Foot self-care in diabetes mellitus: Evaluation of patient awareness.

AIMS: To assess diabetic patients' knowledge and practices regarding foot care. METHODS: This study was conducted as a cross-sectional study in 1030 patients between November 2017 and February 2018.The descriptive survey instrument was developed by the investigators. Survey content and format were based on prior surveys and guidelines. The survey sought socio-demographic characteristics of the patients and the level of knowledge about diabetic foot care practice. RESULTS: 29.5% of patients had bad foot care, 49.6% of patients had moderate foot care and 20.8% of patients had good foot care. There were no significant differences between patient groups in regard to age, gender, foot infection history and having undergone amputation surgery. We found that patients who good at foot care had higher education status (p<0.001), were more likely live in a city (p<0.001), had higher income (p<0.001), had been trained about foot care (p<0.001) and were more likely to have type I DM (p=0.015). Disease duration was longer in those who had good foot care compared to the other groups (p=0.010). CONCLUSIONS: The mean knowledge and practice scores of our patients were moderate, indicating that much is to be done for the education of patients on this matter. We also found that knowledge about the importance of this practice, education status and disease duration had significant influence on the practice of foot-care in patients with DM.

Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults.

BACKGROUND: The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients. METHODS: This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1)pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality. RESULTS: In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1)pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p=0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p=0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p=0.133) significantly increased the likelihood of fatality. CONCLUSIONS: Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.

A case of gynecomastia due to entecavir.

Hepatitis B is an important health problem all over the world as well as in our country. Entecavir is a nucleoside analog used in the treatment of chronic hepatitis B. We present a case of a 55-year-old male patient who developed unilateral gynecomastia while under treatment with entecavir. Physical examination was unremarkable except for minimal hepatomegaly. Laboratory examination revealed: HbsAg: positive, HBeAg: negative, anti-HBe: positive, HBV DNA: 800,000 copies/ml, total anti-HDV: negative, and alanine aminotransferase: 105 U/L (normal range: 0-41). The treatment was started with pegylated interferon. During the follow-up, transaminases did not regress and HBV DNA was found to still be highly positive at the sixth month evaluation. Pegylated interferon treatment was stopped and entecavir was started at a dose of 0.5 mg/day. Six months after the initiation of entecavir treatment, the patient presented with a painful swelling in the right breast. On physical examination, there was painful gynecomastia on the right side, which was confirmed with mammography and ultrasound of the breast tissue. The patient was not taking any drug that may have caused gynecomastia. Hormonal status of the patient was normal. Laboratory values were normal. We considered that this unilateral gynecomastia might be an adverse effect of entecavir. Since the patient had a rapid viral and biochemical response to entecavir, the drug was continued under close follow-up and there was no further progression of the gynecomastia.

Ecthyma gangrenosum without bacteremia in a previously healthy man: a case report.

INTRODUCTION: Ecthyma gangrenosum is known as a characteristic lesion of Pseudomonas aeruginosa sepsis and is usually seen in immunocompromised patients. CASE PRESENTATION: A previously healthy 63-year-old man was admitted with sloughy necrotic ulcerations of the skin over his sternum. He was afebrile and in good condition. A skin biopsy revealed ecthyma gangrenosum. Blood cultures remained sterile, but a culture of biopsy material grew Pseudomonas aeruginosa. CONCLUSION: Ecthyma gangrenosum may develop even in the absence of bacteremia and even in immunocompetent patients. It should be considered as a possible diagnosis even when a previously healthy patient has negative blood cultures.

The coexistence of hepatitis A and infectious mononucleosis.

Hepatitis A is an acute, self-limited disease that spreads predominantly by the fecal-oral route. Hepatitis A characteristically has an acute, sudden influenza-like onset with a prominence of myalgia, headache, fever and malaise. Infectious mononucleosis is an acute illness characterized clinically by sore throat, fever and lymphadenopathy. The virus usually spreads from person to person by close contact with nasopharyngeal secretions. In this case the coexistence of both diseases in the same patient is found interesting.