Economic impact of diabetic foot ulcers on healthcare in Saudi Arabia: a retrospective study.

BACKGROUND: Diabetic foot ulcers (DFU) are a critical complication of diabetes mellitus (DM) affecting life quality and significantly impacting healthcare resources. OBJECTIVE: Determine the direct medical costs associated with treating DFU in King Fahad Hospital of the University and identify factors that could assist in developing resource management guidelines in Saudi Arabia. DESIGN: Retrospective study. SETTING: SETTING: King Fahad Hospital of the University, Al-Khobar, Saudi Arabia. PATIENTS AND METHODS: The study included diabetic patients admitted with foot ulcerations between 2007 and 2017 inclusive. We determined management costs including drug usage, wound dressings, surgical procedures, admissions, and basic investigation. MAIN OUTCOME MEASURES: Factors affecting the direct perspective medical costs of managing DFU. SAMPLE SIZE: 99 patients. RESULTS: The overall cost of managing 99 patients with DFU was 6 618 043.3 SAR ($1 764 632.68 USD), which further translates to approximately 6684.9 SAR per patient/year ($1782.6 USD). The highest cost incurred was for admission expenditure (45.6%), followed by debridement (14.5%) and intensive care unit (ICU) admission (10.4%). CONCLUSION: The overall healthcare expenditure in treating DFU is high, with hospital admissions and surgical procedures adding a significant increase to the total cost. Focused patient education on overall glycemic control and prevention of DFU may decrease complications and hence, the overall cost. LIMITATIONS: Identified only the direct medical costs of DFU as the indirect costs were subjective and more difficult to quantify. CONFLICT OF INTEREST: None.

The ugly face of deep vein thrombosis: Phlegmasia Cerulea Dolens-Case report.

INTRODUCTION: Phlegmasia Cerulea Dolens (PCD), a rare & life-threatening condition caused by a massive deep venous thrombosis that is associated with arterial occlusion caused by the subsequent compartment syndrome. CASE PRESENTATION: A 56-year-old male was diagnosed as a case of extensive left femoral DVT & pulmonary embolism. Two days after being managed by systemic thrombolytics & heparin, his condition worsened as he developed cyanosis of the affected limb, compartment syndrome & foot drop so he was referred to our facility for further management. CT venogram showed a thrombosis of the left popliteal vein extending into the left common iliac vein confirming the diagnosis of PCD & May-Turner syndrome. We adopted a limb preserving approach using a pharmacomechanical catheter directed thrombolysis (PCDT). The patient recovered fully with a complete resolution of his foot drop. DISCUSSION: Several treatment options have been suggested to improve the outcomes of PCD, but due to the rarity of this condition a gold standard treatment is still controversial. But regardless of the chosen approach, there is an urgent need to decrease the thrombus burden to prevent further adverse sequelae like amputation or even death which can be achieved by using PCDT as it was demonstrated in our case. CONCLUSION: Our case shows that a rare entity of DVT as PCD could be a result of improper management of acute proximal DVT in the background of anatomical variabilities & that despite the late presentation of such a rare condition there still a role for a limb preserving approach with endovascular techniques.

Extensive vascular occlusions as initial presentations of systemic lupus erythematosis. A case report and review of literature.

Widespread arterial and venous thrombosis is a very rare initial presentation of systemic lupus erythematosus (SLE). We report a case with extensive vascular occlusion as the initial manifestation of SLE. Although these cases have high morbidity and mortality, yet our patient recovered with minimal complications.

Intravenous lornoxicam is more effective than paracetamol as a supplemental analgesic after lower abdominal surgery: a randomized controlled trial.

BACKGROUND: The aim of this prospective, randomized, double-blind study was to determine the more effective supplemental analgesic, paracetamol or lornoxicam, for postoperative pain relief after lower abdominal surgery. METHODS: Sixty patients scheduled for lower abdominal surgery under general anesthesia were randomly allocated to receive either isotonic saline (control group), intravenous paracetamol 1 g every 6 h (paracetamol group), or lornoxicam 16 mg then 8 mg after 12 h (lornoxicam group). Additionally pain was treated postoperatively with morphine patient-controlled analgesia. Postoperative pain scores measured by the verbal pain score (VPS), morphine consumption, and the incidence of side effects were measured at 1, 2, 4, 8, 12, and 24 h postoperatively. RESULTS: Morphine consumption at 12 and 24 h was significantly lower in the lornoxicam group (19.25 ± 5.7 mg and 23.1 ± 6.5 mg) than in the paracetamol group (23.4 ± 6.6 mg and 28.6 ± 7.6 mg). Both treatment groups had less morphine consumption than the control group (28.5 ± 5 mg and 38.1 ± 6.6 mg) at 12 and 24 h, respectively. Additionally, VPS was reduced in the paracetamol and the lornoxicam groups compared with the control group both at rest and on coughing. Further analysis revealed that VPS in the lornoxicam group was significantly lower than that in the paracetamol group only during coughing. Drug-related side effects were comparable in all groups. CONCLUSIONS: Lornoxicam is superior to paracetamol for postoperative analgesia after lower abdominal surgery. However, paracetamol could be an alternative supplemental analgesic whenever an NSAID is unsuitable. TRIAL REGISTRATION: clinicaltrials.gov.identifier:NCT01564680.