Prognostic significance of non-enteric blood culture in diabetic foot disease

The diabetic foot is a group of syndromes in which ischemia, neuropathy and infection leads to tissue breakdown resulting in morbidity and possible lower extremity amputation. The diagnosis is based on clinical criteria investigations. It is imperative that such patients are managed by a team of Physician, Surgeon, Social care worker, Physiotherapist and a Podiatrist. In this study we included 100 diabetic foot patients in the age group of 30 to 80 years. The study was done for a period of one year. 47% of our patients had Meggit Wagner grade 3 and 10% had grade 5. 27% of the patients had renal failure and 30% had anemia. These patients were subjected to non-enteric culture of blood under sterile precautions. 80% of our patients showed positive culture. The organisms commonly isolated were Staphylococcus aureus, beta haemolytic Streptococcus and Klebsiella pneumoniae. Less commonly isolated were Citrobacter species, Proteus mirabilis and anaerobes. 40% of patients with positive culture went on to have lower extremity amputation. Thus we concluded that non enteric culture in diabetic foot disease has prognostic significance and the spectrum of infection in diabetic foot disease is polymicrobial in nature and at par with the literature.

A comparative study on lower extremity amputation (LEA) stump outcome in diabetic and non-diabetic patients in a tertiary care hospital of Raipur City, Chhattisgarh, India.

Background: Amputation is among the oldest operation known to man. It is the surgical removal of a limb or body part and performed to remove diseased tissue or relieve pain. Amputation is associated with some complications. Infection and failure of stump to heal are major complications. The Diabetes related Lower Extremity Amputation (LEA) is likely to be associated with a worse outcome as compared to the non-diabetic amputations because of the presence of several risk factors which hamper the wound healing process. Amputees with diabetes are more likely to undergo amputation at a younger age and need higher-level amputations when compared with patients without diabetes. With this background, the present study was planned to understand the factors that place diabetic patients at increased risk of amputation in the study area so that further morbidity can be prevented. Methods: The current prospective study was conducted in the Department of Surgery, Dr. B.R.A.M. Hospital, Pt. JNM Medical College, Raipur (C.G.) India, among 60 patients admitted in the General Surgery wards during January 2013 to August 2014. Study subjects were categorized into those related to diabetes mellitus and those due to other causes. All Investigations relevant to the study (Random blood sugar, Serum albumin, Complete blood count, renal function test and Doppler) were done in all the patients. Postoperatively the cases were examined for various complications of amputation stump in post operative period were noted. Results: Mean age for diabetic cases was 50 years and that for non-diabetic cases was 47 years. In this study, among the diabetic amputations, 84 % were males and 16 % were females. Total 60 amputations were performed in the study. Stump infection (50 % in diabetics and 29 % in non-diabetics) was the most common stump complication. Followed by wound dehiscence (25 % in diabetics and 11 % in non-diabetics) Conclusion: Diabetic amputations are at a higher risk of complications. They need to be carefully screened and selected for appropriate level of amputation and watched meticulously for occurrence of complications.

The challenges of "walking free" from disability

The functional independence of persons with disabilities will be achieved through provisions of affordable, appropriate and accessible prosthetic devices. The Physicians for Peace "Walking Free" Program, through the Departments of Rehabilitation Medicine and Orthopedics, Philippine General Hospital, rose up to the six challenges of ensuring sustainable delivery of high technology, low cost prostheses to indigent Filipino amputees that not only provide community reintegration but economic empowerment as well.

Analysis of the Risk Factors for Lower Extremity Amputation due to Diabetic Foot Complications / 대한족부족관절학회지

PURPOSE: To evaluate the possible risk factors of lower extremity amputations in diabetic foot patients. MATERIALS AND METHODS: The study is based on 37 patients who received lower extremity amputations from April, 1997 to February 2005 due to diabetic foot complications with at least 1 year follow up. As for the control group, 49 diabetes patients who had been treated at the endocrinology department for at least 1 year without any diabetic foot complication were evaluated. As for the possible risk factors, age, gender, duration of diabetes mellitus, body mass index, Hb A1c, blood glucose level, total cholesterol, s-creatinine, C-peptide, smoking, alcohol, hypertension, cardiovascular disease, CVA, retinopathy and neuropathy were investigated. RESULTS: Among the possible risk factors evaluated, age, Hb A1c, smoking, neuropathy and blood glucose level factors showed statistically significant difference between the diabetic amputation and the control group. CONCLUSION: In reducing the risk of the lower extremity amputations in the diabetic patients due to diabetic foot complications, strict control of blood glucose level and cessation of smoking were found to be utmost important.

Capture-recapture method to estimate lower extremity amputation rates in Rio de Janeiro, Brazil

Objective. To estimate rates of lower extremity amputations (LEAs) in persons with peripheral vascular disease, diabetes mellitus, trauma, neoplasm, osteomyelitis, or emphysematous gangrene. Methods. Regional amputee registries were used to estimate the rate of lower extremity amputations with the capture-recapture (CR) technique. Data were extracted from three amputee registries in Rio de Janeiro: source 1, with 1 191 cases from 23 hospitals; source 2, with 157 cases from a limb-fitting center; and source 3, with 34 cases from a rehabilitation center. Amputee death certificates from source 1 identified 257 deaths from 1992 to 1994. Three CR models were evaluated using sources 2 and 3. In order to avoid an overestimation of the rate of LEAs, two models were applied for the data analysis: in one case, deceased patients listed in source 1 were excluded from the model, and in the other case, deceased patients were included as well. Results. Excluding the 257 deaths, the estimated number of amputations in the municipality of Rio de Janeiro from 1992 to 1994 was 3 954, for a mean annual incidence rate of 13.9 per 100 000 inhabitants. Among persons with diabetes, the annual incidence rate of lower extremity amputations was substantially higher (180.6 per 100 000 persons per year), representing 13 times the risk of individuals without diabetes. The yearly rate of LEAs according to the routine surveillance system was estimated at 5.4 and 96.9 per 100 000 in the general population and in diabetics, respectively. If data from the three registries are added, 1 382 patients with LEAs were identified, with the reasons for the amputations distributed as follows: peripheral vascular disease = 804 (58.1%); diabetes mellitus = 379 (27.4%); trauma = 103 (7.4%); osteomyelitis = 44 (3.1%); gangrene = 36 (2.6%), and neoplasm = 16 (1.1%). Conclusions. These findings show a high incidence of LEAs in Brazil, when compared to countries such as Spain, that is attributable mainly to peripheral vascular disease and diabetes mellitus

Objetivos. Estimar las tasas de amputación del miembro inferior (AMI) en individuos con vasculopatías periféricas, diabetes sacarina, traumatismos, neoplasias, osteomielitis o gangrena enfisematosa. Métodos. Se utilizaron los registros regionales de amputados para estimar la tasa de AMI con el método de captura-recaptura (CR). Los datos se obtuvieron a partir de tres registros de amputados de Río de Janeiro: la fuente 1, con 1 191 casos de 23 hospitales; la fuente 2, con 157 casos de un centro de miembros artificiales, y la fuente 3, con 34 casos de un centro de rehabilitación. Los certificados de defunción de los amputados de la fuente 1 identificaron 257 muertes entre 1992 y 1994. Se investigaron dos modelos de CR utilizando las fuentes 2 y 3. Con el fin de evitar la sobreestimación de la tasa de AMI, en el análisis de los datos se aplicaron dos modelos: en uno se excluyeron los pacientes fallecidos que figuraban en la fuente 1, y en el otro se incluyeron. Resultados. Excluyendo las 257 muertes, el número estimado de amputaciones en el municipio de Río de Janeiro entre 1992 y 1994 fue de 3 954, lo cual representa una incidencia anual media de 13,9 por 100 000 habitantes. En los pacientes diabéticos, la incidencia anual de AMI fue considerablemente mayor (180,6 por 100 000), lo cual representa un riesgo 13 veces mayor que en individuos sin diabetes. De acuerdo con el sistema de vigilancia habitual, las correspondientes tasas anuales de AMI fueron de 5,4 y 96,9, respectivamente. Combinando los datos de los tres registros, se identificaron 1 382 pacientes con AMI, cuyas causas se distribuyeron del siguiente modo: vasculopatías periféricas, 804 (58,1%); diabetes sacarina, 379 (27,4%); traumatismos, 103 (7,4%); osteomielitis, 44 (3,1%); gangrena, 36 (2,6%), y neoplasias, 16 (1,1%). Conclusiones. En comparación con otros países, como España, estos resultados muestran una alta incidencia de AMI en Brasil, atribuible principalmente a las vasculopatías periféricas y a la diabetes sacarina