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Sample records for foot ulcers prospective

  1. Depression and incident diabetic foot ulcers: a prospective cohort study

    Science.gov (United States)

    Williams, Lisa H.; Rutter, Carolyn M.; Katon, Wayne J.; Reiber, Gayle E.; Ciechanowski, Paul; Heckbert, Susan R.; Lin, Elizabeth H.B.; Ludman, Evette J.; Oliver, Malia M.; Young, Bessie A.; Von Korff, Michael

    2010-01-01

    Objective To test whether depression is associated with an increased risk of incident diabetic foot ulcers. Methods The Pathways Epidemiologic Study is a population-based prospective cohort study of 4839 patients with diabetes in 2000–2007. The present analysis included 3474 adults with type 2 diabetes and no prior diabetic foot ulcers or amputations. Mean follow-up was 4.1 years. Major and minor depression assessed by the Patient Health Questionnaire-9 (PHQ-9) were the exposures of interest. The outcome of interest was incident diabetic foot ulcers. We computed the hazard ratio (HR) and 95% CI for incident diabetic foot ulcers, comparing patients with major and minor depression to those without depression and adjusting for sociodemographic characteristics, medical comorbidity, glycosylated hemoglobin (HbA1c), diabetes duration, insulin use, number of diabetes complications, body mass index, smoking status, and foot self-care. Sensitivity analyses also adjusted for peripheral neuropathy and peripheral arterial disease as defined by diagnosis codes. Results Compared to patients without depression, patients with major depression by PHQ-9 had a two-fold increase in the risk of incident diabetic foot ulcers (adjusted HR 2.00, 95% CI: 1.24, 3.25). There was no statistically significant association between minor depression by PHQ-9 and incident diabetic foot ulcers (adjusted HR 1.37, 95% CI: 0.77, 2.44). Conclusion Major depression by PHQ-9 is associated with a two-fold higher risk of incident diabetic foot ulcers. Future studies of this association should include better measures of peripheral neuropathy and peripheral arterial disease, which are possible confounders and/or mediators. PMID:20670730

  2. A prospective study of risk factors for foot ulceration: The West of Ireland Diabetes Foot Study.

    LENUS (Irish Health Repository)

    Hurley, L

    2013-09-25

    BackgroundThis is the first study to examine risk factors for diabetic foot ulceration in Irish general practice.AimTo determine the prevalence of established risk factors for foot ulceration in a community-based cohort, and to explore the potential for estimated glomerular filtration rate (eGFR) to act as a novel risk factor.DesignA prospective observational study.MethodsPatients with diabetes attending 12 (of 17) invited general practices were invited for foot screening. Validated clinical tests were carried out at baseline to assess for vascular and sensory impairment and foot deformity. Ulcer incidence was ascertained by patient self-report and medical record. Patients were re-assessed 18 months later. ResultsOf 828 invitees, 563 (68%) attended screening. On examination 23-25% had sensory dysfunction and 18-39% had evidence of vascular impairment. Using the Scottish Intercollegiate Guidelines Network risk stratification system we found the proportion at moderate and high risk of future ulceration to be 25% and 11% respectively. At follow-up 16\\/383 patients (4.2%) developed a new foot ulcer (annual incidence rate of 2.6%). We observed an increasing probability of abnormal vascular and sensory test results (pedal pulse palpation, doppler waveform assessment, 10g monofilament, vibration perception and neuropathy disability score) with declining eGFR levels. We were unable to show an independent association between new ulceration and reduced eGFR [Odds ratio 1.01; p=0.64].ConclusionsOur data show the extent of foot complications in a representative sample of diabetes patients in Ireland. Use of eGFR did not improve identification of patients at risk of foot ulceration.

  3. Foot ulcer risk and location in relation to prospective clinical assessment of foot shape and mobility among persons with diabetes.

    Science.gov (United States)

    Cowley, Matthew S; Boyko, Edward J; Shofer, Jane B; Ahroni, Jessie H; Ledoux, William R

    2008-11-01

    We assessed baseline clinical foot shape for 2939 feet of diabetic subjects who were monitored prospectively for foot ulceration. Assessments included hammer/claw toes, hallux valgus, hallux limitus, prominent metatarsal heads, bony prominences, Charcot deformity, plantar callus, foot type, muscle atrophy, ankle and hallux mobility, and neuropathy. Risk factors were linked to ulcer occurrence and location via a Cox proportional hazards model. Hammer/claw toes (hazard ratio [HR] (95% confidence interval [CI])=1.43 (1.06, 1.94) p=0.02), marked hammer/claw toes (HR=1.77 (1.18, 2.66) p=0.006), bony prominences (HR=1.38 (1.02, 1.88), p=0.04), and foot type (Charcot or drop foot vs. neutrally aligned) (HR=2.34 (1.33, 4.10), p=0.003) were significant risk factors for ulceration adjusting for age, body mass index, insulin medication, ulcer history and amputation history. With adjustment for neuropathy only hammer/claw toes (HR=1.40 (1.03, 1.90), p=0.03) and foot type (HR=1.76 (1.04, 3.04), p=0.05) were significantly related to ulceration. However, there was no relationship between ulcer location and foot deformity. Certain foot deformities were predictive of ulceration, although there was no relationship between clinical foot deformity and ulcer location.

  4. Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial.

    Science.gov (United States)

    Pham, H; Armstrong, D G; Harvey, C; Harkless, L B; Giurini, J M; Veves, A

    2000-05-01

    Diabetic foot ulceration is a preventable long-term complication of diabetes. A multicenter prospective follow-up study was conducted to determine which risk factors in foot screening have a high association with the development of foot ulceration. A total of 248 patients from 3 large diabetic foot centers were enrolled in a prospective study. Neuropathy symptom score, neuropathy disability score (NDS), vibration perception threshold (VPT), Semmes-Weinstein monofilaments (SWFs), joint mobility, peak plantar foot pressures, and vascular status were evaluated in all patients at the beginning of the study. Patients were followed-up every 6 months for a mean period of 30 months (range 6-40), and all new foot ulcers were recorded. The sensitivity, specificity, and positive predictive value of each risk factor were evaluated. Foot ulcers developed in 95 feet (19%) or 73 patients (29%) during the study. Patients who developed foot ulcers were more frequently men, had diabetes for a longer duration, had nonpalpable pedal pulses, had reduced joint mobility, had a high NDS, had a high VPT, and had an inability to feel a 5.07 SWE NDS alone had the best sensitivity, whereas the combination of the NDS and the inability to feel a 5.07 SWF reached a sensitivity of 99%. On the other hand, the best specificity for a single factor was offered by foot pressures, and the best combination was that of NDS and foot pressures. Univariate logistical regression analysis yielded a statistically significant odds ratio (OR) for sex, race, duration of diabetes, palpable pulses, history of foot ulceration, high NDSs, high VPTs, high SWFs, and high foot pressures. In addition, 94 (99%) of the 95 ulcerated feet had a high NDS and/or SWF which resulted in the highest OR of 26.2 (95% CI 3.6-190). Furthermore, in multivariate logistical regression analysis, the only significant factors were high NDSs, VPTs, SWFs, and foot pressures. Clinical examination and a 5.07 SWF test are the two most sensitive

  5. Clinical Prospective Study on the Use of Subcutaneous Carboxytherapy in the Treatment of Diabetic Foot Ulcer.

    Science.gov (United States)

    Khiat, Lynda; Leibaschoff, Gustavo H

    2018-03-22

    Diabetic footfoot ulcer (DFU) is a serious complication of diabetes mellitus, and possibly the major morbidity of the diabetic foot. It is the most common foot injury in diabetic patients and can lead to lower-extremity amputation. Management of DFU requires a systematic knowledge of the major risk factors for amputation, frequent routine evaluation, scrupulous preventive maintenance, and correction of peripheral arterial insufficiency. Carboxytherapy refers to the subcutaneous injection of CO2 to improve the microcirculation and promote wound-healing by stimulating the microcirculation. Since optimal ulcer-healing requires adequate tissue perfusion, it is considered that carboxytherapy could be useful in the treatment of DFU. The present prospective clinical study included 40 patients with different sizes and types of chronic DFU. In addition to cleaning of the wound, antibiotics and debridement as necessary, the treatment protocol included blood sugar control, medication, healthy habits, no weight-bearing, and carboxytherapy. The results showed that this treatment that included carboxytherapy promoted wound-healing and prevented amputation. These positive effects should be confirmed through a complete study that includes different clinical and instrumental parameters.

  6. Spectrum of bacteria associated with diabetic foot ulcer and biofilm formation: A prospective study

    Directory of Open Access Journals (Sweden)

    Asima Banu

    2015-09-01

    The organisms causing chronic diabetic foot ulcers were commonly multidrug-resistant; this was also observed among biofilm formers. Therefore, screening for biofilm formation, along with the usual antibiogram, needs to be performed as a routine procedure in chronic diabetic ulcers to formulate effective treatment strategies for these patients.

  7. Pathophysiology diabetic foot ulcer

    Science.gov (United States)

    Syafril, S.

    2018-03-01

    Diabetes Mellitus (DM) is known to have many complications. Diabetes and its complications are rapidly becoming the world’s most significant cause of morbidity and mortality, and one of the most distressing is Diabetic Foot Ulcer (DFU). Chronic wound complications are a growing concern worldwide, and the effect is a warning to public health and the economy. The etiology of a DFU is multifaceted, and several components cause added together create a sufficient impact on ulceration: neuropathy, vasculopathy, immunopathy, mechanical stress, and neuroarthropathy. There are many classifications of the diabetic foot. About 50% of patients with foot ulcers due to DM present clinical signs of infection. It is essential to manage multifactorial etiology of DFU to get a good outcome.

  8. Hard-to-heal diabetes-related foot ulcers: current challenges and future prospects

    Directory of Open Access Journals (Sweden)

    Nube V

    2016-11-01

    Full Text Available Vanessa Nube,1 Georgina Frank,1 Jessica White,1 Sarah Stubbs,1 Sara Nannery,2 Louise Pfrunder,2 Stephen M Twigg,3 Susan V McLennan4 1Department of Podiatry, Sydney Local Health District, Camperdown, NSW, Australia; 2Diabetes Centre High Risk Foot Service, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; 3Discipline of Medicine, Sydney Medical School, University of Sydney, Camperdown, Sydney, NSW, Australia; 4Department of Endocrinology, Royal Prince Alfred Hospital, Camperdown, Sydney, NSW, Australia Abstract: Diabetes-related foot ulceration is a frequent cause for hospital admission and the leading cause of nontraumatic lower limb amputation, placing a high burden on the health system, patient, and their families. Considerable advances in treatments and the establishment of specialized services and teams have improved healing rates and reduced unnecessary amputations. However, amputation rates remain high in some areas, with unacceptable variations within countries yet to be resolved. Specific risk factors including infection, ischemia, ulcer size, depth, and duration as well as probing to bone (or osteomyelitis, location of ulcer, sensory loss, deformity (and high plantar pressure, advanced age, number of ulcers present, and renal disease are associated with poor outcome and delayed healing. To assist in prediction of difficult-to-heal ulcers, more than 13 classification systems have been developed. Ulcer depth (or size, infection, and ischemia are the most common risk factors identified. High-quality treatment protocols and guidelines exist to facilitate best practice in the standard of care. Under these conditions, 66%–77% of foot ulcers will heal. The remaining proportion represents a group unlikely to heal and who will live with a non-healing wound or undergo amputation. The authors have applied their experience of managing patients in this discussion of why some ulcers are harder to heal. The article explores the effects of

  9. Relationship between maceration and wound healing on diabetic foot ulcers in Indonesia: a prospective study.

    Science.gov (United States)

    Haryanto, Haryanto; Arisandi, Defa; Suriadi, Suriadi; Imran, Imran; Ogai, Kazuhiro; Sanada, Hiromi; Okuwa, Mayumi; Sugama, Junko

    2017-06-01

    The aim of this study was to clarify the relationship between maceration and wound healing. A prospective longitudinal design was used in this study. The wound condition determined the type of dressings used and the dressing change frequency. A total of 62 participants with diabetic foot ulcers (70 wounds) were divided into two groups: non-macerated (n = 52) and macerated wounds (n = 18). Each group was evaluated weekly using the Bates-Jensen Wound Assessment Tool, with follow-ups until week 4. The Mann-Whitney U test showed that the changes in the wound area in week 1 were faster in the non-macerated group than the macerated group (P = 0·02). The Pearson correlation analysis showed a moderate correlation between maceration and wound healing from enrolment until week 4 (P = 0·002). After week 4, the Kaplan-Meier analysis showed that the non-macerated wounds healed significantly faster than the macerated wounds (log-rank test = 19·378, P = 0·000). The Cox regression analysis confirmed that maceration was a significant and independent predictor of wound healing in this study (adjusted hazard ratio, 0·324; 95% CI, 0·131-0·799; P = 0·014). The results of this study demonstrated that there is a relationship between maceration and wound healing. Changes in the wound area can help predict the healing of wounds with maceration in clinical settings. © 2016 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  10. Diabetic foot ulcers. Pathophysiology, assessment, and therapy.

    OpenAIRE

    Bowering, C. K.

    2001-01-01

    OBJECTIVE: To review underlying causes of diabetic foot ulceration, provide a practical assessment of patients at risk, and outline an evidence-based approach to therapy for diabetic patients with foot ulcers. QUALITY OF EVIDENCE: A MEDLINE search was conducted for the period from 1979 to 1999 for articles relating to diabetic foot ulcers. Most studies found were case series or small controlled trials. MAIN MESSAGE: Foot ulcers in diabetic patients are common and frequently lead to lower limb...

  11. Diabetes: foot ulcers and amputations.

    Science.gov (United States)

    Hunt, Dereck L

    2011-08-26

    Diabetic foot ulceration is full-thickness penetration of the dermis of the foot in a person with diabetes. Severity is classified using the Wagner system, which grades it from 1 to 5. The annual incidence of ulcers among people with diabetes is 2.5% to 10.7% in resource-rich countries, and the annual incidence of amputation for any reason is 0.25% to 1.8%. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to prevent foot ulcers and amputations in people with diabetes? What are the effects of treatments in people with diabetes with foot ulceration? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 50 systematic reviews and RCTs that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review, we present information relating to the effectiveness and safety of the following interventions: debridement, human cultured dermis, human skin equivalent, patient education, pressure off-loading with felted foam or pressure-relief half-shoe, pressure off-loading with total-contact or non-removable casts, screening and referral to foot-care clinics, systemic hyperbaric oxygen for non-infected ulcers, systemic hyperbaric oxygen in infected ulcers, therapeutic footwear, topical growth factors, and wound dressings.

  12. Resource utilisation and costs associated with the treatment of diabetic foot ulcers. Prospective data from the Eurodiale Study

    DEFF Research Database (Denmark)

    Prompers, L.; Huijberts, M.; Schaper, N.

    2008-01-01

    Aims/hypothesis The aim of the present study was to investigate resource utilisation and associated costs in patients with diabetic foot ulcers and to analyse differences in resource utilisation between individuals with or without peripheral arterial disease (PAD) and/or infection. Methods Data....... In view of the magnitude of the costs associated with in-hospital stay, reducing the number and duration of hospital admissions seems an attractive option to decrease costs in diabetic foot disease Udgivelsesdato: 2008/10...

  13. Delivery of care to diabetic patients with foot ulcers in daily practice: results of the Eurodiale Study, a prospective cohort study

    DEFF Research Database (Denmark)

    Prompers, L.; Huijberts, M.; Apelqvist, J.

    2008-01-01

    Aims To determine current management and to identify patient-related factors and barriers that influence management strategies in diabetic foot disease. Methods The Eurodiale Study is a prospective cohort study of 1232 consecutive individuals presenting with a new diabetic foot ulcer in 14 centres...... suggest that current guidelines are too general and that healthcare organizational barriers and personal beliefs result in underuse of recommended therapies. Action should be undertaken to overcome these barriers and to guarantee the delivery of optimal care for the many individuals with diabetic foot...... across Europe. We determined the use of management strategies: referral, use of offloading, vascular imaging and revascularization. Results Twenty-seven percent of the patients had been treated for > 3 months before referral to a foot clinic. This varied considerably between countries (6-55%). At study...

  14. EFFICACY OF VACUUM ASSISTED CLOSURE DRESSINGS WHEN COMPARED TO MOIST WOUND DRESSINGS IN THE MANAGEMENT OF DIABETIC FOOT ULCERS : A PROSPECTIVE COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Ballapalli Hari

    2015-10-01

    Full Text Available INTRODUCTION: F oot ulceration is mainly responsible for the morbidity of diabetes mellitus. They deprive the patient of quality working days and add to his financial burden. Several novel methods of wound healing came to vogue among which vacuum assisted dressing is becoming quite popular. Present study aim s to evaluate its efficacy when compared to regular moist wound dressings. OBJECTIVES: To study the effectiveness of vacuum assisted dressings in terms of Rate of wound healing. MATERIALS AND METHODS: we carried out a prospective study at Narayana medical college hospital on two groups (group A and group B of diabetic foot ulcer patients, whom we selected randomly after considering inclusion and exclusion criteria . Vacuum assisted dressings were done in group A patients and normal moist wound dressings in group B. At the start of the treatment and every week thereafter, size and depth of ulcers were recorded and results were compared at complete wound healing or at the end of 12 weeks of treatment whichever is earlier. S trict glycaemic control was maintaine d throughout the treatment period. RESULTS : significant healing was noticed in group A patients (vacuum assisted dressings group both in terms of ulcer size and depth. Wounds appeared more - healthy i.e. with less slough and more red granulation tissue in g roup A patients. CONCLUSION: vacuum assisted dressing is an efficacious method in the treatment of diabetic foot ulcers with significantly reduced hospital stay

  15. Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: a prospective case–control study

    OpenAIRE

    Lone, Ali M.; Zaroo, Mohd I.; Laway, Bashir A.; Pala, Nazir A.; Bashir, Sheikh A.; Rasool, Altaf

    2014-01-01

    Objective: To compare the effectiveness of vacuum-assisted closure (VAC) versus conventional dressings in the healing of diabetic foot ulcerations (DFUs) in terms of healing rate (time to prepare the wound for closure either spontaneously or by surgery), safety, and patient satisfaction.Methods: Randomized case–control study enrolling 56 patients, divided into two groups. Group A (patients treated with VAC) and Group B (patients treated with conventional dressings), with an equal number of pa...

  16. The use of low output laser therapy to accelerate healing of diabetic foot ulcers: a randomized prospective controlled trial

    Science.gov (United States)

    Naidu, S. V. L. G.; Subapriya, S.; Yeoh, C. N.; Soosai, S.; Shalini, V.; Harwant, S.

    2005-11-01

    The aim of this study was to assess the effects of low output laser therapy as an adjuvant treatment in grade 1 diabetic foot ulcers. Methods: Sixteen patients were randomly divided equally into two groups. Group A had daily dressing only, while group B had low output laser therapy instituted five days a week in addition to daily dressing. Serial measurement of the ulcer was done weekly using digital photography and analyzed. Results: The rate of healing in group A was 10.42 mm2/week, and in group B was 66.14mm2/week. The difference in the rate of healing was statistically significant, pdiabetic ulcer healing by six times in a six week period.

  17. Effect of oral nutritional supplementation on wound healing in diabetic foot ulcers: a prospective randomized controlled trial.

    Science.gov (United States)

    Armstrong, D G; Hanft, J R; Driver, V R; Smith, A P S; Lazaro-Martinez, J L; Reyzelman, A M; Furst, G J; Vayser, D J; Cervantes, H L; Snyder, R J; Moore, M F; May, P E; Nelson, J L; Baggs, G E; Voss, A C

    2014-09-01

    Among people with diabetes, 10-25% will experience a foot ulcer. Research has shown that supplementation with arginine, glutamine and β-hydroxy-β-methylbutyrate may improve wound repair. This study tested whether such supplementation would improve healing of foot ulcers in persons with diabetes. Along with standard of care, 270 subjects received, in a double-blinded fashion, (twice per day) either arginine, glutamine and β-hydroxy-β-methylbutyrate or a control drink for 16 weeks. The proportion of subjects with total wound closure and time to complete healing was assessed. In a post-hoc analysis, the interaction of serum albumin or limb perfusion, as measured by ankle-brachial index, and supplementation on healing was investigated. Overall, there were no group differences in wound closure or time to wound healing at week 16. However, in subjects with an albumin level of ≤ 40 g/l and/or an ankle-brachial index of healed at week 16 compared with control subjects (P = 0.03 and 0.008, respectively). Those with low albumin or decreased limb perfusion in the supplementation group were 1.70 (95% CI 1.04-2.79) and 1.66 (95% CI 1.15-2.38) times more likely to heal. While no differences in healing were identified with supplementation in non-ischaemic patients or those with normal albumin, addition of arginine, glutamine and β-hydroxy-β-methylbutyrate as an adjunct to standard of care may improve healing of diabetic foot ulcers in patients with risk of poor limb perfusion and/or low albumin levels. Further investigation involving arginine, glutamine and β-hydroxy-β-methylbutyrate in these high-risk subgroups might prove clinically valuable. © 2014 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.

  18. Growth factors for treating diabetic foot ulcers

    DEFF Research Database (Denmark)

    Martí-Carvajal, Arturo J; Gluud, Christian; Nicola, Susana

    2015-01-01

    following treatment for diabetic foot ulcers (RR 0.64, 95% CI 0.14 to 2.94; P value 0.56, low quality of evidence)Although 11 trials reported time to complete healing of the foot ulcers in people with diabetes , meta-analysis was not possible for this outcome due to the unique comparisons within each trial...... (minimum of one toe), complete healing of the foot ulcer, and time to complete healing of the diabetic foot ulcer as the primary outcomes. DATA COLLECTION AND ANALYSIS: Independently, we selected randomised clinical trials, assessed risk of bias, and extracted data in duplicate. We estimated risk ratios......BACKGROUND: Foot ulcers are a major complication of diabetes mellitus, often leading to amputation. Growth factors derived from blood platelets, endothelium, or macrophages could potentially be an important treatment for these wounds but they may also confer risks. OBJECTIVES: To assess...

  19. Role of procalcitonin in infected diabetic foot ulcer.

    Science.gov (United States)

    Park, Jung Ho; Suh, Dong Hun; Kim, Hak Jun; Lee, Yong In; Kwak, Il Hoon; Choi, Gi Won

    2017-06-01

    Procalcitonin (PCT) has been recently accepted as a marker for diagnosing infection. The aim of the present study was to determine whether PCT levels are associated with infection severity of diabetic foot ulcers and whether PCT levels would be helpful to differentiate infected diabetic foot ulcer (IDFU) from IDFU associated with other infectious diseases (IDFU+O). We prospectively included 123 diabetic patients hospitalized for IDFU. Infection severity of diabetic foot ulcers was graded according to the Infectious Diseases Society of America-International Working Group on the Diabetic Foot clinical classification of diabetic foot infection. Chest radiograph, urinalysis, urine microscopy, urine culture, and blood cultures (if fever was present) were performed for all patients to diagnose other infectious diseases. Laboratory parameters were measured from blood venous samples. PCT (Spearman's ρ=0.338, Pdiabetic foot ulcers. However, only PCT levels could differentiate patients with associated infectious diseases from patients with no concomitant infection (area under the receiver-operator characteristic curve 0.869, Pdiabetic foot ulcers and PCT levels>0.59ng/mL in patients with IDFU may be associated with other systemic bacterial infection. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Patient education for preventing diabetic foot ulceration

    NARCIS (Netherlands)

    Dorresteijn, J.A.; Kriegsman, D.M.; Assendelft, W.J.; Valk, G.D.

    2014-01-01

    BACKGROUND: Ulceration of the feet, which can result in loss of limbs and even death, is one of the major health problems for people with diabetes mellitus. OBJECTIVES: To assess the effects of patient education on the prevention of foot ulcers in patients with diabetes mellitus. SEARCH METHODS: We

  1. Patient education for preventing diabetic foot ulceration

    NARCIS (Netherlands)

    Dorresteijn, J.A.; Kriegsman, D.M.; Assendelft, W.J.J.; Valk, G.D.

    2012-01-01

    BACKGROUND: Ulceration of the feet, which can result in loss of limbs and even death, is one of the major health problems for people with diabetes mellitus. OBJECTIVES: To assess the effects of patient education on the prevention of foot ulcers in patients with diabetes mellitus. SEARCH METHODS:

  2. Mortality associated with acute Charcot foot and neuropathic foot ulceration

    NARCIS (Netherlands)

    van Baal, Juliette; Hubbard, Richard; Game, Fran; Jeffcoate, William

    2010-01-01

    To compare the mortality of patients with an acute Charcot foot with a matched population with uninfected neuropathic foot ulcers (NFUs). Data were extracted from a specialist departmental database, supplemented by hospital records. The findings were compared with the results of earlier populations

  3. CLINICOMICROBIOLOGICAL STUDY OF DIABETIC FOOT ULCERS

    Directory of Open Access Journals (Sweden)

    Nirmal Kumar Palaniappan

    2017-11-01

    Full Text Available BACKGROUND Type 2 diabetes mellitus is a chronic disease caused by a combination of lifestyle and genetic factors affecting all organs in the body. Foot ulcers are one of the common and serious long-term complications of diabetes leads to recurrent and chronic infections, which results in limb loss when treatment is delayed. The aim of this study is to find out the clinical outcome and microbiological profile in patients admitted with diabetic foot ulcers. MATERIALS AND METHODS The study conducted between November 2008 to November 2009 over 50 patients with history of foot ulceration and diabetes. 50 patients were admitted with diabetic foot ulcer over a period of one year between November 2008-2009. They were studied after getting written consent. A predesigned pro forma was used to get the parameters comprising age, gender, duration, type of diabetes mellitus, presence of neuropathy, nephropathy (serum creatinine, urine albumin, retinopathy (screening funduscopy by ophthalmologist. RESULTS Among 50 patients admitted and treated for diabetic foot ulcers with mean stay of 18 days, 29 (58% had complete healing on conservative management, 18 (36% underwent minor amputation (toes, 3 (6% had major amputation (below knee/above knee. No mortality among the study groups encountered. Gram-negative aerobes E. coli (36%, Pseudomonas (52%, Klebsiella (28%, Proteus vulgaris (20% and Acinetobacter (16% were most frequently isolated followed by gram-positive aerobes MRSA (14%, Enterococcus (6%, Strep pyogenes (4% and no anaerobic growth. CONCLUSION Diabetic foot infections are frequently polymicrobial and predominantly gram-negative aerobic bacteria at presentation. Multidrug resistance pseudomonas aeruginosa and MRSA in diabetic foot ulcer is at its emergence and life threatening. Initial aggressive multimodal approach with surgical intervention, culture specific and sensitive targeted combined broad-spectrum antibiotics decreases the morbidity and mortality

  4. Diabetic foot ulcers: Part II. Management.

    Science.gov (United States)

    Alavi, Afsaneh; Sibbald, R Gary; Mayer, Dieter; Goodman, Laurie; Botros, Mariam; Armstrong, David G; Woo, Kevin; Boeni, Thomas; Ayello, Elizabeth A; Kirsner, Robert S

    2014-01-01

    The management of diabetic foot ulcers can be optimized by using an interdisciplinary team approach addressing the correctable risk factors (ie, poor vascular supply, infection control and treatment, and plantar pressure redistribution) along with optimizing local wound care. Dermatologists can initiate diabetic foot care. The first step is recognizing that a loss of skin integrity (ie, a callus, blister, or ulcer) considerably increases the risk of preventable amputations. A holistic approach to wound assessment is required. Early detection and effective management of these ulcers can reduce complications, including preventable amputations and possible mortality. Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  5. Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: a prospective case-control study.

    Science.gov (United States)

    Lone, Ali M; Zaroo, Mohd I; Laway, Bashir A; Pala, Nazir A; Bashir, Sheikh A; Rasool, Altaf

    2014-01-01

    To compare the effectiveness of vacuum-assisted closure (VAC) versus conventional dressings in the healing of diabetic foot ulcerations (DFUs) in terms of healing rate (time to prepare the wound for closure either spontaneously or by surgery), safety, and patient satisfaction. Randomized case-control study enrolling 56 patients, divided into two groups. Group A (patients treated with VAC) and Group B (patients treated with conventional dressings), with an equal number of patients in each group. DFUs were treated until wound closure, either spontaneously, surgically, or until completion of the 8-week period. Granulation tissue appeared in 26 (92.85%) patients by the end of Week 2 in Group A, while it appeared in 15 (53.57%) patients by that time in Group B. 100% granulation was achieved in 21 (77.78%) patients by the end of Week 5 in Group A as compared to only 10 (40%) patients by that time in Group B. Patients in Group A had fewer number of positive blood cultures, secondary amputations and were satisfied with treatment as compared to Group B. VAC appears to be more effective, safe, and patient satisfactory compared to conventional dressings for the treatment of DFUs.

  6. Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: a prospective case–control study

    Science.gov (United States)

    Lone, Ali M.; Zaroo, Mohd I.; Laway, Bashir A.; Pala, Nazir A.; Bashir, Sheikh A.; Rasool, Altaf

    2014-01-01

    Objective To compare the effectiveness of vacuum-assisted closure (VAC) versus conventional dressings in the healing of diabetic foot ulcerations (DFUs) in terms of healing rate (time to prepare the wound for closure either spontaneously or by surgery), safety, and patient satisfaction. Methods Randomized case–control study enrolling 56 patients, divided into two groups. Group A (patients treated with VAC) and Group B (patients treated with conventional dressings), with an equal number of patients in each group. DFUs were treated until wound closure, either spontaneously, surgically, or until completion of the 8-week period. Results Granulation tissue appeared in 26 (92.85%) patients by the end of Week 2 in Group A, while it appeared in 15 (53.57%) patients by that time in Group B. 100% granulation was achieved in 21 (77.78%) patients by the end of Week 5 in Group A as compared to only 10 (40%) patients by that time in Group B. Patients in Group A had fewer number of positive blood cultures, secondary amputations and were satisfied with treatment as compared to Group B. Conclusion VAC appears to be more effective, safe, and patient satisfactory compared to conventional dressings for the treatment of DFUs. PMID:24765245

  7. Vacuum-assisted closure versus conventional dressings in the management of diabetic foot ulcers: a prospective case–control study

    Directory of Open Access Journals (Sweden)

    Ali M. Lone

    2014-04-01

    Full Text Available Objective: To compare the effectiveness of vacuum-assisted closure (VAC versus conventional dressings in the healing of diabetic foot ulcerations (DFUs in terms of healing rate (time to prepare the wound for closure either spontaneously or by surgery, safety, and patient satisfaction. Methods: Randomized case–control study enrolling 56 patients, divided into two groups. Group A (patients treated with VAC and Group B (patients treated with conventional dressings, with an equal number of patients in each group. DFUs were treated until wound closure, either spontaneously, surgically, or until completion of the 8-week period. Results: Granulation tissue appeared in 26 (92.85% patients by the end of Week 2 in Group A, while it appeared in 15 (53.57% patients by that time in Group B. 100% granulation was achieved in 21 (77.78% patients by the end of Week 5 in Group A as compared to only 10 (40% patients by that time in Group B. Patients in Group A had fewer number of positive blood cultures, secondary amputations and were satisfied with treatment as compared to Group B. Conclusion: VAC appears to be more effective, safe, and patient satisfactory compared to conventional dressings for the treatment of DFUs.

  8. Synergistic action of protease-modulating matrix and autologous growth factors in healing of diabetic foot ulcers. A prospective randomized trial.

    Science.gov (United States)

    Kakagia, Despoina D; Kazakos, Konstantinos J; Xarchas, Konstantinos C; Karanikas, Michael; Georgiadis, George S; Tripsiannis, Gregory; Manolas, Constantinos

    2007-01-01

    This study tests the hypothesis that addition of a protease-modulating matrix enhances the efficacy of autologous growth factors in diabetic ulcers. Fifty-one patients with chronic diabetic foot ulcers were managed as outpatients at the Democritus University Hospital of Alexandroupolis and followed up for 8 weeks. All target ulcers were > or = 2.5 cm in any one dimension and had been previously treated only with moist gauze. Patients were randomly allocated in three groups of 17 patients each: Group A was treated only with the oxidized regenerated cellulose/collagen biomaterial (Promogran, Johnson & Johnson, New Brunswick, NJ), Group B was treated only with autologous growth factors delivered by Gravitational Platelet Separation System (GPS, Biomet), and Group C was managed by a combination of both. All ulcers were digitally photographed at initiation of the study and then at change of dressings once weekly. Computerized planimetry (Texas Health Science Center ImageTool, Version 3.0) was used to assess ulcer dimensions that were analyzed for homogeneity and significance using the Statistical Package for Social Sciences, Version 13.0. Post hoc analysis revealed that there was significantly greater reduction of all three dimensions of the ulcers in Group C compared to Groups A and B (all P<.001). Although reduction of ulcer dimensions was greater in Group A than in Group B, these differences did not reach statistical significance. It is concluded that protease-modulating dressings act synergistically with autologous growth factors and enhance their efficacy in diabetic foot ulcers.

  9. The efficacy and safety of Dermagraft in improving the healing of chronic diabetic foot ulcers: results of a prospective randomized trial.

    Science.gov (United States)

    Marston, William A; Hanft, Jason; Norwood, Paul; Pollak, Richard

    2003-06-01

    To determine if a human fibroblast-derived dermal substitute could promote the healing of diabetic foot ulcers. A randomized, controlled, multicenter study was undertaken at 35 centers throughout the U.S. and enrolled 314 patients to evaluate complete wound closure by 12 weeks. Patients were randomized to either the Dermagraft treatment group or control (conventional therapy). Except for the application of Dermagraft, treatment of study ulcers was identical for patients in both groups. All patients received pressure-reducing footwear and were allowed to be ambulatory during the study. The results demonstrated that patients with chronic diabetic foot ulcers of >6 weeks duration experienced a significant clinical benefit when treated with Dermagraft versus patients treated with conventional therapy alone. With regard to complete wound closure by week 12, 30.0% (39 of 130) of Dermagraft patients healed compared with 18.3% (21 of 115) of control patients (P = 0.023). The overall incidence of adverse events was similar for both the Dermagraft and control groups, but the Dermagraft group experienced significantly fewer ulcer-related adverse events. The data from this study show that Dermagraft is a safe and effective treatment for chronic diabetic foot ulcers.

  10. A Prospective, Descriptive Study to Assess the Clinical Benefits of Using Calendula officinalis Hydroglycolic Extract for the Topical Treatment of Diabetic Foot Ulcers.

    Science.gov (United States)

    Buzzi, Marcelo; de Freitas, Franciele; Winter, Marcos

    2016-03-01

    Diabetic foot ulcers (DFUs) have a significant impact on patient quality of life. A prospective, descriptive pilot study was conducted between May 2012 and December 2013 through the dermatology outpatient unit in a Brazilian hospital to evaluate the clinical benefits of using Calendula officinalis hydroglycolic extract in the treatment of DFUs. Patients diagnosed with a stable neuropathic ulcer of >3 months' duration; ranging in size from 0.5-40 cm(2); without osteomyelitis, gangrene, bone exposure, cancer, or deep tissue infection; ages 18-90 years; with adequate glycemic control and no history of an allergy to C. officinalis were enrolled. Patients provided demographic and diabetes-related information and were evaluated biweekly for 30 weeks or until healing (ie, full epithelialization with no wound drainage). DFUs were measured and clinically examined for microbiological flora and presence of odor, tissue type (eg, granulation, fibrin sloth, necrosis), exudate, and retraction rate using planimetry images. Patients' blood tests and neuropathic pain assessment (the latter by clinician-directed questionnaire) were performed at baseline and the end of treatment; pain also was assessed during dressing changes using a 10-point rating scale. Patients' ulcers were treated twice daily with C. officinalis hydroglycolic extract spray solution and covered with saline-moistened, sterile, nonadherent gauze and bandages followed by foot offloading with adequate protective footwear. Patients received their first treatment in the clinic then performed care at home. From a potential population of 109 patients, 25 did not meet the inclusion criteria. Of the remaining 84 participants enrolled, 43 withdrew before study completion; cited reasons included lost to follow-up (16), medical judgment (2), failure to attend >3 scheduled visits (17), protocol violation (5), and death (3). Forty-one (41) - 17 women, average age 62 years (range 44-82 years), average glycemic level 153 mg

  11. Classification of diabetic foot ulcers.

    Science.gov (United States)

    Game, Frances

    2016-01-01

    It is known that the relative importance of factors involved in the development of diabetic foot problems can vary in both their presence and severity between patients and lesions. This may be one of the reasons why outcomes seem to vary centre to centre and why some treatments may seem more effective in some people than others. There is a need therefore to classify and describe lesions of the foot in patients with diabetes in a manner that is agreed across all communities but is simple to use in clinical practice. No single system is currently in widespread use, although a number have been published. Not all are well validated outside the system from which they were derived, and it has not always been made clear the clinical purposes to which such classifications should be put to use, whether that be for research, clinical description in routine clinical care or audit. Here the currently published classification systems, their validation in clinical practice, whether they were designed for research, audit or clinical care, and the strengths and weaknesses of each are explored. Copyright © 2016 John Wiley & Sons, Ltd.

  12. Topical application of the bee hive protectant propolis is well tolerated and improves human diabetic foot ulcer healing in a prospective feasibility study.

    Science.gov (United States)

    Henshaw, Frances R; Bolton, Thyra; Nube, Vanessa; Hood, Anita; Veldhoen, Danielle; Pfrunder, Louise; McKew, Genevieve L; Macleod, Colin; McLennan, Susan V; Twigg, Stephen M

    2014-01-01

    Propolis is a naturally occurring anti-inflammatory bee derived protectant resin. We have previously reported that topically applied propolis reduces inflammation and improves cutaneous ulcer healing in diabetic rodents. The aim of this study was to determine if propolis shows efficacy in a pilot study of human diabetic foot ulcer (DFU) healing and if it is well tolerated. Serial consenting subjects (n=24) with DFU ≥4 weeks' duration had topical propolis applied at each clinic review for 6 weeks. Post-debridement wound fluid was analyzed for viable bacterial count and pro-inflammatory MMP-9 activity. Ulcer healing data were compared with a matched control cohort of n=84 with comparable DFU treated recently at the same center. Ulcer area was reduced by a mean 41% in the propolis group compared with 16% in the control group at week 1 (P<0.001), and by 63 vs. 44% at week 3, respectively (P<0.05). In addition, 10 vs. 2% (P<0.001), then 19 vs. 12% (P<0.05) of propolis treated vs. control ulcers had fully healed by weeks 3 and 7, respectively. Post-debridement wound fluid active MMP-9 was significantly reduced, by 18.1 vs. 2.8% week 3 from baseline in propolis treated ulcers vs. controls (P<0.001), as were bacterial counts (P<0.001). No adverse effects from propolis were reported. Topical propolis is a well-tolerated therapy for wound healing and this pilot in human DFU indicates for the first time that it may enhance wound closure in this setting when applied weekly. A multi-site randomized controlled of topical propolis now appears to be warranted in diabetic foot ulcers. Copyright © 2014 The Authors. Published by Elsevier Inc. All rights reserved.

  13. Predictors of lower-extremity amputation in patients with an infected diabetic foot ulcer

    DEFF Research Database (Denmark)

    Pickwell, Kirsty; Siersma, Volkert; Kars, Marleen

    2015-01-01

    OBJECTIVE Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation...... of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation. RESEARCH DESIGN AND METHODS We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries....... RESULTS Among these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity...

  14. Effectiveness of bridge V.A.C. dressings in the treatment of diabetic foot ulcers

    OpenAIRE

    Nather, Aziz; Hong, Ng Yau; Lin, Wong Keng; Sakharam, Joshi Abhijit

    2011-01-01

    Objectives: This is a prospective study of the clinical efficacy of the V.A.C. Granufoam Bridge Dressing for the treatment of diabetic foot ulcers. Materials and methods: Five consecutive patients with diabetic foot ulcers were treated with V.A.C. Granufoam Bridge Dressings and studied over a period of 22-48 days. The indications for treatment included diabetic patients with open ray amputation wounds and wounds post-drainage for abscess with exposed deep structures. Clinical outcome was meas...

  15. The prevalence of foot ulceration in patients with rheumatoid arthritis.

    Science.gov (United States)

    Firth, Jill; Hale, Claire; Helliwell, Philip; Hill, Jackie; Nelson, E Andrea

    2008-02-15

    To establish the prevalence of foot ulceration in patients with rheumatoid arthritis (RA) in secondary care. A postal survey of all patients with RA (n = 1,130) under the care of rheumatologists in Bradford, West Yorkshire, UK was performed. The prevalence data were validated through clinical examination, case-note review, and contact with health professionals. The false-negative rate was investigated in a subsample of patients (n = 70) who denied any history of ulceration. The postal survey achieved a 78% response rate. Following validation, the point prevalence of foot ulceration was 3.39% and the overall prevalence was 9.73%. The false-positive rate was initially high at 21.21%, but use of diagrammatic questionnaire data to exclude leg ulceration reduced the rate to 10.76%. The false-negative rate was 11.76%. The most common sites for ulceration were the dorsal aspect of hammer toes, the metatarsal heads, and the metatarsophalangeal joint in patients with hallux abducto valgus, with 33% of patients reporting multiple sites of ulceration. Patients with open-foot and healed-foot ulceration had significantly longer RA disease duration, reported significantly greater use of special footwear, and had a higher prevalence of foot surgery than ulcer-free patients. Foot ulceration affects a significant proportion of patients with RA. Further work is needed to establish risk factors for foot ulceration in RA and to target foot health provision more effectively.

  16. Healing ulcers and preventing their recurrences in the diabetic foot

    Directory of Open Access Journals (Sweden)

    S Raja Sabapathy

    2016-01-01

    Full Text Available Fifteen percent of people with diabetes develop an ulcer in the course of their lifetime. Eighty-five percent of the major amputations in diabetes mellitus are preceded by an ulcer. Management of ulcers and preventing their recurrence is important for the quality of life of the individual and reducing the cost of care of treatment. The main causative factors of ulceration are neuropathy, vasculopathy and limited joint mobility. Altered bio-mechanics due to the deformities secondary to neuropathy and limited joint mobility leads to focal points of increased pressure, which compromises circulation leading to ulcers. Ulcer management must not only address the healing of ulcers but also should correct the altered bio-mechanics to reduce the focal pressure points and prevent recurrence. An analysis of 700 patients presenting with foot problems to the Diabetic Clinic of Ganga Hospital led to the stratification of these patients into four classes of incremental severity. Class 1 – the foot at risk, Class 2 – superficial ulcers without infection, Class 3 – the crippled foot and Class 4 – the critical foot. Almost 77.5% presented in either Class 3 or 4 with complicated foot ulcers requiring major reconstruction or amputation. Class 1 foot can be managed conservatively with foot care and appropriate foot wear. Class 2 in addition to measures for ulcer healing would need surgery to correct the altered bio-mechanics to prevent the recurrence. The procedures called surgical offloading would depend on the site of the ulcer and would need an in-depth clinical study of the foot. Class 3 would need major reconstructive procedures and Class 4 would need amputation since it may be life-threatening. As clinicians, our main efforts must be focused towards identifying patients in Class 1 and offer advice on foot care and Class 2 where appropriate surgical offloading procedure would help preserve the foot.

  17. The Effect of Foot Exercises on Wound Healing in Type 2 Diabetic Patients With a Foot Ulcer.

    Science.gov (United States)

    Eraydin, Şahizer; Avşar, Gülçin

    2017-12-19

    The purpose of this study was to investigate the effect of foot exercises on wound healing in type 2 diabetic patients with a diabetic foot ulcer. Prospective, randomized controlled study. Sixty-five patients from an outpatient clinic with grade 1 or 2 ulcers (Wagner classification) who met study criteria agreed to participate; 60 patients completed the study and were included in the final analysis. Subjects were followed up between February 2014 and June 2015. Subjects were recruited by the researchers in the clinics where they received treatment. Subjects were randomly allocated to either the control or intervention group. Data were collected using investigator-developed forms: patient information form and the diabetic foot exercises log. Patients in the intervention group received standard wound care and performed daily foot exercises for 12 weeks; the control group received standard wound care but no exercises. The ulcers of the patients in both the intervention and control groups were examined and measured at the 4th, 8th, and 12th weeks. The groups were compared in terms of the ulcer size and depth. To analyze and compare the data, frequency distribution, mean (standard deviation), variance analysis, and the independent samples t test and the χ test were used. The mean ulcer areas were 12.63 (14.43), 6.91 (5.44), 4.30 (3.70), and 3.29 (3.80) cm (P diabetic foot ulcer sizes in the study intervention group in the 4th and 12th weeks compared to beginning baseline (P ≤ .05). However, only the 12th week was different from the beginning in the control group (P = .000). The mean depths of the ulcers were 0.56 (0.85), 0.42 (0.68), 0.36 (0.50), and 0.28 (0.38) cm in the study intervention group (P foot exercises should be included in the treatment plan when managing patients with diabetic foot ulcers.

  18. Diabetic foot ulcers – evidence-based wound management: A ...

    African Journals Online (AJOL)

    Diabetic foot ulcers have a significant impact on the individual patient's quality of life, potential morbidity and even mortality. Diabetic foot ulcers also consume a gradually increasing portion of our health care budget. Whenever possible the focus should be on prevention rather than cure. All diabetic patients must have both ...

  19. Diabetic foot disease: impact of ulcer location on ulcer healing

    DEFF Research Database (Denmark)

    Pickwell, KM; Siersma, Volkert Dirk; Kars, M

    2013-01-01

    Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing.......Healing of heel ulcers in patients with diabetes is considered to be poor, but there is relatively little information on the influence of ulcer location on ulcer healing....

  20. Malignant melanoma misdiagnosed as diabetic foot ulcer: A case report.

    Science.gov (United States)

    Gao, Wei; Chen, Dawei; Ran, Xingwu

    2017-07-01

    Acral lentiginous melanoma (AML) does not exhibit the classic signs of malignant melanoma. ALM is frequently misdiagnosed because of its unusual sites and atypical clinical morphologies, which lead to poor prognosis. A female patient aged 78 years was presented to our center with two ulcers on her right foot. Diabetic foot ulcer was considered as the primary diagnosis. The ulcers failed to improve after 2 weeks' therapy. An incisional biopsy of the lesion revealed malignant melanoma. The patient received wide excision, skin grafting as well as biotherapy. The lesion was healed and no other metastasis has been founded until now. Clinicians must maintain a high level of suspicion in distinguishing malignant melanoma from other more benign skin lesions of the foot. The need for early biopsy of ulcer, even when clinical suspicion is low, can not be overemphasized. Only in this way can we reduce misdiagnosis rate and improve survival rate in patients with foot ulcer.

  1. Radiologic changes of ulcerated foot in leprosy

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Jung Hyun; Ahn, Eun Joo; Chung, Eun Chul; Rhee, Chung Sik [Ewha Woman' s University College of Medicine, Seoul (Korea, Republic of); Choi, Sung Jun [Institute for Leprosy Research, KLCA, Uiwang (Korea, Republic of)

    1990-12-15

    There are radiologically characteristic bone changes on the foot and tarsus in leprosy. The bone changes are primarily due to Mycobacterium leprae infection and secondarily to the injurious effect, such as trauma, and infection on the denervated tissue. 117 bone changes of 100 leprosy patients with plantar ulcerations from Jan. 1984 to Oct. 1989 in the Korean Leprosy Control Center were analyzed. Male to female ratio was about 2 : 1 and the most prevalent age was 41 to 60 years, and according to Ridley-Jopling's classification. L-type was most common (46%). One hundred and eleven cases (94.9%) showed bone changes, suggesting high incidence of bone changes in patients with plantar ulcers. Specific findings were observed in two cases(1.7%). One hundred and nine cases showed nonspecific bone changes, which were osteomyelitis(23.1%), neurotrophic changes(39.3%), periostitis(5.1%) and arthritis(12.8%). Extensive bone involvement was seen in neurotrophic changes involving forefoot and metatarsal in 22 of 46 cases, and in secondary changes involving metatarsal bone in 23, tarsus in 20 of 49 cases.

  2. Radiologic changes of ulcerated foot in leprosy

    International Nuclear Information System (INIS)

    Yoo, Jung Hyun; Ahn, Eun Joo; Chung, Eun Chul; Rhee, Chung Sik; Choi, Sung Jun

    1990-01-01

    There are radiologically characteristic bone changes on the foot and tarsus in leprosy. The bone changes are primarily due to Mycobacterium leprae infection and secondarily to the injurious effect, such as trauma, and infection on the denervated tissue. 117 bone changes of 100 leprosy patients with plantar ulcerations from Jan. 1984 to Oct. 1989 in the Korean Leprosy Control Center were analyzed. Male to female ratio was about 2 : 1 and the most prevalent age was 41 to 60 years, and according to Ridley-Jopling's classification. L-type was most common (46%). One hundred and eleven cases (94.9%) showed bone changes, suggesting high incidence of bone changes in patients with plantar ulcers. Specific findings were observed in two cases(1.7%). One hundred and nine cases showed nonspecific bone changes, which were osteomyelitis(23.1%), neurotrophic changes(39.3%), periostitis(5.1%) and arthritis(12.8%). Extensive bone involvement was seen in neurotrophic changes involving forefoot and metatarsal in 22 of 46 cases, and in secondary changes involving metatarsal bone in 23, tarsus in 20 of 49 cases

  3. Total contact cast for neuropathic diabetic foot ulcers

    International Nuclear Information System (INIS)

    Ali, R.; Yaqoob, M.Y.

    2008-01-01

    To determine the outcome of diabetic neuropathic foot ulcers treated with Total Contact Cast (TCC) in terms of percentage of ulcers healed and time to heal. The study included diabetic patients with non-ischemic neuropathic foot ulcers of upto grade 2 of Wagner's classification. Ulcers were debrided off necrotic tissues and Total Contact Cast (TCC) was applied. TCC was renewed every 2 weeks till healing. Cases were labeled as cast failure when there was no reduction in wound size in 4 consecutive weeks or worsening to a higher grade. Main outcome measures were the percentage of ulcers healed and time to heal in the cast. Thirty four (87.17%) patients were males and 5(12.82%) were females. The mean age was 62 +- 13.05 years. All patients had NIDDM. Out of the 52 ulcers, 41(78.84%) healed with TCC in an average 2 casts duration (mean 32 days). There were 11(21.15%) cast failure. Majority (63.63%) of cast failure ulcers were located on pressure bearing area of heel. Most (90%) of the ulcers on forefoot and midsole region healed with TCC (p<0.001). Longer ulcer duration (mean 57.45 +- 29.64 days) significantly reduced ulcer healing (p<0.001). Total contact cast was an effective treatment modality for neuropathic diabetic foot ulcers of Wagner's grade 2, located on forefoot and midsole region. (author)

  4. Neuropathic diabetic foot ulcers – evidence-to-practice

    Directory of Open Access Journals (Sweden)

    Ndip A

    2012-02-01

    Full Text Available Agbor Ndip1–3, Leonard Ebah3,4, Aloysius Mbako51Department of Diabetes and Medicine, Manchester Royal Infirmary, Central Manchester Foundation Trust, UK; 2Department of Medicine, Royal Bolton Hospital, Bolton, UK; 3Cardiovascular Research Group, School of Biomedicine, University of Manchester, UK; 4Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester Foundation Trust, UK; 5Department of Orthopaedic Surgery, Wrexham Maelor Hospital, Wales, UKAbstract: Foot ulcers and their attendant complications are disquietingly high in people with diabetes, a majority of whom have underlying neuropathy. This review examines the evidence base underpinning the prevention and management of neuropathic diabetic foot ulcers in order to inform best clinical practice. Since it may be impractical to ask patients not to weight-bear at all, relief of pressure through the use of offloading casting devices remains the mainstay for management of neuropathic ulcers, whilst provision of appropriate footwear is essential in ulcer prevention. Simple non-surgical debridement and application of hydrogels are both effective in preparing the wound bed for healthy granulation and therefore enhancing healing. Initial empirical antibiotic therapy for infected ulcers should cover the most common bacterial flora. There is limited evidence supporting the use of adjunctive therapies such as hyperbaric oxygen and cytokines or growth factors. In selected cases, recombinant human platelet-derived growth factor has been shown to enhance healing; however, its widespread use cannot be advised due to the availability of more cost-effective approaches. While patient education may be beneficial, the evidence base remains thin and conflicting. In conclusion, best management of foot ulcers is achieved by what is taken out of the foot (pressure, callus, infection, and slough rather than what is put on the foot (adjuvant treatment.Keywords: diabetic foot ulcers, neuropathic

  5. A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable

    NARCIS (Netherlands)

    Bus, Sicco A.; van Netten, Jaap J.

    2016-01-01

    Diabetic foot ulceration poses a heavy burden on the patient and the healthcare system, but prevention thereof receives little attention. For every euro spent on ulcer prevention, ten are spent on ulcer healing, and for every randomized controlled trial conducted on prevention, ten are conducted on

  6. Effectiveness of vacuum-assisted closure (VAC) therapy in the healing of chronic diabetic foot ulcers.

    Science.gov (United States)

    Nather, Aziz; Chionh, Siok Bee; Han, Audrey Y Y; Chan, Pauline P L; Nambiar, Ajay

    2010-05-01

    This is the fi rst prospective study done locally to determine the effectiveness of vacuum-assisted closure (VAC) therapy in the healing of chronic diabetic foot ulcers. An electronic vacuum pump was used to apply controlled negative pressure evenly across the wound surface. Changes in wound dimension, presence of wound granulation and infection status of diabetic foot ulcers in 11 consecutive patients with diabetes were followed over the course of VAC therapy. Healing was achieved in all wounds. Nine wounds were closed by split-skin grafting and 2 by secondary closure. The average length of treatment with VAC therapy was 23.3 days. Ten wounds showed reduction in wound size. All wounds were satisfactorily granulated and cleared of bacterial infection at the end of VAC therapy. VAC therapy was useful in the treatment of diabetic foot infection and ulcers, which after debridement, may present with exposed tendon, fascia and/or bone. These included ray amputation wounds, wounds post-debridement for necrotising fasciitis, wounds post-drainage for abscess, a heel ulcer and a sole ulcer. It was able to prepare ulcers well for closure via split-skin grafting or secondary closure in good time. This reduced cost of VAC therapy, as therapy was not prolonged to attain greater reduction in wound area. VAC therapy also provides a sterile, more controlled resting environment to large, exudating wound surfaces. Large diabetic foot ulcers were thus made more manageable.

  7. STUDIES ON BACTERIAL INFECTIONS OF DIABETIC FOOT ULCER

    African Journals Online (AJOL)

    Dr Oboro VO

    Microbial study for aerobic organisms from 100 cases of diabetic foot ulcers was carried out to determine the ... affect 239 million people world wide. ... cause the breakdown of the skin. ... complications, such as peripheral vascular disease,.

  8. Peripheral arterial angiography and interventional treatment in diabetic foot ulcers

    International Nuclear Information System (INIS)

    Guo Xiaohua; Cheng Yongde; Hu Suying; He Jianrong; Lin Kaiqin; Jin Honglai; Shi Shijie

    2003-01-01

    Objective: To assess the changes of peripheral arteries and choice of interventional treatment in diabetic foot ulcers. Methods: Thirty-six diabetic patients with foot ulcers were examined by lower extremity DSA with simultaneous ultrasonic Doppler examination for correlative study and interventional treatment carried out in 17 segmental stenotic cases. Among them, 12 patients were treated by PTA and 5 patients by intravascular stenting. Results: Irregular stenoses and obstruction were observed in all patients with peripheral foot ulcers. DSA examination was more reliable comparing with Doppler examination for demonstration of the arterial injury above the level of popliteal artery. PTA and primary stenting were effective in all of these subjects outcoming with promotion of the lower extremity arterial blood perfusion and foreseen curing efficacy. Conclusions: Peripheral arterial stenoses were common in diabetic patients with foot ulcers. In clinical practice, DSA examination and interventional treatment could give a fertile prognosis and reduce disabling

  9. Clinical workflow for personalized foot pressure ulcer prevention.

    Science.gov (United States)

    Bucki, M; Luboz, V; Perrier, A; Champion, E; Diot, B; Vuillerme, N; Payan, Y

    2016-09-01

    Foot pressure ulcers are a common complication of diabetes because of patient's lack of sensitivity due to neuropathy. Deep pressure ulcers appear internally when pressures applied on the foot create high internal strains nearby bony structures. Monitoring tissue strains in persons with diabetes is therefore important for an efficient prevention. We propose to use personalized biomechanical foot models to assess strains within the foot and to determine the risk of ulcer formation. Our workflow generates a foot model adapted to a patient's morphology by deforming an atlas model to conform it to the contours of segmented medical images of the patient's foot. Our biomechanical model is composed of rigid bodies for the bones, joined by ligaments and muscles, and a finite element mesh representing the soft tissues. Using our registration algorithm to conform three datasets, three new patient models were created. After applying a pressure load below these foot models, the Von Mises equivalent strains and "cluster volumes" (i.e. volumes of contiguous elements with strains above a given threshold) were measured within eight functionally meaningful foot regions. The results show the variability of both location and strain values among the three considered patients. This study also confirms that the anatomy of the foot has an influence on the risk of pressure ulcer. Copyright © 2016. Published by Elsevier Ltd.

  10. Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location.

    Science.gov (United States)

    Ledoux, William R; Shofer, Jane B; Cowley, Matthew S; Ahroni, Jessie H; Cohen, Victoria; Boyko, Edward J

    2013-01-01

    We prospectively examined the relationship between site-specific peak plantar pressure (PPP) and ulcer risk. Researchers have previously reported associations between diabetic foot ulcer and elevated plantar foot pressure, but the effect of location-specific pressures has not been studied. Diabetic subjects (n=591) were enrolled from a single VA hospital. Five measurements of in-shoe plantar pressure were collected using F-Scan. Pressures were measured at 8 areas: heel, lateral midfoot, medial midfoot, first metatarsal, second through fourth metatarsal, fifth metatarsal, hallux, and other toes. The relationship between incident plantar foot ulcer and PPP or pressure-time integral (PTI) was assessed using Cox regression. During follow-up (2.4years), 47 subjects developed plantar ulcers (10 heel, 12 metatarsal, 19 hallux, 6 other). Overall mean PPP was higher for ulcer subjects (219 vs. 194kPa), but the relationship differed by site (the metatarsals with ulcers had higher pressure, while the opposite was true for the hallux and heel). A statistical analysis was not performed on the means, but hazard ratios from a Cox survival analysis were nonsignificant for PPP across all sites and when adjusted for location. However, when the metatarsals were considered separately, higher baseline PPP was significantly associated with greater ulcer risk; at other sites, this relationship was nonsignificant. Hazard ratios for all PTI data were nonsignificant. Location must be considered when assessing the relationship between PPP and plantar ulceration. © 2013.

  11. Risk factors, ulcer grade and management outcome of diabetic foot ...

    African Journals Online (AJOL)

    Risk factors, ulcer grade and management outcome of diabetic foot ulcers in a Tropical Tertiary Care Hospital. ... Data documented included age, gender, type of DM, duration of DM, risk factors of DFU, duration of DFU ... 85.2% had type 2 DM.

  12. Foot ulcers in the diabetic patient, prevention and treatment

    Science.gov (United States)

    Wu, Stephanie C; Driver, Vickie R; Wrobel, James S; Armstrong, David G

    2007-01-01

    Lower extremity complications in persons with diabetes have become an increasingly significant public health concern in both the developed and developing world. These complications, beginning with neuropathy and subsequent diabetic foot wounds frequently lead to infection and lower extremity amputation even in the absence of critical limb ischemia. In order to diminish the detrimental consequences associated with diabetic foot ulcers, a com-mon-sense-based treatment approach must be implemented. Many of the etiological factors contributing to the formation of diabetic foot ulceration may be identified using simple, inexpensive equipment in a clinical setting. Prevention of diabetic foot ulcers can be accomplished in a primary care setting with a brief history and screening for loss of protective sensation via the Semmes-Weinstein monofilament. Specialist clinics may quantify neuropathy, plantar foot pressure, and assess vascular status with Doppler ultrasound and ankle-brachial blood pressure indices. These measurements, in conjunction with other findings from the history and physical examination, may enable clinicians to stratify patients based on risk and help determine the type of intervention. Other effective clinical interventions may include patient education, optimizing glycemic control, smoking cessation, and diligent foot care. Recent technological advanced combined with better understanding of the wound healing process have resulted in a myriad of advanced wound healing modalities in the treatment of diabetic foot ulcers. However, it is imperative to remember the fundamental basics in the healing of diabetic foot ulcers: adequate perfusion, debridement, infection control, and pressure mitigation. Early recognition of the etiological factors along with prompt management of diabetic foot ulcers is essential for successful outcome. PMID:17583176

  13. Wound healing: total contact cast vs. custom-made temporary footwear for patients with diabetic foot ulceration

    NARCIS (Netherlands)

    van der Weg, F.B.; van der Windt, D.A.W.M.; Vahl, A.C.

    2008-01-01

    The objective of this study was to compare the effectiveness of irremovable total-contact casts (TCC) and custom-made temporary footwear (CTF) to heal neuropathic foot ulcerations in individuals with diabetes. In this prospective clinical trial, 43 patients with plantar ulcer Grade 1 or 2 (Wagner

  14. Coping style and depression influence the healing of diabetic foot ulcers: observational and mechanistic evidence.

    Science.gov (United States)

    Vedhara, K; Miles, J N V; Wetherell, M A; Dawe, K; Searle, A; Tallon, D; Cullum, N; Day, A; Dayan, C; Drake, N; Price, P; Tarlton, J; Weinman, J; Campbell, R

    2010-08-01

    Experimental evidence suggests that the healing of diabetic foot ulcers is affected by psychosocial factors such as distress. We examined this proposal in a prospective study, in which we considered the role of psychological distress and coping style in the healing of diabetic foot ulcers over a 24 week period. We also explored the role of salivary cortisol and matrix metalloproteinases (MMPs) as potential mechanisms. For this prospective observational study we recruited 93 (68 men; mean age 60 years) patients with neuropathic or neuroischaemic diabetic foot ulcers from specialist podiatry clinics in secondary care. Clinical and demographic determinants of healing, psychological distress, coping, salivary cortisol and both MMP2 and MMP9 were assessed at baseline. Ulcers were assessed at baseline and at 6, 12 and 24 weeks post-baseline. The primary outcome was ulcer status at 24 weeks, i.e. healed vs not healed. After controlling for clinical and demographic determinants of healing, ulcer healing at 24 weeks was predicted by confrontation coping, but not by depression or anxiety. Patients with unhealed ulcers exhibited greater confrontation coping (model including depression: OR 0.809, 95% CI 0.704-0.929, p = 0.003; model including anxiety: OR 0.810, 95% CI 0.704-0.930, p = 0.003). However, change in ulcer size over the observation period was associated with depression only (p = 0.04, d = 0.31). Healed ulcers by 24 weeks were also associated with lower evening cortisol, higher precursor MMP2 and a greater cortisol awakening response. Confrontation coping and depression predict ulcer healing. Our preliminary enquiry into biological mechanisms suggests that cortisol and precursor MMP2 may underlie these relationships.

  15. Hyperbaric oxygen in the treatment of a diabetic foot ulcer.

    LENUS (Irish Health Repository)

    Davenport, Colin

    2011-02-01

    Although simultaneous pancreas and kidney transplant improves most complications of type 1 diabetes, suppression of the immune system increases the risk for infection. The authors report the case of a patient who, despite receiving a simultaneous pancreas and kidney transplant, subsequently developed neuro-ischemic ulcers of his right foot requiring repeated amputations. He then developed an infected ulcer of his remaining right big toe, with significant implications for his mobility. This ulcer proved resistant to multiple courses of antibiotics and care in a specialist foot clinic but resolved completely following a course of hyperbaric oxygen therapy. The role of hyperbaric oxygen in diabetic foot ulcers is not yet fully established but should be considered in resistant cases with vascular insufficiency and a significant infective component.

  16. Hyperbaric oxygen in the treatment of a diabetic foot ulcer.

    LENUS (Irish Health Repository)

    Davenport, Colin

    2012-02-01

    Although simultaneous pancreas and kidney transplant improves most complications of type 1 diabetes, suppression of the immune system increases the risk for infection. The authors report the case of a patient who, despite receiving a simultaneous pancreas and kidney transplant, subsequently developed neuro-ischemic ulcers of his right foot requiring repeated amputations. He then developed an infected ulcer of his remaining right big toe, with significant implications for his mobility. This ulcer proved resistant to multiple courses of antibiotics and care in a specialist foot clinic but resolved completely following a course of hyperbaric oxygen therapy. The role of hyperbaric oxygen in diabetic foot ulcers is not yet fully established but should be considered in resistant cases with vascular insufficiency and a significant infective component.

  17. Early detection of foot ulcers through asymmetry analysis

    Science.gov (United States)

    Kaabouch, Naima; Chen, Yi; Hu, Wen-Chen; Anderson, Julie; Ames, Forrest; Paulson, Rolf

    2009-02-01

    Foot ulcers affect millions of Americans annually. Areas that are likely to ulcerate have been associated with increased local skin temperatures due to inflammation and enzymatic autolysis of tissue. Conventional methods to assess skin, including inspection and palpation, may be valuable approaches, but usually they do not detect changes in skin integrity until an ulcer has already developed. Conversely, infrared imaging is a technology able to assess the integrity of the skin and its many layers, thus having the potential to index the cascade of physiological events in the prevention, assessment, and management of foot ulcers. In this paper, we propose a technique, asymmetry analysis, to automatically analyze the infrared images in order to detect inflammation. Preliminary results show that the proposed technique can be reliable and efficient to detect inflammation and, hence, predict potential ulceration.

  18. Resection of the metatarsal head for diabetic foot ulcers.

    Science.gov (United States)

    Wieman, T J; Mercke, Y K; Cerrito, P B; Taber, S W

    1998-11-01

    Diabetic foot ulceration is a worldwide health problem. Approximately 15% of the 10 million diabetic patients in the United States will develop a foot ulceration at some time in their lives. The presence of a foot ulcer in this population is extremely debilitating and dramatically increases the risk of lower extremity amputation, accounting for approximately 67,000 lost limbs each year. Additionally, the costs associated with treating foot ulcers in diabetic patients is a major expense in the overall care of this patient group. An 11-year retrospective study was conducted to evaluate 101 consecutive patients with diabetic ulcers of the forefoot who were treated using resection of the metatarsal head as the primary means of obtaining wound closure. The results indicate that 88% of the ulcers were healed by using this technique, and relatively more rapidly than would be expected when compared with historical norms. Resection of the metatarsal head is a safe and relatively inexpensive procedure that facilitates closure of the lesion, helps to control infection, and prevents countless and costly amputations.

  19. The management of neuropathic ulcers of the foot in diabetes by shock wave therapy

    Directory of Open Access Journals (Sweden)

    Pascone Michele

    2009-05-01

    Full Text Available Abstract Background Diabetes is becoming one of the most common chronic diseases, and ulcers are its most serious complication. Beginning with neuropathy, the subsequent foot wounds frequently lead to lower extremity amputation, even in the absence of critical limb ischemia. In recent years, some researchers have studied external shock wave therapy (ESWT as a new approach to soft tissue wound healing. The rationale of this study was to evaluate if ESWT is effective in the management of neuropathic diabetic foot ulcers. Methods We designed a randomized, prospective, controlled study in which we recruited 30 patients affected by neuropathic diabetic foot ulcers and then divided them into two groups based on different management strategies. One group was treated with standard care and shock wave therapy. The other group was treated with only standard care. The healing of the ulcers was evaluated over 20 weeks by the rate of re-epithelization. Results After 20 weeks of treatment, 53.33% of the ESWT-treated patients had complete wound closure compared with 33.33% of the control patients, and the healing times were 60.8 and 82.2 days, respectively (p 2/die in the ESWT-group and 1.30 mm2/die in the control group (p Conclusion Therefore, ESWT may be a useful adjunct in the management of diabetic foot ulceration. Trial registration Current Controlled Trials ISRCTN21800909

  20. Effective management of patients with diabetes foot ulcers: outcomes of an Interprofessional Diabetes Foot Ulcer Team.

    Science.gov (United States)

    Ogrin, Rajna; Houghton, Pamela E; Thompson, G William

    2015-08-01

    A longitudinal observational study on a convenience sample was conducted between 4 January and 31 December of 2010 to evaluate clinical outcomes that occur when a new Interprofessional Diabetes Foot Ulcer Team (IPDFUT) helps in the management of diabetes-related foot ulcers (DFUs) in patients living in a small urban community in Ontario, Canada. Eighty-three patients presented to the IPDFUT with 114 DFUs of average duration of 19·5 ± 2·7 weeks. Patients were 58·4 ± 1·4 years of age and 90% had type 2 diabetes, HbA1c of 8·3 ± 2·0%, with an average diabetes duration of 22·3 ± 3·4 years; in 69% of patients, 78 DFUs healed in an average duration of 7·4 ± 0·7 weeks, requiring an average of 3·8 clinic visits. Amputation of a toe led to healing in three patients (4%) and one patient required a below-knee amputation. Six patients died and three withdrew. Adding a skilled IPDFUT that is trained to work together resulted in improved healing outcomes. The rate of healing, proportion of wounds closed and complication rate were similar if not better than the results published previously in Canada and around the world. The IPDFUT appears to be a successful model of care and could be used as a template to provide effective community care to the patients with DFU in Ontario, Canada. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  1. The predictors of foot ulceration in patients with rheumatoid arthritis.

    Science.gov (United States)

    Firth, Jill; Waxman, Robin; Law, Graham; Nelson, E Andrea; Helliwell, Philip; Siddle, Heidi; Otter, Simon; Butters, Violet; Baker, Lesley; Hryniw, Rosemary; Bradley, Sarah; Loughrey, Lorraine; Alcacer-Pitarch, Begonya; Davies, Samantha; Tranter, Jennifer

    2014-05-01

    This study was conducted to determine the predictors of foot ulceration occurring in patients with rheumatoid arthritis (RA) without diabetes. A multi-centre case control study was undertaken; participants were recruited from eight sites (UK). Cases were adults diagnosed with RA (without diabetes) and the presence of a validated foot ulcer, defined as a full thickness skin defect occurring in isolation on / below the midline of the malleoli and requiring > 14 days to heal. Controls met the same criteria but were ulcer naive. Clinical examination included loss of sensation (10g monofilament); ankle-brachial pressure index (ABPI); forefoot deformity (Platto); plantar pressures (PressureStat); RA disease activity (36 swollen/tender joint counts) and the presence of vasculitis. History taking included past ulceration/foot surgery; current medication and smoking status. Participants completed the Health Assessment Questionnaire (HAQ) and Foot Impact Scale. A total of 83 cases with 112 current ulcers and 190 ulcer naïve controls participated. Cases were significantly older (mean age 71 years; 95 % confidence interval [CI], 69-73 vs. 62 years, 60-64) and had longer RA disease duration (mean 22 years; 19-25 vs. 15, 13-17). Univariate analysis showed that risk of ulceration increases with loss of sensation; abnormality of ABPI and foot deformity. Plantar pressures and joint counts were not significant predictors. HAQ score and history of foot surgery were strongly associated with ulceration (odds ratio [OR] = 1.704, 95 % CI 1.274-2.280 and OR = 2.256, 95 % CI 1.294-3.932). Three cases and two controls presented with suspected cutaneous vasculitis. In logistic regression modelling, ABPI (OR = 0.04; 95 % CI, 0.01-0.28) forefoot deformity (OR = 1.14; 95 % CI, 1.08-1.21) and loss of sensation (OR = 1.22; 95 % CI, 1.10-1.36) predicted risk of ulceration. In patients with RA, ABPI, forefoot deformity and loss of sensation predict risk of ulceration

  2. Assessing diabetic foot ulcer development risk with hyperspectral tissue oximetry

    Science.gov (United States)

    Yudovsky, Dmitry; Nouvong, Aksone; Schomacker, Kevin; Pilon, Laurent

    2011-02-01

    Foot ulceration remains a serious health concern for diabetic patients and has a major impact on the cost of diabetes treatment. Early detection and preventive care, such as offloading or improved hygiene, can greatly reduce the risk of further complications. We aim to assess the use of hyperspectral tissue oximetry in predicting the risk of diabetic foot ulcer formation. Tissue oximetry measurements are performed during several visits with hyperspectral imaging of the feet in type 1 and 2 diabetes mellitus subjects that are at risk for foot ulceration. The data are retrospectively analyzed at 21 sites that ulcerated during the course of our study and an ulceration prediction index is developed. Then, an image processing algorithm based on this index is implemented. This algorithm is able to predict tissue at risk of ulceration with a sensitivity and specificity of 95 and 80%, respectively, for images taken, on average, 58 days before tissue damage is apparent to the naked eye. Receiver operating characteristic analysis is also performed to give a range of sensitivity/specificity values resulting in a Q-value of 89%.

  3. Foot ulcers in the diabetic patient, prevention and treatment

    Directory of Open Access Journals (Sweden)

    Stephanie C Wu

    2007-03-01

    Full Text Available Stephanie C Wu1, Vickie R Driver1, James S Wrobel2, David G Armstrong21Center for Lower Extremity Ambulatory Research,William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, and National Center of Limb Salvage, Advocate Lutheran General Hospital, Chicago, IL, USA; 2Center for Lower Extremity Ambulatory Research, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine, Chicago, IL, USAAbstract: Lower extremity complications in persons with diabetes have become an increasingly significant public health concern in both the developed and developing world. These complications, beginning with neuropathy and subsequent diabetic foot wounds frequently lead to infection and lower extremity amputation even in the absence of critical limb ischemia. In order to diminish the detrimental consequences associated with diabetic foot ulcers, a common-sense-based treatment approach must be implemented. Many of the etiological factors contributing to the formation of diabetic foot ulceration may be identified using simple, inexpensive equipment in a clinical setting. Prevention of diabetic foot ulcers can be accomplished in a primary care setting with a brief history and screening for loss of protective sensation via the Semmes-Weinstein monofilament. Specialist clinics may quantify neuropathy, plantar foot pressure, and assess vascular status with Doppler ultrasound and ankle-brachial blood pressure indices. These measurements, in conjunction with other findings from the history and physical examination, may enable clinicians to stratify patients based on risk and help determine the type of intervention. Other effective clinical interventions may include patient education, optimizing glycemic control, smoking cessation, and diligent foot care. Recent technological advanced combined with better understanding of the wound healing process have resulted in a myriad of advanced

  4. Increased healing in diabetic toe ulcers in a multidisciplinary foot clinic—An observational cohort study

    DEFF Research Database (Denmark)

    Almdal, Thomas Peter; Nielsen, A.A.; Nielsen, K.E.

    2015-01-01

    AIM: To study toe ulcer healing in patients with diabetic foot ulcers attending a multidisciplinary foot clinic over a 10 years period. METHODS: The study was retrospective, consecutive and observational during 2001 through 2011. The patients were treated according to the International Consensus...... on the Diabetic Foot. During the period the chiropodist staffing in the foot clinic was doubled; new offloading material and orthopedic foot corrections for recalcitrant ulcers were introduced. Healing was investigated in toe ulcers in Cox regression models. RESULTS: 2634 patients developed foot ulcers, of which...

  5. Transcutaneous oxygen pressure measurement in diabetic foot ulcers: mean values and cut-point for wound healing.

    Science.gov (United States)

    Yang, Chuan; Weng, Huan; Chen, Lihong; Yang, Haiyun; Luo, Guangming; Mai, Lifang; Jin, Guoshu; Yan, Li

    2013-01-01

    The purpose of this study was to investigate mean values and cut-point of transcutaneous oxygen pressure (TcPO2) measurement in patients with diabetic foot ulcers. Prospective, descriptive study. Sixty-one patients with diabetes mellitus and foot ulcers comprised the sample. The research setting was Sun Yat-sen Memorial Hospital of SunYat-sen University, Guangzhou, China. Participants underwent transcutaneous oxygen (TcPO2) measurement at the dorsum of foot. Patients were classified into 3 groups according to clinical outcomes: (1) ulcers healed with intact skin group, (2) ulcer improved, and (3) ulcer failed to improve. TcPO2 was assessed and cut-points for predicting diabetic foot ulcer healing were calculated. Thirty-six patients healed with intact skin, 8 experienced improvement, and 17 showed no improvement. Mean TcPO2 levels were significantly higher (Pfoot ulcers. In contrast, all patients with TcPO2≥ 40 mmHg achieved wound closure. Measurement of TcPO2 in the supine position revealed a cut-point value of 25 mmHg as the best threshold for predicting diabetic foot ulcer healing; the area under the curve using this cut-point was 0.838 (95% confidence interval = 0.700-0.976). The sensitivity, specificity, positive predictive value, and negative predictive value for TxPO2 were 88.6%, 82.4%, 90.7%, and 72.2%, respectively. TcPO2≥ 40 mmHg was associated with diabetic foot ulcer healing, but a TcPO2≤ 10 mmHg was associated with failure of wound healing. We found that a cut-point of 25 mmHg was most predictive of diabetic foot ulcer healing.

  6. High osteoprotegerin is associated with development of foot ulcer in type 1 diabetes

    DEFF Research Database (Denmark)

    Zobel, Emilie H; von Scholten, Bernt J; Lajer, Maria

    2016-01-01

    BACKGROUND AND AIM: The bone-related peptide osteoprotegerin has been linked to vascular calcification and peripheral vascular disease. We investigated the association between osteoprotegerin and development of foot complications in persons with type 1 diabetes. MATERIALS AND METHODS: Prospective...... observational study of 573 persons with type 1 diabetes, 225 women; age [mean±SD] 42.3±10.3years. Plasma osteoprotegerin was measured by ELISA. RESULTS: Median (IQR) osteoprotegerin was 2.80(2.35-3.63)μg/L and follow-up time (median (range)) was 12.7(0.1-15.6)years. Endpoints included: new foot ulceration (n......=153), Charcot foot (n=14), vascular surgery/amputation (n=53), loss of foot pulse (n=57), and peripheral neuropathy (n=99). In unadjusted analyses, higher osteoprotegerin was associated with development of all endpoints (p≤0.026). Higher osteoprotegerin remained associated with development of foot...

  7. Non-contact ulcer area calculation system for neuropathic foot ulcer.

    Science.gov (United States)

    Shah, Parth; Mahajan, Siddaram; Nageswaran, Sharmila; Paul, Sathish Kumar; Ebenzer, Mannam

    2017-08-11

    Around 125,785 new cases in year 2013-14 of leprosy were detected in India as per WHO report on leprosy in September 2015 which accounts to approximately 62% of the total new cases. Anaesthetic foot caused by leprosy leads to uneven loading of foot leading to ulcer in approximately 20% of the cases. Much efforts have gone in identifying newer techniques to efficiently monitor the progress of ulcer healing. Current techniques followed in measuring the size of ulcers, have not been found to be so accurate but are still is followed by clinicians across the globe. Quantification of prognosis of the condition would be required to understand the efficacy of current treatment methods and plan for further treatment. This study aims at developing a non contact technique to precisely measure the size of ulcer in patients affected by leprosy. Using MATLAB software, GUI was designed to process the acquired ulcer image by segmenting and calculating the pixel area of the image. The image was further converted to a standard measurement using a reference object. The developed technique was tested on 16 ulcer images acquired from 10 leprosy patients with plantar ulcers. Statistical analysis was done using MedCalc analysis software to find the reliability of the system. The analysis showed a very high correlation coefficient (r=0.9882) between the ulcer area measurements done using traditional technique and the newly developed technique, The reliability of the newly developed technique was significant with a significance level of 99.9%. The designed non-contact ulcer area calculating system using MATLAB is found to be a reliable system in calculating the size of ulcers. The technique would help clinicians have a reliable tool to monitor the progress of ulcer healing and help modify the treatment protocol if needed. Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  8. The Effect of Foot Exercises on Wound Healing in Type 2 Diabetic Patients With a Foot Ulcer: A Randomized Control Study.

    Science.gov (United States)

    Eraydin, Şahizer; Avşar, Gülçin

    The purpose of this study was to investigate the effect of foot exercises on wound healing in type 2 diabetic patients with a diabetic foot ulcer. Prospective, randomized controlled study. Sixty-five patients from an outpatient clinic with grade 1 or 2 ulcers (Wagner classification) who met study criteria agreed to participate; 60 patients completed the study and were included in the final analysis. Subjects were followed up between February 2014 and June 2015. Subjects were recruited by the researchers in the clinics where they received treatment. Subjects were randomly allocated to either the control or intervention group. Data were collected using investigator-developed forms: patient information form and the diabetic foot exercises log. Patients in the intervention group received standard wound care and performed daily foot exercises for 12 weeks; the control group received standard wound care but no exercises. The ulcers of the patients in both the intervention and control groups were examined and measured at the 4th, 8th, and 12th weeks. The groups were compared in terms of the ulcer size and depth. To analyze and compare the data, frequency distribution, mean (standard deviation), variance analysis, and the independent samples t test and the χ test were used. The mean ulcer areas were 12.63 (14.43), 6.91 (5.44), 4.30 (3.70), and 3.29 (3.80) cm (P diabetic foot ulcer sizes in the study intervention group in the 4th and 12th weeks compared to beginning baseline (P ≤ .05). However, only the 12th week was different from the beginning in the control group (P = .000). The mean depths of the ulcers were 0.56 (0.85), 0.42 (0.68), 0.36 (0.50), and 0.28 (0.38) cm in the study intervention group (P foot exercises should be included in the treatment plan when managing patients with diabetic foot ulcers.

  9. Cost-effectiveness of telemonitoring of diabetic foot ulcer patients

    DEFF Research Database (Denmark)

    Fasterholdt, Iben; Gerstrøm, Marie; Rasmussen, Benjamin Schnack Brandt

    2016-01-01

    This study compared the cost-effectiveness of telemonitoring with standard monitoring for patients with diabetic foot ulcers. The economic evaluation was nested within a pragmatic randomised controlled trial. A total of 374 patients were randomised to either telemonitoring or standard monitoring...

  10. 130 DIABETIC FOOT ULCERS: CURRENT TRENDS IN ...

    African Journals Online (AJOL)

    drclement

    *Department of Orthopaedics and Trauma, University of Benin Teaching Hospital, ... well as patient education will markedly .... broad spectrum antibiotic therapy only .... Discuss any foot powders with a healthcare professional prior to use. 2.

  11. Association of Sociodemographic Factors with Spirituality and Hope in Patients with Diabetic Foot Ulcers.

    Science.gov (United States)

    Salomé, Geraldo Magela; de Almeida, Sergio Aguinaldo; Mendes, Bruno; de Carvalho, Maiume Roana Ferreira; Bueno, José Carlos; Massahud, Marcelo Renato; Ferreira, Lydia Masako

    2017-01-01

    To evaluate levels of spirituality and hope in patients with diabetic foot ulcers (DFUs) according to sociodemographic factors. This was a primary, prospective, descriptive, analytical, and clinical study. Questionnaires assessing sociodemographic and clinical characteristics of the patients, the Spirituality Self-rating Scale (SSRS), and the Herth Hope Index (HHI) were administered to all participants. University-affiliated skilled nursing center and outpatient wound care clinic in Pouso Alegre, Brazil. Fifty adult patients with DFUs participated in the study. Patients with ischemic diabetic foot and mixed ulcers were excluded from the study. On average, patients with DFUs had low levels of spirituality (mean SSRS score, 12.6) and low hope for cure (mean HHI, 16.5). Patients younger than 60 years reported significantly lower levels of spirituality (mean SSRS scores, 11.0), and those older than 70 years had significantly lower hope for cure (mean HHI, 12.5) than other age groups (P = .040). Level of spirituality was significantly lower among women (P = .015) and those living with an ulcer for more than 2 years, who also reported significantly lower hope for cure (P = .029) compared with patients having an ulcer for less than 2 years. On average, patients with DFUs, especially women and older adults, had a low sense of hope and spirituality. Except for gender, age, and ulcer duration, other sociodemographic and ulcer characteristics had no significant effect on the study population's spirituality and hope.

  12. Effectiveness of bridge V.A.C. dressings in the treatment of diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Aziz Nather

    2011-03-01

    Full Text Available Objectives: This is a prospective study of the clinical efficacy of the V.A.C. Granufoam Bridge Dressing for the treatment of diabetic foot ulcers. Materials and methods: Five consecutive patients with diabetic foot ulcers were treated with V.A.C. Granufoam Bridge Dressings and studied over a period of 22–48 days. The indications for treatment included diabetic patients with open ray amputation wounds and wounds post-drainage for abscess with exposed deep structures. Clinical outcome was measured in terms of reduction in wound dimensions, presence of wound granulation, microbial clearance, and development of wound complications. Results: Our results showed that with V.A.C. therapy, wound healing occurred in all patients. The number of dressings required ranged from 8 to 10. The baseline average wound size was 23.1 cm2. Wound areas shrunk by 18.4–41.7%. All subjects achieved 100% wound bed granulation with an average length of treatment of 33 days. Microbial clearance was achieved in all cases. All wounds healed by secondary intention in one case and four cases required split-thickness skin grafting. Conclusion: The V.A.C. Granufoam Bridge Dressing is effective in the treatment of diabetic foot ulcers. It promotes reduction of wound area, wound bed granulation, and microbial clearance. By allowing placement of the suction pad outside the foot, it allowed patients to wear protective shoes and to walk non-weight bearing with crutches during V.A.C. therapy.

  13. Increased Mortality in Diabetic Foot Ulcer Patients: The Significance of Ulcer Type

    Science.gov (United States)

    Chammas, N. K.; Hill, R. L. R.; Edmonds, M. E.

    2016-01-01

    Diabetic foot ulcer (DFU) patients have a greater than twofold increase in mortality compared with nonulcerated diabetic patients. We investigated (a) cause of death in DFU patients, (b) age at death, and (c) relationship between cause of death and ulcer type. This was an eleven-year retrospective study on DFU patients who attended King's College Hospital Foot Clinic and subsequently died. A control group of nonulcerated diabetic patients was matched for age and type of diabetes mellitus. The cause of death was identified from death certificates (DC) and postmortem (PM) examinations. There were 243 DFU patient deaths during this period. Ischaemic heart disease (IHD) was the major cause of death in 62.5% on PM compared to 45.7% on DC. Mean age at death from IHD on PM was 5 years lower in DFU patients compared to controls (68.2 ± 8.7 years versus 73.1 ± 8.0 years, P = 0.015). IHD as a cause of death at PM was significantly linked to neuropathic foot ulcers (OR 3.064, 95% CI 1.003–9.366, and P = 0.049). Conclusions. IHD is the major cause of premature mortality in DFU patients with the neuropathic foot ulcer patients being at a greater risk. PMID:27213157

  14. Risk factors for plantar foot ulcer recurrence in neuropathic diabetic patients

    NARCIS (Netherlands)

    Waaijman, Roelof; de Haart, Mirjam; Arts, Mark L. J.; Wever, Daniel; Verlouw, Anke J. W. E.; Nollet, Frans; Bus, Sicco A.

    2014-01-01

    Recurrence of plantar foot ulcers is a common and major problem in diabetes but not well understood. Foot biomechanics and patient behavior may be important. The aim was to identify risk factors for ulcer recurrence and to establish targets for ulcer prevention. As part of a footwear trial, 171

  15. How common are foot problems among individuals with diabetes? Diabetic foot ulcers in the Dutch population

    NARCIS (Netherlands)

    Stoekenbroek, Robert M.; Lokin, Joost L. C.; Nielen, Mark M.; Stroes, Erik S. G.; Koelemay, Mark J. W.

    2017-01-01

    Aims/hypothesis Contemporary data on diabetic foot ulcer prevalence are scarce. Most studies were conducted in the 1990s, reporting incidence rates of 1.9-2.6%. Since then the prevalence of diabetes has doubled and the organisation of diabetes care has undergone major changes. Up-to-date data that

  16. A COMPARATIVE STUDY BETWEEN HYDROFIBER DRESSING & POVIDONE DRESSING IN DIABETIC FOOT ULCERS

    Directory of Open Access Journals (Sweden)

    Rithin

    2016-03-01

    Full Text Available BACKGROUND Diabetic Foot Ulcer (DFU is the most common complication of Diabetes Mellitus (DM. It occurs in 15% of all patients with DM. Major increase in mortality among diabetic patients, observed over the past 20 years is considered to be due to the development of macro and micro vascular complications, including failure of the wound healing process. Non-healing chronic diabetic ulcers are often treated with extracellular matrix replacement therapy.so far, it is a common trend in diabetic foot care domain to use advanced moist wound therapy. At present, there are various categories of moist dressings available such as povidone dressings, adhesive backing film, silicone coated foam, hydrogels, hydrocolloids etc. AIMS & OBJECTIVES 1 To study efficacy of hydrofiber dressings and wound healing in diabetic foot ulcers. 2 To compare the safety, final outcome and patient compliance in hydrofiber and povidone dressing. MATERIALS & METHODS This prospective, observational study is carried in our department from September 2014 to September 2015. All the patients with age of 30 years and above were admitted in AJIMS satisfying the inclusion and exclusion criteria were taken into the study. The patients were followed until the ulcer is treated. STATISTICAL ANALYSIS Data are presented as Mean and Standard Deviation (SD. Fischer’s exact test and Chi-Square Test were used as appropriate. GraphPad Prism Version 6.0h was used to analyze data and to prepare graphs. A ‘P’ value below the level of 0.05 was taken as statistically significant. RESULTS Among the patients who were studied, hydrofiber dressings helped in the better & faster healing of DFU. CONCLUSION In comparison with povidone gauze dressings to hydrofiber dressings in diabetic foot ulcers, the latter is more efficacious in controlling the infection, minimal usage of antibiotics, faster healing rate and patient compliance during dressings.

  17. Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities

    Science.gov (United States)

    Amin, Noha; Doupis, John

    2016-01-01

    The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities. PMID:27076876

  18. TIME Of Diabetic Ulcer Foot Suffering And Depression Symptoms In Ulin General Hospital Banjarmasin

    OpenAIRE

    Puteri, Rizka Dwi; Darwis, Yulizar; Heriyani, Farida

    2017-01-01

    Diabetic foot ulcers are one kind of chronic complication of diabetes mellitus in the form of an open wound on the skin's surface and may be accompanied by local tissue death. Long term suffering of diabetic foot ulcers with physical and psychological changes may cause symptoms of depression. The aim of this study was to determine the correlation between long term suffering of diabetic foot ulcers and symptoms of depression in RSUD Ulin Banjarmasin. This was an analytic observational study w...

  19. From the diabetic foot ulcer and beyond: how do foot infections spread in patients with diabetes?

    Science.gov (United States)

    Aragón-Sánchez, Javier; Lázaro-Martínez, Jose Luis; Pulido-Duque, Juan; Maynar, Manuel

    2012-01-01

    A diabetic foot infection is usually the result of a pre-existing foot ulceration and is the leading cause of lower extremity amputation in patients with diabetes. It is widely accepted that diabetic foot infections may be challenging to treat for several reasons. The devastating effects of hyperglycemia on host defense, ischemia, multi-drug resistant bacteria and spreading of infection through the foot may complicate the course of diabetic foot infections. Understanding the ways in which infections spread through the diabetic foot is a pivotal factor in order to decide the best approach for the patient's treatment. The ways in which infections spread can be explained by the anatomical division of the foot into compartments, the tendons included in the compartments, the initial location of the point of entry of the infection and the type of infection that the patient has. The aim of this paper is to further comment on the existed and proposed anatomical principles of the spread of infection through the foot in patients with diabetes. PMID:23050067

  20. Prevalence, Clinical Presentation, and Factors Associated With Diabetic Foot Ulcer in Two Regional Hospitals in Cameroon.

    Science.gov (United States)

    Tindong, Maxime; Palle, John N; Nebongo, Daniel; Aminde, Leopold Ndemnge; Mboue-Djieka, Yannick; Mbarga, Nicole T Fouda; Dehayem, Mesmin Y; Choukem, Siméon-Pierre

    2018-03-01

    This study aimed to determine the prevalence of diabetic foot ulcer and high risk for ulceration, describe the clinical presentation, and identify factors associated with diabetic foot ulcer in the Southwest regional hospitals of Cameroon. In this cross-sectional study, data were collected using a structured questionnaire administered to consecutive patients with diabetes. Findings from detailed foot examination were recorded. Diabetic foot ulcer was diagnosed according to the International Working Group on Diabetic Foot (IWGDF) definition. Data were analyzed with Stata IC version 12. Of the 203 participants included, 63.1% were females. Age ranged from 26 to 96 years. The median duration of diabetes was 4.0 years (interquartile range 1.0-8.0 years). The prevalence of diabetic foot ulcer was 11.8% (24), of whom 29.2% (7) had high grade (grades 2 to 4), and most of the ulcers 58.3% (14) were located at the plantar region. The prevalence of high risk for ulceration was 21.8% (39). Loss of protective sensation (OR = 3.73, 95% CI = 1.43-9.71; P = .007), and peripheral arterial disease (OR = 3.48, 95% CI = 1.14-10.56; P = .028) were independently associated with diabetic foot. Diabetic foot ulcer is a common complication among patients with diabetes attending these regional hospitals. Loss of protective sensation, and peripheral arterial disease increase the odds of having diabetic foot ulcer, and we suggest them as the main target of interest for prevention.

  1. Wound bed preparation for ischemic diabetic foot ulcer.

    Science.gov (United States)

    Zhang, Zhaoxin; Lv, Lei; Guan, Sheng

    2015-01-01

    This study is to evaluate the effect of allograft skin on wound angiogenesis and wound bed preparation of ischemic diabetic foot ulcer. A total of 60 cases of patients with diabetic foot ulcer were randomly divided into the experimental group (n = 30) and the control group (n = 30). After debridement, in the experimental group, allograft skin was used to cover the wound while in the control group, vaseline and gauze was used to cover the wound. The wound was opened and dressed at 3, 5, 7, 14 days after operation and the growth condition of the granulation tissue was observed and recorded. The wound bed preparation time of the experimental group was 14.37 ± 1.06 days, compared with the control group 25.99 ± 4.03 days, there was statistically significant difference (t = 14.78, P cure time of the experimental group was 32 ± 1.93 days and this time was significantly shortened than the control group 39.73 ± 2.55 days (t = 12.521, P ulcer and shorten the wound bed preparation time and treatment cycle.

  2. Factors Associated with Diabetic Foot Ulcers in Benin – City, Nigeria ...

    African Journals Online (AJOL)

    Factors Associated with Diabetic Foot Ulcers in Benin – City, Nigeria. ... reported precipitating factors of DFU were puncture wounds (20.4%) and burns/scalds ... The most commonly identified risk factors for DFU were improper foot-care ...

  3. Treatment of Diabetic Foot Ulcer Using Matriderm In Comparison with a Skin Graft

    Directory of Open Access Journals (Sweden)

    Hyojin Jeon

    2013-07-01

    Full Text Available BackgroundFor patients with neuropathy, vasculopathy, and impairment of wound healing, treatment of a diabetic foot ulcer poses many challenges. A large number of dermal analogues have been invented in an effort to overcome these challenges. Matriderm, a dermal analogue, is made from bovine collagen and elastin. This study was conducted in order to evaluate the effectiveness of Matriderm for treatment of diabetic foot ulcers, in comparison with skin grafting.MethodsSixty patients with diabetic foot ulcer were included in this prospective study. The average age of the patients, who had type II diabetes mellitus, was 58 years old. The patients were allocated to an experimental or control group with their consents. The patients were selected with their consent for inclusion in an experimental group and a control group. Patients in the experimental group received a Matriderm appliance and a split-thickness skin graft, while those in the control group received only a split-thickness skin graft.ResultsA shorter hospitalization period (7.52 weeks was observed in the experimental group than in the control group (9.22 weeks, and a shorter period of time (8.61 weeks was required for complete healing, compared with the control group (12.94 weeks, with statistical significance (P<0.05. A higher elasticity ratio of the affected side to the non-affected side was observed in the experimental group, compared with the control group (P<0.01.ConclusionsMatriderm enables effective healing and improves elasticity in treatment of patients with diabetic foot ulcer.

  4. Australian Diabetes Foot Network: management of diabetes-related foot ulceration - a clinical update.

    Science.gov (United States)

    Bergin, Shan M; Gurr, Joel M; Allard, Bernard P; Holland, Emma L; Horsley, Mark W; Kamp, Maarten C; Lazzarini, Peter A; Nube, Vanessa L; Sinha, Ashim K; Warnock, Jason T; Alford, Jan B; Wraight, Paul R

    2012-08-20

    Appropriate assessment and management of diabetes-related foot ulcers (DRFUs) is essential to reduce amputation risk. Management requires debridement, wound dressing, pressure off-loading, good glycaemic control and potentially antibiotic therapy and vascular intervention. As a minimum, all DRFUs should be managed by a doctor and a podiatrist and/or wound care nurse. Health professionals unable to provide appropriate care for people with DRFUs should promptly refer individuals to professionals with the requisite knowledge and skills. Indicators for immediate referral to an emergency department or multidisciplinary foot care team (MFCT) include gangrene, limb-threatening ischaemia, deep ulcers (bone, joint or tendon in the wound base), ascending cellulitis, systemic symptoms of infection and abscesses. Referral to an MFCT should occur if there is lack of wound progress after 4 weeks of appropriate treatment.

  5. Assessment of foot perfusion in patients with a diabetic foot ulcer.

    Science.gov (United States)

    Forsythe, Rachael O; Hinchliffe, Robert J

    2016-01-01

    Assessment of foot perfusion is a vital step in the management of patients with diabetic foot ulceration, in order to understand the risk of amputation and likelihood of wound healing. Underlying peripheral artery disease is a common finding in patients with foot ulceration and is associated with poor outcomes. Assessment of foot perfusion should therefore focus on identifying the presence of peripheral artery disease and to subsequently estimate the effect this may have on wound healing. Assessment of perfusion can be difficult because of the often complex, diffuse and distal nature of peripheral artery disease in patients with diabetes, as well as poor collateralisation and heavy vascular calcification. Conventional methods of assessing tissue perfusion in the peripheral circulation may be unreliable in patients with diabetes, and it may therefore be difficult to determine the extent to which poor perfusion contributes to foot ulceration. Anatomical data obtained on cross-sectional imaging is important but must be combined with measurements of tissue perfusion (such as transcutaneous oxygen tension) in order to understand the global and regional perfusion deficit present in a patient with diabetic foot ulceration. Ankle-brachial pressure index is routinely used to screen for peripheral artery disease, but its use in patients with diabetes is limited in the presence of neuropathy and medial arterial calcification. Toe pressure index may be more useful because of the relative sparing of pedal arteries from medial calcification but may not always be possible in patients with ulceration. Fluorescence angiography is a non-invasive technique that can provide rapid quantitative information about regional tissue perfusion; capillaroscopy, iontophoresis and hyperspectral imaging may also be useful in assessing physiological perfusion but are not widely available. There may be a future role for specialized perfusion imaging of these patients, including magnetic resonance

  6. Increased healing in diabetic toe ulcers in a multidisciplinary foot clinic-An observational cohort study.

    Science.gov (United States)

    Almdal, T; Nielsen, A Anker; Nielsen, K E; Jørgensen, M E; Rasmussen, A; Hangaard, S; Siersma, V; Holstein, P E

    2015-12-01

    To study toe ulcer healing in patients with diabetic foot ulcers attending a multidisciplinary foot clinic over a 10 years period. The study was retrospective, consecutive and observational during 2001 through 2011. The patients were treated according to the International Consensus on the Diabetic Foot. During the period the chiropodist staffing in the foot clinic was doubled; new offloading material and orthopedic foot corrections for recalcitrant ulcers were introduced. Healing was investigated in toe ulcers in Cox regression models. 2634 patients developed foot ulcers, of which 1461 developed toe ulcers; in 790 patients these were neuropathic, in 551 they were neuro-ischemic and in 120 they were critically ischemic. One-year healing rates increased in the period 2001-2011 from 75% to 91% for neuropathic toe ulcers and from 72% to 80% for neuro-ischemic toe ulcers, while no changes was observed for ischemic toe ulcers. Adjusted for changes in the patient population, the overall rate of healing for neuropathic and neuro-ischemic toe ulcers almost doubled (HR=1.95 [95% CI: 1.36-2.80]). The results show that the healing of toe ulcers improved. This outcome could not be explained by changes in the patient characteristics, but coincided with a number of improvements in organization and therapy. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  7. Mesenchymal Stem Cells Improve Healing of Diabetic Foot Ulcer

    Directory of Open Access Journals (Sweden)

    Yue Cao

    2017-01-01

    Full Text Available Mesenchymal stem cells (MSCs, an ideal cell source for regenerative therapy with no ethical issues, play an important role in diabetic foot ulcer (DFU. Growing evidence has demonstrated that MSCs transplantation can accelerate wound closure, ameliorate clinical parameters, and avoid amputation. In this review, we clarify the mechanism of preclinical studies, as well as safety and efficacy of clinical trials in the treatment of DFU. Bone marrow-derived mesenchymal stem cells (BM-MSCs, compared with MSCs derived from other tissues, may be a suitable cell type that can provide easy, effective, and cost-efficient transplantation to treat DFU and protect patients from amputation.

  8. New Research Methods Developed for Studying Diabetic Foot Ulceration

    Science.gov (United States)

    1998-01-01

    Dr. Brian Davis, one of the Cleveland Clinic Foundation's researchers, has been investigating the risk factors related to diabetic foot ulceration, a problem that accounts for 20 percent of all hospital admissions for diabetic patients. He had developed a sensor pad to measure the friction and pressure forces under a person's foot when walking. As part of NASA Lewis Research Center's Space Act Agreement with the Cleveland Clinic Foundation, Dr. Davis requested Lewis' assistance in visualizing the data from the sensor pad. As a result, Lewis' Interactive Data Display System (IDDS) was installed at the Cleveland Clinic. This computer graphics program is normally used to visualize the flow of air through aircraft turbine engines, producing color two- and three-dimensional images.

  9. Trichloroacetic Acid Spray for the Treatment of Foot Ulcers of Foot and Mouth Disease in Cattle

    Directory of Open Access Journals (Sweden)

    Imad I. Aldabagh, Oday S. Al-Obaddy and Hafidh I. Al-Sadi*

    2012-01-01

    Full Text Available An attempt was made to evaluate the therapeutic effect of trichloroacetic acid (TCA for ulcers of the hooves of 120 cattle affected with foot and mouth disease (FMD. Each hoof was cleaned and washed with water before using the TCA spray (2% once daily. Biopsies were taken from the soft tissue lesions before and after10 days of treatment. These tissue specimens were processed routinely for histopathological examination. A marked improvement was seen in the pain inflicted by palpation of the affected hoof. Microscopically, coagulative necrosis of the soft tissue of the hoof was seen. An advanced stage of healing of the hoof ulcers was observed on 10th day post–treatment. It was concluded that 2% solution of TCA was an effective treatment of ulcers of the hooves of cattle affected with FMD.

  10. Plantar pressure in diabetic peripheral neuropathy patients with active foot ulceration, previous ulceration and no history of ulceration: a meta-analysis of observational studies.

    Science.gov (United States)

    Fernando, Malindu Eranga; Crowther, Robert George; Pappas, Elise; Lazzarini, Peter Anthony; Cunningham, Margaret; Sangla, Kunwarjit Singh; Buttner, Petra; Golledge, Jonathan

    2014-01-01

    Elevated dynamic plantar pressures are a consistent finding in diabetes patients with peripheral neuropathy with implications for plantar foot ulceration. This meta-analysis aimed to compare the plantar pressures of diabetes patients that had peripheral neuropathy and those with neuropathy with active or previous foot ulcers. Published articles were identified from Medline via OVID, CINAHL, SCOPUS, INFORMIT, Cochrane Central EMBASE via OVID and Web of Science via ISI Web of Knowledge bibliographic databases. Observational studies reporting barefoot dynamic plantar pressure in adults with diabetic peripheral neuropathy, where at least one group had a history of plantar foot ulcers were included. Interventional studies, shod plantar pressure studies and studies not published in English were excluded. Overall mean peak plantar pressure (MPP) and pressure time integral (PTI) were primary outcomes. The six secondary outcomes were MPP and PTI at the rear foot, mid foot and fore foot. The protocol of the meta-analysis was published with PROPSERO, (registration number CRD42013004310). Eight observational studies were included. Overall MPP and PTI were greater in diabetic peripheral neuropathy patients with foot ulceration compared to those without ulceration (standardised mean difference 0.551, 95% CI 0.290-0.811, pdiabetic peripheral neuropathy with a history of foot ulceration compared to those with diabetic neuropathy without a history of ulceration. More homogenous data is needed to confirm these findings.

  11. Skin grafting and tissue replacement for treating foot ulcers in people with diabetes

    NARCIS (Netherlands)

    Santema, Trientje B.; Poyck, Paul P. C.; Ubbink, Dirk T.

    2016-01-01

    Foot ulceration is a major problem in people with diabetes and is the leading cause of hospitalisation and limb amputations. Skin grafts and tissue replacements can be used to reconstruct skin defects for people with diabetic foot ulcers in addition to providing them with standard care. Skin

  12. Glucose metabolism in chronic diabetic foot ulcers measured in vivo using microdialysis

    DEFF Research Database (Denmark)

    Simonsen, L; Holstein, P; Larsen, K

    1998-01-01

    Ten subjects with diabetes mellitus and unilateral chronic foot ulcer were investigated. Local tissue concentrations of glucose and lactate were measured using the microdialysis method at a distance of 0.5-1 cm from the edge of the ulcer and in normal skin in the contralateral foot. Subcutaneous...

  13. Literature review on the management of diabetic foot ulcer

    Science.gov (United States)

    Yazdanpanah, Leila; Nasiri, Morteza; Adarvishi, Sara

    2015-01-01

    Diabetic foot ulcer (DFU) is the most costly and devastating complication of diabetes mellitus, which affect 15% of diabetic patients during their lifetime. Based on National Institute for Health and Clinical Excellence strategies, early effective management of DFU can reduce the severity of complications such as preventable amputations and possible mortality, and also can improve overall quality of life. The management of DFU should be optimized by using a multidisciplinary team, due to a holistic approach to wound management is required. Based on studies, blood sugar control, wound debridement, advanced dressings and offloading modalities should always be a part of DFU management. Furthermore, surgery to heal chronic ulcer and prevent recurrence should be considered as an essential component of management in some cases. Also, hyperbaric oxygen therapy, electrical stimulation, negative pressure wound therapy, bio-engineered skin and growth factors could be used as adjunct therapies for rapid healing of DFU. So, it’s suggested that with appropriate patient education encourages them to regular foot care in order to prevent DFU and its complications. PMID:25685277

  14. Analysis of risk factors for neuropathic foot ulceration in diabetes mellitus.

    Science.gov (United States)

    Bennett, P J; Stocks, A E; Whittam, D J

    1996-03-01

    Diabetes mellitus affects about one in 25 Australians. Neuropathic foot ulceration is a frequent complication in persons with diabetes. This study evaluates the importance of different risk factors for the development of this condition. The role of nonenzymatic glycosylation and pressure beneath the sole of the foot in the pathogenesis of neuropathic foot ulcers was investigated. Twenty-seven subjects with diabetes with a recent history of neuropathic foot ulceration were matched by age and sex with a group of 50 control subjects without neuropathy or history of foot ulceration. The degree of nonenzymatic glycosylation was assessed by analyzing the average level of glycosylated hemoglobin in the 3 years prior to the development of the foot ulcer and a goniometer assessment of peripheral joint (hand and ankle) flexibility. Dynamic pressure of the plantar aspect of the foot was recorded using a Musgrave Footprint System pedobarograph during a normal gait cycle. There was no significant difference in age, sex, body mass index, and duration or type of diabetes between the ulcer and control groups. The pressure of the plantar aspect of the foot was significantly elevated (p < 0.01). Ankle joint flexibility was reduced (p < 0.01) in cases with neuropathic foot ulceration compared with the control group. There was a trend toward elevation of glycosylated hemoglobin (HbA1c fraction) or HbA1c in the ulcer group (p = 0.06). The results suggested that nonenzymatic glycosylation occurs at a more significant level in patients with diabetes with a history of neuropathic foot ulceration.

  15. The prevention of diabetic foot ulceration: how biomechanical research informs clinical practice

    Directory of Open Access Journals (Sweden)

    Frank E. DiLiberto

    Full Text Available ABSTRACT Background Implementation of interprofessional clinical guidelines for the prevention of neuropathic diabetic foot ulceration has demonstrated positive effects regarding ulceration and amputation rates. Current foot care recommendations are primarily based on research regarding the prevention of ulcer recurrence and focused on reducing the magnitude of plantar stress (pressure overload. Yet, foot ulceration remains to be a prevalent and debilitating consequence of Diabetes Mellitus. There is limited evidence targeting the prevention of first-time ulceration, and there is a need to consider additional factors of plantar stress to supplement current guidelines. Objectives The first purpose of this article is to discuss the biomechanical theory underpinning diabetic foot ulcerations and illustrate how plantar tissue underloading may precede overloading and breakdown. The second purpose of this commentary is to discuss how advances in biomechanical foot modeling can inform clinical practice in the prevention of first-time ulceration. Discussion Research demonstrates that progressive weight-bearing activity programs to address the frequency of plantar stress and avoid underloading do not increase ulceration risk. Multi-segment foot modeling studies indicate that dynamic foot function of the midfoot and forefoot is compromised in people with diabetes. Emerging research demonstrates that implementation of foot-specific exercises may positively influence dynamic foot function and improve plantar stress in people with diabetes. Conclusion Continued work is needed to determine how to best design and integrate activity recommendations and foot-specific exercise programs into the current interprofessional paradigm for the prevention of first-time ulceration in people with Diabetes Mellitus.

  16. Role of neuropathy and high foot pressures in diabetic foot ulceration.

    Science.gov (United States)

    Frykberg, R G; Lavery, L A; Pham, H; Harvey, C; Harkless, L; Veves, A

    1998-10-01

    High plantar foot pressures in association with peripheral neuropathy have been ascertained to be important risk factors for ulceration in the diabetic foot. Most studies investigating these parameters have been limited by their size and the homogeneity of study subjects. The objective of this study was therefore to ascertain the risk of ulceration associated with high foot pressures and peripheral neuropathy in a large and diverse diabetic population. We studied a cross-sectional group of 251 diabetic patients of Caucasian (group C) (n=121), black (group B) (n=36), and Hispanic (group H) (n=94) racial origins with an overall age of 58.5+/-12.5 years (range 20-83). There was an equal distribution of men and women across the entire study population. All patients underwent a complete medical history and lower extremity evaluation for neuropathy and foot pressures. Neuropathic parameters were dichotomized (0/1) into two high-risk variables: patients with a vibration perception threshold (VPT) > or =25 V were categorized as HiVPT (n=132) and those with Semmes-Weinstein monofilament tests > or =5.07 were classified as HiSWF (n=190). The mean dynamic foot pressures of three footsteps were measured using the F-scan mat system with patients walking without shoes. Maximum plantar pressures were dichotomized into a high-pressure variable (Pmax6) indicating those subjects with pressures > or =6 kg/cm2 (n=96). A total of 99 patients had a current or prior history of ulceration at baseline. Joint mobility was significantly greater in the Hispanic cohort compared with the other groups at the first metatarsal-phalangeal joint (C 67+/-23 degrees, B 69+/-23 degrees, H 82+/-23 degrees, P=0.000), while the subtalar joint mobility was reduced in the Caucasian group (C 21+/-8 degrees, B 26+/-7 degrees, H 27+/-11 degrees, P=0.000). Maximum plantar foot pressures were significantly higher in the Caucasian group (C 6.7+/-2.9 kg/cm2, B 5.7+/-2.8 kg/cm2, H 4.4+/-1.9 kg/cm2, P=0

  17. Comparison platelet indices in diabetic patients with and without diabetic foot ulcer

    Science.gov (United States)

    Mardia, A. I.; Gatot, D.; Lindarto, D.

    2018-03-01

    Diabetes Mellitus is a group of metabolic disease which incidence increases every year. Some diabetic patients have diabetic foot ulcer as acomplication. The occurrence of ulcers in diabetic patients can be caused by the presence of thrombosis due to increased platelet function. Therefore, a cross-sectional study on 40 diabetic patients was performed at RSUP Adam Malik Medan to see whether there were differences in platelet indices between diabetic patients with and without diabetic foot ulcers. Platelets indices were examined and looked for differences in diabetic patients with and without diabetic foot ulcers. Data were analyzed using Chi-Square and Mann-Whitney U test with 95% CI. P-valuediabetic patients with diabetic foot ulcers indicating more reactive and aggregatable platelet function.

  18. Primary squamous cell carcinoma with mucormycosis in a diabetic foot ulcer.

    Science.gov (United States)

    Mandal, Palash Kumar; Bhattacharyya, Nirmal Kumar; Mookerjee, Sekhar Kumar; Chaudhuri, Bhaskarnarayan

    2013-02-01

    The diabetic foot ulcer is one of the major complications of diabetes mellitus leading to prolonged hospital stay. Non-healing foot ulcers in diabetes may be due to peripheral neuropathy and/or vasculopathy. Non-healing occurs following a trivial trauma due to loss of local immunity and increased infection by bacteria and fungus. Candida and mucormycosis are common fungal infection in diabetic foot ulcer. Squamous cell carcinoma in any non-healing ulcer is a common occurrence. But squamous cell carcinoma in non-healing diabetic foot ulcer is rarely reported. Here, mucormycosis in a diabetic foot ulcer which turned into squamous cell carcinoma is reported in a 62-year-old male with poor glycaemic control for last 21 years who presented with a non-healing ulcer of 8 months' duration over dorsum of left forefoot. Microbiological examination revealed presence of mucormycosis infection and histopathology of ulcer showed infiltrating well-differentiated squamous cell carcinoma. The clinicians and pathologists should be aware of these combinations because only eradication of mucormycosis may not cure the ulcer, rather presence of squamous cell carcinoma may be ignored that may be an immediate threat to the patient's life.

  19. Topical propolis improves wound healing in patients with diabetic foot ulcer: a randomized controlled trial.

    Science.gov (United States)

    Afkhamizadeh, Mozhgan; Aboutorabi, Robab; Ravari, Hassan; Fathi Najafi, Mohsen; Ataei Azimi, Sajad; Javadian Langaroodi, Adineh; Yaghoubi, Mohammad Ali; Sahebkar, Amirhossein

    2017-08-22

    In this randomized controlled trial, diabetic patients with foot ulcers (Wagner grades 1 and 2) were randomly assigned to conventional therapies for diabetic foot ulcer plus topical propolis ointment (5%; twice daily) or conventional therapies alone. The process of ulcer healing was observed during 4 weeks and compared between the two groups regarding the size, erythema, exudates, white blood cell (WBC) count and erythrocyte sedimentation rate (ESR). The process of ulcer size reduction during the four-week period of study was significantly different between the groups. However, this difference was not significant between the third and fourth weeks. There was no significant difference between two groups regarding erythema and exudate reduction as well as WBC count and ESR. Administration of topical propolis ointment in addition to the conventional treatments of diabetic foot ulcer could reduce the size of ulcers with Wagner grades 1 and 2.

  20. Presence of chronic diabetic foot ulcers is associated with more frequent and more advanced retinopathy.

    Science.gov (United States)

    Sellman, A; Katzman, P; Andreasson, S; Löndahl, M

    2018-05-23

    To clarify the frequency and severity of diabetic retinopathy in a group of people with Type 2 diabetes and chronic diabetic foot ulcers, and to compare visual acuity, levels of retinopathy and clinical significant macular oedema with a matched control group of people with Type 2 diabetes without a history of chronic diabetic foot ulcers. Visual acuity and fundus imaging were evaluated in 90 white people with at least 3 months' duration of full-thickness diabetic foot ulcers below the ankle and the results compared with those in 180 white people with Type 2 diabetes without a history of chronic diabetic foot ulcers (control group). Controls were matched for age, sex and duration of diabetes. Despite similar age and diabetes duration, severe non-proliferative or proliferative diabetic retinopathy was present in 41% of the people in the diabetic foot ulcer group as compared to 15% in the control group (Pdiabetic foot ulcer group was without any diabetic retinopathy as compared to 34% among controls. Proliferative diabetic retinopathy was more common in the diabetic foot ulcer group (31% vs 8%; Pdiabetic retinopathy did not differ between groups. Clinically significant macular oedema was more frequently present, and the diabetic foot ulcer group exhibited significantly worse results in best and worst eye visual acuity testing. In this northern European setting almost all people with Type 2 diabetes and chronic diabetic foot ulcers had diabetic retinopathy. Almost one-third had proliferative diabetic retinopathy as compared to diabetic retinopathy was linked to worse visual acuity. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  1. Advanced glycation end products assessed by skin autofluorescence: a new marker of diabetic foot ulceration.

    Science.gov (United States)

    Vouillarmet, Julien; Maucort-Boulch, Delphine; Michon, Paul; Thivolet, Charles

    2013-07-01

    Accumulation of advanced glycation end products (AGEs) may contribute to diabetic foot ulceration (DFU). Our goal was to determine whether AGEs measurement by skin autofluorescence (SAF) would be an additional marker for DFU management. We performed SAF analysis in 66 patients with a history of DFU prospectively included and compared the results with those of 84 control patients with diabetic peripheral neuropathy without DFU. We then assessed the prognostic value of SAF levels on the healing rate in the DFU group. Mean SAF value was significantly higher in the DFU group in comparison with the control group, even after adjustment for other diabetes complications (3.2±0.6 arbitrary units vs. 2.9±0.6 arbitrary units; P=0.001). In the DFU group, 58 (88%) patients had an active wound at inclusion. The mean DFU duration was 14±13 weeks. The healing rate was 47% after 2 months of appropriate foot care. A trend for a correlation between SAF levels and healing time in DFU subjects was observed but was not statistically significant (P=0.06). Increased SAF levels are associated with neuropathic foot complications in diabetes. Use of SAF measurement to assess foot vulnerability and to predict DFU events in high-risk patients appears to be promising.

  2. The efficacy of topical Royal Jelly on diabetic foot ulcers healing: A case series

    Directory of Open Access Journals (Sweden)

    Mansour Siavash

    2011-01-01

    Full Text Available Background: Foot ulcers and infections are the major sources of morbidity in individuals with diabetes mellitus. This study aimed to evaluate the efficacy of topical Royal Jelly (a worker honey bee product on healing diabetic foot ulcers. Methods: Diabetic patients with foot ulcers that were referred to our clinic at Khorshid Hospital, Isfahan, Iran; were evaluated three times a week and treated according to standard treatments consisted of offloading, infection control, vascular improvement and debridement if required. In addition, all ulcers were measured and then topical sterile 5% Royal Jelly was applied on the total surface area of the wounds. Eventually, they were covered with sterile dressings. Each patient was followed for a period of three months or until the complete healing. Results: A total of eight patients were enrolled in this study. Of these, two had two ulcers and, therefore, ten ulcers were evaluated. Two ulcers were excluded. Seven of the remained eight ulcers healed. Mean duration of complete healing was 41 days. One ulcer did not completely heal but improved to 40% smaller in length, 32% in width and 28% in depth. The mean length, width and depth reduction rates were 0.35 mm/day, 0.28 mm/day and 0.11 mm/day, respectively. Conclusions: Royal Jelly dressing may be an effective method for treating diabetic foot ulcers besides standard treatments.

  3. [Research progress of dipeptidyl peptidase 4 inhibitors on healing of chronic diabetic foot ulcers].

    Science.gov (United States)

    Gao, Yunyi; Liang, Yujie; Ran, Xingwu

    2018-05-01

    To review the effect of dipeptidyl peptidase 4 (DPP-4) inhibitors on the wound healing and its mechanisms in chronic diabetic foot ulcers. The latest literature concerning DPP-4 inhibitors for chronic diabetic foot ulcers was extensively reviewed, as well as the potential benefit and mechanism of DPP-4 inhibitors on wound healing of diabetic foot ulcers was analyzed thoroughly. DPP-4 inhibitors can accelerated the ulcer healing. The mechanisms probably include inhibiting the expression of the matrix metalloproteinase (MMP) and restoring the balance of the wound MMP and the tissue inhibitors of MMP; promoting recruitment of endothelial progenitor cells and augmenting angiogenesis; optimizing extracellular matrix construction and the immune response to persistent hypoxia in chronic diabetes wounds, and so on. At present, clinical researches show that DPP-4 inhibitors may be considered as an adjuvant treatment for chronic diabetic foot ulcers. DPP-4 inhibitors show promise in the local wound healing of chronic diabetic foot ulcers. However, more strictly designed, adequately powered, long-term follow-up, and high-quality randomized control trials are needed to further verify their efficacy and safety for chronic diabetic foot ulcers.

  4. The process of implementing a rural VA wound care program for diabetic foot ulcer patients.

    Science.gov (United States)

    Reiber, Gayle E; Raugi, Gregory J; Rowberg, Donald

    2007-10-01

    Delivering and documenting evidence-based treatment to all Department of Veterans Affairs (VA) foot ulcer patients has wide appeal. However, primary and secondary care medical centers where 52% of these patients receive care are at a disadvantage given the frequent absence of trained specialists to manage diabetic foot ulcers. A retrospective review of diabetic foot ulcer patient records and a provider survey were conducted to document the foot ulcer problem and to assess practitioner needs. Results showed of the 125 persons with foot ulcers identified through administrative data, only, 21% of diabetic foot patients were correctly coded. Chronic Care and Microsystem models were used to prepare a tailored intervention in a VA primary care medical center. The site Principal Investigators, a multidisciplinary site wound care team, and study investigators jointly implemented a diabetic foot ulcer program. Intervention components include wound care team education and training, standardized good wound care practices based on strong scientific evidence, and a wound care template embedded in the electronic medical record to facilitate data collection, clinical decision making, patient ordering, and coding. A strategy for delivering offloading pressure devices, regular case management support, and 24/7 emergency assistance also was developed. It took 9 months to implement the model. Patients were enrolled and followed for 1 year. Process and outcome evaluations are on-going.

  5. Relationship of microalbuminuria with the diabetic foot ulcers in type II diabetes.

    Science.gov (United States)

    Guerrero-Romero, F; Rodríguez-Morán, M

    1998-01-01

    Microalbuminuria is a significant risk factor associated with nephropathy, retinopathy, and cardiovascular disease; however, there are no previous reports on the relationship of microalbuminuria with diabetic foot ulcers or stroke, despite the fact that microalbuminuria is a marker of vascular damage. The purpose of this study was to determine the relationship of microalbuminuria with diabetic foot ulcers in type II diabetes patients. In this, cross-sectional clinical study, outpatients of the offices at first level medical care in Durango, Mexico, were included in one of two groups; (a) patients with diabetic foot ulcers and (b) control of group patients without diabetic foot ulcers. Diabetic foot diagnosis was established on the basis of clinical criteria and pletismography. Patients diagnosed with renal disease, urinary tract infection, acute febrile illness, or heart failure and those receiving angiotensin-converting enzyme inhibitors were excluded from the study. Microalbuminuria was measured, on a 24-h urine collection, by precipitation with sulfasalicylic acid, and turbidity was determined by measuring absorbance with a spectrophotometer. The study included 670 diabetic patients. Using both odds ratio and logistic regression analyses, diabetes duration, cigarette smoking, aging, and microalbuminuria showed a strong relationship with diabetic foot ulcers. Microalbuminuria should be considered as an independent risk factor for diabetic foot ulcers.

  6. Topical oxygen therapy results in complete wound healing in diabetic foot ulcers.

    Science.gov (United States)

    Yu, Janelle; Lu, Suzanne; McLaren, Ann-Marie; Perry, Julie A; Cross, Karen M

    2016-11-01

    Diabetic foot ulcers (DFUs) are a significant problem in an aging population. Fifteen percent of diabetics develop a DFU over their lifetime, which can lead to potential amputation. The 5-year survival rate after amputation is 31%, which is greater than the lifetime risk of mortality from cancer. Topical oxygen is a promising technique for the adjunctive therapy of chronic wounds including DFUs, but few controlled studies exist to support its clinical adoption. The aim of this study was to compare a portable topical oxygen delivery system in patients with nonhealing DFUs to standard best practice. Twenty patients were randomized into a topical oxygen group (n = 10), and a nonplacebo control group with regular dressings and standard care (n = 10), and attended the diabetic foot clinic once weekly for 8 weeks. Ulcer surface area over time was analyzed using standardized digital imaging software. DFUs were present without healing for a mean duration of 76 weeks prior to the study. They found a significant difference in healing rate between patients receiving topical oxygen and those receiving standard care. Topical oxygen, therefore, represents a potentially exciting new technology to shorten healing time in patients with nonhealing DFUs. More prospective randomized and powered studies are needed to determine the benefits of topical oxygen, but our current results are very promising. © 2016 by the Wound Healing Society.

  7. Allogeneic epidermal substitutes in the treatment of chronic diabetic leg and foot ulcers

    Directory of Open Access Journals (Sweden)

    Andrea Marchesi

    2014-09-01

    Full Text Available Aim: Diabetic foot ulcers are the most common cause of nontraumatic lower extremity amputations in the industrialized world. Tissue-engineering products offer a lower extremity salvage strategy when healing does not proceed according to the standard of care. New allogeneic sheets are available for the management of diabetic leg and foot ulcers. Methods: The endpoints of this case series study regard preliminary outcomes of the application of allogeneic keratinocytes composed of benzyl ester of hyaluronic acid to 16 diabetic foot and leg ulcers in 11 patients with type 2 diabetes mellitus. Results: Between 21 and 70 days after cellular therapy, 6 out of 16 lesions were completely healed, reducing the wound dimension by 70% and improving the wound bed score by 52%. Conclusion: The clinical results of the new allogeneic sheets indicate that allogeneic keratinocytes may represent an effective and safe therapy for diabetic foot and leg ulcers in the multidisciplinary approach to this diabetes-related complication.

  8. A Randomized Controlled Trial Comparing Telemedical and Standard Outpatient Monitoring of Diabetic Foot Ulcers

    DEFF Research Database (Denmark)

    Rasmussen, Benjamin S B; Froekjaer, Johnny; Bjerregaard, Mads R

    2015-01-01

    OBJECTIVE: The role of telemedical monitoring in diabetic foot ulcer care is still uncertain. Our aim was to compare telemedical and standard outpatient monitoring in the care of patients with diabetic foot ulcers in a randomized controlled trial. RESEARCH DESIGN AND METHODS: Of the 736 screened...... individuals with diabetic foot ulcers, 401 met the eligibility criteria and were randomized between October 2010 and November 2014. The per-protocol telemedical monitoring consisted of two consultations in the patient's own home and one consultation at the outpatient clinic. Standard practice consisted...... monitoring, a higher mortality throws into question the role of telemedicine in monitoring diabetic foot ulcers. Further studies are needed to investigate effects of telemedicine on mortality and other clinical outcomes and to identify patient subgroups that may have a poorer outcome through telemedical...

  9. Patient and professional delay in the referral trajectory of patients with diabetic foot ulcers

    NARCIS (Netherlands)

    Sanders, A.P.; Stoeldraaijers, L.G.M.C.; Pero, M.W.M.; Hermkes, P.J.; Carolina, R.C.A.; Elders, P.J.M.

    2013-01-01

    Aims: A cohort study investigated referral and treatment trajectories of patients with diabetic foot ulceration consulting podiatrists. The study aims were to quantify patient, professional and treatment (=total) delay and to identify relationships between patient- or professional-related

  10. Effect of Custom-Made Footwear on Foot Ulcer Recurrence in Diabetes

    Science.gov (United States)

    Bus, Sicco A.; Waaijman, Roelof; Arts, Mark; de Haart, Mirjam; Busch-Westbroek, Tessa; van Baal, Jeff; Nollet, Frans

    2013-01-01

    OBJECTIVE Custom-made footwear is the treatment of choice to prevent foot ulcer recurrence in diabetes. This footwear primarily aims to offload plantar regions at high ulcer risk. However, ulcer recurrence rates are high. We assessed the effect of offloading-improved custom-made footwear and the role of footwear adherence on plantar foot ulcer recurrence. RESEARCH DESIGN AND METHODS We randomly assigned 171 neuropathic diabetic patients with a recently healed plantar foot ulcer to custom-made footwear with improved and subsequently preserved offloading (∼20% peak pressure relief by modifying the footwear) or to usual care (i.e., nonimproved custom-made footwear). Primary outcome was plantar foot ulcer recurrence in 18 months. Secondary outcome was ulcer recurrence in patients with an objectively measured adherence of ≥80% of steps taken. RESULTS On the basis of intention-to-treat, 33 of 85 patients (38.8%) with improved footwear and 38 of 86 patients (44.2%) with usual care had a recurrent ulcer (relative risk −11%, odds ratio 0.80 [95% CI 0.44–1.47], P = 0.48). Ulcer-free survival curves were not significantly different between groups (P = 0.40). In the 79 patients (46% of total group) with high adherence, 9 of 35 (25.7%) with improved footwear and 21 of 44 (47.8%) with usual care had a recurrent ulcer (relative risk −46%, odds ratio 0.38 [0.15–0.99], P = 0.045). CONCLUSIONS Offloading-improved custom-made footwear does not significantly reduce the incidence of plantar foot ulcer recurrence in diabetes compared with custom-made footwear that does not undergo such improvement, unless it is worn as recommended. PMID:24130357

  11. Clinical profile and management outcome of diabetic foot ulcers in a tertiary care hospital

    International Nuclear Information System (INIS)

    Mahmood, K.; Akhtar, T.; Talib, A.; Naqvi, I.H.

    2008-01-01

    To determine major risk factors and management outcome of diabetic foot ulcers in order to prevent amputation. One-hundred and sixteen consecutive diabetic patients, with foot ulcers of Wagner's grade 1 to 4 were assessed at baseline for demographic information, detailed history, neuropathy, peripheral pulses and frequency of diabetic complication. Glycemic control was determined on the basis of HbA1c levels. Appropriate medical and surgical treatments were carried out and patients were followed-up until healing or for 6 months as end point of study. Outcome was recorded as healed, incomplete healing and amputated. Results: A majority of subjects had type 2 diabetes (95.7%) with male predominance (66%). The mean age was 54.29 +- 7.71 years. Most of the patients were overweight, hyperglycemic and had diabetes > 10 years duration. Neuropathic ulcers were found in 91 (78.4%) patients, while rest of the 25 (22.6 %) had neuroischemic ulcers. Wound cultures revealed polymicrobial organisms. Foot ulcers of 89 (77.7%) patients healed without amputation and 17 (14.7%) patients had minor or major amputations. Long-duration of diabetes, poor glycemic control and type of foot ulcers had effect on prognosis (p<0.05). Effective glycemic control, optimal wound care, aggressive medical management and timely surgical intervention may decrease disabling morbidity with better outcome of diabetic foot ulcer. (author)

  12. Treatment of a non-healing diabetic foot ulcer with platelet-rich plasma

    Directory of Open Access Journals (Sweden)

    Deepak H Suresh

    2014-01-01

    Full Text Available Lower extremity ulcers and amputations are an increasing problem among individuals with diabetes. Among diabetes mellitus-related complications, foot ulceration is the most common, affecting approximately 15% of diabetic patients during their lifetime. The pathogenesis of diabetic ulcer is peripheral sensory neuropathy, calluses, oedema and peripheral vascular disease. Diabetic ulcer is managed by adequate control of infections and blood sugar levels, surgical debridement with various dressings and off loading of the foot from pressure. In spite of these standard measures, some recalcitrant non-healing ulcers need additional growth factors for healing. Autologous platelet-rich plasma is easy and cost-effective method in treating diabetic ulcers as it provides necessary growth factors which enhance healing.

  13. Effect of Infrared Radiation on the Healing of Diabetic Foot Ulcer

    Science.gov (United States)

    Hakim, Ashrafalsadat; Sadeghi Moghadam, Ali; Shariati, Abdalali; karimi, Hamid; Haghighizadeh, Mohamad Hossien

    2016-01-01

    Background Diabetic foot ulcer is a worldwide health care concern affecting tens of thousands of patients. If these ulcers left untreated, they can create severe complications. Objectives This study was designed to examine the effect of infrared radiation on the healing of diabetic foot ulcer. Patients and Methods This clinical trial was performed on 50 patients referred to Dr. Ganjavian hospital in Dezful city, Iran, with diabetic foot ulcer degree 1 and 2 (based on Wegener Scale). Sample size was determined based on relevant studies of the recent decade. Patients were classified into the intervention and control groups (n = 25 in each group) in terms of age, gender, degree of ulcer, ulcer site and body mass index. In this study, work progress was evaluated according to the checklist of diabetic foot ulcer healing evaluation. Results The results of the current study showed that there was a statistically significant difference in healing ulcers (P < 0.05) and mean healing time (P < 0.05) between the two groups. Conclusions Using the infrared plus routine dressing is more effective than using merely routine dressing. PMID:27942260

  14. The Role of Pressure Offloading on Diabetic Foot Ulcer Healing and Prevention of Recurrence

    NARCIS (Netherlands)

    Bus, Sicco A.

    2016-01-01

    An increased plantar pressure is a causative factor in the development of plantar foot ulcers in people with diabetes mellitus, and ulcers are a precursor of lower extremity amputation. In this article, the evidence is reviewed that relieving areas of increased plantar pressure (ie, offloading) can

  15. Collagen-based wound dressings for the treatment of diabetes-related foot ulcers: a systematic review

    Directory of Open Access Journals (Sweden)

    Holmes C

    2013-01-01

    Full Text Available Crystal Holmes,1 James S Wrobel,1 Mark P MacEachern,2 Blaise R Boles31Department of Internal Medicine, University of Michigan Medical School, 2A Alfred Taubman Health Sciences Library, University of Michigan, 3Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI, USABackground: Diabetic foot ulcers are a major source of morbidity, limb loss, and mortality. A prolonged inflammatory response, extracellular matrix degradation irregularities, and increased bacteria presence have all been hypothesized as major contributing factors in the delayed healing of diabetic wounds. Collagen components such as fibroblast and keratinocytes are fundamental to the process of wound healing and skin formation. Wound dressings that contain collagen products create a biological scaffold matrix that supports the regulation of extracellular components and promotes wound healing.Methods: A systematic review of studies reporting collagen wound dressings used in the treatment of Diabetic foot ulcers was conducted. Comprehensive searches were run in Ovid MEDLINE, PubMed, EMBASE, and ISI Web of Science to capture citations pertaining to the use of collagen wound dressings in the treatment of diabetic foot ulcers. The searches were limited to human studies reported in English.Results: Using our search strategy, 26 papers were discussed, and included 13 randomized designs, twelve prospective cohorts, and one retrospective cohort, representing 2386 patients with diabetic foot ulcers. Our design was not a formal meta-analysis. In those studies where complete epithelialization, 58% of collagen-treated wounds completely healed (weighted mean 67%. Only 23% of studies reported control group healing with 29% healing (weighted mean 11% described for controls.Conclusion: Collagen- based wound dressings can be an effective tool in the healing of diabetic foot wounds. The current studies show an overall increase in healing rates despite

  16. Implementation of foot thermometry plus mHealth to prevent diabetic foot ulcers: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Lazo-Porras, Maria; Bernabe-Ortiz, Antonio; Sacksteder, Katherine A; Gilman, Robert H; Malaga, German; Armstrong, David G; Miranda, J Jaime

    2016-04-19

    Diabetic foot neuropathy (DFN) is one of the most important complications of diabetes mellitus; its early diagnosis and intervention can prevent foot ulcers and the need for amputation. Thermometry, measuring the temperature of the feet, is a promising emerging modality for diabetic foot ulcer prevention. However, patient compliance with at-home monitoring is concerning. Delivering messages to remind patients to perform thermometry and foot care might be helpful to guarantee regular foot monitoring. This trial was designed to compare the incidence of diabetic foot ulcers (DFUs) between participants who receive thermometry alone and those who receive thermometry as well as mHealth (SMS and voice messaging) over a year-long study period. This is an evaluator-blinded, randomized, 12-month trial. Individuals with a diagnosis of type 2 diabetes mellitus, aged between 18-80 years, having a present dorsalis pedis pulse in both feet, are in risk group 2 or 3 using the diabetic foot risk classification system (as specified by the International Working Group on the Diabetic Foot), have an operating cell phone or a caregiver with an operating cell phone, and have the ability to provide informed consent will be eligible to participate in the study. Recruitment will be performed in diabetes outpatient clinics at two Ministry of Health tertiary hospitals in Lima, Peru. participants in both groups will receive education about foot care at the beginning of the study and they will be provided with a thermometry device (TempStat™). TempStat™ is a tool that captures a thermal image of the feet, which, depending on the temperature of the feet, shows different colors. In this study, if a participant notes a single yellow image or variance between one foot and the contralateral foot, they will be prompted to notify a nurse to evaluate their activity within the previous 2 weeks and make appropriate recommendations. In addition to thermometry, participants in the intervention arm

  17. Can macrocirculation changes predict nonhealing diabetic foot ulcers?

    Science.gov (United States)

    Lee, Ye-Na; Kim, Hyon-Surk; Kang, Jeong-A; Han, Seung-Kyu

    2014-01-01

    Transcutaneous partial oxygen tension (TcpO2) is considered the gold standard for assessment of tissue oxygenation, which is an essential factor for wound healing. The purpose of this study was to evaluate the association between macrocirculation and TcpO2 in persons with diabetes mellitus. Ninety-eight patients with diabetic foot ulcers participated in the study (61 men and 37 women). The subjects had a mean age of 66.6 years (range, 30-83 years) and were treated at the Diabetic Wound Center of Korea University Guro Hospital, Seoul, Republic of Korea. Macrocirculation was evaluated using 2 techniques: computed tomographic angiography and Doppler ultrasound. Macrocirculation scores were based on the patency of the two tibial arteries in 98 patients. Computed tomographic angiography and Doppler ultrasound scores (0-4 points) were given according to intraluminal filling defects and arterial pulse waveform of each vessel, respectively. Tissue oxygenation was measured by TcpO2. Macrocirculation scores were statistically analyzed as a function of the TcpO2. Statistical analysis revealed no significant linear trend between the macrocirculation status and TcpO2. Biavariate analysis using the Fisher exact test, Mantel-Haenszel tests, and McNemar-Bowker tests also found no significant relationship between macrocirculation and TcpO2. Computed tomographic angiography and Doppler ultrasound are not sufficiently reliable substitutes for TcpO2 measurements in regard to determining the optimal treatment for diabetic patients.

  18. Effectiveness of Heberprot P for Diabetic Foot Ulcer in a Health Area

    Directory of Open Access Journals (Sweden)

    Grisell Mariela Mass Basulto

    2014-04-01

    Full Text Available Background: many papers on the effectiveness of Heberprot P in granulation and healing of diabetic foot ulcer in outpatient settings have been published, but very few stem from Primary Health Care. Objective: to evaluate the therapeutic effectiveness of Herberprot P in patients with diabetic foot ulcer. Methods: a descriptive, case series study was conducted in 15 patients with diabetic foot treated with Herberprot P in the Area IV Community Teaching Polyclinic from January to December 2012. Variables analyzed were age, sex, clinical classification of the disease and classification and evolution of the lesion. Results: diabetic foot ulcer was more frequent in patients aged 60-69 years, predominantly females. Most patients were diagnosed with neuroinfectious diabetic foot, and the most frequent lesion was deep ulcer, developed by 9 patients. Complete healing was observed in 11 patients, 6 of them in a period of 20-30 days. Conclusion: results show, and especially confirm the effectiveness of Heberprot P in the treatment of patients with diabetic foot ulcer in Primary Health Care.

  19. Topical Administration of Pirfenidone Increases Healing of Chronic Diabetic Foot Ulcers: A Randomized Crossover Study

    Directory of Open Access Journals (Sweden)

    Marcela Janka-Zires

    2016-01-01

    Full Text Available Only 30 percent of chronic diabetic foot ulcers heal after 20 weeks of standard treatment. Pirfenidone is a drug with biological, anti-inflammatory, and antifibrotic effects. The aim of this study was to evaluate the effect of topical pirfenidone added to conventional treatment in noninfected chronic diabetic foot ulcers. This was a randomized crossover study. Group 1 received topical pirfenidone plus conventional treatment for 8 weeks; after this period, they were switched to receive conventional treatment only for 8 more weeks. In group 2, the order of the treatments was the opposite. The end points were complete ulcer healing and size reduction. Final data were obtained from 35 ulcers in 24 patients. Fifty-two percent of ulcers treated with pirfenidone healed before 8 weeks versus 14.3% treated with conventional treatment only (P=0.025. Between 8 and 16 weeks, 30.8% ulcers that received pirfenidone healed versus 0% with conventional treatment (P=0.081. By week 8, the reduction in ulcer size was 100% [73–100] with pirfenidone versus 57.5% with conventional treatment [28.9–74] (P=0.011. By week 16, the reduction was 93% [42.7–100] with pirfenidone and 21.8% [8–77.5] with conventional treatment (P=0.050. The addition of topical pirfenidone to conventional treatment significantly improves the healing of chronic diabetic noninfected foot ulcers.

  20. Is simulation training effective in increasing podiatrists' confidence in foot ulcer management?

    Directory of Open Access Journals (Sweden)

    Régo Patricia M

    2011-06-01

    Full Text Available Abstract Background Foot ulcers are a frequent reason for diabetes-related hospitalisation. Clinical training is known to have a beneficial impact on foot ulcer outcomes. Clinical training using simulation techniques has rarely been used in the management of diabetes-related foot complications or chronic wounds. Simulation can be defined as a device or environment that attempts to replicate the real world. The few non-web-based foot-related simulation courses have focused solely on training for a single skill or "part task" (for example, practicing ingrown toenail procedures on models. This pilot study aimed to primarily investigate the effect of a training program using multiple methods of simulation on participants' clinical confidence in the management of foot ulcers. Methods Sixteen podiatrists participated in a two-day Foot Ulcer Simulation Training (FUST course. The course included pre-requisite web-based learning modules, practicing individual foot ulcer management part tasks (for example, debriding a model foot ulcer, and participating in replicated clinical consultation scenarios (for example, treating a standardised patient (actor with a model foot ulcer. The primary outcome measure of the course was participants' pre- and post completion of confidence surveys, using a five-point Likert scale (1 = Unacceptable-5 = Proficient. Participants' knowledge, satisfaction and their perception of the relevance and fidelity (realism of a range of course elements were also investigated. Parametric statistics were used to analyse the data. Pearson's r was used for correlation, ANOVA for testing the differences between groups, and a paired-sample t-test to determine the significance between pre- and post-workshop scores. A minimum significance level of p Results An overall 42% improvement in clinical confidence was observed following completion of FUST (mean scores 3.10 compared to 4.40, p Conclusions This pilot study suggests simulation training

  1. Polydeoxyribonucleotide Improves Peripheral Tissue Oxygenation and Accelerates Angiogenesis in Diabetic Foot Ulcers

    Directory of Open Access Journals (Sweden)

    Seoyoung Kim

    2017-11-01

    Full Text Available Background Polydeoxyribonucleotide (PDRN is known to have anti-inflammatory and angiogenic effects and to accelerate wound healing. The aim of this study was to investigate whether PDRN could improve peripheral tissue oxygenation and angiogenesis in diabetic foot ulcers. Methods This was a prospective randomized controlled clinical trial. Twenty patients with a non-healing diabetic foot ulcer were randomly distributed into a control group (n=10 and a PDRN group (n=10. Initial surgical debridement and secondary surgical procedures such as a split-thickness skin graft, primary closure, or local flap were performed. Between the initial surgical debridement and secondary surgical procedures, 0.9% normal saline (3 mL or PDRN was injected for 2 weeks by the intramuscular (1 ampule, 3 mL, 5.625 mg, 5 days per week and perilesional routes (1 ampule, 3 mL, 5.625 mg, 2 days per week. Transcutaneous oxygen tension (TcPO2 was evaluated using the Periflux System 5000 with TcPO2/CO2 unit 5040 before the injections and on days 1, 3, 7, 14, and 28 after the start of the injections. A pathologic review (hematoxylin and eosin stain of the debrided specimens was conducted by a pathologist, and vessel density (average number of vessels per visual field was calculated. Results Compared with the control group, the PDRN-treated group showed improvements in peripheral tissue oxygenation on day 7 (P<0.01, day 14 (P<0.001, and day 28 (P<0.001. The pathologic review of the specimens from the PDRN group showed increased angiogenesis and improved inflammation compared with the control group. No statistically significant difference was found between the control group and the PDRN group in terms of vessel density (P=0.094. Complete healing was achieved in every patient. Conclusions In this study, PDRN improved peripheral tissue oxygenation. Moreover, PDRN is thought to be effective in improving inflammation and angiogenesis in diabetic foot ulcers.

  2. The Role of Pressure Offloading on Diabetic Foot Ulcer Healing and Prevention of Recurrence.

    Science.gov (United States)

    Bus, Sicco A

    2016-09-01

    An increased plantar pressure is a causative factor in the development of plantar foot ulcers in people with diabetes mellitus, and ulcers are a precursor of lower extremity amputation. In this article, the evidence is reviewed that relieving areas of increased plantar pressure (ie, offloading) can heal plantar foot ulcers and prevent their recurrence. Noninfected, nonischemic neuropathic plantar forefoot ulcers should heal in 6 to 8 weeks with adequate offloading. Recent meta-analyses and systematic reviews show that nonremovable knee-high devices are most effective. This is probably because they eliminate the problem of nonadherence with the use of a removable device. Studies show a large discrepancy between evidence-based recommendations on offloading and what is used in clinical practice. Many clinics continue to use methods that are less effective or have not been proven to be effective, while ignoring evidence-based methods. Strategies are proposed to address this issue, notably the adoption and implementation of recent international guidelines by professional societies and a stronger focus of clinicians on expedited healing. For the prevention of plantar foot ulcer recurrence in high-risk patients, 2 recent trials have shown that the incidence of recurrence can be significantly reduced with custom-made footwear that has a demonstrated pressure-relieving effect through guidance by plantar pressure measurements, under the condition that the footwear is worn. This review helps to inform clinicians about effective offloading treatment for healing plantar foot ulcers and preventing their recurrence.

  3. A review of becaplermin gel in the treatment of diabetic neuropathic foot ulcers

    Directory of Open Access Journals (Sweden)

    Robert C Fang

    2008-03-01

    Full Text Available Robert C Fang, Robert D GalianoDivision of Plastic and Reconstructive Surgery and Wound Healing Research Laboratory, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USAAbstract: Diabetic neuropathic foot ulcers represent a serious health care burden to patients and to society. While the management of chronic diabetic foot ulcers has improved in recent years, it remains a frustrating problem for a variety of clinicians. This review examines the scientific underpinnings supporting the use of becaplermin (Regranex®; Ortho-McNeil Pharmaceutical, Raritan, NJ, or recombinant human platelet-derived growth factor (rhPDGF-BB, in diabetic forefoot wounds. An emphasis is placed upon proper medical and surgical care of diabetic foot wounds, as multiple studies have demonstrated that the success of this growth factor in accelerating healing is ultimately dependent on proper ulcer care. A focus on the cost-effectiveness of this form of therapy in the treatment of diabetic foot ulcers is also outlined.Keywords: becaplermin, diabetes, foot ulcer, growth factor

  4. [Vacuum-assisted therapy for various wound types including diabetic foot ulcer].

    Science.gov (United States)

    Farah, Raymond; Gantus, Maher; Kogan, Leonid

    2011-03-01

    Vacuum is a noninvasive system that creates a localized controlled negative pressure environment. In this study, vacuum was provided by the V.A.C. Therapy system, which promotes wound healing by delayed primary or secondary intention through creating a moist wound environment, preparing the wound bed for closure, reducing edema, and promoting formation and perfusion of granulation tissue. Vacuum-assisted closure therapy is indicated for use in all care settings and for a variety of wound types including diabetic foot ulcers. The purpose of this study was to evaluate safety and clinical efficacy of negative pressure wound therapy (NPWT) compared with advanced moist wound therapy and standard treatment to treat foot ulcers in diabetic patients. This trial enrolled 43 patients; most of them were diabetic patients at any age with various skin ulcers and diabetic foot. These patients were divided into two groups, 17 patients were treated with vacuum and the 26 patients in the control group were treated with standard therapy including debridement. A greater proportion of foot and skin ulcers achieved complete ulcer closure with vacuum-assisted therapy p<0.001 compared with the standard therapy. Vacuum therapy significantly decreased the duration and frequency of admission p=0.032 and decreased the rate of amputation p<0.001. Results of our trial support other studies and demonstrate that vacuum is as safe as and more efficacious than standard therapy in the treatment of diabetic foot ulcers. A significantly greater number of patients achieved complete ulcer closure and granulation tissue formation with this therapy. The study group showed a significant reduction in the median time needed to heal ulcers, reduction of the number of admissions and amputation frequency.

  5. Topical 5% potassium permanganate solution accelerates the healing process in chronic diabetic foot ulcers.

    Science.gov (United States)

    Delgado-Enciso, Iván; Madrigal-Perez, Violeta M; Lara-Esqueda, Agustin; Diaz-Sanchez, Martha G; Guzman-Esquivel, Jose; Rosas-Vizcaino, Luis E; Virgen-Jimenez, Oscar O; Kleiman-Trujillo, Juleny; Lagarda-Canales, Maria R; Ceja-Espiritu, Gabriel; Rangel-Salgado, Viridiana; Lopez-Lemus, Uriel A; Delgado-Enciso, Josuel; Lara-Basulto, Agustin D; Soriano Hernández, Alejandro D

    2018-02-01

    Potassium permanganate has been reported to be an effective treatment for certain types of wounds. The aim of the present study was to evaluate the use of potassium permanganate in the treatment of diabetic foot ulcers. A single-blind, randomized, controlled clinical trial was conducted on patients with type 2 diabetes mellitus that presented with a foot ulcer persisting for >3 months. The control group (n=10) was treated with the current standard treatment, which comprises of measures for reducing pressure in the ulcerated area, daily cleansing of the ulcer with potable water and antiseptic wash solution, and the application of a disinfectant solution on the entire surface area of the ulcer; while the intervention group (n=15) received the standard treatment plus 5% topical potassium permanganate solution applied once a day for 21 days. In the intervention group, 1 patient did not tolerate the treatment and was eliminated from the study on the first day. The remaining patients tolerated the interventions well. At the end of the treatment period, ulcers in the control group had decreased by 38% whereas those in the intervention group decreased by 73% (Ppermanganate is well tolerated and significantly accelerates the healing process of diabetic foot ulcers.

  6. A methodological framework for detecting ulcers' risk in diabetic foot subjects by combining gait analysis, a new musculoskeletal foot model and a foot finite element model.

    Science.gov (United States)

    Scarton, Alessandra; Guiotto, Annamaria; Malaquias, Tiago; Spolaor, Fabiola; Sinigaglia, Giacomo; Cobelli, Claudio; Jonkers, Ilse; Sawacha, Zimi

    2018-02-01

    Diabetic foot is one of the most debilitating complications of diabetes and may lead to plantar ulcers. In the last decade, gait analysis, musculoskeletal modelling (MSM) and finite element modelling (FEM) have shown their ability to contribute to diabetic foot prevention and suggested that the origin of the plantar ulcers is in deeper tissue layers rather than on the plantar surface. Hence the aim of the current work is to develop a methodology that improves FEM-derived foot internal stresses prediction, for diabetic foot prevention applications. A 3D foot FEM was combined with MSM derived force to predict the sites of excessive internal stresses on the foot. In vivo gait analysis data, and an MRI scan of a foot from a healthy subject were acquired and used to develop a six degrees of freedom (6 DOF) foot MSM and a 3D subject-specific foot FEM. Ankle kinematics were applied as boundary conditions to the FEM together with: 1. only Ground Reaction Forces (GRFs); 2. OpenSim derived extrinsic muscles forces estimated with a standard OpenSim MSM; 3. extrinsic muscle forces derived through the (6 DOF) foot MSM; 4. intrinsic and extrinsic muscles forces derived through the 6 DOF foot MSM. For model validation purposes, simulated peak pressures were extracted and compared with those measured experimentally. The importance of foot muscles in controlling plantar pressure distribution and internal stresses is confirmed by the improved accuracy in the estimation of the peak pressures obtained with the inclusion of intrinsic and extrinsic muscle forces. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Low-level laser therapy and Calendula officinalis in repairing diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Ana Flávia Machado de Carvalho

    Full Text Available Abstract OBJECTIVE To evaluate the effects of low-level laser therapy isolated and associated with Calendula officinalis oil in treating diabetic foot ulcers. METHOD An experimental, randomized, controlled, prospective, interventional clinical case study using a quantitative approach. The sample consisted of 32 diabetic patients of both genders. Participants were randomly divided into four groups. Doppler Ultrasound evaluation of the Ankle-Brachial Index, brief pain inventory and analog pain scale were performed at baseline and after 30 days. RESULTS Reduced pain was observed in the Low-level laser therapy and Low-level laser therapy associated with Essential Fatty Acids groups (p<0.01. Regarding the Ankle-Brachial Index and Doppler Ultrasound, all groups remained stable. By analyzing lesion area reduction, Low-level laser therapy associated with Essential fatty acids group showed a significance of p=0.0032, and the Low-level laser therapy group showed p=0.0428. CONCLUSION Low-level laser therapy, performed alone or associated with the Calendula officinalis oil was effective in relieving pain and accelerating the tissue repair process of diabetic foot.

  8. Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers

    OpenAIRE

    Tang, Ulla Hellstrand; Z?gner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

    2015-01-01

    Objective: Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and ...

  9. Effects of intravenous Semelil (ANGIPARSTM on diabetic foot ulcers healing: A multicenter clinical trial

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    Larijani B

    2008-04-01

    Full Text Available Some diabetic foot ulcers, which are notoriously difficult to cure, are one of the most common health problems in diabetic patients .There are several surgical and medical options which already have been introduced for treatment of diabetic foot ulcers, so some patient will require amputation. The purpose of this study was to evaluate the efficacy of intravenous Semelil (ANGIPARSTM, a naive herbal extract to accelerate healing of diabetic foot ulcers. A multi-centric randomized controlled trial was conducted to evaluate intravenous Semelil for healing of diabetic foot ulcers. Sixteen diabetic patients were treated with intravenous Semelil, and nine other patients were treated with placebo as control group. Both groups were otherwise treated by wound debridement and irrigation with normal saline solution, systemic antibiotic therapy and daily wound dressing. Before and after intervention, the foot ulcer surface area was measured, by digital photography, mapping and planimetry. After 4 weeks, the mean foot ulcer surface area decreased from 479.93±379.75 mm2 to 198.93±143.75 mm2 in the intervention group (p = 0.000 and from 766.22±960.50 mm2 to 689.11±846.74 mm2 in the control group (p = 0.076. Average wound closure in the treatment group was significantly greater than placebo group (64% vs. 25%, p= 0.015. This herbal extract by intravenous rout in combination with conventional therapy is more effective than conventional therapy by itself probably without side effect. However, further studies are required in the future to confirm these results in larger population.

  10. Depression symptoms in people with diabetes attending outpatient podiatry clinics for the treatment of foot ulcers

    OpenAIRE

    Pearson, Sue; Nash, Toni; Ireland, Vanessa

    2014-01-01

    Background The purpose of this study was to examine the prevalence of depressive symptoms, diabetes self-management, and quality of life in people with diabetes and foot ulcers. Ulcer status, mortality and amputations were also assessed at six months follow-up. Methods This was a cross-sectional survey of people attending outpatient podiatry clinics at a major tertiary referral hospital. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ). Diabetes self-care was ass...

  11. Perceived usability and use of custom-made footwear in diabetic patients at high risk for foot ulceration

    NARCIS (Netherlands)

    Arts, Mark L. J.; de Haart, Mirjam; Bus, Sicco A.; Bakker, Jan P. J.; Hacking, Hub G. A.; Nollet, Frans

    2014-01-01

    To assess the perceived usability and use of custom- made footwear in diabetic patients who are at high-risk for foot ulceration, and to elucidate the determinants of usability and use. Survey. A total of 153 patients with diabetes, peripheral neuropathy, prior plantar foot ulceration and newly

  12. The Efficacy of Jing Wan Hong Ointment for Nerve Injury Diabetic Foot Ulcer and Its Mechanisms

    Directory of Open Access Journals (Sweden)

    Shumei Jin

    2014-01-01

    Full Text Available Jing Wan Hong ointment contains 30 kinds of Chinese herbs, with functions of activating blood circulation to disperse blood stasis, clearing heat, eliminating dampness, and reducing swelling by detoxification. Therefore, Jing Wan Hong ointment may facilitate the healing of ulcers. The aim of this study was to evaluate the efficacy and mechanisms of Jing Wan Hong ointment for healing diabetic foot ulceration in Wistar rats induced by streptozotocin and sciatic nerve damage. The results showed that Jing Wan Hong ointment had a marked effect on foot ulcers in diabetic rats induced by initial nerve injury. These effects were manifested by reducing the foot ulcer size and Wagner grade after seven days of treatment. The diabetic rats with foot ulcers were almost healed after 21 days of treatment. Moreover, the mechanisms of this effect seem to be dependent on increased expression of PDGF mRNA, but there was no influence on the expression of TGF-β, VEGF, and FLT-1 mRNA.

  13. Diffuse reflectance spectroscopy for monitoring diabetic foot ulcer - A pilot study

    Science.gov (United States)

    Anand, Suresh; Sujatha, N.; Narayanamurthy, V. B.; Seshadri, V.; Poddar, Richa

    2014-02-01

    Foot ulceration due to diabetes mellitus is a major problem affecting 12-25% of diabetic subjects in their lifetime. An untreated ulcer further gets infected which causes necrosis leading to amputation of lower extremities. Early identification of risk factors and treatment for these chronic wounds would reduce health care costs and improve the quality of life for people with diabetes. Recent clinical investigations have shown that a series of factors including reduced oxygen delivery and disturbed metabolism have been observed on patients with foot ulceration due to diabetes. Also, these factors can impair the wound healing process. Optical techniques based on diffuse reflectance spectroscopy provide characteristic spectral finger prints shed light on tissue oxygenation levels and morphological composition of a tissue. This study deals with the application of diffuse reflectance intensity ratios based on oxyhemoglobin bands (R542/R580), ratios of oxy- and deoxy-hemoglobin bands (R580/R555), total hemoglobin concentration and hemoglobin oxygen saturation between normal and diabetic foot ulcer sites. Preliminary results obtained are found to be promising indicating the application of reflectance spectroscopy in the assessment of foot ulcer healing.

  14. The role of nerve growth factor in the prophylaxis and treatment of diabetic foot ulcers

    Science.gov (United States)

    Tiaka, Elisavet K; Papanas, Nikolaos; Manolakis, Anastassios C; Maltezos, Efstratios

    2011-01-01

    Diabetic foot ulcers are still particularly difficult to heal. Therefore, preventing and therapeutic adjuncts are increasingly being explored. Nerve growth factor (NGF) is a promising agent exhibiting beneficial actions on both diabetic peripheral neuropathy, one of the main causes of foot ulcers, and on ulcer healing. Indeed, preclinical research in animal models of diabetes has revealed the trophic effect of NGF on small C-fibres, while phase 2 human trials have provided evidence for a favourable effect on sensory neuropathy. However, the results of a phase 3 trial were moderate and, therefore, not enough to encourage widespread use of NGF in the treatment of diabetic neuropathy. Available literature on the role of NGF on diabetic wound healing is sparse but encouraging. Exogenous supplementation of NGF or the use of alternative techniques to increase its endogenous expression could emerge as a protective and therapeutic modality for diabetic foot ulcers in addition to standard treatment and other growth factors. The present review provides an outlook on the role of NGF in the prophylaxis and treatment of diabetic foot ulcers. PMID:22928161

  15. Radiographic Abnormalities in the Feet of Diabetic Patients with Neuropathy and Foot Ulceration.

    Science.gov (United States)

    Viswanathan, Vijay; Kumpatla, Satyavani; Rao, V Narayan

    2014-11-01

    People with diabetic neuropathy are frequently prone to several bone and joint abnormalities. Simple radiographic findings have been proven to be quite useful in the detection of such abnormalities, which might be helpful not only for early diagnosis but also in following the course of diabetes through stages of reconstruction of the ulcerated foot.The present study was designed to identify the common foot abnormalities in south Indian diabetic subjects with and without neuropathy using radiographic imaging. About 150 (M:F 94:56) subjects with type 2 diabetes were categorised into three groups: Group I (50 diabetic patients), Group II (50 patients with neuropathy), and Group III (50 diabetic patients with both neuropathy and foot ulceration). Demographic details, duration of diabetes and HbA1c values were recorded. Vibration perception threshold was measured for assessment of neuropathy. Bone and joint abnormalities in the feet and legs of the study subjects were identified using standardised dorsi-plantar and lateral weight-bearing radiographs. Radiographic findings of the study subjects revealed that those with both neuropathy and foot ulceration and a longer duration of diabetes had more number of bone and joint abnormalities. Subjects with neuropathy alone also showed presence of several abnormalities, including periosteal reaction, osteopenia, and Charcot changes. The present findings highlight the impact of neuropathy and duration of diabetes on the development of foot abnormalities in subjects with diabetes. Using radiographic imaging can help in early identification of abnormalities and better management of the diabetic foot.

  16. Offloading the diabetic foot: toward healing wounds and extending ulcer-free days in remission

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    Boghossian JA

    2017-07-01

    Full Text Available Jano A Boghossian,1 John D Miller,2 David G Armstrong1 1Department of Surgery, Southern Arizona Limb Salvage Alliance, University of Arizona, Tucson, AZ, 2Department of Podiatric Surgery and Medicine, DVA Maryland Healthcare System, Baltimore, MD, USA Abstract: Management of the diabetic foot is multifaceted and requires constant monitoring from patients and health care providers. The alarmingly high rate of recurrence of ulcerations in diabetic foot requires a change in our approach to care and to the vernacular in the medical literature. With its high rates of morbidity and recurrence, care of the complex diabetic foot may be aptly comparable to many forms of cancer. Therefore, our efforts should be not only in rapid healing of open wounds but also in maximizing ulcer-free days for the patient in diabetic foot remission. One facet of the multidisciplinary approach in managing wounds is achieved by reducing peak plantar pressures by offloading the foot with various conservative and surgical techniques aimed at reducing areas of stress caused by ambulation and improper shoe gear. Evidence supports the use of total contact casts as the gold standard for offloading open wounds; however, other methods have gained popularity as well. Novel approaches in surgical techniques and advances in wearable technology appear to show promise in measuring and modulating dangerous pressure and inflammation to extend remission and improve quality of life for these most complex patients. Keywords: diabetic foot, ulcer, remission, amputation, offloading, wearables 

  17. Effect of custom-made footwear on foot ulcer recurrence in diabetes: a multicenter randomized controlled trial

    NARCIS (Netherlands)

    Bus, Sicco A.; Waaijman, Roelof; Arts, Mark; de Haart, Mirjam; Busch-Westbroek, Tessa; van Baal, Jeff; Nollet, Frans

    2013-01-01

    Custom-made footwear is the treatment of choice to prevent foot ulcer recurrence in diabetes. This footwear primarily aims to offload plantar regions at high ulcer risk. However, ulcer recurrence rates are high. We assessed the effect of offloading-improved custom-made footwear and the role of

  18. Plantar pressures are higher in cases with diabetic foot ulcers compared to controls despite a longer stance phase duration.

    Science.gov (United States)

    Fernando, Malindu E; Crowther, Robert G; Lazzarini, Peter A; Sangla, Kunwarjit S; Wearing, Scott; Buttner, Petra; Golledge, Jonathan

    2016-09-15

    Current international guidelines advocate achieving at least a 30 % reduction in maximum plantar pressure to reduce the risk of foot ulcers in people with diabetes. However, whether plantar pressures differ in cases with foot ulcers to controls without ulcers is not clear. The aim of this study was to assess if plantar pressures were higher in patients with active plantar diabetic foot ulcers (cases) compared to patients with diabetes without a foot ulcer history (diabetes controls) and people without diabetes or a foot ulcer history (healthy controls). Twenty-one cases with diabetic foot ulcers, 69 diabetes controls and 56 healthy controls were recruited for this case-control study. Plantar pressures at ten sites on both feet and stance phase duration were measured using a pre-established protocol. Primary outcomes were mean peak plantar pressure, pressure-time integral and stance phase duration. Non-parametric analyses were used with Holm's correction to correct for multiple testing. Binary logistic regression models were used to adjust outcomes for age, sex and body mass index. Median differences with 95 % confidence intervals and Cohen's d values (standardised mean difference) were reported for all significant outcomes. The majority of ulcers were located on the plantar surface of the hallux and toes. When adjusted for age, sex and body mass index, the mean peak plantar pressure and pressure-time integral of toes and the mid-foot were significantly higher in cases compared to diabetes and healthy controls (p diabetic foot ulcers despite having a longer stance phase duration which would be expected to lower plantar pressure. Whether plantar pressure changes can predict ulcer healing should be the focus of future research. These results highlight the importance of offloading feet during active ulceration in addition to before ulceration.

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

    Science.gov (United States)

    Viswanathan, Vijay; Kesavan, Rajesh; Kavitha, K.V.; Kumpatla, Satyavani

    2011-01-01

    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. PMID:21911968

  20. Effects of topical Kiwifruit on healing of neuropathic diabetic foot ulcer

    Directory of Open Access Journals (Sweden)

    Gholamreza Mohajeri

    2014-01-01

    Full Text Available Background: Kiwifruit (Actindia Deliciosa is demonstrated to have antibacterial and pro-angiogenic effects. It also contains proteolytic enzymes (actinidin and ascorbic acid. In this study, the effects of Kiwifruit on neuropathic diabetic foot ulcer healing in clinical settings were evaluated. Materials and Methods: In this randomized clinical trial of 37 patients (17 in experimental and 20 in control groups with neuropathic diabetic foot ulcer were studied in Isfahan-Iran. Patients of the control group received just the standard treatments. In the experimental group, in addition to the standard treatments, ulcers were dressed with pure extract of kiwifruit twice daily for 21 days. The ulcers were examined and evaluated based on macroscopic, microscopic and microbiological status. Pre- and post-interventions, biopsies were taken from the ulcers to perform microbiological and histological studies. Results: Mean reduction in surface area of foot ulcer in the experimental group was significantly higher than the control group (168.11 ± 22.31 vs. 88.80 ± 12.04 mm 2 respectively, P < 0.0001. The amount of collagen and granulation tissues was significantly higher in the experimental groups than the control group (P value < 0.0001. Significantly higher levels of angiogenesis and vascularization were found in the kiwifruit treated patients (P value < 0.0001. No significant antibacterial effect was observed for kiwifruit. Conclusion: Natural compounds in the kiwifruit including protein-dissolving enzymes (Actinidin improved different aspects of the wound healing process. Based on these benefits and safety aspects, we conclude that using kiwifruit is a simple, applicable and effective way for treatment of neuropathic diabetic foot ulcer.

  1. Off-loading the diabetic foot for ulcer prevention and healing

    NARCIS (Netherlands)

    Cavanagh, Peter R.; Bus, Sicco A.

    2010-01-01

    Retrospective and prospective studies have shown that elevated plantar pressure is a causative factor in the development of many plantar ulcers in diabetic patients and that ulceration is often a precursor of lower-extremity amputation. Herein, we review the evidence that relieving areas of elevated

  2. Off-loading the diabetic foot for ulcer prevention and healing

    NARCIS (Netherlands)

    Cavanagh, Peter R.; Bus, Sicco A.

    2011-01-01

    Retrospective and prospective studies have shown that elevated plantar pressure is a causative factor in the development of many plantar ulcers in diabetic patients and that ulceration is often a precursor of lower-extremity amputation. Herein, we review the evidence that relieving areas of elevated

  3. Off-loading the diabetic foot for ulcer prevention and healing

    NARCIS (Netherlands)

    Cavanagh, Peter R.; Bus, Sicco A.

    2010-01-01

    Retrospective and prospective studies have shown that elevated plantar pressure is a causative factor in the development of many plantar ulcers in diabetic patients and that ulceration is often a precursor of lower extremity amputation. In this article, we review the evidence that relieving areas of

  4. Evaluation of "care of the foot" as a risk factor for diabetic foot ulceration: the role of internal physicians.

    Science.gov (United States)

    Oguejiofor, O C; Oli, J M; Odenigbo, C U

    2009-03-01

    Several risk factors predispose the diabetic patient to foot ulceration, including "inadequate care of the foot". This risk factor for foot ulceration has not been previously evaluated among Nigeria diabetic patients and is the objective of this study. One hundred and twenty (120) diabetic patients with and without symptoms of peripheral neuropathy receiving care at the medical outpatient department (MOPD) and the diabetic clinic of the Nnamdi Azikiwe University Teaching Hospital Nnewi were recruited consecutively as they presented. They were administered structured questionnaires to assess some variables concerning care of their feet as provided to them by their physicians. Among the 120 diabetic participants, 83 (69.2%) had neuropathic symptoms (the symptomatic participants) while 37 (30.8%) were asymptomatic (the asymptomatic participants). Eighty (80; 96.4%) of the symptomatic vs 36 (97.3%) of the asymptomatic participants had never had their feet examined by their physician. Also, 26 (31.3%) of the symptomatic vs 12 (32.4%) of the asymptomatic participants had never received any form of advice on how to take special care of their feet by their physician, and 26 (31.3%) of the symptomatic vs 6 (16.2%) of the asymptomatic participants walked unshod most times in their immediate surroundings. Physicians do not provide adequate care to the feet of their diabetic patients irrespective of the presence or absence of neuropathic symptoms, making this variable a critical risk factor for diabetic foot ulceration and amputation. Continuing medical education to health care providers emphasizing adequate "care of the foot" of the diabetic patient, will reduce avoidable loss of limbs to diabetes.

  5. Structured health care for subjects with diabetic foot ulcers results in a reduction of major amputation rates

    Science.gov (United States)

    2013-01-01

    Objective We tested the effects of structured health care for the diabetic foot in one region in Germany aiming to reduce the number of major amputations. Research design and methods In a prospective study we investigated patients with diabetic foot in a structured system of outpatient, in-patient and rehabilitative treatment. Subjects were recruited between January 1st, 2000 and December 31, 2007. All participants underwent a two-year follow-up. The modified University of Texas Wound Classification System (UT) was the basis for documentation and data analysis. We evaluated numbers of major amputations, rates of ulcer healing and mortality. In order to compare the effect of the structured health care program with usual care in patients with diabetic foot we evaluated the same parameters at another regional hospital without interdisciplinary care of diabetic foot (controls). Results 684 patients with diabetic foot and 508 controls were investigated. At discharge from hospital 28.3% (structured health care program, SHC) vs. 23.0% (controls) of all ulcers had healed completely. 51.5% (SHC) vs. 49.8% (controls) were in UT grade 1. Major amputations were performed in 32 subjects of the structured health care program group (4.7%) vs. 110 (21.7%) in controls (p<0.0001). Mortality during hospitalization was 2.5% (SHC) vs. 9.4% in controls (p<0.001). Conclusions With the structured health care program we achieved a significant reduction of major amputation rates by more than 75% as compared to standard care. PMID:23497152

  6. The Effectiveness of Hypochlorous Acid Solution on Healing of Infected Diabetic Foot Ulcers

    Science.gov (United States)

    Ragab, Islam I.; Kamal, Ahmed

    2017-01-01

    Wound cleansing remains a corner stone in the management of diabetic foot ulcer. Hydrogen Peroxide (H[subscript 2]O[subscript 2]) and Povidone Iodine are topical antimicrobial agents but known to be toxic to cells involved in the wound healing cascade. The biggest challenge for the physicians and nurses is searching for a safe, noncytotoxic and…

  7. IWGDF guidance on the prevention of foot ulcers in at-risk patients with diabetes

    NARCIS (Netherlands)

    Bus, S. A.; van Netten, J. J.; Lavery, L. A.; Monteiro-Soares, M.; Rasmussen, A.; Jubiz, Y.; Price, P. E.

    2016-01-01

    Recommendations To identify a person with diabetes at risk for foot ulceration, examine the feet annually to seek evidence for signs or symptoms of peripheral neuropathy and peripheral artery disease. (GRADE strength of recommendation: strong; Quality of evidence: low) In a person with diabetes who

  8. A case series of verrucae vulgares mimicking hyperkeratosis in individuals with diabetic foot ulcers.

    Science.gov (United States)

    Quast, D R; Nauck, M A; Bechara, F G; Meier, J J

    2017-08-01

    Diabetic foot ulcers are a common complication in the advanced stages of diabetes mellitus. Certain lesions may be refractory to usual treatments with prolonged healing. In these cases, differential diagnoses to classical ulcers should be considered. Although plantar warts are a common and easy-to-diagnose finding in the general population, diagnosis can be challenging in people with diabetic foot ulcers, as they mimic hyperkeratosis in these people. We report seven cases of people with diabetic foot ulcers and verrucae vulgares mimicking treatment-refractory hyperkeratosis, presenting to our centre between 2014 and 2016. Diagnosis was aided by the clinical presentation, followed by dermoscopy and punch biopsy. Treatment included topical application of 5-fluoruracil and salicylic acid (four people), cryotherapy (three people) and surgical excision (three people), all in combination with local pressure offloading. In five people, the verrucae were completely removed after a mean treatment period of 9.4 months; two individuals were lost to follow-up. Verrucae may be more common in people with diabetic foot lesions and polyneuropathy than generally assumed. Typical findings include small, pinhead-sized bleedings within and surrounding hyperkeratous lesions. These findings should alert the clinician for the potential presence of a verruca. In such cases, biopsy should be performed to enable specific diagnosis and treatment. © 2017 Diabetes UK.

  9. Effect of negative pressure wound therapy on molecular markers in diabetic foot ulcers.

    Science.gov (United States)

    Karam, Rehab A; Rezk, Noha A; Abdel Rahman, Tamer M; Al Saeed, Mohamed

    2018-08-15

    Diabetic foot ulcers are one of the most common complications of diabetes with high morbidity and mortality. Negative pressure wound therapy (NPWT) is one of the treatment modalities that facilitates the wound healing process; however, its molecular mechanism remains unclear. The aim of this study was to investigate the mechanism of action of NPWT in the treatment of diabetic foot ulcers via measuring the tissue expression of genes related to the wound healing process. The study included 40 patients with diabetic foot ulceration, 20 of them received NPWT and the other 20 were a control group treated with advanced moist therapy. Granulation tissue biopsies were obtained before and 10 days after treatment in both groups and subjected to real-time polymerase chain reaction to measure the mRNA expression of TGF-β1, VEGF, TNF-α, IL-1β, MMP-1, MMP-9 and TIMP-1 which are involved in the wound healing pathway. After 10 days of treatment with NPWT, the mRNA levels of IL-1β, TNF-α, MMP-1, and MMP-9 were significantly downregulated, while the levels of VEGF, TGF-β1 and TIMP-1 were significantly increased. Our study demonstrated that NPWT promotes wound healing in diabetic foot ulcers possibly by affecting growth factors, inflammatory cytokines, and matrix metalloproteinases. Copyright © 2018 Elsevier B.V. All rights reserved.

  10. Extracorporeal shockwave therapy in the treatment of chronic diabetic foot ulcers

    DEFF Research Database (Denmark)

    Jeppesen, S M; Yderstraede, K B; Rasmussen, B S B

    2016-01-01

    OBJECTIVE: To investigate the efficacy of extracorporeal shockwave therapy (ESWT) on healing chronic diabetic foot ulcers (DFU). METHOD: Patients with chronic DFUs were randomised (1:1) to receive a series of six ESWT treatments over 3 weeks in combination with standard care or standard care alone...

  11. A qualitative study of the key factors in implementing telemedical monitoring of diabetic foot ulcer patients

    DEFF Research Database (Denmark)

    Rasmussen, B S B; Jensen, L K; Froekjaer, J

    2015-01-01

    of a telemedical intervention. We posed the following research question: What are the key organizational factors in the implementation of telemedicine in wound care? METHODS: In connection with a randomized controlled trial of telemedical intervention for patients with diabetic foot ulcers in the region...

  12. Hyperbaric oxygen for the treatment of diabetic foot ulcers: a systematic review

    NARCIS (Netherlands)

    Stoekenbroek, R. M.; Santema, T. B.; Legemate, D. A.; Ubbink, D. T.; van den Brink, A.; Koelemay, M. J. W.

    2014-01-01

    A systematic review of randomized clinical trials (RCTs) to assess the additional value of hyperbaric oxygen therapy (HBOT) in promoting the healing of diabetic foot ulcers and preventing amputations was performed. MEDLINE, Embase, and the Cochrane Library were searched to identify RCTs in patients

  13. Footwear used by individuals with diabetes and a history of foot ulcer.

    Science.gov (United States)

    Reiber, Gayle E; Smith, Douglas G; Wallace, Carolyn M; Vath, Christy A; Sullivan, Katrina; Hayes, Shane; Yu, Onchee; Martin, Don; Maciejewski, Matthew

    2002-01-01

    To describe footwear preferences of people with diabetes and a history of foot ulcer from two large western Washington State healthcare organizations. As part of a clinical trial of footwear, self-reported information on footwear preferences, use, and cost were obtained from persons with diabetes and a prior healed foot ulcer for the year before their study enrollment. All participants' shoes were allocated into optimal, adequate, and dangerous categories based on design, structural and safety features, and materials. The 309 males and 91 females in this study averaged 62 years of age. At baseline, men owned an average of 6 (+3) pairs of shoes, with an average purchase price of $56, while women owned an average of 8 (+5) pairs, with an average purchase price of $42. Women spent an average of 51% of their time in shoes in dangerous shoes compared to men who spent 27% of their time. Men and women spent nearly 30% of their time while out of bed in slippers, stockings, and barefoot. People with a history of diabetes and foot ulcers needed several styles of safe and attractive shoes for regular activities. Healthcare professionals can provide patients with information on good footwear choices to help them select adequate shoes while avoiding dangerous shoes. This approach is more realistic than trying to move all people with prior foot risk factors or ulcers into uniformly optimal footwear, since recent evidence does not support this practice.

  14. Non invasive blood flow assessment in diabetic foot ulcer using laser speckle contrast imaging technique

    Science.gov (United States)

    Jayanthy, A. K.; Sujatha, N.; Reddy, M. Ramasubba; Narayanamoorthy, V. B.

    2014-03-01

    Measuring microcirculatory tissue blood perfusion is of interest for both clinicians and researchers in a wide range of applications and can provide essential information of the progress of treatment of certain diseases which causes either an increased or decreased blood flow. Diabetic ulcer associated with alterations in tissue blood flow is the most common cause of non-traumatic lower extremity amputations. A technique which can detect the onset of ulcer and provide essential information on the progress of the treatment of ulcer would be of great help to the clinicians. A noninvasive, noncontact and whole field laser speckle contrast imaging (LSCI) technique has been described in this paper which is used to assess the changes in blood flow in diabetic ulcer affected areas of the foot. The blood flow assessment at the wound site can provide critical information on the efficiency and progress of the treatment given to the diabetic ulcer subjects. The technique may also potentially fulfill a significant need in diabetic foot ulcer screening and management.

  15. Role of endothelial progenitor cells and inflammatory cytokines in healing of diabetic foot ulcers.

    Directory of Open Access Journals (Sweden)

    Francesco Tecilazich

    Full Text Available To evaluate changes in endothelial progenitor cells (EPCs and cytokines in patients with diabetic foot ulceration (DFU in association with wound healing.We studied healthy subjects, diabetic patients not at risk of DFU, at risk of DFU and with active DFU. We prospectively followed the DFU patients over a 12-week period. We also investigated similar changes in diabetic rabbit and mouse models of wound healing.All EPC phenotypes except the kinase insert domain receptor (KDR(+CD133(+ were reduced in the at risk and the DFU groups compared to the controls. There were no major EPC differences between the control and not at risk group, and between the at risk and DFU groups. Serum stromal-cell derived factor-1 (SDF-1 and stem cell factor (SCF were increased in DFU patients. DFU patients who healed their ulcers had lower CD34(+KDR(+ count at visits 3 and 4, serum c-reactive protein (CRP and granulocyte-macrophage colony-stimulating factor (GM-CSF at visit 1, interleukin-1 (IL-1 at visits 1 and 4. EPCs tended to be higher in both diabetic animal models when compared to their non-diabetic counterparts both before and ten days after wounding.Uncomplicated diabetes does not affect EPCs. EPCs are reduced in patients at risk or with DFU while complete wound healing is associated with CD34(+KDR(+ reduction, suggesting possible increased homing. Low baseline CRP, IL-1α and GM-CSF serum levels were associated with complete wound healing and may potentially serve as prognostic markers of DFU healing. No animal model alone is representative of the human condition, indicating the need for multiple experimental models.

  16. Assessment of prevalence and risk factors of peripheral arterial disease in diabetic foot ulcer

    Directory of Open Access Journals (Sweden)

    Thulasikumar G

    2017-07-01

    Full Text Available Diabetic foot ulcer(DFU is very common yet challenging complication of diabetes worldwide. These ulcers are biologically compromised majorly by ischemia and neuropathy. Ischemia has gained recognition as a significant cause of DFU. The association of peripheral arterial disease(PAD largely impacts the treatment outcomes of DFU in terms of ulcer healing, lower limb amputations and mortality. The burden of PAD in DFU in South Indian population has not been assessed adequately in the recent years. A multidisciplinary approach to DFU and prompt diagnosis of ischemia will decrease the loss of limb and life. The objective of the study was to assess the peripheral arterial disease and associated risk factors in patients with diabetic foot ulcer. A total of 100 patients were evaluated in this study. The patients were subjected to detailed history and clinical examination which included distal pulse assessment, ankle-brachial index(ABI and duplex scan to evaluate PAD. The data was subjected to statistical analysis to find out association between parameters of interest. The prevalence of PAD in DFU was found to be 36%. It was more prevalent in males and in age>40 years and higher with increasing age. PAD was associated almost equally with plantar and dorsal ulcers, more often whole of foot was involved. There is significant association of PAD with longer diabetic duration(p<0.0001 with mean disease duration of 10 years. Previous studies aimed to study prevalence of PAD in diabetes irrespective of foot ulcer. The present study analyzed various factors coexisting with DFU and PAD. The results conclude that peripheral arterial disease is a potential risk factor for major limb amputations.

  17. Factors Associated With Quality of Life in Patients With Diabetic Foot Ulcers

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    Nasiriziba

    2015-01-01

    Full Text Available Background Diabetic foot ulcer (DFU is a serious and costly complication in diabetes which affects approximately 15% of patients with diabetes and affects their quality of life (QOL. Objectives The purpose of this study was to investigate the factors associated with QOL in patients with DFU. Patients and Methods This cross-sectional study was performed on 60 patients (32 males and 28 females hospitalized for DFU, performed through convenience sampling. Data related factors and the QOL questionnaire for patients with DFU were abridged. This questionnaire has 29 questions in six dimensions of enjoying life, physical health, daily activities dependence, negative emotions, concern about wound, and wound caring, which evaluate the QOL in patients with DFU. The scoring method for this tool is five optional Likert. Descriptive and analytic statistical methods were used to analyze the data. Results Of the 60 patients with DFU, 53% were male and 47% female with an average age of 58.08 ± 11.95 years and average QOL of 41.1 ± 9.15. Statistical analysis showed that age (P = 0.002, employment (P ≤ 0001, socioeconomic status (P = 0.016, leg ulcer (P ≤ 0001, and the number of foot ulcer (P = 0.017 had a statistically significant relationship with QOL and its dimensions. Other variables did not have a significant relationship with QOL, but some of them such as smoking during negative emotions (P = 0.046 and marital status affecting the foot care difficulties (P = 0.03 had significant statistical relationships with QOL. Conclusions Diabetic foot ulcer affects different aspects of life and can reduce patient’s QOL. To improve the care behaviors and have a better control of foot ulcers and improve the QOL for these patients, taking into account factors such as age, occupation, marital status, number of wounds, and economic status is essential to plan for care and health needs in these patients.

  18. Health-Related Quality of Life Predicts Major Amputation and Death, but Not Healing, in People With Diabetes Presenting With Foot Ulcers

    DEFF Research Database (Denmark)

    Siersma, V.; Thorsen, H.; Holstein, P.E.

    2014-01-01

    healing, major amputation and death.Research design and methodsWe followed 1088 patients with new diabetic foot ulcers presenting for treatment at one of the 14 centers in 10 European countries participating in the Eurodiale study, prospectively until healing (76.9%), major amputation (4.6%) or death (6...... for major amputation (Mobility, Self-Care, Usual Activities) and death (Self-care, Usual Activities, Pain/Discomfort).ConclusionsLow HRQoL appears to be predictive for major amputation and death, but high HRQoL does not increase healing. Future studies into the influence of HRQoL on ulcer outcome...

  19. Sural artery perforator flap with posterior tibial neurovascular decompression for recurrent foot ulcer in leprosy patients

    Directory of Open Access Journals (Sweden)

    Ismail, Hossam El-din Ali

    2017-01-01

    Full Text Available Introduction: The sensory loss and alteration of the shape of the foot make the foot liable to trauma and pressure, and subsequently cause more callus formation, blisters, and ulcers. Foot ulcers usually are liable to secondary infection as cellulitis or osteomyelitis, and may result in amputations. Foot ulcers are a major problem and a major cause of handicaps in leprosy patients. The current study is to present our clinical experience and evaluate the use of sural flap with posterior tibial neurovascular decompression (PTND in recurrent foot ulcers in leprosy patients.Patient and methods: A total number of 9 patients were suffering from chronic sequelae of leprosy as recurrent foot ulcers. All the patients were reconstructed with the reverse sural artery fasciocutaneous flap with posterior tibial neurovascular decompression from September 2012 to August 2015. Six patients were male and three were female with a mean age of 39.8 years (range, 30–50 years. All the soft tissue defects were in the weight-bearing area of the inside of the foot. The flap sizes ranged from 15/4 to 18/6 cm. Mean follow-up period was 21.2 months (range, 35–2 months.Results: All the flaps healed uneventfully. There was no major complication as total flap necrosis. Only minor complications occurred which were treated without surgical intervention except in two patients who developed superficial necrosis of the skin paddle. Surgical debridement was done one week later. The flap was completely viable after surgery, and the contour of the foot was restored. We found that an improvement of sensation occurred in those patients in whom the anesthesia started one year ago or less and no sensory recovery in patient in whom the anesthesia had lasted for more than two years.Conclusion: The reverse sural artery flap with posterior tibial neurovascular decompression provides a reliable method for recurrent foot soft tissue reconstruction in leprosy patients with encouraging

  20. The effect of flexor tenotomy on healing and prevention of neuropathic diabetic foot ulcers on the distal end of the toe

    Directory of Open Access Journals (Sweden)

    van Netten Jaap J

    2013-01-01

    Full Text Available Abstract Background Flexor tenotomy is a minimally invasive surgical alternative for the treatment of neuropathic diabetic foot ulcers on the distal end of the toe. The influence of infection on healing and time to heal after flexor tenotomy is unknown. Flexor tenotomy can also be used as a prophylactic treatment. The effectiveness as a prophylactic treatment has not been described before. Methods A retrospective study was performed with the inclusion of all consecutive flexor tenotomies from one hospital between January 2005 and December 2011. Results From 38 ulcers, 35 healed (92%, with a mean time to heal of 22 ± 26 days. The longest duration for healing was found for infected ulcers that were penetrating to bone (35 days; p = .042. Cases of prophylactic flexor tenotomies (n=9 did not result in any ulcer or other complications during follow-up. Conclusions The results of this study suggest that flexor tenotomy may be beneficial for neuropathic diabetic foot ulcers on the distal end of the toe, with a high healing percentage and a short mean time to heal. Infected ulcers that penetrated to bone took a significantly longer time to heal. Prospective research, to confirm the results of this retrospective study, should be performed.

  1. Risk factors of foot ulceration in patients with Diabetes Mellitus type 2

    Directory of Open Access Journals (Sweden)

    Patricia Bañuelos-Barrera

    2013-12-01

    Full Text Available Objective. Identify the risk factors for foot ulceration in patients with diabetes type 2 (DM2 who attended a primary care center in the city of Colima (Mexico. Methodology. This was a descriptive cross-sectional study conducted during 2012 with the participation of 87 patients with DM2 from both sexes and older than 30 years of age. Socio-demographic, anthropometric, clinical, and biochemical variables were measured. The study inquired about prior evaluation of the feet and prior education on diabetes by the healthcare team. Results. The mean age was 59 years and 70% were women. The average number of years since diagnosis was nine years; only 35% had good glycemia control; 66% engage in exercise; 51% wear open shoes; none had temperature differences in the feet; 82% had some type of dermatological abnormality; 50% had deformities in their feet. A total of 24% had been diagnosed with peripheral neuropathy and another 11% had peripheral vascular disease. Sixty percent of all the patients had risk of foot ulceration. Only 23% of the participants had had previous foot exams. One of every three diabetic patients had received education about the disease. Conclusion. An important proportion of the patients had risk of foot ulceration, contrary to the insufficient percentage of individuals with previous inspection and education about foot care. For nursing, it is an area of opportunity in this level of care to improve the inspection and education on diabetes, specifically on foot care, mainly in those patients with a prolonged evolution of the disease, deficient glycemia control, and risk of ulceration.

  2. Advantages of early diagnosis of diabetic neuropathy in the prevention of diabetic foot ulcers.

    Science.gov (United States)

    Sanz-Corbalán, Irene; Lázaro-Martínez, José Luis; García-Morales, Esther; Molines-Barroso, Raúl; Álvaro-Afonso, Francisco; García-Álvarez, Yolanda

    2017-12-26

    to evaluate the utility of the sudomotor function test (SFT) as a clinical tool in the Risk Stratification System of diabetic patients and to demonstrate the earlier detection of the risk of developing diabetic foot ulcers (DFU) compared to the standard clinical tests. prospective follow-up study on 263 patients enrolled consecutively over 3.5 years. Diabetic patients without active DFU were classified according to the International Working Group Risk Stratification System (RSS) and categorized according to the results of the Semmes-Wenstein Monofilament (SWM) and biothesiometer measurements or the SFT. The main outcome evaluated was the development of DFU. median follow-up was 42 [38-44] months. Sixty patients (22.8%) developed DFU after a median of 6.2 [3-17] months. Ten patients that were included in the no-risk group (group 0) based on the SWM and biothesiometer results developed DFU. Thus the sensitivity of this approach was 83.33% and the specificity was 50.47%. Based on the SFT results, all patients that developed DFU were included in the correct risk group. This approach had 100% sensitivity and 31.53% specificity. Regarding the diagnostic accuracy of the two Methods, the respective AUC values were 0.776 (95% CI 0.702-0.849) and 0.816 (95% CI 0.757-0.874). SFT improved RSS in diabetic patients in a specialized diabetic foot unit. SFT categorized patients correctly according to the risk of developing DFU. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. The efficacy and safety of natural honey on the healing of foot ulcers: a case series.

    Science.gov (United States)

    Mohamed, Hashim; Salma, Mansour Abu; Al Lenjawi, Badriya; Abdi, Seham; Gouda, Zaghloul; Barakat, Nour; Elmahdi, Hisham; Abraham, Sisy; Hamza, Abdul Hakeem; Al Khozaei, Dhyiaa; Al Majid, Shawqia; Al Majid, Hanaa; Abdini, Johina; Al Jaber, Maryam; Al Masseh, Fareeda; Al Ali, Amal Abdulla

    2015-04-01

    This clinical observation investigated the efficacy, cost-effectiveness, and acceptability of natural honey on the healing of a variety of chronic foot ulcers at the primary care level. A total of 12 patients with foot ulcers utilizing natural honey as an effective alternative to more expensive, advanced wound products were followed. Cases were referred to Umgwailinah Primary Health Care Center, Doha, Qatar from different health centers and from Hamad General Hospital, Doha, Qatar. There were also self-referred cases. After rinsing the site with normal saline, natural honey was applied and the wound was covered by glycerin-impregnated gauze (Adaptic Non-Adhering Dressing, Systagenix, San Antonio, TX) to prevent the absorption of honey into the cotton gauze and away from the wound site. Patients were followed on a daily basis for an average of 4 weeks. All ulcers healed with no contractures or scars with a mean healing time of 3 weeks. There was a 75% reduction in the dressing budget of the health center and a high level of satisfaction among both health professionals and patients. Patients' pain levels were reduced significantly after using natural honey, as evidenced by the use of the Visual Analog Scale. The use of natural honey in the management of chronic foot ulcers proved to be efficacious, cost-effective, and acceptable by both clinicians and patients.

  4. Platelet rich plasma for treatment of nonhealing diabetic foot ulcers: a case report.

    Science.gov (United States)

    Mehrannia, Masoud; Vaezi, Mitra; Yousefshahi, Fardin; Rouhipour, Nahid

    2014-02-01

    Diabetic foot ulcers are one of the most important causes of lower limb amputations worldwide. The conventional treatments of diabetic foot ulcers are costly and often require patients to be hospitalized for long periods of time, thus representing a huge burden on any health care system. The use of autologous platelet-rich plasma (PRP), which is rich in multiple growth factors, may bear some similarities to the natural wound healing process. Nonetheless, few studies on human subjects have so far addressed the efficacy of PRP as a novel and minimally invasive treatment. Today, there is only 1 approved and available system to separate PRP from a patient's own blood in order to be used in diabetic ulcers. This system incorporates bovine thrombin for activation of PRP gel and may be applied by many healthcare providers without the need for extensive special training. In this report, a patient with extensive diabetic foot ulcers, non-responsive to other treatment modalities, was successfully treated by PRP. Copyright © 2014 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

  5. Painful ulceration and quality of life of patients with the diabetic foot syndrome

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    Radka Vymětalová

    2016-12-01

    Full Text Available Aim: The aim of this study was to evaluate the influence of pain on quality of life of patients with diabetic foot syndrome. Design: Cross-sectional study. Methods: Quality of life was assessed using a Czech version of the Diabetic Foot Ulcer Scale (DFS, a standardized questionnaire. The sample consisted of 247 patients with diabetic foot syndrome. The intensity of pain in diabetic ulcers was measured using a visual analogue scale (VAS from 0 (no pain to 10 (maximum pain. Data was collected between April 2014 and December 2014 in 18 podiatric and chronic wound outpatient clinics throughout the Czech Republic. Results: Quality of life in patients with permanent pain was lower in all domains of the DFS questionnaire in comparison with patients who reported no pain. For patients who attended chronic wound outpatient clinics quality of life was significantly lower in four domains of the DFS (Leisure, Physical health, Emotions, and Friends than for patients who did not attend chronic pain outpatient clinics. A statistically significant moderate negative correlation was found between intensity of pain and quality of life in the following domains: Physical health (r = -0.592, Daily activities (r = -0.456, Emotions (r = -0.503, and Treatment (r = -0.434. Conclusion: Pain ulceration affects quality of life of patients with diabetic foot syndrome.

  6. Aescin-based topical formulation to prevent foot wounds and ulcerations in diabetic microangiopathy.

    Science.gov (United States)

    Hu, S; Belcaro, G; Dugall, M; Hosoi, M; Togni, S; Maramaldi, G; Giacomelli, L

    2016-10-01

    Impairment of the peripheral microcirculation in diabetic patients often leads to severe complications in the lower extremities, such as foot infections and ulcerations. In this study, a novel aescin-based formulation has been evaluated as a potential approach to prevent skin breaks and ulcerations by improving the peripheral microcirculation and skin hydration. In this registry study, 63 patients with moderate diabetic microangiopathy were recruited. Informed participants freely decided to follow either a standard management (SM) to prevent diabetic foot diseases (n = 31) or SM associated with topical application of the aescin-based cream (n = 32). Peripheral microcirculatory parameters such as resting skin flux, venoarteriolar response and transcutaneous gas tension were evaluated at inclusion and after 8 weeks. In addition, several skin parameters of the foot area, such as integrity (as number of skin breaks/patients), hydration and content of dead cells were assessed at the defined observational study periods. Improvements in cutaneous peripheral microcirculation parameters were observed at 8 weeks in both groups; however, a remarkable and significant beneficial effect resulted to be exerted by the aescin-based cream treatment. In fact, the microcirculatory parameters evaluated significantly improved in the standard management + aescin-based cream group, compared with baseline and with the standard management group. Similar findings were reported for skin parameters of the foot area. The topical formulation containing aescin could represent a valid approach to manage skin wounds and prevent skin ulcerations in patients affected by moderate diabetic microangiopathy.

  7. Diagnosis and treatment of peripheral arterial disease in diabetic patients with a foot ulcer. A progress report of the International Working Group on the Diabetic Foot

    NARCIS (Netherlands)

    Schaper, N. C.; Andros, G.; Apelqvist, J.; Bakker, K.; Lammer, J.; Lepantalo, M.; Mills, J. L.; Reekers, J.; Shearman, C. P.; Zierler, R. E.; Hinchliffe, R. J.

    2012-01-01

    The International Working Group on the Diabetic Foot (IWDGF) has produced in 2011 a guideline on the diagnosis and treatment of peripheral arterial disease in patients with diabetes and a foot ulcer. This document, together with a systematic review that provided the background information on

  8. Unsuspected osteomyelitis in diabetic foot ulcers. Diagnosis and monitoring by leukocyte scanning with indium in 111 oxyquinoline

    International Nuclear Information System (INIS)

    Newman, L.G.; Waller, J.; Palestro, C.J.; Schwartz, M.; Klein, M.J.; Hermann, G.; Harrington, E.; Harrington, M.; Roman, S.H.; Stagnaro-Green, A.

    1991-01-01

    The prevalence of osteomyelitis in diabetic foot ulcers is unknown. Early diagnosis of this infection is critical, as prompt antibiotic treatment decreases the rate of amputation. The authors therefore assessed the prevalence of osteomyelitis in 35 diabetic patients with 41 foot ulcers. They compared results of roentgenograms, leukocyte scans with indium In 111 oxyquinoline, and bone scans with the diagnostic criterion standards of bone histologic and culture findings. Leukocyte scans were repeated at 2- to 3-week intervals during antibiotic treatment. Consecutive samples were obtained from 54 diabetic patients. Thirty-five patients with 41 foot ulcers were included. As determined by bone biopsy and culture, osteomyelitis was found to underlie 28 (68%) of 41 diabetic foot ulcers. Only nine (32%) of the 28 cases were diagnosed clinically by the referring physician. Underscoring the clinically silent nature of osteomyelitis in these ulcers, 19 (68%) of 28 occurred in outpatients, 19 (68%) of 28 occurred in ulcers not exposing bone, and 18 (64%) of 28 had no evidence of inflammation on physical examination. All patients with ulcers that exposed bone had osteomyelitis. Of the imaging tests, the leukocyte scan had the highest sensitivity, 89%. In patients with osteomyelitis, the leukocyte scan image intensity decreased by 16 to 34 days of antibiotic treatment and normalized by 36 to 54 days. The majority of diabetic foot ulcers have an underlying osteomyelitis that is clinically unsuspected. Leukocyte scans are highly sensitive for diagnosing osteomyelitis in diabetic foot ulcers and may be useful for monitoring the efficacy of antibiotic treatment. The recommend that diabetic patients with foot ulcers that expose bone should be treated for osteomyelitis

  9. Managing the Diabetic Foot Ulcer: How Best Practices Fit the Real 2018 United States.

    Science.gov (United States)

    Ilonzo, Nicole; Patel, Munir; Lantis, John C

    2018-06-01

    Diabetes Mellitus is a serious systemic illness that has an epidemic-like increasing prevalence in the United States, as well as the rest of the world. With the increasing number of people with diabetes comes the higher incidence of diabetes-related complications. One of these known complications, diabetic foot ulcers (DFU), has an estimated lifetime incidence of 15% in diabetics. Having a DFU increases the risk of infection, amputation, and even death, which is why prompt treatment and surveillance of such ulcers is imperative. Multiple organizations and journals have recently published best practices to heal and close DFU. Despite these guidelines, it is estimated that only 50% of all diabetic foot ulcers close within one year in the United States. To further confuse this picture, many trials include postoperative wounds that behave in a very different way than chronic wounds. The management of diabetic ulcers requires an understanding of not only the pathophysiology along with a multi-modal approach involving local wound care, pressure prevention, infection control, and, in some, revascularization, but also how care is delivered in the United States presently. In this review, we hope to elucidate the current knowledge and modalities used in ulcer management and to focus on key areas and best practices to inform the clinician, both in what they should do and what they can do.

  10. Temperature- and pH-sensitive wearable materials for monitoring foot ulcers

    Directory of Open Access Journals (Sweden)

    Salvo P

    2017-01-01

    Full Text Available Pietro Salvo,1,2 Nicola Calisi,1 Bernardo Melai,1 Valentina Dini,3 Clara Paoletti,1 Tommaso Lomonaco,1 Andrea Pucci,1 Fabio Di Francesco,1 Alberto Piaggesi,4 Marco Romanelli3 1Department of Chemistry and Industrial Chemistry, University of Pisa, 2Institute of Clinical Physiology, National Council of Research, 3Wound Healing Research Unit, Department of Dermatology, University of Pisa, 4Diabetic Foot Section, Department of Medicine, University of Pisa, Pisa, Italy Abstract: Foot ulcers account for 15% of comorbidities associated with diabetes. Presently, no device allows the status of foot ulcers to be continuously monitored when patients are not hospitalized. In this study, we describe a temperature and a pH sensor capable of monitoring diabetic foot and venous leg ulcers developed in the frame of the seventh framework program European Union project SWAN-iCare (smart wearable and autonomous negative pressure device for wound monitoring and therapy. Temperature is measured by exploiting the variations in the electrical resistance of a nanocomposite consisting of multiwalled carbon nanotubes and poly(styrene-b-(ethylene-co-butylene-b-styrene. The pH sensor used a graphene oxide (GO layer that changes its electrical potential when pH changes. The temperature sensor has a sensitivity of ~85 Ω/°C in the range 25°C–50°C and a high repeatability (maximum standard deviation of 0.1% over seven repeated measurements. For a GO concentration of 4 mg/mL, the pH sensor has a sensitivity of ~42 mV/pH and high linearity (R2=0.99. Keywords: diabetic foot ulcer, wearable sensors, wound temperature, wound pH

  11. Association of Hemoglobin A1c and Wound Healing in Diabetic Foot Ulcers.

    Science.gov (United States)

    Fesseha, Betiel K; Abularrage, Christopher J; Hines, Kathryn F; Sherman, Ronald; Frost, Priscilla; Langan, Susan; Canner, Joseph; Likes, Kendall C; Hosseini, Sayed M; Jack, Gwendolyne; Hicks, Caitlin W; Yalamanchi, Swaytha; Mathioudakis, Nestoras

    2018-04-16

    This study evaluated the association between hemoglobin A 1c (A1C) and wound outcomes in patients with diabetic foot ulcers (DFUs). We conducted a retrospective analysis of an ongoing prospective, clinic-based study of patients with DFUs treated at an academic institution during a 4.7-year period. Data from 270 participants and 584 wounds were included in the analysis. Cox proportional hazards regression was used to assess the incidence of wound healing at any follow-up time in relation to categories of baseline A1C and the incidence of long-term (≥90 days) wound healing in relation to tertiles of nadir A1C change and mean A1C change from baseline, adjusted for potential confounders. Baseline A1C was not associated with wound healing in univariate or fully adjusted models. Compared with a nadir A1C change from baseline of -0.29 to 0.0 (tertile 2), a nadir A1C change of 0.09 to 2.4 (tertile 3) was positively associated with long-term wound healing in the subset of participants with baseline A1C healing was seen with the mean A1C change from baseline in this group. Neither nadir A1C change nor mean A1C change were associated with long-term wound healing in participants with baseline A1C ≥7.5%. There does not appear to be a clinically meaningful association between baseline or prospective A1C and wound healing in patients with DFUs. The paradoxical finding of accelerated wound healing and increase in A1C in participants with better baseline glycemic control requires confirmation in further studies. © 2018 by the American Diabetes Association.

  12. A patient with foot ulcer and severe metabolic alkalosis.

    Science.gov (United States)

    John, Ruby Samuel; Simoes, Sonia; Reddi, Alluru S

    2012-01-01

    We report a case of triple acid-base disorder with metabolic alkalosis as the primary disorder in a 65-year-old man due to ingestion and application to leg ulcers of baking soda (calcium bicarbonate). The blood pH was 7.65 with hypochloremia, hypokalemia, and prerenal azotemia. He was treated with isotonic saline with K replacement, and the patient improved without any adverse clinical consequences. We discuss the causes, mechanisms, and management of Cl-responsive (depletion) metabolic alkalosis.

  13. Comparision of Vacuum-Asisted Closure and Moist Wound Dressing in the Treatment of Diabetic Foot Ulcers

    OpenAIRE

    Ravari, Hassan; Modaghegh, Mohammad-Hadi Saeed; Kazemzadeh, Gholam Hosein; Johari, Hamed Ghoddusi; Vatanchi, Attieh Mohammadzadeh; Sangaki, Abolghasem; Shahrodi, Mohammad Vahedian

    2013-01-01

    Background: Vacuum-assisted closure (VAC) is a new method in wound care which speeds wound healing by causing vacuum, improving tissue perfusion and suctioning the exudates. This study aims to evaluate its efficacy in the treatment of diabetic foot ulcers. Materials and Methods: Thirteen patients with diabetic foot ulcers were enrolled in the moist dressing group, and 10 patients in the VAC group. The site, size and depth of the wound were inspected and recorded before and every three days du...

  14. The value of debridement and Vacuum-Assisted Closure (V.A.C.) Therapy in diabetic foot ulcers.

    Science.gov (United States)

    Eneroth, Magnus; van Houtum, William H

    2008-01-01

    Treatment of diabetic foot ulcers includes a number of different regimes such as glycaemic control, re-vascularization, surgical, local wound treatment, offloading and other non-surgical treatments. Although considered the standard of care, the scientific evidence behind the various debridements used is scarce. This presentation will focus on debridement and V.A.C. Therapy, two treatments widely used in patients with diabetes and foot ulcers. A review of existing literature on these treatments in diabetic foot ulcers, with focus on description of the various types of debridements used, the principles behind negative pressure wound therapy (NPWT) using the V.A.C. Therapy system and level of evidence. Five randomized controlled trials (RCT) of debridement were identified; three assessed the effectiveness of a hydrogel as a debridement method, one evaluated surgical debridement and one evaluated larval therapy. Pooling the three hydrogel RCTs suggested that hydrogels are significantly more effective than gauze or standard care in healing diabetic foot ulcers. Surgical debridement and larval therapy showed no significant benefit. Other debridement methods such as enzyme preparations or polysaccharide beads have not been evaluated in RCTs of people with diabetes. More than 300 articles have been published on negative pressure wound therapy, including several small RCTs and a larger multi-centre RCT of diabetic foot ulcers. Negative pressure wound therapy seems to be a safe and effective treatment for complex diabetic foot wounds, and could lead to a higher proportion of healed wounds, faster healing rates, and potentially fewer re-amputations than standard care. Although debridement of the ulcer is considered a prerequisite for healing of diabetic foot ulcers, the grade of evidence is quite low. This may be due to a lack of studies rather than lack of effect. Negative pressure wound therapy seems to be safe and effective in the treatment of some diabetic foot ulcers

  15. Noninvasive assessment of diabetic foot ulcers with diffuse photon density wave methodology: pilot human study

    Science.gov (United States)

    Papazoglou, Elisabeth S.; Neidrauer, Michael; Zubkov, Leonid; Weingarten, Michael S.; Pourrezaei, Kambiz

    2009-11-01

    A pilot human study is conducted to evaluate the potential of using diffuse photon density wave (DPDW) methodology at near-infrared (NIR) wavelengths (685 to 830 nm) to monitor changes in tissue hemoglobin concentration in diabetic foot ulcers. Hemoglobin concentration is measured by DPDW in 12 human wounds for a period ranging from 10 to 61 weeks. In all wounds that healed completely, gradual decreases in optical absorption coefficient, oxygenated hemoglobin concentration, and total hemoglobin concentration are observed between the first and last measurements. In nonhealing wounds, the rates of change of these properties are nearly zero or slightly positive, and a statistically significant difference (pdiabetic foot ulcers, and indicate that it may have clinical utility in the evaluation of wound healing potential.

  16. A system for treatment of diabetic foot ulcers using led irradiation and natural latex

    Directory of Open Access Journals (Sweden)

    Gustavo Adolfo Marcelino de Almeida Nunes

    Full Text Available Abstract Introduction: We developed and tested a new system for inducing the healing of diabetic foot ulcers. The system relies on the regenerative properties of its two components: an insole with a sheet of natural latex and a device that contains a matrix of light emitting diodes with wavelength of 635 nm. Methods The electronic and latex based devices were developed, and a four weeks test was performed in one control group (CG of five ulcers and one experimental group (EG of eight ulcers. The CG was treated with a standard approach, based on a silver-releasing foam dressing, and the EG was treated with the system under test. For each ulcer, an index for quantifying the percentage ulcer recovery, named CRU(%, has been calculated; a CRU(% = 0% means no healing, and a CRU(% = 100% means total healing. Results There were statistically significant increases of CRU(% of 51.8% (p = 0.022, for the CG, and of 78.4% (p < 0.001, for the EG. The increase in the EG was higher than the increase in the CG, and the difference was statistically significant (p < 0.001. The results showed that the proposed method had, for these particular sets of ulcers, faster healing rates, than for the standard method. Conclusion The results hint that the proposed method seems promising as a future treatment method. However, the technique must undergo further testing before it can be considered for extensive clinical applications.

  17. Effect of custom-made footwear on foot ulcer recurrence in diabetes: a multicenter randomized controlled trial.

    Science.gov (United States)

    Bus, Sicco A; Waaijman, Roelof; Arts, Mark; de Haart, Mirjam; Busch-Westbroek, Tessa; van Baal, Jeff; Nollet, Frans

    2013-12-01

    Custom-made footwear is the treatment of choice to prevent foot ulcer recurrence in diabetes. This footwear primarily aims to offload plantar regions at high ulcer risk. However, ulcer recurrence rates are high. We assessed the effect of offloading-improved custom-made footwear and the role of footwear adherence on plantar foot ulcer recurrence. We randomly assigned 171 neuropathic diabetic patients with a recently healed plantar foot ulcer to custom-made footwear with improved and subsequently preserved offloading (∼20% peak pressure relief by modifying the footwear) or to usual care (i.e., nonimproved custom-made footwear). Primary outcome was plantar foot ulcer recurrence in 18 months. Secondary outcome was ulcer recurrence in patients with an objectively measured adherence of ≥80% of steps taken. On the basis of intention-to-treat, 33 of 85 patients (38.8%) with improved footwear and 38 of 86 patients (44.2%) with usual care had a recurrent ulcer (relative risk -11%, odds ratio 0.80 [95% CI 0.44-1.47], P = 0.48). Ulcer-free survival curves were not significantly different between groups (P = 0.40). In the 79 patients (46% of total group) with high adherence, 9 of 35 (25.7%) with improved footwear and 21 of 44 (47.8%) with usual care had a recurrent ulcer (relative risk -46%, odds ratio 0.38 [0.15-0.99], P = 0.045). Offloading-improved custom-made footwear does not significantly reduce the incidence of plantar foot ulcer recurrence in diabetes compared with custom-made footwear that does not undergo such improvement, unless it is worn as recommended.

  18. Self-esteem in patients with diabetes mellitus and foot ulcers.

    Science.gov (United States)

    Salomé, Geraldo Magela; Maria de Souza Pellegrino, Donata; Blanes, Leila; Ferreira, Lydia Masako

    2011-08-01

    To evaluate self-esteem in individuals with diabetes mellitus (DM) and foot ulcers. This was a controlled, cross-sectional, analytical study. We selected 50 individuals with DM and foot ulcers (study group), as well as 50 with DM and without foot ulcers (control group). Self-esteem was evaluated using the Federal University of São Paulo/Paulista School of Medicine Portuguese-language version of the Rosenberg Self-Esteem Scale, on which scores range from 0 to 30, higher scores indicating lower self-esteem. Of the individuals evaluated, 27 (54%) of those in the study group and 31 (62%) of those in the control group were classified as being of low socioeconomic status (monthly income at or above, but less than double, the national minimum wage). In addition, 27 (54%) of the study group patients had type 2 DM, compared with 29 (58%) of those in the control group. Hypertension was observed in 31 (62%) of the study group patients and 29 (58%) of the control group patients. Of the patients in the study group, 33 (66%) had been diagnosed with heart disease, compared with 23 (46%) of those in the control group. High Rosenberg Self-Esteem Scale scores (21-30) were more common in the study group, being observed in 30 (60%) of the patients, whereas 33 (66%) of the control group patients had low scores (0-10). Foot ulcers appear to have a negative impact on the self-esteem of patients with DM. Copyright © 2010 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  19. The development and validation of a neuropathy- and foot ulcer-specific quality of life instrument.

    Science.gov (United States)

    Vileikyte, Loretta; Peyrot, Mark; Bundy, Christine; Rubin, Richard R; Leventhal, Howard; Mora, Pablo; Shaw, Jonathan E; Baker, Paul; Boulton, Andrew J M

    2003-09-01

    The purpose of this study was to develop a questionnaire that measures patients' perceptions of the impact of diabetic peripheral neuropathy and foot ulcers on their quality of life and to assess the psychometric properties of this instrument in a sample of patients with varying severity and symptomatology of diabetic peripheral neuropathy. The neuropathy- and foot ulcer-specific quality of life instrument (NeuroQoL), generated from interviews with patients with (n = 47) and without (n = 15) diabetic peripheral neuropathy, was administered to 418 consecutive patients with diabetic peripheral neuropathy (35% with foot ulcer history) attending either U.K. (n = 290) or U.S. (n = 128) diabetes centers. Psychometric tests of NeuroQoL included factor analyses and internal consistency of scales; a series of multivariate analyses were performed to establish its criterion, construct, and incremental validity. Results were compared with those obtained using the Short Form (SF)-12 measure of health-related functioning. Factor analyses of NeuroQoL revealed three physical symptom measures and two psychosocial functioning measures with good reliability (alpha = 0.86-0.95). NeuroQoL was more strongly associated with measures of neuropathic severity than SF-12, more fully mediated the relationship of diabetic peripheral neuropathy with overall quality of life, and significantly increased explained variance in overall quality of life over SF-12. NeuroQoL reliably captures the key dimensions of the patients' experience of diabetic peripheral neuropathy and is a valid tool for studying the impact of neuropathy and foot ulceration on quality of life.

  20. Microbiological profile and clinical outcome of severe foot ulcers of diabetic inpatients

    Directory of Open Access Journals (Sweden)

    Marivaldo Loyola Aragão(

    2010-09-01

    Full Text Available Objectives: To describe the microbiological profile and clinical outcomes of diabetic foot ulcers of inpatients of a tertiary university hospital, at Ceara, Brazil. Methods: We conducted a retrospective analysis of medical charts data of all diabetic inpatients of the Endocrine and Diabetes Unit of Walter Cantídio University Hospital (Federal University of Ceará, admitted from January, 2006 to June, 2007 for severe foot ulcers (minimum of grade 2 of Wagner`s classification, which were refractory to ambulatory treatment. Clinical data from each patient were recorded (sex, age, diabetes duration, and comorbidities as well as microbiological characteristics of foot ulcers and surgical (amputations material. Results: We identified 17 diabetic patients, all type 2, aged 58.11 ± 10.8 years and 12.4 ± 8.4 years of disease, 58.8% male. Of ulcers, 41.1% were grade 2; 35.2% grade 3; 11.7% grade 4 and 11.7% grade 5 of Wagner; 64.7% with less than 3 months of evolution. Debridement was performed in 82.3% of patients and amputation in 47%; osteomyelitis was identified in 47% of cases. All patients started empiric antibiotic therapy, where ciprofloxacin/metronidazole was the most used scheme (76.5%. Cultures were negative in 12.5% of the patients. In the positive ones, the most prevalent bacterial pathogens detected in the culture materials were: S. aureus (57.1%; S. viridans (28.7%; P. aeruginosas (28.7%; M. morganii (28.7%. The majority (75% of isolated S. aureus were methicillin-resistant, but were sensitive to vacomicin. Conclusion: We observed the presence of polymicrobial flora with a large number of multiresistant pathogens and high prevalence of osteomyelitis and amputations in diabetic patients with severe ulcers, neuropathy and peripheral vascular disease.

  1. Heberprot-P: a novel product for treating advanced diabetic foot ulcer.

    Science.gov (United States)

    Berlanga, Jorge; Fernández, José I; López, Ernesto; López, Pedro A; del Río, Amaurys; Valenzuela, Carmen; Baldomero, Julio; Muzio, Verena; Raíces, Manuel; Silva, Ricardo; Acevedo, Boris E; Herrera, Luis

    2013-01-01

    Diabetic foot ulcer is a principal diabetic complication. It has been shown that diabetic patients have decreased growth factor concentrations in their tissues, particularly epidermal growth factor. Growth factor shortage impairs wound healing, which leads to chronic nonhealing wounds and sometimes eventual amputation. Ischemic diabetic foot ulcer is the most difficult to treat and confers the highest amputation risk. Injecting epidermal growth factor deep into the wound bottom and contours encourages a more effective pharmacodynamic response in terms of granulation tissue growth and wound closure. Epidermal growth factor injected into the ulcer matrix may also result in association with extracellular matrix proteins, thus enhancing cell proliferation and migration. Heberprot-P is an innovative Cuban product containing recombinant human epidermal growth factor for peri- and intra-lesional infiltration; evidence reveals it accelerates healing of deep and complex ulcers, both ischemic and neuropathic, and reduces diabetes-related amputations. Clinical trials of Heberprot-P in patients with diabetic foot ulcers have shown that repeated local infiltration of this product can enhance healing of chronic wounds safely and efficaciously. As a result, Heberprot-P was registered in Cuba in 2006, and in 2007 was included in the National Basic Medications List and approved for marketing. It has been registered in 15 other countries, enabling treatment of more than 100,000 patients. Heberprot-P is a unique therapy for the most complicated and recalcitrant chronic wounds usually associated with high amputation risk. Local injection in complex diabetic wounds has demonstrated a favorable risk-benefit ratio by speeding healing, reducing recurrences and attenuating amputation risk. Further testing and deployment worldwide of Heberprot-P would provide an opportunity to assess the product's potential to address an important unmet medical need.

  2. Plectranthus amboinicus and Centella asiatica Cream for the Treatment of Diabetic Foot Ulcers

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    Yuan-Sung Kuo

    2012-01-01

    Full Text Available Effects of a topical cream containing P. amboinicus (Lour. Spreng. (Lamiaceae and C. asiatica (L. Urban (Umbelliferae were evaluated and compared to effects of hydrocolloid fiber wound dressing for diabetic foot ulcers. A single-center, randomized, controlled, open-label study was conducted. Twenty-four type 1 or type 2 diabetes patients aged 20 years or older with Wagner grade 3 foot ulcers postsurgical debridement were enrolled between October 2008 and December 2009. Twelve randomly assigned patients were treated with WH-1 cream containing P. amboinicus and C. asiatica twice daily for two weeks. Another 12 patients were treated with hydrocolloid fiber dressings changed at 7 days or when clinically indicated. Wound condition and safety were assessed at days 7 and 14 and results were compared between groups. No statistically significant differences were seen in percent changes in wound size at 7- and 14-day assessments of WH-1 cream and hydrocolloid dressing groups. A slightly higher proportion of patients in the WH-1 cream group (10 of 12; 90.9% showed Wagner grade improvement compared to the hydrocolloid fiber dressing group but without statistical significance. For treating diabetic foot ulcers, P. amboinicus and C. asiatica cream is a safe alternative to hydrocolloid fiber dressing without significant difference in effectiveness.

  3. Prediction of Wound Healing in Diabetic Foot Ulcers: an Observational Study in Tertiary Hospital in Indonesia

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    Pradana Soewondo

    2017-04-01

    Full Text Available Aim: to evaluate the role of clinical characteristics, functional markers of vasodilation, inflammatory response, and atherosclerosis in predicting wound healing in diabetic foot ulcer. Methods: a cohort study (February – October 2010 was conducted from 40 subjects with acute diabetic foot ulcer at clinical ward of Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia. Each subject underwent at least two variable measurements, i.e. during inflammatory phase and proliferation phase. The studied variables were clinical characteristics, complete peripheral blood count (CBC and differential count, levels of HbA1c, ureum, creatinine, lipid profile, fasting blood glucose (FBG, marker of endothelial dysfunction (asymmetric dimethylarginine/ADMA, endothelin-1/ET-1, and flow-mediated dilation/FMD of brachial artery, and marker of vascular calcification (osteoprotegerin/OPG. Results: median of time achieving 50% granulation tissue in our study was 21 days. There were nine factors that contribute in the development of 50% granulation tissue, i.e. family history of diabetes mellitus (DM, previous history of wound, wound area, duration of existing wound, captopril and simvastatin medications, levels of ADMA, ET-1, and OPG. There were three out of the nine factors that significantly correlated with wound healing, i.e. wound area, OPG levels, and simvastatin medications. Conclusion: in acute diabetic foot ulcers, wound area and OPG levels had positive correlation with wound healing, whereas simvastatin medications had negative correlation with wound healing.

  4. Comparing negative pressure wound treatment with honey dressing in healing of foot ulcers in diabetics

    International Nuclear Information System (INIS)

    Bashir, U.; Maqsood, R.; Shabbir, H.

    2018-01-01

    To evaluate and compare the effectiveness of vacuum assisted treatment with that of honey dressing in duration of healing of foot ulcers in diabetics. Study Design: Randomized control study. Place and Duration of Study: Combined Military Hospital Multan and Nishtar Hospital Multan, from Aug 2016 till Feb 2017. Patients and Methods: A total of 95 patients with ages between 30-60 years of both sexes, who presented with diabetic ulcers of foot involving subcutaneous tissue and skin. Patients were divided randomly into two groups; Group V and H. Group V was subjected to Vacuum Pack closure (negative pressure wound treatment) and group H was treated with honey dressing, follow up was done till the appearance of healthy tissue after initial debridement, suitable for STSG (Split Thickness Skin Graft) or primary closure. Results: Healthy tissue appeared much faster in Vacuum assisted treatment, then with honey dressing with mean of 18.2 days for V.A.C and 28.8 days for honey dressing. Conclusion: Vacuum assisted closure was more effective in the treatment of foot ulcers in diabetics. It promotes healthy granulation tissue in the wound bed at a faster rate in comparison to honey dressing. (author)

  5. Prediction of Wound Healing in Diabetic Foot Ulcers: an Observational Study in Tertiary Hospital in Indonesia.

    Science.gov (United States)

    Soewondo, Pradana; Suyono, Slamet; Sastrosuwignyo, Mpu Kanoko; Harahap, Alida R; Sutrisna, Bambang; Makmun, Lukman H

    2017-01-01

    to evaluate the role of clinical characteristics, functional markers of vasodilation, inflammatory response, and atherosclerosis in predicting wound healing in diabetic foot ulcer. a cohort study (February - October 2010) was conducted from 40 subjects with acute diabetic foot ulcer at clinical ward of Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia. Each subject underwent at least two variable measurements, i.e. during inflammatory phase and proliferation phase. The studied variables were clinical characteristics, complete peripheral blood count (CBC) and differential count, levels of HbA1c, ureum, creatinine, lipid profile, fasting blood glucose (FBG), marker of endothelial dysfunction (asymmetric dimethylarginine/ADMA, endothelin-1/ET-1, and flow-mediated dilation/FMD of brachial artery), and marker of vascular calcification (osteoprotegerin/OPG). median of time achieving 50% granulation tissue in our study was 21 days. There were nine factors that contribute in the development of 50% granulation tissue, i.e. family history of diabetes mellitus (DM), previous history of wound, wound area, duration of existing wound, captopril and simvastatin medications, levels of ADMA, ET-1, and OPG. There were three out of the nine factors that significantly correlated with wound healing, i.e. wound area, OPG levels, and simvastatin medications. in acute diabetic foot ulcers, wound area and OPG levels had positive correlation with wound healing, whereas simvastatin medications had negative correlation with wound healing.

  6. Electrochemical skin conductance to detect sudomotor dysfunction, peripheral neuropathy and the risk of foot ulceration among Saudi patients with diabetes mellitus.

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    Sheshah, Eman; Madanat, Amal; Al-Greesheh, Fahad; Al-Qaisi, Dalal; Al-Harbi, Mohammad; Aman, Reem; Al-Ghamdi, Abdul Aziz; Al-Madani, Khaled

    2015-01-01

    Sudomotor dysfunction is manifested clinically as abnormal sweating leading to dryness of feet skin and increased risk of foot ulceration. The aim of this study was to test the performance of foot electrochemical skin conductance (ESC) to detect diabetic peripheral neuropathy and the risk of foot ulceration against traditional methods in Saudi patients with diabetes mellitus. This cross-sectional study was conducted on 296 Saudi patients with diabetes mellitus. Painful neuropathic symptoms were evaluated using the neuropathy symptom score (NSS). The risk of foot ulceration and diabetic peripheral neuropathy were determined using the neuropathy disability score (NDS). Vibration perception threshold (VPT) was assessed using neurothesiometer. Neurophysiological assessment of the right and left sural, peroneal and tibial nerves was performed in 222 participants. Diabetic peripheral neuropathy was defined according to the definition of the American Academy of Neurology. ESC was measured with Sudoscan. Feet-ESC decreased as the scores of sensory and motor function tests increased. Feet-ESC decreased as the NSS, NDS and severity of diabetic peripheral neuropathy increased. Sensitivity of feet-ESC peripheral neuropathy assessed by VPT ≥ 25 V, NDS ≥ 3, NDS ≥ 6 was 90.1, 61 and 63.8 % respectively and specificity 77, 85 and 81.9 % respectively. Sensitivity of feet-ESC peripheral neuropathy assessed by VPT ≥ 25 V, NDS ≥ 3, NDS ≥ 6 was 100, 80.6 and 80.9 % respectively. Sensitivity and specificity of feet-ESC peripheral neuropathy were 67.5 and 58.9 % respectively. Sudoscan a simple and objective tool can be used to detect diabetic peripheral neuropathy and the risk of foot ulceration among patients with diabetes mellitus. Prospective studies to confirm our results are warranted.

  7. Hyperbaric Oxygen Therapy for the Treatment of Diabetic Foot Ulcers: A Health Technology Assessment

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    Lambrinos, Anna; Chan, Brian; Wells, David; Holubowich, Corinne

    2017-01-01

    Background About 15% to 25% of people with diabetes will develop a foot ulcer. These wounds are often resistant to healing; therefore, people with diabetes experience lower limb amputation at about 20 times the rate of people without diabetes. If an ulcer does not heal with standard wound care, other therapeutic interventions are offered, one of which is hyperbaric oxygen therapy (HBOT). However, the effectiveness of this therapy is not clearly known. The objectives of this health technology assessment were to assess the safety, clinical effectiveness, and cost-effectiveness of standard wound care plus HBOT versus standard wound care alone for the treatment of diabetic foot ulcers. We also investigated the preferences and perspectives of people with diabetic foot ulcers through lived experience. Methods We performed a review of the clinical and economic literature for the effectiveness and cost-effectiveness of hyperbaric oxygen therapy, as well as the budget impact of HBOT from the perspective of the Ministry of Health and Long-Term Care. We assessed the quality of the body of clinical evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Working Group criteria. To better understand the preferences, perspectives, and values of patients with diabetic foot ulcers and their experience with HBOT, we conducted interviews and administered an online survey. Results Seven randomized controlled trials and one nonrandomized controlled trial met the inclusion criteria. Comparing standard wound care plus HBOT with standard wound care alone, we found mixed results for major amputation rates (GRADE quality of evidence: low), a significant difference in favour of standard wound care plus HBOT on ulcers healed (GRADE quality of evidence: low), and no difference in terms of adverse events (GRADE quality of evidence: moderate). There is a large degree of uncertainty associated with the evaluation of the cost-effectiveness of standard wound

  8. The Assessment of Social Support and Self-Care Requisites for Preventing Diabetic Foot Ulcer in Diabetic Foot Patients

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    Mohammad Taher

    2016-03-01

    Full Text Available Background and Objectives: Diabetic foot as one of the most common complications of diabetes is involved in more than %25 of diabetic patients’ lives, and if not treated properly can lead to amputation up to %20. The lack of self-care is the underlying cause of mortality, morbidity and chronic complications of diabetes. Identification and rectifying of diabetic foot care needs of patients can additionally reduce readmission; also, %85 of diabetic foot problems can be prevented. Materials and Methods: In this descriptive study, 130patients with diabetic foot from Shahid Modarres hospital were selected using census method. Data in forms of demographic questionnaire, self-care requisites assessment tool for preventing diabetic foot ulcer, and Social Support Behavior Scale were completed by patients and then were collected. Data were analyzed by SPSS version 16. Results: In this study, a significant relationship was found between self-care and social support (P<0.05. This means that people with better social support reported better self-care than those with weaker social support. A significant relationship in level of education and monthly income with self-care was seen, as well as in level of education, monthly income and marital status with social support (P<0.001. Conclusions: The results showed that social support can be considered as an effective factor in individual self-care behaviors, and with regard to this factor in educational, treatment and care programs of patients, can improve their self-care, in addition to decreasing economic costs, and improve their qualities of lives as well.

  9. A review of a bi-layered living cell treatment (Apligraf® in the treatment of venous leg ulcers and diabetic foot ulcers

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    Larissa Zaulyanov

    2007-04-01

    Full Text Available Larissa Zaulyanov, Robert S Kirsner Department of Dermatology and Cutaneous Surgery; University of Miami Miller School of Medicine, Miami, Florida, USAAbstract: Apligraf® (Organogenesis, Canton, MA is a bi-layered bioengineered skin substitute and was the first engineered skin US Food and Drug Administration (FDA-approved to promote the healing of ulcers that have failed standard wound care. Constructed by culturing human foreskin-derived neonatal fibroblasts in a bovine type I collagen matrix over which human foreskin-derived neonatal epidermal keratinocytes are then cultured and allowed to stratify, Apligraf provides both cells and matrix for the nonhealing wound. Its exact mechanism of action is not known, but it is known to produce cytokines and growth factors similar to healthy human skin. Initially approved by the FDA in 1998 for the treatment of venous ulcers greater than one-month duration that have not adequately responded to conventional therapy, Apligraf later received approval in 2000 for treatment of diabetic foot ulcers of greater than three weeks duration. Herein, we review the use of Apligraf in the treatment of chronic venous leg ulcers and diabetic foot ulcers. Our goal is to provide a working understanding of appropriate patient selection and proper use of the product for any physician treating this segment of the aging population.Keywords: wound healing, Apligraf®, venous leg ulcer, diabetic foot ulcer

  10. Low-level laser therapy and Calendula officinalis in repairing diabetic foot ulcers.

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    Carvalho, Ana Flávia Machado de; Feitosa, Maura Cristina Porto; Coelho, Nayana Pinheiro Machado de Freitas; Rebêlo, Veruska Cronemberger Nogueira; Castro, Juçara Gonçalves de; Sousa, Patrícia Regina Gomes de; Feitosa, Valrian Campos; Arisawa, Emilia Angela Lo Schiavo

    2016-01-01

    To evaluate the effects of low-level laser therapy isolated and associated with Calendula officinalis oil in treating diabetic foot ulcers. An experimental, randomized, controlled, prospective, interventional clinical case study using a quantitative approach. The sample consisted of 32 diabetic patients of both genders. Participants were randomly divided into four groups. Doppler Ultrasound evaluation of the Ankle-Brachial Index, brief pain inventory and analog pain scale were performed at baseline and after 30 days. Reduced pain was observed in the Low-level laser therapy and Low-level laser therapy associated with Essential Fatty Acids groups (pgrupos. Ultrassom Doppler, avaliação do Índice Tornozelo-Braquial, Inventário breve de dor e escala de dor analógica foram realizados no início e após 30 dias. Houve redução da dor nos grupos Terapia a Laser de Baixa Intensidade e Terapia a Laser de Baixa intensidade associada aos Ácidos Graxos Essenciais, com pgrupos mantiveram-se estáveis. Na análise da redução de área da lesão, o grupo Terapia a Laser de Baixa Intensidade associada aos Ácidos Graxos Essenciais apresentou uma significância p=0,0032, e o grupo Terapia a Laser de Baixa Intensidade, p=0,0428. A Terapia a Laser de Baixa Intensidade, realizada tanto isoladamente quanto associada ao óleo de Calendula officinalis, foi eficaz no alívio da dor e na aceleração do processo de reparo tecidual de pé diabético.

  11. A descriptive study on prevalence of bacterial pathogens in diabetic ulcer and Interventional component for the prevention of foot ulcers

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    Jerlin Priya, Rajamanickam Rajkumar, Bakthasingh

    2014-11-01

    Full Text Available Diabetes is considered to have reached epidemic proportions worldwide. The most distressing complication of diabetes is foot ulcer and is the major cause of lower limb amputation. Hence, they require a prolonged hospital stay to combat more serious complications like gangrene and lower limb amputation. Early detection and prompt treatment help in alleviating the ulceration. Methods: The present study was conducted among 50 diabetes patients. Study subjects were selected using non probability purposive sampling technique. Pus samples were collected by using sterile swabs in a sterile manner from the ulcerated area. The wounds are washed vigorously with normal saline solution before collection of specimen. The specimens were transported immediately to the laboratory for culture. The clinical specimens were first screened microscopically by Gram’s stain, and then cultured on blood agar (aerobically and an aerobically, MacConkey agar and Robertson cooked meat broth for 48 hours at 37°C in 5-10 percent CO2 and bacteria’s were isolated. Results: The socio demographic profile of the present study reveals that males were predominant among the study population. Type II diabetes was more common, majority of study subjects are suffering from diabetes for more than 5 years and are treated with oral hypoglycemic drugs. The wound size was ≤ 2cms in majority of study subjects. The bacteriological profile of diabetic ulcer reveals that a majority of 23 (46% had growth of Staphylococcus aureus and 19 (38% had growth of klebsiella and a minimum of 6 (12% and 2 (4% had grown of Pseudomonas and Staphylococcus albus. Conclusion: Early detection of these bacterial pathogens helps to minimize the disease progress.

  12. Low Level Laser Therapy for the Treatment of Diabetic Foot Ulcers: A Critical Survey

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    Kathrin H. Beckmann

    2014-01-01

    Full Text Available Diabetic foot ulcers as one of the most common complications of diabetes mellitus are defined as nonhealing or long-lasting chronic skin ulcers in diabetic patients. Multidisciplinary care for the diabetic foot is common, but treatment results are often unsatisfactory. Low level laser therapy (LLLT on wound areas as well as on acupuncture points, as a noninvasive, pain-free method with minor side effects, has been considered as a possible treatment option for the diabetic foot syndrome. A systematic literature review identified 1764 articles on this topic. Finally, we adopted 22 eligible references; 8 of them were cell studies, 6 were animal studies, and 8 were clinical trials. Cell studies and animal studies gave evidence of cellular migration, viability, and proliferation of fibroblast cells, quicker reepithelization and reformed connective tissue, enhancement of microcirculation, and anti-inflammatory effects by inhibition of prostaglandine, interleukin, and cytokine as well as direct antibacterial effects by induction of reactive oxygen species (ROS. The transferral of these data into clinical medicine is under debate. The majority of clinical studies show a potential benefit of LLLT in wound healing of diabetic ulcers. But there are a lot of aspects in these studies limiting final evidence about the actual output of this kind of treatment method. In summary, all studies give enough evidence to continue research on laser therapy for diabetic ulcers, but clinical trials using human models do not provide sufficient evidence to establish the usefulness of LLLT as an effective tool in wound care regimes at present. Further well designed research trials are required to determine the true value of LLLT in routine wound care.

  13. Depression symptoms in people with diabetes attending outpatient podiatry clinics for the treatment of foot ulcers.

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    Pearson, Sue; Nash, Toni; Ireland, Vanessa

    2014-01-01

    The purpose of this study was to examine the prevalence of depressive symptoms, diabetes self-management, and quality of life in people with diabetes and foot ulcers. Ulcer status, mortality and amputations were also assessed at six months follow-up. This was a cross-sectional survey of people attending outpatient podiatry clinics at a major tertiary referral hospital. Depressive symptoms were measured using the Patient Health Questionnaire (PHQ). Diabetes self-care was assessed using the Summary of Diabetes Self Care Activities (SDSCA) measure. Health-related quality of life was measured using the physical component summary score (PCS) and the mental component summary score (MCS) of the SF-12. Of the 60 participants in the study 14 (23.3%) reported mild symptoms of depression (PHQ score 5-9) and 17 (28.3%) moderate to severe depressive symptoms (PHQ score > 9). Twenty-one (35%) met the criteria for previously recognized depression (on antidepressants and/or a diagnosis of depression in the last 12 months) and 17 (28.3%) for depression not previously recognized (PHQ > 4). Seventeen (28%) participants had been receiving antidepressant treatment for a median duration of 104 weeks (IQR 20, 494 weeks). Despite antidepressant treatment 12 participants (70.6% of those taking antidepressants) still reported moderate to severe depressive symptoms at the time of the study. Patients with PHQ scores > 4 reported poorer adherence to diabetes self-care activities including general diet, exercise, blood sugar monitoring and foot care when compared to those participants with PHQ scores  4 compared with no deaths and 2 amputations in participants with PHQ scores diabetes and foot ulcers. Depressive symptoms were associated with overall poorer diabetes self-management and health-related quality of life (HRQoL). There was no association between depressive symptoms and ulcer outcomes at six-months follow-up.

  14. The LeucoPatch® system in the management of hard-to-heal diabetic foot ulcers

    DEFF Research Database (Denmark)

    Game, Frances; Jeffcoate, William; Tarnow, Lise

    2017-01-01

    BACKGROUND: Diabetic foot ulcers are a common and severe complication of diabetes mellitus. Standard treatment includes debridement, offloading, management of infection and revascularisation where appropriate, although healing times may be long. The LeucoPatch® device is used to generate...... results have been obtained in non-controlled studies this system, but this now needs to be tested in a randomised controlled trial (RCT). If confirmed, the LeucoPatch® may become an important new tool in the armamentarium in the management of diabetic foot ulcers which are hard-to-heal. METHODS: People...... with diabetes and hard-to-heal ulcers of the foot will receive either pre-specified good standard care or good standard care supplemented by the application of the LeucoPatch® device. The primary outcome will be the percentage of ulcers healed within 20 weeks. Healing will be defined as complete...

  15. Methicillin-resistant Staphylococcus aureus nasal carriage and infection among patients with diabetic foot ulcer.

    Science.gov (United States)

    Lin, Shin-Yi; Lin, Nai-Yu; Huang, Yu-Yao; Hsieh, Chi-Chun; Huang, Yhu-Chering

    2018-06-04

    To evaluate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in patients with diabetic foot ulcer (DFU) in Taiwan, and to assess the concordance between colonizing and clinical MRSA isolates from the patients. A total of 354 nasal specimens were collected from 112 to 242 diabetic patients with and without foot ulcer, respectively. MRSA clinical isolates from DFU wound cultures were collected for comparison. Nasal carriage rate of S. aureus and MRSA was similar between diabetic patients with and without foot ulcer (15.2% vs. 16.9% for S. aureus and 5.4% vs. 1.7% for MRSA). Nasal S. aureus colonization was an independent predictor for wound S. aureus infection (Odds ratio [OR]: 5.33, 95% confidence interval [CI]: 1.61-17.59), so did nasal MRSA colonization (OR: 19.09, 95% CI: 2.12-171.91). The levels of glycated hemoglobin, and the usage with immunosuppressant agent were associated with S. aureus nasal colonization while oral hypoglycemic agent usage a protective factor. Sequence type 59/staphylococcal chromosome cassette mec IV or V, the local endemic community-associated clone, accounted for 42% and 70% of the clinical and colonizing isolates, respectively. Six of 10 patients with paired colonizing and clinical isolates, either MRSA or methicillin-sensitive S. aureus, had a genetically identical strain from a single patient. Less than one-fifth of patients with DFU have nasal S. aureus, including MRSA, colonization; however, the colonization is significantly associated with S. aureus diabetic foot infection. Screening for S. aureus colonizing status in DFU patients might have a potential clinical implication. Copyright © 2018. Published by Elsevier B.V.

  16. Efficacy of Cellular Therapy for Diabetic Foot Ulcer: A Meta-Analysis of Randomized Controlled Clinical Trials.

    Science.gov (United States)

    Zhang, Ye; Deng, Hong; Tang, Zhouping

    2017-12-01

    Diabetes mellitus is a widely spread chronic disease with growing incidence worldwide, and diabetic foot ulcer is one of the most serious complications of diabetes. Cellular therapy has shown promise in the management of diabetic foot ulcer in many preclinical experiments and clinical researches. Here, we performed a meta-analysis to evaluate the efficacy and safety of cellular therapy in the management of diabetic foot ulcer. We systematically searched PubMed, MEDLINE, EMBASE, and Cochrane Library databases from inception to May 2017 for randomized controlled trials assessing the efficacy of cellular therapy in diabetic foot ulcer, and a meta-analysis was conducted. A total of 6 randomized controlled clinical trials involving 241 individuals were included in this meta-analysis. The results suggested that cellular therapy could help accelerating the healing of diabetic foot ulcer, presented as higher ankle-brachial index (mean difference = 0.17, 95% confidence interval [CI] = 0.11 to 0.23), higher transcutaneous oxygen pressure (standardized mean difference [SMD] = 1.43; 95% CI, 1.09- to 1.78), higher ulcer healing rate (relative risk [RR] = 1.78; 95% CI, 1.41 to 2.25), higher amputation-free survival (RR = 1.25; 95% CI, 1.11 to 1.40), and lower scale of pain (SMD = -1.69; 95% CI, -2.05 to -1.33). Furthermore, cellular therapy seemed to be safe, with no serious complications and low risk of short-term slight complications. Cellular therapy could accelerate the rate of diabetic foot ulcer healing and may be more efficient than standard therapy for diabetic foot treatment.

  17. Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis.

    Science.gov (United States)

    Rigato, Mauro; Pizzol, Damiano; Tiago, Armindo; Putoto, Giovanni; Avogaro, Angelo; Fadini, Gian Paolo

    2018-05-26

    Among non-communicable diseases, diabetes represents a growing public health problem in Africa, where diabetes-related needs remain mostly unmet and the disabling features of foot are worsened by hygienic, cultural, and healthcare issues. We aimed to review clinical characteristics, prevalence, and outcomes of patients with diabetic foot ulcer in Africa. We searched the literature for cross-sectional and longitudinal studies reporting the characteristics of patients with diabetic foot in African countries, with a particular focus on ulcer prevalence, amputation rate, and mortality. Fifty-five full-text papers and ten abstracts were retrieved, reporting data from 19 African countries on 56,173 diabetic patients. According to the data collected, the overall prevalence of foot ulcers was 13% and increased over time, especially since 2001. Approximately 15% of patients with foot lesions underwent major amputation and 14.2% died during hospitalization. In patients with diabetic ulcers, insulin therapy was uncommon and neuropathy was the most common predisposing factor, but the prevalence of peripheral arterial disease correlated with amputation rates. Amputation and mortality decreased over time, probably as result of the implementation of screening programs in the last ten years. Mortality was directly related to previous amputation. The diabetic foot disease in Africa is a growing problem and is burden by high rate of in-hospital mortality. Educational interventions and screening programs including evaluation of the vascular status may play a crucial role to counter diabetic foot disease in Africa. Copyright © 2018 Elsevier B.V. All rights reserved.

  18. The clinical and cost effectiveness of bee honey dressing in the treatment of diabetic foot ulcers.

    Science.gov (United States)

    Moghazy, A M; Shams, M E; Adly, O A; Abbas, A H; El-Badawy, M A; Elsakka, D M; Hassan, S A; Abdelmohsen, W S; Ali, O S; Mohamed, B A

    2010-09-01

    Honey is known, since antiquity, as an effective wound dressing. Emergence of resistant strains and the financial burden of modern dressings, have revived honey as cost-effective dressing particularly in developing countries. Its suitability for all stages of wound healing suggests its clinical effectiveness in diabetic foot wound infections. Thirty infected diabetic foot wounds were randomly selected from patients presenting to Surgery Department, Suez Canal University Hospital, Ismailia, Egypt. Honey dressing was applied to wounds for 3 months till healing, grafting or failure of treatment. Changes in grade and stage of wounds, using University of Texas Diabetic Wound Classification, as well as surface area were recorded weekly. Bacterial load was determined before and after honey dressing. Complete healing was significantly achieved in 43.3% of ulcers. Decrease in size and healthy granulation was significantly observed in another 43.3% of patients. Bacterial load of all ulcers was significantly reduced after the first week of honey dressing. Failure of treatment was observed in 6.7% of ulcers. This study proves that commercial clover honey is a clinical and cost-effective dressing for diabetic wound in developing countries. It is omnipresence and concordance with cultural beliefs makes it a typical environmentally based method for treating these conditions. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

  19. A randomized, controlled clinical trial of honey-impregnated dressing for treating diabetic foot ulcer

    International Nuclear Information System (INIS)

    Imran, M.

    2015-01-01

    To investigate the effect of Beri-honey-impregnated dressing on diabetic foot ulcer and compare it with normal saline dressing. Study Design: A randomized, controlled trial. Place and Duration of Study: Sughra Shafi Medical Complex, Narowal, Pakistan and Bhatti International Trust (BIT) Hospital, Affiliated with Central Park Medical College, Lahore, from February 2006 to February 2010. Methodology: Patients with Wagner's grade 1 and 2 ulcers were enrolled. Those patients were divided in two groups; group A (n=179) treated with honey dressing and group B (n=169) treated with normal saline dressing. Outcome measures were calculated in terms of proportion of wounds completely healed (primary outcome), wound healing time, and deterioration of wounds. Patients were followed-up for a maximum of 120 days. Results: One hundred and thirty six wounds (75.97%) out of 179 were completely healed with honey dressing and 97 (57.39%) out of 169 wtih saline dressing (p=0.001). The median wound healing time was 18.00 (6 - 120) days (Median with IQR) in group A and 29.00 (7 - 120) days (Median with IQR) in group B (p < 0.001). Conclusion: The present results showed that honey is an effective dressing agent instead of conventional dressings, in treating patients of diabetic foot ulcer. (author)

  20. Rare Case of Aspergillus ochraceus Osteomyelitis of Calcaneus Bone in a Patient with Diabetic Foot Ulcers

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    Farhang Babamahmoodi

    2015-01-01

    Full Text Available Diabetes is the most common metabolic disease in humans. One of the major complications of the disease is foot ulcer that is prone to infection. The most common causes of infection which have been reported in these patients are bacteria and fungi such as Candida, Aspergillus, and Rhizopus species. We report one such rare case with calcaneal osteomyelitis caused by Aspergillus ochraceus in a patient with diabetic foot osteomyelitis. The case was a 68-year-old male with a history of type II diabetes for 2 years. The patient had two ulcers on the right heel bones for the past 6 months with no significant improvement. One of the most important predisposing factors to infectious diseases, especially opportunistic fungal infection, is diabetes mellitus. Aspergillus species can involve bony tissue through vascular system, direct infection, and trauma. Proper and early diagnosis and treatment of diabetic foot infection can reduce or prevent complications, such as osteomyelitis and amputation. The annual examination of feet for skin and nail lesion, sensation, anatomical changes, and vascular circulation can be useful for prevention and control of infection.

  1. Novel Pressure-Sensing Smart Insole System Used for the Prevention of Pressure Ulceration in the Insensate Foot

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    Allyson R. Alfonso, BS, BA

    2017-12-01

    Full Text Available Summary:. Wounds of the foot challenge reconstructive surgeons to manage multiple factors: sensibility, stability, and durability. In this article, we focus on the insensate foot, which poses challenges to wound prevention with its propensity to develop pressure ulceration. The authors present the innovative use of a pressure-sensing smart insole system (SurroSense Rx, Orpyx Medical Technologies Inc., Calgary, Canada in the management of the insensate foot in a patient following foot reconstruction. The pressure-sensing smart insole system provided unique feedback to both patient and provider in ways that contributed to the prevention of pressure ulcer recurrence, as well as highlight the importance of prescribed footwear in both the affected and unaffected foot. Wearable real-time monitoring and feedback faces the challenge of patient adherence. Future studies are indicated to examine the specific behaviors that are associated with favorable outcomes and long-term behavior changes.

  2. Treatment of Diabetic Foot Ulcers through Systemic Effects of Extremely Low Frequency Electromagnetic Fields

    Science.gov (United States)

    Trejo-Núñez, A. D.; Pérez-Chávez, F.; García-Sánchez, C.; Serrano-Luna, G.; Cañendo-Dorantes, L.

    2008-08-01

    This study was designed to, investigate the healing effects of extremely low frequency electromagnetic fields (ELF-EMF) on diabetic foot ulcers and test two different exposure systems aimed at reducing the ELF-EMF exposure time of patients. In the first system the ELF-EMF were applied to the arm where only 3% of the total blood volume/min circulates at any given time. In the second system the ELF-EMF were applied to the thorax where more than 100% of the total blood volume/minute circulates at any given time. Twenty-six diabetic patients, with superficial neuropathic ulcers unresponsive to medical treatment were included in this preliminary report. In the first group (17 patients), the arm was exposed two hours twice a week to a extremely low frequency electromagnetic field of 0.45-0.9 mTrms, 120 Hz generated inside a solenoid coil of 10.1 cm by 20.5 cm long. In the second group the thorax of 7 patients was exposed 25 minutes twice a week to an electromagnetic field of 0.4-0.85 mTrms, 120 Hz generated in the center of a squared quasi-Helmholtz coil 52 cm by side. One patient was assigned to a placebo configuration of each exposure system with identical appearance as the active equipment but without magnetic field. Patients with deep ulcers, infected ulcers, cancer, or auto-immune disease were excluded. These preliminary results showed that the two exposure systems accelerate the healing process of neuropathic ulcers. Complete healing of the ulcer had a median duration of 90 days in both exposure systems. Therefore thorax exposure where more blood is exposed to ELF-EMF per unit of time was able to reduce 4.8 times the patient treatment time. In those patients assigned to the placebo equipment no healing effects were observed. This study will continue with a parallel, double blind placebo controlled protocol.

  3. Management and prevention of diabetic foot ulcers and infections: a health economic review.

    Science.gov (United States)

    Chow, Ivy; Lemos, Elkin V; Einarson, Thomas R

    2008-01-01

    Diabetic foot ulcers and infections are common and incur substantial economic burden for society, patients and families. We performed a comprehensive review, on a number of databases, of health economic evaluations of a variety of different prevention, diagnostic and treatment strategies in the area of diabetic foot ulcers and infections. We included English-language, peer-reviewed, cost-effectiveness, cost-minimization, cost-utility and cost-benefit studies that evaluated a treatment modality against placebo or comparator (i.e. drug, standard of care), regardless of year. Differences were settled through consensus. The search resulted in 1885 potential citations, of which 20 studies were retained for analysis (3 cost minimization, 13 cost effectiveness and 4 cost utility). Quality scores of studies ranged from 70.8% (fair) to 87.5% (good); mean = 78.4% +/- 5.33%.In diagnosing osteomyelitis in patients with diabetic foot infection, magnetic resonance imaging (MRI) showed 82% sensitivity and 80% specificity. MRI cost less than 3-phase bone scanning + Indium (In)-111/Gallium (Ga)-67; however, when compared with prolonged antibacterials, MRI cost $US120 (year 1993 value) more without additional quality-adjusted life-expectancy. Prevention strategies improved life expectancy and QALYs and reduced foot ulcer rates and amputations.Ampicillin/sulbactam and imipenem/cilastatin were both 80% successful in treating diabetic foot infections but the latter cost $US2924 more (year 1994 value). Linezolid cure rates were higher (97.7%) than vancomycin (86.0%) and cost $US873 less (year 2004 value). Ertapenem costs were significantly lower than piperacillin/tazobactam ($US356 vs $US503, respectively; year 2005 values). Becaplermin plus good wound care may be cost effective in specific populations. Bioengineered living-skin equivalents increased ulcer-free months and ulcers healed, but costs varied between countries. Promogran produced more ulcer-free months than wound care alone

  4. An Automatic Assessment System of Diabetic Foot Ulcers Based on Wound Area Determination, Color Segmentation, and Healing Score Evaluation.

    Science.gov (United States)

    Wang, Lei; Pedersen, Peder C; Strong, Diane M; Tulu, Bengisu; Agu, Emmanuel; Ignotz, Ron; He, Qian

    2015-08-07

    For individuals with type 2 diabetes, foot ulcers represent a significant health issue. The aim of this study is to design and evaluate a wound assessment system to help wound clinics assess patients with foot ulcers in a way that complements their current visual examination and manual measurements of their foot ulcers. The physical components of the system consist of an image capture box, a smartphone for wound image capture and a laptop for analyzing the wound image. The wound image assessment algorithms calculate the overall wound area, color segmented wound areas, and a healing score, to provide a quantitative assessment of the wound healing status both for a single wound image and comparisons of subsequent images to an initial wound image. The system was evaluated by assessing foot ulcers for 12 patients in the Wound Clinic at University of Massachusetts Medical School. As performance measures, the Matthews correlation coefficient (MCC) value for the wound area determination algorithm tested on 32 foot ulcer images was .68. The clinical validity of our healing score algorithm relative to the experienced clinicians was measured by Krippendorff's alpha coefficient (KAC) and ranged from .42 to .81. Our system provides a promising real-time method for wound assessment based on image analysis. Clinical comparisons indicate that the optimized mean-shift-based algorithm is well suited for wound area determination. Clinical evaluation of our healing score algorithm shows its potential to provide clinicians with a quantitative method for evaluating wound healing status. © 2015 Diabetes Technology Society.

  5. Frequency of common bacteria and their antibiotic sensitivity pattern in diabetics presenting with foot ulcer

    International Nuclear Information System (INIS)

    Rahim, F.; Ishfaq, M.; Rahman, S.U.; Afridi, A.K.

    2016-01-01

    Foot ulcers are one of the most important complications of diabetes mellitus and often lead to lower limb amputation. Diabetic foot ulcers are susceptible to infection. The objective of this study was to determine the frequency of common bacteria infecting these ulcers and their antibiotic sensitivity pattern. Methods: This descriptive cross-sectional study was performed in the Departments of Medicine and Surgery, Khyber Teaching Hospital, Peshawar from April, 2011 to February, 2012. Specimens collected from ulcers of 131 patients were inoculated on Blood Agar and MacConkey Agar, and antibiotic sensitivity was tested using standard disc diffusion method. Results: Out of 131, specimens from 120 patients yielded 176 bacteria. Sixty-six patients had monomicrobial infection while polymicrobial growth was obtained in 54 patients. Overall, Staphylococcus aureus (38.6%) was the most common isolate followed by Pseudomonas aeruginosa (27.3%). Staphylococcus aureus was most often sensitive to Moxifloxacin, Imipenem/Meropenem, Vancomycin and Linezolid while it showed varying sensitivity to Penicillins and Cephalosporins. 47.1% isolates of Staphylococcus aureus were resistant to Methicillin. Most of the gram negative rods were sensitive to Imipenem/Meropenem, Piperacillin-Tazobactam and Ticarcillin-Clavulanate. Majority of gram negative bacteria were found resistant to Cephalosporins and Moxifloxacin except Pseudomonas which showed variable sensitivity to Ceftriaxone, Ceftazidime and Moxifloxacin. Conclusions: Majority of isolates were found resistant to the commonly used antibiotics. Most commonly isolated bacterium, Staphylococcus aureus was most often sensitive to Moxifloxacin, Imipenem/Meropenem, Vancomycin and Linezolid, while majority isolated gram negative rods were sensitive to Imipenem/Meropenem, Piperacillin-Tazobactam and Ticarcillin-Clavulanate. (author)

  6. Outcomes after foot surgery in people with a diabetic foot ulcer and a 12-month follow-up.

    Science.gov (United States)

    Lenselink, E; Holloway, S; Eefting, D

    2017-05-02

    The aim of this study was to retrospectively measure the outcomes of foot-sparing surgery at one year follow-up for patients with diabetic foot ulcers (DFUs). We assessed wound healing and the need for further surgery in relation to the variables that influence healing. Data were retrospectively collected by reviewing the electronic files of patients attending the Wound Expert Clinic (WEC). Outcomes of surgical debridement, toe, ray and transmetatarsal amputations were assessed. A total of 129 cases in 121 patients were identified for inclusion. The results demonstrated that complete wound healing was reached in 52% (61/117) of the patients within 12 months. The need for additional surgery or for major amputation was 56% (n=72/129) and 30% (n=39/129) respectively. The need for an additional procedure was particularly high after surgical debridement (75%, 33/44) and transmetatarsal amputation (64%, 7/11). Risk factors for non-healing or for a major amputation were: infection (p=0.01), ischaemia (p=0.01), a history of peripheral arterial occlusive disease (p<0.01) and smoking (p=0.01). Additional findings were that not all patients underwent vascular assessment and in half of the patients there was a delay in undergoing revascularisation. The results of the study reveal some areas for improvement including timely revascularisation and performance of multiple debridement procedures if needed in order to save a limb.

  7. Podiatry evaluation of a chitosan gelling fibre dressing in diabetic foot ulceration.

    Science.gov (United States)

    Walker, Angela

    2016-06-23

    The purpose of this small evaluation on five patients presenting to community podiatry services in Birmingham with foot ulceration was to explore common problems associated with diabetes and other high-risk conditions and illustrate the clinical effectiveness and experience of using a chitosan absorbent gelling fibre dressing (KytoCel®, Aspen Medical). Each of these case studies bought their individual complex issues and complications that affected the healing process. General wound care involved debridement, if required, dressings, pressure redistribution addressing footwear needs, systemic antibiotics where required, and shared care with the multidisciplinary team (MDT) in secondary care where appropriate.

  8. Application of 3D reconstruction system in diabetic foot ulcer injury assessment

    Science.gov (United States)

    Li, Jun; Jiang, Li; Li, Tianjian; Liang, Xiaoyao

    2018-04-01

    To deal with the considerable deviation of transparency tracing method and digital planimetry method used in current clinical diabetic foot ulcer injury assessment, this paper proposes a 3D reconstruction system which can be used to get foot model with good quality texture, then injury assessment is done by measuring the reconstructed model. The system uses the Intel RealSense SR300 depth camera which is based on infrared structured-light as input device, the required data from different view is collected by moving the camera around the scanned object. The geometry model is reconstructed by fusing the collected data, then the mesh is sub-divided to increase the number of mesh vertices and the color of each vertex is determined using a non-linear optimization, all colored vertices compose the surface texture of the reconstructed model. Experimental results indicate that the reconstructed model has millimeter-level geometric accuracy and texture with few artificial effect.

  9. The foot-health of people with diabetes in a regional Australian population: a prospective clinical audit

    Directory of Open Access Journals (Sweden)

    Perrin Byron M

    2012-03-01

    Full Text Available Abstract Background There is limited understanding of the foot-health of people with diabetes in Australian regional areas. The aim of this study was to document the foot-health of people with diabetes who attend publically funded podiatric services in a regional Australian population. Methods A three month prospective clinical audit was undertaken by the publically-funded podiatric services of a large regional area of Victoria, Australia. The primary variables of interest were the University of Texas (UT diabetic foot risk classification of each patient and the incidence of new foot ulceration during the study period. Age, gender, diabetes type, duration of diabetes and the podiatric service the patients attended were the other variables of interest. Results Five hundred and seventy six patients were seen during the three month period. Over 49% had a UT risk classification at a level at least peripheral neuropathy or more serious diabetes-related foot morbidity. Higher risk at baseline was associated with longer duration of diabetes (F = 31.7, p χ2 = 40.3, p 0.001 and type 1 diabetes (χ2 = 37.3, p 0.001. A prior history of foot pathology was the overwhelming predictor for incident ulceration during the time period (OR 8.1 (95% CI 3.6 to 18.2, p Conclusions The publically funded podiatric services of this large regional area of Australia deal with a disproportionally large number of people with diabetes at high risk of future diabetes-related foot complications. These findings may be useful in ensuring appropriate allocation of resources for future public health services involved in diabetic foot health service delivery in regional areas.

  10. THE INFLUENCE OF PERIPHERAL NEUROPATHY AND PERIPHERAL VASCULAR DISEASE IN THE OUTCOME OF DIABETIC FOOT MANAGEMENT – A PROSPECTIVE STUDY

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    Sundar Prakash S, Krishnakumar, Chandra Prabha

    2015-04-01

    Full Text Available Objective: Peripheral neuropathy and Peripheral Vascular Disease are the risk factors for the development of diabetic foot. The aim of this study was to evaluate differences and predictors of outcome parameters in patients with diabetic foot by stratifying these subjects according to the severity of these risk factors. Materials and methods: This is a prospective study conducted in 70 patients in the age group of 30-90 years diagnosed as Type II Diabetes with foot ulcers. After detailed clinical examination the following tests were conducted in all the patients: Complete blood count (CBC, Haemoglobin (Hb, Random Blood Sugar (RBS, Erythrocyte Sedimentation rate (ESR, Chest X-ray(CXR, Electrocardiography (ECG, foot X-ray, pus culture, Neuropathy testing by Semmes Weinstein Monofilament Test and Vibration Perception Threshold and Peripheral vascularity assessment by Duplex Doppler. Then grading of the ulcers was done using Wagner’s Grade. The outcome of the patients was assessed by recording the healing time, mode of surgery and amputation rates of the patients. Results: A total of 70 patients with diabetic foot were consecutively included into the study (65.7% male, age (31% in 51-60 years, mean diabetes duration (5.2 years, Ulcer Grade (37% in Grade IV, Foot lesions (45.7% in toe, Blood sugar levels (64% in 300-400 mg/dl, Neuropathy (84%, Peripheral vascular disease (67%, major amputation (7% and mortality (1.4%. Conclusion: All diabetic patients should undergo testing for neuropathy and peripheral vascular disease apart from doing other tests.

  11. Wound healing: total contact cast vs. custom-made temporary footwear for patients with diabetic foot ulceration.

    Science.gov (United States)

    Van De Weg, F B; Van Der Windt, D A W M; Vahl, A C

    2008-03-01

    The objective of this study was to compare the effectiveness of irremovable total-contact casts (TCC) and custom-made temporary footwear (CTF) to heal neuropathic foot ulcerations in individuals with diabetes. In this prospective clinical trial, 43 patients with plantar ulcer Grade 1 or 2 (Wagner scale) were randomized to one of two off-loading modalities: TCC or CTF. Outcomes assessed were wound surface area reduction (cm2) and time to wound healing (days) at 2, 4, 8 and 16 weeks. To evaluate safety, possible side effects were recorded at each follow-up visit. The results showed no significant difference in wound surface area reduction (adjusted for baseline wound surface) at 2, 4, 8 or 16 weeks (adjusted mean difference 0.10 cm2; 95% CI -0.92-0.72 at 16 weeks). At 16 weeks, 12 patients had a completely healed ulcer, 6 per group. The median time to healing was shorter for the patients using a cast (52 vs. 90 days, p = 0.26). Five patients with TCC and two with CTF developed device-related complications. It was concluded that: (i) the rate of wound healing is not significantly different for patients treated with CTF or TCC. The difference in wound surface area was small and not significant at any time during follow-up; and (ii) the difference in healing time (38 days) may have attained statistical significance if the numbers in these sub-groups (2 x 6) had been higher. Since there appears to be little difference in effectiveness between both off-loading modalities, further investigation into the benefits of CTF is warranted.

  12. Effectiveness of combined laser-puncture and conventional wound care to accelerate diabetic foot ulcer healing

    Directory of Open Access Journals (Sweden)

    Adiningsih Srilestari

    2017-05-01

    Full Text Available Background: Impaired wound healing is a common complication of diabetes. It has complex pathophysiologic mechanisms and often necessitates amputation. Our study aimed to evaluate the effectiveness of combined laser-puncture and conventional wound care in the treatment of diabetic foot ulcers.Methods: This was a double-blind controlled randomized clinical trial on 36 patients, conducted at the Metabolic Endocrine Outpatient Clinic, Cipto Mangunkusumo Hospital, Jakarta, between May and August 2015. Stimulation by laser-puncture (the treatment group or sham stimulation (the control group were performed on top of the standard wound care. Laser-puncture or sham were done on several acupuncture points i.e. LI4 Hegu, ST36 Zusanli, SP6 Sanyinjiao and KI3 Taixi bilaterally, combined with irradiation on the ulcers itself twice a week for four weeks. The mean reduction in ulcer sizes (week 2–1, week 3–1, week 4–1 were measured every week and compared between the two groups and analyzed by Mann-Whitney test.Results: The initial median ulcer size were 4.75 (0.10–9.94 cm2 and 2.33 (0.90–9.88 cm2 in laser-puncture and sham groups, respectively (p=0.027. The median reduction of ulcer size at week 2–1 was -1.079 (-3.25 to -0.09 vs -0.36 (-0.81 to -1.47 cm2, (p=0.000; at week 3–1 was -1.70 (-3.15 to -0.01 vs -0.36 (-0.80 to -0.28 cm2, (p=0.000; and at week 4–1 was -1.22 (-2.72 to 0.00 vs -0.38 (-0.74 to -0.57 cm2, (p=0.012.Conclusion: Combined laser-puncture and conventional wound care treatment are effective in accelerating the healing of diabetic foot ulcer.

  13. Motivation, effort and life circumstances as predictors of foot ulcers and amputations in people with Type 2 diabetes mellitus

    DEFF Research Database (Denmark)

    Bruun, Christine; Guassora, Ann Dorrit; Nielsen, Anni Brit Sternhagen

    2014-01-01

    Abstract AIM: To investigate the predictive value of both patients' motivation and effort in their management of Type 2 diabetes and their life circumstances for the development of foot ulcers and amputations. METHODS: This study was based on the Diabetes Care in General Practice study and Danish...... regression models, respectively. RESULTS: Foot ulcer prevalence 6 years after diabetes diagnosis was 2.93% (95% CI 1.86-4.00) among 956 patients. General practitioners' indication of 'poor' vs 'very good' patient motivation for diabetes management was associated with higher foot ulcer prevalence (odds ratio...... motivation was also associated with a higher amputation incidence (hazard ratio 7.57, 95% CI 2.43-23.57), although not in fully adjusted models. CONCLUSIONS: General practitioners' existing knowledge of patients' life circumstances, motivation and effort in diabetes management should be included in treatment...

  14. Heat-washout measurements compared to distal blood pressure and perfusion in orthopaedic patients with foot ulcers

    DEFF Research Database (Denmark)

    Midttun, M; Azad, B B S; Broholm, R

    2015-01-01

    Distal blood pressure and local skin perfusion pressure were compared to measurement of blood flow rate (BFR) measured by the heat-washout method in orthopaedic patients with and without diabetes, all with a foot ulcer in one foot, compared to healthy controls. The correlation was good between heat......-washout and distal blood pressure in patients with diabetes with and without an ulcer (P = 0·024 and 0·059, respectively). The correlation was weak in patients without diabetes with and without an ulcer, most probably due to power problems (P = 0·118 and 0·116, respectively). The correlation in the healthy controls...... the surrounding tissue, and therefore, measurements are easier made in these subjects. BFR in the first toe increased significantly in all patients when the foot was moved from heart level to 50 cm below heart level (P = between 0·03 and 0·05) as previously seen in patients with claudication...

  15. Genetic parameters of wound healing in patients with neuropatic diabetic foot ulcers

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    Ekaterina L. Zaitseva

    2017-12-01

    Full Text Available Background. Tissue repair processes are impaired in diabetic foot ulcers (DFUs. Previous research has shown that glycaemic control, cytokines and growth factors play an important role in wound healing. Emerging evidence also suggests that genes play a role via their regulation of cell proliferation, collagen synthesis and granulation tissue formation. Aim. To evaluate collagen genes expression in different stages of wound healing in patients with DFUs. Materials and methods. Prospective study included four patients with neuropathic DFUs after surgical debridement. Tissue samples were taken for morphological and genetic tests on days 0, 10 and 15 of local treatment to evaluate expression of collagen genes (i.e. COL1A1, COL1A2, COL3A1 and to perform morphological tests. Results. The present study confirmed that the size of wounds decreased by 8.8 ± 7% after 10 days of local treatment and by 18.3 ± 8% after 15 days of local treatment. According to histological examination of wound biopsies at day 10, all patients showed a tendency for lower levels of inflammatory infiltrate, increased number of fibroblast-like cells, presence of maturing granulation tissue and emergence of connective tissue fibres. After 15 days, we detected inflammatory infiltration in the wounds, despite the formation of mature granulation tissue. According to results of genetic analysis on day 10 of local wound treatment, we found a tendency for increased expression of collagen genes relative to the baseline: COL1A1 increased by 3.2 ± 1.3 times, COL1A2 by 2.0 ± 1.0 times and COL3A1 by 1.25 ± 1.1 times. On day 15 of local treatment, in contrast, we found a tendency for decreased expression of COL1A1, COL1A2 and COL3A1 relative to the baseline (1.7 ± 0.6, 2.5 ± 2 and 20.0 ± 3 times, respectively. Conclusions. The expression of collagen genes (COL1A1, COL1A2, COL3A1 is more pronounced in proliferation phase and is subsequently reduced towards the end. These data were

  16. Importance of factors determining the low health-related quality of life in people presenting with a diabetic foot ulcer

    DEFF Research Database (Denmark)

    Siersma, V; Thorsen, H; Holstein, P E

    2013-01-01

    To identify the factors responsible for the low health-related quality of life associated with foot ulcers and the relative importance of these factors.......To identify the factors responsible for the low health-related quality of life associated with foot ulcers and the relative importance of these factors....

  17. Can plantar soft tissue mechanics enhance prognosis of diabetic foot ulcer?

    Science.gov (United States)

    Naemi, R; Chatzistergos, P; Suresh, S; Sundar, L; Chockalingam, N; Ramachandran, A

    2017-04-01

    To investigate if the assessment of the mechanical properties of plantar soft tissue can increase the accuracy of predicting Diabetic Foot Ulceration (DFU). 40 patients with diabetic neuropathy and no DFU were recruited. Commonly assessed clinical parameters along with plantar soft tissue stiffness and thickness were measured at baseline using ultrasound elastography technique. 7 patients developed foot ulceration during a 12months follow-up. Logistic regression was used to identify parameters that contribute to predicting the DFU incidence. The effect of using parameters related to the mechanical behaviour of plantar soft tissue on the specificity, sensitivity, prediction strength and accuracy of the predicting models for DFU was assessed. Patients with higher plantar soft tissue thickness and lower stiffness at the 1st Metatarsal head area showed an increased risk of DFU. Adding plantar soft tissue stiffness and thickness to the model improved its specificity (by 3%), sensitivity (by 14%), prediction accuracy (by 5%) and prognosis strength (by 1%). The model containing all predictors was able to effectively (χ 2 (8, N=40)=17.55, P<0.05) distinguish between the patients with and without DFU incidence. The mechanical properties of plantar soft tissue can be used to improve the predictability of DFU in moderate/high risk patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Health locus of control theory in diabetes: a worthwhile approach in managing diabetic foot ulcers?

    Science.gov (United States)

    Przybylski, M

    2010-06-01

    The current global epidemic of type two diabetes mellitus has led to an accompanying increase in both foot ulceration and amputations, which pose significant health problems to populations worldwide. If improved treatment options are to be offered, then we clearly need a better understanding of all aspects of this disease. To date the major focus of diabetes research has been on physical factors, which are undeniably important, but there has been little acknowledgement of the significant psychological effects that can influence health and delay wound healing. The 'health locus of control' (HLC) theory, a psychological theory concerning patients' perceptions of how much control they have over life events (both positive and negative) may well be of use in this patient group. It has been suggested that concordance with treatment is improved when patients have a high 'internal' HLC (as measured by a questionnaire), which aligns with the belief that they have greater control over their health. It has further been suggested that through the implementation of 'group-care' education programmes, patients' attitudes can change, with a shift towards higher 'internal' HLC values. Thus a new approach in patient management might be to implement such education programmes, in the hope of improving adherence to treatment regimens and, hence, patient outcomes. To date there has been little conclusive evidence of the application of this theory, and although various studies have been performed in diabetic populations, only one study has been conducted specifically regarding diabetic foot ulcers. Clearly more research is needed.

  19. Diabetic foot ulcers in conjunction with lower limb lymphedema: pathophysiology and treatment procedures

    Directory of Open Access Journals (Sweden)

    Kanapathy M

    2015-08-01

    Full Text Available Muholan Kanapathy,1 Mark J Portou,1,2 Janice Tsui,1,2 Toby Richards1,21Division of Surgery and Interventional Science, University College London, 2Department of Vascular Surgery, Royal Free London NHS Foundation Trust Hospital, London, UKAbstract: Diabetic foot ulcers (DFUs are complex, chronic, and progressive wounds, and have a significant impact on morbidity, mortality, and quality of life. A particular aspect of DFU that has not been reviewed extensively thus far is its management in conjunction with peripheral limb edema. Peripheral limb edema is a feature of diabetes that has been identified as a significant risk factor for amputation in patients with DFU. Three major etiological factors in development of lymphedema with concurrent DFU are diabetic microangiopathy, failure of autonomic regulation, and recurrent infection. This review outlines the pathophysiology of lymphedema formation in patients with DFU and highlights the cellular and immune components of impaired wound healing in lymphedematous DFU. We then discuss the principles of management of DFU in conjunction with lymphedema.Keywords: diabetic foot ulcer, lymphedema, chronic wound, wound management

  20. A whole health economy approach to reducing MRSA bacteraemia incidence in diabetic foot ulcer patients.

    Science.gov (United States)

    Branton, Fiona; Cathcart, Elaine; Bellamy, Elaine

    2016-05-01

    Ulceration of the foot is a common problem among diabetic patients. Infection is a major risk in diabetic foot ulcers (DFU) and many of these are caused by Staphylococcus aureus , in particular meticillin-resistant strains (MRSA). The control and management of MRSA remains a significant challenge and all healthcare organisations in England are required to meet Zero Tolerance Objectives for cases of MRSA bacteraemia (MRSAB). This paper describes a collaborative approach across the health economy to investigate factors contributing to the acquisition of MRSA and MRSAB among DFU patients and make improvements to care to reduce the risk of healthcare-associated infections. A collaborative approach between acute and community healthcare providers and commissioners was used to conduct Root Cause Analysis and drive improvement to prevent MRSA transmission in DFU patients. Screening of all DFU patients was initiated after 6 MRSAB were found to be associated with in DFU. In total 15 patients with the same MRSA antibiogram were identified. Following the implementation of actions focused on isolation, wound management, screening and cleaning no further cases were identified. This outbreak has demonstrated the value of cross-sector collaboration in investigating HCAI in patients with DFU, improving patient care and reducing the risk of MRSA transmission in these vulnerable patents.

  1. The Proteolytic Fraction from Latex of Vasconcellea cundinamarcensis (P1G10) Enhances Wound Healing of Diabetic Foot Ulcers: A Double-Blind Randomized Pilot Study.

    Science.gov (United States)

    Tonaco, Luís A B; Gomes, Flavia L; Velasquez-Melendez, Gustavo; Lopes, Miriam T P; Salas, Carlos E

    2018-04-01

    The aim of the study was to investigate the role of the proteolytic fraction from Vasconcellea cundinamarcensis, designated as P1G10, on the healing of chronic foot ulcers in neuropathic patients with diabetes 2. Fifty patients were enrolled in a prospective, randomized, double-blind trial, to verify the efficacy and safety of a topical dressing formulated with 0.1% P1G10, intended for wound healing, versus a hydrogel (control) protocol. Upon completion of the intervention, the outcome evaluated the number of patients attaining full epithelization (100%), or at least 80% healing. Statistical analysis compared the data on each group for the significance of the differences. Collection of data was finished in week 16, and the results were analyzed by intention to treat. The results showed that, in the control group, 5 patients attained 100% ulcer healing, 3 patients ≥ 80% healing and 11 experienced ulcer changes ≤ 80%, and the remainder showed no changes or their wounds became worse. Meanwhile, in the P1G10 group, 11 patients experienced full healing, 4 had healing ≥ 80% and 5 had ulcer changes ≤ lower than 80%, and the remainder showed no changes or their wounds became worse. The healing incidence for the first endpoint (100% healing) showed that the P1G10 group was 2.95-fold more efficacious than the control group (CI 95%) and 2.52-fold (CI, 95%) higher than its control for the second endpoint (80% healing). These data support the hypothesis that topical application of the proteolytic fraction identified as P1G10 significantly enhances foot ulcer healing compared to hydrogel treatment.

  2. Staphylococcus aureus Toxins and Diabetic Foot Ulcers: Role in Pathogenesis and Interest in Diagnosis

    Science.gov (United States)

    Dunyach-Remy, Catherine; Ngba Essebe, Christelle; Sotto, Albert; Lavigne, Jean-Philippe

    2016-01-01

    Infection of foot ulcers is a common, often severe and costly complication in diabetes. Diabetic foot infections (DFI) are mainly polymicrobial, and Staphylococcus aureus is the most frequent pathogen isolated. The numerous virulence factors and toxins produced by S. aureus during an infection are well characterized. However, some particular features could be observed in DFI. The aim of this review is to describe the role of S. aureus in DFI and the implication of its toxins in the establishment of the infection. Studies on this issue have helped to distinguish two S. aureus populations in DFI: toxinogenic S. aureus strains (harboring exfoliatin-, EDIN-, PVL- or TSST-encoding genes) and non-toxinogenic strains. Toxinogenic strains are often present in infections with a more severe grade and systemic impact, whereas non-toxinogenic strains seem to remain localized in deep structures and bone involving diabetic foot osteomyelitis. Testing the virulence profile of bacteria seems to be a promising way to predict the behavior of S. aureus in the chronic wounds. PMID:27399775

  3. Skin grafting and tissue replacement for treating foot ulcers in people with diabetes.

    Science.gov (United States)

    Santema, Trientje B; Poyck, Paul P C; Ubbink, Dirk T

    2016-02-11

    Foot ulceration is a major problem in people with diabetes and is the leading cause of hospitalisation and limb amputations. Skin grafts and tissue replacements can be used to reconstruct skin defects for people with diabetic foot ulcers in addition to providing them with standard care. Skin substitutes can consist of bioengineered or artificial skin, autografts (taken from the patient), allografts (taken from another person) or xenografts (taken from animals). To determine the benefits and harms of skin grafting and tissue replacement for treating foot ulcers in people with diabetes. In April 2015 we searched: The Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. We also searched clinical trial registries to identify ongoing studies. We did not apply restrictions to language, date of publication or study setting. Randomised clinical trials (RCTs) of skin grafts or tissue replacements for treating foot ulcers in people with diabetes. Two review authors independently extracted data and assessed the quality of the included studies. We included seventeen studies with a total of 1655 randomised participants in this review. Risk of bias was variable among studies. Blinding of participants, personnel and outcome assessment was not possible in most trials because of obvious differences between the treatments. The lack of a blinded outcome assessor may have caused detection bias when ulcer healing was assessed. However, possible detection bias is hard to prevent due to the nature of the skin replacement products we assessed, and the fact that they are easily recognisable. Strikingly, nearly all studies (15/17) reported industry involvement; at least one of the authors was connected to a commercial organisation or the study was funded by a commercial organisation. In addition, the funnel plot for

  4. A study of prognostic factors in Chinese patients with diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Aiping Wang

    2014-03-01

    Full Text Available Objective: Few studies have identified factors as predictors of clinical prognosis of patients with diabetic foot ulcers (DFUs, especially of Chinese patients. In this study, we assessed the prognostic factors of Chinese patients with DFUs. Methods and materials: This was a retrospective study (January 2009–January 2011 of 194 DFUs conducted in an inpatient population at PLA 454 Hospital in Nanjing, China, to determine the prognostic influential factors of DFUs in Chinese patients. All of the studied patients were grouped into an amputation group, a non-healing group, and a cured group, according to the clinical prognosis. Patient parameters, including gender, age, smoking habits, education level, family history of diabetes mellitus, medical history, duration of foot lesions and complications, ankle-brachial index (ABI, transcutaneous oxygen pressure (TcPO2, urinary albumin/creatinine ratio (Alb/Cr, fundus oculi, electrocardiogram, DFU characteristics, bacterial nature, and neuropathy, were cross-studied among the three groups. Results: Compared with the other two groups, the amputation group showed a higher number of males, older in age, lower ABI and TcPO2 levels, higher Wagner wound grading and size, and significantly higher urinary Alb/Cr ratio, blood urea nitrogen, serum creatinine, white blood cell count, and erythrocyte sedimentation rate. Compared to the cured group (162 patients, more patients with an older age, smoking, family history of diabetes mellitus, medical history of foot ulcerations, lower ABI and TcPO2 levels, higher urine Alb/Cr ratio, and serum creatinine were found in the non-healing group. Regression analysis was used to study the correlation between various factors and clinical prognosis, and the results were as follows: age, Wagner wound classification, and heel ulcerations were negatively correlated to the DFU prognosis, whereas the female population, ABI, and TcPO2 were positively correlated with DFU prognosis

  5. Investigating the effect of external trauma through a dynamic system modeling approach for clustering causality in diabetic foot ulcer development.

    Science.gov (United States)

    Salimi, Parisa; Hamedi, Mohsen; Jamshidi, Nima; Vismeh, Milad

    2017-04-01

    Diabetes and its associated complications are realized as one of the most challenging medical conditions threatening more than 29 million people only in the USA. The forecasts suggest a suffering of more than half a billion worldwide by 2030. Amid all diabetic complications, diabetic foot ulcer (DFU) has attracted much scientific investigations to lead to a better management of this disease. In this paper, a system thinking methodology is adopted to investigate the dynamic nature of the ulceration. The causal loop diagram as a tool is utilized to illustrate the well-researched relations and interrelations between causes of the DFU. The result of clustering causality evaluation suggests a vicious loop that relates external trauma to callus. Consequently a hypothesis is presented which localizes development of foot ulceration considering distribution of normal and shear stress. It specifies that normal and tangential forces, as the main representatives of external trauma, play the most important role in foot ulceration. The evaluation of this hypothesis suggests the significance of the information related to both normal and shear stress for managing DFU. The results also discusses how these two react on different locations on foot such as metatarsal head, heel and hallux. The findings of this study can facilitate tackling the complexity of DFU problem and looking for constructive mitigation measures. Moreover they lead to developing a more promising methodology for managing DFU including better prognosis, designing prosthesis and insoles for DFU and patient caring recommendations. Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. What's new in the literature: an update of new research since the original WHS diabetic foot ulcer guidelines in 2006.

    Science.gov (United States)

    Braun, Liza; Kim, Paul J; Margolis, David; Peters, Edgar J; Lavery, Lawrence A

    2014-01-01

    The objective of the paper was to update the diabetic foot ulcer guidelines that were previously published in 2006. We performed a key word search using MEDLINE and Cochrane reviews for publication between January 2006 and January 2012. Articles that fit the inclusion criteria were reviewed and the previous guidelines were updated. © 2014 by the Wound Healing Society.

  7. In vitro studies on medicinal plants used against bacterial diabetic foot ulcer (BDFU) and urinary tract infected (UTI) causing pathogens.

    Science.gov (United States)

    Subbu Lakshmi, S; Chelladurai, G; Suresh, B

    2016-09-01

    The pus samples from diabetic foot ulcer patients and urine samples from urinary tract infected patients were collected and inoculated in nutrient agar plates. The colonies showing different morphologies were streaked on selective agar plates. The antibacterial assay of selected commercial antibiotics was tested against the foot ulcer and urinary tract isolates. The result revealed that most of the organisms were found to be resistant against the antibiotics. Screening of antibacterial activity of selected plants, methanol extracts of plants were prepared and tested against foot ulcer pathogens. Among the plants used, the methanolic extract Tragia involucrata was very effective against the foot ulcer pathogens and to separate the compounds present in the methanolic extract of T. involucrata, when it was subjected to column chromatography. The fractions obtained were further checked for their antibacterial property and fraction 1 which inhibited the pathogens, were subjected to thin layer chromatography and the structure of the particular phytochemical compound was elucidated by NMR study. The spices were tested for their antibacterial property against the urinary tract pathogens. Among the spices tested; Allium sativum inhibited the growth of the pathogens isolated from urinary tract infection. It can be concluded that the plants extract can be used to discover natural products that may serve as lead for the development of new pharmaceuticals addressing the major therapeutic needs.

  8. The Relationship Between Osteomyelitis Complication and Drug-Resistant Infection Risk in Diabetic Foot Ulcer: A Meta-analysis.

    Science.gov (United States)

    Chen, Yin; Ding, Hui; Wu, Hua; Chen, Hong-Lin

    2017-09-01

    In this study, we aimed to investigate the relationship between osteomyelitis complications and drug-resistant infection risk in diabetic foot ulcer. Searches of MEDLINE and ISI databases were performed for the studies. Odds ratios (ORs) for drug-resistant infection incidence were calculated for diabetic foot ulcer patients with or without osteomyelitis complications. Eleven studies (12 cohorts) with 1526 patients were included in this study. Meta-analysis showed that the summary OR was 3.343 (95% CI = 2.355-4.745; Z = 6.75, P analysis by only pooled the adjusted ORs showed that the result was robust (the summary OR = 4.081, 95% CI = 2.471-6.739). Subgroup analysis by drug-resistant type showed that the summary OR was 4.391 (95% CI = 2.287-8.394) for methicillin-resistant infection subgroup, and 2.693 (95% CI = 1.882-3.851) for multidrug-resistant infection subgroup. The meta-regression showed that drug-resistant incidence ( t = -0.90, P = .389) and published year ( t = -0.11, P = .913) were not related with the OR changes. In conclusion, our meta-analysis indicates that osteomyelitis complications are related with drug-resistant infection risk in diabetic foot ulcer. We suggest bone culture-based narrow-spectrum antibiotic therapy for osteomyelitis for prevention drug-resistant infection in diabetic foot ulcer.

  9. Decreasing incidence of foot ulcer among patients with type 1 and type 2 diabetes in the period 2001-2014

    DEFF Research Database (Denmark)

    Rasmussen, A.; Almdal, T.; Nielsen, A. Anker

    2017-01-01

    Aim: Diabetic foot ulcer (DFU) is a serious complication to diabetes. The aim was to study the incidence of first DFU among patients with type 1 (T1DM) and type 2 diabetes (T2DM), stratified according to etiology: neuropathic, neuro-ischemic or ischemic, over a period of 14 years (2001–2014). Met...

  10. Wound healing effects of dipeptidyl peptidase-4 inhibitors: An emerging concept in management of diabetic foot ulcer-A review.

    Science.gov (United States)

    Saboo, Apoorva; Rathnayake, Ayeshmanthe; Vangaveti, Venkat N; Malabu, Usman H

    2016-01-01

    Dipeptidyl peptidase-4 (DPP-4) inhibitors have a well-known effect on glycaemic control in patients with diabetes but little is known on their wound healing role in this group of population. This paper reviews the effects of DPP-4 inhibitors on wound healing of diabetic foot ulcers. Published data on effects and mechanism of DDP-4 inhibitors on wound healing were derived from Medline, PubMed and Google Scholar search of English language literature from 1994 to 2014 using the key words such as "DPP-4 inhibitors", "endothelial healing" "diabetes" and "chronic ulcers". DPP-4 inhibitors show a potential benefit in processes of wound healing in diabetic chronic foot ulcers. The enzyme inhibitors promote recruitment of endothelial progenitor cells and allow the final scaffolding of wounds. Furthermore DPP-4 inhibitors augment angiogenesis and have widespread effects on optimising the immune response to persistent hypoxia in chronic diabetes wounds. DPP-4 inhibitors show promise in the local wound healing of diabetic foot ulcers in addition to its already established glycaemic control. In the light of high rate of amputations due to non-healing ulcers with profound psychological and economical liability, more investigations on the usefulness of DPP-4 inhibitors in the high risk diabetes population are needed. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  11. Increased Number of Langerhans Cells in the Epidermis of Diabetic Foot Ulcers Correlates with Healing Outcome

    Science.gov (United States)

    Stojadinovic, Olivera; Yin, Natalie; Lehmann, Janin; Pastar, Irena; Kirsner, Robert S.; Tomic-Canic, Marjana

    2015-01-01

    Langerhans cells (LCs) are a specialized subset of epidermal dendritic cells. They represent one of the first cells of immunological barrier and play an important role during the inflammatory phase of acute wound healing. Despite considerable progress in our understanding of the immunopathology of diabetes mellitus and its associated co-morbidities such as diabetic foot ulcers (DFUs), considerable gaps in our knowledge exist. In this study, we utilized the human ex vivo wound model and confirmed the increased epidermal LCs at wound edges during early phases of wound healing. Next, we aimed to determine differences in quantity of LCs between normal human and diabetic foot skin and to learn if the presence of LCs correlates with the healing outcome in DFUs. We utilized immunofluorescence to detect CD207+ LCs in specimens from normal and diabetic foot skin and DFU wound edges. Specimens from DFUs were collected at the initial visit and 4 weeks at the time when the healing outcome was determined. DFUs that decreased in size by >50% were considered to be healing, while DFUs with a size reduction of healing. Quantitative assessment of LCs showed a higher number of LCs in healing when compared to non–healing DFU’s. Our findings provide evidence that LCs are present in higher number in diabetic feet than normal foot skin. Healing DFUs show a higher number of LCs compared to non-healing DFUs. These findings indicate that the epidermal immune barrier plays an important role in the DFU healing outcome and may offer new therapeutic avenues targeting LC in non-healing DFUs. PMID:24277309

  12. Comparison of characteristics and healing course of diabetic foot ulcers by etiological classification: neuropathic, ischemic, and neuro-ischemic type.

    Science.gov (United States)

    Yotsu, Rie Roselyne; Pham, Ngoc Minh; Oe, Makoto; Nagase, Takeshi; Sanada, Hiromi; Hara, Hisao; Fukuda, Shoji; Fujitani, Junko; Yamamoto-Honda, Ritsuko; Kajio, Hiroshi; Noda, Mitsuhiko; Tamaki, Takeshi

    2014-01-01

    To identify differences in the characteristics of patients with diabetic foot ulcers (DFUs) according to their etiological classification and to compare their healing time. Over a 4.5-year period, 73 patients with DFUs were recruited. DFUs were etiologically classified as being of neuropathic, ischemic, or neuro-ischemic origin. Descriptive analyses were performed to characterize study subjects, foot-related factors, and healing outcome and time. Duration of healing was assessed using the Kaplan-Meier method. Healing time among the three types was compared using the log rank test. The number of patients manifesting neuropathic, ischemic, and neuro-ischemic ulcers was 30, 20, and 14, respectively. Differences were identified for age, diabetes duration, body mass index, hypertension, and estimated glomerular filtration rate. Patients with neuro-ischemic ulcers had better ankle-brachial index, skin perfusion pressure (SPP), and transcutaneous oxygen pressure values compared to those with ischemic ulcers. The average time in which 50% of patients had healed wounds was 70, 113, and 233 days for neuropathic, neuro-ischemic, and ischemic ulcers, respectively. Main factors associated with healing were age and SPP values. Based on the etiological ulcer type, DFU healing course and several patient factors differed. Failure to consider the differences in DFU etiology may have led to heterogeneity of results in previous studies on DFUs. Copyright © 2014 Elsevier Inc. All rights reserved.

  13. Lower limb ischaemia in patients with diabetic foot ulcers and gangrene: recognition, anatomic patterns and revascularization strategies.

    Science.gov (United States)

    Mills, Joseph L

    2016-01-01

    The confluence of several chronic conditions--in particular ageing, peripheral artery disease, diabetes, and chronic kidney disease--has created a global wave of lower limbs at risk for major amputation. While frequently asymptomatic or not lifestyle limiting, at least 1% of the population has peripheral artery disease of sufficient severity to be limb threatening. To avoid the critical error of failing to diagnose ischaemia, all patients with diabetic foot ulcers and gangrene should routinely undergo physiologic evaluation of foot perfusion. Ankle brachial index is useful when measurable, but may be falsely elevated or not obtainable in as many as 30% of patients with diabetic foot ulcers primarily because of medial calcinosis. Toe pressures and skin perfusion pressures are applicable to such patients. Copyright © 2016 John Wiley & Sons, Ltd.

  14. Association of fibrinogen with HbA1C in diabetic foot ulcer

    Science.gov (United States)

    Pase, M. A.; Gatot, D.; Lindarto, D.

    2018-03-01

    Fibrinogen is one of the inflammatory markers of vascular changes and endothelial dysfunction in diabetic patients. The aim of this study to associate serum fibrinogen levels with HbA1C in diabetic foot ulcer (DFU). This study was cross-sectional and retrospective in DFU patients from January to July 2017 in Haji Adam Malik Central General Hospital. The patients enrolled in the study were T2DM with DFU as a complication. The grading of DFU was evaluated according to the Wagner’s Classification. Serum fibrinogen level, HbA1C and ankle-brachial index (ABI) were carried out directly in the patients. Fibrinogen serum levels were found significantly with HbA1C (P=0.001, r=0.387) and ABI (P=0.008, r=-0.454). Fibrinogen serum levels in DFU patients were positively correlated with HbA1C and significantly higher in patients with poor glycemic control.

  15. Wound-Healing Peptides for Treatment of Chronic Diabetic Foot Ulcers and Other Infected Skin Injuries

    Directory of Open Access Journals (Sweden)

    Ana Gomes

    2017-10-01

    Full Text Available As the incidence of diabetes continues to increase in the western world, the prevalence of chronic wounds related to this condition continues to be a major focus of wound care research. Additionally, over 50% of chronic wounds exhibit signs and symptoms that are consistent with localized bacterial biofilms underlying severe infections that contribute to tissue destruction, delayed wound-healing and other serious complications. Most current biomedical approaches for advanced wound care aim at providing antimicrobial protection to the open wound together with a matrix scaffold (often collagen-based to boost reestablishment of the skin tissue. Therefore, the present review is focused on the efforts that have been made over the past years to find peptides possessing wound-healing properties, towards the development of new and effective wound care treatments for diabetic foot ulcers and other skin and soft tissue infections.

  16. Wound-Healing Peptides for Treatment of Chronic Diabetic Foot Ulcers and Other Infected Skin Injuries.

    Science.gov (United States)

    Gomes, Ana; Teixeira, Cátia; Ferraz, Ricardo; Prudêncio, Cristina; Gomes, Paula

    2017-10-18

    As the incidence of diabetes continues to increase in the western world, the prevalence of chronic wounds related to this condition continues to be a major focus of wound care research. Additionally, over 50% of chronic wounds exhibit signs and symptoms that are consistent with localized bacterial biofilms underlying severe infections that contribute to tissue destruction, delayed wound-healing and other serious complications. Most current biomedical approaches for advanced wound care aim at providing antimicrobial protection to the open wound together with a matrix scaffold (often collagen-based) to boost reestablishment of the skin tissue. Therefore, the present review is focused on the efforts that have been made over the past years to find peptides possessing wound-healing properties, towards the development of new and effective wound care treatments for diabetic foot ulcers and other skin and soft tissue infections.

  17. Pervasive Home Care - Technological support for treatment of diabetic foot ulcers at home

    DEFF Research Database (Denmark)

    Larsen, Simon Bo

    2006-01-01

    of the patient in collaboration with patient and home care clinicians. My main research method has been qualitative analysis of the empirical results generated during an experimental project using Participatory Design (PD) to investigate potential futures in the treatment of patients with diabetic foot ulcers...... the need arises for moving treatment and care involving specialised knowledge from the hospital to the home. In this dissertation I use the term Home Care" for the multidisciplinary investigation of how this movement can be supported with technology enabling the expert to carry on a treatment in the home...... approach that I outline in this dissertation. Furthermore I describe the results of the project contributing to three related scientific fields: home care technologies, telemedicine and computer supported cooperative work (CSCW). The main conclusion towards home care technologies is that the many visionary...

  18. Pirfenidone Accelerates Wound Healing in Chronic Diabetic Foot Ulcers: A Randomized, Double-Blind Controlled Trial

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    Luz E. Gasca-Lozano

    2017-01-01

    Full Text Available Background. Diabetic foot ulcers are one disabling complication of diabetes mellitus. Pirfenidone (PFD is a potent modulator of extracellular matrix. Modified diallyl disulfide oxide (M-DDO is an antimicrobial and antiseptic agent. Aim. To evaluate efficacy of topical PFD + M-DDO in a randomized, double-blind trial versus ketanserin in the treatment of noninfected chronic DFU. Methods. Patients received PFD + M-DDO or ketanserin for 6 months. Relative ulcer volume (RUV was measured every month; biopsies were taken at baseline and months 1 and 2 for histopathology and gene expression analysis for COL-1α, COL-4, KGF, VEGF, ACTA2 (α-SMA, elastin, fibronectin, TGF-β1, TGF-β3, HIF-1α, and HIF-1β. Results. Reduction of median RUV in the PFD + M-DDO group was 62%, 89.8%, and 99.7% at months 1–3 and 100% from months 4 to 6. Ketanserin reduced RUV in 38.4%, 56%, 60.8%, 94%, 94.8%, and 100% from the first to the sixth month, respectively. Healing score improved 4.5 points with PFD + M-DDO and 1.5 points with ketanserin compared to basal value. Histology analysis revealed few inflammatory cells and organized/ordered collagen fiber bundles in PFD + M-DDO. Expression of most genes was increased with PFD + M-DDO; 43.8% of ulcers were resolved using PFD + M-DDO and 23.5% with ketanserin. Conclusion. PFD + M-DDO was more effective than ketanserin in RUV reduction.

  19. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study

    DEFF Research Database (Denmark)

    Prompers, L.; Schaper, N.; Apelqvist, J.

    2008-01-01

    ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of non-healing in PAD patients only. Conclusions/Interpretation Predictors of healing differ between patients with and without PAD, suggesting that diabetic foot......Aims/hypothesis Outcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD). We therefore examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients and examined whether...

  20. Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers.

    Science.gov (United States)

    Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

    2015-01-01

    Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan(®). An exploratory analysis of the association of risk factors with PP was performed. Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux rigidus appeared to increase the PP under the medial

  1. Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers

    Directory of Open Access Journals (Sweden)

    Ulla Hellstrand Tang

    2015-06-01

    Full Text Available Objective: Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients and methods: Patients diagnosed with type 1 (n=27 or type 2 (n=47 diabetes (mean age 60.0±15.0 years were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan®. An exploratory analysis of the association of risk factors with PP was performed. Results: Neuropathy was present in 28 (38%, and 39 (53% had callosities in the heel region. Low forefoot arch was present in 57 (77%. Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. Conclusions: This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU. Hallux valgus

  2. Adherence to wearing prescription custom-made footwear in patients with diabetes at high risk for plantar foot ulceration.

    Science.gov (United States)

    Waaijman, Roelof; Keukenkamp, Renske; de Haart, Mirjam; Polomski, Wojtek P; Nollet, Frans; Bus, Sicco A

    2013-06-01

    Prescription custom-made footwear can only be effective in preventing diabetic foot ulcers if worn by the patient. Particularly, the high prevalence of recurrent foot ulcers focuses the attention on adherence, for which objective data are nonexisting. We objectively assessed adherence in patients with high risk of ulcer recurrence and evaluated what determines adherence. In 107 patients with diabetes, neuropathy, a recently healed plantar foot ulcer, and custom-made footwear, footwear use was measured during 7 consecutive days using a shoe-worn, temperature-based monitor. Daily step count was measured simultaneously using an ankle-worn activity monitor. Patients logged time away from home. Adherence was calculated as the percentage of steps that prescription footwear was worn. Determinants of adherence were evaluated in multivariate linear regression analysis. Mean ± SD adherence was 71 ± 25%. Adherence at home was 61 ± 32%, over 3,959 ± 2,594 steps, and away from home 87 ± 26%, over 2,604 ± 2,507 steps. In 35 patients with low adherence (footwear were significantly associated with higher adherence. The results show that adherence to wearing custom-made footwear is insufficient, particularly at home where patients exhibit their largest walking activity. This low adherence is a major threat for reulceration. These objective findings provide directions for improvement in adherence, which could include prescribing specific off-loading footwear for indoors, and they set a reference for future comparative research on footwear adherence in diabetes.

  3. Increased ratio of serum matrix metalloproteinase-9 against TIMP-1 predicts poor wound healing in diabetic foot ulcers.

    Science.gov (United States)

    Li, Zhihong; Guo, Shuqin; Yao, Fang; Zhang, Yunliang; Li, Tingting

    2013-01-01

    Little is known about serum concentrations of Matrix Metalloproteinase-9 (MMP-9), MMP-2, TIMP-1 and TIMP-2 in diabetic patients with foot ulcers. This study demonstrates their relationship with wound healing. Ninety-four patients with diabetic foot ulcers were recruited in the study. Serum MMP-9, MMP-2, TIMP-1 and TIMP-2 were measured at the first clinic visit and the end of 4-week treatment and followed up till 12 weeks. According to the decreasing rate of ulcer healing area at the fourth week, we divided those cases into good and poor healers. Through analyses, we explore the possible relationship among those factors and degree of wound healing. The median level of serum MMP-9 in good healers was lower than poor healers at first visit (124.2 μg/L vs 374.6 μg/L, phealing than MMP-9 alone before therapy and after 4 week treatment (r = -0.6475 vs -0.3251, r = -0.7096 vs -0.1231, respectively). Receiver Operator Curve (ROC) showed that the cutoff for MMP-9/TIMP-1 ratio at healing and might provide a novel target for the future therapy in diabetic foot ulcers. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Motivation, effort and life circumstances as predictors of foot ulcers and amputations in people with Type 2 diabetes mellitus.

    Science.gov (United States)

    Bruun, C; Guassora, A D; Nielsen, A B S; Siersma, V; Holstein, P E; de Fine Olivarius, N

    2014-11-01

    To investigate the predictive value of both patients' motivation and effort in their management of Type 2 diabetes and their life circumstances for the development of foot ulcers and amputations. This study was based on the Diabetes Care in General Practice study and Danish population and health registers. The associations between patient motivation, effort and life circumstances and foot ulcer prevalence 6 years after diabetes diagnosis and the incidence of amputation in the following 13 years were analysed using odds ratios from logistic regression and hazard ratios from Cox regression models, respectively. Foot ulcer prevalence 6 years after diabetes diagnosis was 2.93% (95% CI 1.86-4.00) among 956 patients. General practitioners' indication of 'poor' vs 'very good' patient motivation for diabetes management was associated with higher foot ulcer prevalence (odds ratio 6.11, 95% CI 1.22-30.61). The same trend was seen for 'poor' vs 'good' influence of the patient's own effort in diabetes treatment (odds ratio 7.06, 95% CI 2.65-18.84). Of 1058 patients examined at 6-year follow-up, 45 experienced amputation during the following 13 years. 'Poor' vs 'good' influence of the patients' own effort was associated with amputation (hazard ratio 7.12, 95% CI 3.40-14.92). When general practitioners assessed the influence of patients' life circumstances as 'poor' vs 'good', the amputation incidence increased (hazard ratio 2.97, 95% CI 1.22-7.24). 'Poor' vs 'very good' patient motivation was also associated with a higher amputation incidence (hazard ratio 7.57, 95% CI 2.43-23.57), although not in fully adjusted models. General practitioners' existing knowledge of patients' life circumstances, motivation and effort in diabetes management should be included in treatment strategies to prevent foot complications. © 2014 The Authors. Diabetic Medicine © 2014 Diabetes UK.

  5. Comparisons of negative pressure wound therapy and ultrasonic debridement for diabetic foot ulcers: a network meta-analysis.

    Science.gov (United States)

    Wang, Ruran; Feng, Yanhua; Di, Bo

    2015-01-01

    a network meta-analysis was performed to compare the strength and weakness of negative pressure wound therapy (NPWT) with ultrasound debridement (UD) as for diabetic foot ulcers (DFU). PubMed, Ovid EMBASE, Web of Science, Cochrane library databases, and Chinese Biomedical Literature Database were searched till February 2015. Clinical compared studies of negative pressure wound therapy and ultrasound debridement were enrolled. The primary efficacy outcomes included healed ulcers, reduction of ulcer areas and time to closure. Secondary amputation including major and minor amputations was used to assess the safety profile. Out of 715 studies, 32 were selected which enrolled 2880 diabetic patients. The pooled analysis revealed that NPWT including vacuum assisted closure (VAC) and vacuum sealing drainage (VSD) were as efficacious as ultrasound debridement improving healed ulcers, odds ratio, 0.86; 95% CI 0.28 to 2.6 and 1.2; 95% CI 0.38 to 4, respectively. However, both were better to standard wound care in wound healing patients. Compared with the standard wound care treated diabetic foot ulcers, NPWT and UD resulted in a significantly superior efficacy in time to wound closure and decrement in area of wound. No significances were observed between NPWT and UD groups in both indicators. Fewer patients tended to receive amputation in NPWT and UD groups compared to standard wound care group. The results of the network meta-analysis indicated that negative pressure wound therapy was similar to ultrasound debridement for diabetic foot ulcers, but better than standard wound care both in efficacy and safety profile.

  6. Comparisons of negative pressure wound therapy and ultrasonic debridement for diabetic foot ulcers: a network meta-analysis

    Science.gov (United States)

    Wang, Ruran; Feng, Yanhua; Di, Bo

    2015-01-01

    Objective: a network meta-analysis was performed to compare the strength and weakness of negative pressure wound therapy (NPWT) with ultrasound debridement (UD) as for diabetic foot ulcers (DFU). Methods: PubMed, Ovid EMBASE, Web of Science, Cochrane library databases, and Chinese Biomedical Literature Database were searched till February 2015. Clinical compared studies of negative pressure wound therapy and ultrasound debridement were enrolled. The primary efficacy outcomes included healed ulcers, reduction of ulcer areas and time to closure. Secondary amputation including major and minor amputations was used to assess the safety profile. Results: Out of 715 studies, 32 were selected which enrolled 2880 diabetic patients. The pooled analysis revealed that NPWT including vacuum assisted closure (VAC) and vacuum sealing drainage (VSD) were as efficacious as ultrasound debridement improving healed ulcers, odds ratio, 0.86; 95% CI 0.28 to 2.6 and 1.2; 95% CI 0.38 to 4, respectively. However, both were better to standard wound care in wound healing patients. Compared with the standard wound care treated diabetic foot ulcers, NPWT and UD resulted in a significantly superior efficacy in time to wound closure and decrement in area of wound. No significances were observed between NPWT and UD groups in both indicators. Fewer patients tended to receive amputation in NPWT and UD groups compared to standard wound care group. Conclusions: The results of the network meta-analysis indicated that negative pressure wound therapy was similar to ultrasound debridement for diabetic foot ulcers, but better than standard wound care both in efficacy and safety profile. PMID:26550165

  7. STUDY ON COMPARISON OF THE EFFECT OF TOPICAL INSULIN WITH NORMAL SALINE DRESSING IN HEALING OF DIABETIC FOOT ULCERS

    Directory of Open Access Journals (Sweden)

    Chinnam Venkata Reddy

    2017-05-01

    Full Text Available BACKGROUND Numerous topical medication and gels are promoted for ulcer care and healing. Relatively, few have proved to be more efficacious than saline wet-to-dry dressings. The present study was aimed to compare the effect of topical insulin and normal saline dressing in healing of diabetic foot ulcers. MATERIALS AND METHODS The present two-year hospital-based randomised-controlled trial was conducted in the Department of General Surgery, Rangaraya Medical College, Kakinada, from April 2015 to March 2017. A total of 60 patients with diabetic foot ulcers were studied. Based on the envelop method, patients were divided into two groups of 30 patients each that is group A (topical insulin and group B (normal saline. RESULTS In this males (66.67% in group A and 83.33% in group B outnumbered females in both the groups with male-to-female ratio of 2:1 in group A and 4:1 in group B. The mean age in group A was 52.00 ± 11.00 years, and in group B, it was 57.00 ± 9.80 years (p=1.000. Among patients with group A, significant reduction of mean ulcer area was observed (307.23 ± 169.87 mm2 with higher mean percentage reduction (35.19 ± 19.00 percent, whereas in group B, the mean percentage reduction was significantly less (18.82 ± 4.06 percent with less reduction of mean final ulcer area (149.90 ± 64.45 mm2 (p<0.001. CONCLUSION Overall, topical insulin dressing provided favourable outcome in patients with diabetic foot ulcer by significant reduction in wound area when compared to normal saline dressing and it had positive role in reducing the wound infection if present.

  8. Epidemiology of Diabetic Foot Ulcers and Amputations in Romania: Results of a Cross-Sectional Quality of Life Questionnaire Based Survey

    Directory of Open Access Journals (Sweden)

    Cosmina I. Bondor

    2016-01-01

    Full Text Available This is a post hoc analysis of quality of life in diabetic neuropathy patients in a cross-sectional survey performed in 2012 in Romania, using the Norfolk QOL-DN in which 21,756 patients with self-reported diabetes were enrolled. This current analysis aims to expand research on the diabetic foot and to provide an update on the number of foot ulcers found in Romania. Of the 21,174 patients included in this analysis, 14.85% reported a history of foot ulcers and 3.60% reported an amputation. The percentage of neuropathy patients with foot ulcers increased with age; the lowest percentage was observed in the 20–29-year age group (6.62% and the highest in the 80–89-year age group (17.68%. The highest number of amputations was reported in the 70–79-year age group (largest group. Compared to patients without foot ulcers, those with foot ulcers had significantly higher scores for total DN and all its subdomains translating to worse QOL (p<0.001. This analysis showed a high rate of foot ulcers and amputations in Romanian diabetic patients. It underscores the need for implementation of effective screening and educational programs.

  9. The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification independently predicts wound healing in diabetic foot ulcers.

    Science.gov (United States)

    Hicks, Caitlin W; Canner, Joseph K; Mathioudakis, Nestoras; Sherman, Ronald; Malas, Mahmoud B; Black, James H; Abularrage, Christopher J

    2018-04-02

    Previous studies have reported correlation between the Wound, Ischemia, and foot Infection (WIfI) classification system and wound healing time on unadjusted analyses. However, in the only multivariable analysis to date, WIfI stage was not predictive of wound healing. Our aim was to examine the association between WIfI classification and wound healing after risk adjustment in patients with diabetic foot ulcers (DFUs) treated in a multidisciplinary setting. All patients presenting to our multidisciplinary DFU clinic from June 2012 to July 2017 were enrolled in a prospective database. A Cox proportional hazards model accounting for patients' sociodemographics, comorbidities, medication profiles, and wound characteristics was used to assess the association between WIfI classification and likelihood of wound healing at 1 year. There were 310 DFU patients enrolled (mean age, 59.0 ± 0.7 years; 60.3% male; 60.0% black) with 709 wounds, including 32.4% WIfI stage 1, 19.9% stage 2, 25.2% stage 3, and 22.4% stage 4. Mean wound healing time increased with increasing WIfI stage (stage 1, 96.9 ± 8.3 days; stage 4, 195.1 ± 10.6 days; P healing at 1 year was 94.1% ± 2.0% for stage 1 wounds vs 67.4% ± 4.4% for stage 4 (P healing (stage 4 vs stage 1: hazard ratio, [HR] 0.44; 95% confidence interval, 0.33-0.59). Peripheral artery disease (HR, 0.73), increasing wound area (HR, 0.99 per square centimeter), and longer time from wound onset to first assessment (HR, 0.97 per month) also decreased the likelihood of wound healing, whereas use of clopidogrel was protective (HR, 1.39; all, P ≤ .04). The top three predictors of poor wound healing were WIfI stage 4 (z score, -5.40), increasing wound area (z score, -3.14), and WIfI stage 3 (z score, -3.11), respectively. Among patients with DFU, the WIfI classification system predicts wound healing at 1 year in both crude and risk-adjusted analyses. This is the first study to validate the WIfI score as an independent

  10. The impact of glycaemic variability on wound healing in the diabetic foot - A retrospective study of new ulcers presenting to a specialist multidisciplinary foot clinic.

    Science.gov (United States)

    Dhatariya, Ketan K; Li Ping Wah-Pun Sin, Edwin; Cheng, Joyce Oi Suet; Li, Francesca Yan Nok; Yue, Anson Wei Yue; Gooday, Catherine; Nunney, Ian

    2018-01-01

    Glycaemic variability - the visit-to-visit variation in HbA1c - plays a possible role in the development of micro and macrovascular disease in patients with diabetes. Whether HbA1c variability is a factor determining wound healing in diabetic foot ulcers remains unknown. We aimed to determine whether HbA1c variability is associated with foot ulcer healing time. A retrospective analysis of patients presenting to our specialist multidisciplinary foot clinic between July 2013 and March 2015, with at least three HbA1c measurements within five years of presentation and more than two follow-up reviews. HbA1c variation was measured by magnitude of standard deviation. 629 new referrals were seen between July 2013 and March 2015. Of these, 172 patients had their number of days to healing recorded and sufficient numbers of HbA1c values to determine variability. The overall geometric mean days to heal was 91.1 days (SD 80.8-102.7). In the low HbA1c variability group the geometric mean days to heal was 78.0 days (60.2-101.2) vs 126.9 days (102.0-158.0) in the high Hb1Ac variability group (p = .032). Those with low HbA1c (healed faster than those with high HbA1c and high variability (73.5 days [59.5-90.8] vs 111.0 days [92.0-134.0], p = .007). Additionally, our results show that time to healing is more dependent on the mean HbA1c than the variability in HbA1c (p = .007). Our data suggest that there was a significant association between HbA1c variability and healing time in diabetic foot ulcers. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Amputations and foot ulcers in patients newly diagnosed with Type 2 diabetes mellitus and observed for 19 years. The role of age, gender and co-morbidity

    DEFF Research Database (Denmark)

    Bruun, C; Siersma, V.; Guassora, A.D.

    2013-01-01

    To determine the prevalence of foot ulcers and the incidence of amputations in patients with Type 2 diabetes observed for 19 years after diagnosis. We investigated the role of gender, age and co-morbidities.......To determine the prevalence of foot ulcers and the incidence of amputations in patients with Type 2 diabetes observed for 19 years after diagnosis. We investigated the role of gender, age and co-morbidities....

  12. Cost-effectiveness of becaplermin gel on wound healing of diabetic foot ulcers.

    Science.gov (United States)

    Gilligan, Adrienne M; Waycaster, Curtis R; Motley, Travis A

    2015-01-01

    We sought to determine the long-term cost effectiveness (payer's perspective) of becaplermin gel plus good wound care (BGWC) vs. good wound care (GWC) alone in terms of wound healing and risk of amputation in patients with diabetic foot ulcers (DFUs). Outcomes data were derived from a propensity score-matched cohort from the Curative Health Services database between 1998 and 2004, which was followed for 20 weeks. A four-state Markov model was used to predict costs and outcomes of wound healing and risk of amputation for BGWC vs. GWC alone over 1 year in patients with DFU. The primary outcome was closed-wound weeks. Transition probabilities for healing and amputation were derived from the aforementioned propensity score-matched cohorts. Ulcer recurrence was estimated from the medical literature. Utilization for becaplermin was calculated using the dosing algorithm in the product labeling. Of 24,898 eligible patients, 9.6% received BGWC. Based on the model, patients treated with BGWC had substantially more closed-wound weeks compared with GWC (16.1 vs. 12.5 weeks, respectively). More patients receiving BGWC had healed wounds at 1 year compared with those receiving GWC (48.1% vs. 38.3%). Risk of amputation was lower in the BGWC cohort (6.8% vs. 9.8%). Expected annual direct costs for DFU were $21,920 for BGWC and $24,640 for GWC. BGWC was economically dominant over GWC, providing better outcomes at a lower cost in patients with DFU. Compared with GWC alone, BGWC is more effective in healing wounds and lowering amputation risk, thereby decreasing long-term costs for DFU. © 2015 by the Wound Healing Society.

  13. Treatment of Diabetic Foot Ulcers in the Home: Video Consultations as an Alternative to Outpatient Hospital Care

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    Jane Clemensen

    2008-01-01

    Full Text Available The aim of this study was to investigate whether video consultations in the home can support a viable alternative to visits to the hospital outpatient clinic for patients with diabetic foot ulcers. And furthermore whether patients, relatives, visiting nurses, and experts at the hospital will experience satisfaction and increased confidence with this new course of treatment. Participatory design methods were applied as well as field observations, semistructured interviews, focus groups, and qualitative analysis of transcriptions of telemedical consultations conducted during a pilot test. This study shows that it is possible for experts at the hospital to conduct clinical examinations and decision making at a distance, in close cooperation with the visiting nurse and the patient. The visiting nurse experienced increased confidence with the treatment of the foot ulcer and characterized the consultations as a learning situation. All patients expressed satisfaction and felt confidence with this new way of working.

  14. Patients' Experience of therapeutic footwear whilst living at risk of neuropathic diabetic foot ulceration: an interpretative phenomenological analysis (IPA).

    Science.gov (United States)

    Paton, Joanne S; Roberts, Anne; Bruce, Graham K; Marsden, Jonathan

    2014-02-22

    Previous work has found that people with diabetes do not wear their therapeutic footwear as directed, but the thinking behind this behaviour is unclear. Adherence to therapeutic footwear advice must improve in order to reduce foot ulceration and amputation risk in people with diabetes and neuropathy. Therefore this study aimed to explore the psychological influences and personal experiences behind the daily footwear selection of individuals with diabetes and neuropathy. An interpretative phenomenological analysis (IPA) approach was used to explore the understanding and experience of therapeutic footwear use in people living at risk of diabetic neuropathic foot ulceration. This study benefited from the purposive selection of a small sample of four people and used in-depth semi structured interviews because it facilitated the deep and detailed examination of personal thoughts and feelings behind footwear selection. Four overlapping themes that interact to regulate footwear choice emerged from the analyses: a) Self-perception dilemma; resolving the balance of risk experienced by people with diabetes and neuropathy day to day, between choosing to wear footwear to look and feel normal and choosing footwear to protect their feet from foot ulceration; b) Reflective adaption; The modification and individualisation of a set of values about footwear usage created in the minds of people with diabetes and neuropathy; c) Adherence response; The realignment of footwear choice with personal values, to reinforce the decision not to change behaviour or bring about increased footwear adherence, with or without appearance management; d) Reality appraisal; A here and now appraisal of the personal benefit of footwear choice on emotional and physical wellbeing, with additional consideration to the preservation of therapeutic footwear. For some people living at risk of diabetic neuropathic foot ulceration, the decision whether or not to wear therapeutic footwear is driven by the

  15. Development and validation of health related quality of life questionnaire (Indian scenario) in diabetic foot ulcer patients.

    Science.gov (United States)

    Kateel, Ramya; Augustine, Alfred J; Ullal, Sheetal; Prabhu, Shivananda; Bhat, Rahul; Adhikari, Prabha

    2017-12-01

    To develop and validate Health Related Quality of Life Questionnaire in Diabetic Foot Ulcer Patients (HRQLQDFU) for Indian scenario. This study was conducted in two phases. First phase was Development of HRQLQDFU which included literature search and expert interview. Second phase was validation of HRQLQDFL which included face validation, content validation and construct validation. Face validation was done by ten diabetic foot ulcer patients, ten practicing nurses and ten care givers. They were asked to read and respond to questionnaire and report any difficulty in understanding the questions. Further they were asked to add any item to the questionnaire which according to them has a significant effect on quality of life. Content validation was done by six subject experts who judged the content relevance of questionnaire with score ranging from zero to four; zero being least relevant and four being most relevant. Content validity index was calculated for each question. Questions having content validity index≥0.8 were selected for the study. Reliability was tested by calculating Cronbach's alpha. In the development phase a questionnaire containing 37 questions with six domains was developed. None of patient had difficulty in understanding questions. After content validation a new questionnaire containing 20 questions was developed. Cronbach's alpha was 0.86 which shows good reliability. The new health related quality of life questionnaire on diabetic foot ulcer patients for an Indian scenario is validated and can be a reliably measure for quality of life in diabetic foot ulcer patients. Copyright © 2017 Diabetes India. Published by Elsevier Ltd. All rights reserved.

  16. Patients’ Experience of therapeutic footwear whilst living at risk of neuropathic diabetic foot ulceration: an interpretative phenomenological analysis (IPA)

    Science.gov (United States)

    2014-01-01

    Background Previous work has found that people with diabetes do not wear their therapeutic footwear as directed, but the thinking behind this behaviour is unclear. Adherence to therapeutic footwear advice must improve in order to reduce foot ulceration and amputation risk in people with diabetes and neuropathy. Therefore this study aimed to explore the psychological influences and personal experiences behind the daily footwear selection of individuals with diabetes and neuropathy. Methods An interpretative phenomenological analysis (IPA) approach was used to explore the understanding and experience of therapeutic footwear use in people living at risk of diabetic neuropathic foot ulceration. This study benefited from the purposive selection of a small sample of four people and used in-depth semi structured interviews because it facilitated the deep and detailed examination of personal thoughts and feelings behind footwear selection. Findings Four overlapping themes that interact to regulate footwear choice emerged from the analyses: a) Self-perception dilemma; resolving the balance of risk experienced by people with diabetes and neuropathy day to day, between choosing to wear footwear to look and feel normal and choosing footwear to protect their feet from foot ulceration; b) Reflective adaption; The modification and individualisation of a set of values about footwear usage created in the minds of people with diabetes and neuropathy; c) Adherence response; The realignment of footwear choice with personal values, to reinforce the decision not to change behaviour or bring about increased footwear adherence, with or without appearance management; d) Reality appraisal; A here and now appraisal of the personal benefit of footwear choice on emotional and physical wellbeing, with additional consideration to the preservation of therapeutic footwear. Conclusion For some people living at risk of diabetic neuropathic foot ulceration, the decision whether or not to wear

  17. Ultrasound therapy for recalcitrant diabetic foot ulcers: results of a randomized, double-blind, controlled, multicenter study.

    Science.gov (United States)

    Ennis, William J; Foremann, Phil; Mozen, Neal; Massey, Joi; Conner-Kerr, Teresa; Meneses, Patricio

    2005-08-01

    An estimated 15% of patients with diabetes will develop a foot ulcer sometime in their life, making them 30 to 40 times more likely to undergo amputation due to a non-healing foot ulcer than the non-diabetic population. To determine the safety and efficacy of a new, non-contact, kilohertz ultrasound therapy for the healing of recalcitrant diabetic foot ulcers - as well as to evaluate the impact on total closure and quantitative bacterial cultures and the effect on healing of various levels of sharp/surgical debridement - a randomized, double-blinded, sham-controlled, multicenter study was conducted in hospital-based and private wound care clinics. Patients (55 met criteria for efficacy analysis) received standard of care, which included products that provide a moist environment, offloading diabetic shoes and socks, debridement, wound evaluation, and measurement. The "therapy" was either active 40 KHz ultrasound delivered by a saline mist or a "sham device" which delivered a saline mist without the use of ultrasound. After 12 weeks of care, the proportion of wounds healed (defined as complete epithelialization without drainage) in the active ultrasound therapy device group was significantly higher than that in the sham control group (40.7% versus 14.3%, P = 0.0366, Fisher's exact test). The ultrasound treatment was easy to use and no difference in the number and type of adverse events between the two treatment groups was noted. Of interest, wounds were debrided at baseline followed by a quantitative culture biopsy. The results of these cultures demonstrated a significant bioburden (greater than 10(5)) in the majority of cases, despite a lack of clinical signs of infection. Compared to control, this therapeutic modality was found to increase the healing rate of recalcitrant, diabetic foot ulcers.

  18. A model to estimate cost-savings in diabetic foot ulcer prevention efforts.

    Science.gov (United States)

    Barshes, Neal R; Saedi, Samira; Wrobel, James; Kougias, Panos; Kundakcioglu, O Erhun; Armstrong, David G

    2017-04-01

    Sustained efforts at preventing diabetic foot ulcers (DFUs) and subsequent leg amputations are sporadic in most health care systems despite the high costs associated with such complications. We sought to estimate effectiveness targets at which cost-savings (i.e. improved health outcomes at decreased total costs) might occur. A Markov model with probabilistic sensitivity analyses was used to simulate the five-year survival, incidence of foot complications, and total health care costs in a hypothetical population of 100,000 people with diabetes. Clinical event and cost estimates were obtained from previously-published trials and studies. A population without previous DFU but with 17% neuropathy and 11% peripheral artery disease (PAD) prevalence was assumed. Primary prevention (PP) was defined as reducing initial DFU incidence. PP was more than 90% likely to provide cost-savings when annual prevention costs are less than $50/person and/or annual DFU incidence is reduced by at least 25%. Efforts directed at patients with diabetes who were at moderate or high risk for DFUs were very likely to provide cost-savings if DFU incidence was decreased by at least 10% and/or the cost was less than $150 per person per year. Low-cost DFU primary prevention efforts producing even small decreases in DFU incidence may provide the best opportunity for cost-savings, especially if focused on patients with neuropathy and/or PAD. Mobile phone-based reminders, self-identification of risk factors (ex. Ipswich touch test), and written brochures may be among such low-cost interventions that should be investigated for cost-savings potential. Published by Elsevier Inc.

  19. A prospective cohort study of prognostic factors for the healing of heel pressure ulcers.

    Science.gov (United States)

    McGinnis, Elizabeth; Greenwood, Darren C; Nelson, E Andrea; Nixon, Jane

    2014-03-01

    pressure ulcers, 25-30% of which are on the heels are a major burden to patients and healthcare systems. A better understanding of factors associated with healing is required to inform treatment and research priorities. to identify patient and pressure ulcer characteristics associated with the healing of heel pressure ulcers. patients with heel pressure ulcers were recruited to a prospective cohort study in a large teaching hospital in the UK, with a maximum 18-month follow-up. Cox proportional hazards model regression analysis was used to identify prognostic factors for healing. one hundred and forty of 148 patients recruited were analysed. They had 183 pressure ulcers: 77 ulcers healed, 5 were on limbs amputated prior to ulcer healing, 88 were on patients who died prior to healing, 11 were present at the end of the study and 2 were lost to follow-up. The median time to healing was 121 (range 8-440) days. Of 12 variables associated with healing (P ≤ 0.2), multi-variable analysis identified two factors which were independently predictive of healing including the presence of a severe (versus superficial) ulcer (hazard ratio = 0.48, P ulcer severity and the presence of peripheral arterial disease significantly reduced the probability of healing. Treatments for heel pressure ulcers should consider the severity of the ulcer and the presence of peripheral arterial disease.

  20. An exploratory study on differences in cumulative plantar tissue stress between healing and non-healing plantar neuropathic diabetic foot ulcers

    NARCIS (Netherlands)

    van Netten, Jaap J.; van Baal, Jeff G.; Bril, Adriaan; Wissink, Marieke; Bus, Sicco A.

    2018-01-01

    Mechanical stress is important in causing and healing plantar diabetic foot ulcers, but almost always studied as peak pressure only. Measuring cumulative plantar tissue stress combines plantar pressure and ambulatory activity, and better defines the load on ulcers. Our aim was to explore differences

  1. The use of plasma rich in growth factors (PRGF-Endoret) in the treatment of a severe mal perforant ulcer in the foot of a person with diabetes.

    Science.gov (United States)

    Orcajo, Beatriz; Muruzabal, Francisco; Isasmendi, María Concepción; Gutierrez, Nerea; Sánchez, Mikel; Orive, Gorka; Anitua, Eduardo

    2011-08-01

    A 71 year old person with diabetes with a severe mal perforant ulcer in the right foot was treated twice with autologous plasma-rich in growth factors (PRGF) obtained from her own blood. After PRGF treatment the severe mal perforant ulcer completely healed in 10 weeks. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  2. S100A8/A9 is an important host defence mediator in neuropathic foot ulcers in patients with type 2 diabetes mellitus

    DEFF Research Database (Denmark)

    Trøstrup, Hannah; Holstein, Per; Christophersen, Lars

    2016-01-01

    Chronic wounds and in particular diabetic foot ulcers (DFUs) are a growing clinical challenge, but the underlying molecular pathophysiological mechanisms are unclear. Recently, we reported reduced levels of the immunomodulating and antimicrobial S100A8/A9 in non-healing venous leg ulcers (VLUs...

  3. Comparision of vacuum-asisted closure and moist wound dressing in the treatment of diabetic foot ulcers.

    Science.gov (United States)

    Ravari, Hassan; Modaghegh, Mohammad-Hadi Saeed; Kazemzadeh, Gholam Hosein; Johari, Hamed Ghoddusi; Vatanchi, Attieh Mohammadzadeh; Sangaki, Abolghasem; Shahrodi, Mohammad Vahedian

    2013-01-01

    Vacuum-assisted closure (VAC) is a new method in wound care which speeds wound healing by causing vacuum, improving tissue perfusion and suctioning the exudates. This study aims to evaluate its efficacy in the treatment of diabetic foot ulcers. Thirteen patients with diabetic foot ulcers were enrolled in the moist dressing group, and 10 patients in the VAC group. The site, size and depth of the wound were inspected and recorded before and every three days during the study period. Patient satisfaction and formation of granulation tissue were also assessed. Improvement of the wound in the form of reducing the diameter and depth and increasing proliferation of granulation tissue was significant in most of the patients of the VAC group after two weeks. Satisfaction of patients in the VAC group was evaluated as excellent as no amputation was done in this group. Wagner score was reduced in both the study groups, although this decrement was not significant in the moist dressing group. VAC appears to be as safe as and more efficacious than moist dressing for the treatment of diabetic foot ulcers.

  4. Comparision of Vacuum-Asisted Closure and Moist Wound Dressing in the Treatment of Diabetic Foot Ulcers

    Science.gov (United States)

    Ravari, Hassan; Modaghegh, Mohammad-Hadi Saeed; Kazemzadeh, Gholam Hosein; Johari, Hamed Ghoddusi; Vatanchi, Attieh Mohammadzadeh; Sangaki, Abolghasem; Shahrodi, Mohammad Vahedian

    2013-01-01

    Background: Vacuum-assisted closure (VAC) is a new method in wound care which speeds wound healing by causing vacuum, improving tissue perfusion and suctioning the exudates. This study aims to evaluate its efficacy in the treatment of diabetic foot ulcers. Materials and Methods: Thirteen patients with diabetic foot ulcers were enrolled in the moist dressing group, and 10 patients in the VAC group. The site, size and depth of the wound were inspected and recorded before and every three days during the study period. Patient satisfaction and formation of granulation tissue were also assessed. Results: Improvement of the wound in the form of reducing the diameter and depth and increasing proliferation of granulation tissue was significant in most of the patients of the VAC group after two weeks. Satisfaction of patients in the VAC group was evaluated as excellent as no amputation was done in this group. Wagner score was reduced in both the study groups, although this decrement was not significant in the moist dressing group. Conclusion: VAC appears to be as safe as and more efficacious than moist dressing for the treatment of diabetic foot ulcers. PMID:23723599

  5. Comparision of vacuum-asisted closure and moist wound dressing in the treatment of diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Hassan Ravari

    2013-01-01

    Full Text Available Background: Vacuum-assisted closure (VAC is a new method in wound care which speeds wound healing by causing vacuum, improving tissue perfusion and suctioning the exudates. This study aims to evaluate its efficacy in the treatment of diabetic foot ulcers. Materials and Methods: Thirteen patients with diabetic foot ulcers were enrolled in the moist dressing group, and 10 patients in the VAC group. The site, size and depth of the wound were inspected and recorded before and every three days during the study period. Patient satisfaction and formation of granulation tissue were also assessed. Results: Improvement of the wound in the form of reducing the diameter and depth and increasing proliferation of granulation tissue was significant in most of the patients of the VAC group after two weeks. Satisfaction of patients in the VAC group was evaluated as excellent as no amputation was done in this group. Wagner score was reduced in both the study groups, although this decrement was not significant in the moist dressing group. Conclusion: VAC appears to be as safe as and more efficacious than moist dressing for the treatment of diabetic foot ulcers.

  6. Preliminary investigation of topical nitroglycerin formulations containing natural wound healing agent in diabetes-induced foot ulcer.

    Science.gov (United States)

    Hotkar, Mukesh S; Avachat, Amelia M; Bhosale, Sagar S; Oswal, Yogesh M

    2015-04-01

    Nitroglycerin (NTG) is an organic nitrate rapidly denitrated by enzymes to release free radical nitric oxide and shows improved wound healing and tissue protection from oxidative damage. The purpose of this study was to evaluate whether topical application of NTG in the form of gel/ointment along with a natural wound healing agent, aloe vera, would bring about wound healing by using diabetes-induced foot ulcer model and rat excision wound model. All these formulations were evaluated for pH, viscosity, drug content and ex vivo diffusion studies using rat skin. Based on ex vivo permeation studies, the formulation consisting of carbopol 974p as a gelling agent and aloe vera was found to be suitable. The in vivo study used streptozotocin-induced diabetic foot ulcer and rat excision wound models to analyse wound healing activity. The wound size in animals of all treated groups was significantly reduced compared with that of the diabetic control and marketed treated animals. This study showed that the gel formed with carbopol 974p (1%) and aloe vera promotes significant wound healing and closure in diabetic rats compared with the commercial product and provides a promising product to be used in diabetes-induced foot ulcer. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  7. Quality of life in patients with diabetic foot ulcers: validation of the Cardiff Wound Impact Schedule in a Canadian population.

    Science.gov (United States)

    Jaksa, Peter J; Mahoney, James L

    2010-12-01

    The purpose of this study was to evaluate and validate the Cardiff Wound Impact Schedule (CWIS), a disease-specific quality-of-life measure, in a diabetic foot ulcer (DFU) population. Patients with DFUs have restrictions as part of their treatment and rehabilitation, which can affect health-related quality of life (HRQoL). Because of the high number of comorbidities experienced in diabetes, a disease-specific quality-of-life measure is needed to best assess the affect of a foot ulcer on HRQoL. Patients with DFUs completed the CWIS and a World Health Organization generic quality-of-life questionnaire. Validity was assessed by comparing domains of the questionnaires. Patients were categorised using the University of Texas wound classification system. Mean CWIS scores were compared between categories to assess the questionnaire's ability to differentiate wound severity. Patients with open ulcers scored significantly lower on the CWIS than those with healed ulcers. Correlations between questionnaire domains were as follows: Social Life with Social Functioning (r = 0·641, P Health (r = 0·533, P Health-Related Quality of Life with Vitality (r = 0·425, P < 0·01). However, there was no significant difference in mean CWIS scores between categories of wound severity. We have demonstrated the ability of the CWIS in assessing HRQoL in a DFU population and its ability to differentiate between healed and non healed states. © 2010 The Authors. Journal Compilation © 2010 Blackwell Publishing Ltd and Medicalhelplines.com Inc.

  8. Atypical Diabetic Foot Ulcer Keratinocyte Protein Signaling Correlates with Impaired Wound Healing

    Science.gov (United States)

    Hoke, Glenn D.; Ramos, Corrine; Hoke, Nicholas N.; Crossland, Mary C.; Shawler, Lisa G.

    2016-01-01

    Diabetes mellitus is associated with chronic diabetic foot ulcers (DFUs) and wound infections often resulting in lower extremity amputations. The protein signaling architecture of the mechanisms responsible for impaired DFU healing has not been characterized. In this preliminary clinical study, the intracellular levels of proteins involved in signal transduction networks relevant to wound healing were non-biasedly measured using reverse-phase protein arrays (RPPA) in keratinocytes isolated from DFU wound biopsies. RPPA allows for the simultaneous documentation and assessment of the signaling pathways active in each DFU. Thus, RPPA provides for the accurate mapping of wound healing pathways associated with apoptosis, proliferation, senescence, survival, and angiogenesis. From the study data, we have identified potential diagnostic, or predictive, biomarkers for DFU wound healing derived from the ratios of quantified signaling protein expressions within interconnected pathways. These biomarkers may allow physicians to personalize therapeutic strategies for DFU management on an individual basis based upon the signaling architecture present in each wound. Additionally, we have identified altered, interconnected signaling pathways within DFU keratinocytes that may help guide the development of therapeutics to modulate these dysregulated pathways, many of which parallel the therapeutic targets which are the hallmarks of molecular therapies for treating cancer. PMID:27840833

  9. Atypical Diabetic Foot Ulcer Keratinocyte Protein Signaling Correlates with Impaired Wound Healing.

    Science.gov (United States)

    Hoke, Glenn D; Ramos, Corrine; Hoke, Nicholas N; Crossland, Mary C; Shawler, Lisa G; Boykin, Joseph V

    2016-01-01

    Diabetes mellitus is associated with chronic diabetic foot ulcers (DFUs) and wound infections often resulting in lower extremity amputations. The protein signaling architecture of the mechanisms responsible for impaired DFU healing has not been characterized. In this preliminary clinical study, the intracellular levels of proteins involved in signal transduction networks relevant to wound healing were non-biasedly measured using reverse-phase protein arrays (RPPA) in keratinocytes isolated from DFU wound biopsies. RPPA allows for the simultaneous documentation and assessment of the signaling pathways active in each DFU. Thus, RPPA provides for the accurate mapping of wound healing pathways associated with apoptosis, proliferation, senescence, survival, and angiogenesis. From the study data, we have identified potential diagnostic, or predictive, biomarkers for DFU wound healing derived from the ratios of quantified signaling protein expressions within interconnected pathways. These biomarkers may allow physicians to personalize therapeutic strategies for DFU management on an individual basis based upon the signaling architecture present in each wound. Additionally, we have identified altered, interconnected signaling pathways within DFU keratinocytes that may help guide the development of therapeutics to modulate these dysregulated pathways, many of which parallel the therapeutic targets which are the hallmarks of molecular therapies for treating cancer.

  10. Effects of insulin on the skin: possible healing benefits for diabetic foot ulcers.

    Science.gov (United States)

    Emanuelli, T; Burgeiro, A; Carvalho, E

    2016-12-01

    Diabetic foot ulcers affect 15-20 % of all diabetic patients and remain an important challenge since the available therapies have limited efficacy and some of the novel therapeutic approaches, which include growth factors and stem cells, are highly expensive and their safety remains to be evaluated. Despite its low cost and safety, the interest for topical insulin as a healing agent has increased only in the last 20 years. The molecular mechanisms of insulin signaling and its metabolic effects have been well studied in its classical target tissues. However, little is known about the specific effects of insulin in healthy or even diabetic skin. In addition, the mechanisms involved in the effects of insulin on wound healing have been virtually unknown until about 10 years ago. This paper will review the most recent advances in the cellular and molecular mechanisms that underlie the beneficial effects of insulin on skin wound healing in diabetes. Emerging evidence that links dysfunction of key cellular organelles, namely the endoplasmic reticulum and the mitochondria, to changes in the autophagy response, as well as the impaired wound healing in diabetic patients will also be discussed along with the putative mechanisms whereby insulin could regulate/modulate these alterations.

  11. A two-phase model of plantar tissue: a step toward prediction of diabetic foot ulceration.

    Science.gov (United States)

    Sciumè, G; Boso, D P; Gray, W G; Cobelli, C; Schrefler, B A

    2014-11-01

    A new computational model, based on the thermodynamically constrained averaging theory, has been recently proposed to predict tumor initiation and proliferation. A similar mathematical approach is proposed here as an aid in diabetic ulcer prevention. The common aspects at the continuum level are the macroscopic balance equations governing the flow of the fluid phase, diffusion of chemical species, tissue mechanics, and some of the constitutive equations. The soft plantar tissue is modeled as a two-phase system: a solid phase consisting of the tissue cells and their extracellular matrix, and a fluid one (interstitial fluid and dissolved chemical species). The solid phase may become necrotic depending on the stress level and on the oxygen availability in the tissue. Actually, in diabetic patients, peripheral vascular disease impacts tissue necrosis; this is considered in the model via the introduction of an effective diffusion coefficient that governs transport of nutrients within the microvasculature. The governing equations of the mathematical model are discretized in space by the finite element method and in time domain using the θ-Wilson Method. While the full mathematical model is developed in this paper, the example is limited to the simulation of several gait cycles of a healthy foot. Copyright © 2014 John Wiley & Sons, Ltd.

  12. Foot & Mouth Disease & Ulcerative/Vesicular Rule-outs: Challenges Encountered in Recent Outbreaks

    Energy Technology Data Exchange (ETDEWEB)

    Hullinger, P

    2008-01-28

    Foot and mouth disease (FMD) is a highly infectious and contagious viral disease affecting bovidae (cattle, zebus, domestic buffaloes, yaks), sheep, goats, swine, all wild ruminants and suidae. Camelidae (camels, dromedaries, llamas, vicunas) have low susceptibility. Foot and mouth disease is caused by a RNS virus of the family Picornaviridae, genus Aphthovirus. There are seven immunologically distinct serotypes: A, O, C, SAT1, SAT2, SAT3, Asia 1. Foot and mouth disease causes significant economic loss both to countries who manage it as an endemic disease (with or without vaccination), as well as those FMD free countries which may become infected. The mortality rate is low in adult animals, but often higher in young due to myocarditis. Foot and mouth disease is endemic in parts of Asia, Africa, the Middle East and South America (sporadic outbreaks in free areas). The Office of International Epizootics (OIE), also referred to the World Organization for Animal Health maintains an official list of free countries and zones.1 The OIE Terrestrial Code (Chapter 2.2.10) provides detailed information on the categories of freedom that can be allocated to a country as well as guidelines for the surveillance for foot and mouth disease (Appendix 3.8.7). In short, countries may be completely free of FMD, free with vaccination or infected with foot and mouth disease virus (FMDV). Source of FMDV include incubating and clinically affected animals with virus present in breath, saliva, faeces, urine, milk and semen. In experimental settings virus has been detected in milk several days before the onset of clinical signs2. Additional sources of virus are meat and by-products in which pH has remained above 6.0 as well as persistently infected carrier animals. Carrier animals may include cattle and water buffalo; convalescent animals and exposed vaccinates (virus persists in the oropharynx for up to 30 months in cattle or longer in buffalo, 9 months in sheep). Pigs do not become carriers

  13. The Most Prevalnet Organism in Diabetic Foot Ulcers and Its Drug Sensitivity and Resistance to Different Standard Antibiotics

    International Nuclear Information System (INIS)

    Nageen, A.

    2016-01-01

    Objective: To find the most prevalent organism in diabetic foot ulcers and its drug sensitivity and resistance to different standard antibiotics. Study Design: Adescriptive and cross-sectional study. Place and Duration of Study: Ward 7, Jinnah Postgraduate Medical Center, Karachi, from December 2010 to December 2012. Methodology: Ninety-five diabetic patients with infected foot wounds of Wegener grade 2 - 5 who had not received any previous antibiotics were included in the study by consecutive sampling. Pus culture specimen from wounds was taken and the organism isolated was identified. Also the most sensitive group of antibiotics and the most resistant one to that organism was noted. Results: Staphylococcus aureus was the most prevalent organism constituting 23.16% (n=22) of the organisms isolated; Escherichia coli with 17.89% (n=17) and Klebsiella with 12.63% (n=12) followed. Males presented more with diabetic foot (n=52) out of 95 patients. The most common age group affected was 41 - 60 years (73 patients). The organisms were most sensitive to Meropenem, effective in 90 (95%) patients and most resistant to Cotrimoxazole (80, 84% patients). Out of the 95 patients, 39 (41%) patients were hypertensive, 30 (31.5%) were obese and 14 (15%) were smokers. Staphylococcus aureus was the most prevalent organism overall irrespective to gender, age groups and co-morbidity of the patients. Conclusion: Staphylococcus aureus was the most frequent organism in diabetic foot ulcers; the most effective antibiotic is Meropenem and least effective is Cotrimoxazole. (author)

  14. Primary infragenicular angioplasty for diabetic neuroischemic foot ulcers following the angiosome distribution: a new paradigm for the vascular interventionist?

    Directory of Open Access Journals (Sweden)

    Alexandrescu V

    2011-08-01

    Full Text Available Vlad Alexandrescu1, Gerard Hubermont21Department of Vascular Surgery, Princess Paola Hospital, Marche- en-Famenne, Belgium; 2Department of Diabetology, Princess Paola Hospital, Marche-en-Famenne and Sainte-Thérèse Hospital, Bastogne, BelgiumAbstract: The angiosome principle was first described by Jan Taylor in 1987 in the plastic reconstructive surgery field, providing useful information on the vascular anatomy of the human body. Specifically concerning foot and ankle pathology, it may help the clinician to select better vascular access and specific strategies for revascularization. This knowledge may be particularly beneficial when treating diabetic neuroischemic foot wounds associated with particularly aggressive atherosclerotic disease and a poor collateral circulation. The implementation of angiosome-based strategies in diabetic infragenicular vascular reconstruction may afford encouraging wound healing and limb preservation rates using both bypass and endovascular techniques. The minimal invasiveness of these novel strategies enables us to perform more specific and more distal tibial and/or foot arterial reconstructions, in one or multiple targeted vessels. This paper reviews the available literature on this revascularization strategy and focuses on the potential benefit of angiosome-guided primary angioplasty for diabetic ischemic foot ulcers.Keywords: critical limb ischemia, diabetic foot, limb salvage, angiosomes, angioplasty

  15. Culture-based Screening of Aerobic Microbiome in Diabetic Foot Subjects and Developing Non-Healing Ulcers

    Directory of Open Access Journals (Sweden)

    Saba Noor

    2016-11-01

    Full Text Available The study was carried on diabetic foot patients to deduce clinical attributes, the occurrence of the range of aerobic microbial flora and to assess their comparative in vitro susceptibility to the customarily used antimicrobials. We also studied the potential risk factors involved in the development of non-healing ulcers. A total of 87 organisms were isolated from 70 specimens, including Escherichia coli (19.5% among the Gram-negative and Staphylococcus aureus (18.4% among the Gram-positive as the predominant aerobes explored. Pseudomonas aeruginosa and Escherichia coli were predominant isolates of non-healing ulcers. The antimicrobial sensitivity pattern revealed that vancomycin (100% and amikacin (90.4% exhibited highest sensitivity to Gram-positive cocci, while all strains of Pseudomonas aeruginosa were sensitive towards imipenem (100%. The prevalent uncontrolled glycemic status, altered lipid spectra, the existence of neuropathy and peripheral vascular disease, suggested predisposition towards the development of non-healing lesions. The study has underlined the need for continuous surveillance of bacteria and their antimicrobial sensitivity blueprints to provide the basis for empirical therapy and to minimize the risk of complications. Further, stringent clinical evaluation and medical history will help in revealing the risk of developing non-healing status in diabetic foot ulcers.

  16. Disturbed hypoxic responses as a pathogenic mechanism of diabetic foot ulcers.

    Science.gov (United States)

    Catrina, Sergiu-Bogdan; Zheng, Xiaowei

    2016-01-01

    Diabetic foot ulceration (DFU) is a chronic complication of diabetes that is characterized by impaired wound healing in the lower extremities. DFU remains a major clinical challenge because of poor understanding of its pathogenic mechanisms. Impaired wound healing in diabetes is characterized by decreased angiogenesis, reduced bone marrow-derived endothelial progenitor cell (EPC) recruitment, and decreased fibroblast and keratinocyte proliferation and migration. Recently, increasing evidence has suggested that increased hypoxic conditions and impaired cellular responses to hypoxia are essential pathogenic factors of delayed wound healing in DFU. Hypoxia-inducible factor-1 (HIF-1, a heterodimer of HIF-1α and HIF-1β) is a master regulator of oxygen homeostasis that mediates the adaptive cellular responses to hypoxia by regulating the expression of genes involved in angiogenesis, metabolic changes, proliferation, migration, and cell survival. However, HIF-1 signalling is inhibited in diabetes as a result of hyperglycaemia-induced HIF-1α destabilization and functional repression. Increasing HIF-1α expression and activity using various approaches promotes angiogenesis, EPC recruitment, and granulation, thereby improving wound healing in experimental diabetes. The mechanisms underlying HIF-1α regulation in diabetes and the therapeutic strategies targeting HIF-1 signalling for the treatment of diabetic wounds are discussed in this review. Further investigations of the pathways involved in HIF-1α regulation in diabetes are required to advance our understanding of the mechanisms underlying impaired wound healing in diabetes and to provide a foundation for developing novel therapeutic approaches to treat DFU. Copyright © 2016 John Wiley & Sons, Ltd.

  17. A prospective window into medical device-related pressure ulcers in intensive care.

    Science.gov (United States)

    Coyer, Fiona M; Stotts, Nancy A; Blackman, Virginia Schmied

    2014-12-01

    The aim of this study was to determine the prevalence, severity, location, aetiology, treatment and healing of medical device-related pressure ulcers (PUs) in intensive care patients for up to 7 days. A prospective repeated measures study design was used. Patients in six intensive care units of two major medical centres, one each in Australia and the USA, were screened 1 day per month for 6 months. Those with device-related ulcers were followed daily for up to 7 days. The outcome measures were device-related ulcer prevalence, pain, infection, treatment and healing. Fifteen of 483 patients had device-related ulcers and 9 of 15 with 11 ulcers were followed beyond screening. Their mean age was 60·5 years, and most were men, overweight and at increased risk of PU. Endotracheal (ET) and nasogastric (NG) tubes were the cause of most device-related ulcers. Repositioning was the most frequent treatment. Four of 11 ulcers healed within the 7-day observation period. In conclusion, device-related ulcer prevalence was 3·1%, similar to that reported in the limited literature available, indicating an ongoing problem. Systematic assessment and repositioning of devices are the mainstays of care. We recommend continued prevalence determination and that nurses remain vigilant to prevent device-related ulcers, especially in patients with NG and ET tubes. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.

  18. The Use of Best Practice in the Treatment of a Complex Diabetic Foot Ulcer: A Case Report

    Directory of Open Access Journals (Sweden)

    Melodie Blakely

    2016-03-01

    Full Text Available Background and Purpose: Published guidelines for effective management of diabetic foot ulcers (DFU include total contact casting (TCC. The purpose of this case study is to describe the application of best practice guidelines for the treatment of a diabetic foot ulcer (DFU in a complex patient where TCC offloading could not be utilized. Case Description: The patient was a 47 year-old female with a five-plus year history of a full-thickness DFU on the left plantar mid-foot. Treatment included sharp and ultrasound debridement, the use of a silver hydrofiber dressing, edema management via compression therapy, negative pressure wound therapy, offloading via customized 1/4 inch adhesive-backed felt applied to the plantar foot in addition to an offloading boot and use of a wheelchair, patient education regarding diabetes management, and the application of a bilayered living skin-equivalent biologic dressing. Outcomes: At 15 weeks the wound was closed and the patient was transitioned into diabetic footwear. Discussion: The felt offloading was a beneficial alternative to TCC. The patient’s longer than average healing rate may have been complicated by the duration of her wound, her 41 year history of diabetes, and the fact that gold standard offloading (TCC was not able to be used. Further research is needed regarding the use of felt for offloading, such as application technique for wounds on different areas of the foot, comparison of different types of felt, and the use of felt in conjunction with various offloading devices.

  19. Perceived usability and use of custom-made footwear in diabetic patients at high risk for foot ulceration.

    Science.gov (United States)

    Arts, Mark L J; de Haart, Mirjam; Bus, Sicco A; Bakker, Jan P J; Hacking, Hub G A; Nollet, Frans

    2014-04-01

    To assess the perceived usability and use of custom- made footwear in diabetic patients who are at high-risk for foot ulceration, and to elucidate the determinants of usability and use. Survey. A total of 153 patients with diabetes, peripheral neuropathy, prior plantar foot ulceration and newly prescribed custom-made footwear, recruited from 10 Dutch multidisciplinary foot clinics. The Questionnaire of Usability Evaluation was used to assess the patients' perception of weight, appearance, comfort, durability, donning/doffing, stability, benefit and overall appreciation of their prescription footwear (all expressed as visual analogue scores). Data on priorities for usability and footwear use (in h/day) were obtained from patient reports. Multivariate logistic regression analysis was used to assess determinants of usability and use. Median (interquartile range) score for overall appreciation was 8.3 (7.1-9.1). Scores ranged from 6.5 (4.5-8.6) for weight to 9.6 (6.3-9.9) for donning/doffing. Footwear comfort was listed most often (33.3%) as the highest priority. Footwear use was benefit of the footwear (p = 0.045). Perceived usability of footwear was mostly positive, although individual scores and priorities varied considerably. Footwear use was low to moderate and dependent only on the perceived benefit of the footwear. Therefore, practitioners should focus on enhancing the patient's ap-preciation of the therapeutic benefit of custom-made footwear.

  20. The Study of Influence of Different Methods of Local Treatment on Wound Healing in Patients with Diabetic Foot Ulcers.

    Science.gov (United States)

    Zaitseva, E L; Tokmakova, A Y; Shestakova, M V; Galstyan, G R; Doronina, L P

    To evaluate the influence of different methods of local treatment on tissue repair in patients with diabetic foot ulcers. We evaluated such clinical characteristics as wound size and local perfusion after using negative pressure wound therapy (NPWT), local collagen, and standard care in patients with diabetic foot ulcers. We observed 63 patients with neuropathic and neuroischemic forms of diabetic foot (without critical ischemia) after surgical debridement. After that 21 patients received NPWT, 21 local collagen treatment and 21 ― standard care. After using NPWT wound area and depth decreased in 19,8% and 42,8% (p<0.05), in group of collagen dressings in 26,4 and 30,4% (p<0.05). In control group those parameters were 17,0 и 16.6% respectively (p<0.05). There was found the significant increase of local perfusion according to oxygen monitoring in group of NPWT (p<0.05). The received data showed that the intensity of lower limb tissue repair processes increases more significant after using NPWT and collagen dressings in comparison to standard care which is found according to wound size and tissue perfusion alterations.

  1. Prospective study of ankle and foot fractures in elderly women

    Directory of Open Access Journals (Sweden)

    Yadagiri Surender Rao

    2015-01-01

    Full Text Available The epidemiology of ankle fractures in old people is changing as time passes on. The incidence of ankle fractures increases with advancing age. The study conducted was among a rural popula-tion which comprised of 68 women (32 women with ankle fractures & 36 women with foot fractures. Patients studied were in the age group more than 50 years. The study highlights the etiological & risk factors for fractures of ankle & foot. The commonest ankle fracture was the lateral malleolar fracture & the commonest foot fracture was the 5th Metatarsal fracture. Diabetes is a risk factor which increases the occurrence of ankle and foot injuries.

  2. Diet in the Aetiology of Ulcerative Colitis: A European Prospective Cohort Study

    DEFF Research Database (Denmark)

    Hart, Andrew R; Luben, Robert; Olsen, Anja

    2008-01-01

    Background/Aims: The causes of ulcerative colitis are unknown, although it is plausible that dietary factors are involved. Case-control studies of diet and ulcerative colitis are subject to recall biases. The aim of this study was to examine the prospective relationship between the intake...... was supplied and the subjects were followed up for the development of ulcerative colitis. Each incident case was matched with four controls and dietary variables were divided into quartiles. Results: A total of 139 subjects with incident ulcerative colitis were identified. No dietary associations were detected......, apart from a marginally significant positive association with an increasing percentage intake of energy from total polyunsaturated fatty acids (trend across quartiles OR = 1.19 (95% CI = 0.99-1.43) p = 0.07). Conclusions: No associations between ulcerative colitis and diet were detected, apart from...

  3. Severe Upper Gastrointestinal Hemorrhage from Linear Gastric Ulcers in Large Hiatal Hernias: a Large Prospective Case Series of Cameron Ulcers

    Science.gov (United States)

    Camus, Marine; Jensen, Dennis M.; Ohning, Gordon V.; Kovacs, Thomas O.; Ghassemi, Kevin A.; Jutabha, Rome; Machicado, Gustavo A.; Dulai, Gareth S.; Hines, Joel O.

    2013-01-01

    Background and study aims Cameron ulcers are a rare but clinically significant cause of severe upper gastrointestinal hemorrhage (SUGIH). Our aims were to describe (1) the diagnosis, treatment and outcomes of patients with Cameron ulcers causing hospitalization for SUGIH, (2) the differences between patients with occult vs. overt bleeding and (3) between patients treated surgically and medically. Patients and methods Over the past 17 years, all consecutive patients hospitalized in our two tertiary referral medical centers for severe UGIH or severe obscure GIH and entered into our large prospective databasis were screened for Cameron ulcer diagnosis. Results Cameron ulcers were diagnosed in 25 patients of 3960 patients with SUGIH (0.6%). 21 patients had follow-up (median [IQR] time of 20.4 months [8.5–31.8]). Patients were more often elderly females with chronic anemia, always had large hiatal hernias, and were usually referred for obscure SUGIH. Twelve (57.2%) patients were referred to surgery for rebleeding and recurrent blood loss while treated with high dose of proton pump inhibitors (PPI). 9 (42.8%) other patients continued PPI without any rebleeding during the follow-up. Patients with overt bleeding had significantly more prior hospitalizations for SUGIH, more often stigmata of hemorrhage on ulcers, and more red blood cell transfusions than patients with occult bleeding. However, there was no difference in rebleeding and mortality rates between the two groups. Conclusions Cameron ulcers in large hiatal hernias are an uncommon cause of SUGIH. Most of patients are referred for obscure GIH. The choice of medical vs. surgical therapy should be individualized. PMID:23616128

  4. Diabetic complications do not hamper improvement of health-related quality of life over the course of treatment of diabetic foot ulcers - the Eurodiale study.

    Science.gov (United States)

    Siersma, Volkert; Thorsen, Hanne; Holstein, Per E; Kars, Marleen; Apelqvist, Jan; Jude, Edward B; Piaggesi, Alberto; Bakker, Karel; Edmonds, Michael; Jirkovská, Alexandra; Mauricio, Didac; Reike, Heinrich; Spraul, Maximilian; Uccioli, Luigi; Urbancic, Vilma; van Acker, Kristien; van Baal, Jeff; Schaper, Nicolaas C

    2017-07-01

    Diabetic complications, and in particular diabetic foot ulcers (DFUs), are associated with low health-related quality of life (HRQoL). We evaluated whether the presence of diabetic complications also influenced the improvement of HRQoL during DFU treatment. 1088 patients presenting for DFU treatment at the centers participating in the Eurodiale study were followed prospectively up to one year. HRQoL was measured both at presentation and after healing or at end of follow up, using EQ-5D: a standardized instrument consisting of five domains and a summary index. The influence of diabetic comorbidity on the course of HRQoL was evaluated for each of the EQ-5D outcomes in multi-level linear regression analyses, adjusting for baseline characteristics. HRQoL improved in all EQ-5D outcomes over the course of treatment for those DFUs that healed. The few significant differences in the development of HRQoL between patients with and without comorbidity showed a more beneficial development for patients with comorbidity in DFUs that did not heal or healed slowly. Comorbidity does not hamper improvement of HRQoL in DFU treatment. On the contrary, HRQoL improved sometimes more in patients with certain comorbidity with hard-to-heal ulcers. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. A feasibility study of UMTS mobile phones for supporting nurses doing home visits to patients with diabetic foot ulcers

    DEFF Research Database (Denmark)

    Larsen, Simon Bo; Clemensen, Jane; Ejskjær, Niels

    2006-01-01

    We tested the feasibility of Universal Mobile Telephone System (UMTS) mobile phones for video consultations in the home. Five patients with diabetic foot ulcers were included in the study. Each of them was offered three video consultations instead of visits to the hospital outpatient clinic....... The consultations took from 5 to 18 min. In all 15 consultations, the hospital experts were able to assess the ulcer in cooperation with the visiting nurse and to decide on the treatment. However, technical problems sometimes made it difficult for them. Connectivity problems occurred in seven of the 15...... consultations. Also, the audio signal was rather unstable at times. In all situations except one, however, the clinicians were able to reach a decision that the expert felt confident about, and after all consultations the atmosphere and participants' attitudes were very positive....

  6. Diabetic Foot Ulcers and Epidermal Growth Factor: Revisiting the Local Delivery Route for a Successful Outcome

    Directory of Open Access Journals (Sweden)

    Jorge Berlanga-Acosta

    2017-01-01

    Full Text Available Soon after epidermal growth factor (EGF discovery, some in vivo models appeared demonstrating its property to enhance cutaneous wound healing. EGF was the first growth factor (GF introduced in the clinical arena as a healing enhancer, exerting its mitogenic effects on epithelial, fibroblastoid, and endothelial cells via a tyrosine kinase membrane receptor. Compelling evidences from the 90s documented that, for EGF, locally prolonged bioavailability and hourly interaction with the receptor were necessary for a successful tissue response. Eventually, the enthusiasm on the clinical use of EGF to steer the healing process was wiped out as the topical route to deliver proteins started to be questioned. The simultaneous in vivo experiments, emphasizing the impact of the parenterally administered EGF on epithelial and nonepithelial organs in terms of mitogenesis and cytoprotection, rendered the theoretical fundamentals for the injectable use of EGF and shaped the hypothesis that locally infiltrating the diabetic ulcers would lead to an effective healing. Although the diabetic chronic wounds microenvironment is hostile for local GFs bioavailability, EGF local infiltration circumvented the limitations of its topical application, thus expanding its therapeutic prospect. Our clinical pharmacovigilance and basic studies attest the significance of the GF local infiltration for chronic wounds healing.

  7. Antibiotic Sensitivity in Pseudomonas aeruginosa of Diabetic Patient’s Foot Ulcer

    OpenAIRE

    Pratiwi Apridamayanti; Khairunnisa Azani Meilinasary; Rafika Sari

    2016-01-01

    Diabetes Mellitus (DM) patients are at risk to have the diabetic ulcer. The main reason for DM’s patient with ulcer complication to be treated and healed in hospital is bacterial infection. One of many bacteria that infects diabetic ulcer is Pseudomonas aeruginosa. This conditian can be treated by antibiotic. The using antibiotic is often inaccurate causing the microbe resistance. To choose the right antibiotic, it needs to test the antibiotic’s sensitivity towards Pseudomonas aeruginosa. The...

  8. The clinical assessment study of the foot (CASF: study protocol for a prospective observational study of foot pain and foot osteoarthritis in the general population

    Directory of Open Access Journals (Sweden)

    Menz Hylton B

    2011-09-01

    Full Text Available Abstract Background Symptomatic osteoarthritis (OA affects approximately 10% of adults aged over 60 years. The foot joint complex is commonly affected by OA, yet there is relatively little research into OA of the foot, compared with other frequently affected sites such as the knee and hand. Existing epidemiological studies of foot OA have focussed predominantly on the first metatarsophalangeal joint at the expense of other joints. This three-year prospective population-based observational cohort study will describe the prevalence of symptomatic radiographic foot OA, relate its occurrence to symptoms, examination findings and life-style-factors, describe the natural history of foot OA, and examine how it presents to, and is diagnosed and managed in primary care. Methods All adults aged 50 years and over registered with four general practices in North Staffordshire, UK, will be invited to participate in a postal Health Survey questionnaire. Respondents to the questionnaire who indicate that they have experienced foot pain in the preceding twelve months will be invited to attend a research clinic for a detailed clinical assessment. This assessment will consist of: clinical interview; physical examination; digital photography of both feet and ankles; plain x-rays of both feet, ankles and hands; ultrasound examination of the plantar fascia; anthropometric measurement; and a further self-complete questionnaire. Follow-up will be undertaken in consenting participants by postal questionnaire at 18 months (clinic attenders only and three years (clinic attenders and survey participants, and also by review of medical records. Discussion This three-year prospective epidemiological study will combine survey data, comprehensive clinical, x-ray and ultrasound assessment, and review of primary care records to identify radiographic phenotypes of foot OA in a population of community-dwelling older adults, and describe their impact on symptoms, function and

  9. Polymicrobial nature of chronic diabetic foot ulcer biofilm infections determined using bacterial tag encoded FLX amplicon pyrosequencing (bTEFAP.

    Directory of Open Access Journals (Sweden)

    Scot E Dowd

    Full Text Available BACKGROUND: Diabetic extremity ulcers are associated with chronic infections. Such ulcer infections are too often followed by amputation because there is little or no understanding of the ecology of such infections or how to control or eliminate this type of chronic infection. A primary impediment to the healing of chronic wounds is biofilm phenotype infections. Diabetic foot ulcers are the most common, disabling, and costly complications of diabetes. Here we seek to derive a better understanding of the polymicrobial nature of chronic diabetic extremity ulcer infections. METHODS AND FINDINGS: Using a new bacterial tag encoded FLX amplicon pyrosequencing (bTEFAP approach we have evaluated the bacterial diversity of 40 chronic diabetic foot ulcers from different patients. The most prevalent bacterial genus associated with diabetic chronic wounds was Corynebacterium spp. Findings also show that obligate anaerobes including Bacteroides, Peptoniphilus, Fingoldia, Anaerococcus, and Peptostreptococcus spp. are ubiquitous in diabetic ulcers, comprising a significant portion of the wound biofilm communities. Other major components of the bacterial communities included commonly cultured genera such as Streptococcus, Serratia, Staphylococcus and Enterococcus spp. CONCLUSIONS: In this article, we highlight the patterns of population diversity observed in the samples and introduce preliminary evidence to support the concept of functional equivalent pathogroups (FEP. Here we introduce FEP as consortia of genotypically distinct bacteria that symbiotically produce a pathogenic community. According to this hypothesis, individual members of these communities when they occur alone may not cause disease but when they coaggregate or consort together into a FEP the synergistic effect provides the functional equivalence of well-known pathogens, such as Staphylococcus aureus, giving the biofilm community the factors necessary to maintain chronic biofilm infections

  10. Diabetic foot ulcer management in clinical practice in the UK: costs and outcomes.

    Science.gov (United States)

    Guest, Julian F; Fuller, Graham W; Vowden, Peter

    2018-02-01

    The aim of this study was to estimate the patterns of care and annual levels of health care resource use attributable to managing diabetic foot ulcers (DFUs) in clinical practice by the UK's National Health Service (NHS), and the associated costs of patient management. This was a retrospective cohort analysis of the records of 130 patients with a newly diagnosed DFU in The Health Improvement Network (THIN) database. Patients' characteristics, wound-related health outcomes and health care resource use were quantified, and the total NHS cost of patient management was estimated at 2015-2016 prices. Patients were predominantly managed in the community by nurses, with minimal clinical involvement of specialist physicians. 5% of patients saw a podiatrist, and 5% received a pressure-offloading device. Additionally, 17% of patients had at least one amputation within the first 12 months from initial presentation of their DFU. 14% of DFUs were documented as being clinically infected at initial presentation, although an additional 31% of patients were prescribed an antimicrobial dressing at the time of presentation. Of all the DFUs, 35% healed within 12 months, and the mean time to healing was 4·4 months. Over the study period, 48% of all patients received at least one prescription for a compression system, but significantly more patients healed if they never received compression (67% versus 16%; P cost of wound care over 12 months was an estimated £7800 per DFU (of which 13% was attributable to amputations), ranging from £2140 to £8800 per healed and unhealed DFU, respectively, and £16 900 per amputated wound. Consolidated medical records from a primary care held database provided 'real-world evidence' highlighting the consequences of inefficient and inadequate management of DFUs in clinical practice in the UK. Clinical and economic benefits to both patients and the NHS could accrue from strategies that focus on (i) wound prevention, (ii) improving wound-healing rates

  11. Non-healing foot ulcers in diabetic patients: general and local interfering conditions and management options with advanced wound dressings.

    Science.gov (United States)

    Uccioli, Luigi; Izzo, Valentina; Meloni, Marco; Vainieri, Erika; Ruotolo, Valeria; Giurato, Laura

    2015-04-01

    Medical knowledge about wound management has improved as recent studies have investigated the healing process and its biochemical background. Despite this, foot ulcers remain an important clinical problem, often resulting in costly, prolonged treatment. A non-healing ulcer is also a strong risk factor for major amputation. Many factors can interfere with wound healing, including the patient's general health status (i.e., nutritional condition indicated by albumin levels) or drugs such as steroids that can interfere with normal healing. Diabetic complications (i.e., renal insufficiency) may delay healing and account for higher amputation rates observed in diabetic patients under dialysis treatment. Wound environment (e.g., presence of neuropathy, ischaemia, and infection) may significantly influence healing by interfering with the physiological healing cascade and adding local release of factors that may worsen the wound. The timely and well-orchestrated release of factors regulating the healing process, observed in acute wounds, is impaired in non-healing wounds that are blocked in a chronic inflammatory phase without progressing to healing. This chronic phase is characterised by elevated protease activity (EPA) of metalloproteinases (MMPs) and serine proteases (e.g., human neutrophil elastase) that interfere with collagen synthesis, as well as growth factor release and action. EPA (mainly MMP 9, MMP-8 and elastase) and inflammatory factors present in the wound bed (such as IL-1, IL-6, and TNFa) account for the catabolic state of non-healing ulcers. The availability of wound dressings that modulate EPA has added new therapeutic options for treating non-healing ulcers. The literature confirms advantages obtained by reducing protease activity in the wound bed, with better outcomes achieved by using these dressings compared with traditional ones. New technologies also allow a physician to know the status of the wound bed environment, particularly EPA, in a clinical

  12. Protocol for a systematic review and individual patient data meta-analysis of prognostic factors of foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS).

    Science.gov (United States)

    Crawford, Fay; Anandan, Chantelle; Chappell, Francesca M; Murray, Gordon D; Price, Jacqueline F; Sheikh, Aziz; Simpson, Colin R; Maxwell, Martin; Stansby, Gerard P; Young, Matthew J; Abbott, Caroline A; Boulton, Andrew J M; Boyko, Edward J; Kastenbauer, Thomas; Leese, Graham P; Monami, Matteo; Monteiro-Soares, Matilde; Rith-Najarian, Stephen J; Veves, Aristidis; Coates, Nikki; Jeffcoate, William J; Leech, Nicola; Fahey, Tom; Tierney, Jayne

    2013-02-15

    Diabetes-related lower limb amputations are associated with considerable morbidity and mortality and are usually preceded by foot ulceration. The available systematic reviews of aggregate data are compromised because the primary studies report both adjusted and unadjusted estimates. As adjusted meta-analyses of aggregate data can be challenging, the best way to standardise the analytical approach is to conduct a meta-analysis based on individual patient data (IPD).There are however many challenges and fundamental methodological omissions are common; protocols are rare and the assessment of the risk of bias arising from the conduct of individual studies is frequently not performed, largely because of the absence of widely agreed criteria for assessing the risk of bias in this type of review. In this protocol we propose key methodological approaches to underpin our IPD systematic review of prognostic factors of foot ulceration in diabetes.Review questions;1. What are the most highly prognostic factors for foot ulceration (i.e. symptoms, signs, diagnostic tests) in people with diabetes?2. Can the data from each study be adjusted for a consistent set of adjustment factors?3. Does the model accuracy change when patient populations are stratified according to demographic and/or clinical characteristics? MEDLINE and EMBASE databases from their inception until early 2012 were searched and the corresponding authors of all eligible primary studies invited to contribute their raw data. We developed relevant quality assurance items likely to identify occasions when study validity may have been compromised from several sources. A confidentiality agreement, arrangements for communication and reporting as well as ethical and governance considerations are explained.We have agreement from the corresponding authors of all studies which meet the eligibility criteria and they collectively possess data from more than 17000 patients. We propose, as a provisional analysis plan, to use a

  13. Incidence and risk factors for surgically acquired pressure ulcers: a prospective cohort study investigators.

    Science.gov (United States)

    Webster, Joan; Lister, Carolyn; Corry, Jean; Holland, Michelle; Coleman, Kerrie; Marquart, Louise

    2015-01-01

    To assess the incidence of hospital-acquired, surgery-related pressure injury (ulcers) and identify risk factors for these injuries. We used a prospective cohort study to investigate the research question. The study was conducted at a major metropolitan hospital in Brisbane, Australia. Five hundred thirty-four adult patients booked for any surgical procedure expected to last more than 30 minutes were eligible for inclusion. Patients who provided informed consent for study participation were assessed for pressure ulcers, using the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel Guidelines, before entering the operating room and again in the post-anesthetic care unit (PACU). Research nurses and all PACU nurses were trained in skin assessment and in pressure ulcer staging. Patients were not assessed again after their discharge from the PACU. Seven patients (1.3%) had existing pressure injuries (ulcers) and a further 6 (1.3%) developed a surgery-related pressure ulcer. Risk factors associated with surgery-related pressure injuries were similar to non-surgically related risks and included older age, skin condition, and being admitted from a location other than one's own home. Length of surgery was not associated with pressure ulcer development in this cohort. Perioperative nurses play an important role in identifying existing or new pressure injuries. However, many of these nurses are unfamiliar with pressure ulcer classification, so education in this area is essential. Although the incidence of surgically acquired pressure ulcers was low in this cohort, careful skin inspection before and after surgery provides an opportunity for early treatment and may prevent existing lesions progressing to higher stages.

  14. Ulcers

    Science.gov (United States)

    ... of the stomach and intestines. In certain circumstances stress can help cause ulcers. But this usually only happens when illness involving severe emotional or physical stress is involved — such as when someone too sick ...

  15. Ulcers

    Science.gov (United States)

    ... These include both regular and decaffeinated coffee, tea, chocolate, meat extracts, alcohol, black pepper, chili powder, mustard ... Disease, peptic ulcers, proton pump inhibitor, sucralfate, triple therapy January 1, 1996 Copyright © American Academy of Family ...

  16. Débridement and Autologous Lipotransfer for Chronic Ulceration of the Diabetic Foot and Lower Limb Improves Wound Healing.

    Science.gov (United States)

    Stasch, Tilman; Hoehne, Julius; Huynh, Tuan; De Baerdemaeker, Randy; Grandel, Siegfried; Herold, Christian

    2015-12-01

    The application of autologous lipotransfer (fat grafting, lipofilling) in reconstructive surgery is steadily becoming more popular as evidence of the regenerative and reparative effects of fat becomes better known. The authors investigated the use of autologous lipotransfer for treatment of chronic diabetic and other foot and lower limb ulcers. Twenty-six patients with nonhealing wounds were treated with surgical débridement and autologous lipotransfer (using the débridement and autologous lipotransfer method). The mean age of the wounds before intervention was 16.7 months. Wound size after débridement averaged 5.1 ± 2.6 cm2. On average, 7.1 ± 3.3 cc of lipoaspirate was transferred into the wound area. Twenty-two of 25 wounds (88 percent) healed completely within a mean of 68.0 ± 33.0 days. A reduction of wound size by 50 percent was achieved after an average of 4 weeks. In one patient with an ulcer within particularly scarred tissues on the lower limb, a repeated session of lipotransfer led to complete wound healing after another 4 weeks. The authors describe a simple and useful technique to improve wound healing in diabetic feet and chronic lower limb ulcers with a background of peripheral vascular disease, where other interventional options to achieve wound healing have failed.

  17. Evaluation of wound healing in diabetic foot ulcer using platelet-rich plasma gel: A single-arm clinical trial.

    Science.gov (United States)

    Mohammadi, Mohammad Hossein; Molavi, Behnam; Mohammadi, Saeed; Nikbakht, Mohsen; Mohammadi, Ashraf Malek; Mostafaei, Shayan; Norooznezhad, Amir Hossein; Ghorbani Abdegah, Ali; Ghavamzadeh, Ardeshir

    2017-04-01

    The aim of the present study was to evaluate the effectiveness of using autologous platelet-rich plasma (PRP) gel for treatment of diabetic foot ulcer (DFU) during the first 4 weeks of the treatment. In this longitudinal and single-arm trial, 100 patients were randomly selected after meeting certain inclusion and exclusion criteria; of these 100 patients, 70 (70%) were enrolled in the trial. After the primary care actions such as wound debridement, the area of each wound was calculated and recorded. The PRP therapy (2mL/cm 2 of ulcers) was performed weekly until the healing time for each patient. We used one sample T-test for healing wounds and Bootstrap resampling approach for reporting confidence interval with 1000 Bootstrap samples. The p-valuehealing time was 8.7, 8 weeks (SD: 3.93) except for 2 mentioned cases. According to one sample T-test, wound area (cm 2 ), on average, significantly decreased to 51.9% (CI: 46.7-57.1) through the first four weeks of therapy. Furthermore, significant correlation (0.22) was not found between area of ulcers and healing duration (p-value>0.5). According to the results, PRP could be considered as a candidate treatment for non-healing DFUs as it may prevent future complications such as amputation or death in this pathological phenomenon. Copyright © 2016 Elsevier Ltd. All rights reserved.

  18. Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers: systematic review and meta-analysis

    Directory of Open Access Journals (Sweden)

    Liu S

    2017-04-01

    Full Text Available Si Liu,1 Chao-zhu He,1 Yan-ting Cai,1 Qiu-ping Xing,1 Ying-zhen Guo,1 Zhi-long Chen,1 Ji-liang Su,1 Li-ping Yang2 1School of Nursing, Nanchang University, 2Department of Endocrinology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China Objectives: The aim of this study was to perform an updated systematic review and meta-analysis to assess the clinical efficacy, safety, and cost-effectiveness of negative-pressure wound therapy (NPWT in the treatment of diabetic foot ulcers (DFUs.Methods: We searched the Cochrane Library, MEDLINE, EMBASE, Ovid, and Chinese Biological Medicine databases up to June 30, 2016. We also manually searched the articles from reference lists of the retrieved articles, which used the NPWT system in studies of vacuum-assisted closure therapy. Studies were identified and selected, and two independent reviewers extracted data from the studies.Results: A total of eleven randomized controlled trials, which included a total of 1,044 patients, were selected from 691 identified studies. Compared with standard dressing changes, NPWT had a higher rate of complete healing of ulcers (relative risk, 1.48; 95% confidence interval [CI]: 1.24–1.76; P<0.001, shorter healing time (mean difference, −8.07; 95% CI: −13.70–−2.45; P=0.005, greater reduction in ulcer area (mean difference, 12.18; 95% CI: 8.50–15.86; P<0.00001, greater reduction in ulcer depth (mean difference, 40.82; 95% CI: 35.97–45.67; P<0.00001, fewer amputations (relative risk, 0.31; 95% CI: 0.15–0.62; P=0.001, and no effect on the incidence of treatment-related adverse effects (relative risk, 1.12; 95% CI: 0.66–1.89; P=0.68. Meanwhile, many analyses showed that the NPWT was more cost-effective than standard dressing changes.Conclusion: These results indicate that NPWT is efficacious, safe, and cost-effective in treating DFUs. Keywords: diabetic foot ulcers, negative-pressure wound therapy, complete wound closure, amputation, meta

  19. The impact of the multidisciplinary team in the management of individuals with diabetic foot ulcers: a systematic review.

    Science.gov (United States)

    Buggy, A; Moore, Z

    2017-06-02

    To assess the impact of the multidisciplinary team in the management of the diabetic foot compared with those who did not receive multidisciplinary care. A systematic review of the literature was conducted using the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Embase and Cochrane Library. The following search terms were used: diabetic foot, multidisciplinary team, patient care team, multidisciplinary care team. Data were extracted using a bespoke data extraction tool and quality appraisal of the studies was undertaken using the EBL Critical Appraisal checklist. Data analysis was undertaken using RevMan with results presented as odds ratio for dichotomous data, or mean difference for continuous data, all with the associated 95% confidence intervals. The search identified 19 eligible studies. Severity of amputation, death rates and length of hospital stay of clients receiving multidisciplinary team care were improved when compared with those who did not receive multidisciplinary team care. Ulcer healing and quality of life showed an improvement but not all studies explored these outcomes. Only 7 of the 19 articles appraised were found to be of acceptable quality, questioning the generalisability of the results. From the currently available evidence a positive impact of the multidisciplinary team on diabetic foot outcomes can be seen, but due to the lack of high-quality evidence and substantial heterogeneity in the studies, these results should be interpreted with caution.

  20. Diagnosing pelvic osteomyelitis beneath pressure ulcers in spinal cord injured patients: a prospective study.

    Science.gov (United States)

    Brunel, A-S; Lamy, B; Cyteval, C; Perrochia, H; Téot, L; Masson, R; Bertet, H; Bourdon, A; Morquin, D; Reynes, J; Le Moing, V

    2016-03-01

    There is no consensus on a diagnostic strategy for osteomyelitis underlying pressure ulcers. We conducted a prospective study to assess the accuracy of multiple bone biopsies and imaging to diagnose pelvic osteomyelitis. Patients with clinically suspected osteomyelitis beneath pelvic pressure ulcers were enrolled. Bone magnetic resonance imaging (MRI) and surgical bone biopsies (three or more for microbiology and one for histology per ulcer) were performed. Bacterial osteomyelitis diagnosis relied upon the association of positive histology and microbiology (at least one positive culture for non-commensal microorganisms or three or more for commensal microorganisms of the skin). From 2011 to 2014, 34 patients with 44 pressure ulcers were included. Bacterial osteomyelitis was diagnosed for 28 (82.3%) patients and 35 (79.5%) ulcers according to the composite criterion. Discrepancy was observed between histology and microbiology for 5 (11.4%) ulcers. Most common isolates were Staphylococcus aureus (77.1%), Peptostreptococcus (48.6%) and Bacteroides (40%), cultured in three or more samples in 42.9% of ulcers for S. aureus and ≥20% for anaerobes. Only 2.8% of ulcers had three or more positive specimens with coagulase-negative staphylococci, group B Streptococcus, and nil with enterococci and Pseudomonas aeruginosa. Staphylococcus aureus, Proteus and group milleri Streptococcus were recovered from one sample in 22.8%, 11.4% and 11.4% of ulcers, respectively. Agreement was poor between biopsies and MRI (κ 0.2). Sensitivity of MRI was 94.3% and specificity was 22.2%. The diagnosis of pelvic osteomyelitis relies on multiple surgical bone biopsies with microbiological and histological analyses. At least three bone samples allows the detection of pathogens and exclusion of contaminants. MRI is not routinely useful for diagnosis. Copyright © 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

  1. Footwear and offloading interventions to prevent and heal foot ulcers and reduce plantar pressure in patients with diabetes: a systematic review.

    Science.gov (United States)

    Bus, S A; van Deursen, R W; Armstrong, D G; Lewis, J E A; Caravaggi, C F; Cavanagh, P R

    2016-01-01

    Footwear and offloading techniques are commonly used in clinical practice for preventing and healing of foot ulcers in persons with diabetes. The goal of this systematic review is to assess the medical scientific literature on this topic to better inform clinical practice about effective treatment. We searched the medical scientific literature indexed in PubMed, EMBASE, CINAHL, and the Cochrane database for original research studies published since 1 May 2006 related to four groups of interventions: (1) casting; (2) footwear; (3) surgical offloading; and (4) other offloading interventions. Primary outcomes were ulcer prevention, ulcer healing, and pressure reduction. We reviewed both controlled and non-controlled studies. Controlled studies were assessed for methodological quality, and extracted key data was presented in evidence and risk of bias tables. Uncontrolled studies were assessed and summarized on a narrative basis. Outcomes are presented and discussed in conjunction with data from our previous systematic review covering the literature from before 1 May 2006. We included two systematic reviews and meta-analyses, 32 randomized controlled trials, 15 other controlled studies, and another 127 non-controlled studies. Several randomized controlled trials with low risk of bias show the efficacy of therapeutic footwear that demonstrates to relief plantar pressure and is worn by the patient, in the prevention of plantar foot ulcer recurrence. Two meta-analyses show non-removable offloading to be more effective than removable offloading for healing plantar neuropathic forefoot ulcers. Due to the limited number of controlled studies, clear evidence on the efficacy of surgical offloading and felted foam is not yet available. Interestingly, surgical offloading seems more effective in preventing than in healing ulcers. A number of controlled and uncontrolled studies show that plantar pressure can be reduced by several conservative and surgical approaches. Sufficient

  2. An economic evaluation of VAC therapy compared with wound dressings in the treatment of diabetic foot ulcers.

    Science.gov (United States)

    Flack, S; Apelqvist, J; Keith, M; Trueman, P; Williams, D

    2008-02-01

    To determine the cost-effectiveness ofVacuum Assisted Closure (VAC) therapy (KCI Medical), based on a comparison with both traditional and advanced wound dressings, for the treatment of diabetic foot ulcers in the US. A Markov model was designed to estimate the cost per amputation avoided and the cost per quality-adjusted life year (QALY) of VAC therapy, compared with both traditional and advanced dressings. Over a one-year period the Markov model simulated 1000 patients using transition probabilities obtained from the literature. The health states used in the model were: uninfected ulcer; infected ulcer; infected ulcer post-amputation; healed; healed post-amputation; amputation; and death. Patients initially treated with VAC switched to the advanced dressing after three months of treatment if their wound remained unhealed. Patients treated with traditional or advanced dressings were assumed to continue with their treatment for the full 12 months if they remained unhealed. The model results demonstrate improved healing rates (61% versus 59%), more QALYs (0.54 versus 0.53) and an overall lower cost of care ($52,830 versus $61,757 per person) for patients treated with VAC therapy compared with advanced dressings. Vacuum Assisted Closure was also shown to be a dominant intervention when compared with traditional dressings. The model results indicate thatVAC therapy is less costly and more effective than both traditional and advanced dressings. The results are robust to changes in key parameters, including the transition probabilities, the cost ofVAC therapy and the utility weights applied to health states.

  3. Relationship and susceptibility profile of Staphylococcus aureus infection diabetic foot ulcers with Staphylococcus aureus nasal carriage.

    Science.gov (United States)

    Taha, Aza Bahadeen

    2013-03-01

    Staphylococcus aureus is the main cause of diabetic foot infection with the patient's endogenous flora as the principal source. Nasal carriage of S. aureus has been identified as an important risk factor for the acquisition of diabetic foot infections. The study assessment the associations of S. aureus with methicillin resistant S. aureus were isolation from diabetic foot infection and nasal carriage of the same patients and their antibiotic susceptibility profile. Diagnosis of S. aureus and methicillin resistant S. aureus were carried out by using standard procedures. Antibiotic sensitivity profiles were determent by breakpoint dilution method. Out of 222 S. aureus isolation, 139 (62.61%) were isolated from the diabetic foot and 83 (37.39%) from the nasal carriage. Seventy one (30.87%) of the patients were S. aureus infection diabetic foot with nasal carriage. Among diabetic foot infection and nasal carriage patients, 40.85% of S. aureus were considered as methicillin resistant S. aureus. Rifampicin (96.40%) and Levofloxacin (91.44%) were active against S. aureus. Patients at strong risk for methicillin resistant S. aureus nasal carriage and subsequent diabetic foot infection with high resistance to antibiotics. Copyright © 2012 Elsevier Ltd. All rights reserved.

  4. Diabetic complications do not hamper improvement of health-related quality of life over the course of treatment of diabetic foot ulcers

    DEFF Research Database (Denmark)

    Siersma, Volkert; Thorsen, Hanne; Holstein, Per E.

    2017-01-01

    Aims: Diabetic complications, and in particular diabetic foot ulcers (DFUs), are associated with low health-related quality of life (HRQoL). We evaluated whether the presence of diabetic complications also influenced the improvement of HRQoL during DFU treatment. Methods: 1088 patients presenting...

  5. Development of an IoT early-warning temperature home-monitoring system for diabetic foot ulcer-or Charcot-feet patients

    DEFF Research Database (Denmark)

    Dittmann, Lars; Petersen, Martin Nordal; Yderstræde, Knud Bonnet

    2017-01-01

    In severe cases, diabetic patients can develop ulcers at the feet and lower leg regions.This,together with a condition called Charcot-foot, can lead to severe wounds, numbness and eventually amputation. There are ways to treat the condition, but the key element is early-warning and early treatment....

  6. Performance of prognostic markers in the prediction of wound healing or amputation among patients with foot ulcers in diabetes: a systematic review

    NARCIS (Netherlands)

    Brownrigg, J. R. W.; Hinchliffe, R. J.; Apelqvist, J.; Boyko, E. J.; Fitridge, R.; Mills, J. L.; Reekers, J.; Shearman, C. P.; Zierler, R. E.; Schaper, N. C.

    2016-01-01

    Prediction of wound healing and major amputation in patients with diabetic foot ulceration is clinically important to stratify risk and target interventions for limb salvage. No consensus exists as to which measure of peripheral artery disease (PAD) can best predict outcomes. To evaluate the

  7. Comparing the Meggitt-Wagner and the University of Texas wound classification systems for diabetic foot ulcers: inter-observer analyses

    NARCIS (Netherlands)

    Santema, Trientje B.; Lenselink, Ellie A.; Balm, Ron; Ubbink, Dirk T.

    2016-01-01

    Accurate classification of diabetic foot ulcers is essential for inter-clinician communication, assessment of healing tendency and determination of treatment options. The aim of this study was to assess the inter-observer agreement (IOA) of the most commonly used classification systems for diabetic

  8. Topically applied connective tissue growth factor/CCN2 improves diabetic preclinical cutaneous wound healing: potential role for CTGF in human diabetic foot ulcer healing.

    Science.gov (United States)

    Henshaw, F R; Boughton, P; Lo, L; McLennan, S V; Twigg, S M

    2015-01-01

    Topical application of CTGF/CCN2 to rodent diabetic and control wounds was examined. In parallel research, correlation of CTGF wound fluid levels with healing rate in human diabetic foot ulcers was undertaken. Full thickness cutaneous wounds in diabetic and nondiabetic control rats were treated topically with 1 μg rhCTGF or vehicle alone, on 2 consecutive days. Wound healing rate was observed on day 14 and wound sites were examined for breaking strength and granulation tissue. In the human study across 32 subjects, serial CTGF regulation was analyzed longitudinally in postdebridement diabetic wound fluid. CTGF treated diabetic wounds had an accelerated closure rate compared with vehicle treated diabetic wounds. Healed skin withstood more strain before breaking in CTGF treated rat wounds. Granulation tissue from CTGF treatment in diabetic wounds showed collagen IV accumulation compared with nondiabetic animals. Wound α-smooth muscle actin was increased in CTGF treated diabetic wounds compared with untreated diabetic wounds, as was macrophage infiltration. Endogenous wound fluid CTGF protein rate of increase in human diabetic foot ulcers correlated positively with foot ulcer healing rate (r = 0.406; P diabetic foot ulcers.

  9. Systematic review and meta-analysis of skin substitutes in the treatment of diabetic foot ulcers: Highlights of a Cochrane systematic review

    NARCIS (Netherlands)

    Santema, T. B. Katrien; Poyck, Paul P. C.; Ubbink, Dirk T.

    2016-01-01

    Skin substitutes are increasingly used in the treatment of various types of acute and chronic wounds. The aim of this study was to perform a systematic review and meta-analysis to evaluate the effectiveness of skin substitutes on ulcer healing and limb salvage in the treatment of diabetic foot

  10. Association of the gene expression variation of tumor necrosis factor-α and expressions changes of dopamine receptor genes in progression of diabetic severe foot ulcers

    Directory of Open Access Journals (Sweden)

    Hajar Vaseghi

    2017-11-01

    Full Text Available Objective(s:Regulation of pro-inflammatory factors such as TNF-, which are secreted by the immune cells through induction of their several receptors including dopamine receptors (especially DRD2 and DRD3 is one of the noticeable problems in diabetic severe foot ulcer healing. This study was conducted to evaluate the alteration of TNF- in plasma as well as DRD2 and DRD3 changes in PBMCs of diabetics with severe foot ulcers. Materials and Methods: Peripheral blood samples were collected from 31 subjects with ulcers, 29 without ulcers, and 25 healthy individuals. Total mRNA was extracted from PBMCs for the study of DRD2, DRD3, and TNF- gene expression variations. Expression patterns of these genes were evaluated by real-time PCR. Consequently, concentration of TNF- was investigated in plasma. Results: Significant decrease in gene expression and plasma concentration of TNF- in PBMCs was observed in both patient groups at P Conclusion: We concluded that DRD2 and DRD3 expression alteration and presence of new DRD3 transcripts can be effective in reduction of TNF-α expression as a pro-inflammatory factor. Performing complementary studies, may explain that variations in DRD2 and DRD3 are prognostic and effective markers attributed to the development of diabetes severe foot ulcers.

  11. Four-fold increase in foot ulcers in type 2 diabetic subjects without an increase in major amputations by a multidisciplinary setting

    DEFF Research Database (Denmark)

    Hedetoft, Christoffer; Rasmussen, Anne; Fabrin, Jesper

    2008-01-01

    AIMS: We observed a large increase in type 2 diabetic subjects with foot ulcers in our diabetic outpatient foot clinic and wanted to identify the amputations rate and individuals at risk of amputations by comparing those who had had a regular control in the multidisciplinary foot clinic prior...... to the amputations and those who had not. METHODS: We examined all clinical records from the orthopaedic surgery department and the diabetic outpatient foot clinic of diabetic patients who underwent amputations for 6 years. RESULTS: Eighty-eight patients with type 2 diabetes underwent 142 amputations; 42 major...... and 100 minor amputations. There was no increase in the number of major amputations in this period. In the group not followed in the foot clinic prior to amputations we showed a greater major amputations rate (p

  12. Buried chip skin grafting in neuropathic diabetic foot ulcers following vacuum-assisted wound bed preparation: enhancing a classic surgical tool with novel technologies.

    Science.gov (United States)

    Kopp, Jürgen; Kneser, Ulrich; Bach, Alexander D; Horch, Raymund E

    2004-09-01

    In patients with diabetes mellitus, complications such as polyneuropathy and peripheral angiopathy inevitably lead to diabetic foot complications including foot ulcers, gangrene, and osteoarthropathy. These conditions necessitate minor or major amputation as part of treatment. In patients with Charcot's arthropathy and predominant neuropathy, recurrent foot ulcers are common in areas of high pressure. Such high pressure is caused by the degrading of the architecture of the foot and inadequate footwear. These patients are a clinical challenge. A select group of such patients may benefit from free surgical tissue transfer, though free or local flap surgery is often difficult or even impossible owing to an impaired arterial circulation. In such wounds, surgical debridement followed by skin grafts often fail due to bacterial burden in the wounds. To circumvent these problems, the authors developed a therapeutic approach using buried chip skin grafting to close granulation wound beds in diabetic feet. Locally applied vacuum therapy (VAC) for wound bed preparation of chronic, nonresponsive foot ulcers and subsequent grafting using the burying technique with a minute fraction of skin was used. Firm closure was achieved. The closed wound was resistant to mechanical irritation.

  13. Vacuum-assisted wound closure for the management of a foot ulcer due to Buerger's disease.

    Science.gov (United States)

    Canter, Halil Ibrahim; Isci, Evren; Erk, Yucel

    2009-02-01

    Thromboangiitis obliterans is a segmental inflammatory disease of the small- and medium-sized vessels mainly affecting the extremities. Although there are numerous reports concerning the treatment of these debilitating, chronic ulcers, such as skin grafting, local flaps, and free flaps, this report is the first published case of a patient with Buerger's disease, successfully managed with vacuum-assisted closure (VAC) application. This therapy decreases the period of hospital stay and increases patient comfort between dressings. Further clinical studies are needed to demonstrate the effectiveness and safety of VAC therapy in treatment of ulcers due to different kinds of vasculitis.

  14. The LeucoPatch® system in the management of hard-to-heal diabetic foot ulcers: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Game, Frances; Jeffcoate, William; Tarnow, Lise; Day, Florence; Fitzsimmons, Deborah; Jacobsen, Judith

    2017-10-10

    Diabetic foot ulcers are a common and severe complication of diabetes mellitus. Standard treatment includes debridement, offloading, management of infection and revascularisation where appropriate, although healing times may be long. The LeucoPatch® device is used to generate an autologous platelet-rich fibrin and leucocyte wound dressing produced from the patient's own venous blood by centrifugation, but without the addition of any reagents. The final product comprises a thin, circular patch composed predominantly of fibrin together with living platelets and leucocytes. Promising results have been obtained in non-controlled studies this system, but this now needs to be tested in a randomised controlled trial (RCT). If confirmed, the LeucoPatch® may become an important new tool in the armamentarium in the management of diabetic foot ulcers which are hard-to-heal. People with diabetes and hard-to-heal ulcers of the foot will receive either pre-specified good standard care or good standard care supplemented by the application of the LeucoPatch® device. The primary outcome will be the percentage of ulcers healed within 20 weeks. Healing will be defined as complete epithelialisation without discharge that is maintained for 4 weeks and is confirmed by an observer blind to randomisation group. Ulcers of the foot are a major source of morbidity to patients with diabetes and costs to health care economies. The study population is designed to be as inclusive as possible with the aim of maximising the external validity of any findings. The primary outcome measure is healing within 20 weeks of randomisation and the trial also includes a number of secondary outcome measures. Among these are rate of change in ulcer area as a predictor of the likelihood of eventual healing, minor and major amputation of the target limb, the incidence of infection and quality of life. International Standard Randomised Controlled Trial, ISRCTN27665670 . Registered on 5 July 2013.

  15. Use of maggot therapy for treating a diabetic foot ulcer colonized by multidrug resistant bacteria in Brazil

    Directory of Open Access Journals (Sweden)

    Marilia A.R.Q. Pinheiro

    2015-01-01

    Full Text Available This study reports the efficacy of maggot therapy in the treatment of diabetic foot ulcer infected with multidrug resistant microorganisms. A 74 year old female patient with diabetes for over 30 years, was treated with maggot therapy using larvae of Chrysomya megacephala. The microbiological samples were collected to evaluate aetiology of the infection. The therapy done for 43 days resulted in a reduction of necrosis and the ulcer′s retraction of 0.7 cm [2] in area. Analysis of the bacteriological swabs revealed the presence of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Further studies need to be done to confirm the role of maggot therapy in wound healing using a large sample and a proper study design.

  16. Use of Leukocyte Platelet (L-PRF Rich Fibrin in Diabetic Foot Ulcer with Osteomyelitis (Three Clinical Cases Report

    Directory of Open Access Journals (Sweden)

    Alessandro Crisci

    2018-04-01

    Full Text Available In this study, the use of fibrin rich in leukocytes and platelets (L-PRF was explored to heal osteomyelitis ulcers in a diabetic foot. The goal was to standardize the utilization of L-PRF in patients with osteomyelitis to direct it for healing. L-PRF was obtained autologously from the peripheral blood of the diabetic patients (n = 3 having osteomyelitis and skin lesions for at least six months. The L-PRF and supernatant serum were inserted into the skin lesion to the bone after a surgical debridement. The evolution of lesions over time was analyzed. All three patients showed positivity to the Probe-to-Bone test and Nuclear Magnetic Resonance detected cortico-periosteal thickening and/or outbreaks of spongy cortical osteolysis in adjacency of the ulcer. The infections were caused by Cocci Gram-positive bacteria, such as S. Aureus, S. β-hemolytic, S. Viridans and Bacilli; and Gram-negative such as Pseudomonas, Proteus, Enterobacter; and yeast, Candida. The blood count did not show any significant alterations. To date, all three patients have healed skin lesions (in a patient for about two years with no evidence of infection. These preliminary results showed that L-PRF membranes could be a new method of therapy in such problematic diseases. Overall, the L-PRF treatment in osteomyelitis of a diabetic foot seems to be easy and cost-effective by regenerative therapy of chronic skin lesions. In addition, it will improve our understanding of wound healing.

  17. Pharmacoeconomic analysis of epidermal growth factor (HeberprotP ® for the treatment of diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    G R Galstyan

    2013-03-01

    Full Text Available Introduction. The epidermal growth factor (EGF; HeberprotP ® is the new treatment for deep persistent diabetic foot ulcers (Wagner grade 3–4. The effectiveness of EGF measured as the reduction of the time to complete granulation of tissue lesions was confirmed in randomised clinical trials, but the cost of this new treatment is high. Aim. To analyze the costs and outcomes of the use of EGF (Heberprot-P® for the treatment of DFU in high- ly specialized medical institutions. Material and methods. We tested the hypothesis that the use of Heberprot-P® in diabetic foot ulcers – DFU – (Wagner grade 3–4 would reduce the rate of amputations and increase survival at acceptable cost for the Russian healthcare system. We used the data from international published literature to construct mathematical model representing clinical outcomes in the cohort of patients treated with only standard methods or standard methods in combination with Heberport-P®. We calculated direct costs associated with both strategies of treatment taking into account the risk of amputation. Results. The use of Heberprot-P® may prevent 52 amputations and save 29.54 years of life in a cohort of 100 DFU patients (Wagner grade 3–4. The incremental costs of EGF treatment were RUR 1.170.000 per life year gained and did not exceed the accepted threshold of less than three times GDP per capita. Conclusion. Mathematic modelling demonstrated the feasibility of introduction of EGF in combination with standard treatment for DFU in highly specialized medical institutions.

  18. Clinical effectiveness of hemoglobin spray (Granulox® as adjunctive therapy in the treatment of chronic diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Sharon D. Hunt

    2016-11-01

    Full Text Available Introduction: Hemoglobin spray (Granulox® comprises purified hemoglobin and is a novel approach for increasing oxygen availability in the wound bed in diabetic foot ulcer patients. Its mode of action is to bind oxygen from the atmosphere and diffuse it into the wound bed to accelerate wound healing in slow-healing wounds. Patients and methods: Wound healing outcomes, that is, wound size, pain, percentage of slough, and exudate levels, were compared retrospectively to a similar cohort of patients treated over the same period the previous year. The same inclusion and exclusion criteria applied to both groups. Results: All 20 (100% hemoglobin spray-treated patients and 15 (75% control patients experienced some wound healing by week 4, with 5 (25% and 1 (5%, respectively, achieving complete wound closure. At week 4, mean wound size reduction was 63% in the hemoglobin spray group versus 26% for controls, increasing to 95% reduction at week 28 in the hemoglobin spray group versus 63% for controls (p<0.05 at all timepoints. Hemoglobin spray was associated with substantially lower pain scores using a 10-cm visual analogue scale, with 19/19 patients (100% being pain-free from week 12 onwards, compared to 6/18 patients (33% in the control group. At week 28, 2/18 patients (11% in the control group still had pain. Both groups had similar baseline slough levels, but hemoglobin spray-treated wounds had slough completely eliminated after 4 weeks versus 10% mean reduction in the control group (p<0.001. Hemoglobin spray was associated with markedly reduced exudate levels; within 4 weeks, no patients had high exudate levels in the hemoglobin spray group versus 5 in the control group. Conclusion: Standard wound care plus hemoglobin spray results in improvements in wound closure, wound size reduction, pain, slough, and exudate levels compared to control patients for chronic diabetic foot ulcer treatment.

  19. The management of diabetic foot ulcers in Danish hospitals is not optimal

    DEFF Research Database (Denmark)

    Kirketerp-Møller, Klaus; Svendsen, Ole Lander; Jansen, Rasmus Bo

    2015-01-01

    INTRODUCTION: The diabetic foot is a complicated health issue which ideally involves several different specialists to ensure the most effective treatment. The Danish Health and Medicines Authority recently published a national guideline to address the implementation of multidisciplinary teams......) were mostly orthopaedic surgeons. A classification system of the diabetic foot was rarely or never used, and eight respondents (42%) reported having a multidisciplinary team in accordance with the national guidelines. 73% of the respondents performed some form of surgical intervention on diabetic feet......, mainly minor procedures. CONCLUSION: The study demonstrated that several areas of treatment practices relating to the diabetic foot had potential for improvement as they did not adhere to national Danish guidelines. A follow-up survey, allowing time for local implementation, seems warranted....

  20. Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients Who Attend the Diabetic Follow-Up Clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-Based Cross-Sectional Study

    Science.gov (United States)

    Mariam, Tesfamichael G.; Alemayehu, Abebaw; Tesfaye, Eleni; Mequannt, Worku; Temesgen, Kiber; Yetwale, Fisseha

    2017-01-01

    Diabetes mellitus is a metabolic disorder which is characterized by multiple long-term complications that affect almost every system in the body. Foot ulcers are one of the main complications of diabetes mellitus. However, there is limited evidence on the occurrence of foot ulcer and influencing factors in Ethiopia. An institutional-based cross-sectional study was conducted in Gondar University Hospital, Ethiopia, to investigate foot ulcer occurrence in diabetic patients. Systematic random sampling was used to select 279 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. Odds ratio with 95% confidence interval was computed to determine the level of significance. Diabetic foot ulcer was found to be 13.6%. Rural residence [AOR = 2.57; 95% CI: 1.42, 5.93], type II diabetes mellitus [AOR = 2.58; 95% CI: 1.22, 6.45], overweight [AOR = 2.12; 95% CI: 1.15, 3.10], obesity [AOR = 2.65; 95% CI: 1.25, 5.83], poor foot self-care practice [AOR = 2.52; 95% CI: 1.21, 6.53], and neuropathy [AOR = 21.76; 95% CI: 8.43, 57.47] were factors associated with diabetic foot ulcer. Diabetic foot ulcer was found to be high. Provision of special emphasis for rural residence, decreasing excessive weight gain, managing neuropathy, and promoting foot self-care practice would decrease diabetic foot ulcer. PMID:28791310

  1. Prevalence of Diabetic Foot Ulcer and Associated Factors among Adult Diabetic Patients Who Attend the Diabetic Follow-Up Clinic at the University of Gondar Referral Hospital, North West Ethiopia, 2016: Institutional-Based Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Tesfamichael G. Mariam

    2017-01-01

    Full Text Available Diabetes mellitus is a metabolic disorder which is characterized by multiple long-term complications that affect almost every system in the body. Foot ulcers are one of the main complications of diabetes mellitus. However, there is limited evidence on the occurrence of foot ulcer and influencing factors in Ethiopia. An institutional-based cross-sectional study was conducted in Gondar University Hospital, Ethiopia, to investigate foot ulcer occurrence in diabetic patients. Systematic random sampling was used to select 279 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with diabetic foot ulcer. Odds ratio with 95% confidence interval was computed to determine the level of significance. Diabetic foot ulcer was found to be 13.6%. Rural residence [AOR = 2.57; 95% CI: 1.42, 5.93], type II diabetes mellitus [AOR = 2.58; 95% CI: 1.22, 6.45], overweight [AOR = 2.12; 95% CI: 1.15, 3.10], obesity [AOR = 2.65; 95% CI: 1.25, 5.83], poor foot self-care practice [AOR = 2.52; 95% CI: 1.21, 6.53], and neuropathy [AOR = 21.76; 95% CI: 8.43, 57.47] were factors associated with diabetic foot ulcer. Diabetic foot ulcer was found to be high. Provision of special emphasis for rural residence, decreasing excessive weight gain, managing neuropathy, and promoting foot self-care practice would decrease diabetic foot ulcer.

  2. Bacterial Prevalence and Antibiotic Resistance in Clinical Isolates of Diabetic Foot Ulcers in the Northeast of Tamaulipas, Mexico.

    Science.gov (United States)

    Sánchez-Sánchez, Mario; Cruz-Pulido, Wendy Lizeth; Bladinieres-Cámara, Eduardo; Alcalá-Durán, Rodrigo; Rivera-Sánchez, Gildardo; Bocanegra-García, Virgilio

    2017-06-01

    Diabetic foot ulcers (DFUs) are a serious and common problem in patients with diabetes mellitus and constitute one of the major causes of lower extremity amputation. The microbiological profile of DFUs depends on the acute or chronic character of the wound. Aerobic gram-positive cocci are the predominant organisms isolated from DFUs. Diabetic foot biopsies from patients admitted to the Angiology and Vascular Surgery Hospital of the Northeast, in Reynosa, Tamaulipas from December 2011 to April 2016 were analyzed. The samples were processed using standard microbiology techniques. Antimicrobial susceptibility testing was carried out according to the protocol established by the Clinical & Laboratory Standards Institute (CLSI). We obtained 246 bacterial isolates, based on the results of phenotypic resistance. The least effective antibiotics for gram-positive bacteria were penicillin and dicloxacillin; for gram-negative bacteria, cefalotin and penicillin were the least effective. Levofloxacin, cefalotin, and amikacin were the most effective antibiotics for gram-positive and negative bacteria, respectively. Enterobacter genus was significantly associated with muscle biopsies ( P = .011) and samples without growth were significantly associated with specimens of pyogenic origin ( P = .000). In 215 DFU samples, we found that Staphylococcus aureus was the most commonly isolated pathogen followed by Enterobacter sp. This is consistent with previous reports. Enterobacter species may play an important role in the colonization/infection of certain tissues; however, further studies are needed in this regard.

  3. The Wound Healing Effects of Herbal Cream Containing Oliveria Decumbens and Pelargonium Graveolens Essential Oils in Diabetic Foot Ulcer Model.

    Science.gov (United States)

    Mahboubi, Mohaddese; Taghizadeh, Mohsen; Khamechian, Tahereh; Tamtaji, Omid Reza; Mokhtari, Rasoul; Talaei, Sayyed Alireza

    2018-01-01

    The number of diabetic patients in adult population is increasing. All this population are at risk of developing diabetic foot ulcers (DFUs) that are associated with unwanted ailments and high mortality. In spite of current therapies for DFUs, further therapies are needed to help the patients. The efficacy of herbal cream containing Pelargonium graveolens and Oliveria decombens essential oils was evaluated topically for treatment of DFUs in rat animal model in comparison with two other herbal formulas containing each essential oil alone, placebo (the basic formula without active ingredients) and normal saline as control groups. After anesthesia of diabetic rats (n=75) induced by streptozotocin (STZ), diabetic wounds were visible on the hind dorsal surface of the foot . The treatments were initiated on Day 1 and repeated 3 times a day for thirteen consecutive days. On day 1, 3, 5, 8 and 13, the wound sizes were determined and assessed histologically. Three herbal formulations reduced the size of wounds in rats with DFUs, while the cream containing combined herbals of O. decumbens and P. graveolens essential oils had the highest tissue repair in DFU rat models. Due to better wound healing effects of combined herbal cream containing O. decumbens and P. graveolens essential oils, it can be recommended in treatment of DFUs.

  4. Wound healing outcomes in a diabetic foot ulcer outpatient clinic at an acute care hospital: a retrospective study.

    Science.gov (United States)

    Lu, S H; McLaren, A-M

    2017-10-01

    Patients with diabetic foot ulcers (DFU) have an increased risk of lower extremity amputation. A retrospective chart review of patients with DFUs attending the Foot Treatment and Assessment chiropodist-led outpatient clinic at an inner-city academic hospital was conducted to determine wound healing outcomes and characteristics contributing to outcomes. We reviewed the complete clinical history of 279 patients with 332 DFUs spanning over a five-year period. The mean age of patients was 61.5±12.5 years and most patients (83.5%) had one DFU. The majority of wounds (82.5%) were in the forefoot. Overall, 267/332 (80.5%) wounds healed. A greater proportion of wounds healed in the forefoot (82.5%) and midfoot (87.1%) than hindfoot (51.9%; phealing. Our findings are the first to demonstrate the benefits of chiropodists leading an acute care outpatient clinic in the management of DFUs in Canada and delivers wound healing outcomes equivalent to or exceeding those previously published.

  5. The importance of growth factors for the treatment of chronic wounds in the case of diabetic foot ulcers

    Directory of Open Access Journals (Sweden)

    Ehm, Alexandra

    2010-01-01

    Full Text Available Introduction: Ulcers as a result of diabetes mellitus are a serious problem with an enormous impact on the overall global disease burden due to the increasing prevalence of diabetes. Because of long hospital stays, rehabilitation, often required home care and the use of social services diabetic foot complications are costly. Therapy with growth factors could be an effective and innovative add-on to standard wound care. Research questions: What is the benefit of therapies with growth factors alone or in combination with other technologies in the treatment of diabetic foot ulcer assessed regarding medical, economical, social, ethical and juridical aspects? Methods: We systematically searched relevant databases limited to English and German language and publications since 1990. Cost values were adjusted to the price level of 2008 and converted into Euro. A review and an assessment of the quality of publications were conducted following approved methodical standards conforming to evidence-based medicine and health economics. Results: We identified 25 studies (14 randomized controlled trials (RCT, nine cost-effectiveness analyses, two meta-analyses. The RCT compared an add-on therapy to standard wound care with standard wound care/placebo alone or extracellular wound matrix: in six studies becaplermin, in two rhEGF, in one bFGF, and in five studies the metabolically active skin grafts Dermagraft and Apligraf. The study duration ranged from twelve to 20 weeks and the study population included between 17 to 382 patients, average 130 patients. The treatment with becaplermin, rhEGF and skin implants Dermagraft and Apligraf showed in eight out of 13 studies an advantage concerning complete wound closure and the time to complete wound healing. Evidence for a benefit of treatment with bFGF could not be found. In four out of 14 studies the proportion of adverse events was 30% per study group with no difference between the treatment groups. The methodological

  6. Performance of prognostic markers in the prediction of wound healing or amputation among patients with foot ulcers in diabetes: a systematic review.

    Science.gov (United States)

    Brownrigg, J R W; Hinchliffe, R J; Apelqvist, J; Boyko, E J; Fitridge, R; Mills, J L; Reekers, J; Shearman, C P; Zierler, R E; Schaper, N C

    2016-01-01

    Prediction of wound healing and major amputation in patients with diabetic foot ulceration is clinically important to stratify risk and target interventions for limb salvage. No consensus exists as to which measure of peripheral artery disease (PAD) can best predict outcomes. To evaluate the prognostic utility of index PAD measures for the prediction of healing and/or major amputation among patients with active diabetic foot ulceration, two reviewers independently screened potential studies for inclusion. Two further reviewers independently extracted study data and performed an assessment of methodological quality using the Quality in Prognostic Studies instrument. Of 9476 citations reviewed, 11 studies reporting on 9 markers of PAD met the inclusion criteria. Annualized healing rates varied from 18% to 61%; corresponding major amputation rates varied from 3% to 19%. Among 10 studies, skin perfusion pressure ≥ 40 mmHg, toe pressure ≥ 30 mmHg (and ≥ 45 mmHg) and transcutaneous pressure of oxygen (TcPO2 ) ≥ 25 mmHg were associated with at least a 25% higher chance of healing. Four studies evaluated PAD measures for predicting major amputation. Ankle pressure diabetic foot ulceration, the measurement of skin perfusion pressures, toe pressures and TcPO2 appear to be more useful in predicting ulcer healing than ankle pressures or the ABI. Conversely, an ankle pressure of < 50 mmHg or an ABI < 0.5 is associated with a significant increase in the incidence of major amputation. Copyright © 2015 John Wiley & Sons, Ltd.

  7. Outcomes in diabetic foot ulcer patients with isolated T2 marrow signal abnormality in the underlying bone: should the diagnosis of ''osteitis'' be changed to ''early osteomyelitis''?

    International Nuclear Information System (INIS)

    Duryea, Dennis; Bernard, Stephanie; Flemming, Donald; Walker, Eric; French, Cristy

    2017-01-01

    To evaluate the variability of clinical treatment and outcomes based on reporting of diabetic foot ulcer MRI findings of adjacent marrow T2 hyperintensity with normal T1 signal. A retrospective review was conducted of 46 MRI examinations evaluating diabetic foot ulcers that demonstrated normal T1 marrow signal, but T2 marrow hyperintensity deep to the ulcer. The cohort was divided based on MRI report impressions into three groups; ''osteitis without osteomyelitis'' (OW), ''osteitis but cannot exclude early osteomyelitis'' (OCEO) and ''early osteomyelitis'' (EO). Patient demographics (age, gender) and accessory MRI findings of ulcer and sinus tract depth were recorded. Initial clinical assessment and medical treatment (route and duration of antibiotics), healing versus disease progression and histology or microbiology results were recorded. The isolated marrow T2 signal hyperintensity was reported as OW in 12 patients, OCEO in 18, and EO in 16. No statistical difference in clinical assessment was demonstrated between the OW, OCEO, and EO groups. Pathological condition was available in 15 patients within 0-7 days (mean 2.4 days) of the MRI examination, with 14 (93%) of these positive for osteomyelitis by histopathology or positive cultures. Initial diagnosis of or progression to osteomyelitis was shown in 28 patients (61%). Treatment of suspected osteomyelitis is heavily determined by clinical factors. Patients who initially demonstrate only T2 marrow signal abnormality under a diabetic ulcer are eventually diagnosed as osteomyelitis in 61% of cases and deserve aggressive treatment as early osteomyelitis when meeting clinical parameters. (orig.)

  8. The management of diabetic foot ulcers in Danish hospitals is not optimal

    DEFF Research Database (Denmark)

    Kirketerp-Møller, Klaus; Svendsen, Ole Lander; Jansen, Rasmus Bo

    2015-01-01

    INTRODUCTION: The diabetic foot is a complicated health issue which ideally involves several different specialists to ensure the most effective treatment. The Danish Health and Medicines Authority recently published a national guideline to address the implementation of multidisciplinary teams...... in the treatment. The objective of this study was to describe the treatment practices at the time the guidelines were launched. METHODS: A questionnaire-based survey was conducted among Danish hospital departments working with diabetic feet. All public departments were invited by e-mail to participate......) were mostly orthopaedic surgeons. A classification system of the diabetic foot was rarely or never used, and eight respondents (42%) reported having a multidisciplinary team in accordance with the national guidelines. 73% of the respondents performed some form of surgical intervention on diabetic feet...

  9. The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing but not major amputation in patients with diabetic foot ulcers treated in a multidisciplinary setting.

    Science.gov (United States)

    Mathioudakis, Nestoras; Hicks, Caitlin W; Canner, Joseph K; Sherman, Ronald L; Hines, Kathryn F; Lum, Ying W; Perler, Bruce A; Abularrage, Christopher J

    2017-06-01

    The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) threatened limb classification has been shown to correlate well with risk of major amputation and time to wound healing in heterogeneous diabetic and nondiabetic populations. Major amputation continues to plague the most severe stage 4 WIfI patients, with 1-year amputation rates of 20% to 64%. Our aim was to determine the association between WIfI stage and wound healing and major amputation among patients with diabetic foot ulcers (DFUs) treated in a multidisciplinary setting. All patients presenting to our multidisciplinary DFU clinic from July 2012 to December 2015 were enrolled in a prospective database. Wound healing and major amputation were compared for patients stratified by WIfI classification. There were 217 DFU patients with 439 wounds (mean age, 58.3 ± 0.8 years; 58% male, 63% black) enrolled, including 28% WIfI stage 1, 11% stage 2, 33% stage 3, and 28% stage 4. Peripheral arterial disease and dialysis were more common in patients with advanced (stage 3 or 4) wounds (P ≤ .05). Demographics of the patients, socioeconomic status, and comorbidities were otherwise similar between groups. There was a significant increase in the number of active wounds per limb at presentation with increasing WIfI stage (stage 1, 1.1 ± 0.1; stage 4, 1.4 ± 0.1; P = .03). Mean wound area (stage 1, 2.6 ± 0.6 cm 2 ; stage 4, 15.3 ± 2.8 cm 2 ) and depth (stage 1, 0.2 ± 0.0 cm; stage 4, 0.8 ± 0.1 cm) also increased progressively with increasing wound stage (P healing (P healing time was 190 ± 17 days, and risk of major amputation at 1 year was 5.7% ± 3.2%. Among patients with DFU, the WIfI classification system correlated well with wound healing but was not associated with risk of major amputation at 1 year. Although further prospective research is warranted, our results suggest that use of a multidisciplinary approach for DFUs may augment healing time and reduce amputation

  10. Comparative Clinical Study of the Wound Healing Effects of a Novel Micropore Particle Technology: Effects on Wounds, Venous Leg Ulcers, and Diabetic Foot Ulcers

    Science.gov (United States)

    Bilyayeva, Olga O; Neshta, Viacheslav V; Golub, Alexander A; Sams-Dodd, Frank

    2017-08-01

    The purpose of this study was to determine the wound healing effects of Acapsil, a white, odorless powder based on micropore particle technology (MPPT) (Willingsford Ltd, Southampton, UK) by comparing it to Gentaxane (Gentaksan, Borshchagovsky CCP, Kyiv, Ukraine) (polydimethylsiloxane powder with gentamicin antibiotic) and Ioddicerin (Farmak, Kyiv, Ukraine) (iodine with dimethyl sulfoxide [DMSO]). The study included 266 patients with primarily trophic ulcers caused by pancreatic diabetes and venous insufficiency of the lower extremities, carbuncles, phlegmons, infected third- or fourth-degree heat burns, and infiltrations of postoperative wounds. The products were applied once daily to the wound until it was clean (ie, free from necrosis, pus, and fibrinogenous thickenings). The number of days (mean ± standard deviation) to a clean wound was 3.0 ± 0.9 for MPPT (n = 88) compared with 7.0 ± 1.2 and 8.0 ± 1.1 for Gentaxane (n = 90) and iodine/DMSO (n = 88), respectively. Thus, MPPT reduced the time to reach a clean wound by 57% and 62%, respectively. Products were used once daily until a clean wound was reached, which also reflects the number of applications. Days to onset of granulation for MPPT, Gentaxane, and iodine/DMSO were 4.5 ± 0.8, 9.2 ± 1.4, and 10.3 ± 1.5 days, respectively; and days to onset of epithelialization were 7.8 ± 1.1, 14.1 ± 1.9, and 16.4 ± 2.7 days, respectively. Subgroup analysis of patients with diabetic foot and venous leg ulcers found that each of these demonstrated the same pattern of healing as the overall study. The number of hospitalization days was 14.6 ± 5.6 for MPPT, 21.0 ± 10.7 for Gentaxane, and 24.0 ± 7.9 for iodine/DMSO. Compared with Gentaxane, patients receiving MPPT had a 31% reduction in hospitalization duration and a 39% reduction compared with iodine/DMSO. These findings demonstrate that MPPT represents a valuable new approach to wound care.

  11. Leucocyte- and platelet-rich fibrin (L-PRF) as a regenerative medicine strategy for the treatment of refractory leg ulcers: a prospective cohort study.

    Science.gov (United States)

    Pinto, Nelson R; Ubilla, Matias; Zamora, Yelka; Del Rio, Verónica; Dohan Ehrenfest, David M; Quirynen, Marc

    2017-07-20

    Chronic wounds (VLU: venous leg ulcer, DFU: diabetic foot ulcer, PU: pressure ulcer, or complex wounds) affect a significant proportion of the population. Despite appropriate standard wound care, such ulcers unfortunately may remain open for months or even years. The use of leukocyte- and platelet-rich fibrin (L-PRF) to cure skin ulcers is a simple and inexpensive method, widely used in some countries but unknown or neglected in most others. This auto-controlled prospective cohort study explored and quantified accurately for the first time the adjunctive benefits of topical applications of L-PRF in the management of such refractory ulcers in a diverse group of patients. Forty-four consecutive patients with VLUs (n = 28, 32 wounds: 17 ≤ 10 cm 2 and 15 > 10 cm 2 ), DPUs (n = 9, 10 wounds), PUs (n = 5), or complex wounds (n = 2), all refractory to standard treatment for ≥3 months, received a weekly application of L-PRF membranes. L-PRF was prepared following the original L-PRF method developed more than 15 years ago (400g, 12 minutes) using the Intra-Spin L-PRF centrifuge/system and the XPression box kit (Intra-Lock, Boca Raton, FL, USA; the only CE/FDA cleared system for the preparation of L-PRF). Changes in wound area were recorded longitudinally via digital planimetry. Adverse events and pain levels were also registered. All wounds showed significant improvements after the L-PRF therapy. All VLUs ≤ 10 cm 2 , all DFUs, as well as the two complex wounds showed full closure within a 3-month period. All wounds of patients with VLUs > 10 cm 2 who continued therapy (10 wounds) could be closed, whereas in the five patients who discontinued therapy improvement of wound size was observed. Two out of the five PUs were closed, with improvement in the remaining three patients who again interrupted therapy (surface evolution from 7.35 ± 4.31 cm 2 to 5.78 ± 3.81 cm 2 ). No adverse events were observed. A topical application of L-PRF on

  12. Fibreglass Total Contact Casting, Removable Cast Walkers, and Irremovable Cast Walkers to Treat Diabetic Neuropathic Foot Ulcers: A Health Technology Assessment

    Science.gov (United States)

    Costa, Vania; Tu, Hong Anh; Wells, David; Weir, Mark; Holubowich, Corinne; Walter, Melissa

    2017-01-01

    Background Diabetic neuropathic foot ulcers are a risk factor for lower leg amputation. Many experts recommend offloading with fibreglass total contact casting, removable cast walkers, and irremovable cast walkers as a way to treat these ulcers. Methods We completed a health technology assessment, which included an evaluation of clinical benefits and harms, value for money, and patient preferences for offloading devices. We performed a systematic literature search on August 17, 2016, to identify randomized controlled trials that compared fibreglass total contact casting, removable cast walkers, and irremovable cast walkers with other treatments (offloading or non-offloading) in patients with diabetic neuropathic foot ulcers. We developed a decision-analytic model to assess the cost-effectiveness of fibreglass total contact casting, removable cast walkers, and irremovable cast walkers, and we conducted a 5-year budget impact analysis. Finally, we interviewed people with diabetes who had lived experience with foot ulcers, asking them about the different offloading devices and the factors that influenced their treatment choices. Results We identified 13 randomized controlled trials. The evidence suggests that total contact casting, removable cast walkers, and irremovable cast walkers are beneficial in the treatment of neuropathic, noninfected foot ulcers in patients with diabetes but without severe peripheral arterial disease. Compared to removable cast walkers, ulcer healing was improved with total contact casting (moderate quality evidence; risk difference 0.17 [95% confidence interval 0.00–0.33]) and irremovable cast walkers (low quality evidence; risk difference 0.21 [95% confidence interval 0.01–0.40]). We found no difference in ulcer healing between total contact casting and irremovable cast walkers (low quality evidence; risk difference 0.02 [95% confidence interval −0.11–0.14]). The economic analysis showed that total contact casting and irremovable

  13. A prospective study of risk for peptic ulcer disease in Seventh-Day Adventists.

    Science.gov (United States)

    Kurata, J H; Nogawa, A N; Abbey, D E; Petersen, F

    1992-03-01

    Cross-sectional and prospective data were collected and analyzed to identify risk factors for the development of peptic ulcer disease in a population of 34,198 white, non-Hispanic Seventh-Day Adventists. On a life-style questionnaire administered in 1976, 3853 subjects reported ever having had a physician-diagnosed peptic ulcer for a lifetime prevalence of 13.5% for men and 11.0% for women. Odds ratios of greater than 2.0 (P less than 0.0001) were observed for use of "stronger pain relievers," current cigarette smoking, and history of rheumatism or other arthritis and coronary disease. For both sexes, lower but statistically significant odds ratios (P less than 0.05) were found for eating white bread, "snacking," ever having smoked cigarettes, low church involvement, poor dietary adherence, high blood pressure, rheumatoid arthritis, aspirin use, job frustration and dissatisfaction, having a "blue collar household," and having less education. During 3 years of follow-up, 154 incident cases of ulcer were identified. The average annual incidence was 1.7 per 1000. Multivariate adjusted relative risks were statistically significant for using stronger pain relievers (P less than 0.001), having rheumatic conditions (P = 0.006), and using aspirin (P = 0.013). These findings suggest that rheumatic disease and use of aspirin and stronger pain relievers are more important risk factors for development of peptic ulcer disease in certain populations than diet, life-style, or psychological or socioeconomic characteristics.

  14. Topically Applied Connective Tissue Growth Factor/CCN2 Improves Diabetic Preclinical Cutaneous Wound Healing: Potential Role for CTGF in Human Diabetic Foot Ulcer Healing

    OpenAIRE

    Henshaw, F. R.; Boughton, P.; Lo, L.; McLennan, S. V.; Twigg, S. M.

    2015-01-01

    Aims/Hypothesis. Topical application of CTGF/CCN2 to rodent diabetic and control wounds was examined. In parallel research, correlation of CTGF wound fluid levels with healing rate in human diabetic foot ulcers was undertaken. Methods. Full thickness cutaneous wounds in diabetic and nondiabetic control rats were treated topically with 1??g?rhCTGF or vehicle alone, on 2 consecutive days. Wound healing rate was observed on day 14 and wound sites were examined for breaking strength and granulati...

  15. Molecular epidemiology of Staphylococcus aureus strains isolated from inpatients with infected diabetic foot ulcers in an Algerian University Hospital.

    Science.gov (United States)

    Djahmi, N; Messad, N; Nedjai, S; Moussaoui, A; Mazouz, D; Richard, J-L; Sotto, A; Lavigne, J-P

    2013-09-01

    Staphylococcus aureus is the most common pathogen cultured from diabetic foot infection (DFI). The consequence of its spread to soft tissue and bony structures is a major causal factor for lower-limb amputation. The objective of the study was to explore ecological data and epidemiological characteristics of S. aureus strains isolated from DFI in an Algerian hospital setting. Patients were included if they were admitted for DFI in the Department of Diabetology at the Annaba University Hospital from April 2011 to March 2012. Ulcers were classified according to the Infectious Diseases Society of America/International Working Group on the Diabetic Foot classification system. All S. aureus isolates were analysed. Using oligonucleotide arrays, S. aureus resistance and virulence genes were determined and each isolate was affiliated to a clonal complex. Among the 128 patients, 277 strains were isolated from 183 samples (1.51 isolate per sample). Aerobic Gram-negative bacilli were the most common isolated organisms (54.9% of all isolates). The study of ecological data highlighted the extremely high rate of multidrug-resistant organisms (MDROs) (58.5% of all isolates). The situation was especially striking for S. aureus [(85.9% were methicillin-resistant S. aureus (MRSA)], Klebsiella pneumonia (83.8%) and Escherichia coli (60%). Among the S. aureus isolates, 82.2% of MRSA belonged to ST239, one of the most worldwide disseminated clones. Ten strains (13.7%) belonged to the European clone PVL+ ST80. ermA, aacA-aphD, aphA, tetM, fosB, sek, seq, lukDE, fnbB, cap8 and agr group 1 genes were significantly associated with MRSA strains (p study shows for the first time the alarming prevalence of MDROs in DFI in Algeria. ©2013 The Authors Clinical Microbiology and Infection ©2013 European Society of Clinical Microbiology and Infectious Diseases.

  16. An Alteration of Lymphocytes Subpopulations and Immunoglobulins Levels in Patients with Diabetic Foot Ulcers Infected Particularly by Resistant Pathogens

    Directory of Open Access Journals (Sweden)

    Vladimíra Fejfarová

    2016-01-01

    Full Text Available The aim of our study was to analyse immune abnormalities in patients with chronic infected diabetic foot ulcers (DFUs especially those infected by resistant microorganisms. Methods. 68 patients treated in our foot clinic for infected chronic DFUs with 34 matched diabetic controls were studied. Patients with infected DFUs were subdivided into two subgroups according to the antibiotic sensitivity of causal pathogen: subgroup S infected by sensitive (n=50 and subgroup R by resistant pathogens (n=18. Selected immunological markers were compared between the study groups and subgroups. Results. Patients with infected chronic DFUs had, in comparison with diabetic controls, significantly reduced percentages (p<0.01 and total numbers of lymphocytes (p<0.001 involving B lymphocytes (p<0.01, CD4+ (p<0.01, and CD8+ T cells (p<0.01 and their naive and memory effector cells. Higher levels of IgG (p<0.05 including IgG1 (p<0.001 and IgG3 (p<0.05 were found in patients with DFUs compared to diabetic controls. Serum levels of immunoglobulin subclasses IgG2 and IgG3 correlated negatively with metabolic control (p<0.05. A trend towards an increased frequency of IgG2 deficiency was found in patients with DFUs compared to diabetic controls (22% versus 15%; NS. Subgroup R revealed lower levels of immunoglobulins, especially of IgG4 (p<0.01 in contrast to patients infected by sensitive bacteria. The innate immunity did not differ significantly between the study groups. Conclusion. Our study showed changes mainly in the adaptive immune system represented by low levels of lymphocyte subpopulations and their memory effector cells, and also changes in humoral immunity in patients with DFUs, even those infected by resistant pathogens, in comparison with diabetic controls.

  17. Effect of low-level light therapy on diabetic foot ulcers: a near-infrared spectroscopy study

    Science.gov (United States)

    Salvi, Massimo; Rimini, Daniele; Molinari, Filippo; Bestente, Gianni; Bruno, Alberto

    2017-03-01

    Diabetic foot ulcer (DFU) is a diabetic complication due to peripheral vasculopathy and neuropathy. A promising technology for wound healing in DFU is low-level light therapy (LLLT). Despite several studies showing positive effects of LLLT on DFU, LLLT's physiological effects have not yet been studied. The objective of this study was to investigate vascular and nervous systems modification in DFU after LLLT. Two samples of 45 DFU patients and 11 healthy controls (HCs) were recruited. The total hemoglobin (totHb) concentration change was monitored before and after LLLT by near-infrared spectroscopy and analyzed in time and frequency domains. The spectral power of the totHb changes in the very-low frequency (VLF, 20 to 60 mHz) and low frequency (LF, 60 to 140 mHz) bandwidths was calculated. Data analysis revealed a mean increase of totHb concentration after LLLT in DFU patients, but not in HC. VLF/LF ratio decreased significantly after the LLLT period in DFU patients (indicating an increased activity of the autonomic nervous system), but not in HC. Eventually, different treatment intensities in LLLT therapy showed a different response in DFU. Overall, our results demonstrate that LLLT improves blood flow and autonomic nervous system regulation in DFU and the importance of light intensity in therapeutic protocols.

  18. Association between Serum Cystatin C and Diabetic Foot Ulceration in Patients with Type 2 Diabetes: A Cross-Sectional Study

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    Jie Zhao

    2016-01-01

    Full Text Available Serum cystatin C (CysC has been identified as a possible potential biomarker in a variety of diabetic complications, including diabetic peripheral neuropathy and peripheral artery disease. We aimed to examine the association between CysC and diabetic foot ulceration (DFU in patients with type 2 diabetes (T2D. 411 patients with T2D were enrolled in this cross-sectional study at a university hospital. Clinical manifestations and biochemical parameters were compared between DFU group and non-DFU group. The association between serum CysC and DFU was explored by binary logistic regression analysis. The cut point of CysC for DFU was also evaluated by receiver operating characteristic (ROC curve. The prevalence of coronary artery disease, diabetic nephropathy (DN, and DFU dramatically increased with CysC (P<0.01 in CysC quartiles. Multivariate logistic regression analysis indicated that the significant risk factors for DFU were serum CysC, coronary artery disease, hypertension, insulin use, the differences between supine and sitting TcPO2, and hypertension. ROC curve analysis revealed that the cut point of CysC for DFU was 0.735 mg/L. Serum CysC levels correlated with DFU and severity of tissue loss. Our study results indicated that serum CysC was associated with a high prevalence of DFU in Chinese T2D subjects.

  19. Association between Serum Cystatin C and Diabetic Foot Ulceration in Patients with Type 2 Diabetes: A Cross-Sectional Study

    Science.gov (United States)

    Zhao, Jie; Deng, Wuquan; Zhang, Yuping; Zheng, Yanling; Zhou, Lina; Boey, Johnson; Armstrong, David G.; Yang, Gangyi

    2016-01-01

    Serum cystatin C (CysC) has been identified as a possible potential biomarker in a variety of diabetic complications, including diabetic peripheral neuropathy and peripheral artery disease. We aimed to examine the association between CysC and diabetic foot ulceration (DFU) in patients with type 2 diabetes (T2D). 411 patients with T2D were enrolled in this cross-sectional study at a university hospital. Clinical manifestations and biochemical parameters were compared between DFU group and non-DFU group. The association between serum CysC and DFU was explored by binary logistic regression analysis. The cut point of CysC for DFU was also evaluated by receiver operating characteristic (ROC) curve. The prevalence of coronary artery disease, diabetic nephropathy (DN), and DFU dramatically increased with CysC (P < 0.01) in CysC quartiles. Multivariate logistic regression analysis indicated that the significant risk factors for DFU were serum CysC, coronary artery disease, hypertension, insulin use, the differences between supine and sitting TcPO2, and hypertension. ROC curve analysis revealed that the cut point of CysC for DFU was 0.735 mg/L. Serum CysC levels correlated with DFU and severity of tissue loss. Our study results indicated that serum CysC was associated with a high prevalence of DFU in Chinese T2D subjects. PMID:27668262

  20. Neighborhood socioeconomic disadvantage is not associated with wound healing in diabetic foot ulcer patients treated in a multidisciplinary setting.

    Science.gov (United States)

    Hicks, Caitlin W; Canner, Joseph K; Mathioudakis, Nestoras; Sherman, Ronald L; Hines, Kathryn; Lippincott, Christopher; Black, James H; Abularrage, Christopher J

    2018-04-01

    Socioeconomic deprivation is associated with poor glycemic control and higher hospital admission rates in patients with diabetes. We sought to quantify the effects of neighborhood socioeconomic deprivation on wound healing among a cohort of patients with diabetic foot ulceration (DFU) treated in a multidisciplinary setting. Socioeconomic disadvantage was calculated for all patients using the area deprivation index (ADI) stratified by quartile (from ADI-0: least through ADI-3: most). Predictors of wound healing were assessed using Cox proportional hazards models accounting for patient demographics, wound characteristics, and ADI category. Six hundred twenty-one wounds were evaluated, including 59% ADI-0, 7% ADI-1, 12% ADI-2, and 22% ADI-3. After accounting for patient demographics and wound characteristics, the likelihood of wound healing was similar between groups (ADI-3 versus ADI-0: hazards ratio [HR] 1.03 [95% confidence interval 0.76-1.41]). Independent predictors of poor wound healing included peripheral arterial disease (HR 0.75), worse wound stage (stage 4: HR 0.48), larger wound area (HR 0.99), and partially dependent functional status (HR 0.45) (all, P healing was largely dependent on wound characteristics and vascular status rather than patient demographics or neighborhood socioeconomic disadvantage. Use of a multidisciplinary approach to the management of DFU may overcome the negative effects of socioeconomic disadvantage frequently described in the diabetic population. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Reactive Eccrine Syringofibroadenoma Associated with Neuropathy, Venous Stasis, and Diabetic Foot Ulcer

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    Thirawut Sirikham

    2016-06-01

    Full Text Available Eccrine syringofibroadenoma (ESFA is an uncommon benign adnexal neoplasm which derives from cells of the acrosyringium of eccrine sweat glands. The clinical appearance is nonspecific but the histological features are typical. Five clinical subtypes of ESFA exist: (1 solitary ESFA; (2 multiple ESFA associated with ectodermal dysplasia; (3 multiple ESFA without cutaneous features; (4 unilateral linear ESFA (nevoid, and (5 reactive ESFA associated with inflammatory or neoplastic dermatoses. We report the case of a 42-year-old man with long-standing diabetes and neuropathy, presenting with a 4-year history of asymptomatic erythematous plaques on a background of brown hyperpigmentation on the left foot. The clinical presentation and histopathological findings are compatible with reactive ESFA.

  2. [Non operative treatment for perforated peptic ulcer: results of a prospective study].

    Science.gov (United States)

    Songne, B; Jean, F; Foulatier, O; Khalil, H; Scotté, M

    2004-12-01

    The conservative management of perforated peptic ulcer has not gained widespread acceptance despite introduction of proton-pomp inhibitors because surgical procedures can achieve immediate closure by eventually using a laparoscopic approach. The aim of this prospective study was to evaluate the results of Taylor's method and to identify predictive factors of failure of medical treatment in patients presenting with perforated peptic ulcer. Between 1990 and 2000, 82 consecutive patients, with diagnosis of perforated peptic ulcer were prospectively included in this study. They were initially treated with non-operative procedure (nasogastric suction and intravenous administration of H2-blockers or proton-pomp inhibitors). No clinical improvement after 24 hours required a surgical treatment. Predictive factors of failure of non-operative treatment were tested in univariate or multivariate analysis. Clinical improvement was obtained with non-operative treatment in 54% of the patients (44/82). The overall mortality rate was 1%. In univariate analysis, significant predictive factors of failure of non-operative treatment were: size of pneumoperitoneum, heart beat >94 bpm, abdominal meteorism, pain at digital rectal exam, and age >59 years. In multivariate analysis, the significant factors were the size of pneumoperitoneum, heart beat, and abdominal meteorism. The association of these criteria: size of pneumoperitoneum >size of the first lumbar vertebra, heart beat >94 bpm, pain at digital rectal exam and age > 59 years , led to surgical treatment in all cases. These results suggest that more than 50% of patients with perforated peptic ulcer respond to conservative treatment without surgery and that the association of few criteria (size of pneumoperitoneum, heart beat, pain at digital rectal exam and age) require emergency surgery.

  3. Prospective Analysis of Surgical Bone Margins After Partial Foot Amputation in Diabetic Patients Admitted With Moderate to Severe Foot Infections.

    Science.gov (United States)

    Schmidt, Brian M; McHugh, Jonathan B; Patel, Rajiv M; Wrobel, James S

    2018-04-01

    Osteomyelitis is common in diabetic foot infections and medical management can lead to poor outcomes. Surgical management involves sending histopathologic and microbiologic specimens which guides future intervention. We examined the effect of obtainment of surgical margins in patients undergoing forefoot amputations to identify patient characteristics associated with outcomes. Secondary aims included evaluating interobserver reliability of histopathologic data at both the distal-to and proximal-to surgical bone margin. Data were prospectively collected on 72 individuals and was pooled for analysis. Standardized method to retrieve intraoperative bone margins was established. A univariate analysis was performed. Negative outcomes, including major lower extremity amputation, wound dehiscence, reulceration, reamputation, or death were recorded. Viable proximal margins were obtained in 63 out of 72 cases (87.5%). Strong interobserver reliability of histopathology was recorded. Univariate analysis demonstrated preoperative platelets, albumin, probe-to-bone testing, absolute toe pressures, smaller wound surface area were associated with obtaining viable margins. Residual osteomyelitis resulted in readmission 2.6 times more often and more postoperative complications. Certain patients were significantly different in the viable margin group versus dirty margin group. High interobserver reliability was demonstrated. Obtainment of viable margins resulted in reduced rates of readmission and negative outcomes. Prognostic, Level I: Prospective.

  4. Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia

    OpenAIRE

    Moses, J. Fallah; Hughes, Christopher D.; Patel, Pratik B.; Chao, Tiffany E.; Konneh, Solomane A.; Jallabah, Torsou Y.; Kikubaire, Michael Kiiza; Meara, John G.; Hagander, Lars

    2015-01-01

    Introduction The incidence of perforated peptic ulcer remains high in low and middle-income countries. Mortality can be significant, and early surgical management with careful evaluation of pre-operative risk factors is essential. The purpose of this study was to describe the clinical outcomes of surgical treatment for perforated peptic ulcer disease in Liberia and to explore risk factors for adverse outcomes. Methods This study prospectively examined 20 consecutive patients undergoing primar...

  5. Peptic ulcer bleeding patients with Rockall scores ≥6 are at risk of long-term ulcer rebleeding: A 3.5-year prospective longitudinal study.

    Science.gov (United States)

    Yang, Er-Hsiang; Cheng, Hsiu-Chi; Wu, Chung-Tai; Chen, Wei-Ying; Lin, Meng-Ying; Sheu, Bor-Shyang

    2018-01-01

    Patients with high Rockall scores have increased risk of rebleeding and mortality within 30 days after peptic ulcer bleeding, but long-term outcomes deserve follow-up after cessation of proton pump inhibitors. The paper aimed to validate whether patients with high Rockall scores have more recurrent ulcer bleeding in a 3.5-year longitudinal cohort. Between August 2011 and July 2014, 368 patients with peptic ulcer bleeding were prospectively enrolled after endoscopic hemostasis to receive proton pump inhibitors for at least 8 to 16 weeks. These subjects were categorized into either a Rockall scores ≥6 group (n = 257) or a Rockall scores ulcer bleeding. The proportion of patients with rebleeding during the 3.5-year follow-up was higher in patients with Rockall scores ≥6 than in those with scores ulcer (P = 0.04) were three additional independent factors found to increase rebleeding risk. The cumulative rebleeding rate was higher in patients with Rockall scores ≥6 with more than or equal to any two additional factors than in those with fewer than two additional factors (15.69 vs. 7.63 per 100 person-year, P = 0.012, log-rank test). Patients with Rockall scores ≥6 are at risk of long-term recurrent peptic ulcer bleeding. The risk can be independently increased by the presence of activated partial thromboplastin time prolonged ≥1.5-fold, American Society of Anesthesiologists class ≥III, and gastric ulcer in patients with Rockall scores ≥6. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

  6. Systematic review of economic evaluations of human cell-derived wound care products for the treatment of venous leg and diabetic foot ulcers

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    Langer Astrid

    2009-07-01

    Full Text Available Abstract Background Tissue engineering is an emerging field. Novel bioengineered skin substitutes and genetically derived growth factors offer innovative approaches to reduce the burden of diabetic foot and venous leg ulcers for both patients and health care systems. However, they frequently are very costly. Based on a systematic review of the literature, this study assesses the cost-effectiveness of these growth factors and tissue-engineered artificial skin for treating chronic wounds. Methods On the basis of an extensive explorative search, an appropriate algorithm for a systematic database search was developed. The following databases were searched: BIOSIS Previews, CRD databases, Cochrane Library, EconLit, Embase, Medline, and Web of Science. Only completed and published trial- or model-based studies which contained a full economic evaluation of growth factors and bioengineered skin substitutes for the treatment of chronic wounds were included. Two reviewers independently undertook the assessment of study quality. The relevant studies were assessed by a modified version of the Consensus on Health Economic Criteria (CHEC list and a published checklist for evaluating model-based economic evaluations. Results Eleven health economic evaluations were included. Three biotechnology products were identified for which topical growth factors or bioengineered skin substitutes for the treatment of chronic leg ulceration were economically assessed: (1 Apligraf®, a bilayered living human skin equivalent indicated for the treatment of diabetic foot and venous leg ulcers (five studies; (2 Dermagraft®, a human fibroblast-derived dermal substitute, which is indicated only for use in the treatment of full-thickness diabetic foot ulcers (one study; (3 REGRANEX® Gel, a human platelet-derived growth factor for the treatment of deep neuropathic diabetic foot ulcers (five studies. The studies considered in this review were of varying and partly low

  7. A prospective cohort study of postoperative complications in the management of perforated peptic ulcer.

    Science.gov (United States)

    Sharma, Smita S; Mamtani, Manju R; Sharma, Mamta S; Kulkarni, Hemant

    2006-06-16

    With dwindling rates of postoperative mortality in perforated peptic ulcer that is attributable to H2-receptor blocker usage, there is a need to shift the focus towards the prevention of postoperative morbidity. Further, the simultaneous contribution of several putative clinical predictors to this postoperative morbidity is not fully appreciated. Our objective was to assess the predictors of the risk, rate and number of postoperative complications in surgically treated patients of perforated peptic ulcer. In a prospective cohort study of 96 subjects presenting as perforated peptic ulcer and treated using Graham's omentoplatsy patch or gastrojejunostomy (with total truncal vagotomy), we assessed the association of clinical predictors with three domains of postoperative complications: the risk of developing a complication, the rate of developing the first complication and the risk of developing higher number of complications. We used multiple regression methods - logistic regression, Cox proportional hazards regression and Poisson regression, respectively - to examine the association of the predictors with these three domains. We observed that the risk of developing a postoperative complication was significantly influenced by the presence of a concomitant medical illness [odds ratio (OR) = 8.9, p = 0.001], abdominal distension (3.8, 0.048) and a need of blood transfusion (OR = 8.2, p = 0.027). Using Poisson regression, it was observed that the risk for a higher number of complications was influenced by the same three factors [relative risk (RR) = 2.6, p = 0.015; RR = 4.6, p management in patients of perforated peptic ulcer.

  8. A prospective cohort study of postoperative complications in the management of perforated peptic ulcer

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    Sharma Mamta S

    2006-06-01

    Full Text Available Abstract Background With dwindling rates of postoperative mortality in perforated peptic ulcer that is attributable to H2-receptor blocker usage, there is a need to shift the focus towards the prevention of postoperative morbidity. Further, the simultaneous contribution of several putative clinical predictors to this postoperative morbidity is not fully appreciated. Our objective was to assess the predictors of the risk, rate and number of postoperative complications in surgically treated patients of perforated peptic ulcer. Methods In a prospective cohort study of 96 subjects presenting as perforated peptic ulcer and treated using Graham's omentoplatsy patch or gastrojejunostomy (with total truncal vagotomy, we assessed the association of clinical predictors with three domains of postoperative complications: the risk of developing a complication, the rate of developing the first complication and the risk of developing higher number of complications. We used multiple regression methods – logistic regression, Cox proportional hazards regression and Poisson regression, respectively – to examine the association of the predictors with these three domains. Results We observed that the risk of developing a postoperative complication was significantly influenced by the presence of a concomitant medical illness [odds ratio (OR = 8.9, p = 0.001], abdominal distension (3.8, 0.048 and a need of blood transfusion (OR = 8.2, p = 0.027. Using Poisson regression, it was observed that the risk for a higher number of complications was influenced by the same three factors [relative risk (RR = 2.6, p = 0.015; RR = 4.6, p - blood group (RH = 4.7, p = 0.04. Conclusion Abdominal distension, presence of a concomitant medical illness and a history suggestive of shock at the time of admission warrant a closer and alacritous postoperative management in patients of perforated peptic ulcer.

  9. Data-driven directions for effective footwear provision for the high-risk diabetic foot

    NARCIS (Netherlands)

    Arts, M. L. J.; de Haart, M.; Waaijman, R.; Dahmen, R.; Berendsen, H.; Nollet, F.; Bus, S. A.

    2015-01-01

    Custom-made footwear is used to offload the diabetic foot to prevent plantar foot ulcers. This prospective study evaluates the offloading effects of modifying custom-made footwear and aims to provide data-driven directions for the provision of effectively offloading footwear in clinical practice.

  10. BLEEDING PEPTIC ULCER, NONSTEROIDAL ANTIINFLAMMATORY DRUGS AND HELICOBACTER PYLORI INFECTION – A PROSPECTIVE, CONTROLLED, RANDOMIZED STUDY

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    Pavel Skok

    2002-06-01

    Full Text Available Background. The explanation of peptic ulcer etiology has changed significantly in the past decade after the clarification of the significance of Helicobacter pylori infection.Aim. To evaluate the effectiveness of Helicobacter pylori eradication in patients with hemorrhaging peptic ulcer and patients with peptic ulcer without complications.Study ethics. The study was approved in 1998 by the Medical Ethics Committee of the Republic of Slovenia (No. 90/09/98.Type of study. Prospective, controlled and randomized study, carried out between 1998–2000.Patients and methods. The study included 80 patients (50 male and 30 female, av.age 57.5 years, SD ± 17.1, range 22– 80 in which endoscopy confirmed hemorrhage from peptic ulcer of stomach or duodenum and Helicobacter pylori infection. In all cases endoscopic hemostasis was performed: injection sclerotherapy with diluted adrenalin 1:10,000 and 1% polidocanol or argon plasma coagulation. The control group was made up of 80 patients (50 male and 30 female, av.age 56.8 years, SD ± 16.8, range 19–80 with peptic ulcer of stomach or duodenum and Helicobacter pylori infection. Infection was confirmed by a rapid urease test and histologic investigation of the gastric mucosa. In all cases the recommended drug combinations were used in the treatment of the infection: a proton pump inhibitor, omeprazol (4 weeks, and combination of antibiotics, claritromycin and metronidazole or with regard to the antibiogram (1 week. The therapeutic success was ascertained endoscopically four weeks after inclusion in the study. Infection eradication was confirmed by the rapid urease test and histologic investigation of the gastric mucosa.Results. Four weeks after inclusion in the study the success of infection eradication was 92.5% in the study group, in the control group it was 91.3% (p > 0.05. In 6 patients (7.5%, 6/ 80 from the study group and in 7 (8.8%, 7/80 from the control group we introduced a replacement treatment

  11. Cellular versus acellular matrix devices in treatment of diabetic foot ulcers: study protocol for a comparative efficacy randomized controlled trial

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    Lev-Tov Hadar

    2013-01-01

    Full Text Available Abstract Background Diabetic foot ulcers (DFUs represent a significant source of morbidity and an enormous financial burden. Standard care for DFUs involves systemic glucose control, ensuring adequate perfusion, debridement of nonviable tissue, off-loading, control of infection, local wound care and patient education, all administered by a multidisciplinary team. Unfortunately, even with the best standard of care (SOC available, only 24% or 30% of DFUs will heal at weeks 12 or 20, respectively. The extracellular matrix (ECM in DFUs is abnormal and its impairment has been proposed as a key target for new therapeutic devices. These devices intend to replace the aberrant ECM by implanting a matrix, either devoid of cells or enhanced with fibroblasts, keratinocytes or both as well as various growth factors. These new bioengineered skin substitutes are proposed to encourage angiogenesis and in-growth of new tissue, and to utilize living cells to generate cytokines needed for wound repair. To date, the efficacy of bioengineered ECM containing live cellular elements for improving healing above that of a SOC control group has not been compared with the efficacy of an ECM devoid of cells relative to the same SOC. Our hypothesis is that there is no difference in the improved healing effected by either of these two product types relative to SOC. Methods/Design To test this hypothesis we propose a randomized, single-blind, clinical trial with three arms: SOC, SOC plus Dermagraft® (bioengineered ECM containing living fibroblasts and SOC plus Oasis® (ECM devoid of living cells in patients with nonhealing DFUs. The primary outcome is the percentage of subjects that achieved complete wound closure by week 12. Discussion If our hypothesis is correct, then immense cost savings could be realized by using the orders-of-magnitude less expensive acellular ECM device without compromising patient health outcomes. The article describes the protocol proposed to test

  12. Area Determination of Diabetic Foot Ulcer Images Using a Cascaded Two-Stage SVM-Based Classification.

    Science.gov (United States)

    Wang, Lei; Pedersen, Peder C; Agu, Emmanuel; Strong, Diane M; Tulu, Bengisu

    2017-09-01

    The standard chronic wound assessment method based on visual examination is potentially inaccurate and also represents a significant clinical workload. Hence, computer-based systems providing quantitative wound assessment may be valuable for accurately monitoring wound healing status, with the wound area the best suited for automated analysis. Here, we present a novel approach, using support vector machines (SVM) to determine the wound boundaries on foot ulcer images captured with an image capture box, which provides controlled lighting and range. After superpixel segmentation, a cascaded two-stage classifier operates as follows: in the first stage, a set of k binary SVM classifiers are trained and applied to different subsets of the entire training images dataset, and incorrectly classified instances are collected. In the second stage, another binary SVM classifier is trained on the incorrectly classified set. We extracted various color and texture descriptors from superpixels that are used as input for each stage in the classifier training. Specifically, color and bag-of-word representations of local dense scale invariant feature transformation features are descriptors for ruling out irrelevant regions, and color and wavelet-based features are descriptors for distinguishing healthy tissue from wound regions. Finally, the detected wound boundary is refined by applying the conditional random field method. We have implemented the wound classification on a Nexus 5 smartphone platform, except for training which was done offline. Results are compared with other classifiers and show that our approach provides high global performance rates (average sensitivity = 73.3%, specificity = 94.6%) and is sufficiently efficient for a smartphone-based image analysis.

  13. Critical Appraisal of the Quality of Evidence Addressing the Diagnosis, Prognosis, and Management of Peripheral Artery Disease in Patients With Diabetic Foot Ulceration.

    Science.gov (United States)

    Ali, Stephen R; Ozdemir, Baris A; Hinchliffe, Robert J

    2018-06-13

    There is a paucity of robust evidence on prevention and management of diabetic foot ulcers (DFUs) to inform treatment. This study appraises the current quality of the evidence addressing diagnosis, prognosis, and management of peripheral artery disease (PAD) in patients with DFUs using a newly devised 21 point scoring (TOPS) disease specific research appraisal tool published by the International Working Group on the Diabetic Foot (IWGDF) and European Wound Management Association. The 2015 IWGDF guidance on diagnosis, prognosis, and management of PAD in patients with DFUs was used to identify studies pertaining to prevention and management. Two reviewers assessed these articles against TOPS, which examines study design, conduct, and outcome reporting. The overall median score was 8 (3-12/21). The median design total score was 2 (0-4/11). The median conduct total score was 2 (1-4/6). The median outcomes total score was 3 (1-4/4). There was improvement with time in overall total (Spearman Rho 0.39, p = .0005), design total (0.35, p = .0023), and outcomes total (0.35, p = .0002), but not conduct total (-0.03, p = .8132) scores. Although this analysis revealed an improvement over time in the overall calibre of studies, the present quality remains poor on which to inform the diagnosis, management, and prognosis of patients with PAD and diabetic foot ulceration. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

  14. A prospective study of periodontal disease and risk of gastric and duodenal ulcer in male health professionals.

    Science.gov (United States)

    Boylan, Matthew R; Khalili, Hamed; Huang, Edward S; Michaud, Dominique S; Izard, Jacques; Joshipura, Kaumudi J; Chan, Andrew T

    2014-02-13

    Periodontal disease has been associated with higher circulating levels of inflammatory markers and conditions associated with chronic inflammation, including vascular disease, diabetes mellitus, and cancer. Limited data exist on the relationship between periodontal disease and gastric and duodenal ulcer. We conducted a prospective cohort study of 49,120 men in the Health Professionals Follow-up Study, aged 40-75 years at enrollment in 1986. Biennially, we assessed periodontal disease, tooth loss, and other risk factors for gastric and duodenal ulcer. We validated diagnoses of gastric and duodenal ulcer through medical record review. We used Cox proportional hazards modeling, adjusting for potential confounders, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). We documented 138 cases of gastric ulcer and 124 cases of duodenal ulcer with available information on Helicobacter pylori status over 24 years of follow-up. After adjustment for risk factors, including smoking and regular use of aspirin and non-steroidal anti-inflammatory drugs, men with periodontal disease with bone loss had a multivariate HR of ulcer of 1.62 (95% CI, 1.24-2.12). Periodontal disease appeared to be associated with a similar risk of developing ulcers that were H. pylori negative (HR 1.75; 95% CI, 1.26-2.43) than H. pylori positive (HR 1.40; 95% CI, 0.87-2.24), as well as ulcers in the stomach (HR 1.75; 95% CI, 1.21-2.53) than ulcers in the duodenum (HR 1.47; 95% CI, 0.98-2.19). Periodontal disease is associated with an increased risk of incident gastric and duodenal ulcer. This relationship may be mediated by alterations in the oral and gastrointestinal microbiome and/or systemic inflammatory factors.

  15. Metformin Induces Cell Cycle Arrest, Reduced Proliferation, Wound Healing Impairment In Vivo and Is Associated to Clinical Outcomes in Diabetic Foot Ulcer Patients.

    Science.gov (United States)

    Ochoa-Gonzalez, Fatima; Cervantes-Villagrana, Alberto R; Fernandez-Ruiz, Julio C; Nava-Ramirez, Hilda S; Hernandez-Correa, Adriana C; Enciso-Moreno, Jose A; Castañeda-Delgado, Julio E

    2016-01-01

    Several epidemiological studies in diabetic patients have demonstrated a protective effect of metformin to the development of several types of cancer. The underlying mechanisms of such phenomenon is related to the effect of metformin on cell proliferation among which, mTOR, AMPK and other targets have been identified. However, little is known about the role that metformin treatment have on other cell types such as keratinocytes and whether exposure to metformin of these cells might have serious repercussions in wound healing delay and in the development of complications in diabetic patients with foot ulcers or in their exacerbation. HaCaT Cells were exposed to various concentrations of metformin and cell viability was evaluated by a Resazurin assay; Proliferation was also evaluated with a colony formation assay and with CFSE dilution assay by flow cytometry. Cell cycle was also evaluated by flow cytometry by PI staining. An animal model of wound healing was used to evaluate the effect of metformin in wound closure. Also, an analysis of patients receiving metformin treatment was performed to determine the effect of metformin treatment on the outcome and wound area. Statistical analysis was performed on SPSS v. 18 and GraphPad software v.5. Metformin treatment significantly reduces cell proliferation; colony formation and alterations of the cell cycle are observed also in the metformin treated cells, particularly in the S phase. There is a significant increase in the area of the wound of the metformin treated animals at different time points (Pdiabetic foot ulcers at the time of hospitalization. A protective effect of metformin was observed for amputation, probably associated with the anti inflammatory effects reported of metformin. Metformin treatment reduces cell proliferation and reduces wound healing in an animal model and affects clinical outcomes in diabetic foot ulcer patients. Chronic use of this drug should be further investigated to provide evidence of

  16. ESOPHAGEAL REFLUX DISEASE, PEPTIC ULCER AND HELICOBACTER PYLORI INFECTION – A PROSPECTIVE, CONTROLLED STUDY

    Directory of Open Access Journals (Sweden)

    Pavel Skok

    2003-02-01

    Full Text Available Background. A possible association of esophageal reflux disease with peptic ulcer, Helicobacter pylori infection or the results of eradication, has not been elucidated. It is an alarming fact that in developed countries the incidence of esophageal adenocarcinoma, which is associated with reflux disease, is increasing.Aim. The aim of the study was to establish the prevalence of esophageal reflux disease after eradication of H. pylori infection in patients with hemorrhaging and nonhemorrhaging peptic ulcer of stomach or duodenum.Patients and methods. Study was approved in 1998 by the Slovenian Medical Ethics Committee (No. 90/09/98. Prospective, controlled and randomized, carried out between 1998– 2000.The study included 80 patients (50 male and 30 female, av. age 57.5 years, SD ± 17.1, range 22–80 years in which endoscopy confirmed hemorrhage from peptic ulcer of stomach or duodenum and HP infection. The control group was made up of 80 patients (50 male and 30 female, av. age 56.8 years, SD ± 16.8, range 19–80 years with peptic ulcer of stomach or duodenum and H.pylori infection in the same period of time. In all cases the recommended drug combinations were used in the treatment of the infection: a proton pump inhibitor, omeprazol (4 weeks, and combination of antibiotics, claritromycin and metronidazole or with regard to the antibiogram (1 week. The therapeutic success was ascertained endoscopically four weeks after inclusion in the study. Infection eradication was confirmed by the rapid urease test and histologic investigation of the gastric mucosa. One year later, in the course of follow-up, in patients with endoscopic investigations, 24-hour pH-metry or fiberoptic spectrophotometric bilirubin determination, bilimetry, we tried to establish signs of esophageal reflux disease.Results. Four weeks after inclusion in the study the success of infection eradication was 92.5% in the study group while in the control group reached 91.25%, p > 0

  17. The association between MCP-1, VEGF polymorphisms and their serum levels in patients with diabetic foot ulcer.

    Science.gov (United States)

    Li, Xiaolei

    2018-06-01

    The purpose of the present study was to investigate distribution of monocyte chemoattractant protein-1 (MCP-1) -2518A/G and vascular endothelial growth factor (VEGF) -634G/C polymorphisms in type 2 diabetes melitus patients (T2DM) presenting diabetic foot ulcer (DFU). Additionally, we evaluated the effects of these 2 polymorphisms on serum levels of MCP-1 and VEGF in the study population.Patients diagnosed with T2DM without or with DFU were recruited in the study. The distribution of MCP-1 -2518A/G and VEGF -634G/C polymorphisms was investigated by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Enzyme-linked immunosorbent assay (ELISA) was applied to detect the protein levels of MCP-1 and VEGF. The comparisons of protein levels in DFU patients were performed by student t test according to their genotypes.The frequencies of GG genotype and G allele of MCP-1 -2518A/G was increased in DFU patients, compared with T2DM patients (odds ratio [OR] = 2.60, 95% confidence interval [CI] = 1.23-5.50, P = .011 and OR = 1.72, 95% CI = 1.18-2.50, P = .005, respectively). Moreover, the increased frequency of GG was significantly associated with up-regulated MCP-1 level in DFU patients (P < .001). Analysis for VEGF -634G/C polymorphisms indicated that the prevalence of CC genotype and C allele of the polymorphisms was decreased in DFU patients, compared with T2DM patients (OR = 0.36, 95% CI = 0.17-0.77, P = .008 and OR = 0.63, 95% CI = 0.43-0.91, P = .015, respectively). DFU patients carrying CC genotype had a higher level of VEGF than those with other genotypes (P = .007).MCP-1 -2518A/G and VEGF -634G/C polymorphisms may involve in occurrence and progress of DFU through regulating transcription activity of the genes.

  18. A prospective evaluation of a pressure ulcer prevention and management E-Learning Program for adults with spinal cord injury.

    Science.gov (United States)

    Brace, Jacalyn A; Schubart, Jane R

    2010-08-01

    Pressure ulcers are a common complication of spinal cord injury (SCI). Pressure ulcer education programs for spinal cord injured individuals have been found to have a positive effect on care protocol adherence. A prospective study was conducted among hospitalized spinal cord-injured men and women to determine if viewing the Pressure Ulcer Prevention and Management Education for Adults with Spinal Cord Injury: E-Learning Program affects their knowledge scores. A 20-question multiple-choice pre-/post learning test was developed and validated by 12 rehabilitation nurses. Twenty (20) patients (13 men, seven women; mean age 49 years, [SD: 18.26] with injuries to the cervical [seven], thoracic [six], and lumbar [six] regions) volunteered. Most (42%) had completed high school and time since SCI ranged from 2 weeks to 27 years. Eighteen (18) participants completed both the pre- and post test. Of those, 16 showed improvement in pressure ulcer knowledge scores. The median scores improved from 65 (range 25 to 100) pre-program to 92.5 (range 75 to 100) post-program. Descriptive statistics, Student's t-test, and analysis of variance (ANOVA) were used to analyze the data. The results suggest that a single viewing of this e-learning program could improve pressure ulcer knowledge of hospitalized adults with SCI. Research to ascertain the effects of this and other educational programs on pressure ulcer rates is needed.

  19. Diabetes - foot ulcers

    Science.gov (United States)

    ... learn more about taking care of your feet . Debridement Debridement is the process to remove dead skin and ... A visiting nurse may also help you. Other types of dressings are: Dressing that contains medicine Skin ...

  20. Comparison of Negative Pressure Wound Therapy Using Vacuum-Assisted Closure with Advanced Moist Wound Therapy in the Treatment of Diabetic Foot Ulcers.

    Science.gov (United States)

    Sajid, Muhammad Tanveer; Mustafa, Qurat ul Ain; Shaheen, Neelofar; Hussain, Syed Mukarram; Shukr, Irfan; Ahmed, Muhammad

    2015-11-01

    To evaluate the clinical efficacy of Negative Pressure Wound Therapy (NPWT) using Vacuum Assisted Closure (VAC) compared with Advanced Moist Wound Therapy (AMWT) to treat Diabetic Foot Ulcer (DFU). Randomized control trial. Surgical Department, Combined Military Hospital (CMH) / Military Hospital (MH), Rawalpindi, from November 2010 to June 2012. The study consisted of 278 patients, with 139 patients each in Group 'A' and 'B', who were subjected to AMWT and NPWT, respectively. Wound was assessed digitally every week for 2 weeks. Wound dimension and surface area were determined using University of Texas Health Centre at San Antonio (UTHCSA) image tool version 3.0. Efficacies of AMWT and NPWT were compared in terms of reduction in wound area over 2 weeks. Mean age of presentation in group A was 55.88 ± 10.97 years while in group B, it was 56.83 ± 11.3 (p=0.48). Mean duration of diabetes at presentation was 15.65 ± 4.86 and 15.96 ± 5.79 years in group A and B, respectively (p=0.74). Majority of patients had Wagner's grade 2 ulcer (82% in group A and 87.8% in group B, p= 0.18). Initial wound size in group A was 15.07 ± 2.92 cm2 and in group B 15.09 ± 2.81 cm2 (p = 0.95). Wound size measured after 2 weeks, treatment was in group A13.70 ± 2.92 cm2 and in group B 11.53 ± 2.78 cm2 (p VAC was more efficacious than AMWT in the management of diabetic foot ulcers.

  1. Cost-Utility Analysis of Heberprot-P as an Add-on Therapy to Good Wound Care for Patients in Slovakia with Advanced Diabetic Foot Ulcer

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    Tomas Tesar

    2017-12-01

    Full Text Available Objectives: To explore whether Heberprot-P (an epidermal growth factor is a cost-effective option for the treatment of advanced diabetic foot ulcer as an add-on therapy to good wound care (GWC in Slovakia from the perspective of health care payers.Methods: A Markov model was constructed to compare the costs and effects of Heberprot-P plus GWC to those of GWC alone from the perspective of health care payers. The 52-week clinical trial period was extended to 5- and 10-year time horizons. Transition probabilities were calculated based on a previous clinical trial of Heberprot, utility values were derived from the scientific literature, and cost vectors were collected from the General Health Insurance Fund database in Slovakia. A one-way deterministic sensitivity analysis was employed to explore the influence of uncertainty for each input parameter on the incremental cost-effectiveness ratio (ICER.Results: Based on the ICER threshold of €30,030 per quality-adjusted life year (QALY recommended by the Slovak Ministry of Health, Heberprot-P therapy plus GWC is not a cost-effective alternative to GWC alone over a 10-year time horizon. The ICER increases if a longer time horizon is applied, as the incremental costs are similar, but the aggregated utility gain from avoided amputation is lower. Based on the sensitivity analysis, the utility multiplier for the health state “no ulcer after small amputation” had the most impact on the ICER; however, the model was robust to changes in all input parameters.Conclusions: Heberprot-P, as an add-on therapy to GWC in the treatment of advanced diabetic foot ulcer, is not a cost-effective alternative to GWC alone. However, if the unit cost of Heberprot-P were to be reduced to <€273, its ICER would be <€30,030.

  2. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers

    International Nuclear Information System (INIS)

    Sajid, M.T.; Mustafa, Q.U.A.

    2015-01-01

    Objective: To evaluate the clinical efficacy of Negative Pressure Wound Therapy (NPWT) using Vacuum Assisted Closure (VAC) compared with Advanced Moist Wound Therapy (AMWT) to treat Diabetic Foot Ulcer (DFU). Study Design: Randomized control trial. Place and Duration of Study: Surgical Department, Combined Military Hospital (CMH) / Military Hospital (MH), Rawalpindi, from November 2010 to June 2012. Methodology: The study consisted of 278 patients, with 139 patients each in Group A and B, who were subjected to AMWT and NPWT, respectively. Wound was assessed digitally every week for 2 weeks. Wound dimension and surface area were determined using University of Texas Health Centre at San Antonio (UTHCSA) image tool version 3.0. Efficacies of AMWT and NPWT were compared in terms of reduction in wound area over 2 weeks. Results: Mean age of presentation in group Awas 55.88 10.97 years while in group B, it was 56.83 ± 11.3 (p=0.48). Mean duration of diabetes at presentation was 15.65 ± 4.86 and 15.96 ± 5.79 years in group A and B, respectively (p=0.74). Majority of patients had Wagner's grade 2 ulcer (82% in group A and 87.8% in group B, p= 0.18). Initial wound size in group A was 15.07 ± 2.92 cm2and in group B 15.09 ± 2.81 cm2(p = 0.95). Wound size measured after 2 weeks, treatment was in group A13.70 ± 2.92 cm2 and in group B 11.53 ± 2.78 cm2 (p < 0.001). Wound area reduction in both groups revealed statistically significant faster healing in group B as compared to group A(p < 0.001). Conclusion: NPWT using VAC was more efficacious than AMWT in the management of diabetic foot ulcers. (author)

  3. An in vivo and in vitro investigation of the effect of Aloe vera gel ethanolic extract using animal model with diabetic foot ulcer

    Directory of Open Access Journals (Sweden)

    Mohan Daburkar

    2014-01-01

    Full Text Available Aim: To examine the preventive effect of Aloe vera gel ethanolic extract using diabetic foot ulcer (DFUs protocol in Wistar rats. Materials and Methods: Male Wistar rats were divided into untreated control (Group I, untreated DFUs (Group II, DFUs treated with A. vera gel ethanolic extract (Group III, DFUs treated with topical A. vera gel (Group IV, DFUs treated with A. vera gel ethanolic extract and topical A. vera gel (Group V. The rats in the treatment groups were daily administered the A. vera gel and ethanolic extract for 9 days. Fasting blood glucose levels and percentage of wound ulcer contraction were measured on day 3, 6, and 9. Statistical Analysis used: The results are expressed as a mean ± Standard Error Mean (SEM. Data were analyzed using one-way analysis of variance (ANOVA after Newman-Keuls test. P < 0.05 were considered statistically significant in all cases. Results: Oral administration of A. vera gel ethanolic extract at a dose of 300 mg/kg body weight per day to diabetic rats for a period of 9 days resulted in a significant reduction in fasting blood glucose and a significant improvement in plasma insulin. Topical application of A. vera gel at a dose 30 mg/kg body weight per day to streptozotocin (STZ-induced diabetic rats for a period of 9 days resulted in no change in blood glucose and plasma insulin. Oral administration as well as topical application of A. vera gel ethanolic extract and gel significantly reduced the blood glucose, improved the plasma insulin, and significantly increased DNA and glycosaminoglycans (GAGs to improve the wound ulcer healing as well as the breaking strength on day 9. Conclusions: Present findings provide a scientific rationale for the use of A. vera gel ethanolic extract, and showed that the gel attenuated the diabetic foot wound in rats.

  4. Dipeptidyl Peptidase 4 Inhibition May Facilitate Healing of Chronic Foot Ulcers in Patients with Type 2 Diabetes

    Directory of Open Access Journals (Sweden)

    Raffaele Marfella

    2012-01-01

    Full Text Available The pathophysiology of chronic diabetic ulcers is complex and still incompletely understood, both micro- and macroangiopathy strongly contribute to the development and delayed healing of diabetic wounds, through an impaired tissue feeding and response to ischemia. With adequate treatment, some ulcers may last only weeks; however, many ulcers are difficult to treat and may last months, in certain cases years; 19–35% of ulcers are reported as nonhealing. As no efficient therapy is available, it is a high priority to develop new strategies for treatment of this devastating complication. Because experimental and pathological studies suggest that incretin hormone glucagon-like peptide-1 may improves VEGF generation and promote the upregulation of HIF-1α through a reduction of oxidative stress, the study evaluated the effect of the augmentation of GLP-1, by inhibitors of the dipeptidyl peptidase-4, such as vildagliptin, on angiogenesis process and wound healing in diabetic chronic ulcers. Although elucidation of the pathophysiologic importance of these aspects awaits further confirmations, the present study evidences an additional aspect of how DPP-4 inhibition might contribute to improved ulcer outcome.

  5. Epidemiology and outcome in patients of diabetic foot

    International Nuclear Information System (INIS)

    Ashraf, M.N.; Rehman, K.U.; Malik, K.I.; Iqbal, G.S.

    2011-01-01

    Background: The aim of study was detailed analysis of the presentation of diabetic foot ulcers, characteristics and predictors of outcome (incidence of amputation in neuropathic, ischemic, neuro ischemic) in patients presenting with diabetic foot at our hospital. Methods: This prospective analytic study was conducted from January 2009-August 2010 at POF Hospital Wah Cantt. Diabetic patients who presented with foot ulcers were enrolled in this study. Demographics of patients along with ulcer size, type, site and Grade according to Wagner Classification were recorded. Wounds were managed with daily dressings, nursing care and de-sloughing of necrotic tissue along with appropriate antibiotic cover. Patients were followed over period until wound healed completely or a lower limb amputation performed, the outcome noted and patient was deemed to have completed study. Results: One hundred and fifteen patients with mean age 55.46 +- 8.23 years, both male and female were included in this study. Out of 115 patients 111 patients had Type-II diabetes while only 4 presented with Type-I. Mean Duration of diabetes was 14.61 +- 2.17 years. With respect to underlying causes 18.3% foot ulcers were ischemic, 22.6% were neuropathic and 59% were neuro-ischemic. Median ulcer size was 74% of ulcer classified as Wagner grade-II and III while 24% were of Grade-V. Lower limb amputation were performed in 25% of patients whereas limb salvage achieved in 75% of patients with wounds healed (median healing time 5 (3-10 weeks). Conclusion: Preservation of the limb function without endangering the patient must be a goal of treating diabetic foot. Once foot amputation is successful, rehabilitation with orthotic or prosthetic devices may allow years of a functional extremity along with preventive measures like cessation of smoking, daily foot hygiene and foot inspection. (author)

  6. Biotechnological aspects of plants metabolites in the treatment of ulcer: A new prospective

    Directory of Open Access Journals (Sweden)

    Amit Kishore Singh

    2018-06-01

    Full Text Available Ulcer is one of the most common diseases affecting throughout the world population. The allopathic treatment of ulcer adversely affects the health by causing harmful side effects. Currently, many herbal plants and secondary metabolites have been used for the ulcer treatment. In the present review, many herbal plants and their parts (root, rhizome, bark, leaves and fruits have been listed in the table are currently being used for ulcer treatment. These metabolites are responsible for ulcer-neutralization or anti-inflammatory properties. In silico study, plant metabolites showed interaction between protodioscin (secondary metabolites of Asparagus racemosus and interferon-γ (virulent factor of gastric ulcer during molecular docking. All the residues of interferon-γ exhibited hydrophobic interactions with plant metabolites. These interactions helps in understanding the plant secondary metabolites vis a vis will open a new door in the research field of new drug discovery and designing for the ulcer treatment.

  7. L-form plastics in the treatment of post-burn trophic ulcers and cicatrices of the foot calcaneal area.

    Science.gov (United States)

    Shakirov, Babur M; Tagaev, Komil R; Tursunov, Bachron S; Achtamov, Dgamshed A

    2009-03-01

    The burn trauma of the posterior surface of calcaneus region and ankle joint followed by cicatrix formation in the Achilles tendon zone is often complicated by unhealing trophic ulcers. Eleven patients (seven men and four women, aged 9-54 years) have been operated on under our observation for prolonged unhealing ulcers and cicatrices located in the Achilles tendon zone. After cicatrices dissection, L-form plastic surgery was performed. The postoperative period was smooth; a skin graft was appropriately fixed to the proper tissues and the wound margins. Good results were achieved in 10 cases, and no complications were noted. However, in only one patient a marginal necrosis of the external talus part adjoining the ulcer due to tissue changes has been noted, but that had no influence on the good results of the operation.

  8. Isolation of bacteria from diabetic foot ulcers with special reference to anaerobe isolation by simple two-step combustion technique in candle jar

    Directory of Open Access Journals (Sweden)

    Jayeeta Haldar

    2017-01-01

    Results: All the 43 samples were culture positive, of which aerobic Gram-negative bacteria (GNB predominated, followed by Staphylococcus aureus, Enterococcus and diphtheroids. Anaerobes isolated from 21 samples were Peptostreptococcus, Bacteroides, Porphyromonas, Veillonella spp. and Clostridium perfringens by both GasPak and in-house developed and modified candle jar techniques. Imipenem and metronidazole were most sensitive while clindamycin, penicillin and cefoxitin were least sensitive drugs for anaerobes. Aerobic GNB were found to be multidrug resistant, especially to penicillin and cephalosporins. The most sensitive drug was piperacillin-tazobactam. Interpretation & conclusions: For isolation of anaerobes from clinical specimens such as diabetic foot ulcers, modified candle jar technique was found to be as reliable as GasPak system. This modified technique needs to be tested for many other clinical materials which are not yet evaluated.

  9. The beneficial effects of probiotic administration on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Mohseni, Sima; Bayani, Masomeh; Bahmani, Fereshteh; Tajabadi-Ebrahimi, Maryam; Bayani, Mohammad Ali; Jafari, Parvaneh; Asemi, Zatollah

    2018-03-01

    This study was conducted to evaluate the effects of probiotic supplementation on wound healing and metabolic status in subjects with diabetic foot ulcer (DFU). This randomized, double-blind, placebo-controlled trial was conducted among 60 subjects (aged 40-85 years old) with grade 3 diabetic foot ulcer. Individuals were randomly divided into 2 groups (30 subjects each group) to receive either probiotic or placebo daily for 12 weeks. After the 12-week intervention, compared with the placebo, probiotic supplementation led to significant reductions in ulcer length (-1.3 ± 0.9 vs. -0.8 ± 0.7 cm, P = .01), width (-1.1 ± 0.7 vs. -0.7 ± 0.7 cm, P = .02), and depth (-0.5 ± 0.3 vs. -0.3 ± 0.3 cm, P = .02). Furthermore, significant reductions in fasting plasma glucose (-29.6 ± 30.3 vs. -5.8 ± 39.8 mg/dL, P = .01), serum insulin concentrations (-4.3 ± 7.9 vs. +0.4 ± 8.5 μIU/mL, P = .03), and haemoglobin A1c (-0.6 ± 0.5 vs. -0.2 ± 0.4%, P = .003) and a significant rise in the quantitative insulin sensitivity check index (+0.01 ± 0.01 vs. -0.01 ± 0.02, P = .003) were seen following supplementation of probiotic compared with the placebo. Additionally, compared with the placebo, probiotic supplementation resulted in significant decreases in serum total cholesterol (-4.8 ± 16.1 vs. +7.0 ± 27.1 mg/dL, P = .04), high-sensitivity C-reactive protein (-9.0 ± 14.7 vs. -1.7 ± 8.6 mg/L, P = .02), plasma malondialdehyde (-0.8 ± 0.8 vs. -0.2 ± 0.8 μmol/L, P = .001), and significant increases in plasma nitric oxide (+6.2 ± 8.2 vs. +0.8 ± 8.0 μmol/L, P = .01) and total antioxidant capacity concentrations (+179.3 ± 97.2 vs. -85.1 ± 203.4 mmol/L, P diabetic foot ulcer had beneficial effects on ulcer size, glycaemic control, total cholesterol, high-sensitivity C-reactive protein, plasma nitric oxide, total antioxidant capacity, and malondialdehyde levels. Copyright © 2017 John Wiley

  10. A Prospective Study of Periodontal Disease and Risk of Gastric and Duodenal Ulcer in Male Health Professionals

    OpenAIRE

    Boylan, Matthew R; Khalili, Hamed; Huang, Edward S; Michaud, Dominique S; Izard, Jacques; Joshipura, Kaumudi J; Chan, Andrew T

    2014-01-01

    OBJECTIVES: Periodontal disease has been associated with higher circulating levels of inflammatory markers and conditions associated with chronic inflammation, including vascular disease, diabetes mellitus, and cancer. Limited data exist on the relationship between periodontal disease and gastric and duodenal ulcer. METHODS: We conducted a prospective cohort study of 49,120 men in the Health Professionals Follow-up Study, aged 40–75 years at enrollment in 1986. Biennially, we assessed periodo...

  11. Efficacy and safety evaluation of systemic extremely low frequency magnetic fields used in the healing of diabetic foot ulcers--phase II data.

    Science.gov (United States)

    Cañedo-Dorantes, Luis; Soenksen, Luis R; García-Sánchez, Clara; Trejo-Núñez, Daphny; Pérez-Chávez, Fernando; Guerrero, Arturo; Cardona-Vicario, Melisa; García-Lara, Carlos; Collí-Magaña, Dianelly; Serrano-Luna, Gregorio; Angeles Chimal, José S; Cabrera, Guillermo

    2015-08-01

    Cellular and animal models investigating extremely low frequency magnetic fields (ELF-MF) have reported promotion of leukocyte-endothelial interactions, angiogenesis, myofibroblast and keratinocyte proliferation, improvement of peripheral neuropathy and diabetic wound healing. In humans, it has also been reported that systemic exposure to ELF-MF stimulates peripheral blood mononuclear cells, promoting angiogenesis and healing of chronic leg ulcers. The aim of the study was to investigate the effect of exposing different blood volumes to specific ELF-MFs (120 Hz sinusoidal waves of 0.4-0.9 mT RMS) to induce healing of diabetic foot ulcers (DFUs). Twenty six diabetic patients with non-responsive DFUs were divided into two exposure groups to receive treatment and record healing time. The forearm group, exposed to ELF-MF 2 h/day, twice weekly (3.6 l of blood/session); and the thorax group, exposed 25 min/day, 2 times/week (162.5 l of blood/session). Treatment period was 100 days or upon complete healing. Ulcer recurrences and adverse effects were investigated during short-term (<1 year) and long-term (3.4-7.8 years) follow-up. Mean healing time was 61.48 ± 33.08 days in the forearm group and 62.56 ± 29.33 days for the thorax group. No adverse effects or ulcer recurrences in the original ulcer site were reported during treatment, the short-term follow-up period or the long-term follow-up period in both groups. Healing time was independent of the amount of blood exposed to ELF-MF used in this trial. ELF-MFs are effective and safe and could be applied to non-healing DFUs in conjunction with other preventive interventions to reduce DFUs complications. Copyright © 2015 IMSS. Published by Elsevier Inc. All rights reserved.

  12. Assessment of maximum tolerated dose of a new herbal drug, Semelil (ANGIPARSTM in patients with diabetic foot ulcer: A Phase I clinical trial

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    Heshmat R

    2008-04-01

    Full Text Available Background and the purpose of the study: In many cases of diabetic foot ulcer (DFU management, wound healing is incomplete, and wound closure and epithelial junctional integrity are rarely achieved. Our aim was to evaluate the maximum tolerated dose (MTD and dose-limiting toxicity (DLT of Semelil (ANGIPARSTM, a new herbal compound for wound treatment in a Phase I clinical trial.Methods: In this open label study, six male diabetic patients with a mean age of 57±7.6 years were treated with escalating intravenous doses of Semelil, which started at 2 cc/day to 13.5 cc/day for 28 days. Patients were assessed with a full physical exam; variables which analyzed included age, past history of diabetes and its duration, blood pressure, body temperature, weight, characteristics of DFU, Na, K, liver function test, Complete Blood Count and Differential(CBC & diff, serum amylase, HbA1c, PT, PTT, proteinuria, hematuria, and side effects were recorded. All the measurements were taken at the beginning of treatment, the end of week 2 and week 4. We also evaluated Semelil's side effects at the end of weeks 4 and 8 after ending therapy.Results and major conclusions: Up to the drug dose of 10 cc/day foot ulcer dramatically improved. We did not observe any clinical or laboratory side effects at this or lower dose levels in diabetic patients. With daily dose of 13.5 cc of Semelil we observed phlebitis at the infusion site, which was the only side effect. Therefore, in this study we determined the MTD of Semelil at 10 cc/day, and the only DLT was phlebitis in injection vein. The recommended dose of Semelil I.V. administration for Phase II studies was 4 cc/day.

  13. Effects of a pulsatile electrostatic field on ischemic injury to the diabetic foot: evaluation of refractory ulcers.

    Science.gov (United States)

    Liani, Mario; Trabassi, Ernesto; Cusaro, Claudio; Zoppis, Elisabetta; Maduli, Elisabetta; Pezzato, Roberto; Piccoli, Paola; Maraschin, Maddalena; Bau, Piero; Cortese, Pietro; Cogo, Albero; Salvati, Filippo; Liani, Rossella

    2014-10-01

    The macro- and microcirculation disease, in patients with type 2 diabetes mellitus (T2DM), induces ischemic wounds of the lower limbs. We have tried to reduce the aggregation of red blood cells and to improve the O2 supply to the tissues and speed the healing of ulcers in T2DM patients. We enrolled 25 obese subjects without glucose intolerance (group A; BMI greater than 30 kg/m2), 20 obese adults intolerant to glucose (group B) and two subgroups, groups C and D, with T2DM and with leg ulcers. The groups A, B and C were treated with PESF. Body weight, O2 extraction, the capillary pulse, blood pressure and the surface of the ulcers were monitored. The technique PESF shows to have positive effects on the metabolism, on the reduction of body weight in the groups A and B, increasing extraction of O2 in group C and increase the speed of healing of wounds in group C compared to group D. In group A, there was a significant reduction in systolic and diastolic blood pressure. The technique PESF has affected the metabolic processes and the speed of wound healing ulcer in patients with T2DM. Copyright © 2013 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.

  14. Three-Dimensional Human Tissue Models That Incorporate Diabetic Foot Ulcer-Derived Fibroblasts Mimic In Vivo Features of Chronic Wounds

    Science.gov (United States)

    Maione, Anna G.; Brudno, Yevgeny; Stojadinovic, Olivera; Park, Lara K.; Smith, Avi; Tellechea, Ana; Leal, Ermelindo C.; Kearney, Cathal J.; Veves, Aristidis; Tomic-Canic, Marjana; Mooney, David J.

    2015-01-01

    Diabetic foot ulcers (DFU) are a major, debilitating complication of diabetes mellitus. Unfortunately, many DFUs are refractory to existing treatments and frequently lead to amputation. The development of more effective therapies has been hampered by the lack of predictive in vitro methods to investigate the mechanisms underlying impaired healing. To address this need for realistic wound-healing models, we established patient-derived fibroblasts from DFUs and site-matched controls and used them to construct three-dimensional (3D) models of chronic wound healing. Incorporation of DFU-derived fibroblasts into these models accurately recapitulated the following key aspects of chronic ulcers: reduced stimulation of angiogenesis, increased keratinocyte proliferation, decreased re-epithelialization, and impaired extracellular matrix deposition. In addition to reflecting clinical attributes of DFUs, the wound-healing potential of DFU fibroblasts demonstrated in this suite of models correlated with in vivo wound closure in mice. Thus, the reported panel of 3D DFU models provides a more biologically relevant platform for elucidating the cell–cell and cell–matrix-related mechanisms responsible for chronic wound pathogenesis and may improve translation of in vitro findings into efficacious clinical applications. PMID:25343343

  15. The effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Razzaghi, Reza; Pourbagheri, Hamideh; Momen-Heravi, Mansooreh; Bahmani, Fereshteh; Shadi, Jafar; Soleimani, Zahra; Asemi, Zatollah

    2017-04-01

    This study was conducted to evaluate the effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer (DFU). This randomized, double-blind, placebo-controlled trial was performed among 60 patients with grade 3 DFU according to "Wagner-Meggitt's" criteria. Participants were randomly divided into two groups (each 30 participants) and received either 50,000IU vitamin D supplements every 2weeks for 12weeks (group A) or placebo (group B). Fasting blood samples were taken at study baseline and after 12-week intervention to determine related markers. After 12weeks of intervention, compared with the placebo, vitamin D supplementation resulted in a significant reduction in ulcer length (-2.1±1.1 vs. -1.1±1.1cm, P=0.001), width (-2.0±1.2 vs. -1.1±1.0cm, P=0.02) and depth (-1.0±0.5 vs. -0.5±0.5cm, Phealing due to its effect on improved glycemic control. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Prevalence and incidence of peptic ulcer disease in a Danish County--a prospective cohort study.

    OpenAIRE

    Rosenstock, S J; Jørgensen, T

    1995-01-01

    Peptic ulcer prevalence and five year incidence were assessed in a sex and age stratified population sample of 3608 Danish subjects aged 30-60 years. Statements of peptic ulcer disease obtained from questionnaires were scrutinised by reviewing medical records. Life time ulcer prevalence (95% confidence intervals) was 5.6 (4.9-6.4) per cent. Male to female prevalence ratio was 2.2:1, and duodenal to gastric ulcer prevalence ratio was 3.8:1. Thirty two participants with no previous history of p...

  17. Effect of vonoprazan on the treatment of artificial gastric ulcers after endoscopic submucosal dissection: Prospective randomized controlled trial.

    Science.gov (United States)

    Tsuchiya, Izumi; Kato, Yuri; Tanida, Emiko; Masui, Yoshifumi; Kato, Shingo; Nakajima, Atsushi; Izumi, Motoyoshi

    2017-07-01

    Proton pump inhibitors are effective for the treatment of gastric ulcers after endoscopic submucosal dissection (ESD). However, the most excellent therapy is controversial. Vonoprazan, an active potassium-competitive acid blocker, has a strong gastric acid secretion inhibitory effect, but its efficacy for the treatment of post-ESD gastric ulcers is unclear. Herein, we aimed to determine the healing effect of vonoprazan on post-ESD gastric ulcers. We carried out a prospective randomized controlled trial examining 92 patients who had undergone ESD for the treatment of gastric neoplasms between April 2015 and June 2016 at Machida Municipal Hospital. Patients were treated with 20 mg/day vonoprazan (V group) or 20 mg/day esomeprazole (E group) for 8 weeks. We evaluated the 8-week cure rate for artificial ulcers and any complications after ESD. A total of 80 patients (median age, 73.5 years; 71.3% male) were analyzed. Cure rate for the V group was significantly higher than that for the E group (94.9% [37/39] vs 78.0% [32/41], respectively; P = 0.049). In a multivariate analysis, only vonoprazan was correlated with ulcer healing (odds ratio = 6.33; 95% CI = 1.21-33.20; P = 0.029). Delayed bleeding was experienced only in the E group (7.3% [3/41]), but no significant difference compared with the V group was observed (P = 0.241). Vonoprazan was significantly superior to esomeprazole for the healing of post-ESD gastric ulcers and should be considered as a treatment of first choice. © 2017 Japan Gastroenterological Endoscopy Society.

  18. Combination of Open Subtotal Calcanectomy and Stabilization With External Fixation as Limb Salvage Procedure in Hindfoot-Infected Diabetic Foot Ulcers.

    Science.gov (United States)

    Dalla Paola, Luca; Carone, Anna; Boscarino, Giulio; Scavone, Giuseppe; Vasilache, Lucian

    2016-12-01

    Diabetic hindfoot ulcers, complicated by osteomyelitis, are associated with a high risk of major amputation. Partial calcanectomy, preceded by an effective management of the infection and of the eventual peripheral artery disease, can be considered as valid therapeutic option. We have evaluated a therapeutic protocol for diabetic hindfoot ulcers complicated by osteomyelitis, which, besides an adequate surgical debridement, considers a reconstructive pathway assisted by the positioning of a circular external fixator. We made a prospective study of a cohort of diabetic patients affected by heel ulcer complicated by osteomyelitis. All patients underwent open partial calcanectomy associated with the positioning of a circular external frame specifically designed for hindfoot stabilization and offloading. A reconstructive procedure was implemented starting with the application of negative pressure wound therapy and coverage with dermal substitute and split thickness skin grafting. From November 2014 to November 2015, 18 consecutive patients were enrolled. Mean follow-up period was 212.3 ± 64.0 days. Healing was achieved in 18 (100%) patients. The mean healing time was 69.0 ± 64.0 days. No major amputation had to be performed during the follow-up. Open partial calcanectomy associated with external fixation and skin reconstruction was as efficient as limb salvage in patients with infected lesions of the hindfoot complicated by calcaneal osteomyelitis.

  19. Clinical application of oral form of ANGIPARSTM and in combination with topical form as a new treatment for diabetic foot ulcers: A randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Bahrami A

    2008-04-01

    Full Text Available ANGIPARSTM is a new herbal extract which has been produced in oral, topical, and intravenous forms. The present article contains preliminary results of the study which was planned to evaluate the efficacy and safety of orally applied ANGIPARSTM and to compare it with the combination of oral and topical forms and also with conventional therapy in patients with diabetic ulcers of the lower extremities."nTwenty one patients with diabetic foot ulcers were divided into 3 groups. The first group received 100 mg of oral ANGIPARSTM twice a day for 6 weeks in addition to conventional therapies. In the second group, ANGIPARSTM gel 3% was added to the oral form of the same product besides the conventional therapies for the same period of time. Finally, in the third group which was considered as control, only conventional therapies were performed. The patients were followed for 6 weeks. Parameters such as granulation tissue formation, skin epithelization, and wound surface areas changes were analyzed to determine the effectiveness of the compound in wounds healing. Furthermore, drug safety was assessed by monitoring adverse events and by clinical and laboratory evaluations."nThe study data showed significant differences between the intervention and control groups with respect to efficacy and tolerability. In each intervention group, primary wound healings occurred following 2 weeks. Complete wound healing which was greater than 70% improvement in wounds surface areas was achieved in 83% and 100% of group 1 and group 2 participants, respectively after 6 weeks. On the other hand, at the same period of time, only 22.2% of patients in control group revealed complete healing. Therefore, ANGIPARSTM had significant positive effect in increasing the incidence of complete wound closure compared with control group (p = 0.042. However, our evaluations indicated that adding topical treatment with 3% gel once a day to the oral therapy with the same product did not make

  20. IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes

    NARCIS (Netherlands)

    Hinchliffe, R. J.; Brownrigg, J. R. W.; Apelqvist, J.; Boyko, E. J.; Fitridge, R.; Mills, J. L.; Reekers, J.; Shearman, C. P.; Zierler, R. E.; Schaper, N. C.

    2016-01-01

    Recommendations Examine a patient with diabetes annually for the presence of peripheral artery disease (PAD); this should include, at a minimum, taking a history and palpating foot pulses. (GRADE strength of recommendation: strong; quality of evidence: low) Evaluate a patient with diabetes and a

  1. Effectiveness of Topical Sucralfate in the Management of Pressure Ulcer in Hospitalized Patients: A Prospective, Randomized, Placebo-Controlled Trial.

    Science.gov (United States)

    Ala, Shahram; Saeedi, Majid; Gholipour, Afshin; Ahmadi, Motahareh; Asoodeh, Ali; Shiva, Afshin

    2018-04-10

    The aim of this study was to evaluate the effectiveness of topical sucralfate in the management of pressure ulcer (PU) in hospitalized patients. Forty hospitalized patients with stage II PU were included in this prospective, double-blind, randomized, placebo-controlled trial and were randomly divided into 2 groups receiving either sucralfate gel or placebo, on a daily basis. The patients were visited every day for 14 days, the ulcer was evaluated using the Pressure Ulcer Scale for Healing (PUSH) and changes to the measured scores over time were used as an indicator of wound healing. There were no statistically significant differences in any of the demographic characteristics between both groups. Both of the interventions reduced the average PUSH score, and at the end of the trial, all but 2 patients were healed. One in each group discontinued the trial because of exacerbation of the ulcer. No significant between-group difference in the average PUSH score reduction was observed (6.36 ± 2.11 vs. 5.89 ± 1.41, P = 0.42). Although the average healing time was less in the sucralfate group (6.05 ± 2.17 vs. 7.78 ± 3.42), the difference was not statistically significant (P = 0.07). Sucralfate gel does not improve healing of PU compared with placebo.

  2. Do pressure ulcers influence length of hospital stay in surgical cardiothoracic patients? A prospective evaluation.

    NARCIS (Netherlands)

    Schuurman, J.P.; Schoonhoven, L.; Keller, B.P.; Ramshorst, B. van

    2009-01-01

    AIM AND OBJECTIVE: The aim and objective of this study was to determine whether the occurrence of pressure ulcers following cardiothoracic surgery increases the length of hospitalisation. BACKGROUND: Literature suggests that a pressure ulcer extends the length of hospital stay. The impact of

  3. Pressure Ulcers: Developing Clinical Indicators in Evidence-based Practice. A Prospective Study.

    Science.gov (United States)

    Tsaras, Konstantinos; Chatzi, Maria; Kleisiaris, Christos F; Fradelos, Evangelos C; Kourkouta, Lambrini; Papathanasiou, Ioanna V

    2016-10-01

    It is widely recognized that Intensive Care Unit (ICU) patients have a greater likelihood of developing pressure ulcers in comparison to hospital or home care patients. Accordingly, this study aimed to evaluate whether specific clinical characteristics could be used as clinical indicators towards pressure ulcers prevention. We monitored 210 hospitalized ICU patients during a 12-month period. Pressure ulcers were assessed following the current guidelines. Clinical characteristics such as gender, age, hospitalized days, hemodialysis treatment, hematocrit, and serum albumin levels were considered as the most common predictors for pressure ulcers development. The significance of associations was controlled using multiple logistic regression after adjusting for clinical characteristics and was presented as adjusted odds ratio (AOR). The prevalence of pressure ulcers was 24.3%. Logistic regression revealed that patients with increased age AOR=1.04; (CI: 1.01-1.07) and last-long hospitalization AOR=1.17; (CI: 1.11-1.23) were significantly more likely to present pressure ulcers compared to the younger ones and patients with less length of stay, respectively. We also found that patients under hemodialysis treatment were more likely to present pressure ulcers AOR=4.09; (CI: 1.12-14.98) compared to patients that did not underwent hemodialysis and the risk of pressure ulcers development was decreased by 9% for every single unit of hematocrit value increase AOR=0.91; (CI: 0.82-0.99). Our data analysis confirms that the clinical characteristics that were studied are independently associated with pressure ulcers development, and therefore, it is a crucial incentive to consider that these specific clinical characteristics are important indicators in the evidence-based practice.

  4. Stapled transanal rectal resection in solitary rectal ulcer associated with prolapse of the rectum: a prospective study.

    Science.gov (United States)

    Boccasanta, Paolo; Venturi, Marco; Calabro, Giuseppe; Maciocco, Marco; Roviaro, Gian Carlo

    2008-03-01

    At present, none of the conventional surgical treatments of solitary rectal ulcer associated with internal rectal prolapse seems to be satisfactory because of the high incidence of recurrence. The stapled transanal rectal resection has been demonstrated to successfully cure patients with internal rectal prolapse associated with rectocele, or prolapsed hemorrhoids. This prospective study was designed to evaluate the short-term and long-term results of stapled transanal rectal resection in patients affected by solitary rectal ulcer associated with internal rectal prolapse and nonresponders to biofeedback therapy. Fourteen patients were selected on the basis of validated constipation and continence scorings, clinical examination, anorectal manometry, defecography, and colonoscopy and were submitted to biofeedback therapy. Ten nonresponders were operated on and followed up with incidence of failure, defined as no improvement of symptoms and/or recurrence of rectal ulceration, as the primary outcome measure. Operative time, hospital stay, postoperative pain, time to return to normal activity, overall patient satisfaction index, and presence of residual rectal prolapse also were evaluated. At a mean follow-up of 27.2 (range, 24-34) months, symptoms significantly improved, with 80 percent of excellent/good results and none of the ten operated patients showed a recurrence of rectal ulcer. Operative time, hospital stay, and time to return to normal activity were similar to those reported after stapled transanal rectal resection for obstructed defecation, whereas postoperative pain was slightly higher. One patient complained of perineal abscess, requiring surgery. The stapled transanal rectal resection is safe and effective in the cure of solitary rectal ulcer associated with internal rectal prolapse, with minimal complications and no recurrences after two years. Randomized trials with sufficient number of patients are necessary to compare the efficacy of stapled transanal

  5. Effect of Helicobacter pylori eradication and antisecretory maintenance therapy on peptic ulcer recurrence in cirrhotic patients: a prospective, cohort 2-year follow-up study.

    Science.gov (United States)

    Tzathas, Charalambos; Triantafyllou, Konstantinos; Mallas, Elias; Triantafyllou, George; Ladas, Spiros D

    2008-07-01

    The role of Helicobacter pylori eradication to cure peptic ulcer disease in patients with cirrhosis is not clear. To investigate the course of peptic ulcer disease in cirrhotics, first after healing with either H. pylori eradication or omeprazole therapy and second while on omeprazole maintenance therapy after recurrence. Prospective cohort study in a tertiary-care hospital in Greece. Out of 365 consecutive cirrhotic patients who underwent endoscopy, 67 had peptic ulcer and 30 were enrolled. H. pylori positive patients received eradication therapy and H. pylori negative patients received omeprazole treatment. Follow-up endoscopies were performed at 12 and 24 months or when symptoms recurred. Patients with ulcer recurrence were treated with omeprazole maintenance therapy. The main outcome measurement of the study was peptic ulcer relapse rate during follow-up. Twenty-eight patients with healed ulcers were followed for up to 2 years. During follow-up, ulcer relapsed in 17 patients (8/18 H. pylori positive and 9/10 H. pylori negative at study entry, P=0.041), including 2 patients who died from ulcer bleeding. No further ulcer relapse was observed in the remaining 15 patients who received omeprazole maintenance therapy for the rest of follow-up. H. pylori negative status (P=0.002) and severity of cirrhosis (P=0.015) at study entry were independently related to shorter peptic ulcer relapse-free time. H. pylori eradication does not protect all cirrhotics from ulcer recurrence and the majority of ulcers recur in H. pylori negative patients. Therefore, omeprazole maintenance treatment is mandatory, irrespectively of H. pylori status.

  6. The Relationship of Static Anthropometric Measurements to Lower Leg, Ankle, and Foot Injuries in Air Force Academy Cadets: A Prospective Longitudinal Study

    National Research Council Canada - National Science Library

    McMahon, Thomas

    2001-01-01

    The purpose of this prospective cohort study was to investigate the relationship between static anthropometric measures or demographical information and overuse injuries in the lower leg, ankle and foot...

  7. An Explorative Study on the Efficacy and Feasibility of the Use of Motivational Interviewing to Improve Footwear Adherence in Persons with Diabetes at High Risk for Foot Ulceration.

    Science.gov (United States)

    Keukenkamp, Renske; Merkx, Maarten J; Busch-Westbroek, Tessa E; Bus, Sicco A

    2018-03-01

    In this explorative study, we assessed the effect and feasibility of using motivational interviewing to improve footwear adherence in persons with diabetes who are at high risk for foot ulceration and show low adherence to wearing prescribed custom-made footwear. Thirteen individuals with diabetes, ulcer history, and low footwear adherence (ie, motivational interviewing. Adherence was objectively measured over 7 days using ankle- and shoe-worn sensors and was calculated as the percentage of total steps that prescribed footwear was worn. Adherence was assessed at home and away from home at baseline and 1 week and 3 months after the intervention. Feasibility was assessed for interviewer proficiency to apply motivational interviewing and for protocol executability. Median (range) baseline, 1-week, and 3-month adherence at home was 49% (6%-63%), 84% (5%-98%), and 40% (4%-80%), respectively, in the motivational interviewing group and 35% (13%-64%), 33% (15%-55%), and 31% (3%-66%), respectively, in the standard education group. Baseline, 1-week, and 3-month adherence away from home was 91% (79%-100%), 97% (62%-99%) and 92% (86%-98%), respectively, in the motivational interviewing group and 78% (32%-97%), 91% (28%-98%), and 93% (57%-100%), respectively, in the standard education group. None of the differences were statistically significant. Interviewer proficiency was good, and the protocol could be successfully executed in the given time frame. Footwear adherence at home increases 1 week after motivational interviewing to clinically relevant but not statistically significant levels (ie, 80%) but then returns over time to baseline levels. Away from home, adherence is already sufficient at baseline and remains so over time. The use of motivational interviewing seems feasible for the given purpose and patient group. These findings provide input to larger trials and provisionally suggest that additional or adjunctive therapy may be needed to better preserve adherence.

  8. The Use of Vacuum-Assisted Closure and GranuFoam Silver® Dressing in the Management of Diabetic Foot Ulcer.

    Science.gov (United States)

    Günal, Özgür; Tuncel, Umut; Turan, Aydin; Barut, Sener; Kostakoglu, Naci

    2015-10-01

    The aim of this retrospective study was to evaluate the efficacy of vacuum-assisted closure (VAC) and GranuFoam Silver® dressing (KCI, San Antonio, TX) compared with conventional GranuFoam® dressing in the management of diabetic foot ulcers. Twenty-one consecutive patients treated with conventional or silver-coated foam dressing were reviewed retrospectively. The wound duration was 6 mo. Group 1 (n=10) received conventional foam dressing (GranuFoam) and group 2 (n=11) received silver-coated foam dressing (GranuFoam Silver). The wound surface area, duration of treatment, bacteriology, and recurrence were compared between the groups. The mean age of the patients was 61.70±10.52 y in group 1 and 67.27±11.28 y in group 2. In group 1, the average surface area of the wounds was 45.30±46.96 cm2 and 18.40±23.48 cm2 in the pre-treatment and post-treatment periods, respectively. There was a statistically significant difference between two measurements (p=0.005). Average duration of the treatment was 25.50±27.13 d in this group. In group 2, average surface area of the wounds in the pre-treatment and post-treatment periods were 41.55±36.03 cm2 and 7.64±3.91 cm2, respectively. There was a statistically significant difference between two measurements (p=0.003). Average duration of the treatment was 10.09±3.51 d in this group. The patients treated with silver-impregnated polyurethane foam dressing had reduced recurrence (2 vs. 7 wounds, p=0.030) and increased number of the culture-negative cases at the end of the treatment. With the results of the study, it was concluded that VAC GranuFoam silver dressing can be superior to conventional GranuFoam dressing in reducing the recurrence rate of infected diabetic foot ulcers.

  9. Avoiding foot complications in diabetes

    African Journals Online (AJOL)

    preceded by a foot ulcer.1,2 Every 30 seconds a lower limb or part of a lower limb is ... of foot ulcers are peripheral neuropathy, deformity, peripheral vascular disease and ... Repetitive stresses cause hyperkeratosis, followed by subcutaneous ...

  10. Pressure Ulcer Prevention Program Study: a randomized, controlled prospective comparative value evaluation of 2 pressure ulcer prevention strategies in nursing and rehabilitation centers.

    Science.gov (United States)

    Shannon, Ronald J; Brown, Lynne; Chakravarthy, Debashish

    2012-10-01

    This article assesses the comparative prevention-effectiveness and economic implications of a Pressure Ulcer Prevention Program (PUPP) against standard practice of prevention using Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality [AHRQ]) guidelines and a mixture of commercial products. The study is a randomized, controlled, prospective cohort study with an accompanying economic evaluation. The economic evaluation is performed from the perspective of the nursing and rehabilitation centers. Two nursing and rehabilitation centers under the same quality and safety support organization. Both institutions are experiencing high nursing staff turnover and incidence of pressure ulcers (PrUs). 133 residents at risk of developing PrUs (EQUIP-for-Quality Risk Score Moderate to Very High [MVH]). All are Medicare-eligible residents with Minimum Data Set (MDS) 2.0 evaluations. The PUPP includes a strategic product bundle and decision algorithms driven by MDS 2.0 Resident Assessment Scores to assist in reducing or preventing PrUs and incontinence-associated skin conditions. The control group utilizes a different brand and assortment of commercial skin care products, briefs, pads, and mattresses, but without use of the decision algorithms driven by MDS 2.0 Resident Assessment Scores. Pressure ulcer prevention education was done for all nurses by a nurse certified in the PUPP program at the beginning and ad libitum by trained senior nursing staff at the end of the study. Comparative reduction in the incidence of nosocomial PrUs and average 6-month net cost savings per MVH-risk resident. Residents were assessed for PrU risk using EQUIP-for-Quality risk assessment algorithm based on data from their Minimum Data Set (MDS 2.0), then assigned to either the PUPP program or control group (standard practice following AHRQ guidelines). Residents were followed until discharge, death, development of PrU, or a maximum time period of 6 months. Direct

  11. Clinical and metabolic response to flaxseed oil omega-3 fatty acids supplementation in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Soleimani, Zahra; Hashemdokht, Fatemeh; Bahmani, Fereshteh; Taghizadeh, Mohsen; Memarzadeh, Mohammad Reza; Asemi, Zatollah

    2017-09-01

    Data on the effects of flaxseed oil omega-3 fatty acids supplementation on wound healing and metabolic status in subjects with diabetic foot ulcer (DFU) are scarce. This study was conducted to evaluate the effects of flaxseed oil omega-3 fatty acids supplementation on wound healing and metabolic status in subjects with DFU. The current randomized, double-blind, placebo-controlled trial was conducted among 60 subjects (aged 40-85years old) with grade 3 DFU. Subjects were randomly allocated into two groups (30 subjects each group) to receive either 1000mg omega-3 fatty acids from flaxseed oil supplements or placebo twice a day for 12weeks. After the 12-week intervention, compared with the placebo, omega-3 fatty acids supplementation resulted in significant decreases in ulcer length (-2.0±2.3 vs. -1.0±1.1cm, P=0.03), width (-1.8±1.7 vs. -1.0±1.0cm, P=0.02) and depth (-0.8±0.6 vs. -0.5±0.5cm, P=0.01). Additionally, significant reductions in serum insulin concentrations (-4.4±5.5 vs. +1.4±8.3 μIU/mL, P=0.002), homeostasis model of assessment-estimated insulin resistance (-2.1±3.0 vs. +1.0±5.0, P=0.005) and HbA1c (-0.9±1.5 vs. -0.1±0.4%, P=0.01), and a significant rise in the quantitative insulin sensitivity check index (+0.01±0.01 vs. -0.005±0.02, P=0.002) were seen following supplementation with omega-3 fatty acids compared with the placebo. In addition, omega-3 fatty acids supplementation significantly decreased serum high sensitivity C-reactive protein (hs-CRP) (-25.5±31.5 vs. -8.2±18.9μg/mL, P=0.01), and significantly increased plasma total antioxidant capacity (TAC) (+83.5±111.7 vs. -73.4±195.5mmol/L, Pfatty acids supplementation for 12weeks among subjects with DFU had beneficial effects on parameters of ulcer size, markers of insulin metabolism, serum hs-CRP, plasma TAC and GSH levels. In addition, flaxseed oil omega-3 fatty acids may have played an indirect role in wound healing due to its effects on improved metabolic profiles. Copyright

  12. Epidemiology of hand foot mouth disease in Northern Thailand in 2016: A prospective cohort study

    Directory of Open Access Journals (Sweden)

    Panupong Upala

    2017-06-01

    Full Text Available Objective: To determine the correlations between the meteorological data and the number of hand foot mouth disease (HFMD cases in 2016 in Northern Thailand, and to estimate the medical costs. Methods: A prospective cohort study was conducted. Data on numbers of HFMD cases were collected from 49 hospitals in three different provinces in Northern Thailand: 16 hospitals from Chiang Rai Province, 7 hospitals from Pha Yao Province, and 26 hospitals from Chiang Mai Province. A questionnaire had been developed and tested for validity and reliability before used. The specific form for collecting meteorological data was developed and used in the field. All information was recorded in the same data spread sheet before analysis. Chi-square and correlation tests were used for explaining the epidemiology of HFMD in the areas. An alpha error at 0.05 was used to determine the statistical significance level. Results: A total of 8 261 cases were analyzed in the study. 56.0% were males, 97.5% aged less than 6 years, 82.6% were out-patient department (OPD cases, 75.5% were reported in raining season, and 43.2% were from Chiang Mai Province. The number of HFMD cases had statistically significant correlations with temperature, air pressure, relative humidity, and rainfall amount. Averagely, 216 baht and 3 678 baht per case per visit had to be expended for medical cost in OPD and IPD cases, respectively. Most of the cases had been reported in the border areas: Thai-Myanmar, and Thai-Lao. Conclusions: Thailand health care system should provide a concrete schedule for taking care of HFMD patients during raining season, and should develop an effective preventive and control program for HFMD particularly among children less than 6 years.

  13. Granulocyte-Monocyte Apheresis in Steroid-Dependent, Azathioprine-Intolerant/Resistant Moderate Ulcerative Colitis: A Prospective Multicenter Study

    Directory of Open Access Journals (Sweden)

    Gianni Imperiali

    2017-01-01

    Full Text Available Background. Granulocyte-monocyte apheresis has been proposed for the treatment of ulcerative colitis, although it is limited by costs and variability of results. Aim. To assess effectiveness of granulocyte-monocyte apheresis in patients with steroid-dependent, azathioprine-intolerant/resistant moderate ulcerative colitis. Methods. Consecutive patients fulfilling inclusion criteria were prospectively enrolled, treated by apheresis, and followed up for 12 months. The primary end point of the study was steroid-free clinical remission at 12 months, with no need for biologic therapy or surgery. Results. From January to December 2013, 33 patients were enrolled. After one year of follow-up, 12 (36% patients had clinical remission, were steroid-free, and had no need for biological therapy or surgery; 3 (9% cases showed a clinical response (but not clinical remission. Moreover, 12 (36% patients required biologic therapy, 4 (12% underwent colectomy, and in the other 2 (6% a reduction, but not withdrawal, of steroid dose was achieved. Conclusions. Our study shows that a standard course of granulocyte-monocyte apheresis is associated with a 36% steroid-free clinical remission in patients with steroid-dependent, azathioprine-intolerant or resistant moderate ulcerative colitis. Apheresis might represent an alternative to biologic therapy or surgery in this specific subgroup of patients. This trial is registered with Clinicaltrial.gov NCT03189888.

  14. The impact of team based interprofessional comprehensive assessments on the diagnosis and management of diabetic foot ulcers: A retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Ranjani Somayaji

    Full Text Available Diabetic foot ulcers (DFU are increasingly prevalent, and associated with significant morbidity, mortality, and cost. An interprofessional approach to DFU management is critical given the etiological complexity involved. This study aimed to assess the impact of an interprofessional team approach on DFU diagnosis and management for a cohort of patients receiving treatment in an Ontario Canada home care setting.A retrospective cohort study of patients attending a large regional Community Care Access Centre (CCAC between February 11, 2013-September 30, 2014 was conducted. Following CCAC referral, patients were assessed by an interprofessional team at the Toronto Regional Wound Healing Centre (TRWHC. Those aged > 18 years with a DFU of > 6 weeks duration were included. The primary outcome was the precision of the initial diagnosis relating to DFU etiology (i.e. neuropathic, ischemic or mixed etiology. Secondary outcomes included wound healing, and infection parameters. Analysis was completed with STATA 13.1 (College Stn., TX of pre-determined outcomes with 2 sided α of 0.05.A total of 308 patients were screened, and 49 patients (67.3% male of mean age 64.2 years (SD 13.7 with a diagnosis of DFU > 6 weeks duration were included for analysis. Of these, 95% were referred with unspecified DFU, and were reclassified to a precise diagnosis relating to etiology, including neuropathy, ischemia or neuroischemic etiology following TRWHC assessment (p < 0.001. For secondary outcomes post-assessment, healability assessment was conducted for a greater proportion of patients (100% versus 44%, p < 0.001. Infection was identified in a greater number of patients (p = 0.04, and of the 35 patients, 94.5% had deep and surrounding infection, and 88.0% were initiated on systemic antibiotics. Vascular insufficiency was diagnosed in an additional 14.3% of the cohort (p = 0.03. Offloading/footwear assessment was conducted in all patients compared with 30.6% prior to

  15. Mesenchymal stem cells ameliorate impaired wound healing through enhancing keratinocyte functions in diabetic foot ulcerations on the plantar skin of rats.

    Science.gov (United States)

    Kato, Jiro; Kamiya, Hideki; Himeno, Tatsuhito; Shibata, Taiga; Kondo, Masaki; Okawa, Tetsuji; Fujiya, Atsushi; Fukami, Ayako; Uenishi, Eita; Seino, Yusuke; Tsunekawa, Shin; Hamada, Yoji; Naruse, Keiko; Oiso, Yutaka; Nakamura, Jiro

    2014-01-01

    Although the initial healing stage involves a re-epithelialization in humans, diabetic foot ulceration (DFU) has been investigated using rodent models with wounds on the thigh skin, in which a wound contraction is initiated. In this study, we established a rodent model of DFU on the plantar skin and evaluated the therapeutic efficacy of bone-marrow-derived mesenchymal stem cells (BM-MSCs) in this model. The wounds made on the hind paws or thighs of streptozotocin induced diabetic or control rats were treated with BM-MSCs. Expression levels of phosphorylated focal adhesion kinase (pFAK), matrix metaroprotease (MMP)-2, EGF, and IGF-1, were evaluated in human keratinocytes, which were cultured in conditioned media of BM-MSCs (MSC-CM) with high glucose levels. Re-epithelialization initiated the healing process on the plantar, but not on the thigh, skin. The therapy utilizing BM-MSCs ameliorated the delayed healing in diabetic rats. In the keratinocytes cultured with MSC-CM, the decreased pFAK levels in the high glucose condition were restored, and the MMP2, EGF, and IGF-1 levels increased. Our study established a novel rat DFU model. The impaired healing process in diabetic rats was ameliorated by transplantation of BM-MSCs. This amelioration might be accounted for by the modification of keratinocyte functions. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Increased growth factors play a role in wound healing promoted by noninvasive oxygen-ozone therapy in diabetic patients with foot ulcers.

    Science.gov (United States)

    Zhang, Jing; Guan, Meiping; Xie, Cuihua; Luo, Xiangrong; Zhang, Qian; Xue, Yaoming

    2014-01-01

    Management of diabetic foot ulcers (DFUs) is a great challenge for clinicians. Although the oxygen-ozone treatment improves the diabetic outcome, there are few clinical trials to verify the efficacy and illuminate the underlying mechanisms of oxygen-ozone treatment on DFUs. In the present study, a total of 50 type 2 diabetic patients complicated with DFUs, Wagner stage 2~4, were randomized into control group treated by standard therapy only and ozone group treated by standard therapy plus oxygen-ozone treatment. The therapeutic effects were graded into 4 levels from grade 0 (no change) to grade 3 (wound healing). The wound sizes were measured at baseline and day 20, respectively. Tissue biopsies were performed at baseline and day 11. The expressions of vascular endothelial growth factor (VEGF), transforming growth factor-β (TGF-β), and platelet-derived growth factor (PDGF) proteins in the pathologic specimens were determined by immunohistochemical examinations. The effective rate of ozone group was significantly higher than that of control group (92% versus 64%, P healing of DFUs via potential induction of VEGF, TGF-β, and PDGF at early stage of the treatment. (Clinical trial registry number is ChiCTR-TRC-14004415).

  17. Increased electrical nerve stimulation threshold of the sciatic nerve in patients with diabetic foot gangrene: a prospective parallel cohort study.

    Science.gov (United States)

    Keyl, Cornelius; Held, Tanja; Albiez, Georg; Schmack, Astrid; Wiesenack, Christoph

    2013-07-01

    Peripheral neuropathy may affect nerve conduction in patients with diabetes mellitus. This study was designed to test the hypothesis that the electrical stimulation threshold for a motor response of the sciatic nerve is increased in patients suffering from diabetic foot gangrene compared to non-diabetic patients. Prospective non-randomised trial with two parallel groups. Two university-affiliated hospitals. Patients scheduled for surgical treatment of diabetic foot gangrene (n = 30) and non-diabetic patients (n = 30) displaying no risk factors for neuropathy undergoing orthopaedic foot or ankle surgery. The minimum current intensity required to elicit a typical motor response (dorsiflexion or eversion of the foot) at a pulse width of 0.1 ms and a stimulation frequency of 1 Hz when the needle tip was positioned under ultrasound control directly adjacent to the peroneal component of the sciatic nerve. The non-diabetic patients were younger [64 (SD 12) vs. 74 (SD 7) years] and predominantly female (23 vs. 8). The geometric mean of the motor stimulation threshold was 0.26 [95% confidence interval (95% CI) 0.24 to 0.28] mA in non-diabetic and 1.9 (95% CI 1.6 to 2.2) mA in diabetic patients. The geometric mean of the electrical stimulation threshold was significantly (P diabetic compared to non-diabetic patients. The electrical stimulation threshold for a motor response of the sciatic nerve is increased by a factor of 7.2 in patients with diabetic foot gangrene, which might hamper nerve identification.

  18. [The prospects for using potable mineral waters as agents for the primary prevention of gastroduodenal ulcers].

    Science.gov (United States)

    Polushina, N D; Frolkov, V K

    1990-01-01

    Primary preventive effects of mineral water Essentuki 17 were investigated on 500 male Wistar rats (body mass 200-250 g). It is demonstrated that oral pretreatment with the above water can prevent the onset of gastroduodenal ulcers. Changes in secretion of gastrin, insulin, glucagon, triiodothyronine and thyroxin support the clinical evidence.

  19. The Difference Between the Healing and the Nonhealing Diabetic Foot Ulcer: A Review of the Role of the Microcirculation.

    Science.gov (United States)

    Lowry, Danielle; Saeed, Mujahid; Narendran, Parth; Tiwari, Alok

    2017-09-01

    Diabetic foot disease carries a high morbidity and is a leading cause of lower limb amputation. This may in part be due to the effect diabetes mellitus (DM) has on the microcirculation including in the skin. We conducted a review of studies that have examined the relationship between microcirculatory function and wound healing in patients with DM. A search of the Medline, Embase, and Web of Science databases was performed coupled with a review of references for the period 1946 to March 2015. Nineteen studies of diverse methodology and cohort selection were identified. Poor function of the microcirculation was related to poor outcome. Transcutaneous oxygen pressure (TcPO 2 ) was the most commonly used method to measure the microcirculation and thresholds for poor outcome proposed ranged from 10 mmHg to diabetic and nondiabetic patients. While it is not possible to draw firm conclusions from the evidence currently available there are clear areas that warrant research. Good microcirculation unsurprisingly appears to associate with better wound healing. The influence of DM is not clear, and neither is the degree of improvement required to achieve healing. Studies that examine a clearly defined cohort both with and without DM are urgently required. Accurate quantitative assessment of microcirculation will aid prediction of wound healing identifying those at greatest risk of amputation.

  20. Improving major amputation rates in the multicomplex diabetic foot patient: focus on the severity of peripheral arterial disease

    Science.gov (United States)

    Brechow, Andrej; Slesaczeck, Torsten; Münch, Dirk; Nanning, Thomas; Paetzold, Hartmut; Schwanebeck, Uta; Bornstein, Stefan

    2013-01-01

    Objective: Peripheral arterial disease (PAD), as well as diabetic neuropathy, is a risk factor for the development of diabetic foot ulcers. The aim of this study was to evaluate differences and predictors of outcome parameters in patients with diabetic foot by stratifying these subjects according to the severity of PAD. Research design and methods: In a prospective study, patients with new diabetic foot ulcers have been treated and investigated by structured healthcare. Subjects were recruited between 1 January 2000 and 31 December 2007. All study participants underwent a 2-year follow-up observation period. The patients underwent a standardized examination and classification of their foot ulcers according to a modification of the University of Texas Wound Classification System. The severity of PAD was estimated by measurement of the ankle brachial index (ABI) and the continuous wave Doppler flow curve into undisturbed perfusion (0.9 diabetic foot were consecutively included into the study (69% male, mean age 66.3 ± 11.0 years, mean diabetes duration 15.8 ± 10.2 years). Major amputations (above the ankle) were performed in 4.7% of the patients. 22.1% of these subjects had decompensated PAD. These subjects had delayed ulcer healing, higher risk for major amputation [odds ratio (OR) 7.7, 95% confidence interval (CI) 2.8–21.2, p diabetic foot ulcers regarding to wound healing, major amputation and mortality. PMID:23730502

  1. Outcomes in diabetic foot ulcer patients with isolated T2 marrow signal abnormality in the underlying bone: should the diagnosis of ''osteitis'' be changed to ''early osteomyelitis''?

    Energy Technology Data Exchange (ETDEWEB)

    Duryea, Dennis; Bernard, Stephanie; Flemming, Donald; Walker, Eric; French, Cristy [Milton S. Hershey Medical Center, Department of Radiology, H066, 500 University Drive, PO Box 850, Hershey, PA (United States)

    2017-10-15

    To evaluate the variability of clinical treatment and outcomes based on reporting of diabetic foot ulcer MRI findings of adjacent marrow T2 hyperintensity with normal T1 signal. A retrospective review was conducted of 46 MRI examinations evaluating diabetic foot ulcers that demonstrated normal T1 marrow signal, but T2 marrow hyperintensity deep to the ulcer. The cohort was divided based on MRI report impressions into three groups; ''osteitis without osteomyelitis'' (OW), ''osteitis but cannot exclude early osteomyelitis'' (OCEO) and ''early osteomyelitis'' (EO). Patient demographics (age, gender) and accessory MRI findings of ulcer and sinus tract depth were recorded. Initial clinical assessment and medical treatment (route and duration of antibiotics), healing versus disease progression and histology or microbiology results were recorded. The isolated marrow T2 signal hyperintensity was reported as OW in 12 patients, OCEO in 18, and EO in 16. No statistical difference in clinical assessment was demonstrated between the OW, OCEO, and EO groups. Pathological condition was available in 15 patients within 0-7 days (mean 2.4 days) of the MRI examination, with 14 (93%) of these positive for osteomyelitis by histopathology or positive cultures. Initial diagnosis of or progression to osteomyelitis was shown in 28 patients (61%). Treatment of suspected osteomyelitis is heavily determined by clinical factors. Patients who initially demonstrate only T2 marrow signal abnormality under a diabetic ulcer are eventually diagnosed as osteomyelitis in 61% of cases and deserve aggressive treatment as early osteomyelitis when meeting clinical parameters. (orig.)

  2. 1,25-dihydroxyvitamin D3 induces LL-37 and HBD-2 production in keratinocytes from diabetic foot ulcers promoting wound healing: an in vitro model.

    Science.gov (United States)

    Gonzalez-Curiel, Irma; Trujillo, Valentin; Montoya-Rosales, Alejandra; Rincon, Kublai; Rivas-Calderon, Bruno; deHaro-Acosta, Jeny; Marin-Luevano, Paulina; Lozano-Lopez, Daniel; Enciso-Moreno, Jose A; Rivas-Santiago, Bruno

    2014-01-01

    Diabetic foot ulcers (DFU) are one of the most common diabetes-related cause of hospitalization and often lead to severe infections and poor healing. It has been recently reported that patients with DFU have lower levels of antimicrobial peptides (AMPs) at the lesion area, which contributes with the impairment of wound healing. The aim of this study was to determine whether 1,25-dihydroxyvitamin D3 (1,25 (OH)2 D3) and L-isoleucine induced HBD-2 and LL-37 in primary cultures from DFU. We developed primary cell cultures from skin biopsies from 15 patients with DFU and 15 from healthy donors. Cultures were treated with 1,25 (OH)2D3 or L-isoleucine for 18 h. Keratinocytes phenotype was identified by western blot and flow cytometry. Real time qPCR for DEFB4, CAMP and VDR gene expression was performed as well as an ELISA to measure HBD-2 and LL-37 in supernatant. Antimicrobial activity, in vitro, wound healing and proliferation assays were performed with conditioned supernatant. The results show that primary culture from DFU treated with 1,25(OH)2D3, increased DEFB4 and CAMP gene expression and increased the production of HBD-2 and LL-37 in the culture supernatant. These supernatants had antimicrobial activity over E. coli and induced remarkable keratinocyte migration. In conclusion the 1,25(OH)2D3 restored the production of AMPs in primary cell from DFU which were capable to improve the in vitro wound healing assays, suggesting their potential therapeutic use on the treatment of DFU.

  3. 1,25-dihydroxyvitamin D3 induces LL-37 and HBD-2 production in keratinocytes from diabetic foot ulcers promoting wound healing: an in vitro model.

    Directory of Open Access Journals (Sweden)

    Irma Gonzalez-Curiel

    Full Text Available Diabetic foot ulcers (DFU are one of the most common diabetes-related cause of hospitalization and often lead to severe infections and poor healing. It has been recently reported that patients with DFU have lower levels of antimicrobial peptides (AMPs at the lesion area, which contributes with the impairment of wound healing. The aim of this study was to determine whether 1,25-dihydroxyvitamin D3 (1,25 (OH2 D3 and L-isoleucine induced HBD-2 and LL-37 in primary cultures from DFU. We developed primary cell cultures from skin biopsies from 15 patients with DFU and 15 from healthy donors. Cultures were treated with 1,25 (OH2D3 or L-isoleucine for 18 h. Keratinocytes phenotype was identified by western blot and flow cytometry. Real time qPCR for DEFB4, CAMP and VDR gene expression was performed as well as an ELISA to measure HBD-2 and LL-37 in supernatant. Antimicrobial activity, in vitro, wound healing and proliferation assays were performed with conditioned supernatant. The results show that primary culture from DFU treated with 1,25(OH2D3, increased DEFB4 and CAMP gene expression and increased the production of HBD-2 and LL-37 in the culture supernatant. These supernatants had antimicrobial activity over E. coli and induced remarkable keratinocyte migration. In conclusion the 1,25(OH2D3 restored the production of AMPs in primary cell from DFU which were capable to improve the in vitro wound healing assays, suggesting their potential therapeutic use on the treatment of DFU.

  4. Magnesium Supplementation and the Effects on Wound Healing and Metabolic Status in Patients with Diabetic Foot Ulcer: a Randomized, Double-Blind, Placebo-Controlled Trial.

    Science.gov (United States)

    Razzaghi, Reza; Pidar, Farangis; Momen-Heravi, Mansooreh; Bahmani, Fereshteh; Akbari, Hossein; Asemi, Zatollah

    2018-02-01

    Hypomagnesemia is associated with the development of neuropathy and abnormal platelet activity, both of which are risk factors for diabetic foot ulcer (DFU). This study was carried out to evaluate the effects of magnesium administration on wound healing and metabolic status in subjects with DFU. This randomized, double-blind, placebo-controlled trial was performed among 70 subjects with grade 3 DFU. Subjects were randomly divided into two groups (35 subjects each group) to receive either 250 mg magnesium oxide supplements or placebo daily for 12 weeks. Pre- and post-intervention wound depth and appearance were scored in accordance with the "Wagner-Meggitt's" wound assessment tool. Fasting blood samples were taken at baseline and after the 12-week intervention to assess related markers. After the 12-week treatment, compared with the placebo, magnesium supplementation resulted in a significant increase in serum magnesium (+0.3 ± 0.3 vs. -0.1 ± 0.2 mg/dL, P < 0.001) and significant reductions in ulcer length (-1.8 ± 2.0 vs. -0.9 ± 1.1 cm, P = 0.01), width (-1.6 ± 2.0 vs. -0.8 ± 0.9 cm, P = 0.02), and depth (-0.8 ± 0.8 vs. -0.3 ± 0.5 cm, P = 0.003). In addition, significant reductions in fasting plasma glucose (-45.4 ± 82.6 vs. -10.6 ± 53.7 mg/dL, P = 0.04), serum insulin values (-2.4 ± 5.6 vs. +1.5 ± 9.6 μIU/mL, P = 0.04), and HbA1c (-0.7 ± 1.5 vs. -0.1 ± 0.4%, P = 0.03) and a significant rise in the quantitative insulin sensitivity check index (+0.01 ± 0.01 vs. -0.004 ± 0.02, P = 0.01) were seen following supplementation of magnesium compared with the placebo. Additionally, compared with the placebo, taking magnesium resulted in significant decrease in serum high-sensitivity C-reactive protein (hs-CRP) (-19.6 ± 32.5 vs. -4.8 ± 11.2 mg/L, P = 0.01) and significant increase in plasma total antioxidant capacity (TAC) concentrations (+6.4 ± 65.2 vs. -129.9 ± 208.3 mmol/L, P < 0

  5. Etiology of genital ulcer disease. A prospective study of 278 cases seen in an STD clinic in Paris.

    Science.gov (United States)

    Hope-Rapp, Emilie; Anyfantakis, Vassili; Fouéré, Sebastien; Bonhomme, Philippe; Louison, Jean B; de Marsac, Thibault Tandeau; Chaine, Benedicte; Vallee, Pascale; Casin, Isabelle; Scieux, Catherine; Lassau, François; Janier, Michel

    2010-03-01

    The goal of this study was to identify the causes and factors associated with genital ulcer disease (GUD) among patients attending a sexually transmitted disease (STD) clinic in Paris. This study was a prospective investigation of GUD cases. Data were collected from 1995 to 2005. In each case, a Dark Field Examination (DFE), Gram stain, inoculation onto Thayer Martin agar, Columbia agar and chocolate agar with 1% isovitalex and 20% fetal calf serum, PCR Chlamydia trachomatis (Amplicor Roche), culture for herpes simplex virus (HSV) on MRC 5 cells and PCR HSV (Argene Biosoft) were obtained from the ulceration. First Catch Urine (FCU) PCR for Chlamydia trachomatis and syphilis, HIV, HSV, and HBV serologies were also performed. A total 278 cases of GUD were investigated, 244 (88%) in men and 34 (12%) in women. Primary syphilis accounted for 98 cases (35%), genital herpes for 74 (27%), chancroid for 8 (3%), other infections for 12 (5%). In 91 (32%) patients, no identifiable microorganism was documented. Primary syphilis was more prevalent in MSMs (P chancroid were significantly associated with heterosexuality (both P 10 mm (OR: 9.2 [95% CI: 2.9-30.7], P chancroid and reemergence of infectious syphilis have led to a new distribution of pathogens, genital herpes, primary syphilis and GUD from unknown origin, accounting each for one third of cases. No clinical characteristic is predictive of the etiology, underlining the importance of performing a thorough microbiologic evaluation. Close association with HIV is still a major public health problem.

  6. Location and activity of ulcerative and Crohn's colitis by 111In leukocyte scan. A prospective comparison study

    International Nuclear Information System (INIS)

    Stein, D.T.; Gray, G.M.; Gregory, P.B.; Anderson, M.; Goodwin, D.A.; McDougall, I.R.

    1983-01-01

    A prospective blinded study comparing the 111 In leukocyte scan to barium enema, colonoscopy, or surgery or a combination of these, was carried out in 15 patients (10 with active ulcerative colitis and 5 with active Crohn's colitis). Correlation of disease location to colonic regions between indium scan and other diagnostic studies was excellent in 11 instances, good in 2, and poor in 3. In 2 of the 3 studies where major disagreement occurred, the comparative barium enema was performed greater than 2 mo after the indium scan. Disease activity, estimated by the intensity of radionuclide uptake, was compared to clinical disease activity assessed by the Crohn's Disease Activity Index for both forms of colitis. The relative degree of inflammation estimated by the indium scan correlated well with the independent clinical assessment (correlation coefficient . 0.81). The indium 111 leukocyte scan appears to be an accurate, noninvasive method for assessing the extent and the severity of the inflammation in patients with acute ulcerative or Crohn's colitis

  7. Capacidade funcional dos pacientes com diabetes mellitus e pé ulcerado Capacidad funcional de pacientes con diabetes mellitus y pié ulcerado Functional capability of patients with diabetes with foot ulceration

    Directory of Open Access Journals (Sweden)

    Geraldo Magela Salomé

    2009-01-01

    Full Text Available OBJETIVO: Avaliar a capacidade funcional de pessoas com diabetes mellitus e pé ulcerado. MÉTODOS: Estudo analítico, transversal e comparativo, realizado em hospital público do município de São Paulo, sendo os dados coletados no período de 2 de junho a 30 julho de 2008. Foram selecionados para compor o Grupo de Estudo, 20 pacientes com diabetes mellitus e pé ulcerado; para o Grupo Controle 20 pessoas com diagnóstico médico de diabetes mellitus, sem úlcera no pé. O instrumento utilizado foi Health Assessment Questionnaire-20. RESULTADOS: O grupo estudo diferiu do grupo controle, quanto ao escores HAQ-20, bem como em relação aos componentes 1,2,3,5,6,7 e 8. Também apresentaram diferença estatística significante (POBJETIVO: Evaluar la capacidad funcional de personas con diabetes mellitus y pié ulcerado. MÉTODOS: Se trata de un estudio analítico, transversal y comparativo, realizado en un hospital público del municipio de Sao Paulo, cuyos datos fueron recolectados en el período del 2 de junio al 30 julio del 2008. Fueron seleccionados para componer el Grupo de Estudio, 20 pacientes con diabetes mellitus y pié ulcerado; para el Grupo Control 20 personas con diagnóstico médico de diabetes mellitus, sin úlcera en el pié. El instrumento utilizado fue el Health Assessment Questionnaire-20. RESULTADOS: El grupo de estudio difirió del grupo control, en cuanto a los escores HAQ-20, así como en relación a los componentes 1,2,3,5,6,7 y 8. También presentaron diferencia estadísticamente significativa (POBJECTIVE: To evaluate and compare the functional capability of patients with diabetes with foot ulceration and patients with diabetes without foot ulceration. METHODS: A cross sectional descriptive comparative study was conducted in a public hospital in the district of São Paulo. The sample consisted of 20 patients with foot ulceration and 20 patients without foot ulceration. Data were collected from June 2 to July 30, 2008. The

  8. Priorities in offloading the diabetic foot

    NARCIS (Netherlands)

    Bus, Sicco A.

    2012-01-01

    Biomechanical factors play an important role in diabetic foot disease. Reducing high foot pressures (i.e. offloading) is one of the main goals in healing and preventing foot ulceration. Evidence-based guidelines show the strong association between the efficacy to offload the foot and clinical

  9. An Evaluation of Surgical Functional Reconstruction of the Foot Using Kinetic and Kinematic Systems: A Case Report.

    Science.gov (United States)

    Jordán-Palomar, Elena Irene; Javierre, Etelvina; Rey-Vasalo, José; Alfaro-Santafé, Víctor; Gómez-Benito, María José

    Most pedobarographic studies of microsurgical foot reconstruction have been retrospective. In the present study, we report the results from a prospective pedobarographic study of a patient after microsurgical reconstruction of her foot with a latissimus dorsi flap and a cutaneous paddle, with a 42-month follow-up period. We describe the foot reconstruction plan and the pedobarographic measurements and analyzed its functional outcome. The goal of the present study was to demonstrate that pedobarography could have a role in the treatment of foot reconstruction from a quantitative perspective. The pedobarographic measurements were recorded after the initial coverage surgery and 2 subsequent foot remodeling procedures. A total of 4 pedobarographic measurements and 2 gait analyses were recorded and compared for both the noninvolved foot and the injured foot. Furthermore, the progress of the reconstructed foot was critically evaluated using this method. Both static and dynamic patterns were compared at subsequent follow-up visits after the foot reconstruction. The values and progression of the foot shape, peak foot pressure (kPa), average foot pressure (kPa), total contact surface (cm 2 ), loading time (%), and step time (ms) were recorded. Initially, the pressure distribution of the reconstructed foot showed higher peak values at nonanatomic locations, revealing a greater ulceration risk. Over time, we found an improvement in the shape and values of these factors in the involved foot. To homogenize the pressure distribution and correct the imbalance between the 2 feet, patient-specific insoles were designed and fabricated. In our patient, pedobarography provided an objective, repeatable, and recordable method for the evaluation of the reconstructed foot. Pedobarography can therefore provide valuable insights into the prevention of pressure ulcers and optimization of rehabilitation. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc

  10. Do patients in Dutch nursing homes have more pressure ulcers than patients in German nursing homes? A prospective multicenter cohort study.

    Science.gov (United States)

    Meesterberends, Esther; Halfens, Ruud J G; Spreeuwenberg, Marieke D; Ambergen, Ton A W; Lohrmann, Christa; Neyens, Jacques C L; Schols, Jos M G A

    2013-08-01

    To investigate whether the incidence of pressure ulcers in nursing homes in the Netherlands and Germany differs and, if so, to identify resident-related risk factors, nursing-related interventions, and structural factors associated with pressure ulcer development in nursing home residents. A prospective multicenter cohort study. Ten nursing homes in the Netherlands and 11 nursing homes in Germany (around Berlin and Brandenburg). A total of 547 newly admitted nursing home residents, of which 240 were Dutch and 307 were German. Residents had an expected length of stay of 12 weeks or longer. Data were collected for each resident over a 12-week period and included resident characteristics (eg, demographics, medical history, Braden scale scores, nutritional factors), pressure ulcer prevention and treatment characteristics, staffing ratios and other structural nursing home characteristics, and outcome (pressure ulcer development during the study). Data were obtained by trained research assistants. A significantly higher pressure ulcer incidence rate was found for the Dutch nursing homes (33.3%) compared with the German nursing homes (14.3%). Six factors that explain the difference in pressure ulcer incidence rates were identified: dementia, analgesics use, the use of transfer aids, repositioning the residents, the availability of a tissue viability nurse on the ward, and regular internal quality controls in the nursing home. The pressure ulcer incidence was significantly higher in Dutch nursing homes than in German nursing homes. Factors related to residents, nursing care and structure explain this difference in incidence rates. Continuous attention to pressure ulcer care is important for all health care settings and countries, but Dutch nursing homes especially should pay more attention to repositioning residents, the necessity and correct use of transfer aids, the necessity of analgesics use, the tasks of the tissue viability nurse, and the performance of regular

  11. A prospective randomized evaluation of negative-pressure wound dressings for diabetic foot wounds.

    Science.gov (United States)

    Eginton, Mark T; Brown, Kellie R; Seabrook, Gary R; Towne, Jonathan B; Cambria, Robert A

    2003-11-01

    Optimal treatment for large diabetic foot wounds is ill defined. The purpose of this study was to compare the rate of wound healing with the Vacuum Assisted Closure device trade mark (VAC) to conventional moist dressings in the treatment of large diabetic foot wounds. Diabetics with significant soft tissue defects of the foot were considered for enrollment. Patients were randomized to receive either moist gauze dressings or VAC treatments for 2 weeks, after which they were treated with the alternative dressing for an additional 2 weeks. Wounds were photographed weekly and wound dimensions calculated in a blinded fashion with spatial analysis software. Percent change in wound dimensions were calculated and compared for each weekly assessment and over 2 weeks of therapy with each dressing type. Ten patients were enrolled in the trial, but two were lost to follow-up and two were withdrawn. Complete data were available for analysis on seven wounds in six patients. Average length, width, and depth of the wounds at initiation of the trial was 7.7, 3.5, and 3.1 cm, respectively. Only the wound depth was significantly decreased over the weeks of the trial to 1.2 cm ( p VAC dressings decreased the wound volume and depth significantly more than moist gauze dressings (59% vs. 0% and 49% vs. 8%, respectively). VAC dressings were associated with a decrease in all wound dimensions while wound length and width increased with moist dressings. In summary, over the first several weeks of therapy, VAC dressings decreased wound depth and volume more effectively than moist gauze dressings. Negative-pressure wound treatment may accelerate closure of large foot wounds in the diabetic patient.

  12. Cultural adaptation and validation of the Neuropathy - and Foot Ulcer - Specific Quality of Life instrument (NeuroQol for Brazilian Portuguese - Phase 1 Adaptación cultural y validación del Neuropathy - and Foot Ulcer - Specific Quality of Life (NeuroQol para el idioma portugués de Brasil - Fase 1 Adaptação cultural e validação do Neuropathy - and Foot Ulcer - Specific Quality of Life (NeuroQol para a língua portuguesa do Brasil - Fase 1

    Directory of Open Access Journals (Sweden)

    Antonia Tayana da Franca Xavier

    2011-12-01

    Full Text Available This methodological study aimed to adapt the Neuropathy - and Foot Ulcer - Specific Quality of Life instrument - NeuroQol to Brazilian Portuguese and to analyze its psychometric properties. Participants were 50 people with peripheral diabetic neuropathy and foot ulcers. The floor and ceiling effects, the convergent and discriminant validity and the reliability were analyzed. The Cronbach’s alpha coefficient was used to test the reliability and the Pearson’s correlation coefficient to estimate the convergent validity, the Student’s t test was used to evaluate the discriminant validity in the comparison of the NeuroQol scores between participants with and without ulcers. Floor and ceiling effects were found in some domains of the NeuroQol. The reliability was satisfactory. The correlations between the domains of the NeuroQol and the SF-36 were negative, significant and of moderate to strong magnitude. The findings show that the Brazilian version of the NeuroQol is reliable and valid and may be employed as a useful tool for improving nursing care for people with DM.Estudio metodológico que tuvo como objetivos adaptar el Neuropathy - and Foot Ulcer - Specific Quality of Life - NeuroQol para el idioma portugués de Brasil y analizar sus propiedades psicométricas. Participaron 50 personas con neuropatía diabética periférica y úlceras en los pies. Fueron analizados los efectos floor y ceiling, la validez convergente, la discriminante y la confiabilidad. Fue utilizado el coeficiente alfa de Cronbach para comprobar la confiabilidad y la correlación de Pearson para estimar la validez convergente; el test t-Student fue empleado para evaluar la validez discriminante en la comparación de los puntajes del NeuroQol entre los participantes con y sin úlceras. Se constataron efectos floor y ceiling en algunos dominios del NeuroQol. La confiabilidad fue satisfactoria. Las correlaciones entre los dominios del NeuroQol y SF-36 fueron negativas

  13. Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe : a 1-year prospective cohort study

    NARCIS (Netherlands)

    Nielsen, Rasmus Oestergaard; Buist, Ida; Parner, Erik Thorlund; Nohr, Ellen Aagaard; Sorensen, Henrik; Lind, Martin; Rasmussen, Sten

    Objective To investigate if running distance to first running-related injury varies between foot postures in novice runners wearing neutral shoes. Design A 1-year epidemiological observational prospective cohort study. Setting Denmark. Participants A total of 927 novice runners equivalent to 1854

  14. Data-driven directions for effective footwear provision for the high-risk diabetic foot.

    Science.gov (United States)

    Arts, M L J; de Haart, M; Waaijman, R; Dahmen, R; Berendsen, H; Nollet, F; Bus, S A

    2015-06-01

    Custom-made footwear is used to offload the diabetic foot to prevent plantar foot ulcers. This prospective study evaluates the offloading effects of modifying custom-made footwear and aims to provide data-driven directions for the provision of effectively offloading footwear in clinical practice. Eighty-five people with diabetic neuropathy and a recently healed plantar foot ulcer, who participated in a clinical trial on footwear effectiveness, had their custom-made footwear evaluated with in-shoe plantar pressure measurements at three-monthly intervals. Footwear was modified when peak pressure was ≥ 200 kPa. The effect of single and combined footwear modifications on in-shoe peak pressure at these high-pressure target locations was assessed. All footwear modifications significantly reduced peak pressure at the target locations compared with pre-modification levels (range -6.7% to -24.0%, P diabetic neuropathy and a recently healed plantar foot ulcer, significant offloading can be achieved at high-risk foot regions by modifying custom-made footwear. These results provide data-driven directions for the design and evaluation of custom-made footwear for high-risk people with diabetes, and essentially mean that each shoe prescribed should incorporate those design features that effectively offload the foot. © 2015 The Authors. Diabetic Medicine © 2015 Diabetes UK.

  15. A review of the biomechanics of the diabetic foot

    NARCIS (Netherlands)

    van Schie, C. H. M.

    2005-01-01

    In general, diabetic foot ulcers result from abnormal mechanical loading of the foot, such as repetitive moderate pressure applied to the plantar aspect of the foot while walking. Diabetic peripheral neuropathy causes changes in foot structure, affecting foot function and subsequently leading to

  16. Effectiveness and safety of a nonremovable fiberglass off-bearing cast versus a therapeutic shoe in the treatment of neuropathic foot ulcers: a randomized study.

    Science.gov (United States)

    Caravaggi, C; Faglia, E; De Giglio, R; Mantero, M; Quarantiello, A; Sommariva, E; Gino, M; Pritelli, C; Morabito, A

    2000-12-01

    To evaluate and compare the rate of reduction of the surface area of neuropathic plantar ulcers in diabetic patients treated with nonremovable rigidity-differentiated fiberglass off-bearing casts or a cloth shoe with a rigid sole with unloading alkaform insoles. The secondary aim was to evaluate the side effects and degree of patient acceptance of treatment. Fifty diabetic patients with neuropathic plantar ulcers were consecutively enrolled and randomized to one of two treatment groups. Of the 50 patients, 24 were treated with a specialized cloth shoe with a rigid sole and an unloading alkaform insole (shoe group), and 26 patients were treated with a nonremovable off-bearing fiberglass cast (cast group). All patients in both study groups returned to the clinic for weekly control visits. Their ulcers were treated with a standard dressing. Tracings of the ulcer area using a transparent dressing were performed on the day of entry to the study and after 30 days of treatment. The presence of new ulcerations caused by the use of the pressure-relief apparatus was recorded. Patient acceptance of the treatment was measured using a visual analog scale. At the end of the treatment period, an 8.3% increase of the ulcer area was observed in two patients in the shoe group, whereas in the cast group, no patient presented an increase. The reduction of the ulcer area was statistically more rapid in the cast group (Mann-Whitney test, P = 0.0004). Furthermore, the number of ulcers completely healed at the 30-day time point was 13 (50%) in the cast group and 5 (20.8%) in the shoe group (P = 0.03). In both groups, no side effects were recorded. The average score +/- SD of patient acceptance was 91.15 +/- 9.9 in the shoe group and 88.33 +/- 17.3 (NS) in the cast group. Our study has shown a significant difference in the speed of the reduction of neuropathic plantar ulcers treated with a fiberglass cast compared with a specialized cloth shoe. The use of fiberglass material with variable

  17. Preventative foot care in people with diabetes: Quality patient ...

    African Journals Online (AJOL)

    Foot ulceration and amputation cause extensive burden on individuals and health care systems. One of the reasons for the poor outcome of foot complications in developing countries is the lack of patient education. Due to the multi-factorial pathology of diabetic foot ulceration, the person with diabetes should receive health ...

  18. Prevention of recurrent foot ulcers with plantar pressure-based in-shoe orthoses: the CareFUL prevention multicenter randomized controlled trial.

    Science.gov (United States)

    Ulbrecht, Jan S; Hurley, Timothy; Mauger, David T; Cavanagh, Peter R

    2014-07-01

    To assess the efficacy of in-shoe orthoses that were designed based on shape and barefoot plantar pressure in reducing the incidence of submetatarsal head plantar ulcers in people with diabetes, peripheral neuropathy, and a history of similar prior ulceration. Single-blinded multicenter randomized controlled trial with subjects randomized to wear shape- and pressure-based orthoses (experimental, n = 66) or standard-of-care A5513 orthoses (control, n = 64). Patients were followed for 15 months, until a study end point (forefoot plantar ulcer or nonulcerative plantar forefoot lesion) or to study termination. Proportional hazards regression was used for analysis. There was a trend in the composite primary end point (both ulcers and nonulcerative lesions) across the full follow-up period (P = 0.13) in favor of the experimental orthoses. This trend was due to a marked difference in ulcer occurrence (P = 0.007) but no difference in the rate of nonulcerative lesions (P = 0.76). At 180 days, the ulcer prevention effect of the experimental orthoses was already significant (P = 0.003) when compared with control, and the benefit of the experimental orthoses with respect to the composite end point was also significant (P = 0.042). The hazard ratio was 3.4 (95% CI 1.3-8.7) for the occurrence of a submetatarsal head plantar ulcer in the control compared with experimental arm over the duration of the study. We conclude that shape- and barefoot plantar pressure-based orthoses were more effective in reducing submetatarsal head plantar ulcer recurrence than current standard-of-care orthoses, but they did not significantly reduce nonulcerative lesions. © 2014 by the American Diabetes Association.

  19. Prevention of Recurrent Foot Ulcers With Plantar Pressure–Based In-Shoe Orthoses: The CareFUL Prevention Multicenter Randomized Controlled Trial

    Science.gov (United States)

    Ulbrecht, Jan S.; Hurley, Timothy; Mauger, David T.

    2014-01-01

    OBJECTIVE To assess the efficacy of in-shoe orthoses that were designed based on shape and barefoot plantar pressure in reducing the incidence of submetatarsal head plantar ulcers in people with diabetes, peripheral neuropathy, and a history of similar prior ulceration. RESEARCH DESIGN AND METHODS Single-blinded multicenter randomized controlled trial with subjects randomized to wear shape- and pressure-based orthoses (experimental, n = 66) or standard-of-care A5513 orthoses (control, n = 64). Patients were followed for 15 months, until a study end point (forefoot plantar ulcer or nonulcerative plantar forefoot lesion) or to study termination. Proportional hazards regression was used for analysis. RESULTS There was a trend in the composite primary end point (both ulcers and nonulcerative lesions) across the full follow-up period (P = 0.13) in favor of the experimental orthoses. This trend was due to a marked difference in ulcer occurrence (P = 0.007) but no difference in the rate of nonulcerative lesions (P = 0.76). At 180 days, the ulcer prevention effect of the experimental orthoses was already significant (P = 0.003) when compared with control, and the benefit of the experimental orthoses with respect to the composite end point was also significant (P = 0.042). The hazard ratio was 3.4 (95% CI 1.3–8.7) for the occurrence of a submetatarsal head plantar ulcer in the control compared with experimental arm over the duration of the study. CONCLUSIONS We conclude that shape- and barefoot plantar pressure–based orthoses were more effective in reducing submetatarsal head plantar ulcer recurrence than current standard-of-care orthoses, but they did not significantly reduce nonulcerative lesions. PMID:24760263

  20. The characterization of a full-thickness excision open foot wound model in n5-streptozotocin (STZ)-induced type 2 diabetic rats that mimics diabetic foot ulcer in terms of reduced blood circulation, higher C-reactive protein, elevated inflammation, and reduced cell proliferation

    Science.gov (United States)

    Yu, Caroline Oi-Ling; Leung, Kwok-Sui; Fung, Kwok-Pui; Lam, Francis Fu-Yuen; Ng, Ethel Sau-Kuen; Lau, Kit-Man; Chow, Simon Kwoon-Ho; Cheung, Wing-Hoi

    2017-01-01

    Delayed foot wound healing is a major complication attributed to hyperglycemia in type 2 diabetes mellitus (DM) patients, and these wounds may develop into foot ulcers. There are at least two types of DM wound models used in rodents to study delayed wound healing. However, clinically relevant animal models are not common. Most models use type 1 DM rodents or wounds created on the back rather than on the foot. An open full-thickness excision wound on the footpad of type 2 DM rats is more clinically relevant, but such a model has not yet been characterized systematically. The objective of this study was to investigate and characterize how DM affected a full-thickness excision open foot wound in n5-streptozotocin (n5-STZ)-induced type 2 DM rats. We hypothesized that elevated inflammation, reduced blood circulation, and cell proliferation due to hyperglycemia could delay the wound healing of DM rats. The wounds of DM rats were compared with those of non-DM rats (Ctrl) at Days 1 and 8 post wounding. The wound healing process of the DM rats was significantly delayed compared with that of the Ctrl rats. The DM rats also had higher C-reactive protein (CRP) and lower blood circulation and proliferating cell nuclear antigen (PCNA) in DM wounds. This confirmed that elevated inflammation and reduced blood flow and cell proliferation delayed foot wound healing in the n5-STZ rats. Hence, this open foot wound animal model provides a good approach to study the process of delayed wound healing. PMID:28413186

  1. The characterization of a full-thickness excision open foot wound model in n5-streptozotocin (STZ)-induced type 2 diabetic rats that mimics diabetic foot ulcer in terms of reduced blood circulation, higher C-reactive protein, elevated inflammation, and reduced cell proliferation.

    Science.gov (United States)

    Yu, Caroline Oi-Ling; Leung, Kwok-Sui; Fung, Kwok-Pui; Lam, Francis Fu-Yuen; Ng, Ethel Sau-Kuen; Lau, Kit-Man; Chow, Simon Kwoon-Ho; Cheung, Wing-Hoi

    2017-08-05

    Delayed foot wound healing is a major complication attributed to hyperglycemia in type 2 diabetes mellitus (DM) patients, and these wounds may develop into foot ulcers. There are at least two types of DM wound models used in rodents to study delayed wound healing. However, clinically relevant animal models are not common. Most models use type 1 DM rodents or wounds created on the back rather than on the foot. An open full-thickness excision wound on the footpad of type 2 DM rats is more clinically relevant, but such a model has not yet been characterized systematically. The objective of this study was to investigate and characterize how DM affected a full-thickness excision open foot wound in n5-streptozotocin (n5-STZ)-induced type 2 DM rats. We hypothesized that elevated inflammation, reduced blood circulation, and cell proliferation due to hyperglycemia could delay the wound healing of DM rats. The wounds of DM rats were compared with those of non-DM rats (Ctrl) at Days 1 and 8 post wounding. The wound healing process of the DM rats was significantly delayed compared with that of the Ctrl rats. The DM rats also had higher C-reactive protein (CRP) and lower blood circulation and proliferating cell nuclear antigen (PCNA) in DM wounds. This confirmed that elevated inflammation and reduced blood flow and cell proliferation delayed foot wound healing in the n5-STZ rats. Hence, this open foot wound animal model provides a good approach to study the process of delayed wound healing.

  2. Early Diagnosis of Helicobacter pylori Infection in Vietnamese Patients with Acute Peptic Ulcer Bleeding: A Prospective Study

    Directory of Open Access Journals (Sweden)

    Duc Trong Quach

    2017-01-01

    Full Text Available Aims. To investigate H. pylori infection rate and evaluate a combined set of tests for H. pylori diagnosis in Vietnamese patients with acute peptic ulcer bleeding (PUD. Methods. Consecutive patients with acute PUB were enrolled prospectively. Rapid urease test (RUT with 3 biopsies was carried out randomly. Patients without RUT or with negative RUT received urea breath test (UBT and serological and urinary H. pylori antibody tests. H. pylori was considered positive if RUT or any noninvasive test was positive. Patients were divided into group A (RUT plus noninvasive tests and group B (only noninvasive tests. Results. The overall H. pylori infection rate was 94.2% (161/171. Groups A and B had no differences in demographic characteristics, bleeding severity, endoscopic findings, and proton pump inhibitor use. H. pylori-positive rate in group A was significantly higher than that in group B (98.2% versus 86.7%, p=0.004. The positive rate of RUT was similar at each biopsy site but significantly increased if RUT results from 2 or 3 sites were combined (p<0.05. Conclusions. H. pylori infection rate in Vietnamese patients with acute PUB is high. RUT is an excellent test if at least 2 biopsies are taken.

  3. Extraintestinal manifestations in Crohn's disease and ulcerative colitis: results from a prospective, population-based European inception cohort.

    Science.gov (United States)

    Isene, Rune; Bernklev, Tomm; Høie, Ole; Munkholm, Pia; Tsianos, Epameonondas; Stockbrügger, Reinhold; Odes, Selwyn; Palm, Øyvind; Småstuen, Milada; Moum, Bjørn

    2015-03-01

    In chronic inflammatory bowel disease (IBD) (Crohn's disease [CD] and ulcerative colitis [UC]), symptoms from outside the gastrointestinal tract are frequently seen, and the joints, skin, eyes, and hepatobiliary area are the most usually affected sites (called extraintestinal manifestations [EIM]). The reported prevalence varies, explained by difference in study design and populations under investigation. The aim of our study was to determine the prevalence of EIM in a population-based inception cohort in Europe and Israel. IBD patients were incepted into a cohort that was prospectively followed from 1991 to 2004. A total of 1145 patients were followed for 10 years. The cumulative prevalence of first EIM was 16.9% (193/1145 patients) over a median follow-up time of 10.1 years. Patients with CD were more likely than UC patients to have immune-mediated (arthritis, eye, skin, and liver) manifestations: 20.1% versus 10.4% (p colitis compared to proctitis in UC increased the risk of EIM. In a European inception cohort, EIMs in IBD were consistent with that seen in comparable studies. Patients with CD are twice as likely as UC patients to experience EIM, and more extensive distribution of inflammation in UC increases the risk of EIM.

  4. Surgical outcomes for perforated peptic ulcer: A prospective case series at an academic hospital in Monrovia, Liberia

    Directory of Open Access Journals (Sweden)

    J. Fallah Moses

    2015-06-01

    Conclusion: Peptic ulcer disease and its treatment represent a potentially substantial source of morbidity and mortality in limited-resource settings. In this case series, surgical treatment for perforated peptic ulcer disease carried a high mortality, and the results highlight the potential for public health systems strengthening to prevent poor health outcomes. Peptic ulcer disease in low- and middle-income countries presents unique epidemiology and treatment challenges that may differ significantly from evidence-based guidelines in high-income countries.

  5. Peptic Ulcers

    Science.gov (United States)

    ... people of any age — even kids — can develop ulcers. About Peptic Ulcers An ulcer is a sore, which means it's ... that most people can be cured. Causes of Peptic Ulcers in Kids Although stress and certain foods may ...

  6. Challenges and prospects for the control of foot-and-mouth disease: an African perspective

    Directory of Open Access Journals (Sweden)

    Maree FF

    2014-10-01

    Full Text Available Francois F Maree,1,2 Christopher J Kasanga,3, Katherine A Scott,1 Pamela A Opperman,1,2 Melanie Chitray,1,2, Abraham K Sangula,4 Raphael Sallu,3 Yona Sinkala,5 Philemon N Wambura,3 Donald P King,6 David J Paton,6 Mark M Rweyemamu,3 1Transboundary Animal Diseases Programme, Onderstepoort Veterinary Institute, Agricultural Research Council, Onderstepoort, Pretoria, South Africa; 2Department of Microbiology and Plant Pathology, Faculty of Agricultural and Natural Sciences, University of Pretoria, Pretoria, South Africa; 3Southern African Centre for Infectious Diseases Surveillance, Sokoine University of Agriculture, Morogoro, Tanzania; 4Foot-and-Mouth Disease Laboratory, Embakasi, Nairobi, Kenya; 5Department of Disease Control, School of Veterinary Medicine, University of Zambia, Lusaka, Zambia; 6The Pirbright Institute, Pirbright, Surrey, UK Abstract: The epidemiology of foot-and-mouth disease (FMD in Africa is unique in the sense that six of the seven serotypes of FMD viruses (Southern African Territories [SAT] 1, SAT2, SAT3, A, O, and C, with the exception of Asia-1, have occurred in the last decade. Due to underreporting of FMD, the current strains circulating throughout sub-Saharan Africa are in many cases unknown. For SAT1, SAT2, and serotype A viruses, the genetic diversity is reflected in antigenic variation, and indications are that vaccine strains may be needed for each topotype. This has serious implications for control using vaccines and for choice of strains to include in regional antigen banks. The epidemiology is further complicated by the fact that SAT1, SAT2, and SAT3 viruses are maintained and spread by wildlife, persistently infecting African buffalo in particular. Although the precise mechanism of transmission of FMD from buffalo to cattle is not well understood, it is facilitated by direct contact between these two species. Once cattle are infected they may maintain SAT infections without the further involvement of buffalo. No

  7. Predictive validity of granulation tissue color measured by digital image analysis for deep pressure ulcer healing: a multicenter prospective cohort study.

    Science.gov (United States)

    Iizaka, Shinji; Kaitani, Toshiko; Sugama, Junko; Nakagami, Gojiro; Naito, Ayumi; Koyanagi, Hiroe; Konya, Chizuko; Sanada, Hiromi

    2013-01-01

    This multicenter prospective cohort study examined the predictive validity of granulation tissue color evaluated by digital image analysis for deep pressure ulcer healing. Ninety-one patients with deep pressure ulcers were followed for 3 weeks. From a wound photograph taken at baseline, an image representing the granulation red index (GRI) was processed in which a redder color represented higher values. We calculated the average GRI over granulation tissue and the proportion of pixels exceeding the threshold intensity of 80 for the granulation tissue surface (%GRI80) and wound surface (%wound red index 80). In the receiver operating characteristics curve analysis, most GRI parameters had adequate discriminative values for both improvement of the DESIGN-R total score and wound closure. Ulcers were categorized by the obtained cutoff points of the average GRI (≤80, >80), %GRI80 (≤55, >55-80, >80%), and %wound red index 80 (≤25, >25-50, >50%). In the linear mixed model, higher classes for all GRI parameters showed significantly greater relative improvement in overall wound severity during the 3 weeks after adjustment for patient characteristics and wound locations. Assessment of granulation tissue color by digital image analysis will be useful as an objective monitoring tool for granulation tissue quality or surrogate outcomes of pressure ulcer healing. © 2012 by the Wound Healing Society.

  8. Frequency and risk factors of gastric and duodenal ulcers or erosions in children: a prospective 1-month European multicenter study

    DEFF Research Database (Denmark)

    Kalach, Nicolas; Bontems, Patrick; Koletzko, Sibylle

    2010-01-01

    There are no solid figures of the frequency of ulcer disease during childhood in Europe. We assessed its frequency and analyzed known risk factors.......There are no solid figures of the frequency of ulcer disease during childhood in Europe. We assessed its frequency and analyzed known risk factors....

  9. Patients With Diabetic Foot Disease Fear Major Lower-Extremity Amputation More Than Death.

    Science.gov (United States)

    Wukich, Dane K; Raspovic, Katherine M; Suder, Natalie C

    2018-02-01

    The aim of this study was to identify the most-feared complications of diabetes mellitus (DM), comparing those with diabetic foot pathology with those without diabetic foot pathology. We determined the frequency of patients ranking major lower-extremity amputation (LEA) as their greatest fear in comparison to blindness, death, diabetic foot infection (DFI), or end-stage renal disease (ESRD) requiring dialysis. We further categorized the study group patients (N = 207) by their pathology such as diabetic foot ulcer (DFU), Charcot neuroarthropathy, foot infection, or acute neuropathic fractures and dislocations. The control group (N = 254) was comprised of patients with diabetes who presented with common non-diabetes-related foot pathology. A total of 461 patients were enrolled in this study and included 254 patients without diabetic foot complications and 207 patients with diabetic foot problems. When comparing patients with and without diabetic disease, no significant differences were observed with regard to their fear of blindness, DFI, or ESRD requiring dialysis. Patients with diabetic foot disease (61 of 207, 31.9%) were 136% more likely (odds ratio [OR] = 2.36; 95% CI = 1.51-3.70; P = .002] to rank major LEA as their greatest fear when compared with diabetic patients without foot disease (42 of 254, 16.5%) and were 49% less likely (OR = 0.51; 95% CI = 0.34-0.79; P = .002) to rank death as their greatest fear compared with patients without diabetic foot disease. Patients with diabetic foot pathology fear major LEA more than death, foot infection, or ESRD. Variables that were associated with ranking LEA as the greatest fear were the presence of a diabetic-related foot complication, duration of DM ≥10 years, insulin use, and the presence of peripheral neuropathy. Level II: Prospective, Case controlled study.

  10. Radionuclide imaging in diagnosis and therapy of the diabetic foot

    International Nuclear Information System (INIS)

    Zhu Cansheng

    2000-01-01

    Early and accurate diagnosis of angiopathy or infection of the diabetic foot is the key to the successful management. Radionuclide imaging is very useful in detecting diabetic microangiopathy, assessing the prognosis of foot ulcers, and diagnosing the osteomyelitis

  11. Comorbidities associated with Egyptian diabetic foot disease subtypes

    Directory of Open Access Journals (Sweden)

    Mary N. Rizk

    2013-01-01

    Conclusion Special attention should be paid toward the identification of patients who are at risk of foot ulceration to help prevent foot problems. Comorbid conditions must also be identified early and managed aggressively.

  12. [Minor foot amputations in diabetic foot syndrome].

    Science.gov (United States)

    Biehl, C; Eckhard, M; Szalay, G; Heiss, C

    2016-10-01

    The treatment strategy for diabetic foot syndrome must take into account protective sensibility of the foot, open wounds, infection status, and the rules of septic bone surgery. Interventions are classified as elective, prophylactic, curative, or emergency. Amputations in the forefoot and midfoot region are performed as ray amputations (including metatarsal), which can often be carried out as "inner" amputations. Gentle tissue treatment mandatory because of greater risk of revision with re-amputation compared to classical amputation. Good demarcation of infection, acute osteomyelitis, osteolytic lesions, neurotropic ulcer, arterial and venous blood flow to the other toes, gangrene of other toes with metatarsal affection. Arterial occlusive disease, infection of neighboring areas, avoidable amputations, poorly healing ulcers on the lower leg. Primary dorsal approach; minimal incisional distance (5 cm) to minimize skin necrosis risk. Atraumatic preparation, minimize hemostasis to not compromise the borderline perfusion situation. In amputations, plantar skin preparation and longer seams placed as dorsal as possible, either disarticulated and maintain cartilage, or round the cortical metatarsal bone after resection. Diabetes control. Braun splint, mobilization in a shoe with forefoot decompression and hindfoot support, physiotherapy. Antibiotics based on resistance testing. If no complications, dressing change on postoperative day 1. Optimal wound drainage by lowering foot several times a day; drainage removal after 12-24 h. Insoles and footwear optimization. Amputations require continued attention and if necessary treatment to avoid sequelae. Insufficient treatment associated with recurrent ulceration and altered anatomy.

  13. Staphylococcus aureus small colony variants in diabetic foot infections

    Directory of Open Access Journals (Sweden)

    Estrella Cervantes-García

    2015-03-01

    Full Text Available Background: Staphylococcus aureus (S. aureus is one of the major pathogens causing chronic infections. The ability of S. aureus to acquire resistance to a diverse range of antimicrobial compounds results in limited treatment options, particularly in methicillin-resistant S. aureus (MRSA. A mechanism by which S. aureus develops reduced susceptibility to antimicrobials is through the formation of small colony variants (SCVs. Infections by SCVs of S. aureus are an upcoming problem due to difficulties in laboratory diagnosis and resistance to antimicrobial therapy. Methods: A prospective study was performed on 120 patients diagnosed with both type 2 diabetes mellitus and infected diabetic foot ulcers. The study was carried out from July 2012 to December 2013 in Hospital General de Mexico. The samples were cultured in blood agar, mannitol salt agar, and MacConkey agar media, and incubated at 37°C in aerobic conditions. Results: We describe the first known cases of diabetic foot infections caused by MRSA-SCVs in patients diagnosed with type 2 diabetes mellitus and infected diabetic foot ulcers. In all of our cases, the patients had not received any form of gentamicin therapy. Conclusions: The antibiotic therapy commonly used in diabetic patients with infected diabetic foot ulcers fails in the case of MRSA-SCVs because the intracellular location protects S. aureus-SCVs from the host's defenses and also helps them resist antibiotics. The cases studied in this article add to the spectrum of persistent and relapsing infections attributed to MRSA-SCVs and emphasizes that these variants may also play a relevant role in diabetic foot infections.

  14. Mortality from nonulcer bleeding is similar to that of ulcer bleeding in high-risk patients with nonvariceal hemorrhage: a prospective database study in Italy.

    Science.gov (United States)

    Marmo, Riccardo; Del Piano, Mario; Rotondano, Gianluca; Koch, Maurizio; Bianco, Maria Antonia; Zambelli, Alessandro; Di Matteo, Giovanni; Grossi, Enzo; Cipolletta, Livio; Prometeo Investigators

    2012-02-01

    Nonulcer causes of bleeding are often regarded as minor, ie, associated with a lower risk of mortality. To assess the risk of death from nonulcer causes of upper GI bleeding (UGIB). Secondary analysis of prospectively collected data from 3 national databases. Community and teaching hospitals. Consecutive patients admitted for acute nonvariceal UGIB. Early endoscopy, medical and endoscopic treatment as appropriate. Thirty-day mortality, recurrent bleeding, and need for surgery. A total of 3207 patients (65.8% male), mean (standard deviation) age 68.3 (16.4) years, were analyzed. Overall mortality was 4.45% (143 patients). According to the source of bleeding, mortality was 9.8% for neoplasia, 4.8% for Mallory-Weiss tears, 4.8% for vascular lesions, 4.4% for gastroduodenal erosions, 4.4% for duodenal ulcer, and 3.1% for gastric ulcer. Frequency of death was not different among benign endoscopic diagnoses (overall P = .567). Risk of death was significantly higher in patients with neoplasia compared with benign conditions (odds ratio 2.50; 95% CI, 1.32-4.46; P bleeding peptic ulcers in the clinical context of a high-risk patient. Copyright © 2012 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  15. La efectividad de los ácidos grasos hiperoxigenados en el cuidado de la piel perilesional, la prevención de las úlceras por presión, vasculares y de pie diabético The effectiveness of hyperoxygenated fatty acids in the care of skin perilesional, the prevention of the pressure ulcers, vascular ulcers and diabetic foot

    Directory of Open Access Journals (Sweden)

    F. Martínez Cuervo

    2009-03-01

    members, in the diabetic foot and the wound care of the perilesional ulcer. The hyperoxygenated fatty acids are an optimal therapeutic option that should form a part of the clinical protocols of action of nursery in the prevention of the chronic ulcers and in the wound care of the perilesional ulcer.

  16. Comparison of the Otto Bock solid ankle cushion heel foot with wooden keel to the low-cost CR-Equipements™ solid ankle cushion heel foot with polypropylene keel: A randomized prospective double-blind crossover study assessing patient satisfaction and energy expenditure.

    Science.gov (United States)

    Lacraz, Alain; Armand, Stéphane; Turcot, Katia; Carmona, Gorki; Stern, Richard; Borens, Olivier; Assal, Mathieu

    2017-06-01

    The International Committee of the Red Cross supports a worldwide program of prosthetic fitting and rehabilitation. In this context, a prosthetic foot was developed and widely distributed in least developed countries. Prospective, randomized, double-blind, controlled study. To compare patient satisfaction and energy expenditure during ambulation between a low-cost prosthetic foot designed with a polypropylene keel (CR-Equipements ™ solid ankle cushion heel, International Committee of the Red Cross) to a well-recognized solid ankle cushion heel foot with a wooden keel (solid ankle cushion heel foot, Otto Bock). A total of 15 participants with unilateral transtibial amputation were evaluated using the two prosthetic feet in a randomized prospective double-blind crossover study. Main outcomes were patient satisfaction questionnaires (Satisfaction with Prosthesis Questionnaire and prosthetic foot satisfaction) and energy expenditure (oxygen consumption-mL/kg/min, oxygen cost-mL/kg/m, and heart rate-bpm). There were no significant differences between the two prosthetic feet for satisfaction and energy expenditure. The low-cost solid ankle cushion heel foot with polypropylene keel provides comparable satisfaction and similar energy expenditure as the solid ankle cushion heel foot with wooden keel. Clinical relevance The results of this study support the application and widespread use of the CR-Equipements ™ solid ankle cushion heel foot. From a cost-effectiveness standpoint, patients are well satisfied and exhibit similar outcomes at a substantially lower cost.

  17. Imaging of Charcot foot

    International Nuclear Information System (INIS)

    Erlemann, Rainer; Schmitz, Annette

    2014-01-01

    The onset of a Charcot foot ist a feared complication of a long lasting diabetes mellitus. A peripheral neuropathy and continuous weight bearing of the foot subsequent to repeated traumas depict the conditions. There exist three types of a Charcot foot, an atrophic, a hypertophic and a mixed type. In early stages a differentiation from osteoarthritis is difficult. Subluxation or luxation within the Lisfranc's joint is typical. The joints of the foot could rapidly and extensively be destroyed or may present the morphology of a 'superosteoarthritis'. Often, soft tissue infections or osteomyelitis evolve from ulcers of the skin as entry points. Diagnosis of osteomyelitis necessitate MR imaging as plain radiography offers only low sensitivity for detection of an osteomyelitis. The existence of periosteal reactions is not a proof for osteomyelitis. Bone marrow edema and soft tissue edema also appear in a non infected Charcot foot. The range of soft tissue infections goes from cellulitis over phlegmon to abscesses. The ghost sign is the most suitable diagnostic criterion for osteomyelitis. In addition, the penumbra sign or the existence of a sinus tract between a skin ulcer and the affected bone may be helpful. (orig.)

  18. Towards surface analysis on diabetic feet soles to predict ulcerations using photometric stereo

    NARCIS (Netherlands)

    Liu, C.; van der Heijden, Ferdinand; van Netten, Jaap J.; Vo-Dinh, Tuan; Mahadevan-Jansen, Anita; Grundfest, Warren

    2012-01-01

    Diabetic foot ulceration is a major complication for patients with diabetes mellitus. Approximately 15% to 25% of patients with Type I and Type II diabetes eventually develop feet ulcers. If not adequately treated, these ulcers may lead to foot infection, and ultimately to total (or partial) lower

  19. [Comparison between Endoscopic Therapy and Medical Therapy in Peptic Ulcer Patients with Adherent Clot: A Multicenter Prospective Observational Cohort Study].

    Science.gov (United States)

    Kim, Si Hye; Jung, Jin Tae; Kwon, Joong Goo; Kim, Eun Young; Lee, Dong Wook; Jeon, Seong Woo; Park, Kyung Sik; Lee, Si Hyung; Park, Jeong Bae; Ha, Chang Yoon; Park, Youn Sun

    2015-08-01

    The optimal management of bleeding peptic ulcer with adherent clot remains controversial. The purpose of this study was to compare clinical outcome between endoscopic therapy and medical therapy. We also evaluated the risk factors of rebleeding in Forrest type IIB peptic ulcer. Upper gastrointestinal (UGI) bleeding registry data from 8 hospitals in Korea between February 2011 and December 2013 were reviewed and categorized according to the Forrest classification. Patients with acute UGI bleeding from peptic ulcer with adherent clots were enrolled. Among a total of 1,101 patients diagnosed with peptic ulcer bleeding, 126 bleedings (11.4%) were classified as Forrest type IIB. Of the 126 patients with adherent clots, 84 (66.7%) received endoscopic therapy and 42 (33.3%) were managed with medical therapy alone. The baseline characteristics of patients in two groups were similar except for higher Glasgow Blatchford Score and pre-endoscopic Rockall score in medical therapy group. Bleeding related mortality (1.2% vs.10%; p=0.018) and all cause mortality (3.7% vs. 20.0%; p=0.005) were significantly lower in the endoscopic therapy group. However, there was no difference between endoscopic therapy and medical therapy regarding rebleeding (7.1% vs. 9.5%; p=0.641). In multivariate analysis, independent risk factors of rebleeding were previous medication with aspirin and/or NSAID (OR, 13.1; p=0.025). In patients with Forrest type IIB peptic ulcer bleeding, endoscopic therapy was associated with a significant reduction in bleeding related mortality and all cause mortality compared with medical therapy alone. Important risk factor of rebleeding was use of aspirin and/or NSAID.

  20. Prevalence and risk factors of diabetes mellitus foot syndrome ...

    African Journals Online (AJOL)

    Background: Diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and thesociety. Diabetic foot ulcers are largely preventable by identifying people at risk of ulceration throughexamination of the feet, education and frequent follow-up of these ...

  1. Clinico-microbiological Profile of Septic Diabetic Foot with Special Reference to Anaerobic Infection.

    Science.gov (United States)

    Sasikumar, K; Vijayakumar, Chellappa; Jagdish, Sadasivan; Kadambari, Dharanipragada; Raj Kumar, Nagarajan; Biswas, Rakhi; Parija, Subhash Chandra

    2018-03-01

    Introduction Diabetic foot infections are a major cause of non-traumatic amputations. The role of anaerobes in the prognosis of these infections is particularly unclear. This study was conducted with the aim of correlating microbiological profiles with clinical outcomes in these diabetic foot ulcer patients. Methodology This prospective observational study was done in a tertiary care centre in South India. All patients admitted with diabetic foot ulcers for two years were included in the study. Tissue biopsies were collected from the ulcer for aerobic and anaerobic cultures. The patients were grouped as those with aerobic infection alone (anaerobe negative) and those with mixed aerobic and anaerobic infections (anaerobe positive). Anaerobic culture was performed using the Robertson cooked meat (RCM) medium. The ulcer of the foot was described with respect to site, size, duration, history of previous amputation(s), and history of number and class of antibiotic intake prior to hospitalization. Clinical course and Wagner's grades of the diabetic foot ulcers were compared for aerobic and anaerobic infections. Results A total of 104 patients were included in the study. There were no significant differences between the two groups with regards to duration of diabetes, random blood sugar (RBS) at the time of admission, compliance to drugs, and mode of blood sugar control and prior intake of antibiotics. Patients with anaerobic infections were found to have a higher incidence of fever in this study (38.1% vs. 14.5%; p = 0.0057), as compared to patients with aerobic infections. More than half of the patients in the anaerobic infection group presented with Wagner's grade IV and above, as compared to the aerobic infection group (59.5% vs. 32.2%; p = 0.0059), which was statistically significant. Patients with anaerobic infections also had high numbers of major and minor amputations when compared to patients with aerobic infections. Conclusion Septic diabetic foot patients with

  2. Using the Oxford Foot Model to determine the association between objective measures of foot function and results of the AOFAS Ankle-Hindfoot Scale and the Foot Function Index: a prospective gait analysis study in Germany.

    Science.gov (United States)

    Kostuj, Tanja; Stief, Felix; Hartmann, Kirsten Anna; Schaper, Katharina; Arabmotlagh, Mohammad; Baums, Mike H; Meurer, Andrea; Krummenauer, Frank; Lieske, Sebastian

    2018-04-05

    After cross-cultural adaption for the German translation of the Ankle-Hindfoot Scale of the American Orthopaedic Foot and Ankle Society (AOFAS-AHS) and agreement analysis with the Foot Function Index (FFI-D), the following gait analysis study using the Oxford Foot Model (OFM) was carried out to show which of the two scores better correlates with objective gait dysfunction. Results of the AOFAS-AHS and FFI-D, as well as data from three-dimensional gait analysis were collected from 20 patients with mild to severe ankle and hindfoot pathologies.Kinematic and kinetic gait data were correlated with the results of the total AOFAS scale and FFI-D as well as the results of those items representing hindfoot function in the AOFAS-AHS assessment. With respect to the foot disorders in our patients (osteoarthritis and prearthritic conditions), we correlated the total range of motion (ROM) in the ankle and subtalar joints as identified by the OFM with values identified during clinical examination 'translated' into score values. Furthermore, reduced walking speed, reduced step length and reduced maximum ankle power generation during push-off were taken into account and correlated to gait abnormalities described in the scores. An analysis of correlations with CIs between the FFI-D and the AOFAS-AHS items and the gait parameters was performed by means of the Jonckheere-Terpstra test; furthermore, exploratory factor analysis was applied to identify common information structures and thereby redundancy in the FFI-D and the AOFAS-AHS items. Objective findings for hindfoot disorders, namely a reduced ROM, in the ankle and subtalar joints, respectively, as well as reduced ankle power generation during push-off, showed a better correlation with the AOFAS-AHS total score-as well as AOFAS-AHS items representing ROM in the ankle, subtalar joints and gait function-compared with the FFI-D score.Factor analysis, however, could not identify FFI-D items consistently related to these three

  3. Foot Complications in a Representative Australian Inpatient Population

    Directory of Open Access Journals (Sweden)

    Peter A. Lazzarini

    2017-01-01

    Full Text Available We investigated the prevalence and factors independently associated with foot complications in a representative inpatient population (adults admitted for any reason with and without diabetes. We analysed data from the Foot disease in inpatients study, a sample of 733 representative inpatients. Previous amputation, previous foot ulceration, peripheral arterial disease (PAD, peripheral neuropathy (PN, and foot deformity were the foot complications assessed. Sociodemographic, medical, and foot treatment history were collected. Overall, 46.0% had a foot complication with 23.9% having multiple; those with diabetes had higher prevalence of foot complications than those without diabetes (p<0.01. Previous amputation (4.1% was independently associated with previous foot ulceration, foot deformity, cerebrovascular accident, and past surgeon treatment (p<0.01. Previous foot ulceration (9.8% was associated with PN, PAD, past podiatry, and past nurse treatment (p<0.02. PAD (21.0% was associated with older age, males, indigenous people, cancer, PN, and past surgeon treatment (p<0.02. PN (22.0% was associated with older age, diabetes, mobility impairment, and PAD (p<0.05. Foot deformity (22.4% was associated with older age, mobility impairment, past podiatry treatment, and PN (p<0.01. Nearly half of all inpatients had a foot complication. Those with foot complications were older, male, indigenous, had diabetes, cerebrovascular accident, mobility impairment, and other foot complications or past foot treatment.

  4. Diabetic foot and PAD: the endovascular approach

    NARCIS (Netherlands)

    Reekers, J. A.; Lammer, J.

    2012-01-01

    Diabetic foot ulceration (DFU) is recognized as one of the most serious complications of diabetes. Active revascularisation plays a crucial role in achieving ulcer healing. Non-surgical, minimally invasive, revascularisation options for DFU have expanded over the last decade and have become a

  5. Health-related quality of life and self-esteem in patients with diabetic foot ulcers: results of a cross-sectional comparative study.

    Science.gov (United States)

    de Meneses, Luiz Carlos; Blanes, Leila; Francescato Veiga, Daniela; Carvalho Gomes, Heitor; Masako Ferreira, Lydia

    2011-03-01

    To evaluate health-related quality of life (HRQoL) and self-esteem in patients with diabetic foot ulcers (DFUs), a cross-sectional, comparative study was conducted among 35 consecutive patients with diabetes mellitus (DM) attending outpatient clinics in Pouso Alegre, Brazil. Fifteen (15) patients with and 20 without a DFU participated in the study. Demographic variables were obtained and HRQoL and self-esteem were assessed using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and Rosenberg Self-Esteem Scale. In both groups, 80% of patients were women. Average age did not differ significantly between the DFU and control groups (average 56 [SD 8.42] and 52 years [SD 6.68], respectively) but disease duration was significantly longer (P Self-esteem scores were similar in both groups. The results of this study confirm that patient HRQoL is negatively affected by the presence of a DFU. Wound prevention programs for patients with DM may help reduce the scope of this problem while DFU treatment programs that include psychological support may improve patient QoL.

  6. A Prospective Study of Venous Thromboembolic Prophylaxis Using Foot Pumps Following Total Knee Replacement in a Chinese Population

    Directory of Open Access Journals (Sweden)

    Yiu-Chung Wong

    2013-06-01

    Conclusion: The rate of proximal DVT after TKR was low (4.5% without pharmacological prophylaxis. We advise against the use of pharmacological prophylaxis in Chinese population for TKRs because of the low risk of proximal DVT and its possible bleeding complications. Foot pump did not lower the rate of DVTfurther, and its use for DVT prophylaxis in TKR is not necessary.

  7. Preventing Diabetic Foot Complications : Strategic Recommendations

    African Journals Online (AJOL)

    The diabetic foot is the commonest cause of non-traumatic lower extremity amputation in the developed and developing nations. Several risk factors predispose the diabetic patient to foot ulceration and peripheral neuropathy, with peripheral vascular disease are the commonest risk factors. Clinical examination for these risk ...

  8. Clinical Efficacy and Safety of Oral Qing-Dai in Patients with Ulcerative Colitis: A Single-Center Open-Label Prospective Study.

    Science.gov (United States)

    Sugimoto, Shinya; Naganuma, Makoto; Kiyohara, Hiroki; Arai, Mari; Ono, Keiko; Mori, Kiyoto; Saigusa, Keiichiro; Nanki, Kosaku; Takeshita, Kozue; Takeshita, Tatsuya; Mutaguchi, Makoto; Mizuno, Shinta; Bessho, Rieko; Nakazato, Yoshihiro; Hisamatsu, Tadakazu; Inoue, Nagamu; Ogata, Haruhiko; Iwao, Yasushi; Kanai, Takanori

    2016-01-01

    Chinese herbal medicine Qing-Dai (also known as indigo naturalis) has been used to treat various inflammatory conditions. However, not much has been studied about the use of oral Qing-Dai in the treatment for ulcerative colitis (UC) patients. Studies exploring alternative treatments for UC are of considerable interest. In this study, we aimed at prospectively evaluating the safety and efficacy of Qing-Dai for UC patients. The open-label, prospective pilot study was conducted at Keio University Hospital. A total of 20 patients with moderate UC activity were enrolled. Oral Qing-Dai in capsule form was taken twice a day (daily dose, 2 g) for 8 weeks. At week 8, the rates of clinical response, clinical remission, and mucosal healing were 72, 33, and 61%, respectively. The clinical and endoscopic scores, CRP levels, and fecal occult blood results were also significantly improved. We observed 2 patients with mild liver dysfunction; 1 patient discontinued due to infectious colitis and 1 patient discontinued due to mild nausea. This is the first prospective study indicating that oral Qing-Dai is effective for inducing remission in patients with moderate UC activity and can be tolerated. Thus, Qing-Dai may be considered an alternative treatment for patients, although further investigation is warranted. © 2016 S. Karger AG, Basel.

  9. Location-dependent depth and undermining formation of pressure ulcers.

    Science.gov (United States)

    Takahashi, Yoshiko; Isogai, Zenzo; Mizokami, Fumihiro; Furuta, Katsunori; Nemoto, Tetsuya; Kanoh, Hiroyuki; Yoneda, Masahiko

    2013-08-01

    We examined the location-specific properties of pressure ulcers, focusing on depth and undermining formation, which are often unfavorable factors for ulcer healing. We conducted a retrospective observational study of 2 independent databases on pressure ulcers. Databases from a 200-bed hospital (database A) and a 300-bed hospital (database B) were collected during different time periods. Relationships between ulcer location, ulcer depth, and undermining formation were analyzed. All pressure ulcers were accurately diagnosed and classified according to their locations. A total of 282 pressure ulcers in 189 patients from database A and 232 pressure ulcers in 154 patients from database B were analyzed. It was found that pressure ulcers primarily developed over the sacrum. Ratio of stages III and IV pressure ulcers was high in pressure ulcers of the foot, ankle, and crus on the lower leg. Among the deep pressure ulcers, undermining formation was frequently observed on the greater trochanter, ilium, and sacrum. In contrast, pressure ulcers of the foot, ankle, and crus did not exhibit undermining formation. Our results revealed marked differences in pressure ulcer properties depending on their location. Factors affecting depth and undermining of pressure ulcers appear to be related to anatomical and physical properties of the bone and subcutaneous tissue. Copyright © 2013 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.

  10. Education for diabetic foot

    Directory of Open Access Journals (Sweden)

    Fabio Batista

    2009-03-01

    Full Text Available Objective: The purpose of this investigation was to stratify the risk in a consecutive group of diabetic patients presenting, for the first time, in a diabetic foot clinic. Additional aims were to investigate the preventive measures in the local health system and to evaluate the level of patient’s awareness about diabetic foot-associated morbidity. Methods: Fifty consecutive adult diabetic patients referred to a Diabetic Foot Clinic of a Municipal Public Hospital comprised the sample for this observational study. The enrollment visit was considered as the first health-system intervention for potential foot morbidity. The average time elapsed since a diagnosis of diabetes among patients was five years. Rresults: At the time of presentation, 94% of sample was not using appropriate footwear. Pedal pulses (dorsalis pedis and/or posterior tibial arteries were palpable in 76% of patients. Thirty subjects (60% had signs of peripheral neuropathy. Twenty-one subjects (42% had clinical deformity. There was a positive correlation between a history of foot ulcer, the presence of peripheral neuropathy, and the presence of foot deformity (p < 0.004 in each correlation. Cconclusions: Informing and educating the patients and those interested in this subject and these problems is essential for favorable outcomes in this scenario.

  11. Handcrafted Vacuum-Assisted Device for Skin Ulcers Treatment Versus Traditional Therapy, Randomized Controlled Trial.

    Science.gov (United States)

    Gonzalez, Israel Gonzalez; Angel, Medina Andrade Luis; Baez, Maria Valeria Jimenez; Ruiz Flores, Brenda; de Los Angeles Martinez Ferretiz, Maria; Woolf, Stephanny Vanestty; López, Israel; Sandoval-Jurado, Luis; Pat-Espadas, Fany Guadalupe; Cruz, Alan Alejandro Reyes; Delgado, Arsenio Torres

    2017-02-01

    Chronic lower limb ulcers constitute a public health problem, with important socioeconomic implications and high attention cost. This trial evaluates handcrafted vacuum-assisted therapy versus traditional treatment effectiveness for lower limbs ulcers. It was a prospective randomized clinical trial conducted over 144 patients with lower limbs ulcers. Patients were randomized into two groups of 72 patients: Experimental group were treated with debridement, cure and a handcrafted vacuum-assisted device that was changed every 72 h. Control group was treated with debridement and cure with soap every 24 h. Ulcers were evaluated every 72 h and on 10th day. The presence of systemic inflammatory response, pain, granulation tissue and viability for discharge was registered and analyzed . After exclusion of 18 patients, 126 were included, 65.1% were men with an average of 58 years. Sole region ulcer by diabetic foot was the more frequent in both groups (73%). Leukocytes count, systemic inflammatory response and pain were significantly lower in experimental group (p ulcers. This system would benefit patients favoring earlier infection control, faster granulation tissue appearance and earlier discharge. Clinical trials registered in https://www.clinicaltrials.gov/ Number NCT02512159.

  12. Peptic Ulcer

    Science.gov (United States)

    A peptic ulcer is a sore in the lining of your stomach or your duodenum, the first part of your ... Comes and goes for several days or weeks Peptic ulcers happen when the acids that help you digest ...

  13. Stomach ulcer

    Science.gov (United States)

    ... erode the stomach wall. A major cause of stomach ulcers is the bacteria called Helicobacter pylori . Treatment regimens for ulcers caused this bacterium usually include medications to suppress the stomach acid as well as antibiotics to eradicate the ...

  14. A prospective case series evaluating the safety and efficacy of the Klox BioPhotonic System in venous leg ulcers

    Directory of Open Access Journals (Sweden)

    Nikolis A

    2016-09-01

    Full Text Available Andreas Nikolis,1 Doria Grimard,2 Yves Pesant,3 Giovanni Scapagnini,4 Denis Vézina5 1Division of Plastic Surgery, Victoria Park Research Centre, Montreal, 2Q&T Research Chicoutimi, Chicoutimi, 3St-Jerome Medical Research Inc., St-Jerome, Quebec, Canada; 4Department of Medicine and Health Sciences, School of Medicine, University of Molise, Campobasso, Italy; 5Klox Technologies, Laval, Quebec, Canada Purpose: To investigate the safety and efficacy of the BioPhotonic System developed by Klox Technologies in a case series of ten patients with venous leg ulcers.Patients and methods: Ten patients with chronic venous leg ulcers, having failed on at least one previous therapy, were enrolled into this case series.Results: Nine patients were evaluable for efficacy. A response (defined as decrease in wound surface area was observed in seven patients (77.8%. Of these, four patients (44.4% achieved wound closure on average 4 months (127.5 days following the beginning of the treatment. Two patients did not respond to the investigational treatment. Quality of life improved over time throughout the study. Compliance was excellent, with 93.2% of visits completed as per protocol. Safety was unremarkable, with only four treatment-emergent-related adverse events, for which no specific intervention was required.Conclusion: The BioPhotonic System was shown to be safe and extremely well tolerated. It also demonstrated potential in terms of wound closure, wound surface area decrease, and wound bed preparation. Keywords: biophotonics, light, photobiomodulation, venous leg ulcers

  15. A study of dynamic foot pressure measurement in diabetic patients

    Directory of Open Access Journals (Sweden)

    Milka D Madhale

    2017-01-01

    Full Text Available Introduction: Diabetic foot ulcer is a major source of morbidity and a leading cause of hospitalization. It is estimated that approximately 20% of hospital admissions among patients with diabetes mellitus are due to diabetic foot ulcer. It can lead to infection, gangrene, amputation, and even death if appropriate care is not provided. Overall, the lower limb amputation in diabetic patients is 15 times higher than in non-diabetics. In the majority of cases, the cause for the foot ulcer is the altered architecture of the foot due to neuropathy resulting in abnormal pressure points on the soles. Purpose: The aim of this study is to develop low cost, lightweight foot pressure scanner and check its reliability and validity which can help to prevent foot ulceration. Design/Methodology/Approach: In the present study, a low cost, lightweight foot pressure scanner is developed, and dynamic plantar pressures in a group of 110 Indian patients with diabetes with or without neuropathy and foot ulcers are measured. Practical Implications: If these pressure points can be detected, ulcers can be prevented by providing offloading footwear. Originality/Value: Differences are found in dynamic foot pressures in different study groups, namely, diabetic patients, patients with diabetic peripheral neuropathy, patients with foot ulcers, and nondiabetics. The differences are significant (P < 0.01, which showed the validity of the tool. Reliability and consistency of the tool was checked by test–retest method. Paper Type: Original Research work. Conclusion: Based on the results of the present study, it is concluded that the scanner