Background: Acute appendicitis (AC) is a common surgical problem requiring emergency hospitalization for urgent appendectomy. In case of diabetic patients, the incidence of developing acute appendicitis including its complications like abscess, gangrene and perforation is higher than non-diabetic. Day by day, laparoscopic appendectomy is having an improved outcome in non-diabetic and non-obese patients. The aim of this study was to compare the outcomes of laparoscopic appendectomy versus open appendectomy in acute appendicitis of obese diabetic patients. Methods: A comparative study was carried out in a tertiary care hospital in Dhaka City. Hospitalized obese diabetic patients with a diagnosis of acute appendicitis, who underwent appendectomy, were considered as study population. Obesity was defined as body mass index (BMI) greater than 30 kg/m2 according to World Health Organization and American Obesity Association guidelines. Patients were divided into two groups according to type of appendectomy; 50 patients by laparoscopic appendectomy as group LA and 50 patients by open appendectomy as group OA. Results: Most patients were obese I (30.0-34.9 kg/m2) in group LA and OA (92.0% and 86.0%, respectively, p<0.05). Uncontrolled diabetes mellitus was detected in most of the patients of both group LA (96.0%) and OA (98.0%). Mean operation time, mean duration of post-operation ileus, mean hospital stay and post-operation complications were less in group LA than group OA which is statistically significant (p< 0.05). No patient developed wound infection after laparoscopic appendectomy; whereas, 8.0% patients had wound infection in open appendectomy (p<0.05). Conclusion: In this study, laparoscopic appendectomy had good outcome over its open counterpart regarding shorter operating time, hospital stay, less wound infection, postoperative pain and time to return to usual activities. Birdem Med J 2020; 10(3): 145-148

Background: Diabetic foot is one of the most feared complications of diabetes and is the leading cause of hospitalization in diabetic patients. Limb-threatening infection in diabetic patients are usually polymicrobial involving both multiple aerobic and anaerobic organisms.Methods: The present study was a cross sectional study, conducted in the Department of Surgery and Microbiology at BIRDEM General Hospital, Dhaka, over a period of 9 months during January 2017- September’ 2017. The study included a total of 77 adult patients of clinically diagnosed diabetic foot patients presenting to outpatient department and emergency ward. The standard case definition of diabetic foot is ‘any pathology occurring in the foot of a patient suffering from diabetes mellitus or as a result of long term complication of diabetes mellitus’.Results: 17(22.1%) patients had Klebsiella pneumonia, 14(18.2%) had Pseudomonas aeruginosa, 11(14.3%) had Staphylococcus aureus, 10(13.0%) had Escherichia coli, 6(7.8%) had Coagulase-negative staphylococci and 8(10.4%) had Providencia spp. In Escherichia coli 100% sensitivity to imipenem, 70% to amoxicillinclavulanic acid, amikacin, piperacillin-tazobactam. In Coagulase-negative Staphylococci 83.3% sensitivity to tetracycline, 66.7% to ceftriaxone. In Proteus mirabilis 100% sensitivity to tetracycline, amikacin, ceftriaxone, imipenem, piperacillin-tazobactam. In Enterococcus spp.75.0% sensitivity to tetracycline. In Citrobacter spp. 100% sensitivity to imipenem.Conclusion: Common organism found in diabetic foot ulcer patients were Klebsiella pneumonia, Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Coagulase-negative staphylococci and Providencia spp. In tetracycline, amikacin, ceftriaxone, imipenem, piperacillin-tazobactam was 100% sensitive in Proteus mirabilis and only imipenem found in Citrobacter spp.Birdem Med J 2018; 8(3): 251-256

Background: This study aims to evaluate the effectiveness of 0.5% bupivacaine soaked surgicel placed in the gall bladder bed and infi ltration at port sites at laparoscopic cholecystectomy, in relieving pain during 1st 24 hours post procedure.Method: In this RCT, 50 patients with chronic cholecystitis were divided into two groups of 25 each. Group-A -Bupivacaine soaked surgicel kept in gall bladder bed and infi ltration at trocar sites, Group-Bno local anaesthesia was used in the gall bladder bed and at trocar sites. Population was included on the basis of systemic random sampling based on the inclusion and exclusion criteria. Post operatively, the character and intensity of pain was assessed by visual analog scale (VAS) scoring for 24 hours. Result:The fi ndings of our study showed variable intensity of parietal, visceral and shoulder pain in two groups over 24 hours post-surgery. The intensity of pain in Group-A was less than in Group-B. Conclusion:Parietal, visceral and shoulder pain were prominent after laparoscopic cholecystectomy and can be effectively controlled by 0.5% bupivacaine soaked surgicel in the gall bladder bed and infi ltration at trocar sites.

Diabetic retinopathy (DR) is one of the most common causes of blindness in developed countries. Early detection of diabetic retinopathy (DR) is crucial for preventing irreversible blindness. To measure the association of diabetic retinopathy with dabetic foot a cross-sectional study was carried out at Department of Ophthalmology and Surgery, BIRDEM General Hospital, Dhaka from January 2017 to September 2017. Patients were included, who were known diabetic. New cases of type-2 diabetes were also included because they might have complications at the time of diagnosis because of the nature of disease. Mean duration of diabetes was significantly higher in DFU with DR group. BUN and diabetes retinopathy were statistically significant (p<0.05) between two groups. Mean HbA1c, pre-prandial glucose, C-peptide, cholesterol, triglyceride, HDL, LDL, hematocrit, creatinine, ABI, TBI and DM foot ulcer were not statistically significant (p>0.05) between two groups. Most patients (33.3%) had a grade I ulcer in DF with DR group and 33.3% in DF without DR group. Medication taking was significantly high patients who were DF without DR. Combined agents was 11(36.7%) and 11(36.7%) in DF with DR and DF without DR group respectively. Insulin was taken 16(53.3%) in DF with DR group and 19(63.3%) in DF without DR group. Maximum patients had a grade I ulcer in diabetes foot ulcer. Medication taking was significantly high patients who were diabetes foot ulcer than without diabetes foot ulcer. Mean insulin, BUN and diabetes retinopathy was found significantly higher in diabetes with diabetes foot ulcer. Mean insulin BUN and diabetic retinopathy was was significantly higher in diabetes with diabetes foot ulcer. Bangladesh Med J. 2017 Sep; 46 (3): 90-93