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Al-Quwaidhi AJ, AlSaleh EM. Future Projections of Diabetes-Related Amputations in Eastern Saudi Arabia During 2022-2045 Using a Validated Epidemiological Model. Cureus 2023; 15:e45972. [PMID: 37900427 PMCID: PMC10600592 DOI: 10.7759/cureus.45972] [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] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
INTRODUCTION Diabetes-related amputations (DRA) are associated with significant morbidity and mortality. There are limited studies on the burden of this condition and its future projections in Saudi Arabia. OBJECTIVES To estimate future forecasts in the burden of DRA (number of cases and mortalities) among adult diabetics (aged ≥20 years) in Al-Ahsa, Eastern Region of Saudi Arabia from 2022 to 2045. METHODS A simulation epidemiological model was designed and validated. It is a simple discrete-state model composed of multiple states, in which diabetics make annual transitions to either 'Major Amputations', 'Minor Amputations', or 'No Amputations' states, and then to two states of mortalities. The data inputs required are minimal, including the total diagnosed cases of diabetes for 2022 and transition parameters obtained from recent published literature. The model used some reasonable assumptions and scenarios for testing potential uncertainties around the model outputs. Model validation was conducted by comparing its estimates with the observed local data from two main hospitals in Al-Ahsa for 2022. RESULTS The model projected that the total number of DRA among diabetics in Al-Ahsa will increase from 129 (uncertainty interval (UI): 103-154) in 2022 to 169 (UI: 136-203) in 2030 and 227 (UI: 182-272) in 2045, assuming that the incidence rates of major and minor amputations among diabetics will remain constant. However, assuming that these incidence rates will show a gradual decline of 20% every three years, the model predicted the total number of DRA to decrease from 103 (UI: 82-124) in 2022 to 91 (UI: 73-110) in 2030 and 61 (UI: 49-74) in 2045. CONCLUSION DRA impose a considerable burden on patients and the healthcare system, despite the possibility of a potential decrease in incidence rates.
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Affiliation(s)
| | - Essa M AlSaleh
- Infection Control, Al-Ahsa Directorate of Health Affairs, Ministry of Health, Hofuf, SAU
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AlZubaidi HAA, Alfaqih ANO, Alothayqi MHA, Alfaqih HMH, Albarakati AJA, Taha M, Alnashri AM. Knowledge and Practice of the Preventive and Care Methods for Diabetic Foot Among the Caregivers of Diabetic Patients in Saudi Arabia. Cureus 2023; 15:e37887. [PMID: 37213954 PMCID: PMC10199721 DOI: 10.7759/cureus.37887] [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] [Accepted: 04/20/2023] [Indexed: 05/23/2023] Open
Abstract
Background Diabetic foot syndrome is a complex and multifactorial disease process involving neuropathy, peripheral arterial disease, osteomyelitis, diabetic foot ulcer (DFU), and amputation. DFUs are a common and burdensome manifestation of the syndrome, responsible for diabetes-related morbidity and mortality. Successful management of DFU requires collaboration between patients and caregivers. This study assesses the knowledge, experience, and practices of the caregivers of diabetic foot patients in Saudi Arabia, highlighting the need for targeted interventions to improve knowledge and practices in certain subgroups of caregivers. Method The primary objective of this study was to evaluate the proficiency and practicality of caregivers who provide care to patients with diabetic foot in the Kingdom of Saudi Arabia. To accomplish this, a cross-sectional study was conducted among caregivers of diabetic foot patients who were aged 18 years or older and living in Saudi Arabia. The participants were randomly chosen to ensure that the sample was representative. The data collection process involved the distribution of a structured online questionnaire via various social media platforms. Prior to the distribution of the questionnaire, the participants were informed about the study's objectives, and their informed consent was obtained. Additionally, adequate measures were taken to ensure the confidentiality of the participants and their caregiving status. Results Among the initial pool of 2990 participants, 1023 individuals were excluded from the study due to their status as non-caregivers of diabetic patients or being under the age of 18 years. Consequently, the final sample size consisted of 1921 caregivers. The majority of the participants were female (61.6%), married (58.6%), and had a bachelor's degree (52.4%). The findings revealed that 34.6% of caregivers were attending to patients with diabetic foot, of which 8.5% reported poor foot status and 9.1% reported amputation. Caregivers reported examining the patient's feet in 75.2% of cases, and the feet were cleaned and moisturized by either the patient or caregiver. Nails were trimmed by 77.8% of caregivers, and 49.8% of them did not permit patients to walk barefoot. Moreover, knowledge of diabetic foot care was positively correlated with being female, having a post-graduate degree, having personal experience with diabetes, caring for a patient with diabetic foot, and having prior experience in treating diabetic foot. Conversely, lower knowledge levels were associated with divorced or unemployed caregivers and those residing in the northern region. Conclusion The present study highlights that caregivers of diabetic foot patients in Saudi Arabia possess a satisfactory level of knowledge and follow appropriate practices regarding foot care. Nonetheless, it is imperative to identify specific subgroups of caregivers who may require additional education and training to improve their knowledge and practices concerning diabetic foot care. The results of this study could potentially inform the design of tailored interventions aimed at reducing the significant burden of morbidity and mortality attributed to diabetic foot syndrome in the Saudi Arabian context.
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Affiliation(s)
- Hassan Ali A AlZubaidi
- Department of Medicine and Surgery, Umm AlQura University, Al-Qunfudah College of Medicine, Al-Qunfudhah, SAU
| | - Ali Nori O Alfaqih
- Department of Medicine and Surgery, Umm AlQura University, Al-Qunfudah College of Medicine, Al-Qunfudhah, SAU
| | | | - Hassan Mohammed H Alfaqih
- Department of Medicine and Surgery, Umm AlQura University, Al-Qunfudah College of Medicine, Al-Qunfudhah, SAU
| | - Alaa Jameel A Albarakati
- Department of Surgery, Umm AlQura University, Al-Qunfudah College of Medicine, Al-Qunfudhah, SAU
| | - Medhat Taha
- Department of Anatomy, Umm AlQura University, Al-Qunfudah College of Medicine, Al-Qunfudhah, SAU
- Department of Anatomy and Embryology, Mansoura University, Mansoura, EGY
| | - Abdulkarim M Alnashri
- Department of Medicine and Surgery, Umm AlQura University, Al-Qunfudah College of Medicine, Al-Qunfudhah, SAU
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Tan Dat H, Chi Thanh T, Le An P, Thy Khue N. The High Re-Ulceration Rate in Lower Extremity Amputation Intervention in Type 2 Diabetic Vietnamese Patients After 24-Month Follow-Up at Cho Ray Hospital, Vietnam. Health Serv Insights 2023; 16:11786329231174336. [PMID: 37197084 PMCID: PMC10184238 DOI: 10.1177/11786329231174336] [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: 12/21/2022] [Accepted: 04/15/2023] [Indexed: 05/19/2023] Open
Abstract
Diabetic foot ulcers (DFU) are a prevalent and severe disease with vascular and/or neurological complications, and if not diagnosed and treated promptly, it may rapidly deteriorate. Despite amputation or nonamputation treatment, there is still a high rate of re-ulceration. Previous studies have shown that the recurrence rate varies from 43% to 59% after 2 years. Currently, there is still a high rate of lower extremity amputation intervention, particularly above-the-ankle amputation, at Cho Ray Hospital in Vietnam, reaching 50%. The effectiveness of this intervention in the long term based on re-ulceration has not been evaluated in Vietnamese diabetic patients (DPs). This study aims to describe the long-term outcomes of amputation intervention in Type 2 DPs after 24 months and identify factors related to DFU recurrence in order to improve DFU management in low-middle-income countries like Vietnam. From January to June 2022, archived clinical and direct visit or phone follow-up data were collected and analyzed from diabetic foot ulcer patients with low extremity amputation who were treated at Cho Ray hospital from 2018 to 2020. The high re-ulceration rate in the 24th month was 29.8% (17/57), and the factor related to this outcome was "late diagnosis and care" (32.4 days vs 26.9 days with P = .03). Other potential factors (higher rates but no significant statistical difference with P > .05) included failure of HbA1c control greater than 9% (82.5% vs 67.5%), the severity of foot ulcers with TEXAS 3B (82% vs 60%), the number of years having diabetes (8.7 years vs 6.7 years), loss of monofilament sensation (82.5% vs 70.6%), and a history of diabetic foot ulcer (17.6% vs 10%). The re-ulceration after 24 months might depend on various clinical factors. Therefore, early diagnosis and care for diabetic foot ulcers could help reduce amputation rates and the risk of re-ulceration.
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Affiliation(s)
| | - Tran Chi Thanh
- Tran Chi Thanh, University of Medicine and Pharmacy of Ho Chi Minh City, 215 Hong Bang, Ho Chi Minh City 75000, Vietnam.
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Bandarian F, Qorbani M, Nasli-Esfahani E, Sanjari M, Rambod C, Larijani B. Epidemiology of Diabetes Foot Amputation and its Risk Factors in the Middle East Region: A Systematic Review and Meta-Analysis. INT J LOW EXTR WOUND 2022:15347346221109057. [PMID: 35730157 DOI: 10.1177/15347346221109057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aimed to review epidemiology of diabetic foot (DF) amputation and provide a pooled estimation of DF amputation rate in the region. A comprehensive search was performed in Web of Science, PubMed, Scopus and EMBASE databases using appropriate search term. Obtained records were entered endnote software and after removing duplicats were screened by title, abstract and full text. Data was extracted from the remained documents. Random effect meta-analysis was used to pool the estimated prevalence rate due to sever heterogeneity between studies. Finally 17 articles in diabetes, 20 in patients with DFU (diabetic foot ulcer) and two in both remained after screening and included in meta-analysis. Overall pooled amputation rate in diabetes was 2% (95% CI: 1%-3%) which was not significantly different between countries. The pooled prevalence of amputation rate in DFU patients was 33% (24%-43%) and the pooled prevalence in Saudi Arabia was significantly higher than in other countries. The estimated rate of foot amputation in diabetes patients and those with DFUs in the Middle East region is approximately high, which may indicate low quality of preventive foot care, low socioeconomics and low patients awareness or education in countries with high amputation rate.
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Affiliation(s)
- Fatemeh Bandarian
- Metabolomics and Genomics Research Center, Endocrinology and Metabolism Molecular- Cellular Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, 391934Alborz University of Medical Sciences, Karaj, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Sanjari
- Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Camelia Rambod
- Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular -Cellular Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, 48439Tehran University of Medical Sciences, Tehran, Iran
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Polikandrioti M. Quality of life in diabetic foot ulcer, grade 3: associated demographic factors. Folia Med (Plovdiv) 2022; 64:229-239. [DOI: 10.3897/folmed.64.e64876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/11/2021] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction: Patients with diabetic foot ulcer grade 3 experience some limitations that adversely affect their quality of life (QoL).
Aim: The aim of the study was to explore demographic characteristics associated with the quality of life of diabetic foot ulcer patients, grade 3.
Materials and methods: The present study recruited 120 diabetic foot ulcer patients. Data collected by completion of SF-36 Health Survey (SF-36).
Results: Of the 120 participants, 65.8% were men and 73% were more than 60 years of age. Patients showed moderate to high levels of quality of life in social functionality, energy/fatigue, emotional well-being, and physical pain (medians: 50, 60, 72, and 67.5, respectively) and poor levels in physical functioning, role physical, and role emotional (medians: 22, 0 and 0, respectively). In addition, patients had moderate levels of quality of life in general health (median: 48.5). It was observed that physical functioning was significantly associated with place of residence (p=0.005). Moreover, physical role was significantly associated with age (p=0.020) and occupation (p=0.018), while emotional role was significantly associated with age (p=0.012), marital status (p=0.016), and occupation (p=0.012). Energy/fatigue was significantly associated with age (p=0.026), marital status (p=0.018), and occupation (p=0.009). Emotional well-being was significantly associated with gender (p=0.009), level of education (p=0.001), and occupation (p=0.007). Social functionality was significantly associated with marital status (p=0.001) while pain was significantly associated with education level (p=0.010). General health was significantly associated with marital status (p=0.037), and place of residence (p=0.024).
Conclusions: The findings of the present study may adequately inform stakeholders in the field of diabetic foot ulcer grade 3 when planning effective care.
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Almohammadi AA, Alnashri MM, Abdulrahman T Harun R, Alsamiri SM, Alkhatieb MT. Pattern and type of amputation and mortality rate associated with diabetic foot in Jeddah, Saudi Arabia: A retrospective Cohort Study. Ann Med Surg (Lond) 2022; 73:103174. [PMID: 34976392 PMCID: PMC8689050 DOI: 10.1016/j.amsu.2021.103174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 01/13/2023] Open
Abstract
Background Diabetic foot complications constitute a major public health problem worldwide, especially in Jeddah, Saudi Arabia, where the prevalence of diabetes is high. Our study was designed to determine the pattern and type of amputations performed on patients with diabetic foot admitted to a tertiary center in Jeddah, Saudi Arabia; we also aimed to determine the 7-year mortality rate of patients with diabetic foot at the same institution. Materials and methods This retrospective study was conducted between January 2013 and September 2020 at a tertiary center in Jeddah, Saudi Arabia. It included all patients previously diagnosed with diabetes mellitus who presented to the hospital with either diabetic foot ulcers or foot gangrene (dry/wet/gas). The medical records of 358 patients were reviewed to acquire information regarding demographics, admission history regarding diabetes and its outcome, medical and surgical history, the level of amputation, and the presence of infection. Results Among the participants, 84.9% underwent amputation, 38.2% underwent minor amputations, 40.1% underwent major amputations, and 21.7% underwent both types of amputation. The most common cause of amputation was infection (50.3%). There were 75 deaths and a 7-year mortality rate of 20%. Low mean hemoglobin and high mean creatinine levels were significantly associated with mortality (p < 0.05). Conclusion Efforts to decrease the risk of amputation and mortality among patients with diabetic foot complications are required. Early detection of the risk factors and intervention in specialist centers with a multidisciplinary approach is essential. Diabetic foot complications are a serious health problem, especially in our society. The risk for lower limb amputation increased significantly with a high hemoglobin A1c. Once infection occurs, the risk of diabetic foot–related amputation significantly increases. Premature death was identified among patients underwent amputation.
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Affiliation(s)
| | | | | | | | - Maram Taha Alkhatieb
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Altoijry A, AlGhofili H, Alanazi SN, AlHindawi DA, AlAkeel NS, Julaidan BS, AlHamzah M, Altuwaijri T. Diabetic foot and peripheral arterial disease. Single centre experience. Saudi Med J 2021; 42:49-55. [PMID: 33399171 PMCID: PMC7989311 DOI: 10.15537/smj.2021.1.25640] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/14/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To determine the prevalence of vasculopathic diabetic foot and the associated factors in a Saudi tertiary center. Methods: This retrospective chart review included adult patients (≥18 years) diagnosed with diabetic foot between May 2015 and July 2019 in King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia. Based on clinical presentation and laboratory results, the patients were categorized into 2 groups namely, "vascular induced diabetic foot group" and "non-vascular induced diabetic foot group". RESULTS A total of 404 diabetic patients were enrolled in the study. The mean age of the patients was 62.03±12.30 years; 61.9% were males. Most of the diabetic foot cases had a non-vascular etiology (n=327, 80.9%), while 77 cases (19.1%) were due to vasculopathy. Patient in the vascular group had a significantly higher incidence of coronary artery disease (32.5% versus 14.4%; p greater than 0.001), and a higher incidence of peripheral artery disease (PAD) in the unaffected limb (22.1% versus 2.1%; p less than 0.001). Conclusion: Most cases of diabetic foot were due to non-vascular causes. Old age, history of coronary artery disease, or PAD in the unaffected limb were factors that were significantly associated with diabetic foot due to arterial disease.
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Affiliation(s)
- Abdulmajeed Altoijry
- Division of Vascular Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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Lane KL, Abusamaan MS, Voss BF, Thurber EG, Al-Hajri N, Gopakumar S, Le JT, Gill S, Blanck J, Prichett L, Hicks CW, Sherman RL, Abularrage CJ, Mathioudakis NN. Glycemic control and diabetic foot ulcer outcomes: A systematic review and meta-analysis of observational studies. J Diabetes Complications 2020; 34:107638. [PMID: 32527671 PMCID: PMC7721205 DOI: 10.1016/j.jdiacomp.2020.107638] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 05/05/2020] [Accepted: 05/16/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To evaluate the association between glycemic control (hemoglobin A1C, fasting glucose, and random glucose) and the outcomes of wound healing and lower extremity amputation (LEA) among patients with diabetic foot ulcers (DFUs). RESEARCH DESIGN AND METHODS Medline, EMBASE, Cochrane Library, and Scopus were searched for observational studies published up to March 2019. Five independent reviewers assessed in duplicate the eligibility of each study based on predefined eligibility criteria and two independent reviewers assessed risk of bias. Ameta-analysis was performed to calculate a pooled odds ratio (OR) or hazard ratio (HR) using random effects for glycemic measures in relation to the outcomes of wound healing and LEA. Subgroup analyses were conducted to explore potential source of heterogeneity between studies. The study protocol is registered with PROSPERO (CRD42018096842). RESULTS Of 4572 study records screened, 60 observational studies met the study eligibility criteria of which 47 studies had appropriate data for inclusion in one or more meta-analyses(n = 12,604 DFUs). For cohort studies comparing A1C >7.0 to 7.5% vs. lower A1C levels, the pooled OR for LEA was 2.04 (95% CI, 0.91, 4.57) and for studies comparing A1C ≥ 8% vs. <8%, the pooled OR for LEA was 4.80 (95% CI 2.83, 8.13). For cohort studies comparing fasting glucose ≥126 vs. <126 mg/dl, the pooled OR for LEA was 1.46 (95% CI, 1.02, 2.09). There was no association with A1C category and wound healing (OR or HR). There was high risk of bias with respect to comparability of cohorts as many studies did not adjust for potential confounders in the association between glycemic control and DFU outcomes. CONCLUSIONS Our findings suggest that A1C levels ≥8% and fasting glucose levels ≥126 mg/dl are associated with increased likelihood of LEA in patients with DFUs. A purposively designed prospective study is needed to better understand the mechanisms underlying the association between hyperglycemia and LEA.
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Affiliation(s)
- Kyrstin L Lane
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Mohammed S Abusamaan
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Betiel Fesseha Voss
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Emilia G Thurber
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Noora Al-Hajri
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Shraddha Gopakumar
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Jimmy T Le
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Sharoon Gill
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Jaime Blanck
- Informationist Services, Welch Medical Library, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Laura Prichett
- Biostatistics, Epidemiology and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Ronald L Sherman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Christopher J Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Nestoras N Mathioudakis
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
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Al Ayed M, Ababneh M, Alwin Robert A, Al Misfer N, Cruz M, Austria HC, Al Dawish M. Factors Associated With Health-Related Quality of Life in Patients With Diabetic Foot Ulcer: A Cross-Sectional Study From Saudi Arabia. Cureus 2020; 12:e8658. [PMID: 32699658 PMCID: PMC7370698 DOI: 10.7759/cureus.8658] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background and objective Diabetic foot ulcers (DFU) have been shown to have a high impact on the patients' perceived health-related quality of life (HRQOL). The aim of this study was to estimate the HRQOL and its related risk factors in patients with foot ulcers associated with type 2 diabetes mellitus (T2DM). Methods This cross-sectional study was performed on 81 patients with DFU, from January 2019 to July 2019 at the Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia. The study population was purposively and conveniently chosen based on patients' availability during their regular and customary outpatient clinic visits. Using the Arabic version of the Short-Form 36-Item Survey (SF-36), these patients were interviewed and their HRQOL scores were was assessed. The SF-36 covered eight aspects of health such as physical functioning, body pain, limitations in the roles induced by physical health problems, limitations in the roles caused by personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions. Results It was evident that age, gender, education, occupation, smoking, duration of diabetes, hypertension, dyslipidemia, body mass index (BMI), and the number of diabetes-associated complications, hypertension, and dyslipidemia significantly affected the patients' physical functions. The physical health of the patient was strongly influenced by gender, education, occupation, income, BMI, and the number of complications. The emotional health of the patient was affected by dyslipidemia, deformity, prior amputations, as well as BMI and glycosylated hemoglobin (HbA1c). The social standing of the patient was influenced by age, income, education, and occupation. The degree of pain experienced by the patient varied with age and the number of complications, as well as notable differences in their general health. The factors of age, education, occupation, income, and the number of diabetic complications induced several health changes in varying degrees. The patients with DFU revealed overall lower HRQOL relating to all the eight aspects of the SF-36. Conclusion The patients with DFU in Saudi Arabia generally revealed lower HRQOL. However, prospective and large-scale studies are required in the future to support these findings.
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Affiliation(s)
- Mousab Al Ayed
- Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, Riyadh, SAU
| | - Mutasem Ababneh
- Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, Riyadh, SAU
| | | | - Nasser Al Misfer
- Department of Physical Therapy, Prince Sultan Military Medical City, Riyadh, SAU
| | - Maria Cruz
- Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, Riyadh, SAU
| | - Hesiel C Austria
- Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, Riyadh, SAU
| | - Mohamed Al Dawish
- Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, Riyadh, SAU
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Dong J, Tian M, Song F, Tang J, Liu Y, Wu M, Li J, Zhou J, Huang L, Dong W, Lu S. Epidemiological investigation of vascular etiological examinations in the diagnosis and treatment of lower-extremity ulcers in China. Wound Repair Regen 2020; 28:532-538. [PMID: 32386345 DOI: 10.1111/wrr.12810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/27/2022]
Abstract
The vascular causes of lower-extremity ulcers cannot be neglected because they can directly affect treatment methods. No detailed epidemiological statistics have described vascular etiological diagnosis in China. This study aimed to explore the prevalence of clinical vascular etiological examination of lower-extremity ulcers and improve the diagnosis and treatment effectiveness of lower-extremity ulcers. Data were collected from the WoundCareLog database, which includes 2413 cases of lower-extremity ulcers from 478 hospitals nationwide. Data analysis revealed that 1698 (70.4%) lower-extremity blood flow examinations (including physical examination [PE] and assistant examinations [AE]) were performed, of which 61.7% were PE, 10.4% were AE only, and 27.9% were the combined PE and AE[PAE]. The proportion of nonexaminations was higher in the nondiabetic group than in the diabetic group (χ2 = 34.5; P < .01). The positive rates of vascular etiological examination in the diabetic and nondiabetic groups were 69.7% and 70.7%, respectively. Among the four economic regions of China, there were statistically significant differences in the use of the different examination methods. The examination of vascular diseases in lower-extremity ulcers in China has not been fully popularized and requires improvement; there was no statistically significant difference between examination rates by doctors and nurses, which is mainly based on PE. However, PE has certain rates of misdiagnosis and missed diagnosis. The false-positive and false-negative rates were 25.7% and 57.6%, respectively. The use of an AE can compensate for this deficiency by making diagnosis more precise, while the quantitative diagnostic criteria allow disease diagnosis to transcend geographical and operator differences and maximize uniformity. The vascular B-ultrasound examination is more suitable for the medical environment in China because of its mature technology, high hospital penetration rate, and low cost.
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Affiliation(s)
- Jiaoyun Dong
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Tian
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fei Song
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiajun Tang
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingkai Liu
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Minjie Wu
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Li
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jingqi Zhou
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lifang Huang
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Dong
- Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Key Laboratory of Regenerative Medicine, Ministry of Education, Guangzhou, Guangdong, China
| | - Shuliang Lu
- Wound Healing Center, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Alkhalaf MI, Hussein RH, Hamza A. Green synthesis of silver nanoparticles by Nigella sativa extract alleviates diabetic neuropathy through anti-inflammatory and antioxidant effects. Saudi J Biol Sci 2020; 27:2410-2419. [PMID: 32884424 PMCID: PMC7451673 DOI: 10.1016/j.sjbs.2020.05.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 10/27/2022] Open
Abstract
Green synthesis of silver nanoparticles has gained great interest among scientists. In view of this data, we conducted this study to identify the ameliorative effect of green synthesis of silver nanoparticles using Nigella sativa extract in diabetic neuropathy induced experimentally. In this study, 50 adult male albino rats were used and they were randomly divided into five groups; the first group was the healthy control group, the second group were the diabetic neuropathy diabetic neuropathy induced, Groups (3-6) diabetic neuropathy induced group and treated with silver nanoparticles, Nigella sativa extract and green synthesized silver nanoparticles using Nigella sativa extract respectively. Biochemical parameters including diabetic, inflammatory and antioxidant biomarkers were evaluated. Brain histopathology was also performed. Results revealed substantial rise in glucose, AGE, aldose reductase with insulin reduction in diabetic neuropathy induced group as compared to healthy control. Also, inflammatory markers increased significantly in diabetic neuropathy induced group. A remarkable change in oxidative status was observed in the same group. Furthermore, significant decline in nitrotyrosin level was observed. Regarding gene expression, we found significant down regulation in brain TKr A accompanied by upregulation of nerve growth factor in diabetic neuropathy group comparing with healthy control. Several treatments for diabetic neuropathy remarkably ameliorate all the investigated biomarkers. Histological findings are greatly relied on for the results achieved in this study. Therefore, it can be established that green synthesis of silver nanoparticles in combination with Nigella sativa extract could be a newly neuroprotective agents against inflammation and oxidative stress characterizing diabetic neuropathy through their antidiabetic, anti-inflammatory and anti-oxidants effects.
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Affiliation(s)
- Maha I Alkhalaf
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.,Biochemistry Department, Faculty of Science, University of Jeddah, Jeddah, Saudi Arabia
| | - Rasha H Hussein
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.,Biochemistry Department, Faculty of Science, University of Jeddah, Jeddah, Saudi Arabia.,Biochemistry and Nutrition Department, Faculty of Women for Arts, Science and Education, Ain Shams University, Cairo, Egypt
| | - Amal Hamza
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.,Biochemistry Department, Faculty of Science, University of Jeddah, Jeddah, Saudi Arabia.,Biochemistry and Nutrition Department, Faculty of Women for Arts, Science and Education, Ain Shams University, Cairo, Egypt
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12
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Polikandrioti M, Vasilopoulos G, Koutelekos I, Panoutsopoulos G, Gerogianni G, Alikari V, Dousis E, Zartaloudi A. Depression in diabetic foot ulcer: Associated factors and the impact of perceived social support and anxiety on depression. Int Wound J 2020; 17:900-909. [PMID: 32219987 DOI: 10.1111/iwj.13348] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 03/13/2020] [Indexed: 12/31/2022] Open
Abstract
Diabetic foot ulcer (DFU) exerts a heavy physical and emotional burden on patients with diabetes mellitus. The purpose of the present study was to explore the impact of anxiety and perceived social support on depression of DFU patients well as patients' characteristics associated with depression. The sample of the study consisted of 180 DFU patients. Data collected by the completion of "Self-rating Depression/Anxiety Scale- Zung" (SDS/SAS) and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients had moderate levels of anxiety and depression (median: 36, 42, respectively) and high levels of perceived social support from their significant ones, their family and friends (median: 24, 24, 17, respectively). After multiple regression factors that were found to have an impact on depression after taking into account all other factors, were patient's age of above 70 years, patient's anxiety and the social support they received from their significant ones. More specifically, patients aged above 70 years had 9.51 points higher depression than patients aged <50 years of age (β = 9.51, 95% CI: [0.76, 18.25], P = .034). Moreover, one point increase in patient's anxiety score indicated an increase of 0.71 points in patient's depression (β = 0.71, 95% CI: [0.43, 1.00], P = .001). On the contrary, one point increase in patient's social support from their significant ones indicated a decrease of 1.52 points in patient's depression (β = -1.52, 95% CI: [-0.25, -2.79], P = .020). Clinically, a better understanding of factors having an impact on depression on DFU may provide an essential in planning cost effective interventions.
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Affiliation(s)
| | | | | | | | | | - Victoria Alikari
- Department of Nursing, University of West Attica, Athens, Greece
| | - Evaggelos Dousis
- Department of Nursing, University of West Attica, Athens, Greece
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13
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Ugwu E, Adeleye O, Gezawa I, Okpe I, Enamino M, Ezeani I. Predictors of lower extremity amputation in patients with diabetic foot ulcer: findings from MEDFUN, a multi-center observational study. J Foot Ankle Res 2019; 12:34. [PMID: 31223342 PMCID: PMC6570910 DOI: 10.1186/s13047-019-0345-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/04/2019] [Indexed: 12/19/2022] Open
Abstract
Background Lower extremity amputation (LEA) is a potential sequelae of diabetic foot ulceration (DFU) and is associated with huge morbidly and mortality. Low and middle income countries are currently at the greatest risk of diabetes-related complications and deaths. We sought to identify demographic, clinical and laboratory variables that significantly predict LEA in patients hospitalized for DFU. Methods The Multi-center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study conducted between March 2016 and April 2017 in six tertiary healthcare institutions. We prospectively followed 336 diabetic patients hospitalized for DFU and managed by a multidisciplinary team until discharge or death. Demographic and diabetes-related information and ulcer characteristics were documented. Patients were evaluated for neuropathy, peripheral arterial disease (PAD) and medical co-morbidities while relevant laboratory and imaging tests were performed. The study end-points were ulcer healing, LEA, duration of hospitalization and mortality. Here we present data on amputation. Results One hundred and nineteen subjects (35.4%) underwent LEA during the follow-up period. Univariate predictors of LEA were ulcer duration more than 1 month prior to hospitalization (P < 0.001), PAD (P < 0.001), Wagner grade ≥ 4 (P < 0.001), wound infection (P 0.041), Proteinuria (P 0.021), leucocytosis (P 0.001) and osteomyelitis (P < 0.001). On multivariate regression, only three variables emerged as significant independent predictors of LEA and these include: ulcer duration more than 1 month (O.R. 10.3, 95% C.I. 4.055–26.132), PAD (O.R. 2.8, 95% C.I. 1.520–5.110) and presence of osteomyelitis (O.R. 5.6, 95% C.I. 2.930–10.776). Age, gender, diabetes type and duration, neuropathy, glycemic control and anemia did not predict LEA in the studied population. Conclusion We identified duration of ulcer greater than 1 month, PAD, Wagner grade 4 or higher, proteinuria, leucocytosis, wound infection and osteomyelitis as the significant predictors of LEA in patients hospitalized for DFU. Prompt attention to these risk factors may reduce amputation rate among these patients.
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Affiliation(s)
- Ejiofor Ugwu
- 1Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Enugu State University of Science and Technology, Enugu, Nigeria
| | - Olufunmilayo Adeleye
- 2Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Lagos State University, Lagos, Nigeria
| | - Ibrahim Gezawa
- 3Department of Medicine, Division of endocrinology, Diabetes and Metabolism, Bayero University, Kano, Nigeria
| | - Innocent Okpe
- 4Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Ahmadu Bello University, Zaria, Nigeria
| | - Marcelina Enamino
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Federal Medical Center, Keffi, Nigeria
| | - Ignatius Ezeani
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, Federal Medical Center, Umuahia, Nigeria
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14
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Tsoulou V, Karamolegou E, Kourakos M, Vasilopoulos G, Polikandrioti M. Association of State and Trait Anxiety Between Patients Who Had Undergone Traumatic Amputation and Their Family Caregivers. INT J LOW EXTR WOUND 2019; 18:176-185. [PMID: 31096796 DOI: 10.1177/1534734619848580] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this research was to explore the association between state and trait anxiety experienced by patients who had undergone traumatic amputation and their family caregivers. The sample studied consisted of 50 hospitalized patients who had undergone traumatic amputation and 50 family caregivers. The collected data included patients' and caregivers' characteristics and the State Trait Anxiety Inventory scores. Fifty percent of patients and caregivers scored below 50 and 47, respectively (median), in trait anxiety. In terms of state anxiety, at least 50% of patients and caregivers scored below 56 and 50.5, respectively. These values indicate moderate to high levels of the impact of amputation on the trait and state anxiety of amputees and their caregivers. A positive linear correlation was found between the trait and state anxiety of the patients as well as between the trait and state anxiety of caregivers, as expected (ρ = 0.915, P < .001, and ρ = 0.920, P < .001, respectively). A statistically significant positive correlation was also observed between state patient anxiety and state anxiety of caregivers (ρ = 0.239 and P = .039) and between trait patient anxiety and trait anxiety of caregivers (ρ = 0.322 and P = .030). More specifically, as the patient's anxiety score (either trait temporary) increases, the score of the caregivers' anxiety increases and vice versa. Nurses should be aware of the association between anxiety of amputees and caregivers and, therefore, work in multidisciplinary teams to maximize clinical outcomes for patients after amputation and their families.
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15
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Zubair M, Al Amri M, Ahmad J. A retrospective study of ABI and TBI during the healing of ulcer among diabetic patients. Diabetes Metab Syndr 2019; 13:78-83. [PMID: 30641806 DOI: 10.1016/j.dsx.2018.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 08/21/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the role of ABI and TBI in the detection of ulcer wounds among diabetic patients. METHODS A retrospective approach is used to enroll 192 diabetic patients to detect their ulcer wounds using ABI and TBI index. HbA1c and lipid profile were other important variables in determining the efficacy of screening test. Frequency analysis and Pearson Correlation were used to analyze the data through SPSS. FINDINGS The results have shown that 57.1% male and 42.9% female were treated in <0.60 ABI group; 67.4% male and 32.6% female were treated in 0.60-0.90 ABI group; 65.9% male and 34.1% female were treated in 0.90-1.30 ABI group; and 63.8% male and 36.2% female were treated in >1.30 ABI group. The correlation showed insignificant association between ABI and ulcer outcomes, but significant association between TBI and ulcer outcomes at 5% level of significance. CONCLUSION The study concluded that ABI should be based on standardized normal values to be used as an effective biomarker in screening diabetic foot ulcer patients.
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Affiliation(s)
- Mohammad Zubair
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk, 71491, Saudi Arabia; Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, 202002, India.
| | - Marai Al Amri
- Department of Surgery, Faculty of Medicine, University of Tabuk, Tabuk, 71491, Saudi Arabia
| | - Jamal Ahmad
- Rajiv Gandhi Centre for Diabetes and Endocrinology, Faculty of Medicine, J.N. Medical College, Aligarh Muslim University, Aligarh, 202002, India.
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16
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Uysal S, Arda B, Taşbakan MI, Çetinkalp Ş, Şimşir IY, Öztürk AM, Uysal A, Ertam İ. Risk factors for amputation in patients with diabetic foot infection: a prospective study. Int Wound J 2017; 14:1219-1224. [PMID: 28722354 PMCID: PMC7950123 DOI: 10.1111/iwj.12788] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/07/2017] [Indexed: 12/18/2022] Open
Abstract
There is a variety of diagnostic and therapeutic algorithms for diabetic foot infections (DFIs). Some of them are too difficult to be applied in routine clinical approach. In the routine clinical approach, it is necessary to find new risk factors and end up with a quick and easy assessment of DFIs. In this study, we aimed to evaluate the independent risk factors for osteomyelitis, amputation and major amputation in patients with DFI using standard scoring procedures. We prospectively studied 379 patients with DFI. The variables were analysed using logistic analysis. A total of 126 cases (33·2%) underwent amputation. The odds ratios in the amputation model were 3·09 for osteomyelitis (P < 0·001), 4·90 for arterial stenosis (AS) (P < 0·001), 3·67 for the history of DFI (P = 0·001), 2·47 for ulcer duration >60 days (P = 0·001), 3·10 for ulcer depth > 15 mm (P < 0·001) and 10·28 for fungal DFI (P = 0·015). In this study, the unusual result of well-known literature was fungal DFI as an independent risk factor for amputation in patients with DFI.
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Affiliation(s)
- Serhat Uysal
- Department of Infectious Diseases and Clinical MicrobiologyEge University Medical FacultyIzmirTurkey
| | - Bilgin Arda
- Department of Infectious Diseases and Clinical MicrobiologyEge University Medical FacultyIzmirTurkey
| | - Meltem I Taşbakan
- Department of Infectious Diseases and Clinical MicrobiologyEge University Medical FacultyIzmirTurkey
| | - Şevki Çetinkalp
- Department of Endocrinology and MetabolismEge University Medical FacultyIzmirTurkey
| | - Ilgın Y Şimşir
- Department of Endocrinology and MetabolismEge University Medical FacultyIzmirTurkey
| | - Anıl M Öztürk
- Department of Orthopedics and TraumatologyEge University Medical FacultyIzmirTurkey
| | - Ayşe Uysal
- Department of Internal MedicineEge University Medical FacultyIzmirTurkey
| | - İlgen Ertam
- Department of DermatologyEge University Medical FacultyIzmirTurkey
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Petropoulos IN, Javed S, Azmi S, Khan A, Ponirakis G, Malik RA. Diabetic neuropathy and painful diabetic neuropathy in the Middle East and North Africa (MENA) region: Much work needs to be done. J Taibah Univ Med Sci 2016. [DOI: 10.1016/j.jtumed.2016.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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