Wagner Classification Research Articles

Susceptibilities of pus cultures in diabetic foot patients: an observational study

Objectives: The aim of our study is to evaluate the organisms growing into the pus cultures of diabetic foot patients and to further document their sensitivity and resistance toward antibiotics. Methods: This study was conducted among admitted patients in the department of Medicine and Orthopedics, of a tertiary care hospital, including patients with known diabetes mellitus for the last 5 years, with a foot ulcer of any grade and a positive culture for bacterial growth. Cultures showing fungal growth were excluded. Results: There were 139 participants in our study with a mean age of 55.27 years, and mean HbA1c levels of 9.51%, 101 (72.66%) patients were males and 38 (27.33%) females. According to the Wagner classification; there were 48 (34.53%) patients in grade 2, 27 (19.42%) patients in grade 3, 54 (38.84%) patients in grade 4, and 10 (7.19%) patients in grade 5. The most frequently isolated bacteria were Staphylococcus aureus (43.16%), methicillin-resistant staphylococcal aureus (5.03%), Enterococcus species (5.75%), Streptococcus species (7.91%), Pseudomonas aeruginosa (20.14%), Escherichia coli (24.46%), Klebsiella pneumonia 7 (5.03%), Proteus vulgaris 6 (4.31%), Proteus mirabilis 3 (2.15%), Enterobacter species 7 (5.03%), Morganella morganii 2 (1.43%), and Acinetobacter 7 (5.03%). Amikacin was the most susceptible antibiotic to the majority of the microorganisms, followed by gentamicin, piperacillin/tazobactam, vancomycin chloramphenicol, and clindamycin. Among the resistant antibiotics, penicillins and cephalosporins were the notable ones. Conclusions: This study will decipher the bacteriological profiles among patients of diabetic foot ulcers according to their susceptibility and might be helpful to provide effective treatment.

Retinal changes among pre-eclamptic patients in University of Benin Teaching Hospital, Benin, Nigeria

Background: Preeclampsia is one of the hypertensive disorders in pregnancy that contributes significantly to maternal and fetal morbidity and mortality, with the impact felt more in developing countries. It is characterized by endothelial dysfunction and vasospasm of vessels which can be observed by an ocular fundal examination. The aim of this study was to determine the ocular fundus findings of women with preeclampsia.
 Methods: This was a cross-sectional study, carried out at the University of Benin Teaching Hospital involving a total of 220 pregnant women. The women were divided into two groups of 110 pregnant women (A&B).Their Age and Gestational age was cross-matched and retinopathy graded according to Keith and Wagner classification. Group A was made up of Preeclamptic women and Group B was made up of healthy pregnant women. Visual acuity was measured using Snellens’ chart, and the fundus was examined with direct ophthalmoscope.
 Results: This showed that the retinal changes observed in the preeclamptic women were associated with their age (P = 0.009), gestational age (P = 0.044), blood pressure (P = 0.001), Proteinuria (P = 0.001), Severity of the disease (P = 0.001), visual acuity (P = 0.035) as well as with the visual symptoms (P = 0.001) but not statistically significant with the gravida (P = 0.799).
 Conclusion: Our study highlights the importance of timely ophthalmoscopy which helps to assess severity of disease (pre-eclampsia) which affects the decision of induction of delivery to predict and prevent possible complications which in turn immensely helps in judicious management of disease. Also, the study revealed that preeclamptic women who are multigravida are more likely to have retinopathy than primigravida.

IDF21-0128 Diabetic Foot Ulcers: Factors Related to Greater Clinical Severity at Presentation

Background: Diabetic foot ulcer (DFU) is an important diabetes complication associated to higher mortality and lower quality of life. DFU severity strongly depends on depth and the presence of infection. Previous studies have tried to identify factors related to DFU severity, most of them using the Wagner classification as the discriminative criteria. A number of factors have already been pointed out: smoking, higher body mass index, older age, insulin therapy, ulcer’s duration and localization. There are no data published on this subject in the Portuguese population, although it has already been stated that greater clinical severity at presentation is associated with increased risk of short-term amputation. Aim: To evaluate the factors related to infected and deep (and thus more severe) DFU at presentation. Method: Cross-sectional study including patients that attended a first diabetic foot appointment at our unit during the year of 2018. Only adult patients with an active DFU were included. Ulcers were classified as infected if they were graded a score ≥2 on the PEDIS classification and/or a stage B or D on the Texas classification; deep if they were graded a score ≥2 on the Texas classification and/or a grade ≥2 on the Wagner classification. Results: 435 patients were included, most of which were men (62.1%). Their median age was 70.0 (IQR 58.0-79.0) years and the mean diabetes duration was 20.0 (IQR 10.0-25.0) years. DFU infection was associated to poor nail care, both according to PEDIS (p=0.004) and Texas (p=0.005) classifications (OR≈2.000). The same association was found with peripheral artery disease (p=0.025 and p=0.009; OR≈1.800), lesion duration shorter than one month (p=0.023 and p=0.029; OR≈1.700) and dorsal and interdigital ulcer location (p=0.022 and p=0.018). Structural deformities were associated with infected DFU according to Texas classification (p=0.045). Diabetes duration over 10 years was associated with deeper wounds, both according to Texas (p=0.030) and Wagner (p=0.031) classifications (OR≈2.700). Being already on antibiotics at the time of the first appointment was associated with both infected and deep DFU. No association was found with patients’ age, HbA1c level (<7 vs ≥7%), neuropathy, education level or insulin therapy. Discussion: As other authors have described, we found that peripheral artery disease and dorsal ulcers are associated with increased lesion severity. We also found an association between interdigital ulcer location and infection, meaning that DFU in this location also tend to be more severe. This might be due to the fact that this area typically accumulates humidity and is often neglected in diabetic foot examination. Individuals with infected DFU are twice more likely to have poor nail care. Toenails may be a reservoir for bacterial and fungal colonization and thus may be associated to DFU severity. We also point out structural deformities and longer diabetes duration to be associated with more severe lesions. Previous medication with antibiotics by primary care physicians and need for quicker referral to our center also seem to be a sign of severity.

Risk Factors Related Amputation on Diabetic Foot Patients in Dr. M. Djamil General Hospital Padang

Backgrounds. Diabetic foot is the most common cause of nontraumatic lower-extremity amputation. This study aims to assess the relationship of risk factors with the incidence of amputation in diabetic foot patients based on the Wagner classification at Dr. M. Djamil General Hospital Padang.&#x0D; Methods. The study design is an analytic observational study with a cross-sectional approach. A total of 46 diabetes mellitus patients with diabetic foot complications participated in this study. The risk factors assessed were gender, age, smoking status, hypertension, uncontrolled blood sugar, hypoalbumin, peripheral arterial disease, infection, and peripheral neuropathy. The assessment of the degree of diabetic foot complications was carried out using the Wagner classification. &#x0D; Results. The most age group for diabetic foot sufferers is the age group of 41-60 years, which is 57.7% with the male sex being more dominant (59.6%) than the female gender. In the subject, there were more patients with the Wagner 4 classification (32.7%) than the other classification levels. Based on direct observation of patients, it was found that 53.8% of diabetic foot patients were amputated. Based on the results of the analysis, it was found that PAD (peripheral arterial disease) and peripheral neuropathy are variables that significantly affect amputation.&#x0D; Conclusion. Peripheral neuropathy and peripheral arterial disease are associated with amputation and peripheral arterial disease is a major risk factor for amputation in diabetic foot patients based on the Wagner classification.

УРОВЕНЬ СОДЕРЖАНИЯ ТРОМБОЦИТОВ В КРОВИ У ПАЦИЕНТОВ С СИНДРОМОМ ДИАБЕТИЧЕСКОЙ СТОПЫ КАК КРИТЕРИЙ ТЯЖЕСТИ ПОРАЖЕНИЯ

Background. Diabetes mellitus is a global threat to public health. DFU is a marker of increased mortality in diabetic patients. It is important to understand the factors that would indicate the appearance of complications of diabetes mellitus. Objective. To investigate the factors influencing the occurrence of complications in patients with diabetes mellitus, to identify independent predictors of complications. Material and methods. A prospective non-randomized observational study was carried out from June 1, 2021 to September 1, 2021. The study involved 42 patients. The patients were divided into 2 groups: group 1 included subjects with a history of type 2 diabetes, group 2 – those with type 2 diabetes, complicated by DFU. Results. During the study, the level of platelets in the blood of all patients was 222.0 (177.5; 318.5)×109/l. The platelet count in group 1 was equal to 186 (154.5; 251.5)×109/l, and in group 2 it was 326.0 (239.25; 357.25)×109/l, statistical differences were significant (p &lt;0.001). We divided the patients with DFS according to the Wagner classification, where platelet counts were determined for each of the classification grades. The level of platelets in patients with grade 1 was 267.0 (222.0; 322.5)×109/l, in those with grade 2 – 358.0 (234.75; 280.25)×109/l, in subjects with grade 3 – 340 (309.5; 360.5)×109/l, in those with grade 4 – 328 (305,75; 330,0)×109/l, and in those with grade 5 – 404 (293.5; 407.75)×109/l. The obtained data showed that the platelet count in the blood of patients with diabetes mellitus, complicated by diabetic foot syndrome was higher, than in patients with diabetes mellitus without complications. The platelet count in patients with diabetic foot syndrome gradually increased with an increase in the degree on the Wagner scale. The blood platelet count can be useful in assessing the severity of diabetic foot syndrome. Conclusions. The platelet count in patients with type 2 diabetes can be considered as a laboratory criterion and an independent risk factor for complications.

Intralesional Epidermal Growth Factor for Diabetic Foot Ulcers.

To determine the role of the intralesional recombinant epidermal growth factor (rEGF) in the healing and prevention of extremity amputation in advanced diabetic foot ulcer patients. Observational study. Department of Cardiovascular Surgery, Duzce State Hospital, Duzce, Turkey, between November 2018 and September 2019. A total of 58 patients with diabetic foot ulcers that were treated at the study place were enrolled. The lesions were graded with Wagner Classification System. EGF (75 microg of Heberprot-P) vials were stored at +4°C and cold-chain requirements were followed. EGF 5 mL was dissolved with 0.09% saline solution; and 0.5-1 ml of the solution was injected into the tissues and edge of the lesions regularly. The data was evaluated at the end of two years of the treatment period. The primary objective was wound healing, formation of granulation tissue; and the secondary objective was the prevention of lower extremity amputation. Diabetic foot ulcers wound healing was achieved in 93.1% (n=54) of patients with the formation of granulation tissue. The complete recovery was observed in 94.1% (n=32) of the patients who had Grade III and IV lesions. Lower extremity amputation was performed in two (3.4%) subjects. The lesions of two patients required flap surgery. The most common adverse events were tremor and syncope. Recombinant epidermal growth factor is highly effective for the treatment of diabetic foot ulcers and prevention of extremity amputation. Intralesional rEGf provides efficient and safe wound healing/closure in patients with diabetic foot ulcers. Key Words: Amputation, Epidermal growth factor, Diabetic foot, Wound healing.

Analysis of Influencing Factors of Diabetic Foot Minor Amputation

Objective: To investigate the factors that influence diabetic foot (DF) minor amputation. Methods: In this case-control study, the clinical data of 955 hospitalized patients with DF were retrospectively analyzed, according to whether hospitalization amputation was divided into minor amputation and the non-amputation group, compared two groups of general data, laboratory examination, diabetes complications and complications, such as differences, multiple factors regression analysis DF Risk factors associated with minor amputation in patients. Results: There were statistically significant differences between the two groups in DPN, DR, PAD, ABI, TBI, and Wagner grades, as well as age, sex, HbA1c, FPG, Scr, SUA, TC, ALB, HDL-C, WBC, and Hb (P&lt;0.05). The logistic regression analysis that HbA1c (odds ratio [OR] 1.082 [95% CI 1.011–1.158], p= 0.023), ABI＜0.9 (odds ratio [OR] 1.793 [95% CI 1.316–2.443], p=0.000), TBI＜0.7(odds ratio [OR] 2.569 [95% CI 1.889–3.495], p=0.000), Wagner classification (odds ratio [OR] 2.792 [95% CI 2.303–3.384], p=0.000) and PAD (odds ratio [OR] 2.343 [95% CI 1.731–3.170], p=0.000) were significant risk factors for DF minor amputation (P＜0.05). Higher Hb (odds ratio [OR] 0.981 [95% CI 0.973–0.988], p=0.000) was an independent protective factor for minor amputation. Conclusion: HbA1c, lower ankle brachial index level, and lower toe-brachial index level were all related with minor amputation. Wagner classification and diabetic peripheral angiopathy may represent a novel independent factor. In light of these concerns, early preventive and timely multidisciplinary assistance is critical to prevent diabetic foot minor amputation.

Correlation of HBA 1C and duration of diabetes mellitus with grades of diabetic foot.

Objective: To find the correlation of HbA 1c and duration of diabetes mellitus with grades of diabetic foot according to Wagner classification. Study Design: Cross-sectional study. Setting: Bahawal Victoria Hospital Bahawalpur. Period: May 2020 to April 2021. Material &amp; Methods: 100 patients of 25-65 years of age with diabetic foot who presented in OPD or emergency department were included in study. Wounds of the diabetic foot were graded according to Wagner classification. HbA1c (Glycosylated haemoglobin) level was measured and duration of diabetes mellitus was calculated. SPSS Version 20 was used to analyze the data. Correlation of HbA1c and duration of diabetes mellitus with grades of diabetic foot was calculated and the chi- square test was applied, and results were considered significant where p value was ≤ 0.05. Results: The mean age was 51.46 ± 10.51. There were 70 male patients and 30 female patients. Mean value of HbA1c was 8.31±2.02. Neuropathy (52%) was the most common among risk factors for diabetic foot. Correlation between level of HbA1c and grades of diabetic foot was not significant (p value of 0.346). There was significant correlation between duration of disease and Wagner grades (p value was 0.003). Conclusion: Severity of diabetic foot is not correlated with HbA1c level but it is significantly related with duration of DM. Peripheral neuropathy is the main risk factor for diabetic foot.

Wagner's Classification as a Tool for Treating Diabetic Foot Ulcers: Our Observations at a Suburban Teaching Hospital.

ObjectivesThe study aims to scale patients with diabetic foot ulcers according to Wagner’s classification, measure the various risk factors, study various outcomes and improve the treatment measures.MethodologyThe article presents materials on a prospective observational study of 50 diabetic foot patients with different presentations who underwent stage-specific intervention.ResultsPoor glycemic control, lifestyle factors, and smoking showed increased risks for foot ulcer complications. Diabetic neuropathy and vasculopathy have been significant outcome predictors. As a result, advanced Wagner’s grades showed increased amputation risks and multimodal management.ConclusionsStratification of diabetic foot patients and appropriate management based on their Wagner’s grade helps reduce amputation rates and mortality. In addition, multimodal management and exceptional attention to diabetes and lifestyle control improve long-term outcomes.

Clinical and microbiological profile of bacterial pathogens from patients with diabetic foot infections at a teaching hospital in the northeast China

Background: Diabetic foot ulcer infection (DFI) is a frequent complication of diabetes. Objective: The aim is to determine the clinical and microbiological profiles and the antibiotic resistance phenotype, analyze the DFIs risk factors. Methods: The present study is a retrospective, single-center study conducted at a teaching hospital in the northeast China. 242 cases of patients with diabetic foot disease Wagner grade 0–5 over 2 years were screened and the recovered data consisted of the clinical features, risk factors, etiology and drug resistant profiles. Results: The total percentage of Gram-negative rods (GNRs) and Gram-positive cocci (GPCs) was 138 (54.92%) and 113 (45.02%). The most common isolates were Pseudomonas aeruginosa and Staphylococcus aureus, accounting for 22.37% and 19.74%, respectively. Logistic regression analysis showed that the duration of ulcer, duration of antibiotic use, Wagner classification and osteomyelitis were risk factors for multi-drug resistant (MDR) bacteria infection ( p&lt;0.05). Conclusion: The predominate pathogens of patients with DFI were GNRs, followed by GPCs in the region. They exhibited the different antibiotic resistance phenotype. The data provided advice on selection of highly sensitive antibiotics in the management of DFIs.

The Infected Diabetic Foot: A Microbiological Analysis

Category:Basic Sciences/Biologics; DiabetesIntroduction/Purpose:Diabetic foot infections show increasing prevalence. Their therapy is time consuming and expensive. Standardized antibiotic treatments do not exist. Suboptimal antibiotic therapy increases the morbidity of the patient. The aim of the study was to evaluate the dominating bacterial colonization in the diabetic foot. Furthermore we evaluated the changes of the colonization during surgical and antibiotic treatment and the efficiency of the therapy.Methods:The study included 100 patients with a diabetic foot syndrome and a pedal ulcer. Ulcers were classified according to Wagner Classification. HbA1c, CRP and patients BMI were documented. All patients underwent an angiologic investigation with arterial doppler ultrasonography and TcpO2 measurement. An MRI of the affected foot was performed to rule out osteomyelitis. All patients underwent surgical and antibiotic treatment. Surgery included debridement, abscess drainage, VAK therapy, bony resection, minor amputation, resection arthroplasty, Helal osteotomies. Osteomyelitis was pathologically verified. Microbiological results of superficial and deep smears, which were taken during the surgical therapy were analyzed. The antibiotic treatment was adapted to the bacterial resistance.Results:The duration of antibiotic treatment varied from 1 to 136 days (Mean:19.6 days, SD:17.3 ). The mean number of surgical interventions was 2.6. The dominating initial antibiotic treatment was Clindamycin/ Cefuroxim (48%) followed by Clindamycin (11%),Cefuroxim (7%), Clindamycin/ Ciprofloxacin (6%), Tazobactam (3%). The dominating bacteria were gram +. The difference of the percentage distribution compared to the gram- bacteria was statistically significant. The only significant percentage change of the antibiotic treatment was seen after the first surgical intervention, when the initial antibiotic treatment was significantly more effective against gram - bacteria. A change of the antibiotic treatment was seen with 1. Clindamycin / Ciprofloxacin in 66%, 2. Tazobactam in 67%, 3.Clindamycin in 36% and Clindamycin/ Cefuroxim in 35%.Conclusion:The dominating bacteria of the infected diabetic feet were gram +. The initial i.v. antibiotic treatment with Clindamycin/ Cefuroxim was effective in 66%. An optimization of the initial antibiotic treatment with greater focus on the gram + bacteria seems to be necessary.

The use of histoequivalent-bioplastic material for chronic foot ulcers on patients with diabetes

The main goal of this study was to improve the results of therapy in patients with chronic wounds on the foot in diabetics (I-II degree according to Wagner's classification) using histoequivalent bioplastic material «G-derm».Materials and methods. The study included 72 patients. The comparison group included 35 patients who underwent standard treatment with hydrocolloid dressings. The main group consisted of 37 patients. For them, in addition to standard treatment, the histoequivalent-bioplastic material «G-derm» was used. The patients' condition was assessed in dynamics on the 1st, 10th, 30th days from the start of treatment.Results. By the 30th day, the complete epithelialization was registered in 12 (16.7%) patients. The main group included 8 (21.6%) cases, and the control group – 4 (11.4%). The unsatisfactory epithelialization (healing less than a quarter of the initial area) by the 30th day of treatment was in 14 (19.4%) patients: in the main group – in 4 (10.9%) patients, in the comparison group – in 10 (28.5%) of patients. The remaining 25 (67.6%) patients in the main group and 21 (60%) participants in the comparison group had satisfactory epithelialization results by the 30th day of treatment.Conclusion. The results of this study show the effectiveness of using histoequivalent bioplastic material G-derm in local treatment of chronic wounds in patients with neuropathic diabetes in combination with standard therapies.The use of histoequivalent-bioplastic material in patients with diabetes leads to faster regeneration of the wound as well as increases the cases of complete epithelialization.

A STUDY ON RBC MORPHOLOGY AMONG SUBJECTS WITH VARIOUS GRADES OF DIABETIC FOOT ULCERS

Diabetes causes higher levels of blood glucose and often leads to complications like foot ulcers. Hemoglobin present within the red blood cells (RBCs) combines with blood glucose to form glycated hemoglobin (HbA1c) and its higher levels lead to serious life-threatening conditions. The aim of this study was to investigate the shape and texture features of RBCs among various grades of diabetic foot ulcers (DFUs). The study population ([Formula: see text], age: [Formula: see text] years) was grouped based on Wagner classification. Blood samples (5[Formula: see text]mL) were collected to determine the blood glucose and lipid profiles. A gray-level co-occurrence matrix (GLCM) was applied to obtain the textural information from the microscopic blood smear images. The Pearson test exhibited a negative correlation for HDL ([Formula: see text], [Formula: see text]) against HbA1c. A statistically significant correlation ([Formula: see text]) was observed for area, perimeter, equiv-diameter, convex area, major AL and minor AL against HbA1c. The HDL and RBC morphological features (area, perimeter, equiv-diameter, convex area, major AL and minor AL) exhibited statistically significant differences ([Formula: see text]) between the control and grade-2 groups. The texture features namely contrast ([Formula: see text], [Formula: see text]) and homogeneity ([Formula: see text], [Formula: see text]) exhibited statistically significant differences between the grade-2 and grade-0 subjects, depicting larger texture variations among the DFU subjects. The results affirmed that the features extracted from RBCs differ among various grades of DFUs.

Observation on the curative effect of fibula transverse transport technique in the treatment of diabetic foot ulcer

To investigate the clinical effect of fibula transverse transport technique in the treatment of diabetic foot ulcer. Nine patients (7 males and 2 females) with diabetic foot ulcer were treated with fibula transverse transport technique from September 2017 to September 2020. The mean age was (55±9) years (ranged from 43 to 66 years). In terms of Wagner classification, 2 cases were in grade 2, 5 cases were in grade 3, and the other 2 cases were in grade 4. All of the cases involved ischemic ulcers or ischemic-nerve ulcers. The transcutaneous oxygen pressure (TcPO2) of the dorsal foot of the affected limb was measured, with the ulcer healing and TcPO2 changes recorded at follow-up. All the 9 patients were followed up for (23±12) months (3 to 38 months). It was found that all patients with foot ulcers were cured within (4.2±1.9) months (2 to 8 months), and all the patients obtained limb salvage. Besides, there was no serious complications occurred, such as skin necrosis and needle tract infection. Before the operation, the TcPO2 of the affected foot was (28.6±3.8) mmHg(1 mmHg=0.133 kPa), while it was (35.0±5.6) mmHg three months after operation (P<0.05). The technique of fibula transverse transport can effectively improve the microcirculation function of diabetic foot, and it can promote the healing of the ulcer with few complications.

Superficial Tissue Swabs Versus Deep Tissue Samples in the Detection of Microbiological Profile of Infected Diabetic Foot Ulcerations.

This study aimed to determine the most accurate microbiological test for the detection of micro-organisms in infected diabetic foot ulcerations in people living with type-2 Diabetes. For 20 eligible patients, a superficial tissue swab and a deep tissue sample were taken during a regular appointment at a Diabetes out-patient's Podiatry Clinic. Two specimens were collected from each wound for microbial culturing after debridement. Infected foot ulcerations were graded according to the Wagner's classification as per clinical protocol. This study found a significant difference [p = 0.028] between the two different samples. The deep tissue sample was found to be more accurate in identifying micro-organisms than the superficial swabs, although the latter is more widely used in clinical practice. Further studies are warranted to provide more evidence to clinicians on the best method to adopt when swabbing different types of diabetic foot ulcerations with different wound classification since, it is clearly still a matter of debate how to detect wound infection.

Is ischaemia-modified albumin a biomarker in wagner classification in diabetic foot ulcers?

We aimed to determine the relationship of ischaemia-modified albumin (IMA) with diabetic foot ulcers and its predictive value in the Wagner classification. Our cross-sectional study was conducted in 120 diabetic foot patients and 60 healthy individuals with similar body mass index (BMI) and age. Patients with a diabetic foot were classified according to the Wagner classification. Biochemical parameters, C-reactive protein (CRP) and IMA levels were measured in all patients and healthy volunteers. Screening performance characteristics of CRP and IMA were calculated according to Wagner classes and the presence of osteomyelitis. The levels of BMI, CRP and IMA in diabetic foot patients were significantly higher than the healthy controls. When we grouped the patients according to the Wagner classification, there were no significant differences between the Wagner groups in terms of BMI. The highest IMA levels were detected in Wagner grade 5. CRP had higher sensitivity and specificity than IMA in the discrimination of other grades, except for grade 4-5 separation. For Wagner grade 4-5 distinction, IMA had 84.6% sensitivity and 94.7% specificity. IMA had a higher predictive value in discrimination of the Wagner grade 4-5. In the management of diabetic foot patients, it may be recommended that IMA is evaluated by clinicians.

Dose-response and efficacy of low-level laser therapy on diabetic foot ulcers healing: Protocol of a randomized controlled trial

BackgroundCurrent evidence shows that low-level laser therapy (LLLT) is an effective non-invasive and non-pharmacological strategy to treat diabetic foot ulcers (DFU). However, knowledge of parameterization efficacy remains unclear. Methods: This randomized, double-blind, controlled trial will be conducted at the Physical Therapy University Clinic. Eighty volunteers will be randomized into four groups. The control group will receive placebo LLLT + conventional treatment. The three active groups will receive 10 (G10), 8 (G8), or 4 J/cm2 (G4) of GaAs 904 nm LLLT plus conventional treatment twice a week for 20 sessions. Conventional treatment involves cleaning and dressing the ulcers. The main outcome will be the area of ulcers and Wagner classification score. Assessments will take place before treatment, after 5 and 10 weeks of treatment, and in the third month after treatment, by a blinded evaluator. Implications: This trial can potentially provide important information and assist in clinical decision-making regarding DFU treatment with LLLT.Trial Registration:NCT04246814, registered 29th January 2020.

Wagner’s Classification for Management and Evaluation of Diabetic Foot: A Prospective Study

Background: In our community diabetes is one of the most common co-morbid illnesses. Out of its several complications in long course diabetic foot is one of them. Morbidity and mortality due to this complication is a major health issue. Objective: This study is undertaken for management and evaluation of foot ulceration to avoid amputation of lower extremities due to diabetic foot disease. Methods: This prospective observational study conducted between July 2019 and September 2020, 40 patients with diabetic foot admitted to Department of General Surgery, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar (TS) were subjected to surgical treatment depending upon the Wagner’s classification. Data was collected and analyzed by statistical software SPSS V 25. Results: Majority of the patients presented with higher grade and with poor glycemic control at the time of presentation. Conservative management with antibiotics was useful in a small subset of the patients. Majority of the patients needed surgical treatment in the form of debridement to amputations. Conclusion: Patient education and strict glycemic control can reduce the burden of diabetic foot. Early diagnosis and hospitalization, appropriate treatment including medical and surgical treatment according to the grade can reduce the morbidity mortality and improve the outcome of the disease. Keywords: Antibiotics; Amputation; Wagner classification; Complications; Glycemic control.

Diabetic Foot: its grades and mode of presentation at a tertiary care hospital of Peshawar, Khyber Pakhtunkhwa, Pakistan

Introduction: Diabetic foot is defined as the foot of diabetic patients with ulceration, infection, and/or destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. Foot ulcers are the principal cause of severe complications and hospitalization among patients with diabetes, substantially increasing the costs of this disease.&#x0D; Objectives: To describe the presentation, distribute the diabetic foot lesions according to Wagner’s classification, and determine the outcome of diabetic foot ulceration in a tertiary care hospital of Peshawar, Pakistan.&#x0D; Materials &amp; Methods: This study was conducted in the Surgery department of Rehman Medical Institute Peshawar. Thirty nine (39) patients with diabetic foot disease presenting from Jan 2018 to Dec 2019 were included in the study. The patients were evaluated and managed by classifying their disease according to Wagner’s classification for diabetic foot disease. Statistical analysis was done by using SPSS version 26 for descriptive statistics.&#x0D; Results: The most common age of presentation with diabetic foot lesion was between 41-70 years; out of 39 patients, 28 (71.8%) were males and 11 (28.2%) were females. Their mode of presentation was as follows- 22 cases (56.4%) with Ulcer, 9 cases (23.1%) with Cellulitis, 7 cases (17.9%) with Gangrene, and 1 case (2.6%) with Abscess. The most common grade of presentation were grades 3 and 4 Wagner’s lesion followed by Grade 1, and Grade 2. Debridement was the most common treatment modality (56.2%), followed by Amputation (41%).&#x0D; Conclusion: Foot ulceration in diabetic patients is a resource-consuming, disabling morbidity that often is the first step towards lower extremity amputation. Diabetic foot lesions can be easily graded according to the Wagner classification and helps in correlating appropriate treatment to the grade of the lesion for a better outcome.

Prevalence of Peripheral Arterial Disease in Diabetic Foot Ulcer Patients and its Impact in Limb Salvage.

Diabetic foot ulcer syndrome is a common complication of diabetes mellitus. Three main factors contribute to it: neuropathy, vasculopathy, and infection. This study was conducted to evaluate the prevalence of peripheral arterial disease (PAD) in diabetic foot ulcer patients and its impact on limb salvage as an outcome. This prospective cross-sectional study included 392 cases, who were divided according to the presence of PAD into 2 groups; patients with PAD were labeled as PAD +ve (172 cases) and those without PAD were labeled as PAD -ve (22 cases). All cases were clinically assessed, and routine laboratory examinations were ordered. Moreover, duplex ultrasound was done for suspected cases of having PAD by examination. Computed tomography angiography was ordered for patients who are in need of a revascularization procedure. Cases were managed by debridement and/or revascularization. After that, these cases were assessed clinically and radiologically for vascularity and infection and the possibility for amputation was evaluated. Infection was classified using Wagner Classification System, and revascularization was decided according to the TASC II system. The incidence of PAD in cases with diabetic foot ulcer syndrome was 43.87%. No difference was detected between the 2 groups regarding age and gender (P > .05). The prevalence of smoking, hemodialysis, ischemic heart disease (IHD), and hypertension was more significantly higher in cases with PAD (P < .05). Revascularization procedures were only performed in cases that had documented severe PAD or chronic limb-threatening ischemia in addition to foot ulcer and/or infection. With regard to limb salvage, it was more significantly performed in cases without PAD (82.3% vs 48.3% in PAD cases; P < .001). Male gender, smoking, ankle-brachial pressure index, hemodialysis, IHD, neuropathy, HbA1C, PAD, and high Wagner classification were predictors of limb amputation (P < .05). PAD is associated with worse outcomes in diabetic foot ulcer patients. Not only does it constitute a great number among diabetic foot ulcer patients, but it also has a negative impact on limb salvage.