Diabetic Foot Self Care Pada Diabetisi

ABSTRACT: DIABETIC FOOT SELF CARE ON DIABETES PATIENTS Background: Diabetes Mellitus (DM) can cause complications in various body systems. One of the complications of DM is complications in the feet which can cause diabetic foot ulcers and lead to leg amputation. Diabetic foot complications can be prevented by performing routine foot care or diabetic foot care. Objective: The purpose of this study was to determine the description of diabetic foot care in patients with diabetes mellitus consisting of personal self-care, podiatric care, and footwear and socks. Method: This type of research is descriptive quantitative research. Data was collected using a diabetic foot care questionnaire. The number of samples in this study was 51 people. The sampling method is a non-probability technique using consecutive sampling. The study was conducted in the Kuranji Health Center Working Area in July – November 2021. Result: The results showed that most respondents (64.70%) had poor personal self-care in foot care, 82.3% of respondents had poor podiatric care habits. and 52.94% of respondents have good habits in choosing footwear. Conclusion: From the results of the study, it was concluded that people with diabetes have bad habits in performing foot care so that this is one of the risk factors for complications in the feet. To increase awareness of people with diabetes in performing foot care, it is recommended that nurses can provide education and teach people with diabetes to take care of their feet Keywords: Diabetes Mellitus; Foot Complications; Foot Care INTISARI : DIABETIC FOOT SELF CARE PADA DIABETISI Latar Belakang : Diabetes Melitus (DM) dapat menyebabkan komplikasi pada berbagai sistem tubuh. Salah satu komplikasi DM adalah komplikasi pada kaki yang dapat menimbulkan ulkus kaki diabetik dan berujung dengan amputasi kaki. Pencegahan komplikasi pada kaki dapat dilakukan diabetisi dengan melakukan perawatan kaki rutin atau diabetic foot care.Tujuan : Tujuan penelitian ini adalah untuk mengetahui gambaran diabetic foot care pada pasien diabetes melitus yang terdiri dari personal self care, podiatric care, serta footwear and sock.Metode : Jenis penelitian ini adalah penelitian deskriptif kuantitatif. Pengumpulan data dilakukan menggunakan kuesioner diabetic foot care. Jumlah sampel dalam penelitian ini adalah 51 orang. Metode pengambilan sampel adalah dengan Teknik non probability dengan menggunakan consecutive sampling. Penelitian dilakukan di Wilayah Kerja Puskesmas Kuranji pada Bulan Juli – November 2021.Hasil : Hasil penelitian menunjukkan bahwa sebagian besar responden (64,70%) memiliki personal self care yang kurang baik dalam perawatan kaki, 82,3% responden memiliki kebiasan podiatric care yang kurang baik dan 52,94% responden memiliki kebiasaan baik dalam pemilihan alas kaki.Kesimpulan : Diabetisi memiliki kebiasaan yang kurang baik dalam melakukan perawatan kaki sehingga ini menjadi salah satu faktor resiko terjadinya komplikasi pada kaki. Untuk meningkatkan kesadaran diabetisi dalam melakukan perawatan kaki disarankan perawat dapat memberikan edukasi dan mengajarkan diabetisi untuk melakukan perawatan kaki Kata Kunci : Diabetes Melitus; Komplikasi Kaki; Perawatan Kaki

Leg Amputation due to Buerger’s Disease: Management with Combined Korean Medicine

In this Case Report, a patient with Buerger’s disease who had a leg amputation below his lower right knee and a vascular bypass of right leg, developed a wound caused by his prosthetic leg and subjective discomfort. The patient received skin flap surgery but the wound did not heal properly. He was admitted to the Korean Medicine Hospital where his wound, right leg coldness, and phantom pain were treated with combined Korean medicine. The patient was hospitalized again where he underwent micro-drilling surgery. The patient was re-admitted to the Korean Medicine Hospital where he received combined Korean medicine treatment (CKMT) and carbon arc light treatment (CALT) for his wound, leg coldness, stiffness, and hypoplasia. The temperature of his right leg increased, the numeric rating scale score for assessing pain fell from 5 to 1.5, and subjective discomfort was reduced (< 20%) suggesting this may be an effective treatment.

The Risk of Nephropathy, Retinopathy, and Leg Amputation in Patients With Diabetes and Hypertension: A Nationwide, Population-Based Retrospective Cohort Study

PurposeTo compare the risks of chronic kidney disease (CKD), end-stage renal disease (ESRD), sight-threatening retinopathy, and leg amputation between patients with diabetes or hypertension.MethodsFrom January 1, 2000, to December 31, 2015, we identified 28943 matched pairs of patients with diabetes with and without subsequent hypertension, 89102 pairs of patients with hypertension with and without subsequent diabetes, and 145294 pairs of patients with coexisting diabetes and hypertension with a previous history of diabetes or hypertension from Taiwan’s National Health Insurance Research Database. Cox proportional-hazard models were used for calculating the risks of CKD, sight-threatening retinopathy, and leg amputation.ResultsThe mean follow-up time of this study in different cohorts was between 3.59 and 4.28 years. In diabetes patients with vs. without subsequent hypertension, hypertension patients with vs. without subsequent diabetes, and comorbid diabetes and hypertension patients with previous diabetes vs. with previous hypertension, the adjusted HRs (95% CIs) for CKD were 2.77 (2.61-2.94), 1.73 (1.68-1.77), and 1.04 (1.02-1.07); for ESRD were 42.38 (22.62-79.4), 2.76 (2.43-3.13), and 0.72 (0.66-0.79); for sight-threatening retinopathy were 2.07 (1.85-2.3), 3.41 (3.14-3.71), and for leg amputation were 1.51 (1.43-1.58); and 4.74 (3.02-7.43), 6.27(4.72-8.31), and 1.19(1.03-1.38).ConclusionsThis study demonstrated that both diabetes and hypertension are risk factors for the development of CKD, retinopathy, and amputation. Tracing subsequent diabetes for patients with hypertension, and hypertension for patients with diabetes are important in clinical settings.

Ankle‐Brachial Index and Subsequent Risk of Severe Ischemic Leg Outcomes: The ARIC Study

Background Ankle‐brachial index (ABI) is used to identify lower‐extremity peripheral artery disease (PAD). However, its association with severe ischemic leg outcomes (eg, amputation) has not been investigated in the general population. Methods and Results Among 13 735 ARIC (Atherosclerosis Risk in Communities) study participants without clinical manifestations of PAD (mean age, 54 [SD, 5.8] years; 44.4% men; and 73.6% White) at baseline (1987–1989), we quantified the prospective association between ABI and subsequent severe ischemic leg outcomes, critical limb ischemia (PAD with rest pain or tissue loss) and ischemic leg amputation (PAD requiring amputation) according to discharge diagnosis. Over a median follow‐up of ≈28 years, there were 221 and 129 events of critical limb ischemia and ischemic leg amputation, respectively. After adjusting for demographics, ABI ≤0.90 versus 1.11 to 1.20 had a ≈4‐fold higher risk of critical limb ischemia and ischemic leg amputation (hazard ratios, 3.85 [95% CI, 2.09–7.11] and 4.39 [95% CI, 2.08–9.27]). The magnitude of the association was modestly attenuated after multivariable adjustment (hazard ratios, 2.44 [95% CI, 1.29–4.61] and 2.72 [95% CI, 1.25–5.91], respectively). ABI 0.91 to 1.00 and 1.01 to 1.10 were also associated with these severe leg outcomes, with hazard ratios ranging from 1.7 to 2.0 after accounting for potential clinical and demographic confounders. The associations were largely consistent across various subgroups. Conclusions In a middle‐aged community‐based cohort, lower ABI was independently and robustly associated with increased risk of severe ischemic leg outcomes. Our results further support ABI ≤0.90 as a threshold diagnosing PAD and also suggest the importance of recognizing the prognostic value of ABI 0.91 to 1.10 for limb prognosis.

Toll signalling promotes blastema cell proliferation during cricket leg regeneration via insect macrophages

Hemimetabolous insects, such as the two-spotted cricket Gryllus bimaculatus, can recover lost tissues in contrast to the limited regenerative abilities in human tissues. Following cricket leg amputation, the wound surface is covered by the wound epidermis, and plasmatocytes, which are insect macrophages, accumulate in the wound region. Here, we studied the function of Toll-related molecules identified by comparative RNA-seq during leg regeneration. Among 11 Toll genes in the Gryllus genome, expression of Gb'Toll2-1, Gb'Toll2-2, and Gb'Toll2-5 was upregulated during regeneration. RNA interference (RNAi) of Gb'Toll, Gb'Toll2-1, Gb'Toll2-2, Gb'Toll2-3, or Gb'Toll2-4 produced regeneration defects in more than 50% of crickets. RNAi of Gb'Toll2-2 decreased the ratios of S and M phase cells, expression of JAK/STAT signalling genes, and accumulation of plasmatocytes in the blastema. Depletion of plasmatocytes in crickets using clodronate also produced regeneration defects, along with reduced proliferating cells in the regenerating legs. Plasmatocyte depletion also downregulated the expression of Toll and JAK/STAT signalling genes in the regenerating legs. These results suggest that Spz-Toll-related signalling in plasmatocytes promotes leg regeneration through blastema cell proliferation by regulating the Upd-JAK/STAT signalling pathway.

Case Report: Diabetic nephropathy aggravates the progression and prognosis of COVID-19-associated acute limb ischemia

Hypercoagulation is a hallmark of both the novel coronavirus disease (COVID-19) and type 2 diabetes mellitus (T2DM). It increases the risk for vascular thrombosis, including peripheral artery diseases. Among others, acute limb ischemia (ALI) is one of most common complications that requires immediate and prompt treatments to reduce morbidity and mortality. However, the complex interplay between COVID-19, T2DM and its complications (e.g., diabetic nephropathy), and ALI creates a great challenge in the management of the disease. Here, we present a case of a 59-year-old diabetic female with progressive pain in her left leg in the last five years, which was significantly intensified following COVID-19 diagnosis. Bluish coloration, numbness and functional impairments were observed during examinations with no palpable pulsation on left posterior tibial and dorsalis pedis arteries. The patient also had diabetic nephropathy (stage III), hypoalbuminemia, anemia and a urinary tract infection that complicated the management of the disease. Due to the excruciating pain and the worsening of the limb conditions, right leg revascularization and left leg amputation were performed at day 14 after admission. Following the surgeries, no more pain was observed and patient was discharged for further follow-up at the outpatient clinic.