Diabetic Foot: Epidemiological and Clinical Aspects in the Department of Medicine and Endocrinology of the Hospital of Mali, Mali

We are celebrating the 85 anniversary and 61 years of research, pedagogical and medical activities of one of the nation’s leading endocrinologists, the promoter of academic endocrinology, the founder and the first head of the department of endocrinology of the Pirogov Russian National Research Medical University (RNIMU) Honored Doctor of the Russian Federation, Professor Vladimir Vasilyevich Potemkin. V.V. Potemkin was the first in our country who began to teach endocrinology at the department of internal diseases of the pediatric faculty of the 2nd Moscow State Medical Institute (now Pirogov Russian National Research Medical University (RNIM). In 1972, after his transfer to the Department of General Medicine, V.V. Potemkin established a course of endocrinology at the chair of internal medicine. Soon, endocrinology became an independent course and on its basis a separate chair was set up. Heading first the course and then the chair for 40 years, V.V. Potemkin proved himself a talented teacher, scientist, and excellent clinicist. V.V. Potemkin is the author of 7 textbooks on various aspects of endocrinology, including the nation’s first fundamental manual Endocrinology, published, in addition to Russian, also in French, Spanish and twice in English. In his research work, V.V. Potemkin focuses on the problems of pathogenesis, clinical aspects, and treatment of diabetes and obesity. Research results obtained by V.V. Potemkin in studying the development of oxidative stress and impaired insulin-binding blood activity in patients with newly diagnosed T2D with normal body weight and suffering from obesity made it possible to find two different pathogenetic mechanisms underlying their hyperglycemia. V.V. Potemkin studied the role of cytokines in the development of diabetic foot syndrome, which led to the conclusion that the criteria for the effectiveness of treatment of patients with type 2 diabetes complicated by diabetic foot syndrome, along with normoglycemia are also decreased activity of lipid peroxidation, stabilization of antioxidant defence, normalization of the level of TNF-alpha proinflammatory cytokine. In troduction of V.V. Potemkin’s findings into clinical practice helps to improve the results of treatment of patients with diabetic foot syndrome, prevent gangrene, and reduce their direct and indirect financial costs. Professor V.V. Potemkin celebrates his anniversary at the heirght of his creative powers. We wish our dear colleague good health, inexhaustible energy, and new creative successes for many years!

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Prevalence, Clinical Aspects and Outcomes in a Large Cohort of Persons with Diabetic Foot Disease: Comparison between Neuropathic and Ischemic Ulcers

Journal of Clinical Medicine ◽

10.3390/jcm9061780 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1780 ◽

Cited By ~ 4

Author(s):

Marco Meloni ◽

Valentina Izzo ◽

Laura Giurato ◽

José Luis Lázaro-Martínez ◽

Luigi Uccioli

Keyword(s):

Heart Failure ◽

Limb Salvage ◽

Diabetic Foot ◽

Major Amputation ◽

Healing Time ◽

Clinical Aspects ◽

Diabetic Foot Disease ◽

Foot Disease ◽

Stage Renal Disease ◽

End Stage

This study aims to evaluate clinical and ulcer characteristics as well the outcomes of patients with diabetic foot ulcers (DFUs). The study group was composed of DFUs patients managed by a limb salvage protocol according to guidance. Clinical and ulcers findings were described, and 1-year outcomes defined as limb salvage, healing, healing time, major amputation and death were compared between neuropathic and ischemic DFUs. One thousand, one hundred and ninety-eight subjects were included; 386 (32.2%) neuropathic and 812 (67.8%) ischemic DFUs. Neuropathic patients were younger (69.5 ± 11.5 vs. 74.5 ± 11.5, p < 0.0001) and reported less cases of nephropathy (22.8 vs. 39.6%, p < 0.0001), ischemic heart disease (22.8 vs. 36.9, p = 0.0004), cerebrovascular disease (8.3 vs. 17.2%, p = 0.002), heart failure (10.1 vs. 24.7%, p = 0.0002) and end-stage-renal-disease (ESRD) (5.4 vs. 27%, p = 0.0001) than ischemic patients; they also showed less cases of large (>5 cm2) (10.3 vs. 22.9%, p = 0.0007), infected (40.4 vs. 55.7%, p = 0.0005) and deep to the bone (22.3 vs. 39.2, p = 0.0002) ulcers, as well less multiple ulcerations (21.8 vs. 32.8%, p = 0.006) than patients with ischemic DFUs. The outcomes for neuropathic and ischemic DFUs were limb salvage (98.4 vs. 82.3%, p < 0.0001), healing (97.3 vs. 79.6%, p < 0.0001), healing time (34.9 vs. 35.6 weeks, p = 0.8), major amputation (0.5 vs. 6.6%, p = 0.0001), death (1.1 vs. 11%, p < 0.0001) respectively. Revascularization failure and ESRD were independent predictors of major amputation, while heart failure and number of co-morbidities (≥5) were independent predictors of death. Ischemic DFUs patients showed more severe clinical and ulcers features as well worse outcomes than neuropathic DFUs patients.

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Clinical aspects of reactive oxygen and nitrogen species

Biochemical Society Symposium ◽

10.1042/bss0710121 ◽

2004 ◽

Vol 71 ◽

pp. 121-133 ◽

Cited By ~ 25

Author(s):

Ascan Warnholtz ◽

Maria Wendt ◽

Michael August ◽

Thomas Münzel

Keyword(s):

Oxidative Stress ◽

Reactive Oxygen Species ◽

Risk Factor ◽

Endothelial Dysfunction ◽

Vascular Tissue ◽

Rapid Development ◽

Reactive Oxygen ◽

Clinical Aspects ◽

No Production ◽

Oxygen Species

Endothelial dysfunction in the setting of cardiovascular risk factors, such as hypercholesterolaemia, hypertension, diabetes mellitus and chronic smoking, as well as in the setting of heart failure, has been shown to be at least partly dependent on the production of reactive oxygen species in endothelial and/or smooth muscle cells and the adventitia, and the subsequent decrease in vascular bioavailability of NO. Superoxide-producing enzymes involved in increased oxidative stress within vascular tissue include NAD(P)H-oxidase, xanthine oxidase and endothelial nitric oxide synthase in an uncoupled state. Recent studies indicate that endothelial dysfunction of peripheral and coronary resistance and conductance vessels represents a strong and independent risk factor for future cardiovascular events. Ways to reduce endothelial dysfunction include risk-factor modification and treatment with substances that have been shown to reduce oxidative stress and, simultaneously, to stimulate endothelial NO production, such as inhibitors of angiotensin-converting enzyme or the statins. In contrast, in conditions where increased production of reactive oxygen species, such as superoxide, in vascular tissue is established, treatment with NO, e.g. via administration of nitroglycerin, results in a rapid development of endothelial dysfunction, which may worsen the prognosis in patients with established coronary artery disease.

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