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We aimed to analyze sex-related differences in clinical outcomes among patients with diabetic foot disease (DFD) managed in a third-level referral center. We retrospectively analyzed data of admissions performed in our department between 2011 and 2015 for DFD. We collected demographic and clinical data, procedures performed during the admission, and short- and long-term outcomes in terms of healing rate and healing time, major amputation, and mortality rates during the follow-up. We focused on differences between genders and tried to figure out if sex could be considered a predictive factor. We collected data from 1237 admission performed in 842 patients (615 men [73%] and 227 women [27%]; age: 68.6 ± 27.9 years; diabetes duration: 16.4 ± 13.4 years; body mass index: 28.2 ± 6.4 kg/m2; hemoglobin A1c 7.9 ± 1.9%). Men showed a higher prevalence of comorbidities and previous ulcers or revascularization procedures. Men had a significantly higher healing rate compared with women (85.4% vs 63.2%, P <.001), but a longer healing time (124 ± 27 days vs 87 ± 14 days, P =.02). Major amputation did not differ between groups, while mortality rate was significantly higher in men (24.5% vs 16.1%, P =.02). In Cox's regression analysis, male sex was a positive predictive factor for healing and a negative one for time to heal and mortality. The difference in mortality was confirmed by a Kaplan-Meier analysis (log rank test: P =.03). DFD represents a severe disease and a strong marker of mortality affecting more severely on clinical outcomes and survival on men. [ABSTRACT FROM AUTHOR]

Guillain-Barré syndrome (GBS) represents an acute inflammatory immune-mediated demyelinating polyradiculoneuropathy with an incidence of 0.6 per 100 000 people. In this article, we report the case of a 19-year-old girl affected by GBS since the age of 2 who presented at our clinic complaining for a chronic plantar hindfoot–infected ulceration. Serology showed increase of inflammatory markers and leukocytosis, and magnetic resonance imaging revealed osteomyelitis of calcaneum and soft tissue alterations with air bubbles. The patient was treated in our clinic by an integrated multidisciplinary approach consisting of immediate admission, soft tissue and bone debridement, and administration of antibiotics under the close control of infectious disease specialist. After the control of acute condition, the patient underwent negative pressure therapy associated with instillation of antiseptic solution until the restoration of bone and soft tissue loss of substance and, eventually, to the application of bioactive glass substitute until the achievement of complete wound healing. [ABSTRACT FROM AUTHOR]

This pilot study examined the effect of recombinant type I human collagen on post- surgical diabetic foot lesion healing by secondary intention. Twenty-four patients (17 male, 7 female; mean age 66.2±2.4 years; duration of diabetes 9.7±4.2 years, HbA1c 7.3±1.5%) were randomised to receive type 1 recombinant human collagen plus standard treatment (n=12) or standard treatment (n=12). They were evaluated weekly for 6 months or until complete healing had occurred. Rate and time of healing, recurrence and adverse reactions/hypersensitivity to treatment were recorded. The group that received type 1 recombinant human collagen had a significantly higher healing rate (83.3% versus 58.3%, P<0.01) and shorter healing time (64±4 days versus 90±11 days, P<0.02) than the group receiving standard treatment. There were no between-group differences in adverse events, recurrence or re-interventions during follow-up. The addition of type I recombinant human collagen to standard treatment increased healing rate and shortened healing time in patients with post-surgical diabetic foot wounds. [ABSTRACT FROM AUTHOR]

Aim: To test if mechanical keratolysis (MK) is able to restore skin elasticity in high-risk DF patients. Method: A cohort of consecutive DFP attending the preventative outpatient clinic of the diabetic foot (DF) section of our hospital was prospectively evaluated for the presence of localised hyperkeratosis (HK), deformities (D) and skin temperature (ST), and underwent keratolysis mechanically removing keratosis with a #10 scalpel in the hand of expert podologists (LAN, EL, NR). Skin hardness was blindly measured before and after the procedures by means of a durometer by another podologist (LA) at I and V metatarsal-phalangeal Joints (I-MTP, V-MTP) and at the heel. Rsults: 102 DFP [age 74.1±10.5 yrs; DM duration 19.4±8.7 yrs; HbA1c 7.8±1.9%: 52% males; 61 with (Group1) and 41 without (Group2) HK] were studied. Group1 showed a higher prevalence of D (95.1% vs 78.6%, p=0.014) and higher ST (33.4±1.9°C vs 32.6±1.8°C, p=0.03) compared to Group2. SH at I-MPJ (39.2±20.4 UI vs 27.2±15.9 UI p=0.002) V-MPJ (37.2±19.3 UI vs 28.8±17.5 UI p=0.027), were significantly greater in Group1 compared to Group2, while no differences were found at heel. MK reduced significantly SH both at I-MPJ (ΔSH 5.0±7.0 UI, p=0.0024), V-MPJ (ΔSH 3.4±5.6 UI, p=0.0008) and at heel (ΔSH 1.3±3.2UI, p=0.03), annulling the differences in SH with Group2. Conclusion: HK is a frequent feature in high-risk DFP and is associated with D and increased ST; MK performed by expert podologists is able to restore skin elasticity in DFP at high ulcerative risk. [ABSTRACT FROM AUTHOR]

Aim: Lean Thinking is a certified technique for the quality implementation in complex systems like factories, distribution chain supply etc. Aim of our study was to check if the application of the lean management approach to our DF clinic would produce positive effects in the quality of the work of the podologists. Method: A thorough analyisis of working processes was carried out in our DF clinic for six consecutive months and three critical aspects were identified: 1. The supplying of materials and the organization of storage, 2. The pathways for the patients accessing the clinic for being visited or leaving it after the visit and 3. The distant location of the waiting room. The interventions consisted in 1. the implementation of a web-based operative program for the supply of materials and the re-organization of the storage, 2. the creation of separate pathways for patients in and out the clinic and 3. The relocation of the waiting room. we measured before and after the changes for one month respectively: 1. rates of missing materials (RMM), 2. time for patients' changing in the visit rooms (TPC) and 3. rate of occupation of the waiting room (ROW). Results / Discussion: RMM significantly decreased after the intervention (3.2±1.1% vs 12.4±3.7%, p<0.01); TPC reduced as well (5.2±2.3 min vs 10.8±4.1 min p<0.05), while ROW did not show significant modifications although it improved (72.4±16.8% vs 60.1±22.3% ns). Conclusion: Lean management is effective in improving the quality of podological work in a DF clinic. [ABSTRACT FROM AUTHOR]

Aim: To compare diabetic foot patients (DFP) at high ulcerative risk in primary and secondary prevention from a podological point of view. Method: A cohort of consecutive DFP attending the preventative outpatient clinic of the diabetic foot (DF) section of our hospital in primary (Group1) or secondary (Group2) prevention were prospectively blindly evaluated for the following parameters: condition of autonomy (A), hygiene (H), compliance (C), shoes (S) and nails (N); presence of new lesions )=(NL), hyperkeratosis (HK), fissurations (F), deformities (D); ABPI, skin hardness (SH) measured with a durometer at metatarsal-phalangeal joint (I-MPJ and V-MPJ) and heel, skin temperature (T) at the dorsum of the foot. Results / Discussion: 102 DFP (64 Group1/38 Group2; age 74.1±10.5 yrs; DM duration 19.4±8.7 yrs; HbA1c 7.8±1.9%: 52% males) were studied. No significant difference emerged between the two groups for levels of A, H and C; S and N were superimposable as the number of NL (3 Group 1 vs 7 in Group 2), HK (57.8% vs 63.2%), F (3.1% vs 2,6%) and D (85.9% vs 84.2%). ABPI (1.22±0.28 in Group 1 vs 1.33±0.51 in Group 2) showed no differences as well as T (33.3±1.7 °C vs 32.7 ±1.9°C), while SH at I-MPJ (30.1±17.2 UI vs 41.5 ±21.3 UI p=0.003) V-MPJ (29.2±18.4 UI vs 38.2±20.9 UI p=0.025), and at heel (30.1±15.5 UI vs 37.4±14.3 p=0.018) were all significantly greater in Group 2 compared to Group 1. Conclusion: SH is able discriminated between new and recurrent DFP at high ulcerative risk. [ABSTRACT FROM AUTHOR]