Background Diabetic foot ulcer (DFU) is one of the most serious complications of diabetes mellitus with devastating outcomes. Poorly treated DFU leads to osteomyelitis, gangrene and limb amputation. There is an increased risk of mortality for the amputees and increased number of bacterial resistance in survived patients. Struggle on choice of the best antibiotic(s) for DFU is escalating. Objectives To determine risk factors associated with mortality in patients with DFU. To investigate bacterial drug resistance in survived or deceased patients around amputation. Methodology This is a retrospective cohort study that involved all diabetic patients who had DFU or minor or major amputation at Hebron Governmental Hospital from 2013 to 2020. Antibiotic use and bacterial isolates along with culture and sensitivity test results were retrieved from patients' profiles and laboratory records. Major outcome of study was survival rate around amputation. Patients who missed test results for FBS or HbAc1, or who had no wound culture were excluded. SPSS version 22 was used to analyze data. Results Eighty four subjects were included in this study, 64.8 ± 12.58 years old, 63.1% males who had diabetic foot ulcer, minor or major limb amputation between 2013 and 2020 at Hebron Governmental Hospital. Forty tow patients (50%) had diabetic foot ulcer, 28 patients (33.3%) had major limb amputation, and 14 patients (16.7%), succumbed to minor amputation. Average FBS was 292.8 ± 136.33 mg/dl and average HbA1C was 8.55 ± 1.89%. Mortality rate was 9.5%. Using the Chi square test, we found a significant relationship between mortality and type of isolated bacteria, p = 0.033 and between diabetic complications (nephropathy) and mortality, p = 0.033. There was a significant relationship between antibiotic use and mortality, p = 0.04, especially with metronidazole and colistin, if they were used around limb amputation. Conclusions Mortality of diabetic patients with DFU was associated with nephropathy and Acinetobacter or E. coli infections.
Background: At the junction between obesity, metabolic syndrome and liver failure, lies Non-alcoholic fatty liver disease. Recent studies elaborated on role of metformin in patients with non-alcoholic fatty liver disease. This observation has not been studied at a global scale, neither it was investigated in different ethnical groups. Objectives: We aim at determining the risk factors associated with prognosis of non-alcoholic fatty liver disease among a cohort of patients in Southern West Bank, Palestine. Methods: A retrospective cohort study involving 300 NAFLD patients who visited the internal medicine department at Hebron Governmental Hospital from October 2017 till September 2018. Two hundred and three patients diagnosed with non-alcoholic fatty liver disease, were included in this study. Lab test results within the past 6 months, comorbidity and medication history were collected from patients` profiles. Data was analyzed using SPSS V20. Liver Fibrosis score was determined by using non-alcoholic fatty liver disease fibrosis score calculator. Results: Two hundred and three non-alcoholic fatty liver disease patients (58.6% females), 54.78 (±12.27) years old were included in the study. Almost 65.5% of these patients have BMI >30 Kg/m2. It was found that, 62.25% of the 58 diabetic patients in this study had liver fibrosis score > 0.676 comparing to non-alcoholic fatty liver disease patients who are non-diabetic. There was a significant relationship between diabetes and fibrosis score, α=0.000. There was also a significant relationship between hyperlipidemia and fibrosis score of non-alcoholic fatty liver disease patients, α=0.023. We found a significant relationship between fibrosis score and hypertension, α=0.000. In the same context, there was a significant relationship between NAFLD patients who were on statin therapy and those who were not using statin therapy, α= 0.015. Metformin was not associated with significant relationship between users and non-users non-alcoholic fatty liver disease subjects. Conclusion: Diabetes mellitus, hypertension, hyperlipidemia and statin use were associated with NAFLD prognosis.
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