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Tuttolomondo A, Di Raimondo D, Casuccio A, Guercio G, Del Cuore A, Puleo MG, Della Corte V, Bellia C, Caronia A, Maida C, Pecoraro R, Simonetta I, Gulotta G, Ciaccio M, Pinto A. Endothelial function, adipokine serum levels and white matter hyperintesities in subjects with diabetic foot syndrome. J Clin Endocrinol Metab 2019; 104:3920-3930. [PMID: 30977833 DOI: 10.1210/jc.2018-02507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 04/08/2019] [Indexed: 12/29/2022]
Abstract
CONTEXT No study analysed the prevalence of white matter hyperintesities (WMHs) in subjects with diabetic foot syndrome (DFS) and their relationship with adipokine serum levels and indexes of endothelial and cognitive performance. OBJECTIVE To evaluate omentin and vaspin serum levels and WMHs prevalence in subjects with DFS and to analyse their relationship with other endothelial, arterial stiffness and cognitive function. RESEARCH DESIGN AND METHODS Case-control study enrolling 40 subjects with DFS, 40 diabetic subjects without foot complications, 40 controls with foot lesions without diabetes and 40 patients without diabetes mellitus. MAIN OUTCOME MEASURE Pulse wave velocity (PWV), augmentation index (Aix), Reactive hyperemia index (RHI), serum vaspin and omentin levels, Fazekas Score, MMSE. RESULTS Subjects with DFS showed higher mean PWV values if compared with diabetic controls, lower RHI values if compared with controls. They also showed a lower mean MMSE score, significantly lower omentin serum levels, a higher prevalence of grade 2 severity of periventricular hyperintensities (PVH). We observed a significant positive correlation between PWV and PVH, between Fazekas Score and PWV among diabetic subjects, whereas among subjects with diabetic foot we observed a significant negative correlation between PVH and RHI. CONCLUSIONS Diabetes seems to be more associated with endothelial function disturbance in comparison with patients with diabetic foot that exhibit a more strict association with microvascular brain damage as indicated by our significant finding of an association with periventricular hyperintensities.
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Affiliation(s)
| | | | - Alessandra Casuccio
- Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
| | - Giovanni Guercio
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.)
| | | | - Maria Grazia Puleo
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
| | - Vittoriano Della Corte
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
| | - Chiara Bellia
- Section of Clinical Biochemistry and Molecular Biology, Department of Biopathology and Medical Biotechnologies (Di.Bi.Med.), University of Palermo
| | | | - Carlo Maida
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
| | - Rosaria Pecoraro
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
| | - Irene Simonetta
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
| | - Gaspare Gulotta
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.)
| | - Marcello Ciaccio
- Section of Clinical Biochemistry and Molecular Biology, Department of Biopathology and Medical Biotechnologies (Di.Bi.Med.), University of Palermo
| | - Antonio Pinto
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine G. D'Alessandro, University of Palermo ( Italy)
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Hassan Al Imam M, Alamgir H, Jahan Akhtar N, Hossain Z, Islam R, Sohrab Hossain M. Characterisation of persons with lower limb amputation who attended a tertiary rehabilitation centre in Bangladesh. Disabil Rehabil 2019; 42:1995-2001. [DOI: 10.1080/09638288.2018.1544671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development, University of South Asia, Dhaka, Bangladesh
| | - Hasanat Alamgir
- Department of Public Health, New York Medical College, Valhalla, NY, USA
| | - Noor Jahan Akhtar
- Department of Prosthetics & Orthotics, Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh
| | - Zahid Hossain
- Department of Physiotherapy, Bangladesh Health Professions Institute, Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh
| | - Rangila Islam
- Department of Occupational Therapy, Beautiful Mind, Dhaka, Bangladesh
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Mabrouk M, Kumar P, Choonara YE, du Toit LC, Pillay V. Artificial, Triple-Layered, Nanomembranous Wound Patch for Potential Diabetic Foot Ulcer Intervention. MATERIALS (BASEL, SWITZERLAND) 2018; 11:E2128. [PMID: 30380682 PMCID: PMC6265852 DOI: 10.3390/ma11112128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/20/2018] [Accepted: 10/23/2018] [Indexed: 12/24/2022]
Abstract
The present work aims to electrospin a triple layered wound patch for potential treatment of diabetic foot ulcers (DFU). The patch consisted of poly(acrylic acid) (PAA) as the skin contacting layer, polyvinyl pyrrolidone (PVP) as the middle layer, and polycaprolactone (PCL) as the outermost layer, wherein the PVP layer was loaded in situ with an antibiotic (ciprofloxacin, CFX). Morphology and mechanical properties were investigated using SEM and texture analysis. Patch quality was studied with regards to wettability, adherence, water resistance, and moisture uptake of individual layers. SEM results confirmed the fibrous and membranous nature of layers with a nano-to-micro size range. Mechanical properties of the composite patch demonstrated a tensile strength of 12.8 ± 0.5 MPa, deformation energy of 54.35 ± 0.1 J/m³, and resilience of 17.8 ± 0.7%, which were superior compared to individual layers. Patch quality tests revealed that the PCL layer showed very low wettability, adherence, and moisture uptake compared to the PVP and PAA layers. In vitro drug release data revealed an increase in cumulative drug release with higher drug loading. The results above confirm the potential of a triple layered, tripolymeric, wound patch for DFU intervention.
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Affiliation(s)
- Mostafa Mabrouk
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown 2109, South Africa.
- Refractories, Ceramics and Building Materials Department, National Research Centre, 33 El Bohouthst. (former EL Tahrirst.), Dokki, Giza P.O.12622, Egypt.
| | - Pradeep Kumar
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown 2109, South Africa.
| | - Yahya E Choonara
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown 2109, South Africa.
| | - Lisa C du Toit
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown 2109, South Africa.
| | - Viness Pillay
- Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 7 York Road, Parktown 2109, South Africa.
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Abstract
BACKGROUND The Amputation Prevention Initiative is a project conducted jointly by the Massachusetts Public Health Association and the Massachusetts Podiatric Medical Society that seeks to study methods to reduce nontraumatic lower-extremity amputations from diabetes. METHODS To determine the rate of diabetes-related lower-extremity amputations in Massachusetts and identify the groups most at risk, hospital billing and discharge data were analyzed. To examine the components of the diabetic foot examination routinely performed by general practitioners, surveys were conducted in conjunction with physician meetings in Massachusetts (n = 149) and in six other states (n = 490). RESULTS The average age-adjusted number of diabetes-related lower-extremity amputations in 2004 was 30.8 per 100,000 and 5.3 per 1,000 diabetic patients in MA, with high-risk groups being identified as men and black individuals. Among the general practitioners surveyed in Massachusetts, only 2.01% reported routinely conducting all four key components of the diabetic foot examination, with 28.86% reporting not performing any components. CONCLUSIONS These findings suggest that many general practitioners may be failing to perform the major components of the diabetic foot examination believed to prevent foot ulcers and lower-extremity amputations.
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Affiliation(s)
- Emily A Cook
- Division of Podiatric Surgery, Mount Auburn Hospital, Harvard Medical School, Cambridge, MA
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Katz DE, Friedman ND, Ostrovski E, Ravid D, Amrami N, Avivi D, Mengesha B, Zaidenstein R, Lazarovitch T, Dadon M, Marchaim D. Diabetic foot infection in hospitalized adults. J Infect Chemother 2016; 22:167-73. [PMID: 26806149 DOI: 10.1016/j.jiac.2015.12.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/15/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Acute infections of the diabetic foot (DFI) are a common and complex condition. Patients are generally managed in the ambulatory setting and epidemiological data pertaining to hospitalized patients is lacking. The aim of this study was to analyze the epidemiology, microbiology and outcomes of hospitalized patients with DFI, who are managed at a referral center equipped with hyperbaric oxygen (HBO) therapy. METHODS A retrospective cohort study of adult patients admitted to a tertiary referral center with DFI over a six-month period in 2013 was undertaken. Predictors of clinical outcomes and efficacy of treatment modalities were analyzed by Cox regression. RESULTS Sixty-one patients with DFI were identified. Most patients were elderly (67 ± 13 years), with long-standing (17 ± 9 years), poorly controlled (HbA1c 9 ± 3%) diabetes. Most patients had polymicrobial infection (80%); specifically, anaerobic (39%) and multi or extensively-drug resistant organisms (61%). Administration of appropriate antimicrobials was delayed for >48 h in 83%. Advanced age was associated with worse outcomes. Sicker patients with severe peripheral vascular disease were managed with HBO. The use of HBO was associated with higher costs and increased functional deterioration, and did not prevent future limb amputation. CONCLUSIONS Our study illustrates the descriptive epidemiology of hospitalized adults with DFI predominantly of polymicrobial etiology. MDROs and anaerobic organisms are common causative pathogens, and appropriate antibiotics were frequently delayed. HBO treatment may delay the need for limb amputation, but not obviate this eventual outcome.
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Affiliation(s)
- David E Katz
- Department of Internal Medicine D, Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - Evgenia Ostrovski
- Department of Internal Medicine D, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Dor Ravid
- Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Nadav Amrami
- Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Dori Avivi
- Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Bethlehem Mengesha
- Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Ronit Zaidenstein
- Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tsilia Lazarovitch
- Clinical Microbiology Laboratory, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Mor Dadon
- Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Dror Marchaim
- Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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Fernandez MLG, Lozano RM, Diaz MIGQ, Jurado MAG, Hernandez DM, Montesinos JVB. How effective is orthotic treatment in patients with recurrent diabetic foot ulcers? J Am Podiatr Med Assoc 2014; 103:281-90. [PMID: 23878380 DOI: 10.7547/1030281] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND We assessed the efficacy of customized foot orthotic therapy by comparing reulceration rates, minor amputation rates, and work and daily living activities before and after therapy. Peak plantar pressures and peak plantar impulses were compared with the patients not wearing and wearing their prescribed footwear. METHODS One hundred seventeen patients with diabetes were prescribed therapeutic insoles and footwear based on the results of a detailed biomechanical study and were followed for 2 years. All of the patients had a history of foot ulcers, but none had undergone previous orthotic therapy. RESULTS Before treatment, the reulceration rate was 79% and the amputation rate was 54%. Two years after the start of orthotic therapy, the reulceration rate was 15% and the amputation rate was 6%. Orthotic therapy reduced peak plantar pressures in patients with reulcerations and in those without (P < .05), although a significant decrease in peak plantar impulses was achieved only in patients not experiencing reulceration. Sick leave was reduced from 100% to 26%. CONCLUSIONS Personalized orthotic therapy targeted at reducing plantar pressures by off-loading protects high-risk patients against reulceration. Treatment reduced the reulceration rate and peak plantar pressures, leading to patients' return to work or other activities.
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The reliability of physical performance measures in peripheral neuropathy. Gait Posture 2008; 28:343-6. [PMID: 18321706 DOI: 10.1016/j.gaitpost.2008.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2007] [Revised: 12/31/2007] [Accepted: 01/20/2008] [Indexed: 02/02/2023]
Abstract
UNLABELLED The purpose of this study was to evaluate the test-retest reliability of select physical performance measures among people with peripheral neuropathy (PN). METHODS 20 PN patients (12 women, 8 men, mean age=68.4+/-12.5 years) were assessed on two separate occasions. Plantar pressure sensitivity was determined with a monofilament of known strength. Functional capacity and mobility were measured by the 6-min walk (6MW) and timed up-and-go (TUG) tests, respectively. Standing balance was evaluated by computing the average velocity (VEL) and area enclosing 95% of the body COP (A95) while participants stood quietly with eyes closed for multiple trials of varying length. Isokinetic knee extensor and flexor peak torque (KEPT, KFPT) were measured with an dynamometer during five maximal voluntary contractions. RESULTS Plantar sensitivity and all measures of physical function demonstrated significant reliability. High reliability was observed for the 6MW (ICC=0.94) and the two-trial average TUG (ICC=0.99). Similarly, KEPT and KFPT were highly reliable whether using the top trial, or averaging the three best trials (ICCs>0.96). Averaging multiple standing balance trials generally increased ICC values, with 30s trials appearing to possess the highest reliability. DISCUSSION Despite the heterogeneity of the PN population, select measures of physical performance are highly reliable and therefore recommended for use when examining physical function in these patients.
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Pinto A, Tuttolomondo A, Di Raimondo D, Fernandez P, La Placa S, Di Gati M, Licata G. Cardiovascular risk profile and morbidity in subjects affected by type 2 diabetes mellitus with and without diabetic foot. Metabolism 2008; 57:676-82. [PMID: 18442633 DOI: 10.1016/j.metabol.2008.01.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 01/09/2008] [Indexed: 12/16/2022]
Abstract
Diabetic foot syndrome (DFS) is the most frequent cause of hospitalization of diabetic patients and one of the most economically demanding complications of diabetes. People with diabetes have been shown to have higher mortality than people without diabetes. On this basis, the aim of our study was to evaluate the possible role of diabetic foot as a cardiovascular risk marker in patients with type 2 diabetes mellitus. We enrolled 102 consecutive patients with type 2 diabetes mellitus with diabetic foot and 123 patients with type 2 diabetes mellitus without limb lesions to compare the prevalence of main cardiovascular risk factors, subclinical cardiovascular disease, previous cardiovascular morbidity, and incidence of new vascular events on a 5-year follow-up. Diabetic patients with diabetic foot were more likely to have a higher prevalence of cardiovascular risk factors such as hypercholesterolemia, hypertriglyceridemia, hyperuricemia, and microalbuminuria or proteinuria, a higher prevalence of a previous cardiovascular morbidity (coronary artery disease, transient ischemic attack/ischemic stroke, diabetic retinopathy), and a higher prevalence of subclinical cardiovascular disease. Furthermore, diabetic patients with foot ulceration showed, on a 5-year follow-up, a higher incidence of new-onset vascular events (coronary artery disease, transient ischemic attack/ischemic stroke, diabetic retinopathy). At multivariate analysis, duration of diabetes, age, hemoglobin A1c, and DFS maintained a significant association with cardiovascular morbidity; but DFS presence showed the highest hazard ratio.
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Affiliation(s)
- Antonio Pinto
- Biomedical Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy
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Kravitz SR, McGuire JB, Sharma S. The treatment of diabetic foot ulcers: reviewing the literature and a surgical algorithm. Adv Skin Wound Care 2007; 20:227-37; quiz 237-9. [PMID: 17415031 DOI: 10.1097/01.asw.0000266643.97417.eb] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To provide an overview of the literature related to the treatment of diabetic foot ulcers. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in wound care. OBJECTIVES After reading this article and taking this test, the reader should be able to:
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Affiliation(s)
- Steven R Kravitz
- Leonard Abrams Center for Advanced Wound Healing, Department of Orthopedics and Primary Podiatric Medicine, Temple University School of Podiatric Medicine, Philadelphia, PA, USA
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Frykberg RG, Zgonis T, Armstrong DG, Driver VR, Giurini JM, Kravitz SR, Landsman AS, Lavery LA, Moore JC, Schuberth JM, Wukich DK, Andersen C, Vanore JV. Diabetic foot disorders. A clinical practice guideline (2006 revision). J Foot Ankle Surg 2006; 45:S1-66. [PMID: 17280936 DOI: 10.1016/s1067-2516(07)60001-5] [Citation(s) in RCA: 438] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The prevalence of diabetes mellitus is growing at epidemic proportions in the United States and worldwide. Most alarming is the steady increase in type 2 diabetes, especially among young and obese people. An estimated 7% of the US population has diabetes, and because of the increased longevity of this population, diabetes-associated complications are expected to rise in prevalence. Foot ulcerations, infections, Charcot neuroarthropathy, and peripheral arterial disease frequently result in gangrene and lower limb amputation. Consequently, foot disorders are leading causes of hospitalization for persons with diabetes and account for billion-dollar expenditures annually in the US. Although not all foot complications can be prevented, dramatic reductions in frequency have been achieved by taking a multidisciplinary approach to patient management. Using this concept, the authors present a clinical practice guideline for diabetic foot disorders based on currently available evidence, committee consensus, and current clinical practice. The pathophysiology and treatment of diabetic foot ulcers, infections, and the diabetic Charcot foot are reviewed. While these guidelines cannot and should not dictate the care of all affected patients, they provide evidence-based guidance for general patterns of practice. If these concepts are embraced and incorporated into patient management protocols, a major reduction in diabetic limb amputations is certainly an attainable goal.
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Affiliation(s)
- Robert G Frykberg
- Podiatric Surgery, Carl T. Hayden VA Medical Center, Phoenix, Arizona 85012, USA.
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