Diabetic Foot Patients Research Articles

Clinical observation on tuina plus foot bath with Chinese medicine for diabetic foot in early stage

To observe the clinical effect of tuina plus foot bath with Chinese medicine for patients with diabetic foot (DF) in early stage. A total of 70 patients with early-stage DF were randomly allocated by the random number table into two groups, with 35 cases in each group. Patients in the control group received conventional medication, while patients in the observation group received tuina plus foot bath with Chinese medicine on the basis of conventional medication. The clinical efficacy was compared after 2 courses of treatment. After treatment, intra-group comparisons of ankle-brachial index (ABI) showed statistical significance in both groups (both P<0.05). The curative rate was 83.3% in the observation group, with the total effective rate of 96.7%, versus 29.4% and 76.5% in the control group, respectively, and the between-group comparisons showed statistical significance (both P<0.05), indicating a better effect in the observation group. Tuina plus foot bath with Chinese medicine has a good therapeutic effect for DF patients in early stage.

Clinical and experimental study of matrix metalloproteinase-9/angiotensin/vascular endothelial growth factor signaling axis in diabetic foot

Objective To investigate the role of matrix metalloproteinase-9/angiostatin/vascular endothelial growth factor signal axis in diabetic foot (DF) disease. Methods Immunofluorescence staining, Real-time quantitative reverse transcriptase-polymerase chain reaction (RT-qPCR) and Western blotting were used to detect the messenger RNA (mRNA) and protein expression level of matrix metalloproteinase-9 (MMP-9) and vascular endothelial growth factor (VEGF) in normal and the foot wound tissues of DF patients. Human umbilical vein endothelial cells (HUVECs) were selected as the study subjects. The experiment was divided into 4 groups: normal control group; high glucose (25 mmol/L) model group; high glucose + anti-MMP-9 (5 μg/ml) group and high glucose + anti-angiostatin (5 μg/ml) group. The cell culture supernatant and a part of cells were collected at 12, 24 and 48 h, respectively. The secretion and expression of VEGF were detected by enzyme-linked immunosorbent assay (ELISA), RT-qPCR and Western blotting. Results The results of clinical samples showed that MMP-9 was highly expressed in the tissues of DF patients with foot wounds compared with normal subjects(mRNA level: P=0.000; protein level: P=0.000). However, VEGF showed significant low expression in the tissues of DF patients with foot wounds(mRNA level: P=0.003; protein level: P=0.000). The results of cell experiments showed that compared with the normal group at 12, 24, 48h, the VEGF secretion and mRNA and protein expression level of in the high glucose group were significantly decreased (secretion level: P=0.032, 0.006, 0.004; mRNA level: P=0.003, 0.000, 0.000; protein level: P=0.000, 0.000, 0.000); However, compared with the high glucose group, the VEGF secretion and mRNA and protein levels of the two treatment groups were significantly increased (anti-MMP-9 secretion level: P=0.041, 0.003, 0.000; mRNA level: P=0.039, 0.006, 0.005; protein level: P=0.089, 0.042, 0.037; anti-angiostatin secretion level: P=0.005, 0.001, 0.000; mRNA level: P=0.004, 0.001, 0.000; protein level: P=0.031, 0.001, 0.000), and it was time-dependent. Conclusion The expression of MMP-9 in the DF patients is negatively correlated with the expression of VEGF. The inhibition of MMP-9 and angiostatin can significantly promote the VEGF secretion and expression in HUVECs induced by high glucose, which will provide theoretical basis on clinical treatment for DF. Key words: Matrix metalloproteinase-9; Angiostatin; Vascular endothelial growth factor; Diabetic foot

Effectiveness of revascularization of the ulcerated foot in diabetic patients with peripheral artery disease for one year follow-up

Diabetes is an important risk factor for atherosclerosis. The diabetic foot is characterized by the presence of arteriopathy and neuropathy. When ischemia is diagnosed, restoration of pulsatile blood flow by revascularization may be considered for salvaging the limb. The treatment options are angioplasty with or without stenting and surgical bypass or hybrid procedures combining the two. To evaluate the outcomes of severe ischemic diabetic foot ulcers for which percutaneous transluminal angioplasty (PTA) was considered as the first-line vascular procedure. Factors associated with successful PTA were also evaluated. In 80 consecutive diabetic patients with foot ulcers and severe limb ischemia, PTAwas performed if feasible. All patients were followed until healing or for one year. Clinical and angiographic factors in fluencing outcomes after PTA were sought by univariate and multivariate analysis. PTAwas done in 73 of the 80 (91.2%) patients, and considered clinically succe ssful in 58(79.9%). Successful PTA was significantly higher in patients with Superficial femoral artery, posterior Tibialis and dorsalis pedis arteries involvement in the univariate analysis. Seven patients were expired during the study follow up due to MI, pulmonary thromboembolism and GI bleeding. PTA in diabetic patients with severe ischemic foot ulcers provided favorable. Some parameters could be used for predicting PTA successfulness.

Diabetično stopalo kot zaplet sladkorne bolezni

Uvod: Diabetično stopalo je skupina sindromov, pri katerih nevropatija, ishemija in infekcija pripeljejo do destrukcije tkiva, končna posledica je zbolevnost, lahko pa tudi amputacija. Namen raziskave je bil ugotoviti pogostost pojava diabetičnega stopala pri pacientih s sladkorno boleznijo.Metode: V raziskavi je bila uporabljena raziskava mešanih metod. Tehnika zbiranja podatkov je bilo anketiranje 60 pacientov s sladkorno boleznijo in delno strukturiran intervju z dvema medicinskima sestrama, ki delata v diabetološki ambulanti. Kvantitativni podatki so bili analizirani z opisno in bivariatno statistiko. Kvalitativni podatki so bili analizirani s pomočjo metode analize vsebine.Rezultati: Ugotovili smo, da amputacija noge ni pogost zaplet diabetičnega stopala (U = 4,4, p = 0,217) in da ne moremo trditi, da je diabetično stopalo pogostejše pri moških kot pri ženskah (U = 0,6, p = 0,417), ter da so pacienti zelo dobro poučeni glede nege stopal in pravilne obutve.Diskusija in zaključek: Najpomembnejša informacija o zdravstveni vzgoji pri diabetičnem stopalu za paciente je, da so o tem zapletu ozaveščeni pisno in ustno. Diabetično stopalo za paciente najpogosteje prinese spremembo v kakovosti življenja. Možnost za nadaljevanje raziskave bi bila izvedba enake raziskave na večjem številu pacientov.

Application of risk grade management based on the three-stage treatment mode in patients of diabetic foot

Objective To discuss the application value of risk grade management based on the three-stage treatment mode in the prevention of diabetic foot. Methods A total of 150 diabetic patients in Tianjin Binhai New District Community from January 2016 to January 2017 were enrolled in the study by convenient sampling method. According to the weighted integral of Gavin's diabetic foot risk factors, the subjects were divided into low, medium and high risk groups. Under the three-stage treatment mode, different levels of risk were incorporated into different management levels. Subjects were followed up for 12 months using grade management mode. The incidence of foot ulcers, risk grade of diabetic foot, lower extremity arterial blood supply, and foot self-care ability were observed. Results After the intervention, 8 patients were diagnosed with stage I diabetic foot ulcer, and the scores of risk factors of diabetic foot were lower than those before the intervention; the differences were statistically significant (P<0.05). The ankle brachial pressure indices of lower extremity artery was higher than that before the intervention, the score of diabetic foot self-care ability was (55.4±7.5) points, which was significantly higher than that before the intervention; and the differences were statistically significant (P<0.05). Conclusions The implementation of the risk grade management for diabetic foot based on three-stage treatment mode reduces the risk factors of diabetic foot, improves the peripheral vascular disease, the foot self-care ability, and the quality of life of diabetic patients. Key words: Diabetic foot; Nursing care; Risk grade management; Three-stage treatment

Thermal map of the diabetic foot using infrared thermography

BackgroundDiabetes mellitus is a public health problem and major threat to quality of life and related expenses. The diabetic foot is a degeneration of the vascular structure of the foot, with the patients presenting neurological degeneration, which need to be identified at an early stage. The aim of this research was to study the use of infrared thermography in analysing the temperature variability of the foot in diabetic patients, segmenting the sole of the foot into four areas of interest. MethodsA descriptive, cross-sectional, and observational study was conducted in a sample of 277 diabetic patients [138 men (49.8%) and 139 women (50.2%)], with a mean age of 63.41 ± 17.69 years and BMI of 29.08 ± 5.86. Images were acquired with a FLIR E60bx® infrared camera. The data was analysed statistically using the IBM SPSS Statistics 22 program package. ResultsThe results showed that the technique distinguishes any temperature variability between the different study areas of the soles of either foot. ConclusionsIn evaluating the foot at risk, infrared thermography can provide useful clinical information to assist in the early diagnosis and prevention of lesions in compromised zones of the foot.

Knowledge and Awareness of Diabetic Foot Complications in Diabetic Patients

Background: diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society. Foot ulcers are more likely to be of neuropathic origin, and therefore eminently preventable, in developing countries, which will experience the greatest rise in the prevalence of type 2 diabetes. Aim of the Work: to assess the level of awareness of Diabetic foot disease amongst patients with type 2 diabetes mellitus aim. To measure the knowledge of diabetic about sign and symptoms of diabetic foot. To measure the knowledge of risk factors of diabetic foot in diabetic patients. Patients and Methods: this is a questionnaire-based cross-sectional study enrolling a total of 100 randomly selected diabetic foot Saudi adults ensuring diversity in age range and educational stages. Descriptive analysis was done using Statistical Package for Social Sciences (SPSS) 23. Awareness levels for DF were calculated as absolute frequencies and were reported as overall percentages. Results: a number of 99 participants with type 2 Diabetes Mellitus participated in the study, 91% of the participants were either overweight or obese, 92% of participants had concomitant hypertension, (57.5%), dyslipidemia and (26.7%) eye problems. Also 76% of the specimen reported altered sensation in their lower limbs, and 90% reported having no previous diabetic foot disease education. Only 22.2% of participants reported having examined their feet, but only when they experienced a problem. A number of participants achieved mediocre scores for knowledge (mean 4.45, standard deviation (s.d.) 2.201, confidence interval (CI) 4.2–4.7) and practice (mean 11.09, s.d. 2.233, CI 10.8–11.5) on diabetic foot care (DFC). Those who had a higher level of education and who were less than 65 years old had a significantly better score for previous foot care education (p <0.05). Conclusion: The study demonstrated that awareness of DFD was suboptimal, based on current DFC guidelines. To minimize the burden of DFD, improved screening and prevention programs as well as patient education should be provided to T2DM patients, whilst maintaining an aggressive approach to risk factor modifications, footwear and identifying the at-risk foot.

Knowledge and Awareness of Diabetic Foot Complications in Diabetic Patients

Background: diabetic foot problems are common throughout the world, resulting in major economic consequences for the patients, their families, and society. Foot ulcers are more likely to be of neuropathic origin, and therefore eminently preventable, in developing countries, which will experience the greatest rise in the prevalence of type 2 diabetes. Aim of the Work: to assess the level of awareness of Diabetic foot disease amongst patients with type 2 diabetes mellitus aim. To measure the knowledge of diabetic about sign and symptoms of diabetic foot. To measure the knowledge of risk factors of diabetic foot in diabetic patients. Patients and Methods: this is a questionnaire-based cross-sectional study enrolling a total of 100 randomly selected diabetic foot Saudi adults ensuring diversity in age range and educational stages. Descriptive analysis was done using Statistical Package for Social Sciences (SPSS) 23. Awareness levels for DF were calculated as absolute frequencies and were reported as overall percentages. Results: a number of 99 participants with type 2 Diabetes Mellitus participated in the study, 91% of the participants were either overweight or obese, 92% of participants had concomitant hypertension, (57.5%), dyslipidemia and (26.7%) eye problems. Also 76% of the specimen reported altered sensation in their lower limbs, and 90% reported having no previous diabetic foot disease education. Only 22.2% of participants reported having examined their feet, but only when they experienced a problem. A number of participants achieved mediocre scores for knowledge (mean 4.45, standard deviation (s.d.) 2.201, confidence interval (CI) 4.2–4.7) and practice (mean 11.09, s.d. 2.233, CI 10.8–11.5) on diabetic foot care (DFC). Those who had a higher level of education and who were less than 65 years old had a significantly better score for previous foot care education (p <0.05). Conclusion: The study demonstrated that awareness of DFD was suboptimal, based on current DFC guidelines. To minimize the burden of DFD, improved screening and prevention programs as well as patient education should be provided to T2DM patients, whilst maintaining an aggressive approach to risk factor modifications, footwear and identifying the at-risk foot.

Skin temperature of the foot: comparing transthyretin Familial Amyloid Polyneuropathy and Diabetic Foot patients

Skin temperature regulation is dependent on the autonomic nervous system function, which may be impaired in patients with neuropathy. Literature reporting thermographic assessment of patients with established diagnosis of Diabetic Foot (DF) is scarce, but this information is completely absent in patients suffering from Transthyretin Familial Amyloid Polyneuropathy (TTR-FAP). The aim of this study is to compare skin temperature distribution in patients with DF and TTR-FAP. Thermograms of the dorsal and plantar surfaces of twelve neuropathic patients, six with DF and six with TTR-FAP, were assessed and compared. Skin temperature was significantly higher in the diabetic foot group, in both regions of interest. Thermal symmetry values were high, but similar in both groups. The bias between the right and left foot was smaller, with smaller limits of agreement in TTR-FAP patients, suggesting a lower agreement between the temperature of the right and left feet in DF patients.

MORINGA OLEIFERA LEAF EXTRACT LOADED HYDROGEL FOR DIABETIC WOUND HEALING

Diabetic wounds (DW) are a chronic, non-healing wound on the feet of diabetic patients that pose a serious challenge to world health. Around 84% of diabetic patients undergo lower leg amputations. Though numerous topical and systemic drugs have been used to heal the DW, these drugs have led to the emergence and subsequent rapid overgrowth of resistant bacterial strains, side effects and toxicity. Many herbal plants have very important role in wound healing because they promote the natural repair mechanisms. Moringaoleifera (MO) is an important medicinal plant which has an impressive range of medicinal uses including antimicrobial, anti-inflammatory, antidiabetic, antioxidant and anticancer activities. Recently few researchers reported that MO extracts have effective wound healing property due to the presence of rich flavonoids and vicenin-2. The objective of the present study was to develop hydrogel formulations loaded with Moringaoleifera leaves extract. The prepared hydrogels were evaluated for physical appearance, rheological behavior, skin irritation and wound-healing power in streptozotocin-induced diabetic male wistar albino rats. Results showed that all hydrogel formulations exhibited good and acceptable physical properties. All the animals tolerated the applied gels and no signs of irritations were noticed during the skin irritation study. The in-vivo wound healing studies showed a time dependent increase in percentage of wound, a contraction which is higher than that produced by the control groups. These contractions were statistically significant (P&lt;0.001), during the first 10 days of the study with MO-Hydrogel administration. The MO-hydrogel showed the highest percent wound contraction with complete wound closure and epithelization was observed on 7thday of wound induction.

Clinical study on treatment of diabetic foot by traditional Chinese medicine fumigation combined with conventional therapy

Objective To evaluate the curative effect of traditional Chinese medicine fumigation combined with conventional therapy for the diabetic foot. Methods A total of 90 patients with type 2 diabetes who were treated in the hospital from March 2015 to August 2017 were enrolled in this study. On the basis of conventional treatment, the treatment group received the traditional Chinese medicine fumigation, while the control group received warm water fumigation. The total limb popliteal artery, femoral artery, posterior tibial artery and dorsalis pedis artery and a score of symptoms and signs were compared between two groups after 4 weeks. Results The total effective rate of the treatment group was 73.3% (33/45), while the control group was 53.3% (24/45), and the difference was statistically significant (χ2=3.876, P=0.049). After treatment, total limb femoral artery (58.38 ± 12.53 cm/s vs. 51.94 ± 11.62 cm/s, t=2.528), popliteal artery (43.87 ± 9.46 cm/s vs. 39.87 ± 8.28 cm/s, t=2.134), posterior tibial artery (35.72 ± 8.29 cm/s vs. 30.89 ± 8.51 cm/s, t=2.725), dorsalis pedis artery (26.82 ± 8.10 cm/s vs. 22.87 ± 7.39 cm/s, t=2.413) of the treatment group were significantly higher than those of the control group (P<0.05). The main symptom score (2.0 ± 1.5 vs. 4.1 ± 2.1, t=5.419), sub syndrome score (3.1 ± 1.8 vs. 5.1 ± 2.3, t=4.692), tongue and pulse condition score (1.8 ± 0.8 vs. 2.4 ± 0.6, t=4.277) of the treatment group were significantly lower than those of the control group (P<0.01). Conclusions The traditional Chinese medicine fumigation combined with conventional therapy could improve the lower extremity blood flow status in diabetic foot patients and clinical symptoms. Key words: Diabetic foot; Steaming washing therapy; Compounds(TCD); Integrated Chinese traditional and western medicine therapy

Incidence of Diabetic Foot in Patients With Diabetes Mellitus in a Basic Health Unit

Introduction: Diabetic neuropathy is one of the complications that integrates the pathogenic diabetic foot triad. This neuropathy leads to a foot sensory loss, making the patient vulnerable to minor injuries that could precipitate lesions, subsequent infection and foot amputation. Therefore, the diagnosis needs to come from a complete and detailed physical examination. Objective: The present study aims to investigate the incidence of diabetic foot in diabetic patients who are users of the Basic Health Unit (BHS) in the city of Olinda, Pernambuco. Methodology: The sample of this descriptive exploratory of quantitative methods study was composed of 50 diabetic users of the Basic Health Unit. After signing a Free and Informed Consent Form, a questionnaire was applied regarding the perception of the diabetic on signs and symptoms which are observed in the diabetic foot, proceeding with a thorough evaluation of the feet using 10g of monofilament and performing the Pin Prick Test. Results and Discussion: In total, 70% of patients reported poor glycemic control, 63% reported neuropathic symptoms such as numbness and tingling in the feet and 57% of the evaluated patients have thickened nails and dried or scaly feet. Regarding the vascular evaluation 47% of the evaluated presented with a decreased pedal pulse and 7% presented with this same pulse absent, while 40% had decreased posterior tibial pulse and 7% did not present any pulse at palpation. Regarding the sensitivity assessment, 30% of diabetics presented abnormal results in one of the feet and 7% had no painful and tactile reflex through the sting sensation test. Conclusion: A preventive evaluation of the feet on diabetic patients resulted in important data that informs about the high prevalence of neuropathic findings, contributing to a greater knowledge for the UBS professional team about the presence of neuropathic foot in their diabetic users.

An exploration of the relationship between foot skin temperature and blood flow in type 2 diabetes mellitus patients: a cross-sectional study.

[Purpose] The current study aimed to investigate the reliability of infrared thermography as a method of determining foot skin temperature, and to determine the relationship between foot skin temperature and blood flow in type 2 diabetes mellitus (DM) patients. [Participants and Methods] Eighty-five patients were recruited and their foot skin temperature and the ankle brachial index (ABI) were measured using infrared thermography and an automated oscillometry, respectively. A correlation between foot skin temperature and blood flow was performed. The patients were screened and classified according to two groups; diabetic peripheral neuropathy (DPN) and non-DPN. Discriminant validity was determined by comparing the foot skin temperature between the two groups. [Results] The test-retest reliability of foot skin temperature was high. A positive correlation was found between foot skin temperature and ABI in both feet. The foot skin temperatures in the DPN group were found to be significant lower when compared with those in the non-DPN group. [Conclusion] Foot skin temperature is an indirect method of evaluating blood flow in the feet of diabetic patients and can be used as a clinical outcome measurement of treatments used to improve blood flow in type 2 DM patients.

Age-related changes in the tactile pressure sensitivity threshold in the sole of the foot in diabetic patients.

[Purpose] Patients diagnosed with diabetes mellitus (DM) are known to experience sensory disturbances in their feet secondary to diabetic neuropathy (DN). The sole of the foot tactile pressure sensitivity threshold in patients with DM was evaluated in addition to examining age-related effects based on the sites studied. Whether the tactile pressure sensitivity threshold in the sole of the foot in elderly patients with DM was associated with the duration of DM or aging was evaluated. [Participants and Methods] Our study included 204 patients with DM (136males and 68 females). Patients were divided into the following age groups: 20–39 (20 patients), 40–49 (26 patients), 50–59 (34 patients), 60–69 (60 patients), 70–79 (45 patients), and 80–89 years (19 patients). Using Semmes-Weinstein monofilament testing, the tactile pressure sensitivity threshold at the sole of the foot was evaluated in the bilateral halluces, first metatarsal head, fifth toe metatarsal head, and the heels, and age-related effects were examined. [Results] At all the sites that were examined, we observed an age-related increase in the tactile pressure sensitivity threshold value, and this finding demonstrated a positive partial correlation with the duration of DM. [Conclusion] Aging influences DN-induced degeneration of peripheral nerves.

Https://www.omicsonline.org/open-access/predictors-and-outcomes-of-gastrointestinal-bleeding-in-patients-with-acute-myocardial-infarction-2329-6925-1000368-104303.html

Background: Diabetic foot (DF) is one of the most widespread type 2 diabetes mellitus “T2DM” complications, it originates from the conjunction of neuropathy and vascular disease. Some reports suggest that amputees might be prone to cognitive decline. Aim of the work: To investigate the cognitive function of DF patients and the relations between it and diabetes complications& comorbidities. Patients and methods: One hundred dementia-free subjects with DF aged >18 were enrolled in the study through the period from March to August 2018 from the Vascular outpatient clinic of Qena University Hospital and only patients whom gave consent have joined the study. The mean age of the study group was 61 years, with 70 males and 30 females, their demographic characters were recorded and medical cognitive tests were applied. Patients have been undergone clinical vascular examination, data on diabetic complications and comorbidities were gathered; (HbA1c) tests were carried out for all patients. Results: The mean Mini-Mental State Examination “MMSE” score of subjects was 24.6 and 40% had global cognitive dysfunction (MMSE ≤ 24). Between elderly subjects (aged ≥ 65), MMSE impairment was linked to amputation, episodic memory impairment was connected to foot amputation and complications. Elderly subjects with HbA1c >7% had elevated odds of psychomotor slowness and abstract reasoning impairment. However, such findings were not present in adult subjects <65 years. Conclusion: Diabetic foot is the severest form of T2DM that causes significant impairment in all cognitive domains. The severity of depression is significantly increased with the intensity of amputation.

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

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.

Tissue Oxygenation and Negative-Pressure Wound Therapy When Applied to the Feet of Persons With Diabetes Mellitus: An Observational Study.

Our group has reported that negative-pressure wound therapy (NPWT) decreases tissue oxygenation by 84% in the foot of diabetic patients because the pad of the connecting drainage tube and foam sponge of the NPWT system compress the wound bed. The purpose of this study was to determine whether an NPWT modified dressing application reduces tissue oxygenation in the feet of persons with diabetes mellitus. A prospective, clinical, observational study. We enrolled 30 patients with diabetic mellitus; their mean age was 63.9 ± 11.2 years (mean ± standard deviation). All were cared for at the diabetic wound center at an academic tertiary medical center in South Korea between 2014 and January 2015. Transcutaneous partial oxygen pressures (TcpO2) were measured to determine tissue oxygenation levels beneath modified NPWT dressings. A TcpO2 sensor was fixed at the tarsometatarsal area of the contralateral unwounded foot. A negative pressure of -125 mm Hg was applied until TcpO2 reached a plateau state; values were measured before, during, and after the modified NPWT. The Wilcoxon' and Mann-Whitney U tests were used to compare differences between these measurements. TcpO2 levels decreased by 26% during the modified NPWT. Mean TcpO2 values before, during, and after turning off the therapy were 54.3 ± 15.3 mm Hg, 41.6 ± 16.3 mm Hg, and 53.3 ± 15.6 mm Hg (P < .05), respectively. Applying NPWT without the pad of the connecting drainage tube significantly reduces the amount of tissue oxygenation loss beneath foam dressings on the skin of the foot dorsum in diabetic patients.

Clinicopathological study of diabetic foot in Bundelkhand area with special reference to fungal infection in asymptomatic feet of diabetic patients

Background: As with substantial increasing in incidence of diabetes mellitus in present century and with huge prevalence in population; the incidence of one of the dreadful complication of diabetes i.e. diabetic foot also increases, leading to increase morbidity and mortality. Fungal infection in foot is one of the underweighted cause of foot ulceration. These microulceration in conjunction with diabetes may leads to fulminant infection. The study comprised of 66 cases out of which 16 served as control. Aim and objectives of our study is to study the incidence of fungal infection in asymptomatic feet of diabetic patients, identification of the type of fungus, comparison with nondiabetics and clinicopathological study of the patients.Methods: The present study was carried at Department of Surgery, MLB. Medical College, Jhansi, the study group was classified into two groups. Control group; this group comprised of non-diabetic patients with foot lesions. Disease group; diabetic patients with foot lesions. Webs scrapings were inoculated in Sabouraud’s media slopes. Cultured media were examined after 3 days for the growth. Identification depends on colonial appearance and the morphology of the spores and by Gram, s and AFB Staining.Results: By this study we conclude that fungal infection in asymptomatic foot of diabetes patient are significantly more than non-diabetic patients which is accentuated by duration, type, glycaemic control and practice of bare foot walking which makes diabetic patient more prone for diabetic foot. So, the foot care of patients of diabetes should include the prophylactic steps to prevent fungal growth.Conclusions: By above study, we reasonably conclude that fungal infection in diabetic patients plays a pivotal role in formation of diabetic foot disease, so by eradication of fungal infection in asymptomatic foot of diabetic patient by general preventive methods and/or pharmacological methods may be beneficial in reducing morbidity and mortality in diabetic foot patients.

Reconstruction of severe atherosclerotic and obstructive diabetic feet using thoracodorsal artery perforator flaps with long vascular pedicles.

Foot ulcers in diabetic patients often require free flaps. A long vascular pedicle is mandatory so that more proximal vessels can be used as recipient vessels, especially when the flap is used to reconstruct distal foot defects. We evaluated the outcome of diabetic foot defect that were reconstructed using thoracodorsal artery perforator (TDAP) flaps with long vascular pedicles. We reconstructed the foot defects of 22 diabetic patients. Nineteen patients were male, and the mean age was 56.4 years. The defects were located in big toe in 11 patients; fourth and/or fifth toe, including lateral aspect of the foot, in 8 patients; and dorsum of the foot, medial plantar, and first metatarsal medial head in 1 patient each. CT angiography showed that the two main vessels of the lower leg remained intact in 7 patients, only one vessel was intact in the lower leg of 11, and no vessels were visible in 4. The flap size ranged between 5 × 4 cm2 and 18 × 11cm2 , with a mean pedicle length of 16.5 cm. The anterior tibial artery was used as the recipient vessel in 15 patients, while the posterior tibial artery was used in 7. All the flaps survived. Three wound disruptions and two partial flap losses healed conservatively, without further surgery. Ulcer due to diabetes recurred in three cases. The mean follow-up period was 46.1 months. All wounds healed completely. TDAP flaps with long vascular pedicles may be a viable choice for reconstructing defects in the feet of diabetic patients.

Triton Hodge Test for Detection of Metallo-Β-Lactamases Producing Pseudomonas Aeruginosa Isolates from Egyptian Patients with Infected Diabetic Foot

Background: One of the dreadful complications of diabetes is infected diabetic foot. Accurate detection of carbapenemase-producing Pseudomonas aeruginosa, in the form of metallo-beta-lactamases (MBLs) is necessary to determine the antibiotics for its treatment. Objectives: This study was designed to evaluate the efficacy of Triton Hodge Test (THT) versus MHT for detection of MBLs-producing P. aeruginosa isolates from infected diabetic foot patients. Methodology: Samples were collected from 500 infected diabetic footpatients. They were processed and P. aeruginosa isolates were identified. Then, carbapenem resistant P. aeruginosa (CRPA)isolates weredetected. Modified Hodge test (MHT) and Triton Hodge Test (THT) were used for detectionof MBLs. Furthermore, bla IMP , bla VIM and bla NDM MBLs genes were detected by multiplex and uniplex PCR. Resistance pattern of CRPA isolates was determined. Results: Isolation rate of P. aeruginosa from infected diabetic foot patients was 90/500 (18.00%). CRPA isolates were 16/90 (17.78%). In these isolates, the detection rate of bla NDM , bla VIM and bla IMP genes was (2/16, 12.5%), (10/16,62.5%) and (6/16,37.5%); respectively. The sensitivity, specificity and accuracy of THT in detection of NDM, VIM and IMP carbapenemases are 100 %. On the other hand, the sensitivity of MHT in detection of the studied types are 0.0%, 30.0% and 50.0%; respectively. Its specificity is 100% for all types and its accuracy is 87.5%, 56.3% and 83.1% in detection of these types. No resistance to tigecycline and colistin was detected among CRPA isolates. Conclusion: the THT is a more sensitive and accurate phenotypic test in comparison to MHT for detection of NDM, VIM and IMP carbapenemases in CRPA isolates.