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The Foot in Diabetes - part 6

Nhiễm trùng bàn chân thường gặp ở bệnh nhân tiểu đường. Tỷ lệ và mức độ nghiêm trọng của nhiễm trùng như vậy là lớn hơn ở những người bị bệnh tiểu đường hơn so với dân số không đái tháo đường | 182 The Foot in Diabetes At present Dermagraft presents a new and exciting treatment for the indolent plantar neuropathic ulcer that has failed to respond to conventional treatment. GRANULOCYTE-COLONY STIMULATING FACTOR GCSF Foot infection is common in patients with diabetes mellitus. The incidence and severity of such infections is greater in people with diabetes than in the non-diabetic population. The higher risk may be related to abnormalities in host defence mechanisms including defects in neutrophil function4 5. Effective neutrophil antimicrobial action depends on the generation of several oxygen-derived free radicals. These toxic metabolites e.g. superoxide anion are formed during the respiratory or oxidative burst that is activated after chemotaxis and phagocytosis. Deficiencies in neutrophil chemotaxis phagocytosis superoxide production respiratory burst activity and intracellular killing have been described in association with diabetes. Granulocyte-colony stimulating factor GCSF is an endogenous haemopoietic growth factor that induces terminal differentiation and release of neutrophils from the bone marrow. The recombinant form is used widely to treat chemotherapy-induced neutropenia. Endogenous GCSF concentrations rise during bacterial sepsis in both neutropenic6 and non-neutropenic states7 these findings suggest that GCSF may have a central role in the neutrophil response to infection8. In addition GCSF improves function in both normal and dysfunctional neutrophils9. Since diabetes represents an immunocompromised state secondary to neutrophil dysfunction we investigated the effect of systemic recombinant human GCSF filgrastim treatment in diabetic patients with foot infection. The aims of the study were to assess the effects of the GCSF on the clinical response and to measure the generation of neutrophil superoxide in patients and healthy controls10. Patients received either GCSF or a similar volume of placebo saline solution . GCSF or placebo was .