Effective communication leading to better adherence to treatment and wound closure in diabetic patients. Presentation of a case / Comunicación efectiva que condiciona un mejor apego al tratamiento y cierre de heridas en el paciente diabético. Presentación de caso

Abstract Introduction: Diabetes mellitus is a chronic degenerative disease of multifactorial etiology that causes a metabolic disorder, resulting in chronic hyperglycemia, leading to microvascular and macrovascular complications in different organs. Currently, about 422 million people worldwide are living with diabetes and it is estimated that by 2045 it will affect 693 million adults. Clinical case: In this article, we report the case of a 54-year-old man with type 2 diabetes mellitus with poor adherence to treatment and with risk factors that perpetuate poor control and the incidence of complications. Conclusion: Several studies demonstrate that the higher the patient's level of understanding of the disease, the greater the adherence to the treatment strategies and the better the glycemic control, resulting in a decrease in complications. Therefore, emphasizing effective communication is always one of the best strategies to guide the diabetic patient.

Resumen Introducción: La diabetes mellitus es una enfermedad degenerativa crónica de etiología multifactorial que causa un trastorno metabólico, dando lugar a hiperglucemia crónica, lo que conlleva a complicaciones microvasculares y macrovasculares en diferentes órganos. Actualmente, alrededor de 422 millones de personas en todo el mundo viven con diabetes y se estima que en 2045 afectará a 693 millones de adultos. Caso clínico: En este artículo presentamos el caso de un varón de 54 años con diabetes mellitus tipo 2 con mala adherencia al tratamiento y con factores de riesgo que perpetúan el mal control y la incidencia de complicaciones. Conclusión: Diversos estudios demuestran que cuanto mayor es el nivel de comprensión de la enfermedad por parte del paciente, mayor es la adherencia a las estrategias de tratamiento y mejor es el control glucémico, lo que se traduce en una disminución de las complicaciones. Por lo tanto, hacer hincapié en una comunicación efectiva es siempre una de las mejores estrategias para orientar al paciente diabético.

Intervenções terapêuticas não farmacológicas para o tratamento de úlceras no pé diabético: revisão integrativa / Intervenciones terapéuticas no farmacológicas para el tratamiento de las úlceras diabéticas: revisión integral de la literatura / Non-pharmacological therapeutic interventions for the treatment of diabetic foot ulcers: an integrative literature review

Introdução: As úlceras no pé diabético surgem da interação complexa entreneuropatia periférica e doença arterial periférica, comprometendo a cicatrização após traumas. Objetivo: Explorar a diversidade de intervenções terapêuticas não farmacológicas que têm sido estudadas e avaliadas quanto à sua eficácia e segurança no tratamento de úlceras no pé diabético. Metodologia: Pesquisa do tipo revisão integrativa da literatura. Para obtenção dos resultados foi realizado um levantamento nas plataformas PubMed e Biblioteca Virtual em Saúde. Para elaboração dos resultados foram selecionados 21 artigos. Resultados: As intervenções encontradas foram oxigenoterapia hiperbárica, terapia de feridas por pressão negativa, uso de matriz dérmica, plasma rico em plaquetas, plasma atmosférico frio, tratamentos com curativos especiais e uso de solas rígidas, entre outros. Mostraram uma variabilidade na taxa de cicatrização e no tempo de fechamento da ferida, bem como na melhoria da regeneração tecidual. Conclusão: As pesquisas mostram uma diversidade de intervenções terapêuticas não farmacológicas utilizadas no tratamento de úlceras no pé diabético, ressaltando a necessidade de abordagens individualizadas e mais estudos para determinar a eficácia e segurança de cada intervenção (AU).

Introduction:Diabetic foot ulcers arise from the complex interaction between peripheral neuropathy and peripheral arterial disease, compromising wound healing after traumas. Objective:To explore the diversity of non-pharmacological therapeutic interventions that have been studied and evaluated for their effectiveness and safety in the treatment of diabetic foot ulcers. Methodology: An integrative literature review was conducted. The search for results was performed on the PubMed and Virtual Health Library platforms. Twenty-one articles were selected for result elaboration.Results:The identified interventions included hyperbaric oxygen therapy, negative pressure wound therapy, use of dermal matrix, platelet-rich plasma, cold atmospheric plasma, treatments with special dressings, and the use of rigid soles, among others. They exhibited variability in the healing rate and wound closure time, as well as improvement in tissue regeneration.Conclusion:The research demonstrates a diversity of non-pharmacological therapeutic interventions used in the treatment of diabetic foot ulcers, emphasizing the need for individualized approaches and further studies to determine the effectiveness and safety of each intervention (AU).

Introducción: Las úlceras en el pie diabético surgen de la interacción compleja entre neuropatía periférica y enfermedad arterial periférica, comprometiendo la cicatrización después de traumas.Objetivo: Explorar la diversidad de intervenciones terapéuticas no farmacológicas que han sido estudiadas y evaluadas en cuanto a su eficacia y seguridad en el tratamiento de úlceras en el pie diabético.Metodología: Investigación del tipo revisión integrativa de la literatura. Para obtener los resultados se realizó un estudio en las plataformas PubMed y Biblioteca Virtual en Salud. Para la elaboración de los resultados se seleccionaron 21 artículos. Resultados: Las intervenciones encontradas fueron oxigenoterapia hiperbárica, terapia de heridas por presión negativa, uso de matriz dérmica, plasma rico en plaquetas, plasma atmosférico frío, tratamientos con curativos especiales y uso de suelas rígidas, entre otros. Mostraron una variabilidad en la tasa de cicatrización y en el tiempo de cierre de la herida, así como en la mejora de la regeneración tisular. Conclusión: Las investigaciones muestran una diversidad de intervenciones terapéuticas no farmacológicas utilizadas en el tratamiento de úlceras en el pie diabético, resaltando la necesidad de enfoques individualizados y más estudios para determinar la eficacia y seguridad de cada intervención (AU).

Efecto de la inmunidad celular en el tratamiento de las úlceras del pie diabético con Heberprot-P® / Effect of cellular immunity in the treatment of diabetic foot ulcers with Heberprot-P®

Introducción: Los diabéticos muestran una disminuida función del sistema inmune. Su complicación más temida es la aparición de las úlceras del pie. El Heberprot-P® tiene efectos beneficiosos en la curación de estas úlceras. Objetivo: Evaluar el efecto de la inmunidad celular en el tratamiento de las úlceras del pie diabético con Heberprot-P®. Métodos: Se realizó un estudio observacional, prospectivo, de serie de casos, en 30 pacientes con úlcera de pie diabético, ingresados en el Instituto Nacional de Angiología y Cirugía Vascular. Se administraron 75 µg de Heberprot-P®, tres veces por semana, a través de vías peri- e intralesional, durante ocho semanas. Se evaluaron las variables edad, sexo, glucemia en ayunas, creatinina, urea, ácido úrico, prueba de hipersensibilidad retardada, porcentaje de granulación, tiempo de cierre de la lesión y localización de la úlcera, antes de comenzar el tratamiento, a las 4 y 8 semanas. Resultados: Se precisó un predominio del 60 por ciento en el sexo femenino y del color de piel blanca. Los niveles de glucemia y creatinina se comportaron más elevados en los anérgicos; la urea fue similar tanto en anérgicos como en reactivos; y el ácido úrico resultó mayor en hombres reactivos y en mujeres anérgicas. Hubo mayor proporción de reactivos (63,6 por ciento), que en la cuarta semana presentaron un tejido de granulación igual o mayor al 50 por ciento; y a la octava, igual o mayor al 70 por ciento. Conclusiones: La condición en los pacientes diabéticos de ser reactivo a las pruebas de hipersensibilidad retardada con úlcera de pie diabético de tipo neuropática, tratados con Heberprot-P®, está asociada directamente con una mejor respuesta en la cicatrización de sus lesiones, mediante la formación del tejido de granulación, que favorece el cierre total o parcial de la lesión. Esto no ocurrió con los pacientes anérgicos a dicha prueba(AU)

Introduction: Diabetics show decreased immune system function. Its most feared complication is the appearance of foot ulcers. Heberprot-P® has beneficial effects in healing these ulcers. Objective: To assess the effect of cellular immunity in the treatment of diabetic foot ulcers with Heberprot-P®. Methods: An observational, prospective, case series study was conducted in 30 patients with diabetic foot ulcer admitted to the National Institute of Angiology and Vascular Surgery. 75 µg of Heberprot-P®, three times a week, were administered through peri- and intralesional routes, during eight weeks. The variables age, sex, fasting blood glucose, creatinine, urea, uric acid, delayed hypersensitivity test, percentage of granulation, time of closure of the lesion and location of the ulcer, before starting treatment, at 4 and 8 weeks were evaluated. Results: A predominance of 60 % in females and white skin color were specified. Blood glucose and creatinine levels behaved higher in the anergics; urea was similar in both anergics and reagents; and uric acid was higher in reactive men and anergic women. There was a higher proportion of reagents (63.6 por ciento), which in the fourth week presented a granulation tissue equal to or greater than 50 por ciento; and at the eighth week, it was equal to or greater than 70 por ciento. Conclusions: The condition of being reactive to delayed hypersensitivity tests in diabetic patients with diabetic foot ulcer of neuropathic type, treated with Heberprot-P® is directly associated with a better response in the healing of their lesions, through the formation of granulation tissue, which favors the total or partial closure of the lesion. This did not occur with patients who were anergic to this test(AU)

Correlation of serum adiponectin, D-dimer and NLR levels with disease severity and prognosis in patients with diabetic foot ulcer infection / 中华内分泌外科杂志

Objective:To explore the correlation of serum adiponectin (APN) , D-dimer (D-D) and neutrophil-to-lymphocyte ratio (NLR) levels with disease severity and prognosis in patients with diabetic foot ulcer infection.Methods:92 patients with diabetic foot ulcer infection in the Nantong Third Hospital Affiliated to Nantong University from Feb. 2020 to Feb. 2021 were selected, and they were divided into mild ( n=30) , moderate ( n=44) and severe ( n=18) patients according to the severity of the disease. The serum APN, D-D and NLR levels in patients with different severity were compared, the relationship between serum APN, D-D and NLR levels and disease severity in patients with diabetic foot ulcer infection were analyzed. Patients were followed up for 1 year, and the prognosis of the patients was counted. Factors affecting serum APN, D-D and NLR levels in patients with diabetic foot ulcer infection were analyzed, and the receiver operating curve (ROC) was used to analyze the value of serum APN, D-D and NLR levels in predicting poor prognosis of patients. Results:There were significant differences in serum APN, D-D and NLR levels in patients with different severity ( P<0.05) . APN level in severe patients was 5.35±0.98, in moderate patients was 7.64±1.25, both lower than that of the mild patients 9.19±1.73 ( P<0.05) . Serum APN level in severe patients was lower than that in moderate patients ( P<0.05) . Serum D-D and NLR levels were 3.49±0.72 and 2.86±0.58 in severe patients, respectively; and they were 3.02±0.63 and 2.24±0.46 in moderate patients, higher than that of mild patients 2.43±0.51; 1.71±0.33 ( P<0.05) . The levels of serum D-D and NLR in severe patients were higher than those in moderate patients ( P<0.05) . Spearman correlation analysis showed that the severity of the disease was negatively correlated with serum APN levels ( r=-0.414, P<0.001) , and positively correlated with serum D-D and NLR levels in patients with diabetic foot ulcer infection ( r=0.387, P<0.001; r=0.461, P<0.001) . Univariate analysis showed that the proportion of severe disease, serum fasting blood glucose, glycosylated hemoglobin, fibrinogen, D-D and NLR levels in patients with poor prognosis were higher than those in patients with good prognosis ( P<0.05) , and the APN level in patients with poor prognosis was lower than that in patients with good prognosis ( P<0.05) . Logistic multivariate regression analysis showed that severe disease, serum glycosylated hemoglobin, APN, D-D, and NLR levels were independent risk factors for poor prognosis in patients with diabetic foot ulcer infection ( P<0.05) . ROC analysis showed that the optimal cut-off points of serum APN, D-D and NLR levels for predicting poor prognosis of patients were 5.73 mg/L, 3.06 mg/L, 2.12, the sensitivity was 78.57%, 82.14%, 85.71%, the specificity was 76.56%, 67.19%, 73.44%, the area under the curve (AUC) was 0.793, 0.784, 0.818, the specificity and AUC of the three were 98.44 %, 0.918, respectively. Conclusions:Serum APN, D-D and NLR levels are related to the severity of the disease in patients with diabetic foot ulcer infection. Clinical detection of serum APN, D-D and NLR levels can be used as sensitive indicators to predict poor prognosis.

Topical Effects of Aloe Vera in Healing Diabetic Foot Ulcers: A Protocol of Systematic Review

@#Introduction: Wound care is a very important part of managing diabetic foot ulcers. The importance of choosing the right topical therapy for managing diabetic foot ulcers aims to help speed up the wound healing process. Aloe vera is one of the traditional natural ingredients that is often used in wound care and can maintain a moist atmosphere in wound care. So it is necessary to have a systematic review to provide comprehensive evidence regarding the topical effects of aloe vera in increasing wound healing in diabetic foot ulcers. This study aims to determine the topical effect of aloe vera in healing diabetic foot ulcers. Methods: This research is a systematic completion that will use six databases (CINAHL, Academic, PubMed, ProQuest, ScienceDirect, SpringerLink, and google scholar) to search for randomized controlled trial and Quasi-Experimental articles randomly in 2007-2022. The Systematic Review protocol used follows PRISMA as a guide in preparing insights and The Joanna Briggs Institute (JBI) Critical Appraisal Tools to assess research quality. This study will determine the effect of topical aloe vera on wound healing in diabetic foot ulcers. Discussion: The results of this study can be useful for knowing the topical effects of aloe vera for wound healing in diabetic foot ulcers. Trial Registration: This protocol has been registered on the protocol registration site for systematic review namely PROSPERO with registration number CRD42022318695.

Bone marrow-derived mesenchymal stem cell-conditioned medium ameliorates diabetic foot ulcers in rats

Abstract Objectives: This study aimed to explore the effects of bone marrow-derived Mesenchymal Stem Cell-Conditioned Medium (MSC-CM) treating diabetic foot ulcers in rats. Methods: Models of T2DM rats were induced by a high-fat diet and intraperitoneal injection of STZ in SD rats. Models of Diabetic Foot Ulcers (DFUs) were made by operation on hind limbs in diabetic rats. Rats were divided into four groups (n = 6 for each group), i.e., Normal Control group (NC), Diabetes Control group (DM-C), MSC-CM group and Mesenchymal Stem Cells group (MSCs). MSC-CM group was treated with an injection of conditioned medium derived from preconditioned rats' bone marrow MSCs around ulcers. MSCs group were treated with an injection of rats' bone marrow MSCs. The other two groups were treated with an injection of PBS. After the treatment, wound closure, re-epithelialization (thickness of the stratum granulosums of the skin, by H&E staining), cell proliferation (Ki67, by IHC), angiogenesis (CD31, by IFC), autophagy (LC3B, by IFC and WB; autoly-sosome, by EM) and pyroptosis (IL-1β, NLRP3, Caspase-1, GSDMD and GSDMD-N, by WB) in ulcers were evaluated. Results: After the treatment wound area rate, IL-1β by ELISA, and IL-1β, Caspase-1, GSDMD and GSDMD-N by WB of MSC-CM group were less than those of DM group. The thickness of the stratum granulosums of the skin, proliferation index of Ki67, mean optic density of CD31 and LC3B by IFC, and LC3B by WB of MSC-CM group were more than those of DM group. The present analysis demonstrated that the injection of MSC-CM into rats with DFUs enhanced the wound-healing process by accelerating wound closure, promoting cell proliferation and angiogenesis, enhancing cell autophagy, and reducing cell pyroptosis in ulcers. Conclusions: Studies conducted indicate that MSC-CM administration could be a novel cell-free therapeutic approach to treat DFUs accelerating the wound healing process and avoiding the risk of living cells therapy.

Construction and verification of an intelligent measurement model for diabetic foot ulcer / 中南大学学报(医学版)

OBJECTIVES@#The measurement of diabetic foot ulcers is important for the success in diabetic foot ulcer management. At present, it lacks the accurate and convenient measurement tools in clinical. In recent years, artificial intelligence technology has demonstrated the potential application value in the field of image segmentation and recognition. This study aims to construct an intelligent measurement model of diabetic foot ulcers based on the deep learning method, and to conduct preliminary verification.@*METHODS@#The data of 1 042 diabetic foot ulcers clinical samples were collected. The ulcers and color areas were manually labeled, of which 782 were used as the training data set and 260 as the test data set. The Mask RCNN ulcer tissue color semantic segmentation and RetinaNet scale digital scale target detection were used to build a model. The training data set was input into the model and iterated. The test data set was used to verify the intelligent measurement model.@*RESULTS@#This study established an intelligent measurement model of diabetic foot ulcers based on deep learning. The mean average precision@.5 intersection over union (mAP@.5IOU) of the color region segmentation in the training set and the test set were 87.9% and 63.9%, respectively; the mAP@.5IOU of the ruler scale digital detection in the training set and the test set were 96.5% and 83.4%, respectively. Compared with the manual measurement result of the test sample, the average error of the intelligent measurement result was about 3 mm.@*CONCLUSIONS@#The intelligent measurement model has good accuracy and robustness in measuring the diabetic foot ulcers. Future research can further optimize the model with larger-scale data samples.

Prospective observational study evaluating association of sociodemographic parameters, Wagner’s grading, peripheral arterial disease and diabetic peripheral neuropathy with the outcomes of diabetic foot ulcers

Background: The present study was conducted to determine the association of sociodemographic parameters, comorbid conditions and complications of diabetes mellitus (DM) with the treatment outcomes of diabetic foot ulcers.Methods: The present prospective observational study enrolled 105 participants aged 30-85 years with diabetic foot ulcers presenting to general surgery department during a period of 18 months. Participants who were terminally ill, who had trophic ulcers of Hansen’s disease and filariasis and its sequelae were excluded. The study was approved by institutional ethics committee and written informed consent was obtained from all study participants. Data was analyzed using R and the test of significance was chi square test, p<0.05 was considered statistically significant.Results: Higher proportion of male participants and those aged between 50-69 years were encountered. Male participants were of higher age and the mean duration of DM in participants with diabetic foot ulcer was 8 years. The mean HbA1C of study participants was 8.1%, 38.1% participants had high plasma glucose. Food deformity was observed in 41% participants. 62.9% and 66.7% participants had diabetic peripheral neuropathy and peripheral arterial disease respectively. The mean time required for healing among participants with diabetic foot ulcers was 45.8 Significant association of major amputation with diabetic peripheral neuropathy (p=0.02), Wagner’s grading (p<0.001) and peripheral arterial disease (PAD) (p=0.006) was observed.Conclusions: The presence of diabetic peripheral neuropathy and PAD were risk factors for major amputations in diabetic foot ulcers. Lower Wagner’s grading was associated with lower chances of major amputation.

Prospective observational study evaluating the predictive value of ankle branchial pressure index on the outcomes of diabetic foot ulcers

Background: The study was conducted to determine the diagnostic accuracy of ankle branchial pressure index (ABPI) in predicting major amputation and duration of wound healing in diabetic foot ulcers.Methods: 105 participants (30-85 years) admitted in general surgery inpatient with diabetic foot ulcers during 18 months were enrolled in the present prospective observational study. Institutional ethics committee approved the study and written informed consent was obtained from all study participants. Data was analyzed using R and the tests of significance were chi square test and ANOVA. Area under curve (AUC) of receiver operator characteristic (ROC) was used to describe the diagnostic accuracy of ABPI. P<0.05 was considered statistically significant.Results: The mean ABPI of study participants was 0.7 with 23.8% participants having normal ABPI. Lower ABPI was associated with longer duration of ulcer healing (p=0.003). All participants with ABPI <0.3 required more than 120 days for wound healing (p<0.001) and required above knee amputation (p<0.001). AUC ROC of ABPI and major amputation is 0.987 with 92.9% sensitivity and 98.9% specificity. Significantly higher proportion of participants with ABPI ≤0.48 underwent major amputation. The AUC of ROC of ABPI on duration of wound healing was 0.953 with 84.9% sensitivity and 98.1% specificity.    Conclusions: ABPI can be used as a routine tool in all patients with diabetic foot ulcers for screening peripheral arterial disease so that the decision for amputation can be made early during diabetic foot ulcers.

Study of Glycated Haemoglobin and Lipid Profile in Patients with Diabetic Foot Ulcer

Introduction: Diabetic foot ulcer is a major disablingcomplication of Diabetes Mellitus and often precedes lowerextremity amputation. This study aims to evaluate the level ofHbA1c and lipid profile in patients with diabetic foot ulcer asT2DM patients areprone to diabetic dyslipidemia,which puts them at risk ofdeveloping macrovascular and microvascular diseases.Material and methods: The study was accomplished at atertiary care hospital in Jammu & Kashmir. One hundred tensubjects with T2DM were enrolled for the present study, thisincluded 55 subjects with DFU and 55 subjects without DFU.The HbA1c and lipid profile of the subjects were measuredwith standard methods.Results: In our study HbA1c level was found higher indiabetic patients with diabetic foot ulcer when compared withpatients without. Also lipid profile was found deranged indiabetic foot ulcer patients in comparison to control group. Itwas found that approximately 78% DFU have HbA1c levels˃7%. Unlike the DFU-patients, 79% of patients without DFUhave HbA1c level controlled.Conclusion: As diabetic foot ulcer is a major disablingcomplication of Diabetes Mellitus and often precedes lowerextremity amputation, we conclude that HbA1c level shouldbe maintained in normal range and regulating it is imperativefor avoiding T2DM complications.

Comparing the efficacy of nano crystalline silver dressing versus betadine dressing in management of diabetic foot ulcer

Background: The incidence of diabetes and its complications is rising as a result of the lifestyle changes. The foot is most frequent site for complication in patients with diabetes. Dressings have a vital part to play in the management of wounds. The ideal antiseptic is one that is lethal to all forms of bacteria, has no deleterious effect on healing tissues, delineates the operative areas, easily applied and has wide spectrum of activity and absence of acquired bacterial resistance. Nanotechnology makes it possible to expand the surface area of silver particles markedly to nanoscale. They expand the surface area of silver particles increasing their contact with bacteria.Methods: In the proposed study, over a period of 18 months, 60 cases (30-30 in 2 groups) of diabetic foot ulcers were studied with respect to response (healing) to nano silver dressing and betadine dressing after dividing them randomly. Assessment was based on various parameters like size reduction, healthy granulation tissue, etc.Results: It was seen that percentage reduction in size, was more in nano silver group as compared to betadine group. Wounds were managed successfully, early in nano silver group and wound healing was better in nano silver group as compared to betadine group. Also, nano silver was better antimicrobial.Conclusions: The prospective study showed nano silver gel is safe and effective in wound management and gives better efficacy and faster response as compared to traditional betadine dressing.

One year randomized controlled trial to compare the effectiveness of honey dressing versus povidone iodine dressing for diabetic foot ulcer at Dr. Prabhakar Kore Hospital and MRC, Belagavi

Background: The objective of the study is to find out the effect of honey dressing versus povidone iodine dressing for reduction of wound size in diabetic foot ulcer.Methods: This randomized controlled trial was done in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital, Belagavi from January 2017 to December 2017. 64 patients were randomized into 32 group each undergoing unprocessed honey dressing and other group undergoing povidone iodine dressing.Results: The mean wound size in honey dressing was 23.16 cm2 and 23.03 cm2 in povidone dressings  at baseline, 23.16 cm2 and 22.94 cm2 at 1st day follow up, 23.16 cm2 and 22.94 cm2 at 3rd day follow up, 19.38 cm2 and  20.28 cm2 at 5th day follow up, 16.13 cm2 and 17.06 cm2 at 7th day follow up, 12.44 cm2 and  16.13 cm2 at 10th day follow up and the end of 15th day, it was 10.69 cm2 and 15.06 cm2 respectively in honey dressing group and povidone dressing group. The difference in the wound size in honey dressing group and povidone dressing group at 1st day, 3rd day, 5th day, 7th day, 10th day follow up period were statistically not significant (p>0.05). The difference in the wound size in honey dressing group at 15th day follow up period were statistically significant (p<0.05).Conclusions: This study shows more favorable results with honey dressing for reduction of wound size in diabetic foot ulcers.

Effect of Sildenafil in the Management of Grade 2 Diabetic Foot Ulcers: A Prospective Study

Background: Diabetes mellitus has become a global epidemic. Mortality and morbidity due to this is increasing in alarmingproportion. The financial burden to society by this is markedly increasing every year.Materials and Methods: This randomized control study included 72 patients of age group 44–75 (36 studies and 36 controlgroups). The study group is provided sildenafil 25 mg daily orally for 36 days. The phase of the healing process is comparedin both groups.Results: In the study group, all 36 patients showed complete healing in 22 days but in control group, only 6 patients hadcomplete healing on 36 days and other 30 patients are at various stage of healing. The difference was obvious statistically.Conclusion: Although the sildenafil is mainly used for erectile dysfunction syndrome and other medical conditions its role inthe management of diabetic foot ulcer is commendable.

Prevalence of ESBL producing enterobacteriaceae in diabetic foot ulcers

Introduction: Diabetic foot ulcer is one of the dreaded complications among the diabetic patients which are disabling, leading to repeated hospitalizations and even amputation, drastically reducing the quality of life. Hence proper management of diabetic foot infections by choosing appropriate antibiotic is crucial. The aim of the study: This study was undertaken to know about the prevalence of ESBL producing Enterobacteriaceae in Diabetic foot ulcers and their antibiotic sensitivity pattern to aid in the effective treatment of infection. Materials and methods: A total of 200 Pus samples were collected from the patients admitted and/ or attending in-patient or out-patient departments of Rajah Muthiah Medical College and Hospital. Only Enterobacteriaceae were isolated and antibiotic sensitivity testing was done according to CLSI guidelines. All the isolates were screened for ESBL and confirmed by phenotypic confirmatory tests. Results: A total of 60 Enterobacteriaceae were isolated from diabetic foot ulcer patients among which 27 (45%) isolates were ESBL producers. ESBL production is predominantly seen in E.coli (48.1%) followed by Klebsiella (44.4%), P. mirabilis (3.3%) and P. vulgaris (3.3%). ESBL producers were sensitive to Imipenam (88.9%), Amikacin (77.8%) and Gentamicin (55.6%) whereas highly resistant to Ampicillin, Amoxyclav, Cefuroxime and Ceftriaxone. Conclusion: This study shows the higher prevalence of ESBL producing Enterobacteriaceae in diabetic foot ulcers. Imipenam, Amikacin and Gentamicin can be used for empirical treatment but early identification and treatment according to antibiotic sensitivity pattern helps in preventing the emergence and propagation of multidrug resistance strains.

Therapeutic effect of medical and health care joint management on patients with diabetic foot ulcer / 中华内分泌外科杂志

Objective To build new management model for diabetic foot disease,and to observe the therapeutic effect of diabetic foot ulcers under the new model.Methods 52 patients with newly diagnosed diabetic foot disease were recruited and randomly divided into the experimental group (n=26) and the control group (n=26).While the experimental group adopted the interdisciplinary collaboration model (nurse-doctor jointed diabetes care management model),the control group were treated by the single department pattern.The foot ulcer healing rate,average length of stay (ALOS),fasting plasma glucose (FPG),2 h postprandial blood glucose (2 h PBG),glycosylated hemoglobin (HbA1c),and the patient awareness of the knowledge about diabetes self-management were respectively compared at 3 and 6 months.Results After receiving a multidisciplinary joint diagnosis and treatment,FPG and 2 h PBG of the patients from the experimental group [(6.44±2.93)mmol/L,(8.52± 2.09)mmol/L] were significantly decreased than those of the patients from the control group [(8.17±3.19)mmol/L,(10.77±3.27)mmol/L].HbA1c at 3 and 6 months (7.2％,7.7％) and ulcer recurrence rate (3.8％) after 6 months of patients of the experimental group were significantly reduced than those of the control group(8.9％,9.1％ and 15.4％).When compared with patients of the control group,patients of varying severity in the experimental group showed significantly shortened ulcer healing time and hospital stay.Moreover,patients from the experimental group showed statistically higher knowledge level and self management ability (P＜0.05).Conclusion Through interdisciplinary collaboration,podiatric medical joint management model can significantly improve cure rate,shorten ALOS,improve blood sugar control and patient satisfaction.

Isolation of Trichophyton rubrum from Diabetic Foot Ulcers of 4 Patients / 대한의진균학회지

Trichophyton rubrum is a common cause of superficial dermatophytosis in humans, such as tinea pedis, tinea unguium, tinea corporis and tinea cruris. T. rubrum usually attaches to keratin of the epidermis and uses it as a source of nutrients. Therefore, isolation of T. rubrum from non-keratinous skin, such as ulcer, is very rare. We describe 4 patients with T. rubrum-infected diabetic foot ulcer.

Diabetic foot complications among patients attending a specialist diabetes clinic in Jamaica: prevalence and associated factors / Complicaciones del pie diabético entre pacientes que asistían a una clínica especializada de diabetes en Jamaica: prevalencia y pactores asociados

OBJECTIVES: To estimate the prevalence of diabetic foot complications among patients at a specialist diabetes clinic in Jamaica and identify factors associated with foot complications. METHODS: A stratified random sample of 188 patients were interviewed and examined between 2009 and 2010. Trained nurses obtained demographic and clinical data, measured anthropometrics and performed foot examinations including inspection for amputations, ulcers or infection and assessment of pain, vibration and pressure perception. RESULTS: Participants included 143 women and 45 men (mean age 56 years; mean diabetes duration 16 years). The prevalence of amputations was 8.5% (95% CI 4.5, 12.5%) and was higher among men (22.2%) compared to women (4.2%, p < 0.05). Prevalence of current ulcers and current foot infections was 4.3% and 3.7%, respectively. Overall, 12% of patients had at least one of these foot complications. Foot complications were more prevalent among men, patients with high blood pressure (BP > 130/80 mmHg) or peripheral neuropathy. In multivariable logistic regression models, factors associated with foot complications were: neuropathy (OR 9.3 [95% CI 2.8, 30.3]), high BP (OR 7.9 [1.3, 49.7]) and diabetes duration (OR 1.32 [1.02, 1.72]). CONCLUSION: Approximately one of every eight patients in this specialist clinic had a major foot complication. Associated factors were neuropathy, high blood pressure and longer duration of diabetes.

OBJETIVOS: Estimar la prevalencia de complicaciones de pie diabético entre pacientes de una clínica especializada en diabetes en Jamaica, e identificar los factores asociados con complicaciones de pie. SUJETOS Y MÉTODOS: Se realizaron entrevistas y exámenes a una muestra aleatoria estratificada de 188 pacientes entre 2009 y 2010. Enfermeras entrenadas obtuvieron datos demográficos y clínicos, realizaron mediciones antropométricas, así como exámenes de pie - incluyendo la inspección de las amputaciones, las úlceras o infección, y evaluación de la percepción del dolor, la vibración y la presión. RESULTADOS: Los participantes incluyeron 143 mujeres y 45 hombres (edad promedio: 56 años; duración promedio de la diabetes: 16 años). La prevalencia de las amputaciones fue 8.5% (IC de 95%: 4.5, 12.5%) y fue mayor entre los hombres (22.2%) en comparación con las mujeres (4.2%, p < 0.05). La prevalencia de las úlceras e infecciones de pie corrientes fue de 4.3% y 3.7%, respectivamente. En general, 12% de los pacientes tenían al menos una de estas complicaciones de pie. Las complicaciones de pie fueron más frecuentes entre los hombres, los pacientes con hipertensión arterial (BP > 130/80 mmHg), o con neuropatía periférica. De acuerdo con los modelos de regresión logística multivariable, los factores asociados con las complicaciones de pie fueron: la neuropatía (OR 9.3 [95% CI 2.8, 30.3]), BP alto (OR 7.9 [1.3, 49.7]) y la duración de la diabetes (OR 1.32 [1.02, 1.72]). CONCLUSIÓN: Aproximadamente uno de cada ocho pacientes en esta clínica especializada tuvo una complicación de pie importante. Los factores asociados fueron: neuropatía, presión alta y mayor duración de la diabetes.

Tratamiento de úlceras severas de pie diabético con factor de crecimiento epidérmico recombinante (Heberprot-P). Análisis retrospectivo de los resultados obtenidos en Argentina / Tratamento de úlceras severas de pé diabético com fator de crescimento epidérmico recombinante (Heberprot-P). Análise retrospectiva dos resultados obtidos na Argentina / Treatment of severe diabetic foot ulcers with recombinant human epidermal growth factor (Heberprot-P®. Retrospective analysis of the results obtained in Argentina

Antecedentes: Los tratamientos actualmente disponibles para aquellos pacientes que presentan úlceras severas por pie diabético incluyen distintas medidas terapéuticas, tanto médicas como quirúrgicas. Sin embargo, la tasa de amputación en los pacientes con úlceras severas continúa siendo elevada. La administración local de factor de crecimiento epidérmico humano para promover la granulación y la cicatrización de úlceras crónicas severas por pie diabético es una nueva alternativa que se ha comenzado a utilizar en la práctica médica enciertos países. El factor de crecimiento epidérmico humano recombinante es una alternativa de tratamiento actualmente disponible en Argentina.Objetivo: El objetivo del presente trabajo es evaluar los resultados del tratamiento de las úlceras severas de pie diabético (Wagner 3-4) con factor de crecimiento epidérmico (Heberprot-P) utilizado en la práctica médica habitual. Métodos: Se incluyeron en el presente análisis retrospectivo 124 pacientes (67% hombres y 33% mujeres) con diagnóstico de Pie Diabético (42% Wagner 3 y 57% Wagner 4) que fueron tratados con una dosis de 75 μg del factor de crecimiento epidérmico, Heberprot-P®, administrado por peri e intralesionalmente desde Marzo de 2009 a Diciembre de 2011. Los pacientes fueron atendidos en forma ambulatoria en los servicios de nutrición y cirugía vascular de hospitales públicos y privados de la Argentina. Resultados: El 91% de los pacientes presentó respuesta de granulación parcial. La tasa de respuesta de granulación total obtenida fue del 70.3%, con una tasa de cierre total de la úlcera en el 69.2% de los pacientes. El tiempo medio de cicatrización fue de 13 semanas. El porcentaje de pacientes amputados y con recurrencia de la lesión luego de 6 meses de seguimiento fue del 10.4% y 4.2% respectivamente. El tratamiento fue bien tolerado. Se presentaron eventos adversos (EAs) en el 29% de los pacientes. Los más frecuentes fueron escalofríos, infección local ...

Antecedentes: Os tratamentos atualmente disponíveis para pacientes que apresentam úlceras severas devido a pé diabético incluem diferentes medidas terapêuticas, tanto médicasquanto cirúrgicas. Entretanto, a taxa de amputação nos pacientes com úlceras severas continua sendo elevada. A administração local de fator de crescimento epidérmico humano para promover a granulação e a cicatrização de úlceras crônicas severas por pé diabético é uma nova alternativa que começou a ser utilizada na prática médica em alguns países. O fator de crescimento epidérmico humano recombinante é uma alternativa de tratamento atualmente disponível na Argentina. Objetivo: O objetivo do presente trabalho é avaliar os resultados do tratamento das úlcerasseveras de pé diabético (Wagner 3-4) com fator de crescimento epidérmico (Heberprot-P®) utilizado na prática médica habitual. Métodos: Incluiram-se na presente análise retrospectiva 124 pacientes (67% homens e 33% mulheres) com diagnóstico de Pé Diabético (42% Wagner 3 e 57% Wagner 4) que foram tratados com uma dose de 75 μg do fator de crescimento epidérmico, Heberprot-P®, administrado por peri e intralesionalmente de março de 2009 a dezembro de 2011. Ospacientes foram atendidos de forma ambulatória nos serviços de nutrição e cirurgia vascular dos hospitais públicos e privados da Argentina. Resultados: 91% dos pacientes apresentou resposta de granulação parcial. A taxa deresposta de granulação total obtida foi de 70.3%, com uma taxa de fechamento total da úlcera em 69.2% dos pacientes. O tempo médio de cicatrização foi de 13 semanas. A porcentagem de pacientes amputados e com recorrência da lesão depois de 6 meses de seguimento foide 10.4% e 4.2% respectivamente. O tratamento foi bem tolerado. Apresentaram-se eventos adversos (EAs) em 29% dos pacientes. Os mais frequentes foram calafrios, infecção local, dorno local de aplicação, febre e hipotensão arterial, de intensidade leve-moderados...

Background: Treatments currently available for patients with severe diabetic foot ulcers include different therapeutic alternatives as well as surgery measures. However, amputationrate in these patients is still high. Local administration of recombinant human epidermal growth factor (Heberprot-P®) to promote granulation and healing of severe chronic ulcers in diabetic foot is the new alternative that has been recently applied in some countries. Thisproduct is currently available in Argentina. Objective: The purpose of the present work is to evaluate the results of the local treatment of severe diabetic foot ulcers (Wagner 3-4) with recombinant human epidermal growth factor (Heberprot-P®) used in daily medical practice. Methods: From March 2009 to December 2011, 124 patients (67% men and 33% women) diagnosed with diabetic foot ulcer (42% Wagner 3 and 57% Wagner 4) who had receivedperi and intralesional administration of 75 μg of Heberprot-P®, were included in this retrospective analysis. These patients were outpatients seen at the nutrition, diabetes and vascular departments of argentine public and private hospitals. Results: Granulation response was shown in 91% of patients. The complete granulation response rate obtained was 70.3%, with a complete ulcer closure in 69.2% of the patients.Mean wound healing time was 13 weeks. After 6 month follow up, there were 10.4% amputations and 4.2% recurrence. The treatment was well tolerated. Adverse events (AEs)were reported in 29% of patients. The most frequent were shiver, local infection, pain in the application site, fever and arterial hypotension, all with mild to moderate intensity. Threeserious AEs (SAEs) were reported: two of them were patients with lower limb infections and the third a case of anaphylactic reaction, all with complete recovery. No deaths were reported. ...

A questionnaire based survey on awareness of diabetic foot care in Indian population with diabetes: A cross-sectional multicentre study.

Objective: To find awareness regarding foot care in Indian population with diabetes in various parts of India. Materials and Method: A cross-sectional study design was used to perform a multicenter, national level survey from August, 2011 to February, 2012 in various parts of India. Descriptive analysis was done using Statistical Package for Social Sciences (SPSS) 16. Awareness levels for diabetic foot care were calculated as absolute frequencies and were reported as overall percentages. Spearman test was used to find the correlation for foot problems and diabetic foot care with socioeconomic status. Results: A total of 323 peoples were screened (there were 222 men and 101 women in the study with a mean age of 58.2 ± 8.6 years). 8.7% of men reported ulcer during the 1 st year of onset of diabetes, where as 8.3% of women were prone for ulcers in 16-20 years of diabetes, 56.4% of the population in urban area and 46.6% of the population in the rural area had been educated regarding foot care in diabetes. However, only 30.5% of population in urban areas and 9.7% of population in the rural areas knew about the importance of shoe selection in diabetes. Spearman's correlation was significant for foot problems with family income and educational status, P = 0.03 and P = 0.02 respectively. Conclusion: There is a need to bridge the disparity in awareness regarding diabetic foot management in Indian masses. More aggressive measures are required to implement current preventive foot care strategies in India.

A pilot study on the effects of a polyherbal formulation cream on diabetic foot ulcers.

Background & objectives: Diabetic foot ulcers are the most common cause of non-traumatic lower extremity amputations in developing countries. The aim of this pilot study was to evaluate the safety of using a polyherbal formulation in healing diabetic foot ulcers in comparison with standard silver sulphadiazine cream among patients with type 2 diabetes. Methods: A total of 40 (M:F=29:14) consecutive type 2 diabetes patients with foot ulcers were enrolled in this study. They were randomly assigned to two groups of 20 each; Group 1 was treated with polyherbal formulation and group 2 with silver sulphadiazine cream. All the patients were followed up for a period of 5 months. The baseline ulcer size was noted and photograph of the wound was taken at the baseline and at each follow up visit. Number of days taken for healing of the wound was recorded. Results: The mean age of patients, duration of diabetes and HbA1c% were similar in both the study groups. The mean length and width of the ulcers was also similar in both the groups at baseline visit. There was a significant decrease in the size of the wound (length and width) in both the study groups (P<0.001). The mean time taken for the healing of the ulcer was around 43 days in both groups. Interpretation & conclusions: Diabetic wound cream prepared by using polyherbal formulation was found to be effective as well as safe in healing diabetic foot ulcers like the standard silver sulphadiazine cream.