We have read with interest the editorial written by Papanas and Papachristou. 1 This article highlights some relevant aspects about the potential role of bidirectional cytokine imbalance due to SARS-Cov-2 (severe acute respiratory syndrome coronavirus 2) infections in diabetic foot patients referred to neuropathy, peripheral arterial disease, and improvement of injuries due to decrease of daily activities. Almost 8 months have passed since the SARS-CoV-2 outbreak began. We have witnessed how vulnerable populations, for example, patients with diabetes mellitus, are at major risk. In our hospital, we frequently treated patients with SARS-Cov-2 infected and diabetic foot simultaneously. Therefore, it is also relevant to discuss about corticoid therapy as an important pillar in the management and effect on wound healing. Both topical and systemic corticosteroids induce many changes on the skin. The treatment potency and duration have an effect on wound healing. 2 They reduce the proliferation of keratinocytes and fibroblasts 3 and decrease the expression of genes involved in collagen synthesis, such the human type VII collagen gene-COL7A1. 4 Moreover, collagen alterations have been observed by inhalation of lowdose corticosteroids for a short time. 5 Additionally, the presence of biofilms, which consist of encapsulated bacteria in a layer of extracellular polymeric substances that help their survival, is an important factor to take into account in wound healing. 6 The response mechanism of bacteria to steroids has remained unclear, but they have a direct action reducing biomass. 7 Another factor is the bacterial resistance, with different effects depending on the phenotype-gram positive or negative-and type of corticosteroids employed. 8 We conclude that continuous use of corticosteroids would have a negative effect in terms of wound healing. However, its use at low doses in critically ill patients with respiratory failure reduced the mortality rate; therefore, it is important that the physician take into account the doses and prescription of corticosteroids to adapt the ulcer therapy. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The objective was to determine the association between a diabetes mellitus duration greater than 10 years and the severity of diabetic foot in hospitalized patients in Latin America. Analytical, observational, and retrospective study based in secondary databases. Patients older than 18 years with diagnosis of diabetes mellitus (DM) and hospitalized for any causes were included. The independent and dependent variables were having more than 10 years of diagnosis of DM and the severity of the diabetic foot disease (Wagner> = 2), respectively. A crude Poisson regression analysis was performed to obtain prevalence rates adjusted to confounders. Male gender was 54.8% and the median age was 62 years. In the group with more than10 years of disease (n = 903) 18% (n = 162) had severe injuries. We performed two Poisson regression analyzes, one of which included the entire sample; and in the other, only patients with some degree of ulcer were included at the time of evaluation (Wagner > = 1). In the first analysis the PR was 1.95 ( p < 0.01) adjusted for the significant variables in the bivariate analysis and in the second analysis the PR was 1.18 ( p < 0.01) adding to the adjustment the days of injury prior to hospitalization and the location of the ulcer. We conclude that in patients with more than 10 years of diabetes mellitus, diabetic foot injuries are more severe, regardless type of diabetes, gender, age, history of amputation and days of injury prior to hospitalization for inpatients in Latin America.