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Baek YJ, Lee E, Jung J, Won SH, An CY, Kang EM, Park SY, Baek SL, Chun DI, Kim TH. Diabetic Foot Osteomyelitis Undergoing Amputation: Epidemiology and Prognostic Factors for Treatment Failure. Open Forum Infect Dis 2024; 11:ofae236. [PMID: 38983712 PMCID: PMC11232692 DOI: 10.1093/ofid/ofae236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Indexed: 07/11/2024] Open
Abstract
Background When treating diabetic foot osteomyelitis (DFO), it remains difficult to determine the presence of residual infection and the optimal treatment after bone resection. In this study, we aimed to investigate the clinical characteristics of and prognostic factors in patients with DFO undergoing amputation. Methods This retrospective study involved 101 patients with DFO who underwent amputation. Data on their demographics, clinical characteristics, tissue culture, and surgery type were collected. Patients were grouped according to primary closure status and clinical outcome postamputation. A good outcome was defined as a successful complete remission, characterized by the maintenance of complete wound healing with no sign of infection at 6 months postamputation. Multivariate logistic regression analysis was performed. Outcomes according to surgery type were also analyzed. Results Staphylococcus aureus (17%) and Pseudomonas species (14%) were the most prevalent pathogens. Gram-negative bacteria were isolated from 62% of patients. In patients with primary closure, hemodialysis and ankle brachial index (ABI) <0.6 were associated with poor outcomes. In patients with DFO, ABI <0.6 was the only prognostic factor associated with treatment failure. Antimicrobial stewardship allows patients who underwent major amputation to reduce the duration of antibiotic therapy compared to those after minor amputation, although it did not contribute to reducing mortality. Conclusions Peripheral artery disease and hemodialysis were associated with poor outcomes despite radical resection of the infected bone. Vigilant monitoring after amputation and antimicrobial stewardship implemented based on microbiological epidemiology, prognostic factors, and the type of surgery are important. A multidisciplinary team could assist in these activities to ensure treatment success.
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Affiliation(s)
- Yae Jee Baek
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Eunjung Lee
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jongtak Jung
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Sung Hun Won
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Chi Young An
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Eun Myeong Kang
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Hanyang University Seoul Hospital, Seoul, Republic of Korea
| | - Seung Lim Baek
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Dong-Il Chun
- Department of Orthopedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
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Mubaraki AA, Alotaibi NM, Alshaer AA, Alhamayani MH, Althobaiti MF, Alqurashi AM, Alqaedi A, Aljehafy HA. Awareness Level of Diabetic Neuropathy and Its Complications Among Taif City Population in Saudi Arabia. Int J Gen Med 2023; 16:4207-4213. [PMID: 37731898 PMCID: PMC10508277 DOI: 10.2147/ijgm.s426573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/13/2023] [Indexed: 09/22/2023] Open
Abstract
Background Diabetes mellitus (DM) has become one of the most prevalent medical conditions worldwide. Despite the fact that DM affects a substantial proportion of the Saudi population over the age of 30, the general level of awareness of diabetic neuropathy has been reported to be poor in Saudi Arabia. Objective To determine the level of awareness of diabetic neuropathy and its complications among the population of Taif City. Methods This cross-sectional study evaluated the level of awareness of diabetic neuropathy among the population of Taif City using an online pre-designed self-administered questionnaire. Results Of 486 participants enrolled in the study, 57.2% were females and 42.8% were males. In addition, 88.1% of the participants were Saudis. Our study showed that awareness of diabetic neuropathy and its complications among the population of Taif was almost non-existent, with 83.9% of the participants having never heard of diabetic neuropathy in their life. The level of awareness of this disorder was scored as 7.65 1.01 out of a total of 18, even though the educational level of the participants was excellent, and 61.3% of them had a university degree and above. Conclusion This is the first report demonstrating the knowledge of diabetic neuropathy among residents of Taif City. Regardless of educational level, the knowledge of diabetic neuropathy was poor, necessitating greater efforts to increase public awareness using different approaches and campaigns. This will help in the early detection of such complications and impact the response to different treatment modalities.
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Affiliation(s)
- Adnan A Mubaraki
- Department of Medicine, Faculty of Medicine, Taif University, Taif, Saudi Arabia
| | - Naif M Alotaibi
- Intern Medical Student, Faculty of Medicine, Taif University, Taif, Saudi Arabia
| | | | | | - Meshal F Althobaiti
- Intern Medical Student, Faculty of Medicine, Taif University, Taif, Saudi Arabia
| | - Alsharif M Alqurashi
- Intern Medical Student, Faculty of Medicine, Taif University, Taif, Saudi Arabia
| | - Asrar Alqaedi
- Department of Pediatric Nephrology, Taif Children Hospital, Taif, Saudi Arabia
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Santos AADA, Gomes AFL, Silva FSSD, Lima HDC, Silva JMMD, Guedes MBOG, Araújo DN, Botelho Filho CADL, Lopes MR, Lopes JM. Tendência temporal das complicações do pé diabético e da cobertura da Atenção Primária à Saúde nas capitais brasileiras, 2008–2018. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2022. [DOI: 10.5712/rbmfc17(44)3420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introdução: Complicações diabéticas são condições preveníveis em sua maioria, sendo o pé diabético uma das mais comuns. O manejo adequado do pé diabético mitiga eventos incapacitantes e maiores gastos ao sistema de saúde. As intervenções efetivas na Atenção Primária à Saúde (APS) possibilitam prevenir as complicações diabéticas. Objetivo: Analisar a tendência das complicações do pé diabético e sua relação com a cobertura da APS nas capitais brasileiras, entre 2008 e 2018. Métodos: Estudo ecológico de séries temporais das incidências acumuladas de complicações do pé diabético nas 27 capitais utilizando dados do Sistema de Informação sobre Hipertensos e Diabéticos. As variáveis independentes foram ano, cobertura da APS e da Estratégia Saúde da Família. Empregou-se modelo de regressão de Prais-Winsten. Resultados: No Brasil, ocorreram 45.095 casos de complicações do pé diabético no período, com média de 0,57 casos/100.000 habitantes (p<0,001) — estável em 14 capitais (p>0,05) e crescente em 13 capitais (p<0,05). Há associação entre elevação do nível de cobertura da APS e estabilidade na evolução das complicações diabéticas (p<0,05). Conclusões: Evidencia-se aumento da ocorrência das complicações do pé diabético, contudo, nas capitais com crescimento da cobertura da APS, houve controle da progressão.
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Batista FW, Araújo T, Brandão MGSA, Ponte VA. BENEFITS OF OZONE THERAPY IN THE TREATMENT OF FOOT ULCERS IN PEOPLE WITH DIABETES MELLITUS. ESTIMA 2021. [DOI: 10.30886/estima.v19.1090_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: To identify the benefits of ozone therapy in the treatment of foot ulcers in people with diabetes mellitus. Method: Literature review carried out in the CINAHL, Cochrane Library, LILACS, PUBMED, SciELO, SCOPUS and Web of Science databases in the period between April and May 2020. In each database, the controlled descriptors were delimited in the Science Descriptors of Health and Medical Subject Headings, keywords defined: Ozone (Ozone), Diabetic Foot (Diabetic foot), with the help of the Boolean operator AND. Results: 14 primary studies were selected. Most studies have level II evidence, published in English, in different journals, from different parts of the world. 15 benefits of ozone therapy for the treatment of foot ulcers were identified, with a predominance of increased granulation tissue and intensification in the progress of tissue repair. Conclusion: The use of ozone therapy has shown several benefits in the progress in tissue repair of foot ulcers in people with diabetes, increased granulation tissue, promoted antiseptic and bactericidal activities, preventing oxidative stress.
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Affiliation(s)
| | - Thiago Araújo
- Universidade da Integração Internacional da Lusofonia Afro-Brasileira
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Batista FW, Araújo T, Brandão MGSA, Ponte VA. BENEFÍCIOS DA OZONIOTERAPIA NO TRATAMENTO DE ÚLCERAS NOS PÉS EM PESSOAS COM DIABETES MELLITUS. ESTIMA 2021. [DOI: 10.30886/estima.v19.1090_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo:Identificar os benefícios da ozonioterapia no tratamento de úlceras nos pés de pessoas com diabetes mellitus. Métodos: Revisão de literatura realizada nas bases de dados CINAHL, CochraneLibrary, LILACS, PUBMED, SciELO, SCOPUS e Web of Science, no período de abril a maio de 2020. Em cada base de dados, os descritores controlados foram delimitados nos Descritores em Ciências da Saúde e Medical Subject Headings, definidas as palavras-chaves: Ozônio (Ozone) e Pé Diabético (Diabeticfoot), com auxílio do operador booleano AND. Resultados:Houve a seleção de 14 estudos primários. A maioria dos estudos possui nível II de evidência, publicados em inglês, em distintos periódicos, oriundos de diversas partes do mundo. Foram identificados 15 benefícios da ozonioterapia para o tratamento de úlceras nos pés, com predomínio de aumento do tecido de granulação e intensificação no progresso do reparo tecidual. Conclusão: O uso da ozonioterapia apresentou diversos benefícios no progresso do reparo tecidual de úlceras nos pés em pessoas com diabetes, aumentando o tecido de granulação, promovendo atividades antissépticas e bactericidas e prevenindo o estresse oxidativo.
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Affiliation(s)
| | - Thiago Araújo
- Universidade da Integração Internacional da Lusofonia Afro-Brasileira
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Affiliation(s)
- Hélio Amante Miot
- Universidade Estadual Paulista - UNESP, Faculdade de Medicina de Botucatu, Departamento de Dermatologia e Radioterapia, Botucatu, SP, Brasil
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Dos Santos VP, Alves CAS, Queiroz AB, Barberino MGMDA, Fidelis RJR, Fidelis C, de Araújo JS. Is there concordance between bone and tendon cultures in patients with foot tissue loss? J Vasc Bras 2019; 18:e20190063. [PMID: 31762776 PMCID: PMC6852700 DOI: 10.1590/1677-5449.190063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Deep infections of the extremities are a challenge that threaten limb salvage. Objectives To investigate whether the results of bone and deep tissue cultures from patients with trophic limb ulcers coincide. Methods A retrospective study was conducted with data from 54 patients with deep trophic limb ulcers admitted to the Complexo Hospitalar Universitário Professor Edgard Santos, Salvador (BA), Brazil. The study analyzed all patients for whom cultures of material from foot wounds in patients with tissue loss had been performed using two specimen types: bone and fragments of deep tendon. The study analyzed concordance between the two sample types and total number of microorganisms and numbers of microorganisms by Gram staining in both samples. Results The mean age of the 54 patients in the sample was 63.6 years, 80% had PAOD, 70% were diabetic, and 72% were hypertensive. Analysis of the cultures showed that 28 (52%) pairs of samples from the 54 patients exhibited complete concordance, with the same microorganisms grown from fragments of deep tendon and bone. There was partial disagreement in 13 samples (24%) and total disagreement in 13 (24%). On average, 1.62 microorganisms were isolated from deep tendon fragments and 1.72 were isolated from bone samples. Analyzing Gram-positive microorganisms separately, the mean number of species grown was 0.48 for tendon cultures and 0.44 for bone cultures. In contrast, the mean number of Gram-negative microorganisms isolated was 1.14 for tendon samples and 1.27 for bone samples. Conclusions Around half of the patients with foot tissue loss had bone and tendon cultures that coincided exactly.
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Affiliation(s)
- Vanessa Prado Dos Santos
- Universidade Federal da Bahia - UFBA, Instituto de Humanidades Artes e Ciências Professor Milton Santos, Salvador, BA, Brasil
| | - Carlos Alberto Silveira Alves
- Universidade Federal da Bahia - UFBA, Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, BA, Brasil
| | - André Brito Queiroz
- Universidade Federal da Bahia - UFBA, Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, BA, Brasil
| | | | - Ronald José Ribeiro Fidelis
- Universidade Federal da Bahia - UFBA, Complexo Hospitalar Universitário Professor Edgard Santos, Salvador, BA, Brasil
| | - Cícero Fidelis
- Universidade Federal da Bahia - UFBA, Faculdade de Medicina da Bahia, Salvador, BA, Brasil
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Amini A, Soleimani H, Abdollhifar MA, Moradi A, Ghoreishi SK, Chien S, Bayat M. Stereological and gene expression examinations on the combined effects of photobiomodulation and curcumin on wound healing in type one diabetic rats. J Cell Biochem 2019; 120:17994-18004. [PMID: 31148250 DOI: 10.1002/jcb.29102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/19/2019] [Accepted: 04/29/2019] [Indexed: 12/16/2022]
Abstract
We examined the effects of photobiomodulation (PBM) independently and combined with curcumin on stereological parameters and basic fibroblast growth factor (bFGF), hypoxia-inducible factor-1α (HIF-1α), and stromal cell-derived factor-1α (SDF-1α) gene expressions in an excisional wound model of rats with type one diabetes mellitus (T1DM). T1DM was induced by an injection of streptozotocin (STZ) in each of the 90 male Wistar rats. One round excision was generated in the skin on the back of each of the 108 rats. The rats were divided into six groups (n = 18 per group): control (diabetic), untreated group; vehicle (diabetic) group, which received sesame oil; PBM (diabetic) group; curcumin (diabetic) group; PBM + curcumin (diabetic) group; and a healthy control group. On days 4, 7, and 15, we conducted both stereological and quantitative real-time PCR (qRT-PCR) analyses. The PBM and PBM + curcumin groups had significantly better inflammatory response modulation in terms of macrophages (P < .01), neutrophils (P < .001), and increased fibroblast values compared with the other groups at day 4 (P < .001), day 7 (P < .01), and day 15 (P < .001). PBM treatment resulted in increased bFGF gene expression on days 4 (P < .001) and 7 (P < .001), and SDF-1α gene expression on day 4 (P < .001). The curcumin group had increased bFGF (P < .001) expression on day 4. Both the PBM and PBM + curcumin groups significantly increased wound healing by modulation of the inflammatory response, and increased fibroblast values and angiogenesis. The PBM group increased bFGF and SDF-1α according to stereological and gene expression analyses compared with the other groups. The PBM and PBM + curcumin groups significantly increased the skin injury repair process to more rapidly reach the proliferation phase of the wound healing in T1DM rats.
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Affiliation(s)
- Abdollah Amini
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hasan Soleimani
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad-Amin Abdollhifar
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Moradi
- Department of Biology and Anatomical Sciences, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Sufan Chien
- Price Institute of Surgical Research, University of Louisville, and Noveratech LLC of Louisville, Louisville, Kentucky, USA
| | - Mohammad Bayat
- Price Institute of Surgical Research, University of Louisville, and Noveratech LLC of Louisville, Louisville, Kentucky, USA.,Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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