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Raghav SS, Kumar B, Sethiya NK, Lal DK. Diabetic Foot Ulcer Management and Treatment: An Overview of Published Patents. Curr Diabetes Rev 2024; 20:e120623217906. [PMID: 37309771 DOI: 10.2174/1573399820666230612161846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/24/2023] [Accepted: 05/15/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND One of the most challenging effects of diabetes is diabetic foot ulceration (DFU). DFU may occur in up to one-third of individuals with diabetes mellitus (D.M.) at some point in their lives. The major cause of morbidity in D.M. patients is DFU. The length of treatment is difficult, and DFU recurrence is common. OBJECTIVE The most crucial element for the treatment and prevention of DFUs require a multidisciplinary approach. Patients who are at risk should be identified, depending on the type of risk, prophylactic actions etc. It is imperative to identify at-risk patients and take preventative measures accordingly. METHOD The at-risk diabetes-related foot ulcer was identified based on the risk category classification, while the foot ulcers were evaluated using Wagner's classification system. RESULTS Literature reported that patients with lower limb vascular insufficiency, loss of vibratory sensation, or protective sensation loss have an increased risk of developing foot ulcers. Proper categorization and therapeutic measures will be implemented after the DFU has been formed. The appropriate assessment and management of general health status should include glycemic control, the diagnosis and treatment of vascular disease, standard care for wounds, diagnosis, and infection treatments. CONCLUSION The review reflects the updated awareness of the treatment and management of DFU based on the current and past literature and patent analysis.
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Affiliation(s)
| | - Bhavna Kumar
- Faculty of Pharmacy, DIT University, Dehradun 248009, Uttarakhand, India
| | | | - Diwya Kumar Lal
- Faculty of Pharmacy, DIT University, Dehradun 248009, Uttarakhand, India
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Muacevic A, Adler JR, Alahmari DA, Hameed LN, Alfurayh KM, Alaql KB. Knowledge, Awareness, and Practice Related to Diabetic Foot Ulcer Among Healthcare Workers and Diabetic Patients and Their Relatives in Saudi Arabia: A Cross-Sectional Study. Cureus 2022; 14:e32221. [PMID: 36620825 PMCID: PMC9812341 DOI: 10.7759/cureus.32221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Background Diabetes mellitus is a chronic progressive metabolic disorder characterized by high blood sugar affecting the whole body resulting in a significant impact on the quality of life for the patients and their families. Diabetes mellitus complications lead to morbidity, disability, and mortality and represent a serious global health issue threatening the health system worldwide and resulting in a critical economic impact for all countries, especially epidemic ones. Objective The objective of this study was to assess the level of knowledge and awareness regarding diabetic foot and related behaviour among diabetic patients and their relatives, as well as healthcare workers in Saudi Arabia. Methods A cross-sectional analytic study was conducted in 2022 on healthcare workers, diabetic patients, and their relatives above the age of 18 in Saudi Arabia by using a valid, pretested structured questionnaire. The collected data were analyzed using IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States). Results In this study, there was no correlation between the healthcare workers' attitude and knowledge. A total of 131 healthcare workers were involved, and a majority of them had good knowledge regarding the predisposing factors of diabetic foot ulcers, and 63 (48.1%) had good knowledge regarding diabetes foot care. On the other hand, there was poor knowledge regarding the characteristics and complications of diabetes ulcers. This study showed various attitudes among healthcare workers regarding diabetic ulcer care. For example, they prioritized the prevention of ulcers over treatment (N=67, 51.1%), the majority of healthcare workers were very keen to wound care (N=77, 58.8%), and they believed that it was their responsibility to educate their patients about reducing re-ulceration (N=86; 65.7%). However, 52 participants (39.7%) considered management of diabetic foot ulcer time-consuming, 54 (41.2%) mentioned that if they had the opportunity, they would like to avoid taking care of the diabetic wound, and 51 (38.9%) reported non-satisfaction with diabetic wound care. One hundred diabetic patients and 117 relatives also were involved, and only 41.3% of participants (patients and relatives) had good knowledge regarding diabetes mellitus. However, our findings also revealed that 91.65% of the participants had good knowledge and a favourable attitude towards diabetes mellitus and diabetic foot care. Nevertheless, even though the participants had good knowledge regarding foot care, they had poor practice, with 56.55% scoring poor on the assessment questionnaire. Conclusion Our study shows that most of the participants had good knowledge and attitudes but poor practices. This highlights the need for more efforts to educate the Saudi population about diabetes and its complications.
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Srivastava P, Sondak T, Sivashanmugam K, Kim KS. A Review of Immunomodulatory Reprogramming by Probiotics in Combating Chronic and Acute Diabetic Foot Ulcers (DFUs). Pharmaceutics 2022; 14:2436. [PMID: 36365254 PMCID: PMC9699442 DOI: 10.3390/pharmaceutics14112436] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/02/2022] [Accepted: 11/08/2022] [Indexed: 08/29/2023] Open
Abstract
Diabetic foot ulcers (DFUs) are characterized by a lack of angiogenesis and distal limb diabetic neuropathy. This makes it possible for opportunistic pathogens to protect the biofilm-encased micro-communities, causing a delay in wound healing. The acute and chronic phases of DFU-associated infections are distinguished by the differential expression of innate proinflammatory cytokines and tumor necrosis factors (TNF-α and -β). Efforts are being made to reduce the microbial bioburden of wounds by using therapies such as debridement, hyperbaric oxygen therapy, shock wave therapy, and empirical antibiotic treatment. However, the constant evolution of pathogens limits the effectiveness of these therapies. In the wound-healing process, continuous homeostasis and remodeling processes by commensal microbes undoubtedly provide a protective barrier against diverse pathogens. Among commensal microbes, probiotics are beneficial microbes that should be administered orally or topically to regulate gut-skin interaction and to activate inflammation and proinflammatory cytokine production. The goal of this review is to bridge the gap between the role of probiotics in managing the innate immune response and the function of proinflammatory mediators in diabetic wound healing. We also highlight probiotic encapsulation or nanoformulations with prebiotics and extracellular vesicles (EVs) as innovative ways to tackle target DFUs.
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Affiliation(s)
- Prakhar Srivastava
- Department of Chemistry and Chemistry Institute of Functional Materials, Pusan National University, Busan 46241, Korea
| | - Tesalonika Sondak
- Department of Chemistry and Chemistry Institute of Functional Materials, Pusan National University, Busan 46241, Korea
| | - Karthikeyan Sivashanmugam
- School of Biosciences and Technology, High Throughput Screening Lab, Vellore Institute of Technology, Vellore 632014, Tamil Nadu, India
| | - Kwang-sun Kim
- Department of Chemistry and Chemistry Institute of Functional Materials, Pusan National University, Busan 46241, Korea
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Vierhout BP, Visser R, Hutting KH, El Moumni M, van Baal JG, de Vries JPPM. Comparing a non-removable total contact cast with a non-removable softcast in diabetic foot ulcers: A retrospective study of a prospective database. Diabetes Res Clin Pract 2022; 191:110036. [PMID: 35963371 DOI: 10.1016/j.diabres.2022.110036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Diabetic foot ulcers (DFUs) are mostly cured by an off-loading cast. Healing ratios of a non-removable Total Contact Softcast (TCS) were compared to a conventional Total Contact Cast (TCC), the latter reporting negative effects on lifestyle and transportation. METHODS Analysis of prospectively collected data for 2010-2017. Included were patients with a neuropathic DFU. Ischemic ulcers were excluded, as were Charcot arthropathy, non-plantar/non-forefoot ulcer location, and compliance issues. Patients with TCS were compared to TCC. Primary and secondary outcomes were healing ratio and healing time of DFU. RESULTS 50 patients with 61 cast periods were included. Mean age was 63.7 ± 10.1 years. Overall successful ulcer healing was 71% (43/61). Except for depth of the DFUs, between-group patient characteristics were comparable; deeper DFUs were reported in the TCC group. This group reported 65% healed DFU (22/34), the TCS group 74% (20/27). Mean healing time was 8.4 weeks (95 %CI 5.9-10.8) for TCC and 5.5 weeks (95 %CI 4.2-6.9) for TCS (p = 0.052). Depth of the wound was a confounder. CONCLUSIONS TCS had a similar DFU healing ratio and a potentially clinically relevant effect (HR 1.47, 95 %CI 0.64-3.38) on healing time (ns). Ulcer depth is important for time to ulcer healing. A randomized study is recommended.
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Affiliation(s)
| | - Rene Visser
- Department of Surgery, Wilhelmina Hospital WZA, Assen, the Netherlands
| | - K H Hutting
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands
| | - Mostafa El Moumni
- Department of Surgery, Division of Trauma Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
| | - Jeff G van Baal
- Department of Surgery, Ziekenhuisgroep Twente, Almelo, the Netherlands; University of Cardiff, Cardiff, UK
| | - Jean-Paul P M de Vries
- Department of Surgery, Division of Vascular Surgery, University Medical Center Groningen, University of Groningen, the Netherlands
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Fang X, Jia S, Wang Q, Liu HF, Zhou Y, Zhang L, Dai T, Luo H, Peng H, Yuan J, Zhou H. Clinicians' Perspectives About the Feasibility and Effectiveness of Using Telemedicine in First Aid: A Qualitative Study. Int J Gen Med 2021; 14:3343-3353. [PMID: 34285559 PMCID: PMC8285227 DOI: 10.2147/ijgm.s314901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/31/2021] [Indexed: 11/23/2022] Open
Abstract
Objective This study investigated clinicians’ perspectives on the feasibility and effectiveness of using telemedicine in the context of providing first aid. It is crucial to identify and explore clinicians’ attitudes and awareness of tele-first-aid in China to keep pace with ongoing global trends. Design This was a qualitative study. Data gathered from in-depth interviews with 22 clinicians were coded into themes and analyzed. Participants Participants included hospital-based clinicians: four clinical specialists, eight emergency nurses, four emergency doctors, three general practitioners, and three clinical administrators. Setting The study was conducted in university-affiliated hospitals. Results All clinicians who were invited to participate believed that the use of telemedicine in first aid was promising and effective. Participants stated that relevant technology should be designed to synergize the chain of existing platforms in the industry and that it should be determined who has the authority to utilize such technology and how it should be used to achieve the sought-after benefits. The use of such technology refreshes the role of clinicians and their relationship with patients. Additionally, participants believed that the government could play an important role especially in the reform of medical systems. Conclusion Telemedicine can facilitate the provision of conventional first aid and systematically exploit existing resources due to its feasibility and effectiveness. The social benefits of using tele-first-aid in clinical and community applications, especially when used in coordination with existing resources, make its adoption an inevitable trend in the field.
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Affiliation(s)
- Xiaoqun Fang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Shulei Jia
- School of Nursing, Nanchang University, Nanchang, 330006, People's Republic of China
| | - Qiuyan Wang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Hui-Fang Liu
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Yumei Zhou
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Lingling Zhang
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Tanghua Dai
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Hui Luo
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Hui Peng
- Department of Rehabilitation Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, People's Republic of China
| | - Jun Yuan
- School of Nursing, Nanchang University, Nanchang, 330006, People's Republic of China
| | - Huyan Zhou
- School of Nursing, Nanchang University, Nanchang, 330006, People's Republic of China
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Current Therapeutic Strategies in Diabetic Foot Ulcers. Medicina (B Aires) 2019; 55:medicina55110714. [PMID: 31731539 PMCID: PMC6915664 DOI: 10.3390/medicina55110714] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 01/07/2023] Open
Abstract
Diabetic foot ulcers (DFUs) are the fastest growing chronic complication of diabetes mellitus, with more than 400 million people diagnosed globally, and the condition is responsible for lower extremity amputation in 85% of people affected, leading to high-cost hospital care and increased mortality risk. Neuropathy and peripheral arterial disease trigger deformities or trauma, and aggravating factors such as infection and edema are the etiological factors for the development of DFUs. DFUs require identifying the etiology and assessing the co-morbidities to provide the correct therapeutic approach, essential to reducing lower-extremity amputation risk. This review focuses on the current treatment strategies for DFUs with a special emphasis on tissue engineering techniques and regenerative medicine that collectively target all components of chronic wound pathology.
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