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A Study of Changes in Immunohistochemical Markers (Ki67, CD34, neurofilament protein) Peripheral Neuropathic Diabetic Foot Ulcers after Glycaemic Control.

Utkarsh Kumar, Sanjeev Kumar Gupta, Anjali Singh, S.K. Singh, Shreekant Bharti.




Abstract
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The aim of this study is to see the effects of glycaemic control on Immunohistochemical markers (Ki67, CD34 and Neurofilament protein) in diabetic neuropathic ulcers. It is an observational study with 30 patients regards to patient’s demographic data, clinical, pathological and wound characteristics and their correlation with tissue Ki67, NFP, CD34 expression after glycaemic control. Inclusion criteria of Diabetic foot ulcers present for > 6 weeks having peripheral neuropathy. In our study, the Mean wound area before Glycemic control was32.43±24.72cm2 & after glycemic control was reduced to 13.00±9.68 cm2 with complete healing of ulcers in two patients after 6 weeks. The majority of patients (46.7%) were between 6-10% LI(Labelling index) of Ki67 on day1 and there seems to be an increase in Ki-67 with an increase in tissue proliferation, as the majority of patients (46.7%) were in between 16-20% LI(Labelling index) of Ki67 after 6 weeks(P=0.025). None of our patients (n=30) showed immunostaining for neurofilament protein at presentation, However, after glycemic control, 2/30(6.66%) patients show NFP expression. The difference was not statistically significant. Expression of CD34 was significantly increased after Glycemic control (p=0.005). So, we conclude that Glycemic control decreases the wound surface area and thereby help in the healing of foot ulcers. Glycemic control results in increased expression of CD34 and Ki67 but there is no significant change in Neurofilament Protein.

Key words: glycaemic control, Immunohistochemical marker, Peripheral neuropathy, Diabetic control






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