scholarly journals Clinical and microbiological profile of diabetic foot ulcers in a tertiary care setup: a cross sectional analysis

Author(s):  
Siddharth Rai ◽  
Harleen Uppal ◽  
Arvind Kumar Sharma ◽  
Anil Kumar Gupta

Background: Diabetes associated neuropathy and vasculopathy leads to development of diabetic foot ulcers (DFU). They are responsible for considerable morbidity and a significant cost of health‐care worldwide. The magnitude of the problem becomes worse in regions where foot care is inadequate like in our country. The aim of the study to determine the microbiological profile and antimicrobial susceptibility pattern of organisms isolated from patients with diabetic foot ulcers.  Methods: The study was a cross sectional study done at King George’s Medical College, Lucknow from 2012-2014 in Lucknow, Uttar Pradesh. Based on the inclusion criteria sample were collected from 112 patients. The standard protocol for the identification of microorganisms was followed.  A descriptive analysis of the data was done.Results: Out of the 112 ulcers total 180 isolates were found. Of the 112 cases, 78 were monomicrobial, 32 were polymicrobial, and 2 cases were sterile on culture. The most common bacteria found was Staphylococcus aureus. Most of the staphylococcus isolated were sensitive to vancomycin, teicoplanin, cephalosporins, linezolid levofloxacin and pipercillin-tazobactum. Nearly 65% of S. aureus were methicillin‐resistant S. aureus.Conclusions: This study compiled clinical and microbiological profile of diabetic foot ulcers along with their antibiotic susceptibility patterns. Our study illuminates light on a high figure of neglected and poorly treated NHUs which could have been managed well and early treatment will prevent devastating consequences such as sepsis and amputation.  

2018 ◽  
Vol 5 (7) ◽  
pp. 2537
Author(s):  
Praveena D. L. ◽  
Shashi M. Uppin ◽  
S. S. Shimikore

Background: Diabetes mellitus-related foot ulceration is very common. Several classification systems for diabetic foot ulcers have been proposed. The present study was intended to assess the role of Wagner wound classification in predicting the outcome of diabetic foot ulcer and also know the grade of Wagner’s classification to which majority of diabetic foot ulcer patients.Methods: This present one year cross sectional study was carried out at the Department of General Surgery. A total of 100 patients with diabetic foot ulcer who presented during the study period were included. The diabetic foot ulcers were graded according to the Wagner’s classification. The relative risk of amputation in different grades of diabetic foot ulcer based on Wagner classification was determined.Results: In this study majority of the patients were males (79%) and the male to female ratio was 3.76:1. The mean age was noted as 55.8±10.45 years. Majority of the patients had duration of ulcer less than one month (88%). Surrounding skin was inflamed in 60% of the patients, necrosis was present in 40% and slough was noted in 98% while 44% of the patients had necrotic tissue. Based on Wagner’s Classification, most of the patients (48%) had Grade II diabetic foot ulcers. With regard to management, in 44% of the patients’ debridement was done and 36% of the patients had disarticulation or amputation in 36%. Of the 48 patients with grade II ulcer, 79% of the patients had healing without amputation. Of the 58 patients with grade I and II diabetic foot ulcers, 82.76% had healing without amputation compared to 17.24% of the patients who needed amputation. Patients with Grade III, IV and V had 3.59 times higher risk of amputation compared to patients with grade I and II. (p<0.001; 95% CI- 1.95 to 6.62).Conclusions: Grading of diabetic foot ulcer based on Wagner’s classification affects and predicts the outcome and the risk of amputation increases with increasing grade. Most of the patients admitted for diabetic foot ulcers in our hospital belonged to Wagner’s grade II (48%).


2021 ◽  
Vol 12 (1) ◽  
pp. 1-6
Author(s):  
Kharisma Pratama

Abstract Background: Diabetes mellitus (DM) is a metabolic disease characterized by an increase in blood sugar levels due to damage to insulin secretion. Neuropathy is a common complication of diabetes mellitus. One way to prevent neuropathy or other complications is to do regular foot care. The role of caregiver in diabetic foot care is important to improve the quality of life of patients living with diabetes mellitus. They need to be provided with the latest knowledge and support regarding diabetic foot care. Purpose: Study was to determine the relationship between care giver knowledge about diabetic foot care and foot ulcers at risk of developing ulceration in DM. Methods: This study was an analytical study with a cross sectional study design. The research sample was 40 respondents who met the criteria. The data were collected using a knowledge questionnaire with 20 questions and a risk observation sheet for diabetic foot. Results: This study showed that most of the respondents had less knowledge about diabetic foot care, namely 26 (65%). The study also showed a relationship between the lack of knowledge about foot care and the risk of foot injury for people with diabetes, a = 0.05 (95% CI). Conclusion: This study has proven that a care giver must be equipped with diabetic foot care competency, and  DM patinets can avoid complications of diabetic foot ulcers. Nurse should provide education to the community regularly, especially on the novelty of the knowledge that has been gained either from research or from the experience gained in the clinic or nursing home.   Abstrak Latar Belakang: Diabetes melitus (DM) merupakan suatu penyakit metabolik yang di tandai dengan adanya peningkatan kadar gula darah akibat kerusakan pada sekresi insulin. Neuropati merupakan salah satu komplikasi diabetes melitus yang sering terjadi. Salah satu cara mencegahan neuropati atau komplikasi lainnya yaitu dengan melakukan perawatan kaki yang rutin. Peran care giver dalam perawtan kaki diabetik sangat diperlukan untuk peningkatan kualitas hidup pasien dengan diabetes mellitus. Mereka perlu diberikan pembekalan serta dukungan ilmu yang terbaru mengenai perawtan kaki diabetik. Tujuan: Adapun tujuan penelitian ini adalah untuk mengetahui hubungan antara pengetahuan care giver tentang perawatan kaki diabetik dengan kejadian kaki beresiko terjadinya ulkus pada penderita DM. Metode: Penelitian ini adalah penelitian analitik dengan  rancangan penelitian cross sectional. Sampel penelitian sebanyak 40 responden yang memenuhi kriteria.  Pengumpulan data dilakukan dengan menggunakan kuesioner pengetahuan dengan 20 pertanyaan dan lembar observasi resiko kaki diabetik. Hasil: Hasil Penelitian menunjukkan sebagian besar responden memiliki pengetahuan yang kurang tentang perawatan kaki diabetik yaitu sebesar 26 (65%). Penelitian juga menunjukkan adanya hubungan antara kurangnya tingkat pengetahuan tentang perawatan kaki dengan resiko terjadinya luka pada kaki penderita DM, a=0.05 (CI 95%). Kesimpulan: Penelitian ini telah membuktikan bahwa pendamping anggota keluarga yang sakit harus dibekali kompetensi perawatan kaki diabetik, dengan harapan penderita DM dapat terhindar dari komplikasi ulkus kaki diabetikum. Bagi kolega perawat untuk terus memberikan edukasi pada masyarakat khususnya terhadap kebaruan ilmu yang telah didapat baik dari penelitian ataupun dari pengalaman yang didapat diklinik atau rumah perawatan.  


Jurnal NERS ◽  
2020 ◽  
Vol 14 (3) ◽  
pp. 316
Author(s):  
Rohmatul Faizah ◽  
Gabriel Wanda Sinawang ◽  
Andrik Hermanto ◽  
Mohamad Roni Alfatih

Introduction: Diabetes mellitus is a chronic disease of the endocrine system that has numerous complications such as diabetic foot ulcers. Amputation is the last frontier for the treatment of diabetic foot ulcers but they can be prevented through proper self-foot-care behavior. The aim of this study was to explain the support factors of self foot care for diabetes mellitus patients.Methods: The methods used were self-foot-care identification in the literature, with the relevant literature identification based on the topics and titles obtained from Scopus, ScienceDirect and ProQuest. This was as well as analysis of the results from examining the various behaviors that support self-foot-care behavior in the literature. The references included was the research conducted from 2013 - 2019 as follows: 2 descriptive correlation studies, 3 descriptive studies, 2 prospective studies, 1 prospective cohort study, 1 pre-experimental study, 3 quasi-experimental studies, 1 case study and 3 cross-sectional studies.Results: All of the journals included discussed foot care behavior. Education programs regarding foot care are a major factor that supports foot care behavior.Conclusion: All of the journals that were obtained stated that there was a positive influence on the diabetic foot condition where routine foot care behavior was implemented. Self-foot-care behavior also requires other supporting factors to obtain the maximum results.


Author(s):  
Sezai ÖZKAN ◽  
cihan ADANAS ◽  
hamit hakan alp

Background: We aimed to determine the relationship of ischemia-modified albumin (IMA) with diabetic foot ulcers and its predictive value in the Wagner classification. Methods: Our cross-sectional study was conducted in 120 diabetic foot patients and 60 healthy individuals with similar body mass index and age. Patients with a diabetic foot were classified according to the Wagner classification. Biochemical parameters, C-reactive protein (CRP) and IMA levels were measured in all patients and healthy volunteers. Screening performance characteristics of CRP and IMA were calculated according to Wagner classes and the presence of osteomyelitis. Results: CRP and IMA levels in the patient group were significantly higher than the control group. The highest IMA levels were detected in Wagner grade 5. CRP had higher sensitivity and specificity than IMA in the discrimination of other grades, except for grade 4-5 separation. For Wagner grade 4-5 distinction, IMA had 84.6% sensitivity and 94.7% specificity. Conclusion: IMA may play a role in the pathogenesis of diabetic foot ulcers and had a higher predictive value in discrimination of the Wagner grade 4 and 5. In the management of diabetic foot patients, it may be recommended that IMA is evaluated by clinicians.


BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ahmed Shabhay ◽  
Pius Horumpende ◽  
Zarina Shabhay ◽  
Andrew Mganga ◽  
Jeff Van Baal ◽  
...  

Abstract Background Diabetic foot ulcers complications are the major cause of non-traumatic major limb amputation. We aimed at assessing the clinical profiles of diabetic foot ulcer patients undergoing major limb amputation in the Surgical Department at Kilimanjaro Christian Medical Centre (KCMC), a tertiary care hospital in North-eastern Tanzania. Methods A cross—sectional hospital-based study was conducted from September 2018 through March 2019. Demographic data were obtained from structured questionnaires. Diabetic foot ulcers were graded according to the Meggitt-Wagner classification system. Hemoglobin and random blood glucose levels data were retrieved from patients’ files. Results A total of 60 patients were recruited in the study. More than half (31/60; 51.67%) were amputated. Thirty-five (58.33%) were males. Fifty-nine (98.33%) had type II diabetes. Nearly two-thirds (34/60; 56.67%) had duration of diabetes for more than 5 years. The mean age was 60.06 ± 11.33 years (range 30–87). The mean haemoglobin level was 10.20 ± 2.73 g/dl and 9.84 ± 2.69 g/dl among amputees. Nearly two thirds (42/60; 70.00%) had a haemoglobin level below 12 g/dl, with more than a half (23/42; 54.76%) undergoing major limb amputation. Two thirds (23/31; 74.19%) of all patients who underwent major limb amputation had mean hemoglobin level below 12 g/dl. The mean Random Blood Glucose (MRBG) was 13.18 ± 6.17 mmol/L and 14.16 ± 6.10 mmol/L for amputees. Almost two thirds of the study population i.e., 42/60(70.00%) had poor glycemic control with random blood glucose level above 10.0 mmol/L. More than half 23/42 (54.76%) of the patients with poor glycemic control underwent some form of major limb amputation; which is nearly two thirds (23/31; 74.19%) of the total amputees. Twenty-eight (46.67%) had Meggitt-Wagner classification grade 3, of which nearly two thirds (17:60.71%) underwent major limb amputation. Conclusion In this study, the cohort of patients suffering from diabetic foot ulcers treated in a tertiary care center in north-eastern Tanzania, the likelihood of amputation significantly correlated with the initial grade of the Meggit-Wagner ulcer classification. High blood glucose levels and anaemia seem to be also important risk factors but correlation did not reveal statistical significance.


Author(s):  
Gopal Teli ◽  
B. G. Ponnappa

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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