ABSTRACT
Background: Foot ulcer is one of the most common and deadest complications of diabetes mellitus. This is also a frequent cause of hospitalization and disability. Most of the patients with diabetic foot ulcers living in developing countries present to healthcare facilities fairly late with advanced foot ulcers because of poor economic status, inadequate knowledge of self-care, sociocultural reasons and poor and inadequate diabetes healthcare. Methods: A prospective study was conducted in the department of Surgery, JNMC Sawangi (Meghe), Wardha of DMIMS (DU) with the aim to evaluate the pattern of distribution of foot ulcers in diabetic foot patients and related complications. We enrolled 30 diabetic patients in the study, of these 21 (70%) were males and 9 (30%) were females with male to female ratio 2.33. Results: The mean age of presentation was 52.93 ± 14.10 and the mean duration of diabetes was 8.20 ± 10.06. The maximum numbers of lesion was present in the region of second to fifth metatarsal (53.33%), followed by heel (26.66%) and great toe (10%). Maximum patients 9 (30%) had grade II lesions as per Wagner’s classification and 12 (40%) had II B as per University of Texas diabetic wound classification. Associated deformity was present in 36.66%, insensitivity to the 5.07 S-W monofilaments in 56.66%, impaired vibration in 43.33%, and abnormal Achilles tendon reflex in 40%. Ankle–brachial index <0.8 was present in 33.33%. Only 13.33% patients were using customized footwear whereas 46.66% were walking barefoot, the difference was statistically significant P = 0.0027. Conclusion: The health education to promote Knowledge, Attitude, Behavior and Practice (KABP) is essential to prevent diabetes associated foot complications.
ABSTRACT
Background: Chronic kidney failure is characterized with progressive and irreversible diminishing of glomerular filtration rate. AVF has been unanimously considered the gold standard vascular access of choice for hemodialysis. Arterio-venous fistula (AVF) for hemodialysis should be created in patients with endogenous creatinine clearance < 20 mL/min/1,73m2. Aim of current study was to choose the proper site for arteriovenous fistula creation with minimal complications. Methods: It was a prospective study, carried out in the dept. of surgery from April 2008 to August 2013. A total of 140 patients were studied over the period. The fistulae were created using radial artery cephalic vein side to side and brachial artery cephalic vein side to side or end to side anastomosis. Statistical analysis used: Mean, Standard deviation, Standard error. Results: A total 140 patients were studied, out of them 104 were males and 36 were females. The radiocephalic site was used for 82 (58.57%) patients and 58 (41.43%) patients were operated on brachiocephalic site. The mean inner diameter of radial artery, brachial artery and cephalic vein (intima to intima) at elbow and wrist were 21.49001 ± 0.901 (SE - 0.28492), 3.72533 ± 1.06837 (SE - 0.30841) and 0.68079 ± 0.49551 (SE - 0.116790) respectively. The mean flows velocity of brachial and radial artery were 76.10526 ± 4.54477 (SE - 1.04264) and 52.64286 ± 5.5968 (SE - 1.495810) respectively. The success rate of AV fistula on table was 97.85% (137 out of 140). The incidence of complication was 18.57%. Conclusion: The site for fistula creation depends on the quality of the artery and vein. To achieve good success rates preoperative color Doppler is essential to evaluate the vessels. The complication rates can be minimised by following standard operating protocols.
ABSTRACT
Madura foot or mycetoma is a chronic granulomatous disease characterized by localized infection of subcutaneous tissues by actinomycetes or fungi. The recurrence rate for the disease if treated inadequately is very high. Recurrence presents with swelling and multiple discharging sinuses. This is an unusual presentation of the disease without discharging sinuses which is probable the first report of this kind in the literature. A 34 year old, male, presented with the painless, progressive swellings over right foot since 4 years. No sinuses or discharge could be found on skin surface. The postoperative recurrence rate is very high, and this can be local or distant at the regional lymph nodes. This could be due to the disease biology and behavior or inadequate surgical excision. Usually it presents with multiple sinus tracts, and granule. We reported a case with classical absence of sinus tracts in recurrent actinomycosis.