A clinical analysis of diabetic patients with hand ulcer in a diabetic foot centre

Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients and lead to high morbidity and mortality. Numerous dressings have been developed to facilitate wound healing of DFUs. This study investigated the wound healing efficacy of silver-releasing foam dressings versus silver-containing cream in managing outpatients with DFUs. Sixty patients with Wagner Grade 1 to 2 DFUs were recruited. The treatment group received silver-releasing foam dressing (Biatain® Ag Non-Adhesive Foam dressing; Coloplast, Humlebaek, Denmark). The control group received 1% silver sulfadiazine (SSD) cream. The ulcer area in the silver foam group was significantly reduced compared with that in the SSD group after four weeks of treatment (silver foam group: 76.43 ± 7.41%, SSD group: 27.00 ± 4.95%, p < 0.001). The weekly wound healing rate in the silver foam group was superior to the SSD group during the first three weeks of treatment (p < 0.05). The silver-releasing foam dressing is more effective than SSD in promoting wound healing of DFUs. The effect is more pronounced in the initial three weeks of the treatment. Thus, silver-releasing foam could be an effective wound dressing for DFUs, mainly in the early period of wound management.

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Diagnostic value of procalcitonin, erythrocyte sedimentation rate (ESR), quantitative C-reactive protein (CRP) and clinical findings associated with osteomyelitis in patients with diabetic foot

Human Antibodies ◽

10.3233/hab-210439 ◽

2021 ◽

pp. 1-7

Author(s):

Zahra Soleimani ◽

Fatemeh Amighi ◽

Zarichehr Vakili ◽

Mansooreh Momen-Heravi ◽

Seyyed Alireza Moravveji

Keyword(s):

Erythrocyte Sedimentation Rate ◽

Sedimentation Rate ◽

Roc Curve ◽

Diabetic Foot ◽

Diagnostic Value ◽

Clinical Findings ◽

Diabetic Patients ◽

C Reactive Protein ◽

Reactive Protein ◽

Erythrocyte Sedimentation

BACKGROUND: The diagnosis of osteomyelitis is a key step of diabetic foot management. Procalcitonin (PCT) is a novel infection marker. This study aimed to investigate the diagnostic value of procalcitonin and other conventional infection markers and clinical findings in diagnosis of osteomyelitis in diabetic foot patients. METHODS AND MATERIALS: This diagnostic value study was carried out on ninety patients with diabetic infected foot ulcers admitted in Kashan Beheshti Hospital, 2016. After obtaining consent, 10 cc blood sample was taken for measuring serum PCT, CBC, ESR, CRP and FBS. Clinical characteristics of the wounds were noted. Magnetic resonance imaging of the foot was performed in all patients to diagnose osteomyelitis. All statistical analyses were done with the use of SPSS-16. RESULTS: PCT levels were 0.13 ± 0.02 ng/mili patients with osteomyelitis (n= 45) and 0.04 ± 0.02 ng/ml in patients without osteomyelitis (n= 45). PCT, Erythrocyte sedimentation rate and C-reactive protein was found significantly higher in patients with osteomyelitis (p< 0.001). The ROC curve was calculated for PCT. The area under the ROC curve for infection identification was 1 (p< 0.001). The best cut-off value for PCT was 0.085 ng/ml. Sensitivity, specificity, and positive and negative predictive values were 100%, 97.8%,97.8% and 100%, respectively. CONCLUSION: In this group of patients, PCT was useful to discriminate patients with bone infection. Also, Erythrocyte sedimentation rate and C-reactive protein can be used as a marker of osteomyelitis in diabetic patients.

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A STUDY ON KNOWLEDGE, ATTITUDES, AND PRACTICES FOR THE PREVENTION OF DIABETIC FOOT IN RURAL TERTIARY CARE TEACHING HOSPITAL

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2017v9i9.20114 ◽

2017 ◽

Vol 9 (9) ◽

pp. 138

Author(s):

Gopal Teli ◽

B. G. Ponnappa

Keyword(s):

Diabetic Foot ◽

Tertiary Care ◽

Self Care ◽

Research Centre ◽

Care Practice ◽

Diabetic Patients ◽

Foot Care ◽

Cross Sectional ◽

Attitudes And Practices ◽

The Mean

Objective: To assess the knowledge, attitude, and practice of diabetic patients regarding care of their own feet.Methods: This is a cross-sectional study conducted in the inpatient department of surgery at Adichunchanagiri hospital and research centre, B. G. Nagara, Karnataka, India from 1st Nov. 2016 to 31st Dec. 2016. The relation between gender and knowledge, attitude and practices of people with diabetes patients were compared by using the Chi-square test at 95% confidence interval at p<0.05.Results: Out of 51 patients, 72.54% were male and 27.46% female and 45.1% of the patients were in the age range 61-80 y. The mean SD of the age was 60.49±14.02. The mean SD of body weight of the patient was 66.17±8.54. The majority of the patients 45.1% were farmers and 41.7% were illiterate. Most of them did not know the practice of correct foot hygiene (39.22%) and what abnormalities observe in their feet (66.67%). We found that 90.2% patients were engaged in foot self-care practice and more than half of them (54.1%) always inspected their footwear before using it. Interestingly, more women were involved in foot care (100%) as compared to men (86.46%) but statistically not significant (p=0.147).Conclusion: We found that patients were not having sufficient knowledge about the correct hygiene of the foot, what abnormalities to observe in their feet and about ideal footwear. Even though females were showing interest towards self-care examination and foot care practice, it is essential that all the diabetic patients must be educated about the knowledge, attitude and foot self-care practice to prevent diabetic foot related complications.

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Joint Consultation Clinic by Infectious Diseases Specialists and Podiatry team (ID-POD) Compliments the Care of Diabetic Patients with Foot Infections by Reducing Cost and Decreasing Outpatient Clinic Visits

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.776 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S328-S328

Author(s):

Pushpalatha Bangalore Lingegowda ◽

Say-Tat Ooi ◽

Jyoti Somani ◽

Chelsea Law ◽

Boon Kiak Yeo

Keyword(s):

Infectious Diseases ◽

Diabetic Foot ◽

Wound Care ◽

Cost Savings ◽

Outpatient Setting ◽

Multidisciplinary Teams ◽

Diabetic Patients ◽

Wound Debridement ◽

Diabetic Foot Infections ◽

Before And After

Abstract Background Management of diabetic foot infections (DFI) is challenging and involves multidisciplinary teams to improve outcomes (1). Appropriate wound care of patients with DFI plays an important role in successfully curing infections and promote wound healing. In Singapore, Infectious Diseases (ID) specialists help in the management of DFI by recommending appropriate antibiotics for infected wounds while wound debridement are managed by Podiatrists (POD). When patients are hospitalized multidisciplinary teams including Vascular Surgery review patients. In the outpatient setting patients have multiple appointments including ID and Endocrinology etc. The time spent and costs incurred by patients for traveling to multiple appointments is considerable. A joint ID-POD clinic was initiated to reduce the cost and inconvenience for patients. Methods A joint weekly clinic was initiated in October’16 and the data was analyzed upto May’17. Finance was involved in deriving costs. The service costs for consultations payable by patients before and after the initiation of the joint clinic were compared. Results First 6 months experience of initiating the joint ID-POD clinic is reported. 35 unique patients had a total of 88 visits. 1/third of the patients had more than 2 visits to the joint clinic. For each visit to the joint clinic the patient paid 25% less compared with having separate clinics. The hospital lowered the service cost for the new clinic by 11%. This was done by minimizing the time involvement of the ID physician. Conclusion Joint ID-POD clinic for managing diabetic patients with foot infections revealed several advantages. Hospital outpatient visits for each patient decreased by 50% for those requiring care of both ID and POD, without compromising care. With the consolidation of care each individual patient had a cost savings of 25% for the joint consultation. This joint clinic while making it convenient for patients has revealed significant cost savings to patients especially for those requiring multiple visits. We recommend hospitals with high prevalence of Diabetes and Diabetic foot infections to consider joint ID-POD clinics to reduce hassle and increase saving for patients. Disclosures All authors: No reported disclosures.

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Staphylococcus aureus strains isolated from diabetic foot ulcers. Identification of the antibiotic resistant phenotypes

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2013-0038 ◽

2013 ◽

Vol 20 (4) ◽

pp. 389-393 ◽

Cited By ~ 2

Author(s):

Teodora Chiţă ◽

Delia Muntean ◽

Luminiţa Badiţoiu ◽

Bogdan Timar ◽

Roxana Moldovan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Staphylococcus Aureus ◽

Diabetic Foot ◽

Foot Ulcer ◽

Foot Ulcers ◽

Resistance Pattern ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Bacterial Strains ◽

Diabetes Clinic

Abstract Background and aims: Infected foot ulcer is one of the most feared complications of diabetes mellitus. Staphylococcus aureus is the most frequently isolated pathogen in diabetic foot infections. The aim of this study was to evaluate the prevalence of S. aureus strains involved in producing foot infections in diabetic patients and the antibiotic resistance pattern of these strains. Material and methods: The study included 33 S. aureus strains isolated from 55 diabetic foot ulcers. The subjects were selected from the 2465 patients with diabetes mellitus hospitalized in the Timişoara Diabetes Clinic, between 2011 and 2013. Germs’ identification relied on cultural and biochemical characteristics. Final identification and antimicrobial testing were performed using the Vitek 2 (Bio Merieux France) automatic analyzer. Results: All the 55 samples collected from diabetic foot ulcers were positive. We isolated 64 bacterial strains (some samples were positive for 2 microorganisms). The most frequently isolated germ was S. aureus, in 33 samples (51.56%). All these S. aureus strains showed resistance to benzylpenicillin, while only 33.33% were methicillin-resistant (MRSA). Conclusions: The most frequently isolated germ in the wound secretions from diabetic foot ulcers was S. aureus. The highest percentage of antimicrobial resistance was recorded to benzylpenicillin and erythromycin.

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Randomized Prospective Controlled Trial of Recombinant Granulocyte Colony-Stimulating Factor as Adjunctive Therapy for Limb-Threatening Diabetic Foot Infection

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.45.4.1094-1098.2001 ◽

2001 ◽

Vol 45 (4) ◽

pp. 1094-1098 ◽

Cited By ~ 66

Author(s):

Fausto de Lalla ◽

Giampietro Pellizzer ◽

Marco Strazzabosco ◽

Zeno Martini ◽

Giovanni Du Jardin ◽

...

Keyword(s):

Diabetic Foot ◽

Adjunctive Therapy ◽

Standard Treatment ◽

Diabetic Patients ◽

Cumulative Number ◽

Granulocyte Colony Stimulating Factor ◽

Colony Stimulating Factor ◽

Diabetic Foot Infection ◽

Number Of Patients ◽

Stimulating Factor

ABSTRACT Adult diabetic patients admitted to our Diabetes Center from September 1996 to January 1998 for severe, limb-threatening foot infection were consecutively enrolled in a prospective, randomized, controlled clinical study aimed at assessing the safety and efficacy of recombinant human granulocyte colony-stimulating factor (G-CSF) (lenograstim) as an adjunctive therapy for the standard treatment of diabetic foot infection. Forty patients, all of whom displayed evidence of osteomyelitis and long-standing ulcer infection, were randomized 1:1 to receive either conventional treatment (i.e., antimicrobial therapy plus local treatment) or conventional therapy plus 263 μg of G-CSF subcutaneously daily for 21 days. The empiric antibiotic treatment (a combination of ciprofloxacin plus clindamycin) was further adjusted, when necessary, according to the results of cultures and sensitivity testing. Microbiologic assessment of foot ulcers was performed by both deep-tissue biopsy and swab cultures, performed at enrollment and on days 7 and 21 thereafter. Patients were monitored for 6 months; the major endpoints (i.e., cure, improvement, failure, and amputation) were blindly assessed at weeks 3 and 9. At enrollment, both patient groups were comparable in terms of both demographic and clinical data. None of the G-CSF-treated patients experienced either local or systemic adverse effects. At the 3- and 9-week assessments, no significant differences between the two groups could be observed concerning the number of patients either cured or improved, the number of patients displaying therapeutic failure, or the species and number of microorganisms previously yielded from cultures at day 7 and day 21. Conversely, among this small series of patients the cumulative number of amputations observed after 9 weeks of treatment appeared to be lower in the G-CSF arm; in fact, only three patients (15%) in this group had required amputation, whereas nine patients (45%) in the other group had required amputation (P = 0.038). In conclusion, the administration of G-CSF for 3 weeks as an adjunctive therapy for limb-threatening diabetic foot infection was associated with a lower rate of amputation within 9 weeks after the commencement of standard treatment. Further clinical studies aimed at precisely defining the role of this approach to this serious complication of diabetes mellitus appear to be justified.

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Blind Comparative study between Silver nanoparticles dressings and Standard Moist Wound Dressings (SMWD) in management of diabetic foot ulcers

QJM ◽

10.1093/qjmed/hcab097.040 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Amr Abdelaal ◽

Mostafa Soliman ◽

Hany Rafik ◽

Mohamed Emam ◽

Mohamed Mahmoud Mohamed Elsadek

Keyword(s):

Silver Nanoparticles ◽

Diabetic Foot ◽

Wound Dressing ◽

Treatment Modalities ◽

Controlled Study ◽

Foot Ulcers ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Group A ◽

Group B

Abstract Background Diabetic foot ulcers (DFUs) are the main cause of hospitalization in diabetic patients and they are considered a major worldwide health problem. Thus, there is a need to evaluate various treatment modalities. In this study we will assess the clinical efficacy of Silver nanoparticles dressing vs Standard Moist Wound Dressing (SMWD) in management of diabetic foot ulcers. Objective To compare wound outcome, limb salvage, healing time of diabetes related foot ulcers and cost effectiveness in terms of duration of hospital stay between Silver nanotechnology dressings and Standard moist wound therapy (SMWT) in management of diabetic foot ulcers. Patients and Methods This is a prospective randomized controlled study involving 34 patients with active diabetic foot ulcers, in a high volume tertiary referral vascular center. They were divided into 2 groups: 17 patients (group A) were prescribed SMWD and the other 17 patients (group B) received Silver nanoparticles wound dressing. Results Our study correlates with the study conducted by K.Suhas et al. which had observed that Silver nanoparticles wound dressing was safe and effective treatment for complex diabetic foot wounds and could lead to higher proportion of healed wounds and faster healing rates. At the end of the study, group B promised a better outcome as compared to group A. Conclusion The role of Silver nanoparticles wound dressing in healing of diabetic foot ulcers has been proposed as a novel method of manipulating the chronic wound environment in a way that it reduces bacterial burden and chronic interstitial wound fluid, increases vascularity and cytokine expression and to an extent mechanically exploiting the viscoelasticity of peri wound tissues.

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Pro- and Anti-Angiogenic Factors: Their Relevance in Diabetic Foot Syndrome—A Review

Angiology ◽

10.1177/00033197211042684 ◽

2021 ◽

pp. 000331972110426

Author(s):

Martyna Schönborn ◽

Patrycja Łączak ◽

Paweł Pasieka ◽

Sebastian Borys ◽

Anna Płotek ◽

...

Keyword(s):

Diabetic Foot ◽

Healing Process ◽

Arterial Disease ◽

Angiogenic Factors ◽

Diabetic Foot Syndrome ◽

Tissue Loss ◽

Comprehensive Treatment ◽

Diabetic Patients ◽

Impaired Wound Healing ◽

Peripheral Arterial

Peripheral arterial disease can involve tissue loss in up to 50% of patients with diabetic foot syndrome (DFS). Consequently, revascularization of narrowed or occluded arteries is one of the most common forms of comprehensive treatment. However, technically successful angioplasty does not always result in the healing of ulcers. The pathomechanism of this phenomenon is still not fully understood, but inadequate angiogenesis in tissue repair may play an essential role. Changes in pro- and anti-angiogenic factors among patients with DFS are not always clear and conclusive. In particular, some studies underline the role of decreased concentration of pro-angiogenic factors and higher levels of anti-angiogenic mediators. Nevertheless, there are still controversial issues, including the paradox of impaired wound healing despite high concentrations of some pro-angiogenic factors, dynamics of their expression during the healing process, and their mutual relationships. Exploring this process among diabetic patients may provide new insight into well-known methods of treatment and show their real benefits and chances for improving outcomes.

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