Lower Limbs Of Diabetic Patients Research Articles

Association of Balance with Somatosensory Loss of Lower Limb in Diabetic Patients

Background: Diabetes, a prevalent global health issue, notably in Pakistan, poses significant challenges in healthcare management due to its complications, including impaired balance and increased fall risk. Objective: This study aimed to investigate the association between balance impairment and somatosensory loss in diabetic patients, focusing on the impact of aging and gender differences. Methods: A cross-sectional study was conducted over six months at Akhtar Seed Trust Teaching Hospital, Lahore, involving 600 participants. The Berg Balance Scale (BBS) and Rivermead assessments were used to evaluate balance and somatosensory loss. Participants included males and females aged above 25, with stratification into positive and negative cases based on their balance and somatosensory status. Results: Of the 600 participants (224 males, 376 females), 150 were categorized as positive cases, showing significant balance impairment. The BBS assessment revealed that two-point discrimination was more affected compared to vibratory sense and proprioception. The study found a statistically significant association between somatosensory loss and balance impairment, irrespective of age and gender. Conclusion: The study concludes that there is a significant correlation between somatosensory loss and balance impairment in diabetic patients, with aging and gender playing a lesser role. These findings underscore the need for targeted balance and sensory training in diabetic care to reduce fall risks.

LncRNA SNHG16 Knockdown Promotes Diabetic Foot Ulcer Wound Healing via Sponging MiR-31-5p.

Diabetic foot ulcers are caused by nerve abnormalities and vascular lesions in the distal lower limbs of diabetic patients. However, the causes of diabetic foot ulcers are diverse and the treatment process is complex. Therefore, understanding the pathogenesis of diabetic foot ulcers through lncRNA and formulating effective means are the key to the cure of patients. Tissues were collected from 76 diabetic foot ulcer patients and 50 non-diabetic patients undergoing traumatic amputation. Human dermal fibroblasts (HDFs) were induced by high glucose to obtain diabetic foot ulcer cell model. The lncRNA SNHG16 (SNHG16) and miR-31-5p expression in tissues and cells was detected by real-time quantitative reverse transcription PCR (RT-qPCR). Cell Counting Kit-8 (CCK-8) and Transwell assays were used to evaluate the biological behavior of the cells, and the association between SNHG16 and miR-31-5p was explored by luciferase reporting assay. SNHG16 was distinctly expressed in diabetic foot ulcer tissue samples, while miR-31-5p was decreased. In vitro cell function assays confirmed that the proliferation level was inhibited in the constructed diabetic foot ulcer cell model (HG group), as was the migration and invasion ability. After transfection with silencing SNHG16, the biological behavior of the cells was promoted. Mechanistically, SNHG16 sponge miR-31-5p regulated disease progression. Recovery experiments revealed that miR-31-5p inhibitor counteracted the effect of silencing SNHG16 on cell viability. SNHG16 knockdown may regulate the biological function of cells by targeting miR-31-5p to promote wound healing and ameliorate the condition of diabetic foot ulcer patients.

Midterm Results of Endovascular Management of Multilevel Arterial Disease in Lower Limb in Diabetic Patients

Midterm Results of Endovascular Management of Multilevel Arterial Disease in Lower Limb in Diabetic Patients

Перебіг та ефективність лікування варикозної хвороби вен нижніх кінцівок у хворих на цукровий діабет

Актуальність. Цукровий діабет 2-го типу (ЦД2) є чинником ризику артеріосклерозу нижніх кінцівок, а зв’язок зі станом венозного басейну судин ніг залишається вивченим недостатньо, не з’ясовано ефективність хірургічних методів лікування хворих із варикозом. Мета дослідження: проаналізувати характер перебігу варикозної хвороби вен ніг та ефективність лікувальних заходів на тлі ЦД2. Матеріали і методи. Під наглядом перебувало 302 хворі (75 чоловіків і 227 жінок віком 29–72 роки), 16 % з яких раніше перенесли флеботромбоз, а частота II–VI класів венозної недостатності становила відповідно 10, 14, 37, 16 і 23 %. Ендовенозну лазерну коагуляцію виконано 263 пацієнтам, а 39 — традиційну флебектомію або лігування перфорантів. Результати. Серед обстежених хворих на варикозну хворобу вен нижніх кінцівок ЦД2 виявлено в 9 % випадків, частіше у чоловіків і пацієнтів старших вікових груп на тлі атеросклерозу судин ніг (здухвинних, стегнових, гомілкових, підколінних артерій), що супроводжувалося частішим залученням до процесу великої підшкірної вени та приустєвим її розширенням, переважанням тяжких класів венозної недостатності, значно гіршими результатами хірургічного лікування варикозу та більшою частотою розвитку ускладнень, незважаючи на частіше фонове використання рівароксабану і низькомолекулярних гепаринів, а ефективність ендовенозної лазерної абляції за чотири тижні після її проведення поступається показнику в групі без ЦД2, при цьому рівень глікемії обернено корелює з показником поверхневого натягу венозної крові, що має прогностичну значущість у контексті подальших лікувальних заходів. Висновок. Наявність ЦД2 є чинником ризику тяжкого перебігу варикозу вен ніг, негативним фактором щодо прогнозу ефективності хірургічного лікування цього захворювання й числа ускладнень.

Eficácia do hidratante Regenèr emulsão em pacientes diabéticos

This study aimed to evaluate the effectiveness of Regenèr Emulsion moisturizer in the process of regeneration and maintenance of skin health in the lower limbs of patients with Diabetes Mellitus. Qualitative, exploratory, case-study research, carried out in a public hospital in Greater Florianópolis, Santa Catarina, between August and October 2020. The results reported by the patients were the reduction of dryness of the skin on the legs and/or feet or xerosis, improvement in skin color related to diabetic dermopathy lesions, improvement in skin sensitivity and resistance, reduction of itching, reduction of skin discomfort and discomfort, as well as improvement in the skin and its color, when compared to the initial day and the day end of treatment. It is concluded that the study has great relevance for the field of nursing, it presents an approach to preventive care and effective hydration for maintaining the quality of the skin of the lower limbs of diabetic patients.

Treatment of Diabetic Lower Limb Wounds with Ozonized Sunflower Oil and Collagenase

Scientific studies have proven that ozone presents benefits as a therapeutic agent when used according to well-defined protocols and safe in the health field, it can be a potent oxidant known. The objective of this research was to verify the effectiveness of the treatment with ozonized sunflower oil in cutaneous wounds of diabetic lower limbs, how to isolate and identify the microorganisms present in the wound before and during the treatments, and quantitative evaluating by measuring the diameters of the same. The present research was approved by the Unicastelo Ethics in Research Committee under the number of the opinion 168.652/2012. 6 patients were selected from the municipality of Fernandópolis - SP, and 9 patients in the city of Jales - SP, randomly divided into 2 groups. The curatives were performed by a single trained and calibrated examiner in the homes of each patient being. The research included two groups: group 1 = treatment ozonized sunflower oil (n = 8) and group 2 = treatment with collagenase (n = 7). Weekly samples were collected with sterile swab for culture, isolation and identification of microorganisms present in the wounds. It was found that the ozonized sunflower oil was effective in healing of wounds in the lower limbs of diabetic patients, while collagenase induced healing of certain injuries and other injured areas were increased. It can be concluded that the ozonized sunflower oil caused change in microbiological pattern, which was not seen in patients treated with collagenase. Keywords: Diabetic foot, Ulcer, Natural compound, Conventional compound, Ozone therapy, Antioxidant action, Healing. Read more →

Chinese Association of Orthopaedic Surgeons (CAOS) clinical guideline for the treatment of diabetic foot ulcers using tibial cortex transverse transport technique (version 2020)

Ilizarov discovered the phenomenon of rich vascular network formation during distraction osteogenesis for limb regeneration and functional reconstruction. The tension-stress rule could activate and enhance the regenerative potentials of living tissues, leading to growth or regeneration of muscles, fascia, blood vessels, and nerves simultaneously. Orthopaedic surgeons in China applied the tibial cortex transverse transport (TTT) technique to reconstruct limb microcirculation, to treat lower extremity microvascular lesions and diabetic foot ulcers since 2001. Clinical studies from China demonstrated that the TTT technique could effectively regenerate the microvascular network in the lower limbs of diabetic patients, promote ulcer healing and reduce the amputation rate. As a novel treatment for severe Diabetic Foot Ulcers (DFU), the TTT technique may be adopted in different countries to benefit DFU patients worldwide. This guideline is initiated by the Chinese Association of Orthopaedic Surgeons (CAOS) TTT Technique for Diabetes Foot Taskforce Group. This guideline provides clear recommendations for indications, contraindications, principles for surgical procedures, preoperative and postoperative management, which maximize the success rate for TTT surgery in treatment of severe DFU. This guideline provides clear recommendations for indications, contraindications, principles for surgical procedures, preoperative and postoperative management, which maximize the success rate for TTT surgery in severe DFU treatment. This guideline serves as a starting reference for those who are interested or about to carry out TTT surgery. As an alternative novel treatment for severe DFU, we hope that the TTT technique may be adopted in different countries soon to benefit DFU patients worldwide.

Objectivization of vacuum-compression therapy effects on micro- and macrovascular perfusion in type 2 diabetic patients.

The present study aimed to evaluate the characteristic influence of physical therapeutic procedures of vacuum-compression therapy (VCT) on microvascular perfusion (MiP) and macrovascular perfusion (MaP) of the lower limb in diabetic patients. A sample of nine patients with a medical history of type 2 diabetes was used for the purpose of this study. Most of the subjects' medical conditions included venous and neurological complications of the lower limb, whereas the rest of the subjects entered the treatment due to injury recovery or their phlebological disease. The PeriFlux System 5000 (Perimed, Sweden) diagnostic device was used to measure MiP. The MaP was evaluated based on the perfusion index (PI) using the Extremiter monitoring device (Embitron, Czech Republic) designed to perform VCT procedures. The study found that MiP and MaP increase as an effect of VCT procedures and at the same time PI clearly reflects the effect of the applied vacuum and compression phases, verifying the method's vital influence on peripheral perfusion disorders.

VARIATIONS IN DORSALIS PEDIS ARTERY

Introduction: Dorsalis pedis artery is the chief artery of the dorsum of foot and is the artery of choice for grafting in vascular surgery of ischemic lower limbs in diabetic patients. Material & Methods: Dorsalis pedis artery was dissected and traced during routine cadaveric dissection in 41 foots. Observation & Results: We observed origin of dorsalis pedis artery from peroneal artery in 2.44% cases. Five branches from dorsalis pedis artery were observed in 2.44% and 6 branches in 2.44% cases. Conclusion: Study of variation in origin and branching pattern of dorsalis pedis artery is helpful in delimiting the graft

Outcomes of Management of Necrotizing Soft Tissue- Infections in Lower Limbs of Diabetic Patients

Necrotizing soft tissue infection (NSTI) of the lower limb in diabetic patients (pts) is a common serious problem and is often associated with serious complications such as increased morbidity and mortality. The study aimed to assess 3 years (yrs) experience of NSTI and to review treatment and outcome in diabetic pts at Al Thoura Teaching Hospital between May 1ST 2014 –30th April 2017, over a period of 3 yrs.24 cases of NSTI of lower limbs in diabetic pts were admittedin the period of MAY 1ST 2014 –30th April 2017. Assessment and analyzing details about their presentation, clinical features, predisposing factors, treatment offered, and outcomes were performed .16 male and 8 female pts with a mean age of 56.4 yrs (range of 39- 78 yrs) were included . Majority of patients were in the age group of 50 to 70 yrs. The most important risk factors were (glycosylated HbA1c > 9.5% in 91.66%), smoking (58.33%), hypertension and hyperlipidemia (66.66% & 83.33% respectively). Neuropathy was found in 62.5% and PVD in 50%. The total involved feet are 27. The port of infection was mostly by previous unhealed feet ulcer 48.1%. The most operated surgical procedure is aggressive frequent necrectomy (51%). Multiple toes amputations and extended tarsal amputation were needed in 29.6% and 20.8% respectively. The need for grafting, flap advancement after surgical control of infection was needed in 6 cases. The failure rate of conservative surgery was 11.11%. Complete healing was in 70.37% of cases. The morbidity rate was high in all patients in this study 92.59%. The mortality rate was 3.7%. We conclude that NSTI of lower limbs is a life-threatening infective condition, common among diabetic patients, and early diagnosis with immediate and frequent surgical debridement could reduce systemic complications, morbidity, and mortality considerably.

Outcome of patients undergoing amputation for diabetic foot ulcer

Background: Foot ulcers are the principal cause of severe complications and hospitalization among patients with diabetes, substantially increasing the costs with this disease. Peripheral neuropathy, ulceration, infection, and peripheral vascular disease are the principal factors for ulcer complications and loss of a lower limb in diabetic patients. The aim of the present endeavor was to study the patients undergoing amputation for the diabetic foot ulcer.Methods: Total 150 patients with diabetic foot ulcer were included in this study. The variables investigated were related to diabetes, infection, and surgical treatment. In our series amputation were done at different levels anatomical levels ranging from toe level ranging from toe level to above knee amputation.Results: Pus culture and sensitivity done for diabetic foot ulcers reveal E. coil as the most common organism (40%). Skin biopsy done in these patients reveal neuropathic changes in 102 patients. 40% of patients had vaso-occlusive disease. Nine out of 150 patients showed osteomyelitis changes emphasizing those diabetic ulcer patients are prone for osteomyelitis of the underlying bone. 46% of patients with diabetic foot ulcer needed either minor or major amputation, which correlates with the standard study.Conclusions: Lack of awareness about diabetes mellitus and its lower limb complications, poor compliance to the treatment, poorly controlled blood sugar levels, delay in diagnosis, and late presentation to the tertiary care center are all factors which led to the occurrence of diabetic foot ulcer.

Vascular factors and neuropathy in lower limb of diabetic patients

Asymmetric clinical presentation in some patients with diabetic polyneuropathy may result from the different vascular environments in both lower limbs. The aim of the study is to determine the association of neuropathy with vascular factors in each lower limb of diabetic patients. A total of 102 patients (204 lower limbs) given a diagnosis of diabetic polyneuropathy were enrolled. The primary end points are sensory nerve action potential (SNAP) amplitude and conduction velocity (CV) of the sural nerve and independent variables are vascular and nonvascular factors. Vascular factors include mean arterial pressure and pulse pressure at the ankle, ankle-brachial index, and arterial stiffness assessed by pulse wave velocity. Nonvascular factors include age, gender, height, body weight, body mass index, total cholesterol, and hemoglobin A1C. Age, hemoglobin A1C, and ankle pulse pressure were inversely correlated with SNAP amplitude of the sural nerve, while no factors were correlated with CV of the sural nerve. Increased arterial stiffness was significant in the limbs group with abnormal SNAP amplitude of the sural nerve, while increased height was significant in the limbs group with abnormal CV of the sural nerve. Vascular factors were more significantly associated with decreased SNAP amplitude rather than decreased CV of the sural nerve in the nerve conduction study of diabetic patients.

Patency of Reverse Saphenous Vein Graft for Revascularization of Lower Limbs in Diabetic Patients

Objectives: Diabetic patients are prone to early development of vasculopathy, resulting in lower limb ischemia, which can lead to non-healing ulcers, foot infection, loss of limb, and even death. These patients need revascularization of their limb either using endovascular or open surgical techniques. Not all patients are suitable for endovascular treatment warranting the open surgical revascularization techniques.

Marine Omega3 wound matrix for the treatment of complicated wounds

Summary Introduction Complicated wounds in the lower extremity can arise as a consequence of insufficient soft-tissue coverage after amputations in diabetic patients. The Kerecis® Omega3 wound matrix is a decellularized skin matrix derived from codfish and represents an alternative treatment option to achieve wound healing. Methods 5 patients with diabetes mellitus and complicated wounds in the lower limb with exposed bony segments were treated with the Omega3 wound matrix between November 2014 and November 2015. Following initial debridement in the operating room, the wound matrix was applied and covered with a silicone mesh. In the further course, wound treatment was conducted on outpatient setting. Results In total, 7 wounds were treated with localization at the level of the thigh (n=2) and the forefoot (n=5). For the wounds at the thigh, it took 26 weeks to achieve wound closure, whereas the wounds at the level of the forefoot showed healing times between 13 and 41 weeks. In all patients, a reduction of analgetics intake was noted when the treatment with the Omega3 wound matrix was initiated. Conclusion The Kerecis® Omega3 wound matrix represents a viable treatment option in complicated wounds in the lower limb of diabetic patients to circumvent an otherwise necessary proximalization of amputation level. Further studies comparing the Omega3 wound matrix with appropriate control groups of standard therapies for soft-tissue conditioning/coverage like negative pressure therapy, biosurgery and other acellular dermal matrices are warranted.

Development of the Tardivo Algorithm to Predict Amputation Risk of Diabetic Foot.

Diabetes is a chronic disease that affects almost 19% of the elderly population in Brazil and similar percentages around the world. Amputation of lower limbs in diabetic patients who present foot complications is a common occurrence with a significant reduction of life quality, and heavy costs on the health system. Unfortunately, there is no easy protocol to define the conditions that should be considered to proceed to amputation. The main objective of the present study is to create a simple prognostic score to evaluate the diabetic foot, which is called Tardivo Algorithm. Calculation of the score is based on three main factors: Wagner classification, signs of peripheral arterial disease (PAD), which is evaluated by using Peripheral Arterial Disease Classification, and the location of ulcers. The final score is obtained by multiplying the value of the individual factors. Patients with good peripheral vascularization received a value of 1, while clinical signs of ischemia received a value of 2 (PAD 2). Ulcer location was defined as forefoot, midfoot and hind foot. The conservative treatment used in patients with scores below 12 was based on a recently developed Photodynamic Therapy (PDT) protocol. 85.5% of these patients presented a good outcome and avoided amputation. The results showed that scores 12 or higher represented a significantly higher probability of amputation (Odds ratio and logistic regression-IC 95%, 12.2–1886.5). The Tardivo algorithm is a simple prognostic score for the diabetic foot, easily accessible by physicians. It helps to determine the amputation risk and the best treatment, whether it is conservative or surgical management.

Motor strategy patterns study of diabetic neuropathic individuals while walking. A wavelet approach

The aim of this study was to investigate muscle׳s energy patterns and spectral properties of diabetic neuropathic individuals during gait cycle using wavelet approach. Twenty-one diabetic patients diagnosed with peripheral neuropathy, and 21 non-diabetic individuals were assessed during the whole gait cycle. Activation patterns of vastus lateralis, medial gastrocnemius and tibialis anterior were studied by means of bipolar surface EMG. The signal׳s energy and frequency were compared between groups using t-test. The energy was compared in each frequency band (7–542Hz) using ANOVAs for repeated measures for each group and each muscle. The diabetic individuals displayed lower energies in lower frequency bands for all muscles and higher energies in higher frequency bands for the extensors׳ muscles. They also showed lower total energy of gastrocnemius and a higher total energy of vastus, considering the whole gait cycle. The overall results suggest a change in the neuromuscular strategy of the main extensor muscles of the lower limb of diabetic patients to compensate the ankle extensor deficit to propel the body forward and accomplish the walking task.

Dermatomycosis in lower limbs of diabetic patients followed by podiatry consultation

BackgroundDiabetic patients are particularly susceptible to fungal infections due to modifications that occur in their immunological system. These modifications compromise natural defences, such as skin and nails, especially from lower limbs. AimsAssessing the presence of dermatomycosis in lower limbs of Portuguese diabetic patients followed on Podiatry consultation. Determination of possible predisposing factors and the most frequent fungal species associated with the cases are included in the study. MethodsA six-month prospective study was carried out in 163 diabetic patients with signs and symptoms of dermatomycosis followed by Podiatry at the Portuguese Diabetes Association in Lisbon. Samples from the skin and/or nails of the lower limbs were collected and demographic and clinical data of those patients were recorded. ResultsTrichophyton rubrum was the most frequently isolated dermatophyte (12.1%), followed by Trichophyton mentagrophytes (7.7%) and Trichophyton tonsurans (4.4%). Our study showed positive associations between type 2 diabetes and the presence of dermatomycosis in the studied population (p=0.013); this association was also shown between the occurrence of dermatomycosis and the localization of the body lesion (p=0.000). No other predisposing factor tested was positively associated with infection (p>0.05). ConclusionsData on superficial fungal infections in diabetic patients are scarce in Portugal. This study provides information on the characterization of dermatomycosis in lower limbs of diabetic patients.

Role of Ultrasound Arterial Mapping in Planning Therapeutic Options for Critical Ischemia of Lower Limbs in Diabetic Patients

To assess the role of ultrasound arterial mapping in planning therapeutic options for critical limb ischemia (CLI) in diabetic patients. This observational and comparative study included 244 patients with CLI. All participants (64% were diabetic) underwent ultrasound arterial mapping before planning surgical treatment. We established two groups: diabetic (n = 156) and nondiabetic (n = 88). Arterial mapping was divided into segments. We studied 2,021 individual segments and used arteriography when ultrasound arterial mapping was not conclusive. We compared the degree of pathology between the groups, agreement between the treatment decision made after ultrasound mapping and the final surgical decision in both groups, and agreement between ultrasound mapping and arteriography in patients who underwent both procedures. Diabetic patients had a significantly higher degree of pathology in all segments, except the common iliac artery. Decisions made after ultrasound mapping matched the final surgical decision 90% and 94% of the time in diabetic patients and nondiabetic patients, respectively. Decisions made on the basis of ultrasound arterial mapping matched decisions made on the basis of arteriography in 86.3%. Ultrasound arterial mapping allowed for good therapeutic planning for CLI in diabetic patients, even though these patients had more severe arterial pathology.

Determination of the Augmentation Effects of Hyaluronic Acid on Different Heel Structures in Amputated Lower Limbs of Diabetic Patients Using Ultrasound Elastography

This study measured tissue properties of different anatomies of heels in amputated lower limbs of diabetic patients before and after hyaluronic acid (HA) or normal saline (NS) injections. Seven amputated lower limbs from six diabetic patients constituted the experimental group and one amputated lower limb from a diabetic patient served as the control. The limbs were placed in a fixation platform. A 5–12 MHz linear-array ultrasound transducer controlled by a stepping motor was used to load and unload tested heels. The loading-unloading velocity was 6 mm/s and the maximum loading stress was 178 kPa. Loading-unloading tests were performed before and after 1 mL HA injections into heels in the experimental group. The control limb underwent the same test before and after 1 mL NS injection. The unloaded thickness and Young‘s modulus of the macrochambers, microchambers and heel pads were determined before and after the interventions. The unloaded thickness of the macrochambers and the heel pad increased significantly (p = 0.012) after HA injection. The Young’s modulus of the macrochambers decreased nonsignificantly after HA injections. Similar thickness and tissue stiffness changes were observed in the control limb. The baseline heel-pad energy dissipation ratio (EDRhp) was 81.3 ± 1.3% and decreased significantly (p = 0.012) to 73.1 ± 1.7% after HA injections. The EDRhp in the control increased after NS injection. Histologic examinations revealed localized HA accumulation in the macrochambers with an extension into the adjacent fibrous septa. Injection of HA can increase tissue thickness and enhance heel-pad tissue resilience.

Lower Limb Vascular Disease in Diabetic Patients:: A Study with Calf Compression Contrast-enhanced Magnetic Resonance Angiography at 3.0 Tesla

To retrospectively analyze the significance of 3.0-T contrast-enhanced (CE) magnetic resonance angiography (MRA) with calf compression in the lower limbs of diabetic patients with peripheral vascular disease. Sixty-one type 2 diabetes patients underwent both MRA and digital subtraction angiography (DSA) within 1 week. The patients were divided into two groups: one with (pressure) and one without (conventional) calf compression during MRA. Two radiologists evaluated the quality of MRA images and compared the two groups. Cohen's kappa statistic was used to determine the concordance between MRA and DSA. Image quality in the calf and foot was better in the group with calf pressure than the conventional group without applied pressure (P = .001 [calf], 0.008 [foot]). Significantly more runoff vessels in the calf were detected with MRA than with DSA (P = .0043 [conventional], 0.0031 [pressure]). The kappa values were 0.928 in the conventional group and 0.979 in the pressure group, but in the conventional group, the diagnostic accuracy of CE-MRA was lower than that of DSA (P = .002). Diagnostic accuracy in the pressure group was significantly higher than that in the conventional group (P = .009). The overall sensitivity and specificity for >50% stenosis or occlusion was 93.8% and 98.5%, respectively, in the conventional group and 98.7% and 99.6%, respectively, in the pressure group. With calf compression, venous overlap (P = .0396, .0425) and deep vein overlap (P = .022, .022) were significantly reduced in the leg and foot. Calf compression with 3.0-T CE-MRA was convenient and practical and could improve image quality and diagnostic accuracy in diabetic patients with peripheral vascular disease by reducing venous overlap.