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Fulltext The physiological, biochemical and quality of life changes in chronic diabetic foot ulcer after hyperbaric oxygen therapy

Mohd Yazid, B., Ayesyah, A., Mohd Rohaizat, H., Nurhanani, A. B.

Medicine & Health, 2017;12(2):210-219.
MyJurnal

Hyperbaric oxygen therapy (HBOT) was established to increase oxygenation and antimicrobial effect that potentially improve the healing of chronic ulcer. Present study aim to assess the effects of HBOT in chronic diabetic foot ulcer (DFU). A total of sixty patients classified according to Wagner 1, 2 or 3 chronic diabetic foot ulcers, were recruited and subsequently divided randomly into two groups; HBOT and control group. All patients underwent the standard treatment for DFU, but for the HBOT group, underwent 20 HBOT sessions, each lasted 80 – 90 mins at 2.5 atmospheres absolute (ATA). White cell count (WCC) and C-reactive protein (CRP) levels were taken during inclusion, at second and fourth week of treatment. Wound sizes were documented at each follow up until six months follow up. SF-36 at one-month post hyperbaric oxygen therapy was used to measure the health-related quality of life. Reduction of WCC and CRP in HBOT group were significant throughout the treatment (p=0.046 and p=0.039, respectively). A total of 26 patients (86.7%) from the HBOT group achieved complete ulcer healing at six months’ follow-up, while 18 patients (60%) in the control group’s ulcer healed completely. Patients treated with HBOT had significantly better mental and physical health constituent of quality of life. It must be emphasised that HBOT is an adjunctive therapy to the standard management of chronic DFU in accelerating wound healing for a better quality of life.
Keywords: oxygenation, quality of life, wound healing

Matched MeSH terms: Foot Ulcer*
Fulltext Efficacy of Topical Wound Oxygen Therapy in Healing Chronic Diabetic Foot Ulcers: Systematic Review and Meta-Analysis

Carter MJ, Frykberg RG, Oropallo A, Sen CK, Armstrong DG, Nair HKR, et al.

Adv Wound Care (New Rochelle), 2023 Apr;12(4):177-186.
PMID: 35593010 DOI: 10.1089/wound.2022.0041

Objective: To conduct a systematic review and meta-analysis of recently published randomized controlled trials (RCTs) that employed the use of topical oxygen therapy (TOT) as an adjunct therapy in the treatment of Wagner 1 and 2 diabetic foot ulcers. Approach: Following a literature search of eligible studies from 2010 onward, four RCTs were included. Studies were analyzed for patient and wound characteristics, outcomes, risk of bias, and quality of the evidence assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. A random-effects meta-analysis for complete wound healing was carried out due to statistical heterogeneity of included studies. Results: Risk of bias judgment (RoB2 analysis) resulted in one low-risk trial and three trials with some risk. One study was determined to be the origin of the statistical heterogeneity. Pooled results showed statistical significance with a risk ratio (RR) of 1.59 (95% confidence interval [CI]: 1.07-2.37; p = 0.021). Sensitivity analysis, based on imputed values for missing outcomes, demonstrated that both the RR and 95% CIs changed little. The GRADE ratings for each domain were as follows: (a) risk of bias: moderate (3); (b) imprecision: moderate (2), high (1); (c) inconsistency: low (2), high (1); (d) indirectness: moderate (2), high (1); and (e) publication bias: moderate (1), high (2). Overall, the evidence was moderate. Innovation: Our study shows that TOT is a viable diabetic foot ulcer therapy. Conclusions: These data support the use of TOT for the treatment of chronic Wagner 1 or 2 diabetic foot ulcers in the absence of infection and ischemia.

Matched MeSH terms: Foot Ulcer*
Fulltext The psychological impact of diabetic limb problems

Bahari R

International Medical Journal Malaysia, 2015;14(2):3-8.
MyJurnal

Limb problem is a common complication for patients with diabetes. While the impact of diabetic limb problems
on physical health is well known, the psychological impact of the condition is still largely unknown. People with
diabetes with or without foot ulcers frequently suffer from major depressive disorder, and this is made worse
by the presence of limb complications. Furthermore, depression itself can have negative consequences on the
person’s diabetes. Hence, in caring for people with diabetic foot problem, the psychological sequelae must not
be overlooked but managed accordingly

Matched MeSH terms: Foot Ulcer
Fulltext Foot ulcers and their association with diabetic Charcot foot complications

Rahman NA, Fauzi AA, Chung TY, Latif LA, Chan SC

Aust J Gen Pract, 2020 2 3;49(1-2):48-53.
PMID: 32008261 DOI: 10.31128/AJGP-07-19-4991

BACKGROUND AND OBJECTIVES: Diabetic Charcot foot (DCF) can cause gross structural deformities of the foot and ankle. The main objective of this study was to identify complications of DCF and its associated factors.
METHOD: This is a retrospective cohort study. Data on medical background, previous DCF treatment and complications were obtained. Multiple logistic regression analysis was performed to measure factors related to various complications of DCF.
RESULTS: Ninety-eight patient records were retrieved. Of the 83 patients who were still alive, 75.9% (n = 63) had recurrent ulcers, 53.0% (n = 44) had undergone foot surgery and 45.8% (n = 38) had undergone amputation. Patients with a history of recurrent ulcers have the highest predilection to amputation (odds ratio: 8.5; 95% confidence interval: 1.8, 39.1).
DISCUSSION: In terms of DCF complications, foot ulcers are an independent predictor of recurrent foot ulcers, foot surgery and amputation. Regular foot assessment of patients with DCF to prevent ulcers is strongly recommended.

Matched MeSH terms: Foot Ulcer/etiology; Foot Ulcer/physiopathology*
Fifty-Patient Study Evaluating the Efficacy of Modified Collagen With Glycerin in Periwound Skin Management

Nair HKR

Int J Low Extrem Wounds, 2018 Mar;17(1):54-61.
PMID: 29564953 DOI: 10.1177/1534734618762225

The management of chronic nonhealing ulcers pose a great challenge because they are associated with morbidity and increased costs. This report presents the observations of standard management along with application of modified collagen with glycerin (MCG) in the periwound area for management of nonhealing wounds. This observational report included 50 patients (33 male, 17 female) aged 24 to 94 years having nonhealing wounds. All wounds were treated using standard treatment protocols (TIME concept), whereas the periwound severity was assessed using the Harikrishna Periwound Skin Classification (HPSC). All patients received once-daily application of MCG lotion directly in the periwound areas and compression bandaging until there was complete wound healing. Patient compliance was ensured by regular follow-up and counseling. All diabetic patients were counseled to ensure glycemic control during the entire follow-up period. The criteria used for wound healing were based on clinical observation, and proper epithelialization of the wound was the end point. The median age of the wounds was 12.0 weeks (95% CI = 8.00 - 58.08). Majority of the non-healing wounds were diabetic foot ulcers with age of wound between 4 weeks to 15 years. The median time to complete wound healing was 12.71 (95% CI = 10.00-16.67) weeks. Standard treatment protocol of TIME principle with periwound area assessment based on HPSC 2015 and treatment accordingly with topical application of MCG along with additional measures has shown complete healing of nonhealing wounds. However, further large-scale comparative studies are needed to substantiate these effects on a larger population.

Matched MeSH terms: Foot Ulcer/diagnosis; Foot Ulcer/drug therapy*
A preliminary note on the treatment of ulcers with shark liver oil

Velupillay M

Journal of the Malaya Branch of the British Medical Association, 1941;5:34-40.

Matched MeSH terms: Foot Ulcer
Fulltext Sociodemographic and lifestyle factors as the risk of diabetic foot ulcer in the University of Malaya Medical Centre

Misliza A, Mas Ayu S

JUMMEC, 2009;12(1):15-21.
MyJurnal

A case-control study was conducted between November 2005 and May 2007 in the University of Malaya Medical Centre (UMMC), University of Malaya, Kuala Lumpur, Malaysia. The objective of this study was to identify specific socio-demographic and lifestyle factors which were associated with foot ulcer in Type 1 and Type 2 diabetes patients. There were 125 cases and 250 controls by using universal sampling. Diabetic foot ulcer was defined as "the full thickness skin break at least to Grade 1 Wagner Stage, occurring distal to malleoli". The case was defined as the diabetic patient who was newly diagnosed or who has a known case of diabetic foot ulcer and the control was defined as the diabetic patient without active foot ulcer. Data was collected via face-to-face interview using a structured questionnaire. Results showed that diabetic patients at younger age group, 44 years old and less (OR 5.90 95% CI 2.31, 15.10), Indian (OR 3.24 95% CI 1.66, 6.30), and smoker (OR 3.85 95% CI 1.77, 8.35) were the independent risk factor for diabetic foot ulcer.

Matched MeSH terms: Foot Ulcer
Herbs for Effective Treatment of Diabetes Mellitus Wounds: Medicinal Chemistry and Future Therapeutic Options

Hussan F, Yahaya MF, Teoh SL, Das S

Mini Rev Med Chem, 2018;18(8):697-710.
PMID: 28971772 DOI: 10.2174/1389557517666170927155707

The incidence of diabetes mellitus (DM) has increased globally. Various complications such as blindness, nephropathy leading to renal failure, neuropathy, foot ulceration, amputation, and disturbance in autonomic nervous system were reported. Although, allopathy treatment still remains the treatment of choice, there is a need to look at the easy availability, patient compliance and cheaper cost of the drugs used in day-day practice. In this regard, complementary and alternative medicine has a greater role to play. Numerous plant extracts were shown to exhibit antihyperglycemic properties. In the present review, we surfed published literature in Pubmed and google databases with regard to the herbs used for DM wound treatment. We also discuss the possible mechanism of wound healing in DM with regard to advanced glycation end products, inflammation, macrophages, non-leukocytic cells such as keratinocytes, fibroblasts and endothelial cells, matrix metalloproteinase and miRNA. The review opens the door for effective treatment of DM wounds with plant extracts and plan future treatment options.

Matched MeSH terms: Foot Ulcer
Fulltext Depression, anxiety and sexual dysfunction in patients with Diabetes Mellitus with and without Foot Ulcer

Husin H, Sidi H, Baharudin A

International Medical Journal Malaysia, 2017;16(1):53-66.
MyJurnal

Introduction: Anxiety and depression are both associated with increased morbidity in diabetic population, especially those afflicted with foot ulcer, whereas Erectile Dysfunction (“ED”) and Female Sexual Dysfunction (“FSD”) are amongst the common complication found in diabetes. This study aimed to determine the prevalence of anxiety and depression as primary outcome and sexual dysfunction (“SD”) as a secondary outcome in diabetic patients with and without foot ulcer (“DFU”).
Methods: A cross-sectional study was conducted in Hospital Raja Permaisuri Bainun Ipoh, Perak, where 164 diabetic patients were recruited for the purpose of this study. Hospital Anxiety and Depression Scale (“HADS”) were utilised to measure anxiety and depression. International Index for Erectile Function 5 (“IIEF-5”) and the Malay version of Female Sexual Function Index (“MVFSFI”) were used to detect SD. Simple and multiple logistic regressions were referred to in order to evaluate the factors associated with anxiety, depression and SD.
Results: In the group with foot ulcer, 36.8% had depressive and anxiety risk respectively compared to without the foot ulcer, 37.5% and 38.5% respectively. Male gender (AOR=6.3,p=0.002,95%CI 1.975, 20.205) and having lower education status (AOR=6.0,p=0.018,95%CI1.36,26.59,) was associated with foot ulcer. High prevalence of SD found in foot ulcer group (52.6%,p=0.006). Those with depression (OR=4.421,95% CI 1.08,18.16,p=0.039) and male gender (OR=18.42,p<0.01,95%CI5.5,-61.62) predicts present of SD.
Conclusion: Depression and anxiety prevalent were similar for both with and without diabetic foot ulcer. Several significant predictor factors were identified for DFU group, for anxiety and depression risk and for SD in a diabetes patient. Further studies are required to establish the directional nature of this relationship.
Keywords: Depression, Anxiety, Diabetic food ulcer (DFU), Erectile Dysfunction (ED), Female Sexual Dysfunction (FSD)
Study site: outpatient clinic of medical and orthopedic departments in Hospital Raja Permaisuri Bainun (HRPB) Ipoh, Perak, Malaysia

Matched MeSH terms: Foot Ulcer
Fulltext Retrospective study of predictors for foot ulceration among diabetic patients attending Kuala Langat Health Centre from 1999 to 2008

Faridah K, Azmi MT

Malaysian Journal of Community Health, 2009;15(2):43-59.
MyJurnal

Background : Foot ulcers and its complications are an important cause of morbidity and mortality in diabetes. The aim of this retrospective study is to determine the ulcer-free survival in diabetic foot and its relevant predictors in a cohort of diabetic patients in the primary health care setting.
Methods : Data of newly diagnosed diabetics (n=1121) who received treatment in five health centers in the district of Kuala Langat, Selangor between 1st January 1999 until the 30th June 2008 were studied. Information was gathered by reviewing patient’s medical records. All patients were followed until 31st December 2008. The duration of ulcer-free survival was measured from the date of being diagnosed as diabetic until the development of the ulcer.
Results : The total incidence of diabetic foot ulcer was 9.9% (n=111), with an average annual incidence of 1%. The total incidence of amputation was 1.2%. Mean age of being diagnosed having diabetic was 52+10.7 year old and mean age of being diagnosed having diabetic foot ulcer was 54.68+10.16 year old. The mean for overall ulcer-free survival was 99 months (95%CI:96-102). Male gender (LR=6.56; p=0.01), smokers (LR=3.94; p=0.04), low body mass index (LR=4.45; p=0.03), impaired renal function (LR=5.17; p=0.02) and long duration between follow-up (LR=25.10; p

Matched MeSH terms: Foot Ulcer