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1.
BMC Surg ; 21(1): 34, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435942

RESUMO

BACKGROUND: Diabetic foot ulcers complications are the major cause of non-traumatic major limb amputation. We aimed at assessing the clinical profiles of diabetic foot ulcer patients undergoing major limb amputation in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC), a tertiary care hospital in North-eastern Tanzania. METHODS: A cross-sectional hospital-based study was conducted from September 2018 through March 2019. Demographic data were obtained from structured questionnaires. Diabetic foot ulcers were graded according to the Meggitt-Wagner classification system. Hemoglobin and random blood glucose levels data were retrieved from patients' files. RESULTS: A total of 60 patients were recruited in the study. More than half (31/60; 51.67%) were amputated. Thirty-five (58.33%) were males. Fifty-nine (98.33%) had type II diabetes. Nearly two-thirds (34/60; 56.67%) had duration of diabetes for more than 5 years. The mean age was 60.06 ± 11.33 years (range 30-87). The mean haemoglobin level was 10.20 ± 2.73 g/dl and 9.84 ± 2.69 g/dl among amputees. Nearly two thirds (42/60; 70.00%) had a haemoglobin level below 12 g/dl, with more than a half (23/42; 54.76%) undergoing major limb amputation. Two thirds (23/31; 74.19%) of all patients who underwent major limb amputation had mean hemoglobin level below 12 g/dl. The mean Random Blood Glucose (MRBG) was 13.18 ± 6.17 mmol/L and 14.16 ± 6.10 mmol/L for amputees. Almost two thirds of the study population i.e., 42/60(70.00%) had poor glycemic control with random blood glucose level above 10.0 mmol/L. More than half 23/42 (54.76%) of the patients with poor glycemic control underwent some form of major limb amputation; which is nearly two thirds (23/31; 74.19%) of the total amputees. Twenty-eight (46.67%) had Meggitt-Wagner classification grade 3, of which nearly two thirds (17:60.71%) underwent major limb amputation. CONCLUSION: In this study, the cohort of patients suffering from diabetic foot ulcers treated in a tertiary care center in north-eastern Tanzania, the likelihood of amputation significantly correlated with the initial grade of the Meggit-Wagner ulcer classification. High blood glucose levels and anaemia seem to be also important risk factors but correlation did not reveal statistical significance.


Assuntos
Amputação/estatística & dados numéricos , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/cirurgia , Úlcera do Pé , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Pé Diabético/epidemiologia , Pé Diabético/etiologia , Feminino , Humanos , Extremidade Inferior/cirurgia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Tanzânia/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento , Extremidade Superior/cirurgia
2.
Clin Podiatr Med Surg ; 38(1): 31-53, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33220743

RESUMO

The management of pedal ulcerations is often challenging because of a failure to correct underlying biomechanical deformities. Without correcting the biomechanical driving force creating the increased plantar pressures, it is unlikely for routine wound care to provide lasting solutions to pedal ulcerations. Patients with diabetes often experience glycosylation of their tendons, leading to contracture and pursuant deformity, creating imbalanced pressure distributions and eventual plantar ulceration. This article evaluates the efficacy of various lower extremity tendon transfers to balance the foot and redistribute plantar pressures to prevent or heal ulceration.


Assuntos
Pé Diabético/cirurgia , Neuropatias Diabéticas/cirurgia , Deformidades Adquiridas do Pé/cirurgia , Procedimentos Ortopédicos , Pé Diabético/etiologia , Neuropatias Diabéticas/complicações , Deformidades Adquiridas do Pé/etiologia , Humanos
3.
PLoS One ; 15(9): e0239236, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936828

RESUMO

PURPOSE: A considerable number of diabetic foot ulcer (DFU) patients require amputation every year, which worsens their quality of life, aggravates the social burden, and shortens their life expectancy. Considering these negative effects, it is important to explore the relative risk factors affecting amputation in DFU patients. METHODS: The PubMed, SCIE and Embase databases were comprehensively searched for prospective or retrospective studies published before October 31, 2019. All English language studies involving DFU patients were included, and RevMan 5.3 software was used to analyse the data. RESULTS: This meta-analysis includes 21 studies involving 6505 participants, including 2006 patients who required a lower limb amputation. The following variables were associated with an increased risk of amputation: male sex (odds ratios (OR) = 1.30, 95% confidence interval (CI) = 1.16~1.46, P<0.00001), smoking history (OR = 1.19, 95% CI = 1.04~1.35, P = 0.009), a history of foot ulcers (OR = 2.48, 95% CI = 2.00~3.07, P<0.00001), osteomyelitis (OR = 3.70, 95% CI = 3.02~4.53, P<0.00001), gangrene (OR = 10.90, 95% CI = 5.73~20.8, P<0.00001), a lower body mass index (mean difference IV (MD) = -0.88, 95% CI = -1.30~-0.47, P<0.0001), and a higher white blood cell count (MD = 2.42, 95% CI = 2.02~2.82, P<0.00001). However, age (MD = 1.24, 95% CI = -0.45~2.93, P = 0.15), type of diabetes (OR = 0.96, 95% CI = 0.61~1.52, P = 0.86), hypertension (OR = 1.19, 95% CI = 0.96~1.47, P = 0.12), and HbA1c level (MD = 0.02, 95% CI = -0.28~0.33, P = 0.87) were not associated with amputation in patients with DFU. CONCLUSIONS: Our meta-analysis identified several risk factors for amputation in DFU patients, including the male sex, a smoking history, a history of foot ulcers, osteomyelitis, gangrene, a lower body mass index, and a higher white blood cell count. Once gangrene occurs, the risk of amputation rapidly increases.


Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Pé Diabético/cirurgia , Úlcera do Pé/cirurgia , Extremidade Inferior/cirurgia , Amputação/métodos , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/etiologia , Pé Diabético/fisiopatologia , Úlcera do Pé/fisiopatologia , Humanos , Extremidade Inferior/fisiopatologia , Qualidade de Vida , Fatores de Risco
4.
J Wound Ostomy Continence Nurs ; 47(5): 445-449, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925589

RESUMO

BACKGROUND: Prior to the COVID-19 pandemic, the Cardiovascular Surgery (CV) service of an academic medical center conducted a quality improvement project to decrease readmissions to the hospital from 2 rehabilitation facilities using telehealth via video calling. This initiative became of great importance with the COVID-19 pandemic because it helped the CV service better navigate and more efficiently meet the patient care needs associated with patient care restrictions. The CV service had to quickly evaluate and implement measures to reduce the rate of transmission of the coronavirus, which included adapting the clinic workflow to comply with state and federal recommendations. To minimize the interruption of clinical services and the associated revenue, a rapid transition from outpatient clinic visits to telehealth visits was implemented. CASES: Two cases reports of patients with wounds managed with 2 different telehealth platforms are described. Doxy.me platform allows the provider to e-mail or text a link to their personal waiting room for patients to join the video call. The second platform is Cisco Jabber platform to connect directly to the nursing unit at a skilled nursing or rehabilitation facility. CONCLUSION: Health care systems have had to adjust the manner in which they triage, evaluate, and care for patients using telehealth platforms that do not rely on in-person clinic visits during the COVID-19 pandemic. There are multiple telehealth platforms that require careful planning and treatment implementation. Each health care agency needs to choose the one or ones that function the best in their care setting.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/patologia , Pé Diabético/terapia , Pneumonia Viral/epidemiologia , Telemedicina/organização & administração , Idoso , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Pé Diabético/etiologia , Feminino , Humanos , Masculino , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão
5.
Gerokomos (Madr., Ed. impr.) ; 31(2): 113-118, jun. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-193893

RESUMO

INTRODUCCIÓN: La presencia del pie diabético es una complicación frecuente en la persona que vive con diabetes. En su etiopatogenia confluyen factores conductuales, ambientales y el control de la enfermedad; no obstante, se reconoce la influencia de factores genéticos en su desarrollo y evolución. OBJETIVO: Sistematizar la asociación de los polimorfismos genéticos como riesgo para el desarrollo de pie diabético a través de la producción científica indexada. METODOLOGÍA: Revisión bibliográfica de los años 2010 a 2018; se realizó mediante la búsqueda sistemática en las bases de datos PubMed, Scopus, CONRICYT y WOS. Los descriptores fueron tres: "polymorphism" AND "diabetic foot" OR "foot ulcer diabetic". Se incluyeron artículos a texto completo en inglés con metodología de casos y controles, y que midieran estadísticamente factores de riesgo mediante la odds ratio y los riesgos relativos. Se utilizó la plataforma FLC 2.0 para evaluar la calidad del estudio. RESULTADOS: 13 artículos cumplieron con los criterios de inclusión; se identificaron 9 polimorfismos como factores para la aparición de pie diabético: HIF-1α, MCP-1-2518A/G, TLR9-1237 T/C, MAPK14 rs80028505, LOX G473A, gen FokI del receptor VDR, MMPs-1562C>T, TCF7L2, HIF-1α p582s y 4 como factores protectores: VEGF rs699947, VEGF-634G/C, eNOS Glu298Asp y VEGF 2578 C/A. CONCLUSIÓN: La susceptibilidad, gravedad y aparición del pie diabético está asociado con factores genéticos implicados en distintos mecanismos fisiopatológicos


INTRODUCTION: Diabetic foot is a frequent complication in patients with diabetes. The risk factors associated with its development and evolution are related to the behavioral, environmental and disease control characteristics, however, the influence of genetic factors in the development of this complication has been recognized. OBJECTIVE: To analyze the available evidence on the association of genetic polymorphisms in the risk of presenting diabetic foot. METHODOLOGY: Articles were reviewed in English, not older than 10 years, with a methodology of cases and controls that statistically measure risk factors through odds ratio and relative risk. Therefore the search was performed in databases such as PubMed, Scopus, CONRICYT and WOS with maximum date until January 31, 2018. Controlled descriptors "polymorphism" AND "diabetic foot" OR "foot ulcer diabetic" were applied. The FLC 2.0 platform was used to evaluate the quality of the study. RESULTS: Thirteen articles were selected, there being 9 polymorphisms with risk factors such as HIF-1α, MCP-1-2518A/G, TLR9-1237 T/C, MAPK14 rs80028505, LOX G473A, FokI gene of the VDR receptor, MMPs-1562C>T, TCF7L2, HIF-1α p582s and 4 protective factors such as VEGF rs699947, VEGF-634G/C, eNOS Glu298Asp and VEGF 2578 C/A. CONCLUSION: The susceptibility, severity and appearance of diabetic foot they are associated with genetic factors that are involved in different physiopathological mechanisms


Assuntos
Humanos , Polimorfismo Genético/fisiologia , Pé Diabético/enfermagem , Pé Diabético/complicações , Pé Diabético/etiologia , Pé Diabético/genética , Fatores de Risco , Razão de Chances
6.
Diabetes Res Clin Pract ; 163: 108147, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32302666

RESUMO

AIM: The aim of this study was to investigate the factors involved in healing failure in a population of patients with diabetic foot ulcers (DFU) after one year of follow-up. METHODS: One hundred and forty-four patients were treated for DFU in a tertiary-care center and had a regular follow-up for one year. Laboratory measurements and clinical assessments, including long-term diabetes complications and risk factors for DFU, were collected at baseline and patients were divided in two groups according to the outcome [Healed group (H, n = 91), and Not Healed group (NH, n = 53)]. RESULTS: Compared with H group, NH group had significant higher levels of urinary albumin excretion [H vs NH, median (IQR), 23.5 (10.1, 41.1) vs 26.4 (20.8, 141.1), P = 0.032] and significantly increased prevalence of diabetic kidney disease (DKD) (22% vs 40%, P = 0.038) and Charcot Arthropathy (3% vs 16%, P = 0.025). No differences among the other long-term complications of diabetes, risk factors for DFU or clinical features were found. The multiple logistic regression analysis identified DKD and Charcot Arthropathy as negative predictors of healing. CONCLUSIONS: In a population of people with type 2 diabetes with DFU treated in a tertiary-care center, DKD and Charcot Arthropathy were related to poor healing within one year-follow-up.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Pé Diabético/etiologia , Úlcera do Pé/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária
7.
Clin Podiatr Med Surg ; 37(2): 371-384, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32146989

RESUMO

Offloading the diabetic foot remains the major consideration for ulceration prevention and healing. This narrative literature review presents a brief overview of current guidelines for offloading the diabetic foot and discusses the implications that come with offloading treatment modalities and their effects on the kinetic chain of the lower extremity. We also present the latest innovative studies from the Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science that advance the knowledge in this field and provide avenues for future research opportunities.


Assuntos
Pé Diabético/terapia , Pé Diabético/etiologia , Pé Diabético/fisiopatologia , Humanos , Aparelhos Ortopédicos , Sapatos , Suporte de Carga , Cicatrização
8.
J Foot Ankle Res ; 13: 1, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31956341

RESUMO

Background: The "cancer analogy" is powerful for communicating risk to and organizing care for patients with diabetic foot syndrome. One potentially underappreciated similarity between cancer and foot ulcers is that both can recur at anatomical locations distinct from the primary occurrence, albeit with different physiological mechanisms. Few studies have characterized the location of diabetic foot ulcer recurrence, and these have been limited by considering only the first recurrent wound following a recent-healed wound. We therefore characterized the anatomical locations at which diabetic foot ulcers are likely to recur considering multiple wounds during follow-up and the locations of all prior wounds documented in the participant's history. Methods: We completed a secondary analysis of existing data from a 129 participant multi-center study of participants in diabetic foot remission. The primary outcome was plantar foot ulceration, and each participant was followed for 34 weeks or until withdrawing consent, allowing characterization of all wounds occurring. We stratified the anatomical locations of wounds prior to the trial by the following outcome categories during the trial: no recurrence, recurrence to the same anatomical location, recurrence to a different anatomical location on the same foot, and recurrence to the contralateral foot. Results: A large percentage (48%) of wounds recurred to the contralateral foot, and the proportion of subsequent foot ulcer to the contralateral limb was largely unaffected by the anatomical location of foot ulcer prior to the study. Only 17% of prior diabetic foot ulcers were followed by recurrence to the same anatomical location. Rates of recurrence remained high during treatment of a wound (0.41 foot ulcer/ulcer-year). Participants had documented wounds to 2.2 distinct anatomical locations on average, and more than 60% of participants had wounds to more than one plantar location by the end of the study. Conclusions: Given the significant morbidity, mortality, and resource utilization associated with foot ulcer recidivism, quality and evidenced-based preventive care is essential. Our results better characterize the burden of recurrence and to what anatomy recurrence is most likely. These insights may benefit providers and patients alike for the provision of high-quality preventive care thereby resulting in reduced morbidity, mortality, and cost. Trial registration: The study providing the data for this secondary analysis was registered on ClinicalTrials.gov (NCT02647346) on January 6, 2016. The study was retrospectively registered.


Assuntos
Pé Diabético/patologia , Úlcera Cutânea/patologia , Adulto , Ensaios Clínicos como Assunto , Pé Diabético/etiologia , Pé Diabético/prevenção & controle , Feminino , Hallux/patologia , Humanos , Perna (Membro)/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva , Indução de Remissão , Prevenção Secundária , Úlcera Cutânea/etiologia , Úlcera Cutânea/prevenção & controle
9.
Clin Podiatr Med Surg ; 37(1): 151-169, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31735265

RESUMO

Biomechanical changes to the lower extremity in patients with diabetes mellitus are typically greatest with peripheral neuropathy, although peripheral arterial disease also impacts limb function. Changes to anatomic structures can impact daily function. These static changes, coupled with kinetic and kinematic changes of gait, lead to increased vertical and shear ground reactive forces, resulting in ulcerations. Unsteadiness secondary to diminished postural stability and increased sway increase fall risk. These clinical challenges and exacerbation of foot position and dynamic changes associated with limb salvage procedures, amputations, and prostheses are necessary and can impact daily function, independence, quality of life, and mortality.


Assuntos
Pé Diabético/fisiopatologia , Pé Diabético/terapia , Amputação , Membros Artificiais , Fenômenos Biomecânicos , Pé Diabético/etiologia , Marcha , Humanos , Salvamento de Membro
10.
Eur J Clin Microbiol Infect Dis ; 39(2): 353-360, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31786695

RESUMO

Genetic variation in Toll-like receptors (TLRs) has previously been associated with susceptibility to complicated skin and skin structure infections (cSSSIs). The aim of this study was to investigate associations between the severity of cSSSIs, i.e., major abscesses and diabetic foot infections (DFIs), and a set of genetic polymorphisms in the Toll-like receptor pathway. A total of 121 patients with major abscesses and 132 with DFIs participating in a randomized clinical trial were genotyped for 13 nonsynonymous single-nucleotide polymorphisms (SNPs) in genes coding for TLRs and the signaling adaptor molecule TIRAP. Infection severity was defined by lesion size at clinical presentation for both types of infections. The PEDIS infection score was also used to define severity of DFIs. Linear regression models were used to study factors independently associated with severity. In patients with large abscesses, hetero- or homozygosity for the allelic variant TLR6 (P249S) was associated with significantly smaller lesions while homozygosity for the allelic variant TLR1 (R80T) was associated with significantly larger lesions. PRRs genes were not significantly associated with PEDIS. However, patients with DFI hetero- or homozygous for the allelic variant TLR1 (S248N) had significantly larger lesions. Polymorphisms in TLR1 and TLR6 influence the severity of cSSSIs as assessed by the lesion size of major abscesses and DFIs. ClinicalTrial.gov Identifier: NCT00402727.


Assuntos
Abscesso/etiologia , Pé Diabético/etiologia , Predisposição Genética para Doença , Glicoproteínas de Membrana/genética , Polimorfismo de Nucleotídeo Único , Receptores de Interleucina-1/genética , Receptor 1 Toll-Like/genética , Receptor 6 Toll-Like/genética , Abscesso/diagnóstico , Adulto , Idoso , Alelos , Comorbidade , Pé Diabético/diagnóstico , Suscetibilidade a Doenças/imunologia , Feminino , Estudos de Associação Genética , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade
11.
Nephrology (Carlton) ; 25(2): 150-155, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31025471

RESUMO

OBJECTIVE: Chronic kidney disease (CKD) is a severe complication of diabetes mellitus (DM). However, the prevalence of CKD among DM patients with diabetic foot (DF) is unknown. Accordingly, we conducted a cross-sectional study at a tertiary hospital to explore the prevalence of CKD among DF patients. METHODS: A total of 42 132 inpatients with DM were enrolled from May 2015 to October 2018. Four hundred and forty-seven DF patients were selected, and 116 patients with incomplete data were excluded. CKD was defined as an estimated glomerular filtration rate < 60 mL/min per 1.73 m2 or presence of proteinuria (urine protein ≥1). We compared the CKD prevalence of DF patients with non-DF patients and general CKD patients hospitalized in China. Multivariable regression analysis was performed to explore the relationship between different variables in DF patients and CKD. RESULTS: A total of 361 DF patients aged 67.9 ± 12.2 years were analyzed. Of these patients, 63.7% of were males. The prevalence of CKD was 49.0% (n = 177), which was higher than that observed for the general inpatients (4.5%, n = 871 742). However, 59.9% of CKD patients were not diagnosed during their hospitalizations. In the multivariable logistic regression analysis, after adjusting for potential confounders, the following variables were correlated with CKD: uric acid (odds ratio (OR) = 1.49, 95% confidence interval (CI) = 1.22-1.82), homocysteine (OR = 1.05, 95% CI = 1.00-1.10), and HBA1C (OR = 1.23, 95% CI = 1.04-1.47). CONCLUSION: This study revealed that the prevalence of CKD among DF patients was high, and special attention should be paid to these patients.


Assuntos
Diabetes Mellitus Tipo 2 , Pé Diabético , Idoso , China/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Pé Diabético/diagnóstico , Pé Diabético/epidemiologia , Pé Diabético/etiologia , Feminino , Taxa de Filtração Glomerular , Humanos , Masculino , Prevalência , Proteinúria/diagnóstico , Proteinúria/etiologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/etiologia , Fatores de Risco , Centros de Atenção Terciária/estatística & dados numéricos
12.
Eur J Vasc Endovasc Surg ; 59(1): 117-127, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31732468

RESUMO

OBJECTIVE: Diabetes mellitus has reached epidemic proportions. Foot ulceration is a multifactorial complication of diabetes associated with marked morbidity and mortality. Innate immune Toll-like receptor 4 (TLR4) mediated inflammation has been implicated in the systemic pathogenesis of diabetes and may contribute to impairment of wound healing. This study investigates the effect of high glucose and hypoxic conditions on TLR4 activation and signalling in vitro and in vivo. METHODS: Fibroblasts cultured at physiological glucose concentration (5.5 mM) were exposed to glucose concentrations from 0 mM to 25 mM, with duplicates placed in a hypoxic chamber. TLR4 inhibition was assessed in the 25 mM glucose groups. Diabetes was induced in wild type (WT) and TLR4 knockout (KO) C57BL/6 mice by intraperitoneal injection of low dose streptozocin (STZ). Hindlimb ischaemia was induced by femoral artery ligation four weeks post streptozocin, and a full thickness 4 mm skin wound inflicted below the knee. Wound healing was assessed via digital planimetry on days 3, 7, and 14 post surgery. RESULTS: Hypoxic and high glucose (25 mM) conditions led to an increase in TLR4 protein expression, apoptosis, and interleukin (IL)-6 release. Inhibition with a TLR4 neutralising antibody and specific TLR4 antagonist ameliorated the effects of high glucose and ischaemia (p < .05). In vivo, wound healing was significantly impaired in the diabetic ischaemic group at day 14 (p < .05). Diabetic ischaemic wounds in TLR4 KO mice exhibited significantly improved healing rates compared with those in WT mice at all time points. CONCLUSION: Hypoxia stimulates upregulation of TLR4 protein expression and this effect is exaggerated by hyperglycaemia. In TLR4 KO mice, there is a significant improvement in the healing of diabetic ischaemic wounds compared with WT. It is suggested that a synergistic effect between hypoxia and hyperglycaemia impairing wound healing exists, through TLR4 mediated inflammation.


Assuntos
Pé Diabético/patologia , Hiperglicemia/complicações , Isquemia/complicações , Receptor 4 Toll-Like/metabolismo , Cicatrização/fisiologia , Animais , Hipóxia Celular/fisiologia , Células Cultivadas , Diabetes Mellitus Experimental/sangue , Diabetes Mellitus Experimental/induzido quimicamente , Diabetes Mellitus Experimental/complicações , Pé Diabético/etiologia , Modelos Animais de Doenças , Fibroblastos , Humanos , Hiperglicemia/sangue , Hiperglicemia/fisiopatologia , Interleucina-6/metabolismo , Isquemia/sangue , Isquemia/fisiopatologia , Masculino , Camundongos , Camundongos Knockout , Cultura Primária de Células , Transdução de Sinais/fisiologia , Pele/citologia , Estreptozocina/toxicidade , Receptor 4 Toll-Like/antagonistas & inibidores , Receptor 4 Toll-Like/genética , Regulação para Cima
13.
Curr Diabetes Rev ; 16(3): 270-277, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31146664

RESUMO

BACKGROUND: This cross sectional study investigated the clinical use of the ankle-brachial index (ABI) and toe brachial index (TBI) in 91 type 2 diabetic foot ulcer patients who visited the diabetic foot clinic, Prince Sultan Military Medical City, Saudi Arabia during July 2017 and January 2018. MATERIALS AND METHODS: The ABI and TBI facilitated the detection of peripheral arterial disease (PAD) and the patients' medical records were used to collect the clinical and demographic variables. The variables of duration (p = 0.047) and treatment (p = 0.046) of the ABI showed significant differences. Age (p = 0.034) and duration (p = 0.001) were the factors related to the diagnosis of TBI by the "χ2" test. RESULTS: From the TBI, 26.4% of the patients were found to have PAD, while the ABI showed that 21.8% of patients had the condition. However, no statistical significance was noted. From the regression analysis, the variable duration of diabetes (≥ 20 years of age) was recognized as an independent risk factor for TBI. CONCLUSION: In conclusion, it is recommended both the ABI and TBI to be used as screening tests for PAD in diabetic foot ulcer patients.


Assuntos
Índice Tornozelo-Braço , Diabetes Mellitus Tipo 2/fisiopatologia , Angiopatias Diabéticas/diagnóstico , Pé Diabético/fisiopatologia , Doença Arterial Periférica/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Angiopatias Diabéticas/etiologia , Angiopatias Diabéticas/fisiopatologia , Pé Diabético/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/etiologia , Doença Arterial Periférica/fisiopatologia , Arábia Saudita
14.
Natl Med J India ; 32(1): 22-23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31823935

RESUMO

Dracunculiasis or guinea-worm infection is a water-borne, parasitic disease that can cause major morbidity. Dracunculiasis in patients with diabetes can be misdiagnosed as a diabetic foot abscess, which is a common complication of poorly controlled diabetes. This is a report of guinea-worm disease (GWD) in a 57-year-old man with diabetes from a rural area of Kerala. There is need for awareness among physicians about the occurrence of GWD in people with diabetes and the need to ensure supply of safe drinking water to prevent its re- emergence. Though WHO has declared India free of GWD, a few cases have been reported from the country.


Assuntos
Abscesso/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/diagnóstico , Dracunculíase/diagnóstico , Dracunculus/isolamento & purificação , Abscesso/parasitologia , Animais , Pé Diabético/etiologia , Diagnóstico Diferencial , Dracunculíase/parasitologia , Água Potável/parasitologia , , Humanos , Índia , Masculino , Pessoa de Meia-Idade
15.
J Foot Ankle Res ; 12: 56, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31827623

RESUMO

Background: There is limited Australian epidemiological research that reports on the foot-health characteristics of people with diabetes, especially within rural and regional settings. The objective of this study was to explore the associations between demographic, socio-economic and diabetes-related variables with diabetes-related foot morbidity in people residing in regional and rural Australia. Methods: Adults with diabetes were recruited from non-metropolitan Australian publicly-funded podiatry services. The primary variable of interest was the University of Texas diabetic foot risk classification designated to each participant at baseline. Independent risk factors for diabetes-related foot morbidity were identified using multivariable analysis. Results: Eight-hundred and ninety-nine participants enrolled, 443 (49.3%) in Tasmania and 456 (50.7%) in Victoria. Mean age was 67 years (SD 12.7), 9.2% had type 1 diabetes, 506 (56.3%) were male, 498 (55.4%) had diabetes for longer than 10 years and 550 (61.2%) either did not know the ideal HbA1c target or reported that it was ≥7.0. A majority had peripheral neuropathy or worse foot morbidity (61.0%). Foot morbidity was associated with male sex (OR 2.42, 95% CI 1.82-3.22), duration of diabetes > 20 years (OR 3.25, 95% CI 2.22-4.75), and Tasmanian residence (OR 3.38, 95% CI 2.35-4.86). Conclusions: A high proportion of the regional Australian clinical population with diabetes seen by the publicly-funded podiatric services in this study were at high risk of future limb threatening foot morbidity, and participants residing in Northern Tasmania are more likely to have worse diabetes-related foot morbidity than those from regional Victoria. Service models should be reviewed to ensure that diabetes-related foot services are appropriately developed and resourced to deliver interdisciplinary evidence-based care.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Pé Diabético/etiologia , Podiatria/economia , População Rural/estatística & dados numéricos , Idoso , Austrália/epidemiologia , Estudos de Coortes , Estudos Transversais , Diabetes Mellitus Tipo 1/epidemiologia , Pé Diabético/epidemiologia , Pé Diabético/mortalidade , Pé Diabético/patologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/epidemiologia , Podiatria/normas , Prevalência , Estudos Prospectivos , Fatores de Risco , Serviços de Saúde Rural/normas , População Rural/tendências , Fatores Socioeconômicos , Tasmânia/epidemiologia , Vitória/epidemiologia
16.
J Diabetes Res ; 2019: 3426878, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31828160

RESUMO

Objectives: Tetrahydrobiopterin (BH4) pathway that included generation of neopterin (Neop), biopterin (Biop), and nitric oxide (NO) is altered in type 2 diabetes (T2D). The aim of this study was to assess the biomarkers of BH4 pathway in noninfected DFUs and to relate these levels to the variables of diabetes as well as to the hematological indices. Methods: We performed a cross-sectional investigating study in a Kurdish people including 30 healthy subjects (group I), 66 T2D patients (group II), and 57 DFUs patients (group III). Hematological indices including red cell distribution width (RDW), mean platelet volume (MPV), and platelet distribution width (PDW) were determined by Coulter hematological analysis. Serum BH4 markers including NO, Neop, and Biop were determined by using an enzyme-linked immunosorbent assay (ELISA) technology. The relationship between BH4 markers with glycemic and hematological indices was assessed by Spearman's correlation and multivariable regression analysis. Results: Neop was significantly increased while PDW was significantly decreased in group III compared with group II patients. Nitric oxide was found to be inversely correlated with age (r = -0.382), duration of diabetes (r = -0.264), mean arterial blood pressure (r = -0.532), body mass index (r = -0.321), RDW (r = -0.322), and PDW (r = -0.284) in group III patients. Circulating Neop and Biop significantly correlated with RDW and erythrocyte sedimentation rate. Multivariable regression analysis revealed that serum Neop predicted the DFUs in 92.5% of group III patients. Conclusion: Tetrahydrobiopterin biomarkers are predictors of DFUs and the significant correlation of neopterin with red distribution width and erythrocyte sedimentation rate indicating the role of neopterin in the vascular and inflammation concerns of noninfected DFUs.


Assuntos
Biopterina/análogos & derivados , Biopterina/sangue , Diabetes Mellitus Tipo 2/sangue , Pé Diabético/sangue , Neopterina/sangue , Óxido Nítrico/sangue , Adulto , Biomarcadores/sangue , Biopterina/metabolismo , Sedimentação Sanguínea , Estudos de Casos e Controles , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/etiologia , Índices de Eritrócitos , Feminino , Humanos , Masculino , Volume Plaquetário Médio , Redes e Vias Metabólicas , Pessoa de Meia-Idade , Análise Multivariada
17.
Angiol Sosud Khir ; 25(4): 28-33, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31855198

RESUMO

BACKGROUND: Diabetes mellitus a commonly encountered pathology in the whole world and has a tendency towards steady growth of morbidity and development of vascular complications. The presence of haemostatic disorders and genetic susceptibility to thrombosis in patients with diabetes mellitus increases the risk for the development of thrombotic complications. AIM: The purpose of the study was to determine the incidence rate of thrombophilic conditions (TC) and thrombosis-associated gene carrier status (TAGCS) in patients suffering from neuroischaemic form of diabetic foot. PATIENTS AND METHODS: The study enrolled a total of 38 patients undergoing treatment at the Department of Vascular Surgery for critical ischaemia of lower limbs combined with diabetes mellitus during the period from 2016 to 2018. There were 29 (76.3%) men and 9 (23.7%) women. The mean age amounted to 58.9±7.3 years. The diagnosis of TC and TAGCS was made based on the study for the presence of the markers of antiphospholipid syndrome, level of homocysteine and antithrombin III, proteins C and S, as well as comprehensive genetic study in order to reveal gene polymorphisms (prothrombin, Leiden mutation, MTHFR gene, MTR gene and others). Based on the obtained findings we calculated the incidence rate of TC and TAGCS, as well as their combinations in the examined patients. RESULTS: In the studied group of patients we revealed various incidence of TC and TAGCS, and, most importantly, that of a combination of these conditions. All cases of thrombophilias were combined with TAGCS. Hyperhomocysteinemia was most commonly combined with the MTRR 66 A>G gene mutation, the presence of lupus anticoagulant - with PAI-1 675 5G>4G, whereas thrombophilic conditions - with MTRR 66 A>G and PAI-I - 675 5G>4G. Two patients were found to be carriers of the factor V Leiden mutation. CONCLUSION: The examined patients were diagnosed as having TC or TAGCS, as well as their combinations in one form or another, thus increasing the risk for the development of thromboses and embolisms in such patients.


Assuntos
Complicações do Diabetes/complicações , Pé Diabético/etiologia , Tromboembolia/etiologia , Trombofilia/complicações , Idoso , Complicações do Diabetes/genética , Pé Diabético/genética , Feminino , Heterozigoto , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Tromboembolia/genética , Trombofilia/genética
18.
Medicina (Kaunas) ; 55(11)2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31731539

RESUMO

Diabetic foot ulcers (DFUs) are the fastest growing chronic complication of diabetes mellitus, with more than 400 million people diagnosed globally, and the condition is responsible for lower extremity amputation in 85% of people affected, leading to high-cost hospital care and increased mortality risk. Neuropathy and peripheral arterial disease trigger deformities or trauma, and aggravating factors such as infection and edema are the etiological factors for the development of DFUs. DFUs require identifying the etiology and assessing the co-morbidities to provide the correct therapeutic approach, essential to reducing lower-extremity amputation risk. This review focuses on the current treatment strategies for DFUs with a special emphasis on tissue engineering techniques and regenerative medicine that collectively target all components of chronic wound pathology.


Assuntos
Complicações do Diabetes/terapia , Pé Diabético/terapia , Desbridamento/métodos , Diabetes Mellitus/terapia , Pé Diabético/etiologia , Humanos , Terapia a Laser/métodos , Doenças do Sistema Nervoso Periférico/complicações , Doenças do Sistema Nervoso Periférico/etiologia , Dermatopatias/complicações
19.
Pak J Pharm Sci ; 32(4 (Suppl)): 1843-1848, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31680081

RESUMO

The present study aimed to decipher the bacterial infections in diabetic foot human patients in Pakistan and the anti-microbial susceptibility for clinical relevance. A total of 30 samples were collected from hospitalized type 2 diabetic patients (men and women) having foot ulcers. The collected samples were cultured on mannitol salt agar, Blood agar and MacConkey's agar and cetrimide agar. Gram staining and specific biochemical tests were performed to identify the invading bacteria. Antibiotic sensitivity and resistance pattern was performed for isolated bacteria by Kirby-Bauer disc diffusion method. In diabetic foot ulcers, most prevalent bacteria were S. aureus with percent positivity of 83% followed by E. coli (66%), K. pneumoniae (40%) and P. aeruginosa (16%). The infected ulcer with poly-microorganisms was 83.4% and the infected ulcer with single isolates was 16.6%. Imipenem was found to be most sensitive antibiotic against Gram positive as well as Gram negative bacterial isolates from diabetic foot ulcer human patients. Gram negative isolates from diabetic foot showed resistance to ampicillin, sulfamethoxazole/trimethoprim, cefotaxime/clavulanate, metronidazole. The diabetic foot ulcers of human patients revealed high prevalence of S. aureus followed by E. coli, K. pneumoniae and P. aeruginosa respectively. Imipenem was found to be the most sensitive antibiotic for all the bacterial isolates from foot ulcers of type 2 diabetic patients. This study suggests imipenem as effective antibiotic for treatment of diabetic foot ulcers against bacteria.


Assuntos
Antibacterianos/uso terapêutico , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Diabetes Mellitus Tipo 2/microbiologia , Pé Diabético/tratamento farmacológico , Pé Diabético/microbiologia , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/etiologia , Feminino , Humanos , Masculino , Testes de Sensibilidade Microbiana/métodos , Pessoa de Meia-Idade , Paquistão
20.
Diabetes Care ; 42(12): 2290-2297, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31582427

RESUMO

OBJECTIVE: Diabetes is the leading cause of nontraumatic lower-extremity amputations (LEAs). Identification of patients with foot ulcers at risk for amputation remains clinically challenging. Plasma copeptin, a surrogate marker of vasopressin, is associated with the risk of cardiovascular and renal complications in diabetes. RESEARCH DESIGN AND METHODS: We assessed the association between baseline plasma copeptin and risk of LEA during follow-up in four cohorts of people with type 1 (GENESIS, n = 503, and GENEDIAB, n = 207) or type 2 diabetes (DIABHYCAR, n = 3,101, and SURDIAGENE, n = 1,452) with a median duration of follow-up between 5 and 10 years. Copeptin concentration was measured in baseline plasma samples by an immunoluminometric assay. RESULTS: In the pooled cohorts with type 1 diabetes (n = 710), the cumulative incidence of LEA during follow-up by increasing tertiles (tertile 1 [TER1], TER2, and TER3) of baseline plasma copeptin was 3.9% (TER1), 3.3% (TER2), and 10.0% (TER3) (P = 0.002). Cox regression analyses confirmed the association of copeptin with LEA: hazard ratio (HR) for 1 SD increment of log[copeptin] was 1.89 (95% CI 1.28-2.82), P = 0.002. In the pooled cohorts of type 2 diabetes (n = 4,553), the cumulative incidence of LEA was 1.1% (TER1), 2.9% (TER2), and 3.6% (TER3) (P < 0.0001). In Cox regression analyses, baseline plasma copeptin was significantly associated with LEA: HR for 1 SD increment of log[copeptin] was 1.42 (1.15-1.74), P = 0.001. Similar results were observed in the cohort with type 2 diabetes for lower-limb revascularization (HR 1.20 [95% CI 1.03-1.39], P = 0.02). CONCLUSIONS: Baseline plasma copeptin is associated with cumulative incidence of LEA in cohorts of people with both type 1 and type 2 diabetes and may help to identify patients at risk for LEA.


Assuntos
Amputação , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 2/sangue , Pé Diabético/sangue , Glicopeptídeos/sangue , Adulto , Idoso , Biomarcadores/sangue , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/cirurgia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/cirurgia , Pé Diabético/etiologia , Pé Diabético/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Modelos de Riscos Proporcionais , Medição de Risco , Fatores de Risco
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