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Robert Frykberg
DPM, MPH
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Aksone Nouvong
DPM
Asst. Editor
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CURRENT ISSUE

Ankle Brachial Index and Transcutaneous Partial Pressure of Oxygen as predictors of wound healing in diabetic foot ulcers
Ankle Brachial Index and Transcutaneous Partial Pressure of Oxygen as predictors of wound healing in diabetic foot ulcers

Peripheral Occlusive Vascular Disease impairs the healing process in diabetic foot ulcers. Ankle Brachial Index is the conventional method of assessing POVD and Transcutaneous Partial Pressure of Oxygen. It is a relatively new measure of assessing microvascular circulation. Our aim was to compare and contrast the utility of ABI and TcPO2 in predicting wound healing in diabetic foot ulcers. The study included 118 diabetic foot ulcer patients who had their ABI and TcPO2 measured. A handheld doppler device measured the ABI, and an electrochemical transducer measured the TcPO2. Wound outcome was classified as either healed or not healed. The mean ABI in the healed group was 0.96±0.24 and 0.61±0.27 (p<0.001) in the not healed group. The mean TcPO2 in the healed group was 33.77±15.51 and 23.29±14.77 (p=0.002) in the not healed group. The agreement rate of ABI with TcPO2 was 59.3%. More than 90% of ulcers with normal ABI and/or TcPO2 healed. With aggressive management of POVD a good percent of wounds with abnormal ABI and/or TcPO2 also healed. By plotting the ROC curve, in our population, an ABI value of 0.77 was found to have 80% sensitivity and 75% specificity, and a TcPO2 value of 22.5 mm Hg was found to have 74.4% sensitivity and 53.6% specificity in predicting wound healing. Both ABI and TcPO2 measured different aspects of POVD and were complementary in predicting wound healing in diabetic foot ulcers. The optimal cut-off values for both measures for our population were also defined.

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A new staging system for cellulitis in diabetic lower limbs – improving diabetic foot practice around the world
A new staging system for cellulitis in diabetic lower limbs – improving diabetic foot practice around the world

The number of diabetic foot complications is rising globally due to the increased incidence of diabetes. Various research, guidelines, and practices in managing diabetic foot are being adopted from the West. In the majority of Asian and African countries, where a large population with diabetes exists, the diabetic foot is often neglected. Geographic differences in diabetic foot disorders, as well as in podiatric surgeon practices, are noticeable. Infectious diseases like cellulitis, abscesses of leg, and necrotizing fasciitis, etc. are known to affect the diabetic lower limbs. When there are relatively few trained and certified podiatric surgeons and diabetic limb salvage specialist, there are also very few research studies on these diseases, particularly in many developing countries, including India. The author, as a practicing diabetic limb salvage sub-specialist, presents a new staging system for cellulitis in diabetic lower limb for the first time. This simple staging system is likely to help standardize the practice of diabetic lower limb salvage worldwide. By including photographic cases in this article, surgeons and specialists will hopefully better understand the new staging system. This will enable them to diagnose dreaded infections like necrotizing fasciitis more confidently in their diabetic lower limb salvage practice.

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Risk factors for diabetic foot ulceration among patients attending primary health care services
Risk factors for diabetic foot ulceration among patients attending primary health care services

Diabetes mellitus is a global health problem with rising prevalence worldwide. Diabetes mellitus is a multi-system disease affecting many systems and tissues. Foot problems, including foot ulcerations, are common with diabetes. Foot ulceration risk factors are based on many factors and may differ from community to community. The objective of the study was to determine diabetic foot ulceration risk factors among Saudi patients with Type 2 diabetes in primary care centers. We designed a cross-sectional study and randomly selected 400 patients. Of the 400, 350 participated and completed a standard assessment form. Of the 350 subjects who participated, 57% were male and 43% were female. The prevalence of peripheral vascular disease was 15%, hallux vulgus was 22.5%, inappropriate foot wear was 41%, and peripheral neuropathy was 47.5%. Peripheral neuropathy and inappropriate foot wear were the most common risk factors for foot ulceration.

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What’s the buzz: bee products and their potential value in diabetic wound healing.
What’s the buzz: bee products and their potential value in diabetic wound healing.

Foot ulceration, secondary to diabetes, is the most common reason for lower limb amputation, accounting for 50-70% of non-traumatic lower limb amputations. Rather than progressing through the usual wound healing phases, diabetic wounds become ‘stuck’, predominantly in the inflammatory phase. Normal feedback mechanisms that conclude the inflammatory stage are short-circuited, and the inflammatory response is upregulated and persistent. Chronic diabetic wounds always have a bacterial load, and the increased tissue bacterial burden may impede healing. Since ancient times, bee-derived products have been used as medicines and as potential wound healing therapies. Their anti-inflammatory and anti-bacterial properties have been widely reported. Honey, propolis, royal jelly, and bee venom have pre-clinical wound healing properties. This review seeks to examine factors that prevent diabetic wound healing and the potential of four bee products to promote diabetic human healing in these wounds. The indication for key clinical trials in this exciting area of bee-derived products is also emphasized.

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