Study of Diabetic Foot Problems Among Patients Attending the Diabetic Foot Clinic at Royal Hampshire County Hospital, United Kingdom: A Single-Centre Experience.

Background Patients with diabetes mellitus (DM) are on the rise all over the world. Simultaneously, the complications of DM are also increasing. Diabetes-related foot problems have been another concern among health professionals, especially foot ulcers, osteomyelitis, and amputations. Objectives We determined the prevalence of gender, age, types of DM including non-diabetics, various foot-related presentations, complications, and their outcomes. Methods A retrospective descriptive cross-sectional study was conducted among new patients attending a diabetic foot clinic over a period of six months, from January 1, 2019 to June 30, 2019. To confirm the outcome of the study, all of them were followed up for at least four months from the date of diagnosis. Results The study showed that most patients were males (65.5%). The most common age group for diabetic foot problems was 81-90 years, and about 80% of the foot problems were diagnosed in patients over 60 years. The study disclosed that 86.2% of the population had type 2 DM, 56.9% had ulcers, and 13.8% had osteomyelitis. The outcome of our study demonstrated that 65.5% of the patients were cured and discharged within four months of the diagnosis, but 10.3% of the population needed amputation. During the four-month follow-up period, 3.4% of our study population died due to non-foot-related causes. A total of 48.1% of our ulcer patients were discharged within eight weeks of diagnosis. However, 26% of ulcer patients and 75% of osteomyelitis patients needed more than four months to be discharged. Peripheral neuropathy and peripheral arterial disease (PAD) were present in 91% of ulcer patients. Among our osteomyelitis group, 100% had peripheral neuropathy, and 87.5% had PAD. About 20% of ulcer patients and none of the osteomyelitis patients were diagnosed with chronic kidney disease (CKD) stages beyond 3b. About 2/3rd of our ulcer and osteomyelitis population had an HbA1C level of more than 7.5%. Conclusion Male patients over 60 years of age with type 2 DM are more at risk of developing diabetes-related foot issues. Ulcer with or without osteomyelitis was the most common complication among our study population. Results showed that a significant amount of osteomyelitis patients underwent foot amputation. Poor glycaemic control of HbA1C of more than 7.5%, peripheral neuropathy, and PAD were the most common risk factors for developing foot-related complications. Prolonged use of antibiotics and a dedicated professional team may be needed to manage these complications successfully.

Infective Endocarditis Following Post-COVID Organizing Pneumonia Complicated by Multiple Splenic Abscesses and Glomerular Nephritis.

The association of glomerular nephritis and infective endocarditis with liver abscesses is a clinically complex entity that often makes the diagnosis challenging. Here, we report a case of a 50-year-old woman who presented with a febrile illness of two weeks' duration along with myalgia and malaise of four days' duration. She had a background history of well-controlled type 2 diabetes mellitus for five years with a past history of ischemic heart disease diagnosed five years ago. At the time of presentation, she was on long-term steroids for post-coronavirus disease (COVID) organizing pneumonia diagnosed three months back. With serial investigations, she was found to have subacute bacterial endocarditis with multiple liver and splenic abscesses. She was managed with antibiotics as per local protocols after which she made a successful recovery of her clinical status. The uniqueness of this case is the development of rare complications of subacute bacterial endocarditis in the background of immunosuppression.

Aseptic Abscess of the Spleen as an Antecedent Manifestation of Behçet's Disease.

Behçet's disease (BD) is a multisystem autoimmune vasculitis that manifests as oral and genital ulcers with varying degrees of dermatological and ocular involvement. Aseptic splenic abscesses are a rare entity commonly occurring in autoinflammatory diseases and are rarely associated with BD. Here, we present the case of a 16-year-old male with BD who presented with prolonged fever and constitutional symptoms and was found to have an aseptic splenic abscess. Rapid resolution of the symptoms along with radiological evidence of abscess shrinkage was achieved with corticosteroid therapy.

Demographic Characteristics and Disease Pattern Among Non-COVID-19 Patients Admitted to Medical Units of a Tertiary Care Hospital in Sri Lanka During Lockdown of the COVID-19 Pandemic: A Comparison During and Before Lockdown.

BACKGROUND: The COVID-19 infection was rapidly spreading almost all over the world, and the first case was confirmed on 27th January 2020 by a foreign tourist in Sri Lanka. The first Sri Lankan citizen with COVID-19 was confirmed on 11th March 2020. Soon after the confirmation of the disease, long days of lockdown were imposed in almost all parts of the world, including Sri Lanka, to control the spread of the disease.  Objectives: To determine the demographic characteristics such as age, sex, number of patients, and disease pattern among non-COVID-19 patients admitted to the medical units during the lockdown of the COVID-19 pandemic and to compare these characteristics with the data before the lockdown. METHODS: This was a cross-sectional analytical study. It was conducted at the Teaching Hospital in Batticaloa, Sri Lanka. All the non-COVID-19 patients admitted to medical wards and intensive care units (ICU) were included in this study. Patients admitted to the medical intensive care unit (MICU) and coronary care unit (CCU) were considered ICU admissions in this study. They were studied over a period of one month during lockdown (11th March 2020 to 10th April 2020) and compared with the patients admitted one month prior to the lockdown (11th February 2020 to 10th March 2020). RESULTS: Totally, 2340 non-COVID-19 patients (52.5% males) were admitted before the lockdown, and 1376 non-COVID-19 patients (56.2% males) were admitted during the lockdown. This reduction in admission is statistically significant (p-value is <0.001, df=3715). Patients admitted to the wards before lockdown were 2283 (97.6%) and during lockdown were 1309 (95.1%). ICU admissions were N=57 (2.4%) before lockdown and N=67 (4.9%) during lockdown. The common age distribution before the lockdown showed that 26.4% were 31-50 and 41.5% were 51-70 years. Similarly, during lockdown, the age distribution disclosed that 28.9% were 31-50 years and 42.9% were 51-70 years. The disease pattern demonstrated that before lockdown, the majority of patients were admitted for routine hemodialysis (13.2%), to get an injection (9.9%), ischemic heart disease (8.4%), chronic kidney disease (7.3%), and viral fever, including dengue (7.2%). Likewise, during lockdown, more patients were admitted for routine hemodialysis (10.7%), viral fever, including dengue (9.3%), ischemic heart disease (8.8%), to get an injection (8.5%), and chronic kidney disease (5.9%).  Conclusion: There was a significant reduction in the number of non-COVID-19-related admissions during the period of lockdown. However, there was not much difference in the proportion of admissions according to gender, age, and disease pattern before and during lockdown. More number of male patients were admitted than female patients. Most of the admitted patients were under the age group of 51-70 years. The highest number of patients were admitted for routine hemodialysis before and during lockdown. However, a slightly higher number of patients were admitted to the ICU during lockdown. Therefore, strengthening the ICU facilities may be an important preparation to accommodate more patients in the future if a similar kind of emergency lockdown occurs in a pandemic situation. In addition, admissions due to non-communicable diseases (NCD) didn't fall in proportion during the pre-COVID-19 period and the lockdown period. Therefore, the redistribution of healthcare facilities needs to be done wisely to face the challenges caused by the NCDs.

Herpes Zoster in a Patient With Dengue Infection: A Case Report of a Rare Co-Infection.

Dengue is an infectious disease that plays an essential role in morbidity and mortality in developing countries. Occasionally, it presents with rare presentations and co-infections. Co-infection of herpes zoster and dengue is possible in countries such as these where both infections are common. Varicella-zoster infection is one of the self-limiting viral infections, and dengue fever is an endemic infection in Sri Lanka. When there is suspicion in diagnosis due to a change of natural course or overlapping of clinical features, concurrent co-infections have to be strongly suspected. We present the case of a 46-year-old female who had herpes zoster and dengue infection and was managed with a multidisciplinary team approach. The patient improved without any complications.

Systemic Melioidosis Presenting as Septic Arthritis.

Melioidosis is a pyogenic infection that is potentially fatal, caused by the bacterium Burkholderia pseudomallei, which is commonly a soilborne pathogen.It is endemic in the Indian subcontinent, northern Australia, and Southeast Asia. Melioidosis has a wide spectrum of clinical manifestations that can mimic various diseases. Septic arthritis is a rare but well-known clinical presentation. Here, we report a case of an adult presenting with acute knee joint pain and swelling. He was subsequently found to have septic arthritis with other system involvement and diagnosed as a case of melioidosis; he responded well to the treatment.

Diagnosis of Multisystem Inflammatory Syndrome in Children in a Resource-Limited Center.

Multisystem inflammatory syndrome in children (MIS-C) has become a serious disease entity following the high prevalence of coronavirus disease 2019 (COVID-19) infection with the involvement of gastrointestinal organs, kidneys, heart, and lungs. When the patient presents with mucocutaneous findings such as conjunctival injection, red lips, neurocognitive symptoms, swollen hands and lymphadenopathy, it is always highly recommended to exclude multisystem inflammatory syndrome.  As it affects multiple organs, it can result in more serious consequences. The manifestations depend largely on the organ involved. Therefore, successful management partly depends on the early diagnosis. Many treatment strategies have been put forth to tackle the disorder so far.

First Case of Autoimmune Hemolytic Anemia Associated With COVID-19 Infection in Sri Lanka: A Case Report.

Autoimmune hemolytic anemia (AIHA) is a condition characterized by the increased destruction of red blood cells (RBCs) mediated by anti-erythrocyte autoantibodies with or without complement activation. Its clinical presentation is heterogeneous, ranging from asymptomatic to severe forms with fatal outcomes, and it can be either idiopathic or secondary to a coexisting disorder. In this report, we present a case of a patient who suffered from her first episode of acute and severe AIHA during Severe Acute Respiratory Syndrome Coronavirus - 2 (SARS-CoV-2) and responded well with the treatment.

A Pregnant Patient Presenting With Unilateral Sacroiliitis Following Dengue Hemorrhagic Fever: A Case Report.

Dengue virus infection is an arthropod-born infection with high global prevalence. A spectrum of clinical syndromes and complications were recognized following dengue fever that can range from undifferentiated fever to dengue shock syndrome. Neurological complications following dengue fever can extend to various sequelae, including transverse myelitis. We report a 20-year-old pregnant woman with a recent diagnosis of dengue hemorrhagic fever (DHF) at the period of amenorrhea (POA) of 28 weeks, presenting with left-sided severe buttock pain. Following extensive investigations, we found left-sided sacroiliitis to be the cause of the buttock pain. She completely recovered with appropriate management.

Cytomegalovirus-Associated Splenic Infarction in a Young Female Patient.

Cytomegalovirus (CMV) infection generally causes asymptomatic infection in the majority of immunocompetent individuals. However, the presentation may be complicated by life-threatening conditions in immunocompromised patients. We report a case of a 23-year-old healthy Caucasian female with acute CMV infection and splenic infarction. Serological studies confirmed acute CMV infection, and echocardiography did not show any evidence of endocarditis or mural thrombosis. We did not consider antiviral and anticoagulation therapies due to the immunocompetent nature of the patient and since the condition was suspected to be a minor vessel disease likely triggered by CMV infection.