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Globally and nationally, Diabetes mellitus with its complications has become the contemporary and challenging health problem. Diabetic foot ulcers are the most serious complication of the disease. Diabetes mellitus appears to be an independent risk factor for infection with multi drug resistant organisms causing several abnormalities of the host defense mechanisms that might result in a higher risk of certain infections. Hence early diagnosis of microbial infections will aim to appropriate antibiotic therapy to avoid further complications such as cellulitis, gas gangrene and amputation. Hence this study had been done to evaluate the microbial pathogens causing diabetic foot ulcers along with its antibiogram. Pus samples were collected from 100 patients with diabetic foot ulcers attending Department of Surgery, Government General Hospital, Vijayawada and sent to Microbiology department, Siddhartha Medical College for processing. Diabetic patients of all age groups and both gender were included and those patients who were on antibiotic therapy were excluded . Out of 100 samples processed 90(90%) were culture positives, of which 101 pathogens were isolated, 70(69.3%) were Gram negative and 31(30.6%) were Gram positive Pseudomonas ssp were found to be predominant followed by Escherichia.coli and Staphylococcus aureus. All the pathogens were found to be highly sensitive to Piperacillin- tazobactam, Gentamicin and least sensitivity to Azithromycin. The results of this study therefore alert us to the need for proper management of antibiotics to optimize patient care and improve clinical outcome.

The present study explored the possible role of adenosine deaminase and guanine deaminase in diabetic foot ulcers which is considered one of the main chronic complications of diabetes mellitus. Serum adenosine deaminase, guanine deaminase, and some biochemical parameters were investigated in 54 patients with diabetic foot ulcers and 40 healthy individuals. According to our findings, adenosine deaminase and guanine deaminase activities are much higher in diabetic foot ulcer patients than in healthy individuals. A strong positive correlation was found between adenosine deaminase and guanine deaminase activities. Adenosine deaminase and guanine deaminase had 100% sensitivity and specificity for diagnosing diabetic foot ulcers, and their area under the receiver operating characteristic curve was 1.0. Kinetic study displayed significant changes in Vmax and Km between patients and healthy individuals for both adenosine deaminase and guanine deaminase. Based on results, it can be concluded that the increase of adenosine deaminase and guanine deaminase activities may negatively contribute in diabetic foot ulcers progression.

Background: This study was designed to explore whether participant-driven patient education in group sessions, compared to the provision of standard information, will contribute to a statistically significant reduction in new ulceration during 20 months in patients with diabetes and high risk of ulceration. Methods and Material: This is a six-month interim assessment. The CONSORT guidelines were used to construct a randomized controlled trial. Age 34–78 years old, diabetes mellitus, sensory neuropathy, and a healed foot ulcer below the ankle were the inclusion criteria; 526 individuals (both male and female) were screened in order. Results: The research involved a total of 125 patients. Because of concerns regarding the patients' capacity to complete the trial according to protocol, an interim analysis of 85 participants was conducted after six months. After six months, 44.70 percent of the participants had acquired a new foot ulcer, with no statistical difference between the two groups. The number of patients was insufficient to draw any statistical conclusions about the intervention's effectiveness. Plantar stress ulcers and external trauma were the most common causes of ulcer formation.Conclusions: It was concluded that patients with diabetes and a healed foot ulcer develop foot ulcers despite participant-driven group education as this high-risk patient group has external risk factors that are beyond this form of education. The educational method should be evaluated in patients with a lower risk of ulceration.

Objective: The aim of this study was to determine the frequency of different types of amputations in diabetic foot ulcers. Study Design: A Prospective Study. Place and Duration: In the Surgical Unit II of Holy Family Hospital, Rawalpindi for one year duration from July 2017 to July 2018. Methods: In this study, all diabetic foot ulcers patients of four and fifth grade were included in the study. Standard hip disarticulation, amputation up to above or below knee ray amputation was performed accordingly. Results: A total of 53 patients were included in the study. The male patients were 30 years old, women were 23 years old. The minimum age was 30, the highest was 80 and the mean age was 58.26. According to Wagner's classification, 9 patients had stage 4 and 5 had left-sided amputation in 28 patients (52.2%) had 25 patients (47.2%) had right sided. Big toe Amputation was performed in (9.6%)5 ,2 toe amputated in (3.8%) patients, in 1 patient little toe amputation was done. Trans knee amputation in1 (2.0%), in 34 (61.93%) patients below knee amputation, in (2.09%) patient hip disarticulation and in 10 (18%) above knee amputation. Conclusion: The final results of a prospective study indicate that diabetic foot ulcers efficacy is associated with longer duration of diabetes and poor glycemic control. Non-traumatic diabetic ulcers and lower extremity amputations are costly and an important issue for patients, government and health care system. Key words: Ulcer, diabetic foot, Wagner grade, amputation.

Objective: The aim of this study was to determine the frequency of different types of amputations in diabetic foot ulcers. Study Design: A Prospective Study. Place and Duration: This prospective study was carried out in Surgical Department of Bahawal Victoria Hospoital (BVH), Bahawalpur for one year duration from October 2017 to September 2018. Methods: In this study, all diabetic foot ulcers patients of four and fifth grade were included in the study. Standard hip disarticulation, amputation up to above or below knee ray amputation was performed accordingly. Results: A total of 53 patients were included in the study. The male patients were 30 years old, women were 23 years old. The minimum age was 30, the highest was 80 and the mean age was 58.26. According to Wagner's classification, 9 patients had stage 4 and 5 had left-sided amputation in 28 patients (52.2%) had 25 patients (47.2%) had right sided. Big toe Amputation was performed in (9.6%)5 ,2 toe amputated in (3.8%) patients, in 1 patient little toe amputation was done. Trans knee amputation in1 (2.0%), in 34 (61.93%) patients below knee amputation, in (2.09%) patient hip disarticulation and in 10 (18%) above knee amputation. Conclusion: The final results of a prospective study indicate that diabetic foot ulcers efficacy is associated with longer duration of diabetes and poor glycemic control. Non-traumatic diabetic ulcers and lower extremity amputations are costly and an important issue for patients, government and health care system. Key words: Ulcer, diabetic foot, Wagner grade, amputation.

Intro -- Contents -- Preface -- Chapter 1 -- Machine Vision for Early Diabetes Diagnosis -- Abstract -- 1. Introduction -- 1.1. Types -- 1.1.1. Type 1 Diabetes -- 1.1.2. Type 2 Diabetes -- 1.1.3. Gestational Diabetes -- 1.1.4. Pre Diabetes -- 1.1.5. Symptoms -- 1.2. Causes -- 1.2.1. Type 1 Diabetes -- 1.2.2. Type 2 Diabetes -- 1.3. Gestational Diabetes -- 2. Literature Survey -- 3. Methodology -- 3.1. Cold Stress Experiment -- 3.2. Hot Stress Experiment -- 4. Results -- 4.1. Patient Database -- 4.2. Cold Stress -- 4.3. Hot Stress -- 5. Discussion -- Conclusion -- References -- Chapter 2 -- Clinical Applications of Mesenchymal Stem Cells in Non-Healing Diabetic Foot Ulcers (DFUs): An Effective Treatment -- Abstract -- 1. Diabetes Mellitus -- 1.1. Introduction to Diabetes Mellitus -- 1.2. Classification of Diabetes -- 1.3. Prevalence of Diabetes -- 1.4. Complications due to Diabetes -- 1.4.1. Cardiovascular Disease -- 1.4.2. Nerve Damage (Neuropathy) -- 1.4.3. Kidney Damage (Nephropathy) -- 1.4.4. Eye Damage (Retinopathy) -- 1.4.5. Foot Ulcers -- 1.4.6. Skin Conditions -- 1.4.7. Depression -- 2. Diabetic Foot Ulcer (DFU) -- 2.1. Introduction to Diabetic Foot Ulcer (DFU) -- 2.2. Treatment of DFUs -- 2.2.1. Debridement -- 2.2.2. Autografts and Allografts -- 2.2.3. Offloading -- 3. Wound Healing and Chronic Wounds -- 3.1. Wound Healing -- 3.1.1. Inflammatory Phase -- 3.1.2. Proliferative Phase -- 3.1.3 Maturation Phase -- 3.2. Chronic Wound -- 4. Mesenchymal Stem Cells (MSCs) -- 4.1. Introduction to MSCs -- 4.2. Sources of Mesenchymal Stem Cells -- 4.3. Expression of Cell Surface Markers -- 4.4. Clinical Application of MSCs in DFUs -- 4.5. Mechanism of Action of MSCs in DFUs -- 4.5.1. Anti-Inflammatory Action -- 4.5.2. Role in Angiogenesis -- 4.5.3. Paracrine Secretion of Growth Factors and Cytokines.

Aim: To know the frequency of different types of amputation in diabetic foot ulcers. Material and methods: A prospective study was held in the Department of Surgery and Orthopedic department of POF Hospital Wah Cantt among 53 consecutive patients for one year from April 2019 to April 2020. All patients with Wagner fourth and fifth-degree diabetic foot ulcers were included in the study. Standard hip disarticulation, amputation above knee, amputation below knee and ray amputation were performed accordingly. Results: 53 patients participated in the study. Men were 30 years old, women 23 years old. The minimum age is 30 years, the maximum is 80 years, the average age is 58.26 years. According to Wagner's classification, 9 patients were grade 4 and the rest were grade 5. The right side was in 25 (47.2%) patients and the left side was in 28 (52.8%) patients. Finger amputation in 5 (9.4%), amputation with 2 fingers in 2 (3.8%), amputation with 3 fingers in 1 (1.9%) patients, little finger in 1 (1.9%) patients, amputation below knees in 33 (62.3%) patients, 1 patient of ray knee amputation (1.9%), above knee amputation in 9 (17%) patients and hip bone disarticulation in 1 (1.9%) patient. Conclusion: The final results of a prospective study of diabetic foot ulcers indicate that the result is associated with poor glycemic control and longer duration of diabetes. Non-traumatic diabetic ulcers and amputations of the lower extremities are an important and costly problem for patients, healthcare systems and government. Key words: diabetic foot, ulcer, amputation, Wagner's degree.

Background: Skin is the single largest organ of the body that protects against mechanical trauma, radiation and infection. Because of its complexity a wide range of diseases can develop from the skin ranging from infectious diseases to malignancy, some of which may present as non-healing ulcers. Non healing ulcers are an important cause of morbidity in developing countries. Study of non-healing skin ulcers is challenging and at times even frustrating than any other skin lesions. This study was taken keeping in view the present scenario were patient with non-healing ulcers go unnoticed for a long time without biopsy resulting in uncertainty of developing malignancy which can otherwise be identified at a very early stage by early histopathological examination. Aim: Aim of this study was to study the histopathological outcome of non-healing ulcers in this geographical area where much is not known about the etiology of non-healing ulcers. Methodology: This study was hospital based two years prospective study extending from January 2016 to December 2017 conducted in Department of Pathology, Government Medical College Srinagar. During this period patients referred from peripheral hospitals with ulcers that had not healed for 4 weeks or more after conventional therapies were included in this study. The detailed history and clinical examination findings were retrieved from the case files. Biopsies received were processed as per the standard protocol and slides were examined by the senior pathologist in the Department of Pathology, Government Medical College Srinagar. Results: During the two years period department received biopsies from 282 patients with non-healing ulcers. Out of 282 patients 180 were males and 102 were females with a M:F ratio of 1.76:1. 0ut of the 282 cases 100 (35.46%) were diagnosed as malignant ulcers and 182(64.54%) were diagnosed as benign ulcers (Table 1). Out of the 282 cases, 70 cases (24.82%) were found to be neuropathic diabetic ulcers, 52 (18.43%) were diagnosed as tubercular ulcers, 44 ...