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Diabetic Foot Ulcer: Synopsis of the Epidemiology and Pathophysiology

Diabetic Foot Ulcer: Synopsis of the Epidemiology and Pathophysiology

Diabetic foot ulcer is a common problem among people living with diabetes. It is often an unpleasant experience due to its chronicity, unsightly nature and some degree of negative psychological feeling associated with having a chronic wound. Mobility may also become an issue at a point which further compounds the problem. Closely related is the major sequela of limb amputation. Amputation leads to permanent disability with inability to perform some daily activities. As the diabetes epidemic continues to spread, it is logic to anticipate a rise in complications like DFU in the absence of well articulate strategies that are executed at all levels. Hence, particular attention to feet care should be a central focus in educating and managing patients with diabetes to ensure that DFU is either prevented or noticed early enough.
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Bacteriological Profile in Diabetic Foot Patients

Bacteriological Profile in Diabetic Foot Patients

DOI: 10.4236/jdm.2017.74021 268 Journal of Diabetes Mellitus thorization from the private clinic staff, the complete set-up of the clinical re- cords was analysed. The following variables were studied: age (measured in years), gender, origin, lesion Wagner’s classification, cultures, isolated microor- ganism, and antibiogram report. Analysis and data processing were performed through descriptive statistics with Origin, Statgrahics Plus Version 5.0. statistics package. The hypothesis stablished was: there is a high diabetic foot incidence with presence of both, Gram-positive bacteria Staphylococcus aureus and gram-negative bacteria Escherichia coli .
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Diabetic foot ulcer and its surgical management

Diabetic foot ulcer and its surgical management

class should be given education of diabetes mellitus and its risk factors. Prevention is the better than cure is true in this disease, too. Effective glycemic control and education are of key importance for decreasing diabetic foot disease, while early presentation and hospital admission, aggressive and appropriate medical and surgical treatment according to grade of disease can improve outcome and reduce the morbidity and mortality due to diabetes.

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Effectiveness of a Self Foot Care Educational Program for Prevention of Diabetic Foot Disease

Effectiveness of a Self Foot Care Educational Program for Prevention of Diabetic Foot Disease

Previous studies on the education of patients with chronic diseases have re- ported that self-foot-care educational programs for prevention of diabetic foot disease which incorporate self-monitoring and feedback show educational ef- fects such as improvements in symptoms and changes in behaviors [8] [9] [10] [11]. Based on this, the authors have developed a “self-foot-care educational program (SFCEP)” for prevention of type 2 diabetic foot disease of DM patients, which incorporates self-foot-care and self-monitoring as an element in the foot-care education to improve the patients’ awareness of diabetic foot disease so that patients will be able to conduct foot-care routinely, and change their beha- viors to prevent the occurrence of the disease. This study aims to provide educa- tion for patients with type 2 DM using the above educational program (SFCEP), and verify the effectiveness of the program by a randomized controlled trial (RCT).
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Characterizing multisegment foot kinematics during gait in diabetic foot patients

Characterizing multisegment foot kinematics during gait in diabetic foot patients

The study of structure and function of the diabetic foot have received little attention in the literature, while most of the studies have concentrated on the kinetic analysis by means of force and plantar pressure plates [4-12]. On the other hand kinematic analysis would be clinically very important for diabetic neuropathic patients in order to appreciate the supination-pronation and inversion-ever- sion movement of forefoot vs midfoot and hindfoot. Unfortunately, currently available movement analysis protocols [13-16] are not suitable for this purpose. These procedures, which utilize rigid mounting plates by means of elastic bandages and lengthy anatomical calibration procedures [13-15,17], cannot be easily applied in patients with peripheral artery disease or neuropathies.
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DIABETIC FOOT ULCER – AN AYURVEDIC PERSPECTIVE

DIABETIC FOOT ULCER – AN AYURVEDIC PERSPECTIVE

The greatest fear of diabetic patients is loss of eyesight and amputation. Diabetic foot is a quiet dread of disability with the ever dangling end of an amputation, thus makes the diabetic foot the most feared and devastating complication of diabetes. Current therapies have a limited success rate and fall short in addressing the micro vascular pathology present in diabetics. The circumstances have never been better for the preservation of diabetic lower extremity .The challenge is to get these patients back on their feet. So there is an urgent need for the proper understanding of pathogenesis of Diabetic foot as per the principles of Ayurveda for finding out a safe and effective Ayurvedic management. The concept of Prameha, Dushta vrana, Rakta dushti and Sonitha Mokshana are the key factors that should be addressed during the Ayurvedic management of Diabetic Foot.
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Collagen sponge dressings in diabetic foot ulcers

Collagen sponge dressings in diabetic foot ulcers

Wound healing is a complex process that involves the timely expression of numerous growth factors that promote cellular migration and proliferation, production of new connective tissue matrix, and collagen deposition. (Spence, 1997; Singer and Clark, 1999) In addition, diabetic foot ulcers are chronic wounds that are stuck in the inflammation phase and show a cessation of epidermal growth or migration over the wound surface. (Loots et al., 1998; Loots et al., 1999) A common characteristic of all chronic wounds is the elevation of the levels of matrix metalloproteinase, which results in increased proteolytic activity and inactivation of the growth factors involved in the wound-healing process. The use of collagen sponge dressing has been shown to specifically inhibit the action of these proteases without affecting the activity of the growth factors. Thus, theoretically, collagen sponge dressing may be an advantageous alternative to the moistened gauze that is the current standard of care.
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Diabetic Foot Ulcers

Diabetic Foot Ulcers

Once the infection has cleared and healthy granulation tissue appears, thought can be given to surgical reconstruction of the wound and the foot. Delayed primary closure or more complicated reconstructive surgery like additional bone resections, tissue flaps, or skin grafts may be done. These lesions often require maximum use of all members of the diabetic foot team.

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A Pictorial Review of Diabetic foot Manifestations

A Pictorial Review of Diabetic foot Manifestations

Unsurprisingly, the diabetic foot can present in a myriad manner of ways, from structural abnormalities, to a wide range of infective manifestations (superficial or deep seated). These can indeed provide a significant diagnostic dilemma in the management of such patients. Imaging thus plays a crucial role in the differentiation of various pathologies. Radiographs are the preferred initial form of imaging/screening, being readily available and relatively inexpensive. These also provide excellent resolution and visualization of osseous structures, joint spaces, fractures, loose bodies, osteophytes and enthesophytes. However, especially in the scenario of early infection or neuroarthropathy, the detection rate and accuracy is at best only 50-60% 3 , due to inability to adequately demonstrate the
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DIABETIC FOOT ULCERS AND BIOFILM FORMATION

DIABETIC FOOT ULCERS AND BIOFILM FORMATION

100 samples were collected from patients with chronic diabetic foot ulcer. The study group comprised 70 male patients and 30 female patients, whose ages ranged from 30-70 years. From these samples, 80 isolates were obtained. 28(35%) Gram positive organisms and 52(65%) gram negative organisms were isolated. No polymicrobial infections were noted. Psuedomonas aueroginosa1 8(22.5%) Staphylococcus aureus 14(17.5%) were the most commonly isolated organisms followed by E.coli15(18.75%), Klebsiella pneumonia10(12.5%), Methicillin Sensitive Staphylococcus aureus7(8.75%), Enterococcus5(6.25%), Proteus mirabilis 5(6.25%), Citrobacter 2(2.5%), Acenobacter 2(2.5%). 34(42.5%) Diabetic Ulcer patients had Biofilm Producing bacteria. From the figure it is clear that Gram negative 23(67.64%) Gram positive 11(32.35%) Microbes have predominant Biofilm production like E.coli(26.4%), Klebsiella pneumoniae(23.1%), Staphylococcus aureus(17.64%) Pseudomonas aueroginosa(14.7%), MSSA(8.82%), Betahemolytic streptococci(5.88%), Citrobacter(1%).
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The Diabetic Foot Research in Arabs’ Countries

The Diabetic Foot Research in Arabs’ Countries

gangrene and/or ischemia [6]. Some of these presenta- tions may overlap in the same patient and frequently on both feet. The reported annual incidence of diabetic foot ulceration varies between 2.1% to 7.4% [7] and the life- time risk of developing a diabetic foot ulcer has been estimated to be as high as 25% [8]. If not timely and properly managed, the ultimate endpoint of diabetic foot ulcer is amputation in 15% - 27% [7,8]. Furthermore, amputation is usually associated with significant morbid- ity [7] mortality [9], in addition to social, psychological and financial consequences [7,8,10].
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Concordance in diabetic foot ulcer infection

Concordance in diabetic foot ulcer infection

Diabetic foot ulcers can take many weeks or often months to heal and are known to have a negative impact on patients ’ functional ability, quality of life, as well as a wider societal impact in terms of reduced work product- ivity, health costs and fi nancial loss. 8–11 The combination of immunological perturbations caused by diabetes and an open wound frequently results in clinically apparent infection. At presentation about half of recent onset diabetic foot ulcers are clinically infected. 12 Diabetic foot infection is thought to be the most common cause of diabetes-related hospital admissions and precedes approximately 80% of non-traumatic lower-limb amputations. 6 13 14
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Epidemiological and Clinical Features of Diabetic Foot in Cotonou

Epidemiological and Clinical Features of Diabetic Foot in Cotonou

Method: This was a retrospective, study, which took place July 1, 2006 to July 31, 2011. Seven hundred and six diabetic patients among which 152 had diabetic foot were in-patient during the study period and 30 cases could not be included. One hundred twenty-two patients could not be inclued in our study. Analyses focused on demographic and anthropometric characteristics (BMI), the factors favoring the occurrence of foot injuries and appearance of the injuries. Bacteriological samples of the lesions were made by swabbing. The samples were placed on a transport medium of live bacteria and seeded agar sheep blood and eosin methylene blue (EMB). The result was read 48 hours later to determinethe antibiotic predisposition. We could not utilize systolic pres- sure index which is delete examining ; least expensive technique, for we do not have it. Doppler ultrasonography of the lower limbs was requested, depending on the disease duration and clinical signs, to assess the vasculari- zation, location and extent of any stenosis of the arteries. It has been achieved in 98 patients. The peripheral arterial disease (PAD) was diagnosed whenthe stenosis was greater than or equal to 50% at the femoral or tibial arteries. Antibiotic therapy was probabilistic first line and then targeted after results of bacteriological analyzes. The amputation was indicated in cases of lesion progression despite medical treatment.
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Diabetic foot infection and its management: A review

Diabetic foot infection and its management: A review

Diabetic foot infections increase the risk of morbidity, hospitalization, and amputations. Early recognition, classification, diagnosis, and treatment of foot complications are needed to optimize outcomes in patients with diabetes. It is important to accurate classification of DFI to guide the treatment regimens. The infected wound requires proper antibiotic therapy, and the agents and duration of treatment should be predicted based on the severity of the infection. Initial antibiotic therapy should select empirically, and it is based on the presenting clinical features, assessment of infection severity and by knowledge of antibiotic resistance pattern. Clinical failure of appropriate antibiotic therapy occurs due to patient non-adherence, antibiotic resistance, undiagnosed deep abscess or osteomyelitis, or severe tissue ischemia.
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The treatment of diabetic foot infections: focus on ertapenem

The treatment of diabetic foot infections: focus on ertapenem

from a large, prospective treatment trial of diabetic foot infections (SIDESTEP), the association between clinical treatment failure and baseline history, physical and labora- tory findings was assessed by univariate and multivariate logistic regression analyses. Among 402 patients clinically evaluable 10 days after completing antibiotic therapy, base- line factors significantly (P  0.05) associated by univariate analysis with treatment failure were “severe” (vs “moderate”) University of Texas (UT) wound grade; elevated white blood cell count, C-reactive protein or erythrocyte sedimentation rate; high wound severity score; inpatient treatment; low serum albumin; male sex; and skin temperature of affected foot 10 ° C above that of unaffected foot. By multivariate
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Redefined clinical spectra of diabetic foot syndrome

Redefined clinical spectra of diabetic foot syndrome

Purpose: The aim of this study was to present the redefined clinical spectra of diabetic foot syndrome (RCS-DFS) and determine whether the RCS-DFS can be used to predict amputations. Patients and methods: This is a retrospective study of type 2 diabetic patients referred with DFS for management at King Abdullah University Hospital (KAUH) between January 2014 and December 2015. Data collection form and diabetic foot (DF) characteristic chart were used to document the following: demographic data, diabetes-related parameters, DF characteristics, surgical interventions and amputations. The predominant clinical presentations of DF problems (ulcer, sepsis or gangrene) were integrated with the clinical criteria for diabetic foot infection (DFI) diagnosis and classification of Infectious Diseases Association of America (IDSA)/Interna- tional Working Group on Diabetic Foot (IWGDF) to redefine the clinical spectra of DFS. Related risk characteristics and amputation rate at all levels were compared between the three RCS. Results: In this study, there were 95 (47.0%) septic DFS (SDFS) patients, 65 (32.2%) ulcerative DFS (UDFS) patients and 42 (20.8%) gangrenous DFS (GDFS) patients. Poor glycemic control (HbA1c >7.5%), hypertension, history of the same foot problems, duration of symptoms, revas- cularizations and ischemic severity were significantly different between the three RCS. UDFS had the highest rate of limb salvage without amputations (70.8%). GDFS had the highest rate for final toe amputations (52.4%) and major amputations (23.8%). Final minor amputation rate was around 20% for both SDFS and GDFS.
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Hyperbaric oxygen therapy and diabetic foot ulcers

Hyperbaric oxygen therapy and diabetic foot ulcers

Hyperbaric oxygen therapy and diabetic foot ulcers Knowledge and attitudes of Canadian primary care physicians.. Wayne Evans MD Richard Gill Aurelia O.[r]

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Cost and benefits of the Diabetic Foot Clinic in Samoa

Cost and benefits of the Diabetic Foot Clinic in Samoa

developing diabetic foot ulcers [20, 23], therefore the Diabetic Foot Clinic provides education about the personal foot care that clients have to perform. There are seven essential self-care behaviours in people with diabetes which predict good outcomes for preventing diabetic foot ulcers; healthy eating, being physically active, monitoring of blood sugar, compliant with medications, good problem-solving skills, healthy coping skills and risk-reduction behaviours [59]. All clients from the Diabetic Foot Clinic in Samoa reported that they take their diabetes medication every day and most clients seemed aware of the risks and did not walk barefoot inside or outside, see table 14. The table also shows that most of the clients check their feet for blisters or changes every day or every 1-2 days, which is important for the early detection of foot ulcers.
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A Microbial Study of Diabetic Foot Ulcer Infections.

A Microbial Study of Diabetic Foot Ulcer Infections.

that induces terminal differentiation and release of neutrophils from the bone marrow. G-CSF stimulates the growth and improves the function of both normal and defective neutrophils, including in patients with diabetes and has immunomodulatory and antibiotic-enhancing functions. In its purified, cloned recombinant form, commercially approved G-CSF has been used to treat various difficult infectious problems. Because G-CSF specifically enhances neutrophil functions, several investigators have explored using it as an adjunct to treating diabetic foot infections. In a metanalysis study conducted by Lipsky et al adjunctive G-CSF treatment does not appear to hasten the clinical resolution of diabetic foot infection or ulceration but is associated with a reduced rate of amputation and other surgical procedures. Treatment with G-CSF was also associated with a tendency toward a shorter duration of parenteral antibiotic therapy 55 .
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Clinical Pattern of Diabetic Foot Infections and their Management

Clinical Pattern of Diabetic Foot Infections and their Management

Patients with diabetic foot syndrome remain at extremely high risk patients for foot complications throughout their life 43 . Health education must include information about what to do in the event of an injury or impending amputation in addition to preventive foot care aspects. Regular after care in special institutions considerably reduces the risk of recurrence of lesions and subsequent amputation in these patients. Numerous studies in the past two years have shown that more than 50% of all amputations in diabetics are avoidable if the following procedures are applied systematically.
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