Clinical Profile and Outcome in Patients of Diabetic Foot Infection.

PURPOSE: The aim is to study the clinical profile and outcome of patients presenting with diabetic foot infections (DFI). METHODS: This was a prospective study recruiting patients >18 years of age, with DFI. All patients underwent a detailed history and clinical examination. Patients were classified as per the International Working Group on the Diabetic Foot -IDSA classification. The patients were followed up every month for 3 months. Clinical outcome was studied regarding the rate of amputations, readmissions, and mortality. RESULTS: There were 65 patients with a mean age of 58.49 ± 11.04 years with male predilection (83.08%). Mean duration of diabetes mellitus was 12.03 ± 6.96 years. Ulcer (92.31%) and discharge (72.31%) were the most common presenting complaints. Monomicrobial growth was present in 36 patients (55.38%). Majority of isolates were Gram-negative (71.43%). The most common isolates were Escherichia coli and Staphylococcus aureus (28.57% each). Mild, moderate, and severe DFI was present in 40%, 47.69%, and 12.31% of patients, respectively. Severe DFI was associated with poor ulcer healing (P = 0.02) and higher number of major amputations (P < 0.001). Minor amputations were most commonly associated with moderate and severe DFI. Severe DFI had the highest number of readmissions (P = 0.04). Patients undergoing minor amputations had a significant association with area of ulcer (P < 0.001). CONCLUSION: This study shows the predominance of monomicrobial growth and Gram-negative organisms in diabetic foot patients. With increase in the severity of DFI, there was increased rate of hospital readmissions, amputations (major and minor), and mortality. Dimensions of ulcer may have a bearing on rate of minor amputations.

Ameboma of Colon Simulating Colonic Adenocarcinoma.

Amebiasis is common in tropical and developing countries with variable symptoms. Ameboma of the colon occurs rarely due to the annular growth of granulation tissue and can present as mass lesion simulating colonic carcinoma in elderly individuals. Due to diagnostic dilemma or in case of complications, for example, acute intestinal obstruction, perforation, or bleeding per rectum, the patient requires urgent surgical exploration and final diagnosis is made on histopathological examination.

Liquid Paraffin vs Hyaluronic Acid in Preventing Intraperitoneal Adhesions.

Adhesion formation after abdominal and pelvic operations remains a challenging problem. Role of adjuvant barriers have been studied but there is no comparative study between liquid paraffin and hyaluronic acid as a barrier method. Hence, we planned to compare the effectiveness of 0.4 % hyaluronic acid and liquid paraffin in the prevention of postoperative intraperitoneal adhesions in rats. This prospective, randomized and controlled study was conducted in 60 adult Wistar albino rats. Surgical trauma by caecal abrasion and 1 g talcum powder was used in the rat model to induce adhesion formation. After trauma, 3 ml normal saline was instilled in the peritoneal cavity in control group (n = 20), 3 ml liquid paraffin was instilled in experimental group A (n = 20) and 3 ml 0.4 % hyaluronic acid was instilled in experimental group B (n = 20). Two weeks after laparotomy, repeat laparotomy was performed and the adhesions were scored according to Zuhlke classification. Liquid paraffin and hyaluronic acid both reduce the extent and grade of adhesions both macroscopically (p = 0.018, p = 0.017) and microscopically (p = 0.019, p = 0.019) respectively. Although there was significant reduction in adhesions by hyaluronic acid at certain specific sites as compared with liquid paraffin, its overall effectiveness in preventing postoperative intraperitoneal adhesions is not significantly different from liquid paraffin (p = 0.092, p = 0.193) respectively. The presence of liquid paraffin and hyaluronic acid in the peritoneal cavity reduce postoperative intraperitoneal adhesions significantly in rats. However, there is no overall significant difference in the effectiveness of two groups. Dosage and safety of these chemicals in human beings remains to be established.

Literature search for research planning and identification of research problem.

Literature search is a key step in performing good authentic research. It helps in formulating a research question and planning the study. The available published data are enormous; therefore, choosing the appropriate articles relevant to your study in question is an art. It can be time-consuming, tiring and can lead to disinterest or even abandonment of search in between if not carried out in a step-wise manner. Various databases are available for performing literature search. This article primarily stresses on how to formulate a research question, the various types and sources for literature search, which will help make your search specific and time-saving.

Endoscopic Needle Knife Sphincterotome-an Alternative for Retrieval of an Entrapped Nasogastric Tube.

Knowledge of the use of a nasogastric tube (NG) is integral in medical practice as a whole and more so in gastrointestinal diseases because of its wide range of uses. Accidental fixation of the nasogastric tube during surgery is a rare complication. Various methods have been described for retrieval of an entrapped, retained or stapled nasogastric tube. We describe here a novel technique in which an endoscopic needle knife sphincterotome using a side-view endoscope was used successfully to cut the knots and release the entrapped NG tube. Although stress should always be laid on prevention, the flexible endoscopic approach is a small-duration procedure, a minimally invasive, cost-effective technique for the removal of a nasogastric tube that avoids the need of redo surgery and unnecessary exposure to anaesthesia.