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Benyakorn T, Orrapin S. Association Between the Society for Vascular Surgery (SVS)-WIfI (Wound, Ischemia, Foot Infection) Classification, Wagner-Meggitt Classification, and Amputation Rate in Patients With Diabetic Foot Infection. INT J LOW EXTR WOUND 2024; 23:33-42. [PMID: 37853714 DOI: 10.1177/15347346231208342] [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: 10/20/2023]
Abstract
Diabetic foot infection (DFI) is a common problem in patients with diabetic foot disease. Amputations and other complications of DFI lead to significant morbidity and mortality. The Society for Vascular Surgery (SVS)-WIfI (wound, ischemia, and foot infection) classification system can evaluate the benefit from revascularization and the risk of amputation in 1 and 3 years. We aimed to evaluate SVS-WIfI and Wagner-Meggitt (WM) prediction of DFI outcome, and to determine factors associated with major amputation and mortality rate. The patients with diabetes who presented between June 2018 and May 2020 with characteristics suggesting a more serious DFI or potential indications for hospitalization were reviewed in this cohort study. Demographic data, clinical characteristics, and type of revascularization were evaluated. One-year and 3-year amputation and mortality rates were the main outcomes. The grading of WM classification and the SVS-WIfI score were compared between amputation and nonamputation groups. Association between mortality and comorbidity were analyzed. One hundred and thirty-one patients admitted with DFI were included in study. And 73.28% had peripheral arterial disease (PAD). The 1-year and 3-year major amputation rates were 16.03% and 26.23%, respectively. Seventy-eight (59.54%) patients required minor amputation to control infection before revascularization. PAD (risk ratio [RR] 1.47: 95% confidence interval [CI] 1.29-1.67, P = .032), benefit from revascularization clinical stage 3 on SVS-WIfI score (RR 4.56: 95%CI 1.21-17.21, P = 0.007), and high WM classification score (RR 9.46: 95% CI 5.65-15.82, P < 0.001) were associated by multivariate analysis with high amputation rates. 1-year & 3-year amputation risk on SVS-WIfI score were not associated with amputation rates in DFI (P = .263 and .496). Only 9 (6.8%) patients were lost to follow up during the 3-year period. WM classification score, SVS-WIfI score on benefit from revascularization, and PAD were strongly associated with major amputation rates in patients with DFI.
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Affiliation(s)
- Thoetphum Benyakorn
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand
- Thammasat University Center of excellence for Diabetic foot Care (TU-CDC), Thammasat University Hospital, Pathum Thani, Thailand
| | - Saritphat Orrapin
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand
- Thammasat University Center of excellence for Diabetic foot Care (TU-CDC), Thammasat University Hospital, Pathum Thani, Thailand
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Reddie M, Shallal C, Frey D. A Scoping Review of Footwear Worn by People With Diabetes in Low- and Middle-Income Countries: Implications for Ulcer Prevention Programs. GLOBAL HEALTH, SCIENCE AND PRACTICE 2023; 11:GHSP-D-22-00392. [PMID: 37116930 PMCID: PMC10141434 DOI: 10.9745/ghsp-d-22-00392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/29/2023] [Indexed: 04/30/2023]
Abstract
International guidelines advise people with diabetes to wear close-toed, thick-soled footwear to protect against foot ulceration. However, this type of footwear is incompatible with some of the cultures, climates, and socioeconomic conditions in many low- and middle-income countries (LMICs). This scoping review aims to summarize what is known about footwear used by people with diabetes in LMICs and consider whether international diabetic foot guidelines are practical and actionable in these contexts, given current practices. PubMed, CINAHL, Scopus, Embase, Web of Science, Latin American and Caribbean Health Sciences Literature, and African Journals Online were searched for articles that documented the footwear used by people with diabetes in LMICs. Twenty-five studies from 13 countries were eligible for inclusion and indicated that a large proportion of people with diabetes wear footwear that is considered inappropriate by current guidance, with sandals and flip-flops being popular choices in a majority of the studies. Reasons given for these choices include poverty, lack of awareness of and provider communication about the importance of footwear selection, comfort, and cultural norms. We recommend that LMIC health care systems relying on international guidelines critically consider whether their recommendations are sensible in their settings. Diabetic foot experts and LMIC-based health care stakeholders should collaborate to design alternative guidelines, strategies, and interventions specifically for LMIC contexts to increase preventative practice feasibility and uptake.
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Affiliation(s)
- Madison Reddie
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Christopher Shallal
- Harvard University-Massachusetts Institute of Technology Health Sciences and Technology, Cambridge, MA, USA
| | - Daniel Frey
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
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Yasom S, Khumsri W, Boonsongserm P, Kitkumthorn N, Ruangvejvorachai P, Sooksamran A, Wanotayan R, Mutirangura A. B1 siRNA Increases de novo DNA Methylation of B1 Elements and Promotes Wound Healing in Diabetic Rats. Front Cell Dev Biol 2022; 9:802024. [PMID: 35127718 PMCID: PMC8807477 DOI: 10.3389/fcell.2021.802024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022] Open
Abstract
Alu (B1 in rodents) hypomethylation, commonly found in diabetes mellitus patients, increases DNA damage and, consequently, delays the healing process. Alu siRNA increases Alu methylation, reduces DNA damage, and promotes cell proliferation.Aim: To explore whether B1 siRNA treatment restores B1 hypomethylation, resulting in a reduction in DNA damage and acceleration of the healing process in diabetic rat wounds.Methods: We generated splinted-excisional wounds in a streptozotocin (STZ)-induced type I diabetic rat model and treated the wounds with B1 siRNA/Ca-P nanoparticles to generate de novo DNA methylation in B1 intersperse elements. After treatment, we investigated B1 methylation levels, wound closure rate, wound histopathological structure, and DNA damage markers in diabetic wounds compared to nondiabetic wounds.Results: We reported that STZ-induced diabetic rat wounds exhibited B1 hypomethylation, wound repair defects, anatomical feature defects, and greater DNA damage compared to normal rats. We also determined that B1 siRNA treatment by Ca-P nanoparticle delivery restored a decrease in B1 methylation levels, remedied delayed wound healing, and improved the histological appearance of the wounds by reducing DNA damage.Conclusion: B1 hypomethylation is inducible in an STZ-induced type I diabetes rat model. Restoration of B1 hypomethylation using B1 siRNA leads to increased genome stability and improved wound repair in diabetes. Thus, B1 siRNA intervention may be a promising strategy for reprogramming DNA methylation to treat or prevent DNA damage-related diseases.
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Affiliation(s)
- Sakawdaurn Yasom
- Center of Excellence in Molecular Genetics of Cancer and Human Disease, Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
- Interdisciplinary Program of Biomedical Sciences, Graduate School, Chulalongkorn University, Bangkok, Thailand
| | - Wilunplus Khumsri
- Center of Excellence in Molecular Genetics of Cancer and Human Disease, Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
- Interdisciplinary Program of Biomedical Sciences, Graduate School, Chulalongkorn University, Bangkok, Thailand
| | - Papatson Boonsongserm
- Center of Excellence in Molecular Genetics of Cancer and Human Disease, Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Nakarin Kitkumthorn
- Department of Oral Biology, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | | | - Apasee Sooksamran
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Rujira Wanotayan
- Department of Radiological Technology, Faculty of Medical Technology, Mahidol University, Nakhon Pathom, Thailand
| | - Apiwat Mutirangura
- Center of Excellence in Molecular Genetics of Cancer and Human Disease, Department of Anatomy, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
- *Correspondence: Apiwat Mutirangura,
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Thungtak R, Wannapakhe J, Lapanantasin S. Thai version of the Questionnaire for Diabetes-Related Foot Disease (Thai Q-DFD): validity and reliability. Heliyon 2021; 7:e07832. [PMID: 34471712 PMCID: PMC8387758 DOI: 10.1016/j.heliyon.2021.e07832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 07/12/2021] [Accepted: 08/16/2021] [Indexed: 11/27/2022] Open
Abstract
Aims To reduce diabetic foot complications, an annual screening of diabetes-related foot disease (DRFD) should be promoted. The screening tool as the Thai translated Questionnaire for Diabetes-related Foot Disease, Thai Q-DFD, has been established. The study was designed to assess the validity and reliability of the Thai Q-DFD before practical use in the community. Methods One hundred and thirty-nine persons with diabetes volunteered in a concurrent validity testing for agreement in diagnosis between the Thai Q-DFD and the standard clinical examinations. The test-retest reliability (a stability of a tool over time between three days apart) was assessed in 50 volunteers. The agreement in either validity or reliability test was evaluated using kappa coefficient. Results The screening diagnosis as DRFD by the Thai Q-DFD substantially agreed with that by the standard clinical examinations (kappa = 0.71). The Thai Q-DFD also showed high sensitivity (0.92) and specificity (0.78). Additionally, the Thai Q-DFD presented good test-retest reliability for DRFD diagnosis (kappa = 0.74). Conclusions The Thai Q-DFD is comparable to the original English version in terms of concurrent validity and test-retest reliability. Therefore, it can be used for a screening of DRFD in Thai people.
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Affiliation(s)
- Rapeepun Thungtak
- Physical Therapy Division, Faculty of Physical Therapy, Srinakharinwirot University, Ongkharak, Nakhonnayok 26120, Thailand
| | - Jirabhorn Wannapakhe
- Physical Therapy Division, Faculty of Physical Therapy, Srinakharinwirot University, Ongkharak, Nakhonnayok 26120, Thailand
| | - Saitida Lapanantasin
- Physical Therapy Division, Faculty of Physical Therapy, Srinakharinwirot University, Ongkharak, Nakhonnayok 26120, Thailand
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Kulkantrakorn K, Chomjit A, Sithinamsuwan P, Tharavanij T, Suwankanoknark J, Napunnaphat P. 0.075% capsaicin lotion for the treatment of painful diabetic neuropathy: A randomized, double-blind, crossover, placebo-controlled trial. J Clin Neurosci 2018; 62:174-179. [PMID: 30472337 DOI: 10.1016/j.jocn.2018.11.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/11/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE A randomized, double-blinded, crossover, placebo controlled trial was conducted to evaluate the efficacy and safety of 0.075% capsaicin lotion for treating painful diabetic neuropathy (PDN). PATIENTS AND METHODS PDN subjects were randomized to receive 0.075% capsaicin/placebo for 8 weeks, then crossing over to the other treatment after a 4-weeks washout period. Primary endpoint was the change in visual analog scale score of pain severity. Secondary outcomes were score changes in Neuropathic Pain Scale, short-form McGill Pain Questionnaires, and proportions of patients with pain score reductions of 30% and 50%, and adverse events. RESULTS A total of 42 subjects were enrolled, 27 completed at least an 8-week treatment period. Intention-to-treat analysis showed no significant improvement in pain control with capsaicin lotion compared with placebo for all pain measures and proportion of patients who had 30% or 50% pain relief, respectively. Per protocol analysis were consistent. Capsaicin lotion was well tolerated but local skin reactions were common. CONCLUSION In patients with PDN, the efficacy of 0.075% capsaicin lotion was similar to placebo but was well tolerated. More work is needed to assess different capsaicin formulations.
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Affiliation(s)
- Kongkiat Kulkantrakorn
- Division of Neurology, Department of Internal Medicine, Thammasat University, Pathumthani, Thailand; Center of Excellence for Diabetic Foot Care, Thammasat University Hospital, Pathumthani, Thailand.
| | - Assawin Chomjit
- Division of Neurology, Department of Internal Medicine, Thammasat University, Pathumthani, Thailand
| | - Pasiri Sithinamsuwan
- Division of Neurology, Department of Internal Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Thipaporn Tharavanij
- Center of Excellence for Diabetic Foot Care, Thammasat University Hospital, Pathumthani, Thailand; Division of Endocrinology and Metabolism, Department of Internal Medicine, Thammasat University, Pathumthani, Thailand; Diabetes and Metabolic Syndrome Research Unit, Thammasat University, Pathumthani, Thailand; Center of Excellence in Applied Epidemiology, Thammasat University, Pathumthani, Thailand
| | - Juthamas Suwankanoknark
- Division of Neurology, Department of Internal Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand
| | - Phunyada Napunnaphat
- Center of Excellence for Diabetic Foot Care, Thammasat University Hospital, Pathumthani, Thailand; Department of Nursing, Thammasat University Hospital, Pathumthani, Thailand
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Abstract
Like other countries in the Western Pacific region, Thailand is facing increasing numbers of patients with diabetes due to unhealthy diets, high obesity rates, and an aging society. Diabetes is a considerable burden for developing countries as it reduces quality of life, increases mortality, and drives up healthcare costs. The disease detection rate in Thailand has improved in recent years, but glycemic control remains suboptimal and significant numbers of patients suffer from complications. Universal healthcare coverage has increased access to care, but inequality exists between different health plans and non-medication diabetes supplies are not yet widely covered. Diabetes self-management education has not yet been standardized and a multidisciplinary team approach is not widely utilized. The Thai government recognizes the burden of diabetes and has launched nationwide programs of health promotion and disease prevention. In addition, local initiatives have targeted reductions in specific complications, including retinopathy and diabetic foot problems, which has resulted in better disease prevention and treatment. Along with strategic public health planning, increased collaboration between private and public sectors, enhanced professional training, increased use of technology and data management, and equitable distribution of care are all needed to improve outcomes of patients with diabetes in Thailand.
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Affiliation(s)
- Sirimon Reutrakul
- Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Rd., Ratchathewi, Bangkok, 10400, Thailand.
| | - Chaicharn Deerochanawong
- Rajavithi Hospital, College of Medicine, Rangsit University, Ministry of Public Health, Bangkok, 10400, Thailand
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7<sup>th</sup> Asian PAD Workshop. Ann Vasc Dis 2016; 9:135-47. [DOI: 10.3400/avd.pad.16-01000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Deerochanawong C, Ferrario A. Diabetes management in Thailand: a literature review of the burden, costs, and outcomes. Global Health 2013; 9:11. [PMID: 23497447 PMCID: PMC3623827 DOI: 10.1186/1744-8603-9-11] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 03/04/2013] [Indexed: 12/13/2022] Open
Abstract
Management of diabetes represents an enormous challenge for health systems at every level of development. The latter are tested for their ability to continuously deliver high quality care to patients from the day they are diagnosed throughout their life. In this study, we review the status of diabetes management in Thailand and try to identify the key challenges the country needs to address to reduce the current (and future) medical and economic burden caused by the disease.We conducted a literature review on the burden, costs, and outcomes of diabetes in Thailand. This information was complemented by personal communication with senior officials in the Thai Ministry of Health.We identified the following priorities for the future management of diabetes in Thailand. First, increasing screening of diabetes in high risk population and promoting annual screening of diabetes complications in all diabetic patients. Second, identifying and addressing factors affecting poor treatment outcomes. Third, policy should specify clear targets and provide and use a monitoring framework to track progress. Fourth, efforts are needed to further improve data availability. Up-to-date data on the medical and economic burden of diabetes representative at the national level and at least the regional level are essential to identify needs and monitor progress towards established targets. Fifth, promotion of a healthy lifestyle for prevention of diabetes through education and quality information delivered to the public.
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Affiliation(s)
- Chaicharn Deerochanawong
- Rajavithi hospital, College of Medicine, Rangsit University, Ministry of Public Health, Bangkok, 10400, Thailand
| | - Alessandra Ferrario
- LSE Health, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
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Abstract
Diabetic foot is a leading cause of admission, amputation, and mortality in diabetic patients. A multidisciplinary team approach is highly recommended for the management of patients with foot problems. To heal diabetic foot ulcers, all methods have to be conducted step by step under an efficient program, and all specialists should be well organized also, which was confirmed by the 2 cases described in this article.
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Affiliation(s)
- Yufeng Jiang
- The 306 Hospital of Chinese PLA, Beijing, China
- Chinese PLA General Hospital, Beijing, China
- Burns Institute, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing, China
| | | | - Xiaobing Fu
- Chinese PLA General Hospital, Beijing, China
- Burns Institute, The First Affiliated Hospital of Chinese PLA General Hospital, Beijing, China
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