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Injuries to the axillary artery from proximal humeral fractures are uncommon. There are only 66 such injuries reported across the world literature to date. We report an additional case of axillary artery injury. This case highlights the importance of maintaining a high index of suspicion to prevent diagnostic delay.
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INTRODUCTION: Brachial artery injuries from elbow dislocations are uncommon, but they may lead to disastrous consequences if the diagnosis is delayed. PRESENTATION OF CASE: We report a case of a patient who sustained a fall onto the elbow, with dislocation and brachial artery injury, despite an ipsilateral radial pulse being palpable. DISCUSSION: Clinicians should maintain a high index of suspicion for brachial injury when patients present with a fall onto the elbow coupled with signs suggestive of fracture-dislocation, nerve injury and/or signs of limb ischemia. Frank ischamia, however, is uncommon as there is a rich collateral anastomosis in the upper limb. CONCLUSION: A high index of suspicion should be maintained in order to make the diagnosis early. Exploration with excision of the injured segment and reverse vein interposition grafting is the treatment of choice in these cases.
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UNLABELLED: : Wonder of Life (kalanchoe pinnata) leaves are commonly used to treat diabetic foot infections. These patients are usually non-compliant with conventional medical therapy. We surmised that these patients would have a higher incidence of treatment failures. Patients admitted with diabetic foot infections were separated into two groups: a Study Group comprised patients who used topical kalanchoe pinnata and a Medical Therapy Group contained patients who were compliant with conventional treatment. The patients were observed over the course of their hospitalisation. RESULTS: There were 382 patients in the Medical Therapy Group and 96 in the Study Group, who waited 9.21 ± 5.3 days (Mean ± SD) before seeking medical attention. There were similar rates of all amputations (34.8% vs. 37.5%; P = 0.643) and mortality (0.8% vs. 1.0%; P = 1.000) in the Study and Medical Therapy groups. CONCLUSIONS: There may be value in the use of topical kalanchoe pinnata to treat diabetic foot infections.
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Pé Diabético/tratamento farmacológico , Kalanchoe , Fitoterapia , Pé Diabético/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/estatística & dados numéricos , Folhas de Planta , Trinidad e Tobago/epidemiologiaRESUMO
CONTEXT: Foot infection is the most common complication of diabetes mellitus in the Caribbean. Diabetic foot infections place a heavy burden on health care resources in the Caribbean. OBJECTIVE: To evaluate the treatment-related costs for diabetic foot infections in a Caribbean nation. METHODS: We identified all patients with diabetic foot infections in a 730-bed hospital serving a catchment population of approximately 400,000 persons from June 1, 2011 through July 31, 2012. The following data were collected: details of infection, antibiotic usage, investigations performed, number of physician consultations, details of operative treatment, and duration of hospitalization. Total charges were tallied to determine the final cost for inhospital treatment of diabetic foot infections. RESULTS: There were 446 patients hospitalized with diabetic foot infections, yielding approximately 0.75% annual risk for patients with diabetes to develop foot infections. The mean duration of hospitalization was 22.5 days. Sixteen patients (3.6%) were treated conservatively without an operative procedure and 430 (96.4%) required some form of operative intervention. There were 885 debridements, 193 minor amputations and 60 major amputations, 7102 wound dressings, 2763 wound cultures, and 27,015 glucometer measurements. When the hospital charges were tallied, a total of US $13,922,178 (mean, US $31,216) were spent to treat diabetic foot infections in these 446 patients during 1 year at this hospital. CONCLUSIONS: Each year, the government of Trinidad and Tobago spends US $85 million, or 0.4% of their gross domestic product, solely to treat patients hospitalized for diabetic foot infections. With this level of national expenditure and the anticipated increase in the prevalence of diabetes, it is necessary to revive the call for investment in preventive public health strategies.
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Pé Diabético/economia , Doenças do Pé/economia , Custos Hospitalares/estatística & dados numéricos , Hospitalização/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/complicações , Pé Diabético/sangue , Pé Diabético/terapia , Feminino , Doenças do Pé/terapia , Hemoglobinas Glicadas/análise , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Trinidad e Tobago , Adulto JovemRESUMO
AIMS: To examine the microbiologic profile of diabetic foot infections in order to guide empiric antibiotic choices. METHODS: All patients with moderate-severe diabetic foot infections at a tertiary care facility were identified from July 2011 to June 2012. Culture samples were routinely collected before empiric antibiotics were commenced. Retrospective chart review was performed to extract the following data: demographics, clinical details, empiric antibiotic choice and microbiologic data. Descriptive analyses were performed using SPSS 12.0. RESULTS: There were 139 patients at a mean age of 56.9 ± 12.4 years. Mixed poly-microbial infections were present in 56.8% of cases. Of 221 organisms isolated, 64.7% were gram-negative aerobes, 32.1% were gram-positive aerobes and 3.2% were obligate anaerobes. Multidrug resistant organisms were encountered in 25.9% of cases and included ESBL producers (11.3%), MRSA (4.5%) and VRE (1.4%). Both ciprofloxacin and ceftazidime had good overall anti-microbial activity against gram-negative (68% and 62%, respectively) and gram-positive pathogens (69% and 48%, respectively). Obligate anaerobes were uncommonly isolated due to institutional constraints. CONCLUSION: In this environment, both ciprofloxacin and ceftazidime provide good broad-spectrum anti-microbial activity against the commonly isolated pathogens. Either agent can be used as single agent empiric therapy in patients with moderate/severe diabetic infections in our setting. Although institutional limitations precluded isolation of anaerobes in most cases, there is sufficient evidence for anti-anaerobic agents to be recommended as a part of empiric therapy.
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Pé Diabético/microbiologia , Infecção dos Ferimentos/microbiologia , Adulto , Idoso , Antibacterianos/uso terapêutico , Ceftazidima/uso terapêutico , Ciprofloxacina/uso terapêutico , Pé Diabético/diagnóstico , Pé Diabético/tratamento farmacológico , Pé Diabético/epidemiologia , Farmacorresistência Bacteriana Múltipla , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Centros de Atenção Terciária , Trinidad e Tobago/epidemiologia , Infecção dos Ferimentos/diagnóstico , Infecção dos Ferimentos/tratamento farmacológico , Infecção dos Ferimentos/epidemiologiaRESUMO
INTRODUCTION: This study evaluates the epidemiology of diabetic foot infections in an Eastern Caribbean nation in order to direct public health preventive measures. METHODS: We prospectively identified all patients with diabetic foot infections who were admitted to tertiary care hospitals across Trinidad and Tobago from July 2011 to June 2012. A questionnaire was used to collect data on demographics, patient knowledge, avoidance of risk factors for chronic diseases (a proxy to unhealthy lifestyles), and glycosylated hemoglobin measurements on admission as an index of blood glucose control. The data were analyzed with statistical software. RESULTS: There were 446 patients with diabetic foot infections (mean age = 56.9 years, standard deviation = 12.4 years). Most patients had Type 2 diabetes (93.3%) and were of Indo-Trinidadian (49.1%) or Afro-Trinidadian (41.7%) descent. There were preexisting complications of diabetes in 82.9% of patients with Type 2 diabetes: foot infections requiring hospitalization (70.2%), ischemic heart disease (32.5%), renal impairment (13.7%), and retinopathy (22.1%). Despite most patients claiming compliance with treatment, 75% had glycosylated hemoglobin levels above 7.1% at presentation, and 49.3% continued unhealthy lifestyles. Despite the high prevalence of diabetic complications at admission, and despite 70% having had previous hospitalization for treatment of foot infections, only 57.4% of patients reported ever being counseled or taught about foot care by medical personnel. CONCLUSIONS: There is room for improvement in public health strategies to prevent diabetic foot complications in this setting. Such strategies should focus on patient education with emphasis on lifestyle modification and compliance with medical therapy.
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Pé Diabético/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Pé Diabético/complicações , Feminino , Hemoglobinas Glicadas/análise , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Distribuição por Sexo , Dermatopatias Infecciosas/complicações , Inquéritos e Questionários , Centros de Atenção Terciária/estatística & dados numéricos , Trinidad e Tobago/epidemiologia , Adulto JovemRESUMO
We wish to present and highlight the feasibility of an endovascular approach under local anaesthesia for acute rupture of abdominal aortic aneurysm with circulatory collapse and ongoing haemorrhage requiring emergency intervention.