GHP August 2015

ghp August 2015 | 9 industry insight Abstract In the present study diabetic patients of both sexes at an aged ranging between 47 to 58 years were treated for wound infection on their feet due to dia- betes mellitus. The patients were treated for five days twice a day in an oxygen rich foot bath. The oxygen foot bath had good effect on bacteria localized in the wound on feet since 66% of the patient totally recov- ered from bacterial infections on their feet. Further- more, witnesses from the included subjects and their physicians clearly point at a patient amelioration. Introduction Diabetic foot ulcers occur as a result of various factors, such as mechanical changes in conforma- tion of the bony architecture of the foot, peripheral neuropathy, and atherosclerotic peripheral arterial disease, all of which occur with higher frequency and intensity in the diabetic subjects compared to the normal population. Diabetes causes non enzymatic glycation predis- poses ligaments to stiffness. Neuropathy in diabetic subjects causes loss of protective sensation and loss of coordination of muscle groups in the foot and leg, both of which increase mechanical stresses during ambulation. Diabetic foot lesions are responsible for more hospi- talizations than any other complication of diabetes. Diabetes is the leading cause of non-traumatic lower extremity amputations in the World, with approxi- mately 5% of diabetics developing foot ulcers each year and 1% requiring amputation. Physical examination of the extremity having a diabetic ulcer can be divided into examination of the ulcer and the general condition of the extremity, assessment of the possibility of vascular insufficien- cy, and assessment for the possibility of peripheral neuropathy (Hsiao-Chuan L, et al. 2014). The staging of diabetic foot wounds is based on the depth of soft tissue and osseous involvement. A complete blood cell count should be done, along with assessment of serum glucose, glycohemoglobin, and creatinine levels (Guideline, 2014, International Expert Committee 2009, Vehik K, Beam CA, Mahon JL, et al. 2011). A vascular surgeon and/or podiatric surgeon should evaluate all patients with diabetic foot ulcers so as to determine the need for debridement, revisional sur- gery on bony architecture, vascular reconstruction, or soft tissue coverage. In the present study we show an alternative way of treating foot wounds and the method can be used to avoid deep soft tissue wounds by preventive use of oxygen rich foot bath. Material and methods Patients This study was limited to infected wounds of 15 diabetic patient presented to a diabetic clinic in Khartoum, Sudan between January and February 2015. The age of the patients range from 47 to 58 years and both sexes were represented. Determina- tion of infection was made clinically by looking for signs of inflammation. None of the patients has taken any antibiotic for the last 30 days prior to the study. No other history of illness besides diabetes mellitus was known when the study started. Treatment of subjects The patients in this pilot study were treated by foot bath with 2% of BioCool ® twice a day for 5 days. When the results obtained from this first group of subjects indicated that we had achieved the objective of the study, the study was terminated. The BioCool ® can be used at a concentration between 0.05 to 4.00 % deepening on which microorganism killing is aimed at. The temperature of the foot bath should be 37 C for optimal effect. This has previously been tested and 2% have been found to be optimal for killing of all types of microorganisms both pro and eukaryotic ones (Sandström G., Eriksson J-O., and Saeed A., 2014). Material Substance: The test substance ( BioCool ® ) was obtained from the company BioCool AB, Skellefteå, Sweden. Hereafter described as test substance. The test substance has been described on the open mar- ket as BioCool ®. The mechanism by which the mi- croorganism is killed is a chemical reaction resulting in singlet oxygen. Singlet oxygen is known from other biological systems to have killing effect on micro- organisms (Kniel et al., 2003) . The substance has previously been tested and found to kill Escherichia coli (Nandi et al., 2010). The Swedish governmental owned company FOA-test performed the test. In the present study test substance was tested at concen- tration of 2%. Specimen Collection Two cultures were taken from every wound, before and after treating with the substance. The wound and area surrounding it was cleansed with sterile physiologic glucose solution by means of a sterile compress passed over the wound surface to reduce the amount of contaminating bacteria. The swab was held in contact with the wound for at least 5 s before any debridement was done. At the end of debride- ment, a deep tissue was taken. Deep tissue was defined as the last non-viable tissue removed from the deepest area of the wound. All swabs were placed in a tube and delivered to the microbiology laboratory was usually made within 30 min. Cultures were performed by standard procedures. Bacterial isolates were identified to the species level. Results In table 1 it is described the outcome of treatment of patients with the substance. Out of the group of subjects treated with the substance 66 % showed no growth of bacteria at all although all of them had signs and symptoms of deep infection wounds to start with. The other 34 % of subjects showed a clear decrease in bacterial growth after treatment although not a complete lack of bacteria in the wounds. The normal flora of the subjects was not affected dramati- cally since the normal flora was fully recovered when treatment was stopped. Moreover no difference between sexes could be found and no effect failure due to age was noted. Patient 7-15 had the following bacteria Staphylo- coccus aureus, Beta haemolytic streptococcus,