Study of Surgical Management of Diabetic Foot in Telangana Population

Introduction: The foot is highly entity to cope with a large degree of repetitive stress. Fatty tissue on the plantar surface and a thickened dermis and epidermis cushion and absorb repeated forces of compression, torsion, and shear during locomotion and standing. Materials and Methods: Eighty-nine patients between 35 and 65 years visiting MediCiti Institute of Medical Science, Ghanpur, Medchal-501401, Telangana, suffering from diabetic foot were selected for study. The patients belonged to middle socioeconomic status; due to illiteracy and poverty, they were not regularly taking antidiabetic drugs. Results: Clinical manifestations were the duration of onset of diabetic was 23 (25.8%) newly diagnosed, 17 (19.1%) had 1–5 years, and 49 (55%) had >5 years. Duration of diabetic foot ulcers was 21 (23.5%) had >4 weeks, 39 (43.8%) had 4–52 weeks, and 29 (32.5%) had >52 weeks. Anatomical sites were 44 (49.4%) had forefoot, 12 (13.4%) had mid foot, 9 (10.1%) had hind foot, 24 (26.9%) had whole foot, and foot affected were 45 (50.5%) right foot, 19 (21.3%) left foot, and 25 (28%) both foot. Types of ulcer were as follows: 52 (58.4%) were neuropathic, 26 (29.2%) had ischemic, 4 (4.49) had neuroischemic, and 7 (7.86%) was unclassified; Wagen’s classification was as follows: 3 (3.37%) had Stage I, 32 (35.9%) had Stage II, 26 (29.2%) had Stage III, 13 (14.6%) had Stage IV, and 15 (16.8%) Stage V. Types of operations were as follows: 33 (37%) had debridement, 44 (49.4%) had lower limb amputation, 23 (25.8%) had minor amputation, 21 (23.5%) had major amputation, 5 (5.6%) had skin grafting, and 7 (7.86%) had incision and drainage. Conclusion: A surgeon the having complete knowledge of foot anatomy can justify the proper management of diabetic foot surgery. Early recognition and proper treatment are mandatory to avoid poor outcomes. Surgery must always be combined with antibiotics and revascularization

Study of Liver Abscess: Its Etiology and Treatment in Telangana Population

Introduction: Liver (hepar) is a largest metabolic center in the body. It is said that the liver is the busiest port in the lake of life. Etiology of the liver abscess has changed to pyogenic abscess (PA). PA of liver remains a major diagnostic and therapeutic challenge despite advances in diagnostic technology and new strategies for treatment. Materials and Methods: Ninety-six patients aged between 25 and 65 years visiting MediCiti Hospital (MediCiti Institute of Medical Sciences), Ghanpur, Medchal – 501401, Telangana, were selected for study. Results: The clinical manifestation was as follows: 72 (75%) had fever, 72 (75%) had abdominal pain, 70 (72.9%) had nausea and vomiting, 48 (50%) had night sweats, 42 (43.7%) had weight loss, 9 (9.37%) had jaundice, 29 (302%) had diarrhea, and 38 (39.5%) had chest symptoms (cough, chest pain, and shortness of breath). Hematological and biological study had 54 (56.2%) 45–46 (u/I) alanine aminotransferase (ALT), 42 (43.7%) had 47–48 ALT, and 38 (39.5%) had 40–41 (u/I) ALT; 38 (39.5%) had 40–41 aspirate aminotransferase (AST) and 58 (60.4%) had 42–43 (u/I) AST; 62 (64.5%) had 470–471 alkaline phosphatase (ALP) (u/I) and 34 (35.4%) had 472–473 ALP (U/I); 52 (54.1%) had 11–12 serum bilirubin (Mm/I) and 44 (45.8%) had 13–14 serum bilirubin (Mm/I); 62 (64.5%) had 11–11.5 hemoglobin (Hb)% (gm/I), 62 (64.5%) had 11.6–11.7 Hb% (gm/I), and 34 (35.4%) had 11.6–11.7 Hb% (gm/I); 51 (53.%) had 17.2–17.3 white blood count (WBC) (× 109/I) and 45 (46.8%) had 17.4–17.5 WBC (× 109/I); and 53 (55.2%) had 14.45–14.46 neutrophils and 43 (44.7%) had neutrophils 14.47–14.48 (109/I). The isolated bacteria were as follows: 32 (33.3%) were Gram negative, 17 (17.7%) were anaerobic Bacilli, and 47 (48.9%) were streptococci. Conclusion: The initial diagnostic investigation, antibiotics as first-line treatment followed by antibiotic with PNA/PDA, and ultimately, surgery was effective treatment. Such types of approach will have better prognosis except in patients with malignant disease.

Study of Cholecystitis in Telangana Population

Introduction: Cholecystitis is a potentially life-threatening condition which affects >20 million globally every year. Gall bladder (GB) stones are the major contributor to acute cholecystitis (AC). Materials and Methods: Eighty-six patients (32 males and 54 females) aged between 25 and 60 years who were regularly visiting MediCiti Institute of Medical Science Hospital having symptoms of cholelithiasis were selected for study. Results: The clinical manifestation was 100% tenderness in right hypochondrium, 28 (32.5%) had fever, 6 (6.97%) had jaundice, 23 (26.7%) had vomiting, and 29 (33.7%) had leukocytosis. The mode of presentation was as follows: 14 (16.2%) had emergency and 72 (83.7%) has elective presentation, and types of pathology were as follows: 75 (87.2%) had calculus cholecystitis and 11 (12.7%) had idiopathic. The organism cultured post-surgically were as follows: 29 (33.7%) had Escherichia coli, 14 (16.2%) had Staphylococcus aureus, 6 (6.97%) had Salmonella, 13 (15.1%) had no organism, and 24 (27.9%) were not done culture due to early healing. This pragmatic approach to the patients with different clinical manifestation with different organism culture study at different age in both sexes will be quite useful to surgeons and physicians to treat efficiently cholecystitis to prevent morbidity and mortality. Conclusion: Clinician at various levels needs to have good understanding of varied clinical presentations of AC, silent (chronic) cholecystitis, and different management options, their pros and cons to be able treat the conditions effectively

Study of Intestinal Obstruction in Telangana Population

Introduction: Intestinal obstruction occurs when there is an interruption in the forward flow of intestinal contents. This interruption can occur at any point along the length of the gastrointestinal tract and clinical symptoms often vary based on the level of obstruction. Materials and Methods: A total of 86 patients between 19 and 68 years were regularly visiting the hospital (Mediciti Institute of Medical Sciences, Ghanpur, Medchal-501401, Telangana) were selected for study because the clinical evaluation of intestinal obstruction is a surgical emergency and treatment would largely depend on early diagnosis and skillful management. Results: The clinical manifestations were 100% pain in abdominal, 100% distention of abdomen 72 (83.7%) had vomiting, 69 (80.2%) had tenderness, 62 (72%) had constipation, 64 (74.4%) had dehydration, 16 (18.6%) had fever, 24 (27.9%) had palpable mass, 63 (73.2%) had increased bowel sound, and 11 (12.7%) had decreased bowel sounds. The etiology of intestinal obstruction was, 30 (34.8%) had adhesion and band, 16 (18.6%) had hernia, 15 (17.4%) had tuberculosis (TB) stricture, 13 (15.1%) had volvulus, and 12 (13.9%) had malignancy. Types of operations were 21 (24.4%) had resection and end to end ileo-ileal anastomosis, 24 (27.9) had release of adhesion band, 16 (18.6%) had hernia repair, 6 (6.97%) had 13 (15%) had untwisting volvulus, 4 (4.65%) had resection and end to end jejunoileal anastomosis, and 2 (2.32%) had tube caestomy. Post-operative had were 7 (8.13%) had wound infections, 5 (5.18%) had respiratory infections, 3 (3.48%) had entero-cutaneous fistula, 4 (4.65%) had prolonged ileus, 8 (9.30%) deaths due to septicemia. Conclusion: Intestinal obstruction, which still remains an important surgical emergency, obstructions due to adhesions is increasing due to abdominal and pelvic surgeries; obstruction due to TB stricture will have post-surgical complications. Early operation is mandatory to avoid development peritonitis and systemic sepsis associated with multi-organ failure.