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

Ocular disorders among school-going Pakistani children

The objective of this work is to find out the pattern of eye problems in School-going children of ages 6 to 15 years. The current work designed as descriptive and cross sectional study. All students of schools/ Madaris [religious schools] of district Lasbela were screened during the first week of February 2001 to 30[th] September 2002. all students of Schools/ Madaris of district Lasbela were included in the study. Visual acuity was measured using Standard Snellen's chart; external examination was carried out with the help of torch and Direct Ophthalmoscope. Children with VA<6/12 were refracted to best correction. The team included a community ophthalmologist, an ophthalmologist, an ophthalmic technician and a community social worker. Structured questionnaire was prepared and operational methods were field tested and refined by piloting at the outpatient of Eye Department, JPMC abbreviation for what?. Ophthalmic technician with community social worker checked vision of all students. Ophthalmologist examined the children for any abnormality and refracted children with VA<6/12. All schools and madaris of the target area were visited. The results showed that out of 25437 examined school going children, 77.16% were found to be normal and 22.84% had some ocular problem. When main stream schools were compared to madaris for any eye abnormality, the respective figures were 20.7% to 34.34 as an appreciable difference. Amblyopia 0.24% [0.21% to 0.37], Blephritis 0.146%, [1,46 to 1.44], cataract 0.17 [0.17 to 0.19], Conjunctivitis 11.10% [10.03 to 17.00], glaucoma 0.007% [0.005 to 0.02], nystagmus 0.10% [0.10 to 0.07], ptosis 0.12% [0.14 to 0.04], refractive errors 2.90% [2.14 to 7.00], squint 0.45% [0.45 to 0.54], VADD 3.29% [3.29 to 3.14], vernal catarrh 1.90% [1.62 to 3.33], non-specific 1.01% [0.98 to 1.19]. Appreciable difference is noted in conjunctivitis, refractive errors and spring catarrh. It was concluded that schools screening could play an important role in promotion of eye health and prevention of childhood blindness. It should be an important component of any program of [prevention and control of blindness]

Frequency of hepatitis C infection in diabetic patients

Diabetic patients are at an increased risk of acquiring Hepatitis C Virus [HCV] infection owing to the nature of the disease and its inherent complications or frequent parental exposure. On the other hand HCV infection may itself contribute to the development of Diabetes Mellitus. The epidemiological evidence of this association has not been studied in Pakistan at a population level and its exact biological mechanisms are not obvious. Objective of this study was to study the frequency of HCV infection among adult diabetic patients attending the Hospital the study comprised of 100 Diabetic patients visiting the outpatient clinics or admitted in the medical wards of a Teaching Hospital, in Peshawar. Diabetes was confirmed according to the new diagnostic criteria based on 2 fasting or 2 random plasma glucose levels of more than 126 milligram per deciliter [mg/dL] and 200 mg/dL respectively. The presence of HCV infection was confirmed by Enzyme Linked Immuno-Sorbent Assay [ELISA] method. A concise history of the patient, examination and laboratory findings were recorded on a Performa. Out of the hundred diabetics 36% were found to be anti HCV positive and all of them had type II diabetes. There was no gender difference in the seropositive cases. Serum Glutamic-Pyruvic Transaminase [SGPT] level was raised in 75% of the positive cases as compared to the 25% of the seronegative patients. The seropositive cases had a comparatively higher blood sugar level. HCV infection occurs more often in type II diabetic and further investigations should be done in diabetic patients with raised SGPT for the presence of chronic HCV infection

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