---

Abstract: Finding a simple clinical method for early and cost-effective diagnosis of osteomyelitis in diabetic patients is of great importance due to high prevalence of diabetic foot infection and the devastating outcome of osteomyelitis. Bone involvement in diabetic foot infection is due to local spread not hematogenous spread. Therefore, bone exposure predisposes bone to osteomyelitis. In this study, diabetic foot ulcers were examined by sterile probe (D/E) to detect exposed bone in the depth of the ulcer and the results were compared with the results of other clinical and paraclinical methods. This study was performed on 35 cases admitted in Imam Khomeini Hospital with a total of 37 pedal ulcers in 1998. Among 37 evaluated ulcers, 17 were positive on probing and 20 were negative on probing. Among 17 positive ulcers, 13 had osteomyelitis. Among 20 ulcers with negative probing, only 5 ulcers had osteomyelitis. The sensitivity, specificity and positive predictive value of bone touch by probing were %78.9, %76.4 and %75, respectively. So, there is strong association between bone touch by probing in the depth of diabetic foot ulcers with the presence of osteomyelitis.

---

Introduction: Foot problem in diabetic patients is one of the most common and serious chronic complications and is considered to be a consequence of peripheral neuropathy, peripheral vascular disease and immunopathy. The aim of this study was to compare the efficacy of local epidermal growth factors (EGF) and placebo therapy to facilitate wound healing in diabetics with foot ulcer. Material and Methods: This study was a single-blind placebo-controlled trial. Thirty diabetic patients (14 females and 16 males, aged 27-77 years) were treated with EGF and 10 diabetic patients (3 females and 7 males, aged 32-75 years) with placebo. Both groups received debridement, scrubbing with normal saline, systemic antibiotic therapy and bandage with EGF or placebo daily and were followed for 4 weeks. Ulcer closure (%) was calculated by use of an equation [(Final - initial-size)/Initial size] × 100. Results: After 4 weeks, mean closure was significantly higher in EGF group compared with placebo (71.2% Vs 48.9%, p<0.03). 100% closure was observed in 7 patients (with 30 ulcers) from EGF group and in one patient (with 12 ulcers) from placebo group. EGF showed a greater efficacy in ulcer healing (RR=3.4, 95%CI: 1.84-13.61). Conclusion: This study showed that EGF was significantly superior to placebo in ulcer healing. As a result, use of EGF appears to be helpful to diabetics with foot ulcers.

---

Introduction: Diabetes a major threat fo public health today and deaths resulting from its later complications such as diabetic foot, have increased alarmingly, causing physical and emotional problems and disability for diabetic patients. The current strategy for prevention of diabetic foot prevention is health education. This study was conducted to assess effects of educational interventions based on the HBM model used in food care by type 2 diabtetic patients. Materials and Methods: This is an interventional study in which 108 type 2 diabetic patients attending the the Kermanshah diabetic centre participated. They were randomly divided into the case and control groups. For data collection by interview a questionnaire consisting of 59 questions arranged in 5 sections including the demographic HBM model parts (perceived susceptibility, perceived severity, perceived benefits, perceived barriers) and also cues of action foot care at home (self-reporting) and the checklist section was used. Realibility and validity of this questionnaire was confirmed before the study. Educational interventions based on HBM model were implemented in three 60 minute-sessions after completion of questionnaires and the data was again collected after one month. Results: Findings showed means for knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, mean grades were at average levels and whereas the foot care mean grade was below average. After intervention, however, the results demonstrated that knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, action and checklist mean grades in type 2 diabetic patients increased significantly in the case group. Discussion: The findings of this study showed that foot care increased when knowledge, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, elevated. These study results confirm the effectiveness and influence of the use of the HBM model in foot care by type 2 diabetic patients.

---

Abstract

Introduction: Diabetic foot ulcer is one of the major complications of diabetes mellitus patients occurring in 15% of these individuals. The aim of this study is to evaluate the risk factors of diabetic foot ulcer and determine its treatment in diabetic patients. Methods and Materials: This cross-sectional study was performed on 100 diabetic patients with foot ulcer, hospitalized in the Shahid Beheshti and Yahayanejad hospitals in Babol from 2003 to 2004. Information was collected with two questionnaires, one for demographic characteristics and the other covering the risk factors of diabetic foot ulcer and its treatment. Data was analyzed by SPSS software, P values <0.05 were considered significant. Results: There was no significant difference between gender and smoking, or alcohol consumption and obesity (p>0. 05). Foot ulcer occurred incidentally in 66% of patients and in 18%, foreign bodies were the cause. Seventy-three percent of patients (27 males and 46 females) had abnormal foot structure, revealing a significant difference between sex and abnormal foot structure (P=0. 001). Conclusion: Although diabetic foot ulcer cannot be prevented, but controlling the risk factors and educating people, can significantly decrease the incidence rate and morbidity.

 

---

Abstract

Introduction: Diabetes mellitus is the most common human metabolic disease and chronic non healing diabetic foot ulcers are a critical complication for these patients. ANGIPARS is a new herbal extract which has been introduced to accelerate healing of these ulcers. The purpose of this study was to investigate the efficacy and safety of oral ANGIPARS in patients with chronic diabetic foot ulcers and also its effect on inflammatory blood markers. Materials and Methods: In a double–blind placebo-controlled trial, 40 patients with diabetic foot ulcers of at least 4 weeks duration, were randomized to receive either oral ANGIPARS, or placebo twice a day, until the ulcer was completely healed or for a maximum of 6 weeks and followed up to 12 weeks. Standard foot ulcer care was given to all patients. The healing process was assessed with measuring ulcer surface area and time needed to achieve complete wound healing. Drug safety was assessed by monitoring adverse events, using clinical and laboratory evaluations. Results: In both groups, wound surface area decreased significantly (p<0. 0005). Mean improvement ratio was 95. 8% in the ANGIPARS group and 79. 2% in the placebo group, although mean percent of wound area reduction in the former group was higher than in the placebo group at weekly assessments, this difference was not statistically significant ( p= 0. 25) except for at the 4th week. (84/2% vs. 56%, p = 0. 013) Ultimately, complete wound healing was achieved in 90% and 70% of ANGIPARS group and placebo group, respectively, after 12 weeks. Time to achieve complete wound healing, also, was not different significantly in either groups. (6. 2 vs. 7. 4 weeks, p = 0. 3) Significant reduction in ESR was seen in the ANGIPARS group. ( p = 0. 04) There was no significant changes in laboratory parameters. Two complications most likely attributable to ANGIPARS reported were worsening of proliferative diabetic retinopathy in one patient and acute renal failure and acute hepatitis in another patient with diabetic nephropathy. Conclusion: Although ANGIPARS enhanced wound healing at least within weeks 2 to 4 of treatment, we did not observe a significant effect in the outcome. Therefore, standard foot ulcer care seems to be the cornerstone of diabetic foot ulcer management and ANGIPARS should probably be reserved for treatment of the non-healing or difficult-to-heal ulcers that do not respond to standard treatments. Further studies are required to assess the efficacy of this new herbal extract.

---

Introduction: Diabetic foot ulcer is a serious complication of diabetes mellitus; it consists of lesions in the deep tissues associated with neurological disorders and peripheral vascular disease in the lower limbs. Delayed wound healing in diabetes leads to long-term hospitalization and even amputation of distal organs. Diabetes mellitus is associated with decreased nitric oxide bioavailability that causes dysfunction of the skin. Nitric oxide, a short-lived free radical, is produced in the skin, where it has important physiological functions. Much evidence suggests that nitric oxide accelerates wound healing. This review describes the pathways of nitric oxide production in the skin as well as role of nitric oxide donors in diabetic wound healing. Increased oxidative stress and arginase activity contribute to decreased nitric oxide bioavailability in diabetes. Based on data available, nitric oxide donors such as nitrite increase nitric oxide levels in the diabetic wound and improve would healing. It seems that increased nitric oxide in diabetic patients improves wound healing by increased collagen deposition and keratinocytes proliferation in the wound edges there by increasing reepithelialization capacity, chemoattractant of cytokines, increased formation of small blood vessels and increased blood flow to the wound site. In conclusion, nitric oxide donors could be considered as a potential and cost-effective treatment for diabetic wounds.
 

---

Introduction: Peripheral arterial disease (PAD) is common in diabetic patients, and about half of the patients with diabetic foot ulcers (DFU) have concomitant peripheral arterial disease (PAD). The purpose of this study was to select an appropriate and comprehensive clinical guide in the management of DFU. The part of the practical guide that pertains to this is based on three systematic reviews in three sections of diagnosis, prognosis, and treatment for DFU in patients with PAD. Materials and Methods: In this study, the ADAPTE methodology process consiss of the three stages of preparation, acceptance or final adoption and finalization for the localization of an international clinical guide. Results: Results are presented in the form of questions and recommendations in three sections, i.e. diagnosis, 2 questions and 3 recommendations, diagnosis  prognosis and treatment. In the diagnosis section, and in the prognosis section (2 questions and 6 recommendations), and in the treatment section (3 questions and 8 recommendations). Conclusion: In this practical guide, our take home massage, i.e. what we should learn and practice is summarized as follows:  1) We examine a patient with diabetes for peripheral arterial disease yearly. 2) Despite the best possible treatment in patients with DFU, if the wound does not improve after six weeks, we should refer the patient to a vascular surgeon. 3) Patients with PAD, associated with foot infections are at high risk for extreme amputation of the lower limbs and need urgent interventions. 4) All patients with diabetes with ischemic DFU should receive appropriate therapeutic treatment, similar to that for cardiovascular patients.
 

---

Introduction: The Pender’s health promotion model is a framework used for determining health-promoting lifestyle behaviors in people with chronic diseases. This study aims to investigate the effect of educational intervention based on the Pender’s health promotion model on the lifestyles of patients with diabetic foot ulcers. Materials and Methods: In this clinical trial conducted in 2019, 74 patients were selected based on inclusion criteria by convenience sampling and allocated into two groups, the intervention and control, using the randomized block method. Both groups completed the demographic characteristics- and the Health-Promoting Lifestyle Profile Questionnaires. Data obtained were analyzed using SPSS 16, using descriptive & comparative statistical methods, including independent t-test, paired t-test and ANCOVA. Results: After the intervention, a significant increase was observed in the average score of the intervention group in all lifestyle dimensions (P<0.001). Comparing the changes in the average scores of lifestyle and its dimensions in both groups 50 days after the intervention, an increase was observed in the average scores of lifestyle and its dimensions in the intervention group, compared to those in the control group (P<0.001). Conclusion: Educational intervention based on the Pender’s health promotion model can promote the lifestyles of patients with diabetic foot ulcers, results of which can be used in educational interventions aimed at patients with diabetic foot ulcers to change their lifestyles.

---

Abstract:
Introduction: Due to the current unpredictable changes following the global coronavirus disease (COVID-19) pandemic, significant changes have taken place in the healthcare systems. Most of the clinical and evidence-based care services for patients with diabetic foot has been disrupted. Therefore, many patients with diabetic foot ulcers cannot receive the necessary care, despite its great significance. All healthcare providers, including physicians and nurses, have difficult tasks and responsibilities during the COVID-19 crisis. Although patients with diabetic feet are at risk of infection, hospitalization, amputation, and death, they must remain out of hospitals, and distance educational and therapeutic services must be provided for them. This study aimed to introduce and describe the recommendations of the International Working Group on the Diabetic Foot (IWGDF) for the care of patients with diabetic feet during the new COVID-19 pandemic. 

---

Hajj is one of the main pillars of Islam, and it is obligatory for all adult Muslims who can afford to travel and are in acceptable health. In this religious event, every year, about 2 to 3 million Muslim pilgrims of different nationalities gather in the city of Mecca, Kingdom of Saudi Arabia, and a large part of this population consists of older adults (25% over 65 years old) who are exposed to various chronic diseases such as diabetes. At least 5% of pilgrims have diabetes, and 13.8% have underlying diabetic neuropathy. Diabetic foot ulcer, a preventable complication of diabetes, is one of the most common reasons for visiting a doctor during Hajj, and if not treated, it leads to amputation and disability. It has profound consequences on the health system and society.On the other hand, many conditions affect pilgrims. Crowding, hot desert weather, physical activity in the open environment, neglecting self-management, changes in diet, and the existence of restrictions such as the prohibition of placing oneself in the shade can be examples of new conditions that increase the risk of diabetic foot ulcers. This article provides recommendations for preventing diabetic foot ulcers for patients with diabetes and their medical teams before and during this valuable spiritual pilgrimage.

---

---