Management of infected diabetic wound: a scoping review of guidelines

Background: Various international guidelines and recommendations are available for management of diabetic foot infections. We present a review of the guidelines and recommendations for management of these infections. Methods: A systematic literature search was conducted through MEDLINE, CENTRAL, EMBASE, LILACS, DARE, and national health bodies. Based on the review of fifteen documents, we present details on the importance of suspecting and diagnosing skin, superficial infections, and bone infections in diabetics. Results: The guidelines recommend classifying the infections based on severity to guide the treatment. While antibiotics have shown the best results, other treatments like hyperbaric oxygen therapy and negative wound pressure have been debated. It is suggested that a team of specialists should be in-charge of managing the infected wounds. Infectious Diseases Society of America (IDSA) 2012 guidelines are widely followed world-over. All guidelines and reviews have consistent suggestions on the assessment of the severity of infection, diagnosis, start, selection, and duration of antibiotic therapy. Conclusions: It is reasonable to conclude that the IDSA 2012 guidelines are commonly followed across the world. There is a consensus among the Australian guidelines, Canadian guidelines, IDSA 2012, National Institute for Health and Care Excellence (NICE) 2015, and International Working Group on the Diabetic Foot (IWGDF) 2016 guidelines on the management of infected wounds for patients with diabetes mellitus.

Download Full-text

Epidemiological Evidence of the Recent Surge in MS in Asia and Australia: A Systematic Review

Journal of Kermanshah University of Medical Sciences ◽

10.5812/jkums.111028 ◽

2021 ◽

Vol 25 (2) ◽

Author(s):

Sharareh Eskandarieh ◽

Mohammad Ali Sahraian

Keyword(s):

Multiple Sclerosis ◽

New Zealand ◽

Incidence Rate ◽

United Arab Emirates ◽

Literature Search ◽

Systematic Literature Search ◽

Epidemiological Evidence ◽

Male Ratio ◽

The World ◽

Lower Incidence Rate

Context: Recently, the incidence and prevalence of multiple sclerosis (MS) have increased drastically in different regions of the world, including Asia. The present study aimed to systematically review the recent MS epidemiology in Asia, New Zealand, and Australia. Methods: A systematic literature search was performed in Medline and Embase databases to retrieve the available studies regarding MS epidemiology in Asia, New Zealand, and Australia. Results: Most of the studies were performed in hospital settings. The female-to-male ratio in the sample populations varied from 1.5:1 in Turkey to 5:1 in Malaysia. The total mean age at the onset of MS varied from the minimum of 28 years in Hong Kong to the maximum of 36 years in the United Arab Emirates. Among 16 pertinent studies in this regard, seven addressed the incidence rate of MS, and 13 addressed the prevalence of the disease. The highest prevalence rate was reported to be respectively 124.2 and 148.06 in Australia and Iran versus 2.73 in Malaysia (06 per 100,000 population), while a higher incidence rate was estimated at 6.88 and 6.7 per 100,000 population in Kuwait and Australia, respectively compared to the lower incidence rate per 100,000 population in China (0.2 in females, 0.12 in males). Conclusions: According to the results, the prevalence of MS has increased in Asia, while the prevalence of MS in this continent is lower compared to the rates reported in Australia, Europe, and North America.

Download Full-text

Viktor Vasilievich Trusov — organizer of endocrinology service of Izhevsk

Kazan medical journal ◽

10.17816/kmj2021-964 ◽

2021 ◽

Vol 102 (6) ◽

pp. 964-968

Author(s):

E V Khalimov ◽

A Yu Mikhailov ◽

S N Styazhkina ◽

M A Zavalina ◽

S I Likhovskikh

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Scientific School ◽

Medical Academy ◽

Organization Of Care ◽

Practical Support ◽

Patients With Diabetes ◽

State Medical Academy ◽

Guidelines And Recommendations ◽

Methodological Guidelines

The article is devoted to the 85th anniversary of Professor Viktor Vasilyevich Trusov (19362012), one of the prominent representatives of the therapeutic, scientific school of the Izhevsk State Medical Academy. In the range of diverse scientific interests and developments of Viktor Vasilyevich, a significant part was the issues of practical support to patients with endocrinological pathology, including patients with diabetes mellitus. Professor V.V. Trusov was a member of the Board of Russian Association of Endocrinologists, a member of the European Association for the Study of Diabetes, a member of the American Diabetes Association, worked on the problems of optimizing care for patients with diabetes. The article highlights the diabetology segment of the endocrinology service in Izhevsk on the materials of the endocrinological department of the State Clinical Hospital No. 6. The role of Professor Viktor Vasilyevich Trusov in the organization of the endocrinological center of Izhevsk, the viability of the methodological guidelines and recommendations laid down by him in the organization of care for patients with diabetes mellitus was noted. The organization of the work of the endocrinology center are considered. The analysis of the main indicators of the prevalence of diabetes mellitus was carried out according to the data of the endocrinology department (20172020). The special place of the diabetic foot clinic in the work of the center is highlighted. Modern and original methods of management of such complications of diabetes mellitus as diabetic foot syndrome are presented.

Download Full-text

Vitamin D and Diabetic Foot

10.5772/intechopen.97115 ◽

2021 ◽

Author(s):

Antony Macido

Keyword(s):

Vitamin D ◽

Diabetic Foot ◽

Large Scale ◽

Negative Relationship ◽

Hydroxyvitamin D ◽

Diabetic Foot Infections ◽

Randomized Controlled Studies ◽

Patients With Diabetes ◽

The Status ◽

25 Hydroxyvitamin D

Approximately 15% of patients with diabetes mellitus (DM) are prone to developing diabetic foot ulcers (DFU) in their lifetime. The term vitamin D status or 25-hydroxyvitamin D [25(OH)D] levels are used interchangeably to represent the status of vitamin D in individuals throughout this paper. Evidence suggests a relationship between 25(OH)D levels and DFU. However, very minimal data is available on the association between DFU and vitamin D deficiency. After a careful review of the literature, it was inferred that vitamin D could be associated with DFU and diabetic foot infections. Available evidence on vitamin D and DFU suggests a negative correlation between 25(OH)D levels and the presence of DFU. Evidence also supports a negative relationship between 25(OH)D levels and diabetic foot infections. Further large-scale randomized controlled studies need to be done to confirm the relationship between 25(OH)D levels and DFU including the use of vitamin D in the management of DFU and diabetic foot infections.

Download Full-text

Green Energy as a Driver for Green Economy and Organizations’ Sustainability

Management and Economics Research Journal ◽

10.18639/merj.2018.04.687613 ◽

2018 ◽

Vol 4 (2) ◽

pp. 242

Author(s):

Maria José Sousa ◽

Jorge Miguel Martins ◽

Miguel Sousa ◽

◽

...

Keyword(s):

Literature Search ◽

Research Question ◽

Innovation Process ◽

Green Energy ◽

Literature Survey ◽

Green Economy ◽

Systematic Literature Search ◽

Green Innovation ◽

The World ◽

Innovation Model

Since the last decade, the concepts of green innovation and green economy have become more and more attractive to researchers and policymakers. This research brings some light to the association of those themes with the concept of green energy. Therefore, this paper is a critical review of the green innovations directed explicitly to the green energy challenges faced by organizations and the world economies. The research question is as follows: What are the main dimensions of a model to implement a green innovation process focused on green energy in organizations? The methodology used to answer the research question was qualitative, and the main techniques included a systematic literature search and survey. The main findings of the study were the identification of the most relevant dimensions of a green innovation model to be implemented in organizations. The article structure is based on the different concepts about innovation and green innovation, related to the green economy, and the analysis of two situational cases on green energy. Finally, we present the analysis made on the articles identified by the literature survey and the green innovation model. By making this research on green economy and related concepts of green innovation and green energy, this paper seeks to make a valid contribution to their definitions and for operationalizing the green innovation model in organizations.

Download Full-text

Surgical Diabetic Foot Infections: Is Osteomyelitis Associated With a Worse Prognosis?

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620986695 ◽

2021 ◽

pp. 153473462098669

Author(s):

Javier Aragón-Sánchez ◽

Gerardo Víquez-Molina ◽

María Eugenia López-Valverde ◽

José María Rojas-Bonilla ◽

Christian Murillo-Vargas

Keyword(s):

Hospital Stay ◽

Antibiotic Treatment ◽

Diabetic Foot ◽

Length Of Hospital Stay ◽

Limb Loss ◽

Diabetic Foot Infections ◽

Patients With Diabetes ◽

Hospital Stays ◽

Hospital Stay Duration ◽

Worse Prognosis

It has been reported that patients with diabetes and foot ulcers complicated with osteomyelitis (OM) have a worse prognosis than those complicated with soft tissue infections (STI). Our study aimed to determine whether OM is associated with a worse prognosis in cases of moderate and severe diabetic foot infections requiring surgery. A retrospective series consisted of 150 patients who underwent surgery for diabetic foot infections. We studied the differences between OM versus STI. Furthermore, diabetic foot infections were reclassified into four groups: moderate STI (M-STI), moderate OM (M-OM), severe STI (S-STI), and severe OM (S-OM). The variables associated with prognosis were limb loss, length of hospital stay, duration of antibiotic treatment, recurrence of the infection, and time to healing (both the initial ulcer and the postoperative wound). No differences in limb salvage, hospital stay, duration of antibiotic treatment, recurrence of the infection, and time to healing were found when comparing OM with STI. Patients with M-O had a higher rate of recurrences after initial treatment and a longer time to healing when comparing with M-STI. We didn’t find any differences between severe infections with or without OM. In conclusion, we have found in our surgical series of diabetic foot infections that OM is not associated with worse prognosis when comparing with STI regarding limb loss rate, length of hospital stays, duration of antibiotic treatment, recurrence of the infection, and time to healing. The results of the present series should further be confirmed by other authors.

Download Full-text

Utilisation of the 2019 IWGDF diabetic foot infection guidelines to benchmark practice and improve the delivery of care in persons with diabetic foot infections

Journal of Foot and Ankle Research ◽

10.1186/s13047-021-00448-w ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Matthew Malone ◽

Adriaan Erasmus ◽

Saskia Schwarzer ◽

Namson S. Lau ◽

Mehtab Ahmad ◽

...

Keyword(s):

Clinical Practice ◽

High Risk ◽

Diabetic Foot ◽

Clinical Performance ◽

Improve Patient Care ◽

Delivery Of Care ◽

Diabetic Foot Infection ◽

Diabetic Foot Infections ◽

Bone Biopsies ◽

Patients With Diabetes

Abstract Aims To utilise the 2019 International Working Group on the Diabetic Foot (IWGDF) - diabetic foot infection (DFI) guidelines as an audit tool for clinical practice in patients with diabetes attending a High-Risk Foot Service. Methods Data from 93 consecutive patients were collected over a 19-month period in patients attending a High-Risk Foot Service. The diagnosis and management of each patient in the sample were compared against the 2019 IWGDF DFI guidelines, grouped into four categories: Diagnosis, Microbiology, Treatment of soft tissue infection, and Surgical treatment and osteomyelitis. Deficits in performance were recorded using the recommendations as a benchmark standard. Results There were 109 DFI events. Nineteen (63%) of the recommendations were met, 7 (24%) were partially met, and four (13%) recommendations were not met. Fourteen of the sample had no documented requests for full blood counts. Tissue was obtained for culture in 32 (29%) of the sample. No percutaneous bone biopsies were performed. Only 13 (28%) patients had intraoperative bone specimens sent for culture and sensitivities, with no bone specimens sent for histopathology. Modification of antibiotic therapy following available culture results was low, occurring in 12 out of 63 possible occasions (19%). The duration of antibiotic regimens in PEDIS 2 infections and osteomyelitis was greater than that recommended. Conclusions Utilising the IWGDF DFI guidelines to benchmark clinical practice is a useful tool to identify gaps in clinical performance or service delivery and may help to improve patient care.

Download Full-text

The 15-Months Clinical Experience of SARS-CoV-2: A Literature Review of Therapies and Adjuvants

Antioxidants ◽

10.3390/antiox10060881 ◽

2021 ◽

Vol 10 (6) ◽

pp. 881

Author(s):

Alessio Danilo Inchingolo ◽

Gianna Dipalma ◽

Angelo Michele Inchingolo ◽

Giuseppina Malcangi ◽

Luigi Santacroce ◽

...

Keyword(s):

Literature Search ◽

Web Of Science ◽

Diagnostic Methods ◽

World Health ◽

Evidence Based ◽

Systematic Literature Search ◽

The World ◽

Health Organization ◽

Near Future ◽

Early Diagnostic

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the virus responsible for the coronavirus disease of 2019 (COVID-19) that emerged in December 2019 in Wuhan, China, and rapidly spread worldwide, with a daily increase in confirmed cases and infection-related deaths. The World Health Organization declared a pandemic on the 11th of March 2020. COVID-19 presents flu-like symptoms that become severe in high-risk medically compromised subjects. The aim of this study was to perform an updated overview of the treatments and adjuvant protocols for COVID-19. Methods: A systematic literature search of databases was performed (MEDLINE PubMed, Google Scholar, UpToDate, Embase, and Web of Science) using the keywords: “COVID-19”, “2019-nCoV”, “coronavirus” and “SARS-CoV-2” (date range: 1 January 2019 to 31st October 2020), focused on clinical features and treatments. Results: The main treatments retrieved were antivirals, antimalarials, convalescent plasma, immunomodulators, corticosteroids, anticoagulants, and mesenchymal stem cells. Most of the described treatments may provide benefits to COVID-19 subjects, but no one protocol has definitively proven its efficacy. Conclusions: While many efforts are being spent worldwide in research aimed at identifying early diagnostic methods and evidence-based effective treatments, mass vaccination is thought to be the best option against this disease in the near future.

Download Full-text

Gout as a trigger for acute Charcot neuro-osteoarthropathy?

British Journal of Diabetes ◽

10.15277/bjd.2017.146 ◽

2017 ◽

Vol 17 (4) ◽

pp. 156-159

Author(s):

Shailesh Gohil ◽

Rajesh Jogia ◽

Rachel Berrington ◽

Marie-France Kong

Keyword(s):

Diabetic Foot ◽

Initial Treatment ◽

Treatment Delay ◽

Acute Gout ◽

Diagnostic Challenge ◽

Diabetic Foot Infections ◽

First Case ◽

Patients With Diabetes

Patients with diabetes and a painful, hot, swollen foot can sometimes present a diagnostic challenge. Gout can often present in a similar fashion to diabetic foot infections or acute Charcot neuro-osteoarthropathy, and cases have been described where patients with Charcot neuro-osteoarthropathy were misdiagnosed as having gout, leading to treatment delay. We describe a patient who presented with a painful, swollen, warm foot who did not respond to initial treatment with antibiotics. Improvement in his symptoms occurred following treatment for gout, however he then went on to develop Charcot neuro-osteoarthropathy. As far as we are aware, this is the first case described in the literature where acute gout may have triggered acute Charcot neuro-osteoarthropathy. It is important to bear in mind that more than one pathology may be present in a patient at the same time or may closely follow one another.

Download Full-text