Diabetic foot syndrome: Immune-inflammatory features as possible cardiovascular markers in diabetes

Diabetic foot ulcerations have been extensively reported as vascular complications of diabetes mellitus associated with a high degree of morbidity and mortality. Diabetic foot syndrome (DFS), as defined by the World Health Organization, is an “ulceration of the foot (distally from the ankle and including the ankle) associated with neuropathy and different grades of ischemia and infection”. Pathogenic events able to cause diabetic foot ulcers are multifactorial. Among the commonest causes of this pathogenic pathway it’s possible to consider peripheral neuropathy, foot deformity, abnormal foot pressures, abnormal joint mobility, trauma, peripheral artery disease. Several studies reported how diabetic patients show a higher mortality rate compared to patients without diabetes and in particular these studies under filled how cardiovascular mortality and morbidity is 2-4 times higher among patients affected by type 2 diabetes mellitus. This higher degree of cardiovascular morbidity has been explained as due to the observed higher prevalence of major cardiovascular risk factor, of asymptomatic findings of cardiovascular diseases, and of prevalence and incidence of cardiovascular and cerebrovascular events in diabetic patients with foot complications. In diabetes a fundamental pathogenic pathway of most of vascular complications has been reported as linked to a complex interplay of inflammatory, metabolic and procoagulant variables. These pathogenetic aspects have a direct interplay with an insulin resistance, subsequent obesity, diabetes, hypertension, prothrombotic state and blood lipid disorder. Involvement of inflammatory markers such as IL-6 plasma levels and resistin in diabetic subjects as reported by Tuttolomondo et al confirmed the pathogenetic issue of the a “adipo-vascular” axis that may contribute to cardiovascular risk in patients with type 2 diabetes. This “adipo-vascular axis” in patients with type 2 diabetes has been reported as characterized by lower plasma levels of adiponectin and higher plasma levels of interleukin-6 thus linking foot ulcers pathogenesis to microvascular and inflammatory events. The purpose of this review is to highlight the immune inflammatory features of DFS and its possible role as a marker of cardiovascular risk in diabetes patients and to focus the management of major complications related to diabetes such as infections and peripheral arteriopathy.     

Puberty in girls of the 21st century

Several studies have noted contemporary girls are undergoing pubertal maturation at younger ages. During this same time period many Western nations have experienced an obesity epidemic, prompting investigators and public health officials to consider the association of these 2 events, and if other exposures might impact this relationship. There are several potential mechanisms that could impact the relationship of pubertal timing in girls with greater body mass, including direct effects of obesity on pubertal timing as well underlying exposures that impact body mass as well as timing of pubertal maturation. These underlying conditions include chemical compounds that could impact synthesis or action of sex hormones, called endocrine disrupting chemicals (EDs). We examine the decline in the age of breast development and potential genetic and environmental influences, the obesity epidemic in the US and other nations, and potential mechanisms to explain the relationship between greater body mass index with earlier puberty in girls.     

Role of a point-of-care protease activity diagnostic test in Canadian clinical practice: a Canadian expert consensus ©

Nonhealing wounds (stalled, healable) challenge affected individuals, wound clinicians, and society. Nonhealing may result despite local factors being corrected. The interplay between tissue degradation, increased inflammatory response, and abundant protease activity is a challenging quandary. A modified Delphi process was utilized to investigate a protease activity test and practice implications.     

Symptoms associated with malignant wounds: a prospective case series

A significant proportion of cancer patients develop malignant wounds. Malignant wounds are generally nonhealable and are managed with palliative methods. Palliative wound care encompasses the pain and symptom management of such wounds. Sixty-seven of 472 cancer patients from a prospective sequential case series of palliative medicine consultations demonstrated malignant wounds at the time of referral and were studied to determine the most common symptoms and anatomic sites associated with malignant wounds. Data were collected from patients' own reports of up to three wound-related symptoms. Overall, 67.7% of malignant wounds were associated with at least one of the following eight symptoms: pain, mass effect, esthetic distress, exudation, odor, pruritus, bleeding, and crusting; 21.9% of wounds were associated with two or more symptoms; and 11.5% of wounds were associated with three symptoms. The symptom point prevalence was 31.3% for pain, 23.9% for mass effect, 19.4% for esthetic distress, 17.9% for exudation, 11.9% for odor, 6% for pruritus, 6% for bleeding, and 1.5% for crusting. Breast cancer patients had the highest prevalence of malignant wounds (47.1%). The anterior chest wall and breast was the site of 31.2% of wounds. The perineum and genitalia presented with the highest ratio of symptoms per wound (2.2). The results of this study reflect that malignant wounds are associated with a significant symptomatic burden, and reinforces the need for thorough clinical assessment and evaluation of symptoms. Further research is required to define the optimal methods of pain and symptom management for malignant wounds.     

Associations Between Neighborhood Resources and Physical Activity in Inner-City Minority Children

ObjectiveThe role of neighborhood physical activity resources on childhood physical activity level is increasingly examined in pediatric obesity research. We describe how availability of physical activity resources varies by individual and block characteristics and then examine its associations with physical activity levels of Latino and black children in East Harlem, New York City.MethodsPhysical activity resource availability by individual and block characteristics were assessed in 324 children. Availability was measured against 4 physical activity measures: average weekly hours of outdoor unscheduled physical activity, average weekly metabolic hours of scheduled physical activity, daily hours of sedentary behavior, and daily steps.ResultsPhysical activity resource availability differed by race/ethnicity, caregiver education, and income. Presence of one or more playgrounds on a child's block was positively associated with outdoor unscheduled physical activity (odds ratio [OR] = 1.95, 95% confidence interval [CI] 1.11–3.43). Presence of an after-school program on a child's block was associated with increased hours of scheduled physical activity (OR = 3.25, 95% CI 1.41–7.50) and decreased sedentary behavior (OR = 3.24, 95% CI 1.30–8.07). The more resources a child had available, the greater the level of outdoor unscheduled physical activity (P for linear trend = .026).ConclusionsNeighborhood physical activity resource availability differs by demographic factors, potentially placing certain groups at risk for low physical activity level. Availability of select physical activity resources was associated with reported physical activity levels of East Harlem children but not with objective measures of physical activity.