40 research outputs found
Exercise Training to Target Gait Unsteadiness in People with Diabetes
Balance impairment and an associated high fall rate in people with diabetes is common, and a huge burden to quality of life and healthcare systems. Causes of impaired balance are commonly attributed to both sensory and motor deficits, which includes impaired muscle strength and function. This study investigated the effects of resistance exercise training on balance control during walking over level ground and on stairs. Ten DM people (age: 62 years, BMI: 29kg/m2, VPT: 9V) and 6 DM people with DPN (age: 59 years, BMI: 27kg/m2, VPT: 31V) performed a 16-week intervention of weekly resistance exercise training to increase ankle and knee extensor muscle strength. Six DM controls did not take part in the intervention (age: 50 years, BMI: 26kg/m2, VPT: 12V). Balance during gait was quantified before and after the intervention, by separation between the body centre-of-mass and centre-of-pressure under the feet during both level and stair walking. Knee and ankle extensor muscle strength was assessed using a dynamometer. The exercise intervention increased strength of ankle plantar flexors (22%) and knee extensors (30%). Despite the increases in lower limb muscle strength produced by the intervention, no improvements in balance were seen post training. However, gait speed did increase by 8%, which previous research has shown to be associated with quality of life. Controls showed no training effects in any variables. Although this exercise intervention had a positive effect on gait by increasing walking speed, there was no effect on the control of balance. Previous research has identified that medio-lateral (side-to-side) balance is impaired in people with DPN. The muscles exercised in the present study mainly control the major sagittal plane (forwards-backwards) movements that occur during gait. Interventions targeting the lateral stabilising muscles of the hip and trunk, may show greater potential efficacy in redressing the balance impairment of this population
ΠΠΎΠΈΡΠΊ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ Π΄ΠΈΠ°Π±Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠΉ Π΄ΠΈΡΡΠ°Π»ΡΠ½ΠΎΠΉ ΡΠΈΠΌΠΌΠ΅ΡΡΠΈΡΠ½ΠΎΠΉ ΠΏΠΎΠ»ΠΈΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΠΈ
ΠΠΈΠ°Π±Π΅ΡΠΈΡΠ΅ΡΠΊΠ°Ρ Π΄ΠΈΡΡΠ°Π»ΡΠ½Π°Ρ ΡΠΈΠΌΠΌΠ΅ΡΡΠΈΡΠ½Π°Ρ ΠΏΠΎΠ»ΠΈΠ½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΡ (ΠΠΠ‘Π) Π²ΡΡΡΠ΅ΡΠ°Π΅ΡΡΡ ΠΏΡΠΈΠ±Π»ΠΈΠ·ΠΈΡΠ΅Π»ΡΠ½ΠΎ Ρ ΡΡΠ΅ΡΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
Ρ Π΄ΠΈΠ°Π±Π΅ΡΠΎΠΌ ΠΈΒ Π°ΡΡΠΎΡΠΈΠΈΡΡΠ΅ΡΡΡ Ρ Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΡΠΌΠΈ Π±ΠΎΠ»Π΅Π²ΡΠΌΠΈ ΡΠΈΠ½Π΄ΡΠΎΠΌΠ°ΠΌΠΈ ΠΈ ΠΏΠΎΠ²ΡΡΠ΅Π½Π½ΠΎΠΉ ΡΠΌΠ΅ΡΡΠ½ΠΎΡΡΡΡ. ΠΠΈΠ°Π³Π½ΠΎΡΡΠΈΠΊΠ° ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠ°Ρ ΠΎΡΠ΅Π½ΠΊΠ° ΠΠΠ‘ΠΒ ΠΎΡΡΠ°Π΅ΡΡΡ Π½Π΅ΠΏΡΠΎΡΡΠΎΠΉ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠΎΠΉ Π½Π΅ ΡΠΎΠ»ΡΠΊΠΎ Π΄Π»Ρ Π²ΡΠ°ΡΠ΅ΠΉ ΠΎΠ±ΡΠ΅ΠΉ ΠΏΡΠ°ΠΊΡΠΈΠΊΠΈ, Π½ΠΎ ΠΈ Π΄Π»Ρ ΡΠΏΠ΅ΡΠΈΠ°Π»ΠΈΡΡΠΎΠ², ΠΏΡΠΈΠ½ΠΈΠΌΠ°ΡΡΠΈΡ
ΡΡΠ°ΡΡΠΈΠ΅ Π²Β ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΠΏΡΡΠ°Π½ΠΈΡΡ
. ΠΠΏΡΠΈΠΌΠ°Π»ΡΠ½ΡΠΉ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ Π΄ΠΈΠ°Π±Π΅ΡΠ° ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΠ΅ΡΠ²ΠΎΠΎΡΠ΅ΡΠ΅Π΄Π½ΠΎΠΉ Π·Π°Π΄Π°ΡΠ΅ΠΉ Π² ΠΏΡΠΎΡΠΈΠ»Π°ΠΊΡΠΈΠΊΠ΅ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΈ Π²Π΅Π΄Π΅Π½ΠΈΠΈΒ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΠΠΠ‘Π. ΠΠ΄Π½Π°ΠΊΠΎ ΠΎΠ΄Π½ΠΎΠ³ΠΎ Π³Π»ΠΈΠΊΠ΅ΠΌΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ Π½Π΅Π΄ΠΎΡΡΠ°ΡΠΎΡΠ½ΠΎ Π΄Π»Ρ ΠΏΡΠ΅Π΄ΠΎΡΠ²ΡΠ°ΡΠ΅Π½ΠΈΡ ΡΠ°Π·Π²ΠΈΡΠΈΡ ΠΈ ΠΏΡΠΎΠ³ΡΠ΅ΡΡΠΈΡΠΎΠ²Π°Π½ΠΈΡΒ ΠΠΠ‘Π, ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎ ΠΏΡΠΈ Π΄ΠΈΠ°Π±Π΅ΡΠ΅ 2-Π³ΠΎ ΡΠΈΠΏΠ°. ΠΡΠΎΠΌΠ΅ ΡΠΎΠ³ΠΎ, Ρ Π·Π½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΡΠ°ΡΡΠΈ Π±ΠΎΠ»ΡΠ½ΡΡ
Π½Π΅ ΡΠ΄Π°Π΅ΡΡΡ Π΄ΠΎΡΡΠΈΡΡ Π½ΠΎΡΠΌΠΎΠ³Π»ΠΈΠΊΠ΅ΠΌΠΈΠΈ.Β ΠΠ½Π°ΡΠΈΡΠ΅Π»ΡΠ½ΡΠ΅ ΡΡΠΏΠ΅Ρ
ΠΈ Π΄ΠΎΡΡΠΈΠ³Π½ΡΡΡ Π² ΠΊΠΎΠ½ΡΡΠΎΠ»Π΅ ΡΠΈΠΌΠΏΡΠΎΠΌΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π±ΠΎΠ»Π΅ΠΉ, Π½ΠΎ ΠΏΡΠΈ ΡΡΠΎΠΌ ΠΎΡΡΠ°Π΅ΡΡΡ ΠΏΡΠΎΠ±Π»Π΅ΠΌΠ°Β ΡΠ΅Π½ΡΠΎΡΠ½ΠΎΠ³ΠΎ Π΄Π΅ΡΠΈΡΠΈΡΠ° ΠΈ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅Π·Π° ΠΠΠ‘Π. ΠΡΠ±ΠΎΡ ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π²ΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΠ΅ΠΉ Π²Π»ΠΈΡΠ½ΠΈΡ Π½Π° Π΅ΡΡΠ΅ΡΡΠ²Π΅Π½Π½ΠΎΠ΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π±ΠΎΠ»Π΅Π·Π½ΠΈΒ ΠΎΠ³ΡΠ°Π½ΠΈΡΠ΅Π½. ΠΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΎ Π½Π΅ΡΠΊΠΎΠ»ΡΠΊΠΎ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΠ΅ΡΠ°ΠΏΠ΅Π²ΡΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΏΠΎΠ΄Ρ
ΠΎΠ΄ΠΎΠ², Π½ΠΎ ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΡ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
ΠΈΡΠΏΡΡΠ°Π½ΠΈΠΉ Π½Π΅ Π΄Π°Π»ΠΈΠΎΠΆΠΈΠ΄Π°Π΅ΠΌΡΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ², Π° Π² Π½Π΅ΠΊΠΎΡΠΎΡΡΡ
ΡΠ»ΡΡΠ°ΡΡ
Π΄Π°ΠΆΠ΅ ΠΎΠΊΠ°Π·Π°Π»ΠΈΡΡ ΡΠ°Π·ΠΎΡΠ°ΡΠΎΠ²ΡΠ²Π°ΡΡΠΈΠΌΠΈ. ΠΠ΅ΡΠΌΠΎΡΡΡ Π½Π° ΡΡΠΎ, Π² ΡΡΠ΄Π΅Β ΡΠ°Π½Π΄ΠΎΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
ΠΊΠΎΠ½ΡΡΠΎΠ»ΠΈΡΡΠ΅ΠΌΡΡ
ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠΉ ΠΏΠΎ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΡ ΠΏΠ°ΡΠΎΠ³Π΅Π½Π΅ΡΠΈΡΠ΅ΡΠΊΠΎΠ³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΏΠΎΠΊΠ°Π·Π°Π½ΠΎ ΠΎΠ±Π½Π°Π΄Π΅ΠΆΠΈΠ²Π°ΡΡΠ΅Π΅Β ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΎΠ΅ ΡΠ»ΡΡΡΠ΅Π½ΠΈΠ΅ ΠΎΡΠ½ΠΎΡΠΈΡΠ΅Π»ΡΠ½ΠΎ Π½Π΅ΠΉΡΠΎΠΏΠ°ΡΠΈΡΠ΅ΡΠΊΠΈΡ
Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ Π² ΠΊΠΎΠ½Π΅ΡΠ½ΡΡ
ΡΠΎΡΠΊΠ°Ρ
, ΠΎΡΠΎΠ±Π΅Π½Π½ΠΎ ΠΏΡΠΈ ΠΈΡΠΏΠΎΠ»ΡΠ·ΠΎΠ²Π°Π½ΠΈΠΈ Ξ±-Π»ΠΈΠΏΠΎΠ΅Π²ΠΎΠΉΒ ΠΊΠΈΡΠ»ΠΎΡΡ ΠΈ Π°ΠΊΡΠΎΠ²Π΅Π³ΠΈΠ½Π°. ΠΠΎΠ·ΠΌΠΎΠΆΠ½ΠΎΡΡΡ Π²Π»ΠΈΡΠ½ΠΈΡ Π½Π° ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ ΠΠΠ‘Π ΡΡΠ΅Π±ΡΠ΅Ρ Π΄Π°Π»ΡΠ½Π΅ΠΉΡΠ΅Π³ΠΎ ΠΏΠΎΠ΄ΡΠ²Π΅ΡΠΆΠ΄Π΅Π½ΠΈΡ Π² ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΡ
Β ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡΡ
Π½Π°ΡΡΠ΄Ρ Ρ ΠΏΠΎΠ½ΠΈΠΌΠ°Π½ΠΈΠ΅ΠΌ ΠΌΠ΅Ρ
Π°Π½ΠΈΠ·ΠΌΠΎΠ² Π΄Π΅ΠΉΡΡΠ²ΠΈΡ ΠΌΠ½ΠΎΠ³ΠΎΠΎΠ±Π΅ΡΠ°ΡΡΠ΅Π³ΠΎ Π»Π΅ΡΠ΅Π½ΠΈΡ
Hydrodebridement of wounds: effectiveness in reducing wound bacterial contamination and potential for air bacterial contamination
<p>Abstract</p> <p>Background</p> <p>The purpose of this study was to assess the level of air contamination with bacteria after surgical hydrodebridement and to determine the effectiveness of hydro surgery on bacterial reduction of a simulated infected wound.</p> <p>Methods</p> <p>Four porcine samples were scored then infected with a broth culture containing a variety of organisms and incubated at 37Β°C for 24 hours. The infected samples were then debrided with the hydro surgery tool (Versajet, Smith and Nephew, Largo, Florida, USA). Samples were taken for microbiology, histology and scanning electron microscopy pre-infection, post infection and post debridement. Air bacterial contamination was evaluated before, during and after debridement by using active and passive methods; for active sampling the SAS-Super 90 air sampler was used, for passive sampling settle plates were located at set distances around the clinic room.</p> <p>Results</p> <p>There was no statistically significant reduction in bacterial contamination of the porcine samples post hydrodebridement. Analysis of the passive sampling showed a significant (<it>p </it>< 0.001) increase in microbial counts post hydrodebridement. Levels ranging from 950 colony forming units per meter cubed (CFUs/m<sup>3</sup>) to 16780 CFUs/m<sup>3 </sup>were observed with active sampling of the air whilst using hydro surgery equipment compared with a basal count of 582 CFUs/m<sup>3</sup>. During removal of the wound dressing, a significant increase was observed relative to basal counts (<it>p </it>< 0.05). Microbial load of the air samples was still significantly raised 1 hour post-therapy.</p> <p>Conclusion</p> <p>The results suggest a significant increase in bacterial air contamination both by active sampling and passive sampling. We believe that action might be taken to mitigate fallout in the settings in which this technique is used.</p
An intelligent insole system with personalised digital feedback reduces foot pressures during daily life: An 18-month randomised controlled trial
Aims: High plantar pressure is a major risk factor in the development of diabetic foot ulcers (DFUs) and recent evidence shows plantar pressure feedback reduces DFU recurrence. This study investigated whether continued use of an intelligent insole system by patients at high-risk of DFUs causes a reduction in plantar pressures. Methods: Forty-six patients with diabetic peripheral neuropathy and previous DFU were randomised to intervention (IG) or control groups (CG). Patients received an intelligent insole system, consisting of pressure-sensing insoles and digital watch. Patients wore the device during all daily activity for 18-months or until ulceration, and integrated pressure was recorded continuously. The device provided high-pressure feedback to IG only via audio-visual-vibrational alerts. High-pressure parameters at the whole foot, forefoot and rearfoot were compared between groups, with multilevel binary logistic regression analysis. Results: CG experienced more high-pressure bouts over time than IG across all areas of the foot (P 16 weeks of wearing the device. Conclusions: Continuous plantar pressure feedback via an intelligent insole system reduces number of bouts of high-pressure in patients at high-risk of DFU. These findings suggest that patients were learning which activities generated high-pressure, and pre-emptively offloading to avoid further alerts
Small Nerve Fiber Damage and Langerhans Cells in Type 1 and Type 2 Diabetes and LADA Measured by Corneal Confocal Microscopy.
PurposeIncreased corneal and epidermal Langerhans cells (LCs) have been reported in patients with diabetic neuropathy. The aim of this study was to quantify the density of LCs in relation to corneal nerve morphology and the presence of diabetic neuropathy and to determine if this differed in patients with type 1 diabetes mellitus (T1DM), type 2 diabetes mellitus (T2DM), and latent autoimmune diabetes of adults (LADA).MethodsPatients with T1DM (n = 25), T2DM (n = 36), or LADA (n = 23) and control subjects (n = 23) underwent detailed assessment of peripheral neuropathy and corneal confocal microscopy. Corneal nerve fiber density (CNFD), branch density (CNBD), length (CNFL) and total, immature and mature LC densities were quantified.ResultsLower CNFD (P ConclusionsThis study shows significant corneal nerve loss and an increase in LC density in patients with T1DM, T2DM, and LADA. Furthermore, increased LC density correlated with corneal nerve loss in patients with T1DM
Development and validation of a clinical prediction rule for development of diabetic foot ulceration: an analysis of data from five cohort studies.
Introduction The aim of the study was to develop and validate a clinical prediction rule (CPR) for foot ulceration in people with diabetes. Research design and methods Development of a CPR using individual participant data from four international cohort studies identified by systematic review, with validation in a fifth study. Development cohorts were from primary and secondary care foot clinics in Europe and the USA (n=8255, adults over 18 years old, with diabetes, ulcer free at recruitment). Using data from monofilament testing, presence/absence of pulses, and participant history of previous ulcer and/or amputation, we developed a simple CPR to predict who will develop a foot ulcer within 2βyears of initial assessment and validated it in a fifth study (n=3324). The CPRβs performance was assessed with C-statistics, calibration slopes, calibration-in-the-large, and a net benefit analysis. Results CPR scores of 0, 1, 2, 3, and 4 had a risk of ulcer within 2βyears of 2.4% (95% CI 1.5% to 3.9%), 6.0% (95% CI 3.5% to 9.5%), 14.0% (95% CI 8.5% to 21.3%), 29.2% (95% CI 19.2% to 41.0%), and 51.1% (95% CI 37.9% to 64.1%), respectively. In the validation dataset, calibration-in-the-large was β0.374 (95% CI β0.561 to β0.187) and calibration slope 1.139 (95% CI 0.994 to 1.283). The C-statistic was 0.829 (95% CI 0.790 to 0.868). The net benefit analysis suggested that people with a CPR score of 1 or more (risk of ulceration 6.0% or more) should be referred for treatment. Conclusion The clinical prediction rule is simple, using routinely obtained data, and could help prevent foot ulcers by redirecting care to patients with scores of 1 or above. It has been validated in a community setting, and requires further validation in secondary care settings
One step closer to understanding the role of bacteria in diabetic foot ulcers: characterising the microbiome of ulcers
Background:
The aim of this study was to characterise the microbiome of new and recurrent diabetic foot ulcers using 16S amplicon sequencing (16S AS), allowing the identification of a wider range of bacterial species that may be important in the development of chronicity in these debilitating wounds. Twenty patients not receiving antibiotics for the past three months were selected, with swabs taken from each individual for culture and 16S AS. DNA was isolated using a combination of bead beating and kit extraction. Samples were sequenced on the Illumina Hiseq 2500 platform.
Results:
Conventional laboratory culture showed positive growth from only 55 % of the patients, whereas 16S AS was positive for 75 % of the patients (41 unique genera, representing 82 different operational taxonomic units (OTUβs). S. aureus was isolated in 72 % of culture-positive samples, whereas the most commonly detected bacteria in all ulcers were Peptoniphilusspp., Anaerococcus spp. and Corynebacterium spp., with the addition of Staphylococcus spp. in new ulcers. The majority of OTUβs residing in both new and recurrent ulcers (over 67 %) were identified as facultative or strict anaerobic Gram-positive organisms. Principal component analysis (PCA) showed no difference in clustering between the two groups (new and recurrent ulcers).
Conclusions:
The abundance of anaerobic bacteria has important implications for treatment as it suggests that the microbiome of each ulcer βstarts afreshβ and that, although diverse, are not distinctly different from one another with respect to new or recurrent ulcers. Therefore, when considering antibiotic therapy the duration of current ulceration may be a more important consideration than a history of healed ulcer
Indirect comparison of interventions using published randomised trials: systematic review of PDE-5 inhibitors for erectile dysfunction
BACKGROUND: There are no randomised and properly blinded trials directly comparing one PDE-5 inhibitor with another in a normal home setting. Valid indirect comparisons with a common comparator must examine equivalent doses, similar duration, similar populations, with the same outcomes reported in the same way. METHODS: Published randomised, double-blind trials of oral PDE-5 inhibitors for erectile dysfunction were sought from reference lists in previous reviews and electronic searching. Analyses of efficacy and harm were carried out for each treatment, and results compared where there was a common comparator and consistency of outcome reporting, using equivalent doses. RESULTS: Analysis was limited by differential reporting of outcomes. Sildenafil trials were clinically and geographically more diverse. Tadalafil and vardenafil trials tended to use enriched enrolment. Using all trials, the three interventions were similar for consistently reported efficacy outcomes. Rates of successful intercourse for sildenafil, tadalafil and vardenafil were 65%, 62%, and 59%, with placebo rates of 23β28%. The rates of improved erections were 76%, 75% and 71%, respectively, with placebo rates of 22β24%, and NNTs of 1.9 or 2.0. Reporting of withdrawals was less consistent, but all-cause withdrawals for sildenafil, tadalafil and vardenafil were 8% 13% and 20%. All three drugs were well tolerated, with headache being the most commonly reported event at 13β17%. There were few serious adverse events. CONCLUSION: There were differences between trials in outcomes reported, limiting comparisons, and the most useful outcomes were not reported. For common outcomes there was similar efficacy between PDE-5 inhibitors