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Potential of Thermal Imaging to Detect Complications in Diabetes
Published in U. Snekhalatha, K. Palani Thanaraj, Kurt Ammer, Artificial Intelligence-Based Infrared Thermal Image Processing and Its Applications, 2023
U. Snekhalatha, K. Palani Thanaraj, Kurt Ammer
Diabetic foot ulcer is characterized first by the formation of inflammation in the affected regions which is caused by damaging of the blood vessels due to high levels of glucose in the circulating blood. It then leads to neuropathy in the foot regions which, when left unnoticed, develops into foot ulcers. In addition to the neuropathy, other factors also increase the risk of diabetic foot ulcers, namely (i) insufficient blood supply to the foot regions, (ii) obesity, (iii) improper footwear that leads to skin damage and breakdown, and (iv) poor healing of the wound due to peripheral arterial disease which is often found in diabetic subjects (Lawrrence A. Lavery and Armstrong, 2007). Recently, the application of thermal imaging in studying the temperature variations of severe diabetic subjects in the foot regions due to inflammation has captured the interest of researchers. This is due to the advancement of thermal sensors which now provides improved thermal resolution and temperature sensitivity. To illustrate the application of thermal imagery in diabetic foot analysis, we provide here a few sample foot thermograms of normal and diabetic subjects based on the work (Hernandez-Contreras et al., 2019). Figure 6.8a shows the thermal imaging of subjects with a severe diabetic condition. The temperature pattern in the left foot is different compared to the contralateral region of the other. This is a common feature signifying peripheral neuropathy. However, for the normal subjects shown in Figure 6.8b, we could observe that the temperature patterns in both the legs are similar.
Optical Angiography at Diabetes
Published in Andrey V. Dunaev, Valery V. Tuchin, Biomedical Photonics for Diabetes Research, 2023
Dan Zhu, Jingtan Zhu, Dongyu Li, Tingting Yu, Wei Feng, Rui Shi
Diabetic foot ulcer is one of the most common complications in diabetic patients. Microvascular reactive damage will lead to the progression of diabetic foot ulcer. Jan et al. [67] used LDF to measure the amount of skin blood perfusion on the first metatarsus bone under mechanical stress (300 mmHg) and rapid thermal stress (42°C) in humans, and further evaluated metabolic, neurogenic, and myogenic responses by wavelet analysis. Results showed that metabolic neurogenic and myogenic responses to thermal stimulation were significantly reduced in diabetic patients, especially the neurogenic and myogenic control during the first vasodilation, and metabolism during the second vasodilation. In diabetic patients, myogenic control of mechanical stress stimulation was significantly reduced during reactive hyperemia. Such results suggested that diabetes would cause metabolic neurogenic and myogenic control disorders, leading to microvascular dysfunction. Therefore, the response of microvessels to locally applied mechanical and thermal stresses may be used to evaluate the risk of diabetic foot ulcers.
General Thermography
Published in James Stewart Campbell, M. Nathaniel Mead, Human Medical Thermography, 2023
James Stewart Campbell, M. Nathaniel Mead
Diabetic foot ulcers and related complications are debilitating and costly sequelae of diabetes.201 Infection, neuropathy, and peripheral artery disease are key contributors to amputation risk in these patients.202 When compared to normal subjects, diabetic patients tend to have warmer feet and exhibit significantly greater temperature differences between feet. Additionally, the presence of neuropathy raises foot temperature; both ischemic and neuro-ischemic feet are warmer than healthy feet.203
Evaluation of porphyrin loaded dry alginate foams containing poloxamer 407 and β-cyclodextrin-derivatives intended for wound treatment
Published in Pharmaceutical Development and Technology, 2018
Victoria J. Valerón Bergh, Elin Johannessen, Therese Andersen, Hanne Hjorth Tønnesen
Treatment of acute and chronic wounds is a challenge for the healthcare system. Diabetic foot ulcers, venous leg ulcers or pressure ulcers are typical chronic wounds that have become a major health issue (Frykberg & Banks 2015). Bacterial infections are often present in such wounds, being one of the factors delaying healing. Bacterial infections in wounds are usually treated with systemic antimicrobials. However, the low blood supply and often heavily infected lesions makes a local topical treatment of the infection beneficial (Pachuau 2015). Bacterial resistance toward topical treatments with antibiotics is a major concern (Colsky et al. 1998; Elston 2009; Walsh et al. 2016). Therefore, alternatives to classical antibiotics to be used in topical infections are needed. Antibacterial photodynamic therapy (aPDT) is a treatment modality involving radiation of appropriate wavelength, a photosensitizer (PS) and oxygen. aPDT produces radicals that can kill bacteria through a fast and unspecific mechanism and thus development of bacterial resistance is unlikely (Maisch 2015). Therefore, aPDT is a promising tool in topical treatment of infected wounds (Maisch et al. 2004; Dai et al. 2009).
Experimental treatments in clinical trials for diabetic foot ulcers: wound healers in the pipeline
Published in Expert Opinion on Investigational Drugs, 2023
Brandon J Sumpio, Ikram Mezghani, Enya Wang, Zhuqing Li, Eleftheria-Angeliki Valsami, Georgios Theocharidis, Aristidis Veves
Diabetic foot ulcers remain a substantial problem for patients and clinicians. As many new advancements come to the market, it is important to remember that despite all these new advancements in technology and therapeutics, standard of care remains an integral aspect of limb salvage and caring for the diabetic foot ulcer. It is important the patient with diabetes continue to work toward risk factor modifications and are adherent to their diabetic regiments to ensure a normal hemoglobin A1C. In addition without adequate off-loading, debridement, and antibiotics, most DFU will fail to heal. Therefore, we would like the stress that none of these products are a substitute for standard of care. Rather these products should be used in conjunction.
Modern management of diabetic foot osteomyelitis. The when, how and why of conservative approaches
Published in Expert Review of Anti-infective Therapy, 2018
Javier Aragón-Sánchez, Benjamin A Lipsky
The development of a foot ulcer in a person with diabetes mellitus is a common and worrying complication. Infection is a frequent complication of a diabetic foot ulcer. In a prospective cohort of patients with diabetes, 9.1% developed a foot infection following a wound or penetrating trauma [1]. Infection was associated with higher risk of hospitalization and lower extremity amputation, when compared with patients who did not develop an infection [1]. Just over half of diabetic foot ulcers are clinically infected at presentation [2], and about 40% of the others will develop infection during follow-up [2]. Infections typically begin in the soft tissue, but may spread contiguously to involve the bone. Diabetic foot osteomyelitis (DFO) appears to complicate about 20% of diabetic foot infections (DFIs) seen in an outpatient clinic [3], but can be present in more than 70% of patients hospitalized for the infection [4]. When osteomyelitis complicates a diabetic foot wound, it is associated with worse outcomes compared with just soft tissue infections [5]. However, in one series of severe cases requiring admission there was a higher rate of major amputations among patients with deep abscesses compared to patients with osteomyelitis [6]. Traditionally, DFO has been considered a complex and difficult to treat infection, with a high rate of relapse [7]. However, recent experience and studies have shown that most cases can be managed with a ‘conservative’ approach, defined as treatment exclusively with antibiotics or surgical removing as little bone and soft tissue as necessary [4,8]. This approach can often avoid loss of the foot and provide hope for a better outcome for patients with diabetes and foot osteomyelitis.