OAR@UM Collection:

Glycaemic control and its relation to foot skin pH in people living with type 2 diabetes mellitus

Wed, 01 Jan 2020 00:00:00 GMT

Title: Glycaemic control and its relation to foot skin pH in people living with type 2 diabetes mellitus Abstract: Aim: To determine any differences in foot skin pH values in people living with type 2 diabetes presenting with different glycaemic control levels within the Maltese population, when compared to healthy individuals. Research Design and Method: A quantitative comparative observational study was conducted on a population of Maltese patients living with type 2 diabetes and a group of healthy patients, as controls. Two hundred and forty-one participants (n=241) were recruited for this study, 180 living with type 2 diabetes mellitus and 61 healthy participants. The participants living with type 2 diabetes were categorised into 3 different groups according to their HbA1c levels. A 20 minutes acclimatisation period was given to each participant before skin pH testing commenced. Demographic information such as age, gender, weight, height, diabetes duration, medications, BMI, daily physical activity and alcohol intake were recorded prior to testing. Once the acclimatisation period was over, skin pH at predefined sites (plantar, interdigital and dorsal areas of each foot) was measured utilizing the Skin pH meter (Apera PH60F). Participants required to attend for only a single session. The researcher followed a predefined protocol when taking skin pH readings for each participant. The Shapiro-Wilk test was used to determine the normality of data. The Kruskal Wallis test was employed to determine if a significant difference was found between groups, while other statistical tests such as the Shapiro-Wilk, Spearman correlation, Mann Whitney and Chi-square tests were used to analyse and compare other variables in relation to foot skin pH. Results: The study found a significant difference (p < 0.05) between mean skin pH at the 3 regions of interest (ROI) and the 4 groups of participants recruited in the study. Group 2 (good HbA1c) presented with the lowest foot skin pH in all ROI, followed by group 1 (healthy), group 3 (fair HbA1c) and with group 4 (poor HbA1c) having the highest skin pH values. The mean interdigital foot skin pH was always higher (less acidic in nature), when compared to the other sites for both the left and right foot across all groups. The higher the HbA1c score, the higher (less acidic) the mean foot skin pH was observed in all ROI. Conclusions: The results of this study demonstrated significant differences between the four groups and concluded that the more controlled blood glucose levels, the less foot skin pH tends to fluctuate from the normal acidic values. With the aid of this study health policies should start considering testing for skin pH especially in the foot region to enable health professionals to pinpoint disturbances in the skin acid mantle which can result in frequent skin infections and conditions affecting immunocompromised patients such as those with uncontrolled diabetes. Description: M.Sc. (Melit.)

Investigating auxetic insole material and its effect on plantar pressure in patients living with type 2 diabetes mellitus

Wed, 01 Jan 2020 00:00:00 GMT

Title: Investigating auxetic insole material and its effect on plantar pressure in patients living with type 2 diabetes mellitus Abstract: Background: Foot orthotic treatment is one of the primary means used in the treatment and prevention of ulceration as orthoses reduce peak plantar pressures by providing a larger contact surface area over which forces can be better re-distributed thus preventing skin breakdown. The most common materials that have been used for decades in insole fabrication are EVA (ethyl vinyl acetate) and PE (polyethylene). In recent years auxetic materials have attracted a lot of attention due to their enhanced mechanical properties. Auxetic materials have been described as a class of materials with a negative Poisson’s ratio that is they become fatter when stretched and narrower when compressed.This factor contributes to enhanced properties such as increased shear stiffness, increased plane strain fracture toughness and also an increased indentation resistance. Conventional insole materials such as EVA and polyethylene behave contrary to Auxetic material since they possess a positive Poisson’s ratio. Thus, this material was used in this study in order to determine whether it is more effective in reducing plantar pressure in diabetic foot when compared to conventional insole material. Aim: The aim of the study was to determine whether the innovative Auxetic foam material, when applied as an insole material is effective in reducing plantar pressure in the diabetic foot. Research Design and Method: The study employed a Quasi-experimental design where participants acted as their own control. In this study participants were invited to perform four main trials with the control, EVA,60PPI and 90PPI insole materials. Foot pressure mapping was done using the in-shoe system to obtain the mean peak plantar pressure and mean pressure-time integral for the 1st metatarsophalangeal joint region, 2nd - 4th metatarsophalangeal joint region and 5th metatarsophalangeal joint region bilaterally. Results: The results indicate that that the highest peak plantar pressures were recorded with the EVA insole in all foot masks when compared to the control, 60PPI and 90PPI insole. Also the 90PPI auxetic material was found to be effective in reducing the mean peak plantar pressure whilst the 60PPI insole was found to be ineffective in pressure reduction. From the results of this study weight when seen collectively did not have an effect on peak plantar pressure but when it was categorized in three different weight groups and examined individually, in the lowest weight category, a significant result was observed especially in the right 2-4th MPJ region. Description: M.SC.PODIATRY

The effect of cocaine on arterial perfusion of the lower limbs

Wed, 01 Jan 2020 00:00:00 GMT

Title: The effect of cocaine on arterial perfusion of the lower limbs Abstract: Aim – Worldwide, substance abuse is on the rise, especially amongst the young generation. Although cocaine-induced cardiovascular and cerebrovascular events are well-documented, knowledge about the relationship of cocaine use and its effect on arterial perfusion in the lower limbs is scarce. This study sought to investigate the relationship between cocaine use and peripheral arterial disease. Methods – The study population comprised of 30 subjects’ dependent on cocaine, smoking and alcohol [Group A] and another 30 subjects’ dependent on smoking and alcohol only [Group B]. A comprehensive lower limb vascular assessment was conducted utilizing pulse palpation, Doppler spectral waveform analysis, Ankle brachial pressure index and Toe brachial pressure index to determine the arterial perfusion status in the lower limbs. Results - The cocaine users’ group had lower ABPIs and TBPIs than the alcohol and smoking group only suggesting poorer vascular perfusion in lower limbs. Furthermore, a larger percentage of cocaine users had monophasic/continuous waveforms of all 3 pedal pulses compared to alcoholics/ smokers. Conversely, there was a higher percentage of alcoholic and smokers only with biphasic/ triphasic waveforms compared to cocaine users implying better vascular perfusion. Conclusion - This study exhibits that cocaine diminishes the arterial perfusion of the lower limbs suggesting that cocaine use increases the risk of peripheral arterial disease in this specific population. Regular vascular foot screening in this population is warranted if foot complications are to be avoided. Description: M.SC.PODIATRY