Podiatry
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Item Development of a prognostic model for stump healing in major lower limb amputation among the diabetic population(MDPI, 2021-07-12) Ashraff, Suhel; Siddiqui, Muhammad; Carline, Tom; Rush, Robert; Santos, Derek; Raza, ZahidBackground: This study aimed to explore the effect of haematological markers as well as patient characteristics on stump healing in patients who underwent a lower limb amputation procedure. In addition, a practical model regarding factors that affected stump healing was developed. Methods: Patients who underwent a major lower limb amputation (above knee and below knee) at the Royal Infirmary of Edinburgh from the period of 2007 to 2010 were included in this study. A prognostic model utilizing backward stepwise logistical regression was developed to measure the probability of lower limb stump healing. The relationship between the dependent and independent variables was identified using univariate and multivariate logistic regression. Results: Three variables, namely serum sodium, serum creatinine and serum high density lipid cholesterol were identified which influenced stump healing. Patients with normal serum sodium were 75% more likely to have lower limb stump healing compared to that of patients with abnormal serum sodium (odds ratio [OR] 1.756; 95% confidence interval [CI] 1.048–2.942). Patients with normal serum creatinine were 66% more likely to have their stump healed (OR 1.664; 95% CI 0.94 to 2.946). The healing rate of patients with a normal level of serum high density lipid cholesterol was 75%, in contrast to patients with an aberrant level of serum high density lipids cholesterol (OR 1.753; 95% CI 1.061 to 2.895). The effectiveness of the retrospective stump-healing model was demonstrated by the area under the ROC curve (0.612), which was supported by the Hosmer and Lemeshow goodness-of-fit test (p = 0.879). Conclusions: Serum sodium, serum high density lipid cholesterol and serum creatinine have a strong correlation with lower limb stump healing. However, serum sodium and serum high density lipid cholesterol secondary to multiple co-morbidities in this cohort group could be altered secondary to disease pathology itself.Item Prediction of stump healing in lower limb amputation: A narrative review(Mark Allen Group, 2019-12-11) Ashraff, Suhel; Siddiqui, Muhammad A.; Santos, Derek; Carline, TomBoth types of diabetes, as well as different forms of acquired diabetes, are associated with diabetic peripheral neuropathy. Diabetic foot ulcers (DFU) is the condition most commonly related to somatic peripheral neuropathy, often leading to gangrene and limb amputation. Independent from large-vessel disease, sensory loss may result in DFU development and even amputation. The crucial part of any lower limb amputation is the stump healing process, which represents the central goal of postoperative management. Despite the importance attributed to this process, a standard set of guidelines regarding efficient healing methods is yet to be formulated. Health professionals are faced with the challenge of assessing the different risk factors and deciding which has a greater influence on the stump healing rate. There is currently an insufficient number of studies regarding factors effecting lower limb amputation. The main purpose of this review is to discuss the markers that can be helpful in the prediction of stump healing in patients who have undergone lower limb amputation.Item Predictive parameters of arteriovenous fistula maturation in patients with end-stage renal disease(Korean Society of Nephrology, 2018-09-30) Siddiqui, Muhammad A.; Ashraff, Suhel; Santos, Derek; Rush, Robert; Carline, Tom; Raza, ZahidBackground:The objevctive of the present study was to explore the potential influence of blood markers and patient factors such as risk factors, kidney function profile, coagulation profile, lipid profile, body mass index, blood pressure, and vein diameter on the maturation of arteriovenous fistula (AVF) in patients with end-stage renal disease. Methods:Retrospective data from 300 patients who had undergone AVF creation at the Royal Infirmary of Edinburgh were examined. A predictive logistic regression model was developed using a backward stepwise procedure. Model performance, discrimination, and calibration were assessed using the receiver operating characteristic (ROC) curve and Hosmer-Lemeshow goodness-of-fit test. The final model was externally validated by 100 prospective patients who received a new fistula at the Royal Infirmary of Edinburgh. Results:A total of 400 (300 retrospective and 100 prospective) patients were recruited for this study, with a mean age of 60.14 ± 15.9 years (development set) and 58 ± 15 years (validation set), respectively (P = 0.208). Study results showed that males were twice as likely to undergo fistula maturation as females, while patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula and a preoperative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation as compared with a vein size of less than 2.5 mm. The model for fistula maturation had fair discrimination, as indicated by the area under the ROC curve (0.68), but good calibration as indicated by the Hosmer-Lemeshow test (P = 0.79). The area under the receiver operating curve for the validation model in the validation set was 0.59. Similarly, in the validation set, the Hosmer-Lemeshow statistic indicated an agreement between the observed and predicted probabilities of maturation (P > 0.05). Conclusion:Gender, PVD, and vein size are independent predictors of AVF maturation. The clinical utility of these risk categories in the maturation of AVF requires further evaluation in longer follow-up.Item Complications of Stump Healing Among Diabetic Population(Society of Endocrinology and Metabolism of Turkey, 2018-06-19) Ashraff, Suhel; Siddiqui, Muhammad A.; Santos, Derek; Carline, TomLower limb amputation is a major procedure performed in diabetic patients with multiple comorbidities. Almost 10% of the National Health Service budget is taken up by diabetes, with diabetes-related complications accounting for 80% of the costs. The process of wound healing is complex and involves regenerating the cellular organization and the tissue layers. Diabetics are five times more predisposed to wound infection than patients without diabetes mellitus. The amputated stump frequently becomes infected due to inadequate blood circulation, a weak immune system, and poorly controlled diabetes mellitus. Pain, stump edema, and osteomyelitis are significant complications associated with lower limb amputation wounds. A number of factors may substantiate the need for re-amputation, such as stump pain and/or phantom limb pain, delayed stump infection, the formation of symptomatic bone spurs, assessment of the skin flap designed to preserve stump length, and preparation of the stump for the prosthetic device. There are currently no reliable standards that can be referred to prior to leg amputation. The clinicians, therefore, have to rely on their judgment and investigatory parameters. The main purpose of this review is to discuss the difficulties of stump healing in the diabetic population.Item Obesity and insulin resistance: Management in diabetes(2013-09) Ashraff, Suhel; Siddiqui, Muhammad A.; Carline, TomObesity today, is a major public health problem across the world. The rapid increase in the incidence of obesity and associated co-morbidities presents a major challenge to health care globally. Insulin resistance is commonly associated with obesity and other life style diseases. However, much uncertainty remains about the mechanism regarding the association between insulin resistance and human disease mainly because of the difficulties of defining insulin resistance in clinical terms and of quantifying insulin action in humans. This review looks at the available literature concerning the link between obesity and insulin resistance and discusses the various approaches of their management.Item Development of prognostic model for fistula maturation in patients with advanced renal failure(BioMed Central, 2018-03-07) Siddiqui, Muhammad A.; Ashraff, Suhel; Santos, Derek; Rush, Robert; Carline, Tom; Raza, ZahidBackground: This study aimed to explore the role of patient's characteristic and haematological factors as predictive on the maturation of arteriovenous fistulae in patients who underwent vascular access surgery at the Royal Infirmary of Edinburgh. Methods: Retrospective data from 300 patients who had undergone fistula creation between February 2007 and October 2010 was examined. A predictive logistic regression model was developed using the backward stepwise procedure. Model performance, discrimination and calibration, was assessed using the receiver operating characteristics (ROC) curve and Hosmer and Lemeshow goodness of fit test. Results: Three variables were identified which independently influenced fistula maturation. Males were twice as likely to undergo fistula maturation, compared to that of females (odds ratio (OR) 0.514; 95% confidence interval (CI) 0.308-0.857), patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula (OR 3.140; 95% CI 1.596-6.177) and a pre-operative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation compared to a vein size less than 2.5 mm (OR 4.532; 95% CI 2.063-9.958). The model for fistula maturation had fair discrimination as indicated by the area under the ROC curve (0.68; 95% CI 0.615-0. 738) but good calibration indicated by Hosmer and Lemeshow test (p = 0.79). Conclusion: Gender, PVD and vein size are independent predictors of arteriovenous fistula maturation. The clinical utility of these risk equation in the maturation of arteriovenous fistulae requires further validation in the newly treated patients.Item An overview of AVF maturation and endothelial dysfunction in an advanced renal failure(BioMed Central, 2017-10-02) Siddiqui, Muhammad A.; Ashraff, Suhel; Santos, Derek; Carline, TomItem Effect of Exercise and Muscle Contraction on Insulin Action, Transportation and Sensitivity and Muscle Fibres in type II Diabetes Mellitus(Scientific & Academic Publishing, 2012-11) Rehman, A. U.; Siddiqui, Muhammad A.; Ashraff, SuhelThis review will critically evaluate the role of exercise in increasing the insulin action, transportation and sensitivity in skeletal muscles. The review will also, try to explore the relationship between the insulin stimulation and glucose transporter type 4 (GLUT-4) protein after the exercise The secondary purpose of this review is to explore whether the exercise induced sensitivity of glucose transport activation is mediated by translocation of greater number of GLUT-4 to the cell surface, and the role of different types of exercise in increasing insulin sensitivity. The review concluded that the stimulation of insulin and exercise is relevant to the physiological developed process of GLUT-4, isoform gene expression is precise and associated with the exercise only. While performing the endurance exercise as well as resistance training we can maintain the muscle bulk and prevent the atrophy in DM. Furthermore, it was proved that the resistance training puts direct effects on the muscles glycogen uptake intracellular and extra cellular signalling pathway and GLUT4, when the subject fed the rich diet of carbohydrate and participates in the exercise. These effects also found in the non-diabetes and healthy subjects.Item Maturation of arteriovenous fistula: Analysis of key factors(The Korean Society of Nephrology, 2017-12-31) Siddiqui, Muhammad A.; Ashraff, Suhel; Carline, TomThe growing proportion of individuals suffering from chronic kidney disease has considerable repercussions for both kidney specialists and primary care. Progressive and permanent renal failure is most frequently treated with hemodialysis. The efficiency of hemodialysis treatment relies on the functional status of vascular access. Determining the type of vascular access has prime significance for maximizing successful maturation of a fistula and avoiding surgical revision. Despite the frequency of arteriovenous fistula procedures, there are no consistent criteria applied before creation of arteriovenous fistulae. Increased prevalence and use of arteriovenous fistulae would result if there were reliable criteria to assess which arteriovenous fistulae are more likely to reach maturity without additional procedures. Published studies assessing the predictive markers of fistula maturation vary to a great extent with regard to definitions, design, study size, patient sample, and clinical factors. As a result, surgeons and specialists must decide which possible risk factors are most likely to occur, as well as which parameters to employ when evaluating the success rate of fistula development in patients awaiting the creation of permanent access. The purpose of this literature review is to discuss the role of patient factors and blood markers in the development of arteriovenous fistulae.Item The psychosocial impact of diabetes in adolescents: A review(2013-05) Ashraff, Suhel; Siddiqui, Muhammad A.; Carline, TomType 1 Diabetes mellitus is known to have a major psychological impact on adolescents. Different types of therapies have been developed to support the patient as well as their families to deal with this impact. These include Behavioral Family Systems Therapy and Cognitive Behavioral Therapy. However, studies conducted recently, though few in numbers have shown a direct relationship between general psychological functioning and metabolic control. Self-management of diabetes and its complication therefore, is an integral part of these program. This review looks into the various studies carried out that decide the best approach towards addressing the psychological aspect of type 1 Diabetes Mellitus. OMSB, 2013.