The prevalence rate and spectrum of fungi infecting deep tissues of diabetic lower-limb wounds (DLWs) have not been previously studied. Five hundred eighteen (382 male and 136 female) consecutive patients with type 2 diabetes hospitalized due to infected lower-limb wounds were enlisted in this study. Deep tissue (approximately 0.5-؋ 0.5-cm size) taken perioperatively from the wound bed was cultured for fungi. Fungi was found in 27.2% (141/518) of the study population. Candida parapsilosis (25.5%), Candida tropicalis (22.7%), Trichosporon asahii (12.8%), Candida albicans (10.6%), and Aspergillus species (5.0%) were the most predominant fungal isolates. Of the fungal isolates, 17.7% were resistant to itraconazole, 6.9% were resistant to amphotericin B, 6.9% were resistant to voriconazole, 3.9% were resistant to fluconazole, and 1.5% were resistant to flucytosine. Of the population, 79.7% (413/518) had bacterial infection in deep tissue. The predominant isolates were Enterococcus faecalis (14.1%), Staphylococcus aureus (12.2%), and Pseudomonas aeruginosa (10.8%). Mixed fungal and bacterial infections were seen in 21.4% of patients, while 5.8% had only fungal infection and 58.3% had only bacterial infections. Another 14.5% had neither bacteria nor fungi in the deep tissue. Patients with higher glycosylated hemoglobin levels had significantly more fungal infections. Our study reveals that deep-seated fungal infections are high in DLWs. In the context of delayed wound healing and amputation rates due to DLWs, it is important to study the pathogenicity of fungi in deep tissues of DLWs and their possible contribution to delayed wound healing. The role of antifungal agents in wound management needs to be evaluated further.Diabetes is now a worldwide epidemic. Among the 191 WHO member states, India has the highest number of people with diabetes (37). Fifteen percent of patients with diabetes develop lower-extremity ulcers during their lifetimes. Diabetes is the most common cause for nontraumatic amputation of lower extremities (1, 39). Eighty-five percent of these lowerlimb amputations are preceded by polymicrobial infections of the wound (23,26,36). Despite proper surgical and antibacterial therapy for infected diabetic lower-limb wounds (DLWs), the global long-term outcome of patients was found to be poor; only Ͻ50% of these patients had global therapeutic success (16,22).Fungal infections among immunocompromised patients are one of the major health concerns worldwide (5, 13, 19), but the spectrum of fungi infecting DLWs and their pathogenicity have not yet been studied thoroughly. Therefore, clinicians and surgeons treating diabetic foot wounds suspect only bacterial infections and treat them with antibacterial agents. They do not routinely send deep tissue from the wound bed for fungal culture and sensitivity, either due to lack of literature support or due to the assumption that there would not be any fungal infections in the DLWs. Surprisingly, our retrospective pilot study showed 27.9% positive fungal cultures in 3...
Background India started its vaccination programme for Coronavirus-19 infection (COVID-19) on 16 January 2021 with CovishieldTM (Oxford/Astra Zeneca vaccine manufactured by Serum Institute of India) and Covaxin ® (Bharat Biotech, India). We designed the present study to study the effectiveness of vaccines for COVID-19 in prevention of breakthrough infections and severe symptomatic cases among health care workers in a real-life scenario in Mumbai, India. Furthermore, we also wanted to study the factors associated with this effectiveness. Methods This is cohort analysis of secondary data of 2762 individuals working in a tertiary health care setting in Mumbai, India (16 January 2021 to 16 October 2021). Vaccination records of all groups of health care staff (including the date of vaccination, type of vaccine taken, and date of positivity for COVID-19) were maintained at the hospital. The staff were tested for COVID-19 at least once a week and when symptomatic. The observation time for everyone was divided into unvaccinated, partially vaccinated (14 days after the first dose); and fully vaccinated (14 days after the second dose). If the individual was found to be positive, the day of positivity was considered the ‘day of the event’ for that individual. We combined unvaccinated/partially vaccinated into one group and completely vaccinated in the other group. We estimated hazard ratios (HR) and their 95% confidence intervals. The vaccine effectiveness (VE) was assessed as (1-HR)*100. Results The mean age (SD) of the study participants was 32.3 (8.3) years; majority of these individuals had taken Covishield TM (99.0%) and only 0.9% (n = 27) had taken Covaxin ®. The incidence rate in the overall population was 0.067/100 person-days (PD). The incidence rate was significantly higher in the unvaccinated/partially vaccinated group compared with the fully vaccinated group (0.0989 / 100 PD vs 0.0403/100 PD; p < 0.001). The adjusted HR (aHR) in the fully vaccinated group compared with the unvaccinated/partially vaccinated group in the complete cohort was 0.30 (95% CI: 0.23, 0.39). Thus, the vaccine effectiveness (VE) for full vaccination was 70% (95% CI: 61%, 77%). It remained the same in the Covishield TM only cohort. The VE in completely vaccinated and with a history of previous infection was 88% (95% CI: 80%, 93%). Only 11 health care workers required hospitalization over the entire observation period; the incidence rate in our cohort was 0.0016 / 100 PD. None of the HCWs reported any severe adverse events after vaccination. Conclusions In this real-world scenario, we did find that complete vaccination reduced the rate of infection, particularly severe infection in health care personnel even during the severe delta wave in the country. Even among those infected, the hospitalisation rates were very low, and none died. We did not record any major side effects of vaccination in these personnel. Previous infection with COVID-19 and complete vaccination had a significantly higher effectiveness in prevention of infection.
Tuberculosis (TB) is one of the major health problems in developing countries. India has the highest TB burden with approximately 27% of global TB [6]. (India TB Report 2018 Revised National TB Control Programme (2018)). The most common form of tuberculosis constitutes pulmonary tuberculosis. Among extra pulmonary tuberculosis, the musculoskeletal tuberculosis accounts for about 10–15% cases (Mohd Altaf Mir, Imran Ahmad, Mihd Yaseen (2016) World J Plast Surg 5(3):313–318). Hand involvement is seen in 10% of patients with musculoskeletal disease. There has been recent interest in tuberculosis of the hand because of a rising incidence owing to increasing numbers of immigration, an aging population, and immunosuppressed people including affected patients with human immunodeficiency virus [3,7] (Centre for Disease Control (1995) MMWR 14:1–16), Al-Qattan MM, Al-Namla A, Al-Thunayan A, Al-Omawi M (2011) J Hand Surg 36:1413–1422). Tuberculous tenosynovial disease (TBTS) is the most common presentation of hand tuberculosis. In the hand, the flexor tendon sheath and radio-ulnar bursae are the most common sites of tenosynovitis. Tuberculosis of hand is more commonly seen in the dominant hand of the male population (Al-Qattan MM, Al-Namla A, Al-Thunayan A, Al-Omawi M (2011) J Hand Surg 36:1413–1422). Here, we present a case of TBTS affecting extensor compartment of dominant hand in a post renal transplant immunosuppressed individual.
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