Prevalence and risk factors for diabetic lower limb amputation: a clinic-based case control study

Objective: The aim of the study was to evaluate the prevalence of and risk factors for lower limb amputation in a specialist foot clinic-based setting. Methods: A retrospective quantitative study was conducted, using clinical and biochemical profiles of diabetic foot patients attending the High Risk Foot Clinic at The Townsville Hospital, Australia, between January 1, 2011, and December 31, 2013. Results: The total study sample included 129 subjects, comprising 81 males and 48 females with M : F ratio of 1.7 : 1. Twenty-three subjects were Indigenous Australians, representing 17.8% of the study population. The average age of the cohort was 63.4 years ± 14.1 years [CI 90.98–65.89]. Lower limb amputation was identified as a common and significant outcome (n = 44), occurring in 34.1%, more commonly amongst the Indigenous Australians (56.5% versus 29.2%; p = 0.94, OR 0.94). Risk factors most closely associated with amputation included diabetic retinopathy (p = 0.00, OR 4.4), coronary artery bypass graft (CABG) surgery (p = 0.01, OR 4.1), Charcot's arthropathy (p = 0.01, OR 2.9), and Indigenous ethnicity (p = 0.01, OR 3.4). Although average serum creatinine, corrected calcium, and glycosylated haemoglobin A1c (Hba1c) levels were higher amongst amputees they were statistically insignificant. Conclusions: Lower limb amputation is a common outcome and linked to ethnicity and neurovascular diabetic complications amongst subjects with diabetic foot ulcer. Further research is needed to identify why risk of lower limb amputation seems to differ according to ethnicity

NOD.Cd1-/- mice have increased numbers of CD4+CD25+Foxp3+ T regulatory cells in the periphery

Recent studies indicate Natural Killer T (NKT) lymphocytes and Regulatory T (Treg) cells interact to regulate immune responses. NOD mice bearing a targeted deletion of the NKT cell restriction molecule, CD1d, lack NKT cells. To determine whether absence of NKT cells has an effect on Treg numbers, NOD/Lt and NOD.Cd1-/- mice were examined for differences in their Treg population. Flow cytometric analysis of 10-week old female mice of both strains revealed that NOD.Cd1-/- mice have a higher number of CD4+CD25+Foxp3+ T cells in both the spleen and liver. Further studies on differences in regulatory T cells between these strains at different ages and the effect of adoptive transfer of NKT cells on Treg cells would give us a better understanding about interactions of these two populations

High rate of diabetes in the Asia-Pacific Island: possible role of rapid urbanization: a hospital based study

Asia-Pacific countries are experiencing lifestyle-related non-communicable disease crises. Kimbe, one of Papua New Guinea's provincial capitals is noted as the fastest growing city in the South Pacific subcontinent yet its impact on diabetes mellitus (DM) is not known. To determine pattern of newly diagnosed DM, we conducted a retrospective review of Kimbe General Hospital medical admissions from January 2009 to December 2012. 125 patients were diagnosed with diabetes with male: female ratio of 1.1: 1. Overall, number of patients diagnosed with DM at the hospital increased rapidly from 16 in 2009 to 49 in 2012; p <0.05. Majority of the patients were of young population aged <50 years representing 72 % of the cohort and predominantly of coastal province of origin. Almost 3/4th of the study population was based in Kimbe town and its suburb with only 32 subjects (25.6%) identified as rural residents; p<0.05. This study suggests that subjects living in Asia-Pacific area of rapid urbanization are at higher risk of diabetes compared to residents of rural areas. It highlights the need for adequate health planning and education as part of urbanization program in the DM-prone Asia-Pacific population. Further prospective studies are needed to verify our findings

Response to: comment on “prevalence and risk factors for siabetic lower limb amputation: a clinic-based case control study”

[Extract] The observations by Bakhtiyari and Mansournia on our study [1] were received with great interest. We believe our study was consistent with a case-control format [2]. In particular, our target population was selected from subjects diagnosed with diabetic foot ulcer (DFU) at the local high-risk foot clinic, effectively fulfilling the criteria of control (DFU without amputations) and case (DFU with amputation), as previously described [3]

Emerging role of iron oxide nanoparticles in the diagnostic imaging of pancreatic cancer: a systematic review

Background/Aims: Pancreatic cancer is the fourth most common cause of cancer associated death worldwide with a five year survival rate less than 5%. The poor prognosis is mainly due to late presentation in 80% of patients and its drug resistant nature. Most diagnoses are made using contrast-enhanced computed-tomography (CT) or magnetic-resonance-imaging (MRI) which have a limited sensitivity between 76-86%. Iron oxide nanoparticles are increasingly used in the diagnostic imaging of pancreatic cancer, due their ability to selectively target tumour cells thereby increasing image resolution. The aim of this study is to identify studies investigating the use of iron oxide nanoparticles in the diagnostic imaging of pancreatic cancer. Methods: A systematic review was performed using PubMed for records up to 2015. Search terms used included "iron oxide nanoparticles", "pancreatic cancer" and "imaging". Results: A total of 16 studies were identified evaluating the use of iron oxide nanoparticles in the imaging of pancreatic cancer in-vitro and in in-vivo animal models. Eight of the studies evaluated the use of superparamagnetic-iron-oxide-nanoparticles (SPION), they showed SPION significantly decrease the T2 and T2* relaxation times of tumour tissue, providing a high sensitivity for MRI. Similar results were seen in eight studies that investigated the use of iron oxide nanoparticles conjugated to other molecules including gelatin, survivin, chemokine-receptor-4, silica-gold, endothelial-growth-factor-receptor, urokinase-receptor activator, Clostridium and a sonic-hedgehog target. Conclusion: Iron oxide nanoparticles in the form of SPION or conjugates are biocompatible and effective at targeting tumour cells and significantly attenuate MRI signals in T2-weighted images of pancreatic cancers from a range of cell lines

Prevalence and risk factors of lower limb amputation in patients with end-stage renal failure on dialysis: a systematic review

Background: Renal dialysis has recently been recognised as a risk factor for lower limb amputation (LLA). However, exact rates and associated risk factors for the LLA are incompletely understood. Aim: Prevalence and risk factors of LLA in end-stage renal failure (ESRF) subjects on renal dialysis were investigated from the existing literature. Methods: Published data on the subject were derived from MEDLINE, PubMed, and Google Scholar search of English language literature from January 1, 1980, to July 31, 2015, using designated key words. Results: Seventy studies were identified out of which 6 full-text published studies were included in this systematic review of which 5 included patients on haemodialysis alone and one included patients on both haemodialysis and peritoneal dialysis. The reported findings on prevalence of amputation in the renal failure on dialysis cohort ranged from 1.7% to 13.4%. Five out of the six studies identified diabetes as the leading risk factor for amputation in subjects with ESRF on renal dialysis. Other risk factors identified were high haemoglobin A1c, elevated c-reactive protein, and low serum albumin. Conclusions: This review demonstrates high rate of LLA in ESRF patients receiving dialysis therapy. It has also identified diabetes and markers of inflammation as risk factors of amputation in ESRF subjects on dialysis

Effect of glucagon-like peptide 1 receptor agonists on albuminuria in adult patients with type 2 diabetes mellitus: A systematic review and meta-analysis

Aims: To determine the effect of glucagon-like peptide 1 receptor agonists (GLP-1RAs) on albuminuria in adult patients with type 2 diabetes mellitus (T2DM). Methods: Medline Ovid, Scopus, Web of Science, EMCARE and CINAHL databases from database inception until 27 January 2022. Studies were eligible for inclusion if they were randomized controlled trials that involved treatment with a GLP-1RA in adult patients with T2DM and assessed the effect on albuminuria in each treatment arm. Data extraction was conducted independently by three individual reviewers. The PRISMA guidelines were followed regarding data extraction and quality assessment. Data were pooled using a random effects inverse variance model and all analysis was carried out with RevMan 5.4 software. The Jadad scoring tool was employed to assess the quality of evidence and risk of bias in the randomized controlled trials. Results: The initial search revealed 2419 articles, of which 19 were included in this study. An additional three articles were identified from hand-searching references of included reviews. Therefore, in total, 22 articles comprising 39 714 patients were included. Meta-analysis suggested that use of GLP1-RAs was associated with a reduction in albuminuria in patients with T2DM (weighted mean difference −16.14%, 95% CI −18.42 to −13.86%; p < .0001) compared with controls. Conclusions: This meta-analysis indicates that GLP-1RAs are associated with a significant reduction in albuminuria in adult patients with T2DM when compared with placebo

Metabolic and anthropometric influences on nerve conduction parameters in patients with peripheral neuropathy: a retrospective chart analysis

Background and Aims: Nerve conduction study (NCS) measures how fast an electrical impulse moves through the nerve and is a standard technique for diagnosing and assessing neurological diseases. Despite diabetes and obesity being a common accompaniment of peripheral neuropathy, their effects on NCS patterns have not been elucidated conclusively. Our study aimed to assess several anthropometric and metabolic factors with NCS outcomes to address this gap. Research Design and Methods: This retrospective chart analysis study was conducted on subjects who underwent NCS between 1 January 2009 and 31 December 2019 at a regional hospital. Metabolic, anthropometric, demographical and NCS data were collected from patients’ health records. Results: In total, 120 subjects presenting with sensorimotor peripheral neuropathy symptoms were included in the study. Age, HbA1c, urea and ESR variables were significantly negatively associated with nerve conduction outcomes (Spearman’s correlation rho between −0.210 and −0.456, p < 0.038). HbA1c and age consistently had the most substantial contribution to velocity and amplitude in all regression models (beta coefficients between −0.157 and 0.516, p < 0.001). Urea also significantly account for a large amount of variance in amplitude and velocity in the lower limbs. Conclusion: This study suggests that the severity of sensorimotor neuropathy is influenced by glycaemic control, age and uraemia. The interpretation of NCS results must consider these factors suggesting that improved glycaemic and uraemic control may improve nerve conduction outcomes

Prevalence and Risk Factors for Diabetic Lower Limb Amputation: A Clinic-Based Case Control Study

Objective: The aim of the study was to evaluate the prevalence of and risk factors for lower limb amputation in a specialist foot clinic-based setting. Methods: A retrospective quantitative study was conducted, using clinical and biochemical profiles of diabetic foot patients attending the High Risk Foot Clinic at The Townsville Hospital, Australia, between January 1, 2011, and December 31, 2013. Results: The total study sample included 129 subjects, comprising 81 males and 48 females with M : F ratio of 1.7 : 1. Twenty-three subjects were Indigenous Australians, representing 17.8% of the study population. The average age of the cohort was 63.4 years ± 14.1 years [CI 90.98–65.89]. Lower limb amputation was identified as a common and significant outcome (n = 44), occurring in 34.1%, more commonly amongst the Indigenous Australians (56.5% versus 29.2%; p = 0.94, OR 0.94). Risk factors most closely associated with amputation included diabetic retinopathy (p = 0.00, OR 4.4), coronary artery bypass graft (CABG) surgery (p = 0.01, OR 4.1), Charcot's arthropathy (p = 0.01, OR 2.9), and Indigenous ethnicity (p = 0.01, OR 3.4). Although average serum creatinine, corrected calcium, and glycosylated haemoglobin A1c (Hba1c) levels were higher amongst amputees they were statistically insignificant. Conclusions: Lower limb amputation is a common outcome and linked to ethnicity and neurovascular diabetic complications amongst subjects with diabetic foot ulcer. Further research is needed to identify why risk of lower limb amputation seems to differ according to ethnicity

Emerging therapeutic potential of nanoparticles in pancreatic cancer: a systematic review of clinical trials

Pancreatic cancer is an aggressive disease with a five year survival rate of less than 5%, which is associated with late presentation. In recent years, research into nanomedicine and the use of nanoparticles as therapeutic agents for cancers has increased. This article describes the latest developments in the use of nanoparticles, and evaluates the risks and benefits of nanoparticles as an emerging therapy for pancreatic cancer. The Preferred Reporting Items of Systematic Reviews and Meta-Analyses checklist was used. Studies were extracted by searching the Embase, MEDLINE, SCOPUS, Web of Science, and Cochrane Library databases from inception to 18 March 2016 with no language restrictions. Clinical trials involving the use of nanoparticles as a therapeutic or prognostic option in patients with pancreatic cancer were considered. Selected studies were evaluated using the Jadad score for randomised control trials and the Therapy CA Worksheet for intervention studies. Of the 210 articles found, 10 clinical trials including one randomised control trial and nine phase I/II clinical trials met the inclusion criteria and were analysed. These studies demonstrated that nanoparticles can be used in conjunction with chemotherapeutic agents increasing their efficacy whilst reducing their toxicity. Increased efficacy of treatment with nanoparticles may improve the clinical outcomes and quality of life in patients with pancreatic cancer, although the long-term side effects are yet to be defined. The study registration number is CRD42015020009