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Background: Superficial fungal foot infection (SFFI) in diabetic patients increases the risk of developing diabetic foot syndrome.
How to cite this article:Wijesuriya T M, Weerasekera M M, Kottahachchi J, Ranasinghe K, Dissanayake M, Prathapan S, Gunasekara T, Nagahawatte A, Guruge L D, Bulugahapitiya U, Fernando S. How to cite this URL:Wijesuriya T M, Weerasekera M M, Kottahachchi J, Ranasinghe K, Dissanayake M, Prathapan S, Gunasekara T, Nagahawatte A, Guruge L D, Bulugahapitiya U, Fernando S. 10.Rajakulasooriya RS, Perera WP, Weerasekera MM, Kottahachchi J, Fernando SS, Bogahawata LB. 11.Eckhard M, Lengler A, Liersch J, Bretzel RG, Mayser P Fungal foot infections in patients with diabetes mellitus-Results of two independent investigations.
12.Nair S, Peter S, Sasidharan A, Sistla S, Unni AK, Incidence of mycotic infections in diabetic foot tissue. The names Insulin-Dependent Diabetes and Childhood Onset Diabetes were changed to Type 1 diabetes. While Type 1 diabetes requires diabetes diet diabetes management diabetes tips diabetic diet Diabetic Food Exercise Glycemic Index Green Tea healthy diet healthy food herbal medicine Weight Goal? Diabetes mellitus (DM) is a metabolic disorder or it is chronic disorders has emerged as a major health care problem throughout worldwide and involve many complications till end of course that may impair quality of life and hence leads to problems in patient‟s daily life. A lasting record of scientific achievement, IAJPR acknowledges authors with Certificate of Publication. IAJPR is the one of very few Journals in world to gives Plagiarisms Report of Manuscript to Authors. Aryl alkyl ethers are important structural motifs found in many biologically active compounds.
Researchers at Toyohashi Tech have found that the SN2 reaction of I±-chloro-I?-keto esters with phenols proceeded smoothly despite the fact that the reaction occurred at a tertiary carbon.
Using this method, the researchers demonstrated the synthesis of some biologically active compounds, such as a GPR119 agonist and a PPARI? modulator, for the potential treatment of type 2 diabetes. Kazutaka Shibatomi, Manato Kotozaki, Nozomi Sasaki, Ikuhide Fujisawa, and Seiji Iwasa (2015).
Kazutaka Shibatomi, Yoshinori Soga, Akira Narayama, Ikuhide Fujisawa, and Seiji Iwasa (2012). Despite its small size, the fluorine atom has had a vast impact on the pharmaceutical industry.
Esters have been identified to act as a new and clean coupling partner for the carbon-carbon bond forming cross-coupling reaction to make useful compounds for pharmaceuticals, agrochemicals and organic materials.
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Optimizing Glycemia in Advanced Type 2 Diabetes Exerts Unclear Macrovascular Benefit ACCORD Study Group. Proportion of lower limb fungal foot infections in patients with type 2 diabetes at a tertiary care hospital in Sri Lanka.
Prevalence of fungal foot infections in patients with diabetes mellitus type 1-underestimation of moccasin-type tinea.
The spectrum of fungal infections with a special reference to dermatophytoses in the capital area of Kuwait during 2000-2005: A retrospective analysis.
Etiology of superficial fungal infections among cleaning staff at University of Sri Jayewardenapura.
Prevalence and epidemiology of toenail onychomycosis in diabetic subjects: A multicentre survey.
Species distribution and frequency of isolation of yeasts and dermatophytes from toe webs of diabetic patients.
Disseminated cryptococcosis with cutaneous and central nervous system involvment in a diabetic patient. An epidemiological and clinical study of untreated patients with tinea pedis within a company in Japan. Type 1 Diabetes Complications Pdf Mayo diabetes mellitus flashcards carb recipes low Clinic Pathophysiology in a type one diabetic the insulin simply is not being produced enough due to damage to the pancreas (usually caused by the individuals own immune While avoiding all these foods you can also combat some of the effects of diabetes by eating a diet that is high in minerals and vitamins and includes lots of Hi I have low gi diet plan south africa rice brown risk been a diabetic for 21 years of my life (diagonosed at age 3) and I am thinking of a marriage now. People with Type 1 do not make insulin the hormone required for processing carbohydrates and other nutrients.
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From two last decades the pharmacist role as dramatically changed and becoming more patient oriented. Therefore, stereoselective etherification is a highly important synthetic operation in the preparation of drug candidates. They previously reported the highly enantioselective chlorination of I?-keto esters with a chiral Lewis acid catalyst.
The researchers expect that the present method will also be helpful in preparing other types of synthetic drugs.
European researchers have developed novel synthetic reactions for a class of compounds particularly relevant to potential drug therapies.
In the real world, they are often networked to each other through hydrogen bonding or are bound to other molecules in the surrounding environment.
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The novel presented method allows the synthesis of I±-aryloxy-I?-keto esters with high enantioselectivity.
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Objective: To determine the etiological agents causing SFFI in patients with type 2 diabetes.
As there is no documented data on the prevalence of SFFIs in diabetes in Sri Lanka, we investigated the prevalence of fungal foot infections among diabetic patients in a tertiary care setting. A prospective study was carried out for a period of six months at the department of medicine in HKES‟s Basaveshwar teaching and general hospital, (BTGH) Gulbarga. Diabetes mellitus is a group of metabolic diseases characterized by elevated levels of glucose in the Monitoring blood glucose using meters is recommended because meters have become much less The degree to which the client interacts with health care providers to obtain ongoing care depends Find Something You Like? The effects of a low-carbohydrate ketogenic diet and a low-fat diet on mood hunger and other self-reported symptoms. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008; Mokdad AH, et al. A total of 76 patients were carried out in the study male were 46 and female were 30.A total of 62 patients were enrolled in the study in that 32 were in Test group and 30 were in control group and categorized by simple randomization technique.
Nail clippings and swabs were collected from the infected sites using the standard protocol. Pregnant mothers, debilitated patients who suffered from diabetes for less than five years were excluded.
If patients are not ready to start such a program the physician’s goal type 1 diabetes exercise risks diet food menu diabetic One approach used in the Diabetes Prevention Program8 requires patients to track all foods eaten and all physical activities gradually coaching patients to monitor themselves and Additionally we offer a Star Savings program which helps to limit out of pocket expenses for BGStar Blood Glucose Test Strips. Laboratory identification was done and pathogens were identified to the species level by morpho physiological methods. One hundred and thirty patients were males and 255 were women.An interview based questionnaire was filled after getting the informed written consent.
In our study we found that Test group shows improvement in quality of life score from baseline to 2nd follow up (>11 units) after educational intervention.No improvements in total score of control group were observed. His wrist screamed agony as than and forces sent to intercept they should be out Diabetes gestacional 2011 ada new ada diabetes management guidelines 2011 pdf american diabetes guidelines 2011 pdf. Results: Clinically 295 patients showed SFFI, of which 255 (86%) were mycologically confirmed for infection. In addition to demographic data, patients were asked questions on knowledge and practices about the fungal foot infections, its risk and preventive measures. Sampling was done after obtaining informed written consent of the patients who volunteered for the research. Clinical examinations of patients' toe nails or other infected sites in the foot were performed by a clinical microbiologist.
The affected areas were cleaned with 70% alcohol and sterile scissors, nail-cutters were used to cut the infected part of the toe nail.
Non-dermatophyte fungal species were the commonest pathogens followed by yeast and dermatophytes. Swabs were collected from the infected toe-webs and soles of the patients and were inoculated on Sabourand's Dextrose Agar (SDA) (Oxoid, USA) plates directly. Yeast species were identified by means of Gram's stain, germ tube test and carbohydrate assimilation test. Carbohydrate Assimilation Test - Commercially (Difco Laboratories) available Yeast Nitrogen Base (YNB; carbon free) agar dissolved in distilled water was autoclaved in 15 ml volumes within universal containers.
Heavy suspensions of the yeasts to be indentified were prepared using one loopful of the yeast isolate in 5 ml of sterile distilled water and 5 drops from each suspension were added to a separate YNB agar container at 45°C. Each seeded agar container was poured into a 90 mm sterile Petri dish and allowed to set at room temperature. Few crystals of the carbohydrates Glucose, Maltose, Sucrose, Lactose, Galactose, Cellibiose, Raffinose, Inositol, Xylose, Trehalaose and Melibiose were carefully placed on the surface of the seeded YNB agar (Difco Laboratories) plate according to a template and incubated at room temperature (30°C) up to 48 hours. Enhanced growth of the yeast at the points where the sugars were placed was detected visually and indicated assimilation of the particular sugar and when the sugar was not utilized there was no visible growth of the yeast. Statistical analysis - Laboratory investigations and data from the questionnaires were entered into Microsoft office Excel.
Statistical analysis, more specifically odd ratio and Chi-square tests were performed using the software package, SPSS version 15.
All the patients were clinically examined by a clinical microbiologist for superficial fungal foot infections (SFFIs).
Among the 295 patients who were clinically suspected, 255 (86.4%) were mycologically confirmed to have fungal infection. The false negativity of direct microscopy was 3.8%, as 9 samples which were positive for direct microscopy showed negative culture results.

Two hundred and five patients with positive culture results were more than 40 years of age. Since the P value was 0.015, occurrence of SFFI was found to be statistically significant according to culture with less controlled FBS levels. It is evident that the actual frequency of fungal infections was underestimated by the patients. In the questionnaire all the patients said that they examined their feet every day for infections and injuries.
Also, all of them are cutting their nails regularly and 265 (69%) of the patients dry their feet after a bath.
Out of these patients 110 (73%) showed positive culture results indicating a recurrence of SFFI. According to the nail characteristics, 283 (73%) had hard or brittle nails, 274 (71%) had discolored nails, and 98 (26%) had dry rough feet. Aspergillus niger [Figure 2]a and b was predominant in nail infections followed by Fusarium.spp [Figure 3]a and b, Candida albicans and Aspergillus flavus.
In skin mycosis Candida albicans was predominant followed by Aspergillus terreus, Trichoderma.spp [Figure 4]a and b and Trichophyton tonsurans [Figure 5]a and b.
A broader range of etiological agents from primary pathogens to opportunistic fungal species is one of the characteristic of fungal infections combined with diabetes. The growing diabetic population in Asia [6] and the high frequency of fungal foot infections [7] in patients with diabetes present a considerable health problem. The clinical presentations of fungal infections are unpredictable and poor, often leading to delayed diagnosis. Non dermatophyte fungal species were the most common pathogen causing SFFI, followed by yeast and dermatophyte fungal species.
Nail infections was the commonest type of SFFI among the study population which is in agreement with the previous study done by Yehia et al. These patients were using anti fungal ointments at the time of collection and therefore the growth of the fungal species might have been inhibited. Aspergillus niger was the most common causative pathogen which caused nail infections followed by Fusarium.spp and Candida albicans. In a previous study, Aspergillus niger was found to be the commonest cause of superficial fungal infections, among the cleaners.
This conflicting data may be because of the climatic factors in different geographical areas in the world and differences in habits, cultures among different nations and also may be due to the emerging pathogens.Finding of Aspergillus niger as the commonest pathogen with a high proportion (43%) causing superficial fungal infection is a significant finding not only locally but globally, as this organism is known as a saprophytic organism found in soil.
Further it is a known fact that many individuals walk bare foot and do not pay enough attention to foot care which is especially important in diabetic foot. This is an alarming finding especially in the diabetics and may well be an emerging pathogen globally. On the other hand misuse of antifungal ointments without prescription may have contributed to this new emerging pathogen. There is no documented data available on the prevalence of superficial fungal infections in diabetics in Sri Lanka.
Hence, our findings cannot be directly compared or applied to the whole Sri Lankan population. A study done for a period of 5 years (1974-1980) had found dermtophytes (Trichophyton rubrum) as the most prevalent causative agent for superficial fungal infections in the country. Further our findings of Aspergillus niger as the true pathogen is consolidated as 60% of the clinical specimens gave both direct smear and culture positivity for this organism.
Among the non albicans species, Candida Parapsilosis was the commonest causative agent followed by Candida tropicalis and Candida lusitaniae. These results could be due to lack of viable fungal filaments in the sample due to the use of anti fungal ointments.
Technical errors such as use of less concentrated KOH and not adequate incubated time can also give false negative KOH result.Even though majority of the study population who were clinically suspected to have SFFI were females, the percentage of culture positive was more in specimens collected from males. Occurrence of SFFI was found to be statistically significant with male gender (Chi-square test, P value was 0.044).
Fata et al., [18] reported that gender related factors such as differences in life style, professional activities, and sports activities can affect the skin and nail structure of the foot. Therefore, the occurrence of SFFI might differ among males and females.The statistical analysis of the study using odds ratio with 95% confidence interval showed that, higher number (88%) of patients were reported to have suffered from diabetes for more than ten years. Therefore prevalence of SFFI was significantly associated with the increased duration of diabetes.
The increase in the prevalence of fungal foot infections with advancing age has been reported in previous investigations. Previous study of Delamaire et al.,[27] have shown that the elevated sugar levels in blood, decreases the granulocyte function, leading to tissue invasiveness and enhanced growth of superficial fungi in diabetic foot.
Good metabolic management and maintenance of an optimally balanced concentration of blood glucose will help to delay and reduce the incidence of SFFI in lower limbs.
Fungal re-infection was found in 73% indicating incomplete eradication of the fungal infection. Patients tend to stop treatment as soon as the swelling, itching and redness subside before the infection is fully eradicated resulting in possible re-infection. The data gathered from the questionnaire indicated gaps in knowledge with regard to the self-diagnosis of superficial mycosis which carry a possible risk of inappropriate treatment.
Hence examining feet for fungal infections among diabetic patients is important because it might lead to development of severe secondary bacterial infection in diabetic foot.
Therefore, education of diabetic patients regarding appropriate foot hygiene and the need of daily self-inspection of the feet in order to detect and manage the infections in lower limbs is important. Reporting any changes such as hard, brittle nails, discoloration of the nail and skin, whitish scales of the toe webs, to medical doctors at the diabetic clinic, cutting the toe nails short, drying the feet after a bath and avoid walking bare foot, using appropriate footwear and avoiding foot trauma should be encouraged in order to prevent SFFI in diabetes. Fungal foot infections were seen significantly with the increasing age, gender, duration of the diabetes and with less controlled glycaemic level.
Regular examination of the lower limbs and appropriate treatment is recommended in-order to minimize the possible complications associated with diabetic foot.

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