Common foot problems in diabetic foot clinic.

OBJECTIVE: To study common foot problems presented in diabetic foot clinic. MATERIAL AND METHOD: A retrospectively review of out patient department records and diabetic foot evaluation forms of patients who visited the diabetic foot clinic at King Chulalongkorn Memorial Hospital between 2004 and 2006. RESULTS: Of all diabetic patients, 70 men and 80 women with the average age of 63.8 years were included in this study. About 32% of all reported cases had lower extremity amputation in which the toe was the most common level. Foot problems were evaluated and categorized in four aspects, dermatological, neurological, musculoskeletal, and vascular, which were 67.30%, 79.3%, 74.0%, and 39.3% respectively. More than half of the patients had skin dryness, nail problem and callus formation. Fifty six percent had the abnormal plantar pressure area, which was presented as callus. The great toe was the most common site of callus formation, which was correlated with gait cycle. The current ulcer was 18.8%, which was presented mostly at heel and great toe. Three-fourth of the patients (75.3%) had lost protective sensation, measured by the 5.07 monofilament testing. The most common problem found in musculoskeletal system was limited motion of the joint (44.0%). Claw toe or hammer toe were reported as 32.0% whereas the other deformities were bunnion (12.0%), charcot joint (6.0%) and flat feet (5.3%). The authors classified patients based on category risk to further lower extremity amputation into four groups. Forty-seven percent had highest risk for having further amputation because they had lost protective sensation from monofilament testing, previous current ulcer, or history of amputation. Only half of the patients had previous foot care education. CONCLUSION: Multidisciplinary diabetic foot care including patient education (proper foot care and footwear), early detection, effective management of foot problems, and scheduled follow-up must be emphasized to prevent diabetes-related lower extremities amputation.

Uropathogens and empiric antibiotics for the treatment of urinary tract infections in spinal cord injured patients at rehabilitation center, Thai Red Cross Society during 2001 to 2005.

BACKGROUND: Urinary tract infection (UTI) is common in spinal cord injured patients. The authors investigated the epidemiology of bacteria associated with UTI to select an appropriate antibiotic for empirical treatment of UTI before obtaining a bacterial culture. OBJECTIVE: To determine the prevalence, as well as the causative bacteria and their susceptibility pattern of urinary tract infection in spinal cord injured patients hospitalized to the Rehabilitation Center, Thai Red Cross Society, Samutprakarn, Thailand from January 2001 to December 2005. MATERIAL AND METHOD: A retrospective chart review of 76 spinal cord injured patients. RESULTS: Of all spinal cord injured patients, there were 50 males and 26 females, with the average age of 44.70 years. The average length of hospitalization was 104.5 days. 71.2% of the patients needed intermittent catheterization for bladder drainage, and only 2.7% had suprapubic cystostomy. None of patient had indwelling catheterization. Forty-six patients had 68 episodes of UTI (60.52%). Eighteen patients had recurrent UTI (14 patients had two episodes and four patients had three episodes). E. coli was the most common isolated pathogen (74.36%) followed by K. pneumoniae (12.82%), E. faecalis (5%) and P. mirabilis (5%). Most gram-negative pathogens were susceptible to amikacin and third generation cephalosporins. The susceptibility of these organisms to cotrimoxazole, amoxicillin/clavulanate, and ciprofloxacin were in the range of 34.6-60.0%, 44.0-50.0% and 25.9-50.0%, respectively. CONCLUSION: Urinary tract infections were commonly observed among spinal cord injured patients in the presented institution. E. coli was the most common isolated pathogen. Surprisingly, most gram-negative pathogens were resistant to cotrimoxazole, amoxicillin/clavulanate, and ciprofloxacin. An antibiotic of choice for UTI in our patients should be aminoglycoside or third generation cephalosporins.

Reliability of foot caliper.

OBJECTIVES: To determine the reliability of foot caliper DESIGN: Descriptive study. SETTING: Rehabilitation Medicine Outpatient Department, King Chulalongkorn Memorial Hospital. SUBJECT: Fifteen volunteers were recruited from Rehabilitation residents and health care professionals of Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: The authors created 3 sets of simple Foot Caliper and measured foot dimension including foot width, foot length and toe depth while subjects stood with equal weight bearing to both feet. The authors set 3 examiners to measure foot dimension by the same method. To determine reliability of 3 sets of foot caliper, one examiner was assigned to measure foot dimension of 30 feet with all calipers. To determine the reliability of examiners, all examiners measured foot dimension of the same 30 feet. All parameters were recorded in millimeters. The data was analyzed and presented as intraclass correlation coefficients (ICC) with 95% CI. RESULTS: There were fifteen volunteers (8 men and 7 women). The average age was 28.6 +/- 4.11 years (range 22-39). Average foot width,length and great toe depth (millimeters) were 9.64 +/- 0.63, 24.17 +/- 1.10 and 1.91 +/- 0.24 respectively. For reliability analysis of 3 sets off foot caliper, the intraclass correlation coefficients (ICC) with 95% CI were 0.985 (0.972-0.992), 0.996 (0.992-0.998) and 0.982 (0.968-991) for foot width, length and great toe depth, respectively. For Inter-examiner reliability, intraclass correlation coefficients (ICC) were 0.941 (0.864-0.969), 0.850 (0.46-0.920) and 0.834 (0.721-0.910) for foot width, length and great toe depth, respectively. These results showed high agreement of data. CONCLUSION: These simple foot calipers have high reliability forf oot measurement. These devices are appropriate for clinical use.