71 results on '"Alexandra Jirkovská"'
Search Results
2. Comparison of the impact of autologous cell therapy and conservative standard treatment on tissue oxygen supply and course of the diabetic foot in patients with chronic limb-threatening ischemia: A randomized controlled trial
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Michal Dubský, Jitka Husáková, Robert Bem, Alexandra Jirkovská, Andrea Němcová, Vladimíra Fejfarová, Karol Sutoris, Michal Kahle, and Edward B. Jude
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chronic limb-threatening ischemia ,autologous cell therapy ,diabetic foot ,revascularization ,major amputation of lower extremity ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
BackgroundAutologous cell therapy (ACT) is a new treatment method for patients with diabetes and no-option chronic limb-threatening ischemia (NO-CLTI). We aimed to assess the impact of ACT on NO-CLTI in comparison with standard treatment (ST) in a randomized controlled trial.MethodsDiabetic patients with NO-CLTI were randomized to receive either ACT (n=21) or ST (n=19). After 12 weeks, those in the ST group, who did not improve were treated with ACT. The effect of ACT on ischemia and wound healing was assessed by changes in transcutaneous oxygen pressure (TcPO2) and the number of healed patients at 12 weeks. Pain was evaluated by Visual Analogue Scale (VAS). Amputation rates and amputation-free survival (AFS) were assessed in both groups.ResultsDuring the first 12 weeks, TcPO2 increased in the ACT group from 20.8 ± 9.6 to 41.9 ± 18.3 mm Hg (p=0.005) whereas there was no change in the ST group (from 21.2 ± 11.4 to 23.9 ± 13.5 mm Hg). Difference in TcPO2 in the ACT group compared to ST group was 21.1 mm Hg (p=0.034) after 12 weeks. In the period from week 12 to week 24, when ST group received ACT, the TcPO2 in this group increased from 20.1 ± 13.9 to 41.9 ± 14.8 (p=0.005) while it did not change significantly in the ACT in this period. At 24 weeks, there was no significant difference in mean TcPO2 between the two groups. Wound healing was greater at 12 weeks in the ACT group compared to the ST group (5/16 vs. 0/13, p=0.048). Pain measured using VAS was reduced in the ACT group after 12 weeks compared to the baseline, and the difference in scores was again significant (p
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- 2022
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3. Effects of a 12-Week Interventional Exercise Programme on Muscle Strength, Mobility and Fitness in Patients With Diabetic Foot in Remission: Results From BIONEDIAN Randomised Controlled Trial
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Eliška Vrátná, Jitka Husáková, Radka Jarošíková, Michal Dubský, Veronika Wosková, Robert Bém, Alexandra Jirkovská, Kateřina Králová, Bára Pyšková, Věra Lánská, and Vladimíra Fejfarová
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diabetic foot ,physical activity ,diabetes mellitus ,exercise ,education ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
ObjectivesDiabetic foot syndrome (DFS) is a serious late diabetic complication characterised by limited joint mobility and other biomechanical and muscle abnormalities.AimTo evaluate the effect of an interventional exercise programme on anthropometric parameters, muscle strength, mobility and fitness in patients with diabetic foot in remission.Data Sources and Study SelectionThirty-eight patients with type 2 diabetes and DFS without active lesions (mean age 65 ± 6.9 years, BMI 32 ± 4.7 kg.m-2, waist-hip ratio (WHR)1.02 ± 0.06) were enrolled in our randomised controlled trial. All subjects were randomised into two groups: an intervention group (I; n=19) and a control group (C; n=19). The 12-week exercise intervention focused on ankle and small-joint mobility in the foot, strengthening and stretching of the lower extremity muscles, and improvements in fitness. Changes (Δ=final minus initial results) in physical activity were assessed using the International Physical Activity Questionnaire (IPAQ), with joint mobility detected by goniometry, muscle strength by dynamometry, and fitness using the Senior Fitness Test (SFT).Data extractionDue to reulceration, 15.8% of patients from group I (3/19) and 15.8% of patients from group C were excluded. Based on the IPAQ, group I was more active when it came to heavy (p=0.03) and moderate physical activity (p=0.06) after intervention compared to group C. Group I improved significantly in larger-joint flexibility (p=0.012) compared to controls. In group I, dynamometric parameters increased significantly in both lower limbs (left leg; p=0.013, right leg; p=0.043) compared to group C. We observed a positive trend in the improvement of fitness in group I compared to group C. We also confirmed positive correlations between heavy physical activity and selected parameters of flexibility (r=0.47; p=0.007), SFT (r=0.453; p=0.011) and dynamometry (r=0.58; p
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- 2022
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4. Stimulation TcPO2 Testing Improves Diagnosis of Peripheral Arterial Disease in Patients With Diabetic Foot
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Vladimíra Fejfarová, Jiří Matuška, Edward Jude, Pavlína Piťhová, Milan Flekač, Karel Roztočil, Veronika Wosková, Michal Dubský, Alexandra Jirkovská, Robert Bém, Jitka Husáková, and Věra Lánská
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diabetic foot ,PAD - peripheral arterial disease ,microcirculation ,TcPO2 and TcPCO2 measurement ,diagnosis ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
BackgroundAll diagnostic procedures of peripheral arterial disease (PAD) in diabetic foot (DF) are complicated due to diabetes mellitus and its late complications.The aim of our study is to enhance diagnosis of PAD using a novel transcutaneous oximetry (TcPO2) stimulation test.MethodsThe study comprised patients with mild-to-moderate PAD(WIfI–I 1 or 2) and baseline TcPO2 values of 30-50 mmHg.TcPO2 was measured across 107 different angiosomes. Stimulation examination involved a modification of the Ratschow test. All patients underwent PAD assessment (systolic blood pressures (SBP), toe pressures (TP), the ankle-brachial indexes (ABI) and toe-brachial indexes (TBI), duplex ultrasound of circulation). Angiosomes were divided into two groups based on ultrasound findings: group M(n=60) with monophasic flow; group T(n=47) with triphasic flow. Large vessel parameters and TcPO2 at rest and after exercise (minimal TcPO2, changes in TcPO2 from baseline (Δ,%), TcPO2 recovery time) measured during the stimulation test were compared between study groups.ResultsDuring the TcPO2 stimulation exercise test, group M exhibited significantly lower minimal TcPO2 (26.2 ± 11.1 vs. 31.4 ± 9.4 mmHg; p
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- 2021
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5. The Superiority of Removable Contact Splints in the Healing of Diabetic Foot during Postoperative Care
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Vladimíra Fejfarová, Jaroslav Pavlů, Robert Bém, Veronika Wosková, Michal Dubský, Andrea Němcová, Alexandra Jirkovská, Bedřich Sixta, Karol Sutoris, Filip Thieme, David G. Armstrong, Eliška Vrátná, Jitka Hazdrová, and Věra Lánská
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
Objective. Off-loading is one of the crucial components of diabetic foot (DF) therapy. However, there remains a paucity of studies on the most suitable off-loading for DF patients under postoperative care. The aim of our study was to evaluate the effect of different protective off-loading devices on healing and postoperative complications in DF patients following limb preservation surgery. Methods. This observational study comprised 127 DF patients. All enrolled patients had undergone foot surgery and were off-loaded empirically as follows: wheelchair+removable contact splint (RCS) (group R: 29.2%), wheelchair only (group W: 48%), and wheelchair+removable prefabricated device (group WP: 22.8%). We compared the primary (e.g., the number of healed patients, healing time, and duration of antibiotic (ATB) therapy) and secondary outcomes (e.g., number of reamputations and number and duration of rehospitalizations) with regard to the operation regions across all study groups. Results. The lowest number of postoperative complications (number of reamputations: p=0.028; rehospitalizations: p=0.0085; and major amputations: p=0.02) was in group R compared to groups W and WP. There was a strong trend toward a higher percentage of healed patients (78.4% vs. 55.7% and 65.5%; p=0.068) over a shorter duration (13.7 vs. 16.5 and 20.3 weeks; p=0.055) in the R group, as well. Furthermore, our subanalysis revealed better primary outcomes in patients operated in the midfoot and better secondary outcomes in patients after forefoot surgery—odds ratios favouring the R group included healing at 2.5 (95% CI, 1.04-6.15; p=0.037), reamputations at 0.32 (95% CI, 0.12-0.84; p=0.018), and rehospitalizations at 0.22 (95% CI, 0.08-0.58; p=0.0013). Conclusions. This observational study suggests that removable contact splint combined with a wheelchair is better than a wheelchair with or without removable off-loading device for accelerating wound healing after surgical procedures; it also minimises overall postoperative complications, reducing the number of reamputations by up to 77% and the number of rehospitalizations by up to 66%.
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- 2019
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6. An Alteration of Lymphocytes Subpopulations and Immunoglobulins Levels in Patients with Diabetic Foot Ulcers Infected Particularly by Resistant Pathogens
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Vladimíra Fejfarová, Alexandra Jirkovská, Michal Dubský, Frances Game, Jana Vydláková, Alena Sekerková, Jana Franeková, Monika Kučerová, Ilja Stříž, Vladimír Petkov, Robert Bém, Veronika Wosková, Andrea Němcová, and Jelena Skibová
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
The aim of our study was to analyse immune abnormalities in patients with chronic infected diabetic foot ulcers (DFUs) especially those infected by resistant microorganisms. Methods. 68 patients treated in our foot clinic for infected chronic DFUs with 34 matched diabetic controls were studied. Patients with infected DFUs were subdivided into two subgroups according to the antibiotic sensitivity of causal pathogen: subgroup S infected by sensitive (n=50) and subgroup R by resistant pathogens (n=18). Selected immunological markers were compared between the study groups and subgroups. Results. Patients with infected chronic DFUs had, in comparison with diabetic controls, significantly reduced percentages (p
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- 2016
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7. Impact of Inherited Prothrombotic Disorders on the Long-Term Clinical Outcome of Percutaneous Transluminal Angioplasty in Patients with Diabetes
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Michal Dubský, Alexandra Jirkovská, Libuše Pagáčová, Robert Bém, Andrea Němcová, Vladimíra Fejfarová, Veronika Wosková, and Edward B. Jude
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
The aim of our study was to analyse inherited thrombotic disorders that influence the long-term outcome of PTA. Methods. Diabetic patients with peripheral arterial disease (PAD) treated by PTA in our centre between 2008 and 2011 were included in the study. Patients were divided into unsuccessful PTA group (75 patients), successful PTA group (58 patients), and control group (65 patients, with diabetes but no PAD). Diagnosis of inherited thrombotic disorders included mutation in factor V (Leiden), factor II (prothrombin), and mutation in genes for methylenetetrahydrofolate reductase—MTHFR (C677T and A1298C). Results. The genotypic frequency of Leiden allele G1691A was significantly associated with a risk of unsuccessful PTA in comparison with successful PTA group and control group (OR 8.8 (1.1–70.6), p=0.041, and OR 9.8 (1.2–79.2), p=0.032, resp.). However, we only observed a trend for the association of the prothrombin allele G20210A and risk of PTA failure. The frequencies of alleles of MTHFR 677 or 1298 did not differ significantly among the groups. Conclusion. Our study showed higher frequency of heterozygous form of Leiden mutation in diabetic patients with unsuccessful outcome of PTA in comparison with patients with successful PTA and diabetic patients without PAD.
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- 2015
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8. Does the Diabetic Foot Have a Significant Impact on Selected Psychological or Social Characteristics of Patients with Diabetes Mellitus?
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Vladimíra Fejfarová, Alexandra Jirkovská, Eva Dragomirecká, Frances Game, Robert Bém, Michal Dubský, Veronika Wosková, Marta Křížová, Jelena Skibová, and Stephanie Wu
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Published
- 2014
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9. Comment on 'Impact of Diabetic Foot on Selected Psychological or Social Characteristics'
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Vladimíra Fejfarová, Alexandra Jirkovská, Eva Dragomirecká, Frances Game, Robert Bém, Michal Dubský, Veronika Wosková, Marta Křížová, Jelena Skibová, and Stephanie Wu
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Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Published
- 2014
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10. What are the specifics of diabetic foot syndrome and why we need interdisciplinary recommendations for its diagnosis and treatment?
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Alexandra, Jirkovská, Vladimíra, Fejfarová, Michal, Dubský, Veronika, Wosková, Jiří, Jarkovský, Klára, Benešová, and Tomáš, Pavlík
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Diabetes Mellitus ,Internal Medicine ,Humans ,Prognosis ,Cardiology and Cardiovascular Medicine ,Amputation, Surgical ,Diabetic Foot - Abstract
The care of patients with diabetic foot syndrome (DFS) requires interdisciplinary cooperation, and therefore interdisciplinary recommendations focused on the diagnosis and treatment and prevention of DFS are in place. We also need these recommendations because DFS has its own specifics that affect its diagnosis, therapy, but also the prognosis of patients. These include, for example, the different course of infection and PAD in patients with diabetes, the diagnosis of neuropathic Charcot osteoarthropathy, and the frequent association with end stage kidney disease, which worsens the course of SDN and increases its risk. Last but not least, the specifics of DFS include the issue of amputations with a significantly worse prognosis than in people without diabetes. The creation of an interdisciplinary team in foot clinics, providing comprehensive care for patients with DFS according to the recommended procedure, is associated with improved prognosis of patients with DFS, especially the reduction of amputations.
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- 2021
11. Podiatric care from diabetologists point of view
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Vladimíra Fejfarová, Miroslav Koliba, Jarmila Jirkovská, Hana Kůsová, Pavlína Piťhová, Alexandra Jirkovská, Bedřich Sixta, and Marcela Szabo
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Male ,Peripheral Arterial Disease ,Physicians ,Internal Medicine ,Humans ,Female ,Podiatry ,Cardiology and Cardiovascular Medicine ,Diabetic Foot ,Anti-Bacterial Agents - Abstract
Scoring for the risk of Diabetic foot syndrome (DFS) should be performed regularly in each patient with diabetes mellitus (DM). Patients at risk for DFS should be followed by diabetologists, those with moderate and severe risk for the development of DFS or those with DFS in remission should be already followed by podiatrists. The aim of our study was to determine the extent of DFS risk screening procedures, dispensary care of patients at risk for DFS and treatment of patients with newly developed DFS in diabetes clinics in the Czech Republic.To find out the study data, we prepared in cooperation with the#268;DS#268;LS JEP Committee a questionnaire survey for outpatient diabetology specialists.The questionnaire was completed by 57% (76/135) of diabetologists. Most of them dispensary approximately 1000- 2000 patients with DM. Their feet are checked by 98.7% of diabetologists (1.6 ± 0.8 times a year on average). Screening for the risk of DFS (13024) is performing in less than 100 patients by 74.3% of diabetologists, in 100-200 patients by 14.9% and in more than 200 patients by 10.8% of diabetologists. 77% of respondents are able to examine neuropathy, the rest send their patients to neurologists, peripheral arterial disease is evaluated by only 47.3% of diabetologists (35.3% of them use some form of instrumental examination), others (48.6%) send patients to angiologists, 4.1% of diabetologists do not examine PAD at all). Based on the assessed findings, more than half of the respondents (50.7%) perform scoring for the risk of DFS, but 1/5 of outpatient diabetologists do not know how the scoring is performed. If colleagues find a patient at a risk for DFS, they usually follow him/her by themselves (64.4%), in 24.6% of cases they send the patient immediately to podiatry or surgery (11%). If a patient with a new DFS comes at diabetology clinic, 72.6% of diabetologists are able to prescribe off-loading, 60.3% antibiotics, 47.9% local therapy. Only 52.1% of diabetologists send a patient with a new DFS to outpatient foot clinic, 39.7% to surgery, the rest of them elsewhere.Based on the questionnaire survey results, the screening of DFS is currently severely undersized in outpatient diabetology clinics, it is sufficiently performed only by 11% of diabetologists. Only 16% of diabetologists perform some form of non-invasive diagnostic procedures detecting peripheral arterial disease, neuropathy examinations are more common. If a diabetologist meet a patient with newly developed DFS, he/she is able to prescribe off-loading or antibiotics, but only half of the diabetologists send the patient to outpatient foot clinic, probably due to a lack of them or their overload.
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- 2022
12. Main Factors Predicting Nonresponders to Autologous Cell Therapy for Critical Limb Ischemia in Patients With Diabetic Foot
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Michal Dubský, Robert Bém, Vladimíra Fejfarová, Karol Sutoris, Alexandra Jirkovská, Edward B. Jude, Jitka Husáková, Jelena Skibova, and Andrea Nemcova
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Male ,Heterozygote ,medicine.medical_specialty ,Cell Transplantation ,Critical Illness ,030204 cardiovascular system & hematology ,Risk Assessment ,Transplantation, Autologous ,Gastroenterology ,Cell therapy ,03 medical and health sciences ,Blood Coagulation Disorders, Inherited ,0302 clinical medicine ,Ischemia ,Risk Factors ,Internal medicine ,medicine ,Humans ,Treatment Failure ,Methylenetetrahydrofolate Reductase (NADPH2) ,Activated Protein C Resistance ,Aged ,030304 developmental biology ,0303 health sciences ,Univariate analysis ,biology ,business.industry ,Homozygote ,Factor V ,Heterozygote advantage ,Critical limb ischemia ,Middle Aged ,Stepwise regression ,medicine.disease ,Diabetic foot ,Diabetic Foot ,Methylenetetrahydrofolate reductase ,Mutation ,biology.protein ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Protein C ,medicine.drug - Abstract
Autologous cell therapy (ACT) is a new treatment for patients with no-option critical limb ischemia (NO-CLI). We evaluated the factors involved in the nonresponse to ACT in patients with CLI and diabetic foot. Diabetic patients (n = 72) with NO-CLI treated using ACT in our foot clinic over a period of 8 years were divided into responders (n = 57) and nonresponders (n = 15). Nonresponder was defined as an insufficient increase in transcutaneous oxygen pressure by
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- 2021
13. Clinical and (31)P magnetic resonance spectroscopy characterization of patients with critical limb ischemia before and after autologous cell therapy
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Miloslav Drobný, Andrea Němcová, Milan Hájek, Monika Dezortova, Alexandra Jirkovská, Petr Šedivý, Jitka Hazdrová, Michal Dubský, Robert Bém, and Vladimíra Fejfarová
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0301 basic medicine ,medicine.medical_specialty ,Magnetic Resonance Spectroscopy ,Physiology ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Revascularization ,Transplantation, Autologous ,Phosphocreatine ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Ischemia ,Internal medicine ,Diabetes mellitus ,Humans ,Medicine ,TCPO ,Bone Marrow Transplantation ,Leg ,business.industry ,General Medicine ,Critical limb ischemia ,medicine.disease ,Transplantation ,030104 developmental biology ,chemistry ,Cardiology ,Arteriogenesis ,medicine.symptom ,business ,Phosphorus Radioisotopes ,Perfusion ,Follow-Up Studies - Abstract
Autologous cell therapy (ACT) is a new treatment method for diabetic patients with critical limb ischemia (CLI) not eligible for standard revascularization. After intramuscular injection of bone marrow-derived mononuclear cells local arteriogenesis in the ischemic tissue occurs. Studies assessing visualization of this therapeutic vasculogenesis after ACT by novel imaging techniques are lacking. The aim of our study was to assess the effect of ACT on possible metabolic changes and perfusion of critically ischemic limbs using (31)P magnetic resonance spectroscopy ((31)P MRS) and its possible correlation with changes of transcutaneous oxygen pressure (TcPO2). Twenty-one patients with diabetes and no-option CLI treated by ACT in our foot clinic over 8 years were included in the study. TcPO2 as well as rest (phosphocreatine, adenosine triphosphate and inorganic phosphate) and dynamic (mitochondrial capacity and phosphocreatine recovery time) (31)P-MRS parameters were evaluated at baseline and 3 months after cell treatment. TcPO2 increased significantly after 3 months compared with baseline (from 22.4±8.2 to 37.6±13.3 mm Hg, p=0.0002). Rest and dynamic (31)P MRS parameters were not significantly different after ACT in comparison with baseline values. Our study showed a significant increase of TcPO2 on the dorsum of the foot after ACT. We did not observe any changes of rest or dynamic (31)P MRS parameters in the area of the proximal calf where the cell suspension has been injected into.
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- 2019
14. Impact of severe diabetic kidney disease on the clinical outcome of autologous cell therapy in people with diabetes and critical limb ischaemia
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Edward B. Jude, Jelena Skibova, Andrea Němcová, Vladimíra Fejfarová, Jitka Hazdrová, Jaroslav Chlupac, Alexandra Jirkovská, Michal Dubský, Karol Sutoris, and Robert Bém
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Male ,medicine.medical_specialty ,Critical Illness ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Cell- and Tissue-Based Therapy ,030209 endocrinology & metabolism ,Revascularization ,Severity of Illness Index ,Transplantation, Autologous ,Gastroenterology ,Amputation, Surgical ,Cell therapy ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Ischemia ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,Diabetic Nephropathies ,030212 general & internal medicine ,Aged ,Czech Republic ,Retrospective Studies ,Foot ,business.industry ,Hazard ratio ,Case-control study ,Retrospective cohort study ,Middle Aged ,Limb Salvage ,medicine.disease ,Diabetic Foot ,Transplantation ,Treatment Outcome ,Case-Control Studies ,Female ,business ,Vascular Surgical Procedures ,Follow-Up Studies ,Kidney disease - Abstract
AIM To assess the impact of autologous cell therapy on critical limb ischaemia in people with diabetes and diabetic kidney disease. METHODS A total of 59 people with diabetes (type 1 or type 2) and critical limb ischaemia, persisting after standard revascularization, were treated with cell therapy in our foot clinic over 7 years; this group comprised 17 people with and 42 without severe diabetic kidney disease. The control group had the same inclusion criteria, but was treated conservatively and comprised 21 people with and 23 without severe diabetic kidney disease. Severe diabetic kidney disease was defined as chronic kidney disease stages 4-5 (GFR
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- 2019
15. Benefits of Acidifying Agents in Local Therapy of Diabetic Foot Ulcers Infected by Pseudomonas sp: A Pilot Study
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Michal Dubský, Alexandra Jirkovská, Věra Lánská, Jitka Niklová, Hana Tibenská, Veronika Wosková, Robert Bém, Andrea Němcová, Edward B. Jude, and Vladimíra Fejfarová
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Acidifying agents ,medicine.medical_specialty ,biology ,medicine.drug_class ,business.industry ,Antibiotics ,Pseudomonas ,030209 endocrinology & metabolism ,General Medicine ,medicine.disease ,biology.organism_classification ,Diabetic foot ,030207 dermatology & venereal diseases ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Surgery ,Wound healing ,business - Abstract
Infections caused by Pseudomonas sp are difficult to resolve by antibiotics (ATBs) and local therapy. The aim of our pilot study was to assess the effect of different local agents—particularly acidifying solutions—on the healing of diabetic foot ulcers (DFUs), eradication of pathogens, and economic costs related to DFU therapy. In this case study, we monitored 32 DFU patients infected by Pseudomonas species. Patients were divided into 2 groups according to the local therapy provided: group 1 (n = 15)—modern local treatment; group 2 (n = 17)—acidifying antiseptic solutions. The study groups differed only with regard to ATB usage prior to enrolment in the study ( P = .004), but did not differ with regard to age, diabetes control, peripheral arterial disease, or microcirculation status. During the follow-up period, DFUs healed in 20% of cases in group 1, but there were no cases of healing in group 2 (NS). The length of ATB therapy, the number of new osteomyelitis, lower limb amputations, and the changes of DFUs status/proportions did not differ significantly between study groups. Pseudomonas was eradicated in 67% of cases in group 1 and in 65% of cases in group 2. The local treatment given to group 2 patients was associated with lower costs ( P < .0001). Conclusion. Acidifying agents had the same effect as modern healing agents on wound healing, the number of amputations, and the eradication of Pseudomonas. Moreover, therapy performed using acidifying solutions proved in our pilot study markedly cheaper.
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- 2019
16. Endothelial Progenitor Cells Biology in Diabetes Mellitus and Peripheral Arterial Disease and their Therapeutic Potential
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Andrea Němcová, Michal Dubský, Vladimíra Fejfarová, Robert Bém, Anna Pyšná, Alexandra Jirkovská, Edward B. Jude, and Jitka Hazdrová
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0301 basic medicine ,Cancer Research ,Population ,Cell- and Tissue-Based Therapy ,Biology ,Peripheral Arterial Disease ,03 medical and health sciences ,Paracrine signalling ,0302 clinical medicine ,Diabetes mellitus ,Diabetes Mellitus ,medicine ,Animals ,Humans ,Progenitor cell ,education ,Cells, Cultured ,Endothelial Progenitor Cells ,Progenitor ,education.field_of_study ,Cell Differentiation ,Cell Biology ,medicine.disease ,Peripheral ,030104 developmental biology ,Diabetic foot ulcer ,030220 oncology & carcinogenesis ,embryonic structures ,Immunology ,cardiovascular system ,Stem cell ,circulatory and respiratory physiology - Abstract
Endothelial progenitors are a population of cells with the inherent capacity to differentiate into mature endothelial cells and proangiogenic paracrine action. These characteristics have led to extensive studies being performed and tested in the treatment of tissue ischemia. The natural course of diabetes mellitus (DM) results in multiple areas of vascular damage. Thus endothelial progenitor cells'(EPCs) beneficial potential is particularly desirable in diabetic patients. In this review, we summarize contemporary knowledge of EPC biology in DM. It has been shown that EPC functions are considerably impaired by DM. The presence of peripheral arterial disease (PAD) seems to further exacerbate the deficiencies of EPCs. However, studies examining EPC counts in PAD and DM observed disparate results, which can be due to a lack of consensus on precise EPC immunotype used in the different studies. Nevertheless, the results of EPC-based autologous cell therapy (ACT) are promising. In addition, EPCs have been shown to bean independent predictor of cardiovascular risk and diabetic foot ulcer healing.
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- 2018
17. 219-OR: Comparison of the Impact of Autologous Cell Therapy and Conservative Treatment on Chronic Limb-Threatening Ischemia in Patients with Diabetic Foot: A Randomized Controlled Trial
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Robert Bém, Vladimíra Fejfarová, Andrea Nemcova, Jitka Husáková, Karol Sutoris, Alexandra Jirkovská, and Michal Dubsky
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medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Standard treatment ,Ischemia ,medicine.disease ,Diabetic foot ,Surgery ,law.invention ,Cell therapy ,Amputation ,Randomized controlled trial ,law ,Diabetes mellitus ,Internal Medicine ,medicine ,In patient ,business - Abstract
Background: Autologous cell-therapy (ACT) is a new treatment method for patients with diabetes and no-option chronic limb-threatening ischemia (NO-CLTI). We aimed to assess the impact of ACT on CLTI in comparison with standard treatment (ST) in a randomized controlled trial. Methods: Forty diabetic patients with NO-CLTI were randomized to receive either cell therapy (n=20) or standard conservative therapy (n=16); 4 patients dropped out of the study. After 3 months, those in the ST group were switched to ACT (cell therapy crossover). The effect on ischemia and diabetic foot was assessed by changes in transcutaneous oxygen pressure (TcPO2) and the number of healed patients at 3 months. Amputation rates and amputation-free survival (AFS) were assessed at 3 months and then during 12-month follow-up. Results: TcPO2 increased significantly in the ACT group after 1 and 3 months (both p Conclusions: Our study showed that ACT in patients with no-option CLTI and diabetic foot significantly improved limb ischemia and wound healing when compared to standard conservative therapy, without influencing amputation rates and with a trend to higher 1-year AFS in comparison with delayed ACT treatment in ST group. Disclosure M. Dubsky: None. R. Bem: None. A. Nemcova: None. J. Husáková: None. V. Fejfarova: None. A. Jirkovska: None. K. Sutoris: None. Funding Ministry of Health of the Czech Republic (16-27262A, 00023001)
- Published
- 2020
18. 221-OR: Does Cell Therapy Improve the Quality of Life of Patients with Chronic Limb-Threatening Ischemia? A Randomized Controlled Trial
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Alexandra Jirkovská, Andrea Nemcova, Jitka Husáková, Vladimíra Fejfarová, Michal Dubsky, and Robert Bém
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medicine.medical_specialty ,Randomization ,Visual analogue scale ,business.industry ,Endocrinology, Diabetes and Metabolism ,Ischemia ,Chronic pain ,medicine.disease ,law.invention ,Cell therapy ,Randomized controlled trial ,Quality of life ,law ,Internal medicine ,Internal Medicine ,medicine ,business ,Depression (differential diagnoses) - Abstract
Background: Autologous cell therapy (ACT) is the last option for patients with no-option chronic limb-threatening ischemia (NO-CLTI) and severe pain. The aim of our study was to assess the impact of ACT on a patient’s quality of life, chronic pain and depression using standardized questionnaires. Methods: Forty patients with NO-CLTI were randomized and divided into groups treated initially with ACT (iACT, n=20) or standard conservative therapy (iST, n=16); 4 patients dropped out of the study. After 3 months, those in the standard therapy (ST) group were switched to (cell therapy crossover). All patients filled out the standardized EQ-5D questionnaire assessing their quality of life. Pain was evaluated using a special questionnaire including the Visual Analogue Scale (VAS) and Wong-Baker Faces (WB). The questionnaires were evaluated before randomization; in the iST group at 3 months after ST and then at 3 months after ACT. Results: Pain was significantly reduced in the iACT group after 3 months compared to baseline in both VAS and WB scores (both p Conclusion: Our study showed significant pain reduction in NO-CLTI patients after ACT; this treatment also led to a decrease in depression rate and overall improvement in their quality of life. Disclosure J. Husáková: None. R. Bem: None. A. Nemcova: None. V. Fejfarova: None. A. Jirkovska: None. M. Dubsky: None. Funding Ministry of Health of the Czech Republic (16-27262A); Project for Development of Research Organization (00023001); IKEM, Prague, Czech Republic
- Published
- 2020
19. Incidence and Risk Factors of Diabetic Foot Syndrome in Patients Early After Pancreas or Kidney/Pancreas Transplantation and its Association with Preventive Measures
- Author
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Věra Lánská, J Vařeková, P Girman, K Králová, S Kratochvílová, F Saudek, Vladimíra Fejfarová, K Dad'ová, Robert Bém, Veronika Wosková, E Vrátná, Michal Dubský, Alexandra Jirkovská, and J Husáková
- Subjects
medicine.medical_specialty ,Diabetic neuropathy ,business.industry ,Incidence (epidemiology) ,General Medicine ,medicine.disease ,Diabetic foot ,Organ transplantation ,Transplantation ,medicine.anatomical_structure ,Internal medicine ,Diabetes mellitus ,medicine ,Surgery ,In patient ,Pancreas ,business - Abstract
Diabetic foot (DF) can develop in diabetic patients after organ transplantation (Tx) due to several factors including peripheral arterial disease (PAD), diabetic neuropathy and inappropriate DF prevention. Aim: To assess the occurrence of DF and associated risk factors in transplant patients. Methods: Fifty-seven diabetic patients were enrolled as part of this prospective study. All patients underwent organ Tx (01/2013-12/2015) and were followed up for minimum of 12 months up to a maximum of 50 months. Over the study period we evaluated DF incidence and identified a number of factors likely to influence DF development, including organ function, presence of late complications, PAD, history of DF, levels of physical activity before and after Tx, patient education and standards of DF prevention. Results: Active DF developed in 31.6% (18/57) of patients after organ Tx within 11 months on average (10.7 ± 8 months). The following factors significantly correlated with DF development: diabetes control (p = .0065), PAD (p2;p = .01), history of DF (p = .0031), deformities (p = .0021) and increased leisure-time physical activity (LTPA) before Tx (p = .037). However, based on logistic stepwise regression analysis, the only factors significantly associated with DF during the post-transplant period were: PAD, deformities and increased LTPA. Education was provided to patients periodically (2.6 ± 2.5 times) during the observation period. Although 94.7% of patients regularly inspected their feet (4.5 ± 2.9 times/week), only 26.3% of transplant patients used appropriate footwear. Conclusions: Incidence of DF was relatively high, affecting almost 1/3 of pancreas and kidney/pancreas recipients. The predominant risk factors were: presence of PAD, foot deformities and higher LTPA before Tx. Therefore, we recommend a programme involving more detailed vascular and physical examinations and more intensive education focusing on physical activity and DF prevention in at-risk patients before transplantation.
- Published
- 2021
20. Diabetic foot syndrome: importance of calf muscles MR spectroscopy in the assessment of limb ischemia and effect of revascularization
- Author
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Andrea Němcová, Michal Dubský, Monika Dezortova, Vladimíra Fejfarová, Robert Bém, Milan Hájek, Alexandra Jirkovská, Miloslav Drobný, Petr Šedivý, and Anna Pyšná
- Subjects
Male ,In vivo magnetic resonance spectroscopy ,medicine.medical_specialty ,Magnetic Resonance Spectroscopy ,Supine position ,Phosphocreatine ,medicine.medical_treatment ,030209 endocrinology & metabolism ,030204 cardiovascular system & hematology ,Revascularization ,Phosphates ,03 medical and health sciences ,chemistry.chemical_compound ,Adenosine Triphosphate ,0302 clinical medicine ,Ischemia ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,Exercise physiology ,Muscle, Skeletal ,Exercise ,Aged ,Peripheral Vascular Diseases ,Leg ,business.industry ,Critical limb ischemia ,Middle Aged ,medicine.disease ,Diabetic foot ,Diabetic Foot ,chemistry ,Case-Control Studies ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Vascular Surgical Procedures - Abstract
The standard method for assessment of effect of revascularization in patients with diabetic foot (DF) and critical limb ischemia (CLI) is transcutaneous oxygen pressure (TcPO2). Phosphorus magnetic resonance spectroscopy (31P MRS) enables to evaluate oxidative muscle metabolism that could be impaired in patients with diabetes and its complications. The aim of our study was to compare MRS of calf muscle between patients with DF and CLI and healthy controls and to evaluate the contribution of MRS in the assessment of the effect of revascularization.Thirty-four diabetic patients with DF and CLI treated either by autologous cell therapy (ACT; 15 patients) or percutaneous transluminal angioplasty (PTA; 12 patients) in our foot clinic during 2013-2016 and 19 healthy controls were included into the study. TcPO2 measurement was used as a standard method of non-invasive evaluation of limb ischemia. MRS examinations were performed using the whole-body 3T MR system 1 day before and 3 months after the procedure. Subjects were examined in a supine position with the coil fixed under the m. gastrocnemius. MRS parameters were obtained at rest and during the exercise period. Rest MRS parameters of oxidative muscle metabolism such as phosphocreatine (PCr), inorganic phosphate (Pi), phosphodiesters (PDE), adenosine triphosphate (ATP), dynamic MRS parameters such as recovery constant PCr (τPCr) and mitochondrial capacity (Qmax), and pH were compared between patients and healthy controls, and also before and 3 months after revascularization.Patients with CLI had significantly lower PCr/Pi (p0.001), significantly higher Pi and pH (both p0.01), significantly lower Qmax and prolonged τPCr (both p0.001) in comparison with healthy controls. We observed a significant improvement in TcPO2 at 3 months after revascularization (from 26.4 ± 11.7 to 39.7 ± 17.7 mm Hg, p0.005). However, the rest MRS parameters did not change significantly after revascularization. In individual cases we observed improvement of dynamic MRS parameters. There was no correlation between MRS parameters and TcPO2 values.Results of our study show impaired oxidative metabolism of calf muscles in patients with CLI in comparison with healthy controls. We observed an improvement in dynamic MRS parameters in individual cases; this finding should be verified in a large number of patients during longer follow-up.Key words: autologous cell therapy - critical limb ischemia - diabetic foot - MR spectroscopy.
- Published
- 2017
21. Cell therapy of critical limb ischemia in diabetic patients – State of art
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Edward B. Jude, Andrea Nemcova, Michal Dubský, Alexandra Jirkovská, Vladimíra Fejfarová, and Robert Bém
- Subjects
Male ,0301 basic medicine ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Cell- and Tissue-Based Therapy ,Ischemia ,Context (language use) ,030204 cardiovascular system & hematology ,Revascularization ,Amputation, Surgical ,Peripheral Arterial Disease ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Internal medicine ,Diabetes mellitus ,Internal Medicine ,medicine ,Humans ,Foot Ulcer ,Wound Healing ,business.industry ,Therapeutic effect ,General Medicine ,Critical limb ischemia ,Middle Aged ,Limb Salvage ,medicine.disease ,Diabetic foot ,Diabetic Foot ,Surgery ,Clinical trial ,030104 developmental biology ,Female ,medicine.symptom ,business ,Diabetic Angiopathies - Abstract
In this review we report on the state of cell therapy of critical limb ischemia (CLI) with respect to differences between diabetic and non-diabetic patients mainly from the clinical point of view. CLI is the most severe form of peripheral arterial disease and its diagnosis and treatment in diabetic patients is very difficult. The therapeutic effect of standard methods of CLI treatment is only partial - more than one third of diabetic patients are not eligible for standard revascularization; therefore, new therapeutic techniques such as cell therapy have been studied in clinical trials. Presence of CLI in patients with diabetic foot disease is associated with worse clinical outcomes such as lack of healing of foot ulcers, major amputations and premature mortality. A revascularization procedure cannot be successful as the only method in contrast to patients without diabetes, but it must always be part of a complex therapy focused not only on ischemia, but also on treatment of infection, off-loading, metabolic control of diabetes and nutrition, local therapy, etc. Therefore, the main criteria for cell therapy may vary in diabetic patients and non-diabetic persons and results of this treatment method should always be assessed in the context of ensuring comprehensive therapy. This review carries out an analysis of the source of precursor cells, route of administration and brings a brief report of published data with respect to diabetic and non-diabetic patients and our experience with autologous cell therapy of diabetic patients with CLI. Analysis of the studies in terms of diabetes is difficult, because in most of them sub-analysis for diabetic patients is not performed separately. The other problem is that it is not clear if diabetic patients received adequate complex treatment for their foot ulcers which can strongly affect the rate of major amputation as an outcome of CLI treatment.
- Published
- 2017
22. Benefits of Acidifying Agents in Local Therapy of Diabetic Foot Ulcers Infected by
- Author
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Vladimíra, Fejfarová, Hana, Tibenská, Jitka, Niklová, Robert, Bém, Michal, Dubský, Veronika, Wosková, Andrea, Němcová, Alexandra, Jirkovská, Edward, Jude, and Věra, Lánská
- Subjects
Male ,Wound Healing ,Pilot Projects ,Middle Aged ,Administration, Cutaneous ,Diabetic Foot ,Treatment Outcome ,Cost Savings ,Pseudomonas ,Anti-Infective Agents, Local ,Wound Infection ,Humans ,Drug Therapy, Combination ,Female ,Pseudomonas Infections ,Drug Monitoring ,Acetic Acid - Abstract
Infections caused by Pseudomonas sp are difficult to resolve by antibiotics (ATBs) and local therapy. The aim of our pilot study was to assess the effect of different local agents-particularly acidifying solutions-on the healing of diabetic foot ulcers (DFUs), eradication of pathogens, and economic costs related to DFU therapy. In this case study, we monitored 32 DFU patients infected by
- Published
- 2019
23. The Superiority of Removable Contact Splints in the Healing of Diabetic Foot during Postoperative Care
- Author
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Bedřich Sixta, Eliška Vrátná, Věra Lánská, Karol Sutoris, Michal Dubský, Vladimíra Fejfarová, Veronika Wosková, Alexandra Jirkovská, Robert Bém, David G. Armstrong, Filip Thieme, Andrea Němcová, Jaroslav Pavlů, and Jitka Hazdrová
- Subjects
Male ,Reoperation ,medicine.medical_specialty ,Time Factors ,Article Subject ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,medicine.disease_cause ,Patient Readmission ,lcsh:Diseases of the endocrine glands. Clinical endocrinology ,Amputation, Surgical ,Weight-bearing ,Weight-Bearing ,Endocrinology ,Wheelchair ,Risk Factors ,medicine ,Humans ,Orthopedic Procedures ,In patient ,Device Removal ,Aged ,Postoperative Care ,Wound Healing ,lcsh:RC648-665 ,business.industry ,Forefoot ,Equipment Design ,Length of Stay ,Middle Aged ,medicine.disease ,Diabetic foot ,Diabetic Foot ,Anti-Bacterial Agents ,Surgery ,Splints ,Treatment Outcome ,Wheelchairs ,Female ,Observational study ,Splint (medicine) ,business ,Research Article - Abstract
Objective. Off-loading is one of the crucial components of diabetic foot (DF) therapy. However, there remains a paucity of studies on the most suitable off-loading for DF patients under postoperative care. The aim of our study was to evaluate the effect of different protective off-loading devices on healing and postoperative complications in DF patients following limb preservation surgery. Methods. This observational study comprised 127 DF patients. All enrolled patients had undergone foot surgery and were off-loaded empirically as follows: wheelchair+removable contact splint (RCS) (group R: 29.2%), wheelchair only (group W: 48%), and wheelchair+removable prefabricated device (group WP: 22.8%). We compared the primary (e.g., the number of healed patients, healing time, and duration of antibiotic (ATB) therapy) and secondary outcomes (e.g., number of reamputations and number and duration of rehospitalizations) with regard to the operation regions across all study groups. Results. The lowest number of postoperative complications (number of reamputations: p=0.028; rehospitalizations: p=0.0085; and major amputations: p=0.02) was in group R compared to groups W and WP. There was a strong trend toward a higher percentage of healed patients (78.4% vs. 55.7% and 65.5%; p=0.068) over a shorter duration (13.7 vs. 16.5 and 20.3 weeks; p=0.055) in the R group, as well. Furthermore, our subanalysis revealed better primary outcomes in patients operated in the midfoot and better secondary outcomes in patients after forefoot surgery—odds ratios favouring the R group included healing at 2.5 (95% CI, 1.04-6.15; p=0.037), reamputations at 0.32 (95% CI, 0.12-0.84; p=0.018), and rehospitalizations at 0.22 (95% CI, 0.08-0.58; p=0.0013). Conclusions. This observational study suggests that removable contact splint combined with a wheelchair is better than a wheelchair with or without removable off-loading device for accelerating wound healing after surgical procedures; it also minimises overall postoperative complications, reducing the number of reamputations by up to 77% and the number of rehospitalizations by up to 66%.
- Published
- 2019
24. Cumulative long-term recurrence of diabetic foot ulcers in two cohorts from centres in Germany and the Czech Republic
- Author
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Katherine Ogurtsova, Michal Dubský, Dan Ziegler, Alexandra Jirkovská, Andrea Icks, Gerhard Rümenapf, Stephan Morbach, and Burkhard Haastert
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,030209 endocrinology & metabolism ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Recurrence ,Risk Factors ,Germany ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Cumulative incidence ,Prospective Studies ,030212 general & internal medicine ,Renal replacement therapy ,Aged ,Czech Republic ,Aged, 80 and over ,business.industry ,Proportional hazards model ,Incidence ,Incidence (epidemiology) ,General Medicine ,Middle Aged ,medicine.disease ,Diabetic foot ,Diabetic Foot ,Diabetic foot ulcer ,Diabetes Mellitus, Type 2 ,Amputation ,Female ,business - Abstract
Aims Our aim was to comprehensively estimate the incidence of diabetic foot ulcer (DFU) recurrence and corresponding risk factors in two cohorts. Methods Prospective data from patients with active DFU from two diabetes centres in Germany (GER, n = 222) and the Czech Republic (CZ, n = 99) were analysed. Crude cumulative incidences were obtained. Additionally, time to recurrence and risk factors were investigated using multivariate Cox models. Results 69%(154) of patients in GER and 70%(69) in CZ experienced at least one DFU recurrence; 25%(56) in DEU and 15%(15) in CZ died; 5%(11) and 9%(9) were lost to follow-up. The crude cumulative incidence in the first year was 28% in GER and 25% in CZ; 68%/70% within ten years, and 69%/70% in 15 years. In GER, renal replacement therapy was associated with shorter time to recurrence (HR = 3.71, 95%CI:1.26–10.87); no history of DFU before the index lesion with longer time to recurrence (HR = 0.62, 0.42–0.92). In CZ, type 2 diabetes (HR = 2.57, 1.18–5.62) and index ulcer treatment by minor amputation (HR = 2.11, 1.03–4.33) were associated with shorter time to recurrence. Conclusions Cumulative DFU recurrence was approximately 70% in 15 years in both cohorts. We found a significantly higher risk of future recurrence in patients having a consecutive ulcer compared with the first ever ulcer.
- Published
- 2021
25. Difference in Serum Endostatin Levels in Diabetic Patients with Critical Limb Ischemia Treated by Autologous Cell Therapy or Percutaneous Transluminal Angioplasty
- Author
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Edward B. Jude, Michal Dubsky, Jelena Skibova, L. Kolesar, Alexandra Jirkovská, Veronika Wosková, Vladimíra Fejfarová, Anna Pyšná, Andrea Nemcova, and Robert Bém
- Subjects
0301 basic medicine ,Male ,Autologous cell ,Percutaneous ,medicine.medical_treatment ,endostatin ,Cell- and Tissue-Based Therapy ,Antigens, CD34 ,030204 cardiovascular system & hematology ,Transluminal Angioplasty ,0302 clinical medicine ,Ischemia ,Peripheral Vascular Diseases ,autologous cell therapy ,Stem Cells ,Middle Aged ,Diabetic Foot ,Endostatins ,Treatment Outcome ,cardiovascular system ,Medicine ,Female ,medicine.symptom ,Endostatin ,critical limb ischemia ,medicine.medical_specialty ,angiogenic factors ,Biomedical Engineering ,Urology ,Neovascularization, Physiologic ,macromolecular substances ,Revascularization ,Transplantation, Autologous ,03 medical and health sciences ,Vasculogenesis ,medicine ,Humans ,Aged ,Transplantation ,business.industry ,Angioplasty ,Extremities ,Cell Biology ,Critical limb ischemia ,Original Articles ,body regions ,030104 developmental biology ,Diabetes Mellitus, Type 2 ,Transcutaneous oxygen ,business ,Stem Cell Transplantation - Abstract
The aim of this study was to compare the serum levels of the anti-angiogenic factor endostatin (S-endostatin) as a potential marker of vasculogenesis after autologous cell therapy (ACT) versus percutaneous transluminal angioplasty (PTA) in diabetic patients with critical limb ischemia (CLI). A total of 25 diabetic patients with CLI treated in our foot clinic during the period 2008–2014 with ACT generating potential vasculogenesis were consecutively included in the study; 14 diabetic patients with CLI who underwent PTA during the same period were included in a control group in which no vasculogenesis had occurred. S-endostatin was measured before revascularization and at 1, 3, and 6 months after the procedure. The effect of ACT and PTA on tissue ischemia was confirmed by transcutaneous oxygen pressure (TcPO2) measurement at the same intervals. While S-endostatin levels increased significantly at 1 and 3 months after ACT (both P < 0.001), no significant change of S-endostatin after PTA was observed. Elevation of S-endostatin levels significantly correlated with an increase in TcPO2 at 1 month after ACT ( r = 0.557; P < 0.001). Our study showed that endostatin might be a potential marker of vasculogenesis because of its significant increase after ACT in diabetic patients with CLI in contrast to those undergoing PTA. This increase may be a sign of a protective feedback mechanism of this anti-angiogenic factor.
- Published
- 2018
26. Perfusion scintigraphy in the assessment of autologous cell therapy in diabetic patients with critical limb ischemia
- Author
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Marie Buncová, Veronika Wosková, Andrea Nemcova, Robert Bém, Alexandra Jirkovská, Anna Pyšná, Michal Dubsky, and Vladimíra Fejfarová
- Subjects
Male ,Technetium Tc 99m Sestamibi ,medicine.medical_specialty ,Autologous cell ,Physiology ,Perfusion Imaging ,Cell- and Tissue-Based Therapy ,030209 endocrinology & metabolism ,030204 cardiovascular system & hematology ,Scintigraphy ,Transplantation, Autologous ,Calf muscles ,Cell therapy ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,TCPO ,Aged ,Leg ,medicine.diagnostic_test ,business.industry ,General Medicine ,Critical limb ischemia ,Middle Aged ,Diabetic Foot ,body regions ,chemistry ,Diabetes Mellitus, Type 2 ,Cardiology ,Female ,medicine.symptom ,Transcutaneous oxygen ,business ,Perfusion - Abstract
Perfusion scintigraphy with technetium-99-methoxy-isobutyl-isonitrile (99mTc-MIBI) is often used for assessing myocardial function but the number of studies concerning lower limb perfusion is limited. The aim of our study was to assess whether 99mTc-MIBI was an eligible method for evaluation of the effect of cell therapy on critical limb ischemia (CLI) in diabetic patients. 99mTc-MIBI of calf muscles was performed before and 3 months after autologous cell therapy (ACT) in 24 diabetic patients with CLI. Scintigraphic parameters such as rest count and exercising count after a stress test were defined. These parameters and their ratios were compared between treated and untreated (control) limbs and with changes in transcutaneous oxygen pressure (TcPO2) that served as a reference method. The effect of ACT was confirmed by a significant increase in TcPO2 values (p˂0.001) at 3 months after ACT. We did not observe any significant changes of scintigraphic parameters both at rest and after stress 3 months after ACT, there were no differences between treated and control limbs and no association with TcPO2 changes. Results of our study showed no significant contribution of 99mTc-MIBI of calf muscles to the assessment of ACT in diabetic patients with CLI over a 3-month follow-up period.
- Published
- 2018
27. Predictors of Lower-Extremity Amputation in Patients With an Infected Diabetic Foot Ulcer
- Author
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V. Urbancic, Alexandra Jirkovská, H. Reike, Kristien Van Acker, Marleen Kars, Luigi Uccioli, Jeff G. van Baal, Didac Mauricio, Edward B. Jude, Gunnel Ragnarson Tennvall, Per Holstein, K. Bakker, Nicolaas C. Schaper, Alberto Piaggesi, Jan Apelqvist, Michael Edmonds, M. Spraul, K. Pickwell, Volkert Siersma, Health Services Research, Interne Geneeskunde, RS: CAPHRI School for Public Health and Primary Care, and RS: CAPHRI - R2 - Creating Value-Based Health Care
- Subjects
Male ,medicine.medical_specialty ,Fever ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Infections ,Amputation, Surgical ,Settore MED/13 - Endocrinologia ,Peripheral Arterial Disease ,Risk Factors ,Diabetes mellitus ,Internal Medicine ,medicine ,Edema ,Humans ,Prospective Studies ,Prospective cohort study ,Aged ,Advanced and Specialized Nursing ,Framingham Risk Score ,business.industry ,Prognosis ,medicine.disease ,Diabetic foot ,Diabetic Foot ,Surgery ,C-Reactive Protein ,Diabetic foot ulcer ,Amputation ,Odorants ,Cohort ,Female ,Observational study ,business - Abstract
OBJECTIVE Infection commonly complicates diabetic foot ulcers and is associated with a poor outcome. In a cohort of individuals with an infected diabetic foot ulcer, we aimed to determine independent predictors of lower-extremity amputation and the predictive value for amputation of the International Working Group on the Diabetic Foot (IWGDF) classification system and to develop a risk score for predicting amputation. RESEARCH DESIGN AND METHODS We prospectively studied 575 patients with an infected diabetic foot ulcer presenting to 1 of 14 diabetic foot clinics in 10 European countries. RESULTS Among these patients, 159 (28%) underwent an amputation. Independent risk factors for amputation were as follows: periwound edema, foul smell, (non)purulent exudate, deep ulcer, positive probe-to-bone test, pretibial edema, fever, and elevated C-reactive protein. Increasing IWGDF severity of infection also independently predicted amputation. We developed a risk score for any amputation and for amputations excluding the lesser toes (including the variables sex, pain on palpation, periwound edema, ulcer size, ulcer depth, and peripheral arterial disease) that predicted amputation better than the IWGDF system (area under the ROC curves 0.80, 0.78, and 0.67, respectively). CONCLUSIONS For individuals with an infected diabetic foot ulcer, we identified independent predictors of amputation, validated the prognostic value of the IWGDF classification system, and developed a new risk score for amputation that can be readily used in daily clinical practice. Our risk score may have better prognostic accuracy than the IWGDF system, the only currently available system, but our findings need to be validated in other cohorts.
- Published
- 2015
28. Role of Serum Levels of Angiogenic Cytokines in Assessment of Angiogenesis after Stem Cell Therapy of Diabetic Patients with Critical Limb Ischemia
- Author
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L. Kolesar, Libuse Pagacova, Alexandra Jirkovská, Eva Syková, Michal Dubsky, Vladimíra Fejfarová, Robert Bém, Martin Varga, and Edward B. Jude
- Subjects
Male ,Angiogenesis ,Partial Pressure ,medicine.medical_treatment ,Biomedical Engineering ,lcsh:Medicine ,Neovascularization, Physiologic ,Antigens, CD34 ,Transplantation, Autologous ,Vasculogenesis ,Ischemia ,Diabetes Mellitus ,medicine ,Humans ,Aged ,Transplantation ,business.industry ,lcsh:R ,Cell Biology ,Stem-cell therapy ,Critical limb ischemia ,Middle Aged ,Endostatins ,Oxygen ,Immunology ,Cancer research ,Cytokines ,Female ,Stem cell ,medicine.symptom ,business ,Stem Cell Transplantation - Abstract
The release of proangiogenic cytokines into the circulation after stem cell (SC) therapy and compensatory increase of angiogenesis inhibitors may reflect local vasculogenesis but also can increase the risk of side effects. The aim of our study was to evaluate serum levels of angiogenic cytokines with regard to the assessment of local and systemic vasculogenesis in diabetic patients with no-option critical limb ischemia (NO-CLI). Twenty-five diabetic patients with NO-CLI treated with SCs isolated from bone marrow or stimulated peripheral blood were included in the study. Serum levels of proangiogenic cytokines (VEGF, bFGF, Ang-1, PDGF-AA, and PDGF-BB) and an antiangiogenic cytokine (endostatin) were assessed 6 months after cell treatment, compared to baseline values, and correlated with the number of injected CD34+ cells. The clinical effect of SC therapy (assessed by changes in TcPO2) and potential systemic vasculogenesis (assessed by eye fundus examination) were evaluated after 6 months. Serum levels of angiogenic inhibitor endostatin increased significantly after 1 and 3 months ( p = 0.0003), but no significant increase in serum levels of proangiogenic cytokines was observed. A significant correlation between number of injected CD34+ cells and serum levels of endostatin was observed ( r = 0.41, p < 0.05); however, proangiogenic cytokines did not correlate with CD34+ cells. No correlation between increase in TcPO2 after treatment and serum levels of any of the angiogenic cytokines were seen, and no signs of systemic vasculogenesis in the retina were observed after 6 months. Despite the significant increase in the levels of the angiogenic inhibitor endostatin following SC treatment, there was no risk of systemic vasculogenesis after SC therapy as documented by serum levels of proangiogenic cytokines or changes in the retina.
- Published
- 2014
29. [Has been changed numbers and characteristics of patients with major amputations indicated for the diabetic foot in our department during last decade?]
- Author
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Vladimíra, Fejfarová, Alexandra, Jirkovská, Vladimír, Petkov, Ludmila, Řezaninová, Robert, Bém, Michal, Dubský, Veronika, Wosková, Andrea, Němcová, and Jelena, Skibová
- Subjects
Adult ,Male ,Humans ,Female ,Bacterial Infections ,Middle Aged ,Severity of Illness Index ,Amputation, Surgical ,Diabetic Foot ,Aged ,Anti-Bacterial Agents ,Czech Republic - Abstract
One of the most serious complications of the diabetic foot (DF) is a major amputation, which is associated with poor patient prognosis. The occurrence of major amputations may be influenced by a variety of factors including deep infection caused by resistant pathogens.The aims of our study were to compare the incidence of major amputations in podiatric center, characteristics of amputated patients with the DF and other factors contributing to major amputations in last decade.We included into our study all patients hospitalized for the DF in our center whose underwent major amputations from 9/2004 to 9/2006 (group 1) and from 9/2013 to 9/2015 (group 2). Risk factors such as severity of DF ulcers based on Texas classification, duration of previous anti-biotic therapy, the presence and severity of peripheral arterial disease (PAD) according to Graziani classification, the number of revascularizations, renal failure/hemodialysis, osteomyelitis, infectious agents found before amputations and their resistance were compared between the study groups.During the 1st study period (9/2004-9/2006) 373 patients were hospitalized for the DF, of whom 3.2 % underwent major amputation (12/373 - group 1), during the 2nd study period (9/2013-9/2015) 376 patients, of whom 5.1 % absolved major amputation (19/376 - group 2). As the numbers of major amputations as their indications were similar in both study groups. The study groups did not differ significantly in the age, BMI, duration and type of diabetes, duration of DF and severity of DF ulcers, the presence of renal failure/hemodialysis, osteomyelitis and PAD. Group 2 had milder forms of PAD by Graziani classification (4.4 ±1.4 vs 5.7 ± 0.9; p = 0.012) and a higher number of revascularizations before major amputations (2.5 ± 1.5 vs 1 ± 1; p = 0.003) compared to the group 1. These patients were significantly longer treated by antibiotics (5.4 ± 2.4 vs 2.5 ± 2 months; p = 0.002) and underwent more resections and minor amputations (3.1 ± 2.1 vs 0.9 ± 0.5; p = 0.0004) before major amputations in contrast to the group 1. There was a trend to higher incidence of Gram-negatives (65.1 % vs 61.5 %; NS) with a predominance of Enterobacteriacae species (60.7 % vs 56 %; NS) and a trend to the increase of Pseudomonas (25 % vs 18.8 %; NS) and Enterococci sp. (46.7 % vs 20 %; NS) in the group 2 compared to the group 1. The incidences as of MRSA, multidrug resistant Pseudomonas sp. of other resistant microbes were similar in both study groups.The incidence of major amputations in patients hospitalized for the DF remains unchanged during the last decade. The therapy of factors leading to amputations has evidently intensified. This is in accordance with the latest international recommendations for the therapy of DF. In the future, it is appropriate to focus on the improvement of detection and treatment of infection and ischemia in such risk group of patients.Key words: diabetic foot - major amputation.
- Published
- 2017
30. The relationship between chronic venous insufficiency and diabetes mellitus
- Author
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Helena Cermakova, Andrea Němcová, Alexandra Svědínková, Jelena Skibova, Robert Bém, Karel Roztocil, Veronika Wosková, Alexandra Jirkovská, Vladimíra Fejfarová, and Michal Dubský
- Subjects
Male ,medicine.medical_specialty ,Chronic venous insufficiency ,MEDLINE ,Severity of Illness Index ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Internal medicine ,Severity of illness ,Diabetes Mellitus ,medicine ,Humans ,Ankle Brachial Index ,Aged ,business.industry ,Middle Aged ,medicine.disease ,Chronic disease ,Venous Insufficiency ,Chronic Disease ,Female ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Published
- 2017
31. Diabetic complications do not hamper improvement of health-related quality of life over the course of treatment of diabetic foot ulcers - the Eurodiale study
- Author
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Kristien Van Acker, Jeff G. van Baal, Didac Mauricio, Nicolaas C. Schaper, Marleen Kars, Alberto Piaggesi, Luigi Uccioli, Volkert Siersma, V. Urbancic, Hanne Thorsen, Michael Edmonds, H. Reike, Alexandra Jirkovská, K. Bakker, Edward B. Jude, M. Spraul, Jan Apelqvist, Per Holstein, Interne Geneeskunde, MUMC+: MA Endocrinologie (9), RS: CAPHRI - R2 - Creating Value-Based Health Care, and RS: CARIM - R3.02 - Hypertension and target organ damage
- Subjects
Male ,Longitudinal study ,Endocrinology, Diabetes and Metabolism ,Health-related quality of life ,Comorbidity ,Anxiety ,DISEASE ,Settore MED/13 - Endocrinologia ,Cohort Studies ,0302 clinical medicine ,Endocrinology ,Diabetes mellitus ,Quality of life ,Cost of Illness ,Activities of Daily Living ,MEDICAL CONDITIONS ,030212 general & internal medicine ,Longitudinal Studies ,Prospective Studies ,Prospective cohort study ,AMPUTATION ,Depression ,Middle Aged ,Combined Modality Therapy ,humanities ,Diabetic Foot ,Europe ,Diabetic foot ulcer ,Aged ,Diabetes Complications ,Female ,Humans ,Psychiatric Status Rating Scales ,Self-Management ,Wound Healing ,Quality of Life ,BURDEN ,Cohort study ,medicine.medical_specialty ,030209 endocrinology & metabolism ,PROSPECTIVE-COHORT ,03 medical and health sciences ,PEOPLE ,Internal Medicine ,medicine ,business.industry ,CARE ,medicine.disease ,Diabetic foot ,Physical therapy ,business - Abstract
Aims: Diabetic complications, and in particular diabetic foot ulcers (DFUs), are associated with low health-related quality of life (HRQoL). We evaluated whether the presence of diabetic complications also influenced the improvement of HRQoL during DFU treatment.Methods: 1088 patients presenting for DFU treatment at the centers participating in the Eurodiale study were followed prospectively up to one year. HRQoL was measured both at presentation and after healing or at end of follow up, using EQ-5D: a standardized instrument consisting of five domains and a summary index. The influence of diabetic comorbidity on the course of HRQoL was evaluated for each of the EQ-5D outcomes in multi-level linear regression analyses, adjusting for baseline characteristics.Results: HRQoL improved in all EQ-5D outcomes over the course of treatment for those DFUs that healed. The few significant differences in the development of HRQoL between patients with and without comorbidity showed a more beneficial development for patients with comorbidity in DFUs that did not heal or healed slowly.Conclusions: Comorbidity does not hamper improvement of HRQoL in DFU treatment. On the contrary, HRQoL improved sometimes more in patients with certain comorbidity with hard-to-heal ulcers. (C) 2017 Elsevier Inc. All rights reserved.
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- 2017
32. [Diabetic foot syndrome from the perspective of internist educated in podiatry]
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Alexandra, Jirkovská
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Internal Medicine ,Humans ,Podiatry ,Diabetic Foot - Abstract
Podiatry is the science dealing with the diagnostics and treatment of the foot and ankle and associated tissues and structures by all appropriate methods and also with the local manifestation of the overall processes in this area. Diabetic foot disease is defined as infection, ulceration or destruction of tissues of the foot associated with neuropathy and/or peripheral artery disease in the lower extremity of people with diabetes according to the latest edition of the International Consensus. Successful treatment and prevention of diabetic foot syndrome depends on a holistic approach, in which it is seen as part of the multiple organ involvement. Teamwork of series of experts is therefore necessary. Internist with diabetes and podiatric education plays a key role in this team in particular, when control diabetes and in the prevention and treatment of co-morbidities, in the diagnosis of malnutrition and in the nutritional therapy and in the early diagnosis and effective treatment of infections. Last but not least, internist in collaboration with other professionals works when treatment of lower limb ischemia, suitable offloading of the ulcer and topical therapy and in the prevention of ulcers. Recurrent ulcerations are the major problem in podiatry and it can occur in up to 40% of patients in the first year after healing. Follow-up of patients with diabetic foot syndrome by experienced internist can help reduce the serious consequences, including amputation and cardiovascular mortality.Key words: diabetic foot - internal medicine - podiatry.
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- 2016
33. EFFECTIVENESS OF NEGATIVE PRESSURE WOUND THERAPY IN NEUROPATHIC DIABETIC FOOT ULCERS: AN UMBRELLA REVIEW PROTOCOL.
- Author
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Miloslav, KLUGAR, Lucia, KANTOROVÁ, Andrea, POKORNÁ, Michal, HÁJEK, Tereza, VRBOVÁ, Alexandra, JIRKOVSKÁ, Michal, DUBSKÝ, Vladimíra, FEJF AROVÁ, Jarmila, JIRKOVSKÁ, Miroslav, KOLIBA, Dušan, KUČERA, Petr, KRAWCZYK, Bedřich, SIXTA, Veronika, WOSKOVÁ, Zuzana, FIALOVÁ, and Jitka, KLUGAROVÁ
- Subjects
DIABETIC foot ,NEGATIVE-pressure wound therapy ,FOOT ulcers ,NEUROPATHY ,META-analysis - Abstract
Copyright of Zdravotnicke listy is the property of Alexander Dubcek University in Trencin, Faculty of Nursing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2020
34. EFFECTIVENESS OF HYPERBARIC OXYGEN THERAPY IN NEUROPATHIC AND NEUROISCHEMIC DIABETIC FOOT ULCERS: AN UMBRELLA REVIEW PROTOCOL.
- Author
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Miloslav, KLUGAR, Lucia, KANTOROVÁ, Andrea, POKORNÁ, Michal, HÁJEK, Tereza, VRBOVÁ, Alexandra, JIRKOVSKÁ, Michal, DUBSKÝ, Vladimíra, FEJFAROVÁ, Jarmila, JIRKOVSKÁ, Miroslav, KOLIBA, Dušan, KUČERA, Petr, KRAWCZYK, Bedřich, SIXTA, Veronika, WOSKOVÁ, Zuzana, FIALOVÁ, and Jitka, KLUGAROVÁ
- Subjects
HYPERBARIC oxygenation ,DIABETIC foot ,SYSTEMATIC reviews ,NEUROPATHY ,ISCHEMIA - Abstract
Copyright of Zdravotnicke listy is the property of Alexander Dubcek University in Trencin, Faculty of Nursing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2020
35. AUTOLOGOUS CELL THERAPY IN CHRONIC LIMB-THREATENING ISCHEMIA: AN UMBRELLA REVIEW PROTOCOL.
- Author
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Miloslav, KLUGAR, Lucia, KANTOROVÁ, Andrea, POKORNÁ, Michal, HÁJEK, Tereza, VRBOVÁ, Alexandra, JIRKOVSKÁ, Michal, DUBSKÝ, Vladimíra, FEJFAROVÁ, Jarmila, JIRKOVSKÁ, Miroslav, KOLIBA, Dušan, KUČERA, Petr, KRAWCZYK, Bedřich, SIXTA, Veronika, WOSKOVÁ, Zuzana, FIALOVÁ, and Jitka, KLUGAROVÁ
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CELLULAR therapy ,ISCHEMIA ,DISEASES of the anatomical extremities ,PERIPHERAL vascular diseases ,DIABETES complications - Abstract
Copyright of Zdravotnicke listy is the property of Alexander Dubcek University in Trencin, Faculty of Nursing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
- Published
- 2020
36. Both autologous bone marrow mononuclear cell and peripheral blood progenitor cell therapies similarly improve ischaemia in patients with diabetic foot in comparison with control treatment
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Robert Bém, Vladimíra Fejfarová, Eva Syková, Edward B. Jude, Libuse Pagacova, S. Langkramer, Alexandra Jirkovská, Michal Dubsky, Bedrich Sixta, and M. Varga
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medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,CD34 ,Urology ,medicine.disease ,Peripheral blood mononuclear cell ,Diabetic foot ,Surgery ,Cell therapy ,Endocrinology ,medicine.anatomical_structure ,Diabetes mellitus ,Internal Medicine ,medicine ,Peripheral blood cell ,Bone marrow ,Progenitor cell ,business - Abstract
Background The aim of our study was to compare the effect of bone marrow mononuclear cell and peripheral blood progenitor cell therapies in patients with diabetic foot disease and critical limb ischaemia unresponsive to revascularization with conservative therapy. Methods Twenty-eight patients with diabetic foot disease (17 treated by bone marrow cells and 11 by peripheral blood cell) were included into an active group and 22 patients into a control group without cell treatment. Transcutaneous oxygen pressure and rate of major amputation, as the main outcome measures, were compared between bone marrow cells, peripheral blood cell and control groups over 6 months; both cell therapy methods were also compared by the characteristics of cell suspensions. Possible adverse events were evaluated by changes of serum levels of angiogenic cytokines and retinal fundoscopic examination. Results The transcutaneous oxygen pressure increased significantly (p
- Published
- 2013
37. Risk factors for recurrence of diabetic foot ulcers: prospective follow-up analysis in the Eurodiale subgroup
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Alexandra Jirkovská, Michal Dubský, Jelena Skibova, Benjamin A. Lipsky, Robert Bém, Vladimíra Fejfarová, Nicolaas C. Schaper, MUMC+: MA Endocrinologie (9), Interne Geneeskunde, and RS: CARIM School for Cardiovascular Diseases
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Male ,medicine.medical_specialty ,Time Factors ,Risk factors for reulceration ,Diabetic foot ulcer ,Dermatology ,Severity of Illness Index ,Recurrence ,Risk Factors ,Internal medicine ,Severity of illness ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Wound Healing ,business.industry ,Incidence ,Osteomyelitis ,Incidence (epidemiology) ,Original Articles ,Odds ratio ,Middle Aged ,medicine.disease ,Diabetic foot ,Diabetic Foot ,Confidence interval ,Surgery ,Europe ,Female ,business ,Ulcer recurrence ,Follow-Up Studies - Abstract
Few studies have examined factors associated with diabetic foot ulcer (DFU) recurrence. Using data from patients enrolled in the prospective Eurodiale DFU study, we investigated the frequency of and risk factors for DFU recurrence after healing during a 3‐year follow‐up period. At our site, 93 Eurodiale‐enrolled patients had a healed DFU. Among these, 14 were not alive; of the remaining 79 patients we enrolled 73 in this study. On entry to the Eurodiale study, we assessed demographic factors (age, sex and distance from hospital); diabetes‐related factors [duration, and glycated haemoglobin (HbA1c) levels]; comorbidities (obesity, renal failure, smoking and alcohol abuse) and DFU‐related factors [peripheral arterial disease, ulcer infection, C‐reactive protein (CRP) and; foot deformities]. During the 3‐year follow‐up period, a DFU had recurred in 42 patients (57·5%). By stepwise logistic regression of findings at initial DFU presentation, the significant independent predictors for recurrence were plantar ulcer location [odds ratio (OR) 8·62, 95% confidence interval (CI) 2·2–33·2]; presence of osteomyelitis (OR 5·17, 95% CI 1·4–18·7); HbA1c > 7·5% ([DCCT], OR 4·07, 95% CI 1·1–15·6) and CRP > 5 mg/l (OR 4·27, 95% CI 1·2–15·7). In these patients with a healed DFU, the majority had a recurrence of DFU during a 3‐year follow‐up period, despite intensive foot care. The findings at diagnosis of the initial DFU were independent risk factors associated with ulcer recurrence (plantar location, bone infection, poor diabetes control and elevated CRP) and define those at high risk for recurrence, but may be amenable to targeted interventions.
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- 2012
38. The Charcot Foot in Diabetes
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Andrew J.M. Boulton, Alexandra Jirkovská, Luigi Uccioli, Georges Ha Van, David G. Armstrong, Lee J. Sanders, Agnes Hartemann, Frances L. Game, Stephan Morbach, Michael Edmonds, Lee C. Rogers, Michael S. Pinzur, Robert G. Frykberg, William Jeffcoate, Dario Pitocco, William B. Morrison, Edward B. Jude, and Dane K. Wukich
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Orthotic Devices ,Pediatrics ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Arthrodesis ,medicine.medical_treatment ,Consensus Report ,law.invention ,Bone remodeling ,Fractures, Bone ,Immobilization ,Randomized controlled trial ,Diabetic Neuropathies ,law ,Bone Density ,Diabetes mellitus ,Internal Medicine ,Medicine ,Humans ,Ankle Injuries ,Advanced and Specialized Nursing ,business.industry ,Reviews/Commentaries/ADA Statements ,Foot ,RANK Ligand ,General Medicine ,medicine.disease ,Diabetic foot ,Magnetic Resonance Imaging ,Diabetic Foot ,Natural history ,Radiography ,Bone Diseases, Metabolic ,Disease Progression ,Neuropathic arthropathy ,Physical therapy ,Cytokines ,Arthropathy, Neurogenic ,business ,Complication ,Algorithms ,Ankle Joint ,Foot (unit) - Abstract
The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. First described in 1883, this enigmatic condition continues to challenge even the most experienced practitioners. Now considered an inflammatory syndrome, the diabetic Charcot foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. An international task force of experts was convened by the American Diabetes Association and the American Podiatric Medical Association in January 2011 to summarize available evidence on the pathophysiology, natural history, presentations, and treatment recommendations for this entity. (J Am Podiatr Med Assoc 101(5): 437–446, 2011)
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- 2011
39. Differences in minor amputation rate in diabetic foot disease throughout Europe are in part explained by differences in disease severity at presentation
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Luigi Uccioli, Michael Edmonds, J. van Baal, Isabel Ferreira, Didac Mauricio, Nicolaas C. Schaper, V. Urbancic, H. Reike, Maya S. P. Huijberts, K. Bakker, Alexandra Jirkovská, K. J. Van Acker, L. Prompers, Per Holstein, Alberto Piaggesi, G. Ragnarson Tennvall, Jan Apelqvist, E. Jude, P. van Battum, and M. Spraul
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medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,Incidence (epidemiology) ,medicine.medical_treatment ,Odds ratio ,medicine.disease ,Diabetic foot ,Confidence interval ,Surgery ,Endocrinology ,Diabetic foot ulcer ,Amputation ,Internal medicine ,Severity of illness ,Internal Medicine ,medicine ,business ,Prospective cohort study - Abstract
Objectives The incidence of minor amputation may vary significantly, and determinants of minor amputation have not been studied systematically. We evaluated minor amputation rate, the determinants of minor amputation and differences in amputation rate between European centres. Methods In the Eurodiale study, a prospective cohort study of 1232 patients (1088 followed until end-point) with a new diabetic foot ulcer were followed on a monthly basis until healing, death, major amputation or up to a maximum of 1 year. Ulcers were treated according to international guidelines. Baseline characteristics independently associated with minor amputation were examined using multiple logistic regression modelling. Based on the results of the multivariable analysis, a disease severity score was calculated for each patient. Results One hundred and ninety-four (18%) patients underwent a minor amputation. Predictors of minor amputation were depth of the ulcer (odds ratio 6.08, confidence interval 4.10-9.03), peripheral arterial disease (odds ratio 1.84, confidence interval 1.30-2.60), infection (odds ratio 1.56, confidence interval 1.05-2.30) and male sex (odds ratio 1.42, confidence interval 0.99-2.04). Minor amputation rate varied between 2.4 and 34% in the centres. Minor amputation rate in centres correlated strongly with disease severity score at the moment of presentation to the foot clinic (r = 0.75). Conclusions Minor amputation is performed frequently in diabetic foot centres throughout Europe and is determined by depth of the ulcer, peripheral arterial disease, infection and male sex. There are important differences in amputation rate between the European centres, which can be explained in part by severity of disease at presentation. This may suggest that early referral to foot clinics can prevent minor amputations.
- Published
- 2011
40. Prediction of outcome in individuals with diabetic foot ulcers: focus on the differences between individuals with and without peripheral arterial disease. The EURODIALE Study
- Author
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Alberto Piaggesi, Isabel Ferreira, Jan Apelqvist, J. van Baal, Didac Mauricio, Per Holstein, Edward B. Jude, K. Bakker, Alexandra Jirkovská, Nicolaas C. Schaper, V. Urbancic, M. Spraul, Luigi Uccioli, K. J. Van Acker, F. Van Merode, Maya S. P. Huijberts, Michael Edmonds, H. Reike, L. Prompers, and Gunnel Ragnarson-Tennvall
- Subjects
Co-morbidities ,Diabetes ,Foot ulcer ,Infection ,Non-healing ,Outcome ,Peripheral arterial disease ,Predictive model ,Male ,medicine.medical_specialty ,Multivariate analysis ,Endocrinology, Diabetes and Metabolism ,Diabetic angiopathy ,Article ,Settore MED/13 - Endocrinologia ,Predictive Value of Tests ,Diabetes mellitus ,Internal medicine ,medicine ,Internal Medicine ,Humans ,Age of Onset ,Aged ,Wound Healing ,Vascular disease ,business.industry ,Middle Aged ,medicine.disease ,Diabetic foot ,Diabetic Foot ,Surgery ,Diabetic foot ulcer ,Treatment Outcome ,Predictive value of tests ,Multivariate Analysis ,Female ,Age of onset ,business ,Diabetic Angiopathies - Abstract
Aims/hypothesis Outcome data on individuals with diabetic foot ulcers are scarce, especially in those with peripheral arterial disease (PAD). We therefore examined the clinical characteristics that best predict poor outcome in a large population of diabetic foot ulcer patients and examined whether such predictors differ between patients with and without PAD. Methods Analyses were conducted within the EURODIALE Study, a prospective cohort study of 1,088 diabetic foot ulcer patients across 14 centres in Europe. Multiple logistic regression modelling was used to identify independent predictors of outcome (i.e. non-healing of the foot ulcer). Results After 1 year of follow-up, 23% of the patients had not healed. Independent baseline predictors of non-healing in the whole study population were older age, male sex, heart failure, the inability to stand or walk without help, end-stage renal disease, larger ulcer size, peripheral neuropathy and PAD. When analyses were performed according to PAD status, infection emerged as a specific predictor of non-healing in PAD patients only. Conclusions/interpretation Predictors of healing differ between patients with and without PAD, suggesting that diabetic foot ulcers with or without concomitant PAD should be defined as two separate disease states. The observed negative impact of infection on healing that was confined to patients with PAD needs further investigation.
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- 2008
41. Power Spectral Analysis of Heart Rate Variability in Patients with Charcot’s Neuroarthropathy
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Jana Hosová, P Boucek, Vladimíra Fejfarová, Stephanie C. Wu, Alexandra Jirkovská, Jelena Skibova, and Robert Bém
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Male ,medicine.medical_specialty ,Sympathetic Denervation ,Diabetic Neuropathies ,Heart Rate ,Spinal osteoarthropathy ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Heart rate variability ,In patient ,business.industry ,Power spectral analysis ,General Medicine ,Middle Aged ,medicine.disease ,Neurovascular bundle ,Surgery ,Autonomic Nervous System Diseases ,Case-Control Studies ,Orthopedic surgery ,Electrocardiography, Ambulatory ,Cardiology ,Female ,Arthropathy, Neurogenic ,business - Abstract
Charcot’s or neuropathic osteoarthropathy is one of the most debilitating orthopedic sequelae of diabetes mellitus. Distinguishing Charcot’s neuroarthropathy from clinically similar conditions may be challenging. The neurovascular theory postulates that Charcot’s neuroarthropathy may be secondary to sympathetic denervation of the lower-extremity vasculature. A convenient method for assessing autonomic neuropathy in patients with Charcot’s neuroarthropathy is needed. Short-term power spectral analysis (PSA) of heart rate variability (HRV), a noninvasive and quantitative method for assessing autonomic neuropathy, may be advantageous compared with the traditionally used Ewing’s cardiovascular reflex tests. However, there are limitations to the clinical use of PSA of HRV because of poor standardization. We standardized PSA of HRV and assessed autonomic neuropathy in 17 people with acute Charcot’s neuroarthropathy using PSA of HRV versus Ewing’s tests. More patients with Charcot’s neuroarthropathy were diagnosed as having autonomic neuropathy with PSA of HRV than with Ewing’s tests (94% versus 82%); however, no significant difference between the two methods was found. The results of this study suggest that PSA of HRV requires minimal patient collaboration and time expenditure compared with Ewing’s tests and may be useful in detecting autonomic neuropathy in patients with Charcot’s neuroarthropathy. (J Am Podiatr Med Assoc 96(1): 1–8, 2006)
- Published
- 2006
42. Comparison of microbial findings and resistance to antibiotics between transplant patients, patients on hemodialysis, and other patients with the diabetic foot
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Jelena Skibova, P Boucek, Alexandra Jirkovská, Vladimíra Fejfarová, and Vladimír Petkov
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medicine.medical_specialty ,Imipenem ,medicine.drug_class ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Antibiotics ,Microbial Sensitivity Tests ,Endocrinology ,Renal Dialysis ,Internal medicine ,Diabetes mellitus ,Drug Resistance, Bacterial ,Outpatients ,Internal Medicine ,medicine ,Dialysis ,Bacteria ,business.industry ,Incidence ,Bacterial Infections ,medicine.disease ,Kidney Transplantation ,Diabetic foot ,Diabetic Foot ,Anti-Bacterial Agents ,Surgery ,Transplantation ,Hemodialysis ,business ,Piperacillin ,medicine.drug - Abstract
Infectious complications of the diabetic foot may be influenced by impaired renal function and by immunosuppression therapy. Aims: To assess differences in microbial findings and resistance to antibiotics between transplant recipients, hemodialysis patients, and other patients with the diabetic foot. Methods: 207 patients treated in the foot clinic for diabetic ulcers from 12/1998 to 12/1999 were included into this retrospective study. Patients were divided into three groups (transplant, dialysis, and other patients). Occurrence of individual bacterial species and resistance to antibiotics was compared between study groups. Results: Study groups did not differ significantly in ulcer grades defined by the Wagner classification or in the mean number of pathogens per patient. The prevalence of individual microorganisms did not differ between the study groups. However, the study groups differed significantly in the occurrence of microbial resistance to antibiotics. Transplant patients had more frequently Staphylococcus aureus resistant to oxacillin (P
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- 2004
43. Comment on 'Impact of Diabetic Foot on Selected Psychological or Social Characteristics'
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Veronika Wosková, Vladimíra Fejfarová, Stephanie C. Wu, Alexandra Jirkovská, Michal Dubský, Marta Křížová, Robert Bém, Frances L. Game, Jelena Skibova, and Eva Dragomirecká
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Male ,medicine.medical_specialty ,Social characteristics ,Activities of daily living ,Endocrinology, Diabetes and Metabolism ,MEDLINE ,Severity of Illness Index ,lcsh:Diseases of the endocrine glands. Clinical endocrinology ,Amputation, Surgical ,Endocrinology ,Neuritis ,Quality of life ,Cost of Illness ,Internal medicine ,Diabetes mellitus ,Activities of Daily Living ,Adaptation, Psychological ,Diabetes Mellitus ,medicine ,Humans ,Psychiatry ,Letter to the Editor ,Depression (differential diagnoses) ,Aged ,Czech Republic ,Psychiatric Status Rating Scales ,Depressive Disorder, Major ,lcsh:RC648-665 ,business.industry ,Depression ,Incidence (epidemiology) ,Incidence ,Middle Aged ,medicine.disease ,Mental health ,Diabetic foot ,Comorbidity ,Diabetic Foot ,Socioeconomic Factors ,Tolerability ,Case-Control Studies ,Physical therapy ,Quality of Life ,Female ,business ,Psychosocial ,Stress, Psychological - Abstract
The aim of our case-control study was to compare selected psychological and social characteristics between diabetic patients with and without the DF (controls).104 patients with and 48 without DF were included into our study. Both study groups were compared in terms of selected psychosocial characteristics.Compared to controls, patients with DF had a significantly worse quality of life in the area of health and standard of living as shown by lower physical health domain (12.7 ± 2.8 versus 14.7 ± 2.5; P0.001) and environment domain (14.1 ± 2.2 versus 15 ± 1.8; P0.01) that negatively correlated with diabetes duration (r = -0.061; P = 0.003). Patients with DF subjectively felt more depressed in contrast to controls (24.5 versus 7.3%; P0.05); however, the depressive tuning was objectively proven in higher percentage in both study groups (83.2 versus 89.6; NS). We observed a significantly lower level of achieved education (P0.01), more patients with disability pensions (P0.01), and low self-support (P0.001) in patients with the DF compared to controls. In the subgroup of patients with a previous major amputation and DF (n = 6), there were significantly worse outcomes as in the environment domain (P0.01), employment status, and stress readaptation (P0.01) in contrast to the main study groups.Patients with DF had a predominantly worse standard of living. In contrast to our expectations, patients with DF appeared to have good stress tolerability and mental health (with the exception of patients with previous major amputation) and did not reveal severe forms of depression or any associated consequences.
- Published
- 2014
44. Comparison of the effect of stem cell therapy and percutaneous transluminal angioplasty on diabetic foot disease in patients with critical limb ischemia
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Andrea Nemcova, Robert Bém, Edward B. Jude, Libuse Pagacova, Eva Syková, Vladimíra Fejfarová, Alexandra Jirkovská, Michal Dubský, Jan H. Peregrin, Jaroslav Chlupac, and Bedrich Sixta
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Male ,Cancer Research ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,Immunology ,Cell- and Tissue-Based Therapy ,Disease ,Peripheral Arterial Disease ,medicine ,Immunology and Allergy ,Humans ,In patient ,Autografts ,Genetics (clinical) ,Aged ,Transplantation ,business.industry ,Angioplasty ,Cell Biology ,Stem-cell therapy ,Critical limb ischemia ,Middle Aged ,medicine.disease ,Diabetic foot ,Diabetic Foot ,Surgery ,body regions ,surgical procedures, operative ,Oncology ,Female ,medicine.symptom ,Stem cell ,business ,Wound healing ,Stem Cell Transplantation - Abstract
Background aims. The aim of our study was to compare the effect of autologous stem cell therapy (SCT) and percutaneous transluminal angioplasty (PTA) on diabetic foot disease (DFD) in patients with critical limb ischemia (CLI). Methods. Thirty-one patients with DFD and CLI treated by autologous stem cells and 30 patients treated by PTA were included in the study; 23 patients with the same inclusion criteria who could not undergo PTA or SCT formed the control group. Amputation-free survival, transcutaneous oxygen pressure (TcPO2) and wound healing were assessed over 12 months. Results. Amputation-free survival after 6 and 12 months was significantly greater in the SCT and PTA groups compared with controls (P ¼ 0.001 and P ¼ 0.0029, respectively) without significant differences between the active treatment groups. Increase in TcPO2 did not differ between SCT and PTA groups until 12 months (both Ps < 0.05 compared with baseline), whereas TcPO2 in the control group did not change over the follow-up period. More healed ulcers were observed up to 12 months in the SCT group compared with the PTA and control groups (84 versus 57.7 versus 44.4 %; P ¼ 0.042). Conclusions. Our study showed comparable effects of SCT and PTA on CLI, a major amputation rate that was superior to conservative therapy in patients with diabetic foot and an observable effect of SCT on wound healing. Our results support SCT as a potential promising treatment in patients with CLI and diabetic foot.
- Published
- 2014
45. Does the Diabetic Foot Have a Significant Impact on Selected Psychological or Social Characteristics of Patients with Diabetes Mellitus?
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Jelena Skibova, Marta Křížová, Alexandra Jirkovská, Veronika Wosková, Michal Dubský, Vladimíra Fejfarová, Stephanie C. Wu, Robert Bém, Frances L. Game, and Eva Dragomirecká
- Subjects
medicine.medical_specialty ,lcsh:RC648-665 ,Article Subject ,business.industry ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Case-control study ,medicine.disease ,Diabetic foot ,lcsh:Diseases of the endocrine glands. Clinical endocrinology ,Endocrinology ,Quality of life ,Amputation ,Tolerability ,Diabetes mellitus ,Internal medicine ,Severity of illness ,medicine ,Physical therapy ,business ,Psychosocial ,Research Article - Abstract
The aim of our case-control study was to compare selected psychological and social characteristics between diabetic patients with and without the DF (controls).Methods. 104 patients with and 48 without DF were included into our study. Both study groups were compared in terms of selected psychosocial characteristics.Results. Compared to controls, patients with DF had a significantly worse quality of life in the area of health and standard of living as shown by lower physical health domain (12.7±2.8versus14.7±2.5;P<0.001) and environment domain (14.1±2.2versus15±1.8;P<0.01) that negatively correlated with diabetes duration (r=-0.061;P=0.003). Patients with DF subjectively felt more depressed in contrast to controls (24.5 versus 7.3%;P<0.05); however, the depressive tuning was objectively proven in higher percentage in both study groups (83.2 versus 89.6; NS). We observed a significantly lower level of achieved education (P<0.01), more patients with disability pensions (P<0.01), and low self-support (P<0.001) in patients with the DF compared to controls. In the subgroup of patients with a previous major amputation and DF (n=6), there were significantly worse outcomes as in the environment domain (P<0.01), employment status, and stress readaptation (P<0.01) in contrast to the main study groups.Conclusions. Patients with DF had a predominantly worse standard of living. In contrast to our expectations, patients with DF appeared to have good stress tolerability and mental health (with the exception of patients with previous major amputation) and did not reveal severe forms of depression or any associated consequences.
- Published
- 2014
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46. Calcaneal ultrasonometry in patients with Charcot osteoarthropathy and its relationship with densitometry in the lumbar spine and femoral neck and with markers of bone turnover
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Alexandra Jirkovská, Hosová J, P. Bouček, Jelena Skibova, and P. Kasalický
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musculoskeletal diseases ,Bone mineral ,medicine.medical_specialty ,Bone disease ,Bone density ,business.industry ,Endocrinology, Diabetes and Metabolism ,musculoskeletal system ,medicine.disease ,Diabetic foot ,Bone remodeling ,Surgery ,Endocrinology ,medicine.anatomical_structure ,Spinal osteoarthropathy ,Internal Medicine ,medicine ,Calcaneus ,Nuclear medicine ,business ,Femoral neck - Abstract
Aims To assess calcaneal ultrasonometry in Charcot osteoarthropathy (CO) and to compare it with densitometry measured by dual energy X-ray absorptiometry (DEXA) and with bone remodelling markers. Patients and methods A group of 16 diabetic patients in the acute stage of CO with a mean age (± sd) of 51 ± 13 years was compared with 26 sex- and age-matched control subjects. Both calcaneal quantitative ultrasound (QUS) parameter stiffness and bone mineral density (BMD) measured in lumbar spine and femoral neck by DEXA were compared. Collagen type I cross-linked C-telopeptides (ICTP) were used for assessment of bone resorption. Results Patients with acute CO had significantly lower stiffness of the calcaneus in the Charcot and non-Charcot foot (both P
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- 2001
47. Identification of patients at risk for diabetic foot
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Vladimı́r Bartoš, Veronika Wosková, Alexandra Jirkovská, Jelena Skibova, and P Boucek
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Endocrinology, Diabetes and Metabolism ,Physical examination ,medicine.disease ,Diabetic foot ,Angiopathy ,Surgery ,Vibration perception ,Endocrinology ,Peripheral neuropathy ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Medical history ,Risk factor ,business - Abstract
The aim of the study was the comparison of a simple standardized noninvasive examination of neuropathy and angiopathy with routine diagnostic practice in community diabetes clinics for the identification of patients at risk of foot ulceration. Consecutive patients (n=322), aged 30 years and more, with a diabetes duration of more than 5 years, were examined by trained podiatric nurses in six diabetes clinics over a 1-year period; 44 of these patients had active or previous foot ulcerations. We evaluated the differences between the routine diagnostic practice (based on the patient's medical history and a physical examination) and noninvasive testing of peripheral neuropathy [vibration perception threshold (VPT) and the Semmes-Weinstein 10-g monofilament wire system] and angiopathy [Doppler ankle/brachial index (ABI)]. Using receiver operating characteristic (ROC) analysis, we evaluated the sensitivity and specificity of noninvasive testing methods for identifying patients at risk and selecting the optimal diagnostic cutoff points. Patients with severe neuropathy, as determined by noninvasive testing (VPT > or =30 V and/or insensitivity to 10 g monofilament), had been diagnosed to have neuropathy in diabetes clinics in 54% of cases. Patients with angiopathy at risk of developing diabetic foot ulcers (ABI < or =0.8) had been diagnosed, in diabetes clinics, to have peripheral arterial disease in 50% (they reported claudications in 41%, had femoral artery bruits detected in 29% and nonpalpable peripheral pulsations in 12%). Our findings stress the importance of using standardized simple noninvasive testing methods to increase the accuracy of identifying patients at risk for the diabetic foot at the community level.
- Published
- 2001
48. Minor amputation does not negatively affect health-related quality of life as compared with conservative treatment in patients with a diabetic foot ulcer: An observational study
- Author
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Volkert Siersma, Alexandra Jirkovská, Per Holstein, Michael Edmonds, H. Reike, K. J. Van Acker, M. Spraul, Luigi Uccioli, Alberto Piaggesi, V. Urbancic, Jan Apelqvist, K. Bakker, E. Jude, Marleen Kars, K. Pickwell, J. van Baal, Didac Mauricio, and Nicolaas C. Schaper
- Subjects
medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Population ,030209 endocrinology & metabolism ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Randomized controlled trial ,Quality of life ,law ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,030212 general & internal medicine ,education ,education.field_of_study ,business.industry ,medicine.disease ,Diabetic foot ,humanities ,Diabetic foot ulcer ,Amputation ,Propensity score matching ,Physical therapy ,business - Abstract
Background: Health-related quality of life (HRQoL) is poor in patients with persistent diabetic foot ulcers and poor HRQoL predicts worse outcomes in these patients. Amputation is often considered a treatment failure, which is why conservative treatment is generally preferred over amputation. However, it is unclear whether minor amputation negatively affects HRQoL compared with conservative treatment in patients with diabetic foot ulcers. Methods: In the cohort of the multicenter, prospective, observational Eurodiale study, we determined difference in change of HRQoL measured by EQ-5D between patients with a diabetic foot ulcers that healed after conservative treatment (n = 676) and after minor amputation (n = 145). Propensity score was used to adjust for known confounders, attempting to overcome lack of randomization. Results: Baseline HRQoL was not significantly different between patients treated conservatively and undergoing minor amputation. In addition, there was no difference in the change of HRQoL between these groups. In patients who healed 6 to 12 months after the first visit, HRQoL on the anxiety/depression subscale even appeared to improve more in those who underwent minor amputation. Conclusions: Minor amputation was not associated with a negative impact on HRQoL in patients with a diabetic foot ulcers. It may therefore not be considered treatment failure in terms of HRQoL but rather a viable treatment option. A randomized controlled trial is warranted to further examine the influence of minor amputations on health-related quality of life. (Less)
- Published
- 2016
49. Intranasal Calcitonin in the Treatment of Acute Charcot Neuroosteoarthropathy
- Author
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Alexandra Jirkovská, Robert Bém, Jelena Skibova, Edward B. Jude, and Vladimíra Fejfarová
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Advanced and Specialized Nursing ,medicine.medical_specialty ,Diabetic neuropathy ,business.industry ,Endocrinology, Diabetes and Metabolism ,opera ,medicine.disease ,Diabetic foot ,Swollen foot ,Gastroenterology ,Bone resorption ,Bone remodeling ,Surgery ,Vibration perception ,N-terminal telopeptide ,Calcitonin ,Internal medicine ,Internal Medicine ,medicine ,business ,opera.character - Abstract
Charcot neuroosteoarthropathy (CNO) can lead to disruption of the bone architecture of the foot (1). Increased osteoclastic activity is believed to be responsible for the bone destruction in CNO (2). Previous studies showed COOH-terminal telopeptide region of type 1 collagen (1CTP) and bone-specific alkaline phosphatase (BALP) as useful markers of bone turnover in patients with CNO (3–5). Presently, only bisphosphonates have been demonstrated to have some benefit in patients with CNO (6). However, bisphosphonates may have potential disadvantages in that they decrease bone remodeling and are contraindicated in patients with renal insufficiency (7). Our previous study (8) showed positive effects of calcitonin on bone resorption in patients with acute CNO. In this study, we set out to assess the effect of calcitonin on bone metabolism and disease activity during a 6-month treatment with intranasal calcitonin in acute CNO. Thirty-two consecutive patients with acute CNO were entered into the study. Subjects were recruited from our diabetic foot clinic during a 17-month period and were followed up for 6 months. The study was approved by the local ethics committee, and all participants gave written informed consent. Acute CNO was defined by clinical signs: warm, swollen foot and skin temperatures ≥2°C at the site of maximum deformity of the affected foot compared with a similar site on the contralateral foot (infrared thermometer) and confirmed by plain X-ray and three-phase technetium bone scan (9). The presence of diabetic neuropathy was determined by measurement of vibration perception …
- Published
- 2006
50. Importance of factors determining the low health-related quality of life in people presenting with a diabetic foot ulcer: the Eurodiale study
- Author
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Luigi Uccioli, M. Spraul, Hanne Thorsen, K. Bakker, J. van Baal, Didac Mauricio, Alberto Piaggesi, Jan Apelqvist, E. Jude, Volkert Siersma, Michael Edmonds, H. Reike, K. J. Van Acker, Alexandra Jirkovská, V. Urbancic, Per Holstein, Nicolaas C. Schaper, G. Ragnarson Tennvall, Marleen Kars, Interne Geneeskunde, MUMC+: MA Endocrinologie (9), and RS: CARIM School for Cardiovascular Diseases
- Subjects
Male ,medicine.medical_specialty ,Cross-sectional study ,Endocrinology, Diabetes and Metabolism ,MEDLINE ,Settore MED/13 - Endocrinologia ,Endocrinology ,Quality of life (healthcare) ,Internal Medicine ,medicine ,Humans ,Prospective Studies ,Prospective cohort study ,Depression (differential diagnoses) ,Aged ,business.industry ,Patient Acceptance of Health Care ,medicine.disease ,Diabetic Foot ,Europe ,Self Care ,Cross-Sectional Studies ,Diabetic foot ulcer ,Quality of Life ,Physical therapy ,Anxiety ,Female ,Observational study ,medicine.symptom ,business - Abstract
AimTo identify the factors responsible for the low health-related quality of life associated with foot ulcers and the relative importance of these factors. MethodsA total of 1232 patients with a new foot ulcer, who presented at one of the 14 centres in 10 European countries participating in the Eurodiale study, were included in this cross-sectional study. Patient and ulcer characteristics were obtained as well as results from the Euro-Qol-5D questionnaire, a health-related quality of life instrument with five domains (mobility, self-care, usual activities, pain/discomfort and anxiety/depression). To analyse the relative importance of comorbidities and ulcer- and patient-related factors for health-related quality of life, linear regression models were used to calculate the relative contributions of each factor to the fit (R-2) of the model. ResultsPatients reported poor overall health-related quality of life, with problems primarily in the mobility and pain/discomfort domains. Among the comorbidities, the inability to stand or walk without help was the most important determinant of decreased health-related quality of life in all five domains. Among ulcer-related factors, ulcer size, limb-threatening ischaemia and elevated C-reactive protein concentration also had high importance in all domains. The clinical diagnosis of infection, peripheral arterial disease and polyneuropathy were only important in the pain/discomfort domain. ConclusionsThe factors that determine health-related quality of life are diverse and to an extent not disease-specific. To improve health-related quality of life, treatment should not only be focused on ulcer healing but a multifactorial approach by a specialized multidisciplinary team is also important. What's new? The inability to stand or walk without help is the most important determinant of poor health-related quality of life. Other factors with high importance are ulcer size, elevated C-reactive protein concentration and limb-threatening ischaemia. To improve health-related quality of life, treatment should not only be focused on ulcer healing but a multifactorial approach by a specialized multidisciplinary team is also important.
- Published
- 2013
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