Background: Diabetic foot ulcers (DFUs) are the most common and serious complications in uncontrolled diabetes. Infections are predominantly polymicrobial, with aerobic Gram-positive, anerobic, and fungal infections. Early detection of fungal infection and initiation of appropriate treatment in DFUs may lead to better healing and avoid amputations. The primary objective was to find out the prevalence of DFUs getting infected with fungus and the secondary objective was to identify the appropriate methodology for the detection of the fungus in DFUs.Materials and methods: This was a cross-sectional observational study carried out in a tertiary care hospital with a sample size of 60 DFUs. Microbiological analysis was done by swab culture and deep tissue culture. Observational data were collected and the significance level was statistically analyzed.Results: In the present study, the prevalence of fungal infections in DFUs was 31.7%. Only fungal tissue was positive in 15%, the fungal swab was positive in 8.33%, and both tissue and swab were positive in 8.33%. All these patients were treated with antifungal treatment as per the culture report in addition to appropriate antimicrobial therapy. Conclusion:A fungal culture should be done in all patients with non-healing DFUs. Both fungal swab and tissue culture testing should be advocated in patients with DFUs for better mycological evaluation. The addition of antifungal medications may provide better outcomes in selected cases.
BACKGROUNDRespiratory cytology has assumed a primary diagnostic place in the makeup for patients with pulmonary disease. Diagnosis of cellular specimens from the respiratory tract is established throughout the world as a vital diagnostic procedure in evaluation of any patient with a suspected lung lesion in which morphological confirmation is indicated. At present, most of the major medical institution throughout the world utilise some combination of various cytological specimens in the diagnostic workup of patient with suspected lung cancer.
Diabetes mellitus predisposes to the formation of gallstones. Surgery for gallstone disease (GSD) in diabetic patients also carries more risk compared with nondiabetic patients. The objective of the present study was to evaluate the intraoperative findings of elective laparoscopic cholecystectomy in diabetics and nondiabetics. MethodsThis study was carried out for two years in the department of general surgery as a prospective observational study. Two groups of patients with uncomplicated gallstone disease were recruited: one group included 75 diabetics and the other one included 75 nondiabetics. The two study groups were matched by age and gender. Detailed history and intraoperative findings and their outcomes were recorded. Patients with emergency laparoscopic cholecystectomy for acute cholecystitis and its complications and cholecystectomy associated with common bile duct (CBD) stones were excluded from the study. ResultsThe results of elective laparoscopic cholecystectomy in the groups were compared. No demographic differences were found between the groups. Adverse intraoperative findings such as thick-walled gallbladder (GB), pericholecystic collections, and adhesions to the surrounding structures, surgical difficulties, modification to subtotal cholecystectomy, and open conversion were more frequent in diabetic patients than in nondiabetic patients. ConclusionLaparoscopic cholecystectomy in diabetic patients had more adverse intraoperative findings in comparison to nondiabetic patients. However, in elective laparoscopic cholecystectomy, good preoperative preparation and meticulous surgical technique are mandatory to achieve similar outcomes between the groups.
Introduction Acute appendicitis is a common surgical emergency. Clinical assessment plays a major role; however, subtle clinical features in early stages and atypical presentation makes diagnosis challenging. Ultrasonography (USG) of the abdomen is a usual investigation that aids in diagnosis, however, it is operator dependent. A contrast-enhanced computed tomography (CECT) of the abdomen is more accurate; however, it exposes the patient to hazardous radiation. The study aimed to combine clinical assessment and USG abdomen in the reliable diagnosis of acute appendicitis. Objectives The objective of this study was to assess the diagnostic reliability of the Modified Alvarado Score and ultrasonography of the abdomen in acute appendicitis. Material and methods All patients with right iliac fossa pain, clinically suspected of having acute appendicitis, admitted to the department of general surgery, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, between January 2019 and July 2020, who gave consent were included. Clinically, Modified Alvarado Score (MAS) was calculated, after which patients were subjected to USG abdomen, where findings were noted and a sonologic score was calculated. The study group was the patients who needed appendicectomy (n=138). Operative findings were noted. Histopathological diagnosis of acute appendicitis was deemed as confirmatory in these cases and was correlated with MAS and USG scores to determine diagnostic accuracy. Results A combined clinicoradiological (MAS + USG) score of seven showed a sensitivity of 81.8% and a specificity of 100%. The specificity of score seven or above was 100%; however, the sensitivity at 81.8%. The diagnostic accuracy of the clinicoradiological was 87.5%. The negative appendicectomy rate was 4.34%, with a diagnosis of acute appendicitis being confirmed for 95.7% of patients upon histopathological examination. Conclusion The MAS and USG of the abdomen, which is an affordable and non-invasive tool, showed increased diagnostic reliability, and hence it can help reduce the use of CECT abdomen, as CECT abdomen is considered as a gold standard for confirmation or exclusion of diagnosis of acute appendicitis. Use of the combined scoring system of MAS and USG abdomen can be used as a cost-effective alternative.
BACKGROUND Traditional approach to pathological diagnosis includes histopathological examination of paraffin sections stained with a variety of histochemical techniques. These routine approaches may be disappointing at times in differentiating benign from malignant lesions and occasionally fail to render a precise diagnosis. There has been a growing interest in the study of DNA and proliferation markers. One of the most recent studies is on Nucleolar Organiser Regions (NORs) using a simple silver reduction technique (AgNOR) method. 1 Aim of the Study-This study was conducted to correlate cytological and histopathological diagnosis of breast lumps, to categorise lesions as benign or malignant and to evaluate the AgNOR counts in differentiating benign and malignant tumours. MATERIALS AND METHODS Eighty-four patients referred to Department of Surgery in Jawaharlal Nehru Medical College, Aligarh were screened for this study. The study was conducted from April 2000 to September 2001 over a period of 17 months. Patients were counseled, and an informed consent was taken. Upon enrolment and clinical examination, the patients were subjected to FNAC of breast and lymph node, if present and surgical excision with histopathology wherever possible. The data is presented as mean and standard deviation. All the observations of AgNOR count were statistically evaluated by using students' 't' test. RESULTS In our study, 80 (95.2%) cases were female and remaining 4 (4.8%) cases were male. There were 32 (38.1%) cases of benign lesions and 52 (61.9%) were malignant lesions. The range of AgNOR counts in benign lesions were found to be 1.9-3.2 (2.30.26). The range of AgNOR counts in malignant lesions was found to be 4.9-6.8 (5.370.3). There was significant statistical difference (p < 0.005) between AgNOR counts in benign and malignant lesions. CONCLUSION This study concludes that AgNOR counts and dispersion pattern of AgNOR dots have a diagnostic value in distinguishing benign from malignant lesions of breast.
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