Monsoon sets in and so do foot infections

This article has been published in Deccan Chronicle on Sept 12, 2008
Be Alert
-->About 50 per cent of all non-traumatic amputations are due to diabetes-related foot ulcers.
-->Globally, an amputation is performed due to foot infection, every 30 seconds.
-->Patients should never walk bare foots, even inside the house. They should wear right footwear, preferably made of microcellular rubber.

With the onset of rain city doctors are witnessing a sharp upswing in the number of diabetics’ patients with foot infections-and a gross lack of awareness is to blame, they say.

“The feet are highly vulnerable to infection in diabetics due to a nervous condition called ‘neuropathy’ that causes loss of sensation,” said Dr Vijay Viswanathan, Diabetologist, MV Hospital for Diabetes, where at least two major amputation are performed everyday.

While 40 percent of all patients develop neuropathy within five to ten years of developing diabetes, smoking and excessive alcohol speed up the process.

The monsoon triggers a spurt of foot infection with people wading in water, and staying in wet shoes and shocks, inviting fungal infection between the toes. Patients who do not have their diabetes under control are the worst hit, as even a tiny pinprick can cause devastating damage. Infections like ‘athlete’s foot’ can be very harmful in a diabetes patient, as their healing capacity is low.

“Several patients get infected when they mistakenly cut into the skin, while trimming their toes nail. Diabetes with neuropathy should only file their nail do not cut them,” cautions Dr Ratnavel, Professor of Dermatology and Cosmetology, Stanley Medical College.

Wearing wrong footwear, not drying wet foot properly and walking bare foot even inside house are the most common reason for foot infections. A rise in the incidence of foot ulcer is also seen in summer, when people tend to visit temples, bare foot.

“Foot infections often recur, sometimes even thrice a year. Each time, the infected part has to be cut into, sutured and dressed. Hospitalization is required and the patient has to shell out a minimum of Rs 60,000. All for a condition that can be prevented with little care” Dr Vishwanathan concludes.

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

Vaccum Assisted Closure (VAC)

The latest in Diabetic foot wound healing ……..now at M.V. Hospital

Diabetic foot ulcer is a cause for enormous suffering, loss in economic productivity and mortality. The outcome is poor because of the severity of the disease. Management is often sub optimal because of poor understanding of the subject and it is unfashionable and generally omitted from professional training and largely neglected in research. The result is that ignorance is endemic; management is guided by belief and habits more than by evidence and research allocation is minimal. The technology has been revolutionized and recent advances are a boon to man-kind. One such example is VACCUM ASSISTED CLOSURE device which works on the principle of negative pressure wound therapy (NPWT). It involves the delivery of intermittent or continuous sub-atmospheric pressure through a specialized pump connected to the wound surface maintaining a closed environment. The pump is connected to a canister, which serves to collect wound discharge and exudates. Studies have shown that VAC therapy system yielded a higher proportion of healed wounds, faster time to wound closure, a more rapid and robust granulation tissue response and reduced risk for a second amputation. Keeping pace with time and technology, the VAC system has been introduced recently at our centre. We at M.V. Hospital are using this technology in treating diabetic foot ulcers and have achieved good results. VAC therapy is indicated in larger, deeper and partial foot amputation wounds. However, they are contraindicated in small wounds responding to debridement.

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website

Know about the important test for Diabetes Control – Glycosylated Hemoglobin ( Hba1c)

Diabetes Mellitus, a chronic disease characterized by hyperglycemia of the eyes, heart, kidneys, blood vessels and other organ systems. The disease is accompanied by carbohydrate, lipid & protein metabolism disturbances. Traditional methods of assessing glycemic control in diabetes is by analyzing the medical history, performing a physical examination and measuring blood and urine glucose, while extremely important for routine care have only limited value as indices of long term glycemic status. It is only with the development of glycated Hb (GHb), testing that accurate, objective measure of long term glycemic status is possible.

The terms “glycated hemoglobin” also called glycohemoglobin or glycosylated Hb – refers to a series of stable minor Hb components that are formed slowly and non- enzymatically from Hb and glucose. Of the fast moving Hb’s identified in the 1950’s, HbA1C is present in greatest quantity in both normal and diabetic individuals. HbA1C is formed by the nonenzymatic glycation of free amino groups at the ‘N’ terminal of the amino acid valine of the Hb “B” chain.

The glucose remains bound during the erythrocyte life cycle. It is related to the degree of blood glucose level elevation and the time interval over which this occurs as well as the erythrocyte life span. The HbA1C level correlates with the mean glucose concentration prevailing in the course of the patient’s recent history (approximately 6-8 weeks). Therefore provides much more reliable information for glycemic monitoring than do determination of blood glucose or urinary glucose.

Test Principle
The HbA1C determination is based on the turbidimetric inhibition immunoassay for haemolysed whole blood. The HbA1C in the sample reacts with the anti HbA1C antibody to form a soluble antigenantibody complex. The polyhaptens react with excess anti HbA1C antibodies to form an insoluble antibody polyhapten complex, which can be determined turbidimetrically. Liberated Hemoglobin from the haemolysed sample is correlated to a derivative having a characteristic spectrum and subsequently determined.

Normal reference range is 4.3 to 6.0 %. However, good control for a diabetic patient is considered as, an HbA1C value below 7.0 %. Glycohemoglobin is a valuable tool for assessing glycemic control and is routinely used in the care of persons with diabetes. Measurement of GHb has also shown useful research applications facilitating studies requiring objective assessment of long term glucose control. Reports have shown that regular monitoring of GHb among diabetic patients can facilitate changes in treatment resulting in improved glycemic control.

Disclaimer: All opinions and Information published here is for medical education only. It is not intended as and does not substitute for medical advice. If you are a patient, please see your doctor for evaluation of your individual case. Under no circumstances will the authors be liable to you for any direct or indirect damages arising in connection with use of this website.