Diabetes is the common cause for amputation of lower limb. Foot ulcers and associated complications are important causes of mortality and morbidity in patients with diabetes. Hence, it is important to predict diabetic foot ulcer in its early stages to eliminate the risks of foot amputation. Inlow’s 60 second diabetic foot ulcer screening tool is gaining immense attention over the years which is associated with its simplicity to use, rapid detection of high risk diabetic feet, and provides referral for patients necessitating treatment. A systematic review is conducted to assess the reliability and credibility of using Inlow’s 60 second diabetic foot screening tool for diabetic foot risk stratification and to examine its feasibility in the Indian context. Eight studies suited the inclusion criteria which were analysed systematically. The findings of the paper reveal that the sixty second tool acts as a better tool for diabetic foot ulcer risk stratification; however, modifications are necessary for its application in the Indian context.
Valentino syndrome is one of the rare classical presentations of duodenal perforation, wherein the leaked contents collect at the right lower quadrant of the abdomen causing local peritonitis and mimicking appendicitis. Here we present a case profile of a 28-year-old gentleman, who presented with right lower quadrant abdominal pain and mass, which was clinically diagnosed as acute appendicular inflammatory mass. Later with laboratory reports and radiological imaging, he was confirmed to have acute pancreatitis, and actually the peripancreatic fluid collection has tracked down into the right iliac fossa and pelvis to present similar to Valentino syndrome. This article is reported to highlight acute pancreatitis as a cause of Valentino syndrome.
Sentinel lymph node biopsy is the widely acceptable method for the examination of the breast cancer in the patients. This biopsy is considered as the best method for identifying the axillary involvement. Various dyes are used in this biopsy to find the sentinel lymph node. However, methylene blue dye (MBD) is considered to have a low risk of anaphylaxis, be cost effective and widely available.A systematic review and meta-analysis is performed on the utilisation of the methylene blue dye in the sentinel lymph node biopsy in the examination of breast cancer.Eight studies were appropriate for the inclusion criteria that were analysed systematically wherein meta- analysis is performed on studies which had ample data that comparatively analysed the efficiency of methylene blue. However, only two studies were selected for meta- analysis based on the availability of data.Systematic review reveals that methylene blue dye can be used as the best alternative when compared to other dyes in the detection of sentinel lymph node in the patients with breast cancer. However, the meta-analysis of two studies revealed no statistical significance defining the efficacy of methylene blue for sentinel lymph node detection.
Background: To compare the performance of Ranson’s Score (RS) and Glasgow Score (GS) with Revised Atlanta Classification (RAC) in prediction of mortality, and to check their suitability to replace RAC for surgical intervention of gallstone induced acute pancreatitis (GAP).Methods: A hospital based prospective study was conducted between April 2014 and May 2017 with patients presenting with GAP. RS and GS was evaluated using data in first 24 hours and at 48 hours post admission. Patients were classified into mild, moderate and severe based on RAC at the time of hospital stay. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each scoring system. Receiver Operating Characteristics (ROC) curves for mortality, ICU admission, Organ Failure (OF) and Gallstone Recurrence (GR) were plotted and predictive accuracy of each scoring system was measured by the Area under Curve (AUC). AUC values were compared for statistical significance using De Long test. A p-value of <0.05 was considered statistically significant.Results: Of 81 patients, 15 patients had OF and local complication classified as SAP, with persistent OF (16.0%). The AUC for RS was consistently the highest for predicting mortality (0.943), recurrence of gallstone (0.766), ICU-admission (0.801) and OF (0.852). RS had high specificity (61.9%), PPV (88.2%), Accuracy (90.1%) for predicting mortality, recurrence of gallstone and OF. Glasgow criteria had high sensitivity (85.1%), NPV (79.4) in predicting ICU-admission.Conclusions: RS in comparable with RAC in predicting mortality, GR in patients with GAP and early referral for surgical intervention.
Background: Inguinal hernia repair is the most commonly done surgery of all general surgical procedures. Hence in an attempt to decrease the pain and increase the patient’s comfort, various techniques have been considered to fix the mesh. The aim of this study was to compare the differences between the two techniques of mesh fixation namely the minimal stitch method and the continuous suturing in terms of various parameters. Methods: This study was conducted selecting 126 patients who attended the general surgery OPD at ESIC MC and PGIMSR and randomly allocating them to the two study groups; the patients were followed up till 6 months post-operatively. The parameters taken into account were: the operative time, the duration of hospital stay, the pain scores at various time intervals (POD 1, 3, 7, 30, 60, 90, 180) and the incidence of complications if any. Results: Among the 126 male patients enrolled in the study, the highest % belonged to the age group 51-60. 90% of them had unilateral hernias. The pain scores were significantly low in the minimal stitch group from the first postoperative day up to 1 month. The operative time and duration of hospital stay was also significantly decreased in the minimal stitch group. Conclusions: Hence, the minimal stitch technique used for inguinal hernia repair in our study proved to be comparable to the conventional suturing, better than the latter in terms of patients’ subjective satisfactory factors such as less operative time and less hospital stay while having no significant difference in terms of occurrence of chronic inguinodynia or any other postoperative complications.
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