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Pasek J, Szajkowski S, Rokicka D, Wróbel M, Travagli V, Cieślar G. Impact of ozone concentration on the treatment effectiveness of diabetic foot syndrome: a pilot single-centre study. Postepy Dermatol Alergol 2024; 41:626-633. [PMID: 39877112 PMCID: PMC11770577 DOI: 10.5114/ada.2024.145477] [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: 07/24/2024] [Accepted: 08/22/2024] [Indexed: 01/31/2025] Open
Abstract
Introduction Diabetic foot syndrome (DFS) a severe complication of diabetes which can result in ulcers, infections, or tissue damage in the feet. Aim To compare the treatment effectiveness in patients with DFS using local O3 therapy depending on the O3 concentration. Material and methods The study included 50 patients, 24 male and 26 female ones, in the age range between 39 and 84 years, with DFS. In group 1 (25 patients), 30 µg/ml doses of ozone were applied, and in group 2 (25 patients) doses of 60 µg/ml. A total of 30 local ozone therapy procedures, lasting 30 min each, were performed in both groups, in two sessions (15 procedures), with a 4-week break between sessions. The effectiveness of wound healing was evaluated by computerized planimetry, and pain intensity was assessed with the use of the VAS scale. Results After treatment, a statistically significant reduction in the area of wounds and the intensity of pain was achieved in both groups. The median (IQR) wound size after treatment in group 1 was: 4.5 (4-5) cm2, and in group 2: 4 (3-4.5) cm2; (p = 0.027). The median (IQR) pain intensity (VAS) after treatment in group 1 was: 5 (4-5) points, and in group 2: 4 (3-4.5) points (p = 0.002). Conclusions The use of a higher concentration ozone increased the effectiveness of the therapy in terms of reducing the wound surface area and alleviating the pain. Therefore, the possibility of using higher ozone concentrations in the treatment of diabetic foot syndrome is worth considering.
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Affiliation(s)
- Jarosław Pasek
- Władysław Biegañski Collegium Medicum, Jan Długosz University, Czêstochowa, Poland
| | - Sebastian Szajkowski
- Faculty of Medical and Social Sciences, Warsaw Medical Academy of Applied Sciences, Warsaw, Poland
| | - Dominika Rokicka
- Department of Internal Diseases, Diabetology, and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases in Zabrze, Poland
| | - Marta Wróbel
- Department of Internal Diseases, Diabetology, and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, Silesian Centre for Heart Diseases in Zabrze, Poland
| | - Valter Travagli
- Department of Biotechnology, Chemistry and Pharmacy, Siena, Italy
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine in Bytom, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Poland
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Flynn S, Kirwan E, MacGilchrist C, McIntosh C. The impact of COVID-19 on the care of diabetic foot ulcers: A scoping review. J Tissue Viability 2024; 33:521-529. [PMID: 38981778 DOI: 10.1016/j.jtv.2024.06.016] [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: 10/03/2023] [Revised: 06/11/2024] [Accepted: 06/27/2024] [Indexed: 07/11/2024]
Abstract
AIM The aims and objectives of this scoping review were to conduct a systematic search of the literature to identify the nature and extent of the research evidence to which the COVID-19 pandemic impacted and disrupted the care of Diabetic Foot Ulcers (DFU) and the subsequent impact on patient outcomes. Secondly, to identify transformation in models of care and service delivery, adoption of innovative technologies and new models of service innovations, including modalities such as telehealth that were adopted during the pandemic. METHODS This systematic scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR). RESULTS Nineteen papers were included. These studies explored aspects of care for DFUs during the COVID-19 pandemic. The focus of these studies ranged from exploring new modalities of care such as telehealth, reporting of clinical outcomes, development of triage systems and patient behaviors during COVID-19. CONCLUSION Ten of twelve studies reported on DFU outcomes and reported a worsening of outcomes compared to pre-pandemic times. Reduced DFU presentations, alongside an increase in urgent hospitalisations and amputation, were key themes that emerged from this review. More high-quality evidence is needed to establish any longer-lasting effects of the Covid-19 pandemic on people living with DFU. Further, there is a lack of evidence relating to the feasibility and success of telemedicine and limited data on changes to service delivery, including triage systems in this patient cohort.
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Affiliation(s)
- Sinead Flynn
- Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds (ARIW), College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland.
| | - Ellen Kirwan
- Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland
| | - Claire MacGilchrist
- Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds (ARIW), College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
| | - Caroline McIntosh
- Discipline of Podiatric Medicine, School of Health Sciences, University of Galway, Galway, Ireland; Alliance for Research and Innovation in Wounds (ARIW), College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
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Goyal G, Majumdar S, Biswas Bose U, Shrivastava MR, Mukherjee JJ, Banka SP, Kapoor S, Jude E. The effect of the different waves of COVID-19 pandemic on the outcome of diabetic foot ulcers. INT J LOW EXTR WOUND 2024:15347346241237284. [PMID: 38659365 DOI: 10.1177/15347346241237284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
AIMS COVID-19 pandemic has massively impacted human health. We studied the effect of COVID-19 on outcome of Diabetic foot ulcers (DFUs). OBJECTIVES AND METHODS We recruited 483 people with DFUs from June 2020 to April 2022 (pandemic) together with a matched group of 226 people with DFU from March 2019 to March 2020 (pre-pandemic). Primary endpoint was outcome of ulcers-healed or amputation (major/minor). It was sub-analysed into 3 waves of COVID-19. Secondary endpoint was healing of individual types of DFUs. Basic anthropometric data included site and type of ulcer (ischemic or neuropathic), duration, presence or absence of infection and Wagner's grading of DFUs was collected for all patients. Diagnosis of peripheral neuropathy was done by monofilament testing and peripheral arterial disease by handheld Doppler and ankle brachial index (ABI). Standardized treatment protocol was provided. All patients were monitored for 6 months. RESULTS In the pandemic group 323 (66.9%) patients in whom ulcers healed, 70 (14.5%) underwent minor amputation, 11 (2.2%) major amputation, 29 (6%) were lost to follow up, 22 (4.6%) were not healed. Rate of healing of DFU was higher (66.9% vs 53.5%) and rate of amputation was lower (16.7% vs 23.4%) in the pandemic group than in the pre-pandemic group (P = 0.001 and 0.037 respectively). Rate of healing in first, second and third wave was 65.4%, 75.2%, 58.3% respectively (P = 0.001). Neuropathic ulcers though less prevalent (49.8% vs 57.8%) in the first two waves than in the third wave, healing was better (79.3% vs 75.6%) in the first two waves than in the third wave (P = 0.085 and 0.488 respectively). Similarly, amputation rates in ischemic and neuro-ischemic ulcers were greater in the third wave than first two waves (46.7% vs 15.7%, P = 0.049). CONCLUSION During the COVID-19 pandemic, healing of neuropathic ulcers was better, especially in the first and second waves and travel restriction may have accounted for this. However, worsening of ischemic and neuro-ischemic ulcers was observed with more amputation in these two groups. Conversely, in the third wave withdrawal of lockdown led to worsening of DFUs resulting in less healing and more amputation.
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Affiliation(s)
| | | | | | | | | | - S P Banka
- ILS Hospital, Saltlake, Kolkata, India
| | - S Kapoor
- ILS Hospital, Saltlake, Kolkata, India
| | - Edward Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust, Ashton under Lyne, UK
- University of Manchester, Manchester, UK
- Manchester Metropolitan University, Manchester, UK
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Yazdanpanah L, Shahbazian H, Hesam S, Ahmadi B, Zamani AM. Two-year incidence and risk factors of diabetic foot ulcer: second phase report of Ahvaz diabetic foot cohort (ADFC) study. BMC Endocr Disord 2024; 24:46. [PMID: 38622562 PMCID: PMC11017491 DOI: 10.1186/s12902-024-01572-x] [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: 01/31/2023] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
AIM/INTRODUCTION This study was designed as the second phase of a prospective cohort study to evaluate the incidence and risk factors of diabetic foot ulcers (DFU). MATERIALS AND METHODS The study was conducted in a university hospital in Iran. Each participant was checked and followed up for two years in terms of developing newfound DFU as ultimate outcome. We investigated the variables using univariate analysis and then by backward elimination multiple logistic regression. RESULTS We followed up 901 eligible patients with diabetes for two years. The mean age of the participants was 53.24 ± 11.46 years, and 58.53% of them were female. The two-year cumulative incidence of diabetic foot ulcer was 8% (95% CI 0.071, 0.089) [Incidence rate: 49.9 /1000 person-years]. However, the second-year incidence which was coincident with the COVID-19 pandemic was higher than the first-year incidence (4.18% and 1.8%, respectively). Based on our analysis, the following variables were the main risk factors for DFU incidence: former history of DFU or amputation [OR = 76.5, 95% CI(33.45,174.97), P value < 0.001], ill-fitting foot-wear [OR = 10.38, 95% CI(4.47,24.12), P value < 0.001], smoking [OR = 3.87,95%CI(1.28, 11.71),P value = 0.016], lack of preventive foot care [OR = 2.91%CI(1.02,8.29),P value = 0.045], and insufficient physical activity[OR = 2.25,95% CI(0.95,5.35),P value = 0.066]. CONCLUSION Overall, the two-year cumulative incidence of diabetic foot ulcer was 8% [Incidence rate: 49.9 /1000 person-years]; however, the second-year incidence was higher than the first-year incidence which was coincident with the COVID-19 pandemic (4.18% and 1.8%, respectively). Independent risk factors of DFU occurrence were prior history of DFU or amputation, ill-fitting footwear, smoking, lack of preventive foot care, and insufficient physical activity.
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Affiliation(s)
- Leila Yazdanpanah
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, 61357-15794, Ahvaz, Iran.
| | - Hajieh Shahbazian
- Diabetes Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, 61357-15794, Ahvaz, Iran
| | - Saeed Hesam
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnam Ahmadi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Mohammad Zamani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Hartmann-Boyce J, Highton P, Rees K, Onakpoya I, Suklan J, Curtis F, O'Mahoney L, Morris E, Kudlek L, Morgan J, Lynch R, Marpadga S, Seidu S, Khunti K. The impact of the COVID-19 pandemic and associated disruptions in health-care provision on clinical outcomes in people with diabetes: a systematic review. Lancet Diabetes Endocrinol 2024; 12:132-148. [PMID: 38272607 DOI: 10.1016/s2213-8587(23)00351-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 01/27/2024]
Abstract
The COVID-19 pandemic triggered disruptions to health care and lifestyles that could conceivably impact diabetes management. We set out to identify the impact of disruptions caused by COVID-19 on clinical outcomes in people with diabetes. We performed a systematic review of the available literature in the MEDLINE and OVID databases from Jan 1, 2020, to June 7, 2023, and included 138 studies (n>1 000 000 people). All but five studies were judged to be at some risk of bias. All studies compared prepandemic with pandemic periods. All-cause mortality (six studies) and diabetes-related mortality (13 studies) showed consistent increases, and most studies indicated increases in sight loss (six studies). In adult and mixed samples, data generally suggested no difference in diabetic ketoacidosis frequency or severity, whereas in children and adolescents most studies showed increases with some due to new-onset diabetes (69 studies). Data suggested decreases in hospital admissions in adults but increases in diabetes-related admissions to paediatric intensive care units (35 studies). Data were equivocal on diabetic foot ulcer presentations (nine studies), emergency department admissions (nine studies), and overall amputation rates (20 studies). No studies investigated renal failure. Where reported, the impact was most pronounced for females, younger people, and racial and ethnic minority groups. Further studies are needed to investigate the longer-term impact of the pandemic and the on potential differential impacts, which risk further exacerbating existing inequalities within people with diabetes.
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Affiliation(s)
- Jamie Hartmann-Boyce
- Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA, USA; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | | | | | - Igho Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - Jana Suklan
- National Institute for Health and Care Research Newcastle In Vitro Diagnostics Co-operative, Newcastle University, Newcastle, UK
| | - Ffion Curtis
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | | | - Elizabeth Morris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laura Kudlek
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Jessica Morgan
- Medical Sciences Division, University of Oxford, Oxford, UK
| | - Rosie Lynch
- Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Samuel Seidu
- Diabetes Research Centre, University of Leicester, UK
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Anthony L, Gillies M, Iyer V, Goh D. The Indirect Impact of COVID-19 Pandemic on Lower Extremity Amputations - An Australian Study. Vasc Health Risk Manag 2023; 19:797-803. [PMID: 38108023 PMCID: PMC10724556 DOI: 10.2147/vhrm.s426434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/13/2023] [Indexed: 12/19/2023] Open
Abstract
Background The COVID-19 pandemic has had indirect and deleterious effects on patient health due to interruptions to routine provision of healthcare. This is particularly true for patients with chronic conditions like peripheral vascular disease (PVD). This study aims to evaluate the impact of the pandemic on patients with PVD in Australia by analysing rates of amputation, indications for amputation and urgency of surgery in the pre-pandemic and pandemic periods. Methods The Australian Vascular Audit was used to capture lower extremity amputation data in Victoria, Australia, in the 22 months before and after the start of the pandemic. Results The number of total amputations increased from 1770 pre-pandemic to 1850 during the pandemic, a 4.3% increase. This was largely driven by a statistically significant, 19% increase in major amputations. The number of minor amputations remained relatively similar in the two time periods. Amputations due to tissue loss secondary to arterial insufficiency increased from 474 to 526, an 11% increase, potentially indicating disruptions to revascularisation procedures contributing to the rise in amputations. Elective and emergency surgeries fell by 14% and 18%, respectively, while semi-urgent amputations increased by 32%. Conclusion This study found an increase in the number of amputations overall and a significant increase in major amputations during the pandemic compared to pre-pandemic times. Tissue loss secondary to arterial insufficiency was an increasingly common indication for amputation that was observed in the pandemic group, indicating that disruption to revascularisation likely contributed to this increase in amputations. These findings can inform and direct future vascular surgery service delivery to prepare for the post-pandemic recovery. Additionally, this study further confirms that patients with chronic diseases are often disproportionately disadvantaged when global crises affect routine provision of healthcare and calls for better systems to be developed that can be used in such crises in the future.
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Affiliation(s)
- Lakmali Anthony
- Department of Vascular Surgery, Northern Health, Epping, Victoria, Australia
| | - Madeline Gillies
- Department of Surgery, Goulburn Valley Health, Shepparton, Victoria, Australia
| | - Vikram Iyer
- Department of Vascular Surgery, Northern Health, Epping, Victoria, Australia
| | - David Goh
- Department of Vascular Surgery, Northern Health, Epping, Victoria, Australia
- Department of Vascular Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
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Demirkoparan M, Vahabi A, Özbek B, Mert M, Yıldırım Şimşir I, Erdem HA, Öztürk AM, Çetinkalp Ş. Efficacy of telemedicine applications in patients with diabetic foot ulcers: A focus on mortality and major amputation rates. Int Wound J 2023; 20:3955-3962. [PMID: 37340728 PMCID: PMC10681535 DOI: 10.1111/iwj.14283] [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: 04/12/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023] Open
Abstract
Amputations related to diabetic foot ulcers (DFU) are associated with high morbidity and mortality rates. Glycaemic control and close follow-up protocols are essential to prevent such ulcers. Coronavirus disease (COVID) related restrictions and regulations might have a negative impact on patients who are with DFU or candidates for DFU. We retrospectively analysed 126 cases that had DFU underwent amputation surgery. Comparative analyses were done between cases that were admitted before COVID restrictions (Group A) and cases admitted after COVID restrictions (Group B). Two groups were homogenic demographically. There was no significant difference between groups in terms of mortality (p = 0.239) and amputation rates (p = 0.461). The number of emergent cases in the pandemic period doubled the number in pre-pandemic period even though this finding was not statistically significant (p = 0.112). Fastly adapted consulting practice and follow-up protocols to compensate for the problems created by COVID-related regulations seem to be effective in terms of mortality and amputation rates.
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Affiliation(s)
- Mesut Demirkoparan
- Department of Orthopedics and TraumatologyEge University School of MedicineIzmirTurkey
| | - Arman Vahabi
- Department of Orthopedics and TraumatologyEge University School of MedicineIzmirTurkey
| | - Berker Özbek
- Department of Orthopedics and TraumatologyEge University School of MedicineIzmirTurkey
| | - Merve Mert
- Department of Infectious Diseases and Clinical MicrobiologyEge University School of MedicineIzmirTurkey
| | - Ilgın Yıldırım Şimşir
- Department of Internal Medicine, Division of Endocrinology and Metabolism DisordersEge University School of MedicineIzmirTurkey
| | - Hüseyin Aytaç Erdem
- Department of Infectious Diseases and Clinical MicrobiologyEge University School of MedicineIzmirTurkey
| | - Anıl Murat Öztürk
- Department of Orthopedics and TraumatologyEge University School of MedicineIzmirTurkey
| | - Şevki Çetinkalp
- Department of Internal Medicine, Division of Endocrinology and Metabolism DisordersEge University School of MedicineIzmirTurkey
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Anthony L, Gillies M, Tran M, Goh D. The indirect impact of COVID-19 pandemic on limb preservation care- a retrospective analysis of trends in lower limb revascularisation. J Foot Ankle Res 2023; 16:48. [PMID: 37559067 PMCID: PMC10411013 DOI: 10.1186/s13047-023-00648-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 07/11/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Disruptions caused by COVID-19 pandemic have profoundly influenced the management of many conditions, especially vascular pathologies including limb preservation care. The aim of this study is to evaluate the impact of the pandemic on patients with peripheral arterial disease (PAD) focusing on lower limb revascularisation procedure volume, their indication and urgency of surgery. METHODS The Australian Vascular Audit (AVA) was used to capture data on revascularisation procedures before and after the onset of the pandemic in Victoria, Australia. Information on patient demographics, procedures performed, their indication and urgency of surgery were collected. RESULTS There was a significant 22.7% increase in revascularisations for PAD during the COVID-19 pandemic, driven solely by a 31.9% increase in endovascular revascularisation procedures. Revascularisation procedures for all indications of PAD, namely claudication, rest pain and tissue loss, increased by 14.8%, 39.2% and 27.4% respectively, during the pandemic compared to pre-pandemic times. Open procedures declined by 10.2% during the pandemic. There were significant 13.9% and 62.2% increases in elective and semi-urgent revascularisations respectively during the pandemic while emergency revascularisations for PAD fell by 4.2%. There were no significant increases in toe, forefoot or below knee amputations during the pandemic compared to pre-pandemic times. CONCLUSIONS This study found that the volume of revascularisation for PAD increased significantly during the pandemic indicating that patients with PAD had significant deterioration of their condition during the pandemic. This is likely multifactorial; due to disruptions to standard provision of podiatry, vascular surgery and endocrinology services to these patients, a decline in overall health and changes in health-related behaviours due to restrictions and infection control methods imposed during the pandemic. The number of elective and semi-urgent procedures also increased during the pandemic which reflects the significant deterioration of PAD patients during the pandemic. This study highlights a concerning trend of worsening PAD when routine care of these patients is disrupted. Such data should be instrumental in contingency planning and resource allocation for managing the ongoing pandemic.
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Affiliation(s)
- Lakmali Anthony
- Department of Vascular Surgery, Northern Health, 185 Cooper Street, Epping, VIC, 3076, Australia.
| | - Madeline Gillies
- Department of General Surgery, Goulburn Valley Health, 2-48 Graham Street, Shepparton, VIC, 3630, Australia
| | - Morica Tran
- Department of Podiatry, Austin Health, 145 Studley Road, Heidelberg, VIC, 3084, Australia
| | - David Goh
- Department of Vascular Surgery, Northern Health, 185 Cooper Street, Epping, VIC, 3076, Australia
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Pride L, Kabeil M, Alabi O, Minc SD, Fakorede FA, Ochoa LN, Wright AS, Wohlauer MV. A review of disparities in peripheral artery disease and diabetes-related amputations during the COVID-19 pandemic. Semin Vasc Surg 2023; 36:90-99. [PMID: 36958904 PMCID: PMC9780019 DOI: 10.1053/j.semvascsurg.2022.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/06/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic has profoundly affected health care delivery. In addition to the significant morbidity and mortality associated with acute illness from COVID-19, the indirect impact has been far-reaching, including substantial disruptions in chronic disease care. As a result of pandemic disruptions in health care, vulnerable and minority populations have faced health inequalities. The aim of this review was to investigate how the COVID-19 pandemic has impacted vulnerable populations with limb-threatening peripheral artery disease and diabetic foot infections.
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Affiliation(s)
- Laura Pride
- Augusta University/University of Georgia Medical Partnership, Athens, GA
| | - Mahmood Kabeil
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Olamide Alabi
- Division of Vascular Surgery and Endovascular Therapy, Emory University School of Medicine, Atlanta, GA
| | - Samantha D Minc
- Division of Vascular and Endovascular Surgery, Department of Cardiovascular and Thoracic Surgery, School of Medicine, Department of Occupational Health and Environmental Sciences, School of Public Health, West Virginia University, Morgantown, WV
| | | | - Lyssa N Ochoa
- San Antonio Vascular and Endovascular Clinic, San Antonio, TX
| | - A Sharee Wright
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC
| | - Max V Wohlauer
- Division of Vascular Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO.
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Pappachan JM, Cassidy B, Fernandez CJ, Chandrabalan V, Yap MH. The role of artificial intelligence technology in the care of diabetic foot ulcers: the past, the present, and the future. World J Diabetes 2022; 13:1131-1139. [PMID: 36578875 PMCID: PMC9791570 DOI: 10.4239/wjd.v13.i12.1131] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/01/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022] Open
Abstract
Foot ulcers are common complications of diabetes mellitus and substantially increase the morbidity and mortality due to this disease. Wound care by regular monitoring of the progress of healing with clinical review of the ulcers, dressing changes, appropriate antibiotic therapy for infection and proper offloading of the ulcer are the cornerstones of the management of foot ulcers. Assessing the progress of foot ulcers can be a challenge for the clinician and patient due to logistic issues such as regular attendance in the clinic. Foot clinics are often busy and because of manpower issues, ulcer reviews can be delayed with detrimental effects on the healing as a result of a lack of appropriate and timely changes in management. Wound photographs have been historically useful to assess the progress of diabetic foot ulcers over the past few decades. Mobile phones with digital cameras have recently revolutionized the capture of foot ulcer images. Patients can send ulcer photographs to diabetes care professionals electronically for remote monitoring, largely avoiding the logistics of patient transport to clinics with a reduction on clinic pressures. Artificial intelligence-based technologies have been developed in recent years to improve this remote monitoring of diabetic foot ulcers with the use of mobile apps. This is expected to make a huge impact on diabetic foot ulcer care with further research and development of more accurate and scientific technologies in future. This clinical update review aims to compile evidence on this hot topic to empower clinicians with the latest developments in the field.
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Affiliation(s)
- Joseph M Pappachan
- Department of Endocrinology & Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
| | - Bill Cassidy
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
| | | | - Vishnu Chandrabalan
- Department of Data Science, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
| | - Moi Hoon Yap
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
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