Numbness In Feet Research Articles

Prevalence of somatic symptoms among Ebola Virus Disease (EVD) survivors in Africa: a systematic review and meta-analysis

BackgroundMany Ebola virus disease (EVD) survivors have reported somatic and neuropsychological symptoms after discharge from the Ebola Treatment Unit (ETU). Since the 2014–2016 Ebola epidemic in West Africa, various studies have investigated and identified these symptoms. Evidence on somatic symptoms is widely available in the literature, however, there is no concise overview of the prevalence across different time intervals.MethodsThis meta-analysis was conducted following the (PRISMA) guidelines. A database search was conducted to identify original studies that reported the prevalence of symptoms. The primary outcome measure was the prevalence rate of several somatic symptoms. Results were pooled, and prevalence rates were assessed over time, to elucidate any particular trends.ResultsWe included 23 studies (5,714 participants). The pooled prevalence was: arthralgia 50% (95% CI: 41%-59%); headache 44% (95% CI: 36%-52%); myalgia 32% (95% CI: 26%-38%); abdominal pain 27% (95% CI: 15%-39%); fatigue 25% (95% CI: 19%-31%); numbness of feet 16% (95% CI: 14%-18%); numbness of hands 12% (95% CI: 10%-14%) and hearing loss 9% (95% CI: 5%-12%). Prevalence across different time intervals revealed significant patterns. All the symptoms persisted for more than 2 years after discharge except for abdominal pain.ConclusionThe pooled prevalence rates of somatic symptoms are notably high. Arthralgia and headache are the most prevalent of the symptoms, with hearing loss and numbness in hands and feet being the least. We found that arthralgia, myalgia, and abdominal pain decreased over time. However, headache, fatigue, numbness of hands and feet, and hearing loss increased over time.

Prediction models of persistent taxane-induced peripheral neuropathy among breast cancer survivors using whole-exome sequencing

Persistent taxane-induced peripheral neuropathy (TIPN) is highly prevalent among early-stage breast cancer survivors (ESBCS) and has detrimental effect on quality of life. We leveraged logistic regression models to develop and validate polygenic prediction models to estimate the risk of persistent PN symptoms in a training cohort and validation cohort taking clinical risk factors into account. Based on 337 whole-exome sequenced ESBCS two of five prediction models for individual PN symptoms obtained AUC results above 60% when validated. Using the model for numbness in feet (35 SNVs) in the test cohort, 73% survivors were correctly predicted. For tingling in feet (55 SNVs) 70% were correctly predicted. Both models included SNVs from the ADAMTS20, APT6V0A2, CCDC88C, CYP2C8, EPHA5, NR1H3, PSKH2/APTV0D2, and SCN10A genes. For cramps in feet, difficulty climbing stairs and difficulty opening a jar the validation was unsuccessful. Polygenic prediction models including clinical risk factors can estimate the risk of persistent taxane-induced numbness in feet and tingling in feet in ESBCS.

The Relationship between Numbness and Quality of Life.

Numbness is a term commonly used in clinical practice to describe an abnormal sensory experience that is produced by a stimulus or is present even without a stimulus. However, there is still much that remains obscure in this field, and also, few reports have focused on its symptoms. In addition, while pain itself is known to have a significant impact on quality of life (QOL), the relationship between numbness and QOL is often unclear. Therefore, we conducted an epidemiological survey and analyzed the relationship between painless numbness and QOL, using type, location, and age as influencing factors, respectively. A nationwide epidemiological survey was conducted by mail using a survey panel designed by the Nippon Research Center. Questionnaires were sent to 10,000 randomly selected people aged 18 and over from all over Japan. Out of the 5682 people who responded, the relationship between numbness and QOL was analyzed using the EuroQol 5 Dimension-3L (EQ5D-3L) for patients who are currently experiencing painless numbness. The results suggest that painless numbness affects QOL and that QOL decreases as its intensity increases. Furthermore, the two factors of numbness of feet and numbness among the young may be less likely to affect QOL. This study may be of great significance in the field of numbness research.

Acute uremic polyneuropathy in a patient with Alzheimer’s disease

The article presents a case of acute uremic neuropathy. Without any visible cause, a 71-year-old patient felt weakness in legs and numbness in feet. Her neurological status assessment on admission to the hospital showed peripheral tetraparesis and impaired sensitivity of the polyneuropathic type. Neurological symptoms appeared due to renal dysfunction, which had been confi rmed with laboratory test. Electroneuromyography revealed signs of acute demyelinating polyneuropathy. Аt the hospital, the patient was diagnosed Alzheimer’s disease. The treatment provided at the hospital led to normalization of her laboratory parameters and complete restoration of motor functions. The peculiarity of the presented clinical case is that the patient started violating drinking regime due to her cognitive impairment which resulted in renal dysfunction and acute uremic neuropathy. The other peculiarity of the case is that it was enough to correct the water-electrolyte disorders to fully restore the patient’s motor functions within a month, without the use of dialysis. Finally, the article discusses the issue of pathogenesis and diff erential diagnosis of other types of polyneuropathies.

172P Prediction of persistent taxane-induced peripheral neuropathy among early-stage breast cancer survivors using whole-exome sequencing

Persistent taxane-induced peripheral neuropathy (TIPN) among early-stage breast cancer survivors (ESBCS) is common and impacts quality of life. We aimed to explore genetic variants as risk factors. A population-based cohort of 884 residual-free ESBCS in Sweden were sent the EORTC chemotherapy-induced PN (CIPN20), 342 agreed to additional whole-exome sequencing for prediction modelling. Analysis focused on the symptoms tingling and numbness in feet, cramps in feet, difficulty opening a jar and difficulty climbing stairs since these showed highest relative risks compared to controls in our previous studies1 and are of clinical importance (under review). The raw sequencing data was aligned to the human reference genome (GRCh38), quality controls according to standard guidelines using the Genome Analysis Toolkit. The final filtered set included 55150 common genetic variants (MAF ≥ 1%). We adjusted for age, taxane, cumulative dose, time since treatment, BMI, and diabetes mellitus. Prediction models (logistic regression) were based on the single-nucleotide variants (SNVs) and insertions/deletions (INDELs) associated with TIPN in a training set of 70% of the ESBCS (N=237) with planned subsequent validation of the remaining 30%. P-value thresholds for permutations with 50-80% false discovery rates (FDR) was ≤ 0.000875, ≤ 0.001125, ≤ 0.001125, ≤ 0.0005, and ≤ 0.0005 for numbness feet, tingling feet, cramps feet, difficulty opening a jar, and difficulty climbing stairs. Using these thresholds 71, 79, 69, 33, and 46 genetic variants were identified representing in total 282 unique variants. Prediction models developed, reaches a max accuracy of 70-90% (Table).Table: 172PAccuracySensitivitySpecificityNumbness feet79,15%52,46%88,51%Tingling feet80,85%41,27%95,35%Cramps feet75,32%31,94%94,48%Diff opening jar77,64%13,79%98,32%Diff climbing stairs90,72%32,14%98,56% Open table in a new tab Genetic prediction models of persistent TIPN may indicate a genetic risk, which could contribute to more individualised adjuvant treatment decisions. Further analysis is needed and ongoing. 1Engvall BJC 2021.

P046 A rare case of peripheral T cell lymphoma presenting as peripheral neuropathy & myositis

Abstract Background/Aims Peripheral T cell Lymphomas are a heterogeneous group of very aggressive and rare lymphomas in the western world accounting for 5% to 15% of non-Hodgkin lymphomas. Inflammatory myositis and nephropathy associated with hematological malignancies are extremely rare. Methods A 64-year-old gentleman presented with progressive neuropathy with pain and numbness in feet, clawing in both hands, muscle weakness and wasting. He also noticed a rash in his groin and scrotum (erythematous) and new erectile dysfunction along with Raynaud’s, dry eyes, and unintentional weight loss over a year. His paternal uncle suffered from peripheral neuropathy. He had splinter hemorrhage and telangiectasia on general examination. Neurological examination revealed clawing of hands, muscle wasting in his hands and legs in distribution of right median, ulnar, left radial, bilateral sural and bilateral peroneal nerve. Results He had normal routine blood tests (FBC, U&Es and LFTS and CRP). Rheumatology work up revealed CK of 204, LDH 317, ANA 1: 640 titre, negative ENA, dsDNA, ANCA, RF, anti CCP antibodies, myositis blot, normal C3, C4, protein electrophoresis, IgG sub classes and negative para neoplastic screen including anti Ri, anti Yo and anti Hu and a negative urine dip for blood or proteins. Echocardiogram revealed small pericardial effusion. PET scan showed markedly avid lesion in ascending colon proven to be low-grade tubulovillous adenoma on biopsy. MRI of thighs showed inflammatory change consistent with myositis and nerve conduction studies has revealed mono neuritis multiplex. Peroneal nerve biopsy showed small vessel lymphocytic vasculitis followed by skin biopsy of thigh and shin consistent with features of lymphocytic vasculitis and angiocentric NK cell lymphomatous changes. On the bases of his presenting symptoms and investigations, he was treated with 60mg of oral prednisolone and pulsed cyclophosphamide at dose of 15mg /kg for 6 cycles for multisystemic inflammatory condition causing mono neuritis multiplex and myositis. His cyclophosphamide was stopped after 4 cycles as there was no response to treatment and MDT review confirmed that skin and nerve biopsies features were consistent with peripheral T cell lymphoma. Further treatment was with CH(O)P (minus vincristine) under the care of oncologists. Conclusion Peripheral T cell lymphoma (PTCL) is a rare and aggressive heterogeneous group of lymphomas. Risk factors include family history of hematological malignancies and smoking. Rashes may be the antecedent finding in about 20% to 50% of angioimmunoblastic T cell lymphoma patients, with skin manifestations ranging from urticarial lesions to nodular tumor. Patients with cutaneous T cell lymphomas often present with “chronic dermatitis” which is resistant to therapy, early-stage having a predilection for folds and non-exposed sun areas. Cancer associated inflammatory myopathies are rare syndromes occurring in 10%-30% of all malignancies and inflammatory myopathies associated with hematological malignancies are even rarer entities. Disclosure M. Ashraf: None. J. David: None.

Dedifferentiated chordoma: a case report of a rare subtype of chordoma

Chordoma is a malignant tumour showing notochordal differentiation with three identified subtypes including chordoma not otherwise specified, chondroid chordoma and dedifferentiated chordoma. Dedifferentiated chordoma is rare and carries the worst prognosis of all subtypes due to rapid progression and potential for metastases. It is characterized by a high-grade sarcomatous component juxtaposed to conventional chordoma. We report a case of a dedifferentiated chordoma in a 71 year old woman who presented with pain in the lower back, numbness of feet and loss of weight of recent onset. Per-rectal examination revealed a soft tissue mass in the presacral region while imaging showed a solid and cystic lesion with calcifications in the presacral region. The radiological impression was of a retro rectal cystic hamartoma, an epidermoid cyst, or a chronic abscess. The resected specimen comprised a lobulated mass of soft, gelatinous tissue with haemorrhage and necrosis. Microscopy showed a biphasic tumour composed of conventional chordoma juxtaposed with high-grade sarcomatous component. Morphology and immunohistochemistry were compatible with a chordoma with a focal high-grade spindle cell sarcomatous component in keeping with a dedifferentiated chordoma.

A 4-year follow-up of non-freezing cold injury with cold allodynia and neuropathy in 26 naval soldiers.

Background and aims Non-freezing cold injuries (NFCI), which typically may occur in military personnel, may result from exposure to cold, at temperatures around 0 °C or above, and worsened by wind and moisture. The injury is due to cooling but not freezing of tissue like in frostbite. NFCI may result in in chronic neuropathy and cold hypersensitivity. A recent retrospective study of small-and large fibres has suggested that NFCI results in neuropathic pain due to a sensory neuropathy and question a longitudinal study to verify a possible observation of improvement of NFCI over time. The present study is a 4-year follow-up investigation of large - and small-fibre function in 26 naval cadets and officers who were exposed to cold injury during the same military expedition. Methods The 26 soldiers were investigated clinically (with investigation of motor function, reflexes, sensibility), with nerve conduction studies (NCS) of major nerves in upper- and lower extremity, small fibre testing (QST, measurement of thermal thresholds), measurements of subcutaneous fat tissue and maximal O2 uptake. Investigations found place 2 months following the actual military expedition, with follow-up investigations of affected soldiers at 6-12 months and up to 3-4 years. In order to elucidate possible mechanisms (disinhibition of cold pain by myelinated nerve fibres) of cold allodynia, cold pain thresholds were measured following an ischemic block of conduction of large and small myelinated nerve fibres. Results Of 26 soldiers, 19 complained of numbness in feet and a large majority of 16 of cold hypersensitivity 2 months following injury. There were significant alterations of both large- and small-fibre function, indicating a general large- and small-fibre neuropathy. The most prominent finding was a pronounced cold allodynia, inversely correlated with the amount of subcutaneous fat. During the first year, results of NCS and thermal testing gradually normalized in most. Seven soldiers developed chronic symptoms in the form of cold hypersensitivity and with findings of cold allodynia, which was not further enhanced, but abolished following block of conduction of myelinated nerve fibres. Seven soldiers were free of symptoms from that start of the investigation, probably because they had been more eager to keep their legs moving during the exposure to cold. Conclusions Of a total of 26 soldiers, only seven developed chronic symptoms of cold hypersensitivity, corresponding to the finding of cold allodynia by thermal testing. The cold allodynia may not be explained by disinhibition of cold pain by myelinated fibres as in healthy subjects. A large majority recovered from an initial large-and small fibre neuropathy, demonstrating that recovery from NFCI may occur. Implications Although large-and small fibre neuropathy may be restored following cold injury, there is a risk of a permanent and disabling cold hypersensitivity, corresponding to the findings of cold allodynia. It is of uttermost importance to secure military personnel from the risk of cold injuries. It seems important to avoid immobilisation of extremities during exposure to cold.

Self-Reported Ache, Pain, or Numbness in Feet and Use of Computers amongst Working-Age Finns.

The use of the computers and other technical devices has increased. The aim of our work was to study the possible relation between self-reported foot symptoms and use of computers and cell phones using a questionnaire. The study was carried out as a cross-sectional study by posting a questionnaire to 15,000 working-age Finns. A total of 6121 responded, and 7.1% of respondents reported that they very often experienced pain, numbness, and aches in the feet. They also often experienced other symptoms: 52.3% had symptoms in the neck, 53.5% in had problems in the hip and lower back, and 14.6% often had sleeping disorders/disturbances. Only 11.2% of the respondents thought that their symptoms were connected to the use of desktop computers. We found that persons with symptoms in the feet quite often, or more often, had additional physical and mental symptoms. In future studies, it is important to take into account that the persons with symptoms in the feet may very often have other symptoms, and the use of computers can influence these symptoms.

Long-term proton pump inhibitor therapy and falls and fractures in elderly women: a prospective cohort study.

Proton pump inhibitors (PPIs) are widely used in the elderly. Recent studies have suggested that long-term PPI therapy is associated with fractures in the elderly, however the mechanism remains unknown. We investigated the association between long-term PPI therapy ≥1 year and fracture risk factors including bone structure, falls, and balance-related function in a post hoc analysis of a longitudinal population-based prospective cohort of elderly postmenopausal women and replicated the findings in a second prospective study of falling in elderly postmenopausal women. Long-term PPI therapy was associated with increased risk of falls and fracture-related hospitalizations; adjusted odds ratio (AOR) 2.17; 95% CI, 1.25-3.77; p = 0.006 and 1.95; 95% CI, 1.20-3.16; p = 0.007, respectively. In the replication study, long-term PPI use was associated with an increased risk of self-reported falling; AOR, 1.51; 95% CI, 1.00-2.27; p = 0.049. No association of long-term PPI therapy with bone structure was observed; however, questionnaire-assessed falls-associated metrics such as limiting outdoor activity (p = 0.002) and indoor activity (p = 0.001) due to fear of falling, dizziness (p < 0.001) and numbness of feet (p = 0.017) and objective clinical measurement such as Timed Up and Go (p = 0.002) and Romberg eyes closed (p = 0.025) tests were all significantly impaired in long-term PPI users. Long-term PPI users were also more likely to have low vitamin B12 levels than non-users (50% versus 21%, p = 0.003). In conclusion, similar to previous studies, we identified an increased fracture risk in subjects on long-term PPI therapy. This increase in fracture risk in elderly women, already at high risk of fracture, appears to be mediated via increased falls risk and falling rather than impaired bone structure and should be carefully considered when prescribing long-term PPI therapy.

Impact of dose modification on intravenous bortezomib-induced peripheral neuropathy in multiple myeloma patients.

Patients discontinue bortezomib treatment despite good response to the therapy because of bortezomib-induced neuropathy. Early and active dose reduction is recommended for efficacy of treatment. This study evaluates patterns of bortezomib-associated neuropathy and examines the effectiveness of dose modification on symptom management and treatment compliance. This is a retrospective cohort study of multiple myeloma patients who received bortezomib intravenously from 2009 to 2012 at Samsung Medical Center, Seoul, Korea. Peripheral neuropathy was assessed using neurotoxicity subscale of the FACT/GOG-Ntx at daily clinical practice; physicians modified the dosage and schedule of bortezomib treatment. Mixed-effect models were used for evaluating changes of neuropathy symptoms over time. Linear spline models and multivariate logistic regression were used for testing the effectiveness of interventions. There were 1,060 visits of 55 multiple myeloma patients during the study period. Patients were most likely to have numbness of feet, painful burning in feet, muscle weakness, and the symptoms worsened over time (P < 0.05). For patients who received intervention (n = 32, 58.1 %), neuropathy symptoms were significantly decreased after the intervention (coefficient, -0.1 (95 % confidence interval (CI), -0.8, 0.6)). The intervention group had on average 5.19 (95 % CI, 3.79, 6.59) more bortezomib administrations and was 1.4 times more likely to complete the treatment (odds ratio, 1.40 (95 % CI, 0.31, 6.32)) than the nonintervention group. Close monitoring of peripheral neuropathy in patients receiving bortezomib is a feasible and useful way to manage neuropathy in the real world.

Neurophobia among medical students and non-specialist doctors in Sri Lanka

BackgroundNeurophobia is the fear of neurosciences held by medical students and doctors. The present study aims to identify whether Neurology is considered a difficult subject by medical students and non-specialist doctors from Sri Lanka and evaluate reasons for such perceived difficulties.MethodsThe study was conducted from May-June 2008. One hundred non-specialist doctors from the Colombo South Teaching Hospital and 150 medical students from the University of Sri Jayewardenepura were invited for the study. Data were collected by a pre-tested expert-validated self-administered questionnaire, designed to assess the degree of perceived difficulty, confidence, interest and knowledge of Neurology as compared to other subjects. It also evaluated reasons and probable strategies to overcome the perceived difficulties and/or lack of interests.ResultsAll non-specialist doctors and 148 medical students responded to the questionnaire (response rate–99.2%). The most favourite subject among medical students and non-specialist doctors were Cardiology and Endocrinology respectively, while Neurology was ranked third. In all participants the current level of interest was most for Cardiology (3.52±1.36), while Neurology was the least interesting specialty for majority of medical students (18.5%) and non-specialist doctors (25.0%). The current level of knowledge among medical students was most for Cardiology (3.12±0.86), while Neurology (2.53±0.96) was ranked fifth. The most difficult specialty for majority of medical students (50.0%) and non-specialist doctors (41.7%) was Neurology. All the participants were least confident when dealing with patients with headache (2.20±0.81), numbness of feet (2.07±0.79) and dizziness (2.07±0.78) when compared to dealing with other non-neurological complaints. The commonest reasons ‘why Neurology was felt to be a difficult subject’ were; the need to know basic neuro-anatomy and having a complex clinical examination. Participants’ felt that clinical/hospital based teaching (3.49±0.65), case discussions (3.45±0.68) and teaching aids (3.10±0.89) would be the most important teaching strategies to improve their competency in Neurology.ConclusionNeurology is considered a difficult subject by undergraduates and non-specialist doctors of Sri Lanka. The main reason for the perceived difficulty was the lack of understanding of basic sciences and deficiencies in clinical teaching. This lack of confidence could have a significant impact on patient care.

Common Sleeping Related Problems and Illnesses of Persons who Stayed within Geopathic Stress Zone

The study attempted to determine the common sleeping related problems and illnesses among persons who stayed for a period of time within geopathic stress (GS) zone. This descriptive research was conducted in November 2008 to April 2009 among conveniently and purposely selected home and office occupants in the third district of the province of Iloilo, Philippines who after having been surveyed using the Y-rod dowsing tool were found exposed within GS zone. The study used a self-made data gathering instrument based on several internet published theories and researches on problems and illnesses indirectly caused by GS. The study revealed that persons who stayed by seating or sleeping with their parts of bodies exposed within GS zone for a period of time commonly experienced the following: (a) Seating: Frequent waking with feeling of tiredness, tingling and numbness of feet, fatigue in the morning and restless sleep; Migraine, rheumatism, nervousness and high blood. (b) Heads: Insomnia, frequent waking with feeling of tiredness and fatigue in the morning; Migraine, nervousness, and demonic attacked. (c) Chests: Tingling and numbness of hands, frequent waking with feeling of tiredness, insomnia and fatigue in the morning; Cardiovascular circulation problem, asthma, and migraine. (d) Abdomens: Tingling and numbness of feet, insomnia and fatigue in the morning; Rheumatism, migraine, and nervousness. (e) Extremities: Tingling and numbness of feet, insomnia and fatigue in the morning; Arthritis, migraine, and nervousness.

Zangfu zheng (patterns) are associated with clinical manifestations of zang shang (target-organ damage) in arterial hypertension

Abstract Background Hypertension is a clinical condition that manifests target-organ damage (TOD) with symptoms. This study investigates the association between Zangfu patterns and symptomatic manifestations of TOD. Methods Datasets with manifestations of Zangfu patterns (Liver-fire blazing upwards; Kidney-yin deficiency and Liver-yang rising; obstruction of phlegm and dampness of Heart/Liver/Gallbladder; qi and blood deficiency leading to Liver-yang rising; Kidney-yin/yang deficiency) and TODs (cerebrovascular, heart and kidney) were compiled from literature. The Pattern Differentiation Algorithm was used to test and to determine diagnostic accuracy with these datasets. A questionnaire was developed from datasets and applied to 43 subjects newly diagnosed with hypertension. Pattern differentiation was performed and the results were statistically analyzed for association between descriptions of patterns and TOD. Results The observed diagnostic accuracy, sensitivity and specificity were 98.0%, 96.2% and 99.8% respectively. Similarity between patterns and TOD datasets was mostly negligible. Twelve manifestations demonstrated high prevalence, namely red tongue (81.4%), headache (72.1%), irritability (67.4%), palpitation (60.5%), blurred vision, insomnia and mental fatigue (58.1%), frequent nocturnal urination, numbness in feet and hands, shortness of breath (55.8%), and heavy limbs sensation, wiry pulse (51.2%). No significant association was found between blood pressure variables (systolic, diastolic, mean, pulse pressure) and manifestations. Conclusion Zangfu patterns are associated with clinical manifestations of TOD. Manifestations associated patterns indicate morbid conditions to be secondary to hypertension rather than simple blood pressure.

Left Leg Pain- Basketball

HISTORY: 21 yo male collegiate basketball player presents to the team physician with complaints of anterior left leg pain for 1 month. One week into his pain he states he noticed an area of swelling on his shin. He experiences pain only when jumping and landing in basketball. He is pain free with jogging, weightlifting and daily activities. He denies tingling or numbness in foot. PHYSICAL EXAMINATION: Muscular African-American male. Tenderness and palpable area of induration over the anteromedial cortex of his left tibia. Mild pain with fulcrum test. Negative tuning fork test. Neurovascularly intact distally. DIFFERENTIAL DIAGNOSIS: 1.Stress fracture 2.Medial tibial stress syndrome 3.Chronic exertional compartment syndrome 4.Neoplasia: osteosarcoma TESTS AND RESULTS: X-ray: Periosteal elevation over anterior cortex of left tibia with a faint linear lucency extending perpendicularly MRI: Incomplete transverse stress fracture of the anterior mid-tibial diaphysis Vitamin D 25-OH total: 10 mg/ml (30-100 nl) Calcium, intact PTH: normal FINAL WORKING DIAGNOSES: 1) Anterior cortex tibial stress fracture, 2) Vitamin D Deficiency TREATMENT: 1.Player treated conservatively; non-weight-bearing to tall pneumatic brace to gradual return to play over four months. Started Vitamin D replacement-50,000 units twice weekly × 2 months, then maintenance dose. 2.One month after full return player admits a gradual return of pain. Re-imaging shows persistent radiolucent line. Vitamin D level is still deficient, player admits poor compliance. Player shut down for 2 weeks, bone stimulator, then gradual return to play. 3.Six months from initial presentation, pain and fracture line persist. Sent to surgeon, lateral compression plate surgically placed. FOLLOW UP: Patient was aggressively rehabbed and back in practice 8 weeks out from surgery when he jumped off his left leg, heard a crack, and fell. Player incurred comminuted tibia-fibula fractures at level of plate. Player underwent a second surgery with intramedullary nail placement in left tibia. Vitamin D levels remained slightly deficient, again due to poor compliance. At this time, the player is taking Vitamin D under direct observation in the training room. He is finishing rehabilitation and has returned to sport.

Evaluation of foot problems among diabetics in rural population

Diabetes is the most common metabolic disease encountered by a surgeon. A sound knowledge of symptomatology, clinical signs and etiology can prevent most of the disease burden and complications and thus reduce social burden. The study tells about common foot problems among diabetes and correlates it with the awareness among people. The study aims to obtain an initial and representative data sample to identify the common pedal complications of diabetes mellitus and to provide an initial projection for the development of a podiatric foot health education program within the Hospital-Medical Centre Complex. 500 diabetic patients were examined of whom 52 had diabetic foot lesions. The symptoms, signs and grade of foot lesion were cross studied with duration, type and occupation of patient. Chi square test was performed and a probability value of p <0.05 was considered significant. The prevalence of diabetic foot in a hospital based rural diabetic population was observed to be 10.4%. Foot lesion were common in the age group 41-60 years. The most common symptom was numbness in foot ( 40.6%) and was more common in long duration diabetes, Type II diabetes and outdoor workers. Common foot deformity observed were callosities (54.6%) and Hallux valgus/ varus (28%). The least common was Charcot's deformity (3.6%). Ulceration (23%) and amputation (5.7%) were higher in outdoor workers. Wagner's grade 2 lesions were the most common foot lesion with diabetic foot. The questionare regarding knowledge, awareness and foot care showed. 99.8% did not inspect the feet properly and 74% washed their feet properly.

腰部つい間板ヘルニアの手術成績 固定，非固定群の比較について

The clinical foil-up of 66 patients was obtained by re-examination and 67 patients by questionnaires. They were followed more than minimum of three years after surgery. The over-all clinical results were as follows: forty-seven patients (71.2per cent) excellent, twelve patients (18.1per cent) good, six patients (9.1per cent) fair and one patient (1.5per cent) poor.Of thirty-four patients without fusion, 97per cent were satisfactory. On the other hand, of thirty-two patients with fusion, 81per cent achieved excellent and good results. The incidence of fair and poor results, caused by residual low back pain and numbness of foot, was greater in the fusion group than in the non-fusion group.The relationship between the clinical results and roentgenographic changes was not significant.