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Coronary artery disease (CAD) is a common problem amongst diabetic foot syndrome (DFS) patients, associated with peripheral arterial disease. This analytic cross‐sectional study investigates the diagnostic efficacy of the Toe Brachial Index (TBI) in the detection of CAD in 62 DFS patients. The presence of CAD was assessed by longitudinal strain echocardiography, a sensitive method that provides a more accurate measure of intrinsic left ventricular contractility than left ventricular ejection fraction, especially in diabetic patients. Univariate and multivariate logistic regression identified CAD‐associated factors. Receiver operating characteristic curve evaluated TBI and toe pressure's diagnostic performance for CAD. p‐Values < 0.05 were considered significant. There was a significant association between TBI and CAD, with each 0.01 increase in TBI associated with a 15% decrease in the odds of CAD development (odds ratio = 0.85, 95% CI: 0.72–0.99, p = 0.039). TBI demonstrated an area under the curve of 0.854, a sensitivity of 80.0% and a specificity of 66.7% at a cut‐off of 0.69. Additionally, toe pressure exhibited an area under the curve of 0.845, sensitivity of 74.0% and specificity of 75.0% at a cut‐off of 68.0 mmHg. Overall accuracy for TBI and toe pressure was 77.4% and 74.2%, respectively, indicating their potential for CAD risk stratification in the DFS population. This study highlights a significant association between low TBI and the presence of CAD in DFS patients. Consequently, TBI emerges as a valuable screening tool for identifying CAD within this population. [ABSTRACT FROM AUTHOR]

Aim/Introduction: This study was designed as the second phase of a prospective cohort study to evaluate the incidence and risk factors of diabetic foot ulcers (DFU). Materials and methods: The study was conducted in a university hospital in Iran. Each participant was checked and followed up for two years in terms of developing newfound DFU as ultimate outcome. We investigated the variables using univariate analysis and then by backward elimination multiple logistic regression. Results: We followed up 901 eligible patients with diabetes for two years. The mean age of the participants was 53.24 ± 11.46 years, and 58.53% of them were female. The two-year cumulative incidence of diabetic foot ulcer was 8% (95% CI 0.071, 0.089) [Incidence rate: 49.9 /1000 person-years]. However, the second-year incidence which was coincident with the COVID-19 pandemic was higher than the first-year incidence (4.18% and 1.8%, respectively). Based on our analysis, the following variables were the main risk factors for DFU incidence: former history of DFU or amputation [OR = 76.5, 95% CI(33.45,174.97), P value < 0.001], ill-fitting foot-wear [OR = 10.38, 95% CI(4.47,24.12), P value < 0.001], smoking [OR = 3.87,95%CI(1.28, 11.71),P value = 0.016], lack of preventive foot care [OR = 2.91%CI(1.02,8.29),P value = 0.045], and insufficient physical activity[OR = 2.25,95% CI(0.95,5.35),P value = 0.066]. Conclusion: Overall, the two-year cumulative incidence of diabetic foot ulcer was 8% [Incidence rate: 49.9 /1000 person-years]; however, the second-year incidence was higher than the first-year incidence which was coincident with the COVID-19 pandemic (4.18% and 1.8%, respectively). Independent risk factors of DFU occurrence were prior history of DFU or amputation, ill-fitting footwear, smoking, lack of preventive foot care, and insufficient physical activity. [ABSTRACT FROM AUTHOR]

Purpose: This research compares the effectiveness of weight-bearing exercise on a rebounder, as well as ankle exercise therapy on biomechanics and quality of life (QoL) in patients with diabetic neuropathic feet. Methods: The present investigation is a clinical trial study with two experimental groups and one control group. A total of 48 women... [ABSTRACT FROM AUTHOR]

Diabetic foot ulcers (DFUs) pose a significant clinical challenge, often leading to amputations and hospitalisation. This study aimed to investigate the characteristics and outcomes of DFUs treated with surgical debridement and standardised wound care. This descriptive cross‐sectional study focused on diabetic patients with appropriate vascular conditions, as determined by an Ankle Brachial Index >0.9. Based on their infection status, participants were admitted to Poursina Hospital in Rasht, Iran, and subjected to initial supportive measures, antibiotic therapy and surgical debridement. The study incorporated primary treatment with wet bandages, silver spray and fibrinolysin ointment. Statistical analysis employed SPSS 22 software. Most patients were male (54.7%) and under 60 years old (50.7%). Overweight status was prevalent in 69.3% of diabetic ulcer patients, amongst whom 48% underwent wrist debridement. The 64% and 36% of the cases had grade III and grade II Texas index. Moreover, 96% of patients exhibited signs of infection and were classified as Stage Texas B. Reoperation was necessary for 34.7% of patients. The mean hospital stay was 8.5 ± 7.55 days, and the average recovery time was 15.2 ± 15.19 days. Out of 75 patients, 10 were unable to return to limb function due to disability. In this study, around one‐third of patients required secondary repair with grafts and flaps. A small number of them were unable to recover because of underlying disability, and the mean recovery time in other cases was 24 days. Future studies should follow up with patients for longer periods to assess long‐term therapeutic outcomes and quality of life. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcer and potential subsequent lower extremity amputation are major complications of diabetes mellitus and are also prominent morbidity factors that could affect patients' quality of life. Objectives: This study aimed to assess the prevalence of diabetic foot amputation and explore correlates of amputation cause and type among subjects with diabetes mellitus in Tehran, Iran. Methods: A descriptive cross-sectional study was conducted to assess the demographic, sociological, and clinical characteristics of subjects who had undergone lower extremity amputation due to diabetic foot ulcers, from 2011 to 2020, in two educational medical centers in Tehran, Iran. We examined the medical records of 4676 individuals who were admitted to Shariati and Sina hospitals due to diabetic foot issues. Information related to patient demographics (age, gender, marital status), social factors (education level, insurance), and clinical data (medical history, laboratory results, and characteristics of diabetic foot ulcers) was collected for subjects who had undergone lower extremity amputation due to diabetic foot ulcer. The collected data was reported using average values, standard deviations and proportions and analyzed using statistical tests. Results: During one decade, 882 out of 4676 (18.8%) patients with diabetic foot ulcers underwent lower extremity amputations of various types in Sina and Shariati hospitals in Tehran, Iran. Of these, 692 (14.5%) were included for further analysis in the study and the rest were excluded due to lack of sufficient recorded data. About 75.9% of the study population was male, and the average age including both sexes was 60 years. About 92.7% were married, and on average, subjects had been afflicted with diabetes mellitus for 15.1 years. Statistical analysis using Pearson's chi-square test showed there was a significant association between the treatment regimen for diabetes mellitus and the type of amputation (P =.01), as well as between the duration of the disease and the cause of amputation (P =.01) and its type (P =.04). Conclusion: diabetes mellitus related treatment regimen and duration of disease are significantly associated with amputation cause and type. Plain Language Summary: Understanding Why and How Diabetic Patients Lose Their Feet: A Study from Tehran, Iran This study explored patients with diabetes in Tehran, Iran, experience foot problems leading to amputation. We looked at the records of 4676 patients over a decade, finding that 18.8% had lower limb amputations. Key factors included treatment methods for diabetes and the duration of the disease, significantly impacting the cause and type of amputation. These insights can guide better care to prevent such serious complications in patients with diabetes. [ABSTRACT FROM AUTHOR]

Background and purpose: The lack of timely foot care among individuals with diabetics often lead to ulceration followed by infection and amputation. This study aimed to evaluate the foot self-care status and foot screening practices among patients with type 2 diabetes in various cities across Iran. Methods: The cross-sectional descriptive study was performed on patients with type 2 diabetes in 10 main cities of Iran. The information about demographic and lifestyle factors, diabetes history, and diabetic foot self-care (DFSQ) was assessed. Additionally, the neurological and vascular condition of the foot were screened by Inlow's 60-Second Screen. Results: The study included 1094 diabetic patients with, with a majority being female (64.8%) and married (92.5%). The average age of the participants was 57.6 ± 10.21 (mean ± SD), and the mean duration of diabetes was 11.56 ± 7.41 years. Based on Inlow's 60-Second Screen criteria, 58% of the patients should undergo yearly foot ulcer screening, 47% exhibited peripheral neuropathy, and 37% were found to have inappropriate footwear. Conclusion: The high prevalence of peripheral neuropathy observed in approximately half of the participants across different regions of Iran underscores the importance of continuous patient education regarding foot care and appropriate footwear. Furthermore, regular foot ulcer screenings, following the recommended intervals outlined in Inlow's screening protocol, should be implemented to effectively manage diabetic foot complications. [ABSTRACT FROM AUTHOR]

Aim: This paper presented the methodology and main findings of a population-based survey to determine diabetes care status among type 2 diabetic subjects in Iran. The current study assessed treatment goal achievements in type 2 diabetics, diabetes care service utilization, prevalence of diabetes complications, and psychological effects of diabetes in a representative sample of Iranian population in urban and rural areas. Materials and Methods: This nationwide study was conducted between 2018 and 2020 as the observational survey entitled "Diabetes Care (DiaCare)". We studied a representative sample of participants with type 2 diabetes, aged 35–75 years, living in urban and rural areas in all thirty- one provinces of Iran. Data were collected by an interviewer in a form of a questionnaire that includes demographic and socioeconomic status, family and drug history, lifestyle, and self-reported psychological status according to a Patient's Health Questionnaire (PHQ). Management goal achievements, diabetes care service utilization, diabetes complications and psychological effects of diabetes were also assessed. Physical measurements were measured based on standard protocol. Fasting blood glucose (FBG), HbA1c, lipid profile, and also urine albumin to creatinine ratio were obtained from all participants of the study. Results: Overall, 13,334 people with type 2 diabetes in 31 provinces of Iran completed the survey (response rate: 99.6%). In total 13,321 participants, 6683(50.17%) women and 6638(49.83%) men were included in our analysis. Thirteen recruited patients refused after the consenting process and did not respond. The mean age (SD) of total participants was 54.86 ± 9.44 years and 71.50% were from the urban areas. 13.66% of diabetic patients had achieved the triple target of management [controlled HbA1c, blood pressure, and Low-Density Lipoprotein-Cholesterol (LDL-C)] in the whole country. While 28.74% of people had controlled HbA1c and 33.40% of them had controlled FBG. Diabetic subjects living in rural areas had less controlled HbA1c (23.93 vs. 29.48), controlled FBG (29.50 vs. 34.20) and controlled triple targets (10.45 vs. 14.32) than those living in urban areas. Diabetic neuropathy and diabetic foot were more common in women than men, while end-stage of renal disease (ESRD) was more common in men than women. Conclusions: This population-based study provided representative information about diabetes care in Iran. The high prevalence of diabetes and low proportion of diabetes control in Iran implies that it is necessary to identify factors associated with poor treatment goal achievements. Besides, general improvements in management and care of diabetes are mandatory. [ABSTRACT FROM AUTHOR]

Purpose: Adoption of international working group on the diabetic foot (IWGDF) guidance on prevention and management of foot problems in patients with diabetes was the study aim. Methods: The ADAPTE process consisted of three main phases of set-up, adoption, and finalization with overall 24 steps was used. In set- up phase, organizing committee by a multidisciplinary approach was established. In adoption phase, comprehensive search in databases and guideline resources was done. According to the inclusion criteria, the 2015IWGDF guidance was selected for adoption process. Quality, currency, content and consistency of the guidance were assessed. Also, consensus on different level of agreement for each recommendation were reported. On finalization phase, the adopted version was reviewed by the guidance developer and the final guidance for local use in Iran was disseminated. Results: The 2015 IWGDF guidance with 77 recommendations was adopted after screening of 1760 documents retrieved from Jan. 2006 to Nov. 2016. An organizing committee was established according to a multidisciplinary approach including 73 members with endocrinology, orthopedic & vascular surgery, dermatology, infectious diseases, physical medicine and rehabilitation specialties, general practitioners and nurses. This guidance obtained a good quality in all six domains of AGREE II instrument (Score ≥ 80%), good currency, content, and consistency. Also, during the third round of Delphi, the consensus on the agreement level of each recommendation were greater than 80% and 77 recommendations of the original guidance were kept in the adopted version. Conclusion: The 2015 IWGDF guidance with 77 recommendations adopted for local use in different health care settings of Iran. [ABSTRACT FROM AUTHOR]

Foot ulcer in diabetic patients could often result in significantly impaired quality of life. This study aimed to translate and validate the DFS‐SF in Iran. The DFS‐SF was translated into Persian, and then its validity and reliability were tested in 262 patients with DFUs. Content validity was evaluated using content validity ratio (CVR) and content validity index (CVI), and criterion validity was assessed through Spearman's correlation between dimensions of the DFS‐SF and the EQ‐5D‐5L. Construct validity was measured using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and convergent‐discriminant validity was examined by calculating the average variance extracted (AVE) and composite reliability (CR). Cronbach's alpha and intraclass correlation coefficient (ICC) were calculated to evaluate the reliability of the measure. CVR ≥0.66 and CVI = 0.81 were calculated. Spearman's correlation ranged from 0.23 to 0.78 across all dimensions. The results of EFA showed that all six dimensions of the DFS‐SF had an eigenvalue more than 1; accounting for 68.88% of the total variance. CFA confirmed the DFS‐SF as a six‐dimension structure with good fit indices of χ2/df = 2.15 < 5, RMSEA = 0.06 < 0.08, CFI = 0.91 ≥ 0.90, TLI = 0.90 ≥ 0.90, and RMR = 0.04, as well as with adequate fit indices of GFI = 0.84 ≤ 0.90, NFI = 0.86 ≤ 0.90. Estimates of ≥0.50 for AVE were not observed in two of the six dimensions and CR ≥0.70 was obtained for all dimensions. The reliability was calculated with a Cronbach's alpha of 0.89 and ICC >0.69 for all dimensions. Our findings confirmed the validity and reliability of the Persian DFS‐SF; therefore, it can be used to assess QoL in patients with DFSs in clinical and research settings in Iran. [ABSTRACT FROM AUTHOR]

Purpose: Diabetes-related distress (DRD) has negative emotional effects on the patients' quality of life. This is while the condition often goes undiagnosed despite it being common among diabetic patients. This study investigated the prevalence of DRD and its association with diabetes complications among a group of Iranian type 2 diabetic patients (T2DM). Methods: This descriptive-analytical cross-sectional study was conducted on 186 T2DM patients referred to a diabetes clinic in a teaching hospital from the beginning of May 2019 to the end of April 2020. Two questionnaires on disease-related information and diabetes distress screening scale (DDS) were filled out for each patient. The latter was divided into four domains, emotional burden (EB), diabetes-related interpersonal distress (ID), physician-related distress (PD), and regimen-related distress (RD). In addition to the frequency of DRD and its association with age, sex, body mass index (BMI), hypertension, hemoglobin A1C, duration of disease, and type of medication regimen (oral, insulin, or mix) along with the history of cardiovascular disease (CVDs), retinopathy, nephropathy, and diabetic foot were assessed. Results: DRD was reported in 47% of the patients. Being female, old age, hypertension, high hemoglobin A1C levels, nephropathy, and retinopathy were significantly associated with DRD (P-value = < 0.001, 0.013, 0.014, 0.007, 0.001, and 0.004, respectively). The history of the diabetic foot had a significant relationship with PD and ID (P-value = 0.007 and < 0.001, respectively). Multivariate regression showed gender and the existence of complications to have a direct effect on the development of DRD. Conclusion: DRD prevalence is relatively high and requires screening to identify and treat high-risk patients. Further studies are needed to study diabetes, its complications and their relation with DRD to help reduce such conditions and improve the patient's quality of life. [ABSTRACT FROM AUTHOR]

The article discusses how spiritual wellbeing can improve the quality of life (QoL) of patients with chronic diseases like diabetic foot ulcer (DFU). Also cited are the factors that adversely affect QoL like fatigue due to disease consequences, ulcer infection, and social isolation, and the 2018-2019 Iranian study that uses the Diabetes Quality of Life (DQOL) and the Palutzian and Ellison Spiritual Wellbeing questionnaires to assess the patients' QoL and existential wellbeing.

Background: Diabetic Foot Ulcer (DFU) is the most costly and devastating complication of diabetes mellitus which can lead to infection, gangrene, amputation, and even death if the necessary care is not provided. Nowadays, some herbal products have shown therapeutic effects on healing of DFU. So, this study aimed to assess the effects of topical olive oil on the healing of DFU. Methods: This double-blind randomized clinical trial study was conducted in Diabetes Clinic of Ahvaz Golestan hospital, Iran, in 2014. Thirty-four patients with DFU of Wagner's ulcer grade 1 or 2 were enrolled in this study. Patients who were randomly assigned to intervention group (n = 17) received topical olive oil in addition to routine cares, whereas patients in control group (n = 17) just received routine cares. Intervention was done once a day for 4 weeks in both groups, and in the end of each week; the ulcers were assessed and scored. Data was collected by demographic and clinical characteristics checklists as well as diabetic foot ulcer healing checklist, and was analyzed by SPSS version 19 software using descriptive (mean and standard deviation) and analytic (student's sample t-test, chi-square and repeated-measures analysis of variance) statistics. Results: At the end of 4th week, there was a significant differences between two groups regarding to 3 parameters of ulcer including degree (P = 0.03), color (P = 0.04) and surrounding tissues (P < 0.001) as well as total status of ulcer (P = 0.001), while related to ulcer drainages no significant difference was seen between the two groups (P = 0.072). At the end of the follow up, olive oil significantly decreased ulcer area (P = 0.01) and depth (P = 0.02) compared with control group. Complete ulcer healing in the intervention group was significantly greater than control group (73.3% vs. 13.3%, P = 0.003) at the end of follow up. Also, there were no adverse effects to report during the study in intervention group. Conclusions: Our results indicated that olive oil in combination with routine cares is more effective than routine cares alone, and is without any side effect. However, further studies are required in the future to confirm these results. Trial registration: IRCT2014083014251N2. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot self-care refers to a group of self-management behaviors that can reduce the incidence of foot ulcers and amputations. It is necessary to have a valid and reliable standard tool to measure foot self-care in diabetic patients. This study aimed to evaluate the psychometric properties of the Persian version of the Diabetic Foot Self-Care Questionnaire of the University of Malaga, Spain (DFSQ-UMA) in Iran. Methods: This cross-sectional study was conducted with 407 diabetic patients who were selected using a convenient sampling method. Construct validity was assessed by exploratory (with 207 patients) and confirmatory (with 200 patients) factor analyses. Internal consistency was calculated using Cronbach's alpha and McDonald's omega coefficients. Results: In the exploratory factor analysis, three factors with eigenvalues of 3.84, 2.41, and 2.26 were extracted that together explained 56.74% of the total variance of diabetic foot self-care. A Cronbach's alpha of 0.865 was found for the total instrument. Conclusions: The Persian version of the DFSQ-UMA has good validity and reliability, and given its good psychometric properties, it can be used in future studies. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcer (DFU) is known as a serious complication of diabetes mellitus in patients with diabetes, imposing heavy medical costs on healthcare systems due to its chronic nature. patients with severe diabetic foot ulcer are often disabled to work, and some of them may even die, leading to associated productivity losses. Since no previous study has investigated the economic burden of DFU in Iran, this study is to estimate the economic burden of diabetic foot disease in Iran., Methods: In this descriptive cross-sectional study, randomly selected samples consisted of 542 patients with DFU, hospitalized in the hospitals of Shahid Beheshti University of Medical Sciences. The demographic profile and cost data used in this analysis were derived from a researcher-designed checklist. Lost productivity was calculated based on Human Capital Approach, and the total economic cost of DFU was determined using patient-level data on costs and prevalence data from the global burden of diseases reports. All analyses were performed using SPSS software (Version 23), and Microsoft Excel (Version 19)., Results: The economic burden of DFU in Iran in two scenarios of discounting future costs and not discounting them was about $8.7 billion and $35 billion, respectively (about 0.59 and 2.41% of GDP). 79.25% of the estimated costs in this study were indirect costs and productivity losses, of which 99.34% (7,918.4 million Dollars) were productivity losses due to premature death. 20.75% (2,064.4 million dollars) of the estimated costs in this study were direct costs. The average length of stay (LOS) was 8.10 days (SD = 9.32), and 73.3% of patients recovered and were discharged after hospitalization and 7.6% died. The majority of the costs are imposed on the age group of 60-69 year (53.42% of the productivity lost due to hospital length of stay, 58.91% of the productivity lost due to premature death & 40.41% of direct costs)., Conclusions: DFU represents a heavy burden to patients, Iran's health system, and the economy. Early prevention strategies need to be prioritized in making public health policies. These policies and decisions can be in the area of changing lifestyle, health education, changing people's behavior, and encouraging physical activity that targeted high-risk populations in order to reduce the prevalence of diabetic foot and resulting substantial economic burden., (© 2024. The Author(s).)

Diabetic foot infection is among the most common complications of diabetes mellitus which significantly causes hospitalization and is the most prevalent etiology of nontraumatic amputation worldwide. The current study aimed at assessing the frequency and antimicrobial susceptibility patterns of diabetic foot infection of patients from the Bandar Abbas area, in the south of Iran. In this study, a total of 83 diabetic patients with diabetic infected foot wounds referring to Shahid Mohammadi Hospital, Bandar Abbas, from 2017 to 2018 were assessed. Samples were obtained from wound sites and evaluated by aerobic culture and also an antibiogram test for antibiotic susceptibility. Factors including age, sex, type of diabetes, the medication used for diabetes, previous history of diabetic foot infection, duration of wound incidence, fever, and laboratory indices were recorded for each subject. The most prevalent detected bacteria were Escherichia coli (20.5%), Enterococcus sp. (16.9%), Klebsiella sp. (12%), Staphylococcus aureus (8.4%), Enterobacter sp. (7.2%), and Acinetobacter sp. (6%). The results of antibiogram tests revealed the most and the least antibiotic sensitivity for E. coli sp. as meropenem and ciprofloxacin, for Enterococcus sp. as gentamicin and ciprofloxacin, for Klebsiella sp. as amikacin and cotrimoxazole, and for Enterobacter sp. as cotrimoxazole and both amikacin and ciprofloxacin. Staphylococcus aureus was sensitive to vancomycin and doxycycline, and Acinetobacter sp. was 100% resistant to all antibiotics except amikacin and gentamycin. A significant statistical association was found between the C-reactive protein and the patients' diabetic foot infection organisms (P = 0.019). Findings of the study revealed E. coli sp. as the most common bacteria which are infecting the foot lesions in the studied population. The highest antibiotic susceptibility was seen for vancomycin, linezolid, and carbapenem. [ABSTRACT FROM AUTHOR]

Introduction: Providing health care to patients at home could be causing the mortality and readmission rates reduction in addition to satisfaction of both patients and health care providers increase. The aim of this study was to assess the cost-effectiveness of home care service compared to hospital based care in patients with diabetic foot ulcer. Methods: An economic evaluation study and a trial study were simultaneously conducted in Iran. In trial phase, patients with diabetic foot ulcer were randomly assigned to the home care or hospital care. The Cost and Quality of life data were determined as measures of the study. Incremental cost-effectiveness ratio was calculated for comparative purposes. The model consisted of five stages of the disease. The Tree Age Pro 2009 and R software's were used for data analysis. Results: 120 patients were enrolled in our trial; among which 30 patients were in home care service group and 90 patients in hospital based care group. The rate of ulcer size reduction in hospital based care was significant (P value = 0.003) in comparison with home care service. The total cost of the home care and hospital strategies were 1720.4 US$, 3940.3 US$ and the total effectiveness were 0.31 and 0.29, respectively. The incremental cost-effectiveness ratio (ICER) was 117,300 US$ per quality-adjusted life year for home care intervention compared to hospital based care. Based on ICER plane home care treatment will be placed on the southeastern quadrant of the Cost-Effectiveness Plane, and is suggested as a more dominant treatment alternative. Conclusions: Regarding current evidence, home care strategy for patients suffering diabetic foot ulcer enjoys more cost effectiveness compared to hospital care. It is suggested that healthcare policy makers determine the tariff for health care services for disease groups according to the activity based costing approach. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcers (DFUs) are common problems in diabetes. One of the most important factors affecting the quality of diabetes care is knowledge and practice. The current study aimed at determining the knowledge and practice of patients with diabetes regarding the prevention and care of DFUs. Methods: The current analytical, cross sectional study was conducted in Guilan Province (north of Iran) on 375 patients registered in the medical records as type 2 diabetes mellitus. Demographic characteristics, knowledge, and practice of participants were recorded in a questionnaire during face-to-face interviews conducted by the researcher. Descriptive and inferential statistics were performed using SPSS version18. Results: The mean score of knowledge was 8.63 ± 2.5 out of 15, indicating that the majority of participants had a poor knowledge (84.8%). The mean practice score was 7.6 ± 2.5 out of 15, indicating that a half of them had poor performance (49.6%). There was a significant and direct correlation between knowledge and practice. Knowledge level, place of residence, marital status, and history of admission due to diabetic foot were predictors of practice score. Conclusions: According to the low level of knowledge and practice in patients with diabetes regarding the prevention and care of DFUs, and considering the significant relationship of some demographics of patients with knowledge and practice scores, a targeted educational program is needed to promote knowledge of patients with diabetes. [ABSTRACT FROM AUTHOR]

Demographic, antibiotic resistance patterns, capsular serotypes, biofilm formation and carbapenemase gene profiles among NDM-1 positive I K. pneumoniae i isolates. Characterization of a new metallo- -lactamase gene, blaNDM-1, and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. PCR characterization and typing of Klebsiella pneumoniae using capsular type-specific, variable number tandem repeat and virulence gene targets. [Extracted from the article]

Introduction: Diabetic foot ulcer is a complication of diabetes mellitus and can be associated with an increased risk of amputation or even death as a result of a wound infection. E.coli can lead to worsening of the condition of the wound. The aim of this study was to identify β-lactamase genes in E. coli isolated from diabetic foot ulcers Materials and Methods: In this experimental study, 110 isolates of E. coli from patients with diabetic foot ulcers hospitalized in the infectious ward of the in Peymanieh, Jahrom and Ali Asghar and Namazi, Shiraz, hospitals in 1396 were selected. Determination of antibiotic susceptibility, phenotypic identification of strains producing broad-spectrum beta-lactamases (ESBLs), strains producing MBL and strains producing Carbapenemas was done. The existence of genes encoding bla TEM, bla SHV and bla OXA-1 enzymes was investigated by multiplex PCR assay Results: In this study, 35 isolates of Escherichia coli were isolated. 13 isolates produced broad-spectrum betalactamases. Genetically, 19 isolates with TEM gene (54.2%) and 3 isolates with SHV (8.5%), which simultaneously had 1 isolate from 3 isolates with SHV, also had OXA-1 gene (2.8%). The highest susceptibility of Escherichia coli was to maropenem (99%) and the lowest antibiotic susceptibility to amikacin (3.2%). Conclusion: According to the results of this study and monitoring of antibiotic resistance in patients with diabetic foot ulcers, treatment of infections caused by this agent can be facilitated. [ABSTRACT FROM AUTHOR]

Background and Aims: Methicillin-resistant Staphylococcus aureus is the most common bacterial agent of diabetic foot Infection (DFI).The Virulence factors of this bacterium increases the severity of the degree of wound infection, and if not treated promptly, results in lower limb amputation and death of the affected patients. The aim of this study was to isolate methicillin resistant Staphylococcus aureus carries the mecA gene and to detect 4 Virulence genes hla, lukED, sei and hlg from patients with diabetic foot infection in order to evaluate their role in severity of infection. Materials and Methods: 30 cases of diabetic foot infections in Mazandaran province were collected from pus drainage and Staphylococcus aureus was purified according to culture characteristics and biochemical tests. The molecular evaluation of the isolates after DNA extraction was performed with five pairs of specific primers of intended genes, by PCR method. Results: Of the 30 patients, 14 isolates (46.6%) of S. aureus were isolated and identified. Each 14 samples contained mecA gene and the frequency of hla, lukED, sei and hlg genes in isolates was 100%, 100%, 71.4% and 64.2%, respectively. Conclusions: Identification of these 4 genes with the mecA gene in S. aureus isolated from diabetic foot Infection can be an effective and reliable genetic marker for diagnosis of foot infection in diabetic patients. To prevent amputation, diagnosis of infection by PCR method and appropriate timely antibiotic therapy are required for Diabetic patients. [ABSTRACT FROM AUTHOR]

Background and Aims: In the present study, we have tried to isolate an effective lytic bacteriophages on drug-resistant Escherichia coli isolated from diabetic ulcer wounds. Materials and Methods: Two E.coli strains were isolated by using standard methods from patients in Razi Hospital of Rasht. Waste water of the same hospital was used as a source for isolation of lytic bacteriophages. Agar layer method was used to isolate and plaque finding. Determination of host range of isolated phages was performed using five standard reference collection of E. coli. Finally, Transmission electron microscopy was used for morphological analysis of the isolated bacteriophages. Morphotype and family of isolated phages were determined based on Bradley recommendation and final version of International Committee on Taxonomy of Viruses (ICTV) report, respectively. Results: The results showed that the isolated bacteria were highly resistant to the antibiotics tested. Based on morphological characteristics, the separated virus belongs to siphoviridae family. Based on Bradley classification, isolated phage against strains of E.coli belongs to the morphotype B1. Conclusions: The isolated bacteriophage from waste water efficiently lysed the multiresistant strains of E. coli. Therefore, bacteriophages could potentially be used as an alternative for antibiotics for treating infections by multiresistant E. coli. [ABSTRACT FROM AUTHOR]

Objective: The need for improved wound care is receiving considerable attention in the Islamic Republic of Iran. Beginning in 2003, maggot therapy (MT) became part of Iran's effort to advance its wound care technology. The first cohort of patients treated with MT was analysed to evaluate the use of this treatment. Method: Patients treated with MT at three hospitals in Tehran were analysed retrospectively. Primary outcomes were time to wound debridement and time to wound healing. Factors potentially influencing primary outcomes were also recorded, including demographic factors (such as age, race, gender), wound characteristics, underlying medical illnesses, and treatment attitudes. Results: We analysed 28 patients with 29 wounds. Most (55%) of the wounds were ischaemic, neuropathic or mixed-pathology foot ulcers in patients with diabetes. Half were considered unsalvageable. All were completely debrided and subsequently healed with MT, without amputation, grafts, or advanced interventions. Osteomyelitis was present in all cases before MT, but appeared to have been eradicated, without recurrence during at least three years' follow-up. The most common adverse events were malodour, with wound pain reported in two patients. All patients and therapists were pleased with their overall experience. Conclusion: Maggot therapy can provide advanced wound care even in resource-limited areas. Maggot therapy was very acceptable to the patients and their therapists. Declaration of interest: Ronald Sherman is on the Board of Directors of the BioTherapeutics, Education and Research (BTER) Foundation, which supports education and research in biotherapy. He is also the Cofounder and Laboratory Director of Monarch Labs, which produces medicinal maggots. However, Monarch Labs was not involved in this research, provided no financial or material support, and does not stand to gain from the success of MT in the Islamic Republic of Iran. Neither does Dr. Sherman's professional career stand to gain from publishing this research, as he has already retired from the University of California. The remaining authors declare no conflicts of interest. [ABSTRACT FROM AUTHOR]

Introduction: Lower extremity conditions including peripheral artery disease, peripheral neuropathy, foot ulcer, and amputation are more common in diabetic patients, compared to non-diabetic cases. These conditions affect 30% of individuals, aged above 40 years. Foot ulcers are among the most common, serious, and costly complications associated with diabetes, causing a two- to four-fold increase in the risk of mortality; therefore, identification of risk factors can help prevent the irreparable side-effects. In the present study, we aimed to determine the foot condition in diabetic patients. Methodology: In this descriptive, cross-sectional study, foot condition was analyzed in 355 diabetic patients, referred to Razi Educational-Therapeutic Center in Rasht, Iran in 2013. The subjects were selected via convenience sampling and were evaluated by a trained nurse. Data were collected through interviews and a researcher-made questionnaire. For statistical analysis, descriptive and inferential statistics, Chi-square, and logistic regression analysis were calculated and performed, using SPSS version 16. P-value less than 0.05 was considered statistically significant. Results: Based on the Chi-square test results, there was a significant relationship between foot ulcer and dry skin (without sweat) (P=0.01), fissure (P=0.004), impaired growth of toenails (P=0.02), blister (P=0.008), hammer toe (P=0.05), claw toe (P=0.001), Charcot arthropathy (P=0.02), superficial pain (induced by a pin), vibrational sense (induced by a tuning fork) (P=0.001), pulse of dorsalis pedis artery and right/left posterior tibia (P<0.001), ulcer scar (P=0.001), cause of hospitalization, and history of hospitalization due to foot problems (P=0.001). Based on the logistic regression analysis, variables associated with diabetic foot condition included blister, claw toe, and cause of hospitalization due to diabetes. Conclusion: Since blister, claw toe, and cause of hospitalization seem to be associated with foot ulcer, nurses can play an important role in the prevention and timely treatment of foot ulcers through identifying the risk factors. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic foot ulcer is one of the serious complications of diabetes. Even in some cases, this condition can lead to lower limb amputation. Generally, education can help prevent the complications of diabetes including diabetic foot ulcer. Therefore, evaluation of the main domains of education (cognitive, functional, and emotional domains) can be a good strategy for proper educational planning in hospitalization units. Methodology: This descriptive, analytical, one-stage study was performed on 60 patients (30 males and 30 females) with diabetic foot ulcers in Noor and Ali Asghar hospitals of Isfahan, Iran. Information was collected using a questionnaire on cognitive, functional, and emotional domains of education. For data analysis, descriptive statistics were calculated and analysis of variance was performed using SPSS version 20. Results: The present study showed that both sexes had similar educational needs in functional and cognitive domains (P>0.05). However, in the emotional domain, anxiety and disappointment about the future of the disease were more prevalent in women. Conclusion: The present study, which aimed to determine the learning needs of patients in three major educational domains, showed that more attention needs to be paid to all these domains, especially the emotional aspect in order to propose an appropriate educational program. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate anaerobic and aerobic bacteria profile and determination of antibiotic susceptibility pattern in aerobic bacteria. Method: Specimens were cultured using optimal aerobic and anaerobic microbiological techniques. Identification of bacterial isolates was performed by standard microbiological methods and antibiotic susceptibility testing was performed according to the guidelines of Clinical and Laboratory Standards Institute (CLSI). Result: 92 bacterial strains were isolated from 60 samples of diabetic foot ulcers. Predominant aerobic bacteria isolated from these infections were S. aureus (28%) followed by Enterobacteriaceae family (24%) including Escherichia coli (15%), Citrobacterspp. (4%), Enterobacter spp. (4%), and coagulase-negative Staphylococcus spp. (17%), Enterococcus spp. (15%), Pseudomonas aeruginosa (7%) and Acinetobacter spp. (4%). No Clostridium spp. were isolated and 4% Bacteroides fragilis obtained from anaerobic culture. All Gram-positive isolates were susceptible to linezolid while all Enterobacteriaceae showed sensitivity to imipenem. Conclusion: Most of DFIs specimens were poly microbial infection and predominant bacteria were S. aureus and B. fragilis. These wounds may require use of combined antimicrobial therapy for initial management. [ABSTRACT FROM AUTHOR]

Since infectious foot ulcers represent one of the major causes of lower-limb amputation, it calls for an appropriate action for early detection and sufficient treatment of diabetic foot infection (DFI). The present study aimed at investigating the bacterial epidemiology and antimicrobial resistance (AMR) patterns of DFIs in Iran. We have conducted a systematic search in PubMed, Embase, Web of Science, Scopus, Google Scholar, and Scientific Information Database to identify all articles reporting the proportion of different kinds of bacteria isolated from Iranian DFI samples. Quality was assessed using Joanna Briggs Institute tool. A pooled estimate of proportion with a corresponding 95% confidence interval (95% CI) was calculated using the random effect method. Fifteen studies were eligible, of which 1970 bacterial isolates were obtained from 1316 patients. The most predominant isolates recovered from DFIs was Staphylococcus aureus with a pooled proportion of 24.29% (95% CI: 20.25%, 28.57%) from which 55% (95% CI: 38%, 72%) were methicillin-resistant S. aureus (MRSA). Among Gram-negative strains, Escherichia coli had the highest proportion (17.19%; 95% CI: 13.96%, 20.68%) followed by Pseudomonas aeruginosa , 7.54% (95% CI: 4.56%, 11.14%). The highest pooled estimates of resistance against cotrimoxazole and ciprofloxacin were found in S. aureus 66% (95% CI: 48%, 82%) and E coli isolates 68% (95% CI: 51%, 84%), respectively. Our study revealed that AMR is at a high level in Iran and clinicians should be aware of bacterial resistance patterns to prescribe appropriate antibiotic regimens.

Background and Aims: We aimed to compare the effect of topical olive oil dressing plus standard care with standard care alone on the treatment of grade 1 and 2 diabetic foot ulcers (DFUs) in type 2 diabetes mellitus (T2DM) patients., Methods: This assessor-blind randomized controlled trial included 60 T2DM patients with DFU referred to the Diabetes Clinic of Shahid Mohammadi Hospital, Bandar Abbas, Iran, from February 21 to August 22, 2017. Patients were randomly assigned to intervention (n = 30) and control (n = 30) groups. The intervention group received standard care, including wound irrigation with normal saline and oral antibiotics plus daily topical olive oil dressing for four weeks, and the control group only received standard care. The wound healing assessment scale (wound degree, color, drainage, and surrounding tissue healing) was recorded weekly and the total wound status was determined at the end of the study., Results: Treatment with olive oil led to significantly higher scores of ulcer degree, color, drainage, and surrounding tissue healing at weeks one, two, three and four in the olive oil group than in the control group (P < 0.001). Also, the total wound status score was higher in the olive oil group compared to the control group (P < 0.001). The proportions of completely healed, partially healed, and unhealed wounds were 76.6%, 23.3% and 0% in the intervention group, and 0%, 93.3% and 6.7% in the control group, respectively., Conclusions: Topical olive oil dressing promoted the healing of DFU and it can be recommended as a safe and effective treatment in this regard., Trial Registration: Iranian Registry of Clinical Trials (IRCT), IRCT20150607022585N4. Registered 05/12/2018. Retrospectively registered, https://www.irct.ir/trial/19460., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2022. Published by Elsevier Ltd.)

Background: Maximum willingness to pay (WTP) for a health benefit is connected to perceived value. This two-center study aims to analyse diabetic patients' WTP for obtaining a specific preventive treatment package to reduce severe diabetic complications and determine the factors that impact this value., Methods: This cross-sectional research included 557 diabetics from two cities in Iran. The WTP for a preventative package minimising major diabetes complications (cardiovascular, renal, ocular, and diabetic foot) by 50% and 100% was tested using eight scenarios. The Diabetes Attitude Scoring Questionnaire (DAS-3) was used to examine patient attitudes toward diabetes. To determine WTP, a two-stage hurdle method was used. The level of significance was fixed to 0.05., Results: Around 80% of 557 people interviewed (mean age 47.54) stated they wanted to pay for a diabetes prevention package. This package's WTP varied from 169.4 to $374.5 depending on the complication and degree of risk reduction. The largest value diabetic patients willing to pay for preventative packages that reduce the chance of blindness was reported, while the lowest cost was stated for the diabetic foot. WTP is influenced by wealth, location of study, marital status, and attitude toward special training, but not by the type of diabetes, inpatient or outpatient setting, or the complications diabetes patients are impacted by. Patients' diabetes attitudes were mainly negative. The score of the attitude of patients towards diabetes was generally suboptimal., Conclusion: Most diabetic patients were willing to pay for a preventive package and this value was not affected by the type of diabetes and its severity. Our research found that diabetic individuals are willing to pay the most for a preventative package that reduces the chance of blindness, and the least for diabetic foot care. WTP can help health officials allocate resources and manage budgets. The attitude of diabetic patients toward diabetes still needs further interventional research, however., Competing Interests: Conflict of Interest There were no conflict of interest for this work for none of the authors., (Copyright © 2022 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.)

Background: Kiwifruit (Actindia Deliciosa) is demonstrated to have antibacterial and pro-angiogenic effects. It also contains proteolytic enzymes (actinidin) and ascorbic acid. In this study, the effects of Kiwifruit on neuropathic diabetic foot ulcer healing in clinical settings were evaluated. Materials and Methods: In this randomized clinical trial of 37 patients (17 in experimental and 20 in control groups) with neuropathic diabetic foot ulcer were studied in Isfahan-Iran. Patients of the control group received just the standard treatments. In the experimental group, in addition to the standard treatments, ulcers were dressed with pure extract of kiwifruit twice daily for 21 days. The ulcers were examined and evaluated based on macroscopic, microscopic and microbiological status. Pre- and post-interventions, biopsies were taken from the ulcers to perform microbiological and histological studies. Results: Mean reduction in surface area of foot ulcer in the experimental group was significantly higher than the control group (168.11 ± 22.31 vs. 88.80 ± 12.04 mm² respectively, P < 0.0001). The amount of collagen and granulation tissues was significantly higher in the experimental groups than the control group (P value < 0.0001). Significantly higher levels of angiogenesis and vascularization were found in the kiwifruit treated patients (P value < 0.0001). No significant antibacterial effect was observed for kiwifruit. Conclusion: Natural compounds in the kiwifruit including protein-dissolving enzymes (Actinidin) improved different aspects of the wound healing process. Based on these benefits and safety aspects, we conclude that using kiwifruit is a simple, applicable and effective way for treatment of neuropathic diabetic foot ulcer. [ABSTRACT FROM AUTHOR]

Evidence-based nursing is recognized as an indicator of quality in nursing practice, a basis for accountability and the gold standard of professional nursing care. The aim of this study was to explore nurses' experiences and perceptions about evidence-based nursing practice in giving care to patients with diabetic foot ulcers. A qualitative research design was adopted, and content analysis was used to analyse data. Semistructured interviews were held with 19 bachelor-degree nurses working in a teaching hospital in an urban area of Iran. During data analysis, two main themes developed: 'structural backgrounds of the organization' and 'empowerment'. Accordingly, it was concluded that successful implementation of evidence-based nursing requires the reconfiguration of the administrative structure in the hospital. In addition, it requires the support of nurse leaders to facilitate the implementation of evidence-based nursing in the practice. [ABSTRACT FROM AUTHOR]

Background: One of the major risk factors of foot ulcer is uncontrolled diabetes mellitus (DM) or in fact uncontrolled HbA1C. The aim of this study was to evaluate the relationship between controlling HbA1C and foot ulcer. Methods: This analytic case-control study was conducted in Alzahra Hospital, Isfahan, Iran during 2010-2011. The case group included 65 male non-smoker patients who had suffered DM for more than 10 years. They were not hypertensive, did not have a history of a previous foot ulcer and were diagnosed with foot ulcer at the time of the study. The control group included 65 male patients with the same background but without foot ulcer. HbA1C levels in both groups 6 months before the study and at the time of study were evaluated. The collected data was analyzed in SPSS18. Findings: Mean time of having DM in the control group was lower than the case group (13.30 vs. 15.49 years). HbA1C < 7% was found in 7.69% of the case group and 52.31% of the control group. Conclusion: The results of this study showed uncontrolled HbA1C as the major factor to create foot ulcer. Therefore, constant measurement of HbA1C, controlling DM and modification of the treatment method if necessary can prevent this life threatening complication. [ABSTRACT FROM AUTHOR]

Diabetes Mellitus (DM) is the most common metabolic disease in the world. About 15% of diabetic patients experience diabetic foot ulcer (DFU). Despite all the efforts in treating DFUs, the incidence of lower extremity amputations remains rather high. There are different modalities for treating this complication of DM. Angipars™ is a novel safe herbal formulation, recently presented for treating the condition. This study presents a trial which has been designed to evaluate the efficacy and safety of Angipars™ in treatment of DFUs in larger scale. In this randomized double-blind placebo controlled trial, a total of 300 participants (150 in each of the two arms) will be recruited from a tertiary clinic in Tehran. The patients aged between 18 and 75 years and are diagnosed with grade II or III of foot ulcer based on the Wagner's wound classification. The closure of the wound surface area is determined as the primary outcome, whereas the secondary outcome consists of ankle brachial index, toe pressure, wound bed temperature, overall clinical and patient impression of change, and the adverse effects of Angipars™. These factors will be measured at baseline as well as 2, 4, 6, 10 and 18 weeks after the six weeks treatment period by an individual unaware of the participants' baseline characteristics and their treatment allocation. We will also collect data and analyze intention-to-treat of our intervention. The results of this study will provide valuable new information regarding Angipars™, a novel herbal drug hypothesized to be effective in treating DFUs. [ABSTRACT FROM AUTHOR]

Introduction. A diabetic foot lesion remains a major cause of morbidity in diabetic patients with chronic kidney disease. We studied the relation between kidney function and the risk of amputation in patients with diabetic foot. Materials and Methods. We reviewed retrospectively the charts of 244 patients admitted to Imam Khomeini Hospital of Sari, Iran, for diabetic foot from 1996 to 2005. Their clinical characteristics and kidney function indicators, including urine protein excretion and serum creatinine were analyzed and compared between amputees and nonamputees. Results. There were 244 patients with diabetic foot who were admitted to our center during the studied period. The duration of being affected by DM was between 3 months and 34 years (mean, 11.80 ± 6.81 years). Sixty-six patients (27.0%) underwent amputation. The amputees were older than the nonamputees (61.1 ± 11.5 years versus 55.6 ± 12.5 years, P < .001). There were 20 patients (30.3%) in the amputee group and 44 (24.7%) in the nonamputee group who had proteinuria (P = .38). The mean creatinine level was significantly higher in the amputees compared to the nonamputees (1.78 ± 1.36 mg/dL versus 1.28 ± 1.23 mg/dL, P = .03). Conclusions. Lower extremity amputations in our patients with diabetic foot were strongly associated with elevated serum creatinine levels. The presence of this complication necessitates intensifying actions in order to prevent amputations. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study was to evaluate the impact of a simple educational program on the knowledge and practice of people with type 2 diabetes in relation to the foot at risk in Tehran, Iran. Methods: One hundred and forty-eight people with type 2 diabetes underwent a structured interview using a 32-item designed questionnaire (DiFoKaPS-32) about their knowledge of foot care standards in diabetes and their personal foot care behaviours. Each participant in the study received a single 20min education session individually. The mode of the intervention was face-to-face. Results: The applied educational intervention aimed at patients with type 2 diabetes has improved their knowledge and practice about diabetic foot care (P <0.0001 and P =0.011; Wilcoxon Signed Ranks test, respectively). Knowledge and practice scores were increased significantly after the education in the lean group (BMI≤25) rather than the obese ones. Conclusions: In conclusion the findings of our study have shown that a simple face-to-face education is an effective and applied method to improve the knowledge about foot care. It has also shown that it could increase the motivation and change the behaviour of people with type 2 diabetes regarding their feet. In addition, the obese patients referring to a diabetic clinic need much more attentions and tighter care programs. [Copyright &y& Elsevier]

Background: Diabetic foot (DF) is the main cause of nontraumatic lower extremity amputation. Early recognition and management of risk factors for foot complications may prevent amputations and other adverse outcomes.Materials and Methods: At our hospital we have a protocol for the management of patients hospitalized because of DF. We collected clinical and laboratory data, details of diabetes complications, and history of comorbidities in 146 patients who were admitted for management of DF to determine the risk factors of amputation (major or minor) in these patients. We divided these patients into two groups, those whose treatment included amputation and those who were treated conservatively and carried out a comparative analysis of the variables in the two groups.Results: Major amputation was performed in 5.5% of the patients and minor amputation in 22.6%. Those who required amputation presented a significantly higher (P < 0.05) incidence of nephropathy, history of previous amputation, ischemic diabetic foot and first fasting blood glucose (FBG) > 200 mg/dl after admission. Multivariable-adjusted odds ratios in stepwise logistic regression model was 2.64 for nephropathy (95%CI: 1.06 to 6.60; P = 0.03); 3.03 for ischemic diabetic foot (95%CI: 1.28 to 7.18; P = 0.01); and 3.01 for first FBG > 200 after admission (95%CI: 1.32 to 6.83; P= 0.01).Conclusion: Nephropathy, ischemic diabetic foot, and first FBG > 200 mg/dl are independent predictors of limb amputation in patients hospitalized for DF lesions. In addition to early detection and treatment of foot lesions, early management of risk factors is also important. [ABSTRACT FROM AUTHOR]

Background and Aims: The present study was conducted to determine the situation of foot self-care practice among Iranian women with diabetes., Methods: In this cross-sectional study, 475 women completed the Diabetic Foot Self-Care Questionnaire (DFSQ) along with other questions. The overall and three components scores including personal care, podiatric care, and foot wearing, were calculated and their relationship with other factors was analyzed., Results: The average total DFSQ score was 60.38 ± 9.9, and 16.98 ± 7, 5.95 ± 2.11, and 12.26 ± 3.95 for personal care, podiatric care, and footwear respectively. Education level, self-reported health status, and life satisfaction had a significant relationship with footwear score, and smoking and life satisfaction were related to personal care and podiatric care respectively. In Pearson regression, DM self-care was correlated with all three components and total DFSQ score. Also, depression and SCS (Social Capital Status) correlated with DFSQ scores except with personal self-care and footwear respectively. Body Mass Index (BMI) and Quality of Life (QoL) were significantly correlated with footwear and podiatric care scores., Conclusion: In this study, the DFSQ result was almost acceptable, however, it highlights the importance of suitable interventions to establish better self-care practice among Iranian diabetic women., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interests., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Approximately 25% of people with diabetes will experience diabetic foot ulcers (DFUs) during their lifetime. The present study was designed to determine the type of microorganisms isolated from the DFUs and their antibiotic resistance pattern, and to determine predisposing factors contributing to antibiotic resistance at the authors' wound care clinic in Qazvin, Iran., Methods: A cross-sectional study was conducted from May to December 2017. One specimen for microbiological studies was obtained from the deep tissue. All demographic, clinical, and laboratory data and results of ulcer culture were collected for each case. Antimicrobial susceptibility testing to different agents was carried out using the disc diffusion method. A p value < 0.05 was considered significant., Results: 95 aerobic microorganisms were isolated from 105 specimens. Among Gram-positive and negative bacteria, Staphylococcus spp. and Escherichia (E). coli were the most frequent organisms isolated, respectively. Multidrug resistant (MDR) organisms constituted up to 48.4%, with 37.5% of isolated Enterococcus spp. being VRE, 48.8% of Staphylococcus spp. being methicillin-resistant, 77.8% of isolated E. coli being ESBL and 66.7% of isolated Pseudomonas being MDR. The minimum and maximum prevalence of resistance in Gram-negative bacteria were 17.6% and 87.5% for imipenem and ceftazidime, respectively. The prevalence of Gram-negative bacilli was higher in older patients (p value = 0.039) and rose markedly in patients with a higher number of hospitalizations (p value = 0.015)., Conclusion: Due to emergence of antibiotic resistance pathogens, culture specimens and antibiotic sensitivity testing are essential for correct management of the DFU infections and the selection of appropriate antibiotics., (Copyright © 2019 Elsevier Ltd. All rights reserved.)