[Neuropad test in evaluation of diabetic foot]. / Testul Neuropad in evaluarea piciorului diabetic.

AIM: Diabetic neuropathy (DN) is the main cause of foot ulceration. One of the earliest modifications is the loss of normal sudomotor function, a sign of autonomic neuropathy. The aim of this study is to evaluate sudomotor dysfunction using a new tool (Neuropad) in diabetic patients with foot ulceration. MATERIAL AND METHODS: We included 58 diabetic patients with foot ulceration admitted in 2010 in the Clinical Center for Diabetes, Nutrition and Metabolic Diseases. We collected data regarding age, gender, type and duration of diabetes, glycated hemoglobin (HbAlc), history of amputations and duration of hospital admission. Peripheral neuropathy was evaluated through the Neuropathy Disability Score (NDS) and autonomic neuropathy was tested through Neuropad. RESULTS: 95% of patients had NDS > or = 6, among which 76% had also positive Neuropad test. Patients with both peripheral and autonomic neuropathy had longer duration of diabetes (p = 0.027) but similar HbA1c as patients with only peripheral neuropathy (p = 0.09). The former also had longer duration of current admission (p = 0.022) and a higher percentage of these patients had history of amputations (p = 0.041). CONCLUSIONS: Neuropad is a reliable, easy to use test for the diagnosis of autonomic neuropathy, which puts patients at greater risk for foot ulceration and amputation.

Tuberculous meningitis--clinical and epidemiological considerations (a retrospective study 2008-2011).

UNLABELLED: Tuberculous meningitis represents one of the most severe forms of tuberculosis and is often a difficult diagnostic and therapeutic problem. The objective of this study is to analyze the cases of tuberculous meningitis in our region. MATERIAL AND METHODS: We retrospectively analyzed 76 observation sheets of patients aged 4 months to 84 years, diagnosed with tuberculous meningitis, admitted to Infectious Diseases Hospital Iasi during 2008 to 2011. RESULTS: Tuberculous meningitis has affected mostly males (65.7%). Only a small proportion of patients (23.68%) had tuberculosis in their personal history. 26.2% were diagnosed also with other localization of tuberculosis (mostly pulmonary). Fever was identified in only 43.4% of cases; 40% of patients had an altered conscience at admission. The outcome was favorable in all cases. CONCLUSIONS: Tuberculous meningitis predominantly affects males, almost equally affects patients with other focuses of TB and those with a history of tuberculosis disease.

[Antibiotic therapy in the infected diabetic foot]. / Terapia cu antibiotice în infectiile piciorului diabetic.

UNLABELLED: Foot infections in patients with diabetes cause substantial morbidity and may lead to amputation of a lower extremity. Management of diabetic foot infections involves evaluating and determining the severity of infection as the basis for selecting the appropriate approach to antibiotic treatment. AIM: The purpose of our study is to analyse the etiologic agents commonly involved in diabetic foot infections and to appreciate the outcome of these infections with antibiotic therapy. MATERIAL AND METHODS: We included 90 patiens with infection of the diabetic foot, admitted in the Diabetes Clinic, "Sf. Spiridon" Hospital; wound swabs were collected from 79 infected ulcers. The seriousness of the infection was assesed using the IDSA clinical classification. RESULTS: 45% of the infections were monomicrobial (typically with gram-positive cocci), but we also found gram-negative rods and enterococci. Initial therapy was usually empiric, while definitive therapy is based on the results of culture and sensitivity tests, as well as the clinical response to empiric therapy. CONCLUSIONS: The effectiveness of the antibiotic therapy, based on the clinical evolution and the absence of surgical intervention is related to the presence or absence of ischaemia and other diabetes-related complications rather than to the microorganism itself; antibiotics are a crucially important adjunct in the complex therapy of the diabetic foot.