Aspirin in diabetic patients at primary prevention: insights of the VITAL cohort

D.Caldeira1,2,3· M. Alves3,4,5 · J. J. Ferreira3,4 · F. J. Pinto1,2

Received: 5 October 2022 / Accepted: 29 December 2022 / Published online: 18 January 2023 © The Author(s) 2023

D. Caldeira

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1 Centro Cardiovascular da Universidade de Lisboa–CCUL (CCUL@RISE), Faculdade de Medicina, CEMBE, CAML, Universidade de Lisboa, Lisbon, Portugal

2 Serviço de Cardiologia, Hospital Universitário de Santa Maria–CHULN, Lisbon, Portugal

3 Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

4 Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal

5 Serviço de Medicina III, Hospital Pulido Valente, CHLN, Lisbon, Portugal

Abstract

Purpose Aspirin use among patients with diabetes in primary prevention is still a matter of debate. We aimed to evaluate the potential cardiovascular risk benefit of aspirin in primary prevention, using data from a contemporary cohort.

Methods Retrospective analysis of the VITAL cohort with>20,000 individuals at primary prevention who were followed for a median of 5.3 years. The population was evaluated according to the baseline diabetes status, and then aspirin use was evaluated among diabetic patients. Cox regression models were used to estimate the risks of mortality and cardiovascular outcomes. The estimates were reported using adjusted hazard ratio (HR) and 95% confidence intervals (95%CI).

Results Diabetic patients (n=3549; 13.7%) showed to increase the risk of all-cause mortality (HR 1.61, 95%CI 1.33–1.94), and major adverse cardiovascular events (MACE) (HR 1.36 95%CI 1.11–1.68) than non-diabetic population. Diabetic patients taking aspirin were older, more frequently man, hypertensive, current users of statins, and current smokers compared with diabetic patients who did not use aspirin at baseline. There was no difference between diabetic aspirin users and non-users regarding all-cause mortality (HR 0.80, 95%CI 0.59, 1.10), MACE (HR 0.92, 95%CI 0.64, 1.33), coronary heart disease (HR 0.98, 95%CI 0.67, 1.43), or stroke (HR 0.87, 95%CI 0.48, 1.58).

Conclusions The VITAL data confirmed diabetes as an important risk factor for cardiovascular events in a contemporary cohort but did not show cardiovascular benefits of aspirin in primary prevention among people with diabetes who were shown to be at higher risk of cardiovascular events.

Keywords Cardiovascular disease · Primary prevention · Aspirin · Diabetes

Guidelines on interventions to enhance healing of foot ulcers in people with diabetes IWGDF 2023 update

AUTHORS

Pam Chen1,2, Nalini Campillo Vilorio3 , Ketan Dhatariya4, 5, William Jeffcoate6 , Ralf Lobmann7 , Caroline McIntosh8 , Alberto Piaggesi9 , John Steinberg10, Prash Vas11, Vijay Viswanathan12, Stephanie Wu13, Fran Game14, on behalf of the International Working Group on the Diabetic Foot

INSTITUTIONS

1 Joondalup Health Campus, Ramsay Healthcare Australia, Joondalup, Western Australia, Australia

2 Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia

3 Department of Diabetology, Diabetic Foot Unit, Plaza de la Salud General Hospital, Santo Domingo, Dominican Republic

4 Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

5 Norwich Medical School, University of East Anglia, Norwich, UK

6 Retired physician, Nottingham, UK

7 Clinic for Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Stuttgart, Germany

8 Podiatric Medicine, School of Health Sciences, University of Galway, Ireland

9 Diabetic Foot Section, Department of Medicine, University of Pisa, Italy

10 Georgetown University School of Medicine, Washington DC, USA

11 King’s College Hospital NHS Foundation Trust, London, UK

12 MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Center, Chennai, India

13 Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA

14 University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK

Guidelines on the prevention of foot ulcers in persons with diabetes IWGDF 2023 update

AUTHORS

Sicco A. Bus1,2, Isabel C.N Sacco3 , Matilde Monteiro-Soares4,5,6, Anita Raspovic7 , Joanne Paton8 , Anne Rasmussen9 , Larry A. Lavery10, Jaap J. van Netten1,2, on behalf of the International Working Group on the Diabetic Foot

INSTITUTIONS

1 Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam, the Netherlands

2 Amsterdam Movement Sciences, program Rehabilitation & Development, Amsterdam, the Netherlands

3 Physical Therapy, Speech and Occupational Therapy department, School of Medicine, University of São Paulo, São Paulo, Brazil

4 Higher School of Health of the Portuguese Red Cross, Lisbon, Portugal

5 Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal

6 RISE@ CINTESIS, Faculty of Medicine, Oporto University, Porto, Portugal

7 Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia

8 School of Health Professions, University of Plymouth, Plymouth, UK

9 Steno Diabetes Center Copenhagen, Herlev, Denmark

10 Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA

Guidelines on the diagnosis and treatment of foot infection in persons with diabetes IWGDF/IDSA 2023

AUTHORS

Éric Senneville1 , Zaina Albalawi2 , Suzanne A.

van Asten3 , Zulfiqarali G. Abbas4 , Geneve Allison5 ,

Javier Aragón-Sánchez6 , John M. Embil7 , Lawrence

A. Lavery8 , Majdi Alhasan9 , Orhan Oz10, Ilker

Uçkay11, Vilma Urbančič-Rovan12, Zhang-Rong Xu13,

Edgar J.G. Peters14, on behalf of the International

Working Group on the Diabetic Foot

INSTITUTIONS

1 Department of Infectious Diseases, Gustave Dron Hospital, Tourcoing, France

2 Department of Medicine, Division of Endocrinology, Memorial University, Canada

3 Leiden University Medical Centre, Leiden, the Netherlands

4 Abbas Medical Centre, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

5 Tufts Medical Center, Department of Medicine, Boston, Massachusetts, USA

6 La Paloma Hospital, Las Palmas de Gran Canaria, Spain

7 Alberta Public Laboratories, University of Alberta Hospital, Edmonton, Alberta, Canada

8 Department of Plastic Surgery, Southwestern Medical Center, Dallas, Texas, USA

9 Department of Medicine, Prisma Health-Midlands, Columbia, South Carolina, USA

10 UT Southwestern Medical Center, Dallas, Texas, USA

11 Balgrist University Hospital, Zurich, Switzerland

12 Faculty of Medicine, University Medical Centre, University of Ljubljana, Ljubljana, Slovenia

13 Diabetes Centre, The 306th Hospital of PLA, Beijing, China

14 Department of Internal Medicine, Infection and Immunity Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands

Wound drainage measurements: a narrative review

Terri Shih1  · Sarah Park1  · Linnea R. Thorlacius2,3 · Steven Daveluy4  · Amit Garg5  · Susanne D. Goegji6  · Joslyn S. Kirby7  · Barry M. McGrath8  · Peter T. Riis2  · Bente Villumsen9  · Kari Zalik10 · Gregor B. E. Jemec2,11 · Jennifer L. Hsiao12

Received: 16 July 2022 / Revised: 7 December 2022 / Accepted: 6 January 2023 © The Author(s) 2023

Abstract

Drainage from chronic wounds can significantly negatively impact a patient’s quality of life. Change in severity of wound drainage is an important measure of treatment efficacy for wounds. This study reviews existing tools used to assess wound drainage. Qualitative drainage tools are overall less burdensome, and however, differences in user interpretation may reduce inter-rater reliability. Quantitative drainage tools enable more reliable comparisons of drainage severity and treatment response between patients but sometimes require equipment to administer, increasing responder burden. Gaps in the current wound drainage measurement landscape are highlighted. Many of the existing scales have not been validated in robust studies. There is also a lack of validated global drainage measurement tools for patients with chronic inflammatory skin disorders with drainage, such as hidradenitis suppurativa or pyoderma gangrenosum. Development of a succinct drainage measurement tool for inflammatory skin diseases where drainage is a prominent symptom will improve monitoring of meaningful treatment response.

Keywords Hidradenitis suppurativa · Wound · Drainage · Measure · Tool

Jennifer L. Hsiao

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1 David Gefen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

2 Department of Dermatology, Zealand University Hospital, Roskilde, Denmark

3 Department of Dermato-Venereology & Wound Healing Centre, Bispebjerg Hospital, Copenhagen, Denmark

4 Department of Dermatology, Wayne State University, Detroit, MI, USA

5 Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA

6 Amsterdam, The Netherlands

7 Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA

8 HS Ireland, County Clare, Ireland

9 Danish HS Patients’ Association, Copenhagen, Denmark

10 Toronto, Canada

11 Health Sciences Faculty, University of Copenhagen, Copenhagen, Denmark

12 Department of Dermatology, University of Southern California, 1441 Eastlake Ave, Ezralow Tower, Suite 5301, Los Angeles, CA 90033-9174, USA

The Role of Conservative Management in the Avascular Necrosis of the Femoral Head: A Review of Systematic Reviews

M. L. V. Sai Krishna1 iD· Santanu Kar1  iD · Raj Kumar1   · Hargovind Singh1  · Ravi Mittal1  iD· Vijay Kumar Digge1 iD

Received: 29 July 2022 / Accepted: 6 January 2023 / Published online: 3 February 2023

© Indian Orthopaedics Association 2023

Abstract

Introduction/Background Multiple medical and surgical treatments have been described in the early stages of Avascular Necrosis (AVN) of the femoral head which delay the disease progression. Similarly, multiple studies, trials, reviews, and systematic reviews exist for the various treatments described and their outcomes but with no consensus over which is superior. So in this study, we reviewed the systematic reviews of all the conservative therapies for AVN of the femoral head systematically to identify a single or a combination of non-surgical treatment choices in the initial stages of the disease.

Methodology A thorough literature search has been carried out in January 2022 through the use of Pubmed, EMBASE, and Cochrane electronic databases using PRISMA guidelines. The Mesh words and Keywords used were “femoral head AVN”, “Conservative management”, and “Systematic Reviews”. The inclusion criteria used during the screening were, any systematic reviews which included patients with AVN either idiopathic or secondary, who are managed with conservative therapies like bisphosphonates, Hyper Baric Oxygen Therapy (HBOT), Shock wave therapies like Extracorporeal Shock Wave Therapy (ESWT), or electrical therapy like Pulsed Electro Magnetic Field (PEMF). The quality of the included systematic reviews was assessed using AMSTAR-2 criteria.

Results The initial search yielded 364 studies which on screening based on our inclusion criteria finally resulted in seven systematic reviews to be included in the present study. There were two systematic reviews for Hyper Baric Oxygen Therapy (HBOT), two for Extracorporeal Shock Wave Therapy (ESWT), one for electrical stimulation modalities like Pulsed Electro Magnetic Field (PEMF), and two for bisphosphonates. The follow-up of the patients in the included systematic reviews varied from 6 weeks to 10 years. The total number of patients varied from 77 to over 1000 across the systematic reviews. Almost all of the studies included a control group that either received the intended treatment with adjuncts or did not receive any treatment at all. Because of the heterogeneous nature of included articles in the systematic reviews, meta-analysis was performed in only three of the included systematic reviews.

Conclusion Of all the modalities of treatment described, bisphosphonates are easily available and cost-effective and do not require any hospital resources/machinery for delivering the treatment. So they can be used as an initial line of treatment for patients with early stages of AVN (Ficat and Arlet 1–3) and based on the hospital availability of resources could be supplemented with any of the biophysical modalities (ESWT/PEMF/HBOT) for maximum efficacy to delay the disease progression.

Level of Clinical Evidence Systematic review.

Keywords Femoral head AVN · Conservative management · Bisphosphonates · ESWT · PEMF · HBOT · Systematic review

Vijay Kumar Digge 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

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1 Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Room No 3096, 3rd Floor, Teaching Block, New Delhi, India