Diabetic foot ulcer is a debilitating complication of long‐standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out‐of‐pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital‐based cross‐sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out‐of‐pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650–₹81 120) ($378.14 [$122.56–$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non‐medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non‐medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden.
17 November 2023 in Current Tropical Medicine Reports
Nitrobenzene poisoning is an uncommon but serious form of intoxication. Nitrobenzene is used in dyes, paints, lubricating oils, and crop-flowering stimulants. Ingestion produces acute methemoglobinemia and cyanosis, which fails to produce improvement in high-flow oxygen therapy. We present here a case of a 25-year-old male presenting with diffuse headache, fatigue, and cyanosis after attempting suicide by consumption of 15 mL of 20% nitrobenzene. Oxygen saturation (SpO2) was 85% on room air and was not improving on oxygen therapy. Serum methemoglobin level was 22% of hemoglobin. The patient was treated with IV methylene blue and oral ascorbic acid along with supportive management. He attained recovery by day three and was subsequently discharged. Acute methemoglobinemia following nitrobenzene poisoning is of grave concern and demands timely identification and diligent management with methylene blue and ascorbic acid alongside supportive measures.
The convergence of artificial intelligence (AI) and stem cell therapy marks a transformative advancement in regenerative medicine. This manuscript explores how AI-driven approaches are being integrated into stem cell research and therapy, enhancing disease mechanism insights, therapeutic strategies, and clinical practices. AI's role spans from diagnostic algorithms to predictive analytics for patient outcomes, particularly in complex biomedical data analysis. This integration addresses challenges in stem cell therapy, such as precise cell characterization and optimization of cell differentiation processes. AI-enhanced therapies are showing promise in treating various conditions, including neurodegenerative diseases, orthopedic ailments, and cardiovascular disorders. The manuscript highlights several case studies demonstrating AI's impact on stem cell therapy, such as predictive analytics in post-transplant relapse and automated cell classification. It also discusses the broadening scope of AI in medical fields, economic and accessibility considerations, and the ethical and regulatory challenges posed by this technological integration. The future direction emphasizes ongoing AI advancements, improving predictive models, and robust ethical frameworks. This synthesis underscores the potential of AI and stem cell therapy to revolutionize healthcare by offering new treatment avenues for previously incurable diseases.
The use of recombinant human granulocyte-colony stimulating factor (G-CSF) is an uncommon aetiology for acute kidney injury in cancer patients. Several patterns of renal injury due to G-CSF have been discussed in the literature. Here, we present a case of a 48-year-old man with monoclonal gammopathy of renal significance who received filgrastim for planned autologous stem cell transplantation and developed acute kidney injury presenting as crescentic glomerulonephritis. The patient was treated with steroids, plasmapheresis, and cyclophosphamide. He attained complete recovery and proceeded with stem cell transplantation. We conducted an extensive review of the literature on the subject, which revealed that 10 of the 18 biopsy-proven cases of G-CSF-induced renal injury presented as crescentic glomerulonephritis. When G-CSF is administered to patients with an underlying renal pathology (usually autoimmune or monoclonal in aetiology), the migration and degranulation of activated neutrophils in the glomerular microenvironment in large numbers results in glomerular basement membrane rupture and crescent formation. Timely renal biopsy and aggressive initiation of treatment aid in attaining renal recovery and a favourable prognosis in cancer patients.