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Background: Diabetes is a rapidly growing health challenge and potential epidemic across low-and-middle-income countries like India. Diabetic retinopathy (DR) is a consequence of diabetic microangiopathy, which may cause visual deterioration due to macular edema in any stage and vitreous hemorrhage or tractional retinal detachment in the advanced proliferative retinopathy stages. Aims and Objectives: The aim was to study the retinopathy status in diabetic patients with a risk of diabetic foot syndrome (DFS) visiting a western regional hospital in India. Materials and Methods: In this cross-sectional study, all patients with diabetes mellitus (DM) with a risk of DFS, visiting a tertiary care hospital during the study period, underwent an ophthalmological evaluation for documentation of their retinopathy status. Results: One hundred and fourteen patients diagnosed to have a risk profile for DFS were included in the study. Their mean age was 61.22 years and 81.6% were males. The mean duration of DM was 12.24 years, respectively. Of the 114 patients, 72 had DR. An increased presence of retinopathy in patients with an increased risk grade of diabetic foot (DF) was found significant by the Chi-square test. (P<0.001). Conclusion: Our study found an increased presence of DR in Western Indian cohort with DFS. The severity of retinopathy was greater in patients with higher grades of risk for DF, therefore establishment of an association between DR and DFS will help in developing an integrated management strategy for these two grave consequences of diabetes. [ABSTRACT FROM AUTHOR]

Objective of the study was to find the association of vitamin D receptor (VDR) polymorphisms (Fokl, Taql and Apal) with vitamin D levels in diabetic foot ulcer (DFU) patients in South India. In this case–control study, plasma vitamin D levels and VDR genotype frequencies of 70 cases (DFU patients) were compared with 70 diabetic (diabetes mellitus [DM] [non‐DFU]) patients and 70 apparently healthy controls (HC) from South India. Plasma vitamin D levels were measured using the ELISA technique, and genotyping of VDR polymorphisms was carried out using real‐time polymerase chain reaction. Logistic regression was used to find the association between DFU versus HC and DFU versus DM traits. Association analysis was performed based on additive, dominant and recessive models with age and gender as covariates. A 45.7% of DFU patients have sufficient vitamin D levels than 48.6% and 40% of DM patients and HC, respectively. Linkage disequilibrium analysis for DFU versus HC and DFU versus DM traits shows that single nucleotide polymorphisms (SNPs) Taq1 (rs731236) and Apal (rs7975232) are in strong linkage disequilibrium in DFU patients. The alleles and genotype frequencies were similar in all three groups. Although the additive model does not show statistical significance, age and sex correlate with the three SNPs (Fokl, Taql and Apal). No association was found between VDR gene polymorphisms and vitamin D levels in DFU patients in Southern India. On the other hand, age and sex correlate with the three SNPs. [ABSTRACT FROM AUTHOR]

Introduction: India has a diabetic population of about 50.8 million, which is expected to increase to 87 million by 2030. Infection worsens the wound condition, delays the healing mechanism, and if appropriate measures are not taken in time, it could lead to systemic infection, septicemia, amputation, or even death. Diabetic foot problems, such as ulcerations, diseases, and gangrene, are the most common cause of hospitalization among diabetic patients. Objective: To determine the microbiological profile and antibiotic susceptibility patterns of organisms isolated from diabetic foot ulcers. Material and methods: A six-month retrospective study was carried out between January 2023 and June 2023 in the Department of Microbiology Government Medical College Anantapur. 250 Wound swabs were collected from diabetic foot ulcer patients and processed per the standard procedure. Antibiotic sensitivity testing was performed using the Kirby Bauer disc diffusion method by CLSI guidelines. Results: Out of 250 samples, 175 (70%) samples yielded growth. Among 175 GNB 124 (70.8%) and GPC 51 (21.6%). Conclusion: In this study, among Gram-negative bacilli, Pseudomonas aeruginosa was the predominant organism 45(36.2%), followed by Escherichia coli 32(25.8%). Among Gram positive cocci, Staphylococcus aureus are 27 (52.9%) out of 27staphylococcus aureus 12 (44.4%) were resistant to Methicillin [MRSA]. The antibiotic profile shows that proper antibiotic usage, if enacted through institutional policy, can reduce morbidity among diabetic foot ulcer patients. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcer is a debilitating complication of long‐standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out‐of‐pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital‐based cross‐sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out‐of‐pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650–₹81 120) ($378.14 [$122.56–$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non‐medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non‐medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden. [ABSTRACT FROM AUTHOR]

This advanced review focuses on preventing and managing Diabetic Foot Ulcers (DFUs), with a particular emphasis on the Indian context. It explores a range of strategies, including patient education, empirical therapeutics, advanced diagnostics like Polymerase Chain Reaction (PCR), and innovative treatments such as maggot therapy, Negative Pressure Wound Therapy (NPWT), Proximal Tibial Cortex Transverse Distraction (PTCTD), Platelet-rich Plasma (PRP), Leukocyte-Platelet-rich Fibrin (L-PRF), regenerative stem cell interventions, and novel applications like sucrose octasulfate dressings. The study underscores the critical role of patient education and timely interventions in preventing DFU complications. Advanced therapies, including maggot therapy, NPWT, PTCTD, PRP, and L-PRF, show promising results in expediting wound healing and reducing recurrence rates. Innovative approaches like antibioticloaded nano fibres and electrical stimulation offer new avenues for inhibiting bacterial growth and promoting wound healing. In summary, the prevention of DFU infections hinges on the trifecta of patient education, empirical therapeutics, and scrupulous wound management. Advanced therapeutic modalities offer a frontier of exciting possibilities for refining outcomes, particularly in regions like India with its unique infection profiles. This multidisciplinary tapestry, interwoven with emerging technologies, holds great potential for elevating the management of DFUs and ultimately enhancing the quality of life for those afflicted by this ailment. This advanced study represents the vanguard of DFU research, offering insights into pioneering strategies that warrant further exploration through rigorous research and large-scale clinical trials, thereby guiding the evolution of DFU management practices. [ABSTRACT FROM AUTHOR]

Background and Objectives: Diabetes Mellitus (DM) is a significant health concern in India, characterized as a modern-day epidemic, with the potential to affect multiple organs and lead to various complications. Cardiac autonomic neuropathy (CAN) represents one of the serious yet often overlooked complications of diabetes. This study aims to ascertain the prevalence of CAN in diabetic patients and investigate its correlation with the duration of DM and glycemic control. Materials and Methods: 134 diabetic patients were included based on predetermined criteria. Demographic information, medical history, and clinical examinations were recorded. CAN assessment involved three tests for parasympathetic and two tests for sympathetic function, with patients categorized as normal, early CAN, definite CAN, or severe CAN according to Ewing's criteria. Results: The prevalence of CAN among the study population was 60%. Individuals with CAN exhibited significantly longer durations of diabetes and higher HbA1c levels compared to those with normal cardiac autonomic function. CAN showed a significant association with DM duration and glycemic control, but not with age. CAN patients presented with background retinopathy, various retinopathies, maculopathy and clinical symptoms such as diabetic foot, cataracts, muscle wasting, and tingling. Conclusion: CAN emerges as a prevalent and often asymptomatic consequence of diabetes. Hence, routine screening for CAN is recommended for all diabetic patients to facilitate early detection and intervention. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic foot ulcers are critical complications of uncontrolled diabetes, with peripheral neuropathy, peripheral arterial disease, and immune suppression as primary contributing factors. Adenosine Deaminase (ADA), an enzyme, has been identified as a promising marker for cell-mediated immunity. Its estimation may serve as a predictive marker for immunomodulation, which, in turn, leads to complications among individuals with diabetes. Aim: To estimate serum ADA levels in diabetic patients without diabetic foot and diabetic patients with diabetic foot. Additionally, the study aimed to investigate the association of ADA serum levels with glucose, Glycated Haemoglobin (HbA1c), and the severity of wounds. Materials and Methods: This cross-sectional study was conducted in the central laboratory Department of Biochemistry at Krishna Rajendra Hospital (KR Hospital), Mysuru Medical College and Research Institute, Mysuru, India, from August to September 2021. The study included diabetic foot cases (n=45) and Type 2 diabetes patients on regular follow-up in the Department of Medicine without diabetic foot and any other complications (n=45). Venous blood samples were analysed for ADA, glucose, HbA1c, and complete blood count. The data were statistically analysed using the Mann-Whitney U test, Kruskal-Wallis test, and Spearman rank correlation test. Results: The present study observed a higher incidence of diabetic foot among males. It showed a statistically significant increase in serum ADA, HbA1C, and neutrophil count in patients with diabetic foot compared to patients with diabetes without diabetic foot ulcers, with mean Standard Deviation (SD) of 71.79±25.11, 11.53±3.11%, and 75.91±9.77%, respectively. Serum ADA exhibited a positive correlation with HbA1C and different grades of ulcers. Conclusion: The present study demonstrated a significantly increased serum ADA in diabetic ulcers and a positive correlation with different grades of ulcers. This finding contributes to a better understanding of the disease's pathogenesis at different stages. Furthermore, the positive correlation between ADA and HbA1C levels may play an important role in predicting the glycaemic and immunological status of these patients. [ABSTRACT FROM AUTHOR]

Tropical honey has been used for the treatment of ulcers since ancient times. But there is less medical evidence supporting this. Hence this research was planned to study the efficacy, safety and cost-effectiveness of tropical honey in treating Wagner grade 1 and grade 2 diabetic foot ulcers and compare it with povidone-iodine. We conducted an open-labeled randomized controlled clinical trial at a tertiary care hospital. It included patients with diabetic foot ulcers of Wagner grade 1 and 2 of at least two weeks duration. 80 patients were randomly assigned to either tropical honey dressing or povidone-iodine dressing once a day or once in two days. The primary outcome assessed was a percentage reduction in ulcer size at the end of six weeks in both groups. The secondary outcomes were ulcer depth, slough quantity, exudate, granulation score, microbiological clearance, cost-effective analysis and incidence of adverse effects. The tropical honey group had a significantly (p=0.023) reduced ulcer size (82.45±16.79%) compared to povidone-iodine (72.67±20.19%). It had a significantly (p=0.014) greater number of patients (n=13) with a completely healed wound at the end of six weeks compared to povidone-iodine (n=4). The tropical honey group had more patients with better slough and granulation scores. Tropical honey can therefore be used effectively for treating Wagner grade 1 diabetic foot ulcers with the added advantage of better cost-effectiveness and strong antibacterial action. Study was registered in the clinical trial registry of India. CTRI/2015/01/005457. [ABSTRACT FROM AUTHOR]

Small soft tissue defects of the distal tibia and hindfoot resulting from traumatic, operative, or neoplastic conditions and chronic ulcers can be successfully dealt with the use of the reverse sural artery flap (RSAF). This study aimed to know the association between the successful outcome of the flap and the selected factors.Our retrospective study included 40 patients who had soft tissue defect in the distal third of the leg, heel, ankle and dorsum of the foot. Detailed history was obtained, thorough clinical examination performed, necessary preoperative investigations done and reverse sural artery fasciocutaneous flap cover performed.All the patients selected in the study group underwent reverse sural artery flap cover in a satisfactory way. Majority of the patients were discharged with no complications and a minor group of them with minimal complications.Reverse sural artery flap is a versatile and reliable flap for the coverage of soft tissue defects of distal lower extremity. The leading independent factors which contribute to the success of the flap are trauma as the aetiology, distal third of the leg, and dorsum of the foot being the site of the defect and flap size of 24 sq. cm in comparison to the rest of the factors in the study. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes and frequently necessitates amputation, which lowers quality of life with the distressing prospect of re-amputation and increased mortality. The available classifications for a standardized approach to diabetic foot ulceration, though crucial in predicting clinical outcomes, have their limitations. Aims and Objectives: This study examined the reliability of the University of Texas (UT) classification system in predicting outcomes of diabetic foot in a tertiary center in Kerala, South India. Materials and Methods: In this prospective observational study, 98 DFU patients at Jubilee Mission Medical College and Research Institute, Thrissur, from December 2019 to June 2022 were categorized according to UT classification, and the treatment with outcomes for 6 months was recorded. Results: Among the total population, 24.4% of diabetic feet achieved healing without amputation. We observed an increasing incidence of impairment of healing (P=0.018) and in the number of amputations in Grades 1, 2, and 3 (P=0.000). At 6 months, 52% of diabetic feet, including those who underwent amputation, healed completely. Conclusion: DFU in a lower grade but higher stage according to the UT classification showed impaired healing and higher amputation rates as this system includes infection and ischemia. This classification allows reliable categorization and enables re-allocation of grade and stage of diabetic foot during treatment and follow-up, thereby facilitating effective management and predicting outcome. [ABSTRACT FROM AUTHOR]

Aims: Peripheral neuropathy is a common microvascular complication in diabetes and a risk factor for the development of diabetic foot ulcers and amputations. Vibrasense (Ayati Devices) is a handheld, battery-operated, rapid screening device for diabetic peripheral neuropathy (DPN) that works by quantifying vibration perception threshold (VPT). In this study, we compared Vibrasense against a biothesiometer and nerve conduction study for screening DPN. Methods: A total of 562 subjects with type 2 diabetes mellitus underwent neuropathy assessments including clinical examination, 10-g monofilament test, VPT evaluation with Vibrasense and a standard biothesiometer. Those with an average VPT ≥ 15 V with Vibrasense were noted to have DPN. A subset of these patients (N = 61) underwent nerve conduction study (NCS). Diagnostic accuracy of Vibrasense was compared against a standard biothesiometer and abnormal NCS. Results: Average VPTs measured with Vibrasense had a strong positive correlation with standard biothesiometer values (Spearman's correlation 0.891, P < 0.001). Vibrasense showed sensitivity and specificity of 87.89% and 86.81% compared to biothesiometer, and 82.14% and 78.79% compared to NCS, respectively. Conclusions: Vibrasense demonstrated good diagnostic accuracy for detecting peripheral neuropathy in type 2 diabetes and can be an effective screening device in routine clinical settings. Trial registration: Clinical trials registry of India (CTRI/2022/11/047002). Registered 3 November 2022. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=76167. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes is a common non-communicable disease in the world. Diabetic foot ulcer is a common complication of diabetes mellitus. Awareness and practice of foot self-care play a major role in the prevention of complications due to diabetic neuropathy. Methods: Descriptive cross-sectional study was conducted among diabetic patients from Sep 2022 to Feb 2023. A semi-structured questionnaire containing four parts including socio-demographic including clinical details, questions related to knowledge and practice of foot self-care, and clinical examination was used. Ten grams monofilament and 128 Hz tuning fork were used to assess the sensation of the foot. Results: A total of 211 patients were included. The average age was found to be 58.4 ± 10.0 years and the majority were females (64.0%). The mean percentage score of knowledge on diabetes and foot self-care was found to be 59.6 ± 27.5 and 55.1 ± 11.9, respectively. Participants with low knowledge scores and those who do not engage in regular physical activity had significant poor foot care practices. The majority (54.5%) of the participants had at least one of the clinical problems related to diabetic foot. The most common problem was found to be heel fissures (29.4%), followed by deformed nails (15.2%), callus (5.2%), toe web infection (3.3%), and ulcer (2.8%). Monofilament test and vibration was not detectable in 12.3% and 15.2%, respectively. Conclusion: More than half of the participants were found to have good diabetic foot self-care practices. Diabetics having good knowledge on foot care and involving in regular physical activity showed good foot self-care practices. [ABSTRACT FROM AUTHOR]

Introduction: The Kashmir valley, which has experienced political instability since 1989, has witnessed a rise in amputations and a different aetiology compared to other parts of India. Limited data exists on the changing patterns of various causes of amputations before and after 1989 in the Kashmir valley, India. Aim: To analyse the demographic characteristics, amputation patterns, and different causes among amputees. Materials and Methods: A retrospective cross-sectional study was conducted at the Artificial Limb Centre (ALC) of Bone and Joint Hospital Barzulla, Srinagar, India. The study included 504 patients whose medical records were reviewed from 2006 to 2018 to identify the aetiology, geographical distribution, and level of amputation. Descriptive analysis was performed to determine the frequencies of various causes and levels of amputation. Results: The study found that the most common traumatic causes of amputation were Road Traffic Accidents (RTAs), firearm injuries, and blasts. Non traumatic amputations (vascular disease and malignancies) accounted for 30% of cases. Lower limb amputations (91.5%) were more prevalent than upper limb amputations (8.5%). Conclusion: Prior to 1989, RTA accidents were the major cause of amputations, but there was a surge in amputations caused by firearm injuries and blasts. Additionally, there has been increase in amputations caused by malignancies and dysvascular ischaemia in non traumatic causes. [ABSTRACT FROM AUTHOR]

Peripheral arterial disease (PAD) is one of the underdiagnosed and undertreated vascular diseases despite its significant burden in India. In India, the etiological aspects, diagnostic approaches, treatment modalities, and other preventive measures probably vary in different regions. Therefore, this consensus was developed that provides a unified approach for physicians to effectively diagnose and manage PAD in India. In this consensus, we identify that the prevalence of PAD varies from 5% to 25% in Indian setting. Both atherosclerotic and non-atherosclerotic risk factors may underlie PAD. Asymptomatic PAD remains the most common presentation of the disease. The detailed clinical history, physical changes in the lower leg skin, and examination of peripheral pulses can provide clues to the diagnosis. Ankle-brachial index and Duplex ultrasound are advised as the initial choice of diagnostic measures. Besides control of risk factors such as hypertension, diabetes, dyslipidemia, and smoking, pharmacological treatment with anti-platelet and antithrombotic drugs is advised. By efficacy, ticagrelor is considered equivalent to clopidogrel and cilostazol is advised in intermittent claudication. In the revascularization of tibio-pedal lesions, endovascular therapy is effective and arterial bypass with vein graft may be needed in difficult and extensive revascularization scenarios. In these lesions, prosthetic grafts must be avoided. Diabetic foot ulcer management is challenging as foot care among diabetics is poor. In limb, salvation should always be a priority with avoidance of amputation if possible. Stem cell therapy has been successful in PAD which can be advised to "no-option" patients to prevent amputation. Physicians should undertake effective screening of PAD and be considered "PAD Clinics" in India. [ABSTRACT FROM AUTHOR]

Background: Diabetes is one of the most common comorbid illnesses in our community. Diabetes is associated with numerous complications related to microvascular, macrovascular, and metabolic etiologies. One of its complications in long course is diabetic foot ulcer and the associated morbidity and mortality is a major health issue. Aims and Objectives: This study was conducted to describe the lesions we treat, study and compare outcomes and to identify measures to decrease morbidity and mortality due to diabetic foot disease. Materials and Methods: All patients who attended general surgery outpatient department at M.Y. Hospital (M.P.) India between July 1st 2021 and June 30th, 2022 were included in this study with nonhealing Diabetic foot Ulcer Wagners Stage 3 for more than 2 weeks without any other comorbidities. Results: Majority of the patients presented with higher grade and with poor glycemic control at the time of presentation. Conservative management with antibiotics was useful in a small subset of the patients. Majority of the patients needed surgical treatment in the form of debridement to amputations. Conclusion: Diabetic limb disease is more prevalent in male sex commonly in 51-60 years of age group. 74% of patients presented with foot ulcer and Staphylococcus aureus was found the most common microorganism in pus culture from wounds. Local applicants are effective in controlling ulcers. In our study, hydrogel with colloidal silver was most effective followed by silver nitrate. Early and aggressive treatment of these ulcers can prevent the rate of amputation. [ABSTRACT FROM AUTHOR]

Background: Finegoldia magna (formerly known as Peptococcus magnus or Peptostreptococcus magnus) belonging to phylum Firmicutes, class Clostridia and genus Finegoldia, is the only species known to cause infections in human beings. Amongst Gram positive anaerobic cocci, F. magna is known to be the most virulent with a high pathogenic potential. Significant upsurge in antimicrobial resistance among anaerobes has been documented by various studies. F. magna is known to be susceptible to most of the anti-anaerobic antimicrobials, however, multidrug resistant strains are being reported in literature. The present study was undertaken to highlight the role of F. magna in clinical infections and to analyze their antimicrobial susceptibility patterns. Methods: The present study was conducted in a tertiary care teaching hospital in Southern India. 42 clinical isolates of F. magna recovered from diverse clinical infections between January 2011 to December 2015 were studied. These isolates were subjected to antimicrobial susceptibility testing against metronidazole, clindamycin, cefoxitin, penicillin, chloramphenicol and linezolid. Results: Among the 42 isolates studied, majority of them were revived from diabetic foot infections (31%) followed by necrotizing fasciitis (19%) and deep-seated abscesses (19%). All the F. magna isolates showed good in-vitro activity against metronidazole, cefoxitin, linezolid and chloramphenicol. Clindamycin and penicillin resistance were observed against 9.5% and 2.4% of the isolates respectively. However, β-lactamase activity was not detected. Conclusion: The antimicrobial resistance among anaerobes varies from pathogen to pathogen and region to region. Hence, a deep understanding of resistance pattern is necessary for better management of clinical infections. [ABSTRACT FROM AUTHOR]

Background. The regulation of vascular endothelial growth factor (VEGF) by genetic factors in T2DM and DFU still requires thorough investigation. Hence, the present study aimed to investigate the association of VEGF +405 G/C in DFU subjects and correlate it with its circulatory levels, infection severity, and amputation rate. Materials and Methods. This study registered a total of 754 participants of which group I: healthy controls (n = 297), group II: T2DM subjects (n = 242), and group III: DFU subjects (n = 215). Genotyping and levels of rs2010963 were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) and ELISA, respectively. Results. Results of the current study showed a clear decline in circulatory VEGF-A levels in DFU subjects. VEGF-A was decreased in DFU subjects with the mutant "CC" genotype. The mutant "CC" of VEGF +405G/C was also found to be more susceptible to ulcer grade (III and IV) and major amputations. Conclusion. VEGF +405G/C SNP is associated with levels, infection severity, and amputation amongst South Indian DFU patients. [ABSTRACT FROM AUTHOR]

Background: Levonadifloxacin and its oral prodrug, Alalevonadifloxacin, are novel antibiotics licensed in India for the treatment of acute bacterial skin and soft tissue infections, including diabetic foot infections and concurrent bacteremia. Objective: The objective of this study is to assess the activity of levonadifloxacin against contemporary Staphylococcus aureus clinical isolates, including methicillin‑resistant S. aureus (MRSA). Methods: A total of 102 S. aureus isolates (non‑duplicate one per patient from diverse specimens) were collected from January to December 2021. Isolates were further screened for methicillin‑resistance by the disk‑diffusion method using Cefoxitin (30 mcg). Susceptibilities of levonadifloxacin and other antibiotics were then determined using the disk‑diffusion method performed as per the recommendations of the Clinical and Laboratory Standards Institute. Results: Among 102 isolates, 49 (57.8%) were MRSA. Against all isolates, the susceptibilities to gentamicin, cotrimoxazole, erythromycin, clindamycin, and ciprofloxacin were 61.8, 60, 30.4, 57.8, and 12.7%, respectively, while levonadifloxacin showed 100% susceptibility. Furthermore, the susceptibilities of linezolid and vancomycin were also 100%. Conclusion: Levonadifloxacin is a newer, safer, and alternative treatment option for infections caused by diverse multidrug‑resistant S. aureus, including MRSA. This study, in conjunction with other previous studies, also re‑established that levonadifloxacin susceptibilities can be reliably determined using the disk‑diffusion method. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcer disease is one of the most common complications of diabetes, especially in developing nations like India. Management and successful treatment of diabetic ulcers have been under rigorous research and interventions for the past few decades now. This study is an attempt to analyze the effects of a relatively newer treatment modality for diabetic foot ulcers. Aims and Objectives: The primary objective of this study was to determine results after treating patients of diabetic foot ulcers with local insulin injection therapy and compare with the placebo group after 1 week of treatment. Materials and Methods: In this study, 50 patients with diabetic foot ulcer disease were enrolled, of which 25 patients were randomly selected for the intervention group and the rest were kept in a control group. In the intervention group, patients were treated by injecting insulin preparation at the ulcer site whereas in control group, normal saline was used. Wound assessment was done by measuring the ulcer size and by determining the ankle peak systolic velocity (APSV) using color Doppler technique before and after the treatment in both intervention and control groups. Results: Mean ulcer size before the treatment (7.19 cm²) was higher than post-treatment size (3.48 cm²) and the difference was statistically highly significant (P=0.00) while there was no significant difference in ulcer size post-treatment by insulin or non-insulin (normal saline) group (P=0.274). Mean APSV before the treatment (30.75 cm/s) was lower than post-treatment velocity (43.50 cm/s) and the difference was statistically highly significant (P=0.00) while there was no significant difference in APSV post-treatment by insulin or non-insulin (normal saline) group (P=0.061). Conclusion: It meant that insulin and normal saline were equally effective in reducing ulcer size and improving APSV without being superior to one another. [ABSTRACT FROM AUTHOR]

Objective: Diabetes mellitus is a prevalent chronic health condition associated with high blood glucose levels. Among its complications, diabetic foot ulcers (DFUs) are particularly concerning due to their potential for infection and lower extremity amputation. In India, where diabetes prevalence is high and rising, understanding the prevalence and risk factors of DFUs is essential for effective healthcare planning and intervention strategies.A search was conducted across PubMed, Scopus, Embase, and Google Scholar to identify studies reporting the prevalence of DFUs published until December 2023. Statistical analysis was performed using R software, employing a random effects model with a 95% confidence interval. Publication bias was assessed via funnel plot visualization and Egger’s test. Subgroup analyses were conducted based on different variables. Moreover, determinants associated with DFUs were also assessed qualitatively.Eighteen studies involving a total of 55,988 people with diabetes were included. The pooled prevalence of DFUs in India was estimated at 6.2% (95% CI: 4.0; 9.4%). Subgroup analysis revealed a higher prevalence in males (14.5%) compared to females (7.7%), although not statistically significant (p = 0.17). Regional analysis indicated similar prevalence in the East (9.5%), South (7.4%), and North (5.6%) regions of India (p = 0.42). Hospital-based studies exhibited a higher prevalence (7.5%) compared to community-based studies (2.5%) (p = 0.02). Longer diabetes duration, male gender, older age, comorbidities, and an unhealthy lifestyle were identified as major risk factors for DFUs.The relatively low yet considerable prevalence of DFUs in India emphasizes the need for preventive strategies. The findings advocate for policymakers to prioritize interventions focusing on patient education, lifestyle modifications, and regular healthcare follow-up to reduce the burden of DFUs and improve outcomes in people with diabetes.Methods: Diabetes mellitus is a prevalent chronic health condition associated with high blood glucose levels. Among its complications, diabetic foot ulcers (DFUs) are particularly concerning due to their potential for infection and lower extremity amputation. In India, where diabetes prevalence is high and rising, understanding the prevalence and risk factors of DFUs is essential for effective healthcare planning and intervention strategies.A search was conducted across PubMed, Scopus, Embase, and Google Scholar to identify studies reporting the prevalence of DFUs published until December 2023. Statistical analysis was performed using R software, employing a random effects model with a 95% confidence interval. Publication bias was assessed via funnel plot visualization and Egger’s test. Subgroup analyses were conducted based on different variables. Moreover, determinants associated with DFUs were also assessed qualitatively.Eighteen studies involving a total of 55,988 people with diabetes were included. The pooled prevalence of DFUs in India was estimated at 6.2% (95% CI: 4.0; 9.4%). Subgroup analysis revealed a higher prevalence in males (14.5%) compared to females (7.7%), although not statistically significant (p = 0.17). Regional analysis indicated similar prevalence in the East (9.5%), South (7.4%), and North (5.6%) regions of India (p = 0.42). Hospital-based studies exhibited a higher prevalence (7.5%) compared to community-based studies (2.5%) (p = 0.02). Longer diabetes duration, male gender, older age, comorbidities, and an unhealthy lifestyle were identified as major risk factors for DFUs.The relatively low yet considerable prevalence of DFUs in India emphasizes the need for preventive strategies. The findings advocate for policymakers to prioritize interventions focusing on patient education, lifestyle modifications, and regular healthcare follow-up to reduce the burden of DFUs and improve outcomes in people with diabetes.Results: Diabetes mellitus is a prevalent chronic health condition associated with high blood glucose levels. Among its complications, diabetic foot ulcers (DFUs) are particularly concerning due to their potential for infection and lower extremity amputation. In India, where diabetes prevalence is high and rising, understanding the prevalence and risk factors of DFUs is essential for effective healthcare planning and intervention strategies.A search was conducted across PubMed, Scopus, Embase, and Google Scholar to identify studies reporting the prevalence of DFUs published until December 2023. Statistical analysis was performed using R software, employing a random effects model with a 95% confidence interval. Publication bias was assessed via funnel plot visualization and Egger’s test. Subgroup analyses were conducted based on different variables. Moreover, determinants associated with DFUs were also assessed qualitatively.Eighteen studies involving a total of 55,988 people with diabetes were included. The pooled prevalence of DFUs in India was estimated at 6.2% (95% CI: 4.0; 9.4%). Subgroup analysis revealed a higher prevalence in males (14.5%) compared to females (7.7%), although not statistically significant (p = 0.17). Regional analysis indicated similar prevalence in the East (9.5%), South (7.4%), and North (5.6%) regions of India (p = 0.42). Hospital-based studies exhibited a higher prevalence (7.5%) compared to community-based studies (2.5%) (p = 0.02). Longer diabetes duration, male gender, older age, comorbidities, and an unhealthy lifestyle were identified as major risk factors for DFUs.The relatively low yet considerable prevalence of DFUs in India emphasizes the need for preventive strategies. The findings advocate for policymakers to prioritize interventions focusing on patient education, lifestyle modifications, and regular healthcare follow-up to reduce the burden of DFUs and improve outcomes in people with diabetes.Conclusions: Diabetes mellitus is a prevalent chronic health condition associated with high blood glucose levels. Among its complications, diabetic foot ulcers (DFUs) are particularly concerning due to their potential for infection and lower extremity amputation. In India, where diabetes prevalence is high and rising, understanding the prevalence and risk factors of DFUs is essential for effective healthcare planning and intervention strategies.A search was conducted across PubMed, Scopus, Embase, and Google Scholar to identify studies reporting the prevalence of DFUs published until December 2023. Statistical analysis was performed using R software, employing a random effects model with a 95% confidence interval. Publication bias was assessed via funnel plot visualization and Egger’s test. Subgroup analyses were conducted based on different variables. Moreover, determinants associated with DFUs were also assessed qualitatively.Eighteen studies involving a total of 55,988 people with diabetes were included. The pooled prevalence of DFUs in India was estimated at 6.2% (95% CI: 4.0; 9.4%). Subgroup analysis revealed a higher prevalence in males (14.5%) compared to females (7.7%), although not statistically significant (p = 0.17). Regional analysis indicated similar prevalence in the East (9.5%), South (7.4%), and North (5.6%) regions of India (p = 0.42). Hospital-based studies exhibited a higher prevalence (7.5%) compared to community-based studies (2.5%) (p = 0.02). Longer diabetes duration, male gender, older age, comorbidities, and an unhealthy lifestyle were identified as major risk factors for DFUs.The relatively low yet considerable prevalence of DFUs in India emphasizes the need for preventive strategies. The findings advocate for policymakers to prioritize interventions focusing on patient education, lifestyle modifications, and regular healthcare follow-up to reduce the burden of DFUs and improve outcomes in people with diabetes. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcers (DFU) are one of the major complications of diabetes. Despite proper insulin treatment and a strict diabetic diet, 15% of diabetic population develop non-healing ulcers which leads to amputation of the lower limb. Wound dressings represent a part of the management of diabetic foot ulceration. Normal saline (0.9%) wound dressings have been a useful adjunct in the treatment of open wounds. Topical insulin dressing improves wound healing by regulating oxidative and inflammatory responses. PRP dressing has emerged as an adjunctive and newer method for treating DFUs. Hence, the present study was undertaken to compare the effect of topical insulin, platelet-rich plasma (PRP), and normal saline dressing in healing of DFU. Aims and Objectives: The aim of the study was to study the comparison between topical application of insulin versus PRP versus regular normal saline dressing in healing of DFU. Materials and Methods: It is a duration based prospective comparative study including 60 patients divided equally into normal saline dressing group, topical insulin dressing group and PRP dressing group after they fulfilled all the inclusion and exclusion criteria and after obtaining the proper informed and written consent from relatives/patients. Ulcers at days 0, 7 and 14 in terms of size, depth and percentage reduction in area of wound were analyzed. Results: The mean ulcer size at day 14 in normal saline was 4.19±0.95, in Insulin 2.64±0.83 while 2.08±0.47 in PRP group. The mean ulcer depth at day 14 in normal saline was 5.35±1.18, in insulin 4.30±1.38 while 2.35±1.42 (mm) in PRP group, percentage reduction of mean ulcer size in normal saline was 27.02±4.46, in insulin 50.31±7.53 and 63.80±5.75% in PRP group. Conclusion: PRP appears to be a promising agent in terms of faster wound healing, more significant reduction in the size of DFU as compared to topical insulin and other conventional dressings. [ABSTRACT FROM AUTHOR]

Background Diabetic foot and lower limb complications affect 40-60 million people globally. A rapid method is needed to understand the bioburden and type of infecting bacteria on diabetic foot ulcers. Aim To compare the accuracy and efficacy of a novel multispectral imaging device, against the standard culture method and correlate bacterial bioburden levels with metagenome sequencing. Method A clinical study was conducted on diabetic foot ulcer patients. Wounds, post-debridement, were imaged using the multispectral imaging device and the report, containing spatially mapped regions of bacterial burden along with their bacterial gram type, was compared with the culture sensitivity report. Additionally, metagenome sequencing was done on a subset of the patient samples.Results A total of 157 patients were imaged, and 177 deep tissue biopsies were taken from colour-coded regions (Gram Positive/Gram Negative infected) identified by the machine learning algorithm. The class-averaged accuracy of the device was found to be 90.4% for gram-positive, -negative, polymicrobial and for no bacterial burden. A total of 26 biopsies were also sent for 16S rRNA sequencing. Of these, cultures were positive in 17 and correlated with the species identified through 16S rRNA results in 16 cases. In five cases where there was no growth in culture, the multispectral imaging device could still detect the presence of bacteria as confirmed by 16S rRNA results (using 50 reads as a cut-off) and thus be used as an adjunct for monitoring wounds' bacterial burden over time. Conclusions The novel multispectral imaging device can be used to effectively understand the bioburden in a wound of clinical significance and the gram type of infecting bacteria. Implications for clinical practice The autofluorescence imaging device can assist doctors in evaluating wounds' bacterial burden level, spatial bioburden extent and the gram type of bacteria present, thus aiding in effective debridement and proper wound-management protocols. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic foot ulcer (DFU) is very susceptible to infection, which rapidly spreads in the foot and ultimately leads to amputation. Diabetic foot infection (DFI) is a serious threat to public health around the world because it can lead to death. The aim of this study was to design a foot care practice tool and evaluate the effectiveness on diabetics in terms of knowledge, skill and hemoglobin A1c. Methods: An experimental pretest - posttest study design was used for this study. A total of 200 diabetics participated in this study in which 100 diabetics in the control group and 100 diabetics in the experimental group. Results: The present study findings show that 48.1 % improvement in foot care knowledge in the experimental group and 7.1% improvement in the control group. Experimental group showed 0.46 % reduction in HbA1C level comparing to a 0.05% reduction in HbA1C in the control group. Conclusions: This study showed an increase in the foot care knowledge and skill of diabetics after the intervention and drastic reduction in HbA1C in the experimental group compared to the control group. The study conveys a strong message to diabetes health care providers about the critical need for foot care awareness programmes among diabetics. [ABSTRACT FROM AUTHOR]

Objective: India has the world's largest number of diabetics. Non-traumatic lower limb amputation is the most common devastating complication of diabetes, primarily due to diabetic foot ulcers (DFU) and diabetic foot infections (DFI). In India, the incidence of foot ulcers ranges from 8-17 per cent. DFIs are predominantly polymicrobial and multidrug-resistant (MDR) with the ability to form biofilm, which is an important virulence factor and results in treatment failure. Aim: The main objectives of the study are to identify the multidrug-resistant bacteria associated with these infections, their antibiotic sensitivity pattern, and to detect the biofilm formation. Materials and Methods: This is a prospective and hospital-based study was conducted in the Department of Microbiology, Shadan Institute of Medical Sciences, Teaching Hospital and Research Center over a period of 1 year (2021-2022). Inclusion Criteria: The study participants were diabetic patients with DFUs presenting to the surgical outpatient clinic and medical wards. Selection criteria were being 18 years of age or older with a diagnosis of diabetes and complication of DFUs. Exclusion Criteria: Other foot ulcers unrelated to diabetic were excluded. Bacteria were isolated and identified using a Microgen kit. Biofilm forming ability and antibiogram of isolates were determined using microtiter plate and disk diffusion methods, respectively. Results: According to age wise distribution of the study subjects, the majority of the patients (30 patients) belonged to the age group 51-60 years. Followed by 29 patients in the age group of 61-70 years. In our study, Biofilm assay of High Congo red agar method showed 12.0% positive cases, tube method showed 24.00%, and Tissue culture plate method showed 22.00%. On the other hand, Weak Congo red agar method 56.00%, tube method 16.00%, Tissue culture plate method showed 22.00%. In our study, among Biofilm formers few strains were sensitive to Clindamycin, Amikacin and Lenizolid, 3, 56, 59 respectively. Number of strain resistance to Penicillin G: 32, Tetracycline 27, Gentamycin 30, Clindamycin 35, Amoxy-clav 38, Cefoxitin 30 and Ciprofloxacin 45. Moreover, among resistant few strains were sensitive to Clindamycin, Amikacin and Lenizolid 35, 10, 4 respectively. Conclusion: This study showed that bacteria isolated from diabetic foot ulcers are polymicrobial, Biofilm producers and showed resistance to commonly used antibiotics. Knowledge on antibiotic sensitivity pattern and biofilm phenotype of the isolates will be helpful in determining the drugs for the treatment of diabetic ulcers. [ABSTRACT FROM AUTHOR]

Background: About 10% of patients with type 2 diabetes mellitus at the time of diagnosis have more than one risk factor for developing foot ulceration, and it increases to 15% in a lifetime. The risk of development of Diabetic foot ulcers/gangrene can be prevented by the patient's self-foot care practice at home. The present study aimed to determine the prevalence of awareness of self-foot care practice among diabetic patients in a rural setting. The study also aimed to identify the factors preventing dry or wet diabetic gangrene development and subsequent amputation. Methods: A hospital-based cross-sectional study was carried out among 1687 people with diabetes mellitus (DM) who attended orthopedic and diabetic OPD in a tertiary care hospital in Kamrup, Assam, India. An appropriate self-explanatory questionnaire about knowledge of self-foot care practice was given to all study participants. Foot examination was performed by authors participated in the study on all patients. The observations and results were categorized according to the International Diabetes Federation foot risk categories. Results: Of 1687 patients included in this study, 298 (17.7%) had foot ulcers of various grades, 164 (9.76%) had peripheral vascular disease, and 484 (28.7%), had peripheral neuropathy of different grades. After multivariate analysis, patients on insulin and combination therapy and peripheral neuropathy were significantly associated with the presence of foot ulcers. The mean knowledge score was as low as 9.7 ± 4.8 out of a total score of 23. Low awareness and knowledge were associated with low mean scores due to a lack of formal education (8.3 ± 6.1). Among the 1687 patients, only 381 (22.5%) are aware and have some knowledge about self-foot care, and 686 (40.6%) had their feet examined by a doctor only once since their initial diagnosis. The incidence of development of diabetic-related complications was significantly low in those who know about foot self-care as well as those whose feet had been inspected by a physician at least once. Conclusion: The incidence of development of diabetic-related complications was significantly low in those who know about foot self-care as well as those whose feet had been examined by a physician of family doctors at least once. There is a need to educate all patients of diabetes about self-foot care. It is prudent to establish an integrated foot care services within primary care centers and in the diabetic clinic to identify feet at risk, institute early preventive measures, and provide continuous foot care education through images videos on WhatsApp to patients and primary health care givers. [ABSTRACT FROM AUTHOR]

Objective: To assess the patterns and predictors of pharmacotherapy and QOL in DFS patients in an Indian tertiary care hospital. Methods: A cross-sectional study was conducted among inpatients with DFS. Data on sociodemographic and clinical factors, pharmacotherapy, clinical outcomes, and QOL were analyzed using the chi-squared test, independent sample t -test, and binary logistic regression. Results: We screened 3284 inpatients and included consecutive 87 (2.7%) DFS patients. The mean age was 56.08 ± 11.05 years, with a male preponderance (75.8%). Mean HbA1c was 9.9 ± 2.483. About 75% of patients received insulin, and polypharmacy was noticed in 82.7%. About 67.8% of DFS patients had other vascular complications of diabetes, with diabetic retinopathy being the most common in 89%. Amputations were noticed in 32.1% of patients. Overall, poor QOL was seen in 79.3% of patients. The mean scores for different domains were as follows: physical, 41.51 ± 14.15; psychological, 42.90 ± 11.16; social relationships, 43.06 ± 19.36; and environment, 47.17 ± 13. The presence of complications from diabetes was a significant predictor of the utilization of antihypertensives (OR: 2.92, CI [1.09, 7.79], P = 0.03) and poor QOL (OR: 4.54, CI [0.965, 21.41], P = 0.05). Conclusion: DFS patients in this study were found to be younger with poor glycemic control and other vascular complications of diabetes. The presence of other complications of diabetes in DFS patients was found to be a predictor of pharmacotherapy and poor QOL. [ABSTRACT FROM AUTHOR]

Emerging shreds of evidence indicates that the risk of diabetic foot ulcer and associated morbidity can be reduced through the intensive glycemic control. There are very few studies which assessed the effects of glycemic control on diabetic foot problems among Indian patients. We aimed to assess the effect of glycemic control on the outcomes of diabetic foot problems among adult type 2 diabetes (T2DM) patients with foot ulcers. A cross sectional study was conducted among the T2DM patients from a tertiary care teaching hospital in South India. The demographic characters, risk factors, treatment characters, glycemic status were collected among the patients and analyzed against the outcomes of diabetic foot ulcers by reviewing their medical records. Descriptive statistics were used to present the data. The Chi-square test and ANOVA were used for was used for the categorical variables and continuous parameters to identify the factors affecting the outcomes, respectively. All analysis was performed in SPSS v21. Out of the 100 participants included in the study, 70% were male. The majority (78%) were from an age group of 40 to 70 years, and the mean age was found to be 59.91 ± 10.6 years. The mean duration of diabetes was 9.66 years. Only ankle-brachial Index score (p=0.001) was significantly associated with the type of ulcers, whereas other factors not (p>0.05). A high level of average HbA1c, BMI, ABI index and poor glycemic status was associated with a significant debridement strategy and longer duration of hospitalization; however, it was not substantial. Our study inferred that poor glycemic status is associated with a significant debridement strategy and longer duration of hospitalization. However, these findings need to be strengthened with adequately powered prospective studies. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes related foot problems like osteomyelitis and Charcot (neuro-osteoarthropathy) are associated with high morbidity and high healthcare costs. Soft tissue and bone infection involving the foot is particularly common in patients with diabetes mellitus. Osteomyelitis and neuropathic osteoarthropathy often coexists in diabetes. Differentiating between these two entities is often difficult but crucial as the management may differ significantly. Aim: To assess the role of Magnetic Resonance Imaging (MRI) in diabetic foot and its ability to identify features which help to reliably differentiate infection from neuropathy and to describe the MRI imaging findings of infection and neuropathic changes in diabetic foot. Materials and Methods: The present cross-sectional study was conducted in Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India, from June 2013 to October 2015. All diabetic patients with suspected osteomyelitis or charcot who were referred for MRI were included. MRI was interpreted based on the following parameters location, distribution of oedema pattern, deformity, soft tissue changes and bone marrow signal change. Forty eight patients with diabetic foot, who underwent foot surgery with debridement or drainage and MR findings of the patient were compared with histopathology or culture respectively. Comparison of MR findings were also done with Computed Tomography (CT)/Positron Emission Tomography (PET) wherever available. Results: In this study, MRI findings with focal single bone involvement along with diffuse marrow oedema pattern, absence of deformity, forefoot/hindfoot location, presence of soft tissue changes like ulcer/sinus tract/fistulas and abscess formation were in favour of osteomyelitis. Several bones and joints involvement along with subchondral/periarticular location, presence of deformity, absence of soft tissue changes and midfoot location were in favour of Charcot's. Conclusion: The MRI was found to be the most reliable and sensible tool for imaging techniques to differentiate osteomyelitis with diabetic neuropathic arthropathy, with the sensitivity and specificity of MRI as 83.3% and 77.8%, respectively. [ABSTRACT FROM AUTHOR]

Background: Anaemia is an important health indicatorfound common inallagesdue to deficiency of iron, acute and chronic blood loss, parasitic infections affecting Red BloodCells production andsurvival which may cause anaemia. Method: Study was conducted on 71309 anaemicpatientsat Bhaktivedanta hospital and Research Institute,Thane Maharashtra India. Hemoglobin and packed cell volume values were analyzed based on gender, age groups (20-40 years,40-60 yearsand 60-80 years) . Result:one third of men and two third of women in the given study population were seen to be anaemic of variable disease. Conclusion:Prevalence and extent of anaemia irrespective of the etiology affects disease outcome in all acute and chronic conditions, whether it is surgical wound healing, heart failure, diabetic foot ulcers etc. Adequate medical and dietary management of anaemia should be conjoint approach in any disease management strategy by the healthcare professionals along with the presenting medical surgical condition. Study also highlights the need of attention towards anaemia in male as well. [ABSTRACT FROM AUTHOR]

Background-India is experiencing a rapid health transition, with large and rising burdens of chronic diseases, which were estimated to account for 53% of all deaths in 2005. Earlier estimates projected that the number of deaths attributable to chronic diseases would rise from 3.78 million in 1990 (40.4% of all deaths) to 7.63 million in 2020 (66.7% of all deaths). Aims and Objectives-To find out the prevalence of Complications of Type 2 Diabetes Mellitus and its association with different risk factors in Urban Etawah (U.P.) including tobacco, alcohol, fatty meals and physical activity. Material and Methods-The present study is a community-based study performed among 400 participants using cluster sampling technique in the field practice area of Urban health training centre, Department of Community Medicine, UPUMS, Saifai, Etawah. The participants were interviewed using a pre-tested questionnaire using Diabetes Complication Index. Results-Among the diabetics, the prevalence of coronary heart disease (CHD), peripheral vascular disease (PVD), cerebrovascular accidents (CVA), cataract, neuropathy and foot problems were 24%, 24%, 7%, 15.4%, 38%, 26% and 2% respectively. A statistically significant association was seen with fatty meals and complications. Conclusion - All the diabetic complications observed need to be addressed in prevention and control strategies in the study area. Heath screening camps will be organized for the people for awareness. [ABSTRACT FROM AUTHOR]

Introduction: Evidence on the prevalence of foot problems among people with diabetes in India at a national level is lacking. Hence, this study was aimed to assess the burden of high-risk (HR) feet in people with diabetes across India., Research Design and Methods: A cross-sectional national-level project 'Save the Feet and Keep Walking' campaign was conducted by the Research Society for the Study of Diabetes in India (RSSDI) from July 10, 2022 to August 10, 2022. A modified version of 3 min foot examination was used to assess the foot problems. Around 10 000 doctors with RSSDI membership were trained online to conduct foot screening and provided a standardised monofilament for detection of loss of protective sensation. People with diabetes aged >18 years who visited the clinics during the study period were examined for foot problems. Data were collected online using the semi-structured questionnaire. A total of 33 259 participants with complete information were included for the final analysis. The foot at risk was categorised based on International Working Group on the Diabetic Foot guidelines 2023., Results: Nearly 75% of the participants were aged above 45 years. Around 49% had diabetes duration >5 years and uncontrolled diabetes (hemoglobin A1c >8%). Presence of history of foot ulcer (20%), lower limb amputation (15.3%), foot deformities (24.5%) and absence of diminished dorsal pedis and posterior tibial pulses (26.4%) was noted in the study participants. Around 25.2% of them had HR feet and highly prevalent among males. Diabetic kidney and retinal complications were present in 70% and 75.5% of people with HR feet. Presence of heel fissures (OR (95% CI) 4.6 (4.2 to 5.1)) and callus or corns (OR (95% CI) 3.6 (3.3 to 4.0)) were significantly associated with HR feet., Conclusions: One-fourth of people with diabetes were found to have HR feet in India. The findings are suggestive of regular screening of people with diabetes for foot problems and strengthening of primary healthcare., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Diabetes is a metabolic disorder which is characterized by elevation in the blood sugar levels. Diabetes leads to multiple long-term complications of the various systems in the body. Foot ulcer accounts for significant morbidity, mortality and health care expenditure. Aim and objective. The aim of this study was to access the effectiveness of nursing intervention to improve patients' foot self-care knowledge and skills practices in diabetic patients with foot ulcer in south India. Methods: Quantitative and interventional research approach was adopted for this study, systematic random sampling was used to select 30 patients with diabetic foot ulcer, who fulfilled both the inclusion and exclusion criteria. A 60 second's tool: screening for high-risk diabetes foot, was used to assess the foot risk. Modified Nottingham Assessment of Functional Foot-care was used to assess foot care practices. RBS, HbA1C levels using hexokinase method and 10g monofilament were used to assess foot sensation. Results: There has been a statistically significant difference between the pre-test and post-test levels of knowledge about foot self-care practices Conclusion: The study showed that nursing interventions, IEC, foot care practices and counselling has a significant impact in reducing the foot ulcers and stress among the diabetic patients. Diabetic clinic should initiate interventional foot education program and foot self-care practices throughout the country. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcer is a major cause for diabetes related morbidity and hospitalization. Up to one-third of people with diabetes develop diabetic foot ulceration (DFU) during their lifetime and over 50% of these ulcerations become infected. Diabetic foot infections (DFIs) are associated with major morbidity, increasing mortality, high costs, increased risk of lower extremity amputation (LEA), and reduced quality of life. Aims and Objective: The current study was conducted to determine the microbiological profile and antibiotic susceptibility pattern of organisms in diabetic foot ulcers patients at a tertiary care center in Srinagar province. Materials and Methods: This was a Crosssectional, observational study conducted in diabetic patients with diabetic foot infection, randomly selected from outpatient departments (OPDs) and wards of Surgery and Medicine department, with Wagner grade 1-5 ulcers and irrespective of anti-diabetic treatment and diabetic foot injury treatment. Samples were processed and bacterial isolates were identified by standard microbiological procedures. Results: After following inclusion and exclusion criteria, 120 patients were considered for this study. In present study most common age group was 51-60 years age group (44%) followed by 41-50 years (32%). 66% of participants were males. 55% patients had diabetes for more than 10 years. 43% patients had ulcer size less than 5 cm2. The most common category as per Wagner’s classification was Grade 1, which comprised of 48% of study participants, followed by Grade 0 (28%) and Grade 2 (18%). Grade 3 and above comprised 7% of cases. Of the 120 study participants, 103 (86%) showed growth on culture. Among these 62 (60%) showed mono-microbial growth with 41 cases showing mixed growth. The most commonly isolated bacteria were Methicillin Resistant Staphylococcus aureus (MRSA) (23%), Coagulase Negative Staphylococci (CoNS) (18%), pseudomonas aeruginosa (18%), Methicillin Sensitive-Staphylococci Aureus (9%), Klebsiella Pneumoniae (9%), and Escherichia Coli (8%). Linezolid, vancomycin, clindamycin, gentamicin were most effective antimicrobial agents against gram positive bacteria. Iimipenem, piperacillin tazobactam, cefoperazone sulbactam & gentamicin were most effective antimicrobial agents against gram negative bacteria. Conclusion: Early microbiological evaluation for bacteriological profile, the nature of the infection either monomicrobial or polymicrobial and antibiotic sensitivity testing can improve treatment outcome, reduces complications, morbidity as well as multidrug resistance. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding the foot care practices among practitioners is still scarce in the Indian scenario. This study aimed at assessing the foot care practices among diabetologists from various parts of the country. Methods: A cross-sectional online survey was conducted among diabetologists, to understand their foot care practices across India, who were part of Diabetic Foot Research India (DFRI) and have participated in the study. Results: In a total of 89 participants, majority of the diabetologists examined patients with a history of foot infection once in 3 months (53%), 128 Hz tuning fork has been used for diagnosis of high-risk foot (31%), majority of patients were advised to use TCC by diabetologists (73%), and footwear was manufactured by qualified orthotist and prosthetics (60%). The foot problems commonly treated by diabetologists are cellulitis (26%) followed by callus (24%). Patients were also referred to other specialists (69%); almost all the participants used antibiotics (95%), and medication and wound care management (29%) were also a part of their practice. Conclusion: The diabetologists displayed a multidisciplinary approach to the treatment and management of foot care practices among patients with foot complications. It is imperative to establish effective communication between diabetologists and/or other practitioners to generate sufficient evidence to determine the foot care practices throughout the country. [ABSTRACT FROM AUTHOR]

Diabetic neuropathies are among the commonest of all the long term diabetic complications and is the main initiating factor for diabetic foot ulceration (DFU). Epidemiological data on symptomatic diabetic neuropathy which is a common scenario in surgical practice in India remain poor due to inconsistent definitions, poor ascertainment, and a lack of population based studies. This study was aimed to stratify the diabetic foot patients according to their neuropathy severity, type of foot and on quantifying the much morbid painful diabetic neuropathy prevalence in our hospital concomitantly assessing the relationship between symptoms and signs of neuropathy. Over a period of 18 months, an observational study of 120 patients admitted with diabetic foot our college. Patients were stratified according to their severity of neuropathy by Neuropathy Symptom Score (NSS) and Neuropathy Disability Score (NDS) and vascular status by ABPI measurement thereby categorised as Neuropathic, Ischemic and Neuroischemicfoot. Our study showed a high prevalence of neuropathy (81.7%), peripheral vascular disease (70.8%) and infection (77.5%). We also got a significant positive correlation between severity of neuropathy and variables like duration of diabetes (r = 0.267, p = 0.003) and HbA1c (r = 0.526, p8) had painful neuropathic symptoms (NSS =5), whereas 31.8% of patients without clinical neuropathy (NDS =2) had painful symptoms. Our study showed worsening clinical neuropathy scores associated with an increasing proportion of patients with ix more severe painful neuropathic symptoms (with r =0.753 and p value <0.001) which challenge the dogma that painful neuropathic symptoms improves as the severity of neuropathy worsens. [ABSTRACT FROM AUTHOR]

The diabetic foot is an unfortunate complication of diabetes, but it is one that is preventable. One such strategy to prevent this complication is by using appropriate footwear. Footwear should, however, be considered a 'double-edged sword' as it can prevent foot complications, as well as cause them. Although there are various guidelines on footwear laid down by different international bodies, it can be difficult to execute them in practice, as there are various factors that govern usage of diabetic footwear in developing countries. The authors suggest a simple and practical approach for using diabetic footwear in these developing countries. [ABSTRACT FROM AUTHOR]

Aims: Characteristics of diabetes-related foot ulcers (DFU), association with recurrence and amputation are poorly described in the Asian Indian population., Methods: A prospectively maintained database was reviewed to characterize DFU and its association with amputation and recurrence., Results: Of 200 patients, 63.5 % were male, the median age was 62 years (Min-Max:40-86), and median BMI was 27.90 kg/m 2 (Min-Max:18.5-42.7). Median duration of Diabetes mellitus was 15 years (Min-Max:2-43). Complete healing occurred at a median of three months (Min-Max:0.23-37.62). Amputation for the current ulcer was required in 43.4 % of individuals. Ulcer recurrence was documented in 42.4 % instances, 66.1 % evolving on the ipsilateral side. Previous amputation was associated with the risk of subsequent amputation (Adjusted OR-3.08,p-0.047). Median time to ulcer recurrence was 4.23 years among those with amputation, in contrast to 9.61 years in those with healing. Cardiovascular death was the commonest cause of mortality, followed by sepsis. At a median follow up of 6.08 years, mortality at 1,3,5 and 10 years was 2.5 %,2.5 %,8.2 % and 30.9 % respectively among those who underwent amputation versus 0 %,0 %,10.1 % and 24.5 % respectively for those who achieved healing., Conclusions: Patients with DFU in India incur amputations at rates higher than conventionally described. With previous amputation, subsequent amputation risk triples. Ten-year mortality is 25%-30 %. Underestimates of the burden of recurrence and mortality are consequential of limited follow-up., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Research Trust of DiabetesIndia (DiabetesIndia) and National Diabetes Obesity and Cholesterol Foundation (N-DOC). Published by Elsevier Ltd. All rights reserved.)

Diabetic Foot Infections are ruled as the major complication of Diabetes Mellitus which ultimately results in amputations and associate with greater morbidity and mortality. Appropriate choice of antibiotics andidentification of microbial flora have boundless role in providing optimal therapy to the patients. This study was conducted in a secondary care hospital in South India to spot-out bacteriology and antibiotic sensitivity pattern among patients afflicted with Diabetic Foot Infection. Methods: The Prospective Observational study was carried out for a period of six months from January 2019 to June 2019. Pus swabs were collected aseptically from 169 patients, whom were clinically suspected of infected diabetic wounds. Bacterial isolates were identified by standard methods and undergone antibiotic susceptibility test. Results: Among 169 patients 56.80% were males and 43.19% were females: mean age was 64 ± 18.71years. Sole was found to be the major site of ulcer (31.95%) and Grade III ulceration (41.42) was predominant. Total eight organisms were isolated, in which Staphylococcus aureus44(39.28%) was the most frequent and Meropenem was the antibiotic that showed highest susceptibility rates for the entire organisms. Conclusion: The prevalence of S aureusin this hospital setting was found to be high. The high level of sensitivity was observed to Meropenem and Gentamicin. Appropriate antimicrobial therapy according to susceptibility pattern would reduce further complications and multidrug resistance in diabetic foot ulcer patients. [ABSTRACT FROM AUTHOR]

Background & objectives: Proper identification of the infection causing microbe in diabetic foot infections (DFIs) is essential for starting appropriate treatment. The objectives of this study were to compare fine-needle aspiration microbiology (FNAM) with wound swab as methods of sample collection in isolating microorganisms causing DFIs and also to compare the microbiological profile and sensitivity pattern of the infecting organisms. Methods: This study was conducted targeting all consecutive patients with DFIs with perfusion, extent, depth, infection and sensation (PEDIS) grade 2, 3, and 4 infections admitted in the department of Surgery of a tertiary care hospital in south India during July to August 2017. A superficial wound swab and an FNAM were collected from all the patients. These swabs are analyzed using standard microbiological techniques. Results: Eighty patients with DFI were included. Bacterial culture using FNAM samples yielded growth in 58.75 per cent samples, whereas wound swab samples yielded growth in 93.8 per cent cultures done. Measure of agreement between the two techniques using Kappa statistics was 0.069 (P=0.28). Interpretation & conclusions: In diabetic wound infections, wound swabs were sufficient to identify organisms in all grades of infection. However, in deeper infections (grade 3 and 4), FNAM would be a reliable investigation than wound swab. [ABSTRACT FROM AUTHOR]

Background: Diabetic ulcers are a common morbidity associated with poorly controlled glycemic status. Most patients often have neuropathy and vasculopathy as the etiology behind such ulcers. These factors not only lead to poor wound healing but also nonhealing ulcers. Nonhealing ulcers pose therapeutic challenges as they are usually not amenable to be treated with simple wound care and hence require newer modalities to effectively cure this condition that leads to a plethora of poor health outcomes. This study was conducted to see the effect of autologous noncultured keratinocyte cell suspension in chronic nonhealing diabetic ulcers that failed to normal wound care. Material and Methods: It was an observational pilot study. A total of 05 patients with nonhealing ulcers, attending the tertiary care teaching hospital in North India, were included in the study. Inclusion criteria was type 2 DM with more than 5 years duration of diabetes mellitus and glycated hemoglobin (HbA1c) <9 g%. History was taken in detail; name, age, sex, address, duration of disease and various other treatments taken from outside were noted; and size of ulcer was recorded as per Proforma. Results: A total of 5 patients were enrolled in the study, three (60%) and two (40%) patients were male and female, respectively. Three (60%) patients were habitual for tobacco use. Mean age of patients was 45 ± 6.51 years. Mean duration of ulcers was 4.8 ± 1.48 months. Area of ulcers ranged from 31.2 to 122.2 cm2. Majority of cases, three (60%) of diabetic foot ulcers, were improved at 9–12 weeks and remaining two cases with large size of ulcer were healed at 13–16 weeks and 17–20 weeks, respectively. Majority (80%) of patients revealed >50% reduction in the size of ulcer within 2 weeks. Conclusion: Noncultured keratinocytes are useful in healing of nonhealing diabetic ulcer. [ABSTRACT FROM AUTHOR]

Background: Diabetes Mellitus (DM) causes micro and macro vascular complications. One of the complications of DM is diabetic foot that results in amputations and decreased quality of life. The aim of this study was to assess the awareness and practice about foot care and associated factors among admitted patients in a teaching hospital of coastal Karnataka, India. Material and Methods: A cross-sectional study was conducted in a medical college hospital after obtaining institutional ethics approval from 24th December 2016 to 21st January 2017. Adults with diabetes (N=317) admitted in the hospital were interviewed with a validated structured questionnaire for awareness and practice regarding foot care. The scores obtained were further graded into good and poor. Data was analyzed with SPSS version 22 for descriptive statistics. Bivariate logistic and linear regressions were used to determine the association between variables and awareness/practice scores. Results: Mean age of the participants was 56.98 (±10.54) years with males constituting the majority (63.4%). Good awareness and practice scores were observed among 69.1% and 41.6% participants, respectively. Good awareness scores were associated with male patients (p=0.027), currently not married (p=0.044), below poverty line socioeconomic status (p=0.014) and presence of foot ulcer (p=0.021). Good practice scores was associated with secondary schooling (p=0.003) and receiving insulin (p=0.045). Moderate correlation with coefficient 0.493 (p<0.001) was observed between awareness and practice scores. Conclusion: Seven and four out of 10 study participants had good awareness and practice scores about foot care, respectively. A tailor-made health education module addressing the lacunae identified in the awareness and practice domains needs to be provided to the patients with diabetes mellitus. [ABSTRACT FROM AUTHOR]

Objectives: Levonadifloxacin (WCK 771; IV) and its prodrug alalevonadifloxacin (WCK 2349; oral) are benzoquinolizine fluoroquinolones, recently approved in India for the treatment of acute bacterial skin and skin structure infections with concurrent bacteraemia and diabetic foot infections. Ahead of its market launch, the present study aimed to assess the in vitro activity of levonadifloxacin against contemporary Staphylococcus aureus isolates collected from a large tertiary care hospital in India. Additionally, levonadifloxacin activity was tested against hVISA and Bengal Bay clone MRSA isolates.Methods: Non-duplicate S. aureus (n = 793) isolates collected at Christian Medical College hospital, Vellore, India during 2013-19 were included in the study. MRSA isolates were identified using a cefoxitin disc diffusion assay. MICs of levonadifloxacin and comparator antibiotics were determined using the broth microdilution method. Mutations in QRDRs were identified for selected levofloxacin-non-susceptible isolates. MLST profiling was undertaken to detect the Bengal Bay clone.Results: Among the 793 isolates, 441 (55.6%) were MRSA and 626 (78.9%) were non-susceptible to levofloxacin. Levonadifloxacin showed MIC50 and MIC90 values of 0.25 and 0.5 mg/L, respectively, for all S. aureus, which included hVISA and Bengal Bay clone MRSA. The potency of levonadifloxacin was 16 times superior compared with levofloxacin.Conclusions: The present study demonstrated potent activity of levonadifloxacin against contemporary S. aureus isolates, which included MRSA isolates, hVISA isolates, Bengal Bay clone isolates and a high proportion of quinolone-non-susceptible isolates. The potent activity of levonadifloxacin observed in this study supports its clinical use for the treatment of S. aureus infections. [ABSTRACT FROM AUTHOR]

Aim: This study was carried out on patients with diabetic foot ulcer (DFU) to assess the clinical characteristics, spectrum of microbial flora, antibiotic sensitivity, and devise an empiric antimicrobial therapy. Material Methods: Clinical data and tissue samples were collected from 105 diabetic foot ulcer patients between December 2018 and November 2019. The collected samples were processed as per Clinical and Laboratory Standards Institute guidelines and clinical and microbiological data was analyzed. Results: In this study of 105 patients, DFU was most common in males in 5th and 6th decade of life. Majority of patients had poor glycemic control and neuropathy. Of 110 bacterial isolates obtained from 97 samples, 73.7% were Gram-negative bacteria, and 27.3% were Gram-positive. Most of samples (48.6%) showed growth of single bacteria, growth of two bacteria and polymicrobial growth was seen in 28.6% and 15.2% of tissue samples respectively of which. Pseudomonas was predominant isolate (27.3%) sensitive to imipenem (90%), amikacin (86.6%), gentamicin (83.3%), and cefotaxime (80%) followed by Staphylococcus aureus (19.1%) sensitive to amikacin and gentamicin (100%), and ofloxacin (90%). Pseudomonas, E. coli, Proteus and Klebsiella were highly resistant to ampicillin and amoxicillin-clavulanic acid. Conclusion: This study showed DFU are common in 5th and 6th decades of life. Gram-negative bacteria are predominant infective organism. Most of both Gram-negative and Gram-positive bacteria are resistant to variable degrees to commonly used antibiotics and sensitive to aminoglycosides. Amikacin and gentamicin can be used as empiric antibiotics for treatment of DFU infections. [ABSTRACT FROM AUTHOR]

Introduction: Diabetic foot ulcer is one of the major complications following diabetes. In India, 15% of diabetic patient develop DFU once in their lifetime. Neuropathy associated with diabetes is a major factor in development of foot ulcer in such patients. Infection, peripheral arterial diseases, altered functions of white blood cells, stem cells and regenerating tissues, and co-morbidities lead to delayed wound healing. Matrix rhythm therapy is a recent advancement in the field of Physiotherapy. It provides external oscillation that activates normal rhythm of cell that is between 8 and 12 Hz which improves cellular function within cell and extracellular matrix, enhancing tissue healing. A 70-year-old female presented with infected diabetic foot ulcer on her right foot in out-patient department of KLE hospital. She had nonhealing ulcer since one and half months and undergone conservative treatment of wound care along with strategies of diabetic foot care. Clinical findings: Subject complained of pain with score of 2 at rest and 6 while walking which was recorded on the basis of Visual Analogue Scale. Wound appeared ischemic and non-healing. On wound assessment, size of wound was 12 mm in diameter and 6 mm depth. It was identified as Type D grade I on the basis of classification of wound provided by University of Texas Health Science center. Intervention: Matrix rhythm therapy was applied on posterior aspect of leg region extending around wound area once a week for 5 weeks with treatment duration of 1 h. Result: Pain of the subject after 5 weeks of intervention was 0 at rest and 2 while walking on the basis of VAS. Size of wound decreased with dimension of 6 mm in diameter and 2 mm depth and categorized as Type A grade 1. Conclusion: Matrix rhythm therapy could be considered as adjunct in wound healing of diabetic foot ulcer. [ABSTRACT FROM AUTHOR]

Background: Levonadifloxacin is a novel antibiotic belonging to the benzoquinolizine subclass of fluoroquinolones with potent activity against MRSA and quinolone-resistant Staphylococcus aureus. IV levonadifloxacin and its oral prodrug alalevonadifloxacin have recently been approved in India for the treatment of acute bacterial skin and skin structure infections (ABSSSIs) including diabetic foot infections.Objectives: To investigate the in vitro activity of levonadifloxacin against contemporary clinical isolates collected from multiple tertiary care hospitals across India in the Antimicrobial Susceptibility Profiling of Indian Resistotypes (ASPIRE) surveillance study.Methods: A total of 1376 clinical isolates, consisting of staphylococci (n = 677), streptococci (n = 178), Enterobacterales (n = 320), Pseudomonas aeruginosa (n = 140) and Acinetobacter baumannii (n = 61), collected (2016-18) from 16 tertiary hospitals located across 12 states in India, were included in the study. The MICs of levonadifloxacin and comparator antibiotics were determined using the reference agar dilution method and broth microdilution method.Results: Levonadifloxacin exhibited potent activity against MSSA (MIC50/90: 0.5/1 mg/L), MRSA (MIC50/90: 0.5/1 mg/L) and levofloxacin-resistant S. aureus (MIC50/90: 1/1 mg/L) isolates. Similarly, potent activity of levonadifloxacin was also observed against CoNS including MDR isolates (MIC50/90: 1/2 mg/L). Against Streptococcus pneumoniae, levonadifloxacin (MIC50/90: 0.5/0.5 mg/L) showed superior activity compared with levofloxacin (MIC50/90: 1/2 mg/L). Among levofloxacin-susceptible Enterobacterales, 80.6% of isolates were inhibited at ≤2 mg/L levonadifloxacin.Conclusions: Levonadifloxacin displayed potent activity against contemporary MRSA and fluoroquinolone-resistant staphylococcal isolates, thus offering a valuable IV as well as an oral therapeutic option for the treatment of ABSSSIs. Furthermore, levonadifloxacin exhibited a broad-spectrum activity profile as evident from its activity against streptococci and levofloxacin-susceptible Gram-negative isolates. [ABSTRACT FROM AUTHOR]

A randomised prospective study was conducted with patients from two centres in order to analyse and study the efficacy of two types of Amit Jain's offloading system in neuropathic diabetic foot ulcers. The patients were divided into two groups, with all the odd number patients receiving standard Amit Jain's offloading and all even number patients receiving Amit Jain's variant offloading system. Seventeen patients were enrolled, eight in the standard group and nine in the variant group. The majority were women. The average duration of diabetes was 13.41 ± 9.34 years. Most patients had forefoot ulcers (76.5%). The average ulcer diameter in the variant group (1.89 ± 0.86 cm) was significantly lower than the standard group (3.94 ± 1.37 cm). The majority (94%) of ulcers were healed at the end of 8 weeks. There was no significant difference in the groups, with overall average healing being 35.41 ± 9.00 days. Amit Jain's offloading system is a new, simple, synthetic, therapeutic offloading system. This pilot study shows it to be an effective offloading system for diabetic foot ulcers, helping to facilitate healing efficiently. This system is a good choice for offloading in clinical practice in developing and underdeveloped countries, where felted foam may not be available and total contact casting cannot be used. Further studies are needed to assess the efficacy of different variants of Amit Jain's offloading system. [ABSTRACT FROM AUTHOR]

Background: The impact of diabetic foot infections is enormous in India. Studies on vitamin D levels in diabetes mellitus foot infections are scarce. The primary objective of the present study was to compare the serum vitamin D level between diabetics with foot infections and those without foot infections and the secondary objective was to assess the association between the vitamin D level and the severity of foot infections and outcomes. Methods: The study included 176 type 2 diabetics who attended Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India, between September 2012 and June 2014. The serum vitamin D level was measured for 88 diabetics with foot infections (Group 1) and 88 without foot infections (Group 2) using the ELISA 25OH vitamin D DIAsource kit (DIAsource ImmunoAssays S.A., Belgium) and compared. Both groups were followed up for 6 months for outcomes. The qualitative variables were analyzed using the χ² test and the quantitative variables using the Student t test. The statistical analyses were performed using SPSS, version 17.0. A P value of less than 0.05 was considered significant. Results: The mean serum vitamin D level was not significantly different between the two groups (P=0.306). Among the patients in Group 1 who either required amputations or died, 97.44% had subnormal vitamin D levels in contrast to 59.18% in those who were grafted or achieved wound healing (P=0.001). Among those who achieved wound healing within 6 months, 78.9% had normal vitamin D levels (P=0.0006). Conclusion: The study found no significant difference in the serum level of vitamin D between diabetics with and without foot infections. However, vitamin D deficiency was associated with a poor outcome in diabetics with foot infections. [ABSTRACT FROM AUTHOR]

Aims: Our study aimed to look at the prevalence and patterns of cardiac autonomic neuropathy related dysfunction in male patients of type 2 diabetes mellitus with chronic Charcot's foot. Methods: A total of 74 male patients with type 2 diabetes mellitus were included in this study. Three groups of patients were selected: Group 1 included patients with chronic Charcot's foot (n = 24), group 2 included patients with diabetic peripheral neuropathy without chronic Charcot's foot (n = 22) and group 3 included patients without peripheral neuropathy or chronic Charcot's foot (n = 28). The autonomic functions were tested using a personal computer-based cardiac autonomic neuropathy (CANS-504) analyser. Results: The combined sympathetic (SNS) and parasympathetic autonomic function (PNS) abnormalities were detected in about 70.8% in the chronic Charcot's group, 55.6% in the peripheral neuropathy group and 35.7% in the non-neuropathic group. In patients with chronic Charcot's foot (n = 24), 29.2% had normal, 20.8% had borderline and 50% had abnormal PNS functions, while 4.2% had normal, 16.7% had borderline and 79.2% had abnormal SNS functions. The Meary's angle (183.18 ± 73.83 vs 157.98 ± 14.11; p < 0.196) and Calcaneal pitch (7.07 ± 3.30 vs 8.5 ± 1.88; p < 0.219) were greater in the subjects with combined autonomic neuropathy, suggesting more structural deformity in them. Conclusion: Cardiac autonomic neuropathy-related dysfunction was found to be more common in type 2 diabetes patients with chronic Charcot's foot. This study has highlighted that patients with diabetic mellitus and chronic Charcot's foot should be screened comprehensively in order to prevent complications related to cardiac autonomic dysfunction. [ABSTRACT FROM AUTHOR]