RESUMO
Objective: Impaired cellular immunity and reduced phagocytic function of polymorphonuclear leukocytes facilitate the development of skin fungal and bacterial infections due to uncontrolled hyperglycemia in diabetic patients. In our study, we aimed to assess onychomycosis and/or tinea pedis frequency in diabetic patients, and effects on the development of chronic complications, particularly foot ulcer
Methods: We included 227 diabetic patients in the study. Forty-three patients had diabetic foot ulcer. We screened and recorded demographic characteristics, HbA1c levels of patients, and presence of complications We examined patients dermatologically, and collected samples by scalpel from skin between toes, and from sole, toe nail, and area surrounding nails from suspected to have fungal infection
Results: Native positivity between toes was higher in men compared to women [p<0.05]. We obtained significant relation between HbA1c elevation and native positivity between toes [p<0.05]. Fungal infection between toes, at sole and toe nail significantly increased in patients with diabetic foot ulcer compared to patients without diabetic foot ulcer [p<0.05]. Moreover, native positivity in patients with diabetic foot ulcer correlated with presence of fungal infection examination findings [p<0.05]
Conclusion: Fungal infections were more frequently observed in the presence of poor glycemic control and peripheral vascular disease in diabetic patients in compliance with the literature, and the presence of fungal infection may also responsible for the development of foot ulcers
RESUMO
To asses the efficiency of iloprost [an analogue of prostacyclin] infusion on endothelial functions and amputation rate in diabetic foot ulcers with complicated macroangiopathy Sixty [36 men/ 24 women] type 2 diabetic patients [61.8 +/- 9.7 years, mean +/- SD] with diabetic foot ulcer and peripheral arterial occlusive disease, stage III or more by Wagner classification, and 15 [9 male/ 6 female] healthy controls [60.7 +/- 9.1 years, mean +/- SD] were enrolled in the study. Thirty patients [group I] had iloprost infusion [0.5-2 ng/kg/min for 6 h] for 10 consecutive days. Endothelial functions were determined by brachial arterial flow mediated dilation [FMD] method at stage 0 [basal], 10th and 30th days. Group II patients [n=30] were treated in the same manner as group I except iloprost treatment constituting a patient control group Group I patients showed a significant improvement in the endothelial functions at 10th day, and 30th day [p=0.002] in respect to group II. There were no differences between group I and group II regarding the hospitalization period and amputation rates. Iloprost was well tolerated. Three patients had adverse reactions such as maculo-papular skin eruptions, itching, hypotension and dyspnea due to iloprost infusion; one completed the treatment and 2 had to discontinue the iloprost infusion. Ten-day iloprost infusion therapy to patients with diabetic foot ulcers seems to be efficient in the improvement of endothelial function, but, despite our positive clinical observation, this improvement does not affect the outcome of the amputation rates at 30 days follow up period