Diabetic foot is a common, preventable complication of diabetes mellitus. This was a prospective study (April 2004 to October 2005) of 55 diabetic foot patients attending surgical out and in-patient departments at a rural hospital in Mahrastra, India. To determine the prevalence of diabetic foot amongst our patients with diabetes and the associated risk factors. All patients underwent medical assessment, including foot examination, those with diabetic foot answered an interviewer-administered questionnaire on foot healthcare practices. Symptoms, examination findings, glycaemic control, duration and classification of diabetes, occupation and smoking habits were cross studied with diabetic foot according to Wagner’s grading. The prevalence of diabetic foot was 11% and 84% of patients were men. The commonest presentation was Wagner’s grade 2 diabetic foot (34.5%) and most patients (69%) worked outside. The majority of patients with Wagner’s grade 2—5 had uncontrolled diabetes. Neuropathic and vasculopathic components were major predictors of diabetic foot. More than half (64.5%) of our patients were ignorant of foot healthcare practices. Patients with diabetes at this rural clinic need to be better informed on how to examine and care for their feet. They would also benefit from measures to help them improve glycaemic control.
213 123Dear Sir, Blunt trauma to the parotid gland is usually associated with skeletal injury to the mandible and to more vital structures. It is extremely rare because a considerable force is required to injure the parotid gland in blunt trauma [1,2,3]. A 24-year-old gentleman presented with history of road traffi c accident (overturning of the vehicle in which he was traveling). He had transient loss of consciousness and right ear bleeding. There was no history of vomiting, seizures, nasal or oral bleed. His general and systemic examination was routine. Neurologically GCS was E4V5M6 and pupils were bilaterally equal and reacting to light. Facial nerve functions were also normal. There were no focal neurological defi cits. Local examination revealed lacerated wound over right temporal region with swelling over the right parotid region with bruising and tenderness (Fig. 1). Oral cavity examination was normal. Computed tomography showed marked soft tissue swelling involving the right parotid gland. There was no evidence of any intracranial haematoma or underlying bone injury. Local wound was sutured after thorough cleaning. He also had lacerated wound over left arm that was sutured. He was started on antibiotics and recovered. This is a unique case of blunt traumatic injury to the parotid gland in an adult where there was no associated injury to the facial skeleton, parotid gland and ductal structures. In a patient with swelling in the parotid one should rule out the injury to the parotid gland and ductal structures [1]. Clinically in our patient there was no evidence of salivary leak and there was no injury to the facial skeleton as confi rmed by CT scan, however it showed a swollen parotid gland. When there is suspicion ductal integrity a sialography is recommended [1], however it was not needed in our patient. Once the injuries to the facial nerve, skeletal system and ductal structures can be excluded, blunt parotid trauma does not require invasive diagnostic procedures and can be managed conservatively [1,4]. We could manage this unique case of an adult sustained parotid injury without any associated injury to the facial skeleton, parotid gland and ductal structures with good results.
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