Frostbite secondary to antimycobacterial-induced peripheral neuropathy: a case report.

This case report describes a unique scenario in which antimycobacterial-induced peripheral neuropathy (PN) culminates in severe bilateral foot frostbite. Drug-induced peripheral neuropathy (DIPN) is explored in the context of TB treatment, highlighting the role of medications such as isoniazid (INH) and their potential to cause PN. The report highlights the importance of identifying PN in patients undergoing antimycobacterial treatment. Early recognition and proper management of PN is crucial to prevent complications. Notably, the report advocates for patient education regarding medication side effects and avoiding harmful practices, such as ice immersion, to alliviate neuropathic pain. Emphasis is directed towards the need for a multidisciplinary approach to patient care and a focus on preventative strategies to improve patient outcomes and avoid severe debilitating complications.

Use of Traditional Remedies for Treatment of Diabetic Foot Ulcers: A Cross-Sectional Study at a Tertiary Center in Saudi Arabia.

Patients with diabetic foot ulcer (DFU) are prone to major complications including amputations. Traditional remedies (TR) have been used to treat DFU around the world. This study aims to identify the prevalence of TR among patients with DFU in our local cohort and its effect on DFU. 1408 patients were included in the analysis. Data were collected retrospectively from patients' medical records. DFU characteristics include grading ulcers using the Wagner scale (WG) and infections (cellulitis and osteomyelitis). Ulcer management (UM) includes medical treatment, self-medical treatment, traditional treatment, and medical-traditional treatment. The mean age of the cohort was 60 years (SD = 12.4). The mean duration of diabetes was 18.6 years (SD = 9.3) and the mean duration of open wounds was 206.9 days (SD = 545.6). The majority were males (71%) and had type 2 diabetes (96%, SD = .204). Forty-three percent of patients were treated with TR (29% were self-prescribed and 14% prescribed by a physician) while 48% had medical treatment and 10% were self-treated using medical treatment. More than two-thirds of the cohort had cellulitis and/or osteomyelitis at the time of presentation. The use of traditional treatment was significantly associated with higher WG (WG 4 OR = 1.936, 95% CI: 1.338-2.800; WG 5 OR = 2.937, 95% CI:1.614-5.346; P < 0.05). Moreover, osteomyelitis was associated with medical-traditional treatment (OR = 1.608, 95% CI: 1.006-2.572; P < 0.05) and increased wound depth (WG 3 OR = 1.969, 95% CI: 1.193-3.250; WG 4 OR = 1.874, 95% CI: 1.115-3.15; P < 0.05). There is high use of TR for the treatment of DFU in our cohort. High Wagner-grade of foot ulcers and the presence of osteomyelitis were highly associated with DFU. This study showed for the first time the use of traditional potions by medical physicians. Both physicians and patients need to be made aware of the detrimental effects of using traditional methods on DFU.

The Impact of Frequent Glucose Monitoring on the Prevalence of Complications Among Patients With Diabetes in Saudi Arabia.

BACKGROUND: Diabetes mellitus (DM), including type 1 diabetes (T1D) and type 2 diabetes (T2D), affects the absorption of glucose from the blood. DM has serious complications that can be prevented by adequate knowledge of the disease and its complications, a healthy lifestyle, a modified diet, and regular glucose monitoring. Hence, this study aimed to assess the effects of frequent glucose monitoring on the occurrence of DM complications. METHODS: This cross-sectional study was performed at King Abdulaziz University Hospital between June and December 2022 and included patients with T1D or T2D. After consent, participants who agreed to join filled out an online questionnaire that was used to acquire information, such as demographic data, type of diabetes, blood glucose monitoring, and diabetic complications. RESULTS: A total of 206 diabetic patients participated in this study, with a mean age of 41.2±19.37, with 53.4% having T1D. Most participants monitored their glucose levels (85.4%), and the majority (65.3%) monitored them once or more daily. Patients who monitored their glucose levels more frequently had significantly fewer complications (p = 0.002). Continuous glucose monitoring (CGM) was the best monitoring method, as it demonstrated the lowest rate of complications compared to other methods (p = 0.002). CONCLUSIONS: Frequent glucose monitoring and the use of CGM devices were associated with a decreased number of DM complications. Thus, we recommend that physicians encourage patients to perform CGM as it helps increase the frequency of monitoring.

Predictors of burden perceived by informal caregivers of patients registered in the home health-care unit.

Context: Studies have reported multiple variables that can affect the level of burden on informal caregivers. The need for informal caregivers is expected to increase in the upcoming years. Informal caregivers are an important extension of the formal health-care system. Aims: The aim of this study was to discover the characteristics of informal caregivers of adult patients, to determine the socioeconomic, psychological, and physical consequences facing informal caregivers, and to measure caregivers' burdens and needs. Settings and Design: An analytical cross-sectional study that was carried out in Saudi Arabia, in the home health-care unit of King Abdelaziz University Hospital in the city of Jeddah. Subjects and Methods: A.validated self-administered questionnaire in Arabic and English was used. The required sample size was 122 participants. Ethical approval was obtained. Statistical Analysis Used: Descriptive statistics consisted of means, standard deviations, frequency tables, cross-tabulation, and charts. Categorical variables were compared using the Chi-square test to determine significant relationships between variables. Results: A.total of 124 participants responded to a request to participate in the study. The majority of the caregivers (92) were family members. There was a significant relationship between the nature of the connection between the caregiver and the recipient in association with the burden scale (P = 0.001). No significant relationship was found between caregivers' gender, marital status, or income level and the burden score. Conclusions: Most of the caregivers reported no burden to minimal burden. The relationship with the care recipient has a negative impact on the burden scale.

Résumé Contexte: Des études ont fait état de plusieurs variables qui peuvent influer sur le niveau de charge des aidants naturels. Le besoin d'aidants naturels devrait augmenter dans les années à venir. Les aidants naturels constituent un prolongement important du système formel de soins de santé. Objectifs: Le Le but de cette étude était de découvrir les caractéristiques des aidants proches de patients adultes, de déterminer les effets socio-économiques, psychologiques, et les conséquences physiques auxquelles sont confrontés les aidants naturels, et pour mesurer les fardeaux et les besoins des aidants. Paramètres et conception : une analyse étude transversale qui a été menée en Arabie Saoudite, dans l'unité de soins à domicile de l'Hôpital Universitaire Roi Abdelaziz de la ville de Djeddah. Sujets et méthodes: Un questionnaire auto-administré validé en arabe et en anglais a été utilisé. La taille d'échantillon requise était 122 participants. L'approbation éthique a été obtenue. Analyse statistique utilisée: Les statistiques descriptives se composaient de moyennes, d'écarts types, tableaux de fréquences, tableaux croisés et graphiques. Les variables catégorielles ont été comparées à l'aide du test du chi carré pour déterminer les relations significatives entre variables. Résultats: Au total, 124 participants ont répondu à une demande de participation à l'étude. La majorité des soignants (92) étaient des membres de la famille. Il y avait une relation significative entre la nature du lien entre le soignant et le bénéficiaire dans association avec l'échelle de charge (P = 0,001). Aucune relation significative n'a été trouvée entre le sexe, l'état matrimonial ou le niveau de revenu des aidants. et le score de charge. Conclusions: La plupart des soignants ont signalé un fardeau nul à un fardeau minimal. La relation avec le bénéficiaire des soins a un impact négatif sur l'échelle de la charge. Mots-clés: Fardeau de l'aidant, personnes âgées et bénéficiaires de soins, soins à domicile, aidants proches.

Surgical confidence when operating among residents in surgery - a cross-sectional study (SCAR study).

BACKGROUND: Self-confidence, is one of the critical variables influencing surgical resident's abilities, and lack of confidence maybe a reason for not entering medical practice immediately. Measuring the level of confidence of senior surgical residents (SSRs) is a crucial step in assessing preparedness to practice. In this study, we aim to measure their confidence level and the factors that might contribute to it. METHODS: Cross-sectional survey conducted at King Abdulaziz University Hospital on SSRs in Saudi Arabia (SA). We approached 142 SSRs, 127 responded. Statistical analysis was performed using RStudio v 3.6.2. Descriptive statistics were performed using counts and percentages for categorical variables and using mean ± standard deviation for continuous variables. Multivariate linear regression (t-statistics) was used to assess the factors associated with confidence in performing essential procedures, while the association between demographics and residency-related factor with the number of completed cases was tested using Chi-square. The level of significance was determined as 0.05. RESULTS: Response rate was 89.4%. Among surveyed residents, 66% had completed < 750 cases as a primary surgeon. More than 90% of SSRs were confident in performing appendectomy, open inguinal hernia repair, laparoscopic cholecystectomy, and trauma laparotomy, while 88% were confident in being on-call in level-I trauma center. No difference was noted in confidence level in relation to the number of performed cases. Residents from the Ministry of Health accounted for 56.3% of the study population and showed a higher confidence level compared to others. 94% of SSRs plan to pursue fellowship training program. CONCLUSION: The study showed that the confidence of SSRs in performing common general surgery procedures was as expected. However, it's important to recognize that confidence doesn't necessarily reflect competence. Considering the majority of SSRs planned to pursue fellowship training programs, it may be time to consider changing the structure of surgical training in SA to a modular format to allow earlier and more intensive exposure.

The effect of therapeutic footwear on the recurrence and new formation of foot ulcers in previously affected diabetic patients in Jeddah, Saudi Arabia.

AIM: Diabetic foot ulcers (DFUs), which are a common serious complication of diabetes mellitus, (lifetime occurrence, 19%-34%) account for at least 85% of all lower-limb amputations in diabetic patients. Special footwear (therapeutic footwear) is frequently recommended for such patients to adapt to changes in their foot structure. We aimed to, measure the effect of therapeutic footwear on DFU development and recurrence among previously affected patients in Saudi Arabia. MATERIALS AND METHODS: A cross-sectional study was performed between June and September 2022. The study targeted patients aged ≥18 years previously diagnosed with DFU. Participants were contacted by telephone to complete a questionnaire assessing footwear use and foot care. RESULTS: This study included 115 participants with a mean age of 61.9 ± 11.63; overall, 47% of participants used therapeutic footwear and 46% were adherent with wearing it. The DFU recurrence rate among patients who used therapeutic footwear was 27.8% versus 52.5% among patients who did not (p = 0.013). While using therapeutic footwear, patients with foot deformities reported a lower ulcer healing rate than those who did not (50% vs. 81.8%, p = 0.04). Patients who examined their feet had a lower recurrence rate than those who did not (38.5% vs. 50%, p = 0.43). CONCLUSION: Therapeutic footwear use was significantly associated with decreased DFU recurrence. Further investigation to enhance the evidence for the effectiveness of therapeutic footwear in DFUs is warranted.

Impact of COVID-19 Crisis in the Management of Diabetic Foot Patients in King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

Background The COVID-19 pandemic has a heavy burden on the approach of diabetic foot care worldwide. We aim to determine the impact of the COVID-19 outbreak on patients with diabetic foot (DF). Materials and methods This population-based cohort study included all patients diagnosed with the diabetic foot from 2019-2020 (pre-lockdown) and 2020-2021 (post-lockdown) in a tertiary center of Jeddah, Saudi Arabia. Results Among all the participants (n=358), a non-significant difference was found between amputation rate during and before the COVID-19 pandemic (P-value=0.0983). Also, it showed a significantly higher percentage of patients who had acute lower limb ischemia compared to those having it before the pandemic (P-value=0.029). Conclusions and relevance In conclusion, our study found that the COVID-19 pandemic was not associated with excess amputations along with mortality rate, as the management during the pandemic showed adequate diabetic foot care by improving the prevention methods through hospital protocol restrictions and facilitating access to virtual clinics.

Knowledge of Diabetic Foot Among Nurses at a Tertiary Hospital in Saudi Arabia.

Background: Diabetic foot is the leading cause of hospitalization among patients with diabetes mellitus (DM). Nurses have a significant role in helping diabetic foot patients by educating them about their condition. Therefore, assessing the knowledge of diabetic foot among nurses will help provide better healthcare services to these patients. Objective: This study aimed to assess the knowledge of diabetic foot care among the nursing staff at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia. Methods: This cross-sectional study was conducted at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia, from March to May 2020. A total of 172 nurses from different departments of the hospital were randomly selected. A validated questionnaire including 68 yes-or-no questions about diabetic foot management was used for the assessment. Results: The average total score of the entire questionnaire was 59 (standard deviation, ±7). During our study, the nursing school curriculum was found to be the major source of knowledge for nurses. Statistical significance (p=0.031) was found for the association between educational background and answers to the risk factor questions. According to our results, most nurses indicated that they believed that reporting any changes to the feet and toes and signs of infection to the physician was the best way to prevent the development of DM foot. Conclusion: Specialized training programs beyond basic nursing education will reinforce knowledge and skills, resulting in an expected lower risk of amputation for DM patients.

Post-amputation pain among lower limb amputees in a tertiary care hospital in Jeddah, Saudi Arabia: A retrospective study.

OBJECTIVES: To estimate the prevalence of post- amputation pain among lower-limb amputees and its burden on their lives. METHODS: A retrospective patients record review of lower limb amputation surgeries was carried out at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between 2008-2019. e collected data included: patients demographics, surgical operations, chronic pain characteristics, functional impairment, and treatment. RESULTS: A total of 645 lower-limb amputations carried out on 509 patients, 104 (20.4%) patients had more than one amputation surgery carried out, and 40 (7.9%) patients having bilateral amputations. The estimated prevalence of chronic post-amputation pain among the lower-limb amputees was approximately 61.5%. Persistent postoperative neuropathic pain was the most common type of pain following amputation, followed by residual limb pain, then phantom limb pain. The most common cause of amputation was diabetes and its related complications (76%). The mean age at surgery was 57.46±12.02 years. Although diabetes was a common comorbid illness (95.6%), it had no correlation with the development of chronic post-amputation pain. However, peripheral vascular disease had a strong association (p=0.009), especially with the development of phantom limb pain (54.5%; p=0.016). The most common reason for functional impairment among the amputees was disability (52.7%), while only 6.6% said it was secondary to pain. CONCLUSION: Post-amputation pain is one of the major consequences of amputation. Pain was poorly managed among these patients. Special considerations should be obtained to manage these patients' pain and reduce their suffering.

Pattern and type of amputation and mortality rate associated with diabetic foot in Jeddah, Saudi Arabia: A retrospective Cohort Study.

BACKGROUND: Diabetic foot complications constitute a major public health problem worldwide, especially in Jeddah, Saudi Arabia, where the prevalence of diabetes is high. Our study was designed to determine the pattern and type of amputations performed on patients with diabetic foot admitted to a tertiary center in Jeddah, Saudi Arabia; we also aimed to determine the 7-year mortality rate of patients with diabetic foot at the same institution. MATERIALS AND METHODS: This retrospective study was conducted between January 2013 and September 2020 at a tertiary center in Jeddah, Saudi Arabia. It included all patients previously diagnosed with diabetes mellitus who presented to the hospital with either diabetic foot ulcers or foot gangrene (dry/wet/gas). The medical records of 358 patients were reviewed to acquire information regarding demographics, admission history regarding diabetes and its outcome, medical and surgical history, the level of amputation, and the presence of infection. RESULTS: Among the participants, 84.9% underwent amputation, 38.2% underwent minor amputations, 40.1% underwent major amputations, and 21.7% underwent both types of amputation. The most common cause of amputation was infection (50.3%). There were 75 deaths and a 7-year mortality rate of 20%. Low mean hemoglobin and high mean creatinine levels were significantly associated with mortality (p < 0.05). CONCLUSION: Efforts to decrease the risk of amputation and mortality among patients with diabetic foot complications are required. Early detection of the risk factors and intervention in specialist centers with a multidisciplinary approach is essential.

Truncal necrobiosis lipoidica diabeticorum: A first case report.

INTRODUCTION: Necrobiosis lipoidica (NL) is a known chronic rare granulomatous dermatitis. NL typically occurs in the lower extremity, there have only been previously reported cases of NL on the face, scalp, forearms, and dorsum of the hands. However, truncal NL is not a typical location. PRESENTATION OF CASE: A 67-year-old man known to have diabetes type 2, presented with a 3-year history of painful and itchy skin lesions on the right lateral chest wall. On clinical examination, he had a red discolored patch with superficial capillaries and yellow discoloration at the center. Based on the histological examination, necrobiosis lipoidica was confirmed. Initial treatment with clobetasol propionate, tacrolimus, and topical corticosteroid cream was unsuccessful, and further NL lesions developed on the lower limb. DISCUSSION: NL rash is characterized by its location in the lower limbs and rarely involves fingers, hands, scalp, or face. It is noteworthy that the patient presented with NL skin lesions bon the trunk, which is outside the usual presentation. The prevalence of NL ranges from 0.3% to 1.2% among patients with diabetes mellitus. The treatment of NL is usually difficult. Initial management includes smoking cessation and proper diabetes control. In addition, intralesional and topical corticosteroids might be effective. In this case report, there was no improvement in NL despite the use of topical corticosteroids. CONCLUSION: Immediate diagnosis and treatment of NL may prevent disease progression; therefore, the diagnosis of NL should be considered, even in an unusual location.

Management of a Difficult-to-Treat Diabetic Foot Wound Complicated by Osteomyelitis: A Case Study.

INTRODUCTION: Diabetic ulcers are a major health issue worldwide, causing significant economic burdens and affecting both the patient and the society as a whole. Predisposing factors in diabetic patients, known as the pathogenic triad, comprise trauma, ischemia, and neuropathy. Regardless of the cause, correct diagnosis and prompt treatment are essential in the management of leg ulcers. Case History. We report a case of a 51-year-old male patient, with a known history of type 2 diabetes mellitus who presented to our hospital with a history of two ulcers, one that he was mainly complaining of, which was actively infected and located at the posterior part of the distal left leg, and the second, dry ulcer caused by unrecognized trauma, located on the heel of the same limb. Magnetic resonance imaging showed osteomyelitis and degenerative changes in the calcaneonavicular and tarsal joints. The patient underwent multiple sessions of excisional debridement. He was started on negative pressure wound therapy with some improvements. However, after skin graft failure, Nanoflex powder was used, leading to complete wound closure within one month of treatment. CONCLUSION: A multidisciplinary holistic approach must be used when treating diabetic foot ulcers. Different modalities and sessions of debridement should be performed after optimizing the general condition of the patient.

Knowledge of diabetic foot care management among medical students at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

OBJECTIVES: To evaluate medical students' knowledge of diabetic foot care management and its related factors. METHODS: This was a cross-sectional, descriptive study of 303 students studying at King Abdulaziz University Hospital, Jeddah, Saudi Arabia conducted from June to July 2019. Data were collected using a two-part questionnaire. The first one captured student information; the second assessed student knowledge. It consists of 68 true and false questions divided into 4 subscales (risk factors, foot examination, foot complications and footwear selection). The higher the total score is, the higher the students' knowledge. RESULTS: The total average knowledge score was 55.5±5.5 out of 68. While the mean score was 14.11/16 for risk factors, 9.24/10 for foot examination, 24.21/32 for foot complications, and 7.88/10 for footwear selection subscales. Only 56.4% of students educated diabetic patients about diabetic foot risks;concurrently, only 63% performed foot examinations in diabetes patients. Students who educated diabetic patients, preformed foot exam, or attended extra elective clinical rotation in a diabetic foot team, had a significantly higher knowledge level. Conclusion: Students were found to have high level of knowledge regarding diabetic foot management. Students who educated patients about diabetic foot risk, performed foot examination on patients and students who took elective rotations in a diabetic foot care team had a higher knowledge level.

Biofilm en el pie diabético: un reto añadido / Biofilm in the diabetic foot: an added challenge

En el presente artículo se revisa el papel del biofilm en la progresión de la úlcera de pie diabético con presencia de biofilm. Se revisan los conceptos recientes sobre la fisiopatología del biofilm bacteriano y de la aparición del concepto "grupos de patógenos funcionalmente equivalentes", así como de las colonizaciones fúngicas presentes en la herida de pie diabético. La detección clínica del biofilm continúa siendo dificultosa a la cabecera del paciente y se destaca especialmente la importancia del desbridamiento y el uso de antimicrobianos tópicos apropiados según el documento de consenso actual sobre manejo del biofilm en el pie diabético

In this article it is reviewed the role of biofilm in the progression of diabetic foot ulcer with biofilm. Recent concepts on the pathophysiology of the bacterial biofilm and the new concept of "groups of functionally equivalent pathogens" as well as the fungal colonizations present in the diabetic foot wound are reviewed. The clinical detection of the biofilm continues to be difficult at the patient's bedside and the importance of debridement. The use of appropriate topical antimicrobials according to the current consensus document on biofilm management in the diabetic foot is especially highlighted