The international journal of lower extremity wounds最新文献

Euglycemic Diabetic ketoacidosis (E-DKA) is a life-threatening emergency characterized by ketonemia and metabolic acidosis in presence of relatively normal glycemic values. In recent years it has been associated with some predisposing conditions including sodium-glucose transporter 2 inhibitors (SGLT2-i) therapy, widely used in high-risk cardiovascular patients. We report the case of a 78-year-old diabetic woman treated with dapagliflozin, affected by critical limb threatening ischemia and septic osteoarthritis of interphalangeal joint of first right toe. At admission blood exams allowed diagnosis of E-DKA associated to acute kidney failure. The occurrence of the condition was probably due to foot infection acting on a trigger on a SGLT2-i predisposition. We treated the patient according to guidelines' indications achieving the resolution of the metabolic derangement. After the control of acute condition and return of metabolic parameters within the normal range, the patient underwent revascularization procedure and surgical debridement eventually obtaining complete healing of foot lesion.

Charcot neuro-osteoarthropathy (CNO) is a manifestation of peripheral neuropathy as a chronic complication of diabetes mellitus but, less frequently, can be associated to other conditions such as alcoholism or neurotoxic therapies. An increasingly emerging cause of CNO is the use of oncological drugs which can cause neuropathic damage. The use of these therapies dramatically increased in recent years. CNO leads to a progressive degeneration of the foot's joints and to bone destruction and resorption which ends in deformities. These alterations in the foot's anatomy determine a high risk of ulceration, infection, and osteomyelitis. The superimposition of osteomyelitis on CNO increases the risk of major amputation, already high in patients suffering either from only CNO or osteomyelitis alone. We report the case of a 61-year old nondiabetic woman affected by CNO as a consequence of antiblastic therapy for breast cancer and the subsequent overlap of osteomyelitis, confirmed by magnetic resonance imaging. This case underlines how it is necessary to consider CNO as a possible complication of antiblastic therapy in the view of the severe consequences of missing its diagnosis.

Charcot osteoarthropathy (CO) is an unusual and frequently misdiagnosed complication of diabetes mellitus. The delayed diagnosis can have severe consequences for patients' limb and life. Its diagnosis is based firstly in its clinical suspicion, is mainly clinical and is confirmed by imaging tests, like magnetic resorance imaging. Specific biomarkers for its early detection and therapy have not been found yet. The understanding of CO pathogenesis and measurement of molecules involved in this can head to this direction. The purpose of this review is to summarize/describe the most current studies measuring biomarkers in people with CO. Confocal corneal microscopy (CCM), inflammatory markers including IL-1, IL-6 and TNF-a, bone metabolism markers like RANK, RANKL, OPG, advanced glycation end products (AGEs) and bone mineral density (BMD) were among the most popular ones included in a large number of studies of the last 20 years and people with CO have significant different levels of the above comparing to non-Charcot groups. Future and larger studies can lead to the discovery of novel biomarkers of the prompt detection of this special entity at an early stage.

Management of residual deformity in patients with Charcot Neuro-osteoarthropathy represents a therapeutic challenge. The midfoot is the most frequently affected area, leading to the typical rocker-bottom deformity. Surgical exostectomy in these areas of bony prominences offers a non-reconstructive method to remove pressure and allow ulcers to heal or prevent their development when conservative measures fail. This review includes a total of 11 studies, aimed to assess the outcome of exostectomies in the prevention and recurrence of ulcers under the bony prominence in patients with Charcot midfoot and its main complications. Exostectomy was successful in 60% of cases after the first surgery and in 90.7% of cases in total. The procedure, when done below the lateral column, seems to have a higher number of diverse complications. This fact must be taken into account when performing this procedure.

Diabetic foot ulcers (DFUs) represent a severe complication of diabetes mellitus, leading to significant morbidity, amputation risk, and healthcare burden. This systematic review and meta-analysis aimed to evaluate the association between circulating ischemia-modified albumin (IMA) levels and DFU. A comprehensive search of PubMed, Scopus, Cochrane Central and Google Scholar databases was conducted to identify eligible observational studies reporting IMA concentrations in DFU patients, diabetics without foot ulcers, and healthy controls. Meta-analyses were performed using both frequentist random-effects models and Bayesian approaches. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were used to express continuous outcomes. PET-PEESE regression analyses assessed publication bias and small-study effects. A total of six studies were included, with five eligible for meta-analysis. Compared to healthy controls, DFU patients exhibited significantly higher IMA levels [pooled SMD = 3.21 (95% CI: 1.40, 5.03)]. Similarly, DFU patients had higher IMA levels than diabetics without foot ulcers [pooled SMD = 1.21 (95% CI: 0.23, 2.20)]. Both frequentist and Bayesian analyses consistently supported these findings despite notable heterogeneity. Adjusted analyses of IMA for serum albumin further confirmed its discriminative value in DFU. PET-PEESE analyses did not detect significant publication bias. This meta-analysis highlights the potential of IMA as a biomarker for diagnosis, risk stratification, and monitoring in DFU management. Despite significant associations, high inter-study heterogeneity and the limited number of studies restrict generalizability. Future research should focus on standardizing measurement protocols, validating clinical cut-offs, and conducting large-scale prospective studies to confirm its utility.

Charcot neuro-osteoarthropathy (CNO) is a complication of diabetes occurring in people with diabetic neuropathy with a prevalence of 0.5% to 1% that may culminate to foot deformity, amputation, and early mortality. However, it is not known why only certain patients with diabetic neuropathy develop CNO. Hence, early recognition of risk factors, timely diagnosis, and appropriate intervention of CNO is pertinent. Recent understanding of the pathophysiology of CNO has expanded to suggest the involvement of RANKL-OPG pathways. But pharmaco-therapeutic interventions targeting bone metabolism predominantly inhibiting RANKL were not found to be useful. Moreover, there are not enough markers to help identify patients with diabetes who are at a higher risk of developing CNO. Hence, we explored the literature in the present systematic review of mainly case-control studies to identify genetic factors that could help in understanding the pathophysiology and risk factors for the development of CNO. We could identify 7 relevant studies identifying single nucleotide polymorphism of OPG and RANK genes. There is an isolated study identifying alterations of micro RNA associated with RANKL-OPG pathway. Another study found epigenetic alterations by performing whole methylome sequencing in people with CNO compared to control. These genetic factors can be used as a diagnostic marker and their functional counterparts as targets for future therapeutic interventions. However, we found that literature is sparse on the genetic risk factors for CNO in people with diabetic neuropathy and there is still a lot of scope for future studies towards finding the molecular and genetic markers for CNO.

Charcot neuro-osteoarthropathy (CN) is a severe and often underrecognized complication of diabetes mellitus, primarily affecting individuals with diabetic neuropathy. Its clinical course is marked by progressive joint destruction and foot deformities. This review aims to summarize current evidence regarding the role of CN in the development and recurrence of diabetic foot ulcers (DFUs), the risk of amputation, and long-term survival outcomes, as well as to highlight key mechanisms contributing to these complications. Individuals with CN exhibit a significantly higher risk of DFUs, particularly in the midfoot region, due to structural deformities and increased plantar pressure. The risk of amputation is markedly elevated in individuals with CN, especially when DFUs are present. Mortality rates in CN are substantial, with five-year survival comparable to or worse than several malignancies. The development of foot ulcers and amputations in CN results from a complex interaction of neuropathy, structural deformity and chronic inflammation. Therefore, CN is a high-risk condition associated with serious foot complications and elevated mortality. Early recognition, multidisciplinary management, and further research into its independent prognostic impact are essential to improve long-term outcomes.

Charcot neuropathic arthropathy (CN) impacts peripheral lower extremity nerves, leading to joint destruction, and has a significant economic burden on the healthcare system. This economic burden is further exacerbated by the projected increase in diabetes mellitus cases over the coming decades, with a corresponding anticipated rise in CN. This study assesses CN management costs through a single institution retrospective chart review and cost-effectiveness through economic modeling by utilizing a well-established equation to determine the cost-effectiveness of conservative management. This retrospective chart review from a single academic center analyzed costs and outcomes for CN patients undergoing exostectomy, arthrodesis, major amputation, minor amputation, or casting from 2000-2022. This retrospective review analyzed 216 CN patients (average age 58, 54% male). Costs were $57 949 for exostectomy, $149 009 for arthrodesis, $40 313 for major amputation, $55 035 for minor amputation, $125 851 for failed casting, and $8233 for casting. We conducted a break-even analysis that determined that intervention with casting was cost-effective compared to failed casting. Total contact casting is a cost-effective first-line treatment for CN, capable of managing non-advanced cases effectively and reducing the economic burden of surgical intervention. This study provides a critical framework for practitioners to assess cost-effectiveness in various institutional contexts.