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1.
J Wound Care ; 30(8): 598-603, 2021 Aug 02.
Artículo en Inglés | MEDLINE | ID: mdl-34382842

RESUMEN

AIM: People with active diabetic foot disease should be rapidly referred by health professionals along a pathway of care to a multidisciplinary foot team. The aim was to investigate patients' self-reported understanding of their foot risk status and reasons for their referral to a multidisciplinary foot team. METHOD: This seven-month service evaluation included consecutive newly referred patients. Participants completed a questionnaire which asked firstly about their understanding of their foot risk status, secondly about their pathway of care before presentation to the multidisciplinary foot team, and thirdly about their interest in diabetes-related foot education and preferred learning style. RESULTS: There were 202 participants; 65% were male, mean age was 64±15 years (mean±standard deviation (SD)), 86% had type 2 diabetes, and mean HbA1c was 65±23mmol/mol (8.3±3.7%). Only 4% of participants knew their current foot risk status and 52% did not know why their care had been escalated to a multidisciplinary foot clinic. Participants with type 2 diabetes more readily expressed an interest in further foot education compared with participants with type 1 diabetes, (70% versus 29%, p=0.001). CONCLUSIONS: These findings show that people with diabetes and foot disease are less aware of their foot risk status or why they are referred to a multidisciplinary team. Participants indicated a variable interest in further learning about foot complications. These findings indicate possible communication and educational barriers between patients and health professionals which may contribute to delayed presentation or suboptimal engagement.


Asunto(s)
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Pie Diabético , Anciano , Diabetes Mellitus Tipo 1/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente , Derivación y Consulta , Cicatrización de Heridas
2.
Muscle Nerve ; 47(3): 351-6, 2013 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-23169592

RESUMEN

INTRODUCTION: In this study we validated a modified laser Doppler imager method (mLDIf) for assessing C-fiber function and compared it to the original (oLDIf). Both measure flare size in foot skin after heating, but the mLDIf uses 47°C (vs. 44°C), making it quicker and better suited for clinical use. METHODS: To confirm that mLDIf assesses C-fiber function, 5 healthy controls (HC) were studied before and after local anesthesia (LA). Reproducibility and comparison with oLDIf was assessed in HC (n = 16). Finally, diabetes subjects with (DN(+), n = 10) and without (DN(-), n = 16) neuropathy were studied. RESULTS: LA almost abolished the flare (9.3 ± 3.0 cm(2) vs. 1.7 ± 0.3 cm(2), P < 0.0001). mLDIf produced larger flares (9.9 ± 3.4 vs. 5.7 ± 2.3 cm(2), P < 0.0001), but correlated with oLDIf (r = 0.81, P < 0.001). mLDIf was reduced in DN(-) (6.8 ± 2.8 vs. HC, P = 0.003), markedly so in DN(+) (2.0 ± 1.1 vs. HC and DN(-), P < 0.0001). CONCLUSION: The mLDIf is a quick, practical method for assessing C-fiber function in the clinical setting.


Asunto(s)
Neuropatías Diabéticas/diagnóstico , Fibras Nerviosas Amielínicas/fisiología , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Adulto , Diabetes Mellitus Tipo 2/fisiopatología , Femenino , Pie/inervación , Calor , Humanos , Masculino , Persona de Mediana Edad , Neuroimagen , Dimensión del Dolor/métodos , Reproducibilidad de los Resultados , Piel/lesiones
3.
Int J Low Extrem Wounds ; : 15347346231188874, 2023 Jul 18.
Artículo en Inglés | MEDLINE | ID: mdl-37464779

RESUMEN

Chronic limb-threatening ischaemia (CLTI) is a severe form of peripheral arterial disease (PAD) and is associated with an increased risk of amputation, mortality, and significantly impaired quality of life. International guidelines recommend considering timely revascularisation and optimal medical therapy to improve limb perfusion in individuals with CLTI. The 2 primary revascularization approaches for CLTI are open bypass surgery (BS) and endovascular therapy (EV), however, there is currently no consensus on the best initial treatment strategy for CLTI, leading to uncertainty among clinicians. To shed light on this issue, 2 recent trials, namely best endovascular versus best surgical therapy in patients with CLI (BEST-CLI) and bypass versus angioplasty for severe ischaemia of the leg (BASIL-2), have tried to provide valuable insights. While a definitive conclusion on the optimal revascularisation approach is still pending, these trials offer immediate and clinically relevant information to the diabetic foot multidisciplinary team. The trials encompassed a distinct range of patient cohorts and included participants with varying degrees of medical and physical frailty. Taken together, their findings, highlight the need for an individualised revascularisation strategy which accounts for underlying comorbidities, risk factors, disease severity, availability of suitable bypass conduits, surgical risks, and timely access to procedures. Regardless of the chosen strategy, early referral of patients with diabetes and CLTI to a specialist team within a multidisciplinary environment is crucial. Comprehensive care should encompass essential elements such as adequate debridement, infection control, offloading, glycaemic control, smoking cessation, and patient education. By addressing these aspects, healthcare providers can optimise the management and outcomes for individuals with CLTI and diabetes.

4.
Int J Low Extrem Wounds ; : 15347346231166550, 2023 Mar 30.
Artículo en Inglés | MEDLINE | ID: mdl-36998215

RESUMEN

Charcot neuro-osteoarthropathy (CNO), or Charcot foot, is a disabling complication of diabetes, which is poorly understood and frequently overlooked. We describe an atypical presentation of an active Charcot foot in a woman with a long-standing type 1 diabetes who did not exhibit loss of protective sensation (sensate to a 10-gram monofilament) or loss of vibration sensation. These standard measures of large nerve fibre function ruled out "classical" neuropathy. However, additional testing showed reduced sweat gland function most likely related to degeneration of c-fibres (small fibre neuropathy). This case raises the awareness that in addition to the "textbook" description, in diabetes, Charcot foot can develop in individuals with "minimal" or "no signs" of clinical neuropathy. The onset of active Charcot foot should be suspected in every person with diabetes and history of trauma even when foot and ankle x-rays are normal. Offloading should be initiated until the diagnosis is proven otherwise.

5.
Int J Low Extrem Wounds ; 21(4): 658-660, 2022 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-33891517

RESUMEN

There is accumulating evidence to indicate an association between coronavirus infectious disease 2019 (COVID-19) and clusters of incident cutaneous eruptions. Of these, chilblains-like perniosis have received widespread medical and media attention. These typically affect the toes, and have been called "COVID-toes." Other acral lesions such as large bullae have also been reported. However, a definitive causal relationship with the severe acute respiratory syndrome coronavirus 2 has not yet been definitively proven, nor has a pathogenic mechanism been established. These episodes are self-limiting, but we need to know whether long-term sequelae exist.


Asunto(s)
COVID-19 , Eritema Pernio , Enfermedades Transmisibles , Enfermedades de la Piel , Humanos , Pandemias , COVID-19/epidemiología , Eritema Pernio/diagnóstico , Eritema Pernio/epidemiología , Eritema Pernio/etiología , Enfermedades de la Piel/epidemiología , Enfermedades de la Piel/etiología , Dedos del Pie , Enfermedades Transmisibles/complicaciones , Enfermedades Transmisibles/patología
6.
Exp Clin Endocrinol Diabetes ; 130(3): 165-171, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33352595

RESUMEN

AIM: The diabetic foot attack (DFA) is perhaps the most devastating form of diabetic foot infection, presenting with rapidly progressive skin and tissue necrosis, threatening both limb and life. However, clinical outcome data in this specific group of patients are not available. METHODS: Analysis of 106 consecutive patients who underwent emergency hospitalisation for DFA (TEXAS Grade 3B or 3D and Infectious Diseases Society of America (IDSA) Class 4 criteria). Outcomes evaluated were: 1) Healing 2) major amputation 3) death 4) not healed. The first outcome reached in one of these four categories over the follow-up period (18.4±3.6 months) was considered. We also estimated amputation free survival. RESULTS: Overall, 57.5% (n=61) healed, 5.6% (n=6) underwent major amputation, 23.5% (n=25) died without healing and 13.2% (n=14) were alive without healing. Predictive factors associated with outcomes were: Healing (age<60, p=0.0017; no Peripheral arterial disease (PAD) p= 0.002; not on dialysis p=0.006); major amputation (CRP>100 mg/L, p=0.001; gram+ve organisms, p=0.0013; dialysis, p= 0.001), and for death (age>60, p= 0.0001; gram+ve organisms p=0.004; presence of PAD, p=0.0032; CRP, p=0.034). The major amputation free survival was 71% during the first 12 months from admission, however it had reduced to 55.4% by the end of the follow-up period. CONCLUSIONS: In a unique population of hospitalised individuals with DFA, we report excellent healing and limb salvage rates using a dedicated protocol in a multidisciplinary setting. An additional novel finding was the concerning observation that such an admission was associated with high 18-month mortality, almost all of which was after discharge from hospital.


Asunto(s)
Diabetes Mellitus , Pie Diabético , Amputación Quirúrgica , Pie Diabético/cirugía , Estudios de Seguimiento , Hospitalización , Humanos , Isquemia , Recuperación del Miembro , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento
7.
Rev Diabet Stud ; 17(1): 17-20, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34289002

RESUMEN

The co-existence of diabetic peripheral neuropathy (DPN) and depression in subjects with diabetes is being increasingly recognized. The interaction of these two serious comorbidities may increase morbidity and mortality. An emerging thought is that persisting depression, along with stroke and cognitive dysfunction, may represent a cluster of potential microvascular injuries affecting the brain, which shares a common risk factor with DPN. Current evidence highlights metabolic and clinical covariates, which may interact in subjects with DPN and depression. However, there is a lack of rigorous enquiry into the confounding effect of cognitive dysfunction and vascular brain disease. Furthermore, high-quality longitudinal studies exploring the direct impact of these comorbidities on diabetes course and on the progression of the comorbidities themselves are lacking. Improved insights into comorbid DPN and depression may help to improve screening for and treatment of both these conditions.


Asunto(s)
Diabetes Mellitus , Neuropatías Diabéticas , Lobos , Animales , Comorbilidad , Depresión/etiología , Neuropatías Diabéticas/diagnóstico , Neuropatías Diabéticas/epidemiología , Humanos , Factores de Riesgo
8.
Curr Pharm Des ; 27(8): 1080-1092, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33292111

RESUMEN

The care of the individual with diabetic foot disease (DFD) represents a significant challenge. In addition to the primary foot pathology, individuals with DFD are frequently compromised by multiple co-existent medical complications. Successful management of DFD, therefore requires simultaneous addressal of these issues alongside high-quality foot care. We explore the pharmacological treatments in DFD with an emphasis on the emerging putative technologies centred on addressing the pathobiology of wound healing but also discuss developments in infection control, Charcot neuroarthropathy, cardiovascular and diabetes care. Many of these will have a significant impact on future treatment paradigms and how we amalgamate these novel technologies may help shape the standard of care in DFD hereafter. However, there is a need for better quality of evidence and cost-effectiveness data prior to widespread adoption into routine care is considered.


Asunto(s)
Diabetes Mellitus , Pie Diabético , Pie Diabético/tratamiento farmacológico , Humanos , Cicatrización de Heridas
9.
Front Endocrinol (Lausanne) ; 12: 649405, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34220705

RESUMEN

The finding that high-dose dexamethasone improves survival in those requiring critical care due to COVID-19 will mean much greater usage of glucocorticoids in the subsequent waves of coronavirus infection. Furthermore, the consistent finding of adverse outcomes from COVID-19 in individuals with obesity, hypertension and diabetes has focussed attention on the metabolic dysfunction that may arise with critical illness. The SARS coronavirus itself may promote relative insulin deficiency, ketogenesis and hyperglycaemia in susceptible individuals. In conjunction with prolonged critical care, these components will promote a catabolic state. Insulin infusion is the mainstay of therapy for treatment of hyperglycaemia in acute illness but what is the effect of insulin on the admixture of glucocorticoids and COVID-19? This article reviews the evidence for the effect of insulin on clinical outcomes and intermediary metabolism in critical illness.


Asunto(s)
Tratamiento Farmacológico de COVID-19 , Glucocorticoides/efectos adversos , Insulina/uso terapéutico , Enfermedades Metabólicas/inducido químicamente , Enfermedades Metabólicas/prevención & control , COVID-19/complicaciones , Cuidados Críticos/métodos , Enfermedad Crítica/terapia , Dexametasona/efectos adversos , Dexametasona/uso terapéutico , Complicaciones de la Diabetes/diagnóstico , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/mortalidad , Diabetes Mellitus/tratamiento farmacológico , Diabetes Mellitus/mortalidad , Diabetes Mellitus/virología , Glucocorticoides/uso terapéutico , Humanos , Hiperglucemia/complicaciones , Hiperglucemia/tratamiento farmacológico , Hiperglucemia/mortalidad , Enfermedades Metabólicas/etiología , Obesidad/complicaciones , Obesidad/tratamiento farmacológico , Obesidad/mortalidad , SARS-CoV-2/fisiología , Resultado del Tratamiento
10.
Int J Low Extrem Wounds ; 20(4): 300-308, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32370639

RESUMEN

Whether deep swab cultures taken at admission reliably identify pathogens compared to surgical bone specimens in hospitalized individuals with diabetic foot osteomyelitis and soft tissue infection is unclear. Comparison of microbiological isolates between a deep wound swab (DWS) taken at the time of admission through the actively infected, discharging ulcer probing to the bone and the subsequent surgical bone sample (SBS) taken during surgical debridement was made. A total of 63 subjects (age 60.8 ± 13.5 years, 75% male, 80% Type 2 diabetes, HbA1C 8.9%±2.2%) were included. The proportion of Gram-positive (DWS 49% v SBS 52%) and Gram-negative (DWS 60% v SBS 60%) isolates was similar between the techniques. However, the overall concordance of isolates between the two techniques was only fair (κ=0.302). The best concordance was observed for Staphylococcus aureus (κ=0.571) and MRSA (κ=0.644). There was a correlation between number of isolates in SBS with prior antibiotic therapy of any duration (r= -0.358, p=0.005) and with the duration of ulceration (r=0.296, p=0.045); no clinical correlations were found for DWS. Prior antibiotic therapy (p=0.03) and duration of ulceration <8 weeks (p=0.025) were predictive of negative growth on SBS. In conclusion, we found only a fair concordance between deep wound swabs acquired at admission and surgical bone specimens in those presenting with a severe diabetic foot infection and features of osteomyelitis. Ensuring early surgical debridement of all infected tissue and obtaining bone specimens should be considered a clinical priority, which may also reduce the likelihood of negative growth on SBS.


Asunto(s)
Diabetes Mellitus Tipo 2 , Pie Diabético , Osteomielitis , Infecciones de los Tejidos Blandos , Infecciones Estafilocócicas , Anciano , Antibacterianos/uso terapéutico , Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/complicaciones , Pie Diabético/diagnóstico , Pie Diabético/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/diagnóstico , Osteomielitis/tratamiento farmacológico , Osteomielitis/cirugía , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Infecciones de los Tejidos Blandos/terapia , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico
11.
Int J Low Extrem Wounds ; 19(4): 341-349, 2020 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-32787600

RESUMEN

Chronic wounds cause considerable morbidity and utilize significant health care resources. In addition to addressing wound etiology and treating infection, regular debridement is a key component of wound care with a proven ability to accelerate healing. In this regard, a significant innovation in wound care has been the development of ultrasound debridement technology. The purpose of this review is to evaluate the current evidence behind the technology with an emphasis on noncontact low-frequency (NCLF) ultrasound. A number of studies, especially those evaluating NCLF technology, have demonstrated the potential of ultrasound debridement to effectively remove devitalized tissue, control bioburden, alleviate pain, and expedite healing. However, most of the studies are underpowered, involve heterogeneous ulcer types, and demonstrate significant methodological limitations making comparison between studies difficult; there is a paucity of data on cost-effectiveness. Future clinical trials on ultrasound debridement technology must address the design issues prevalent in current studies, and report on clinically relevant endpoints before adoption into best-practice algorithms can be recommended.


Asunto(s)
Desbridamiento , Úlcera de la Pierna , Ultrasonografía , Enfermedad Crónica , Desbridamiento/instrumentación , Desbridamiento/métodos , Humanos , Úlcera de la Pierna/clasificación , Úlcera de la Pierna/diagnóstico , Úlcera de la Pierna/fisiopatología , Úlcera de la Pierna/cirugía , Cirugía Asistida por Computador/métodos , Ultrasonografía/instrumentación , Ultrasonografía/métodos
12.
Exp Clin Endocrinol Diabetes ; 128(5): 347-349, 2020 May.
Artículo en Inglés | MEDLINE | ID: mdl-30562826

RESUMEN

The association between diabetes and depression is well recognised. Similarly, diabetic peripheral neuropathy (DPN) is a frequent complication of diabetes. Given the high prevalence of these conditions individually, it is hardly surprising they frequently interact, conferring additional morbidity and a higher mortality risk. Despite this, the specific clinical characteristics that underpin co-morbid depression and DPN remain unclear. Additionally, there is insufficient insight into causal pathways and temporal trends. High-quality epidemiological data is limited, but they suggest that these conditions may share certain common risk factors, although there are also distinct differences such as gender. Improved insights into the risk factors for the co-existence of DPN and depression may help towards improved screening for and treatment of these conditions.


Asunto(s)
Trastorno Depresivo/epidemiología , Neuropatías Diabéticas/epidemiología , Adulto , Comorbilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo
13.
J Clin Orthop Trauma ; 11(3): 357-368, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32405193

RESUMEN

BACKGROUND: Charcot neuroarthropathy is a complex condition characterised by progressive deformity, limited treatment options and a high amputation rate. Surgical reconstruction of Charcot foot has been proposed as a method to preserve the foot. However, limited information exists on the different methods of reconstruction available, their outcomes and complications. METHODS: We systematically analysed published data from Jan 1993 to Dec 2018 to assess methods of fixation and associated outcomes for the surgical reconstruction in Charcot neuroarthropathy. Statistical analyses were undertaken to determine the amputation rates, return to ambulation and complications associated with these techniques. RESULTS: A total of 1116 feet (1089 patients) were reported to have undergone reconstruction with significant heterogeneity in patient selection. Of these, 726 (65%) were reported to undergo internal fixation, 346 feet (31%) external fixation and 44 (4%) undergoing simultaneous internal and external fixation. No single technique demonstrated a significant benefit over the other. Overall, the bone fusion rate was 86.1%. Complications directly attributable to the technique employed were noted in 36% of individuals. The reported post-reconstruction amputation rate was only 5.5% with 91% apparently returning to ambulation. CONCLUSIONS: Although no preferential method of fixation was identified, we find that the current options for surgical reconstruction could offer limb salvage with a low amputation risk in a highly selected population. However, the lack of controlled studies, inconsistent reporting of outcomes and heterogeneity of patient selection mean that the quality of evidence is low.

14.
Rev Diabet Stud ; 15: 71-73, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31904758

RESUMEN

Diabetic foot complications now represent the 10th leading cause of disease burden and disability. Wound healing is impaired, leading to chronic ulceration. Local high oxygen concentration is required by the metabolically active cells in the wound, which may render the region hypoxic, even in the absence of peripheral arterial disease. Therefore, the contribution of hyperbaric oxygen to improved healing rates has been extensively investigated. More recent developments include products delivering topical oxygen therapy (TOT) directly at the wound site, either by continuous delivery or by pressurized systems. A very recent systematic review has found that TOT increases wound healing rates in chronic, less severe diabetic foot ulcers (DFUs), and it promotes high rates of healing in more severe ulcers. Thus, TOT appears to be very promising to improve healing in DFUs. We now need more experience regarding its therapeutic place in the algorithm of DFU management and in relation to optimal patient selection.


Asunto(s)
Pie Diabético/terapia , Oxígeno/administración & dosificación , Administración Tópica , Pie Diabético/fisiopatología , Humanos , Cicatrización de Heridas
15.
PLoS One ; 13(3): e0193452, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29518115

RESUMEN

INTRODUCTION: The laser Doppler imaging (LDI) FLARE and corneal confocal microscopy (CCM) are reliable markers of small fibre function (SFF) and structure (SFS), respectively, but the impact of potential confounding variables needs to be defined. The objective of this study was to determine the influence of age, anthropometric and biochemical variables on LDI and CCM. METHODS: 80 healthy volunteers (43 males) (age: 39.7±15.2 yrs.) underwent LDIFLARE and CCM assessment and the effect of age, anthropometric and biochemical variables was determined using multivariate analysis. RESULTS: There was an age-related decline in LDIFLARE (0.07cm2/yr; R2 = 0.669; p = <0.0001) and CCM parameters (CNFD: 0.05 fibres/mm2 /yr; R2 = 0.590; p = <0.0001, CNBD: 0.06 branches/mm2/yr; R2 = 0.549; p = 0.001and CNFL 0.07 mm/mm2/yr; R2 = 0.369; p = 0.009). BMI did not influence SFF (p = 0.08) but had a significant independent association with CNFD (p = 0.01). Fasting triglycerides (TG) independently influenced the LDIFLARE (ßc:-0.204; p = 0.008) and all CCM indices (ßc:-0.191 to -0.243; p = <0.05). HbA1c was significantly associated with CNFD only (p = 0.001) but not with LDIFLARE, CNBD or CNFL (p = ≥0.05). Blood pressure and total cholesterol were not associated with LDIFLARE or any CCM parameters. There was a significant correlation between LDIFLARE and all CCM parameters (p = ≤0.01). CONCLUSIONS: This study shows that in healthy controls, both SFF measured by LDIFLARE and SFS assessed by CCM showed a significant inverse correlation with age and triglycerides, perhaps suggesting the use of age-specific normative values when interpreting these outcomes. Furthermore, this study shows that in healthy controls, despite measuring different neural parameters, both methods correlated significantly with each other.


Asunto(s)
Envejecimiento/metabolismo , Envejecimiento/patología , Córnea/anatomía & histología , Córnea/metabolismo , Flujometría por Láser-Doppler , Microscopía Confocal , Adulto , Anciano , Presión Sanguínea , Índice de Masa Corporal , Colesterol/metabolismo , Córnea/irrigación sanguínea , Estudios Transversales , Femenino , Humanos , Modelos Lineales , Estudios Longitudinales , Masculino , Microcirculación/fisiología , Persona de Mediana Edad , Análisis Multivariante , Triglicéridos/metabolismo , Adulto Joven
16.
Int J Low Extrem Wounds ; 17(1): 7-13, 2018 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-29430981

RESUMEN

The "diabetic foot attack" is one of the most devastating presentations of diabetic foot disease, typically presenting as an acutely inflamed foot with rapidly progressive skin and tissue necrosis, at times associated with significant systemic symptoms. Without intervention, it may escalate over hours to limb-threatening proportions and poses a high amputation risk. There are only best practice approaches but no international protocols to guide management. Immediate recognition of a typical infected diabetic foot attack, predominated by severe infection, with prompt surgical intervention to debride all infected tissue alongside broad-spectrum antibiotic therapy is vital to ensure both limb and patient survival. Postoperative access to multidisciplinary and advanced wound care therapies is also necessary. More subtle forms exist: these include the ischemic diabetic foot attack and, possibly, in a contemporary categorization, acute Charcot neuroarthropathy. To emphasize the importance of timely action especially in the infected and ischemic diabetic foot attack, we revisit the concept of "time is tissue" and draw parallels with advances in acute myocardial infarction and stroke care. At the moment, international protocols to guide management of severe diabetic foot presentations do not specifically use the term. However, we believe that it may help increase awareness of the urgent actions required in some situations.


Asunto(s)
Pie Diabético , Manejo de la Enfermedad , Pie Diabético/diagnóstico , Pie Diabético/epidemiología , Pie Diabético/terapia , Salud Global , Humanos , Morbilidad/tendencias , Índice de Severidad de la Enfermedad
18.
Rev Diabet Stud ; 12(1-2): 29-47, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26676660

RESUMEN

Neurological complications of diabetes are common, affecting up to 50% of people with diabetes. In these patients, diabetic sensorimotor neuropathy (DSPN) is by far the most frequent complication. Detecting DSPN has traditionally been a clinical exercise that is based on signs and symptoms. However, the appearance of morphometric and neurophysiological techniques along with composite scoring systems and new screening tools has induced a paradigm change in the detection and stratification of DSPN and our understanding of its natural history and etiopathogenesis. These newer techniques have provided further evidence that changes in small nerve fiber structure and function precede large fiber changes in diabetes. Although useful, the challenge for the use of these new techniques will be their sensitivity and specificity when widely adopted and ultimately, their ability to demonstrate improvement when pathogenic mechanisms are corrected. Concurrently, we have also witnessed an emergence of simpler screening tools or methods that are mainly aimed at quicker detection of large fiber neuropathy in the outpatient setting. In this review, we have focused on techniques and tools that receive particular attention in the current literature, their use in research and potential use in the clinical environment.


Asunto(s)
Neuropatías Diabéticas/diagnóstico , Diabetes Mellitus Tipo 2/complicaciones , Humanos
19.
Brain Behav ; 5(7): e00354, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-26221574

RESUMEN

INTRODUCTION: The diagnosis and quantification of chemotherapy-induced peripheral neuropathy (CIPN) remains a challenge. Conventional methods including quantitative sensory testing (QST), nerve conduction tests, and biopsy are unable to detect subclinical changes, and do not consistently correlate with severity of patients' symptoms and functional impairment. This study aims to determine the utility of the LDI (laser Doppler imager) FLARE technique in the diagnosis of CIPN and whether it correlates with symptom severity. MATERIALS AND METHODS: We assessed 24 patients with established CIPN [12 due to platinum analogs (PA) and 12 to Taxanes (TX)] and 24 matched healthy controls (HC). All underwent neurophysiological examination including vibration perception threshold (VPT), sural nerve amplitude (SNAP) and conduction velocity (SNCV), LDIFLARE, and fasting biochemistry. The QLQ-CIPN20 questionnaire was used to assess symptom severity. RESULTS: HC, combined chemotherapy (CG), PA , and TX groups were matched for age, sex, BMI, and blood pressure. The LDIFLARE was significantly reduced in CG compared to HC (P =< 0.0001), whereas SNAP (P = 0.058) and SNCV (P = 0.054) were not. The LDIFLARE correlated with the QLQ-CIPN20 symptom scores in all three categories namely, CG (P =< 0.0001), PA (P = 0.001) and TX (P = 0.027) whilst, VPT, SNAP, and SNCV did not. CONCLUSION: Our findings suggest that the LDIFLARE technique is more helpful in confirming the diagnosis of CIPN in patients with distal sensory symptoms than current commonly used methods. Moreover, this novel test fulfils the unmet need for a diagnostic test that relates to the severity of symptoms. This may be useful in quantifying early changes in small fibre function indicating early CIPN.


Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Examen Neurológico , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/diagnóstico , Compuestos de Platino/efectos adversos , Taxoides/efectos adversos , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Presión Sanguínea , Índice de Masa Corporal , Femenino , Pie/fisiopatología , Calor , Humanos , Rayos Láser , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso Periférico/fisiopatología , Compuestos de Platino/uso terapéutico , Índice de Severidad de la Enfermedad , Fenómenos Fisiológicos de la Piel , Taxoides/uso terapéutico , Vasodilatación/fisiología
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