No abstract available.
Diabetic Foot*

Diabetic foot infections make up a significant number of orthopaedic ward admissions. The recommended choice of empirical antibiotics used in Malaysia for diabetic foot infections is based on the National Antibiotic Guidelines 2008. The pattern of bacteriology and the effectiveness of the treatment of diabetic foot infections based on this guideline were analyzed through a retrospective study in our hospital. Data over a period of one year (May 2012- April 2013) was analyzed, and 96 patients were included in this study. Polymicrobial growth (58%) was mainly isolated, followed with an almost equal percentage of gram-negative (22%) and gram-positive organisms (20%). The empirical antibiotics based on the national antibiotic guidelines were used as definitive antibiotics in 85% of the cases. Although there was slight variation in the pattern of organisms as compared to other studies conducted in this country, the high rate of positive clinical response proved that the antibiotic guideline was still effective in diabetic foot infection treatment.
Diabetic Foot

Diabetic foot disease is the leading cause of non-traumatic amputations of the lower limb, hence a major health care and socioeconomic burden. It has been found that most of the costs occur in the inpatient setting; therefore this study is to quantify the costs of managing inpatient diabetic foot infections (DFI). We treated 182 inpatients from May 2012 till April 2013 and analysed the cost of antibiotic usage, wound dressing, surgical procedure, admission and basic investigation costs. The total cost was ~ USD 11,000 (2013). This number, however, only reflects the cost for managing an acute infection. The price for follow-up care as an outpatient, rehabilitation and indirect costs (emotional suffering, reduced productivity) is estimated to be much more.
Diabetic Foot

Good knowledge and practice regarding diabetic foot care will reduce the risk of diabetic foot complications and ultimately amputation. This study is conducted to assess patients’ knowledge and compliance of diabetic foot care. A cross sectional study performed on patients who were admitted to HSNZ from the 1st September 2013 to 30th April 2014 for diabetic foot infections. They were interviewed with a questionnaire of 15 ‘yes’ or ‘no’ questions on foot care knowledge and practice. Score of 1 was given for each ‘yes’ answer. The level of knowledge and practice, whether good or poor, was determined based on the median score of each category. The result was tested using a chi-square test in SPSS version 17. A total of 157 patients were included in this study with a mean age of 56.33 years (31-77). There were 72 male (45.9%) and 85 female (54.1%) patients with the majority of them being Malays (154 patients, 98.1%). Majority of the patients (58%) had poor foot care knowledge while 97 patients (61.8%) had poor diabetic foot care practice as compared to the median score. Based on the chi square test of relatedness, there was no significant association between knowledge and practice with any of the variables. In conclusion, the majority of patients admitted for diabetic foot infections had poor knowledge and practice of diabetic foot care. Education regarding foot care strategies should be emphasized and empowered within the diabetic population.
Diabetic Foot

SUMMARY Introduction: Patients suffering from diabetes mellitus (DM) frequently present with infected diabetic foot ulcers (DFU). This study was done to record the anatomical site and the grade of ulcers according to Wagner’s classification and to culture the microorganisms from the ulcers and determine their antibiotic sensitivity. Materials and methods: Prospective study was conducted on 77 diabetic patients who were admitted with DFU from June until December 2011. Patients with end stage renal failure, those who had previous vascular surgery on the involved limb, or hyperbaric oxygen or maggot therapy for the ulcers, or had unrelated skin diseases around the involved foot were excluded from the study. Specimens for culture were obtained by a sterile swab stick or tissue sample was taken from the wound with sterile surgical instruments. Results: Wagner’s grade III and IV ulcers were most common. Majority of the ulcers involved toes (48%). Gram negative microorganisms were predominantly isolated (71.1%). Gram positive microorganisms were less frequently cultured (27.7%). Fungus was cultured from one sample (1.2%). Gram negative microorganisms were sensitive to aminoglycosides, cephalosporins or β-lactamase inhibitors. More than 40% were resistant to ampicillin. Gram positive microorganisms were sensitive to cloxacillin. MRSA were sensitive to vancomycin. Conclusion: Empirical use of antibiotics should be curtailed to prevent development of drug resistant strains of microorganisms and MRSA. We suggest use of antiseptic solutions to clean the ulcers until antibiotic sensitivity report is available. Results of our altered treatment regimen we plan to publish in a later study.
Diabetic Foot ; Foot Ulcer

No abstract available.
Atherosclerosis* ; Diabetic Foot*

The ulcer lesion in diabetic foot is a major complication and usually leads to disability. Current treatments composed mostly of medication or amputation if required. After the conference of Vietnamese -American on diabetic foot care in June 2000, we have established a new plan of management, included early operation, proper debridement and appropriate blood sugar control. Method and material: retrospective and cross sectional study on 16 type II diabetics (5 males and 11 females) with foot infection. All these patients were operated to remove dead bones and necrotic tissues, sutured the wound in one layer and immobilized the pain leg within 21 days. They were also treated with insulin and investigated the arterial system by Doppler ultrasound. Results: average age of patients: 562 years. Average glycemia: 19020mg%. Left foot: 9. Right foot: 6. Both feet: 3. The duration from onset to ulcer: 60.2 years. Doppler ultrasonography showed the decrease flow pattern of lower limbs in 14 cases, atherosclerosis: 2. After surgery, 11 patients were healed completely within 21 days, 3 others within 30 days and 2 patients had to be amputated
Diabetic Foot ; surgery

Introduction: Foot infections are one of the major complications of diabetes mellitus and a significant risk factor for lower extremity amputation. Providing effective antimicrobial therapy is an important component in treating these infections. This study assesses the microbial isolates of patients with diabetic foot infections and their antibiotic susceptibility pattern. Materials and Methods: A retrospective study of 75 patients with diabetic foot infections admitted to RIPAS hospital between June 2008 and June 2010 was undertaken. Bacteriological specimens were obtained and processed using standard hospital procedure for microbiological culture and sensitivity testing. Results: Overall, 40 (54%) patients had subcutaneous infections, 22 (29%) had infected superficial ulcers, seven (9%) had infected deep ulcers involving muscle tissues and six (8%) had osteomyelitis. A total of 98 pathogens were isolated. Forty percent of the patients had polymicrobial infection, 39 (52%) had single organism and 6(8%) had no growth. Gram-negative bacteria (67%) were more commonly isolated than gram-positive bacteria (30%). The three most frequently found gram-negative organisms were Pseudomonas aeruginosa (19.4%), Klebsiella pneumoniae (15.3%), and Acinetobacter spp. (10.2%) and gram-positive organisms were Staphylococcus aureus (10.2%), Streptococcus pyogenes (7.1%) and Methicillin resistant Staphylococcus aureus [MRSA] (7.1%). Vancomycin was found to be the most effective against gram-positive bacteria while amikacin was the most effective against gram-negative bacteria based on antibiotic testing. Conclusion: In 40% of diabetic feet infection was polymicrobial. Staphylococcus aureus and Pseudomonas aeruginosa were the most common gram-positive and gram-negative organisms respectively. This study helps us to choose the empirical antibiotics for cases of diabetic foot infections.
Diabetic Complications ; Diabetic Foot ; Microbiology ; Bacteriology

Introduction: Colonoscopy is an investigation for the evaluation of lower gastrointestinal symptoms. Just like any other conditions, it is important to be aware of the spectrum of findings so that appropriate referral and decisions can be made. Materials and Methods: Patients (mean age 52.3 ± 15.3 years old with almost equal proportion of genders) referred for colonoscopy in RIPAS Hospital over a five year period (January 2003 to December 2007) were retrospectively identified and studied. Results: The most common indication for colonoscopy was bleeding per rectum (22.9%), followed by evaluation of abdominal pain (18.6%), anaemia (11.7%), colorectal cancer screening (11.7%), evaluation of constipation (5.9%) and altered bowel habits (3.8%). A large proportion (58.4%) colonoscopy was normal. The most common positive finding was haemorrhoids (30.3%), majority of which were categorised as grade I. This was followed by colonic polyps (17.6%), diverticular disease (12.1%), non-specific colitis (4.0%), colorectal cancers (4.0%) and ulcers (3.6%), melanosis coli (0.4%) and telangiectasia (0.1%). Colorectal cancer was most common among the Malays (4.4%), followed by the Chinese (4.0%), the indigenous (2.8%) and the others (1.2%). Conclusions: Our study showed that the most common indication was for the evaluation of bleeding per rectum. Majority had normal colonoscopy and the most common positive finding was haemorrhoids. Importantly colorectal neoplasms accounted for one fifth of procedures with colorectal cancers accounting for four percent.
Diabetic Complications ; Diabetic Foot ; Microbiology ; Bacteriology

Amputation of diabetic foot ulcer and infection is a critical modality for saving a patient's life from life threatening infections or ischemic limbs. However, it can cause serious handicaps or complications, such as lifetime shortening and re-amputation of the other limb. The minimal amputation is the main goal of amputation in diabetic patients. However, insufficient amputation can have a harmful effect on patients. The decision of amputation is very difficult and should be made using multidisciplinary approaches. All aspects of the patient's situation, including vascular status, degree of infection, and medical conditions should be considered. The foot surgeon should keep in mind the notion that proper amputation can lead to a new life for diabetic foot patients.
Amputation* ; Diabetic Foot* ; Extremities ; Foot ; Humans ; Ulcer*