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Zou L, Wei Q, Pan S, Xiao F, Jiang Y, Zhong Y, Xie Y. Comparison of the Effects of Combined Femoral and Sciatic Nerves Block versus General Anesthesia on Hemodynamic Stability and Postoperative Complication in Patients with Diabetic Foot: A Prospective, Double-Blind and Randomized Controlled Trial. Diabetes Metab Syndr Obes 2024; 17:2243-2257. [PMID: 38854443 PMCID: PMC11162629 DOI: 10.2147/dmso.s465814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 05/30/2024] [Indexed: 06/11/2024] Open
Abstract
Background Perioperative anesthetic management of patients with diabetic foot undergoing surgical treatment is challenging due to their poor cardiovascular health status. According to previous literature, general anesthesia and peripheral nerve block have their own advantages and disadvantages for such patients. We reported the effect of these two anesthesia techniques on perioperative hemodynamics and prognosis in these patients. Methods This study employed a prospective randomized controlled design, where patients meeting the inclusion criteria were assigned to two groups: the general anesthesia group (GA group) and the peripheral nerve block group (PNB group). The primary outcomes were the differences in intraoperative hemodynamic stability and the incidence of postoperative complications between the two groups. The second outcomes were postoperative numerical rating scale scores, analgesic drug remedies, postoperative sleep conditions monitored by sleep bracelets and health status assessed by EQ-5D-5 L scores. Results One hundred and nine subjects were enrolled in this study, including 54 in the GA group and 55 in the PNB group. The baseline parameters of the two groups were comparable. The GA group exhibited a significantly higher incidence of hypotension, and Colloid intake and total fluid intake were significantly higher in the GA group than in the PNB group. Additionally, a larger proportion of patients in the GA group. The scores of postoperative pain during the 48 hours after surgery were significantly higher, and more patients needed tramadol for postoperative analgesia during the 24 h after surgery in the GA group than in the PNB group. Patients in the PNB group slept better, first feeding time, earlier out-of-bed activity and earlier discharge from the hospital, compared to the GA group. However, there was no obvious difference in postoperative complications between the two groups except pharyngeal pain. Conclusion Peripheral nerve block is a better option in patients with diabetes undergoing elective below-knee surgery than general anesthesia.
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Affiliation(s)
- Liyun Zou
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Qiufeng Wei
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Sining Pan
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Fei Xiao
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
- Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Yage Jiang
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yu Zhong
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yubo Xie
- Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
- Guangxi Key Laboratory of Enhanced Recovery After Surgery for Gastrointestinal Cancer, The First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
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Lopes GSG, Landeiro MJL, Maciel T, Sousa MRMGCD. Clinical practice guidelines of foot care practice for patients with type 2 diabetes: A scoping review using self-care model. Contemp Nurse 2024:1-21. [PMID: 38831701 DOI: 10.1080/10376178.2024.2362289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/27/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Type 2 diabetes can lead to severe foot complications, making self-care education, guided by clinical guidelines, crucial. However, fragmented and dispersed recommendations challenge effective implementation of these guidelines. Bringing together recommendations and presenting them according to a self-care model can provide a solid framework and facilitate the interpretation of results. AIMS to map the international guidelines that provide recommendations to nurses to enable people with type 2 diabetes for foot self-care and synthesize the recommendations according to the key concepts of the middle-range theory of self-care for chronic diseases. DESIGN A scoping review was undertaken, using the methodological guidance of the Joanna Briggs Institute. DATA SOURCES Databases were searched between September 2022 and June 2023, including PubMed, CINAHL, PsycINFO, Scopus, Web of Science Core Collection, ProQuest Dissertations and Theses Global, guideline websites and related professional association websites. The databases were chosen for their comprehensive coverage of the area. METHODS Eligible articles included guidance documents providing foot care recommendations for diabetes, published or updated between 2013 and 2023. Two reviewers summarized the recommendations presented in at least two guidelines according to the key concepts of the self-care model. The PRISMA-ScR checklist was used. RESULTS Seventeen guidelines were included. In total, we synthesized 175 recommendations. The recommendations were framed in three dimensions and their respective categories: Self-care maintenance (education for prevention, control of risk factors, daily foot care, footwear, and socks), Self-care monitoring (foot inspection, detection of signs of infection, and detection of other diabetes-related foot disease complications), and Self-care management (responses to signs and symptoms, foot wound care, follow-up with health professionals, and health services). CONCLUSIONS The main aspect of foot care revolves around daily care, including cleaning, moisturizing, nail care, selecting appropriate footwear, and regular inspection of both feet and footwear.
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Affiliation(s)
- Geysa Santos Góis Lopes
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- CINTESIS@RISE NursID, Porto, Portugal
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Xu Z, Cheng K, Wang K, Gui L. Experiences of middle-aged individuals with lower extremity amputation caused by diabetic foot ulcer after disability in China: A qualitative study. Nurs Open 2024; 11:e2213. [PMID: 38875354 PMCID: PMC11178130 DOI: 10.1002/nop2.2213] [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: 10/18/2023] [Accepted: 05/31/2024] [Indexed: 06/16/2024] Open
Abstract
AIM To understand the experiences of individuals who undergo LEA due to DFU after disability. DESIGN A descriptive research design in qualitative research. METHODS Semi-structured interviews were used in this qualitative descriptive study. Eleven middle-aged patients (45-59 years) who underwent LEA due to DFU were purposively selected and interviewed. Qualitative data were thematically analysed. RESULTS Three themes and 10 subthemes were identified. The themes were (1) role function confusion, (2) self-concept stress and (3) unreasonable objective support. Subthemes included (1) weakened career role, (2) family role reversal, (3) social role restriction, (4) over-focusing on appearance, (5) immersion in patient experience, (6) living with faith, (7) polarization of independent consciousness, (8) low perceived benefits of peer support, (9) existence of treatment disruption and (10) poor participation in medical decision-making.
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Affiliation(s)
- Ziwei Xu
- School of Nursing, Naval Medical University, Shanghai, China
| | - Kangyao Cheng
- School of Nursing, Naval Medical University, Shanghai, China
| | - Kuan Wang
- School of Nursing, Naval Medical University, Shanghai, China
| | - Li Gui
- School of Nursing, Naval Medical University, Shanghai, China
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Wang Y, Wang X, Chen R, Gu L, Liu D, Ruan S, Cao H. The Role of Leukocyte-Platelet-Rich Fibrin in Promoting Wound Healing in Diabetic Foot Ulcers. INT J LOW EXTR WOUND 2024; 23:306-314. [PMID: 34775872 DOI: 10.1177/15347346211052811] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To explore the effect of leukocyte-platelet-rich fibrin (L-PRF) on promoting wound healing in diabetic foot ulcers. A total of 42 patients with diabetic foot ulcers at our hospital from January 2017 to July 2020 were retrospectively analyzed. A control group and a PRF group were established. The two groups of patients underwent debridement. In the platelet-rich fibrin (PRF) group, autologous L-PRF was used to cover ulcer wounds. One time each week, Vaseline gauze was used to cover the ulcer wounds. In contrast, the control group was treated with the external application of mupirocin ointment and recombinant human epidermal growth factor gel (yeast). Two times each week, the sterile Vaseline gauze was covered with a bandage. Both groups were treated for 5 weeks. The wound recovery of the two groups was observed. During the early stage of treatment (first and second weeks) for diabetic foot ulcers, the wound healing rate was significantly better with L-PRF treatment than traditional treatment. For later-stage treatment (third to fifth weeks), the overall cure rate was higher with L-PRF than the traditional treatment method. L-PRF can effectively promote wound healing in diabetic foot ulcers.
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Affiliation(s)
- Yuqi Wang
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
- Jinzhou Medical University Union Training Base, Shiyan, Hubei, P.R. China
| | - Xiaotao Wang
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Rong Chen
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Liuwei Gu
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
- Jinzhou Medical University Union Training Base, Shiyan, Hubei, P.R. China
| | - Desen Liu
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Siyuan Ruan
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
| | - Hong Cao
- Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, P.R. China
- Hubei Key Laboratory of Wudang Local Chinese Medicine Research, Shiyan, Hubei, P.R. China
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Zhao C, Feng M, Gluchman M, Ma X, Li J, Wang H. Acellular fish skin grafts in the treatment of diabetic wounds: Advantages and clinical translation. J Diabetes 2024; 16:e13554. [PMID: 38664883 PMCID: PMC11045921 DOI: 10.1111/1753-0407.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/23/2024] [Accepted: 02/26/2024] [Indexed: 04/29/2024] Open
Abstract
Diabetic wounds cannot undergo normal wound healing due to changes in the concentration of hyperglycemia in the body and soon evolve into chronic wounds causing amputation or even death of patients. Diabetic wounds directly affect the quality of patients and social medical management; thus researchers started to focus on skin transplantation technology. The acellular fish skin grafts (AFSGs) are derived from wild fish, which avoids the influence of human immune function and the spread of the virus through low-cost decellularization. AFSGs contain a large amount of collagen and omega-3 polyunsaturated fatty acids and they have an amazing effect on wound regeneration. However, after our search in major databases, we found that there were few research trials in this field, and only one was clinically approved. Therefore, we summarized the advantages of AFSGs and listed the problems faced in clinical use. The purpose of this paper is to enable researchers to better carry out original experiments at various stages.
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Affiliation(s)
- Chenyu Zhao
- Department of Ion Channel Pharmacology, School of PharmacyChina Medical UniversityShenyangChina
- Department of China Medical University‐The Queen's University of Belfast Joint College, School of PharmacyChina Medical UniversityShenyangChina
- School of PharmacyQueen's University BelfastBelfastUK
| | - Mengyi Feng
- School of Pharmaceutical ScienceWenzhou Medical UniversityWenzhouChina
| | - Martin Gluchman
- Department of China Medical University‐The Queen's University of Belfast Joint College, School of PharmacyChina Medical UniversityShenyangChina
- School of PharmacyQueen's University BelfastBelfastUK
| | - Xianghe Ma
- Department of China Medical University‐The Queen's University of Belfast Joint College, School of PharmacyChina Medical UniversityShenyangChina
- School of PharmacyQueen's University BelfastBelfastUK
| | - Jinhao Li
- Department of Ion Channel Pharmacology, School of PharmacyChina Medical UniversityShenyangChina
| | - Hui Wang
- Department of Ion Channel Pharmacology, School of PharmacyChina Medical UniversityShenyangChina
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Haghdoost A, Mobayen M, Baghi I, Haghani‐Dogahe Z, Zarei R, Pirooz A, Balou HA, Feizkhah A. Potassium permanganate in treatment of diabetic foot ulcer: A randomized clinical trial. Health Sci Rep 2024; 7:e2073. [PMID: 38650725 PMCID: PMC11033332 DOI: 10.1002/hsr2.2073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/03/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
Background and Aims Diabetic foot ulcers (DFU) are a severe complication in diabetes patients, often resulting in significant morbidity and mortality due to non-healing. This study investigated the effectiveness of 5% topical potassium permanganate on these ulcers. Methods A clinical trial was conducted on 23 patients with Wagner grade I and II DFU. Patients in the control group received standard treatment, while those in the intervention group also received 5% potassium permanganate topically. Data were recorded at 0, 7, 14, and 21 days for analysis. Results Among 23 patients studied, 7 (30.4%) were male and 16 (43.7%) female, with an average age of 59 ± 4 years. Both groups showed a statistically significant decrease in wound size and infection over time (p < 0.001). The intervention group, however, had a more substantial reduction in wound size and infection rate (p < 0.05). Conclusion Potassium permanganate, when applied topically, is both well-tolerated and effective in enhancing wound healing and reducing infection in DFU, suggesting its potential as a complementary treatment.
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Affiliation(s)
- Afrooz Haghdoost
- General Surgery DepartmentGuilan University of Medical SciencesRashtIran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Iraj Baghi
- General Surgery DepartmentGuilan University of Medical SciencesRashtIran
| | - Zahra Haghani‐Dogahe
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Reza Zarei
- Department of Statistics, Faculty of Mathematical SciencesUniversity of GuilanRashtIran
| | - Amir Pirooz
- Clinical Research Development Unit of Poursina HospitalGuilan University of Medical SciencesRashtIran
| | - Heydar Ali Balou
- School of Medicine, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Alireza Feizkhah
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
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7
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Zúnica-García S, Blanquer-Gregori JJ, Sánchez-Ortiga R, Jiménez-Trujillo MI, Chicharro-Luna E. Relationship between diabetic peripheral neuropathy and adherence to the Mediterranean diet in patients with type 2 diabetes mellitus: an observational study. J Endocrinol Invest 2024:10.1007/s40618-024-02341-2. [PMID: 38499935 DOI: 10.1007/s40618-024-02341-2] [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: 12/19/2023] [Accepted: 02/15/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE The main study goal is to assess the relationship between adherence to the mediterranean diet (MD) and the presence of diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus (T2DM). METHODS Observational pilot study of 174 patients diagnosed with T2DM. Sociodemographic and anthropometric variables, physical activity, smoking habits, blood biochemical parameters and comorbidities were recorded. The presence of alterations in sensitivity to pressure, pain, thermal and vibration was explored. Good MD adherence was a score ≥ 9 the 14-point MD adherence questionnaire (MEDAS-14). RESULTS The study population consisted of 174 patients (61.5% men and 38.5% women), with a mean age of 69.56 ± 8.86 years; 19% of these patients adhered to the MD. The score obtained in the MEDAS-14 was higher in patients who did not present alterations in sensitivity to pressure (p = 0.047) or vibration (p = 0.021). The patients without diabetic peripheral neuropathy were more likely to comply with the MD and had a higher score on the MEDAS-14 (p = 0.047). However, multivariate analysis showed that only altered sensitivity to pressure was associated with adherence to the MD (altered sensitivity OR = 2.9; 95%CI 1.02-8.22; p = 0.045). CONCLUSIONS Although the patients with DPN had lower scores on the MEDAS questionnaire and therefore poorer adherence to the mediterranean diet, the only parameter significantly associated with the MD was that of sensitivity to pressure (monofilament test).
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Affiliation(s)
- S Zúnica-García
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, Miguel Hernández University, Ctra N332, Km 87, 03550, San Juan de Alicante, Alicante, CP, Spain.
| | | | - R Sánchez-Ortiga
- Endocrinology and Nutrition Department, Dr. Balmis General University Hospital, Alicante, Spain
| | - M I Jiménez-Trujillo
- Department of Medicine and Surgery, Psychology, Preventive Medicine and Public Health and Medical Microbiology and Immunology, Nursing and Stomatology, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
| | - E Chicharro-Luna
- Department of Behavioural Sciences and Health, Nursing Area, Faculty of Medicine, Miguel Hernández University, Ctra N332, Km 87, 03550, San Juan de Alicante, Alicante, CP, Spain
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Ju W, Al-Busaidi IS, Lunt H, Hudson B. Patient perceptions of barriers to attending annual diabetes review and foot assessment in general practice: a qualitative study. J Prim Health Care 2024; 16:53-60. [PMID: 38546785 DOI: 10.1071/hc23081] [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: 07/28/2023] [Accepted: 12/04/2023] [Indexed: 04/02/2024] Open
Abstract
Introduction Regular diabetic foot checks, at least annually, are important for early identification of risk factors and prevention of ulceration and amputation. To ensure this, most general practices in Aotearoa New Zealand (NZ) offer free annual diabetes reviews (ADRs) which include a comprehensive foot evaluation. However, attendance rates at these ADRs are low. Aim To explore patients' perspectives on the barriers to attending ADRs and foot checks. Methods Semi-structured interviews with people with type 2 diabetes who were overdue their ADR (n = 13; 7 women, 6 Māori) from two urban practices were conducted. Interviews were audio recorded and transcribed verbatim and then analysed using an inductive thematic analysis approach. Results We identified three key themes demonstrating barriers to attendance: healthcare-associated factors (suboptimal clinician-patient relationship, not having a consistent general practitioner (GP)); patient-related factors (co-morbid health conditions, issues surrounding identity, and logistical issues); and systemic factors (COVID-19 pandemic, travel distance to the practice, unawareness of available foot care services). Participants' feedback focused on patient-centred approaches for improvements to service delivery, for example using online educational materials, and utilising culturally appropriate models of health including Te Whare Tapa Whā and Whānau Ora approach. Discussion We identified several barriers to attendance, some of which are potentially modifiable. Addressing modifiable barriers and incorporating suggestions made by participants may improve access to the ADR and reduce non-attendance. Further participatory action research could explore these insights in ways that facilitate tino rangatiratanga (self-determination) and palpable action.
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Affiliation(s)
- William Ju
- Department of Primary Care and Clinical Simulation, University of Otago, Christchurch, New Zealand
| | - Ibrahim S Al-Busaidi
- Department of Primary Care and Clinical Simulation, University of Otago, Christchurch, New Zealand
| | - Helen Lunt
- Department of Medicine, University of Otago, Christchurch, New Zealand; and Diabetes Centre, Christchurch Hospital, Christchurch, New Zealand
| | - Ben Hudson
- Department of Primary Care and Clinical Simulation, University of Otago, Christchurch, New Zealand
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Bonnet E, Maulin L, Senneville E, Castan B, Fourcade C, Loubet P, Poitrenaud D, Schuldiner S, Sotto A, Lavigne JP, Lesprit P. Clinical practice recommendations for infectious disease management of diabetic foot infection (DFI) - 2023 SPILF. Infect Dis Now 2024; 54:104832. [PMID: 37952582 DOI: 10.1016/j.idnow.2023.104832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
In march 2020, the International Working Group on the Diabetic Foot (IWGDF) published an update of the 2015 guidelines on the diagnosis and management of diabetic foot infection (DFI). While we (the French ID society, SPILF) endorsed some of these recommendations, we wanted to update our own 2006 guidelines and specifically provide informative elements on modalities of microbiological diagnosis and antibiotic treatment (especially first- and second-line regiments, oral switch and duration). The recommendations put forward in the present guidelines are addressed to healthcare professionals managing patients with DFI and more specifically focused on infectious disease management of this type of infection, which clearly needs a multidisciplinary approach. Staging of the severity of the infection is mandatory using the classification drawn up by the IWGDF. Microbiological samples should be taken only in the event of clinical signs suggesting infection in accordance with a strict preliminarily established protocol. Empirical antibiotic therapy should be chosen according to the IWGDF grade of infection and duration of the wound, but must always cover methicillin-sensitive Staphylococcus aureus. Early reevaluation of the patient is a fundamental step, and duration of antibiotic therapy can be shortened in many situations. When osteomyelitis is suspected, standard foot radiograph is the first-line imagery examination and a bone biopsy should be performed for microbiological documentation. Histological analysis of the bone sample is no longer recommended. High dosages of antibiotics are recommended in cases of confirmed osteomyelitis.
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Affiliation(s)
- E Bonnet
- Service des Maladies Infectieuses et Tropicales, CHU Toulouse-Purpan, 31059 Toulouse, France.
| | - L Maulin
- Maladies Infectieuses, CH du Pays d'Aix, 13100 Aix en Provence, France
| | - E Senneville
- Service Universitaire des Maladies Infectieuses, CH Dron, 59200 Tourcoing, France
| | - B Castan
- Service de Médecine Interne et Maladies Infectieuses, CH Périgueux, 24019 Périgueux, France
| | - C Fourcade
- Equipe Mobile d'Infectiologie, Clinique Pasteur, Clinavenir, 31300 Toulouse, France
| | - P Loubet
- Service des Maladies Infectieuses et Tropicales, CHU Caremeau, 30029 Nîmes, France
| | - D Poitrenaud
- Unité Fonctionnelle d'Infectiologie, CH Notre Dame de la Miséricorde, 20000 Ajaccio, France
| | - S Schuldiner
- Service des Maladies Métaboliques et Endocriniennes, CHU Caremeau, 30029 Nîmes, France
| | - A Sotto
- Service des Maladies Infectieuses et Tropicales, CHU Caremeau, 30029 Nîmes, France
| | - J P Lavigne
- Service de Microbiologie et Hygiène Hospitalière, CHU Caremeau, 30029 Nîmes, France
| | - P Lesprit
- Maladies Infectieuses, CHU Grenoble Alpes, 38043, Grenoble, France
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Cai X, Fang X, Wu L, Meng X. The efficacy and safety of non-surgical treatment of diabetic foot wound infections and ulcers: A systemic review and meta-analysis. Int Wound J 2024; 21:e14615. [PMID: 38379242 PMCID: PMC10827650 DOI: 10.1111/iwj.14615] [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: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 02/22/2024] Open
Abstract
This meta-analysis evaluates the efficacy and safety of non-surgical treatments for diabetic foot ulcers and infections. After a rigorous literature review, seven studies were selected for detailed analysis. The findings demonstrate that non-surgical treatments significantly reduce wound infection rates (standardized mean difference [SMD] = -15.15, 95% confidence interval [CI]: [-19.05, -11.25], p < 0.01) compared to surgical methods. Ulcer healing rates were found to be comparable between non-surgical and surgical approaches (SMD = 0.07, 95% CI: [-0.38, 0.51], p = 0.15). Importantly, the rate of amputations within 6 months post-treatment was significantly lower in the non-surgical group (risk ratio [RR] = 0.19, 95% CI: [0.09, 0.41], p < 0.01). Additionally, a lower mortality rate was observed in patients treated non-surgically (RR = 0.28, 95% CI: [0.13, 0.59], p < 0.01). These results affirm the effectiveness and safety of non-surgical interventions in managing diabetic foot ulcers, suggesting that they should be considered a viable option in diabetic foot care.
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Affiliation(s)
- Xuchao Cai
- Department of Wound RepairHangzhou First People's HospitalHangzhouZhejiangChina
| | - Xin Fang
- Department of Vascular SurgeryHangzhou First People's HospitalHangzhouZhejiangChina
| | - Linjun Wu
- Department of Wound RepairHangzhou First People's HospitalHangzhouZhejiangChina
| | - Xiaohu Meng
- Department of Vascular SurgeryHangzhou First People's HospitalHangzhouZhejiangChina
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Abuzinadah AR, Alrawaili MS, Alshareef AA, Alkully HS, Milyani H, Alamri B, Alshora W, Bamaga AK. Values and diagnostic accuracy of sensory nerve action potentials in control participants and participants with diabetes with and without clinical diabetic neuropathy, based on neuropathy scale measurements. Brain Behav 2024; 14:e3423. [PMID: 38351301 PMCID: PMC10864687 DOI: 10.1002/brb3.3423] [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: 07/07/2023] [Revised: 12/26/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND The assessment of the normative values of sensory nerve action potentials (SNAP) and their diagnostic accuracies using validated neuropathy-assessment tools to classify participants into groups with and without neuropathy was not previously described in the literature. METHODS The Utah Early Neuropathy Scale (UENS), Michigan neuropathy-screening instrument, and nerve conduction data were collected prospectively. We described and compared the values of the sural, superficial peroneal sensory (SPS), and superficial radial SNAP amplitude in different age groups for three groups. Group 1 (G1)-control participants (UENS <5), group 2 (G2)-participants with diabetes without clinical diabetic neuropathy (UENS <5), and group 3 (G3)-participants with clinical diabetic neuropathy (UENS ≥5). We also described the diagnostic accuracy of single-nerve amplitude and a combined sensory polyneuropathy index (CSPNI) that consists of four total points (one point for each of the following nerves if their amplitude was <25% lower limit of normal: right sural, left sural, right SPS, and left SPS potentials). RESULTS We assessed 135 participants, including 41, 37, and 57 participants in G1, G2, and G3, respectively, with age median (interquartile ranges) of 51 (45-56), 47 (38-56), and 54 (51-61) years, respectively, whereas 19 (46.3%), 18 (48.7%), and 32 (56.14%) of them were males, respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) scores were 68.4%, 92.3%, 86.7%, and 80% for the sural amplitude; 86%, 58.3%, 62%, and 84% for the SPS amplitude; 66.7%, 94.4%, 90.5%, and 78.2% for the CSPNI of 3; and 54.4%, 98.6%, 96.9%, and 73.2% for the CSPNI of 4, respectively. CONCLUSION Sural nerve had a high specificity for neuropathy; however, the CSPNI had the highest specificity and PPV, whereas the SPS had the highest sensitivity and NPV.
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Affiliation(s)
- Ahmad R. Abuzinadah
- Department of Neurology, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
- Neuromuscular Medicine UnitKing Abdulaziz University Hospital, King Abdulaziz UniversityJeddahSaudi Arabia
| | - Moafaq S. Alrawaili
- Department of Neurology, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
- Neuromuscular Medicine UnitKing Abdulaziz University Hospital, King Abdulaziz UniversityJeddahSaudi Arabia
| | - Aysha A. Alshareef
- Department of Neurology, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
- Neuromuscular Medicine UnitKing Abdulaziz University Hospital, King Abdulaziz UniversityJeddahSaudi Arabia
| | - Hussien S. Alkully
- Neurology Section, Department of NeurosciencesKing Faisal Specialist Hospital and Research CentreJeddahSaudi Arabia
| | - Haneen Milyani
- Neurophysiology Department, National Neuroscience InstituteKing Fahad Medical CityRiyadhSaudi Arabia
| | - Bashayr Alamri
- Internal Medicine Department, Neurology divisionKing Fahad General HospitalJeddahSaudi Arabia
| | - Weam Alshora
- Department of Family MedicineKing Abdulaziz University Hospital, King Abdulaziz UniversityJeddahSaudi Arabia
| | - Ahmed K. Bamaga
- Pediatric Neurology Unit, Department of Pediatric, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
- Division of Pediatric Neurology, Department of PediatricsKing Faisal Specialist Hospital and Research CentreJeddahSaudi Arabia
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12
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Xu J, Hua Y, Lei J, Peng X, Cheng L, Jiang Q, Yang J. Effects of skin flap grafting combined with vacuum sealing drainage on ulcer area, pain level, and serum inflammation in diabetic foot patients. Am J Transl Res 2023; 15:6939-6948. [PMID: 38187004 PMCID: PMC10767521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/01/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE To study the effects of skin flap grafting combined with vacuum sealing drainage (VSD) on ulcer area, pain level and serum inflammation in patients with diabetic foot (DF). METHODS In this retrospective study, 121 patients with DF who were treated in the Affiliated Hospital of Xinyang Vocational and Technical College between April 2018 and April 2022 were included as study subjects, including 50 cases receiving skin flap grafting (control group) and 71 cases receiving skin flap grafting combined with VSD (research group). Information on clinical efficacy, survival rate of the grafted flap, amputation and complications, ulcer area, rehabilitation (granulation tissue formation time, ulcer wound healing time), pain level (Visual Analogue Scale [VAS]), and serum inflammatory factors (interleukin [IL]-6, tumor necrosis factor [TNF]-α, and C-reactive protein [CRP]) were collected for comparative analyses. Univariate and multivariate analyses were conducted to screen the risk factors for patients' prognosis. RESULTS The overall response rate and the survival rate of the grafted flap in the research group were markedly higher compared with the control group, while the amputation rate was significantly lower (all P<0.05). Besides, the research group exhibited an evidently smaller post-treatment ulcer area, lower VAS, IL-6, TNF-α and CRP levels, and shorter granulation tissue formation time and ulcer wound healing time than the control group (all P<0.05). Neither group of patients experienced significant complications. The use of skin flap grafting + VSD was a protective factor for postoperative outcome. CONCLUSIONS Skin flap grafting combined with VSD is effective in treating DF patients, which can validly reduce ulcer area and inhibit serum inflammation after treatment, thus accelerating rehabilitation.
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Affiliation(s)
- Jipeng Xu
- Department of Dermatology, Affiliated Hospital of Xinyang Vocational and Technical CollegeXinyang 464099, Henan, China
| | - Ye Hua
- Department of Orthopedics and Dermatology, Affiliated Hospital of Xinyang Vocational and Technical CollegeXinyang 464099, Henan, China
| | - Jun Lei
- Department of Orthopedics and Dermatology, Affiliated Hospital of Xinyang Vocational and Technical CollegeXinyang 464099, Henan, China
| | - Xuefei Peng
- Department of Orthopedics and Dermatology, Affiliated Hospital of Xinyang Vocational and Technical CollegeXinyang 464099, Henan, China
| | - Lu Cheng
- Department of Dermatology, Affiliated Hospital of Xinyang Vocational and Technical CollegeXinyang 464099, Henan, China
| | - Qixue Jiang
- Department of Dermatology, Affiliated Hospital of Xinyang Vocational and Technical CollegeXinyang 464099, Henan, China
| | - Jun Yang
- Department of Orthopedics and Dermatology, Affiliated Hospital of Xinyang Vocational and Technical CollegeXinyang 464099, Henan, China
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13
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Wu S, Xu Y, Guo L, Jiang X. A meta-analysis of the effectiveness of antibacterial bone cement in the treatment of diabetic foot skin wound infections. Int Wound J 2023; 21:e14487. [PMID: 37973553 PMCID: PMC10898415 DOI: 10.1111/iwj.14487] [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: 10/15/2023] [Revised: 10/18/2023] [Accepted: 10/22/2023] [Indexed: 11/19/2023] Open
Abstract
A meta-analysis research was implemented to appraise the effect of antibiotic bone cement (ABC) in treating infected diabetic foot wounds (IDFWs). Inclusive literature research till April 2023 was done and 1237 interconnected researches were revised. The 15 selected researches enclosed 895 IDFWs persons were in the utilized researchers' starting point, 449 of them were utilizing ABC, and 446 were in the control group. Odds ratio and 95% confidence intervals were utilized to appraise the consequence of ABC in treating IDFWs by the contentious approach and a fixed or random model. ABC had significantly lower wound healing time (MD, -9.83; 95% CI, -12.45--7.20, p < 0.001), and time to bacterial conversion of the wound (MD, -7.30; 95% CI, -10.38--4.32, p < 0.001) compared to control in IDFWs persons. However, caution needs to be taken when interacting with its values since there was a low sample size of most of the chosen research found for the comparisons in the meta-analysis.
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Affiliation(s)
- Shuwei Wu
- Department of Dermatology, West China HospitalSichuan UniversityChengduChina
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease‐related Molecular Network, West China HospitalSichuan UniversityChengduChina
| | - Yuanyuan Xu
- Department of Dermatology, West China HospitalSichuan UniversityChengduChina
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease‐related Molecular Network, West China HospitalSichuan UniversityChengduChina
| | - Linghong Guo
- Department of Dermatology, West China HospitalSichuan UniversityChengduChina
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease‐related Molecular Network, West China HospitalSichuan UniversityChengduChina
| | - Xian Jiang
- Department of Dermatology, West China HospitalSichuan UniversityChengduChina
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease‐related Molecular Network, West China HospitalSichuan UniversityChengduChina
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14
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Clayton EO, Njoku-Austin C, Scott DM, Cain JD, Hogan MV. Racial and Ethnic Disparities in the Management of Diabetic Feet. Curr Rev Musculoskelet Med 2023; 16:550-556. [PMID: 37733148 PMCID: PMC10587034 DOI: 10.1007/s12178-023-09867-7] [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] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE OF REVIEW Diabetes mellitus is a chronic medical condition affecting many individuals worldwide and leads to billions of dollars spent within the healthcare system for its treatment and complications. Complications from diabetes include diabetic foot conditions that can have a devasting impact on quality of life. Diabetic foot ulcers and amputations occur in minority individuals at an increased rate compared to Caucasian individuals. This review provides an update examining the racial and ethnic disparities in the management of diabetic foot conditions and the differences in rates of amputation. RECENT FINDINGS Current research continues to show a disparity as it relates to diabetic foot management. There are novel treatment options for diabetic foot ulcers that are currently being explored. However, there continues to be a lack in racial diversity in new treatment studies conducted in the USA. Individuals from racial and ethnic minority groups have diabetes at higher rates compared to Caucasian individuals, and are also more likely to develop diabetic foot ulcers and receive amputations. Over the last few years, more efforts have been made to improve health disparities. However, there needs to be an improvement in increasing racial diversity when investigating new therapies for diabetic foot ulcers.
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Affiliation(s)
- Elizabeth O Clayton
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave., Suite #911, Pittsburgh, PA, 15213, USA
| | - Confidence Njoku-Austin
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave., Suite #911, Pittsburgh, PA, 15213, USA
| | - Devon M Scott
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave., Suite #911, Pittsburgh, PA, 15213, USA
| | - Jarrett D Cain
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave., Suite #911, Pittsburgh, PA, 15213, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave., Suite #911, Pittsburgh, PA, 15213, USA.
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15
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Rezaei-Nejad A, Amirkhani MA, Ebrahimi A, Ghorani SM, Alamoutifard E, Nilforoushzadeh MA, Mollapour-Sisakht M. The Therapeutic Efficacy of Freeze-Dried Human Amniotic Membrane Allograft Gel for Diabetic Foot Ulcers: A Phase-1 Clinical Trial. INT J LOW EXTR WOUND 2023:15347346231204246. [PMID: 37828852 DOI: 10.1177/15347346231204246] [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: 10/14/2023]
Abstract
Diabetic foot ulcers (DFUs) are classified as hard-to-heal wounds, which occur in approximately 15% of diabetic patients. Several interventions have shown efficacy in reducing the risk of amputation among patients with DFU, including timely diagnosis and management of infection and ischemia, debridement of necrotic tissues, reducing mechanical pressure on ulcers, and patient education. One major challenge in the management of DFUs is optimizing wound care to improve healing outcomes. Recently, interdisciplinary approaches proposed a new generation of wound dressing which increased efficacy and significantly decreased the healing time. The current study assessed the healing characteristics of chronic DFUs treated with lyophilized amniotic membrane gel (LAMG) in combination with standard care, versus a placebo hydrogel with standard care. In total, 18 patients (8 male, 10 female) were randomly assigned to the control group, which received standard care and a gelatin scaffold (placebo), or the intervention group, which received standard care along with LAMG. We evaluated the reduction in wound size and assessed the patient's health-related quality of life over 9 weeks. In the LAMG group (n = 9) and the Placebo group (n = 9), the wounds were reduced in size by a mean of 73.4% ± 15.3% and 13.1% ± 10.1%, respectively (P = .008). Patients treated with LAMG demonstrated significant improvements in the scores related to physical function, physical limitation, physical pain, general health, social function, emotional problems, and energy levels compared to the control group. The findings of this study indicate that using the LAMG with standard care significantly enhances wound healing.
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Affiliation(s)
- Aida Rezaei-Nejad
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Ebrahimi
- Foot and Ankle Research and Innovation Laboratory (FARIL), Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Emad Alamoutifard
- Department of Cardiothoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
| | | | - Mahsa Mollapour-Sisakht
- Faculty of Pharmacy, Biotechnology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Stem Cell and Regenerative Medicine Innovation Center, Tehran University of Medical Sciences, Tehran, Iran
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16
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Tian M, Tang J, Huang R, Dong J, Jia H. Circ_072697 knockdown promotes advanced glycation end products-induced cell proliferation and migration in HaCaT cells via miR-3150a-3p/KDM2A axis. BMC Endocr Disord 2023; 23:200. [PMID: 37726685 PMCID: PMC10507952 DOI: 10.1186/s12902-023-01430-2] [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: 02/10/2023] [Accepted: 08/01/2023] [Indexed: 09/21/2023] Open
Abstract
OBJECTIVE Diabetes foot ulcer (DFU) is a serious complication of diabetes, which can lead to significant mortality and amputation rate. Our previous study found circ_072697 was highly expressed in DFU tissues, but the regulatory mechanism of circ_072697 in DFU remains unclear. METHODS The relative expressions of circ_072697, miR-3150a-3p, and KDM2A in DFU patients or advanced glycation end products (AGEs)-treated HaCaT cells (used as DFU cell model) were determined by using qRT-PCR. Cell proliferation and migration abilities were determined by using CCK-8 and Transwell assays. The interaction between miR-3150a-3p with circ_072697 or KDM2A were verified by RNA immunoprecipitation (RIP) and dual-luciferase reporter assays. Furthermore, the protein expression of genes involved in MAPK signaling pathway was detected by western blot. RESULTS The expression of circ_072697 was significantly upregulated in DFU tissues, while the expression of miR-3150a-3p was downregulated. Circ_072697 knockdown promoted the proliferation and migration of AGEs-treated HaCaT cells. miR-3150a-3p was confirmed as a target of circ_072697 and its inhibitor reversed the promotion effects of circ_072697 knockdown on biological behavior of cells. In addition, KDM2A was considered as a target of miR-3150a-3p and it was highly expressed in DFU samples. Importantly, circ_072697 could regulate KDM2A expression through sponging miR-3150a-3p, and this axis had effect on the MAPK signaling pathway. CONCLUSIONS Overall, circ_072697 regulated the biological behaviors of keratinocytes in DFU via miR-3150a-3p/KDM2A axis and MAPK signaling pathway, revealing a new insight into the pathogenesis and potential therapeutic targets of DFU.
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Affiliation(s)
- Ming Tian
- Department of Burn, Wound Healing Center, Shanghai Burn Institute, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Jiajun Tang
- Wound Healing Center, Department of Burn, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Rong Huang
- Department of General Surgery, Putuo Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200062, China.
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Second Road, Shanghai, 200025, China.
| | - Jiaoyun Dong
- Department of Burn, Wound Healing Center, Shanghai Burn Institute, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Second Road, Shanghai, 200025, China.
| | - Huiying Jia
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Second Road, Shanghai, 200025, China.
- Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Clinical Research Center for Metabolic Diseases, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No.197 Ruijin Second Road, Shanghai, 200025, China.
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17
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Ntuli S, Letswalo DM. Diabetic foot and lower limb amputations at central, provincial and tertiary hospitals-underscores the need for organised foot health services at primary healthcare level. Foot (Edinb) 2023; 56:102039. [PMID: 37244198 DOI: 10.1016/j.foot.2023.102039] [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: 01/23/2023] [Revised: 04/13/2023] [Accepted: 05/06/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Diabetic foot amputations are a devastating outcome for any diabetic patient. They are associated with various risk factors, including failure to risk stratify the diabetic foot. Early risk stratification could lower foot complications risk at the primary healthcare level (PHC). In the Republic of South Africa (RSA), PHC clinics are the first entry point to the public healthcare system. Failure to correctly identify, risk categorise, and refer diabetic foot complications at this level may lead to poor clinical outcomes for diabetic patients. This study looks at the incidence of diabetic-related amputations at central and tertiary hospitals in Gauteng to highlight the case of the needed foot health services at the PHC level. METHODS A cross-sectional retrospective study that reviewed prospectively collected theatre records database of all patients who underwent a diabetic-related foot and lower limb amputation between January 2017 and June 2019. Inferential and descriptive statistics were performed, and patient demographics, risk factors and type of amputation were reviewed. RESULTS There were 1862 diabetic-related amputations in the period under review. Most patients (98 %) came from a poor socioeconomic background earning ZAR 0.00-70 000.00 (USD 0.00-4754.41) per annum. Most amputations, 62 % were in males, and the majority, 71 % of amputations, were in patients younger than 65. The first amputation was major in 73 % of the cases, and an infected foot ulcer was a primary amputation cause in 75 % of patients. CONCLUSION Amputations are a sign of poor clinical outcomes for diabetic patients. Due to the hierarchal nature of healthcare delivery in RSA, diabetic-related foot amputations could imply inadequate care of or access to diabetic foot complications at the PHC level in RSA. A lack of access to structured foot health services at PHC levels impedes early identification of foot complication identification and appropriate referral resulting in amputation in some of the patients.
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Affiliation(s)
- Simiso Ntuli
- Department of Podiatry, Faculty of Health Sciences, University of Johannesburg, P O Box 524 Auckland Park 2006, Gauteng, South Africa.
| | - Dimakatso Maria Letswalo
- Gauteng Department of Health, Dr George Mukhari Academic Hospital, 3111 Setlogelo Drive, Ga-Rankuwa Unit 2, Ga-Rankuwa, 0208, Pretoria, South Africa
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18
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Gu S, Fan B, Wan F, Gao T, Qi Y, Zhou J, Zhang Y, Gu D, Xie W. Antibacterial Activity and Mechanism of Canagliflozin against Methicillin-Resistant Staphylococcus aureus. Molecules 2023; 28:5668. [PMID: 37570637 PMCID: PMC10420104 DOI: 10.3390/molecules28155668] [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: 06/20/2023] [Revised: 07/24/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Diabetic foot infection (DFI) is a common complication in diabetes patients, with foot infections being the leading cause of amputations. Staphylococcus aureus is frequently found in diabetic foot infections, of which methicillin-resistant Staphylococcus aureus (MRSA) has become a major clinical and epidemiological challenge. Since MRSA strains are resistant to most β-lactam antibiotics, and also partially resistant to other antibiotics, treatment is difficult and costly. The emergence of drug-resistant bacteria often arises from overuse or misuse of antibiotics. Clinically, canagliflozin is commonly used for the treatment of type 2 diabetes. On this basis, we investigated the antibacterial activity and mechanism of canagliflozin against MRSA, with the aim to discover novel functions of canagliflozin and provide new insights for the treatment of MRSA. Using the microbroth dilution method to determine the half maximal inhibitory concentration of drugs, we found that canagliflozin not only can inhibit the growth of methicillin-sensitive Staphylococcus aureus (MSSA) but also exhibits antibacterial activity against MRSA. The IC50 values, at approximately 56.01 μM and 57.60 μM, were almost the same. At 12 h, canagliflozin showed a significant antibacterial effect against MRSA at and above 30 μM. In addition, its combined use with penicillin achieved better antibacterial effects, which were increased by about three times. Additive antibacterial activity (FICI = 0.69) was found between penicillin and canagliflozin, which was better than that of doxycycline and canagliflozin (FICI = 0.95). Canagliflozin also affected bacterial metabolic markers, such as glucose, ATP, and lactic acid. The results of crystal violet staining indicate that canagliflozin disrupted the formation of bacterial biofilm. Our electron microscopy results showed that canagliflozin distorted the bacterial cell wall. The results of RT-PCR suggest that canagliflozin down-regulated the expressions of biofilm-related gene (clfA, cna, agrC, mgrA, hld) and methicillin-resistance gene (mecA), which was related to MRSA. Molecular docking also indicated that canagliflozin affected some interesting targets of MRSA, such as the sarA, crtM and fnbA proteins. In conclusion, canagliflozin exhibits antibacterial activity against MRSA by affecting bacterial metabolism, inhibiting its biofilm formation, distorting the bacterial cell wall, and altering the gene expression of biofilm formation and its virulence. Our study reveals the antibacterial activity of canagliflozin against MRSA, providing a new reference for treating diabetic foot infections.
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Affiliation(s)
- Siyao Gu
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (S.G.); (F.W.); (T.G.); (Y.Q.); (Y.Z.)
- Open FIESTA Center, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Department of Laboratory Medicine, Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, China;
| | - Bing Fan
- Department of Laboratory Medicine, Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, China;
| | - Fang Wan
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (S.G.); (F.W.); (T.G.); (Y.Q.); (Y.Z.)
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
| | - Tong Gao
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (S.G.); (F.W.); (T.G.); (Y.Q.); (Y.Z.)
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
| | - Yuanyuan Qi
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (S.G.); (F.W.); (T.G.); (Y.Q.); (Y.Z.)
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
| | - Jin Zhou
- Institute for Ocean Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China;
| | - Yaou Zhang
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (S.G.); (F.W.); (T.G.); (Y.Q.); (Y.Z.)
- Open FIESTA Center, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
| | - Dayong Gu
- Department of Laboratory Medicine, Shenzhen Institute of Translational Medicine, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People’s Hospital, Shenzhen 518035, China;
| | - Weidong Xie
- State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China; (S.G.); (F.W.); (T.G.); (Y.Q.); (Y.Z.)
- Open FIESTA Center, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
- Shenzhen Key Laboratory of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055, China
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Pirri C, Biz C, Pirri N, Macchi V, Porzionato A, De Caro R, Ruggieri P, Stecco C. Crural and Plantar Fasciae Changes in Chronic Charcot Diabetic Foot: A Cross-Sectional Ultrasound Imaging Study-An Evidence of Fascial Continuity. J Clin Med 2023; 12:4664. [PMID: 37510779 PMCID: PMC10380358 DOI: 10.3390/jcm12144664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Crural fascia (CF) and plantar fascia (PF) are biomechanically crucial in the gait and in the proprioception, particularly in the propulsion phase of the foot during the gait cycle and in the dissipation of forces during weight-bearing activities. Recent studies have revealed an association between increases in PF thickness and diabetes. The purpose of this study was to measure and compare by ultrasound (US) imaging the thickness of the CF and PF at different regions/levels in chronic Charcot diabetic foot patients (group 1) and in healthy volunteers (group 2). A cross-sectional study was performed using US imaging to measure the CF with Pirri et al.'s protocol and PF with a new protocol in a sample of 31 subjects (15 patients and 16 healthy participants). The findings for CF and PF revealed statistically significant differences in the poster region of CF (Post 1: group 1 vs. group 2: p = 0.03; Post 2: group 1 vs. group 2: p = 0.03) and in PF at two different levels (PF level 1: group 1 vs. group 2: p < 0.0001; PF level 2: group 1 vs. group 2: p < 0.0001). These findings suggest that chronic Charcot diabetic foot patients have CF and PF thicker compared to healthy volunteers. The US examination suggests that fascial thicknesses behavior in these patients points out altered fascial remodeling due to diabetes pathology and biomechanical changes.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
| | - Carlo Biz
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Nina Pirri
- Department of Medicine-DIMED, School of Radiology, Radiology Institute, University of Padova, 35121 Padova, Italy
| | - Veronica Macchi
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
| | - Andrea Porzionato
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
| | - Pietro Ruggieri
- Department of Orthopedics and Orthopedic Oncology, University of Padova, 35128 Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy
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20
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Mirghani HO. Vitamin D deficiency among outpatients and hospitalized patients with diabetic foot ulcers: A systematic review and meta-analysis. World J Meta-Anal 2023; 11:218-227. [DOI: 10.13105/wjma.v11.i5.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/06/2023] [Accepted: 05/06/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND The definition of diabetic foot syndrome (DFS) varies depending on the location and resources. Few classifications are available according to the indication. DF ulcers and vitamin D deficiency are common diseases among patients with diabetes. Previous literature has shown an association between DF ulcer (DFU) and vitamin D deficiency. However, the available meta-0analysis was limited by substantial bias.
AIM To investigate the association between DFUs and vitamin D levels.
METHODS We searched PubMed, MEDLINE, and Cochrane Library, EBSCO, and Google Scholar for studies comparing vitamin D levels and DF. The keywords DFU, DFS, diabetic septic foot, vitamin D level, 25-hydroxy vitamin D, vitamin D status, and vitamin D deficiency were used. The search engine was set for articles published during the period from inception to October 2022. A predetermined table was used to collect the study information.
RESULTS Vitamin D level was lower among patients with DFU compared to their counterparts [odds ratio (OR): -5.77; 95% confidence interval (CI): -7.87 to -3.66; χ2 was 84.62, mean difference, 9; I2 for heterogeneity, 89%; P < 0.001 and P for overall effect < 0.001]. The results remained robust for hospitalized patients (OR: -6.32 95%CI: -11.66 to -0.97; χ2 was 19.39; mean difference, 2; I2 for heterogeneity, 90%; P = 0.02).
CONCLUSION Vitamin D was lower among outpatients and hospitalized patients with DFUs. Further larger randomized controlled trials are needed.
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Affiliation(s)
- Hyder Osman Mirghani
- Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Saudi Arabia, Tabuk 3378, Saudi Arabia
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Ji J, Zhao X, Huang J, Wu X, Xie F, Li L, Wang T, Mi S. Apolipoprotein A-IV of diabetic-foot patients upregulates tumor necrosis factor α expression in microfluidic arterial models. Exp Biol Med (Maywood) 2023; 248:691-701. [PMID: 36775868 PMCID: PMC10408548 DOI: 10.1177/15353702221147562] [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: 09/14/2022] [Accepted: 11/21/2022] [Indexed: 02/14/2023] Open
Abstract
Diabetic peripheral arterial atherosclerosis is one of the important characteristics of diabetic foot syndrome. Apolipoprotein (Apo A-IV) participates in various physiological processes, and animal studies have shown that it has roles of anti-atherosclerosis, prevention of platelet aggregation and thrombosis. Apo A-IV glycosylation is closely related to the occurrence and development of diabetic peripheral atherosclerosis. This study aimed to explore the mechanism of diabetic peripheral arterial lesions caused by glycosylated Apo A-IV. Type 2 diabetes mellitus (T2DM) and T2DM with diabetic foot patients (T2DM-F; n = 45, 30) were enrolled in this study, and individuals without diabetes (n = 35) served as normal controls (NC). In T2DM group, serum Apo A-IV content was higher than those in NC and T2DM-F group, as carboxymethyl lysine (CML) glycosylation of Apo A-IV in mixed serum from T2DM-F group was identified to be more significant than those in two other groups. Within a microfluidic arterial chip model, Apo A-IV from T2DM and T2DM-F group significantly increased transcription and protein levels of tumor necrosis factor alpha (TNF-α) in chip arteries, and CML expression was observed in T2DM-F group, which were associated with increased nuclear receptor subfamily 4 group A member 3 (NR4A3) expression. Recombinant human Apo A-IV could reverse the stimulating effect of serum Apo A-IV from T2DM-F group on TNF-α expression, and NR4A3 blocking peptide downregulated TNF-α expression by inhibiting NR4A3 expression. In the chip arteries, Apo A-IV from T2DM and T2DM-F increased TNF-α expression and turn them into a pre-atherosclerotic state, which might be one of the important mechanisms of glycosylated Apo A-IV to induce diabetic peripheral arterial lesions and eventually lead to diabetic foot.
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Affiliation(s)
- Jun Ji
- Department of Cardiovascular Surgery, University of Chinese Academy of Science Shenzhen Hospital, Shenzhen 518027, China
| | - Xiaoyu Zhao
- Bio-manufacturing Engineering Laboratory, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055 China
| | - Jiajun Huang
- Bio-manufacturing Engineering Laboratory, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055 China
| | - Xuanqin Wu
- Department of Cardiovascular Surgery, University of Chinese Academy of Science Shenzhen Hospital, Shenzhen 518027, China
| | - Fang Xie
- Department of Endocrinology, University of Chinese Academy of Science Shenzhen Hospital, Shenzhen 518027, China
| | - Liang Li
- Department of Cardiovascular Surgery, University of Chinese Academy of Science Shenzhen Hospital, Shenzhen 518027, China
| | - Tao Wang
- Department of Cardiovascular Surgery, University of Chinese Academy of Science Shenzhen Hospital, Shenzhen 518027, China
| | - Shengli Mi
- Bio-manufacturing Engineering Laboratory, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen 518055 China
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22
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Vansteenland I, Forss R. What are the current diabetic foot assessment methods in private podiatry practices in Flanders, Belgium: an exploratory mixed method study. J Foot Ankle Res 2023; 16:17. [PMID: 36973800 PMCID: PMC10041772 DOI: 10.1186/s13047-023-00615-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 03/16/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Diabetic foot assessments detect patients at risk for developing a diabetes-related foot ulceration and can significantly reduce the risk of amputation. In order to organize this assessment effectively, diabetic foot assessment guidelines are required according to the International Working Group of the Diabetic Foot. However, these international guidelines have not been adapted into a national guideline for podiatrists in Flanders, Belgium. This study aims to identify the methods and guidelines currently used to assess the diabetic foot in private podiatry practices in Flanders, Belgium and to explore the podiatrists' opinions on developing a national diabetic foot assessment guideline. METHODS This exploratory mixed method study was composed of an anonymous online survey comprising of open- and closed-ended questions followed by 1:1 online semi-structured interviews. Participants were recruited via e-mail and a closed private Facebook group of podiatry alumni. Data was analyzed using SPSS statistics and thematic analysis described by Braun and Clarke. RESULTS This study showed that the vascular assessment of the diabetic foot exists solely of a medical history and palpation of the pedal pulses. Non-invasive tests such as doppler, toe brachial pressure index or ankle brachial pressure index are seldom used. Only 66% reported to use a guideline for the diabetic foot assessment. There was a variety of reported guidelines and risk stratification systems in use in private podiatry practices in Flanders, Belgium. CONCLUSION Non-invasive tests such as the doppler, ankle brachial pressure index or toe brachial pressure index are rarely used for the vascular assessment of the diabetic foot. Diabetic foot assessment guidelines and risk stratification systems to identify patients at risk for developing a diabetic foot ulcer were not frequently used. International guidelines of the International Working Group of the Diabetic Foot have not yet been implemented in private podiatry practices in Flanders, Belgium. This exploratory research has provided useful information for future research studies.
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Affiliation(s)
- Irene Vansteenland
- School of Sport & Health Sciences, University of Brighton, 49 Darley Road, Eastbourne, BN20 7UR, UK.
- Podoconsult Vansteenland Irene BV, Hendrik Consciencelaan 54, 9950, Lievegem, Belgium.
| | - Rachel Forss
- Centre for Regenerative Medicine and Devices, University of Brighton, Brighton, UK
- School of Sport and Health Sciences, University of Brighton, 49 Darley Road, Eastbourne, BN20 7UR, UK
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Nkonge KM, Nkonge DK, Nkonge TN. Screening for diabetic peripheral neuropathy in resource-limited settings. Diabetol Metab Syndr 2023; 15:55. [PMID: 36945043 PMCID: PMC10031885 DOI: 10.1186/s13098-023-01032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Diabetic neuropathy is the most common microvascular complication of diabetes mellitus and a major risk factor for diabetes-related lower-extremity complications. Diffuse neuropathy is the most frequently encountered pattern of neurological dysfunction and presents clinically as distal symmetrical sensorimotor polyneuropathy. Due to the increasing public health significance of diabetes mellitus and its complications, screening for diabetic peripheral neuropathy is essential. Consequently, a review of the principles that guide screening practices, especially in resource-limited clinical settings, is urgently needed. MAIN BODY Numerous evidence-based assessments are used to detect diabetic peripheral neuropathy. In accordance with current guideline recommendations from the American Diabetes Association, International Diabetes Federation, International Working Group on the Diabetic Foot, and National Institute for Health and Care Excellence, a screening algorithm for diabetic peripheral neuropathy based on multiphasic clinical assessment, stratification according to risk of developing diabetic foot syndrome, individualized treatment, and scheduled follow-up is suggested for use in resource-limited settings. CONCLUSIONS Screening for diabetic peripheral neuropathy in resource-limited settings requires a practical and comprehensive approach in order to promptly identify affected individuals. The principles of screening for diabetic peripheral neuropathy are: multiphasic approach, risk stratification, individualized treatment, and scheduled follow-up. Regular screening for diabetes-related foot disease using simple clinical assessments may improve patient outcomes.
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Dong T, Huang Q, Sun Z. Antibiotic-laden bone cement for diabetic foot infected wounds: A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1134318. [PMID: 37008902 PMCID: PMC10060955 DOI: 10.3389/fendo.2023.1134318] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023] Open
Abstract
Objective A large body of literature has demonstrated the significant efficacy of antibiotic bone cement in treating infected diabetic foot wounds, but there is less corresponding evidence-based medical evidence. Therefore, this article provides a meta-analysis of the effectiveness of antibiotic bone cement in treating infected diabetic foot wounds to provide a reference basis for clinical treatment. Methods PubMed, Embase, Cochrane library, Scoup, China Knowledge Network (CNKI), Wanfang database, and the ClinicalTrials.gov were searched, and the search time was from the establishment of the database to October 2022, and two investigators independently. Two investigators independently screened eligible studies, evaluated the quality of the literature using the Cochrane Evaluation Manual, and performed statistical analysis of the data using RevMan 5.3 software. Results A total of nine randomized controlled studies (n=532) were included and, compared with the control group, antibiotic bone cement treatment reduced the time to wound healing (MD=-7.30 95% CI [-10.38, -4.23]), length of hospital stay (MD=-6.32, 95% CI [-10.15, -2.48]), time to bacterial conversion of the wound (MD=-5.15, 95% CI [-7.15,-2.19]), and the number of procedures (MD=-2.35, 95% CI [-3.68, -1.02]). Conclusion Antibiotic bone cement has significant advantages over traditional treatment of diabetic foot wound infection and is worthy of clinical promotion and application. Systematic review registration PROSPERO identifier, CDR 362293.
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Affiliation(s)
- Tingting Dong
- Department of Endocrinology and Metabolism, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region (Hospital.C.T.), Chengdu, China
| | - Qi Huang
- Department of Orthopedics, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region (Hospital.C.T.), Chengdu, China
| | - Zengmei Sun
- Department of Endocrinology and Metabolism, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region (Hospital.C.T.), Chengdu, China
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25
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Liu Y, Jiang C, Zhang X, Ma B, Ding Y, Jin Y, Liu Y, Li L, Zhao C. Anterior superior iliac spine distraction for severe and recalcitrant diabetic foot ulcers. Injury 2023; 54:778-783. [PMID: 36481053 DOI: 10.1016/j.injury.2022.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE The study aimed to introduce anterior superior iliac spine distraction to treat severe and recalcitrant diabetic foot ulcers. For comparison, we also included another group of diabetic foot ulcers treated with proximal tibial cortex transverse distraction. METHODS From February 1998 to February 2020, 87 patients (87 feet) with severe and recalcitrant diabetic foot ulcers were treated. The mean age of patients at surgery was 64 years (range, 47 to 87 years). The severity of the narrowed artery was assessed using the ankle-brachial index test. For comparison, another group of 91 patients (91 diabetic foot ulcers) treated with proximal tibial cortex transverse distraction was included. RESULTS The mean preoperative ankle-brachial indexes of the two groups were 0.41±0.07 and 0.39±0.05 (OR 0.65 [95% CI -0.77 to 1.58]; P=0.62), respectively. The mean preoperative limb pain was 3.42±2.84 cm and 3.52±3.11 cm (OR 1.54 [95% CI -077 to 1.35]; P=0.083), respectively. At the 2-year follow-up visit, ulcers healed in 72 (83%) and 74 (81%) patients, respectively (P=0.188). The mean postoperative limb pain was 0.52±0.23 cm and 0.49±0.41 cm (OR 2.32 [95% CI -0.27 to 1.66]; P=0.078), respectively. Pin-site infection occurred in 2 patients and 8 patients (P=0.09), respectively. Ulcer recurrence occurred in 13 (15%) patients and 15 (16%) patients (P=0.205), respectively. CONCLUSIONS Anterior superior iliac spine transverse distraction may be an effective alternative treatment for severe and recalcitrant diabetic foot ulcers. It may be associated with fewer distraction-site complications than proximal tibial cortex transverse distraction. LEVEL OF EVIDENCE Therapeutic study, Level IIa.
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Affiliation(s)
- Yingliang Liu
- Department of Orthopaedics, People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan 675000, China
| | - Changhai Jiang
- Department of Orthopaedics, People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan 675000, China.
| | - Xu Zhang
- Department of Hand Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Bingshu Ma
- Department of Orthopaedics, People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan 675000, China
| | - Yanfen Ding
- Department of Orthopaedics, People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan 675000, China
| | - Yanhong Jin
- Department of Orthopaedics, People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan 675000, China
| | - Yanjun Liu
- Department of Orthopaedics, People's Hospital of Chuxiong Yi Autonomous Prefecture, Chuxiong, Yunnan 675000, China
| | - Linhong Li
- Department of Orthopaedics, People's Hospital of Xishuangbanna State, Yunnan, China
| | - Chenglong Zhao
- Department of Orthopaedics, People's Hospital of Mile City of Honghe State, Yunnan, China
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26
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Allen LL, Khakharia A, Phillips LS, Johnson TM, Uphold CR, Perkins MM, Vaughan E. Annual Foot Exams are Associated with Reduced Incident Amputation among Older Veterans with Diabetes. J Appl Gerontol 2023; 42:205-212. [PMID: 36189677 DOI: 10.1177/07334648221129855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
We conducted a secondary data analysis to evaluate the association between annual foot exams and incident lower extremity amputations (LEA) among older veterans with diabetes during FY2007-FY2014. Older Veterans with at least one primary care provider visit each year (N = 664,162) and at least one foot exam each year (N = 72,892) and the overlap were identified from the 5 years prior to the study period of interest (FY2002-FY2006 (N = 71,122)). After excluding incident LEA related to cancer and trauma, 71,018 veterans (mean age +/- SD, % male) were included in the final cohort, which was followed from FY2007-FY2014 to evaluate the influence of subsequent annual foot exams and incident LEA. Consistent annual foot exams were protective for incident LEA in older veterans with diabetes, adjusted OR was 0.85 (97% CI: 0.74-0.96). Results indicate that adherence to annual foot exam guidelines can reduce incident LEA in older veterans with diabetes.
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Affiliation(s)
- Latricia L Allen
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, GA, USA.,19998Atlanta VA Health Care System, Atlanta, GA, USA.,Division of General Medicine and Geriatrics, Department of Medicine, 1371Emory University School of Medicine, Atlanta, GA, USA
| | - Anjali Khakharia
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, GA, USA.,19998Atlanta VA Health Care System, Atlanta, GA, USA.,Division of General Medicine and Geriatrics, Department of Medicine, 1371Emory University School of Medicine, Atlanta, GA, USA
| | - Lawrence S Phillips
- 19998Atlanta VA Health Care System, Atlanta, GA, USA.,Division of Endocrinology, Metabolism and Lipids, Department of Medicine, 1371Emory University School of Medicine, Atlanta, GA, USA
| | - Theodore M Johnson
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, GA, USA.,19998Atlanta VA Health Care System, Atlanta, GA, USA.,Division of General Medicine and Geriatrics, Department of Medicine, 1371Emory University School of Medicine, Atlanta, GA, USA
| | - Constance R Uphold
- Geriatric Research Education and Clinical Center, 158428VA North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Molly M Perkins
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, GA, USA.,19998Atlanta VA Health Care System, Atlanta, GA, USA.,Division of General Medicine and Geriatrics, Department of Medicine, 1371Emory University School of Medicine, Atlanta, GA, USA
| | - Elizabeth Vaughan
- Department of Veterans Affairs, Birmingham/Atlanta Geriatric Research Education and Clinical Center, Atlanta, GA, USA.,19998Atlanta VA Health Care System, Atlanta, GA, USA.,Division of General Medicine and Geriatrics, Department of Medicine, 1371Emory University School of Medicine, Atlanta, GA, USA
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27
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A scoping review of theories used to investigate clinician adherence to clinical practice guidelines. Int J Clin Pharm 2023; 45:52-63. [PMID: 36385205 PMCID: PMC9938823 DOI: 10.1007/s11096-022-01490-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Routine utilization of evidence-based clinical practice guidelines (CPGs) is an effective strategy to optimize patient care and reduce practice variation. Healthcare professionals' failure to adhere to CPGs introduces risks to both patients and the sustainability of healthcare systems. The integration of theory to investigate adherence provides greater insight into the often complex reasons for suboptimal behaviors. AIM To determine the coverage of literature surrounding the use of theory in studies of CPG adherence, report the key findings and identify the knowledge gaps. METHOD In April 2021, three bibliographic databases were searched for studies published since January 2010, adopting theory to investigate health professionals' adherence to CPGs. Two reviewers independently screened the articles for eligibility and charted the data. A narrative approach to synthesis was employed. RESULTS The review includes 12 articles. Studies were limited to primarily investigations of physicians, quantitative designs, single disease states and few countries. The use of behavioral theories facilitated pooling of data of barriers and facilitators of adherence. The domains and constructs of a number of the reported theories are captured within the Theoretical Domains Framework (TDF); the most common barriers aligned with the TDF domain of environmental context and resources, fewer studies reported facilitators. CONCLUSION There is emerging use of behavioral theories investigating physicians' adherence to CPGs. Although limited in number, these studies present specific insight into common barriers and facilitators, thus providing valuable evidence for refining existing and future implementation strategies. Similar investigations of other health professionals are warranted.
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28
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Niami F, Molavynejad S, Hemmati AA, Bijan Nejad D, Yazdanpanah L, Maram NS, Saki Malehi A, Mahmoudi M. Evaluation of the effect of a gel made with amniotic fluid formulation on the healing of diabetic foot ulcers: A triple-blind clinical trial. Front Public Health 2022; 10:1025391. [PMID: 36589960 PMCID: PMC9798771 DOI: 10.3389/fpubh.2022.1025391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/07/2022] [Indexed: 12/23/2022] Open
Abstract
Aim The aim of this study was to evaluate the effect of a gel made with amniotic fluid (AF) formulation on wound healing in diabetic foot ulcers. Methods This clinical trial was performed on 92 type 2 diabetic patients referring to the Diabetes Clinic of Golestan Hospital of Ahvaz, southwest of Iran in 2019-2020. Patients were randomly divided into three groups of intervention and one placebo group. The wounds of the three intervention groups were dressed with gauze impregnated with an AF formulation gel while wounds of the control group were dressed with plain gauze without any topical agent. Chi-square tests and generalized estimating equations (GEE) with a significance level of 0.05 were used to analyze the data. Results At the end of the eighth week of intervention, there was a statistically significant difference among the four groups in terms of wound grade, wound color, condition of the tissues surrounding the wound, the overall condition of the wound, and the duration of wound healing (P < 0.05). Conclusions Based on our experience with the patients in the present study, we believe that AF represents a useful and safe option for the treatment of chronic diabetic foot ulcers. Clinical trial registration https://en.irct.ir/trial/51551, Identifier: IRCT20201010048985N1.
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Affiliation(s)
- Fatemeh Niami
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shahram Molavynejad
- Nursing Care Research Center in Chronic Diseases, School of Nursing and Midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,*Correspondence: Shahram Molavynejad
| | - Ali Asghar Hemmati
- Marine Pharmaceutical Science Research Center, School of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Darioush Bijan Nejad
- Cellular and Molecular Research Center, Medical Basic Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Leila Yazdanpanah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nader Shakiba Maram
- Nanotechnology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amal Saki Malehi
- Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mandana Mahmoudi
- Obstetrics and Gynecologic Department, Mehr Hospital, Ahvaz, Iran
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Ruiz-Sánchez FJ, Ruiz-Muñoz M, Martín-Martín J, Coheña-Jimenez M, Perez-Belloso AJ, Pilar Romero-Galisteo R, Gónzalez-Sánchez M. Management and treatment of ankle sprain according to clinical practice guidelines: A PRISMA systematic review. Medicine (Baltimore) 2022; 101:e31087. [PMID: 36281183 PMCID: PMC9592509 DOI: 10.1097/md.0000000000031087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The lateral sprain of the ankle is a very frequent injury in the population in general, appearing in the emergency services frequently. The general objective was to review the current clinical practice guidelines (CPGs) on management and treatment of ankle sprains, assess their quality, analyze the levels of evidence and summarize the grades of recommendation. METHODS A systematic search of the literature in relevant databases with the search terms "ankle," "sprain," "practice guideline," and "guideline" was carried out. There were included those guidelines that had the system of grades of recommendation and level of evidence concerning to management and treatment of ankle sprain. The quality of the guides was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS Seven clinical practice guides were included in this review. The AGREE II scores ranged from 42% to 100%, with only six CPGs explicitly declaring the use of a systematic methodology. Seventeen recommendations were extracted and summarized. DISCUSSION Six of the recommendations analyzed present enough evidence to be applied in clinical practice and are highly recommended for ankle sprain management: Ottawa rules, manual therapy, cryotherapy, functional supports, early ambulation, short term NSAIDs and rehabilitation.
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Affiliation(s)
- Francisco J. Ruiz-Sánchez
- Department of Nursing and Podiatry, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos, Málaga, Spain
| | - María Ruiz-Muñoz
- Department of Nursing and Podiatry, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos, Málaga, Spain
| | - Jaime Martín-Martín
- Department of Human Anatomy, Legal Medicine and History of Science, Faculty of Medicine, University of Málaga, Málaga, Spain
| | - Manuel Coheña-Jimenez
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain
| | - Ana J. Perez-Belloso
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Sevilla, Spain
| | - Rita Pilar Romero-Galisteo
- Department of Physiotherapy, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos, Málaga, Spain
| | - Manuel Gónzalez-Sánchez
- Department of Physiotherapy, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos, Málaga, Spain
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Hartman-Petrycka M, Knefel G, Lebiedowska A, Nowak M, Błońska-Fajfrowska B. Taste perception and food preferences in patients with diabetic foot ulcers before and after hyperbaric oxygen therapy. Nutr Diabetes 2022; 12:41. [PMID: 36198698 PMCID: PMC9534922 DOI: 10.1038/s41387-022-00219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 09/07/2022] [Accepted: 09/23/2022] [Indexed: 11/28/2022] Open
Abstract
Objective The aim of the study was to evaluate the effect of hyperbaric oxygen therapy (HBOT) on taste perception and food preferences in patients with diabetic foot ulcers. Methods The study involved 75 healthy people (Group C) and 23 patients with diabetic foot ulcers before HBOT (Group Db) and after 25–30 HBOT treatments (Group Da) (2.5 ATA, 87 min). The sip and spit method was used to examine the taste perception for 5 basic flavours. Food preferences were studied using photographs of dishes. Results The recognition thresholds in Group C were lower than in Group Db for 5 basic flavours. The taste intensity in Group C was higher than in Group Db for: 0.1% and 1.0% monosodium glutamate, 0.02% citric acid, and 0.002% quinine hydrochloride. The hedonic response in Group C was more negative than in Group Db for: 0.18% sodium chloride, 0.3% monosodium glutamate and 0.1% citric acid. The pleasure derived from eating in Group C was lower than in Group Db for sour and salty products. The recognition thresholds in Group Db were higher than in Group Da for umami and sour. The taste intensity in Group Db was lower than in Group Da for: 0.1%, 0.3% and 1.0% monosodium glutamate. The pleasure derived from eating in Group Db was higher than in Group Da for chocolate and crisps. Conclusions In people with diabetic foot ulcers, an impaired all 5 basic tastes occurred with different food preferences compared to healthy people. HBOT causes beneficial changes resulting in increased sensitivity to umami and sour taste as well as a decrease in the pleasure derived from eating chocolate and crisps.
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Affiliation(s)
- Magdalena Hartman-Petrycka
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
| | - Grzegorz Knefel
- Dr Stanisław Sakiel Centre for Burn Treatment, Siemianowice Śląskie, Poland
| | - Agata Lebiedowska
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland.
| | - Mariusz Nowak
- Dr Stanisław Sakiel Centre for Burn Treatment, Siemianowice Śląskie, Poland
| | - Barbara Błońska-Fajfrowska
- Department of Basic Biomedical Science, Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Poland
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31
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Getting Ready for Foot Care Certification: Foot Care Health History and Risk Factor Assessment. J Wound Ostomy Continence Nurs 2022; 49:492-494. [PMID: 36108235 DOI: 10.1097/won.0000000000000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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32
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Pallin JA, McIntosh C, Kavanagh P, Dinneen SF, Kearney PM, Buckley CM. A scoping review protocol to map the evidence on the risks and benefits of population based diabetic foot screening. HRB Open Res 2022; 5:50. [PMID: 37601115 PMCID: PMC10432895 DOI: 10.12688/hrbopenres.13585.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 08/22/2023] Open
Abstract
Background: Diabetic foot ulcers are one of the most common lower extremity complications of diabetes, with the lifetime risk of a person developing a DFU estimated to be as high as 34%. It is recommended that those with diabetes receive an annual review of their feet, by a trained healthcare professional, to identify risk factors for ulceration and allow for subsequent risk stratification, patient education and provision of appropriate care to prevent ulceration and amputation. Internationally, while many countries have a diabetic foot care pathway, it is not a structured population health screening programme unlike other areas of preventive care for people with diabetes such as retinopathy screening. A structured diabetic foot screening pathway could allow for earlier identification of the at-risk foot. However, the introduction of any population screening programme should meet the Wilson and Jungner principles of screening. This paper presents a protocol for a scoping review of existing evidence on screening for the at-risk-foot against the Wilson and Junger principles. Methods: The scoping review will be conducted in line with the six-stage methodological framework by Arksey & O'Mally and the Joanna Briggs Institute (JBI) scoping review methodology. Medline (EBSCO), Scopus, ScienceDirect and EMBASE databases will be searched. Studies relating to the burden of diabetic foot ulcers, their pathophysiology and screening tests for peripheral neuropathy and peripheral artery disease, and screening programmes will be included. A data extraction tool will be used to facilitate a chronological narrative synthesis of results. Results: These will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR). Conclusion: This scoping review will evaluate and map the evidence surrounding diabetic foot ulcers using the Wilson and Jungner principles of screening as a framework.
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Affiliation(s)
- Jennifer A. Pallin
- School of Public Health, University College Cork, Cork City, Cork, T12 XF62, Ireland
| | - Caroline McIntosh
- Discipline of Podiatric Medicine, National University of Ireland, Galway, Galway City, Galway, H91 TK33, Ireland
| | - Paul Kavanagh
- Health Intelligence Unit, Strategic Planning and Transformation, Jervis House, Jervis Street, Health Service Executive, Dublin 1, D01 W596, Ireland
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin 2, D02 YN77, Ireland
| | - Sean F. Dinneen
- School of Medicine, National University of Ireland Galway, Galway City, Galway, H91 TK33, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, University College Hospital, Galway, Galway, H91 YR71, Ireland
| | - Patricia M. Kearney
- School of Public Health, University College Cork, Cork City, Cork, T12 XF62, Ireland
| | - Claire M. Buckley
- School of Public Health, University College Cork, Cork City, Cork, T12 XF62, Ireland
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Karakousis ND, Pyrgioti EE, Georgakopoulos PN, Papanas N. Sarcopenia, Frailty and Diabetic Foot: A Mini Narrative Review. INT J LOW EXTR WOUND 2022:15347346221111420. [PMID: 35791577 DOI: 10.1177/15347346221111420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The aim of this narrative mini review was to investigate the potential association of the diabetic foot (DF) with sarcopenia and frailty. Data is still limited, but it appears that DF patients may be more prone to frailty. In addition, patients with DF and sarcopenia exhibit more frequently foot ulcers and amputations, as well as increased mortality rates post-operatively. Further studies are now needed to see how these realizations may be used in clinical practice, aiming to improve DF outcomes.
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Affiliation(s)
| | | | | | - Nikolaos Papanas
- Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, Alexandroupolis, Greece
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Magnetic Resonance Imaging Data Features to Evaluate the Efficacy of Compound Skin Graft for Diabetic Foot. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5707231. [PMID: 35815055 PMCID: PMC9213126 DOI: 10.1155/2022/5707231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/17/2022]
Abstract
This study aimed to analyze the role of magnetic resonance imaging (MRI) data characteristics based on the deep learning algorithm in evaluating the treatment of diabetic foot (DF) with composite skin graft. In this study, 78 patients with DF were randomly rolled into the experimental group (composite skin graft) and control group (autologous skin graft) with 39 patients in each group. MRI scans were performed before and after treatment to compare the changes of experimental observation indicators such as healing time, recurrence rate, and scar score. The results showed that T1-weighted imaging (T1WI) of the scanning sequence was considerably increased in the experimental group after treatment. The signal intensity of fat-suppressed T2-weighted imaging (T2WI) and fat-suppressed T1WI enhancement sequences was considerably decreased
. In addition, compared with the control group, the recurrence rate, healing time, and scar score in the experimental group were considerably decreased
. The accuracy, specificity, and sensitivity of MRI imaging information in evaluating the therapeutic effect of DF patients were 85.2%, 89.75%, and 86.47%, respectively. According to the specificity and sensitivity, the subject operating characteristic curve was drawn, and the area under the curve was determined to be 0.838. In summary, MRI image data characteristics based on the deep learning algorithm can provide auxiliary reference information for the efficacy evaluation of compound skin transplantation for DF.
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35
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Serrano-Coll H, Cardona-Castro N. Neuropathic ulcers in leprosy: clinical features, diagnosis and treatment. J Wound Care 2022; 31:S32-S40. [PMID: 35678776 DOI: 10.12968/jowc.2022.31.sup6.s32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Leprosy is a neglected disease caused by Mycobacterium leprae and Mycobacterium lepromatosis, and is related to significant disabilities resulting from the neural damage generated by this mycobacteria. Neuropathic ulcers-lesions that can appear at the plantar and extra-plantar levels-are one such disability, and diagnosis requires an adequate dermatological, neurological and microbiological evaluation. The treatment of these lesions is based on a multidisciplinary approach that includes debridement of the necrotic tissue, controlling infections, reducing pressure areas, optimising blood flow, and nerve decompression. This review aims to describe the clinical features, diagnostic methods and treatment of neuropathic ulcers in leprosy. The diagnostic methods and medical management used in leprosy ulcers are based on those used for diabetic foot. This requires radical change as these diseases are immunologically and physiologically very different.
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Affiliation(s)
- Héctor Serrano-Coll
- Research Group in Education and Health Sciences, UNISANGIL-San Gil, Colombia.,Leprosy Research Group, Colombian Institute of Tropical Medicine, CES University, Medellín, Colombia
| | - Nora Cardona-Castro
- Leprosy Research Group, Colombian Institute of Tropical Medicine, CES University, Medellín, Colombia
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36
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Price MR, Cupler Z, Hawk C, Bednarz EM, Walters SA, Daniels CJ. Systematic review of guideline-recommended medications prescribed for treatment of low back pain. Chiropr Man Therap 2022; 30:26. [PMID: 35562756 PMCID: PMC9101938 DOI: 10.1186/s12998-022-00435-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/22/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To identify and descriptively compare medication recommendations among low back pain (LBP) clinical practice guidelines (CPG). METHODS We searched PubMed, Cochrane Database of Systematic Review, Index to Chiropractic Literature, AMED, CINAHL, and PEDro to identify CPGs that described the management of mechanical LBP in the prior five years. Two investigators independently screened titles and abstracts and potentially relevant full text were considered for eligibility. Four investigators independently applied the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument for critical appraisal. Data were extracted for pharmaceutical intervention, the strength of recommendation, and appropriateness for the duration of LBP. RESULTS 316 citations were identified, 50 full-text articles were assessed, and nine guidelines with global representation met the eligibility criteria. These CPGs addressed pharmacological treatments with or without non-pharmacological treatments. All CPGS focused on the management of acute, chronic, or unspecified duration of LBP. The mean overall AGREE II score was 89.3% (SD 3.5%). The lowest domain mean score was for applicability, 80.4% (SD 5.2%), and the highest was Scope and Purpose, 94.0% (SD 2.4%). There were ten classifications of medications described in the included CPGs: acetaminophen, antibiotics, anticonvulsants, antidepressants, benzodiazepines, non-steroidal anti-inflammatory drugs (NSAIDs), opioids, oral corticosteroids, skeletal muscle relaxants (SMRs), and atypical opioids. CONCLUSIONS Nine CPGs, included ten medication classes for the management of LBP. NSAIDs were the most frequently recommended medication for the treatment of both acute and chronic LBP as a first line pharmacological therapy. Acetaminophen and SMRs were inconsistently recommended for acute LBP. Meanwhile, with less consensus among CPGs, acetaminophen and antidepressants were proposed as second-choice therapies for chronic LBP. There was significant heterogeneity of recommendations within many medication classes, although oral corticosteroids, benzodiazepines, anticonvulsants, and antibiotics were not recommended by any CPGs for acute or chronic LBP.
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Affiliation(s)
| | | | - Cheryl Hawk
- Texas Chiropractic College, Pasadena, TX USA
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Al-Sanaani EA, Ismail A, Abdul Manaf MR, Suddin LS, Mustafa N, Sukor N, Alabed AAA, Alkhodary AA, Aljunid SM. Health insurance status and its determinants among patients with type 2 diabetes mellitus in a tertiary teaching hospital in Malaysia. PLoS One 2022; 17:e0267897. [PMID: 35511889 PMCID: PMC9070921 DOI: 10.1371/journal.pone.0267897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Even in a country with a tax-based healthcare financing system, health insurance can play an important role, especially in the management of chronic diseases with high disease and economic burden such as Type 2 Diabetes Mellitus (T2DM). The insurance coverage among T2DM patients in Malaysia is currently unclear. The aim of this study was to determine the insurance status of T2DM patients in public and private healthcare facilities in Malaysia, and the association between this status and patients’ sociodemographic and economic factors.
Methods
A cross-sectional study among T2DM patients seeking inpatient or outpatient treatment at a public tertiary hospital (Hospital Canselor Tuanku Muhriz) and a private tertiary hospital (Universiti Kebangsaan Malaysia Specialist Centre) in Kuala Lumpur between August 2019 and March 2020. Patients were identified via convenience sampling using a self-administered questionnaire. Data collection focused on identifying insurance status as the dependent factor while the independent factors were the patients’ sociodemographic characteristics and economic factors.
Results
Of 400 T2DM patients, 313 responded (response rate, 78.3%) and 76.0% were uninsured. About 69.6% of the respondents had low monthly incomes of <RM5000. Two-thirds of participants (59.1%) spent RM100–500 for outpatient visits whilst 58.5% spent <RM100 on medicines per month (RM1 = USD0.244). Patients who visited a private facility had five times more likely to have insurance than patients who visited a public facility. Participants aged 18–49 years with higher education levels were 4.8 times more likely to be insured than participants aged ≥50 years with low education levels (2 times).
Conclusions
The majority of T2DM patients were uninsured. The main factors determining health insurance status were public facilities, age of ≥ 50 years, low education level, unemployment, and monthly expenditure on medicines.
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Affiliation(s)
- Essam Ali Al-Sanaani
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Ministry of Public Health and Population, Sana’a, Yemen
| | - Aniza Ismail
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- * E-mail:
| | - Mohd Rizal Abdul Manaf
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Leny Suzana Suddin
- Faculty of Medicine, Department of Community Health, Universiti Teknologi MARA, Shah Alam, Selangor, Malaysia
| | - Norlaila Mustafa
- Faculty of Medicine, Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Norlela Sukor
- Faculty of Medicine, Department of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Alabed Ali A. Alabed
- Faculty of Medicine, Department of Community Medicine, Lincoln University College, Kota Bharu, Malaysia
| | - Ahmed Abdelmajed Alkhodary
- Faculty of Medicine, Department of Community Health, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Faculty of Medicine, International Centre for Casemix and Clinical Coding, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Syed Mohamed Aljunid
- Faculty of Medicine, International Centre for Casemix and Clinical Coding, National University of Malaysia, Kuala Lumpur, Malaysia
- Faculty of Public Health, Department of Health Policy and Management, Kuwait University, Kuwait, Kuwait
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Dinoto E, Ferlito F, La Marca MA, Tortomasi G, Urso F, Evola S, Guercio G, Marcianò M, Pakeliani D, Bajardi G, Pecoraro F. The Role of Early Revascularization and Biomarkers in the Management of Diabetic Foot Ulcers: A Single Center Experience. Diagnostics (Basel) 2022; 12:diagnostics12020538. [PMID: 35204630 PMCID: PMC8871223 DOI: 10.3390/diagnostics12020538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 02/08/2022] [Accepted: 02/16/2022] [Indexed: 11/23/2022] Open
Abstract
Diabetic neuropathy and Peripheral Arterial Disease (PAD) are the main etiological factors in foot ulceration. Herein, we report our experience of diabetic foot ulceration (DFU) management, with an analysis of the relationship between the rate of lower extremity amputation, in persons with infected DFU, after revascularization procedures performed to prevent major amputation. This study highlights the role of different biomarkers, showing their usefulness and potentiality in diabetic foot ulcer management, especially for the early diagnosis and therapy effectiveness monitoring. A retrospective analysis, from September 2016 to January 2021, of diabetic patients presenting diabetic foot with DFU, was performed. All patients were treated with at least one vascular procedure (endovascular, open, hybrid procedures) targeting PAD lesions. Outcomes measured were perioperative mortality and morbidity. Freedom from occlusion, primary and secondary patency, and amputation rate were registered. A total of 267 patients, with a mean age of 72.5 years, were included in the study. The major amputation rate was 6.2%, minor amputation rate was 17%. In our experience, extreme revascularization to obtain direct flow reduced the rate of amputations, with an increase in ulcer healing.
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Affiliation(s)
- Ettore Dinoto
- Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy; (F.F.); (M.A.L.M.); (G.T.); (F.U.); (G.B.); (F.P.)
- Correspondence:
| | - Francesca Ferlito
- Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy; (F.F.); (M.A.L.M.); (G.T.); (F.U.); (G.B.); (F.P.)
| | - Manfredi Agostino La Marca
- Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy; (F.F.); (M.A.L.M.); (G.T.); (F.U.); (G.B.); (F.P.)
| | - Graziella Tortomasi
- Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy; (F.F.); (M.A.L.M.); (G.T.); (F.U.); (G.B.); (F.P.)
| | - Francesca Urso
- Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy; (F.F.); (M.A.L.M.); (G.T.); (F.U.); (G.B.); (F.P.)
| | - Salvatore Evola
- Unit of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE) “G. D’Alessandro”, University Hospital Paolo Giaccone, University of Palermo, 90127 Palermo, Italy;
| | - Giovanni Guercio
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy;
- Department of General and Emergency Surgery, Paolo Giaccone University Hospital, 90127 Palermo, Italy;
| | - Marco Marcianò
- Department of General and Emergency Surgery, Paolo Giaccone University Hospital, 90127 Palermo, Italy;
| | - David Pakeliani
- Vascular Surgery Unit, Ospedali Riuniti Villa Sofia-Cervello, 90100 Palermo, Italy;
| | - Guido Bajardi
- Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy; (F.F.); (M.A.L.M.); (G.T.); (F.U.); (G.B.); (F.P.)
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy;
| | - Felice Pecoraro
- Vascular Surgery Unit, AOUP Policlinico “P. Giaccone”, 90127 Palermo, Italy; (F.F.); (M.A.L.M.); (G.T.); (F.U.); (G.B.); (F.P.)
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90127 Palermo, Italy;
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Ali AAM, Essawy EAR, Mohamed NS, Abdel Moneim AE, Attaby FA. Physalis pubescens L. alleviates testicular disruptions associated with streptozotocin-induced diabetes in male Wistar rats, Rattus norvegicus. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:12300-12312. [PMID: 34562212 DOI: 10.1007/s11356-021-16616-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/15/2021] [Indexed: 06/13/2023]
Abstract
Testicular impairment is a serious complication of diabetes that is mediated by oxidative stress and inflammation. Physalis has antioxidative and anti-inflammatory actions. Thus, the present study investigated the ameliorative role of Physalis juice (PJ) prepared from the fruits against testicular damages in streptozotocin (STZ)-induced diabetic rats. Adult male Wistar rats were divided randomly into five groups (n=6): control, orally administered 5 mL PJ/kg daily (PJ), injected intraperitoneally with a single dose of 55 mg STZ/kg without treatment (STZ), or treated daily with PJ (STZ+PJ) or with 500 mg metformin/kg (STZ+Met), for 28 days. The STZ group showed a marked elevation in the blood glucose level by 230%, whereas remarkable declines in the serum levels of testosterone (44%), follicle-stimulating hormone (FSH) (48%), and luteinizing hormone (LH) (36%), as compared to controls. In comparison to controls, the testis of the STZ group showed remarkable declines in the testis weight (15%), the glutathione (GSH) content (45%), mRNA and protein levels of B-cell lymphoma-2 (Bcl-2) (48 and 35%), mRNA and activities of superoxide dismutase (SOD) (63 and 40%), catalase (CAT) (56 and 31%), glutathione peroxidase (GPx) (51 and 44%), and glutathione reductase (GR) (62 and 43%), whereas marked elevations in the levels of interleukin-1 beta (IL-1β (169%), tumor necrosis factor-alfa (TNFα) (85%), nitric oxide (NO) (96%), malondialdehyde (MDA) (83%), mRNA and protein levels of Bcl-2-associated X protein (Bax) (400 and 61%), and mRNA level of caspase-3 (Cas-3) (370%). Some histopathological alterations were observed in the testicular tissue of the STZ group. In contrast, PJ markedly alleviated all the abovementioned disturbances. In conclusion, PJ at a dose of 5 mL/kg attenuated the diabetes-associated testicular impairments, which may be due to its antioxidative, anti-inflammatory, and antiapoptotic actions.
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Affiliation(s)
| | | | | | - Ahmed E Abdel Moneim
- Zoology and Entomology Department, Faculty of Science, Helwan University, Helwan, Egypt
| | - Fawzy Ali Attaby
- Chemistry Department, Faculty of Science, Cairo University, Giza, Egypt
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40
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Zhang H, Zhang M, Wang X, Zhang M, Wang X, Li Y, Cui Z, Chen X, Han Y, Zhao W. Electrospun multifunctional nanofibrous mats loaded with bioactive anemoside B4 for accelerated wound healing in diabetic mice. Drug Deliv 2022; 29:174-185. [PMID: 34978237 PMCID: PMC8725929 DOI: 10.1080/10717544.2021.2021319] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
With the worldwide prevalence of diabetes and considering the complicated microenvironment of diabetic wounds, the design and development of innovative multifunctional wound dressing materials are much wanted for the treatment of hard-to-heal wounds in diabetic patients. In the present study, anti-inflammatory ingredients loaded with nanofibrous wound dressing materials were manufactured by a promising blend-electrospinning strategy, and their capability for treating the diabetic wound was also systematically explored. A polymer blend consisting of Chitosan (CS) and polyvinyl alcohol (PVA) was electrospun into CS-PVA nanofibrous mats as control groups. In the meanwhile, a bioactive ingredient of Chinese medicine Pulsatilla, anemoside B4(ANE), with different contents were loaded into the electrospinning solution to construct CS-PVA-ANE nanofibrous mats. The developed CS-PVA-ANE wound dressing materials exhibited multifunctional properties including prominent water absorption, biomimetic elastic mechanical properties, and sustained ANE releasing behavior, as well as outstanding hemostatic properties. The in vitro studies showed that the CS-PVA-ANE nanofiber mats could significantly suppress lipopolysaccharide (LPS)-stimulated differentiation of pro-inflammatory (M1) macrophage subsets, and notably reduce the reactive oxygen species (ROS) generation, as well as obviously decrease inflammatory cytokine release. The in vivo animal studies showed that the CS-PVA-ANE nanofiber mats promoted the healing of diabetic wounds by significantly enhancing wound closure rates, accelerating excellent angiogenesis, promoting re-epithelization and collagen matrix deposition throughout all stages of wound healing. The present study demonstrated that CS-PVA-ANE nanofiber mats could effectively shorten the wound-healing time by inhibiting inflammatory activity, which makes them promising candidates for the treatment of hard-to-heal wounds caused by diabetes.
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Affiliation(s)
- Hao Zhang
- Qingdao University Medical College, Qingdao, China
| | | | - Xumei Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Mi Zhang
- Qingdao University Medical College, Qingdao, China
| | - Xuelian Wang
- Qingdao University Medical College, Qingdao, China
| | - Yiyang Li
- Qingdao University Medical College, Qingdao, China
| | - Zhuoer Cui
- Qingdao University Medical College, Qingdao, China
| | - Xiuping Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yantao Han
- Qingdao University Medical College, Qingdao, China
| | - Wenwen Zhao
- Qingdao University Medical College, Qingdao, China.,State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
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41
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An N, Wu BT, Yang YW, Huang ZH, Feng JF. Re-understanding and focusing on normoalbuminuric diabetic kidney disease. Front Endocrinol (Lausanne) 2022; 13:1077929. [PMID: 36531487 PMCID: PMC9757068 DOI: 10.3389/fendo.2022.1077929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
Diabetes mellitus (DM) has grown up to be an important issue of global public health because of its high incidence rate. About 25% of DM patients can develop diabetic foot/ulcers (DF/DFU). Diabetic kidney disease (DKD) is the main cause of end-stage kidney disease (ESKD). DF/DFU and DKD are serious complications of DM. Therefore, early diagnosis and timely prevention and treatment of DF/DFU and DKD are essential for the progress of DM. The clinical diagnosis and staging of DKD are mostly based on the urinary albumin excretion rate (UAER) and EGFR. However, clinically, DKD patients show normoalbuminuric diabetic kidney disease (NADKD) instead of clinical proteinuria. The old NADKD concept is no longer suitable and should be updated accordingly with the redefinition of normal proteinuria by NKF/FDA. Based on the relevant guidelines of DM and CKD and combined with the current situation of clinical research, the review described NADKD from the aspects of epidemiology, pathological mechanism, clinical characteristics, biomarkers, disease diagnosis, and the relationship with DF/DFU to arouse the new understanding of NADKD in the medical profession and pay attention to it.
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Affiliation(s)
- Na An
- National Health Commission Key Laboratory of Nuclear Technology Medical Transformation (MIANYANG CENTRAL HOSPITAL), Mianyang, China
- Departments of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Bi-tao Wu
- National Health Commission Key Laboratory of Nuclear Technology Medical Transformation (MIANYANG CENTRAL HOSPITAL), Mianyang, China
- Departments of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Yu-wei Yang
- National Health Commission Key Laboratory of Nuclear Technology Medical Transformation (MIANYANG CENTRAL HOSPITAL), Mianyang, China
- Departments of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
| | - Zheng-hong Huang
- College of Medical Technology, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jia-fu Feng
- National Health Commission Key Laboratory of Nuclear Technology Medical Transformation (MIANYANG CENTRAL HOSPITAL), Mianyang, China
- Departments of Clinical Laboratory, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China
- *Correspondence: Jia-fu Feng, ;
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42
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Chen X, Wu J, Cao X, Jiang H, Wu Z, Zeng Z, Chen H, Zhang J. The role of gel wound dressings loaded with stem cells in the treatment of diabetic foot ulcers. Am J Transl Res 2021; 13:13261-13272. [PMID: 35035674 PMCID: PMC8748097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/03/2021] [Indexed: 06/14/2023]
Abstract
Diabetic foot ulcers (DFUs) are a serious complication of diabetes and the main cause of nontraumatic lower limb amputations, resulting in a serious economic burden on society. The main causes of DFUs include peripheral neuropathy, foot deformity, chronic inflammation, and peripheral artery disease. There are many clinical approaches for the treatment of DFUs, but they are all aimed at addressing a single aetiological factor. Stem cells (SCs), which express many cytokines and a variety of nerve growth factors and modulate immunological function in the wound, may accelerate DFU healing by promoting angiogenesis, cell proliferation, and nerve growth and regulating the inflammatory response. However, the survival time of SCs without scaffold support in the wound is short. Multifunctional gel wound dressings play a critical role in skin wound healing due to their ability to maintain SC survival for a long time, provide moisture and prevent electrolyte and water loss in DFUs. Among the many methods for clinical treatment of DFUs, the most successful one is therapy with gel dressings loaded with SCs. To accelerate DFU healing, gel wound dressings loaded with SCs are needed to promote the survival and migration of SCs and increase wound contraction. This review summarizes the research advancements regarding multifunctional gel wound dressings and SCs in the treatment of DFU to demonstrate the effectiveness and safety of this combinational therapeutic strategy.
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Affiliation(s)
- Xionglin Chen
- Department of Histology & Embryology and Medical Genetics, School of Medicine, Jiujiang UniversityJiujiang 332000, Jiangxi, China
| | - Jianfang Wu
- Department of Pathogenic Biology and Immunology, School of Medicine, Jiujiang UniversityJiujiang 332000, Jiangxi, China
| | - Xiaoming Cao
- Department of Anatomy, School of Medicine, Jiujiang UniversityJiujiang 332000, Jiangxi, China
| | - He Jiang
- Department of Histology & Embryology and Medical Genetics, School of Medicine, Jiujiang UniversityJiujiang 332000, Jiangxi, China
| | - Zhiren Wu
- Department of Preventive Medicine, Grade 2019, School of Medicine, Jiujiang UniversityJiujiang 332000, Jiangxi, China
| | - Zidu Zeng
- Department of Preventive Medicine, Grade 2019, School of Medicine, Jiujiang UniversityJiujiang 332000, Jiangxi, China
| | - Hui Chen
- Department of Anatomy, School of Medicine, Jiujiang UniversityJiujiang 332000, Jiangxi, China
| | - Jie Zhang
- Department of Histology & Embryology and Medical Genetics, School of Medicine, Jiujiang UniversityJiujiang 332000, Jiangxi, China
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Abuzinadah AR, Alkully HS, Alanazy MH, Alrawaili MS, Milyani HA, AlAmri B, AlShareef AA, Bamaga AK. Translation, validation, and diagnostic accuracy of the Arabic version of the Michigan neuropathy screening instrument. Medicine (Baltimore) 2021; 100:e27627. [PMID: 34871227 PMCID: PMC8568465 DOI: 10.1097/md.0000000000027627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 10/07/2021] [Indexed: 01/05/2023] Open
Abstract
The Michigan Neuropathy Screening Instrument (MNSI) is used to screen patients for diabetic neuropathy (DNP). We aimed to translate the MNSI questionnaire into Arabic (MNSIq-Ar) and to assess the validity and diagnostic performance of the MNSI Arabic version (MNSI-Ar).Cronbach alpha α and the interclass correlation coefficient were used to measure the reliability and reproducibility of the MNSIq-Ar. The instrument's validity was assessed by Spearman correlation with the Utah Early Neuropathy Scale (UENS), the Modified Toronto Neuropathy Score (mTCNS), diabetic neuropathy symptoms (DNS), and sural nerve amplitude (SNA). The construct validity of the MNSI-Ar was assessed by its ability to differentiate the severity of DNP (using the Kruskal-Wallis test). The diagnostic performance was assessed through the receiver operator curve area.We recruited 89 participants (mean [SD] age, 50.8 [12.3] years; 48% men). The MNSIq-Ar showed an α of 0.81 and intraclass correlation coefficient = 0.94, and the correlation coefficients with UENS, mTCNS, DNS, and sural nerve amplitude were 0.67, 0.83, 0.73, and -0.49, respectively (all P < .0001). The MNSI-Ar was able to differentiate the different severities of DNP. The receiver operator curve area was 0.93 with a high sensitivity of 95.9% and 100% for probable and confirmed DNP, respectively.MNSI-Ar is a reliable and valid tool to screen for diabetic neuropathy in the Arabic language with a good diagnostic performance and high sensitivity.
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Affiliation(s)
- Ahmad R. Abuzinadah
- King Abdulaziz University, Faculty of Medicine and King Abdulaziz University Hospital, Internal Medicine Department, Neurology Division, Neuroscience Unit, Jeddah, Saudi Arabia
- King Abdulaziz University, King Fahad Medical Research Center and King Abdulaziz University Hospital, Neuromuscular Medicine Unit, Jeddah, Saudi Arabia
| | - Hussien S. Alkully
- King Abdulaziz University, King Abdulaziz University Hospital, Internal Medicine Department, Neurology Division, Jeddah, Saudi Arabia
| | - Mohammed H. Alanazy
- Department of Internal Medicine, King Saud University Medical City and College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Moafaq S. Alrawaili
- King Abdulaziz University, King Abdulaziz University Hospital, Internal Medicine Department, Neurology Division, Jeddah, Saudi Arabia
| | - Haneen A. Milyani
- King Abdulaziz University, King Abdulaziz University Hospital, Internal Medicine Department, Neurology Division, Jeddah, Saudi Arabia
| | - Bashayr AlAmri
- King Abdulaziz University, King Abdulaziz University Hospital, Internal Medicine Department, Neurology Division, Jeddah, Saudi Arabia
| | - Aysha A. AlShareef
- King Abdulaziz University, Faculty of Medicine and King Abdulaziz University Hospital, Internal Medicine Department, Neurology Division, Neuroscience Unit, Jeddah, Saudi Arabia
- King Abdulaziz University, King Fahad Medical Research Center and King Abdulaziz University Hospital, Neuromuscular Medicine Unit, Jeddah, Saudi Arabia
| | - Ahmed K. Bamaga
- King Abdulaziz University, Faculty of Medicine and King Abdulaziz University Hospital, Pediatric Department, Pediatric Neurology Division, Jeddah, Saudi Arabia
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Retrospective Observational Study on Microbial Contamination of Ulcerative Foot Lesions in Diabetic Patients. MICROBIOLOGY RESEARCH 2021. [DOI: 10.3390/microbiolres12040058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
According to recent studies, there are almost 435 million people worldwide with diabetes mellitus. It is estimated that of these 148 million will develop Diabetic foot ulcers (DFUs) during their lifetime, of which 35 to 50% will be infected. In this scenario, the presence and frequency of pathogenic microorganisms and their level of susceptibility to the most frequent classes of antibiotics used to treat this pathological condition from patients with DFUs admitted to the outpatient clinic of vascular surgery of the Federico II University Hospital of Naples from January 2019 to March 2021 were investigated. Furthermore, the diabetic population characteristics under study (i.e., general, clinical, and comorbidities) and the pathogenic bacteria isolated from lesions were also considered. Bacterial strains poorly susceptible to antibiotics were more frequent in polymicrobial infections than in monomicrobial infections. β-Lactams showed the highest levels of resistance, followed by fluoroquinolones, aminoglycosides, and finally macrolides. The main findings of the study demonstrated that the occurrence of resistant microorganisms is the dominant factor in ulcer healing; thus it is essential to investigate the antibiotics’ susceptibility before setting antibiotic therapy to avoid inappropriate prescriptions that would affect the treatment and increase the development and spread of antibiotic resistance.
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Gracia-Sánchez A, López-Pineda A, Chicharro-Luna E, Gil-Guillén VF. A Delphi Study Protocol to Identify Recommendations on Physical Activity and Exercise in Patients with Diabetes and Risk of Foot Ulcerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10988. [PMID: 34682736 PMCID: PMC8536116 DOI: 10.3390/ijerph182010988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 01/05/2023]
Abstract
Patients with diabetes mellitus are exposed to important complications, such as diabetic neuropathy or peripheral vascular disease. The evidence on the guidelines that these patients, with a certain risk of suffering foot ulcerations, should follow before, during and after physical exercise is scarce. The objective of this study is to identify the physical exercise guidelines to recommend based on the risk of the foot of the patient with diabetes through a consensus of experts. A three-round Delphi study will be conducted. A scientific committee (multidisciplinary group of four national experts) will review the proposal of experts and the Delphi questionnaire before submitting. A group of experts in the management and approach of the diabetic foot of an international and multidisciplinary nature will form the panel of experts, who must express their degree of (dis)agreement with each of the statements contained in the Delphi questionnaire. The percentage will be calculated in response categories, and a cut-off point of 80% will be set to define the consensus of (dis)agreement of the panelists. The results of the study could provide a series of recommendations on the realization of physical exercise in diabetic patients at risk of suffering foot ulcerations.
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Affiliation(s)
- Alba Gracia-Sánchez
- Department of Behavioral and Health Sciences, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (A.G.-S.); (E.C.-L.)
| | - Adriana López-Pineda
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain;
| | - Esther Chicharro-Luna
- Department of Behavioral and Health Sciences, Miguel Hernández University, 03550 San Juan de Alicante, Spain; (A.G.-S.); (E.C.-L.)
| | - Vicente F. Gil-Guillén
- Clinical Medicine Department, Miguel Hernandez University, 03550 San Juan de Alicante, Spain;
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Pirri C, Fede C, Pirri N, Petrelli L, Fan C, De Caro R, Stecco C. Diabetic Foot: The Role of Fasciae, a Narrative Review. BIOLOGY 2021; 10:biology10080759. [PMID: 34439991 PMCID: PMC8389550 DOI: 10.3390/biology10080759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/15/2021] [Accepted: 08/04/2021] [Indexed: 12/19/2022]
Abstract
Simple Summary Diabetes mellitus and its complications are increasingly prevalent worldwide with severe impacts on patients and health care systems. Diabetic foot ulcers have an important impact on disability, morbidity, and mortality. The mechanism of diabetic wound chronicity has not yet been understood in a complete way. Regarding the involved soft tissues, little space has been given to the fasciae, even if nowadays there is more and more evidence of their role in proprioception, muscular force transmission, skin vascularization and tropism, and wound healing. Thus, we aimed to deepen the fascial involvement in diabetic wounds. Based on this review, we suggest that a clear scientific perception of fascial role can improve treatment strategies and create new perspectives of treatment. Abstract Wound healing is an intricate, dynamic process, in which various elements such as hyperglycemia, neuropathy, blood supply, matrix turnover, wound contraction, and the microbiome all have a role in this “out of tune” diabetic complex symphony, particularly noticeable in the complications of diabetic foot. Recently it was demonstrated that the fasciae have a crucial role in proprioception, muscular force transmission, skin vascularization and tropism, and wound healing. Indeed, the fasciae are a dynamic multifaceted meshwork of connective tissue comprised of diverse cells settled down in the extracellular matrix and nervous fibers; each constituent plays a particular role in the fasciae adapting in various ways to the diverse stimuli. This review intends to deepen the discussion on the possible fascial role in diabetic wounds. In diabetes, the thickening of collagen, the fragmentation of elastic fibers, and the changes in glycosaminoglycans, in particular hyaluronan, leads to changes in the stiffness, gliding, and the distribution of force transmission in the fasciae, with cascading repercussions at the cellular and molecular levels, consequently feeding a vicious pathophysiological circle. A clear scientific perception of fascial role from microscopic and macroscopic points of view can facilitate the identification of appropriate treatment strategies for wounds in diabetes and create new perspectives of treatment.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (C.F.); (R.D.C.); (C.S.)
- Correspondence:
| | - Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (C.F.); (R.D.C.); (C.S.)
| | - Nina Pirri
- School of Medicine and Surgery, University of Messina, 98125 Messina, Italy;
| | - Lucia Petrelli
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (C.F.); (R.D.C.); (C.S.)
| | - Chenglei Fan
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (C.F.); (R.D.C.); (C.S.)
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (C.F.); (R.D.C.); (C.S.)
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, 35121 Padua, Italy; (C.F.); (L.P.); (C.F.); (R.D.C.); (C.S.)
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Dijkers MP, Ward I, Annaswamy T, Dedrick D, Hoffecker L, Millis SR. What Determines the Quality of Rehabilitation Clinical Practice Guidelines?: An Overview Study. Am J Phys Med Rehabil 2021; 100:790-797. [PMID: 33214385 PMCID: PMC8265547 DOI: 10.1097/phm.0000000000001645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of the study was to determine what factors determine the quality of rehabilitation clinical practice guidelines. DESIGN Six databases were searched for articles that had applied the Appraisal of Guidelines for Research & Evaluation II quality assessment tool to rehabilitation clinical practice guidelines. The 573 deduplicated abstracts were independently screened by two authors, resulting in 81 articles, the full texts of which were independently screened by two authors for Appraisal of Guidelines for Research & Evaluation II application to rehabilitation clinical practice guidelines, resulting in a final selection of 40 reviews appraising 504 clinical practice guidelines. Data were extracted from these by one author and checked by a second. Data on each clinical practice guideline included the six Appraisal of Guidelines for Research & Evaluation II domain scores, as well as the two Appraisal of Guidelines for Research & Evaluation II global evaluations. RESULTS All six Appraisal of Guidelines for Research & Evaluation II domain scores were statistically significant predictors of overall clinical practice guideline quality rating; D3 (rigor of development) was the strongest and D1 (scope and purpose) the weakest (overall model P < 0.001, R2 = 0.53). Five of the six domain scores were significant predictors of the clinical practice guideline use recommendation, with D3 the strongest predictor and D5 (applicability) the weakest (overall model P < 0.001, pseudo R2 = 0.53). CONCLUSIONS Quality of rehabilitation clinical practice guidelines may be improved by addressing key domains such as rigor of development.
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Ogunlana MO, Govender P, Oyewole OO, Odole AC, Falola JL, Adesina OF, Akindipe JA. Qualitative exploration into reasons for delay in seeking medical help with diabetic foot problems. Int J Qual Stud Health Well-being 2021; 16:1945206. [PMID: 34219610 PMCID: PMC8259813 DOI: 10.1080/17482631.2021.1945206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose Delay in reporting foot symptoms in patients with diabetes to health-care professionals is said to be responsible for limb amputation. While reasons for these delays have been investigated elsewhere, they are not well documented in Nigeria. This study explored the causes of delayed presentation in a Nigerian sample of patients with diabetic foot ulcers. Method The study followed an explorative qualitative design in which the lived experience of eight participants with diabetes were explored. The participants completed in-depth interviews which were digitally audio-recorded and transcribed verbatim. Data were analysed thematically using deductive reasoning. Results The study identified four themes which included knowledge and awareness of foot challenges, risk perception, health seeking triggers and behaviours and competing priority as the factors responsible for delay in presentation of diabetic foot complications. Conclusions Limited knowledge and awareness and negative health seeking behaviours including self-management and consultation of traditionalists were the major reasons for delays.
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Affiliation(s)
- Michael Opeoluwa Ogunlana
- Federal Medical Centre, Abeokuta, Nigeria.,College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Pragashnie Govender
- Discipline of Occupational Therapy, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Olufemi Oyeleye Oyewole
- Department of Physiotherapy , Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
| | | | | | - Olubiyi F Adesina
- Unit of Endocrinology, Department of Internal Medicine, Federal Medical Centre, Abeokuta, Nigeria
| | - Jabez Ariyo Akindipe
- Unit of Plastic Surgery, Department of Surgery, Federal Medical Centre, Abeokuta, Nigeria
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Diabetic foot disease: a systematic literature review of patient-reported outcome measures. Qual Life Res 2021; 30:3395-3405. [PMID: 34109501 DOI: 10.1007/s11136-021-02892-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE Diabetic foot disease is one of the most serious and expensive complications of diabetes. Patient-reported outcome measures (PROMs) analyse patients' perception of their disability, functionality and health. The goal of this work was to conduct a systematic review regarding the specific PROMs related to the evaluation of diabetic foot disease and to extract and analyse the values of their measurement properties. METHODS Electronic databases included were PubMed, CINAHL, Scopus, PEDro, Cochrane, SciELO and EMBASE. The search terms used were foot, diabet*, diabetic foot, questionnaire, patient-reported outcome, self-care, valid*, reliabil*. Studies whose did not satisfy the Critical Appraisals Skills Programme (CASP) Diagnostic Study Checklist were excluded. The measurement properties extracted were: Internal Consistency, Test-retest, Inter-rater and Intra-rater, Standard Error of Measurement, Minimum Detectable Measurement Difference, Content Validity, Construct Validity, Criterion Validity and Responsiveness. RESULTS The PROMs selected for this review were 12 questionnaires. The Diabetic foot self-care questionnaire (DFSQ-UMA) and the Questionnaire for Diabetes Related Foot Disease (Q-DFD) were the PROMs that showed the highest number of completed measurement properties. CONCLUSION According to the results, it is relevant to create specific questionnaires for the evaluation of diabetic foot disease. It seems appropriate to use both DFSQ-UMA and Q-DFD when assessing patients with diabetic foot disease.
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Interpretation of Near-Infrared Imaging in Acute and Chronic Wound Care. Diagnostics (Basel) 2021; 11:diagnostics11050778. [PMID: 33925990 PMCID: PMC8144992 DOI: 10.3390/diagnostics11050778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
Vascular assessment is a critical component of wound care. Current routine noninvasive vascular studies have limitations which can give a false sense of security of the presence of adequate perfusion for healing. Near-infrared imaging modalities can serve as an additional diagnostic assessment of wounds in which adequate perfusion is a concern. Correct interpretation of near-infrared images obtained is critical as subtleties that exist in the acute and chronic wound population goes beyond the interpretation that increased signal is consistent with adequate perfusion for healing. The objective of this paper is to educate providers on the correct interpretation of this point-of-care imaging modality in day-to-day wound-care practice to guide clinical decision-making for rapid wound resolution.
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