Diabetic Foot Complications Research Articles

Healthcare workers' perspectives on diabetic foot complications among type 2 diabetes mellitus patients in Fiji.

Diabetic Foot Complications (DFCs) are a growing cause of morbidity and mortality with less than one third of physicians able to discern the signs of diabetes related peripheral neuropathy. DFCs and resultant amputations account for a considerable proportion of surgeries in Fiji, with very limited literature available to verify the factors that influence these alarming figures. This study aimed to explore Health Care Workers' (HCWs) perspectives on diabetic foot complications and challenges of foot care management in Fiji. An exploratory descriptive qualitative design was used among HCWs at the Sigatoka Sub Divisional Hospital (SDH), Fiji in 2021. HCWs at the SDH were required to have a minimum work experience of at least six months in public health. All participants who met the inclusion criteria were selected through purposive sampling. Data was collected using a focus group discussion guide composed of semi-structured open-ended questions to guide the Focus Group Discussions (FGDs). Focus discussions were audio recorded and transcribed with thematic analysis applied to derive the themes and sub-themes outlined in the study. Twenty HCWs participated in four FGDs with four major themes identified. The first theme was HCWs' perceptions and practice of foot care which revealed that all participants had adequate diabetic foot care knowledge. The second theme was factors affecting foot care which was mainly focused on identified barriers such as inadequate patient foot care knowledge, the lack of resources such as manpower, and health system challenges like the COVID-19 pandemic. The third theme is creating awareness among patients and HCWs to improve foot care practices. The fourth theme is strengthening foot care practices at the different levels of health care that is aimed at optimizing diabetic foot outcomes. Various foot care barriers namely patient factors and the lack of resources is a concern depicted in this study. There is a need to address health system barriers and enforce diabetic foot education, screening and care for patients and the community.

Analysis of conditions related to diabetic foot in the pre and post COVID-19 pandemic in Brazil

With the COVID-19 pandemic, an exacerbation of hospitalizations due to diabetic foot was noted in Brazil, which was due to the loss of access to primary health care by the population, especially the most economically disadvantaged in a country with a vast continental extension and very unequal, economically. We carried out an observational, retrospective and descriptive analysis of hospital data on hospitalization for diabetic foot treatment, using SIH/SUS and DataSUS between 2015 and 2023. Mortality, length of stay, costs, nature of care and demographic distribution of procedures were analyzed. During the period, 196,523 hospitalizations were recorded for the treatment of complicated diabetic foot. In addition, 5,711 cases of deaths were associated with a fatality rate of 0.54%. In relation to financial expenditure, the Northeast Region stood out with the highest expenditure rate. The most socially vulnerable regions had higher hospitalization and mortality rates, although there was little change in financial resources during the pre- and post-pandemic period. This situation highlights the need to promote greater regional equity in indicators and access to health to minimize preventable problems such as UPD. Situations such as the one experienced in the COVID-19 pandemic served to highlight the shortcomings of the country's health system and how the health-disease process is strongly linked to local socioeconomic conditions, making it necessary to promote collective health measures aimed at minimizing disparities regions in Brazilian territory. The lack of data collected by the health event registration system in the country constitutes a limitation in the present study, which makes us suggest greater rigor and diversity in the collection of information in order to better translate the reality of the data presented here.

Exploring the psychosocial burden of foot complications in diabetes: A cross-sectional survey and qualitative interview study in a United Kingdom coastal community.

Foot complications in diabetes are common and destructive, resulting in substantial healthcare costs and high rates of morbidity. Coastal areas have a significantly higher burden of disease. People with diabetes experience disproportionately high rates of psychological health issues, including anxiety, depression and diabetes distress. These can affect self-management and concordance with preventive measures and treatments of foot complications, negatively impacting on outcomes. Access to psychological health services is variable across the United Kingdom and there is a paucity of high-quality evidence for the effectiveness of treatments for diabetes distress. This study aimed to explore experiences of psychosocial burden and perceptions and experiences of psychosocial support, among patients with diabetes and foot complications living in a coastal area. Patients were eligible to participate if they had experienced diabetes-related foot complications (amputation, ulceration and/or Charcot neuroarthropathy) within the last 5years and scored positive for diabetes distress on a validated screening tool (DDS2). Eligible patients completed cross-sectional questionnaires describing symptoms of diabetes distress (DDS17), anxiety (GAD-7) and depression (PHQ-9) and to take part in a face-to-face, semi-structured interview. Questionnaires were analysed using frequencies and interviews were analysed using reflexive thematic analysis. A total of 183 patients completed the DDS2 screening questionnaire. Of these, 56 (30.6%) screened positive for diabetes distress. Twenty-seven patients completed DDS17, GAD-7 and PHQ-9 questionnaires. Eleven (40.7%) participants indicated high levels of diabetes distress and four (14.8%) indicated moderate distress. Seventeen participants (age range 52-81years; 12 men) took part in an interview. Four key themes were identified: impact of living with foot problems; emotional consequences of foot problems; experiences and perceptions of psychological support; and strategies to cope with the emotional impact of foot problems. Diabetes distress was prevalent among patients with diabetes-related foot complications. Foot problems impacted on participants' daily activities, social lives and ability to work. Despite expressing feelings of ongoing fear, worry and depression relating to their foot problems, only one participant had accessed formal psychological support. Many participants relied on talking to podiatrists at routine appointments and described developing various strategies to cope. The psychosocial burden of living with foot complications in diabetes must not be overlooked by health professionals. Findings from this study can inform the design of future services and interventions.

Predictors of operative management in diabetic foot ulcers.

Surgery plays a key role in the management of complicated diabetic foot disease (DFD). Currently, indications for medical versus surgical management are poorly defined. Prompt identification of patients who require surgery may reduce morbidities and length of hospital stay. This study aims to analyse factors in DFD that necessitate early surgical interventions. All patients admitted under a multi-disciplinary diabetic foot team in a tertiary institution over 2years were included in a retrospective case-control study comparing patients who received medical management and patients who received surgical management. Logistic regression was performed to identify factors associated with surgical management of diabetic foot complications. Three hundred and forty patients were included. 49% of patients required surgical management. Toe ulceration, elevated C-reactive protein (CRP), and the presence of osteomyelitis were associated with surgical management. Multivariate analysis calculated an odds ratio (OR) of 1.01 for CRP (p<0.001), OR 2.19 (p<0.019) favouring surgical management for forefoot ulcers, and OR 2.2 (p<0.019) if osteomyelitis was present. Patients with elevated CRP levels, a forefoot diabetic ulcer and established osteomyelitis were more likely to undergo surgical management. Prompt recognition of these patients has the potential benefit of earlier decision making in definitive surgical interventions.

Effectiveness of a Multidisciplinary Limb Preservation Program in Reducing Regional Hospitalization Rates for Patients With Diabetes-Related Foot Complications.

This study evaluated the toe and flow model (TFM), a limb preservation program led by podiatric surgeons in Alberta, Canada, for its impact on hospitalization rates and length of stay (LOS) in patients with diabetic foot complication (DFC). Diabetes, a leading cause of non-traumatic lower extremity amputations (LEAs) in Canada, often results in diabetic foot ulcers (DFUs), a major cause of infection, amputation, and hospitalization. TFM has reportedly reduced amputation rates by 39% to 56%. The study analyzed Alberta's health database from 2007 to 2017, focusing on diabetes patients aged 20 and above. It included patients with various DFCs and compared outcomes in regions using TFM and standard of care (SOC). The study also examined data from two major cities, one with TFM and the other without, including rural referrals to Calgary and Edmonton. The data were normalized for the diabetic population and analyzed using a standard Student's t-test. TFM regions showed significantly lower hospitalization rates (p = 1.22E-12) than SOC regions. Over 11 years, TFM maintained lower average and median LOS by 0.13 and 0.26 days, respectively. TFM access reduced hospitalization risk by up to 30%, and patients in TFM regions had a 21% shorter LOS compared to SOC regions. Despite similar demographics and healthcare systems, the TFM region benefited from a dedicated multidisciplinary program and comprehensive limb preservation services. The study shows that TFM effectively reduces hospitalizations and LOS for DFCs, with significantly better outcomes in the TFM region than in SOC regions.

Knowledge, Attitude, and Practice of Adult Diabetics Regarding Diabetic Foot Ulcers: A Cross-Sectional Study in Saudi Arabia.

Background Diabetic foot ulcers (DFUs) are one of the most common and fatal complications of diabetic patients with uncontrolled diabetes mellitus (DM) that may end with their feet amputation. These complications can be prevented through the adherence of diabetic patients to their diabetes management plan and by educating them about risk factors, complications of diabetic foot, and proper foot care. To develop effective health education programs to educate diabetic patients and caregivers regarding diabetic foot and its effective care, we should first identify gaps in patients' knowledge and perception of diabetic foot and evaluate their practice of foot care. Objectives This study aimed to evaluate knowledge and attitude toward DFUs and the practice of foot care among adult diabetic patients attending Al-Qunfudah Diabetes Center, Saudi Arabia, from October 2022 to March 2023. Methods A total of 403 adult diabetic patients were recruited in this cross-sectional study during their attendance at the diabetes center in Al-Qunfudah district, Saudi Arabia. The study researchers conducted a physical face-to-face interview with each diabetic patient using a validated questionnaire with closed-ended questions to collect their responses regarding their knowledge and attitude toward DFUs and their behavior toward foot care. The collected data were analyzed using IBM SPSS Statistics for Windows, version 23 (released 2015; IBM Corp., Armonk, New York, United States). Results Out of 403 diabetics, 50.4% (n = 203) had inadequate knowledge (knowledge score < 80%), 46.4% (n = 187) had negative attitudes (attitude score < 80%) toward DFUs, and the majority could not practice foot care well, with 77.7% (n = 313) giving a practice score less than 80%. Seventy patients (17.4%) self-reported a history of DFUs. Predictors of good knowledge about DFUs among diabetics include age between 30 and 59 years (odds ratio (OR) = 2.942, confidence interval (CI) 95% = 1.695-2.107, p < 0.001), marriage (OR = 3.101, CI 95% = 1.893-5.079, p < 0.001), working (OR = 5.325, CI 95% = 3.019-9.389, p < 0.001), diploma education (OR = 8.205, CI 95% = 3.332-20.203, p < 0.001), managing DM with oral drugs (OR = 2.219, CI 95% = 1.399-3.519, p < 0.001), and having no DFUs (OR = 2.712, CI 95% = 1.557-4.723, p < 0.001). Males were more likely to practice foot care well (OR = 1.925, CI 95% = 1.142-3.245, p = 0.013). Primary education (OR = 3.421, CI 95% = 1.655-7.073, p < 0.001) predicted appropriate foot care. Patients with DM for one to five years (OR = 1.995, CI 95% = 1.139-3.493, p = 0.016) and those on diet and metformin (OR = 2.133, CI 95% = 1.134-4.011, p = 0.019) were expected to have better foot care than other diabetics. Conclusion Diabetic patients in the Al-Qunfudah district of Saudi Arabia had inadequate knowledge and negative attitudes toward DFUs, and their foot care behaviors were inadequate. Furthermore, DFUs were self-reported in around 17% of diabetic patients. Specialized training programs are recommended to enhance knowledge regarding DFUs among diabetics and motivate and train them and caregivers on how to conduct proper foot care. These educational programs should target all diabetics, with an emphasis on those with DFUs, females, non-working patients, individuals who have had DM for a longer time, and illiterate diabetics. To understand the factors behind patients' negative attitudes toward diabetic foot, future qualitative research is required.

Implication of Peripheral Neuropathy on Unplanned Readmissions in Patients Hospitalized for Complicated Diabetic Foot Disease.

Introduction. Unplanned readmissions are common following discharge in patients after hospitalization for diabetic foot disease (DFD) complications. The aim of this study was to identify factors associated with readmissions in these high-risk patients, treated in a multidisciplinary setting and the implication of measures that could effectively reduce readmission rates. Methods. Patients presenting with DFDs admitted between 2015 and 2017 were studied retrospectively in a single-centre patient database. The demographics and clinical comorbidities were analyzed and comparison was made between 2 groups: patients readmitted within 30 days of discharge and those who did not require readmission. Multivariate analysis was performed to identify risk factors associated with readmissions. Results. In total, 340 patients were included. The unplanned readmission rate was 10.9%. More than half of readmissions (71%) were related to wound deterioration and infection. In the readmission group, the patients had lower body mass index, higher rate of osteomyelitis, lower rate of debridement, and evidence of peripheral vascular disease below the knee in the index admissions but these were not significant. In the multivariate analysis, peripheral neuropathy was the only significant risk associated with unplanned readmissions (odds ratio: 2.78, 95% confidence interval: 1.23-6.29, P = .014). Conclusion. This study demonstrates a significant association between peripheral neuropathy and unplanned readmissions. The implications of this nonmodifiable risk factor in reducing readmissions include all levels of patient care delivery such as adequate preparation for discharge and transition back into the community. Recognition and education in successful long-term offloading of insensate diabetic feet may help reduce rates of unplanned readmission.

A study to assess the efficacy of local applicants to prevent complications of diabetic foot

Background: Diabetes is one of the most common comorbid illnesses in our community. Diabetes is associated with numerous complications related to microvascular, macrovascular, and metabolic etiologies. One of its complications in long course is diabetic foot ulcer and the associated morbidity and mortality is a major health issue. Aims and Objectives: This study was conducted to describe the lesions we treat, study and compare outcomes and to identify measures to decrease morbidity and mortality due to diabetic foot disease. Materials and Methods: All patients who attended general surgery outpatient department at M.Y. Hospital (M.P.) India between July 1st 2021 and June 30th, 2022 were included in this study with nonhealing Diabetic foot Ulcer Wagners Stage 3 for more than 2 weeks without any other comorbidities. Results: Majority of the patients presented with higher grade and with poor glycemic control at the time of presentation. Conservative management with antibiotics was useful in a small subset of the patients. Majority of the patients needed surgical treatment in the form of debridement to amputations. Conclusion: Diabetic limb disease is more prevalent in male sex commonly in 51–60 years of age group. 74% of patients presented with foot ulcer and Staphylococcus aureus was found the most common microorganism in pus culture from wounds. Local applicants are effective in controlling ulcers. In our study, hydrogel with colloidal silver was most effective followed by silver nitrate. Early and aggressive treatment of these ulcers can prevent the rate of amputation.

Cuidados de Enfermería en paciente con pie diabético amputado

Diabetes Mellitus is a chronic condition caused by an excessive increase of blood glucose; it is associated with many complications, and one of the most severe is diabetic foot, characterized by clinical deterioration causing a lesion or ulcer in the foot, which tends to get easily infected. Amputation is a complication of diabetic foot, with impact on the quality of life of persons with diabetes. The Nursing professional plays an essential role in the process of care for persons with diabetes, both in the prevention of complications and in the intervention for solving them. The case report of a 79-year-old diabetic woman is presented; she was admitted due to infection of the supracondylar stump of her lower right limb. At arrival at the unit of reference, there was assessment according to Marjory Gordon’s functional patters, and eleven Nursing diagnoses were identified in total. During the Nursing assessment, it was found that the lack of commitment by the patient in terms of self-care had contributed to the development of diabetic foot and amputation, leading to an alteration in her general functioning regarding management of her health, nutrition, activity and exercise, perception, self-esteem, and concern for changes at personal and family level. The Nursing Care Process based on the use of Nursing Diagnosis Taxonomy (NANDA), Outcomes (NOC) and Interventions (NIC) allowed to apply care in a safe and effective way in order to reach patient improvement.

DEPRESSIVE DISORDERS AND THEIR CORRECTION IN PATIENTS WITH COMPLICATED DIABETIC FOOT SYNDROME

Abstract. The aim of the study. To assess the frequency and expressiveness of depressive disorder in patients with complicated SDS, as well as the effectiveness of pharmacotherapy with venlafaxine in this contingent of individuals.&#x0D; Materials and methods. A comprehensive clinical and psychopathological examination of 270 patients for complicated diabetic foot syndrome (DFS) was conducted for the period 2019–2022.&#x0D; Results. All patients were operated on, an autopsy and drainage of a purulent-necrotic foci of the foot or amputation at different levels was performed. The average age of the patients was (64,2 ± 2,3) years. The average duration of diabetes was (12,4 ± 1,6) years. Depressive disorders were detected in 169 patients, which made up 62,6 % of the total group, including 106 women (62,7 %) and 63 men (37,3 %). To evaluate the effectiveness of psychopharmacotherapy of depressive disorders, patients were divided into two groups. Patients of the control group (n = 84) received standard therapy (local treatment of wounds, antibacterial, infusion, disaggregant and vascular therapy, analgesia, correction of glycemia). Patients in the main group (n = 85) were prescribed venlafaxine (Venlafaxine) in a dose of 75–150 mg in the morning during meals, for 3 months, along with standard therapy. Psychopathological examination was carried out during hospitalization, on the 20–21st day of treatment and 3 months after the start of therapy. In the control group (standard therapy), depressive disorder did not undergo a significant (P&gt;0,05) improvement.&#x0D; Conclusions. The conducted course of psychopharmacotherapy of depressive disorders in patients with complicated SDS had a significant effect, both in terms of the manifestations of depression itself (Р&lt;0.05), and in improving the quality of life of patients (Р&lt;0.05). Treatment with venlafaxine made it possible to reduce the manifestations of depression already on the 20–21st day of treatment. The reduction of depressive symptoms was most clearly recorded 3 months after the start of therapy.

Direct Endolymphatic Ozone Therapy in Patients with Diabetic Foot Syndrome: Analysis of the Effectiveness

Introduction. Chronic inflammatory process on the foot leads to the depletion of immune defense mechanisms against infection in patients with diabetes mellitus. Application of ozonized solutions, endolymphatic therapy contributes to fight against the infectious process and maintenance of the body homeostasis.The aim of the study was to evaluate safety and clinical effectiveness of direct endolymphatic ozone therapy in patients with purulent-necrotic complications of diabetic foot syndrome.Methods. Clinical outcomes of direct endolymphatic ozone therapy, being part of complex therapy, were analyzed in 23 patients with purulent-necrotic complications of diabetic foot syndrome. Inclusion criteria were the degree of damage to the foot according to Wagner 2-4, ankle-brachial index (ABI) less than 0.7. Direct antegrade endolymphatic ozone therapy consisted of introduction of ozonized isotonic sterile sodium chloride solution into the lymphatic collector of the middle third leg for 5 days. The parameters of treatment duration, degree of the pain syndrome, severity of surgical intervention, dynamics of the bacterial contamination, leukocytes and blood lymphocytes, leukocyte indices were assessed.Results. Under endolymphatic ozone therapy, all patients reported positive changes in subjective perception, the level of peripheral blood lymphocytes increased by 15.3%, which reflected an improvement in the adaptive potential of the body, bacterial contamination decreased by 68.6%, the severity of operations decreased by 39.4%. The duration of treatment did not change statistically significant. Conclusion. Direct endolymphatic ozone therapy is an effective way to influence the course of the purulent-necrotic process in the complex treatment of diabetic syndrome. The main focus of the technique is correction of the bacterial contamination of inflammation; this option promotes activation of reparative processes in the wound, reduces the risk of infection generalization, and preserves a limb footing ability. The use of leukocyte indices to assess the course of the inflammatory process on the foot in patients with diabetes mellitus is difficult in clinical practice due to the decreased body's reactivity.

A prospective observational study of role of pedis scoring in predicting complications of diabetic foot in a tertiary centre

Background: Diabetes mellitus is one of the most common non-communicable diseases affecting major population in the world. Diabetic foot ulcer still remains the most common manifestation of diabetes mellitus requiring hospitalisation and invariably resulting in increased risk of morbidity. Our aim is to know the usefulness of PEDIS scoring in identifying the severity of diabetic foot ulcer and its management. Methods: In this prospective observational study, data of patients with foot ulcer who came to Apollo hospital in Chennai were collected for one year from July 2021 to May 2022. They were followed up for a period of six months. Patients were assessed and classified according to the PEDIS scoring system. All the data were analyzed by IBM SPSS statistics for windows version 25.0 (IBM corp, Armonk, Newyork USA). All p values &lt;0.05 were considered as statistically significant. Results: Out of one seventy-five patients, one hundred and thirteen were categorized as low risk group with a score between 0-7 and sixty-two as high-risk group with a score between 8-12. Majority of the high-risk groups developed complications like non healing ulcer, osteomyelitis, amputation. It is more prevalent among men with age preponderance for elderly. Whereas management of low-risk groups were limited only to conservative management and debridement. Of twenty-one patients with osteomyelitis, thirteen patients underwent amputation. Conclusions: Based on our study, we have come to a conclusion that the PEDIS scoring system actually helps in grading the diabetic foot and its management.

Application of the RELATIVE scheme in the program of treatment of microcirculation disorders in patients with diabetes

The work is devoted to the study of the effectiveness of the RELATIVE scheme (Reosorbilact, Latren, Tivortin) in patients with microcirculation disorders on the background of complicated diabetes mellitus. The study included 33 patients diagnosed with complicated diabetic foot syndrome. It was found that the use of complex infusion therapy according to the RELATIVE scheme for the treatment of microcirculation disorders in patients with diabetic foot syndrome helped to normalize blood glucose levels, improve patients’ well-being, stabilize laboratory and biochemical parameters, reduce the severity of postoperative pain and the number of patients’ complaints (insomnia, night pain, irritability and restlessness).

Oxidative Stress and Inflammatory Biomarkers in Patients with Diabetic Foot.

Background and Objectives: Diabetic foot (DF) development is driven by complex interactions of hyperglycemia, inflammation, and oxidative stress (OS). We aimed to investigate OS and inflammatory biomarkers in patients with DF and their potential to improve early diagnosis and management of DF. Materials and Methods: The prooxidant−antioxidant balance (PAB), superoxide dismutase (SOD), total oxidative status (TOS), total sulfhydryl groups (SHG), routine biochemical parameters, and complete blood count were determined in 42 patients with type-2 DM, of which 23 patients had DF, while 19 patients were without DF complications. The neutrophils-to-lymphocyte ratio (NLR) was evaluated as a biomarker of inflammation. Results: Patients with DF had significantly higher (p < 0.05) PAB levels (170 ± 33.9 U/L) compared to those without DF complications (142 ± 31.3 U/L). In addition, patients with DF had significantly reduced SOD activities (p < 0.01). NLR values were significantly higher in the DF group (median: 2.8; interquartile range: 2.0−4.3) than in the group without DF (median: 1.4; interquartile range: 1.4−2.1; p < 0.01). A positive correlation was found between the PAB and NLR index (r = 0.449; p < 0.05). The diagnostic accuracy of both PAB (AUC = 0.741; p < 0.01) and NLR (AUC = 0.760; p < 0.01) was estimated as acceptable. Conclusions: In conclusion, the development of DF is associated with enhanced OS and inflammation processes. PAB and NLR could be useful non-invasive biomarkers of DF development.

Pathogen-specific molecular imaging and molecular testing methods in the prognosis of the complicated course of diabetic foot syndrome, the risk of amputation, and patient survival

The aim of this review was to provide extended information on current trends in the diagnosis of complicated diabetic foot syndrome (DFS), the most frequent and severe complication of diabetes mellitus, including hightech medical imaging methods and instrumental and laboratory predictors of the complicated course and risk of amputation in DFS.The article provides an analytical review of modern publications over the past 5 years on diagnosis and therapy. Pilot data on the use of high-tech medical imaging methods, assessment of skin microbiota and ulcers in DFS, molecular testing methods in terms of predicting the amputation risk and survival of patients with DFS, as well as the effectiveness of biosensing systems have been systematized, summarized, and subjected to analytical evaluation.The review provides an expert assessment of the capabilities of pathogen-specific molecular imaging using modern positron emission tomography (PET), single-photon emission computed tomography (SPECT), and highenergy radionuclides in bacterial infection to understand its pathogenesis, minimize diagnostic problems, improve antimicrobial treatment, and address fundamental and applied aspects of DFS. Literature data on the assessment of foot perfusion in diabetic patients with varying degrees of limb ischemia by hybrid technologies (SPECT / CT and PET / CT) and new modalities of magnetic resonance imaging (MRI) are also systematized, which contributes to new understanding of the response to revascularization, surgical shunting, and stimulation of angiogenesis within ischemic tissue, as well as potentially to healing of foot ulcers.The review is aimed at substantiating a multidisciplinary approach in DFS, selection, development, and implementation of innovative strategies for diagnostic modalities to identify diabetic foot pathologies, and choice of an adequate method for treating and monitoring the results of therapy in the context of personalized medicine.

The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions-A Single-Center Study.

The prevalence of diabetic foot complications is continuously increasing as diabetes has become one of the most important “epidemics” of our time. The main objective of this study was to describe the appropriate surgical intervention for the complicated neuropathic diabetic foot; the secondary goal was to find the risk factors associated with minor/major amputation and good or adverse surgical outcomes. This is an observational, retrospective study conducted between 1 January 2018 and 31 December 2019, which included 251 patients from the General Surgery Department at the Dr I. Cantacuzino Clinical Hospital in Bucharest with type II diabetes mellitus and neuropathic diabetic foot complications. The surgical conditions identified at admission were the following: osteitis (38.6%), infected foot ulcer (27.5%), gangrene (20.7%), infected Charcot foot (3.6%), non-healing wound (3.6%), necrosis (3.2%), and granulated wound (2.8%). We found that a minor surgical procedure (transmetatarsal amputation of the toe and debridement) was performed in 85.8% of cases, and only 14.2% needed major amputations. Osteitis was mainly associated with minor surgery (p = 0.001), while the gangrene and the infected Charcot foot were predictable for major amputation, with OR = 2.230, 95% CI (1.024–4.857) and OR = 5.316, 95% CI (1.354–20.877), respectively. Admission anemia and diabetic nephropathy were predictive of a major therapeutical approach, with p = 0.011, OR = 2.975, 95% CI (1.244–8.116) and p = 0.001, OR = 3.565, 95% CI (1.623–7.832), respectively. All the major amputations had a good outcome, while only several minor surgeries were interpreted as the adverse outcome (n = 24). Osteitis (45.8%) and admission anemia (79.2%) were more frequently associated with adverse outcomes, with p = 0.447 and p = 0.054, respectively. The complicated neuropathic diabetic foot requires a surgical procedure mainly associated with a good outcome.

Wound-Healing and Antibacterial Activity of the Quercetin–4-Formyl Phenyl Boronic Acid Complex against Bacterial Pathogens of Diabetic Foot Ulcer

Complications of diabetic foot can be prevented using a naturally occurring, efficient, and newly synthesized antimicrobial agent. The purpose of the study was to improve wound healing and antibacterial effects of quercetin and its esterified complex with 4-formyl phenyl boronic acid (4FPBA–Q) compared with phenytoin. The formation of the 4FPBA–Q complex was confirmed by thin-layer chromatography (TLC), Fourier transform infrared (FTIR) spectroscopy, and mass spectrometry (MS). The prepared 4FPBA–Q complex was used against Gram-positive bacteria along with Gram-negative bacteria, and more than 2-fold decrease in minimum inhibitory concentrations (MIC) was observed compared to pure quercetin. Scanning electron microscopic images of Pseudomonas aeruginosa and Staphylococcus aureus showed their complete destruction after incubation with the 4FPBA–Q complex even after 3 h. Interestingly, wound-healing properties of the 4FPBA–Q complex in infected diabetic rats increased from 64 to 99% as compared to phenytoin, which were increased from those of noninfected diabetic rats. Furthermore, histopathological evaluations showed significantly enhanced wound healing, re-epithelialization, fibroblasts, and angiogenesis in wounds of diabetic rats after 10 days. Conclusively, reduction in the primary irritation index (PDII) and improved antibacterial and wound-healing properties render the 4FPBA–Q complex ideal for diabetic foot ulcer treatment.

Mortality Risk Associated with Diabetic Foot Complications in People with or without History of Diabetic Foot Hospitalizations.

The aim of this study was to evaluate the risk of death after hospitalizations for diabetic foot (DF) complications, comparing two different cohorts of people with or without a prior history of DF hospitalizations across the years 2011 to 2018 in Tuscany, Italy. The DF complications were categorized by administrative source datasets such as: amputations (both major and minor), gangrene, ulcers, infections, Charcot and revascularizations. A further aim was to present the trend over time of the first ever incidents of diabetic foot hospitalizations in Tuscany. The eight-year-mortality rate was higher in the cohort with prior hospitalizations (n = 6633; 59%) compared with the cohort with first incident DF hospitalizations (n = 5028; 44%). Amputations (especially major ones) and ulcers had the worst effect on survival in people without basal history of DF hospitalizations and respectively in those with a history of prior DF hospitalizations. In both cohorts, revascularization procedures, when compared to ulcers, were associated with a significantly reduced risk of mortality. The prevalence rate of minor amputations showed a slightly rising trend over time. This result agrees with the national trend. Conversely, the progressive increase over time of revascularizations, associated with the fractional decrease in the rate of gangrene, suggests a trend for more proactive behavior by DF care teams in Tuscany.

Topical Administration of Lactiplantibacillus plantarum Accelerates the Healing of Chronic Diabetic Foot Ulcers through Modifications of Infection, Angiogenesis, Macrophage Phenotype and Neutrophil Response.

This work aimed to evaluate the adjuvant treatment to surgical debridement using topical applications of Lactiplantibacillus plantarum ATCC 10241 cultures in complicated diabetic foot ulcers as compared to diabetic foot ulcers receiving surgical wound debridement. A randomised controlled trial was performed involving 22 outpatients with complicated diabetic foot ulcers that either received surgical debridement (SuDe, n = 12) or surgical debridement plus topical applications of L. plantarum cultures (SuDe + Lp, n = 10) every week during a 12 week treatment period. Compared to patients receiving SuDe, patients treated with SuDe + Lp exhibited significantly increased fibroplasia and angiogenesis, as determined by Masson’s trichrome staining and the study of CD34 cells, α-smooth muscle actin to semi-quantify vascular area, number of vessels and endothelial cells. In addition, a promotion of the polarisation of macrophages from M1 (CD68) to M2 (CD163) phenotype was observed in SuDe + Lp patients with remarkable differences in the tissue localisation. Bacterial counts were significantly diminished in the SuDe + Lp group compared to the SuDe group. Ex vivo assays, using polymorphonuclears isolated from peripheral blood of patients with diabetes and healthy individuals and challenged with Staphylococcus aureus demonstrated that the addition of L. plantarum supernatants significantly improved the phagocytosis of these cells. L. plantarum-secreted components increased the neutrophils bactericidal activity and regulated the netosis induced by S. aureus. At day 49, the average wound area reduction with SuDe + Lp was 73.5% compared with 45.8% for SuDe (p < 0.05). More patients progressed to closure with SuDe + Lp compared with SuDe treatment, indicating the ability of L. plantarum to accelerate the healing. At day 60, 60% of patients treated with SuDe + Lp achieved 100% of wound area reduction compared with 40% for SuDe. We propose that SuDe + Lp could be an effective adjuvant to surgical debridement when SuDe is not satisfactory for patients with complicated diabetic foot ulcers. The treatment is cheap and easy to apply and the product is easy to obtain.

Features of the dynamics of inflammatory markers during local treatment of complicated formsof diabetic foot syndrome

Features of the dynamics of inflammatory markers during local treatment of complicated formsof diabetic foot syndrome