Spontaneous pre-axial polydactyly in Swiss mice

ABSTRACT: Spontaneous polydactyly has been described in several species, but only one report about it in Swiss mice. The aim of the current study was to report the spontaneous occurrence of pre-axial polydactyly in Swiss mice. Clinical examination showed one extra toe laterally to the first digit, in the plantar region, alopecia in the back, altered face growth anatomy and changed perineal region anatomy. Pre-axial polydactyly in the tibial side, fused metatarsals and Y-shaped free phalanges were evidenced in the radiographic images. Pre-axial polydactyly observed in the plantar region differed from that in reports on albino Swiss mice with post-axial polydactyly (Po/Po+) phenotype featured by one extra toe in the ulnar side of one, or both, front limbs, which is the dominant feature. The observed findings highlight the importance of both clinical examinations and close attention by professionals involved in rodents’ breeding on physical changes resulting from different causes, including the genetic ones, since they reveal mutations and, sometimes, new biomodels.

Carcinoma Cuniculatum with Bone Invasion Mimicking a Viral Wart

Carcinoma cuniculatum is a rare variant of low-grade and well-differentiated squamous cell carcinoma. It is a locally invasive tumor, although it has low metastatic potential. It was originally described in the plantar region but may exceptionally appear in other locations. It predominates in middle-aged men and presents clinically as an exophytic, solitary, painful tumor, with insidious growth. Histologically, this tumor simulates a variety of benign dermatoses and may require several biopsies for the correct diagnosis. It is often misdiagnosed as a viral wart, due to the clinical similarity and the indolent course. The treatment of choice is surgical excision due to the high risk of recurrence and locally aggressive behavior. Amputation can be performed in cases of deep tissue invasion. We present a case of carcinoma cuniculatum in which the late diagnosis favored the invasion of the underlying bone, resulting in amputation of the affected finger.

Treating complex palmar–plantar wounds using a bilaminar ‘trapdoor’ technique: a case series

Objective: Due to the similarities of glabrous skin, the plantar region is an excellent donor area for covering complex palmar–plantar wounds. However, taking grafts from the plantar area often results in significant morbidity at the donor site or non-integration of the graft due to the greater thickness of the plantar corneal layer. Method: This is a prospective case series including patients with burns or wounds who have been treated with a dermal graft using the bilaminar ‘trapdoor’ technique. This procedure is used to remove a thin graft from the deep plantar dermis after the partial elevation of the first layer including the entire epidermis and superficial part of the dermis. Results: At the donor area in the four patients in this case series, we observed healing at around 10 days, and absence of hypertrophic scar in all patients. There was complete re-epithelialisation between two and three weeks from the periphery to the centre of the deep dermal graft, and from the glandular epithelium transferred with the graft. During the follow-up, patients presented aesthetic and functional features of glabrous and amelanotic skin, with similar resistance to those of the adjacent areas of the wound in the palmar–plantar region. Conclusion: This technique has some advantages, such as less surgical time, minimal morbidity in the plantar donor area, easy integration of the grafts, and maintenance of the functional and aesthetic properties of glabrous skin both in the plantar donor area and in the palmar–plantar recipient region. Declaration of interest: The authors have no conflicts of interest to declare.

Estimation of Various Walking Intensities Based on Wearable Plantar Pressure Sensors Using Artificial Neural Networks

Walking has been demonstrated to improve health in people with diabetes and peripheral arterial disease. However, continuous walking can produce repeated stress on the plantar foot and cause a high risk of foot ulcers. In addition, a higher walking intensity (i.e., including different speeds and durations) will increase the risk. Therefore, quantifying the walking intensity is essential for rehabilitation interventions to indicate suitable walking exercise. This study proposed a machine learning model to classify the walking speed and duration using plantar region pressure images. A wearable plantar pressure measurement system was used to measure plantar pressures during walking. An Artificial Neural Network (ANN) was adopted to develop a model for walking intensity classification using different plantar region pressure images, including the first toe (T1), the first metatarsal head (M1), the second metatarsal head (M2), and the heel (HL). The classification consisted of three walking speeds (i.e., slow at 0.8 m/s, moderate at 1.6 m/s, and fast at 2.4 m/s) and two walking durations (i.e., 10 min and 20 min). Of the 12 participants, 10 participants (720 images) were randomly selected to train the classification model, and 2 participants (144 images) were utilized to evaluate the model performance. Experimental evaluation indicated that the ANN model effectively classified different walking speeds and durations based on the plantar region pressure images. Each plantar region pressure image (i.e., T1, M1, M2, and HL) generates different accuracies of the classification model. Higher performance was achieved when classifying walking speeds (0.8 m/s, 1.6 m/s, and 2.4 m/s) and 10 min walking duration in the T1 region, evidenced by an F1-score of 0.94. The dataset T1 could be an essential variable in machine learning to classify the walking intensity at different speeds and durations.

Schwannoma of the medial plantar nerve: a case report

We report the case of a 60-year-old woman with a schwannoma of the medial plantar nerve. She presented with the complaint of pain for about 2 years and a painful lesion in the medial plantar region of the left forefoot and on the second toe. Physical examination showed well-defined, firm tumor masses painful to palpation on the medial and plantar surface of the left forefoot and second toe. We surgically explored the area and excised 3 lesions, resulting in complete pain relief and no aesthetic complaints. Schwannomas of the medial plantar nerve are rare tumors, with only a few reports of cases extending to the forefoot. The finding of multiple schwannomas may be a red flag for the possible existence of local, painful, nerve lesions despite a negative Tinel sign. Appropriate surgical planning contributed to our successful intervention, without aesthetic, painful, or functional sequelae for the patient. Level of Evidence V; Therapeutic Studies; Expert Opinion.

A study of the dermatoglyphic pattern in diabetic subjects in Kalaburagi district

Dermatoglyphics is the scientific study of epidermal ridges and their configurations on the palmar region of hand and fingers and plantar region of foot and toes. Diabetes mellitus is a metabolic disorder characterized by hyperglycemia resulting from defect in insulin secretion, action or both. Dermatoglyphic patterns are genetically determined and can be used as supportive for diagnosis of various hereditary disorders including T2DM. This study was carried out to compare palmar dermatoglyphic pattern in T2DM and control group and compare with previous studies. A hospital based case control study was conducted 100 cases of T2DM are taken from Basaweshwar hospital Gulbarga, and another 100 persons are included as control group. The palms and fingers are smeared with ink to bring out the dermatoglyphiic patterns which were subsequently studied.There was increased number of whorls and decreased number of ulnar loops in both T2DM patients compared with normal individuals. Total finger ridge count and Absolute finger ridge count is increased in both T2DM patients and there is also increased atd angle. The knowledge of dermatoglyphics in patients with T2DM and essential hypertension can be utilized to find out genetic correlation. The existence of such relation might be important for the screening programme for prevention of T2DM.

Evaluation of Small Fiber Peripheral Neuropathy With Infrared Thermographic Camera in Prediabetes

Introduction: The typical microvascular complications of diabetes may ocasionaly occur in patients with prediabetes (PD). Diabetic peripheral neuropathy (DPN) is associated with poor glycemic control as well as with the metabolic syndrome components independently of HbA1c levels. Small fiber DPN is one of the most chalenging diagnosis due to the usualy normal physical examination as well as electrophysiological nerve evaluation. The thermographic camera has emerged as a novel tool for the detection of small nerve fiber dysfunction. The aim of the present study was to evaluate thermography of the plantar foot in individuals with PD. Methods: This was a cross-sectional study with a sample of 51 patients aged 27 to 71 years. Patients were divided into the following three groups: control (n = 18), diabetic (n = 17), and prediabetic (n = 16). The diagnosis of PD was made according to ADA standards. Thermographic analysis of the plantar region was performed using a FLIR C2 camera. Results: Overall, 510 foot regions were analyzed. There were significant diferences in plantar temperatures between prediabetes vs controls as follows: hallux (L: 25.24 ± 2.02 vs 23.6 ± 1.79 ºC; p=0.009/ R: 25.44 ± 2.05 vs 23.89 ± 1.73 ºC; p=0.01); fifth metatarsal (L: 26.31 ± 1.72 vs 24.88 ± 1.38 °C; p=0.006 /R: 26.12 ± 1.60 vs 24.74 ± 1.41 °C; p= 0.006); and calcaneus (L: 26.46 ± 1.71 vs 24.93 ± 1.41 °C; p=0.005 / R: 26.58 ± 1.85 vs 25.07 ± 1.18 °C; p=0.004). There were no similar results for temperatures in individuals with diabetes comparing with prediabetes: hallux (L:25.24 ± 2.02 vs 25.76 ± 2.30 °C; p=0.24 /R: 25.44 ± 2.05 vs 25.64 ± 1.92 °C; p=0.38); fifth metatarsal (L: 26.31 ± 1.72 vs 26.03 ± 1.27 °C; p=0.3 / R: 26.12 ± 1.60 vs 26.21 ± 1.57 °C; p=0.43); and calcaneus (L26.46 ± 1.71 vs 26.82 ± 1.41 °C; p=0.23 / R: 26.58 ± 1.85 vs 26.99 ± 1.42 °C; p=0.24). Conclusion: We found siginificant abnormalities in temperature of various sites of the plantar region in PD feets suggesting that small fiber damage may occur before the onset of type 2 diabetes.

Subunit Principle: Key Element for Plantar Reconstruction with Free Sensate Flaps

Purpose: Plantar wounds represent a frequent practice of the plastic and reconstructive surgeon. The uniqueness and high complexity of the microarchitecture and biomechanics of the plantar region explain the complex challenge of its reconstruction. With the advances in microsurgery, including the plantar subunit principle, both applied in the restoration of plantar defects through the use of sensorineural free flaps have allowed an optimal reconstruction.Methods: A descriptive, retrospective study was carried out in a period of time established between January 2016 and January 2019, obtaining a total of 18 patients with plantar defects, reconstructed using sensory free flaps. Tissue stability, recovery of protective sensitivity, early ambulation, and correct use of footwear were evaluated.Results: The most frequent etiology was secondary to oncological resections due to melanoma (n = 12, 66.7%), followed by gunshot wounds (n = 4, 22.2%). Subunit 3 was the most frequently involved in 38.9% (n = 7). In the 88.8% of the cases, was used an anterolateral thigh flap (n = 16) and the lateral antebrachial flap in 22.2% (n = 2). The free flap survival rate was 100%. An average of seven points was obtained at 6 months based on the Semmes-Weinstein test. The mean for the return to their daily activities was 2.5 months. The patients of 94.4% (n = 17) recovered ambulation and could footwear. Conclusion: The reconstruction of plantar defects must have a systematic approached, taking the subunit principle as a central point. The treatment of plantar defects with sensorineural free flaps represent an unprecedented option for optimal reconstruction.

POTENTIALS OF NUTRITIONAL FOLLOW-UP IN A DIABETIC PATIENT HOSPITALIZED WITH ULCERATION TABLE IN PLANT REGION

Introduction: Approximately 15% of diabetic individuals are affected with foot ulceration, one of the main causes of lower limb amputation. The percentage of diabetic survival after amputation of a lower limb (MI) is 50% three years after the surgical procedure and the mortality rate varies between 39% to 68% after five years. The impact on the quality of life of diabetic people is high, not only economically, the feelings involved contribute to a negative prognosis. Therefore, adequate metabolic and nutritional control, as well as periodic assessment of immunity and comorbidities, should be part of the therapeutic routine of diabetic patients. Experience report: The work in question refers to the nutritional approach performed on a 71-year-old female patient admitted to the hospital with an ulcer in the right plantar region. In anthropometry, the nutritional status indicators indicated eutrophy with nutritional risk. The biochemical evaluation identified anemic condition and sepsis. Physical evaluation showed the presence of edema in the right and left MI. Glycemic and blood pressure levels were monitored daily. A hypercaloric and hyperprotein diet was prescribed, plus protein supplementation with specific immunomodulators for special metabolic situations that prevent energy-protein malnutrition, in addition to the adequacy of vitamins and minerals, in order to avoid nutritional deficiencies arising from the drug-nutrient interaction. Nutritional monitoring lasted 13 days. Ulceration regressed from the entire plantar region, only to the right hallux, which was amputated. Final considerations: There was an improvement in nutritional and biochemical parameters until hospital discharge.