The Pattern and Surgical Management of Diabetic Foot at Muhimbili National Hospital; Dar-es-Salaam; Tanzania

Background:Diabetic foot is one of the chronic consequences of diabetes mellitus and isresponsible for about 50of non-traumatic lower limb amputations.It is thus associated with social devastation to the patients and their families;both emotionally and economically.This study aimed at determining the pattern and the surgical management of patients with Diabetic Foot at Muhimbili National Hospital; from March to December 2008. Methods: All in-patients with diabetic foot who were admitted in the hospital during the study period were included into the study.Results: A total of 67 patients presented with diabetic foot during the study period of 10 months 4.5had Type 1 Diabetes Mellitus and 95.5had Type 2.The mean age of the patients was 52.4 years with a range of 21-75 years.The mean hospital stay was35.5 days.Most patients had a positive family history of Diabetes Mellitus (59.7).Majority of them lacked the known risk factors for foot ulceration such as hypertension;elevated cholesterol levels;trauma and duration of Diabetes Mellitus for longer than 10 years.Wagner Grade 4 and 5 were the most common ulcers encountered and major amputation was done in 44.8of the patients.The mortality rate was relatively high (25.4). Mortality was significantly higher in those with Wagner's Grade ulcers 3 (p-value = 0.0322). Conclusion:Diabetic foot ulceration was found to be a significant cause of morbidity and mortality in our setting.These patients stay in the surgical ward for a prolonged period of time.This causes a significant strain to the provision health services in the hospital.Designing a diabetic foot management protocol and initiating a diabetic foot unit for admission of these patients could reduce the associated morbidity and mortality and improve outcome

Bacteriological evaluation of diabetic ulcers in Nigeria

Diabetic foot ulcers are a common cause of morbidity and mortality in Nigeria. The lesions are usually infected, and this study was carried out in Enugu State, Nigeria to determine the common bacterial pathogens that infect ulcers and their antimicrobial susceptibly patterns. Deep wound swabs were collected from 71 consecutive diabetic patients admitted with foot ulcers into the medical wards of University of Nigeria Teaching Hospital, Enugu (26% of 274 total diabetes-related admissions). Polymicrobial isolates of Clostridium spp, Staphylococcus aureus, Escherichia coli, or Klebsiella aerogenes were found in 26 (53%) cases. Clostridium species showed susceptibility to fluoroquinolones, and high resistance to beta-lactams. Escherichia coli and Klebsiella aerogenes showed resistance to the aminoglycosides and beta-lactams. All the gram-negative organisms showed significant susceptibility to the fluoroquinolones used. Clostridium species, Staphylococcus aureus, Escherichia coli, and Klebsiella aerogenes were the most common causes of diabetic foot infections in the study and the rates of antibiotic resistance were observed to be relatively high. Antibiotic susceptibility testing remains of paramount importance in the management of diabetic foot ulceration

Foot Ulceration in Nigerian Diabetic Patients: a Study of Risk Factors

Diabetic foot ulceration is an important cause of morbidity and mortality in Nigerian diabetic patients. Identification of the risk factors for ulceration is; therefore; of paramount significance. This study aimed to determine these risk factors. Forty-seven (47) diabetic patients with past or present foot ulceration were studied together with an equal number of controls which were diabetic subjects with no past/present history of ulceration. Risk factors strongly associated with foot ulceration included peripheral vascular disease; male sex; nephropathy; retinopathy; foot deformities; history of previous foot ulceration or amputation; cataract formation; poor glycaemic control; neuropathy; and tinea pedis. Weakly associated risk factors were walking unshod; being of low socio-educational status; and smoking. We concluded that many risk factors for foot ulceration are potentially preventable. As part of a comprehensive footcare programme; education on footcare should be directed at patients; family members; and healthcare providers