Incidental Finding of Chronic Lymphocytic Leukemia After Podiatric Surgery: Case Report.

Chronic lymphocytic leukemia (CLL) is hematopoietic neoplasm that typically remains insidious and undetected until symptoms arise. We present a patient that underwent podiatric surgery for a symptomatic bunion at the Veteran Affairs Medical Center Northport with resultant incidental finding of CLL. This facility mandates that all excised bone and tissue be submitted for gross examination by a pathologist. This case highlights the potential benefit of pathological examination of bone specimens for potential early detection of pathologies.

Choosing a Vibratory Test to Pair With Semmes Weinstein Monofilament Testing for Evaluating Lower Extremity Sensation in Patients With Diabetes: A Comparison of Three Vibratory Methodologies.

BACKGROUND: Numerous guidelines recommend pairing Semmes-Weinstein monofilament (SWM) testing with a secondary clinical test when screening for diabetic peripheral neuropathy, yet time is very limited in clinical practice. This study compared the time to complete and the diagnostic agreement of three vibratory sensation tests. METHODS: Sixty-five individuals (42% male; aged: 61 ± 12 years) were recruited. A single investigator administered the following tests bilaterally: 10-site SWM, traditional tuning fork (TTF), electronic tuning fork (ETF), and vibration perception threshold (VPT) via biothesiometer. Times to physically administer the tests were compared with a one-way repeated measures ANOVA. Cochran's Q test was used to compare the varied tests' diagnostic agreement. RESULTS: The ANOVA indicated there were significant (P < .001, partial eta squared = .442) differences in time to complete the varied tests. Sidak post hoc comparisons indicated the VPT (21.2 ± 14.3) testing took an intermediate time to complete, while the ETF (9.7 ± 6.5) and TTF (10.1 ± 7.5) tests took the least amount of time, and the SWM (28.6 ± 8.4) test took the longest time. There were also numerous significant differences (P ≤ .001) between the different tests in regards to neuropathy diagnoses. CONCLUSIONS: Tuning fork methods required 11 seconds less to administer than VPT testing. Although that may seem trivial, it is worth noting peripheral neuropathy screening often fails to occur in the precious few minutes clinicians are allotted per patient. Considering ETF's intrinsic control of stimulus amplitude and its ease of use with an embedded timer, the ETF is recommended over the TTF. Clinicians should also be mindful that different tests yield different diagnostic conclusions.

Educating Orphaned and Vulnerable Children in Elgeyo-Marakwet County, Kenya.

According to UNICEF, 13.3 million children (0-17 years) worldwide have lost one or both parents to AIDS. Nearly 12 million of these children live in sub-Saharan Africa. Together, with other children who have been severely impacted by the AIDS pandemic, these orphaned and vulnerable children (OVC) are at higher risk of missing out on schooling, living in households with less food security, and suffering from anxiety and depression. Although the needs of OVC are complex and influenced by numerous variables, the provision of education has the potential to address many aspects of a child's well-being, including food and nutrition, health care, social welfare, and protection. Drawing on data collected using the Orphans and Vulnerable Children (OVC) Well-being Tool in one area of Kenya, the authors of this study describe their findings on the educational well-being of the surveyed children and present recommendations for teachers on how to better support the diverse needs of OVCs.