The foot in type 2 diabetes: is there a link between vascular calcification and bone mineral density?

Aims

To examine the relationship between vascular calcification in the foot (FVC) and bone mineral density (BMD) in the heel of type 2 diabetes mellitus (DM) subjects.

Methods

65 subjects with type 2 DM and serum creatinine < 125 μmol/l underwent CT scanning of the foot to assess FVC and dual energy X ray absorptiometry (DEXA) scan to assess heel BMD. Routine biochemistry including osteoprotegerin (OPG) and Receptor activator of nuclear factor kappa-B ligand (RANKL) was also carried out.

Results

The proportion of subjects with FVC was 43%, whilst 40% had low BMD (T score < −1.0). Age, neuropathy and 25 hydroxyvitamin D were independent predictors of FVC. Body-weight, eGFR, 25 hydroxyvitamin D, OPG, and total cholesterol were independent predictors of low heel BMD. There was no correlation between albuminuria and BMD or FVC. There was no difference in heel BMD between those with FVC and those without, but those with frank osteoporosis were significantly more likely to have FVC than those with higher BMD.

Conclusions

There is no clear-cut association between FVC and low BMD in type 2 DM with relatively well-preserved renal function. Age, neuropathy, eGFR, hyperlipidemia, body-weight, 25 hydroxyvitamin D and OPG play a complex role in their pathogenesis.     

Tuberculosis in children: New diagnostic blood tests

The interferon-gamma-release assays were developed to overcome the pitfalls and logistic difficulties of the tuberculin skin test (TST) for the diagnosis of latent tuberculosis infection (LTBI). These blood tests measure the in vitro production of interferon-gamma by sensitized lymphocytes in response to Mycobacterium tuberculosis-specific antigens. Two interferon-gamma-release assays are registered for use in Canada: the QuantiFERON-TB Gold In-Tube assay (Cellestis Inc, Australia) and the T.SPOT–TB test (Oxford Immunotec, United Kingdom). Evaluation of these tests has been hampered by the lack of a gold standard for LTBI, and limited paediatric data on their use. It appears that they are more specific than the TST, and may be useful for evaluating TST-positive patients at low risk of true LTBI. Moreover, they may add sensitivity if used in addition to the TST in immunocompromised patients, very young children and close contacts of infectious adults. A summary of these tests, their limitations and their application to clinical paediatric practice are described.     

The Basic Knowledge Assessment Tool: Is It Useful?

Registered Nurses (RN's) caring for the critically ill, require a wide range of specialised skills and knowledge. Assessing knowledge of RN's within Intensive Care Units (ICU's) is imperative if we are to ensure that patients are afforded quality care. The aim of this study was to evaluate existing knowledge of the RN's working in the ICU of a major teaching hospital using the Basic Knowledge Assessment Tool (BKAT).Overall mean test scores of 78% were encouraging. Knowledge gaps were evident in gastrointestinal and endocrine disorders. Significantly higher scores were obtained by RN's trained in the hospital based system (p=0.02) and those possessing ICU qualifications (p=0.01). There were no differences in scores according to age and length of ICU experience. Registered nurses scored badly in a number of questions, which highlighted some problems in the terminology used in the BKAT.     

Leaking mycotic abdominal aortic aneurysm

A case of leaking mycotic abdominal aortic aneurysm is reported, with a brief review of the literature. A 58 year old female presented with shoulder and abdominal pain associated with diarrhoea, vomiting and fever with leucocytosis. Computed tomography of the abdomen showed pooling of contrast in the retroperitoneum anterior to a non-dilated abdominal aorta. There was considerable retroperitoneal blood accumulating in a mass-like lesion in the right lower abdomen and pelvis obstructing the right renal collecting system. Laparotomy revealed a 4 cm diameter saccular aneurysm of the abdominal aorta, with a 1 cm diameter neck. Culture of the thrombus grew Streptococcus pyogenes.