Symptoms Of Peripheral Vascular Disease Research Articles

Proposed Research Protocol to Study the Effects of Adding Fitness Devices to Vascular Rehabilitation for the Treatment of Claudication

Peripheral vascular disease affects millions of adults in the US annually. Between $224 and $414 billion dollars in healthcare spending goes towards medications, procedures and hospitalizations for peripheral vascular disease every year1. Claudication is the most common and often earliest symptom of peripheral vascular disease. Supervised exercise programs have been shown to be at least equally as effective as percutaneous interventions for claudication symptoms and thus could save millions of dollars, decrease interventions and hospitalizations and thereby increase quality of life for claudicants when universally implemented as first line therapy. However, there are many barriers to widespread use of supervised exercise therapy for claudication patients. Recently portable fitness tracking devices have been developed but they have not been utilized as a component of supervised exercise therapy. It was our hypothesis that we could utilize this technology to overcome some of the barriers to enrollment and participation in supervised exercise therapy as well as improve the durability of the results. We developed a research protocol to evaluate the use of walking tracking devices as part of a home program following completion of a supervised exercise program. The goal was to identify improvements in patients walking distances and quality of life following completion of a supervise exercise therapy program and to evaluate if these improvements were maintained by providing the patient a fitness device that would track their walking distances and allow them to upload that data to the research team. Unfortunately, recruitment and enrollment in the study was slow and the study was closed. We wish to share the research protocol and what we have learned with other investigators who may desire to study supervised exercise therapy, walking distance and quality of life with or without the inclusion of a portable fitness device on exercise treatment for claudication.

Review of Topical Sodium Heparin 1000 IU/g Gel in Symptomatic Uncomplicated Superficial Thrombophlebitis.

Heparin, a mixture of sulfated polymorphic polysaccharides (glycosaminoglycan) chains of variable lengths and weights and a natural anticoagulant, is widely used in medical practice to prevent intravascular blood coagulation. Heparin has demonstrated antithrombotic and anti-inflammatory activity, and it is mostly administered systemically (intravenously or subcutaneously) for primary or secondary prevention of venous thromboembolism after surgical interventions, or immobilized patients, or on short-term antithrombotic therapy of patients with atrial fibrillation who must undergo treatment. However, since systemic administration of heparin could be, in certain cases, linked to an increased risk of bleeding, topical heparin is widely used for the prevention and treatment of local symptoms of peripheral vascular disorders, such as venous insufficiency, varicose veins, or superficial thrombophlebitis. This review summarizes the main safety and efficacy characteristics of the topical formulation of Heparin in Gel form (1000 International Units of Heparin/g Gel) currently in use, which has demonstrated an excellent efficacy and tolerability profile in reducing signs and symptoms of peripheral vascular disease, e.g., varicose syndromes and their complications, phlebothrombosis, thrombophlebitis, superficial periphlebitis, varicose ulcers, for post-operative varicophlebitis, sequelae of saphenectomy, for traumas and contusions, local edemas and infiltrates, subcutaneous hematoma and for traumatic affections of musculotendinous and capsuloligamentous apparatuses.

Cilostazol Attenuates AngII-Induced Cardiac Fibrosis in apoE Deficient Mice.

Cardiac fibrosis is characterized by the net accumulation of extracellular matrix in the myocardium and is an integral component of most pathological cardiac conditions. Cilostazol, a selective inhibitor of phosphodiesterase type III with anti-platelet, anti-mitogenic, and vasodilating properties, is widely used to treat the ischemic symptoms of peripheral vascular disease. Here, we investigated whether cilostazol has a protective effect against Angiotensin II (AngII)-induced cardiac fibrosis. Male apolipoprotein E-deficient mice were fed either a normal diet or a diet containing cilostazol (0.1% wt/wt). After 1 week of diet consumption, the mice were infused with saline or AngII (1000 ng kg−1 min−1) for 28 days. AngII infusion increased heart/body weight ratio (p < 0.05), perivascular fibrosis (p < 0.05), and interstitial cardiac fibrosis (p < 0.0001), but were significantly attenuated by cilostazol treatment (p < 0.05, respectively). Cilostazol also reduced AngII-induced increases in fibrotic and inflammatory gene expression (p < 0.05, respectively). Furthermore, cilostazol attenuated both protein and mRNA abundance of osteopontin induced by AngII in vivo. In cultured human cardiac myocytes, cilostazol reduced mRNA expression of AngII-induced osteopontin in dose-dependent manner. This reduction was mimicked by forskolin treatment but was cancelled by co-treatment of H-89. Cilostazol attenuates AngII-induced cardiac fibrosis in mice through activation of the cAMP–PKA pathway.

ASSESSMENT OF PERIPHERAL VASCULAR DAMAGE IN PATIENTS WITH DIFFERENT DEGREES OF BLOOD PRESSURE INCREASE

Purpose – to investigate the frequency of peripheral arteries damage by determining theankle- brachial index (ABI) in patients with hypertension of 1-3 degrees of the older agecategory (&gt; 55 years) using automatic devices for measuring blood pressure.Material and methods. The object of the study were patients with hypertension olderthan 55 years, 150 people (50 patients with elevated blood pressure levels 1, 2 and3 degrees), as well as 20 healthy people of the same age. The study included only patientswho did not have obvious clinical symptoms of peripheral vascular disease. The studydid not include patients with persistent cardiac arrhythmias (atrial fibrillation, frequentventricular arrhythmias, etc.). Simultaneous measurement of blood pressure on the armwith a higher level of blood pressure and on the leg in a supine position was carriedout. After that, the ankle- brachial index was calculated as the ratio of the mean systolicblood pressure (SBP) separately on the right and left ankle to the mean SAT level on thebrachial of the arm with higher BP. If ABI less than 0.9 damage of peripheral arteries ona proper side was diagnosed. Results. For a detailed analysis, we divided all patients with hypertension dependingon the value of the ankle- shoulder index into two subgroups: subgroup A includedpatients (n = 141) with hypertension with an index value&gt; 0.9, and subgroup B (n = 9) –respectively &lt;0.9. The mean age of patients in subgroup A was 64.5 ± 1.1 years, subgroupB – 66.5 ± 2.1 years (p&gt; 0.05 between subgroups). SAT in subgroup A was 159.4 ± 2.9mm Hg, in subgroup B – 162.1 ± 4.2 mm Hg. (p&gt; 0.05 between subgroups). Patients inboth subgroups did not differ in age, sex, body mass index, smoking frequency. Patients inboth subgroups had significantly elevated serum total cholesterol of 6.5 ± 0.2 mmol / l and6.7 ± 0.5 mmol / l, respectively. The degree of increase in diastolic blood pressure (BP)in subgroup A was significantly higher than 103.2 ± 1.2 mm Hg. compared with subgroupB – 78 ± 4.6 mm Hg (p &lt;0.01). Serum creatinine levels in patients with signs of peripheralarterial lesions were higher than in patients without signs of lesions of 99.4 ± 3.6 μmol /l versus 88.2 ± 3.1 μmol / l (p &lt;0.05). Type 2 diabetes was found in 44 % in subgroup Band in 7 % in subgroup A.Conclusions. The most common signs of peripheral vascular disease were observed inpatients older than 55 years with isolated systolic hypertension, type 2 diabetes mellitusand elevated serum creatinine.

Prognostic value of low ankle-brachial index in patients with resistant hypertension

In the presence of resistant hypertension, patients have a significantly higher risk of stroke, myocardial infarction, kidney disease, heart failure, and death than patients with elevated blood pressure. Increased arterial stiffness is an important factor in determining cardiovascular risk. Peripheral artery damage is a target organ lesion, and its presence puts the patient at high or very high risk. The simplest non-invasive method of detecting peripheral vascular damage in patients is to determine the ankle-brachial index (ABI). Aim. To detect the frequency of damage to the lower extremity peripheral arteries by determining the ankle-brachial index and its impact on the subsequent prognosis in patients of older age (&gt;55 years) with resistant hypertension using automatic blood pressure monitors. Materials and methods. The object of the study were patients with hypertension aged 55 years – 150 people with elevated blood pressure of the 3rd degree and 20 healthy people of the same age. The study included only those patients who did not have clinical symptoms of peripheral vascular disease, type 2 diabetes mellitus. Determination of the ABI was performed by an automatic device. Results. The frequency of femoral artery lesions detection by measuring blood pressure on the brachial and legs in asymptomatic patients with resistant hypertension was 14.0 %. For a detailed analysis, we divided all patients with hypertension depending on the value of the ABI into two subgroups: subgroup A included patients (n = 129) with an ABI value &gt;0.9, subgroup B (n = 21) – with the value of ≤0.9. In patients with resistant hypertension and peripheral arterial disease, the more common factors were: longer duration of hypertension, the presence of isolated systolic hypertension and a lower level of glomerular filtration rate. Decreased ABI (≤0.9) in patients with resistant hypertension was associated with a 1.4-fold increased risk of adverse cardiovascular complications and a 1.9-fold increased risk of all-cause mortality. Conclusions. In patients with resistant hypertension, a reduced ankle-brachial index was associated with a 1.4-fold increased risk of adverse cardiovascular complications and a 1.9-fold increased risk of all-cause mortality.

Clinical study of peripheral vascular diseases and treatment modalities

Peripheral vascular disease is circulation disorders that affect blood vessels outside of the heart and brain. It often neglected by patients but in later stage it causes serious problems. Smoking tobacco is the main culprit for PVD. So, this challenging subject is taken up for the present study in which we will be studying the clinical profile and management modalities for PVD in our hospital. This prospective study was conducted between September 2014 to September 2021on patients admitted to Smt. B. K. Shah Medical Institute and Research Centre, Dhiraj Hospital Piparia Vadodara. 50 patients having symptoms of peripheral vascular disease. This prospective study conducted at S.B.K.S.M.I.R&amp;C. Dhiraj Hospital Piparia Vadodara, included 50 patients with acute pancreatitis, male and female (M: F =41:9),mean age is 35.5 years, smoking is the significant risk factor, medical therapy is more preferable in initial of disease while surgical treatment late phase. Peripheral vascular disease is mainly seen in elderly male specially seen in smokers and tobacco chewer ,claudication ,restpain,ulcer are the main symptoms , management is based upon claudication grading grade 1 and grade 2 can be manged conservatively while grade 3 and 4 required surgical management. Ilizarov, vascular bypass graft.

Diabetes-related Foot and Lower Limb Complications and Foot Self-Care Practices in Khartoum, Sudan: A Cross-sectional Study

BackgroundDiabetic foot complications are major health problems with substantial morbidity and mortality. Our study measured the frequency of patient-reported diabetes-related foot problems and foot self-care practices among Sudanese individuals with diabetes. MethodologyThis was a cross-sectional health facility-based study conducted at Abdallah Khalil Diabetes Center, Khartoum state, Sudan. Data was collected in the period from January to March, 2021. A convenience sample of 194 Sudanese diabetic patients, aged 20 and above were enrolled in this study. A pretested interviewer-administered questionnaire was used to obtain data on socio-demographic and clinical characteristics, patient-reported foot problems and foot self-care practices. Results194 patients were included in this study, mean diabetes duration 10.20±8.07 years, 60.3% were females, 47.4% were unemployed and 28.9% were illiterate. 80.4% reported having at least one or more sensory peripheral neuropathy symptoms, 36.6% reported one or more peripheral vascular disease symptoms in the previous month, and 29.4% had a history of foot ulceration. Reported foot self-care practices were suboptimal; poor scores were reported by 40.7%, average scores by 55.2%, while only 4.1% attained good scores. 52.5% never or rarely examined the bottom of their feet on a daily basis.HbA1c was found to be predictive of foot ulceration (p value 0.038), while duration and peripheral vascular disease were found to be predictive of amputations. (p value 0.001 and 0.021, respectively). ConclusionDiabetes related foot complications were frequently reported by our study participants, yet adoption of preventive foot self-care practices was of average levels. This highly suggests that continuous health education should be regularly provided to diabetic patients.

Diabetes Related Foot And Lower Limb Complications And Quality of Foot Care Among Adult Diabetic Patients Attending Abdallah Khalil Diabetes Center, Khartoum State, Sudan 2020/2021

BackgroundDiabetic foot complications result in substantial morbidity and mortality, fortunately they can be prevented. Our study measured the frequency of patient-reported diabetes-related foot problems and foot self-care practices among diabetic patients attending Abdallah Khalil Diabetes Center, Khartoum state, Sudan. MethodologyThis was a descriptive cross-sectional health facility-based study conducted at Abdallah Khalil Diabetes Center in Omdurman, Khartoum in the period from January to March, 2021. A convenience sample of 194 (n=250) Sudanese diabetic patients, aged 20 and above were in enrolled in this study. A pretested interviewer-administered questionnaire was used to obtain data on socio-demographic and clinical characteristics, patient-reported foot problems and foot self-care practices, data was analyzed using SPSS 23, chi-square and multi-variate logistic regression tests were used to measure associations and predictive factors among different variables. Results194 patients were included in this study (response rate: 77.6%), mean diabetes duration 10.20±8.07 years, 60.3% were female, 47.4% were unemployed and 10.8% were retired, illiterate participants represented (28.9%). 80.4% reported having at least one or more sensory peripheral neuropathy symptoms, 36.6% reported one or more peripheral vascular disease symptoms in the previous month, and 29.4% had a history of foot ulceration. Reported foot self-care practices were overall suboptimal; 55.2 average scores (25-36), only 4.1% attained good scores (37-48). 24.7$ and 27.8% never or rarely examine the bottom of their feet each day. On multivariate logistic regression HbA1c was found to be predictive of foot ulceration (p value 0.038), while duration and peripheral vascular disease were found to be predictive of amputations. (p value 0.001 and 0.021, respectively). ConclusionDiabetes related foot complications were frequently reported by our study participants, yet adoption of preventive foot self-care practices was of average levels, making it something very vital and urgent to carry out routine foot care educational programs and sessions. Future research for assessing the effectiveness of the preventive programs is going to be needed. Key words: Diabetes Mellitus, Diabetic Foot, Self-Care, Ulcer, Amputation

Covid-19 és perifériás verőérbetegség

[Patients with peripheral vascular disease (PAD) are negatively affected by the coronavirus epidemic in several ways. Fewer-than-usual doctor-patient encounters make it more difficult to detect disease or disease progression. Outbreaks due to the epidemic reinforce a sedentary lifestyle that can mask the symptoms of PAD through lack of exercise. Another risk is that patients with cardiovascular disease are at risk for severe Covid-19 disease, and have a significantly increased risk of mortality. In the case of home treatment of Covid-19 infection in a patient with PAD, close observation is required to make a timely decision on the need for hospitalization. Vaccination, which is gradually available to all PAD patients, could be the solution to prevent the disease.]

Development and Pilot Testing of a Diabetes Foot Care and Complications Questionnaire for Adults with Diabetes in Oman: The Diabetic Foot Disease and Foot Care Questionnaire.

ObjectivesDiabetic foot disease causes substantial morbidity and mortality, but it can be prevented. Our study examined the frequency of diabetes-related foot problems and foot self-care practices, as reported by consecutive patients attending primary and secondary diabetes services in Muscat, Oman.MethodsA cross-sectional survey utilizing a newly developed and pre-tested questionnaire was conducted at eight primary health care centers and one polyclinic (secondary care) in A'Seeb, Muscat. A convenience sample of 353 consecutive Omanis, aged 20 years and above, diagnosed with diabetes were invited to participate in this study. We collected data on clinico-demographic characteristics, patient-reported foot complications, and foot self-care practices.ResultsOf the 350 patients who agreed to participate (mean diabetes duration 7.9±7.4 years, response rate: 99.2%), 62.3% were female, 57.4% were unemployed, more than half were illiterate (52.9%), and around three-quarters (71.4%) were unsure of the type of diabetes they had. More than half (55.1%) reported having at least one or more sensory peripheral neuropathy symptoms, almost half (49.1%) reported one or more peripheral vascular disease symptoms in the previous month, and 12.5% a history of foot ulceration. Reported foot self-care practices were overall suboptimal; 54.7% did not examine the bottom of their feet each day.ConclusionsAlthough self-reported diabetes-related foot complications were common in this population, foot self-care practices were inadequate. These findings suggest a need for the provision of regular foot care education to patients with diabetes. Future research should explore barriers to recommended foot self-care practices.

Anti-inflammatory properties of cilostazol: Its interruption of DNA binding activity of NF-κB from the Toll-like receptor signaling pathways

Cilostazol, a selective inhibitor of phosphodiesterase type III with anti-platelet, anti-mitogenic, and vasodilating properties, is widely used to treat ischemic symptoms of peripheral vascular disease. Ample evidence has suggested that cilostazol also exhibits an anti-inflammatory effect, but its anti-inflammatory mechanism is not fully understood. Here, we showed that cilostazol specifically inhibited expression of cytokines, which are induced by nuclear factor-κB (NF-κB) activation, in RAW264.7 macrophage cells stimulated with different Toll-like receptor (TLR) ligands. Cilostazol was found to significantly reduce TLR-4 and TLR-3 ligands-stimulated NF-κB transcriptional activity, which was quantified by luciferase reporter assays. However, cilostazol was without effect on IκBα degradation and NF-κB p65 phosphorylation and nuclear translocation after challenge with the TLR-4 ligand lipopolysaccharide (LPS). Cilostazol did not also prevent the LPS-induced increase in phosphorylated levels of the mitogen-activated protein kinase (MAPK) family. On the other hand, using chromatin immunoprecipitation assays, we demonstrated that cilostazol reduced the LPS-induced transcriptional activities of interleukin-6 and tumor necrosis factor-α by preventing the recruitment of NF-κB p65 to these gene promoters. When cilostazol was given to mice by oral gavage daily for 7 days, LPS-induced aberrant pro-inflammatory cytokine production and end-organ tissue injury were significantly reduced. The results of this study suggest that cilostazol is capable of directly interrupting DNA binding activity of NF-κB proteins from the TLR signaling pathways. The therapy to specifically intervene in this pathway may be potentially beneficial for the prevention of different inflammatory disorders.

A Study on The Prevalence And Risk Factors Associated with Peripheral Vascular Disease In Type2 Diabetes Mellitus

A Study on The Prevalence And Risk Factors Associated with Peripheral Vascular Disease In Type2 Diabetes Mellitus

Risk factors for 30-day unplanned readmission following infrainguinal endovascular interventions

ObjectiveUnplanned hospital readmissions following surgical interventions are associated with adverse events and contribute to increasing health care costs. Despite numerous studies defining risk factors following lower extremity bypass surgery, evidence regarding readmission after endovascular interventions is limited. This study aimed to identify predictors of 30-day unplanned readmission following infrainguinal endovascular interventions. MethodsWe identified all patients undergoing an infrainguinal endovascular intervention in the targeted vascular module of the American College of Surgeons National Surgical Quality Improvement Program between 2012 and 2014. Perioperative outcomes were stratified by symptom status (chronic limb-threatening ischemia [CLI] vs claudication). Patients who died during index admission and those who remained in the hospital after 30 days were excluded. Indications for unplanned readmission related to the index procedure were evaluated. Multivariable logistic regression was used to identify preoperative and in-hospital (during index admission) risk factors of 30-day unplanned readmission. ResultsThere were 4449 patients who underwent infrainguinal endovascular intervention, of whom 2802 (63%) had CLI (66% tissue loss) and 1647 (37%) had claudication. The unplanned readmission rates for CLI and claudication patients were 16% (n = 447) and 6.5% (n = 107), respectively. Mortality after index admission was higher for readmitted patients compared with those not readmitted (CLI, 3.4% vs 0.7% [P < .001]; claudication, 2.8% vs 0.1% [P < .01]). Approximately 50% of all unplanned readmissions were related to the index procedure. Among CLI patients, the most common indication for readmission related to the index procedure was wound or infection related (42%), whereas patients with claudication were mainly readmitted for recurrent symptoms of peripheral vascular disease (28%). In patients with CLI, predictors of unplanned readmission included diabetes (odds ratio, 1.3; 95% confidence interval, 1.01-1.6), congestive heart failure (1.6; 1.1-2.5), renal insufficiency (1.7; 1.3-2.2), preoperative dialysis (1.4; 1.02-1.9), tibial angioplasty/stenting (1.3; 1.04-1.6), in-hospital bleeding (1.9; 1.04-3.5), in-hospital unplanned return to the operating room (1.9; 1.1-3.5), and discharge other than to home (1.5; 1.1-2.0). Risk factors for those with claudication were dependent functional status (3.5; 1.4-8.7), smoking (1.6; 1.02-2.5), diabetes (1.5; 1.01-2.3), preoperative dialysis (3.6; 1.6-8.3), procedure time exceeding 120 minutes (1.8; 1.1-2.7), in-hospital bleeding (2.9; 1.2-7.4), and in-hospital unplanned return to the operating room (3.4; 1.2-9.4). ConclusionsUnplanned readmission after endovascular treatment is relatively common, especially in patients with CLI, and is associated with substantially increased mortality. Awareness of these risk factors will help providers identify patients at high risk who may benefit from early surveillance, and prophylactic measures focused on decreasing postoperative complications may reduce the rate of readmission.

Transfemoral transcatheter aortic valve implantation in patients with small diseased peripheral vessels.

The aim of this study was to assess the feasibility, safety and short-term outcomes of transfemoral transcatheter aortic valve implantation (TF-TAVI) in patients with small diseased peripheral vessels. The transfemoral (TF) route for transcatheter aortic valve (TAVI) is the default option due to associated advantages. However, this is limited due to the high prevalence of significant peripheral arterial disease and increased risk of vascular complications. Of 539 consecutive patients undergoing TAVI in a single Italian center, 23 patients underwent TF-TAVI in the presence of small peripheral vessels as defined by a minimal luminal diameter (MLD) of ≤5.5mm [by computed tomography (CT)] and/or the inability to advance a large-bore sheath. Calcification was defined as being concentric if calcium extended more than 270° around the circumference of the artery. All patients underwent 30-day clinical follow-up. 17 (73.9%) patients underwent peripheral vessel pre-dilatation with a semi-compliant balloon and 6 (26.1%) patients with a Solopath sheath. 6 (26.1%) patients suffered a peri-procedural complication, with 1 patient requiring surgical embolectomy for thrombotic occlusion and the remaining patients successfully managed percutaneously in the catheter laboratory. No patient suffered a vessel perforation or required implantation of a covered stent. At 30-day follow-up, all patients were free of symptoms and signs or symptoms of peripheral vascular disease, with well-functioning TAVI prostheses as evaluated by echocardiography. Performing TF-TAVI is feasible in patients with no other viable vascular access option in the presence of small MLD and calcification of the peripheral vasculature, with any anticipated acute vascular complication managed in the catheter laboratory with established percutaneous techniques.

Cilostazol prevents retinal ischemic damage partly via inhibition of tumor necrosis factor‐α‐induced nuclear factor‐kappa B/activator protein‐1 signaling pathway

Cilostazol is a specific inhibitor of phosphodiesterase III and is widely used to treat ischemic symptoms of peripheral vascular disease. We evaluated the protective effects of cilostazol in a murine model of ocular ischemic syndrome in which retinal ischemia was induced by 5-h unilateral ligation of both the pterygopalatine artery (PPA) and the external carotid artery (ECA) in anesthetized mice. The effects of cilostazol (30 mg/kg, p.o.) on ischemia/reperfusion (I/R)-induced retinal damage were examined by histological, retinal vascular permeability, and electrophysiological analyses. Using immunoblotting, the protective mechanism for cilostazol was evaluated by examining antiinflammatory effects of cilostazol on the expression of tumor necrosis factors-α (TNF-α) and tight junction proteins (ZO-1 and claudin-5), and the phosphorylations of nuclear factor-kappa B (NF-κB) and c-Jun. The histological analysis revealed that I/R decreased the cell number in the ganglion cell layer (GCL) and the thicknesses of the inner plexiform layer (IPL) and inner nuclear layer (INL), and that cilostazol attenuated these decreases. Additionally, cilostazol prevented the hyperpermeability of blood vessels. Electroretinogram (ERG) measurements revealed that cilostazol prevented the I/R-induced reductions in a-, b-, and oscillatory potential (OP) wave amplitudes seen at 5 days after I/R. Cilostazol inhibited the increased expression of TNF-α and the phosphorylation levels of NF-κB and c-Jun in the retina after I/R. In addition, cilostazol prevented TNF-α-induced reduction of ZO-1 and claudin-5 expression in human retinal microvascular endothelial cells (HRMECs). These findings indicate that cilostazol may prevent I/R-induced retinal damage partly through inhibition of TNF-α-induced NF-κB/AP-1 signaling pathway.

Quantification of walking events in patients with Intermittent Claudication

Introduction: Intermittent claudication (IC) is a symptom of peripheral vascular disease and describes a cramp-like pain in the calf or thigh muscles, aggravated by physical activity (PA) and relieved by rest. Patients report needing to stop whilst walking, but few studies have attempted to quantify their walking patterns. The aim of this study was to compare the duration and cadence of free-living walking events of IC patients with aged-matched controls.

Ergotismo secundario a la asociación ergotamina-ritonavir: A propósito de 3 casos

Ergotism is a complication of the acute intoxication or chronic abuse of ergot derivatives. It may be manifested by a vasomotor syndrome with peripheral vascular disease frequently involving extremities. We report three patients infected with human immunodeficiency virus (HIV), in antiretroviral treatment (ART) that included a protease inhibitor as ritonavir, and had received self-medicated ergotamine. They developed symptoms of peripheral vascular disease and the physical examination showed no arterial pulses in the affected vessels. Arterial Doppler confirmed signs of diffuse arterial spasm in all of them. An arteriography was performed to the second patient and it showed obliteration of the distal sector of the ulnar and radial arteries. Ergotism secondary to ergotamine-ritonavir association was diagnosed. Patients were treated discontinuing the administration of involved drugs, arterial vasodilators and prophylactic anticoagulation, with marked improvement of symptoms.

The Role of the Wnt Antagonist Dickkopf-1 Gene in Oral Squamous Cell Carcinoma

influenced the side from which a fibular flap can be harvested, or in cases with bilateral abnormalities a different flap all together. These results are comparable to studies done by other authors that showed pre-operative imaging influencing reconstruction in 21-25% of patients. Proponents against routine preoperative imaging have used clinical examination coupled with a history of diagnosis or symptoms of peripheral vascular disease to guide the need for pre-operative studies. Arguments against this are due to the relatively high rate of congenital abnormalities that would be missed with this screening. In this review we find a total of 6 patients (8%) with positive pre-operative studies due to congenital abnormalities versus 10 patients (13%) being due to acquired abnormalities, mainly arthrosclerotic plaques. In a study of 495 lower extremity angiograms there was an overall 5.6% of variant trifurcation of the popliteal artery, leading to 2 and rarely 1 vessel runoff to the foot. The results of this study and others highlight the importance of pre-operative imaging prior to fibular flap transfer to identify both acquired and congenital abnormalities in order to decrease risk of vascular compromise to the lower extremity.

An assessment of peripheral vascular disease in patients with diabetic foot ulcer

Background Peripheral vascular disease (PVD) is a chronic limb ischaemia caused by atherosclerosis of the peripheral arteries. Diabetes mellitus is a risk factor for this disease. The most common symptom of PVD is muscle pain in the lower limbs on exercise. In diabetes, pain perception may be blunted by the presence of peripheral neuropathy. Therefore, a patient with diabetes and PVD is more likely to present with an ischaemic ulcer or gangrene than a patient without diabetes. The use of ankle-brachial-pressure index (ABI) in the clinic and bedside provide a measure of blood flow to the ankle. This could help early detection, initiate early therapy and may thus reduce the risk of critical limb ischaemia and limb loss. Objective The purpose of this study is to evaluate the occurrence of peripheral vascular disease using ankle-brachial index in diabetic patients with and without foot ulcers and the risk factors associated with diabetic foot ulcer (DFU). Method This prospective study involved all type 2 DM patients with foot ulcer (DFU population) and those without foot ulcers (non-DFU population) seen in our hospital. Their demographic, clinical and laboratory parameters were noted and documented. Measurement of ABI was done using a portable hand held Doppler and ankle pressures < 0.9 is suggestive of PVD. Results A total of 74 patients were recruited. Males were 42 (56.8%) and females were 32 (43.2%). The mean age of the patients was 62.89 ± 10.66 years and the duration of diabetes was 7.61 ± 7.57 years. Forty-six (62.2%) presented with foot ulcer while 28 (37.8%) were without foot ulcer. Patients with PVD represented by ABI < 0.9 was DFU 31(76.4%) while in non-DFU it was 10 (13.4%). Multivariant analysis of variables associated with DFU in those with ABI < 0.9 showed correlation with tobacco use r = .235, p = 0.044; duration of diabetes r = −.427; p = 0.001; and systolic blood pressure r = −.301; p = 0.009. Discussion The occurrence of PVD determined by the absence of >2 pulses by palpation alone and using ABI was 25.7% and 55.4% respectively. This suggests that assessment by palpation is subjective while the use of Doppler is quantitative and more reliable. DFU patients with PVD showed a significant correlation with tobacco use, duration of diabetes and systolic blood pressure but not with dyslipidaemia. Conclusion This study shows that these patients had risk factors for PVD. The use of hand held Doppler will aid early diagnosis of critical limb at risk of loss and help to prevent and reduce the high rate of limb loss in our patients.

Cilostazol is anti‐inflammatory in BV2 microglial cells by inactivating nuclear factor‐kappaB and inhibiting mitogen‐activated protein kinases

Cilostazol is a specific inhibitor of 3'-5'-cyclic adenosine monophosphate (cAMP) phosphodiesterase, which is widely used to treat ischemic symptoms of peripheral vascular disease. Although cilostazol has been shown to exhibit vasodilator properties as well as antiplatelet and anti-inflammatory effects, its cellular mechanism in microglia is unknown. In the present study, we assessed the anti-inflammatory effect of cilostazol on the production of pro-inflammatory mediators in lipopolysaccharide (LPS)-stimulated murine BV2 microglia. We examined the effects of cilostazol on LPS-induced nuclear factor-kappaB (NF-kappaB) activation and phosphorylation of mitogen-activated protein kinases (MAPKs). Cilostazol suppressed production of nitric oxide (NO), prostaglandin E(2) (PGE(2)) and the proinflammatory cytokines, interleukin-1 (IL-1), tumour necrosis factor-alpha, and monocyte chemoattractant protein-1 (MCP-1), in a concentration-dependent manner. Inhibitory effects of cilostazol were not affected by treatment with an adenylate cyclase inhibitor, SQ 22536, indicating that these actions of cilostazol were cAMP-independent. Cilostazol significantly inhibited the DNA binding and transcriptional activity of NF-kappaB. Moreover, cilostazol blocked signalling upstream of NF-kappaB activation by inhibiting extracellular signal-regulated kinases 1 and 2 (ERK1/2) and c-Jun N-terminal kinase (JNK), but without affecting the activity of p38 MAPK. Our results demonstrate that suppression of the NF-kappaB, ERK, JNK signalling pathways may inhibit LPS-induced NO and PGE(2) production. Therefore, cilostazol may have therapeutic potential for neurodegenerative diseases by inhibiting pro-inflammatory mediators and cytokine production in activated microglia.