scholarly journals Non-Tropical Diabetic Hand Syndrome in Peru: A Case Report

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A394-A394
Author(s):  
Gonzalo Francisco Miranda ◽  
Luciana del Pilar Rafael
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Arterial Disease ◽  
Diabetic Neuropathy ◽  
Urban Areas ◽  
Ketone Bodies ◽  
Arterial Disease ◽  
Surgical Debridement ◽  
Diabetic Patients ◽  
Left Hand ◽  
Peripheral Arterial

Abstract Background: The diabetic foot is the most studied spectrum in relation to musculoskeletal complications in diabetic patients but upper extremities may be affected, producing from superficial hand injuries to multiorganic failure due to sepsis. Tropical diabetic hand syndrome has been used to describe a potentially dangerous infection in the hand, generally diagnosed in areas of the tropics. Nevertheless, cases have been seen in non-tropical areas in marginal urban areas which are part of the spectrum of Non tropical diabetic hand syndrome. Clinical Case: A 52-year-old woman, from marginal urban area of Lima- Peru with type 2 diabetes mellitus (T2DM) of 6 years in poor metabolic control. She was admitted to the emergency room with two weeks of volume increase, erythema, purulent secretion, flogosis in the fifth finger of the left hand and fever. Initial tests confirmed mild diabetic ketoacidosis and sepsis (pH: 7.29; Glucose: 320 mg / dl, Bicarbonate: 15 mEq/L, Ketone bodies - urine (+), leukocytes 14360 cells/mm3, CRP: 180). Intravenous antibiotic was started. A surgical debridement and amputation of the fifth finger of the left hand was decided. Patient with unfavorable evolution, on the eight day, was admitted to new surgical debridement without clinical improvement. Arterial Doppler Ultrasound and CT angiography confirmed distal arterial insufficiency due to monophasic flow in the left ulnar artery with the presence of collateral circulattion. A third surgical debridement and amputation of the fourth finger of the left hand was done with favorable postoperative clinical evolution. Non tropical diabetic hand syndrome affects predominantly women, between 50 to 60 years, with low socio-cultural level and deficient glycemic control, as in case presented. Other factors include body mass index < 20kg/m2, DM 1 and diabetic neuropathy. Diabetic neuropathy is the most common risk factor in Non tropical diabetic hand syndrome cases, with a prevalence of 88%, while peripheral arterial disease was present in 11% of cases. In this report, neuropathy and peripheral arterial disease were present. Conclusion: Non tropical diabetic hand syndrome is uncommon and underdiagnosed complication of Diabetes Mellitus that has an important clinical repercussion as an important cause of disability. Detailed physical examination of the hands in a patient with diabetes for detection of these cases is highlighted because an early diagnosis and treatment improves prognosis.

scholarly journals Lower sensitivity of ankle-brachial index measurements among people suffering with diabetes-associated vascular disorders: A systematic review

2019 ◽  
Vol 7 ◽  
pp. 205031211983503 ◽  
Author(s):  
Ayman Abouhamda ◽  
Majid Alturkstani ◽  
Yousef Jan
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Arterial Disease ◽  
Systemic Disease ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Lower Sensitivity ◽  
Index Measurement ◽  
Cardiovascular Morbidity And Mortality ◽  
Peripheral Arterial

Diabetes mellitus is a systemic disease affecting microvascular and macrovascular systems and is considered as the strongest risk factor for peripheral arterial disease. Although the prevalence of the peripheral arterial disease is high among people living with diabetes, its severity is not accurately detected with the prevalent diagnostic methodologies. The ankle-brachial index measurement is a simple, objective, and reliable tool for diagnosis of peripheral arterial disease. However, it is of limited value in the diagnosis of peripheral arterial disease among diabetic patients due to its low sensitivity among diabetic individuals. Diabetes mellitus results in atherosclerosis and calcification of peripheral arterial walls leading to false normal ankle-brachial index values. Therefore, healthcare practitioners should be careful not to misinterpret ankle-brachial index results among diabetic patients. A literature search was conducted using the keywords “ankle-brachial index,” “interpretation,” “limitations,” “diabetic foot,” and “peripheral arterial disease” on different medical search engines. The results were manually scanned and then further reviewed to select the articles related to our topic of discussion. This article will review the use of ankle-brachial index measurement among diabetic patients, its limitations and its prognostic value. In Conclusion, Ankle-brachial index can be used for diagnosis of peripheral arterial disease with some precautions (e.g. raising the threshold of diagnosis or using the lowest systolic pressure value measured at the ankle) and can also be a prognostic indicator for cardiovascular morbidity and mortality.

The interrelationship between diabetes mellitus and peripheral arterial disease – a systematic review

VASA ◽  
2020 ◽  
pp. 1-8
Author(s):  
Konstanze Stoberock ◽  
Mark Kaschwich ◽  
Shiva Sophia Nicolay ◽  
Nazeh Mahmoud ◽  
Franziska Heidemann ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Peripheral Arterial Disease ◽  
Practice Guidelines ◽  
Perioperative Complications ◽  
English Literature ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Consensus Statements ◽  
Peripheral Arterial

Summary: This systematic review examined the interrelationship between concomitant diabetes mellitus (DM) and peripheral arterial disease (PAD). The objective was to determine differences in the prevalence as well as in the outcomes in diabetic vs. non-diabetic PAD patients. The current review followed a study protocol that was published online in German in 2017. The search included societal practice guidelines, consensus statements, systematic reviews, meta-analyses, and observational studies published from 2007 to 2020 reporting symptomatic PAD and concomitant DM in patients undergoing invasive open-surgical and endovascular revascularizations. German and English literature has been considered. Eligibility criteria were verified by three independent reviewers. Disagreement was resolved by discussion involving a fourth reviewer. 580 articles were identified. After exclusion of non-eligible studies, 61 papers from 30 countries remained, respectively 850,072 patients. The included studies showed that PAD prevalence differed between diabetic vs. non-diabetic populations (20–50% vs. 10–26%), and further by age, gender, ethnicity, duration of existing diabetes, and geographic region. The included studies revealed worse outcomes regarding perioperative complications, amputation rate, and mortality rate in diabetic patients when compared to non-diabetic patients. In both groups, the amputation rates decreased during the research period. This review emphasizes an interrelationship between PAD and DM. To improve the outcomes, early detection of PAD in diabetic patients, and vice versa, should be recommended. The results of this systematic review may help to update societal practice guidelines.

Fifteen Coagulation and Fibrinolysis Parameters in Diabetes Mellitus and in Patients with Vasculopathy

1984 ◽  
Vol 52 (02) ◽  
pp. 138-143 ◽  
Author(s):  
M Christe ◽  
J Fritschi ◽  
B Lämmle ◽  
T H Tran ◽  
G A Marbet ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Arterial Disease ◽  
Negative Correlation ◽  
Fibrinolytic Activity ◽  
Antithrombin Iii ◽  
Predictor Variable ◽  
Arterial Disease ◽  
Thrombin Time ◽  
Peripheral Arterial ◽  
Coagulation And Fibrinolysis

SummaryFifteen haemostasis parameters have been measured in 48 normal persons, 36 diabetics without and 44 with complications and 27 with peripheral arterial disease. Since the patients groups are older than normals, part of the differences are due to age. However, the differences are significant between normals and patients. They become highly significant for the diabetics with complications and nephropathy (Table 7). In diabetics without complications factor VIII functions, fibrinogen and thrombin time are related to age whereas there is a negative correlation for the fibrinolytic activity and antithrombin III. The diabetic complications shade off the correlations, which subsist only for VIIIR: CoF, VIIIR: Ag, ATIII and lysis before stasis. With Hbalc as dependent variable VIIIR:CoF is the only significant predictor variable in diabetics (Table 9).

Peripheral Arterial Disease in Non-Diabetic Patients is Associated with Worse Outcomes after LVAD Implantation

2021 ◽  
Vol 40 (4) ◽  
pp. S171-S172
Author(s):  
V.T. Truong ◽  
S. Shreenivas ◽  
I. Rajapreyar ◽  
M. Shah ◽  
R.J. Alvarez ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Arterial Disease ◽  
Diabetic Patients ◽  
Peripheral Arterial

scholarly journals The relation of anatomical distribution of symptomatic peripheral arterial disease (PAD) with HbA1c level in patients with type 2 diabetes mellitus

2021 ◽  
Vol 12 ◽  
pp. 204201882110005
Author(s):  
Nawaf J. Shatnawi ◽  
Nabil A. Al-Zoubi ◽  
Hassan M. Hawamdeh ◽  
Yousef S. Khader ◽  
Mowafeq Heis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Peripheral Arterial Disease ◽  
Hba1c Level ◽  
Arterial Disease ◽  
Anatomical Distribution ◽  
The Mean ◽  
Peripheral Arterial

Aims: Increased level of glycated hemoglobin (HbA1c) is associated with an increased prevalence of peripheral arterial disease (PAD). This study aimed to assess the relationship between the anatomical distribution of symptomatic PAD lesions in patients with type 2 diabetes and HbA1c levels at the time of PAD diagnosis. Patients and methods: A retrospective study was conducted at King Abdullah University Hospital during the period August 2011 to December 2015. Consecutive patients with type 2 diabetes presented with symptomatic PAD confirmed by computed tomography-angiography (CTA) were included in this study. CTA images were reviewed. Relevant information including demographic data, PAD symptoms, comorbidities, HbA1c level, lipid profile, C-reactive protein and the mean platelets volume were retrieved from medical records. Results: A total of 332 patients with type 2 diabetes (255 males and 77 females) were included in this study. The mean HbA1c at the time of PAD diagnosis was 8.68% (±2.06%). The prevalence of hemodynamic relevant atherosclerotic lesions of the superficial femoral artery, popliteal artery, leg vessels, femoro-popliteal, and crural segments was significantly higher in patients with HbA1c >7.5% compared with patients with HbA1c ⩽7.5%. Conclusion: The anatomical distribution of symptomatic PAD in patients with type 2 diabetes mellitus differed significantly according to HbA1c level at the time of PAD diagnosis.

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