Diabetic foot and disaster; risk factors for amputation during the Syrian crisis
Diabetic foot and disaster; risk factors for amputation during the Syrian crisis
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DOI：
10.1016/j.jdiacomp.2019.107493
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发表时间：
2020-02-01
影响因子：
3
通讯作者：
Alsabek, Mhd Belal
中科院分区：
文献类型：
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作者：
Aziz, Abdul Razzak Abdul;Alsabek, Mhd Belal
背景：叙利亚的糖尿病足患者在最近的长期危机中面临许多挑战和困难，这场危机自2011年以来一直盛行。这项研究确定了糖尿病足截肢的危险因素，无论是轻微截肢还是大型截肢。方法：本研究回顾了叙利亚大马士革教学医院糖尿病足门诊2012年1月至2017年12月期间糖尿病足门诊患者的病历。我们根据最终结果将病变分为：非截肢、轻度截肢和大部截肢。我们预测了下肢截肢的独立危险因素。结果：共有2317名糖尿病患者定期来我科就诊，有2722名糖尿病足症状。我们研究了2006个病变属于1630例糖尿病足患者。分为：A组(非截肢结局，n=1372)、B组(小截肢结局，n=528)和C组(最终结局，大截肢，n=106)。男性略占优势(56.73%；n=1138)，但大截肢的风险明显较高(6.77%；n=77)。15.10%的患者年龄在70岁以上，年龄与截肢风险无明显关系。根据Meggitt-Wagner分类，1~5级病变的主要截肢率为5.28%，孤立5级病变的截肢率为87.30%，感染程度为42.07%；小截肢率为38.5%，大截肢率为8.44%。周围闭塞性动脉疾病(PAD)的存在使小截肢发生率增加1倍(44.02%)，大截肢发生率增加5倍(15.16%)。足跟溃疡有向大腿截肢方向发展的趋势(18.80%)，而DFU后跟溃疡的发生率为3.36%。对3例保守治疗、不作为截肢独立危险因素的糖尿病足战伤患者进行了随访，只要采用标准护理。结论：本文是第一篇探讨灾难中糖尿病足护理现状的文章。它计算出，在危机期间，糖尿病足患者被忽视的风险明显更高。在没有早期发现伤口、畸形和PAD的情况下，DFU很可能在晚期来到足科医生那里。不健康的环境驱使DFU走向损伤、脂肪组织和感染。在危机地区工作的非政府组织(NGO)和当地机构应关注糖尿病足患者的特殊护理要求，重视糖尿病足的标准护理，并定期随访直至最终痊愈。(C)2019 Elsevier Inc.保留所有权利。
Background: Diabetic foot patients in Syria faced many challenges and difficulties during the recent long term crisis that has prevailed since 2011. This study establishes the risk factors of diabetic foot amputation, either minor or major amputation. It also suggests facilities to improve diabetic foot care in the disaster.Methods: This is a retrospective study that reviewed diabetic foot outpatients' charts between Jan 2012 and Dec 2017 in Diabetic Foot Clinic in Damascus Teaching Hospital, Syria. We classified the lesions according to the final outcome into: non-amputation, minor and major amputation. We predicted the independent risk factors of lower extremity amputation (LEA).Results: A total of 2317 diabetic patients visited our clinic regularly with 2722 diabetic foot symptoms. We studied 2006 lesions belong to 1630 diabetic foot patients. They were divided into: group A (outcome without amputation, n = 1372), group B (outcome with minor amputation, n = 528) and group C (final outcome with major amputation, n = 106). Males were slightly predominant (56.73%; n = 1138), but with clearly higher risk of major amputation (6.77%; n = 77). 15.10% of patients was older than 70 years, with no significant relationship between age and amputation risk. According to Meggitt-Wagner classification system, the major amputation rate was (5.28%) in the lesions grade 1 through 5, it went up to (87.30) in isolated grade 5 lesions.The study recorded a degree of infection in (42.07%; n = 844) of the cases. The amputation rate went up in this group of patients to 38.5% and 8.44% for minor and major amputation, respectively. The presence of peripheral occlusive artery disease (PAD) doubled the minor amputation incidence one time (44.02%), and major amputation incidence five times (15.16%). The heel ulcer showed a great tendency toward the major amputation (18.80%), while the incidence rate in the DFUs spared heel was (3.36%). The war injuries of the diabetic foot was followed up in three cases that were treated conservatively and didn't considered an independent risk factor for amputation as long as the standard care was applied.Conclusion: This article is the first one that discussed the reality of the diabetic foot care in disasters. It figures out that diabetic foot patients are obviously at higher risk of neglect during the crisis. In the absence of early detecting of wounds, deformities and PAD, DFUs likely come to the podiatrists in advanced stages. The unhealthy environment drives DFUs toward injuries, cellulites and infection. Non-Governmental Organizations (NGOs) and local institutions that work in crisis areas should pay attention for special care requirements of diabetic foot patients, for the standard care of the diabetic foot and the regular follow-up till the healing eventually. (C) 2019 Elsevier Inc. All rights reserved.