Pedographic assessment of the impact of off-the-shelf orthopedic shoes on the load distribution under the feet in patients with a high risk of developing diabetic foot syndrome

BACKGROUND: It is known that the so-called “rocker” outsole helps to reduce the load on the forefoot and toes. Such an outsole is available in ready-made orthopedic shoes of some Russian manufacturers, however, an objective assessment of their impact on the load distribution under the foot during walking has not been carried out.AIMS: To study the pressure distribution inside the off-the-shelf orthopedic shoes“Sursil-Ortho” in comparison with the load inside the shoes used by patients on a daily basis.METHODS: We studied 20 patients (40 feet) with a high risk of diabetic foot syndrome. According to clinical data, a risk regions were determined on the plantar surface of the feet. In-shoe pedography (pedar, novel,Germany) was performed in shoes usually worn by the patients, and in orthopedic shoes“Sursil-Orto”(Moscow). The maximum peak pressure (MPP) was calculated. Criterion of efficiency: MPP in the risk region<200 kPa or reducing it by 25% or more.RESULTS: There was a significant decrease of the median MPP in the forefoot and in the risk region. The percentage of feet with MPP >200 kPa in the risk region decreased from 58% to 30% (p=0,014), in any area of the forefoot — from 63% to 30% (p=0,04). The increase in MPP under the midfoot and hindfoot did not exceed +14% (ns). Tested footwear was effective in 71% of cases. Predictors of the insufficient effect were: higher initial MPP in the risk region, risk region on the hallux or in the lateral part of the forefoot.CONCLUSIONS: Shoes with a rigid rocker outsole significantly reduce the pressure under the forefoot and under the toes during walking. The degree of load reduction varies: the lateral part of the forefoot and 2-5 toes are most unloaded, and the hallux and medial forefoot are slightly less

The state of specific immunity of population of the Republic of Tajikistan to measles, rubella, poliomyelitis viruses

Relevance. To achieve the goals of measles and rubella elimination and poliomyelitis eradication programs, immunization coverage of at least 95% of the target population is required. Objective data on the state of specific herd immunity are provided only by the results of serosurveys. In the Republic of Tajikistan, such monitoring is not carried out regularly. Therefore, the purpose of the study was to assess the actual state of the specific herd immunity to measles, rubella, and poliomyelitis viruses. Materials and methods. The blood sera of 563 children and adults collected in 7 cities and 13 districts of Tajikistan in 2020 were investigated. The level of antibodies (ABs) to measles and rubella viruses was determined using enzyme immunoassay. Test systems VectoKor-IgG (VECTOR-BEST, Russia) and Ecolab, Russia were used to determine ABs to measles and rubella virus, respectively. Neutralizing antibodies (nABs) to the 3 types of poliovirus (PV) were determined in 359 sera using a neutralization reaction with Sabin strains of types 1, 2, 3. Results. The conducted serosurvey showed the level of the specific herd immunity to rubella to be 87.9% in total population, including 86.2% in children, 93.1% in adolescents, and 93.5% and adults, that is sufficient to prevent transmission of the rubella virus. The proportion of individuals seropositive to measles was 54.5%, which is not enough to prevent sustained secondary transmission of infection and the resumption of circulation of the endemic strain of measles virus. The children under 15 years of age should be considered a population at risk of the infection, since children accounted for 38% among seronegative individuals. In general, less than 95% of the examined patients had nABs to PV: 94.4% to PV1, 86.1% to PV2, 83.6% to PV3; 3.3% did not have antibodies to all three types of PV. The level of herd immunity varied in the examined groups depending on the vaccination schedule and the composition of the poliovirus vaccines used: nABs to PV2 had 59.6% of children born during the period when vaccines containing PV2 were not used, and 85.7% of children born after the introduction of trivalent IPV. Deficiency in immunity to PV2 was the cause of a polio outbreak in 2021 caused by circulating vaccine-derived PV type 2. Conclusion. A high level of humoral immunity to the rubella virus was determined. Shortcomings of routine immunization against measles and polio associated with insufficient coverage and lack of IPV have been identified. Conducting regular serological monitoring in the Republic of Tajikistan is advisable to obtain objective information about the level of herd immunity, identify vulnerable groups of the population, and plan additional immunization activities

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Genome analysis of E. coli isolated from Crohn’s disease patients

Abstract Background Escherichia coli (E. coli) has been increasingly implicated in the pathogenesis of Crohn’s disease (CD). The phylogeny of E. coli isolated from Crohn’s disease patients (CDEC) was controversial, and while genotyping results suggested heterogeneity, the sequenced strains of E. coli from CD patients were closely related. Results We performed the shotgun genome sequencing of 28 E. coli isolates from ten CD patients and compared genomes from these isolates with already published genomes of CD strains and other pathogenic and non-pathogenic strains. CDEC was shown to belong to A, B1, B2 and D phylogenetic groups. The plasmid and several operons from the reference CD-associated E. coli strain LF82 were demonstrated to be more often present in CDEC genomes belonging to different phylogenetic groups than in genomes of commensal strains. The operons include carbon-source induced invasion GimA island, prophage I, iron uptake operons I and II, capsular assembly pathogenetic island IV and propanediol and galactitol utilization operons. Conclusions Our findings suggest that CDEC are phylogenetically diverse. However, some strains isolated from independent sources possess highly similar chromosome or plasmids. Though no CD-specific genes or functional domains were present in all CD-associated strains, some genes and operons are more often found in the genomes of CDEC than in commensal E. coli. They are principally linked to gut colonization and utilization of propanediol and other sugar alcohols