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Mamino E, Lithfous S, Pebayle T, Dufour A, Després O. Test-retest and inter-rater reliability of two devices measuring tactile mechanical detection thresholds in healthy adults: Semmes-Weinstein monofilaments and the cutaneous mechanical stimulator. Muscle Nerve 2024. [PMID: 39295499 DOI: 10.1002/mus.28258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 09/03/2024] [Accepted: 09/05/2024] [Indexed: 09/21/2024]
Abstract
INTRODUCTION/AIMS Limitations exist in evaluating mechanical detection thresholds (MDTs) due to a lack of dependable electronic instruments designed to assess Aβ fibers and measure MDTs across different body areas. This study aims to evaluate the test-retest and inter-rater reliability of the cutaneous mechanical stimulator (CMS), an electronic tactile stimulator, in quantifying MDTs. METHODS Using a test-retest design, participants underwent assessments of MDTs using Semmes-Weinstein monofilaments (SWM) and the CMS. This study included 27 healthy volunteers (mean age 24.07 ± 3.76 years). Two raters assessed MDTs using SWM and the CMS at two stimulation sites (the left hand and foot) in two experimental sessions approximately 2 weeks apart. RESULTS MDTs using SWM and the CMS showed excellent reliability on the hand (intraclass correlation coefficient [ICC] = .84) and foot (ICC = .90). A comparison of results obtained at the two sessions showed that MDTs on the hand displayed good reliability for both SWM (ICC = .63) and the CMS (ICC = .73), whereas MDTs on the foot displayed fair reliability for SWM (ICC = .50) and the CMS (ICC = .42). MDTs exhibited good inter-rater reliability with SWM (ICC = .66) and excellent inter-rater reliability with the CMS (ICC = .82) on the hand, as well as showing fair inter-rater reliability with SWM (ICC = .53) and good inter-rater reliability with the CMS (ICC = .60) on the foot. DISCUSSION The CMS showed superior inter-rater reliability, indicating its potential as a valuable tool for assessing tactile sensitivity in research and clinical settings.
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Affiliation(s)
- Elisa Mamino
- Laboratoire de Neurosciences Cognitives et Adaptives (LNCA), UMR 7364 CNRS-Université de Strasbourg (UNISTRA), Strasbourg, France
| | - Ségolène Lithfous
- Laboratoire de Neurosciences Cognitives et Adaptives (LNCA), UMR 7364 CNRS-Université de Strasbourg (UNISTRA), Strasbourg, France
| | - Thierry Pebayle
- Centre d'Investigations Neurocognitives et Neurophysiologiques (CI2N), UAR 3489 CNRS-Université de Strasbourg (UNISTRA), Strasbourg Cedex, France
| | - André Dufour
- Laboratoire de Neurosciences Cognitives et Adaptives (LNCA), UMR 7364 CNRS-Université de Strasbourg (UNISTRA), Strasbourg, France
- Centre d'Investigations Neurocognitives et Neurophysiologiques (CI2N), UAR 3489 CNRS-Université de Strasbourg (UNISTRA), Strasbourg Cedex, France
| | - Olivier Després
- Laboratoire de Neurosciences Cognitives et Adaptives (LNCA), UMR 7364 CNRS-Université de Strasbourg (UNISTRA), Strasbourg, France
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Tentolouris A, Stergioti A, Eleftheriadou I, Siafarikas C, Tsilingiris D. Screening tools for diabetic foot ulcers: a narrative review. Hormones (Athens) 2024:10.1007/s42000-024-00598-z. [PMID: 39227550 DOI: 10.1007/s42000-024-00598-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024]
Abstract
The prevalence of diabetic foot ulcers (DFUs) is 4 to 10% among people with diabetes mellitus. DFUs are associated with increased morbidity and mortality as well as reduced quality of life and have a significant impact on overall healthcare expenditure. The main predisposing factors for DFU are diabetic neuropathy, peripheral arterial disease, and trauma. The fact that a range of tests can be used to identify patients at risk for DFU often causes confusion among practitioners regarding which screening tests should be implemented in clinical practice. Herein we sought to determine whether tests of somatic nerve function, such as pinprick sensation, thermal (cold/hot) test, ankle reflexes, vibration perception, 10-g monofilament, Ipswich touch test, neuropathy disability score, and nerve conduction studies, predict the development of DFUs. In addition, we examined whether sudomotor function screening tests, such as Neuropad, sympathetic skin response, and other tests, such as elevated plantar pressure or temperature measurements, can be used for DFU screening. If not treated properly, DFUs can have serious consequences, including amputation, early detection and treatment are vital for patient outcomes.
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Affiliation(s)
- Anastasios Tentolouris
- First Department of Propaedeutic Internal Medicine and Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 11527, Greece.
| | - Anastasia Stergioti
- First Department of Propaedeutic Internal Medicine and Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 11527, Greece
| | - Ioanna Eleftheriadou
- First Department of Propaedeutic Internal Medicine and Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 11527, Greece
| | - Christos Siafarikas
- First Department of Propaedeutic Internal Medicine and Diabetes Center, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 11527, Greece
| | - Dimitrios Tsilingiris
- First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thracae, Dragana, Alexandroupolis, 68100, Greece
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Penitente PA, Onuki VTL, Goiato JCV, da Silva EVF, de Moraes Melo Neto CL, Turcio KHL, de Magalhães Bertoz AP, Dos Santos DM, Goiato MC. Influence of new complete dentures on the touch perception threshold and quality of life of edentulous patients. Gerodontology 2024. [PMID: 38563231 DOI: 10.1111/ger.12753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To evaluate the touch perception threshold of the alveolar mucosa and quality of life of edentulous patients before (T0) and 30 days after (T1) the insertion of new complete dentures. BACKGROUND Touch perception is important so that edentulous patients can detect the position of complete dentures in their mouth. MATERIALS AND METHODS This study included 32 complete denture wearers with good oral and systemic health and no temporomandibular disorders for at least 5 years. At each time point (T0 and T1), two tests were performed (touch perception threshold and quality-of-life scale). The touch perception threshold (Von Frey or Semmes-Weinstein test) was assessed using nylon monofilaments on the regions of the alveolar mucosa of the maxilla and mandible. The Oral Health Impact Profile for edentulous individuals (OHIP-EDENT) was administered to evaluate oral health-related quality of life. RESULTS In the maxilla and mandible, the touch perception thresholds for all regions of the alveolar mucosa were significantly lower at T1 than at T0. The OHIP-EDENT mean scores showed that the overall quality of life was significantly better at T1 (3.6) than at T0 (4.7), and a significant improvement in quality of life was observed in all domains of the OHIP-EDENT at T1. For touch perception threshold, effect sizes ranged from 0.4 to 0.8; and for quality of life, effect sizes ranged from 0.4 to 1.0. CONCLUSIONS New complete dentures reduced the touch perception threshold of the alveolar mucosa of both edentulous arches and improved individuals' quality of life.
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Affiliation(s)
- Paulo Augusto Penitente
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, São Paulo State University (UNESP), Aracatuba, São Paulo, Brazil
| | - Victoria Tiyemi Lopes Onuki
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, São Paulo State University (UNESP), Aracatuba, São Paulo, Brazil
| | | | | | | | - Karina Helga Leal Turcio
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, São Paulo State University (UNESP), Aracatuba, São Paulo, Brazil
| | | | - Daniela Micheline Dos Santos
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, São Paulo State University (UNESP), Aracatuba, São Paulo, Brazil
| | - Marcelo Coelho Goiato
- Department of Dental Materials and Prosthodontics, Aracatuba Dental School, São Paulo State University (UNESP), Aracatuba, São Paulo, Brazil
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Virgin LN. On the mechanics of monofilaments used in touch sensory perception. Med Eng Phys 2024; 123:104083. [PMID: 38365337 DOI: 10.1016/j.medengphy.2023.104083] [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: 10/18/2023] [Revised: 11/30/2023] [Accepted: 12/10/2023] [Indexed: 02/18/2024]
Abstract
The buckling of a slender monofilament is a standard clinical method used to assess touch sensory perception, with specific applications to somatosensory impairment in patients after a stroke, detecting carpal tunnel syndrome, and as a prognosis tool for diabetic peripheral neuropathy. The basis of this approach is the Semmes-Weinstein monofilament, which comprises a calibrated set of thin, polycarbonate rods with different diameters. Application of a monofilament onto the surface of the skin with increasing pressure causes the rod to buckle. That is, at a specific force of pushing down on the far end, the monofilament suddenly bows out sidewards - the buckling load. The ability of a patient to detect increasingly finer monofilament buckling (pressure threshold) is then used to assess sensory deterioration. This paper addresses the underlying mechanics of the buckling process. Despite the accuracy and repeatability problems that have been reported in the literature, and the necessarily subjective aspects of sensory physiology, the mathematical modeling of the monofilament buckling is unambiguous and provides some fundamental insight into the parameters that underlie this approach.
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Affiliation(s)
- Lawrence N Virgin
- Department of Mechanical Engineering, Duke University, Durham, NC 27708, USA.
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Yoo SH, Kim WJ, Chae JS, Kang BK, Kang MJ, Beak MH. Efficacy of scrambler therapy in patients with painful diabetic peripheral neuropathy: A single-arm, prospective, pilot study. Medicine (Baltimore) 2023; 102:e35357. [PMID: 37773810 PMCID: PMC10545242 DOI: 10.1097/md.0000000000035357] [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: 06/22/2023] [Accepted: 09/01/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND A variety of medications are available to manage painful diabetic peripheral neuropathy (DPN), but the proper treatment remains challenging. Accordingly, various neuromodulation modalities have been used. However, no prospective clinical trials have evaluated the use of scrambler therapy (ST) in painful DPN. This study aimed to explore the long-term effects of ST in managing painful DPN. METHODS The patients received 10 consecutive STs of 45 minutes every 1 to 2 days. The primary outcome was pain score. We measured the visual analog scale (VAS) pain scores at baseline, during ST, immediately after ST, and at 1, 2, 3, and 6 months after ST. The secondary outcomes were Michigan Neuropathy Screening Instrument (MNSI), Semmes-Weinstein monofilament test, and Leeds Assessment of Neuropathic Symptoms and Signs pain scores, which were measured at baseline, immediately after ST, and at 1, 2, 3, and 6 months after ST. RESULTS VAS scores showed significant improvement at the 8th, 9th, and 10th sessions during ST and 1 month after ST. The MNSI self-report component score was decreased 1 month after the ST. However, all other outcomes did not show significant differences compared to the baseline. CONCLUSION ST may have short-term effects and limited long-term effects on painful DPN.
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Affiliation(s)
- Seung Hee Yoo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Won-joong Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Ji Seon Chae
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Seoul Hospital, Seoul, Republic of Korea
| | - Bo Kyung Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Min Jeong Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Min Hyouk Beak
- Department of Anesthesiology and Pain Medicine, College of Medicine, Ewha Womans University, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
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Sharma K N S, Kumar H A. Assessment of the diagnostic accuracy of Vibrasense compared to a biothesiometer and nerve conduction study for screening diabetic peripheral neuropathy. J Foot Ankle Res 2023; 16:65. [PMID: 37770911 PMCID: PMC10537102 DOI: 10.1186/s13047-023-00667-3] [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: 05/26/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
AIMS Peripheral neuropathy is a common microvascular complication in diabetes and a risk factor for the development of diabetic foot ulcers and amputations. Vibrasense (Ayati Devices) is a handheld, battery-operated, rapid screening device for diabetic peripheral neuropathy (DPN) that works by quantifying vibration perception threshold (VPT). In this study, we compared Vibrasense against a biothesiometer and nerve conduction study for screening DPN. METHODS A total of 562 subjects with type 2 diabetes mellitus underwent neuropathy assessments including clinical examination, 10-g monofilament test, VPT evaluation with Vibrasense and a standard biothesiometer. Those with an average VPT ≥ 15 V with Vibrasense were noted to have DPN. A subset of these patients (N = 61) underwent nerve conduction study (NCS). Diagnostic accuracy of Vibrasense was compared against a standard biothesiometer and abnormal NCS. RESULTS Average VPTs measured with Vibrasense had a strong positive correlation with standard biothesiometer values (Spearman's correlation 0.891, P < 0.001). Vibrasense showed sensitivity and specificity of 87.89% and 86.81% compared to biothesiometer, and 82.14% and 78.79% compared to NCS, respectively. CONCLUSIONS Vibrasense demonstrated good diagnostic accuracy for detecting peripheral neuropathy in type 2 diabetes and can be an effective screening device in routine clinical settings. TRIAL REGISTRATION Clinical trials registry of India (CTRI/2022/11/047002). Registered 3 November 2022. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=76167 .
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Affiliation(s)
- Srihari Sharma K N
- College of Physiotherapy, Dayananda Sagar University, Shavige Malleshwara Hills, 1st Stage, Kumaraswamy Layout, Bangalore, Karnataka, India, 560111.
| | - Anil Kumar H
- Department of Medicine, Dr Chandramma Dayananda Sagar Institute of Medical Education and Research (CDSIMER), Kanakapura, Karnataka, India
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Nkonge KM, Nkonge DK, Nkonge TN. Screening for diabetic peripheral neuropathy in resource-limited settings. Diabetol Metab Syndr 2023; 15:55. [PMID: 36945043 PMCID: PMC10031885 DOI: 10.1186/s13098-023-01032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Diabetic neuropathy is the most common microvascular complication of diabetes mellitus and a major risk factor for diabetes-related lower-extremity complications. Diffuse neuropathy is the most frequently encountered pattern of neurological dysfunction and presents clinically as distal symmetrical sensorimotor polyneuropathy. Due to the increasing public health significance of diabetes mellitus and its complications, screening for diabetic peripheral neuropathy is essential. Consequently, a review of the principles that guide screening practices, especially in resource-limited clinical settings, is urgently needed. MAIN BODY Numerous evidence-based assessments are used to detect diabetic peripheral neuropathy. In accordance with current guideline recommendations from the American Diabetes Association, International Diabetes Federation, International Working Group on the Diabetic Foot, and National Institute for Health and Care Excellence, a screening algorithm for diabetic peripheral neuropathy based on multiphasic clinical assessment, stratification according to risk of developing diabetic foot syndrome, individualized treatment, and scheduled follow-up is suggested for use in resource-limited settings. CONCLUSIONS Screening for diabetic peripheral neuropathy in resource-limited settings requires a practical and comprehensive approach in order to promptly identify affected individuals. The principles of screening for diabetic peripheral neuropathy are: multiphasic approach, risk stratification, individualized treatment, and scheduled follow-up. Regular screening for diabetes-related foot disease using simple clinical assessments may improve patient outcomes.
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Stauffer SJ, Seth M, Pohlig RT, Beisheim-Ryan EH, Horne JR, Smith SC, Sarlo FB, Sions JM. Risk Factors for Underreporting of Life-Limiting Comorbidity Among Adults With Lower-Limb Loss. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231205083. [PMID: 37837278 PMCID: PMC10576913 DOI: 10.1177/00469580231205083] [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: 03/20/2023] [Revised: 07/29/2023] [Accepted: 09/05/2023] [Indexed: 10/15/2023]
Abstract
Peripheral neuropathy (PN) and peripheral arterial disease (PAD) are life-limiting comorbidities among adults with lower-limb loss that may not be adequately addressed in current care models. The objective of this study was to evaluate underreporting of PN and PAD among adults with lower-limb loss. We conducted a secondary analysis of a cross-sectional dataset of community-dwelling adults with unilateral lower-limb loss seen in an outpatient Limb Loss Clinic (n = 196; mean age = 56.7 ± 14.4 years; 73.5% male). Individuals participated in standardized clinical examinations including Semmes-Weinstein monofilament testing to assess for PN and pedal pulse palpation to assess for PAD. Bivariate regression was performed to identify key variables for subsequent stepwise logistic regression to discern risk factors. Clinical examination results indicated 16.8% (n = 33) of participants had suspected PN alone, 15.8% (n = 31) had suspected PAD alone, and 23.0% (n = 45) had suspected PN and PAD. More than half of participants with clinical examination findings of PN or PAD failed to self-report the condition (57.7% and 86.8%, respectively). Among adults with lower-limb loss with suspected PN, participants with dysvascular amputations were at lower risk of underreporting (odds ratio [OR] = 0.2, 95% CI: 0.1-0.6). For those with suspected PAD, those who reported more medication prescriptions were at lower risk of underreporting (OR = 0.8, 95% CI: 0.7-1.0). Adults with lower-limb loss underreport PN and PAD per a medical history checklist, which may indicate underdiagnosis or lack of patient awareness. Routine assessment is highly recommended in this population and may be especially critical among individuals with non-dysvascular etiology.
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Affiliation(s)
- Samantha Jeanne Stauffer
- University of Delaware, Newark, DE, USA
- Independence Prosthetics-Orthotics, Inc., Newark, DE, USA
| | - Mayank Seth
- University of Delaware, Newark, DE, USA
- Children’s Specialized Hospital, Union, NJ, USA
| | | | - Emma Haldane Beisheim-Ryan
- University of Delaware, Newark, DE, USA
- Defense Health Agency, Falls Church, VA, USA
- Naval Medical Center San Diego, San Diego, CA, USA
| | | | - Sarah Carolyn Smith
- University of Delaware, Newark, DE, USA
- University of Maryland, Baltimore, MD, USA
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Guo S, Jing Y, Li C, Zhu D, Wang W. Carotid atherosclerosis: An independent risk factor for small fiber nerve dysfunction in patients with type 2 diabetes mellitus. J Diabetes Investig 2022; 14:289-296. [PMID: 36350031 PMCID: PMC9889662 DOI: 10.1111/jdi.13936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 10/08/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022] Open
Abstract
AIMS/INTRODUCTION To explore whether carotid atherosclerosis is an independent risk factor for small fiber nerve dysfunction in type 2 diabetes mellitus patients. MATERIALS AND METHODS A total of 247 type 2 diabetes patients from Nanjing Drum Tower Hospital received carotid ultrasonography and quantitative sensory testing, including cold and warm detection thresholds, and some patients received cold and heat pain detection thresholds, respectively. According to the results of quantitative sensory testing, patients were divided into normal small fiber nerve function (NSF) and small fiber nerve dysfunction (SFD) group. Meanwhile, patients were divided into the non-carotid atherosclerosis group, carotid intimal thickening, unilateral carotid atherosclerosis and bilateral carotid atherosclerosis group. The correlation between carotid ultrasonography with quantitative sensory testing parameters was analyzed by SPSS 26.0. RESULTS First, the incidence rate of SFD increased significantly in patients with carotid atherosclerosis (72.2%, P < 0.001) especially in bilateral carotid atherosclerosis (81.7%, P < 0.001). Second, compared with the NS group, the carotid intima-media thickness in SFD was thicker (P = 0.018) and the size of atherosclerotic plaque was larger (P < 0.001). In addition, the cold detection threshold decreased (P < 0.001), whereas the warm detection threshold (P < 0.001) and heat pain detection threshold (P < 0.001) increased as aggravation of carotid atherosclerosis. In the correlation analysis, the size of atherosclerotic plaque presented a positive correlation with the warm detection threshold (r = 0.476, P < 0.001) and heat pain detection threshold (r = 0.213, P < 0.001), but presented a negative correlation with the cold detection threshold (r = -0.239, P < 0.01). Furthermore, carotid atherosclerosis (odds ratio 2.326, P = 0.017), especially bilateral carotid atherosclerosis (odds ratio 5.042, P = 0.001), was an independent risk factor for SFD (P < 0.05). CONCLUSIONS Carotid atherosclerosis was significantly associated with quantitative sensory testing and found to be an independent risk factor for small fiber nerve dysfunction in type 2 diabetes patients.
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Affiliation(s)
- Simin Guo
- Nanjing Drum Tower HospitalChinese Academy of Medical Science, Peking Union Medical College, Peking Union Medical College Hospital, Graduate School of Peking Union Medical CollegeNanjingChina
| | - Yali Jing
- Department of EndocrinologyDrum Tower Hospital Affiliated to Nanjing University Medical School, Branch of National Clinical Research Center for Metabolic DiseasesNanjingChina,Endocrine and Metabolic Disease Medical CenterDrum Tower Hospital affiliated to Nanjing University Medical SchoolNanjingChina
| | - Chenxi Li
- Department of EndocrinologyDrum Tower Hospital Affiliated to Nanjing University Medical School, Branch of National Clinical Research Center for Metabolic DiseasesNanjingChina,Endocrine and Metabolic Disease Medical CenterDrum Tower Hospital affiliated to Nanjing University Medical SchoolNanjingChina
| | - Dalong Zhu
- Department of EndocrinologyDrum Tower Hospital Affiliated to Nanjing University Medical School, Branch of National Clinical Research Center for Metabolic DiseasesNanjingChina,Endocrine and Metabolic Disease Medical CenterDrum Tower Hospital affiliated to Nanjing University Medical SchoolNanjingChina
| | - Weimin Wang
- Department of EndocrinologyDrum Tower Hospital Affiliated to Nanjing University Medical School, Branch of National Clinical Research Center for Metabolic DiseasesNanjingChina,Endocrine and Metabolic Disease Medical CenterDrum Tower Hospital affiliated to Nanjing University Medical SchoolNanjingChina
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Štotl I, Blagus R, Urbančič-Rovan V. Individualised screening of diabetic foot: creation of a prediction model based on penalised regression and assessment of theoretical efficacy. Diabetologia 2022; 65:291-300. [PMID: 34741637 DOI: 10.1007/s00125-021-05604-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/23/2021] [Indexed: 01/22/2023]
Abstract
AIMS/HYPOTHESIS A large proportion of people with diabetes do not receive proper foot screening due to insufficiencies in healthcare systems. Introducing an effective risk prediction model into the screening protocol would potentially reduce the required screening frequency for those considered at low risk for diabetic foot complications. The main aim of the study was to investigate the value of individualised risk assignment for foot complications for optimisation of screening. METHODS From 2015 to 2020, 11,878 routine follow-up foot investigations were performed in the tertiary diabetes clinic. From these, 4282 screening investigations with complete data containing all of 18 designated variables collected at regular clinical and foot screening visits were selected for the study sample. Penalised logistic regression models for the prediction of loss of protective sensation (LOPS) and loss of peripheral pulses (LPP) were developed and evaluated. RESULTS Using leave-one-out cross validation (LOOCV), the penalised regression model showed an AUC of 0.84 (95% CI 0.82, 0.85) for prediction of LOPS and 0.80 (95% CI 0.78, 0.83) for prediction of LPP. Calibration analysis (based on LOOCV) presented consistent recall of probabilities, with a Brier score of 0.08 (intercept 0.01 [95% CI -0.09, 0.12], slope 1.00 [95% CI 0.92, 1.09]) for LOPS and a Brier score of 0.05 (intercept 0.01 [95% CI -0.12, 0.14], slope 1.09 [95% CI 0.95, 1.22]) for LPP. In a hypothetical follow-up period of 2 years, the regular screening interval was increased from 1 year to 2 years for individuals at low risk. In individuals with an International Working Group on the Diabetic Foot (IWGDF) risk 0, we could show a 40.5% reduction in the absolute number of screening examinations (3614 instead of 6074 screenings) when a 10% risk cut-off was used and a 26.5% reduction (4463 instead of 6074 screenings) when the risk cut-off was set to 5%. CONCLUSIONS/INTERPRETATION Enhancement of the protocol for diabetic foot screening by inclusion of a prediction model allows differentiation of individuals with diabetes based on the likelihood of complications. This could potentially reduce the number of screenings needed in those considered at low risk of diabetic foot complications. The proposed model requires further refinement and external validation, but it shows the potential for improving compliance with screening guidelines.
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Affiliation(s)
- Iztok Štotl
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
| | - Rok Blagus
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Faculty of Sports, University of Ljubljana, Ljubljana, Slovenia
| | - Vilma Urbančič-Rovan
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Lyon MM. Diabetic Ulcer Prevention. PHYSICIAN ASSISTANT CLINICS 2022. [DOI: 10.1016/j.cpha.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leren L, Eide H, Johansen EA, Jelnes R, Ljoså TM. Background pain in persons with chronic leg ulcers: An exploratory study of symptom characteristics and management. Int Wound J 2021; 19:1357-1369. [PMID: 34897978 PMCID: PMC9493215 DOI: 10.1111/iwj.13730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022] Open
Abstract
This exploratory descriptive study aimed to describe characteristics and management of background pain related to chronic leg ulcers. A total of 121 participants were recruited from two wound care clinics using a consecutive sampling method. Data were obtained through screening interview, clinical examination, and questionnaires. The mean average background pain intensity was 4.5 (SD 2.56) (CI 95% 4.0-5.0). Pain interfered mostly with general activity (mean 4.3), sleep (mean 4.1), and walking ability (mean 4.0) (0-10 NRS). The most frequently reported descriptors of background pain were 'tender', 'stabbing', 'aching', and 'hot-burning'. Most of the participants stated that the pain was intermittent. Less than 60% had analgesics prescribed specifically for ulcer related pain, and the respondents reported that pain management provided a mean pain relief of 45.9% (SD 33.9, range 0-100). The findings indicate that ulcer related background pain is a significant problem that interferes with daily function, and that pain management in wound care is still inadequate.
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Affiliation(s)
- Lena Leren
- Centre for Health and Technology, Faculty of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- Centre for Health and Technology, Faculty of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Edda Aslaug Johansen
- Faculty of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Rolf Jelnes
- Medical Department, Hospital of Southern, Sonderborg, Denmark
| | - Tone Marte Ljoså
- Centre for Health and Technology, Faculty of Nursing and Health Sciences, University of South-Eastern Norway, Drammen, Norway
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Sharma C, Kaur I, Singh H, Grover IS, Singh J. A randomized comparative study of methylcobalamin, methylcobalamin plus pregabalin and methylcobalamin plus duloxetine in patients of painful diabetic neuropathy. Indian J Pharmacol 2021; 53:358-363. [PMID: 34854403 PMCID: PMC8641739 DOI: 10.4103/ijp.ijp_1159_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
CONTEXT: Diabetic neuropathy affects 10.5%–32.2% of diabetic population posing clinical burden onto society. AIMS: We aimed to study the efficacy, safety, and tolerability of methylcobalamin, methylcobalamin plus pregabalin, and methylcobalamin plus duloxetine in patients of painful diabetic neuropathy. SETTINGS AND DESIGN: It is a prospective, randomized, open-label, interventional, and parallel-group study done in patients of painful diabetic neuropathy. MATERIALS AND METHODS: A total of 100 patients were recruited and randomized to three study groups A, B, and C on methylcobalamin, methylcobalamin and pregabalin, and methylcobalamin and duloxetine, respectively. Patients were assessed at day 0 and 4, 8, and 12 weeks. The tuning fork test, monofilament test, Thermal Sensitivity testing, and Visual Analog Scale (VAS) were used to analyze vibration, pressure, thermal sensitivity, and pain. STATISTICAL ANALYSIS USED: The results are expressed as mean ± standard deviation. Appropriate statistical methods were used to calculate P value (<0.05 – significant). RESULTS: The increase in number of patients with vibration perception is 11.6%, 37.9%, and 41.4%; pressure sensation is 7.6%, 37.9%, and 37.9%; and thermal sensitivity is 15.4%, 31.1%, and 37.9% in Groups A, B, and C, respectively. The decrease in VAS scores is 0.58 ± 0.14, 3.82 ± 0.05, and 4.17 ± 0.48 in Groups A, B, and C correspondingly. The adverse effects reported in Groups A, B, and C are 0%, 6.9%, and 10.3%, respectively. CONCLUSIONS: Group C is more efficacious when compared to Groups A and B while Group B is safer.
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Affiliation(s)
- Chetna Sharma
- Department of Pharmacology, GMC, Amritsar, Punjab, India
| | - Inderpal Kaur
- Department of Pharmacology, GMC, Amritsar, Punjab, India
| | | | | | - Jatinder Singh
- Department of Pharmacology, GMC, Amritsar, Punjab, India
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Carmena-Pantoja M, Álvaro-Afonso FJ, García-Morales E, García-Álvarez Y, Tardáguila-García A, Lázaro-Martínez JL. The Influence of Arterial Calcification on Clinical Outcomes in Patients with Diabetic Foot Ulcer Complicated by Osteomyelitis Treated by Surgery. INT J LOW EXTR WOUND 2021:15347346211022587. [PMID: 34048273 DOI: 10.1177/15347346211022587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of our study was to analyze the influence of radiographic arterial calcification (RAC) on clinical outcomes and wound healing in patients with diabetic foot ulcers complicated by osteomyelitis treated by surgery. We analyzed retrospectively the clinical records of 102 patients with diabetic foot osteomyelitis who underwent surgery at a specialized diabetic foot unit between January 2014 and December 2016. The clinical data of evolution until its complete epithelialization and a follow-up 1 year were reviewed, and after reviewing the radiological images, patients were classified into 2 groups: those with RAC and those without RAC. We analyzed several clinical features in both groups. The presence of RAC was associated with a greater time of healing (10.68 ± 7.24 vs 8.11 ± 4.50 weeks; P = .029) and shorter time to recurrence and reulceration (13.30 ± 9.25 vs 18.81 ± 11.63 weeks; P = .036). However, this association was not found for patients with mild and moderate peripheral artery disease (PAD), whose time of healing was 8.97 ± 4.51 weeks compared to 9.16 ± 6.39 weeks for patients without PAD; P = .864. The time of healing of diabetic foot ulcers complicated by osteomyelitis treated by surgery can be negatively affected by the presence of RAC even more than by the presence of mild and moderate ischemia. The presence of RAC may offer clinical guidance at the level of primary care though this would need thorough validation in future studies.
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Affiliation(s)
| | - Francisco Javier Álvaro-Afonso
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 16734Universidad Complutense de Madrid, Madrid, Spain
| | - Esther García-Morales
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 16734Universidad Complutense de Madrid, Madrid, Spain
| | - Yolanda García-Álvarez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 16734Universidad Complutense de Madrid, Madrid, Spain
| | - Aroa Tardáguila-García
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 16734Universidad Complutense de Madrid, Madrid, Spain
| | - José Luis Lázaro-Martínez
- Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 16734Universidad Complutense de Madrid, Madrid, Spain
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Cetira-Filho EL, Costa FWG, Santos SE, Mello MDJR, Silva PGDB, de Aguiar ASW. Sensitive nerve function measurement in facial trauma: An observational study. J Clin Exp Dent 2021; 13:e14-e21. [PMID: 33425226 PMCID: PMC7781219 DOI: 10.4317/jced.56830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 08/10/2020] [Indexed: 11/05/2022] Open
Abstract
Background Facial trauma is responsible for various types of health damage and may be functional or aesthetic. Depending on the degree of energy released in this type of trauma, sometimes an irreversibility degree is obtained. This study aimed to perform an objective evaluation of traumatic peripheral nerve injuries resulting from mandibular fractures and midface, using silicon monofilaments.
Material and Methods This was an observational, cross-sectional study. All patients with maxillofacial fractures, who were hospitalized by the department of Oral and Maxillofacial Surgery of Instituto Dr. José Frota Hospital, were randomly recruited and screened for inclusion in the present study. Sixty patients, victims of automobile accidents or firearms, were evaluated using Semmes Weinstein monofilaments in the regions corresponding to the mental and infraorbital nerves, right and left.
Results The highest frequencies mandibular nerve changes were those that there was a loss protective sensation, but in which, the patient can feel deep pressure and pain; In which the worst sensory alterations occurred in patients’ victims of firearm. In the middle third of the face, the worst alterations were those that there was a loss of the protective and discriminating sensation for hot and cold.
Conclusions The use of monofilaments is a support tool in oral and maxillofacial traumatology for the diagnosis and monitoring of peripheral sensory alterations. Key words:Peripheral nerve injuries, facial trauma, wounds and injuries, accidents, traffic, violence.
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Affiliation(s)
- Edson-Luiz Cetira-Filho
- DDS,OMS, MSc student. Oral and Maxillofacial Surgeon and master's in science student in Federal University of Ceará (UFC). Professor of Mauricio de Nassau University (UNINASSAU), Fortaleza, Ceará, Brazil
| | - Fábio-Wildson-Gurgel Costa
- DDS, OMS, MSc, PhD. Oral and Maxillofacial Surgeon, MSc, PhD, Associate Professor, Department of Clinical Dentistry, UFC, Fortaleza, Ceará, Brazil
| | - Saulo-Ellery Santos
- DDS, OMS, MSc, PhD. Oral and Maxillofacial Surgeon, MSc, PhD, Associate Professor, Division of Oral Surgery, UNIFOR, Fortaleza, Ceará, Brazil
| | | | | | - Andréa-Silvia-Walter de Aguiar
- DDS, Oral and Maxillofacial Surgeon, MSc, PhD, Associate Professor, Department of Clinical Dentistry, UFC, Fortaleza, Ceará, Brazil
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Lewis HC, Cendales LC. Vascularized composite allotransplantation in the United States: A retrospective analysis of the Organ Procurement and Transplantation Network data after 5 years of the Final Rule. Am J Transplant 2021; 21:291-296. [PMID: 32484257 DOI: 10.1111/ajt.16086] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/30/2020] [Accepted: 05/03/2020] [Indexed: 01/25/2023]
Abstract
On July 3, 2014, the Organ Procurement and Transplantation Network (OPTN) began overseeing vascularized composite allotransplantation/allografts (VCA) in the United States. For the past 6 years, centers performing VCAs have been requested to submit data into a biometric repository, in parallel with systems used by solid organ transplant centers. Currently, 62 VCAs are reported in the entire OPTN database, with 36 of these transplants reported as performed after VCA was added to the OPTN Final Rule. Of these 36 recipients, 16 received uterus transplants, most of which (11) occurred from living donors. Ten patients received hand transplants and 6 received face transplants. Two patients received abdominal wall transplants, 1 patient received a scalp transplant, and 1 patient received a penile transplant. The present manuscript represents the query of a nationalized database for VCA type, immunosuppression treatment, and clinical outcomes for VCAs. This manuscript provides a report of the current VCA data reported to the OPTN after the Final Rule.
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Affiliation(s)
- Holly C Lewis
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Linda C Cendales
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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Abdominoplasty with Scarpa Fascia Preservation: Randomized Controlled Trial with Assessment of Scar Quality and Cutaneous Sensibility. Plast Reconstr Surg 2020; 146:156e-164e. [PMID: 32740578 DOI: 10.1097/prs.0000000000007024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Scarpa fascia preservation during abdominoplasty has been shown to reduce complications associated with the traditional technique. As an extension of a previously published randomized controlled trial, this study aims to clarify whether preservation of Scarpa fascia during abdominoplasty has an influence on scar quality or sensibility recovery. METHODS This was a single-center clinical trial, involving 160 patients randomly assigned to one of two surgical procedures: classic full abdominoplasty (group A) and abdominoplasty with preservation of Scarpa fascia (group B). Patients were later convoked to assess scar quality and abdominal cutaneous sensibility. Scar quality was evaluated through the Patient and Observer Scar Assessment Scale. Cutaneous sensibility was measured on the upper and lower abdomen, using light touch, Semmes-Weinstein testing (5.07/10-g monofilament), and a 25-gauge needle. RESULTS A total of 99 patients (group A, 54 patients; group B, 45 patients) responded to contact, with a mean follow-up time of 44 months. Concerning scar quality, Patient and Observer Scar Assessment Scale scores were similar between groups. On the upper abdomen, there was a statistically significant difference between groups on cutaneous sensibility, on the examination with the Semmes-Weinstein 5.07/10-g monofilament (group A, 79.6 percent; group B, 93.3 percent; p = 0.046) and pain (group A, 90.7 percent; group B, 100 percent; p = 0.044). No statistically significant differences were found between groups on the lower abdomen. A considerable proportion of patients (two-thirds) still presented sensibility alterations in the subumbilical area 3½ years after abdominoplasty. CONCLUSION Scarpa fascia preservation during abdominoplasty does not influence scar quality, but it improves sensibility recovery in the supraumbilical area. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Hu A, Koh B, Teo MR. A review of the current evidence on the sensitivity and specificity of the Ipswich touch test for the screening of loss of protective sensation in patients with diabetes mellitus. Diabetol Int 2020; 12:145-150. [PMID: 33786269 DOI: 10.1007/s13340-020-00451-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/25/2020] [Indexed: 10/24/2022]
Abstract
Aims To evaluate the sensitivity and specificity of the Ipswich touch test for the screening of loss of protective sensation in patients with diabetes mellitus based on the current literature. Methods Three electronic databases were searched for eligible studies that investigated the sensitivity and specificity of the Ipswich touch test. Methodological quality was assessed using the QUADAS-2 tool. Results Five studies that reported the sensitivity and specificity of the Ipswich touch test were included. When compared to the 10 g monofilament, the sensitivity ranges from 51 to 83.3% and the specificity ranges from 96.4 to 98%. When compared to the vibration perception test ≥25 V, Ipswich touch test sensitivity ranges from 76 to 100% and specificity ranges from 90 to 96.6%. Conclusions The Ipswich touch test has a high specificity in screening for loss of protective sensation in the feet of patients with diabetes mellitus. It is a useful test to be included in diabetic foot screenings, especially when other sensory tools are not available. However, more rigorous studies need to be conducted as there is currently only a limited pool of research evidence to substantiate it as a screening tool for loss of protective sensation in the diabetic foot.
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Affiliation(s)
- Arnold Hu
- Podiatry Department, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Beatrice Koh
- Podiatry Department, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606 Singapore
| | - Melissa-Raye Teo
- Podiatry Department, Ng Teng Fong General Hospital, National University Health System, 1 Jurong East Street 21, Singapore, 609606 Singapore
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Chicharro-Luna E, Pomares-Gómez FJ, Ortega-Ávila AB, Coheña-Jiménez M, Gijon-Nogueron G. Variability in the clinical diagnosis of diabetic peripheral neuropathy. Prim Care Diabetes 2020; 14:53-60. [PMID: 31208891 DOI: 10.1016/j.pcd.2019.05.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/13/2019] [Accepted: 05/23/2019] [Indexed: 10/26/2022]
Abstract
AIMS The aims of this study are to assess the variability in the prevalence of diabetic peripheral neuropathy (DPN), according to the diagnostic and clinical guidelines used. METHODS A cross-sectional observational study was conducted of 111 patients with diabetes mellitus. The presence/absence of DPN was determined according to 12 different criteria stipulated in various clinical guidelines (ADA 2018, IWGDF 2016, IDF 2012 and CONUEI 2018). The Cohen's kappa coefficient (κ) was performed to determine the degree of agreement for DPN diagnosis among the different criteria. RESULTS The recorded prevalence of DPN ranged from 13.1% (criterion ADA 2018) to 68.5% (criterion IDF 2012). The sensory parameter that was most commonly affected was the non-perception of vibration (68.5%) and the absence of Achilles reflexes (59.4%). IWGDF, based on the use of a monofilament, cotton wisp and tuning fork, was the test with more agreements, presenting good agreement with 2 criteria from ADA 2018 (k=0.845), 1b2 (k=0.817), 2 criteria from IWGDF 2016 (k=0.933), (k=0.817), 1 criteria from IDF 2012 (k=0.845) and 1 criteria from CONUEI 2018 (k=0.860), all p<0.001. CONCLUSION The IWGDF criterion based on the use of a monofilament, cotton wisp and tuning fork for the diagnosis presented the highest level of concordance with the other criteria (>0.8).
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Affiliation(s)
- Esther Chicharro-Luna
- Departament of Behavioral Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, San Juan de Alicante, Spain.
| | | | - Ana Belén Ortega-Ávila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Spain.
| | | | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Spain; Instituto de Investigación Biomedica de Malaga (IBIMA), Spain.
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20
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Chicharro-Luna E, Pomares-Gómez FJ, Ortega-Ávila AB, Marchena-Rodríguez A, Blanquer-Gregori JFJ, Navarro-Flores E. Predictive model to identify the risk of losing protective sensibility of the foot in patients with diabetes mellitus. Int Wound J 2019; 17:220-227. [PMID: 31691513 DOI: 10.1111/iwj.13263] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 12/15/2022] Open
Abstract
Diabetic neuropathy is defined as the presence of symptoms and signs of peripheral nerve dysfunction in diabetics. The aim of this study is to develop a predictive logistic model to identify the risk of losing protective sensitivity in the foot. This descriptive cross-sectional study included 111 patients diagnosed with diabetes mellitus. Participants completed a questionnaire designed to evaluate neuropathic symptoms, and multivariate analysis was subsequently performed to identify an optimal predictive model. The explanatory capacity was evaluated by calculating the R2 coefficient of Nagelkerke. Predictive capacity was evaluated by calculating sensitivity, specificity, and estimation of the area under the receiver operational curve. Protective sensitivity loss was detected in 19.1% of participants. Variables associated by multivariate analysis were: educational level (OR: 31.4, 95% CI: 2.5-383.3, P = .007) and two items from the questionnaire: one related to bleeding and wet socks (OR: 28.3, 95% CI: 3.7-215.9, P = .001) and the other related to electrical sensations (OR: 52.9, 95% CI: 4.3-643.9, P = .002), which were both statistically significant. The predictive model included the variables of age, sex, duration of diabetes, and educational level, and it had a sensitivity of 81.3% and a specificity of 95.5%. This model has a high predictive capacity to identify patients at risk of developing sensory neuropathy.
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Affiliation(s)
- Esther Chicharro-Luna
- Department of Behavioral Sciences and Health, Nursing Area, Faculty of Medicine, University Miguel Hernández, San Juan de Alicante, Spain
| | | | - Ana Belen Ortega-Ávila
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | - Ana Marchena-Rodríguez
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Malaga, Malaga, Spain
| | | | - Emmanuel Navarro-Flores
- Department of Nursing, Faculty of Nursing and Podiatry, Frailty Research Organized Group, Universidad de Valencia, Valencia, Spain
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Pérez-Panero AJ, Ruiz-Muñoz M, Cuesta-Vargas AI, Gónzalez-Sánchez M. Prevention, assessment, diagnosis and management of diabetic foot based on clinical practice guidelines: A systematic review. Medicine (Baltimore) 2019; 98:e16877. [PMID: 31464916 PMCID: PMC6736276 DOI: 10.1097/md.0000000000016877] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/26/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023] Open
Abstract
AIM Diabetic foot complications are the main reason for hospitalization and amputation in people with diabetes and have a prevalence of up to 25%. Clinical practice guidelines are recommendations based on evidence with the aim of improving health care. The main aim of this study was to carry out a systematic review of the levels of the evaluation and treatment strategies that appear in the clinical practice guidelines focus on diabetic foot or diabetes with diabetic foot section. Another objective of this study was to perform an analysis of the levels of evidence in support of the recommendations made by the selected clinical practice guidelines. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and a quality assessment by the Appraisal of Guidelines for Research and Evaluation (AGREE II) were performed. The databases checked were "NICE", "Cinahl", "Health Guide", "RNAO", "Sign", "PubMed", "Scopus" and "NCG". The search terms included were "diabetic foot", "guideline(s)", "practice guideline(s)" and "diabetes." RESULTS Twelve articles were selected after checked inclusion criteria and quality assessment. A summary and classification of the recommendations was completed. CONCLUSIONS The heterogeneity of levels of evidence and grades of recommendation of the CPGs included regarding the management, approach and treatment of DF makes it difficult to interpret and assume them in clinical practice in order to select the most correct procedures. Despite this and according to the detailed study of the guidelines included in this work, it can be concluded that the highly recommendable interventions for DF management are debridement (very high level of evidence and strongly recommended), foot evaluation (moderate level of evidence and fairly recommended) and therapeutic footwear (moderate level of evidence and fairly recommended).
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Affiliation(s)
| | | | - Antonio I. Cuesta-Vargas
- Department of Physiotherapy, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos 29071, Málaga, Spain
| | - Manuel Gónzalez-Sánchez
- Department of Physiotherapy, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos 29071, Málaga, Spain
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Rinkel WD, Aziz MH, Van Neck JW, Cabezas MC, van der Ark LA, Coert JH. Development of grading scales of pedal sensory loss using Mokken scale analysis on the Rotterdam Diabetic Foot Study Test Battery data. Muscle Nerve 2019; 60:520-527. [PMID: 31281987 PMCID: PMC6852564 DOI: 10.1002/mus.26628] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 06/24/2019] [Accepted: 07/01/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Loss of sensation due to diabetes-related neuropathy often leads to diabetic foot ulceration. Several test instruments are used to assess sensation, such as static and moving 2-point discrimination (S2PD, M2PD), monofilaments, and tuning forks. METHODS Mokken scale analysis was applied to the Rotterdam Diabetic Foot Study data to select hierarchies of tests to construct measurement scales. RESULTS We developed 39-item and 31-item scales to measure loss of sensation for research purposes and a 13-item scale for clinical practice. All instruments were strongly scalable and reliable. The 39 items can be classified into 5 hierarchically ordered core clusters: S2PD, M2PD, vibration sense, monofilaments, and prior ulcer or amputation. DISCUSSION Guided by the presented scales, clinicians may better classify the grade of sensory loss in diabetic patients' feet. Thus, a more personalized approach concerning individual recommendations, intervention strategies, and patient information may be applied.
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Affiliation(s)
- Willem D Rinkel
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive, and Hand Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Hosein Aziz
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Johan W Van Neck
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine/Centre for Diabetes, Endocrinology and Vascular Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - L Andries van der Ark
- Faculty of Social and Behavioural Sciences, Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - J Henk Coert
- Department of Plastic, Reconstructive, and Hand Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Martinez-Santos A, Preece S, Nester CJ. Evaluation of orthotic insoles for people with diabetes who are at-risk of first ulceration. J Foot Ankle Res 2019; 12:35. [PMID: 31244900 PMCID: PMC6582464 DOI: 10.1186/s13047-019-0344-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 06/03/2019] [Indexed: 01/27/2023] Open
Abstract
Objective This study focussed on pressure relieving orthotic insoles designed for retail footwear and people with diabetes and at risk of first forefoot ulceration. The aim was to investigate whether the pressure relieving effects of a customised metatarsal bar and forefoot cushioning are sensitive to bar location and shape, and material choice. Research design and methods Patient-specific foot shape was used to design an orthotic insole, with metatarsal bar location and shape customised according to plantar pressure data. Changes in forefoot plantar pressure were investigated when 60 people with diabetes and neuropathy walked in nine variants of the orthotic insole. These comprised three variations in proximal/distal location of the customised metatarsal bar and three different metatarsal head offloading materials. Results & conclusions The most frequent reductions in pressure occurred when the anterior edge of the metatarsal bar was placed at 77% of the peak pressure values, and its effects were independent of the choice of EVA or Poron offloading material. In the flat insole, 61% of participants had one or more metatarsal head areas with pressure above the 200 KPa, reducing to 58% when adopting generic orthotic design rules and 51% when using the best orthotic insole of the nine tested. Our results confirm that plantar pressure relief is sensitive to orthotic insole design decisions and individual patient feet.
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Preliminary Effectiveness of Auricular Point Acupressure on Chemotherapy-Induced Neuropathy: Part 2 Laboratory-Assessed and Objective Outcomes. Pain Manag Nurs 2019; 20:623-632. [PMID: 31204029 DOI: 10.1016/j.pmn.2019.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 03/18/2019] [Accepted: 04/24/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To manage chemotherapy-induced neuropathy (CIN), this paper explores reliable and valid objectives measures to evaluate the treatment effects of auricular point acupressure (APA). DESIGN/METHOD This study was a repeated-measures one-group design. Participants received four weeks of APA to manage their CIN. The laboratory-assessed and objective outcomes included quantitative sensory testing, grip and pinch strength, and inflammatory biomarkers. Wilcoxon matched pairs signed-rank tests were conducted to determine change scores of outcomes at pre- vs. post- and pre- vs. 1-month follow-up. Spearman's rho correlation coefficient was used to examine the linear association of score changes of all objective study outcomes. RESULTS Comparing pre-and-post APA, (1) the mean score of the monofilament for all lower extremity sites tested decreased after APA, indicating sensory improvement; (2) the suprathreshold pinprick stimuli mean scores on the upper extremities increased, except the scores from the index finger and thumb; (3) the pain tolerance of thumb and trapezius areas increased; (4) decreasing IL1β (p = .05), IFNγ (p = .02), IL-2 (p = .03), IL-6 (p = .05), IL-10 (p = .05), and IP10/CXCL10 (p = .04) were observed pre-post APA. Conditional pain modulation was significantly (p< .05) associated with pain intensity (r = 0.55), tingling (r = 0.59); and IL1β concentration (r = 0.53) pre-post APA. The sustained effects of 4-week APA were observed at the 1-month follow-up. CONCLUSIONS Our study findings demonstrated the promising effectiveness of APA in the management of CIN, and these treatment effects can be assessed using reliable and valid objective measures. CLINICAL IMPLICATIONS If the efficacy of APA to manage CIN is confirmed in a larger sample, APA has the potential to be a scalable treatment for CIN because it is a reproducible, standardized, and easy-to-perform intervention.
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Beginning a Diabetes Quality Improvement Project. Can J Diabetes 2019; 43:234-240. [DOI: 10.1016/j.jcjd.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/07/2019] [Accepted: 02/13/2019] [Indexed: 11/21/2022]
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Rinkel WD, van der Oest MJW, Dijkstra DA, Castro Cabezas M, Coert JH. Predicting ulcer-free survival using the discriminative value of screening test locations. Diabetes Metab Res Rev 2019; 35:e3119. [PMID: 30575290 DOI: 10.1002/dmrr.3119] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/16/2018] [Accepted: 12/16/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Current guidelines recommend screening the feet of diabetic subjects with a 10-g monofilament or tuning fork. We investigated which tests and locations on the feet have the best predictive value regarding 1-year ulcer-free survival in diabetic subjects participating in the prospective Rotterdam Diabetic Foot Study. METHODS Decision tree analysis was used to predict ulcer-free survival based on responses from individual test locations (monofilaments on 10 sites, vibration sense was tested on both halluces and medial malleoli). Separate trees for patients with and without a history of diabetic foot ulcer (DFU) were developed. RESULTS Four hundred sixteen subjects (mean [SD] age, 61.8 years [12.4]; range, 21.6-90.2) were measured, of whom 24 developed new DFUs. Three tests exhibited discriminative and predictive properties: testing vibration sense on the medial malleolus and monofilament testing on heel and hallux. The decision tree to predict ulcer-free survival in patients with a history of DFU yielded a sensitivity of 87.0%, which was 99.6% for the tree of patients without a history of DFU. CONCLUSION The findings of this study aids medical decision making by discriminating between high- and low-risk patients of developing DFU using selective testing on sites with predictive properties.
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Affiliation(s)
- Willem D Rinkel
- Department of Plastic, Reconstructive, and Hand surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Plastic, Reconstructive, and Hand surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
- Department of Plastic, Reconstructive, and Hand surgery, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | - Mark J W van der Oest
- Department of Plastic, Reconstructive, and Hand surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Don A Dijkstra
- Department of Internal Medicine/Centre for Diabetes, Endocrinology and Vascular Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine/Centre for Diabetes, Endocrinology and Vascular Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Jan Hendrik Coert
- Department of Plastic, Reconstructive, and Hand surgery, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Plastic, Reconstructive, and Hand surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
- Department of Plastic, Reconstructive, and Hand surgery, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
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Sanz-Corbalán I, Lázaro-Martínez JL, García-Morales E, Molines-Barroso R, Álvaro-Afonso F, García-Álvarez Y. Advantages of early diagnosis of diabetic neuropathy in the prevention of diabetic foot ulcers. Diabetes Res Clin Pract 2018; 146:148-154. [PMID: 29287839 DOI: 10.1016/j.diabres.2017.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/13/2017] [Accepted: 12/21/2017] [Indexed: 12/18/2022]
Abstract
AIMS To evaluate the utility of the sudomotor function test (SFT) as a clinical tool in the Risk Stratification System of diabetic patients and to demonstrate the earlier detection of the risk of developing diabetic foot ulcers (DFU) compared to the standard clinical tests. METHODS Prospective follow-up study on 263 patients enrolled consecutively over 3.5 years. Diabetic patients without active DFU were classified according to the International Working Group Risk Stratification System (RSS) and categorized according to the results of the Semmes-Wenstein Monofilament (SWM) and biothesiometer measurements or the SFT. The main outcome evaluated was the development of DFU. RESULTS Median follow-up was 42 [38-44] months. Sixty patients (22.8%) developed DFU after a median of 6.2 [3-17] months. Ten patients that were included in the no-risk group (group 0) based on the SWM and biothesiometer results developed DFU. Thus the sensitivity of this approach was 83.33% and the specificity was 50.47%. Based on the SFT results, all patients that developed DFU were included in the correct risk group. This approach had 100% sensitivity and 31.53% specificity. Regarding the diagnostic accuracy of the two Methods, the respective AUC values were 0.776 (95% CI 0.702-0.849) and 0.816 (95% CI 0.757-0.874). CONCLUSIONS SFT improved RSS in diabetic patients in a specialized diabetic foot unit. SFT categorized patients correctly according to the risk of developing DFU.
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Jansson RW, Hufthammer KO, Krohn J. Diabetic retinopathy in type 1 diabetes patients in Western Norway. Acta Ophthalmol 2018; 96:465-474. [PMID: 29369506 DOI: 10.1111/aos.13654] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/06/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE To describe the prevalence of diabetic retinopathy (DR), associated risk factors and health-related quality of life (HRQoL) in a population-based cohort of patients with type 1 diabetes mellitus (DM1). METHODS All patients underwent a general and ophthalmic examination including seven-field stereo fundus photography for grading of DR and diabetic macular oedema (DMO). Kaplan-Meier survival analyses were performed to evaluate disease progression in relation to diabetes duration, age and year of diabetes onset. HRQoL and its association with DR were assessed by the Medical Outcomes Study Short Form 36 (SF-36) questionnaire. RESULTS A total of 237 DM1 patients were included. Mean age at inclusion was 34 years (range, 4-75 years), and mean diabetes duration was 19 years (range, 5 months-63 years). A total of 145 patients (61%) had DR. Sixty-two patients (26%) had mild, 39 (16%) moderate and 13 (5%) severe nonproliferative DR, while 31 (13%) had proliferative DR. The prevalence of DMO was 8%. The most important risk factors predicting severity of DR were diabetes duration (p < 0.0001) and HbA1c level (p < 0.0001). Neuropathy (p = 0.006), nephropathy (p = 0.004) and male gender (p = 0.02) were also significant predictors of DR. Compared to normative SF-36 data, there was a linear trend of decreasing HRQoL with increasing severity of DR that was statistically significant for the four physical dimension scores. CONCLUSION The prevalence of DR in DM1 was largely within the range of previous reports. Diabetes duration, HbA1c level, neuropathy, nephropathy and male gender were all significant predictors of DR severity. The patients with more severe DR had lower HRQoL.
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Affiliation(s)
- Ragnhild W. Jansson
- Department of Clinical Medicine; Section of Ophthalmology; University of Bergen; Bergen Norway
- Department of Ophthalmology; Haukeland University Hospital; Bergen Norway
| | | | - Jørgen Krohn
- Department of Clinical Medicine; Section of Ophthalmology; University of Bergen; Bergen Norway
- Department of Ophthalmology; Haukeland University Hospital; Bergen Norway
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Li D, Yang JY, Wang T, Shen S, Tang H. Risks of diabetic foot syndrome and amputation associated with sodium glucose co-transporter 2 inhibitors: A Meta-analysis of Randomized Controlled Trials. DIABETES & METABOLISM 2018; 44:410-414. [PMID: 29506779 DOI: 10.1016/j.diabet.2018.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/19/2018] [Accepted: 02/08/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The U.S. Food and Drug Administration recently issued a safety communication requiring new warnings of increased leg and foot amputation risk be added to canagliflozin drug labelling. However, the risk associated with other sodium-glucose co-transporter 2 inhibitors (SGLT2i) remains uncertain. AIM This meta-analysis aimed to evaluate the potential risks of diabetic foot syndrome (DFS) and amputation associated with SGLT2i. METHODS Relevant databases were searched from inception to June 14, 2017 to identify randomized controlled trials (RCTs) that evaluated risks of DFS and amputation associated with SGLT2i use. A random effects model was performed to estimate odds ratios (ORs) and 95% confidence intervals (CIs) using STATA 14. RESULTS Fourteen RCTs involving 26,167 patients were eligible for this meta-analysis. SGLT2i were not significantly associated with increased risk of DFS compared with placebo (OR 1.05, 95% CI: 0.58-1.89). No significant association was observed in the subgroup and sensitivity analysis on DFS risk either. Although SGLT2i, as a class, were not significantly associated with amputation risk (OR 1.40, 95% CI: 0.81-2.41), subgroup analysis showed an increased incidence of amputation in participants using canagliflozin (OR 1.89, 95% CI: 1.37-2.60), compared with oral anti-diabetic drugs and placebo, but not in those using empagliflozin (OR 1.02, 95% CI: 0.71-1.48). CONCLUSION Current evidence from RCTs suggests that canagliflozin may be positively associated with an increased risk of amputation. Due to limited data, large-scale studies are required to further clarify the association between amputation and individual SGLT2i drugs.
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Affiliation(s)
- D Li
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - J Yufeng Yang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T Wang
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Shen
- Department of Pharmacy, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - H Tang
- Department of Pharmacy, Peking University Third Hospital, 49, North Garden Road, Haidian District, Beijing, 100191, China; Department of Epidemiology, Richard M. Fairbanks School of Public Health, Indiana University,Indianapolis, IN, USA.
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Martinez-Hervás S, Mendez MM, Folgado J, Tormos C, Ascaso P, Peiró M, Real JT, Ascaso JF. Altered Semmes-Weinstein monofilament test results are associated with oxidative stress markers in type 2 diabetic subjects. J Transl Med 2017; 15:187. [PMID: 28874161 PMCID: PMC5586059 DOI: 10.1186/s12967-017-1291-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 08/29/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Different lines of evidence suggest that oxidative stress (OS) is implicated in the pathogenesis of diabetic neuropathy. The Semmes-Weinstein monofilament (SWM) test is an efficient tool for evaluating diabetic polyneuropathy and diabetic foot. In this study, we analyzed the association between OS markers and altered SWM test results in type 2 diabetes (T2DM) patients. METHODS Seventy T2DM patients were studied and 34 showed altered SWM results. The clinical and biochemical parameters were determined using standardized methods. Levels of oxidized glutathione (GSSG) and malondialdehyde (MDA) were measured in circulating mononuclear cells using high-performance liquid chromatography. RESULTS We found that T2DM patients with altered SWM test results had significantly higher GSSG (3.53 ± 0.31 vs. 3.31 ± 0.35 mmol/ml, p < 0.05) and MDA (1.88 ± 0.16 vs. 1.75 ± 0.19 nmol/ml, p < 0.01) values compared to diabetic patients with normal SWM test outcomes. Moreover, altered SWM test results were independently related to age, glycosylated hemoglobin, and GSSG levels, but there was no association between OS markers and altered neuropathy sensitivity score (NSS) values. CONCLUSIONS Alteration of the glutathione system and MDA values in T2DM patients are associated with loss of proprioceptive (pressure) sensitivity, but not with symptomatic polyneuropathy (as evaluated by NSS). This finding may be important for understanding how OS affects distal symmetric polyneuropathy in diabetic patients.
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Affiliation(s)
- Sergio Martinez-Hervás
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBERDEM), Barcelona, Spain.,Department of Medicine, University of Valencia and INCLIVA, Valencia, Spain
| | - Mercedes Molina Mendez
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain
| | - José Folgado
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain
| | - Carmen Tormos
- Department of Biochemistry and Molecular Biology, University of Valencia, Valencia, Spain.,CIBER de Obesidad, Madrid, Spain
| | - Pilar Ascaso
- Department of Medicine, University of Valencia and INCLIVA, Valencia, Spain
| | - Marta Peiró
- CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBERDEM), Barcelona, Spain
| | - Jose T Real
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain. .,CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBERDEM), Barcelona, Spain. .,Department of Medicine, University of Valencia and INCLIVA, Valencia, Spain.
| | - Juan F Ascaso
- Service of Endocrinology and Nutrition, Hospital Clínico Universitario de Valencia, Avda Blasco Ibañez, 17, 46010, Valencia, Spain.,CIBER de Diabetes y Enfermedades Metabólicas asociadas (CIBERDEM), Barcelona, Spain.,Department of Medicine, University of Valencia and INCLIVA, Valencia, Spain
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Tremp M, Oranges CM, Wang WJ, Wettstein R, Zhang YX, Schaefer DJ, Kalbermatten DF. The "nugget design": A modified segmental gracilis free flap for small-sized defect reconstruction on the lower extremity. J Plast Reconstr Aesthet Surg 2017; 70:1261-1266. [PMID: 28716695 DOI: 10.1016/j.bjps.2017.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 05/14/2017] [Accepted: 06/25/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little attention has been given to the segmental free gracilis muscle flap supplied by secondary proximal pedicles. We introduce a technical refinement for small-sized three-dimensional defect reconstruction on the foot. METHODS Between November 2013 and August 2016, three patients with a mean age of 66 years (range 47-70 years) were included. A segmental gracilis free flap supplied by the most proximal secondary pedicle was harvested according to a modified "nugget design" to treat small-sized defects on the lower extremity requiring dead space reconstruction. Minor and major complications, sensitivity with Semmes-Weinstein monofilament test, soft tissue stability and patient satisfaction at final follow-up were recorded. RESULTS In one case, a segmental gracilis muscle was used for dorsal foot reconstruction after debridement of metatarsal phalanx I with osteomyelitis. In two cases, the segmental gracilis free muscle was harvested for defect reconstruction on the right plantar foot after excision of a melanoma. The first patient required revision after partial failure of the initial segmental gracilis free muscle flap. Overall, good results in foot function and a high degree of patient satisfaction was achieved (Likert scale 9.7, range 9-10) after a mean follow-up of 13 months (range 3-24 months). CONCLUSIONS Taken from the very proximal dorsal part of the gracilis muscle supplied by the most proximal secondary pedicle and leaving the vast majority of the muscle intact preserves the option to harvest a normal gracilis flap. This technique is especially suitable for small, three-dimensional defects on the lower extremity.
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Affiliation(s)
- M Tremp
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, Spitalstrasse 21, 4031 Basel, Switzerland
| | - C M Oranges
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, Spitalstrasse 21, 4031 Basel, Switzerland
| | - W J Wang
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, Spitalstrasse 21, 4031 Basel, Switzerland; Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital NO. 639, Zhizaoju Road, 200011 Shanghai, China
| | - R Wettstein
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Y X Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital NO. 639, Zhizaoju Road, 200011 Shanghai, China
| | - D J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, Spitalstrasse 21, 4031 Basel, Switzerland
| | - D F Kalbermatten
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, Spitalstrasse 21, 4031 Basel, Switzerland.
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Smith SM, Dworkin RH, Turk DC, Baron R, Polydefkis M, Tracey I, Borsook D, Edwards RR, Harris RE, Wager TD, Arendt-Nielsen L, Burke LB, Carr DB, Chappell A, Farrar JT, Freeman R, Gilron I, Goli V, Haeussler J, Jensen T, Katz NP, Kent J, Kopecky EA, Lee DA, Maixner W, Markman JD, McArthur JC, McDermott MP, Parvathenani L, Raja SN, Rappaport BA, Rice ASC, Rowbotham MC, Tobias JK, Wasan AD, Witter J. The Potential Role of Sensory Testing, Skin Biopsy, and Functional Brain Imaging as Biomarkers in Chronic Pain Clinical Trials: IMMPACT Considerations. THE JOURNAL OF PAIN 2017; 18:757-777. [PMID: 28254585 PMCID: PMC5484729 DOI: 10.1016/j.jpain.2017.02.429] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/19/2017] [Accepted: 02/16/2017] [Indexed: 02/08/2023]
Abstract
Valid and reliable biomarkers can play an important role in clinical trials as indicators of biological or pathogenic processes or as a signal of treatment response. Currently, there are no biomarkers for pain qualified by the U.S. Food and Drug Administration or the European Medicines Agency for use in clinical trials. This article summarizes an Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials meeting in which 3 potential biomarkers were discussed for use in the development of analgesic treatments: 1) sensory testing, 2) skin punch biopsy, and 3) brain imaging. The empirical evidence supporting the use of these tests is described within the context of the 4 categories of biomarkers: 1) diagnostic, 2) prognostic, 3) predictive, and 4) pharmacodynamic. Although sensory testing, skin punch biopsy, and brain imaging are promising tools for pain in clinical trials, additional evidence is needed to further support and standardize these tests for use as biomarkers in pain clinical trials. PERSPECTIVE The applicability of sensory testing, skin biopsy, and brain imaging as diagnostic, prognostic, predictive, and pharmacodynamic biomarkers for use in analgesic treatment trials is considered. Evidence in support of their use and outlining problems is presented, as well as a call for further standardization and demonstrations of validity and reliability.
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Carlesso GP, Gonçalves MHB, Moreschi D. Avaliação do conhecimento de pacientes diabéticos sobre medidas preventivas do pé diabético em Maringá (PR). J Vasc Bras 2017; 16:113-118. [PMID: 29930635 PMCID: PMC5915859 DOI: 10.1590/1677-5449.006416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Contexto O atual envelhecimento da população tem gerado maior predominância de doenças crônicas, como o diabetes, a qual está associada a um risco elevado de complicações crônicas e agudas. Entre essas, o pé diabético (PD) destaca-se por possuir alta incidência e grande poder mutilador. Objetivo Avaliar o conhecimento da população diabética das Unidades Básicas de Saúde (UBS) de Maringá (PR) sobre a prevenção do PD. Métodos Estudo descritivo, quantitativo, tipo inquérito por entrevista. A população estudada foi composta por 80 portadores de diabetes, cadastrados em UBS de Maringá (PR). A coleta de dados buscou levantar dados sociodemográficos e epidemiológicos, bem como as atitudes de controle do diabetes e do autocuidado para prevenção do PD. Resultados Do total de entrevistados, nove não realizavam qualquer tipo de exame para controle do diabetes e a renda mensal predominante foi de até um salário mínimo. O grau de escolaridade e a renda mensal não se mostraram relevantes em relação ao conhecimento de cuidados preventivos do PD e nem uma maior adesão a hábitos de vida saudáveis. O cuidado com o PD tende a melhorar à medida que exista uma compreensão mais clara dos fatores que conduzem à perda do membro e um crescente consenso sobre a gestão de vários aspectos clínicos do cuidado com o pé. Conclusão Existe uma falta de aprendizado das medidas preventivas, mesmo nos pacientes com algum nível de instrução, o que induz a uma prática deficiente de cuidados.
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Affiliation(s)
| | | | - Dorival Moreschi
- Centro Universitário Cesumar - UniCesumar, Cirurgia Vascular, Maringá, PR, Brasil
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Pruitt J, Moracho-Vilrriales C, Threatt T, Wagner S, Wu J, Romero-Sandoval EA. Identification, prevalence, and treatment of painful diabetic neuropathy in patients from a rural area in South Carolina. J Pain Res 2017; 10:833-843. [PMID: 28435320 PMCID: PMC5391160 DOI: 10.2147/jpr.s129139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) represents significant burdens to many patients and the public health-care system. Patients with diabetes in rural areas have higher risk of developing complications and having less access to proper treatment. We studied a rural population of patients with diabetes who attended a pharmacist-led free clinic for a diabetic education program. Our objectives were to 1) determine the prevalence of DPN and painful diabetic neuropathy (p-DN) in patients with type 2 diabetes; 2) assess the proportion of patients with DPN and p-DN left undocumented upon physician referral to a pharmacist-led free clinic; and 3) determine the appropriateness of pain medication regimen. We performed a retrospective analysis of clinical records of patients from the Presbyterian College School of Pharmacy (PCSP) Wellness Center located in Clinton, SC. Diagnoses of DPN and/or p-DN were obtained from referral notes in the clinical records and compared with results from foot examinations performed in the free clinic and clinical features. Medication regimens were also obtained and compared using American Academy of Neurology (AAN) treatment guidelines. Within our study population (n=111), the prevalence of DPN was 62.2% (national average of 28%–45%) and that of p-DN was 23.4% (national average of 11%–24%). In p-DN patients (n=26), 53.8% (n=14) had a documented diagnosis of p-DN by the referring physician, and 46.2% (n=12) were identified by the pharmacists. A total of 95% (19 of 20) of the patients treated for p-DN received adequate pharmacological agents, though suboptimal as per clinical guidelines. More than 50% of the patients used subtherapeutic doses of their medications. Gabapentin was the most frequently used medication in our population (65.4%). Patients in rural South Carolina had a higher prevalence of DPN and p-DN with >60% undocumented cases of p-DN. More than 95% of treated patients did not receive optimum therapy according to AAN guidelines.
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Affiliation(s)
- Jimmy Pruitt
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC, USA
| | - Carolina Moracho-Vilrriales
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC, USA.,Department of Biochemistry and Biotechnology, University of Alcalá de Henares, Madrid, Spain
| | - Tiffaney Threatt
- Department of Pharmacy Practice, Presbyterian College School of Pharmacy, Clinton, SC, USA
| | - Sarah Wagner
- Department of Pharmacy Practice, Presbyterian College School of Pharmacy, Clinton, SC, USA
| | - Jun Wu
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC, USA
| | - E Alfonso Romero-Sandoval
- Department of Pharmaceutical and Administrative Sciences, Presbyterian College School of Pharmacy, Clinton, SC, USA
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Rinkel WD, Aziz MH, Van Deelen MJ, Willemsen SP, Castro Cabezas M, Van Neck JW, Coert JH. Normative data for cutaneous threshold and spatial discrimination in the feet. Muscle Nerve 2017; 56:399-407. [DOI: 10.1002/mus.25512] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 11/25/2016] [Accepted: 12/07/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Willem D. Rinkel
- Department of Plastic, Reconstructive, and Hand Surgery; Erasmus University Medical Center; Room Ee 15.93, Box 2040 3000 CA Rotterdam the Netherlands
- Department of Plastic; Reconstructive, and Hand Surgery, Franciscus Gasthuis; Rotterdam the Netherlands
| | - M. Hosein Aziz
- Department of Plastic, Reconstructive, and Hand Surgery; Erasmus University Medical Center; Room Ee 15.93, Box 2040 3000 CA Rotterdam the Netherlands
| | - Meike J.M. Van Deelen
- Department of Plastic, Reconstructive, and Hand Surgery; Erasmus University Medical Center; Room Ee 15.93, Box 2040 3000 CA Rotterdam the Netherlands
| | - Sten P. Willemsen
- Department of Biostatistics; Erasmus University Medical Center; Rotterdam the Netherlands
| | - Manuel Castro Cabezas
- Department of Internal Medicine/Centre for Diabetes, Endocrinology, and Vascular Medicine; Franciscus Gasthuis; Rotterdam the Netherlands
| | - Johan W. Van Neck
- Department of Plastic, Reconstructive, and Hand Surgery; Erasmus University Medical Center; Room Ee 15.93, Box 2040 3000 CA Rotterdam the Netherlands
| | - J. Henk Coert
- Department of Plastic, Reconstructive, and Hand Surgery; Erasmus University Medical Center; Room Ee 15.93, Box 2040 3000 CA Rotterdam the Netherlands
- Department of Plastic; Reconstructive, and Hand Surgery, Franciscus Gasthuis; Rotterdam the Netherlands
- Department of Plastic, Reconstructive, and Hand Surgery; Utrecht University Medical Center; Utrecht the Netherlands
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Rinkel WD, Castro Cabezas M, Setyo JH, Van Neck JW, Coert JH. Traditional Methods versus Quantitative Sensory Testing of the Feet at Risk. Plast Reconstr Surg 2017; 139:752e-763e. [DOI: 10.1097/prs.0000000000003047] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Diabetic polyneuropathy (DPN) is a serious complication of diabetes that leads to early disability in patients if late diagnosed. There has been a lot of research into pathophysiological mechanisms of nerve fiber damage and risk factors for neurological complications of diabetes. Early diagnosis of the latter is quite a challenge and, thus, the problem of finding more reliable diagnostic modalities is rather pressing. In this review, an interdisciplinary approach to the said problem, high-end diagnostic methods, and clinical features of DPN are described.
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Affiliation(s)
- S E Avetisov
- Research Institute of Eye Diseases, 11A, B Rossolimo St., Moscow, Russian Federation, 119021; I.M. Sechenov First Moscow State Medical University, 8 bld.2 Trubetskaya St., Moscow, Russian Federation, 119991
| | - N A Chernenkova
- Research Institute of Eye Diseases, 11A, B Rossolimo St., Moscow, Russian Federation, 119021
| | - Z V Surnina
- Research Institute of Eye Diseases, 11A, B Rossolimo St., Moscow, Russian Federation, 119021
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Jeon BJ, Choi HJ, Kang JS, Tak MS, Park ES. Comparison of five systems of classification of diabetic foot ulcers and predictive factors for amputation. Int Wound J 2016; 14:537-545. [PMID: 27723246 DOI: 10.1111/iwj.12642] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/19/2016] [Accepted: 06/20/2016] [Indexed: 12/23/2022] Open
Abstract
Diabetes mellitus is a common metabolic disorder. Among various complications, diabetic neuropathy and peripheral vascular disorders are closely associated with diabetic foot ulcers (DFUs). Lower extremity ulcers and amputations are ongoing problems among individuals with diabetes. There are several classification systems for DFUs; however, no prognostic system has to date been accepted as the gold standard or the optimum prediction tool for amputations. A retrospective study was designed. Demographic data and baseline laboratory data were gathered and scored or evaluated using five representative DFU classification systems. These included (i) the diabetic ulcer severity score (DUSS); (ii) University of Texas (UT) diabetic wound classification; (iii) Meggitt-Wagner classification; (iv) depth of the ulcer, extent of bacterial colonisation, phase of ulcer and association aetiology (DEPA) scoring system; and (v) site, ischaemia, neuropathy, bacterial infection and depth (SINBAD) score. Finally, a statistical analysis was performed. A total of 137 patients were included in this study. During the follow-up, DFU had healed in 51·1% of subjects and 48·9% of the individuals underwent lower extremity amputations (LEAs). In a univariable logistic regression analysis, history of previous DFU, hypertension, neuropathy, haemoglobin, C-reactive protein (CRP) and ankle-brachial index (ABI) showed a statistically significant difference between the healed group and the LEA group. Moreover, the stages, grades or overall prognostic ability of all five classifications were highly associated with the overall occurrence of LEA. On multivariable logistic regression analysis of the risk of LEA, all classifications showed a significant positive trend with an increased number of amputations. All the five classification systems exhibited high sensitivity, specificity, classification accuracy, positive predictive, negative predictive and area under the curve (AUC) values. They showed substantial accuracy and their main variables were associated with LEA occurrence. The Wagner and UT systems, although they are relatively simple to assess, were better predictors of LEA.
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Affiliation(s)
- Byung-Joon Jeon
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hwan Jun Choi
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Cheonan-si, Republic of Korea
| | - Jin Seok Kang
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Cheonan-si, Republic of Korea
| | - Min Sung Tak
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Cheonan-si, Republic of Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University College of Medicine, Cheonan-si, Republic of Korea
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Formosa C, Gatt A, Chockalingam N. A Critical Evaluation of Existing Diabetic Foot Screening Guidelines. Rev Diabet Stud 2016; 13:158-186. [PMID: 28012281 PMCID: PMC5553765 DOI: 10.1900/rds.2016.13.158] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 10/19/2015] [Accepted: 10/25/2015] [Indexed: 12/15/2022] Open
Abstract
AIM To evaluate critically the current guidelines for foot screening in patients with diabetes, and to examine their relevance in terms of advancement in clinical practice, improvement in technology, and change in socio-cultural structure. METHODS A structured literature search was conducted in Pubmed/Medline, CINAHL, Cochrane Register of Controlled Trials, and Google between January 2011 and January 2015 using the keywords '(Diabetes) AND (Foot Screening) AND (Guidelines)'. RESULTS Ten complete diabetes foot screening guidelines were identified and selected for analysis. Six of them included the full-process guidelines recommended by the International Diabetes Federation. Evaluation of the existing diabetes foot screening guidelines showed substantial variability in terms of different evidence-based methods and grading systems to achieve targets, making it difficult to compare the guidelines. In some of the guidelines, it is unclear how the authors have derived the recommendations, i.e. on which study results they are based, making it difficult for the users to understand them. CONCLUSIONS Limitations of currently available guidelines and lack of evidence on which the guidelines are based are responsible for the current gaps between guidelines, standard clinical practice, and development of complications. For the development of standard recommendations and everyday clinical practice, it will be necessary to pay more attention to both the limitations of guidelines and the underlying evidence.
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Affiliation(s)
- Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Tal-Qroqq, Msida, MSD 2080, Malta
- Faculty of Health Sciences, Staffordshire University, UK
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Tal-Qroqq, Msida, MSD 2080, Malta
- Faculty of Health Sciences, Staffordshire University, UK
| | - Nachiappan Chockalingam
- Faculty of Health Sciences, University of Malta, Tal-Qroqq, Msida, MSD 2080, Malta
- Faculty of Health Sciences, Staffordshire University, UK
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Mani R, Margolis DJ, Shukla V, Akita S, Lazarides M, Piaggesi A, Falanga V, Teot L, Xie T, Bing FX, Romanelli M, Attinger C, Han CM, Lu S, Meaume S, Xu Z, Viswanathan V. Optimizing Technology Use for Chronic Lower-Extremity Wound Healing. INT J LOW EXTR WOUND 2016; 15:102-19. [DOI: 10.1177/1534734616646261] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Innovations in technology are used in managing chronic wounds. Despite the wide range of technologies available, healing of chronic wounds remains variable. In this paper, the authors offer an evidence based approach to the use of technology for diagnosis and management based on the concept of standardised care.
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Affiliation(s)
- Raj Mani
- Southampton University Hospital NHS Trust, Southampton, UK
- Chiang Mia University, Thailand
- Shanghai Jiao Tong University School of Medicine, Shanghai
| | | | | | | | | | | | | | - Luc Teot
- Hôpital Lapeyronie, Montpellier, France
| | - Ting Xie
- Ninth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | | | - Chun Mao Han
- Zhejiang University Medical College, Hunghzhou, China
| | - Shuliang Lu
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | | | - Vijay Viswanathan
- MV Hospital for Diabetes and Prof M. Viswanathan Diabetes Research Centre, WHO Collaborating Centre for Education, Training and Research in Diabetes, Chennai, India
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Lee WJ, Jang S, Lee SH, Lee HS. Correlation Between the Severity of Diabetic Peripheral Polyneuropathy and Glycosylated Hemoglobin Levels: A Quantitative Study. Ann Rehabil Med 2016; 40:263-70. [PMID: 27152276 PMCID: PMC4855120 DOI: 10.5535/arm.2016.40.2.263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/20/2015] [Indexed: 11/20/2022] Open
Abstract
Objective To investigate risk factors for diabetic peripheral polyneuropathy and their correlation with the quantified severity of nerve dysfunction in patients with diabetes mellitus (DM). Methods A total of 187 diabetic patients with clinically suspected polyneuropathy (PN) were subclassified into 2 groups according to electrodiagnostic testing: a DM-PN group of 153 diabetic patients without electrophysiological abnormality and a DM+PN group of 34 diabetic patients with polyneuropathy. For all patients, age, sex, height, weight, duration of DM, and plasma glycosylated hemoglobin (HbA1c) level were comparatively investigated. A composite score was introduced to quantitatively analyze the results of the nerve conduction studies. Logistic regression analysis and multiple regression analysis were used to evaluate correlations between significant risk factors and severity of diabetic polyneuropathy. Results The DM+PN group showed a significantly higher HbA1c level and composite score, as compared with the DM-PN group. Increased HbA1c level and old age were significant predictive factors for polyneuropathy in diabetic patients (odds ratio=5.233 and 4.745, respectively). In the multiple linear regression model, HbA1c and age showed a significant positive association with composite score, in order (β=1.560 and 0.253, respectively). Conclusion Increased HbA1c level indicative of a state of chronic hyperglycemia was a risk factor for polyneuropathy in diabetic patients and a quantitative measure of its severity.
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Affiliation(s)
- Won-Jae Lee
- Department of Physical Medicine & Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Sol Jang
- Department of Physical Medicine & Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Seung-Hwa Lee
- Department of Physical Medicine & Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
| | - Hyun-Seok Lee
- Department of Physical Medicine & Rehabilitation, Veterans Health Service Medical Center, Seoul, Korea
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43
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di Summa PG, Schaffer C, Zaugg P, Bauquis O, Raffoul W. Lumbar artery perforator (LAP) flap: a salvage tool for extended lumbo-sacral necrosis after bilateral internal iliac arteries embolization. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2016; 3:20-4. [PMID: 27583264 PMCID: PMC4996068 DOI: 10.3109/23320885.2016.1166965] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/13/2016] [Indexed: 01/28/2023]
Abstract
We report the case of a 52-year-old man presenting an extensive lumbosacral necrosis after bilateral internal iliac arteries embolization following unstable pelvic fracture. Coverage of the defect was performed using two extended lumbar artery perforator flaps in a propeller fashion. Good functional and esthetic result was achieved at one-year follow-up.
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Affiliation(s)
- Pietro Giovanni di Summa
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital , Lausanne , Switzerland
| | - Clara Schaffer
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital , Lausanne , Switzerland
| | - Patrice Zaugg
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital , Lausanne , Switzerland
| | - Olivier Bauquis
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital , Lausanne , Switzerland
| | - Wassim Raffoul
- Department of Plastic, Reconstructive and Hand Surgery, Lausanne University Hospital , Lausanne , Switzerland
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Kaminski MR, Raspovic A, McMahon LP, Erbas B, Landorf KB. Risk factors for foot ulceration in adults with end-stage renal disease on dialysis: study protocol for a prospective observational cohort study. J Foot Ankle Res 2015; 8:53. [PMID: 26388946 PMCID: PMC4575467 DOI: 10.1186/s13047-015-0110-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 09/10/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Adults with end-stage renal disease treated with dialysis experience a high burden of foot ulceration and lower extremity amputation. However, the risk factors for foot ulceration in the dialysis population are incompletely understood due to the lack of high-quality prospective evidence. This article outlines the design of a prospective observational cohort study, which aims to investigate the risk factors for foot ulceration in adults on dialysis. METHODS/DESIGN This study will recruit 430 participants with end-stage renal disease on dialysis from satellite and home-therapy dialysis units across multiple health organisations in Melbourne, Victoria, Australia. Data collection at baseline will include a participant interview, medical record review, completion of a health-status questionnaire and a non-invasive foot assessment. Twenty participants will also be recruited to a reliability study to evaluate the reproducibility of testing procedures. Primary outcome data includes: new foot ulcer(s). Secondary outcome data includes: number of new foot ulcers, time to onset of new foot ulcer(s), new lower extremity amputation(s), episodes of infection of the foot or lower extremity, episodes of osteomyelitis, foot-related hospitalisations, revascularisation procedure(s) of the lower extremity, new podiatry interventions, kidney transplantation, and mortality. Participants will be assessed at baseline, and at 12 months they will be evaluated for the primary and secondary outcomes. Multivariate Cox proportional hazards models will be used to assess predictors of new foot ulceration and time to event secondary outcomes. Logistic regression will be used for binary outcomes including prevalence of foot ulcerations. DISCUSSION This is the first multi-centre prospective observational cohort study to investigate risk factors for foot ulceration in adults with end-stage renal disease on dialysis. This study will improve on prior studies by using prospective methods, multi-centre recruitment, statistical methods to control for confounding variables, and a pre-specified sample size estimation. The findings can inform the design of future trials evaluating the effectiveness of clinical interventions, which may lead to improved patient outcomes in the dialysis setting.
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Affiliation(s)
- Michelle R Kaminski
- Discipline of Podiatry and Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Melbourne, VIC 3086 Australia ; Department of Podiatry, Eastern Health, Melbourne, VIC 3156 Australia
| | - Anita Raspovic
- Discipline of Podiatry and Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Melbourne, VIC 3086 Australia
| | - Lawrence P McMahon
- Departments of Renal Medicine and Obstetric Medicine, Eastern Health Clinical School, Monash University, Melbourne, VIC 3128 Australia
| | - Bircan Erbas
- Department of Public Health, College of Science, Health and Engineering, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086 Australia
| | - Karl B Landorf
- Discipline of Podiatry and Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Melbourne, VIC 3086 Australia
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45
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Miller JD, Najafi B, Armstrong DG. Current Standards and Advances in Diabetic Ulcer Prevention and Elderly Fall Prevention Using Wearable Technology. CURRENT GERIATRICS REPORTS 2015. [DOI: 10.1007/s13670-015-0136-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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46
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Ghisleni MM, Biolchi V, Jordon BC, Rempel C, Genro JP, Pozzobon A. Association study of C936T polymorphism of the VEGF gene and the C242T polymorphism of the p22phox gene with diabetes mellitus type 2 and distal diabetic polyneuropathy. Mol Med Rep 2015; 12:4626-1633. [PMID: 26130419 DOI: 10.3892/mmr.2015.3988] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 06/05/2015] [Indexed: 11/06/2022] Open
Abstract
Even with long‑term glycemic control, diabetes mellitus type 2 (DM2) remains the predominant cause of diabetic neuropathy. Single nucleotide polymorphism (SNP) C936T of the vascular endothelial growth factor (VEGF) gene and the SNP C242T of the p22phox (CYBA) gene have been investigated in relation to DM2 and its complications. The aim of the present study was to investigate the association between these two SNPs and DM2, and also between the SNPs and the signs and symptoms of diabetic distal polyneuropathy. The DM2 group consisted of 98 individuals and the control group consisted of 104 individuals. The results demonstrated that there was no association between the different genotypes or alleles and increased risk of the disease (P>0.05). With SNP C242T, a significant association with body mass index between the CTxTT genotypes (P=0.043) was identified; and the greatest body mass indexes were among individuals with the TT genotype. An association between the degree of neuropathic symptoms and genotypic/allelic distribution of these polymorphisms was not observed. In conclusion, the investigated polymorphisms are not correlated with the risk of developing DM2.
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Affiliation(s)
- Melissa Mottin Ghisleni
- Department of Biological and Health Sciences, Postgraduate Program in Biotechnology, Univates University Center, Rio Grande do Sul, Lajeado 95900‑000, Brazil
| | - Vanderlei Biolchi
- Department of Biological and Health Sciences, Postgraduate Program in Biotechnology, Univates University Center, Rio Grande do Sul, Lajeado 95900‑000, Brazil
| | - Bruna Cristina Jordon
- Department of Biological and Health Sciences, Postgraduate Program in Biotechnology, Univates University Center, Rio Grande do Sul, Lajeado 95900‑000, Brazil
| | - Claudete Rempel
- Department of Biological and Health Sciences, Postgraduate Program in Biotechnology, Univates University Center, Rio Grande do Sul, Lajeado 95900‑000, Brazil
| | - Júlia Pasqualini Genro
- Department of Biological and Health Sciences, Postgraduate Program in Biotechnology, Univates University Center, Rio Grande do Sul, Lajeado 95900‑000, Brazil
| | - Adriane Pozzobon
- Department of Biological and Health Sciences, Postgraduate Program in Biotechnology, Univates University Center, Rio Grande do Sul, Lajeado 95900‑000, Brazil
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Levy D. Diabetic neuropathy--it's been a long journey: will we ever arrive? J Diabetes Complications 2014; 28:255-6. [PMID: 24636760 DOI: 10.1016/j.jdiacomp.2014.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 10/25/2022]
Affiliation(s)
- David Levy
- Diabetes & Endocrinology, Hon Sen Lecturer, Queen Mary, University of London, Gillian Hanson Centre, Barts Health, Whipps Cross University Hospital, London UK E11 1NR.
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Tsapas A, Liakos A, Paschos P, Karagiannis T, Bekiari E, Tentolouris N, Boura P. A simple plaster for screening for diabetic neuropathy: a diagnostic test accuracy systematic review and meta-analysis. Metabolism 2014; 63:584-92. [PMID: 24405753 DOI: 10.1016/j.metabol.2013.11.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/22/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Neuropad is an adhesive indicator test applied at the plantar surface of the foot that detects sweating through color change. We examined the diagnostic accuracy of this simple plaster as triage test for screening for clinically relevant diabetic sensorimotor polyneuropathy in adult outpatients with type 1 or type 2 diabetes. MATERIALS/METHODS Systematic review and meta-analysis of diagnostic accuracy studies. We searched Medline, Embase, Cochrane Library, Biosis Previews, Web of Science, Scopus and gray literature without date or language restrictions. We pooled estimates of sensitivity and specificity, and fitted hierarchical models to produce summary receiver operating characteristic curves. We assessed methodological quality of included studies utilizing the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RESULTS Eighteen studies with 3470 participants met the inclusion criteria. Average sensitivity and specificity were 86% (95% CI 79 to 91) and 65% (95% CI 51 to 76) respectively. Likelihood ratios (LRs) were LR+=2.44 and LR-=0.22. Subgroup analyses per reference standard utilized provided similar estimates. Most studies were at risk of bias for patient selection and use of index or reference test, and had concerns regarding applicability due to patient selection. CONCLUSION The adhesive indicator test has reasonable sensitivity and could be used for triage of diabetic neuropathy to rule out foot at risk. Patients who tested positive should be referred to specialized care to establish a definite diagnosis. There is insufficient evidence for effectiveness on patient-important outcomes and cost-effectiveness of implementation in the diagnostic pathway compared with the standard clinical examination.
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Affiliation(s)
- Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece; Harris Manchester College, University of Oxford, Oxford, OX1 3TD, United Kingdom.
| | - Aris Liakos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece
| | - Paschalis Paschos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece
| | - Thomas Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece
| | - Eleni Bekiari
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece
| | - Nikolaos Tentolouris
- First Department of Propedeutic and Internal Medicine, University of Athens School of Medicine, 17 Ag. Thoma Street, 11527 Athens, Greece
| | - Panagiota Boura
- Second Medical Department, Aristotle University Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece
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49
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Bueno E, Benjamin MJ, Sisk G, Sampson CE, Carty M, Pribaz JJ, Pomahac B, Talbot SG. Rehabilitation following hand transplantation. Hand (N Y) 2014; 9:9-15. [PMID: 24570631 PMCID: PMC3928383 DOI: 10.1007/s11552-013-9568-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hand allotransplantation can restore motor, sensory and cosmetic functions to upper extremity amputees. Over 70 hand transplant operations have been performed worldwide, but there is little published regarding post-hand transplant rehabilitation. METHODS The Brigham and Women's Hospital (BWH) Hand Transplantation Team's post-hand transplant rehabilitation protocol is presented here. The protocol must be modified to address each transplant recipient's unique needs. It builds on universally used modalities of hand rehabilitation such as splinting, edema and scar management, range of motion exercises, activities of daily living training, electrical stimulation, cognitive training and strengthening. RESULTS The BWH hand transplant rehabilitation protocol consists of four phases with distinct goals, frequency, and modalities. (1) Pre-operative: functional assessments are completed and goals and expectations of transplantation are established. (2) Initial post-operative (post-operative weeks 1-2): hand protection, minimization of swelling, education, and discharge. (3) Intermediate (post-operative weeks 2-8): therapy aims to prevent and/or decrease scar adhesion, increase tensile strength, flexibility and function, and prevent joint contractures. (4) Late (from 8 weeks forward): maximization of function and strength, and transition to routine activities. The frequency of rehabilitation therapy decreases gradually from the initial to late phases. CONCLUSIONS Rehabilitation therapy after hand transplantation follows a progressive increase in activity in parallel with wound healing and nerve regeneration. Careful documentation of progress and outcomes is essential to demonstrate the utility of interventions and to optimize therapy protocols.
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Affiliation(s)
- Ericka Bueno
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Marie-Jose Benjamin
- />Department of Rehabilitation Services, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Geoffroy Sisk
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Christian E. Sampson
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Matthew Carty
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Julian J. Pribaz
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Bohdan Pomahac
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
| | - Simon G. Talbot
- />Division of Plastic Surgery, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115 USA
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Shalaby SY, Blume P, Sumpio BE. New modalities in the chronic ischemic diabetic foot management. Clin Podiatr Med Surg 2014; 31:27-42. [PMID: 24296016 DOI: 10.1016/j.cpm.2013.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The diabetic population is increasing worldwide at a staggering rate. Diabetic foot ulcers are a major contributor to nontraumatic lower limb amputations and peripheral arterial disease is one of main contributing pathophysiologic causes of diabetic ulcers. The dire need to reduce complication and wound healing recovery period of the chronic ischemic diabetic foot (CIDF) is indispensable to limb salvage and improvement of quality of life of patients with CIDF. This article discusses newer modalities that have been proposed to improve CIDF efficiently, safely, and effectively either alone or as adjuvants to conventional therapy.
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Affiliation(s)
- Sherif Y Shalaby
- Department of Vascular Surgery, Yale University School of Medicine, 310 Cedar Street, New Haven, CT 06510, USA
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