Pruritus induced self injury behavior: an overlooked risk factor for amputation in diabetic neuropathy?

The reported external traumas among people with diabetes-related foot ulcers and their outcomes: A systematic review of case reports

The objective of this systematic review was to collate evidence published in case reports on the reported origins of external traumas that contribute to the development of diabetic foot ulcers and their outcomes. The review also aimed to suggest reporting criteria for external traumas contributing to the development of diabetic foot ulcers. The search strategy led to the identification of 1224 articles across six electronic databases. Additional articles were also sourced from other electronic platforms (Google scholar) and the reference lists of the included case reports. Ninety‐four articles met the inclusion criteria and were published between 1989 and 2020. The included case reports were independently assessed for methodological quality using a Joanna Briggs Institute (JBI) checklist. Following the verbatim extraction of data, the JBI three steps approach to “meta‐aggregation” for managing qualitative data was used to synthesise the data on external traumas that contributed to the development of foot ulcers along with the reported outcome. Information on the included case report characteristics was also extracted. The case reports included 155 patients. Average age was 57.2 years with a range from 17 to 86 years. External traumas were mainly experienced in the domestic setting and were categorised into two main categories, mechanical trauma (n = 87, 60%) or burns (n = 58, 40%). The most frequently reported origins of external trauma were contact with a hot surface, animal bites, friction, and puncture wounds. Although healing was the most frequent outcome, a prolonged time was recorded for the ulcers to heal highlighting the importance of prevention. Prevention might not eradicate origins of external trauma 100%, showing the importance of patient and/or family role in monitoring domestic risks, early detection of ulcer and seeking immediate professional care. Foot ulcers need to be reported against standardised criteria considering local characteristics of the ulcer and the individual's general profile.

Technical feasibility and safety profile of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT)

Background

In this study, we specifically aimed to analyze the technical and safety aspects of laparoscopic diverted sleeve gastrectomy with ileal transposition (DSIT) in patients with type 2 diabetes (T2DM).

Methods

A total of 360 patients with type 2 diabetes who underwent a DSIT procedure within the past 2-year period (2011–2013) were analyzed. Operation time, length of hospital stay, perioperative and postoperative complications, and mortality were recorded and analyzed.

Results

The participants consisted of 229 males (63.6 %) and 131 females (36.4 %). Mean duration of follow-up was 12.4 months (range, 6–31). One early and two late mortalities occurred. Early mortality was due to an anastomotic leak, and late mortalities were related to myocardial infarction and a traffic accident. Leakage and bleeding were the most common surgical complications. The total number of surgical complications was 22 (6.1 %). Of those, 19 occurred within the first month (early) and 3 occurred after the first month (late). Among early complications, seven (1.94 %) required re-operation, two patients (0.55 %) required endoscopic treatment, and the remaining ten were managed conservatively. Late surgical complications (sleeve angulation) were noted in three patients (0.83) and were treated by endoscopic stents. Surgery-related non-surgical complications occurred in 19 cases (5.2 %), and neurological complications were noted in 11 patients (3.05 %). Additional surgical intervention was required in 26 patients (7.22 %). Of those, 15 (4.16 %) required cholecystectomy.

Conclusions

Our data demonstrate that DSIT is a technically feasible operation and can be safely performed in type 2 diabetic patients with acceptable complication and mortality rates.