The medical management of diabetes mellitus with particular reference to the lower extremity: the Jamaica experience

Predisposing factors for the diabetic foot include peripheral neuropathy, peripheral vascular disease (PVD), hyperglycaemia and increased duration of diabetes. From the records of patients admitted to the University Hospital of the West Indies with the diabetic foot, we reviewed the results of the microbiology of wound swabs from diabetic foot ulcers. We noted the high prevalence of PVD (66.6 percent), peripheral neuropathy (50 percent), hyperglycaemia (75.6 percent) and increased duration of diabetes (17.5 years). A history of past foot ulcers was common and 87.2 percent had polymicrobial infection. The commonest organisms were gram positive organisms which were usually sensitive to the 2 antibiotic regimes that were commonly used. Euglycaemia, a favourable lipid profile, control of blood pressure, yearly foot examination and institution of measures to prevent foot trauma are important in the prevention of foot ulceration.(Au)

Peripheral occlusive arterial disease in diabetic clinic attendees

Peripheral occlusive arterial disease occurs with a greater frequency in the diabetic population than in the general population. It can have debilitating effects and so early detection and intervention are important. The aim of this study was to investigate the prevalence of peripheral occlusive arterial disease (POAD) among a sample of diabetic patients attending the out-patient clinic at the University Hospital of the West Indies (UHWI), Mona. A sphygmomanometer was used to measure arm and ankle blood pressures in 80 diabetic patients, and the ankle-brachial systolic pressure index (ABI) was determined. The presence or absence of peripheral pulses was detected with the Multi-dopplex (model 1). POAD was defined by the absence of one or more peripheral pulses and/or an ABI < 0.09. Of the 80 diabetic patients examined, 18 (22.5 percent) were found to have POAD. Seventy-eight percent of diabetics with POAD had the disease in both legs. Intermittent claudication was diagnosed in 27.7 percent of patients with POAD. A significantly larger proportion of diabetics with POAD were hypertensive and/or neuropathic (p < 0.05). The results suggest that serious attention should be given to the quantitative screening for POAD in the diabetic patients attending the clinic at the UHWI (AU)

The in-patient profile of lower limb neurovascular disease in a Trinidadian population - abstract

Lower limb neurovascular disease is an extremely common problem in Trinidad, accounting for about 55 per cent of the surgical in-patient population. Because detailed information on the profile of these patients is not documented a prospective survey of lower limb disease was carried out among all patients admitted to 116 adult surgical beds over a 3-month period. A form was designed to collect demographic data, diagnosis, operations dressings, antibiotics and risk factors, and completed for each patient on admission and updated till discharge. Of a total of 203 patients with lower limb disease 7 with varicose vein as the underlying pathology were excluded. There were 100 males in the 196 cases and Afro-Trinidadians (75.5 per cent) were predominant over Indo-Trinidadians (21.4 per cent). Wet gangrene accounted for 36 per cent, other infections 30 per cent, non-healing ulcer 19 per cent, dry gangrene 9 per cent and rest pain 7 per cent. Trauma initiated 35 per cent of the septic lesions. Forty-two (21.4 per cent) patients had major amputations. Patients stayed in hospital for a long time (average 22.2 days), used dressings frequently (15.1 dressings per patient) and required considerable antibiotic medication (20.7 days). Diabetes mellitus was the commonest associated disease (63 per cent). Lower limb ischaemia and gangrene result in considerable cost to our medical institutions. Foot care especially in diabetics could reduce the incidence of these problems since trauma is often a precipitating factor (AU)