Relationship between self-reported high-heeled shoe use and bone mineral density using quantitative ultrasound at a community health fair.

This is the first known study to examine the relationship between high-heel use and bone mineral density (BMD). Because women are disproportionately affected by osteoporosis, it is important to identify possible modifiable behaviors of women that may adversely affect bone health. Many studies have shown changes in body mechanics when wearing high-heeled shoes in comparison to normal gait. Because the composition of bone changes according to mechanical load and muscle activity, this study investigates whether wearing high heels may alter BMD. Two hundred and twenty-one participants at a community health fair in Lansing, Michigan, were surveyed on high-heel use and bone health risk (gender, thin/small frame, fair skin, family history of fracture, smoking history, walking, dairy consumption, and early menopause or oopherectomy at <45 years old). Quantitative ultrasound (QUS) of the heel by Hologic's Sahara Sonometer was used to measure BMD. The mean age was 45.2 (SD 13.7) years, and the majority of participants were female (208, 94 %). A significant difference between mean BMD and high-heel use was not found. Independent correlations existed between fair skinned/sunburn easily and BMD, r(212) = -0.14, p = 0.038, as well as history of smoking and BMD, r(212) = -0.14, p = 0.042. Bone health risk score was strongly correlated with heel use binary variable "yes/no," r(210) = 0.21, p = 0.003. Our study suggests that wearing high-heeled shoes does not lead to appreciable differences in BMD among community health fair participants as assessed by QUS.

Giant cell arteritis of the thyroid in a 69-year-old male.

We report the case of a 69-year-old Caucasian male with a histological confirmed diagnosis of giant cell arteritis (GCA) of the thyroid. To our knowledge this is the second reported case of GCA of the thyroid with a histological confirmed diagnosis. Unique to this case is that our patient did not have the simultaneous occurrence of a positive temporal artery biopsy or classic symptoms of temporal arteritis. The patient presented with fever of unknown origin, and fatigue. Laboratory reports included a sedimentation rate of >100 mm/h and C-reactive protein level of 17.1 mg/dL. Goiter with irregular calcifications was found on the computed tomography image. Temporal artery biopsy was negative. The patient continued to have intermittent fever after discharge and was readmitted to the hospital 41 days after discharge for fever and increasing fatigue. The thyroid was resected to rule out neoplasia. Granulomatous GCA was identified within the thyroid specimen.

Tattooing: medical uses and problems.

Decorative tattooing is a custom thousands of years old and is growing in popularity today. Medical professionals may be less familiar with its medical applications-medical alert tattooing, reconstructive and cosmetic applications, endoscopic tattooing, corneal tattooing, tattooing in radiation oncology, and uses in forensic medicine. We review current medically related tattooing applications and discuss their potential risks and benefits.

Asymptomatic severe hypocalcemia secondary to vitamin d deficiency in an elderly patient.

Objective. To describe an asymptomatic presentation of severe hypocalcemia secondary to vitamin D deficiency in an elderly patient. Methods. We describe the presentation and clinical course of an elderly woman with asymptomatic severe hypocalcemia referred to an endocrinology clinic for hyperparathyroidism. Results. The patient is an 83-year-old Caucasian woman who presented to an endocrinology clinic for evaluation of hyperparathyroidism, with an intact PTH of 462 pg/mL (normal range 14-72 pg/mL). The same lab report included a serum calcium of 5.2 mg/dL (normal range 8-10.5 mg/dL). She displayed no signs or symptoms of hypocalcemia. Given the extreme severity of hypocalcemia and her age, she was hospitalized. Vitamin D deficiency was suspected and was subsequently confirmed with undetectable serum levels. The patient remained asymptomatic throughout her hospital stay. Total and ionized calcium levels at discharge were 7.2 mg/dL and 1.03 mmol/L (normal range 1.1-1.4 mmol/L), respectively. Conclusion. Physicians should exercise prudent management with respect to the vitamin D status of the elderly patient, as certain patients may exhibit severe hypovitaminosis D and hypocalcemia without apparent clinical symptoms.

Relationship between depressive symptoms and cardiovascular risk factors among selected Latino patients at a community clinic.

The objective of this study was to explore the relationship between severity of depression and cardiovascular disease (CVD) risk factors among selected Latino patients within a primary care setting. We conducted a cross-sectional analysis of 164 low-income Latino patients at San Ysidro Health Center (SYHC) who had been recruited into a mental health program between January 2007 and March 2008. Patients were between the ages of 18 and 83 years, 54 were males and 109 females. Patients were screened using the 9-item patient health questionnaire (PHQ-9), a standardized instrument used to measure depression severity. We used regression models to analyze the relationship between severity of depression and CVD risk factors. Seventy-eight percent of the patients had at least mild depression based on PHQ-9 score categories. Significant age-adjusted pairwise associations were found with CVD risk factors; body mass index (BMI), diabetes status, serum cholesterol level, and serum triglyceride level were all associated with depression severity score. Regression models indicated that diabetic patients on anti-depressive medication with higher BMI scores and triglyceride levels had significantly higher depression severity scores. Clinicians should be made aware that depressive symptoms may impede efforts to modify BMI, serum triglycerides, anti-depression medication, and diabetes among Latino patients. They should, therefore, screen and treat depression among Latinos at risk to CVD.