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Ahmed S, Barwick A, Sharma A, Hasan MZ, Kabir MA, Nancarrow S. Examining characteristics of those who receive pedorthic services: A clinical audit. PLoS One 2024; 19:e0304443. [PMID: 38950041 PMCID: PMC11216586 DOI: 10.1371/journal.pone.0304443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/14/2024] [Indexed: 07/03/2024] Open
Abstract
Diabetes-related foot complications, including neuropathic plantar forefoot ulcers, are a significant contributor to morbidity and increased healthcare costs. This retrospective clinical audit examines the characteristics of people accessing pedorthics services who are at risk of neuropathic plantar forefoot ulcer (re)occurrence and the pathways and funding models used to access these services. A clinical record audit was conducted on all patients accessing a pedorthics service who had diabetes and neuropathy with a history of plantar forefoot ulceration. The data included demographics, diabetes and neuropathy duration, main forefoot pathology and other comorbidity, footwear and insole interventions, and health fund access status. A total of 70 patient records were accessed, and relevant data was extracted. The mean age of participants was 64.69 (standard deviation (SD) 11.78) years; 61% were male and 39% female. Duration of diabetes ranged from one to 35 years, with a mean of 14.09 years (SD 6.58). The mean duration of neuropathy was 8.56 (SD 4.16) years. The most common forefoot conditions were bony prominences at 71% (n = 50), rigid flat foot and limited joint mobility (53%, n = 37), and hallux abductovalgus at 47% (n = 33). All participants had hyperkeratosis; 34% (n = 24) had forefoot amputation, and around 34% (n = 24) had a history of digital amputation. Various publicly funded packages and private health insurance were accessed. This study investigates the sociodemographic and medical profiles of individuals with diabetes-related foot complexities prone to neuropathic plantar forefoot ulcers. It is the first to examine patients receiving pedorthic services, informing practitioner surveys and preventive care strategies. Understanding patient characteristics aids in optimising multidisciplinary care and reducing ulcer incidence. Further studies are warranted to explore the field to establish an effective multidisciplinary care approach between medical professionals, podiatrists and pedorthists to optimise patient outcomes.
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Affiliation(s)
- Sayed Ahmed
- School of Health and Human Sciences, Southern Cross University, Queensland, Australia
- Foot Balance Technology Pty Ltd, Sydney, NSW, Australia
| | - Alex Barwick
- School of Health and Human Sciences, Southern Cross University, Queensland, Australia
| | - Anita Sharma
- Department of Geriatric Medicine, Nepean Hospital, Penrith, NSW, Australia
- Nepean Clinical School, Faculty of Medicine and Health, University of Sydney, Kingswood, NSW, Australia
| | - Md. Zobaer Hasan
- School of Science, Monash University Malaysia, Bandar Sunway, Selangor Darul Ehsan, Malaysia
| | - Muhammad Ashad Kabir
- School of Computing, Mathematics and Engineering, Charles Sturt University, Bathurst, NSW, Australia
| | - Susan Nancarrow
- School of Health and Human Sciences, Southern Cross University, Queensland, Australia
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Chatzistergos P, Chockalingam N. Diabetic ulcer alert: Time to rethink our approach to patient adherence. Diabet Med 2024; 41:e15276. [PMID: 38140765 DOI: 10.1111/dme.15276] [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] [Received: 09/13/2023] [Accepted: 12/13/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Panagiotis Chatzistergos
- Centre for Biomechanics and Rehabilitation Technology, Staffordshire University, Stoke on Trent, UK
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technology, Staffordshire University, Stoke on Trent, UK
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Zheng H, Na H, Yao J, Su S, Han F, Li X, Chen X. 16S rRNA seq-identified Corynebacterium promotes pyroptosis to aggravate diabetic foot ulcer. BMC Infect Dis 2024; 24:366. [PMID: 38561650 PMCID: PMC10986075 DOI: 10.1186/s12879-024-09235-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Diabetic foot ulcer (DFU) is one of the main chronic complications caused by diabetes, leading to amputation in severe cases. Bacterial infection affects the wound healing in DFU. METHODS DFU patients who met the criteria were selected, and the clinical data were recorded in detail. The pus exudate from the patient's foot wound and venous blood were collected for biochemical analysis. The distribution of bacterial flora in pus exudates of patients was analyzed by 16S rRNA sequencing, and the correlation between DFU and pathogenic variables, pyroptosis and immunity was analyzed by statistical analysis. Then, the effects of key bacteria on the inflammation, proliferation, apoptosis, and pyroptosis of polymorphonuclear leukocytes were investigated by ELISA, CCK-8, flow cytometry, RT-qPCR and western blot. RESULTS Clinical data analysis showed that Wagner score was positively correlated with the level of inflammatory factors, and there was high CD3+, CD4+, and low CD8+ levels in DFU patients with high Wagner score. Through alpha, beta diversity analysis and species composition analysis, Corynebacterium accounted for a large proportion in DFU. Logistics regression model and Person correlation analysis demonstrated that mixed bacterial infections could aggravate foot ulcer, and the number of bacteria was closely related to inflammatory factors PCT, PRT, immune cells CD8+, and pyroptosis-related proteins GSDMD and NLRP3. Through in vitro experiments, Corynebacterium inhibited cell proliferation, promoted inflammation (TNF-α, PCT, CRP), apoptosis and pyroptosis (IL-1β, LDH, IL-18, GSDMD, NLRP3, and caspase-3). CONCLUSION Mixed bacterial infections exacerbate DFU progression with a high predominance of Corynebacterium, and Corynebacterium promotes inflammation, apoptosis and pyroptosis to inhibit DFU healing.
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Affiliation(s)
- Hailong Zheng
- Department of Endocrinology, The First Affiliated Hospital of Hainan Medical University, Hainan Province, No. 31, Longhua Road, Haikou City, 570102, China
| | - Han Na
- Department of Endocrinology, The First Affiliated Hospital of Hainan Medical University, Hainan Province, No. 31, Longhua Road, Haikou City, 570102, China
| | - Jiangling Yao
- Department of Wound Repair, The First Affiliated Hospital of Hainan Medical University, Hainan Province, No. 31, Longhua Road, Haikou City, 570102, China
| | - Sheng Su
- Department of Endocrinology, The First Affiliated Hospital of Hainan Medical University, Hainan Province, No. 31, Longhua Road, Haikou City, 570102, China
| | - Feng Han
- Department of Clinical Laboratory, The First Affiliated Hospital of Hainan Medical University, Hainan Province, No. 31, Longhua Road, Haikou City, 570102, China
| | - Xiaoyan Li
- Department of Endocrinology, The First Affiliated Hospital of Hainan Medical University, Hainan Province, No. 31, Longhua Road, Haikou City, 570102, China
| | - Xiaopan Chen
- Department of Endocrinology, The First Affiliated Hospital of Hainan Medical University, Hainan Province, No. 31, Longhua Road, Haikou City, 570102, China.
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Lucoveis MLS, Gamba M, Silva EQ, Pinto LAS, Sacco ICN. The effects of the use of customized silicone digital orthoses on pre-ulcerative lesions and plantar pressure during walking in people with diabetic neuropathy: A study protocol for a randomized controlled trial. Contemp Clin Trials Commun 2024; 37:101247. [PMID: 38269045 PMCID: PMC10806755 DOI: 10.1016/j.conctc.2023.101247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/15/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024] Open
Abstract
Background People with diabetes and diabetic peripheral neuropathy (DPN) often develop calluses due to toe misalignment and increased plantar pressure. Untreated, these issues can progress into ulcers, making early intervention crucial. This trial protocol aims to evaluate the efficacy and safety of customized silicone digital orthoses in preventing ulcers, pre-ulcerative lesions, and peak pressure during gait in people with DPN. Methods In this superiority randomized controlled parallel trial with single-blind assessment, 60 participants will be allocated to the control group (CG) or the intervention group (IG). The CG will receive specialized nurse-administered foot care, including callus removal, nail care guidance, and self-care education. The IG will receive the same care plus a customized silicone orthosis for toe realignment for 6 months. Assessments will occur at baseline and 3 and 6 months for the primary outcomes (pre-ulcerative lesions and ulcer incidence) and secondary outcomes (pressure distribution, foot function and health, quality of life, safety, and comfort). Two-way ANOVAs (p < .05) will assess group, time, and group by time effects following an intention-to-treat approach. Conclusion Although recommended for foot ulcer prevention, custom silicone orthosis adoption remains limited due to the low certainty of evidence. This trial seeks to provide more consistent evidence for the use of toe orthoses in preventing callus and ulcer formation for individuals with DPN. Trial registry ClinicalTrials.gov (NCT05683106) "Effects of Customized Silicone Digital Orthoses in People with Diabetic Neuropathy" (registered on December 20, 2022).
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Affiliation(s)
- Maria L S Lucoveis
- School of Medicine, Physical Therapy, Speech and Occupational Therapy Dept., University of Sao Paulo, Sao Paulo, Brazil
| | - Mônica Gamba
- Nursing School at Federal University of São Paulo, São Paulo, Brazil
| | - Erica Queiroz Silva
- School of Medicine, Physical Therapy, Speech and Occupational Therapy Dept., University of Sao Paulo, Sao Paulo, Brazil
| | - Letícia A S Pinto
- School of Medicine, Physical Therapy, Speech and Occupational Therapy Dept., University of Sao Paulo, Sao Paulo, Brazil
| | - Isabel C N Sacco
- School of Medicine, Physical Therapy, Speech and Occupational Therapy Dept., University of Sao Paulo, Sao Paulo, Brazil
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Khalil SHA, Deeb HMAE, Ajang MOD, Osman NA, Amin NG. Impact of diabetic peripheral neuropathy on gait abnormalities in patients with type 2 diabetes mellitus. Diabetol Int 2024; 15:58-66. [PMID: 38264222 PMCID: PMC10800313 DOI: 10.1007/s13340-023-00652-y] [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: 03/26/2023] [Accepted: 07/25/2023] [Indexed: 01/25/2024]
Abstract
Background Many patients with type 2 diabetes (T2DM) suffer from diabetic peripheral neuropathy (DPN) and impaired muscle coordination. These changes may lead to walking instability, and gait abnormalities resulting in increased fall risk and lower limb amputations. The aim of this study was to assess the impact of DPN and patient footwear on the gait in patients with diabetes, in addition to Comparing the peak plantar pressure (PPP) in patients with and without DPN and assessing its association with gait abnormalities. Methodology This is an observational case-control study. Forty Subjects with T2DM were divided into two age and sex-matched groups, 20 subjects each. Group A: subjects with DPN. Group B: subjects without DPN. All study participants were subjected to a thorough history taking, clinical examinations focusing on detailed foot examination, PPP assessment, and functional gait evaluation. Results The results obtained in this study showed a median gait assessment score of 21 (17.0-22.5) for group A and 26 (23.5-26.0) for group B which was statistically significant (p < 0.001). There was no statistically significant difference between both groups (p > 0.05) regarding the assessment of footwear appropriateness. Comparing the PPP measurement among both studied groups, the prevalence of an elevated PPP was 80% in group A compared to 65% in group B, which was statistically non-significant, p = 0.288. Conclusions Gait abnormalities are common among patients with T2DM even in the absence of DPN. However, the presence of DPN was the strongest independent risk factor for gait abnormalities among the studied factors.
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Affiliation(s)
- Samir H. Assaad Khalil
- Department of Internal Medicine, Unit of Diabetes, Lipidology and Metabolism, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Martin Otwang Dak Ajang
- Department of Internal Medicine, Unit of Diabetes, Lipidology and Metabolism, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Department of Internal Medicine, Faculty of Medicine, Upper-Nile University, Juba, South Sudan
| | - Nermin A. Osman
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Noha Gaber Amin
- Department of Internal Medicine, Unit of Diabetes, Lipidology and Metabolism, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Huang X, Han J, Nong Y, Sun J, Wang Q, Zhai Z, Mo J, Huang J, Lu W. Triglyceride-glucose index is strongly associated with all-cause mortality in elderly females with diabetic foot ulcers: A 9-year follow-up study. Int Wound J 2024; 21:e14344. [PMID: 37555254 PMCID: PMC10777761 DOI: 10.1111/iwj.14344] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
This study aims to explore the association between the triglyceride-glucose (TyG) index and all-cause mortality in patients with diabetic foot ulcers (DFUs) through an ambispective cohort study. A total of 555 inpatients with DFUs were qualified to participate in the trial study from 2013 to 2022. Throughout a median 63-month period, all subjects were followed up every 6 months. According to the three quantiles of the TyG index, participants were divided into three groups: low-level (≤8.75, n = 185), moderate-level (8.76-9.33, n = 185) and high-level (≥9.34, n = 185). The association between the TyG index and all-cause mortality in patients with DFUs was then assessed. During the follow-up period, out of 555 patients with DFUs, 116 died (20.9%). After adjusting for confounding factors, the TyG index was positively associated with all-cause mortality in patients with DFUs (HR = 1.733; 95% CI = 1.341-2.241; p < 0.001). Compared with the low-level TyG index, the moderate-level TyG index (HR = 1.685; 95% CI = 1.011-2.810; p = 0.045) and the high-level TyG index (HR = 2.769; 95% CI = 1.678-4.568; p < 0.001) were positively correlated with all-cause mortality in patients with DFUs. Additionally, in subgroup analysis, both females (HR = 1.905; 95% CI = 1.250-2.904; p = 0.003), males (HR = 1.729; 95% CI = 1.240-2.409; p = 0.001), younger (<65 years old) (HR = 1.467; 95% CI = 1.008-2.135; p = 0.046) and elderly (≥ 65) (HR = 1.933; 95% CI = 1.339-2.791; p < 0.001) showed a positive correlation between TyG index and all-cause mortality rate in patients with DFUs. Furthermore, in the high-level TyG index group compared, males (HR = 2.699; 95% CI = 1.457-4.998) and participants aged <65 years (HR = 2.031; 95% CI = 0.972-4.242), with the TyG index level increase by 1.0, the risk for all-cause mortality increased 3.277-fold in females (HR = 4.277; 95% CI = 1.645-11.124) and 1.909-fold in elderly aged ≥65 years (HR = 2.909; 95% CI = 1.486-5.695), respectively. Kaplan-Meier survival curve analysis showed that the higher the TyG index level, the higher risk of all-cause mortality in patients with DFUs (log-rank, all p < 0.001). Briefly, this study implies a strong positive correlation between the TyG index and all-cause mortality in patients with DFUs, especially in older women. Therefore, special attention should be paid to elderly females with DFUs because they have a higher TyG index level and risk of all-cause mortality than other populations in daily clinical practice.
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Affiliation(s)
- Xiuxian Huang
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Jiaxia Han
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Yuechou Nong
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Jingxia Sun
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Qiu Wang
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Zhenwei Zhai
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Jiacheng Mo
- Information Network Center of Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Jianhao Huang
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Wensheng Lu
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
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Panda D, Nayak S. Stem Cell-Based Tissue Engineering Approaches for Diabetic Foot Ulcer: a Review from Mechanism to Clinical Trial. Stem Cell Rev Rep 2024; 20:88-123. [PMID: 37867186 DOI: 10.1007/s12015-023-10640-z] [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] [Accepted: 10/05/2023] [Indexed: 10/24/2023]
Abstract
Diabetic foot ulcer (DFU) is a complication from incomplete or prolonged wound healing, at times requires amputation, putting substantial health and socioeconomic burden. Wound healing is a dynamic overlapping process that can be regulated by arrays of molecular factors showing redundancy in function. However, dysregulation in the mechanism of angiogenesis, extra cellular matrix (ECM) formation and immune modulation are the major causes for impair wound healing in hyperglycaemic patients. Despite development of wound care research, there is a lack of well-accepted targeted therapy with multidisciplinary approach for DFU treatment. Stem cell therapy holds a promising outcome both in preclinical and clinical trials because of its ability to promote healing via regeneration and specialized tissue differentiation. Among different types of stem cells, regenerative potential of mesenchymal stem cell (MSC) is well demonstrated in both experimental and clinical trial. Still there is a huge knowledge gap among medical practitioners for deciding the best stem cell source, administration route, and safety. This review strengthens the fact that why stem cell therapy is a promising candidate to treat DFU and cited multiple tissue engineering and biomaterial-based approaches for delivering stem cells and their aftermath paracrine events. Based on the pre-clinical and clinical studies, the review tried to come up with optimum stem cell source and delivery route for the treatment of DFU. At last, the review glances on possible direction to enhance therapeutics strategy for the same, including different approaches like: phytocompounds, exosomes, scaffold geometry, cell preconditioning and licensing etc.
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Affiliation(s)
- Debarchan Panda
- Department of Integrative Biology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India
| | - Sunita Nayak
- Department of Integrative Biology, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu, 632014, India.
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Asadi R, Mostafavinia A, Amini A, Ahmadi H, Ahrabi B, Omidi H, Pourhashemi E, Hajihosseintehrani M, Rezaei F, Mohsenifar Z, Chien S, Bayat M. Acceleration of a delayed healing wound repair model in diabetic rats by additive impacts of photobiomodulation plus conditioned medium of adipose-derived stem cells. J Diabetes Metab Disord 2023; 22:1551-1560. [PMID: 37975122 PMCID: PMC10638220 DOI: 10.1007/s40200-023-01285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/17/2023] [Indexed: 11/19/2023]
Abstract
Purpose This study aimed to investigate the effects of photobiomodulation (PBM) and conditioned medium (CM) derived from human adipose-derived stem cells (h-ASCs), both individually and in combination, on the maturation stage of an ischemic infected delayed healing wound model (IIDHWM) in type I diabetic (TIDM) rats. Methods The study involved the extraction of h-ASCs from donated fat, assessment of their immunophenotypic markers, cell culture, and extraction and concentration of CM from cultured 1 × 10^6 h-ASCs. TIDM was induced in 24 male adult rats, divided into four groups: control, CM group, PBM group (80 Hz, 0.2 J/cm2, 890 nm), and rats receiving both CM and PBM. Clinical and laboratory evaluations were conducted on days 4, 8, and 16, and euthanasia was performed using CO2 on day 16. Tensiometrical and stereological examinations were carried out using two wound samples from each rat. Results Across all evaluated factors, including wound closure ratio, microbiological, tensiometrical, and stereological parameters, similar patterns were observed. The outcomes of CM + PBM, PBM, and CM treatments were significantly superior in all evaluated parameters compared to the control group (p = 0.000 for all). Both PBM and CM + PBM treatments showed better tensiometrical and stereological results than CM alone (almost all, p = 0.000), and CM + PBM outperformed PBM alone in almost all aspects (p = 0.000). Microbiologically, both CM + PBM and PBM exhibited fewer colony-forming units (CFU) than CM alone (both, p = 0.000). Conclusion PBM, CM, and CM + PBM interventions substantially enhanced the maturation stage of the wound healing process in IIDHWM of TIDM rats by mitigating the inflammatory response and reducing CFU count. Moreover, these treatments promoted new tissue formation in the wound bed and improved wound strength. Notably, the combined effects of CM + PBM surpassed the individual effects of CM and PBM. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01285-3.
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Affiliation(s)
- Robabeh Asadi
- Department of Paramedicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Atarodalsadat Mostafavinia
- Department of Anatomical Sciences and Cognitive Neuroscience, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Abdollah Amini
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Houssein Ahmadi
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Ahrabi
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Omidi
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | | | - Zhaleh Mohsenifar
- Department of Pathology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sufan Chien
- Price Institute of Surgical Research, University of Louisville, and Noveratech LLC of Louisville, Louisville, USA
| | - Mohammad Bayat
- Price Institute of Surgical Research, University of Louisville, and Noveratech LLC of Louisville, Louisville, USA
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Sohrabi K, Ahmadi H, Amini A, Ahrabi B, Mostafavinia A, Omidi H, Mirzaei M, Fadaei Fathabady F, Fridoni M, Rahmannia M, Chien S, Bayat M. Promising improvement in infected Wound Healing in Type two Diabetic rats by Combined effects of conditioned medium of human adipose-derived stem cells plus Photobiomodulation. Lab Anim Res 2023; 39:29. [PMID: 37964303 PMCID: PMC10648630 DOI: 10.1186/s42826-023-00178-z] [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: 07/21/2023] [Revised: 10/23/2023] [Accepted: 10/27/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND We aimed to examine the accompanying and solo impacts of conditioned medium of human adipose-derived stem cells (h-ASC-COM) and photobiomodulation (PBM) on the maturation stage of an ischemic infected delayed-healing wound model (IIDHWM) of rats with type 2 diabetes (TIIDM). RESULTS Outcomes of the wound closure ratio (WCR) results, tensiometrical microbiological, and stereological assessment followed almost identical patterns. While the outcomes of h-ASC-COM + PBM, PBM only, and h-ASC-COM only regimes were significantly better for all evaluated methods than those of group 1(all, p < 0.001), PBM alone and h-ASC-COM + PBM therapy achieved superior results than h-ASC-COM only (ranged from p = 0.05 to p < 0.001). In terms of tensiometrical and stereological examinations, the results of h-ASC-COM + PBM experienced better results than the PBM only (all, p < 0.001). CONCLUSIONS h-ASC-COM + PBM, PBM, and h-ASC-COM cures expressively accelerated the maturation stage in the wound healing process of IIDHWM with MRSA in TIIDM rats by diminishing the inflammatory reaction, and the microbial flora of MRSA; and increasing wound strength, WCR, number of fibroblasts, and new blood vessels. While the h-ASC-COM + PBM and PBM were more suitable than the effect of h-ASC-COM, the results of h-ASC-COM + PBM were superior to PBM only.
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Affiliation(s)
- Kaysan Sohrabi
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Houssein Ahmadi
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdollah Amini
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Ahrabi
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atarodalsadat Mostafavinia
- Department of Anatomical Sciences and Cognitive Neuroscience, School of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Hamidreza Omidi
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mansooreh Mirzaei
- Department of Anatomy, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Fatemeh Fadaei Fathabady
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadjavad Fridoni
- Department of Biology and Anatomical Sciences, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Maryam Rahmannia
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sufan Chien
- Price Institute of Surgical Research, University of Louisville and Noveratech LLC, Louisville, KY, USA
| | - Mohammad Bayat
- Price Institute of Surgical Research, University of Louisville and Noveratech LLC, Louisville, KY, USA.
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Guo H, Song Q, Mei S, Xue Z, Li J, Ning T. Distribution of multidrug-resistant bacterial infections in diabetic foot ulcers and risk factors for drug resistance: a retrospective analysis. PeerJ 2023; 11:e16162. [PMID: 37842066 PMCID: PMC10569182 DOI: 10.7717/peerj.16162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/01/2023] [Indexed: 10/17/2023] Open
Abstract
Objective To investigate the distribution, drug resistance and risk factors of multi-drug resistant bacterias (MDROs) in patients with Type 2 diabetic foot ulcers (DFU). Method The clinical data, foot secretions, pathogenic microorganisms and drug sensitivity tests of 147 patients with type 2 diabetes admitted to our department from January 2018 to December 2021 were analyzed. Patients were divided into two groups according to whether they had been infected with MDROs or not. Seventy-one cases were infected with MDROs as the case group, and the remaining 76 cases were the control group. Chi-square test and t-test were used to analyze the results of MDROs infection and DFU, and logistic multivariate regression was used to evaluate the risk factors of MDROs infection. Results A total of 71 strains were isolated from the MDROs-positive group, with the top three being Staphylococcus aureus (46.48%), Escherichia coli (22.53%), and Pseudomonas aeruginosa (18.31%), respectively. Logistic multifactorial regression analysis showed that history of previous antimicrobial exposure, neuroischemic wound, Wagner grade 3-5, and combined osteomyelitis were associated with Type 2 diabetic foot infection MDROs (P < 0.05). Conclusion Previous history of antimicrobial exposure, neuroischemic wounds, Wagner grade 3-5, and combined osteomyelitis are independent risk factors for MDROs, which can identify the risk factors for MDROs at an early stage and help to identify people at high risk of MDROs infection and take relevant comprehensive treatment in time to slow down the development of the disease.
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Affiliation(s)
- Huihui Guo
- Department of Orthopaedic Surgery, Fuyang People’s Hospital, Fuyang, China
| | - Qiwei Song
- Department of Orthopaedic Surgery, Fuyang People’s Hospital, Fuyang, China
| | - Siwei Mei
- Department of Orthopaedic Surgery, Fuyang People’s Hospital, Fuyang, China
| | - Zhenqiang Xue
- Department of Orthopaedic Surgery, Fuyang People’s Hospital, Fuyang, China
| | - Junjie Li
- Department of Orthopaedic Surgery, Fuyang People’s Hospital, Fuyang, China
| | - Tao Ning
- Department of Orthopaedic Surgery, Fuyang People’s Hospital, Fuyang, China
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11
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Chatzistergos PE, Gatt A, Formosa C, Sinclair JK, Chockalingam N. Effective and clinically relevant optimisation of cushioning stiffness to maximise the offloading capacity of diabetic footwear. Diabetes Res Clin Pract 2023; 204:110914. [PMID: 37742803 DOI: 10.1016/j.diabres.2023.110914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 09/26/2023]
Abstract
INTRODUCTION Optimising the cushioning stiffness of diabetic footwear/orthoses can significantly enhance their offloading capacity. This study explores whether optimum cushioning stiffness can be predicted using simple demographic and anthropometric parameters. METHODS Sixty-nine adults with diabetes and loss of protective sensation in their feet were recruited for this cross-sectional observational study. In-shoe plantar pressure was measured using Pedar® for a neutral diabetic shoe (baseline) and after adding cushioning footbeds of varying stiffness. The cushioning stiffness that achieved maximum offloading was identified for each participant. The link between optimum cushioning stiffness and plantar loading or demographic/anthropometric parameters was assessed using multinomial regression. RESULTS People with higher baseline plantar loading required stiffer cushioning materials for maximum offloading. Using sex, age, weight, height, and shoe-size as covariates correctly predicted the cushioning stiffness that minimised peak pressure across the entire foot, or specifically in the metatarsal heads, midfoot and heel regions in 70%, 72%, 83% and 66% of participants respectively. CONCLUSIONS Increased plantar loading is associated with the need for stiffer cushioning materials for maximum offloading. Patient-specific optimum cushioning stiffness can be predicted using five simple demographic/anthropometric parameters. These results open the way for methods to optimise cushioning stiffness as part of clinical practice.
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Affiliation(s)
- Panagiotis E Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom.
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Jonathan K Sinclair
- Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston, United Kingdom
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom; Faculty of Health Sciences, University of Malta, Msida, Malta
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12
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Gibson AA, Cox E, Gale J, Craig ME, King S, Chow CK, Colagiuri S, Nassar N. Association of oral health with risk of incident micro and macrovascular complications: A prospective cohort study of 24,862 people with diabetes. Diabetes Res Clin Pract 2023; 203:110857. [PMID: 37563015 DOI: 10.1016/j.diabres.2023.110857] [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: 06/06/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 08/12/2023]
Abstract
AIMS To investigate the association between self-reported oral health and incident micro and macrovascular diabetes complications. METHODS This prospective cohort study linked data from the 45 and Up Study, Australia, to administrative health records. The participants were 24,862 men and women, aged ≥45 years, with diabetes at baseline (2006-2009). The oral health of participants was assessed by questionnaire. Incident diabetes complications were determined using hospitalisation data and claims for medical services up until 2019. Hazard ratios for the association between oral health and incident complications were calculated using multivariable cox proportional hazards models. RESULTS Almost 60 % of participants had <20 teeth, and 38 % rated their teeth and gums as fair or poor. Compared with those with ≥20 teeth, those with 0 teeth had an increased risk of cardiovascular disease (aHR 1.24, 95 % CI: 1.15, 1.35), lower limb (aHR 1.22, 95 % CI: 1.11, 1.33) and kidney (aHR 1.19, 95 % CI: 1.11, 1.29) complications. Individuals with 1-9 teeth had an increased risk of eye complications (aHR 1.14, 95 % CI: 1.07, 1.22). The associations were generally consistent for poor self-rated teeth and gums. CONCLUSIONS Self-reported oral health measures may be a marker of elevated risk of complications in people with diabetes.
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Affiliation(s)
- Alice A Gibson
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia.
| | - Emma Cox
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia
| | - Joanne Gale
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Maria E Craig
- Charles Perkins Centre, The University of Sydney, NSW, Australia; Discipline of Paediatrics & Child Health, School of Clinical Medicine, UNSW Medicine & Health, Sydney, NSW, Australia
| | - Shalinie King
- Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Sydney Dental School, Faculty of Medicine and Heath, The University of Sydney, NSW, Australia
| | - Clara K Chow
- Charles Perkins Centre, The University of Sydney, NSW, Australia; Westmead Applied Research Centre, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, NSW, Australia
| | - Stephen Colagiuri
- Charles Perkins Centre, The University of Sydney, NSW, Australia; Faculty of Medicine and Health, The University of Sydney, NSW, Australia
| | - Natasha Nassar
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW, Australia; Charles Perkins Centre, The University of Sydney, NSW, Australia; Child Population and Translational Health Research, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW, Australia
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13
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An HM, Choi YS, Bae SK, Lee YK. Effect of the Combination of Probiotics and Korean Red Ginseng on Diabetic Wound Healing Exposed to Diesel Exhaust Particles(DEPs). MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1155. [PMID: 37374359 DOI: 10.3390/medicina59061155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Diesel exhaust particles (DEPs) are a major component of air pollution and adversely affect respiratory and cardiovascular disease and diabetic foot ulcers if diabetic patients are exposed to them. There are currently no studies on treating diabetic wounds exposed to DEPs. So, the effect of a combination of probiotics and Korean red ginseng on a diabetic wound model exposed to DEPs was confirmed. Materials and Methods: Rats were randomly divided into three groups according to DEP inhalation concentration and whether they underwent applications of probiotics (PB) and Korean red ginseng (KRG). Wound tissue was collected from all rats, and wound healing was evaluated using molecular biology and histology methods. Results: The wound size of all groups decreased over time, but there was no significant difference. As a result of the molecular biology experiment, the expression of NF-κB p65 on day 7 was significantly higher in group 2 than in the normal control group. As a result of histological analysis, unlike the primary control group, it was confirmed that granule tissue was formed on the 14th day in the normal control group and group 2. Conclusions: The findings in this study suggest that combined treatment with PB and KRG can promote the healing of DEP-exposed diabetic wounds.
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Affiliation(s)
- Hye Min An
- Department of Medical Sciences, Soonchunhyang University, Asan-si 31538, Republic of Korea
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon-si 14584, Republic of Korea
| | - Young Suk Choi
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon-si 14584, Republic of Korea
- Department of Biology, Soonchunhyang University, Asan-si 31538, Republic of Korea
| | - Sung Kyoung Bae
- Department of Medical Sciences, Soonchunhyang University, Asan-si 31538, Republic of Korea
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon-si 14584, Republic of Korea
| | - Young Koo Lee
- Department of Orthopedic Surgery, Soonchunhyang University Bucheon Hospital, Bucheon-si 14584, Republic of Korea
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14
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Hodge JG, Robinson JL, Mellott AJ. Tailoring the secretome composition of mesenchymal stem cells to augment specific functions of epidermal regeneration: an in vitro diabetic model. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1194314. [PMID: 37378005 PMCID: PMC10291509 DOI: 10.3389/fmedt.2023.1194314] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Wound healing consists of a dynamic series of events that are highly dependent on paracrine factors for proper progression through the phases of wound healing. Inappropriate progression through the phases is associated with insufficient epidermal regeneration (i.e., re-epithelialization) of wounds and subsequent propagation of chronic wounds, such as diabetic ulcers, which are associated with increased patient morbidity. Recently, investigation into the dynamic secretome of Adipose-derived Mesenchymal Stem Cells (ASCs), have shown promise in augmenting the wound healing response of chronic diabetic wounds. However, currently utilized 2D culture techniques are known to drastically alter the regenerative phenotype of ASCs. In this study a novel tissue-mimetic 3D system was utilized as a means to culture ASCs. Methods The capacity for the ASC secretome to augment epidermal regeneration activity was then evaluated after exposure of ASCs to "wound priming stimuli" in 2D and 3D. The priming stimuli consisted of coating the 2D and 3D systems with the wound matrix proteins, collagen type I, fibronectin, and fibrin. To understand the potential benefit of the ASC secretome in the context of diabetic wounds, keratinocytes (KCs) were exposed to super-physiological glucose levels to induce a diabetic-like phenotype (idKCs). Results Relative to KCs, idKC exhibited a 52% and 23% decline in proliferation and migration, respectively. Subsequently, analyses of the ASC secretome were performed. ASC conditioned media (ASC-CM) from tissue-mimetic culture demonstrated a > 50% increase secretion of proteins and a 2-fold increase in secreted EVs, relative to 2D culture. Interestingly, the different priming stimuli did not alter the total amount of protein or EVs secreted within the tissue-mimetic system. However, evaluation of specific soluble proteins via ELISA revealed significant differences in key epidermal regeneration factors, such as EGF, IGF-1, FGF-2, MMP-1, TIMP-1, and TGFβ-1. Additionally, the relative effect of ASC-EVs from the 2D and 3D system on idKCs epidermal regeneration functionality varied significantly, with EVs from 3D-Collagen culture providing the most significant benefit on idKC activity. Discussion Together, these data support the utilization of tissue-mimetic culture system to enhance the adaptability and secretory activity of MSC-like populations in order to generate tailored biologics, via priming stimuli, for specific wound healing applications.
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Affiliation(s)
- Jacob G. Hodge
- Bioengineering Graduate Program, University of Kansas, Lawrence, KS, United States
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS, United States
| | - Jennifer L. Robinson
- Bioengineering Graduate Program, University of Kansas, Lawrence, KS, United States
- Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, KS, United States
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, WA, United States
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, United States
| | - Adam J. Mellott
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS, United States
- Ronawk Inc., Olathe, KS, United States
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15
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Adam CA, Marcu DTM, Mitu O, Roca M, Aursulesei Onofrei V, Zabara ML, Tribuș LC, Cumpăt C, Crișan Dabija R, Mitu F. Old and Novel Predictors for Cardiovascular Risk in Diabetic Foot Syndrome—A Narrative Review. APPLIED SCIENCES 2023; 13:5990. [DOI: 10.3390/app13105990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/17/2024]
Abstract
Diabetic foot syndrome (DFS) is a complication associated with diabetes that has a strong negative impact, both medically and socio-economically. Recent epidemiological data show that one in six patients with diabetes will develop an ulcer in their lifetime. Vascular complications associated with diabetic foot have multiple prognostic implications in addition to limiting functional status and leading to decreased quality of life for these patients. We searched the electronic databases of PubMed, MEDLINE and EMBASE for studies that evaluated the role of DFS as a cardiovascular risk factor through the pathophysiological mechanisms involved, in particular the inflammatory ones and the associated metabolic changes. In the era of evidence-based medicine, the management of these cases in multidisciplinary teams of “cardio-diabetologists” prevents the occurrence of long-term disabling complications and has prognostic value for cardiovascular morbidity and mortality among diabetic patients. Identifying artificial-intelligence-based cardiovascular risk prediction models or conducting extensive clinical trials on gene therapy or potential therapeutic targets promoted by in vitro studies represent future research directions with a modulating role on the risk of morbidity and mortality in patients with DFS.
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Affiliation(s)
- Cristina Andreea Adam
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, 700661 Iasi, Romania
| | - Dragos Traian Marius Marcu
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, 700115 Iasi, Romania
| | - Ovidiu Mitu
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Mihai Roca
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, 700661 Iasi, Romania
| | - Viviana Aursulesei Onofrei
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- “St. Spiridon” Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Mihai Lucian Zabara
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Laura Carina Tribuș
- Department of Internal Medicine, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Internal Medicine, Ilfov County Emergency Hospital, 022104 Bucharest, Romania
| | - Carmen Cumpăt
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Management, “Alexandru Ioan Cuza” University, 700506 Iasi, Romania
| | - Radu Crișan Dabija
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, 700115 Iasi, Romania
| | - Florin Mitu
- Department of Medical Specialties I and III and Department of Surgical Specialties, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
- Clinical Hospital of Pneumophthisiology Iași, 700115 Iasi, Romania
- Academy of Medical Sciences, 030167 Bucharest, Romania
- Academy of Romanian Scientists, 700050 Iasi, Romania
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16
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Hadi P, Rampal S, Neela VK, Cheema MS, Sarawan Singh SS, Kee Tan E, Sinniah A. Distribution of Causative Microorganisms in Diabetic Foot Infections: A Ten-Year Retrospective Study in a Tertiary Care Hospital in Central Malaysia. Antibiotics (Basel) 2023; 12:antibiotics12040687. [PMID: 37107049 PMCID: PMC10135124 DOI: 10.3390/antibiotics12040687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/07/2022] [Accepted: 12/16/2022] [Indexed: 04/03/2023] Open
Abstract
Diabetes mellitus is a global pandemic, especially in Southeast Asia. Diabetic foot infection (DFI) is a common complication of this condition and causes significant morbidity and mortality in those affected. There is a lack of locally published data on the types of microorganisms and empirical antibiotics being prescribed. This paper highlights the importance of local microorganism culture and antibiotic prescription trends among diabetic foot patients in a tertiary care hospital in central Malaysia. This is a retrospective, cross-sectional study of data taken from January 2010 to December 2019 among 434 patients admitted with diabetic foot infections (DFIs) using the Wagner classification. Patients between the ages of 58 and 68 years old had the highest rate of infection. Pseudomonas Aeruginosa, Proteus spp., and Proteus mirabilis appeared to be the most isolated Gram-negative microorganisms, and Staphylococcus aureus, Streptococcus agalactiae, and MRSA appeared to be the most common Gram-positive microorganisms. The most common empirical antibiotics prescribed were ampicillin/sulbactam, followed by ciprofloxacin and ceftazidime, and the most common therapeutic antibiotics prescribed were ampicillin/sulbactam, ciprofloxacin, and cefuroxime. This study could be immensely pertinent in facilitating future empirical therapy guidelines for treating diabetic foot infections.
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Affiliation(s)
- Parichehr Hadi
- Department of Orthopaedic and Traumatology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang 43400, Malaysia
| | - Sanjiv Rampal
- Department of Orthopaedic and Traumatology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang 43400, Malaysia
- Correspondence: (S.R.); (A.S.)
| | - Vasantha Kumari Neela
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang 43400, Malaysia
| | - Manraj Singh Cheema
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang 43400, Malaysia
| | | | - Eng Kee Tan
- Department of Orthopaedic and Traumatology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang 43400, Malaysia
| | - Ajantha Sinniah
- Department of Pharmacology, Faculty of Medicine, University Malaya, Kuala Lumpur 50603, Malaysia
- Correspondence: (S.R.); (A.S.)
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17
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Samad Omar A, Ahmad Faiz K, Mir Islam Saeed K, Ahmad Humayoun F, Safi K. Epidemiologic and clinical characteristics of diabetic foot ulcer among patients with diabetes in Afghanistan: An IDF supported initiative. Diabetes Res Clin Pract 2023; 196:110227. [PMID: 36543291 DOI: 10.1016/j.diabres.2022.110227] [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: 10/28/2022] [Revised: 12/04/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
AIM The aim is to illustrate epidemiological and clinical characteristics of diabetic patients with foot ulcer (DFU) in Kabul diabetic medical center (KDMC), Afghanistan. METHOD It is a descriptive study explaining the characteristics of diabetic patients with DFU admitted to KDMC, between 1/9/2019 to 31/8/2020 which is a center for management of diabetic patients including DFU. The university of Texas diabetic classification for DFU was used. RESULTS Totally 3159 patients admitted to KMDC of whom 47.4% were females and 96.7% type 2 diabetes. The proportion of DFU was 9.2%. The patients' mean age was 55.4 ± 10.6 years and 78% were coming from Kabul. Prevalence of smoking and snuff use were 8.6% and 5.6% respectively. Majority of females 93% were housewives. The duration of diabetes was 5-19 years. Almost two-third were under glycaemia and HbA1c control and 9.2% had history of amputation. The common symptoms were burning, aching, numbness and tingling. The most common cause of DFU was both neuropathy and arteriopathy. After treatment 16% were referred for orthopedic procedures. CONCLUSIONS DFU affects almost one-tenth of diabetics while a significant number of patients attend at late stage requiring orthopedic treatment. Monitoring of diabetic patients to prevent DFU is important is recommended.
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Affiliation(s)
| | | | - Khwaja Mir Islam Saeed
- Afghanistan National Public Health Institute, Ministry of Public Health, Kabul, Afghanistan
| | | | - Kubra Safi
- Kabul Diabetic Management Center, Afghanistan
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18
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Dama G, Du J, Zhu X, Liu Y, Lin J. Bone marrow-derived mesenchymal stem cells: A promising therapeutic option for the treatment of diabetic foot ulcers. Diabetes Res Clin Pract 2023; 195:110201. [PMID: 36493913 DOI: 10.1016/j.diabres.2022.110201] [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: 02/20/2022] [Revised: 08/31/2022] [Accepted: 12/01/2022] [Indexed: 12/12/2022]
Abstract
Chronic wounds fail to heal through the three normal stages of healing (inflammatory, proliferative, and remodelling), resulting in a chronic tissue injury that is not repaired within the average time limit. Patients suffering from type 1 and type 2 diabetes are prone to develop diabetic foot ulcers (DFUs), which commonly develop into chronic wounds that are non treatable with conventional therapies. DFU develops due to various risk factors, such as peripheral neuropathy, peripheral vascular disease, arterial insufficiency, foot deformities, trauma and impaired resistance to infection. DFUs have gradually become a major problem in the health care system worldwide. In this review, we not only focus on the pathogenesis of DFU but also comprehensively summarize the outcomes of preclinical and clinical studies thus far and the potential therapeutic mechanism of bone marrow-derived mesenchymal stem cells (BMSCs) for the treatment of DFU. Based on the published results, BMSC transplantation can contribute to wound healing through growth factor secretion, anti-inflammation, differentiation into tissue-specific cells, neovascularization, re-epithelialization and angiogenesis in DFUs. Moreover, clinical trials showed that BMSC treatment in patients with diabetic ulcers improved ulcer healing and the ankle-brachial index, ameliorated pain scores, and enhanced claudication walking distances with no reported complications. In conclusion, although BMSC transplantation exhibits promising therapeutic potential in DFU treatment, additional studies should be performed to confirm their efficacy and long-term safety in DFU patients.
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Affiliation(s)
- Ganesh Dama
- Stem Cell and Biotherapy Engineering Research Center of Henan, Henan Joint International Research Laboratory of Stem Cell Medicine, Xinxiang Medical University, East of JinSui Road #601, 453003 Xinxiang, China; Department of Community Health, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Kepala Batas, Malaysia
| | - Jiang Du
- Stem Cell and Biotherapy Engineering Research Center of Henan, Henan Joint International Research Laboratory of Stem Cell Medicine, Xinxiang Medical University, East of JinSui Road #601, 453003 Xinxiang, China; College of Medical Engineering, Xinxiang Medical University, East of JinSui Road #601, 453003 Xinxiang, China
| | - Xinxing Zhu
- Stem Cell and Biotherapy Engineering Research Center of Henan, Henan Joint International Research Laboratory of Stem Cell Medicine, Xinxiang Medical University, East of JinSui Road #601, 453003 Xinxiang, China; College of Medical Engineering, Xinxiang Medical University, East of JinSui Road #601, 453003 Xinxiang, China
| | - Yanli Liu
- Stem Cell and Biotherapy Engineering Research Center of Henan, Henan Joint International Research Laboratory of Stem Cell Medicine, Xinxiang Medical University, East of JinSui Road #601, 453003 Xinxiang, China; College of Life Sciences and Technology, Xinxiang Medical University, East of JinSui Road #601, 453003 Xinxiang, China.
| | - Juntang Lin
- Stem Cell and Biotherapy Engineering Research Center of Henan, Henan Joint International Research Laboratory of Stem Cell Medicine, Xinxiang Medical University, East of JinSui Road #601, 453003 Xinxiang, China; College of Medical Engineering, Xinxiang Medical University, East of JinSui Road #601, 453003 Xinxiang, China; College of Life Sciences and Technology, Xinxiang Medical University, East of JinSui Road #601, 453003 Xinxiang, China.
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Alsheikh S, AlGhofili H, Alageel R, Ababtain O, Alarify G, Alwehaibi N, Altoijry A. Diabetic Foot Care: A Screening on Primary Care Providers' Attitude and Practice in Riyadh, Saudi Arabia. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010064. [PMID: 36676687 PMCID: PMC9861771 DOI: 10.3390/medicina59010064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 12/29/2022]
Abstract
Background and Objectives: Diabetic foot (DF) disease is one of the myriad complications of diabetes. Positive outcomes are expected through a multidisciplinary approach as provided by primary care providers (PCPs). This study aimed to assess the knowledge of DF and attitude of physicians in primary healthcare settings toward DF diagnosis and prevention in Saudi Arabia. Materials and Methods: This observational cross-sectional study used a self-administered questionnaire that was completed by family medicine consultants, residents, and general practitioners working in primary care settings in Riyadh. Results: Of the 152 physicians who completed the survey, (43.4%) completed more than 10 h of diabetes continuing medical education (CME) over the past three years. Most (96.1%) PCPs educate patients about foot self-inspection, and only (64.5%) perform foot inspection at every visit in high-risk diabetic foot patients. PCP knowledge about diagnosing and managing diabetic foot infection was suboptimal. Only 53.9% of participants reported performing a probe-to-bone in DF patients with open wounds. Conclusions: We identified knowledge and action gaps among PCPs. Physicians had acceptable knowledge about preventive measures. However, deficits were found regarding diagnosing and management of DF infections. We recommend addressing these knowledge gaps by incorporating DF lectures and workshops within family medicine conferences and residency programs.
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Affiliation(s)
- Sultan Alsheikh
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
- Correspondence: ; Tel./Fax: +966-114671585
| | - Hesham AlGhofili
- Department of Vascular Surgery, King Salman Heart Center, King Fahad Medical City, Riyadh 12231, Saudi Arabia
- Division of Vascular Surgery, Department of Surgery, University of Toronto, Toronto, ON 11525, Canada
| | - Reema Alageel
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Omar Ababtain
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Ghadah Alarify
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
| | - Nasser Alwehaibi
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
- Department of Surgery, King Fahad Specialist Hospital, Buraidah 52366, Saudi Arabia
| | - Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh 11322, Saudi Arabia
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20
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Akkus G, Sert M. Diabetic foot ulcers: A devastating complication of diabetes mellitus continues non-stop in spite of new medical treatment modalities. World J Diabetes 2022; 13:1106-1121. [PMID: 36578865 PMCID: PMC9791571 DOI: 10.4239/wjd.v13.i12.1106] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/21/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic foot ulcer is a devastating complication of diabetes mellitus and significant cause of mortality and morbidity all over the world and can be complex and costly. The development of foot ulcer in a diabetic patient has been estimated to be 19%-34% through their lifetime. The pathophysiology of diabetic foot ulcer consist of neuropathy, trauma and, in many patients, additional peripheral arterial disease. In particular, diabetic neuropathy leads to foot deformity, callus formation, and insensitivity to trauma or pressure. The standard algorithms in diabetic foot ulcer management include assessing the ulcer grade classification, surgical debridement, dressing to facilitate wound healing, off-loading, vascular assessment (status and presence of a chance for interventional vascular correction), and infection and glycemic control. Although especially surgical procedures are sometimes inevitable, they are poor predictive factors for the prognosis of diabetic foot ulcer. Different novel treatment modalities such as nonsurgical debridement agents, oxygen therapies, and negative pressure wound therapy, topical drugs, cellular bioproducts, human growth factors, energy-based therapies, and systematic therapies have been available for patients with diabetic foot ulcer. However, it is uncertain whether they are effective in terms of promoting wound healing related with a limited number of randomized controlled trials. This review aims at evaluating diabetic foot ulcer with regard to all aspects. We will also focus on conventional and novel adjunctive therapy in diabetic foot management.
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Affiliation(s)
- Gamze Akkus
- Department of Endocrinology, Cukurova University, Adana 33170, Turkey
| | - Murat Sert
- Department of Internal Medicine, Cukurova University Medical Faculty, Adana 33170, Turkey
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Cardiovascular/Stroke Risk Stratification in Diabetic Foot Infection Patients Using Deep Learning-Based Artificial Intelligence: An Investigative Study. J Clin Med 2022; 11:jcm11226844. [PMID: 36431321 PMCID: PMC9693632 DOI: 10.3390/jcm11226844] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
A diabetic foot infection (DFI) is among the most serious, incurable, and costly to treat conditions. The presence of a DFI renders machine learning (ML) systems extremely nonlinear, posing difficulties in CVD/stroke risk stratification. In addition, there is a limited number of well-explained ML paradigms due to comorbidity, sample size limits, and weak scientific and clinical validation methodologies. Deep neural networks (DNN) are potent machines for learning that generalize nonlinear situations. The objective of this article is to propose a novel investigation of deep learning (DL) solutions for predicting CVD/stroke risk in DFI patients. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) search strategy was used for the selection of 207 studies. We hypothesize that a DFI is responsible for increased morbidity and mortality due to the worsening of atherosclerotic disease and affecting coronary artery disease (CAD). Since surrogate biomarkers for CAD, such as carotid artery disease, can be used for monitoring CVD, we can thus use a DL-based model, namely, Long Short-Term Memory (LSTM) and Recurrent Neural Networks (RNN) for CVD/stroke risk prediction in DFI patients, which combines covariates such as office and laboratory-based biomarkers, carotid ultrasound image phenotype (CUSIP) lesions, along with the DFI severity. We confirmed the viability of CVD/stroke risk stratification in the DFI patients. Strong designs were found in the research of the DL architectures for CVD/stroke risk stratification. Finally, we analyzed the AI bias and proposed strategies for the early diagnosis of CVD/stroke in DFI patients. Since DFI patients have an aggressive atherosclerotic disease, leading to prominent CVD/stroke risk, we, therefore, conclude that the DL paradigm is very effective for predicting the risk of CVD/stroke in DFI patients.
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Ge Y, Wang J, Cao W, Niu Q, Wu Y, Feng Y, Xu Z, Liu Y. Low Temperature Plasma Jet Affects Acute Skin Wounds in Diabetic Mice Through Reactive Components. INT J LOW EXTR WOUND 2022:15347346221139519. [PMID: 36380558 DOI: 10.1177/15347346221139519] [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: 02/17/2024]
Abstract
As a common complication of diabetes, diabetic foot ulcers serious affect the life quality even lead to amputation if it's not properly treated. In this paper, we developed a Low Temperature Plasma Jet (LTPJ) system for treating diabetic foot ulcers on streptozotocin-induced diabetic mice. This system generates time-dependent reactive nitrogen and oxygen species (RNOS), which have temperature below 40°C. The wound area of normal mice was significantly reduced after LTPJ treatment. Histological and immunohistochemistry analysis showed faster deposition of collagen and more vessel formation both in plasma-treated normal and diabetic mice on Day 3. However, diabetic wounds showed poor collagen deposition and angiogenesis on Day 8, which might be the reason of slow wound healing. Reactive nitrogen species (RNS) that generated by LTPJ can promote endogenous nitric oxide (NO) production in diabetic wounds, thus promoting inflammation, stromal deposition, angiogenesis, cell proliferation and remodeling, while excess reactive oxygen species (ROS) will exacerbate oxidative stress in wound tissues of diabetic mice. In conclusion, LTPJ improved acute wound healing in normal mice, increased collagen deposition and angiogenesis in initial diabetic wound healing, but had no significant effect on diabetic wound healing rate.
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Affiliation(s)
- Yang Ge
- The CAS Key Laboratory of Bio-Medical Diagnostics, 165085Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Jun Wang
- The CAS Key Laboratory of Bio-Medical Diagnostics, 165085Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
- Nanjing Guoke Medical Enginneering Technology Development co., LTD, Nanjing, Jiangsu, China
| | - Wei Cao
- The CAS Key Laboratory of Bio-Medical Diagnostics, 165085Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Qun Niu
- The CAS Key Laboratory of Bio-Medical Diagnostics, 165085Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Yanfan Wu
- The CAS Key Laboratory of Bio-Medical Diagnostics, 165085Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Yongtong Feng
- The CAS Key Laboratory of Bio-Medical Diagnostics, 165085Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Zhengping Xu
- The CAS Key Laboratory of Bio-Medical Diagnostics, 165085Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
| | - Yi Liu
- The CAS Key Laboratory of Bio-Medical Diagnostics, 165085Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, China
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Hodge JG, Zamierowski DS, Robinson JL, Mellott AJ. Evaluating polymeric biomaterials to improve next generation wound dressing design. Biomater Res 2022; 26:50. [PMID: 36183134 PMCID: PMC9526981 DOI: 10.1186/s40824-022-00291-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 08/28/2022] [Indexed: 11/24/2022] Open
Abstract
Wound healing is a dynamic series of interconnected events with the ultimate goal of promoting neotissue formation and restoration of anatomical function. Yet, the complexity of wound healing can often result in development of complex, chronic wounds, which currently results in a significant strain and burden to our healthcare system. The advancement of new and effective wound care therapies remains a critical issue, with the current therapeutic modalities often remaining inadequate. Notably, the field of tissue engineering has grown significantly in the last several years, in part, due to the diverse properties and applications of polymeric biomaterials. The interdisciplinary cohesion of the chemical, biological, physical, and material sciences is pertinent to advancing our current understanding of biomaterials and generating new wound care modalities. However, there is still room for closing the gap between the clinical and material science realms in order to more effectively develop novel wound care therapies that aid in the treatment of complex wounds. Thus, in this review, we discuss key material science principles in the context of polymeric biomaterials, provide a clinical breadth to discuss how these properties affect wound dressing design, and the role of polymeric biomaterials in the innovation and design of the next generation of wound dressings.
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Affiliation(s)
- Jacob G Hodge
- Bioengineering Graduate Program, University of Kansas, Lawrence, KS, USA.,Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - David S Zamierowski
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jennifer L Robinson
- Department of Chemical and Petroleum Engineering, University of Kansas, Mail Stop: 3051, 3901 Rainbow Blvd, Lawrence, KS, 66160, USA
| | - Adam J Mellott
- Department of Plastic Surgery, University of Kansas Medical Center, Kansas City, KS, USA.
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Muste JC, Valentim CCS, Iyer AI, Mammo DA, Alsaloum P, Xu CM, Russell MW, Singh RP, Talcott KE. Progression to Vision-Threatening Retinopathy Complications Following Panretinal Laser for Proliferative Diabetic Retinopathy. Ophthalmic Surg Lasers Imaging Retina 2022; 53:186-193. [PMID: 35417294 DOI: 10.3928/23258160-20220316-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To report the time in which patients with panretinal photocoagulation (PDR) progress to vision-threatening retinopathy (VTR) complications after receiving PRP, and risk factors in routine clinical practice. PATIENTS AND METHODS Records of patients with complete PRP for PDR were retrospectively reviewed for up to 3.5 years after PRP. Two hundred twenty eyes were selected. RESULTS Time from PRP to VTR was 1.25 ± 0.82 years. Age, Black race, neovascularization of the disc on examination, diabetic foot disease (DFD), and high-risk PDR characteristics on fluorescein angiography were identified as significant risk factors. Half of patients with DFD on examination developed a VTR within 1.5 years after PRP (P < .001). CONCLUSION In clinical practice, providers may consider DFD and Black race as predictors of time to VTR event within 4 years after PRP in patients with PDR. [Ophthalmic Surg Lasers Imaging Retina. 2022;53(4):186-193.].
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Yamada H, Naito R, Nishimura M, Kawakami R, Morinaga E, Morita Y, Shimizu M, Yoshimatsu G, Sawamoto O, Matsumoto S, Imafuku S, Sakata N, Kodama S. Xenotransplantation of neonatal porcine bone marrow–derived mesenchymal stem cells improves diabetic wound healing by promoting angiogenesis and lymphangiogenesis. Xenotransplantation 2022; 29:e12739. [DOI: 10.1111/xen.12739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/25/2022] [Accepted: 02/15/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Hideaki Yamada
- Department of Regenerative Medicine & Transplantation Faculty of Medicine Fukuoka University Fukuoka Japan
- Center for Regenerative Medicine Fukuoka University Hospital Fukuoka Japan
- Department of Cardiovascular Surgery Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Reiko Naito
- Department of Dermatology Fukuoka Central Hospital Fukuoka Japan
| | - Masuhiro Nishimura
- Research and Development Center Otsuka Pharmaceutical Factory, Inc. Naruto Tokushima Japan
| | - Ryo Kawakami
- Department of Regenerative Medicine & Transplantation Faculty of Medicine Fukuoka University Fukuoka Japan
- Research Institute for Regenerative Medicine Fukuoka University Fukuoka Japan
| | - Eri Morinaga
- Department of Regenerative Medicine & Transplantation Faculty of Medicine Fukuoka University Fukuoka Japan
- Center for Regenerative Medicine Fukuoka University Hospital Fukuoka Japan
- Department of Plastic Reconstructive & Aesthetic Surgery Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Yuichi Morita
- Department of Regenerative Medicine & Transplantation Faculty of Medicine Fukuoka University Fukuoka Japan
- Center for Regenerative Medicine Fukuoka University Hospital Fukuoka Japan
- Department of Cardiovascular Surgery Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Masayuki Shimizu
- Department of Regenerative Medicine & Transplantation Faculty of Medicine Fukuoka University Fukuoka Japan
- Center for Regenerative Medicine Fukuoka University Hospital Fukuoka Japan
- Department of Cardiovascular Surgery Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Gumpei Yoshimatsu
- Department of Regenerative Medicine & Transplantation Faculty of Medicine Fukuoka University Fukuoka Japan
- Center for Regenerative Medicine Fukuoka University Hospital Fukuoka Japan
- Research Institute for Regenerative Medicine Fukuoka University Fukuoka Japan
| | - Osamu Sawamoto
- Research and Development Center Otsuka Pharmaceutical Factory, Inc. Naruto Tokushima Japan
| | - Shinichi Matsumoto
- Research and Development Center Otsuka Pharmaceutical Factory, Inc. Naruto Tokushima Japan
| | - Shinichi Imafuku
- Department of Dermatology Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Naoaki Sakata
- Department of Regenerative Medicine & Transplantation Faculty of Medicine Fukuoka University Fukuoka Japan
- Center for Regenerative Medicine Fukuoka University Hospital Fukuoka Japan
- Research Institute for Regenerative Medicine Fukuoka University Fukuoka Japan
| | - Shohta Kodama
- Department of Regenerative Medicine & Transplantation Faculty of Medicine Fukuoka University Fukuoka Japan
- Center for Regenerative Medicine Fukuoka University Hospital Fukuoka Japan
- Research Institute for Regenerative Medicine Fukuoka University Fukuoka Japan
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Williamson HM, Bartlett M, Desai M. Duplex ultrasound derived maximal systolic acceleration can be a reliable and rapid alternative to ankle brachial pressure indices for the diabetic population with lower extremity arterial disease; a prospective, observational cohort study. JRSM Cardiovasc Dis 2022; 11:20480040211070481. [PMID: 35083041 PMCID: PMC8785324 DOI: 10.1177/20480040211070481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/05/2021] [Accepted: 11/11/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: Ankle brachial pressure index (ABPI) is limited for diabetic patients. This can have costly impacts upon patient's quality of life along with healthcare budgets, with diabetic care equating to approximately 10% of NHS expenditure.11 We aimed to determine whether ultrasound waveform parameters are an alternative for quantifying lower extremity peripheral arterial disease (PAD) where ABPI is unreliable.
Design: This was a prospective, observational study. Waveform parameters, systolic rise time (SRT), maximal systolic acceleration (AccMax) and peak systolic velocity (PSV) were recorded at ankle and compared to the ABPI and an aorta-ankle duplex ultrasound scan (DUS) as gold standard.
Setting: Measurements were obtained by a Clinical Vascular Scientist at the Royal Free Hospital.
Participants: Participants (≥18yrs) with known PAD, but without previous vascular intervention were allocated to non-diabetic control (n = 24) and diabetic test groups (n = 22).
Outcome measures: The primary outcome measure was the correlation of novel ultrasound derived indices to PAD severity. The secondary outcome was the efficacy of this correlation in the diabetic population.
Results: AccMax was most powerful in detecting PAD in both groups when compared to ABPI in the controls (r = 0.805; p < 0.01) and to DUS in control and test groups (r = −0.633 to −0.643; p < 0.01). In the test group, PSV did not consistently quantify PAD. SRT measurements were inconclusive throughout.
Conclusion: AccMax is a rapid alternative tool for diagnosing PAD in diabetic patients. With further research, this simple test may prove useful for monitoring PAD progression in patients unsuitable for ABPI, reducing the need for lengthy repeat duplex scans.
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Affiliation(s)
| | - Matthew Bartlett
- Royal Free London NHS Foundation Trust, Vascular Studies, London, UK
- Department of Surgery & Interventional Medicine, University College London, London, UK
| | - Mital Desai
- Department of Surgery & Interventional Medicine, University College London, London, UK
- Royal Free London NHS Foundation Trust, Vascular Surgery, London, UK
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Lee JW, Kim JY, Lee NR, Lee YH. Effect of pulsed electromagnetic fields stimulation on ischemic skin model. Electromagn Biol Med 2022; 41:15-24. [PMID: 34380341 DOI: 10.1080/15368378.2021.1963763] [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: 02/22/2021] [Accepted: 05/01/2021] [Indexed: 10/20/2022]
Abstract
This study aimed to evaluate the effect of Pulsed Electromagnetic Fields (PEMF) in improving blood flow reduction and tissue necrosis of ischemic animal induced by skin flap. In each experiment, twenty rats (280-320 g) were randomly divided into control group (n = 10) and PEMF (n = 10) group. All of the rats were performed skin flap in back. In the PEMF group, PEMF (1 Hz, 10 mT) was performed in each experiment. In Experiment-1 (n = 20), PEMF was performed for 90 minutes. In Experiment-2 (n = 20), additionally, a blocking film was inserted, and suture was performed to induce necrosis. PEMF was performed for 30 minutes each day for 7 days. As a result of Speckle-Flow Index (SFI) analysis, in the control group, blood flow continued to decrease immediately after the procedure. In the PEMF group, blood flow was remained constant after 30 minutes and increased after 60 minutes. The blood flow in a specific region substantially increased from the initial state. As a result of skin necrosis analysis, the progression rate in the PEMF group was slower than that of the control group. The rate of necrosis in the PEMF group decreased dramatically from the 6th day, and there was a statistically significant difference between the two groups at the 7th day (p < .05). In this study, it was confirmed that PEMF (1 Hz, 10 mT) has a blood flow improvement and skin tissue necrosis alleviation in the ischemic flap animal model.
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Affiliation(s)
- Ja-Woo Lee
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
| | - Jun-Young Kim
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
| | - Na-Ra Lee
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
| | - Yong-Heum Lee
- Department of Biomedical Engineering, Yonsei University, Wonju, Republic of Korea
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Wang J, Xue T, Li H, Guo S. Nomogram Prediction for the Risk of Diabetic Foot in Patients With Type 2 Diabetes Mellitus. Front Endocrinol (Lausanne) 2022; 13:890057. [PMID: 35909507 PMCID: PMC9325991 DOI: 10.3389/fendo.2022.890057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
AIMS To develop and validate a nomogram prediction model for the risk of diabetic foot in patients with type 2 diabetes mellitus (T2DM) and evaluate its clinical application value. METHODS We retrospectively collected clinical data from 1,950 patients with T2DM from the Second Affiliated Hospital of Xi'an Jiaotong University between January 2012 and June 2021. The patients were divided into training cohort and validation cohort according to the random number table method at a ratio of 7:3. The independent risk factors for diabetic foot among patients with T2DM were identified by multivariate logistic regression analysis. Then, a nomogram prediction model was developed using the independent risk factors. The model performances were evaluated by the area under the receiver operating characteristic curve (AUC), calibration plot, Hosmer-Lemeshow test, and the decision curve analysis (DCA). RESULTS Multivariate logistic regression analysis indicated that age, hemoglobin A1c (HbA1c), low-density lipoprotein (LDL), total cholesterol (TC), smoke, and drink were independent risk factors for diabetic foot among patients with T2DM (P < 0.05). The AUCs of training cohort and validation cohort were 0.806 (95% CI: 0.775∼0.837) and 0.857 (95% CI: 0.814∼0.899), respectively, suggesting good discrimination of the model. Calibration curves of training cohort and validation cohort showed a favorable consistency between the predicted probability and the actual probability. In addition, the P values of Hosmer-Lemeshow test for training cohort and validation cohort were 0.826 and 0.480, respectively, suggesting a high calibration of the model. When the threshold probability was set as 11.6% in the DCA curve, the clinical net benefits of training cohort and validation cohort were 58% and 65%, respectively, indicating good clinical usefulness of the model. CONCLUSION We developed and validated a user-friendly nomogram prediction model for the risk of diabetic foot in patients with T2DM. Nomograms may help clinicians early screen and identify patients at high risk of diabetic foot.
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Affiliation(s)
- Jie Wang
- Department of Orthopedic Surgery, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Tong Xue
- Department of Neonatology, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Haopeng Li
- Department of Orthopedic Surgery, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Haopeng Li,
| | - Shuai Guo
- Department of Orthopedic Surgery, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Biomarker Prediction of Postoperative Healing of Diabetic Foot Ulcers: A Retrospective Observational Study of Serum Albumin. J Wound Ostomy Continence Nurs 2021; 48:339-344. [PMID: 34186553 DOI: 10.1097/won.0000000000000780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this study was to investigate the relationship and to determine potential usefulness of serum albumin as a biomarker for predicting postoperative diabetic foot ulcer (DFU) healing. DESIGN A retrospective study. SUBJECTS AND SETTING The sample comprised 266 inpatients with type 2 diabetes receiving care in The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. Among them, 174 had DFUs and underwent surgery for foot DFUs including amputation, skin grafting, and flap procedures. A comparison group consisted of 92 inpatients without a DFU or surgery. METHODS The association between healing and preoperative albumin levels was analyzed via a logistic regression model and receiver operating characteristic (ROC) curve. RESULTS The albumin value of patients with DFU grade 3 or more (3.23 ± 0.58 g/dL) was lower than that of patients with DFU grade 1-2 (3.58 ± 0.5 g/dL), and both were lower than that of the comparison group (3.89 ± 0.3 g/dL). Patients with a DFU with hypoalbuminemia (<3.5 g/dL) had a 2.5-fold higher risk of nonhealing at postoperative 28 days than patients with normal levels (odds ratio = 3.51; 95% confidence interval, 1.75-7.06; P < .001). For patients with a DFU overall, the ROC curve showed a preoperative albumin cutoff of 3.44 g/dL for DFU wound healing. CONCLUSIONS For patients with a DFU undergoing surgery, preoperative serum albumin may be used as a biomarker for predicting postoperative healing.
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Adeyemo AT, Kolawole B, Rotimi VO, Aboderin AO. Multicentre study of the burden of multidrug-resistant bacteria in the aetiology of infected diabetic foot ulcers. Afr J Lab Med 2021; 10:1261. [PMID: 33824857 PMCID: PMC8008032 DOI: 10.4102/ajlm.v10i1.1261] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/22/2020] [Indexed: 01/13/2023] Open
Abstract
Background Infected diabetic foot ulcer (IDFU) is a public health issue and the leading cause of non-traumatic limb amputation. Very few published data on IDFU exist in most West African countries. Objective The study investigated the aetiology and antibacterial drug resistance burden of IDFU in tertiary hospitals in Osun state, Nigeria, between July 2016 and April 2017. Methods Isolates were cultured from tissue biopsies or aspirates collected from patients with IDFU. Bacterial identification, antibiotic susceptibility testing and phenotypic detection of extended-spectrum beta-lactamase and carbapenemase production were done by established protocols. Specific resistance genes were detected by polymerase chain reaction. Results There were 218 microorganisms isolated from 93 IDFUs, comprising 129 (59.2%) Gram-negative bacilli (GNB), 59 (27.1%) Gram-positive cocci and 29 (13.3%) anaerobic bacteria. The top five facultative anaerobic bacteria isolated were: Staphylococcus aureus (34; 15.6%), Escherichia coli (23; 10.6%), Pseudomonas aeruginosa (20; 9.2%), Klebsiella pneumoniae (19; 8.7%) and Citrobacter spp. (19; 8.7%). The most common anaerobes were Bacteroides spp. (7; 3.2%) and Peptostreptococcus anaerobius (6; 2.8%). Seventy-four IDFUs (80%) were infected by multidrug-resistant bacteria, predominantly methicillin-resistant S. aureus and GNB producing extended-spectrum β-lactamases, mainly of the CTX-M variety. Only 4 (3.1%) GNB produced carbapenemases encoded predominantly by bla VIM. Factors associated with presence of multidrug-resistant bacteria were peripheral neuropathy (adjusted odds ratio [AOR] = 4.05, p = 0.04) and duration of foot infection of more than 1 month (AOR = 7.63, p = 0.02). Conclusion Multidrug-resistant facultative anaerobic bacteria are overrepresented as agents of IDFU. A relatively low proportion of the aetiological agents were anaerobic bacteria.
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Affiliation(s)
- Adeyemi T Adeyemo
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Nigeria
| | - Babatope Kolawole
- Department of Medicine, Faculty of Clinical Science, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Vincent O Rotimi
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Aaron O Aboderin
- Department of Medical Microbiology and Parasitology, Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Nigeria.,Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Science, Obafemi Awolowo University, Ile-Ife, Nigeria
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Wu J, Liu M, Huang H. Risk Factors Associated With Diabetic Foot Ulcers and Its Relationship With ABI and Brachial-Ankle Pulse Wave Velocity. INT J LOW EXTR WOUND 2021; 21:609-616. [PMID: 33686903 DOI: 10.1177/1534734620982233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
To evaluate the risk factors associated with diabetic foot ulcers (DFUs) and to analyze the relationship of DFUs and the value of Ankle-Brachial Index (ABI) and brachial-ankle pulse wave velocity (baPWV). In this retrospective study, the risk factors associated with DFUs were analyzed, and the value of ABI and baPWV were measured to find its relationship with DFUs. Binary logistic regression analysis indicated that neuropathy and ABI were independent risk factors for DFUs. The patients were divided into 2 groups according to the value of ABI. For patients with DFUs, the value of baPWV decreased with the decrease of ABI. In normal or high ABI group, about a quarter of patients who suffered from DFUs had a higher value of baPWV than the others without DFUs. The pathogenesis of DFUs was multifactorial. Regarding the occurrence and development of foot ulcers, the action of vascular occlusion was more important than vascular sclerosis. ABI measurements should be taken more seriously in patients with DFUs. baPWV should be taken with care in the follow-up of the patients without DFUs. However, in patients with a normal value of ABI, the degree of vascular sclerosis of patients with DFUs may be greater than those without ulceration.
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Affiliation(s)
- Jialu Wu
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Min Liu
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, People's Republic of China
| | - Hui Huang
- Sichuan University, West China Hospital, Chengdu, Sichuan Province, People's Republic of China
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Malekpour Alamdari N, Mehraneroodi B, Gholizadeh B, Zeinalpour A, Safe P, Besharat S. The efficacy of negative pressure wound therapy compared with conventional dressing in treating infected diabetic foot ulcers: a randomized controlled trial. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00941-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Paton J, Abey S, Hendy P, Williams J, Collings R, Callaghan L. Behaviour change approaches for individuals with diabetes to improve foot self-management: a scoping review. J Foot Ankle Res 2021; 14:1. [PMID: 33407755 PMCID: PMC7788877 DOI: 10.1186/s13047-020-00440-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/23/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Diabetes related foot complications are increasing in complexity, frequency and cost. The application of self-management strategies can reduce the risk of individuals developing foot complications. The type, range and nature of the literature focusing on interventions that support patients with diabetic foot self-management is unknown. This scoping review aimed to i) identify self-management actions and risky behaviour avoidance strategies within interventions, ii) map the theoretical functions through which these behaviour change interventions have an effect, iii) display gaps in the research. METHODOLOGY Arksey and Malley's (2003) 5 stage framework was followed to conduct the scoping study. This methodological framework was selected because it was developed specifically for scoping reviews and therefore offered clear methodological distinction from systematic review methodology. . Databases were searched from inception of the project until June 2020 supplemented by hand searching of reference lists. In total 988 papers were identified. These were independently screened by three reviewers, identifying 19 eligible papers. Data extraction and charting of data was independently conducted by three reviewers to identify study characteristics, self-management actions and risky behaviours. Data was charted against the COM-B (capability, opportunity, motivation, behaviour) model of behaviour to determine intervention function. RESULTS In total 25 different foot self-management actions and risk behaviours were classified into three themes; routine self-management, trauma avoidance and warning signs and actions. Inspect feet daily received the most attention. The majority of interventions focused on knowledge and skills, but overlooked taking action and decision making. Intervention mapping identified four primary intervention functions (education, persuasion, training and enablement) used to address deficits in capability, opportunity and motivation that positively improved foot self-management behaviour. No studies targeted first ulcer prevention, and most either did not measure or improve foot health outcomes. CONCLUSION This review charted the evidence for interventions promoting diabetic foot self-management through a theoretical behaviour change perspective. A core set of behaviour change activities and intervention functions associated with positive changes in behaviour were identified. This information will provide researchers with a useful basis for developing self-management interventions.
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Affiliation(s)
- Joanne Paton
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK.
| | - Sally Abey
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
| | - Phil Hendy
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
| | - Jennifer Williams
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
- Torbay & South Devon NHS Foundation Trust, Torbay Hospital, Lowes Bridge, Torquay, TR2 7AA, UK
| | - Richard Collings
- School of Health Professions, Faculty of Health, University of Plymouth, Derriford Road, Plymouth, PL6 8BH, UK
- Torbay & South Devon NHS Foundation Trust, Torbay Hospital, Lowes Bridge, Torquay, TR2 7AA, UK
| | - Lynne Callaghan
- Penninsula Medical School, Faculty of Health, University of Plymouth, John Bull Building Plymouth Science Park, Plymouth, PL6 8BT, UK
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Hamid MH, Arbab AH, Yousef BA. Bacteriological profile and antibiotic susceptibility of diabetic Foot infections at Ribat University hospital; a retrospective study from Sudan. J Diabetes Metab Disord 2020; 19:1397-1406. [PMID: 33553032 DOI: 10.1007/s40200-020-00660-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/08/2020] [Indexed: 12/19/2022]
Abstract
Purpose Diabetic foot infection (DFI) is one of the most feared complications of diabetes. In Sudan, the number of cases and the problems associated with diabetic foot infections increased in recent years. This study aimed to assess the bacteriological profile of patients with DFIs and their antibiotic susceptibility pattern. Methods A descriptive retrospective cross-sectional study was carried out at Surgery Department of Ribat University Hospital. All medical records of patients with DFIs during the period from September 2017 to February 2019 were reviewed using data collection sheet. The collected data were analyzed using Statistical Package for Social Sciences. Results Out of 250 DFI patients, 73.2% of them were males, and 86.4% of them had type 2 diabetes mellitus, and most of them suffered from diabetes for more than 10 years. Regarding culture results, 64.7% and 35.3% of the samples revealed presence of single microorganism and mixed infections, respectively. A total of 335 bacterial isolates were identified, gram-negative were more prevalent than gram-positive organisms. The most frequently isolated organisms were Proteus spp. Staphylococcus aureus, and Escherichia coli. Furthermore, antibiotic susceptibility pattern showed that imipenem, amikacin and vancomycin have the highest activity against isolated bacteria, and all isolates were found to be completely resistant to different cephalosporin drugs. Conclusion Among the studied samples, gram-negative bacteria were found to be more common in DFI patients, Proteus spp. and S. aureus were the most common microorganisms. Moreover, different isolated microorganisms showed to have different degrees of resistance and sensitivity to various antibacterial drugs.
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Affiliation(s)
- Maram H Hamid
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Khartoum, Al-Qasr Ave, 1111 Khartoum, Sudan
| | - Ahmed H Arbab
- Department of Pharmacognosy, Faculty of Pharmacy, University of Khartoum, Al-Qasr Ave, 11111 Khartoum, Sudan.,Department of Pharmacognosy, Faculty of Pharmacy, Omdurman Islamic University, Omdurman, Sudan
| | - Bashir A Yousef
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Al-Qasr Ave, 11111 Khartoum, Sudan
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Shi R, Lian W, Jin Y, Cao C, Han S, Yang X, Zhao S, Li M, Zhao H. Role and effect of vein-transplanted human umbilical cord mesenchymal stem cells in the repair of diabetic foot ulcers in rats. Acta Biochim Biophys Sin (Shanghai) 2020; 52:620-630. [PMID: 32484226 PMCID: PMC7333920 DOI: 10.1093/abbs/gmaa039] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/15/2020] [Accepted: 03/31/2020] [Indexed: 12/13/2022] Open
Abstract
Diabetic foot ulcer (DFU) is one of diabetic complications, which is frequently present and tormented in diabetes mellitus. Most multipotent mesenchymal stromal cells (MSCs) are capable of immune evasion, providing an allogeneic, ready-to-use, cell product option for therapeutic applications. The beneficial effect of MSCs for the treatment of a variety of traumatic injuries, such as open wounds, has been extensively explored. In this study, a rat DFU model was used to simulate the pathophysiology of clinical patients and to investigate the localization of human umbilical cord mesenchymal stem cells (hUC-MSCs) after intravenous transplantation and its role in DFU healing, so as to evaluate the potential of hUC-MSCs in the treatment of DFU. The diabetic rat model was established by streptozotocin injection, which was used to create full-thickness foot dorsal skin wounds to mimic DFU by a 6-mm skin biopsy punch and a Westcott scissor. The hUC-MSCs were transplanted through femoral vein, and the ulcer cicatrization situation and the fate of hUC-MSCs were evaluated. Our data suggest that intravenously transplantated hUC-MSCs have the ability to migrate and locate to the wound tissue and are helpful to wound healing in DFU rats, partly by regulating inflammation, trans-differentiation and providing growth factors that promote angiogenesis, cell proliferation and collagen deposition. Herein, we demonstrate that hUC-MSC transplantation is able to accelerate DFU healing in rats and transplantation of exogenous stem cells may be a potential strategy for clinical application in DFUs.
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Affiliation(s)
- Rongfeng Shi
- Department of Interventional Radiology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Weishuai Lian
- Department of Interventional & Vascular Surgery, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai 200072, China
- Institute of Medical Intervention Engineering, Tongji University, Shanghai 200072, China
| | - Yinpeng Jin
- Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Chuanwu Cao
- Department of Interventional & Vascular Surgery, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai 200072, China
- Institute of Medical Intervention Engineering, Tongji University, Shanghai 200072, China
| | - Shilong Han
- Department of Interventional & Vascular Surgery, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai 200072, China
- Institute of Medical Intervention Engineering, Tongji University, Shanghai 200072, China
| | - Xiaohu Yang
- Department of Interventional Radiology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Suming Zhao
- Department of Interventional Radiology, Affiliated Hospital of Nantong University, Nantong 226001, China
| | - Maoquan Li
- Department of Interventional & Vascular Surgery, Shanghai Tenth People’s Hospital, Tongji University, School of Medicine, Shanghai 200072, China
- Institute of Medical Intervention Engineering, Tongji University, Shanghai 200072, China
| | - Hui Zhao
- Department of Interventional Radiology, Affiliated Hospital of Nantong University, Nantong 226001, China
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Chai W, Wang Y, Jiao F, Wu Y, Wang S. A Severe Diabetic Foot Ulcer With Intermediate Cuneiform Displacement and Multidrug-Resistant Pseudomonas aeruginosa Infection: A Rare Case Report. Front Med (Lausanne) 2020; 7:131. [PMID: 32373618 PMCID: PMC7187760 DOI: 10.3389/fmed.2020.00131] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/26/2020] [Indexed: 11/24/2022] Open
Abstract
Diabetic foot ulcer (DFU) is considered as one of the most serious and prevailing complications of diabetes mellitus, while it is the major cause of amputations in diabetic patients. Herein, we reported an acquired severe traumatic DFU with an intermediate cuneiform hairline fracture and displacement in a 55-year old male (Grade IV of Wagner classification; Grade III of IWGDF classification). The Pseudomonas aeruginosa was identified in pus culture. Data of antibiotic susceptibility testing indicated that the isolates of Pseudomonas aeruginosa were multi-drug resistant. Routine debridement, clearing displaced intermediate cuneiform and drainage were performed to facilitate the outflow of pus and pressure mitigation. Dressing with Prontosan solution and gel was applied to the wound, and meropenem was systemically administrated in addition to effective glycemic control. The DFU has been fully healed after ~40-day treatment. For this case, clearing the displaced and fractured intermediate cuneiform is essential for the heal of the DFU in addition to the common strategy for DFU treatment, i.e., the combination of debridement, pressure mitigation, wound dressing with Prontosan, antibiotic selection and effective glycemic control. This case report might have value for the treatment of complex DFU with bone fracture and displacement, reducing the risk of amputation.
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Affiliation(s)
- Wei Chai
- Department of Surgery, Tianjin Second Hospital, Tianjin, China
| | - Yuqing Wang
- Cheeloo College of Medicine, Shandong University, Jinan, China.,Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China
| | - Fengjuan Jiao
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China.,Shandong Collaborative Innovation Center for Diagnosis, Treatment & Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jining, China
| | - Yili Wu
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China.,Shandong Collaborative Innovation Center for Diagnosis, Treatment & Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jining, China
| | - Shuai Wang
- Shandong Key Laboratory of Behavioral Medicine, School of Mental Health, Jining Medical University, Jining, China.,Shandong Collaborative Innovation Center for Diagnosis, Treatment & Behavioral Interventions of Mental Disorders, Institute of Mental Health, Jining Medical University, Jining, China
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Shi C, Wang C, Liu H, Li Q, Li R, Zhang Y, Liu Y, Shao Y, Wang J. Selection of Appropriate Wound Dressing for Various Wounds. Front Bioeng Biotechnol 2020; 8:182. [PMID: 32266224 PMCID: PMC7096556 DOI: 10.3389/fbioe.2020.00182] [Citation(s) in RCA: 186] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/24/2020] [Indexed: 12/30/2022] Open
Abstract
There are many factors involved in wound healing, and the healing process is not static. The therapeutic effect of modern wound dressings in the clinical management of wounds is documented. However, there are few reports regarding the reasonable selection of dressings for certain types of wounds in the clinic. In this article, we retrospect the history of wound dressing development and the classification of modern wound dressings. In addition, the pros and cons of mainstream modern wound dressings for the healing of different wounds, such as diabetic foot ulcers, pressure ulcers, burns and scalds, and chronic leg ulcers, as well as the physiological mechanisms involved in wound healing are summarized. This article provides a clinical guideline for selecting suitable wound dressings according to the types of wounds.
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Affiliation(s)
- Chenyu Shi
- School of Nursing, Jilin University, Changchun, China.,Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Chenyu Wang
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Qiuju Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ronghang Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yan Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yuzhe Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ying Shao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China.,Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- School of Nursing, Jilin University, Changchun, China.,Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
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Liu P, Zhu Y, Li Q, Cheng B. Comprehensive Analysis of Differentially Expressed miRNAs and mRNAs Reveals That miR-181a-5p Plays a Key Role in Diabetic Dermal Fibroblasts. J Diabetes Res 2020; 2020:4581954. [PMID: 33102604 PMCID: PMC7568154 DOI: 10.1155/2020/4581954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/05/2020] [Indexed: 12/16/2022] Open
Abstract
A diabetic nonhealing wound causes heavy economic burden and compromised quality of life in patients. The human dermal fibroblast (HDF), which is an important kind of effector cell in the wound healing process, represents different biological behaviors in the normal and diabetic skins. Given this, we attempt to explore functional changes in diabetic skin-derived HDFs and try to find out the "hub" genes that modulate diabetic HDFs and may be the potential therapeutic targets of diabetic wound healing. We searched the GEO database for related miRNA (GSE68185, GSE84971) and mRNA (GSE49566, GSE78891) profiles. After eliminating batch effects and identifying differentially expressed genes (DEGs), we applied enrichment analyses and found that 3 miRNAs and 30 mRNAs were differentially expressed in diabetic HDFs. Enrichment analyses showed that these genes are closely related to wound healing, for example, extracellular matrix (ECM) organization, angiogenesis, cell proliferation, and migration. Subsequently, we constructed the gene correlation network of DEGs to identify hub genes by merging the protein-protein interaction network, weighted gene coexpression network, and predicted miRNA-mRNA regulatory network. Based on the gene correlation network, we identified the top 3 hub genes: miR-181a-5p, POSTN, and CDH11. Among these, POSTN is a predicted target of miR-181a-5p and is supposed to work together with CDH11 as a functional group. Finally, we verified the expression pattern of the hub genes by in vitro quantification experiments in glucose-cultured HDFs. Our study suggested that miR-181a-5p possibly plays a key role in modulation of HDF behaviors during the diabetic state. However, the effects and mechanisms of miR-181a-5p in high glucose-cultured HDFs remain to be explored in the future.
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Affiliation(s)
- Peng Liu
- Department of Burn & Plastic Surgery, General Hospital of Southern Theatre Command of PLA, 111 Guangzhou Liuhua Road, Guangzhou 510010, China
- Huabo Post-Doctoral Research Center, Biological Pharmaceutical Research Institute, 111 Guangzhou Liuhua Road, Guangzhou 510010, China
| | - Yi Zhu
- Department of Anesthesiology, General Hospital of Southern Theatre Command of PLA, 111 Guangzhou Liuhua Road, Guangzhou 510010, China
| | - Qin Li
- Department of Burn & Plastic Surgery, General Hospital of Southern Theatre Command of PLA, 111 Guangzhou Liuhua Road, Guangzhou 510010, China
| | - Biao Cheng
- Department of Burn & Plastic Surgery, General Hospital of Southern Theatre Command of PLA, 111 Guangzhou Liuhua Road, Guangzhou 510010, China
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Ponnam H, Lamba C, Oberai P, Masood S, Yandamuri S, Rao MN, Manchanda R. Calendula mother tincture vs normal saline for ulcer dressing as an add-on to Individualized Homoeopathic Intervention in the management of Diabetic Foot Ulcer: A Randomized Controlled Pilot Study. INDIAN JOURNAL OF RESEARCH IN HOMOEOPATHY 2020. [DOI: 10.4103/ijrh.ijrh_87_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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New Concepts in the Management of Charcot Neuroarthropathy in Diabetes. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1307:391-415. [PMID: 32124412 DOI: 10.1007/5584_2020_498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Charcot Neuroarthropathy (CN) is an uncommon, debilitating and often underdiagnosed complication of chronic diabetes mellitus though, it can also occur in other medical conditions resulting from nerve injury. Till date, the etiology of CN remains unknown, but enhanced osteoclastogenesis is believed to play a central role in the pathogenesis of CN, in the presence of neuropathy. CN compromises the overall health and quality of life. Delayed diagnosis can result in a severe deformity that can act as a gateway to ulceration, infection and in the worst case, can lead to limb loss. In an early stage of CN, immobilization with offloading plays a key role to a successful treatment. Medical therapies seem to have limited role in the treatment of CN.In case of severe deformity, proper footwear or bracing may help prevent further deterioration and development of an ulcer. In individuals with a concomitant ulcer with osteomyelitis, soft tissue infection and severe deformity, where conservative measures fall short, surgical intervention becomes the only choice of treatment. Early diagnosis and proper management at an early stage can help prevent the occurrence of CN and amputation.
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Moulaei K, Malek M, Sheikhtaheri A. Monitoring of external predisposing factors for Diabetic Foot: A literature review and physicians' perspectives. Med J Islam Repub Iran 2019; 33:159. [PMID: 32280665 PMCID: PMC7137813 DOI: 10.34171/mjiri.33.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Indexed: 11/11/2022] Open
Abstract
Background: Diabetic foot is one of the most important complications of diabetes caused by the existence of some destructive factors in different anatomical locations of feet. Management and monitoring of these factors are very important to decrease or avoid ulcerating lesions of the foot. The purpose of this study is to identify and introduce the predisposing factors and anatomical locations associated with these destructive factors. Methods: First, we conducted a comprehensive review of different databases to identify the factors and associated anatomical locations from the previous studies. Then, we designed a questionnaire and invited physicians and specialists to express their perspectives on these factors and locations. The data were analyzed using SPSS version 23. Frequency, percentage, mean and standard deviation of these variables were calculated. Results: Based on the literature review, four factors, including pressure, moisture and sweat, temperature, and acceleration were identified as factors destructive to the tissues of the diabetic foot and worsen ulcers. The view of specialists approved the results of the literature review. Besides, there was an insignificant difference between the results of the literature review and the specialists' view in terms of anatomical locations that need to be continuously monitored. Conclusion: Monitoring the pressure in heel, first metatarsal, and first metatarsal head; moisture and sweat under the fingers, hallux and heels as well as the temperature at the first metatarsal, first metatarsal head, and the third metatarsal head are important in preventing ulceration, destructing the foot tissue, and accelerating the treatment process.
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Affiliation(s)
- Khadijeh Moulaei
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Malek
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology and Metabolism, Iran University of medical sciences, Tehran, Iran
| | - Abbas Sheikhtaheri
- Health Management and Economics Research Center, Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Azzopardi YM, Gatt A, Chockalingam N, Formosa C. Agreement of clinical tests for the diagnosis of peripheral arterial disease. Prim Care Diabetes 2019; 13:82-86. [PMID: 30201222 DOI: 10.1016/j.pcd.2018.08.005] [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: 07/09/2018] [Revised: 08/15/2018] [Accepted: 08/22/2018] [Indexed: 01/20/2023]
Abstract
AIM The aim of this study was to compare different screening modalities in the detection of PAD in a primary care setting. METHODS Fifty participants living with Type 2 diabetes were recruited. Pulse palpation, waveform analysis, ankle brachial pressure index, absolute toe pressure, toe brachial pressure index and transcutaneous oxygen pressure were compared in the detection of peripheral arterial disease. One hundred limbs were included for analysis. RESULTS This study showed different results in peripheral arterial disease screening tests in the same group of participants. The highest percentage of participants who had PAD was for the Doppler Waveform (93.0%). This was followed by TBPI (72.0%), ABPI (57.0%), ATP (35.0%), TCPO (30.0%) and pulse palpation (23.0%). The difference between these percentages is significant (p<0.0005). The magnitude of the effect size is medium/moderate (Cramer's V=0.498). CONCLUSION This study demonstrates that inconsistencies exist between the agreement of the 6 different modalities used to detect PAD. These findings should create an awareness amongst clinicians when interpreting results of these tests. The authors advocate for urgent, more robust studies utilizing a gold standard modality for the diagnosis of PAD in order to provide evidence regarding which screening modalities would yield the most valid results.
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Affiliation(s)
| | - Alfred Gatt
- Faculty of Health Sciences, University of Malta, Malta; School of Life Sciences and Education, Staffordshire University, United Kingdom.
| | - Nachiappan Chockalingam
- Faculty of Health Sciences, University of Malta, Malta; School of Life Sciences and Education, Staffordshire University, United Kingdom.
| | - Cynthia Formosa
- Faculty of Health Sciences, University of Malta, Malta; School of Life Sciences and Education, Staffordshire University, United Kingdom.
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Al Ayed MY, Ababneh M, Alwin Robert A, Alzaid A, Ahmed RA, Salman A, Musallam MA, Al Dawish MA. Common Pathogens and Antibiotic Sensitivity Profiles of Infected Diabetic Foot Ulcers in Saudi Arabia. INT J LOW EXTR WOUND 2018; 17:161-168. [PMID: 30141366 DOI: 10.1177/1534734618793557] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We sought to define the type and antibiotic sensitivity response of pathogens isolated from diabetic foot ulcers based on ulcer location and Wagner classification. This retrospective analysis was done among 126 patients between 40 and 70 years of age at the Prince Sultan Military Medical City, Riyadh, Saudi Arabia, using the swab culture method for microbiological assessment. Data on demographic variables, ulcer sites (location), and depth of ulcer (Wagner classification) were also collected. A total of 134 pathogens were isolated from 126 patients. The most common gram-negative pathogen identified was Pseudomonas aeruginosa (15.6%), followed by Klebsiella spp (6.7%). The most common gram-positive pathogen was Staphylococcus aureus (35%), followed by Streptococcus (8.9%). The most widely accepted antibiotic to which the gram-negative bacteria were sensitive was gentamycin (20.1%), followed by ciprofloxacin (19%). The most routinely used antibiotic in the treatment of the gram-positive bacteria was erythromycin (16%), with trimethoprim-sulfamethoxazole (14.1%) being the next most effective. In conclusion, Pseudomonas aeruginosa, Klebsiella spp, Staphylococcus aureus, and Streptococcus were the most common causes of diabetic foot infections. However, the frequency of encountered pathogens and respective sensitivity to antibiotic therapy may be influenced by the location site and severity of the ulceration.
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Affiliation(s)
| | | | | | - Aus Alzaid
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Ahmed Salman
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Mohn J, Igland J, Zoffmann V, Peyrot M, Graue M. Factors explaining variation in self-esteem among persons with type 1 diabetes and elevated HbA1c. PLoS One 2018; 13:e0201006. [PMID: 30096144 PMCID: PMC6086418 DOI: 10.1371/journal.pone.0201006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 07/07/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To investigate associations between perceived autonomy support from health-care professionals, autonomy-driven motivation, diabetes self-perceived competence and self-esteem in adults (age 18-55 yrs) with suboptimally regulated type 1 diabetes mellitus (T1DM) with at least one HbA1c≥8.0% (≥64 mmol/mol) during the past year, and whether these factors could predict decrease in self-esteem over time. METHODS A cross-sectional population-based survey was performed, and 9 months follow-up data were collected. Data collection comprised clinical and socio-demographic variables, blood sampling (HbA1c) and self-report questionnaires; the Health Care Climate Questionnaire (HCCQ), Treatment Self-Regulation Questionnaire (TSRQ), the Perceived Competence in Diabetes Scale (PCDS), and the Rosenberg Self-esteem Scale (RSES). We fitted block-wise linear regression models to assess associations between RSES and variables of interest (HCCQ, TSRQ, PCDS, HbA1c, clinical and socio-demographic variables) and linear regression models to assess predictors of change over time. FINDINGS In this study sample, aged 36.7 (±10.7) mean HbA1c 9.3% (±1.1), 31.5% had long-term complications and 42.7% had experienced severe hypoglycemia within the previous 12 months. In the final regression model the association between PCDS and RSES was strongly significant (B = 1.99, p<0.001) and the associations between HCCQ, TSRQ and RSES were reduced to non-significance. All predictor variables combined explained 42% of the variability of RSES (adjusted R2 = 0.423) with PCDS contributing 18% to explained variance (R-square change = 0.184, p<0.001). The strongest predictors of change in RSES over time were long-term complications (B = 2.76, p<0.001), specifically foot-related problems, and being female (B = -2.16, p = 0.002). CONCLUSIONS Perceived autonomy support, autonomy-driven motivation and diabetes self-perceived competence play a significant role in explaining self-esteem among adults with suboptimally regulated T1DM. Healthcare professionals should acknowledge self-esteem as a valuable factor in understanding the multifaceted health choices people with T1DM make. TRIAL REGISTRATION Clinical Trials.gov with identification number NCT 01317459.
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Affiliation(s)
- Jannike Mohn
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Section of Endocrinology, Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Jannicke Igland
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Vibeke Zoffmann
- Research Unit Women’s and Children’s Health, The Juliane Marie Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mark Peyrot
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Sociology, Loyola University Maryland, Baltimore, Maryland, United States of America
| | - Marit Graue
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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MacRury S, Stephen K, Main F, Gorman J, Jones S, Macfarlane D. Reducing Amputations in People with Diabetes (RAPID): Evaluation of a New Care Pathway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15050999. [PMID: 29772673 PMCID: PMC5982038 DOI: 10.3390/ijerph15050999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 12/30/2022]
Abstract
People with diabetes are at increased risk of foot ulcers, which, if left untreated, can lead to infection, gangrene, and subsequent amputation. Management by a multidisciplinary diabetes foot team has been shown to reduce amputation rates; however, accessing specialist treatment is made particularly difficult when living in remote and rural locations, such as many individuals cared for within NHS Highland. The RAPID project was made up of two phases: firstly, to evaluate the technical feasibility of a new integrated care pathway using innovative technology, and secondly, to establish process enhancement of the pathway to justify a larger-scale study. Omni-HubTM enabled a face-to-face consultation by the community podiatrist to be enhanced by virtual consultation with members of the multidisciplinary foot team, including specialist diabetes podiatrists and a diabetes consultant. The technical feasibility study provided recommended changes focused around adaptations to the equipment used and the best means to gain successful connectivity. The process enhancement study demonstrated positive outcomes in the process with positive effects both in the service received by patients and experiences of healthcare professionals involved. The RAPID project provides evidence and justification for a larger-scale empirical study to test an embedded pathway and technology solution, which will inform policy change and a paradigm shift in the management of foot ulceration in the community.
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Affiliation(s)
- Sandra MacRury
- Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness IV2 3JH, UK.
| | - Kate Stephen
- Institute of Health Research and Innovation, University of the Highlands and Islands, Inverness IV2 3JH, UK.
| | - Fiona Main
- Highland Health Board, Inverness IV2 3UJ, UK.
| | - Jane Gorman
- Highland Health Board, Inverness IV2 3UJ, UK.
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Bader DL, Worsley PR. Technologies to monitor the health of loaded skin tissues. Biomed Eng Online 2018; 17:40. [PMID: 29650012 PMCID: PMC5897925 DOI: 10.1186/s12938-018-0470-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/24/2018] [Indexed: 01/18/2023] Open
Abstract
There are many situations where the skin and underlying soft tissues are compromised by mechanical loading in the form or pressure, or pressure in combination with shear. If sustained, this can lead to damage in the tissues particularly adjacent to bony prominences, resulting in chronic wounds. An array of bioengineering technologies have been adopted to assess the integrity of loaded soft tissues. This paper aims to review these approaches for the quantification, simulation and early detection of mechanically-induced skin damage. The review considers different measurements at the interface between the skin and support surface/medical device, involving pressure, shear, friction and the local microclimate. The potential of the techniques to monitor the physiological response of the skin to these external stimuli including biophysical measurement devices and sampling of biofluids are critically analysed. In addition, it includes an analysis of medical imaging technologies and computational modelling to provide a means by which tissue deformation can be quantified and thresholds for tissue damage defined. Bioengineering measurement and imaging technologies have provided an insight into the temporal status of loaded skin. Despite the advances in technology, to date, the translation to clinical tools which are robust and cost effective has been limited. There is a need to adapt existing technologies and simulation platforms to enable patients, carers and clinicians to employ appropriate intervention strategies to minimise soft tissue damage.
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Affiliation(s)
- Dan L Bader
- Skin Health Group, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Peter R Worsley
- Skin Health Group, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
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Safety and effectiveness of Traditional Chinese Medicinal herbs for diabetic foot: a systematic review and Meta-analysis. J TRADIT CHIN MED 2017. [DOI: 10.1016/s0254-6272(18)30036-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Liu M, Zhang W, Yan Z, Yuan X. Smoking increases the risk of diabetic foot amputation: A meta-analysis. Exp Ther Med 2017; 15:1680-1685. [PMID: 29434753 DOI: 10.3892/etm.2017.5538] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 06/06/2017] [Indexed: 12/17/2022] Open
Abstract
Accumulating evidence suggests that smoking is associated with diabetic foot amputation. However, the currently available results are inconsistent and controversial. Therefore, the present study performed a meta-analysis to systematically review the association between smoking and diabetic foot amputation and to investigate the risk factors of diabetic foot amputation. Public databases, including PubMed and Embase, were searched prior to 29th February 2016. The heterogeneity was assessed using the Cochran's Q statistic and the I2 statistic, and odds ratio (OR) and 95% confidence interval (CI) were calculated and pooled appropriately. Sensitivity analysis was performed to evaluate the stability of the results. In addition, Egger's test was applied to assess any potential publication bias. Based on the research, a total of eight studies, including five cohort studies and three case control studies were included. The data indicated that smoking significantly increased the risk of diabetic foot amputation (OR=1.65; 95% CI, 1.09-2.50; P<0.0001) compared with non-smoking. Sensitivity analysis demonstrated that the pooled analysis did not vary substantially following the exclusion of any one study. Additionally, there was no evidence of publication bias (Egger's test, t=0.1378; P=0.8958). Furthermore, no significant difference was observed between the minor and major amputation groups in patients who smoked (OR=0.79; 95% CI, 0.24-2.58). The results of the present meta-analysis suggested that smoking is a notable risk factor for diabetic foot amputation. Smoking cessation appears to reduce the risk of diabetic foot amputation.
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Affiliation(s)
- Min Liu
- Department of Endocrinology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010050, P.R. China
| | - Wei Zhang
- Department of Ophthalmology, Affiliated People's Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010020, P.R. China
| | - Zhaoli Yan
- Department of Endocrinology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010050, P.R. China
| | - Xiangzhen Yuan
- Health Care Center, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010050, P.R. China
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Wu S, Applewhite AJ, Niezgoda J, Snyder R, Shah J, Cullen B, Schultz G, Harrison J, Hill R, Howell M, Speyrer M, Utra H, de Leon J, Lee W, Treadwell T. Oxidized Regenerated Cellulose/Collagen Dressings: Review of Evidence and Recommendations. Adv Skin Wound Care 2017; 30:S1-S18. [PMID: 29049055 PMCID: PMC5704727 DOI: 10.1097/01.asw.0000525951.20270.6c] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/06/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Healthcare systems are being challenged to manage increasing numbers of nonhealing wounds. Wound dressings are one of the first lines of defense in wound management, and numerous options exist. The oxidized regenerated cellulose (ORC)/collagen dressing may offer healthcare providers a robust and cost-effective tool for use in a variety of wounds. DESIGN A multidisciplinary panel meeting was convened to discuss the use of ORC/collagen dressings in wound care and provide practice recommendations. A literature search was conducted to provide a brief review of the peer-reviewed studies published between January 2000 and March 2016 to inform the meeting. SETTING A 2-day panel meeting convened in February 2017. PARTICIPANTS Healthcare providers with experience using ORC/collagen dressings. This multidisciplinary panel of 15 experts in wound healing included podiatrists, wound care specialists (doctors, certified wound care nurses, and research scientists), and an orthopedist. RESULTS The literature search identified 58 articles, a majority of which were low levels of evidence (69.3% were level 3 or lower). Panel members identified wound types, such as abrasions, burns, stalled wounds, diabetic foot ulcers, and pressure injuries, where ORC/collagen dressing use could be beneficial. Panel members then provided recommendations and technical pearls for the use of ORC/collagen dressings in practice. Barriers to ORC/collagen dressing use were discussed, and potential resolutions were offered. CONCLUSIONS An ORC/collagen dressing can be a critical tool for clinicians to help manage a variety of wounds. Clinical and economic studies comparing standard-of-care dressings and plain collagen dressings to ORC/collagen dressings are needed.
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Affiliation(s)
- Stephanie Wu
- Stephanie Wu, DPM, MS, is Professor of Surgery, Dr William M. School College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, Center for Lower Extremity Ambulatory Research (CLEAR), North Chicago, Illinois. Andrew J. Applewhite, MD, CSWP, is Medical Director and Physician, Comprehensive Wound Care and Hyperbaric Center at Baylor University Medical Center, Dallas, Texas. Jeffrey Niezgoda, MD, FACHM, MAPWCA, CHWS, is President and Chief Medical Officer of Advancing the Zenith of Healthcare, Milwaukee, Wisconsin. Robert Snyder, DPM, MSc, is Professor and Director of Clinical Research, Barry University School of Podiatric Medicine, North Miami Beach, Florida. Jayesh Shah, MD, is President, South Texas Wound Associated PA, San Antonio, Texas. Breda Cullen, PhD, is R&D Program Director, Systagenix, Gargrave, United Kingdom. Gregory Schultz, PhD, is Professor, University of Florida College of Medicine, Gainesville, Florida. Janis Harrison, BSN, RN, CWOCN, CFCN, is Partner and Chief Clinical Consultant to Harrison WOC Services LLC, Thurston, Nebraska. Rosemary Hill, RN, CWOCN, CETN(C), is Enterostomal Therapist, Lions Gate Hospital, North Vancouver, British Columbia, Canada. Melania Howell, RN, CWOCN, is Wound Care Consultant, Dynamic Wound Care Solutions LLC, Turlock, California. Marcus Speyrer, RN, CWS, is Chief Operating Officer, The Wound Treatment Center LLC, Opelousas General Health System, Opelousas, Louisiana. Howard Utra, BSN, RN, CWCN, is Registered Nurse, Innovated Healing Systems, Tampa, Florida. Jean de Leon, MD, FAPWCA, is Professor, University of Texas Southwestern Medical Center, Dallas, Texas. Wayne Lee, MD, is in private practice, Hill Country Orthopaedic Surgery & Sports Medicine, San Antonio, Texas. Terry Treadwell, MD, is Medical Director, Institute for Advanced Wound Care at Baptist Medical Center, Montgomery, Alabama. ACKNOWLEDGMENTS: The authors thank Ricardo Martinez and Julie M. Robertson (ACELITY) for manuscript preparation and editing. Drs Wu, Applewhite, Niezgoda, Snyder, Shah, Schultz, de Leon, Lee, and Treadwell; Ms Harrison, Hill, and Howell; and Mr Speyrer and Mr Utra are consultants for ACELITY. Dr Cullen is an employee of Systagenix, an ACELITY Company. The panel meeting was sponsored by ACELITY
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Hlinková E, Nemcová J, Žiaková K. EDUCATIONAL ASSESSMENT OF DIABETICS REQUIRING VASCULAR SURGERY. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2017. [DOI: 10.15452/cejnm.2017.08.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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