Complications Of Diabetic Foot Ulcers Research Articles

Hubungan Perilaku Perawatan Kaki Dengan Terjadinya Komplikasi Diabetic Foot Ulcer Pada Pasien DM Tipe 2 Di RSUD Pagelaran Cianjur Tahun 2023

Diabetes Mellitus is a chronic disease characterized by an increase in blood sugar levels, the cause of which is unhealthy lifestyle behavior, lack of physical activity and stress, which can cause various chronic complications. A complication that is often found in sufferes with type 2 diabetes melilitus is diabetic foot ulcers which are open wounds on the surface of the skin of the feet. A further impact of diabetic foot ulcers is amputation. Prevention that can be done for these complications is to have good foot care behavior. Objective: Tis study was to determine the relationship between foot care behavior and the event of complications of diabetic foot ulcers in RSUD Pagelaran Cianjur. Methods: This study used analytic descriptive quantitative method with Cross-sectional technique with 30 respondents. Results: Based on the results of the analysis using the Chi-square statistical test obtained p = 0,000 < α = 0,05 then Ha is accepted, which means there is a relationship between foot care behavior and the event of complications of diabetic foot ulcers in patients whit type 2 diabetes mellitus in RSUD Pagelaran Cianjur . Conclusion: That there are is a significant relationship between foot care behavior and the event of complications of diabetic foot ulcers in patients whit type 2 diabetes mellitus in RSUD Pagelaran Cianjur. Suggestion: It is hoped that good foot care behavioe will be maintained by patients with type 2 diabetes mellitus so that complications of diabetic foot ulcesr can be prevented

Limb Amputations in a Tertiary Care Hospital, North India: A Cross-sectional Epidemiological Study – Can We Prevent This?

Abstract Background: Disability due to limb amputations is a major but preventable public health problem that is associated with profound economic, social, and psychological effects on the patients and their families, especially in developing countries where the supportive (prosthetic) services are meager or almost absent. The purpose of this study was to outline the patterns and indications for limb amputations in a tertiary care center of northern India and to compare our experience with that of other published data. Materials and Methods: This was an observational study conducted at a tertiary care hospital in northern India. All the patients who underwent limb amputations at this hospital between January 2018 and April 2020 were included in the study. Results: A total of 37 patients underwent various amputations during the study period. The age group ranged between 12 and 80 years (mean of 54.9 years) and the most effected age group was between 50 and 60 years (45%). Males outnumbered females with a ratio of 4:1. When the pattern of amputations was studied, 34 were lower limb amputations and 3 were upper limb amputations. On subcategorization, 45% underwent below-knee amputations followed by above-knee amputations (29%). Diabetes mellitus was the most common cause, followed by trauma and peripheral arterial disease. Conclusion: Complications of diabetic foot ulcers and trauma resulting from road traffic accidents were the most common indications for major limb amputation in our study. Implementation of comprehensive care for diabetes by multidisciplinary approach via diabetic clinics at all the hospitals can help in reducing the complications of diabetes thus reducing the disability due to amputations. Road traffic accidents can also be reduced or prevented by implementing stricter laws and increasing the social awareness.

Whole genome sequencing and pan-genome analysis of Staphylococcus/Mammaliicoccus spp. isolated from diabetic foot ulcers and contralateral healthy skin of Algerian patients

BackgroundDiabetic foot infections (DFIs) are the most common complications of diabetic foot ulcers (DFUs), and a significant cause of lower extremity amputation. In this study we used whole genome sequencing to characterize the clonal composition, virulence and resistance genetic determinants of 58 Staphylococcus/Mammaliicoccus spp. isolates from contralateral healthy skin and DFU from 44 hospitalized patients.ResultsS. aureus (n = 32) and S. epidermidis (n = 10) isolates were recovered from both DFUs and healthy skin, whereas, S. haemolyticus (n = 8), M. sciuri (n = 1), S. hominis (n = 1) and S. simulans (n = 3) were recovered exclusively from healthy skin. In contrast, S. caprae (n = 2) and S. saprophyticus (n = 1) were recovered only from DFUs. Among S. aureus isolates, MRSA were present with high prevalence (27/32, 84.4%), 18 of which (66.7%) were from DFUs and 9 (33.3%) from healthy skin. In contrast, the coagulase-negative Staphylococcus (CoNS)/Mammaliicoccus isolates (n = 26), in particular S. epidermidis and S. haemolyticus were more prevalent in healthy skin, (10/26, 38.5%) and (8/26, 30.8%), respectively. MLST, spa and SCCmec typing classified the 32 S. aureus isolates into 6 STs, ST672, ST80, ST241, ST1, ST97, ST291 and 4 unknown STs (STNF); 8 spa types, t044, t037, t3841, t1247, t127, t639, t937 and t9432 and 2 SCCmec types, type IV and type III(A). Among CoNS, the S. epidermidis isolates belonged to ST54, ST35 and ST640. S. haemolyticus belonged to ST3, ST25, ST29, ST1 and ST56. The sole M. sciuri isolate was found to carry an SCCmec type III(A). A wide range of virulence genes and antimicrobial resistance genes were found among our isolates, with varying distribution between species or STs. The pan-genome analysis revealed a highly clonal population of Staphylococcus isolates, particularly among S. aureus isolates. Interestingly, the majority of S. aureus isolates including MRSA, recovered from the healthy skin and DFUs of the same patient belonged to the same clone and exhibited similar virulence/resistance genotype.ConclusionsOur study provides clinically relevant information on the population profile, virulence and antibiotic resistance of Staphylococcus/Mammaliicoccus spp. in DFIs, which could serve as a basis for further studies on these as well as other groups of pathogens associated with DFIs.

BUERGER ALLEN EXERCISE ON THE RISK OF INJURY IN THE FEET OF DIABETES MELLITUS TYPE 2

Diabetes Mellitus is a chronic metabolic disease that requires medical care and self-management to prevent complications of diabetic ulcers. The Buerger Allen Exercise is a specific exercise that aims to increase circulation to the legs by using changes in gravity and using muscle contraction through active movements of the legs to increase circulation of peripheral blood vessels. The Inlow's 60-second Diabetic Foot Screen Tool is an indicator for assessing the risk of foot injuries. This study aims to determine the effect of Buerger Allen Exercise on the risk of foot injuries in patients with diabetes mellitus type 2 at Masbagik Health Center. The research design used a pre-experimental design with a one group pretest-posttest design. The sampling technique was purposive sampling with a sample of 18 respondents who met the inclusion criteria. Data analysis used univariate and bivariate analysis. The mean value of the risk of foot ulcers in diabetes mellitus respondents before the intervention was 9.00 with a standard deviation of 1.328 and after the intervention the mean value was 8.54 with a standard deviation of 1.286. The results of the Wilcoxon test show a p value: 0.000 which means that there is an effect of Buerger Allen Exercise on the risk of foot injuries in patients with diabetes mellitus type 2 and is hoped that the Buerger Allen Exercise intervention can be applied as an effort to prevent complications of diabetic foot ulcers in patients with DM type 2.
 
 Keywords: Diabetes Mellitus; Buerger Allen Exercise; Foot Wound Risk

Successful Outpatient Treatment of Severe Diabetic-Foot Myositis and Osteomyelitis Caused by Extensively Drug-Resistant Enterococcus faecalis with Teicoplanin plus Rifampicin: A Case Report.

BACKGROUND Foot ulcers are high-morbidity and debilitating complications of diabetes mellitus, and carry significantly increased rates of associated major amputations. They contribute to significantly worse quality of life. Osteomyelitis is a frequent complication of diabetic foot ulcers, since bacteria can contiguously spread from soft tissues to the bone, involving the cortex first and then the bone marrow. Unfortunately, clinically unsuspected osteomyelitis is frequent in persisting diabetic foot ulcers. It is associated with limb amputations and increased mortality. CASE REPORT We describe a 76-year-old man with long-standing insulin-treated type 2 diabetes, who experienced extensively drug-resistant Enterococcus faecalis diabetic foot myositis and osteomyelitis associated with sepsis. He was successfully treated with surgical debridement combined with the administration of teicoplanin plus rifampicin in the outpatient setting, completing, in total, a twelve-week course of antibiotic therapy. CONCLUSIONS Clinically unsuspected osteomyelitis in patients with persisting diabetic foot ulcers has been associated with infections from highly resistant bacteria. Early and accurate diagnosis of diabetic foot osteomyelitis, as well as proper therapeutic approach (antimicrobial and surgical), is of great importance to reduce the risk of minor and major amputations, septic shock leading to multiple organ failure, and overall mortality.

Risk factors for reamputation in patients with diabetic foot: A case-control study

BackgroundReamputation as a complication of diabetic foot ulcers presents a high economic burden and represents a therapeutic failure. It is paramount to identify as early as possible patients in whom a minor amputation may not be the best option. The purpose of this investigation was to do a case-controlled study to determine risk factors associated with re-amputation in patients with DFU (diabetic foot ulcers) at two University Hospitals. MethodsMulticentric, observational, retrospective, case-control study from clinical records of 2 university hospitals. Our study included 420 patients, with 171 cases (re-amputations), and 249 controls. We performed a multivariate logistic regression analysis and time-to-event survival analysis to identify re-amputation risk factors. ResultsStatistically significant risk factors were artery history of tobacco use (p = 0.001); male sex (p = 0.048); arterial occlusion in Doppler ultrasound (p = 0.001); percentage of stenosis in arterial ultrasound>50 % (p = 0.053); requirement of vascular intervention (p = 0.01); and microvascular involvement in photoplethysmography (p = 0.033). The most parsimonious regression model suggests that history of tobacco use, male sex, arterial occlusion in ultrasound, and percentage of stenosis in arterial ultrasound>50 % remained statistically significant. The survival analysis identified earlier amputations in patients with larger occlusion in arterial ultrasound, high leukocyte count, and elevated ESR. ConclusionDirect and surrogate outcomes in patients with diabetic foot ulcers identify vascular involvement as an important risk factor for reamputation. Level of evidenceIII

2-Octylcyclopentanone Inhibits Beta Lactam Resistant Diabetic Wound Pathogens.

Microbial infection is a frequent complication of diabetic foot ulcers, with up to 82% of ulcers being infected at the initial stage of diabetes. Furthermore, the emergence of beta lactam resistant pathogens managed to eliminate the use of beta lactam antibiotics as a chemotherapeutic alternative. This further increases the amputation and mortality rate. Hence, the aim of this study is to evaluate antimicrobial efficacy of a ketone derivative 2-octylcyclopentanone against diabetic wound pathogens. The inhibitory activity of the compound was determined using disc diffusion and broth microdilution assay. Generally, 2-octylcyclopentanone showed broad-spectrum antimicrobial activity, particularly against beta lactam resistant pathogens. The compound showed comparably better antimicrobial activity than all reference antibiotics, including chloramphenicol, streptomycin, ampicillin and penicillin. In addition, the same compound also inhibits a clinically isolated Pseudonomas aeruginosa that was resistant to all reference antibiotics. The activity was microbicidal based on the low minimal lethality concentration recorded, particularly on MRSA, P. aeruginosa and Candida utilis. The killing efficiency of the compound was concentration dependent. During kill curve analysis, the inhibitory activity of 2-octylcyclopentanone was concentration and time-dependent. 99.9% of reduction of bacterial growth was observed. MRSA and P. aeruginosa, two significant diabetic wound infections, are totally inhibited by the molecule at a concentration of minimum lethality concentration. In short, 2-octylcyclopentanone exhibited significant inhibitory towards wide range of diabetic wound pathogens. Which is considered crucial since it will provide a safe and effective alternative treatment for diabetic ulcer infection.

Exploring barriers and enablers of self-management behaviours in patients with diabetic foot ulcers: A qualitative study from the perceptions of patients, caregivers, and healthcare professionals in primary care.

Exploring barriers and enablers of self-management behaviours in patients with diabetic foot ulcers: A qualitative study from the perceptions of patients, caregivers, and healthcare professionals in primary care.

Diabetic Foot Complications: A Retrospective Cohort Study.

Diabetes mellitus is a highly prevalent disease globally and contributes to significant morbidity and mortality. As a consequence of multiple pathophysiologic changes which are associated with diabetes, these patients frequently suffer from foot-related disorders: infections, ulcerations, and gangrene. Approximately half of all amputations occur in diabetic individuals, usually as a complication of diabetic foot ulcers. In this retrospective study, we analyzed and characterized a cohort of 69 patients and their diabetes-related foot complications. The main characteristics of our cohort were as follows: older age at diagnosis (mean age 66); higher incidence of diabetes in males; predominantly urban patient population. The most frequent complications of the lower extremity were ulcerations and gangrene. Moreover, in our study, 35% of patients required surgical reintervention, and 27% suffered from complications, while 13% required ICU admission. However, diabetic foot lesions are preventable via simple interventions which pointedly reduce foot amputations. Early identification and the appropriate medical and surgical treatment of the complications associated with diabetic foot disease are important because they still remain common, complex and costly.

The Relationship of Obesity to Diabetic Foot Ulcer in Type 2 Diabetes Mellitus Patients

Diabetes mellitus is a group of metabolic diseases, the common finding of which is elevated blood glucose levels, known as hyperglycemia. Severe hyperglycemia causes classic symptoms such as polyuria, polydipsia, and polyphagia and unexplained weight loss. This study used an observational descriptive analytic method with a cross sectional design to 42 respondents of type 2 Diabetes mellitus patients at PKU Muhammadiyah Gamping Hospital. The blood sugar levels, HbA1C, height, weight and incidence of diabetic foot ulcers were recorded. Data analysis used the Chi-Square test to see the relationship between obesity and the incidence of diabetic foot ulcers in patients with type 2 diabetes mellitus. The results of the study on 42 respondents showed that there were 31 Diabetes mellitus patients with diabetic foot ulcers (73.8%) while 11 people (26.2%). There were 21 male patients (50%) and 21 female patients (50%). A total of study subjects with normal Body Mass Index had type 2 diabetes mellitus with complications of diabetic foot ulcers (77.8%.), 13 study subjects with overweight Body Mass Index experienced type 2 diabetes mellitus with complications of diabetic foot ulcers (61.9%.), 11 study subjects with Body Mass Index obese class 1 had type 2 diabetes mellitus with complications of diabetic foot ulcers (91.7%). In patients with type 2 diabetes mellitus without complications of diabetic foot ulcers with normal Body Mass Index, there were 2 people (22.8%.) In patients with type 2 diabetes mellitus without complications of diabetic foot ulcers with Body Mass Index overweight, there were 8 people (38.1%). Then in patients with type 2 diabetes mellitus without complications of diabetic foot ulcers with Body Mass Index obesity class 1 obtained 1 person (8.3%). The Chi-Square test was performed and the p value = 0.166. There is no significant relationship between obesity and the incidence of diabetic foot ulcers in patients with type 2 diabetes mellitus.

Ultrasonographic features of diabetic foot osteomyelitis: a case series.

Osteomyelitis is a limb-threatening complication of diabetic foot ulcers. Early identification of the disease is key to ensuring successful prognosis. In this study, we describe ultrasonographic features for the identification of osteomyelitis. Patients were screened through clinical, ultrasonographic and probe-to-bone tests. Ultrasonographic features in three patients that could be used to identify diabetic foot osteomyelitis included periosteal reaction, periosteal elevation, cortical erosions and presence of sequestrum, all of which were confirmed by a plain X-ray. An ultrasonographic examination could be used for the early detection of osteomyelitis, which could help clinicians devise prompt treatment strategies.

A Deep Learning Method for Early Detection of Diabetic Foot Using Decision Fusion and Thermal Images

Diabetes mellitus (DM) is one of the major diseases that cause death worldwide and lead to complications of diabetic foot ulcers (DFU). Improper and late handling of a diabetic foot patient can result in an amputation of the patient’s foot. Early detection of DFU symptoms can be observed using thermal imaging with a computer-assisted classifier. Previous study of DFU detection using thermal image only achieved 97% of accuracy, and it has to be improved. This article proposes a novel framework for DFU classification based on thermal imaging using deep neural networks and decision fusion. Here, decision fusion combines the classification result from a parallel classifier. We used the convolutional neural network (CNN) model of ShuffleNet and MobileNetV2 as the baseline classifier. In developing the classifier model, firstly, the MobileNetV2 and ShuffleNet were trained using plantar thermogram datasets. Then, the classification results of those two models were fused using a novel decision fusion method to increase the accuracy rate. The proposed framework achieved 100% accuracy in classifying the DFU thermal images in binary classes of positive and negative cases. The accuracy of the proposed Decision Fusion (DF) was increased by about 3.4% from baseline ShuffleNet and MobileNetV2. Overall, the proposed framework outperformed in classifying the images compared with the state-of-the-art deep learning and the traditional machine-learning-based classifier.

Predicting Amputation in Patients With Diabetic Foot Ulcers: A Systematic Review.

Foot ulcers are a leading cause of morbidity in diabetics. One of the known complications of diabetic foot ulcers is lower limb amputation which makes it a major socioeconomic problem. Currently, there’s a lack of knowledge on the predictors of amputations in diabetics with foot ulcers. We performed a systematic review of studies that identified risk factors of amputation in patients with diabetic foot ulcers. This systematic review aims to identify the predictors of amputation in order to optimize the management strategy and care plan. Medline database was searched and inclusion criteria were implemented for the selection of studies. The risk factors extracted were part of four categories: (i) history and physical examination, (ii) ulcer characteristics, (iii) lab results, and (iv) co-morbidities. The data extracted were in the form of odds ratios, 95% confidence intervals, and predictive values. The mean values with standard deviations of the included risk factors were recorded, and the incidence of risk factors among the amputation groups was identified or calculated when the data were sufficient. Seven articles were selected reporting on 3481 patients. This review identified peripheral arterial disease, neuropathy, high Wagner’s grade, osteomyelitis, postprandial glucose level, white cell count, c-reactive protein, erythrocyte sedimentation rate, low hemoglobin, and albumin as the most significant predictors of amputation.

Caring-Based Supportive Educative Enhance Prevention Ability Of Diabetic Ulcers In Patients With Type II Diabetes

Background: Patients with diabetes mellitus are at risk for complications of diabetic foot ulcers. This complication can avoid if people with diabetes mellitus have the proper knowledge of self-care management. This study aimed to determine the effect of self-care management education on preventing foot ulcers in patients with type II diabetes mellitus. 
 Methods: The design of this study is quasi-experiment. The number of samples was 86 with a simple randomized sample divided into two groups, 43 in the treatment group caring base supportive educative activities, and 43 in the control group distributing leaflets on diabetes. Results from studies were analyzed using the paired t-test and the independent t- test.
 Results: These study results are based on independent t-test scores of self-care management in the treatment and control groups after the intervention, namely p = 0.002. The difference in the delta score of self-care management scores in the treatment and control groups after the intervention was p=0.000.
 Conclusion: The results showed that self-care management education interventions effectively increased the ability of self-care patients with type II diabetes mellitus to prevent complications of diabetic ulcers. This intervention can be a promotive effort to increase self-care independence in patients with type II diabetes mellitus to avoid complications of diabetic wounds.

Bacteriological Profile of Diabetic Foot Ulcers and Detection of Methicillin-Resistant Staphylococcus aureus and Extended-Spectrum β-Lactamase Producers in a Tertiary Care Hospital.

IntroductionDiabetic foot infection is the most dreaded complication of diabetes mellitus and the commonest cause of hospitalization and limb amputation. Identification of the causative agent responsible for diabetic foot infection and the earliest initiation of appropriate antimicrobial therapy are vital for the control and prevention of the complication of diabetic foot ulcers. Therefore, we conducted this study to determine the bacteriological profile of diabetic foot ulcers and to detect methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase (ESBL) producers in our institute.MethodologyDuring the study period, samples were collected from the foot ulcers of 100 patients at the Diabetic Outpatient Department. The samples were processed according to the standard laboratory protocol, and bacterial isolates were identified. Antibiotic susceptibility testing was performed using the modified Kirby-Bauer disk diffusion technique, and results were interpreted according to the Clinical and Laboratory Standards Institute guidelines (CLSI 2016). A phenotypic test for MRSA detection was performed using cefoxitin (30 μg) disk. ResultsThe highest incidence of diabetic foot ulcers was observed in patients aged 41-50 years. There were 83 men and 17 women, with a male to female ratio of 4.882. Of the 100 collected samples, 73 were positive for microbial growth, and 27 samples showed no growth. Of the 73 positive cultures, monomicrobial infection was found in 48 patients, and polymicrobial infection was found in 25 patients. Gram-positive pathogens were isolated from 34 patients, and gram-negative microbes were isolated from 64 patients. Among all collected isolates (n=100), Staphylococcus aureus was the most predominant organism and Acinetobacter species was the least common (only two isolates). Among the gram-negative bacteria, Pseudomonas aeruginosa was predominant. All the isolated gram-positive bacteria were susceptible to vancomycin. Gram-negative bacteria were highly susceptible to colistin with the exception of Proteus species which is intrinsically resistant to colistin and it is not reported for Proteus species. ESBL producers were primarily found among Klebsiella species isolates (22.22%). Among 29 S. aureus isolates, 8 (27.5%) were found to be MRSA producers.ConclusionBased on the bacteriological profile of diabetic foot ulcers, S. aureus among the gram-positive isolates and P. aeruginosa among the gram-negative isolates were the predominant pathogens. Infections caused by multidrug-resistant bacteria such as MRSA and ESBL producers have been reported with increasing frequency. According to the antibiotic susceptibility pattern, treatment can be initiated, continued, or altered, thereby reducing morbidity in patients with diabetic foot ulcers.

MAJOR LIMB AMPUTATIONS: OUR EXPERIENCE IN A TERTIARY CARE HOSPITAL, VISAKHAPATNAM

The purpose of this study was to outline the patterns, indications and short-term complications of major limb amputations attending King George Hospital, Tertiary Care Centre, Visakhapatnam. This was a retrospective study at the King George Hospital between June 2019 and May 2020. Data were collected using previous medical records of the patients. A total of 80 patients were entered into the study. Their ages ranged between 20–70years with an average age of 53.5 yrs. Males outnumbered females by a ratio of 4:1. The most common indication for major limb amputation was diabetic foot complications followed by vascular disease, trauma, gas gangrene I and high voltage electrical burns respectively. Lower limbs were involved in 77.5% of cases and upper limbs in 22.5% of cases giving a lower limb to upper limb ratio of 3.4:1. Below knee, amputation was the most common procedure performed in 46.25%. There was no bilateral limb amputation. All the aspects regarding the type of amputation, complication rates, etiologies, have been studied. In limb amputations, the indications are many and the pattern varies from place to place. Complications of diabetic foot ulcers, PAOD and trauma resulting from road trafc crashes were the most common indications for major limb amputation in our environment. The majority of these amputations are preventable by the provision of health education, early presentation and appropriate management of the common indications.

Study to Determine the Complications and Treatment of Diabetic Foot Ulcer

Background: Diabetic foot ulcer is a solitary most costly and severe complication of diabetes mellitus. Foot ulcers are the after-effect of a combination of various causes, counting peripheral arterial disease and peripheral neuropathy. Patients with diabetic foot ulcers for the most part require lower limb amputation.
 Objective: The purpose of this examination is to survey the outcomes and complications of diabetic foot ulcers in diabetic patients and to explore the impacts of certain hazard factors on ulcer healing.
 Place and Duration: In the Orthopedic unit, Dow University Of Medical and Health Sciences, SMBBIT Karachi, for nearly a two-year duration from March 2018 to April 2020.
 Methods: This study was conducted on 120 patients. All patients with diabetes and DFU 18 to 90 of age were selected. 120 grown-up patients with DFUs were selected for the analysis. The diabetes duration and demographic data were recorded. Clinical proof of infection has been accounted for, as indicated by the American Association for Infectious Diseases. At that point debridement and careful treatment were begun to evacuate all the dead tissue. Follow-up was done week by week for two-year. SPSS 22 was utilized for data collection and statistical analysis. Data are introduced as a percentage and p < 0.05 was considered as the significance level. The Fisher’s test and χ2 test were utilized to test the variables relationship. Multivariate logistic regression analysis was utilized to change different variables when testing the impact of each risk factor on the outcome of DFU.
 Results: A sum of 120 patients with diabetic foot ulcers were selected. 60% of patients had relieved ulcers, 8% still not resolved; In 27% of patients, minimum amputation, 7% more protuberant amputation, 2% repetitive ulcer and mortality rate was 1%. The investigation indicated that there is a measurably noteworthy connection between the foot ulcers healing with diabetes and the accompanying factors: HbA1c level, patients’ age, diabetes duration, diabetes complications (ulcer size and peripheral neuropathy).
 Conclusion: The outcomes and complications of diabetic foot ulceration can be anticipated by a few factors, some of which can be changed. Changing compatible factors, for example, better diabetes control, peripheral neuropathy treatment and early treatment of ulcers can reduce complications and encourage healing of ulcers.

Assessment of diabetic foot risk among diabetic patients in a tertiary care hospital, South India.

INTRODUCTION:Foot problems are most common among patients with diabetes, and they are an important cause of morbidity in patients with diabetes mellitus (DM). They can be prevented by following a simple foot care practice. The study objective was to stratify the level of risk for diabetic foot ulcer (DFU) among patients with diabetes by screening.MATERIALS And METHODS:A descriptive cross-sectional study design was adopted in this study. The sample size was 196, and a standardized INLOW'S 60-s diabetic foot screening tool was used to assess the risk of diabetic foot. Data collection was done by face-to-face interview, and diabetic foot risk (DFR) was assessed by direct observation, inspection, and palpation methods.RESULTS:Among the 196 patients, majority required yearly foot screen in both feet. The mean and standard deviation of the level of DFR in the left foot (LF) and right foot (RF) was 4.31 ± 2.267 and 4.51 ± 2.391, respectively. There was a statistically significant association between the practice of treatment and level of foot screening recommendation in the LF with Chi-square value of χ2= 8.20 (df = 2) and RF with Chi-square value of χ2= 7.95 (df = 2) at P < 0.05 level.CONCLUSION:Health-care providers should be made aware of the regular practice of screening the foot of diabetic patients along with health education awareness programs. It may be helpful to identify the foot ulcer risk at an early stage. It will prevent further complications of DFU and recurrence of ulcer and will reduce the economic burden to patients and their family members and the health-care system.

Implementation of spiritual care in patients with diabetic foot ulcers: a literature review.

Lower extremity amputation is a complication of diabetic foot ulcers that can cause spiritual crisis. Integrating spiritual care into nursing practice is important to overcome this. However, studies articulating the role of nurses in spiritual care when caring for patients with diabetic foot ulcers is limited. This article aims to describe the importance of providing spiritual care for this group of patients. The interpretation of spiritual care with respect to the relationship between the patient and the family, and the role of the nurse are discussed. The findings offer a theoretical perspective on spiritual care that can be used to develop spiritual interventions, as well as prevent spiritual crises in patients with diabetic foot ulcers.

In Reply to the Letter to the Editor Regarding “Bibliometric and Visualized Analysis of Stem Cell Therapy for Spinal Cord Injury Based on Web of Science and CiteSpace in the Last 20 Years”

The aim of this study was to demonstrate the state of diabetic foot ulcer (DFU) research in the past 10 years by bibliometric analysis, especially by performing document co-citation and co-word visualization analysis to reveal the research hotspots, frontiers, and core literature. The literature in connection with DFUs from 2007 to 2018 was retrieved from the Web of Science Core Collection database (WoSCC). We used the WoSCC and CiteSpace to analyze publication outcomes, journals, research direction, research hotspots, and frontiers. Overall, 4580 publications on DFUs were retrieved until March 22, 2018. The number of publications from the United States accounts for approximately one third of all publications from the top 10 countries. Surgery accounted for the largest proportion of the publications we retrieved from the WoSCC in terms of research areas. Results of this analysis indicated that DFU research has been in a stable, mature stage. Developed countries pay more attention to DFU research field than do developing countries, especially the United States. The complications of DFUs, such as lower extremity amputation and diabetic foot infection, are the hotspots. Diabetic foot infection, wound management, prediction studies on DFU, and diseases related to DFU are the research frontiers that should be observed closely in the future.