Introduction: Diabetic foot ulcers are important diabetes-related microvascular complications aggravated due to multiple pre-existing factors such as peripheral arterial disease, immune system factors, bone abnormalities, diabetic neuropathy, infections and repetitive external or minor trauma. Diabetic foot ulcers could lead to lower limb amputation if not managed appropriately. Aim: To evaluate the use of topical insulin in chronic diabetic foot ulcers at a tertiary care centre. Materials and Methods: This prospective analytical study of 12 months duration was conducted in Department of Surgery, in diabetic patients between the age group of 25 to 70 years, presenting for the first time with diabetic foot ulcer. A total of 60 patients were divided into two groups alternately as group A patients underwent dressing with topical insulin and group B patients underwent dressing with regular normal saline. Sterile transparent gauze was placed on the wound to mark the wound borders and the wound area measured. With the help of ruler the two largest perpendicular diameters were measured and these were multiplied to obtain the wound area in cm2. Ulcers were cleaned with normal saline and a sterile gauze soaked with Human mixtard insulin and normal saline. Four units of 0.1 mL-Human mixtard insulin with 1 mL normal saline used for each 10 cm2 of wound in group A. Data was analysed by using SPSS software. Chi-square test was used and p-value of <0.05 was considered as significant. Results: Mean age distribution was 51.2±9.6 years and 50.6±10.9 years in group A and B, respectively. Mean HbA1c at admission was 6.3±0.9 and 6.1±0.8 in group A and B, respectively. On day 0,7,15 wound measurements were done. A statistically significant difference was noted in reduction of average surface area of wound at day 7, 15 between group A and B. Insulin dressing group showed better changes than saline dressing group. Percentage reduction of surface area of wound at day 15 was 67.8±11.45 in insulin dressing group and 49.51±18.21 in saline dressing group, statistically significant difference was noted. Average time required for granulation tissue to appear was 6.08±2.15 days and 9.48±4.21 days in group A and B, respectively, statistically significant difference was noted (p<0.001). Conclusion: The application of topical insulin is secure and successful in patients with diabetic foot ulcers. Topically applied insulin can increase speed of wound healing and there are no chances of systemic side effects.
Background: Anastomotic leak is a major complication often leading to significant morbidity and mortality. A method to predict leaks in the early postoperative period will help in better management and outcome. Though serum biomarkers like C-reactive protein and procalcitonin levels are often used to predict chances of developing complications, they are nonspecific and suggest mainly ongoing sepsis in general. Detection and assessment of the presence of these biomarkers at the local milieu is an alternate non-invasive option as they are produced at the injury site and increase in anastomotic leaks. If measured serially, can guide to a strong suspicion of a leak before the clinical signs are evident. Methods: Forty-eight patients who underwent intestinal anastomosis for various indications were included. Serial measurement of drain fluid C-reactive protein and procalcitonin were measured on postoperative days 3, 5 and 7.Results: 7 patients developed leaks with two deaths. CRP and procalcitonin levels were higher on all days in comparison with the no leak group. CRP had the highest sensitivity on day 5 with 85.71% and 97.56% specificity on day7. The sensitivity and specificity of procalcitonin were 71.43% and 97.56% on day 5 and day 7. Accuracy was 93.7% for CRP and 87.5% for procalcitonin on the seventh day.Conclusions: Serial analysis of drain fluid CRP and procalcitonin showed persistently increased levels in patients with an anastomotic leak. Correlation of the levels in patients with anastomotic leak suggests the possibility of their utility in the early detection of leaks.
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