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Julien CA, Ha Van G, M'Bemba J, Bourgeon M, Dardari D, Lepeut M, Dumont I, Zemmache MZ, Serrand C, Bouillet B, Sultan A, Schuldiner S. Real-world treatment patterns and diagnosis of charcot foot in franco-belgian diabetic foot expert centers (The EPiChar Study). Acta Diabetol 2023; 60:1209-1218. [PMID: 37184671 DOI: 10.1007/s00592-023-02101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/09/2023] [Indexed: 05/16/2023]
Abstract
AIM To evaluate the real-life diagnosis and therapeutic means of Charcot Neuroosteoarthropathy (CN) in French-Belgian diabetic foot expert centers. METHODS We collected clinical characteristics, results of exams and therapeutic pathways of consecutive adult patients with diabetic osteoarthropathy seen in consultation or hospitalization from January 1 to December 31, 2019 in 31 diabetic foot expert centers. The primary outcome was to describe the diagnostic and management methods for CN according to patient clinical characteristics, the clinical-radiological characteristics of acute and chronic CN and discharge means. RESULTS 467 patients were included: 364 with chronic CN and 103 in the acute phase. 101 patients had bilateral chronic CN. Most patients were male (73.4%), treated with insulin (73.3%), and with multicomplicated diabetes. In the acute phase, edema and increased foot temperature were present in 75% and 58.3% of cases, respectively. Diagnosis confirmation was usually by MRI and the mode of discharge was variable. In the chronic phase, orthopedic shoes were prescribed in 81.5% of cases. CONCLUSIONS This observational study highlights the diagnostic and therapeutic practices in 31 diabetic foot centers. Our results highlight that the use of MRI and the modalities of offloading, an essential treatment in the acute phase, need to be better standardized. Centers were highly encouraging about creating a patient registry.
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Affiliation(s)
- Carole-Anne Julien
- Service des Maladies métaboliques et Endocriniennes, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Georges Ha Van
- Service de Diabétologie, AP-HP La Pitié Salpétrière, Paris, France
| | | | - Muriel Bourgeon
- Service Endocrinologie, AP-HP Kremlin Bicêtre, Kremlin Bicêtre, France
| | - Dured Dardari
- Service de Diabétologie, CH Sud Francilien, Corbeil-Essonnes, France
| | - Marc Lepeut
- Service de Diabétologie, CH Roubaix, Roubaix, France
| | | | - Mohammed Zakarya Zemmache
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Chris Serrand
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Benjamin Bouillet
- Service d'Endocrinologie, Diabétologie, Maladies Métaboliques, CHU Dijon, Dijon, France
| | - Ariane Sultan
- 10PhyMedExp, INSERM U1046, UMR 9214, Univ Montpellier, Service Des Maladies Métaboliques, CHU Montpellier, Montpellier, France
| | - Sophie Schuldiner
- VBIC, INSERM U1047, Univ Montpellier, Service Des Maladies Métaboliques Et Endocriniennes, CHU Nîmes, Clinique du Pied Gard Occitanie, Route de Carnon, 30240, Le Grau du Roi, France.
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Gooday C, Hardeman W, Poland F, Woodburn J, Dhatariya K. Controversies in the management of active Charcot neuroarthropathy. Ther Adv Endocrinol Metab 2023; 14:20420188231160406. [PMID: 37101723 PMCID: PMC10123890 DOI: 10.1177/20420188231160406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 02/11/2023] [Indexed: 04/28/2023] Open
Abstract
Charcot neuroarthropathy (CN) was first described over 150 years ago. Despite this there remains uncertanity around the factors that contribute to its development, and progression. This article will discuss the current controversies around the pathogenesis, epidemiology, diagnosis, assessment and management of the condition. The exact pathogenesis of CN is not fully understood, and it is likely to be multifactorial, with perhaps currently unknown mechanisms contributing to its development. Further studies are needed to examine opportunities to help screen for and diagnose CN. As a result of many of these factors, the true prevalence of CN is still largely unknown. Almost all of the recommendations for the assessment and treatment of CN are based on low-quality level III and IV evidence. Despite recommendations to offer people with CN nonremovable devices, currently only 40-50% people are treated with this type of device. Evidence is also lacking about the optimal duration of treatment; reported outcomes range from 3 months to more than a year. The reason for this variation is not entirely clear. A lack of standardised definitions for diagnosis, remission and relapse, heterogeneity of populations, different management approaches, monitoring techniques with unknown diagnostic precision and variation in follow-up times prevent meaningful comparison of outcome data. If people can be better supported to manage the emotional and physical consequences of CN, then this could improve people's quality of life and well-being. Finally, we highlight the need for an internationally coordinated approach to research in CN.
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Affiliation(s)
| | - Wendy Hardeman
- Behavioural and Implementation Science Group, School of Health Sciences, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Fiona Poland
- Institute for Volunteering Research, Faculty of Medicine and Health Science, University of East Anglia, Norwich, UK
| | - Jim Woodburn
- School of Health Sciences and Social Work, Griffith University, Southport, QLD, Australia
| | - Ketan Dhatariya
- Elsie Bertram Diabetes Centre, Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
- Norwich Medical School, University of East Anglia, Norwich, UK
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Yammine K, Boulos K, Assi C, Hayek F. Amputation and mortality frequencies associated with diabetic Charcot foot arthropathy: a meta-analysis. Foot Ankle Surg 2022; 28:1170-1176. [PMID: 36028441 DOI: 10.1016/j.fas.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Five-year mortality and amputation frequencies after new-onset diabetic ulceration have been reported up to 55% and 74%, respectively. for patients with lower-extremity amputation. Following Charcot arthropathy, these frequencies were reported with wide variations. The aim of this meta-analysis is to provide a quantitative evaluation of amputation and mortality frequencies in a diabetic patient with a Charcot foot arthropathy. METHODS Electronic search strategy was applied on Medline, Web of Science, Cochrane Library and Google Scholar since inception to December 2021. Extracted data included study design, sample and patients characteristics, diabetes type and duration, lab results, ulcers at diagnosis, co-morbidities and follow up period. Meta-analysis reporting random-effects values was used to generate the weights results. RESULTS A total of 16 studies were included in the quantitative meta-analysis with a pooled sample of 2250 patients with 2272 Charcot feet. Two studies including 255 patients yielded a 1-year mortality frequency of 4% (95% CI = 0.018-0.065). Seven studies including 1706 patients reported a 5-year mortality frequency of 24.5% (95% CI = 0.172-0.326, I² = 88.5%). Four studies including 277 patients yielded a seven plus year mortality frequency of 16% (95% CI = 0.065-0.289, I² = 84.3%). Ten studies including 871 foot yielded an amputation frequency of 15% (95% CI = 0.067-0.258, I² = 93.6%) where 9% where major amputations (95% CI = 0.062-0.127, I² = 60%) and 5% were minor amputations (95% CI = 0.004-0.126, I² = 94.7%) CONCLUSION: Diabetic Charcot arthropathy yields marked risk of amputation and mortality. However, mortality frequencies were unexpectedly lesser compared to those related to the published frequencies associated with diabetic foot ulcers.
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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.
| | - Karl Boulos
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
| | - Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon; Center for Evidence-Based Anatomy, Sport & Orthopedics Research
| | - Fady Hayek
- Division of Vascular Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University, School of Medicine, Lebanon
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4
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Gratwohl V, Jentzsch T, Schöni M, Kaiser D, Berli MC, Böni T, Waibel FWA. Long-term follow-up of conservative treatment of Charcot feet. Arch Orthop Trauma Surg 2022; 142:2553-2566. [PMID: 33829302 PMCID: PMC9474498 DOI: 10.1007/s00402-021-03881-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/24/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Charcot arthropathy (CN) can ultimately lead to limb loss despite appropriate treatment. Initial conservative treatment is the accepted treatment in case of a plantigrade foot. The aim of this retrospective study was to investigate the mid- to long-term clinical course of CN initially being treated conservatively, and to identify risk factors for reactivation and contralateral development of CN as well as common complications in CN. METHODS A total of 184 Charcot feet in 159 patients (median age 60.0 (interquartile range (IQR) 15.5) years, 49 (30.1%) women) were retrospectively analyzed by patient chart review. Rates of limb salvage, reactivation, contralateral development and common complications were recorded. Statistical analysis was performed to identify possible risk factors for limb loss, CN reactivation, contralateral CN development, and ulcer development. RESULTS Major amputation-free survival could be achieved in 92.9% feet after a median follow-up of 5.2 (IQR 4.25, range 2.2-11.25) years. CN recurrence occurred in 13.6%. 32.1% had bilateral CN involvement. Ulcers were present in 72.3%. 88.1% patients were ambulating in orthopaedic footwear without any further aids. Presence of Diabetes mellitus was associated with reactivation of CN, major amputation and ulcer recurrence. Smoking was associated with ulcer development and necessity of amputations. CONCLUSIONS With consistent conservative treatment of CN with orthopaedic footwear or orthoses, limb preservation can be achieved in 92.9% after a median follow-up of 5.2 years. Patients with diabetic CN are at an increased risk of developing complications and CN reactivation. To prevent ulcers and amputations, every effort should be made to make patients stop smoking. LEVEL OF EVIDENCE III, long-term retrospective cohort study.
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Affiliation(s)
- Viviane Gratwohl
- grid.412373.00000 0004 0518 9682Divisions of “Prosthetics and Orthotics” and “Foot and Ankle Surgery”, Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Thorsten Jentzsch
- grid.412373.00000 0004 0518 9682Divisions of “Prosthetics and Orthotics” and “Foot and Ankle Surgery”, Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Madlaina Schöni
- grid.412373.00000 0004 0518 9682Divisions of “Prosthetics and Orthotics” and “Foot and Ankle Surgery”, Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Dominik Kaiser
- grid.412373.00000 0004 0518 9682Divisions of “Prosthetics and Orthotics” and “Foot and Ankle Surgery”, Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Martin C. Berli
- grid.412373.00000 0004 0518 9682Divisions of “Prosthetics and Orthotics” and “Foot and Ankle Surgery”, Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Thomas Böni
- grid.412373.00000 0004 0518 9682Divisions of “Prosthetics and Orthotics” and “Foot and Ankle Surgery”, Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
| | - Felix W. A. Waibel
- grid.412373.00000 0004 0518 9682Divisions of “Prosthetics and Orthotics” and “Foot and Ankle Surgery”, Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008 Zürich, Switzerland
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Orioli L, Hammer F, Vande Berg B, Putineanu D, Maiter D, Vandeleene B. Prevalence, Characteristics, and Prognosis of Peripheral Arterial Disease in Patients With Diabetic Charcot Foot. J Foot Ankle Surg 2021; 60:1158-1163. [PMID: 34108117 DOI: 10.1053/j.jfas.2021.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 04/10/2021] [Accepted: 04/29/2021] [Indexed: 02/03/2023]
Abstract
Charcot foot (CF) is a rare complication of diabetes associated with foot deformities and foot ulcers. Peripheral arterial disease (PAD) is a factor of poor prognosis in patients with diabetic foot ulcers (DFUs). However, PAD has infrequently been studied in CF. We aimed to determine the prevalence, the characteristics and the prognosis of PAD in a large group of patients with diabetic CF. We retrospectively compared 56 patients with diabetic CF to 116 patients with diabetic foot without CF. The prevalence of PAD in patients with CF was 66.1%. Compared to patients without CF, patients with CF had similar risks to have PAD (OR 0.98, 95%CI 0.50-1.94, p= .97) and neuro-ischemic DFUs (OR 1.19, 95%CI 0.57-2.49, p= .65), more risk to have lesions of distal arteries (OR 4.17, 95%CI 1.76-9.94, p= .001) and less risk to need revascularization (OR 0.14, 95%CI 0.06-0.36, p< .001). In patients with CF, PAD was strongly predicted by DFUs (OR 24.55, 95%CI 1.80-334.43, p= .016) and coronary artery disease (OR 17.11, 95%CI 1.75-167.43, p =.015). Survival rate and limb salvage rate in patients with CF were not worsened by PAD and by neuro-ischemic DFUs, respectively. In conclusion, we show that PAD should not be overlooked in patients with diabetic CF, especially in those having DFUs or coronary artery disease. PAD in patients with CF differed from that of patients without CF since it predominated in distal arteries and required less often revascularization.
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Affiliation(s)
- Laura Orioli
- Fellow, Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
| | - Frank Hammer
- Attending Physician, Department of Medical Imaging, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Bruno Vande Berg
- Professor, Department of Medical Imaging, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Dan Putineanu
- Attending Physician, Department of Traumatology and Orthopedic Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Dominique Maiter
- Professor, Head of Department, Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Bernard Vandeleene
- Attending Physician, Department of Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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6
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Zellers JA, Mueller MJ, Commean PK, Chen L, Jeong HJ, Hastings MK. Multi-System Factors Associated with Metatarsophalangeal Joint Deformity in Individuals with Type 2 Diabetes. J Clin Med 2020; 9:E1012. [PMID: 32260124 PMCID: PMC7230982 DOI: 10.3390/jcm9041012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 12/31/2022] Open
Abstract
The underlying factors contributing to metatarsophalangeal joint deformity, a known precursor to skin breakdown in individuals with diabetes mellitus (DM), is likely to involve multiple body systems. The purpose of this cross-sectional study was to identify multi-system factors associated with metatarsophalangeal joint deformity in individuals with type 2 DM and peripheral neuropathy (n = 60). Metatarsophalangeal joint deformity was quantified with a computed tomography (CT) scan. System biomarkers included the musculoskeletal system (foot intrinsic muscle deterioration, tarsal/metatarsal bone mineral density, ankle dorsiflexion, metatarsophalangeal extension movement during a sit to stand task); the vascular system (ankle-brachial index); and the endocrine/immune systems (high sensitivity C-reactive protein, skin intrinsic fluorescence, and hemoglobin A1C). Muscle deterioration (r = 0.27), bone density (r = -0.35), metatarsophalangeal extension movement (r = 0.50), maximum dorsiflexion (r = -0.31), and ankle-brachial index (r = 0.33) were related to metatarsophalangeal joint deformity (p < 0.05). Bone mineral density and metatarsophalangeal extension movement were retained in a regression model relating to deformity (R2 = 0.34). All musculoskeletal system biomarkers and the ankle-brachial index demonstrated weak to moderate relationships to metatarsophalangeal joint deformity. Bone mineral density of the tarsal/metatarsal bones and extending the toes during a sit to stand task were the two strongest factors associated with metatarsophalangeal joint deformity. Evaluation and management of foot bone mineral density and toe extension movement pattern could reduce metatarsophalangeal joint deformity and the risk of skin breakdown and subsequent amputation.
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Affiliation(s)
- Jennifer A. Zellers
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Ave., St. Louis, MO 63108, USA; (J.A.Z.); (M.J.M.); (H.-J.J.)
| | - Michael J. Mueller
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Ave., St. Louis, MO 63108, USA; (J.A.Z.); (M.J.M.); (H.-J.J.)
| | - Paul K. Commean
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, 510 South Kingshighway Blvd., St. Louis, MO 63110, USA;
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine in St. Louis, 660 S. Euclid Ave., St. Louis, MO 63110, USA;
| | - Hyo-Jung Jeong
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Ave., St. Louis, MO 63108, USA; (J.A.Z.); (M.J.M.); (H.-J.J.)
| | - Mary K. Hastings
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, 4444 Forest Park Ave., St. Louis, MO 63108, USA; (J.A.Z.); (M.J.M.); (H.-J.J.)
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Pafili K, Trypsianis G, Papazoglou D, Maltezos E, Papanas N. Cardiovascular Autonomic Neuropathy and Distal Symmetric Sensorimotor Polyneuropathy: These Two Diabetic Microvascular Complications do not Invariably Co-Exist. Curr Vasc Pharmacol 2019; 18:50-56. [PMID: 30156161 DOI: 10.2174/1570161116666180829120101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/02/2018] [Accepted: 08/07/2018] [Indexed: 11/22/2022]
Abstract
Background:
Cardiovascular autonomic neuropathy (CAN) and distal symmetrical sensorimotor
polyneuropathy (DSPN) are serious microvascular complications of diabetes mellitus (DM).
Their simultaneous development remains disputable. The aim of the present study was to examine the
correlation between CAN and the presence/severity of DSPN in DM.
Methods:
Subjects with type 1 (group A: n=51; mean age 40.4 years) and type 2 DM (group B: n=153;
mean age 64.6 years) were studied. Evaluation of DSPN was based on neuropathy disability score. Assessment
of CAN was based on the battery of 4 standardized cardiovascular autonomic function tests.
Results:
In group A, patients with moderate/severe DSPN exhibited a 12-fold higher likelihood of CAN
in univariate analysis (p=0.035). However, significance was lost after adjustment for gender, age, DM
duration, and haemoglobin A1c. In group A, likelihood for CAN did not correlate with the presence of
mild DSPN in univariate and multivariate analysis. In group B, likelihood of CAN was similar in patients
with mild and in those with moderate/severe DSPN compared with patients without DSPN in
univariate and multivariate analysis. In between group comparison CAN was similarly distributed in the
2 groups (p for interaction=0.367), in patients with no, mild and moderate/severe DSPN.
Conclusion:
CAN does not always co-exist with degrees of DSPN, ranging from mild to moderate/
severe and is similarly distributed in T1DM and T2DM patients with mild and moderate/severe
DSPN and in patients without DSPN.
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Affiliation(s)
- Kalliopi Pafili
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Grigoris Trypsianis
- Department of Medical Statistics, Medical Faculty, Democritus University of Thrace, Alexandroupolis, Alexandroupolis, Greece
| | - Dimitrios Papazoglou
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Efstratios Maltezos
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Nikolaos Papanas
- Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
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Chaudhary S, Bhansali A, Rastogi A. Mortality in Asian Indians with Charcot's neuroarthropathy: a nested cohort prospective study. Acta Diabetol 2019; 56:1259-1264. [PMID: 31187250 DOI: 10.1007/s00592-019-01376-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 06/04/2019] [Indexed: 10/26/2022]
Abstract
AIMS We studied mortality in individuals of diabetes with or without Charcot neuroarthropathy (CN). METHODS People attending diabetic foot care facility with CN of foot (Cohort 1) were prospectively evaluated. Details pertaining to the duration of diabetes, microvascular and macrovascular complications, foot ulcer, amputation and mortality outcomes were recorded and compared with those without foot complications (Cohort 2) by multivariate logistic regression. RESULTS Data for 260 individuals of diabetes with CN and 520 individuals without CN were analysed. Mean age at presentation with CN was 55.8 ± 9.1 years, and duration of diabetes was 12.9 ± 7.8 years. 39.8% individuals with CN had foot ulcer, and 15.3% had amputation. People with CN were younger (55 ± 9.1 vs. 59.9 ± 8.1 years, p < 0.001) and had higher prevalence of microvascular complications. A total of 39 (15%) individuals with CN and 50 (9.8%) (p = 0.03) individuals without CN died during median follow-up of 40(24-51) months. People with CN had 2.7 times (OR 2.72, 95% CI 1.4-5.2, p = 0.003) increased mortality risk when matched for potential confounders. Prevalent CAD and low eGFR predicted higher mortality in people with CN. CONCLUSIONS People with Charcot neuroarthropathy have almost three times increased risk of mortality despite being younger at presentation.
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Affiliation(s)
| | - Anil Bhansali
- Department of Endocrinology, PGIMER, Chandigarh, 160012, India
| | - Ashu Rastogi
- Department of Endocrinology, PGIMER, Chandigarh, 160012, India.
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9
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Jansen RB, Jørgensen B, Holstein PE, Møller KK, Svendsen OL. Mortality and complications after treatment of acute diabetic Charcot foot. J Diabetes Complications 2018; 32:1141-1147. [PMID: 30301593 DOI: 10.1016/j.jdiacomp.2018.09.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/13/2018] [Accepted: 09/20/2018] [Indexed: 11/22/2022]
Abstract
AIMS Charcot foot is a rare but disabling complication to diabetic neuropathy, and can cause permanent, limb-threatening deformities. The aim of this study was to investigate a population of patients a Charcot foot on a case-by-case basis, in order to assess the consequences of an acute Charcot foot and its complications. METHODS The study was conducted a retrospective study of patients admitted to the Copenhagen Wound Healing Center between 1996 and 2015 with the diagnosis of Charcot foot (DM14.6) and diabetes mellitus type 1 or 2 (DE10.X and DE11.X). Physical and electronic records were used, and compared to data from the Danish Diabetes Registry. RESULTS In total 392 patients were identified of which 173 were included. There were 26% with type 1 diabetes (initial HbA1c 81.7 ± 21.4 mmol/mol) and 74% with type 2 diabetes (initial HbA1c 66.5 ± 20.3 mmol/mol). Primary off-loading was with a removable walker in 95% of the cases (average off-loading time 8.3 months). The 5-year mortality was 14% with a mean survival time of 12.7 years. There was an association between lack of compliance and occurrence of foot complications, as well as between having a Charcot foot and leaving the workforce. CONCLUSION More patients had type 1 diabetes compared to the background population, and they had a higher HbA1c than the general population of diabetes patients. A total of 67% developed complications such as ulcers, while patients non-compliant to treatment did significantly worse than those being compliant. The 5-year mortality was low, 14%, and comparable to diabetes patients without Charcot foot.
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Affiliation(s)
- Rasmus Bo Jansen
- Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen NV, Denmark.
| | - Bo Jørgensen
- Center for Wound Healing, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen NV, Denmark
| | - Per E Holstein
- Center for Wound Healing, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen NV, Denmark
| | - Klaus Kirketerp Møller
- Center for Wound Healing, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen NV, Denmark
| | - Ole Lander Svendsen
- Department of Endocrinology, Bispebjerg Hospital, University of Copenhagen, DK-2400 Copenhagen NV, Denmark
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10
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Doria M, Viadé J, Palomera E, Pérez R, Lladó M, Costa E, Huguet T, Reverter JL, Serra-Prat M, Franch-Nadal J, Mauricio D. Short-term foot complications in Charcot neuroarthropathy: A retrospective study in tertiary care centres in Spain. ACTA ACUST UNITED AC 2018; 65:479-485. [PMID: 30108031 DOI: 10.1016/j.endinu.2018.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications. PATIENTS AND METHODS A retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed. Logistic regression analyses were used to determine significant predictors of the predefined clinical events. RESULTS Signs of diabetic neuropathy were found in almost all patients (98.9%) at the initial assessment, approximately half of them had diabetic retinopathy or nephropathy (61.5% and 51.8%, respectively), and peripheral artery disease was uncommon (8.6%). Thirty-eight patients (47.5%) experienced one or more relevant clinical events: 22 (27.5%) a new foot ulcer; 7 (8.7%) a major amputation; 20 (25%) were admitted to hospital; and 4 (5%) died. Only the presence of diabetic nephropathy was independently associated to development of any of the complications studied (p = 0.009; odds ratio = 3.37; 95% CI: 1.12-10.1). CONCLUSIONS Almost half the patients with CN attending specialised foot care units in tertiary hospitals experienced short-term CN-associated complications, and the risk was 3 times higher in those with a history of diabetic nephropathy.
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Affiliation(s)
- Montserrat Doria
- Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain; Diabetic Foot Unit, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Jordi Viadé
- Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain
| | | | - Ricard Pérez
- Department of Radiology, University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Melcior Lladó
- Diabetic Foot Unit, University Hospital Son Espases, Palma de Mallorca, Spain
| | - Elisabet Costa
- Department of Endocrinology and Nutrition, University Hospital Josep Trueta, Girona, Spain
| | - Teresa Huguet
- Diabetic Foot Unit, University Hospital Mutua, Terrassa, Spain
| | - Jordi Lluís Reverter
- Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain
| | | | - Josep Franch-Nadal
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Spain; Primary Health Care Center Raval Sud, Gerència d'Atenció Primaria, Institut Català de la Salut, Barcelona, Spain
| | - Dídac Mauricio
- Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute Germans Trias i Pujol, Badalona, Spain; Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Spain; Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
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11
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Anichini R, Policardo L, Lombardo FL, Salutini E, Tedeschi A, Viti S, Francia P, Brocco E, Maggini M, Seghieri G, De Bellis A. Hospitalization for Charcot neuroarthropathy in diabetes: A population study in Italy. Diabetes Res Clin Pract 2017; 129:25-31. [PMID: 28500867 DOI: 10.1016/j.diabres.2017.03.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/28/2017] [Indexed: 01/29/2023]
Abstract
AIMS To provide data on hospitalization and incidence rates of Charcot neuroarthropathy (CN) and its relation to lower limbs' amputations/revascularizations in population with diabetes of Italy as well as of one of its regions (Tuscany). METHODS Hospitalizations with CN diagnosis (codes ICD-9-CM: 7130, 7135, 7138) have been recorded in people with diabetes over years 2003-2013 in Italy and 2008-2015 in Tuscany. Amputations, peripheral vascular disease, revascularizations and infections were likewise evaluated. RESULTS Between 2003 and 2013 CN hospitalizations were very infrequent in Italy ranging between 14×100,000 and 11×100,000 patients with diabetes. In Tuscany they declined to a minimum of 7×100,000 patients in 2015, after a previous increase to a maximum of 22×100,000 (p=NS for both). Yearly CN incidence remained constant in Italy, declining in Tuscany to a minimum of 3.4×100,000 diabetic patients in 2015 (p=0.047). CN patients were younger and with longer length of hospital stay than those with non-Charcot diabetic foot (p<0.05 for both). Amputation and infection rates were manifold higher in CN patients than in those with non-Charcot diabetic foot, while the revascularization rate was similar in both. CONCLUSIONS Over last decade, in Italy and Tuscany yearly CN incidence and hospitalization rates concerned only a small percentage of patients, remaining constant over years and declining in Tuscany in the last couple of years. CN was significantly associated to younger age, longer hospital stay and greater risk of amputations and infections while the need of revascularization was similar to that of non-Charcot diabetic foot.
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Affiliation(s)
- Roberto Anichini
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
| | | | - Flavia Lucia Lombardo
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
| | - Elisabetta Salutini
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
| | - Anna Tedeschi
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
| | - Secondina Viti
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
| | - Piergiorgio Francia
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Enrico Brocco
- Regional Referral Center for the Treatment of Diabetic Foot, Policlinico Abano Terme, Padova, Italy
| | - Marina Maggini
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
| | | | - Alessandra De Bellis
- Diabetes Unit and Diabetes Foot Unit, San Jacopo Hospital, USL Centro-Toscana, Pistoia, Italy
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12
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Letter to the Editor Regarding: Diabetic Peripheral Neuropathy as a Predictor of Asymptomatic Myocardial Ischemia in Type 2 Diabetes Mellitus: A Cross-Sectional Study. Adv Ther 2016; 33:1848-1852. [PMID: 27671327 PMCID: PMC5055559 DOI: 10.1007/s12325-016-0410-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Indexed: 11/24/2022]
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13
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Hudzik B, Szkodziński J, Hawranek M, Lekston A, Poloński L, Gąsior M. CHA2DS2-VASc score is useful in predicting poor 12-month outcomes following myocardial infarction in diabetic patients without atrial fibrillation. Acta Diabetol 2016; 53:807-15. [PMID: 27339195 PMCID: PMC5014889 DOI: 10.1007/s00592-016-0877-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 06/08/2016] [Indexed: 12/22/2022]
Abstract
AIMS TIMI risk score and GRACE risk model are widely available and accepted scores for risk assessment in STEMI patients and include predictors of poor outcomes. CHA2DS2-VASc is a validated score for predicting embolic/stroke risk in patients with non-valvular atrial fibrillation. Its components contribute to the worse prognosis following myocardial infarction. The advantage of the CHA2DS2-VASc score in comparison with other risk scores is that it provides a comprehensive, fast, and simple method for physicians in risk evaluation that requires no calculators or computers. Therefore, we have set out to examine the prognostic significance of CHA2DS2-VASc score following STEMI in diabetic patients without AF. METHODS A total of 472 patients with diabetes mellitus and STEMI undergoing primary PCI were enrolled. Based on the estimated CHA2DS2-VASc score, the study population was divided into three groups: group 1 (N = 111) with a moderate CHA2DS2-VASc score of 2 or 3; group 2 (N = 257) with a high CHA2DS2-VASc score of 4 or 5; and group 3 (N = 104) with a very high CHA2DS2-VASc score of 6 or higher. RESULTS In diabetic patients with STEMI, the median of CHA2DS2-VASc score was 4 (interquartile range 3-5). In-hospital mortality rate was similar across three groups. CHA2DS2-VASc score was not a risk factor of in-hospital mortality. ROC analysis revealed good diagnostic value of CHA2DS2-VASc score in predicting long-term mortality (AUC 0.62 95 % CI 0.57-0.66 P = 0.0003) and stroke (AUC 0.75 95 % CI 0.71-0.79 P = 0.0003), but no value in predicting long-term myocardial infarction. CHA2DS2-VASc score was an independent predictor of 12-month mortality and stroke. One-point increment in CHA2DS2-VASc score was associated with an increase in the risk of 12-month death by 24 % and for 12-month stroke by 101 %. CONCLUSIONS In diabetic patients with STEMI and no previous AF, median CHA2DS2-VASc score was high (4 points) and predicted 12-month death and stroke. However, it failed to predict in-hospital death and 12-month MI. CHA2DS2-VASc score had a similar discrimination performance in predicting 12-month mortality as TIMI risk score and a better discrimination performance in predicting 12-month stroke than TIMI risk score. Thus, it can serve as an additive tool in identifying high-risk patients that require aggressive management.
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Affiliation(s)
- Bartosz Hudzik
- Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland.
| | - Janusz Szkodziński
- Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland
| | - Michal Hawranek
- Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland
| | - Andrzej Lekston
- Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland
| | - Lech Poloński
- Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland
| | - Mariusz Gąsior
- Third Department of Cardiology, Silesian Center for Heart Disease, SMDZ in Zabrze, Medical University of Silesia in Katowice, Curie-Sklodowska 9, 41-800, Zabrze, Poland
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14
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Tashakori-Sabzevar F, Ramezani M, Hosseinzadeh H, Parizadeh SMR, Movassaghi AR, Ghorbani A, Mohajeri SA. Protective and hypoglycemic effects of celery seed on streptozotocin-induced diabetic rats: experimental and histopathological evaluation. Acta Diabetol 2016; 53:609-19. [PMID: 26940333 DOI: 10.1007/s00592-016-0842-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 01/16/2016] [Indexed: 01/06/2023]
Abstract
AIMS Diabetes mellitus is a major manifestation of metabolic disorder which presents with hyperglycemia (high levels of serum blood sugar). In the present study, we aimed to investigate the effects of celery seed extract on different biochemical factors and histopathological changes in normal and streptozotocin (STZ)-induced diabetic rats. METHODS A total of 35 male Wistar rats were divided into five groups (one normal and four diabetic groups). STZ was injected intraperitoneally to induce diabetes. The effects of hexane extract of celery seed and glibenclamide (as a positive control) were compared. Blood samples were analyzed on days 0, 18, and 33, and histopathological evaluations were performed at the end of the study. RESULTS Glucose, triglycerides, and cholesterol levels significantly decreased, whereas insulin and high-density lipoprotein (HDL) levels increased in the extract-administered groups, as compared to the negative diabetic control group (P < 0.0001). The concentrations of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in serum of the extract-administered groups were significantly less than the negative control group (P < 0.0001). Histopathological reports revealed significantly less atrophy, necrosis, and inflammation in the rats receiving celery seed extract compared to the negative control group. CONCLUSIONS The results indicated that celery seed extract can be effective in controlling hyperglycemia and hyperlipidemia in diabetic rats, and demonstrated its protective effects against pancreatic toxicity resulting from STZ-induction.
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Affiliation(s)
| | - Masoud Ramezani
- Student Research Committee (SRC), Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Hosseinzadeh
- Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Ahmad Reza Movassaghi
- Department of Pathobiology, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Ahmad Ghorbani
- Pharmacological Research Center of Medicinal Plants, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyed Ahmad Mohajeri
- Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran.
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15
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Ramanujam CL, Han D, Zgonis T. Lower Extremity Amputation and Mortality Rates in the Reconstructed Diabetic Charcot Foot and Ankle With External Fixation: Data Analysis of 116 Patients. Foot Ankle Spec 2016; 9:113-26. [PMID: 26276212 DOI: 10.1177/1938640015599036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
UNLABELLED The aim of this study was to determine the lower extremity amputation and mortality rates of a group of patients who underwent reconstructive surgery using circular external fixation for treatment of diabetic Charcot neuroarthropathy (CN) of the foot and/or ankle. Existing studies regarding lower extremity amputation or mortality rates for diabetic CN of the foot and/or ankle have been performed on mostly conservatively treated patients. The objective of the statistical analysis in this studied population was to understand the difference in overall amputation and mortality rates between the 2 main groups: one with foot and/or ankle ulceration (group 1), and the other without ulceration or osteomyelitis (group 2, control group). Within group 1, 2 subgroups were established: one with osteomyelitis (group 1A) and the other without osteomyelitis (group 1B). Initially, a retrospective analysis of 150 consecutive surgically reconstructed diabetic foot and ankle cases using circular external fixation from January 2005 through December 2012 was conducted. Those which were not supported with the diagnosis of diabetic CN were excluded and the 2 other charts without proper follow-up duration (6 months) for analysis were removed, resulting in the final sample size of N = 116. There were a total of n = 7 (6.0%) below the knee amputations (group 1A = 1, group 1B = 4, and group 2 = 2) with a total of n = 5 mortalities (4.3%) (group 1A = 2, group 1B = 2, and group 2 = 1). The total amount of time for a lower extremity amputation event (n = 7) since the time of surgical reconstruction was 729.43 ± 519.73 days (range 230-1777 days) while for a mortality event (n = 5), it was 1302.00 ± 765.48 days (range 633-2499 days). LEVELS OF EVIDENCE Prognostic, Level III: Retrospective study.
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Affiliation(s)
- Crystal L Ramanujam
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas (CLR)Department of Management Science & Statistics, College of Business, The University of Texas at San Antonio, San Antonio, Texas (DH)Externship and Reconstructive Foot and Ankle Fellowship Programs, Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas (TZ)
| | - David Han
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas (CLR)Department of Management Science & Statistics, College of Business, The University of Texas at San Antonio, San Antonio, Texas (DH)Externship and Reconstructive Foot and Ankle Fellowship Programs, Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas (TZ)
| | - Thomas Zgonis
- Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas (CLR)Department of Management Science & Statistics, College of Business, The University of Texas at San Antonio, San Antonio, Texas (DH)Externship and Reconstructive Foot and Ankle Fellowship Programs, Division of Podiatric Medicine and Surgery, Department of Orthopaedic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas (TZ)
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16
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Papanas N, Pafili K, Maltezos E. Charcot osteoarthropathy and coronary artery disease in diabetes: the twilight of innocence? Acta Diabetol 2016; 53:123-4. [PMID: 25721037 DOI: 10.1007/s00592-015-0723-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/05/2015] [Indexed: 11/25/2022]
Affiliation(s)
- N Papanas
- Outpatient Clinic of the Diabetic Foot, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, G. Kondyli 22c, 68100, Alexandroupolis, Greece.
| | - K Pafili
- Outpatient Clinic of the Diabetic Foot, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, G. Kondyli 22c, 68100, Alexandroupolis, Greece
| | - E Maltezos
- Outpatient Clinic of the Diabetic Foot, Second Department of Internal Medicine, Democritus University of Thrace, University Hospital of Alexandroupolis, G. Kondyli 22c, 68100, Alexandroupolis, Greece
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Marano R, Pitocco D, Di Stasio E, Savino G, Merlino B, Trani C, Pirro F, Rutigliano C, Santangelo C, Minoiu AC, Natale L, Bonomo L. MDCT assessment of CAD in type-2 diabetic subjects with diabetic neuropathy: the role of Charcot neuro-arthropathy. Eur Radiol 2015; 26:788-96. [PMID: 26139314 DOI: 10.1007/s00330-015-3864-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 05/14/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare the CACS and CAD severity assessed by MDCT in neuropathic type-2 diabetic patients with and without Charcot-neuroarthropathy (CN). METHODS Thirty-four CN asymptomatic-patients and 36 asymptomatic-patients with diabetic-neuropathy (DN) without CN underwent MDCT to assess CACS and severity of CAD. Patients were classified as positive for significant CAD in presence of at least one stenosis >50 % on MDCT-coronary-angiography (MDCT-CA). Groups were matched for age, sex and traditional CAD risk-factors. The coronary-angiography (CA) was performed in all patients with at least a significant stenosis detected by MDCT-CA, both as reference and eventually as treatment. RESULTS CN patients showed higher rates of significant CAD in comparison with DN subjects [p < 0.001], while non-significant differences were observed in CACS (p = 0.980). No significant differences were also observed in CACS distribution in all subjects for stenosis ≥/<50 % (p = 0.814), as well as in both groups (p = 0.661 and 0.559, respectively). The MDCT-CA showed an overall diagnostic-accuracy for significant CAD of 87%. CONCLUSIONS These preliminary data suggest that CN-patients have a higher prevalence of severe CAD in comparison with DN-patients, while coronary plaques do not exhibit an increased amount of calcium. MDCT may be helpful to assess the CV risk in such asymptomatic type-2-diabetic patients with autonomic-neuropathy. KEY POINTS Type 2-diabetic-patients with CN result having more severe coronary artery plaque-burden. MDCT-CA may stratify the CV risk in type 2-diabetic-patients with CN. Adequate diagnostic is mandatory for optimal management of type 2-diabetic-patients with CN.
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Affiliation(s)
- Riccardo Marano
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy.
| | - Dario Pitocco
- Department of Internal Medicine, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Enrico Di Stasio
- Department of Clinical Biochemistry, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Giancarlo Savino
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Biagio Merlino
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Medicine - Institute of Cardiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Federica Pirro
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Claudia Rutigliano
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Carolina Santangelo
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Aurelian Costin Minoiu
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Luigi Natale
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Lorenzo Bonomo
- Department of Radiological Sciences - Institute of Radiology, Catholic University of Rome, "A. Gemelli" University Hospital, L.go Agostino Gemelli 8, 00168, Rome, Italy
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