Bacterial and C linical P rofile of D iabetic F oot U lcer using O ptimal C ulture T echniques: A Prospective Hospital Based Study

Background: Diabetic foot ulcers (DFU) are the complications of diabetes mellitus. The infection of diabetic foot ulcer is microbes in nature. If they are not recognized and controlled it may lead to many devastating consequences like limb amputation, sepsis, and even mortality. So, the present study was aimed that to determine the bacterial and clinical profile of diabetic foot ulcer using optimal culture techniques. Methods: This prospective study was conducted on Type 2 Diabetic patients with foot ulcer. Around 206 total cases were enrolled on the basis of inclusion and exclusion criteria. The duration of study was over a period of two years. Results: The result of this study revealed that causative agent of DFU were found due to aerobic in n = 170 cases whereas anae robic bacteria in n = 36 cases. Conclusion: This study concludes that that proper care should be offered, causative organisms should be timely identified and antibiotic should be sensibly chosen to cut short the morbidity and mortality of DFU.

Study of Glycated Haemoglobin and Lipid Profile in Patients with Diabetic Foot Ulcer

Introduction: Diabetic foot ulcer is a major disablingcomplication of Diabetes Mellitus and often precedes lowerextremity amputation. This study aims to evaluate the level ofHbA1c and lipid profile in patients with diabetic foot ulcer asT2DM patients areprone to diabetic dyslipidemia,which puts them at risk ofdeveloping macrovascular and microvascular diseases.Material and methods: The study was accomplished at atertiary care hospital in Jammu & Kashmir. One hundred tensubjects with T2DM were enrolled for the present study, thisincluded 55 subjects with DFU and 55 subjects without DFU.The HbA1c and lipid profile of the subjects were measuredwith standard methods.Results: In our study HbA1c level was found higher indiabetic patients with diabetic foot ulcer when compared withpatients without. Also lipid profile was found deranged indiabetic foot ulcer patients in comparison to control group. Itwas found that approximately 78% DFU have HbA1c levels˃7%. Unlike the DFU-patients, 79% of patients without DFUhave HbA1c level controlled.Conclusion: As diabetic foot ulcer is a major disablingcomplication of Diabetes Mellitus and often precedes lowerextremity amputation, we conclude that HbA1c level shouldbe maintained in normal range and regulating it is imperativefor avoiding T2DM complications.

Retrograde Venous Perfusion in Chronic Ulcers of Lower Limb.

Chronic foot ulcers are difficult to treat. These patients need prolong treatment which is costly and often associated with non-compliance. These patients are vulnerable to develop gangrene leading to amputation. Retrograde venous perfusion (RVP) is a new therapeutic approach which was recently introduced to the treatment of diabetic foot as an adjunctive line to systemic therapy and local therapy. It is based on principle of regional anesthesia. Recently, Latin American investigators, applied this approach to local therapy of pedal ischemia. Since then this approach was mainly employed for therapy of diabetic neuropathic pedal ulcers. In this work, the efficacy of this approach was explored in 5 group of chronic foot disorder – 1) Diabetic foot presenting as foot infection, 2) Dibetic neuropathic pedal ulcers, 3) Diabetic pedal ischemia and infection, 4) Nondiabetic post traumatic foot ulcers, 5) Non-diabetic ischemic ulcer and pre-gangrene or gangrene. The present study was conducted on 56 patients having non healing ulcer of lower limb. Regular dressing and debridment and retrograde venous perfusion therapy was done in all patients. Results were assessed after completion of therapy. The following conclusions are drawn from the present study. Out of all diabetic patients, 23.7% of cases presented as diabetic foot. The incidence of diabetic foot patients was 64.29% out of all studied patients with ulcer foot. Maximum number of patients, 28.57% were in 31-40 years age group. The mean age of the patients was 44.4 years. There was male predominance with male and female ratio being 1.55:1. Mean reduction of ulcer size after RVP therapy was 63.89%. Maximum improvement was found in patients with diabetic pedal ischemia and infection i.e. 70% where as patients with non diabetic post traumatic foot ulcers had minimum improvement i.e. 52.22%. Whole foot or more than 4 toe amputation was not required in any patient in therapy group. After RVP therapy gangrene or pre-gangrene was prevented in 72.73% of patients. Minimum days of stay was 11-15 days in 32.14% of patients. Average duration of hospital stay was 18 days. Patients with foot ulcer in whom RVP therapy was not done, average duration of hospital stay was 31 days. This denotes that RVP reduces the time of therapy an avoids prolonged treatment. The ratio of diabetic and non-diabetic patients with neuropathy was 2.5:1. In Doppler ultrasound study, patients with sign of ischemia, ankle-brachial pressure index was less than 0.6 in 22 patients, out of them 16 patients were diabetic. After RVP therapy 93.33% of diabetic foot patients and 80% of non-diabetic foot ulcer patients ankle-brachial ratio became more then 0.8 denoting that after RVP therapy the blood flow in lower limb was increased. The present study confirms the good result in respect to decrease in ulcer size, overcome critical complications which are threatening the foot, early healing of ulcer, increase blood flow in ischemic foot, check progression of gangrene and pre-gangrene and to conserve the foot to avoid amputation. This study entailed expansion of the application of RVP to intractable post-traumatic ulcers of the foot and lower leg, as well as, to critical pedal ischemia in diabetic and non-diabetic patients.

A Multi-center,Randomized,Double-blind,Placebo-controlled Clinical Studies on the Efficiency of ZICAOYOUSHA in Treating Diabetic Foot Ulcers / 浙江中医药大学学报

[Objective] To observe the clinical efficacy of ZICAOYOUSHA in treating diabetic foot ulcers.[Method] A multi-center ,randomized,double-blind,placebo-control ed study was conducted. A total of 232 patients with diabetic foot ulcers were randomly assigned the treatment group and control group,in foundation treatment at the same time,the therapy group which was treated by External Application ZICAOYOUSHA had 174 patients,the contrast group which was treated by External Application Gentamicin Emery cloth had 58 patients. Observe the aspect improvement situation in two groups separately in accordance with Wagner grading,carry out statistics processing.[Results] Two groups of curative effect indices had significant differ-ence. [Conclusion] ZICAOYOUSHA is an effective drug for external use in treating diabetic foot ulcers.