1
|
Gouëffic Y, Dubosq-Lebaz M, Heautot JF, Tricotel A, Sauguet A. Paclitaxel-Coated Balloons for Femoropopliteal Artery Disease Treatment in French Patients: A Longitudinal Observational Study. Catheter Cardiovasc Interv 2025. [PMID: 40384368 DOI: 10.1002/ccd.31581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2024] [Revised: 04/09/2025] [Accepted: 05/01/2025] [Indexed: 05/20/2025]
Abstract
BACKGROUND Clinical studies have demonstrated the safety and effectiveness of drug-coated balloon (DCB) angioplasty for femoropopliteal revascularization. Long-term studies in routine practice are limited. AIMS The aim of this study was to assess long-term outcomes after DCB angioplasty for femoropopliteal peripheral artery disease in a real-word-French population. METHODS Patients with lower-limb PAD treated with at least one IN.PACT Admiral DCB in the year 2018 were identified from the French National Health Data System, representing > 99% of the French population. Primary outcomes were all-cause mortality, major amputation (including target and nontarget limbs and vessels), and reintervention (any infrainguinal reintervention or new intervention of the target lesions, nontarget lesions, target limbs, or contralateral limbs) within 1 year from the date of angioplasty. Patients were followed for 3 years from the date of angioplasty. RESULTS A total of 3595 patients (average age 71.2 years) were enrolled, including 35.7% females, 35.3% with chronic limb-threatening ischemia (CLTI), 38.2% with diabetes, and 35.9% with a history of revascularization. All-cause mortality was 7.5% at 1 year and 19.7% at 3 years. The major amputation rate was 2.7% at 1 year and 4.6% at 3 years. The total reintervention rate was 25.9% at 1 year and 43.4% at 3 years. Three-year rates were significantly higher in patients with CLTI (vs. patients with intermittent claudication), diabetes (vs. no diabetes), and prior revascularization (vs. no prior revascularization). CONCLUSIONS This real-world analysis with long-term follow-up showed satisfactory limb salvage and low mortality following angioplasty with DCBs for the treatment of femoropopliteal artery disease.
Collapse
Affiliation(s)
- Yann Gouëffic
- Vascular & Endovascular Department, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Maxime Dubosq-Lebaz
- Vascular & Endovascular Department, Lille University Hospital, Lille, France
| | | | - Aurore Tricotel
- Real World Solutions, IQVIA Operations France, La Défense, France
| | - Antoine Sauguet
- Department of Cardiology, Clinique Pasteur, Toulouse, France
| |
Collapse
|
2
|
Hayes J, Rafferty JM, Cheung WY, Akbari A, Thomas RL, Bain S, Topliss C, Stephens JW. Impact of diabetes on long-term mortality following major lower limb amputation: A population-based cohort study in Wales. Diabetes Res Clin Pract 2025; 223:112156. [PMID: 40216200 DOI: 10.1016/j.diabres.2025.112156] [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: 02/15/2025] [Revised: 03/24/2025] [Accepted: 03/27/2025] [Indexed: 04/14/2025]
Abstract
BACKGROUND Major lower limb amputation is associated with high morbidity and mortality, particularly among patients with diabetes. Previous studies suggest variable mortality rates, but none have investigated the impact of diabetes in Wales. METHODS A population-based cohort study was conducted using anonymised data from the Secure Anonymised Information Linkage Databank. Survival from all incident major amputations in persons ≥ 18 years from 2006 to 2013 in Wales was assessed over 5-year follow-up. Kaplan-Meier survival curves and Cox regression models, stratified by amputation level, were used to examine the time-dependent effect of diabetes on mortality while adjusting for confounding factors. RESULTS 2542 individuals underwent major amputation, 48.4 % had diabetes. Mortality at 30 days was 9.2 % and 61.9 % within 5 years. Patients with diabetes had higher 5-year mortality (67.0 %) compared to those without diabetes (57.1 %). Diabetes was associated with an increased risk of long-term mortality (hazard ratio 1.62, p < 0.001), but a reduced risk of death in the first 30 days post-amputation. A history of peripheral vascular disease and above-knee amputation were strong predictors of mortality. CONCLUSION Time-stratified analysis demonstrates lower short-term but higher long-term mortality risk for persons with diabetes following major amputation. Further research is required to explore interventions aimed at improving survival.
Collapse
Affiliation(s)
- Jennifer Hayes
- Diabetes Research Unit Cymru, United Kingdom; Swansea Bay Health Board, United Kingdom.
| | - James M Rafferty
- Swansea Trials Unit, Swansea University Medical School, United Kingdom
| | | | - Ashley Akbari
- Administrative Data Research Centre Wales, United Kingdom
| | | | - Steve Bain
- Diabetes Research Unit Cymru, United Kingdom; Swansea Bay Health Board, United Kingdom
| | | | - Jeffery W Stephens
- Diabetes Research Unit Cymru, United Kingdom; Swansea Bay Health Board, United Kingdom
| |
Collapse
|
3
|
Karakayalı M, Artac I, Ilis D, Omar T, Arslan A, Guzel E, Karabag Y, Rencuzogullari I. Comparison of the risk scoring systems in long term restenosis due to percutaneous interventions to the superficial femoral artery. VASA 2025; 54:184-191. [PMID: 39882671 DOI: 10.1024/0301-1526/a001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2025]
Abstract
Background: Percutaneous superficial femoral interventions remain the preferred method of treatment for superficial femoral artery (SFA) disease. Nevertheless, long term restenosis continues to be a major limitation of percutaneous interventions. In this context, the objective of this study is to compare the efficacies of CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, ATRIA-HSV, and HATCH risk scoring systems in predicting long-term (5 years) restenosis due to percutaneous interventions to the superficial femoral artery. Patients and methods: The sample of this retrospective study consisted of 545 peripheral artery disease (PAD) patients with a percutaneous intervention to the SFA. Of these patients, 362 and 183 were included in the group of PAD patients without long-term (5 years) SFA restenosis (Group 1) and in the group of PAD patients with long-term SFA restenosis (Group 2). The efficacies of CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, ATRIA-HSV, and HATCH risk scoring systems in predicting the development of long-term SFA restenosis were comparatively analyzed. Results: CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, ATRIA-HSV, and HATCH risk scores all increased with long-term SFA restenosis. The receiver operating characteristic (ROC) curve analysis revealed that all five risk scoring systems successfully predicted long-term SFA restenosis, whereas the paired ROC curve analysis revealed that CHA2DS2-VASc-HS scores of >4 had the best prognostic power in predicting long term SFA restenosis. Conclusions: The study findings indicated that the CHA2DS2-VASc-HS score was an independent predictor of the development of SFA restenosis. The CHA2DS2-VASc-HS risk scoring system, which is the modified version of CHA2DS2-VASc, outperformed the CHA2DS2-VASc, HATCH, ATRIA, and ATRIA-HSV, the modified version of ATRIA, risk scoring systems in predicting long-term (5 years) SFA restenosis.
Collapse
Affiliation(s)
- Muammer Karakayalı
- Department of Cardiology, Kafkas University School of Medicine, Kars, Turkey
| | - Inanç Artac
- Department of Cardiology, Kafkas University School of Medicine, Kars, Turkey
| | - Doğan Ilis
- Department of Cardiology, Kafkas University School of Medicine, Kars, Turkey
| | - Timor Omar
- Department of Cardiology, Kafkas University School of Medicine, Kars, Turkey
| | - Ayca Arslan
- Department of Cardiology, Kafkas University School of Medicine, Kars, Turkey
| | - Ezgi Guzel
- Department of Cardiology, Kafkas University School of Medicine, Kars, Turkey
| | - Yavuz Karabag
- Department of Cardiology, Kafkas University School of Medicine, Kars, Turkey
| | | |
Collapse
|
4
|
Yong E, Zhu X, Weng J, Ng MJM, Khoo YM, Lo ZJ. Role of therapeutic treatment with antiseptic solutions in the care of diabetic foot ulcers. J Wound Care 2025; 34:S4-S13. [PMID: 40173121 DOI: 10.12968/jowc.2025.34.sup4c.s4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2025]
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) are a prevalent and severe complication of diabetes, leading to significant morbidity, impaired health-related quality of life (HRQoL) and economic burden on healthcare systems. The complexity of DFUs often results in prolonged healing and high recurrence rates. Effective management strategies are crucial for improving outcomes and reducing complications. AIM This study aimed to review the efficacy of antiseptic solutions in the treatment and care of DFUs. METHOD A literature analysis was conducted to review clinical studies and guidelines on the use and efficacy of antiseptic solutions, particularly Octenisept® (0.1% octenidine dihydrochloride and 2% 2-phenoxyethanol). The review focused on the antimicrobial properties, biofilm-disruption capabilities and wound healing outcomes associated with the use of antiseptic solutions in DFU management. RESULTS Antiseptic solutions have potential to reduce bioburden, disrupt biofilm and modulate healing. There is a need to balance antimicrobial clinical efficacy with tolerability and cytotoxicity. The use and choice of adjunctive antiseptic solutions must be tailored to the patient, as antimicrobial efficacy can vary for antiseptic solutions, particularly for hypochlorous solutions. It is important to use products according to their instructions, with consideration of minimum contact time to maximise clinical efficacy. Low-pressure irrigation is adjunctive, and concurrent wound-bed preparation, including debridement, frequent inspection, infection and moisture control, remain important. CONCLUSIONS The therapeutic application of antiseptic solutions in DFU care presents a promising approach to enhancing wound healing and reducing infection risks. Integrating these solutions into standard wound care protocols could lower the incidence of complications, improve HRQoL and decrease the economic burden associated with diabetic foot disease. Further large-scale studies are recommended to validate these findings and refine guidelines for antiseptic use in DFU management.
Collapse
Affiliation(s)
- Enming Yong
- Consultant, Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Xiaoli Zhu
- Senior Nurse Clinician, Nursing Services, National Healthcare Group Polyclinics, Singapore
| | - Jiayi Weng
- Medical Officer, Department of Orthopaedics, Woodlands Health, Singapore
| | - Marcus Jia Ming Ng
- Resident, Plastic, Reconstructive and Aesthetic Surgery Service, Tan Tock Seng Hospital, Singapore
| | | | - Zhiwen Joseph Lo
- Head and Senior Consultant, Vascular Surgery Service, Department of Surgery, Woodlands Health, Singapore
| |
Collapse
|
5
|
Patel RA, Ghosh K, Shakir A, Koesters E, Rastogi P, Cripps C. Vascular Steal Phenomenon in Lower Extremity Reconstruction: A Review of Literature and Case Report. Ann Plast Surg 2025; 94:487-491. [PMID: 40117513 DOI: 10.1097/sap.0000000000004230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2025]
Abstract
INTRODUCTION Free tissue transfer is a well-described tool for complex lower extremity reconstruction in areas of local tissue paucity. Successful coverage of orthopedic hardware or exposed vital structures create opportunities for limb salvage. METHODS A retrospective chart review was performed of a patient sustaining a gunshot wound to the lower extremity with bony and soft tissue loss who underwent orthopedic fixation and free tissue transfer at the authors' institution with resultant distal extremity necrosis consistent with vascular steal phenomenon. A systematic literature review using preferred reporting items for systematic reviews and meta-analyses guidelines was performed using the keywords "free tissue transfer," OR "free flap," AND "vascular steal" on PubMed, Ovid/Medline, and Scopus. RESULTS After orthopedic fixation, a free anterolateral thigh flap anastomosed end-to-end with an already transected posterior tibial artery for soft tissue coverage. Despite a technically uncomplicated and successful reconstruction, the patient's postoperative course was complicated by steal syndrome, which ultimately led to distal forefoot necrosis and need for transmetatarsal amputation and secondary intention wound healing. Literature review of cases with similar vascular steal phenomenon after free tissue transfer yielded 6 studies totaling 10 patients. All patients with vascular steal phenomenon were previously diagnosed with diabetes and peripheral vascular disease. Despite a majority of single-vessel extremities receiving free tissue transfer with end-to-side techniques, outcomes after vascular steal universally resulted in amputation. CONCLUSIONS Although vascular steal after free flap reconstruction is a documented phenomenon, this is the first recorded description of vascular steal syndrome from a ballistic-type mechanism in the trauma setting. Overall, this case and review of literature serves as a reminder of the tenuous nature of distal perfusion to the diseased extremity and prompts careful consideration during reconstruction to prevent high morbidity distal ischemia.
Collapse
Affiliation(s)
- Ronak A Patel
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Hospitals, Chicago, IL
| | | | | | | | | | | |
Collapse
|
6
|
Yadav U, Kumar N, Sarvottam K. Obese have comparable ankle brachial pressure index but higher β-cell function and insulin resistance as compared to normal-weight type 2 diabetes mellitus patients. Acta Diabetol 2025; 62:543-550. [PMID: 39368013 DOI: 10.1007/s00592-024-02379-x] [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: 02/09/2024] [Accepted: 09/22/2024] [Indexed: 10/07/2024]
Abstract
OBJECTIVES To compare ankle brachial pressure index (ABPI) in normal weight and obese/overweight type 2 diabetes mellitus patients (T2DM) to see the impact of obesity on the occurrence of peripheral artery disease (PAD) in T2DM patients. Secondly to investigate the relationship between ABPI, insulin resistance, and beta cell function and between adipocytokines and obesity parameters. METHODS A total of 120 BMI-categorized Normal weight (NW) T2DM (n = 53) patients and obese/overweight T2DM (n = 67) patients were recruited in this study. ABPI measurements were performed for the assessment of PAD. The anthropometry and body composition of the patients were measured. Plasma fasting insulin, adiponectin, and IL-6 levels were measured by ELISA kits. RESULTS ABPI scores were found to be comparable between both groups of patients (p = 0.787). A significant positive correlation was observed between ABPI and beta cell function. Insulin resistance was found to correlate positively while adiponectin negatively with obesity parameters. CONCLUSION The ABPI score was comparable between both groups of patients, suggesting that vascular complications may occur at the same rate in NW as well as in obese/overweight diabetic patients. The positive association of insulin resistance as well as the negative association of adiponectin with obesity parameters, are suggestive of the importance of body fat distribution in predicting insulin resistance and the inflammatory status of the cells.
Collapse
Affiliation(s)
- Umashree Yadav
- Department of Physiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Nilesh Kumar
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Kumar Sarvottam
- Department of Physiology, All India Institute of Medical Sciences, Gorakhpur, Uttar Pradesh, India.
| |
Collapse
|
7
|
Mascio A, Comisi C, Cinelli V, Pitocco D, Greco T, Maccauro G, Perisano C. Radiological Assessment of Charcot Neuro-Osteoarthropathy in Diabetic Foot: A Narrative Review. Diagnostics (Basel) 2025; 15:767. [PMID: 40150109 PMCID: PMC11940856 DOI: 10.3390/diagnostics15060767] [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: 02/03/2025] [Revised: 03/05/2025] [Accepted: 03/16/2025] [Indexed: 03/29/2025] Open
Abstract
Charcot Neuro-Osteoarthropathy (CNO) is a debilitating complication predominantly affecting individuals with diabetes and peripheral neuropathy. Radiological assessment plays a central role in the diagnosis, staging, and management of CNO. While plain radiographs remain the cornerstone of initial imaging, advanced modalities such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) have significantly enhanced diagnostic accuracy. Nuclear imaging, including bone scintigraphy, radiolabeled leukocyte scans, and FDG-PET/CT, offers additional diagnostic precision in complex cases, especially when differentiating CNO from infections or evaluating patients with metal implants. This review underscores the importance of a multimodal imaging approach suited to the clinical stage and specific diagnostic challenges of CNO. It highlights the critical need for standardized imaging protocols and integrated diagnostic algorithms that combine radiological, clinical, and laboratory findings. Advances in imaging biomarkers and novel techniques such as diffusion-weighted MRI hold promise for improving early detection and monitoring treatment efficacy. In conclusion, the effective management of CNO in diabetic foot patients requires a multidisciplinary approach that integrates advanced imaging technologies with clinical expertise. Timely and accurate diagnosis not only prevents debilitating complications but also facilitates the development of personalized therapeutic strategies, ultimately improving patient outcomes.
Collapse
Affiliation(s)
- Antonio Mascio
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00136 Rome, Italy; (A.M.); (V.C.); (T.G.); (G.M.); (C.P.)
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy
| | - Chiara Comisi
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00136 Rome, Italy; (A.M.); (V.C.); (T.G.); (G.M.); (C.P.)
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy
| | - Virginia Cinelli
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00136 Rome, Italy; (A.M.); (V.C.); (T.G.); (G.M.); (C.P.)
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Endocrinology, University Hospital “A. Gemelli”, Catholic University of the Sacred Heart, 00136 Rome, Italy;
| | - Tommaso Greco
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00136 Rome, Italy; (A.M.); (V.C.); (T.G.); (G.M.); (C.P.)
- Department of Life Sciences, Health, and Healthcare Professions, Link Campus University, 00165 Rome, Italy
| | - Giulio Maccauro
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00136 Rome, Italy; (A.M.); (V.C.); (T.G.); (G.M.); (C.P.)
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy
| | - Carlo Perisano
- Department of Orthopedics and Geriatric Sciences, Catholic University of the Sacred Heart, 00136 Rome, Italy; (A.M.); (V.C.); (T.G.); (G.M.); (C.P.)
- Department of Orthopedics and Rheumatological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00136 Rome, Italy
| |
Collapse
|
8
|
Geng XQ, Chen SF, Wang FY, Yang HJ, Zhao YL, Xu ZR, Yang Y. Correlation between key indicators of continuous glucose monitoring and the risk of diabetic foot. World J Diabetes 2025; 16:99277. [PMID: 40093283 PMCID: PMC11885981 DOI: 10.4239/wjd.v16.i3.99277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 11/09/2024] [Accepted: 12/23/2024] [Indexed: 01/21/2025] Open
Abstract
BACKGROUND Continuous glucose monitoring (CGM) metrics, such as time in range (TIR) and glycemic risk index (GRI), have been linked to various diabetes-related complications, including diabetic foot (DF). AIM To investigate the association between CGM-derived indicators and the risk of DF in individuals with type 2 diabetes mellitus (T2DM). METHODS A total of 591 individuals with T2DM (297 with DF and 294 without DF) were enrolled. Relevant clinical data, complications, comorbidities, hematological parameters, and 72-hour CGM data were collected. Logistic regression analysis was employed to examine the relationship between these measurements and the risk of DF. RESULTS Individuals with DF exhibited higher mean blood glucose (MBG) levels and increased proportions of time above range (TAR), TAR level 1, and TAR level 2, but lower TIR (all P < 0.001). Patients with DF had significantly lower rates of achieving target ranges for TIR, TAR, and TAR level 2 than those without DF (all P < 0.05). Logistic regression analysis revealed that GRI, MBG, and TAR level 1 were positively associated with DF risk, while TIR was inversely correlated (all P < 0.05). Achieving TIR and TAR was inversely correlated with white blood cell count and glycated hemoglobin A1c levels (P < 0.05). Additionally, achieving TAR was influenced by fasting plasma glucose, body mass index, diabetes duration, and antidiabetic medication use. CONCLUSION CGM metrics, particularly TIR and GRI, are significantly associated with the risk of DF in T2DM, emphasizing the importance of improved glucose control.
Collapse
Affiliation(s)
- Xin-Qian Geng
- Department of Endocrinology, Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Shun-Fang Chen
- Department of Endocrinology, Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Fei-Ying Wang
- Department of Endocrinology, Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Hui-Jun Yang
- Department of Endocrinology, Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Yun-Li Zhao
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education and Yunnan Province, Yunnan University, Kunming 650500, Yunnan Province, China
| | - Zhang-Rong Xu
- The Diabetic Center of PLA, The Ninth Medical Center of PLA General Hospital (306th Hosp PLA), Beijing 100101, China
| | - Ying Yang
- Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| |
Collapse
|
9
|
Parveen K, Hussain MA, Anwar S, Elagib HM, Kausar MA. Comprehensive review on diabetic foot ulcers and neuropathy: Treatment, prevention and management. World J Diabetes 2025; 16:100329. [PMID: 40093290 PMCID: PMC11885961 DOI: 10.4239/wjd.v16.i3.100329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 11/27/2024] [Accepted: 12/27/2024] [Indexed: 01/21/2025] Open
Abstract
Diabetic foot (DF) is a major public health concern. As evident from numerous previous studies, supervision of DF ulcer (DFU) is crucial, and a specific quality check-up is needed. Patients should be educated about glycaemic management, DFUs, foot lesions, proper care for injuries, diet, and surgery. Certain reasonably priced treatments, such as hyperbaric oxygen and vacuum-assisted closure therapy, are also available for DFUs, along with modern wound care products and techniques. Nonetheless, DF care (cleaning, applying antimicrobial cream when wounded, and foot reflexology), blood glucose monitoring to control diabetes, and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs. Between 50% and 80% of DF infections are preventable. Regardless of the intensity of the lesion, it needs to be treated carefully and checked daily during infection. Tissue regeneration can be aided by cleaning, dressing, and application of topical medicines. The choice of shoes is also important because it affects blood circulation and nerve impulses. In general, regular check-ups, monitoring of the patient's condition, measuring blood glucose levels, and providing frequent guidance regarding DFU care are crucial. Finally, this important clinical problem requires involvement of multiple professionals to properly manage it.
Collapse
Affiliation(s)
- Kehkashan Parveen
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India
| | - Malik Asif Hussain
- Department of Pathology, College of Medicine, University of Ha’il, Ha'il 53962, Saudi Arabia
| | - Sadaf Anwar
- Department of Biochemistry, College of Medicine, University of Ha’il, Ha'il 53962, Saudi Arabia
| | | | - Mohd Adnan Kausar
- Department of Biochemistry, College of Medicine, University of Ha’il, Ha'il 53962, Saudi Arabia
| |
Collapse
|
10
|
Ning Y, Hu J, Zhu Y, Tang W, Yan S, Li H, Zhang Z, Lu C, Ren K, Shi P, Yao T, Wang Q, Zhao Y, Gao T, Zhang R, Dong H. NIR-II imaging-based detection of early changes in lower limb perfusion in type 2 diabetes patients without peripheral artery disease. Diabetes Res Clin Pract 2025; 221:112038. [PMID: 39929338 DOI: 10.1016/j.diabres.2025.112038] [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: 11/07/2024] [Revised: 01/20/2025] [Accepted: 02/03/2025] [Indexed: 02/14/2025]
Abstract
AIMS The formation of lower limb arterial plaques, exacerbated by type 2 diabetes (T2D), represents an early stage of lower limb peripheral artery disease (PAD). Second near-infrared region (NIR-II) imaging is an emerging technique with high sensitivity for detecting perfusion levels. This study explores the value of NIR-II imaging in identifying perfusion changes due to lower extremity arterial plaques in T2D patients without PAD. METHODS NIR-II imaging with indocyanine green (ICG) was conducted on 120 T2D patients, who were categorized into two groups: plaque and non-plaque. NIR-II parameters and clinical characteristics were analyzed between the two groups to identify significant predictors of lower extremity arterial plaques. RESULTS Six NIR-II imaging parameters (T start, T 1/2, Tmax, Ingress rate, Egress, and Egress rate) showed significant differences and diagnostic efficacy between the two groups. Three NIR-II parameters (T start, Egress, and Egress rate) and two clinical characteristics (age and sex) were identified as independent predictors of lower limb artery plaques. The nomogram showed that a combined model with NIR-II parameters and clinical characteristics exhibited higher diagnostic efficacy. CONCLUSION NIR-II imaging can effectively detect early perfusion changes in T2D patients, showing great potential for pre-diagnosis of individuals at high risk for PAD.
Collapse
Affiliation(s)
- Yijie Ning
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China; Vascular Institute of Shanxi Medical University, Taiyuan, China
| | - Jie Hu
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China; Vascular Institute of Shanxi Medical University, Taiyuan, China
| | - Yikun Zhu
- Department of Endocrinology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Wei Tang
- Department of Endocrinology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Sheng Yan
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China; Vascular Institute of Shanxi Medical University, Taiyuan, China
| | - Haifeng Li
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China; Vascular Institute of Shanxi Medical University, Taiyuan, China
| | - Zeyu Zhang
- Key Laboratory of Big Data-Based Precision Medicine of Ministry of Industry and Information Technology, School of Engineering Medicine, Beihang University, Beijing, China
| | - Chuanlong Lu
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China; Vascular Institute of Shanxi Medical University, Taiyuan, China
| | - Keyao Ren
- Department of Endocrinology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Peilu Shi
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China; Vascular Institute of Shanxi Medical University, Taiyuan, China
| | - Tian Yao
- First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Qian Wang
- Department of Neurology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yan Zhao
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China; Vascular Institute of Shanxi Medical University, Taiyuan, China
| | - Tingting Gao
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China; Vascular Institute of Shanxi Medical University, Taiyuan, China
| | - Ruijing Zhang
- Vascular Institute of Shanxi Medical University, Taiyuan, China.; Department of Nephrology, The Second Hospital of Shanxi Medical University, Taiyuan, China.
| | - Honglin Dong
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China; Vascular Institute of Shanxi Medical University, Taiyuan, China..
| |
Collapse
|
11
|
Alenazi F, Khan MS. Novel antimicrobial strategies for diabetic foot infections: addressing challenges and resistance. Acta Diabetol 2025; 62:303-321. [PMID: 39760785 DOI: 10.1007/s00592-024-02438-3] [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: 09/07/2024] [Accepted: 12/22/2024] [Indexed: 01/07/2025]
Abstract
AIMS This review examines the challenges posed by Diabetic Foot Infections (DFIs), focusing on the impact of neuropathy, peripheral arterial disease, immunopathy, and the polymicrobial nature of these infections. The aim is to explore the factors contributing to antimicrobial resistance and assess the potential of novel antimicrobial treatments and drug delivery systems in improving patient outcomes. METHOD A comprehensive analysis of existing literature on DFIs was conducted, highlighting the multifactorial pathogenesis and polymicrobial composition of these infections. The review delves into the rise of antimicrobial resistance due to the overuse of antimicrobials, biofilm formation, and microbial genetic adaptability. Additionally, it considers glycemic control, patient adherence, and recurrence rates as contributing factors to treatment failure. Emerging therapies, including new antimicrobial classes and innovative drug delivery systems, were evaluated for their potential efficacy. RESULTS DFIs present unique treatment challenges, with high rates of antimicrobial resistance and poor response to standard therapies. Biofilm formation and the genetic adaptability of pathogens worsen resistance, complicating treatment. Current antimicrobial therapies are further hindered by poor glycemic control and patient adherence, leading to recurrent infections. Novel antimicrobial classes and innovative delivery systems show promise in addressing these challenges by offering more targeted, effective treatments. These new approaches aim to reduce resistance and improve treatment outcomes. CONCLUSION DFIs remain a clinical challenge due to their multifactorial nature and antimicrobial resistance. The development of novel antimicrobials and drug delivery systems is crucial to improving patient outcomes and combating resistance. Future research should focus on enhancing treatment efficacy, reducing resistance, and addressing patient adherence to reduce the burden of DFIs.
Collapse
Affiliation(s)
- Fahaad Alenazi
- Department of Pharmacology, College of Medicine, University of Ha'il, Ha'il City, Saudi Arabia
| | - Mohd Shahid Khan
- Department of Microbiology, Hind Institute of Medical Sciences, Mau, Ataria, Sitapur, Uttar Pradesh, India.
| |
Collapse
|
12
|
Yu H, Zhang J, Qian F, Yao P, Xu K, Wu P, Li R, Qiu Z, Li R, Zhu K, Li L, Geng T, Yu X, Li D, Liao Y, Pan A, Liu G. Large-Scale Plasma Proteomics Improves Prediction of Peripheral Artery Disease in Individuals With Type 2 Diabetes: A Prospective Cohort Study. Diabetes Care 2025; 48:381-389. [PMID: 39749935 DOI: 10.2337/dc24-1696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Accepted: 11/15/2024] [Indexed: 01/04/2025]
Abstract
OBJECTIVE Peripheral artery disease (PAD) is a significant complication of type 2 diabetes (T2D), yet the association between plasma proteomics and PAD in people with T2D remains unclear. We aimed to explore the relationship between plasma proteomics and PAD in individuals with T2D, and assess whether proteomics could refine PAD risk prediction. RESEARCH DESIGN AND METHODS This cohort study included 1,859 individuals with T2D from the UK Biobank. Multivariable-adjusted Cox regression models were used to explore associations between 2,920 plasma proteins and incident PAD. Proteins were further selected as predictors using least absolute shrinkage and selection operator (LASSO) penalty. Predictive performance was assessed using Harrell's C-index, time-dependent area under the receiver operating characteristic curve, continuous/categorical net reclassification improvement, and integrated discrimination improvement. RESULTS Over a median follow-up of 13.2 years, 157 incident PAD cases occurred. We observed 463 proteins associated with PAD risk, primarily involved in pathways related to signal transduction, inflammatory response, plasma membrane, protein binding, and cytokine-cytokine receptor interactions. Ranking by P values, the top five proteins associated with increased PAD risk included EDA2R, ADM, NPPB, CD302, and NPC2, while BCAN, UMOD, PLB1, CA6, and KLK3 were the top five proteins inversely associated with PAD risk. Incorporating 45 LASSO-selected proteins or a weighted protein risk score significantly enhanced PAD prediction beyond clinical variables alone, reaching a maximum C-index of 0.835. CONCLUSIONS This study identified plasma proteins associated with PAD risk in individuals with T2D. Adding proteomic data into the clinical model significantly improved PAD prediction.
Collapse
Affiliation(s)
- Hancheng Yu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jijuan Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Frank Qian
- Section of Cardiovascular Medicine, Boston Medical Center and Boston University Chobanian & Avedisian School of Medicine, Boston, MA
| | - Pang Yao
- Nuffield Department of Population Health, University of Oxford, Oxford, U.K
| | - Kun Xu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zixin Qiu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ruyi Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Zhu
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Li
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tingting Geng
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuefeng Yu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Danpei Li
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunfei Liao
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - An Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gang Liu
- Division of Endocrinology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Laboratory of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
13
|
Jude EB, Siafarikas C, Rastogi A, Bem R, Tankova T, Kong MF, LaFontaine J, Pappachan J, Tentolouris N. Demographic and Clinical Characteristics of Patients With Charcot Neuro-Osteoarthropathy in People With Diabetes Mellitus in Six Countries: A Multicenter Observational Study From 1996 to 2022. J Diabetes Res 2025; 2025:4275741. [PMID: 39817102 PMCID: PMC11735061 DOI: 10.1155/jdr/4275741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 11/04/2024] [Accepted: 12/12/2024] [Indexed: 01/18/2025] Open
Abstract
Aim: To describe the demographic and clinical characteristics of patients with Charcot neuro-osteoarthropathy (CNO) and to examine for differences between participants with Type 1 diabetes mellitus (DM) (T1DM) and Type 2 diabetes mellitus (T2DM). Materials and Methods: Multicenter observational study in eight diabetic foot clinics in six countries between January 1, 1996, and December 31, 2022. Demographic, clinical, and laboratory parameters were obtained from the medical records. Analyses were performed using parametric or nonparametric statistical tests for variables with normally or nonnormally distributed values, respectively. Comparisons of the qualitative data were performed using the chi-square test. Results: Seven hundred seventy-four patients with DM and CNO were included. The mean age at diagnosis of CNO was 54.5 ± 11.7 years, and the median (interquartile range (IQR)) diabetes duration at diagnosis of CNO was 15 (10-22) years. Among participants, 71.8% (n = 546) were male and 83.2% (n = 634) had T2DM. Neuropathy was present in 91.7% (n = 688), retinopathy in 60.2% (n = 452), and nephropathy in 45.2% (n = 337). Subjects with T1DM, compared to T2DM, were diagnosed with CNO at a younger age (46.9 ± 11.0 vs. 57.9 ± 10.2 years, p < 0.001), had longer diabetes duration (median value (IQR): 29.0 (21.0-38.0) vs. 14.0 (8.0-20.0) years, p < 0.001), and had more often microvascular complications (neuropathy, 95.2% in T1DM vs. 87.4% in T2DM, p = 0.006; retinopathy, 83.3% vs. 55.4%, p < 0.001; and nephropathy 67.5% vs. 40.5%, p < 0.001). Conclusions: CNO is predominant in males, occurs in long-standing DM, and is often accompanied by microvascular complications. People with T1DM, compared to those with T2DM, are affected at a younger age, have longer diabetes duration, and have more often microvascular complications.
Collapse
Affiliation(s)
- E. B. Jude
- Department of Diabetes and Endocrinology, Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton Under Lyne and University of Manchester and Manchester Metropolitan University, Manchester, UK
| | - C. Siafarikas
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| | - A. Rastogi
- Diabetes and Endocrinology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - R. Bem
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - T. Tankova
- Department of Endocrinology, Medical University of Sofia, Sofia, Bulgaria
| | - M.-F. Kong
- Diabetes and Endocrinology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J. LaFontaine
- UTRGV School of Podiatric Medicine, Department of Podiatric Medicine, Surgery and Biomechanics, Harlingen, Texas, USA
| | - J. Pappachan
- Diabetes and Endocrinology, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley, UK
| | - N. Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece
| |
Collapse
|
14
|
Li KR, Rohrich RN, Lava CX, Gupta NJ, Hidalgo CM, Episalla NC, Akbari CM, Evans KK. A Combined "Vasculoplastic" Approach to the Vasculopathic Patient Undergoing Limb Salvage: Understanding the Role of Endovascular Revascularization for Lower Extremity Free Tissue Transfer. J Reconstr Microsurg 2024. [PMID: 39730119 DOI: 10.1055/a-2491-3381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2024]
Abstract
BACKGROUND Multidisciplinary care with vascular surgery and plastic surgery is essential for lower extremity free flap (LEFF) success in the chronic wound population with diabetes and peripheral vascular disease. There is a lack of understanding on performing targeted direct endovascular reperfusion on a vessel that will be used as the flap recipient. Our study compares outcomes of patients who received targeted revascularization (TR) to the recipient vessel for LEFF anastomosis versus nontargeted revascularization (NR) of arterial recipients prior to LEFF. METHODS LEFF patients who underwent preoperative endovascular revascularization (ER) from July 2011 to January 2023 were reviewed. Location of ER, demographics, perioperative details, and outcomes were collected. TR was performed on the same vessel as the flap recipient and NR was located on a different vessel than the flap recipient. RESULTS A total of 55 LEFF patients were identified. Overall, 50.91% (n = 28) received TR and 49.1% (n = 27) received NR. Average age was 60.3 ± 10.9 years and average Charlson Comorbidity Index was 5.3 ± 1.9. On preoperative angiogram, the TR group had significantly lower rates of ER above the knee (3.6 vs. 33.3%, p < 0.001). Immediate flap success rate was 98.2%, with no differences between groups (p = 1.000). No significant differences were found in rates of any postoperative flap complications (p = 0.898), takeback (p = 0.352), partial flap necrosis (p = 0.648), or dehiscence (p = 0.729). Both TR and NR groups had similar rates of a postoperative angiogram (42.9 vs. 48.2%, p = 0.694) and reintervention (35.7 vs. 40.7% p = 0.701). Amputation rates were similar between TR and NR (17.9 vs. 14.8%, p = 1.000). CONCLUSION Close follow-up with vascular and plastic surgery is required for patients who undergo ER prior to LEFF, as nearly half of our cohort required additional endovascular procedures. Overall, we observed no significant differences in complication rates for the TR and NR groups, informing revascularization strategies for free tissue transfer in a highly comorbid chronic wound population.
Collapse
Affiliation(s)
- Karen R Li
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
- Georgetown University School of Medicine; Washington, District of Columbia
| | - Rachel N Rohrich
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Christian X Lava
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
- Georgetown University School of Medicine; Washington, District of Columbia
| | - Nisha J Gupta
- Georgetown University School of Medicine; Washington, District of Columbia
| | - Cecelia M Hidalgo
- Georgetown University School of Medicine; Washington, District of Columbia
| | - Nicole C Episalla
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Cameron M Akbari
- Department of Vascular Surgery, MedStar Georgetown University Hospital; Washington, District of Columbia
| | - Karen K Evans
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| |
Collapse
|
15
|
Fadil HA, Alrehaili ZS, Alharbi KM, Almuzaini AF, Alharbi RH, Alharbi HS, Elbadawy HM, Alahmadi YM. A Cross-Sectional Retrospective Study Assessing Potentially Inappropriate Medications for Elderly Diabetic Patients in a Tertiary Care Hospital in Saudi Arabia. Risk Manag Healthc Policy 2024; 17:3227-3238. [PMID: 39717360 PMCID: PMC11665171 DOI: 10.2147/rmhp.s484334] [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: 09/08/2024] [Accepted: 12/08/2024] [Indexed: 12/25/2024] Open
Abstract
Background The aging global population presents challenges in medication management, particularly among diabetic elderly patients vulnerable to potentially inappropriate medications (PIM). PIM can lead to adverse outcomes like hypoglycemia, falls, cognitive decline, and hospitalizations, affecting quality of life and survival. This study aimed to assess PIM prevalence among diabetic elderly patients in a tertiary care hospital in Saudi Arabia, using the American Geriatrics Society 2023 Updated Beers Criteria. Methods A cross-sectional retrospective study was conducted among 480 diabetic adults aged 60 years or older at a tertiary care hospital over 3 months. Data, including demographics, comorbidities, and medication use, were extracted from Electronic Health Records. 2023 AGS Updated Beers Criteria® was followed. Results The median age was 66 years with a male predominance (62.7%). Peripheral vascular disease (42.7%) and prior myocardial infarction (22.7%) were prevalent comorbidities. Inappropriate insulin use was observed in 17.7% of insulin users, mainly short-acting insulin without basal/long-acting insulin. Approximately 39.2% of patients were prescribed antidiabetic drugs deemed inappropriate by Beers Criteria, with Gliclazide being the most common (35.6%). Despite potential drug-disease interactions, such as urogenital infections, half of the patients received cautioned drugs, while only 4.2% experienced such infections. Conclusion The study highlights the prevalence of PIMs among diabetic elderly patients in Madinah, Saudi Arabia. Adherence to Beers Criteria guidelines is crucial to optimize therapy for this population. Age and congestive heart failure were significant predictors of PIM use.
Collapse
Affiliation(s)
- Haifa A Fadil
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Kingdom of Saudi Arabia
| | - Ziyad S Alrehaili
- Medical and Pharmaceutical Services, Pharmacy Department, General Directorate of Medical Services Ministry of Interior, Riyadh, Kingdom of Saudi Arabia
| | - Khaled M Alharbi
- Ambulatory Care Pharmacy Department, Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Abdulaziz F Almuzaini
- Pharmaceutical Care Department, King Salman Bin Abdulaziz Medical City, Madinah, Kingdom of Saudi Arabia
| | - Raed Hamed Alharbi
- Pharmaceutical Care Department, King Salman Bin Abdulaziz Medical City, Madinah, Kingdom of Saudi Arabia
| | - Hindi S Alharbi
- Pharmaceutical Care Department, King Salman Bin Abdulaziz Medical City, Madinah, Kingdom of Saudi Arabia
| | - Hossein M Elbadawy
- Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Madinah, Kingdom of Saudi Arabia
- Health and Life Research Center, Taibah University, Madinah, Saudi Arabia
| | - Yaser M Alahmadi
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, Madinah, Kingdom of Saudi Arabia
| |
Collapse
|
16
|
Dauriz M, Csermely A, Santi L, Tregnaghi E, Grotto A, Lucianer T, Altomari A, Rinaldi E, Tardivo S, Bonetti B, Bonora E. Diabetes mellitus in stroke unit: prevalence and outcomes-the Verona acute coronary syndrome and stroke in diabetes outcome (VASD-OUTCOME) study. Acta Diabetol 2024; 61:1543-1552. [PMID: 38951223 DOI: 10.1007/s00592-024-02318-w] [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: 02/15/2024] [Accepted: 06/02/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Cerebrovascular accidents (CVA) represent a major complication in diabetes (DM). Real-life evidence as to whether modern management of CVA and DM have softened this relationship is limited. Therefore, we estimated prevalence and impact of DM on in-hospital survival and complications in a contemporary cohort of subjects with CVA. METHODS We retrospectively evaluated the records of 937 patients admitted for CVA at the Stroke Unit of Verona University Hospital during a 3-year period. Pre-existing or de novo DM was ascertained by prior diagnosis, glucose-lowering therapy at admission/discharge or admittance plasma glucose ≥ 200 mg/dL. Multiple regressions were applied to test DM as predictor of in-hospital mortality, complications (composite of infections, cardio- and cerebrovascular complications, major bleeding and pulmonary complications), duration and costs of hospitalization. RESULTS Diabetes prevalence was 21%, of which 22% de novo diagnoses. Compared to non-DM, diabetic individuals were older and carried an increased burden of cardiovascular risk factors. Compared to known DM, de novo DM individuals were younger, had higher admittance plasma glucose and poorer cardiovascular comorbidities. Overall, DM versus non-DM individuals did not show significantly increased risk of death (14.0 vs. 9.3%; crude-OR 1.59 95% CI 0.99-2.56). Controlling for confounders did not improve significance. DM resulted independent predictor for in-hospital complications (36.2% vs. 26.9%; adj-OR 1.49, 1.04-2.13), but not for duration and costs of hospitalization. CONCLUSION DM frequently occurs in patients admitted for stroke and carries an excess burden of adverse in-hospital complications, urgently calling for strategies to anticipate DM diagnosis and tailored treatment in high-risk individuals.
Collapse
Affiliation(s)
- Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy.
| | - Alessandro Csermely
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Lorenza Santi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Elena Tregnaghi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Alberto Grotto
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Tiziano Lucianer
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Anna Altomari
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Elisabetta Rinaldi
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Stefano Tardivo
- Department of Diagnostic and Public Health, University and Hospital Trust of Verona, Verona, Italy
| | - Bruno Bonetti
- Division of Neurology, Department of Neurological Sciences, Hospital Trust of Verona, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Medicine, University and Hospital Trust of Verona, Ospedale Maggiore, Piazzale Stefani, 1, 37126, Verona, Italy.
| |
Collapse
|
17
|
Sobhy M, Eletriby A, Ragy H, Kandil H, Saleh MA, Farag N, Guindy R, Bendary A, Nayel AME, Shawky A, Khairy A, Mortada A, Zarif B, Badran H, Khorshid H, Mahmoud K, Said K, Leon K, Abdelsabour M, Tawfik M, Abdelmegid MAKF, Koriem M, Loutfi M, Wadie M, Elnoamany M, Sadaka M, Seleem M, Zahran M, Amin OA, Elkaffas S, Ayad S, Kilany WE, Ammar W, Elawady W, Elhammady W, Abdelhady Y. ACE Inhibitors and Angiotensin Receptor Blockers for the Primary and Secondary Prevention of Cardiovascular Outcomes: Recommendations from the 2024 Egyptian Cardiology Expert Consensus in Collaboration with the CVREP Foundation. Cardiol Ther 2024; 13:707-736. [PMID: 39455534 DOI: 10.1007/s40119-024-00381-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/23/2024] [Indexed: 10/28/2024] Open
Abstract
INTRODUCTION The renin-angiotensin-aldosterone system (RAAS) plays a pivotal role in regulating blood pressure (BP), with dysregulation of RAAS resulting in hypertension and potentially heart failure (HF), myocardial infarction (MI), cardio-renal syndrome, and stroke. RAAS inhibitors, such as angiotensin-converting enzyme inhibitors (ACEis) and angiotensin receptor blockers (ARBs), have advantages beyond BP control. However, differences between these two drug classes need to be considered when choosing a therapy for preventing cardiovascular events. METHODS A panel of 36 Egyptian cardiologists developed consensus statements on RAAS inhibitors for primary and secondary prevention of cardiovascular outcomes and stroke, using a modified three-step Delphi process. RESULTS The consensus statements highlight the importance of effective BP control and the role of RAAS blockade for prevention and management of various cardiovascular diseases. ACEis and ARBs differ in their mode of action and, thus, clinical effects. On the basis of available evidence, the consensus group recommended the following: ACEis should be considered as first choice (in preference to ARBs) to reduce the risk of MI, for primary prevention of HF, and for secondary prevention of stroke. ACEis and ARBs show equivalent efficacy for the primary prevention of stroke. Evidence also favors the preferential use of ACEis in patients with type 2 diabetes, for BP control, for the primary prevention of diabetic kidney disease, and to reduce the risk of major cardiovascular and renal outcomes. Treatment with an ACEi should be started within 24 h of ST segment elevation MI (and continued long term) in patients with HF, left ventricular systolic dysfunction, and/or diabetes. Angiotensin receptor/neprilysin inhibitors (ARNIs) are the first choice for patients with HF and reduced ejection fraction, with ACEis being the second choice in this group. ARBs are indicated as alternatives in patients who cannot tolerate ACEis. ACEis may be associated with cough development, but the incidence tends to be overestimated, and the risk can be reduced by use of a lipophilic ACEi or combining the ACEi with a calcium channel blocker. CONCLUSION RAAS blockade is an essential component of hypertension therapy; however, the protective effects provided by ACEis are superior to those of ARBs. Therefore, an ACEi is indicated in almost all cases, unless not tolerated.
Collapse
Affiliation(s)
- Mohamed Sobhy
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
- Cardiovascular Research, Education and Prevention (CVREP) Foundation, Alexandria, Egypt.
- ICC Hospital, 24 Al Ghatwary Street, Smouha, Alexandria, 21648, Egypt.
| | - Adel Eletriby
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hany Ragy
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Hossam Kandil
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Ayman Saleh
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Nabil Farag
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ramez Guindy
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ahmed Bendary
- Department of Cardiology, Faculty of Medicine, Banha University, Banha, Egypt
| | | | - Ahmed Shawky
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ayman Khairy
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ayman Mortada
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Bassem Zarif
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Haitham Badran
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hazem Khorshid
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Kareem Mahmoud
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Karim Said
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Khaled Leon
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Mahmoud Abdelsabour
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mazen Tawfik
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Koriem
- Department of Cardiology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed Loutfi
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Cardiovascular Research, Education and Prevention (CVREP) Foundation, Alexandria, Egypt
| | - Moheb Wadie
- Department of Cardiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed Elnoamany
- Department of Cardiology, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Mohamed Sadaka
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Cardiovascular Research, Education and Prevention (CVREP) Foundation, Alexandria, Egypt
| | - Mohamed Seleem
- Department of Cardiology, National Heart Institute, Cairo, Egypt
| | - Mohamed Zahran
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Osama A Amin
- Department of Cardiology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Sameh Elkaffas
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherif Ayad
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
- Cardiovascular Research, Education and Prevention (CVREP) Foundation, Alexandria, Egypt
| | - Wael El Kilany
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Walid Ammar
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Waleed Elawady
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Walid Elhammady
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yasser Abdelhady
- Department of Cardiology, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| |
Collapse
|
18
|
Alhusban S, Nofal M, Kovacs-Kasa A, Kress TC, Koseoglu MM, Zaied AA, Belin de Chantemele EJ, Annex BH. Glucosamine-Mediated Hexosamine Biosynthesis Pathway Activation Uses ATF4 to Promote "Exercise-Like" Angiogenesis and Perfusion Recovery in PAD. Circulation 2024; 150:1702-1719. [PMID: 39253813 PMCID: PMC11955094 DOI: 10.1161/circulationaha.124.069580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 08/06/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Endothelial cells (ECs) use glycolysis to produce energy. In preclinical models of peripheral arterial disease, further activation of EC glycolysis was ineffective or deleterious in promoting hypoxia-dependent angiogenesis, whereas pentose phosphate pathway activation was effective. Hexosamine biosynthesis pathway, pentose phosphate pathway, and glycolysis are closely linked. Glucosamine directly activates hexosamine biosynthesis pathway. METHODS Hind-limb ischemia in endothelial nitric oxide synthase knockout (eNOS-/-) and BALB/c mice was used. Glucosamine (600 μg/g per day) was injected intraperitoneally. Blood flow recovery was assessed using laser Doppler perfusion imaging and angiogenesis was studied by CD31 immunostaining. In vitro, human umbilical vein ECs and mouse microvascular ECs with glucosamine, L-glucose, or vascular endothelial growth factor (VEGF165a) were tested under hypoxia and serum starvation. Cell Counting Kit-8, tube formation, intracellular reactive oxygen species, electric cell-substrate impedance sensing, and fluorescein isothiocyanate dextran permeability were assessed. Glycolysis and oxidative phosphorylation were assessed by seahorse assay. Gene expression was assessed using RNA sequencing, real-time quantitative polymerase chain reaction, and Western blot. Human muscle biopsies from patients with peripheral arterial disease were assessed for EC O-GlcNAcylation before and after supervised exercise versus standard medical care. RESULTS On day 3 after hind-limb ischemia, glucosamine-treated versus control eNOS-/- mice had less necrosis (n=4 or 5 per group). Beginning on day 7 after hind-limb ischemia, glucosamine-treated versus control BALB/c mice had higher blood flow, which persisted to day 21, when ischemic muscles showed greater CD31 staining per muscle fiber (n=8 per group). In vitro, glucosamine versus L-glucose ECs showed improved survival (n=6 per group) and tube formation (n=6 per group). RNA sequencing of glucosamine versus L-glucose ECs showed increased amino acid metabolism (n=3 per group). That resulted in increased oxidative phosphorylation (n=8-12 per group) and serine biosynthesis pathway without an increase in glycolysis or pentose phosphate pathway genes (n=6 per group). This was associated with better barrier function (n=6-8 per group) and less reactive oxygen species (n=7 or 8 per group) compared with activating glycolysis by VEGF165a. These effects were mediated by activating transcription factor 4, a driver of exercise-induced angiogenesis. In muscle biopsies from humans with peripheral arterial disease, EC/O-GlcNAcylation was increased by 12 weeks of supervised exercise versus standard medical care (n=6 per group). CONCLUSIONS In cells, mice, and humans, activation of hexosamine biosynthesis pathway by glucosamine in peripheral arterial disease induces an "exercise-like" angiogenesis and offers a promising novel therapeutic pathway to treat this challenging disorder.
Collapse
Affiliation(s)
- Suhib Alhusban
- Vascular Biology Center (S.A., M.N., A.K.-K., T.C.K., M.M.K., A.A.Z., E.J.B.d.C., B.H.A.), Medical College of Georgia at Augusta University
| | - Mohamed Nofal
- Vascular Biology Center (S.A., M.N., A.K.-K., T.C.K., M.M.K., A.A.Z., E.J.B.d.C., B.H.A.), Medical College of Georgia at Augusta University
| | - Anita Kovacs-Kasa
- Vascular Biology Center (S.A., M.N., A.K.-K., T.C.K., M.M.K., A.A.Z., E.J.B.d.C., B.H.A.), Medical College of Georgia at Augusta University
| | - Taylor C Kress
- Vascular Biology Center (S.A., M.N., A.K.-K., T.C.K., M.M.K., A.A.Z., E.J.B.d.C., B.H.A.), Medical College of Georgia at Augusta University
| | - M Murat Koseoglu
- Vascular Biology Center (S.A., M.N., A.K.-K., T.C.K., M.M.K., A.A.Z., E.J.B.d.C., B.H.A.), Medical College of Georgia at Augusta University
| | - Abdelrahman A Zaied
- Vascular Biology Center (S.A., M.N., A.K.-K., T.C.K., M.M.K., A.A.Z., E.J.B.d.C., B.H.A.), Medical College of Georgia at Augusta University
- Department of Medicine (A.A.Z., B.H.A.), Medical College of Georgia at Augusta University
| | - Eric J Belin de Chantemele
- Vascular Biology Center (S.A., M.N., A.K.-K., T.C.K., M.M.K., A.A.Z., E.J.B.d.C., B.H.A.), Medical College of Georgia at Augusta University
| | - Brian H Annex
- Vascular Biology Center (S.A., M.N., A.K.-K., T.C.K., M.M.K., A.A.Z., E.J.B.d.C., B.H.A.), Medical College of Georgia at Augusta University
- Department of Medicine (A.A.Z., B.H.A.), Medical College of Georgia at Augusta University
| |
Collapse
|
19
|
Ponukumati AS, Krafcik BM, Newton L, Baribeau V, Mao J, Zhou W, Goodney EJ, Fowler XP, Eid MA, Moore KO, Armstrong DG, Feinberg MW, Bonaca MP, Creager MA, Goodney PP. Association between tissue loss type and amputation risk among Medicare patients with concomitant diabetes and peripheral arterial disease. J Vasc Surg 2024; 80:1543-1552.e12. [PMID: 38880181 PMCID: PMC11493498 DOI: 10.1016/j.jvs.2024.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/05/2024] [Accepted: 06/09/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE Prior studies have described risk factors associated with amputation in patients with concomitant diabetes and peripheral arterial disease (DM/PAD). However, the association between the severity and extent of tissue loss type and amputation risk remains less well-described. We aimed to quantify the role of different tissue loss types in amputation risk among patients with DM/PAD, in the context of demographic, preventive, and socioeconomic factors. METHODS Applying International Classification of Diseases (ICD)-9 and ICD-10 codes to Medicare claims data (2007-2019), we identified all patients with continuous fee-for-service Medicare coverage diagnosed with DM/PAD. Eight tissue loss categories were established using ICD-9 and ICD-10 diagnosis codes, ranging from lymphadenitis (least severe) to gangrene (most severe). We created a Cox proportional hazards model to quantify associations between tissue loss type and 1- and 5-year amputation risk, adjusting for age, race/ethnicity, sex, rurality, income, comorbidities, and preventive factors. Regional variation in DM/PAD rates and risk-adjusted amputation rates was examined at the hospital referral region level. RESULTS We identified 12,257,174 patients with DM/PAD (48% male, 76% White, 10% prior myocardial infarction, 30% chronic kidney disease). Although 2.2 million patients (18%) had some form of tissue loss, 10.0 million patients (82%) did not. The 1-year crude amputation rate (major and minor) was 6.4% in patients with tissue loss, and 0.4% in patients without tissue loss. Among patients with tissue loss, the 1-year any amputation rate varied from 0.89% for patients with lymphadenitis to 26% for patients with gangrene. The 1-year amputation risk varied from two-fold for patients with lymphadenitis (adjusted hazard ratio, 1.96; 95% confidence interval, 1.43-2.69) to 29-fold for patients with gangrene (adjusted hazard ratio, 28.7; 95% confidence interval, 28.1-29.3), compared with patients without tissue loss. No other demographic variable including age, sex, race, or region incurred a hazard ratio for 1- or 5-year amputation risk higher than the least severe tissue loss category. Results were similar across minor and major amputation, and 1- and 5-year amputation outcomes. At a regional level, higher DM/PAD rates were inversely correlated with risk-adjusted 5-year amputation rates (R2 = 0.43). CONCLUSIONS Among 12 million patients with DM/PAD, the most significant predictor of amputation was the presence and extent of tissue loss, with an association greater in effect size than any other factor studied. Tissue loss could be used in awareness campaigns as a simple marker of high-risk patients. Patients with any type of tissue loss require expedited wound care, revascularization as appropriate, and infection management to avoid amputation. Establishing systems of care to provide these interventions in regions with high amputation rates may prove beneficial for these populations.
Collapse
Affiliation(s)
- Aravind S Ponukumati
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; VA Medical Center, White River Junction, VT.
| | - Brianna M Krafcik
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Laura Newton
- VA Medical Center, White River Junction, VT; Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Vincent Baribeau
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Jialin Mao
- Weill Cornell Medical Center, New York, NY
| | - Weiping Zhou
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Eric J Goodney
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Xavier P Fowler
- Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Mark A Eid
- Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Kayla O Moore
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California, Los Angeles, CA
| | - Mark W Feinberg
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA
| | - Marc P Bonaca
- Colorado Prevention Center, University of Colorado, Denver, CO
| | - Mark A Creager
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Philip P Goodney
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; VA Medical Center, White River Junction, VT; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH
| |
Collapse
|
20
|
Chen Y, Liu K, Xu X, Wu G, Zhu L, Zha J, Cheng C. Symmetrical peripheral gangrene caused by urosepsis: Case reports and literature review. Medicine (Baltimore) 2024; 103:e39508. [PMID: 39465777 PMCID: PMC11460895 DOI: 10.1097/md.0000000000039508] [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: 05/22/2024] [Indexed: 10/29/2024] Open
Abstract
RATIONALE Symmetrical peripheral gangrene (SPG) is a serious and rare complication in patients with urosepsis, characterized by distal limb symmetry impairment. PATIENT CONCERNS In this study, 3 cases of SPG caused by urosepsis were reported, and the Chinese and English literature on SPG caused by urosepsis was reviewed. The demographic, clinicopathological, treatment, and follow-up data of the patients were summarized and analyzed. DIAGNOSIS SPG was diagnosed with clinical symptoms. INTERVENTIONS We conducted urological invasive surgery, administered anti-infective therapy, implemented fluid resuscitation and blood product transfusion, provided mechanical ventilation support, optimized myocardial contractility, administered heparin and B vitamins, utilized papaverine for vasodilation, performed hemodialysis and plasma exchange, peripheral skin warming along with other treatment modalities. OUTCOMES Two patients died and 1 patient underwent autoamputation. LESSONS Our cases and literature review demonstrate that timely and accurate diagnosis, effective infection control, correction of hypoperfusion, organ function support, early management of disseminated intravascular coagulation, avoidance of premature amputation, and multidisciplinary comprehensive treatment are crucial for the successful treatment of SPG caused by urosepsis.
Collapse
Affiliation(s)
- Yuanyuan Chen
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Provinces, China
| | - Kai Liu
- Department of Cardiovascular, Anqing Municipal Hospital, Anqing City, Anhui Provinces, China
| | - Xiujuan Xu
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Provinces, China
| | - Gaofei Wu
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Provinces, China
| | - Lianghua Zhu
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Provinces, China
| | - Junjing Zha
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Provinces, China
| | - Chuji Cheng
- Department of Critical Care Medicine, Anqing Municipal Hospital, Anqing City, Anhui Provinces, China
| |
Collapse
|
21
|
Saeed H, Skalski A. Vessel Geometry Estimation for Patients with Peripheral Artery Disease. SENSORS (BASEL, SWITZERLAND) 2024; 24:6441. [PMID: 39409481 PMCID: PMC11479335 DOI: 10.3390/s24196441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2024] [Revised: 09/19/2024] [Accepted: 10/03/2024] [Indexed: 10/20/2024]
Abstract
The estimation of vessels' centerlines is a critical step in assessing the geometry of the vessel, the topological representation of the vessel tree, and vascular network visualization. In this research, we present a novel method for obtaining geometric parameters from peripheral arteries in 3D medical binary volumes. Our approach focuses on centerline extraction, which yields smooth and robust results. The procedure starts with a segmented 3D binary volume, from which a distance map is generated using the Euclidean distance transform. Subsequently, a skeleton is extracted, and seed points and endpoints are identified. A search methodology is used to derive the best path on the skeletonized 3D binary array while tracking from the goal points to the seed point. We use the distance transform to calculate the distance between voxels and the nearest vessel surface, while also addressing bifurcations when vessels divide into multiple branches. The proposed method was evaluated on 22 real cases and 10 synthetically generated vessels. We compared our method to different state-of-the-art approaches and demonstrated its better performance. The proposed method achieved an average error of 1.382 mm with real patient data and 0.571 mm with synthetic data, both of which are lower than the errors obtained by other state-of-the-art methodologies. This extraction of the centerline facilitates the estimation of multiple geometric parameters of vessels, including radius, curvature, and length.
Collapse
Affiliation(s)
- Hassan Saeed
- Department of Measurement and Electronics, AGH University of Krakow, 30-059 Krakow, Poland;
- MedApp S.A., 30-037 Krakow, Poland
| | - Andrzej Skalski
- Department of Measurement and Electronics, AGH University of Krakow, 30-059 Krakow, Poland;
- MedApp S.A., 30-037 Krakow, Poland
| |
Collapse
|
22
|
Okunlola AO, Ajao TO, Karim A, Sabi M, Kolawole O, Ugwoke K, Mahadevaswamysusheela MK. A Review of Peripheral Artery Disease in Diabetic Patients in Sub-Saharan Africa. Cureus 2024; 16:e69808. [PMID: 39429407 PMCID: PMC11491116 DOI: 10.7759/cureus.69808] [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: 09/20/2024] [Indexed: 10/22/2024] Open
Abstract
Peripheral artery disease (PAD) is an atherosclerotic occlusive disease of the lower extremities and is associated with an increased risk of amputation and cardiovascular events. The interplay between diabetes and PAD is complex, influenced by shared risk factors such as hypertension, dyslipidemia, and smoking. High rates of undiagnosed diabetes, coupled with barriers to accessing care, contribute to the complexity of managing PAD. Unique to the Sub-Sahara region is associations with communicable diseases such as human immunodeficiency virus and tuberculosis which further complicates the epidemiological landscape. Comprehensive management strategies, including lifestyle modifications, pharmacological interventions, and revascularization procedures, are essential. However, the region faces challenges such as inadequate healthcare infrastructure and high costs of treatment. This narrative review highlights the epidemiology of PAD in people with diabetes, the risk factors associated with PAD, the impact of PAD on the morbidity and mortality of individuals with diabetes, as well as the management of PAD in individuals with diabetes, with attention geared toward Sub-Saharan Africa These insights are critical for developing effective strategies to mitigate the burden of PAD in diabetes, especially in Sub-Saharan Africa. Further research is essential to understand the associations between diabetes and other diseases in the region.
Collapse
Affiliation(s)
| | - Temitope O Ajao
- General and Acute Medicine, United Lincolnshire Hospitals NHS Trust, Lincolnshire, GBR
| | - Abbas Karim
- Emergency Medicine, United Lincolnshire Hospitals NHS Trust, Lincolnshire, GBR
| | - Mwila Sabi
- Respiratory Medicine, United Lincolnshire Hospitals NHS Trust, Lincolnshire, GBR
| | - Olayinka Kolawole
- Internal Medicine, Hull University Teaching Hospitals NHS Trust, Hull, GBR
| | - Kenneth Ugwoke
- Vascular Surgery, United Lincolnshire Hospitals NHS Trust, Lincolnshire, GBR
| | | |
Collapse
|
23
|
Alrashed FA, Iqbal M, Al-Regaiey KA, Ansari AA, Alderaa AA, Alhammad SA, Alsubiheen AM, Ahmad T. Evaluating diabetic foot care knowledge and practices at education level. Medicine (Baltimore) 2024; 103:e39449. [PMID: 39183414 PMCID: PMC11346884 DOI: 10.1097/md.0000000000039449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 08/04/2024] [Accepted: 08/05/2024] [Indexed: 08/27/2024] Open
Abstract
Diabetic foot is one of the complications in type 2 diabetes mellitus. Adequate knowledge and practice are an important aspect to control further deteriorating conditions such as ulcers and amputations. Thus, the objective of this cross-sectional study was to investigate the impact of the education levels of diabetic patients on diabetic foot care knowledge and practice. This cross-sectional study with a convenient sampling technique was conducted on 534 patients with diabetes mellitus from public and private care hospitals. The data was collected using a validated, pretested and structured bilingual (Arabic, English) questionnaire. There were 534 patients interviewed, 39.1% of whom were males and 60.9% of whom were females and 61.4% of the patients had had T2DM for over 10 years. There was a significant difference in education levels between the male and female patients (53.8% and 46.2%, P = .001). Furthermore, 83.9% patients were married. The difference in education between the married and the single, divorced, and widowed patients was significant (P = .007). Patients with uncontrolled HbA1c were 2.43 times more likely to have hypertension (RR = 2.43, P = .03), while patients with highly uncontrolled diabetes had 3.1 times more chances of hypertension (RR = 3.1, P = .009). Heart disease prevalence was 3.27 times higher in diabetes patients with uncontrolled HbA1c and 3.37 times higher in patients with highly uncontrolled HbA1c. Patients with diabetes who have been diabetic for more than 10 years have a greater risk of heart disease (RR = 2.1; P = .03). Patients with lower education levels exhibited more diabetic complications compared to patients with higher education levels (P < .05). The present study highlights the importance of education and awareness campaigns targeting diabetic patients, especially those with lower education levels, to improve diabetes control and prevent, or manage, comorbidities. Healthcare providers should also prioritize patient education and medication adherence to improve diabetes management and reduce the risk of complications.
Collapse
Affiliation(s)
- Fahad Abdulaziz Alrashed
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Muhammad Iqbal
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Khalid A. Al-Regaiey
- Department of Physiology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Asrar Ahmad Ansari
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Asma A. Alderaa
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Saad A. Alhammad
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman M. Alsubiheen
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Tauseef Ahmad
- Department of Medical Education, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| |
Collapse
|
24
|
Viswanathan V, Gupta A, Devarajan A, Kumpatla S, Shukla S, Agarwal S, Makkar BM, Saboo B, Kumar V, Sahay RK. Early screening for foot problems in people with diabetes is the need of the hour: 'Save the Feet and Keep Walking Campaign' in India. BMJ Open Diabetes Res Care 2024; 12:e004064. [PMID: 39097296 PMCID: PMC11298753 DOI: 10.1136/bmjdrc-2024-004064] [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: 01/22/2024] [Accepted: 06/27/2024] [Indexed: 08/05/2024] Open
Abstract
INTRODUCTION Evidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk (HR) feet in people with diabetes across India. RESEARCH DESIGN AND METHODS A cross-sectional national-level project 'Save the Feet and Keep Walking' campaign was conducted by the Research Society for the Study of Diabetes in India (RSSDI) from July 10, 2022 to August 10, 2022. A modified version of 3 min foot examination was used to assess the foot problems. Around 10 000 doctors with RSSDI membership were trained online to conduct foot screening and provided a standardised monofilament for detection of loss of protective sensation. People with diabetes aged >18 years who visited the clinics during the study period were examined for foot problems. Data were collected online using the semi-structured questionnaire. A total of 33 259 participants with complete information were included for the final analysis. The foot at risk was categorised based on International Working Group on the Diabetic Foot guidelines 2023. RESULTS Nearly 75% of the participants were aged above 45 years. Around 49% had diabetes duration >5 years and uncontrolled diabetes (hemoglobin A1c >8%). Presence of history of foot ulcer (20%), lower limb amputation (15.3%), foot deformities (24.5%) and absence of diminished dorsal pedis and posterior tibial pulses (26.4%) was noted in the study participants. Around 25.2% of them had HR feet and highly prevalent among males. Diabetic kidney and retinal complications were present in 70% and 75.5% of people with HR feet. Presence of heel fissures (OR (95% CI) 4.6 (4.2 to 5.1)) and callus or corns (OR (95% CI) 3.6 (3.3 to 4.0)) were significantly associated with HR feet. CONCLUSIONS One-fourth of people with diabetes were found to have HR feet in India. The findings are suggestive of regular screening of people with diabetes for foot problems and strengthening of primary healthcare.
Collapse
Affiliation(s)
- Vijay Viswanathan
- M V Hospital for Diabetes and Professor M Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu, India
| | - Amit Gupta
- Centre for Diabetes Care, Greater Noida, Uttar Pradesh, India
| | - Arutselvi Devarajan
- M V Hospital for Diabetes and Professor M Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu, India
| | - Satyavani Kumpatla
- M V Hospital for Diabetes and Professor M Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu, India
| | | | - Sanjay Agarwal
- Department of Diabetes, Aegle Clinic—Diabetes Care, Pune, Maharashtra, India
- Department of Medicine & Diabetes, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | - Banshi Saboo
- Diabetes Care and Hormone Clinic, Ahmedabad, India
| | | | | |
Collapse
|
25
|
Aanniz T, Zeouk I, Elouafy Y, Touhtouh J, Hassani R, Hammani K, Benali T, El-Shazly M, Khalid A, Abdalla AN, Aboulaghras S, Goh KW, Ming LC, Razi P, Bakrim S, Bouyahya A. Initial report on the multiple biological and pharmacological properties of hispolon: Exploring stochastic mechanisms. Biomed Pharmacother 2024; 177:117072. [PMID: 38991301 DOI: 10.1016/j.biopha.2024.117072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/15/2024] [Accepted: 06/29/2024] [Indexed: 07/13/2024] Open
Abstract
The development of natural substances derived from nature poses a significant challenge as technologies for the extraction and characterization of active principles advance. Hispolon has received a lot of attention in recent years, ascribable to its wide range of biological activities. It is a phenolic molecule that was extracted from several mushroom species such as Phellinus igniarius, Phellinus linteus, Phellinus lonicerinus, Phellinus merrillii, and Inonotus hispidus. To provide a comprehensive overview of the pharmacological activities of hispolon, this review highlights its anticancer, anti-inflammatory, antioxidant, antibacterial, and anti-diabetic activities. Several scientific research databases, including Google Scholar, Web of Science, PubMed, SciFinder, SpringerLink, Science Direct, Scopus, and, Wiley Online were used to gather the data on hispolon until May 2024. The in vitro and in vivo studies have revealed that hispolon exhibited significant anticancer properties through modifying several signaling pathways including cell apoptosis, cycle arrest, autophagy, and inhibition of angiogenesis and metastasis. Hispolon's antimicrobial activity was proven against many bacterial, fungal, and viral pathogens, highlighting its potential use as a novel antimicrobial agent. Additionally, hispolon displayed potent anti-inflammatory activity through the suppression of key inflammatory mediators, such as inducible NO synthase (iNOS), tumor necrosis factor-α (TNF-α), and cyclooxygenases-2 (COX-2), and the modulation of mitogen-activated protein kinases (MAPK) and nuclear factor kappa B (NF-κB) signaling pathways. The antioxidant potential of hispolon was attributed to its capacity to neutralize reactive oxygen species (ROS) and to increase the activity of antioxidant enzymes, indicating a possible involvement in the prevention of oxidative stress-related illnesses. Hispolon's antidiabetic activity was associated with the inhibition of aldose reductase and α-glucosidase. Studies on hispolon emphasized its potential use as a promising scaffold for the development of novel therapeutic agents targeting various diseases, including cancer, infectious diseases, inflammatory disorders, and diabetes.
Collapse
Affiliation(s)
- Tarik Aanniz
- Biotechnology Laboratory (MedBiotech), Bioinova Research Center, Rabat Medical and Pharmacy School, Mohammed V University, Rabat, Morocco
| | - Ikrame Zeouk
- Laboratoire de Pharmacologie, Toxicologie, Faculté de Médecine, de Pharmacie et de Médecine dentaire de Fès, Université Sidi Mohamed Ben Abdellah, Morocco
| | - Youssef Elouafy
- Laboratory of Materials, Nanotechnology and Environment LMNE, Faculty of Sciences, Mohammed V University in Rabat, Rabat BP 1014, Morocco
| | - Jihane Touhtouh
- Laboratory of Natural Resources and Environment, Polydisciplinary Faculty of Taza, Sidi Mohamed Ben Abdellah University of Fez, B.P. 1223 Taza-Gare, Taza, Morocco
| | - Rym Hassani
- Biology Department, University College AlDarb, Jazan University, Jazan 45142, Saudi Arabia
| | - Khalil Hammani
- Laboratory of Natural Resources and Environment, Polydisciplinary Faculty of Taza, Sidi Mohamed Ben Abdellah University of Fez, B.P. 1223 Taza-Gare, Taza, Morocco
| | - Taoufiq Benali
- Environment and Health Team, Polydisciplinary Faculty of Safi, Cadi Ayyad University, Safi 46030, Morocco
| | - Mohamed El-Shazly
- Department of Pharmacognosy, Faculty of Pharmacy, Ain-Shams University, Cairo 11566, Egypt; Pharmaceutical Biology Department, Faculty of Pharmacy and Biotechnology, The German University in Cairo, Cairo 11432, Egypt
| | - Asaad Khalid
- Substance Abuse and Toxicology Research Center, Jazan University, P.O. Box: 114, Jazan 45142, Saudi Arabia; Medicinal and Aromatic Plants and Traditional Medicine Research Institute, National Center for Research, P. O. Box 2404, Khartoum, Sudan.
| | - Ashraf N Abdalla
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia
| | - Sara Aboulaghras
- Laboratory of Human Pathologies Biology, Faculty of Sciences, Mohammed V University in Rabat, Rabat 10106, Morocco
| | - Khang Wen Goh
- Faculty of Data Science and Information Technology, INTI International University, Nilai, Malaysia
| | - Long Chiau Ming
- School of Medical and Life Sciences, Sunway University, Sunway City, Malaysia
| | - Pakhrur Razi
- Center of Disaster Monitoring and Earth Observation, Universitas Negeri Padang, Padang, Indonesia.
| | - Saad Bakrim
- Geo-Bio-Environment Engineering and Innovation Laboratory, Molecular Engineering, Biotechnology and Innovation Team, Polydisciplinary Faculty of Taroudant, Ibn Zohr University, Agadir 80000, Morocco
| | - Abdelhakim Bouyahya
- Laboratory of Human Pathologies Biology, Faculty of Sciences, Mohammed V University in Rabat, Rabat 10106, Morocco.
| |
Collapse
|
26
|
Elahi R, Nazari M, Mohammadi V, Esmaeilzadeh K, Esmaeilzadeh A. IL-17 in type II diabetes mellitus (T2DM) immunopathogenesis and complications; molecular approaches. Mol Immunol 2024; 171:66-76. [PMID: 38795686 DOI: 10.1016/j.molimm.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 03/06/2024] [Accepted: 03/19/2024] [Indexed: 05/28/2024]
Abstract
Chronic inflammation has long been considered the characteristic feature of type II diabetes mellitus (T2DM) Immunopathogenesis. Pro-inflammatory cytokines are considered the central drivers of the inflammatory cascade leading to β-cell dysfunction and insulin resistance (IR), two major pathologic events contributing to T2DM. Analyzing the cytokine profile of T2DM patients has also introduced interleukin-17 (IL-17) as an upstream regulator of inflammation, regarding its role in inducing the nuclear factor-kappa B (NF-κB) pathway. In diabetic tissues, IL-17 induces the expression of inflammatory cytokines and chemokines. Hence, IL-17 can deteriorate insulin signaling and β-cell function by activating the JNK pathway and inducing infiltration of neutrophils into pancreatic islets, respectively. Additionally, higher levels of IL-17 expression in patients with diabetic complications compared to non-complicated individuals have also proposed a role for IL-17 in T2DM complications. Here, we highlight the role of IL-17 in the Immunopathogenesis of T2DM and corresponding pathways, recent advances in preclinical and clinical studies targeting IL-17 in T2DM, and corresponding challenges and possible solutions.
Collapse
Affiliation(s)
- Reza Elahi
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mahdis Nazari
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Vahid Mohammadi
- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Kimia Esmaeilzadeh
- Department of Medical Nanotechnology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Abdolreza Esmaeilzadeh
- Department of Immunology, Zanjan University of Medical Sciences, Zanjan, Iran; Cancer Gene Therapy Research Center (CGRC), Zanjan University of Medical Sciences, Zanjan, Iran.
| |
Collapse
|
27
|
Wyse JM, Sullivan BA, Lopez P, Guda T, Rathbone CR, Wechsler ME. Poly(Lactic-Co-Glycolic Acid) Microparticles for the Delivery of Model Drug Compounds for Applications in Vascular Tissue Engineering. Cells Tissues Organs 2024; 213:475-485. [PMID: 38934132 PMCID: PMC11631679 DOI: 10.1159/000539971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Localized delivery of angiogenesis-promoting factors such as small molecules, nucleic acids, peptides, and proteins to promote the repair and regeneration of damaged tissues remains a challenge in vascular tissue engineering. Current delivery methods such as direct administration of therapeutics can fail to maintain the necessary sustained release profile and often rely on supraphysiologic doses to achieve the desired therapeutic effect. By implementing a microparticle delivery system, localized delivery can be coupled with sustained and controlled release to mitigate the risks involved with the high dosages currently required from direct therapeutic administration. METHODS For this purpose, poly(lactic-co-glycolic acid) (PLGA) microparticles were fabricated via anti-solvent microencapsulation and the loading, release, and delivery of model angiogenic molecules, specifically a small molecule, nucleic acid, and protein, were assessed in vitro using microvascular fragments (MVFs). RESULTS The microencapsulation approach utilized enabled rapid spherical particle formation and encapsulation of model drugs of different sizes, all in one method. The addition of a fibrin scaffold, required for the culture of the MVFs, reduced the initial burst of model drugs observed in release profiles from PLGA alone. Lastly, in vitro studies using MVFs demonstrated that higher concentrations of microparticles led to greater co-localization of the model therapeutic (miRNA) with MVFs, which is vital for targeted delivery methods. It was also found that the biodistribution of miRNA using the delivered microparticle system was enhanced compared to direct administration. CONCLUSION Overall, PLGA microparticles, formulated and loaded with model therapeutic compounds in one step, resulted in improved biodistribution in a model of the vasculature leading to a future in translational revascularization.
Collapse
Affiliation(s)
- Jordyn M. Wyse
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
- University of Texas at San Antonio - University of Texas Health Science Center at San Antonio Joint Graduate Program in Biomedical Engineering, San Antonio, TX, USA
| | - Bryan A. Sullivan
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
- University of Texas at San Antonio - University of Texas Health Science Center at San Antonio Joint Graduate Program in Biomedical Engineering, San Antonio, TX, USA
| | - Priscilla Lopez
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Teja Guda
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
- Institute of Regenerative Medicine, University of Texas at San Antonio, San Antonio, TX, USA
| | - Christopher R. Rathbone
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
- Institute of Regenerative Medicine, University of Texas at San Antonio, San Antonio, TX, USA
| | - Marissa E. Wechsler
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, USA
- Institute of Regenerative Medicine, University of Texas at San Antonio, San Antonio, TX, USA
| |
Collapse
|
28
|
Amato B, Novellino E, Morlando D, Vanoli C, Vanoli E, Ferrara F, Difruscolo R, Goffredo VM, Compagna R, Tenore GC, Stornaiuolo M, Fordellone M, Caradonna E. Benefits of Taurisolo in Diabetic Patients with Peripheral Artery Disease. J Cardiovasc Dev Dis 2024; 11:174. [PMID: 38921674 PMCID: PMC11203668 DOI: 10.3390/jcdd11060174] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/29/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Trimethyl-N-oxide (TMAO) has been linked to peripheral artery disease (PAD). TaurisoloⓇ is a natural, balanced phytocomplex containing resveratrol, quercetin, catechins, procianidins, gallic acid, and caffeic acid. Numerous studies have shown that TaurisoloⓇ reduces the damage of TMAO and exerts a protective effect on endothelial cells (ECs). The aim of this randomized, double-blind, single-center study was to evaluate the effects of TaurisoloⓇ on claudication in patients with PAD (Rutheford grade I, category II, Fontaine Classification: Stage IIA, American Medical Association Whole Person Impairment Classification: Class 0-WPI 0%) in two parallel groups of 31 patients. The primary outcomes were an increase in the pain-free walking distance and the ankle/brachial pressure index at the beginning and at the end of the treatment with Taurisolo. The secondary endpoint was the serum TMAO changes. The claudication distance improved by 14.1% in the Taurisolo group and by 2.0% in the placebo group, while the maximal distance increased by 15.8% and 0.6% only, respectively (both p < 0.05). The TMAO plasma levels decreased from 3.97 ± 2.13 micromole/L to 0.87 ± 0.48 (p < 0.0001) in the treated group. All these changes were highly significant both in univariate mixed models as well as in the adjusted model. Ultimately, TaurisoloⓇ might be an effective intervention to ameliorate intermittent claudication.
Collapse
Affiliation(s)
- Bruno Amato
- Department of Public Health, Università degli Studi di Napoli Federico II, 80138 Naples, Italy; (B.A.); (D.M.)
| | - Ettore Novellino
- Chimica Farmaceutica e Tossicologica, Università Cattolica del Sacro Cuore, 20123 Rome, Italy;
| | - Davide Morlando
- Department of Public Health, Università degli Studi di Napoli Federico II, 80138 Naples, Italy; (B.A.); (D.M.)
| | - Camilla Vanoli
- Clinical Psychology, Antioch University Los Angeles, Culver City, CA 90230, USA
| | - Emilio Vanoli
- School of Nursing, University of Pavia, 27100 Pavia, Italy;
| | - Fulvio Ferrara
- Centro Diagnostico Italiano, Department of Clinical Laboratory, 20100 Milan, Italy; (F.F.); (E.C.)
| | - Rossana Difruscolo
- Biotecnologie Mediche e Farmaceutiche, Università degli Studi di Bari, 70126 Bari, Italy;
| | - Vito Maria Goffredo
- Department of Interdisciplinary Medicine, Università degli Studi di Bari, 70124 Bari, Italy;
| | - Rita Compagna
- Vascular Surgery Unit AORN Ospedale dei Colli, 80131 Naples, Italy;
| | - Gian Carlo Tenore
- Department of Pharmacy, Università degli Studi di Napoli Federico II, 80138 Naples, Italy; (G.C.T.); (M.S.)
| | - Mariano Stornaiuolo
- Department of Pharmacy, Università degli Studi di Napoli Federico II, 80138 Naples, Italy; (G.C.T.); (M.S.)
| | - Mario Fordellone
- Unità di Statistica Medica, Dipartimento di Salute Mentale e Fisica e Medicina Preventiva, Università degli Studi della Campania ‘Luigi Vanvitelli’, 81020 Napoli, Italy;
| | - Eugenio Caradonna
- Centro Diagnostico Italiano, Department of Clinical Laboratory, 20100 Milan, Italy; (F.F.); (E.C.)
| |
Collapse
|
29
|
Wahidi R, Zhang Y, Li R, Xu J, Zayed MA, Hastings MK, Zheng J. Quantitative Assessment of Peripheral Oxidative Metabolism With a New Dynamic 1H MRI Technique: A Pilot Study in People With and Without Diabetes Mellitus. J Magn Reson Imaging 2024; 59:2091-2100. [PMID: 37695103 PMCID: PMC10925551 DOI: 10.1002/jmri.28996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) is linked to impaired mitochondrial function. Chemical exchange saturation transfer (CEST) magnetic resonance imaging (MRI) is a gadolinium-contrast-free 1H method to assess mitochondrial function by measuring low-concentration metabolites. A CEST MRI-based technique may serve as a non-invasive proxy for assessing mitochondrial health. HYPOTHESIS A 1H CEST MRI technique may detect significant differences in in vivo skeletal muscle phosphocreatine (SMPCr) kinetics between healthy volunteers and T2DM patients undergoing standardized isometric exercise. STUDY TYPE Cross-sectional study. SUBJECTS Seven subjects without T2DM (T2DM-) and seven age, sex, and BMI-matched subjects with T2DM (T2DM+). FIELD STRENGTH/SEQUENCE Single-shot rapid acquisition with refocusing echoes (RARE) and single-shot gradient-echo sequences, 3 T. ASSESSMENT Subjects underwent a rest-exercise-recovery imaging protocol to dynamically acquire SMPCr maps in calf musculature. Medial gastrocnemius (MG) and soleus SMPCr concentrations were plotted over time, and SMPCr recovery time, τ , was determined. Mitochondrial function index was calculated as the ratio of resting SMPCr to τ . Participants underwent a second exercise protocol for imaging of skeletal muscle blood flow (SMBF), and its association with SMPCr was assessed. STATISTICAL TESTS Unpaired t-tests and Pearson correlation coefficient. A P value <0.05 was considered statistically significant. RESULTS SMPCr concentrations in MG and soleus displayed expected declines during exercise and returns to baseline during recovery. τ was significantly longer in the T2DM+ cohort (MG 83.5 ± 25.8 vs. 54.0 ± 21.1, soleus 90.5 ± 18.9 vs. 51.2 ± 14.5). The mitochondrial function index in the soleus was significantly lower in the T2DM+ cohort (0.33 ± 0.08 vs. 0.66 ± 0.19). SMBF was moderately correlated with the SMPCr in T2DM-; this correlation was not significant in T2DM+ (r = -0.23, P = 0.269). CONCLUSION The CEST MRI method is feasible for quantifying SMPCr in peripheral muscle tissue. T2DM+ individuals had significantly lower oxidative capacities than T2DM- individuals. In T2DM, skeletal muscle metabolism appeared to be decoupled from perfusion. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
Collapse
Affiliation(s)
- Ryan Wahidi
- Washington University School of Medicine, Missouri, Saint Louis, USA
| | - Yi Zhang
- Key Laboratory for Biomedical Engineering of Ministry of Education, Department of Biomedical Engineering, College of Biomedical Engineering & Instrument Science, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ran Li
- Washington University School of Medicine, Missouri, Saint Louis, USA
| | - Jiadi Xu
- John Hopkins University, Baltimore, MD, USA
| | - Mohamed A. Zayed
- Washington University School of Medicine, Missouri, Saint Louis, USA
| | - Mary K. Hastings
- Washington University School of Medicine, Missouri, Saint Louis, USA
| | - Jie Zheng
- Washington University School of Medicine, Missouri, Saint Louis, USA
| |
Collapse
|
30
|
Tran V, Galvan B, Khemka S, Holder K, Ansari MM. Importance of Using Angiography for the Early Detection of Chronic Limb Ischemia in Diabetic Foot Wounds. Cureus 2024; 16:e61906. [PMID: 38975476 PMCID: PMC11227889 DOI: 10.7759/cureus.61906] [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: 06/07/2024] [Indexed: 07/09/2024] Open
Abstract
Peripheral artery disease (PAD) affects millions of people worldwide, presenting with varying symptom severity, including chronic total occlusion of arteries, and occasionally, limb amputation. There are various interventions, such as atherectomy and the use of drug-coated balloons and stents, which have been developed to revascularize affected ischemic regions. However, each interventional approach must be individualized due to a patient's unique underlying conditions. Comorbid conditions, especially diabetes, play a significant role in PAD, as poorly controlled diabetes can accelerate PAD progression. For this reason, an early and accurate diagnosis of PAD is crucial, especially when symptoms may present dissimilar to classic PAD symptoms, often leading to misdiagnosis. The presented cases highlight the tailored interventions to revascularize arteries in patients with diabetic foot wounds utilizing catheters, stents, guidewires, and balloons, made possible after early angiogram. These interventions have been promising in treating PAD patients, and highlight the need for early diagnosis and timely and customized interventions to prevent limb amputation and mitigate potential complications.
Collapse
Affiliation(s)
- Vivie Tran
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Bernardo Galvan
- General Surgery, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Sachi Khemka
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | | | - Mohammad M Ansari
- Cardiology, Texas Tech University, Lubbock, USA
- Cardiology, Texas Tech University Health Sciences Center, Lubbock, USA
| |
Collapse
|
31
|
Stanek A, Mikhailidis DP, Paraskevas KI, Jawien A, Antignani PL, Mansilha A, Blinc A, Poredoš P. Specificities of primary and secondary prevention of lower extremity artery disease in patients with diabetes mellitus. INT ANGIOL 2024; 43:367-373. [PMID: 39041784 DOI: 10.23736/s0392-9590.24.05260-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
Diabetes mellitus (DM) is a major risk factor for lower extremity arterial disease (LEAD) and about 20% of symptomatic patients with LEAD have DM. In subjects with DM, LEAD is a cause of morbidity and mortality. DM typically causes complications in the form of macro- and microangiopathy. In these patients, macroangiopathy manifests as atherosclerosis like in non-diabetic patients. However, its course is accelerated due to accompanying risk factors like hyperlipidemia and hypertension, with cumulative effects. Other factors are also relevant such as inflammation, endothelial dysfunction, platelet activation, blood rheological properties, hypercoagulability, and factors stimulating vascular smooth muscle cell proliferation. Additionally, DM is a risk factor for restenosis and amputation. DM is strongly associated with femoral-popliteal and tibial LEAD, which manifests earlier in patients with DM and may progress more rapidly to critical limb ischemia. Diabetic microangiopathy is characterized by arteriolosclerosis and interstitial fibrosis which additionally affects progression and outcomes of angiopathy of lower limbs. Glycemic control particularly decreases microangiopathic complications, while prevention of macrovascular complications requires treatment of accompanying risk factors like hypertension and dyslipidemia.
Collapse
Affiliation(s)
- Agata Stanek
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, Poland -
| | - Dimitri P Mikhailidis
- Division of Surgery and Interventional Science, Department of Surgical Biotechnology, University College London Medical School, London, UK
- Department of Clinical Biochemistry, University College London (UCL), Royal Free Hospital Campus, London, UK
| | | | - Arkadiusz Jawien
- Collegium Medicum, Department of Vascular Surgery and Angiology, Nicolaus Copernicus University, Bydgoszcz, Poland
| | | | - Armando Mansilha
- Department of Angiology and Vascular Surgery, Faculty of Medicine, Sao Joao University Hospital, University of Porto, Porto, Portugal
| | - Ales Blinc
- Department of Vascular Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Pavel Poredoš
- Department of Vascular Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
32
|
Alameddine D, Satam K, Slade M, Wang H, Mena-Hurtado C, Turner J, Inzucchi SE, Ochoa Chaar CI. Insulin Requirement and Infrainguinal Bypass Outcomes in Patients with Peripheral Arterial Disease. Ann Vasc Surg 2024; 102:25-34. [PMID: 38307234 DOI: 10.1016/j.avsg.2023.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 02/04/2024]
Abstract
BACKGROUND Diabetes mellitus (DM) is a major risk factor for peripheral artery disease. The association of DM with major adverse limb events (MALE) after lower extremity revascularization remains controversial, as patients with diabetes are typically analyzed as a single, homogenous group. Using a large national database, this study examines the impact of insulin use and glycemic control on the outcomes following infrainguinal bypass. The hypothesis is that prevalent insulin therapy and elevated hemoglobin A1c (HbA1c) are associated with an increased risk of MALEs after infrainguinal bypass in patients with DM and could therefore be used for risk stratification. METHODS The Vascular Quality Initiative database files for infrainguinal bypass (2007-2021) were retrospectively reviewed. Patients with DM undergoing bypass for peripheral artery disease were included. Patients on dialysis or with prior kidney transplantation were excluded. The characteristics and outcomes of patients with insulin-requiring diabetes mellitus (IRDM) were compared to those of patients not requiring insulin (noninsulin-requiring diabetes mellitus [NIRDM]) prior to the bypass procedure. RESULTS A total of 9,686 patients with DM (56% IRDM) underwent bypass. Patients with IRDM were significantly younger than patients with NIRDM, more likely to be female (P < 0.01), African American (P < 0.01), and Hispanic (P = 0.031), and more likely to have comorbidities and be categorized into American Society of Anesthesiologist classes IV-V. They were more likely to be treated for chronic limb-threatening ischemia (P < 0.001). Patients with IRDM had significantly higher perioperative complications with no difference in perioperative mortality between the 2 groups. Beyond the perioperative period, with a mean follow-up of 427 days, patients with IRDM had significantly lower crude rates of primary patency and higher crude rates of major amputation, MALE, and mortality compared to patients with NIRDM. Regression analyses demonstrated that insulin requirement, but not HbA1c, was independently associated with a higher risk of MALE (hazard ratio = 1.17 [1.06-1.29]) and mortality (hazard ratio = 1.28 [1.16-1.43]). CONCLUSIONS Insulin requirement, but not HbA1c, is significantly associated with MALEs and survival after infrainguinal bypass in the Vascular Quality Initiative. Stratification of patients with DM based on their prevalent insulin use prior to infrainguinal bypass surgery could improve the prediction of outcomes of peripheral arterial bypass surgery in patients with diabetes.
Collapse
Affiliation(s)
- Dana Alameddine
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT.
| | - Keyuree Satam
- Department of Vascular Surgery, Stanford Hospital, Palo Alto, CA
| | - Martin Slade
- Department of Epidemiology and Public Health, Yale University, New Haven, CT
| | - He Wang
- Department of Pathology, Yale University School of Medicine, New Haven, CT
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Jeffrey Turner
- Section of Nephrology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Silvio E Inzucchi
- Section of Endocrinology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
33
|
Widiastuti HP, Paonganan R, Setiani D, Arsyawina A, Pramono JS, Hilda H. Buerger-Allen exercises' effectiveness for improving lower limb circulation. HEALTHCARE IN LOW-RESOURCE SETTINGS 2024. [DOI: 10.4081/hls.2024.11965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2025] Open
Abstract
Impaired peripheral perfusion in the legs is the most common complaint experienced by patients with type 2 Diabetes Mellitus (DM). One nursing intervention in the form of physical exercise that can be administered to DM patients to prevent peripheral perfusion disorders and increase vascularization of the lower extremities is the Buerger-Allen Exercise (BAE). The goal of this study was to analyze the effectiveness of BAE in improving lower extremity circulation. The population consisted of patients with type 2 DM. The research design employed a quasi-experiment with pre-test and post-test, including a control group. A sample of 24 respondents was divided into an intervention group and a control group. The sampling technique used was purposive sampling. Data were obtained through direct Ankle-Brachial Index (ABI) measurement using a Doppler ultrasound and an aneroid sphygmomanometer, temporary blood sugar level measurements using a glucometer, and leg sensitivity measurements using a monofilament tool. Paired T-tests and independent T-tests were used as statistical tests. The results of the Paired T-test for lower limb circulation in the intervention group yielded a p-value of 0.000, indicating a significant difference in the circulation of the lower extremities before and after the intervention. The results of the independent T-test also showed a p-value of 0.000, indicating significance. Thus, BAE can improve lower limb circulation in patients with type 2 DM.
Collapse
|
34
|
Froldi G. View on Metformin: Antidiabetic and Pleiotropic Effects, Pharmacokinetics, Side Effects, and Sex-Related Differences. Pharmaceuticals (Basel) 2024; 17:478. [PMID: 38675438 PMCID: PMC11054066 DOI: 10.3390/ph17040478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Metformin is a synthetic biguanide used as an antidiabetic drug in type 2 diabetes mellitus, achieved by studying the bioactive metabolites of Galega officinalis L. It is also used off-label for various other diseases, such as subclinical diabetes, obesity, polycystic ovary syndrome, etc. In addition, metformin is proposed as an add-on therapy for several conditions, including autoimmune diseases, neurodegenerative diseases, and cancer. Although metformin has been used for many decades, it is still the subject of many pharmacodynamic and pharmacokinetic studies in light of its extensive use. Metformin acts at the mitochondrial level by inhibiting the respiratory chain, thus increasing the AMP/ATP ratio and, subsequently, activating the AMP-activated protein kinase. However, several other mechanisms have been proposed, including binding to presenilin enhancer 2, increasing GLP1 release, and modification of microRNA expression. Regarding its pharmacokinetics, after oral administration, metformin is absorbed, distributed, and eliminated, mainly through the renal route, using transporters for cationic solutes, since it exists as an ionic molecule at physiological pH. In this review, particular consideration has been paid to literature data from the last 10 years, deepening the study of clinical trials inherent to new uses of metformin, the differences in effectiveness and safety observed between the sexes, and the unwanted side effects. For this last objective, metformin safety was also evaluated using both VigiBase and EudraVigilance, respectively, the WHO and European databases of the reported adverse drug reactions, to assess the extent of metformin side effects in real-life use.
Collapse
Affiliation(s)
- Guglielmina Froldi
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35131 Padova, Italy
| |
Collapse
|
35
|
Ismail A, Lawal Y, Gezawa ID, Ramalan MA, Uloko AE, Usman MI. Doppler Sonographic Characteristics and Clinical Outcomes of Diabetic Foot Syndrome: A 5-Year Audit from a Tertiary Hospital in Northern Nigeria. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2024; 14:127-133. [PMID: 38562386 PMCID: PMC10980325 DOI: 10.4103/jwas.jwas_185_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 07/31/2023] [Indexed: 04/04/2024]
Abstract
Background Diabetes foot syndrome is one of the common complications of diabetes. Detailed information on the clinical and vascular characteristics of patients with diabetic foot disease in relation to the outcome of the care provided to these patients will be useful to policymakers and clinicians in early detection and timely interventions for the prevention of disabling complications. Materials and Methods This is a review of patients with diabetic foot managed in Aminu Kano Teaching Hospital over 5 years (January 2017-May 2022). The sociodemographic characteristics, Wagner classification of the foot, Doppler sonographic characteristics and clinical outcomes, etc., were reviewed. Results A total of 51 patients were reviewed. Males and females accounted for 56.8% and 43.1%, respectively. Twenty-five patients had Wagner grade 4 ulcers, and fewer patients had Wagner grade 1 and 5-foot ulcers. The mean ± standard deviation Doppler arterial intimal media thickness was 1.53 ± 0.33 (range 0.90-2.40 mm). The majority of DFS patients had Doppler sonographic lesions on the right lower limb 28 (54.9%) only, and 11 (21.6%) of the lesions were bilateral. The posterior tibial artery 11 (21.6%) was the most involved arterial segment with plaques, followed by a combination of popliteal and tibial arterial 10 (19.6%) segments. At 6 months, 45.2% had limb amputation, 17.6% healed ulcers, 17.6% delayed wound healing, and 9.8% died. Conclusion There is an unacceptably high prevalence of poor treatment outcomes, thus, contributing to a huge burden of care to patients living with diabetes. There is a strong association between severe arterial stenosis detected by Doppler ultrasound and higher rates of amputations.
Collapse
Affiliation(s)
- Anas Ismail
- Department of Radiology, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Yusuf Lawal
- Department of Radiology, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ibrahim D Gezawa
- Endocrinology, Diabetes and Metabolism Unit, Department of Internal Medicine, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Mansur Aliyu Ramalan
- Endocrinology, Diabetes and Metabolism Unit, Department of Internal Medicine, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Andrew E Uloko
- Endocrinology, Diabetes and Metabolism Unit, Department of Internal Medicine, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Mustapha Ibrahim Usman
- Orthopedic Unit, Department of Surgery, Bayero University Kano and Aminu Kano Teaching Hospital, Kano, Nigeria
| |
Collapse
|
36
|
White M, McDermott KM, Bose S, Wang C, Srinivas T, Kalbaugh C, Hicks CW. Risks and Benefits of the Proposed Amputation Reduction and Compassion Act for Disadvantaged Patients. Ann Vasc Surg 2024; 101:179-185. [PMID: 38142961 PMCID: PMC10957305 DOI: 10.1016/j.avsg.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 12/06/2023] [Indexed: 12/26/2023]
Abstract
Racial, ethnic, and socioeconomic disparities in the major risk factors for vascular disease and access to vascular specialist care are well-documented.1-3 The higher incidence of diabetes, peripheral artery disease (PAD), and related nontraumatic lower extremity amputation among racial and ethnic minority groups, those of low socioeconomic status, and those with poor access to care based on geography (together, referred to below as disadvantaged groups) are particularly pervasive.1,4-9 Practitioners of vascular surgery and endovascular therapy are uniquely positioned to address health inequities in lower extremity screening, medical management, intervention, and limb preservation among the population of adults at the highest risk for limb loss.
Collapse
Affiliation(s)
- Midori White
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | | | - Sanuja Bose
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Caroline Wang
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Tara Srinivas
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Corey Kalbaugh
- Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN
| | - Caitlin W Hicks
- Department of Surgery, Johns Hopkins University, Baltimore, MD.
| |
Collapse
|
37
|
Egle M, Wang WC, Fann YC, Johansen MC, Lee JT, Yeh CH, Jason Lin CH, Jeng JS, Sun Y, Lien LM, Gottesman RF. Sex Differences in the Role of Multimorbidity on Poststroke Disability: The Taiwan Stroke Registry. Neurology 2024; 102:e209140. [PMID: 38330286 PMCID: PMC11067697 DOI: 10.1212/wnl.0000000000209140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/28/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Multimorbidity is common in patients who experience stroke. Less is known about the effect of specific multimorbidity patterns on long-term disability in patients with stroke. Furthermore, given the increased poststroke disability frequently seen in female vs male patients, it is unknown whether multimorbidity has a similar association with disability in both sexes. We assessed whether specific multimorbidity clusters were associated with greater long-term poststroke disability burden overall and by sex. METHODS In the Taiwan Stroke Registry, an ongoing nationwide prospective registry, patients with first-ever ischemic stroke were enrolled; this analysis is restricted to those individuals surviving to at least 6 months poststroke. Using a hierarchical clustering approach, clusters of prestroke multimorbidity were generated based on 16 risk factors; the algorithm identified 5 distinct clusters. The association between clusters and 12-month poststroke disability, defined using the modified Rankin Scale (mRS), was determined using logistic regression models, with additional models stratified by sex. The longitudinal association between multimorbidity and functional status change was assessed using mixed-effects models. RESULTS Nine-thousand eight hundred eighteen patients with first-ever ischemic stroke were included. The cluster with no risk factors was the reference, "healthier" risk group (N = 1,373). Patients with a cluster profile of diabetes, peripheral artery disease (PAD), and chronic kidney disease (CKD) (N = 1882) had significantly greater disability (mRS ≥ 3) at 1 month (OR [95% CI] = 1.36 [1.13-1.63]), 3 months (OR [95% CI] = 1.27 [1.04-1.55]), and 6 months (OR [95% CI] = 1.30 [1.06-1.59]) but not at 12 months (OR [95% CI] = 1.16 [0.95-1.42]) than patients with a healthier risk factor profile. In the sex-stratified analysis, the associations with this risk cluster remained consistent in male patients (OR [95% CI] = 1.42 [1.06-1.89]) at 12 months, who also had a higher comorbidity burden, but not in female patients (OR [95% CI] = 0.95 [0.71-1.26]), who had higher proportions of severe strokes and severe disability (p-interaction = 0.04). DISCUSSION Taiwanese patients with multimorbidity, specifically the concurrent presence of diabetes, PAD, and CKD, had higher odds of a worse functional outcome in the first 6 months poststroke. Clusters of multimorbidity may be less informative for long-term disability in female patients. Further studies should evaluate other mechanisms for worse disability in female patients poststroke.
Collapse
Affiliation(s)
- Marco Egle
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Wei-Chun Wang
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yang C Fann
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Michelle C Johansen
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Jiunn-Tay Lee
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chung-Hsin Yeh
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chih-Hao Jason Lin
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Jiann-Shing Jeng
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Yu Sun
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Li-Ming Lien
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Rebecca F Gottesman
- From the National Institute of Neurological Disorders and Stroke (M.E., W.-C.W., Y.C.F., R.F.G.), Intramural Research Program, National Institutes of Health, Bethesda, MD; Department of Neurology (W.-C.W.), China Medical University Hospital, Taichung, Taiwan; Department of Neurology (M.C.J.), The Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurology (J.-T.L.), Tri-Service General Hospital, National Defense Medical Center, Taipei; Department of Nursing (C.-H.Y.), College of Nursing and Health, Da-Yeh University; Department of Neurology (C.-H.Y.), Yuan Rung Hospital, Changhua, Taiwan; Director of Stroke Center (C.-H.J.L.), Department of Neurology Stroke Center, Lin Shin Hospital; Stroke Center and Department of Neurology (J.-S.J.), National Taiwan University Hospital; Department of Neurology (Y.S.), En Chu Kong Hospital, New Taipei City; and Department of Neurology (L.-M.L.), Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| |
Collapse
|
38
|
Schults JA, Young ER, Marsh N, Larsen E, Corley A, Ware RS, Murgo M, Alexandrou E, McGrail M, Gowardman J, Charles KR, Regli A, Yasuda H, Rickard CM. Risk factors for arterial catheter failure and complications during critical care hospitalisation: a secondary analysis of a multisite, randomised trial. J Intensive Care 2024; 12:12. [PMID: 38459599 PMCID: PMC10924392 DOI: 10.1186/s40560-024-00719-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/04/2024] [Indexed: 03/10/2024] Open
Abstract
OBJECTIVES Arterial catheters (ACs) are critical for haemodynamic monitoring and blood sampling but are prone to complications. We investigated the incidence and risk factors of AC failure. METHODS Secondary analysis of a multi-centre randomised controlled trial (ACTRN 12610000505000). Analysis included a subset of adult intensive care unit patients with an AC. The primary outcome was all-cause device failure. Secondary outcomes were catheter associated bloodstream infection (CABSI), suspected CABSI, occlusion, thrombosis, accidental removal, pain, and line fracture. Risk factors associated with AC failure were investigated using Cox proportional hazards and competing-risk models. RESULTS Of 664 patients, 173 (26%) experienced AC failure (incidence rate [IR] 37/1000 catheter days). Suspected CABSI was the most common failure type (11%; IR 15.3/1000 catheter days), followed by occlusion (8%; IR 11.9/1,000 catheter days), and accidental removal (4%; IR 5.5/1000 catheter days). CABSI occurred in 16 (2%) patients. All-cause failure and occlusion were reduced with ultrasound-assisted insertion (failure: adjusted hazard ratio [HR] 0.43, 95% CI 0.25, 0.76; occlusion: sub-HR 0.11, 95% CI 0.03, 0.43). Increased age was associated with less AC failure (60-74 years HR 0.63, 95% CI 0.44 to 0.89; 75 + years HR 0.36, 95% CI 0.20, 0.64; referent 15-59 years). Females experienced more occlusion (adjusted sub-HR 2.53, 95% CI 1.49, 4.29), while patients with diabetes had less (SHR 0.15, 95% CI 0.04, 0.63). Suspected CABSI was associated with an abnormal insertion site appearance (SHR 2.71, 95% CI 1.48, 4.99). CONCLUSIONS AC failure is common with ultrasound-guided insertion associated with lower failure rates. Trial registration Australian New Zealand Clinical Trial Registry (ACTRN 12610000505000); date registered: 18 June 2010.
Collapse
Affiliation(s)
- Jessica A Schults
- Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia.
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia.
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia.
| | - Emily R Young
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Emily Larsen
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Amanda Corley
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Marghie Murgo
- Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia
| | - Evan Alexandrou
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
- Department of Intensive Care, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Matthew McGrail
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - John Gowardman
- Intensive Care Service, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Karina R Charles
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Adrian Regli
- Department of Intensive Care, Fiona Stanley Hospital, Perth, Western Australia, Australia
- Medical School, The Notre Dame University, Fremantle, Western Australia, Australia
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saimata Medical Center, Saitama, Japan
- Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center, Tokyo, Japan
| | - Claire M Rickard
- Metro North Health, Herston Infectious Disease Institute, Herston, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Alliance for Vascular Access Teaching and Research Group, Nathan, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| |
Collapse
|
39
|
Krittanawong C, Escobar J, Virk HUH, Alam M, Virani S, Lavie CJ, Narayan KMV, Sharma R. Lifestyle Approach and Medical Therapy of Lower Extremity Peripheral Artery Disease. Am J Med 2024; 137:202-209. [PMID: 37980970 DOI: 10.1016/j.amjmed.2023.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/21/2023]
Abstract
Lower extremity peripheral artery disease (PAD) is common among patients with several risk factors, such as elderly, smoking, hypertension, and diabetes mellitus. Notably, PAD is associated with a higher risk of cardiovascular complications. Non-invasive interventions are beneficial to improve morbidity and mortality among patients with PAD. Traditional risk factors like smoking, diabetes mellitus, hypertension, and dyslipidemia play a significant role in the development of PAD. Still, additional factors such as mental health, glycemic control, diet, exercise, obesity management, lipid-lowering therapy, and antiplatelet therapy have emerged as important considerations. Managing these factors can help improve outcomes and reduce complications in PAD patients. Antiplatelet therapy with aspirin or clopidogrel is recommended in PAD patients, with clopidogrel showing more significant benefits in symptomatic PAD individuals. Managing several risk factors is crucial for improving outcomes and reducing complications in patients with PAD. Further research is also needed to explore the potential benefits of novel therapies. Ultimately, a comprehensive approach to PAD management is essential for improving morbidity and mortality among patients with this condition.
Collapse
Affiliation(s)
| | - Johao Escobar
- Division of Cardiology, Harlem Cardiology, New York, NY
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | | | - Salim Virani
- Section of Cardiology, Baylor College of Medicine, Houston, Texas; The Aga Khan University, Karachi, Pakistan; Baylor College of Medicine, Houston, Texas
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, La
| | - K M Venkat Narayan
- Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, Ga
| | - Raman Sharma
- Department of Medicine/Cardiology, The Zena and Michael A. Wiener Cardiovascular Institute and the Marie-Josée Henry R. Kravis Cardiovascular Health Center, Icahn School of Medicine at the Mount Sinai Hospital, Mount Sinai Heart, New York, NY
| |
Collapse
|
40
|
Yu Q, Chen C, Cao J, Xu J, Lu J, Yuan L. Efficiency and safety of dual pathway inhibition for the prevention of femoropopliteal artery restenosis in repeated endovascular interventions. J Vasc Surg 2024; 79:623-631.e2. [PMID: 37951514 DOI: 10.1016/j.jvs.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/18/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE There is a lack of consensus regarding the optimal strategy for evaluating the efficiency and safety of dual-pathway inhibition (DPI) in preventing femoropopliteal restenosis in patients undergoing repeated endovascular interventions. Despite several therapeutic interventions available for preventing femoropopliteal restenosis post repeated endovascular interventions, the ideal strategy, particularly evaluating the efficacy and safety of DPI, remains a matter of debate. METHODS From January 2015 to September 2021, patients who underwent repeated endovascular interventions for femoropopliteal restenosis were compared with those who underwent DPI or dual antiplatelet therapy (DAPT) after surgery using a propensity score-matched analysis. The primary outcome was clinically driven target lesion revascularization (CD-TLR). The principal safety outcome was a composite of major bleeding and clinically relevant non-major (CRNM) bleeding. To further enhance the rigor, Kaplan-Meier plots, Cox proportional hazards modeling, and sensitivity analyses, as well as subgroup analyses were employed, reducing potential confounders. RESULTS A total of 441 patients were included in our study, of whom 294 (66.7%) received DAPT and 147 (33.1%) received DPI, with 114 matched pairs (mean age, 72.21 years; 84.2% male). Cumulative probability of CD-TLR at 36 months in the DPI group (17%) trended lower than that in the DAPT group (32%) (hazard ratio [HR], 0.45; 95% confidence interval [CI], 0.26-0.78; P =.004). The cumulative probability of freedom from CD-TLR at 36 months in the DPI group was 83%. No significant difference was observed in the composite outcome of major or CRNM bleeding between the DPI and DAPT groups (HR, 1.26; 95% CI, 0.34 to 4.69; P = .730). The DPI group was associated with significantly lower rates of CD-TLR in the main subgroup analyses of diabetes (P = .001), previous smoking history (P = .008), longer lesion length (>10 cm) (P = .003), and treatment with debulking strategy (P = .003). CONCLUSIONS In our investigation focused on CD-TLR, we found that DPI exhibited a significant reduction in the risk of reintervention compared with other treatment modalities. This underscores the potential of DPI as a viable therapeutic strategy in preventing reinterventions. Moreover, our assessment of safety outcomes revealed that the bleeding risks associated with DPI were on par with DAPT, thereby not compromising patient safety. These findings pave the way for potential broader clinical implications, emphasizing the effectiveness and safety of DPI in the context of reducing reintervention risks.
Collapse
Affiliation(s)
- Qingyuan Yu
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Cheng Chen
- ChangZheng Hospital, Navy Military Medical University, Shanghai, China
| | - Jingzhu Cao
- Department of Endocrinology, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Jinyan Xu
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Jin Lu
- Department of Endocrinology, Changhai Hospital, Navy Military Medical University, Shanghai, China
| | - Liangxi Yuan
- Department of Vascular Surgery, Changhai Hospital, Navy Military Medical University, Shanghai, China.
| |
Collapse
|
41
|
Martinez A, Huang J, Harzand A. The Pink Tax: Sex and Gender Disparities in Peripheral Artery Disease. US CARDIOLOGY REVIEW 2024; 18:e04. [PMID: 39494404 PMCID: PMC11526481 DOI: 10.15420/usc.2022.28] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 11/27/2023] [Indexed: 11/05/2024] Open
Abstract
Peripheral artery disease (PAD) is an atherosclerotic disease associated with significant functional impairment, morbidity, and mortality. Among women, PAD remains poorly recognized and undermanaged. Compared with men, women with PAD tend to be underdiagnosed or misdiagnosed, have poorer quality of life, and experience higher rates of PAD-related morbidity and cardiovascular mortality. In this review, we describe the sex- and gender-related differences in the epidemiology, presentation, diagnosis, and management of PAD. We provide specific recommendations to overcome these factors, including greater awareness and an increased emphasis on tailored and more aggressive interventions for women with PAD. Such changes are warranted and necessary to achieve more equitable outcomes in women with PAD, including improved limb outcomes, enhanced lifestyle, and cardiovascular risk reduction.
Collapse
Affiliation(s)
- Andrea Martinez
- Department of Medicine, Massachusetts General HospitalBoston, MA
| | - Jingwen Huang
- Department of Medicine, School of Medicine, Emory UniversityAtlanta, GA
| | - Arash Harzand
- Division of Cardiology, Department of Medicine, School of Medicine, Emory UniversityAtlanta, GA
- Cardiology Department, Atlanta VA Medical CenterDecatur, GA
| |
Collapse
|
42
|
Yates J. Use of simple lymphatic drainage on truncal lymphoedema for a patient with diabetes and peripheral arterial disease. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:100-103. [PMID: 38335097 DOI: 10.12968/bjon.2024.33.3.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/12/2024]
Abstract
Lymphoedema is the gradual, abnormal build-up of lymph fluid in the tissues resulting from a failure of the lymphatic system. The swelling impedes movement and is painful. Compression garments are contraindicated and not tolerated by patients with extensive peripheral arterial disease. In this case study, simple lymphatic drainage was therefore considered a safer treatment option to reduce oedema and to encourage proactive self-management for a patient with bilateral amputations, diabetes and peripheral arterial disease.
Collapse
Affiliation(s)
- Jennifer Yates
- Vascular and Lymphoedema Nurse Specialist, Sheffield Teaching Hospitals
| |
Collapse
|
43
|
Bulum T, Brkljačić N, Tičinović Ivančić A, Čavlović M, Prkačin I, Tomić M. In Association with Other Risk Factors, Smoking Is the Main Predictor for Lower Transcutaneous Oxygen Pressure in Type 2 Diabetes. Biomedicines 2024; 12:381. [PMID: 38397984 PMCID: PMC10886561 DOI: 10.3390/biomedicines12020381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) significantly increases the risk of peripheral artery disease (PAD), and diabetes is the leading cause of nontraumatic amputations. This study investigated the risk factors for transcutaneous oxygen pressure (TcPO2) in T2DM, a noninvasive method to quantify skin oxygenation and the underlying microvascular circulation. The study included 119 T2DM patients (91 male/28 female). TcPO2 measurements were conducted with the Tina TCM4 Series transcutaneous monitor (Radiometer, Copenhagen, Sweden) and skin electrodes. Patients with TcPO2 < 40 mmHg were younger (p = 0.001), had significantly higher systolic blood pressure (SBP) (p = 0.023), glycated hemoglobin (HbA1c) (p = 0.013), fasting plasma glucose (fPG) (p = 0.038), total cholesterol (p = 0.006), LDL cholesterol (p = 0.004), and had more frequent smoking habits (p = 0.001) than those with TcPO2 ≥ 40 mmHg. The main predictors for the TcPO2 value (R2 = 0.211) obtained via stepwise regression analysis were age, smoking, SBP, HbA1c, fPG, and total and LDL cholesterol. Among all the listed predictors, smoking, HbA1c, and LDL cholesterol were found to be the most significant, with negative parameter estimates of -3.051310 (p = 0.0007), -2.032018 (p = 0.0003), and -2.560353 (p = 0.0046). The results of our study suggest that in association with other risk factors, smoking is the main predictor for lower TcPO2 in T2DM.
Collapse
Affiliation(s)
- Tomislav Bulum
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Neva Brkljačić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | | | - Maja Čavlović
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Ingrid Prkačin
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Internal Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Martina Tomić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| |
Collapse
|
44
|
Shanmugasundaram S, Herman K, Rundback JH. Percutaneous Deep Venous Arterialization in Patients with No-Option Critical Limb Ischemia Performed in an Office-Based Laboratory Setting. J Vasc Interv Radiol 2024; 35:278-284. [PMID: 37839526 DOI: 10.1016/j.jvir.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023] Open
Abstract
PURPOSE To evaluate the feasibility and safety of percutaneous deep venous arterialization (pDVA) performed in an office-based laboratory (OBL) for patients with no-option critical limb ischemia (CLI). MATERIALS AND METHODS A retrospective chart review was performed of all patients who underwent pDVA using commercially available devices from January 2018 to November 2021 in a single OBL. In total, 22 patients (10 males and 12 females; Rutherford 4, 5, and 6: n = 1, 8, and 13, respectively) were identified with a median follow-up of 140 days. Amputation-free survival, wound healing, pDVA patency, and overall survival were evaluated at 30 days, 6 months, and throughout the remaining follow-up period. RESULTS All patients had undergone failed previous attempts at endovascular arterial reconstruction. At 6 months after procedure, 6.4% of arteriovenous conduits remained patent; 83.3% (10/12) of patients experienced complete or partial wound healing. In addition, 78.6% of patients avoided an above-ankle amputation, and overall survival was 83.6%. Nine patients underwent endovascular reinterventions at 6 months. One mild adverse event and 4 moderate adverse events occurred after procedure, and 1 cardiac death occurred 5 days after procedure. CONCLUSIONS pDVA is safe and feasible in the OBL for patients with no-option CLI. Many patients avoided an above-ankle amputation during the study period despite low overall pDVA patency.
Collapse
Affiliation(s)
| | - Kevin Herman
- NJ Endovascular & Amputation Prevention, West Orange, New Jersey
| | - John H Rundback
- NJ Endovascular & Amputation Prevention, West Orange, New Jersey.
| |
Collapse
|
45
|
Damara FA, Alameddine D, Slade M, Cardella J, Tonnessen B, Guzman RJ, Ochoa Chaar CI. Arterial dissection during peripheral vascular interventions. J Vasc Surg 2024; 79:339-347.e6. [PMID: 37838217 DOI: 10.1016/j.jvs.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE Arterial dissection (AD) is a known complication of peripheral vascular interventions (PVIs), but its incidence and significance have not been well-characterized. This study examines AD in the Vascular Quality Initiative database for patients treated for peripheral arterial disease. Our hypothesis is that AD is associated with decreased patency and worse limb outcomes. METHODS The Vascular Quality Initiative PVI registry (2016-2021) was reviewed. Patients were divided based on the presence or absence of reported AD during the procedure. Trend of incidence and management of AD was derived. The characteristics and outcomes of patients with and without AD were compared. The primary endpoint was primary patency. RESULTS There was a total of 177,790 cases, and 3% had AD. The incidence of AD significantly increased over the study period from 2.4% to 3.6% (P = .007). Endovascular therapy was used to treat AD in 83.7% of cases, 14.5% were treated medically, and only 1.8% required open surgery. Patients with AD were significantly more likely to be female (47.4% vs 39.7%; P < .001). Patient with AD were more likely to have a history of smoking (79.7% vs 77.2%; P < .001), but were significantly less likely to be on dialysis (8.2% vs 9.3%; P < .001) compared with patients without AD. Patients with AD were more likely to have femoropopliteal disease (45.2% vs 38.0%; P < .001) and undergo treatment of more complex disease as denoted by higher mean number of lesions treated (1.95 ± 1.01 vs 1.71 ± 0.89; P < .001), longer occlusion length (8 ± 16 vs 7 ± 15 cm; P < .001), and more severe TransAtlantic Inter-Society Consensus grade (Grade D: 36.2% vs 29.1%; P < .001). The proportion of stenting as a treatment modality was higher in the dissection group (55.4% vs 41.1%; P < .001). After a mean follow-up of 828 days, patients with AD had significantly lower primary patency than patients without AD. Kaplan-Meier curves demonstrated that the AD group had lower primary patency (86.9% vs 91%; P < .001) and reintervention-free survival (79.5 % vs 84.1%; P < .001) at 1 year with difference in amputation-free survival. Cox proportional hazard regression confirmed the independent association of AD with primary patency and reintervention-free survival. CONCLUSIONS AD is more common in women and is more likely to occur during treatment of the femoropopliteal segment. AD is associated with decreased primary patency and reintervention-free survival after PVI for peripheral arterial disease.
Collapse
Affiliation(s)
- Fachreza Aryo Damara
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT.
| | - Dana Alameddine
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Martin Slade
- Yale Occupational and Environmental Medicine Program, Yale University School of Medicine, New Haven, CT
| | - Jonathan Cardella
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Britt Tonnessen
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
46
|
Takematsu E, Massidda M, Howe G, Goldman J, Felli P, Mei L, Callahan G, Sligar AD, Smalling R, Baker AB. Transmembrane stem factor nanodiscs enhanced revascularization in a hind limb ischemia model in diabetic, hyperlipidemic rabbits. Sci Rep 2024; 14:2352. [PMID: 38287067 PMCID: PMC10825164 DOI: 10.1038/s41598-024-52888-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 01/24/2024] [Indexed: 01/31/2024] Open
Abstract
Therapies to revascularize ischemic tissue have long been a goal for the treatment of vascular disease and other disorders. Therapies using stem cell factor (SCF), also known as a c-Kit ligand, had great promise for treating ischemia for myocardial infarct and stroke, however clinical development for SCF was stopped due to toxic side effects including mast cell activation in patients. We recently developed a novel therapy using a transmembrane form of SCF (tmSCF) delivered in lipid nanodiscs. In previous studies, we demonstrated tmSCF nanodiscs were able to induce revascularization of ischemia limbs in mice and did not activate mast cells. To advance this therapeutic towards clinical application, we tested this therapy in an advanced model of hindlimb ischemia in rabbits with hyperlipidemia and diabetes. This model has therapeutic resistance to angiogenic therapies and maintains long term deficits in recovery from ischemic injury. We treated rabbits with local treatment with tmSCF nanodiscs or control solution delivered locally from an alginate gel delivered into the ischemic limb of the rabbits. After eight weeks, we found significantly higher vascularity in the tmSCF nanodisc-treated group in comparison to alginate treated control as quantified through angiography. Histological analysis also showed a significantly higher number of small and large blood vessels in the ischemic muscles of the tmSCF nanodisc treated group. Importantly, we did not observe inflammation or mast cell activation in the rabbits. Overall, this study supports the therapeutic potential of tmSCF nanodiscs for treating peripheral ischemia.
Collapse
Affiliation(s)
- Eri Takematsu
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, BME 5.202D, C0800, Austin, TX, 78712, USA
- School of Medicine, Surgery, Stanford University, Stanford, CA, USA
| | - Miles Massidda
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, BME 5.202D, C0800, Austin, TX, 78712, USA
| | - Gretchen Howe
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
| | - Julia Goldman
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
- Center for Laboratory Animal Medicine and Care, UT Health Science Center at Houston, Houston, TX, USA
| | - Patricia Felli
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
- Center for Laboratory Animal Medicine and Care, UT Health Science Center at Houston, Houston, TX, USA
| | - Lei Mei
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, BME 5.202D, C0800, Austin, TX, 78712, USA
| | - Gregory Callahan
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, BME 5.202D, C0800, Austin, TX, 78712, USA
| | - Andrew D Sligar
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, BME 5.202D, C0800, Austin, TX, 78712, USA
| | - Richard Smalling
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, TX, USA
- Memorial Hermann Heart and Vascular Institute, Houston, TX, USA
| | - Aaron B Baker
- Department of Biomedical Engineering, University of Texas at Austin, 1 University Station, BME 5.202D, C0800, Austin, TX, 78712, USA.
- Institute for Cellular and Molecular Biology, University of Texas at Austin, Austin, TX, USA.
- The Institute for Computational Engineering and Sciences, University of Texas at Austin, Austin, TX, USA.
- Institute for Biomaterials, Drug Delivery and Regenerative Medicine, University of Texas at Austin, Austin, TX, USA.
| |
Collapse
|
47
|
Jbrael YJ, Hamad BK. Ameliorating impact of coenzyme Q10 on the profile of adipokines, cardiomyopathy, and hematological markers correlated with the glucotoxicity sequelae in diabetic rats. PLoS One 2024; 19:e0296775. [PMID: 38227584 PMCID: PMC10790996 DOI: 10.1371/journal.pone.0296775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/18/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND In diabetes, high blood glucose induces glucotoxicity, resulting in the further damage of pancreatic beta-cells and then precipitating diabetic complications. This study was aimed to investigate the relationship between glucotoxicity with the level of adipokines, diabetic cardiomyopathy, and hematological markers. Moreover, the study examined the potential modulatory effect of coenzyme Q10 (CoQ10) on the aforementioned markers associated with the sequelae of diabetes mellitus. MATERIAL AND METHODS Twenty-four male rats were randomly assigned to receive an injection of STZ to induce diabetes (n = 16) or to remain uninduced (n = 8). The hyperglycemic status was induced in fasting rats by single intraperitoneal injection of STZ (45 mg /kg b.w.) dissolved in citrate buffer (pH 4.5). Three days after STZ injection, rats were divided into three groups; Normal control group (A), Diabetic control group (B), and CoQ10- treated diabetic group (C). The group (C) was fed with the basal diet supplemented with 5 g of CoQ10 per kilogram of diet for three weeks after the diabetes induction. After 21 days, the blood and serum samples were taken to conduct biochemical analyses. Blood glucose was determined by Blood Glucose Monitoring System. Adipokines or cytokines were evaluated by ELISA from a serum sample. Cardiac myopathy biomarkers were estimated by UP-Converting Phosphor Immunoassay Analyzer, and hematological parameters were measured by automatic hematology analyzer. RESULTS In hyperglycemic rats, the level of fasting blood glucose, and serum level of resistin, omentin, TNF-α, and cardiomyopathy biomarkers significantly increased (P < 0.05). The treatment with CoQ10 significantly decreased the profile of adipokines and cardiomyopathy markers (cardiac enzymes and LPPLA2) in diabetic rats and also reduced glucose levels (P < 0.05). Lymphocyte percentages significantly decreased while significant increases were observed in granulocytes and MID percentages in hyperglycemic rats. CONCLUSION Diabetic rats had higher serum levels of adipokines and cardiomyopathy markers. Among the hematological markers, GRA% and MID% increased while LYM% decreased. The profile of adipokines and cardiomyopathy markers improved when CoQ10 was supplemented. The study suggests that CoQ10 may have a beneficial effect on improving diabetic complications.
Collapse
Affiliation(s)
- Yousif Jameel Jbrael
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Badraldin Kareem Hamad
- Department of Pharmacology and Toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- University of Kurdistan Hawler (UKH), School of Medicine, Erbil, Iraq
| |
Collapse
|
48
|
Hsu L, Li L, Poon LY. Analysis of risk factors of infection in diabetic foot patients. Int Wound J 2024; 21:e14411. [PMID: 37731215 PMCID: PMC10788463 DOI: 10.1111/iwj.14411] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 09/22/2023] Open
Abstract
This cross-sectional study assessed the risk factors for infection in 150 diabetic foot patients admitted to the Xiamen University Hospital between October 2020 and October 2022. Patients were categorised as infected (n = 80) or uninfected (n = 70) cohorts. The diabetic foot was evaluated using the American Diabetic Foot Grading system, whereas ulcers were categorised using Wagner's method. Analysed were patient-specific information, clinical data and risk factors including neuropathy, arterial disease and foot deformities. Our findings revealed no statistically significant differences between infected and uninfected cohorts concerning age, body mass index, gender, duration of diabetes or ankle-brachial index values (p > 0.05). However, infected group had a higher proportion of smokers and reduced socio-economic status (p < 0.05). Wagner grades indicated a greater severity in the infected group, with grade 3, grade 4 and grade 5 differing significantly (p < 0.05). Comparative analysis of ulcer characteristics revealed no statistically significant differences in ulcer surface area and depth, but the infected group had a higher prevalence of osteomyelitis and a greater number of ulcers (p > 0.05). Blood vessel complications, retinopathy, the presence of three or more ulcers, osteomyelitis and diabetic nephropathy were substantially more prevalent in the infected group, as determined by univariate analysis (p < 0.05). Subsequent multivariate logistic analysis revealed that patients with blood vessel complications, retinopathy, osteomyelitis, diabetic nephropathy and three or more ulcers were at increased risk for infection (p < 0.05). In addition, lifestyle factors, such as smoking, sedentary behaviour, inadequate foot hygiene, obesity and poor glycaemic control, were also associated with higher infection rates. A multivariate analysis of foot wound factors revealed that deeper, longer and recurrent lesions increased the likelihood of infection. Escherichia coli was the most frequently isolated bacterium from the infected group's bacterial culture, followed by Pseudomonas aeruginosa and Staphylococcus aureus. The study enhanced our comprehension of the multifactorial risk factors associated with infections in diabetic foot patients, highlighting the need for thorough clinical evaluation, lifestyle modification and vigilant infection control.
Collapse
Affiliation(s)
- Limei Hsu
- School of MedicineXiamen UniversityXiamenChina
| | - Le Li
- Department of The First Hospital of Xiamen University, School of MedicineXiamen UniversityXiamenChina
| | | |
Collapse
|
49
|
Herrera D, Rueda Capistrani DE, Obando Vera S, Sanchez Cruz C, Linarez Nuñez KA, Banegas D, Argueta A, Murillo Md MI, Clervil K, Perez Moreno EJ, Calderon Martinez E. The Role of Physiotherapy in Peripheral Artery Disease in Patients With Diabetes Mellitus: A Narrative Review. Cureus 2024; 16:e52019. [PMID: 38344599 PMCID: PMC10854460 DOI: 10.7759/cureus.52019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2024] [Indexed: 12/04/2024] Open
Abstract
Diabetes mellitus (DM) comprises a spectrum of metabolic disorders distinguished by the persistent elevation of glucose levels in the bloodstream. It stands as a primary risk factor for peripheral arterial disease (PAD), denoted by atherosclerosis affecting the lower extremities. One clinical manifestation of symptomatic PAD is intermittent claudication alleviated by rest but also capable of presenting as atypical leg pain. Confirmatory diagnostic measures, including the ankle-brachial index (ABI), toe-brachial index (TBI), or Doppler waveform analysis, are imperative in the verification of PAD. For management, the recommendation is to incorporate physiotherapy alongside concurrent medical interventions, such as anticoagulants, antiplatelet agents, statins, or, in certain cases, surgical procedures. This narrative review seeks to elucidate the advantages of physiotherapy in diabetic patients with PAD, contributing to the deceleration of disease progression and improving symptoms. Although supervised exercise therapy is strongly supported by empirical evidence as more beneficial, the absence of supervised environments is a common issue. Consequently, the preference lies in the combination of supervised exercise with home-based regimens. The objective is that each patient exercises for more than three days per week, progressively extending their duration weekly. This approach has demonstrated a noteworthy enhancement in walking functionality, exercise tolerance, pain alleviation, and an overall improvement in the quality of life for patients.
Collapse
Affiliation(s)
- Domenica Herrera
- Medicine, Pontificia Universidad Católica del Ecuador, Quito, ECU
| | | | | | - Camila Sanchez Cruz
- General Practice, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, MEX
| | | | - Douglas Banegas
- General Medicine, Universidad Nacional Autonoma de Honduras, San Pedro Sula, HND
| | - Ariane Argueta
- Medicine, Universidad Salvadoreña Alberto Maferrer, San Salvador, SLV
| | | | - Kenol Clervil
- Emergency Department, Instituto Tecnologico de Santo Domingo (INTEC), Charlotte, USA
| | - Elda J Perez Moreno
- Physiotherapy, Universidad Nacional Autonoma de Mexico, Ciudad de Mexico, MEX
| | | |
Collapse
|
50
|
Viudes-Sarrión N, Aleixandre-Carrera F, Beltrá P, Ortega FJ, Molina-Payá FJ, Velasco E, Delicado-Miralles M. Blood flow effects of percutaneous peripheral nerve stimulation. A blinded, randomized clinical trial. Eur J Clin Invest 2024; 54:e14091. [PMID: 37675595 DOI: 10.1111/eci.14091] [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: 04/13/2023] [Revised: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND The vasculature function is mainly regulated by the autonomic nervous system. Importantly, the sensory-motor nervous system also innervates peripheral vessels and has the capacity to modulate vascular tone. Here we investigated the effects of electrical stimulation of a mixed nerve trunk on blood flow in deep arteries and muscle perfusion. Our hypothesis is that stimulation of a mixed nerve can modify blood flow. METHODS Twenty-nine healthy participants were included into a randomized-crossover and blinded clinical trial. Each subject received a placebo and two percutaneous peripheral nerve stimulation (pPNS) protocols on the median nerve: Pain Threshold continuous Low Frequency (PT-cLF) and Sensory Threshold burst High Frequency (ST-bHF). Blood flow was then assessed bilaterally using Power Doppler Ultrasonography at the main arteries of the arm, and blood perfusion at the forearm muscles. Afterwards, blood flow was quantified using a semi-automatized software, freely shared here. RESULTS Placebo, consisting in needle insertion, produced an immediate and generalized reduction on peak systolic velocity in all arteries. Although nerve stimulation produced mainly no effects, some significant differences were found: both protocols increased the relative perfusion area of the forearm muscles, the ST-bHF protocol prevented the reduction in peak systolic velocity and TAMEAN of the radial artery produced by the control protocol and PT-cLF produced a TAMEAN reduction of the ulnar artery. CONCLUSIONS Therefore, the arterial blood flow in the arm is mainly impervious to the electrical stimulation of the median nerve, composed by autonomic and sensory-motor axons, although it produces mild modifications in the forearm muscles perfusion.
Collapse
Affiliation(s)
- Nuria Viudes-Sarrión
- Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
- Human Movement Biomechanics Research Group, Deptartment of Movement Sciences, KU Leuven, Leuven, Belgium
- Neuroscience in Physiotherapy (NiP), Independent Research Group, Elche, Spain
| | - Fernando Aleixandre-Carrera
- Neuroscience in Physiotherapy (NiP), Independent Research Group, Elche, Spain
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
| | - Patricia Beltrá
- Neuroscience in Physiotherapy (NiP), Independent Research Group, Elche, Spain
- Physical Therapy Department, Valencia University, Valencia, Spain
| | - Francisco Javier Ortega
- Physical therapy and advanced rehabilitation clinic RehAv Elche, Elche, Spain
- Physical Therapy Department, Health Sciences Faculty, CEU-Cardenal Herrera University, CEU Universities, Elche, Spain
| | - Francisco Javier Molina-Payá
- Physical Therapy Department, Health Sciences Faculty, CEU-Cardenal Herrera University, CEU Universities, Elche, Spain
| | - Enrique Velasco
- Neuroscience in Physiotherapy (NiP), Independent Research Group, Elche, Spain
- Laboratory of Ion Channel Research, Department of Cellular and Molecular Medicine, KU Leuven; VIB-KU Leuven Center for Brain & Disease Research, Leuven, Belgium
| | - Miguel Delicado-Miralles
- Neuroscience in Physiotherapy (NiP), Independent Research Group, Elche, Spain
- Instituto de Neurociencias de Alicante, Universidad Miguel Hernández-CSIC, San Juan de Alicante, Spain
| |
Collapse
|