Foot Ulcer Patients Research Articles

Risk factors of foot ulcers in patients with end-stage renal disease on dialysis: A meta-analysis.

The present study aims to assess the risk factors for foot ulcers in patients undergoing dialysis for end-stage renal disease (ESRD) and to provide evidence-based guidance for prevention and treatment. A systematic search was conducted on PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Data from the database inception until May 2023 to identify relevant studies investigating the risk factors for foot ulcers in dialysis patients with ESRD. Two independent researchers conducted the literature screening and data extraction. The meta-analysis was performed using STATA 17.0 software. Ultimately, six articles comprising 1620 patients were included for analysis. The meta-analysis revealed that male (OR, 1.464; 95% CI: 1.082-1.980, p = 0.013), hypertension (OR, 1.781; 95% CI: 1.293-2.4550, p < 0.001), peripheral artery disease (PAD) (OR, 5.014; 95% CI: 2.514-9.998, p < 0.001), type 1 diabetes mellitus (T1DM) (OR, 2.993; 95% CI: 1.477-6.065, p = 0.002) and type 2 diabetes mellitus (T2DM) (OR, 2.498; 95% CI:1.466-4.256, p = 0.001) were risk factors for foot ulcers in dialysis patients with ESRD. Conversely, the female sex (OR, 0.683; 95% CI: 0.505-0.924, p = 0.013) was a protective factor against foot ulcers. Our analysis revealed that male sex, hypertension, PAD, T1DM and T2DM were risk factors for foot ulcers in patients undergoing dialysis for ESRD. Conversely, the female sex was a protective factor against foot ulcers. Therefore, it is crucial to strengthen health education that targets patients with these risk factors and regularly screen high-risk individuals. Early detection and treatment can help delay disease progression.

THE RISK FACTOR OCCURING DIABETIC FOOT ULCER IN TYPE II DIABETES MELLITUS PATIENTS: LITERATURE REVIEW

Type II diabetes continues to increase in prevalence and incidence. One of the important complications of diabetes type II is diabetic foot ulcer, which is a growing public health problem and is a leading cause of amputations and death in diabetic patients. So it is necessary to know what causes diabetic foot ulcers to remain vigilant and prevent this condition. The method used in the preparation of this research is a Literature Review by analyzing several articles that have been determined. This study consisted of ten articles which were analyzed using the manual screening concerning the inclusion and exclusion criteria. The variables studied were neuropathy, duration of diabetes mellitus, foot care, and age. In this study, the results of three articles discussing neuropathy, seven articles discussing the duration of diabetes mellitus, six articles discussing foot care, and four articles discussing age with the occurrence of diabetic foot ulcers. Conclusion: In this study, factors associated with the occurrence of diabetic foot ulcers in patients with type II diabetes were neuropathy, duration of diabetes, foot care, and age.

The skin autofluorescence of advanced glycation end-products relates to the development of foot ulcers in type 2 diabetes: A longitudinal observational study

ObjectivesThe long-term glycemic memory contributes to vascular complications in type 2 diabetes, including those patients with Diabetic Foot Ulcers (DFU). We investigated whether the skin autofluorescence (SAF) of Advanced Glycation End-products related to later DFUs. Research design & methodsSAF was measured with an AGE-Reader in a retrospective cohort of patients hospitalized from 2009 to 2017 for Type 2 Diabetes. New DFUs were registered until the year 2020 and survival analyses were performed. ResultsThe 517 patients (men: 58.0 %), were 62 ± 9 years old at baseline, with a duration of diabetes of 14 ± 10 years, HbA1c: 8.7 ± 1.8 %, complications included 33.8 % macroangiopathies, 44.9 % diabetic kidney diseases and 26.7 % retinopathies. According to the IWGDF classification, the grades of risk for DFU were 0 for 43.2 %, 1 for 23.9 %, 2 for 7.2 %, and 3 for 25.7 %. During the 53 months of follow-up, 58 new DFUs occurred, mostly in patients with SAF higher than its median value (2.65 AU). Adjusted for age and sex, conventional risk factors (duration and control of diabetes, arterial hypertension, dyslipidemia, smoking), and other complications (macroangiopathy, diabetic kidney disease, retinopathy), SAF related to later DFUs. Adjusted for the IWGDF classification, SAF related to new DFUs (HR: 1.81, 95%CI:1.25–2.62). This relationship was significant for the 403 subjects without previous history of DFU (HR: 2.32, 95%CI: 1.36–3.95). SAF did not predict recurrence for patients with a previous history of DFUs. ConclusionSAF, a simple non-invasive marker of glycemic memory, independently predicts the occurrence of a first foot ulcer in patients with Type 2 Diabetes.

Association between diabetic retinopathy and diabetic foot ulcer in patients with diabetes: A meta-analysis.

This study aimed to explore the relationship between diabetic retinopathy (DR) and diabetic foot ulcers (DFUs) to provide evidence for the prevention of diabetic complications. PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chinese Biomedical Literature Database and Wanfang Data databases were searched from their inception until March 2023 for studies on the relationship between DR and DFU. Two researchers independently screened the literature and extracted data according to the inclusion and exclusion criteria. The meta-analysis was performed using the RevMan 5.3 software. Eleven articles referring to 10 208 patients were included, of whom 2191 patients had DFU and 8017 patients did not have DFU. The meta-analysis results showed that DR significantly increased the incidence of DFU (47.94% vs. 16.38%; OR, 4.13; 95% CI, 2.33-7.33; p < 0.001). The results of this study suggest that patients with DR have a higher risk of developing DFU, highlighting the importance of regular screening for these two complications to prevent serious adverse outcomes of diabetes. However, further high-quality studies are required to validate the conclusions of the present study.

Tingkat Pengetahuan Pasien Diabetes Melitus pada Pencegahan Luka Kaki Diabetes

Diabetes mellitus is a chronic disease characterized by elevated blood glucose levels and is the most common disease encountered by the wider community. The most common complication in patients with diabetes mellitus is diabetic foot ulcers. The level of knowledge in people with diabetes mellitus has an important role in preventing diabetic foot ulcers. This study aims to determine the relationship between the level of knowledge of diabetes mellitus patients on the prevention of diabetic foot ulcers at the Kassi-Kassi Public Health Center, Makassar City. The research design used in this study is a correlation design and uses a cross sectional approach. The determination of the sample was carried out by purposive sampling technique with a sample size of 43 people. The correlation test was performed using the Fisher Exact Test statistical test with a significance level of &lt; 0.05. The results showed that there was a significant relationship between the level of knowledge and the prevention of diabetic foot ulcers (p = 0.20 &lt; 0.05). The conclusion of this study is that there is a relationship between the level of knowledge and prevention of diabetic foot ulcers in patients with diabetes mellitus at the Kassi-Kassi Public Health Center Makassar City.

Deep Learning-Based Classification and Feature Extraction for Predicting Pathogenesis of Foot Ulcers in Patients with Diabetes.

The World Health Organization (WHO) has identified that diabetes mellitus (DM) is one of the most prevalent disease worldwide. Individuals with DM have a higher risk of mortality, and it is crucial to prioritize the treatment of foot ulcers, which is a significant complication associated with the disease, as they lead to the development of plantar ulcers, which results in the need to amputate part of the foot or leg. People with diabetes are at risk of experiencing various complications, such as heart disease, eye problems, kidney dysfunction, nerve damage, skin issues, foot ulcers, and dental diseases. Unawareness of the risk associated with diabetic foot ulcers (DFU) is a significant contributing factor to the mortality of diabetic patients. Evolving technological advancements such as deep learning techniques can be used to predict the symptoms of diabetic foot ulcers as early as possible, which helps to provide effective treatment to DM patients. This research introduces a methodology for analyzing images of foot ulcers in diabetic patients, focusing on feature extraction and classification. The dataset used in this study was collected from historical medical records and foot images of patients with diabetes, who commonly experience foot ulcers as a major complication. The dataset was pre-processed and segmented, and features were extracted using a deep recurrent neural network (DRNN). Image and numerical/text data were extracted separately, and the normal and abnormal diabetes ranges were identified. Foot images of patients with abnormal diabetes ranges were separated and classified using a pre-trained fast convolutional neural network (PFCNN) with U++net. The classification procedure involves the analysis of foot ulcers to predict their pathogenesis. To assess the effectiveness of the proposed technique, the study presented simulation results, including a confusion matrix and receiver operating characteristic curve. These results specifically focused on predicting two classes: normal and abnormal diabetes foot ulcerations. The analysis yielded various parameters, including accuracy, precision, recall curve, and area under the curve. The main goal of the study was to introduce an novel technique for assessing the risk of foot ulceration development in patients with diabetes, leveraging the analysis of foot ulcer images. The researchers collected a dataset of foot images and medical data from historical records of patients with diabetes and pre-processed and segmented the data. They then used a deep recurrent neural network to extract features from the segmented data and identified normal and abnormal diabetes ranges based on numerical and text data. Foot images of patients with abnormal diabetes ranges were classified using a pre-trained fast convolutional neural network with U++net to examine foot ulcers and forecast the development of the risk of diabetic foot ulcers (DFU). The study assessed the accuracy of the proposed technique as 99.32% by simulating results for feature extraction and the classification of diabetic foot ulcers. A comparison was made between this proposed technique and existing approaches.

Examination Findings of Type 2 Diabetes Patients’ Feet with and without Ulcers

Objective: We conducted this study to determine the factors that cause foot ulcers in patients with type 2 diabetes mellitus (DM) with or without diabetic foot ulcer (DFU). Methods: This cross-sectional, descriptive study compared the feet examination results of 43 Type 2 DM patients with or without DFU. The study data were collected using a patient identification form and a diabetic foot examination form. Data are presented as percent, mean, and standard deviation. Chi-square and Fisher’s exact tests were used for statistical analysis. The statistical significance level was taken as p&lt;0.05. Results: Of the patients, 63% were male, 79% were married, their mean age was 63.16±9.43, and the mean diabetes year was 18.44±7.77. 74% of the patients had a previous DFU. Of the existing DFU, 58% were on the right foot, 49% were on the toes, 49% were Wagner grade 2, and 37% were infected. There was edema and warmth in the DFU foot (p&lt;0.05). DFU foot had a weaker sense of touch and vibration than the other. Ankle-Brakial Index was below 0.9. Foot pulses were weak, and there were deformities. Conclusion: Patients with DFU feet have an increased risk of recurrent ulcer formation. These patients should be followed periodically and educated about ulcer formation and signs and symptoms of infection.

Medial Arterial Calcification and the Risk of Amputation of Diabetic Foot Ulcer in Patients With Diabetic Kidney Disease.

We assessed the risk factors for major amputation of diabetic foot ulcers (DFUs) in patients with diabetic kidney disease (DKD) stages 3b-5. For DFU assessment, in addition to DFU location and presence of infection, ischemia, and neuropathy, vascular calcification was assessed using the medial arterial calcification (MAC) score. Of 210 patients, 26 (12.4%) underwent major amputations. Only the location and extension of DFU, represented by Texas grade differed between the minor and major amputation groups. However, after adjusting for covariates, ulcer location of mid- or hindfoot (vs. forefoot, odds ratio [OR] = 3.27), Texas grades 2 or 3 (vs. grade 0, OR = 5.78), and severe MAC (vs. no MAC, OR = 4.46) was an independent risk factor for major amputation (all P < 0.05). The current use of antiplatelets was a possible protective factor for major amputations (OR = 0.37, P = 0.055). In conclusion, DFU with severe MAC is associated with major amputation in patients with DKD.

Evaluation of Risk Factors for Foot Ulceration in Individuals with Chronic Kidney Disease

Introduction. CKD, like DM, is an independent risk factor for the development and course of foot ulcers. Objective. The authors studied the incidence and risk factors of foot ulceration in patients with CKD and with or without DM and in patients receiving or not receiving HD. Materials and Methods. Patients with or without DM and with renal failure were divided into 4 groups of 40 patients each according to whether or not they were receiving HD. Data were collected using a patient information form, physical examination of the foot, and risk assessment forms. Results. Lower extremity ulceration was highest in group 3 (HD+DM+) (15% [6 of 40]), that is, in patients with CKD and DM receiving HD (P = .421). Patients in group 3 were at highest risk for foot ulcers (72.5%) compared with other groups (P = .001). Risk factors associated with foot ulceration were advanced stage (ie, stage 4 or 5) CKD, HD treatment, age, BMI, history of lower extremity ulceration and/or amputation, foot deformities, skin and nail pathology, neuropathy, and vascular insufficiency. Conclusions. Patients with CKD receiving HD are at high risk for foot ulcers, and this risk increases with the presence of DM.

Risk Factors of Diabetic Foot Ulcers in Type 2 Diabetes Mellitus Patients: Basis for Foot Care Education

the seventh largest number of diabetic patientsand diabetes is also the third cause of death after stroke andhypertension.Diabetic Foot Ulcers (DFU) are common cause of diabetes mellitus complications.Foot problemsoften receive less attention and it is not the priority for many health professionals in Indonesia. Diabetic foot ulcersare preventable through Diabetes Foot Care Education.Aim:The study aimed to assess risk factors of Diabetic Foot Ulcers in patients with Type 2 Diabetes Mellitus anddevelop an appropriate diabetic foot care education.Methodology: This study used prospective research design and conducted atWocare Diabetic Clinic in BogorIndonesia.Study populations will be all Type 2 Diabetes Mellitus patients with a total sample of 48patients. Ordinaland nominal data were described by absolute values and percentage while continuous data was reported as meanand standard deviation. Univariate data was analyzed by χ2 test or Fisher exact test for categorical and Wilcoxontest for continuous data. The significance level will be set at 95% with p-value=0.05.Result:There was an increase in the average diabetic foot care behavior before and after education with a meanvalue of 79.6 to 79.9.The results of the Wilcoxon test showed a p-value of 0.000.Conclusion:There was a significant difference between behavioral scores before and after intervention with footcare education.

Phenotypic and Genotypic Virulence Characterisation of Staphylococcus pettenkoferi Strains Isolated from Human Bloodstream and Diabetic Foot Infections

Staphylococcus pettenkoferi is a recently described coagulase-negative Staphylococcus identified in human diseases, especially in infections of foot ulcers in patients living with diabetes mellitus. To date, its pathogenicity remains underexplored. In this study, whole-genome analysis was performed on a collection of 29 S. pettenkoferi clinical strains isolated from bloodstream and diabetic foot infections with regard to their phylogenetic relationships and comprehensive analysis of their resistome and virulome. Their virulence was explored by their ability to form biofilm, their growth kinetics and in an in vivo zebrafish embryo infection model. Our results identified two distinct clades (I and II) and two subclades (I-a and I-b) with notable genomic differences. All strains had a slow bacterial growth. Three profiles of biofilm formation were noted, with 89.7% of isolates able to produce biofilm and harbouring a high content of biofilm-encoding genes. Two virulence profiles were also observed in the zebrafish model irrespective of the strains' origin or biofilm profile. Therefore, this study brings new insights in S. pettenkoferi pathogenicity.

Identification and antibiotic susceptibility of microorganisms isolated from diabetic foot ulcers: A pathological aspect.

Diabetic foot ulcers infected with microorganisms increase the risk of amputation. The presence of drug-resistant bacteria in diabetic foot ulcers creates a big challenge during the treatment. The objective of the present study was to determine the bacterial prevalence and antibiotic resistance among bacteria isolated from Chinese patients with diabetic foot ulcers. The present study studied the microbial colonization of diabetic foot ulcers of patients from a single center in China. Wound swabs from 89 patients with diabetic foot ulcers were collected and the presence of microorganisms detected. The isolated microorganisms were subjected to antibiotic susceptibility testing by the disk diffusion method. Of 89 patients, 56 (62.9%) were male and 33 (37.1%) were female, the mean age of patients was 53.2±5.4 years, the mean duration of diabetes was 14.8±2.9 years, the mean random blood sugar was 301±87 mg/dl, mean HbA1c was 7.9±1.4%. Patients with Wanger ulcer grade III (36.0%; P=0.034) and patients within the weight range of 51-75 kg (59.6%; P=0.012) were significantly higher. The prevalence rate of diabetic foot ulcers was 11.3%. Among 153 microorganisms, gram-positive bacteria (52.3%) were more prevalent than gram-negative bacteria (44.4%). Most of the patients with polymicrobial infection were classified to have Wanger III ulcer grade diabetic foot ulcers. Staphylococcus aureus (38.2%) was the most predominant bacteria isolated followed by Staphylococcus epidermidis (29.2%) and Escherichia coli (28.1%). Most of the gram-positive and gram-negative bacteria were resistant to dicloxacillin (73.8%, P=0.021) and cefotaxime (50%), respectively and ~53.4% of the isolates were multi-drug resistance isolates, 61.8% of the Staphylococcus aureus were identified as methicillin-resistant Staphylococcus aureus and 61.8% of the gram-negative bacteria were extended-spectrum β-lactamase producers. Staphylococcus aureus and Escherichia coli were the predominant gram-positive and gram-negative bacteria isolated, respectively. Penicillin resistance was significantly higher among the gram-negative bacteria (P=0.019). Staphylococcus aureus and Escherichia coli were the predominant gram-positive and gram-negative bacteria isolated and levofloxacin and nitrofurantoin were the most effective antibiotics among the gram-positive and gram-negative bacterial isolates, respectively.

The Effectiveness Of Using Learning Media To Increase Knowledge And Preventive Measures Of Diabetic Foot Ulcers In Patients With Diabetes Mellitus

Background : Diabetic foot ulcer is one of the complications of DM's disease. Prevention of diabetic foot ulcers can be done by providing health education to improve the knowledge, attitudes, or actions of patients with diabetes mellitus but it is very necessary to provide a health education in order to be able to understand and able to do it. In fact diabetic ulcer numbers are increasing. It is necessary to increase the method and media delivery of the health education. Objective: The literature of this review aims to be to know the effectiveness of the use of media learning towards increased knowledge and preventive measures of diabetic foot ulcers as well as finding similarities, differences, advantages and disadvantages of the journals in review. Methods: This study uses review literature designs obtained from Google Scholar sources. The key word in this review literature search is the prevention of diabetic foot ulcers with dependent variable use of learning media and independent variables of knowledge and action. Results: Out of 5 studies gained 3 national journals and 2 international journals with the result that health education using the media has a significant influence on knowledge, attitude, and practice.

Diabetic foot exercise training for diabetes mellitus patients to control blood glucose during the COVID-19 pandemic

Physical activity restriction during the pandemic increases the risk of developing diabetic foot ulcers in patients with diabetes mellitus. Community service activities in the form of diabetic foot exercise training aim to increase knowledge and blood glucose control of diabetic mellitus patients' during the pandemic. The activities were carried out in the Tlogorejo and Madulegi villages in Sukodadi Primary Health Care for 60 patients with diabetes mellitus who are members of prolanis. Community service activities include health education about diabetes and foot care, foot exercise training and physical examination, and fasting blood glucose testing. Post-test results showed that 80% of the participants had good knowledge, 15% had sufficient knowledge, and 5% lacked knowledge. Most participants could do foot exercises, and the average fasting blood glucose level of the participants after being given counseling and training was 171.60 mg/dL. Foot exercise training can increase participants' knowledge and can be used as a way to control blood glucose during the COVID-19 pandemic.

Clinical Characteristics of Diabetic Patients with Initial and Recurrent Foot Ulcers

To explore the risk factors for the recurrence of foot ulcers by analyzing clinical characteristics of the patients with diabetic foot ulcers (DFU) in West China Hospital, Sichuan University. A retrospective analysis was carried out with the clinical data of 817 DFU patients hospitalized at West China Hospital, Sichuan University between January 1, 2012 and December 31, 2020. The patients were divided into an initial ulceration group (502 cases) and a recurrent ulceration group (315 cases) according to their history of foot ulcers. The differences in clinical characteristics between the two groups were compared, and multivariate logistic regression analysis was conducted to identify the risk factors associated with the recurrence of foot ulcers. Initial and recurrent DFU patients both had predominantly neuro-ischemic foot ulcers, and the most common sites of ulceration were the first and fifth toes in both groups. Compared with the initial DFU group, more patients in the recurrent group had foot ulcers of Wagner grade 3 and ulcerous wounds located on calluses ( P<0.05), and fewer patients in the recurrent group suffered from foot gangrene ( P<0.05). Patients with recurrent DFU had lower glycated hemoglobin, platelet counts, and fibrinogen levels ( P<0.05), and higher serum uric acid and creatinine levels ( P<0.05). Hemoglobin, white blood cell count, estimated glomerular filtration rate, erythrocyte sedimentation rate and C-reactive protein levels were not significantly different between the two groups ( P>0.05). Multivariable logistic regression analysis showed that male sex ( OR=1.555, 95% CI: 1.097-2.204, P=0.013), duration of diabetes≥10 years ( OR=2.369, 95% CI: 1.473-3.810, P<0.001), history of amputation ( OR=4.518, 95% CI: 2.386-8.553, P<0.001), foot osteoporosis ( OR=1.711, 95% CI: 1.065 to 2.751, P=0.027), ulcerous wound located on foot callus ( OR=1.786, 95% CI: 1.058-3.012, P=0.030), and coronary heart disease ( OR=0.668, 95% CI:0.453-0.987, P=0.043) were significantly associated with the recurrence of foot ulcers. Male sex, duration of diabetes being over 10 years, history of previous amputation, foot osteoporosis, and ulcerous wounds located on foot callus are independent risk factors of recurrent foot ulcers in patients with DFU. Therefore, even after their foot ulcers have healed, special attention should be given to the care of foot for patients with DFU, which may reduce the recurrence of foot ulcers.

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.

A Pilot Study Comparing a Micronized Adipose Tissue Niche versus Standard Wound Care for Treatment of Neuropathic Diabetic Foot Ulcers.

Numerous studies have demonstrated the various properties of micronized adipose tissue (MAT), including angiogenic, anti-inflammatory, and regenerative activities, which can be helpful in wound healing. This exploratory clinical trial aimed to report the efficacy and safety of MAT niche for treating diabetic foot ulcers. Twenty subjects were randomly divided into MAT niche treatment (n = 10) and control groups (n = 10). All patients were followed up weekly for 16 weeks. We evaluated the efficacy of the MAT niche treatment by assessing the (1) reduction in wound area after 4 weeks and (2) percentage of patients who achieved complete wound closure after 16 weeks. All possible adverse events were recorded. The wound area was reduced by 4.3 ± 1.0 cm2 in the treatment group and by 2.0 ± 1.1 cm2 in the control group (p = 0.043). Complete wound healing was achieved after 16 weeks in eight out of 10 patients (80%) in the treatment group and three out of six (50%) in the control group (p = 0.299). No serious adverse events related to MAT niche treatment were observed. Although the present study’s findings do not support the use of this therapy to treat foot ulcers of patients with diabetes owing to the small number of patients included and the absence of statistical significance, the results of this pilot preliminary study are promising in that MAT niche autografts may offer the possibility of a simple and effective treatment for diabetic ulcers. Further follow-up studies with a larger number of patients are required to validate our findings.

Acute diabetic foot in post kidney transplantation patients receiving chronic immunosuppression-clinical presentation and outcomes.

Data regarding diabetic foot ulcers in patients after solid organ transplantation, particularly kidney transplantation, are limited. Chronic immunosuppression may be associated with impaired wound healing and a higher risk of amputations. In this study, we characterised the clinical presentation and outcomes of patients after kidney transplantation admitted to the diabetic foot unit, compared to non-kidney-transplant patients. Data on the baseline characteristics, clinical presentation, and outcomes of all patients admitted to the diabetic foot unit of a large tertiary centre between the years 2014 and 2019 were collected. The most recent admission of each patient was considered. Primary outcomes were major amputations and 1year mortality rate. During the study period, 537 patients were hospitalised, 18 of them were receiving immunosuppressive therapy due to kidney transplantation. Baseline characteristics of the patients were broadly similar, except that smoking was reported by 22.0% of the non-transplant patients and by none of the post-transplant patients (p=0.01). Post-transplant patients tended to be younger (59.4±11.1 vs. 65.3±12.2; p=0.07), were more likely to have type-1 diabetes (16.7% vs. 5.2%; p=0.07) and had lower glucose levels upon admission (9.4±4.3 vs. 12.0±6.4mmol/L; p=0.07). Overall, 30% of the patients underwent major amputation, in-patient mortality rate was 9.3%, and 1year mortality rate was 27.2%. Rates were similar in the post-transplant versus the non-post-transplant patients (p=0.83, 1.00, 0.59, respectively). Post-transplant patients did not incur worse outcomes in spite of immunosuppressive therapy. Limb salvage efforts should be pursued in these patients similar to the overall population.

Long-term Outcomes of Patients Undergoing Partial Calcanectomy

Long-term Outcomes of Patients Undergoing Partial Calcanectomy

Risk factors for foot ulcer recurrence in patients with comorbid diabetic foot osteomyelitis and diabetic nephropathy: A 3-year follow-up study.

This study aimed to explore the risk factors for foot ulcer recurrence in patients with comorbid diabetic foot osteomyelitis (DFO) and diabetic nephropathy (DN). This is a prospective cohort study. Between May 2018 and May 2021, we selected 120 inpatients with comorbid severe diabetic foot infection (PEDIS Grade 3 or above) and DN for inclusion in our study. All cases were followed up for 36 months. The study outcomes were whether foot ulcer recurred and the time to recurrence. The risk factors of ulcer recurrence were analysed by comparing the data of the three groups. According to the recurrence of foot ulcer, the participants were divided into three groups: Group A (no foot ulcer recurrence, n=89), Group B (foot ulcer recurrence within 12-36 months, n=19) and Group C (foot ulcer recurrence within 6-12 months, n=12). The multivariate Cox regression analysis showed that urine albumin-creatinine ratio (UACR) (HR: 1.008, 95% CI: 1.005-1.011, P < .001) and vibration perception threshold (VPT) (HR: 1.064, 95% CI: 1.032-1.096, P < .001) were identified as independent risk factors. Kaplan-Meier curves showed a significant positive association between UACR or VPT and the risk of foot ulcer recurrence (log rank, all P < .05). Areas under the ROC curves for UACR, VPT and the combination of UACR and VPT were 0.802, 0.799 and 0.842, respectively. The best cut-off values of UACR and VPT were 281.51 mg/g and 25.12 V, respectively. In summary, elevated UACR and VPT were independent risk factors. The best clinical cut-off values of UACR and VPT for prediction of foot ulcer recurrence were 281.51 mg/g and 25.12 V, respectively. Besides, our results suggested that microcirculation disorders rather than macrovascular complications play a major role in the recurrence of foot ulcer in patients with comorbid DFO and DN.