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Shen Q, Li B, Chen H, Gao S, Hu Y, Sun Y, Li G. Podiatrist intervention could reduce the incidence of foot ulcers in patients with diabetes: a hospital survey in China. J Wound Care 2024; 33:S25-S32. [PMID: 38573950 DOI: 10.12968/jowc.2024.33.sup4.s25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of podiatrists in preventing diabetic foot ulcers (DFUs) in China. METHOD The study was a prospective investigation. A total of 300 patients were enrolled from May 2016 to May 2018 in Handan Central Hospital, China. All patients who participated in this study had been diagnosed with type 2 diabetes, according to the International Classification of Diseases (ICD-10). All participants underwent our survey, which included basic patient data and information about DFUs. The patients were followed for one year, during which time they received appropriate intervention from podiatrists, including lifestyle guidance, callus resection, tinea grinding and ingrown nail correction. At the end of the year all the patients were surveyed again. The data before and after the year were statistically compared. RESULTS The results showed that the incidence of DFUs in patients with diabetes was significantly decreased after one year of intervention from podiatrists (20.7% versus 6.7%, p<0.001). Additionally, there was a negative correlation between the number of intervention visits and the number of DFU occurrences (Spearman correlation coefficient: -0.496, p<0.001). Furthermore, we found that 68 patients with a history of DFUs or amputation had an obviously reduced incidence of DFUs after intervention by a podiatrist (89.7% versus 27.9%, p<0.001). We also investigated other foot risk factors in all participants, such as limb neuropathy (76.3%), lower extremity vascular disease (65.7%) and foot paralysis (43.7%). CONCLUSION The results of this study help in understanding the situation of patients with diabetes in China and to prove that standardised podiatrist intervention has an important role in inhibiting the occurrence and development of DFUs.
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Affiliation(s)
- Qian Shen
- School of Foreign Studies of Zhongnan University of Economics and Law; Wuhan, China
| | - Binghui Li
- Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huating Chen
- Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suwen Gao
- Department of Endocrinology, Handan Central Hospital, Handan, China
| | - Yingyue Hu
- Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Sun
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gongchi Li
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yan C, Zhou L, Li J, Zhang G, Yang C, Gu J, Lu X, Zhang L, Zeng M. Improved small vessel visibility in diabetic foot arteriography using dual-energy CT. Clin Radiol 2024; 79:e424-e431. [PMID: 38101997 DOI: 10.1016/j.crad.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/07/2023] [Accepted: 11/14/2023] [Indexed: 12/17/2023]
Abstract
AIM To test the feasibility and performance of dual-energy computed tomography (DECT) in foot arteriography of diabetic patients, where contrast medium is largely reduced within the small vessels. MATERIALS AND METHODS A total of 50 diabetic patients were enrolled prospectively, where DECT was acquired immediately after the CT angiography (CTA, group A) of the lower extremity. Two images were derived from the DECT data, one optimal virtual monochromatic image (VMI, group B) and one fusion image (group C), both of which were compared against the CTA image for visualising the foot arteries. The contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were evaluated. The arterial course and contrast were graded each using a five-point scale. The clarity of small vessel depiction was quantified by comparing the number of plantar metatarsal arteries found in the maximum intensity projection image. RESULTS The median CNRs and SNRs obtained in group B were approximately 45% and 20% higher than those in groups A and C, respectively (p<0.05). Group B also received higher subjective scores on the posterior tibial artery and the foot arteries (all >3) than groups A and C. The number of visible branches of the plantar metatarsal arteries was found to be substantially higher (p<0.05) in group B (median=6) than in groups A (median=2) and C (median=4). CONCLUSION DECT was found to be superior to conventional CTA in foot arteriography, and beyond the lower extremity, it might be a general favourable solution for imaging regions with small vessels and reduced contrast medium.
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Affiliation(s)
- C Yan
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China
| | - L Zhou
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China
| | - J Li
- United Imaging Healthcare, Shanghai, China
| | - G Zhang
- United Imaging Healthcare, Shanghai, China
| | - C Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China
| | - J Gu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China
| | - X Lu
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China
| | - L Zhang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China
| | - M Zeng
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Medical Imaging, Shanghai, China.
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An J, Yu H, Gao Z, Hu X, Wang X. Value of cystatin C in predicting recurrence in patients with severe diabetic foot and diabetic foot ulcer. Biomark Med 2023; 17:287-296. [PMID: 37283546 DOI: 10.2217/bmm-2022-0837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Objective: Our objective is to investigate the risk factors and predictive ability of severe diabetic foot (DF) and diabetic foot ulcers (DFUs). Patients & methods: The efficacy of cystatin C in predicting the recurrence of DF and DFU was evaluated using a receiver operating characteristic curve. Results: The findings indicate that, in contrast to non-severe patients, severe cases exhibit elevated levels of cystatin C (p < 0.05). Additionally, a statistically significant increase in cystatin C levels was observed in the subgroup of patients with recurrent DFU (p < 0.01). Conclusion: Cystatin C emerged as a significant risk factor for severe DF and recurrent DFU, with the potential for predicting their occurrence.
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Affiliation(s)
- Jingsi An
- Endocrinology Department, Jinzhou Central Hospital, Jinzhou, Liaoning, 121000, China
- Jinzhou Medical University, Jinzhou, Liaoning, 121000, China
| | - Hongwei Yu
- Department of Cardiology, Jinzhou Central Hospital, Jinzhou, Liaoning, 121000, China
| | - Zhenyu Gao
- Department of Nephrology, Jinzhou Central Hospital, Jinzhou, Liaoning, 121000, China
| | - Xiangka Hu
- Jinzhou Medical University, Jinzhou, Liaoning, 121000, China
| | - Xueying Wang
- Endocrinology Department, Jinzhou Central Hospital, Jinzhou, Liaoning, 121000, China
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Tan CH, Wu Y, Satkunanantham M. Flaps for lower limb diabetic wound reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2023; 79:74-86. [PMID: 36870103 DOI: 10.1016/j.bjps.2023.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 01/29/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND The treatment of chronic diabetic wounds includes wound dressing, debridement, flap surgery, and amputation. For suitable patients with nonhealing wounds, locoregional flaps or free flaps may be used. This paper aims to review the outcomes of flap surgery and identify the risk factors for flap loss. METHODS MEDLINE, Embase, and Cochrane Library were searched. Articles reporting flap loss outcomes for flap surgery in lower limb chronic diabetic wounds were included. Case reports and case series with fewer than five patients were excluded. A subset of articles was used for revascularization subgroup analysis and another subset for meta-analysis of risk factors for flap loss. RESULTS In the free flap group, the total flap failure rate was 7.14% and partial flap failure rate was 7.54%. The rate of major complications requiring operative takeback was 19.0%. Early mortality was 2.76%. In the locoregional flap group, the total flap failure rate was 3.24% and partial flap failure rate was 5.36%. The rate of major complications requiring operative takeback was 13.3%. There was no early mortality. The rate of free flap loss was 18.2% with revascularization, significantly higher than 6.66% without revascularization. CONCLUSIONS Our findings concur with previously published studies on flap loss and complications in diabetic lower limb wounds. There is an increased risk of flap loss in patients who require free flap and revascularization compared to patients who only require free flap. This could be because of the fragile and fibrotic vessels found in diabetics with comorbid atherosclerosis.
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Affiliation(s)
| | | | - Mala Satkunanantham
- Department of Hand and Reconstructive Microsurgery, Tan Tock Seng Hospital, Singapore
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Advances in the Clinical Application of Platelet-Rich Plasma in the Foot and Ankle: A Review. J Clin Med 2023; 12:jcm12031002. [PMID: 36769649 PMCID: PMC9917505 DOI: 10.3390/jcm12031002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/31/2023] Open
Abstract
Autologous and recombinant biologic substances have been generated as a result of the research into the cellular features of the healing process. Orthobiologics are increasingly being used in sports medicine and musculoskeletal surgery. Nevertheless, clinical data are limited; consequently, further studies are required, particularly in foot and ankle pathologies. This review aims to provide evidence of the most recent literature results and ignite the interest of orthopedic specialists eager for an update about the most current discussion on platelet-rich plasma (PRP) clinical applications in the foot and ankle fields. Previous studies have shown that platelet-rich plasma can be beneficial in treating various conditions, such as chronic foot ulcers, osteoarthritis, Achilles tendinopathy, etc. Despite the positive effects of PRP on various musculoskeletal conditions, more prospective studies are needed to confirm its effectiveness at treating ankle and foot pathologies. In addition to clinical trials, other factors, such as the quality of the research and the procedures involved, must be considered before they can be used in patients. More long-term evaluations are needed to support or oppose its application in treating foot and ankle disorders. We present the most extensive review of PRP's clinical applications in the foot and ankle field.
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Belal A, Elanany MA, Raafat M, Hamza HT, Mehany ABM. Calendula officinalis Phytochemicals for the Treatment of Wounds Through Matrix Metalloproteinases-8 and 9 (MMP-8 and MMP-9): In Silico Approach. Nat Prod Commun 2022. [DOI: 10.1177/1934578x221098848] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Diabetic foot ulceration is a common complication of an uncontrolled diabetic regimen and is considered a serious type of wound. Matrix metalloprteinases (MMPs) are the common key enzymes in wound management, overexpression of MMPs can lead to chronic wounds and ulcers. Calendula officinalis extract has established its efficacy in treating wounds in folk medicine. In this research work, we will focus on the chemical constituents of this promising herb and will investigate its abilities to target matrix metalloprteinase-8 (MMP-8) and matrix metalloprteinase-9 (MMP-9) proteins through the usage of computer-aided drug design tools. In the current study, several promising dual inhibitors are identified, such as quercetin, isoquercetin, isorhamnetin, and isorhamnetin 3-O glycoside, they showed to be good inhibitors for both enzyme subtypes with greater docking score energies than RND-336, which has been reported as a selective MMP-9 inhibitor. Binding scores and amino acid interactions in addition to molecular dynamics (MD) will be discussed in detail through this research work.
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Affiliation(s)
- Amany Belal
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, P.O. Box 11099, Taif 21944, Saudi Arabia
| | - Mohamed A. Elanany
- School of Pharmacy and Pharmaceutical Industries, Badr University in Cairo (BUC), Cairo, Egypt
| | - Mohamed Raafat
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Hanan Taher Hamza
- Biology Department, College of Science, Jouf University, P.O. Box 2014, Sakaka, Saudi Arabia
- Department of Zoology, Faculty of Science (Girls), Al-Azhar University, Yousef Abbas Str., Nasr City, Cairo, Egypt
| | - Ahmed B. M. Mehany
- Department of Zoology, Faculty of science (Boys), Al-Azhar University, Nasr City, Cairo, Egypt
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Yammine K, Estephan M. Telemedicine and diabetic foot ulcer outcomes. A meta-analysis of controlled trials. Foot (Edinb) 2022; 50:101872. [PMID: 35219129 DOI: 10.1016/j.foot.2021.101872] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/05/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
Telemedicine (TM) has been advanced as an effective approach to wound care management. In this era of COVID-19 pandemic, it is paramount to assess the evidence behind the use of TM in treating diabetic foot ulcers (DFU). This meta-analysis aims at evaluating the efficacy of TM versus face-to-face attendance in managing DFU. In total, four controlled studies were included in the meta-analysis comprising 3 randomized trials. The total pooled sample comprised 816 patients (816 ulcers): 337 in TM group and 479 in the control group. The results were as follows: (a) healing rate OR was 1.35, in favor of TM (p = 0.4), (b) time to heal with means of 73 ± 24.1 days and 83.5 ± 28.4 days, for the TM and control group, respectively (p = 0.35), c) the amputation rate OR was 0.48 (p = 0.007) in favor of the TM group, d) the mortality rate OR was 1.66 (p = 0.2), and e) a trend for lesser cost than face-to-face group (p = 0.4). While future research using large-sampled controlled studies is warranted, the present meta-analysis demonstrated that treating DFU via TM could be at least as effective as to face-to-face attendance. In times where clinic visits are reduced or not possible such as during this COVID-19 pandemic and the likely-to-happen future outbreaks, TM could be a valuable alternative.
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Affiliation(s)
- Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Diabetic Foot Clinic, Lebanese American University Medical Center-Rizk Hospital, Beirut, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research, Lebanon.
| | - Michel Estephan
- Department of Emergency Medicine, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
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Roy R, Zayas J, Singh SK, Delgado K, Wood SJ, Mohamed MF, Frausto DM, Estupinian R, Giurini EF, Kuzel TM, Zloza A, Reiser J, Shafikhani SH. Overriding impaired FPR chemotaxis signaling in diabetic neutrophil stimulates infection control in murine diabetic wound. eLife 2022; 11:72071. [PMID: 35112667 PMCID: PMC8846594 DOI: 10.7554/elife.72071] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022] Open
Abstract
Infection is a major co-morbidity that contributes to impaired healing in diabetic wounds. Although impairments in diabetic neutrophils have been blamed for this co-morbidity, what causes these impairments and whether they can be overcome, remain largely unclear. Diabetic neutrophils, isolated from diabetic individuals, exhibit chemotaxis impairment but this peculiar functional impairment has been largely ignored because it appears to contradict the clinical findings which blame excessive neutrophil influx as a major impediment to healing in chronic diabetic ulcers. Here, we report that exposure to glucose in diabetic range results in impaired chemotaxis signaling through the formyl peptide receptor (FPR) in neutrophils, culminating in reduced chemotaxis and delayed neutrophil trafficking in the wound of Leprdb (db/db) type two diabetic mice, rendering diabetic wound vulnerable to infection. We further show that at least some auxiliary receptors remain functional under diabetic conditions and their engagement by the pro-inflammatory cytokine CCL3, overrides the requirement for FPR signaling and substantially improves infection control by jumpstarting the neutrophil trafficking toward infection, and stimulates healing in diabetic wound. We posit that CCL3 may have therapeutic potential for the treatment of diabetic foot ulcers if it is applied topically after the surgical debridement process which is intended to reset chronic ulcers into acute fresh wounds.
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Affiliation(s)
- Ruchi Roy
- Department of Medicine, Rush University Medical Center, Chicago, United States
| | - Janet Zayas
- Department of Medicine, Rush University Medical Center, Chicago, United States
| | - Sunil K Singh
- Department of Surgery, Division of Surgical Oncology, University of Illinois at Chicago, Chicago, United States
| | - Kaylee Delgado
- Department of Medicine, Rush University Medical Center, Chicago, United States
| | - Stephen J Wood
- Department of Microbial Pathogens and Immunity, Rush University Medical Center, Chicago, United States
| | - Mohamed F Mohamed
- Department of Medicine, Rush University Medical Center, Chicago, United States
| | - Dulce M Frausto
- Department of Medicine, Rush University Medical Center, Chicago, United States
| | - Ricardo Estupinian
- Department of Medicine, Rush University Medical Center, Chicago, United States
| | - Eileena F Giurini
- Department of Medicine, Rush University Medical Center, Chicago, United States
| | - Timothy M Kuzel
- Department of Medicine, Rush University Medical Center, Chicago, United States
| | - Andrew Zloza
- Department of Medicine, Rush University Medical Center, Chicago, United States
| | - Jochen Reiser
- Department of Medicine, Rush University Medical Center, Chicago, United States
| | - Sasha H Shafikhani
- Department of Medicine, Rush University Medical Center, Chicago, United States
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Afonso AC, Oliveira D, Saavedra MJ, Borges A, Simões M. Biofilms in Diabetic Foot Ulcers: Impact, Risk Factors and Control Strategies. Int J Mol Sci 2021; 22:8278. [PMID: 34361044 PMCID: PMC8347492 DOI: 10.3390/ijms22158278] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetic foot ulcers (DFUs) are a serious complication from diabetes mellitus, with a huge economic, social and psychological impact on the patients' life. One of the main reasons why DFUs are so difficult to heal is related to the presence of biofilms. Biofilms promote wound inflammation and a remarkable lack of response to host defences/treatment options, which can lead to disease progression and chronicity. In fact, appropriate treatment for the elimination of these microbial communities can prevent the disease evolution and, in some cases, even avoid more serious outcomes, such as amputation or death. However, the detection of biofilm-associated DFUs is difficult due to the lack of methods for diagnostics in clinical settings. In this review, the current knowledge on the involvement of biofilms in DFUs is discussed, as well as how the surrounding environment influences biofilm formation and regulation, along with its clinical implications. A special focus is also given to biofilm-associated DFU diagnosis and therapeutic strategies. An overview on promising alternative therapeutics is provided and an algorithm considering biofilm detection and treatment is proposed.
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Affiliation(s)
- Ana C. Afonso
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal; (A.C.A.); (D.O.); (A.B.)
- CITAB—Centre for the Research and Technology for Agro-Environment and Biological Sciences, University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal;
- CEB—Centre of Biological Engineering, Campus de Gualtar, University of Minho, 4710-057 Braga, Portugal
| | - Diana Oliveira
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal; (A.C.A.); (D.O.); (A.B.)
- CIQUP, Department of Chemistry and Biochemistry, Faculty of Sciences, University of Porto, Rua do Campo Alegre, s/n, 4169-007 Porto, Portugal
| | - Maria José Saavedra
- CITAB—Centre for the Research and Technology for Agro-Environment and Biological Sciences, University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal;
- Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences, University of Trás-os-Montes e Alto Douro, 5001-801 Vila Real, Portugal
| | - Anabela Borges
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal; (A.C.A.); (D.O.); (A.B.)
| | - Manuel Simões
- LEPABE—Laboratory for Process Engineering, Environment, Biotechnology and Energy, Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, s/n, 4200-465 Porto, Portugal; (A.C.A.); (D.O.); (A.B.)
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Bechara N, Gunton JE, Flood V, Hng TM, McGloin C. Associations between Nutrients and Foot Ulceration in Diabetes: A Systematic Review. Nutrients 2021; 13:nu13082576. [PMID: 34444735 PMCID: PMC8400510 DOI: 10.3390/nu13082576] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/23/2021] [Accepted: 07/24/2021] [Indexed: 11/16/2022] Open
Abstract
We reviewed the literature to evaluate potential associations between vitamins, nutrients, nutritional status or nutritional interventions and presence or healing of foot ulceration in diabetes. Embase, Medline, PubMed, and the Cochrane Library were searched for studies published prior to September 2020. We assessed eligible studies for the association between nutritional status or interventions and foot ulcers. Fifteen studies met the inclusion criteria and were included in this review. Overall, there is a correlation between poor nutritional status and the presence of foot ulceration or a delay in healing. However, there is not enough data to reach conclusions about whether the relationships are causal or only association. Further research is required to test whether any forms of nutritional supplementation improve foot ulcer healing.
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Affiliation(s)
- Nada Bechara
- Department of Diabetes and Endocrinology, Blacktown-Mt Druitt Hospital, Blacktown, NSW 2148, Australia; (N.B.); (T.-M.H.); (C.M.)
- Westmead Hospital, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Centre for Diabetes, Obesity and Endocrinology Research (CDOER), The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW 2145, Australia
| | - Jenny E. Gunton
- Westmead Hospital, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145, Australia
- Centre for Diabetes, Obesity and Endocrinology Research (CDOER), The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW 2145, Australia
- Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia
- Correspondence:
| | - Victoria Flood
- Westmead Hospital, Research and Education Network, Western Sydney Local Health District, Westmead, NSW 2145, Australia;
- Faculty of Medicine and Health, Sydney School of Health Sciences, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Tien-Ming Hng
- Department of Diabetes and Endocrinology, Blacktown-Mt Druitt Hospital, Blacktown, NSW 2148, Australia; (N.B.); (T.-M.H.); (C.M.)
| | - Clare McGloin
- Department of Diabetes and Endocrinology, Blacktown-Mt Druitt Hospital, Blacktown, NSW 2148, Australia; (N.B.); (T.-M.H.); (C.M.)
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11
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Firdaus MKZH, Jittanoon P. A literature review on intervention programs for diabetic foot care. ENFERMERIA CLINICA 2021. [DOI: 10.1016/j.enfcli.2020.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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12
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ERNANDES RITADECÁSSIA, BRECH GUILHERMECARLOS, LUNA NATÁLIAMARIANASILVA, BEGA ARMANDO, GUIMARÃES DANIELLESERRA, BOCALINI DANILOSALES, SCHERRER JÚNIOR GERSON, GREVE JULIAMARIAD, LEME LUIZEUGÊNIOGARCEZ, ALONSO ANGÉLICACASTILHO. IMPACT OF DIABETIC NEUROPATHY ON QUALITY OF LIFE AND POSTURAL BALANCE IN BRAZILIAN OLDER ADULTS. ACTA ORTOPEDICA BRASILEIRA 2020; 28:275-279. [PMID: 33328782 PMCID: PMC7723388 DOI: 10.1590/1413-785220202806234529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the impact of the Peripheral Diabetic Neuropathy (PDN) on the postural and functional balance and quality of life of Brazilian older adults. METHODS A cross-sectional study. Sixty older men and women (60-79 years) were divided into three groups: control, DM without and with PDN. The following parameters were evaluated: anthropometry; quality of life; postural balance (BESTest); functional balance in force plate (NeuroCom Balance). RESULTS PDN group presented significant differences compared with the other groups, with the worst performance in quality of life than DM2 without PDN in: sensory functioning (p = 0.030); past and future (p = 0.036); death and dying (p = 0.035). Postural balance deficit in the total score (p = 0.025) and biomedical constraints section (p = 0.043) of the BESTest, compared with DM2 without PDN (p = 0.007). In the functional balance (Neurocom), PDN group presented a worse performance in the time spent on the left side (p = 0.030) than the control group. During step up over test, the control group performed the task faster than the group with PDN (p = 0.004). CONCLUSION This study showed that neuropaths presented worse physical performance and postural balance deficits, sensorial limitations, affecting the daily tasks and, as a consequence, decreasing the quality of life in Brazilian older adults. Level of Evidence II, Cross-sectional observational study.
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Chen Y, Meng L, Wang L, Xiao L, Yang C. Establishment of a diagnostic model of coronary heart disease for patients with diabetic foot. Medicine (Baltimore) 2020; 99:e22334. [PMID: 33019409 PMCID: PMC7535636 DOI: 10.1097/md.0000000000022334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to establish a diagnostic model of coronary heart disease (CHD) for diabetic foot (DF) patients.The clinical data of 489 hospitalized patients with DF were retrospectively analyzed in this case-control study. The patients were divided into the CHD group (DF with CHD, n = 212) and the control group (DF without CHD, n = 277). Univariate analysis was performed to screen for CHD-related risk factors, and multivariate logistic regression analysis was conducted to determine significant CHD risk factors. Scores were assigned according to the ratio of risk factors (OR) to establish a diagnostic model of CHD for patients with DF. The area under the ROC curve was used to test the application value of the diagnostic model.The logistic regression analysis showed that the risk factors for CHD in DF patients were age, duration of diabetes, toe-brachial index, hyperuricemia, and chronic renal insufficiency. The area under the ROC curve of the diagnostic model was 0.798 (0.759-0.837), the diagnostic point of CHD was 6 points, the diagnostic sensitivity was 69.3%, and the specificity was 76.5%.The established model has good diagnostic value and provides the basis for preliminary screening for CHD in patients with DF.
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Affiliation(s)
- Ying Chen
- Department of Endocrinology of the Air Force Medical Center, PLA
| | - Liwei Meng
- Department of Endocrinology of the Xiangyang District People's Hospital of Xiangyang City, China
| | - Liangchen Wang
- Department of Endocrinology of the Air Force Medical Center, PLA
| | - Li Xiao
- Department of Endocrinology of the Air Force Medical Center, PLA
| | - Caizhe Yang
- Department of Endocrinology of the Air Force Medical Center, PLA
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McCarthy M, Yates T, Webb D, Game F, Gray L, Davies MJ. Health impacts of seated arm ergometry training in patients with a diabetic foot ulcer: protocol for a randomised controlled trial. BMJ Open 2020; 10:e039062. [PMID: 32565482 PMCID: PMC7311002 DOI: 10.1136/bmjopen-2020-039062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Once diagnosed with a diabetic foot ulcer (DFU), patients are advised to offload, keeping pressure off the foot in order to facilitate ulcer healing. An increase in offloading is often accompanied by reductions in physical activity which can worsen the overall health of patients.While unable to perform traditional forms of upright activity, one mode of exercise that would allow patients to be physically active while adhering to offloading instruction is seated arm ergometry. The merits of tailored aerobic exercise in DFU remain unexplored. METHODS AND ANALYSIS This is a prospective open-label randomised controlled trial. Participants will be randomised to one of two groups, an exercise intervention group or control. The intervention group are required to undertake arm ergometry training at a moderate intensity (65%-75% HRpeak), three times per week for 12 weeks as individually prescribed by an exercise physiologist, while the control group will continue to receive standard care alone. Assessment of outcome measures will occur at baseline and after the intervention period, these will include: a seated VO2 peak test, a blood sample, a short physical performance battery, a dual-energy X-ray absorptiometry scan and completing a range of health-based questionnaires. The above will be used to determine: cardiorespiratory fitness, metabolic health, physical function, body composition and quality of life, respectively. Ulcer area will also be measured as an approximate marker of ulcer healing. ETHICS AND DISSEMINATION This trial has been approved by 'Yorkshire & The Humber-Leeds West Research Ethics Committee' (19/YH/0269). Trial results will be published in peer-reviewed journals and through conference presentations. TRIAL REGISTRATION NUMBER ISRCTN16000053. Registered in accordance with WHO Trial Registration Data Set (version 1.3.1).
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Affiliation(s)
- Matthew McCarthy
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
| | - David Webb
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Frances Game
- Department of Diabetes and Endocrinology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Laura Gray
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, University of Leicester, Leicester, UK
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15
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Aziz M, Garduno R, Mirani ZA, Baqai R, Sheikh AS, Nazir H, Raza Y, Ayaz M, Kazmi SU. Determination of antimicrobial effect of protamine by transmission electron microscopy and SDS PAGE on Pseudomonas aeruginosa isolates from diabetic foot infection. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2020; 22:827-832. [PMID: 32373306 PMCID: PMC7196347 DOI: 10.22038/ijbms.2019.32414.7989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Objective(s): Diabetic foot infection is one of the major complications of diabetes leading to lower limb amputations. Isolation and identification of bacteria causing diabetic foot infection, determination of antibiotic resistance, antimicrobial potential of protamine by electron microscopy and SDS-PAGE analysis, arethe aims of this study. Materials and Methods: 285 pus samples from diabetic foot infection patients were collected from different hospitals of Karachi and Capital Health Hospital, Halifax, Canada. Clinical history of each patient was recorded. Bacterial isolates were cultured on appropriate media; identification was done by morphology, cultural and biochemical tests. Effect of protamine against multi drug resistant strains of Pseudomona aeruginosa was checked by minimum inhibitory concentration in 96 well micro-titer plates. The isolates were grown in bactericidal concentration of protamine on plates to isolate mutants. Effect of protamine on protein expression was checked by SDS- PAGE and ultra-structural morphological changes by transmission electron microscopy. Results: Results indicated prevalence of foot infection as 92% in diabetic patients. Major bacterial isolates were Staphylococcus aureus 65 (23%), P. aeruginosa 80 (28.1%), Klebsiella spp. 37 (13%), Proteus mirabilis 79 (27.7%), and Escherichia coli 24 (12%). These isolates were highly resistant to different antibiotics. MIC value of protamine was 500 µg/ml against P. aeruginosa. SDS-PAGE analysis revealed that protamine can suppress expression of various virulence proteins and electron micrographs indicated condensation of cytoplasm and accumulation of protamine in cytoplasm without damaging the cell membrane. Conclusion: P. aeruginosa and S. aureus were the major isolates expressing multi-drug resistance and protamine sulfate represented good antimicrobial potential.
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Affiliation(s)
- Mubashar Aziz
- Department of Pathobiology, Bahauddin Zakariya University, Multan, Pakistan.,Department of Microbiology, University of Karachi, Karachi, Pakistan
| | - Rafael Garduno
- Department of Microbiology, Dalhousie University, Halifax, Canada
| | | | - Rakhshanda Baqai
- Department of Microbiology, University of Karachi, Karachi, Pakistan.,Departmet of Clinical Microbiology & Immunology, Dadabhoy Institute of Higher Education, Karachi, Pakistan
| | - Ahsan Sattar Sheikh
- Institute of Food Science and Nutrition, Bahauddin Zakariya University, Multan, Pakistan
| | | | - Yasir Raza
- Department of Microbiology, University of Karachi, Karachi, Pakistan
| | - Mazhar Ayaz
- Department of Pathobiology, Bahauddin Zakariya University, Multan, Pakistan
| | - Shahana Urooj Kazmi
- Department of Microbiology, University of Karachi, Karachi, Pakistan.,Departmet of Clinical Microbiology & Immunology, Dadabhoy Institute of Higher Education, Karachi, Pakistan
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16
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Ling E, Lepow B, Zhou H, Enriquez A, Mullen A, Najafi B. The impact of diabetic foot ulcers and unilateral offloading footwear on gait in people with diabetes. Clin Biomech (Bristol, Avon) 2020; 73:157-161. [PMID: 31986461 PMCID: PMC7183883 DOI: 10.1016/j.clinbiomech.2020.01.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/07/2020] [Accepted: 01/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Unilateral offloading footwear prescribed to patients with diabetic foot ulcers elevates one limb relative to the other, which may lead to limp and abnormal gait. This study investigated whether the unilateral foot ulcer and offloading combination negatively impacts gait function beyond diabetic peripheral neuropathy. METHODS Eighty-six participants were recruited in 3 groups: 12 with diabetic peripheral neuropathy and unilateral foot ulcers wearing offloading footwear (offloading group, age = 55.6 ± 9.5 years, BMI = 30.9 ± 4.5 kg/m2), 27 with diabetic peripheral neuropathy (neuropathy group, age = 64.3 ± 7.7 years, BMI = 30.9 ± 5.4 kg/m2), and 47 non-diabetic controls (non-diabetic group, age = 62.9 ± 16.1 years, BMI = 29.0 ± 6.0 kg/m2). Gait function was quantified during a habitual speed walking test using a validated wearable platform. FINDINGS The offloading group exhibited deteriorated gait function compared to the non-diabetic group (p < 0.005, Cohen's effect size d = 0.90-2.61). They also had decreased gait speed (p < 0.001, d = 1.79) and stride length (p < 0.001, d = 1.76), as well as increased gait cycle time (p < 0.001, d = 1.67) and limp (p < 0.050, d = 0.72-1.49) compared to the neuropathy group. The offloading group showed increased gait unsteadiness compared to the neuropathy group, but the difference did not reach statistical significance in our samples. INTERPRETATION This study demonstrated that while diabetic peripheral neuropathy deteriorates gait function, including increasing gait unsteadiness and limp, the diabetic foot ulcer and offloading combination magnifies the deterioration beyond diabetic peripheral neuropathy. These findings promote caution of the current standards of care for treating diabetic foot ulcers with offloading footwear. However, it is possible that a contralateral shoe lift may remedy deteriorated gait function and improve quality of life for unilateral offloading users.
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Affiliation(s)
- Erica Ling
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA,School of Health Professions, Baylor College of Medicine, Houston, Texas, USA
| | - Brian Lepow
- Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, Texas, USA
| | - He Zhou
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ana Enriquez
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ashley Mullen
- School of Health Professions, Baylor College of Medicine, Houston, Texas, USA
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
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Influence of education training in patients with type 2 diabetes in the improvement of lifestyle and biochemical characteristics: a randomized controlled trial. FRONTIERS OF NURSING 2019. [DOI: 10.2478/fon-2019-0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Abstract
Objective
The objective of this randomized controlled trial study was to evaluate the education training in relation to lifestyle improvement in patients with type 2 diabetes through its influence in the levels of glycated hemoglobin (HbA1c), blood pressure, triglyceride, cholesterol levels, and body mass index (BMI).
Methods
The study included patients with type 2 diabetes randomly selected from 20 residential areas in Tirana, Albania where family physicians provide services. The sample size in total was 200 patients in both groups (control and intervention). The education training (four sessions) was conducted by trained nursing staff for 6 months. Patients were screened for the biochemical profile before and after the intervention. To compare the groups with respect to the interest outcomes, the t-test was used. The value of P < 0.05 was considered significant.
Results
There were 104 male patients and 96 female patients. The mean age was 54.9 ± 8.7. No significant differences were found between the study groups in relation to clinical and biochemical data before the education sessions. After the intervention, in the intervention group, the mean level of HbA1c was significantly lower than the value in the control group (6.2% vs 6.8%, P = 0.001) as well as for the mean values of BMI. The mean reduction (more than 15%) in HbA1c after the intervention was 43% in the intervention group and 2% in the control group (OR = 36.9, P < 0.05). Differences in BMI, HbA1c, triglycerides, and cholesterol were more significantly visible in the intervention group. However, the difference in systolic and diastolic blood pressure values was almost the same (P > 0.05).
Conclusions
The results of this study further support that the approach for education of patients with type 2 diabetes on changing lifestyle benefit the patient in controlling diabetes. It is believed that the establishment of diabetes education classes in health centers is an important investment in improving the management of type 2 diabetes.
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Maiya AG, Parameshwar A, Hande M, Nandalike V. Relationship Between Glycated Hemoglobin and Vibration Perception Threshold in Diabetic Peripheral Neuropathy. INT J LOW EXTR WOUND 2019; 19:120-124. [PMID: 31838926 DOI: 10.1177/1534734619882173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Foot ulcers, infections, and deformity are some of the major sources of mortality and morbidity among the diabetic population. The relationship between glycated hemoglobin (HbA1c) and diabetic peripheral neuropathy (DPN) has been well established. There is a dearth of literature on the relationship between vibration perception threshold (VPT) and HbA1c values. So, the objective of the study was to determine the strength of linear relationship between HbA1c levels and vibration perception threshold in DPN. This cross-sectional study was conducted at Kasturba Hospital, Manipal, and diabetic foot screening camps held at various parts of Udupi district. Ethical approval was obtained from the Institutional Ethics Committee, Kasturba Hospital, Manipal (IEC:281/2017). A total of 534 participants ranging from 30 to 70 years of age and were diagnosed with type 2 diabetes mellitus on medications were included in the study. Neuropathy assessment consisting of monofilament and vibration perception threshold was done using Neurotouch beta version (Yostra Labs, Bengaluru, India). HbA1c measurement was done using turbidimetric inhibition immunoassay technique (Roche Diagnostics, Mannheim, Germany). Pearson correlation coefficient showed a moderate to good correlation between HbA1c and VPT (r = .0.753, P < .001). Linear regression result has shown a significant relationship of VPT with HbA1c (4.033 [95% confidence interval = 3.67-4.39]). The present study has concluded that there is strong relationship between HbA1c values and VPT and could be a predictor for complications in the foot following DPN.
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Affiliation(s)
- Arun G Maiya
- Manipal College of Health Professions, Manipal Academy of Health Sciences, Manipal, Karnataka, India
| | - Anche Parameshwar
- Manipal College of Health Professions, Manipal Academy of Health Sciences, Manipal, Karnataka, India
| | - Manjunath Hande
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Salutini E, Brocco E, Da Ros R, Monge L, Uccioli L, Anichini R. The Complexity of Diabetic Foot Management: From Common Care to Best Practice. The Italian Expert Opinion by Delphi Survey. INT J LOW EXTR WOUND 2019; 19:34-43. [PMID: 31838925 DOI: 10.1177/1534734619890814] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Diabetic foot is a major public health issue, driven by diabetes complications (neuropathy, peripheral vascular disease, foot deformity, and abnormal leucocyte function), which may lead to leg amputation, thus resulting in severe disability, reduced quality of life, and high health costs. The prevention of diabetes complications and the early detection and proper management of diabetic foot wounds are the milestones to avoid major amputations. Unfortunately, in many areas, the prevention of diabetic foot lesions is inadequate and wounds may proceed toward infection and chronicity, with limb- and life-threatening results. Using the Delphi method, we conducted a survey on diabetic foot among Italian experts, selected across different Italian clinical centers. This method was used to achieve a consensus on current opinion and clinical leanings on the diagnosis and management of diabetic foot ulcers. Specifically, the aim of the survey was to evaluate the current management of the diabetic foot syndrome; highlight the differences in the approach among a group of experts; evaluate the role of wound bed preparation and antisepsis; and discuss any areas of disagreement in which evidences are sparse and the clinical judgment plays a crucial role in the decision-making process.
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Affiliation(s)
| | - Enrico Brocco
- UO per il trattamento del piede diabetico Policlinico Abano Terme, Terme, Italy
| | | | - Luca Monge
- AOU Città della Salute e della Scienza di Torino, SSD Gestione Complicanze del Diabete e Piede Diabetico, Torino, Italy
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Guo Z, Yue C, Qian Q, He H, Mo Z. Factors associated with lower-extremity amputation in patients with diabetic foot ulcers in a Chinese tertiary care hospital. Int Wound J 2019; 16:1304-1313. [PMID: 31448507 DOI: 10.1111/iwj.13190] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/28/2019] [Indexed: 12/30/2022] Open
Abstract
Providing a better understanding of the risk factors for amputation in this particular region, Hunan province, in China might help patients with diabetic foot ulcers receive timely and appropriate medical care and help prevent amputation. Diabetic foot ulcer patients referred to the Third Xiangya Hospital during the period between December 2014 and September 2018 were enrolled. Participants who underwent amputations and received conservative treatments were compared using univariate and multivariate analyses to identify the independent predictors of amputation. Those who required amputation presented significantly higher levels of white blood cell counts, platelet counts, erythrocyte sedimentation rate, C-reactive protein, and glycated haemoglobin (HbA1c) levels. However, levels of haemoglobin, postprandial plasma C-peptide, triglyceride, high-density lipoprotein cholesterol, albumin, and uric acid were decreased in patients with amputations. Patients with more advanced Wagner grades had much higher rates of amputation. Multivariable-adjusted odds ratios in stepwise logistic regression model was 1.317 for HbA1c (95% CI: 1.015-1.709), 0.255 for triglyceride (95% CI: 0.067-0.975), and 20.947 for Wagner grades (95% CI: 4.216-104.080). Independent risk factors for amputation in these Chinese diabetic foot ulcer patients included an elevated HbA1c level, lower triglyceride level, and higher Wagner grades.
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Affiliation(s)
- Zi Guo
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Chun Yue
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Qiang Qian
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Honghui He
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Zhaohui Mo
- Department of Endocrinology, The Third Xiangya Hospital, Central South University, Changsha, China
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21
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An J, Yu H, Gao Z, Yang W, Li J, Nie X, Wang X, An G. Predictive value of the ratio of homocysteine to serum albumin concentrations in the recurrence of diabetic foot ulcer. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00744-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Bacterial isolation and antibiotic susceptibility from diabetic foot ulcers in Kenya using microbiological tests and comparison with RT-PCR in detection of S. aureus and MRSA. BMC Res Notes 2019; 12:244. [PMID: 31036061 PMCID: PMC6489269 DOI: 10.1186/s13104-019-4278-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 04/23/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Diabetic foot ulcers (DFUs) often lead to hospital admissions, amputations and deaths; however, there is no up-to-date information on microbial isolates from DFUs and no mention of utilization of molecular techniques in Sub-Saharan Africa. We conducted a cross-sectional study among 83 adult patients at a tertiary hospital in Kenya over 12 months. The study aimed to isolate, identify bacteria, their antibiotic susceptibility patterns in active DFUs, and to compare standard microbiological methods versus a real-time PCR commercial kit in the detection of Staphylococcus aureus DNA and methicillin-resistant S. aureus (MRSA) DNA. RESULTS Eighty swabs (94%) were culture-positive; 29% were Gram-positive and 65% were Gram-negative. The main organisms isolated were S. aureus (16%), Escherichia coli (15%), Proteus mirabilis (11%), Klebsiella pneumoniae (7%) and Pseudomonas aeruginosa (7%). The bacterial isolates showed resistance to commonly used antibiotics such as ampicillin, amoxicillin, cefepime, ceftazidime, cefuroxime, clindamycin, erythromycin, piperacillin-tazobactam, tetracycline and trimethoprim-sulphamethoxazole (TMPSMX). Thirty-one percent of the S. aureus isolated and 40% of the Gram-negatives were multi-drug resistant organisms (MDROs). There was a high prevalence of nosocomial bacteria. MRSA were not identified using culture methods but were identified using PCR. PCR was more sensitive but less specific than culture-based methods to identify S. aureus.
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Morgan SJ, Lippman SI, Bautista GE, Harrison JJ, Harding CL, Gallagher LA, Cheng AC, Siehnel R, Ravishankar S, Usui ML, Olerud JE, Fleckman P, Wolcott RD, Manoil C, Singh PK. Bacterial fitness in chronic wounds appears to be mediated by the capacity for high-density growth, not virulence or biofilm functions. PLoS Pathog 2019; 15:e1007511. [PMID: 30893371 PMCID: PMC6448920 DOI: 10.1371/journal.ppat.1007511] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/04/2019] [Accepted: 12/07/2018] [Indexed: 12/19/2022] Open
Abstract
While much is known about acute infection pathogenesis, the understanding of chronic infections has lagged. Here we sought to identify the genes and functions that mediate fitness of the pathogen Pseudomonas aeruginosa in chronic wound infections, and to better understand the selective environment in wounds. We found that clinical isolates from chronic human wounds were frequently defective in virulence functions and biofilm formation, and that many virulence and biofilm formation genes were not required for bacterial fitness in experimental mouse wounds. In contrast, genes involved in anaerobic growth, some metabolic and energy pathways, and membrane integrity were critical. Consistent with these findings, the fitness characteristics of some wound impaired-mutants could be represented by anaerobic, oxidative, and membrane-stress conditions ex vivo, and more comprehensively by high-density bacterial growth conditions, in the absence of a host. These data shed light on the bacterial functions needed in chronic wound infections, the nature of stresses applied to bacteria at chronic infection sites, and suggest therapeutic targets that might compromise wound infection pathogenesis. Chronic infections are poorly understood, hard to model, and treatment resistant. Future progress depends upon understanding infection pathogenesis. Our study suggests that many bacterial virulence and biofilm formation functions are not required for fitness of infecting bacteria in chronic wounds. Instead, we found that functions that mitigate stresses associated with high-density bacterial growth are critical for infection. These findings suggest new approaches to model and target chronic bacterial infections.
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Affiliation(s)
- Sarah J. Morgan
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
| | - Soyeon I. Lippman
- Department of Genome Sciences, University of Washington, Seattle, WA, United States of America
| | - Gilbert E. Bautista
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
| | - Joe J. Harrison
- Department of Biological Sciences, University of Calgary, Calgary, AB, Canada
| | - Christopher L. Harding
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
| | - Larry A. Gallagher
- Department of Genome Sciences, University of Washington, Seattle, WA, United States of America
| | - Ann-Chee Cheng
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
| | - Richard Siehnel
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
| | - Sumedha Ravishankar
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
| | - Marcia L. Usui
- Department of Medicine, University of Washington, Seattle WA, United States of America
| | - John E. Olerud
- Department of Medicine, University of Washington, Seattle WA, United States of America
| | - Philip Fleckman
- Department of Medicine, University of Washington, Seattle WA, United States of America
| | - Randall D. Wolcott
- Southwest Regional Wound Care Center, Lubbock, TX, United States of America
| | - Colin Manoil
- Department of Genome Sciences, University of Washington, Seattle, WA, United States of America
- * E-mail: (CM); (PKS)
| | - Pradeep K. Singh
- Department of Microbiology, University of Washington, Seattle, WA, United States of America
- * E-mail: (CM); (PKS)
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Anyim O, Okafor C, Young E, Obumneme-Anyim I, Nwatu C. Pattern and microbiological characteristics of diabetic foot ulcers in a Nigerian tertiary hospital. Afr Health Sci 2019; 19:1617-1627. [PMID: 31148991 PMCID: PMC6531968 DOI: 10.4314/ahs.v19i1.37] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Purpose To determine the pattern and bacteriological characteristics of diabetic foot ulcers in patients attending a tertiary health care facility. Method 160 Patients with Diabetes Mellitus foot syndrome were recruited, out of which 52 had diabetic foot ulcers. Relevant clinical, biochemical, and microbiological evaluations were carried out on the subjects. Data analysis was done using SPSS version 20. p value was set at <0.05. Results 52 (32.5%) out of 160 subjects with Diabetes Mellitus Foot Syndrome (DMFS) had diabetic foot ulcers. Poor glycaemic control (mean HbA1c = 9.2 (2.7) %), and abuse of antibiotics (76.9%) characterized the subjects. Foot ulcers mainly involved the right lower limb and followed spontaneous blister formation (50%). Microbiological culture pattern was polymicrobial (71.2%); predominantly anaerobic organisms (53.3%). Gram positive and negative aerobic isolates yielded high sensitivity to common quinolones (76% – 87.8%). The gram positive and negative anaerobic isolates were highly sensitive to Clindamycin and Metronidazole respectively (80.2% – 97.8%). High sensitivity (>80%) yield for gram negative anaerobes was recorded for Imipinem and Ampicillin/Sulbactam. Conclusion Diabetic foot ulcers (DFU) contribute about one-third of DMFS. The bacteriological isolates from these ulcers are mainly polymicrobial with high sensitivity to common antibiotics. The need for appropriate use of antibiotics should be advocated among the patients.
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Xu S, Weng X, Wang Y, Lv D, Zeng M, Zhao F, Sun Y. Screening and preliminary validation of T lymphocyte immunoregulation‑associated long non‑coding RNAs in diabetic foot ulcers. Mol Med Rep 2019; 19:2368-2376. [PMID: 30664216 DOI: 10.3892/mmr.2019.9877] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/06/2018] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to investigate the existence of immunoregulation‑associated long non‑coding (lnc)RNAs mediated by T lymphocytes in the wound surfaces of diabetic foot ulcers (DFUs). The wound skin tissues of patients receiving debridement for trauma or DFUs associated with infection were obtained. Dermatological histological changes were observed by pathological staining, and T lymphocyte subsets and inflammation‑associated cytokines were identified. Gene chip technology was used to screen for lncRNAs regulated by immune cells. The wound skin structure in the control group was revealed to be complete, and the inflammatory response was not marked. However, the wound skin structure in the ulcer group was disordered and exhibited a notable inflammatory response. Compared with the control group, expression levels of cluster of differentiation (CD)3 and CD8 in the wound surface tissues of the ulcer group were significantly increased, while the expression levels of interleukin (IL)‑1β, IL‑2, IL‑10, interferon‑γ and tumor necrosis factor‑α were significantly upregulated. A target regulatory association was identified between downregulated lncRNA‑ENST00000411554 and upregulated mitogen‑activated protein kinase (MAPK)1 in DFU tissues, and a negative correlation was detected between this RNA and protein. The present results suggested that an immune functional disorder of T lymphocytes may be closely associated with the development of DFUs. Furthermore, activation of the MAPK signal transduction pathway mediated by the lncRNA‑ENST00000411554/MAPK1 axis may affect the DFU immune regulatory imbalance.
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Affiliation(s)
- Shujuan Xu
- Department of Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Xiaoyu Weng
- Department of Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Ya Wang
- Department of Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Dalun Lv
- Department of Burn and Plastic Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Meihong Zeng
- Department of Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Fen Zhao
- Department of Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
| | - Yu Sun
- Department of Surgery, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui 241001, P.R. China
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Amour AA, Chamba N, Kayandabila J, Lyaruu IA, Marieke D, Shao ER, Howlett W. Prevalence, Patterns, and Factors Associated with Peripheral Neuropathies among Diabetic Patients at Tertiary Hospital in the Kilimanjaro Region: Descriptive Cross-Sectional Study from North-Eastern Tanzania. Int J Endocrinol 2019; 2019:5404781. [PMID: 31275374 PMCID: PMC6582881 DOI: 10.1155/2019/5404781] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/30/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE Diabetic peripheral neuropathy (DPN) is a common microvascular complication of diabetes mellitus (DM) and may progress to diabetic foot, which frequently leads to amputation and/or disability and death. Data is scanty on the burden of diabetic peripheral neuropathy in Tanzania. The aim of this study was to assess the burden of peripheral neuropathy, its severity, and the associated factors. METHODS The study was a cross-sectional hospital-based study and was carried out from October 2017 to March 2018 among adolescent and adult patients attending Kilimanjaro Christian Medical Center (KCMC) diabetes clinic. RESULTS A total of 327 diabetic patients, females n=215 (65.7%) and males n=121 (34.3%), were included in the study. The mean age was 57.2 yrs. A total of 238 (72%) had type 2 and 89 (27.2%) had type1 DM. The prevalence of peripheral neuropathy was 72.2% of whom 55% were severe, 19% were moderate, and 26% were mild. The severity of neuropathy increased with the increase in age >40 years (p < 0.001) and increase in body mass index (p<0.001) and duration of diabetes; duration >7 years (p <0.006). The main associated factors were age >40 years, OR 2.8 (1.0-7.7), >60 years, OR 6.4 (2.3-18.2), obesity, OR 6.7 (0.9-27.7), and hypertension, OR 4.3 (2.2-8.2). CONCLUSION More than half of the patients included in this study were found to have neuropathy, nearly half of whom presented with the severe form. The main risk factors were increasing age, increasing duration of diabetes, obesity, and hypertension. Diabetic peripheral neuropathy is underdiagnosed in northern Tanzania where screening for neuropathy is not routinely done.
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Affiliation(s)
- Ahlam A. Amour
- Department of Internal Medicine, KCMUCo, Moshi, Tanzania
- Department of Internal Medicine, KCMC Hospital, Moshi, Tanzania
- Mnazi Mmoja Hospital, Zanzibar, Tanzania
| | - Nyasatu Chamba
- Department of Internal Medicine, KCMUCo, Moshi, Tanzania
- Department of Internal Medicine, KCMC Hospital, Moshi, Tanzania
| | - Johnstone Kayandabila
- Department of Internal Medicine, KCMUCo, Moshi, Tanzania
- Department of Internal Medicine, KCMC Hospital, Moshi, Tanzania
- Image Doctors Organization, Arusha, Tanzania
| | - Isaack A. Lyaruu
- Department of Internal Medicine, KCMUCo, Moshi, Tanzania
- Department of Internal Medicine, KCMC Hospital, Moshi, Tanzania
| | - Dekker Marieke
- Department of Internal Medicine, KCMC Hospital, Moshi, Tanzania
| | - Elichilia R. Shao
- Department of Internal Medicine, KCMUCo, Moshi, Tanzania
- Department of Internal Medicine, KCMC Hospital, Moshi, Tanzania
- Image Doctors Organization, Arusha, Tanzania
- Better Human Health Foundation, Moshi, Tanzania
| | - William Howlett
- Department of Internal Medicine, KCMUCo, Moshi, Tanzania
- Department of Internal Medicine, KCMC Hospital, Moshi, Tanzania
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Rigato M, Pizzol D, Tiago A, Putoto G, Avogaro A, Fadini GP. Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis. Diabetes Res Clin Pract 2018; 142:63-73. [PMID: 29807105 DOI: 10.1016/j.diabres.2018.05.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/22/2018] [Accepted: 05/09/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Among non-communicable diseases, diabetes represents a growing public health problem in Africa, where diabetes-related needs remain mostly unmet and the disabling features of foot are worsened by hygienic, cultural, and healthcare issues. We aimed to review clinical characteristics, prevalence, and outcomes of patients with diabetic foot ulcer in Africa. METHODS We searched the literature for cross-sectional and longitudinal studies reporting the characteristics of patients with diabetic foot in African countries, with a particular focus on ulcer prevalence, amputation rate, and mortality. FINDINGS Fifty-five full-text papers and ten abstracts were retrieved, reporting data from 19 African countries on 56,173 diabetic patients. According to the data collected, the overall prevalence of foot ulcers was 13% and increased over time, especially since 2001. Approximately 15% of patients with foot lesions underwent major amputation and 14.2% died during hospitalization. In patients with diabetic ulcers, insulin therapy was uncommon and neuropathy was the most common predisposing factor, but the prevalence of peripheral arterial disease correlated with amputation rates. Amputation and mortality decreased over time, probably as result of the implementation of screening programs in the last ten years. Mortality was directly related to previous amputation. INTERPRETATION The diabetic foot disease in Africa is a growing problem and is burden by high rate of in-hospital mortality. Educational interventions and screening programs including evaluation of the vascular status may play a crucial role to counter diabetic foot disease in Africa.
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Affiliation(s)
- Mauro Rigato
- Department of Medicine, University of Padova, Padova, Italy
| | | | | | | | - Angelo Avogaro
- Department of Medicine, University of Padova, Padova, Italy
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Wang L, He T, Fu A, Mao Z, Yi L, Tang S, Yang J. Hesperidin enhances angiogenesis via modulating expression of growth and inflammatory factor in diabetic foot ulcer in rats. EUR J INFLAMM 2018. [DOI: 10.1177/2058739218775255] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
One of the most devastating consequences of diabetes mellitus is a chronic condition, diabetic foot ulcer. Numerous investigations are being targeted to explore newer compounds for treatment of diabetic foot ulcer wounds in diabetic patients. Hesperidin (HSP), an isoflavone glycoside has been established to exhibit antidiabetic and antioxidant potential. In the current investigation, diabetes was induced in rats by administration by streptozotocin (STZ) intraperitoneally (50 mg/kg). Wound-healing capacity was estimated in hind paw of rats by artificially initiating wound injury on the paw dorsal surface. The injured animals were administered with incremental doses of HSP suspension orally (10, 20, 40, 60, and 80 mg/kg) and insulin subcutaneously (10 IU/kg). Parameters such as wound area were estimated every 2 days, and at the end of 20 days of study, biochemical estimations in serum and histopathological observations of the wound were made. HSP (60 and 80 mg/kg) revealed statistically significant ( P < 0.05) improvement in wound dimension, glucose and insulin concentration, and glycated hemoglobin (HbA1C). Administration of HSP indicated significant ( P < 0.05) modulation of mRNA associated with expression of vascular endothelial growth factor (VEGF), whereas the levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6 levels were lowered compared to the control group of animals. Real-time quantitative polymerase chain reaction (RT-qPCR) indicated expression of vascular endothelial growth factor receptors 1 and 2 (VEGFR1 and VEGFR2) compared to glyceraldehyde 3-phosphate dehydrogenase (GAPDH). Histological observations indicated higher expression of VEGF in the groups receiving HSP, indicative of angiogenesis stimulation in the diabetic wound. The results advocate angiogenesis activity of HSP was enhanced owing to reduction in hyperglycemia and oxidative stress–induced damage, reduced expression of inflammatory mediators, and enhanced expression of growth-related factors, thereby promoting healing of diabetic foot ulcer.
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Affiliation(s)
- Li Wang
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting He
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Adan Fu
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory for Molecular Diagnosis of Hubei Province, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhijin Mao
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lan Yi
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sha Tang
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Yang
- Department of Endocrinology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Matos M, Mendes R, Silva AB, Sousa N. Physical activity and exercise on diabetic foot related outcomes: A systematic review. Diabetes Res Clin Pract 2018; 139:81-90. [PMID: 29477503 DOI: 10.1016/j.diabres.2018.02.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/01/2018] [Accepted: 02/13/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diabetic foot is one of the most common complications of diabetes. It has the potential risk of pathologic consequences including infection, ulceration and amputation, but a growing body of evidence suggests that physical activity and exercise may improve diabetic foot outcomes. OBJECTIVE To analyze de effects of exercise and physical activity interventions on diabetic foot outcomes. METHODS A comprehensive and systematic search was conducted according to PRISMA recommendations. Only controlled clinical trials with patients with diabetes were included. RESULTS Six studies, involving 418 patients with diabetes, were included. Two studies used only aerobic exercise; two studies combined aerobic, resistance and balance exercise; and two studies combined aerobic and balance exercise by Thai Chin Chuan methods. Physical activity and exercise significantly improved nerve velocity conduction, peripheral sensory function and foot peak pressure distribution. Moreover, the ulcers incidence rate per year was lower in the intervention groups, compared with the controls [0.02 vs. 0.12]. CONCLUSION This review suggests evidence that physical activity and exercise is an effective non-pharmacological intervention to improve diabetic foot related outcomes. Combined multi-disciplinary treatments are more effective in the prevention of foot complications in patients with diabetes.
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Affiliation(s)
- Monica Matos
- Research Center in Sports Sciences, Health Sciences and Human Development, Vila Real, Portugal.
| | - Romeu Mendes
- University of Trás-os-Montes e Alto Douro, Vila Real, Portugal; Public Health Unit, ACES Douro I - Marão e Douro Norte, Vila Real, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
| | - André B Silva
- Centro Hospitalar Tondela Viseu, Ophthalmology Department, Viseu, Portugal.
| | - Nelson Sousa
- Research Center in Sports Sciences, Health Sciences and Human Development, Vila Real, Portugal; University of Trás-os-Montes e Alto Douro, Vila Real, Portugal.
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Zhong A, Li G, Wang D, Sun Y, Zou X, Li B. The risks and external effects of diabetic foot ulcer on diabetic patients: A hospital-based survey in Wuhan area, China. Wound Repair Regen 2017; 25:858-863. [PMID: 29052949 DOI: 10.1111/wrr.12589] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/18/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Aimei Zhong
- Department of Plastic Surgery; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Gongchi Li
- Department of Hand Surgery; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Dan Wang
- Department of Wound Repair Surgery; Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Yi Sun
- School of Public Health; Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Xinghua Zou
- Department of Wound Repair Surgery; Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Binghui Li
- Department of Wound Repair Surgery; Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
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Behforootan S, Chatzistergos PE, Chockalingam N, Naemi R. A Simulation of the Viscoelastic Behaviour of Heel Pad During Weight-Bearing Activities of Daily Living. Ann Biomed Eng 2017; 45:2750-2761. [DOI: 10.1007/s10439-017-1918-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/06/2017] [Indexed: 11/24/2022]
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Guzmán-Uribe D, Alvarado-Estrada KN, Pierdant-Pérez M, Torres-Álvarez B, Sánchez-Aguilar JM, Rosales-Ibáñez R. Oral mucosa: an alternative epidermic cell source to develop autologous dermal-epidermal substitutes from diabetic subjects. J Appl Oral Sci 2017; 25:186-195. [PMID: 28403359 PMCID: PMC5393539 DOI: 10.1590/1678-77572016-0217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 08/22/2016] [Indexed: 11/30/2022] Open
Abstract
Oral mucosa has been highlighted as a suitable source of epidermal cells due to its intrinsic characteristics such as its higher proliferation rate and its obtainability. Diabetic ulcers have a worldwide prevalence that is variable (1%-11%), meanwhile treatment of this has been proven ineffective. Tissue-engineered skin plays an important role in wound care focusing on strategies such autologous dermal-epidermal substitutes.
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Affiliation(s)
- Daniela Guzmán-Uribe
- Universidad Autónoma de San Luis Potosí, Facultad de Estomatología, Grupo de Investigación en Ingeniería Tisular, San Luis Potosí, México.,Universidad Autónoma de San Luis Potosí, Facultad de Medicina, Maestría en Ciencias en Investigación Clínica, San Luis Potosí, México
| | - Keila Neri Alvarado-Estrada
- Universidad Autónoma de San Luis Potosí, Facultad de Estomatología, Grupo de Investigación en Ingeniería Tisular, San Luis Potosí, México
| | - Mauricio Pierdant-Pérez
- Universidad Autónoma de San Luis Potosí, Facultad de Medicina, Maestría en Ciencias en Investigación Clínica, San Luis Potosí, México
| | - Bertha Torres-Álvarez
- Hospital Central Dr Ignacio Morones Prieto, Departamento de Dermatología, San Luis Potosí, México
| | - Jesus Martin Sánchez-Aguilar
- Universidad Autónoma de San Luis Potosí, Facultad de Medicina, Maestría en Ciencias en Investigación Clínica, San Luis Potosí, México
| | - Raúl Rosales-Ibáñez
- Universidad Autónoma de San Luis Potosí, Facultad de Estomatología, Grupo de Investigación en Ingeniería Tisular, San Luis Potosí, México.,Universidad Nacional Autónoma de México, Facultad de Estudios Superiores Iztacala, Laboratorio en Ingeniería Tisular y Medicina Traslacional, Tlanepantla, México
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Naemi R, Chatzistergos P, Suresh S, Sundar L, Chockalingam N, Ramachandran A. Can plantar soft tissue mechanics enhance prognosis of diabetic foot ulcer? Diabetes Res Clin Pract 2017; 126:182-191. [PMID: 28259007 DOI: 10.1016/j.diabres.2017.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/16/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022]
Abstract
AIM To investigate if the assessment of the mechanical properties of plantar soft tissue can increase the accuracy of predicting Diabetic Foot Ulceration (DFU). METHODS 40 patients with diabetic neuropathy and no DFU were recruited. Commonly assessed clinical parameters along with plantar soft tissue stiffness and thickness were measured at baseline using ultrasound elastography technique. 7 patients developed foot ulceration during a 12months follow-up. Logistic regression was used to identify parameters that contribute to predicting the DFU incidence. The effect of using parameters related to the mechanical behaviour of plantar soft tissue on the specificity, sensitivity, prediction strength and accuracy of the predicting models for DFU was assessed. RESULTS Patients with higher plantar soft tissue thickness and lower stiffness at the 1st Metatarsal head area showed an increased risk of DFU. Adding plantar soft tissue stiffness and thickness to the model improved its specificity (by 3%), sensitivity (by 14%), prediction accuracy (by 5%) and prognosis strength (by 1%). The model containing all predictors was able to effectively (χ2 (8, N=40)=17.55, P<0.05) distinguish between the patients with and without DFU incidence. CONCLUSION The mechanical properties of plantar soft tissue can be used to improve the predictability of DFU in moderate/high risk patients.
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Affiliation(s)
- R Naemi
- School of Life Sciences and Education, Staffordshire University, Stoke on Trent, United Kingdom.
| | - P Chatzistergos
- School of Life Sciences and Education, Staffordshire University, Stoke on Trent, United Kingdom
| | - S Suresh
- India Diabetes Research Foundation, Chennai, India
| | - L Sundar
- India Diabetes Research Foundation, Chennai, India
| | - N Chockalingam
- School of Life Sciences and Education, Staffordshire University, Stoke on Trent, United Kingdom
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Abstract
The estimated prevalence of diabetes is 9.78% in Taiwan. The lifetime risk for patients with diabetes to have foot ulcers might be as high as 25%. About 15% of these patients require major limb amputation because of ischemia and infection. Peripheral artery disease is still a major problem involved in diabetic foot disease and the cause for major amputation despite an increase in the prevalence of revascularization surgery and new revascularization techniques over the past 20 years. We investigated the major limb amputation rates in patients with diabetic foot and critical limb ischemia who had undergone revascularization surgery in our hospital. The records of 42 patients who had undergone revascularization surgery for diabetic foot were retrospectively reviewed. Nineteen patients (45%) required major limb amputation despite revascularization. The affected limbs of only 15 patients (36%) were salvaged. Four patients died soon after surgery because of comorbidities, and another 4 were lost to follow-up. Two patients died from procedure-related sepsis, and overall perioperative mortality was 4.8%. Ten predictive risk factors (duration of diabetes, history of smoking, coronary artery disease, congestive heart failure, cerebral vascular accident, contralateral amputation, end-stage renal disease, fever episode, wound infection severity score, and arterial obstruction level) were included for analysis. Although none was significant, long-duration diabetes (OR: 1.13), end-stage renal disease (OR: 10.02), wound infection (OR: 1.56), and infrapopliteal lesions (OR: 3.00) tended to be unfavorable predictive risk factors of limb amputation. Revascularization surgery is still potentially beneficial for these patients--eg, it decreases the contralateral limb amputation rate by 7.5%--if done early in high-risk patients.
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Zheng J, Muccigrosso D, Zhang X, An H, Coggan AR, Adil B, Hildebolt CF, Vemuri C, Geraghty P, Hastings MK, Mueller MJ. Oximetric angiosome imaging in diabetic feet. J Magn Reson Imaging 2016; 44:940-6. [PMID: 26970103 PMCID: PMC5369352 DOI: 10.1002/jmri.25220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 02/19/2016] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To develop a noncontrast oximetric angiosome imaging approach to assess skeletal muscle oxygenation in diabetic feet. MATERIALS AND METHODS In four healthy and five subjects with diabetes, the feasibility of foot oximetry was examined using a 3T clinical magnetic resonance imaging (MRI) scanner. The subjects' feet were scanned at rest and during a toe-flexion isometric exercise. The oxygen extraction fraction of skeletal muscle was measured using a susceptibility-based MRI method. Our newly developed MR foot oximetric angiosome model was compared with the traditional angiosome model in the assessment of the distribution of oxygen extraction fraction. RESULTS Using the traditional angiosome during the toe-flexion exercise, the oxygen extraction fraction in the medial foot of healthy subjects increased (4.9 ± 3%) and decreased (-2.7 ± 4.4%) in subjects with diabetes (difference = 7.6%; 95% confidence interval = -13.7 ± 1.4; P = 0.02). Using the oximetric angiosome, the percent difference in the areas of oxygen extraction fraction within the 0.7-1.0 range (expected oxygen extraction fraction during exercise) between rest and exercise was higher in healthy subjects (8 ± 4%) than in subjects with diabetes (4 ± 4%; P = 0.02). CONCLUSION This study demonstrates the feasibility of measuring skeletal muscle oxygen extraction fraction in the foot muscle during a toe-flexion isometric exercise. Instead of assessing oxygen extraction fraction in a foot muscle region linked to a supplying artery (traditional angiosome), the foot oximetric angiosome model assesses oxygen extraction fraction by its different levels in all foot muscle regions and thus may be more appropriate for assessing local ischemia in ulcerated diabetic feet. J. Magn. Reson. Imaging 2016. J. MAGN. RESON. IMAGING 2016;44:940-946.
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Affiliation(s)
- Jie Zheng
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.
| | - David Muccigrosso
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Xiaodong Zhang
- Department of Radiology, Peking University First Hospital, Beijing, China
| | - Hongyu An
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Andrew R Coggan
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bashir Adil
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Charles F Hildebolt
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chandu Vemuri
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Patrick Geraghty
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Mary K Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Michael J Mueller
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, Missouri, USA
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Ji L, Bai JJ, Sun J, Wang Z. Nursing care for diabetic toe ulcers: A case series report and literature review. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kengne AP, Dzudie AI, Fezeu LL, Mbanya JC. Impact of Secondary Foot Complications on the Inpatient Department of the Diabetes Unit of Yaoundé Central Hospital. INT J LOW EXTR WOUND 2016; 5:64-8. [PMID: 16543215 DOI: 10.1177/1534734606286455] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetic foot ulceration and gangrene are preventable long-term complications of diabetes mellitus. This cross-sectional study was conducted to evaluate the impact of secondary foot complications on hospital admission and activities of the diabetes service of Yaoundé Central Hospital (YCH). A total of 207 patient files were included in this study, the period of which was from November 1999 to October 2000, 1 year of activity of the inpatient department of the Diabetes and Endocrine Unit of YCH. General characteristics of the patients were considered, the reason for their admission, the duration of their hospitalization in the service, and the outcome. The diabetic foot problem was the second most common cause of hospital admission in 27 (13%) patients. Secondary foot complication was the associated cause of mortality in 19.3% of cases of death (6 out of 31) in this study. The highest duration of hospitalization was recorded in patients with foot problems (29.4±5.4 days), the finding being statistically significant. Foot problems accounted for 0.25% of bed occupancy for the selected period. Five patients underwent amputation because of foot problems. A high rate of hospital discharge upon request was recorded among patients with foot problems (25% of the cases). This study suggests that diabetic foot is the second biggest cause of hospital admission in this setting; however, it is the main cause of prolonged hospital stay and bed occupancy.
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Affiliation(s)
- Andre Pascal Kengne
- The George Institute for International Health (The University of Sydney), NSW, Australia.
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de Macedo GMC, Nunes S, Barreto T. Skin disorders in diabetes mellitus: an epidemiology and physiopathology review. Diabetol Metab Syndr 2016; 8:63. [PMID: 27583022 PMCID: PMC5006568 DOI: 10.1186/s13098-016-0176-y] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 08/09/2016] [Indexed: 01/19/2023] Open
Abstract
Skin disorders, usually neglected and frequently underdiagnosed among diabetic patients, are common complications and encounter a broad spectrum of disorders in both type 1 and type 2 diabetes mellitus (DM)-e.g. cutaneous infection, dry skin, pruritus. Skin disorders are highly associated with increased risk of important outcomes, such as skin lesions, ulcerations and diabetic foot, which can lead to major complications and revolve around multifactorial factors besides hyperglycemia and advanced glycation end products. Although diabetic's skin disorders are consistent in the literature, there is limited data regarding early-stage skin disorders in DM patients. Disease control, early-stage treatment (e.g. skin hydration, orthotic devices) and awareness can reduce morbidity of DM patients. Thus, better understanding of the burden of skin disorders in DM patients may raise awareness on prevention and management. Therefore, the aim of this study is to perform a literature review to evaluate the main clinical characteristics and complications of skin disorders in diabetic's patients. Additionally, physiopathology early-stage skin disorders and dermocosmetic management were also reviewed.
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Affiliation(s)
- Geisa Maria Campos de Macedo
- Endocrine and Diabetes Department, Agamenon Magalhães Hospital, Estrada do Arraial, 2723, Casa Amarela, Recife, PE 52070-230 Brazil
| | - Samanta Nunes
- Brazilian Society of Dermatology São Paulo, São Paulo, 05423 010 Brazil
| | - Tania Barreto
- Diabetes Division, Sanofi, São Paulo, São Paulo 05693-000 Brazil
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A method for subject-specific modelling and optimisation of the cushioning properties of insole materials used in diabetic footwear. Med Eng Phys 2015; 37:531-8. [DOI: 10.1016/j.medengphy.2015.03.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 02/03/2015] [Accepted: 03/23/2015] [Indexed: 01/21/2023]
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Hussan F, Teoh SL, Muhamad N, Mazlan M, Latiff AA. Momordica charantia ointment accelerates diabetic wound healing and enhances transforming growth factor-β expression. J Wound Care 2014; 23:400, 402, 404-7. [PMID: 25139598 DOI: 10.12968/jowc.2014.23.8.400] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Transforming growth factor-β (TGF-β) plays an important role in wound healing. Delayed wound healing is a consequence of diabetes, leading to high morbidity and poor quality of life. Momordica charantia (MC) fruit possesses anti-diabetic and wound healing properties. This study aimed to explore the changes in TGF-β expression in diabetic wounds treated with topical MC fruit extract. METHODS Fifty-six male Sprague-Dawley rats were divided into a normal control group and five diabetic groups of ten rats each. Intravenous streptozotocin (50mg/kg) was given to induce diabetes in the diabetic groups. Full thickness excision wounds were created on the thoracodorsal region of the animals, and these wounds were then treated with vehicle, MC powder, MC ointment and povidone ointment or ointment base for ten days. Wound healing was determined by the rate of wound closure, total protein content and TGF-β expression in the wounds, and histological observation. RESULTS Diabetic groups showed delayed wound closure rates compared to the control group. The wound closure rate in the MC ointment group was significantly faster than that of the untreated diabetic group (p<0.05). The MC ointment group also showed intense TGF-β expression and a high level of total protein content. CONCLUSION MC ointment has a promising potential for use as an alternative topical medication for diabetic wounds. This work has shown that it accelerates wound healing in diabetic rats, and it is suggested here that this occurs by enhancing TGF-β expression. Further work is recommended to explore this effect.
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Affiliation(s)
- F Hussan
- Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia
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Haji Zaine N, Burns J, Vicaretti M, Fletcher JP, Begg L, Hitos K. Characteristics of diabetic foot ulcers in Western Sydney, Australia. J Foot Ankle Res 2014; 7:39. [PMID: 25279002 PMCID: PMC4182857 DOI: 10.1186/s13047-014-0039-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 08/29/2014] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Australia is ranked ninth of 39 countries in the Western Pacific region most affected by diabetes. Patients with diabetes are at high risk of developing foot ulcerations that can develop into non-healing wounds. Recent studies suggest that the lifetime risk of developing a diabetic foot ulcer is as high as 25%. Few studies have reported the prevalence of, risk factors and socioeconomic status associated with, diabetic foot ulcers in Australia. The aim of this study was to evaluate the characteristics of diabetic foot ulcers in a tertiary referral outpatient hospital setting in Western Sydney, Australia. METHODS From January-December 2011, a total of 195 outpatients with diabetes were retrospectively extracted for analysis from the Westmead Hospital's Foot Wound Clinic Registry. Data on demographics, socioeconomic status, co-morbidities, foot ulcer characteristics and treatment were recorded on a standardised form. RESULTS Demographics and physical characteristics were: 66.2% male, median age 67 years (IQR: 56-76), median body mass index (BMI) of 28 kg/m(2) (IQR: 25.2-34.1), 75.4% had peripheral neuropathy and the median postcode score for socioeconomic status was 996 (IQR: 897-1022). Diabetic foot ulcer characteristics were: median cross sectional area of 1.5 cm(2) (IQR: 0.5-7.0), median volume of 0.4 cm(3) (IQR: 0.11-3.0), 45.1% on the plantar aspect of the foot, 16.6% UT Wound Grade of 0C to 3C (with ischaemia) and 11.8% with a Grade 0D to 3D (with infection and ischaemia) and 25.6% with osteomyelitis. Five patients required an amputation: 1 major and 4 minor amputations. CONCLUSIONS In accordance with other international studies, foot ulcers are more likely to present on the plantar surface of the foot and largely affect overweight older males with a long standing history diabetes in our outpatient hospital in Western Sydney.
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Affiliation(s)
- Norafizah Haji Zaine
- />Arthritis and Musculoskeletal Research Group, The University of Sydney, Sydney, NSW Australia
- />Foot Wound Clinic, Department of Surgery, The University of Sydney, Westmead Hospital, Sydney, NSW Australia
| | - Joshua Burns
- />Arthritis and Musculoskeletal Research Group, The University of Sydney, Sydney, NSW Australia
- />Foot Wound Clinic, Department of Surgery, The University of Sydney, Westmead Hospital, Sydney, NSW Australia
| | - Mauro Vicaretti
- />Foot Wound Clinic, Department of Surgery, The University of Sydney, Westmead Hospital, Sydney, NSW Australia
- />Westmead Research Centre for the Evaluation of Surgical Outcomes, Department of Surgery, The University of Sydney, Sydney, NSW Australia
| | - John P Fletcher
- />Foot Wound Clinic, Department of Surgery, The University of Sydney, Westmead Hospital, Sydney, NSW Australia
- />Westmead Research Centre for the Evaluation of Surgical Outcomes, Department of Surgery, The University of Sydney, Sydney, NSW Australia
| | - Lindy Begg
- />Foot Wound Clinic, Department of Surgery, The University of Sydney, Westmead Hospital, Sydney, NSW Australia
| | - Kerry Hitos
- />Foot Wound Clinic, Department of Surgery, The University of Sydney, Westmead Hospital, Sydney, NSW Australia
- />Westmead Research Centre for the Evaluation of Surgical Outcomes, Department of Surgery, The University of Sydney, Sydney, NSW Australia
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Yanez M, Rincon J, Dones A, De Maria C, Gonzales R, Boland T. In vivo assessment of printed microvasculature in a bilayer skin graft to treat full-thickness wounds. Tissue Eng Part A 2014; 21:224-33. [PMID: 25051339 DOI: 10.1089/ten.tea.2013.0561] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Chronic wounds such as diabetic foot ulcers and venous leg ulcers are common problems in people suffering from type 2 diabetes. These can cause pain, and nerve damage, eventually leading to foot or leg amputation. These types of wounds are very difficult to treat and sometimes take months or even years to heal because of many possible complications during the process. Allogeneic skin grafting has been used to improve wound healing, but the majority of grafts do not survive several days after being implanted. We have been studying the behavior of fibroblasts and keratinocytes in engineered capillary-like endothelial networks. A dermo-epidermal graft has been implanted in an athymic nude mouse model to assess the integration with the host tissue as well as the wound healing process. To build these networks into a skin graft, a modified inkjet printer was used, which allowed the deposit of human microvascular endothelial cells. Neonatal human dermal fibroblast cells and neonatal human epidermal keratinocytes were manually mixed in the collagen matrix while endothelial cells printed. A full-thickness wound was created at the top of the back of athymic nude mice and the area was covered by the bilayered graft. Mice of the different groups were followed until completion of the specified experimental time line, at which time the animals were humanely euthanized and tissue samples were collected. Wound contraction improved by up to 10% when compared with the control groups. Histological analysis showed the neoskin having similar appearance to the normal skin. Both layers, dermis and epidermis, were present with thicknesses resembling normal skin. Immunohistochemistry analysis showed favorable results proving survival of the implanted cells, and confocal images showed the human cells' location in the samples that were collocated with the bilayer printed skin graft.
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Affiliation(s)
- Maria Yanez
- 1 Department of Metallurgical and Materials Engineering, The University of Texas at El Paso , El Paso, Texas
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Strategy of surgical management of peripheral neuropathy form of diabetic foot syndrome in ghana. PLASTIC SURGERY INTERNATIONAL 2014; 2014:185023. [PMID: 25152815 PMCID: PMC4131423 DOI: 10.1155/2014/185023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Revised: 06/28/2014] [Accepted: 06/30/2014] [Indexed: 01/13/2023]
Abstract
Introduction. Foot disorders such as ulceration, infection, and gangrene which are often due to diabetes mellitus are some major causes of morbidity and high amputation. Aim. This study aims to use a group of methods for the management of diabetic foot ulcers (DFU) in order to salvage the lower limb so as to reduce the rate of high amputations of the lower extremity. Materials and Methods. A group of different advanced methods for the management of DFU such as sharp debridement of ulcers, application of vacuum therapy, and other forms of reconstructive plastic surgical procedures were used. Data collection was done at 3 different hospitals where the treatments were given. Results. Fifty-four patients with type 2 diabetes mellitus were enrolled in the current study: females n = 37 (68.51%) and males n = 17 (31.49%) with different stages of PEDIS classification. They underwent different methods of surgical management: debridement, vacuum therapy (some constructed from locally used materials), and skin grafting giving good and fast results. Only 4 had below knee amputations. Conclusion. Using advanced surgical wound management including reconstructive plastic surgical procedures, it was possible to reduce the rate of high amputations of the lower limb.
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Kandhare AD, Ghosh P, Bodhankar SL. Naringin, a flavanone glycoside, promotes angiogenesis and inhibits endothelial apoptosis through modulation of inflammatory and growth factor expression in diabetic foot ulcer in rats. Chem Biol Interact 2014; 219:101-12. [DOI: 10.1016/j.cbi.2014.05.012] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 05/13/2014] [Accepted: 05/20/2014] [Indexed: 12/19/2022]
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Affiliation(s)
| | - Rowan Gillies
- Programme in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA.
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Chatzistergos PE, Naemi R, Sundar L, Ramachandran A, Chockalingam N. The relationship between the mechanical properties of heel-pad and common clinical measures associated with foot ulcers in patients with diabetes. J Diabetes Complications 2014; 28:488-93. [PMID: 24795257 DOI: 10.1016/j.jdiacomp.2014.03.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 11/26/2022]
Abstract
AIM The present study aims at investigating the correlation between the mechanical properties of the heel-pad of people with type-2 diabetes and the clinical parameters used to monitor their health and ulceration risk. METHODS A new device for the in-vivo testing of plantar soft tissues was built and pilot-tested. This device consists of an ultrasound probe connected in series with a dynamometer. Loading is applied manually using a ball-screw actuator. A total of 35 volunteers with type-2 diabetes were recruited and the thickness, stiffness of their heel-pads as well as the energy absorbed during loading were assessed. The participants with diabetes also underwent blood tests and measurements of Ankle Brachial Index and Vibration Perception Threshold. RESULTS Pearson correlation analysis revealed strong correlations between triglycerides and heel-pad stiffness (r=0.675, N=27, p<0.001) and between triglycerides and energy (r=-0.598, N=27, p=0.002). A correlation of medium strength was found between Fasting Blood Sugar (FBS) and stiffness (r=0.408, N=29, p=0.043). CONCLUSIONS People with type-2 diabetes and high levels of triglycerides and FBS are more likely to have stiffer heel-pads. Increased stiffness could limit the tissues' ability to evenly distribute loads making them more vulnerable to trauma and ulceration.
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Affiliation(s)
| | - Roozbeh Naemi
- CSHER, Faculty of Health Sciences, Staffordshire University, Stoke-on-Trent, United Kingdom
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Revest M, Patrat-Delon S, Devillers A, Tattevin P, Michelet C. Contribution of 18fluoro-deoxyglucose PET/CT for the diagnosis of infectious diseases. Med Mal Infect 2014; 44:251-60. [DOI: 10.1016/j.medmal.2014.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 02/03/2014] [Accepted: 04/16/2014] [Indexed: 10/25/2022]
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Rewale V, Prabhakar KR, Chitale AM. Pentoxifylline: a new armamentarium in diabetic foot ulcers. J Clin Diagn Res 2014; 8:84-6. [PMID: 24596731 DOI: 10.7860/jcdr/2014/7856.3984] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 12/09/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Diabetic foot ulcers are estimated to affect 15% of all diabetics and precede almost 85% of foot amputations. Pentoxyfylline a substituted xanthenes' derivative has been reported to increase the blood flow to the microcirculation and enhances tissue oxygenation. It has been widely used in the treatment of intermittent claudication. MATERIALS AND METHODS Pentoxyfylline is known to decrease the rouleaux formation of RBC and hence helps in improving the microcirculation. Out of 67 patients 30 received pentoxyfylline and 32 were on traditional treatment and there was loss of follow-up in five cases. The response was observed subjectively, histologically and by Doppler studies. RESULTS It was observed that the patients on pentoxyfylline had early healing as compared to patients receiving only conventional treatment as evident on biopsy and Doppler. CONCLUSION Here in this research our objective was to determine whether pentoxyfylline (trental 400 mg) taken orally TDS in addition to ambulatory compression bandages and dressings improves the healing rates of diabetic ulcers.
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Affiliation(s)
- Venkatesh Rewale
- Assistant Professor, Department of General Surgery, A.C.P. M Medical College , Sakri Road, Dhule, Maharashtra - 424001, India
| | - Kiran Ravi Prabhakar
- PG Resident (3 year), Department of General Surgery, A.C.P.M Medical College , Sakri Road, Dhule, Maharashtra - 424001, India
| | - Anjali M Chitale
- Professor & Head, Department of General Surgery, A.C.P.M Medical College , Sakri Road, Dhule, Maharashtra - 424001, India
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Nemcová J, Hlinková E. The efficacy of diabetic foot care education. J Clin Nurs 2013; 23:877-82. [PMID: 23875608 DOI: 10.1111/jocn.12290] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To survey the efficacy of education about factors that influence the learning process and behaviour of diabetics following a nursing interventional project in diabetic foot care education. BACKGROUND Educating diabetics can change their behaviour, which may contribute to the prevention of diabetic foot ulcer and amputation. However, there is little information on the factors that contribute to effectiveness of foot care education. DESIGN Survey. METHODS The data before education were collected by using structured assessment based on a practical reasoning scheme. The interventional diabetic foot care education project immediately followed. We used verbal and written patient education material. After education (six months), we used a questionnaire by postadministration. The data were analysed using content analysis, descriptive statistics and inferential statistics. RESULTS We discovered a rise of knowledge, willingness and motivation to learn and to change the behaviour of diabetics after education. The clinical parameters (weight, Body Mass Index, blood pressure) demonstrated a statistically significant positive change six months after education. CONCLUSION The findings after education show a rise in knowledge, willingness and motivation, which are important factors that contribute to changing behaviour of diabetics in diabetic foot care. After education, we identified better results in terms of weight and blood pressure, both of which play a role in the prevention of diabetic ulcer. RELEVANCE TO CLINICAL PRACTICE The education valuable tool ensures knowledge, motivation and willingness to change behaviour in order to prevent diabetic foot complications of diabetics. By using structured assessment, nurses are able to modify their educational interventions.
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Affiliation(s)
- Jana Nemcová
- Nursing Department, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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