DIABETIC FOOT;

Objective: Diabetic foot is one of challenging diseases based on uncontrolled diabetes mellitus. The aim of this study was toevaluate the surgical management in diabetic foot patients presenting with different grades of infection. Design: Descriptive study. Place andduration of study: Surgical unit I, Department of Surgery at Nishtar Hospital Multan for a periods of two years from January 2009 to December2010. Patients and methods: A total of 120 diabetic patients with different severity of foot infections who presented in causality and surgicaloutpatient department Nishtar Hospital Multan, where included in this study. Patients included in this study were above age of twelve years andwere of both sexes. A detailed history was taken followed by the clinical examination. Routine investigations including complete bloodexaminations, complete urine examination, renal parameters, X-ray foot, CXR, ECG and pus for culture and sensitivity were recorded. Lesionswere raded according to Wagner classification and appropriate medical and surgical treatment carried out. Results: This study was carried outon 120 diabetic patients, out of which ninety six (80.0%) were male and twenty four (20%) were female. Male to female ratio was 4:1. Majority ofthe patients (n=66) were between the age group of 50 to 60 years. In majority of these patients forefront was involved, mostly big or little toe,.Patients were grouped into five grades according to the severity of infection. Twenty six (21.6%) patients were managed with antibiotics anddressings, thirteen (10.8%) patients needed debridement and skin grafting while eighty-one needed amputations of different types.Staphylococcus aureus was the commonest organism isolated. Conclusions: Majority of the diabetic foot lesions were in grade II to V. Lessergrade lesions responded well to conservative management with antibiotics, dressings and debridement. While those with higher grades neededamputations. Basic principles of management include early detection of diabetic foot, proper control of infection, control of diabetes mellitus andwound care. Delayed and improper treatment leads to osteomyelitis resulting in amputation and permanent disability of deformity

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Study of bacterial infection and antimicrobial sensitivity pattern in diabetic foot lesion

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v6i2.19372 ◽

2012 ◽

Vol 6 (2) ◽

pp. 20-23

Author(s):

Shameem Akhter ◽

Shah Md Zahurul Haque Asna ◽

M Mushfequr Rahman ◽

MA Hafez

Keyword(s):

Diabetic Foot ◽

Cross Sectional Study ◽

Microbial Pathogens ◽

Cross Sectional ◽

Female Ratio ◽

Antimicrobial Susceptibility Pattern ◽

Antimicrobial Sensitivity ◽

Sensitivity Pattern ◽

Foot Lesions ◽

Diabetic Foot Lesions

A cross sectional study was carried out on patients with diabetic foot lesions to determine the spectrum of aerobic microbial flora and to determine the microbial pathogens of the diabetic foot lesions and their antimicrobial sensitivity pattern. A total of 226 organisms were isolated from 218 patients and polymicrobial infection was found in 3.7 % cases. Age of the study population ranged from 20 - >80 yrs of which most of the patients were from 40 to 70 yrs (81 %). Male female ratio was= 3:1. In this study, Pseudomonas sp. (22.1 %), Proteus mirabilis (16.4 %) and S. aureus (14.6 %) were the predominant organisms isolated. Antimicrobial susceptibility pattern of the isolates were done in which imipenem and ciprofloxacin were found to be the most effective against all organisms.DOI: http://dx.doi.org/10.3329/bjmm.v6i2.19372 Bangladesh J Med Microbiol 2012; 06(02): 20-23

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Prevalence of Diabetic Foot Lesions in Patients With Diabetes Mellitus Under Chronic Hemodialysis in El Gharbia Government Hospitals

Biomedical Journal of Scientific & Technical Research ◽

10.26717/bjstr.2019.13.002463 ◽

2019 ◽

Vol 13 (5) ◽

Author(s):

Yasser Mostafa Hafez

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Chronic Hemodialysis ◽

Government Hospitals ◽

Patients With Diabetes ◽

Foot Lesions ◽

Diabetic Foot Lesions

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Preclinical Symptoms of the Diabetic Foot

Journal of the American Podiatric Medical Association ◽

10.7547/0980114 ◽

2009 ◽

Vol 99 (2) ◽

pp. 114-120

Author(s):

Halil I. Bekler ◽

Aytug Ertav

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Major Amputation ◽

Foot Deformities ◽

Diabetic Patients ◽

Healthy Controls ◽

Nail Changes ◽

Nondiabetic Control ◽

Foot Lesions ◽

Endocrinology Clinic

Background: The diabetic foot is one of the main complications of diabetes mellitus, with a high risk of minor or major amputation. The preclinical foot lesions of patients without foot complaints were compared with healthy controls and analyzed. Methods: This study was conducted with 89 diabetic patients from an endocrinology clinic and 35 nondiabetic control patients. The patients were asked about the presence, types, and durations of pedal complaints; acquired and congenital foot deformities; and atrophy. Patient gaits were inspected for any swelling; skin and nail changes were also recorded. Ranges of articular motion, deformities, crepitations, and any painful perceptions were noted. Results: The differences between groups were significant for sensorial defects, joint changes of the foot, nail abnormalities, and neuropathic changes. Conclusions: Every patient with an established diagnosis of diabetes can be considered a potential sufferer of diabetic foot for whom medical therapy and foot protection programs are indicated. (J Am Podiatr Med Assoc 99(2): 114–120, 2009)

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A study of clinical pathological lesions and different modalities of treatment for diabetic foot

International Surgery Journal ◽

10.18203/2349-2902.isj20175109 ◽

2017 ◽

Vol 4 (12) ◽

pp. 3813

Author(s):

Indira Khedkar ◽

Naresh Saparia

Keyword(s):

Diabetes Mellitus ◽

Diabetic Foot ◽

Statistical Tests ◽

Descriptive Analysis ◽

High Risk Patient ◽

Skin Grafting ◽

Diabetic Patients ◽

Foot Care ◽

Mortality And Morbidity ◽

Surgical Interventions

Background: Diabetes Mellitus is a heterogeneous primary disorder of carbohydrate metabolism characterized by chronic state of hyperglycaemia with multi-etiological factors that generally involve absolute or relative insulin deficiency or both. Diabetic foot is defined as the foot of diabetic patients with ulceration, infection and/or destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. So, the aim of the study was to evaluate the role of various surgical interventions like debridement, minor/major amputations in the management of diabetic foot.Methods: We have included the study of total 60 patients with foot lesion. Patients with Diabetes mellitus with lesions of foot i.e. ulcer, blister. cellulites, abscess and gangrene, presenting to the department of Surgery were treated by different types of treatment. Data analysis was done by appropriate statistical tests (descriptive analysis, chi-square test).Results: 13.33% patients underwent toe amputation, 8.88% patients had below knee amputation, 33.33% patients had debridement followed by dressing, 31.12% patients had skin grafting and 13.33% patients had incision and drainage.Conclusions: This underlines the importance of patient education regarding prophylactic foot care. Patient mortality and morbidity can be reduced by prophylactic foot care, sugar control, proper surgical treatment, regular follow-up of high risk patient, suitable administration of antibiotics.

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Ankle Peak Systolic Velocity: New Parameter to Predict Nonhealing in Diabetic Foot Lesions

Vascular ◽

10.2310/6670.2009.00032 ◽

2009 ◽

Vol 17 (5) ◽

pp. 264-268 ◽

Cited By ~ 7

Author(s):

Rashad A. Bishara ◽

Wassila Taha ◽

Ihab Akladious ◽

Muhammad A. Allam

Keyword(s):

Diabetic Foot ◽

Predictive Value ◽

Peak Systolic Velocity ◽

Major Amputation ◽

Complete Healing ◽

Diabetic Patients ◽

Significant Difference ◽

Before And After ◽

Foot Lesions ◽

Diabetic Foot Lesions

The objective of this study was to determine whether ankle peak systolic velocity (APSV) can predict nonhealing in diabetic foot lesions. Diabetic patients referred for duplex scanning of the lower extremity arteries were included if they had foot lesions such as ulcers, gangrene, or tissue necrosis and had no palpable pedal pulses. End points were healed or healing foot lesions, revascularization, major amputation, or death. One hundred consecutive limbs were included. Forty-three limbs with diabetic foot lesions reached the end point of adequate healing or complete healing, whereas 57 limbs had nonhealing lesions. The APSV was significantly higher in limbs with healed or healing lesions compared with limbs with nonhealed lesions: 53.0 cm/s (41.8–81.6) versus 19.2 cm/s (12.4–26.5), p < .0001. At a cutoff point of 35 cm/s, the APSV showed a sensitivity of 92.9% (95% confidence interval [CI] 82–97), a specificity of 90.6% (95% CI 76–96), a positive predictive value of 92.9%, and a negative predictive value of 90.6% in predicting nonhealing of diabetic foot lesions. There was a significant difference between the APSV before and after revascularization: 20.4 cm/s (12.4–26.3) versus 48.8 cm/s (36.1–80.8), p < .0001. APSV could predict nonhealing of diabetic foot lesions with a high degree of accuracy in this group of patients.

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Diabetic Foot: its grades and mode of presentation at a tertiary care hospital of Peshawar, Khyber Pakhtunkhwa, Pakistan

Journal of Rehman Medical Institute ◽

10.52442/jrmi.v7i2.299 ◽

2021 ◽

Vol 7 (2) ◽

pp. 03-06

Author(s):

Jamil Ahmad ◽

Akash Kumar ◽

Zubair Ahmad Khan ◽

Sarah Rahim ◽

Muhammad Mohsin ◽

...

Keyword(s):

Diabetic Foot ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Diabetic Patients ◽

Care Hospital ◽

Foot Ulceration ◽

Foot Lesions ◽

Diabetic Foot Disease ◽

Foot Disease ◽

Diabetic Foot Lesions

Introduction: Diabetic foot is defined as the foot of diabetic patients with ulceration, infection, and/or destruction of the deep tissues, associated with neurological abnormalities and various degrees of peripheral vascular disease in the lower limb. Foot ulcers are the principal cause of severe complications and hospitalization among patients with diabetes, substantially increasing the costs of this disease. Objectives: To describe the presentation, distribute the diabetic foot lesions according to Wagner’s classification, and determine the outcome of diabetic foot ulceration in a tertiary care hospital of Peshawar, Pakistan. Materials & Methods: This study was conducted in the Surgery department of Rehman Medical Institute Peshawar. Thirty nine (39) patients with diabetic foot disease presenting from Jan 2018 to Dec 2019 were included in the study. The patients were evaluated and managed by classifying their disease according to Wagner’s classification for diabetic foot disease. Statistical analysis was done by using SPSS version 26 for descriptive statistics. Results: The most common age of presentation with diabetic foot lesion was between 41-70 years; out of 39 patients, 28 (71.8%) were males and 11 (28.2%) were females. Their mode of presentation was as follows- 22 cases (56.4%) with Ulcer, 9 cases (23.1%) with Cellulitis, 7 cases (17.9%) with Gangrene, and 1 case (2.6%) with Abscess. The most common grade of presentation were grades 3 and 4 Wagner’s lesion followed by Grade 1, and Grade 2. Debridement was the most common treatment modality (56.2%), followed by Amputation (41%). Conclusion: Foot ulceration in diabetic patients is a resource-consuming, disabling morbidity that often is the first step towards lower extremity amputation. Diabetic foot lesions can be easily graded according to the Wagner classification and helps in correlating appropriate treatment to the grade of the lesion for a better outcome.

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When Uncontrolled Diabetes Mellitus and Severe COVID-19 Converge: The Perfect Storm for Mucormycosis

Journal of Fungi ◽

10.3390/jof7040298 ◽

2021 ◽

Vol 7 (4) ◽

pp. 298

Author(s):

Teny M. John ◽

Ceena N. Jacob ◽

Dimitrios P. Kontoyiannis

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Clinical Features ◽

The Other ◽

Diabetic Patients ◽

Epidemiological Factors ◽

Uncontrolled Diabetes ◽

Diagnostic Certainty ◽

Patients With Diabetes ◽

Perfect Storm

Mucormycosis (MCR) has been increasingly described in patients with coronavirus disease 2019 (COVID-19) but the epidemiological factors, presentation, diagnostic certainty, and outcome of such patients are not well described. We review the published COVID-19-associated mucormycosis (CAMCR) cases (total 41) to identify risk factors, clinical features, and outcomes. CAMCR was typically seen in patients with diabetes mellitus (DM) (94%) especially the ones with poorly controlled DM (67%) and severe or critical COVID-19 (95%). Its presentation was typical of MCR seen in diabetic patients (mostly rhino-orbital and rhino-orbital-cerebral presentation). In sharp contrast to reported COVID-associated aspergillosis (CAPA) cases, nearly all CAMCR infections were proven (93%). Treating physicians should have a high suspicion for CAMCR in patients with uncontrolled diabetes mellitus and severe COVID-19 presenting with rhino-orbital or rhino-cerebral syndromes. CAMR is the convergence of two storms, one of DM and the other of COVID-19.

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Staphylococcus aureus strains isolated from diabetic foot ulcers. Identification of the antibiotic resistant phenotypes

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2013-0038 ◽

2013 ◽

Vol 20 (4) ◽

pp. 389-393 ◽

Cited By ~ 2

Author(s):

Teodora Chiţă ◽

Delia Muntean ◽

Luminiţa Badiţoiu ◽

Bogdan Timar ◽

Roxana Moldovan ◽

...

Keyword(s):

Diabetes Mellitus ◽

Staphylococcus Aureus ◽

Diabetic Foot ◽

Foot Ulcer ◽

Foot Ulcers ◽

Resistance Pattern ◽

Diabetic Patients ◽

Diabetic Foot Ulcers ◽

Bacterial Strains ◽

Diabetes Clinic

Abstract Background and aims: Infected foot ulcer is one of the most feared complications of diabetes mellitus. Staphylococcus aureus is the most frequently isolated pathogen in diabetic foot infections. The aim of this study was to evaluate the prevalence of S. aureus strains involved in producing foot infections in diabetic patients and the antibiotic resistance pattern of these strains. Material and methods: The study included 33 S. aureus strains isolated from 55 diabetic foot ulcers. The subjects were selected from the 2465 patients with diabetes mellitus hospitalized in the Timişoara Diabetes Clinic, between 2011 and 2013. Germs’ identification relied on cultural and biochemical characteristics. Final identification and antimicrobial testing were performed using the Vitek 2 (Bio Merieux France) automatic analyzer. Results: All the 55 samples collected from diabetic foot ulcers were positive. We isolated 64 bacterial strains (some samples were positive for 2 microorganisms). The most frequently isolated germ was S. aureus, in 33 samples (51.56%). All these S. aureus strains showed resistance to benzylpenicillin, while only 33.33% were methicillin-resistant (MRSA). Conclusions: The most frequently isolated germ in the wound secretions from diabetic foot ulcers was S. aureus. The highest percentage of antimicrobial resistance was recorded to benzylpenicillin and erythromycin.

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Predictive value of the risk factors for amputation of lower extremity in patients with diabetic foot in Al-Karama teaching hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20191511 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1549

Author(s):

Mohammed Hillu Surriah ◽

Amir Naif Kadum Al-Imari ◽

Amine Mohammed Bakkour ◽

Riad Rahman Jallod Al-Asadi

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Teaching Hospital ◽

Diabetic Foot ◽

Significant Risk ◽

Female Ratio ◽

Duration Of Diabetes ◽

Long Duration ◽

Control Of Diabetes ◽

Foot Disease

Background: Diabetic foot disease is a foot that exhibits any pathology that results directly from diabetic mellitus or any long-term chronic complication of diabetes mellitus. The aim of the study was to determine the risk factors and indications for amputations among diabetics.Methods: this clinical prospective study includes 120 diabetic foot patients admitted to AL- Karama teaching hospital from 1st January 2015 to 1st January 2019. All patients assessed for age, gender, duration of diabetes, hyperglycemia at admission and control of diabetes, history of smoking, hypertension, assess dominant foot and examination of diabetic foot lesion and classify it according to Meggit-Wagner grading status, indications for amputation and outcome.Results: The male to female ratio was 2:1. Most frequent age group of patients treated by amputation was between 50-80 years. Among patients treated with amputation (68.33%) of patients had diabetes mellitus for 11-20 years. From patients admitted with diabetic foot (53.33%) were smokers. Regarding hypertension (93.33%) of all patients were hypertensive. It was noted that (65%) of patients lesion occur in dominant foot Regarding Wagner's grading system (36.66%) of patients were grade 4 followed by grade 1 (21.66%). regarding mode of treatment (53.33%) of patients treated by amputation and other treated conservatively. Only 3 patients from 60 died while other discharged well after complete treatment.Conclusions: Increasing in age, long duration of diabetes mellitus, poor control of diabetes, smoking and occurrence of lesion in dominant foot all considered as a significant risk factors for increase liability amputation.

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