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suggests that up to 50% of the population served by fluoridated water systems may not receive its full caries-preventive benefits due to not consuming plain tap water. Our findings add support for the need to identify and address barriers to tap water consumption and promote health benefits of fluoridation.

Half of US youth consumed plain tap water on a given day. Consuming plain tap water was not associated with community water fluoridation status. This finding suggests that up to 50% of the population served by fluoridated water systems may not receive its full caries-preventive benefits due to not consuming plain tap water. Our findings add support for the need to identify and address barriers to tap water consumption and promote health benefits of fluoridation.

Psoriatic Arthritis (PsA) is a multifaceted disease in which various musculoskeletal and skin manifestations are involved. Beyond these features, PsA is associated with comorbidities that might increase the burden of the disease.

In the last years a growing interest has come out for the concept of multimorbidity in rheumatology. Multimorbidity was defined as the 'co-existence of two or more chronic diseases in the same individual.' In the multimorbidity concept, the patient is of central concern and all coexisting diseases are of equal importance. Comorbidity was defined as the 'occurrence of any distinct additional entity during the clinical course of patient who has the index disease under study.' In PsA, comorbidity and multimorbidity have often been confusingly used interchangeably, showing that there is an unmet need on this topic.

This perspective article dealt with these different visions of the co-existence of other diseases in PsA, providing a distinction between them, not only for the impact on the treatment decision but also in how this concept might be incorporated into clinical trials design, choosing the right outcome measures for the patient-centric concept of multimorbidity. For this perspective, the authors searched PubMed and the Cochrane library for articles published.

This perspective article dealt with these different visions of the co-existence of other diseases in PsA, providing a distinction between them, not only for the impact on the treatment decision but also in how this concept might be incorporated into clinical trials design, choosing the right outcome measures for the patient-centric concept of multimorbidity. For this perspective, the authors searched PubMed and the Cochrane library for articles published.Necrotizing fasciitis, commonly known as "flesh-eating disease," is an aggressive soft tissue infection that destroys the fascia, subcutaneous tissue, and skin. Specific clinical features (crepitus or radiologic features of gas in tissues) either appear late or are of poor sensitivity. Thus, a high index of clinical suspicion is required for early diagnosis and prompt treatment, which are the best methods of minimizing its high associated morbidity and mortality. We present 3 cases to demonstrate diagnostic difficulties and challenges in management and highlight the feature of pain on muscular activity.Objective To describe the frequency and predisposing factors of aortic structural disease among patients with biopsy-proven giant cell arteritis (GCA). Method A retrospective review identified all patients with biopsy-proven GCA from 1998 to 2013 with aortic imaging. Kaplan-Meier methods were used to estimate cumulative incidence and Cox models were used to examine potential predictors of development of aneurysm/dilatation of the thoracic aorta. Results The cohort included 114 patients with aortic imaging performed within a median time of 1.8 months from GCA diagnosis. Fifty-seven patients (50%) had at least one additional follow-up imaging study. At the first imaging study, 8% had evidence of aneurysm/dilatation and 25% thickening of the thoracic aorta. Excluding prevalent cases, the cumulative incidence for aneurysm/dilatation of the thoracic aorta during follow-up was 0% at both 1 year and 2 years but increased to 10% at 5 years. The sole predictor for development of thoracic aortic aneurysm/dilatation was current smoking (hazard ratio 28.8, 95% confidence interval 1.62, 511.4; p = 0.02). Conclusion Thoracic aortic aneurysm/dilatation was seen in 8% of patients at baseline. Among patients without aortic disease, the cumulative incidence of aortic disease was 10% at 5 years after diagnosis. Current smokers were at an increased risk for developing thoracic aortic damage. Surveillance for aortic damage should be pursued in patients with GCA, particularly those with a smoking history.

The conservative management of a Stanford type B aortic dissection (TBD) is optimal blood pressure management, cardiac rehabilitation, and progressive return to activities of daily living (ADL) while preventing advancing dissection and aortic dilation. see more Recent case reports indicate higher levels of activity may be safe; however, the exercise parameters for chronic TBD conditions span a broad range and the research is limited.

The clinical presentation and outpatient cardiac and physical rehabilitation program for a 61-year-old male with a chronic TBD from his subclavian artery to common iliac arteries is presented. The exercise protocol was developed and based on the available literature for the management of chronic aortic diseases. Eighteen months after the patient's acute TBD event, he began an exercise protocol designed to address the sport specific functional deficits related to his recreational activities. The program incorporated a variety of exercises from resistance training to cardiovascular exerclude particular exercise guidelines beyond general recommendations of light to moderate cardiovascular activities.Objective Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterized by recurrent short episodes (1-3 days) of inflammation and fever. FMF is associated with MEFV gene mutations but some patients with FMF symptoms do not have a mutation in the coding region of the MEFV gene. Vitamin D binding protein (VDBP) has important functions, including transporting vitamin D and its metabolites to target cells. Circulating levels of vitamin D are decreased in several inflammatory conditions, including FMF. Thus, we hypothesize that VDBP may play a crucial role in FMF pathogenesis, in addition to the MEFV gene. Method VDBP genotyping was performed by polymerase chain reaction (PCR)-restriction fragment length polymorphism in 107 FMF patients and 25 healthy individuals without FMF or family history. For this, after amplification of genomic DNA, PCR products were digested with restriction enzymes HaeIII and StyI and evaluated electrophoretically. Results We observed a statistically significant difference in the frequency of the 1F-2 genotype.