The international journal of lower extremity wounds最新文献

This study aimed to investigate the levels of adherence to wearing therapeutic footwear, and the factors associated, among people at high-risk of diabetes-related foot ulcers (DFUs) in Jordan. This was a secondary analysis of data from a multi-centre cross-sectional study of participants at high-risk of DFU in Jordan who had therapeutic footwear. Participants had socio-demographic, health, limb, and psychosocial variables collected, plus self-reported their proportion of adherence time wearing therapeutic footwear on an average day (excluding sleeping time) using a visual analogue scale. Participants were categorized into high (≥60%) or low (<60%) adherence levels, plus users (1%-100% adherence) or non-users (0% adherence) of therapeutic footwear. Of 104 included participants (mean age 58 ± 13 years, 68% males), 65 (62.5%) self-reported low adherence levels and 44 (42.3%) as non-users. No variables were independently associated with low adherence levels (P > .05). Whereas participants with lower self-reported foot care outcome expectation scores were independently associated with non-use of therapeutic footwear (P = .05). Most people at high-risk of DFUs in Jordan self-reported low adherence or total non-use of their therapeutic footwear. Perceived low footcare outcome expectations was the only factor found associated with non-use of therapeutic footwear and further research is needed to explore other potential factors.

Background: Diabetic Foot Ulcer (DFU) is a common and challenging complication of diabetes mellitus, associated with high recurrence, hospitalization, disability, and mortality rates. The Systemic Immune Inflammatory Index (SIRI) based on complete blood counts has been shown to correlate with several diseases but has not been widely studied in DFU.This study aimed to explore the relationship between SIRI and the presence of DFU in individuals with diabetes using data from the National Health and Nutrition Examination Survey (NHANES). Methods: A cross-sectional analysis was conducted on 1246 individuals with diabetes from NHANES cycles 1999-2000, 2001-2002, and 2003-2004. DFUs were identified through patient self-reported data. Multivariate logistic regression models assessed the association between SIRI and DFU, adjusting for potential confounders. Subgroup and interaction analyses were also performed. Results: A total of 117 patients were identified as having DFU. Elevated SIRI levels were significantly associated with DFU presence. In fully adjusted models, a 1-unit increase in SIRI was associated with 24.0% higher odds of DFU prevalence (OR = 1.24; 95% CI: 1.07, 1.43) Subgroup analyses revealed consistent associations across different groups of age, gender, body mass index (BMI), HbA1c, blood glucose, and hemoglobin levels. Conclusion: The findings indicate a positive correlation between SIRI and DFUpresence. Further research is warranted to elucidate the mechanistic links and explore the clinical utility of SIRI in DFU management.

The present descriptive study investigates the general and foot-care self-efficacy and the level of foot-care knowledge of 151 participants who presented to the internal medicine ward and diabetes nursing unit of a training and research hospital in Türkiye. The mean Diabetes Management Self-Efficacy Scale score of the participants was 69.0 ± 15.0 (min: 20, max: 100), the mean Diabetic Foot Care Self-Efficacy Scale score was 56.2 ± 23.1 (min: 9, max: 90) and the mean Diabetes Foot Self-Care Behavior Scale score was 51.5 ± 13.6 (min: 15, max: 75). The total Diabetes Management Self-Efficacy Scale, Diabetic Foot Care Self-Efficacy Scale and Diabetes Foot Self-Care Behavior Scale scores were noted to be higher in the participants who underwent regular health check-ups and used their medication regularly than in those who did not (p < 0.05). People with diabetes should be provided with counseling on the benefits of developing positive behaviors related to self-efficacy and foot self-care, and the prevention of wound development through education, support and the effective self-management of their condition.

Purpose: The current study was aimed to evaluate the potential of Moringa oleifera against diabetic foot ulcer, where the wound healing is impaired and susceptible to infection.

Methods: The effects of M. oleifera hydroalcoholic bark extract (MOHE) on different parameters influencing diabetic wound healing were comprehensively investigated including: anti-inflammatory effects, antibacterial properties, antioxidant activity, anti-diabetic properties, and fibroblast proliferation and migration. Furthermore, in vivo studies were conducted in diabetic rats and Zebrafish to investigate the topical effects of MOHE on wound healing.

Results: The findings of this study demonstrated that MOHE has strong anti-diabetic effect, including a significant inhibition of α-amylase activity (IC50 = 0.043 mg/mL) and 2.92-fold increase in 2-NBDG uptake in McCoy cells. MOHE demonstrated considerable antioxidant activity, inhibiting DPPH (IC50: 0.046 mg/mL) and ABTS (IC50: 0.04 mg/mL) free radicals. In in vitro wound healing studies employing MOHE revealed a significant increase in McCoy fibroblast proliferation (148.83%) and improved migration, resulting in a wound closure rate of 46.3%. MOHE exhibited significant antibacterial activity against pathogenic bacteria species. It efficiently reduced heat-induced RBC hemolysis, with anti-inflammatory effect of 73% at 0.2 mg/mL. Furthermore, MOHE demonstrated better results in the treatment of diabetic wounds in Wistar rats and fin regeneration in Zebra fish compared to Calendula cream.

Conclusion: This evidence based pharmacological study highlights the promising potential of MOHE in facilitating the healing of diabetic wounds, offering a topical approach to address this challenging healthcare issue.

To compare the incidence of infection, wound closure and time to wound closure in patients treated with cryopreserved (CPUT) and lyopreserved umbilical tissue (LPUT) in complex diabetic surgical wounds. This single-blinded 12-week randomized clinical trial compared cryopreserved and lyopreserved amniotic cord tissue to treat complex diabetic foot wounds. LPUT or CRAT was applied at baseline and again after four weeks. We enrolled subjects with UT2A-D and 3A-D wounds (depth to tendon, muscle, or bone with infection and/or PAD) and excluded subjects with ABI < 0.5 or TBI < 0.3, untreated osteomyelitis, and autoimmune diseases. We used a 3-D camera to evaluate wound area and volume. The mean baseline wound areas were 12.9 ± 10.7 cm² for CPUT and 11.7 ± 7.0 cm² for LPUT. The mean baseline wound volume was 7.5 ± 8.1 for CPUT and 9.2 ± 10.2 cm³ for LPUT. There was no difference between CPUT and LPUT in wound closure (36.8% vs 19.0%, P = .21) or infection (10.5% vs 4.8%, P = .60). There was no difference in mean wound area reduction between CPUT and LPUT (75.9 ± 32.3% vs 65.5 ± 38.4%, P = .41), nor in mean volume reduction (85.0 ± 30.8% vs 79.9 ± 31.9%, P = .61). In addition, there was no difference in wound closure trajectories for changes in area (P = .75) or volume (P = .43). Cryopreserved and lyopreserved amniotic tissue provided similar results in patients with complex diabetic foot wounds.

We read with great interest the meta-analysis by Mudgal et al. (2024) regarding the effectiveness and safety assessment of stem cell therapy for diabetic foot ulcers. Indeed, The management of chronic wounds requires innovative approaches to avoid unsuccessful outcomes, and stromal cell therapies have emerged as a potential solution for soft tissue repair. A critical aspect of this therapeutic strategy is the role of mast cells in stimulating delayed inflammation through their interactions with various cells as well as the extracellular matrix. Mast cells are critical in orchestrating the inflammatory response and their activation can influence macrophage behavior and secondary healing efficacy. The use of mesenchymal stromal cells in regenerative medicine for diabetic foot ulcers treatment is often limited by their time-limited anti-inflammatory responses. However, these time-limited effects could not achieve the prolonged effects and impact of cell therapy efficacy and the potential enhancement of cell function by biologically active factors such as growth factors or gene therapeutics for prolonged release. The integration of cell and prolonged release gene therapeutics is a promising approach that goes beyond regenerative medicine by preventing secondary inflammatory complications. While mesenchymal stromal cells have shown promising results in experimental and clinical studies, there are limitations to their efficacy in regenerative medicine for diabetic foot ulcers. These limitations include the heterogeneity of cell populations used in the studies, the difficulty in determining the contribution of cells when used in combination with materials, the lack of data on optimal cell numbers for tissue repair, the effect of culture conditions on cell therapy efficacy, and the potential enhancement of cell efficacy by the use of additional biologics such as growth factors or gene therapeutics. The combination of cell and gene therapy is seen as a promising approach that goes beyond regenerative medicine into the field of molecular surgery of chronic wounds.

Background: Diagnosing red legs on first presentation is challenging. There exists a lack of robustly developed and validated diagnostic red leg tools in clinical practice. Physicians fear missing cases of infectious red legs and treat many patients unnecessarily with antibiotics.

Objective: Develop and validate easy-to-use diagnostic tools applicable at bedside of patients to orient diagnosis of the commonest and most serious causes of infectious red legs (non-necrotizing bacterial dermohypodermitis (NNBDH), and necrotizing fasciitis (NF)) versus the commonest inflammatory cause (eczema).

Methods: We collected data of patients presenting to our dermatology department from January first 2012 until May 17th 2017 with a diagnosis of red leg. Three models were developed using fast frugal trees. Validation was performed in a second cohort of patients.

Results: A total of 187 patients (mean age 56, SD = 21 years, 48.1% women) were included in the development phase and 62 patients (mean age 64, SD = 19, 52% women) in the validation phase. In the validation data set, sensitivity and specificity were respectively 67% and 91% for NNBDH, 83% and 66%, for NF and 88% and 93%, for eczema.

Conclusion: Presentations of suspected lower-limb infections are commonly misdiagnosed, resulting in avoidable antibiotic prescription and hospitalization. We developed an easy-to-use clinical diagnostic tool applicable at the bedside of patients to help orient physicians in certain situations and avoid unnecessary initiation of antibiotics. Future work should focus on validating this tool in primary care to minimize misdiagnosis of red legs and overprescription of antibiotics.

The aim of this study was to compare the microbial loads of patients with diabetic foot infections treated with negative pressure wound therapy (NPWT) with and without irrigation with polyhexamethylene biguanide (NPWTi-P). This is a post hoc analysis of combined data of two randomized clinical trials. We evaluated people with diabetes treated with moderate and severe diabetic foot infections that required surgery. Tissue specimens were obtained after the initial surgery and following a second planned return to the operating room after 48-72 h of NPWT or NPWTi-P, prior to the second surgery. We used quantitative polymerase chain reaction (qPCR) to determine the total microbial loads (Log₁₀ 16S copies per gram of tissue). There was no difference in mean quantitative bacterial cultures among patients that received NPWT and NPWTi-P (before first surgery Log₁₀: NPWT = 6.4 ± 1.8, NPWTi-P = 7.5 ± 1.7 vs before second surgery Log₁₀: NPWT = 6.7 ± 1.8, NPWTi-P = 7.6 ± 1.9 p = .12). There was no difference in wound healing (59.5% vs 50.0%, p = .51) or time to heal (127 ± 109.3 vs 143 ± 95.9), p = .71). There were fewer re-infections in people that received traditional NPWT (28.6% vs 56.3%, p = .05). Level of Clinical Evidence: Level 1.