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Prita, Aulia, Rasjad Chairuddin, Latief Jufri, Seweng Arifin, and Prihantono Prihantono. "Correlation of Ankle Brachial Index (ABI) with Degrees of Diabetic Ulcer." International Journal of Medical Reviews and Case Reports 3, no. 7 (2019): 386–89. https://doi.org/10.5455/IJMRCR.Correlation-Ankle-Brachial-Index.
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Background: Foot ulcer are common complication of Diabetic Mellitus (DM) that has high morbidity and mortality rate and associated with prolonged treatment conditions and increased risk of surgery and amputation. Peripheral arterial disease (PAD) can cause intermittent claudication for the occurrence of foot ulcers in DM. The Ankle Brachial Index (ABI) value can be used as an initial diagnosis for PAD. This study aims to examine the values of ABI in patients with a diabetic foot ulcer and its correlation to diabetic ulcer based on Wagner's classification. Method: The study design was cross-sectional, from April to June 2018. Demographic, clinical and anthropometric data of diabetic ulcer patients who were hospitalized or outpatient at WahidinSudirohusodo Makassar Hospital were recorded for 41 patients. The degree of injury is assessed based on Wagner's criteria, ABI examination is performed and blood sugar checks are performed using blood sugar check strips. Data analyzed using the Spearman's Correlation and Chi-Square test. Results: Subject ABI levels were between 0.85-1.33 with mean of 1.14. Clinical examination results showed 18 (43,9%) subjects had normal and 18 (43,9%) had mild ABI and only 5 (12,2%) subjects with moderate degrees. There is correlation between ABI and Wagner classification, even though the statistical test results showed no significance (p>0,08). Percentage of subjects with Wagner III, IV and V was high in mild ABI (i.e. 40.0%, 40.0% and 20.0%), while the percentage of subjects with Wagner I and II were found to be high in normal ABI (27.8% each) Conclusion: There was correlation between ABI and wagner's classification, that the lower of ABI value, the higher the degree of wagner's classification but statistically insignificant
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Balkı, Ali, and Serkan Göksu. "The relationship between public expenditures and economic growth in the scope of economic classification: The case of Turkiye." Panoeconomicus, no. 00 (2023): 6. http://dx.doi.org/10.2298/pan220925006b.
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The relationship between public expenditures and economic growth is a constantly debated topic among researchers. There are five main models used to test Wagner's Law. This study aims to test Wagner's Law for Turkiye's public expenditure and expenditure types within the scope of economic classification by using all models in the literature. We tested the validity of Wagner's Law in the Turkiye case using the ARDL method applied for the years 1950-2020. Study findings prove that Wagner's Law is valid in Turkiye using the Mann and Peacock models for public expenditure. In addition, the findings support Wagner's Law only in transfer expenditures among sub-components. These findings point out that public expenditure, which increases more than gross domestic product, is dominated by transfer expenditures. The fact that social transfers account for approximately 75% of transfer expenditures in the last decade demonstrates that Turkiye prioritizes the social state function.
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International, Journal of Medical Science and Innovative Research (IJMSIR). "A retrospective of management of diabetic foot according to wagener's classification." International Journal of Medical Science and Innovative Research (IJMSIR) 9, no. 2 (2024): 130–34. https://doi.org/10.5281/zenodo.15372734.
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<strong>Abstract</strong> Diabetes mellitus, a chronic metabolic disease, has a global prevalence of 5%–6%, projected to reach 438 million by 2030. Patients with diabetes are at a doubled risk of peripheral arterial disease and a 15%–25% lifetime risk of diabetic foot ulcers (DFUs), leading to 85% of non-trauma amputations. Peripheral neuropathy and angiopathy contribute to ulcer development, with factors like age, diabetic duration, smoking, obesity, hypertension, poor ankle-brachial index (ABI), and high neutrophil/lymphocyte ratio exacerbating risks. DFU infections prolong treatment, increase hospital stays, and raise healthcare costs, estimated at $4 billion annually in the US. Prompt diagnosis using classification systems like Wagner's can aid in appropriate management, potentially reducing DFU incidence and complications. The study aims to assess diabetic foot lesions using Wagner’s classification, analyse the bacteriological profile of septic diabetic foot, explore various management options, compare outcomes, and suggest measures to reduce morbidity. Wagner’s classification is chosen as a simple and widely accepted tool for this evaluation.
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KINDA, Mohamed Tidjane, and Farida KOINDA. "Dynamique économique et dépenses publiques de santé au Burkina Faso." Revue d’Economie Théorique et Appliquée 7, no. 1 (2017): 1–22. https://doi.org/10.62519/reta.v7n1a1.
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Résumé : Cette recherche examine le lien entre les dépenses publiques de santé et la croissance économique du Burkina Faso sur la période 1980 à 2013. Afin d’atteindre l’objectif de la recherche, le test de cointégration du modèle autorégressif à retards échelonnés (ARDL) de Pesaran et al. (2001) a été appliqué. Ce modèle montre que les dépenses publiques de santé et la croissance économique évoluent ensemble dans le long terme. En plus, l’élasticité-revenu des dépenses publiques de santé est supérieure à l’unité. Par conséquent, nos résultats soutiennent l’hypothèse de Wagner, ce qui implique que la santé est un bien de luxe au Burkina Faso. Du point de vue de politique économique, le test de causalité de Toda et Yamamoto (1995) révèle une causalité unilatérale allant de la croissance économique aux dépenses publiques de santé au Burkina Faso. Mots clés : Dépenses publiques de santé, Croissance économique, Hypothèse de Wagner, Burkina Faso. Classification JEL : H51, I15, O40 Economic dynamic and public health expenditure in Burkina Faso Abstract: This study examines the link between public health expenditure and economic growth in Burkina on the period 1980 to 2013. The AutoRegressif Distributed Lag (ARDL) model of Pesaran and al. (2001) has been applied and shows that the public health expenditure and the economic growth are moving together in the long-run. In addition, the income elasticity of the demand for health is more than unity. Therefore, our findings support Wagner's hypothesis, which implies that health is a luxury goods in Burkina Faso. From policy view point, Toda and Yamamoto causality test, reveals unilateral causality running from economic growth to public health expenditure in Burkina Faso. Keywords: Public health expenditure, Economic growth, Wagner's Hypothesis, Burkina Faso. JEL Classification: H51, I15, O40
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CARTON, OLIVIER, and DOMINIQUE PERRIN. "THE WAGNER HIERARCHY." International Journal of Algebra and Computation 09, no. 05 (1999): 597–620. http://dx.doi.org/10.1142/s0218196799000357.
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This paper is the second part of a series of two in which we present a new version of K. Wagner's hierarchy of ω-rational sets. The first paper presents a new approach to the concepts of chains and superchains. This one presents the classification itself.
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Calhoun, Jason H., Jeff Cantrell, Jose Cobos, et al. "Treatment of Diabetic Foot Infections: Wagner Classification, Therapy, and Outcome." Foot & Ankle 9, no. 3 (1988): 101–6. http://dx.doi.org/10.1177/107110078800900301.
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A total of 850 cases of septic diabetic foot infections were reviewed in 355 patients. Age, sex, other chronic diseases, site, etiology, Wagner grade, treatment, and results were analyzed. One third of the patients were in their sixth decade of life. There were 180 women and 175 men. Chronic diseases included hypertension, congestive heart disease, and renal failure. Staphylococcus aureus was the most common bacteria. Treatment was considered to meet protocol standards if Wagner's algorithms and infectious disease principles were followed. Thirty-nine Wagner grade 0 infections were seen: only one was not treated appropriately. Eighty-eight percent treated per protocol healed and the one not treated appropriately failed. In grade 1, 79% of the 154 evaluable patients were treated appropriately with a 86% success rate versus a 53% success rate for those not treated per protocol. Of three quarters of the 64 patients with grade 2 infections treated according to protocol, 73% healed. One of those in grade 2 who was not treated according to protocol healed. In grade 3,64% of the 251 patients were treated per protocol with a 79% success rate versus a 12% success rate for those who were not treated per protocol. Most of the 189 patients with grade 4 cases were treated according to protocol with 88% success; the 20 not treated per protocol had a 15% success rate. Thirty of the 32 grade 5 patients were treated per protocol and all but one healed. Protocol therapy had a statistically significant effect by χ2 test in the treatment of all groups.
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Shanker, Bharti, Kumar Anjan Anjani, and Narayan Rajesh. "A Prospective Assessment of the Clinic-Demographic Profile and Risk Factors of Diabetic Foot." International Journal of Current Pharmaceutical Review and Research 15, no. 10 (2023): 22–27. https://doi.org/10.5281/zenodo.11617565.
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AbstractAim: The objective of the present study was to assess association between socio-demographic, behavioural andclinical risk factors and diabetic foot and response of patients to various treatment modalities.Methods: A prospective study was conducted in the General Surgery Department of Bhagwan Mahavir instituteof medical science, Pawapuri, Nalanda, Bihar, India for 7 months. 50 patients were included in the study. Allpatients who presented to surgical outpatient department or were admitted to the surgical wards with signs andsymptoms of diabetic foot during the 7 months period were included.Results: Out of 50 patients in our study, 20 (40%) were in the age group of 51-60 years followed by 13 (26%)in the age group 61-70 years. There was a male preponderance in our study with 36 (72%) patients out of 50.Majority of the study subjects were literate with overall literacy rate being 60%. 96% study subjects belonged tolow class. Among the 50 patients, 13 (26%) were unmarried showing lack of support and care and rest (74%)were married. Labourers accounted for 34% of study participants, farmers constituted 30%, businessmen 18%and others 18% of study subjects. Most of the participants had type II diabetes for >10 years. 80% of studyparticipants had family history of diabetes. 92% of study participants were overweight (BMI 25-29.9) andremaining 8% were obese (BMI ≥30). Hypertension was present in 72% of study participants, ischemic heartdisease in 60% and hypercholesterolemia in 70%.Conclusion: Diabetic foot is a common complication of long-standing diabetes. Several socio-demographicfactors like advancing age, low socio-economic status, lack of family support, occupations involving risk oftrauma to foot contribute to the risk of developing diabetic foot in diabetics. Hence it is essential to educate allthe diabetic patients at risk about good glycemic control, risk factors, proper foot care, periodic foot examinationand neurological examination of lower limbs, prompt treatment of foot lesions and regular follow-up.
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Nitish, Prabhakar. "A Hospital-Based Study to Examine Socio-Demographic, Behavioural, and Clinical Risk Factors for Diabetic Foot and Patient Response to Therapy." International Journal of Current Pharmaceutical Review and Research 15, no. 04 (2023): 240–47. https://doi.org/10.5281/zenodo.12636062.
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AbstractAim: The objective of the present study was to assess association between sociodemographic, behavioural and clinical risk factors of diabetic foot and response of patients tovarious treatment modalities.Methods: A prospective study was conducted in the Department of General Surgery,Government Medical College, Bettiah, Bihar, India for 12 months. 100 patients wereincluded in the study. All patients who presented to surgical outpatient department or wereadmitted via emergency to the surgical wards with signs and symptoms of diabetic footduring the 12 months period were included. The study was conducted after obtainingapproval from institutional ethics committee.Results: Out of 100 patients in study, 42 (42%) were in the age group of 51-60 yearsfollowed by 26 (26%) in the age group 61-70 years. There was a male preponderance in thestudy with 70 (70%) patients out of 100 being males. Majority of the study subjects wereliterate with overall literacy rate being 60%. 96% study subjects belonged to low class.Among the 100 patients, 25 (25%) were unmarried showing lack of support and care and rest(75%) were married. Labourers accounted for 35% of study participants, farmers constituted30%, businessmen 17% and others 18% of study subjects. Among the 100 study participants,44 (44%) either smoked or chewed tobacco and 36 (36%) consumed alcohol. Majority (90%)of the patients were sedentary, 5% performed light physical activity while the remaining 5%performed moderate physical activity. Most of the participants had type II diabetes for >10years. 80% of study participants had family history of diabetes. 92% of study participantswere overweight (BMI 25-29.9) and remaining 8% were obese (BMI ≥30). Hypertension waspresent in 75% of study participants, ischemic heart disease in 60% and hypercholesterolemiain 70%.Conclusion: Diabetic foot is a common complication of long-standing diabetes. Severalsocio-demographic factors like advancing age, low socio-economic status, lack of familysupport, occupations involving risk of trauma to foot contribute to the risk of developingdiabetic foot in diabetics. Hence it is essential to educate all the diabetic patients at risk aboutgood glycemic control, risk factors, proper foot care, periodic foot examination andneurological examination of lower limbs, prompt treatment of foot lesions and regularfollow-up.
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Ajeet, Kumar, Kumar Bhartendu, and Manisha. "A Study to Assess the Clinico-Demographic Profile and Risk Factors of Diabetic Foot and Response of Patients to Various Treatment Modalities." International Journal of Current Pharmaceutical Review and Research 16, no. 4 (2024): 373–78. https://doi.org/10.5281/zenodo.12788869.
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Aim: The objective of the present study was to assess association between socio-demographic, behavioural andclinical risk factors and diabetic foot and response of patients to various treatment modalities.Methods: A prospective study was conducted in the General Surgery Department of for 7 months. 50 patientswere included in the study. All patients who presented to surgical outpatient department or were admitted to thesurgical wards with signs and symptoms of diabetic foot during the 7 months period were included.Results: Out of 50 patients in our study, 20 (40%) were in the age group of 51-60 years followed by 13 (26%) inthe age group 61-70 years. There was a male preponderance in our study with 36 (72%) patients out of 50. Majorityof the study subjects were literate with overall literacy rate being 60%. 96% study subjects belonged to low class.Among the 50 patients, 13 (26%) were unmarried showing lack of support and care and rest (74%) were married.Labourers accounted for 34% of study participants, farmers constituted 30%, businessmen 18% and others 18%of study subjects. Most of the participants had type II diabetes for >10 years. 80% of study participants had familyhistory of diabetes. 92% of study participants were overweight (BMI 25-29.9) and remaining 8% were obese (BMI≥30). Hypertension was present in 72% of study participants, ischemic heart disease in 60% andhypercholesterolemia in 70%.Conclusion: Diabetic foot is a common complication of long-standing diabetes. Several socio-demographicfactors like advancing age, low socio-economic status, lack of family support, occupations involving risk oftrauma to foot contribute to the risk of developing diabetic foot in diabetics. Hence it is essential to educate all thediabetic patients at risk about good glycemic control, risk factors, proper foot care, periodic foot examination andneurological examination of lower limbs, prompt treatment of foot lesions and regular follow-up.
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Mohammed, Adel Gassab, Dheyaa Kadhim Al-Waeli, Samih Abed Odhaib, and Mahmood Thamer Altemimi. "Assessing the Features of Diabetic Foot Ulcers among Individuals with Type 2 Diabetes Mellitus in Thi Qar, Iraq." F1000Research 13 (May 28, 2024): 539. http://dx.doi.org/10.12688/f1000research.150995.1.
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Background This study aimed to evaluate the characteristics of diabetic foot ulcers in individuals with type 2 diabetes mellitus (T2DM) in Iraq. Methods The study included 881 participants with T2DM and different types of foot ulcers, who attended a specialized diabetes center. Data on demographics, clinical characteristics, biochemical investigations, comorbidities, and treatment regimens were collected and analyzed. Results The majority of the cases (96.8%) were due to T2DM, with an average age of 58 years and a mean BMI of 30 kg/m2. Participants had elevated serum creatinine, blood urea, and glucose levels, with uncontrolled HbA1c levels. Comorbidities included hypertension, ischemic heart disease, diabetic neuropathy, and retinopathy. Most participants were on insulin and statins. Diabetic foot ulcers were mainly on the right foot (48%) and classified as Grade 2 in Wagner's system. Some participants had Charcot deformity or stages of amputation. Conclusions Random plasma glucose levels and diabetic retinopathy were significantly associated with the classification of foot ulcers. Further research is needed to explore additional variables related to T2DM and foot ulcers, emphasizing the importance of glucose control and retinopathy in ulcer classification.
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Santos, Vanessa Prado dos, Denise Rabelo da Silveira, and Roberto Augusto Caffaro. "Risk factors for primary major amputation in diabetic patients." Sao Paulo Medical Journal 124, no. 2 (2006): 66–70. http://dx.doi.org/10.1590/s1516-31802006000200004.
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CONTEXT AND OBJECTIVE: Diabetic patients present high risk of having to undergo minor or major amputation during their lifetimes, because of ischemia or infection. The aim of this study was to identify and quantify risk factors for major amputation in diabetic patients with foot infections. DESIGN AND SETTING: Retrospective clinical-surgical trial at the Vascular Surgery Service of Santa Casa de São Paulo. METHODS: Ninety-nine patients with diabetic foot infections who underwent 129 hospitalizations in the Vascular Surgery Unit were analyzed in accordance with a pre-established protocol to compare two groups of diabetic patients: one that underwent major amputations and the other that underwent minor amputations or debridements. The patients were predominantly male, in their sixth decade of life, and had type 2 diabetes mellitus. Chronic arterial insufficiency, age, diabetes mellitus duration, ascending lymphangitis, calcaneal lesions, Wagner's classification, laboratory tests and different microorganisms in deep tissue cultures were the risk factors evaluated in all patients. RESULTS: The statistically significant risk factors for major amputation included age, ascending lymphangitis (odds ratio, OR: 2.5), calcaneal lesions (OR: 10.5), Wagner grade 5 lesions (OR: 3.4), chronic arterial insufficiency without possibility of revascularization (OR: 5.4) and diabetes duration. Presence of Gram-positive microorganisms was associated with the need of major amputation. The serum urea, creatinine, glucose and white blood cell levels were not significant risk factors for major amputation. CONCLUSIONS: The risk factors for major amputation were: age, ascending lymphangitis, calcaneal lesions, Wagner grade 5 lesions, arterial insufficiency, diabetes duration and Gram-positive microorganisms in cultures.
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Decroli, Gilang Dwipa, Raflis Rustam, and Vendry Rivaldy. "The Relationship between Germ Patterns and Severity of Diabetic Ulcers Based on Wagner's Score at Dr. M. Djamil General Hospital Padang." Bioscientia Medicina : Journal of Biomedicine and Translational Research 6, no. 8 (2022): 2097–102. http://dx.doi.org/10.37275/bsm.v6i8.562.
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Background: Diabetes Mellitus (DM) is a condition of increasing blood sugar levels which increases the risk of macrovascular and microvascular damage, thereby reducing the quality of life of the sufferer. One of the common complications in people with diabetes mellitus is diabetic ulcers. The classification system commonly used to determine the degree of diabetic ulcers is Wagner's criteria, which consists of 5 degrees of severity. Diabetic wounds become a place for bacterial growth and the production of exudate, which results in a longer healing process and causes tissue damage. 
 Methods: This study is a cross-sectional analytic observational study in diabetic ulcer patients treated at Dr. M. Djamil General Hospital Padang. The sampling technique in this study was consecutive sampling. The subjects of this study amounted to 36 people, with the majority aged >50 years and the female sex being found more than the male. Data analysis was performed using SPSS version 25 through univariate and bivariate analysis.
 Results: The grades of diabetic ulcers in the treated patients ranged from mild to severe. All subjects in this study had monomicrobial results. Gram-negative bacteria were the most commonly found, namely, 77.8%. In this study, there was no significant relationship between bacterial patterns and the severity of diabetic ulcers based on Wagner in patients treated at Dr. M Djamil General Hospital Padang (p-value > 0.05).
 Conclusion: Klebsiella sp is the most common type of bacteria that causes diabetic ulcers. No polymicrobial bacteria were found in this study. No correlation was found between the pattern of germs and the severity of diabetic ulcers in patients treated at Dr. M Djamil General Hospital, Padang.
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Kurniawati, Sri. "Granger Causality Between Local Government Expenditure and Economic Growth in Indonesia." Journal of Business and Economics Review (JBER) Vol.3(4) Oct-Dec 2018 3, no. 4 (2018): 80–86. http://dx.doi.org/10.35609/jber.2018.3.4(1).
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Objective - This study examines the causal relationship between government expenditure and economic growth in West Kalimantan between 2009 and 2015. This research resulted in the enactment of Wagner's Law and/or Keynes's Theory in West Kalimantan leading the local government to take the right policies as an effort towards improving economic development. Methodology/Technique - By using panel data that combines time series data and cross-site data, it will be estimated by the Granger causality test which begins with a stationary test and co-integration test. Based on the co-integration tests, the results suggest that there is a long-term relationship between government expenditure and economic growth. Meanwhile, based on the Granger causality test, there is no reciprocal relationship between government expenditure and economic growth. Findings - A direct relationship in the form of the influence of government expenditure on economic growth in West Kalimantan. Novelty - These results are in line with the Keynes's Theory through its national income function. Type of Paper: Empirical Keywords: Government Expenditure; Economic Growth; Co-integration; Causality. JEL Classification: F40, F43, F49.
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COSIMO, MAGAZZINO. "The Nexus between Disaggregated Public Spending and GDP in the Euro Area." Economics Bulletin 32, no. 3 (2021): 2560–79. https://doi.org/10.5281/zenodo.4686770.
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This paper aims to analyze the nexus between disaggregated public spending and GDP in the Euro Area for the period 1990-2010 at a disaggregated level, using a time series approach. We estimated this nexus for ten items of public spending according to the COFOG functional classification. Taking into account cross-section dependence and group-wise heteroskedasticity, cointegration tests reveal a long-run relationship between real per capita GDP and real spending for defence, for housing and community amenities, and for recreation, culture and religion. Moreover, Granger causality tests results show clear evidence against the Keynesian view (G→Y). Finally, decomposing the GDP with Hodrick and Prescott filter, Estonia, Luxembourg, Ireland and Greece exhibit wider fluctuations. Some notes on the policy implications of this analysis conclude the paper.
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COSIMO, MAGAZZINO. "Disaggregated public spending, GDP and Money Supply: Evidence for Italy." European Journal of Economics, Finance and Administrative Sciences 41 (April 15, 2021): 118–31. https://doi.org/10.5281/zenodo.4694411.
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The aim of this article is to analyze the relationship between public spending and GDP controlling for the money supply in Italy for the period 1990-2010 at a disaggregated level, using a time series approach. After a brief introduction, a survey of the economic literature on this issue is shown, before estimating this nexus for ten items of public spending according to the COFOG functional classification. Cointegration tests reveal a long-run relationship between GDP, money supply and eight spending items. Moreover, Granger causality tests results show evidence in favour of Wagner’s Law in two cases (Y->G), while a bi-directional flow has been found in only one case. The Keynesian hypothesis (G->Y) is supported by five series of spending. Some notes on the policy implications of this analysis conclude the paper.
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COSIMO, MAGAZZINO. "Wagner versus Keynes: Public Spending and National Income in Italy at a Disaggregated Level." Journal of Policy Modeling 34, no. 6 (2021): 890–905. https://doi.org/10.1016/j.jpolmod.2012.05.012.
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Wagner's Law is the first model of public spending in the history of public finance. The aim of this study is to assess its empirical evidence in Italy for the period 1960–2008 at a disaggregated level, using a time series approach. After a brief introduction, a survey of the economic literature on this issue is shown, before estimating the specifications of Wagner's Law for some specific items of public spending (for interests, for final consumption, for labor dependent income, for grants on production, and for public investments), according to the Bank of Italy classification. We found a cointegration relationship for three out of five items. Moreover, results from Granger causality tests show evidence in favor of Wagner's Law only for passive interests spending in the long-run, and for dependent labor income spending in the short-run. Some notes on the policy implications of our empirical results conclude the paper.
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L., Praveena D., Shashi M. Uppin, and S. S. Shimikore. "A one year cross sectional study on role of Wagner’s classification in predicting the outcome in diabetic foot ulcer patients." International Surgery Journal 5, no. 7 (2018): 2537. http://dx.doi.org/10.18203/2349-2902.isj20182769.
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Background: Diabetes mellitus-related foot ulceration is very common. Several classification systems for diabetic foot ulcers have been proposed. The present study was intended to assess the role of Wagner wound classification in predicting the outcome of diabetic foot ulcer and also know the grade of Wagner’s classification to which majority of diabetic foot ulcer patients.Methods: This present one year cross sectional study was carried out at the Department of General Surgery. A total of 100 patients with diabetic foot ulcer who presented during the study period were included. The diabetic foot ulcers were graded according to the Wagner’s classification. The relative risk of amputation in different grades of diabetic foot ulcer based on Wagner classification was determined.Results: In this study majority of the patients were males (79%) and the male to female ratio was 3.76:1. The mean age was noted as 55.8±10.45 years. Majority of the patients had duration of ulcer less than one month (88%). Surrounding skin was inflamed in 60% of the patients, necrosis was present in 40% and slough was noted in 98% while 44% of the patients had necrotic tissue. Based on Wagner’s Classification, most of the patients (48%) had Grade II diabetic foot ulcers. With regard to management, in 44% of the patients’ debridement was done and 36% of the patients had disarticulation or amputation in 36%. Of the 48 patients with grade II ulcer, 79% of the patients had healing without amputation. Of the 58 patients with grade I and II diabetic foot ulcers, 82.76% had healing without amputation compared to 17.24% of the patients who needed amputation. Patients with Grade III, IV and V had 3.59 times higher risk of amputation compared to patients with grade I and II. (p<0.001; 95% CI- 1.95 to 6.62).Conclusions: Grading of diabetic foot ulcer based on Wagner’s classification affects and predicts the outcome and the risk of amputation increases with increasing grade. Most of the patients admitted for diabetic foot ulcers in our hospital belonged to Wagner’s grade II (48%).
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Krivoshchekov, E. P., E. B. Elshin, G. S. Alyapyshev, and A. V. Poseryaev. "The use of histoequivalent-bioplastic material for chronic foot ulcers on patients with diabetes." Bulletin of the Medical Institute "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH), no. 6 (November 1, 2021): 61–70. http://dx.doi.org/10.20340/vmi-rvz.2021.6.clin.2.
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The main goal of this study was to improve the results of therapy in patients with chronic wounds on the foot in diabetics (I-II degree according to Wagner's classification) using histoequivalent bioplastic material «G-derm».Materials and methods. The study included 72 patients. The comparison group included 35 patients who underwent standard treatment with hydrocolloid dressings. The main group consisted of 37 patients. For them, in addition to standard treatment, the histoequivalent-bioplastic material «G-derm» was used. The patients' condition was assessed in dynamics on the 1st, 10th, 30th days from the start of treatment.Results. By the 30th day, the complete epithelialization was registered in 12 (16.7%) patients. The main group included 8 (21.6%) cases, and the control group – 4 (11.4%). The unsatisfactory epithelialization (healing less than a quarter of the initial area) by the 30th day of treatment was in 14 (19.4%) patients: in the main group – in 4 (10.9%) patients, in the comparison group – in 10 (28.5%) of patients. The remaining 25 (67.6%) patients in the main group and 21 (60%) participants in the comparison group had satisfactory epithelialization results by the 30th day of treatment.Conclusion. The results of this study show the effectiveness of using histoequivalent bioplastic material G-derm in local treatment of chronic wounds in patients with neuropathic diabetes in combination with standard therapies.The use of histoequivalent-bioplastic material in patients with diabetes leads to faster regeneration of the wound as well as increases the cases of complete epithelialization.
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Khadim, Farheen, Kashif Ali Samin, Amna Baloch, Shahzia Yousaf, Jahangir Anjum, and Saba Shafiq. "To Determine Frequency and Outcome of Dyslipidemia in Diabetic Foot Patients." Pakistan Journal of Medical and Health Sciences 16, no. 12 (2022): 728–30. http://dx.doi.org/10.53350/pjmhs20221612728.
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Objective: To determine frequency and outcome of Dyslipidemia in Diabetic foot patient Study Design: Cross sectional study Place and Duration: Divisional Head Quarter Teaching (DHQ) Hospital Mirpur AJK from January 2021 to January 2022. Methodology: This study includes one hundred and thirty nine (139) patients with Type 2 diabetes and diabetic foot related complication. Patient diagnosed case of type2 DM on oral hypoglycemic agents or on insulin therapy of age >30 of either gender admitted with history of wound in lower limb confirmed on physical examination measuring ankle brachial pressure Index(ABPI) were evaluated for ulcer ,cellulitis and gangrene by using WAGNER's classification. Dyslipidemia is assessed in these patient by sending their fasting lipid profile and data is entered into specially designed Performa. Results: We found that majority of cases having abnormal lipid profile. Dyslipidemia with significant difference was found in diabetic foot patients, 54.7% (n=76) patients show HDL <35 ,56.1%(n=77 )have cholesterol >200mg/dl and 69.8%(n=97) have TAG>150mg/dl. 29.5% patient with diabetes have superficial ulcer, while deep ulcer, cellulitis, localized and extensive gangrene was found with percentage of 31.7% , 20.1% ,10.8%, 7.9% respectively . Conclusion: We concluded that Dyslipidemia is a modifiable risk factor for diabetic foot related complications. So diabetic patients must be advised regular Lipid Profile to decrease risk of diabetic foot related complication. Keywords: Diabetes Mellitus (DM), Dyslipidemia, Diabetic foot, PAD and neuropathy
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Jaroń, Aleksandra, and Grzegorz Trybek. "The Pattern of Mandibular Third Molar Impaction and Assessment of Surgery Difficulty: A Retrospective Study of Radiographs in East Baltic Population." International Journal of Environmental Research and Public Health 18, no. 11 (2021): 6016. http://dx.doi.org/10.3390/ijerph18116016.
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Classifications of impacted teeth allow defining the type and degree of retention, as well as assessing the degree of difficulty of the procedure. The aim of this study was to conduct retrospective analysis of the degree of retention and difficulty in the surgical removal of impacted mandibular third molars in the clinical material of the Department of Oral Surgery in 2013–2018. This study included 1585 dental panoramic radiographs of patients of the Department of Oral Surgery, who reported in 2013–2018, in order to perform surgical removal of the impacted mandibular third molar. Based on dental panoramic radiographs, the degree of retention was determined based on classifications according to Winter, according to Pell and Gregory, according to Tetsch and Wagner, and according to Asanami and Kasazaki. The difficulty of the procedure was also assessed based on the Pederson index. The most common types of lower wisdom tooth impaction are as follows: in Winter’s classification, mesial-angular impaction; in Tetsch and Wagner’s classification, oblique medial-angular impaction; in Pell and Gregory’s classification, impaction grade 2A; and in Asanami and Kasazaki’s classification, 3A and anterior inclination. In most cases of surgical removal of an impacted tooth, the anticipated difficulty of the procedure was rated as very difficult.
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ABEER, EID ALJUHANI. "Assessment of Patients Learning Needs for Prevention of Diabetic Foot." Assessment of Patients Learning Needs for Prevention of Diabetic Foot 10, no. 2 (2023): 88–106. https://doi.org/10.5281/zenodo.8036756.
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<strong>Abstract:</strong> Background: A diabetic foot is a foot that exhibits any pathology that results directly from diabetes mellitus or any long-term (or "chronic") complication of diabetes mellitus. Significance of the Study: In Saudi Arabia, Prevalence of diabetic ulcer is ranging from 2%-10%. High rate of lower limb amputation in DFD (More than 15%) and survival rate for undertaken amputation patient are short. Ninety diabetic amputations are performed monthly in Saudi Arabia capital of Riyadh. DFD and diabetic patients’ awareness of DFD and how to take care of it will reduce the incidence of more complications like amputation. Purpose of the Study: The aim of this study is to assess the patient’s learning needs for prevention of diabetic foot. This aim will be achieved through the following objectives: (1) To assess of the patient’s knowledge for prevention of diabetic foot. (2) what are the factors affecting levels of knowledge of diabetic patients for prevention of diabetic foot? Methodology: The research study design was a descriptive and exploratory study. The study was conducted in the diabetic outpatient clinic, Prince Sultan Medical Military City (PSMMC), Riyadh, Saudi Arabia. Convenience samplings, a total of 400 samples were collected for this study. Research tools: The semi-structured interview questionnaire is divided into two parts, Socio-demographic characteristics, and patient health history. A patient's self-assessment of knowledge. Results And Conclusion: The overall score of knowledge about foot health significantly associated marital status, living arrangement, HbA1c and FBS. <strong>Keywords:</strong> Diabetic foot ulcer, Knowledge about Diabetes, Severity of Diabetic Foot, Ulcer Based on Wagner’s Classification, Neuropathy, Peripheral Vascular Disease. <strong>Title:</strong> Assessment of Patients Learning Needs for Prevention of Diabetic Foot <strong>Author:</strong> ABEER EID ALJUHANI <strong>International Journal of Novel Research in Healthcare and Nursing</strong> <strong>ISSN 2394-7330</strong> <strong>Vol. 10, Issue 2, May 2023 - August 2023</strong> <strong>Page No: 88-106</strong> <strong>Novelty Journals</strong> <strong>Website: www.noveltyjournals.com</strong> <strong>Published Date: 14-June-2023</strong> <strong>DOI: </strong><strong>https://doi.org/10.5281/zenodo.8036756</strong> <strong>Paper Download Link (Source)</strong> <strong>https://www.noveltyjournals.com/upload/paper/Assessment%20of%20Patients%20Learning-14062023-1.pdf</strong>
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Ahmad, Jamil, Akash Kumar, Zubair Ahmad Khan, Sarah Rahim, Muhammad Mohsin, and Abbas Khan. "Diabetic Foot: its grades and mode of presentation at a tertiary care hospital of Peshawar, Khyber Pakhtunkhwa, Pakistan." Journal of Rehman Medical Institute 7, no. 2 (2021): 03–06. http://dx.doi.org/10.52442/jrmi.v7i2.299.
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Introduction: Diabetic foot is defined as the foot of diabetic patients with ulceration, infection, and/or destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. Foot ulcers are the principal cause of severe complications and hospitalization among patients with diabetes, substantially increasing the costs of this disease.
 Objectives: To describe the presentation, distribute the diabetic foot lesions according to Wagner’s classification, and determine the outcome of diabetic foot ulceration in a tertiary care hospital of Peshawar, Pakistan.
 Materials & Methods: This study was conducted in the Surgery department of Rehman Medical Institute Peshawar. Thirty nine (39) patients with diabetic foot disease presenting from Jan 2018 to Dec 2019 were included in the study. The patients were evaluated and managed by classifying their disease according to Wagner’s classification for diabetic foot disease. Statistical analysis was done by using SPSS version 26 for descriptive statistics.
 Results: The most common age of presentation with diabetic foot lesion was between 41-70 years; out of 39 patients, 28 (71.8%) were males and 11 (28.2%) were females. Their mode of presentation was as follows- 22 cases (56.4%) with Ulcer, 9 cases (23.1%) with Cellulitis, 7 cases (17.9%) with Gangrene, and 1 case (2.6%) with Abscess. The most common grade of presentation were grades 3 and 4 Wagner’s lesion followed by Grade 1, and Grade 2. Debridement was the most common treatment modality (56.2%), followed by Amputation (41%).
 Conclusion: Foot ulceration in diabetic patients is a resource-consuming, disabling morbidity that often is the first step towards lower extremity amputation. Diabetic foot lesions can be easily graded according to the Wagner classification and helps in correlating appropriate treatment to the grade of the lesion for a better outcome.
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OMELKOVÁ, MARKÉTA, and JAN JEŽEK. "Two new species of Philosepedon Eaton (Diptera, Psychodidae, Psychodinae) from Europe, with comments on subgeneric classification." Zootaxa 3275, no. 1 (2012): 29. http://dx.doi.org/10.11646/zootaxa.3275.1.3.
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A list of world species for subgenera of Philosepedon Eaton, including Philosepedon s. str., Trichosepedon Krek, and Philo-threticus Krek is given, and the subgenus Bahisepedon subgen. nov. is proposed to include some western hemisphere species.Philosepedon wagneri nom. nov. is proposed to replace P. orientale Wagner, a homonym of P. orientale Krek. Two new spe-cies from Europe, Philosepedon dumosum sp. nov. and P. perdecorum sp. nov., are described, and all important male diagnostic characters are discussed. The number of moth fly species known to occur in the Czech Republic is increased to 172.
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Pignata, Edson Augusto de Jesus Constante, Vinícius Quadros Borges, Gabriel Ferreira Ferraz, and Kelly Cristina Stéfani. "Diabetic foot ulcers and isolated gastrocnemius tightness." Scientific Journal of the Foot & Ankle 12, no. 2 (2018): 150–53. http://dx.doi.org/10.30795/scijfootankle.2018.v12.788.
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Objective: To determine the prevalence of isolated gastrocnemius tightness (IGT) in diabetic patients with plantar ulcers in the forefoot using the Silfverskiöld test. Methods: This prospective cohort study consecutively evaluated 50 diabetic patients with Wagner grade I or II ulcers in the forefoot treatedconservatively on an outpatient basis and assessed them for IGT using the Silfverskiöld test. Results: The prevalence of IGT was 66.7%. There was no significant correlation between IGT and the ulcer’s area or depth (Wagner’s classification) or the patient’s insulin use. Conclusion: The prevalence of IGT in diabetic patients with plantar ulcers is high, suggesting that this complicationmay contribute to the development of plantar ulcers.
 Level of Evidence II; Prospective Cohort Study.
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Loveras, Alexander A. Ozoria, Jacques Paré Espinal, David de luna, and Noemi Acevedo. "1548. Association of bacterial colonization in ulcerative lesions of the diabetic foot together with the cicatrization process." Open Forum Infectious Diseases 7, Supplement_1 (2020): S773—S775. http://dx.doi.org/10.1093/ofid/ofaa439.1728.
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Abstract Background In 2018, a review of the scientific literature identifed biofilm studies in the past 3 years. Wherein, the role of the biofilm in the progression of the diabetic foot ulcer with the presence of biofilm is reviewed. As a result, tissue sampling is more effective than transcure, Levin, and aspiration. A study in Cuba evaluate the effectiveness of a new proposal for antimicrobial treatment in patients with diabetic foot infection in 2017. The method used was a experimental type of two groups. The control group, was treated with the treatment scheme proposed in the Comprehensive Care Program for the patient with diabetic foot ulcer (PAIPUPD). Instead, the other experimental group was treated according to the scheme based on the local microbial map. They used a random distribution. Using the Wagner classification, there were patients classificate with a grade of W2 (13% of patients), W3 (66%) and W4 (12%). The most frequent germs found were Staphylococcus aureus, Escherichia coli and Enterobacter sp. The experimental group required less days with hospitalization. Methods This is an observational study of primary source with a non-probability sample with 58 patients. Adult patients diagnosed with type 2 diabetes mellitus, with diabetic foot, Wagner classification 1, 2 and 3, who attended the healing area of the Institute of Diabetes of Santiago were included. After identifying the colonized pathogen, its cicatrization process was evaluate for four weeks. Results Of the total sample, 12.07% belonged to Wagner 1, 43.1% to Wagner 2 and 44.83% to the Wagner 3 classification. In the case of the Wagner 3 group, S. aureus and Pseudomona aeruginosa were present in 6 cases. Despite the infectious processes detected by the culture, the patients showed a successful cicatrization process after four weeks of evaluation. Graph 1: Isolated Microorganism Vs Wagner’s Degree (n=60) Graph 2: Gram positive microorganism vs. healing process per week in patients with diabetic foot (n=22) Graph 3: Gram-negative microorganism vs. healing process (n=33) Conclusion During the four weeks of clinical evaluation, more than 88% of patients progressed positively to clinical recovery, regardless of the type of bacteria colonized and/or their resistance to antibiotics. Disclosures All Authors: No reported disclosures
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G.K., Prashant, and Suryanarayan Reddy V. "Wagner’s Classification for Management and Evaluation of Diabetic Foot: A Prospective Study." International Journal of Research and Review 8, no. 7 (2021): 327–31. http://dx.doi.org/10.52403/ijrr.20210745.
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Background: In our community diabetes is one of the most common co-morbid illnesses. Out of its several complications in long course diabetic foot is one of them. Morbidity and mortality due to this complication is a major health issue. Objective: This study is undertaken for management and evaluation of foot ulceration to avoid amputation of lower extremities due to diabetic foot disease. Methods: This prospective observational study conducted between July 2019 and September 2020, 40 patients with diabetic foot admitted to Department of General Surgery, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar (TS) were subjected to surgical treatment depending upon the Wagner’s classification. Data was collected and analyzed by statistical software SPSS V 25. Results: Majority of the patients presented with higher grade and with poor glycemic control at the time of presentation. Conservative management with antibiotics was useful in a small subset of the patients. Majority of the patients needed surgical treatment in the form of debridement to amputations. Conclusion: Patient education and strict glycemic control can reduce the burden of diabetic foot. Early diagnosis and hospitalization, appropriate treatment including medical and surgical treatment according to the grade can reduce the morbidity mortality and improve the outcome of the disease. Keywords: Antibiotics; Amputation; Wagner classification; Complications; Glycemic control.
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Taufik, Rahmat, Raflis Rustam, Vendry Rivaldy, and Hafni Bachtiar. "KORELASI ANTARA NILAI ANKLE BRACHIAL INDEX DENGAN DERAJAT KAKI DIABETES KLASIFIKASI WAGNER DI RSUP DR M.DJAMIL PADANG." Majalah Kedokteran Andalas 38, no. 3 (2015): 181. http://dx.doi.org/10.22338/mka.v38.i3.p181-188.2015.
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AbstrakDiabetes Mellitus merupakan penyakit yang merupakan epidemi global dan menyumbang angka kematian tertinggi di dunia. Salah satu komplikasi diabetes adalah penyakit arteri perifer (PAP), suatu kondisi yang ditandai oleh penyumbatan dalam arteri ekstremitas inferior. Tingkat keparahan PAP dapat diperiksa dengan modalitas pemeriksaan non-invasif seperti pemeriksaan ABI (ante brachial index). Derajat keparahan kaki diabetes dapat di kategorikan berdasarkan klasifikasi Wagner. Penelitian ini bertujuan untuk mengetahui korelasi antara nilai ABI dengan derajat keparahan kaki diabetik klasifikasi Wagner pasien di RS M Djamil Padang. Dengan metode survei analitik desain cross sectional, pada pasien dengan kaki diabetik dilakukan pemeriksaan ABI dan pemeriksaan derajat kaki diabetik klasifikasi Wagner. Data kemudian dianalisis dengan menggunakan uji non-parametrik dengan tingkat kepercayaan 95%. Signifikansi dari hasil tes ditentukan oleh nilai p <0,05. Dari total 48 sampel diperoleh bahwa nilai ABI adalah obstruksi ringan pada 23 orang (47,92%), dan sebagian besar pasien kaki diabetes klasifikasi Wagner adalah derajat 1 sebanyak 17 (35,42%). Uji statistik menemukan hubungan yang signifikan antara nilai ABI dengan derajat kaki diabetik klasifikasi Wagner (p = 0,000). Dapat disimpulkan, terdapat hubungan yang signifikan antara nilai ABI dengan derajat kaki diabetik klasifikasi Wagner di RSUP Dr M. Djamil Padang.ABSTRACTDiabetes Mellitus is a global epidemic disease and accounts for the highest mortality rate in the world. One of its complications is Peripheral Arterial Disease (PAP) which characterized by blockages in the arteries of inferior extremity. The severity of PAP can be detected and determined by a non-invasive method namely ABI (ante brachial index). The degree of severity of diabetic foot can be classified into several categories based on Wagner classifications. This study aimed to determine the correlation between the values of ABI with the degree of Wagner classification-diabetic foot of patients in M Djamil Padang hospital. Analytical survey with cross sectional design has been done. The variables needed were measured and analysed with a non-parametric test with a 95% confidence level to determine the relationships between variables. Of 48 samples, 23 people (47.92%) were having mild obstruction of ABI values, and about one-third of the samples (35,42%) were having first degree of diabetic foot based on Wagner classification. Statistical analysis showed a significant correlation between ABI values and the degree of diabetic foot based on Wagner classification (p=0.000). To be concluded, there was a significant correlation between ABI values and the degree of Wagner classification-diabetic foot in M.Djamil Padang hospital.
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Made Adi Narendranatha, I., I. Putu Raditya Dananjaya, I. Made Suma Wirawan, and Ida Bagus Putu Wiyasa. "Evaluation and Management of Diabetes Mellitus with Diabetic Foot According to Wagners Classification: A Case Report." International Journal of Science and Research (IJSR) 10, no. 3 (2021): 52–54. https://doi.org/10.21275/sr21227133918.
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R., Abhirup H., Chidananda K. V., Jagadish B., Ranjith K. B., Gopinath Pai, and Balakrishna M. A. "Clinico-bacteriological study of diabetic foot ulcer and its management based on Wagner’s classification and HbA1c as an indicator for duration of antibiotic therapy in a tertiary hospital in Sullia." International Surgery Journal 8, no. 7 (2021): 2098. http://dx.doi.org/10.18203/2349-2902.isj20212714.
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Background: Diabetic foot ulcer is a serious and common complication of diabetes mellitus. 12%–25% have a risk of developing a foot ulcer during their lifetime. Diabetic neuropathy and micro- or macro-ischemia are the two main risk factors that cause diabetic foot ulcer.Methods: A cross sectional study was conducted in dept of general surgery, KVGMCH between 1st November 2019 and 30th August 2020 among 90 pts with diabetic foot ulcers, selected by systematic random sampling methods. Considering prevalence of DFU, among the diabetic pts as 8.8%, the sample size was estimated to be 90 using the formula 4pq/L2, with absolute error as 6%. Patients will be managed conservatively with antibiotics like aminoglycosides, cephalosporins, penicillin derivatives and dressings and if needed surgical interventions will be performed.Results: Maximum number of pts had HbA1c levels of >8% and they accounted for 35.55%. Almost 98% of the patients had neuropathy, 50% of them had signs of ischemia and 80% had infection. Maximum number of patients (58.88%) presented with diabetic ulcers belonging to Class 2 of Wagners classification. The most commonly isolated P. aeruginosa was sensitive to colistin, imipenem and amikacin. Most diabetics with HbA1C levels >8, had mean antibiotic duration of 19.04±4.65 days.Conclusions: Prevention is the best treatment. Wagner’s classification helps in correlating appropriate treatment to proper grade of lesion with better outcome. Effective glycemic control and education are of key importance for decreasing diabetic foot disease.
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Kartono, Tommy, Muhammad Nuralim Mallapasi, Mulawardi Mulawardi, Sachraswaty R. Laidding, Meiliati Aminyoto, and Prihantono Prihantono. "Correlation of HDL cholesterol serum and Wagner’s severity level of diabetic foot ulcers." International Journal of Research in Medical Sciences 5, no. 12 (2017): 5129. http://dx.doi.org/10.18203/2320-6012.ijrms20175431.
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Background: Diabetic foot ulcers are one of the leading causes of amputation in non-traumatic patients. This research aimed to investigate the correlation between the level of HDL cholesterol and the severity level of diabetic foot ulcer based on Wagner classification. The study conducted at Wahidin Sudirohusodo Hospital, Makassar, Indonesia.Methods: This is an observational study with the cross-sectional design. The data collected before and after the treatment. The change of the levels of HDL cholesterol and the severity level of the diabetic foot ulcer based on Wagner classification during the treatment were analyzed. Data analyzed using Spearman Correlation test, the paired t-test to assess the change in the levels of HDL cholesterol and the levels of severity of diabetic foot ulcer based on Wagner classification at the time admission and after the treatment. ANOVA test was used to observe the reduction significance of the severity of diabetic foot ulcer based on Wagner classification, and it was categorized as significant if p<0.05.Results: The results indicated that there is a correlation between the level of HDL cholesterol and the severity level of diabetic foot ulcer based on Wagner classification either at the early treatment with p-value = 0.003 (r = - 0.448) and the end of the treatment with p-value = 0.001(r = - 0.477). The lower of the level of cholesterol HDL, the higher was the severity level of the diabetic foot ulcer. Meanwhile, the correlation between the increase of the level of HDL cholesterol and the reduction of Wagner classification during the treatment was statistically insignificant with p-value = 0.100 (r = - 0.215).Conclusions: there was a correlation between elevated HDL cholesterol levels during treatment with Wagner classification decrease during treatment, the higher the HDL change, the higher the Wagner classification, but this was weak correlation and statistically insignificant.
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Villegas-Ch, William, Angel Jaramillo-Alcázar, and Sergio Luján-Mora. "Evaluating the Robustness of Deep Learning Models against Adversarial Attacks: An Analysis with FGSM, PGD and CW." Big Data and Cognitive Computing 8, no. 1 (2024): 8. http://dx.doi.org/10.3390/bdcc8010008.
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This study evaluated the generation of adversarial examples and the subsequent robustness of an image classification model. The attacks were performed using the Fast Gradient Sign method, the Projected Gradient Descent method, and the Carlini and Wagner attack to perturb the original images and analyze their impact on the model’s classification accuracy. Additionally, image manipulation techniques were investigated as defensive measures against adversarial attacks. The results highlighted the model’s vulnerability to conflicting examples: the Fast Gradient Signed Method effectively altered the original classifications, while the Carlini and Wagner method proved less effective. Promising approaches such as noise reduction, image compression, and Gaussian blurring were presented as effective countermeasures. These findings underscore the importance of addressing the vulnerability of machine learning models and the need to develop robust defenses against adversarial examples. This article emphasizes the urgency of addressing the threat posed by harmful standards in machine learning models, highlighting the relevance of implementing effective countermeasures and image manipulation techniques to mitigate the effects of adversarial attacks. These efforts are crucial to safeguarding model integrity and trust in an environment marked by constantly evolving hostile threats. An average 25% decrease in accuracy was observed for the VGG16 model when exposed to the Fast Gradient Signed Method and Projected Gradient Descent attacks, and an even more significant 35% decrease with the Carlini and Wagner method.
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Villegas-Ch, William, Angel Jaramillo-Alcázar, and Sergio Luján-Mora. "Evaluating the Robustness of Deep Learning Models against Adversarial Attacks: An Analysis with FGSM, PGD and CW." Big Data and Cognitive Computing 8, no. 1 (2024): 1–23. https://doi.org/10.3390/bdcc8010008.
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This study evaluated the generation of adversarial examples and the subsequent robustness of an image classification model. The attacks were performed using the Fast Gradient Sign method, the Projected Gradient Descent method, and the Carlini and Wagner attack to perturb the original images and analyze their impact on the model’s classification accuracy. Additionally, image manipulation techniques were investigated as defensive measures against adversarial attacks. The results highlighted the model’s vulnerability to conflicting examples: the Fast Gradient Signed Method effectively altered the original classifications, while the Carlini and Wagner method proved less effective. Promising approaches such as noise reduction, image compression, and Gaussian blurring were presented as effective countermeasures. These findings underscore the importance of addressing the vulnerability of machine learning models and the need to develop robust defenses against adversarial examples. This article emphasizes the urgency of addressing the threat posed by harmful standards in machine learning models, highlighting the relevance of implementing effective countermeasures and image manipulation techniques to mitigate the effects of adversarial attacks. These efforts are crucial to safeguarding model integrity and trust in an environment marked by constantly evolving hostile threats. An average 25% decrease in accuracy was observed for the VGG16 model when exposed to the Fast Gradient Signed Method and Projected Gradient Descent attacks, and an even more significant 35% decrease with the Carlini and Wagner method.
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Jais, Suriadi, Kharisma Pratama, Jery Fahrain, Junaidi Junaidi, Tutur Kardiatun, and Uji Kawuryan. "The SHID wound classification system for diabetic foot ulcer patients: a validity study." Journal of Medicine and Life 15, no. 10 (2022): 1224–28. http://dx.doi.org/10.25122/jml-2022-0090.
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This study aimed to evaluate the predictive validity of the SHID (Suriadi, Haryanto, Imran dan Defa) wound classification system compared to TU (Texas University) and Wagner wound classification systems in Indonesia. A prospective cohort study included patients with diabetic foot ulcers at Kitamura wound clinic in Indonesia. A total of 111 diabetic foot ulcer patients were assessed with SHID, TU, and Wagner wound classification systems. Two postgraduate nursing students assessed 111 wounds of bedside patients and observed them for 4 weeks. The predictive validity test indicated that the cut-off score of ≤grade 2 for SHID was 74% and 97%, ≤grade IB for TU was 77% and 92%, then ≤grade 2 for Wagner was 84% and 71% for sensitivity and specificity, respectively. The area under the curve (AUC) in SHID, TU, and Wagner tools was 0.90 (95% CI: 0.828–0.950), 0.85 (95% CI: I0.766–0.910), and 0.86 (95% CI: 0.775–0.917), respectively. The Youden index for SHID, TU, and Wagner was 0.72%, 0.70%, and 0.55%, respectively. The wound classification systems are good tools for identifying diabetic foot ulcers. However, the newly developed SHID tool produced the best AUC and Youden Index values compared to the Wagner tool.
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Kumaraswamy, S. "Evaluation and Management of Diabetic Foot According to Wagner’s Classification." New Indian Journal of Surgery 11, no. 3 (2020): 359–61. http://dx.doi.org/10.21088/nijs.0976.4747.11320.16.
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Waghmare, Dr Sudatta, Dr Harshal Meshram, Dr Rajesh Mahey, Dr Tilakdas Shetty, and Dr Aman Singh. "Evaluation and management of diabetic foot according to Wagner’s classification." International Journal of Surgery Science 3, no. 4 (2019): 197–201. http://dx.doi.org/10.33545/surgery.2019.v3.i4d.239.
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Choubey, Divakar, and Jishan Ahmed. "WAGNER’S CLASSIFICATION FOR DIABETIC FOOT ULCERS- IS IT STILL RELEVANT?" Journal of Evolution of Medical and Dental Sciences 7, no. 28 (2018): 3155–59. http://dx.doi.org/10.14260/jemds/2018/710.
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Ravoori, Harish Babu, Chinnala Hyndavi, and Pradeep Kumar Vunnam. "A comparative study between Wagner’s classification and new wound based diabetic foot ulcer severity score." International Surgery Journal 10, no. 3 (2023): 443–49. http://dx.doi.org/10.18203/2349-2902.isj20230498.
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Background: Diabetes is considered to be one of the most common health problems all over the world in 21st century. In fact, it has been coined the ‘Black death of the 21st century due to its stark similarities with the 14th century plague in terms of rapid increase in its prevalence, morbidity and mortality. According to WHO, the number of diabetic patients in 2000 reached to 171 million and was predicted to increase to 380 million by 2020. The Indian diabetic population is expected to increase to 57 million by the year 2025. Diabetic foot ulcers are one of the most distressing complications of diabetes affecting around 15% of people with diabetes. The annual incidence of diabetic foot ulcers is around 3% and the reported incidence in U.S and U.K studies ranges as high as 10%. It has been reported that 85% of the lower limb amputations in diabetic patients are preceded by foot ulceration. These systems are variously based on the site of ulcer, depth, and presence or absence of neuropathy, infection and peripheral arterial disease and have been used to compare the outcomes. Diabetic ulcer severity score (DUSS) is one of the latest wound-based systems of classification. However, there is paucity of enough data to validate whether DUSS system is better as compared to other established and commonly used scoring system like Wagner’s classification. Hence, it was decided to validate DUSS scoring system with Wagner’s classification by comparing both keeping in view outcome of the disease. Methods: Patients admitted under various surgical units from January 2022-January 2023, at Mamata medical college and hospital, Khammam. Total of 40 diabetic patients with diabetic foot ulcers irrespective of their duration, attending surgical outpatient clinic or admitted into the hospital (Mamata general hospital) were recruited into the study based on the inclusion and exclusion criteria mentioned below. Results: DUSS score and Wagner’s score were found to be almost equal in evaluating the scores for treatment as p value was found to be statistically significant (p=0.001) and by KAPPA stats there was an absolute agreement (score 1) between DUSS and Wagner’s scoring system. Conclusions: The new severity scoring system (DUSS) is equal to gold standard Wagner’s scoring system for predictive analysis which also provides an early idea regarding hospital admission, local surgery and health care costs. Since this scoring system 72 can be easily applied in daily clinical practice, it may be suitable in estimating putative healthcare costs.
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Malepati, Srikrishna, Prakash Vakamudi, Jithendra Kandati, and Sreeram Satish. "Bacteriological study of diabetic foot ulcer according to Wagner’s classification: a one-year study." International Surgery Journal 5, no. 1 (2017): 98. http://dx.doi.org/10.18203/2349-2902.isj20175534.
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Background: Diabetes is considered as one of the most important and rapidly evolving non-communicable disease which requires top priority around the world. 10-25% of diabetics develop foot infections [DFI’s] during the course of their disease period ranging from simple calluses to major Osteomyelitis. 3 Microbial infections of the diabetic foot ulcers are difficult to manage because of multiple factors associated in response including overall glycaemic control, associated complications like vascular disease and neuropathy. The present study was done to assess the microbial flora according to Wagner’s classification for diabetic foot disease. To isolate, identify the aerobic bacterial pathogens and their drug sensitivity pattern with reference to ESBL productionMethods: A prospective study was conducted at a tertiary care hospital by department of general surgery among Diabetics presenting with diabetic foot infections. All the enrolled cases were classified based on Wagner’s classification and socio demographic data was noted. Specimens from the ulcer were collected and processed for isolation, identification of pathogens based on standard CLSI guidelines. The antibiotic sensitivity of the isolates was done and ESBL production was demonstrated by standard guidelines.Results: 346 cases were enrolled in study and grade-3 Wagner’s ulcers were predominant. Males were predominant, 46-55 years age group was common with mean age of 55.3±1.4 years. Peripheral arterial disease was more common than peripheral neuropathy and both were found significantly associated with development of ulcers. Methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa were most common isolates. MRSA exhibited maximum sensitivity to vancomycin, clindamycin and linezolid. Gram negative isolates exhibited maximum sensitivity to meropenems, piperacillin-tazobactam. The prevalence of ESBL producers in the study was 16.24%.Conclusions: DFI are a serious concern in uncontrolled diabetics and require proper management. Outcome of the infection depends upon the grading of the ulcer as per Wagner’s classification and also the nature of the infection either polymicrobial or with a single organism. Our study highlights and suggests that prospective multicentre studies are required to assess the appropriate antibiotic regimen in diabetic foot ulcers and proper management of antibiotics must be implemented to decrease the incidence and development of multi drug resistant organisms.
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Rizki, Eko, Raflis Rustam, and Vendry Rivaldy. "Risk Factors Related Amputation on Diabetic Foot Patients in Dr. M. Djamil General Hospital Padang." Bioscientia Medicina : Journal of Biomedicine and Translational Research 6, no. 5 (2022): 1732–37. http://dx.doi.org/10.37275/bsm.v6i5.506.
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Backgrounds. Diabetic foot is the most common cause of nontraumatic lower-extremity amputation. This study aims to assess the relationship of risk factors with the incidence of amputation in diabetic foot patients based on the Wagner classification at Dr. M. Djamil General Hospital Padang.
 Methods. The study design is an analytic observational study with a cross-sectional approach. A total of 46 diabetes mellitus patients with diabetic foot complications participated in this study. The risk factors assessed were gender, age, smoking status, hypertension, uncontrolled blood sugar, hypoalbumin, peripheral arterial disease, infection, and peripheral neuropathy. The assessment of the degree of diabetic foot complications was carried out using the Wagner classification. 
 Results. The most age group for diabetic foot sufferers is the age group of 41-60 years, which is 57.7% with the male sex being more dominant (59.6%) than the female gender. In the subject, there were more patients with the Wagner 4 classification (32.7%) than the other classification levels. Based on direct observation of patients, it was found that 53.8% of diabetic foot patients were amputated. Based on the results of the analysis, it was found that PAD (peripheral arterial disease) and peripheral neuropathy are variables that significantly affect amputation.
 Conclusion. Peripheral neuropathy and peripheral arterial disease are associated with amputation and peripheral arterial disease is a major risk factor for amputation in diabetic foot patients based on the Wagner classification.
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Zhu, Chaojun, Bing Zhou, Jiakang Lü, et al. "Principles of STAGE Management for Diabetic Foot Ulcers Based on the Wagner and Texas Classification Systems." International Journal of Lower Extremity Wounds 18, no. 4 (2019): 367–75. http://dx.doi.org/10.1177/1534734619863914.
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The current Wagner and Texas classifications of diabetic foot ulcers (DFUs) are used worldwide to assess the extent of foot lesions, but wound treatment principles based on both the classification systems are lacking. We have summarized the STAGE principles of wound treatment for clinical practice based on the Wagner and Texas classification systems. The STAGE principles refer to the principles of surgical intervention during wound treatment of DFUs and emphasize that “based on anatomical layers, the management focuses on blood supply and includes layer-by-layer incision to the infected area, maintenance of effective wound drainage, and step-by-step treatment of the wound.” During treatment, microcirculation improvement and microvascular angiogenesis (A) are essential for granulation tissue formation in the bone (skeleton, S) and tendons (T) and healing of the wound with reepithelialization (E). We defined the above mentioned steps as the STAGE principles, namely, layer-by-layer incision and step-by-step management (Phase A is essential for the treatments in Phases S-T and G-E). Ulcers or gangrene formed during Phases S-T or T should be treated according to the STAGE or TAGE principles, respectively. Similar treatment principles are applied in the other phases. However, treatments at each phase are not isolated and can be performed simultaneously. The STAGE principle can be combined with the tissue, infection, moisture, and wound edge (TIME) and TIME-H chronic wound treatment principles to eliminate the shortcomings of a single principle in wound management.
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Oseni, Isiaq Olasunkanmi, and Ibrahim Ayoade Adekunle. "The Relevance of Wagner’s Hypothesis in Achieving Sustainable Development Agenda in Nigeria." Signifikan: Jurnal Ilmu Ekonomi 9, no. 1 (2020): 123–36. http://dx.doi.org/10.15408/sjie.v9i1.12884.
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Policy ambiguity in the form of non-directional and non-purposeful use of state resources has made sustainable growth outcomes a mirage in Nigeria. The recent economic crisis prompted the debate on how increased government spending induces sustainable economic growth in Nigeria. This paper examines the validity or otherwise of Wagner’s theory in Nigeria for the realization of the Sustainable Development Goals (SDGs) from 1980 through 2017. By using time-series data on real gross domestic product, total government expenditure, money supply, and domestic investment and adopting the two-step Engle and Granger estimation procedure, result shows that increased government spending significantly predicts variations in real gross domestic product and thus leaned empirical credence to Wagner’s hypothesis as an essential concept for the attainment of Sustainable Development Goals in Nigeria. This paper recommended that the government should exhaust all possible option to increase expenditure in order to realize sustainable growth in Nigeria. JEL Classification: E62, O11 How to Cite:Oseni, I. O., & Adekunle, I. A. (2020). The Relevance of Wagner’s Hypothesis in Achieving Sustainable Development Agenda in Nigeria. Signifikan: Jurnal Ilmu Ekonomi, Vol. 9(1), 123-136. doi: http://dx.doi.org/10.15408/sjie.v9i1.12884
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Jalles, Joao. "Wagner’s law and governments’ functions: granularity matters." Journal of Economic Studies 46, no. 2 (2019): 446–66. http://dx.doi.org/10.1108/jes-02-2018-0049.
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Purpose The purpose of this paper is to assess the responses of different categories of government spending to changes in economic activity. In other words, the authors empirically revisit the validation of the Wagner’s law in a sample of 61 advanced and emerging market economies between 1995 and 2015. Design/methodology/approach The authors do so via panel data instrumental variables and time-series SUR approaches. Findings Evidence from panel data analyses show that the Wagner’s law seems more prevalent in advanced economies and when countries are growing above potential. However, such result depends on the government spending category under scrutiny and the functional form used. Country-specific analysis revealed relatively more cases satisfying Wagner’s proposition within the emerging markets sample. The authors also found evidence of counter-cyclicality in several spending items. All in all, the Wagner’s regularity seems more the exception than the norm. Originality/value While in the literature on the size of the public sector with respect to a country’s level of economic development has received much attention, the authors make several novel contributions: since some economists criticized Wagner’s law because of ambiguity of the measurement of government expenditure (Musgrave, 1969), instead of looking at aggregate public expenditures, the authors go much more granular into the different functions of government (to this end, the authors use the Classification of Functions of the Government nomenclature). The authors check the validity of the Law via an instrumental variable approach in a panel setting; after that, the authors take into account the phase of the business cycle using a new filtering technique to compute potential GDP (output gap); then, the authors cross-check the baseline results by considering alternative functional form specifications of the Law; and finally, the authors look at individual countries one at the time via SUR analysis.
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Jørgensen, Tue Smith, Ylva Hellsten, Hans Gottlieb, and Stig Brorson. "Assessment of diabetic foot ulcers based on pictorial material: an interobserver study." Journal of Wound Care 29, no. 11 (2020): 658–63. http://dx.doi.org/10.12968/jowc.2020.29.11.658.
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Objective: The frequent change in clinicians, and the emerging use of photographic documentation in wound management, could require a more diverse treatment of patients due to poor interobserver agreement. The aim of this study was to assess the interobserver agreement of a commonly used classification system for diabetic foot ulcers (DFUs), the Meggitt–Wagner classification, and to compare the agreement on classification with the agreement in treatment recommendations. Method: An interobserver study was conducted based on a questionnaire linked to 30 photographs of DFUs. Different groups of observers were tested to investigate whether there was a difference between professions or level of education: experienced orthopaedic wound care doctors (n=7); nurses specialised in wound care (n=8) and untrained nurses assigned to a diabetic wound care training course (n=23). Krippendorff's alpha was used to calculate interobserver agreement, and an agreement of >0.67 was defined as substantial. Results: The Krippendorff's alpha value for interobserver agreement on the Meggitt–Wagner classification was 0.52 for the doctors group, 0.67 for the specialised nurses and 0.61 for the untrained nurses. The corresponding values regarding agreement on recommendation of surgical revision of the wound were 0.35, 0.22 and 0.15, respectively. The choice of dressing type or antibiotic treatment had even lower interobserver agreement. Conclusions: The interobserver agreement on the Meggitt–Wagner classification was substantial in the specialised nurse group, but the evaluation and treatment of DFUs should not be exclusively based on pictorial materials.
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Jawed Mohammad Akther, Imran Ali Khan, Vinay V. Shahpurkar, Najnin Khanam, and Zahiruddin Quazi Syed. "Evaluation of the diabetic foot according to Wagner’s classification in a rural teaching hospital." British Journal of Diabetes & Vascular Disease 11, no. 2 (2011): 74–79. http://dx.doi.org/10.1177/1474651411406372.
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Pei, YongTing. "Semantics of paired feminine images in the operatic creativity of R. Wagner (on the example of the Tangheiser opera)." Aspects of Historical Musicology 29, no. 29 (2022): 143–59. http://dx.doi.org/10.34064/khnum2-29.08.
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Statement of the problem. Musical semantics is directly related to the phenomenon of musical content – modeling, understanding and generalization of the events of a musical work. The semantic approach is based on the study of the content of the elements of the musical language. Turning to paired images embodies a new perspective on the classification of operatic characters. The lack of research on this issue determines the scientific novelty and relevance of the chosen topic. The work of R. Wagner is indicative of the phenomenon of paired images. In his opera works, such characters form their own dramatic line. Analysis of recent research and publications. Among the latest studies devoted to the worldview of R. Wagner and the philosophy of his work, the scientific investigations of L. Havrylchyk (2015) and B. Kotyuk (2013), O. Polishchuk, V. Warrior (2016) proved useful. Issues directly related to the Tannh&#228;user opera, namely, the mythological aspect and tonal semantics, are considered in the works of O. Roschenko (2007), S. Litti (2014), K. Seigrified (2015). Separately, it should be noted the research on semantics as a general cultural and, in particular, musical category – O. K&#252;hl’s manual (2008) and F. Mozhaev’s article (2014). Main objective of the study is to determine the semantics of paired female images – Venus and Elizabeth – in R. Wagner’s opera “Tangh&#228;user”. The scientific novelty. The novelty of the research lies in the fact that for the first time the semantics of paired female images is investigated using onomatopoeic and comparative methods at the level of musical language and at the figurative-emotional plan in the context of the general dramaturgy of the opera. Methodology. The following research methods are used: onomatological, semantic, genre-stylistic, functional-systemic, structural-functional, comparative, intonation analysis method. Results and conclusion. The semantics of the images of Elizabeth and Venus embody the idea of a contrasting juxtaposition of two worldviews. At the “mythological” level, which in R. Wagner’s operas serves as the foundation, the first basis, connections with Apollonian and Dionysian principles can be traced. These aesthetic categories are used to denote the two primary forms of cultural creativity – light, intellectual, rational and dark, passionate, ecstatic-irrational. At the highest, “religious” level, the images of Venus and Elizabeth correspond to different forms of religion: pagan and Christian. In the opera “Tannh&#228;user” Elizabeth and Venus are participants in the main love triangle (Tannh&#228;user-Venus-Elizaveta) and have different effects on the fate of the protagonist of the opera. The semantics of the images of Venus and Elizabeth are most appropriate to be considered precisely in the context of their pairing, and not separately. Two female characters are built according to the principle of complementary contrast and during the dramatic development remain two opposite “driving forces” of the main storyline.
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Irawan, Julcrithno, and Mulawardi Mulawardi. "An Epidemiologic Study on Type 2 Diabetic Foot Disorders in Indonesia -A Perspective from an Uncontrolled Blood Glucose Level until Amputation-." Perspective: The Practice of Vascular Surgery in The ‘New Normal Times’ 1, no. 2 (2020): 41–45. http://dx.doi.org/10.36864/jinasvs.2020.2.010.
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Introduction: The prevalence of diabetes mellitus is continuously increasing worldwide and expected to reach more than 500 million people in 10 to 15 years later. In Indonesia, neglected case for diabetic foot and uncontrolled blood glucose level make the amputation rate is higher. The aim of this study is to describe the diabetic foot disease among Indonesian population, underlying disease, and the all of the treatments in our hospital. Method: All conservative and operative procedures in diabetic foot during the period of January 2017 – December 2018 was collected in Wahidin Sudirohusodo Hospital. All demographic data, disease classifications, laboratory results, and treatments were collected from medical records retrospectively. Results: In total of 229 patients, were found 1.02:1 male-to-female ratio of patients, where most of patients were in the sixth decade as much as 41%. The most Wagner classification was in the Grade 4 (29.%), HbA1C >6.5mg/dL was found in 68.6% patients with higher WBC counts in 71.2%. Of 44.1% patients were treated conservatively, whilst 127 (55.9%) patients were treated operatively, which were debridement and amputation procedures. We found mortality rate of 3.9% as an outcome. Conclusion: The incidence of diabetic foot is increasing. Uncontrolled blood glucose levels (HbA1C) become one of the causes. Proper handling on controlling blood glucose and podiatry treatment can decrease morbidity and mortality rates. Keywords: diabetic foot, Wagner, amputation, Indonesia
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Jun, Dongkeun, Yongseok Kwon, Jaehyun Bae, et al. "Using DIRECT Wound Assessment to Predict Limb Salvage and Provide Prognosis of Diabetic Foot Ulcers." Journal of Wound Management and Research 17, no. 1 (2021): 9–18. http://dx.doi.org/10.22467/jwmr.2020.01368.
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Background: Many wound assessment systems including the Wagner classification and University of Texas (UT) grading system have been previously described. The authors of this study applied the DIRECT (Debridement of necrosis, Infection control, Revascularization, Exudate control, Chronicity, and Top surface) wound coding system for initial assessment of diabetic foot ulcers (DFUs) to predict limb salvage and prognosis.<br/>Methods: From January 2016 to February 2020, a total of 169 first-time DFU patients were retrospectively evaluated using the DIRECT wound coding assessment system. DFUs were followed up for at least 6 months, and scores in each component of the coding system according to final limb status were statistically evaluated. The coding assessment’s ability to predict major amputation was compared to those of the Wagner classification and the UT grading system.<br/>Results: Subjects were divided into complete healing (n=80, 47.3%), not healed (n=71, 42%), and amputation (n=18, 10.7%) groups. The mean values of each component of DIRECT assessment for the complete healing/amputation groups were D 0.86/1.56 (P<0.001), I 0.46/0.89 (P=0.001), R 0.65/0.94 (P=0.014), E 1.15/1.56 (P=0.049), C 0.69/0.89 (P=0.086), T 0.53/0.72 (P=0.13) and the sum was 3.140/4.741 (P<0.001). The area under the receiver operating characteristic curve of the DIRECT, Wagner, and UT grading systems was 0.722, 0.603, and 0.663, respectively.<br/>Conclusion: The DIRECT coding system shows a greater association with prediction of amputation or complete healing, compared with the Wagner and UT wound classification systems. This more accurate wound assessment system will be helpful in predicting prognosis and planning treatments.
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Jaén-Garcia, Manuel. "A Review of Wagner’s Law with Disaggregated Data for Spain." Applied Economics Quarterly: Volume 66, Issue 1 66, no. 1 (2020): 65–92. http://dx.doi.org/10.3790/aeq.66.1.65.
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Wagner’s Law has been widely tested using empirical analysis, yet very few studies have conducted this analysis using disaggregated data over an extended period of time. This study examines the economic classification of public spending (COFOG) in Spain for the period 1958 – 2015. Our findings confirm previous results in the sense that the law is not rejected for public spending as a whole. Furthermore, our results reveal that social aid and current transfers can be considered as luxury goods as their demand grows more than proportionally when income rises. Our findings also confirm the results of other studies in which education, healthcare and social aid all fail to reject Wagner’s Law. The study provides two important contributions to the literature. First, the study considers a substantially long time period to examine the relationship between different categories of public spending and economic growth. This type of analysis has been carried out on occasion for other economies but never for the Spanish case. Second, our study uses the methodology of unit roots and cointegration with structural breaks, representing an innovation in this field.
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Khan, Kamran, Irfan Ali Sheikh, Usman Ghani, et al. "Efficacy of Vacuum Assisted Closure Therapy In Healing Diabetic Foot." Pakistan Armed Forces Medical Journal 75, SUPPL-1 (2025): S24—S28. https://doi.org/10.51253/pafmj.v75isuppl-1.6331.
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Objective: To determine the efficacy of vacuum assisted closure therapy compared to conventional therapy in treatment of diabetic foot. Study design: Prospective comparative study Place and Duration of Study: Pak Emirates Military Hospital and Combined Military Hospital, Rawalpindi Pakistan, from November 2019 to December 2020. Methodology: All patients with type II diabetes mellitus aged 45 years and above having Wagner’s classification I or II for diabetic foot were consecutively enrolled into two groups (Group A: vacuum assisted closure technique; Group B: conventional wound management technique). Patients were assessed till 4 weeks. The outcomes were assessed as pain, ulcer size, Wagner’s grade, Granulation score, complete healing, time duration since healing, and debridement requirement. Results: Of total 60 patients, the median age was 58(54-64) years. There were 21(35%) males and 39(65%) females. The median duration of diabetes was 13(12-15) years. Pain was found significantly lower in group A than that of group B, i.e., 3(0-3) vs. 7 (6-7), p-value <0.001. Similarly, ulcer size was significantly lower in group A as compared to group B, i.e., 12(10-12) vs. 13(13-14), p-value <0.001. However, no significant association of Wagner’s grade (p-value 0.108), granulation score (p-value 0.776), complete healing (p-value 0.573), time duration since healing (p-value 0.633), and debridement requirement (p-value 0.273) was found with respect to group. Conclusion: The efficacy of vacuum assisted closure was found higher in treatment of diabetic foot compared to conventional therapy.
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Maulana, Muhammad Ghaly, Nanang Miftah Fajari, and Dewi Indah Noviana Pratiwi. "Correlation of Ankle - Brachial Index (ABI) and Low - Density Lipoprotein (LDL) with Diabetic Foot Severity Degree." Berkala Kedokteran 16, no. 1 (2020): 41. http://dx.doi.org/10.20527/jbk.v16i1.8205.
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Abstract: Diabetic foot is a complication of diabetes mellitus which is characterized by ulceration in the legs. The severity of the diabetic foot can be determined by the Wagner-Meggit system which in this study uses 5 categories namely degrees 1 - 5 degrees. ABI (Ankle-Brachial Index) is an evaluation of peripheral arterial disease in diabetic foot patients. LDL is the main factor of atherosclerosis which causes macrovascular disorders in diabetic foot. The purpose of this study was to determine the correlation between ABI and LDL on the severity of diabetic foot based on the Wagner-Meggit classification. The method used is observational analytic with cross sectional approach. A total of 35 samples were obtained by consecutive sampling. Data analysis was performed using the Spearman test and logistic regression. A significant correlation was obtained between ABI and the severity of diabetic foot (p = 0.06; r = -0.424), there was no correlation between LDL and the severity of diabetic foot (p = 0.09; r = -0.395). The results of logistic regression analysis found no correlation between ABI (p = 0.163; OR = 0.008) and LDL (p = 0.69; OR = 0.984) with the severity of the diabetic foot. Obtained Negelkerke R Square value of 0.095. Keywords: Diabetic foot, ABI, LDL, Wagner-Meggit classification