We investigated whether disclosure of coronary heart disease (CHD) genetic risk influences perceived personal control (PPC) and genetic counseling satisfaction (GCS). Participants (n = 207, age: 45-65 years) were randomized to receive estimated 10-year risk of CHD based on a conventional risk score (CRS) with or without a genetic risk score (GRS). Risk estimates were disclosed by a genetic counselor who also reviewed how GRS altered risk in those randomized to CRS+GRS. Each participant subsequently met with a physician and then completed surveys to assess PPC and GCS. Participants who received CRS+GRS had higher PPC than those who received CRS alone although the absolute difference was small (25.2 ± 2.7 vs 24.1 ± 3.8, p = 0.04). A greater proportion of CRS+GRS participants had higher GCS scores (17.3 ± 5.3 vs 15.9 ± 6.3, p = 0.06). In the CRS+GRS group, PPC and GCS scores were not correlated with GRS. Within both groups, PPC and GCS scores were similar in patients with or without family history (p = NS). In conclusion, patients who received their genetic risk of CHD had higher PPC and tended to have higher GCS. Our findings suggest that disclosure of genetic risk of CHD together with conventional risk estimates is appreciated by patients. Whether this results in improved outcomes needs additional investigation.

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The Food and Drug Administration (FDA) had approved fingolimod usage for multiple sclerosis in 2010. Melanoma after the usage of fingolimod immunomodulation was reported rarely in clinical trials, and only two case reports exist in the published literature, both occurring in Europe. Most of the incidences reported in clinical trials were in-situ, whereas both case reports were of malignant melanoma. Fingolimod has been found to inhibit metastatic melanoma growth in a mouse model that depends on vascular endothelial growth factor (VEGF)-induced angiogenesis for metastasis. However, there are numerous pathways of angiogenesis and tumour growth found in vivo by which melanoma can expand that do not mandate VEGF. We report a case of superficial spreading malignant melanoma occurring after fingolimod therapy in the USA.

Background: Perceived personal control (PPC) represents the belief that a person can alter his/her own situation or state. Higher PPC has been associated with increased health-related quality of life and helps facilitate healthy behavioral changes. We investigated whether disclosure of coronary heart disease (CHD) genetic risk influences PPC and genetic counseling satisfaction (GCS) in the myocardial infarction genes (MI-GENES) study, a randomized controlled trial of disclosing genetic risk of CHD. Methods: Participants (40-65 year-old, at intermediate 10-year CHD risk, and not on statins) were randomized to receive estimated 10-year risk of CHD based on their Framingham Risk Score (FRS) or FRS plus a 28 SNP genetic risk score (FRS*GRS). CHD risk was disclosed in each arm by a genetic counselor during a 30-minute scripted session that included a discussion of the impact of family history on CHD risk. For FRS*GRS participants, the genetic counselor also reviewed how their genetic risk score altered their FRS. Each participant then met with a physician to engage in shared-decision making regarding the need for statin therapy. Afterwards, study participants were asked to complete validated surveys to assess PPC and GCS. The 9-item PPC questionnaire was scored 0-9, with higher scores indicating greater control beliefs. The 5-item GCS questionnaire was scored 0-10, with greater scores indicating greater satisfaction with the disclosure session. Results: 207 patients (mean age 58.8±5 years, 46.7% males) were randomized to receive either FRS or FRS*GRS. Patients randomized to receive FRS*GRS had higher PPC compared to FRS although the absolute difference was small (8.85±0.77 vs. 8.54±1.31, P=0.016). Patients randomized to receive FRS*GRS also had a higher GCS score than FRS patients (9.08±2.67 vs. 8.3±3.67, P=0.050]. Conclusions: Disclosure of genetic risk for CHD did not adversely affect PPC or GCS. In fact, patients who received CHD genetic risk information had higher PPC and GCS. Our findings suggest that disclosure of CHD genetic risk is appreciated by patients and may empower them to improve health-related behaviors.

Category: Ankle; Ankle Arthritis; Arthroscopy; Bunion; Hindfoot; Midfoot/Forefoot; Sports; Trauma Introduction/Purpose: The use of intraoperative topical vancomycin powder has recently increased in popularity as a method of theoretically decreasing post-operative surgical site infections; however, there is limited research in orthopaedic trauma to support its use. This study evaluates the use of topical vancomycin powder to decrease post-operative infections following lower extremity trauma. We also investigated socio-demographic factors and medical comorbidities that were associated with post- operative surgical site infections. Methods: We conducted a review of 226 patients at a single Level 1 Trauma Center following surgery between the years 2015 and 2020. These patients were treated predominantly by a single fellowship trained foot and ankle orthopaedic surgeon. Demographic factors, medical comorbidities, postoperative infections, and use of vancomycin powder were reviewed. Analysis of 4 groups (no infection, superficial infection, deep infection, or both) was performed using Fischer's exact test and Student t-test. A logistic regression model was utilized to identify independent demographic factors and medical comorbidities that were associated with surgical site infection. Results: The final cohort included 221 patients, of which 26 received intraoperative vancomycin powder. There were 23 total post-operative surgical site infections. Of those, 14 infections were superficial, 3 were deep, and 6 were both superficial and deep. All but one of these infections were in patients without vancomycin powder applied. Patients who received intraoperative vancomycin powder were statistically significantly less likely to acquire post-operative surgical site infections than those who did not (1 vs. 22, p=0.031). The one postsurgical site infection with vancomycin use was a deep infection in a patient with chronic kidney disease that had previously undergone three irrigation and debridement surgeries for a gunshot wound. Male sex was the only demographic or comorbidity factor associated with postoperative surgical site infection (p=0.009, OR=4.006). Conclusion: We found an association between topical vancomycin use and lower likelihood of developing postsurgical wound infections in lower extremity trauma. This is consistent with similar studies in spinal surgery. In contrast to previous studies, we did not find a significant association between medical comorbidities or demographic factors other than male sex and surgical site infection. Future studies should aim to identify which patients would have the greatest reduction of risk for postsurgical wound infections with the use of intraoperative topical vancomycin powder.