title: Topical "soft candle" applications for infected diabetic foot wounds: a cause for concern?
abstract: OBJECTIVE
  There is a cultural barrier to early medical intervention for diabetic foot infections in Trinidad & Tobago, stemming from the strong cultural belief in "soft candle" as effective treatment. We carried out a case-control study to evaluate the outcomes of "soft candle" to treat diabetic foot infections.
  
  
  METHODS
  ALL CONSECUTIVE PATIENTS ADMITTED WITH DIABETIC FOOT INFECTIONS WERE INTERVIEWED TO COLLECT DATA ON: demographics, medical history, unhealthy lifestyle markers (exposure to risk factors for chronic diseases), chosen treatment and details of "soft candle" use. The hospital records were accessed on discharge to records the main outcome measures: HbA1c readings, duration of hospitalization, amputation and in-hospital mortality. Two groups were defined: The control group included patients who sought medical attention after detecting a foot infection. The study group included patients who recognized their infection but voluntarily chose to utilize "soft candle" regimens. We excluded patients who voluntarily chose to use other forms of non-traditional treatment or sought no treatment at all. Outcomes were compared using SPSS ver 19. A two-tailed P value was calculated for variables of interest in each group using Fisher's exact test. The duration of hospitalization between the groups was compared using paired T-Test. A P value <0.05 was considered statistically significant.
  
  
  RESULTS
  There were 442 patients who met inclusion criteria: There were 60 patients in the study group at an average age of 55.2 years (SD ± 11.4; range 43-88): 63% had HBA1c readings >7.0% at presentation and 95% had unhealthy lifestyle habits. There were 382 patients in the control group at an average age of 59.1 years (SD ± 12.6, Range 37-89): 74% with HBA1c readings >7.0% at presentation and 48% with unhealthy lifestyle habits. Patients who used "soft candle" had significantly longer duration of hospitalization (15.5 ± 10.2 vs 9.2 ± 3.9 days; P<0.001) and major amputations (13.3% vs 5.6%; P=0.048) that was considered clinically significant. There was no difference in minor amputations (31.7% vs 34.3%; P=0.770) or in-hospital mortality (1.7% vs 0.52%; P=0.355) between the groups.
  
  
  CONCLUSIONS
  In its current form, the traditional practice of topical "soft candle" application to diabetic foot wounds may be potentially harmful. Persons with diabetes should be warned about these effects. We have identified the target population for educational campaigns.
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago, West Indies;
authors.forename: Shamir O
authors.initials: SO
authors.lastname: Cawich
authors.affiliation: Department of Surgery, San Fernando General Hospital, Trinidad & Tobago, West Indies.
authors.forename: Patrick
authors.initials: P
authors.lastname: Harnarayan
authors.affiliation: Department of Surgery, San Fernando General Hospital, Trinidad & Tobago, West Indies.
authors.forename: Shariful
authors.initials: S
authors.lastname: Islam
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago, West Indies;
authors.forename: Bobb
authors.initials: B
authors.lastname: Nahmorah J
authors.affiliation: Department of Surgery, San Fernando General Hospital, Trinidad & Tobago, West Indies.
authors.forename: Steve
authors.initials: S
authors.lastname: Budhooram
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago, West Indies;
authors.forename: Shivaa
authors.initials: S
authors.lastname: Ramsewak
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago, West Indies;
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ramdass
authors.affiliation: Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine Campus, Trinidad and Tobago, West Indies;
authors.forename: Vijay
authors.initials: V
authors.lastname: Naraynsingh
keywords: Alternative; Amputation; Diabetes; Foot Infection; Paraffin