Diabetic foot infections and their management in a tertiary care hospital

Diabetic foot is a common complication of diabetes world over. We conducted this study to determine common microbiological pathogens in Diabetic Foot Infections [DFI] at a tertiary care hospital and their management. In this observational study deep wound swabs of all admitted diabetic patients were taken, pathogens isolated, antibiotic used and its response depending on complete resolution of symptoms and biochemical markers were recorded. Data were analysed on SPSS-11. A total of 114 cases were recorded. Sixty-eight [59%] cases had ulcers on forefoot, 28 [25%] mid-foot and 18 [16%] hind-foot. One hundred and four pathogens were isolated from wound swabs after debridement. Commonest pathogen isolated was Staphylococcus aureus [52, 46%] followed by E. coli [11, 10%], MRSA was found in 10 [9%] cases, streptococcus in 6 [5%] and pseudomonas in 5 [4%] cases. Polymicrobial infection was also seen in a few cases. Surgical intervention included superficial debridement in 88 [77%] cases, toe amputation/forefoot amputation in 19 [17%] cases, and below/above knee [major] amputation in 7 [6%] cases. Commonest antibiotic used was Cefoperazone/Sulbactam in 43 [38%] cases, alone or in combination, followed by Ceftraixone 36 [33%] cases. Linezolid was used for MRSA. Ninety-four [82%] patients responded to treatment and were recorded as 'cured'. Diabetic Foot ulcers often present with serious foot infections. Commonest pathogens are Staph. aureus, E. coli, Pseudomonas spp. and MRSA. Treatment was effective with Cefoperazone/Sulbactam and Ceftraixone. MRSA was treated successfully with Linezolid

Awareness diabetic retinopathy amongst known diabetics

To study awareness regarding Diabetic Retinopathy [DR] amongst established diabetics. This cross-sectional observational study was done at Department of Diabetes and Endocrinology, Hayatabad Medical Complex Peshawar, Pakistan with technical support from Hyber Institute of Ophthalmic Medical Sciences, Peshawar. Two hundred and two indoor patients were interviewed and duration of diabetes, drugs taken for the control of diabetes, history of any previous eye examination was recorded. Later dilated fundoscopy was done by endocrinologist and finally all the patients were sent for independent assessment by an ophthalmologist for categorizing DR and if needed laser was done for the affected eyes. Of 202 patients only 9 [4%] patients had optimum diabetic control with HbA[1]C of <7. Ninety four [47%] had previous eye examination while 18 [53%] had never had their eyes examined. Of those examined 77 [81.9%] had been seen by ophthalmologist, 13 [13.8%] by physician/endocrinologist and only 4[4.3%] by general practitioners [G.Ps]. Dilated fundoscopy showed 118[58%] patients had retinopathy. Thirty eight [18.8%] patients were offered laser treatment after appropriate investigations. Screening and awareness of DR amongst patients is particularly low in our setup. We need to increase awareness amongst our patients regarding this complication of diabetes