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Luo Y, Liu C, Li C, Jin M, Pi L, Jin Z. The incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers: A meta-analysis. Int Wound J 2024; 21:e14931. [PMID: 38972836 PMCID: PMC11227953 DOI: 10.1111/iwj.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 07/09/2024] Open
Abstract
This study analysed the incidence of lower extremity amputation and its associated risk factors in patients with diabetic foot ulcers. This study systematically searched both Chinese and English databases, including CNKI, Wanfang, VIP, PubMed, EMBASE and Web of Science, to identify cohort studies related to lower extremity amputation and associated risk factors in patients with diabetic foot ulcers up to October 2023. The patients were stratified based on whether they underwent lower extremity amputation, and relevant data, including basic information, patient characteristics, complications, comorbidities and pertinent laboratory test data, were extracted from the included studies. The literature quality assessment in this study utilized the Newcastle-Ottawa Scale to screen for high-quality literature, resulting in the inclusion of 16 cohort studies, all of which were of at least moderate quality. Meta-analysis of outcome indicators was conducted using the Stata 14.0 software. The results indicate that the overall amputation rate of lower extremities in patients with diabetic foot ulcers is 31% (0.25, 0.38). Among the 16 variables evaluated, gender (male), smoking history, body mass index (BMI), hypertension, cardiovascular disease, kidney disease, white blood cell count, haemoglobin and albumin levels were found to be correlated with the occurrence of lower extremity amputation in patients with diabetic foot ulcers. However, no significant correlation was observed between age, diabetes type, duration of diabetes, stroke, glycosylated haemoglobin, creatinine and total cholesterol levels and lower extremity amputation in patients with diabetic foot ulcers. This meta-analysis indicates that the overall amputation rate in patients with diabetic foot ulcers is 31%. Factors such as gender (male), smoking history, high BMI, hypertension, cardiovascular disease, kidney disease, white blood cell count, haemoglobin and albumin levels are identified as significant risk factors for lower extremity amputation in diabetic foot ulcer patients. These findings suggest that attention should be focused on these risk factors in patients with diabetic foot ulcers to reduce the risk of lower extremity amputation. Therefore, preventive and intervention measures targeting these risk factors are of significant importance in clinical practice. (Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier [CRD42024497538]).
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Affiliation(s)
- Yinli Luo
- Department of DermatologyYanbian University HospitalJilinChina
- Department of Medical CosmetologyYanbian University HospitalJilinChina
| | - Chang Liu
- Department of Medical CosmetologyYanbian University HospitalJilinChina
| | - Chuying Li
- Department of Medical CosmetologyYanbian University HospitalJilinChina
| | - Meitong Jin
- Department of DermatologyYanbian University HospitalJilinChina
- Department of Medical CosmetologyYanbian University HospitalJilinChina
| | - Longquan Pi
- Department of Medical CosmetologyYanbian University HospitalJilinChina
| | - Zhehu Jin
- Department of DermatologyYanbian University HospitalJilinChina
- Department of Medical CosmetologyYanbian University HospitalJilinChina
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Hançerlioğlu S, Toygar İ, Ayhan A, Yilmaz İ, Orhan Y, Özdemir GS, Şimşir IY, Çetinkalp Ş. Burden of Diabetic Foot Patients' Caregivers and Affecting Factors: A Cross-Sectional Study. INT J LOW EXTR WOUND 2023; 22:680-686. [PMID: 34338563 DOI: 10.1177/15347346211036530] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
With the increase in the diabetic foot patients in recent decades, the caregivers of diabetic foot patients increase too. Most of these caregivers are informal caregivers. However, the studies examining the burden of the caregivers and affecting factors are limited. This study was conducted to determine the burden of the caregivers of diabetic foot patients and affecting factors. This cross-sectional study was conducted between the January and October 2020 in a diabetic foot council of a university hospital. Zarit Caregiver Burden Scale and a participant identification form were used for data collection. Most of the caregivers were female (75.2%) and the mean age was 51.27 ± 11.48 years. The burden of the caregivers was at moderate level in the current study. Factors affecting the caregivers' burden were caregivers' age, patients' family structure, caregivers' education level, caregivers' income level, hours per week spending for the care of the patients, and lack of choice.
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Affiliation(s)
| | | | | | | | - Yavuz Orhan
- Dokuz Eylül University Hospital, Izmir, Turkey
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Zhang H, Huang C, Bai J, Wang J. Effect of diabetic foot ulcers and other risk factors on the prevalence of lower extremity amputation: A meta-analysis. Int Wound J 2023; 20:3035-3047. [PMID: 37095728 PMCID: PMC10502264 DOI: 10.1111/iwj.14179] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/26/2023] Open
Abstract
A meta-analysis study was conducted to measure the consequence of diabetic foot ulcers (DFUs) and other risk factors (RFs) on the prevalence of lower extremity amputation (LEA). A comprehensive literature inspection till February 2023 was applied and 2765 interrelated studies were reviewed. Of the 32 chosen studies enclosed, 9934 subjects were in the chosen studies' starting point, and 2906 of them were with LEA. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of DFUs and other RFs on the prevalence of LEA by the continuous and dichotomous approaches and a fixed or random effect model. Male gender (OR, 1.30; 95% CI, 1.17-1.44, P < .001), smoking (OR, 1.24; 95% CI, 1.01-1.53, P = .04), previous foot ulcer (OR, 2.69; 95% CI, 1.93-3.74, P < .001), osteomyelitis (OR, 3.87; 95% CI, 2.28-6.57, P < .001), gangrene (OR, 14.45; 95% CI, 7.03-29.72, P < .001), hypertension (OR, 1.17; 95% CI, 1.03-1.33, P = .01), and white blood cells count (WBCC) (MD, 2.05; 95% CI, 1.37-2.74, P < .001) were significantly shown to be an RF in LEA in subjects with DFUs. Age (MD, 0.81; 95% CI, -0.75 to 2.37, P = .31), body mass index (MD, -0.55; 95% CI, -1.15 to 0.05, P = .07), diabetes mellitus type (OR, 0.99; 95% CI, 0.63-1.56, P = .96), and glycated haemoglobin (MD, 0.33; 95% CI, -0.15 to 0.81, P = .17) were not shown to be an RF in LEA in subjects with DFUs. Male gender, smoking, previous foot ulcer, osteomyelitis, gangrene, hypertension, and WBCC were significantly shown to be an RF in LEA in subjects with DFUs. However, age and diabetes mellitus type were not shown to be RF in LEA in subjects with DFUs. However, caused of the small sample sizes of several chosen studies for this meta-analysis, care must be exercised when dealing with its values.
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Affiliation(s)
- Huiling Zhang
- Department of Endocrinology and MetabologyLiaocheng People's HospitalShandongChina
| | - Chuanwang Huang
- Department of Orthopedic SurgeryLiaocheng People's HospitalShandongChina
| | - Jie Bai
- Department of Endocrinology and MetabologyLiaocheng People's HospitalShandongChina
| | - Jing Wang
- Department of Endocrinology and MetabologyLiaocheng People's HospitalShandongChina
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Negash W, Assefa T, Sahiledengle B, Tahir A, Regassa Z, Feleke Z, Regasa T, Tekalegn Y, Mamo A, Teferu Z, Solomon D, Gezahegn H, Bekele K, Zenbaba D, Tasew A, Desta F, Atlaw D, Wilfong T. Prevalences of diabetic foot ulcer and foot self-care practice, and associated factors in adult patients with diabetes in south-east Ethiopia. J Int Med Res 2022; 50:3000605221129028. [PMID: 36224759 PMCID: PMC9561672 DOI: 10.1177/03000605221129028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/08/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We aimed to assess the prevalences of foot ulcer and foot self-care practices, and identify associated factors in adult patients with diabetes attending a referral hospital in south-east Ethiopia. METHODS We performed a cross-sectional study of 267 diabetic patients. Multivariable binary logistic regression was used to identify factors associated with diabetic foot ulcer and foot self-care practice. RESULTS The prevalence of diabetic foot ulcer was 11.2% (95% confidence interval [CI] 7.42-15.05). One hundred and forty-four (53.9%; 47.9, 59.9) patients demonstrated good foot self-care. Living rurally (adjusted odds ratio 2.27; 95% CI: 1.86-6.97), lack of regular exercise (3.91; 1.51-10.10), peripheral neuropathy (2.77; 1.05-7.33) and foot calluses (5.69; 1.74-18.59) were associated with diabetic foot ulcer. Urban inhabitants (2.01; 1.09-3.69), patients with diabetes for >10 years (2.92; 1.48-5.77), women (2.95; 1.66-5.22), and patients with a glucometer at home (2.05; 1.09-3.85) were more likely to have good foot self-care practice. CONCLUSION The prevalence of diabetic foot ulcer was 11.2%. This prevalence is lower than those identified in other Ethiopian studies. However, patient awareness regarding foot self-care practice and risk reduction should be improved.
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Affiliation(s)
- Wogene Negash
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Tesfaye Assefa
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Biniyam Sahiledengle
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Anwar Tahir
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Zegeye Regassa
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Zegeye Feleke
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Tadele Regasa
- Biomedical Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Yohannes Tekalegn
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Ayele Mamo
- Pharmacy Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Zinash Teferu
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Damtew Solomon
- Biomedical Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Habtamu Gezahegn
- Biomedical Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Kebebe Bekele
- Surgery Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Demisu Zenbaba
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Alelign Tasew
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Fikreab Desta
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Daniel Atlaw
- Biomedical Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Tara Wilfong
- School of Public Health, Haramaya University College of Health
and Medical Sciences, Harar, Ethiopia
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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: 47] [Impact Index Per Article: 11.8] [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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Lin C, Liu J, Sun H. Risk factors for lower extremity amputation in patients with diabetic foot ulcers: A meta-analysis. PLoS One 2020; 15:e0239236. [PMID: 32936828 PMCID: PMC7494323 DOI: 10.1371/journal.pone.0239236] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 09/01/2020] [Indexed: 12/15/2022] Open
Abstract
PURPOSE A considerable number of diabetic foot ulcer (DFU) patients require amputation every year, which worsens their quality of life, aggravates the social burden, and shortens their life expectancy. Considering these negative effects, it is important to explore the relative risk factors affecting amputation in DFU patients. METHODS The PubMed, SCIE and Embase databases were comprehensively searched for prospective or retrospective studies published before October 31, 2019. All English language studies involving DFU patients were included, and RevMan 5.3 software was used to analyse the data. RESULTS This meta-analysis includes 21 studies involving 6505 participants, including 2006 patients who required a lower limb amputation. The following variables were associated with an increased risk of amputation: male sex (odds ratios (OR) = 1.30, 95% confidence interval (CI) = 1.16~1.46, P<0.00001), smoking history (OR = 1.19, 95% CI = 1.04~1.35, P = 0.009), a history of foot ulcers (OR = 2.48, 95% CI = 2.00~3.07, P<0.00001), osteomyelitis (OR = 3.70, 95% CI = 3.02~4.53, P<0.00001), gangrene (OR = 10.90, 95% CI = 5.73~20.8, P<0.00001), a lower body mass index (mean difference IV (MD) = -0.88, 95% CI = -1.30~-0.47, P<0.0001), and a higher white blood cell count (MD = 2.42, 95% CI = 2.02~2.82, P<0.00001). However, age (MD = 1.24, 95% CI = -0.45~2.93, P = 0.15), type of diabetes (OR = 0.96, 95% CI = 0.61~1.52, P = 0.86), hypertension (OR = 1.19, 95% CI = 0.96~1.47, P = 0.12), and HbA1c level (MD = 0.02, 95% CI = -0.28~0.33, P = 0.87) were not associated with amputation in patients with DFU. CONCLUSIONS Our meta-analysis identified several risk factors for amputation in DFU patients, including the male sex, a smoking history, a history of foot ulcers, osteomyelitis, gangrene, a lower body mass index, and a higher white blood cell count. Once gangrene occurs, the risk of amputation rapidly increases.
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Affiliation(s)
- Chunmei Lin
- Department of Endocrinology and Metabolism, Fujian Medical University Xiamen Humanity Hospital, Xiamen, Fujian Province, People’s Republic of China
| | - Jinhao Liu
- Department of Vascular Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, People’s Republic of China
| | - Hu Sun
- Department of Vascular Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, Fujian Province, People’s Republic of China
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Determinants of wound healing in patients hospitalized for diabetic foot ulcer: results from the MEDFUN study. Endocr Regul 2020; 54:207-216. [PMID: 32857716 DOI: 10.2478/enr-2020-0023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The high amputation rates from diabetic foot ulcer (DFU) in Nigeria and prolonged hospitalization due to poor wound healing is a source of concern. Furthermore, factors that affect wound healing of DFUs have not yet been well studied in Nigeria, whereas knowing these factors could improve DFU outcomes. Therefore, the objective of this study was to determine the factors that are associated with the wound healing in patients hospitalized for DFU. METHODS The Multi-Center Evaluation of Diabetic Foot Ulcer in Nigeria (MEDFUN) was an observational study involving 336 diabetic patients hospitalized for DFU and managed by a multi-disciplinary team until discharge or death. Demographic, clinical, and biochemical characteristics were documented. Test statistics used were chi square, t-test, univariate, and multivariate logistic regression. The study endpoints were ulcer healing, LEA, duration of hospitalization, and mortality. Here we present data on wound healing. RESULTS The mean ± SD age was 55.9±12.5 years. Univariate predictors of wound healing were ulcer duration more than 1 month prior to hospitalization (p<0.001), peripheral arterial disease (PAD) (p<0.001), foot gangrene (p<0.001), Ulcer grade ≥3 (p=0.002), proteinuria (p=0.005), anemia (p=0.009), renal impairment (p=0.021), glycated hemoglobin ≥7% (0.012), and osteomyelitis (p<0.001). On multivariate regression, osteomyelitis was the strongest independent predictor of wound healing after adjusting for all other variables (OR 0.035; 95% CI 0.004-0.332). This was followed by PAD (OR 0.093; 95% CI 0.028-0.311), ulcer duration >1 month (OR 0.109; 95% CI 0.030-0.395), anemia (OR 0.179; 95% CI 0.056-0.571). CONCLUSION Presence of osteomyelitis, duration of ulcer greater than 1 month, PAD, Wagner grade 3 or higher, proteinuria, presence of gangrene, anemia, renal impairment, and HbA1c ≥7% were the significant predictors of wound healing in patients hospitalized for DFU. Early identification and prompt attention to these factors in a diabetic foot wound might significantly improve healing and reduce adverse outcomes such as amputation and death.
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Bekele F, Chelkeba L, Fekadu G, Bekele K. Risk factors and outcomes of diabetic foot ulcer among diabetes mellitus patients admitted to Nekemte referral hospital, western Ethiopia: Prospective observational study. Ann Med Surg (Lond) 2020; 51:17-23. [PMID: 32015875 PMCID: PMC6992950 DOI: 10.1016/j.amsu.2020.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/21/2019] [Accepted: 01/13/2020] [Indexed: 11/30/2022] Open
Abstract
Objectives Diabetic foot ulcer is one of the complications of diabetes mellitus. The diabetic patients with foot infections especially gangrene require long-term hospitalization and carry the risk of limb amputation. Despite these challenges, there are a scarce studies done on risk factors and no finding on outcomes of diabetic foot ulcers in Ethiopia. Patients and methods A prospective observational study was conducted among diabetes patients with diabetic foot ulcer at Nekemte referral hospital from March 15 to June 15, 2018. Results Of the 115 diabetes foot ulcer patients admitted to Nekemte referral hospital, 64(55.65%) were males and the mean age of participants was 44.4 ± 14.7 years. Fifty-eight (50.43%) of the patients had chronic health problems and 56(48.69%) had diabetic complications. Of patients with complications, 35(30.43%) were undergone amputations. Diabetic foot ulcer grade ≥4 (AOR = 1.7; 95% CI: 1.604, 4.789), inappropriate antibiotics use (AOR = 2.526; 95% CI: 1.767, 8.314), overweight (AOR = 2.767; 95% CI: 1.827, 9.252), obesity (AOR = 3.020; 95% CI: 2.556, 16.397), poor blood glucose control (AOR = 2.592; 95% CI: 1.937, 7.168) and neuropathy (AOR = 1.565; 95% CI: 1.508, 4.822) were predictors of amputation up on multivariable logistic regression analysis. Conclusion Blood glucose level, higher body mass index, inappropriate antibiotics use, neuropathy and advanced grade of diabetic foot ulcer were independent predictors of amputation. Thus, special emphasis for patients having neuropathy and advanced grade of diabetic foot ulcer as well as weight reduction, managing hyperglycaemia, and appropriate antibiotics prescription practice would decrease untoward effects of diabetic foot ulcer. Foot problems are common in people with diabetes throughout the world, affecting up to 15% of diabetic patients. Diabetic foot complications is the major medical, social and economic problem for all types of diabetes. Advanced diabetes foot infections are the most common diabetes-related cause of hospitalization. Empiric antibiotic regimen is selected for diabetic foot infections on the basis of the likely etiologic agent(s). Peripheral arterial disease (PAD) is present in one-half of all patients with foot ulcers.
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Affiliation(s)
- Firomsa Bekele
- Department of Pharmacy, College of Health Science, Mettu University, Mettu, Ethiopia
| | - Legese Chelkeba
- Department of Pharmacy, Institute of Health Science, Jimma University, Jimma, Ethiopia
| | - Ginenus Fekadu
- Department of Pharmacy, Institute of Health Science, Wollega University, Nekemte, Ethiopia
| | - Kumera Bekele
- Department of Nursing, College of Health Science, Selale University, Fiche, Ethiopia
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Ramadass SK, Nazir LS, Thangam R, Perumal RK, Manjubala I, Madhan B, Seetharaman S. Type I collagen peptides and nitric oxide releasing electrospun silk fibroin scaffold: A multifunctional approach for the treatment of ischemic chronic wounds. Colloids Surf B Biointerfaces 2018; 175:636-643. [PMID: 30583219 DOI: 10.1016/j.colsurfb.2018.12.025] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/10/2018] [Accepted: 12/11/2018] [Indexed: 12/19/2022]
Abstract
Biomimetic nanofibrous scaffolds targeting multiple dysfunctional processes provide a multi-pronged strategy to restore functions and regenerate the damaged tissue. This study investigates a strategy of combining a regenerative component, Type I collagen Peptide (CP), along with a nitric oxide donor, S-Nitrosoglutathione (GSNO), in the form of nanofibrous scaffold to address the non-healing diabetic ulcer. Silk Fibroin-Polyvinyl alcohol (SF-PVA) nanofibrous scaffold is used as a carrier for delivering functional moieties. The developed nanofibrous electrospun mats (SF-PVA, CP-SF-PVA, and CP-GSNO-SF-PVA) showed continuous, bead-less and randomly oriented fibers with highly porous morphology. The in vitro biocompatibility was assessed by MTT assay, DAPI-Rhodamine 123 and FITC-Phalloidin imaging studies. CP-GSNO-SF-PVA nanofibrous scaffold showed a high degree of cell attachment, spreading of F-actin with viable cell morphology and appreciable inter-cellular connection. Thus the study showed that the proliferation of fibroblast cells are mainly facilitated by the presence of collagen peptide in the nanofibrous matrix. Griess assay demonstrated immediate release of NO for a day from the developed multifunctional scaffold. These results demonstrate the in vitro efficacy of CP-GSNO and indicate the opportunity of CP-GSNO-SF-PVA nanofibrous scaffold for the treatment of ischemic non-healing ulcers.
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Affiliation(s)
- Satiesh Kumar Ramadass
- Faculty of Pharmacy, Sri Ramachandra Medical Centre and Research Institute, Chennai, Tamil Nadu, India
| | - Lone Saquib Nazir
- Department of Biomedical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Ramar Thangam
- CSIR - Central Leather Research Institute, Chennai, Tamil Nadu, India
| | | | - I Manjubala
- Department of Biomedical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, India
| | - Balaraman Madhan
- CSIR - Central Leather Research Institute, Chennai, Tamil Nadu, India.
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Uysal S, Ozturk AM, Tasbakan M, Simsir IY, Unver A, Turgay N, Pullukcu H. Human myiasis in patients with diabetic foot: 18 cases. Ann Saudi Med 2018; 38:208-213. [PMID: 29848939 PMCID: PMC6074300 DOI: 10.5144/0256-4947.2018.208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Myiasis complication of diabetic foot ulcer has only been presented in a few case reports. Therefore, there is a need for additional data on this infestation. OBJECTIVE Evaluate clinical characteristics of human myiasis in patients with diabetic foot. DESIGN Case series. SETTINGS A tertiary referral healthcare institution and a diabetic foot center. PATIENTS AND METHODS Patients with diabetic foot infection com.plicated by myiasis who were admitted between June 2012 and July 2017. MAIN OUTCOME MEASURES Bacterial infection rate, accompanying bacterial agents, amputation (morbidity) and mortality rate. SAMPLE SIZE 18. RESULTS Eight (44.4%) of the patients were female. Sixteen (88.9%) had moderate-to-severe infections; 15 (83.3%) had necrotic tissue. Larval debridement therapy was performed on all patients at the bed.side in consecutive sessions. A third-stage larva of Calliphora was detected in one case (5.6%). Second- and third-stage larvae of Lucilia sericata were detected in 5 (27.8%) and 7 (38.9%) patients, respectively. All the patients had a bacterial infection with myiasis. Twelve (66.7%) patients underwent amputation. Three (16.7%) patients died. Myiasis was more frequent in the months of May, June and July. CONCLUSION To our knowledge, this is the largest reported series of cases of diabetic foot with myiasis. The most common parasitic agent was Lucilia sericata. Bacterial soft tissue infections were observed in all cases. Poor hygienic conditions were noteworthy and all patients were in need of radical surgery. Myiasis complication of diabetic foot is more frequently seen in the spring and summer. LIMITATIONS Insufficient follow-up time for analysis of possible confounding factors. CONFLICT OF INTEREST None.
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Affiliation(s)
- Serhat Uysal
- Serhat Uysal, Infectious Diseases and Clinical Microbiology,, Ministry of Health, Republic of Turkey,, Seyfi Demirsoy State Hospital,, Infectious Diseases and Clinical Microbiology Service,, Diabetic Foot Clinic, Buca, Izmir, 35390, Turkey, T: 902-32425252, , ORCID: http://orcid.org/0000-0002-4294.5999
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