Determining adult type 2 diabetes-related health care needs in an indigenous population from rural Guatemala: a mixed-methods preliminary study.

BACKGROUND: In Guatemala, diabetes is an emerging public health concern. Guatemala has one of the largest indigenous populations in Latin America, and this population frequently does not access the formal health care system. Therefore, knowledge about the emergence of diabetes in this population is limited. METHODS: Interview participants (n=23) were recruited from a convenience sample of indigenous adults with type 2 diabetes at one rural diabetes clinic in Guatemala. A structured interview was used to assess knowledge about diabetes and its complications; access to diabetes-related health care and treatment; dietary and lifestyle changes; and family and social supports for individuals living with diabetes. Interviews were supplemented with two group interviews with community leaders and health care providers. Thematic analysis was used to produce insights into diabetes knowledge, attitudes, and practices. In addition, a chart review of the clinic's electronic medical record identified all adult patients (n=80) presenting in one calendar year for a first-time diabetic consultation. Sociodemographic and clinical variables were extracted and summarized from these records. RESULTS: Salient demographic factors in both the structured interview and chart review samples included low educational levels and high indigenous language preference. In the interview sample, major gaps in biomedical knowledge about diabetes included understanding the causes, chronicity, and long-term end-organ complications of diabetes. Medication costs, medical pluralism, and limited social supports for dietary and lifestyles changes were major practical barriers to disease management. Quantitative data from medical records review revealed high rates of poor glycemic control, overweight and obesity, and medication prescription. CONCLUSIONS: This study provides a preliminary sketch of type 2 diabetes in an indigenous Guatemalan population. Combined qualitative and quantitative data point towards particular needs for implementation and future research, including the need to address gaps in diabetes knowledge, to improve social support systems, and to address the cost barriers associated with disease treatment.

A retrospective analysis of anterior calcaneal osteotomy with allogenic bone graft.

Anterior calcaneal osteotomy (ACO) with extension bone graft is commonly employed in the treatment of symptomatic supple, hypermobile flatfoot in adolescent as well as adult (>or= 18 years of age) patients. Although autogenous bone graft has been considered the gold standard, allogenic bone is widely used for this procedure because it is readily available, requires no additional procedure for procurement and has incorporation rates similar to autogenous bone graft. There is increasing agreement among surgeons that the union rates with allograft bone are comparable with that observed with autograft bone when used in the ACO. We reviewed the medical records of 51 consecutive patients who had undergone 53 ACO with allogenic bone graft for the repair of flatfoot deformity in an effort to further evaluate outcomes associated with the use of allogenic bone graft. All of the patients had at least 12 months of follow-up. The mean time to graft incorporation was 9.10 +/- 1.54 weeks for adolescents and 9.81 +/- 2.13 weeks for adults (P = .0149), The incidence of graft incorporation (bone union) was 100% and 90% (P = .1391) in the adolescent and adult groups, respectively. Complications included lateral column pain, sinus tarsitis, nonunion, calcaneocuboid capsulitis, complex regional pain syndrome, incisional dehiscence, and sural neuritis; and all of the complications occurred in the adult group. The results support the understanding that ACO with allogenic bone graft is a reasonable alternative to autograft bone graft in the treatment of flexible flatfoot in adolescent and adult patients.

Antibiotic-coated intramedullary rod.

Surgical reconstruction for limb salvage is an acceptable and often preferred treatment for patients who are facing potential amputation. Because of the invasive nature of these surgeries, complications such as infection are not uncommon. Osseous infection at the site of implantable hardware may result in a tremendous consequence to the patient. In an attempt to minimize infection with implantable hardware, a local delivery system involving the use of antimicrobial coating on medical devices has been developed. This system optimizes local administration of antibiotics to the sources of infection enabling continuation of limb salvage versus amputation. The authors describe the fabrication of an antibiotic impregnated polymethylmethacrylate (PMMA) intramedullary rod that is used to replace an infected intramedullary nail of the tibia after reconstruction surgery. The benefits of the rod include increased surface area for local delivery of antibiotics, concurrent stabilization of the surgical site, occupancy of the dead space, and ease of removal after eradication of infection.

The flexor digitorum accessorius longus-a cadaveric study.

UNLABELLED: Flexor digitorum accessorius longus is an anatomical variant that has previously been shown to be associated with a variety of pathological conditions localized to the posteromedial aspect of the ankle and hindfoot. In particular, this anomalous muscle has been reported to be the cause of tarsal tunnel syndrome. Despite recognition of this muscular anomaly as a cause of foot and ankle pathology, the origin, course, and insertion of flexor digitorum accessorius longus has not been thoroughly illustrated in the anatomical literature. In an effort to accurately detail the anatomy of the flexor digitorum accessorius longus, we undertook a cadaveric dissection and prepared a photographic study of this anomalous skeletal muscle. LEVEL OF CLINICAL EVIDENCE: 5.