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Mokoala TC, Sididzha V, Molefe ED, Luvhengo TE. Life expectancy of patients with diabetic foot sepsis post-lower extremity amputation at a regional hospital in a South African setting. A retrospective cohort study. Surgeon 2024; 22:e109-e114. [PMID: 38101992 DOI: 10.1016/j.surge.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Diabetes foot sepsis (DFS) is the leading cause of amputation of lower extremities. Over 50 % of patients who have had major lower extremity amputation due to DFS are dead within 4 years following the procedure. AIM To determine the life expectancy of patients following amputation for DFS at a regional hospital in South Africa. METHODS We conducted an audit of patients who had DFS and were admitted over a 5-year period. The duration from admission to time of death was recorded in days. Occurrence of death was confirmed from family members of the deceased using structured telephonic interview questionnaires. Categorical findings were summarized using actual counts and percentages and compared using either the Chi-square or Fisher's exact test. We used the mean with standard deviation or median and range to compare parametric and non-parametric continuous data, respectively. The Shapiro-Wilk test was used to test normality of data. Multivariate logistic regression was done to establish factors that were strongly associated with the mortalities. Adjusted survival curves were added to compare the rate of occurrence of mortality between males and females with age as a confounder. Statistical significance was set at a p-value below 0.05. RESULTS 197 were found of which 100 % of participants had Type 2 diabetes mellitus and 63.5 % were males. Associated comorbidities included hypertension in 73.6 %, obesity in 66 %, alcohol use in 64.5 % and smoking in 58.4 %. 190 participants had an amputation and 19.3 % died. CONCLUSION DFS was more common in males and 96 % of the patients had an amputation. Mortality rate within 4 years following amputation was 19.3 % and was higher in females and individuals with multiple comorbidities.
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Bassil GF, Nader F, Lajmi A, Missaoui Z. Closed Rupture of the Extensor Hallucis Longus (EHL) Tendon Due to Forced Traumatic Hyperflexion of the Hallux: A Case Report. Cureus 2024; 16:e55137. [PMID: 38558707 PMCID: PMC10979719 DOI: 10.7759/cureus.55137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
A closed spontaneous rupture of the extensor hallucis longus (EHL) tendon is an infrequent yet challenging clinical occurrence, typically associated with systemic conditions (diabetes mellitus or rheumatoid arthritis). A closed EHL rupture, however, exists but is only reported as scattered cases in the literature. This article presents a unique case of a traumatic EHL tendon rupture in a patient without underlying predisposing factors. A 66-year-old woman, previously healthy, presented with an inability to dorsiflex her big toe following trauma, showcasing the clinical triad of pain, edema, and deficit in big toe extension. Magnetic resonance imaging confirmed a 5.9 cm EHL tendon gap that was treated by primary end-to-end repair of the ruptured tendon. The aim of this case report is to provide an overview of the literature available concerning the classification and treatment of EHL rupture and to assist in the early diagnosis and treatment of this rare condition.
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Affiliation(s)
- Georges F Bassil
- Orthopedic Surgery, Lebanese University Faculty of Medicine, Beirut, LBN
| | - Fadi Nader
- Orthopedics and Trauma, Université Paris Cité, Paris, FRA
- Orthopedic Surgery, Lebanese University Faculty of Medicine, Beirut, LBN
| | - Achraf Lajmi
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, FRA
| | - Zied Missaoui
- Orthopedic Surgery, Grand Hôpital de l'Est Francilien - Site de Meaux, Meaux, FRA
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3
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Hsu L, Li L, Poon LY. Analysis of risk factors of infection in diabetic foot patients. Int Wound J 2024; 21:e14411. [PMID: 37731215 PMCID: PMC10788463 DOI: 10.1111/iwj.14411] [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: 09/01/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023] Open
Abstract
This cross-sectional study assessed the risk factors for infection in 150 diabetic foot patients admitted to the Xiamen University Hospital between October 2020 and October 2022. Patients were categorised as infected (n = 80) or uninfected (n = 70) cohorts. The diabetic foot was evaluated using the American Diabetic Foot Grading system, whereas ulcers were categorised using Wagner's method. Analysed were patient-specific information, clinical data and risk factors including neuropathy, arterial disease and foot deformities. Our findings revealed no statistically significant differences between infected and uninfected cohorts concerning age, body mass index, gender, duration of diabetes or ankle-brachial index values (p > 0.05). However, infected group had a higher proportion of smokers and reduced socio-economic status (p < 0.05). Wagner grades indicated a greater severity in the infected group, with grade 3, grade 4 and grade 5 differing significantly (p < 0.05). Comparative analysis of ulcer characteristics revealed no statistically significant differences in ulcer surface area and depth, but the infected group had a higher prevalence of osteomyelitis and a greater number of ulcers (p > 0.05). Blood vessel complications, retinopathy, the presence of three or more ulcers, osteomyelitis and diabetic nephropathy were substantially more prevalent in the infected group, as determined by univariate analysis (p < 0.05). Subsequent multivariate logistic analysis revealed that patients with blood vessel complications, retinopathy, osteomyelitis, diabetic nephropathy and three or more ulcers were at increased risk for infection (p < 0.05). In addition, lifestyle factors, such as smoking, sedentary behaviour, inadequate foot hygiene, obesity and poor glycaemic control, were also associated with higher infection rates. A multivariate analysis of foot wound factors revealed that deeper, longer and recurrent lesions increased the likelihood of infection. Escherichia coli was the most frequently isolated bacterium from the infected group's bacterial culture, followed by Pseudomonas aeruginosa and Staphylococcus aureus. The study enhanced our comprehension of the multifactorial risk factors associated with infections in diabetic foot patients, highlighting the need for thorough clinical evaluation, lifestyle modification and vigilant infection control.
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Affiliation(s)
- Limei Hsu
- School of MedicineXiamen UniversityXiamenChina
| | - Le Li
- Department of The First Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
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Bhargava A, Mahakalkar C, Kshirsagar S. Understanding Gangrene in the Context of Peripheral Vascular Disease: Prevalence, Etiology, and Considerations for Amputation-Level Determination. Cureus 2023; 15:e49026. [PMID: 38116352 PMCID: PMC10728580 DOI: 10.7759/cureus.49026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Gangrene is a grave complication of peripheral vascular disease (PVD), characterised by tissue necrosis due to inadequate blood supply. This review article comprehensively explores gangrene in PVD, encompassing its prevalence, aetiology, clinical presentation, diagnostic modalities, management strategies, prognosis, and future directions. Key factors influencing outcomes, including the timeliness of intervention and the choice between limb salvage and amputation, are identified. Moreover, this review underscores the importance of early detection and multidisciplinary care, emphasising the significance of patient-centred approaches. It also calls for increased awareness, continued research, and innovative solutions to improve the lives of individuals grappling with gangrene in the context of PVD.
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Affiliation(s)
- Abhilasha Bhargava
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Chandrashekhar Mahakalkar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shivani Kshirsagar
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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5
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Kim J. The pathophysiology of diabetic foot: a narrative review. JOURNAL OF YEUNGNAM MEDICAL SCIENCE 2023; 40:328-334. [PMID: 37797951 PMCID: PMC10626291 DOI: 10.12701/jyms.2023.00731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023]
Abstract
An aging population and changes in dietary habits have increased the incidence of diabetes, resulting in complications such as diabetic foot ulcers (DFUs). DFUs can lead to serious disabilities, substantial reductions in patient quality of life, and high financial costs for society. By understanding the etiology and pathophysiology of DFUs, their occurrence can be prevented and managed more effectively. The pathophysiology of DFUs involves metabolic dysfunction, diabetic immunopathy, diabetic neuropathy, and angiopathy. The processes by which hyperglycemia causes peripheral nerve damage are related to adenosine triphosphate deficiency, the polyol pathway, oxidative stress, protein kinase C activity, and proinflammatory processes. In the context of hyperglycemia, the suppression of endothelial nitric oxide production leads to microcirculation atherosclerosis, heightened inflammation, and abnormal intimal growth. Diabetic neuropathy involves sensory, motor, and autonomic neuropathies. The interaction between these neuropathies forms a callus that leads to subcutaneous hemorrhage and skin ulcers. Hyperglycemia causes peripheral vascular changes that result in endothelial cell dysfunction and decreased vasodilator secretion, leading to ischemia. The interplay among these four preceding pathophysiological factors fosters the development and progression of infections in individuals with diabetes. Charcot neuroarthropathy is a chronic and progressive degenerative arthropathy characterized by heightened blood flow, increased calcium dissolution, and repeated minor trauma to insensate joints. Directly and comprehensively addressing the pathogenesis of DFUs could pave the way for the development of innovative treatment approaches with the potential to avoid the most serious complications, including major amputations.
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Affiliation(s)
- Jiyoun Kim
- Department of Orthopaedic Surgery, Kosin University College of Medicine, Busan, Korea
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6
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Yastı AÇ, Karaca T, Kendirci M, Akgün AE, Şahiner İT, Akın M. Comparison of the Efficiency of Epidermal Growth Factor and Negative Pressure Wound Therapy in Diabetic Foot Patients. THE INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS 2023; 22:93-102. [PMID: 36069057 DOI: 10.1177/15347346221123638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Advanced modalities are used for wounds where conventional treatment is insufficient in diabetic foot patients. In this study, we investigated the effects of using Epidermal growth factor (EGF) and NPWTmodalities alone or in combination on the frequency and level of amputation. In the retrospective study, which included 286 patients in total, 76 patients were referred with the decision of amputation or amputation was planned during hospitalization. After the treatments, amputation and distalization of amputation were found 73.3% and 33.3% in the conventional treatment patients. While 86.4% amp and 18.2% amp distalization were found in negative pressure wound therapy (NPWT) only patients, this rate was 52.4% and 90.5% in EGF + NPWT patients, 50% and 83.3% in EGF only patients. While amp and distalization rates were found to be significantly better in those receiving only EGF or EGF + NPWT (P = .015, P = .017 respectively for amputation and P = .000 for distalization), no difference was found in those receiving EGF and EGF + NPWT. As a result of our study, although npwt contributed positively to the number and level of amputations compared to conventional treatment, a significant improvement was found in the number and level of amps when EGF was used alone or combined with NPWT. With this result, EGF was thought to be an important treatment modality that should be evaluated in diabetic foot ulcers (DFUs) without amputation decision.
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Affiliation(s)
- Ahmet Çınar Yastı
- Department of General Surgery, 594266Health Sciences University, Ankara, Türkiye
| | | | - Murat Kendirci
- Department of General Surgery, 162313Hitit University, Çorum, Türkiye
| | - Ali Emre Akgün
- General Surgery, 536164Ankara City Hospital, Ankara, Türkiye
| | | | - Merve Akın
- General Surgery, 536164Ankara City Hospital, Ankara, Türkiye
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Liao X, Li SH, El Akkawi MM, Fu XB, Liu HW, Huang YS. Surgical amputation for patients with diabetic foot ulcers: A Chinese expert panel consensus treatment guide. Front Surg 2022; 9:1003339. [PMID: 36425891 PMCID: PMC9679004 DOI: 10.3389/fsurg.2022.1003339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/19/2022] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Diabetic foot disease is a serious complication of diabetes mellitus. Patients with diabetes mellitus have a 25% lifetime risk for developing a foot ulcer, and between 14% and 24% of patients require a major or minor lower limb amputation due to severe gangrene. However, decisions concerning whether to amputate or whether to perform a major or minor lower limb amputation, and how best to determine the amputation plane remain unclear. METHODS To consolidate the current literature with expert opinion to make recommendations that will guide surgical amputation for patients with diabetic foot ulcers. A total of 23 experts experienced in surgical treatment of patients with diabetic foot ulcers formed an expert consensus panel, and presented the relevant evidence, discussed clinical experiences, and derived consensus statements on surgical amputation for patients with diabetic foot ulcers. Each statement was discussed and revised until a unanimous consensus was achieved. RESULTS A total of 16 recommendations for surgical amputation for patients with diabetic foot ulcers were formulated. The experts believe that determination of the amputation plane should be comprehensively evaluated according to a patient's general health status, the degree of injury, and the severity of lower limb vasculopathy. The Wagner grading system and the severity of diabetic lower extremity artery disease are important criteria when determining the degree of amputation. The severity of both diabetic foot infection and systemic underlying diseases are important factors when considering appropriate treatment. Moreover, consideration should also be given to a patient's socioeconomic status. Given the complexities of treating the diabetic foot, relevant issues in which consensus could not be reached will be discussed and revised in future. CONCLUSION This expert consensus could be used to guide doctors in clinical practice, and help patients with diabetic foot ulcers gain access to appropriate amputation treatment.
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Affiliation(s)
- Xuan Liao
- Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China
| | - Sheng-Hong Li
- Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China
| | - Mariya Mohamad El Akkawi
- Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China
| | - Xiao-bing Fu
- Wound Healing and Cell Biology Laboratory, Institute for Basic Research, Trauma Center of Postgraduate Medical College, General Hospital of PLA, Beijing, China
| | - Hong-wei Liu
- Department of Plastic Surgery of the First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine of Ministry of Education, Guangzhou, China
| | - Yue-sheng Huang
- Department of Wound Repair; Institute of Wound Repair and Regeneration Medicine, Southern University of Science and Technology Hospital, Southern University of Science and Technology School of Medicine, Shenzhen, China
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8
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Ahmed R, Augustine R, Chaudhry M, Akhtar UA, Zahid AA, Tariq M, Falahati M, Ahmad IS, Hasan A. Nitric oxide-releasing biomaterials for promoting wound healing in impaired diabetic wounds: State of the art and recent trends. Pharmacotherapy 2022; 149:112707. [PMID: 35303565 DOI: 10.1016/j.biopha.2022.112707] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/31/2022] [Accepted: 02/07/2022] [Indexed: 12/11/2022]
Abstract
Impaired diabetic wounds are serious pathophysiological complications associated with persistent microbial infections including failure in the closure of wounds, and the cause of a high frequency of lower limb amputations. The healing of diabetic wounds is attenuated due to the lack of secretion of growth factors, prolonged inflammation, and/or inhibition of angiogenic activity. Diabetic wound healing can be enhanced by supplying nitric oxide (NO) endogenously or exogenously. NO produced inside the cells by endothelial nitric oxide synthase (eNOS) naturally aids wound healing through its beneficial vasculogenic effects. However, during hyperglycemia, the activity of eNOS is affected, and thus there becomes an utmost need for the topical supply of NO from exogenous sources. Thus, NO-donors that can release NO are loaded into wound healing patches or wound coverage matrices to treat diabetic wounds. The burst release of NO from its donors is prevented by encapsulating them in polymeric hydrogels or nanoparticles for supplying NO for an extended duration of time to the diabetic wounds. In this article, we review the etiology of diabetic wounds, wound healing strategies, and the role of NO in the wound healing process. We further discuss the challenges faced in translating NO-donors as a clinically viable nanomedicine strategy for the treatment of diabetic wounds with a focus on the use of biomaterials for the encapsulation and in vivo controlled delivery of NO-donors.
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Affiliation(s)
- Rashid Ahmed
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar; Biomedical Research Center (BRC), Qatar University, PO Box 2713, Doha, Qatar; Department of Biotechnology, Faculty of Natural and Applied Sciences, Mirpur University of Science and Technology, Mirpur 10250, AJK, Pakistan; Nick Holonyak Jr. Micro and Nanotechnology Laboratory, University of Illinois at Urbana Champaign, IL, USA
| | - Robin Augustine
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar; Biomedical Research Center (BRC), Qatar University, PO Box 2713, Doha, Qatar
| | - Maryam Chaudhry
- Department of Continuing Education, University of Oxford, OX1 2JD Oxford, United Kingdom
| | - Usman A Akhtar
- Department of Chemical Engineering, College of Engineering, Qatar University, Doha 2713, Qatar
| | - Alap Ali Zahid
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar; Biomedical Research Center (BRC), Qatar University, PO Box 2713, Doha, Qatar
| | - Muhammad Tariq
- Department of Biotechnology, Faculty of Natural and Applied Sciences, Mirpur University of Science and Technology, Mirpur 10250, AJK, Pakistan
| | - Mojtaba Falahati
- Nanomedicine Innovation Center Erasmus (NICE), Erasmus Medical Center, 3015GE Rotterdam, The Netherlands
| | - Irfan S Ahmad
- Nick Holonyak Jr. Micro and Nanotechnology Laboratory, University of Illinois at Urbana Champaign, IL, USA; Department of Agricultural and Biological Engineering, University of Illinois at Urbana Champaign, IL, USA; Carle Illinois College of Medicine, University of Illinois at Urbana Champaign, IL, USA
| | - Anwarul Hasan
- Department of Mechanical and Industrial Engineering, College of Engineering, Qatar University, Doha 2713, Qatar; Biomedical Research Center (BRC), Qatar University, PO Box 2713, Doha, Qatar.
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Serena TE, Yaakov R, Moore S, Cole W, Coe S, Snyder R, Patel K, Doner B, Kasper MA, Hamil R, Wendling S, Sabolinski ML. A randomized controlled clinical trial of a hypothermically stored amniotic membrane for use in diabetic foot ulcers. J Comp Eff Res 2020; 9:23-34. [DOI: 10.2217/cer-2019-0142] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: Determine the effectiveness of hypothermically stored amniotic membrane (HSAM) versus standard of care (SOC) in diabetic foot ulcers (DFUs). Methods: A randomized controlled trial was conducted on 76 DFUs analyzed digitally. Results: Cox wound closure for HSAM (38 wounds) was significantly greater (p = 0.04) at weeks 12 (60 vs 38%), and 16 (63 vs 38%). The probability of wound closure increased by 75% (Hazard Ratio = 1.75; 95% CI: 1.16–2.70). HSAM showed >60% reductions in area (82 vs 58%; p = 0.02) and depth (65 vs 39%; p = 0.04) versus SOC. Conclusion: HSAM increased frequency and probability of wound closure in DFUs versus SOC.
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Affiliation(s)
| | - Raphael Yaakov
- SerenaGroup® Research Foundation, Cambridge, MA 02140, USA
| | - Sarah Moore
- SerenaGroup® Research Foundation, Cambridge, MA 02140, USA
| | - Windy Cole
- Kent State University College of Podiatric Medicine, Independence, OH 44131, USA
| | - Stacey Coe
- Kent State University College of Podiatric Medicine, Independence, OH 44131, USA
| | - Rob Snyder
- Barry University School of Podiatry Medicine, North Miami Beach, FL 33168, USA
| | - Keyur Patel
- D & P Medical Group, Pittsburgh, PA 15237, USA
| | - Bryan Doner
- D & P Medical Group, Pittsburgh, PA 15237, USA
| | | | - Rachel Hamil
- SerenaGroup® Research Foundation, Cambridge, MA 02140, USA
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Wang S, Yin C, Han X, Guo A, Chen X, Liu S, Liu Y. Improved Healing of Diabetic Foot Ulcer upon Oxygenation Therapeutics through Oxygen-Loading Nanoperfluorocarbon Triggered by Radial Extracorporeal Shock Wave. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:5738368. [PMID: 31485296 PMCID: PMC6710755 DOI: 10.1155/2019/5738368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/22/2019] [Accepted: 06/24/2019] [Indexed: 12/15/2022]
Abstract
Diabetic foot ulcers (DFUs), the most serious complication of diabetes mellitus, can induce high morbidity, the need to amputate lower extremities, and even death. Although many adjunctive strategies have been applied for the treatment of DFUs, the low treatment efficiency, potential side effects, and high cost are still huge challenges. Recently, nanomaterial-based drug delivery systems (NDDSs) have achieved targeted drug delivery and controlled drug release, offering great promises in various therapeutics for diverse disorders. Additionally, the radial extracorporeal shock wave (rESW) has been shown to function as a robust trigger source for the NDDS to release its contents, as the rESW harbors a potent capability in generating pressure waves and in creating the cavitation effect. Here, we explored the performance of oxygen-loaded nanoperfluorocarbon (Nano-PFC) combined with the rESW as a treatment for DFUs. Prior to in vivo assessment, we first demonstrated the high oxygen affinity in vitro and great biocompatibility of Nano-PFC. Moreover, the rESW-responsive oxygen release behavior from oxygen-saturated Nano-PFC was also successfully verified in vitro and in vivo. Importantly, the wound healing of DFUs was significantly accelerated due to improved blood microcirculation, which was a result of rESW therapy (rESWT), and the targeted release of oxygen into the wound from oxygen-loaded Nano-PFC, which was triggered by the rESW. Collectively, the oxygen-saturated Nano-PFC and rESW provide a completely new approach to treat DFUs, and this study highlights the advantages of combining nanotechnology with rESW in therapeutics.
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Affiliation(s)
- Shunhao Wang
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Chunyang Yin
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xiaoguang Han
- Beijing Jishuitan Hospital, The 4th Clinical Hospital of Peking University Health Science Center, Beijing 100035, China
| | - Anyi Guo
- Beijing Jishuitan Hospital, The 4th Clinical Hospital of Peking University Health Science Center, Beijing 100035, China
| | - Xiaodong Chen
- School of Aerospace Engineering, Beijing Institute of Technology, Beijing 100081, China
| | - Sijin Liu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yajun Liu
- Beijing Jishuitan Hospital, The 4th Clinical Hospital of Peking University Health Science Center, Beijing 100035, China
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11
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Subrata SA, Phuphaibul R. Diabetic foot ulcer care: a concept analysis of the term integrated into nursing practice. Scand J Caring Sci 2019; 33:298-310. [PMID: 30604889 DOI: 10.1111/scs.12645] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/03/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diabetic foot ulcer care demonstrates a beneficial approach to overcoming problems in patients with diabetes. This approach is frequently given but is not always successfully implemented due to its fragmentation amid healthcare providers. What's more, there are a number of different understandings, interchangeable languages and an absence of uniformity overlapping terminologies of meaning for diabetic foot ulcer care. Therefore, analysing the concept of diabetic foot ulcer care is important to provide a wider nursing knowledge, synthesise a greater theoretical model and drive more effective care of diabetic foot ulcer. OBJECTIVE This article aimed to analyse how the concept of diabetic foot ulcer care is clearly defined in the relevant evidence as it has several implications in nursing practice. METHOD Walker and Avant's (1995) method of concept analysis was systematically used in this study. FINDINGS Three critical attributes of diabetic foot ulcer care were determined consisting of assessment, intervention and evaluation. Constructed cases are also presented to differentiate the concept of diabetic foot ulcer care from other concepts. This concept analysis results in the critical attributes of diabetic foot ulcer care, defines an operational definition and describes common goals that improve clarity, consistency and understanding of the concept amid healthcare professionals along with researchers. CONCLUSION Effective implementation of the concept of DFU care into clinical nursing practice may undoubtedly improve patient outcomes and prevent the complexities of DFU in the years to come. Future research needs to be developed for evaluating the current use of this concept.
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Affiliation(s)
- Sumarno A Subrata
- Doctor of Philosophy Program in Nursing (International and Collaborative Program with Foreign Universities), Mahidol University, Thailand.,Department of Nursing, Faculty of Health Sciences, Universitas Muhammadiyah Magelang, Central Java, Indonesia
| | - Rutja Phuphaibul
- Doctor of Philosophy Program in Nursing (International and Collaborative Program with Foreign Universities), Mahidol University, Thailand.,Ramathibodi School of Nursing, Mahidol University, Bangkok, Thailand
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12
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Maiya AG, Kumar AS, Hazari A, Jadhav R, Ramachandra L, Hande HM, Rajgopal SK, Maiya SG, Kalkura P, Keni LG. Photobiomodulation therapy in neuroischaemic diabetic foot ulcers: a novel method of limb salvage. J Wound Care 2018; 27:837-842. [DOI: 10.12968/jowc.2018.27.12.837] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Arun G. Maiya
- Professor and Associate Dean, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - A. Sampath Kumar
- Scholar, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Animesh Hazari
- Scholar, Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - L Ramachandra
- Professor, Head of Department, Department of Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - H. Manjunatha Hande
- Professor, Head of Department; Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shenoy K Rajgopal
- Professor, Associate Dean (Academics), Department of Surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shubha G. Maiya
- Senior Health Educator, WDF Project, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Prabath Kalkura
- Project Manager, WDF Project, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Laxmikant G. Keni
- Assistant Professor–Senior Scale, Manipal Institute of Technology, Manipal Academy of Higher Education, Manipal, Karnataka, India
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13
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Basatneh R, Najafi B, Armstrong DG. Health Sensors, Smart Home Devices, and the Internet of Medical Things: An Opportunity for Dramatic Improvement in Care for the Lower Extremity Complications of Diabetes. J Diabetes Sci Technol 2018; 12:577-586. [PMID: 29635931 PMCID: PMC6154231 DOI: 10.1177/1932296818768618] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The prevalent and long-neglected diabetic foot ulcer (DFU) and its related complications rank among the most debilitating and costly sequelae of diabetes. With the rise of the Internet of medical things (IoMT), along with smart devices, the med-tech industry is on the cusp of a home-care revolution, which could also create opportunity for developing effective solutions with significant potential to reduce DFU-associated costs and saving limbs. This article discusses potential applications of IoMT to the DFU patient population and beyond. METHODS To better understand potential opportunities and challenges associated with implementing IoMT for management of DFU, the authors reviewed recent relevant literatures and included their own expert opinions from a multidisciplinary point of view including podiatry, engineering, and data security. RESULTS The IoMT has opened digital transformation of home-based diabetic foot care, as it enables promoting patient engagement, personalized care and smart management of chronic and noncommunicable diseases through individual data-driven treatment regimens, telecommunication, data mining, and comprehensive feedback tailored to individual requirements. In particular, with recent advances in voice-activated commands technology and its integration as a part of IoMT, new opportunities have emerged to improve the patient's central role and responsibility in enabling an optimized health care ecosystem. CONCLUSIONS The IoMT has opened new opportunities in health care from remote monitoring to smart sensors and medical device integration. While it is at its early stage of development, ultimately we envisage a connected home that, using voice-controlled technology and Bluetooth-radio-connected add-ons, may augment much of what home health does today.
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Affiliation(s)
- Rami Basatneh
- School of Podiatric Medicine, Temple
University, Philadelphia, PA, USA
| | - Bijan Najafi
- Interdisciplinary Consortium for
Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery,
Baylor College of Medicine, Houston, TX, USA
- Bijan Najafi, PhD, Interdisciplinary
Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department
of Surgery, Baylor College of Medicine, One Baylor Plaza, MS: BCM390, Houston,
TX 77030, USA.
| | - David G. Armstrong
- Southwestern Academic Limb Salvage
Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of
Southern California, Los Angeles, CA, USA
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Begum M, Lewison G, Sommariva S, Ciani O, Tarricone R, Sullivan R. European diabetes research and its funding, 2002-2013. Diabet Med 2017. [PMID: 28636762 DOI: 10.1111/dme.13411] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIM This study examined the outputs of research papers in diabetes from 31 European countries between 2002 and 2013, and their funding. METHODS Diabetes research papers in the Web of Science were identified by means of a filter based on journals and title words. For 2009-2013 papers, the funders were coded to show their sector and nationality. RESULTS Europe published 40 547 diabetes papers in the 12 years between 2002 and 2013. Denmark, Sweden and Finland published the most relative to their wealth, but the UK published the most absolutely despite an apparently low burden (as measured by disability-adjusted life years). The largest source of funding was government (30%), followed by the non-profit sector (18%) and industry (13%). The European Commission supported 2.7% of papers, but more in Latvia (33%) and Estonia (16%). Based on an estimated cost per paper of €260 000, the annual research expenditure in Europe was approximately €986 million in 2013. CONCLUSIONS The European diabetes burden in disability-adjusted life years increased by one third between 2002 and 2012, but its output of research papers has decreased from 44% to 36% of the world total. This decrease needs to be reviewed in the context of European non-communicable disease research policy.
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Affiliation(s)
- M Begum
- Department of Cancer Studies, King's College London, Guy's Hospital, London, UK
| | - G Lewison
- Department of Cancer Studies, King's College London, Guy's Hospital, London, UK
| | - S Sommariva
- University of South Florida, College of Public Health, Tampa, USA
| | - O Ciani
- Centre for Research on Health and Social Care Management (CERGAS), Università Commerciale L. Bocconi, Milan, Italy
- University of Exeter Medical School, Evidence Synthesis and Modelling for Health Improvement, Exeter, UK
| | - R Tarricone
- Centre for Research on Health and Social Care Management (CERGAS), Università Commerciale L. Bocconi, Milan, Italy
| | - R Sullivan
- Department of Cancer Studies, King's College London, Guy's Hospital, London, UK
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Kaewprag P, Newton C, Vermillion B, Hyun S, Huang K, Machiraju R. Predictive models for pressure ulcers from intensive care unit electronic health records using Bayesian networks. BMC Med Inform Decis Mak 2017; 17:65. [PMID: 28699545 PMCID: PMC5506589 DOI: 10.1186/s12911-017-0471-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background We develop predictive models enabling clinicians to better understand and explore patient clinical data along with risk factors for pressure ulcers in intensive care unit patients from electronic health record data. Identifying accurate risk factors of pressure ulcers is essential to determining appropriate prevention strategies; in this work we examine medication, diagnosis, and traditional Braden pressure ulcer assessment scale measurements as patient features. In order to predict pressure ulcer incidence and better understand the structure of related risk factors, we construct Bayesian networks from patient features. Bayesian network nodes (features) and edges (conditional dependencies) are simplified with statistical network techniques. Upon reviewing a network visualization of our model, our clinician collaborators were able to identify strong relationships between risk factors widely recognized as associated with pressure ulcers. Methods We present a three-stage framework for predictive analysis of patient clinical data: 1) Developing electronic health record feature extraction functions with assistance of clinicians, 2) simplifying features, and 3) building Bayesian network predictive models. We evaluate all combinations of Bayesian network models from different search algorithms, scoring functions, prior structure initializations, and sets of features. Results From the EHRs of 7,717 ICU patients, we construct Bayesian network predictive models from 86 medication, diagnosis, and Braden scale features. Our model not only identifies known and suspected high PU risk factors, but also substantially increases sensitivity of the prediction - nearly three times higher comparing to logistical regression models - without sacrificing the overall accuracy. We visualize a representative model with which our clinician collaborators identify strong relationships between risk factors widely recognized as associated with pressure ulcers. Conclusions Given the strong adverse effect of pressure ulcers on patients and the high cost for treating pressure ulcers, our Bayesian network based model provides a novel framework for significantly improving the sensitivity of the prediction model. Thus, when the model is deployed in a clinical setting, the caregivers can suitably respond to conditions likely associated with pressure ulcer incidence.
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Affiliation(s)
- Pacharmon Kaewprag
- Department of Computer Science and Engineering, The Ohio State University, Columbus, Ohio, USA.
| | - Cheryl Newton
- Department of Critical Care Nursing, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Brenda Vermillion
- College of Nursing, The Ohio State University, Columbus, Ohio, USA.,Department of Health Services Nursing Education, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sookyung Hyun
- College of Nursing, Pusan National University, Busan, South Korea
| | - Kun Huang
- Department of Computer Science and Engineering, The Ohio State University, Columbus, Ohio, USA. .,Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA.
| | - Raghu Machiraju
- Department of Computer Science and Engineering, The Ohio State University, Columbus, Ohio, USA. .,Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA.
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Gum arabic improves semen quality and oxidative stress capacity in alloxan induced diabetes rats. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2016. [DOI: 10.1016/j.apjr.2016.07.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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