Ulcer Risk Research Articles

THU260 Development Of Plantar Thermography For Screening Of Diabetic Neuropathy

Abstract Disclosure: V. Panamonta: None. R. Jerawatana: None. P. Ariyaprayoon: None. P. Looareesuwan: None. B. Ongphiphadhanakul: None. C. Sriphrapradang: None. B. Ongphiphadhanakul: None. Background: Diabetic foot ulcers are a major complication of diabetes. They are also the leading cause of nontraumatic lower extremity amputation. The incidence of diabetic foot ulcers is highest in those patients with poor glycemic control and neuropathy. In people with diabetic neuropathy, the feet temperature may change due to decreased blood flow and nerve damage. Thermography has been proposed as a noninvasive modality to identify patients at risk for diabetic foot ulcers. In this study, we used thermography and deep learning to stratify patients with diabetes at risk for developing a foot ulcer. Methods: We prospectively record clinical data and plantar thermogram in adult diabetic patients underwent diabetic foot screening at outpatient clinics at Ramathibodi hospital, Bangkok, Thailand during September to December 2022. Altogether, there were 245 thermal images were analyzed using a deep learning algorithm to determine the risk for diabetic foot ulcers by transfer learning using the pre-trained VGG16 model which is a convolutional neural network for image recognition. Twenty percent of the images were set aside for testing purposes while 20% of the images served as the validation set during training of the neural network. The neural network was trained and weighed more toward higher sensitivity of identifying at risk feet for screening purpose. Results: The study sample consisted of individuals with a mean age of 62.5±12.5 years, 57.1% who had diabetes for more than 10 years. The majority of the participants were females (57.1%). The average body mass index (BMI) was 27.8±9.6 (kg/m2). There were 186 thermal images classified as category 0 and 59 images classified as categories 1 to 3 according to the American Diabetes Association risk classification. The trained neural network achieved 75 % accuracy with 95 % sensitivity and 67 % specificity for classifying thermograms as higher than normal risk in the training dataset. For the testing dataset, the sensitivity and specificity was 75% and 41%, respectively. The accuracy, however, decreased to 50% due mainly to the misclassification of normal thermograms from abnormal. Conclusions: These results suggest that thermography combined with deep learning could potentially be developed for screening purpose to stratify patients at risk of developing diabetic foot ulcers. Further research is needed to validate the results in larger datasets and to explore alternative algorithms for predicting diabetic foot ulcers. Presentation: Thursday, June 15, 2023

FRI606 Changes In The Pedal Microcirculation Of Diabetic Patients With Poor Glycemic Control Detected Using Non Invasive Optical Imaging

Abstract Disclosure: I.K. Bolakale-Rufai: None. S. French: None. J.C. Arias: None. K. Concha-Moore: None. T. Tan: None. D.G. Armstrong: None. A. Mazhar: Employee; Self; Modulim. C.C. Weinkauf: None. Background: Microvascular disease (MVD) describes systemic changes in the small vessels (∼100 υm diameter) that impair tissue oxygenation and perfusion. Emerging evidence has shown that MVD (which is prevalent in diabetics) is clinically relevant as it synergistically acts with peripheral arterial disease to increase the risk of limb loss by 22.7-fold. Poor glycemic control has been linked to clinical microvascular disease (nephropathy and retinopathy) However, the direct impact of poor glycemic control on the microcirculation of the feet is unknown as there are currently no standardized non-invasive methods used clinically to assess and quantify MVD of the lower limbs. Spatial frequency domain imaging (SFDI) is a novel non-invasive optical technology that can detect and quantify microvascular disease of the foot by measuring the amount of hemoglobin(HbT1) in the capillaries of the superficial dermis up to 1-2mm deep and oxygenation (StO2) in the dermal micro-circulation. We hypothesize that poor glycemic control in DM affects pedal microcirculation and the changes can be detected using the SFDI technology. Methods: 307 patients (600 lower extremity limbs) were prospectively enrolled at a single institution, Banner University Medicine, Tucson, AZ from 2016- 2023. Diabetic patients were stratified into three groups based on their HbA1c level: ≤6.7%, 6.8-9.9%, and ≥10%. Mann U Whitney test and Spearman rank correlation were used in testing the association between HbA1C and SFDI-metrics with p<.05 considered as statistical significance. Results: We included 230 lower limbs belonging to diabetic patients. The mean age of the patients was 61.7 years. Clinical neuropathy and retinopathy were found in 79% and 30.7% of patients, respectively. SFDI-derived biomarkers of microcirculation were compared among diabetics categorized by HbA1C levels. We observed a significant reduction in papillary dermal perfusion (HbT1) as the glycemic control (HbA1C) of the patients worsened (p<0.001). Although tissue oxygenation (StO2) was not statistically different across diabetic groups, the St02/HbT1 ratio which represents the ratio of tissue oxygenation to perfusion, increased with elevated HbA1C levels. This indicated that poorly controlled diabetics had less oxygen being extracted from their poorly perfused micro-circulation. Conclusions: This study suggests that poor glycemic control directly affects the microcirculation of the feet in diabetic patients. The SFDI technology is a promising noninvasive tool to evaluate microvascular disease of the feet and potentially may be utilized clinically to stratify diabetic patients at risk for foot ulceration or limb loss based on glycemic control over time. Presentation: Friday, June 16, 2023

Aspirin is associated with a reduced incidence of liver disease in men.

The hepatoprotective effects of aspirin have been observed in individuals with viral hepatitis; however, its impact on the general population remains uncertain. Understanding the association between aspirin use and the development of liver diseases is crucial for optimizing preventive strategies. We identified individuals with aspirin use in the UK Biobank and the Penn Medicine Biobank, as well as propensity-score-matched controls. Outcome measures included new liver disease development, diagnosed by MRI or "International Classification of Diseases and Related Health Problems" coding, and incidences of gastrointestinal bleeding and ulcers. In the UK Biobank cohort, regular aspirin use was associated with an 11.2% reduction in the risk of developing new liver diseases during the average 11.84 ± 2.01-year follow-up period (HR=0.888, 95% CI = 0.819-0.963; p = 4.1 × 10-3). Notably, the risk of metabolic dysfunction-associated steatotic liver disease (ICD-10 K76.0) and MRI-diagnosed steatosis was significantly lower among aspirin users (HR = 0.882-0.911), whereas no increased risk of gastrointestinal bleeding or ulcers was observed. These findings were replicated in the Penn Medicine Biobank cohort, in which the protective effect of aspirin appeared to be dependent on the duration of intake. The greatest risk reduction for new liver disease development was observed after at least 1 year of aspirin use (HR = 0.569, 95% CI = 0.425-0.762; p = 1.6 × 10-4). Intriguingly, when considering general risk factors, only men exhibited a lower risk of MRI-confirmed or ICD-coded steatosis with aspirin use (HRs = 0.806-0.906), while no significant protective effect of aspirin was observed in females. This cohort study demonstrated that regular aspirin use was associated with a reduced risk of liver disease in men without an elevated risk of gastrointestinal bleeding or ulcers. Further investigation is warranted to elucidate potential sex-related differences in the effects of aspirin and to inform tailored preventive strategies for liver diseases.

Surgical Interventions Have Lowered Complication Rates Compared to Casting in Charcot Foot

Category: Diabetes; Midfoot/Forefoot Introduction/Purpose: Charcot foot is a serious complication that arises in the setting of combined peripheral neuropathy and trauma. This neurodegenerative disease is often associated with diabetes mellitus and other chronic comorbid diagnoses which can further lead to an increased risk of other injuries such as bone deformities and ulcerations. As there is no standard protocol for the management and treatment of Charcot neuroarthropathy (CN), casting, arthrodesis, exostectomy, and amputation can all be utilized. The understanding of the various comorbidities and management strategies for Charcot foot may allow further guidance for treatment options. The objective of our study was to compare the demographics, lab values, and clinical outcomes of patients who undergo various treatment modalities for CN and determine if there was correlation. Methods: A sample of patients at a single institution diagnosed with CN of the lower extremity and who underwent exostectomy, arthrodesis, amputation, and/or casting were identified through TriNetX. Demographics were collected for the study sample including age, sex, and race. Descriptive statistics in addition to historic and projected rate of arrival were conducted on each subgroup of patients. Relative risk with the associated confidence intervals were completed to assess comparative statistics among the groups for various organ system based comorbid diagnoses and complications. Results: Three-hundred and forty patients were identified; 120 underwent amputation, 130 underwent arthrodesis, 180 underwent exostectomy, and 160 underwent casting. The average age was 62 ± 12 years. Males accounted for 62%, with a higher percentage (66%) in the amputation and exostectomy groups. 85% of patients identified as white. The predicted rate of arrival at this institution for amputation, arthrodesis, exostectomy, and casting was 2.4, 0.7, 2.5, and 4.7 respectively. Amputation was overall associated with a higher percentage of comorbid diagnosis. When compared to the arthrodesis group, casting had a 1.35 times (95% CI: 1.086-1.689) risk of ulceration and was associated with a higher hemoglobin A1C (7.5±2.211 vs 7.22 ± 1.87, p=0.058). Conclusion: Among relatively comparable groups, casting, while effective and the least invasive, is associated with higher risks of ulceration and complications in the future. Complications of Charcot foot can involve skeletal deformities, which can reduce the quality of life for patients. With the expected projected arrival rate of newly diagnosed CN patients at this institution to be highest for casting and lowest for arthrodesis, the consideration for early surgical intervention such as arthrodesis could reduce the risk of complications and readmissions in the future progression of Charcot foot.

The Metabolic Characteristics of Patients at the Risk for Diabetic Foot Ulcer: A Comparative Study of Diabetic Patients with and without Diabetic Foot.

Diabetic foot is a relatively severe complication in patients with type 2 diabetes (T2D), with peripheral neuropathy and angiopathy frequently serving as risk factors. However, it is unknown how the other major systemic metabolic factors impacted the profile of these patients, besides glucose management. Thus, we investigated the distinct characteristics of patients with diabetic foot ulcers and their relationships with angiopathy. We obtained the laboratory data of 334 diabetic patients at Shanghai Pudong Hospital from 2020 to 2023. The comparisons were performed between the groups with or without diabetic foot, including glucose metabolism, lipids profile, liver and kidney function, thyroid function, and serum iron. The association between metabolic factors and lower extremity computed tomography angiography (CTA) was analyzed. We found significant disparities between groups in relation to age, serum protein content, liver transferase, serum creatinine, estimated glomerular filtration rate (eGFR), serum uric acid (UA), small dense low-density lipoprotein (sdLDL), lipoprotein A (LP(a)), apolipoprotein A1 (APOA1), thyroid function, serum iron, and hemoglobin (Hb) (p<0.05). The Spearman correlational analyses showed that the severity of CTA, categorized by the unilateral or bilateral plaque or occlusion, was positively significantly correlated with UA (r=0.499), triglyceride (TG) (r=0.751), whereas inversely correlated with serum albumin (r=-0.510), alanine aminotransferase (r=-0.523), direct bilirubin (DBil) (r=-0.494), total bilirubin (TBil) (r=-0.550), Hb (r=-0.646). This cross-section investigation showed that compared to T2D only, the patients with diabetic foot ulcer (DFU) might display similar glucose metabolic control context but adverse metabolic profiles, and this profile is associated with macrovascular angiopathy characteristics and their severity.

INDIFURUTO: A novel tool for assessing diabetic foot recurrence risk in type 2 diabetes.

This study aimed to evaluate diabetic foot ulcer recurrence using the Indonesia Diabetic Foot Ulcer Recurrence Assessment Tool (INDIFURUTO), a new diabetic foot risk recurrence assessment tool. This study used a prospective cohort design. A total of thirty-three participants met the inclusion criteria. We used sensitivity, specificity values, AUC, and, respectively, a 95% confidence interval (CI) to calculate prognostic accuracy measures. The results showed that this study had an AUC of 0,97 [95% confidence interval (CI) 0.91-1.00]. The cut-off point (Youden Index) was <45, with sensitivity and specificity values of 100% and 90%, respectively. The utilization of this model can facilitate the monitoring and enhancement of foot ulcer recurrence prevention in individuals diagnosed with diabetes. This study showed that the new model had a high prediction. Therefore, this model better stratifies people at high risk of foot ulceration.

Impact of educational intervention on nurses’ knowledge of pressure ulcer risk assessment and prevention: A pilot study

Background: Professional nurses are saddled with a unique role in patient's skincare among hospitalized patients. Inadequate nurses’ knowledge of pressure ulcer risk assessment (PURA) and prevention as a major contributory factor to development of pressure ulcer among “at risk” patients has been identified by previous studies. Aim: To evaluate the impact of an educational intervention on nurses’ knowledge of pressure ulcer risk assessment and prevention at a tertiary hospital, Ibadan, Nigeria. Methods: A pilot study with sample size of 26 nurses selected through simple random sampling technique from selected nursing units of the facility. Data collection was done through a structured questionnaire. Hypotheses were tested with inferential statistics using t-test. Results were presented in descriptive statistics and charts. Level of significance was p-value &lt;0.05. Results: Almost all participants’ knowledge mean score of PURA increased from 4.92 ±1.26 at pre-test to 14.00 ± 0.71 at post-test (p&lt;0.001). Also, knowledge mean score of pressure ulcer prevention improved among intervention group (14.00 ± 0.707) post educational intervention as compared to their counterparts in control group (11.85±1.41). Educational intervention was statistically significant with participants’ knowledge of PURA and prevention (p&lt;0.001). Conclusion: The results of this study confirmed that educational intervention was impactful positively on nurses’ knowledge regarding PURA and prevention strategies at UCH, Ibadan, Nigeria. Thus, a structured educational program on the subject matter is needed to promote quality nursing care delivery according to international best practices among Nigerian nurses.

Treatment options for necrobiosis lipoidica: a systematic review.

Necrobiosis lipoidica (NL) is a rare, idiopathic, and recalcitrant disease of collagen degeneration for which treatment options have been poorly studied. Due to its recurring nature, risk for ulceration, and high morbidity, there is a need to understand existing treatment modalities to better inform clinical care. This review aims to describe the therapeutic modalities reported in the literature for the treatment of NL. A literature search of treatments was performed by searching for publications between January 2016 and May 2022 on PubMed and Scopus. Given the limited high-quality evidence, case reports and series were included. Only publications presenting information on both attempted treatments and outcomes were included. A total of 60 novel articles were identified (54 case reports, two case series, and four retrospective cohort studies). These studies cumulatively reported on 274 patients and covered treatments including phototherapy, topical corticosteroids, topical calcineurin inhibitors, biologics, immunosuppressants, JAK inhibitors, combination therapies, and several others. The greatest amount of evidence was found for photodynamic therapy (improvement in 72 of 80 patients), UVA-based phototherapy (12 of 33), topical corticosteroids (21 of 46), compression therapy (15 of 20), and topical calcineurin inhibitors (11 of 17). Several newer treatments were also described, including ustekinumab and JAK inhibitors. This systematic review provides a comprehensive summary of recently published treatments for NL. As the existing data comes predominantly from case reports and series, statistical conclusions are not assessed. A greater number of randomized controlled trials with standardized endpoints are necessary to compare treatment efficacy.

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.

Ectopic bile duct: A case report and brief review

Introduction: An ectopic bile duct is the confluence of common bile duct (CBD) and main pancreatic duct away from its usual location in the posteromedial wall of the second part of duodenum. This increases risk of choledocholithiasis and pancreatitis, while proximal locations increase risk of duodenal ulceration and stenosis. Case Report: A woman in her late forties was consented to elective laparoscopic cholecystectomy for symptoms of biliary colic and ultrasonographic features of a mobile gallstone. Intraoperative cholangiogram noted dilated biliary tree and main pancreatic duct despite normal liver function values, as well as an ectopic ampulla of Vater to distal third part of duodenum or proximal fourth part of duodenum. The distal bile duct had a longer common channel. The operation was otherwise uncomplicated. Magnetic resonance cholangiopancreatography demonstrated similar findings. The patient recovered uneventfully and was discharged from surgical services. Conclusion: The gold standard for diagnosing ectopic bile ducts is via endoscopic retrograde cholangiopancreatography. Hepatobiliary anatomical variants can also occur in the location of the ampulla, thus it is important for surgeons and trainees to interpret and document this carefully during intraoperative cholangiogram, especially in patients who may require endoscopic retrograde cholangiopancreatography in the perioperative period and/or later date. The patient should be educated on the associated risks and red flags to seek medical attention.

More new cancers in type 2 diabetes with diabetic foot disease: A longitudinal observational study

ObjectiveCancer has been proposed as the primary cause of death in type 2 diabetes (T2D).The life expectancy is reduced after a diabetic foot ulcer. We investigated whether Diabetic Foot Disease related to an increased risk of developing a new cancer.Research design and methods: We conducted a retrospective analysis on a cohort of patients hospitalized for T2D between 2009 and 2017, stratified for the risk of diabetic foot ulcer (International Working Group on Diabetic Foot classification). We highlighted new cancers in their medical records until December 2020. The relationship between Diabetic Foot Disease and later cancers was analyzed by multivariable Cox regression and survival curves were compared. ResultsAmong 519 patients, 27% had a Diabetic Foot Disease, and 159 were classified as grades 1 or 2 (at risk). As compared to the 218 patients graded 0 according to the IWGDF, they were more men, older, with a longer duration of diabetes, more vascular complications, a greater incidence of insulin use, and a higher skin autofluorescence. During the 54 months of follow-up, 63 (12.1%) new cancers were diagnosed. Baseline Diabetic Foot Disease was significantly associated with a higher risk of cancer (multivariable adjusted Hazard ratio: 2.08, 95%CI: 1.02–4.25), whereas the relation was not significant for subjects at risk of DFU (HR: 1.65, 95%CI:0.81–3.35) ConclusionThe risk of cancer was increased twofold in T2D with Diabetic Foot Disease.

Uji Validitas dan Reliabilitas Kuesioner Skrining Kaki Diabetik

Ulceration of the foot in diabetes is common and disabling. It frequently leads to leg amputation, and the risk for leg amputation increases 10 to 30 times higher among the general population. 85% of leg amputations are performed due to diabetic foot ulcers, which can affect the quality of life and be potentially life-threatening. Diabetic foot ulcers are preventable by performing foot screening. The study aims to determine the validity and reliability score of diabetic foot screening questionnaires. The study used an observational descriptive design with a cross-sectional approach to the samples of 35 out of 40 populations. Respondents are selected using simple random sampling techniques. The instrument used was the diabetic foot ulcer and blood sugar observation sheet. The data were tested using SPSS 26 using Pearson Product Moment and Cronbach's Alpha test. The majority of respondents were female, the age ratio of the respondents was 65 years, the blood sugar rate was 234 mg/dl, and the ankle-brachial index rate was 1.04. The Pearson Product Moment results showed that the rcounts &gt; rtable (0.334), while the reliability test using Cronbach’s Alpha value is &gt; 0.60. The diabetic foot screening questionnaire is declared valid, reliable, and appropriate to detect the risk of foot ulcers in patients with Type 2 Diabetes Mellitus. There are ten themes of questions: diabetic diet patterns, anti-diabetic medication consumption, monofilament tests, foot pulse, history of foot ulcers, a history of amputations, foot deformities, nails growing into tissue, callus, and cracks.

Nonsteroidal antiinflamatory drugs and risks of ulceration and other complications: some results of the problem investigation and own clinical observations

Nonsteroidal antiinflamatory drugs (NSAIDs) are widely used in clinical practice. Most widely used among them are “traditional” NSAIDs – 82,9 %, administration of selective COG-2 inhibitors was much less numerous. Starting from the primary care main attention upon using of mentioned drugs should be paid to safety, especially at chronic states, which require prolonged treatment. Safety should be in the center of attention considering influences on heart-and-vessel system and kidney. But mainly authors consider side effects on gastrointestinal tract, because of high spreading and severity. Moreover, side effects from lower segments of gastrointestinal tract demonstrate obvious trend for increasing. Some scientific results proved, that more than 40 % of injures connected with NSAIDs appeared in lower segments of gastrointestinal tract (small intestine and bowel). The article provides the results of own clinical observations of the case with multiple (eight) perforations of gastrointestinal tract upon uncontrolled self administered different NSAIDs by the multiply comorbided patient. We consider such a description demonstrative during practical classes in state and English languages at pre- and postgraduate levels.

Association of Monocyte to Lymphocyte, Neutrophil to Lymphocyte, and Platelet to Lymphocyte Ratios With Non-Healing Lower Extremity Ulcers in Patients With Type 2 Diabetes.

Diabetic ulcers are a prevalent complication of diabetes mellitus and represent one of the most complex and severe complications that can occur in diabetic patients. Most existing studies have separately examined the neutrophil-to-lymphocyte ratio (NLR) prognostic value or the platelet-to-lymphocyte ratio (PLR). However, to our knowledge, no study has evaluated the relationship between the monocyte-to-lymphocyte ratio (MLR) and non-healing lower extremity ulcers (NHLU) in patients. This study explored the association between 3 hematological parameters (MLR, NLR, and PLR) and the risk of non-healing ulceration in patients with type 2 diabetes (T2D). A cross-sectional study was performed using data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2004. The primary outcome variable was NHLU status, determined by patients' self-reported responses to the question, "Have you had an ulcer or sore on your leg or foot that took more than four weeks to heal?" Logistic regression examined the relationships between MLR, NLR, PLR, and NHLU. Stratified analyses were also conducted based on age, gender, hemoglobin (HGB) level, and body mass index (BMI). In the multivariate regression models, after adjusting for age, sex, race/ethnicity, marital status, poverty income ratio (PIR), BMI, HGB, family history of diabetes, and low-density lipoprotein (model 3), the odds ratios (ORs) of MLR and NLR were 1.21 (1.09-1.33) and 1.02 (1.01-1.03), respectively. However, the association was no longer statistically significant for the NLR (OR = 1.0002, 95% CI: 0.99-1.0005, P = .137). In the subgroup analysis, the effect sizes of MLR and NLR on the presence of NHLU were stable in all subgroups (all P > .05). After adjusting for confounding variables, MLR and NLR were significantly increased in T2D participants with NHLU. They may play a significant role in monitoring T2D patients during follow-up visits.

The effectiveness of motivational interviewing on adherence to wearing orthopedic shoes in people with diabetes at low-to-high risk of foot ulceration: A multicenter cluster-randomized controlled trial

AimTo evaluate the effectiveness of motivational interviewing (MI) performed by MI-trained podiatrists in improving adherence to wearing orthopedic shoes in comparison to usual care in people with diabetes at low-to-high risk of ulceration. MethodsPeople with diabetes with loss of protective sensation and/or peripheral artery disease, and with orthopedic shoes prescription were allocated to receive one MI-consultation by a podiatrist randomized to MI training (n = 53) or usual care only (n = 68). Adherence was measured as the percentage of steps taken while wearing orthopedic shoes, determined using an insole temperature microsensor and wrist-worn activity tracker during one week at 3 and 6 months. ResultsThe proportion of participants ≥80 % adherent to wearing their orthopedic shoes was higher in the control group than in the MI-intervention group at 3 months (30.9 % versus 15.1 %; p = 0.044), and not significantly different at 6 months (22.1 % versus 13.2 %; p = 0.210). Average adherence was also higher in the control group than the intervention group at both 3 months (60.9 % versus 50.9 %; p = 0.029) and 6 months (59.9 % versus 49.5 %; p = 0.025). ConclusionsOne podiatrist-led MI-consultation in its current form did not result in higher adherence to wearing orthopedic shoes in people with diabetes 3 and 6 months after inclusion.Trial registration: Netherlands Trial Register NL7710 (available on the International Clinical Trials Registry Platform).

Intralesional betamethasone versus oral propranolol for localized infantile hemangiomas of the lip

Infantile hemangiomas (IHs) of the lips are associated with an increased risk of incomplete involution and ulceration, causing disfigurement. Treatment with oral propranolol (OPT) has credible efficacy but takes months to complete. Thus, this study aimed to investigate the efficacy of intralesional betamethasone injection (IBI) as an alternative treatment for protruding localized IHs of the lips. To investigate the efficacies of OPT and IBI, we designed a prospective, noninferiority, parallel-group study. The primary outcome assessed was treatment response rate. Secondary outcome assessments included lesion size changes and surgical rate. Additionally, complication rates and treatment durations of OPT and IBI were compared. The treatment response rate of IBI was not inferior to that of OPT (95.7% vs. 76.0%, respectively; a difference of 19.7%, 95% confidence interval [CI], -4.4% to 41.6%). The average surgical rate in the IBI group was significantly lower than that in the OPT group (8.7% vs. 40%, respectively; p=0.012), and the average duration of treatment for IBI was shorter than that of OPT (2.1 months vs. 6.3 months, respectively; p<0.001). There were no severe adverse drug events in either group. If not managed properly, small, localized lip IHs may cause disfigurement in a child. Our study demonstrated that IBI is as effective as OPT in treating protruding localized lip IHs. Moreover, IBI treatment has a shorter duration and lower surgical rate than OPT. With proper care, IBI is an effective treatment modality for small and localized lip IHs.

Evaluating the effectiveness of melatonin in reducing the risk of foot ulcers in diabetic patients.

Diabetes and its complications, as a major health concern, are associated with morbidity and mortality around the world. One of these complications is diabetic foot ulcer. Factors such as hyperglycemia, neuropathy, vascular damage and impaired immune system can cause foot ulcers. The present review aims to study the potential effects of melatonin, the main product of pineal glands, on diabetic foot ulcers. A narrative review was performed using present literature in an attempt to identify the different aspects of melatonin's impact on diabetic foot ulcers by searching related keywords in electronic databases without any restriction. This review shows that, melatonin has anti-diabetic effects. It is effective in reducing the risk of hyperglycemia, neuropathy, vascular damage and immune system impairment in diabetic patients. By reducing these complications with melatonin, correspondingly, the incidence of diabetic foot ulcers may also decrease in these patients. The results of this study indicate promising properties of melatonin while dealing with diabetic foot ulcers and their common underlying conditions, but still, it needs to be investigated more in future studies.

Birth weight, childhood obesity, adulthood obesity and body composition, and gastrointestinal diseases: a Mendelian randomization study.

This Mendelian randomization study aimed to investigate the associations of birth weight, childhood BMI, and adulthood BMI, waist-hip ratio, and body composition with the risk of 24 gastrointestinal diseases. Independent genetic instruments associated with the exposures at the genome-wide significance level (p < 5 × 10-8 ) were selected from corresponding large-scale genome-wide association studies. Summary-level data for gastrointestinal diseases were obtained from the UK Biobank, the FinnGen study, and large consortia of European ancestry. Genetically predicted higher levels of birth weight were associated with a lower risk of gastroesophageal reflux. Genetically predicted higher childhood BMI was associated with an increased risk of duodenal ulcer, nonalcoholic fatty liver disease, and cholelithiasis. However, the associations did not persist after adjusting for genetically predicted adulthood BMI. Genetically predicted higher adulthood BMI and waist-hip ratio were associated with 19 and 17 gastrointestinal diseases, respectively. Genetically predicted greater visceral adiposity was associated with an increased risk of 17 gastrointestinal diseases. There were no strong associations among genetically predicted whole-body fat and fat-free mass indices with gastrointestinal diseases. This study suggests that greater adulthood adiposity, measured as either BMI, waist-hip ratio, or visceral adipose tissue, is causally associated with an increased risk of a broad range of gastrointestinal diseases in the European population.

The prevalence of the cagE gene of Helicobacter pylori and its association with gastroduodenal diseases

Background: Helicobacter pylori is the leading cause of gastroduodenal diseases. The CagE protein, which is encoded by the cagE gene on the cag pathogenicity island (cagPAI), plays an important role in supplying energy for the type IV secretion system (T4SS). This study aimed to determine the prevalence of the cagE gene of H. pylori isolates from patients with gastroduodenal diseases, and to investigate the association between the cagE gene and gastroduodenal diseases. Materials and methods: H. pylori strains were isolated from gastric mucosa biopsy specimens of 173 patients with gastroduodenal disease. The polymerase chain reaction technique was performed to identify the cagE gene. Results: The cagE gene was detected in 83.8% of H. pylori isolates. After adjusting for age and gender, the multivariable logistic regression analysis revealed that cagE-positive H. pylori infection was associated with an increased risk for peptic ulcers (aOR = 5.72, 95% CI: 1.11 - 29.38, p = 0.037). Conclusion: High prevalence of the cagE gene was observed among H. pylori isolates from patients with gastroduodenal diseases. The cagE gene was related to an increased risk for peptic ulcers. Key words: Helicobacter pylori, cagE gene, gastroduodenal diseases.

A Mathematical Model Relating Foam Material Properties to Heightened Interface Pressure between a Human and Mattress Surface

Hospital patients often develop pressure injuries when lying in bed for an extended time due to relatively high contact pressures breaking down skin tissues. Pressure injuries adversely affect patients by potentially leading to infection and creating advanced health risks. Our prior research identified children experience highest risk of pressure ulcer in the head region. Thus, this study aimed to gather pressure data and create a corresponding model relating foam material properties to predicted interface pressure between the head and a foam mattress overlay surface. Research findings provide data guiding clinicians and designers to mattresses with material properties capable of reducing the incidence of pressure ulcers in children and adults.