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Phirom K, Rerkasem K. High Mortality in Patients With an Ischemic Foot Ulcer Following Revascularization. INT J LOW EXTR WOUND 2024; 23:43-48. [PMID: 37750201 DOI: 10.1177/15347346231204237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
Critical limb ischemia (CLI) is the advanced stage of peripheral arterial disease, which impairs blood flow to the extremities due to occlusion of arteries, in which patients suffer from ischemic pain at rest and gangrene or ulcers. It is frequently accompanied by major adverse cardiac events, resulting in exceedingly high mortality from a cardiac or cerebrovascular event in this population. Although there have been considerable amounts of novel and costly revascularization and wound dressing technology, mortality is still high. Therefore, the risk factors for such high mortality need to be addressed. This review aimed to summarize the potential risk factors for mortality in patients with CLI of the lower extremities. There are several such risk factors, including modifiable and nonmodifiable risk factors. This review further discusses some highlighted major modified risk factors, including renal failure, cardiovascular, and diabetes. The strategy of regular surveillance and modification of such risk factors in any patients with CLI should be developed.
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Affiliation(s)
- Kochaphan Phirom
- Environmental - Occupational Health Sciences and Non Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Kitttipan Rerkasem
- Environmental - Occupational Health Sciences and Non Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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2
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Cheng Y, Cao G, Yang Q, Niu S, Fang Y, Wang C, Cao J. Acupuncture for rheumatoid vasculitis complicated by refractory foot ulcer: A case report. Medicine (Baltimore) 2023; 102:e35969. [PMID: 37960782 PMCID: PMC10637421 DOI: 10.1097/md.0000000000035969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/16/2023] [Indexed: 11/15/2023] Open
Abstract
INTRODUCTION Rheumatoid vasculitis (RV) is a frequently encountered complication of rheumatoid arthritis (RA), wherein skin vasculitis lesions are observed as a common clinical manifestation, encompassing skin purpura, erythema, vascular occlusion, ulcers, and gangrene. As a matter of fact, it marks the most severe extra-articular manifestation of RA. And the resultant ulcers tend to pose a greater challenge with regard to therapeutic interventions. We report a case of RV complicated by refractory foot ulcer that was successfully treated with puncture. CASE PRESENTATION A 62-year-old man with RV caused by RA developed refractory foot ulcers. Despite the application of topical antibiotics, the wound gradually expanded and remained unhealed for 7 months. Consequently, the patient sought an integrated therapeutic approach involving Traditional Chinese Medicine and was subsequently treated with acupuncture. After 12 weeks of acupuncture, the foot ulcers healed completely. CONCLUSION Acupuncture has the potential to facilitate wound healing and may serve as a viable alternative treatment modality for wounds unresponsive to traditional therapeutic interventions.
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Affiliation(s)
- Yaqing Cheng
- Department of Peripheral Vascular, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Gang Cao
- Department of Peripheral Vascular, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Qiaoli Yang
- Department of Peripheral Vascular, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Shaohui Niu
- Department of Peripheral Vasculoar, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yina Fang
- Department of General Surgery, Xi'an Hospital of Traditional Chinese Medicine, Shanxi, China
| | - Chang Wang
- Department of Peripheral Vascular, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
| | - Jianchun Cao
- Department of Peripheral Vascular, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China
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Aragón-Sánchez J, Víquez-Molina G, López-Valverde ME, Rojas-Bonilla JM, Murillo-Vargas C. Conservative Surgery for Diabetic Foot Osteomyelitis is not Associated With Longer Survival Time Without Recurrence of Foot Ulcer When Compared With Amputation. INT J LOW EXTR WOUND 2023; 22:328-331. [PMID: 33890818 DOI: 10.1177/15347346211009403] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Conservative surgery of diabetic foot osteomyelitis (DFO) in which bone infection is removed without amputation could minimize the biomechanical changes associated with foot surgery. We hypothesize that patients who undergo conservative surgery will have a longer survival time without recurrence of foot ulcers and further amputations than those who undergo any type of amputation to treat DFO. We assessed a retrospective cohort of 108 patients who underwent surgery for DFO from January 2011 to December 2012. Patients were followed-up until May 2020. Reulceration and reamputation-free survival times were plotted using the Kaplan-Meier method and were calculated from the date of first surgery to recurrence, new amputation, or end of the study. A stratified log rank was used to study differences among groups. Cumulative survival without recurrences at 1, 5, and 8 years was 95%, 36%, and 29%, respectively, in patients who underwent conservative surgery and 95%, 43%, and 30%, respectively, in those undergoing amputation. Cumulative survival without a new amputation at 1, 5, and 8 years was 100%, 80%, and 80%, respectively, in patients who underwent conservative surgery and 98%, 82%, and 69%, respectively, in those undergoing amputation. No differences were found regarding either recurrence (log rank, P = .98) or new amputations (log rank, P = .64). In conclusion, conservative surgery is as safe as amputation to arrest bone infection in the feet of patients with diabetes. Conservative surgery was not associated with a lower rate of recurrence and new amputations than those patients who underwent amputations.
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Ababneh A, Moosa S, Al Jarrah Q, Alsoufi Y, Abu Qamar MZ, Saleh M, Jarrah S, Younes NA. Factors Associated With Foot Self-Care in Patients With Diabetes-Related High-Risk Feet: A Cross-Sectional Design. Inquiry 2023; 60:469580231220135. [PMID: 38140753 DOI: 10.1177/00469580231220135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Foot self-care has been commonly studied among people with diabetes. Previous research on foot self-care among those with diabetes-related high-risk feet is almost unavailable or very limited. The current study aims to fill this gap and provide a contemporary unprecedented analysis of this area of specialization. To assess the levels of, and factors associated with foot self-care among people with diabetes-related high-risk feet. A multi-center cross-sectional study from Jordan assessed the foot self-care of 107 participants with diabetes-related high-risk feet. Multiple socio-demographic, physiological, and psychosocial factors were collected, and the Arabic version of the diabetes foot self-care behavior scale was used to estimate the foot self-care of the study population. A multiple linear regression model was employed to identify factors associated with foot self-care. The mean score of foot self-care was 25.4 ± 7.1 (35 is the highest) indicating ~73% of adherence to foot self-care. Factors associated with higher foot self-care were being treated at the King Abdullah University Hospital (β = .30, P < .01) and reporting higher scores of patients' interpretations about neuropathy physical causes of foot ulcers (β = ".22," P = .02). People with diabetes-related high-risk feet reported a relatively adequate foot self-care practice. However, clinicians are still required to enhance foot self-care among this population. Health promotion programs may benefit from engaging people in understanding the pathophysiology of diabetes-related foot ulcers to improve foot self-care practices.
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Affiliation(s)
- Anas Ababneh
- Yarmouk University, Irbid, Jordan
- Applied Science Private University, Amman, Jordan
| | - Sameh Moosa
- National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
| | | | - Yazan Alsoufi
- Jordan University of Science and Technology, Irbid, Jordan
| | | | | | | | - Nidal A Younes
- National Center for Diabetes, Endocrinology, and Genetics, Amman, Jordan
- University of Jordan, Amman, Jordan
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Mizrak HI, Hansen TW, Andersen JA, Rossing P, Rasmussen A, Hansen CS. Distal symmetrical polyneuropathy is present in all individuals with diabetes and foot ulcers - and does not associate with healing time. J Diabetes Complications 2022; 36:108353. [PMID: 36370668 DOI: 10.1016/j.jdiacomp.2022.108353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/13/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
We estimated the occurrence of diabetic neuropathy using six different diagnostic modalities in individuals with newly diagnosed diabetic foot ulcers (DFUs) and assessed the association with DFU healing time. All individuals with DFU had distal symmetrical polyneuropathy. Presence of neuropathy did not associate with ulcer healing time (p ≥ 0.12).
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Affiliation(s)
| | | | - Jonas Askø Andersen
- Steno Diabetes Center Copenhagen, Denmark; Orthopedic Department, North Zealand Hospital, Hillerød Hospital, Denmark
| | - Peter Rossing
- Steno Diabetes Center Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Abstract
BACKGROUND Diabetic foot (DF) problems are common throughout the world, about one-fourth of them develop a foot ulcer and serious cases would suffer from amputation, which seriously affects the patient's work and life. Previous studies indicated that acupuncture as adjuvant therapy would be effective in treating DF. However, these studies have no consistent results. Therefore, the aim of our study was to explore the efficacy and safety of acupuncture as adjuvant therapy for DF. METHODS The randomized controlled trials associated with acupuncture therapy (or as adjuvant therapy) for DF will be included. We will search 6 electronic databases relevant to health sciences, including PubMed, Embase, the Cochrane Library, the Chinese databases Sino-Med, CNKI, and WANFANG database. All searches were from databases inception to March 30, 2019. The primary outcomes are the total curative effective rate, and the hemodynamic parameter and adverse events will be deemed as secondary outcomes. The Stata15.1 software and Review Manager (RevMan 5.3; Cochrane Collaboration, Copenhagen, Denmark) will be used for analysis, to assess the bias risk, subgroup analysis, and data synthesis. RESULTS In this systematic review and meta-analysis, we will synthesize the studies to assess the safety and efficacy of acupuncture as adjuvant therapy for DF. CONCLUSION The summary of our study will clarify whether acupuncture as adjuvant therapy could be an efficient method for DF.
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Affiliation(s)
- Maosheng Lee
- Guangzhou University of Chinese Medicine, University Town of Guangzhou, Panyu District, Guangzhou City
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Futian District, Shenzhen City, Guangdong Province, China
| | - Huilin Li
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Futian District, Shenzhen City, Guangdong Province, China
| | - Deliang Liu
- Department of Endocrinology, Shenzhen Traditional Chinese Medicine Hospital, Futian District, Shenzhen City, Guangdong Province, China
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Pena G, Kuang B, Cowled P, Howell S, Dawson J, Philpot R, Fitridge R. Micronutrient Status in Diabetic Patients with Foot Ulcers. Adv Wound Care (New Rochelle) 2020; 9:9-15. [PMID: 31871826 PMCID: PMC6918841 DOI: 10.1089/wound.2019.0973] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/15/2019] [Indexed: 12/16/2022] Open
Abstract
Objective: To explore the prevalence of micronutrient deficiencies in patients with diabetic foot ulcers and correlate this with foot disease severity and other clinical factors. Approach: Prospective cohort study of diabetic patients with foot ulcers seen in multidisciplinary foot clinics across Adelaide or admitted to the Vascular Surgery Unit at the Royal Adelaide Hospital between February 2017 and September 2018. A total of 131 patients were included in the study. Plasma serum levels of vitamins A, C, D, and E, copper, zinc, and ferritin were measured. Demographic and clinical data, including BMI, smoking status, duration of diabetes, HbA1c, and WIfI score, were obtained. Results: The most prevalent nutritional deficiency found was vitamin D affecting 55.7% of patients. Suboptimal levels of vitamin C affected 73% of patients, comprising marginal levels in 22.2% and deficient levels in 50.8%. Zinc deficiency, vitamin A deficiency, and low ferritin levels were present in 26.9%, 10.9%, and 5.9% of patients, respectively. There was no correlation between BMI, grip strength, duration of diabetes, HbA1c, or smoking status with micronutrient deficiency. Increased severity of diabetic foot disease was associated with lower vitamin C levels (p = 0.02). Innovation: This study has demonstrated that the deficiency of micronutrients, especially vitamin D, vitamin C, zinc, and vitamin A, is common in diabetic patients with foot ulcers. Conclusions: The prevalence of micronutrient deficiency is high in a diabetic population with foot ulcers/wounds. Special concerns regarding the high prevalence of vitamin C and zinc deficiency, given their roles in wound healing. Although further research needs to be performed to determine the clinical implications of our findings, micronutrient deficiency should be considered in diabetic patients with foot wounds.
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Affiliation(s)
- Guilherme Pena
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - Beatrice Kuang
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - Prue Cowled
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - Stuart Howell
- Data Management and Analysis Centre, School of Population Health, The University of Adelaide, Adelaide, Australia
| | - Joseph Dawson
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia
| | - Ross Philpot
- Department of Infectious Disease, The Queen Elizabeth Hospital, Adelaide, Australia
| | - Robert Fitridge
- Department of Vascular and Endovascular Surgery, Royal Adelaide Hospital, Adelaide, Australia
- Discipline of Surgery, The University of Adelaide, Adelaide, Australia
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Sawano T, Nishikawa Y, Ozaki A, Leppold C, Takiguchi M, Saito H, Shimada Y, Morita T, Tsukada M, Ohira H, Tsubokura M. Premature death associated with long-term evacuation among a vulnerable population after the Fukushima nuclear disaster: A case report. Medicine (Baltimore) 2019; 98:e16162. [PMID: 31277119 PMCID: PMC6635282 DOI: 10.1097/md.0000000000016162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The health vulnerability of certain populations such as children, the elderly and individuals with illnesses or physical disability can become significant in disasters. After the 2011 Fukushima Daiichi Nuclear Power Plant (FDNPP) accident, significant health impacts on vulnerable populations were observed during early or mid-term phase of the disaster, presumably associated with the evacuation. However, there is limited information available on the health impacts owing to long-term evacuation after disaster among them. PATIENT CONCERNS A 56-year-old physically challenged male with arteriovenous malformation on his right lower limb, diagnosed when he was 2 years' old, lived near the FDNPP. He and his family were forced to evacuate immediately after the accident. DIAGNOSIS Three months after evacuation following the FDNPP accident, he developed a refractory foot ulcer associated with atrial fibrillation and congestive cardiac failure because of deterioration of arteriovenous malformation, presumably led by repeated evacuations. INTERVENTION Although anticoagulation therapy and diuretic therapy improved his cardiac failure in the initial admission, he decided to only be treated with supportive care after revelation that his arteriovenous malformation was no longer eligible for aggressive intervention. OUTCOME Three years after the long-term evacuation in temporary houses, the patient died of bleeding and infection of the ulcer. LESSONS This case suggests that long-term evacuation for individuals with physical disability may lead to significant health impacts, and even premature death, through the deterioration of daily life activities due to physical and psychological burdens. This case presents a need for further research on ways that disasters impact the health of individuals with physical disabilities, and greater disaster preparation for the needs of populations with physical disabilities.
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Affiliation(s)
- Toyoaki Sawano
- Department of Surgery, Minamisoma Municipal General Hospital
- Department of Public Health, Fukushima Medical University School of Medicine
| | - Yoshitaka Nishikawa
- Department of Internal Medicine, Soma Central Hospital, Fukushima
- Department of Health Informatics, School of Public Health, Kyoto University, Kyoto
| | - Akihiko Ozaki
- Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Claire Leppold
- Global Public Health Unit, School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Mai Takiguchi
- Department of Cardiology, Sukagawa Hospital, Fukushima
| | - Hiroaki Saito
- Department of Gastroenterology, Sendai Kousei Hospital, Miyagi
| | - Yuki Shimada
- Department of Neurosurgery, Minamisoma Municipal General Hospital, Fukushima, Japan
| | - Tomohiro Morita
- Department of Internal Medicine, Soma Central Hospital, Fukushima
| | - Manabu Tsukada
- Department of Surgery, Minamisoma Municipal General Hospital
| | - Hiromichi Ohira
- Department of Surgery, Minamisoma Municipal General Hospital
| | - Masaharu Tsubokura
- Department of Public Health, Fukushima Medical University School of Medicine
- Research Center for Community Health, Minamisoma Municipal General Hospital, Fukushima, Japan
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Abstract
Spontaneous Expulsion of a Necrotic Metatarsal Head from a Dorsal Foot Ulcer in Osteomyelitis Abstract. Osteomyelitis of metatarsal bones is a dreaded complication of foot ulcers of various etiologies, often resulting in amputation of part of the affected limb. In this article, a case is presented in which a spontaneous expulsion of the necrotic bone part occurred, after which the ulcer could heal completely.
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Anderson SG, Shoo H, Saluja S, Anderson CD, Khan A, Livingston M, Jude EB, Lunt M, Dunn G, Heald AH. Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort. Diabetologia 2018; 61:959-967. [PMID: 29264632 PMCID: PMC6448990 DOI: 10.1007/s00125-017-4522-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 09/25/2017] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to determine whether social deprivation in the presence of diabetes is an independent predictor of developing a foot ulcer and separately of mortality. METHODS This was a primary-care-based retrospective analysis of 13,955 adults with type 1 (n = 1370) or type 2 (n = 12,585) diabetes after a median follow-up of 10.5 years. Demographic characteristics, indices of social deprivation and clinical variables were assessed at baseline. The primary outcomes were new foot ulceration (in those without a previous history of foot ulcers) and all-cause mortality. Cox proportional hazard models were used to describe the associations among foot ulceration, social deprivation and mortality. RESULTS The mean age of the population was 69.4 (range: 16-89) years. The incidence of foot ulceration was greater in individuals with type 2 (8.6%) compared with type 1 diabetes (4.8%). Occurrence was similar by sex, but increased with age and deprivation index. Individuals in the highest quintile of deprivation were 77% more likely to develop a foot ulcer compared with those in the lowest quintile (OR 1.77 [95% CI 1.45, 2.14], p < 0.0001). Overall, 2946 (21.1%) deaths were recorded. Compared with individuals without a foot ulcer, the development of a foot ulcer was associated with a higher age- and sex-adjusted mortality rate (25.9% vs 14.0%), and a 72% (HR 1.72 [95% CI 1.56, 1.90], p < 0.001) increased risk of mortality in those with type 2 diabetes. Risk of death increased by 14% per quintile of deprivation in a univariable analysis (HR 1.14 [95% CI 1.10, 1.17]). In multivariable Cox regression analyses, there was a 48% increased risk of mortality in individuals with a foot ulcer (HR 1.48 [95% CI 1.33, 1.66]) independent of the Townsend index score (HR 1.13 [95% CI 1.10, 1.17], per quintile), baseline age, sex, diabetes type, smoking status, hypertension, statin use, β-blocker use, metformin use, HbA1c levels and insulin use. CONCLUSIONS/INTERPRETATION This study confirms the high mortality rate in individuals with diabetes-related foot ulcers. In addition, socioeconomic disadvantage was found to be an independent effect modifier, contributing to an increased burden of mortality in people with diabetes who develop foot ulceration. In light of this, and as diabetes service configurations are orientated for the next 5-10 years, modelling of foot ulceration risk needs to take socioeconomic disadvantage into account.
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Affiliation(s)
- Simon G Anderson
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, Core Technology Facility, The University of Manchester, Manchester, UK
| | - Haika Shoo
- Diabetes and Endocrine Department, East Cheshire NHS Trust, Macclesfield, UK
| | - Sushant Saluja
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine, and Health, Core Technology Facility, The University of Manchester, Manchester, UK
| | | | - Adnan Khan
- Department of Endocrinology and Diabetes, Leighton Hospital, Crewe, UK
| | - Mark Livingston
- Department of Blood Sciences, Walsall Manor Hospital, Walsall, UK
| | - Edward B Jude
- Department of Diabetes and Endocrinology, Tameside Hospital NHS Foundation Trust, Ashton-under-Lyme, UK
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, School of Biological Sciences and Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - George Dunn
- Department of Podiatry, East Cheshire NHS Trust, Macclesfield, UK
| | - Adrian H Heald
- Salford Royal NHS Foundation Trust, Diabetes and Endocrinology, Stott Lane, Salford, UK.
- School of Medical Sciences, Faculty of Biology, Medicine, and Health, and Manchester Academic Health Science Centre (MAHSC), The University of Manchester, 46 Grafton Street, Manchester, M13 9NT, UK.
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Zanchin TN, Serafini CB, Brandão FS, Nery JADC. Polyhexanide 0.2% in treatment of trophic foot ulcers in leprosy - preliminary study. An Bras Dermatol 2018; 93:145-147. [PMID: 29641721 PMCID: PMC5871386 DOI: 10.1590/abd1806-4841.20186655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/14/2017] [Indexed: 11/30/2022] Open
Abstract
Leprosy is a chronic infectious disease caused by Mycobacterium leprae, which affects peripheral nerves, skin and mucous membranes. The impairment of neural function as well as sensory or sensory-motor disabilities in leprosy continue to be a problem that requires careful attention in the management of patients with the aim to avoid or minimize their progression to prevent sequelae. One of the most common characteristics of these ulcers is the tendency to chronicity, with variable therapeutic response. In this article, we shall discuss the therapeutic management of thirteen trophic leprosy ulcers in eight patients using polyhexanide 0.2% products.
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Affiliation(s)
- Túlio Neutzling Zanchin
- Department of Dermatology, Instituto de
Dermatologia Prof. Rubem David Azulay - Santa Casa da Misericórdia do Rio de
Janeiro (IDPRDA-SCMRJ) - Rio de Janeiro (RJ), Brazil
| | - Cássio Battisti Serafini
- Department of Tropical Dermatology, Hospital
Central do Exército (HCE) - Rio de Janeiro (RJ), Brazil
| | - Francine Silva Brandão
- Department of Sanitary Dermatology,
(DST/Hansen's disease), Instituto de Dermatologia Prof. Rubem David Azulay -
Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA-SCMRJ) - Rio de Janeiro
(RJ), Brazil
| | - José Augusto da Costa Nery
- Department of Sanitary Dermatology,
(DST/Hansen's disease), Instituto de Dermatologia Prof. Rubem David Azulay -
Santa Casa da Misericórdia do Rio de Janeiro (IDPRDA-SCMRJ) - Rio de Janeiro
(RJ), Brazil
- Laboratory of Leprosy and Outpatient Clinic
Sousa Araújo - Instituto Oswaldo Cruz - Fundação Oswaldo Cruz (IOC- Fiocruz) -
Rio de Janeiro (RJ), Brazil
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12
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West M, Chuter V, Munteanu S, Hawke F. Defining the gap: a systematic review of the difference in rates of diabetes-related foot complications in Aboriginal and Torres Strait Islander Australians and non-Indigenous Australians. J Foot Ankle Res 2017; 10:48. [PMID: 29151893 PMCID: PMC5678749 DOI: 10.1186/s13047-017-0230-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 10/25/2017] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Aboriginal and Torres Strait Islander community has an increased risk of developing chronic illnesses including diabetes. Among people with diabetes, foot complications are common and make a significant contribution to the morbidity and mortality associated with this disease. The aim of this review was to systematically evaluate the literature comparing the rates of diabetes related foot complications in Aboriginal and Torres Strait Islander Australians to non-Indigenous Australians. METHODS MEDLINE, EMBASE, The Cochrane Library; PUBMED and CINAHL were searched from inception until August 2016. Inclusion criteria were: published cross-sectional or longitudinal studies reporting the prevalence of diabetes related foot complications in both a cohort of Aboriginal and Torres Strait Islander Australians and a cohort of one other Australian population of any age with diabetes. Risk of bias was assessed using the STROBE tool. RESULTS Eleven studies including a total of 157,892 participants were included. Studies were set in Queensland, the Northern Territory and Western Australia, primarily in rural and remote areas. Aboriginal and Torres Strait Islander Australians experienced substantially more diabetes related foot complications with the mean age up to 14 years younger than non-Indigenous Australians. Aboriginality was associated with increased risk of peripheral neuropathy, foot ulceration and amputation. In several studies, Aboriginal and Torres Strait Islander Australians accounted for the vast majority of diabetes related foot complications (up to 91%) while comprising only a small proportion of the regional population. Reporting quality as assessed with the STROBE tool showed underreporting of: methods, sample description and potential sources of bias. There are no data available for some Australian states and for specific types of diabetes related foot complications. CONCLUSIONS Aboriginal and Torres Strait Islander Australians have a 3-6 fold increased likelihood of experiencing a diabetes related foot complication compared to non-Indigenous Australians. Evidence-based, culturally appropriate screening and intervention programs and improved access to effective health care services are required to prevent a widening of the gap in diabetes related foot complications between Aboriginal and Torres Strait Islander and non-Indigenous Australians.
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Affiliation(s)
- Matthew West
- Discipline of Podiatry, Faculty of Health and Medicine, University of Newcastle, Box 127, Ourimbah, PO 2258 Australia
| | - Vivienne Chuter
- Discipline of Podiatry, Faculty of Health and Medicine, University of Newcastle, Box 127, Ourimbah, PO 2258 Australia
| | - Shannon Munteanu
- Discipline of Podiatry, School of Allied Health, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
| | - Fiona Hawke
- Discipline of Podiatry, Faculty of Health and Medicine, University of Newcastle, Box 127, Ourimbah, PO 2258 Australia
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Rohatgi S, Naveen S, Salunke P, Someshwar S, Jerajani HR, Joshi R. The story of a deformed leprous foot. LEPROSY REV 2016; 87:104-108. [PMID: 27255064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Eccrine syringofibroadenoma (ESFA) is a rare adnexal tumour of eccrine ductal proliferation. A 50 year old treated case of leprosy presented with a chronic non healing ulcer of 5 years duration on the deformity laden right foot. Multiple verrucous papules and plaques were seen surrounding the ulcer which showed histopathological findings consistent with ESFA. Although ESFA constitutes a rare association with leprosy, considering the load of treated cases in our country and elsewhere, it may represent an under-reported entity which requires more attention in the post elimination era.
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Chen IW, Yang HM, Chiu CH, Yeh JT, Huang CH, Huang YY. Clinical Characteristics and Risk Factor Analysis for Lower-Extremity Amputations in Diabetic Patients With Foot Ulcer Complicated by Necrotizing Fasciitis. Medicine (Baltimore) 2015; 94:e1957. [PMID: 26554804 PMCID: PMC4915905 DOI: 10.1097/md.0000000000001957] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Patients with diabetes are at a higher risk of having diabetic foot ulcers (DFUs) or necrotizing fasciitis (NF). The present study aims to examine the clinical characteristics and associated risk factors for lower-extremity amputation (LEA) in patients with DFU complicated by NF.We retrospectively reviewed patients treated at a major diabetic foot center in Taiwan between 2009 and 2014. Of the 2265 cases 110 had lower-extremity NF. Limb preservation outcomes were classified as major LEA, minor LEA, or limb-preserved. Clinical characteristics, laboratory data, and bacterial culture results were collected for analysis.Of the 110 patients with NF, 100 had concomitant DFUs (NF with DFU) and the remaining 10 had no DFU (NF without DFU). None of the NF patients without DFU died nor had their leg amputated. Two NF patients with DFU died of complications. The amputation rate in the surviving 98 NF patients with DFU was 72.4% (46.9% minor LEA and 25.5% major LEA). Seventy percent of the NF patients without DFU had monomicrobial infections (60% with Streptococcus species), and 81.4% NF patients with DFU had polymicrobial infections. Anaerobic organisms were identified in 66% of the NF patients with DFU. Multinomial logistic regression analysis revealed an association between high-grade Wagner wound classification (Wagner 4 and Wagner 5) and LEA (adjusted odds ratio [aOR] = 21.856, 95% confidence interval [95% CI] = 1.625-203.947, P = 0.02 and aOR = 20.094, 95% CI = 1.968-205.216, P = 0.01 for major and minor LEA, respectively) for NF patients with DFU. In addition, a lower serum albumin level was associated with major LEA (OR = 0.066, P = 0.002).In summary, once DFUs were complicated by NF, the risk of amputation increased. Empirical treatment for NF patients with DFU should cover polymicrobial infections, including anaerobic organisms. The high-grade wound classification and low serum albumin level were associated with LEA.
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Affiliation(s)
- I-Wen Chen
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine (I-WC, H-MY, C-HH, Y-YH), Molecular Infectious Disease Research Center, Division of Pediatric Infectious Diseases, Department of Pediatrics (C-HC); and Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan (J-TY)
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Alvarez OM, Wendelken ME, Markowitz L, Comfort C. Effect of High-pressure, Intermittent Pneumatic Compression for the Treatment of Peripheral Arterial Disease and Critical Limb Ischemia in Patients Without a Surgical Option. Wounds 2015; 27:293-301. [PMID: 26574751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Thirty-four subjects with symptomatic peripheral arterial disease (PAD) or critical limb ischmeia (CLI) who were experiencing claudication pain, chronic resting pain, numbness, and ischemic lower leg/foot ulceration were randomized into 2 treatment groups. MATERIALS AND METHODS Eighteen of these patients received treatment with high-pressure, intermittent pneumatic compression (HPIPC) 60 minutes twice daily for 16 weeks, and 16 subjects received standard care consisting of an exercise regimen of walking for 20 minutes twice daily for 16 weeks. The HPIPC device delivers bilateral pressures of 120 mm Hg. Cycle times provide sequential compression for 4 seconds (+/- 0.5 seconds) followed by a 16-second rest period (+/- 3.0 seconds), resulting in a 20-second cycle or 3 cycles per minute. The study was designed to measure patient-centered outcomes. The primary endpoint was peak walking time (PWT), defined as time to maximally tolerated claudication pain. Secondary endpoints included change in resting ankle brachial index, ulcer healing, relief of resting/wound pain, and quality of life (QoL) index. Age (73.7 years vs 72.7 years), baseline PWTs (1-6 minutes), and risk factors were similar in both treatment groups. RESULTS At 4 weeks, the percent change from baseline in PWT did not vary significantly between treatment groups (17.8% for HPIPC and 17% for standard care). After 8 weeks, the percent change in PWT for the HPIPC group was 41% compared to 32% for the group receiving standard care (P = 0.062). At the 16-week time point the percent change from baseline in PWT was significantly different between treatment arms (35.5% for the standard care group and 54.7% for the group receiving HPIPC [P = 0.043]). The mean reduction in wound surface area was 57% and 71% at 12 weeks and 16 weeks, respectively, for the HPIPC group, compared to 45% and 56% for the control group. The HPIPC group reported significantly greater pain relief at the 12-week (P = 0.044) and 16- week (P = 0.038) time points. Compared to the control group, the HPIPC group reported improvement in patient-centered outcomes such as physical function and bodily pain. These differences were statistically significant (P less than 0.05) at the 16- week evaluation period. CONCLUSION Therapy consisting of HPIPC for 2 hours daily for a period of 16 weeks significantly improved PWT, reduced resting pain, and improved healing rates, physical function, and bodily pain. There were no devicerelated complications, allowing for long-term use. This study further supports that HPIPC is safe and effective and should be considered for patients who are not candidates for endovascular or surgical procedures. Furthermore, HPIPC offers an excellent alternative for the palliative care of patients with PAD and CLI symptoms.
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Affiliation(s)
- Oscar M Alvarez
- Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, NY and Department of Medicine, New York Medical College, Valhalla, NY
| | - Martin E Wendelken
- Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, NY
| | - Lee Markowitz
- Center for Curative and Palliative Wound Care, Calvary Hospital, Bronx, NY
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deSancha M, Jha K, Williams A. Health beliefs surrounding leprosy induced foot ulceration; an exploratory qualitative study from South Nepal. LEPROSY REV 2015; 86:254-264. [PMID: 26665361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
UNLABELLED Leprosy is a complex and multi-faceted disease responsible for significant disability in several endemic countries. Physical impairments caused by leprosy are often amplified by local sociocultural phenomena in many parts of the world. In Nepal, sociocultural phenomena such as stigmatisation and health beliefs affecting treatment compliance and health seeking behaviours are known to play an important role in the acquisition of disability. Foot-ulceration is reported to be a common sequelae of leprosy, however, presently little research has been published investigating the potential influence of patient beliefs on management of foot ulceration in leprosy affected persons. OBJECTIVE In light of this we conducted an exploratory qualitative study to investigate the health beliefs held by patients with foot ulceration at a Leprosy hospital in Nepal. METHODS A mixture of open-ended interviews (n = 21), three focus groups and a series of field observations were used to explore the explanatory models of foot ulceration thought to be used by leprosy affected people to understand and explain this specific comorbidity. RESULTS Our findings indicated that a wide range of health beliefs were present in our sample, many of which lie outside of the biomedical understanding of illness. This included a range of non-biomedical beliefs regarding wounds and widespread application of the traditional 'hot-cold' model of illness used to explain foot ulceration. DISCUSSION The findings of this study appear to suggest many beliefs held by leprosy affected persons concerning foot ulceration are highly complex, with some expressed beliefs potentially having a negative impact on self-management of ulceration.
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Janjua SA, Pastar Z. A case of malum perforans pedis complicated by chronic osteomyelitis. Acta Dermatovenerol Croat 2015; 23:72-73. [PMID: 25969919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Shahbaz A Janjua
- Shahbaz A. Janjua, MD, Ayza Skin AND Research Center, Lalamusa, Pakistan;
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Cahn A, Elishuv O, Olshtain-Pops K. Establishing a multidisciplinary diabetic foot team in a large tertiary hospital: a workshop. Diabetes Metab Res Rev 2014; 30:350-3. [PMID: 24446250 DOI: 10.1002/dmrr.2527] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 01/09/2014] [Indexed: 11/05/2022]
Abstract
Every year, over 1 million people with diabetes lose a leg due to diabetic foot disease. Most amputations are preceded by a foot ulcer. Causes for the development of foot ulcers are generally multifactorial and may include neuropathy, peripheral vasculopathy, abnormal foot mechanics and infection. Multidisciplinary approach to the patient with acute diabetic foot is mandatory and has been shown to reduce amputation rate. In our article we describe the establishment of a multidisciplinary diabetic foot team in a large tertiary hospital and its outcomes.
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Al-Thani H, El-Menyar A, Koshy V, Hussein A, Sharaf A, Asim M, Sadek A. Implications of foot ulceration in hemodialysis patients: a 5-year observational study. J Diabetes Res 2014; 2014:945075. [PMID: 24724108 PMCID: PMC3958654 DOI: 10.1155/2014/945075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 12/31/2013] [Accepted: 01/27/2014] [Indexed: 11/17/2022] Open
Abstract
Foot ulceration (FU) remains a serious concern for patients worldwide. We analyzed the incidence, risk factors, and outcome of FU in hemodialysis (HD) patients. A retrospective cohort study was conducted for 252 HD patients who were followed up for 5 years. Patients were categorized according to whether they developed FU or not. The FU group (17%) was older and had significantly higher incidence of nephropathy, retinopathy, peripheral (PAD), coronary artery disease (CAD), and diabetes mellitus (DM) as compared to no-FU group. FU group had higher frequency of major amputation (P = 0.001) and HD vascular access (P = 0.01). Patients with combined DM and PAD had a 10-fold increased risk of FU in comparison to those who had DM alone. Presence of PAD was the main independent predictor for development of FU in HD with an adjusted odd ratio (aOR) of 16.0 (95% CI: 4.41-62.18; P = 0.001). After adjusting for age, sex, and CAD, predictors for mortality were PAD (aOR 4.3), FU (aOR 3.6), and DM (aOR 2.6). FU is common in HD patients regardless of DM. However, the presence of PAD is significantly associated with more FU and mortality in HD. HD patients need intensive foot care and warrant progressive modification of vascular risk factors.
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Affiliation(s)
- Hassan Al-Thani
- Vascular Surgery, Department of Surgery, Hamad General Hospital, HMC, P.O. Box 3050, Doha, Qatar
| | - Ayman El-Menyar
- Clinical Research, Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar ; Clinical Medicine, Weill Cornell Medical College, P.O. Box 24144, Doha, Qatar ; Cardiology Section, Internal Medicine, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Valsa Koshy
- Vascular Surgery, Department of Surgery, Hamad General Hospital, HMC, P.O. Box 3050, Doha, Qatar
| | - Ahmed Hussein
- Vascular Surgery, Department of Surgery, Hamad General Hospital, HMC, P.O. Box 3050, Doha, Qatar
| | - Ahmed Sharaf
- Vascular Surgery, Department of Surgery, Hamad General Hospital, HMC, P.O. Box 3050, Doha, Qatar
| | - Mohammad Asim
- Clinical Research, Trauma Surgery, Hamad General Hospital, P.O. Box 3050, Doha, Qatar
| | - Ahmed Sadek
- Vascular Surgery, Department of Surgery, Hamad General Hospital, HMC, P.O. Box 3050, Doha, Qatar
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Coelho CR, Zantut-Wittmann DE, Parisi MCR. A cross-sectional study of depression and self-care in patients with type 2 diabetes with and without foot ulcers. Ostomy Wound Manage 2014; 60:46-51. [PMID: 24515984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Depression has been recognized as a risk factor for foot ulceration in persons with diabetes mellitus. Using convenience sampling methods, a cross-sectional study was conducted among persons with type 2 diabetes treated in a diabetic foot clinic in Sao Paulo, Brazil between February 2010 and December 2011. One hundred (100) patients (average age 62 years, range 38 to 83 years), 50 with a foot ulcer and 50 at risk for developing a foot ulcer, participated. Symptoms of depression were assessed using the Beck Depression Inventory (BDI), where scores increase with severity; and patients were interviewed about foot self-care behaviors. Average BDI scores among patients with an ulcer were higher (mean 20.37; range 1 to 42) than those of patients that had not developed a foot ulcer (mean 15.70; range 2 to 49) (P = 0.030). Self-care behavior was not significantly different between the two groups. Severe depression (P = 0.049, OR= 6.56 95% CI 1.01-42.58) and male gender (P <0.001, OR=14.87 95% CI 3.83-57.82) were associated with the presence of a foot ulcer. Despite reported adequate self-care behaviors, patients with an ulcer had more symptoms of depression than patients who were at risk for developing a foot ulcer. Studies examining cause-and-effect relationships between these observations and the potential role of depression interventions are needed. The results of this and other studies suggest depression screening is important in patients with diabetes mellitus and foot ulcers.
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Affiliation(s)
- Camila Ribeiro Coelho
- Department of Clinical Medicine, Faculty of Medical Sciences-Unicamp, University of Campinas, Sao Paulo, Brazil;
| | | | - Maria Cândida Ribeiro Parisi
- Department of Clinical Medicine, Faculty of Medical Sciences-Unicamp, University of Campinas, Sao Paulo, Brazil; Division of Endocrinology, Department of Clinical Medicine, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil
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Abstract
BACKGROUND Gait-related fall risk is the leading cause of mortality among patients with diabetes, especially those older than 65 years. Deterioration in balance and loss of protective sensation in lower extremities contribute significantly to fall risk in patients with diabetic peripheral neuropathy (DPN). This study aimed to explore the impact of neuropathy and foot ulcer on gait. METHODS We recruited 39 participants (age, 56.9 ± 8.2 years; body mass index, 29.6.3 ± 4.7 kg/m2), including 15 DPN patients without foot ulcers, 16 DPN patients with foot ulcers, and 8 healthy aged-matched controls. Patients with active foot ulcers wore an offloading device during gait examination, including removable cast walker. RESULTS Results suggest that neuropathy alters gait mainly by increasing gait initiation, gait variability (coefficient of variation of gait velocity), and double support (DS) time, while reducing knee range of motion and center of mass sway (p < .05). Interestingly, the presence of foot ulcer does not impact gait velocity (p > .1) but enhances some of the gait parameters such as gait variability and DS time. CONCLUSIONS This study demonstrates that neuropathy deteriorates gait, but the presence of foot ulcers does not alter gait parameters further than neuropathy. In addition, patients with foot ulcers demonstrated a better gait compared with DPN patients without ulcers. We speculate that offloading footwear may be enhancing the somatosensory feedback from sensate skin, thereby positively affecting gait parameters. A study with a larger sample is required to explore the effect of prescribed footwear in the DPN population in order to validate the findings of this research study.
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Affiliation(s)
- Gurtej S. Grewal
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP)/Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Manish Bharara
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP)/Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Robert Menzies
- Wound and Diabetic Foot Center, Department of Medicine, Hamad Medical Co., Doha, Qatar
| | - Talal K. Talal
- Wound and Diabetic Foot Center, Department of Medicine, Hamad Medical Co., Doha, Qatar
| | - David Armstrong
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP)/Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP)/Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona
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Firth J, Nelson A, Briggs M, Gorecki C. Experiences of healthcare provision for foot ulceration occurring in people with rheumatoid arthritis. Musculoskeletal Care 2012; 11:159-67. [PMID: 23027645 DOI: 10.1002/msc.1036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Participants with rheumatoid arthritis (RA) report that foot ulceration has an impact on their health-related quality of life (HRQL) across physical, social and psychological domains. What is not known is how experiences of healthcare provision influence HRQL. The present study set out to map the patent journey while integrating the impact on HRQL. METHODS A purposive sample of RA patients with open foot ulceration was recruited from podiatry clinics in West Yorkshire (UK) between May 2008 and June 2009. Patients with diabetes were excluded (the impact of foot ulceration in this group is well established). In-depth interviews were taped and transcribed. A framework approach to data management was used to facilitate a case- and theme-based analysis. RESULTS Twenty-three RA patients (18 female, five male; aged 45-88 years) participated. Two themes and five sub-themes were identified. The patient journey theme comprised the following sub-themes: access to care; knowledge acquisition; care pathways and continuity of care. Patient-professional relationships comprised the sub-themes: therapeutic patient-professional relationships and task-orientated care. The journey took a highly variable course that was influenced by patient-specific factors (past experience of ulceration; symptomology; knowledge and self-efficacy); service-specific factors (access to care and care pathways) and professional-specific factors (knowing and trusting someone; holism). CONCLUSIONS The present study highlights the need for clearer care pathways for patients affected by foot ulceration improved patient education and better coordination of care.
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Affiliation(s)
- Jill Firth
- Pennine Musculoskeletal Partnership Ltd, Oldham, UK.
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Alexandrescu V, Vincent G, Ngongang C, Ledent G, Hubermont G. Tibial microdissection for diabetic wounds. J Cardiovasc Surg (Torino) 2012; 53:101-106. [PMID: 22231535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Few data are available focusing on controlled blunt microdissection during below-the-knee interventions as sole or synchronous technique coupled to subintimal angioplasty, particularly in the management of diabetic critical-ischemic foot wounds. We present two cases of targeted recanalizations in the tibial and pedal trunks for plantar and forefoot diabetic ischemic tissue defects, following an angiosome-model for perfusion.
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Affiliation(s)
- V Alexandrescu
- Department of Vascular Surgery, Princess Paola Hospitalù, Marche-en-Famenne, Belgium.
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24
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Mutluoğlu M, Uzun G, İpcioğlu OM, Sildiroglu O, Özcan Ö, Turhan V, Mutlu H, Yildiz S. Can procalcitonin predict bone infection in people with diabetes with infected foot ulcers? A pilot study. Diabetes Res Clin Pract 2011; 94:53-6. [PMID: 21658786 DOI: 10.1016/j.diabres.2011.05.023] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 05/09/2011] [Accepted: 05/16/2011] [Indexed: 11/24/2022]
Abstract
AIMS The diagnosis of osteomyelitis is a key step of diabetic foot management. Previous studies showed that procalcitonin (PCT), a novel infection marker, is superior to conventional infection markers in the diagnosis of diabetic foot infection. This study aimed to investigate the serum levels of PCT and other conventional infection markers in diabetic persons with and without osteomyelitis. METHODS Twenty-four patients (18 male, mean age: 61.9±10.8 years) with infected foot ulcers were prospectively enrolled. Clinical characteristics of the wounds were noted. Blood samples were obtained for biochemical analysis. Magnetic resonance imaging of the foot was performed in all patients to diagnose osteomyelitis. RESULTS Osteomyelitis was found in 13 of 24 (54%) patients. PCT levels were 66.7±43.5 pg/ml in patients with osteomyelitis and 58.6±35.5 pg/ml in patients without osteomyelitis. The difference did not reach statistical significance (p=0.627). Erythrocyte sedimentation rate, but not C-reactive protein and white blood cell count, was found significantly higher in patients with osteomyelitis. CONCLUSION In this group of patients, PCT failed to discriminate patients with bone infection. Erythrocyte sedimentation rate can be used as a marker of osteomyelitis in diabetic persons.
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Affiliation(s)
- Mesut Mutluoğlu
- Department of Underwater and Hyperbaric Medicine, Gulhane Military Medical Academy Haydapaşa Teaching Hospital, Istanbul, Turkey
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Hayashi H, Kuwabara C, Tarumi K, Makino E, Fujimoto W. Successful treatment with infliximab for refractory pyoderma gangrenosum associated with inflammatory bowel disease. J Dermatol 2011; 39:576-8. [PMID: 21958000 DOI: 10.1111/j.1346-8138.2011.01346.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Thomas R, Brenton K, Harris B, Ham R, Rees G, Gorvett T, Boregowda K, Stephens JW, Price DE. Foot ulceration in a secondary care diabetic clinic population: a 4-year prospective study. Diabetes Res Clin Pract 2010; 90:e37-9. [PMID: 20828850 DOI: 10.1016/j.diabres.2010.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 08/09/2010] [Indexed: 11/24/2022]
Abstract
Diabetes guidelines recommend that feet are stratified into low-risk, increased-risk and high-risk. We examined prospective foot ulceration in our secondary care diabetes clinic. At 4-year follow-up, foot ulceration was present in 1/586 (0.17%) in the low-risk, 10/305 (3.3%) in those at increased-risk and 28/236 (11.9%) in the high-risk group.
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Affiliation(s)
- R Thomas
- The Diabetes Centre, ABM University HB, Morriston Hospital, Swansea SA6 6NL, UK
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Bhalerao DS, Kinikar AG, Roushani SB, Franklin VX. Shewanelia putrefaciens: a rare microbial agent associated with a non-healing ulcer in a leprosy patient. Indian J Lepr 2010; 82:205-207. [PMID: 21434598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Female aged 55 years presented with signs and symptoms of borderline lepromatous leprosy and presence of a non-healing ulcer and multiple haemorrhagic blisters over dorsum of both feet. Discharge from the various lesions was subjected to microbiological examination and an unusual organism Shewanella purtefaciens was isolated which was sensitive to most routine antibiotics. Patient responded well to cephadroxil therapy with uneventful and complete healing of ulcer and blisters.
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Affiliation(s)
- D S Bhalerao
- Department of Microbiology, Rural Medical College, Pravara Institute of Medical Sciences-DU, Loni-413 736, Dist. Ahmednagar, Maharashtra, India
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Mittlmeier T, Klaue K, Haar P, Beck M. Should one consider primary surgical reconstruction in charcot arthropathy of the feet? Clin Orthop Relat Res 2010; 468:1002-11. [PMID: 19597899 PMCID: PMC2835604 DOI: 10.1007/s11999-009-0972-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 06/23/2009] [Indexed: 01/31/2023]
Abstract
UNLABELLED Charcot neuroosteoarthropathy of the feet can induce severe instability and deformity with subsequent plantar ulceration leading to substantial disability or even amputation. Traditionally, nonoperative treatment is regarded as the primary option of treatment while surgery is restricted to treating complications or failure of nonoperative treatment. Failed nonoperative treatment essentially prolongs treatment period. We retrospectively reviewed 22 patients (26 feet) with midfoot (n = 9) or hindfoot (n = 17) neuropathy who underwent primary surgical reconstruction and reorientation arthrodesis due to manifest instability, nonplantigrade foot position, and deformity with overt (n = 8) or what we judged was impending ulceration (n = 9). The minimum followup was 0.5 years (mean, 2.7 years; range 0.5-7 years). All eight ulcers healed without recurrence of ulceration or manifestation of new ulcers during the followup period. We observed complications leading to further surgery in nine patients: five with perioperative hematoma and four with instability. AOFAS scores rose from a preoperative mean of 39 to 70 points (hindfoot cases) and from 51 points to 84 (midfoot cases). Early surgical reconstruction in high-risk patients can provide timely restoration of a plantigrade and stable foot and improved quality of life of the patient at complication rates comparable to those after secondary surgery following failed nonoperative treatment; however we emphasize we had no control group in this small case series for which we could compare nonoperative treatment. LEVEL OF EVIDENCE Level IV, therapeutic study (case series). See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thomas Mittlmeier
- Chirurgische Klinik und Poliklinik der Universität Rostock, Abteilung für Unfall- und Wiederherstellungschirurgie, Schillingallee 35, 18055, Rostock, Germany.
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Bus SA, Hazenberg CEVBS, van Baal JGS. [Photographic foot scanner for the early diagnosis of diabetic foot]. Ned Tijdschr Geneeskd 2010; 154:A2238. [PMID: 20977813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Early recognition of foot ulcers and pre-ulcerative lesions in diabetic patients is important for the prevention of severe complications such as infection and amputation. The photographic foot-imaging device is a new technique intended as a home-monitoring system for the early diagnosis of signs of diabetic foot disease. The patient regularly takes pictures of the plantar foot surface which a trained healthcare professional remotely assesses. In the case of diagnosed foot problems, the patient is referred for treatment. This telemedical approach is primarily intended for patients who have previously had a foot ulcer or amputation. In particular, patients who are limited in inspecting their own feet may profit from this approach. The diagnosis of foot problems from photographs produced by the system has been proven to be both valid and reliable. If future studies demonstrate the efficacy and cost-effectiveness of this approach in preventing severe foot complications, it may become an integral part of foot care for high-risk diabetic patients.
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Affiliation(s)
- Sicco A Bus
- Ziekenhuisgroep Twente, afd. Chirurgie, Almelo, the Netherlands.
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Meaume S. [Antibiotics in the treatment of foot ulcers and scabs]. Soins 2010:51-55. [PMID: 20201472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Sylvie Meaume
- Service de Gérontologie, Hôpital Charles-Foix, Ivry-sur-Seine.
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Hokkam EN. Assessment of risk factors in diabetic foot ulceration and their impact on the outcome of the disease. Prim Care Diabetes 2009; 3:219-224. [PMID: 19783493 DOI: 10.1016/j.pcd.2009.08.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2009] [Revised: 08/07/2009] [Accepted: 08/14/2009] [Indexed: 10/20/2022]
Abstract
AIMS The current study aims to identify risk factors for diabetic foot ulcer and their impact on the outcome of the disease. METHODS Three hundred diabetic patients were enrolled in the study. One hundred eighty subjects with diabetic foot ulcer and 120 diabetic controls without foot lesions. All expected risk factors were studied in all patients and after a follow up period, patients with diabetic foot ulcer were classified into group A (patients with healed ulcers) and group B (patients with persistent ulcer or ended by amputation). The risk factors were reanalyzed in both groups to find out their impact on the outcome of the disease. RESULTS The following variables were significant factors for foot ulceration: Male gender (P=0.009), previous foot ulcer (P=0.003), peripheral vascular disease (P=0.004), and peripheral neuropathy (P=0.006). Also lack of frequent foot self-examination was independently related to foot ulcer risk. The outcome was related to longer diabetes duration (P=0.004), poor glycaemic control (P=0.006) and anaemia (P=0.003) and presence of infection (P<0.001). CONCLUSIONS Peripheral vascular disease and peripheral neuropathy together with lack of foot self-examination, poor glycaemic control and anaemia are main significant risk factors for diabetic foot ulceration.
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Affiliation(s)
- Emad Naeem Hokkam
- Department of surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
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Tilak R, Prakash P, Nigam C, Tilak V, Gambhir IS, Gulati AK. Cryptococcal meningitis with an antecedent cutaneous Cryptococcal lesion. Dermatol Online J 2009; 15:12. [PMID: 19930999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Cutaneous cryptococcosis, caused by an encapsulated yeast, Cryptococcus neoformans, is generally associated with concomitant systemic infection. Here we report a case of primary cutaneous cryptococcosis with spread to central nervous system in an HIV seronegative young boy. In the present case, a 17-year-old boy who was suffering from a non-healing ulcer on his right great toe for 5 months, presented with the signs and symptoms of meningitis. Cryptococcus neoformans var. gattii was isolated from the CSF of the patient. Amphotericin B administration produced recovery from the meningitis as well as from the ulcer. This case study suggests that primary cutaneous cryptococcosis can be diagnosed provisionally by a simple Gram stained smear and India ink examination in order to avoid occurrence of disseminated cryptococcosis, including meningial involvement, which may have a fatal outcome.
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Affiliation(s)
- Ragini Tilak
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi.
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Agale SV, Kulkarni DR, Valand AG, Zode RR, Grover S. Marjolin's ulcer--a diagnostic dilemma. J Assoc Physicians India 2009; 57:593-594. [PMID: 20209721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Marjolin's ulcer is malignant change in a long-standing ulcer and or scar tissue. Commonly these lesions are treated as chronic ulcers and suspicion of malignancy should be raised with crusting, increase in pain or size of the ulcer and bleeding. We report a case of Marjolin's ulcer arising in a post-traumatic chronic ulcer of sole in a 60-year-old female.
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HAN JT, WANG HT, XIE ST, GUAN H, HAN F, LI N, HU DH. [Application of lavation and drainage with continuous negative pressure in the debridement of diabetic foot complicated by plantar abscess]. Zhonghua Shao Shang Za Zhi 2009; 25:246-248. [PMID: 19951539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate the feasibility of debridement at early stage by combining lavation and drainage under continuous negative pressure in the limb salvage surgery of patients suffering from diabetic foot complicated by plantar abscess. METHODS Ten patients suffering from diabetic foot (10 feet affected) combined with plantar abscess were involved. After being debrided, wounds of patients were lavaged and drained for 7 - 14 ds under continuous negative pressure through a detained stomach tube. Suction under negative pressure continued for 3 - 5 ds after lavation, and then drainage tube was removed. Stitches on wound were removed about 3 weeks after surgery. The condition of the wounds was observed. RESULTS After above-mentioned treatment, local inflammatory response of patients was obviously ameliorated, and the wounds healed with satisfactory preservation of function and shape of the feet. CONCLUSIONS Debridement combined with local lavation and drainage under continuous negative pressure is satisfactory for the treatment of diabetic foot complicated by plantar abscess, and it can preserve the length of the affected limb.
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Affiliation(s)
- Jun-tao HAN
- Burn Center of PLA, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China
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35
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Galkowska H, Podbielska A, Olszewski WL, Stelmach E, Luczak M, Rosinski G, Karnafel W. Epidemiology and prevalence of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis in patients with diabetic foot ulcers: focus on the differences between species isolated from individuals with ischemic vs. neuropathic foot ulcers. Diabetes Res Clin Pract 2009; 84:187-93. [PMID: 19269053 DOI: 10.1016/j.diabres.2009.02.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2008] [Revised: 02/02/2009] [Accepted: 02/09/2009] [Indexed: 11/22/2022]
Abstract
We examined whether foot ischemia or neuropathy with diabetic foot ulcer (DFU) promote selection of staphylococci species, evaluated frequency of MRSA and MRSE among strains yielded from patients with DFU and assessed multidrug resistance of isolates. Patients with DFU and foot osteomyelitis were divided into ischemic foot ulcer (IFU, n=21) and neuropathic foot ulcer (NFU, n=29) groups. Frequency of Staphylococcus epidermidis yielded from curettage of IFU was higher compared with NFU (P<0.05). S. epidermidis was also more frequently isolated from the toe web surface of patients with IFU compared with NFU (55% vs. 17.9%, respectively) and healthy volunteers (HV, n=20) (17.6%, P<0.05). These mostly MRSE strains (83.3-100%) originating from DFU patients were multidrug resistant (88.8%). Also, most of MRSA isolates were multidrug resistant (70.3%). Higher rates of MSSA from DFU patients than HV showed resistance to antimicrobials. This is the first report indicating that diabetic patients with IFU differ with NFU patients in higher frequency of S. epidermidis skin colonization and ulcer infection. We suggest that IFU should be defined as separate disease state of DFU and S. epidermidis should be appreciated as a nosocomial pathogen.
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Affiliation(s)
- Hanna Galkowska
- Department of Surgical Research & Transplantology, Medical Research Center, Polish Academy of Sciences, 02-106 Warsaw, 5 Pawinskiego str, Poland.
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36
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Prompers L, Schaper N, Apelqvist J, Edmonds M, Jude E, Mauricio D, Uccioli L, Urbancic V, Bakker K, Holstein P, Jirkovska A, Piaggesi A, Ragnarson-Tennvall G, Reike H, Spraul M, Van Acker K, Van Baal J, Van Merode F, Ferreira I, Huijberts M. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study. Diabetologia 2008; 51:747-55. [PMID: 18297261 PMCID: PMC2292424 DOI: 10.1007/s00125-008-0940-0] [Citation(s) in RCA: 589] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 01/03/2008] [Indexed: 12/22/2022]
Abstract
AIMS/HYPOTHESIS Outcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD). We therefore examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients and examined whether such predictors differ between patients with and without PAD. METHODS Analyses were conducted within the EURODIALE Study, a prospective cohort study of 1,088 diabetic foot ulcer patients across 14 centres in Europe. Multiple logistic regression modelling was used to identify independent predictors of outcome (i.e. non-healing of the foot ulcer). RESULTS After 1 year of follow-up, 23% of the patients had not healed. Independent baseline predictors of non-healing in the whole study population were older age, male sex, heart failure, the inability to stand or walk without help, end-stage renal disease, larger ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of non-healing in PAD patients only. CONCLUSIONS/INTERPRETATION Predictors of healing differ between patients with and without PAD, suggesting that diabetic foot ulcers with or without concomitant PAD should be defined as two separate disease states. The observed negative impact of infection on healing that was confined to patients with PAD needs further investigation.
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Affiliation(s)
- L Prompers
- Division of Endocrinology, Department of Internal Medicine, University Hospital Maastricht, P. Debeyelaan 25, P.O. Box 5800, 6202 AZ, Maastricht, the Netherlands.
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Li J, Mu H, Ke W, Bao X, Wang Y, Wang Z, Zeng B, Cross H. The sustainability of self-care in two counties of Guizhou Province, Peoples' Republic of China. LEPROSY REV 2008; 79:110-117. [PMID: 18540241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This paper presents the findings of a follow-up survey conducted in two rural counties of Guizhou Province, PRC where a programme to prevent disabilities amongst leprosy affected people had been conducted. An initial 3-year programme had been conducted. One year after the final evaluation of the programme, a team was deployed to conduct a survey in the area. The objective of the survey was to establish the level of adherence to self-care. It was found that 87% of the sample of people living in leprosy villages that were surveyed (n = 31) and 50% of the sample of people living in general communities (n = 50) had continued to apply self-care. Interviews with family members suggested that 18 of the 27 self-care practising subjects living in the leprosy villages received encouragement or active support from family members (9 were single people). Twenty three of the 25 self-care practising subjects living in the communities also received family support (2 were single people). Family support was a highly significant factor influencing adherence in the community (OR = 15.8, CI = 3.0 to 83) but it may not have been the primary motivating factor in the leprosy villages where single people were just as likely to have adhered to self-care than people who were living in families (OR 0.5, CI = 0.06 to 4.2). The prevalence of foot ulceration among that population was recorded but a hypothetical association between the prevalence of foot ulceration and self-care adherence could not be investigated due to insufficient data to address the potential effects of confounding variables. Thirty-eight percent of subjects who did not practice self-care presented with ulceration or foot cracks (n = 29) compared with only 25% of people who did (n = 52).
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Affiliation(s)
- Jinlan Li
- AIDS, STD & Dermatology Institute, Guizhou Provincial CDC, China
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38
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Guseva NG, Starovoĭtova MN. [Unusual case of development of induced scleroderma with general fibrosis, ulcer-necrotic changes in the limbs and calcinosis]. TERAPEVT ARKH 2008; 80:74-76. [PMID: 18590120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Cook J, Cook E, Landsman AS, Basile P, Dinh T, Lyons T, Rosenblum B, Giurini J. A retrospective assessment of partial calcanectomies and factors influencing postoperative course. J Foot Ankle Surg 2007; 46:248-55. [PMID: 17586437 DOI: 10.1053/j.jfas.2007.03.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Accepted: 03/27/2007] [Indexed: 02/03/2023]
Abstract
Partial calcanectomies are a common procedure for the treatment of chronic heel ulcers. We reviewed 50 cases from patients who had partial calcanectomies to determine what factors, if any, affect the rate of healing. Each case was followed up for 1 to 6 years after surgery. We found that calcanectomy wounds were difficult to heal, regardless of the etiology. We examined a multitude of factors to determine which ones affected the rate of closure, including body mass index, vascular status, preoperative albumin levels, wound grade, presence of methacillin-resistant Staphylococcus aureus, and other factors. We found that the average total closure rate for patients undergoing partial calcanectomy was between 51% and 83% after 1 year, depending on various preoperative conditions. Our data suggest that even though the procedure itself is fairly straightforward, the course of recovery is complex, with a fairly high rate of failure after 1 year. We found that preoperative infections with methacillin-resistant Staphylococcus aureus, vascular disease, albumin levels, and preoperative ulcer grade had a significant bearing on the outcomes. We also identified other factors that did not seem to affect surgical outcomes. Based on these findings, the authors suggest some factors that should be considered when performing partial calcanectomies.
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Affiliation(s)
- Jeremy Cook
- Beth Israel Deaconess Medical Center, Department of Surgery, Harvard Medical School, Boston, MA 02215, USA
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40
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Affiliation(s)
- C Matthews
- Department of Rheumatology, St Vincent's University Hospital, Sublin, Ireland.
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41
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Abstract
As part of a cross-sectional study of Norwegian Red Cattle, associations of lameness, lesions at the tarsus, claw shapes, and claw lesions with reproductive performance and production diseases were examined. Fifty-five tiestall herds and 57 freestall herds were sampled by computerized systematic selection and 2,665 cows were trimmed and limb and claw disorders recorded by 13 specifically trained claw trimmers during the late winter and spring of 2002. After exclusions, 2,583 cows were included in this study. Most claw lesions were mild (score 1). Prevalence of moderate and severe lesions (score 2 + 3) did not exceed 5% for any of the lesions. Hazard ratios for independent variables were identified using Cox regression analyses incorporating herd as a random effect in a positive stable frailty model. Wounds and swellings at the tarsus were associated with more clinical mastitis [hazard ratio (HR) = 4.0] and teat injuries (HR = 2.5). Moderate and severe heel-horn erosions in first-lactation cows were associated with increased calving interval (HR = 0.60). Moderate and severe hemorrhages of the sole in first-lactation cows were associated with decreased interval from calving to first service (HR = 1.6) and moderate and severe hemorrhages of the sole were associated with more milk fever (HR = 8.6). All hemorrhages of the sole (scores = 1, 2, and 3) were associated with more reproductive hormonal treatments (HR = 2.3). All sole ulcers in first-lactation cows were associated with longer interval from calving to last service (HR = 0.59) and longer calving interval (HR = 0.61), whereas sole ulcers in older cows were associated with longer calving interval (HR = 0.62). All sole ulcers also were associated with more milk fever (HR = 4.8) in all cows. Moderate and severe sole ulcers in older cows were associated with increased interval from calving to first (HR = 0.35) and last (HR = 0.37) service. Moderate and severe white-line fissures in older cows were associated with increased return rate from previous insemination (HR = 2.4). Our study shows that claw disorders are associated with poorer reproductive performance and some production diseases.
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Affiliation(s)
- A M Sogstad
- Department of Production Animal Medicine, Norwegian School of Veterinary Science, 0033 Oslo, Norway.
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Laird JR, Zeller T, Gray BH, Scheinert D, Vranic M, Reiser C, Biamino G. Limb Salvage Following Laser-Assisted Angioplasty for Critical Limb Ischemia:Results of the LACI Multicenter Trial. J Endovasc Ther 2006; 13:1-11. [PMID: 16445313 DOI: 10.1583/05-1674.1] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To evaluate the effectiveness of laser-assisted angioplasty for patients with critical limb ischemia (CLI) who were poor candidates for surgical revascularization. METHODS A prospective registry at 14 sites in the US and Germany enrolled 145 patients with 155 critically ischemic limbs; the patients were poor candidates for bypass surgery owing to inadequate target vessel or saphenous vein, prohibitive cardiac disease, or significant comorbidities (ASA class 4). Additional comorbid risk factors included diabetes in 66%, hypertension in 83%, previous stroke in 21%, and myocardial infarction in 23%. Endovascular treatment included guidewire traversal and excimer laser angioplasty followed by balloon angioplasty with optional stenting. RESULTS Occlusions were present in 92% of limbs. A mean of 2.7+/-1.4 lesions were treated per limb; the total median treatment length was 11 cm (mean 16.2, range 0.2-123). Stents were implanted in 45% of limbs. Procedural success, defined as <50% residual stenosis in all treated lesions, was seen in 86% of limbs. At 6-month follow-up, limb salvage was achieved in 110 (92%) of 119 surviving patients or 118 (93%) 127 limbs. CONCLUSION Excimer laser-assisted angioplasty for CLI offers high technical success and limb salvage rates in patients unfit for traditional surgical revascularization.
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Affiliation(s)
- John R Laird
- Washington Hospital Center, Washington, DC 20010, USA, and Herzzentrum, Universität Leipzig, Germany.
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[The daily battle concerning legs]. MMW Fortschr Med 2005; 147:6. [PMID: 16184628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
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Dissemond J, Knab J, Lehnen M, Goos M. Increased activity of factor VIII coagulant associated with venous ulcer in a patient with Klinefelter's syndrome. J Eur Acad Dermatol Venereol 2005; 19:240-2. [PMID: 15752302 DOI: 10.1111/j.1468-3083.2004.01117.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Klinefelter's syndrome is the most frequent major abnormality of sexual differentiation in men with two or more X chromosomes. Recurrent venous ulcers as a result of a post-thrombotic syndrome are a well known symptom in patients with Klinefelter's syndrome. Until now the underlying pathomechanisms are not completely understood. Platelet hyperaggregability, factor V Leiden mutation and abnormalities in fibrinolysis were implicated as possible contributing factors. Here we describe the detection of an increased activity of factor VIII coagulant (factor VIII:C). This is the first case report on increased factor VIII:C activity associated with venous ulcers in a patient with Klinefelter's syndrome. Elevated factor VIII plasma levels are gradually accepted to be associated with an increased risk for venous thromboembolism. Therefore, we discuss that the examination of factor VIII:C may help in clarifying individual thromboembolic risks, especially in patients with Klinefelter's syndrome.
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Affiliation(s)
- J Dissemond
- Department of Dermatology, University of Essen, D-45122 Essen, Germany.
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45
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Karande S, Satam N. Hereditary sensory and autonomic neuropathy type IV. Indian Pediatr 2005; 42:608-9. [PMID: 15995280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- Sunil Karande
- Division of Pediatric Neurology, Department of Pediatrics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai 400 022, Maharashtra, India.
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46
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Tristano AG. Selective immunoglobulin A deficiency and primary antiphospholipid syndrome. Rheumatol Int 2005; 25:485-6. [PMID: 15654617 DOI: 10.1007/s00296-004-0512-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2004] [Accepted: 06/26/2004] [Indexed: 11/28/2022]
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Meaume S. [Caring fo infection in chronic ulcers]. Soins 2005:S17, S19-21. [PMID: 15783141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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48
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Mori S, Nagashima M, Yoshida K, Yoshino K, Aoki M, Kawana S, Hirata I, Saniabadi A, Yoshino S. Granulocyte adsorptive apheresis for leg ulcers complicated by rheumatoid arthritis: a report on three successfully treated cases. Int J Dermatol 2004; 43:732-5. [PMID: 15485529 DOI: 10.1111/j.1365-4632.2004.01986.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The treatment of inflammatory leg ulcers complicated by rheumatoid arthritis (RA), which are unresponsive to conventional care, can be frustrating. Furthermore, as granulocytes and monocytes (GM) are major sources of inflammatory cytokines, they have the potential to initiate and perpetuate inflammatory skin lesions. Accordingly, a recent study reported the remission of pyoderma gangrenosum following the reduction of activated peripheral blood GM by adsorptive apheresis (GMA). METHODS In this clinical study, we applied GMA to three cases, each with one leg ulcer below the knee and RA. The ulcers had not responded to conventional therapy, including disinfection, dressing, and antimicrobials, and therefore were thought to represent inflammatory vasculitic lesions. GMA was performed using a column with a capacity of 335 mL, filled with cellulose acetate beads that selectively adsorb granulocytes and monocytes/macrophages (Adacolumn). Each patient received one GMA session/week for five consecutive weeks. The duration of one session was 60 min, with a flow rate of 30 mL/min. RESULTS The ulcers began to recede after two GMA sessions and, by the end of the fifth session, the ulcers in all three patients had healed. No recurrence has been observed up to the time of this report. The treatment was well tolerated and no severe side-effects were observed. CONCLUSIONS GMA, which depletes activated neutrophils and monocytes/macrophages, appears to be effective for inflammatory skin ulcers which do not respond to conventional medications.
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Affiliation(s)
- Shinya Mori
- Department of Joint Disease and Rheumatism, Nippon Medical School, Tokyo, Japan
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Verdú Soriano J, López Casanaova P, Fuentes Pagés G, Torra i Bou JE. [Prevention of pressure ulcers in heels]. Rev Enferm 2004; 27:60-4. [PMID: 15526580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Heels are, for all assistance levels, one of the most frequent locations for the development of pressure ulcers (PU). In this study we deal to investigate in order to determine in patients at risk in an Internal Medicine Unit, the PU incidence on heels, after applying a specific prevention protocol. This protocol particularly designed for pressure ulcers on heels included a combined application of special hydrocellular dressings specially shaped for heels (Allevyn Heel), hyper-oxygenated fatty acids (Mepentol) and special surfaces for pressure management (Aerocare); afterwards, we attempted a comparison of our results with those from previous similar studies. We designed a prospective study which lasted from May 1-2002 until June 30-2003, with a sample of 100 patients without PU included in the study when admitted to the unit. The cumulated incidence established for PU in heels is a 4% which means an incidence rate of 2.06 PU in heels per 1000 persons/day. After observing the results we may affirm that applying the protocol is, under a clinical point of view, as effective as other measures used in previous studies. If we focus on the cost-benefit, the protocol studied represents an option with an excellent cost-efficiency relationship.
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Affiliation(s)
- José Verdú Soriano
- Departamento de Enfermería Comunitaria, Medicina Preventiva y Salud Pública, Universitat d'Alacant, España
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