Photosensitivity During Quinolone Therapy in Diabetic Foot Patients May Falsely Indicate Treatment Failure

2020 ◽  
pp. 153473462095897
Author(s):  
Chariclia V. Loupa ◽  
Evangelia Meimeti ◽  
Eleftherios D. Voyatzoglou ◽  
Andriana Donou ◽  
Sophia Kalantzi ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Clinical Examination ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Sun Exposure ◽  
The Body ◽  
Skin Structure ◽  
Left Limb ◽  
Left Lower Limb

Acute bacterial skin and skin structure infections (ABSSSI), also referred to as skin and soft tissue infections, or skin and skin structure infections, with or without osteomyelitis (OM) in diabetic foot are complications of diabetes. Quinolones are a widely used class of antibiotics in ABSSSI and OM, and photosensitivity is among their adverse reactions. Its appearance may falsely indicate treatment failure. We describe 2 such cases. The first patient is a 49-year-old male with type 2 diabetes mellitus (DM), who presented with left lower limb ulcer with fever (39 °C) over a week. He began treatment with ciprofloxacin, clindamycin, and linezolid. Although his clinical condition and laboratory tests improved, the redness of the left lower limb increased. Clinical examination revealed redness on the face and the parts of the body that had been exposed to sunlight. The patient continued the same antimicrobial therapy and was given instructions to avoid exposure to sunlight. Redness and infection improved, and the patient was discharged. The second case is a 72-year-old male with a history of type 2 DM, admitted to hospital because of an infected ulcer of the first toe of the right limb. The patient received intravenous treatment with levofloxacin and clindamycin. On the fourth hospital day, the patient presented redness (with eczematous plaques) on his left lower limb. Clinical examination revealed that the patient’s bed was placed near a window and his left limb was exposed to direct sunlight. Patient’s bed was changed to avoid sun exposure. Symptoms began to improve over the next few days.

scholarly journals Hyperfibrinogenemia in Peripheral Arterial Disease: Coexistent and Independent Risk Factor (A Report of Two Cases and Review of Literature)

PRILOZI ◽  
2018 ◽  
Vol 39 (2-3) ◽  
pp. 93-96
Author(s):  
Marijan Bosevski ◽  
Gorjan Krstevski ◽  
Irena Mitevska ◽  
Emilija Antova ◽  
Golubinka Bosevska
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Lower Limb ◽  
Case Reports ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Lower Limb Ischemia ◽  
Left Limb ◽  
Peripheral Arterial

Abstract These case reports aim to show that hyperfibrinogenemia is a risk factor for the progression and prognosis of peripheral arterial disease (PAD), in patients with and without diabetes mellitus type 2. We present a patient with PAD who has type 2 diabetes mellitus, who has previously been repeatedly treated for lower limb ischemia with multiple vascular surgeries performed. A few weeks before admission the patient developed critical lower limb ischemia, which was treated with an iliaco-popliteal and femorofemoral bypass. The patient had elevated serum fibrinogen values. In the current admission, renewed left limb ischemia was diagnosed, and surgically evaluated with a recommendation for amputation of the left limb as a surgical recommendation. Our second patient had a stable intermittent claudication, dyslipidemia and hyperfibrinogenemia. He was successfully treated for those risk factors. Regular monitoring of the patient showed improved claudication distance and quality of life Our case reports, supported by a literature review, demonstrate that hyperfibrinogenemia is a possible risk factor for progression and the prognosis of PAD.

scholarly journals Multiple CNS Tumors in a Patient With Neurofibromatosis Type 2: Classical Presentation of a Rare Disease

2020 ◽  
Author(s):  
Aamer Ubaid ◽  
Farishta Waheed ◽  
Awais Naeem
Keyword(s):  
Rare Disease ◽  
Lower Limb ◽  
Neurofibromatosis Type ◽  
Neurofibromatosis Type 2 ◽  
Lumbar Region ◽  
Nerve Paralysis ◽  
Function Tests ◽  
Left Lower Limb ◽  
History Of

Neurofibromatosis type 2 is a genetic autosomal dominant disorder caused by a spontaneous mutation in the gene located on chromosome 22 q11-13.1, which usually emerges in adolescence or early adulthood and is characterized by the development of bilateral vestibular schwannoma. We hereby report the classical case of Neurofibromatosis type 2 in a 25-year-old young male with multiple tumors associated with the disease. This patient presented to us with 3 years history of multiple painless nodules on his skin, facial weakness, left-sided progressive hearing loss, and 20 days history of weakness in the left lower limb. On Examination, he was vital with a GCS of 15/15. He was anemic with no jaundice. He had left inguinal lymphadenopathy along with multiple subcutaneous nodules on different areas, including the scalp, face, left mid-axillary line over the abdomen. He also had Right-sided facial palsy and horizontal nystagmus. CNS examination revealed an upgoing plantar on the left side, right facial nerve palsy, and bilateral vestibulocochlear nerve paralysis. Spine examination revealed spinal tenderness in the lower lumbar region. Superficial abdominal reflexes were absent. Upper limb and right lower limb power, tone, and reflexes were normal while the tone and power in the left lower limb were reduced power being ⅗. Reflexes were also exaggerated in the left lower limb. The right ankle showed swelling, most probably a plexiform neuroma. On investigations, he had normochromic normocytic anemia with mild leucocytosis. Platelets were normal. The rest of the biochemical investigations, including serum electrolytes, liver function tests, and renal function tests, were also normal.MRI brain and spine confirmed bilateral acoustic neuroma and multiple cranial and peripheral nerve tumors i.e., classical presentation of a rare disease neurofibromatosis. He was referred to the neurology unit for further assessment and treatment.

scholarly journals AN ALTERNATE MODALITY OF STRIPPING OF VARICOSE VEINS

2021 ◽  
Vol 9 (06) ◽  
pp. 735-738
Author(s):  
Khulem Stellone Singh ◽  
Midhun Chowdary Kothari ◽  
Shilpa Patankar ◽  
Pankaj Bansode
Keyword(s):  
Risk Factors ◽  
Clinical Examination ◽  
Lower Limb ◽  
Clinical Condition ◽  
Varicose Veins ◽  
Systemic Disease ◽  
Abdominal Pressure ◽  
Prolonged Standing ◽  
Below The Knee ◽  
Left Lower Limb

Varicose veins are very common clinical condition characterised by permanently dilated torturous elongated veins in the leg which is due to incompetence of valves. Risk factors being heredity, occupations of prolong standing, immobility, raised intra abdominal pressure, raised progesterone level, altered oestrogen-progesterone ratio etc. A 27 years old patient with no h/o any systemic disease or co morbidities came with complaints of dilated, tortuous veins in the left lower limb extending from mid-thigh to ankle region since 2 months. Since 1 month the patient was having dull aching pain over the left lower limb on walking and prolonged standing. A thorough clinical examination was done with findings of incompetent Sapheno-femoral junction(SFJ) and perforator incompetence of the left lower limb. A venous Doppler of the left lower limb revealed SFJ dilated and incompetent and Incompetent perforators along the GSV 5 cm below the knee. Following all routine preoperative work-ups, patient was posted for surgery. After ligating all the tributarirs of GSV, while checking the metallic stripper, it snapped in between and was not in a useable condition and there was no other metallic stripper in the OT. Decision had to be taken for an alternative the GSV was sucessfully stripped using a 14F Neltons catheter. Thus as an alternative to metallic stripper, a Neltons catheter can also be used for stripping varicose veins.

scholarly journals A comparative assessment of flexibility of backline and strength of lower limb in bharatnatyam dancers and non-dancers

2021 ◽  
Vol 8 (11) ◽  
pp. 5431
Author(s):  
Shreya M. Otari ◽  
Anjali Puntambekar
Keyword(s):  
Lower Limb ◽  
Statistical Difference ◽  
The Body ◽  
Classical Dance ◽  
Long Period ◽  
Pelvic Inclination ◽  
Lower Limb Strength ◽  
Significant Difference ◽  
Left Lower Limb ◽  
Indian Classical Dance

Background: Bharatnatyam is an Indian classical dance form which have been practiced for a long period of time and is equivalent to any sporting activity. The postures attained during this dance form require good amount of muscle strength and flexibility among the dancers. There is lack of research on flexibility of backline and lower limb strength in bharatnatyam dancers. The overall function of the superficial backline is to support the body in full upright extension and impacts musculoskeletal dynamics. The lumbar lordosis angle and the pelvic inclination angle in bharatnatyam dancers is more than the non-dancers which can affect the backline flexibility. This study analysed if there is any difference, in the lower limb strength and flexibility of backline as compared to participants of same age group.Methods: 10 bharatnatyam dancers and 10 non-dancers between 15 to 30 years participated in this study. Triple hop distance test for both sides and toe touch test was used to check the strength of lower limb and flexibility of backline respectively.Results: There was significant difference in the triple hop distance of right lower limb between bharatnataym dancers and non-dancers. There was no significant difference in the triple hop distance of left lower limb between the two groups. There was not quite significant difference in the toe touch test of between the two groups.Conclusions: There was significant difference in the strength and power of right lower limb of dancers as compared to right lower limb of non-dancers. There was no statistical difference in the left lower limb of both the groups. There was no statistical difference between the flexibility of backline of bharatnatyam dancers and non-dancers.

scholarly journals Strategy of Surgical Management of Peripheral Neuropathy Form of Diabetic Foot Syndrome in Ghana

2014 ◽  
Vol 2014 ◽  
pp. 1-7
Author(s):  
W. M. Rdeini ◽  
P. Agbenorku ◽  
V. A. Mitish
Keyword(s):  
Diabetes Mellitus ◽  
Surgical Management ◽  
Surgical Procedures ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Skin Grafting ◽  
Wound Management ◽  
Vacuum Therapy ◽  
Reconstructive Plastic

Introduction. Foot disorders such as ulceration, infection, and gangrene which are often due to diabetes mellitus are some major causes of morbidity and high amputation. Aim. This study aims to use a group of methods for the management of diabetic foot ulcers (DFU) in order to salvage the lower limb so as to reduce the rate of high amputations of the lower extremity. Materials and Methods. A group of different advanced methods for the management of DFU such as sharp debridement of ulcers, application of vacuum therapy, and other forms of reconstructive plastic surgical procedures were used. Data collection was done at 3 different hospitals where the treatments were given. Results. Fifty-four patients with type 2 diabetes mellitus were enrolled in the current study: females n=37 (68.51%) and males n=17 (31.49%) with different stages of PEDIS classification. They underwent different methods of surgical management: debridement, vacuum therapy (some constructed from locally used materials), and skin grafting giving good and fast results. Only 4 had below knee amputations. Conclusion. Using advanced surgical wound management including reconstructive plastic surgical procedures, it was possible to reduce the rate of high amputations of the lower limb.

scholarly journals Elephantiasis and Directed Occupational Rehabilitation

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Jose Maria Pereira de Godoy ◽  
Henrique Jose Pereira de Godoy ◽  
Ana Carolina Pereira de Godoy ◽  
Maria de Fátima Guerreiro Godoy
Keyword(s):  
Body Mass Index ◽  
Body Weight ◽  
Lower Limb ◽  
Occupational Rehabilitation ◽  
The Body ◽  
Compression Stockings ◽  
Left Lower Limb ◽  
History Of ◽  
Bilateral Lower Limb

The aim of the present study was to demonstrate the cure of elephantiasis over a ten-year follow-up period and novel discoveries with directed occupational rehabilitation. A 66-year-old female patient with a history of bilateral lower limb lymphedema reported the aggravation of the condition over the years, reaching stage III (elephantiasis). The physical examination confirmed elephantiasis. The circumference of the left lower limb was 106 cm. Her body weight was 106 kilograms, height was 160 cm, and the body mass index (BMI) was 41.6 kg/m2. The patient was submitted to intensive treatment for three weeks, which led to a 21-kg reduction in weight and 66 cm reduction in leg circumference. Ten years after treatment, the patient has maintained the results with the compression stockings. Elephantiasis can be cured, although lymphedema cannot. The cure of elephantiasis depends on maintaining the treatment of lymphedema after normalization or near normalization. Directed occupational therapy stimulates the search for new activities and a life closer to normality.

scholarly journals The Influence of Diabetic Foot Exercise on Sugar Levels In Type 2 Diabetes Mellitus Patients at Tanjung Buntung Public Health Center 2018

2018 ◽  
Vol 1 (1) ◽  
pp. 1
Author(s):  
Rizki Sari Utami Muchtar ◽  
Indah Triyani Dingin
Keyword(s):  
Public Health ◽  
Health Center ◽  
Blood Sugar ◽  
Diabetic Foot ◽  
The United States ◽  
The Body ◽  
Public Health Center ◽  
The World ◽  
Sugar Levels

Diabetes is a chronic disease that occurs either when the pancreas does not produce insulin or when the body is not effective enough in producing insulin. The International Diabates Federation (IDF) shows that the number of people who suffer diabetes in Indonesia is estimated at 10 million and half seventh rank highest in the world, Indonesia is the 4th country with the highest prevalence of diabetes in the world after India, China and the United States. The phenomenon found in the Tanjung Buntung Public Health Center working area in 2017 was 420 of them, 206 men and 214 people. This study aims to determine the influence of diabetic foot gymnastics on blood sugar levels with the research design using the Quasi experimental method with pretest and posttest without control research method, by sample collection using total sampling the sample of 20 respondents. The statistical test in this study uses the Paired T-Test which is tested first in the Shapiro-Wilk normality test. The results of it study indicate a decrease of 196.85 with a value of ρ-value of 0.000 or > 0.05. obtained a decrease average in blood sugar levels before diabetic foot exercises 239.60 mg / dL with poor criteria and after exercise 196.85 mg / dL with moderate criteria. Therefore it can be concluded that there is the influence of diabetic foot exercise on blood sugar levels in type 2 DM patients. Advice from researchers is expected to always be held diabetic foot exercise ini Tanjung Buntung’s health center to  reduce blood sugar levels in patient with type 2 diabetesmellitus

scholarly journals Sociodemographic and clinical characteristics of patients with diabetic foot ulcer

2016 ◽  
Vol 62 (2) ◽  
pp. 171-178 ◽  
Author(s):  
Susana Pedras ◽  
Rui Carvalho ◽  
Maria da Graça Pereira
Keyword(s):  
Type 2 Diabetes ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Clinical Characteristics ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Cross Sectional ◽  
Caregiver Support ◽  
Amputation Surgery

Summary Introduction: Diabetic foot is one of the most serious complications of diabetes affecting about 15% of all diabetes patients, and it is the leading cause of nontraumatic lower limb amputations. This study presents a sociodemographic and clinical characterization of patients with diabetic foot ulcer indicated for amputation surgery. Methods: A cross-sectional study with 206 patients with type 2 diabetes and a diabetic foot ulcer indicated for amputation surgery. Patients were assessed on sociodemographic and clinical characteristics, pain intensity and pain interference, after answering the Brief Pain Inventory, and on pain descriptors according to the Douleur Neuropathique 4. Results: Most patients were male, with little formal education and a mean age of 66 years. They had been diagnosed with type 2 diabetes for 18 years on average, and with diabetic foot ulcer on average 4 years prior to the assessment. About 59% of patients experienced pain in the lower limb that significantly affect all areas of their functioning. Conclusion: The social demographic variables play an important role in diabetic foot ulceration. Given that the neuropathic ulcers are more easily preventable, systematic monitoring of patients with neuropathy is important. In patients with neuroischemic foot, strategies to cope or manage more efficiently the pain are paramount. Intervention should be multidisciplinary and take into account sociodemographic and clinical factors, as well as the presence, intensity and interference of pain in the patient's daily life activities and whether the patient has family or caregiver support.

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