Self-directed treatment for lower limb wounds in persons with diabetes: a short report

Patrick Harnarayan, Shamir O Cawich, Shariful Islam, Shivaa Ramsewak, Vijay Naraynsingh Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago Aim: There has been little focus on self-directed treatment for lower limb wounds, although it a common practice among persons with diabetes across the Caribbean. We sought to document this practice in a Caribbean nation. Methods: We prospectively interviewed all consecutive patients with diabetes who were admitted with lower limb wounds at the San Fernando General Hospital in Trinidad and Tobago over a period of 18 months. A questionnaire was used to collect data on patient demographics, use of self-directed treatment, and details of these treatments.Results: Of 839 persons with diabetes who were admitted with infected lower limb wounds, 344 (41%) admitted to self-directed treatment before seeking medical attention. These patients were predominantly male (59.9%) at a mean age of 56.4±12.4 years. The practice was most common in persons of Afro-Caribbean descent (45.9%) and those with type 2 diabetes (93.9%). In this group, 255 (74.4%) patients were previously admitted to hospital for lower limb infections. And of those, 32 (12.6%) had a prior amputation and 108 (42.4%) had at least one operative debridement specifically for foot infections.Conclusion: Caribbean cultural practices may be an important contributor to negative outcomes when treating lower limb wounds in persons with diabetes. Despite being acutely aware of the potentially devastating consequences of inadequate treatment, 41% of our patients with diabetes still opted to use self-directed treatment for lower limb wounds. This deserves further study in order to give a more tailored approach in care delivery. Keywords: diabetes, foot infection, alternative, home, remedy, amputatio

Adverse events in diabetic foot infections: a case control study comparing early versus delayed medical treatment after home remedies

Shamir O Cawich, Patrick Harnarayan, Shariful Islam, Steve Budhooram, Shivaa Ramsewak, Vijay Naraynsingh Department of Clinical Surgical Sciences, University of the West Indies, St Augustine Campus, Trinidad and Tobago, West Indies Background: The aim of conventional medical therapy in diabetic foot infections is to control infection, thereby reducing amputation rates, infectious morbidity, and death. Any delay incurred during a trial of home remedies could allow an infection to progress unchecked, increasing the risk of these adverse outcomes. This study sought to determine the effects of delayed operative interventions and amputations in these patients. Methods: A questionnaire study targeting all consecutive patients admitted with diabetic foot infection was carried out over 1 year. Two groups were defined, ie, a medical therapy group comprising patients who sought medical attention after detecting their infection and a home remedy group comprising those who voluntarily chose to delay medical therapy in favor of home remedies. The patients were followed throughout their hospital admissions. We recorded the duration of hospitalization and number of operative debridements and amputations performed. Results: There were 695 patients with diabetic foot infections, comprising 382 in the medical therapy group and 313 in the home remedy group. Many were previously hospitalized for foot infections in the medical therapy (78%) and home remedy (74.8%) groups. The trial of home remedies lasted for a mean duration of 8.9 days. The home remedy group had a longer duration of hospitalization (16.3 versus 8.5 days; P<0.001), more operative debridements (99.7% versus 94.5%; P<0.001), and more debridements per patient (2.85 versus 2.45; P<0.001). Additionally, in the home remedy group, there was an estimated increase in expenditure of US $10,821.72 US per patient and a trend toward more major amputations (9.3% versus 5.2%; P=0.073). Conclusion: There are negative outcomes when patients delay conventional medical therapy in favour of home remedies to treat diabetic foot infections. These treatments need not be mutually exclusive. We encourage persons with diabetes who wish to try home remedies to seek medical advice in addition as a part of holistic care. Keywords: diabetic foot infections, adverse events, medical treatment, home remedie

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Microbe-Mediated Biotic and Abiotic Stress Tolerance in Crop PlantsFluctuating global climate has increasing influence on the occurrence of biotic and abiotic stresses in agriculture resulting in reduced productivity. The scenario has been estimated to be intensified owing to the increased drought, soil and water salinity, and shortage of water resources. Biotic stress was also encountered in terms of outbreaks of various pathogens. Diseases caused by pathogens are the foremost factor affecting agricultural produce. Copious mechanisms are implemented by plant to tolerate the stressor(s). Key strategies were designed for developing biotic and abiotic stress-tolerant crop varieties, cultivation techniques, and microbial inoculant and products to enhance the tolerance of plants toward biotic and abiotic stresses. In this literature, we focus on the response of plants toward biotic-abiotic stress, plant-beneficial microbes, and microbe-mediated tolerance in crop plants.Not Availabl

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Application of Microbial Products for Enhancing the Nutritional QualityFrequently, altering environmental conditions threaten the agricultural productivity and nutritional quality of the produce. Nutritional requirements of human beings are totally dependent on agriculture. Pressure of increasing population on limited agricultural land to produce nutritionally improved agricultural produce is major concern. Copious strategies were suggested to enhance the nutrient quality of agriculture after the harvesting, but very few strategies were developed and applied in situ. The part of PGPR, AMF, and other endophytic microorganisms in enhancing agricultural productivity is well known. Our current knowledge regarding mechanism of microorganisms in enhancing nutrient quality is still in infancy. This chapter characteristically highlights the involvement of microbes in nutritional enhancement of crops produced and focuses on the probable strategies for nutritional improvement in agricultural produce.Not Availabl