CASE REPORT: A 69-year-old woman presented with fever and lower limb swelling. She had diabetes mellitus, hypertension, dyslipidaemia and a history of surgical resection of vulvar carcinoma. N. meningitidis was isolated from her blood culture.
DISCUSSION: This report provides additional evidence in support of N. meningitidis as a cause of cellulitis.
Methods: We used diffusion MRI and probabilistic tractography to identify the putative white matter connectivity in the brains of 10 CP patients. We tracked the corticospinal tract (CST) of the patients' upper and lower limbs and calculated the white matter connectivity, as indexed by streamlines representing the probability of connection of the CST.
Results: Our results show that diffusion MRI with probabilistic tractography, while having some relation with the clinical diagnosis of CP, reveals a high degree of individual variation in the streamlines representing the CST for upper and lower limbs.
Conclusion: Diffusion MRI with probabilistic tractography provides the state of connectivity from lesioned areas to other parts of the brain and is potentially beneficial to be used as an adjunct to the clinical management of CP, providing a means to monitor intervention outcomes.
METHODS: A cross-sectional study using self-developed survey form was conducted at 13 Medical Rehabilitation Clinics in Malaysia among 541 upper and lower limb amputees of any duration and cause.
RESULTS: The study population had a mean age of 54 years. Majority were males, Malays, married and had completed secondary school. About 70% of amputations were performed due to DM complications and at transtibial level. Fifty-eight percent of unilateral lower limb amputees were using prosthesis with a mean (standard deviation) of 6.48 (±4.55) hours per day. Time since amputation was the true factor associated with prosthesis usage. Longer hours of prosthesis use per day was positively correlated with longer interval after prosthesis restoration (r=0.467).
CONCLUSION: Higher aetiology of DM and lower prosthesis usage among amputees may be because of high prevalence of DM in Malaysia. The prosthesis usage and hours of use per day were low compared to the international reports, which may be influenced by sampling location and time since amputation. Nevertheless, this is a novel multicentre study on the characteristics and prosthesis usage of amputees. Hopefully, this research will assist to support, facilitate and promote prosthesis rehabilitation in Malaysia.
OBJECTIVE: To investigate the effect of hand position and lower limb length measurement method on LQ-YBT scores and their interpretation.
DESIGN: Cross-sectional study.
SETTING: National Sports Institute of Malaysia.
PATIENTS OR OTHER PARTICIPANTS: A total of 46 volunteers, consisting of 23 men (age = 25.7 ± 4.6 years, height = 1.70 ± 0.05 m, mass = 69.3 ± 9.2 kg) and 23 women (age = 23.5 ± 2.5 years, height = 1.59 ± 0.07 m, mass = 55.7 ± 10.6 kg).
INTERVENTION(S): Participants performed the LQ-YBT with hands on hips and hands free to move on both lower limbs.
MAIN OUTCOME MEASURE(S): In a single-legged stance, participants reached with the contralateral limb in each of the anterior, posteromedial, and posterolateral directions 3 times. Maximal reach distances in each direction were normalized to lower limb length measured from the anterior-superior iliac spine to the lateral and medial malleoli. Composite scores (average of the 3 normalized reach distances) and anterior-reach differences (in raw units) were extracted and used to identify participants at risk for injury (ie, anterior-reach difference ≥4 cm or composite score ≤94%). Data were analyzed using paired t tests, Fisher exact tests, and magnitude-based inferences (effect size [ES], ±90% confidence limits [CLs]).
RESULTS: Differences between hand positions in normalized anterior-reach distances were trivial (t91 = -2.075, P = .041; ES = 0.12, 90% CL = ±0.10). In contrast, reach distances were greater when the hands moved freely for the normalized posteromedial (t91 = -6.404, P < .001; ES = 0.42, 90% CL = ±0.11), posterolateral (t91 = -6.052, P < .001; ES = 0.58, 90% CL = ±0.16), and composite (t91 = -7.296, P < .001; ES = 0.47, 90% CL = ±0.11) scores. A similar proportion of the cohort was classified as at risk with the hands on the hips (35% [n = 16]) and the hands free to move (43% [n = 20]; P = .52). However, the participants classified as at risk with the hands on the hips were not all categorized as at risk with the hands free to move and vice versa. The lower limb length measurement method exerted trivial effects on LQ-YBT outcomes.
CONCLUSIONS: Hand position exerted nontrivial effects on LQ-YBT outcomes and interpretation, whereas the lower limb length measurement method had trivial effects.
METHODS: In an international, randomized, double-blind, parallel-group study, symptomatic individuals classified CEAP C0s to C4s were randomized in either treatment arm and treated for 8 weeks. Lower limb symptoms (discomfort, pain and heaviness) were assessed using Visual Analog Scales (VAS), and quality of life (QoL) was measured with the CIVIQ-20 Questionnaire.
RESULTS: A total of 1139 patients were included in the study. Both MPFF treatment regimens were well tolerated and associated with a significant reduction in lower limb symptoms. A non-inferiority of MPFF 1000-mg oral suspension once daily compared to MPFF 500-mg tablet twice daily (P<0.0001) was found for lower limb discomfort (-3.33 cm for MPFF 1000 mg and -3.37 cm for MPFF 500 mg), leg pain (-3.27 cm for MPFF 1000 mg and -3.31 cm for MPFF 500 mg) and leg heaviness (-3.41 cm for MPFF 1000 mg and -3.46 cm for MPFF 500 mg). The patients' QoL was improved by about 20 points on the CIVIQ scale in both groups (19.33 points for MPFF 1000 mg and 20.28 points for MPFF 500 mg).
CONCLUSIONS: MPFF 1000-mg oral suspension and MPFF 500-mg tablets treatments were associated with similar reductions in lower limb symptoms and QoL improvement. The new once daily MPFF1000-mg oral suspension has a similar safety profile to two tablets of MPFF 500 mg, with the advantage of one daily intake, potentially associated with improved patient adherence and easier CVD management.
Materials and Methods: Sixty-three diabetic foot patients admitted from June 15, 2019 to February 15, 2020. Methods included one-on-one interview for clinico-demographic data, physical examination to determine the classification. Patients were followed-up and outcomes were determined. Pearson Chi-square or Fisher's Exact determined association between clinico-demographic data, the classifications, and outcomes. The receiver operating characteristic (ROC) curve determined predictive abilities of classification systems and paired analysis compared the curves. Area Under the Receiver Operating Characteristic Curve (AUC) values used to compare the prediction accuracy. Analysis was set at 95% CI.
Results: Results showed hypertension, duration of diabetes, and ambulation status were significantly associated with major amputation. WIFi showed the highest AUC of 0.899 (p = 0.000). However, paired analysis showed AUC differences between WIFi, Wagner, and University of Texas classifications by grade were not significantly different from each other.
Conclusion: The WIFi, Wagner, and University of Texas classification systems are good predictors of major amputation with WIFi as the most predictive.
CASE PRESENTATION: A 42-year-old Chinese man presented with polytrauma (severe head injury, lung contusions, and right femur fracture). Emergency craniotomy and debridement of right thigh wound were performed on presentation. Intraoperative hypotension secondary to bleeding was complicated by transient need for vasopressors and acute liver enzyme elevation indicating shock liver. Beginning on postoperative day 5, he developed an acute platelet count fall (from 559 to 250 × 109/L over 3 days) associated with left iliofemoral deep vein thrombosis that evolved to bilateral lower limb ischemic necrosis; ultimately, the extent of limb ischemic injury was greater in the left (requiring below-knee amputation) versus the right (transmetatarsal amputation). As the presence of deep vein thrombosis is a key feature known to localize microthrombosis and hence ischemic injury in venous limb gangrene, the concurrence of unilateral lower limb deep vein thrombosis in a typical clinical setting of symmetrical peripheral gangrene (hypotension, proximate shock liver, platelet count fall consistent with disseminated intravascular coagulation) helps to explain asymmetric limb injury - manifesting as a greater degree of ischemic necrosis and extent of amputation in the limb affected by deep vein thrombosis - in a patient whose clinical picture otherwise resembled symmetrical peripheral gangrene.
CONCLUSIONS: Concurrence of unilateral lower limb deep vein thrombosis in a typical clinical setting of symmetrical peripheral gangrene is a potential explanation for greater extent of acral ischemic injury in the limb affected by deep vein thrombosis.
CONCLUSIONS: This first clinical report on CONFNT demonstrated a feasible good alternative in treating young patients with AFM with unilateral L2-L4 palsy and short duration of deficit.