scholarly journals The significance of electrothermometry indices for organization of adequate infusion therapy in diabetic foot syndrome

2012 ◽  
Vol 93 (2) ◽  
pp. 389-390
Author(s):  
R I Fatykhov ◽  
I V Klyushkin ◽  
L A Akhmetyanov
Keyword(s):  
Clinical Data ◽  
Diabetic Foot ◽  
Conservative Therapy ◽  
Dynamic Control ◽  
Diagnostic Procedures ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Infusion Therapy ◽  
Subsequent Formation ◽  
Tissue Ischemia

Aim. To determine the criteria for conservative infusion therapy with the assessment of its effectiveness using the electrothermometry method. Methods. One of the major complications of diabetes is the diabetic foot syndrome. This diagnosis is established on the basis of clinical data and imaging studies. The resulting parameters are objective, but the specificity, selectivity, and the multiplicity of diagnostic procedures negate the effectiveness of these methods, making it difficult to consequently form treatment strategy. Registration of temperature parameters during different degrees of ischemic disturbances of the lower limbs by electrothermometry was performed with the subsequent formation of the algorithm of conservative therapy. Results. In patients with diabetic foot syndrome determined was the direct correlation between the degree of tissue ischemia of the lower extremities and the variation of temperature parameters. The formation of the course of conservative therapy was performed after evaluating the obtained parameters; its formation was based on the main pathogenetic links. Clinical data and the parameters of electrothermometry served as the method of dynamic control. Conclusion. Despite the achieved successes in the modern diagnosis of the diabetic foot syndrome, there still remains a number of inaccuracies, the key ones among then are the difficulties associated with determining the level of trophic disorders; electrothermometry makes it possible to expand the diagnostic horizons, and the obtained result can serve as a prognostic guide for the formation of the tactics of therapy and as a method of dynamic control.

scholarly journals Study of the influence of vacuum therapy on the wound process in patients with diabetic foot syndrome

2019 ◽  
Vol 74 (4) ◽  
pp. 283-288
Author(s):  
Petr A. Gerasimchuk ◽  
Alexander V. Shidlovskyi ◽  
Dmitriy B. Fira ◽  
Andrey V. Pavlyshyn
Keyword(s):  
Diabetes Mellitus ◽  
Negative Pressure ◽  
Diabetic Foot ◽  
Chronic Wound ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Vacuum Therapy ◽  
Social Significance ◽  
Number Of Patients ◽  
Bed Days

Background: According to the International Diabetes Federation (IDF), the number of patients on diabetes mellitus is now more than 415 million people on Earth, until 2030 it will increase to 439 million, and by 2035 ― will reach 592 million. Throughout life, 4.625% of patients with diabetes mellitus develops a diabetic foot syndrome with the formation of wounds, whose treatment, can not yet be considered satisfactory, since in 1525% of patients are the direct cause of high amputations of the lower limbs. This requires finding new effective methods for treating wound defects in patients with diabetic foot syndrome, one of which can be vacuum wound therapy. Aims: To study the effectiveness of vacuum therapy in the treatment of acute and chronic wound process in patients with diabetic foot syndrome, depending on the pathogenetic form of the lesion. Materials and methods: The effect of vacuum therapy on the course of acute and chronic wound process in 231 patients with neuropathic and ischemic form of diabetic foot syndrome was studied during 20142017. Evaluation of the dynamics of the wound process was carried out on the basis of clinical, planimetric, microbiological, morphological methods, as well as microcirculation indices in the area round the wound. Results: Vacuum therapy of acute and chronic wounds in patients with different pathogenetic forms of diabetic foot syndrome, allows to stabilize the course of wound process, stimulate regenerative processes in the wound, improve local microcirculation (p0.05). This, in turn, allows a shorter time to prepare a wound for closure by one of the methods of plastic surgery or create favorable conditions for its independent epithelization. In patients with ischemic lesions (chronic arterial insufficiency of the third degree), the carrying out of vacuum therapy by standard method leads to an intensification of the pain syndrome. This causes the need to apply an initial negative pressure in the system in the range of 7080 mm Hg, which makes it possible to stop pain during the day. At 23 days of the postoperative period, negative pressure is established at standard values. Conclusions: Vacuum therapy of wounds in patients with diabetic foot syndrome is an effective method of treatment that allows the doctor to reduces the duration of treatment of patients in hospital with a neuropathic form of diabetic foot syndrome on average (4.31.7) bed-days, and patients with ischemic form ― on average (4.11.9) bed-days, which has both medical and social significance.

scholarly journals InfusIon therapy regImens In complex treatment of dIabetIc foot syndrome

2014 ◽  
Vol 7 (5) ◽  
pp. 29-31
Author(s):  
Konstantin a. Koreyba ◽  
◽  
aydar r. Minabutdinov ◽  
artur v . sharafutdinov ◽  
ruslan i. fatyhov ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Diabetic Foot Syndrome ◽  
Infusion Therapy ◽  
Complex Treatment

scholarly journals MICROBIAL COMPOSITION OF PURULENT LESIONS IN PATIENTS WITH COMPLICATED DIABETIC FOOT SYNDROME

2019 ◽  
Vol 18 (4) ◽  
pp. 11-16
Author(s):  
S. D. Shapoval ◽  
I. L. Savon ◽  
O. V. Trybushnyy ◽  
L. A. Vasylevsʹka ◽  
L. Yu. Slobodchenko ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Lower Limbs ◽  
Microbial Pathogens ◽  
Diabetic Foot Syndrome ◽  
Microbial Composition ◽  
Quick Method ◽  
Microbial Cells ◽  
Foot Complications ◽  
High Level ◽  
Further Development

Bacterial infection is a major pathogenetic aspects in the formation of diabetic foot complications. Joining infection is the cause of performing amputations of the lower limbs in 25-72 % of cases, especially when diabetic foot is complicated by sepsis. The aim of our study was to identify differences in the microbial background of purulent foci in patients with diabetic foot syndrome complicated by sepsis and for the further development of the algorithm of directed antibiotic therapy. Material and methods. A total of 3653 patients in the dynamics of a complicated diabetic foot syndrome were examined. There were two groups: the first - patients who were treated during 2010-2014 (a comparison group), the second – during 2015-2019 (main group), which according to the gender ratio (χ2=0.09; P=0.7698) and age (P=0.17141) did not differ. The complex bacteriological studies consisted of determining the sensitivity of microorganisms to antibiotics, the qualitative composition of microbial pathogens and the number of microbial cells per 1 g of tissues. To determine the sensitivity of purulent microorganisms to antibiotics a quick method of determination on automated systems «Vitek-2» and «BacT/ ALERT» (France) was applied. Results and discussion. All patients with complicated diabetic foot syndrome were operated under general anesthesia. As a rule, operations on the anterior foot and «high» amputations were performed. 190 people died, death rate was 5.2 %. The analyzed data indicate that in patients with diabetic foot syndrome complicated by the number of microbial cells in tissue 1g to the site of infection did not exceed 105 – 106, while in patients with sepsis, this number was more than 50% was 107 – 1012. Isolation of aerobic monoinfection of purulent foci in patients with complicated diabetic foot syndrome in the period from 2010 to 2019 decreased from 51,4 to 44,4% (P <0,05) determined by an increase in the allocation of gram-positive microorganisms from 55,2 to 60,2% (P<0,05). The dynamics of microbiological research indicates an increase in the proportion of MRSA- staphylococci from 23,4 to 43,3 %. Determined microbial pathogens are characterized by a high level of antibiotic resistance, particularly to antibiotic-I-II generation. Conclusions. These experiments enable to distinguish particularly microbial background of purulent foci of the two groups of patients and determine antibiotic algorithms.

scholarly journals Diabetic neuropathy and risk of diabetic foot syndrome during implementation of the national protocol in management of diabetes

2016 ◽  
pp. 44-51
Author(s):  
V. Tkachenko
Keyword(s):  
Type 2 Diabetes ◽  
Diabetic Neuropathy ◽  
Diabetic Foot ◽  
Primary Care Physicians ◽  
Diabetes Control ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Clinical Protocol ◽  
Positive Effect

The implementation of unified clinical protocol (UCP) has set a target to primary care physicians (PCP) to identify the diabetic neuropathy and angiopathy, screening the risk of diabetic foot syndrome and its prevention. The aim of our research - to determine the frequency of diabetic neuropathy, the risk of diabetic foot syndrome and level of type 2 diabetes control in patients of Kyiv region in terms of implementation of new clinical protocol in type 2 diabetes management. Materials and methods. The reports of health establishments of Kiev region were analyzed and 173 patients with type 2 diabetes were examined (aged 55,13 ± 0,61 years): group 1 - observed by PCP (n=45), group 2 - by endocrinologists (n=128). Patients examination included laboratory tests of diabetes control and evaluation of the lower limbs by Neuropathy Disability Score and determination the "ankle-shoulder" index with the portable Doppler. Statistical analysis - Excel 2007, SPSS, Statistica 6.0. Results. Despite treatment, the average levels of blood glucose, HbA1c, lipidogramme exceeded target levels in patients with type 2 diabetes, indicating their lack of control. In this regard, at 7-9 years of the disease in 19.65% of patients were founeded signs of severe and in 36.42% - moderate diabetic neuropathy of the lower limbs and in 15.03% of patients - occlusion, leading to the development of diabetic foot syndrome in 9.82% of patients, and 70.52% of the patients had moderate (44.51%) or high (26.01%) risk of its development. The differences between patients of PCP and endocrinologists were not found. However, the significant decrease of neuropathy and angiopathy of lower limbs in patients with type 2 diabetes in the Kiev region and reducing the number of amputations for 2012-2014 demonstrates the positive effect of the implementation of UCP. Conclusion. The frequency of diabetic neuropathy and angiopathy of lower limbs, the number of amputations in Kiev region decreased, that indicates a positive effect of implementation of UCP, but the risk of diabetic foot syndrome in patients remains high due to inadequate control of type 2 diabetes by patients and PC physicians and specialists that require optimization.

Efficacy of lower limbs revascularization methods in patients with purulent-necrotic forms of diabetic foot syndrome

2013 ◽  
Vol 21 (3) ◽  
pp. 61-68 ◽  
Author(s):  
S.N. Eroshkin ◽  
◽  
A.P. Kutko ◽  
V.P. Bulavkin ◽  
◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome

scholarly journals CONTRIBUTION OF TRANSCUTANEOUS OXYMETRY IN DIABETIC FOOT SYNDROME

2013 ◽  
Vol 1 ◽  
pp. 307-313
Author(s):  
Ludovit Gaspar ◽  
Matej Bendzala ◽  
Andrea Komornikova ◽  
Ivan Ocadlik ◽  
Michal Makovnik ◽  
...  
Keyword(s):  
Doppler Ultrasound ◽  
Diabetic Foot ◽  
Ultrasound Examination ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Arterial Calcification ◽  
Primary Position ◽  
Transcutaneous Oxygen ◽  
Peripheral Arterial

Four major complications are participating in tissue damage in diabetic foot syndrome – diabetic angiopathy, neuropathy, osteoarthropathy and inflammation. Low ankle-brachial pressure index (ABI) is a well-known indicator for ischemia of lower limbs, but in patients with diabetes mellitus is common also a high ABI (over 1.3) as reliable predictor of the presence of arterial calcification – medial calcinosis. Aim of the study is to determine the degree of ischemia using transcutaneous oximetry in patients with diabetic foot syndrome - with clinical manifestations of peripheral arterial occlusive disease (PAOD) and medial calcinosis. We investigated three groups: first consisted of 46 members in IInd stage of PAOD according to Fontaine classification, in second group were 30 members in IIIrd stage of PAOD and third had 29 members in IVth stage of PAOD. The ABI was determined with Doppler ultrasound examination. Transcutaneous oxygen tension (TcPO2) was measured with Oxykapnomonitor Hellige SMK Germany equipment with sensing probe – transoxode. Resting values of TcPO2 were obtained in lying patient on the foot in first metatarsal space. Subsequently leg was passively elevated into 30 degree angle for 3 minutes and then reimposed into primary position. One minute exercise – plantar and dorsal feet flexion was performed and after the TcPO2 values stabilization the patient hung his shin from the edge of the bed touching the floor. TcPO2 values were continuously recorded by analog waveform. In more severe stages of PAOD according to Fontaine stage III and IV we detected lower levels of TcPO2 under basal resting conditions: 20 respectively 5 mmHg. Patients with IInd stage of PAOD had basal TcPO2 values of 40 mmHg. Conclusions of the study are: TcPO2 values are not affected by the presence of medial calcinosis and sothis method is particularly beneficial in patients where Doppler ultrasound examination shows artificial high pressure values on lower limbs. In the third and fourth stage of PAOD passive leg elevation is as effective in determination of ischemia as working test.

scholarly journals GENETIC PROFILE STAPHYLOCOCCUS AUREUS, ISOLATED FROM BACTERIAL CARRIERS AND PATIENTS WITH INFECTIOUS INFLAMMATORY PATHOLOGY

2018 ◽  
pp. 56-62 ◽  
Author(s):  
V. A. Gritsenko ◽  
A. R. Mavzyutov ◽  
T. M. Pashkova ◽  
O. L. Kartashova ◽  
Ya. V. Tyapaeva ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Diabetic Foot ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Genetic Profile ◽  
Pathogenic Potential ◽  
Asymptomatic Carriage ◽  
Purulent Wounds ◽  
Genetic Profiles

Aim. A comparative genetic evaluation of the pathogenic potential of Staphylococcus aureus strains isolated from bacterial carriers and patients with infectious inflammatory pathology. Materials and methods. The presence of pathogenicity genes (ssp, spa, clfA and clfB) in 163 strains of S. aureus isolated from the mucous membrane of the nasal cavity of bacterial carriers, from the vaginal discharge of women with uterine myoma, the contents of the pustules of newborns with perinatal pyoderma, and the transudate of venous-trophic ulcers lower limbs and purulent wounds in patients with diabetic foot syndrome. Results. It was shown that the frequency of occurrence of ssp, spa, clfA and clfB genes in clinical strains of S. aureus depended on the source of their isolation. In all cultures of S. aureus (except vaginal isolates), the most common gene was ssp (in 66.7 - 94.6% of cases), which was found isolated or in different combinations with other genes (spa, clfA, clfB). It has been established that the genetic profiles of strains of S. aureus isolated from bacterial carriers and patients with infectious inflammatory pathology (perinatal pyoderma, purulent wounds in diabetic foot syndrome) show a pronounced similarity in the presence of ssp, spa, clfA and clfB genes. Conclusion. The possible role of asymptomatic carriage of strains of S. aureus with a pathogenic potential in the development of endogenous infections of different localization is discussed.

scholarly journals Ultrasound elastography as a method of emergency diagnosis of the first signs of transient ischemia of the lower limbs in diabetic foot syndrome

2016 ◽  
Vol 97 (6) ◽  
pp. 860-864
Author(s):  
R I Fatykhov ◽  
I V Klyushkin ◽  
Yu A Klyushkina ◽  
N A Minnemullin ◽  
M N Nasrullaev
Keyword(s):  
Young’S Modulus ◽  
Shear Wave ◽  
Diabetic Foot ◽  
Modulus Of Elasticity ◽  
Young's Modulus ◽  
Shear Wave Elastography ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Transient Ischemia ◽  
Young’S Modulus Of Elasticity

Aim. Evaluate the data of elastography characteristic for the first signs of transient ischemia of lower limbs in diabetes foot syndrome.Methods. In Kazan city clinical hospital №7 measurement of Young’s modulus of elasticity was performed in 12 patients with transient ischemia in diabetic foot syndrome. The methods and assessment of parameters typical for soft tissues of lower limbs we have developed earlier (patent «Method of elastography diagnosis of tissue changes in diabetic foot syndrome»). Color duplex scan of the arteries was performed according to standard method with the use of 5 to 10 MHz linear array probe starting from distal parts of limbs. Measurement of ultrasound density was performed with the use of shear wave elastography with 4 to 15 MHz wide-band linear probe. All parameters were measured in real time mode.Results. Increase of elastomeric index (Young’s modulus of elasticity) to 23.74±2.34 kPa (93,49±1,26%) in the distal segment of the lower extremity (on the foot) is associated with development of transient disorders in the lower limbs in diabetic foot syndrome, which is not always detected with invasive methods of diagnosis.Conclusion. Shear wave elastography is recommended for emergency medical care in diabetic foot syndrome; patients after being diagnosed with type 2 diabetes should dynamically monitor microcirculation of lower limbs that will decrease the risk of need of surgical treatment.

scholarly journals The clinically relevant diabetic foot syndrome morphology

2021 ◽  
Vol 11 (5) ◽  
pp. 262-274
Author(s):  
V. Polyovyy ◽  
Bilel Khorshani ◽  
R. Sydorchuk ◽  
P. Kyfiak ◽  
O. Khomko ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Morphological Changes ◽  
Cellular Level ◽  
Molecular Structures ◽  
Diabetic Foot Syndrome ◽  
Inflammatory Infiltration ◽  
Diffuse Infiltration ◽  
Tissue Ischemia ◽  
Tissue Edema ◽  
The Status

Objective: to evaluate the morphological changes in diabetic foot syndrome emphasizing the ultrastructural cellular changes.Material and methods. Biopsies of the chronic lesions in 120 diabetic foot patients following necessary preparatory stages were studied by histological, histochemical and electron microscopy methods.Results. The inflammatory infiltration and destruction and involving all layers of skin and soft tissue, the phenomena of vacuolation, apoptosis or karyolysis; tissue edema, diffuse infiltration by neutrophils, vascular plethora with stasis, thrombosis, and necrosis were observed. Microcirculatory tract thrombosis exacerbated tissue ischemia, contributing to the progression of pathology. The macrophages' cytoplasm characterized by the presence of phagocytosed and digested microorganisms often intact inside them. The changes in the status of nuclear and perinuclear material were accompanied by compression and dehydration of the cell, which ended in its fragmentation and the formation of tightly contacting bodies of various shapesConclusions. Morphological changes in diabetic foot syndrome are diverse and uneven, occurring not only on tissue and cellular level but involves subcellular and molecular structures, encouraging further research in this field. Foci of destruction and lysis of the newly formed epithelium are characteristic for diabetic foot, which is not observed in the normal wound process.

Quality of Life in Individuals with Diabetic Foot Syndrome

2020 ◽  
Vol 20 (9) ◽  
pp. 1365-1372 ◽  
Author(s):  
Emmanuel Navarro-Flores ◽  
Omar Cauli
Keyword(s):  
Quality Of Life ◽  
Diabetic Foot ◽  
Geographical Area ◽  
Premature Mortality ◽  
Signs And Symptoms ◽  
Lower Limbs ◽  
Diabetic Foot Syndrome ◽  
Diabetic Patients ◽  
The Social

Background and Objective: Diabetic foot syndrome (DFS) is a common long-term complication of diabetes mellitus. DFS has recently been associated with adverse effects that could further impair the quality of life of diabetic patients, and increase the social and economic burden, morbidity, and premature mortality of the disease. The main physio-pathological basis of DFS is due to diabetesinduced neuropathy and angiopathy in the lower limbs and feet. Patients diagnosed with DFS must significantly modify their daily habits in order to cope with signs and symptoms of DFS and this can alter their quality of life. The objective of this review is to summarize the evidence regarding the economic, physical and social limitations which can affect the quality of life (QoL) in patients with DFS, the effects of ulcers and amputations on QoL outcomes. Results: Different aspects related to DFS such as physical alterations, psychological complaints and even disorders, socio-economic difficulties can affect the quality of life of these patients. However, the QoL related to low socio-economic factors gave mixed results and physical activity, education and type of footwear can influence the outcomes. There is a general gender-dependent higher prevalence of DFS in men, although it depends on the geographical area. DFS often co-occurs with other diabetes-induced complications (retinopathy, nephropathy and cardiovascular disorders) and comorbid obesity generally worsens it. Conclusions: Accessibility to health services aimed at reducing inequalities and constant health education and promotion and care regarding psychological and socio-economic issues should be continuously undertaken for individuals with DFS in order to improve their QoL.

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