Diabetic foot ulcers are a serious complication of diabetes mellitus which increases the patient morbidity and also have significant socioeconomic impact. The present review aims to summarize the causes and pathogenesis leading to diabetic foot ulcers, various classification systems and to focus on the current management of this significant and preventable health condition.

The growth hormone receptor (GHR) is expressed in brain regions that are known to participate in the regulation of energy homeostasis and glucose metabolism. We generated a novel transgenic mouse line (GHRcre) to characterize GHR-expressing neurons specifically in the arcuate nucleus of the hypothalamus (ARC). Here, we demonstrate that ARCGHR+ neurons are co-localized with agouti-related peptide (AgRP), growth hormone releasing hormone (GHRH), and somatostatin neurons, which are activated by GH stimulation. Using the designer receptors exclusively activated by designer drugs (DREADD) technique to control the ARCGHR+ neuronal activity, we demonstrate that the activation of ARCGHR+ neurons elevates a respiratory exchange ratio (RER) under both fed and fasted conditions. However, while the activation of ARCGHR+ promotes feeding, under fasting conditions, the activation of ARCGHR+ neurons promotes glucose over fat utilization in the body. This effect was accompanied by significant improvements in glucose tolerance, and was specific to GHR+ versus GHRH+ neurons. The activation of ARCGHR+ neurons increased glucose turnover and whole-body glycolysis, as revealed by hyperinsulinemic-euglycemic clamp studies. Remarkably, the increased insulin sensitivity upon the activation of ARCGHR+ neurons was tissue-specific, as the insulin-stimulated glucose uptake was specifically elevated in the skeletal muscle, in parallel with the increased expression of muscle glycolytic genes. Overall, our results identify the GHR-expressing neuronal population in the ARC as a major regulator of glycolysis and muscle insulin sensitivity in vivo.

Soft tissue defects of hand with exposed tendons, joints, nerves and bone represent a challenge to plastic surgeons. Such defects necessitate early flap coverage to protect underlying vital structures, preserve hand functions and to allow for early rehabilitation. Becker and Gilbert described flap based on the dorsal branch of the ulnar artery for defects around the wrist. We evaluated the use of a dorsal ulnar artery island flap in patients with soft tissue defects of hand. Twelve patients of soft tissue defects of hand underwent dorsal ulnar artery island flap between August 2006 and May 2008. In 10 male and 2 female patients this flap was used to reconstruct defects of the palm, dorsum of hand and first web space. Ten flaps survived completely. Marginal necrosis occurred in two flaps. In one patient suturing was required after debridement and in other patient wound healed by secondary intention. The final outcome was satisfactory. Donor areas which were skin grafted, healed with acceptable cosmetic results. The dorsal ulnar artery island flap is convenient, reliable, and easy to manage and is a single-stage technique for reconstructing soft tissue defects of the palm, dorsum of hand and first web space. Donor site morbidity is minimal, either closed primarily or covered with split thickness skin graft.

Background: Diabetic foot ulcers (DFU) are a common, costly, complex, and disabling complication of diabetes resulting in lower-extremity amputations. Diabetes Mellitus (DM) is associated with an increase in the incidence of peripheral vascular disease (PVD) compared to non-diabetic subjects. DFU are divided into two types: neuropathic ulcers (NPU) and neuro-ischemic ulcers (NIU). PVD in association with neuropathy leads to neuro-ischemic ulcers (NIU).Methods: A cross-sectional observational study was conducted for eighteen months period from October 2016 to March 2018, on 120 type-2 DM patients presenting with DFU at tertiary centre in central India. Informed written consent, detailed history was obtained from the patients including duration of diabetes, history of hypertension, smoking, presenting symptoms and other complications related to diabetes. Examination of foot and evaluation for peripheral pulses, ankle brachial pressure index (ABI), neuropathy and blood pressure were done. Laboratory tests for HbA1C, lipid profile, blood urea, serum creatinine and urine albumin creatine ratio (urine ACR) were done. Statistical analysis used: t test, fisher exact test and univariate analysis.Results: In our study, 1594 patients with T2DM were studied, out of which 120 patients presented with new DFU. Mean age of the patients was 61.5years with an M: F ratio of 1.78:1. NIU was present in 36 and NPU in 84 out of 120 DFU patients. Neuro-ischemic ulcers (NIU) were more common among males (28/78 males vs 8/42 females). NIU was found to have significant association with smoking (25/36 patients), hypertension (28/38 patients) and longer duration of diabetes (13.1 vs 9.2years). Other diabetic complications, retinopathy (26/36 patients) and nephropathy (18/36 patients) were more prevalent in patients with NIU. Dyslipidemia was also found in 58.33% (21/36) patients with NIU however the association was insignificant.Conclusions: Diabetic foot ulcers are very debilitating complication of diabetes, and a leading cause of amputations all over the world. Because of increased association of peripheral vascular disease with diabetic foot ulcers there is a rise in prevalence of neuro-ischaemic ulcers. Early management of peripheral vascular disease is important to prevent development of neuro-ischaemic ulcers.

No abstract

Growth hormone (GH) receptor (GHR), expressed in different brain regions, is known to participate in the regulation of whole-body energy homeostasis and glucose metabolism. However, GH activation of these GHR-expressing neurons is less studied. We have generated a novel GHR-driven Cre recombinase transgenic mouse line (GHR cre) in combination with the floxed tdTomato reporter mouse line we tracked and activated GHR-expressing neurons in different regions of the brain. We focused on neurons of the hypothalamic arcuate nucleus (ARC) where GHR was shown to elicit a negative feedback loop that regulates GH production. We found that ARC GHR+ neurons are co-localized with AgRP, GHRH, and somatostatin neurons, which were activated by GH stimulation. Using designer receptors exclusively activated by designer drugs (DREADDs) to control GHR-ARC neuronal activity, we revealed that activation of GHR-ARC neurons was sufficient in regulating distinct aspects of energy balance and glucose metabolism. Overall, our study provides a novel mouse model to study in vivo regulation and physiological function of GHR-expressing neurons in various brain regions. Furthermore, we identified for the first time specific neuronal population that responds to GH and directly linked it to metabolic responses in vivo.

Purpose The aim of this present article was to know the efficacy of bone mapping/sketching in management of anterior table frontal sinus fracture. Material and methods This prospective clinical study includes 10 patients who reported to department of dentistry, AIIMS Bhopal with anterior table frontal sinus fracture. Sterile plain white paper or a glove cover was used for mapping/sketching. The patients were evaluated for post-operative contour of the fractured frontal sinus defect and any mucocele formation. Results All the 10 patients had no infection or post-operative mucocele formation and all have excellent aesthetic of the anterior table of the frontal sinus. Conclusion Bone mapping/sketching should be done in all comminuted fractures of cranio-maxillofacial region.

Purpose: To analyze the demographic, clinical, and microbiological profile of patients presenting to our unit with chronic wounds of various etiologies with an intent to give a current overview of chronic wounds. Patients and Methods: We performed a prospective observational study of patients presenting with chronic wounds from October 2018 to September 2019. The study was conducted at the Department of Burns and Plastic Surgery of a tertiary care institute in a nonmetropolitan city in Central India. A total of 103 patients were included in the study. Data collected from the patients included demographic details, history, clinical features, and relevant laboratory reports. Wound swabs obtained by Levine's technique were sent for culture and sensitivity studies. Treatment was instituted according to the clinical picture and modified if necessary. Progress was monitored until the wound healed, either by conservative management or by surgical intervention. Patients were followed up for six months thereafter. Results: Most of the patients presented with lower limb wounds (n=81, 78.64%). Swab specimens from 103 wounds were cultured. Among the isolates, gram-negative organisms were more common than gram-positive organisms. Staphylococcus aureus was the most common species isolated, followed by Pseudomonas aeruginosa. The frequency of infections caused by other gram-negative organisms like Klebsiella pneumoniae, Escherichia coli, and Proteus mirabilis was on the rise. There were significant differences in the patterns of antimicrobial resistance in our patients. Sharp debridements were required in almost all cases for wound preparation. Most of the patients (n=74, 71.84%) underwent surgical intervention for achieving wound closure. Split-thickness skin grafting (STSG) was the most common surgical intervention performed (n=45, 43.68% patients), followed by local and distant flaps. Conclusion: Our study gives a current overview of the causes, clinical presentation, prevalent microbial flora, and their antibiotic susceptibilities prevalent in chronic wounds presenting to our unit. Treatments administered are discussed with emphasis on the different reconstructions performed.