Gangrene Of Foot Research Articles

Bir köpekteki post-operatif enfekte yaranın maggot debridman terapi ile tedavisi: Olgu sunumu

Losing its importance over time with the discovery of antibiotics, maggot debridement therapy (MDT) to treat non-healing wounds tends to increase in recent years. However, its use in veterinary medicine is rather limited than human medicine. The material of this case report consisted of a 5-month-old Doberman dog bandaged for a fracture of the left hind toe. An anamnesis was taken that the bandage on the leg area was wet and remained on the wound for five days, and due to these, the foot turned into a macerated and gangrenous structure. Then, the gangrenous foot was amputated, and an infected wound that did not respond to antibiotic therapy occurred in the amputation area. The study was planned to investigate the efficacy of MDT on a post-operative infected wound. For this purpose, the sterile first and second instar larvae of Lucilia sericata were used. The first MDT administration was performed six days after the amputation. The second application was repeated after 24 hours, and the other two applications were repeated 48 hours intervals. After the first application, the amount of discharge gradually decreased in the wound, and rapid healing was determined. The wound was successfully treated by the wound healing-promoting characteristics of sterile L. sericata larvae. It is thought that this study will contribute to the spread of MDT applications, which are applied at a limited level for the treatment of non-healing chronic infected wounds in the field of veterinary medicine.

One of Jehovah’s Witnesses with Gangrenous Foot and Severe Anemia: A Case Report

There are an increasing number of patients who are refusing blood transfusions for several reasons, the most widespread among them being Jehovah’s Witnesses. We present a case of a 66-year-old woman admited to the hospital with gangrene as a complication of the diabetic foot. The hemoglobin level was 4.8g/dl, hematocrit was 15.8% and mean corpuscular volume was 77.1 fL. She needed urgent surgery to amputate her foot. Being one of Jehovah’s Witnesses, she refused blood transfusions. A multimodal blood management approach was applied, and the patient underwent leg amputation without transfusion of any blood product. The treatment strategy is discussed.

A CLINICAL STUDY OF DIABETIC FOOT ULCERS AND MANAGEMENT

Introduction: Diabetic foot may be defined as a group of syndromes in which neuropathy, ischemia and infection lead to tissue breakdown, resulting in morbidity and possible amputation. Foot problem remains very common in people with diabetes throughout the world, affecting up to 15% of diabetic patients during their life time. The aim of this study is to assess the various presentations of diabetic foot ulcers and surgical management. Materials and Methods:This is a hospital based prospective observational study conducted in 50patients of diabetic foot ulcers admitted in the department of General Surgery at Zoram Medical College (ZMC), Falkawn, Mizoram during the period of November 2017 to December 2021. All patients with diabetes mellitus suffering from foot ulcers of all age groups, incidental diagnosis of diabetes with foot ulcers, patients with gangrenous foot complicated by diabetes are included.Patients with foot infections or gangrene foot without diabetes mellitus or incomplete treatment are excluded. Results: The commonest presentation in this study is ulcer followed by gangrene and abscess. The most common site of lesion is toes (42%) followed by dorsum of foot (30%) and planter of foot (16%). 72% of patients (36) had neuropathy, 14% had vasculopathy and 10% had both. 30 (60%) patients are healed by debridement and dressing alone, 11 (22%) patients need amputation or disarticulation to heal. Skin grafting is done in 9 patients. No patient dies of the ulcer. Conclusion: Diabetic foot ulcer is a complication of prolonged diabetes mellitus which increases with age and duration of the disease. The surgical management of diabetic foot ulcers should be based on the knowledge of pathophysiology of diabetes and practice of new treatment modalities.

THE MANAGEMENT OF DIABETIC FOOT IN THE EMERGENCY

Background:Diabetic foot ulcers infected mainly increase the risk of amputation. The aim of our study was to define the predictors of amputation of the diabetic foot, draw the clinical, bacteriological and therapeutic profile of patients presenting to the emergency Aims: To define the predictors of amputation of the diabetic foot, draw the clinical, bacteriological and therapeutic profile of patients presenting to the emergency Patients/methods: This is a prospective observational study spread over twelve months in the medical and surgical emergencies including 108 patients. We investigated socio-demographic, clinical data and treatment of patients hospitalized for diabetic foot. Results: The mean age of patients was 63.7ans, 92.6% were diabetic type2. 57.4% of lesions were acute (ulcers (37%), wet gangrene (33.3%), dry gangrene (13%),cellulitis (24.1%) and acute Charcot foot (9.3%)), 63% following a trauma and 33.2% due to unsuitable footwear. 81.5% had clinical signs of angiopathy and 64.5% of neuropathy. The lesions were classified: uninfected (9.3%), low (9.3%), moderate (38.8%) and severe (42.6%) according to the IDSA / IWGDF and 0D (46.3%) 3D (18.5%) 3B (7.4%) according to the University of Texas. Staphylococcus aureus was the most germ solved. Antibiotics administered if osteitis was Amoxicillin-clavulanate (57.5%) and Ertapenem (31.5%) in his absence. 14.8% received debridement, 1.9% for revascularization and 83.3% for amputation. In our study, the risk of amputation increases with the average socioeconomic level, severity of the infection and the presence of osteitis /osteomyelitis while drying feet after ablution was a protective factor. 9.3% of recurrence and 5.6% of deaths were recorded. Conclusions: The multidisciplinary management of diabetic foot is paramount. The surgery is common immediately but rarely necessary, medical treatment is the first-line therapy avoiding abusive amputations. Prevention requires the establishment of specialized units. Summary:Diabetic foot ulcers infected mainly increase the risk of amputation. The aim of our study was to define the predictors of amputation of the diabetic foot, draw the clinical, bacteriological and therapeutic profile of patients presenting to the emergency. This is a prospective observational study spread over twelve months in the medical and surgical emergencies including 108 patients. In our study, the risk of amputation increases with the average socioeconomic level, severity of the infection and the presence of osteitis /osteomyelitis while drying feet after ablution was a protective factor. 9.3% of recurrence and 5.6% of deaths were recorded.

Bacteriological profile of anaerobes in deep-seated abscess of patients attending a tertiary care hospital

Background: Anaerobes are recognized as important human pathogens causing severe life threatening exogenous and endogenous infection if left untreated. Anaerobes are one of the most neglected pathogens in various clinical samples due to the problem in sample handling, technical difficulties in their cultivation, and identification along with prolonged turnaround time. Aims and Objectives: The present study was undertaken to identify the different anaerobic organisms associated with deep seated abscess and their association with various risk. Materials and Methods: Pus and fluid sample collected in sterile syringe or swab stick were immediately put in RCM and taken to the laboratory. Gram staining, ZN stain, and culture--both aerobic and anaerobic were done. Obligate anaerobes were checked for aerotolerance. Subcultures were done for identification of species level by Gram stain, colony morphology, biochemical tests, and final identification that were done by the Vitek 2 system. Results: Out of the 170 samples, 144 (84.70%) were culture positive and the rest 26 (15.29%) were culture negative; 101 (70.1%) were aerobic, 23 (16%) anaerobes, and 20 (13.9%) mixed aerobic and anaerobic. A total of 51 obligate anaerobes were isolated from various samples. Out of which 32 (62.74 %) anaerobic Gram-positive cocci-Peptostreptococcus anaerobious being the most common and 13 (25.49%) anaerobic Gram-negative bacilli --Bacteroids fragilis being most common and 6 (11.76%) were anaerobic Gram-positive bacilli - Actinomyces meyeri being the most common. Diabetes mellitus was a significant associated factor. Maximum number of anaerobes was isolated from abscess over oral cavity followed by gangrenous foot, scrotal abscess, and diabetic foot. Conclusion: Anaerobes are an important cause of deep-seated abscess—mostly being polymicrobial in nature. Incision--drainage and proper antibiotic therapy is necessary for their early control and prevention of complications.

Septic patient with gangrenous foot : A report of asurgical emergency with afoudroyant course

Septic patient with gangrenous foot : A report of asurgical emergency with afoudroyant course

A Qualitative Study of Pictorial Health Warnings on Malaysian Cigarette Packs: How Do the Adults Understand Them?

The WHO recommended pictorial health warnings (PHWs) on cigarette packs in 2003 to educate and warn the public of smoking effects. Malaysia too has implemented this policy since 2009. This study explored the public’s understanding of the gazetted PHWs depicted on cigarette packs available in Malaysia. A qualitative study using four focus group discussions (FGDs) was conducted among smokers and non-smokers aged 18–40 in Malacca, Peninsular Malaysia. Thematic analyses were performed using the Atlas Ti version 8.0 software. Six themes have emerged reflecting the public’s understanding of the existing PHWs in Malaysia, namely, (i) awareness and exposures, (ii) recall and attention, (iii) perceived goals, (iv) perceived target groups, (v) attitude in understanding, and (vi) knowledge and meaning of PHWs. All participants were aware of the PHWs depicted on legal cigarettes but not seen on most illicit cigarettes. PHWs were perceived to give awareness and warning about the smoking effects targeting smokers and non-smokers. Participants understood the lung and oral health-related images easily than other body parts such as gangrene foot, miscarriages, etc. Besides enforcement on illicit cigarettes without PHWs, policymakers or relevant authorities should emphasize creating relevant and clear pictorial messages in educating the public to avoid confusion affecting the public’s understanding of the PHWs.

Role of affective reactivity induced by cigarette packaging including graphic warning labels: the CASA Study

ObjectiveTo identify whether three types of cigarette pack designs, including three versions of graphic warning label (GWL) plain packs, one GWL absent and branding absent pack (blank) and the smoker’s...

Catastrophic Coronavirus Disease COVID Infection Leading to Gangrene of Foot in Peripartum Women.

Introduction:Pregnancy is a physiologically hypercoagulable state and a coronavirus disease 2019 (COVID-19) infection adds to this burden by accentuating the coagulopathy. We report two cases of severe peri-partum COVID infection leading to extremity gangrene secondary to a pro-thrombotic coagulopathy.Case One:A 37-year-old lady, day-2 postpartum, was brought with severe COVID infection & and respiratory failure. She developed progressive gangrene of the foot. A computed tomography (CT) angiogram confirmed the presence of thrombosis of the left external iliac & and common femoral artery. She was managed with catheter- directed thrombolysis and fasciotomy. The dry gangrene of the foot was managed with a Boyd’s amputation. At 1-year follow-up, she is ambulant with a healthy stump.Case Two:A 34-year-old lady, 36 weeks of gestation, presented with fulminant COVID infection with respiratory failure and pulmonary embolus. The lady developed gangrene of the B/L toes. A CT angiogram revealed thrombosis below the popliteal trifurcation in both limbs along with segmental pulmonary thrombo-embolism involving the right lung and multiple splenic infarcts. She succumbed to the overwhelming infection and sepsis.Discussion:The pathogenesis of coagulopathy in pregnant COVID patients is attributed to the hypercoagulable effect, which leads to thrombo-embolisms and limb ischemia following a cytokine storm syndrome in severe infections. To date, this is the first experience detailing distal limb gangrene in fulminant COVID infection in peri-partum women. Although, cases have been reported on distal limb gangrene in severe COVID infection among non-pregnant individuals.Conclusion:A multidisciplinary team must manage COVID infections in the third trimester. A prompt recognition of any forms of lethal coagulopathy and vigilant treatment will prevent loss of life.

English

BACKGROUND Chronic arterial insufficiency (CAI) results in stenotic-occlusive disease of vascularized arterial disorders of tissues and organs. CAI of the lower extremities represents a significant medical and socio-economic problem due to a high incidence of morbidity, invalidity and mortality. METHODS A cross sectional analytical study was conducted in a group of 100 patients, admitted at the Vascular Department of the Sri Venkateshwara Ramnaraian Ruia Government General Hospital, Tirupati during the period from September 2018 to August 2019, with evident symptoms and signs of different stages of lower extremities CAI verified by ultrasonography. In patients with lower extremity disorder of tissue arterial capillaries, SpO2 was determined by pulse oximetry. CAI of the lower extremity was determined on the basis of clinical findings and colour Doppler duplex scan echo sonography results. Using the conventional method (single-gate) and colour Doppler duplex scan (multi-gate), the presence and localization of stenosis, the segmental predominance (with multisegmental forms) and the degree of progression of stenotic-occlusive lesions were verified. RESULTS Results Using pulse oximetry, depending on the of stage of lower extremities CAI, we revealed a considerable difference in the stages of functional ischemia Mean SpO2: Fontaine I – 95.50 %, Fontaine II – 92.90; in stage critical ischemia SpO2: Fontaine III – 65.00 % and Fontaine IV – 49.87 %. In 29 patients with gangrenous foot and fingers SpO2 was immeasurable and progressive decrease in SpO2 of arterial capillaries (p<0.01 between stages). CONCLUSIONS Due to the reliability and simplicity of pulse oximetry it can be a routinely used diagnostic device for patients with early determined stage of lower extremities CAI. KEYWORDS Chronic Arterial Insufficiency, SPO2, Pulse Oximetry, Ischemia

Industry manipulation of pictorial health warning labels in Pakistan

Approximately 10.5% of adults in Pakistan (about 13 million) smoke cigarettes,1 causing 134 000 deaths annually.2 To reduce the burden of disease, the Pakistan government implemented a requirement in 2010...

A Study on Clinical Profile of Patients with Diabetic Foot

Diabetes is a worldwide problem. A majority of diabetic patients develop foot ulcers in one point of time or other during the course of their illness. A significant number of such patients will require long-term hospital treatment and amputations. The etiopathogenesis of diabetic foot lesions are multifactorial. This study was conducted comprising of 100 patients of Diabetic foot in the Department of Surgery at Medical College. All the patients with Diabetes Mellitus presenting with foot ulcers, infection of foot and gangrene of foot. Incidence of Ulcer was common in patients with 6-10yrs of diabetes (36.53%), followed by 2-5 yrs group (26.92%). Gangrene was found more in 11-15 yrs group (30.43%), while incidence of abscess was relatively same among all groups, while incidence of cellulitis was common among 6-10 yrs group.

The Effect of Family Empowerment in Nursing Implementation Toward Self-Efficacy among Patients with Diabetes Mellitus

Introduction: : Diabetes mellitus is a condition where the body cannot produce the insulin hormone as needed so that there is an excess of normal blood sugar levels. Giving family empowerment in clients with gangrene foot diabetes should be done comprehensively using the nursing process. Interventions that can be done are family empowerment to motivate and improve the self-efficacy of patients with diabetes mellitus. The purpose of this study was to determine the effect self-efficacy before and after the implementation of family empowerment in nursing in patients with diabetes mellitus. Methods: Pre-experiment research with pretest and posttest study design without control group. Forty respondents who met the inclusion criteria were then tested using purposive sampling. The instrument in this study used a self-efficacy questionnaire. The dependent variable of this study is self-efficacy, while the independent variable is family empowerment using the paired sample t-test parametric analysis method. Results: Based on what was answered by the respondents there was a significant influence which showed difference after the posttest. The results obtained values: α = 0.05 which calculated the results of p = 0.00 (p <0.05). This means that, after a posttest, there was a decrease in motivation and self-efficacy. Conclusion: Researchers concluded that there is an effect of family empowerment on patients with diabetes mellitus. The implication of this study is that the role of family is very important in healing patients.

PERIODONTAL HEALTH LITERACY AMONG TYPE 2 DIABETES MELLITUS PATIENTS SUFFERING FROM CHRONIC PERIODONTITIS

Objective: The aim of the present study is to evaluate the awareness level of diabetic patients in regard to the complications of diabetes and specifically periodontitis as a complication of diabetes in Peshawar city of Pakistan with the target of improving oral health education in the population. Materials and Methods: A cross-sectional questionnaire-based study was conducted among 151 Type 2 Diabetes mellitus patients attending periodontology department of Khyber college of dentistry Peshawar Pakistan to assess the level of their awareness about complications of diabetes specifically periodontitis as a complication of type 2 DM. Results: The general level of the Type 2 DM patients regarding complications of diabetes including Eye disease, Kidney disease, gangrene foot, heart disease and stroke was found satisfactory as compared to periodontitis as a complication of diabetes which was found unsatisfactory in this study. Conclusion: Majority of the Type 2 DM patients were aware about the complications of Type 2 DM except periodontitis which is also a complication of Type 2 DM. Therefore, awareness through and among health professionals both Medical and Dental including patients and general public on this issue should be spread through Oral health awareness programs for the general wellbeing of the population.

Arterial Reconstruction and Bypass Repair for Diabetic Ischemic- Gangrenous Foot Ulcers; Long Lasting Implicative way for Level Salvage

Introduction Diabetic wounds are imposed, common, unpredictable refractory lesions which mostly involve the feet in all patients and always lead to amputations. These progressive ulcers need to be attended by an accurate educational planning to protect diabetics from their complications. As postu

Tool to assess appeal–aversion response to graphic warning labels on cigarette packs among US smokers

IntroductionGraphic warning labels on cigarette packaging are mandated in 118 countries and are under consideration in the USA. We propose an appeal–aversion assessment tool to help regulators choose among graphic...

Wound Healing Efficacy of Re Cell Heal in a Diabetic Foot Infection Patient Diagnosed with Gas Gangrene – A Case Report

Gas gangrene is a rapidly progressive and bacterial infection that produces tissue gas in gangrene. The condition may result from ischemia, infection, or trauma or a combination of these processes. A 72-year-old woman with a 10 years history of type-2 diabetes mellitus (NIDDM) presented to the emergency department with a one-week history of left foot painful, swelling, redness, fever and foul-smelling discharge from wound. Wound infection of the left foot worsening progressing to gas gangrene that remains unhealed after a week to one month. She was diagnosed with Clostridium perfringens and Clostridial myonecrosis. The foot X-ray showed a 13 X 8.5 X 1.75 cm and is surrounded by callus under the 1st to 5th metatarsal heads (Figure 3a & 3b). Computed tomography (CT) scan showed moderate air suggesting deep tissue infection, with multiple tiny gas bubbles within under the first metatarsal heads, concerning for gas gangrene. The patient was treated with Poly Herbal Formulation (PHF), Re Cell Heal 500 mg Capsule (PRANATHI HERBALS; License No. T-2265/Ayur/; Letter No 2884/ DA/2018) (p.o) twice a day, in addition to the (Topical) Wound Check Ointment (Letter No 4964/DA/2018) accompanied with debriment over a five (5) months, foot healed without amputation improved therapeutic outcomes, reduce fatalities caused by gas gangrene. Re Cell Heal helps to provide relief in the symptoms like swelling and pain in tissues. Recent scientific evidences and trials conducted on Re Cell Heal is a traditional and alternative medicine in wound therapy, gas gangrene and diabetic related foot problems holds good promise in the future safety without any side effects.

Outcome of limb salvage in single peroneal versus other tibial revascularization in infra-popliteal arterial disease

Background The importance of the angiosome concept in critical limb ischemia remains controversial. The peroneal artery is relatively spared from the terminal stages of atherosclerosis and is often the last tibial vessel to become occluded in diabetes or end-stage vascular disease. The main prejudice, on the contrary, against its use in distal revascularizations is that the perfusion of the foot is indirect, via collaterals from its anterior and posterior branches, despite an extensive collateral arterial bed, so the target vessel may be inadequate for treating a septic or gangrenous foot. The value of peroneal artery revascularization has always been debatable, especially in patients with tissue loss. As one of the most important factors of wound healing is the establishment of in-line flow to the foot, the role of peroneal angioplasty has to be defined. The aim of this retrospective study was to assess the outcomes of single peroneal indirect revascularization (IR) (nonangiosome-targeted tibial angioplasty) versus other tibial direct revascularization (DR) (angiosome-targeted), in infra-popliteal arterial disease. Patients and methods Thirty patients were included and presented to the Vascular Surgery Department of Al-Azhar University Hospitals and El araby Specialized Hospital, Menoufia with infra-popliteal arterial lesions, distributed into two equal groups: 15 patients were treated with single peroneal IR, while 15 patients were treated with other tibial DR during the period from June 2019 to June 2019. Results Fifteen patients reached the endpoint of adequate healing (nine patients with ‘DR’ technique and six patients with ‘ID’ technique) and nine patients underwent major amputations. The limb salvage after 1 year was 70%. Conclusion DR of tibial vessels appears to improve wound healing and limb salvage rates compared with IR, with no effect on patency, morbidity, mortality, or reintervention rates.

Use of Acellular Urinary Bladder Matrix for Accelerated Soft Tissue Recovery in Complicated Gangrenous Diabetic Foot Infections

Use of Acellular Urinary Bladder Matrix for Accelerated Soft Tissue Recovery in Complicated Gangrenous Diabetic Foot Infections

Management and cost of snakebite injuries at a teaching and referral hospital in Western Kenya

Background: Data on the cost of snakebite injuries may inform key pillars of universal health coverage including proper planning, allocation, and utility of resources. This study evaluated the injuries, management, and costs resulting from snakebites at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kenya. Methods: In total, medical records of 127 snakebite victims attending JOOTRH between January 2011 and December 2016 were purposely selected and data on the age, gender, type of residence (urban or rural), part of the body bitten, time of bite, injuries, pre-hospital first aid, time to hospital, length of stay, treatment, and costs were collected. Regression analysis was used to predict the total indirect cost of snakebite injuries and p≤ 0.05 was considered significant. Mortality and loss of income of hospitalized victims were considered as direct costs. Results: It was found that 43 victims were 13-24 years of age, 64 were female, 94 were from rural areas, 92 were bitten on the lower limbs, 49 were bitten between 6.00 pm and midnight, 43 attempted pre-hospital first aid, and the median time to hospital was 4.5 hours. Antivenom, supportive therapy, antibiotics, antihistamines, corticosteroids, analgesics, and non-steroidal anti-inflammatory drugs were used. Cellulitis, compartment syndrome, gangrenous foot, psychiatric disorder, and death were the main complications. Most victims spent 1-5 days in hospital and the median cost of treating a snakebite was 2652 KES (~$26). Drugs, ward charges, and nursing procedures were the highest contributors to the total indirect cost. Victims hospitalized for 6-10 days and >10 days incurred 32% and 62% more costs, respectively, compared to those hospitalized for 1-5 days. Conclusions: The longer snakebite victims are hospitalized, the higher the cost incurred. Continuous medical education on the correct management of snakebites should be encouraged to minimize complications that may increase hospital stays and costs incurred.