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1.
JAMA Netw Open ; 5(1): e2142354, 2022 01 04.
Article in English | MEDLINE | ID: covidwho-1604496

ABSTRACT

Importance: Deferred diabetic foot screening and delays in timely care of acute foot complications during the COVID-19 pandemic may have contributed to an increase in limb loss. Objective: To evaluate the association of the COVID-19 pandemic with diabetes-related care measures, foot complications, and amputation. Design, Setting, and Participants: This population-based cohort study included all adult residents of Ontario, Canada, with diabetes and compared the rates of selected outcomes from January 1, 2020, to February 23, 2021, vs January 1, 2019, to February 23, 2020. Main Outcomes and Measures: Comprehensive in-person diabetes care assessment, including foot examination; hemoglobin A1c (HbA1c) measurement; emergency department visit or hospitalization for diabetic foot ulceration, osteomyelitis, or gangrene; lower extremity open or endovascular revascularization; minor (toe or partial-foot) amputation; and major (above-ankle) leg amputation. Rates and rate ratios (RRs) comparing 2020-2021 vs 2019-2020 for each measure were calculated for 10-week periods, anchored relative to onset of the pandemic on March 11, 2020 (11th week of 2020). Results: On March 11, 2020, the study included 1 488 605 adults with diabetes (median [IQR] age, 65 [55-74] years; 776 665 [52.2%] men), and on March 11, 2019, the study included 1 441 029 adults with diabetes (median [IQR] age, 65 [55-74] years; 751 459 [52.1%] men). After the onset of the pandemic, rates of major amputation in 2020-2021 decreased compared with 2019-2020 levels. The RR for the prepandemic period from January 1 to March 10 was 1.05 (95% CI, 0.88-1.25), with RRs in the pandemic periods ranging from 0.86 (95% CI, 0.72-1.03) in May 20 to July 28 to 0.95 (95% CI, 0.80-1.13) in October 7 to December 15. There were no consistent differences in demographic characteristics or comorbidities of patients undergoing amputation in the 2020-2021 vs 2019-2020 periods. Rates of comprehensive in-person diabetes care assessment and HbA1c measurement declined sharply and remained below 2019-2020 levels (eg, in-person assessment, March 11 to May 19: RR, 0.28; 95% CI, 0.28-0.28). The rates of emergency department visits (eg, March 11 to May 19: RR, 0.67; 95% CI, 0.61-0.75), hospitalization (eg, March 11 to May 19: RR, 0.77; 95% CI, 0.68-0.87), open revascularization (eg, March 11 to May 19: RR, 0.66; 95% CI, 0.56-0.79), endovascular revascularization (March 11 to May 19: RR, 0.70; 95% CI, 0.61-0.81), and minor amputation (March 11 to May 19: RR, 0.70; 95% CI, 0.60-0.83) initially dropped but recovered to 2019-2020 levels over the study period. Conclusions and Relevance: In this population-based cohort study, disruptions in care related to the COVID-19 pandemic were not associated with excess leg amputations among people living with diabetes. As the pandemic ends, improved prevention and treatment of diabetic foot complications will be necessary to maintain these positive results.


Subject(s)
Amputation , COVID-19 , Delivery of Health Care/methods , Diabetes Mellitus , Diabetic Foot/surgery , Pandemics , Aged , COVID-19/epidemiology , Cohort Studies , Comorbidity , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Diabetic Foot/epidemiology , Diabetic Foot/therapy , Emergency Service, Hospital , Female , Foot/pathology , Foot/surgery , Glycated Hemoglobin A , Hospitalization , Humans , Male , Middle Aged , Ontario/epidemiology , Physical Examination , SARS-CoV-2 , Vascular Surgical Procedures
2.
Ann Vasc Surg ; 76: 285-288, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1525691

ABSTRACT

The arterial revascularization procedure is still a challenging issue in Covid-19 associated limb ischemia. Herein we aimed to present a case of a 64 year-old woman with acute ischemic signs in upper extremity who was diagnosed as a probable Covid-19 case incidentally after admission. Although late admission and failed recurrent embolectomies lead to an eventful course, intra-arterial thrombolysis seemed to present a benefitable treatment option for our patient.


Subject(s)
COVID-19/complications , Ischemia/etiology , Upper Extremity/blood supply , Acute Disease , Amputation , COVID-19/diagnosis , Embolectomy , Female , Humans , Ischemia/diagnostic imaging , Ischemia/physiopathology , Ischemia/therapy , Middle Aged , Regional Blood Flow , Thrombolytic Therapy , Time-to-Treatment , Treatment Outcome
3.
Ann Vasc Surg ; 76: 289-292, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1525692

ABSTRACT

To describe the case of a young female patient, affected by Systemic Lupus Erythematous, hospitalized for severe SARS-CoV-2 infection pneumonia and presenting a treatment-resistant acute upper limb ischemia. Two days after hospital admission, the patient suffered sudden right upper limb pain associated with mild functional impairment. At physical examination, radial and ulnar pulses were absent, and no flow signal was detected at duplex ultrasound scan. Therefore, an acute limb ischemia diagnoses was posed. Despite several surgical and endovascular revascularization attempts, the patient underwent an above the elbow amputation in 10th postoperative day from first surgical embolectomy, and she died for respiratory failure 25 days after hospitalization. Our case of acute upper limb ischemia seems to confirm that clinical manifestation and fate of thrombotic disorder in COVID-19 patients could be precipitated by concomitant autoimmune diseases.


Subject(s)
COVID-19/complications , Ischemia/etiology , Lupus Erythematosus, Systemic/complications , Upper Extremity/blood supply , Acute Disease , Amputation , COVID-19/diagnosis , COVID-19/therapy , Disease Progression , Embolectomy , Endovascular Procedures , Fatal Outcome , Female , Humans , Ischemia/diagnostic imaging , Ischemia/physiopathology , Ischemia/therapy , Lupus Erythematosus, Systemic/diagnosis , Middle Aged , Treatment Outcome
4.
Microsurgery ; 41(5): 488-497, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1453627

ABSTRACT

PURPOSE: Adults with traumatic digital amputation (TDA) of the hand may be managed with replantation or revision amputation. To date, there is no systematic review evaluating patient reported outcomes (PROs) comparing replantation versus revision amputation. METHODS: Three databases (MEDLINE, EMBASE, and PubMed) were systematically searched in duplicate from inception until June 13, 2019 using Covidence software. Studies comparing replantation versus revision amputation outcomes were considered for inclusion. Methodological quality was assessed using Methodologic Index for Nonrandomized Studies (MINORS) criteria. Data were pooled in a random-effects meta-analysis model using Revman software. Certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). RESULTS: Of 4350 studies identified, 12 retrospective cohort studies met inclusion criteria and compared TDA outcomes for replantation (n = 717; 82.9% male; mean age 40.3) versus revision amputation (n = 1046; 79.8% male; mean age 41.7). The overall replantation survival rate was 85.3%. The average MINORS score was 57% (13.75/24). Replantation of the thumb had a superior Michigan Hand Questionnaire (MHQ) score (+11.88, 95% CI [7.78-15.99], I2 = 21%) compared with revision amputation. Replantation of single non-thumb digits had a superior MHQ score (+5.31, 95% CI [3.10-7.51], I2 = 67%) and Disability of Arm, Shoulder, and Hand (DASH) score (-5.16, 95% CI [-8.27 to -2.06], I2 = 0%) compared with revision amputation. Most patients in the meta-analysis were from Asian populations (87.9%). CONCLUSION: There is low-quality evidence that thumb replantation achieves superior PROs compared with revision amputation, which may be clinically important. Replantation of single non-thumb digits also yielded superior PROs, which is likely not clinically important and based on very low-quality evidence. Future studies with populations outside Asia are required to determine if PROs vary based on cultural differences toward digital amputation.


Subject(s)
Amputation, Traumatic , Finger Injuries , Adult , Amputation , Amputation, Traumatic/surgery , Female , Finger Injuries/surgery , Humans , Male , Patient Reported Outcome Measures , Replantation , Retrospective Studies
5.
Ann Vasc Surg ; 72: 209-215, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1385038

ABSTRACT

BACKGROUND: Both arterial and venous thrombotic events of the extremities occur in coronavirus disease 2019 (COVID-19) infection, but the etiology of these events remains unclear. This study sought to evaluate pathology specimens of COVID-19-positive patients postamputation, who were found to have Rutherford 3 acute limb ischemia requiring amputation. METHODS: A retrospective review was performed of all vascular surgery emergency room and inpatient consultations in patients who presented to the Mount Sinai Health System from March 26, 2020, to May 10, 2020. Pathology specimens were examined using hematoxylin and eosin stain. The specimens were assessed for the following: inflammatory cells associated with endothelium/apoptotic bodies, mononuclear cells, small vessel congestion, and lymphocytic endotheliitis. Of the specimens evaluated, 2 patients with a known history of peripheral vascular disease were excluded. RESULTS: Inflammatory cells associated with endothelium/apoptotic bodies were seen in all 4 patients and in 4 of 5 specimens. Mononuclear cells were found in 2 of 4 patients. Small vessel congestion was seen in all patients. Lymphocytic endotheliitis was seen in 1 of 4 patients. CONCLUSIONS: This study shows endotheliitis in amputation specimens of four patients with COVID-19 disease and Rutherford Class 3 acute limb ischemia. The findings in these patients is more likely an infectious angiitis because of COVID-19.


Subject(s)
Amputation , COVID-19/complications , Endothelium, Vascular/virology , Lower Extremity/blood supply , Lower Extremity/surgery , Thrombosis/surgery , Thrombosis/virology , Acute Disease , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
6.
Ann Vasc Surg ; 75: 140-143, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1340555

ABSTRACT

The incidence of venous and arterial thromboembolic complications in COVID-19 patients is significant. The vast majority of COVID-19 patients spend their quarantine at home in a self-isolation condition. The occurrence of Acute limb ischemia (ALI) is a dangerous event that needs prompt diagnosis and management with time-dependent recanalization outcomes. We present a case series of three COVID-19 patients who suffered from ALI that occurred during home self-isolation, and that were diagnosed and treated with a significant time-delay due to COVID-19 social implications.


Subject(s)
COVID-19/complications , Delayed Diagnosis , Diagnostic Errors , Ischemia/diagnostic imaging , Peripheral Arterial Disease/diagnostic imaging , Acute Disease , Aged , Aged, 80 and over , Amputation , Anticoagulants/therapeutic use , Blood Vessel Prosthesis Implantation , COVID-19/diagnosis , COVID-19/therapy , Embolectomy , Humans , Ischemia/etiology , Ischemia/surgery , Male , Peripheral Arterial Disease/etiology , Peripheral Arterial Disease/surgery , Predictive Value of Tests , Thrombectomy , Thrombolytic Therapy , Time-to-Treatment , Treatment Outcome
7.
Semin Vasc Surg ; 34(3): 89-95, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1313630

ABSTRACT

The COVID-19 pandemic negatively impacted patients with conditions that are associated with significant morbidity, but might not be immediately life-threatening. Patients with chronic limb-threatening ischemia (CLTI) were affected by delays in care, potentially increasing major limb amputations. This study sought to review strategies employed, and limb salvage outcomes reported, during the COVID-19 pandemic. We performed a literature review of the electronic database PubMed from December 2019 to December 2020. Articles subjected to analysis must have had a specific CLTI group before the pandemic to compare to the pandemic group. Case reports, case series, and non-CLTI comparisons were excluded. The literature search yielded 55 articles for review, of which 6 articles met criteria for analysis. The main classifications used for disease stratification included Rutherford, Fontaine, and SVS WIfI (Wound, Ischemia, Foot Infection). Overall, a decrease in vascular clinical volume was reported, ranging from 29% to 54%. A higher major limb amputation rate (2.6% to 32.2%) during the pandemic surge was reported in 5 of 6 publications. Four of 6 studies also reported minor amputations; 3 of these demonstrated an increase in minor amputations (7% to 17.7%). The CLTI population is vulnerable and it appears that both minor and major amputation rates increased in this population during the pandemic. The limited data available in CLTI patients during the COVID-19 pandemic and use of different stratifications schemes in areas impacted to variable extents prevent recommendations for the best treatment strategy. Further data are required to improve strategies for treating this population to minimize negative outcomes.


Subject(s)
COVID-19 , Peripheral Arterial Disease , Amputation , Chronic Disease , Humans , Ischemia/diagnosis , Ischemia/epidemiology , Ischemia/surgery , Limb Salvage , Pandemics , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/epidemiology , Peripheral Arterial Disease/therapy , Retrospective Studies , Risk Factors , SARS-CoV-2 , Treatment Outcome
8.
Diabetes Metab Syndr ; 15(5): 102204, 2021.
Article in English | MEDLINE | ID: covidwho-1306924

ABSTRACT

AIMS: Identify the prevalence, risk factors and outcomes of lower extremity ischemic complications. METHODS: A systematic review was conducted by searching PubMed and SCOPUS databases for SARS-CoV-2, COVID-19 and peripheral arterial complications. RESULTS: Overall 476 articles were retrieved and 31 articles describing 133 patients were included. The mean age was 65.4 years. Pain and gangrene were the most common presentation. Hypertension (51.3%), diabetes (31.9%) and hypercholesterolemia (17.6%) were associated co-morbidities. Overall, 30.1% of patients died and amputation was required in 11.8% patients. CONCLUSIONS: COVID-19 patients with diabetes or hypertension are susceptible for lower limb complications and require therapeutic anti-coagulation.


Subject(s)
COVID-19 , Diabetic Angiopathies , Hypertension , Aged , Amputation/statistics & numerical data , COVID-19/complications , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/therapy , Comorbidity , Diabetes Mellitus/diagnosis , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Diabetic Angiopathies/complications , Diabetic Angiopathies/diagnosis , Diabetic Angiopathies/epidemiology , Diabetic Angiopathies/therapy , Female , Gangrene/diagnosis , Gangrene/epidemiology , Gangrene/etiology , Gangrene/therapy , Humans , Hypertension/complications , Hypertension/diagnosis , Hypertension/epidemiology , Hypertension/therapy , Lower Extremity , Male , Middle Aged , Peripheral Arterial Disease/diagnosis , Peripheral Arterial Disease/epidemiology , Peripheral Arterial Disease/etiology , Peripheral Arterial Disease/therapy , Prevalence , Prognosis , Risk Factors , SARS-CoV-2/physiology
9.
Ann Vasc Surg ; 76: 285-288, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1305205

ABSTRACT

The arterial revascularization procedure is still a challenging issue in Covid-19 associated limb ischemia. Herein we aimed to present a case of a 64 year-old woman with acute ischemic signs in upper extremity who was diagnosed as a probable Covid-19 case incidentally after admission. Although late admission and failed recurrent embolectomies lead to an eventful course, intra-arterial thrombolysis seemed to present a benefitable treatment option for our patient.


Subject(s)
COVID-19/complications , Ischemia/etiology , Upper Extremity/blood supply , Acute Disease , Amputation , COVID-19/diagnosis , Embolectomy , Female , Humans , Ischemia/diagnostic imaging , Ischemia/physiopathology , Ischemia/therapy , Middle Aged , Regional Blood Flow , Thrombolytic Therapy , Time-to-Treatment , Treatment Outcome
10.
Int J Infect Dis ; 106: 401-404, 2021 May.
Article in English | MEDLINE | ID: covidwho-1279606

ABSTRACT

BACKGROUND: For more than a year, health systems all over the world have been combating the global coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first described in the city of Wuhan in China, presenting as an atypical infection of the lower respiratory tract. METHODS: COVID-19 is characterized by multisystemic involvement, and mortality is attributed mainly to the respiratory system involvement, which may lead to severe acute respiratory distress syndrome and respiratory failure. Several COVID-19-associated complications are being increasingly reported, including arterial and venous thromboembolic events that may lead to amputation of the affected limbs. So far, a large number of reports have described hypercoagulability crises leading to amputation of the lower limbs. However, a search of the National Library of Medicine (MEDLINE) revealed no cases of urgent upper limb amputation in COVID-19 patients. RESULTS: This article describes a novel case of upper limb ischemia in a COVID-19 patient, with rapid progression to hand necrosis, requiring urgent through-arm amputation of the upper limb. CONCLUSIONS: This case emphasizes the need for anticoagulant therapy in COVID-19 patients and to maintain a constant awareness of the possible thromboembolic COVID-19-related sequelae.


Subject(s)
COVID-19/complications , Disease Progression , Ischemia/complications , Ischemia/pathology , Upper Extremity/pathology , Amputation , Humans , Ischemia/surgery , Necrosis , Upper Extremity/surgery
11.
Jt Dis Relat Surg ; 32(2): 551-555, 2021.
Article in English | MEDLINE | ID: covidwho-1279005

ABSTRACT

Although novel coronavirus-2019 (COVID-19) primarily affects the respiratory system, it can affect multiple organ systems, leading to serious complications, such as acute respiratory distress syndrome (ARDS) and multiple organ failure. Nearly 20 to 55% of patients with COVID-19 experience coagulation disorders that cause high mortality in line with the severity of the clinical picture. Thromboembolism can be observed in both venous and arterial systems. The vast majority of thromboembolic events are associated with the venous system and are often observed as pulmonary embolism. Arterial thromboembolisms often involve the arteries in the lower extremities, followed by those in the upper extremities. Herein, we report a rare case of COVID-19 pneumonia whose left arm was amputated at the forearm level after arterial thromboembolism in the left upper extremity. This case report is valuable, as it is the first reported case of upper extremity arterial thromboembolism in Turkey, as well as the only case in the literature in which the patient underwent four surgical interventions and is still alive.


Subject(s)
Amputation/methods , Brachial Artery , COVID-19 , Reoperation/methods , Thrombectomy , Thromboembolism , Upper Extremity , Aged , Brachial Artery/diagnostic imaging , Brachial Artery/pathology , COVID-19/blood , COVID-19/complications , COVID-19/diagnosis , COVID-19/therapy , Computed Tomography Angiography/methods , Humans , Male , Recurrence , SARS-CoV-2/isolation & purification , Severity of Illness Index , Thrombectomy/adverse effects , Thrombectomy/methods , Thromboembolism/complications , Thromboembolism/diagnosis , Thromboembolism/etiology , Treatment Outcome , Upper Extremity/blood supply , Upper Extremity/pathology , Upper Extremity/surgery
13.
Ann Vasc Surg ; 75: 140-143, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1245849

ABSTRACT

The incidence of venous and arterial thromboembolic complications in COVID-19 patients is significant. The vast majority of COVID-19 patients spend their quarantine at home in a self-isolation condition. The occurrence of Acute limb ischemia (ALI) is a dangerous event that needs prompt diagnosis and management with time-dependent recanalization outcomes. We present a case series of three COVID-19 patients who suffered from ALI that occurred during home self-isolation, and that were diagnosed and treated with a significant time-delay due to COVID-19 social implications.


Subject(s)
COVID-19/complications , Delayed Diagnosis , Diagnostic Errors , Ischemia/diagnostic imaging , Peripheral Arterial Disease/diagnostic imaging , Acute Disease , Aged , Aged, 80 and over , Amputation , Anticoagulants/therapeutic use , Blood Vessel Prosthesis Implantation , COVID-19/diagnosis , COVID-19/therapy , Embolectomy , Humans , Ischemia/etiology , Ischemia/surgery , Male , Peripheral Arterial Disease/etiology , Peripheral Arterial Disease/surgery , Predictive Value of Tests , Thrombectomy , Thrombolytic Therapy , Time-to-Treatment , Treatment Outcome
15.
Pneumologie ; 75(7): 526-530, 2021 Jul.
Article in German | MEDLINE | ID: covidwho-1192607

ABSTRACT

We present the case of a slightly obese 39-year-old patient with a severe course of COVID-19 pneumonia. The patient was referred from a hospital to regular care with suspected COVID-19 pneumonia. The initial clinical symptoms consisted of dysuria and fever. A bilateral infiltrate was seen in the chest x-ray. In the CT thorax, advanced COVID-19 typical changes were found on both sides. The COVID-19 infection was confirmed by a positive SARS-CoV-2 PCR from the nasopharynx smear. In the case of progressive ARDS with respiratory exhaustion, the patient was intubated and invasively ventilated. When a bacterial superinfection was suspected, we initiated empirical antibiotic therapy. In addition, a therapy with dexamethasone was applied. Therapy with ASA and weight-adapted semi-therapeutic low molecular weight heparin was also carried out. During the intensive care treatment the patient developed a fulminant septic shock with consecutive severe thrombocytopenia. A dilated tracheotomy was performed. The weaning progress was hampered by recurrent septic attacks. Necrosis in the area of ​​the right foot was identified as the cause of the septic relapses. As there was no alternative focus, surgical rehabilitation with partial amputation was carried out. The patient then remained infection-free and could be weaned from the respirator.


Subject(s)
COVID-19 , Shock, Septic , Adult , Amputation , Critical Care , Female , Humans , SARS-CoV-2 , Shock, Septic/diagnosis , Shock, Septic/therapy
16.
Medicina (Kaunas) ; 57(4)2021 Apr 14.
Article in English | MEDLINE | ID: covidwho-1187001

ABSTRACT

About 422 million people worldwide have diabetes and approximately one-third of them have a major risk factor for diabetic foot ulcers, including poor sensation in their feet from peripheral neuropathy and/or poor perfusion to their feet from peripheral artery disease. The current healthcare ecosystem, which is centered on the treatment of established foot disease, often fails to adequately control key reversible risk factors to prevent diabetic foot ulcers leading to unacceptable high foot disease amputation rate, 40% recurrence of ulcers rate in the first year, and high hospital admissions. Thus, the latest diabetic foot ulcer guidelines emphasize that a paradigm shift in research priority from siloed hospital treatments to innovative integrated community prevention is now critical to address the high diabetic foot ulcer burden. The widespread uptake and acceptance of wearable and digital health technologies provide a means to timely monitor major risk factors associated with diabetic foot ulcer, empower patients in self-care, and effectively deliver the remote monitoring and multi-disciplinary prevention needed for those at-risk people and address the health care access disadvantage that people living in remote areas. This narrative review paper summarizes some of the latest innovations in three specific areas, including technologies supporting triaging high-risk patients, technologies supporting care in place, and technologies empowering self-care. While many of these technologies are still in infancy, we anticipate that in response to the Coronavirus Disease 2019 pandemic and current unmet needs to decentralize care for people with foot disease, we will see a new wave of innovations in the area of digital health, smart wearables, telehealth technologies, and "hospital-at-home" care delivery model. These technologies will be quickly adopted at scale to improve remote management of diabetic foot ulcers, smartly triaging those who need to be seen in outpatient or inpatient clinics, and supporting acute or subacute care at home.


Subject(s)
COVID-19 , Diabetes Mellitus , Diabetic Foot , Amputation , Diabetic Foot/prevention & control , Ecosystem , Humans , SARS-CoV-2
17.
Adv Skin Wound Care ; 34(5): 1-4, 2021 May 01.
Article in English | MEDLINE | ID: covidwho-1183033

ABSTRACT

ABSTRACT: In this case report, the treatment of a patient with a diabetic foot ulcer on his left foot was interrupted by the novel coronavirus 2019 pandemic lockdown in India. The author guided the patient via telephone and online services. Based on the history given by the patient, the lesion started as blistering from improperly fitted footwear that then evolved into multiple infected ulcerations on the dorsal surface of the great toe (osteomyelitis with septic arthritis of the joint). Based on a radiograph and other photographs of the foot lesions, the author prescribed amoxicillin/clavulanic acid in combination with linezolid for 2 weeks. Further, the author guided the patient to dress the wound at home using a medical-grade honey-based product. With no option for an outpatient visit, the author guided the patient to use a plastic ruler and place it below the toe during each dressing. Healing (complete epithelialization) was achieved within 4 weeks.


Subject(s)
Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Diabetic Foot/therapy , Honey , Linezolid/therapeutic use , Amputation , Bandages , COVID-19 , Humans , India , Male , Shoes , Telemedicine , Wound Healing
18.
Vasc Endovascular Surg ; 55(7): 781-786, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1181066

ABSTRACT

The optimal management strategy of acute limb ischemia in non-ventilated patients with COVID-19 is uncertain. We propose that non-ventilated patients who develop COVID-19 related spontaneous arterial thrombosis with associated limb threat may be best suited with percutnaeous revascularization to achieve limb salvage. Herein we describe 5 cases of patients who had severely threatened limbs with complete thrombosis of all 3 tibial arteries who were treated with percutaneous revascularization. All 5 patients were felt to be facing inevitable amputation without revascularization should they survive their COVID hospitalization. We were able to achieve limb salvage in all 5 patients selected for therapy, although 2 ultimately succumbed to respiratory failure.


Subject(s)
Angioplasty, Balloon , Arterial Occlusive Diseases/therapy , COVID-19/complications , Ischemia/therapy , Thrombectomy , Thrombolytic Therapy , Thrombosis/therapy , Aged , Amputation , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/etiology , COVID-19/diagnosis , Fatal Outcome , Humans , Ischemia/diagnostic imaging , Ischemia/etiology , Limb Salvage , Male , Middle Aged , Thrombosis/diagnostic imaging , Thrombosis/etiology , Treatment Outcome
19.
Diabet Med ; 38(7): e14577, 2021 07.
Article in English | MEDLINE | ID: covidwho-1165904

ABSTRACT

AIMS/HYPOTHESIS: The aim of this study was to examine the impact of the COVID-19 epidemic on the hospitalization rates for diabetic foot ulcer (DFU), osteomyelitis and lower limb revascularization procedure in people with DFU. METHODS: This nationwide retrospective cohort study included hospital data on all people hospitalized in France for diabetes in weeks 2-43 in 2020, including the COVID-19 lockdown period, compared to same period in 2019. RESULTS: The number of hospitalizations for DFU decreased significantly in weeks 12-19 (during the lockdown) (p < 10-4 ). Hospitalization for foot osteomyelitis also decreased significantly in weeks 12-19 (p < 10-4 ). The trend was the same for lower limb amputations and revascularizations associated with DFU or amputation. CONCLUSIONS/INTERPRETATION: The marked drop in hospitalization rates for DFU, osteomyelitis and lower limb revascularization procedures in people with DFU observed in France during the lockdown period suggests that COVID-19 was a barrier to DFU care, and may illustrate the combined deleterious effects of hospital overload and changes in health-related behaviour.


Subject(s)
COVID-19/epidemiology , Diabetic Foot/epidemiology , Diabetic Foot/therapy , Hospitalization/statistics & numerical data , Quarantine , Aged , Aged, 80 and over , Amputation/statistics & numerical data , Amputation/trends , COVID-19/prevention & control , Cohort Studies , Communicable Disease Control/methods , Epidemics , Female , France/epidemiology , History, 21st Century , Hospitalization/trends , Humans , Lower Extremity/surgery , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/physiology
20.
Ann Vasc Surg ; 74: 80-87, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1163382

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) causes thromboembolic complications during or post-infection period despite a lack of conventional risk factors. The study aims to learn fundamental changes in COVID-19 patients who underwent embolectomy in terms of clinical characteristics and clot composition. METHODS: In a retrospective cohort study design, we evaluated 21 patients who underwent embolectomy in our clinic between March 12, 2020, and December 31, 2020. Demographics, characteristics, and laboratory values were abstracted and analyzed. Histopathological assessment was held in the pathology department. RESULTS: Of these 21 patients, 11 (52.3%) were SARS-CoV-2 positive and 10 (47.6%) were SARS-CoV-2 negative. There is no statistical difference in terms of anatomic distribution, diagnostic method, length of hospital stay, amputation or mortality levels. Thromboembolic material of COVID-19 patients include significantly less red blood cell (RBC) (21.2-32.6%; P= 0.01), more lymphocyte (14.1-2.6%; P< 0.001), and more leukocyte (27.1-22.1%; P= 0.05). There was no statistical difference between the fibrin ratio. CONCLUSIONS: Inflammatory cells are prominent in arterial thromboembolic material of COVID-19 patients. A combination of hyperinflammation and prothrombotic status may be responsible for this phenomenon.


Subject(s)
COVID-19/complications , Inflammation/pathology , Peripheral Arterial Disease/pathology , Thromboembolism/pathology , Adult , Aged , Aged, 80 and over , Amputation , COVID-19/diagnosis , COVID-19/mortality , Embolectomy , Female , Humans , Inflammation/etiology , Inflammation/mortality , Inflammation/surgery , Length of Stay , Limb Salvage , Male , Middle Aged , Peripheral Arterial Disease/etiology , Peripheral Arterial Disease/mortality , Peripheral Arterial Disease/surgery , Retrospective Studies , Risk Assessment , Risk Factors , Thromboembolism/etiology , Thromboembolism/mortality , Thromboembolism/surgery , Time Factors , Treatment Outcome
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