to the Problem of Diagnostics, Statistics and Standardisation Pavel Lukin, Alex G Kuchumov, Mikhail F Zarivchatskiy, Tatyana Kravtsova
Peripheral artery disease (PAD) stems from atherosclerosis of lower extremity arteries with resultant arterial narrowing or occlusion. The most severe form of PAD is termed chronic limb-threatening ischemia and carries a significant risk of limb loss and cardiovascular mortality. Diabetes mellitus is known to increase the incidence of PAD, accelerate disease progression, and increase disease severity. Patients with concomitant diabetes mellitus and PAD are at high risk for major complications, such as amputation. Despite a decrease in the overall number of amputations performed annually in the United States, amputation rates among those with both diabetes mellitus and PAD have remained stable or even increased in high-risk subgroups. Within this cohort, there is significant regional, racial/ethnic, and socioeconomic variation in amputation risk. Specifically, residents of rural areas, African-American and Native American patients, and those of low socioeconomic status carry the highest risk of amputation … read more
Diabetes mellitus is one of the most widespread metabolic diseases in the world, and diabetic foot ulcer (DFU), as one of its chronic complications, not only causes a large amount of physiological and psychological pain to patients but also places a tremendous burden on the entire economy and society. Despite significant advances in knowledge on the mechanism and in the treatment of DFU, clinical practice is still not satisfactory, and our understanding of its cellular and molecular pathogenesis is far from complete. Fortunately, progress in studying the roles of long non-coding RNAs (lncRNAs), which play important regulatory roles in the expression of genes at multiple levels, suggests that we can apply them in the early diagnosis and potential targeted intervention of DFU. In this review, we briefly summarize the current knowledge regarding the functional roles and potential mechanisms of reported lncRNAs in regulating DFU … read more
a cross-sectional observational study
Purpose: Foot fissure should be prevented in patients with diabetes due to the likelihood of subsequent diabetic ulcer. The purpose of this study was to investigate a cutoff point for skin hydration with fissure and the factors associated with low skin hydration in patients with diabetes.
Subjects and methods: Subjects were patients with diabetes who visited the diabetic foot clinic and were evaluated for skin hydration on the heel between April 2008 and March 2015. Information about fissure, skin hydration, age, sex, autonomic neuropathy, angiopathy, and tinea pedis were collected from the medical charts. Skin hydration on the heel was measured using a moisture checker. Skin hydration was compared between heels with and without fissure, and a cutoff for skin hydration with fissure was determined using receiver operating characteristic analysis. Based on the determined cutoff, factors associated with lower skin hydration were analyzed using logistic regression analysis.
Results: Participants comprised 693 patients. Mean±SD age was 66.8±10.8 years, and 57.0% of subjects were male. The frequency of fissures on the heels was 10.4%. Area under the receiver operating characteristic curve for skin hydration in the presence of fissure was 0.717. Twenty percent was selected as the cutoff point, offering sensitivity of 0.478 and specificity of 0.819. Logistic regression analysis showed correlations between three factors (male sex, tinea pedis, and room temperature) and skin hydration <20.0% (odds ratio [OR] 1.587, 95% CI 1.157–2.178, p=0.004; OR 1.548, 95% CI 1.122–2.135, p=0.005; and OR 0.900, 95% CI 0.823–0.0985, p=0.021, respectively).
Conclusion: To prevent heel fissures, moisturizing care should aim at achieving skin hydration of 20%. If skin hydration is <20%, prevention of fissures may warrant not only specialized moisturizing care but also consideration of treatment for tinea pedis.
Frontiers in Diabetes, Vol. 26
In recent years, “diabetic foot” has become the common name given to chronic complications of diabetes mellitus in the lower limb. This book provides an up-to-date picture of the clinical scenario, the latest understanding of the mechanisms in regard to pathology, the current standards of therapy, and the organizational tasks that a modern approach to such a complex pathology warrants. All contributors have delivered articles that are as informative and straight-to-the point as possible, including not only their own experience in the field, but also giving a wider picture to link each article to the other. The Diabetic Foot Syndrome is not only relevant to specialists, but also to all the caregivers involved in the management of the patients at risk for developing the pathology, those affected, and those who are at risk of recurrences.
Review: Lower Extremity Amputation and Reamputation Predictors in Patients with Diabetic Foot Wounds
A major concern in managing patients with diabetes is their susceptibility to acquiring ulcers in their feet. If these patients are not careful, these ulcers may become infected and eventually lead to additional sequelae, ending in lower extremity amputation. The focus of this study was to determine the major factors of lower extremity amputation in the diabetic foot, in hopes that clinicians may be able to reduce the rate of amputations more effectively.
The authors performed a retrospective review of the records of 132 consecutive patients who had already received a lower extremity amputation or reamputation as a result of diabetic wounds. All patients had been diagnosed with diabetes mellitus type 2, and demographic and clinical data were collected on all of them. These data included age, sex, cigarette smoking history, duration of diabetes, diabetic comorbidities (nephropathy, neuropathy), general comorbidities (peripheral artery disease, hypertension, hyperlipidemia, malignancy), leukocytosis, wound infection status, and culture microorganism and antibiogram results. The side and level of amputation or reamputation were also recorded. Only those patients with wounds of a Wagner-Meggitt classification of 3 to 6 were included … read more