Comparative Study of Bacteriological Profile of Cellulitis in Diabetic versus Non-Diabetic Patient

Introduction: Comparative study of bacteriological profile of cellulitis - in diabetic versus non diabetic patient.Materials and Methods: During a period of June 2018–May 2019 in Sanjay Gandhi Memorial Hospital surgical wards,approximately 100 cases including both diabetic and non-diabetic getting admitted through surgery out patient department,casualty, or transferred from other departments diagnosed as cellulitis based on clinical suspicion. Samples were collectedfrom the deeper portion of the ulcers, among these samples, one swab was used for Gram staining and the other was usedfor culture. A direct Gram stained smear of the specimen was examined. The organisms were identified on the basis of theirGram staining properties, their biochemical reactions, and the culture identified.Results: According to pus culture sensitivity is was found that among Gram-negative isolates, Pseudomonas aeruginosa(25.19% in D and 28.06 in ND) is most common in both diabetic and non-diabetic followed by Escherichia coli (16.12% in Dand 17.39% in ND) and Klebsiella pneumoniae (12.9% in D and 8.6% in ND). Among Gram-positive isolates, Staphylococcusaureus is most commonly isolated followed by Enterococcus in diabetics, as in non-diabetics, S. aureus (32. 25% in D and30.43% in ND) is most commonly isolated followed by Enterococcus (9.6% in D and 4.3% in ND) and methicillin-sensitive S.aureus (1.6% in D and 2.17% in ND) (D – diabetics and ND – non-diabetics).Conclusion: Microbiological evaluation of the ulcers revealed that the prevalence of Gram-negative organisms 47 (57.75%)was found to be more than Gram-positive organisms 14 (17.5%), Candida albicans 3 (3.75%), and polymicrobial species17 (21.25%). Among Gram-negative isolates, P. aeruginosa is most common in both diabetic and non-diabetic followed by E.coli and K. pneumoniae. Among Gram-positive isolates, S. aureus is most commonly isolated followed by Enterococcus indiabetics, as in non-diabetics, S. aureus is most commonly isolated followed by Enterococcus and methicillin-sensitive S. aureus.

Prediction of Difficult Laparoscopic Cholecystectomy Based on Clinical and Ultrasonographic Parameters

Background: Cholelithiasis is the most common biliary pathology. The definitive treatment for cholelithiasis is either open/ laparoscopic cholecystectomy (LC). The objective of this study was to predict difficulty in doing LC based on clinical and ultrasonographic parameters. Materials and Methods: A hundred patients admitted with a diagnosis of cholelithiasis in surgical wards in the Department of Surgery, Shyam Shah Medical College and Associated Sanjay Gandhi Memorial Hospital, Rewa, from June 1, 2018, to May 31, 2019, were included in the study. All necessary investigations were carried out. X-ray, ultrasonography (USG) abdomen, and blood investigations were done. Patients underwent LC, and a careful record of pre-operative and post-operative findings was made and carefully filled in the pro forma. Results: In the present study, body mass index >27.5 kg/m2 (27%) shows a correlation with predicting difficult LC and conversion to open procedure. Clinical parameters such as guarding and rigidity (8%) with mass (12%) were a sign of acute inflammation, associated with ultrasonography findings favor for difficult cholecystectomy. Gallbladder wall thickness (38%) and pericholecystic fluid collection (16%) in USG are strong predictors of difficulty. Conclusion: Clinical and USG findings help to predict difficulty in laparoscopic cholecystectomy and leading to the conversion of LC to open cholecystectomy.

Clinical Study on Acute Inflammatory Inguinoscrotal Lesions

Introduction: Acute inguinoscrotal swellings are the most common swellings affecting both children and adults.Although these swellings are frequently encountered, many times correct diagnosis is not made and testes have beensacrificed. A wide variety of acute inflammatory conditions affects inguinoscrotal region and testes such as inguinalabscess, funiculitis, inguinal lymphadenitis, primary infections of scrotum, and/or secondary infection of testes such asepididymo-orchitis and scrotal abscess, pyocele, and Fournier’s gangrene. Knowledge of the risk factors, prevention,and early detection with prompt treatment of inguinoscrotal lesions, which leads to reduction in morbidity and mortalityassociated with these lesions.Materials and Methods: In this prospective study carried out in 195 patients in the Department of Surgery, Shyam ShahMedical College and associated Gandhi Memorial and Sanjay Gandhi Memorial Hospitals, Rewa, Madhya Pradesh, during theperiod of 1 June 2017 to 31 May 2018. All male patients with complaints of acute painful inguinoscrotal swelling and ulcer witha history of <2 weeks were included in the study. Presenting complaints and detailed history were recorded in a predesignedpro forma. Thorough general examination and local examination were done. Patients were investigated and final diagnosiswas established. Then, treatment was initiated according to diagnosis.Results: Acute epididymo-orchitis (42.6%) was the most common cause for acute inguinoscrotal pathology followed byFournier’s gangrene (19.5%) and scrotal abscess (17.9%). Majority patients belong to the age group of 31–40 years, 22.6%and in the age group of 41–50 years, 20.5%. The most common predisposing factor was lower urinary tract syndrome presentin 47.1% followed by poor personal hygiene (43.07%). Conservative treatment was given in 80 patients. All, except eight casesof epididymo-orchitis (83), two cases of scrotal cellulitis and four cases of inguinal lymphadenitis were treated conservatively.All 38 cases of Fournier’s gangrene and one case of scrotal cellulitis were treated by debridement and daily dressings. Incisionand drainage of pyocele was carried out in five patients. Scrotal exploration with drainage of testicular abscess was done inthree cases. Orchidectomy was required in two cases of testicular abscess.Conclusion: Acute inguinoscrotal lesions are common in younger and middle age individuals with variable symptomatology.Such conditions presenting to emergency department need careful examination, proper evaluation, and prompt treatment.Conservative treatment with rest, scrotal support, antibiotics, and analgesics is effective in case of epididymo-orchitis.Emergency surgical exploration proved to be the best in case of scrotal abscess, Fournier’s gangrene, pyocele, andhematocele. Various predisposing factors can be minimized by proper health education and developing good primary healthcare system.