Unicondylar fractures of the distal femur

AbstractBackgroundUnicondylar fractures of the distal femur are rare, complex, intra-articular fractures. The objective of this multicentre study was to assess the reduction and fixation of unicondylar fractures.HypothesisAnatomic reduction followed by strong fixation allows early rehabilitation therapy and provides good long-term outcomes.Material and methodsWe studied 163 fractures included in two multicentre studies, of which one was retrospective (n=134) and the other prospective (n=29). Follow-up of at least 1 year was required for inclusion. The treatment was at the discretion of the surgeon. Outcome measures were the clinical results assessed using the International Knee Society (IKS) scores and presence after fracture healing of malunion with angulation, an articular surface step-off, and/or tibio-femoral malalignment.ResultsMean age of the study patients was 50.9±24 years, and most patients were males with no previous history of knee disorders. The fracture was due to a high-energy trauma in 51% of cases; 17% of patients had compound fractures and 44% multiple fractures or injuries. The lateral and medial condyles were equally affected. The fracture line was sagittal in 82% of cases and coronal (Hoffa fracture) in 18% of cases. Non-operative treatment was used in 5% of cases and internal fixation in 95% of cases, with either direct screw or buttress-plate fixation for the sagittal fractures and either direct or indirect screw fixation for the coronal fractures. After treatment of the fracture, 15% of patients had articular malunion due to insufficient reduction, with either valgus-varus (10%) or flexion-recurvatum (5%) deformity; and 12% of patients had an articular step-off visible on the antero-posterior or lateral radiograph. Rehabilitation therapy was started immediately in 65% of patients. Time to full weight bearing was 90 days and time to fracture healing 120 days. Complications consisted of disassembly of the construct (2%), avascular necrosis of the condyle (2%), and arthrolysis (5%). The material was removed in 11% of patients. At last follow-up, the IKS knee score was 71±20 and the IKS function score 64±7; flexion range was 106±28° (<90° in 27% of patients); and 12% of patients had knee osteoarthritis.ConclusionAnatomic reduction of unicondylar distal femoral fractures via an appropriate surgical approach, followed by stable internal fixation using either multiple large-diameter screws or a buttress-plate, allows immediate mobilisation, which in turn ensures good long-term outcomes.Level of evidenceIV, cohort study

Screening, prevalence, treatment and control of kidney disease in patients with type 1 and type 2 diabetes in low-to-middle-income countries (2005–2017): the International Diabetes Management Practices Study (IDMPS)

Diabetes is the leading cause of kidney disease worldwide. There is limited information on screening, treatment and control of kidney disease in patients with diabetes in low-to-middle-income countries (LMICs).Fil: Mbanya, Jean Claude. Université de Yaoundé ; CamerúnFil: Aschner, Pablo. Hospital Universitario San Ignacio; Colombia. Pontificia Universidad Javeriana; ColombiaFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Ilkova, Hasan. İstanbul S. Zaim Üniversitesi; TurquíaFil: Lavalle, Fernando. Universidad Autónoma de Nuevo Leon, Facultad de Medicina; MéxicoFil: Ramachandran, Ambady. India Diabetes Research Foundation; IndiaFil: Chantelot, Jean Marc. Sanofi; FranciaFil: Chan, Juliana C. N.. Prince of Wales Hospital; Chin

Persistent poor glycaemic control in individuals with type 2 diabetes in developing countries: 12 years of real-world evidence of the International Diabetes Management Practices Study (IDMPS)

We evaluated the secular trend of glycaemic control in individuals with type 2 diabetes in developing countries, where data are limited. Erratum in Correction to: Persistent poor glycaemic control in individuals with type 2 diabetes in developing countries: 12 years of real-world evidence of the International Diabetes Management Practices Study (IDMPS). Aschner P, Gagliardino JJ, Ilkova H, Lavalle F, Ramachandran A, Mbanya JC, Shestakova M, Chantelot JM, Chan JCN. Diabetologia. 2020 May;63(5):1088-1089. doi: 10.1007/s00125-020-05118-3.Fil: Aschner, Pablo. Pontificia Universidad Javeriana; ColombiaFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Endocrinología Experimental y Aplicada. Universidad Nacional de La Plata. Facultad de Ciencias Médicas. Centro de Endocrinología Experimental y Aplicada; ArgentinaFil: Ilkova, Hasan. İstanbul Üniversitesi; TurquíaFil: Lavalle, Fernando. universidad Autónoma de Nueva León; MéxicoFil: Ramachandran, Ambady. India Diabetes Research Foundation; IndiaFil: Mbanya, Jean Claude. Université de Yaoundé I; CamerúnFil: Shestakova, Marina. Endocrinology Research Center Moscow; RusiaFil: Chantelot, Jean Marc. Sanofi; FranciaFil: Chan, Juliana C. N.. The Chinese University of Hong Kong; Chin

Multifaceted determinants for achieving glycemic control the international diabetes management practice study (IDMPS)

OBJECTIVE - The International Diabetes Mellitus Practice Study is a 5-year survey documenting changes in diabetes treatment practice in developing regions. RESEARCH DESIGN AND METHODS - Logistic regression analysis was used to identify factors for achieving A1C <7% in 11,799 patients (1,898 type 1 diabetic and 9,901 type 2 diabetic) recruited by 937 physicians from 17 countries in Eastern Europe (n = 3,519), Asia (n = 5,888), Latin America (n = 2,116), and Africa (n = 276). RESULTS - Twenty-two percent of type 1 diabetic and 36% of type 2 diabetic patients never had A1C measurements. In those with values for A1C, blood pressure, and LDL cholesterol, 7.5% of type 1 diabetic (n = 696) and 3.6% of type 2 diabetic (n = 3,896) patients attained all three recommended targets (blood pressure < 130/80 mmHg, LDL cholesterol <100 mg/dl, and A1C <7%). Self-monitoring of blood glucose was the only predictor for achieving the A1C goal in type 1 diabetes (odds ratios: Asia 2.24, Latin America 3.55, and Eastern Europe 2.42). In type 2 diabetes, short disease duration (Asia 0.97, Latin America 0.97, and Eastern Europe 0.82) and treatment with few oral glucose-lowering drugs (Asia 0.64, Latin America 0.76, and Eastern Europe 0.62) were predictors. Other region-specific factors included lack of microvascular complications and old age in Latin America and Asia; health insurance coverage and specialist care in Latin America; lack of obesity and self-adjustment of insulin dosages in Asia; and training by a diabetes educator, self-monitoring of blood glucose in patients who self-adjusted insulin, and lack of macrovascular complications in Eastern Europe. CONCLUSIONS - In developing countries, factors pertinent to patients, doctors, and health care systems all impact on glycemic control.Facultad de Ciencias Médica

Multifaceted Determinants for Achieving Glycemic Control the International Diabetes Management Practice Study (IDMPS)

OBJECTIVE - the International Diabetes Mellitus Practice Study is a 5-year survey documenting changes in diabetes treatment practice in developing regions.RESEARCH DESIGN and METHODS - Logistic regression analysis was used to identify factors for achieving A1C <7% in 11,799 patients (1,898 type 1 diabetic and 9,901 type 2 diabetic) recruited by 937 physicians from 1.7 countries in Eastern Europe (n = 3,519), Asia (n = 5,888), Latin America (n = 2,116), and Africa (n = 276).RESULTS - Twenty-two percent of type 1 diabetic and 36% of type 2 diabetic patients never had A1C measurements. in those with values for A1C, blood pressure, and LDL cholesterol, 7.5% of type 1 diabetic (n = 696) and 3.6% of type 2 diabetic (n = 3,896) patients attained all three recommended targets (blood pressure <130/80 mmHg, LDL cholesterol <100 mg/dl, and A1C <7%). Self-monitoring of blood glucose was the only predictor for achieving the A1C goal in type 1 diabetes (odds ratios: Asia 2.24, Latin America 3.55, and Eastern Europe 2.42). in type 2 diabetes, short disease duration (Asia 0.97, Latin America 0.97, and Eastern Europe 0.82) and treatment With few oral glucose-lowering drugs (Asia 0,64, Latin America 0.76, and Eastern Europe 0,62) were predictors, Other region-specific factors included lack of microvascular complications and old age in Latin America and Asia; health insurance coverage and specialist care in Latin America; lack of obesity and self-adjustment of insulin dosages in Asia; and training by a diabetes educator, self-monitoring of blood glucose in Patients who self-adjusted insulin, and lack of macrovascular complications in Eastern Europe.CONCLUSIONS - in developing countries, factors pertinent to Patients, doctors, and health care systems all impact on glycemic control.Chinese Univ Hong Kong, Prince Wales Hosp, Dept Med & Therapeut, Hong Kong, Hong Kong, Peoples R ChinaNatl Univ La Plata, Sch Med,Ctr Expt & Appl Endocrinol, Collaborating Ctr Diabet,Natl Sci & Tech Res Coun, WHO,Pan Amer Hlth Org, La Plata, Buenos Aires, ArgentinaKorea Univ, Guro Hosp, Dept Internal Med, Seoul, South KoreaDept Intercontinental Med Affairs, Paris, FranceUniversidade Federal de São Paulo, Dept Prevent Med, São Paulo, BrazilIuliu Hatieganu Univ Med, Diabet Ctr & Clin, Cluj Napoca, RomaniaIstanbul Univ, Cerrahpasa Med Fac, Dept Internal Med, Istanbul, TurkeyDr A Ramachandrans Diabet Hosp, India Diabet Res Fdn, Madras, Tamil Nadu, IndiaJaveriana Univ, Endocrinol Unit, Bogota, ColombiaUniversidade Federal de São Paulo, Dept Prevent Med, São Paulo, BrazilWeb of Scienc

Maturity-Onset Diabetes of the Young in Children With Incidental Hyperglycemia:: A multicenter Italian study of 172 families

OBJECTIVE - To investigate the prevalence of maturity-onset diabetes of the young (MODY) in Italian children With incidental hyperglycemia. RESEARCH DESIGN AND METHODS - Among 748 subjects age 1-18 years with incidental hyperglycemia, minimal diagnostic criteria for MODY were met by 172 families. Mutational analyses of the glucokinase (GCK) and hepatocyte nuclear factor lot (HNF1A) genes were performed. RESULTS - We identified 85 GCK gene mutations in 109 probands and 10 HNF1A mutations in 12 probands. In GCK patients, the median neonatal weight and age at the first evaluation were lower than those found in patients with HNF1A mutations. Median fasting plasma glucose and impaired fasting glucose/impaired glucose tolerance frequency after oral glucose tolerance testing were higher in GCK patients, who also showed a lower frequency of diabetes than HNF1A patients. CONCLUSIONS - GCK mutations are the prevailing cause of MODY (63.4%) when the index case is recruited in Italian children with incidental hyperglycemia

Previously Associated Type 2 Diabetes Variants May Interact With Physical Activity to Modify the Risk of Impaired Glucose Regulation and Type 2 Diabetes: A Study of 16,003 Swedish Adults

OBJECTIVE-Recent advances in type 2 diabetes genetics have culminated in the discovery and confirmation of multiple risk variants. Two important, and largely unanswered questions are whether this information can be used to identify individuals most susceptible to the adverse consequences of sedentary behavior and to predict their response to lifestyle intervention; such evidence Would be mechanistically informative and provide a rationale for targeting genetically susceptible subgroups of the population. RESEARCH DESIGN AND METHODS-Gene X physical activity interactions were assessed for 17 polymorphisms ill a prospective population-based cohort of initially nondiabetic middle-aged adults. Outcomes were 1) impaired glucose regulation (IGR) versus normal glucose regulation determined with either fasting or 2-h plasma glucose concentrations (n = 16,003), 2) glucose intolerance (in mmol/l, n = 8,860), or 3) incident, type 2 diabetes (n = 2,063 events). RESULTS-Tests of gene X physical activity interactions oil IGR risk for 3 of the 17 polymorphisms were nominally statistically significant: CDKNT2A/B rs10811661 (P-interaction = 0.015), HNF1B rs4430796 (P-interaction = 0.026), and PPARG rs1801282 (P-interaction = 0.04). Consistent interactions were observed for the CDKN2A/B (P-interaction = 0.013) and HNF1B (P-interaction = 0.0009) variants on 2-h glucose concentrations. Where type 2 diabetes was the outcome, only one statistically significant interaction effect was observed, and this was for the HNF1B rs4430796 variant, (P-interaction = 0.0004). The interaction effects for HNF1B on IGR risk and incident diabetes remained significant after correction for multiple testing (P-interaction = 0.015 and 0.0068, respectively). CONCLUSIONS-Our observations suggest that the genetic predisposition to hyperglycemia is partially dependent on a person's lifestyle. Diabetes 58:1411-1418, 200

Best practice guidelines for the molecular genetic diagnosis of maturity-onset diabetes of the young

Member of the EMQN MODY group: Gisela GasparAIMS/HYPOTHESIS: Mutations in the GCK and HNF1A genes are the most common cause of the monogenic forms of diabetes known as 'maturity-onset diabetes of the young'. GCK encodes the glucokinase enzyme, which acts as the pancreatic glucose sensor, and mutations result in stable, mild fasting hyperglycaemia. A progressive insulin secretory defect is seen in patients with mutations in the HNF1A and HNF4A genes encoding the transcription factors hepatocyte nuclear factor-1 alpha and -4 alpha. A molecular genetic diagnosis often changes management, since patients with GCK mutations rarely require pharmacological treatment and HNF1A/4A mutation carriers are sensitive to sulfonylureas. These monogenic forms of diabetes are often misdiagnosed as type 1 or 2 diabetes. Best practice guidelines for genetic testing were developed to guide testing and reporting of results

Update of variants identified in the pancreatic β-cell K ATP channel genes KCNJ11 and ABCC8 in individuals with congenital hyperinsulinism and diabetes

The most common genetic cause of neonatal diabetes and hyperinsulinism is pathogenic variants in ABCC8 and KCNJ11. These genes encode the subunits of the β-cell ATP-sensitive potassium channel, a key component of the glucose-stimulated insulin secretion pathway. Mutations in the two genes cause dysregulated insulin secretion; inactivating mutations cause an oversecretion of insulin, leading to congenital hyperinsulinism, whereas activating mutations cause the opposing phenotype, diabetes. This review focuses on variants identified in ABCC8 and KCNJ11, the phenotypic spectrum and the treatment implications for individuals with pathogenic variants.This article is freely available via Open Access. Click on the publisher URL to access it via the publisher's site.P30 DK020595/NH/NIH HHS/United States K23 DK094866/NH/NIH HHS/United States R03 DK103096/NH/NIH HHS/United States 1-11-CT-41/American Diabetes Association/International R01 DK104942/DK/NIDDK NIH HHS/United States WT_/Wellcome Trust/United Kingdom WT098395/Z/12/Z/WT_/Wellcome Trust/United Kingdom UL1 TR000430/NH/NIH HHS/United States P30 DK020595/DK/NIDDK NIH HHS/United States UL1 TR000430/TR/NCATS NIH HHS/United States 1-17-JDF-008/American Diabetes Association/International 105636/Z/14/Z/WT_/Wellcome Trust/United Kingdom 110675/European Association for the Study of Diabetes-Novo Nordisk/International 16/0005407/DUK_/Diabetes UK/United Kingdom R01 DK104942/NH/NIH HHS/United States R03 DK103096/DK/NIDDK NIH HHS/United States K23 DK094866/DK/NIDDK NIH HHS/United Statespublished version, accepted version (12 month embargo), submitted versio