Beata Mrozikiewicz-Rakowska

Diabetic foot risk factors in type 2 diabetes patients: a cross-sectional case control study

BackgroundDiabetic foot is a serious condition in patients with a long lasting diabetes mellitus. Diabetic foot treated improperly may lead not only to delayed ulceration healing, generalized inflammation, unnecessary surgical intervention, but also to the lower limb amputation. The aim of this study was to compare diabetic foot risk factors in population with type 2 diabetes and risk factors for diabetes in healthy subjects.MethodsThe study included 900 subjects: 145 with diabetic foot, 293 with type 2 diabetes without diabetic foot and 462 healthy controls matched in terms of mean age, gender structure and cardiovascular diseases absence. Study was conducted in Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, Poland. In statistical analysis a logistic regression model, U Mann-Whitney’s and t-Student test were used.ResultsThe binomial logit models analysis showed that the risk of diabetic foot in patients with type 2 diabetes was decreased by patient’s age (odds ratio [OR] = 0.94; 95% confidence interval [CI]: 0.92-0.96; p = 0.00001) and hyperlipidaemia (OR = 0.54; 95% CI: 0.36-0.81; p = 0.01). In contrast, male gender (OR = 2.83; 95% CI: 1.86-4.28; p = 0.00001) diabetes duration (OR = 1.04; 95% CI: 1.03-1.06; p = 0.0003), weight (OR = 1.04; 95% CI: 1.03-1.06; p = 0.00001), height (OR = 1.08; 95% CI: 1.05-1.11; p = 0.00001) and waist circumference (OR = 1.028; 95% CI: 1.007-1.050; p = 0.006) increase the risk of diabetic foot. The onset of type 2 diabetes in healthy subjects was increased by weight (OR = 1.035; 95% CI: 1.024-1.046; p = 0.00001), WC (OR = 1.075; 95% CI: 1.055-1.096; p = 00001), hip circumference (OR = 1.03; 95% CI: 1.01-1.05; p = 0.005), overweight defined with body mass index (BMI) above 24,9 kg/m2 (OR = 2.49; 95% CI: 1.77-3.51; p = 0.00001) and hyperlipidaemia (OR = 3.53; 95% CI: 2.57-4.84; p = 0.00001).ConclusionsRisk factors for Type 2 diabetes and diabetic foot are only partially common. Study proved that patients who are prone to developing diabetic foot experience different risk factors than patients who are at risk of diabetes. Identification of relationship between diabetic foot and diabetes risk factors in appropriate groups may help clinicians to focus on certain factors in diabetic foot prevention.

Application of the Home Telecare System in the Treatment of Diabetic Foot Syndrome

Diabetes is a group of metabolic diseases affecting more than 200 mln people worldwide, which is characterized by elevated blood glucose level. Diabetes causes a number of late complications among which diabetic foot syndrome (DFS) is one of the most dramatic as a major cause of the lower limb amputations. In IBBE PAS the TeleDiaFoS system aimed at monitoring of DFS treatment was developed. In the system, the Central Clinical Server is accessed by the Patient’s Module using a wireless internet connection to send the wound pictures, the blood glucose (BG) readings and the blood pressure (BP) values. Clinical verification of the TeleDiaFoS system has been organized as a randomized 90-days trial with the study and the control groups consisting of 10 type 2 diabetic patients, each. Currently, the evaluation of the first patient treated with multi-injection insulin delivery and antibiotic — dalacin therapies has been terminated. Home telecare therapy led to 12-fold reduction of the wound surface (from 356 mm2 to 29 mm2). During the whole 90-days period BP was controlled efficiently, however, acceptable BG level has not been maintained. In conclusion, application of the system leads to more effective realization of the DFS therapy and has a positive impact on the patient’s comfort.

Risk factors of diabetic foot of neuropathic origin in patients with type 2 diabetes

INTRODUCTION Diabetic foot is a diabetes mellitus complication leading to recurrent ulcerations, risk of osteomyelitis and tissue necrosis which may finally result in amputation. Diabetic foot of neuropathic origin manifesting as autonomic and sensory motor neuropathy is the most common type of this complication. The aim of this study was to identify risk factors of diabetic foot of neuropathic origin occurrence in patients with type 2 diabetes. MATERIAL AND METHODS The study included 240 patients, 74 with diabetic foot of neuropathic origin and 166 with diabetes. Cases and controls were matched in terms of age structure. Patients with peripheral arterial disease were excluded from the study. The study was conducted in the Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, Poland. We used logistic regression models, χ2, U Mann-Whitneys and t-Student tests. RESULTS Logistic regression analysis showed that diabetic foot of neuropathic origin risk factors were: male gender (OR = 6.63; 95% CI: 3.31-13.27; p = 0.00001), duration of diabetes (OR = 1.10; 95% CI: 1.06-1.14; p = 0.00001), height (OR = 1.09; 95% CI: 1.06-1.13; p = 0.00001), weight (OR = 1.04; 95% CI: 1.04-1.06; p = 0.00001) and waist circumference (OR = 1.05; 95% CI: 1.02-1.08; p = 0.001). Although there was a correlation between diabetic foot of neuropathic origin and BMI value, it had no impact on DF occurrence risk. CONCLUSION It is possible to identify patients at risk of diabetic foot development by evaluating anthropometric features. The existence of specific factors increasing the odds of diabetic foot of neuropathic origin occurring may lead to the identification of patients at risk of its development.

Screening for impact of popular herbs improving mental abilities on the transcriptional level of brain transporters

Abstract There are a number of compounds that can modify the activity of ABC (ATP-binding cassette) and SLC (solute carrier) transporters in the blood-brain barrier (BBB). The aim of this study was to investigate the effect of natural and synthetic substances on the expression level of genes encoding transporters present in the BBB (mdr1a, mdr1b, mrp1, mrp2, oatp1a4, oatp1a5 and oatp1c1). Our results showed that verapamil caused the greatest reduction in the mRNA level while other synthetic (piracetam, phenobarbital) and natural (codeine, cyclosporine A, quercetin) substances showed a selective inhibitory effect. Further, the extract from the roots of Panax ginseng C. A. Meyer exhibited a decrease of transcription against selected transporters whereas the extract from Ginkgo biloba L. leaves resulted in an increase of the expression level of tested genes, except for mrp2. Extract from the aerial parts of Hypericum perforatum L. was the only one to cause an increased mRNA level for mdr1 and oatp1c1. These findings suggest that herbs can play an important role in overcoming the BBB and multidrug resistance to pharmacotherapy of brain cancer and mental disorders, based on the activity of selected drug-metabolizing enzymes and transporters located in the BBB

Health related quality of life in patients with diabetic foot ulceration — translation and Polish adaptation of Diabetic Foot Ulcer Scale short form

ObjectivesDiabetic foot ulcer (DFU) is a common complication of diabetes and not only an important factor of mortality among patients with diabetes but also decreases the quality of life. The short form of Diabetic Foot Ulcer Scale (DFS-SF) provides comprehensive measurement of the impact of diabetic foot ulcers on patients’ health related quality of life (HRQoL). The purpose of this study was to translate DFS-SF into Polish and evaluate its psychometric performance in patients with diabetic foot ulcers.MethodsThe DFS-SF translation process was performed in line with Principles of Good Practice for the Translation and Cultural Adaptation Process for patient reported outcome measures (PROMs) developed by ISPOR TCA group. Assessment of the reliability and validity of Polish DFS-SF was performed in native Polish patients with current DFU.ResultsThe DFS-SF validation study involved 212 patients diagnosed with DFU, with 4.4 years of DFU duration on average. The average ulcer size was 5.5 sq. cm, and generally only one limb was affected. Men (72%) and type 2 diabetes patients (86%) prevailed, with 17.8 years representing the mean time since diagnosis. The mean population age was 62.5 years. The internal consistency of all scales of the Polish DFS-SF was high (Cronbach’s alpha ranged from 0.82 to 0.93). Item convergent and discriminant validity was satisfactory (median corrected item-scale correlation ranged from 0.61 to 0.81). The Polish DFS-SF demonstrated good construct validity when correlated with the SF-36v2 and showed better psychometric performance than SF-36v2.ConclusionsThe newly translated Polish DFS-SF may be used to assess the impact of DFU on HRQoL in Polish patients.

Risk factors of charcot neuroarthropathy development in patients with type 2 diabetes.

AIM Charcot neuroarthropathy is a very rare form of diabetic foot syndrome occurring among others in patients with diabetes mellitus. Charcot neuroarthropathy leads to bone tissue destruction and may result in foot amputation. The aim of the study was to identify risk factors of Charcot neuroarthropathy occurrence in patients with diabetic foot and type 2 diabetes. MATERIALS The study included 144 patients with type 2 diabetes; 33 with Charcot neuroarthropathy and 111 with diabetic foot of neuropathic origin without neuroarthropathy. The study was perform in Gastroenterology and Metabolic Diseases Department, Medical University of Warsaw, Poland. RESULTS The regression analysis showed that Charcot neuroarthropathy occurrence risk factors were: male gender (OR=4.94, 95% CI:1.63-15.03, p=0.003), age (OR=0.92, 95% CI:0.87-0.96, p=0.0001), diabetic foot duration (OR=1.19, 95% CI:1.08-1.32, p=0.00002) and height (OR=1.078, 95% CI:1.019-1.140, p=0.007). A positive effect on Charcot neuroarthropathy presence was exerted by body weight (OR=1.027, 95% CI:1.003-1.051, p=0.03) and hips circumference (OR=1.034, 95% CI:0.997-1.072, p=0.04). CONCLUSIONS The existence of the specific factors influencing Charcot neuroarthropathy development may result in earlier identification of patients at risk of its development. There is a necessity to take special care for patients prone to develop Charcot neuroarthropathy in order to prevent its occurrence and severe complications.

The Indirect Costs of Diabetic Foot Ulcers in Poland

Aim: The purpose of this study was to estimate the productivity loss and indirect costs associated with foot ulcers in patients with diabetic foot syndrome (DFS). An additional goal was to estimate the productivity loss and indirect costs in the population of informal caregivers of patients with DFS. Methods: Based on a prospective survey the effects of ulcers on patients’ professional activities were measured, and in addition, the disease-associated loss of productivity in the population of professionally active patients and caregivers was examined. Loss of productivity was measured using a modified WPAI questionnaire. The indirect costs of both absenteeism and presenteeism were estimated using the human capital approach. Results: Mean absenteeism was estimated at 32.63% of the nominal working time, whereas presenteeism was estimated at 23.48% of real working time. Among informal caregivers, mean absenteeism was estimated at 13.67% of the nominal working time, and presenteeism was estimated at 27.21% of real working time. Total annual indirect costs associated with productivity loss in the patient population amounted to EUR 170.8 million, including EUR 117.3 million in costs for sickness absences and EUR 53.5 million in presenteeism costs. Total annual indirect costs associated with productivity loss in the population of informal caregivers amounted to EUR 303.3 million, including EUR 80.8 million in costs for sickness absence and EUR 222.6 million in presenteeism costs. Conclusions: The indirect costs associated with foot ulcers in patients with DFS impose a substantial burden on the Polish economy.

Radionuclide imaging and therapy in a patient with coexistent diabetic foot syndrome and psoriatic arthritis

We report a case of 67-year-old man suffering from psoriatic arthritis, type 2 diabetes and diabetic foot syndrome. The patient presented symptoms of inflammation of the right ankle joint. Scintigraphic imaging with radiolabeled white blood cells was performed to differentiate whether the inflammation was related to psoriatic arthritis or diabetic foot syndrome. After revealing that, the inflammatory process was restricted only to the articular space of subtalar joint, the patient was diagnosed with exacerbation of psoriatic arthritis and qualified for radionuclide synovectomy. In patients with coexistent diabetic foot syndrome and inflammatory arthritis of the foot it is of vital importance to accurately differentiate these two conditions. We conclude that this can be potentially achieved with radiolabeled white blood cells scintigraphic imaging.

The MDR1/ABCB1 gene rs 1045642 polymorphism in colorectal cancer

Introduction Colorectal cancer (CRC) is one of the most frequently diagnosed tumors in Western countries. CRC is a heterogeneous group of tumors with regards to its molecular pathogenesis and genetic factors. Both genetic variations and anthropometric factors may affect morbidity in CRC patients. The aim of this study was to assess the impact of multidrug resistance 1/ATP-binding cassette sub-family B member 1 gene (MDR1/ABCB1) polymorphism rs1045642 and general anthropometric factors on the CRC risk. Material and methods The study included 250 patients who underwent colonoscopy and polypectomy between 2006 and 2013 in a single endoscopy unit in Warsaw, Poland. Results The CRC was diagnosed in 50 individuals, and 200 patients were included in the control group. Cases and controls were matched for mean age and sex (p > 0.05). Factors that were found to significantly increase the risk of CRC were ulcerative colitis (8/35 in the CRC group vs. 8/181 in the control group; p = 0.001), family history of CRC (11/33 vs. 26/172; p = 0.05), and diabetes mellitus (12/34 vs. 28/170; p = 0.04). Allele T of the rs 1045642 polymorphism was more frequently present in CRC cases (in both a co-dominant and recessive model) and in males (in a co-dominant model), although these associations were not statistically significant (p > 0.05). Conclusions The MDR1/ABCB1 gene polymorphism rs 1045642 may be involved in the pathogenesis of CRC and this relationship may be sex-specific for males. However, further population studies are necessary to assess this relationship.

Effect of Camellia sinensis extract on the expression level of transcription factors and cytochrome P450 genes coding phase I drug-metabolizing enzymes

Abstract Green tea (Camellia sinensis) is widely used as a popular beverage and dietary supplement that can significantly reduce the risk of many diseases. Despite the widespread use of green tea, the data regarding the safety as well as herb-drug interactions are limited. Therefore, the aim of our study was to assess the influence of standardized green tea extract (GTE) containing 61% catechins and 0.1% caffeine on the expression level of rat CYP genes and the corresponding transcription factors expression by realtime PCR. The findings showed that GTE resulted in a significant decrease of CYP2C6 expression level by 68% (p<0.001). In case of CYP3A1 and CYP3A2, the mRNA levels were also reduced by extract but in a lesser degree compared to CYP2C6. Simultaneously the significant increase in the mRNA level of CAR, RXR and GR factors was observed by 54% (p<0.05), 79% (p<0.001) and 23% (p<0.05), respectively after 10 days of green tea extract administration. In addition, there was noted a small increase of CYP1A1 expression level by 21% (p>0.05) was noted. No statistically significant differences were observed for CYP1A2 and CYP2D1/2. In the same study we observed an increase in amount of ARNT gene transcript by 27% (p<0.05) in the long-term use. However, green tea extract showed the ability to stimulate HNF-1α both after 3 and 10 days of treatment by 30% (p<0.05) and 80% (p<0.001), respectively. In contrast, no change was observed in the concentration of HNF-4α cDNA. These results suggest that GTE may change the expression of CYP enzymes, especially CYP2C6 (homologue to human CYP2C9) and may participate in clinically significant interactions with drugs metabolized by these enzymes. Streszczenie Zielona herbata (Camellia sinensis) jest powszechnie stosowana jako napój i suplement diety i może istotnie zmniejszać ryzyko wystąpienia wielu chorób. Pomimo powszechnego zastosowania zielonej herbaty, dane dotyczące bezpieczeństwa jak i interakcji preparatu roślinnego i leku syntetycznego są bardzo ograniczone. Celem badania była ocena wpływu standaryzowanego ekstraktu z zielonej herbaty (GTE) zawierającego 61% katechin i 0,1% kofeiny na poziom ekspresji szczurzych genów CYP i czynników transkrypcyjnych stosując technikę real-time PCR. Wyniki wykazały, że GTE znacznie obniża poziom ekspresji CYP2C6 o 68% (p<0,001). W przypadku CYP3A1 i CYP3A2 poziom mRNA tych genów był również redukowany przez ekstrakt, ale w mniejszym stopniu w porównaniu do CYP2C6. Istotny wzrost w poziomie mRNA obserwowano dla czynników CAR, RXR i GR odpowiednio o 54% (p<0,05), 79% (p<0,001) i 23% (p<0,05) po 10 dniach stosowania ekstraktu. Dodatkowo, zanotowano niewielki wzrost poziomu ekspresji CYP1A1 o 21% (p>0,05). Brak istotnych różnic zaobserwowano dla CYP1A2 i CYP2D1/2. W badaniu wykazano również wzrost ilości transkryptu genu ARNT o 27% (p<0,05) podczas dłuższego stosowania. Ponadto, ekstrakt z zielonej herbaty wykazał zdolność do stymulacji HNF-1α zarówno po 3, jak i 10 dniach trwania eksperymentu odpowiednio o 30% (p<0,05) i 80% (p<0,001). Brak zmian obserwowano w przypadku stężenia cDNA dla HNF-4α. Wyniki te sugerują, że GTE może zmieniać ekspresję enzymów CYP, szczególnie w przypadku CYP2C6 (homolog ludzki CYP2C9) i może uczestniczyć w klinicznie istotnych reakcjach z lekami metabolizowanymi przez te enzymy.