COVID-19 and diabetes

Almost immediately after the emergence of the SARS-CoV-2 coronavirus, it was observed that people with chronic diseases, including diabetes, presented an increased risk of hospitalization and mortality. Diabetes can increase the risk of COVID-associated mortality by more than six times. The hypothesis of a bidirectional relationship between COVID-19 and diabetes assumes that diabetes is a risk factor for worse outcomes of COVID-19 treatment and that coronavirus infection is a predisposing factor for newly diagnosed diabetes or hyperglycemic emergencies. New diagnoses or exacerbations of existing diabetes are associated with direct damage to the pancreas or the body's response to chronic inflammation, and ACE receptors play a large role in this pathomechanism. Restrictions implemented in many countries have resulted in poorer control and underdiagnosis of diabetes. In this review, we summarize the impact of acute COVID-19 on people with diabetes, discuss how presentation and epidemiology changed during the pandemic, and consider the broader impact of the pandemic on patients and healthcare delivery

Lower limb ulcers in people experiencing homelessness

The homelessness crisis in Poland poses a serious challenge to the state, with the number of homeless individuals exceeding 30,000 in 2019. In this paper we highlight one of the most common surgical issue of people experiencing homelessness – venous leg ulcers – and present current treatment guidelines. Homeless individuals, particularly exposed to inadequate living conditions, poor hygiene, and circulatory disorders, are at high risk of developing them. Venous ulcers are chronic wounds with prolonged and complex healing processes.They arise due to venous hypertension associated with chronic venous insufficiency and thrombosis. Often, specialized treatment is necessary, which is a challenge for homeless individuals due to difficulties in accessing regular care.The treatment of venous leg ulcers involves a multi-stage process. The gold standard for managing venous leg ulcers is compression therapy, which reduces edema and venous reflux. The TIME strategy outlines the approach to chronic wound management, emphasizing the importance of initial wound cleansing (surgically, enzymatically, or larvotherapy), infection prevention, maintaining proper moisture and wound edge preparation. This requires the use of suitable antiseptics, dressings, and wound hygiene.People experiencing homelessness face specific issues that necessitate a holistic approach, which includes health education, nutrition, and rehabilitation

T.I.M.E.R.S. for foot ulcers – current management strategy

Managing venous ulcers poses significant challenges for nursing personnel. This article outlines the current strategies employed in addressing venous ulcers, with particular emphasis on the updated T.I.M.E.R.S. wound assessment tool and compression therapy. Diagnosis should consider risk factors associated with chronic venous disease as well as other conditions such arterial ischaemia, ulcers related to diabetic neuropathy, or cancer. Doppler duplex ultrasound is typically conducted to validate the diagnosis. In the treatment of chronic wounds, implementing the updated wound assessment strategy T.I.M.E.R.S. is recommended. Optimal wound management requires tailored dressings and usage of antimicrobial agents. Application of local antibiotics on wounds should be avoided, with the exception of gentamicin embedded in a collagen matrix presented in the form of a sponge. Correctly adjusted com-pression therapy is a gold standard of treatment. Pentoxifylline is advised as an oral treatment to expedite the rate of ulcer healing