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Phimnuan P, Dirand Z, Tissot M, Worasakwutiphong S, Sittichokechaiwut A, Grandmottet F, Viyoch J, Viennet C. Beneficial Effects of a Blended Fibroin/Aloe Gel Extract Film on the Biomolecular Mechanism(s) via the MAPK/ERK Pathway Relating to Diabetic Wound Healing. ACS OMEGA 2023; 8:6813-6824. [PMID: 36844531 PMCID: PMC9948169 DOI: 10.1021/acsomega.2c07507] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/23/2023] [Indexed: 06/18/2023]
Abstract
In diabetic patients, the process of wound healing is usually delayed or impaired. A diabetic environment could be associated with dermal fibroblast dysfunction, reduced angiogenesis, the release of excessive proinflammatory cytokines, and senescence features. Alternative therapeutic treatments using natural products are highly demanded for their high potential of bioactive activity in skin repair. Two natural extracts were combined to develop fibroin/aloe gel wound dressing. Our previous studies revealed that the prepared film enhances the healing rate of diabetic foot ulcers (DFUs). Moreover, we aimed to explore its biological effects and underlying biomolecular mechanisms on normal dermal, diabetic dermal, and diabetic wound fibroblasts. Cell culture experiments showed that the γ-irradiated blended fibroin/aloe gel extract film promotes skin wound healing by enhancing cell proliferation and migration, vascular epidermal growth factor (VEGF) secretion, and cell senescence prevention. Its action was mainly linked to the activation of the mitogen-activated protein kinases/extracellular signal-regulated kinase (MAPK/ERK) signaling pathway known to regulate various cellular activities, including proliferation. Therefore, the findings of this study confirm and support our previous data. The blended fibroin/aloe gel extract film displays a biological behavior with favorable properties for delayed wound healing and can be considered as a promising therapeutic approach in the treatment of diabetic nonhealing ulcers.
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Affiliation(s)
- Preeyawass Phimnuan
- Department
of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and
Center of Excellence for Innovation in Chemistry, Naresuan University, Phitsanulok 65000 Thailand
- UMR
1098 RIGHT INSERM EFS FC, DImaCell Imaging Resource Center, University of Franche-Comté, Besançon 25000 France
| | - Zélie Dirand
- UMR
1098 RIGHT INSERM EFS FC, DImaCell Imaging Resource Center, University of Franche-Comté, Besançon 25000 France
| | - Marion Tissot
- UMR
1098 RIGHT INSERM EFS FC, DImaCell Imaging Resource Center, University of Franche-Comté, Besançon 25000 France
| | - Saran Worasakwutiphong
- Division
Plastic and Reconstructive Surgery, Department of Surgery, Faculty
of Medicine, Naresuan University, Phitsanulok 65000 Thailand
| | - Anuphan Sittichokechaiwut
- Department
of Preventive Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok 65000 Thailand
| | - François Grandmottet
- Department
of Biochemistry, Faculty of Medical Science, Naresuan University, Phitsanulok 65000, Thailand
| | - Jarupa Viyoch
- Department
of Pharmaceutical Technology, Faculty of Pharmaceutical Sciences and
Center of Excellence for Innovation in Chemistry, Naresuan University, Phitsanulok 65000 Thailand
| | - Céline Viennet
- UMR
1098 RIGHT INSERM EFS FC, DImaCell Imaging Resource Center, University of Franche-Comté, Besançon 25000 France
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Patients' Perceptions of Reasons Contributing to Delay in Seeking Help at the Onset of a Diabetic Foot Ulcer: A Grounded Theory Study. J Wound Ostomy Continence Nurs 2022; 49:481-487. [PMID: 36108232 DOI: 10.1097/won.0000000000000913] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to explore patients' perception of reasons contributing to delay in seeking help and referral to a wound care specialist at the onset of a diabetic foot ulcer (DFU). DESIGN Constructivist grounded theory study. SUBJECTS AND SETTING The sample comprised 30 individuals with active DFU attending a wound care clinic in southeastern Ontario, Canada. METHODS Participants were selected through purposive and theoretical sampling. Semistructured interviews were conducted with participants until no new properties of the patterns emerged. All interviews were transcribed, coded, and analyzed using methods informed by constructivist grounded theory. RESULTS The reasons contributing to delay to seek help and referral to a wound care specialist were (1) limited knowledge about foot care, (2) unaware of diabetic foot problems, (3) underestimation of ulcer presentation, (4) I thought I could fix it myself, (5) inaccurate diagnosis, and (6) trial and error approach by a nonspecialized wound care provider. CONCLUSIONS Study findings suggest that patients and primary healthcare providers need additional education regarding the management of diabetic foot disease and DFU.
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Khodaie SA, Khalilzadeh SH, Emadi F, Kamalinejad M, Jafari Hajati R, Naseri M. Management of a diabetic foot ulcer with a Myrtle (M. communis) gel based on Persian medicine: A case report. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nguyen H, Koh JY, Li H, Islas-Robles A, Meda Venkata SP, Wang JM, Monks TJ. A novel imidazolinone metformin-methylglyoxal metabolite promotes endothelial cell angiogenesis via the eNOS/HIF-1α pathway. FASEB J 2021; 35:e21645. [PMID: 34105824 PMCID: PMC8237315 DOI: 10.1096/fj.202002674rr] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 12/28/2022]
Abstract
Peripheral arterial disease (PAD) is one of the major complications of diabetes due to an impairment in angiogenesis. Since there is currently no drug with satisfactory efficacy to enhance blood vessel formation, discovering therapies to improve angiogenesis is critical. An imidazolinone metabolite of the metformin‐methylglyoxal scavenging reaction, (E)‐1,1‐dimethyl‐2‐(5‐methyl‐4‐oxo‐4,5‐dihydro‐1H‐imidazol‐2‐yl) guanidine (IMZ), was recently characterized and identified in the urine of type‐2 diabetic patients. Here, we report the pro‐angiogenesis effect of IMZ (increased aortic sprouting, cell migration, network formation, and upregulated multiple pro‐angiogenic factors) in human umbilical vein endothelial cells. Using genetic and pharmacological approaches, we showed that IMZ augmented angiogenesis by activating the endothelial nitric oxide synthase (eNOS)/hypoxia‐inducible factor‐1 alpha (HIF‐1α) pathway. Furthermore, IMZ significantly promoted capillary density in the in vivo Matrigel plug angiogenesis model. Finally, the role of IMZ in post‐ischemic angiogenesis was examined in a chronic hyperglycemia mouse model subjected to hind limb ischemia. We observed improved blood perfusion, increased capillary density, and reduced tissue necrosis in mice receiving IMZ compared to control mice. Our data demonstrate the pro‐angiogenic effects of IMZ, its underlying mechanism, and provides a structural basis for the development of potential pro‐angiogenic agents for the treatment of PAD.
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Affiliation(s)
- Huong Nguyen
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Jia Yi Koh
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Hainan Li
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | | | - Sai Pranathi Meda Venkata
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
| | - Jie-Mei Wang
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA.,Centers for Molecular Medicine and Genetics, Wayne State University, Detroit, MI, USA
| | - Terrence J Monks
- Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, USA
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Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta-analysis. J Foot Ankle Res 2020; 13:15. [PMID: 32192509 PMCID: PMC7083052 DOI: 10.1186/s13047-020-0380-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/27/2020] [Indexed: 12/30/2022] Open
Abstract
Multidisciplinary team (MDT) approach has been shown to reduce diabetic foot ulcerations (DFUs) and lower extremity amputations (LEAs), but there is heterogeneity between team members and interventions. Podiatrists have been suggested as “gatekeepers” for the prevention and management of DFUs. The purpose of our study is to review the effect of podiatric interventions in MDTs on DFUs and LEAs. We conducted a systematic review of available literature. Data’s heterogeneity about DFU outcomes made it impossible for us to include it in a meta-analysis, but we identified 12 studies fulfilling inclusion criteria that allowed for them to be included for LEA outcomes. With the exception of one study, all reported favourable outcomes for MDTs that include podiatry. We found statistical significance in favour of an MDT approach including podiatrists for our primary outcome (total LEAs (RR: 0.69, 95% CI 0.54–0.89, I2 = 64%, P = 0.002)) and major LEAs (RR: 0.45, 95% CI 0.23–0.90, I2 = 67%, P < 0.02). Our systematic review, with a standard search strategy, is the first to specifically address the relevant role of podiatrists and their interventions in an MDT approach for DFU management. Our observations support the literature that MDTs including podiatrists have a positive effect on patient outcomes but there is insufficient evidence that MDTs with podiatry management can reduce the risk of LEAs. Our study highlights the necessity for intervention descriptions and role definition in team approach in daily practice and in published literature.
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Aqueveque P, Osorio R, Pastene F, Saavedra F, Pino E. Capacitive Sensors Array for Plantar Pressure Measurement Insole fabricated with Flexible PCB. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2019; 2018:4393-4396. [PMID: 30441326 DOI: 10.1109/embc.2018.8513383] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diabetic foot is a pathology associated with diabetic neuropathy, where the vast majority of diabetic foot infections terminate in surgical intervention; from debridement to amputation of the involved limb. Commonly, diabetic foot infections come from ulceration produced by high-pressure areas under the foot. For this reason, researchers have been working on a continuous measurement system to detect the high-pressure areas in-shoe in a low cost way. This paper presents the design and implementation of a continuous monitoring device to measure the pressure in-shoe. The pressure sensors are built from commercial flexible PCB and a dielectric sheet. The system measures the pressure distribution in 8 points and sends the information by a wireless Bluetooth link to a personal computer and gives information to the patient in real time.
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Morrison T, Jones S, Causby RS, Thoirs K. Can ultrasound measures of intrinsic foot muscles and plantar soft tissues predict future diabetes-related foot disease? A systematic review. PLoS One 2018; 13:e0199055. [PMID: 29906277 PMCID: PMC6003689 DOI: 10.1371/journal.pone.0199055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/30/2018] [Indexed: 12/25/2022] Open
Abstract
Introduction Diabetes mellitus (DM) is associated with hyperglycaemia and advanced glycosylation end-products. In the foot, the consequences of chronic or uncontrolled diabetes are micro and macrovascular disease, neuropathy, reduced joint mobility and structural and soft tissue changes that increase the risk of ulcer development and amputation. Diabetes foot assessment currently includes a comprehensive history, neurological and vascular assessments and examination focussed on dermatological and musculoskeletal abnormalities. Whilst these assessments are helpful for predicting ulceration risk, direct identifiers that enable early therapeutic intervention are lacking. The intention of this review was to ascertain if B-mode ultrasound could be clinically applied to identify structural change in the diabetic foot and be utilised as an early predictor of ulceration risk. Methods Primary databases and grey literature sources were systematically searched. Selection criteria were that the study included a diabetic sample and used B-mode ultrasound to assess soft tissue structures of the foot (plantar skin, plantar fat pad or intrinsic muscles). Results Fifteen studies were identified for inclusion (combined diabetic sample of 773). Ultrasound demonstrated reductions in tissue thickness in diabetics compared to non-diabetics under first (p = 0.01) and second (p = 0.03) metatarsal heads, but not the third (p = 0.24). Statistical heterogeneity was high for ultrasound thickness measures under metatarsal heads four/five (I2 65%, 81%) and very high for plantar skin (I2 98%), heel pad (I2 76%) and intrinsic muscles (I2 91%, 81%). Extensor digitorum brevis (EDB) ultrasound measures were significantly thinner in diabetics for all dimension measures compared to healthy controls except one study, which reported no significant differences in EDB thickness. Conclusions No direct evidence was found to indicate B-mode ultrasound measures can predict soft tissue changes in the plantar foot in diabetes, although low level studies indicate ultrasound has the potential to identify structural change. Clinical, methodological and statistical heterogeneity limit result applicability. This review highlights the need for robust prospective longitudinal research to examine the predictive validity of this method.
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Affiliation(s)
- Troy Morrison
- School of Health Sciences, University of South Australia, Adelaide, South Australia
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia
- * E-mail:
| | - Sara Jones
- School of Health Sciences, University of South Australia, Adelaide, South Australia
- Department of Rural Health, University of South Australia, Adelaide, South Australia
| | - Ryan S. Causby
- School of Health Sciences, University of South Australia, Adelaide, South Australia
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia
| | - Kerry Thoirs
- School of Health Sciences, University of South Australia, Adelaide, South Australia
- International Centre for Allied Health Evidence (iCAHE), University of South Australia, Adelaide, South Australia
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Kasturi SP, Surarapu S, Uppalanchi S, Dwivedi S, Yogeeswari P, Sigalapalli DK, Bathini NB, Ethiraj KS, Anireddy JS. Synthesis, molecular modeling and evaluation of α-glucosidase inhibition activity of 3,4-dihydroxy piperidines. Eur J Med Chem 2018. [DOI: 10.1016/j.ejmech.2018.02.072] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Evidence based review of literature on detriments to healing of diabetic foot ulcers. Foot Ankle Surg 2017; 23:215-224. [PMID: 29202978 DOI: 10.1016/j.fas.2016.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 04/15/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Diabetes mellitus places a substantial burden on society worldwide. Diabetic foot ulcers are a challenging problem for clinicians. Seven generally accepted detriments to healing of diabetic foot ulcers were identified: infection, glycaemic control, vascular supply, smoking, nutrition, deformity and offloading. The aim of this paper is to present a comprehensive evidence based review of the literature available on detriments to healing of diabetic foot ulcers. METHOD A research question was generated for each of the detriments to healing and a comprehensive review of the literature was performed using the Pubmed database in July 2014. All articles were assessed for relevancy and a level of evidence was assigned. An analysis of the total body of literature was used to assign a grade of recommendation to each detriment. RESULTS Grade A recommendation was assigned to offloading as there was good evidence supporting this intervention. Grade B recommendation was assigned to deformity as there was fair evidence consistent with the hypothesis. Infection and vascular supply had poor quality evidence supporting the research question and grade C recommendation was assigned. Grade I recommendation was assigned to glycaemic control, smoking and nutrition as there was insufficient and conflicting evidence available. CONCLUSION Our literature review revealed good evidence for some factors and insufficient literature on others. Further studies are needed to provide quality evidence regarding detriments to healing of diabetic ulcers.
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Gin H, Rorive M, Gautier S, Condomines M, Saint Aroman M, Garrigue E. Treatment by a moisturizer of xerosis and cracks of the feet in men and women with diabetes: a randomized, double-blind, placebo-controlled study. Diabet Med 2017. [PMID: 28627029 DOI: 10.1111/dme.13402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To evaluate a moisturizer containing urea, glycerine and petrolatum for healing deep open fissures on the feet of people with diabetes. If left untreated, open fissures, an entry point for bacteria, can lead to infection, ulceration and further complications. METHODS This randomized, double-blind, multicentre study at 19 hospitals, general practices and diabetologists in France and Belgium included participants with diabetes and a deep open target fissure on their heel. Participants were randomized to test cream or placebo (1 : 1) for 4 weeks. Complete target fissure healing after 4 weeks (primary criterion) and 2 weeks, target fissure closure, overall fissure healing and xerosis were assessed. RESULTS Some 167 participants were randomized (80 to test cream; 87 to placebo); all were included in the efficacy analyses. The percentage of participants with complete target fissure healing after 4 weeks was higher with test cream than placebo (46.3% vs. 33.3%): the difference did not reach statistical significance (P = 0.088). Fewer participants still had a deep open target fissure with test cream than placebo, the difference was statistically significant and clinically relevant after 2 (24.7% vs. 42.7%, P = 0.027) and 4 weeks (6.4% vs. 24.1%, P = 0.002). The difference in overall fissure healing between test cream and placebo was significant (P < 0.001) and test cream resulted in greater xerosis improvement (P < 0.001 and P = 0.002 at 2 and 4 weeks, respectively). CONCLUSION The activity of the test cream for treating feet fissures of people with diabetes was confirmed by an improvement in open fissure healing and xerosis. The cream was well tolerated.
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Affiliation(s)
- H Gin
- Service de diabétologie, Hospital Haut-Lévêque, 33604, Pessac, France
| | - M Rorive
- Hospitalier Universitaire de Liège, Domaine Universitaire du Sart Tilman, B-4000, Liège, Belgium
| | - S Gautier
- Institut de Recherche Pierre Fabre, CRDPF, 3 avenue Hubert Curien, BP 13562 - 31035, Toulouse Cedex 1, France
| | - M Condomines
- Institut de Recherche Pierre Fabre, CRDPF, 3 avenue Hubert Curien, BP 13562 - 31035, Toulouse Cedex 1, France
| | - M Saint Aroman
- Institut de Recherche Pierre Fabre, CRDPF, 3 avenue Hubert Curien, BP 13562 - 31035, Toulouse Cedex 1, France
| | - E Garrigue
- Institut de Recherche Pierre Fabre, CRDPF, 3 avenue Hubert Curien, BP 13562 - 31035, Toulouse Cedex 1, France
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11
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Implications of Antimicrobial Combinations in Complex Wound Biofilms Containing Fungi. Antimicrob Agents Chemother 2017; 61:AAC.00672-17. [PMID: 28696230 DOI: 10.1128/aac.00672-17] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/03/2017] [Indexed: 01/13/2023] Open
Abstract
Diabetic foot ulcer treatment currently focuses on targeting bacterial biofilms, while dismissing fungi. To investigate this, we used an in vitro biofilm model containing bacteria and fungi, reflective of the wound environment, to test the impact of antimicrobials. Here we showed that while monotreatment approaches influenced biofilm composition, this had no discernible effect on overall quantity. Only by combining bacterium- and fungus-specific antibiotics were we able to decrease the biofilm bioburden, irrespective of composition.
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Adeghate J, Nurulain S, Tekes K, Fehér E, Kalász H, Adeghate E. Novel biological therapies for the treatment of diabetic foot ulcers. Expert Opin Biol Ther 2017; 17:979-987. [PMID: 28532226 DOI: 10.1080/14712598.2017.1333596] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The number of people with diabetes mellitus (DM) is estimated to exceed 640 million by the year 2040. Diabetic foot ulcer (DFU) is a debilitating illness that affects more than 2% of DM patients. DFU is caused by DM-induced neural and vascular lesions leading to a reduced sensation and microcirculation. The increase in the prevalence of DFU has prompted researchers to find new therapies for the management of DFU. Areas covered: This review presents the current status of novel biological therapies used in the treatment of DFU. Literature information and data analysis were collected from PubMed, the website of the American Diabetes Association, and ClinicalTrials.gov. The keywords used in the search were: DM, DFU, complications of DM. Expert opinion: Many biological agents have been investigated in a bid to find an effective therapy for DFU. These include growth factors (platelet-derived growth factor, vascular endothelial growth factor etc), stem cells (epithelial progenitor-, adipose-derived stem cells etc), anti-diabetic drugs (insulin, exendin-4), herbs, urokinase, dalteparin, statins and bio-agents such as acid peptide matrix. Biological agents that can reduce hyperglycaemia, increase sensation, microcirculation and oxygenation and repair lost tissue are the most ideal for the treatment of DFU.
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Affiliation(s)
- Jennifer Adeghate
- a Department of Anatomy , Semmelweis University , Budapest , Hungary
| | - Syed Nurulain
- b COMSATS Institute of Information Technology , Islamabad , Pakistan
| | - Kornélia Tekes
- c Department of Pharmacodynamics , Semmelweis University , Budapest , Hungary
| | - Erzsébet Fehér
- a Department of Anatomy , Semmelweis University , Budapest , Hungary
| | - Huba Kalász
- d Department of Pharmacology and Pharmacotherapy , Semmelweis University , Budapest , Hungary
| | - Ernest Adeghate
- e Department of Anatomy, College of Medicine & Health Sciences , United Arab Emirates University , Al Ain , United Arab Emirates
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Isei T, Abe M, Nakanishi T, Matsuo K, Yamasaki O, Asano Y, Ishii T, Ito T, Inoue Y, Imafuku S, Irisawa R, Ohtsuka M, Ohtsuka M, Ogawa F, Kadono T, Kodera M, Kawakami T, Kawaguchi M, Kukino R, Kono T, Sakai K, Takahara M, Tanioka M, Nakamura Y, Hashimoto A, Hasegawa M, Hayashi M, Fujimoto M, Fujiwara H, Maekawa T, Madokoro N, Yoshino Y, Le Pavoux A, Tachibana T, Ihn H. The wound/burn guidelines - 3: Guidelines for the diagnosis and treatment for diabetic ulcer/gangrene. J Dermatol 2016; 43:591-619. [DOI: 10.1111/1346-8138.13285] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 12/02/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Taiki Isei
- Department of Dermatology; Kansai Medical University; Osaka Japan
| | - Masatoshi Abe
- Department of Dermatology; Gunma University Graduate School of Medicine; Gunma Japan
| | - Takeshi Nakanishi
- Department of Dermatology; Osaka City University Graduate School of Medicine; Osaka Japan
| | - Koma Matsuo
- Department of Dermatology; The Jikei University School of Medicine; Tokyo Japan
| | - Osamu Yamasaki
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Yoshihide Asano
- Department of Dermatology; Faculty of Medicine; University of Tokyo; Tokyo Japan
| | - Takayuki Ishii
- Department of Dermatology; Faculty of Medicine; Institute of Medical, Pharmaceutical and Health Sciences; Kanazawa University; Ishikawa Japan
| | - Takaaki Ito
- Department of Dermatology; Hyogo College of Medicine; Hyogo Japan
| | - Yuji Inoue
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
| | - Shinichi Imafuku
- Department of Dermatology; Faculty of Medicine; Fukuoka University; Fukuoka Japan
| | - Ryokichi Irisawa
- Department of Dermatology; Tokyo Medical University; Tokyo Japan
| | - Masaki Ohtsuka
- Department of Dermatology; Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences; Okayama Japan
| | - Mikio Ohtsuka
- Department of Dermatology; Fukushima Medical University; Fukushima Japan
| | - Fumihide Ogawa
- Department of Dermatology; Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | - Takafumi Kadono
- Department of Dermatology; Faculty of Medicine; University of Tokyo; Tokyo Japan
| | - Masanari Kodera
- Department of Dermatology; Japan Community Health Care Organization Chukyo Hospital; Aichi Japan
| | - Tamihiro Kawakami
- Department of Dermatology; St. Marianna University School of Medicine; Kanagawa Japan
| | - Masakazu Kawaguchi
- Department of Dermatology; Yamagata University Faculty of Medicine; Yamagata Japan
| | - Ryuichi Kukino
- Department of Dermatology; NTT Medical Center; Tokyo Japan
| | - Takeshi Kono
- Department of Dermatology; Nippon Medical School; Tokyo Japan
| | - Keisuke Sakai
- Intensive Care Unit; Kumamoto University Hospital; Kumamoto Japan
| | - Masakazu Takahara
- Department of Dermatology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Miki Tanioka
- Department of Dermatology; Kyoto University Graduate School of Medicine; Kyoto Japan
| | | | - Akira Hashimoto
- Department of Dermatology; Tohoku University Graduate School of Medicine; Miyagi Japan
| | - Minoru Hasegawa
- Department of Dermatology; Faculty of Medicine; Institute of Medical, Pharmaceutical and Health Sciences; Kanazawa University; Ishikawa Japan
| | - Masahiro Hayashi
- Department of Dermatology; Yamagata University Faculty of Medicine; Yamagata Japan
| | - Manabu Fujimoto
- Department of Dermatology; Faculty of Medicine; Institute of Medical, Pharmaceutical and Health Sciences; Kanazawa University; Ishikawa Japan
| | - Hiroshi Fujiwara
- Department of Dermatology; Niigata University Graduate School of Medical and Dental Sciences; Niigata Japan
| | - Takeo Maekawa
- Department of Dermatology; Jichi Medical University; Tochigi Japan
| | - Naoki Madokoro
- Department of Dermatology; Mazda Hospital; Hiroshima Japan
| | - Yuichiro Yoshino
- Department of Dermatology; Japanese Red Cross Kumamoto Hospital; Kumamoto Japan
| | | | - Takao Tachibana
- Department of Dermatology; Osaka Red Cross Hospital; Osaka Japan
| | - Hironobu Ihn
- Department of Dermatology and Plastic Surgery; Faculty of Life Sciences; Kumamoto University; Kumamoto Japan
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Walker CM, Bunch FT, Cavros NG, Dippel EJ. Multidisciplinary approach to the diagnosis and management of patients with peripheral arterial disease. Clin Interv Aging 2015. [PMID: 26203234 PMCID: PMC4504338 DOI: 10.2147/cia.s79355] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Peripheral arterial disease (PAD) is frequently diagnosed after permanent damage has occurred, resulting in a high rate of morbidity, amputation, and loss of life. Early and ongoing diagnosis and treatment is required for this progressive disease. Lifestyle modifications can prevent or delay disease progression and improve symptoms. Limb-sparing endovascular interventions can restore circulation based on appropriate diagnostic testing to pinpoint vascular targets, and intervention must occur as early as possible to ensure optimal clinical outcomes. An algorithm for the diagnosis and management of PAD was developed to enable a collaborative approach between the family practice and primary care physician or internist and various specialists that may include a diabetologist, endocrinologist, smoking cessation expert, hypertension and lipid specialist, endovascular interventionalist, vascular surgeon, orthopedist, neurologist, nurse practitioner, podiatrist, wound healing expert, and/or others. A multidisciplinary team working together has the greatest chance of providing optimal care for the patient with PAD and ensuring ongoing surveillance of the patient’s overall health, ultimately resulting in better quality of life and increased longevity for patients with PAD.
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Affiliation(s)
- Craig M Walker
- Cardiovascular Institute of the South, Tulane University School of Medicine, New Orleans, LA, USA ; Louisiana State University School of Medicine, New Orleans, LA, USA
| | | | - Nick G Cavros
- Cardiovascular Institute of the South, Lafayette General Medical Center, Lafayette, LA, USA
| | - Eric J Dippel
- Cardiovascular Medicine, PC Genesis Heart Institute, Davenport, IA, USA
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Cutaneous manifestations of diabetes mellitus. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2015. [DOI: 10.1016/j.injms.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Yang H, Wang C, Guo M, Zhou Y, Feng Z, Yin Z. Correlations between peroxisome proliferator activator receptor γ, Cystatin C, or advanced oxidation protein product, and atherosclerosis in diabetes patients. Pathol Res Pract 2014; 211:235-9. [PMID: 25543292 DOI: 10.1016/j.prp.2014.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 10/29/2014] [Accepted: 11/07/2014] [Indexed: 10/24/2022]
Abstract
We aimed to explore the relationship between peroxisome proliferator activator receptor γ (PPAR γ), Cystatin C or advanced oxidation protein product (AOPP) and atherosclerosis (AS), and identify their diagnostic values for AS. Eighty AS patients above the age of 75 with type 2 diabetes were screened by brachial-ankle pulse wave velocity (baPWV) and ankle brachial index (ABI). The baseline level of patients was firstly analyzed, and then the expression of PPAR γ was detected by reverse transcriptase-polymerase chain reaction (RT-PCR). Meanwhile, a double-antibody sandwich enzyme-linked immunosorbent assay was performed to analyze the concentration of AOPP, and immunonephelometry was carried out to detect the concentration of Cystatin C. The baseline level of patients was basically consistent. The expression of PPAR γ was significantly higher in severe AS than mild AS patients (P < 0.05), while no differences were found in serum Cystatin C and AOPP between severe AS and mild AS patients (P > 0.05). Thus, PPAR γ exhibited a high diagnostic value for severe AS (AUC = 0.850), but not Cystatin C and AOPP (AUC = 0.553, AUC = 0.4780). Moreover, the combination of PPAR γ, Cystatin C and AOPP exhibited a quite high diagnostic value in AS (AUC = 0.961, Sen = 0.9, Spe = 0.975), which was also higher than PPAR γ alone. In conclusion, the contents of PPAR γ, Cystatin C and AOPP were closely related to AS in diabetes, indicating a potential clinical diagnostic value of PPAR γ, Cystatin C and AOPP in diabetes with AS.
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Affiliation(s)
- Haiyan Yang
- The Cadre Health Care Ward, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University School, Nanjing 210008, Jiangsu Province, China
| | - Chun Wang
- The Cadre Health Care Ward, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University School, Nanjing 210008, Jiangsu Province, China.
| | - Meizi Guo
- The Cadre Health Care Ward, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University School, Nanjing 210008, Jiangsu Province, China
| | - Yihua Zhou
- The Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University School, Nanjing 210008, Jiangsu Province, China
| | - Zhenhua Feng
- The Department of Laboratory Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University School, Nanjing 210008, Jiangsu Province, China
| | - Zhenyu Yin
- The Cadre Health Care Ward, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University School, Nanjing 210008, Jiangsu Province, China
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Blok CS, Vink L, de Boer EM, van Montfrans C, van den Hoogenband HM, Mooij MC, Gauw SA, Vloemans JAFPM, Bruynzeel I, van Kraan A, Kuik J, Waaijman T, Scheper RJ, Gibbs S. Autologous skin substitute for hard-to-heal ulcers: retrospective analysis on safety, applicability, and efficacy in an outpatient and hospitalized setting. Wound Repair Regen 2013; 21:667-76. [PMID: 23926998 DOI: 10.1111/wrr.12082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 06/01/2013] [Indexed: 11/28/2022]
Abstract
Chronic ulcers ((arterio)venous, decubitus, or postoperative) have no tendency to heal within a period of at least 3 months despite optimal therapy according to internationally accepted guidelines. This retrospective study evaluates the safety and efficacy of an autologous, dermal-epidermal skin substitute (SS) for treating ulcers of various origins. Ulcers were treated within 7 Dutch centers over 5 years. Sixty-six ulcers (size: 0.75-150 cm²; duration: 0.25-32 years) with a follow-up time of 24 weeks after a single-skin substitute application were assessed. Wound-bed preparation consisted of vacuum-assisted-closure-therapy (5 days, hospitalized) or application of acellular dermis (5-7 days, outpatient). Time to heal, adverse events, and recurrence 1 year after complete healing were recorded. Complete ulcer healing occurred in 36 of 66 ulcers (55%) at 24 weeks. At that time point, a further 29% of ulcers showed decrease in ulcer size between 50 and 99%. No difference was observed between the hospitalized vs. outpatient treatment with complete healing. There were 32 of 36 healed ulcers that were available for follow-up 1 year after complete closure, of which 27 (84%) were still closed. Only two minor/moderate possibly related adverse events were recorded. This retrospective analysis shows that SS provides a safe and successful treatment for particularly chronic ulcers of various origins.
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Affiliation(s)
- Chantal S Blok
- Department of Dermatology, VU Medical Center, Amsterdam, The Netherlands
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Ahmad I, Akhtar S, Masoodi Z. Role of early radical debridement and skin cover in diabetic foot ulceration. J Wound Care 2012; 21:442-4, 446-7. [DOI: 10.12968/jowc.2012.21.9.442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- I. Ahmad
- Department of Plastic and Reconstructive Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - S. Akhtar
- Department of Plastic and Reconstructive Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Z. Masoodi
- Department of Plastic and Reconstructive Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
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Warriner RA, Snyder RJ, Cardinal MH. Differentiating diabetic foot ulcers that are unlikely to heal by 12 weeks following achieving 50% percent area reduction at 4 weeks. Int Wound J 2011; 8:632-7. [PMID: 21951763 DOI: 10.1111/j.1742-481x.2011.00860.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This retrospective analysis included intent-to-treat control patient data from two published, randomised, diabetic foot ulcer (DFU) trials in an effort to differentiate ulcers that are unlikely to heal by 12 weeks despite early healing progress [≥50% percent area reduction (PAR) at 4 weeks]. Predicted and actual wound area trajectories in DFUs that achieved early healing progress were analysed from weeks 5 to 12 and compared for ulcers that did and did not heal at 12 weeks. In 120 patients who achieved ≥50% PAR by week 4, 62 (52%) failed to heal by 12 weeks. Deviations from the predicted healing course were evident by 6 weeks for non healing ulcers. A 2-week delay in healing significantly lowered healing rates (P = 0·001). For DFUs with ≥50% PAR at 4 weeks, those achieving ≥90% versus <90% PAR at 8 weeks had a 2·7-fold higher healing rate at 12 weeks (P = 0·001). A PAR of <90% at 8 weeks provided a negative predictive value for DFU healing at 12 weeks of 82%. For ulcers that fail to progress or worsen from weeks 4 to 6, and those that fail to achieve 90% PAR at 8 weeks, reevaluation of the wound and its treatment is recommended.
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Seminar Review: A Review of the Basis of Surgical Treatment of Diabetic Foot Infections. INT J LOW EXTR WOUND 2011; 10:33-65. [DOI: 10.1177/1534734611400259] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Infection is an extremely challenging complication of foot ulcers in patients with diabetes. Surgery as part of a multidisciplinary approach is key in the management of many types of diabetic foot infections (DFIs). Unfortunately, the surgical treatment of DFIs is based more on clinical judgment and less on structured evidence, which leaves unresolved doubts. The clinical presentation of DFIs is varied. This review examines the basis of nonvascular surgical treatment of DFIs, emphasizing the importance of the anatomic concepts of the foot, the variety of its clinical presentations, and the concepts of timing surgery. Recent evidence and case reports based on the author’s experience are presented in 2 parts. The first part examines clinical presentation of infections, whereas the second part deals with imaging, foot anatomy, and some case reports.
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Scimeca CL, Bharara M, Fisher TK, Kimbriel H, Mills JL, Armstrong DG. An update on pharmacological interventions for diabetic foot ulcers. Foot Ankle Spec 2010; 3:285-302. [PMID: 20685955 DOI: 10.1177/1938640010376994] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Diabetic foot ulcers are the most common lower extremity complications of diabetes. Peripheral neuropathy and peripheral vascular disease are the underlying risk factors for diabetic foot ulcers, subsequently leading to infections and requiring antimicrobial therapy for the management of the disease. Each risk factor is a target for clinical intervention, with the intent to delay or prevent disease progression to amputation. The effective therapy includes interdisciplinary care, which involves optimized pharmacological interventions in concert with other treatments such as debridement strategies and specialized wound dressings. The pharmacological therapy alone cannot lead to successful therapy, and therefore, these supplementary techniques/modalities should not be overlooked. It is therefore the aim of this report to review various pharmacological interventions, specific to the diabetic foot and wound healing, along with incorporation of advanced therapies required to achieve a multifaceted treatment of diabetic foot ulcers and provide basis for superior drugs as well as drug delivery systems.
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Affiliation(s)
- Christy L Scimeca
- Southern Arizona Limb Salvage Alliance, Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
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Xie XS, Wang YJ, Zuo C, Fan JM, Li XJ. A case report of an effective treatment for diabetic foot ulcers with integration of traditional Chinese medicine and Western medicine. J Diabetes Complications 2009; 23:360-4. [PMID: 18599321 DOI: 10.1016/j.jdiacomp.2008.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2008] [Revised: 04/08/2008] [Accepted: 05/08/2008] [Indexed: 02/05/2023]
Abstract
Diabetes contributes 75-85% of the factors predisposing to foot amputations, usually in association with infection and gangrene. The treatment of foot ulcers is expensive, and the effectiveness of treatment varies. We report herein a case of a diabetic foot ulcer that was treated with integrated traditional Chinese and Western medicine, with desirable cost-effective results. Traditional Chinese medicine (TCM) therapeutic principles include improving the spleen, nourishing yin, regulating qi, and resolving dampness, as well as activating stagnant blood. Western medicine includes wound debridement, skin grafting, and use of insulin, antibiotics, and vasodilators. The patient was treated with a holistic multidisciplinary approach (i.e., a combination of TCM and Western medicine, surgical management, education for diabetic foot care, and psychological counseling). Without this approach, the patient might have ended up with foot amputation and/or sepsis.
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Affiliation(s)
- Xi-Sheng Xie
- Department of Nephrology, West China Hospital of Sichuan University, Guoxuexiang, Wuhou, Chengdu 610041, China.
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Tardivo JP, Baptista MS. Treatment of Osteomyelitis in the Feet of Diabetic Patients by Photodynamic Antimicrobial Chemotherapy. Photomed Laser Surg 2009; 27:145-50. [DOI: 10.1089/pho.2008.2252] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- João P. Tardivo
- CEDERM-UNIFESP e Centro Médico Laser, Instituto de Química da USP, São Paulo, SP, Brazil
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Widatalla AH, Mahadi SEIDI, Shawer MA, Elsayem HA, Ahmed ME. Implementation of diabetic foot ulcer classification system for research purposes to predict lower extremity amputation. Int J Diabetes Dev Ctries 2009; 29:1-5. [PMID: 20062556 PMCID: PMC2802358 DOI: 10.4103/0973-3930.50707] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Patients with diabetic foot ulcers are at a high risk of having both minor or major lower extremity amputations. AIM To identify the extent of risk factors for major and minor amputations in patients with diabetic foot ulcers. MATERIALS AND METHODS This prospective study was conducted from 2003 to 2005. Using the guidelines for wound classification developed by the International Consensus of the Diabetic Foot, patients were assessed for ischemia, neuropathy, linear measurement of wound diameters, depth of wound, and infection. In addition, end stage renal failure was added as a criterion to assess the association of all these criteria with both toe and lower extremity amputation. RESULTS 2,321 patients were studied and their mean age was 55 +/- 12 years. Most (83.5%) of the patients presented with foot ulcers (n = 1394). Plantar ulcers were the most common (42.6%) followed by ulcers of the big toe (39%). Some (28.5%) of the patients had different types of amputations: 10% had major lower extreme amputation (MLEA) with 8.7% amputations being below the knee and minor (toe) amputations accounting for 18.5%. The most commonly amputated (9.9%) toe was the first toe. CONCLUSION The guidelines for wound classification proposed by the International Consensus of the Diabetic Foot are reliable predictive factors and can determine the outcome of diabetic foot management. Significant factors associated with MLEA were ischemia, neuropathy, and end-stage renal disease and those associated with toe amputation were neuropathy, depth of wound, and grade of infection.
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Affiliation(s)
| | | | - Mohamed A. Shawer
- Jabir Abu Eliz Diabetic Center, University of Khartoum. Khartoum, Sudan
| | - Hagir A. Elsayem
- Jabir Abu Eliz Diabetic Center, University of Khartoum. Khartoum, Sudan
| | - Mohamed E. Ahmed
- Jabir Abu Eliz Diabetic Center, University of Khartoum. Khartoum, Sudan
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Abstract
The incidence of diabetes is increasing and therefore patients with diabetic foot ulcers will become increasingly common in the community. The NHS model of Health and Social Care (Department of Health (DH), 2005) places a high emphasis on self care and disease management, and, as a long-term condition, diabetes mellitus requires efficient and effective management. The supervision and organization of the care of diabetic patients is multi-factorial and for this reason, a multi-disciplinary approach is essential for effective care, without which patients with diabetic foot ulcers are at high risk of complications. Diabetic wounds present differently to other chronic wounds; unless these are adequately assessed and treated, there may be devastating consequences for the patient--the most serious being major amputation and/or death. In the first article, accurate assessment was discussed; in this second article, the management of diabetic foot ulcers is explored.
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Affiliation(s)
- Jenny Bentley
- Kings College London, Florence Nightingale School of Nursing and Midwifery.
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Körber A, Graue N, Rietkötter J, Kreuzfelder E, Grabbe S, Dissemond J. Insufficient Tetanus Vaccination Status in Patients with Chronic Leg Ulcers. Dermatology 2008; 217:69-73. [DOI: 10.1159/000127317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2007] [Accepted: 10/31/2007] [Indexed: 11/19/2022] Open
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Omar NS, El-Nahas MR, Gray J. Novel antibiotics for the management of diabetic foot infections. Int J Antimicrob Agents 2007; 31:411-9. [PMID: 18155884 DOI: 10.1016/j.ijantimicag.2007.10.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 10/17/2007] [Indexed: 11/24/2022]
Abstract
Foot infections are a major cause of morbidity in diabetic patients. Staphylococcus aureus is the most important pathogen in mild infections; moderate to severe infections are frequently polymicrobial. Multidrug resistance is an increasing problem in isolates from diabetic feet. Worldwide, up to 30% of patients with diabetic foot infection (DFI) are colonised with methicillin-resistant S. aureus (MRSA), whilst extended-spectrum beta-lactamase-producing Gram-negative bacteria are also common in some countries. This emergence of drug resistance has coincided with the launch or imminent availability of many new antibiotics. Most of these were developed to target multidrug-resistant Gram-positive bacteria, although some have a spectrum of activity that includes Gram-negative bacteria and anaerobes. There is a variable amount of experience with these agents in treating skin and skin-structure infections (SSSIs), especially for DFI. However, at least some have a spectrum of activity and/or pharmacological properties that suggest that they may be of value in managing DFIs. The aim of this paper is to review evidence for the efficacy of new antibiotics in the management of SSSIs, including any data relating specifically to the diabetic foot, and to consider where they might fit into the therapeutic armory against DFI.
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Affiliation(s)
- Nesrene S Omar
- Medical Microbiology & Immunology Department, Faculty of Medicine, Mansoura University, Egypt.
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Faglia E, Clerici G, Mantero M, Caminiti M, Quarantiello A, Curci V, Morabito A. Incidence of critical limb ischemia and amputation outcome in contralateral limb in diabetic patients hospitalized for unilateral critical limb ischemia during 1999-2003 and followed-up until 2005. Diabetes Res Clin Pract 2007; 77:445-50. [PMID: 17316866 DOI: 10.1016/j.diabres.2007.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Accepted: 01/08/2007] [Indexed: 11/26/2022]
Abstract
We studied the incidence of critical limb ischemia (CLI) and amputation outcome of the contralateral limb in 533 diabetic patients hospitalized in our diabetic foot centre because of CLI from 1999 to 2003 and followed-up until 2005. The cumulative incidence rate during the 6-year period reached 49.8% (CI confidence interval=40.6-59.6). All patients underwent arteriography and in 181 (98.4%) the revascularization was performed without different feasibility (p=0.077) compared to that (95.3%) in the initial patients. The severity of lesion evaluated with Wagner grade was lower (chi(2)=33.5, p<0.001) and also the frequency of midfoot and above-the-ankle amputations was lower (p<0.001 and p=0.022, respectively) in contralateral patients. There was no evidence from the logistic analysis to support the association between any of the investigated variables and incidence of CLI in the contralateral limb. Over a 6-year period, almost 50% of the diabetic patients with unilateral CLI developed a CLI in the contralateral limb: however, both severity of foot lesion and amputation level was significantly lower. This fact can be due to prompt therapeutic interventions, made possible thanks to an increased patient awareness acquired by training during the treatment of the unilateral limb.
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Affiliation(s)
- Ezio Faglia
- Diabetology Centre-Diabetic Foot Centre, IRCCS Multimedica, Via Milanese 300, 20099 Sesto San Giovanni (Milan), Italy.
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Abstract
The diabetic foot is a major cause of morbidity and mortality. The present review aims to outline current treatment options for this ghastly diabetic complication. Although considerable progress has been achieved over the past years, there is still a long way to go. Indeed, the International Working Group of the Diabetic Foot reported 2 years ago that a lower extremity was amputated every 30 seconds due to diabetes somewhere in the world. Established therapeutic modalities (revascularisation, casting and debridement) remain the cornerstone of management. At the same time, new treatments (e.g. growth factors, bioengineered skin substitutes, extracellular matrix proteins, etc.) are continuously being developed and explored to improve treatment. Nonetheless, it should not be underestimated that both new and old treatments must be incorporated in a prudent and zealous therapeutic strategy. Essentially, only multidisciplinary foot clinics have demonstrated that the reduction of amputation rates is feasible. The endeavour should be coupled with widespread education on the elementary rules to achieve both primary and secondary prevention.
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Affiliation(s)
- N Papanas
- Outpatient Clinic of Obesity, Diabetes and Metabolism, Second Department of Internal Medicine, Democritus University of Thrace, Greece.
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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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&NA;. Management of diabetic foot depends on the stage of the disease and the underlying pathology. DRUGS & THERAPY PERSPECTIVES 2007. [DOI: 10.2165/00042310-200723040-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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