Plantar pressure distribution in diverse stages of diabetic neuropathy

Background: Diabetic Foot Ulceration in patients with diabetes could be associated with high plantar pressure caused by diabetes neuropathy. Therefore, it seems that one of the ways of identifying high-risk legs in diabetic patients with neuropathy would be characterization of elevated plantar pressure distributions. Objective: Comparing the plantar pressure distribution in diabetic patients who suffered neuropathy with those without neuropathy. Methods and materials: Plantar pressure distribution was recorded in the following categories: 38 diabetic patients without neuropathy, 30, 40 and 34 patients with mild neuropathy, moderate and severe neuropathy respectively. Results: Patients suffered from severe neuropathy suggested higher maximum peak plantar pressure at midfoot, heel, and medial forefoot. The peak pressure of midfoot was significantly different in the following categories as well: patient without neuropathy (32.3 ± 17.9 kPa), mild neuropathic (24.0 ± 17.9 kPa), moderate neuropathic (21.5 ± 12.6 kPa), and severe neuropathic (22.9 ± 10.7 kPa) groups (p = 0.02). Conclusion: The progression of diabetic neuropathy would have been increased followed by the peak plantar pressure. © 2019, Springer Nature Switzerland AG

Effects of zinc supplementation on serum adiponectin concentration and glycemic control in patients with type 2 diabetes

Background: Previous studies have suggested that zinc is involved in insulin homeostasis. Adiponectin is a well-known adipokine with anti-diabetic, anti-atherogenic, and anti-inflammatory properties. The aim of this study was to investigate the effect of zinc supplementation on glycemic control, and the potential mediating role of adiponectin, in patients with type 2 diabetes. Methods: In this randomized double-blind placebo-controlled clinical trial, 60 patients with diabetes, 30-60 years, were randomized to receive either 30 mg/d zinc (as zinc gluconate) or placebo for 12 weeks. Circulating levels of adiponectin, zinc, glucose homeostasis parameters, and lipid profiles, as well as anthropometric parameters and dietary intakes, were assessed. Results: About 53.3 of the patients had zinc insufficiency at baseline. Serum zinc levels improved significantly in the intervention than control group following 12 weeks supplementation (P < 0.001). Adiponectin (1.23 ± 2.23 μg/ml, P = 0.006) and insulin (3.6 ± 4.66 μIU/ml, P = 0.001) levels increased significantly compared to baseline in the zinc group; but this change was not significant compared with the control group. Following supplementation, there were no significant differences in glycemic control and anthropometric parameters between the two groups. Serum HDL levels increased significantly in the zinc (5.37 ± 14.8 mg/dl) compared to control (-1.53 ± 6.9 mg/dl) group following supplementation (P = 0.039). Conclusion: Despite a significant increase in serum zinc level, no improvement was observed in glycemic control, following 12 weeks supplementation with 30 mg/d zinc (as zinc gluconate). Zinc supplementation restored adiponectin concentrations partly within the intervention group, and increased HDL levels compared to the control group. The current findings did not support improvement in glucose homeostasis following zinc supplementation in patients with type 2 diabetes under the present study design. © 2019 Elsevier Gmb

Comparison home care service versus hospital-based care in patients with diabetic foot ulcer: an economic evaluation study

Introduction: Providing health care to patients at home could be causing the mortality and readmission rates reduction in addition to satisfaction of both patients and health care providers increase. The aim of this study was to assess the cost-effectiveness of home care service compared to hospital based care in patients with diabetic foot ulcer. Methods: An economic evaluation study and a trial study were simultaneously conducted in Iran. In trial phase, patients with diabetic foot ulcer were randomly assigned to the home care or hospital care. The Cost and Quality of life data were determined as measures of the study. Incremental cost-effectiveness ratio was calculated for comparative purposes. The model consisted of five stages of the disease. The Tree Age Pro 2009 and R software�s were used for data analysis. Results: 120 patients were enrolled in our trial; among which 30 patients were in home care service group and 90 patients in hospital based care group. The rate of ulcer size reduction in hospital based care was significant (P value = 0.003) in comparison with home care service. The total cost of the home care and hospital strategies were 1720.4 US, 3940.3 US and the total effectiveness were 0.31 and 0.29, respectively. The incremental cost-effectiveness ratio (ICER) was 117,300 US per quality-adjusted life year for home care intervention compared to hospital based care. Based on ICER plane home care treatment will be placed on the southeastern quadrant of the Cost-Effectiveness Plane, and is suggested as a more dominant treatment alternative. Conclusions: Regarding current evidence, home care strategy for patients suffering diabetic foot ulcer enjoys more cost effectiveness compared to hospital care. It is suggested that healthcare policy makers determine the tariff for health care services for disease groups according to the activity based costing approach. © 2020, Springer Nature Switzerland AG

Effects of intravenous Semelil (ANGIPARS�) on diabetic foot ulcers healing: A multicenter clinical trial

Some diabetic foot ulcers, which are notoriously difficult to cure, are one of the most common health problems in diabetic patients .There are several surgical and medical options which already have been introduced for treatment of diabetic foot ulcers, so some patient will require amputation. The purpose of this study was to evaluate the efficacy of intravenous Semelil (ANGIPARS�), a naive herbal extract to accelerate healing of diabetic foot ulcers. A multi-centric randomized controlled trial was conducted to evaluate intravenous Semelil for healing of diabetic foot ulcers. Sixteen diabetic patients were treated with intravenous Semelil, and nine other patients were treated with placebo as control group. Both groups were otherwise treated by wound debridement and irrigation with normal saline solution, systemic antibiotic therapy and daily wound dressing. Before and after intervention, the foot ulcer surface area was measured, by digital photography, mapping and planimetry. After 4 weeks, the mean foot ulcer surface area decreased from 479.93±379.75 mm2 to 198.93±143.75 mm2 in the intervention group (p = 0.000) and from 766.22±960.50 mm2 to 689.11±846.74 mm2 in the control group (p = 0.076). Average wound closure in the treatment group was significantly greater than placebo group (64 vs. 25, p= 0.015). This herbal extract by intravenous rout in combination with conventional therapy is more effective than conventional therapy by itself probably without side effect. However, further studies are required in the future to confirm these results in larger population

Epistatic interaction between adiponectin and survivin gene polymorphisms in endometrial carcinoma

Adiponectin appears to play an important role in the development and progression of several obesity-related malignancies. Also, overexpression of survivin, an inhibitor of apoptosis protein, is associated with increased risk of cancers. The aim of this study was to investigate the association between two polymorphisms in the adiponectin gene and endometrial cancer (EC) risk. We also investigated whether epistasis between surviving and adiponectin gene polymorphisms are associated with EC risk in an Iranian population.The samples comprised formalin-fixed, paraffin-embedded tissue sections obtained from the archive of the pathology department, Imam-Khomeini Hospital and Firouzgar hospital. After DNA extraction the genotyping was performed using PCR-RFLP technique.Single nucleotide polymorphisms (SNPs) in adiponectin (rs1063539, rs2241766) and survivin (rs9904341) gene were evaluated in the study. The increased frequency of ADIPOQ rs1063539C allele (CC. +. CG genotype) was associated with decreased EC risk OR: 0.39(0.17-0.90). Survivin rs9904341C allele (CC. +. CG genotype) was associated with increased EC risk crude OR: 2.75(1.27-5.95), adjusted OR: 2.93(1.27-6.76). We observed an epistatic interaction between survivin rs9904341 CC. +. CG genotype and ADIPOQ rs1063539 GG genotype increasing the risk of EC compared to those with other genotypes OR: 4.86(1.88-12.54), P=0.001.Our findings indicate that adiponectin might have a modulatory effect on survivin role and function in EC, which requires further investigation. © 2014 Elsevier GmbH

A family presenting with multiple endocrine neoplasia type 2B: A case report

<p>Abstract</p> <p>Introduction</p> <p>Multiple endocrine neoplasia 2B, a rare autosomal dominant syndrome, is characterized by early onset of medullary thyroid carcinoma, pheochromocytoma, marfanoid habitus and mucosal neuromas of the tongue, lips, inner cheeks and inner eyelids. Gangliomatosis of the gastrointestinal tract and its complications may also occur in patients with this disease.</p> <p>Case presentation</p> <p>We present the case of a 16-year-old Persian man diagnosed as having a non-invasive form of multiple endocrine neoplasia 2B (medullary thyroid cancer, mucosal neuroma of the tongue, lips and inner eyelids). Our patient, who had a positive family history of medullary thyroid cancer, was of normal height with no signs of marfanoid habitus.</p> <p>Conclusions</p> <p>Ophthalmological and oral manifestations of multiple endocrine neoplasia 2B, as in the case of our patient, are rare presentations of the disease; unfortunately in the case of our patient his condition had not been noted and acted upon until he presented to our department. The diagnosis in our patient's case was made only after his mother presented with the same condition. As a result, we emphasize that physicians should pay more attention to the oral and ocular signs of multiple endocrine neoplasia 2B in order to diagnose this fatal syndrome at an earlier phase.</p

Effects of Electrical Stimulation on the Management of Ischemic Diabetic Foot Ulcers

BACKGROUND AND OBJECTIVE:&nbsp;Diabetic foot ulcer is a major complication caused by diabetes. Electrical stimulation is considered as an efficient modality of diabetic wound healing. This study aimed to investigate the effects of direct-current stimulation of cathodal on skin temperature and acceleration of ischemic diabetic foot ulcer closing. METHODS:&nbsp;This randomized, single-blinded, clinical trial was conducted from November 2013 to September 2014 on 20 patients with type II diabetes suffering from ischemic diabetic foot ulcers. Subjects were randomly divided into two groups of electrical stimulation and placebo. The electrical stimulation group received direct-current cathodal stimulation to the wound for one hour a day, repeating three days a week (4 weeks, 12 sessions), and the placebo group underwent the same procedure with zero-intensity electrical stimulation. Skin surface temperature was measured in the plantar and dorsal areas of the diabetic foot before and after the intervention at sessions one, six and twelve. In addition, the surface of ulcer area was measured at the same intervals (IRCT: 2014110819854 N1). FINDINGS:&nbsp;Comparison of the study groups indicated the mean of skin temperature changes to be significantly higher in the stimulation group compared to the placebo group at sessions one (p=0.01, 0.41&plusmn;0.2 and 0.75&plusmn;0.26), six (p=0.01, 0.25&plusmn;0.27 and 0.6&plusmn;0.21) and twelve (P=0.007, 0.25&plusmn;0.27 and 0.66&plusmn;0.23), respectively. In addition, reduction of the wounded area was considerably higher in the electrical stimulation group (52.68%) compared to the placebo group (38.39%) at session 12 (p=0.02). CONCLUSION:&nbsp;According to the results of this study, direct-current cathodal stimulation could improve skin temperature and accelerate wound closing in ischemic diabetic ulcers

Evaluation and Prevention of Diabetic Neuropathy

Background: Diabetic neuropathy is an incapacitating disease that afflicts almost 50 percent of patients with diabetes. A late finding in type 1 diabetes, diabetic neuropathy can be an early finding in non insulin-dependent diabetes. Diabetic neuropathies are divided primarily into two groups, sensorimotor and autonomic. Patients may acquire only one type of diabetic neuropathy or may present with combinations of neuropathies, such as autonomic neuropathy or distal symmetric polyneuropathy, the latter of which the most common form. Motor deficits, orthostatic hypotension, silent cardiac ischemia, hyperhidrosis, vasomotor instability, gastroparesis, bladder dysfunction, and sexual dysfunction can also result from diabetic neuropathy. Strict control of blood sugar, combined with proper daily foot care, is essential to avoid the complications of this disorder. With the potential to afflict any part of the nervous system, diabetic neuropathy should be suspected in all patients with type 2 diabetes as well as patients who have had type 1 diabetes for over five years. Although some patients with diabetic neuropathy notice few symptoms, upon physical examination mild to moderately severe sensory loss may be noted by the physician. Idiopathic neuropathy has been known to precede the onset of type 2 diabetes

Przewidywanie właściwości dzianin lewo-prawych podczas ściskania stosując metodę elementów skończonych opartą na modelu ściskania pianki

A 3-D finite element model based on the hyperfoam material model was developed in order to predict the compression behaviour of knitted fabrics in a large deformation state. The degree of compressibility of the fabric is determined by the extent of its volume reduction under external pressure. The compression properties of nine produced knitted fabrics at eight pressure values (2.04, 5.10, 10.19, 20.39, 50.97, 101.94, 152.90, and 203.87 kPa) were measured using a fabric thickness tester and results were compared with finite element results. The FEM results of fabric thickness changes (∆T) and fabric compressibility (EMC) showed good agreement with experimental results, with an average error of 5 and 4.9 percent, respectively. However, the results of fabric linearity of the compression (LC) and work of compression (WC) showed fair agreement, with an average error of 24.5 and 24 percent, respectively.Publikacja dotyczy analizy kompresji dzianin lewo-prawych o trzech wariantach splotów. Scharakteryzowano parametry dzianin, tj. ścisłości rządkowe i kolumienkowe, masy, zapis splotu w rzeczywistym przebiegu i na igłach. Wykonano badania eksperymentalne i teoretyczne procesu ściskania dzianin wraz z analizą porównawczą. Badania teoretyczne przeprowadzono w ramach eksperymentu numerycznego w środowisku programu ABAQUS. Uzyskane wyniki badań posłużą w projektowaniu właściwości fizycznych wyrobów skarpetkowych przeznaczonych dla diabetyków