BIOSOFT HELP FILES

1)      Malignant ulcer

1)      Ecthyma -

2)      Tropical ulcer

3)      Atopic eczema

4)      Drug dermatitis

5)      PVD

6)      Diabetic ulcers

7)      Neuropathic ulcers

The intervention group had 0.05 percent topical tretinoin applied for 10 minutes per day, followed by a saline rinse, for a total of four weeks. All wounds had cadexomer iodine gel (Iodosorb) applied between treatments with tretinoin or placebo ointment.
Tom WL, et al. The effect of short-contact topical tretinoin therapy for foot ulcers in patients with diabetes. Arch Dermatol. November 2005;141:1373–7.

The intervention group had 0.05 percent topical tretinoin applied for 10 minutes per day, followed by a saline rinse, for a total of four weeks. All wounds had cadexomer iodine gel (Iodosorb) applied between treatments with tretinoin or placebo ointment.
Tom WL, et al. The effect of short-contact topical tretinoin therapy for foot ulcers in patients with diabetes. Arch Dermatol. November 2005;141:1373–7.

1)      Intertrigo

2)      Fungal infections

3)      Cellulitis

1)      Umbilical infection – Mx with Penicillin or Erythromycin

2)      Umbilical granuloma – 1 mm- 1 cm pink, friable, nodule at the base of the umbilicus, persistent discharge. Mx – Silver nitrate application

1)      Stools containing discharge (fistula, urachal remnants)

2)      Umbilical cellulitis (precursor of sepsis)

3)      Bright res umbilical nodule (umbilical polyp)

4)      Prolapse of intestines through the umbilicus (omphalomesenteric remnants)

5)      Painful swelling of the umbilicus (omphalomesenteric remnants infections)

6)      Painful mass between the umbilicus and the suprapubic area (urachal remnants)

7)      Clear umbilical discharge containing urine (urachal remnants)

8)      Pain and discharge during urination (urachal anomalies)

Eleven RCTs (n = 890) that studied the use of silver nitrate, topical steroids, ethanol wipes, electrocautery, cryocautery, copper sulfate, and common salt were included. Common salt achieved resolution in >90% of cases in five studies and 54–80% in two studies. Topical steroids, silver nitrate, copper sulfate, and cryocautery achieved resolution in >90% and ethanol wipes in 50–65% of cases. Local side effects reported with topical steroids, silver nitrate, cryocauter,y, and electrocautery varied in each study. The salt application did not cause side effects. The risk of bias was high in many RCTs.
Jois RS, Rao S. Management of Umbilical Granuloma in Infants: A Systematic Review of Randomized Controlled Trials.
AJGP 2021;50;8. doi: 10.31128/AJGP-04-20-5371 .

TRADITIONAL MYTHS ABOUT DIABETIC DIET
1) Traditionally diet is a first-line management issue
2) Traditionally diet is often forgotten in drug-treated diabetes
3) Traditionally diet is often thought to manage hyperglycemia
4) Traditionally sugar, sweets, honey, etc are avoided
5) Traditionally we refer to a thing called a diabetic diet
6) It is now evidence-based to say that all these are wrong and of no value

LOADD TRIAL AND LOADD DIET
1) Lifestyles Over and Above Drugs in Diabetes Trial
2) Macronutrient composition carbos 45-60%, ports 10-20%, fats < 30%,
3) Emphasis on healthy eating strategy
4) Structured meal plans
5) Weight loss of 5-7%
6) Education on portion size and control
7) Foods allowed vegetables, fruit, legumes, wholegrain cereals, fish (preferably oily), nuts, low-fat dairy products, and appropriate fats and oils. Meat, when consumed, was to be lean.

REFERENCES
1) Finnish DPS (Diabetes Prevention Study) Tuomilehto J, Lindstrom J, Eriksson J et.al., Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with glucose tolerance. N Engl J Med 2001;344;1343-1350.
2) US DPP (US Diabetes Prevention Program) Knowler WC, Barrett-Connor E,Fowler SE et.al., Reduction in the incidence of type 2 diabetes mellitus with lifestyle intervention or metformin. N Engl J Med 2002;346;393-403.
3) Guidelines for the Prevention of Stroke in Patients With Stroke or Transient Ischemic Attack. A Guideline for Healthcare Professionals From the American. Guidelines for the Prevention of Stroke in Patients With Stroke or Transient. http://stroke.ahajournals.org - published Oct 10th 2010
4) OmniHeart. OmniHeart diets provide more options for heart health. Available at: http://www.omniheart.org/OmniDiets.pdf Accessed October 7, 2008.
5) Salas-Salvadó. J, Bullo M, Babio N et al. Reduction in the incidence of type 2 diabetes with the Mediterranean Diet: Results of the PREDIMED-Reus Nutrition Intervention Randomized trial. Diabetes Care 2010: DOI:10.2337/dc10-1288. Available at: http://care.diabetesjournals.org. Abstract
6) Can gestational weight gain be modified by increasing physical activity and diet counseling? A meta-analysis of interventional trials. Ina Streuling, Andreas Beyerlein, and Rüdiger von Kries. Am J Clin Nutr October 2010 vol. 92 no. 4 678-687
7) Effects of a low–glycemic load diet in overweight and obese pregnant women: a pilot randomized controlled trial. Am J Clin Nutr December 2010 vol. 92 no. 6 1306-1315. Erinn T Rhodes, Dorota B Pawlak, Tamara C Takoudes, Cara B Ebbeling, Henry A Feldman, Margaret M Lovesky, Emily A Cooke, Michael M Leidig, and David S Ludwig
8) Harvard Report on Cancer Prevention
9) In 2001 71% of all deaths in Sri Lanka were due to heart diseases, brain disesaes, blood pressure, diabetes, respiratory diseases, renal diseases ans cancers. The National Policy and Strategic Framework for Prevention and Control of Chronic Non-Communicable. DIseases – 2009. Publication of Ministry of Healthcare and Nutrition Sri Lanka. http://203.94.76.60/Act/NCDPolicy-English.pdf
10) Coppell KJ, Kataoka M, Williams SM et.al., Nutritional Intervention in Patients With Type 2 Diabetes Who Are Hyperglycaemic Despite Optimised Drug Treatment--Lifestyle Over and Above Drugs in Diabetes (LOADD) Study: Randomised Controlled Trial. 08/03/2010; BMJ © 2010 BMJ Publishing Group
11) Ryan DH, Espeland MA, Foster GD, Haffner SM, Hubbard VS, Johnson KC, Kahn SE, Knowler WC, Yanovski SZ: Look AHEAD (Action for Health in Diabetes): design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Control Clin Trials 24:610–628, 2003

Slowness was evaluated using gait speed by the Timed “Up and Go” test (Podsiadlo and Richardson, 1991). The patient must stand up from an armchair, walk 3 m, turn around, walk back to the chair, and sit down. If the participants took 16.8 or more seconds [Portuguese cutoff for people 80 years and older (Almeida et al., 2017)] to perform the test they were considered to have low mobility and categorized as 1. Participants who were not able to do the walking test were also categorized as 1 (low mobility). Participants who performed the test in less than 16.8 s were categorized as 0, meaning good mobility.
Exhaustion was assessed using the question “In this last month, do you feel that you have less energy to do the things you want?,” which was categorized as 0 = no exhaustion or 1 = yes exhaustion.

(v) Low physical activity was assessed by the question “How often do you practice any of the following activities (dancing, walking, farming work, or gardening)?” (Duarte et al., 2014). Answers ranged from one to four, respectively, never/almost never, up to three times a month, once a week, and more than once a week. Answers were then recoded as 0 if answers were “once a week” or “more than once a week,” meaning they were active, and 1 for answers “never/almost never” or “up to three times a month,” which were considered not active.

Alves S, Teixeira L, Ribeiro O and Paúl C (2020) Examining Frailty Phenotype Dimensions in the Oldest Old. Front. Psychol. 11:434. doi: 10.3389/fpsyg.2020.00434