Culture of per-wound bone specimens: a simplified approach for the medical management of diabetic foot osteomyelitis

AbstractSurgical percutaneous bone biopsy specimen after a 14-day antibiotic-free period represents the gold standard of care for diabetic foot osteomyelitis but may be difficult to implement in many institutions. We evaluate a simplified strategy based on the results of per-wound bone specimen culture. For that purpose, we retrospectively reviewed the charts of 80 consecutive patients with diabetic osteomyelitis and bone sample obtained via the wound after a careful debridement. The outcome was defined as favourable if there was a complete healing of the wound with no sign of infection and stable or improved bone X-ray 6 months after antibiotic therapy completion. Culture of bone specimens was positive in 96% of patients, although half of the patients did receive a course of antimicrobials within 14 days of the bone specimen being obtained. A total of 129 bacterial isolates were obtained from bone cultures with a mean of 1.6 ± 1 isolates per patient (Staphylococcus aureus: 33%; coagulase-negative staphylococci: 14%; streptococci: 9%; enterococci: 12%; corynebacteria: 4%; Gram-negative bacilli: 20%; anaerobes: 4%). Forty-six percent of cultures were monomicrobial. The mean duration of follow-up from diagnosis was 17 ± 1 months. Six months after discontinuation of antibiotics, six patients (7.5%) had died, nine were considered as therapeutic failures and 65 were considered as cured. Fifty-four of these 65 patients had follow-up data available at 1 year and remained in remission. In conclusion, a simplified procedure based on the culture of bone sample obtained via the ulcer after a careful debridement of the wound is effective in the medical management of diabetic foot osteomyelitis

Sterilization of hydrogen peroxide resistant bacterial spores with stabilized chlorine dioxide

Bacillus pumilus SAFR-032 spores isolated from a clean room environment are known to exhibit enhanced resistance to peroxide, desiccation, UV radiation and chemical disinfection than other spore-forming bacteria. The survival of B. pumilus SAFR-032 spores to standard clean room sterilization practices requires development of more stringent disinfection agents. Here, we report the effects of a stabilized chlorine dioxide-based biocidal agent against spores of B. pumilus SAFR-032 and Bacillus subtilis ATCC 6051. Viability was determined via CFU measurement after exposure. Chlorine dioxide demonstrated efficacy towards sterilization of spores of B. pumilus SAFR-032 equivalent or better than exposure to hydrogen peroxide. These results indicate efficacy of chlorine dioxide delivered through a stabilized chlorine dioxide product as a means of sterilization of peroxide- and UV-resistant spores.This work is supported by the National Institutes of Health (1R01GM090064-01), a NASA EPSCoR Research Infrastructure Development (RID) grant NN07AL49A, and the University of Oklahoma.Ye

Traitement du diabète.

International audienc

Leucine kinetics and fibrinogen synthesis are increased after vaccination

International audienc

Leucine kinetics and fibrinogen synthesis are increased after vaccination

International audienc

A brief psychological intervention to improve adherence in type 2 diabetes

International audienceOBJECTIVE:Diabetes perceptions, acceptance and treatment motivation are changeable factors of adherence. This study aimed to test the effects of brief psychological interventions based on diabetes threat and mastery perceptions in terms of adherence, acceptance and motivation. Physicians may find such interventions useful during a 15-minute consultation with diabetes patients.RESEARCH DESIGN AND METHODS:This randomized controlled study included 80 patients with type 2 diabetes, recruited from the hospital diabetes department, who were randomly assigned to four intervention groups based on autobiographical recall. Those in the two intervention groups were asked to recall diabetic events based on mastery and threat perceptions, respectively, whereas those in the two control groups recalled non-diabetic events based on positive and negative emotions, respectively. Following this, all participants completed validated self-questionnaires assessing diabetes perceptions, acceptance, treatment motivation and adherence.RESULTS:Patients in the threat group reported less adherence (P<0.01) and less avoidance (P<0.05), and perceived diabetes as less threatening (P<0.05) than those in the mastery group. Similar results were obtained when the threat group was compared with its matched negative-emotion control group (P<0.05, P<0.05 and P=0.087, respectively). Patients in the mastery group reported feeling a stronger sense of mastery (P<0.05) than those in their positive-emotion control group and greater treatment acceptance than those in the threat group (P<0.01).CONCLUSION:Contrary to conventional medical belief, discussing threatening personal events with patients can yield positive results. Health professionals should take threat and mastery perceptions of diabetes into account during regular consultations with a view to improving treatment acceptance and adherence. With this brief intervention of type 2 diabetes patients, it was also more effective to alleviate their emotional difficulties than to enhance their perception of mastery

Récepteurs érythrocytaires d'insuline et IGF-1 dans le syndrome de Prader Willi

National audienc

Récepteurs érythrocytaires d'insuline et IGF-1 dans le syndrome de Prader Willi

Résumé de communication DIA-102National audienc