Small Foot Research Articles

Prenatal diagnosis of recurrent Kagami–Ogata syndrome inherited from a mother affected by Temple syndrome: a case report and literature review

BackgroundKagami–Ogata syndrome (KOS) and Temple syndrome (TS) are two imprinting disorders characterized by the absence or reduced expression of maternal or paternal genes in the chromosome 14q32 region, respectively. We present a rare prenatally diagnosed case of recurrent KOS inherited from a mother affected by TS.Case presentationThe woman’s two affected pregnancies exhibited recurrent manifestations of prenatal overgrowth, polyhydramnios, and omphalocele, as well as a small bell-shaped thorax with coat-hanger ribs postnatally. Prenatal genetic testing using a single-nucleotide polymorphism array detected a 268.2-kb deletion in the chromosome 14q32 imprinted region inherited from the mother, leading to the diagnosis of KOS. Additionally, the woman carried a de novo deletion in the paternal chromosome 14q32 imprinted region and presented with short stature and small hands and feet, indicating a diagnosis of TS.ConclusionsGiven the rarity of KOS as an imprinting disorder, accurate prenatal diagnosis of this rare imprinting disorder depends on two factors: (1) increasing clinician recognition of the clinical phenotype and related genetic mechanism, and (2) emphasizing the importance of imprinted regions in the CMA workflow for laboratory analysis.

PLANTAR STRUCTURES IN RELATION TO A STRAIGHT RETROGRADE HIND FOOT (RHF) NAIL INSERTED THROUGH A MIDLINE HEEL PAD APPROACH: A CADAVERIC STUDY

BackgroundRHF nail is an important tool for simultaneous ankle and subtalar joint stabilisation +/− fusion. Straight and curved RHF nails are available to use, but both seem to endanger plantar structures, especially the lateral plantar artery and nerve and Baxter's nerve.There is a paucity of literature on the structures at risk with a straight RHF nail inserted along a line bisecting the heel pad and the second toe (after Stephenson et al). In this study, plantar structures ‘at risk’ were studied in relation to a straight nail inserted as above.MethodsRe-creating real-life conditions and strictly following the recommended surgical technique with regards to the incision and guide-wire placement, we inserted an Orthosolutions Oxbridge nail into the tibia across the ankle and subtalar joints in 6 cadaveric specimens. Tissue flaps were then raised to expose the heel plantar structures and studied their relation to the inserted nail.ResultsThe medial plantar artery and nerve were always more than 10mm away from the medial edge of the nail, while the Baxter nerve was a mean 14mm behind. The lateral plantar nerve was a mean 7mm medial to the nail, while the artery was a mean 2.3mm away with macroscopic injury in one specimen. The other structures ‘at risk’ were the plantar fascia and small foot muscles.ConclusionLateral plantar artery and nerve are the most vulnerable structures during straight RHF nailing. The risk to heel plantar structures could be mitigated by making incisions longer, blunt dissection down to bone, meticulous retraction of soft tissues and placement of the protection sleeve down to bone to prevent the entrapment of plantar structures during guide-wire placement, reaming and nail insertion.

Novel 14q32.2 paternal deletion encompassing the whole DLK1 gene associated with Temple syndrome

BackgroundTemple syndrome (TS14) is a rare imprinting disorder caused by maternal UPD14, imprinting defects or paternal microdeletions which lead to an increase in the maternal expressed genes and a silencing the paternally expressed genes in the 14q32 imprinted domain. Classical TS14 phenotypic features include pre- and postnatal short stature, small hands and feet, muscular hypotonia, motor delay, feeding difficulties, weight gain, premature puberty along and precocious puberty.MethodsAn exon array comparative genomic hybridization was performed on a patient affected by psychomotor and language delay, muscular hypotonia, relative macrocephaly, and small hand and feet at two years old. At 6 years of age, the proband presented with precocious thelarche. Genes dosage and methylation within the 14q32 region were analyzed by MS-MLPA. Bisulfite PCR and pyrosequencing were employed to quantification methylation at the four known imprinted differentially methylated regions (DMR) within the 14q32 domain: DLK1 DMR, IG-DMR, MEG3 DMR and MEG8 DMR.ResultsThe patient had inherited a 69 Kb deletion, encompassing the entire DLK1 gene, on the paternal allele. Relative hypermethylation of the two maternally methylated intervals, DLK1 and MEG8 DMRs, was observed along with normal methylation level at IG-DMR and MEG3 DMR, resulting in a phenotype consistent with TS14. Additional family members with the deletion showed modest methylation changes at both the DLK1 and MEG8 DMRs consistent with parental transmission.ConclusionWe describe a girl with clinical presentation suggestive of Temple syndrome resulting from a small paternal 14q32 deletion that led to DLK1 whole-gene deletion, as well as hypermethylation of the maternally methylated DLK1-DMR.

New Perspectives on Foot Segment Forces and Joint Kinetics-Integrating Plantar Shear Stresses and Pressures with Multi-segment Foot Modeling.

The role of the many small foot articulations and plantar tissues in gait is not well understood. While kinematic multi-segment foot models have increased our knowledge of foot segmental motions, the integration of kinetics with these models could further advance our understanding of foot mechanics and energetics. However, capturing and effectively utilizing segmental ground reaction forces remains challenging. The purposes of this study were to (1) develop methodology to integrate plantar pressures and shear stresses with a multi-segment foot model, and (2) generate and concisely display key normative data from this combined system. Twenty-six young healthy adults walked barefoot (1.3m/s) across a pressure/shear sensor with markers matching a published 4-segment foot model. A novel anatomical/geometric template-based masking method was developed that successfully separated regions aligned with model segmentation. Directional shear force plots were created to summarize complex plantar shear distributions, showing opposing shear forces both between and within segments. Segment centers of pressure (CoPs) were shown to be primarily stationary within each segment, suggesting that forward progression in healthy gait arises primarily from redistributing weight across relatively fixed contact points as opposed to CoP movement within a segment. Inverse dynamics-based normative foot joint moments and power were presented in the context of these CoPs to aid in interpretation of tissue stresses. Overall, this work represents a successful integration of motion capture with direct plantar pressure and shear measurements for multi-segment foot kinetics. The presented tools are versatile enough to be used with other models and contexts, while the presented normative database may be useful as a baseline comparison for clinical work in gait energetics and efficiency, balance, and motor control. We hope that this work will aid in the advancement and availability of kinetic MSF modeling, increase our knowledge of foot mechanics, and eventually lead to improved clinical diagnosis, rehabilitation, and treatment.

Clinical and genetic analysis of trichohepatoneurodevelopmental syndrome caused by a CCDC47 variant

Trichohepatoneurodevelopmental syndrome is an extremely uncommon autosomal recessive disorder resulting from variants in the CCDC47 gene, which encodes a Ca2+-binding endoplasmic reticulum (ER) transmembrane protein. To date, only four patients with CCDC47 deficiency have been reported, all of them with homozygous truncating CCDC47 variants. For this study, a Chinese family was recruited, which included a patient diagnosed with trichohepatoneurodevelopmental syndrome. Whole exome sequencing (WES) identified the proband's novel homozygous CCDC47 variation (NM_020198: c.634C > T(p.Arg212*). The variant was confirmed to be segregating in the proband and her unaffected relatives through Sanger sequencing. The patient described exhibited a clinical phenotype similar to that of patients with the CCDC47 variant. Compared to reported cases with CCDC47 pathogenic variants, our patients showed a novel complication of hearing impairment. In addition, brain abnormalities, small feet, bilateral hip dislocation, hip dysplasia, overlapping toes, pectus excavatum, scoliosis and narrow chest were not observed in our patient. We also examined five different variations and their corresponding phenotypes from five patients, both in current and previous research. Although some clinical manifestations of trichohepatoneurodevelopmental syndrome were highly variable, the most common phenotypes observed in these patients include microcephaly, profound intellectual disability, severe global development delay, pronounced growth restriction, hypotonia, woolly hair, facial dysmorphism, respiratory and visual abnormalities, gastrointestinal abnormalities, liver dysfunction, pruritus, skeletal and limb abnormalities, congenital heart defects and immunodeficiency. The present report is the first of a Chinese infant with homozygous variant in the CCDC47 gene. We expanded the genetic and phenotypic spectrum associated with trichohepatoneurodevelopmental syndrome.

A Cinderella story: fashion, foot worship and foot moralism in Sweden, 1850–1900

ABSTRACT The article discusses the female beauty ideal of the small foot in the Swedish press during the second half of the nineteenth century, as an object for the male gaze in fiction, as an actual fashion ideal, and as a prescribed beauty practice for women. It consists of three parts, analysing different subgenres within the press. First, I show how a male notion of the beauty and erotic attractiveness of the small foot was constructed in short stories and serial novels published in the daily and weekly press. Next, I show how this ideal was visually represented for its realization in every-day life in figures in fashion journals. Both genres presented an ideal unattainable for most women. Third, I discuss articles in dailies and weeklies giving advice on how to take care of feet, warning against ambitions to make the foot look small. Taken together, representations of female feet in the Swedish press involved a construction of the foot that also constructed women as perpetually failing in relation to the existing beauty ideal, making it part of a discursive misogynist practice, according to which women was supposed to invest in their appearance, and were derided and ridiculed when they did.

Normative Extensor Hallucis Brevis Muscle Activity During Locomotion Following the Development of a Novel Ultrasound-Guided Fine-Wire Electromyography Protocol.

Fine-wire electromyography (EMG) is a traditional laboratory technique to estimate muscle activity of the small foot muscles, however, recordings have not been reported from extensor hallucis brevis (EHB). As an extensor of the great toe, EHB is an important muscle when studying physiological changes associated with foot pathologies such as hallux valgus. The purpose of this study was to develop an ultrasound-guided fine-wire EMG protocol to record EHB muscle activity and report normative EMG profiles of healthy young adults during locomotion. Sixteen asymptomatic young adults completed 20 walking trials at a self-selected velocity. Ensemble averages were calculated from the time normalized linear envelopes and represented from 0% to 100% of the single stance phase of gait. EHB muscle bursts were observed between 0% and 20% of the stance phase of gait in all participants. A second burst of EMG was observed between 80% and 100% of stance in 50% of the participants. This study introduces a novel ultrasound-guided EMG protocol and normative data from EHB recordings suggest a synergistic role to anterior compartment musculature at contact. These results provide preliminary insights into understanding the functional role of EHB and may help elucidate the biomechanical factors exacerbating the progression of hallux pathologies.

Glucosamine-loaded injectable hydrogel promotes autophagy and inhibits apoptosis after cartilage injury

The ability of cartilage to regenerate and repair is limited. N-acetyl- d-glucosamine (GlcNAc) is a nutritional supplement commonly used to activate chondrocytes. To prolong the duration of action of GlcNAc and improve its curative effect after cartilage injury, a GlcNAc thermosensitive hydrogel is prepared based on Pluronic F127 (PF127). The physicochemical properties results indicate that this hydrogel is injectable and retards the release of GlcNAc. Further, the therapeutic benefits of GlcNAc hydrogel are detected through intra-articular injection in rat specimens with cartilage injury. Behavioral experiments results indicate that the rats treated with GlcNAc hydrogel had longer step lengths, smaller foot angles and slower fall times. Compared with the sham group, the expression of Sox9 was 1.5 times and the level of collagen II was 2.4 times in the hydrogel treated group. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining result confirmed that the GlcNAc hydrogel reduce apoptosis by about 50%. Our results of immunohistochemical staining, Western blotting assays and enzyme activity detection all suggested that GlcNAc hydrogel reduce the expression of cleaved-caspase3 and caspase8 (Compared to the sham group, the protein contents were reduced by about 50% in the GlcNAc hydrogel group). We also found that GlcNAc hydrogel activates autophagy through ERK signal pathway. The results of Western blotting indicated that GlcNAc hydrogel increase the levels of LC3B and Becline1 (hydrogel group & sham group, LC3B: 1.56 ± 0.07 & 1.00 ± 0.14; Becline1: 1.98 ± 0.07 & 1.00 ± 0.13). Whereas, the content of P62 reduced after GlcNAc hydrogel treatment, the relative level in sham group and hydrogel group are 1.00 ± 0.02 and 0.73 ± 0.06. Our results revealed that the number of P-ERK positive cells in the hydrogel group (57.36 ± 3.56%) was higher when compared with the sham (24.82 ± 2.72%). And, the ratio of P-ERK and ERK was higher than that in the sham group (1.48 ± 0.07 & 1.00 ± 0.08). The GlcNAc thermosensitive hydrogel is a promising and sustainable drug delivery system for intra-articular injection in the treatment of cartilage injury.

Study on Closely Spaced Asymmetric Footings Embedded in a Reinforced Soil Medium

In practice, footings are rarely laid on the surface or at ground level; usually, they are embedded in the soil medium. Most studies focus on surface footings. This research examines the behavior of two interfering asymmetric footings while considering their widths to be dissimilar and the effect of embedment depth to enhance the ultimate bearing capacity and limit the settlement within the working range. This was evaluated through the finite element method of the ABAQUS software. The soil was assumed to have a Mohr-Coulomb failure, and the asymmetry corresponded to the footing widths. The results are presented in terms of interference factors, i.e., the ultimate bearing capacity (UBC) and the settlement, which are defined as the UBC/settlement ratio of the left/right footing in the presence of the other one placed on reinforced soil. This, in comparison with an identical isolated footing on unreinforced soil. Interference is more significant in small footings than in large ones. Due to behavioral variations, the bearing capacity and settlement are different. This effect increases with an increase in the width of large footings, and the interference factors decrease with an increase in the embedment depth of the footings. When the right footing width is twice that of the other and considering one layer of reinforcement and soil friction angles of 30º and 40º, the percent increments in the bearing capacity of interfering left footings, for a spacing of 0,5 times the left footing width, are 104 and 148%, respectively.

Fiber grating sensors and their recent applications in biomedical domain

Sensors play an important role in measuring various physio-chemical and biological parameters. Biomedical applications of sensors include early level diagnosis of diseases, treatment technique enhancement and also monitoring the effect of medical techniques using suitable biomedical devices. The sensors which are deemed suitable for biomedical applications need to be fast, accurate, flexible, small, and most importantly, biocompatible. The inherent advantages of fibre optic sensors, such as small foot print, electrical passiveness, multiplexing capability and fast response make them the most preferred for biomedical sensing applications. Fibre optics sensors are generally used in the measurement of parameters such as temperature, strain, pressure, displacement, angle, and force. And find applications in diverse regimes like structural health monitoring, shape sensing, seismic sensing; in the bio medical domain, they have been deployed in gait analysis, pulse rate monitoring, body joint angle measurements, acquisition of respiratory parameters, cardiovascular parameters and many more. Despite being a topic of significant interest in biomedical applications, the adoptablility of optical sensors in clinical practice is not very encouraging. Hence, there is a need to address the reasons for the same, and the present review aims to highlight some critical areas. The present review paper primarily discusses the optical fibre grating techniques: their fabrication methods, the applications of these sensors in biophysical and biomechanical measurements, bio proteins and biomarker detection in body fluids. The review also discusses the bottlenecks in the clinical application of these sensors. The comparison of the performance of the optical fibre sensors with other sensing techniques is also discussed in this review paper.

Features of the development of experimental nephropathy in rats during the use of doxorubicin

BACKGROUND. One of the most frequently reproduced models of NS is doxorubicin (adriamycin) nephropathy in rats. However, the mechanisms of its development remain insufficiently studied, and it is not entirely clear to which form of NS the nephrotoxicity induced by doxorubicin should be attributed.THE AIM. Reproduction of doxorubicin nephropathy in rats in an attempt to morphologically identify the resulting pathology and determine the role of free radical oxidation (FRO) in the development of this model of nephrotoxicity.MATERIALS AND METHODS. Nephropathy was reproduced by a single intravenous administration of doxorubicin to male Wistar rats. In the urine, the content of creatinine, daily proteinuria, and albumin release were determined. Histological examination of the kidneys was performed using a Libra 120 electron microscope (Carl Zeiss, Germany). The total prooxidant activity, total antioxidant activity, the concentration of thiobarbiturate-reactive products, and the activity of antioxidant enzymes were assessed in the blood and kidney.RESULTS. Against the background of a gradual decrease in the glomerular filtration rate, a significant consistent increase in protein excretion was recorded, largely due to an increase in albumin excretion. Electron microscopic examination revealed a decrease in the number of small (foot) processes of podocytes, their fusion, sclerotic lesions of the elements of the capillary glomerulus, thinning of the GBM, sclerosis of the interstitium. There was a sharp activation of blood OPA and an increase in the content of TBRP. At the same time, such fast-responding antioxidant enzymes as CAT and SOD were activated. The blood TAA decreased in parallel with the decrease in GPO activity.CONCLUSION. Intravenous administration of doxorubicin to rats induced the development of toxic kidney damage with signs of NS. A characteristic indicator was the development of PU against the background of a decrease in GFR from day 5 and increased many times by the end of the observation period. The greatest contribution to the development of PU was made by an in-crease in albumin excretion. Morphological examination of the kidneys using electron microscopy made it possible to conclude with a high degree of probability that the developed pathology and FSGS are similar. At the same time, FRO activation was recorded, which was expressed in a sig-nificant pro-oxidant effect and a significant decrease in the antioxidant activity of the blood.

A methodological exploration to study 2D arm kinematics in Ophiuroidea (Echinodermata)

Brittle stars, unlike most other echinoderms, do not use their small tube feet for locomotion but instead use their flexible arms to produce a rowing or reverse rowing movement. They are among the fastest-moving echinoderms with the ability of complex locomotory behaviors. Considering the high species diversity and variability in morphotypes, a proper understanding of intra- and interspecies variation in arm flexibility and movement is lacking. This study focuses on the exploration of the methods to investigate the variability in brittle star locomotion and individual arm use. We performed a two-dimensional (2D) image processing on horizontal movement only. The result indicated that sinuosity, disc displacement and arm angle are important parameters to interpret ophiuroid locomotion. A dedicated Python script to calculate the studied movement parameters and visualize the results applicable to all 5-armed brittle stars was developed. These results can serve as the basis for further research in robotics inspired by brittle star locomotion.

A 14-year-old patient with Prader-Willi syndrome: a case report

Prader-Willi Syndrome (PWS) is a disorder resulting from a loss of genetic information on chromosome 15q11.2-q13 inherited from the father. It can be caused by paternal deletions (65-75%) or uniparental maternal disomy (20-30%). The prevalence of PWS is estimated to be 1/10,000 - 1/20,000 births.1 Although its incidence is relatively rare, PWS can cause major health problems for patients and decreased quality of life for their families.
 The course of PWS is characterized by severe hypotonia in the neonatal period, severe feeding problems resulting in growth failure, as well as small hands and feet. Hypogonadism manifests as genital hypoplasia, delayed puberty, and infertility. Children with PWS have delayed motor and language development. Most patients have some degree of intellectual disability. Hyperphagia and obesity occur in early childhood. The patient’s excessive eating behavior affects the patient’s and family’s quality of life, and is often responsible for high morbidity and mortality.

Identification of characteristics of foot position and angle during swing phase in fallers using principal component analysis.

Identifying the characteristics of fallers is important for preventing falls because such events may reduce quality of life. It has been reported that several variables related to foot positions and angles during gait (e.g., sagittal foot angle and minimum toe clearance) differ between fallers and non-fallers. However, examining such representative discrete variables may not be sufficient to detect crucial information, which may be contained in the large portions of unanalyzed data. Therefore, we aimed to identify the comprehensive characteristics of foot position and angle during the swing phase of gait in non-fallers and fallers using principal component analysis (PCA). Thirty non-fallers and 30 fallers were recruited for this study. We performed PCA to reduce the dimensions of foot positions and angles during the swing phase and obtained principal component scores (PCSs) for each principal component vector (PCV), which were then compared between groups. The results revealed that the PCS of PCV3 in fallers was significantly larger than that in non-fallers (p = 0.003, Cohen's d = 0.80). We reconstructed waveforms of foot positions and angles during the swing phase using PCV3 and our main findings can be summarized as follows. Compared to non-fallers, fallers have a 1) low average foot position in the z-axis (i.e., height) during the initial swing phase 2) small average foot angle in the x-axis (i.e., rotation in the sagittal plane), during the initial swing phase, and 3) large variability in foot position in the y-axis (i.e., anterior/posterior position) during the initial swing phase. We can conclude that these are characteristics of gait related to fallers. Therefore, our findings may be beneficial for evaluating fall risk during gait using a device such as a shoe- or insole-embedded inertial measurement unit.

How to Distinguish Attenuated Forms of Mucopolysaccharidosis and Articular Forms of Juvenile Arthritis: Development of Diagnostic Algorithm Based on the Data from Multicenter Retrospective Study

Background. Differential diagnosis of attenuated forms of mucopolysaccharidosis (MPS) and juvenile idiopathic arthritis (JIA) can be challenging due to their similarities.Objective. The aim of the study is to create simple diagnostic criteria (DScore) that would allow to differentiate MPS from JIA for earlier MPS diagnosis.Methods. The retrospective multicenter study included analysis of clinical (joint, heart, eye involvement, hearing loss, hernias, psychomotor delay, noisy breathing, posture disorders, macrocephaly, hepatomegaly, splenomegaly, and growth delay) and laboratory data (ESR, CRP, hemoglobin, WBC, and platelets) from MPS patients (n = 41) and from rheumatoid factor-negative polyarticular category of JIA patients (n = 255). These variables allowed to differentiate both conditions and were used to create DScore.Results. Patients with MPS had younger onset age, male predominance, height and weight delay, lower inflammation markers (WBC, platelets, and ESR), and usually involved joints, especially cervical spine, upper limbs joints, hip, and small foot joints. The prevalence of eye involvement was similar for both diseases, however, the type of involvement was different. JIA patients had uveitis and its’ complications and MPS patients — corneal opacity and cataract. No differences in CRP levels were revealed in most cases. The major diagnostic criterion of MPS was the presence of more than one extra-articular manifestation associated with polyarticular involvement. DScore has included 5 following criteria: ESR ≤ 11 mm/h (38 points), height ≤ -2.0 SD (20 points), onset age of articular manifestations ≤ 1.1 year (24 points), male gender (15 points), and symmetrical limitation of movements in elbow joints (29 points). The sum > 38 points allowed us to differentiate MPS and JIA with sensitivity of 92.7% and specificity of 91.0%.Conclusion. This DScore can be used for differential diagnosis of mild MPS and JIA alongside with routine diagnostic procedures. DScore allows us to identify a group of patients with joint involvement who require MPS exclusion.

Flexor hallucis brevis motor unit behavior in response to moderate increases in rate of force development.

Studies on motor unit behaviour with varying rates of force development have focussed predominantly on comparisons between slow and ballistic (i.e., very fast) contractions. It remains unclear how motor units respond to less extreme changes in rates of force development. Here, we studied a small intrinsic foot muscle, flexor hallucis brevis (FHB) where the aim was to compare motor unit discharge rates and recruitment thresholds at two rates of force development. We specifically chose to investigate relatively slow to moderate rates of force development, not ballistic, as the chosen rates are more akin to those that presumably occur during daily activity. We decomposed electromyographic signals to identify motor unit action potentials obtained from indwelling fine-wire electrodes in FHB, from ten male participants. Participants performed isometric ramp-and-hold contractions from relaxed to 50% of a maximal voluntary contraction. This was done for two rates of force development; one with the ramp performed over 5 s (slow condition) and one over 2.5 s (fast condition). Recruitment thresholds and discharge rates were calculated over the ascending limb of the ramp and compared between the two ramp conditions for matched motor units. A repeated measures nested linear mixed model was used to compare these parameters statistically. A linear repeated measures correlation was used to assess any relationship between changes in recruitment threshold and mean discharge rate between the two conditions. A significant increase in the initial discharge rate (i.e., at recruitment) in the fast (mean: 8.6 ± 2.4 Hz) compared to the slow (mean: 7.8 ±2.3 Hz) condition (P = 0.027), with no changes in recruitment threshold (P = 0.588), mean discharge rate (P = 0.549) or final discharge rate (P = 0.763) was observed. However, we found substantial variability in motor unit responses within and between conditions. A small but significant negative correlation (R2 = 0.33, P = 0.003) was found between the difference in recruitment threshold and the difference in mean discharge rate between the two conditions. These findings suggest that as force increases for contractions with slower force development, increasing the initial discharge rate of recruited motor units produces the increase in rate of force development, without a change in their recruitment thresholds, mean or final discharge rate. However, an important finding was that for only moderate changes in rate of force development, as studied here, not all units respond similarly. This is different from what has been described in the literature for ballistic contractions in other muscle groups, where all motor units respond similarly to the increase in neural drive. Changing the discharge behaviour of a small group of motor units may be sufficient in developing force at the required rate rather than having the discharge behaviour of the entire motor unit pool change equally.

Clinical markers of post-Chikungunya chronic inflammatory joint disease: A Brazilian cohort.

Chikungunya-fever (CHIKF) remains a public health major issue. It is clinically divided into three phases: acute, post-acute and chronic. Chronic cases correspond to 25-40% individuals and, though most of them are characterized by long-lasting arthralgia alone, many of them exhibit persistent or recurrent inflammatory signs that define post-Chikungunya chronic inflammatory joint disease (pCHIKV-CIJD). We aimed to identify early clinical markers of evolution to pCHIKV-CIJD during acute and post-acute phases. We studied a prospective cohort of CHIKF-confirmed volunteers with longitudinal clinical data collection from symptoms onset up to 90 days, including a 21-day visit (D21). Of 169 patients with CHIKF, 86 (50.9%) completed the follow-up, from whom 39 met clinical criteria for pCHIKV-CIJD (45.3%). The relative risk of chronification was higher in women compared to men (RR = 1.52; 95% CI = 1.15-1.99; FDR = 0.03). None of the symptoms or signs presented at D0 behaved as an early predictor of pCHIKV-CIJD, while being symptomatic at D21 was a risk factor for chronification (RR = 1.31; 95% CI = 1.09-1.55; FDR = 0.03). Significance was also observed for joint pain (RR = 1.35; 95% CI = 1.12-1.61; FDR = 0.02), reported edema (RR = 3.61; 95% CI = 1.44-9.06; FDR = 0.03), reported hand and/or feet small joints edema (RR = 4.22; 95% CI = 1.51-11.78; FDR = 0.02), and peri-articular edema observed during physical examination (RR = 2.89; 95% CI = 1.58-5.28; FDR = 0.002). Furthermore, patients with no findings in physical examination at D21 were at lower risk of chronic evolution (RR = 0.41, 95% CI = 0.24-0.70, FDR = 0.01). Twenty-nine pCHIKV-CIJD patients had abnormal articular ultrasonography (90.6% of the examined). The most common findings were synovitis (65.5%) and joint effusion (58.6%). This cohort has provided important insights into the prognostic evaluation of CHIKF. Symptomatic sub-acute disease is a relevant predictor of evolution to chronic arthritis with synovitis, drawing attention to joint pain, edema, multiple articular involvement including small hand and feet joints as risk factors for chronification beyond three months, especially in women. Future studies are needed to accomplish the identification of accurate and early biomarkers of poor clinical prognosis, which would allow better understanding of the disease's evolution and improve patients' management, modifying CHIKF burden on global public health.

Editorial

Editorial

EFFECT OF LEECH APPLICATION IN THE MANAGEMENT OF BURGER’S DISEASE:- A CASE STUDY

The inflammatory response in the arterial wall that involves the surrounding veins and nerves and results in thrombosis of the artery is known as Burger’s disease. Smoker’s disease, also known as TAO (thrombangitis obliterans), primarily affects young males between the ages of 20 and 40. Early on, it affects just one limb, but eventually, both limbs are affected. As far as the genesis of this illness is concerned, there is a strong correlation between smoking, frequent small foot injuries, poor hygiene, and altered autonomic functions. In contrast to surgical intervention, which includes lumbar sympathectomy, omentoplasty, and amputation as the only option if gangrenous stage is present, allopathic management involves conservative treatment with the use of vasodilators, pentoxifylline, and low-dose aspirin.The aforementioned procedure is expensive and has drawbacks. Although the disease is not mentioned in Ayurveda, its symptoms can be linked to strotas dushti lakshana, such as sanga and siranam granthi. Additionally, because rakta is vitiated, raktavaha strotasa dushti is also involved; therefore, leech application was planned based on these two references into account all three factors. Before using leeches and performing the scheduled leech therapy, poorva pradhan paschat karma is conducted. Leech therapy was found to be helpful with fewer problems in a total of 6 sittings.

ETIOLOGY, CLINICAL PRESENTATION, DIAGNOSIS AND TREATMENT OF ACROMICRIA

Acromicria is a rare medical condition manifested by the abnormal underdevelopment of small size of the extremities particularly the habds and feet. Etiology of acromicria include congenital acromicria, aquired acromicria, endocrine disorders and nutritional deficiencies. Clinical presentations are small hands and feet, delayed growth. Limited mobility and bone abnormalities. Diagnosis is based on imaging studies, genetic testing, hormone tests and radio logical assessment. Treatment is linked to the genetic causes, hormonal causes, medical monitoring and orthopedic interventions.