The Effect of Phyllanthus Amarus Aqueous Extract on Blood Glucose in Non-Insulin Dependent Diabetic Patients

The glycaemic response to 124.5 ± 9.3 (mean ± SD) g of pancakes was monitored in 21 non-insulin dependent diabetic (NIDDM) patients while on oral hypoglycaemics, after a one week washout period and after a one week twice daily treatment with 100 ml of an aqueous extract from 12.5 g of powdered aerial parts of Phyllanthus amarus. After the one week washout period, fasting blood glucose (FBG) and postprandial blood glucose increased significantly compared to when on oral hypoglycaemics (P ≤ 0.05). After one week herbal treatment no hypoglycaemic activity was observed. Both FBG and postprandial blood glucose remained very similar to that recorded after the washout period (P > 0.05). Both liver and renal functions based on alanine transaminase (ALAT) and serum creatinine, respectively, were not significantly affected by the use of the extract. Although lymphocyte and monocyte levels were significantly decreased (P ≤ 0.05) and granulocyte level was significantly increased after treatment (P ≤ 0.05) overall total white blood cell (WBC) count and haemoglobin (Hb) were not significantly affected by the one week herbal treatment. We conclude that one week treatment with the aqueous extract of Phyllanthus amarus was incapable of lowering both FBG and postprandial blood glucose in untreated NIDDM patients

Surgical management of Diabetic foot ulcers: A Tanzanian university teaching hospital experience

\ud \ud Diabetic foot ulcers (DFUs) pose a therapeutic challenge to surgeons, especially in developing countries where health care resources are limited and the vast majority of patients present to health facilities late with advanced foot ulcers. A prospective descriptive study was done at Bugando Medical Centre from February 2008 to January 2010 to describe our experience in the surgical management of DFUs in our local environment and compare with what is known in the literature. Of the total 4238 diabetic patients seen at BMC during the period under study, 136 (3.2%) patients had DFUs. Males outnumbered females by the ratio of 1.2:1. Their mean age was 54.32 years (ranged 21-72years). Thirty-eight (27.9%) patients were newly diagnosed diabetic patients. The majority of patients (95.5%) had type 2 diabetes mellitus. The mean duration of diabetes was 8.2 years while the duration of DFUs was 18.34 weeks. Fourteen (10.3%) patients had previous history of foot ulcers and six (4.4%) patients had previous amputations. The forefoot was commonly affected in 60.3% of cases. Neuropathic ulcers were the most common type of DFUs in 57.4% of cases. Wagner's stage 4 and 5 ulcers were the most prevalent at 29.4% and 23.5% respectively. The majority of patients (72.1%) were treated surgically. Lower limb amputation was the most common surgical procedure performed in 56.7% of cases. The complication rate was (33.5%) and surgical site infection was the most common complication (18.8%). Bacterial profile revealed polymicrobial pattern and Staphylococcus aureus was the most frequent microorganism isolated. All the microorganisms isolated showed high resistance to commonly used antibiotics except for Meropenem and imipenem, which were 100% sensitive each respectively. The mean hospital stay was 36.24 ± 12.62 days (ranged 18-128 days). Mortality rate was 13.2%. Diabetic foot ulceration constitutes a major source of morbidity and mortality among patients with diabetes mellitus at Bugando Medical Centre and is the leading cause of non-traumatic lower limb amputation. A multidisciplinary team approach targeting at good glycaemic control, education on foot care and appropriate footware, control of infection and early surgical intervention is required in order to reduce the morbidity and mortality associated with DFUs. Due to polymicrobial infection and antibiotic resistance, surgical intervention must be concerned

Managing the diabetic foot in resource-poor settings: challenges and solutions

Zulfiqarali G Abbas1,2 1Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania; 2Department of Internal Medicine, Abbas Medical Centre, Dar es Salaam, Tanzania Abstract: Diabetes mellitus is one of the most common noncommunicable diseases globally. In Africa, rates of diabetes are increasing, so there is a parallel increase of foot complications. Peripheral neuropathy is the main risk factor for foot ulceration in people with diabetes in developing nations, but peripheral arterial disease is also increasing in number owing to the change in lifestyle and increasing urbanization. Ulceration arising from peripheral neuropathy, peripheral arterial disease, and trauma are highly susceptible to secondary infection and gangrene, and are hence associated with increased morbidity and mortality. Government funding is very limited in many developing countries, and diabetes and its complications impose a heavy burden on health services. In particular, the outcomes of foot complications are often poor, and this is the result of various factors including lack of awareness of the need for foot care among patients, relatives, and health care providers; relatively few professionals with an interest in the diabetic foot and with the training to provide specialist treatment; nonexistent podiatry services; long distances for patients to travel to the clinic; delays among patients in seeking medical care, or the late referral of patients for specialist opinion; and lack of the awareness of the importance of a team approach to care, and the lack of training programs for health care professionals. Many of these can, however, potentially be tackled without exorbitant spending of financial resources. Cost-effective educational efforts should be targeted at both health care workers and patients. These include implementation of sustainable training programs for health care professionals with a special interest in foot care and focusing to disseminate the foot care information, on the prevention and management of the diabetic foot, to other health care professionals and to patients. The Step by Step foot program is an educational program that was first carried out in Tanzania and India. In conclusion, the only way to move forward in developing countries is educational programs on prevention and management of the diabetic foot. An interdisciplinary team approach is needed, and not multidisciplinary, for the management of the diabetic foot. Patients presenting early at a less severe stage will definitely lead to reduction in morbidity and death rates. Keywords: Africa, diabetic foot, peripheral neuropathy, peripheral arterial disease, amputation, diabetic foot ulcers, Step by Step foot projec