scholarly journals A study of effect of tarsal tunnel decompression on sensory improvement in diabetic foot: a prospective randomized control trial

2018 ◽  
Vol 5 (11) ◽  
pp. 3627
Author(s):  
Lakshmanan S. ◽  
Viswanathan M. S. ◽  
R. Anbazhagan
Keyword(s):  
Statistical Significance ◽  
Diabetic Patients ◽  
Decompression Surgery ◽  
Tarsal Tunnel ◽  
Ulcer Formation ◽  
Diabetic Ulcer ◽  
Entrapment Neuropathies ◽  
Sensory Recovery ◽  
Control Limb ◽  
Adequate Decompression

Background: In India approximately, 45000 legs are amputated every year and almost 75% of these amputations are carried out in neuropathic feet which are potentially preventable. Diabetic peripheral nerves are at risk of entrapment neuropathies focally, where these nerves are contained in a closed space. The aim of the study was to find out the effect of decompression of compressed posterior tibial nerve and its branches at tarsal tunnel in restoration of sensation in diabetic foot.Methods: A total of 70 diabetic patients with ulcer foot in one limb (test limb) and with no ulcer on the other limb (control limb) were selected for study. The test limb was subjected to tarsal tunnel release. Sensory recovery was evaluated in the ulcer limb and compared with normal limb in same patient and results were evaluated statistically for significance.Results: Present study shows that following tarsal tunnel decompression surgery on test limb, 65 patients (93%) had sensory gain and 5 patients (7%) had documented no sensory gain on test limb, with statistical significance. After de-compressive surgery on the test limb, 69 patients (98.6%) were documented to have resolving of Tinel sign in the test limb with sensory improvement, suggesting adequate decompression and 1 patient (1.4%) was documented to have persistent Tinel sign suggesting possibility of inadequate decompression with no recovery of sensation, with statistical significance.Conclusions: Present study reveals that decompression of tarsal tunnel in diabetic ulcer foot patients leads to definite improvement in sensation of foot which will prevent further ulcer formation and resultant complications ending in amputations.

scholarly journals Tarsal tunnel decompression: an effective method for prevention of foot complications in diabetic patients with compressive neuropathy at tarsal tunnel

2018 ◽  
Vol 5 (11) ◽  
pp. 3520
Author(s):  
Viswanathan M. S. ◽  
Lakshmanan S. ◽  
R. Anbazhagan
Keyword(s):  
Ulcer Healing ◽  
Diabetic Foot ◽  
Complete Healing ◽  
Diabetic Patients ◽  
Decompression Surgery ◽  
Tarsal Tunnel ◽  
Diabetic Ulcer ◽  
Compressive Neuropathy ◽  
Control Limb

Background: Diabetic foot is one of the most devastating complications of diabetes with 15% lifetime risk of developing ulcer foot. About 80% of diabetic foot is neuropathic in origin, revealing the importance of sensory sensation in preventing the development of diabetic ulcer. This study is aimed to identify the efficiency of tarsal tunnel decompression surgery in diabetic patients in ulcer healing and in the prevention of development of new diabetic related foot complications.Methods: About 70 diabetic patients with ulcer in one foot, acting as test limb and contralateral foot having no ulcer, acting as control limb was included in the study. Tarsal tunnel decompression surgery was done in the test limb and the status of ulcer in the test limb, in terms of diameter/ progress of ulcer healing was observed. In both the study limb and the control limb foot was examined for onset of any new diabetes related foot changes/complications during the follow up period for 18 months.Results: Postoperatively, at 6 weeks, 20 patients (28.6%) had their ulcers fully healed. At 3rd month postoperative follow up 90.48% of ulcers in the test limb showed complete healing following decompression surgery and 9.52% of ulcers showed partial healing. Following decompression surgery in the test limb, only 2 patients (3.28%) developed new diabetes related foot changes/complications as compared to control limb, where 15 patients (24.59%) developed new diabetes related foot changes/complications.Conclusions: Present study firmly proves that following tarsal tunnel decompression surgery, there is improvement in healing of the ulcer with conservative measures and there is a definitive role of tarsal tunnel decompression in prevention of development of new diabetes related foot changes/complications in patients.

scholarly journals Transdermal deferoxamine prevents pressure-induced diabetic ulcers

2014 ◽  
Vol 112 (1) ◽  
pp. 94-99 ◽  
Author(s):  
Dominik Duscher ◽  
Evgenios Neofytou ◽  
Victor W. Wong ◽  
Zeshaan N. Maan ◽  
Robert C. Rennert ◽  
...  
Keyword(s):  
Wound Healing ◽  
Delivery System ◽  
Transdermal Delivery ◽  
Reactive Oxygen ◽  
Diabetic Patients ◽  
Ulcer Formation ◽  
Diabetic Wound ◽  
Diabetic Ulcer ◽  
Diabetic Ulcers ◽  
Diabetic Wound Healing

There is a high mortality in patients with diabetes and severe pressure ulcers. For example, chronic pressure sores of the heels often lead to limb loss in diabetic patients. A major factor underlying this is reduced neovascularization caused by impaired activity of the transcription factor hypoxia inducible factor-1 alpha (HIF-1α). In diabetes, HIF-1α function is compromised by a high glucose-induced and reactive oxygen species-mediated modification of its coactivator p300, leading to impaired HIF-1α transactivation. We examined whether local enhancement of HIF-1α activity would improve diabetic wound healing and minimize the severity of diabetic ulcers. To improve HIF-1α activity we designed a transdermal drug delivery system (TDDS) containing the FDA-approved small molecule deferoxamine (DFO), an iron chelator that increases HIF-1α transactivation in diabetes by preventing iron-catalyzed reactive oxygen stress. Applying this TDDS to a pressure-induced ulcer model in diabetic mice, we found that transdermal delivery of DFO significantly improved wound healing. Unexpectedly, prophylactic application of this transdermal delivery system also prevented diabetic ulcer formation. DFO-treated wounds demonstrated increased collagen density, improved neovascularization, and reduction of free radical formation, leading to decreased cell death. These findings suggest that transdermal delivery of DFO provides a targeted means to both prevent ulcer formation and accelerate diabetic wound healing with the potential for rapid clinical translation.

scholarly journals Performance of the lower limb musculoskeletal system in patients with different degree of diabetic ulcer risk

2020 ◽  
Author(s):  
Snježana Novaković Bursać ◽  
Goran Talić ◽  
Nataša Tomić ◽  
Slavica Jandrić
Keyword(s):  
Muscle Strength ◽  
Range Of Motion ◽  
Statistical Significance ◽  
Metatarsophalangeal Joint ◽  
Manual Muscle Testing ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
First Metatarsophalangeal Joint ◽  
Diabetic Ulcer ◽  
Muscle Testing

Abstract BackgroundThe objective of the study was to determine the correlation between the biomechanical parameters: ankle and foot muscle strength, range of motion (ROM) at ankle joint (AJ), subtalar joint (SJ) and first metatarsophalangeal joint (I MTP) in patients with different diabetic ulcer risk assessed by IWGDF 2019 Guidance risk stratification system.MethodA cross-sectional study included 100 diabetic patients. The patients were classified into 4 risk categories of development of diabetic foot ulcer (DFU) applying IWGDF Guidelines 2019 stratification risk system. The function of ten foot and ankle muscles was evaluated by manual muscle testing and application of the Michigan Diabetic Neuropathy Score (MDNS) system. The range of motion ROM at the ankle, subtalar and first metatarsophalangeal joint was measured with a goniometer. The risk assessment was done applying IWGDF Guidelines 2019 stratification risk system. To test the statistical significance the ANOVA test was applied.ResultsAverage muscle strength in specified categories was category 0:9.2; category 1:13.9; category 2:13.3; category 3:15.2. Average ROM at AJ in specified categories was: category 0:49.3°; category 1:48.8°; category 2:45.5°; category 3:44.6°. Average ROM at SJ in specified categories was: category 0:37.8°; category 1:31.3°; category 2:35°; category 3:28.7°. Average ROM at I MTP in specified categories was: category 0:78.6°; category 1:74.4°; category 2:65.5°; category 3:57.9°. ConclusionThe risk for DFU significantly correlates with foot muscle strength and ROM at SJ, and I MTP, but does not with ROM at AJ.

scholarly journals EVIDENCE - BASED HOMEOPATHY:CASE REPORT OF DIABETIC FOOT ULCER

2021 ◽  
Vol 9 (02) ◽  
pp. 160-169
Author(s):  
Tayade Kanchan R. ◽  
◽  
Singh Priya P. ◽  
Keyword(s):  
Foot Ulcer ◽  
Vascular Diseases ◽  
Diabetic Foot Ulcer ◽  
Type Ii Diabetes Mellitus ◽  
Complete Healing ◽  
Diabetic Patients ◽  
Ulcer Formation ◽  
Diabetic Ulcer ◽  
Uncontrolled Diabetes ◽  
Clinical Background

Diabetes is a globally affected metabolic disease.Diabetic foot ulcer is a frequent complication seen in diabetic patients due to neuropathy and vascular diseases, this is a condition where a structured management,self care& monitoring is necessary to reduce the risk of mortality & morbidity of disease. As per our homoeopathic science, we treat the whole person & not only the disease. We aimed at identifying the disease & treating the disease with the Similimum Constitutionalremedy.People with uncontrolled diabetes are more likely to be affected with the skin disorders and ulcer formation, it occurs due to improper circulation,pressure,trauma and high blood sugar. It increases risk of gangrene, leading to amputation and permanent disability.For this Multidisciplinary Management is necessary to avoid this complication. Background andObjectives:Assessment of diabetic ulcer on the basis of clinical background and totality, with significant improvement and complete cure , and its evidence of pictures of healing observed in the diabetic ulcer.This wasa case of 49 years old male who presented with a history of Diabetic ulcer on left leg malleolus , he is a known case of Insulin dependent type II Diabetes Mellitus .The case presented here is documented from Health Care Homeopathic Clinic,Katraj, Pune Maharashtra, India.Patient was treated with individualized Homeopathic medicine over a period of 6 months , and there was significant improvement with complete healing of ulcer. Methodology:Homeopathic medicine was indicated, based on totality of symptoms and assessed with photographs.

scholarly journals Transcriptomic Analysis of a Diabetic Skin-Humanized Mouse Model Dissects Molecular Pathways Underlying the Delayed Wound Healing Response

Genes ◽  
2020 ◽  
Vol 12 (1) ◽  
pp. 47
Author(s):  
Carlos León ◽  
Francisco García-García ◽  
Sara Llames ◽  
Eva García-Pérez ◽  
Marta Carretero ◽  
...  
Keyword(s):  
Wound Healing ◽  
Functional Enrichment ◽  
Preclinical Model ◽  
Published Data ◽  
Diabetic Patients ◽  
Ulcer Formation ◽  
Histological Features ◽  
Depth Analysis ◽  
Wound Healing Model ◽  
Healing Model

Defective healing leading to cutaneous ulcer formation is one of the most feared complications of diabetes due to its consequences on patients’ quality of life and on the healthcare system. A more in-depth analysis of the underlying molecular pathophysiology is required to develop effective healing-promoting therapies for those patients. Major architectural and functional differences with human epidermis limit extrapolation of results coming from rodents and other small mammal-healing models. Therefore, the search for reliable humanized models has become mandatory. Previously, we developed a diabetes-induced delayed humanized wound healing model that faithfully recapitulated the major histological features of such skin repair-deficient condition. Herein, we present the results of a transcriptomic and functional enrichment analysis followed by a mechanistic analysis performed in such humanized wound healing model. The deregulation of genes implicated in functions such as angiogenesis, apoptosis, and inflammatory signaling processes were evidenced, confirming published data in diabetic patients that in fact might also underlie some of the histological features previously reported in the delayed skin-humanized healing model. Altogether, these molecular findings support the utility of such preclinical model as a valuable tool to gain insight into the molecular basis of the delayed diabetic healing with potential impact in the translational medicine field.

Relation Between Tissue Iron Content and Polarization of Macrophages in Diabetic Ulcer and the Transitional Zone of Diabetic Ulcers with Major Amputation

2021 ◽  
pp. 153473462110374
Author(s):  
Shirin Saberianpour ◽  
Mohamad H. Saeed Modaghegh ◽  
Mehdi Montazer ◽  
Mohammad M. Kamyar ◽  
Fatemeh Sadeghipour Kerman ◽  
...  
Keyword(s):  
Hypoxia Inducible Factor ◽  
Transitional Zone ◽  
Major Amputation ◽  
Blue Staining ◽  
Control Group ◽  
Diabetic Patients ◽  
Tissue Preparation ◽  
Diabetic Ulcer ◽  
Diabetic Ulcers ◽  
Tissue Iron

Most diabetic lower-limb amputations probably result from combinations of contributing causes rather than from unitary causes. Iron-induced damage might modulate the development of chronic diabetes complications. In this study, the relationship between tissue iron levels and polarization of macrophages in induction of angiogenesis was investigated in diabetic ulcer samples and the transitional zone of diabetic ulcers. Patients with diabetic ulcers who underwent amputation were included. The transitional zone of diabetic ulcers, from the same diabetic patients, was used as a control group. After tissue preparation, Perls Prussian blue staining and immunohistochemistry for CD11c, CD163, and CD68 markers were done. Vascular endothelial growth factor (VEGF), hypoxia-inducible factor (HIF), Tie2, and protein kinase B (also known as AKT) transcription of genes were measured by real-time polymerase chain reaction. For statistical analysis, we used independent samples t-test or its nonparametric equivalents, Mann–Whitney U test was used for quantitative variables, and chi-square (or Fisher's exact test) for qualitative variables. According to the results, the ratio of M2 to M1 macrophages was decreased in ulcers tissue compared to the transitional zone of diabetic ulcers. The expression of angiogenesis-related genes was increased due to hypoxia induction such as HIF and VEGF in ulcer tissue ( P < .0001), but the expression of vascular stability-related genes such as Tie2 was decreased ( P < .0001).In amputated diabetic ulcers, the polarization of macrophages is toward the classic type, but no connection was found in terms of tissue iron and help in the polarization of macrophages.

High resolution ultrasonography of peripheral nerves in diabetic patients to evaluate nerve cross sectional area with clinical profile

2021 ◽  
Vol 94 (1121) ◽  
pp. 20200173
Author(s):  
Shamrendra Narayan ◽  
Amit Goel ◽  
Ajai Kumar Singh ◽  
Anup Kumar Thacker ◽  
Neha Singh ◽  
...  
Keyword(s):  
Peripheral Nerves ◽  
Cross Sectional Area ◽  
Diabetic Patients ◽  
Tarsal Tunnel ◽  
Healthy Controls ◽  
Sectional Area ◽  
Cross Sectional ◽  
Early Therapy ◽  
Ultrasound Evaluation ◽  
Compressive Neuropathy

Objectives: The aim of this observational study was ultrasound evaluation of peripheral nerves cross-sectional area (CSA) in subjects with probable diabetic peripheral sensorimotor neuropathy (DPN). CSA was analyzed with reference to clinical and nerve conduction study’s (NCS) parameters for early diagnosis and pattern of involvement. Methods: A total of 50 patients with probable DPN due to Type 2 diabetes and 50 age-matched healthy controls underwent sonographic examinations of ulnar nerve at the lower arm, median nerve proximal to carpal tunnel, the common peroneal nerve proximal to fibular head, tibial nerve proximal to the tarsal tunnel, and sural nerve at lower third leg. Results: CSA was increased in cases of DPN as compared to healthy controls. Area changes were more marked with demyelinating pattern. Probable DPN cases with normal NCS had significantly higher number of peripheral nerves showing increased CSA as compared to healthy control. A cut-off of >4 nerve thickening showed a sensitivity of 86 %, and specificity of 56%. The neuropathy pattern in the lower limb was axonal, whereas in the upper limb, it was demyelinating with the majority showing sonographic feature of associated compressive neuropathy. Conclusion: There is an increase in CSA of peripheral nerve in diabetic patients. It can be used as a morphological marker for classifying DPN with changes being picked up earlier to NCS abnormality. Clinical neurological presentation in probable DPN can also be due to compressive neuropathy in early phases, and ultrasound can be a useful tool. Advances in knowledge: Early pick up of DPN cases shall be useful for early therapy and motivating the patients to actively participate in the treatment. Morphological changes on ultrasonography precedes the electrodiagnostic change in DPN. Symptoms of DPN is not only due to metabolic changes but also compressive neuropathy.

Outcomes of Nonalcoholic Fatty Liver Disease In Covid Positive Diabetic Patients: Cross Sectional Study

2021 ◽  
Vol 15 (12) ◽  
pp. 3241-3243
Author(s):  
Azhar Hussain ◽  
Mehwish Iftikhar ◽  
Amna Rizvi ◽  
Muhammad Latif ◽  
Muhammad Javed Ahmed ◽  
...  
Keyword(s):  
Liver Disease ◽  
Fatty Liver ◽  
Nonalcoholic Fatty Liver Disease ◽  
Fatty Liver Disease ◽  
Statistical Significance ◽  
Cross Sectional Study ◽  
Diabetic Patients ◽  
Sectional Study ◽  
Cross Sectional ◽  
Nonalcoholic Fatty Liver

Background: SARS-CoV-2 principally invades the respiratory system. ACE receptor are also abundant throughout the hepatobiliary system and their increased expression on hepatocyte make patients with NAFLD more vulnerable. Aim: To see outcomes of COVID positive diabetic patients suffering from Nonalcoholic fatty liver disease (NAFLD). Study design: Cross Sectional Study. Methodology: 150 diabetic and COVID PCR positive were recruited from COVID ward of Services Hospital in Lahore. Clinical parameters like BMI, SpO2, Hepatomegaly and lab parameters like HbA1C, AST ALT were noted in spreadsheet. Statistical analysis was done using SPSS v.25. Statistical significance for difference in proportions is calculated using Pearson’s Chi-Squared test. P less than 0.05 was considered statistically significant. Results: Around 84(56%) were males and 66(44%) females, smoked were 27(18%), mean age (years) was 59.7333 ±11.35023, mean BMI (kg/m²) was 30.1425±7.30673, 87(58%) patients had NAFLD, who experienced sever disease (53.2%; x^2=0.010) and more mortalities (60.2%;x^2=0.453) as compared to those who do not had condition. Conclusion: We concluded that NAFLD makes COVID-19 infected patients more fragile. Such patients experienced sever disease and more mortalities however need of mechanical ventilation remains almost equal between those who has NAFLD and those who didn’t had. Keywords: Nonalcoholic fatty liver disease, COVID-19, Diabetes, Mortality and Severity.

scholarly journals Perbandingan efektivitas asam perasetik dan feracrylum pada pola kuman ulkus diabetik

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Angelica M. J. Wagiu ◽  
Richard M. Sumangkut ◽  
Heber B. Sapan ◽  
Louise A. J. Waworuntu
Keyword(s):  
Peripheral Arterial Disease ◽  
Proteus Mirabilis ◽  
Peracetic Acid ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Diabetic Ulcer ◽  
Diabetic Ulcers ◽  
Citrobacter Diversus ◽  
Peripheral Arterial ◽  
Topical Antimicrobial

Abstract: Diabetic ulcer is a condition of infection, ulceration, and or destruction of inner skin tissue related to neurological disorders and degrees of peripheral arterial disease (PAD) in diabetic patients. Diabetic ulcer is prone to infection due to decreased immune response, therefore, opportunistic microbes can become pathogens. Infection is sttill a serious problem in diabetic ulcer since the high cost and long duration of treatment lead to complicated neclected ulcer. This study aimed to obtain the present profile of microbes in diabetic ulcers and the effectivitveness of peracetic acid dan feracrylum in the treatment of diabetic ulcers. This was a descriptive analytical study. The ulcer degree was determined by using PEDIS criteria. Pus specimen was taken with a sterile technique using a transport media, cultured in the Baxtec machine, and the microbes were identified and further tested for sensitivity to peracetic acid dan feracrylum 1%. The results showed that of the 57 patients there were 36 females with a mean age of 58.77+ 9.077 years. Most of the patients (30 patients) had diabetic ulcers of 4th degree. The result of pus culture showed Gram negative Proteus mirabilis as the most frequent microbe (17.5%). The sensitivity test showed that 100% of 12 types of microbes, 83.3% of Citrobacter diversus, and 60% of Proteus mirabilis samples were sensitive to peracetic acid, meanwhile, all microbes were resistant to feracrylum 1% dan NaCl as controls,. Conclusion: Peracetic acid was more effective than feracrylum 1% as topical antimicrobial for diabetic ulcer.Keywords: diabetic ulcer, microbe, topical antimicrobial agentAbstrak: Ulkus diabetik adalah suatu kondisi adanya infeksi, ulserasi dan atau kerusakan jaringan kulit yang lebih dalam yang berhubungan dengan kelainan neurologik serta berbagai tingkatan peripheral arterial disease (PAD) pada penderita diabetes melitus (DM). Ulkus diabetik lebih mudah terinfeksi karena respons kekebalan tubuh penderita DM biasanya menurun, bahkan kuman oportunistik juga dapat menjadi patogen. Infeksi masih menjadi masalah yang paling serius dialami penderita ulkus diabetik oleh karena biaya pengobatan yang besar dan waktu perawatan yang lama sehingga ulkus sering dibiarkan terinfeksi dengan komplikasi tanpa perawatan adekuat. Penelitian ini bertujuan untuk memperoleh data terkini pola kuman penderita ulkus diabetik dan untuk mengetahui efektivitas asam perasetik dan feracrylum pada pola kuman ulkus diabetik. Jenis penelitian ini ialah deskriptif analitik. Derajat ulkus dinilai dengan kriteria PEDIS. Spesimen pus diambil secara steril dengan media transpor, ditanam dalam mesin Baxtec, kemudian dilakukan identifikasi kuman dan uji sensitivitas terhadap asam perasetik dan feracrylum 1%. Hasil penelitian memperlihatkan dari 57 penderita ulkus diabetik terbanyak ialah perempuan (36 penderita) dengan rerata usia 58,77+9,077 tahun. Sebagian besar ulkus diabetik (30 penderita) termasuk derajat 4. Hasil kultur memperlihatkan Proteus mirabilis (Gram negatif) yang tersering (17,5%). Hasil uji sensitivitas pola kuman memperlihatkan 100% sampel dari 12 jenis kuman, 83,3% dari Citrobacter diversus, dan 60% dari Proteus mirabilis sensitif terhadap asam perasetik, sedangkan terhadap feracrylum 1% dan NaCl sebagai kontrol, seluruh kuman telah resisten. Simpulan: Asam perasetik lebih efektif dibandingkan feracrylum 1% sebagai antimikroba topikal pada ulkus diabetik.Kata kunci: ulkus diabetik, mikroba, antimikroba topikal

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