Syndrome. The gender(male) (AOR: 3.71, 95%CI, 1.513-9.114, P=0.004169), education (secondary level) (AOR: 0.179, 95%CI: 0.045-0.70, P=0.0139), and history of foot ulceration (have not experienced foot ulcer) (AOR: 5.5, 95%CI: 2.14-14.165, P=0.000403) were significant associated to Inadequate knowledge score. Washing the foot with warm water and drying between the toes [daily] 84(60.4%) received poor response. Of the participants, 97(69.3%) had Good self-foot care practices. The duration of Diabetic illness (more than five months and less than one year) (AOR: 19.025, 95%CI: 2.716-133.293, P=0.003) and history of foot ulceration (have not experienced foot ulcer) (AOR: 3.377, 95%CI: 1.218-9.366, P=0.019) were significantly associated to Poor self-foot care practices. Conclusion: The finding reveals inadequate knowledge of risk factors for diabetic foot syndromes and poor self-care practices. It gives insight into the respective authorities to develop a comprehensive rehabilitative therapy, focusing on foot health education and addressing every aspect affecting their quality of life.

Differences in characteristics between first-ever foot ulcer and recurrent foot ulcer in patients with diabetes: Prospective observational study.

More effective preventive care can potentially be provided if the characteristics of both the first ever and the recurrent foot ulcers can be clarified. The purpose of this study was to characterize first ever and recurrent foot ulcers in diabetic patients. This study was conducted as a secondary analysis of a prospective study that was entitled: "Factors associated with the discontinuation of wound care specialist clinic visits in patients with diabetic foot ulcers." In 73 diabetes-related foot ulcer patients who visited one wound clinic in Indonesia between August 2020 and February 2021, we investigated characteristics of the patients and wounds, healing period, and cost. Trauma was shown to be the primary cause of the diabetic foot ulcer in both the first ever foot ulcer (n = 48) and recurrent foot ulcer (n = 25) patient groups (95.8% and 100.0%, respectively). The DMIST score for the first ever foot ulcer patients was significantly higher than the DMIST score for the recurrent foot ulcers. This was found to be especially the case in the first ever foot ulcer patients, as not only were there signs of inflammation (45.8%), but there were also signs of local infection (35.4%), or osteomyelitis and signs of local infection (14.6%) present. In the eightfirst ever foot ulcer patients and in the ninerecurrent ulcer patients who were able to be followed through complete healing, the costs found for the first ever foot ulcer patients were significantly higher as compared to the costs for the recurrent foot ulcer patients. To avoid diabetes-related foot ulcers, specialized educational programs on trauma prevention need to be established. Moreover, patients without diabetes-related foot ulcer histories should be educated regarding the need to undergo early consultations before developing any infections.

IJCM_121A: Assessment of risk of foot ulcer in patients with diabetes according to the risk classification consensus of International Working Group on Diabetic Foot (IWGDF) in Ernakulam District, Kerala; a community based cross sectional study

Background: The International Diabetes Federation states that India accounts for 1 in 7 of all adults living with diabetes worldwide. Diabetic foot disease is among the most serious complications of diabetes mellitus as it is a source of major suffering and financial burden for the patient, healthcare professionals and the society in general. The leading cause of lower-limb amputations is diabetes and 40%–85% of these are preventable Objective: Assessment of diabetic foot ulcer risk factors according to International Working Group on the Diabetic Foot (IWGDF) consensus. Methodology: A community based cross-sectional study was done in Ernakulam district involving 600 individuals with diabetes mellitus. The study gathered information on sociodemographic factors, anthropometric details and a detailed foot examination was performed with a IWGDF checklist. The collected data were entered into MS Excel, and the analysis was carried out using SPSS 21.0. Results: Mean age of patients in the study was 61.48 yrs±10.24 years.371 patients (61.83%) were females and 229(38.17%) were males.108 patients (18%) had disturbed sense of vibration (128 Hz). 90 patients (15%) had decreased sensitivity to 10-gram monofilaments. Peripheral arterial disease was present in 47 patients (7.83). 20 patients (3.33%) had history of previous ulcer. 11(1.83%) patients had lower extremity amputation. Patients were classified into four risk groups according to IWGDF criteria. Four hundred and fifty-five patients (75.83%) were in group 0, fifty-five patients (9.1%) in group 1, sixty-six patients (11%) in group 2 and twenty-four patients (4%) in group 3 of IWGDF criteria Conclusion: Routine foot examination in patients with diabetes as per IWGDF guidelines for each risk category will help in prevention of diabetic foot ulcers.

Risk Factors and Frequency of Foot Ulceration in Patients Receiving Chronic Hemodialysis Treatment.

To determine the prevalence and risk factors of foot ulceration in patients receiving hemodialysis treatment. A total of 180 patients who received hemodialysis treatment in two state hospitals and a private health center between April 2017 and September 2017 were included in the study. The researchers collected data using a patient information form and by conducting physical evaluation of the lower extremities. They used the diabetic foot risk assessment algorithm to classify risk according to the data obtained. Of the patients receiving hemodialysis treatment, 6.7% had foot ulceration, 19.4% had a history of foot ulceration, and 8.3% had a history of hospitalization associated with ulceration in a lower extremity. Infected foot ulceration was the most common (6.1%) cause of hospitalizations. In the group with current or past foot ulceration, diabetic nephropathy was the most common etiologic factor of end-stage kidney disease (48.6%); there was a significant between-group difference in diabetic nephropathy (P < .05). Etiologic factors had a significant effect on foot ulcerations: As determined by univariate logistic regression, diabetes (odds ratio [OR], 2.727; P < .05), presence of neuropathy (OR, 4.208; P < .05), low-density lipoprotein cholesterol (OR, 1.013; P < .05), and serum albumin (OR, 0.302; P < .036) all had a statistically significant effect on the presence of foot ulcerations. Patients receiving hemodialysis treatment are at high risk for foot ulceration. Therefore, patient awareness strategies should be expanded to include individuals with end-stage renal disease regardless of diabetes status. Clinical and dialysis nurses should educate these patients about foot ulcerations and foot health to prevent ulcer development.

Characterization of orofacial features in sclerodermatous chronic graft-versus-host disease.

Chronic graft-versus-host disease (cGVHD) is a leading cause of morbidity and mortality following allogeneic hematopoietic cell transplantation (alloHCT). The sclerodermatous form of cGVHD can be particularly debilitating; however, orofacial sclerodermatous involvement remains poorly described. To characterize orofacial features of sclerodermatous cGVHD in a single center cohort of patients who underwent alloHCT. Retrospective data were collected from electronic medical records and analyzed descriptively. There were 39 patients who received alloHCT between 1993 and 2017 and developed orofacial sclerodermatous cGVHD. Concomitant cutaneous sclerodermatous cGVHD was common (n = 20, 51%). Orofacial sclerodermatous cGVHD features included fibrous bands of the buccal mucosa (n = 23, 59%), limited mouth opening (n = 19, 54%), perioral fibrosis (n = 8, 21%), and focal gingival recession (n = 4, 10%). Oral mucosal fibrosis was observed at the site of active or resolved chronic lichenoid inflammation in 30 patients, with all but two also presenting with a history of ulcerations. Management included jaw stretching exercises (n = 10; 6 stable/improved), surgery (n = 3; 2 improved), and intralesional corticosteroid injections (n = 2; 2 improved). Orofacial involvement with sclerodermatous cGVHD can present with multiple manifestations including fibrous banding, limited mouth opening, perioral fibrosis, and focal gingival recession. Surgical and non-surgical management strategies may improve clinical function and reduce morbidity.

Out-of-pocket expenditure among patients with diabetic foot ulcer in a tertiary care hospital of south India: A cross-sectional study.

Diabetic foot ulcer is a debilitating complication of long-standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out-of-pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital-based cross-sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out-of-pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650-₹81 120) ($378.14 [$122.56-$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non-medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non-medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden.

Successful use of platelet-rich plasma as a regeneration technique for a non-healing diabetic leg ulcer with chronic osteomyelitis: A case report

Chronic diabetic leg ulcers can be challenging to manage, particularly when osteomyelitis coexists resulting in serious or even life-threatening conditions if not managed appropriately. Such cases require very long periods of treatment with several debridements, antibiotic bead implants, skin grafts or even amputations in many unfortunate cases. Despite that, conventional management appears to be inadequate with poor outcomes and a higher relapse rate. We report a case of a 26-year-old type 1 diabetic female patient presented with a history of non-healing diabetic leg ulcer complicated by chronic osteomyelitis of the left leg. Several wound debridements were performed with the application of vacuum-assisted closure, and culture-guided antibiotics were given. However, only minimal improvements were observed. Eventually, the leg was labeled as an unsalvagable limb due to poor blood supply based on an ankle-brachial index. Platelet-rich plasma (PRP) was tried showing promising results and significant improvement as confirmed by a gallium scan, which showed evidence of osteomyelitis remission. Two months later, the patient improved significantly with the ulcer healed and the osteomyelitis resolved. Autologous PRP promotes wound healing by providing necessary growth factors, reducing inflammation, and showing bactericidal activity. All efforts must be taken to preserve any limb before labeling it non-salvageable. This case report aimed to draw attention to the method that can be implemented to manage non-healing diabetic leg ulcers complicated by chronic osteomyelitis.

Impact of foot functionality in patients with systemic sclerosis: Cross-sectional study

BackgroundProgressive systemic sclerosis or systemic scleroderma (SS) is a chronic and rare autoimmune disease that mainly affects the skin and various internal organs. Raynaud's phenomenon and digital ulcers are some of the symptoms that affect the foot, causing a decrease in the quality of life of patients. The objective of this study is to determine the functionality of the feet in patients with SS and determine the impact on their daily lives. MethodsA sample of 165 patients (154 women, 11 men) diagnosed with SS with a mean age of 46.29 ± 11.36 years and a mean body mass index (BMI) of 24.90 ± 5.77 was recruited. Each participant completed the Foot Function Index (FFI) questionnaire and the Systemic Sclerosis Questionnaire (SySQ). A multivariate analysis was performed to determine which factors were related to a higher score in both questionnaires. Results32.1% of the participants (n = 53) had claw toe deformities, 79.4% (n = 131) Raynaud's disease and 20% (n = 33) a history of foot ulcers. 51.5% of the participants (n = 85) presented symptoms in their nails, the most frequent sign being thickening, hardening and yellow coloration. The final score of the FFI questionnaire was 3.51 ± 2.41 (0–9.9), the pain subscale being the highest, with a score of 5.06 ± 2.75, followed by foot disability (3.26 ± 2.91) and difficulty performing activities (1.55 ± 2.22). The final score of the SySQ questionnaire was 0.95 ± 0.45 (0.18–2.45), and the subscales with the highest score were symptom frequency (1.30 ± 0.47), symptom intensity (1.11 ± 0.55), and general skill limitation (0.47 ± 0.51). A high correlation was observed between the final FFI score and the final SySQ score (r = 0.712; p=<0.001). Also, between foot activity limitation and general skill limitation (r = 0.658; p=<0.001). A moderate correlation was observed between foot pain score and overall symptom intensity (r = 0.482; p=<0.001). Also, between foot disability and overall symptom frequency (r = 0.556; p=<0.001). The multivariate analysis (R2 0.51) showed that the final FFI score had a significant relationship with the final SySQ score (p < 0.001). No significant correlation was found between age (p = 0.15), gender (p = 0.49), BMI (p = 0.74) or time of diagnosis (p = 0.57) and FFI. ConclusionSS is a disease that affects foot functionality in patients, with a greater impact on the pain scale. There is a correlation between the final FFI score and the final SySQ score, so improving foot functionality could help to improve the overall functionality of the patient with sclerosis.

Clinical characteristics and risk factors associated with bone erosion in patients with tophi

IntroductionIf a large amount of urate crystals is deposited in a joint cavity for an extended period of time, bone erosion will occur and gradually cause skeletal muscle necrosis and joint deformity. The aim of this study was to describe the clinical characteristics and factors associated with bone erosion in gout patients with tophi.MethodsA total of 210 gout patients with tophi were enrolled and divided into a bone erosion group (n = 135) and a non-bone erosion group (n = 75). Digital radiography (DR) was performed to detect bone erosion in the elbow, wrist, knee, ankle joints, interphalangeal and metatarsophalangeal joints. The clinical characteristics were recorded and compared between the two groups. Multivariate logistic regression analysis was conducted to explore the factors associated with bone erosion.ResultsCompared with the non-bone erosion group, the bone erosion group had an older age, longer disease duration of gout and tophi, higher level of serum creatinine (sCr), higher proportion of drinking history and ulceration, and a lower glomerular filtration rate (GFR). Univariate logistic regression analysis results showed that sex, age, body mass index (BMI), gout duration, tophi duration, GFR, white blood cell (WBC) count, sCr level, smoking history, drinking history, and presence of ulceration were associated with bone destruction. Multivariable logistic regression analysis results indicated that tophi duration, drinking history, ulceration and sCr were positively and independently related to bone erosion.ConclusionsTophi patients with bone erosion presented different clinical characteristics. Tophi duration, drinking history, ulceration and sCr were associated with bone erosion in gout patients with tophi.

The global gastric cancer consortium: an update from the Stomach cancer Pooling (StoP) project.

We updated to December 2023 the main findings of the stomach cancer pooling (StoP) project including about 13 000 cases and 31 000 controls from 29 case-control and 5 nested studies. The StoP project quantified more precisely than previously available the positive associations of tobacco smoking, high alcohol consumption, meat intake, selected occupations (e.g. agricultural and miners), gastric ulcer and family history with gastric cancer and the inverse associations with socioeconomic status and selected aspects of diet (fruits, including citrus fruits, vegetables, including allium and mushrooms, and polyphenols). No consistent associations were found with coffee, yoghurt and leisure-time physical activity, metformin or proton pump inhibitors use.

Adult‐onset BRAF V600E‐related multisystem Langerhans cell histiocytosis treated with vemurafenib

AbstractWe report a case of a 65‐year‐old female with 1‐year history of dental pain and oral ulcers. A diagnosis of Langerhans cell histiocytosis (LCH) was made by oral biopsy and CD207 (Langerin) stain, and BRAF V600E mutation was identified. PET/CT revealed an enhancing lesion in the hard palate with extension into the maxillary sinus. Chemotherapy with cytarabine failed, and LCH progressed to affect additional organ systems. Treatment with vemurafenib was started, resulting in a dramatic improvement of painful mucocutaneous ulcers since the first month of treatment. Vemurafenib is effective in children with refractory BRAF V600E‐mutated LCH, and recent data support the use of vemurafenib in adults with refractory multisystem LCH harbouring the same mutation.