Impact of multidisciplinary management via special clinic for the outcome of diabetic foot disease: A prospective observational study.

Introduction: Diabetic foot is a common complication of diabetes mellitus, affecting approximately 15-20% of individuals with diabetes. It is a comorbid condition that significantly impacts the routine life of patients. This study aimed to assess multidisciplinary management strategies and their impact on the outcomes of patients with diabetic foot. Methods: A prospective observational study was conducted on 56 patients with diabetic foot. Outcome measures included the type of surgery, frequency of surgery, morbidity, mortality, patient satisfaction, return to work, and the number of patients using prostheses. Results: The majority of the patients (87%) received surgical treatment. The most common type of surgery performed was debridement (55%), followed by minor amputations (toes amputation/forefoot amputation) (28%) and major amputations (below-knee (B/K) or above-knee (A/K)) (15%). More than 70% of patients had multiple surgeries. The mortality rate was low (7%), and 71% of surviving patients were satisfied with their treatment. Sixty-seven percent of patients had an early return to work. The number of patients using prostheses was also high (73% of major amputation cases). Conclusion: Multidisciplinary management is the most effective approach for diabetic foot patients. These patients may experience less morbidity and an early return to work. A specialized care clinic for diabetic foot patients is essential to prevent treatment failure, loss of follow-up records, permanent limb loss, and economic burdens on society.

Assessment of self-esteem and quality of life in patients with transtibial amputations using an exoskeletal prosthesis.

BACKGROUND: Lower limb amputation can have profound physical, psychological, and social effects on individuals. Assistive aids like prosthetic lower limbs can help an individual regain mobility and thereby affect their self-esteem and quality of life. OBJECTIVE: To assess self-esteem and quality of life in patients with transtibial amputations who are using a transtibial prosthesis and explore the association between sociodemographic and amputation-related factors with self-esteem and prosthesis-related quality of life measures. DESIGN: A cross-sectional study. SETTING: An orthotics and prosthetics center (Bhagwan Mahaveer Viklang Sahayata Samiti) in Jaipur, Rajasthan. PARTICIPANTS: Patients with transtibial amputations using exoskeletal prostheses between July and September 2022, in Jaipur, Rajasthan. MAIN OUTCOME MEASURES: The study used Rosenberg self-esteem questionnaire and Prosthesis Evaluation Questionnaire (PEQ) for self-esteem and quality of life assessment, respectively. Descriptive analysis was used to present the demographic details, and nonparametric tests examined the relationship between PEQ dimensions and sociodemographic variables. RESULTS: The study included 138 participants, primarily <40 years old (45.7%) and mostly engaged in high-activity occupations. Self-esteem mean score (SD) was 19.9 (3.9), with 89.1% exhibiting normal self-esteem. Prosthesis-related quality of life, showed high satisfaction across various domains, including ambulation, appearance, frustration, perceived response, residual limb health, social burden, sounds, utility, and well-being. No significant associations were found between sociodemographic factors, amputation-related variables, and self-esteem. However, PEQ scales showed associations with gender, age, occupation, type of amputation, and years of prosthesis use. CONCLUSION: These results highlight the potential advantages of exoskeletal prostheses in improving the standard of living for people with transtibial amputations. Further research is essential to develop targeted interventions for improving their overall quality of life.

An uncommon case of a fleeting rash from Western Rajasthan.

A 35 year old farmer presented with an erythematous serpiginous rash on dorsal aspect of left foot with intense pruritus and a feeling of something moving slowly in the rash. The photo of the rash is presented below and the case is discussed further.

A 12-Month Randomized Controlled Trial to Assess the Impact of Telemedicine on Patient Experience and Care Continuity.

BACKGROUND: Telemedicine is the use of electronic information to communicate technologies to provide and support healthcare when distance separates the participants. Satisfaction and engagement of patients are key resource indicators for any healthcare setup and healthcare provider for evolving the care continuum (a system that provides a comprehensive range of health services so that care can evolve with the patient over time) and ensuring continuous quality improvement in the systems. As the latest remarkable strategy to connect with patients for consultations and follow-up, telemedicine has been of pivotal importance, especially during the coronavirus disease 2019 (COVID-19), where medicinal services utilize digital sound, video, and information interchanges to remotely access and provide care. MATERIALS AND METHODS: A cross-sectional study was planned during the second wave of the COVID-19 pandemic from April 2021 to April 2022 to assess the impact of telemedicine in essential healthcare delivery by super specialty tertiary care healthcare setup, which is also a medical college, by three consultants and a physiotherapist. RESULTS: There was a significant improvement in satisfaction scores and an improvement in the approach of patients towards telemedicine was observed. Various other parameters, like readmission compliance with medications and a reduction in ED times, were also observed. Finally, clinical endpoints were captured, and the correlation between readmission and medicine adherence was found to be strongly correlated (r = 0.9). A p-value of the reduction in utilization times of ED (emergency department), readmission, and medicine adherence was found to be highly significant Conclusions: Telemedicine is the need of the hour and is now an essential part of healthcare. Its acceptance post-COVID-19 pandemic and adaptability into existing healthcare setups would deliver fruitful results.

Can ultrasound-guided radiofrequency ablation of genicular nerves of the knee, be performed without locating corresponding arterial pulsations-a cadaveric study.

INTRODUCTION: Given the rising prevalence of knee osteoarthritis, radiofrequency ablation of genicular nerves (RFA) has emerged as a promising treatment option for knee pain. The knee has an extremely complex and variable innervation with nearly 13 genicular nerves described. The frequently ablated genicular nerves are the superomedial (SMGN), the superolateral (SLGN), and the inferomedial (IMGN) genicular nerves. Conventionally, under ultrasound guidance, these nerves are ablated near the corresponding arterial pulsations, but due to the rich vascular anastomosis around the knee joint, identifying the arteries corresponding to these constant genicular nerves can be tedious unless guided by some bony landmarks. In this study, we have evaluated whether it is possible to accurately target these three genicular nerves by just locating bony landmarks under ultrasound in human cadaveric knee specimens. METHODS: Fifteen formalin-fixed cadaveric knee specimens were studied. SMGN was targeted 1 cm anterior to the adductor tubercle in the axial view. For SLGN, in the coronal view, the junction of the lateral femoral condyle and shaft was identified, and at the same level in the axial view, the crest between the lateral and posterior femoral cortex was targeted. For IMGN in the coronal view, the midpoint between the most prominent part of the medial tibial condyle and the insertion of the deep fibers of the medial collateral ligament was marked. The medial end of the medial tibial cortex was then targeted at the same level in the axial view. The needle was inserted from anterior to posterior, with an in-plane approach for all nerves. Eosin, 2% W/V, in 0.1 ml was injected. Microdissection was done while keeping the needle in situ. Staining of the nerve was considered a positive outcome, and the percentage was calculated. The nerve-to-needle distance was measured, and the mean with an interquartile range was calculated. RESULT: The accuracies of ultrasound-guided bony landmarks of SMGN, SLGN, and IMGN were 100% in terms of staining, with average nerve-to-needle distances of 1.67, 3.2, and 1.8 mm respectively. CONCLUSION: It is with 100% accuracy, that we can perform RFA of SMGN, SLGN, and IMGN under ultrasound guidance, by locating the aforementioned bony landmarks.

Clinical Profile, Follow-up, and Role of Neuroimaging in Pediatric Guillain-Barré Syndrome in the COVID Era: An Ambispective Study.

Background: To define the varied presentations of Guillain-Barré syndrome in children in the COVID era and 6 months' follow-up outcome. Methods: Ambispective study of 15 months' duration involving children with Guillain-Barré syndrome aged 1 month to 18 years at a tertiary care pediatric hospital. They were categorized into groups A and B based on COVID-19 serology testing. Hughes Disability Scale was used for disability assessment. Modified Rankin scale was used for improvement assessment in follow-up. Results: Of 19 children with Guillain-Barré syndrome, 9 (47%) were females and 10 (53%) were males. Groups A and B had children with negative (8) and positive serology (11), respectively. The most common presentation in both groups was motor weakness. Post-COVID pediatric Guillain-Barré syndrome presented with variants of Guillain-Barré syndrome rather than the classical form (P = .03). In group B, patients with elevated inflammatory markers had poor response to intravenous immunoglobulin, and 5 of 11 patients had good response to pulse steroids, probably depicting an inflammation-predominant pathology. Conclusion: Post-COVID Guillain-Barré syndrome in children presented with Guillain-Barré syndrome variants rather than the classic form. Neuroimaging is of great value in both confirming Guillain-Barré syndrome diagnosis and excluding differentials. Patients with elevated inflammatory markers and residual weakness may be given a pulse steroid trial.

Repercussions of Caregiving on Caregivers of Stroke Survivors: A Cross-Sectional Study.

BACKGROUND: Stroke is one of the most common causes of disability. Stroke survivors may have a wide variety of sensorimotor, cognitive, perceptual, and behavioral dysfunctions. The majority of long-term care for stroke survivors in residential settings is provided by informal caregivers, such as family members. This study was conducted to assess the burden of caregiving on caregivers of stroke survivors. MATERIALS AND METHODS: This cross-sectional study was conducted by the Department of Physical Medicine and Rehabilitation in a tertiary care institute in Western India. Patients were evaluated for inclusion and exclusion criteria. Caregiver strain among caregivers was assessed using the Modified Caregiver Strain Index Questionnaire (MCSI). The Katz index was used to assess activities of daily living. RESULTS: The inclusion and exclusion criteria were fulfilled by 125 primary caregivers of stroke patients. Among stroke survivors, the majority were male (57.6%), and caregivers were wives of stroke survivors (28.8%). There was a significant statistical difference in the median of the modified caregiver strain index when the stroke survivor was male (p=0.034), fully dependent (p<0.001), and had a hemorrhagic stroke (p<0.001). There was no significant statistical difference in the median of the MCSI based on the sex of caregivers (p=0.928). There was a positive correlation between the age of the patient and MCSI (r=0.373, p<0.001). No correlation was found between the MCSI and age of caregivers (r=-0.108, p=0.230) and duration of stroke (r=-0.089, p=0.321). CONCLUSION: The findings in our study provide evidence that caregivers of stroke survivors experience significant levels of strain. It is desirable to recognize caregiver strain during the rehabilitation of stroke survivors and manage it appropriately.

Bowel Management in Patients With Chronic Spinal Cord Injury: A Cross-Sectional Survey.

Introduction Spinal cord injury (SCI) impairs colorectal movement, transit time, and complete evacuation at defecation. Incontinence has been documented to affect quality of life across the globe in different proportions. Bowel management has been recognized as a key factor in SCI patients' participation in the society and leading a satisfactory life. Limited information on bowel management in SCI patients drove us to study the demographic profile and bowel management in a group of chronic SCI patients at a tertiary care rehabilitation center. Methods A total of 42 adults (age: 18-60 years) with SCI and duration > 12 months were enrolled. Patients were evaluated with a semi-structured questionnaire containing both open and closed questions. Data were collected and analyzed using Statistical Package for Social Sciences (SPSS) Version 10. Results Most (52.4%) of the patients were manual laborers (85.7% males). Mean age was 37.6 ± 11 years. The injury level was predominantly thoracic level (69%). Only eight (19%) patients had fecal incontinence; 21(50%) patients used suppository and only six patients were using laxatives. Impacted stool was the most common complication followed by hemorrhoids. Conclusion Young paraplegics is the most common age group affected by SCI. Most of the patients managed their bowel well conservatively with good adherence to bowel rehabilitation program. The study findings emphasize on patient-centric bowel management in SCI patients to reduce the impact on quality of life and minimize complications.

Efficacy of Ultrasound-Guided Particulate Versus Nonparticulate Steroid Injection in Carpal Tunnel Syndrome: An Open-Label Randomized Control Trial.

Introduction Perineural corticosteroid injection is an extensively used and accepted treatment for carpal tunnel syndrome (CTS). However, to this date, there is no guideline as to which corticosteroid has to be used as the standard treatment for CTS. Triamcinolone acetonide is a commonly used particulate steroid that can cause permanent nerve injury if it is accidentally injected into the nerve. Conversely, dexamethasone sodium phosphate is a nonparticulate steroid that would not cause permanent nerve damage following accidental injection. Methods Mild to moderate cases of CTS, confirmed by nerve conduction studies (NCS), with symptoms greater than three months were recruited. The participants received one session of ultrasound-guided perineural injection by the in-plane axial ulnar-sided approach with 4 mL of either dexamethasone (dexamethasone sodium phosphate 8 mg (2 mL) + 2 mL 0.5% bupivacaine) or triamcinolone (triamcinolone acetonide 40 mg/mL (1 mL) + 2 mL 0.5% bupivacaine + 1 mL normal saline) solution. The parameters assessed were Phalen's test time (in seconds), visual analog scale (VAS), and Boston carpal tunnel questionnaire (BCTQ) scores at baseline and two and four months, and NCS changes in sensory nerve conduction velocity (SNCV) and distal motor latency (DML) of the median nerve at baseline and four months. Statistical analysis was conducted using the software SPSS version 26.0 (IBM Corporation, Armonk, NY, USA). Independent samples t-test was used for comparison between groups and the paired t-test for improvement within each group. P values < 0.05 were considered statistically significant. Results The mean age was 42.64 ± 10.99 in the dexamethasone and 45.22 ± 10.602 in the triamcinolone group cases (P = 0.324).There were 58 females (84.06%) and 11 males (15.94%). Each of Phalen's test time, VAS, and BCTQ scores significantly improved within both dexamethasone and triamcinolone groups at the second and fourth months after injection (P < 0.05). The NCS parameters (SNCV and DML) also significantly improved in both groups at the fourth month after the injection (P < 0.05). However, there were no significant differences in the improvement of Phalen's test time between the two groups (P = 0.745), VAS score (P = 0.319), BCTQ score (P = 0.137), SNCV (P = 0.511), or DML (P = 0.753). Postprocedural pain lasted significantly longer in the triamcinolone group (P < 0.05). No major complications were noted in either of the two groups. Conclusion Dexamethasone is as effective as triamcinolone in improving the symptoms of CTS and can be used as a safer and more effective alternative in the treatment of mild to moderate CTS cases.

Assessment of Physical Disability After Three Months in Patients Recovered From COVID-19: A Cross-Sectional Study.

PURPOSE: This study was done to assess the extent of disability in coronavirus disease 2019 (COVID-19) survivors using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). MATERIAL AND METHODS: This was a cross-sectional study with convenient sampling. Institutional ethical clearance was taken. Informed consent was taken from all patients. Disability assessment was done using WHODAS 2.0. All patients were initial reverse transcriptase-polymerase chain reaction (RT-PCR) positive for COVID-19. Patients with neuromuscular deficits or who were taking medication for psychiatric illness before getting infected with COVID-19 were excluded from the study. RESULTS: Fatigue followed by dyspnea was the most common reported symptom after three months of COVID-19 infection. COVID-19 survivors with fatigue or dyspnea had a more significant disability as compared to other patients. Females had a more significant disability when compared to males. We did not find any significant disability in COVID-19 survivors after three months of disease based on body mass index, hospitalization, diabetes, and oxygen requirements. CONCLUSION: COVID-19 survivors suffered from significant disability after three months of disease especially females and survivors with fatigue or dyspnea. Recognizing post-COVID-19 sequelae and the availability of rehabilitation services will be critical in preventing another public health crisis after acute COVID-19 infection.

Model of Streptozotocin-nicotinamide Induced Type 2 Diabetes: a Comparative Review.

The aim of the present study was to review the streptozotocin-nicotinamide (STZ-NA) diabetes model. Type 2 diabetes is more prevalent (90-95%) in adults than type 1. Experimentally- induced diabetes models may be established by chemicals, viral agents, insulin antibodies, surgery, etc. The most advisable and prompt method to induce diabetes is using chemicals, and STZ and alloxan are widely used chemicals. STZ has proven to be a better diabetogenic agent than alloxan because alloxan has many drawbacks, as it induces only type 1 diabetes, has a high mortality rate in rats, and causes ketosis in animals. Moreover, it has lesser selectivity towards ß-cells, and the diabetes-induced is reversible. STZ can be used to induce both type 1 and type 2 diabetes. It is noted that the genotoxic behavior of STZ in animals is accomplished through a reduction of nicotinamide adenine dinucleotide (NAD+) in pancreatic ß-cells via the GLUT2 (Glucose transporter 2), which can cause cellular damage by DNA (Deoxyribonucleic acid) strand breaks that lead to cell death. NA is a biochemical precursor of NAD+, and it is a poly-ADP-ribose-polymerase-1 (PARP- 1) inhibitor. NAD+ is an important redox reaction co-enzyme for the production of adenosine triphosphate (ATP) and many other metabolic pathways. Extreme DNA damage contributes to the over-activation of PARP-1, loss of cellular resources, and necrotic cells death. Some studies have expressed that NA can protect pancreatic ß-cells against the severe cytotoxicity of STZ. The review concluded that the STZ-NA model is dependent on the competency of NA to attain partial protection against the ß-cytotoxic essence of STZ to induce type-2 diabetes.

Role of microbiological tests in diagnosis of genital tuberculosis of women with infertility: A view.

OBJECTIVE: India is a country sharing one fourth of the global incidence of tuberculosis. It is much easier to diagnose pulmonary cases, but challenges are with extrapulmonary cases. Genital tuberculosis is considered as an important cause of infertility in young females in India and difficult to diagnose. It requires incorporation of different modalities that should correctly, timely and rapidly diagnose the case. METHODS: This study was conducted retrospectively for a period of 12 months on 438 endometrial samples from females with history of infertility. Three modalities namely Ziehl-Neelsen staining, Automated liquid culture and Nucleic acid amplification technique (TB-PCR) were compared and their sensitivity in diagnosis of genital tuberculosis was ascertained. RESULTS: Out of 438 samples, 18 samples were found positive with at least one modality. TB-PCR positivity was 3.6% (16 cases) in comparison to culture where positivity was 1.59% (7 cases). Five samples were found culture and TB-PCR positive and only one sample was positive by all three diagnostic tests. CONCLUSION: Infertility in young female per se is usually heart breaking and distressing. Therefore, it is essential to diagnose and treat the cases of genital tuberculosis before irreversible damage of tube may happen. Although, advancement in diagnostic field is there from microscopy to molecular method, but still diagnosis of genital tuberculosis is challenging. Correct diagnosis prevents young female from mental trauma and toxicity of anti-tuberculosis drugs given on suspicion in high prevalence country like India.