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Background: Peripheral arterial disease (PAD) tends to be associated with lower foot skin temperatures, however it is dubious whether there is enough evidence to support this claim. Skin temperature monitoring, and its ability to be an independent diagnostic modality for PAD, particularly in diabetes, has gained remarkable interest in recent years, but its ability to detect and diagnose PAD is not yet clear., Methods: A systematic literature search was conducted in: Academic Search Ultimate, CINAHL, Cochrane Library, LISTA, and MEDLINE Complete until February 2022., Results: A total of nine studies were eligible for review. For the purpose of this review, the inclusion studies were grouped according to the type of investigation analysed: those investigating lower-limb thermal patterns in various populations and those investigating comparisons between various outcome measures to assess blood flow to the feet, including skin temperature measurement. Findings suggest that higher foot skin temperatures were found in PAD patients with Diabetes Mellitus (DM). Foot skin temperature measurements also showed a clear correlation with blood flow to the feet, evaluated by ABI., Conclusions: Variations in foot skin temperature play an important role in the diagnosis of PAD. Current evidence shows that the influence of blood flow on surface skin temperature is complex. The interpretation of thermography as a diagnostic modality for PAD and its severity needs to be considered within the context of the overall medical condition of the individual patient., peer-reviewed

Objective: The aim of this study was to determine sex specific differences in the invasive treatment of symptomatic peripheral arterial occlusive disease (PAOD) between member states participating in the VASCUNET and International Consortium of Vascular Registries., Methods: Data on open surgical revascularisation and peripheral vascular intervention (PVI) of symptomatic PAOD from 2010 to 2017 were collected from population based administrative and registry data from 11 countries. Differences in age, sex, indication, and invasive treatment modality were analysed., Results: Data from 11 countries covering 671 million inhabitants and 1 164 497 hospitalisations (40% women, mean age 72 years, 49% with intermittent claudication, 54% treated with PVI) in Europe (including Russia), North America, Australia, and New Zealand were included. Patient selection and treatment modality varied widely for the proportion of female patients (23% in Portugal and 46% in Sweden), the proportion of patients with claudication (6% in Italy and 69% in Russia), patients’ mean age (70 years in the USA and 76 years in Italy), the proportion of octogenarians (8% in Russia and 33% in Sweden), and the proportion of PVI (24% in Russia and 88% in Italy). Numerous differences between females and males were observed in regard to patient age (72 vs. 70 years), the proportion of octogenarians (28% vs. 15%), proportion of patients with claudication (45% vs. 51%), proportion of PVI (57% vs. 51%), and length of hospital stay (7 days vs. 6 days)., Conclusion: Remarkable differences regarding the proportion of peripheral vascular interventions, patients with claudication, and octogenarians were seen across countries and sexes. Future studies should address the underlying reasons for this, including the impact of national societal guidelines, reimbursement, and differences in health maintenance., peer-reviewed

Every 20 seconds a limb is lost somewhere in the world due to diabetes! Moreover, every 1.2 seconds someone develops a diabetic foot ulceration. Every 7 seconds someone dies from diabetes. Lower-extremity complications of diabetes constitute a substantial burden for people with diabetes. Once healed, foot ulcerations frequently recur. This may suggest that current management of the diabetic foot is not effective, clearly demonstrating the need for the implementation of new and effective strategies aimed primarily at prevention of ulceration. The time to referral will determine the number of ulcerations and re-ulcerations or alternatively ulcerfree days – in other words Time is Tissue! We need to act now without further delay!, peer-reviewed

BACKGROUND: Minor amputations related to diabetic foot complications have become increasingly more frequent in Malta. International recommendations suggest a standardised follow-up for diabetic patients. We aim to compare the latter recommendations with a cohort of patients who underwent minor amputation in the years 2014-2017., METHODS: Data was collected retrospectively from 101 diabetic patients who were admitted to Mater Dei Hospital's Diabetic Foot Ward and required minor amputation. The audit parameters included patient demographics and specifics on the type of amputation, trending of relevant blood investigations prior to surgery and their follow-up history., RESULTS: A significant proportion of patients never had Hba1c (mean 4-year percentage of 34.4%), lipid (36.6%) or renal profile (23.3%) tested in the years leading to their amputations. Furthermore, the mean total Hba1c levels (9.36%) showed that these patients were mostly uncontrolled diabetics. A very large proportion of these patients were not seen at local health centres/diabetes outpatient clinics (65.3%). The majority had not been seen by a podiatrist (61.4%), nor received diabetes education (84.2%) and had not attended ophthalmic clinics (51.5%) in the years preceding their amputation., CONCLUSION: Poor compliance with international guidelines for diabetic patients is likely to contribute to the high rate of minor amputations. A co-ordinated effort to improve compliance with international standards relating to diabetes care is urgently required., peer-reviewed

Mauriac syndrome is a rare complication of poorly-controlled type 1 diabetes mellitus (T1DM) characterised by hepatomegaly, short stature, and pubertal delay. We report the case of a 13-year-old girl with T1DM who presented to our hospital with hyperglycaemia and hepatomegaly, and was also found to have bilateral medullary nephrocalcinosis. It is hypothesised that chronic hyperglycaemia resulting from long-term insulin under-dosage led to chronic acidosis which caused hypercalciuria and consequently, nephrocalcinosis. Poor glycaemic control, Mauriac syndrome and nephrocalcinosis, may be associated with socio-economic difficulties. Both medical optimisation and psychosocial support should be provided to reach optimal glycaemic targets, reverse the features of Mauriac syndrome, and prevent worsening of nephrocalcinosis that could potentially lead to chronic renal impairment., peer-reviewed

Every 30 seconds a limb is lost somewhere in the world due to diabetes! (International Diabetes Federation and International Working Group of the Diabetic Foot, 2005) Diabetic foot ulceration and amputations are a worldwide concern, including Malta where some 500 partial or full amputations of the foot are carried out annually. In the EU, 450,000 amputations cost €2.5 billion yearly (Raghav A et al., 2018), resulting in major economic consequences both for patients and healthcare systems alike. If managed timely, ulceration may be prevented in 80% of the cases. Diabetic foot infections are potentially disastrous complications that progress rapidly following minor traumas. For a long time, scientists have been fighting against infection and it is evident that wound infection is a challenging situation for all healthcare professionals. It has been suggested that infections present in diabetic foot ulcerations are the largest cause of lower extremity amputations, impacting the patient’s quality of life significantly (Camilleri Attard F., Gatt A., Formosa C. 2021). Our research leads us to believe that an increase in pressure on the sole of the foot, followed by a rise in temperature before ulceration, can also be key indicators that could detect those areas which are about to develop a wound, known as a diabetic ulcer (Perren et al 2021). Thus identifying and correcting increased plantar pressures and altered biomechanical factors are key to prevention amongst other risk factors. Diabetic foot amputation and hospitalization are still on the increase. This may suggest that current management of the diabetic foot is not effective, clearly demonstrating the need for the implementation of new and effective strategies aimed primarily at prevention of ulceration. Where the high-risk foot is concerned, “time is tissue” (Setacci C, 2012). One cannot simply afford to wait for complications such as infection to develop as this might mean limb loss and ultimately even death. [Excerpt], peer-reviewed

BACKGROUND Diabetic ketoacidosis (DKA) is one of the most serious diabetes complications. It is characterized by hyperglycemia, anion gap metabolic acidosis and increased total body ketone concentration. DKA is the most common cause of death in youth type 1 diabetic patients and an important cause of morbimortality in type 2 diabetic patients. Its management is complex, however, if it is well performed DKA has a good prognosis. Lately, the need to standardize DKA treatment has become an important issue in our Department. OBJECTIVE Our main objective is to decrease hospital length of stay of DKA patients treated in Hospital Universitari Josep Trueta’s Emergency Department (ED) with the application of a computer decision support and electronic order sets (CDS&EOS) to minimize security errors. DESIGN Quasi-experimental study designed as a before-and-after evaluation of the application of a CDS&EOS in ED’s SILICON® to standardize DKA management. PARTICIPANTS A consecutive non-probabilistic model will be used to select DKA patients aged 18 years old or older treated in Hospital Universitari Josep Trueta’s ED. METHODS The study will include 134 participants in total, 67 for each group (pre and post- intervention). Each sample will be selected in an 18-month period, with a washout period between them. Data will be collected prospectively between May 2021 and October 2024. The association between the independent and dependent variables will be adjusted to avoid possible confounding factors

Peripheral Arterial Disease (PAD) is a world-wide concern, especially in persons living with diabetes. This is a challenging condition since often it is asymptomatic and when symptoms do set in, they could be indicative of advanced disease. The early detection of PAD is important as this enables its early management through lifestyle changes and other non-invasive medical modalities. However, there are various issues related to diagnosing PAD especially at primary care level since there are significant issues relating to diagnostic accuracy that could affect the timely diagnosis of this condition. A clinical assessment tool is only of value if the interpretation of the results is correct and repeatable, which is the main issue relating to the clinical tests outlined in this paper. Although literature highlights the importance of accurate screening, diagnosis and management of PAD, this paper provides evidence from studies on the importance of using different non-invasive modalities when assessing patients with PAD. The authors suggest that when results do not concur, further extensive evaluations should be performed. Such information will alleviate the burden related to PAD and its complications. This paper compares the application of different physiological tests used for the early identification of PAD., peer-reviewed

Text in Turkish ; Abstract: Turkish and English Includes bibliographical references (leaves 61-69) xii, 77 leaves Amaç: Bu çalışmada tip-2 diyabet hastalarının yeme tutumları ve duygu düzenleme güçlükleri ile anksiyete ve depresyon seviyeleri arasındaki ilişkiyi ölçmek amaçlanmıştır. Yöntem: 18 yaşın üzerinde olan ve İstanbul’da yaşayan herhangi bir kronik rahatsızlığı olmayan 234 kişiye ve İstanbul ilinde bulunan İstanbul Bakırköy Dr. Sadi Konuk Eğitim ve Araştırma Hastanesi’ne başvuran tip-2 diyabet tanılı 274 hasta olmak üzere toplamda 508 katılımcıya anket uygulanmıştır. Bulgular: Araştırmanın bulgularına göre tip-2 diyabet hastalarının tip-2 diyabet olmayan grubuna göre anksiyete, depresyon seviyeleri, kısıtlayıcı yeme tutumu puanları anlamlı derecede daha yüksektir. Tip-2 diyabet olmayan bireylerin dışsal yeme tutumu puanı ise tip-2 diyabet olan gruba göre daha yüksektir. Değişkenler arasındaki ilişkiye bakıldığında; tip-2 diyabet hastalarının duygu düzenleme güçlükleri ile anksiyete ve depresyon seviyeleri arasındaki ilişki pozitif yönde, depresyon seviyesi ile kısıtlayıcı yeme tutumu arasındaki ilişki negatif yönde, anksiyete seviyesi ile duygusal yeme tutumu arasındaki ilişki pozitif yöndedir. Regresyon analizine göre tip-2 diyabet hastalığının anksiyete ve depresyon seviyesi üzerinde pozitif yönde bir etkisinin olduğu saptanmıştır. Tip-2 diyabet hastalarının anksiyete seviyesi üzerinde tip-2 diyabet hastalığı ve duygu düzenleme güçlüğünün; depresyon seviyesi üzerinde ise tip-2 diyabet hastalığı, duygu düzenleme güçlüğü ve yeme tutumunun etkisi olduğu saptanmıştır. Alt boyutlar ele alındığında ise tip- 2 diyabet hastalarının kısıtlayıcı yeme tutumunun, duygusal yeme tutumunun, açıklık, amaçlar ve strateji alt boyutlarının depresyon seviyesi üzerinde; kısıtlayıcı yeme tutumunun, açıklık, amaçlar ve strateji alt boyutlarının ise anksiyete seviyesi üzerinde bir etkisinin olduğu saptanmıştır. Sonuç: Tip-2 diyabet hastaları ile tip-2 diyabet olmayan bireyler arasında anksiyete ve depresyon seviyeleri, kısıtlayıcı yeme tutumu ve dışsal yeme tutumları arasında bir farklılık vardır. Tip-2 diyabet hastalarının tip-2 diyabet hastalığının anksiyete ve depresyon seviyeleri üzerinde pozitif yönde bir etkisi vardır. Purpose: In this study, it was aimed to evaluate the relationship between eating attitudes and emotion regulation difficulties of type-2 diabetes patients and their anxiety and depression levels. Methods: 234 people over the age of 18 who do not have any chronic illnesses from Istanbul. In addition, located in the province of Istanbul, total of 508 participants were surveyed, including 274 patients with type – 2 diabetes who applied to Bakirkoy Dr. Sadi Konuk Research and Training Hospital. Results: According to the study's findings, anxiety, depression levels, restrictive eating attitudes are significantly higher than the type-2 non-diabetes group of type- 2 diabetes patients. The external eating attitude score of individuals without type-2 diabetes is higher than in the group with type-2 diabetes. When you look at the relationship between variables; The relationship between emotion editing difficulties and anxiety and depression levels in type-2 diabetes patients is positive, the relationship between depression level and restrictive eating attitude is negative, and the relationship between anxiety level and emotional eating attitude is positive. According to regression analysis, type-2 diabetes has a positive effect on anxiety and depression levels. The anxiety level of type-2 diabetes patients is the difficulty of disease and emotion regulation on type-2 diabetes; on the level of depression, type-2 diabetes, difficulty editing emotions and eating attitude have been found to have an effect. When the sub-dimensions are taken, the restrictive eating attitude of type-2 diabetes patients, emotional eating attitude, openness, objectives and strategy sub-dimensions are on the level of depression; restrictive eating attitude, openness, objectives and strategy sub-dimensions have an effect on anxiety levels. Conclusion: There is a difference between type-2 diabetes patients and person who is without type-2 diabetes, anxiety and depression levels, restrictive eating attitudes and external eating attitudes. Type-2 diabetes patients have a positive effect on anxiety and depression levels of type-2 diabetes. GİRİŞ GENEL BİLGİLER Diyabetes Mellitus (DM) Diyabetes Mellitus Tanı Kriterleri Duygu Düzenleme Güçlüğü Duygunun Tanımı Duygu Düzenleme Stratejileri Duygu Düzenleme Becerileri Duygu Düzenleme Güçlüğü Tip-2 Diyabet ve Duygu Düzenleme Güçlüğü Duygu Düzenleme Güçlüğü ile Anksiyete ve Depresyon Anksiyete Aksiyetenin Kuramsal Yaklaşımları Psikodinamik Yaklaşım Varoluşçu Yaklaşım Davranışçı Yaklaşım Bilişsel Yaklaşım Depresyon Depresyonun Kuramsal Yaklaşımları Psikodinamik Yaklaşım Davranışçı Yaklaşım Bilişsel Yaklaşım Tip-2 Diyabet ile Anksiyete ve Depresyon Düzeyi Yeme Tutumu Duygusal Yeme Tutumu Dışsal Yeme Tutumu Kısıtlayıcı Yeme Tutumu Diyabet ve Yeme Tutumu Yeme Tutumu ile Anksiyete ve Depresyon Seviyesi YÖNTEM Araştırmanın Modeli Araştırmanın Evren ve Örneklemi Veri Toplama Araçları Hastane Anksiyete ve Depresyon Ölçeği (Hospital Anxiety and Depression Scale) (HAD) Duygu Düzenleme Güçlüğü Ölçeği – Kısa Formu (DDGÖ-16) Hollanda Yeme Davranışı Ölçeği (DEBQ) İşlem Verilerin Analizi BULGULAR Çoklu Regresyon Analizi’ne Dair Bulgular TARTIŞMA Araştırmanın Sınırlılıkları Sonuç ve Öneriler Bilgilendirilmiş Gönüllü Olur Formu Sosyo-demografik Form Hastane Anskiyete ve Depresyon Ölçeği (HAD) Duygu Düzenleme Güçlüğü Kısa Formu (DDGÖ-16) Hollanda Yeme Davranışı Ölçeği (DEBQ)

Aim: The aim of this audit was to assess adherence to local guideline in the management of Diabetic Ketoacidosis (DKA). Method: Patients admitted with DKA between April 2013 and March 2015 were identified and data was retrospectively collected from patients’ confidential files and Isoft®. Data collected included initial parameters recorded and biochemical investigations taken (initial and subsequent assessment of pH, HCO3-, blood glucose, potassium levels and urinary ketones), insulin regime started and intravenous fluid administered. Results: During the established time period 40 cases of DKA were identified in 18 patients. Median age was 33 years with a female preponderance of 60%. Six patients had newly diagnosed diabetes mellitus while 8 patients had more than one admission of DKA. All cases had capillary blood glucose monitoring (BGM) and/or venous random blood (plasma) glucose (RBG) checked and pH and HCO3- recorded on admission. 0.9% sodium chloride was the intravenous fluid started in all cases (as recommended by the guideline) and a median of 6.75L was prescribed during the first 24 hours. The median time spent on intravenous insulin infusion was 42.7 hours while the median time to pH >7.30, HCO3- >15mmol/L and negligible urinary ketones were 6.88, 12.83 and 34.5 hours respectively. Subcutaneous insulin was started at a median time of 48.21 hours from initiation of DKA protocol. Conclusion: This audit showed good adherence to local guideline. The great discrepancy between the time to pH >7.3 and the time to negligible urinary ketones highlights the need to introduce tools to measure systemic ketone production in the management of DKA with an update in the current local clinical practice guideline., peer-reviewed