Background:Diabetic foot infections (DFIs) are major public health problems and knowledge of microbes that cause infections are helpful to determine proper antibiotic therapy.Aims:The aim was to investigate the antimicrobial susceptibility pattern of microbes in DFIs.Subjects and Methods:A cross-sectional study was conducted for a period of 6 months at the Department of General Surgery, KMC hospital, Manipal University, Manipal, India. During this period, 108 patients having DFIs admitted in the general surgery wards were tracked from the hospital data management system. These patients’ pus samples were examined as Gram-stained smear and cultured aerobically on blood agar and MacConkey agar plates. Antimicrobial susceptibility test was performed by disc diffusion techniques according to Clinical and Laboratory Standards Institute guidelines.Results:Of the 108 specimens of the diabetic foot lesions, culture showed polymicrobial growth in 44.4% (48/108). Prevalence of Gram-negative organisms (56%, 84/150) was found to be more than Gram-positive organisms (44%, 66/150). However, Staphylococcus aureus was the most frequent pathogen (28%, 42/150). All Gram-positive aerobes were sensitive to doxycycline. All Gram-negative isolates, including extended spectrum beta lactamase producing strains of Proteus mirabilis and Klebsiella oxytoca except Acinetobacter were highly sensitive to amikacin, cefoperazone/sulbactam, and meropenem. Acinetobacter was completely resistant to all the common antibiotics tested.Conclusion:Prevalence showed Gram-negative bacteria was slightly more than Gram-positive bacteria in diabetic foot ulcers. This study recommends doxycycline should be empirical treatment of choice for Gram-positive isolates and amikacin, cefoperazone/sulbactam, and meropenem should be considered for most of the Gram-negatives aerobes.

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The ovary is a relatively frequent site of metastases from malignant neoplasia arising elsewhere in the body, the majority of these originating from the gastrointestinal tract. The best-known tumor of this type is signet ring cell adenocarcinoma (Krukenberg tumor) of gastric origin and large bowel. The gall bladder and bile ducts are extremely rare sources of these metastases. The casuistic describes a female patient, presented with pelvic mass and jaundice. While clinical and imaging results suggested a primary ovarian carcinoma with incidental cholelithiasis and choledocholithiasis, the final diagnosis was obtained on the basis of histopathologic findings of resected specimen.

The purpose of this study was to assess the magnitude of hypoglycemia barrier in terms of physician's treatment choices and algorithm and the impact of hypoglycemia in adherence and persistence to insulin treatment. MethOds: Four hundred thirteen Turkish physicians were interviewed by close ended questions with a mix of dichotomous or bounded continuous response formats. Questions were asked face to face in 2 national diabetes congresses, with a physician mix of 75% internists, 23% endocrinologists, 1,9% family physicians and rest pediatricians and obstetrics. Results: Within 413 replies on how important is the hypoglycemia barrier to reach the target HbA1c on an importance scale, 95% replied either important or very important. 82% of physicians declared that they would change their target HbA1c, if they were not concerned about hypoglycemia. Similarly, 88% of physicians believed more of insulin-treated patients might reach target HbA1c if physicians are not concerned about hypoglycemia. Among the physicians replied 79% stated that less than 40% of their patients reported their hypoglycemic status. If patients experience hypoglycemia, 75% of physicians would reduce the insulin dose for more than 60% of patients, 85% would stop insulin treatment for less than 20% of patients, 91% would switch to other insulins and 62% would to prefer to keep same treatment for less than 20% of the patients. Among the physicians replied, 35% of them declared that patients are willing to stop treatment due to hypoglycemia and more than 50% declared that patient needs a new insulin that causes less hypoglycemia. cOnclusiOns: In this study, physician dimension of hypoglycemia was explored. From the results obtained, it is obvious for the Turkish physicians that hypoglycemia is perceived as a major barrier for the better treatment of the patients. These results show that new treatment options causing less hypoglycemia are needed in the treatment of diabetes mellitus.

There is an increasing demand in the ostrich farming sector for management tools that are capable of motivating, preparing and guiding producers to meet the requirements of ‘environmentally conscious’ consumers. Many methodological options are currently available to conduct sustainability assessments and to ensure the best environmental management of rural activities. One option, the ‘System for weighed environmental impact assessment of rural activities’ (APOIA-NovoRural), has recently been validated for ostrich farming, as a tool for checking the contributions of the activity to local sustainable development. Case studies have favoured the understanding of the main environmental impacts and provided valuable recommendations regarding natural resources management and landscape ecology improvements in ostrich farming systems. Most importantly, the criteria and indicators constructed in this environmental management tool may be used for defining general ‘Terms of Reference’ for sustainable ostrich farming.