scholarly journals Gout as a trigger for acute Charcot neuro-osteoarthropathy?

2017 ◽  
Vol 17 (4) ◽  
pp. 156-159
Author(s):  
Shailesh Gohil ◽  
Rajesh Jogia ◽  
Rachel Berrington ◽  
Marie-France Kong
Keyword(s):  
Diabetic Foot ◽  
Initial Treatment ◽  
Treatment Delay ◽  
Acute Gout ◽  
Diagnostic Challenge ◽  
Diabetic Foot Infections ◽  
First Case ◽  
Patients With Diabetes

Patients with diabetes and a painful, hot, swollen foot can sometimes present a diagnostic challenge. Gout can often present in a similar fashion to diabetic foot infections or acute Charcot neuro-osteoarthropathy, and cases have been described where patients with Charcot neuro-osteoarthropathy were misdiagnosed as having gout, leading to treatment delay. We describe a patient who presented with a painful, swollen, warm foot who did not respond to initial treatment with antibiotics. Improvement in his symptoms occurred following treatment for gout, however he then went on to develop Charcot neuro-osteoarthropathy. As far as we are aware, this is the first case described in the literature where acute gout may have triggered acute Charcot neuro-osteoarthropathy. It is important to bear in mind that more than one pathology may be present in a patient at the same time or may closely follow one another.

scholarly journals Vitamin D and Diabetic Foot

2021 ◽  
Author(s):  
Antony Macido
Keyword(s):  
Vitamin D ◽  
Diabetic Foot ◽  
Large Scale ◽  
Negative Relationship ◽  
Hydroxyvitamin D ◽  
Diabetic Foot Infections ◽  
Randomized Controlled Studies ◽  
Patients With Diabetes ◽  
The Status ◽  
25 Hydroxyvitamin D

Approximately 15% of patients with diabetes mellitus (DM) are prone to developing diabetic foot ulcers (DFU) in their lifetime. The term vitamin D status or 25-hydroxyvitamin D [25(OH)D] levels are used interchangeably to represent the status of vitamin D in individuals throughout this paper. Evidence suggests a relationship between 25(OH)D levels and DFU. However, very minimal data is available on the association between DFU and vitamin D deficiency. After a careful review of the literature, it was inferred that vitamin D could be associated with DFU and diabetic foot infections. Available evidence on vitamin D and DFU suggests a negative correlation between 25(OH)D levels and the presence of DFU. Evidence also supports a negative relationship between 25(OH)D levels and diabetic foot infections. Further large-scale randomized controlled studies need to be done to confirm the relationship between 25(OH)D levels and DFU including the use of vitamin D in the management of DFU and diabetic foot infections.

scholarly journals Diabetic Foot Infections: The Diagnostic Challenges

2020 ◽  
Vol 9 (6) ◽  
pp. 1779
Author(s):  
Chiara Lauri ◽  
Antonio Leone ◽  
Marco Cavallini ◽  
Alberto Signore ◽  
Laura Giurato ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Soft Tissues ◽  
Multimodality Imaging ◽  
Diabetic Patients ◽  
Diagnostic Challenge ◽  
Non Invasive ◽  
Diabetic Foot Infections ◽  
Invasive Test ◽  
Appropriate Treatment ◽  
The Moment

Diabetic foot infections (DFIs) are severe complications of long-standing diabetes, and they represent a diagnostic challenge, since the differentiation between osteomyelitis (OM), soft tissue infection (STI), and Charcot’s osteoarthropathy is very difficult to achieve. Nevertheless, such differential diagnosis is mandatory in order to plan the most appropriate treatment for the patient. The isolation of the pathogen from bone or soft tissues is still the gold standard for diagnosis; however, it would be desirable to have a non-invasive test that is able to detect, localize, and evaluate the extent of the infection with high accuracy. A multidisciplinary approach is the key for the correct management of diabetic patients dealing with infective complications, but at the moment, no definite diagnostic flow charts still exist. This review aims at providing an overview on multimodality imaging for the diagnosis of DFI and to address evidence-based answers to the clinicians when they appeal to radiologists or nuclear medicine (NM) physicians for studying their patients.

Surgical Diabetic Foot Infections: Is Osteomyelitis Associated With a Worse Prognosis?

2021 ◽  
pp. 153473462098669
Author(s):  
Javier Aragón-Sánchez ◽  
Gerardo Víquez-Molina ◽  
María Eugenia López-Valverde ◽  
José María Rojas-Bonilla ◽  
Christian Murillo-Vargas
Keyword(s):  
Hospital Stay ◽  
Antibiotic Treatment ◽  
Diabetic Foot ◽  
Length Of Hospital Stay ◽  
Limb Loss ◽  
Diabetic Foot Infections ◽  
Patients With Diabetes ◽  
Hospital Stays ◽  
Hospital Stay Duration ◽  
Worse Prognosis

It has been reported that patients with diabetes and foot ulcers complicated with osteomyelitis (OM) have a worse prognosis than those complicated with soft tissue infections (STI). Our study aimed to determine whether OM is associated with a worse prognosis in cases of moderate and severe diabetic foot infections requiring surgery. A retrospective series consisted of 150 patients who underwent surgery for diabetic foot infections. We studied the differences between OM versus STI. Furthermore, diabetic foot infections were reclassified into four groups: moderate STI (M-STI), moderate OM (M-OM), severe STI (S-STI), and severe OM (S-OM). The variables associated with prognosis were limb loss, length of hospital stay, duration of antibiotic treatment, recurrence of the infection, and time to healing (both the initial ulcer and the postoperative wound). No differences in limb salvage, hospital stay, duration of antibiotic treatment, recurrence of the infection, and time to healing were found when comparing OM with STI. Patients with M-O had a higher rate of recurrences after initial treatment and a longer time to healing when comparing with M-STI. We didn’t find any differences between severe infections with or without OM. In conclusion, we have found in our surgical series of diabetic foot infections that OM is not associated with worse prognosis when comparing with STI regarding limb loss rate, length of hospital stays, duration of antibiotic treatment, recurrence of the infection, and time to healing. The results of the present series should further be confirmed by other authors.

scholarly journals Utilisation of the 2019 IWGDF diabetic foot infection guidelines to benchmark practice and improve the delivery of care in persons with diabetic foot infections

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Matthew Malone ◽  
Adriaan Erasmus ◽  
Saskia Schwarzer ◽  
Namson S. Lau ◽  
Mehtab Ahmad ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Diabetic Foot ◽  
Clinical Performance ◽  
Improve Patient Care ◽  
Delivery Of Care ◽  
Diabetic Foot Infection ◽  
Diabetic Foot Infections ◽  
Bone Biopsies ◽  
Patients With Diabetes

Abstract Aims To utilise the 2019 International Working Group on the Diabetic Foot (IWGDF) - diabetic foot infection (DFI) guidelines as an audit tool for clinical practice in patients with diabetes attending a High-Risk Foot Service. Methods Data from 93 consecutive patients were collected over a 19-month period in patients attending a High-Risk Foot Service. The diagnosis and management of each patient in the sample were compared against the 2019 IWGDF DFI guidelines, grouped into four categories: Diagnosis, Microbiology, Treatment of soft tissue infection, and Surgical treatment and osteomyelitis. Deficits in performance were recorded using the recommendations as a benchmark standard. Results There were 109 DFI events. Nineteen (63%) of the recommendations were met, 7 (24%) were partially met, and four (13%) recommendations were not met. Fourteen of the sample had no documented requests for full blood counts. Tissue was obtained for culture in 32 (29%) of the sample. No percutaneous bone biopsies were performed. Only 13 (28%) patients had intraoperative bone specimens sent for culture and sensitivities, with no bone specimens sent for histopathology. Modification of antibiotic therapy following available culture results was low, occurring in 12 out of 63 possible occasions (19%). The duration of antibiotic regimens in PEDIS 2 infections and osteomyelitis was greater than that recommended. Conclusions Utilising the IWGDF DFI guidelines to benchmark clinical practice is a useful tool to identify gaps in clinical performance or service delivery and may help to improve patient care.

scholarly journals Management of infected diabetic wound: a scoping review of guidelines

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 737
Author(s):  
Huidi Tchero ◽  
Pauline Kangambega ◽  
Sergiu Fluieraru ◽  
Farid Bekara ◽  
Luc Teot
Keyword(s):  
Diabetic Foot ◽  
Literature Search ◽  
Oxygen Therapy ◽  
Systematic Literature Search ◽  
Bone Infections ◽  
Diabetic Foot Infections ◽  
The World ◽  
Infected Wounds ◽  
Patients With Diabetes ◽  
Guidelines And Recommendations

Background: Various international guidelines and recommendations are available for management of diabetic foot infections. We present a review of the guidelines and recommendations for management of these infections. Methods: A systematic literature search was conducted through MEDLINE, CENTRAL, EMBASE, LILACS, DARE, and national health bodies. Based on the review of fifteen documents, we present details on the importance of suspecting and diagnosing skin, superficial infections, and bone infections in diabetics. Results: The guidelines recommend classifying the infections based on severity to guide the treatment. While antibiotics have shown the best results, other treatments like hyperbaric oxygen therapy and negative wound pressure have been debated. It is suggested that a team of specialists should be in-charge of managing the infected wounds. Infectious Diseases Society of America (IDSA) 2012 guidelines are widely followed world-over. All guidelines and reviews have consistent suggestions on the assessment of the severity of infection, diagnosis, start, selection, and duration of antibiotic therapy. Conclusions: It is reasonable to conclude that the IDSA 2012 guidelines are commonly followed across the world. There is a consensus among the Australian guidelines, Canadian guidelines, IDSA 2012, National Institute for Health and Care Excellence (NICE) 2015, and International Working Group on the Diabetic Foot (IWGDF) 2016 guidelines on the management of infected wounds for patients with diabetes mellitus.

scholarly journals Glycated Hemoglobin (HbA1c) as a Biomarker for Diabetic Foot Peripheral Neuropathy

Diseases ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 16
Author(s):  
Giulia Casadei ◽  
Marta Filippini ◽  
Lorenzo Brognara
Keyword(s):  
Diabetes Mellitus ◽  
Peripheral Neuropathy ◽  
Diabetic Foot ◽  
Glycated Hemoglobin ◽  
Chronic Inflammatory Demyelinating Polyneuropathy ◽  
Glycemic Variability ◽  
Future Research ◽  
Patients With Diabetes ◽  
Axonal Dysfunction ◽  
Biomarker Research

Background: Diabetic peripheral neuropathy (DPN) is known to predict foot ulceration, lower-extremity amputation and mortality. Patients with diabetes mellitus have a predisposition toward developing chronic inflammatory demyelinating polyneuropathy, and this may also facilitate the formation of diabetic foot and cutaneous impairment, which are considered one of the most serious impairments of diabetes mellitus, with a prevalence of 4–10% in this population. Biomarkers research provides opportunities for the early diagnosis of these complications for specific treatments useful to prevent amputation and, therefore, physical inability and mental disturbance. The recent literature has suggested that glycemic levels may be a novel factor in the pathogenesis of diabetic foot complications and is an important mediator of axonal dysfunction. The aim of this systematic literary review is to determine whether hemoglobin A1c (HbA1c) is a positive predictor for diabetic foot peripheral neuropathy and its complications, such as foot cutaneous impairments. There is a lack of consensus regarding the effect of glycemic variability on diabetic foot peripheral neuropathy, unlike other complications such as retinopathy, nephropathy or micro/macrovascular pathology. Methods: Relevant articles were searched in the Medline database using PubMed and Scopus and relevant keywords. The primary search terms used were “glycated hemoglobin” OR “HbA1c” AND “diabetic neuropathies” AND “Foot”. Results: A number of articles (336) were initially identified while searching the scientific literature regarding this topic, and 32 articles were selected and included in this review. Conclusions: This review highlights the role of HbA1c in diabetic foot peripheral neuropathy. Biomarkers play an important role in the decision-making process, and HbA1c levels are extensively used for diabetic foot clinical outcomes and settings, but biomarker research in diabetic foot peripheral neuropathy is in its infancy and will require careful attention to a number of factors and associations, since the consequences of DPN also include neurological alterations. HbA1c is an accurate and easy-to-administer test and can be an effective biomarker in establishing the diagnosis of diabetes, but future research should focus on standardizing the HbA1c level and selecting which DPN value and its correlated complications, such as foot cutaneous impairments, are the most informative.

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