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Aim of the study: To study the effect of topical phenytoin in healing of grade I and II diabetic foot ulcers. Background: Diabetic foot ulcers entail a lot of financial burden both to the patients and also to the treating hospitals. These are estimated to affect 15% of all diabetic individuals during their lifetime. These precede almost 85% of amputations. In India, prevalence of diabetic foot ulcer in clinical population is 3.61%. Increase in the prevalence of foot complications in India is attributed to socio-cultural practices such as bare foot walking, religious practices like walking on fire, use of improper foot wear and lack of knowledge regarding foot care. The three etiological mechanisms involved in formation of diabetic foot ulcer are-ischemia, neuropathy and infection.Phenytoin has been used by some workers and the possible mechanisms of its action in ulcer healing have been described as-increase in the proliferation of fibroblasts, increase in the deposition of collagen, neovascularisation, enhanced granulation tissue formation, decrease in the action of collagenase, decrease in bacterial contamination by removing Staphylococcus aureus, Escherichia coli, Klebsiella species, and Pseudomonas from the wound. Material and methods: A total of one hundred patients (66 males and 34 females) were enrolled in the study half of which were dressed with crushed phenytoin tablet powder (Group 1) and the remaining half was dressed with normal saline (Group 2). Statistical analysis was done using using the SPSS version 22 for Windows, Inc Chicago II.Descriptive statistics was used to find the mean± standard deviation.Mann Whitney test was done to find the difference between the various variables in the two groups. Results: Phenytoin was found to help in early healing of diabetic foot ulcers with the mean epithelisation time was found to be significantly lower in the phenytoin group. Conclusion: Topical phenytoin enhances healing of diabetic foot ulcers and is a cheap and effective modality of treating these patients.

Negative topical pressure, the general category to which the trademarked VAC therapy belongs, is not a new concept in wound therapy. It is also called subatmospheric pressure therapy, vacuum sealing, vacuum-assisted closure therapy, vacuum pack therapy, and sealing aspirative therapy. The VAC therapy system is trademarked by Kinetic Concepts, Inc., or KCI. It was first reported in 1997. The aim of the procedure is to use negative pressure to create suction, which drains the wound of exudate (i.e., fluid, cells, and cellular waste that has escaped from blood vessels and seeped into tissue) and influences the shape and growth of the surface tissues in a way that helps healing. Negative-pressure therapy for the closure of wounds accelerates secondary wound healing. High cost is still a hindrance in its use in developing nations. Many modifications were tried, but their efficacy is yet to be proved. In reality, this method is quite cost effective. It is only the lack of understanding and adequate setup which makes this method hard to use. The main objective of this paper is to focus on the cost effectiveness of VAC and its modifications. We want to emphasize the importance of homemade NPT and the use of simple suction devices.

Wound dehiscence is a postoperative complication encountered following abdominal surgery. A prospective randomized study was conducted to compare the incidence of wound dehiscence with a delayed absorbable and a nonabsorbable suture material in the mass closure of vertical laparotomy wounds. In one group, 100 patients were analyzed after closure with Prolene®, and in another group, 100 patients were analyzed after closure with Vicryl®. The incision was closed by continuous far and near suture technique using polypropylene (Prolene) suture in one group and a synthetic delayed absorbable polyglactin 910 (Vicryl) suture in the other group. There was significant difference in the incidence of wound dehiscence between the two groups: 6 % with Prolene and 17 % with Vicryl, (χ 2 05.944, 1 DF, P value00.0148). The overall incidence of wound dehiscence was 11.5 % in this study. The incidence of wound dehiscence in both the study groups was higher than expected as compared to previous literature. There was a significant difference between the two suture materials. In our study, Prolene is a better suture material for closure of vertical laparotomy wounds.

Introduction:The stimulatory effect of phenytoin on connective tissue suggested possibility for its use in wound healing. Oral phenytoin was first introduced as an antiseizure medication in 1937. Over 60 years investigators have shown an interest in how topical phenytoin may be used to promote wound healing in a variety of chronic wounds. Materials and Methods: A sample of 40 patients with diabetic ulcers was selected using purposive sampling technique. The patients were divided into two groups: Group A (Phenytoin group) (n=20) and Group B (conventional group) (n=20). In Group A, the patient's dressing were done using phenytoin and in Group B, with povidine. The patients were followed up on a daily basis for 9 days in both study and control groups. Wound culture was obtained at the start of the treatment and on the 7 th day of treatment. Then the patients were subjected to split thickness skin grafting on 10 th day. The follow up of the patients were done at one month after discharge in outpatient department for post skin grafting complications. Result: The mean duration of hospital stay in phenytoin group was 21.35±4.71 (SD) days and that in the conventional group was 27.3±6.48 (SD) days. One month follow up complications in conventional group were more as compared to phenytoin group. Conclusion: Topical phenytoin dressing helps in better granulation tissue formation and better graft take up than the conventional dressing. Hospital stay and post-operative complications were less in topical phenytoin dressing group as compared to conventional dressing group. Conflict of interest: Nil Source of funding: Nil

Introduction:-Glycatedhaemoglobin(HbA1c) is used as an indicator of a patient's glycemic status over the previous 2-3 months. According to American Diabetes Association (ADA) Guidelines, HbA1c levels should be maintained below 7% in all diabetic patients in order to prevent the development of microvascular complications. Aims:-To study the effect of iron deficiency anaemia treatment on HbA1c level and to assess whether iron deficiency anaemia affects HbA1c levels. Material and Methods: 50 non-diabetic with confirmed iron deficiency anaemia (IDA) patients and 50 age-matched healthy subjects were enrolled in this study. Results: The mean baseline HbA1c level in the patients with IDA (6.12+0.21%) was significantly higher than controls groups(6.12+0.21%). After treatment of iron deficiency anaemia the mean HbA1c levels, significantly decreased from 6.12+0.21% to 5.21+0.16%. Conclusions: iron deficiency anaemia was associated with higher levels of HbA1c, which could cause problems in the diagnosis of uncontrolled diabetes mellitus in iron deficient patients.

Introduction and Aim: Epilepsy requires lifelong therapy with antiepileptic drugs (AEDs) &having medical and psychological consequence. Present study was conducted to observe the effect of different AEDs on lipid profile and certain liver enzymes on epileptic patients. Material and Methods: 50 epileptic patients receiving AEDs for minimum 1 year were recruited as study group and 50 healthy subjects considered as control group. These subjects were recruited from general community of Punjab. Fasting blood samples were drawn from patients and healthy subjects for the evaluation of total cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol, HDL-cholesterol, AST, ALT & ALP. Results: Significant increase in total cholesterol, triglycerides, LDL-cholesterol, VLDL- cholesterol was observed in epileptic patients while no significant change was recorded in HDL- cholesterol. Maximum increase in total cholesterol, TGs, LDL-cholesterol, VLDL- cholesterol levels was observed in phenytoin treated patients with reference tovalproic acid, carbamazepine, levetiracetam treated patients. Levels of AST, ALT and ALP were significantly increased in epileptic patients. Maximum increase in AST & ALT was observed in levetiracetam treated epileptic patients and maximum rise in ALP levels was found in carbamazepine treated patients with reference to other AEDs treated patients. Conclusion: Aforementioned observations suggested that epileptic patients treated with phenytoin, valproic acid, carbamazepine & levetiracetam for long time could cause dyslipidemia, might be responsible for various CHD’s and hepatotoxicity in epileptic patients. Routine screening of lipid profile and hepatic enzymes during chronic use of AEDs is recommended.

Background: Epilepsy requires lifelong therapy with antiepileptic drugs (AEDs) and having medical and psychological consequence. So, the present study was conducted to evaluate the role of different AEDs on thyroid profile in epileptic patients.Methods: 50 epileptic patients receiving AEDs for minimum 1 year were recruited as study group and 50 healthy subjects considered as control group. These subjects were recruited from general (rural or urban) community of Punjab. Fasting blood samples were drawn from patients and healthy subjects for the evaluation of triiodothyronine (T3), thyroxine (T4) and thyroid stimulating hormone (TSH) levels.Results: Significant increase in TSH levels were recorded in epileptic patients while no significant change was found in T3 and T4 epileptic patients treated with different AEDs with respect to healthy controls. Maximum increase in TSH was seen in phenytoin, treated epileptic patients and maximum fall in TSH was recorded in levetiracetam treated epileptic patients. Maximum increase in T3 and T4 levels was found in phenytoin while a maximum decrease was recorded T3 and T4 levels in carbamazepine treated epileptic patients in comparison to other drugs treated patients.Conclusions: Aforementioned observations suggested that epileptic patients treated with phenytoin, valproic acid, carbamazepine and levetiracetam for long time could cause initiation of subclinical hypothyroidism further could leads to overt hypothyroidism which in turn responsible for pathophysiology of various coronary heart disease. Routine screening of thyroid profile during chronic use of AEDs is recommended.