scholarly journals Informativeness of bone intraoperative culture for diagnose osteomyelitis in diabetic foot patients.

2020 ◽  
Vol 22 (5) ◽  
pp. 428-435
Author(s):  
Vitaly O. Tsvetkov ◽  
Olga V. Kolovanova ◽  
Oxana E. Frolova ◽  
Tatiana A. Gusarova ◽  
Ludmila G. Ezhova
Keyword(s):  
Diabetic Foot ◽  
Clinical Signs ◽  
Diagnostic Value ◽  
Bone Infection ◽  
Control Group ◽  
Bone Culture ◽  
Bone Resection ◽  
Patients With Diabetes ◽  
High Level ◽  
Reliable Sign

BACKGROUND: Diagnosis of osteomyelitis in diabetic foot patients is frequently not obvious due to similar clinical and X-ray signs of bone infection and Sharcot osteopathy, but it is very important because of opposite approach to treatment of these conditions. Today we do not have reliable parameters to determine the devastation of bone infection and, therefore, the rational volume of bone resection and debridement. AIMS: To determine the diagnostic value of bone culture for osteomyelitis in diabetic foot patients. MATERIALS AND METHODS: 177 patients underwent surgery due to different forms of diabetic foot. In 131 of them clinical signs of osteomyelitis were revealed and this diagnosis was confirmed by histology. 46 patients with diabetes who underwent high-level amputation without bone infection formed the control group. Intraoperative bone cultures and histological samples were taken in all cases. RESULTS: We found similar microbial landscape in various forms of diabetic foot and in control group. The frequency of positive intraoperative cultures in patients without osteomyelitis was detected as 63%. The sensitivity of bone culture was counted as 86,3%, the specificity as 37%, the accuracy 73.5%. CONCLUSIONS: Our findings suggest that bone culture is not reliable sign of bone infection in diabetic foot patients due to its low specificity. In our judgment, the only way to determine rational level of bone resection is visual intraoperative assessment and clinical signs such as development of granulation tissue and wound healing.

Comparative Evaluation of the Diagnostic Value of Procalcitonin and hsCRP for the Presence of Mild-to-Moderate Diabetic Foot Infections

2021 ◽  
pp. 153473462110118
Author(s):  
Ani S. Todorova ◽  
Rumyana B. Dimova ◽  
Nevena Y. Chakarova ◽  
Mina S. Serdarova ◽  
Greta G. Grozeva ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
White Blood Cells ◽  
Clinical Signs ◽  
Area Under The Curve ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Diagnostic Value ◽  
Control Group ◽  
Diabetic Foot Infections ◽  
Grade 3

The aim of this study is to compare the efficacy of procalcitonin (PCT) and high-sensitive C-reactive protein (hsCRP) as diagnostic biomarkers in patients with diabetes and mild-to-moderate diabetic foot infections. A total of 119 patients (102 with type 2 diabetes and 17 with type 1 diabetes), of mean age 60.29 ± 10.05 years, divided into 3 groups—diabetic foot ulcer (DFU) with active infection (IDFU group, n = 41), DFU without clinical signs of infection (non-IDFU group, n = 35), and a control group with diabetes without DFU (n = 43). Infection severity was graded according to the International Working Group on the Diabetic Foot guideline—non-IDFU group as Grade 1, IDFU group as Grade 2 (n = 22), and Grade 3 (n = 19). Serum hsCRP was assessed by the immunoturbidimetric method and PCT by the enzyme chemiluminescence immunoassay (ECLIA) method. Levels of white blood cells (WBC) were assessed using the Medonic hematology analyzer and erythrocyte sedimentation rate (ESR) by the Westergren method. Serum hsCRP, WBC count, and ESR were significantly higher in the IDFU group as compared to non-IDFU and control groups, whereas PCT levels did not differ between the groups. hsCRP presented with higher sensitivity (80%), specificity (79%), area under the curve (AUC) 0.856, in comparison to PCT (sensitivity 63%, specificity 62%, AUC 0.617) for the presence of IDFU, as well as in the Grade 3 subgroup (84% sensitivity and specificity, AUC 0.911). The combined model of both markers did not present with better accuracy than using hsCRP alone. In conclusion, hsCRP appears to be a better diagnostic biomarker than PCT in the diagnosis of moderate foot ulcer infection. Both markers fail to distinguish mild infection.

scholarly journals Urinary excretion of type IV collagen as an early marker of renal fibrosis in patients with diabetes mellitus

2011 ◽  
Vol 14 (4) ◽  
pp. 29-31 ◽  
Author(s):  
Irina Arkad'evna Bondar' ◽  
Vadim Valer'evich Klimontov ◽  
Ekaterina Mikhailovna Parfent'eva ◽  
Vyacheslav Vital'evich Romanov ◽  
Alexander Petrovich Nadeev
Keyword(s):  
Type 1 Diabetes ◽  
Urinary Excretion ◽  
Renal Fibrosis ◽  
Type Iv Collagen ◽  
Diagnostic Value ◽  
Control Group ◽  
Type Iv ◽  
Patients With Diabetes

Aim. To determine the diagnostic value of urinary excretion of type IV collagen in patients with type 1 diabetes with different stages of nephropathy.Methods. Urinary type IV collagen was determined in 60 patients with type 1 diabetes (23 with normal albuminuria, 28 with microalbuminuriaand 9 with macroalbuminuria) by an enzyme immunoassay. 10 healthy individuals were acted as the control group. Renal biopsy was performedin 22 patients. Deposits of type IV collagen were revealed by 11 individuals by immunohistochemistry. Results. The urinary excretion of type IV collagen increased with severety of diabetic nephropathy, correlating with the urinary albumin/creatinineratio, serum creatinine and parameters of daytime and nighttime systolic and diastolic blood pressure. Patients with excessive accumulation of typeIV collagen in the glomeruli had significantly higher level of type IV collagen in the urine. Conclusion. The determination of urinary type IV collagen can be used for early detection of renal fibrosis in patients with type 1 diabetes.

Diagnostic efficacy of serum and urinary netrin-1 in the early detection of diabetic nephropathy

2021 ◽  
pp. jim-2021-001785
Author(s):  
Rasha A Elkholy ◽  
Reham L Younis ◽  
Alzahraa A Allam ◽  
Rasha Youssef Hagag ◽  
Muhammad Tarek Abdel Ghafar
Keyword(s):  
Diabetic Nephropathy ◽  
Early Detection ◽  
Characteristic Curve ◽  
Fasting Blood Glucose ◽  
Area Under The Curve ◽  
Diagnostic Value ◽  
Control Group ◽  
Diagnostic Efficacy ◽  
Significant Difference ◽  
Patients With Diabetes

This study aimed to assess the diagnostic value of serum and urinary netrin-1 in patients with type 2 diabetes mellitus (T2DM) at different stages of diabetic nephropathy (DN) and to compare its efficacy of estimation in serum with that in the urine. This study was carried out on 135 patients with T2DM and 45 healthy subjects. The patients with diabetes were divided according to urinary albumin creatinine ratio (UACR) into: T2DM with normoalbuminuria, incipient DN with microalbuminuria, and overt DN with macroalbuminuria groups. Serum and urinary levels of netrin-1 were measured by ELISA. The mean levels of serum and urinary netrin-1 were significantly higher in the microalbuminuric and macroalbuminuric patients with DN than those in the normoalbuminuric patients with T2DM, with the highest values detected in macroalbuminuric patients with DN. Urinary netrin-1 level was significantly higher in the normoalbuminuric T2DM group than control group, whereas no significant difference existed regarding serum netrin-1 level. In T2DM groups, the urinary and serum netrin-1 correlated with each other and were independently related to fasting blood glucose, UACR, and estimated glomerular filtration rate. Receiver operating characteristic curve analysis showed that the area under the curve of urinary netrin-1 was 0.916 which is significantly higher than that of serum netrin-1 (0.812) for the detection of incipient DN and reached 0.938 on coestimation of both urinary and serum netrin-1. In conclusion, netrin-1 is a potential diagnostic marker for early detection of DN with its estimation in urine has higher accuracy than that of serum.

scholarly journals Bubbling Treatment Option in the Complex Therapy of Diabetic Foot Syndrome

2021 ◽  
Vol 14 (3) ◽  
pp. 210-215
Author(s):  
Anton Petrovich Ostroushko ◽  
Alexander Alekseevich Andreev ◽  
Alexander Alexandrovich Shmarin ◽  
Vladislav Valeryevich Novomlinsky ◽  
Anastasia Yurievna Laptiyova ◽  
...  
Keyword(s):  
Treatment Option ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Treatment Method ◽  
Late Complications ◽  
Diabetic Foot Syndrome ◽  
Control Group ◽  
Results Of Treatment ◽  
Patients With Diabetes ◽  
After Cancer

Diabetes mellitus (DM) is the most common and socially significant endocrine disease that leads to early disability and is the most common cause of mortality in patients after cancer and cardiovascular pathology. The cost of managing patients with diabetes can reach 30% of the country's health budget, 90% of which is spent on the treatment of its complications. Diabetic foot syndrome (DFS) is developed in 20-80% of patients and is one of the most dangerous late complications. In clinical practice, various approaches to its treatment are used, but the number of high amputation and mortality rate in this group of patients remains significant. The aim of the study was to improve the results of treatment of patients with diabetic foot syndrome (DFS) by including the bubbling treatment method in the program of therapeutic measures. Forty-eight patients with neuropathic and neuroischemic forms of DFS were treated. The control group consisted of 23 patients receiving conventional treatment, the main group included 26 patients, who were applied bubbling treatment option locally. The analysis of groups of patients showed no significant differences by gender, age, stages of diabetic foot syndrome, depth of necrotic defect, complications and concomitant diseases. The use of the bubbling treatment method in the complex treatment of patients with DFS allowed more effectively arresting symptoms of local (edema, hyperemia, wound exudate, necrolysis) and general inflammation, anemia and intoxication syndromes, contributed to the activation of regeneration processes in soft tissues, which, combined with complex FDS treatment, together, reduced the number of amputations by 18.7%.

scholarly journals Value of Resistin in Early Onset Neonatal Sepsis

2017 ◽  
Vol 07 (01) ◽  
pp. e146-e150
Author(s):  
Abdurrahman Ozdemir ◽  
Yusuf Elgormus
Keyword(s):  
Neonatal Sepsis ◽  
Early Onset ◽  
Neonatal Intensive Care ◽  
Clinical Signs ◽  
Area Under The Curve ◽  
Scoring Systems ◽  
Diagnostic Value ◽  
Sepsis Group ◽  
Control Group ◽  
Reactive Protein

AbstractThe diagnosis of neonatal sepsis is usually difficult because the sign and symptoms are nonspecific. Although C-reactive protein (CRP) and procalcitonin (PCT) are the most commonly used auxiliary tests, they are not reliable enough markers to be used for diagnosis of neonatal sepsis. This study aimed to evaluate the efficacy of resistin in diagnosing early onset neonatal sepsis and to compare its effectiveness to CRP and PCT. This prospective study was performed in the neonatal intensive care unit of Medicine Hospital between June and September 2016. Twenty-nine infants in the sepsis group and 33 infants in the control group were recruited. The Töllner scoring system was used for clinical signs. The hematologic parameters were evaluated using the Manroe and Rodwell scoring systems. The blood samples for CRP, PCT, and resistin were collected at admission (T0), and at 72 hours (T3). Mean plasma resistin level at T0 was 54.20 ± 39.3 ng/mL in the sepsis group and 34.92 ± 6.9 ng/mL in the control group. The sensitivity at T0 for resistin was 76%, and the specificity was 67%. The values of area under the curve (AUC) for CRP, PCT, and resistin were 0.84, 0.66, and 0.72, respectively. We found the diagnostic value of resistin to be lower than CRP, although its plasma levels were elevated. Therefore, we propose that resistin has limited value in diagnosis and follow-up of early-onset neonatal sepsis.

scholarly journals EFFECTIVENESS OF DIABETIC FOOT EXERCISES USING SPONGES AND NEWSPAPERS ON FOOT SENSITIVITY IN PATIENTS WITH DIABETES MELLITUS

2019 ◽  
Vol 5 (6) ◽  
pp. 234-238
Author(s):  
Siti Fadlilah ◽  
Adi Sucipto ◽  
Nazwar Hamdani Rahil
Keyword(s):  
Public Health ◽  
Diabetes Mellitus ◽  
Diabetic Foot ◽  
Community Health Centers ◽  
Public Health Problem ◽  
Sampling Technique ◽  
Total Sample ◽  
Control Group ◽  
Significant Difference ◽  
Patients With Diabetes

Background: Diabetes mellitus is a critical public health problem, and its prevalence in Indonesia remains high. Diabetes mellitus may cause complications, one of which is neuropathy that can impair foot sensitivity. This requires a treatment by doing diabetic foot exercises using sponges and paper.Objective: To examine the effectiveness of diabetic foot exercise using sponges and newspapers on foot sensitivity in patients with diabetes mellitus.Methods: This is a quasi-experimental study with pretest posttest with a control group research design, which was conducted at Public Health Center Depok III, Sleman Regency, Yogyakarta, Indonesia. An accidental sampling technique was used to select participants, with a total sample of 108 respondents consisting of 36 respondents in a control group, 36 respondents in a sponge group, and 36 respondents in a newspaper group. Data were analyzed using Wilcoxon and Mann-Whitney test.Results: Among the three groups, only those who received foot exercises using sponges and newspapers had a significant effect on foot sensitivity (p <.05). However, there was no significant difference on the effect of foot exercise on foot sensitivity between sponges and newspapers group (p >.05).Conclusion: The use of sponges and newspapers in foot exercise could significantly improve foot sensitivity in patients with type 2 diabetes mellitus. It is therefore recommended for nurses to provide the foot exercise as a part of nursing practice in both hospitals and community health centers.

scholarly journals The diagnostic value of immunohistochemical staining of the interstitial vascular C4d complement in membranous nephropathy

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Tala Pourlak ◽  
Sonya Sharifi ◽  
Sepideh Zununi Vahed ◽  
Elham Ahmadian ◽  
Magali Cucchiarini
Keyword(s):  
Pearson Correlation ◽  
Clinical Signs ◽  
Membranous Glomerulonephritis ◽  
Immunohistochemical Analysis ◽  
Diagnostic Value ◽  
Control Group ◽  
Specific Method ◽  
Cross Sectional ◽  
Phospholipase A2 Receptor ◽  
Complex Deposition

Abstract Membranous glomerulonephritis (MGN) is the most common cause of adulthood nephrotic syndrome. Diagnosis of membranous nephritis is based on light electron immunofluorescence microscopy and clinical signs. Immune complex deposition against podocyte antigens such as phospholipase A2 receptor (PLA2R) activates the complement system. Of this, complement Component C4d (C4d) is involved in the classical and lectin pathways. This marker may be used by immunohistochemistry to diagnose MGN when other methods are not available. In this work, C4d expression was monitored by immunohistochemical analysis in the glomerular capillaries of patients with primary MGN (study group, N=33) versus patients with minimal change disease (MCD, control group, N=20) in a cross-sectional evaluation performed based on the diagnosis confirmed by light microscopy and immunofluorescence. There was no significant demographic difference between the two groups except for age (P=0.002). C4d immune-expression was positive in glomerular capillary (2+ to 4+) in most of the MGN patients, while it was negative in the MCD group. The sensitivity and specificity of C4d immunostaining were 95% and 100%, respectively. The Pearson correlation coefficient was 0.74 between C4d (immunohistochemistry) and immunoglobulins (IgG; immunofluorescence) and 0.65 between C4d (immunohistochemistry) and the C3 complement product (immunofluorescence). Immunohistochemical evaluation of C4d is, therefore, a sensitive and specific method that has a high correlation with IgG immunofluorescence.

Maggot Therapy in “Lower-Extremity Hospice” Wound Care

2005 ◽  
Vol 95 (3) ◽  
pp. 254-257 ◽  
Author(s):  
David G. Armstrong ◽  
Precious Salas ◽  
Brian Short ◽  
Billy R. Martin ◽  
Heather R. Kimbriel ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Wound Care ◽  
Control Group ◽  
Infection Prevalence ◽  
University Of Texas ◽  
Maggot Debridement Therapy ◽  
Potential Efficacy ◽  
Significant Difference ◽  
High Level ◽  
Maggot Therapy

We sought to assess, in a case-control model, the potential efficacy of maggot debridement therapy in 60 nonambulatory patients (mean ± SD age, 72.2 ± 6.8 years) with neuroischemic diabetic foot wounds (University of Texas grade C or D wounds below the malleoli) and peripheral vascular disease. Twenty-seven of these patients (45%) healed during 6 months of review. There was no significant difference in the proportion of patients healing in the maggot debridement therapy versus control group (57% versus 33%). Of patients who healed, time to healing was significantly shorter in the maggot therapy than in the control group (18.5 ± 4.8 versus 22.4 ± 4.4 weeks). Approximately one in five patients (22%) underwent a high-level (above-the-foot) amputation. Patients in the control group were three times as likely to undergo amputation (33% versus 10%). Although there was no significant difference in infection prevalence in patients undergoing maggot therapy versus controls (80% versus 60%), there were significantly more antibiotic-free days during follow-up in patients who received maggot therapy (126.8 ± 30.3 versus 81.9 ± 42.1 days). Maggot debridement therapy reduces short-term morbidity in nonambulatory patients with diabetic foot wounds. (J Am Podiatr Med Assoc 95(3): 254–257, 2005)

Conservative Surgery for Diabetic Foot Osteomyelitis is not Associated With Longer Survival Time Without Recurrence of Foot Ulcer When Compared With Amputation

2021 ◽  
pp. 153473462110094
Author(s):  
Javier Aragón-Sánchez ◽  
Gerardo Víquez-Molina ◽  
María E. López-Valverde ◽  
José M. Rojas-Bonilla ◽  
Christian Murillo-Vargas
Keyword(s):  
Survival Time ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Conservative Surgery ◽  
Bone Infection ◽  
Survival Times ◽  
Cumulative Survival ◽  
Kaplan Meier ◽  
Patients With Diabetes ◽  
Diabetic Foot Osteomyelitis

Conservative surgery of diabetic foot osteomyelitis (DFO) in which bone infection is removed without amputation could minimize the biomechanical changes associated with foot surgery. We hypothesize that patients who undergo conservative surgery will have a longer survival time without recurrence of foot ulcers and further amputations than those who undergo any type of amputation to treat DFO. We assessed a retrospective cohort of 108 patients who underwent surgery for DFO from January 2011 to December 2012. Patients were followed-up until May 2020. Reulceration and reamputation-free survival times were plotted using the Kaplan–Meier method and were calculated from the date of first surgery to recurrence, new amputation, or end of the study. A stratified log rank was used to study differences among groups. Cumulative survival without recurrences at 1, 5, and 8 years was 95%, 36%, and 29%, respectively, in patients who underwent conservative surgery and 95%, 43%, and 30%, respectively, in those undergoing amputation. Cumulative survival without a new amputation at 1, 5, and 8 years was 100%, 80%, and 80%, respectively, in patients who underwent conservative surgery and 98%, 82%, and 69%, respectively, in those undergoing amputation. No differences were found regarding either recurrence (log rank, P = .98) or new amputations (log rank, P = .64). In conclusion, conservative surgery is as safe as amputation to arrest bone infection in the feet of patients with diabetes. Conservative surgery was not associated with a lower rate of recurrence and new amputations than those patients who underwent amputations.

scholarly journals Study of clinical and radiological profile of pulmonary tuberculosis among patients having diabetes mellitus

2017 ◽  
Vol 4 (5) ◽  
pp. 1378
Author(s):  
Amrut Kumar Mohapatra ◽  
Pratima Singh ◽  
Saswat Subhankar
Keyword(s):  
Diabetes Mellitus ◽  
Pulmonary Tuberculosis ◽  
Clinical Signs ◽  
Control Group ◽  
Diabetic Patients ◽  
Pulmonary Medicine ◽  
Health Care Centre ◽  
Patients With Diabetes ◽  
Smear Positive Pulmonary Tuberculosis ◽  
Pre Treatment

Background: Onset of tuberculosis is high among diabetic mellitus patients in relation to non-diabetic patients. Due to weakened immune system there is a greater risk of tuberculosis seen among type 2 diabetes mellitus patients. As a result, affected patients have difficulty in responding to any kind of treatment when compared to healthy individuals. The objective was to study the clinical and radiological profile of pulmonary tuberculosis among patients having diabetes mellitus (DM).Methods: The study was conducted at the department of pulmonary medicine, in a tertiary health care centre in Eastern India. The study included smear positive pulmonary tuberculosis (PTB) patients with diabetes mellitus and the patients who were smear positive for pulmonary tuberculosis (control group) who met the criteria to participate in the study after a thorough examination. Informed written consent was obtained from all patients before enrolment.Results: A total of 80 patients (15 to 65 years and above) were enrolled in the study with equal numbers being diagnosed with diabetes who had elevated blood sugar values (refer to Table 1). Classical clinical signs were totally correlated with radiography and 57.5% cases showed pulmonary lesions. Among the radiological findings, infiltration was most common in both groups, but more significant in PTB DM group (75 %) followed by cavity (52.5%) in PTB DM group.Conclusions: It can be concluded from the study that in diabetic patients the pattern of pulmonary tuberculosis was significantly different from non-diabetic patients. Pre-treatment bacillary load was high in diabetic patients with pulmonary tuberculosis.

Sign in / Sign up

Export Citation Format

Share Document