Diagnosis Of Diabetic Foot Research Articles

Monocytes and Fibrinogen as Biomarkers in Type 2 Diabetes Mellitus

Background: In the diagnosis of diabetic foot, in addition to the inflammatory biomarkers that have been widely interested and used, for example procalcitonin, C-reactive protein (CRP), ESR, leukocyte count, neutrophil count, Fibrinogen and Monocytes are considered as biomarkers in this study. possible. Methods: A prospective study was designed to examine the utility of fibrinogen and monocytes in estimating disease severity in patients with DFU (Diabetic Foot Ulcer). The severity of DFU was assessed using the Wagner criteria distinguishing between patients with diabetic foot without ulcer (WDFU) and with non-infected diabetic foot ulcer (NIDFU) or with infected ulcer (IDFU). In this study the AA also wanted to correlate HbA1c to the concentration of Fibrinogen and the appearance of DFU, as well as the level of lymphocytes and monocyte precursors of macrophages in the evolution of ulcerated and non-ulcerated diabetic feet. Results: Mean blood fibrinogen values were significantly higher in patients with DFU grade ≧2 compared to those with DFU grade ≤1 (424.4±138.8 mg/dL versus 395.3±130.0 mg/dL; p=0.091). Fibrinogen values were correlated with CRP levels, neutrophils, ESR and leukocyte count. Monocytes presented a significant difference between non-diabetic patients with ulcer and without ulcer (0.41 vs 0.29 k/L; p=0.000) and between the diabetic without ulcer (WDFU) and non-diabetic without ulcer (NDWU) groups (0.39 vs 0.29 k/L; p=0.000). The Procalcitonin (PCT) value was <0.5 ng/dl, therefore it had no diagnostic significance. Only 1% of the values found were higher than 0.5 with an average of 1.04 ng/dl (range: 0.52-2.5). Conclusions: Neither monocytes nor HbA1c can be considered biomarkers for the risk of ulcer formation in the diabetic foot, but only as biomarkers of type 2 Diabetes Mellitus. Differently, fibrinogenemia, its pre/post intervention ratio, the  angle and the k value of thromboelastography (TEG), have a clinical significance on the risk of onset and development of ulcerated diabetic foot. The cut-off for ulcer formation for both the pre/post intervention ratio of fibrinogenemia and monocythemia is 1.10, with a sensitivity of 84.1% and a specificity of 24.5% for fibrinogen and 93.8% and 14.8% for monocytes.

Prediction of amputation risk of patients with diabetic foot using classification algorithms: A clinical study from a tertiary center.

Diabetic foot ulcers can have vital consequences, such as amputation for patients. The primary purpose of this study is to predict the amputation risk of diabetic foot patients using machine-learning classification algorithms. In this research, 407 patients treated with the diagnosis of diabetic foot between January 2009-September 2019 in Istanbul University Faculty of Medicine in the Department of Undersea and Hyperbaric Medicine were retrospectively evaluated. Principal Component Analysis (PCA) was used to identify the key features associated with the amputation risk in diabetic foot patients within the dataset. Thus, various prediction/classification models were created to predict the "overall" risk of diabetic foot patients. Predictive machine-learning models were created using various algorithms. Additionally to optimize the hyperparameters of the Random Forest Algorithm (RF), experimental use of Bayesian Optimization (BO) has been employed. The sub-dimension data set comprising categorical and numerical values was subjected to a feature selection procedure. Among all the algorithms tested under the defined experimental conditions, the BO-optimized "RF" based on the hybrid approach (PCA-RF-BO) and "Logistic Regression" algorithms demonstrated superior performance with 85% and 90% test accuracies, respectively. In conclusion, our findings would serve as an essential benchmark, offering valuable guidance in reducing such hazards.

Evaluación de aspectos clínicos relacionados con la amputación de miembros inferiores en personas que viven con diabetes mellitus tipo 2 en México

Introduction: Diabetes continues to be a leading cause of disability and death in the world's population. About 25% of people with diabetes will develop an ulcer in one of their lower pelvic limbs. Objective: The present study evaluates the clinical aspects related to lower pelvic limb amputation in a cohort of patients with diabetes mellitus. Methods: Retrospective, cross-sectional study, conducted in collaboration between the Mexican Institute of Social Security and the School of Pharmacy of the Autonomous University of Morelos State, involved a review of records of patients with type 2 diabetes mellitus at the Regional General Hospital "Ignacio García Téllez". One hundred clinical and electronic records were selected based on inclusion criteria, which included age over 18 years, affiliation at the study site, diabetes evolution of at least 10 years, pharmacological treatment for diabetes and diagnosis of diabetic foot with complete healing or amputation as an outcome. Statistical analyses were performed using STATA and ethical approval was obtained. Results: Patients with optimal glycemic control by quantifying their fasting glucose levels (<130 mg/dl) as well as their glycated hemoglobin values (< 7%) had a lower frequency of amputations (p˂0.001; Chi2) compared to those patients without adequate glycemic control. Conclusions: Being male, glycosylated hemoglobin values greater than 7% and mean fasting glucose values greater than 130 mg/L were found to increase the likelihood of having a lower extremity amputation.

Metabolic memory in diabetic foot syndrome (DFS): MICRO-RNAS, single nucleotide polymorphisms (SNPs) frequency and their relationship with indices of endothelial function and adipo-inflammatory dysfunction

BackgroundDiabetic foot is a significant cause of morbidity in diabetic patients, with a rate that is approximately twice that of patients without foot ulcers. “Metabolic memory” represents the epigenetic changes induced by chronic hyperglycaemia, despite the correction of the glucose levels themselves. These epigenetic modifications appear to perpetuate the damage caused by persistently elevated glucose levels even in their absence, acting at various levels, mostly affecting the molecular processes of diabetic ulcer healing.MethodsThe aim of our cross-sectional study was to analyse a cohort of patients with diabetes with and without lower limb ulcers.We examined the effects of epigenetic changes on miRNA 126, 305, and 217 expression and the frequency of the SNPs of genes encoding inflammatory molecules (e.g., IL-6 and TNF-alpha) and their correlations with serum levels of proangiogenic molecules (e.g., ENOS, VEGF and HIF-1alpha) and several adipokines as well as with endothelial dysfunction, assessed noninvasively by reactive hyperaemia peripheral artery tonometry.Between March 2021 and June 2022, 110 patients were enrolled into the study: 50 diabetic patients with diabetic foot injuries, 40 diabetic patients without ulcerative complications and 20 nondiabetic patients as the control group.ResultsDiabetic subjects with lower limb ulcerative lesions exhibited higher levels of inflammatory cytokines, such as VEGF (191.40 ± 200 pg/mL vs. 98.27 ± 56.92 pg/mL vs. 71.01 ± 52.96 pg/mL; p = 0.22), HIF-1alpha (40.18 ± 10.80 ng/mL vs. 33.50 ± 6.16 ng/mL vs. 33.85 ± 6.84 ng/mL; p = 0.10), and Gremlin-1 (1.72 ± 0.512 ng/mL vs. 1.31 ± 0.21 ng/mL vs. 1.11 ± 0.19 ng/mL; p < 0.0005), than those without lower limb ulcers and healthy controls. Furthermore, we observed that miR-217-5p and miR-503-5p were 2.19-fold (p < 0.05) and 6.21-fold (p = 0.001) more highly expressed in diabetic foot patients than in healthy controls, respectively. Additionally, diabetic patients without lower limb ulcerative complications showed 2.41-fold (p = 0) and 2.24-fold (p = 0.029) higher expression of miR-217-5p and miR-503-5p, respectively, than healthy controls. Finally, diabetic patients with and without ulcerative complications of the lower limbs showed higher expression of the VEGFC2578A CC polymorphism (p = 0.001) and lower expression of the VEGFC2578A AC polymorphism (p < 0.005) than the healthy control population. We observed a significant increase in Gremlin-1 levels in patients with diabetic foot, suggesting that this inflammatory adipokine may serve as a predictive marker for the diagnosis of diabetic foot.ConclusionsOur results highlighted that patients with diabetic foot showed predominant expression of the VEGF C2578A CC polymorphism and reduced expression of the AC allele. Additionally, we found an overexpression of miR-217-5p and miR-503-5p in diabetic patients with and without diabetic foot syndrome compared with healthy controls.These results align with those reported in the literature, in which the overexpression of miR-217-5p and miR-503-5p in the context of diabetic foot is reported. The identification of these epigenetic modifications could therefore be helpful in the early diagnosis of diabetic foot and the treatment of risk factors. However, further studies are necessary to confirm this hypothesis.

Classification of Diabetic Foot Thermal Images Using Deep Convolutional Neural Network

Diabetic foot (DF) is one of the most common chronic complications of poorly controlled diabetes mellitus (DM). Early diagnosis of DF and effective treatment is usually difficult by traditional approaches. Lately, it has been found a strong relationship between temperature variation and diabetic foot ulcer emergence. Thus, the current study focused on monitoring the temperature of feet using thermal images and its analysis techniques. The proposed system was based on employing a deep convolutional neural network (CNN) on thermal foot images. Experimental results showed that the proposed CNN has a maximum accuracy of 99.3% with minimum losses. When comparing the proposed system to other relevant systems, the proposed system approved greater accuracy, lower elapsed and testing time, which offers an automatic diagnostic tool for the diabetic foot and differentiates between its types. Thus, a simple, cost-effective, and accurate computer aided design (CAD) system could be presented to get a valuable system for the clinicians in hospitals.

Identifying patterns in multiple biomarkers to diagnose diabetic foot using an explainable genetic programming-based approach

Diabetes mellitus is a global health problem, recognized as the seventh cause of death in the world. One of the most debilitating complications of diabetes mellitus is the diabetic foot (DF), resulting in an increased risk of hospitalization and significant morbidity and mortality. Amputation above or below the knee is a feared complication and the mortality in these patients is higher than for most forms of cancer. Identifying and interpreting relationships existing among the factors involved in DF diagnosis is still challenging. Although machine learning approaches have proven to achieve great accuracy in DF prediction, few advances have been performed in understanding how they make such predictions, resulting in mistrust of their use in real contexts. In this study, we present an approach based on Genetic Programming to build a simple global explainable classifier, named X-GPC, which, unlike existing tools such as LIME and SHAP, provides a global interpretation of the DFU diagnosis through a mathematical model. Also, an easy consultable 3d graph is provided, which could be used by the medical staff to figure out the patients’ situation and take decisions for patients’ healing. Experimental results obtained by using a real-world dataset have shown the ability of the proposal to diagnose DF with an accuracy of 100% outperforming other techniques of the state-of-the-art.

Diabetic foot thermal image segmentation using Double Encoder-ResUnet (DE-ResUnet)

The use of thermography in the early diagnosis of Diabetic Foot (DF) has proven its effectiveness in identifying areas of the plantar foot that are susceptible to ulcer development. Segmentation of the foot sole is one of the most pertinent technical issues that must be performed with great precision. However, because of the inherent difficulties of foot thermal images, such as unclarity and the existence of ambiguities, segmentation approaches have not demonstrated sufficiently accurate and reliable results for clinical use. In this study, we aim to develop a fully automated, robust and accurate segmentation of the diabetic foot. To this end, we propose a deep neural network architecture adopting the encoder-decoder concept called Double Encoder-ResUnet (DE-ResUnet). This network combines the strengths of residual network and U-Net architecture. Moreover, it takes advantage of RGB (Red, Green, Blue) colour images and fuses thermal and colour information to improve segmentation accuracy. Our database consists of 398 pairs of thermal and RGB images. The population includes two groups. The first group of 54 healthy subjects. And a second group of 145 diabetic patients from the National Hospital Dos de Mayo in Peru. The dataset is splitted into 50% for training, 25% for validation and the last 25% is used for testing. This proposed model provided robust and accurate automatic segmentations of the DF and outperformed other state of the art methods with an average intersection over union (IoU) of 97%. In addition, it is able to accurately delineate the part of toes and heels which are high risk regions for ulceration.

Diabetic wound healing approaches: an update.

Diabetic wounds are of profound clinical importance. Despite immense efforts directed towards its management, it results in the development of amputations, following a diagnosis of diabetic foot. With a better understanding of the complexities of the microbalance involved in the healing process, researchers have developed advanced methods for the management of wounds as well as diagnostic tools (especially, for wound infections) to be delivered to clinics sooner. In this review, we address the newer developments that hope to drive the transition from bench to bedside in the coming decade.

Diagnosis of Diabetic Foot

The diabetic foot is a commonly encountered problem in surgical practice. Since treatment of the diabetic foot is quite complex, its management can mandate a multidisciplinary approach, including vascular surgery, acute care surgery, intensive care, podiatry, internal medicine, endocrinology, infectious disease, nursing, case management, and social work. This review highlights some of the details of the diagnosis of the diabetic foot from such an approach. This review contains 10 figures and 30 references Key words: diabetic foot ulcer, infection, ischemia, off-loading, revascularization

Diagnosis of Diabetic Foot

Diagnosis of Diabetic Foot

Diagnosis of Diabetic Foot

Diagnosis of Diabetic Foot

Anatomical 3D Modeling Using IR Sensors and Radiometric Processing Based on Structure from Motion: Towards a Tool for the Diabetic Foot Diagnosis.

Medical infrared thermography has proven to be a complementary procedure to physiological disorders, such as the diabetic foot. However, the technique remains essentially based on 2D images that display partial anatomy. In this context, a 3D thermal model provides improved visualization and faster inspection. This paper presents a 3D reconstruction method associated with temperature information. The proposed solution is based on a Structure from Motion and Multi-view Stereo approach, exploiting a set of multimodal merged images. The infrared images were obtained by automatically processing the radiometric data to remove thermal interferences, segment the RoI, enhance false-color contrast, and for multimodal co-registration under a controlled environment and a ∆T < 2.6% between the RoI and thermal interferences. The geometric verification accuracy was 77% ± 2%. Moreover, a normalized error was adjusted per sample based on a linear model to compensate for the curvature emissivity (error ≈ 10% near to 90°). The 3D models were displayed with temperature information and interaction controls to observe any point of view. The temperature sidebar values were assigned with information retrieved only from the RoI. The results have proven the feasibility of the 3D multimodal construction to be used as a promising tool in the diagnosis of diabetic foot.

BACTERIOLOGICAL PROFILE OF DIABETIC FOOT INFECTIONS AND ITS EFFECTS ON LIMB SALVATION

Objective: To assess the bacteriological profile of infected diabetic foot and its relationship with limb salvation among the patients treated for diabetic foot infection at a tertiary setup.Study Design: Correlational study.&#x0D; Place and Duration of Study: Department of Surgery, Pak Emirates Military Hospital Rawalpindi, from Dec 2018 to Mar 2019.&#x0D; Methodology: A total of 160 cases of infected diabetic foot were included in the study. Diagnosis of diabetic foot was made by the consultant surgeon and bacteriological analysis was done on the specimen by the microbiology laboratory of the same hospital. Relationship of bacteriological profile and other socio-demographic factors was assessed with limb salvation in these patients.&#x0D; Results: There were 121 (75.6%) male patients while females were 39 (24.4%). Commonest organism found was Staphylococcus aureus 49 (30.6%) which was followed by pseudomonas 39 (24.4%). Out of 160 patients treated for the diabetic foot infection, 71 (48.4%) had to undergo the process of limb salvation while 89 (51.6%) were managed conservatively. Poly-microbial infection and raised body mass index (BMI) were significantly associated with limb salvation in the target populace (p-value &lt;0.05).&#x0D; Conclusion: This study depicted high frequency of patients undergoing limb salvation due to diabetic foot infections in our setup. Patients with raised body mass index and those with poly-microbial infection on the culture should be specially attended in order to avoid this irreversible damage to the patient in the process of saving his life from the infective process.

Triple assessment for addressing trio-pathy in diabetic foot – Rapid screening tool for amputation prevention in govt. Hospital setting

Introduction: The present study was done to perform foot examination using Amit Jain’s Triple Assessment screening tool on in-patients in surgical wards. Materials and Methods: A descriptive retrospective study was done at Gajra Raja Medical College, Gwalior (M.P.) in department of surgery during a period from April 2018 to June 2018 on patients of diabetic foot admitted in all six units of surgical wards. Results: A total of 72 patients were included in this study as per search in case records. Majority of patients had diabetes of more than ten years duration and males were more commonly affected. All patients had diagnosis of diabetic foot with varied spectrum of associated lesions alone or in combination. Surgical debridement (66.66%) was the commonest procedure done in these patients. The affected foot of all patients was examined, with component assessment of feeling pedal pulses done in 86.11% cases and testing for sensation was done in 25% cases. In contralateral foot 58% patients were examined, in similar percentage pedal pulses were examined and foot sensations were not tested in any of them. Conclusion: Despite foot examination being of paramount importance it is often incomplete and inadequate in diabetic foot subjects as is also evident from observations of present study. Amit Jain’s Triple assessment of diabetic feet is a rapid inexpensive screening tool for obtaining basic foot information in order to segregate at risk feet and offer preventive care against amputation. Keywords: Amit Jain, Assessment, Triple, Diabetic foot, Trio-pathy, Screening, High risk foot.

Diabetic foot as a complication of diabetes

AdmissionDiabetic foot is a chronic complication of diabetes. Is a shallow or deep skin ulcer. It can occur with both type 1 and type 2 diabetes. Diabetic foot can appear in anyone with diabetes. This condition is associated with all kinds of complications or pathological changes that are a direct result of diabetes. Patients also complain of ulcers, infections and neurogenic arthropathy also known as Charcot's joints. Aim The aim of the study is to analyze the diabetic foot as a complication of diabetes.Material and method Review of available literature on the subject.ResultsAlong with the diagnosis of diabetic foot, doctors classify the disease according to the Wagner classification, i.e. a 6-point scale. The division of the diabetic foot syndrome takes into account the assessment of blood supply, the size and penetration of the ulcer, as well as the severity of the infection and the occurrence of diabetic neuropathy. The first grade of diabetic foot syndrome is free of signs and symptoms of infection, as there is no infection. In the second degree, the infection is local and covers only the skin and subcutaneous tissue, without involvement of deeper tissues and without systemic symptoms. In the third degree of diabetic foot syndrome, a local infection is present without involvement of deeper tissues with erythema over 2 cm in diameter.fascia. The fourth degree of diabetic foot syndrome is characterizedsevere infection, including local lesions in combination with systemic symptoms.ConclusionsDiabetic foot is treated primarily by leveling diabetes and maintaining normal glycemia. In the case of large ulcers, a visit to a surgeon will be required who will develop the ulcer and recommend further action. Also, if you get an infection you will need to take by mouthantibiotic therapy or appropriate topical preparations. Diabetic foot syndrome is just one of many complications of untreated diabetes that can lead to disability or even premature death. This should be a cautionary tale for people who disregard the need for systematic blood glucose control.

Demographic and socioeconomic profiles of patients admitted with diabetic foot complications in a tertiary hospital in Belem - Para.

to assess the socioeconomic and demographic profiles of patients hospitalized with a diagnosis of diabetic foot in a tertiary hospital in Belem-PA, Brazil, as well as to evaluate risk factors for lower limb amputations in such patients, classifying them according to the Wagner and PEDIS classifications. we conducted a descriptive, cross-sectional, unicentric, and analytical study carried out through a structured questionnaire. the study consisted of 57 patients, aged between 48 and 84 years old, 66.7% being male. The average income ranged between one and three (61.4%) minimum wages and below one minimum wage (31.6%). Type II Diabetes Mellitus was predominant (86.0%). Concerning comorbidities, arterial hypertension displayed the highest proportion (62.3%), followed by dyslipidemia (52.8%). Smokers comprised 35.1% of the sample. Infectious diabetic foot (50.9%) and mixed diabetic foot (49.1%) were the most common. Of the 20 patients with previous amputation, 90% had undergone minor amputation, and 10%, major ones. Callosity (92.6%) was the most prevalent deformity. Fifty-four (94.7%) patients underwent surgery, those being debridement (24.1%), minor amputation (37.0%) and major amputation (38.9%). During hospitalization, 78.9% of individuals did not require ICU stay. Hospitalization time varied between three and 59 days, and 78.9% of hospitalized patients did not progress to death, but 43.1% of patients submitted to major amputations died. patients with diabetic foot followed-up have a low socioeconomic profile; most of them underwent surgical procedures, whether major or minor, due to the higher prevalence of infectious diabetic foot and/or non-adherence to non-operative treatment.

İl Geneli Eğitim Araştırma Hastanelerinde Diyabetik Ayak Yarası Tanı ve Tedavi Süreçlerinin Değerlendirilmesi ve Süreçlere Yeni Bir Bakış Açısı Gerekliliği

İl Geneli Eğitim Araştırma Hastanelerinde Diyabetik Ayak Yarası Tanı ve Tedavi Süreçlerinin Değerlendirilmesi ve Süreçlere Yeni Bir Bakış Açısı Gerekliliği

Healing of diabetic ulcers in conditions of biological stimulation of reparation

Purpose of study. The repertory effect evaluation of autologous platelet-rich plasma in the treatment of patients with diabetic foot in stage 2.&#x0D; Materials and methods. The study included 32 patients with diagnosisof diabetic foot in stage 2. At the time of inclusion in the study, all patients had a defect of the skin and subcutaneous fat on the foot, measuring 3–6 cm2, which was not corrected by traditional methods for 3–4 months. The comparison group consisted of 18 patients (56,25%) who received standard therapy. The study group consisted of 14 patients (43,75%), to whom standard therapy was supplemented by local serial administration of autologous platelet-rich plasma. To assess the effectiveness of the therapy, the area of the ulcerative defect was measured before manipulation, as well as at 1 week intervals until the ulcer was completely healed.&#x0D; Results. Our experience with autologous platelet-rich plasma in the treatment of patients with diabetic foot in stage 2 demonstrated the effectiveness of this technique. A progressive, significant (p &lt; 0,01) decrease in the area of the ulcerative defect starting from the 14th day was noted. When using platelet-rich plasma, we managed to achieve complete healing of diabetic ulcers in 64,2% of patients on day 35 and in 100% of patients on day 42.&#x0D; Conclusion. Local administration of an autologous platelet-rich plasma allows the complete healing of diabetic ulcers in stage 2 with an area of 3–6 cm2 for 6 weeks.

Role of Recent Imaging Modalities in Diagnosis of Diabetic Foot

Role of Recent Imaging Modalities in Diagnosis of Diabetic Foot

Limb Salvage in Diabetic Patients with No-Option Critical Limb Ischemia: Outcomes of a Single Center Experience

Objective: To describe the characteristics, the management and the outcome of a consecutive series of patients with diabetic foot (DF) and no-option critical limb ischemia (CLI) treated with a multidimensional, interdisciplinary approach in a dedicated center. Research Design and Methods: The prospective database of the Diabetic Foot Unit of the Maria Cecilia Hospital (Cotignola, Italy) collects medical history, risk factors, chemistry values, angiographic data, characteristic of foot lesions, medical and surgical therapies of all patients admitted with diagnosis of DF and CLI. All patients were followed-up for at least one year and/or total recovery. The primary endpoint was one-year amputation-free survival (AFS), secondary endpoints were limb salvage and survival. Results: Between October 2014 and October 2017, 1024 patients with DF and CLI were admitted to the center. Eighty-four of them (8.2%) fulfilled the criteria for no-option CLI. At one year, AFS, limb salvage, and survival rates were 34%, 34% and 83%, respectively. Lesions located proximal to Lisfranc joint were associated with major amputation (HR 2.1 [1.2-3.6]). One-year survival of patients treated with minor procedures was significantly higher compared to patients treated with major amputation (96% vs 76%, log rank p=0.019). Major amputation was independently associated with mortality (HR 7.83 [1.02-59.89]). Conclusions: The application of dedicated and standardized strategies permitted limb salvage in one-third of patients with no-option CLI. Patients with stable lesions limited to the forefoot and without ischaemic pain had greater probability to successfully receive conservative treatments. Limb salvage was associated with subsequent higher one-year survival. Funding Statement: The authors declare: None. Declaration of Interests: The authors report no relationships that could be construed as a conflict of interest. Ethics Approval Statement: Clinical and procedural data from all patients admitted to Diabetic Foot Unit of the Maria Cecilia Hospital (Cotignola, Italy) are recorded in a dedicated clinical database and accurately verified for completeness and accuracy against the patients’ clinical charts. Patients are prospectively followed up for at least 12 months. The analysis was based on current clinical practice, therefore the regulatory authorities required an ordinary written informed consent to procedures and data collection, which was obtained from all patients. The protocol of the study was in accordance with the Declaration of Helsinki.