Epidemiology and outcome in patients of diabetic foot.

BACKGROUND: The aim of study was detailed analysis of the presentation of diabetic foot ulcers, characteristics and predictors of outcome (incidence of amputation in neuropathic, ischemic, neuro ischemic) in patients presenting with diabetic foot at our hospital. METHODS: This prospective analytic study was conducted from January 2009-August 2010 at POF Hospital Wah Cantt. Diabetic patients who presented with foot ulcers were enrolled in this study. Demographics of patients along with ulcer size, type, site and Grade according to Wagner Classification were recorded. Wounds were managed with daily dressings, nursing care and de-sloughing of necrotic tissue along with appropriate antibiotic cover. Patients were followed over period until wound healed completely or a lower limb amputation performed, the outcome noted and patient was deemed to have completed study. RESULTS: One hundred and fifteen patients with mean age 55.46 +/- 8.23 years, both male and female were included in this study. Out of 115 patients 111 patients had Type-II diabetes while only 4 p resented with Type-I. Mean Duration of diabetes was 14.61 +/- 2.17 years. With respect to underlying causes 18.3% foot ulcers were ischemic, 22.6% were neuropathic and 59% were neuro-ischemic. Median ulcer size was 74% of ulcer classified as Wagner grade-II and III while 24% were of Grade-V. Lower limb amputation were performed in 25% of patients whereas limb salvage achieved in 75% of patients with wounds healed (median healing time 5 (3-10 weeks). CONCLUSION: Preservation of the limb function without endangering the patient must be a goal of treating diabetic foot. Once foot amputation is successful, rehabilitation with orthotic or prosthetic devices may allow years of a functional extremity along with preventive measures like cessation of smoking, dailyfoot hygiene and foot inspection.

Fournier's gangrene--an experience in POF Hospital, Wah Cantt.

OBJECTIVE: To share our experience of treating patients with Fournier's Gangrene and their outcomes at POF Hospital, Wah Cantt. METHODS: A descriptive study was conducted at the Urology Department, POF Hospital, Wah Cantt from October 2006 to March 2007. A total of 22 patients, all men with ages ranging from 30-75 years, were included in the study. The diagnosis was established on the basis of history and clinical examination. The gangrenous patches with crepitus due to subcutaneous collection of seropurulent fluid was a diagnostic sign. RESULTS: A total of 22 patients were included in the study. All patients were men of ages ranging from 30 to 75 years. Of the 22 patients, 10 were diabetic, 02 had history of CVA and 10 had no co-morbids. In 10 patients, genitals and anterior abdominal wall was involved whereas 04 patients had genital and perineal involvement. In 05 patients only genitals were involved whereas 03 patients presented with scortal infection. All patients received broad spectrum antibiotics and underwent regular debridement. Secondary suturing was done in 13 patients, 07 patients needed skin grafting whereas orchidectomy was done in 02 patients. CONCLUSION: Fournier's gangrene is an uncommon but life threatening condition with high associated mortality and morbidity. Early diagnosis and treatment decrease the morbidity and mortality of this life threatening condition.

Risk factors for breast cancer in patients treated at NORI Hospital, Islamabad.

OBJECTIVE: To assess the risk factors for breast cancer in women attending Nuclear Medicine, Oncology and Radiotherapy Institute (NORI) hospital, Islamabad. METHOD: A case control study was conducted at NORI from January to July 2005. A total 300 females, including 150 cases and their age matched healthy 150 controls were included. Cases had newly diagnosed breast cancer based on histopathological findings. Marital status, family history of breast cancer (first degree relatives), breast feeding history (12 months at least), smoking, parity, use of oral contraceptives (regular uptake for at least one year), and menopausal status were evaluated as risk factors for breast cancer. Demographical data and risk factor related information were collected using a short structured questionnaire. Logistic regression analysis was performed to note predictive effect of each factor on risk for breast cancer. P < 0.05 was considered statistically significant. RESULTS: No history of breast-feeding (p = < 0.001), less parity (p = 0.001), smoking (p = 0.001), postmenopausal status (p = 0.002), family history of breast cancer (p = 0.006), unmarried status (p = 0.008), and use of contraceptive pill (p = 0.03) were associated with breast cancer. CONCLUSION: Lack of breast-feeding, less parity, and smoking are most significantly associated with breast cancer in patients attending NORI.