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Viswanathan V, Gupta A, Devarajan A, Kumpatla S, Shukla S, Agarwal S, Makkar BM, Saboo B, Kumar V, Sahay RK. Early screening for foot problems in people with diabetes is the need of the hour: 'Save the Feet and Keep Walking Campaign' in India. BMJ Open Diabetes Res Care 2024; 12:e004064. [PMID: 39097296 PMCID: PMC11298753 DOI: 10.1136/bmjdrc-2024-004064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/27/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Evidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk (HR) feet in people with diabetes across India. RESEARCH DESIGN AND METHODS A cross-sectional national-level project 'Save the Feet and Keep Walking' campaign was conducted by the Research Society for the Study of Diabetes in India (RSSDI) from July 10, 2022 to August 10, 2022. A modified version of 3 min foot examination was used to assess the foot problems. Around 10 000 doctors with RSSDI membership were trained online to conduct foot screening and provided a standardised monofilament for detection of loss of protective sensation. People with diabetes aged >18 years who visited the clinics during the study period were examined for foot problems. Data were collected online using the semi-structured questionnaire. A total of 33 259 participants with complete information were included for the final analysis. The foot at risk was categorised based on International Working Group on the Diabetic Foot guidelines 2023. RESULTS Nearly 75% of the participants were aged above 45 years. Around 49% had diabetes duration >5 years and uncontrolled diabetes (hemoglobin A1c >8%). Presence of history of foot ulcer (20%), lower limb amputation (15.3%), foot deformities (24.5%) and absence of diminished dorsal pedis and posterior tibial pulses (26.4%) was noted in the study participants. Around 25.2% of them had HR feet and highly prevalent among males. Diabetic kidney and retinal complications were present in 70% and 75.5% of people with HR feet. Presence of heel fissures (OR (95% CI) 4.6 (4.2 to 5.1)) and callus or corns (OR (95% CI) 3.6 (3.3 to 4.0)) were significantly associated with HR feet. CONCLUSIONS One-fourth of people with diabetes were found to have HR feet in India. The findings are suggestive of regular screening of people with diabetes for foot problems and strengthening of primary healthcare.
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Affiliation(s)
- Vijay Viswanathan
- M V Hospital for Diabetes and Professor M Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu, India
| | - Amit Gupta
- Centre for Diabetes Care, Greater Noida, Uttar Pradesh, India
| | - Arutselvi Devarajan
- M V Hospital for Diabetes and Professor M Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu, India
| | - Satyavani Kumpatla
- M V Hospital for Diabetes and Professor M Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu, India
| | | | - Sanjay Agarwal
- Department of Diabetes, Aegle Clinic—Diabetes Care, Pune, Maharashtra, India
- Department of Medicine & Diabetes, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | - Banshi Saboo
- Diabetes Care and Hormone Clinic, Ahmedabad, India
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Oe M, Jais S, Sari N, Sanada H, Sasongko A, Haryanto H. Effects of diabetes-related foot ulcer depth on healing days, cost, and quality of life: A prospective observational study. Health Sci Rep 2024; 7:e2273. [PMID: 39114131 PMCID: PMC11303261 DOI: 10.1002/hsr2.2273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 06/28/2024] [Accepted: 07/16/2024] [Indexed: 08/10/2024] Open
Abstract
The relationship between the depth of the diabetes-related foot ulcers, and the healing days, cost, and QOL was examined.Depth 4 and 5 ulcers, namely beyond the tendons, exhibited significantly longer healing days and higher costs than Depth 2 and 3 ulcers. As for QOL, there were no significant differences in utility values between the depth categories.Results on healing time and cost reiterate the importance of early consultation, especially before the depth becomes deeper than the tendon.
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Affiliation(s)
- Makoto Oe
- Department of Nursing, School of Health Sciences, College of Medical, Pharmaceutical and Health SciencesInstitute of Medical, Pharmaceutical and Health Sciences, Kanazawa UniversityKanazawaIshikawaJapan
| | - Suriadi Jais
- Department of Medical Surgical NursingInstitut Teknologi dan Kesehatan Muhamamdiyah Kalimantan BaratPontianakIndonesia
| | - Nurmila Sari
- Depertment of Clinical NursingDoktor Soedarso HospitalPontianakIndonesia
| | - Hiromi Sanada
- Department of Nursing SciencesIshikawa Prefectural Nursing UniversityIshikawaJapan
| | - Agung Sasongko
- Department of Information SystemsUniversitas Bina Sarana InformatikaPontianakIndonesia
| | - Haryanto Haryanto
- Department of Medical Surgical NursingInstitut Teknologi dan Kesehatan Muhamamdiyah Kalimantan BaratPontianakIndonesia
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Sloan G, Dela Pena P, Andag-Silva A, Cunanan E, Jimeno C, Robles JJ, Tesfaye S. Sheffield One-Stop Service: A potential model to improve the screening uptake of diabetic peripheral neuropathy and other microvascular complications of diabetes. J Diabetes Investig 2024. [PMID: 39037334 DOI: 10.1111/jdi.14268] [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: 06/14/2024] [Revised: 06/28/2024] [Accepted: 07/03/2024] [Indexed: 07/23/2024] Open
Abstract
The world is experiencing an enormous rise in the prevalence of diabetes, which is associated with massive healthcare costs that threaten to overwhelm many healthcare systems. Most of the diabetes expenditure is attributed to the management of chronic diabetes complications, including diabetic peripheral neuropathy (DPN)/diabetic foot complications, chronic kidney disease, sight-threatening retinopathy and cardiovascular diseases. Of these complications, the most overlooked is DPN. Most consultations around the world do not even involve taking off shoes and socks to carry out a foot examination, and even when carried out, the peripheral neurological examination using the 10-g monofilament diagnoses DPN when it is already at an advanced stage. Thus, all too often diabetes complications are diagnosed late, resulting in devastating outcomes, particularly in low- to middle-income countries. There is, therefore, an urgent need to instigate new strategies to improve microvascular screening uptake using a holistic protocol for annual diabetes health checks outside the busy diabetes clinic. One such approach, the Sheffield One-Stop Microvascular Screening Service, which involves modern point of care devices to diagnose DPN, has been shown to be feasible and effective, resulting in high uptake and early management of diabetes complications. This article outlines the advantages of this One-Stop Microvascular Screening Service and a plan to trial an adapted version of this service to a resource-limited country, the Philippines. If successful, this model has the potential for implementation in other countries around the world.
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Affiliation(s)
- Gordon Sloan
- Division of Clinical Medicine, University of Sheffield, Sheffield, UK
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Pepito Dela Pena
- Section of Endocrinology, Diabetes and Metabolism, East Avenue Medical Center, Quezon City, Philippines
| | - Aimee Andag-Silva
- Section of Endocrinology and Diabetes, De La Salle University Medical Center, Cavite, Philippines
| | - Elaine Cunanan
- Section of Endocrinology, Diabetes and Metabolism, University of St. Tomas Hospital, Manila, Philippines
| | - Cecilia Jimeno
- Section of Endocrinology, Diabetes and Metabolism, University of the Philippines, Philippine General Hospital, Manila, Philippines
| | - Jeremy Jones Robles
- Section of Endocrinology, Diabetes and Metabolism, Chong Hua Hospital, Cebu, Philippines
| | - Solomon Tesfaye
- Diabetes Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Ren Y, Wang H, Song X, Wu Y, Lyu Y, Zeng W. Advancements in diabetic foot insoles: a comprehensive review of design, manufacturing, and performance evaluation. Front Bioeng Biotechnol 2024; 12:1394758. [PMID: 39076210 PMCID: PMC11284111 DOI: 10.3389/fbioe.2024.1394758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/24/2024] [Indexed: 07/31/2024] Open
Abstract
The escalating prevalence of diabetes has accentuated the significance of addressing the associated diabetic foot problem as a major public health concern. Effectively offloading plantar pressure stands out as a crucial factor in preventing diabetic foot complications. This review comprehensively examines the design, manufacturing, and evaluation strategies employed in the development of diabetic foot insoles. Furthermore, it offers innovative insights and guidance for enhancing their performance and facilitating clinical applications. Insoles designed with total contact customization, utilizing softer and highly absorbent materials, as well as incorporating elliptical porous structures or triply periodic minimal surface structures, prove to be more adept at preventing diabetic foot complications. Fused Deposition Modeling is commonly employed for manufacturing; however, due to limitations in printing complex structures, Selective Laser Sintering is recommended for intricate insole designs. Preceding clinical implementation, in silico and in vitro testing methodologies play a crucial role in thoroughly evaluating the pressure-offloading efficacy of these insoles. Future research directions include advancing inverse design through machine learning, exploring topology optimization for lightweight solutions, integrating flexible sensor configurations, and innovating new skin-like materials tailored for diabetic foot insoles. These endeavors aim to further propel the development and effectiveness of diabetic foot management strategies. Future research avenues should explore inverse design methodologies based on machine learning, topology optimization for lightweight structures, the integration of flexible sensors, and the development of novel skin-like materials specifically tailored for diabetic foot insoles. Advancements in these areas hold promise for further enhancing the effectiveness and applicability of diabetic foot prevention measures.
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Affiliation(s)
- Yuanfei Ren
- The First Department of Hand and Foot Surgery, Central Hospital of Dalian University of Technology, Dalian, China
| | - Hao Wang
- Department of Engineering Mechanics, School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
| | - Xiaoshuang Song
- Department of Engineering Mechanics, School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
| | - Yanli Wu
- Department of Engineering Mechanics, School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
| | - Yongtao Lyu
- Department of Engineering Mechanics, School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
- DUT-BSU Joint Institute, Dalian University of Technology, Dalian, China
| | - Wei Zeng
- Department of Mechanical Engineering, New York Institute of Technology, New York, NY, United States
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Lopes GSG, Landeiro MJL, Maciel T, Sousa MRMGCD. Clinical practice guidelines of foot care practice for patients with type 2 diabetes: A scoping review using self-care model. Contemp Nurse 2024:1-21. [PMID: 38831701 DOI: 10.1080/10376178.2024.2362289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Type 2 diabetes can lead to severe foot complications, making self-care education, guided by clinical guidelines, crucial. However, fragmented and dispersed recommendations challenge effective implementation of these guidelines. Bringing together recommendations and presenting them according to a self-care model can provide a solid framework and facilitate the interpretation of results. AIMS to map the international guidelines that provide recommendations to nurses to enable people with type 2 diabetes for foot self-care and synthesize the recommendations according to the key concepts of the middle-range theory of self-care for chronic diseases. DESIGN A scoping review was undertaken, using the methodological guidance of the Joanna Briggs Institute. DATA SOURCES Databases were searched between September 2022 and June 2023, including PubMed, CINAHL, PsycINFO, Scopus, Web of Science Core Collection, ProQuest Dissertations and Theses Global, guideline websites and related professional association websites. The databases were chosen for their comprehensive coverage of the area. METHODS Eligible articles included guidance documents providing foot care recommendations for diabetes, published or updated between 2013 and 2023. Two reviewers summarized the recommendations presented in at least two guidelines according to the key concepts of the self-care model. The PRISMA-ScR checklist was used. RESULTS Seventeen guidelines were included. In total, we synthesized 175 recommendations. The recommendations were framed in three dimensions and their respective categories: Self-care maintenance (education for prevention, control of risk factors, daily foot care, footwear, and socks), Self-care monitoring (foot inspection, detection of signs of infection, and detection of other diabetes-related foot disease complications), and Self-care management (responses to signs and symptoms, foot wound care, follow-up with health professionals, and health services). CONCLUSIONS The main aspect of foot care revolves around daily care, including cleaning, moisturizing, nail care, selecting appropriate footwear, and regular inspection of both feet and footwear.
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Affiliation(s)
- Geysa Santos Góis Lopes
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- CINTESIS@RISE NursID, Porto, Portugal
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Gormley S, Hart O, French S, O'Shea C, Khashram M. The use of fetal bovine acellular dermal matrix in severe diabetic foot ulceration and threatened limbs with tissue loss the use of FBADM as an adjunct for complex wounds. Vascular 2024; 32:619-625. [PMID: 36415107 DOI: 10.1177/17085381221141115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVES Foot ulceration associated with diabetic foot disease (DFD) and chronic limb-threatening ischaemia (CLTI) presents a complex clinical challenge and failure to heal the wound imposes a significant risk of major limb amputation (MLA). In attempt to accelerate wound healing rates and decrease MLA, tissue engineering research into bio-engineered scaffolds and skin substitutes has become a growing area of interest. Advanced wound therapies such as fetal bovine acellular dermal matrix (FBADM) may have success in the treatment of difficult to heal chronic foot ulcers. The FBADM traps and binds the patients' own epithelial cells to rebuild the dermis layer of the skin. Previous studies have suggested that wounds treated with FBADM had a faster healing rate than wounds managed with conventional dressings. However, these studies excluded foot wounds with chronic exposed bone or tendon, active infection, gangrene, or osteomyelitis and patients with uncontrolled blood glucose levels were excluded. The aim of this study was to assess the efficacy of FBADM for patients admitted to hospital acutely with severe foot ulceration secondary to DFD and CLTI. METHODS Between February 2020 and December 2021, inpatients admitted acutely at a single tertiary centre with a severe non-healing foot ulcer and had a wound suitable for application of a FBADM after primary debridement were included in the study. A severe non-healing foot wound was defined as a Society for Vascular Surgery Wound, Ischaemia, and foot Infection (WIfI) stage of 3 or 4. Participants were prospectively followed up at regular intervals at a multidisciplinary high-risk diabetic foot clinic until June 2022. The primary endpoint was time to wound closure. The secondary endpoints were number of applications of FBADM, readmission rate and amputation-free survival. RESULTS There were 22 patients included in the study with a median age of 71 (50-87) years and 15 were male. Five patients had a WIfI stage of 3 and 17 had a WIfI score of 4. Overall, 14 patients required revascularisation procedures (6 open surgery,8 endovascular intervention). A total of 18 patients achieved complete wound healing with a median time to wound healing of 178 (28-397) days. Two patients underwent a MLA and two patients died prior to complete wound healing. The median length of stay was 16.5 (5-115) days, and 4 patients were readmitted to hospital within 12 months. CONCLUSION FBADM may be a useful adjunct in the acute setting of complex DFD and CLTI ulceration to assist with wound healing. Future comparative prospective studies are required to further validate these preliminary findings.
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Affiliation(s)
- Sinead Gormley
- Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
- Faculty of Medical & Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Odette Hart
- Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Stephen French
- Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Claire O'Shea
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Manar Khashram
- Department of Vascular & Endovascular Surgery, Waikato Hospital, Hamilton, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
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Sanpinit S, Chokpaisarn J, Na-Phatthalung P, Sotthibandhu DS, Yincharoen K, Wetchakul P, Limsuwan S, Chusri S. Effectiveness of Ya-Samarn-Phlae in diabetic wound healing: Evidence from in vitro studies and a multicenter randomized controlled clinical trial. JOURNAL OF ETHNOPHARMACOLOGY 2024; 326:117929. [PMID: 38373661 DOI: 10.1016/j.jep.2024.117929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/29/2023] [Accepted: 02/16/2024] [Indexed: 02/21/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Ya-Samarn-Phlae (YaSP) has traditionally been widely used in southern Thailand for treating chronic and infected wounds, including diabetic foot ulcers. However, there are only a limited number of clinical studies supporting the use of this polyherbal formulation. Therefore, the present work aims to provide clinical evidence to support the application of YaSP, prepared according to a standardized traditional procedure (T-YaSP). Additionally, its potential chemical markers and wound healing-related biological activities were examined. MATERIALS AND METHODS The in vitro wound healing-related biological activities of YaSP ethanol extract and T-YaSP, including antibacterial activity against Staphylococcus epidermidis, inhibition and eradication of staphylococcal biofilm, anti-inflammatory effects, and enhancement of human dermal fibroblast migration in scratch wounds, were examined using well-established protocols. The chemical profiles of the ethanol extract of YaSP and T-YaSP were compared, and with promising chemical markers, arecoline, alpha-mangostin, and curcumin were selected and quantified using the HPLC method. A prospective, multicenter, randomized, controlled, parallel-group study was conducted over 12 weeks to evaluate the efficacy of the YaSP solution as an adjunct therapy, combined with standard wound care, for diabetic ulcers compared to standard treatment. RESULTS The YaSP extract reduces NO production and can scavenge NO radicals in LPS-induced RAW 264.7 macrophage cells. Additionally, in a scratch assay, this extract and one of its herbal components, Curcuma longa, enhance the migration of human dermal fibroblasts. T-YaSP, containing 2.412 ± 0.002 mg/g of arecoline, 2.399 ± 0.005 mg/g of curcumin, and 0.017 ± 0.000 mg/g of α-mangostin, has shown the ability to inhibit the development and eradicate the mature biofilm of S. epidermidis. The use of T-YaSP as an adjunct therapy led to a significantly higher proportion of patients achieving healing within six weeks compared to the standard treatment group (36%/9 patients vs. 4%/1 patient; p = 0.013). After 12 weeks, 19 out of 25 patients in the T-YaSP group experienced complete healing, whereas only four patients in the standard treatment group achieved complete wound healing (76% in the T-YaSP group vs. 16% in the control group; p < 0.001). CONCLUSION The results presented here represent the first randomized controlled trial to demonstrate the effectiveness of the traditional polyherbal solution, T-YaSP, which exhibits a wide range of wound healing-related activities. Utilizing T-YaSP as an adjunctive treatment resulted in a significant improvement in the number of type 2 diabetic patients achieving complete healing. However, to explore and utilize YaSP further, conducting a double-blind, randomized controlled trial with a larger population is necessary.
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Affiliation(s)
- Sineenart Sanpinit
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, 80160, Thailand
| | - Julalak Chokpaisarn
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
| | - Pinanong Na-Phatthalung
- The Second Affiliated Hospital, The First Affiliated Hospital, School of Public Health, Institute of Translational Medicine, Cancer Center, State Key Laboratory of Experimental Hematology, Zhejiang University School of Medicine, Hangzhou, 310058, China
| | | | - Kanyatorn Yincharoen
- Department of Thai Traditional Medicine, Faculty of Science and Technology, Rajamangala University of Technology Srivijaya (RMUTSV), Thung Song, Nakhon Si Thammarat, 80110, Thailand
| | - Palika Wetchakul
- School of Medicine, Walailak University, Thasala, Nakhon Si Thammarat, 80160, Thailand
| | - Surasak Limsuwan
- Faculty of Traditional Thai Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand
| | - Sasitorn Chusri
- School of Health Science and Biomedical Technology Research Group for Vulnerable Populations, MaeFah Luang University, Chiang Rai, 57100, Thailand.
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Baral P, Afnan N, Ahmad Zahra M, Akter B, Rabia Prapti S, Muazzam Hossan M, Haque FKM. Bacteriological analysis and antibiotic resistance in patients with diabetic foot ulcers in Dhaka. PLoS One 2024; 19:e0301767. [PMID: 38758936 PMCID: PMC11101115 DOI: 10.1371/journal.pone.0301767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 03/21/2024] [Indexed: 05/19/2024] Open
Abstract
The primary objective of this study was to isolate bacteria from diabetic foot ulcers and subsequently assess their antibiotic resistance capabilities. Seventy-five patients diagnosed with diabetic foot ulcers were investigated. A number of these patients (97.33%) had type 2 diabetes, with a significant proportion of them having been diagnosed for 1-5 years (29.33%). Notably, a substantial number of these individuals were on insulin usage (78.66%). Among the patients under examination, 49.33% reported having no use of tobacco products, alcohol, or betel leaf. The ulcers analyzed in this study were classified into grades 1-5 according to the Wagner scale. Wagner grade 2 diabetic foot ulcers had the highest number of culture-positive patients, at 33.33%. Pus samples collected from patients were cultured on selective media, and bacterial identity was confirmed by biochemical tests and polymerase chain reaction. A total of 141 isolates were isolated. Among the isolates, 82.97% gram-negative bacteria and 17.02% gram-positive bacteria were detected. Klebsiella pneumoniae was the most common isolate. Proteus spp., Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus were also detected. Approximately 61.33% of the ulcers exhibited were polybacterial. In this study, it was observed that all bacterial isolates, except for Proteus spp., were primarily detected in patients classified under Wagner's grade 2. Moreover, antibiotic susceptibility was also tested on these 141 isolates. Among them, Escherichia coli showed the highest multidrug resistance, 81.81%. Most of the gram-negative bacteria were resistant to ampicillin. All of the gram-negative isolates exhibited high levels of susceptibility to piperacillin-tazobactam, and these levels were Klebsiella pneumoniae (97.56%), Pseudomonas aeruginosa (95.24%), Escherichia coli (81.82%), and Proteus spp. (80%). On the other hand, gram-positive Staphylococcus aureus mostly showed sensitivity towards vancomycin and norfloxacin (79.17%).
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Affiliation(s)
- Poulomi Baral
- Microbiology Program, Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Nafisa Afnan
- Microbiology Program, Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Maftuha Ahmad Zahra
- Microbiology Program, Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Baby Akter
- Biotechnology Program, Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Shek Rabia Prapti
- Biotechnology Program, Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | | | - Fahim Kabir Monjurul Haque
- Microbiology Program, Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
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Witt E, Leach AJ, Bi J, Hatfield S, Cotoia AT, McGovern MK, Cafi AB, Rhodes AC, Cook AN, Uaroon S, Parajuli B, Kim J, Feig V, Scheiflinger A, Nwosu I, Jimenez M, Coleman MC, Buchakjian MR, Bosch DE, Tift MS, Traverso G, Otterbein LE, Byrne JD. Modulation of diabetic wound healing using carbon monoxide gas-entrapping materials. DEVICE 2024; 2:100320. [PMID: 38911126 PMCID: PMC11192243 DOI: 10.1016/j.device.2024.100320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Diabetic wound healing is uniquely challenging to manage due to chronic inflammation and heightened microbial growth from elevated interstitial glucose. Carbon monoxide (CO), widely acknowledged as a toxic gas, is also known to provide unique therapeutic immune modulating effects. To facilitate delivery of CO, we have designed hyaluronic acid-based CO-gas-entrapping materials (CO-GEMs) for topical and prolonged gas delivery to the wound bed. We demonstrate that CO-GEMs promote the healing response in murine diabetic wound models (full-thickness wounds and pressure ulcers) compared to N2-GEMs and untreated controls.
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Affiliation(s)
- Emily Witt
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, 52242, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
| | - Alexander J Leach
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
- Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | - Jianling Bi
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, 52242, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
| | - Samual Hatfield
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
- Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | - Alicia T Cotoia
- Department of Biology and Marine Biology, University of North Carolina Wilmington, Wilmington, NC, 28403, USA
| | - Megan K McGovern
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, 52242, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
| | - Arielle B Cafi
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, 52242, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
| | - Ashley C Rhodes
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, 52242, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
| | - Austin N Cook
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, 52242, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
| | - Slyn Uaroon
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
- Department of Otolaryngology, University of Iowa, Iowa City, IA, 52242, USA
| | - Bishal Parajuli
- Department of Pathology, University of Iowa, Iowa City, IA, 52242, USA
| | - Jinhee Kim
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, ON M5S 1A8, Canada
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Vivian Feig
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Alexandra Scheiflinger
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Ikenna Nwosu
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
- Carver College of Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | - Miguel Jimenez
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, ON M5S 1A8, Canada
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Mitchell C Coleman
- Free Radical and Radiation Biology Program, University of Iowa, Iowa City, IA, 52242, USA
| | - Marisa R Buchakjian
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
- Department of Otolaryngology, University of Iowa, Iowa City, IA, 52242, USA
| | - Dustin E Bosch
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
- Department of Pathology, University of Iowa, Iowa City, IA, 52242, USA
| | - Michael S Tift
- Department of Biology and Marine Biology, University of North Carolina Wilmington, Wilmington, NC, 28403, USA
| | - Giovanni Traverso
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Leo E Otterbein
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - James D Byrne
- Department of Biomedical Engineering, University of Iowa, Iowa City, IA, 52242, USA
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, 52242, USA
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, 52242, USA
- Free Radical and Radiation Biology Program, University of Iowa, Iowa City, IA, 52242, USA
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10
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Liew H, Tang W, Plassmann P, Machin G, Simpson R, Edmonds ME, Petrova NL. Infrared Thermography Shows That a Temperature Difference of 2.2°C (4°F) or Greater Between Corresponding Sites of Neuropathic Feet Does Not Always Lead to a Diabetic Foot Ulcer. J Diabetes Sci Technol 2024:19322968241249970. [PMID: 38708580 DOI: 10.1177/19322968241249970] [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] [Indexed: 05/07/2024]
Abstract
BACKGROUND There is emerging interest in the application of foot temperature monitoring as means of diabetic foot ulcer (DFU) prevention. However, the variability in temperature readings of neuropathic feet remains unknown. The aim of this study was to analyze the long-term consistency of foot thermograms of diabetic feet at the risk of DFU. METHODS A post-hoc analysis of thermal images of 15 participants who remained ulcer-free during a 12-month follow-up were unblinded at the end of the trial. Skin foot temperatures of 12 plantar, 15 dorsal, 3 lateral, and 3 medial regions of interests (ROIs) were derived on monthly thermograms. The temperature differences (∆Ts) of corresponding ROIs of both feet were calculated. RESULTS Over the 12-month study period, out of the total 2026 plantar data points, 20.3% ROIs were rated as abnormal (absolute ∆T ≥ 2.2°C). There was a significant between-visit variability in the proportion of plantar ROIs with ∆T ≥ 2.2°C (range 7.6%-30.8%, chi-square test, P = .001). The proportion of patients presenting with hotspots (ROIs with ∆T ≥ 2.2°C), abnormal plantar foot temperature (mean ∆T of 12 plantar ROIs ≥ 2.2°C), and abnormal whole foot temperature (mean ∆T of 33 ROIs ≥ 2.2°C) varied between visits and showed no pattern (P > .05 for all comparisons). This variability was not related to the season of assessment. CONCLUSIONS Despite the high rate of hotspots on monthly thermograms, all feet remained intact. This study underscores a significant between-visit inconsistency in thermal images of neuropathic feet which should be considered when planning DFU-prevention programs for self-testing and behavior modification.
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Affiliation(s)
- Huiling Liew
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore
| | - Wegin Tang
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
| | | | - Graham Machin
- Temperature and Humidity Group, National Physical Laboratory, London, UK
| | - Robert Simpson
- Temperature and Humidity Group, National Physical Laboratory, London, UK
| | - Michael E Edmonds
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Diabetes and Obesity, School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nina L Petrova
- Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, London, UK
- Diabetes and Obesity, School of Cardiovascular and Metabolic Medicine & Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
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11
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Lusendi FM, Vanherwegen AS, Doggen K, Nobels F, Matricali GA. Evidence-based interventions for identifying candidate quality indicators to assess quality of care in diabetic foot clinics: a scoping review. BMC Public Health 2024; 24:996. [PMID: 38600498 PMCID: PMC11005120 DOI: 10.1186/s12889-024-18306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 03/07/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Foot ulcers in people with diabetes are a serious complication requiring a complex management and have a high societal impact. Quality monitoring systems to optimize diabetic foot care exist, but a formal and more evidence-based approach to develop quality indicators (QIs) is lacking. We aimed to identify a set of candidate indicators for diabetic foot care by adopting an evidence-based methodology. METHODS A systematic search was conducted across four academic databases: PubMed, Embase CINAHL and Cochrane Library. Studies that reported evidence-based interventions related to organization or delivery of diabetic foot care were searched. Data from the eligible studies were summarized and used to formulate process and structure indicators. The evidence for each candidate QI was described in a methodical and transparent manner. The review process was reported according to the "Preferred Reported Items for Systematic reviews and Meta-Analysis" (PRISMA) statements and its extension for scoping reviews. RESULTS In total, 981 full-text articles were screened, and 322 clinical studies were used to formulate 42 candidate QIs. CONCLUSIONS An evidence-based approach could be used to select candidate indicators for diabetic foot ulcer care, relating to the following domains: wound healing interventions, peripheral artery disease, offloading, secondary prevention, and interventions related to organization of care. In a further step, the feasibility of the identified set of indicators will be assessed by a multidisciplinary panel of diabetic foot care stakeholders.
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Affiliation(s)
- Flora Mbela Lusendi
- Health Services Research, Sciensano, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium.
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| | - An-Sofie Vanherwegen
- Health Services Research, Sciensano, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Kris Doggen
- Health Services Research, Sciensano, Rue Juliette Wytsmanstraat 14, Brussels, 1050, Belgium
| | - Frank Nobels
- Multidisciplinary Diabetic Foot Clinic, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Giovanni Arnoldo Matricali
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Multidisciplinary Diabetic Foot Clinic, University Hospital Leuven, Leuven, Belgium
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12
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Ahmad AM, Mohammed AA, Khalifa WA, Ali HM, Abdel-Aziz A. Effect of Buerger-Allen exercise on wound healing in patients with diabetic foot ulcers: a randomised controlled trial. J Wound Care 2024; 33:xci-xcviii. [PMID: 38588058 DOI: 10.12968/jowc.2024.33.sup4a.xci] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
OBJECTIVE A diabetic foot ulcer (DFU) is a complication of type 2 diabetes that is difficult to treat. Buerger-Allen exercise has shown effectiveness in improving foot circulation and neuropathy in several studies; however, to the best of our knowledge, no randomised controlled study has investigated its effectiveness for DFU healing. Therefore, this study aimed to assess the effects of Buerger-Allen exercise on the healing of DFUs in patients with type 2 diabetes. METHOD This is a parallel-group randomised controlled trial (RCT). Of 50 patients with neuropathic DFUs, 41 completed the study. They were assigned randomly to a study group (n=21) and a control group (n=20). Patients in the study group received the standard medical treatment and semi-supervised Buerger-Allen exercise for three sessions per week for four weeks, while patients in the control group only received the standard medical treatment. The outcome measures were: ankle-brachial pressure index (ABPI); ulcer size; ulcer depth; SINBAD score; and ulcer risk for poor outcomes (based on the SINBAD score). RESULTS The study group's mean age was 49.48±6.45 years and the control group's mean age was 49.15±5.85. The study group's ABPI increased significantly compared to the baseline (1.17±0.04 versus 1.11±0.05, respectively; p<0.001) and the control group (1.17±0.04 versus 1.14±0.05, respectively; p=0.04) post-intervention. Ulcer size also reduced significantly in the study group compared to the baseline (2.63±2.0 versus 7.48±5.55cm2, respectively; p<0.001) and the control group (2.63±2.0 versus 6.43±4.45cm2, respectively; p<0.001) post-intervention. Ulcer depth decreased significantly in the study group compared to the baseline (1.71±1.05 versus 4.19±1.74mm, respectively; p<0.001) and the control group (1.71±1.05 versus 2.80±1.57mm, respectively; p=0.01) post-intervention. Furthermore, the SINBAD score in the study group decreased significantly compared to the baseline (1.38±0.86 versus 2.14±1.06, respectively; p<0.001) and the control group (1.38±0.86 versus 2.0±0.79, respectively; p=0.02) post-intervention. Moreover, the ulcer risk for poor outcomes, based on the SINBAD score, reduced significantly only in the study group, compared to the baseline (p=0.041). The control group showed non-significant changes compared to the baseline in all outcome measures (p>0.05). CONCLUSION From the findings of this RCT, Buerger-Allen exercise, in combination with standard wound care, may help accelerate the healing of neuropathic DFUs in patients with type 2 diabetes, and could be suggested as part of the management plan for such conditions as an easy-to-perform offloading exercise intervention.
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Affiliation(s)
- Ahmad Mahdi Ahmad
- 1 Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Egypt
| | | | - Walaa Anwar Khalifa
- 3 Endocrinology Unit, Internal Medicine Department, Faculty of Medicine, Assuit University, Egypt
| | - Heba Mohammed Ali
- 4 Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Beni-Suef University, Egypt
| | - Akram Abdel-Aziz
- 1 Department of Physical Therapy for Cardiovascular and Respiratory Disorders, Faculty of Physical Therapy, Cairo University, Egypt
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13
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Bai Z, Zhou D, Tao K, Lin F, Wang H, Sun H, Liu R, Li Z. The Role of MicroRNA-206 in the Regulation of Diabetic Wound Healing via Hypoxia-Inducible Factor 1-Alpha. Biochem Genet 2024:10.1007/s10528-024-10759-9. [PMID: 38446322 DOI: 10.1007/s10528-024-10759-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/25/2024] [Indexed: 03/07/2024]
Abstract
Successful wound healing in diabetic patients is hindered by dysregulated miRNA expression. This study aimed to investigate the abnormal expression of miRNAs in diabetic wound healing and the potential therapeutic role of modulating the miR-206/HIF-1α pathway. MicroRNA assays were used to identify differentially expressed miRNAs in diabetic wound sites and adjacent areas. In vitro models and a rat diabetic model were established to evaluate the effects of miR-206 on HIF-1α regulation and wound healing. The study revealed differential expression of miR-206 in diabetic wound tissues, its interaction with HIF-1α, and the inhibitory effect of miR-206 on cell growth under high glucose conditions. Modulating the miR-206/HIF-1α pathway using miR-206 antagomir promoted HIF-1α, CD34, and VEGF expression, ultimately enhancing diabetic wound healing.
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Affiliation(s)
- Zeming Bai
- Burn and Plastic Surgery Department, General Hospital of Northern Theater Command, Shenyang, 110000, China
| | - Dapeng Zhou
- Burn and Plastic Surgery Department, General Hospital of Northern Theater Command, Shenyang, 110000, China.
| | - Kai Tao
- Burn and Plastic Surgery Department, General Hospital of Northern Theater Command, Shenyang, 110000, China.
| | - Feng Lin
- Burn and Plastic Surgery Department, General Hospital of Northern Theater Command, Shenyang, 110000, China
| | - Hongyi Wang
- Burn and Plastic Surgery Department, General Hospital of Northern Theater Command, Shenyang, 110000, China
| | - Haiwei Sun
- Burn and Plastic Surgery Department, General Hospital of Northern Theater Command, Shenyang, 110000, China
| | - Ruidi Liu
- Burn and Plastic Surgery Department, General Hospital of Northern Theater Command, Shenyang, 110000, China
| | - Zhe Li
- Burn and Plastic Surgery Department, General Hospital of Northern Theater Command, Shenyang, 110000, China
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14
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Rezaei S, Imani R. Highly Absorbent Egg White/Carbomer-940 Hydrofilm as a Potential Diabetic Wound Dressing. Macromol Biosci 2024; 24:e2300353. [PMID: 37939368 DOI: 10.1002/mabi.202300353] [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: 08/02/2023] [Revised: 10/20/2023] [Indexed: 11/10/2023]
Abstract
Diabetic foot ulcer (DFU) is the most critical problem in diabetic patients. Managing exudate in this kind of wound presents significant challenges in clinics. Advanced wound dressings serve as the most effective approach to managing DFU. Herein, a highly absorbent hydrofilm is presented through a combination of egg white (EW) and Carbomer-940, benefiting from the bioactivity of the EW component and superabsorption capacity of Carbomer-940. The crystallinity of samples rises due to the presence of Carbomer-940. Regarding the high water absorption capacity of Carbomer-940, the swelling ratio and water-holding capacity of samples are also improved via its incorporation of up to 1005%. In contrast, the transmission of water vapor and in vitro degradation rate decreases as Carbomer-940 powers the crystallinity of hydrofilms. Carbomer-940 incorporation in the EW structure accelerates protein release during the time, while this acceleration is partially compensated by the crystallization effect. The cell viability assay demonstrates no toxicity as well as high human foreskin fibroblast cell proliferation for the hybrid hydrofilm sample, where the cell migration is positively affected in the presence of the bioactive components extracted from the dressing. Taken together, the optimized hybrid hydrofilm could be suggested as a promising wound dressing for managing DFUs.
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Affiliation(s)
- Soheila Rezaei
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, 1591634311, Iran
| | - Rana Imani
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, 1591634311, Iran
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15
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Reuvekamp H, Hekman E, van der Heide E, Matthews D. Strategies in surface engineering for the regulation of microclimates in skin-medical product interactions. Heliyon 2024; 10:e25395. [PMID: 38370189 PMCID: PMC10869805 DOI: 10.1016/j.heliyon.2024.e25395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/17/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024] Open
Abstract
There is a growing number of personal healthcare devices that are in prolonged contact with the skin. The functionality of these products is linked to the interface formed by the contact between the medical apparatus and the skin. The interface can be characterised by its topology, compliance, and moisture and thermal regulating capabilities. Many devices are, however, described to have suboptimal and occlusive contacts, resulting in physiological unfavourable microclimates at the interface. The resulting poor management of moisture and temperature can impact the functionality and utility of the device and, in severe cases, lead to physical harm to the user. Being able to control the microclimate is therefore expected to limit medical-device related injuries and prevent associated skin complications. Surface engineering can modify and potentially enhance the regulation of the microclimate factors surrounding the interface between a product's surface and the skin. This review provides an overview of potential engineering solutions considering the needs for, and influences on, regulation of temperature and moisture by considering the skin-medical device interface as a system. These findings serve as a platform for the anticipated progress in the role of surface engineering for skin-device microclimate regulation.
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Affiliation(s)
- H. Reuvekamp
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - E.E.G. Hekman
- Biomedical Device Design and Production Lab, Department of Biomechanical Engineering (BE), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - E. van der Heide
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
| | - D.T.A. Matthews
- Laboratory for Surface Technology and Tribology, Department of Mechanics of Solids, Surfaces and Systems (MS3), Faculty of Engineering Technology, University of Twente, Postbox 217, 7500 AE Enschede, the Netherlands
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16
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Jokar J, Abdulabbas HT, Javanmardi K, Mobasher MA, Jafari S, Ghasemian A, Rahimian N, Zarenezhad A, ُSoltani Hekmat A. Enhancement of bactericidal effects of bacteriophage and gentamicin combination regimen against Staphylococcus aureus and Pseudomonas aeruginosa strains in a mice diabetic wound model. Virus Genes 2024; 60:80-96. [PMID: 38079060 DOI: 10.1007/s11262-023-02037-4] [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: 06/27/2023] [Accepted: 10/17/2023] [Indexed: 02/15/2024]
Abstract
Diabetic patients are more susceptible to developing wound infections resulting in poor and delayed wound healing. Bacteriophages, the viruses that target-specific bacteria, can be used as an alternative to antibiotics to eliminate drug-resistant bacterial infections. Pseudomonas aeruginosa (P. aeruginosa) and Staphylococcus aureus (S. aureus) are among the most frequently identified pathogens in diabetic foot ulcers (DFUs). The aim of this study was assessment of bacteriophage and gentamicin combination effects on bacterial isolates from DFU infections. Specific bacteriophages were collected from sewage and animal feces samples and the phages were enriched using S. aureus and P. aeruginosa cultures. The lytic potential of phage isolates was assessed by the clarity of plaques. We isolated and characterized four lytic phages: Stp2, Psp1, Stp1, and Psp2. The phage cocktail was optimized and investigated in vitro. We also assessed the effects of topical bacteriophage cocktail gel on animal models of DFU. Results revealed that the phage cocktail significantly reduced the mortality rate in diabetic infected mice. We determined that treatment with bacteriophage cocktail effectively decreased bacterial colony counts and improved wound healing in S. aureus and P. aeruginosa infections, especially when administrated concomitantly with gentamicin. The application of complementary therapy using a phage cocktail and gentamicin, could offer an attractive approach for the treatment of wound diabetic bacterial infections.
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Affiliation(s)
- Javad Jokar
- Department of Tissue Engineering, Faculty of Medicine, Fasa University of Medical Science, Fasa, Iran
| | - Hussein T Abdulabbas
- Department of Medical Microbiology, Medical College, Al Muthanna University, Samawah, Al Muthann, Iraq
| | - Kazem Javanmardi
- Department of Physiology, Fasa University of Medical Sciences, Fasa, Iran
| | - Mohammad Ali Mobasher
- Department of Biotechnology, Faculty of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Shima Jafari
- Department of Biotechnology, Faculty of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Abdolmajid Ghasemian
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
| | - Niloofar Rahimian
- Department of Biotechnology, Faculty of Medicine, Fasa University of Medical Sciences, Fasa, Iran
| | - Ali Zarenezhad
- Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran
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17
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Waibel FWA, Uçkay I, Soldevila-Boixader L, Sydler C, Gariani K. Current knowledge of morbidities and direct costs related to diabetic foot disorders: a literature review. Front Endocrinol (Lausanne) 2024; 14:1323315. [PMID: 38298183 PMCID: PMC10829909 DOI: 10.3389/fendo.2023.1323315] [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: 10/17/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
Diabetes is a chronic disease associated with numerous complications including diabetic foot disorders, which are associated with significant morbidity and mortality as well as high costs. The costs associated with diabetic foot disorders comprise those linked to care (direct) and loss of productivity and poor quality of life (indirect). Due to the constant increase in diabetes prevalence, it is expected that diabetic foot disorder will require more resources, both in terms of caregivers and economically. We reviewed findings on management, morbidity, mortality, and costs related to diabetic foot disorder.
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Affiliation(s)
- Felix W. A. Waibel
- Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Ilker Uçkay
- Infectiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Laura Soldevila-Boixader
- Infectious Diseases, Internal Medicine Department, Consorci Sanitari Integral-CSI, Sant Joan Despí Hospital, Barcelona, Spain
| | - Christina Sydler
- Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Karim Gariani
- Service of Endocrinology, Diabetes, Nutrition, and Therapeutic Education, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
- Diabetes Center of the Faculty of Medicine, University of Geneva Medical School, Geneva, Switzerland
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18
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Bosun-Arije SF. Commentary: Development of a resource-use measure to capture costs of diabetic foot ulcers to the United Kingdom National Health Service, patients and society. J Res Nurs 2023; 28:579-581. [PMID: 38162712 PMCID: PMC10756168 DOI: 10.1177/17449871231208173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Stella F Bosun-Arije
- Senior Lecturer and Senior Fellow of Advance HE, Faculty of Health and Education, School of Nursing and Public Health, Manchester Metropolitan University, Manchester, UK
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19
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Letta S, Goshu AT, Sertsu A, Nigussie K, Negash A, Yadeta TA, Bulti FA, Geda B, Dessie Y. Diabetes knowledge and foot care practices among type 2 diabetes patients attending the chronic ambulatory care unit of a public health hospital in eastern Ethiopia: a cross-sectional study. BMJ Open 2023; 13:e070023. [PMID: 38016795 PMCID: PMC10685947 DOI: 10.1136/bmjopen-2022-070023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 10/31/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE To assess diabetes knowledge and foot care practices among type 2 diabetes patients. DESIGN An institution-based cross-sectional study was undertaken from 1 January to 31 January 2021. SETTING Eastern Ethiopia. PARTICIPANTS Randomly selected type 2 diabetes patients who were available during the data collection period were included. OUTCOMES Patients' diabetes knowledge was assessed with the revised diabetes knowledge test questionnaire. Five items were used to evaluate foot self-care practices. RESULTS The study population comprised of 549 patients. About 52.5% of the patients had adequate diabetes knowledge (95% CI: 48.2% to 56.7%). Patients with an educational level of secondary school and above (adjusted OR (AOR): 2.04, 95% CI: 1.13 to 3.71), (AOR: 5.28, 95% CI: 2.28 to 12.22), and those with medium and above wealth status (AOR: 3.81, 95% CI: 2.24 to 6.47), (AOR: 3.46, 95% CI: 1.98 to 6.04), were found to have better odds of having adequate diabetes knowledge. However, those aged >55 years (AOR: 0.47, 95% CI: 0.22 to 0.99) were found to have lower odds of adequate diabetes knowledge.Of the total included patients, 20.2% (95% CI: 16.9% to 23.8%) had good foot care practices. Knowledge of the target fasting plasma glucose (AOR: 3.18, 95% CI: 1.94 to 5.22) and adequate diabetes knowledge (AOR: 3.40, 95% CI: 1.95 to 5.91) were significantly associated with good foot care practices. CONCLUSION According to this study, about half of individuals with type 2 diabetes have adequate levels of knowledge about the disease. In addition, only one out of every five patients has good foot care habits. Diabetes education should emphasise the significance of rigorous adherence to daily foot care practices.
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Affiliation(s)
- Shiferaw Letta
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Abel Tibebu Goshu
- School of Nursing and Midwifery, Asrat Weldeyes Health Science College, Debre Berhan University, Debre Berhan, Ethiopia
| | - Addisu Sertsu
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Kabtamu Nigussie
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Abraham Negash
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
| | - Fekadu Aga Bulti
- School of Nursing and Midwifery, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Biftu Geda
- College of Health Sciences, Department of Nursing, Madda Walabu University, Shashamene, Ethiopia
| | - Yadeta Dessie
- School of Public Health, Haramaya University College of Health and Medical Sciences, Harar, Ethiopia
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20
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OuYang H, Tang Y, Yang F, Ren X, Yang J, Cao H, Yin Y. Platelet-rich plasma for the treatment of diabetic foot ulcer: a systematic review. Front Endocrinol (Lausanne) 2023; 14:1256081. [PMID: 38169990 PMCID: PMC10760804 DOI: 10.3389/fendo.2023.1256081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 11/23/2023] [Indexed: 01/05/2024] Open
Abstract
Background With the increasing incidence of diabetes, diabetic foot ulcer(DFU) has become one of the most common and serious complications in people with diabetes. DFU is associated with significant morbidity and mortality, and can also result in significant economic, social and public health burdens. Due to peripheral neuropathy, peripheral vascular disease, hyperglycemic environment, inflammatory disorders and other factors, the healing of DFU is impaired or delayed, resulting in the formation of diabetic chronic refractory ulcer. Because of these pathological abnormalities in DFU, it may be difficult to promote wound healing with conventional therapies or antibiotics, whereas platelet-rich plasma(PRP) can promote wound healing by releasing various bioactive molecules stored in platelets, making it more promising than traditional antibiotics. Therefore, the purpose of this systematic review is to summarize and analyze the efficacy of PRP in the treatment of DFU. Methods A literature search was undertaken in PubMed, CNKI, EMB-ASE, the Cochrane Library, the WanFang Database and the WeiPu Database by computer. Included controlled studies evaluating the efficacy of PRP in the treatment of diabetic foot ulcers. The data extraction and assessment are on the basis of PRISMA. Results Twenty studies were evaluated, and nineteen measures for the evaluation of the efficacy of PRP in DFU treatment were introduced by eliminating relevant duplicate measures. The efficacy measures that were repeated in various studies mainly included the rate of complete ulcer healing, the percentage of ulcer area reduction, the time required for ulcer healing, wound complications (including infection rate, amputation rate, and degree of amputation), the rate of ulcer recurrence, and the cost and duration of hospitalization for DFU, as well as subsequent survival and quality of life scores. One of the most important indicators were healing rate, ulcer area reduction and healing time. The meta-analysis found that PRP was significantly improve the healing rate(OR = 4.37, 95% CI 3.02-6.33, P < 0.001) and shorten the healing time(MD = -3.21, 95% CI -3.83 to -2.59,P < 0.001)of patients with DFU when compared to the conventional treatment, but there was no significant difference in reducing the of ulcer area(MD = 5.67, 95% CI -0.77 to 12.11,P =0.08>0.05 ). Conclusion The application of PRP to DFU can improve ulcer healing rate and shorten ulcer healing time, but more clinical data are needed to clarify some efficacy measures. At the same time, a standardized preparation process for PRP is essential.
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Affiliation(s)
- Hong OuYang
- Geriatric Diseases Institute of Chengdu, Department of Endocrine and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Yi Tang
- Geriatric Diseases Institute of Chengdu, Department of Endocrine and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Fan Yang
- Geriatric Diseases Institute of Chengdu, Department of Endocrine and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Xin Ren
- Geriatric Diseases Institute of Chengdu, Department of Endocrine and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Jing Yang
- Geriatric Diseases Institute of Chengdu, Department of Endocrine and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Hongyi Cao
- Geriatric Diseases Institute of Chengdu, Department of Endocrine and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu, China
| | - Yifan Yin
- Department of Nephrology, Chengdu Third People’s Hospital, Chengdu, China
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21
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Garland NT, Song JW, Ma T, Kim YJ, Vázquez-Guardado A, Hashkavayi AB, Ganeshan SK, Sharma N, Ryu H, Lee MK, Sumpio B, Jakus MA, Forsberg V, Kaveti R, Sia SK, Veves A, Rogers JA, Ameer GA, Bandodkar AJ. A Miniaturized, Battery-Free, Wireless Wound Monitor That Predicts Wound Closure Rate Early. Adv Healthc Mater 2023; 12:e2301280. [PMID: 37407030 PMCID: PMC10766868 DOI: 10.1002/adhm.202301280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 07/07/2023]
Abstract
Diabetic foot ulcers are chronic wounds that affect millions and increase the risk of amputation and mortality, highlighting the critical need for their early detection. Recent demonstrations of wearable sensors enable real-time wound assessment, but they rely on bulky electronics, making them difficult to interface with wounds. Herein, a miniaturized, wireless, battery-free wound monitor that measures lactate in real-time and seamlessly integrates with bandages for conformal attachment to the wound bed is introduced. Lactate is selected due to its multifaceted role in initiating healing. Studies in healthy and diabetic mice reveal distinct lactate profiles for normal and impaired healing wounds. A mathematical model based on the sensor data predicts wound closure rate within the first 3 days post-injury with ≈76% accuracy, which increases to ≈83% when pH is included. These studies underscore the significance of monitoring biomarkers during the inflammation phase, which can offer several benefits, including short-term use of wound monitors and their easy removal, resulting in lower risks of injury and infection at the wound site. Improvements in prediction accuracy can be achieved by designing mathematical models that build on multiple wound parameters such as pro-inflammatory and metabolic markers. Achieving this goal will require designing multi-analyte wound monitors.
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Affiliation(s)
- Nate T. Garland
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, USA
- Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies (ASSIST), North Carolina State University, Raleigh, NC, USA
| | - Joseph W. Song
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, USA
| | - Tengfei Ma
- IBM T. J. Watson Research Center, Ossining, NY, USA
| | - Yong Jae Kim
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, USA
- Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies (ASSIST), North Carolina State University, Raleigh, NC, USA
| | | | - Ayemeh Bagheri Hashkavayi
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, USA
- Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies (ASSIST), North Carolina State University, Raleigh, NC, USA
| | - Sankalp Koduvayur Ganeshan
- Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies (ASSIST), North Carolina State University, Raleigh, NC, USA
| | - Nivesh Sharma
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, USA
- Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies (ASSIST), North Carolina State University, Raleigh, NC, USA
| | - Hanjun Ryu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Min-Kyu Lee
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Brandon Sumpio
- Joslin-Beth Israel Deaconess Foot Center and the Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Viviane Forsberg
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Department of Natural Sciences, Mid Sweden University, Holmgatan 10, 851 70, Sundsvall, Sweden
| | - Rajaram Kaveti
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, USA
- Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies (ASSIST), North Carolina State University, Raleigh, NC, USA
| | - Samuel K. Sia
- Department of Biomedical Engineering, Columbia University, USA
| | - Aristidis Veves
- Joslin-Beth Israel Deaconess Foot Center and the Rongxiang Xu, MD, Center for Regenerative Therapeutics, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John A. Rogers
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Guillermo A. Ameer
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Center for Advanced Regenerative Engineering, Northwestern University, Evanston, IL, USA
- Simpson Querrey Institute for Bionanotechnology, Evanston, IL, USA
- Chemistry of Life Processes Institute, Northwestern University, Evanston, IL, USA
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- International Institute for Nanotechnology, Northwestern University, Evanston, IL, USA
| | - Amay J. Bandodkar
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC, USA
- Center for Advanced Self-Powered Systems of Integrated Sensors and Technologies (ASSIST), North Carolina State University, Raleigh, NC, USA
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina at Chapel Hill, NC, USA
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22
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Cassidy B, Hoon Yap M, Pappachan JM, Ahmad N, Haycocks S, O'Shea C, Fernandez CJ, Chacko E, Jacob K, Reeves ND. Artificial intelligence for automated detection of diabetic foot ulcers: A real-world proof-of-concept clinical evaluation. Diabetes Res Clin Pract 2023; 205:110951. [PMID: 37848163 DOI: 10.1016/j.diabres.2023.110951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVE Conduct a multicenter proof-of-concept clinical evaluation to assess the accuracy of an artificial intelligence system on a smartphone for automated detection of diabetic foot ulcers. METHODS The evaluation was undertaken with patients with diabetes (n = 81) from September 2020 to January 2021. A total of 203 foot photographs were collected using a smartphone, analysed using the artificial intelligence system, and compared against expert clinician judgement, with 162 images showing at least one ulcer, and 41 showing no ulcer. Sensitivity and specificity of the system against clinician decisions was determined and inter- and intra-rater reliability analysed. RESULTS Predictions/decisions made by the system showed excellent sensitivity (0.9157) and high specificity (0.8857). Merging of intersecting predictions improved specificity to 0.9243. High levels of inter- and intra-rater reliability for clinician agreement on the ability of the artificial intelligence system to detect diabetic foot ulcers was also demonstrated (Kα > 0.8000 for all studies, between and within raters). CONCLUSIONS We demonstrate highly accurate automated diabetic foot ulcer detection using an artificial intelligence system with a low-end smartphone. This is the first key stage in the creation of a fully automated diabetic foot ulcer detection and monitoring system, with these findings underpinning medical device development.
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Affiliation(s)
- Bill Cassidy
- Department of Computing Mathematics, Manchester Metropolitan University, John Dalton Building, Manchester M1 5GD, UK.
| | - Moi Hoon Yap
- Department of Computing Mathematics, Manchester Metropolitan University, John Dalton Building, Manchester M1 5GD, UK.
| | - Joseph M Pappachan
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston PR2 9HT, UK.
| | - Naseer Ahmad
- Manchester University NHS Foundation Trust, Manchester M13 9WL, UK.
| | | | - Claire O'Shea
- Te Whatu Ora Health New Zealand Waikato, Pembroke Street, Hamilton 3240, New Zealand. claire.o'
| | - Cornelious J Fernandez
- Department of Endocrinology and Metabolism, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston LN2 5QY, UK.
| | - Elias Chacko
- Jersey General Hospital, The Parade, St Helier, JE1 3QS Jersey, UK.
| | - Koshy Jacob
- Eastbourne District General Hospital, Kings Drive, Eastbourne BN21 2UD, UK.
| | - Neil D Reeves
- Faculty of Science & Engineering, Manchester Metropolitan University, John Dalton Building, Manchester M1 5GD, UK.
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23
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Morelli MK, Son AH, Bitar Y, Hecker MT. Fear of Missing Organisms (FOMO): the discordance among broad-spectrum empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy for diabetic foot infections and lower extremity osteomyelitis. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e186. [PMID: 38028912 PMCID: PMC10654958 DOI: 10.1017/ash.2023.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 12/01/2023]
Abstract
Objective Empiric broad-spectrum antibiotic therapy is commonly prescribed for patients hospitalized with diabetic foot infections (DFI) and lower extremity osteomyelitis (OM). The primary objective was to evaluate the concordance between empiric antibiotic therapy, microbiologic results, and definitive antibiotic therapy with a focus on methicillin-resistant Staphylococcus aureus (MRSA) and resistant gram-negative organisms. The secondary objective was to evaluate the negative predictive values (NPV) of select risk factors for MRSA and resistant gram-negative organisms for microbiologic results with these organisms. Design Retrospective cohort study. Setting Safety-net health system in Ohio. Patients Adults hospitalized and receiving antibiotic therapy for DFI or lower extremity OM in 2021. Results For 259 unique patients, empiric therapies with activity against MRSA and resistant gram-negative organisms were administered to 224 (86.5%) and 217 (83.8%) patients, respectively. Definitive therapies with activity against MRSA and resistant gram-negative organisms were administered to 91 (35%) and 74 (28.6%) patients, respectively. Of 234 patients with microbiologic testing, 29 (12.4%) had positive cultures with MRSA and 41 (17.5%) with resistant gram-negative organisms. The NPVs of risk factors for MRSA and resistant gram-negative organisms for the absence of these organisms in culture were 91% and 85%, respectively. Conclusions For patients hospitalized with DFI and lower extremity OM, our data suggest opportunities for substantial reductions in empiric therapies with activity against MRSA and resistant gram-negative organisms. The absence of risk factors for these organisms was reasonably good at predicting negative cultures with these organisms.
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Affiliation(s)
- Morgan K. Morelli
- Department of Medicine, Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
- Department of Medicine, Division of Infectious Disease, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - Andrea H. Son
- Department of Pharmacy, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - Yanis Bitar
- Department of Medicine, Division of Infectious Disease, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
| | - Michelle T. Hecker
- Department of Medicine, Division of Infectious Disease, The MetroHealth System, Case Western Reserve University, Cleveland, OH, USA
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24
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Nair HK, Yan TD. Use of bioelectric dressings for patients with hard-to-heal wounds: a case report. J Wound Care 2023; 32:S8-S14. [PMID: 37830843 DOI: 10.12968/jowc.2023.32.sup10a.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
There are many types of dressings available for the management of hard-to-heal (chronic) wounds. This case report illustrates the efficacy of bioelectric dressings in healing hard-to-heal wounds in five patients. Of the patients, four had diabetic foot ulcers (DFUs) and one had a surgical site infection. Wounds were examined using the TIMES concept and debridement was carried out if needed. Amorphous hydrogel was used as conduction fluid before the application of the bioelectric wound dressings. The wound was covered with foam dressing and crepe bandage. In this case report, among all five wounds, one wound healed completely while the other four reduced in size, with the presence of more granulation and re-epithelialisation. In this case report, bioelectric wound dressings were effective in managing infection and promoting wound healing.
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Affiliation(s)
- Harikrishna Kr Nair
- Editor-in-Chief, Wound Asia
- Head of the Wound Care Unit, Department of Internal Medicine, Hospital Kuala Lumpur, Malaysia
| | - Teong Dun Yan
- Wound Care Unit, Department of Internal Medicine, Hospital Kuala Lumpur, Malaysia
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25
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Wada FW, Mekonnen MF, Sawiso ED, Kolato S, Woldegiorgis L, Kera GK, El-Khatib Z, Ashuro AA, Biru M, Boltena MT. Bacterial profile and antimicrobial resistance patterns of infected diabetic foot ulcers in sub-Saharan Africa: a systematic review and meta-analysis. Sci Rep 2023; 13:14655. [PMID: 37670001 PMCID: PMC10480146 DOI: 10.1038/s41598-023-41882-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023] Open
Abstract
The number of diabetic foot ulcer patients is substantially increasing, with the rapidly rising burden of diabetic mellitus in sub-Saharan Africa. The data on the regional prevalence of diabetic foot ulcer infecting bacteria and their antimicrobial resistance patterns is crucial for its proper management. This systematic review and meta-analysis determined the pooled prevalence of bacterial profiles and antimicrobial resistance patterns of infected diabetic foot ulcers in sub-Saharan Africa. A comprehensive search of the literature was performed on CINAHL, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science databases. Critical appraisal was done using the Joanna Briggs Institute's tool for prevalence studies. A pooled statistical meta-analysis was conducted using STATA Version 17.0. The I2 statistics and Egger's test were used to assess the heterogeneity and publication bias. The pooled prevalence and the corresponding 95% confidence interval of bacterial profiles and their antimicrobial resistance patterns were estimated using a random effect model. Eleven studies with a total of 1174 study participants and 1701 bacteria isolates were included. The pooled prevalence of the most common bacterial isolates obtained from DFU were S. aureus (34.34%), E. coli (21.16%), and P. aeruginosa (20.98%). The highest pooled resistance pattern of S. aureus was towards Gentamicin (57.96%) and Ciprofloxacin (52.45%). E.coli and K. Pneumoniae showed more than a 50% resistance rate for the most common antibiotics tested. Both gram-positive and gram-negative bacteria were associated with diabetic foot ulcers in sub-Saharan Africa. Our findings are important for planning treatment with the appropriate antibiotics in the region. The high antimicrobial resistance prevalence rate indicates the need for context-specific effective strategies aimed at infection prevention and evidence-based alternative therapies.
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Affiliation(s)
- Fiseha Wadilo Wada
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
- Department of Medical Laboratory, College of Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia.
- Department of Biomedical Sciences, College of Natural and Computational Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | | | - Edlawit Desta Sawiso
- Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital (NEMMCSH), Wachemo University, Hossana, Ethiopia
| | - Sitotaw Kolato
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
- Department of Medical Laboratory, College of Health Sciences, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | | | | | - Ziad El-Khatib
- World Health Programme, Université du Québec en Abitibi-Témiscamingue, Montreal, QC, Canada
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Mulatu Biru
- USAID Eliminate TB Project, KNCV, Addis Ababa, Ethiopia
| | - Minyahil Tadesse Boltena
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
- Ethiopian-Evidence Based Health Care Centre: A JBI Center of Excellence, Public Health Faculty, Institute of Health, Jimma University, Jimma, Ethiopia
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26
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Berger AG, Deiss-Yehiely E, Vo C, McCoy MG, Almofty S, Feinberg MW, Hammond PT. Electrostatically assembled wound dressings deliver pro-angiogenic anti-miRs preferentially to endothelial cells. Biomaterials 2023; 300:122188. [PMID: 37329684 PMCID: PMC10424785 DOI: 10.1016/j.biomaterials.2023.122188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
Chronic non-healing wounds occur frequently in individuals affected by diabetes, yet standard-of-care treatment leaves many patients inadequately treated or with recurring wounds. MicroRNA (miR) expression is dysregulated in diabetic wounds and drives an anti-angiogenic phenotype, but miRs can be inhibited with short, chemically-modified RNA oligonucleotides (anti-miRs). Clinical translation of anti-miRs is hindered by delivery challenges such as rapid clearance and uptake by off-target cells, requiring repeated injections, excessively large doses, and bolus dosing mismatched to the dynamics of the wound healing process. To address these limitations, we engineered electrostatically assembled wound dressings that locally release anti-miR-92a, as miR-92a is implicated in angiogenesis and wound repair. In vitro, anti-miR-92a released from these dressings was taken up by cells and inhibited its target. An in vivo cellular biodistribution study in murine diabetic wounds revealed that endothelial cells, which play a critical role in angiogenesis, exhibit higher uptake of anti-miR eluted from coated dressings than other cell types involved in the wound healing process. In a proof-of-concept efficacy study in the same wound model, anti-miR targeting anti-angiogenic miR-92a de-repressed target genes, increased gross wound closure, and induced a sex-dependent increase in vascularization. Overall, this proof-of-concept study demonstrates a facile, translational materials approach for modulating gene expression in ulcer endothelial cells to promote angiogenesis and wound healing. Furthermore, we highlight the importance of probing cellular interactions between the drug delivery system and the target cells to drive therapeutic efficacy.
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Affiliation(s)
- Adam G Berger
- Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA; Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Elad Deiss-Yehiely
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Materials Science and Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Chau Vo
- Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA; Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA; Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Michael G McCoy
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sarah Almofty
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA; Institute for Research and Medical Consultations (IRMC), Imam Abdulrahman Bin Faisal University, P.O. Box 1982, Dammam, 31441, Saudi Arabia
| | - Mark W Feinberg
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Paula T Hammond
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA; Institute for Soldier Nanotechnologies, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA.
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27
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Willems R. Health economic considerations to effectively implement telemonitoring of diabetic foot ulcer. THE LANCET REGIONAL HEALTH. EUROPE 2023; 32:100688. [PMID: 37520148 PMCID: PMC10372889 DOI: 10.1016/j.lanepe.2023.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/30/2023] [Indexed: 08/01/2023]
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28
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Chen Y, Wang X, Tao S, Wang Q, Ma PQ, Li ZB, Wu YL, Li DW. Research advances in smart responsive-hydrogel dressings with potential clinical diabetic wound healing properties. Mil Med Res 2023; 10:37. [PMID: 37608335 PMCID: PMC10463485 DOI: 10.1186/s40779-023-00473-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 07/31/2023] [Indexed: 08/24/2023] Open
Abstract
The treatment of chronic and non-healing wounds in diabetic patients remains a major medical problem. Recent reports have shown that hydrogel wound dressings might be an effective strategy for treating diabetic wounds due to their excellent hydrophilicity, good drug-loading ability and sustained drug release properties. As a typical example, hyaluronic acid dressing (Healoderm) has been demonstrated in clinical trials to improve wound-healing efficiency and healing rates for diabetic foot ulcers. However, the drug release and degradation behavior of clinically-used hydrogel wound dressings cannot be adjusted according to the wound microenvironment. Due to the intricacy of diabetic wounds, antibiotics and other medications are frequently combined with hydrogel dressings in clinical practice, although these medications are easily hindered by the hostile environment. In this case, scientists have created responsive-hydrogel dressings based on the microenvironment features of diabetic wounds (such as high glucose and low pH) or combined with external stimuli (such as light or magnetic field) to achieve controllable drug release, gel degradation, and microenvironment improvements in order to overcome these clinical issues. These responsive-hydrogel dressings are anticipated to play a significant role in diabetic therapeutic wound dressings. Here, we review recent advances on responsive-hydrogel dressings towards diabetic wound healing, with focus on hydrogel structure design, the principle of responsiveness, and the behavior of degradation. Last but not least, the advantages and limitations of these responsive-hydrogels in clinical applications will also be discussed. We hope that this review will contribute to furthering progress on hydrogels as an improved dressing for diabetic wound healing and practical clinical application.
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Affiliation(s)
- Ying Chen
- Fujian Provincial Key Laboratory of Innovative Drug Target Research and State Key Laboratory of Cellular Stress Biology, School of Pharmaceutical Sciences, Xiamen University, Xiamen, 361102, Fujian, China
| | - Xing Wang
- Beijing National Laboratory for Molecular Sciences, Institute of Chemistry, Chinese Academy of Sciences, Beijing, 100090, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Sheng Tao
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100091, China
| | - Qi Wang
- Fujian Provincial Key Laboratory of Innovative Drug Target Research and State Key Laboratory of Cellular Stress Biology, School of Pharmaceutical Sciences, Xiamen University, Xiamen, 361102, Fujian, China
| | - Pan-Qin Ma
- Fujian Provincial Key Laboratory of Innovative Drug Target Research and State Key Laboratory of Cellular Stress Biology, School of Pharmaceutical Sciences, Xiamen University, Xiamen, 361102, Fujian, China
| | - Zi-Biao Li
- Institute of Materials Research and Engineering, A*STAR (Agency for Science, Technology and Research), Singapore, 138634, Singapore.
| | - Yun-Long Wu
- Fujian Provincial Key Laboratory of Innovative Drug Target Research and State Key Laboratory of Cellular Stress Biology, School of Pharmaceutical Sciences, Xiamen University, Xiamen, 361102, Fujian, China.
| | - Da-Wei Li
- Senior Department of Orthopedics, the Fourth Medical Center of PLA General Hospital, Beijing, 100091, China.
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29
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Jepson H, Lazzarini PA, Garrett M, Carroll MR. How does the clinical practice of Aotearoa New Zealand podiatrists align with international guidelines for the prevention of diabetes-related foot disease? A cross-sectional survey. J Foot Ankle Res 2023; 16:53. [PMID: 37605269 PMCID: PMC10464278 DOI: 10.1186/s13047-023-00651-x] [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: 05/28/2023] [Accepted: 08/02/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Given the importance of preventive care for the lower limb in people with diabetes, and the absence of local guidelines in Aotearoa New Zealand (NZ), the aim of this study was to determine the alignment of assessment and management used in the prevention of diabetes-related foot disease by NZ podiatrists to the international prevention guideline recommendations. METHODS A 37-item web-based survey was developed using a 5-point Likert scale (0 = always; 5 = never) based on the International Working Group of the Diabetic Foot (IWGDF) 2019 prevention guidelines and included domains on participant demographics, sector, caseloads, guidelines, screening, management, education, and referral. The survey was distributed to NZ podiatrists through the NZ podiatry association and social media. Participants completing > 50% of items were included. The Mann-Whitney U test was used to examine differences between sector subgroups. RESULTS Seventy-seven responses (16.3% of the NZ podiatry workforce) were received, of which 52 completed > 50% of items and were included. Of those 52 podiatrists, 73% were from the private sector. Public sector podiatrists reported higher weekly caseloads of patients with diabetes (p = 0.03) and foot ulcers (p < 0.001). The New Zealand Society for the Study of Diabetes (NZSSD) risk stratification pathway and IWGDF guidelines were the two most frequently utilised guidance documents. Participants reported median scores of at least "often" (< 2) for all items in the assessment and management, inspection, examination, and education provision domains for people with a high-risk foot. More than 50% of respondents reported screening more frequently than guideline recommendations for people with a very low to moderate risk foot. Structured education program was only used by 4 (5%) participants. Public sector podiatrists reported greater provision of custom-made footwear (p = 0.04) and multi-disciplinary team care (p = 0.03). CONCLUSION NZ podiatrists generally follow international guideline recommendations with respect to screening, self-care education, appropriate footwear, and treatment of risk factors for people at-risk of diabetes-related foot disease. However there may be over-screening of people with very low to medium risk occurring in clinical practice. Increasing access to integrated healthcare, custom-made footwear and structured educational programmes appear to be areas of practice that could be developed in future to help prevent diabetes-related foot disease in NZ.
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Affiliation(s)
- Hannah Jepson
- Department of Podiatry, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia
- Metro North Hospital and Health Service, Allied Health Research Collaborative, Brisbane, QLD, Australia
| | - Michele Garrett
- Community and Long Term Conditions Directorate, Te Toka Tumai, Auckland, New Zealand
| | - Matthew R Carroll
- Department of Podiatry, School of Clinical Sciences, Faculty of Health & Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand
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30
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Andersson S, Scandurra I, Nyström U, Varemo M, Hellstrand Tang U. Experiences of a Novel Structured Foot Examination Form for Patients With Diabetes From the Perspective of Health Care Professionals: Qualitative Study. JMIR Nurs 2023; 6:e45501. [PMID: 37463012 PMCID: PMC10488031 DOI: 10.2196/45501] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/07/2023] [Indexed: 07/21/2023] Open
Abstract
BACKGROUND Diabetes is a growing threat to public health, and secondary diseases like foot complications are common. Foot ulcers affect the individual's quality of life and are a great cost to society. Regular foot examinations prevent foot ulcers and are a recommended approach both in Sweden and worldwide. Despite existing guidelines, there are differences in the execution of the foot examination, which results in care inequality. A structured foot examination form based on current guidelines was developed in this study as the first step toward digitalized support in the daily routine, and was validated by diabetes health care professionals. OBJECTIVE The study aimed to validate a structured foot examination form by assessing health care professionals' experiences of working with it "foot side" when examining patients with diabetes. METHODS Semistructured interviews were held in a focus group and individually with 8 informants from different diabetes professions, who were interviewed regarding their experiences of working with the form in clinical practice. The users' data were analyzed inductively using qualitative content analysis. The study is part of a larger project entitled "Optimised care of persons with diabetes and foot complications," with Västra Götaland Region as the responsible health care authority, where the results will be further developed. RESULTS Experiences of working with the form were that it simplified the foot examination by giving it an overview and a clear structure. Using the form made differences in work routines between individuals apparent. It was believed that implementing the form routinely would contribute to a more uniform execution. When patients had foot ulcers, the risk categories (established in guidelines) were perceived as contradictory. For example, there was uncertainty about the definition of chronic ulcers and callosities. The expectations were that the future digital format would simplify documentation and elucidate the foot examination, as well as contribute to the accessibility of updated and relevant data for all individuals concerned. CONCLUSIONS The foot examination form works well as a support tool during preventive foot examination, creates a basis for decision-making, and could contribute to a uniform and safer foot examination with more care equality in agreement with current guidelines. TRIAL REGISTRATION ClinicalTrials.gov NCT05692778; https://clinicaltrials.gov/ct2/show/NCT05692778.
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Affiliation(s)
| | - Isabella Scandurra
- Centre of Empirical Research in Information Systems, Örebro University, Örebro, Sweden
| | - Ulrika Nyström
- Health Centre Dagson Uddevalla, Primary Care Västra Götalandsregionen and Municipal Care, Trollhättan, Sweden
| | - Marika Varemo
- Department of Medicine, Northern Älvsborg County Hospital, Trollhättan, Sweden
| | - Ulla Hellstrand Tang
- Department of Prosthetics and Orthotics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kumar S, Bharali A, Sarma H, Kushari S, Gam S, Hazarika I, Prasad SK, Laloo D. Traditional complementary and alternative medicine (TCAM) for diabetic foot ulcer management: A systematic review. J Ayurveda Integr Med 2023; 14:100745. [PMID: 37441954 PMCID: PMC10435959 DOI: 10.1016/j.jaim.2023.100745] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 07/15/2023] Open
Abstract
Diabetic Foot Ulcers (DFUs) are a devastating micro-vascular complication of diabetes with an increased prevalence and incidence and high rate of morbidity and mortality. Since antibiotics are frequently used to treat DFU, managing the condition has proven to be extremely challenging and may eventually lead to the development of antibiotic resistance. Scientists from around the world are working to develop an alternative solution to the problem of drug resistance by exploring complementary and alternative medicines that may be obtained from natural sources. Hence, the review aims to comprehensively report the information on the natural treatments and therapy used to manage DFU. All of the information described in the current study was gathered from electronic scientific resources, including Google Scholar, PubMed, Scopus, Science Direct, and Springer Link. Findings from the current review revealed the pre-clinical and clinical utility of 18 medicinal plants, 1 isolated compound, 7 polyherbal formulations including herbal creams, a few micronutrients including vitamins and minerals, insect products such as propolis, honey and, Maggot debridement therapy for the treatment and management of DFU. Natural therapies possess better efficacy, low cost, and shorter duration of treatment when compared with the conventional treatments; hence, all information made available about them is crucial to alter the direction of treatment. Furthermore, the data presented in this review are up to date on the potential efficacy of natural complementary medicines for alleviating DFU problems in in vitro and in vivo tests, as well as clinical studies.
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Affiliation(s)
- Suman Kumar
- Assam Science and Technology University, Guwahati, 781013, Assam, India; Department of Pharmaceutical Chemistry, Girijananda Chowdhury Institute of Pharmaceutical Science, Girijananda Chowdhury University, Guwahati, 781017, Assam, India
| | - Alakesh Bharali
- Department of Pharmaceutics, Girijananda Chowdhury Institute of Pharmaceutical Science, Girijananda Chowdhury University, Guwahati, 781017, Assam, India
| | - Himangshu Sarma
- Department of Pharmacognosy, NETES Institute of Pharmaceutical Science, Mirza, 781101, Assam, India
| | - Susankar Kushari
- Assam Science and Technology University, Guwahati, 781013, Assam, India; Department of Pharmaceutical Chemistry, Girijananda Chowdhury Institute of Pharmaceutical Science, Girijananda Chowdhury University, Guwahati, 781017, Assam, India
| | - Sameeran Gam
- Department of Pharmacognosy, NETES Institute of Pharmaceutical Science, Mirza, 781101, Assam, India
| | - Iswar Hazarika
- Department of Pharmacology, Girijananda Chowdhury Institute of Pharmaceutical Science, Girijananda Chowdhury University, Guwahati, 781017, Assam, India
| | - Satyendra K Prasad
- Department of Pharmacognosy, R.T.M. Nagpur University, Nagpur, 440033, India
| | - Damiki Laloo
- Assam Science and Technology University, Guwahati, 781013, Assam, India; Phytochemical Research Laboratory, Department of Pharmacognosy, Girijananda Chowdhury Institute of Pharmaceutical Science, Girijananda Chowdhury University, Guwahati, 781017, Assam, India.
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Serpico L, Dello Iacono S, Cammarano A, De Stefano L. Recent Advances in Stimuli-Responsive Hydrogel-Based Wound Dressing. Gels 2023; 9:451. [PMID: 37367122 DOI: 10.3390/gels9060451] [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: 05/03/2023] [Revised: 05/24/2023] [Accepted: 05/28/2023] [Indexed: 06/28/2023] Open
Abstract
Polymeric materials have found increasing use in biomedical applications in the last decades. Among them, hydrogels represent the chosen class of materials to use in this field, in particular as wound dressings. They are generally non-toxic, biocompatible, and biodegradable, and they can absorb large amounts of exudates. Moreover, hydrogels actively contribute to skin repair promoting fibroblast proliferation and keratinocyte migration, allowing oxygen to permeate, and protecting wounds from microbial invasion. As wound dressing, stimuli-responsive systems are particularly advantageous since they can be active only in response to specific environmental stimuli (such as pH, light, ROS concentration, temperature, and glucose level). In this review, we briefly resume the human skin's structure and functions, as well as the wound healing phases; then, we present recent advances in stimuli-responsive hydrogels-based wound dressings. Lastly, we provide a bibliometric analysis of knowledge produced in the field.
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Affiliation(s)
- Luigia Serpico
- Institute of Applied Sciences and Intelligent Systems (ISASI), National Research Council, Via P. Castellino 111, 80131 Naples, Italy
- Materias Srl, Corso N. Protopisani 50, 80146 Naples, Italy
| | - Stefania Dello Iacono
- Institute of Polymers, Composites and Biomaterials (IPCB), National Research Council, P.le E. Fermi 1, 80055 Portici, Italy
| | | | - Luca De Stefano
- Institute of Applied Sciences and Intelligent Systems (ISASI), National Research Council, Via P. Castellino 111, 80131 Naples, Italy
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33
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Sigmon LB, Woodard EK. What Patients Think: A Study Examining Perceptions of Teamwork, Self-Management, and Quality of Life of Patients Diagnosed With Diabetic Foot Ulceration. Clin Diabetes 2023; 41:518-525. [PMID: 37849512 PMCID: PMC10577505 DOI: 10.2337/cd22-0112] [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] [Indexed: 10/19/2023]
Abstract
Identifying strategies to support patients diagnosed with diabetic foot ulceration (DFU) is essential to affect not only wound outcomes but also mortality and quality of life. This article reports on a cross-sectional, descriptive, correlational study of patients receiving treatment for DFU at a specialty clinic. Most participants were <60 years of age and had been diagnosed with diabetes for >5 years. Results indicated that patients with higher self-management scores reported improved general health, physical functioning, and quality of life. These findings, in a younger patient population with normal work and family obligations, suggest that interventions supporting self-management behaviors can improve physical, emotional, and general health and, ultimately, quality of life. The involvement of an interprofessional care team enhances these self-management behaviors.
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Rangwala US, Tashrifwala F, Egbert NN, Asif AA. The Potential of Topical Therapy for Diabetic Wounds: A Narrative Review. Cureus 2023; 15:e36887. [PMID: 37128530 PMCID: PMC10147563 DOI: 10.7759/cureus.36887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 03/31/2023] Open
Abstract
The rising prevalence of diabetes mellitus brings with it a rise in the occurrence of several complications of the disease such as chronic non-healing wounds. Diabetics are more prone to developing chronic wounds due to complications like peripheral neuropathy, poor foot care, hyperglycaemia and peripheral vascular diseases. The aim of this review is to discuss the various imbalances in the cytokine environment of diabetic wounds and to explore the developments in their management with an emphasis on agents that may be used topically to aid the healing process of chronic wounds. A systematic search was conducted on Scopus, PubMed and Google Scholar and relevant articles were shortlisted. We conclude that increased blood sugar impairs most phases of wound healing in several ways. Supplementary therapy with either topical or systemic cytokines is shown to promote wound healing in a diabetic wound.
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35
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Athonvarangkul D, Wang K, Deng Y, Inzucchi SE, Mayerson A. Improved extremity tissue oxygenation with short-term exposure to textiles embedded with far infrared light emitting thermoactive particles in patients with diabetes mellitus. Diab Vasc Dis Res 2023; 20:14791641231170282. [PMID: 37073436 PMCID: PMC10123901 DOI: 10.1177/14791641231170282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Abstract
METHODS A single-center, prospective, randomized, placebo-controlled, double-blinded, crossover study of 32 subjects with either type 1 or type 2 DM. An active FIR wrap followed by a placebo wrap (or vice versa) was applied to the arm, calf, ankle, and forefoot for 60 min each with continuous TcPO2 measurements. The treatment effect of the active versus placebo wrap was estimated using a linear mixed effect model adjusted for period, sequence, baseline value, and anatomic site. RESULTS The active FIR wrap increased mean TcPO2 at the arm (2.6 ± 0.8 mmHg, p = .002), calf (1.5 ± 0.7 mmHg, p = .03), and ankle (1.7 ± 0.8 mmHg, p = .04) and composite of all sites (1.4 ± 0.5 mmHg, p = .002) after 60 min. The estimated treatment effect was significant for the active FIR wrap at the calf (1.5 ± 0.7 mmHg, p = .045) and in composite of all sites (1.2 ± 0.5 mmHg, p = .013). CONCLUSION Short-term exposure to FIR textiles improves peripheral tissue oxygenation in patients with diabetes.
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Affiliation(s)
- Diana Athonvarangkul
- Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, West Haven Veterans Affairs Medical Center, West Haven, CT, USA
| | - Kaicheng Wang
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Yanhong Deng
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Silvio E Inzucchi
- Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
| | - Adam Mayerson
- Department of Internal Medicine, Section of Endocrinology, Yale School of Medicine, New Haven, CT, USA
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36
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Lemarchand M, Thouin K, De Serres-Bérard T, Bellenfant S, Cadau S, Berthod F. In vitro glycation of a tissue-engineered wound healing model to mimic diabetic ulcers. Biotechnol Bioeng 2023; 120:1657-1666. [PMID: 36810698 DOI: 10.1002/bit.28359] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/08/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023]
Abstract
Diabetic foot ulcers are a major complication of diabetes that occurs following minor trauma. Diabetes-induced hyperglycemia is a leading factor inducing ulcer formation and manifests notably through the accumulation of advanced glycation end-products (AGEs) such as N-carboxymethyl-lysin. AGEs have a negative impact on angiogenesis, innervation, and reepithelialization causing minor wounds to evolve into chronic ulcers which increases the risks of lower limb amputation. However, the impact of AGEs on wound healing is difficult to model (both in vitro on cells, and in vivo in animals) because it involves a long-term toxic effect. We have developed a tissue-engineered wound healing model made of human keratinocytes, fibroblasts, and endothelial cells cultured in a collagen sponge biomaterial. To mimic the deleterious effects induced by glycation on skin wound healing, the model was treated with 300 µM of glyoxal for 15 days to promote AGEs formation. Glyoxal treatment induced carboxymethyl-lysin accumulation and delayed wound closure in the skin mimicking diabetic ulcers. Moreover, this effect was reversed by the addition of aminoguanidine, an inhibitor of AGEs formation. This in vitro diabetic wound healing model could be a great tool for the screening of new molecules to improve the treatment of diabetic ulcers by preventing glycation.
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Affiliation(s)
- Mathias Lemarchand
- LOEX, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Kiefer Thouin
- LOEX, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | | | - Sabrina Bellenfant
- LOEX, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - Sébastien Cadau
- LOEX, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
| | - François Berthod
- LOEX, Centre de recherche du CHU de Québec-Université Laval, Québec, Canada.,Département de Chirurgie, Faculté de Médecine, Université Laval, Québec, Canada
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37
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Lo ZJ, Harish KB, Tan E, Zhu J, Chan S, Liew H, Hoi WH, Liang S, Cho YT, Koo HY, Wu K, Car J. A feasibility study on the efficacy of a patient-owned wound surveillance system for diabetic foot ulcer care (ePOWS study). Digit Health 2023; 9:20552076231205747. [PMID: 37808235 PMCID: PMC10559723 DOI: 10.1177/20552076231205747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
Objective Wound image analysis tools hold promise in helping patients to monitor their wounds. We aim to perform a novel feasibility study on the efficacy of a patient-owned wound surveillance system for diabetic foot ulcer (DFU) care. Methods This two-institutional, prospective, single-arm pilot study examined patients with DFU. An artificial intelligence-enabled image analysis app calculating the wound surface area was installed and patients or caregivers were instructed to take pictures of wounds during dressing changes. Patients were followed until wound deterioration, wound healing, or wound stability at 6 months occurred and the outcomes of interest included study adherence, algorithm performance, and user experience. Results Between January 2021 and December 2021, 39 patients were enrolled in the study, with a mean age of 61.6 ± 8.6 years, and 69% (n = 27) of subjects were male. All patients had documented diabetes and 85% (n = 33) of them had peripheral arterial disease. A mean follow-up for those completing the study was 12.0 ± 8.5 weeks. At the conclusion of the study, 80% of patients (n = 20) had primary wound healing whilst 20% (n = 5) had wound deterioration. The study completion rate was 64% (n = 25). Usage of the app for surveillance of DFU healing, as compared to physician evaluation, yielded a sensitivity of 100%, specificity of 20%, positive predictive value of 83%, and negative predictive value of 100%. Of those who provided user experience feedback, 59% (n = 10) felt the app was easy to use, 47% (n = 8) would recommend the wound analysis app to others but only 6% would pay for the app out of pocket (n = 1). Conclusion Implementation of a patient-owned wound surveillance system is feasible. Most patients were able to effectively monitor wounds using a smartphone app-based solution. The image analysis algorithm demonstrates strong performance in identifying wound healing and is capable of detecting deterioration prior to interval evaluation by a physician. Patients generally found the app easy to use but were reluctant to pay for the use of the solution out of pocket.
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Affiliation(s)
- Zhiwen J Lo
- Department of Surgery, Vascular Surgery Service, Woodlands Health, Singapore, Singapore
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | | | - Elaine Tan
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Julia Zhu
- National Healthcare Group Polyclinics, Singapore, Singapore
| | - Shaun Chan
- Department of General Surgery, Vascular Surgery Service, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Huiling Liew
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Wai H Hoi
- Department of Endocrinology, Woodlands Health, Singapore, Singapore
| | - Shanying Liang
- Department of Surgery, Vascular Surgery Service, Woodlands Health, Singapore, Singapore
| | - Yuan T Cho
- Department of Surgery, Vascular Surgery Service, Woodlands Health, Singapore, Singapore
| | - Hui Y Koo
- Group Integrated Care, National Healthcare Group, Singapore, Singapore
| | | | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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38
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Early detection of diabetic foot ulcers from thermal images using the bag of features technique. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Tanasescu D, Sabau D, Moisin A, Gherman C, Fleaca R, Bacila C, Mohor C, Tanasescu C. Risk assessment of amputation in patients with diabetic foot. Exp Ther Med 2022; 25:12. [PMID: 36561621 PMCID: PMC9748709 DOI: 10.3892/etm.2022.11711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
The prevalence of diabetes has increased dramatically over the past decade, especially in developing countries, reaching pandemic proportions. Although has been the most important factor influencing the prevalence of type 2 diabetes, the prevalence of type 2 diabetes is on the increase among younger adults. The subsequent rate of increase with age is variable, which is more evident in societies where the general prevalence of the disease is higher. Based on clinical and statistical data obtained from the patients who were admitted to The First and Second Surgery Wards in the Sibiu County Emergency University Clinical Hospital (Sibiu, Romania) and the Proctoven Clinic (Sibiu, Romania) between January 2018 and December 2020, the present study attempted to devise a risk score that can be applied for the benefit of patients. The ultimate aim was that this risk score may be eventually applied by diabetologists and surgeons to assess the risk of amputation in patients with diabetic foot lesions. An important part in the therapeutic management of diabetic foot injuries is the assessment of risk factors. Using this risk score system devised, the risk factors that were found to exert influence in aggravating diabetic foot injuries are smoking, obesity, dyslipidaemia, unbalanced diabetes mellitus (glycated haemoglobin ≥7.5%), duration of diabetes >5 years, hepatic steatosis and the co-existence of various heart diseases. To conclude, all these risk factors aforementioned can decrease the effectiveness of treatment and can have a significant impact on the quality of life, if they are not well known.
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Affiliation(s)
- Denisa Tanasescu
- Department of Nursing and Dentistry, ‘Lucian Blaga’ University of Sibiu, Faculty of General Medicine, 550169 Sibiu, Romania,Proctoven Clinic, 550112 Sibiu, Romania
| | - Dan Sabau
- Department of Surgery, Sibiu County Emergency University Clinical Hospital, 550245 Sibiu, Romania,Surgical Clinical Department, ‘Lucian Blaga’ University of Sibiu, Faculty of General Medicine, 550169 Sibiu, Romania
| | - Andrei Moisin
- Department of Surgery, Sibiu County Emergency University Clinical Hospital, 550245 Sibiu, Romania,Correspondence to: Dr Andrei Moisin, Department of Surgery, Sibiu County Emergency University Clinical Hospital, 2-4 Corneliu Coposu Bvd, 550245 Sibiu, Romania
| | - Claudia Gherman
- 2nd Department of Surgery, Cluj-Napoca County Emergency Clinical Hospital, 400347 Cluj-Napoca, Romania,Surgical Clinical Department, ‘Iuliu Hatieganu’ University of Medicine and Pharmacy, Faculty of General Medicine, 400012 Cluj-Napoca, Romania
| | - Radu Fleaca
- Department of Surgery, Sibiu County Emergency University Clinical Hospital, 550245 Sibiu, Romania,Surgical Clinical Department, ‘Lucian Blaga’ University of Sibiu, Faculty of General Medicine, 550169 Sibiu, Romania
| | - Ciprian Bacila
- Department of Nursing and Dentistry, ‘Lucian Blaga’ University of Sibiu, Faculty of General Medicine, 550169 Sibiu, Romania,Clinical Hospital of Psychiatry, ‘Dr. Gheorghe Preda’, 550082 Sibiu, Romania
| | - Calin Mohor
- Department of Surgery, Sibiu County Emergency University Clinical Hospital, 550245 Sibiu, Romania,Preclinical Department, ‘Lucian Blaga’ University of Sibiu, Faculty of General Medicine, 550169 Sibiu, Romania
| | - Ciprian Tanasescu
- Proctoven Clinic, 550112 Sibiu, Romania,Department of Surgery, Sibiu County Emergency University Clinical Hospital, 550245 Sibiu, Romania,Surgical Clinical Department, ‘Lucian Blaga’ University of Sibiu, Faculty of General Medicine, 550169 Sibiu, Romania
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Srivastava P, Sondak T, Sivashanmugam K, Kim KS. A Review of Immunomodulatory Reprogramming by Probiotics in Combating Chronic and Acute Diabetic Foot Ulcers (DFUs). Pharmaceutics 2022; 14:2436. [PMID: 36365254 PMCID: PMC9699442 DOI: 10.3390/pharmaceutics14112436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 08/29/2023] Open
Abstract
Diabetic foot ulcers (DFUs) are characterized by a lack of angiogenesis and distal limb diabetic neuropathy. This makes it possible for opportunistic pathogens to protect the biofilm-encased micro-communities, causing a delay in wound healing. The acute and chronic phases of DFU-associated infections are distinguished by the differential expression of innate proinflammatory cytokines and tumor necrosis factors (TNF-α and -β). Efforts are being made to reduce the microbial bioburden of wounds by using therapies such as debridement, hyperbaric oxygen therapy, shock wave therapy, and empirical antibiotic treatment. However, the constant evolution of pathogens limits the effectiveness of these therapies. In the wound-healing process, continuous homeostasis and remodeling processes by commensal microbes undoubtedly provide a protective barrier against diverse pathogens. Among commensal microbes, probiotics are beneficial microbes that should be administered orally or topically to regulate gut-skin interaction and to activate inflammation and proinflammatory cytokine production. The goal of this review is to bridge the gap between the role of probiotics in managing the innate immune response and the function of proinflammatory mediators in diabetic wound healing. We also highlight probiotic encapsulation or nanoformulations with prebiotics and extracellular vesicles (EVs) as innovative ways to tackle target DFUs.
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Affiliation(s)
- Prakhar Srivastava
- Department of Chemistry and Chemistry Institute of Functional Materials, Pusan National University, Busan 46241, Korea
| | - Tesalonika Sondak
- Department of Chemistry and Chemistry Institute of Functional Materials, Pusan National University, Busan 46241, Korea
| | - Karthikeyan Sivashanmugam
- School of Biosciences and Technology, High Throughput Screening Lab, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - Kwang-sun Kim
- Department of Chemistry and Chemistry Institute of Functional Materials, Pusan National University, Busan 46241, Korea
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41
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Transcultural adaptation of the Malayalam version of the diabetic foot ulcer scale-short form. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Hu Y, Li H, Lv X, Xu Y, Xie Y, Yuwen L, Song Y, Li S, Shao J, Yang D. Stimuli-responsive therapeutic systems for the treatment of diabetic infected wounds. NANOSCALE 2022; 14:12967-12983. [PMID: 36065785 DOI: 10.1039/d2nr03756d] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Diabetic wound infection is a common disease that has significantly reduced people's quality of life. Although tremendous achievements have been made in clinical treatment, the crucial challenge in diabetic infected wound management stems from the detrimental diabetic wound environment and the emergence of bacterial resistance after long-term medication, which result in a reduced efficacy, an increased dosage of medication, and severe side effects. To tackle these issues, it is of great significance to develop an innovative treatment strategy for diabetic wound infection therapy. Currently, the exploitation of nanobiomaterial-based therapeutic systems for diabetic infected wounds is booming, and therapeutic systems with a stimuli-responsive performance have received extensive attention. These therapeutic systems are able to accelerate diabetic infected wound healing due to the on-demand release of therapeutic agents in diabetic infected wounds in response to stimulating factors. Based on the characteristics of diabetic infected wounds, many endogenous stimuli-responsive (e.g., glucose, enzyme, hypoxia, and acidity) therapeutic systems have been employed for the targeted treatment of infected wounds in diabetic patients. Additionally, exogenous stimulants, including light, magnetism, and temperature, are also capable of achieving on-demand drug release and activation. In this review, the characteristics of diabetic infected wounds are presented, and then exogenous/endogenous stimuli therapeutic systems for the treatment of diabetic infected wounds are summarized. Finally, the current challenges and future outlook of stimuli-responsive therapeutic systems are also discussed.
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Affiliation(s)
- Yanling Hu
- Nanjing Polytechnic Institute, Nanjing 210048, China
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), School of Physical and Mathematical Sciences, Nanjing Tech University (NanjingTech), Nanjing 211816, China.
| | - Hui Li
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), School of Physical and Mathematical Sciences, Nanjing Tech University (NanjingTech), Nanjing 211816, China.
| | - Xinyi Lv
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), School of Physical and Mathematical Sciences, Nanjing Tech University (NanjingTech), Nanjing 211816, China.
| | - Yan Xu
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), School of Physical and Mathematical Sciences, Nanjing Tech University (NanjingTech), Nanjing 211816, China.
| | - Yannan Xie
- State Key Lab Organic Electronics & Information Displays (KLOEID), Institute of Advanced Materials (IAM), and Synergetic Innovation Center for Organic Electronics and Information Displays, Nanjing University of Posts & Telecommunications, Nanjing 210023, China.
| | - Lihui Yuwen
- State Key Lab Organic Electronics & Information Displays (KLOEID), Institute of Advanced Materials (IAM), and Synergetic Innovation Center for Organic Electronics and Information Displays, Nanjing University of Posts & Telecommunications, Nanjing 210023, China.
| | - Yingnan Song
- Department of Physiology, School of Basic Medical Sciences, Guizhou Medical University, Guiyang, China
| | - Shengke Li
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macau SAR, China.
| | - Jinjun Shao
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), School of Physical and Mathematical Sciences, Nanjing Tech University (NanjingTech), Nanjing 211816, China.
| | - Dongliang Yang
- Key Laboratory of Flexible Electronics (KLOFE) and Institute of Advanced Materials (IAM), School of Physical and Mathematical Sciences, Nanjing Tech University (NanjingTech), Nanjing 211816, China.
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Du L, Zeng D, Hu X, Ren X, He D. The efficacy of autologous platelet-rich gel and traditional Chinese medicine in diabetic foot treatment: a parallel randomized controlled clinical trial. Ann Vasc Surg 2022; 87:529-537. [PMID: 36064130 DOI: 10.1016/j.avsg.2022.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/30/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Diabetic Foot (DF) is a prevalent metabolic infection. DF wounds are the basis for all cases of non-traumatic lower limbs amputations in diabetes. DF care approaches include debridement of wound, pressure relief in the wounded area, proper wound, infection and ischemia management. However, there is a need for research to develop more effective therapeutic approaches. This study investigated the effectivity and safety of autologous platelet-rich gel combined with conventional treatment and traditional Chinese medicine (TCM) in diabetic foot ulcers therapy. METHODS Sixty diabetic foot ulcer patients were divided into treatment and control groups of 30 patients each. The treatment group involved a combination of autologous platelet-rich gel, conventional treatment, and TCM. The control group was only treated with a combination of conventional therapy and TCM. Laboratory variables, including platelets, hemoglobin, albumin, and HbA1c, were analyzed and compared between treatment and control groups at baseline and end-point. Healing area, volume, and rates were compared in both groups. RESULTS basic patients' data and the wound conditions had no significant difference between treatment and control group. The treatment and control groups cure rates were 93.3% vs. 50%, respectively. The healing rate per two weeks was significantly higher in the treatment than in control group (0.78±0.05 vs. 0.43±0.04). There was no statistically significant difference in the platelets, hemoglobin, albumin, and HbA1c levels in the treatment and control groups. CONCLUSION Autologous platelet-rich gel combined with conventional treatment and traditional Chinese medicine (TCM) is effective and safe for diabetic foot ulcers treatment.
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Affiliation(s)
- Liangliang Du
- Department of Endocrinology, Yueyang Hospital of Traditional Chinese Medicine, No.269 Fengqiao Lake Road, Yueyang City, Hunan Province
| | - Douyun Zeng
- Department of Endocrinology, Yueyang Hospital of Traditional Chinese Medicine, No.269 Fengqiao Lake Road, Yueyang City, Hunan Province
| | - Xian Hu
- Department of Endocrinology, Yueyang Hospital of Traditional Chinese Medicine, No.269 Fengqiao Lake Road, Yueyang City, Hunan Province
| | - Xi Ren
- Department of Endocrinology, Yueyang Hospital of Traditional Chinese Medicine, No.269 Fengqiao Lake Road, Yueyang City, Hunan Province
| | - Dazhi He
- Department of Endocrinology, Yueyang Hospital of Traditional Chinese Medicine, No.269 Fengqiao Lake Road, Yueyang City, Hunan Province.
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Sethuram L, Thomas J, Mukherjee A, Chandrasekaran N. A review on contemporary nanomaterial-based therapeutics for the treatment of diabetic foot ulcers (DFUs) with special reference to the Indian scenario. NANOSCALE ADVANCES 2022; 4:2367-2398. [PMID: 36134136 PMCID: PMC9418054 DOI: 10.1039/d1na00859e] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 04/06/2022] [Indexed: 05/08/2023]
Abstract
Diabetes mellitus (DM) is a predominant chronic metabolic syndrome, resulting in various complications and high mortality associated with diabetic foot ulcers (DFUs). Approximately 15-30% of diabetic patients suffer from DFUs, which is expected to increase annually. The major challenges in treating DFUs are associated with wound infections, alterations to inflammatory responses, angiogenesis and lack of extracellular matrix (ECM) components. Furthermore, the lack of targeted therapy and efficient wound dressings for diabetic wounds often results in extended hospitalization and limb amputations. Hence, it is essential to develop and improve DFU-specific therapies. Nanomaterial-based innovative approaches have tremendous potential for preventing and treating wound infections of bacterial origin. They have greater benefits compared to traditional wound dressing approaches. In this approach, the physiochemical features of nanomaterials allow researchers to employ different methods for diabetic wound healing applications. In this review, the status and prevalence of diabetes mellitus (DM) and amputations due to DFUs in India, the pathophysiology of DFUs and their complications are discussed. Additionally, nanomaterial-based approaches such as the use of nanoemulsions, nanoparticles, nanoliposomes and nanofibers for the treatment of DFUs are studied. Besides, emerging therapeutics such as bioengineered skin substitutes and nanomaterial-based innovative approaches such as antibacterial hyperthermia therapy and gene therapy for the treatment of DFUs are highlighted. The present nanomaterial-based techniques provide a strong base for future therapeutic approaches for skin regeneration strategies in the treatment of diabetic wounds.
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Affiliation(s)
- Lakshimipriya Sethuram
- Centre for Nanobiotechnology, Vellore Institute of Technology Vellore Tamilnadu India +91 416 2243092 +91 416 2202624
| | - John Thomas
- Centre for Nanobiotechnology, Vellore Institute of Technology Vellore Tamilnadu India +91 416 2243092 +91 416 2202624
| | - Amitava Mukherjee
- Centre for Nanobiotechnology, Vellore Institute of Technology Vellore Tamilnadu India +91 416 2243092 +91 416 2202624
| | - Natarajan Chandrasekaran
- Centre for Nanobiotechnology, Vellore Institute of Technology Vellore Tamilnadu India +91 416 2243092 +91 416 2202624
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Dhlamini T, Houreld NN. Clinical Effect of Photobiomodulation on Wound Healing of Diabetic Foot Ulcers: Does Skin Color Needs to Be Considered? J Diabetes Res 2022; 2022:3312840. [PMID: 36573132 PMCID: PMC9789897 DOI: 10.1155/2022/3312840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/15/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Diabetic foot ulcers (DFUs) are one of the most common complications of diabetes. DFUs impede patients' quality of life and are known to be unresponsive to conventional therapy. Photobiomodulation (PBM) is a pain-free, noninvasive treatment method that has been shown to promote chronic wound healing and has been successfully used for the treatment of DFUs. Since skin tone and color can affect the way light interacts with tissue, studies should take this into consideration when determining protocols for the use of PBM. This review is aimed at critically evaluating data of existing studies conducted to evaluate the clinical effect of PBM on DFUs, taking skin color into consideration. A literature search was conducted and resulted in articles on cell studies, animal studies, and clinical trials. Only 13 clinical trials and 2 clinical case studies were adopted and used in this review. All the clinical trials adopted for this review show evidence that PBM together with conventional treatment results in an increased healing rate of DFUs; however, only one study adjusted their protocol according to skin color. There are not enough studies conducted on people of color to determine the safety and efficacy of PBM therapy in such ethnic groups. Future randomized, placebo-controlled clinical trials are necessary on PBM and DFUs and should take skin color into consideration.
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Affiliation(s)
- Thabo Dhlamini
- Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, P.O. Box 17011, Doornfontein, South Africa 2028
| | - Nicolette Nadene Houreld
- Laser Research Centre, Faculty of Health Sciences, University of Johannesburg, P.O. Box 17011, Doornfontein, South Africa 2028
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