The international journal of lower extremity wounds最新文献

Pythiosis is an infectious disease in humans and animals caused by an aquatic fungus-like micro-organism, Pythium insidiosum. Vascular pythiosis is a difficult condition to treat and can lead to loss of limb in addition to being a potentially life-threatening infection. The condition is furthermore unfamiliar among healthcare workers, which often results in delayed treatment or even misdiagnosis. In this study, we report our findings, which have been gathered over a 20-year period in caring for vascular pythiosis in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand. We made a retrospective medical review of 32 patients presented with arterial occlusion who have serum anti-Pythium insidiosum antibodies. All patients underwent computed tomography angiography to confirm the level of arterial occlusion and decided on a treatment plan. Twelve out of 22 patients with infrainguinal disease, femoropopliteal or below-knee vascular occlusion, survived. The mean survival time is 6.58 years. Eight in 10 patients presented with suprainguinal disease died during the follow-up with a mean survival time of 31.6 months. The suprainguinal extension of the disease influenced the outcome, resulting in a higher mortality rate. However, patients presented with chronic limb ischemia had a much greater rate of survival compared to other clinical presentations. Extensive surgical resection combined with antifungal treatment and immunotherapy have proven to be effective in patients with vascular pythiosis in our findings.

Chronic lower leg ulcers (LLUs) are a very common and associated with a high subjective and economic burden. They can be caused by a variety of factors. We have observed a common clinical feature in patients suffering from LLUs, which ultimately proved to be basal cell carcinomas (BCCs). We have nicknamed this sign "the pink doughnut sign." The pink doughnut sign can aid in the early recognition of such BCCs, which is crucial to prevent unnecessary suffering, treatment costs, and poor local outcomes.

Introduction: Wound healing is a dynamic process that begins with inflammation, proliferation, and cell migration of a variety of fibroblast cells. As a result, identifying possible compounds that may improve fibroblast cell wound healing capacity is crucial. Hypericin is a natural quinine that has been reported to possess a wide range of pharmacological profiles, including antioxidant and anti-inflammatory, activities. Herein we examined for the first time the effect of hypericin on normal human dermal fibroblasts (NHDFs) under oxidative stress.

Methods: NHDF were exposed to different concentrations of hypericin (0-20 μg/mL) for 24 h. For the oxidative stress evaluation, H₂O₂ was used as a stressor factor. Cell viability and proliferation levels were evaluated. Immunohistochemistry and flow cytometry were performed to assess cell apoptosis levels and with confocal microscopy we identified the mitochondrial superoxide production under oxidative stress and after the treatment with hypericin. Scratch assay was performed under oxidative stress to evaluate the efficacy of hypericin in wound closure. To gain an insight into the molecular mechanisms of hypericin bioactivity, we analyzed the relative expression levels of genes involved in oxidative response and in wound healing process.

Results: We found that the exposure of NHDF to hypericin under oxidative stress resulted in an increase in cell viability and ATP levels. We found a decrease in apoptosis and mitochondrial superoxide levels after treatment with hypericin. Moreover, treatment with hypericin reduced wound area and promoted wound closure. The levels of selected genes showed that hypericin upregulated the levels of antioxidants genes. Moreover, treatment with hypericin in wound under oxidative stress downregulated the levels of proinflammatory cytokines, and metalloproteinases; and upregulated transcription factors and extracellular matrix genes.

Conclusion: These findings indicated that hypericin possesses significant in vitro antioxidant activity on NHDF and provide new insights into its potential beneficial role in the management of diabetic ulcers.

The aim of this nonsystematic mini review was to discuss serum levels of zinc in subjects with diabetic foot ulcers (DFUs). Most studies have reported low zinc levels in subjects with DFUs. Furthermore, there is some evidence that oral zinc supplementation may have a positive and beneficial impact on DFUs healing. Nonetheless, findings have so far not provided definitive answers. More studies are needed to clarify the role of zinc and its supplementation in this setting.

Patients with diabetic foot ulcer (DFU) are prone to major complications including amputations. Traditional remedies (TR) have been used to treat DFU around the world. This study aims to identify the prevalence of TR among patients with DFU in our local cohort and its effect on DFU. 1408 patients were included in the analysis. Data were collected retrospectively from patients' medical records. DFU characteristics include grading ulcers using the Wagner scale (WG) and infections (cellulitis and osteomyelitis). Ulcer management (UM) includes medical treatment, self-medical treatment, traditional treatment, and medical-traditional treatment. The mean age of the cohort was 60 years (SD = 12.4). The mean duration of diabetes was 18.6 years (SD = 9.3) and the mean duration of open wounds was 206.9 days (SD = 545.6). The majority were males (71%) and had type 2 diabetes (96%, SD = .204). Forty-three percent of patients were treated with TR (29% were self-prescribed and 14% prescribed by a physician) while 48% had medical treatment and 10% were self-treated using medical treatment. More than two-thirds of the cohort had cellulitis and/or osteomyelitis at the time of presentation. The use of traditional treatment was significantly associated with higher WG (WG 4 OR =  1.936, 95% CI: 1.338-2.800; WG 5 OR =  2.937, 95% CI:1.614-5.346; P < 0.05). Moreover, osteomyelitis was associated with medical-traditional treatment (OR = 1.608, 95% CI: 1.006-2.572; P < 0.05) and increased wound depth (WG 3 OR =  1.969, 95% CI: 1.193-3.250; WG 4 OR =  1.874, 95% CI: 1.115-3.15; P < 0.05). There is high use of TR for the treatment of DFU in our cohort. High Wagner-grade of foot ulcers and the presence of osteomyelitis were highly associated with DFU. This study showed for the first time the use of traditional potions by medical physicians. Both physicians and patients need to be made aware of the detrimental effects of using traditional methods on DFU.

This study was conducted in a methodological design with the aim of adapting the "Diabetic Foot Self-Care Questionnaire of the University of Malaga, Spain (DFSQ)" to Turkish, and examining its validity and reliability. The study population of the methodological research consisted of a total of 161 patients diagnosed with diabetes who presented to the Diabetes Clinic Unit. The translation-back translation technique was employed for the linguistic equivalence of the questionnaire. To test the validity of the scale, linguistic and content validity were examined, and exploratory factor analysis was conducted. Cronbach's alpha reliability coefficient, item-total score correlations test, and test-retest technique were used to assess the reliability of the scale. The scope validity index values of the Turkish version of DFSQ ranged between 0.85 and 1.00, and there was no difference in scores given by the consulted experts (Kendall's W  =  0.720; p  =  .707). Exploratory factor analysis conducted to examine the factor structure of the scale revealed that the scale consisted of 16 items and three subscales, explaining a total variance of 84.09%. The factor loadings of the scale ranged from 0.90 to 0.97. The calculated Cronbach's alpha coefficient for the Turkish version of the scale was 0.66.: It was found that the Turkish version of DFSQ is valid and reliable for the Turkish population. The research identified that DFSQ is a valid and reliable tool for determining diabetic patients' knowledge and attitudes toward foot self-care in cross-cultural studies.

Diabetic foot infections (DFIs) are a common and costly complication of diabetes. Soft tissue and bone infections in DFIs frequently lead to amputation and/or sepsis which can be costly for both the patient and the healthcare system. Staphylococcus aureus is the most commonly identified causative agent in DFIs, and people with diabetes may have an increased risk of infection with methicillin-resistant Staphylococcus aureus (MRSA). In addition to increased susceptibility to severe infection, MRSA in DFIs is associated with high rates of treatment failure, morbidity, and hospitalization costs meaning appropriate treatment is a high priority. While hospitalized patients are usually treated with intravenous (IV) vancomycin, this can be costly in terms of inpatient stays, staffing costs, and adverse events. For example, vancomycin-associated acute kidney injury not only delays hospital discharge and increases costs but is also a particular concern for patients with diabetes who already have an increased risk of kidney problems. Vancomycin-resistant strains of S. aureus have also been identified, which means that alternative treatment options may need to be explored. Treatment alternatives to IV vancomycin, including oral antibiotics, have been shown to provide similar efficacy, with reduced costs, outpatient or home-based administration, and with fewer serious adverse effects. Although infectious disease specialists often use IV vancomycin alone, or in combination, as a first-line therapeutic option, they are increasingly seeing the value of outpatient or at-home oral antibiotics as an alternative. This manuscript reviews the evidence for true costs of vancomycin therapy for MRSA-associated DFIs and examines the alternatives.

We aim to identify the factors associated with the failure of amputation of one to three toes (index toe amputation) in patients with diabetes and foot infection. We conducted a retrospective cohort of 175 patients with diabetes who were hospitalized for moderate to severe foot infection and underwent amputation of one to three toes. A Poisson regression model was used to determine the prevalence ratio (PR) as a measure of association. The mean age was 63.3 ± 11.4 years. Fifty-three patients presented failure after undergoing toe amputation (30.3%). Multivariate analysis, adjusted for age and sex, showed the following significant variables: severe infection (PR: 1.78; 95% confidence interval [CI]: 1.14-2.78; P = 0.011), infection by Escherichia coli (PR: 2.21; 95% CI: 1.42-3.43; P < 0.001), infection by Pseudomonas aeruginosa (PR: 2.11; 95% CI: 1.29-3.43; P = 0.003) and prothrombin time (PR: 1.13; 95% CI: 1.05-1.21; P = 0.001), obesity (PR: 0.58; 95% CI: 0.37-0.93; P = 0.024), and haemoglobin value (PR: 0.92; 95% CI: 0.86-0.99; P = 0.023). About one-third of patients who underwent amputation of one to three toes for diabetic foot infection presented a failure and required a more proximal surgery. Severe infections, isolation of Pseudomonas aeruginosa and Escherichia coli, and prolonged prothrombin time were associated with a higher prevalence of failure. However, obesity and an elevated haemoglobin level were associated with a lower prevalence of failure.

It has traditionally been considered that the larger the amount of knowledge, the greater the competency of a physician. However, the vertiginously fast accumulation of novel knowledge in modern medicine raises the risk that students and residents get lost in the chaos of information to which they are exposed. Thus, it becomes evident that redefining the model of medical education (and possibly rethinking what a "good" doctor means) becomes inevitable. Current challenges in medical training include early engagement of medical students in research activities and evidence-based medicine procedures, as well as adoption of new technologies, such as artificial intelligence. Gradually, the paradigm of the competent physician will transform from the "one who knows well" to "one who knows well where to search for knowledge." Given that person-centeredness remains an essential goal of medical education, supervision and assistance by academic staff are needed to ensure that the new training model has a positive impact on person-centered and doctor-patient relationships.