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Diabetic major amputation

Mousab Yousef Al-Ayed, Mutasem Ababneh, Asirvatham Alwin Robert, Ahmed Salman, Abdulghani Al Saeed, Mohamed Abdulaziz Al Dawish
BACKGROUND AND AIMS: Considering that diabetic foot ulceration is one of the major health issues globally, we aimed to evaluate the risk factors associated with foot ulcers in patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 81 T2DM patients (age range: 40-80 years) registered at the Diabetes Treatment Center, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia between April and September 2015 were included in this cross-sectional study after purposive selection and assigning of patient numbers...
August 16, 2018: Current Diabetes Reviews
Ming Ngan Aloysius Tan, Zhiwen Joseph Lo, Soon Hong Lee, Rui Ming Teo, Wei Leong Glenn Tan, Sadhana Chandrasekar
Objective : To evaluate outcomes after transmetatarsal amputation (TMA) in peripheral arterial disease (PAD) limb salvage in an Asian population and identify risk factors associated with TMA failure. Methodology : A retrospective review of 147 patients with PAD, who had undergone TMA between 2008 and 2014, was carried out. Univariate and multivariate analysis were used to identify predictors of TMA failure. Kaplan-Meier survival analysis was used to calculate major amputation and all-cause mortality rates. Results : The mean age was 66 years...
June 25, 2018: Annals of Vascular Diseases
Patricia E Martin, Erin M O'Shaughnessy, Catherine S Wright, Annette Graham
Impaired wound healing and ulceration caused by diabetes mellitus, is a significant healthcare burden, markedly impairs quality of life for patients, and is the major cause of amputation worldwide. Current experimental approaches used to investigate the complex wound healing process often involve cultures of fibroblasts and/or keratinocytes in vitro , which can be limited in terms of complexity and capacity, or utilisation of rodent models in which the mechanisms of wound repair differ substantively from that in humans...
August 16, 2018: Clinical Science (1979-)
Montserrat Doria, Jordi Viadé, Elisabet Palomera, Ricard Pérez, Melcior Lladó, Elisabet Costa, Teresa Huguet, Jordi Lluís Reverter, Mateu Serra-Prat, Josep Franch-Nadal, Dídac Mauricio
OBJECTIVES: To assess the clinical characteristics of patients with Charcot neuroarthropathy (CN) in Spain and to identify predictors for CN-related complications. PATIENTS AND METHODS: A retrospective study was conducted at five tertiary hospitals with diabetic foot care units in Spain. Data were collected from 83 patients, including demographic profiles, foot factors, diabetes characteristics, and presence of microvascular and macrovascular comorbidity, and a podiatric examination was also performed...
August 11, 2018: Endocrinología, Diabetes y Nutrición
Tatiana Chadid, Andrew Morris, Alexandra Surowiec, Scott Robinson, Maiko Sasaki, Jacques Galipeau, Brian P Pollack, Luke P Brewster
OBJECTIVE: Regenerative medicine seeks to stall or to reverse the pathologic consequences of chronic diseases. Many people with diabetes have peripheral arterial disease (PAD), which increases their already high risk of major amputation. Cellular therapies are a promising regenerative medicine approach to PAD that can be used to focally inject regenerative cells to endangered tissue beds. Mesenchymal stem cells (MSCs) are known to promote tissue regeneration through stromal support and paracrine stimulation of new blood vessels (angiogenesis)...
August 10, 2018: Journal of Vascular Surgery
Jocelyn Lu, Michael V DeFazio, Chrisovalantis Lakhiani, Michel Abboud, Morgan Penzler, Tammer Elmarsafi, Paul J Kim, Christopher E Attinger, Karen K Evans
BACKGROUND:  Recent evidence documenting high success rates following microvascular diabetic foot reconstruction has led to a paradigm shift in favor of more aggressive limb preservation. The primary aim of this study was to examine reconstructive and functional outcomes in patients who underwent free tissue transfer (FTT) for recalcitrant diabetic foot ulcers (DFUs) at our tertiary referral center for advanced limb salvage. METHODS:  Between June 2013 and June 2016, 29 patients underwent lower extremity FTT for diabetic foot reconstruction by the senior author (K...
August 12, 2018: Journal of Reconstructive Microsurgery
M Graça Pereira, Susana Pedras, Gabriela Ferreira
AimThis study examined the differences and the predictive role of clinical variables, illness representations, anxiety, and depression symptoms, on self-reported foot care adherence, in patients recently diagnosed with type 2 diabetes mellitus (T2DM) and assessed no longer than a year after the diagnosis (T1) and four months later (T2). BACKGROUND: The high rate of diabetes worldwide is one of the major public health challenges. Foot care is the behavior least performed by patients although regular foot care could prevent complications such as diabetic foot and amputation...
August 10, 2018: Primary Health Care Research & Development
Roberto Ferraresi, Andrea Casini, Maurizio Caminiti, Fabrizio Losurdo, Giacomo Clerici
The diabetic foot represents one of the most dangerous complications of diabetic disease, and it is characterized by the presence of infection, ulceration, or necrosis of the foot tissues associated with various degrees of neuropathy or ischemia. If not correctly and promptly treated, it leads to high rates of major amputations. Although in Italy diabetics are about 5% of the population, more than 50% of major amputations are performed in diabetic patients. Compared to non-diabetic patients, diabetic peripheral artery disease localizes more distally, mostly in the below-the-knee vessels, is typically bilateral with multi-level involvement, and presents earlier onset and more aggressive course...
September 2018: Giornale Italiano di Cardiologia
Alessandro Mantovani, Ilaria Teobaldi, Vincenzo Stoico, Fabrizia Perrone, Marina Zannoni, Luca Cima, Massimiliano Bruti, Lucia Mingolla, Maddalena Trombetta, Enzo Bonora
After basal cell carcinoma, the cutaneous squamous cell carcinoma (cSCC) is the second most frequent non-melanoma skin cancer worldwide, and, classically, arises from the upper coats of the epidermis of sun-exposed areas or from skin areas constantly exposed to a chronic inflammatory stimulus. The occurrence of cSCC seems to be linked to several factors, including exposure to sunlight (or other ultraviolet radiations), immunosuppression, chronic scarring conditions and some familial cancer syndromes. Although the majority of cSCCs are adequately eradicated by surgical excision, a subgroup of cSCC may be linked with an increased risk of recurrence, metastasis and death...
2018: Endocrinology, Diabetes & Metabolism Case Reports
Ssu-Wei Cheng, Chin-Yuan Wang, Jin-Hua Chen, Yu Ko
To estimate the healthcare utilization and costs of major diabetes mellitus (DM)-related complications in Taiwan in the year of first occurrence and in subsequent years.This study is a retrospective claim database analysis using the longitudinal cohort of diabetes patients (LHDB) with 2012 as the base year. Occurrences of 8 DM-related complications of interest were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Annual healthcare costs and utilization of these DM-related complications in the LHDB cohorts of the years 2004 to 2009 were examined, and the generalized linear model was used to estimate annual total healthcare costs for each complication...
August 2018: Medicine (Baltimore)
Mathilde Nativel, Fabrice Schneider, Pierre-Jean Saulnier, Elise Gand, Stéphanie Ragot, Olivier Meilhac, Philippe Rondeau, Elena Burillo, Maxime Cournot, Louis Potier, Gilberto Velho, Michel Marre, Ronan Roussel, Vincent Rigalleau, Kamel Mohammedi, Samy Hadjadj
OBJECTIVE: Inflammation and oxidative stress play an important role in the pathogenesis of lower-extremity artery disease (LEAD). We assessed the prognostic values of inflammatory and redox status biomarkers on the risk of LEAD in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS: Plasma concentrations of tumor necrosis factor-α receptor 1 (TNFR1), angiopoietin-like 2, ischemia-modified albumin (IMA), fluorescent advanced glycation end products, protein carbonyls, and total reductive capacity of plasma were measured at baseline in the SURDIAGENE (Survie, Diabete de type 2 et Genetique) cohort...
August 2, 2018: Diabetes Care
Jessica M Mayor, Wilmer Valentin, Sherene Sharath, Neal R Barshes, Jayer Chung, Panos Kougias, Joseph L Mills
BACKGROUND: Despite advances in endovascular therapy, infrainguinal bypass continues to play a major role in achieving limb salvage. In this study, we sought to compare outcomes of infrainguinal bypass in patients with limb-threatening ischemia who presented with or without foot infection. METHODS: We conducted a retrospective cohort study of patients who underwent infrainguinal bypass for chronic limb-threatening ischemia at a single institution. End points of interest included long-term mortality, 45-day readmission, postoperative length of stay (LOS), major amputation, and time to wound healing...
July 28, 2018: Journal of Vascular Surgery
Tracy J Cheun, Lalithapriya Jayakumar, Maureen K Sheehan, Matthew J Sideman, Lori L Pounds, Mark G Davies
BACKGROUND: Critical hand ischemia owing to below-the-elbow atherosclerotic occlusive disease is relatively uncommon. The aim of this study was to examine the outcomes in patients presenting with critical ischemia owing to below-the-elbow arterial atherosclerotic disease who underwent nonoperative and operative management. METHODS: A database of patients undergoing operative and nonoperative management for symptomatic below-the-elbow atherosclerotic disease between 2006 and 2016 was retrospectively queried...
July 28, 2018: Journal of Vascular Surgery
Aminder Singh, Angela Adams, Bethany Dudley, Eliza Davison, Lauren Jones, Lucy Wales
High-quality perioperative diabetes care is essential to improve surgical outcomes for patients with diabetes. Inadequate perioperative diabetes care is associated with increased wound complications, higher mortality rates and increased length of hospital stay. Despite national guidelines, surgical wards remain a high-risk area for poor diabetes care. An initial baseline audit in 2014 of vascular patients with diabetes undergoing major lower limb amputation identified poor glycaemic control in 90% of patients, with high rates of hypoglycaemia and insulin management errors in 75%...
2018: BMJ Open Quality
Francesca Persiani, Alessandra Paolini, Daniele Camilli, Luca Mascellari, Alessandro Platone, Alessandra Magenta, Sergio Furgiuele
OBJECTIVE: The aim of this study is to analyze the effects of peripheral blood mononuclear cells (PBMNCs) therapy in diabetic patients with critical limb ischemia (CLI), with particular regard to its application, as adjuvant therapy in patients underwent to endovascular revascularization. METHODS: Fifty diabetic patients affected by CLI were enrolled. All patients underwent to PBMNCs therapy. Thirty-two patients underwent to PBMNCs therapy associated to endovascular revascularization (adjuvant therapy group)...
July 24, 2018: Annals of Vascular Surgery
Vijay Viswanathan, Umapathy Dhamodharan, Valarmathi Srinivasan, Rama Rajaram, Vivekanandhan Aravindhan
Compared to other complications the genetics of diabetic foot ulcer is poorly studied. The Interleukin (IL)-6 (-174G > C/rs1800795), Tumor Necrosis Factor (TNF)-α (-308G > A/rs1800629) and (-238G > A/rs361525) and Stromal cell Derived Factor (SDF)-1 (+801G > A/rs1801157) are well characterized single nucleotide polymorphisms (SNPs) which were previously shown to be associated with Diabetic Foot Ulcer (DFU). In the present study, we looked at the association of these SNPs with foot microbial infection, Wagner's ulcer grade and treatment procedure, along with serum levels of these cytokines (intermediate phenotype) and other serum biomarkers (adiponectin, leptin, CRP and HOMA-IR) in subjects with DFU...
July 14, 2018: International Journal of Biological Macromolecules
Anna G Couch, Jonathan Foo, Alicia M James, Stephen Maloney, Cylie M Williams
Background: In the management of diabetes and high-risk patients, timely treatment with scheduled medicines is critical to prevent severe infections and reduce the risk of lower extremity amputation. However, in Australia, few podiatrists have attained endorsement to prescribe. The aims of this study were to identify the costs associated with developing and implementing a podiatry prescribing mentoring program; and to compare the cost of this program against potential healthcare savings produced...
2018: Journal of Foot and Ankle Research
Hira Choudhury, Manisha Pandey, Chua Kui Hua, Cheah Shi Mun, Jessmie Koh Jing, Lillian Kong, Liang Yee Ern, Nik Ahmad Ashraf, Soohg Wai Kit, Tan Sin Yee, Mallikarjuna Rao Pichika, Bapi Gorain, Prashant Kesharwani
Herbal medicine, phytomedicine or botanical medicine are synonymous, utilizes plants intended for medicinal purposes. Medicinal use of herbal medicine in the treatment and prevention of diseases including diabetes has a long history compared to conventional medicine. Diabetes is one of the major public health concerns over the world. Diabetes or hyperglycemia is considered to be one of the common public health hazard; optimal control of which is still not possible. Persistent hyperglycemia or uncontrolled diabetes has the potential to cause serious complications such as kidney disease, vision loss, cardiovascular disease, and lower-limb amputations which contributed towards morbidity and mortality in diabetes...
July 2018: Journal of Traditional and Complementary Medicine
Douglas Franz, Yuanchao Zheng, Nicholas J Leeper, Venita Chandra, Maria Montez-Rath, Tara I Chang
Importance: Patients with end-stage renal disease (ESRD) who receive dialysis are at high risk of lower extremity amputation. Recent studies indicate decreasing rates of lower extremity amputation in non-ESRD populations, but contemporary data for patients with ESRD who receive dialysis are lacking. Objectives: To assess rates of lower extremity amputation among patients with ESRD who receive dialysis during a recent 15-year period; to analyze whether those rates differed by age, sex, diabetes, or geographic region; and to determine 1-year mortality rates in this population after lower extremity amputation...
July 9, 2018: JAMA Internal Medicine
Konstantinos Stavroulakis, Matthias Borowski, Giovanni Torsello, Theodosios Bisdas
PURPOSE: To examine the outcomes of all first-line strategies for the treatment of critical limb ischemia (CLI), identify factors that influenced the treatment choice, and determine the risk of amputation or death after each treatment. METHODS: CRITISCH ( identifier NCT01877252) is a multicenter, national, prospective registry evaluating all available treatment strategies applied in 1200 consecutive CLI patients in 27 vascular centers in Germany...
June 2018: Journal of Endovascular Therapy
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