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Objective: Diabetic foot ulcers (DFUs) are complications of diabetes mellitus. COVID-19 pandemic has massively impacted human health. We studied effect of COVID-19 on outcome of DFUs. Method(s): We recruited 483 people with DFU from June 2020-April 2022 (pandemic group) together with a matched group of 227 people with DFU from March 2019-March 2020 (pre-pandemic group). Matching was done with respect to glycemic control (Average HbA1c in pandemic group 9.15%;pre-pandemic group 8.92%), and renal status. Primary endpoint was outcome of ulcers- healed or undergone amputation. Primary outcome was further sub analyzed in the 3 waves of COVID-19 Secondary endpoint was healing of individual types of DFUs. Basic anthropometric data with site, nature and Wegner's grading of DFUs were collected. Diagnosis of peripheral neuropathy was done by monofilament testing and peripheral arterial disease by handheld Doppler and ABI. Standardized treatment protocol including glycemic control, infection control, debridement, dressing, offloading was provided. All patients were monitored for >6 months. Result(s): In pandemic cohort of 483 patients 323(66.9%) patients had healed ulcers, 70(14.5%) had minor amputation, 11(2,2%) had major amputation, 29(6%) lost to follow up, 22(4.6%) had not healed and 28 are in follow up (5.8%). Rate of healing of DFU in pandemic group was higher (66.9%) than control group (53.5%). Similarly, rate of amputation in pandemic group was less (16.7%) than pre-pandemic group (23.4%). Among healed ulcers in pandemic group, non-infected neuropathic ulcers healed better (77.8%;199/256) than other types (54.6%;124/227) [p< 0.00001]. Similarly, rate of amputation (major/minor) in ischemic and neuroischemic ulcers in pandemic group was more (32.3%;11/34) than other types (15.6%;70/449) [p= 0.011]. Rate of healing of foot ulcers in 1st wave was 65.4% (53/81), 2nd wave 75.2% (158/210), 3rd wave 58.3% (112/192). Neuropathic ulcers though less prevalent in first two waves (49.8%;145/291) than 3rd wave (57.8%;111/192) healing rate was more in first two (79.3%;115/145 vs 75.6%;84/111). [p=0.488 (statistically not significant]. Ischemic and neuroischemic ulcers were more in 3rd wave (7.8%;15/192) than first two waves (6.5%;19/291) and undergone more amputation (46.7%;7/15 vs 15.7%;3/19). [p=0.58 (statistically not significant;due to small sample size]. Discussion/Conclusion: COVID-19 pandemic (mainly first two waves) accounted for travel restrictions contributing to better healing of neuropathic ulcers whereas ischemic and neuroischemic ulcers worsened and underwent more amputation as patients could not seek intervention. Conversely, in third wave withdrawal of COVID restrictions lead to worsening of DFUs leading to less healing and more amputation.Copyright © 2023
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This editorial accompanies "Diabetes-Related Major and Minor Amputation Risk Increased During the COVID-19 Pandemic," by Dominick J. Casciato, DPM, Sara Yancovitz, DPM, John Thompson, DPM, Steven Anderson, DPM, Alex Bischoff, DPM, Shauna Ayres, MPH, CHES, and Ian Barron, DPM, available at https://doi.org/10.7547/20-224.
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BACKGROUND: Along with significant case transmission, hospitalizations, and mortality experienced during the global Sars-CoV-2 (COVID-19) pandemic, there existed a disruption in the delivery of health care across multiple specialties. We studied the effect of the pandemic on inpatients with diabetic foot problems in a level-one trauma center in Central Ohio. METHODS: A retrospective chart review of patients necessitating a consultation by the foot and ankle surgery service were reviewed from the first 8 months of 2020. A total of 270 patients met the inclusion criteria and divided into pre-pandemic (n = 120) and pandemic groups (n = 150). Demographics, medical history, severity of current infection, and medical or surgical management were collected and analyzed. RESULTS: The odds of undergoing any level of amputation was 10.8 times higher during the pandemic versus before the pandemic. The risk of major amputations (below-the-knee or higher) likewise increased with an odds ratio of 12.5 among all patients in the foot and ankle service during the pandemic. Of the patients undergoing any amputation, the odds for receiving a major amputation was 3.1 times higher than before the pandemic. Additionally, the severity of infections increased during the pandemic and a larger proportion of the cases were classified as emergent in the pandemic group compared to the pre-pandemic group. CONCLUSIONS: The effect of the pandemic on the health-care system has had a deleterious effect on people with diabetes-related foot problems resulting in more severe infections, more emergencies, and necessitating more amputations. When an amputation was performed, the likelihood it was a major amputation also increased.Editor's Note: This Original Article accompanies "Diabetes-Related Amputations: A Pandemic within a Pandemic," by Lee C. Rogers, DPM, Robert J. Snyder, DPM, and Warren S. Joseph, DPM, FIDSA, available at https://doi.org/10.7547/20-248.
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BACKGROUND: A decrease in the frequency of amputations due to diabetic foot syndrome (DFS) is one of the parameters that determine the quality of medical care for patients with diabetes mellitus. AIM: Our aim was to study the indicators characterizing medical care for patients with lower limb pathology in diabetes mellitus in St. Petersburg from 2010 to 2021. MATERIALS AND METHODS: Annual reports on the treatment of patients with DFS in city hospitals specializing in the surgical treatment of DFS and in outpatient offices <<Diabetic foot>> (DFO) from 2010 to 2021 were analyzed. RESULT(S): The average number of patients per year admitted to the DFO was 18,527 (34,440 visits). Proportion of patients with foot ulcers - 8,9%, with Charcot's arthropathy - less than 1%. Before 2020, the frequency of above the foot amputations decreased from 48.3% to 8.6%, hospital mortality - from 11.7 to 5.7%, the number of revascularizations increased from 37 to 642 per year. The increase in operational activity was not accompanied by a decrease in the frequency of amputations (59.3% in 2019). Of all amputations, 11.3% were patients referred from DFO. During the epidemic, the number of visits and patients admitted to the DFO decreased by 27,3% and 31%, respectively. The proportion of foot ulcers and the frequency of amputations have not changed. Inpatient care was characterized by a decrease in operational activity, a decrease in the availability of revascularization, a 2-fold increase in the proportion of high amputations and an increase in hospital mortality from 5.7% in 2019 to 14.9% in 2021. CONCLUSION(S): An analysis of the statistics of specialized care for patients with DFS over 12 years showed the reduction of the frequency of high amputations, but revealed an increase in the frequency of surgical interventions in DFS against the background of an almost unchanged proportion of amputations in the structure of all operations. Despite significant quantitative indicators, the outpatient service seems to be insufficiently effective in reaching the target population. The negative impact of the epidemic has led to a significant increase in the frequency of high amputations and mortality. Copyright © Endocrinology Research Centre, 2022.
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BACKGROUND: A decrease in the frequency of amputations due to diabetic foot syndrome (DFS) is one of the parameters that determine the quality of medical care for patients with diabetes mellitus. AIM: Our aim was to study the indicators characterizing medical care for patients with lower limb pathology in diabetes mellitus in St. Petersburg from 2010 to 2021. MATERIALS AND METHODS: Annual reports on the treatment of patients with DFS in city hospitals specializing in the surgical treatment of DFS and in outpatient offices <<Diabetic foot>> (DFO) from 2010 to 2021 were analyzed. RESULT(S): The average number of patients per year admitted to the DFO was 18,527 (34,440 visits). Proportion of patients with foot ulcers - 8,9%, with Charcot's arthropathy - less than 1%. Before 2020, the frequency of above the foot amputations decreased from 48.3% to 8.6%, hospital mortality - from 11.7 to 5.7%, the number of revascularizations increased from 37 to 642 per year. The increase in operational activity was not accompanied by a decrease in the frequency of amputations (59.3% in 2019). Of all amputations, 11.3% were patients referred from DFO. During the epidemic, the number of visits and patients admitted to the DFO decreased by 27,3% and 31%, respectively. The proportion of foot ulcers and the frequency of amputations have not changed. Inpatient care was characterized by a decrease in operational activity, a decrease in the availability of revascularization, a 2-fold increase in the proportion of high amputations and an increase in hospital mortality from 5.7% in 2019 to 14.9% in 2021. CONCLUSION(S): An analysis of the statistics of specialized care for patients with DFS over 12 years showed the reduction of the frequency of high amputations, but revealed an increase in the frequency of surgical interventions in DFS against the background of an almost unchanged proportion of amputations in the structure of all operations. Despite significant quantitative indicators, the outpatient service seems to be insufficiently effective in reaching the target population. The negative impact of the epidemic has led to a significant increase in the frequency of high amputations and mortality. Copyright © Endocrinology Research Centre, 2022.
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Renalase is a mono amine oxidase enzyme that can metabolise the active catecholamines in the body. Renalase is typically expressed in the cardiovascular system, skeletal muscle, and renal system. Renalase gene is important in human diseases and is known to break down catecholamines in the blood. Gene for renalase as extreme frequency of congestive heart failure disease in people with long term renal disease and other disorders was shown to be explained by a protein that is released by the kidney. Recent advances have increased our understanding of its structure, enzymatic activity, mechanisms of action, relationships with human disease states, and potential therapeutic value. An enzyme description of renalase is provided in this review, along with COVID-19 infection. Copyright © 2022, Indian Association of Biomedical Scientists. All rights reserved.
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Background: SARS-COV-2 (COVID-19) pandemic was accompanied by public health orders placing restrictions on healthcare and social systems. Most out-patient based services and GP practices closed face-to-face appointments and transitioned to telehealth. Liverpool High Risk Foot Service (LHRFS) remained functionally open but utilised the Australian clinical triage guide for people with diabetes-related foot disease during COVID-19. Only patient's considered 'highly serious' or 'critical' (i.e. infections' or limb threatening condition) were seen face-to-face. Over this period we anecdotally recognised a significant increase in presentations for Diabetes foot Infections (DFIs). Methods: The South West Sydney Limb Preservation and Wound Research Academic unit established a clinical registry in 2018. All data is prospectively entered into REDCap including demographic, laboratory, outcome and clinical data. Infection presentations to the HRFS recorded in terms of an infection episode, hence one patient may have multiple events of infection. In order to capture the increased activity of COVID-19 we plan to collect from 2020 through June 2022. Pre-COVID data will be from 2018 to early 2020. Results: We will report the number of DFI events by month and year for 2018-2022 and analyse trends of COVID restrictions to determine if this affected the number and severity of DFI events. Conclusion: COVID-19 public health orders limited access to care. We will conclude if this affected people with foot ulcers accessing timely care and if this caused an increase in the number of infections.
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Purpose/Objectives: The increase in life expectancy in recent years is closely related to scientific advances in health area. Thus, longevity led to a greater emergence of chronic diseases, such as diabetes mellitus (DM). In this scenario, chronic wounds represent a serious public health problem. It is estimated that 85% of lower extremity amputations in individuals with DM are related to the presence of foot ulcers. The perception of changes in the skin, such as deformities, superficial traumas and cracks, is impaired in diabetics due to loss of sensitivity, predisposing the appearance of wounds. Ulcers and other injuries can be prevented through simple measures, such as regular skin inspection, specialized care and the use of adequate footwear;as the greater understanding of self-care, the greater the benefits of treatment. In this sense, Primary Care is an effective mean of assisting such individuals, as health education actions can be carried out for this population, their families and caregivers, with a view of promoting health. In addition, the health education process must take place in parallel with medication and dressings, which are essential, especially the latter, given the specificity of the product and the level of tissue regeneration. The primary objective of this study is to present the educational activities developed by the Extension Project Physiotherapy in the Community of the State University of Paraíba in partnership with the research project Tissue Engineering in Epithelial Repair: Biodegradable Scaffold for Tissue Regeneration, which is developing chitosan/Jatropha mollissima scaffolds, in the Laboratory of Evaluation and Development of Biomaterials from the Northeast of the Federal University of Campina Grande. Methodology: The participants consisted of users of Basic Health Units (BHU) in the city of Campina Grande/Paraiba/Brazil. The educational material on Diabetes and Diabetic Foot Wound Care was produced from documents such as articles, guidelines and booklets. The CANVA application was used to create the images and infographics, to facilitate the understanding of the participants, and it was sent along with an explanatory audio. The disclosure took place on the public profile on Instagram @fisionacomunidadeuepb and also through the WhatsApp application for the diabetic elderly who participate in the project, in addition to face-to-face meetings at BHU, to clarify doubts at previously scheduled times and with a limited number of people due to the covid 19 pandemic. Results: The results included a greater understanding of the process of illness and wound development, as well as awareness of the importance of adherence to treatment and care in the use of dressings, especially. According to the records, the participation in the means used was intense, which suggests that these people will also be multipliers in the health education process. Conclusion/Significance: It is concluded that health education strategies, even at the time of a pandemic, are useful in the process of correct information dissemination, helping the most vulnerable population to understand their disease and, at the same time, help them in self care and responsibility, thus facilitating the intervention used by the health and engineering team.
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The successful development and implementation of any healthcare technology requires input from multiple stakeholders including clinical leads, trust information technology directorates as well as project management and procurement. In this process however, a key stakeholder that is often overlooked is the patient.This paper illustrates the crucial importance of patient involvement to avoid poor design and poor uptake of technology and subsequently poor health outcomes.To highlight this, we share a case example evidencing involvement of people with lived experience of foot ulcers resulting from Diabetic foot neuropathy throughout identification of unmet technology needs, design requirements for the device and iterative device development and evaluation.
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Diabetes Mellitus , Diabetic Foot , Biomedical Technology , Diabetic Foot/therapy , Humans , Respect , TechnologyABSTRACT
AIM: To establish outcomes of a priority setting partnership between participants with diabetes mellitus and clinicians to identify the top 10 research priorities for preventing and treating diabetic foot ulcers (DFUs). METHODS: Due to the COVID-19 pandemic, the James Lind Alliance Priority Setting Partnership process was adapted into a digital format which involved a pilot survey to identify understandable uncertainties with high relevance for participants tested by calculating the content validity index; a main survey answered by 53 participants living with diabetes and 49 clinicians; and a final digital workshop to process and prioritise the final top 10 research priorities. RESULTS: The content validity index was satisfactory for 20 out of 25 uncertainties followed by minor changes and one additional uncertainty. After we processed the 26 uncertainties from the main survey and seven current guidelines, a list of 28 research uncertainties remained for review and discussion in the digital workshop. The final top 10 research priorities included the organisation of diabetes care; screening of diabetes, impaired blood circulation, neuropathy, and skin properties; vascular surgical treatment; importance of self-care; help from significant others; pressure relief; and prevention of infection. CONCLUSION: The top 10 research priorities for preventing and treating DFUs represent consensus areas from persons living with diabetes and clinicians to guide future research. These research priorities can justify and inform strategic allocation of research funding. The digitalisation of James Lind Alliance methodology was feasible.
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Biomedical Research , COVID-19 , Diabetes Mellitus , Diabetic Foot , COVID-19/therapy , Diabetic Foot/prevention & control , Health Priorities , Humans , Pandemics , Surveys and QuestionnairesABSTRACT
The COVID-19 pandemic has inhibited the practice of diabetic foot ulcer care, particularly in the community. Comprehensive theory-based nursing care is needed to prevent further complications. Unfortunately, a study combining theory with nursing care in diabetic foot ulcer care has not been explored. When caring for patients with diabetic foot ulcers, who are also at increased risk of severe complications from COVID-19, it is important to take a holistic view of the patient and consider all of their needs and the factors affecting them. Henderson's Need Theory and the 14 basic needs contained within it was chosen to be integrated in the care of patients with diabetic foot ulcers during the pandemic, with the hope that the findings will help nurses to optimise care in both hospital-based and community practice.
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COVID-19 , Diabetes Mellitus , Diabetic Foot , Nursing Care , Diabetic Foot/prevention & control , Humans , Nursing Theory , Pandemics/prevention & controlABSTRACT
Objective. The COVID-19 pandemic continues to wreak havoc in all sectors of society one year after it was declared by the World Health Organization. This retrospective study aims to describe the clinical picture, management, and initial outcomes of patients with infected diabetic neuro-ischemic foot ulcerations (NIFU) afflicted with SARS-CoV-2 managed at a government tertiary hospital during the pandemic;and to compare those who survived from those who did not from this combination of diseases. Methods. Chart review of patients with combined infected diabetic NIFU and COVID-19, admitted at the Philippine General Hospital serving as a COVID-19 referral center, from April 1 to December 31, 2020 was performed. Data collected included patient demographics, clinical presentation including NIFU grade and stage, and severity of COVID-19, coagulation and inflammatory laboratory results, management, and initial outcomes. Results. A total of 59 patients with diabetic foot ulcer were co-managed by the Department of Orthopedics during this period of the pandemic. Nine of these patients were COVID-19 positive of which six patients did not survive their illness. The non-survivors were slightly older (58.33 vs. 52.67 y/o), had more co-morbidities, and presented with more severe COVID-19 (3 patients had critical COVID-19) than the survivors. All nine patients had deranged coagulation parameters including elevated D-dimer levels, and elevated inflammatory markers (CRP, Ferritin, LDH). Procalcitonin levels were increased in four of the non-survivors, and normal in all three survivors. Seven of the patients had severe (Grade II or III) and infected/ischemic (Stage B or D) NIFUs that required surgery;however, two patients succumbed to their illness prior to any surgery. Four of the six non-survivors died due to acute myocardial infarction. Conclusion. The presence of NIFU and COVID-19 in a patient generally results in progression to a turbulent hospital course. This is due to the hypercoagulable and hyperinflammatory states that each disease entity produces, which when combined, are exacerbated. Levels of D-dimer and inflammatory markers, especially procalcitonin, may be used as a predictor of poor outcome, even mortality, in this group of patients. © 2022 University of the Philippines Manila. All rights reserved.
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Background: The COVID-19 pandemic necessitated dramatic changes in the healthcare delivery to diabetic foot people requiring technologic solutions. Aim: To analyze the current status and trends of scientific publications on telehealth for people with diabetic foot in Web of Science (WoS). Method: A bibliometric-type methodology was used. Data were obtained from the WoS Core Collection in July 2021. Publication were identified using relevant search terms (“diabetic”, “tele*”, “Foot ulcer*”). There was no limitation of language considering that study seeks to present a global historical panorama. VOSviewer Software was used to analyze standard bibliometric data on the number of publications, journals, authors, countries, institutions, collaborations and keywords. Results: A total of 65 documents were retrieved from 2003 to 2020. The number of publications on the subject showed a steadily increase from 2003 to 2020, with a sudden peak in 2020 which reached 14 accounting for 21,5% of the total. The top 3 most active journals and authors and the most cited ones are shown in Table 1. The three countries that published the most were the United States of America (15), followed by Denmark (9) and Norway (7). The countries with the most citations were the United States of America (168), Denmark (135) and Netherlands (130). The top 3 most cited institutions were University of Amsterdam (130), Ziekenhuis Groep Twente (110) and Stavanger University Hospital (96). We identified 5 clusters connected by the authors Armstrong D.G, Van Netten J.J and Bus S. The four most frequently used keywords were “telemedicine” (29), care (13), “diabetic foot” (12) and “telehealth” (11). [Formula presented] Discussion: The findings from this bibliometric study showed that telehealth technologies are an emerging area in clinical research publications as a strategy for the continuity of care for diabetic foot people. Since 2003, an increasing number of publications were identified on WoS, mainly in 2020, possibly related to the need for new approaches and healthcare delivery due to the COVID-19 pandemic.
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Background: When a person with diabetes (PwD) develops a foot problem there is often a delay in receiving specialist help, which may result in amputation and health care professionals (HCP) may be accused of medical negligence. Aim: Our aims were to develop an educational tool to recognise the warning signs of foot complications that might lead to amputation and to disseminate the tool and seek endorsement. Method: The delay to specialist help was analysed by the iDEAL group (Insights for Diabetes Excellence, Access and Learning), a multidisciplinary team of diabetes specialists together with a person with diabetes and recommendations were made. Results: An acronym ACT NOW has been devised to act as an educational tool ACT NOW stands for Accident (recent trauma to foot) Change in colour or shape, Temperature change -hot or cold, New pain, Oozing and Wound. The acronym was devised firstly, to help PwD and HCPs recognise the warning signs of foot complications, leading to potential amputation, and secondly, to trigger early and prompt referral to specialist care. On recognising one or more of these features, the PwD can gain confidence, especially during the COVID 19 pandemic, to seek specialist help either directly from a diabetes foot service or through a first contact HCP who can then refer. An ACT NOW tool was also created consisting of the acronym and a a checklist which prompts the PwD, their carers and HCPs to enquire and document the ACT NOW! symptoms or signs and to take possible further information such as a digital photo. The checklist can then be used as a document to facilitate referral to specialist care. Alternatively, the check list can be used when PwDs present for routine assessment with their HCPs. The ACT NOW tool has been disseminated through digital and traditional media and endorsement granted from many organisations, including the IDF. Discussion: Foot ulcers are highly susceptible to infection which can spread rapidly, causing overwhelming tissue destruction or gangrene, necessitating major amputation. The progression from an initial ‘scratch’ to gangrene can take as little as 48 hours. A lack of knowledge and education can lead to a lack of urgency among PwD, carers and HCPs, who may not recognise that they have a foot related problem requiring urgent referral or care interventions. If there are difficulties in accessing a HCP appointment, there is a risk of critical delay in PwD receiving appropriate assessment and treatment. ACT NOW is designed to promote timely referral and save limbs. iDEAL seeks to reduce amputations by 50% in 5 years by encouraging people to use ACT NOW. Prompt assessment and early referral can help reduce this unnecessary suffering. ACT NOW also seeks to reduce stigma often experienced by PwD regarding complications and remove any blame or shame associated with diabetes complications. These changes can be created through encouraging and enabling an environment of education, knowledge and trust using language that enables PwD.
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Aims: The National Institute for Health and Care Excellence recommend that all adult patients with diabetes should have a foot examination 'on any admission to hospital'. However, a 2013 Scotland-wide audit highlighted that this was not being done for over half of patients, with growing concern about hospital-acquired foot ulceration. A similar audit was conducted at a district general hospital in 2021, to assess for any improvement. Method: A 'snap shot' study was performed, identifying all inpatients with diabetes in the general medicine department at St John's Hospital, Livingston, on the 11th February 2021. Data were collected from patient notes including age, HbA1c, last documented foot risk, and any recorded inpatient diabetic foot examination up until the study date. 14 of these patients then underwent a diabetic foot examination. Results: 51 patients with diabetes were identified, 90% of whom had type 2 diabetes. The average age was 73.7 years (SD ± 13.9 years), and the average HbA1c was 65mmol/ mol (SD ± 18.7mmol/mol). 66% had low foot risk on last examination. Only 8% had a diabetic foot examination documented this admission. Of the 14 patients examined during this study, half had evidence of neuropathy, and two had active foot ulcers. Conclusions: This audit demonstrates that there is still much progress to be made in inpatient diabetic footcare. Furthermore, the covid-19 pandemic has likely had an impact both on foot screening and access to podiatry services, making it even more vital to be diligent with foot examinations.
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Multiple clinical trials and real-world studies have demonstrated accelerated healing in diabetic foot ulcers (DFU) treated with advanced modalities, such as topical oxygen therapy (TOT). In addition to healing, the durability of wound closure is a crucial long-term endpoint for DFU clinical trials: an advanced treatment that does not confer a reasonable ulcer-free period will have limited clinical benefit and modest economic value. Preclinical studies suggest that DFUs receiving topical oxygen therapy will experience improved quality of healing: increased collagen deposition and angiogenesis. It is postulated that these changes will translate into a more long-lasting closure for ulcers treated with TOT and SOC compared to ulcers treated with SOC alone. At the conclusion of a recently completed randomised controlled DFU clinical trial evaluating the efficacy of TOT and SOC compared to SOC alone, patients with healed ulcers were asked to enrol in a long-term follow-up study. Healed patients completed four questionnaires through text messages or phone calls within 1-year post completion of the trial. Twenty-nine patients consented to participate in the long-term follow-up trial (17 TOT/SOC and 12 SOC). Only seven subjects were lost to follow up (5 TOT and 2 SOC). This is a surprisingly low number when factoring in the disruption caused by the COVID-19 pandemic that continued throughout the entire follow-up period. In the remaining patients, 85% of the TOT patients and 60% of the SOC remained healed at 1 year. There was one major amputation, which occurred in an SOC-treated patient. The numbers in the long-term follow-up were too small to reach statistical significance; however, there is a strong trend toward more durable closure in ulcers treated with TOT.
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COVID-19 , Diabetes Mellitus , Diabetic Foot , Humans , Diabetic Foot/drug therapy , Oxygen/therapeutic use , Standard of Care , Follow-Up Studies , Pandemics , COVID-19/therapy , Treatment OutcomeABSTRACT
BACKGROUND: Diabetic foot ulcer (DFU) is one of the most terrifying diabetic complications for patients, due to the high mortality rate and risk for amputation. During the COVID-19 pandemic, many diabetic patients limited their visits to the hospital, resulting in delays for treatment especially in emergency cases. OBJECTIVE: This study aimed to compare the characteristics of patients with DFU pre- and during COVID-19 pandemic period. Methods: This study was a retrospective cohort study using foot registry data. We compared our patients' characteristics pre-COVID-19 pandemic period (1 March 2019-28 February 2020) and during COVID-19 pandemic period (1 March 2020-28 February 2021). RESULTS: Cohorts of 84 and 71 patients with DFU pre- and during COVID-19 pandemic period, respectively, were included in this study. High infection grade (66.7% vs 83.1%, P = .032), osteomyelitis event (72.6% vs 87.3%, P = .04), leukocyte count (15 565.0/µL vs 20 280.0/µL, P = .002), neutrophil-to-lymphocyte ratio (7.7 vs 12.1, P = .008), waiting time-to-surgery (39.0 h vs 78.5 h, P = .034), and number of major amputation (20.2% vs 39.4%, P = .014) were significantly higher during the COVID-19 pandemic period. CONCLUSION: During the COVID-19 pandemic, patients with DFU had more severe infection, higher proportion of osteomyelitis, longer waiting time for getting surgical intervention, and higher incidence of major amputation.
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COVID-19 , Diabetes Mellitus , Diabetic Foot , COVID-19/epidemiology , Diabetes Mellitus/epidemiology , Diabetic Foot/surgery , Diabetic Foot/therapy , Hospitals , Humans , Indonesia/epidemiology , Pandemics , Referral and Consultation , Retrospective Studies , Risk FactorsABSTRACT
During the different waves of the coronavirus (COVID-19) pandemic, there has been an increased incidence of diabetes mellitus and diabetic foot infections. Among gram-negative bacteria, Pseudomonas aeruginosa is the predominant causative agent for diabetic foot ulcer infections in low-resource countries. P. aeruginosa possesses a variety of virulence factors, including biofilm formation. Biofilm formation is an important benchmark characteristic in the pathophysiology of diabetic foot ulceration. The main objective of the current study was to identify the most commonly isolated organisms and their antibiotic susceptibility patterns in diabetic foot patients during the COVID-19 pandemic. We also determined the genes associated with bacterial persistence and biofilm formation in the predominantly isolated organism. Accordingly, 100 wound swab samples were collected from diabetic foot patients from different hospitals in Alexandria, Egypt. Through phenotypic detection of biofilm formation, 93% (40) of the 43 P. aeruginosa isolates examined were categorized as biofilm producers. Molecular detection of the biofilm-encoding genes among the 43 P. aeruginosa isolates was as follows: algD (100%), pelF (88%) and pslD (49.7%), and this highlights a need for biofilm formation inhibitors to prevent the persistence of bacterial pathogens, and thus achieve better clinical outcomes in diabetic foot ulcer infections. [ FROM AUTHOR] Copyright of Journal of Pure & Applied Microbiology is the property of Dr. M. N. Khan and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)