Outcome Of Ulcers Research Articles

Advancements in Managing Wound Biofilm: A Systematic Review and Meta-analysis of Randomized Controlled Trials on Topical Modalities.

Despite numerous available agents claiming anti-biofilm properties on wounds, the substantiating evidence remains inconclusive. This study aimed to assess the immediate impact of topical wound treatments on wound biofilm and healing outcomes in acute and chronic ulcers. We comprehensively searched PubMed, ClinicalTrials.gov, and Google Scholar. In addition, eligible gray literature was incorporated. English-language randomized controlled trials (RCTs), observational, cohort, and case-control studies targeting biofilm prevention, inhibition, or elimination across diverse wound types were included. Primary outcomes included biofilm presence and elimination, supplemented by secondary outcomes encompassing reduced wound size, complete closure, and diminished infection indicators. Bacterial load reduction and biofilm presence were also assessed. Twenty-eight articles met the inclusion criteria. Various modalities were identified, including biofilm-visualization techniques, such as wound blotting and handheld autofluorescence imaging. Pooled analysis for the primary outcomes was infeasible due to limited eligible studies and data-reporting challenges. As for the secondary outcomes, the pooled analysis for complete surgical wound closure (2 RCTs, yielding n=284) and presence of surgical site infections/inflammation (2 RCTs, yielding n=284) showed no significant difference, with a log odds ratio (LOD) of 0.58 (95% confidence interval [CI]: -.33, 1.50) and LOD -0.95 (95% CI: -3.54, 1.64; τ2 = 2.32, Q = 2.71, P = .10), respectively. Our findings suggest insufficient evidence to support anti-biofilm claims of topical modalities. Clinicians' skill appears to play a pivotal role in biofilm elimination and wound healing enhancement, with potential optimization through visual-guided techniques, such as wound blotting and autofluorescence imaging. More rigorous clinical trials are warranted to ascertain the efficacy of these techniques.Level of Evidence: Therapeutic, 1A.

The Association of the Neutrophil-Lymphocyte Ratio With Diabetes Mellitus and Diabetic Foot Ulcer: A Review Article

Introduction: Diabetes mellitus (DM) is inappropriately elevated blood glucose levels. Diabetic foot ulcer (DFU) is the most common complication of diabetes mellitus. Many research studies was found that neutrophil lymphocyte ratio (NLR) have positive correlation with HBA1C, blood glucose, and outcome of diabetic foot ulcer. Methods: The literature searches using online databases such as PubMed, ScienceDirect Elsevier, and Google Schoolar. Result: After doing an online search, we found 39 articles were relevant for this review topic. Analysis: Many research studies have found increased HbA1C (≥6,5) and increased blood glucose (random blood glucose ≥ 200mg/dL and/or fasting blood glucose ≥126 mg/dL) in patients with diabetes mellitus have a positive correlation with increased NLR. And there was increased NLR values in patients with diabetic foot ulcer and NLR values was higher (NLR≥6) in non-healing ulcers than in healing ulcers. Conclusion: NLR can be used as screening tool for determining evaluation of diabetes mellitus and as screening tool for determining outcome of diabetic foot ulcers.

Use of consecutive transcutaneous oxygen measurement when assessing the need for revascularization and association with the outcomes of ischemic diabetic ulcers.

This study compared the ankle-brachial index (ABI) with transcutaneous oxygen pressure (TcPO2 ) in assessing peripheral vascular disease (PVD) prevalence in 100 diabetic foot ulcer (DFU) patients. Patients were categorized into vascular or nonvascular reconstruction groups and underwent both ABI and TcPO2 measurements four times over 6 months. Predictive validity for PVD diagnosis was analysed using the area under the receiver-operating characteristic curve (AUC). The study found TcPO2 to be a superior predictor of PVD than ABI. Among the DFU patients, 51 with abnormal TcPO2 values underwent vascular reconstruction. Only TcPO2 values showed significant pretreatment differences between the groups and increased post-reconstruction. These values declined over a 6-month follow-up, whereas ABI values rose. For those with end-stage renal disease (ESRD), TcPO2 values saw a sharp decrease within 3 months. Pre-reconstruction TcPO2 was notably lower in amputation patients versus limb salvage surgery patients. In conclusion, TcPO2 is more effective than ABI for evaluating ischemic limb perfusion and revascularization necessity. It should be prioritized as the primary follow-up tool, especially for ESRD patients.

Association between physical activity levels and healing in people with venous leg ulcers: secondary analysis of prospective cohort data.

To explore the relationship between physical activity levels and wound healing and recurrence in people with venous leg ulcers. Questionnaires and medical records were used to collect data, with responses used to group participants into different physical activity groups. The differences in healing and recurrence outcomes of ulcers among different physical activity groups were compared using Chi-square, Kaplan Meier survival analysis, Cox proportional hazards regression analysis, and Kruskal-Wallis test. To measure the strength of the association between physical activity levels and patient outcomes, Spearman's Rho tests were used. We used descriptive analysis to examine how physical activity levels change over 24 weeks. Participants were classified into four distinct groups based on physical activity levels reported at baseline and week 12. The survival analysis showed higher physical activity level was associated with a shorter time to healing (log-rank test = 14.78, df = 3; p = 0.002). The persistently moderate-to-vigorous group had a 7.3-fold increased likelihood of healing compared to the persistently sedentary group. High levels of physical activity were also associated with a better quality of life score at baseline ( = 0.41, p < 0.000), week 12 ( = 0.36, p < 0.001), and week 24 ( = 0.49, p < 0.000). Most participants (48.5%) reported low levels of physical activity, which remained low for the entire study period. An increased level of physical activity was linked to a shorter healing time and enhanced quality of life. Low levels of physical activity appeared common among people with venous leg ulcers.

Associations between specialty care and improved outcomes among patients with diabetic foot ulcers.

Specialty care may improve diabetic foot ulcer outcomes. Medically underserved populations receive less specialty care. We aimed to determine the association between specialty care and ulcer progression, major amputation, or death. If a beneficial association is found, increasing access to specialty care might help advance health equity. We retrospectively analyzed a cohort of Wisconsin and Illinois Medicare patients with diabetic foot ulcers (n = 55,409), stratified by ulcer severity (i.e., early stage, osteomyelitis, or gangrene). Within each stratum, we constructed Kaplan-Meier curves for event-free survival, defining events as: ulcer progression, major amputation, or death. Patients were grouped based on whether they received specialty care from at least one of six disciplines: endocrinology, infectious disease, orthopedic surgery, plastic surgery, podiatry, and vascular surgery. Multivariate Cox proportional hazard models estimated the association between specialty care and event-free survival, adjusting for sociodemographic factors and comorbidities, and stratifying on ulcer severity. Patients who received specialty care had longer event-free survival compared to those who did not (log-rank p<0.001 for all ulcer severity strata). After adjusting, receipt of specialty care, compared to never, remained associated with improved outcomes for all ulcer severities (early stage adjusted hazard ratio 0.34, 95% CI 0.33-0.35, p<0.001; osteomyelitis aHR 0.22, 95% CI 0.20-0.23, p<0.001; gangrene aHR 0.22, 95% CI 0.20-0.24, p<0.001). Specialty care was associated with longer event-free survivals for patients with diabetic foot ulcers. Increased, equitable access to specialty care might improve diabetic foot ulcer outcomes and disparities.

Neuropathic diabetic foot ulcers in the elderly: clinical outcomes and healing

There is little evidence on healing outcomes of neuropathic foot ulcers in elderly patients. Aims: To determine the healing rates of neuropathic diabetic foot ulcers at 12 and 24 weeks achieved by standard care provided at an established multidisciplinary diabetes foot clinic in patients aged 65 years and above. Data on the incidence of falls and hypoglycaemia were also collected due to their perceived clinical risk in the group studied. Methods: This was a retrospective observational study looking at clinical outcomes of neuropathic foot ulcers. Patients aged 65 years or more presenting with a non-infected neuropathic ulcer at the time of their initial review were identified and classified into two groups: Group E patients were aged above 80 years and Group Y patients 65-80 years. Results: A total of 97 patients, presenting with 106 ulcer episodes, were identified. Mean HbA1c was 60 mmol/mol in Group Y and 55 mmol/mol in Group E. Healing rates of all ulcers at 12 and 24 weeks in the elderly group lagged behind rates in the younger group (67.6% at 12 weeks and 73% at 24 weeks in Group E vs. 78.2% at both intervals in Group Y). The elderly group had more falls, 11% vs. 2% in Group Y. In all, 50% of the falls in Group E were attributed to their prescribed pressure relief (off-loading) devices. Conclusions: With standard foot care given in a multi- disciplinary foot service, neuropathic diabetic foot ulcers can heal in the elderly despite their age-related skin changes. The rate of healing of neuropathic ulcers noted in our study provides a benchmark for healing outcomes and enables comparison with other age groups and centres. Our study identifies a risk of falls associated with off-loading devices and highlights the need for structured falls risk and mobility assessments in this group.

A Cohort Study on the Outcome of Diabetic Foot Ulcers.

Diabetic foot ulcers (DFUs) represent a significant and challenging complication of diabetes mellitus, often leading to serious morbidity and a substantial burden on healthcare systems. The study was conducted with the objectives of evaluating the outcomes of DFUs. A cohort study was conducted to evaluate the outcomes of DFUs from May 2019 to May 2020 at a tertiary care hospital located in Chennai. The study included patients aged 18 to 90 yearswho were diagnosed with DFUs. Individuals with diabetic foot lesions (skin lesions such as fissures, abscess, cellulites) other than ulcers or those without diabetes were excluded. The data was collected from a total of 100 diabetic patients using systematic random sampling technique. The mean (SD) age of the study participants was 54.68 (6.72) years with males constituting 56% of the study population. Among 100 participants, 65% experienced healing while 35% did not. Logistic regression analysis showed that glycated haemoglobin (HbA1c) levels, age, and diabetes duration had significant effect on patient outcome. Logistic regression analysis showed that HbA1c levels, age, and diabetes duration had significant effect on patient outcome. Out of 12 patients with major amputation, seven (58.3%) survived, while out of 19 patients with minor amputations, 18 (94.7%) showed remarkably higher survival rate. Meanwhile, 100% survival rate was observed in patients with no amputation. The study's comprehensive assessment of risk factors and their associations with healing outcomes provides essential knowledge for clinical practice. The study findings collectively support the optimization of interventions and strategies to prevent and manage DFUs, ultimately improving patient care and enhancing their quality of life. The study highlights the significance of glycemic control and limb preservation in DFU management.

An integrated personalized assistive devices approach to reduce the risk of foot ulcer recurrence in diabetes (DIASSIST): study protocol for a multicenter randomized controlled trial

BackgroundPreventing foot ulcers in people with diabetes can increase quality of life and reduce costs. Despite the availability of various interventions to prevent foot ulcers, recurrence rates remain high. We hypothesize that a multimodal treatment approach incorporating various footwear, self-management, and education interventions that matches an individual person’s needs can reduce the risk of ulcer recurrence with beneficial cost-utility. The aim of this study is to assess the effect on foot ulcer recurrence, footwear adherence, and cost-utility of an integrated personalized assistive devices approach in high-risk people with diabetes.MethodsIn a parallel-group multicenter randomized controlled trial, 126 adult participants with diabetes mellitus type 1 or 2, loss of protective sensation based on the presence of peripheral neuropathy, a healed plantar foot ulcer in the preceding 4 years, and possession of any type of custom-made footwear will be included. Participants will be randomly assigned to either enhanced therapy or usual care. Enhanced therapy consists of usual care and additionally a personalized treatment approach including pressure-optimized custom-made footwear, pressure-optimized custom-made footwear for indoor use, at-home daily foot temperature monitoring, and structured education, which includes motivational interviewing and personalized feedback on adherence and self-care. Participants will be followed for 12 months. Assessments include barefoot and in-shoe plantar pressure measurements; questionnaires concerning quality of life, costs, disease, and self-care knowledge; physical activity and footwear use monitoring; and clinical monitoring for foot ulcer outcomes. The study is powered for 3 primary outcomes: foot ulcer recurrence, footwear adherence, and cost-utility, the primary clinical, patient-related, and health-economic outcome respectively.DiscussionThis is the first study to integrate multiple interventions for ulcer prevention into a personalized state-of-the-art treatment approach and assess their combined efficacy in a randomized controlled trial in people with diabetes at high ulcer risk. Proven effectiveness, usability, and cost-utility will facilitate implementation in healthcare, improve the quality of life of high-risk people with diabetes, and reduce treatment costs.Trial registrationClinicalTrials.gov NCT05236660. Registered on 11 February 2022.

Outcomes of heel ulcers in people with diabetes visiting tertiary care diabetes center of Karachi, Pakistan

Abstract Objective: To determine the outcome of heel ulcers in people with diabetes. Materials and Methods: This retrospective cohort study was conducted at the Diabetic Foot Department of Baqai Institute of Diabetology and Endocrinology (BIDE), Karachi. Ethical approval was obtained from the Institutional Review Board of BIDE. Relevant records of all patients of both genders with diabetes aged 18–80 years and ulcer over the heel visiting the Diabetic Foot Clinic from January 2016 to December 2020 were retrieved from the hospital management system of BIDE for evaluation. Pre-designed proformas were filled and Statistical Package for Social Science version 20 was used to analyze data. Results: Overall data of 1073 diabetic people with heel ulcers was retrieved, among them the mean age was 57.95 ± 11.96 years, and 715(66.6%) participants were male. Type 2 diabetes was found in 821 (97.9%) participants and 548 (65.6%) had &gt;10 years duration of diabetes. In regard to type of ulcer, 876 (81.6%) were neuropathic ulcers, 91 (8.5%) were ischemic, and 89 (8.3%) were neuroischemic ulcers. According to university of Texas classification wound classification, 725 (67.6%) fell in stage B followed by 238 (22.2%) in stage A. Regarding heel ulcer outcome, a majority of 459 (95.8%) healed without amputation and only 15 (3.1%) healed with major amputation. Conclusion: We found that the majority of the people with heel ulcers had a favorable outcome and healed without an lower extremity amputation.

Infectious and Noninfectious Corneal Ulcers in Ocular Graft-Versus-Host Disease: Epidemiology, Clinical Characteristics, and Outcomes

To evaluate the incidence, clinical characteristics, microbiological profile, and therapeutic outcomes of corneal ulcers in individuals with chronic ocular graft-vs-host disease (coGVHD). Retrospective clinical cohort study. Review of individuals diagnosed with coGVHD following hematopoietic stem cell transplantation (HSCT) who were seen at the Bascom Palmer Eye Institute between May 2010 and November 2021. Baseline demographics, clinical characteristics, microbiological profile, risk factors for corneal ulceration, and treatment outcomes were collected. Etiology was deemed infectious in individuals with a positive culture or appropriate clinical scenario (presence of stromal infiltrate or hypopyon); otherwise, ulcers were presumed to be noninfectious. Treatment success was defined as reepithelialization with infiltrate resolution, and treatment failure as progression to corneal perforation or keratoplasty. Kaplan-Meier survival analysis estimated the incidence of ulceration. Cox regression analyses examined demographic and risk factors. Infectious and noninfectious ulcer groups were compared using 2-way independent t tests, 1-way analysis of variances, and χ2 tests, as appropriate. 173 individuals were included (53.7±14.4 years old; 59.0% male). Thirty-three individuals developed an ulcer 74.5±54.3 months after HSCT, with estimated 5- and 10-year incidences of 14% and 30%, respectively. Twenty-two (66.6%) ulcers were deemed infectious (15 microbiologically confirmed, 7 clinically) and 11 (33.3%) were deemed noninfectious. Risk factors for corneal ulceration included Black race (hazards ratio [HR] 2.89, 95% CI 1.30-6.42, P < .01), previous ocular surgery (HR 9.16, 95% CI 3.86-21.72, P < .01), eyelid margin abnormalities (HR 3.44, 95% CI 1.69-6.99, P < .01), and topical steroid use (HR 2.74, 95% CI 1.33-5.62, P < .01). Conversely, contact lens use reduced the risk of corneal ulceration (HR 0.29, 95% CI 0.13-0.66, P < .01). Infectious ulcers had a significantly higher frequency of treatment failure than noninfectious ulcers (57.1% vs 20.0%, P=.04). Corneal ulceration is a potential complication of coGVHD, with several clinical features identified as risk factors. Infectious ulcers had worse outcomes than noninfectious ulcers.

Pharmacotherapeutic Management of Pressure Wound in Sushma Koirala Memorial Hospital

Background: Pressure ulcers are the serious kinds of wounds that get developed within the skin tissues. They affect larger surface areas of the body resulting severe pain in the infected body parts of the patients. Pressure wound, thus has been presented as one of the major health problem worldwide. This study was aimed to find out different aspects of pressure ulcer cases and outcomes in Sushma Koirala Memorial Hospital (SKMH). Along with this, the study was targeted to study major affected body part, role of diet in healing wounds, grades of pressure ulcers and medicines used during the management and treatment of such chronic wounds.&#x0D; Methods: A descriptive, unicentric, retrospective study was conducted in 2018 at Sushma Koirala Memorial Hospital. A total of 163 patient records from October 2016 to October 2018 were reviewed. The data was entered in SPSS 16 version for analysis.&#x0D; Results: Pressure ulcers were common among people from the age group 21-40 years. The males were more vulnerable than female. Most people stayed for 41-60 days while the most affected body part in many patients was the sacral region. Third grade sacral region pressure wound was mostly found in the admitted patients. Wounds and injuries were common cause for development of pressure ulcers. The usage of third generation cephalosporin- ceftriaxone was predominantly found during surgery as well as post-surgery. During surgery, most commonly used medications include fentanyl, paracetamol, midazolam and propofol. After surgery, analgesics like ketorolac, combination of ibuprofen and paracetamol were frequently used. For post-surgical condition, ceftriaxone, ascorbic acid, ranitidine and pantoprazole were mostly used. Patients with pressure ulcers were advised to take high protein diet.&#x0D; Conclusion: This study showed sacral region was most affected body part and grade 3 pressure wound were predominant in most of the admitted patients. Ceftriaxone was mostly prescribed antibiotics and combination of paracetamol and ibuprofen was mostly prescribed for analgesic effects.

Growth factors and their receptors in neuropathic diabetic foot ulcers of different durations

BACKGROUND. Growth factors play a leading role in wound healing. Their deficiency in diabetic foot syndrome has been demonstrated in experimental studies, most of them performed on acute wounds. At the same time, currently the effectiveness of local therapy with growth factors of this category of patients, as well as indications and contraindications to it are contradictory and are a subject for discussion. There is no data on the content of growth factors in diabetic foot ulcers of various durations. Meanwhile, the results obtained will help to expand the understanding of the pathogenetic mechanisms of the course and outcomes of diabetic foot ulcers at different stages of healing.AIM: To evaluate the level of growth factors and their receptors in non-healing neuropathic diabetic foot ulcers of different duration.MATERIALS AND METHODS. 89 samples of neuropathic diabetic foot ulcers were examined. Immunohistochemical analysis of biopsies was performed using antibodies to the following growth factors and their receptors: vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF), epidermal growth factor (EGF). Depending on the duration of the wound, the biopsies were divided into 3 groups: group 1 — ≤ 90 days, group 2 — 91-365 days, group 3 — &gt; 365 days.RESULTS. In the samples of wounds, the duration of which did not exceed 90 days, the expression of growth factors and receptors to them was significantly higher than in wounds of longer duration (p=0.0001). There was no significant difference in quantitative indicators of the expression of growth factors and their receptors between wounds lasting from 91 to 365 days and more than 365 days. According to the data of correlation analysis, the expression of VEGF, IGF, EGF and their receptors has a significant negative dependence on the duration of the wound (p= 0.0001).CONCLUSION. In diabetic foot ulcers lasting less than 90 days, the expression of growth factors such as VEGF, IGF, EGF and their receptors is significantly higher than in wounds of longer duration. The dependence of the expression of growth factors on the duration of the ulcer was revealed. The data obtained may explain the differences in the outcomes of chronic wounds and the absence in some cases of the effect of local therapy with growth factors.

The model and efficacy of online nurse-led on the clinical outcome of diabetic foot ulcers: an integrative systematic review and meta-analysis of randomized controlled trials

The model and efficacy of online nurse-led on the clinical outcome of diabetic foot ulcers: an integrative systematic review and meta-analysis of randomized controlled trials

Microbial Prevalence and Outcome of Diabetic Foot Ulcers in Patient’s Candidates for Minor Surgical Interventions

Background: Diabetes mellitus is a progressive disease with chronic complications such as diabetic foot infection, a significant difficulty that inevitably leads to gangrene and amputations.&#x0D; &#x0D; Objective: This study aims to determine microbial prevalence in diabetic foot infections, identify the significance of aggressive surgical therapy and minor amputations in limb salvage and the prevention of more proximal amputations, and identify predicting factors affecting the outcome of these surgical processes.&#x0D; &#x0D; Methods: In this cohort study, microbiological samples were collected from 62 patients with diabetic foot lesions who underwent debridement or minor amputations to determine the prevalence of microorganisms in diabetic foot infections. Then, they were followed up to determine the rate of saved limbs and the factors that affect the outcomes and rate of complications.&#x0D; &#x0D; Results: infections were mainly caused by aerobic Gram-positive bacteria (S. aureus) 53.5%, and aerobic Gram-negative bacteria of enterobacter species 40.4%. Regarding the outcome of surgical intervention, we found an 80.65% success rate of saving the limb with a 30.6% complication rate. Risk factors such as high levels of inflammatory markers and parameters of the severity of peripheral arterial disease showed significant association with the rate of complications and poor outcomes.&#x0D; &#x0D; Conclusions: Debridement and minor surgical amputations effectively prevent more proximal amputations in diabetic foot infections with a high chance of good results. At the same time, the common microorganism in our local population was S. aureus, followed by P. mirabilis, E. coli, and Klebsiella species in diabetic foot infections.

Effect of demographic and clinical characteristics of open wound pressure ulcers in patients at tertiary care hospital of Karachi

Pressure ulcers acquired in a hospital are a common problem in patients with neurological disorders. Although a number of risk factors have been identified, no relationships between risk profile characteristics and pressure ulcer outcomes in hospitalized patients in Karachi have been described. This research aimed to identify the elements that contributed to the emergence of open-wound pressure ulcers in patients with neurological disorders who were being treated in hospitals. A cross-sectional analytical study design was used to enroll 93 study participants from Pakistan's Murshid Hospital and Healthcare Centre (MHHCC). The data was collected using a structured questionnaire. The Chi-Square test and an independent t-test were used to analyze the data using SPSS 21 to determine the results. The study discovered that the Glasgow Comma Scale (p = 0.001), length of hospital stay (p = 0.001), and back care (p = 0.03) were statistically associated with the open wound pressure ulcer. In conclusion, hospitalized patients with neurological disorders showed a significant difference between open wound and close PU in terms of mean GCS, length of hospital stay, and back care.pressure ulcer (PU)

Abstract #1401721: The Effect of the Different Waves of COVID-19 Pandemic on the Outcome of Diabetic Foot Ulcers

Diabetic foot ulcers (DFUs) are complications of diabetes mellitus. COVID-19 pandemic has massively impacted human health. We studied effect of COVID-19 on outcome of DFUs. We recruited 483 people with DFU from June 2020-April 2022 (pandemic group) together with a matched group of 227 people with DFU from March 2019-March 2020 (pre-pandemic group). Matching was done with respect to glycemic control (Average HbA1c in pandemic group 9.15%; pre-pandemic group 8.92%), and renal status. Primary endpoint was outcome of ulcers- healed or undergone amputation. Primary outcome was further sub analyzed in the 3 waves of COVID-19 Secondary endpoint was healing of individual types of DFUs. Basic anthropometric data with site, nature and Wegner’s grading of DFUs were collected. Diagnosis of peripheral neuropathy was done by monofilament testing and peripheral arterial disease by handheld Doppler and ABI. Standardized treatment protocol including glycemic control, infection control, debridement, dressing, offloading was provided. All patients were monitored for >6 months. In pandemic cohort of 483 patients 323(66.9%) patients had healed ulcers, 70(14.5%) had minor amputation, 11(2,2%) had major amputation, 29(6%) lost to follow up, 22(4.6%) had not healed and 28 are in follow up (5.8%). Rate of healing of DFU in pandemic group was higher (66.9%) than control group (53.5%). Similarly, rate of amputation in pandemic group was less (16.7%) than pre-pandemic group (23.4%). Among healed ulcers in pandemic group, non-infected neuropathic ulcers healed better (77.8%; 199/256) than other types (54.6%; 124/227) [p< 0.00001]. Similarly, rate of amputation (major/minor) in ischemic and neuroischemic ulcers in pandemic group was more (32.3%; 11/34) than other types (15.6%; 70/449) [p= 0.011]. Rate of healing of foot ulcers in 1st wave was 65.4% (53/81), 2nd wave 75.2% (158/210), 3rd wave 58.3% (112/192). Neuropathic ulcers though less prevalent in first two waves (49.8%; 145/291) than 3rd wave (57.8%; 111/192) healing rate was more in first two (79.3%; 115/145 vs 75.6%; 84/111). [p=0.488 (statistically not significant]. Ischemic and neuroischemic ulcers were more in 3rd wave (7.8%; 15/192) than first two waves (6.5%; 19/291) and undergone more amputation (46.7%; 7/15 vs 15.7%; 3/19). [p=0.58 (statistically not significant; due to small sample size]. COVID-19 pandemic (mainly first two waves) accounted for travel restrictions contributing to better healing of neuropathic ulcers whereas ischemic and neuroischemic ulcers worsened and underwent more amputation as patients could not seek intervention. Conversely, in third wave withdrawal of COVID restrictions lead to worsening of DFUs leading to less healing and more amputation.

IDF2022-0513 Presentation and outcomes of diabetic heel ulcers; a single-center study from a resource constrained country, Pakistan

IDF2022-0513 Presentation and outcomes of diabetic heel ulcers; a single-center study from a resource constrained country, Pakistan

Examining Albumin as a Bioindicator of Healing Capability in Patients With Diabetic Foot Ulcers: A Retrospective Review

Introduction. Identifying a bioindicator of healing capacity would be beneficial in guiding treatment of and reducing morbidity in patients with DFU. Hypoalbuminemia is a well-established risk factor for amputation and, thus, a promising candidate. Objective. This study was conducted to examine whether albumin values over a 12-week treatment course for DFU correlated with ulcer size and outcomes. Materials and Methods. A retrospective review was conducted of 793 patients who presented to the Atrium Health Wake Forest Baptist Wound Care and Hyperbaric Center between 2010 and 2022. Sixty-two patients met the inclusion criteria. Albumin values and wound size data were collected monthly over a 12-week treatment course. Results. Initial albumin values were not significantly different between patients healed by 12 weeks compared with nonhealed patients. Healed proportion and average initial ulcer size in patients with at least 1 hypoalbuminemia value (&lt;3.0 g/dL) were not significantly different from those in patients with normal albumin levels. Patients who trended from normoalbuminemia to hypoalbuminemia displayed significantly increased wound sizes compared to patients with albumin changes within the normal range (0.04 cm² and −1.17 cm², respectively; P &lt; .05). Monthly changes in albumin correlated poorly with wound healing (r = 0.144, P = .240), and large negative albumin trends (&gt;0.5 g/dL per month) did not correlate with increased wound sizes compared with stable or positive trends. Conclusion. Albumin’s utility as a bioindicator of short-term healing capability is limited to below-normal values.

Exploring Association of Anemia with Diabetic Foot Ulcer and its Impact on Disease Outcome in a Tertiary Care Hospital

Background: Both short-term and long-term complications are common in people with diabetes, making the disease quite difficult to manage. Among them development of foot ulcer is like a nightmare for diabetic patients. Foot deformities, impairment of microcirculation and concomitant neuropathy all add in the development of these ulcers, that are either delayed to heal or do not heal at all leading to amputation or in extreme cases even death. In addition to these major contributors, concomitant comorbidities like anemia may lead to development of an ulcer or effect it’s healing. If anemia identified and treated promptly may enhanced recovery of diabetic foot ulcer patients. We analyzed the effects of anemia on the prognosis of individuals with diabetic foot ulcers (DFUs). Methods: We prospectively followed 165 diabetic patients admitted to the hospital with DFU until they were either discharged or died. Patient's demographic data, characteristics of the ulcers, duration of diabetes, presence of comorbid conditions, need for blood transfusion and diabetic complications were all taken into account. The appropriate imaging and laboratory tests were conducted. The incidence of anemia and its effect on illness outcome in DFU patients were examined. Results: Anemia was found in 70% of patients with 38% required blood transfusion. The presence of gangrene, PAD, and an ulcer that had been present for more than a month prior to admission were all significant demographic and clinical predictors of anemia, [p0.008], [p0.00.1], [p0.001] respectively. Comorbidities like proteinuria [p0.003], moderate [p0.002] and severe [p0.00.1] constriction of the blood vessels, previous stroke [p0.012], kidney dysfunction [p0.002] were all significantly linked with anemia. Regarding effect of anemia on disease outcome delayed wound healing [p0.008], osteomyelitis [p0.005], amputation [p0.034] and mortality [p0.008] were all substantially correlated with anemia. Conclusion: Anemia was seen in majority of patients with DFU. Significant association was found between anemia and worse ulcer outcome in the form of delayed wound healing, osteomyelitis, mputation and mortality. Therefore, it needs to be identified and managed promptly, like other major risk factors such as infection, ischemia and pressure offloading, to promote earlier and complete healing. Keywords: Exploring, Association , Anemia, Diabetic Foot Ulcer , A Tertiary Care Hospital

Impact of microvascular complications on the outcomes of diabetic foot in type 2 diabetic patients with documented peripheral artery disease.

Microvascular disease (MVD) is associated with amputation linked to peripheral artery disease (PAD) in the general population. No study evaluated the impact of diabetic microvascular complications on the outcomes of vascular diabetic foot ulcers (DFU). The aim of the study was to investigate whether retinopathy, nephropathy, and polyneuropathy can predict the outcomes of DFU in type 2 diabetic patients with PAD. Three hundred and thirty-one consecutive patients with vascular DFU were enrolled and followed up for 44.1 ± 23.9 months. The prevalence of retinopathy was significantly higher in subjects with ulcer persistence (45.2%; p < 0.01), minor amputation (48.9%; p < 0.001), and major amputation (57.9%; p < 0.001) than in healed patients (23.3%), and in non-survivors than in survivors (64.9 versus 20.5%; p < 0.001). The prevalence of nephropathy was significantly greater in subjects with ulcer persistence (83.9%; p < 0.01), minor amputation (86.7%; p < 0.001), and major amputation (94.7%; p < 0.001) than in those with healed DFU (64.4%), and in non-survivors than in survivors (88.3 versus 65.7%; p < 0.001). The prevalence of polyneuropathy was significantly higher in non-survivors than in survivors (76.6 versus 61.0%; p = 0.012). Multivariate analysis showed that absence of retinopathy (OR: 0.451; 95% CI: 0.250-0.815; p < 0.001) and nephropathy (OR: 0.450; 95% CI: 0.212-0.951; p = 0.036) were independently associated with healing. Moreover, retinopathy was a predictor both of minor amputation (OR: 2.291; 95% CI: 1.061-4.949; p = 0.034) and mortality (OR: 5.274; 95% CI: 2.524-11.020; p < 0.001). Polyneuropathy never entered the regression model. Diabetic microvascular complications, in particular retinopathy, may predict the outcomes of vascular DFU. Longitudinal studies should confirm this finding.