An atypical and bilateral presentation of Charcot foot disease.

BACKGROUND: Charcot neuropathic osteoarthropathy (CNO) is one of the most devastating complications of neuropathy in patients with diabetes. Establishing diagnosis of CNO is difficult, due to the lack of clear clinical and radiological diagnostic criteria. Diagnosis is even more difficult when there is atypical and bilateral clinical presentation. Since CNO may lead to foot deformity, lower-extremity amputation and significant decrements in quality of life, it must be detected and treated without delay. Treatment focuses mainly on interruption of the inflammatory process and relief from pain using feet offloading devices. In more severe cases, surgical intervention may be needed. Additionally, the use of custom-made insoles and custom-made orthopaedic shoes is mandatory. CASE PRESENTATION: We report a case of a young diabetic patient who presented to our clinic with bilateral and atypical presentation of Charcot foot disease. Patient was treated successfully upon diagnosis with bilateral aircast offloading. Unfortunately, due to depression and non-compliance, the disease progressed to severe and permanent lesions later on. CONCLUSION: Despite the rareness of this disease, clinicians must include CNO into differential diagnosis of diabetic foot oedema, inflammation and deformity.

Successful nonsurgical therapy of a diabetic foot osteomyelitis in a patient with peripheral artery disease with almost complete radiological restoration.

BACKGROUND: Diabetic foot ulcer (DFU) is a common complication in patients with diabetes mellitus (DM) and can consequently lead to soft tissue infection and osteomyelitis. CASE PRESENTATION: We present a case of a 68-year-old man with a history of Type 2 DM and symptomatic peripheral artery disease, referred to our hospital due to an infected lower extremity DFU. Cultures revealed methicillin-resistant Staphylococcus aureus and Stenotrophomonas maltophilia. There was a significant increase of inflammatory marker levels and plain X-rays revealed osteomyelitis. He underwent lower extremity angioplasty for the restoration of the blood flow. He received targeted intravenous antibiotic therapy for 2 weeks and continued ciprofloxacin along with clindamycin per os for 10 more weeks as outpatient. CONCLUSION: As a result, the patient presented almost complete healing of his DFU, reconstruction of osteomyelitis defects in X-ray and complete restoration of his foot functionality only 4 months after the end of the treatment. This case demonstrates a DFU complicated by osteomyelitis which resolved medically and nonsurgically, with the exception of surgical restoration of the blood flow.

Gender differences in human immunodeficiency virus (HIV) RNA and CD4 cell counts among new entrants to HIV care.

Clinic database extraction identified 806 new entrants to human immunodeficiency virus (HIV) care in Cleveland, OH, USA. At entry, women had higher CD4 counts and lower HIV RNA levels than men (mean, 388 vs. 310 cells/microL, and 8.94 x 10(4) vs. 1.27 x 10(5) copies/mL, respectively), but the proportion of entrants with category C illnesses, category B conditions, sexually transmitted diseases and CD4 counts < 200 microL did not differ between genders. Hepatitis B seroprevalence was higher in men (8.7% vs. 0.6%), but there was no difference in hepatitis C prevalence. Whether women in Cleveland seek HIV care earlier, or whether early markers of HIV disease differ between the genders, remains to be determined.

Infective endocarditis in Greece: a changing profile. Epidemiological, microbiological and therapeutic data.

The epidemiology, and clinical and microbiological spectrum, of infective endocarditis (IE) in Greece was analysed in a prospective 4-year study in a tertiary hospital and a heart surgery centre in Athens. In total, 101 cases of IE (71 men, 30 women, aged 54.4 +/- 17.1 years) were studied, with a follow-up period of 3 months. Seventy-seven cases were definite and 24 possible; 59 involved native valves (native valve endocarditis; NVE), 31 prosthetic valves (prosthetic valve endocarditis; PVE), of which nine were early and 22 late, and 11 permanent pacemakers (pacemaker endocarditis; PME). There was a predominant involvement of aortic (48/101) and mitral (40/101) valves. Seven patients had rheumatic valvular disease, two had mitral valve prolapse, and eight had a previous history of IE. Thirteen and six patients had undergone dental and endoscopic procedures, respectively. In 13 patients, intravenous catheters were used within the 3 months before diagnosis of IE. There were three intravenous drug users among the patients. Staphylococcus aureus was the most important pathogen, isolated in 22% of cases, followed by viridans streptococci (19%) and coagulase-negative staphylococci (16%). Enterococcus spp. were responsible for 3%, HACEK group for 2%, and fungi for 6% of cases. Viridans streptococci were the leading cause of NVE (29%), Staphylococcus epidermidis of PVE (16%), and S. aureus of PME (54.5%). Six of 22 S. aureus and ten of 16 S. epidermidis isolates were methicillin-resistant. Surgical intervention, including total pacemaker removal, was performed in 51.5% of patients. Overall mortality was 16%, but was 29% with PVE, and was significantly higher with medical than with combined surgical and medical therapy (24.5% vs. 8%). Compared with previous studies, there were changing trends in the epidemiology, microbiology, treatment and prognosis of IE in Greece.