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Marques R, Lopes M, Ramos P, Neves‐Amado J, Alves P. Prognostic factors for delayed healing of complex wounds in adults: A scoping review. Int Wound J 2023; 20:2869-2886. [PMID: 36916415 PMCID: PMC10410354 DOI: 10.1111/iwj.14128] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/08/2023] [Accepted: 02/13/2023] [Indexed: 03/15/2023] Open
Abstract
Complex or hard-to-heal wounds continue to be a challenge because of the negative impact they have on patients, caregivers, and all the associated costs. This study aimed to identify prognostic factors for the delayed healing of complex wounds. Five databases and grey literature were the sources used to research adults with pressure ulcers/injuries, venous leg ulcers, critical limb-threatening ischaemia, or diabetic foot ulcers and report the prognostic factors for delayed healing in all care settings. In the last 5 years, a total of 42 original peer-reviewed articles were deemed eligible for this scoping review that followed the JBI recommendations and checklist PRISMA-ScR. The most frequent prognostic factors found with statistical significance coinciding with various wound aetiologies were: gender (male), renal disease, diabetes, peripheral arterial disease, the decline in activities of daily life, wound duration, wound area, wound location, high-stage WIfI classification, gangrene, infection, previous ulcers, and low ankle brachial index. It will be essential to apply critical appraisal tools and assessment risk of bias to the included studies, making it possible to make recommendations for clinical practice and build prognostic models. Future studies are recommended because the potential for healing through identification of prognostic factors can be determined, thus allowing an appropriate therapeutic plan to be developed.
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Affiliation(s)
- Raquel Marques
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
| | - Marcos Lopes
- School of Nursing DepartmentUniversidade Federal CearáFortalezaBrazil
| | - Paulo Ramos
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
- Unidade de Saúde Familiar Corino de AndradePortoPortugal
| | - João Neves‐Amado
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
- School of Nursing DepartmentUniversidade Católica PortuguesaPortoPortugal
| | - Paulo Alves
- Centre for Interdisciplinary Research in Health, Instituto de Ciências da SaúdeUniversidade Católica PortuguesaPortoPortugal
- School of Nursing DepartmentUniversidade Católica PortuguesaPortoPortugal
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2
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Wang G, Lin Z, Li Y, Chen L, Reddy SK, Hu Z, Garza L. Colonizing microbiota is associated with clinical outcomes in diabetic wound healing. Adv Drug Deliv Rev 2023; 194:114727. [PMID: 36758858 PMCID: PMC10163681 DOI: 10.1016/j.addr.2023.114727] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/02/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
With the development of society and the improvement of life quality, more than 500 million people are affected by diabetes. More than 10 % of people with diabetes will suffer from diabetic wounds, and 80 % of diabetic wounds will reoccur, so the development of new diabetic wound treatments is of great importance. The development of skin microbe research technology has gradually drawn people's attention to the complex relationship between microbes and diabetic wounds. Many studies have shown that skin microbes are associated with the outcome of diabetic wounds and can even be used as one of the indicators of wound prognosis. Skin microbes have also been found to have the potential to treat diabetic wounds. The wound colonization of different bacteria can exert opposing therapeutic effects. It is necessary to fully understand the skin microbes in diabetic wounds, which can provide valuable guidance for clinical diabetic wound treatment.
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Affiliation(s)
- Gaofeng Wang
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510515, China; Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21210, USA.
| | - Zhen Lin
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Yue Li
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Lu Chen
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Sashank K Reddy
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21210, USA; Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Zhiqi Hu
- Department of Plastic and Aesthetic Surgery, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong Province 510515, China
| | - Luis Garza
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD 21210, USA; Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, MD 21210, USA; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21210, USA.
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3
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Abedin-Do A, Zhang Z, Douville Y, Méthot M, Bernatchez J, Rouabhia M. Engineering diabetic human skin equivalent for in vitro and in vivo applications. Front Bioeng Biotechnol 2022; 10:989888. [PMID: 36246377 PMCID: PMC9561872 DOI: 10.3389/fbioe.2022.989888] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
The prevalence of diabetes is increasing worldwide. Diabetes contributes to 70% of all non-traumatic lower-limb amputations, which are directly caused by diabetic foot ulcers (DFU) that are difficult to heal. Non-healing diabetic ulcers represent one of modern society’s most difficult medical challenges. One of the promising initiatives to treat DFU is the grafting of autologous skin or stimulating the skin cells at the edge of the wound to proliferate and close the wound. The present study was to engineer a diabetic human skin equivalent (DHSE) that contains fibroblasts and keratinocytes extracted from the skin collected from diabetic patients. The DHSE was used to investigate whether exposure to low-intensity electrical stimulation (ES) could promote diabetic cell activity. The ES was generated by a direct current (DC) electric field of 20 or 40 mV/mm. We demonstrated that the fibroblasts and keratinocytes could be extracted from older diabetics, cultured, and used to engineer DHSE. Interestingly, the exposure of DHSE to ES led to a structural improvement through tissue stratification, increased Ki-67 expression, and the deposition of basement membrane proteins (laminin and type IV collagen). The DHSE exposed to ES showed a high level of keratin 5 and 14 expressions in the basal and supra-basal layers. The keratinocyte proliferation was supported by an increased secretion of the keratinocyte growth factor (FGF-7). Exposure to ES decreased the activity of metalloproteinases (MMP) 2 and 9. In conclusion, we extracted keratinocytes and fibroblasts from the skin of diabetic-old donors. These cells were used to engineer skin equivalents and demonstrate that ES can promote diabetic wound healing. This DHSE can be a promising tool for various in vitro studies to understand the wound healing mechanisms under chronic inflammatory conditions such as diabetes. The DHSE could also be used as an autologous substrate to cover the DFU permanently.
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Affiliation(s)
- Atieh Abedin-Do
- Groupe de Recherche en Écologie Buccale, Faculté de Médecine Dentaire Université Laval, Quebec, QC, Canada
- Axe Médecine Régénératrice Centre de Recherche du CHU de Québec Département de Chirurgie Faculté de Médecine, Université Laval, Quebec, QC, Canada
| | - Ze Zhang
- Groupe de Recherche en Écologie Buccale, Faculté de Médecine Dentaire Université Laval, Quebec, QC, Canada
| | - Yvan Douville
- Axe Médecine Régénératrice Centre de Recherche du CHU de Québec Département de Chirurgie Faculté de Médecine, Université Laval, Quebec, QC, Canada
| | - Mirelle Méthot
- Axe Médecine Régénératrice Centre de Recherche du CHU de Québec Département de Chirurgie Faculté de Médecine, Université Laval, Quebec, QC, Canada
| | - Julien Bernatchez
- Axe Médecine Régénératrice Centre de Recherche du CHU de Québec Département de Chirurgie Faculté de Médecine, Université Laval, Quebec, QC, Canada
| | - Mahmoud Rouabhia
- Groupe de Recherche en Écologie Buccale, Faculté de Médecine Dentaire Université Laval, Quebec, QC, Canada
- *Correspondence: Mahmoud Rouabhia,
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Sanchez CA, Niño ME, Calderon M, García LF, Sierra D. Microbiota of diabetic foot infections in a University Hospital in Bogotá, Colombia. Foot (Edinb) 2022; 52:101867. [PMID: 35643034 DOI: 10.1016/j.foot.2021.101867] [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: 04/30/2020] [Revised: 08/09/2021] [Accepted: 09/19/2021] [Indexed: 02/04/2023]
Abstract
The presence of infection in diabetic foot ulcers (DFU) is one of the main causes of lower limb amputation in the world. The presence of polymicrobial infections is usually the standard for isolation in such lesions, with Gram Positive (GP) germs being the main organisms involved, as is described in the global literature. However, some studies indicate a greater number of isolates with Gram Negative (GN) germs, reported mainly in the literature of Middle Eastern countries and in the tropics.
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Affiliation(s)
- Carlos A Sanchez
- Department of Orthopaedics and Traumatology, Hospital de la Samaritana, Carrera 8 #0-29 Sur, Santa Fé, Bogotá, Cundinamarca, Bogotá, Colombia.
| | - Manuel E Niño
- Department of Orthopaedics and Traumatology, Hospital de la Samaritana, Carrera 8 #0-29 Sur, Santa Fé, Bogotá, Cundinamarca, Bogotá, Colombia.
| | - Mauricio Calderon
- Departament of Internal Medicine, Hospital de la Samaritana, Carrera 8 #0-29 Sur, Santa Fé, Bogotá, Cundinamarca, Bogotá, Colombia.
| | - Luisa F García
- Department of Orthopaedics and Traumatology, Hospital de la Samaritana, Carrera 8 #0-29 Sur, Santa Fé, Bogotá, Cundinamarca, Bogotá, Colombia.
| | - Daniela Sierra
- Universidad de la Sabana, Hospital de la Samaritana, Carrera 8 #0-29 Sur, Santa Fé, Bogotá, Cundinamarca, Bogotá, Colombia.
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Wang P, Wang Y, Yi Y, Gong Y, Ji H, Gan Y, Xie F, Fan J, Wang X. MXenes-integrated microneedle combined with asiaticoside to penetrate the cuticle for treatment of diabetic foot ulcer. J Nanobiotechnology 2022; 20:259. [PMID: 35672708 PMCID: PMC9172054 DOI: 10.1186/s12951-022-01468-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/19/2022] [Indexed: 11/10/2022] Open
Abstract
AbstractPatients with diabetic foot ulcers usually suffer from inefficient epithelisation and angiogenesis accompanied by chronic wound healing. Diabetic foot ulcers remain a major challenge in clinical medicine; however, traditional treatments are incapable of transdermal drug delivery, resulting in a low drug delivery rate. We report the development of Ti2C3 MXenes-integrated poly-γ-glutamic acid (γ-PGA) hydrogel microneedles to release asiaticoside (MN-MXenes-AS). Asiaticoside was loaded into PGA-MXenes hydrogel to facilitate cell proliferation while regulating angiogenesis. The characterisation and mechanical strength of the microneedles were investigated in vitro, and the wound-healing efficacy of the microneedles was confirmed in diabetic mice. MXenes significantly improved the mechanical strength of microneedles, while γ-PGA hydrogels provided a moist microenvironment for wound healing. Mice treated with MN-MXenes-AS demonstrated obvious improvements in wound healing process. We successfully fabricated an MXenes-integrated microneedle that possesses sufficient rigidity to penetrate the cuticle for subcutaneous drug delivery, thereby accelerating diabetic wound healing. We demonstrated that MN-MXenes-AS is effective in promoting growth both in vivo and in vitro. Collectively, our data show that MN-MXenes-AS accelerated the healing of diabetic foot ulcers, supporting the use of these microneedles in the treatment of chronic wounds.
Graphical Abstract
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6
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Chen X, Shen Y, Wang Y, Li Y, Guo S, Liang Y, Wang X, Zhou S, Hu X, Ma K, Tian R, Fei W, Sheng Y, Cao H, Que H. Decreased accuracy of erythrocyte sedimentation rate in diagnosing osteomyelitis in diabetic foot infection patients with severe renal impairment: A retrospective cross-sectional study. PLoS One 2022; 17:e0265769. [PMID: 35320298 PMCID: PMC8942204 DOI: 10.1371/journal.pone.0265769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/07/2022] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Rapid diagnosis and treatment of diabetic foot osteomyelitis (DFO) could reduce the risk of amputation and death in patients with diabetic foot infection (DFI). Erythrocyte sedimentation rate (ESR) is considered the most useful serum inflammatory marker for the diagnosis of DFO. However, whether severe renal impairment (SRI) affects its diagnostic accuracy has not been reported previously. OBJECTIVE To investigate the accuracy of ESR in diagnosing DFO in DFI patients with and without SRI. METHODS This was a retrospective cross-sectional study. From the inpatient electronic medical record system, the investigators extracted demographic information, diagnostic information, and laboratory test results of patients with DFI who had been hospitalized in Longhua Hospital from January 1, 2016 to September 30, 2021. Logistic regression was performed to analyze the interaction between ESR and SRI with adjustment for potential confounders. The area under the curve (AUC), cutoff point, sensitivity, specificity, prevalence, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR-) were analyzed by receiver operating characteristic (ROC) curve analysis and VassarStats. RESULTS A total of 364 DFI patients were included in the analysis. The logistic regression analysis results showed that elevated ESR increased the probability of diagnosing DFO (adjusted odds ratio [OR], 2.40; 95% confidence interval [CI], 1.75-3.28; adjusted P < 0.001); SRI was not associated with the diagnosis of DFO (adjusted OR, 3.20; 95% CI, 0.40-25.32; adjusted P = 0.271), but it had an obstructive effect on the diagnosis of DFO by ESR (adjusted OR, 0.48; 95% CI, 0.23-0.99; adjusted P = 0.048). ROC analysis in DFI patients without SRI revealed that the AUC of ESR to diagnose DFO was 0.76 (95% CI, 0.71-0.81), with the cutoff value of 45 mm/h (sensitivity, 67.8%; specificity, 78.0%; prevalence, 44.7%; PPV, 71.3%; NPV, 75.0%; LR+, 3.08; LR-, 0.41). In contrast, in patients with SRI, the AUC of ESR to diagnose DFO was 0.57 (95% CI, 0.40-0.75), with the cutoff value of 42 mm/h (sensitivity, 95.0%; specificity, 29.2%; prevalence, 45.5%; PPV, 52.8%; NPV, 87.5%; LR+, 1.34; LR-, 0.17). CONCLUSIONS The accuracy of ESR in diagnosing DFO in DFI patients with SRI is reduced, and it may not have clinical diagnostic value in these patients.
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Affiliation(s)
- Xin Chen
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yiting Shen
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuying Wang
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yang Li
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Department of Thoracic Surgery, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuyu Guo
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yue Liang
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuanyu Wang
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Siyuan Zhou
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaojie Hu
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Kaiwen Ma
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rui Tian
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wenting Fei
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuqin Sheng
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hengjie Cao
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Longhua Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Huafa Que
- Department of Surgery of Traditional Chinese Medicine, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, China
- * E-mail:
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7
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Branch-Elliman W, Sturgeon D, Karchmer AW, Mull HJ. Association Between Diabetic Foot Infection Wound Culture Positivity and 1-Year Admission for Invasive Infection: A Multicenter Cohort Study. Open Forum Infect Dis 2021; 8:ofab172. [PMID: 34631923 DOI: 10.1093/ofid/ofab172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/30/2021] [Indexed: 11/12/2022] Open
Abstract
Inpatients with culture-positive diabetic foot infections are at elevated risk for subsequent invasive infection with the same causative organism. In outpatients with index diabetic foot ulcers, we found that wound culture positivity was independently associated with increased odds of 1-year admission for systemic infection when compared with culture-negative wounds.
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Affiliation(s)
- Westyn Branch-Elliman
- Section of Infectious Diseases, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA.,Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Sturgeon
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Adolf W Karchmer
- Harvard Medical School, Boston, Massachusetts, USA.,Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Hillary J Mull
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
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8
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Tsai GL, Zilberbrand D, Liao WJ, Horl LP. Healing hard-to-heal diabetic foot ulcers: the role of dehydrated amniotic allograft with cross-linked bovine-tendon collagen and glycosaminoglycan matrix. J Wound Care 2021; 30:S47-S53. [PMID: 34256586 DOI: 10.12968/jowc.2021.30.sup7.s47] [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: 11/11/2022]
Abstract
The treatment of diabetic foot ulcers is complex and costly with an increased risk for infection, which may even lead to amputation. This prospective case series aims to assess the effectiveness of a dehydrated amniotic membrane allograft combined with a bilayer dermal matrix for healing complicated foot ulcers in patients with comorbidities. A total of six patients with complicated full-thickness ulcers and comorbidities, such as diabetes and peripheral vascular disease were treated with this technique. Each wound was measured intraoperatively just before graft application, at 14 days after application, and then at weeks 4, 8, and 12. Changes in wound volume and area were compared over time. One patient had complete wound closure by week eight, a second patient by week 12. The other four patients had wounds that decreased in size during the course of 12 weeks. The mean decrease in wound volume was 73.5% post-removal of the bilayer dermal matrix after two weeks of application. At week 12, the mean decrease in wound area and volume were 93.2% and 97.1%, respectively. This case series provides initial evidence that the combination of dehydrated amniotic membrane allograft with bilayer dermal matrix promotes complete wound closure in patients with comorbidities that may impede wound healing. Further clinical trials are needed to confirm these results.
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Affiliation(s)
- Grace L Tsai
- Department of Podiatry, Mount Sinai, South Nassau, US
| | | | - Wei Jei Liao
- Department of Podiatry, Mount Sinai, South Nassau, US
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9
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Ozone Therapy on Reduction of Bacterial Colonies and Acceleration of Diabetic Foot Ulcer Healing. Home Healthc Now 2021; 38:215-220. [PMID: 32618780 DOI: 10.1097/nhh.0000000000000889] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Diabetic foot ulcers (DFUs) are highly vulnerable to infection and pose risk for limb amputations. Studies have shown that ozone therapy reduces wound size and improves wound healing time better than standard treatments. We examined the effectiveness of combining standard wound care with ozone therapy to reduce bacterial colonization and accelerate healing of DFUs in the home care setting. The control group (n = 12) received standard wound care with antimicrobial dressings every 3 days for 21 days, and the intervention group (n = 15) received the same as control group plus ozone bagging therapy at 70 μg/mL for 10 minutes every 3 days for 21 days. Combining standard wound care with ozone therapy significantly decreased the number of bacterial colonies (p = 0.001). However, no significant difference in DFU assessment score was found between the intervention and control groups (p > 0.05). Combining standard wound care with ozone therapy reduced the number of bacteria in the DFUs but exerted no significant effect on wound healing. Future studies should examine the administration of ozone therapy with different concentrations and times of exposure to explore the right dose for healing DFUs.
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Pulido-Pérez A, Bergón-Sendín M, Suárez-Fernández R, Muñoz-Martín P, Bouza E. Skin and sepsis: contribution of dermatology to a rapid diagnosis. Infection 2021; 49:617-629. [PMID: 33860474 DOI: 10.1007/s15010-021-01608-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/19/2021] [Indexed: 11/24/2022]
Abstract
In patients who develop sepsis, whether due to primary, secondary or metastatic lesions, the skin is frequently affected. However, there are unresolved aspects regarding the general clinical manifestations in the skin or the prognosis and/or therapeutic implications. The main challenge in the approach to sepsis is its early diagnosis and management. In this review, we address the sepsis-skin relationship and the potential impact of early dermatological intervention on the septic patient through ten basic questions. We found little evidence of the participation of the dermatologist in sepsis alert programs. There are early skin changes that may alert clinicians on a possible sepsis, such as skin mottling or variations in acral skin temperature. In addition, the skin is an accessible and highly cost-effective tissue for etiological studies of some forms of sepsis (e.g., meningococcal purpura) and its involvement defines the prognosis of certain patients (e.g., infective endocarditis).
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Affiliation(s)
- A Pulido-Pérez
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007, Madrid, Spain. .,Instituto de Investigación Biomédica Gregorio Marañón, Madrid, Spain.
| | - M Bergón-Sendín
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007, Madrid, Spain.,Instituto de Investigación Biomédica Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - R Suárez-Fernández
- Department of Dermatology, Hospital General Universitario Gregorio Marañón, C/Doctor Esquerdo 46, 28007, Madrid, Spain.,Instituto de Investigación Biomédica Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - P Muñoz-Martín
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.,Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Biomédica Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - E Bouza
- CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Madrid, Spain.,Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Biomédica Gregorio Marañón, Madrid, Spain.,Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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11
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Tola A, Regassa LD, Ayele Y. Prevalence and associated factors of diabetic foot ulcers among type 2 diabetic patients attending chronic follow-up clinics at governmental hospitals of Harari Region, Eastern Ethiopia: A 5-year (2013-2017) retrospective study. SAGE Open Med 2021; 9:2050312120987385. [PMID: 33552513 PMCID: PMC7838876 DOI: 10.1177/2050312120987385] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 12/17/2020] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Diabetic foot disease is a growing major public health problem and the leading cause of prolonged hospital admission, health-related costs, and reduced quality of life for diabetes patients. This study aimed to determine the prevalence of diabetic foot ulcers (DFU) and its associated factors among type 2 diabetes patients in Harari Region, East Ethiopia. METHODS An institution-based retrospective study was conducted from 28 March to 30 April 2018, among type 2 diabetes patients diagnosed between 1 January 2013 and 31 December 2017, at three government hospitals of Harari Region. Data were collected using a standard checklist format. Data were entered into Epi Info Version 7 and analyzed using SPSS 24. Binary and multiple logistic regression models were used to determine the associated factors. Odds ratio with 95% confidence intervals was used to determine level of association. RESULT A document of 502 type 2 diabetes patients was reviewed and included in the final analysis in this study. The prevalence of DFU among type 2 diabetes patients was 21.1%. Being currently married decreased the odds of DFU by 60% (adjusted odds ratio = 0.40; 95% confidence interval: 0.17-0.96). Factors associated with increased diabetes ulcers chance were physical inactivity 2.29 (adjusted odds ratio = 2.29; 95% confidence interval: 1.17-4.48), starting treatment with insulin 4.43 times (adjusted odds ratio = 4.43; 95% confidence interval: 1.84-10.67), obesity 27.76 (adjusted odds ratio = 27.76; 95% confidence interval: 13.96-55.23), delay to start follow-up 2.22 (adjusted odds ratio = 2.22; 95% confidence interval: 1.03-4.82), history of infection 3.50 (adjusted odds ratio= 3.50; 95% confidence interval: 1.83-6.69), and hypertension 3.99 (adjusted odds ratio = 3.99; 95% confidence interval: 2.08-7.65). CONCLUSION The prevalence of DFU among type 2 diabetes is substantially high as more than one in five patients have this complication. Moreover, marital status, physical activity, baseline medication, obesity, delay for follow-up, infection history, and hypertension were significantly associated with the development of DFU.
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Affiliation(s)
- Assefa Tola
- Department of Epidemiology and
Biostatistics, School of Public Health, College of Health and Medical Sciences,
Haramaya University, Harar, Ethiopia
| | - Lemma Demissie Regassa
- Department of Epidemiology and
Biostatistics, School of Public Health, College of Health and Medical Sciences,
Haramaya University, Harar, Ethiopia
| | - Yohanes Ayele
- Department of Clinical Pharmacy, School
of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia
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Polk C, Sampson MM, Roshdy D, Davidson LE. Skin and Soft Tissue Infections in Patients with Diabetes Mellitus. Infect Dis Clin North Am 2020; 35:183-197. [PMID: 33303332 DOI: 10.1016/j.idc.2020.10.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Skin and soft tissue infections are common in diabetics. Diabetic foot infection usually results from disruption of the skin barrier, trauma, pressure, or ischemic wounds. These wounds may become secondarily infected or lead to development of adjacent soft tissue or deeper bone infection. Clinical assessment and diagnosis of these conditions using a multidisciplinary management approach, including careful attention to antibiotic selection, lead to the best outcomes in patient care.
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Affiliation(s)
- Christopher Polk
- Division of Infectious Diseases, Department of Medicine, Atrium Health, Charlotte, NC, USA
| | - Mindy M Sampson
- Division of Infectious Diseases, Department of Medicine, Atrium Health, Charlotte, NC, USA
| | - Danya Roshdy
- Antimicrobial Support Network, Division of Pharmacy, Atrium Health, 1000 Blythe Boulevard, Charlotte, NC 28203, USA
| | - Lisa E Davidson
- Division of Infectious Diseases, Department of Medicine, Atrium Health, 1540 Garden Terrace, Suite 211, Charlotte, NC 28203, USA.
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Vinkel J, Holm NFR, Jakobsen JC, Hyldegaard O. Effects of adding adjunctive hyperbaric oxygen therapy to standard wound care for diabetic foot ulcers: a protocol for a systematic review with meta-analysis and trial sequential analysis. BMJ Open 2020; 10:e031708. [PMID: 32601110 PMCID: PMC7328748 DOI: 10.1136/bmjopen-2019-031708] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Diabetic foot ulcer represents a major health problem globally. Preliminary studies have indicated that systemic treatment of diabetic foot ulcer patients with hyperbaric oxygen therapy have beneficial effects on wound healing, risk of amputation, glycaemic control, atherosclerosis, inflammatory markers and other clinical and laboratory parameters. This protocol for a systematic review aims at identifying the beneficial and harmful effects of adding hyperbaric oxygen therapy to standard wound care for diabetic foot ulcers. METHODS AND ANALYSIS This protocol was performed following the recommendations of the Cochrane Collaboration and the eight-step assessment procedure suggested by Jakobsen and colleagues. We plan to include all relevant randomised clinical trials assessing the effects of hyperbaric oxygen therapy in the treatment of diabetic foot ulcer versus any control group with any intervention defined as standard wound care or similar, together with sham interventions. Our primary outcome will be: all-cause mortality, serious adverse events and quality of life. Our secondary outcomes will be: healing of index wound, major amputation and wound infection. Any eligible trial will be assessed and classified as either high risk of bias or low risk of bias, and our conclusions will be based on trials with low risk of bias. The analyses of the extracted data will be performed using Review Manager 5 and Trial Sequential Analysis. For both our primary and secondary outcomes, we will create a 'Summary of Findings' table and use GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment to assess the quality of the evidence. ETHICS AND DISSEMINATION We use publicly accessible documents as evidence, there is no participant involvement at an individual level and an institutional ethics approval is not required. The results of the review will be sought published in a peer-reviewed journals, also in the event of insignificant results or null results, and thereby it will be disseminated to clinicians and public available. PROSPERO REGISTRATION NUMBER CRD42019139256.
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Affiliation(s)
- Julie Vinkel
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Rigshospitalet, Denmark
| | - Niels Frederich Rose Holm
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Rigshospitalet, Denmark
| | - Janus C Jakobsen
- The Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Rigshospitalet, Denmark
- Department of Cardiology, Holbaek Sygehus, Holbaek, Sjaelland, Denmark
- Department of Regional Health Research, The Faculty of Heath Sciences University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Holbæk Hospital, Holbaek, Denmark
| | - Ole Hyldegaard
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Rigshospitalet, Denmark
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Effects of diabetic foot infection on vascular and immune function in the lower limbs. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00750-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Hersant J, Bigou Y, Ammi M, Henni S, Abraham P. Screening for peripheral artery disease in people with diabetes. Diabet Med 2019; 36:256-257. [PMID: 30198580 DOI: 10.1111/dme.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Hersant
- Vascular Medicine, University Hospital Angers, Angers, France
| | - Y Bigou
- Vascular Medicine, University Hospital Angers, Angers, France
| | - M Ammi
- Vascular Surgery, University Hospital Angers, Angers, France
| | - S Henni
- Vascular Medicine, University Hospital Angers, Angers, France
| | - P Abraham
- Vascular Medicine, University Hospital Angers, Angers, France
- Mitovasc, University of Angers, Angers, France
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Hale AJ, Vicks E, LaSalvia MT, Giurini JM, Karchmer AW. Methicillin-Resistant Staphylococcus aureus Endocarditis from a Diabetic Foot Ulcer Understanding and Mitigating the Risk. J Am Podiatr Med Assoc 2018; 108:528-531. [PMID: 30742500 DOI: 10.7547/17-139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Diabetic foot infections are a common cause of morbidity and mortality in the United States, and successful treatment often requires an aggressive and prolonged approach. Recent work has elucidated the importance of appropriate therapy for a given severity of diabetic foot infection, and highlighted the ongoing risk such patients have for subsequent invasive life-threatening infection should diabetic foot ulcers fail to heal. The authors describe the case of a man with diabetes who had prolonged, delayed healing of a diabetic foot ulcer. The ulcer subsequently became infected by methicillin-resistant Staphylococcus aureus (MRSA). The infection was treated conservatively with oral therapy and minimal debridement. Several months later, he experienced MRSA bloodstream infection and complicating endocarditis. The case highlights the ongoing risk faced by patients when diabetic foot ulcers do not heal promptly, and emphasizes the need for aggressive therapy to promote rapid healing and eradication of MRSA.
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Affiliation(s)
- Andrew J. Hale
- University of Vermont Medical Center and Larner College of Medicine, University of Vermont, Burlington, VT
| | | | - Mary T. LaSalvia
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - John M. Giurini
- Division of Podiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Adolf W. Karchmer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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