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Becker SL, Kody S, Fett NM, Hines A, Alavi A, Ortega-Loayza AG. Approach to the Atypical Wound. Am J Clin Dermatol 2024; 25:559-584. [PMID: 38744780 DOI: 10.1007/s40257-024-00865-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
The heterogeneity of atypical wounds can present diagnostic and therapeutic challenges; however, as the prevalence of atypical wounds grows worldwide, prompt and accurate management is increasingly an essential skill for dermatologists. Addressing the underlying cause of an atypical wound is critical for successful outcomes. An integrated approach with a focus on pain management and patient engagement is recommended to facilitate enduring wound closure. Advances in treatment, in addition to further research and clinical training, are necessary to address the expanding burden of atypical wounds.
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Affiliation(s)
- Sarah L Becker
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Shannon Kody
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | - Nicole M Fett
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA
| | | | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Alex G Ortega-Loayza
- Department of Dermatology, Oregon Health & Science University, 3303 S Bond Ave Building 1, 16th Floor, Portland, OR, 97239, USA.
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Ahmed DY, Adam LN, Ahmed RA, Mirza MK. Assessment of liver enzymes as diagnostic biomarkers in type 2 diabetes mellitus: a cross-sectional study in Zakho, Iraq. Expert Rev Endocrinol Metab 2024; 19:179-185. [PMID: 38050336 DOI: 10.1080/17446651.2023.2291146] [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: 05/31/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND This study aimed to identify the prevalence and factors associated with abnormal liver enzyme profiles in individuals with type 2 diabetes (T2D) in Zakho, to assess the association between demographic characteristics, clinical parameters, kidney function tests, lipid profiles, glucose levels, and T2D, and to identify resident risk factors. RESEARCH DESIGN AND METHODS A cross-sectional analysis of T2D patients admitted to Zakho General Hospital was conducted utilizing hospital records. The primary endpoint of interest was attaining HbA1C levels ≥ 6.5%. Analytical methodologies encompassed linear and multivariate logistic regression analyses, with due consideration of the association between diverse parameters and glycemic alterations. Further, the predictive value of biomarkers was evaluated through Receiver Operating Characteristic (ROC) curves and Area Under the Curve (AUC) analyses, complemented by Spearman correlation analysis to explore relationships among laboratory parameters. RESULTS The study found that 89.4% of participants had HbA1C levels above 6.5%, with a preference for T2D among older individuals (mean age: 52.93-49.89 respectively) and females. Age, glucose levels, and liver enzymes positively correlated with HbA1C. CONCLUSIONS The study emphasizes the diagnostic importance of liver enzymes in individuals with type 2 diabetes, suggesting that these biomarkers could be valuable indicators of disease severity and progression.
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Affiliation(s)
- Dilveen Y Ahmed
- Department of Biology, Faculty of Science, University of Zakho, Duhok, Kurdistan Region, Iraq
| | - Lina N Adam
- Department of Biology, Faculty of Science, University of Zakho, Duhok, Kurdistan Region, Iraq
| | - Resan A Ahmed
- Department of Biology, Faculty of Science, University of Zakho, Duhok, Kurdistan Region, Iraq
| | - Mohammed K Mirza
- Department of Biology, Faculty of Science, University of Zakho, Duhok, Kurdistan Region, Iraq
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Zhou P, Feng H, Qin W, Li Q. KRT17 from skin cells with high glucose stimulation promotes keratinocytes proliferation and migration. Front Endocrinol (Lausanne) 2023; 14:1237048. [PMID: 37929023 PMCID: PMC10622786 DOI: 10.3389/fendo.2023.1237048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Impaired diabetic wound healing is an important issue in diabetic complications. Proliferation and migration of keratinocytes are major processes of skin wound repair after injury. However, hyperkeratosis can affect the speed of wound healing. Based on the results of preliminary experiments on increased KRT17 expression after high glucose stimulation of human skin tissue cells, a cell model of human immortalized keratinocyte (HaCaT) stimulation with different concentrations of KRT17 was established in vitro, and the promotion in cell proliferation and migration were discovered. KRT17 silencing promoted diabetic wound healing in the db/db diabetic wound model. Transcriptome sequencing (RNA-seq) was performed on HaCaT cells after KRT17 stimulation, and analysis showed significant enrichment in the PI3K-AKT signaling pathway, in which the regulation of cell c-MYB mRNA, a key molecule regulating cell proliferation and migration, was significantly upregulated. In vitro assays showed increased c-MYB expression and enhanced pAKT activity after HaCaT cell stimulation by KRT17. We speculate that KRT17 is upregulated under high glucose and promotes keratinocyte proliferation and migration caused hyperkeratosis, through the c-MYB/PI3K-AKT pathway, contributing to delayed wound healing.
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Affiliation(s)
- Peng Zhou
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haijun Feng
- Department of Vascular Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenhui Qin
- Department of Endocrinology, Jingshan Union Hospital of Huazhong University of Science and Technology, Jingshan, China
| | - Qin Li
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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AVCI MERDİN F, AYDEMİR AT, KORKMAZ FN, ŞAH ÜNAL FT, GÖKÇAY CANPOLAT A, ÖKTEM A, DEMİR Ö, ŞAHİN M, EMRAL R, ERDOĞAN MF, GÜLLÜ S, TONYUKUK GEDİK V, KOÇYİĞİT P, ÇORAPÇIOĞLU D. Evaluation of chronic pruritus and associated skin findings in patients with diabetes mellitus. Turk J Med Sci 2023; 53:1489-1497. [PMID: 38813039 PMCID: PMC10763738 DOI: 10.55730/1300-0144.5716] [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] [Received: 03/21/2023] [Revised: 10/26/2023] [Accepted: 09/09/2023] [Indexed: 05/31/2024] Open
Abstract
Background/aim To explore the dermatological lesions associated with chronic pruritus in patients who were followed up at our clinic for type 1 and type 2 diabetes mellitus (DM). Materials and methods The study population consisted of 249 patients with DM, who presented to the endocrinology clinic at Ankara University Faculty of Medicine between January 2022, and March 2022, regardless of whether they had reported experiencing pruritus symptoms. The visual analog scale and 5-D itch scale were used to determine the severity of itching in patients. Dermatological examination findings were also evaluated. Results Of the 249 patients with DM, mean duration since diabetes was diagnosed was 12 ± 9.2 [median 10 (0.3-46)] years, and the mean HbA1c levels were 8.1% ± 2.1%. Pruritus was detected in 77 (30.9%) patients and the mean duration of diabetes diagnosis was 13.4 ± 9.7 years. Examination of the microvascular and macrovascular complications showed that the incidence of retinopathy, nephropathy, neuropathy and peripheral arterial disease was 31.2% (p = 0.003), 31.2% (p = 0.005), 66.2% (p < 0.001) and 10.4% (p = 0.038), respectively, in the group with pruritus. These incidences were significantly higher in the group with pruritus than in those without pruritus. Dermatological examination showed that the most common condition was xerosis (64%), followed by fungal skin infection (16%) and bullous pemphigoid (8%). No skin findings were noted in 7% of patients who complained of itching. Conclusion Chronic pruritus may be associated with several factors such as poor glycemic control, high BMI and microvascular and macrovascular complications in patients with DM. Especially in patients with severe generalized pruritus who do not respond to standard antipruritic treatments, the use of DPP-4 inhibitors, a class of oral antidiabetic agents, should be questioned and all medications being used by the patient should be reviewed.
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Affiliation(s)
- Fatma AVCI MERDİN
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Ahmet Taha AYDEMİR
- Department of Dermatology and Venereal Diseases, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Fatma Nur KORKMAZ
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Fatma Tuğçe ŞAH ÜNAL
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Asena GÖKÇAY CANPOLAT
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Ayşe ÖKTEM
- Department of Dermatology and Venereal Diseases, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Özgür DEMİR
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Mustafa ŞAHİN
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Rıfat EMRAL
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Murat Faik ERDOĞAN
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Sevim GÜLLÜ
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Vedia TONYUKUK GEDİK
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Pelin KOÇYİĞİT
- Department of Dermatology and Venereal Diseases, Faculty of Medicine, Ankara University, Ankara,
Turkiye
| | - Demet ÇORAPÇIOĞLU
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Ankara University, Ankara,
Turkiye
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Vâță D, Stanciu DE, Temelie-Olinici D, Porumb-Andrese E, Tarcău BM, Grecu VB, Gheucă-Solovăstru L. Cutaneous Manifestations Associated with Diabetes Mellitus-A Retrospective Study. Diseases 2023; 11:106. [PMID: 37606477 PMCID: PMC10443279 DOI: 10.3390/diseases11030106] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
Diabetes mellitus (DM) is one of the world's most important health problems, affecting more than half a billion of the world's population today, with an ever-increasing prevalence. Among the most common manifestations of diabetes are skin manifestations, with 30-70% of patients experiencing skin complications during the course of the disease. Conditions such as acanthosis nigricans, diabetic dermopathy, necrobiosis lipoidica, bacterial infections, fungal infections, skin xerosis, and metabolic prurigo are often associated with diabetes and often precede its diagnosis. We conducted a retrospective study on a group of 103 patients hospitalized between January 2018 and December 2022, in a clinic of a county hospital, using as criteria the diagnosis of diabetes mellitus complicated by cutaneous manifestations frequently associated with diabetes. The aim was to observe which are the most common manifestations and whether they correlate with data in the research literature. In the present study, manifestations such as diabetic foot (20% of patients), bacterial (35%) and fungal infections, and cutaneous xerosis (45%) were predominant. Often, the integumentary involvement may precede the diagnosis of the underlying disease. It is therefore very important to recognize, investigate and treat these manifestations as soon as possible.
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Affiliation(s)
- Dan Vâță
- Department of Dermatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (D.V.); (E.P.-A.); (B.-M.T.); (L.G.-S.)
- Dermatology Clinic, “St. Spiridon” Emergency County Hospital, 700106 Iasi, Romania
| | - Diana-Elena Stanciu
- Dermatology Clinic, “St. Spiridon” Emergency County Hospital, 700106 Iasi, Romania
| | - Doinița Temelie-Olinici
- Dermatology Clinic, “St. Spiridon” Emergency County Hospital, 700106 Iasi, Romania
- Department of Cell Biology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Elena Porumb-Andrese
- Department of Dermatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (D.V.); (E.P.-A.); (B.-M.T.); (L.G.-S.)
| | - Bogdan-Marian Tarcău
- Department of Dermatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (D.V.); (E.P.-A.); (B.-M.T.); (L.G.-S.)
- Dermatology Clinic, “St. Spiridon” Emergency County Hospital, 700106 Iasi, Romania
| | - Vasile-Bogdan Grecu
- Department of Cell Biology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Laura Gheucă-Solovăstru
- Department of Dermatology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (D.V.); (E.P.-A.); (B.-M.T.); (L.G.-S.)
- Dermatology Clinic, “St. Spiridon” Emergency County Hospital, 700106 Iasi, Romania
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Mooradian AD. Diabetes-related perturbations in the integrity of physiologic barriers. J Diabetes Complications 2023; 37:108552. [PMID: 37356233 DOI: 10.1016/j.jdiacomp.2023.108552] [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: 03/21/2023] [Revised: 06/19/2023] [Accepted: 06/19/2023] [Indexed: 06/27/2023]
Abstract
One of the hallmarks of health is the integrity of barriers at the cellular and tissue levels. The two cardinal functions of barriers include preventing access of deleterious elements of the environment (barrier function) while facilitating the transport of essential ions, signaling molecules and nutrients needed to maintain the internal milieu (transport function). There are several cellular and subcellular barriers and some of these barriers can be interrelated. The principal physiologic barriers include blood-retinal barrier, blood-brain barrier, blood-testis barrier, renal glomerular/tubular barrier, intestinal barrier, pulmonary blood-alveolar barrier, blood-placental barrier and skin barrier. Tissue specific barriers are the result of the vasculature, cellular composition of the tissue and extracellular matrix within the tissue. Uncontrolled diabetes and acute hyperglycemia may disrupt the integrity of physiologic barriers, primarily through altering the vascular integrity of the tissues and may well contribute to the clinically recognized complications of diabetes. Although diabetes is a systemic disease, some of the organs display clinically significant deterioration in function while others undergo subclinical changes. The pathophysiology of the disruption of these barriers is not entirely clear but it may be related to diabetes-related cellular stress. Understanding the mechanisms of diabetes related dysfunction of various physiologic barriers might help identifying novel therapeutic targets for reducing clinically significant complications of diabetes.
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Affiliation(s)
- Arshag D Mooradian
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Florida Jacksonville College of Medicine, Jacksonville, FL, USA.
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He Y, Li Z, Yu L, Liu Y, Li L, Yang R, Wang X, Gao S, Yu C. Association between the atherogenic index of plasma and carotid artery plaques in patients with coronary heart disease in different glucose metabolism states: an RCSCD-TCM study in Tianjin, China. Endocrine 2023:10.1007/s12020-023-03389-5. [PMID: 37231238 DOI: 10.1007/s12020-023-03389-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 04/26/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The atherogenic index of plasma (AIP) is considered a powerful biomarker of dyslipidemia and atherosclerosis (AS). However, limited evidence is available regarding the relationship between the AIP and carotid artery plaques (CAPs) in patients with coronary heart disease (CHD). METHODS This retrospective study included 9281 patients with CHD who underwent carotid ultrasound. Participants were divided according to the AIP tertiles: T1, AIP < 1.02; T2, 1.02 ≤ AIP < 1.25; and T3, AIP ≥ 1.25. The presence or absence of CAPs was assessed using carotid ultrasound. Logistic regression was used to analyze the relationship between the AIP and CAPs in patients with CHD. The relationship between the AIP and CAPs was assessed according to sex, age, and glucose metabolic status. RESULTS The baseline characteristics revealed significant differences in related parameters among patients with CHD after stratification into the three groups according to the AIP tertiles. Compared with T1, the odds ratio (OR) of T3 in patients with CHD was 1.53 (95% confidence interval [CI]:1.35-1.74). The association between AIP and CAPs was higher in females (OR: 1.63; 95% CI: 1.38-1.92) than in males (OR: 1.38; 95% CI: 1.12-1.70). The OR for patients aged ≤60 years (OR: 1.40; 95% CI: 1.14-1.71) was lower than that for patients aged >60 years (OR: 1.49; 95% CI: 1.26-1.76). AIP was significantly associated with the risk of CAPs formation in different glucose metabolic states, with diabetes having the highest OR value (OR: 1.31; 95% CI: 1.19-1.43). CONCLUSION The AIP and CAPs were significantly associated in patients with CHD, and the association was higher in female than in male patients. The association was lower in patients aged ≤60 years than in patients aged >60 years. Under different glucose metabolism statuses, the association between the AIP and the CAPs among patients with CHD was highest in patients with diabetes.
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Affiliation(s)
- Yuanyuan He
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Zhu Li
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Lu Yu
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Yijia Liu
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Lin Li
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Rongrong Yang
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China
| | - Xianliang Wang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Shan Gao
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China.
| | - Chunquan Yu
- Tianjin University of Traditional Chinese Medicine, 10 Poyanghu Road, West Area, Tuanbo New Town, Jinghai District, Tianjin, 301617, China.
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Hines A, Butterfield R, Boudreaux B, Bhullar P, Severson KJ, McBane RD, Davis MDP, Pittelkow MR, Mangold AR, Alavi A. Characteristics of ulcerated and non‐ulcerated necrobiosis lipoidica. Int J Dermatol 2022; 62:790-796. [PMID: 36479693 DOI: 10.1111/ijd.16529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/30/2022] [Accepted: 11/17/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Necrobiosis lipoidica (NL) is complicated by ulceration in up to 35% of cases. METHODS Retrospective study of patients with NL seen at our institution between January 1, 1992, and May 25, 2021, was conducted. Ulcerated NL (UNL, n = 83) and non-ulcerated NL (NUNL, n = 233) groups were compared. RESULTS Twenty-six percent (83/316) of patients with NL experienced ulceration. UNL was significantly more likely to be painful (52% vs. 36%, P = 0.01), was more likely to have a lesion-associated cutaneous malignancy (7% vs. 0%, P < 0.001), and had a larger median size (7 vs. 5 cm, P = 0.004) compared to NUNL. Vascular studies were performed on a subset of patients and revealed transcutaneous oxygen pressure (TcPO2) < 40 mm Hg in 53% and venous insufficiency in 62% with no significant differences between UNL and NUNL groups. In patients with unilateral ulceration, mean TcPO2 values (39.7 vs. 46.6 mm Hg), regional perfusion index <0.6 (29% vs. 14%), and TcPO2 < 40 mm Hg (43% vs. 14%) were worse in the ulcerated leg compared to the non-ulcerated leg, but these differences were not statistically significant. CONCLUSIONS UNL was more likely to be painful, develop lesion-associated malignancy, and be larger in size compared to NUNL. There were no statistically significant differences in venous insufficiency, arterial Doppler/ankle brachial index, or TcPO2 values between UNL and NUNL patients, however, a significant portion of the cohort demonstrated abnormal vascular studies, particularly on TcPO2 and venous insufficiency testing.
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Affiliation(s)
| | | | | | | | | | - Robert D. McBane
- Division of Vascular Medicine of Cardiovascular Diseases Mayo Clinic Rochester MN USA
| | | | | | | | - Afsaneh Alavi
- Department of Dermatology Mayo Clinic Rochester MN USA
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Shi Y, Lu J, Le N, Wang RK. Integrating a pressure sensor with an OCT handheld probe to facilitate imaging of microvascular information in skin tissue beds. BIOMEDICAL OPTICS EXPRESS 2022; 13:6153-6166. [PMID: 36733756 PMCID: PMC9872897 DOI: 10.1364/boe.473013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/22/2022] [Accepted: 10/23/2022] [Indexed: 05/05/2023]
Abstract
Optical coherence tomography (OCT) and OCT angiography (OCTA) have been increasingly applied in skin imaging applications in dermatology, where the imaging is often performed with the OCT probe in contact with the skin surface. However, this contact mode imaging can introduce uncontrollable mechanical stress applied to the skin, inevitably complicating the interpretation of OCT/OCTA imaging results. There remains a need for a strategy for assessing local pressure applied on the skin during imaging acquisition. This study reports a handheld scanning probe integrated with built-in pressure sensors, allowing the operator to control the mechanical stress applied to the skin in real-time. With real time feedback information, the operator can easily determine whether the pressure applied to the skin would affect the imaging quality so as to obtain repeatable and reliable OCTA images for a more accurate investigation of skin conditions. Using this probe, imaging of palm skin was used in this study to demonstrate how the OCTA imaging would have been affected by different mechanical pressures ranging from 0 to 69 kPa. The results showed that OCTA imaging is relatively stable when the pressure is less than 11 kPa, and within this range, the change of vascular area density calculated from the OCTA imaging is below 0.13%. In addition, the probe was used to augment the OCT monitoring of blood flow changes during a reactive hyperemia experiment, in which the operator could properly control the amount of pressure applied to the skin surface and achieve full release after compression stimulation.
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Affiliation(s)
- Yaping Shi
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
- These authors contributed equally to this study
| | - Jie Lu
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
- These authors contributed equally to this study
| | - Nhan Le
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
| | - Ruikang K. Wang
- Department of Bioengineering, University of Washington, Seattle, WA 98105, USA
- Department of Ophthalmology, University of Washington, Seattle, WA 98105, USA
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Abstract
The physical examination of the patient with diabetes may have revealed findings that confirm the diagnosis, classify the type of diabetes, and begin to evaluate for the macro- and microvascular complications of diabetes and significant comorbid conditions. While screening for the diagnosis of diabetes occurs with assessment for abnormal blood glucose, given the high rates of morbidity and mortality associated with diabetes, utilization of the physical examination plays a key role in identifying patients at risk for the complications of diabetes. The discussion of elements of the physical examination relevant to the patient with diabetes, both type 1 and type 2, will be discussed in this article.
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Affiliation(s)
- Aamir Malik
- Diabetes and Nutrition, Boston University School of Medicine/Boston Medical Center, Section of Endocrinology, Diabetes and Nutrition, 720 Harrison Avenue, DOB 8th Floor, Boston, MA 02118
| | - Sonia Ananthakrishnan
- Boston University School of Medicine/Boston Medical Center, Section of Endocrinology, Diabetes and Nutrition, 72 East Concord Street, Evans 122, Boston, MA, 02118.
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Cione E, Cannataro R, Gallelli L, De Sarro G, Caroleo MC. Exosome microRNAs in Metabolic Syndrome as Tools for the Early Monitoring of Diabetes and Possible Therapeutic Options. Pharmaceuticals (Basel) 2021; 14:ph14121257. [PMID: 34959658 PMCID: PMC8706321 DOI: 10.3390/ph14121257] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 02/07/2023] Open
Abstract
Exosomes are nano-sized extracellular vesicles produced and released by almost all cell types. They play an essential role in cell-cell communications by delivering cellular bioactive compounds such as functional proteins, metabolites, and nucleic acids, including microRNA, to recipient cells. Thus, they are involved in various physio-pathological conditions. Exosome-miRNAs are associated with numerous diseases, including type 2 diabetes, a complex multifactorial metabolic disorder linked to obesity. In addition, exosome-miRNAs are emerging as essential regulators in the progression of diabetes, principally for pancreatic β-cell injury and insulin resistance. Here, we have clustered the recent findings concerning exosome-miRNAs associated with β-cell dysfunction to provide a novel approach for the early diagnosis and therapy of diabetes.
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Affiliation(s)
- Erika Cione
- Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, CS, Italy;
- GalaScreen Laboratories, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, CS, Italy;
- Correspondence:
| | - Roberto Cannataro
- GalaScreen Laboratories, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, CS, Italy;
| | - Luca Gallelli
- Department of Health Science, University of Catanzaro and Operative Unit of Clinical Pharmacology and Pharmacovigilance, Mater Domini Hospital, 88100 Catanzaro, CZ, Italy; (L.G.); (G.D.S.)
| | - Giovambattista De Sarro
- Department of Health Science, University of Catanzaro and Operative Unit of Clinical Pharmacology and Pharmacovigilance, Mater Domini Hospital, 88100 Catanzaro, CZ, Italy; (L.G.); (G.D.S.)
| | - Maria Cristina Caroleo
- Department of Pharmacy, Health and Nutritional Sciences, Department of Excellence 2018-2022, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, CS, Italy;
- GalaScreen Laboratories, University of Calabria, Ed. Polifunzionale, Arcavacata di Rende, 87036 Rende, CS, Italy;
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Foti R, De Pasquale R, Dal Bosco Y, Visalli E, Amato G, Gangemi P, Foti R, Ramondetta A. Clinical and Histopathological Features of Scleroderma-like Disorders: An Update. Medicina (B Aires) 2021; 57:medicina57111275. [PMID: 34833493 PMCID: PMC8625286 DOI: 10.3390/medicina57111275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/10/2021] [Accepted: 11/18/2021] [Indexed: 11/25/2022] Open
Abstract
Scleroderma-like disorders include a set of entities involving cutis, subcutis and, sometimes, even muscular tissue, caused by several pathogenetic mechanisms responsible for different clinical–pathological pictures. The absence of antinuclear antibodies (ANA), Raynaud’s phenomenon and capillaroscopic anomalies constitutes an important element of differential diagnosis with systemic sclerosis. When scleroderma can be excluded, on the basis of the main body sites, clinical evolution, any associated pathological conditions and specific histological features, it is possible to make a correct diagnosis.
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Affiliation(s)
- Rosario Foti
- Division of Reumathology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy; (R.F.); (Y.D.B.); (E.V.); (G.A.)
| | - Rocco De Pasquale
- U.O. Dermatologia, Ospedale San Marco, 95123 Catania, Italy; (R.D.P.); (R.F.)
| | - Ylenia Dal Bosco
- Division of Reumathology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy; (R.F.); (Y.D.B.); (E.V.); (G.A.)
| | - Elisa Visalli
- Division of Reumathology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy; (R.F.); (Y.D.B.); (E.V.); (G.A.)
| | - Giorgio Amato
- Division of Reumathology, A.O.U. “Policlinico-San Marco”, 95123 Catania, Italy; (R.F.); (Y.D.B.); (E.V.); (G.A.)
| | - Pietro Gangemi
- U.O. Anatomia Patologica, Ospedale San Marco, 95123 Catania, Italy;
| | - Riccardo Foti
- U.O. Dermatologia, Ospedale San Marco, 95123 Catania, Italy; (R.D.P.); (R.F.)
| | - Alice Ramondetta
- U.O. Dermatologia, Ospedale San Marco, 95123 Catania, Italy; (R.D.P.); (R.F.)
- Correspondence: ; Tel.: +39-095-479-4298
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Cutaneous Manifestations of the Diabetic Foot. Clin Podiatr Med Surg 2021; 38:569-576. [PMID: 34538435 DOI: 10.1016/j.cpm.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Diabetes mellitus is one of the most common conditions that affects the US population and burdens the health care system. Knowledge of the skin conditions that may occur before diagnosis of diabetes mellitus is made or after the diagnosis is made is pertinent for the practitioner. This article reviews skin disorders found on the lower extremity that are associated with diabetes mellitus.
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14
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Abba S, Messager D, Mihoubi A, Adegas Vila Nova O, Vignes S. [Pigmented lesions of the lower legs]. Rev Med Interne 2021; 43:59-61. [PMID: 34217569 DOI: 10.1016/j.revmed.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 06/13/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Affiliation(s)
- S Abba
- Unité de lymphologie, Centre national de référence des maladies vasculaires rares (lymphœdème primaire, malformations lymphatiques), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - D Messager
- Service de nutrition, Hôpital Cognacq-Jay, 15 rue Eugène-Millon, 75015 Paris, France
| | - A Mihoubi
- Unité de lymphologie, Centre national de référence des maladies vasculaires rares (lymphœdème primaire, malformations lymphatiques), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - O Adegas Vila Nova
- Unité de lymphologie, Centre national de référence des maladies vasculaires rares (lymphœdème primaire, malformations lymphatiques), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France
| | - S Vignes
- Unité de lymphologie, Centre national de référence des maladies vasculaires rares (lymphœdème primaire, malformations lymphatiques), Hôpital Cognacq-Jay, 15, rue Eugène-Millon, 75015 Paris, France.
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15
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Abstract
Diabetes mellitus is a significant worldwide health concern and cutaneous manifestations are common. This review describes characteristic skin findings of diabetes, general skin findings related to diabetes, and findings related to diabetes treatment with a focus on clinical presentation, diagnosis, pathophysiology, epidemiology, and treatment. As the prevalence of diabetes continues to rise, cutaneous manifestations of diabetes mellitus likely will be encountered more frequently by physicians in all disciplines including dermatologists and primary care physicians. Accordingly, knowledge regarding the prevention, diagnosis, and management of cutaneous manifestations is an important aspect in the care of patients with diabetes.
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Affiliation(s)
- Alex Hines
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Afsaneh Alavi
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - Mark D P Davis
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.
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16
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Wang-Evers M, Casper MJ, Glahn J, Luo T, Doyle AE, Karasik D, Kim AC, Phothong W, Nathan NR, Heesakker T, Kositratna G, Manstein D. Assessing the impact of aging and blood pressure on dermal microvasculature by reactive hyperemia optical coherence tomography angiography. Sci Rep 2021; 11:13411. [PMID: 34183707 PMCID: PMC8238964 DOI: 10.1038/s41598-021-92712-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/14/2021] [Indexed: 12/12/2022] Open
Abstract
Visualization and quantification of the skin microvasculature are important for studying the health of the human microcirculation. We correlated structural and pathophysiological changes of the dermal capillary-level microvasculature with age and blood pressure by using the reactive hyperemia optical coherence tomography angiography (RH-OCT-A) technique and evaluated both conventional OCT-A and the RH-OCT-A method as non-invasive imaging alternatives to histopathology. This observational pilot study acquired OCT-A and RH-OCT-A images of the dermal microvasculature of 13 young and 12 old healthy Caucasian female subjects. Two skin biopsies were collected per subject for histological analysis. The dermal microvasculature in OCT-A, RH-OCT-A, and histological images were automatically quantified and significant indications of vessel rarefaction in both old subjects and subjects with high blood pressure were observed by RH-OCT-A and histopathology. We showed that an increase in dermal microvasculature perfusion in response to reactive hyperemia was significantly lower in high blood pressure subjects compared to normal blood pressure subjects (117% vs. 229%). These results demonstrate that RH-OCT-A imaging holds functional information of the microvasculature with respect to physiological factors such as age and blood pressure that may help to monitor early disease progression and assess overall vascular health. Additionally, our results suggest that RH-OCT-A images may serve as a non-invasive alternative to histopathology for vascular analysis.
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Affiliation(s)
- Michael Wang-Evers
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Malte J Casper
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Laboratory for Functional Optical Imaging, Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Joshua Glahn
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Tuanlian Luo
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Abigail E Doyle
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Karasik
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne C Kim
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Weeranut Phothong
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Dermatology, Siriraj Hospital, Mahidol University, BKK, Thailand
| | - Neera R Nathan
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tammy Heesakker
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Garuna Kositratna
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dieter Manstein
- Cutaneous Biology Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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He X, Kuang G, Wu Y, Ou C. Emerging roles of exosomal miRNAs in diabetes mellitus. Clin Transl Med 2021; 11:e468. [PMID: 34185424 PMCID: PMC8236118 DOI: 10.1002/ctm2.468] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022] Open
Abstract
Exosomes are small extracellular vesicles 40-160 nm in diameter that are secreted by almost all cell types. Exosomes can carry diverse cargo including RNA, DNA, lipids, proteins, and metabolites. Exosomes transfer substances and information between cells by circulating in body fluids and are thus involved in diverse physiological and pathological processes in the human body. Recent studies have closely associated exosomal microRNAs (miRNAs) with various human diseases, including diabetes mellitus (DM), which is a complex multifactorial metabolic disorder disease. Exosomal miRNAs are emerging as pivotal regulators in the progression of DM, mainly in terms of pancreatic β-cell injury and insulin resistance. Exosomal miRNAs are closely associated with DM-associated complications, such as diabetic retinopathy (DR), diabetic nephropathy (DN), and diabetic cardiomyopathy (DCM), etc. Further investigations of the mechanisms of action of exosomal miRNAs and their role in DM will be valuable for the thorough understanding of the physiopathological process of DM. Here, we have summarized recent findings regarding exosomal miRNAs associated with DM to provide a new strategy for identifying potential diagnostic biomarkers and drug targets for the early diagnosis and treatment, respectively, of DM.
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Affiliation(s)
- Xiaoyun He
- Department of Pathology, Xiangya HospitalCentral South UniversityChangshaHunan410008China
- Departments of Ultrasound Imaging, Xiangya HospitalCentral South UniversityChangshaHunan410008China
| | - Gaoyan Kuang
- Department of OrthopedicsThe First Affiliated Hospital of Hunan University of Chinese MedicineChangshaHunan410007China
- Postdoctoral Research WorkstationHinye Pharmaceutical Co. LtdChangshaHunan410331China
| | - Yongrong Wu
- Hunan university of Chinese MedicineChangshaHunan410208China
| | - Chunlin Ou
- Department of Pathology, Xiangya HospitalCentral South UniversityChangshaHunan410008China
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18
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Del Baldo F, Diana A, Canton C, Linta N, Chiocchetti R, Fracassi F. The Influence of Skin Thickness on Flash Glucose Monitoring System Accuracy in Dogs with Diabetes Mellitus. Animals (Basel) 2021; 11:ani11020408. [PMID: 33562672 PMCID: PMC7914766 DOI: 10.3390/ani11020408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/25/2021] [Accepted: 02/02/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary A flash glucose monitoring system (FGMS) has been validated for use in dogs with diabetes mellitus and diabetic ketoacidosis. It continuously measures the glucose in the interstitial fluid through a small filament (5 mm long) inserted under the skin. Interstitial glucose concentrations are reportedly comparable to whole blood glucose concentrations. However, several factors can influence the performance of interstitial sensors, including the proportion of interstitial fluid in a tissue. The influence of skin thickness on flash glucose monitoring system accuracy has not been investigated in previous studies; therefore, the aim of this study was to evaluate whether FGMS accuracy is affected by skin thickness. On the basis of our results, skin thickness seems to affect FGMS measurements; the mean bias was significantly inversely correlated (p = 0.02; r = −0.6) with the mean skin thickness, and clinical accuracy according to ISO 15197:2013 criteria was observed only in dogs with skin thickness > 5 mm, with 99% of the results falling in zone A + B of the Parkes consensus error grid analysis. In dogs with thin skin (<5 mm), the clinical accuracy was low, and the results should be interpreted with caution. Abstract A flash glucose monitoring system (FGMS) has been validated for use in diabetic dogs. However, it is unknown whether skin thickness affects FGMS measurements. The aim of this study was to evaluate whether FGMS accuracy is affected by skin thickness. Fourteen client-owned diabetic dogs on insulin treatment were prospectively enrolled in the study. The dogs were divided into two groups according to their ultrasound-measured skin thickness: dogs with skin thickness < 5 mm (Group 1) and dogs with skin thickness > 5 mm (Group 2). On days 1, 7 and 14, glucose curves were obtained simultaneously using the FGMS and a validated portable blood glucose meter. Paired measurements were used to calculate the mean bias and to determine accuracy according to ISO 15197:2013 criteria. The mean bias was significantly inversely correlated (p = 0.02; r = −0.6) with the mean skin thickness. Clinical accuracy was observed only in Group 2, with 99% of the results in zone A + B of the Parkes consensus error grid analysis. In conclusion, skin thickness seems to affect FGMS measurements, and the device is accurate in dogs with thicker skin (>5 mm); in dogs with thin skin (<5 mm), the clinical accuracy is low, and the results should be interpreted with caution.
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19
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Burgmann J, Biester T, Grothaus J, Kordonouri O, Ott H. Pediatric diabetes and skin disease (PeDiSkin): A cross-sectional study in 369 children, adolescents and young adults with type 1 diabetes. Pediatr Diabetes 2020; 21:1556-1565. [PMID: 32985057 DOI: 10.1111/pedi.13130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/19/2020] [Accepted: 09/10/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The spectrum of skin disorders in children with type 1 diabetes (T1D) and their impact on affected persons are still incompletely understood. This study assessed the prevalence of skin diseases, cutaneous complications associated with T1D treatment and skin-related quality of life (QoL) in young T1D persons. METHODS Participation in this interdisciplinary, single-center, cross-sectional, observational study was offered to all persons with T1D ≤20 years. Participants were characterized by a detailed medical history, routine laboratory workup, thorough clinical examinations and an established QoL questionnaire. RESULTS Three hundred and sixty-nine persons were recruited (55% male; age 12.3 ± 4.4 years; HbA1c 7.4 ± 1.0%; mean ± SD). Continuous subcutaneous insulin infusion (CSII) was used by 72.4%, multiple daily injections (MDI) by 27.6% and continuous glucose monitoring (CGM) by 76%. Skin affections occurred in 91.8% of the study population. Device-associated lesions were most prevalent, including lipohypertrophy in 42.2% of MDI and 46.8% of CGM users and contact eczema associated with CSII or CGM in 14.2% and 18.3%, respectively. Diabetes-associated skin disorders and skin infections were rare or absent. Skin-related QoL impairment was low or absent in 95% of patients. CONCLUSIONS Skin diseases have a high prevalence and a broad spectrum in young persons with T1D. Eczematous reactions to CSII and CGM devices represent the most frequent skin complications. This highlights the need for regular skin checkups as an integral part of pediatric diabetes consultations and interdisciplinary cooperation for classification and treatment options.
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Affiliation(s)
- Johanna Burgmann
- Division of Pediatric Dermatology and Allergology, Children's Hospital AUF DER BULT, Hannover, Germany
| | - Torben Biester
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - Julia Grothaus
- Division of Pediatric Dermatology and Allergology, Children's Hospital AUF DER BULT, Hannover, Germany
| | - Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - Hagen Ott
- Division of Pediatric Dermatology and Allergology, Children's Hospital AUF DER BULT, Hannover, Germany
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20
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Trihan JE, Lanéelle D, Metcalfe N, Perez Martin A, Frances P. Diabetes-associated dermatological manifestations in primary care and their association with vascular complications. J Diabetes Metab Disord 2020; 19:989-996. [PMID: 33520817 PMCID: PMC7843712 DOI: 10.1007/s40200-020-00594-1] [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: 04/16/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although type 2 diabetes mellitus (DM) is a global public health problem, the diabetes-associated dermatological (non-infectious) manifestations (DADM) remain poorly understood and under-diagnosed. We aimed to evaluate the prevalence of 7 known DADM in a primary care setting, and their association macro/microvascular complications. METHODS Cross-sectionnal study included patients consulting in general practice for DM-follow up, from November 2016 to January 2017. Patients aged <18 years old or consulting for other reason than DM follow up were excluded. Each patient were screened for diabetic dermopathy (DD), Huntley's papules (HP), necrobiosis lipoidica diabeticorum (NL), acanthosis nigricans (AN), cheiroarthropathy (CA, or stiff hand syndrom), scleredema adultorum of Buschke (SB) and bullosis diabeticorum (BD). RESULTS 213 diabetic patients were included over a period of 3 months. We found a prevalence of 17.8% (38 patients) for DD, 8.5% (18) for HP, 2.8% (6) for NL, 2.3% (5) for AN, 1.9% (4) for CA, 1.4% (3) for SB and 1.4% (3) for BD. DADM seems to be a risk factor for vascular complications (OR 1.97, p ≤ 0.001). Association with vascular involvement was stronger with DD and macroangiopathy (OR 1.86, p ≤ 0.001), and with NL and microangiopathy (OR 9.7, p ≤ 0.001). CONCLUSION In primary care, DM-associated dermatological manifestations present similar prevalence rates to a tertiary care setting, based on litterature. Complete dermatological examination of diabetic patients is essential and could lead to a better overall management of the pathology, as diabetic cutaneous manifestations appear as a sign of vascular involvement.
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Affiliation(s)
- Jean-Eudes Trihan
- Vascular Medicine Department, University Hospital, 86000 Poitiers, France
| | - Damien Lanéelle
- Vascular Medicine Department, University Hospital, 14000 Caen, France
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Majtner T, Nadimi ES, Yderstræde KB, Blanes-Vidal V. Non-invasive detection of diabetic complications via pattern analysis of temporal facial colour variations. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2020; 196:105619. [PMID: 32603987 DOI: 10.1016/j.cmpb.2020.105619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND AND OBJECTIVE Diabetes mellitus is a common disorder amounting to 400 million patients worldwide. It is often accompanied by a number of complications, including neuropathy, nephropathy, and cardiovascular diseases. For example, peripheral neuropathy is present among 20-30% of diabetics before the diagnosis is substantiated. For this reason, a reliable detection method for diabetic complications is crucial and attracts a lot of research attention. METHODS In this paper, we introduce a non-invasive detection framework for patients with diabetic complications that only requires short video recordings of faces from a standard commercial camera. We employed multiple image processing and pattern recognition techniques to process video frames, extract relevant information, and predict the health status. To evaluate our framework, we collected a dataset of 114 video files from diabetic patients, who were diagnosed with diabetes for years and 60 video files from the control group. Extracted features from videos were tested using two conceptually different classifiers. RESULTS We found that our proposed framework correctly identifies patients with diabetic complications with 92.86% accuracy, 100% sensitivity, and 80% specificity. CONCLUSIONS Our study brings a novel perspective on diagnosis procedures in this field. We used multiple techniques from image processing, pattern recognition, and machine learning to robustly process video frames and predict the health status of our subjects with high efficiency.
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Affiliation(s)
- Tomáš Majtner
- Group of Applied AI and Data Science, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark.
| | - Esmaeil S Nadimi
- Group of Applied AI and Data Science, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
| | | | - Victoria Blanes-Vidal
- Group of Applied AI and Data Science, The Maersk Mc-Kinney Moller Institute, University of Southern Denmark, Odense, Denmark
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Crizón-Díaz DP, Morales-Cardona CA. Manifestaciones dermatológicas de la diabetes: clasificación y diagnóstico. IATREIA 2020. [DOI: 10.17533/udea.iatreia.58] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Se estima que en Colombia hay 2.836.500 adultos con diabetes, una enfermedad con una prevalencia del 8,4 %. La exposición a niveles elevados de glucosa afecta los procesos de proliferación y diferenciación en las células de todos los órganos y tejidos, así mismo en los queratinocitos, fibroblastos y demás células presentes en la piel, alteraciones que ocurren en más de un tercio de los diabéticos y que pueden ser la manifestación inicial de la enfermedad. La frecuencia y presentación de estas dermatosis varía según la población estudiada. La dermopatía diabética, la acantosis nigricans, los fibromas laxos, el prurito y la xerosis son las formas más comunes y se consideran marcadores cutáneos de la diabetes. La presente revisión se enfoca en las manifestaciones dermatológicas específicas y no específicas de la diabetes, así como en las relacionadas con su tratamiento. Estas pueden ser un reflejo del estado metabólico actual o previo del paciente diabético y su oportuna identificación permite orientar el diagnóstico primario, sospechar un estado rediabético u optimizar el tratamiento de la enfermedad en los individuos ya diagnosticados.
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Varjú C, Kumánovics G, Czirják L, Matucci-Cerinic M, Minier T. Sclerodermalike syndromes: Great imitators. Clin Dermatol 2019; 38:235-249. [PMID: 32513403 DOI: 10.1016/j.clindermatol.2019.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sclerodermalike syndromes (SLSs) comprise diseases with mucin deposition (eg, scleromyxedema, scleredema), with eosinophilia (eg, eosinophilic fasciitis), metabolic or biochemical abnormalities (eg, nephrogenic systemic fibrosis), or endocrine disorders (eg, POEMS syndrome, or polyneuropathy, organomegaly, endocrinopathy, monoclonal lymphoproliferative disorder, and hypothyroidism). Chronic graft-versus-host disease may also show sclerodermalike skin changes. Inherited progeria syndromes with early aging (eg, Werner syndrome) and a heterogeneous group of hereditary disorders with either skin thickening (eg, stiff skin syndrome) or atrophy and tightening (eg, acrogeria) can also imitate classic systemic sclerosis (SSc). In addition, SLSs can be provoked by several drugs, chemicals, or even physical injury (eg, trauma, vibration stress, radiation). In SLSs, the distribution of skin involvement seems to be atypical compared with SSc. The acral skin involvement is usually missing, and lack of Raynaud phenomenon, scleroderma-specific antinuclear antibodies, the absence of scleroderma capillary pattern, and internal organ manifestations indicate the presence of an SLS. Skin involvement is sometimes nodular, and the underlying tissues can also be affected. For the differential diagnosis, a skin biopsy of the deeper layers including fascia and muscle is required. Histology does not always allow differentiation between SSc and SLSs; therefore, the diagnosis is often based on the distribution, quality of cutaneous involvement, and other accompanying clinical features.
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Affiliation(s)
- Cecília Varjú
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | - Gábor Kumánovics
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Florence, Italy
| | - Tünde Minier
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary.
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Pannu AK, Suryadevara V. Image Diagnosis: Bullosis Diabeticorum. Perm J 2019; 23:19.042. [PMID: 31634117 DOI: 10.7812/tpp/19.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ashok Kumar Pannu
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Varun Suryadevara
- Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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25
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Prevalence Study of Dermatologic Manifestations among Diabetic Patients. Adv Prev Med 2019; 2019:5293193. [PMID: 31355008 PMCID: PMC6634127 DOI: 10.1155/2019/5293193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/19/2019] [Accepted: 02/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background Diabetes mellitus (DM) is an interdisciplinary disorder that needs many different specialties' attention; however, the importance of dermatologists' knowledge has not been highlighted regarding this issue. As a result, we aim to assess the prevalence and variety of DM skin and nail manifestations in an effort to further acquaint dermatologists and other clinicians with diabetic dermatologic manifestations. Methods This was a cross-sectional study; subjects who had a diagnosis of DM, attending to the outpatient endocrinology clinics of Rassoul Akram Hospital, Tehran, Iran, were evaluated by one dermatologist for diabetic dermopathy. The results were recorded in prepared data sheets, and general descriptions of DM duration, DM type, DM control, and drug history as well as the demographic data were gathered. Results Among a total of 255 subjects, the prevalence of one or more identifiable skin conditions was 88.4%. 15.7% of the subjects had nail manifestations. Among cutaneous manifestations, acanthosis nigricans, acral erythema, and onychoschizia showed a significant relationship with the age and disease duration (p<0.05); and knuckle pebbles, eczema, facial erythema, and koilonychias had a meaningful relationship with FBS level and glycated hemoglobin, HbA1c (p<0.05). Conclusion This study provides an overview that facilitates earlier detection and treatment of DM. Also, this data can help physicians and endocrinologists to visualize DM control level.
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26
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Nørgaard K, Kielgast U. Quality of Life is Markedly Impaired by Rheumatological and Skin Manifestations in Patients with Type 1 Diabetes: A Questionnaire Survey. Diabetes Ther 2019; 10:635-647. [PMID: 30778903 PMCID: PMC6437232 DOI: 10.1007/s13300-019-0587-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To estimate lifetime prevalence of diabetes-related upper limb and non-acquired skin manifestations in a representative type 1 diabetes (T1D) population and to identify associations between these conditions and quality of life. METHODS A questionnaire on these complications and measures of quality of life (World Health Organization-Five Well-Being Index [WHO-5]), depression, and diabetes-specific burden (Problem Areas in Diabetes [PAID] scale) was sent to all T1D patients in a Danish clinic (N = 583). RESULTS The response rate was 68.6%. Lifetime prevalence of any upper limb soft tissue lesion was 72%; prevalence of any skin lesion was 10.5%. Frozen shoulder and vitiligo were most common upper limb and skin manifestation, at a prevalence of 53 and 9.1%, respectively. Compared to patients with no skin lesion, those with at least one skin lesion had more depression (19 vs. 33%; P < 0.01) and lower WHO-5 scores. Frozen shoulder was associated with lower WHO-5 scores (P < 0.001), more depression (29 vs. 14%; P < 0.001), and a higher PAID score (P < 0.01). A diagnosis of carpal tunnel syndrome was associated with lower WHO-5 scores (P < 0.001), a higher risk of depression (29 vs. 16%; P < 0.01), and a higher PAID score (P < 0.001). CONCLUSION Upper limb soft tissue lesions and diabetes-specific non-acquired skin lesions are very common in patients with T1D and strongly associated with impaired life quality and increased risk of depression.
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Affiliation(s)
- Kirsten Nørgaard
- Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.
| | - Urd Kielgast
- Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Zealand University Hospital, Køge, Denmark
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27
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ÖZTÜRK AM, TAŞBAKAN MI, METIN DY, YENER C, UYSAL S, YILDIRIM ŞIMŞIR I, ERTAM İ, PULLUKÇU H, ARDA B, ÇETINKALP S. A neglected causative agent in diabetic foot infection: a retrospective evaluation of 13 patients with fungal etiology. Turk J Med Sci 2019; 49:81-86. [PMID: 30761877 PMCID: PMC7350845 DOI: 10.3906/sag-1809-74] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background/aim Clinicians often neglect fungal infections and do not routinely investigate deep tissue from the wound for fungal culture and sensitivity due to insufficient information in the literature. In this study, we aimed to evaluate fungal etiology of invasive fungal diabetic foot which is rarely reported in the literature. Materials and methods The patients who were unresponsive to antibiotic therapy and those with positive fungal in bone or deep tissue culture were enrolled in the study. Detailed hospital records were retrieved for demographics and clinical features. Results A total of 13 patients who were diagnosed with invasive fungal diabetic foot (ten females, three males, mean age 59.8 ± 9 years) were included. All of the patients had type-2 diabetes mellitus. Eleven (84.6%) patients had mixed infection. The most common cause of fungal infections of diabetic foot ulcers was the Candida species. Ten (76.9%) patients underwent amputation, two (15.4%) patients refused amputation, and one patient died before surgery. Conclusion Invasive fungal infections may also be a causative pathogen in deep tissue infections. Therefore, fungal pathogens should be considered in patients unresponsive to long-term antibiotic therapy. Early detection of fungal infections in high-risk individuals is critical for the prevention of severe consequences such as foot amputation.
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Affiliation(s)
- Anıl Murat ÖZTÜRK
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, İzmirTurkey
| | - Meltem Işıkgöz TAŞBAKAN
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Ege University, İzmirTurkey
- * To whom correspondence should be addressed. E-mail:
| | - Dilek Yeşim METIN
- Department of Clinical Microbiology, Faculty of Medicine, Ege University, İzmirTurkey
| | - Can YENER
- Department of Orthopedics and Traumatology, Faculty of Medicine, Ege University, İzmirTurkey
| | - Serhat UYSAL
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Ege University, İzmirTurkey
- Department of Clinical Microbiology and Infectious Diseases, Kanuni Training and Research Hospital, TrabzonTurkey
| | - Ilgın YILDIRIM ŞIMŞIR
- Division of Endocrinology, Department of Internal Diseases, Faculty of Medicine, Ege University, İzmirTurkey
| | - İlgen ERTAM
- Department of Dermatology, Faculty of Medicine, Ege University, İzmirTurkey
| | - Hüsnü PULLUKÇU
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Ege University, İzmirTurkey
| | - Bilgin ARDA
- Department of Clinical Microbiology and Infectious Diseases, Faculty of Medicine, Ege University, İzmirTurkey
| | - Sevki ÇETINKALP
- Division of Endocrinology, Department of Internal Diseases, Faculty of Medicine, Ege University, İzmirTurkey
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Blanes-Vidal V, Majtner T, Avendaño-Valencia LD, Yderstraede KB, Nadimi ES. Invisible Color Variations of Facial Erythema: A Novel Early Marker for Diabetic Complications? J Diabetes Res 2019; 2019:4583895. [PMID: 31565656 PMCID: PMC6745171 DOI: 10.1155/2019/4583895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 07/09/2019] [Indexed: 01/28/2023] Open
Abstract
AIM (1) To quantify the invisible variations of facial erythema that occur as the blood flows in and out of the face of diabetic patients, during the blood pulse wave using an innovative image processing method, on videos recorded with a conventional digital camera and (2) to determine whether this "unveiled" facial red coloration and its periodic variations present specific characteristics in diabetic patients different from those in control subjects. METHODS We video recorded the faces of 20 diabetic patients with peripheral neuropathy, retinopathy, and/or nephropathy and 10 nondiabetic control subjects, using a Canon EOS camera, for 240 s. Only one participant presented visible facial erythema. We applied novel image processing methods to make the facial redness and its variations visible and automatically detected and extracted the redness intensity of eight facial patches, from each frame. We compared average and standard deviations of redness in the two groups using t-tests. RESULTS Facial redness varies, imperceptibly and periodically, between redder and paler, following the heart pulsation. This variation is consistently and significantly larger in diabetic patients compared to controls (p value < 0.001). CONCLUSIONS Our study and its results (i.e., larger variations of facial redness with the heartbeats in diabetic patients) are unprecedented. One limitation is the sample size. Confirmation in a larger study would ground the development of a noninvasive cost-effective automatic tool for early detection of diabetic complications, based on measuring invisible redness variations, by image processing of facial videos captured at home with the patient's smartphone.
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Affiliation(s)
- Victoria Blanes-Vidal
- Group of Machine Learning, Data Science and Artificial Intelligence, Embodied Systems for Robotics and Learning (ESRL), The Mærsk Mc-Kinney Møller Institute, University of Southern Denmark, Denmark
- Center for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Tomas Majtner
- Group of Machine Learning, Data Science and Artificial Intelligence, Embodied Systems for Robotics and Learning (ESRL), The Mærsk Mc-Kinney Møller Institute, University of Southern Denmark, Denmark
| | - Luis David Avendaño-Valencia
- Group of Machine Learning, Data Science and Artificial Intelligence, Embodied Systems for Robotics and Learning (ESRL), The Mærsk Mc-Kinney Møller Institute, University of Southern Denmark, Denmark
| | - Knud B. Yderstraede
- Center for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Steno Diabetes Center, Odense University Hospital, Denmark
- University of Southern Denmark, Denmark
| | - Esmaeil S. Nadimi
- Group of Machine Learning, Data Science and Artificial Intelligence, Embodied Systems for Robotics and Learning (ESRL), The Mærsk Mc-Kinney Møller Institute, University of Southern Denmark, Denmark
- Center for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
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Clinical, radiological, and histological characteristics of Chinese type 2 diabetic patients with diabetic scleredema: an observational study. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0705-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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30
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Ionescu-Tirgoviste C, Gagniuc PA, Gagniuc E. The electrical activity map of the human skin indicates strong differences between normal and diabetic individuals: A gateway to onset prevention. Biosens Bioelectron 2018; 120:188-194. [DOI: 10.1016/j.bios.2018.08.057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 01/09/2023]
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31
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Parodi A, Castello M, Corbetta S, Cordera R, Cristaudo A, Cucchia R, Guazzoni V, Leuzzi M, Mussini A, Patrizi A, Pigatto P, Regazzini R, Rizzo D, Stingeni L, Zichichi L. Skin and diabetes: an experts' opinion from the Italian diabetologists and dermatologists of the DiaDex group. GIORN ITAL DERMAT V 2018; 153:649-658. [DOI: 10.23736/s0392-0488.18.06080-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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32
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Pitts SI, Maruthur NM, Langley GE, Pondo T, Shutt KA, Hollick R, Schrag SJ, Thomas A, Nichols M, Farley M, Watt JP, Miller L, Schaffner W, Holtzman C, Harrison LH. Obesity, Diabetes, and the Risk of Invasive Group B Streptococcal Disease in Nonpregnant Adults in the United States. Open Forum Infect Dis 2018; 5:ofy030. [PMID: 29977953 PMCID: PMC6016410 DOI: 10.1093/ofid/ofy030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/22/2017] [Accepted: 04/24/2018] [Indexed: 02/06/2023] Open
Abstract
Background Rates of invasive group B Streptococcus (GBS) disease, obesity, and diabetes have increased in US adults. We hypothesized that obesity would be independently associated with an increased risk of invasive GBS disease. Methods We identified adults with invasive GBS disease within Active Bacterial Core surveillance during 2010–2012 and used population estimates from the Behavioral Risk Factor Surveillance System to calculate invasive GBS incidence rates. We estimated relative risks (RRs) of invasive GBS using Poisson analysis with offset denominators, with obesity categorized as class I/II (body mass index [BMI] = 30–39.9 kg/m2) and class III (BMI ≥ 40.0 kg/m2). Results In multivariable analysis of 4281 cases, the adjusted RRs of invasive GBS disease were increased for obesity (class I/II: RR, 1.52; 95% confidence interval [CI], 1.14–2.02; and class III: RR, 4.87; 95% CI, 3.50–6.77; reference overweight) and diabetes (RR, 6.04; 95% CI, 4.77–7.65). The adjusted RR associated with class III obesity was 3-fold among persons with diabetes (95% CI, 1.38–6.61) and nearly 9-fold among persons without diabetes (95% CI, 6.41–12.46), compared with overweight. The adjusted RRs associated with diabetes varied by age and BMI, with the highest RR in young populations without obesity. Population attributable risks of invasive GBS disease were 27.2% for obesity and 40.1% for diabetes. Conclusions Obesity and diabetes were associated with substantially increased risk of infection from invasive GBS. Given the population attributable risks of obesity and diabetes, interventions that reduce the prevalence of these conditions would likely reduce the burden of invasive GBS infection.
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Affiliation(s)
- Samantha I Pitts
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nisa M Maruthur
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | - Gayle E Langley
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tracy Pondo
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen A Shutt
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rosemary Hollick
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Stephanie J Schrag
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ann Thomas
- Oregon Public Health Division, Portland, Oregon
| | - Megin Nichols
- New Mexico Department of Public Health, Santa Fe, New Mexico
| | | | - James P Watt
- California Department of Public Health, Richmond, California
| | - Lisa Miller
- University of Colorado School of Public Health, Aurora, Colorado
| | | | | | - Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, University of Pittsburgh, Pittsburgh, Pennsylvania.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Kaae J, Philipsen PA, Wulf HC. Photodynamic therapy of necrobiosis lipoidica using methyl aminolevulinate: A retrospective follow-up study. Photodiagnosis Photodyn Ther 2018; 22:223-226. [DOI: 10.1016/j.pdpdt.2018.04.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 03/27/2018] [Accepted: 04/25/2018] [Indexed: 11/27/2022]
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Ozlu E, Uzuncakmak TK, Takır M, Akdeniz N, Karadag AS. Comparison of cutaneous manifestations in diabetic and nondiabetic obese patients: A prospective, controlled study. North Clin Istanb 2018; 5:114-119. [PMID: 30374476 PMCID: PMC6191549 DOI: 10.14744/nci.2017.68553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 12/21/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Obesity is known to be a risk factor for many diseases including dermatological problems. Here, we aimed to determine the cutaneous manifestations in obese patients and the frequency of the accompanying dermatoses and to investigate the effect of diabetes mellitus in obese patients on cutaneous manifestations compared with the control group. METHODS Our study included a total of 600 adults: 450 obese volunteers and 150 healthy volunteers. The number of diabetic obese patients was 138 (30%), whereas that of nondiabetic obese patients was 312 (70%). A detailed dermatological examination was performed for each case, and accompanying dermatoses were compared. RESULTS The mean body mass index (BMI) in the obese patients and control group was 37.22 kg/m2 and 22.23 kg/m2, respectively. The most common dermatoses in the obese patients were, according to their frequency: striae distensae (291 patients, 64.7%), acrochordon (236 patients, 52.4%), acanthosis nigricans (213 patients, 47.3%), plantar hyperkeratosis (209 patients, 46.4%), and venous insufficiency (202 patients, 44.9%). Although hirsutism was more frequently observed in the nondiabetic obese group than in the diabetic obese group, stasis dermatitis was less frequently observed (p<0.05). CONCLUSION We found that many dermatoses are more frequently observed in the obese patients than in the controls. We observed that the effect of obesity on skin is different from that of diabetes mellitus and that cutaneous manifestations of obesity occur more frequently. More extensive, comprehensive, and advanced studies on this subject are required.
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Affiliation(s)
- Emin Ozlu
- Department of Dermatology, Faculty of Medicine, Duzce University, Duzce, Turkey
| | - Tugba Kevser Uzuncakmak
- Department of Dermatology, Istanbul Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Mumtaz Takır
- Department of Endocrinology and Metabolism, Istanbul Medeniyet University, Istanbul, Turkey
| | - Necmettin Akdeniz
- Department of Dermatology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayse Serap Karadag
- Department of Dermatology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
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Korbel L, Easterling RS, Punja N, Spencer JD. The burden of common infections in children and adolescents with diabetes mellitus: A Pediatric Health Information System study. Pediatr Diabetes 2018; 19:512-519. [PMID: 29094435 DOI: 10.1111/pedi.12594] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/19/2017] [Accepted: 09/19/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People with diabetes mellitus (DM) have increased infection risk. The healthcare utilization of pediatric and adolescent diabetic patients with infection is not well defined. This study evaluates the number of pediatric and adolescent patients with DM that seek medical treatment for infection management and assesses its socioeconomic impact. METHODS A retrospective analysis was performed using the Pediatric Health Information System (PHIS) database on children and adolescents with DM who presented to the Emergency Department (ED) or were hospitalized for infection management from 2008 to 2014. The PHIS database collects admission, demographic, and economic data from 44 freestanding children's hospitals across the United States. RESULTS In total, 123 599 diabetic patient encounters were identified (77% type 1 DM, 23% type 2 DM). ED visits and hospitalizations for type 1 DM and type 2 DM increased throughout the study period. Total charges for these encounters were greater than $250 million dollars per year and increased each year. Infection encounters make up more than 30% of that cost while accounting for only 14% of the visits. Respiratory infections were the most common type of infection followed by skin and soft tissue infections for both ED care and inpatient hospitalizations. Patients with infections had longer hospital length of stay and higher cost per day than those without infections. CONCLUSIONS Children and adolescents with type 1 and type 2 DM commonly present to the ED and require hospitalization for infection evaluation and management. Encounters with infection make up a large proportion of a growing economic burden on the United States' healthcare system. As the prevalence of DM grows, this burden can be expected to become even more significant. Cost-effective strategies for the prevention of infection in pediatric patients with DM are needed.
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Affiliation(s)
- Lindsey Korbel
- Pediatrics Residency Program, Nationwide Children's Hospital, Columbus, Ohio
| | - Robert S Easterling
- College of Medicine and Life Sciences, The University of Toledo, Toledo, Ohio.,Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Nidhi Punja
- Data Resource Center, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - John David Spencer
- Center for Clinical and Translational Research, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Division of Nephrology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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37
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Moazzami B, Razavi N, Babaei M, Haghparast M, Bayani MA. The association between Solar Lentigines and Type-2 Diabetes. CASPIAN JOURNAL OF INTERNAL MEDICINE 2017; 8:317-320. [PMID: 29201325 PMCID: PMC5686313 DOI: 10.22088/cjim.8.4.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Limited information exists between the associations of diabetes mellitus (DM) and solar lentigo (SL); a benign, common skin lesion characterized by hyperpigmented macules. Methods This study was conducted on 90 patients diagnosed with DM and their age and sex matched controls who were referred to the Departments of Endocrinology at Babol University of Medical Science in Northern of Iran from January 2013 to December 2015. All demographic data including age, gender, occupation, family history of DM, estimated average sun exposure and presence of skin lesions were collected and analyzed. Results Presence of SL was significantly higher among patients with DM compared to controls (61.9% vs 33.6%, P<0.001). After adjusting for age, sex and sun exposure rate, results indicated that DM was independently associated with the presence of SL (p=0.002). Stratifying patients based on gender, indicated that DM was significantly associated with SL in females (p=0.03), but not in male patients (p=0.06). Conclusion The findings of the present study indicate that DM is an independent risk factor for the occurrence of SL lesions. These findings could represent a novel association between DM as a chronic oxidation state and SL as an early sign of aging.
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Affiliation(s)
- Bobak Moazzami
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran.,Department of Rheumatology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Niloofar Razavi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Mansour Babaei
- Department of Rheumatology, Ayatollah Rouhani Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Motahareh Haghparast
- Department of Internal Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mohammad Ali Bayani
- Department of Internal Medicine, Babol University of Medical Sciences, Babol, Iran
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Karadag AS, Ozlu E, Lavery MJ. Cutaneous manifestations of diabetes mellitus and the metabolic syndrome. Clin Dermatol 2017; 36:89-93. [PMID: 29241758 DOI: 10.1016/j.clindermatol.2017.09.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Metabolic diseases are commonly encountered in the Western world. Cutaneous manifestations are common in metabolic disorders, such as diabetes mellitus (DM) and the metabolic syndrome (MetS), and metabolic diseases may manifest with specific skin findings. MetS and DM share a common mechanism in their etiopathogenesis. As a result, the skin findings associated with these two diseases partially overlap. Several skin findings in DM and MetS may be the first clinical features of the disease, and early diagnosis facilitates treatment, thereby helping in preventing long-term complications. In this review, MetS and skin manifestations associated with DM are discussed.
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Affiliation(s)
- Ayse Serap Karadag
- Department of Dermatology, Istanbul Medeniyet University, School of Medicine, Istanbul, Turkey.
| | - Emin Ozlu
- Department of Dermatology, Duzce University, School of Medicine, Duzce, Turkey
| | - Michael Joseph Lavery
- Department of Dermatology, St James' Hospital, Trinity College Dublin, Dublin, Ireland
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Raiesi O, Siavash M, Mohammadi F, Chabavizadeh J, Mahaki B, Maherolnaghsh M, Dehghan P. Frequency of Cutaneous Fungal Infections and Azole Resistance of the Isolates in Patients with Diabetes Mellitus. Adv Biomed Res 2017. [PMID: 28626746 PMCID: PMC5468785 DOI: 10.4103/2277-9175.191003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Diabetic patients are more susceptible to cutaneous fungal infections. The higher blood sugar levels cause increasing the cutaneous fungal infections in these patients. The main objective of this study was to find the frequency of fungal infections among cutaneous lesions of diabetic patients and to investigate azole antifungal agent susceptibility of the isolates. Materials and Methods: In this study, type 1diabetes (n = 78) and type 2 diabetes (n = 44) comprised 47 cases (38.5%) with diabetic foot ulcers and 75 cases (61.5%) with skin and nail lesions were studied. Fungal infection was confirmed by direct examination and culture methods. Antifungal susceptibility testing by broth microdilution method was performed according to the CLSI M27-A and M38-A references. Results: Out of 122 diabetic patients, thirty (24.5%) were affected with fungal infections. Frequency of fungal infection was 19.1% in patients with diabetic foot ulcer and 28% of patients with skin and nail lesions. Candida albicans and Aspergillus flavus were the most common species isolated from thirty patients with fungal infection, respectively. Susceptibility testing carried out on 18 representative isolates (13 C. albicans, five C. glabrata) revealed that 12 isolates (10 C. albicans and two C. glabrata isolates) (66.6%) were resistant (minimum inhibitory concentration [MIC] ≥64 mg/ml) to fluconazole (FCZ). Likewise, eight isolates (80%) of Aspergillus spp. were resistant (MIC ≥4 mg/ml), to itraconazole. Conclusion: Our finding expands current knowledge about the frequency of fungal infections in diabetic patients. We noted the high prevalence of FCZ-resistant Candida spp., particularly in diabetic foot ulcers. More attention is important in diabetic centers about this neglected issue.
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Affiliation(s)
- Omid Raiesi
- Department of Mycology and Parasitology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mansour Siavash
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Faezeh Mohammadi
- Department of Mycology and Parasitology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Javaher Chabavizadeh
- Department of Mycology and Parasitology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Mahaki
- Department of Biostatistics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehrnoush Maherolnaghsh
- Department of Mycology and Parasitology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvin Dehghan
- Department of Mycology and Parasitology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Muller KE, Schwartzman JD, Seidel GD. Subcutaneous dirofilariasis: a masquerade of a palisaded granulomatous dermatitis. J Cutan Pathol 2017; 44:373-375. [DOI: 10.1111/cup.12874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/28/2016] [Accepted: 12/13/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Kristen E. Muller
- Department of PathologyDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | | | - Gregory D. Seidel
- Department of PathologyDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
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Hammer E, Lilienthal E, Hofer SE, Schulz S, Bollow E, Holl RW. Risk factors for necrobiosis lipoidica in Type 1 diabetes mellitus. Diabet Med 2017; 34:86-92. [PMID: 27101431 DOI: 10.1111/dme.13138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 10/21/2022]
Abstract
AIMS To compare the clinical and metabolic characteristics of patients with Type 1 diabetes and necrobiosis lipoidica with those of patients with Type 1 diabetes who do not have necrobiosis lipoidica. A multicentre analysis was performed. METHODS Clinical and laboratory data were obtained from 64 133 patients (aged 0-25 years) with Type 1 diabetes with and without necrobiosis lipoidica who were registered in the German/Austrian Diabetes Prospective Documentation Initiative registry. Data were analysed using multivariable regression modelling. Age, diabetes duration, treatment year and sex were considered as confounding factors. RESULTS Results adjusted for demographic variables are presented. In patients with necrobiosis lipoidica, metabolic control was worse (HbA1c 72 vs. 67 mmol/mol, 8.7% vs. 8.3%; P = 0.0065) and the duration of diabetes was longer [6.24 (3.28-9.97) vs. 5.11 (2.08-8.83) years; P = 0.014; not adjusted]. Patients with necrobiosis lipoidica required higher insulin doses than those without (1.02 vs. 0.92 U/kg/day; P < 0.0001). There was no significant difference in the frequency of microvascular complications (microalbuminuria and retinopathy) between the groups. Furthermore, 24.8% and 17.5% of patients with Type 1 diabetes with and without necrobiosis lipoidica, respectively, had elevated thyroid antibodies (P = 0.051). Necrobiosis lipoidica was correlated with coeliac disease in patients with Type 1 diabetes (3.4% vs. 1.0%; P = 0.0035). CONCLUSIONS Our data indicate a strong correlation between hyperglycaemia and the development of necrobiosis lipoidica. We postulate that the underlying pathogenic processes differ from those leading to microalbuminuria and retinopathy, and additional immunological mechanisms may play a role.
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Affiliation(s)
- E Hammer
- Department of Paediatrics, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany
| | - E Lilienthal
- Department of Paediatrics, University of Bochum, Bochum, Germany
| | - S E Hofer
- Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - S Schulz
- Department of Paediatrics, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany
| | - E Bollow
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
- German Centre for Diabetes Research (DZD), Neuherberg, Germany
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Ng HY. Acanthosis nigricans in obese adolescents: prevalence, impact, and management challenges. Adolesc Health Med Ther 2016; 8:1-10. [PMID: 28031729 PMCID: PMC5179206 DOI: 10.2147/ahmt.s103396] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Obesity in adolescence is a public health priority because it usually tracks into adulthood, resulting in enormous medical and social costs. This underscores the importance of early identification and intervention. Acanthosis nigricans (AN) was once considered a rare paraneoplastic dermatosis, but is now frequently observed in obese adolescents. Current understanding suggests that it is associated with insulin resistance and has a unique role in secondary prevention. The purpose of this narrative review is to provide a comprehensive overview of AN in obese adolescents, covering its history, current knowledge on the condition, its clinical significance, management challenges, and the direction of future research.
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Affiliation(s)
- Hak Yung Ng
- Department of Paediatrics and Adolescent Medicine, Tseung Kwan O Hospital, Tseung Kwan O, Hong Kong, China
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Skin Manifestations of Insulin Resistance: From a Biochemical Stance to a Clinical Diagnosis and Management. Dermatol Ther (Heidelb) 2016; 7:37-51. [PMID: 27921251 PMCID: PMC5336429 DOI: 10.1007/s13555-016-0160-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Indexed: 12/18/2022] Open
Abstract
Worldwide, more than 1.9 billion adults are overweight, and around 600 million people suffer from obesity. Similarly, ~382 million individuals live with diabetes, and 40–50% of the global population is labeled at “high risk” (i.e., prediabetes). The impact of these two chronic conditions relies not only on the burden of illnesses per se (i.e., associated increased morbidity and mortality), but also on their increased cost, burden of treatment, and decreased health-related quality of life. For this review a comprehensive search in several databases including PubMed (MEDLINE), Ovid EMBASE, Web of Science, and Scopus was conducted. In both diabetes and obesity, genetic, epigenetic, and environmental factors overlap and are inclusive rather than exclusive. De facto, 70–80% of the patients with obesity and virtually every patient with type 2 diabetes have insulin resistance. Insulin resistance is a well-known pathophysiologic factor in the development of type 2 diabetes, characteristically appearing years before its diagnosis. The gold standard for insulin resistance diagnosis (the euglycemic insulin clamp) is a complex, invasive, costly, and hence unfeasible test to implement in clinical practice. Likewise, laboratory measures and derived indexes [e.g., homeostasis model assessment of insulin resistance (HOMA-IR-)] are indirect, imprecise, and not highly accurate and reproducible tests. However, skin manifestations of insulin resistance (e.g., acrochordons, acanthosis nigricans, androgenetic alopecia, acne, hirsutism) offer a reliable, straightforward, and real-time way to detect insulin resistance. The objective of this review is to aid clinicians in recognizing skin manifestations of insulin resistance. Diagnosing these skin manifestations accurately may cascade positively in the patient’s health by triggering an adequate metabolic evaluation, a timely treatment or referral with the ultimate objective of decreasing diabetes and obesity burden, and improving the health and the quality of care for these patients.
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Arsanjani Shirazi A, Nasiri M, Yazdanpanah L. Dermatological and musculoskeletal assessment of diabetic foot: A narrative review. Diabetes Metab Syndr 2016; 10:S158-S164. [PMID: 27016885 DOI: 10.1016/j.dsx.2016.03.004] [Citation(s) in RCA: 9] [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: 02/18/2016] [Accepted: 03/05/2016] [Indexed: 01/11/2023]
Abstract
AIMS Diabetic Foot Syndrome (DFS) is the most costly and devastating complication of diabetes mellitus (DM), which early effective assessment can reduce the severity of complications including ulceration and amputations. This study aimed to review dermatological and musculoskeletal assessment of diabetic foot. MATERIALS AND METHODS In this review article, we searched for articles published between March 1, 1980 and July 28, 2015 in PubMed, Science Direct, Embase, Web of Science, and Scopus, for both English and non-English language articles with the following keywords: "Diabetic foot syndrome", "Ulceration", "Amputation", "Foot assessment", "Skin disorders" and "Musculoskeletal deformities". RESULTS In dermatological dimension, most studies focused on elucidated changes in skin temperature, color, hardiness and turgor as well as common skin disorders such as Diabetic Dermopathy (DD), Necrobiosis Lipoidica Diabeticorum (NLD) and Diabetic Bullae (DB), which are common in diabetic patients and have high potential for leading to limb-threatening problems such as ulceration and infection. In musculoskeletal dimension, most studies focused on range of motion and muscle strength, gait patterns and as well as foot deformities especially Charcot osteoarthropathy (COA), which is the most destructive musculoskeletal complication of diabetes. CONCLUSION DFS as a common condition in DM patients lead to ulceration and lower limb amputation frequently unless a prompt and comprehensive assessment was taken. So that dermatological and musculoskeletal assessments are usually neglected in primary health care, these assessments should be done frequently to reduce the high risk of serious complications.
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Affiliation(s)
- Azam Arsanjani Shirazi
- Department of Midwifery, Nursing and Midwifery School, Dezful Islamic Azad University, Khouzastan, Iran.
| | - Morteza Nasiri
- Department of Operating Room, Paramedical School, Qom University of Medical Sciences, Qom, Iran.
| | - Leila Yazdanpanah
- Health Research Institute, Diabetes Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Rinkevich Y, Maan ZN, Walmsley GG, Sen SK. Injuries to appendage extremities and digit tips: A clinical and cellular update. Dev Dyn 2016; 244:641-50. [PMID: 25715837 DOI: 10.1002/dvdy.24265] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/12/2015] [Accepted: 02/16/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The regrowth of amputated appendage extremities and the distal tips of digits represent models of tissue regeneration in multiple vertebrate taxa. In humans, digit tip injuries, including traumatic amputation and crush injuries, are among the most common type of injury to the human hand. Despite clinical reports demonstrating natural regeneration of appendages in lower vertebrates and human digits, current treatment options are suboptimal, and are complicated by the anatomical complexities and functions of the different tissues within the digits. RESULTS In light of these challenges, we focus on recent advancements in understanding appendage regeneration from model organisms. We pay special attention to the cellular programs underlying appendage regeneration, where cumulative data from salamanders, fish, frogs, and mice indicate that regeneration occurs by the actions of lineage-restricted precursors. We focus on pathologic states and the interdependency that exists, in both humans and animal models, between the nail organ and the peripheral nerves for successful regeneration. CONCLUSIONS The increased understanding of regeneration in animal models may open new opportunities for basic and translational research aimed at understanding the mechanisms that support limb regeneration, as well as amelioration of limb abnormalities and pathologies.
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Affiliation(s)
- Yuval Rinkevich
- Institute for Stem Cell Biology and Regenerative Medicine, Departments of Pathology and Developmental Biology, Stanford University School of Medicine, Stanford, California
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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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Purim KSM, Titski ACK, Leite N. Dermatological aspects influencing the practice of physical activities by obese individuals. FISIOTERAPIA EM MOVIMENTO 2015. [DOI: 10.1590/0103-5150.028.004.ar02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective : The aim of this study was to perform a systematic review of the major skin diseases affecting obese individuals and their influence on physical activity. Methods : Relevant articles were identified by systematically searching PubMed from 2000 to 2014, using the descriptors "skin diseases" and "obesity", "skin disease" and "obesity", "skin diseases" and "physical activity", "skin disease" and "physical activity". The PEDro Scale (in Brazilian Portuguese) was used to rate the methodological quality of the studies. Results : A total of 320 articles were examined in the first phase. In the end, 11 articles met the proposed criteria and were included for analysis in the systematic review. We investigated cutaneous manifestations of diseases and classified them according to their effects under 5 categories: metabolic (n = 10), aesthetic (n = 7), inflammatory (n = 6), mechanical (n = 5) and infectious (n = 3). The most frequent dermatoses among obese were acanthosis nigricans, acrochordon (skin tags), stretch marks, plantar keratodermia, intertrigo, bacterial and fungal infections. Acanthosis nigricans was found to be the most important metabolic implication of obesity. Conclusion : Although neglected, skin lesions are common in obesity and have implications for physical activity because they cause pain, discomfort, friction, infection, inflammation, embarrassment, limitation or difficulty of movement. Strategies to promote skin health may result in a better integration of physical activity into routine therapy and improve the quality of life of obese individuals.
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van Drielen K, Gunn D, Griffiths C, Griffiths T, Ogden S, Noordam R, Slagboom P, van Heemst D, de Craen A. Markers of health and disease and pigmented spots in a middle-aged population. Br J Dermatol 2015. [DOI: 10.1111/bjd.14051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K. van Drielen
- Department of Gerontology and Geriatrics; Leiden University Medical Center; PO Box 9600 2300 RC Leiden the Netherlands
| | - D.A. Gunn
- Unilever R&D; Sharnbrook Bedfordshire U.K
- Netherlands Consortium of Healthy Aging (NCHA); Leiden the Netherlands
| | - C.E.M. Griffiths
- Dermatology Centre; Salford Royal Hospital; University of Manchester; Manchester Academic Health Science Centre; Manchester U.K
| | - T.W. Griffiths
- Dermatology Centre; Salford Royal Hospital; University of Manchester; Manchester Academic Health Science Centre; Manchester U.K
| | - S. Ogden
- Dermatology Centre; Salford Royal Hospital; University of Manchester; Manchester Academic Health Science Centre; Manchester U.K
| | - R. Noordam
- Department of Gerontology and Geriatrics; Leiden University Medical Center; PO Box 9600 2300 RC Leiden the Netherlands
| | - P.E. Slagboom
- Netherlands Consortium of Healthy Aging (NCHA); Leiden the Netherlands
- Section of Molecular Epidemiology; Department of Medical Statistics and Bioinformatics; Leiden University Medical Center; PO Box 9600 2300 RC Leiden the Netherlands
| | - D. van Heemst
- Department of Gerontology and Geriatrics; Leiden University Medical Center; PO Box 9600 2300 RC Leiden the Netherlands
- Netherlands Consortium of Healthy Aging (NCHA); Leiden the Netherlands
| | - A.J.M. de Craen
- Department of Gerontology and Geriatrics; Leiden University Medical Center; PO Box 9600 2300 RC Leiden the Netherlands
- Netherlands Consortium of Healthy Aging (NCHA); Leiden the Netherlands
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Shrestha B, Neopane AK, Panth R. Scleredema--an uncommon cause of swelling in a child--a case report and review of the literature. BMC Res Notes 2014; 7:571. [PMID: 25159854 PMCID: PMC4153942 DOI: 10.1186/1756-0500-7-571] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 08/22/2014] [Indexed: 11/16/2022] Open
Abstract
Background Body swelling in a child is a common symptom. Apart from systemic causes like renal, hepatic, and cardiac, rarely such a swelling may be caused by dermatologic conditions. Case presentation A child presented with swelling of the body which was subsequently diagnosed as scleredema, a rare and benign dermatologic condition. Scleredema can be confused with similar sounding terms like scleroderma and scleromyxedema. Conclusions The case is presented to highlight scleredema as a rare cause of body swelling in paediatrics and to differentiate it from similar sounding rare terms like scleroderma and scleromyxedema.
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Affiliation(s)
- Bikash Shrestha
- Department of Paediatrics, Nepalese Army Institute of Health Sciences, Shree Birendra Hospital, Swayambhu, Chhauni, Kathmandu, Nepal.
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Renoprotective effect of atorvastatin on STZ-diabetic rats through attenuating kidney-associated dysmetabolism. Eur J Pharmacol 2014; 740:9-14. [PMID: 25008071 DOI: 10.1016/j.ejphar.2014.06.055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 06/21/2014] [Accepted: 06/23/2014] [Indexed: 11/20/2022]
Abstract
Atorvastatin (AT) has been alternatively used for managing diabetic complications in clinic. However, AT-related therapeutic potentiality remains relatively unexplored, especially in diabetic nephropathy. This study aimed to investigate the underlying potentiality that AT exerted on anti-diabetic nephropathy role against streptozotocin (STZ)-induced kidney injury in rats. STZ-diabetic rats were intragastrically administered with AT (10, 20 mg/kg/d) for consecutive 8 weeks. The effects of AT on body weight, levels of blood glucose, lipometabolism, redox state, cellular metabolism, regulator factor and kidney morphological changes were monitored by routine measurement, biochemistry assay, PT-PCR analysis, ultrastructural and pathological observations, respectively. Compared with the diabetic nephropathy rats, AT elevated the body weight of diabetic nephropathy rats (P<0.01), effectively reduced the blood glucose level (P<0.01), increased the levels of insulin and high-density lipoprotein cholesterol (HDL-C) in plasma (P<0.01), and decreased the 24 h urine protein content and serum concentrations of low-density lipoprotein cholesterol (LDL-C) (P<0.01). Meanwhile, increase in kidney tissue, the intrarenal activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were enhanced, while the malonaldehyde (MDA) content was reduced (P<0.01). In addition, the expression of transforming growth factor beta 1 (TGF-β1) mRNA in kidney tissue was notably down-regulated (P<0.01). Furthermore, AT contributed to alleviating STZ-induced nephritic damages in rats. These results demonstrate that atorvastatin exerts the effective protective role against kidney injuries of STZ-induced diabetic nephropathy rat, which the underlying mechanisms are associated with ameliorating glyco, lipometabolism, enhancing antioxidant ability, and mitigating renal damage.
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