Doença falciforme: cuidado com pessoas com úlcera da perna nos serviços de atenção à saúde / Sickle cell disease: caring for people with leg ulcers in heal-thcare services / Enfermedad falciforme: cuidado de personas con úlcera de pierna en los servicios de atención a la salud

Objetivo: identificar o local e os cuidados diretos recebidos por pessoas com úlceras da perna por doença falciforme nos serviços de atenção à saúde. Método: estudo transversal, realizado em 11 centros, no período de agosto de 2019 a abril de 2020. Fizeram parte do estudo 72 pessoas com úlcera da perna ativa. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultado: apresentavam anemia falciforme 91,7% dos participantes, com mediana de três anos de existência da úlcera; 77,8% eram redicivantes; 40,3% compravam os insumos; 66,7% trocavam o próprio curativo no domicílio; 52,8% realizavam uma ou mais trocas diárias; 45,8% dos tratamentos foram prescritos pelo médico; 37,5% eram pomada (colagenase ou antibiótico); 89% não utilizavam compressão para o manejo do edema. Conclusão: a maioria dos participantes não estava inserida na Rede de Atenção à Saúde para o tratamento da úlcera, e não recebia assistência sistematizada e nem insumos apropriados.

Objective: to identify the location and direct care received by people with leg ulcers due to sickle cell disease in health care services. Method: a cross-sectional study carried out in 11 centers from August 2019 to April 2020. The study included 72 people with active leg ulcers. The study was approved by the Research Ethics Committee. Results: a total of 91.7% of the participants had sickle cell anemia, with a median of three years of ulcer existence; 77.8% were recurrent; 40.3% bought the supplies; 66.7% changed their own dressings at home; 52.8% did one or more changes a day; 45.8% of the treatments were prescribed by physician; 37.5% were ointments (collagenase or antibiotics); and 89% did not use compression to manage edema. Conclusion: most of the participants were not included in the Health Care Network for ulcer treatment and did not receive systematized care or appropriate supplies.

Objetivo: identificar el lugar y los cuidados directos recibidos por personas con úlceras de pierna por enfermedad falciforme en los servicios de atención a la salud. Método: estudio transversal, realizado en 11 centros, en el período de agosto de 2019 a abril de 2020. Participaron 72 personas con úlcera de pierna activa. El estudio fue aprobado por el Comité de Ética en Investigación. Resultado: presentaban anemia falciforme 91,7% de los participantes, con una mediana de tres años de existencia de la úlcera; 77,8% eran recidivantes; 40,3% compraban los insumos; 66,7% cambiaban su propio vendaje en el domicilio; 52,8% realizaban uno o más cambios diarios; 45,8% de los tratamientos fueron prescritos por el médico; 37,5% eran pomada (colagenasa o antibiótico); y 89% no utilizaban compresión para el manejo del edema. Conclusión: la mayoría de los participantes no estaba integrada en la Red de Atención a la Salud para el tratamiento de la úlcera, y no recibía asistencia sistematizada ni insumos apropiados.

The effects of aerobic gymnastics training on performance-related variables in an elite athlete: a 2-year follow-up study.

This study investigates individual performance adaptations on 2 years of training between European Aerobics Championships. An elite, 22-year-old aerobic gymnast performed postural coordination test, Y-Balance test, squat and countermovement jumps, 60 s test of repeated jumps, an isokinetic leg muscle strength test, and the Wingate test. Postural stability and flexibility improved in terms of increased distance achieved in the Y-Balance test in the anterior (by 6.3%), posteromedial (by 2%), and posterolateral (by 4.8%) directions. Lower limb muscular endurance also increased, which can be corroborated by a reduced fatigue index in the 60 s test of repeated jumps (from 42% to 27% after the 1st and to 22% after the 2nd year of training). In addition, mean power increased during dominant (by 23.2% at 60°/s and by 18.5% at 180°/s) and non-dominant leg extension (by 4.9% at 180°/s and by 15.5% at 300°/s), plus dominant leg flexion (by 2.0% at 60°/s and by 6.9% at 300°/s). Similarly, peak torque/body weight ratio increased during dominant (by 24.9% at 60°/s, by 11.5% at 180°/s, and by 2.1% at 300°/s) and non-dominant leg extension (by 0.5% at 60°/s and by 6.4% at 300°/s), plus dominant leg flexion (by 1.7% at 60°/s and by 5.4% at 300°/s). However, 2 years of training failed to show any significant improvements in the explosive power of lower limbs and anaerobic performance. These findings indicate that general aerobic gymnastics training without any specific inputs leads to performance adaptation, namely, in abilities closely related to competition routine (dynamic balance and strength endurance of lower limbs).

Evaluating shelf life and anti-browning of shrimp by chitosan-coated nanoliposome loaded with licorice root extract.

Chitosan coating containing nanoliposomes loaded with licorice root extract was prepared to investigate shrimp's shelf life and anti-browning function during 20 days of ice storage. 1% licorice root hydroethanolic extract (LHE) was encapsulated in nanoliposomes or coated with chitosan, and then the shrimp were immersed in coating solutions. LHE treatment had the lowest browning indices (5 and 1.02), TBA (0.32 mg MDA/kg), and FFA (0.01%). Chitosan-coated LHE treatment (Ch-LHE) showed the best performance for TVN, microbial counts, and discoloration. PV, WHC, and cook loss in the treatment with LHE nanoliposome coated with chitosan (Ch-N-LHE) were measured at acceptable levels of 0.53 meq/kg, 86.12%, and 15.06%, respectively. Experiments showed that pure or encapsulated LHE is an effective method for increasing the quality and preventing the browning of shrimp. Additionally, due to its cost-effectiveness and health benefits, it can be an effective natural substitute for sodium metabisulfite at the global export level.

Single-leg versus double-leg hip spica casts in the management of paediatric femoral shaft fractures? A systematic review and meta-analysis.

Background: Paediatric femoral shaft fractures can be managed with single- or double-leg hip spica casting between ages six-months and six-years. The aim of this review was to determine if single-leg hip spicas reduce the impact on family life without compromising fracture stability. Methods: The study was registered on PROSPERO (CRD42023454309). MEDLINE, Embase, Web of Science, Cochrane Library, and clinical trial registers were searched to May 2023 for level I-III evidence. Primary outcomes were impact on family life and fracture stability. Where appropriate, Meta-analysis was completed using RevMan v5.4. Risk of bias was assessed using RoB 2.0 (RCTs) and ROBINS-I (non-RCTs). Certainty of evidence was measured with GRADE. Results: From 234 identified papers, four met the inclusion criteria (two RCTs; two non-RCTs). A total of 339 children were included (single-leg spica: 176; double-leg spica: 163). Three studies were 'high risk' and one study 'moderate risk' of bias. Impact on family life parameters were too heterogenous for pooled meta-analysis. Non-pooled data identified significantly more missed work days in the double-leg spica group and the 'Impact on Family' Scale significantly favoured single-leg spicas. For fracture stability, meta-analysis identified that (i) mal-union rates were significantly lower in single-leg spica: OR 0.08 (95 % CI 0.01 to 0.69; p = 0.02); (ii) MUA in theatre was not significantly different: OR 0.97 (95 % CI 0.19 to 4.86; p = 0.97); and (iii) wedge adjustment was not significantly different: OR 3.46 (95 % CI 0.48 to 24.92; p = 0.22). Certainty of evidence was assessed as 'very low'. Conclusion: Single-leg hip spicas may be associated with reduced impact on family life without compromising fracture stability compared with double-leg hip spicas. However, the evidence is weak. Therefore, a propensity score matched observational study is required to understand if subgroups of patients (age, fracture pattern, mechanism of injury) would benefit from a single- or double-leg hip spica.

Longitudinal Alterations in the Control of Lateral Center of Mass Movement During Walking in a Patient With Unilateral Transtibial Amputation: A Case Study.

This study assessed longitudinal changes in the control of the center of mass (CoM) in the lateral direction through gait reacquisition in an individual with unilateral transtibial amputation (UTTA). We examined a male patient with UTTA who could walk on a parallel bar. The marker trajectories and ground reaction forces were measured every two weeks (total: four times) using an optical motion capture system and force plates. After two measurements, the samples were collected without a parallel bar. Subsequently, we evaluated the CoM movement and its segmental coordination through uncontrolled manifold (UCM) analysis. After the second measurement, the walking speed and step length increased. The lateral CoM movements gradually increased toward the prosthetic side until the third measurement. In the fourth measurement, the CoM movement towards the prosthetic side was the smallest and closest to the intact side at the end of the stance phase. In addition, segmental coordination improved significantly. Enhanced gait performance delayed the improvement of segmental coordination for CoM movement in the lateral direction.

Restless Genital Syndrome: A Case Report of the Challenging Diagnosis.

Restless genital syndrome (RGS) is a rare disorder marked by paresthesia and discomfort in the genital area, akin to restless legs syndrome (RLS). While RLS typically affects the lower limbs, its impact on areas such as the bladder has been noted. RGS individuals exhibit sensory symptoms akin to RLS, including difficulty expressing sensations and a compulsion for genital rubbing. Thus, RGS is viewed as an atypical RLS presentation, characterized by genital sensory symptoms. Despite the rarity, this report details a successfully managed case using conventional RLS treatments. Numerous RGS aspects need clarification, including prevalence and treatment. Due to its distressing nature, sustained investigation is vital. Though lacking a standard treatment, our patient benefited from traditional RLS medication, hinting at shared mechanisms. Further research is vital for understanding and treating RGS effectively.

Interleg coordination in free-walking bug Erthesina fullo (Hemiptera: Pentatomidae).

Insects can adapt their walking patterns to complex and varied environments and retain the ability to walk even after significant changes in their physical attributes, such as amputation. Although the interleg coordination of intact insects has been widely described in previous studies, the adaptive walking patterns in free-walking insects with amputation of 1 or more legs are still unclear. The pentatomid bug Erthesina fullo exhibits a tripod gait, when walking freely on horizontal substrates, like many other insects. In this study, amputations were performed on this species to investigate changes in interleg coordination. The walking parameters were analyzed, such as the locations of touchdown and liftoff, cycle period, walking speed, and head displacement of intact and amputated insects. The results show that E. fullo displays adaptive interleg coordination in response to amputations. With 1 amputated leg, bugs changed to a 3-unit gait, whereas with 2 amputated legs they employed a wave gait. These data are helpful in exploring the motion mode control in walking insects and provide the theoretical basis for the gait control strategy of robots, when leg failure occurs.

Mallard hindlimbs locomotion system respond to changes in sandy ground hardness and slope.

Mallards inhabit soft grounds such as mudflats, marshes, and beaches, demonstrating remarkable proficiency in traversing these grounds. This adeptness is closely linked to the adjustments in the operation of their hindlimbs. This study employs high-speed videography to observe postural adjustments during locomotion across mudflats. Analysis of spatiotemporal parameters of the hindlimbs reveals transient and continuous changes in joints (tarsometatarso-phalangeal joint (TMTPJ), intertarsal joint (ITJ), knee, and hip) during movement on different ground hardness and slope (horizontal and uphill). The results indicate that as the stride length of the mallard increases, its speed also increases. Additionally, the stance phase duration decreases, leading to a decrease in the duty factor. Reduced ground hardness and increased slope lead to delayed adjustment of the TMTPJ, ITJ, and knee. Mallards adjust their stride length by augmenting ITJ flexion on steeper slopes, while reduced hardness prompts a decrease in TMTPJ flexion at touch-down. Additionally, the hip undergoes two brief extensions during the stance phase, indicating its crucial role in posture adjustment and propulsion on uphill grounds. Overall, the hindlimb joints of the mallard function as a whole musculoskeletal system, with each joint employing a distinct strategy for adjusting to adapt to various ground conditions.

Relationship of total sagittal spinal alignment index of thoracic kyphosis and lumbar lordosis with physical function in community-dwelling older adults.

BACKGROUND: Overall spinal curvature is evaluated by calculating the difference between the angles of lumbar lordosis (LL) and thoracic kyphosis (TK) and is expressed as LL minus TK (LL-TK). It is unclear whether LL-TK is associated with physical function in community-dwelling older adults and whether it is more relevant than TK or LL alone. OBJECTIVE: This study aimed to identify whether LL-TK is associated with physical function in community-dwelling older adults, and whether it is strongly associated than TK or LL alone. METHODS: The participants comprised 1,674 community-dwelling older adults who underwent physical assessments (women, n = 1,099; mean age, 67.4 ± 5.3 years). As spinal alignment indices, TK and LL were measured using skin surface methods, and LL-TK was calculated as the difference between them. Decreased LL-TK indicated increased overall spinal curvature. Physical function was determined by measuring single-leg standing, five-times chair-stand, and usual gait speed. Stepwise multiple regression analyses were performed with each physical function as the dependent variable and spinal alignment indices as the independent variables, with adjustments. RESULTS: Multiple regression analyses showed that single-leg standing (ß = 0.092, 95% confidence interval [CI] = 0.071 to 0.214, p < .001) and five-times chair-stand (ß=-0.142, 95% CI = -0.037 to -0.019, p < .001) were significantly associated with LL-TK, but not LL. Both LL-TK (ß = 0.121, 95% CI = 0.001 to 0.004, p < .001) and LL (ß = 0.087, 95% CI = 0.001 to 0.003, p = .003) were significant determinants of usual gait speed. CONCLUSIONS: This study showed that decreased LL-TK may be associated with poor physical function. This association may be stronger than that observed for TK or LL alone.

Relevance of instrumented gait analysis in the prediction of the rebound phenomenon after guided growth intervention.

Predictors of rebound after correction of coronal plane deformities using temporary hemiepiphysiodesis (TH) are not well defined. The following research questions were tested: (1) Is the dynamic knee joint load useful to improve rebound prediction accuracy? (2) Does a large initial deformity play a critical role in rebound development? (3) Are BMI and a young age risk factors for rebound? Fifty children and adolescents with idiopathic knee valgus malalignment were included. A deviation of the mechanical femorotibial angle (MFA) of ≥ 3° into valgus between explantation and the one-year follow-up period was chosen to classify a rebound. A rebound was detected in 22 of the 50 patients (44%). Two predictors of rebound were identified: 1. reduced peak lateral knee joint contact force in the first half of the stance phase at the time of explantation (72.7% prediction); 2. minor initial deformity according to the MFA (70.5% prediction). The best prediction (75%) was obtained by including both parameters in the binary logistic regression method. A TH should not be advised in patients with a minor initial deformity of the leg axis. Dynamic knee joint loading using gait analysis and musculoskeletal modeling can be used to determine the optimum time to remove the plates.

Multicenter survey about leg length discrepancy and total hip arthroplasty: preoperative and intraoperative management.

BACKGROUND: We created a multicenter survey for Italian orthopedic surgeons on how they approach leg length discrepancy (LLD) when dealing with primary total hip arthroplasty. Aim of the study was to show how surgeons manage LLD and follow the literature recommendations during clinical practice. METHODS: The survey was composed of 25 questions divided into four sections: 1-surgeon's profile, 2-preoperative and 3-intraoperative evaluation, and 4-postoperative management. In this paper, we report results to answer Sects. 1 and 2. Absolute and relative frequencies of answers to Sects. 2 and 3 are reported. We divided the participants in subgroups based on the "surgeon's profile" and evaluated difference in the answers given. RESULTS: Absolute and relative frequencies demonstrate low agreement among participants in all phases of LLD management. We demonstrated a statistically significant difference based on the surgeon's profile regarding these questions: radiographic measure of LLD depending on working experience, p = 0.008; digital planning based on surgeons' age, p < 0.001, and workplace, p = 0.026; intraoperative anatomical landmarks based on numbers of procedures per year, p = 0.020; and use of intraoperative X-rays based on working experience, p = 0.002. CONCLUSIONS: LLD is a debated topic with no definitive recommendations. Many decisions still depend on tradition and surgeons' preference.

Wound Healing Society 2023 update on guidelines for arterial ulcers.

The Wound Healing Society guidelines for the treatment of arterial insufficiency ulcers were originally published in 2006, with the last update in 2014. These guidelines provided recommendations, along with their respective levels of evidence, on seven categories: diagnosis, surgery, infection control, wound bed preparation, dressings, adjuvant therapy and long-term maintenance. Over the last 9 years, additional literature regarding these aspects of arterial ulcer management has been published. An advisory panel comprised of academicians, clinicians and researchers was chosen to update the 2014 guidelines. Members included vascular surgeons, internists, plastic surgeons, anaesthesiologists, emergency medicine physicians and dermatologists, all with expertise in wound healing. The goal of this article is to evaluate relevant new findings upon which an updated version of the guidelines will be based.

Empiric Treatment of Classical Pyoderma Gangrenosum in the Outpatient Setting: A Case Report.

Pyoderma gangrenosum (PG) is a rare neutrophilic disorder that typically presents as painful, ulcerative lesions. It is a diagnosis of exclusion and is oftentimes associated with systemic conditions such as inflammatory bowel disease, rheumatoid arthritis, and other inflammatory conditions. PG remains difficult to diagnose, and a delay in recognizing the disease can contribute to appreciable morbidity in the population. Here, we present the case of a 42-year-old male with the classical subtype of PG in the outpatient clinic who failed three courses of antibiotics before responding to corticosteroids.

Treatment of varicose veins using the Cryo laser after foam technique.

Sclerotherapy is the treatment of choice for telangiectasias and reticular veins. The most common side effects of this procedure are hyperpigmentation and matting, which are feared owing to their aesthetic damage and difficulty of treatment. Combined treatments with laser and hypertonic glucose sclerotherapy have been described with excellent results, but limited to treatment of veins of ≤2 mm in diameter. Cryo laser after foam sclerotherapy is a procedure to treat reticular veins in the lower extremities that utilizes first foam sclerotherapy with polidocanol than immediately followed by transdermal Nd:YAG 1064 laser treatment and we can treat veins ≤5 mm. This report presents a successful case of varicose vein treatment using combined transdermal laser and sclerotherapy with foam sclerotherapy with polidocanol to treat veins >2.5 mm in diameter.

Updates in the Management of Leg Length Discrepancy: A Systematic Review.

The aim of this study is to comprehensively investigate the recent literature on the management of leg length discrepancy (LLD). A thorough search of pertinent databases was done in order to find studies that satisfied the requirements for inclusion. A thorough search of PubMed, Web of Science, Scopus, and Science Direct was conducted to find pertinent literature. Rayyan Qatar Computing Research Institute (QRCI, Ar Rayyan, Qatar) was utilized during the whole operation. Eight studies, including a total of 345 patients, were included in our data, and 206 (59.7%) of them were males. Percutaneous epiphysiodesis was the surgical intervention of choice in four studies. LLD can be effectively corrected by temporary and permanent epiphysiodesis. One study reported the incidence of angular deformities following temporary epiphysiodesis. Circumferential periosteal and dual tension-band plating significantly reduced LLD, but reported the incidence of an "over-shoot" in some patients. Bilateral motion control shoes and orthotic insole both were found to improve the patient's gait and trunk symmetry, evidenced by longer and faster steps, reduced ground impact at heel strike, and lower peak plantar pressure in both limbs. Our findings confirm that no inferences about the superiority of a particular management approach for the treatment of LLD can be made. The poor quality of the studies shows that more randomized control trials and prospective studies on the subject are required.

Frequency of Restless Legs Syndrome in Pakistani Patients With Type 2 Diabetes Mellitus.

Objective To determine the frequency of restless legs syndrome (RLS) among Pakistani patients with type 2 diabetes mellitus. Methods This observational cross-sectional study was carried out in the Department of Medicine at Bahawal Victoria Hospital, Quaid-e-Azam Medical College, Bahawalpur, Pakistan, from January 2024 to May 2024. The National Institute of Health (NIH) diagnostic criteria were used to diagnose RLS. Type 2 diabetes mellitus was defined as patients with an HbA1c greater than 7.0%, two random blood glucose readings of ≥200 mg/dL, a previous history of diabetes diagnosis, or those taking anti-hyperglycemic medicines. Patients with a history of leg surgery or amputation, iron deficiency anemia, alcoholism, end-stage kidney disease, chronic liver disease, those on hemodialysis, and pregnant women were excluded from the study. After ethical approval and informed consent were obtained, 255 patients with type 2 diabetes mellitus were included in the study using a non-probability consecutive sampling technique. Demographic information including age, gender, and duration of diabetes was noted, and patients were assessed for diabetes control, peripheral neuropathy, retinopathy, and RLS Patient records were assessed for HbA1c levels and urine examination to diagnose nephropathy. All data were entered into SPSS version 23. A Chi-Square test was applied post-stratification using a p-value of less than 0.05 as significant. Results The mean age was 53.5 ± 12.8 years with 140 (54.9%) females. The mean duration of the disease and mean HbA1c were 6.8 ± 5.4 years and 9.8 ± 2.5%, respectively, with 191 (74.9%) patients having poor control of diabetes. Peripheral neuropathy was seen in 131 (51.4%) patients, retinopathy in 58 (22.7%), and nephropathy in 23 (9.0%). RLS was present in 34 (13.3%) patients with type 2 diabetes mellitus, showing a significant association with diabetes control (p-value = 0.001), peripheral neuropathy (p-value = 0.016), retinopathy (p-value = 0.006), and nephropathy (p-value = 0.011), but not with age (p-value = 0.122), gender (p-value = 0.217), or duration of diabetes (p-value = 0.922). Conclusion RLS was not an uncommon finding in patients with type 2 diabetes mellitus, being more common among those with poor diabetes control and the presence of other complications such as neuropathy, nephropathy, and retinopathy.

Regional fat distribution and hepatic fibrosis and steatosis severity in patients with nonalcoholic fatty liver disease and type 2 diabetes.

Background: Epidemiologic findings suggest that measures of body fat distribution predict health outcomes independent of the overall body fat assessed by body mass index (BMI). This study aimed to evaluate the associations of overall and regional body fat with the severity of hepatic steatosis and fibrosis in type 2 diabetic patients with non-alcoholic fatty liver disease. Methods: Bioelectric impedance analysis and two newly developed anthropometric indices, namely, A Body Shape Index (ABSI) and Body Roundness Index (BRI), were used to estimate the body fat. Based on fibroscan parameters, significant hepatic fibrosis and severe steatosis were defined as ≥F2 and >66%, respectively. Results: Higher total body fat (odds ratio [OR] 1.107, 95% confidence intervals (CI) 1.038-1.182, p = 0.002), trunk fat (OR 1.136, 95% CI 1.034-1.248, p = 0.008) and leg fat (OR 1.381, 95% CI 1.139-1.674, p = 0.001) were associated with liver fibrosis. However, in contrast to the total body fat (OR 1.088, 95% CI 1.017-1.164, p = 0.014) and leg fat (OR 1.317, 95% CI 1.066-1.628, p = 0.011), the trunk fat was not associated with severe hepatic steatosis. BRI performed better than trunk, leg and total body fat in predicting hepatic steatosis (OR 2.186, 95% CI 1.370-3.487, p = 0.001) and fibrosis (OR 2.132, 95% CI 1.419-3.204, p < 0.001). Moreover, the trunk to leg fat ratio and ABSI were not independent predictors of either steatosis or fibrosis (p > 0.05). Conclusion: BRI revealed a superior predictive ability for identifying the degree of hepatic steatosis and stiffness than other obesity indices. Additionally, higher levels of adiposity in the trunk, legs, and overall body were linked to an increased risk of developing liver fibrosis. Although trunk fat did not show an association with severe hepatic steatosis, an increase in leg and total fat was related to liver steatosis.

How to avoid genu recurvatum in leg-length discrepancy treated with tension-band plates. A volumetric magnetic resonance analysis.

Aims and objectives: Genu recurvatum deformity after treatment of leg-length discrepancy (LLD) with tension-band plating is a recognized, but poorly described phenomenon in medical literature. The aim of this study was to evaluate clinical and radiological features of patients treated with tension-band plating for LLD assessing the development of a recurvatum deformity and its relationship to plate and screw disposition in a transversal plane, thus attempting to establish optimal plate positioning. Materials and methods: Retrospective study of children with LLD treated with tension-band plating. Primary endpoints were clinical and radiological knee recurvatum and anterior and posterior physeal areas measured drawing a line spanning from the lateral to the medial tension-band plates in the transverse plane using volumetric magnetic resonance imaging (vMRI). These findings were compared between patients with and without knee recurvatum. Results: Twelve children (mean age 11.7 years) were included. Average follow-up was 2.6 years (1.5-5.0). Tension-band plating led to a significant reduction in LLD (mean, 15 mm). Six patients (50 %) developed clinical genu recurvatum (mean, 22°). According to vMRI, patients with genu recurvatum had a larger posterior to anterior physeal area ratio in both distal femur (1.6 versus 0.9, p < 0.05) and proximal tibial physes (2.2 versus 1.0, p < 0.05). Conclusion: The optimal position of the tension-band plates in distal femoral and proximal tibial physes should be in a point where a posterior to anterior physeal areas ratio is around 1.0, so as to achieve an even distribution of the physeal areas in the multidimensional physeal transverse plane. This point anatomically corresponds in the sagittal X-ray view to an imaginary line located just anterior to the posterior diaphyseal cortical bone on a true lateral radiograph for both femur and tibia.

Restless leg syndrome in systemic lupus erythematosus: Associations with disease activity, quality of life and depression.

OBJECTIVES: The aim of this study was to determine the prevalence of restless leg syndrome (RLS) among patients with SLE, describe their clinical characteristics, examine its impact on health-related quality of life (HRQoL), and evaluate its association with depression. METHODS: A total of 124 SLE patients were recruited, with data on demographics, and clinical features collected. RLS diagnosis was based on the international RLS study group criteria, while depression was assessed by the patient health questionnaire. HRQoL was assessed by a disease-specific validated questionnaire, the LupusQoL, pain intensity was examined through the pain visual analogue scale, and disease activity was evaluated via the patient global assessment. These variables were compared between SLE patients with RLS and without RLS using t-tests or Wilcoxon and the chi-square test of independence for categorical variables. A p-value ≤0.05 was considered statistically significant. RESULTS: Among the SLE patients (mean age 48, 87.1 % women), 32 % had RLS. The SLE patients with RLS were found to have a longer delay in diagnosis (1 vs 0.5 years; p = 0.019) and were less likely to be employed (65 % vs 45 %, p = 0.040) compared to non-RLS patients. In addition, RLS patients were more likely to have coexisting Major Depressive Disorder (MDD) (p = 0.019), higher levels of pain (p = 0.006) and disease activity based on patient global assessment (p = 0.014). Further, most of the domains of LupusQoL were significantly lower in the RLS patients group suggesting a worse HRQoL. CONCLUSION: RLS was present in one-third of the SLE cohort, significantly impairing HRQoL and correlating with depression, higher pain, and increased disease activity. These findings underscore the importance of early RLS detection and management in SLE patients.