Worldwide, Diabetic Foot Ulcers are a major medical, social and Economic Problem and are the Leading Cause of Hospitalization for most of the Patients with Diabetes. Diabetic foot is the most common complication of Diabetes. Diabetic foot ulcerations and infections are one of the leading causes of mortality and morbidity, especially in the developing countries. The Indian diabetic population is expected to increase to 57 Million by the year 2025. Mostly, The Diabetic foot infections are mixed bacterial infections and the proper management of these infections requires an appropriate antibiotic selection, based on the culture and the antimicrobial susceptibility testing results. A prospective study was carried out on 50 diabetic patients with foot ulcers for a period of 6 months from January 2013 to June 2013 admitted at Rajah Muthiah Medical College and hospital. A total of 122 organisms were isolated and an average of 1.22 isolates per case was reported. Poly microbial nature was observed and gram negative (52.45 %) organisms dominated the positive (47.54 %) in case of number of organisms isolated. The most frequent bacterial isolate was Staphylococcus aureus (39.34 %) and E. coli (23.77 %). Antibiotic sensitivity pattern of the isolates was discussed in detail. Neuropathy (29 %) and peripheral vascular disease (27 %) were the common clinical characteristics of the patients. Staphylococcus was the most frequent bacterial isolate in this study followed by E. coli. Diabetic foot ulcers are poly microbial in nature. Beta lactam/ beta lactamase inhibitor combinations, vancomycin, fluroquinolones were the suitable choices for the empiric antibiotic therapy found by this clinical and bacteriological study.
A study of determinant of long waiting period in outpatient department and recommendation on reducing waiting time in Superspeciality hospital
Aims & Objectives:To study the role of laparoscopy in diagnosing the unknown abdominal and pelvic pathologies. Methodology: This is a prospective observational study conducted in the department of surgery at RMMCH for the duration of 2 months. Results: This prospective study consists of 60 patients, in which most of the patients comes under the age group of 11-30 years. Majority of females were affected than male patients about 56.6%. According to the indications for diagnostic laparoscopy, number of patients for abdominal pain for evaluation was 50(83.4%) compared to other indications. More number of patients (13) were diagnosed with Koch's abdomen in regard to other diagnosis made after diagnostic laparoscopy. Most commonly used laparoscopic procedure was Biopsy in 33 patients. Among the patients who reported with diagnosis, in 10 patients pre-operative diagnosis confirmed, in 17 patients diagnosis has changed, in 6 patients no diagnosis could be made, and 27 patients were diagnosed after diagnostic laparoscopy. Conclusion: Laparoscopy is helpful in diagnosing and confirming an unknown case made on clinical and laboratory evaluation. It extensively reduces delay in operative intervention and also reduces morbidity and shortens the post-operative recovery interval. It's a low risk procedure and also provides diagnostic accuracy and therapeutic options.
Introduction: Salivary gland tumours (SGT) are heterogenous group of neoplasms in the maxillofacial area with complex morphologic appearances and different clinical behaviour. They often present as painless enlarging masses, mostly located in parotid glands and mostly benign. Epidemiology: SGT's are more common in women than in men which represents 2%-3% of head and neck neoplasms. Pleomorphic adenomas are most common benign SGT's followed by Warthin tumours. Treatment: Difficulty with salivary gland tumour is they are rare and have long clinical course that requires follow up data for a decade or more. Prospective randomised trails have therefore not been undertaken and hence progress happens slowly. Improved methods of assessment (MRI, CT, Ultrasound, fine needle aspiration biopsy) have had major impact on salivary gland surgery. Most benign tumours are either pleomorphic adenomas (71%) or Warthin's tumours (22%). Conclusion: Treatment for this include both medical and surgical therapy. Medical therapy is indicated for inflammatory infectious masses (eg: reactive or fungal) and lymphoma. When symptomatic, recurrent chronic gland infection (eg: parotitis) proves refractory to conservative medical or endoscopic (i.e. sialoendoscopy) treatments, salivary gland excision is sometimes indicated. Surgical therapy includes parotidectomy and submandibular gland surgery.
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