BACKGROUND Diabetic foot ulcers are inevitable in 15% of diabetic patients even if they follow the diet or control blood sugar level meticulously. The mainstay of treatment for diabetes related foot ulceration is a multidisciplinary team (MDT) approach that includes metabolic control, debridement, offloading/pressure redistribution, vascular control, infection control and seamless integrated wound care. And the ulcer usually is of a chronic type. With regard to topical agents, the effectiveness of topical Insulin is considered valid and effective on wound healing process. The present study is to compare the efficacy of Topical Insulin vs. Normal Saline dressing. MATERIALS AND METHODS This is a non-randomised control study. A total of sixty patients with Diabetic foot ulcer were enrolled and the study was done in
BACKGROUND AND OBJECTIVESAcute appendicitis is the most common cause of acute surgical abdomen and appendicectomy is the most commonly done emergency surgery. Its diagnosis remains an enigmatic challenge, plagued by a high rate of negative explorations (15-30%). There is no single reliable test with satisfactory sensitivity and specificity. The objective of the study was to evaluate role of few known and proven investigations for appendicitis like CRP, leukocyte count, Neutrophil count and Ultrasonography in diagnosing acute appendicitis and reducing the rate of negative appendicectomies. Also we wanted to study whether combining the investigations in same patient would improve the diagnostic accuracy.
METHODSThe present study was conducted in 100 patients who have been clinically diagnosed of having Acute Appendicitis and posted for emergency appendicectomy in General Surgery Department of Sri Venkateshwaraa Medical College and Hospital, Pondicherry, during the period from 1st May 2015 to 31st December 2015. Preoperatively blood for CRP, WBC count, Neutrophil count and USG abdomen were done. All appendicectomy specimens were subjected to histopathological examination postoperatively, which was taken as gold standard. Results of all the four investigations were correlated with HPE reports to evaluate their role in diagnosis of acute appendicitis.
RESULTSIn present study, CRP has highest sensitivity and specificity (90%, 80%) followed by USG (87.5%, 90%), WBC count (78.75%, 80%) and Neutrophil count (77.5%, 80%). Combining CRP and WBC count increases the sensitivity and specificity of the tests (96.25%, 80%). When all the four tests are combined (Either/all) the sensitivity, specificity, positive predictive value and predictive value of negative test increases significantly (100%, 80%, 95.23%, 100% respectively). It was observed that when all the four tests were negative appendicitis could be safely ruled out and surgery can be deferred in these patients. It would reduce the rate of negative appendicectomies.
INTERPRETATIONS AND CONCLUSIONSCRP contains important diagnostic information and hence should always be included in the diagnostic workup of acute appendicitis. The sensitivity of WBC count and Neutrophil count is low individually, but when combined with CRP the sensitivity and specificity increases. Ultrasonography is useful in establishing alternative diagnoses, but its availability and cost-effectiveness should be taken into account. Combining all four investigations significantly increases the diagnostic accuracy. Also when all four tests are negative acute appendicitis is very unlikely and surgery can be safely deferred in these patients thereby reducing the negative appendicectomy rates. We continue to stress that history and clinical examination by a skilled surgeon still remains indispensable in diagnosing acute appendicitis and its importance cannot be undermined. The investigations can be used to complement a Surgeon's clinical diagnosis and not replace it.
BACKGROUNDHernia may be defined as a protrusion of abdominal viscera outside the abdominal cavity through a natural or acquired defect. Inguinal hernias present with a lump in the groin that goes away with minimal pressure or when the patient is lying down. Most cause mild-to-moderate discomfort that increases with activity.A clinical study on inguinal hernia is undertaken to assess the incidence of inguinal hernia in relation to age, gender and occupation, and to find the complications of inguinal hernioplasty in repairing uncomplicated inguinal hernia by measuring postoperative pain and post-operative complication. Recurrences have been a significant problem following hernia repair. Prosthetic materials have been increasingly used in hernia repair to prevent recurrence.
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