Conectar
Faecal contamination of sacral pressure ulcers occurs frequently, so, theoretically, faecal diversion using colostomies is a useful procedure. We retrospectively analysed the data of adult patients for whom colostomies were created to enhance wound healing and compared patients with sacral pressure ulcers who received colostomies and those who did not during the same period. Patients' characteristics analysed included age, gender, comorbidities, WBC count, serum CRP level and microbial profile (before creating colostomy). Additionally, we examined whether the wound was closed, the recurrence rate after wound closure, and mortality outcomes. Regression analysis indicated that colostomy creation was associated with fewer species of gut microbiota cultured and lower rates of wound dehiscence after closure; no association was found between colostomy and mortality. Colostomies help promote wound healing of sacral pressure ulcers after closure by eradicating wound infection, and do not increase patients' mortality rates.
Sepsis is a major cause of death both globally and in the United States. Early identification and treatment of sepsis are crucial for improving patient outcomes. International guidelines recommend hospital sepsis screening programmes, which are commonly implemented in the electronic health record (EHR) as an interruptive sepsis screening alert based on systemic inflammatory response syndrome (SIRS) criteria. Despite widespread use, it is unknown whether these sepsis screening and alert tools improve the delivery of high-quality sepsis care.
The Sepsis Electronic Prompting for Timely Intervention and Care (SEPTIC) master protocol will study two distinct populations in separate trials: emergency department (ED) patients (SEPTIC-ED) and inpatients (SEPTIC-IP). The SEPTIC trials are pragmatic, multicentre, blinded, randomised controlled trials, with equal allocation to compare four SIRS-based sepsis screening alert groups: no alerts (control), nurse alerts only, prescribing clinician alerts only, or nurse and prescribing clinician alerts. Randomisation will be at the patient level. SEPTIC will be performed at eight acute-care hospitals in the greater New York City area and enrol patients at least 18 years old. The primary outcome is the percentage of patients with completion of a modified Surviving Sepsis Campaign (SSC) hour-1 bundle within 3 hours of the first SIRS alert. Secondary outcomes include time from first alert to completion of a modified SSC hour-1 bundle, time from first alert to individual bundle component order and completion, intensive care unit (ICU) transfer, hospital discharge disposition, inpatient mortality at 90 days, positive blood cultures (bacteraemia), adverse antibiotic events, sepsis diagnoses and septic shock diagnoses.
Ethics approval was obtained from the Columbia University Institutional Review Board (IRB) serving as a single IRB. Results will be disseminated in peer-reviewed journal(s), scientific meeting(s) and via social media.
ClinicalTrials.gov: NCT06117605 and
Chronic inflammatory skin diseases, despite low mortality, significantly impair quality of life (QoL). Up to 80% of patients with dermatological conditions experience severe itch and poor sleep, as well as related mental health challenges such as anxiety and depression. The relationship between skin diseases and mental health highlights the challenges that doctors face in treating these conditions. Existing psychotherapeutics, such as mindfulness training, cognitive behavioural therapy and acceptance and commitment therapy, are widely used and effective in the treatment of mental health illnesses. However, there is limited evidence on the application of such interventions in dermatology, and most mental health apps lack robust clinical evaluation. We report the design of a randomised controlled trial to evaluate the efficacy and implementation of a mobile app containing dermatology-specified psychotherapeutic strategies in reducing QoL burden.
English-speaking patients aged 16 years and older with psoriasis, eczema or chronic urticaria will be recruited and randomised into the intervention arm (psychotherapeutic application) or active control group (Healthy365 app, a general wellness application managed by the Singapore Health Promotion Board). This allows a comparative assessment of app-usage-specific outcomes while preserving the blinding of all participants. The primary outcome is the change in the Dermatology Life Quality Index (DLQI) score from baseline to week 8. Secondary outcomes include physician-assessed disease severity at weeks 8 and 16 relative to baseline, differences in other patient-reported measures at weeks 8, 16 and 32, self-reported treatment adherence and initiation/escalation of systemic medications. To understand how patients engage with the app, we will evaluate the implementation process, focusing on key measures such as engagement, satisfaction and willingness to pay. Statistical analysis will be carried out on an intention-to-treat basis, and missing data will be analysed using last observation carried forward.
All participants will receive both verbal and written study information that aligns with Good Clinical Practice guidelines. Ethical approval has been obtained from the National Healthcare Group’s Domain Specific Review Board (reference number: 2022/00751). Results will be disseminated via publication in a relevant journal. Data will be available from the corresponding author on reasonable request.
Persons living with HIV (PLWH) have an augmented risk of cardiovascular disease, including atherosclerosis and myocardial dysfunction, despite effective viral suppression with antiretroviral therapy. Despite the majority of PLWH residing in sub-Saharan Africa, there are limited reports from the region on structural cardiovascular changes due to this residual risk.
The Early Structural Cardiovascular Disease, HIV, and Tuberculosis in East Africa (ASANTE) cross-sectional study will be conducted in a public hospital in Nairobi, Kenya. It will enrol 400 participants (50% women, 50% PLWH) to undergo cardiovascular phenotyping using multimodal imaging (coronary CT angiography (CCTA) and echocardiography) and banking of biological samples (whole blood, peripheral blood mononuclear cells, plasma and urine). We will define the prevalence of subclinical coronary atherosclerosis by CCTA and subclinical myocardial dysfunction by transthoracic echocardiography and evaluate both traditional and non-traditional risk factors, including endemic infections such as latent tuberculosis. This study will contribute important data on phenotypes of and risk factors for HIV-associated cardiovascular disease in this understudied region.
Ethical approval for the ASANTE study was granted by the University of Nairobi-Kenyatta National Hospital Ethical Review Committee, Nairobi, Kenya, and the University of Washington Institutional Review Board, USA. Results will be submitted for publication in peer-reviewed journals.
by Shanhe Liu, Shuailin Li, Shao-Lun Hsu, Fabian N. Fries, Zhen Li, Swarnali Kundu, Berthold Seitz, Maryam Amini, Shweta Suiwal, Julia Zimmermann, Simon Trusen, Tanja Stachon, Nóra Szentmáry
PurposeThe aim of this study was to investigate apoptosis in primary aniridia limbal stromal cells (LSCs) and to assess changes in the expression of genes and proteins associated with the apoptotic pathway in response to cobalt chloride (CoCl2)-induced hypoxic stress, in vitro.
MethodsPrimary human limbal stromal cells were isolated from the limbal region of both aniridia (AN-LSCs; n = 8) and healthy (LSCs; n = 8) donors. The cells were treated with 0 µM, 50 µM, and 75 µM CoCl2 for 48 hours. Apoptosis in each group was assessed by Flow cytometry (FC). The expression levels of apoptosis-related genes, including CASP 3/7/8/9/10, BCL2, BID, BAX, CDKN1A (p21), CDKN1B (p27), TNFα, XIAP, and BIRC5 (Survivin), were measured by qPCR. Protein level of these markers was analyzed by FC. TNFα protein expression in the supernatant was quantified using ELISA.
ResultsFlow cytometry analysis revealed a significantly higher apoptosis rate in AN-LSCs compared to LSCs (p BCL2 mRNA levels (p = 0.0291), Caspase-8 (p = 0.0341), Caspase-10 (p = 0.0085), Bcl-2 (p = 0.0014), XIAP (p = 0.0003) and Survivin (p = 0.0074) protein levels were significantly higher in LSCs than in AN-LSCs. Conversely, Caspase-3 (p = 0.0366), Caspase-9 (p = 0.0354), p21 (p = 0.0003), and p27 (p = 0.0164) protein levels were significantly higher in AN-LSCs than in LSCs. In LSCs, exposure to 75 µM CoCl₂ led to a reduction in BCL2 mRNA (p = 0.0102) and protein levels (p = 0.0484), accompanied by an increase in CDKN1B mRNA level (p = 0.0265). In AN-LSCs, 75 µM CoCl₂ treatment resulted in a decrease in CASP3 (p = 0.049), CASP7 (p = 0.041) and BCL2 (p = 0.0218) mRNA and Bcl-2 protein levels (p = 0.0405) and an increase of TNF-α protein levels in the cell culture supernatant (p = 0.0251).
ConclusionsThe apoptosis rate of LSCs from patients with congenital aniridia is higher than that of the control group, accompanied by alterations in multiple apoptosis-related markers. Additionally, CoCl₂-induced hypoxic stress further increases apoptosis in AN-LSCs and leads to changes in the expression of Caspase 3, Caspase 7, Bcl-2, and CDKN1B (p27). Further research is needed to elucidate the potential therapeutic targets in AAK, with the aim of preventing or slowing the progression of aniridia-associated keratopathy.
Stroke is a leading cause of death and disability worldwide. Stroke survivors and their caregivers often face profound social isolation and various participation restrictions, resulting in frustration and adverse health outcomes. Dyad-focused interventions, which address both survivor and caregiver needs, are essential during the transition process. However, few interventions equally prioritise the outcomes of both survivors and caregivers. This study aims to evaluate the efficacy of a newly developed dyad-focused strategy training intervention in enhancing participation among stroke survivors and their caregivers.
This study employs a single-blind, parallel-group randomised controlled trial with allocation concealment and assessor blinding. We aim to enrol 138 stroke survivor-caregiver dyads, randomly assigned in a 1:1 ratio to either the experimental intervention group or the control group. Both groups will receive their usual rehabilitation plus 45–60 min sessions of the intervention twice weekly for a total of 12 sessions. Outcome measures, including the Participation Measure-3 Domains, 4 Dimensions, General Self-Efficacy Scale and Activity Measure for Post-Acute Care, will be collected at baseline, post-intervention and at 3-month, 6-month and 12-month follow-ups. Data will be analysed using multiple linear regression and mixed-effects regression models. Qualitative indepth interviews with participants, caregivers and therapists will be conducted post intervention, transcribed and thematically analysed.
Ethics approval was obtained from the Ethics Committee of Taipei Medical University (approval number: N202203083), National Taiwan University Hospital (approval number: 202207096RINA) and Taipei Tzu Chi Hospital (approval number: 11 M-107). Findings will be disseminated through presentations at scientific conferences and publications in peer-reviewed journals.
NCT05571150; Preresults.
To investigate unmet need trajectories among young stroke survivors, identify predictive factors and evaluate the lagged effects of unmet needs on post-stroke health outcomes.
Prospective longitudinal study.
We recruited 122 patients with stroke, assessed at four time points over a 6-month follow-up period. The Unmet Needs Questionnaire assessed unmet needs. Predictive factors included participant characteristics and stroke-related factors. Outcome variables included physical functions, quality of life, depressive symptoms and return-to-work status. Generalised Estimating Equations were employed.
Unmet need trajectories decreased over time. Sex, marital status, stroke history, stroke severity, fatigue and cognitive function were key unmet need predictors. Lagged unmet needs were associated with poorer post-stroke health outcomes.
This study highlights the dynamic nature of unmet needs in young stroke survivors and underscores the importance of addressing these needs to improve post-stroke health outcomes. Targeted interventions are essential to mitigate the negative impact of unmet needs on recovery.
Young stroke survivors continue to experience unmet needs in important areas even 6 months post-stroke. Nurses play a crucial role in addressing these challenges by regularly assessing patient care needs, monitoring their progress and implementing targeted interventions. Integrating routine nursing assessments into post-stroke care can help identify high-risk patients and ensure that individualised support is provided throughout the recovery process.
Strengthening the Reporting of Observational Studies in Epidemiology.
No patient or public contribution.
To synthesise evidence on critical care nurses supporting bereaved families in intensive care units (ICUs).
Noblit and Hare's meta-ethnography approach.
We followed Noblit and Hare's 7-phase procedure, using reciprocal translation for data analysis and line-of-argument synthesis. We included studies on registered nurses in adult ICUs with experience supporting bereaved families, using qualitative or mixed-methods studies in English and published in peer-reviewed sources.
Five databases were searched without date restrictions, concluding in January 2024.
The final sample included 24 studies published between 1995 and 2023. The metaphor “Candlelight guides the way through winter's chill” symbolised the crucial role of critical care nurses in supporting bereaved families in ICUs. The synthesis encapsulated two themes: (1) challenges in providing bereavement support, with subthemes of emotional intricacies in bereavement support, and ICU setting limitations; and (2) optimising families' bereavement experiences, with subthemes support systems and emotional commitment, professional nursing behaviours and care practices, and curating personalised and meaningful farewell experiences.
Bereavement support in ICUs poses significant challenges, highlighting the need for greater support for critical care nurses. Nonetheless, these nurses draw on support systems and emotional dedication to overcome obstacles, striving to optimise families' bereavement experiences.
Our findings highlight the importance of structured training programmes (peer support and emotional management) and systemic improvements (optimised workflows and adequate staffing) to enhance quality bereavement care.
This study interprets critical care nurses' experiences supporting bereaved families in intensive care, highlighting the emotional demands. The findings offer insights into improving end-of-life and bereavement care practices and policies, benefiting nurses and families.
This review followed the ENTREQ guidelines for reporting meta-ethnography.
There was no patient or public contribution, as the data were drawn from previously published studies.
CRD42024506847 [PROSPERO]
COVID-19 survivors may experience complex, distressing and persistent symptoms, referred to as long COVID, lasting months or years after diagnosis. More evidence is needed for effective long COVID screening and management.
To explore the clinical profile of long COVID and factors associated with its development.
A multicentre correlational study using a cross-sectional design.
Adults diagnosed with COVID-19 6–9 months earlier were recruited via social media and referrals from three facilities. Participants provided demographic data and assessed their symptoms and functional status using validated questionnaires. Data were analysed using descriptive statistics and binomial logistic regression.
Among 102 participants, 13%–30% reported significant impairments in cognitive, emotional and physical functioning. Over 10% experienced symptoms such as diarrhoea, sleep problems, dyspnoea, nausea, fatigue and pain. These impairments and symptoms were associated with acute symptom severity, chronic disease, overweight status, regular exercise and living without partners.
This study adds to the literature by examining long-term functional status and symptoms in omicron survivors using comprehensive, validated tools. The findings highlight the prevalence and clinical significance of long COVID symptoms, aiding in the identification of functional impairments requiring medical and nursing interventions.
Nurses should recognise these symptoms and educate survivors about potential challenges. Policies addressing long-term issues, including research, health services and education, are essential.
This study follows the STROBE guideline (Table S1).
Patients self-reported symptoms for this study.
ClinicalTrials.gov (NCT05303103)
This study explored the factors associated with oncology nurses' behaviour and intention to provide cancer care to lesbian, gay, bisexual, and transgender (LGBT) individuals in Taiwan.
A qualitative descriptive study.
Semi-structured interviews were conducted with 25 oncology nurses between August and October 2023. The interview data were analysed using the framework method (the socio-ecological model) and constant comparative techniques.
Factors associated with oncology nurses' behaviour and intentions to provide cancer care for LGBT individuals were categorised and presented by the levels of the social-ecological model: (1) intrapersonal level: oncology nurses' attitudes toward LGBT populations and their experiences, confidence, and beliefs in providing cancer care for LGBT individuals; (2) interpersonal level: concerns or interactions with oncology nurses' colleagues, other heterosexual cancer patients, and managers; (3) community and organisation levels: organisational climate and related training courses; and (4) societal and policy level: policy regarding sexual orientation, gender identity collection, and social atmosphere.
Multilevel barriers associated with oncology nurses' behaviours and intentions to provide cancer care to LGBT individuals were identified. The study findings emphasised the importance of related training courses offered by organisations to reduce cancer care disparities among LGBT individuals. These courses also aim to enhance oncology nurses' confidence and comfort in delivering holistic and patient-centred cancer care for this population.
The study findings can be employed to assist in developing related training courses and understand the challenges oncology nurses face when providing cancer care to LGBT individuals.
No patient or public contributions.
by Vivian Y. Tat, Aleksandra K. Drelich, Pinghan Huang, Kamil Khanipov, Jason C. Hsu, Steven G. Widen, Chien-Te Kent Tseng, George Golovko
Severe acute respiratory syndrome coronavirus-1 (SARS-CoV-1) and -2 (SARS-CoV-2) are beta-coronaviruses (β-CoVs) that have caused significant morbidity and mortality worldwide. Therefore, a better understanding of host responses to β-CoVs would provide insights into the pathogenesis of these viruses to identify potential targets for medical countermeasures. In this study, our objective is to use a systems biology approach to explore the magnitude and scope of innate immune responses triggered by SARS-CoV-1 and -2 infection over time in pathologically relevant human lung epithelial cells (Calu-3/2B4 cells). Total RNA extracted at 12, 24, and 48 hours after β-CoVs or mock infection of Calu-3/2B4 cells were subjected to RNA sequencing and functional enrichment analysis to select genes whose expressions were significantly modulated post-infection. The results demonstrate that SARS-CoV-1 and -2 stimulate similar yet distinct innate antiviral signaling pathways in pathologically relevant human lung epithelial cells. Furthermore, we found that many genes related to the viral life cycle, interferons, and interferon-stimulated genes (ISGs) were upregulated at multiple time points. Based on their profound modulation upon infection by SARS-CoV-1, SARS-CoV-2, and Omicron BA.1, four ISGs, i.e., bone marrow stromal cell antigen 2 (BST2), Z-DNA Binding Protein 1 (ZBP1), C-X-C Motif Chemokine Ligand 11 (CXCL11), and Interferon Induced Transmembrane Protein 1 (IFITM1), were identified as potential drug targets against β-CoVs. Our findings suggest that these genes affect both pathogens directly and indirectly through the innate immune response, making them potential targets for host-directed antivirals. Altogether, our results demonstrate that SARS-CoV-1 and SARS-CoV-2 infection induce differential effects on host innate immune responses.
A wide variety of microbial species, including Trichophyton spp., have been detected in diabetic foot ulcers (DFUs). In particular, Trichophyton spp. cause tinea pedis (i.e., athlete's foot) and onychomycosis. However, investigations regarding the correlation between Trichophyton spp. and delayed wound healing are limited to case reports. Moreover, histological changes in wounds caused by Trichophyton spp. remain unclear. In this study, we sought to confirm the delayed wound healing phenotype caused by Trichophyton mentagrophytes infection in a full-thickness excisional wound ob/ob mouse model through histopathological analysis. The inoculation of skin wounds in ob/ob mice with T. mentagrophytes sporules resulted in significant delay on wound healing. Further histopathological analyses demonstrated that the delayed wound healing in ob/ob mice was accompanied by reduced collagen fibre formation and inhibited granulation tissue formation, with spores and elongated mycelia retained in the wound bed and along the wound edges. This suggests that T. mentagrophytes colonization of wounds potentially contributes to delayed wound healing in patients with diabetes. These results suggest that neglected tinea pedis is a potential risk factor for delayed wound healing and progression to refractory wounds in patients with DFU.
Unsupervised exercise is beneficial for pregnant women, and ongoing exercise may affect the course of pregnancy. Therefore, promoting continued exercise among women is critical.
To implement a home-based exercise program, guided by the COM-B model theory, and assess its effects on depression, sleep quality, and sense of control among pregnant women.
Pregnant women (N = 100) were selected and randomly assigned in a 1:1 ratio to either the intervention or the control group. Both groups received exercise instruction. The intervention group received an additional intervention based on the COM-B model theory. Depression and sleep quality were evaluated at 28 and 35 weeks of gestation, while women's sense of control was assessed at 35 weeks of gestation.
In total, 91 participants completed the study, with 100 included in the intention-to-treat analysis. The intervention group showed improvement in depression at 28 and 35 weeks of gestation and in sleep quality at 35 weeks. Although there was no significant difference in the sense of control between the groups, the intervention group demonstrated better emotional control.
A theory-guided exercise intervention shows benefits in improving third-trimester depression, sleep quality, and emotional control. Therefore, exercise programs during pregnancy should consider to encompass capacities, opportunities, and motivations to encourage exercise behavior.
This study was to translate the Pieper–Zulkowski pressure ulcer knowledge test (PZ-PUKT) into Traditional Chinese and evaluate its psychometric properties as well as identify the predictors of knowledge on pressure injury. The PZ-PUKT was translated into Traditional Chinese (TC-PZ-PUKT), and its content validity was evaluated. A total of 296 nurses participated in this study and completed the 72-item TC-PZ-PUKT online. The reliability of the TC-PZ-PUKT was analysed by evaluating its internal consistency and test–retest reliability. Hierarchical regression was used to determine factors associated with TC-PZ-PUKT scores. Content validity was achieved with a score of 0.986. Internal consistency was observed to be reliable, with a Cronbach's alpha of 0.858. The mean knowledge score on the TC-PZ-PUKT was 72.5%, with a 1-week test–retest reliability of r = 0.849. Education level, certification as a wound specialist and self-learning through reading articles, books or guidelines on pressure injury were significantly associated with TC-PZ-PUKT scores. The TC-PZ-PUKT is a valid and reliable tool. Education level, certification as a wound specialist and self-learning regarding pressure injury are related to knowledge of pressure injury.
Pregnant women may experience physical and emotional distress. Exercise is recommended for healthy pregnant women and is beneficial for their mental and physical health. Unsupervised home-based exercise is cost-effective for pregnant women as an occasional solution for their discomfort. However, no synthesis of randomized trials on this topic has been conducted.
The aim of this study was to evaluate the effectiveness of unsupervised home-based exercise during pregnancy.
A systematic search for randomized controlled trials was performed in electronic databases. The review extracted eligibility criteria based on unsupervised home-based exercise intervention. The quality of the included studies was performed using the Cochrane Risk of Bias Tool 2.0. This review was registered a priori in PROSPERO (CRD42023452966).
In total, seven studies were selected for systematic review. Participant adherence rates for the three reported studies varied considerably, ranging from 33% to 75%. Two studies revealed that unsupervised home-based exercise improved symptom severity in relation to long-term adherence to exercise. Two studies suggested that maternal aerobic fitness increased due to exercise. One study revealed improved sleep quality. However, none of the studies supported the positive effects of exercise on fatigue, maternal insulin sensitivity, prenatal weight gain, postnatal weight loss, birth pain, and cesarean section.
Unsupervised home-based exercise improves discomfort symptoms during pregnancy but requires a long intervention period. This finding suggests that the evaluation period needs to be longer to identify the effects of exercise. In addition, a theoretical-based integrity exercise plan should be considered to promote the effectiveness of unsupervised home-based exercise.
Concussion symptoms following a traumatic accident are both common and known to adversely affect mental health and recovery in patients with traumatic brain injury. Depression, highly prevalent among patients with traumatic brain injury, is also associated with the important factors of sleep quality and resilience. However, the mediator and moderator roles of depression following concussion in patients with traumatic brain injury have been underexplored. The aims of this study were to investigate the mediating role of sleep quality in the relation between concussion symptoms and depression and to examine the moderating effect of resilience on this mediated model.
Cross-sectional pretest data analysis of a randomized controlled trial.
A total of 249 adult patients with mild traumatic brain injury (Glasgow Coma Scale 13–15) at admission following brain injury were surveyed at a medical center in Taipei, Taiwan. The outcome variables were concussion symptoms (Rivermead Post-Concussion Symptom Questionnaire), sleep quality (Pittsburgh Sleep Quality Index), resilience (Resilience Scale for Adults), and depression (Beck Depression Inventory II). These data were analyzed using moderated mediation regressions with the SPSS PROCESS macro.
In patients with mild traumatic brain injury, there was a significant positive relation between concussion symptoms and depression, of which sleep quality was a significant mediator. Additionally, resilience had a negative moderating effect on the relations between sleep quality and depression. Patients with less resilience showed a stronger negative effect of sleep quality on depression.
Our findings suggest that ameliorating both concussion symptoms and sleep disturbance is important for reducing the risk of depression in patients with mild traumatic brain injury, especially in those patients with less resilience.
It is essential for clinical nurses to develop interventions for patients with mild traumatic brain injury that will improve their sleep quality, while strengthening their resilience, to alleviate depression.
This cross-sectional study assessed the risk factors for infection in 150 diabetic foot patients admitted to the Xiamen University Hospital between October 2020 and October 2022. Patients were categorised as infected (n = 80) or uninfected (n = 70) cohorts. The diabetic foot was evaluated using the American Diabetic Foot Grading system, whereas ulcers were categorised using Wagner's method. Analysed were patient-specific information, clinical data and risk factors including neuropathy, arterial disease and foot deformities. Our findings revealed no statistically significant differences between infected and uninfected cohorts concerning age, body mass index, gender, duration of diabetes or ankle-brachial index values (p > 0.05). However, infected group had a higher proportion of smokers and reduced socio-economic status (p < 0.05). Wagner grades indicated a greater severity in the infected group, with grade 3, grade 4 and grade 5 differing significantly (p < 0.05). Comparative analysis of ulcer characteristics revealed no statistically significant differences in ulcer surface area and depth, but the infected group had a higher prevalence of osteomyelitis and a greater number of ulcers (p > 0.05). Blood vessel complications, retinopathy, the presence of three or more ulcers, osteomyelitis and diabetic nephropathy were substantially more prevalent in the infected group, as determined by univariate analysis (p < 0.05). Subsequent multivariate logistic analysis revealed that patients with blood vessel complications, retinopathy, osteomyelitis, diabetic nephropathy and three or more ulcers were at increased risk for infection (p < 0.05). In addition, lifestyle factors, such as smoking, sedentary behaviour, inadequate foot hygiene, obesity and poor glycaemic control, were also associated with higher infection rates. A multivariate analysis of foot wound factors revealed that deeper, longer and recurrent lesions increased the likelihood of infection. Escherichia coli was the most frequently isolated bacterium from the infected group's bacterial culture, followed by Pseudomonas aeruginosa and Staphylococcus aureus. The study enhanced our comprehension of the multifactorial risk factors associated with infections in diabetic foot patients, highlighting the need for thorough clinical evaluation, lifestyle modification and vigilant infection control.
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