Prescription Pattern And Usage Of Antimicrobial Agents For Treating Diabetic Foot Infections At Tertiary Care Centre

Objective: Due to the uncertainty about optimal antibiotic treatment, and probably substantial variation in practice, the present study was carried out to determine the bacterial profiles of infected diabetic foot ulcers (DFUs) and also to analyze the prescribing pattern of antibiotics used. Methods: A prospective observational study was carried out in the department of General surgery at a tertiary care teaching hospital, Mangalore. Demographic details and treatment data of 78 patients were collected in a specially designed Proforma, and the data were analyzed using Microsoft Excel. Results: According to Meggit-Wagner's classification, patients admitted with DFUs predominantly belonged to WAGNER 1 category (36%), followed by WAGNER 4 (26%) and WAGNER 2 (22%) categories. Out of 66 culture-positive specimens, 21 (31.8%) had monomicrobial flora, and 45 (68.2%) had polymicrobial flora. A total of 148 organisms were obtained from the specimens. The most common isolates were Staphylococcus aureus (22.3%) and Pseudomonas aeruginosa (17.5%). Ceftriaxone was the most commonly prescribed empirical antibiotic (29%), followed by linezolid (20%), piperacillin-tazobactam (20%), amoxicillin-clavulanic acid (13%), cefoperazone-sulbactam (11%). After the culture and sensitivity (C/S) results, antimicrobials were changed in 74.61% of patients in the preference of Linezolid (51%), Amikacin (27%), Levofloxacin (19%), Ciprofloxacin (17%), Piperacillin-tazobactam (13%), Cefixime (15%), Ceftriaxone (11%) among others. Clindamycin and metronidazole were used to cover anaerobic microorganisms. Conclusion: Most of the microorganisms isolated from DFUs were resistant to many types of antibiotics. Gram-positive organisms were largely sensitive to linezolid and vancomycin, while Gram-negative organisms to amikacin and imipenem. Local treatment of wounds is essential.

Analysis Of Pesticide Poisoning Cases In A Tertiary Care Hospital, Mumbai.

Background: Acute pesticide poisoning (APP) is a serious problem worldwide. Pesticide poisoning is a common meth-od of suicide attempt and less commonly accidental poisoning in India. Methods: A prospective analysis of pesticide poisoning cases admitted to the emergency department of tertiary care, teaching hospital. The data regarding socio-demographic profile, pattern of poisoning, Occupation, type of pesticide poisoning, relation of pesticide poisoning and risk factors, time of ingestion of pesticide poisoning and Seasonal variation were studied. Results: Of 174 cases admit-ted to the emergency department of hospital with a diagnosis of acute pesticide poisoning, the most cases observed in the age group 21-30 years (n: 72, 41.37%). Total males affected were 94 (54.02%) dominating the females 80 (45.98%) and male to female ratio (1.17:1). But in younger age group, females were more affected than males. The maximum cases belonged to the lower socioeconomic class (n: 82, 47.12%) and urban areas (n: 106, 60.91%). Majori-ty of the victims married and belonged to Hindu religion (n: 140, 80.4%). The suicidal was commonest manner of pes-ticide poisoning accounting 98 cases (56.32%). The occurrence of pesticide poisoning was more frequent in the even-ing (n: 82, 47.12%) and during the, monsoon (73, 41.95%). Conclusion: Pesticide poisoning is responsible for great number of admissions and deaths in India. There is a need for adequate guidelines for sale, use, storage and safety practices for the pesticide. These will be helpful for the enhancement of the knowledge, awareness and safety practices among the population for prevention and reduction of the pesticide poisoning. It also emphasized on the early availa-bility of treatment in the poisoning cases

An evaluation of role of sinusitis as focal sepsis in chronic otitis media active mucosal disease: A cross-sectional survey.

Background: Sinusitis causes inflammation of the middle ear mucosa with increased and persistent mucoid/ mucopurulent discharge and remains as a active mucosal disease. Without correcting the sinusitis the management of ear including surgery has frequently led to failures and poor prognosis Objectives: To establish the role of Sinusitis as Focal sepsis in Chronic Otitis media active mucosal disease. An additional objective was to accentuate the need of proper diagnostic endoscopic evaluation and improvement in middle ear mucosal disease status after functional endoscopic sinus surgery. Material and methods: A total of 50 patients aged 18-49 years with Chronic otitis media active mucosal disease (Tubotympanic type of C.S.O.M.) patients with persistent ear discharge even following culture directed topical and systemic antibiotics with 3 months and more of ear discharge seeking care at Otorhinolaryngology outpatient department were included in this study. Results: Mean age of patients was 42.5 ± 10.6 years. 76% subjects were found having septal deviation/ turbinoseptal deformity which was the most common anatomical variant, 34% had enlarged middle turbinate, 32% had medialised uncinate, 30% had enlarged bulla, 22% had enlarged bulla with prominent agger and 18% had paradoxical middle turbinate. Of these 22 patients had the accessory ostium in the posterior fontanel and 10 patients had accessory ostium in the anterior fontanel. Majority (26, 52%) of subjects had Grade I disease i.e. minimal disease limited to Osteo Meatal Complex followed by Grade II 24% i.e. moderate incomplete opacification of one or more sinuses. On otoendoscopy, 36 patients (72%) had a large central perforation, while 14 patients (28%) had a subtotal central perforation Conclusion: A thorough diagnostic nasal evaluation of all Chronic Otitis Media active mucosal type of patients is essential in comprehensive management of the disease. Deviated nasal septum, enlarged middle turbinate, medialised uncinate predispose to sinusitis.

An evaluation of self medication among undergraduate medical students of a rural medical school from western Uttar Pradesh.

Background: Common problems related to self medication are wastage of resources and increasing antimicrobial resistance. They generally entail serious health hazards such as adverse reaction and prolonged suffering. Aim: The study aimed to analyze the pattern, factors influencing and potential adverse effects of self-medication among the undergraduate medical students Material and methods: The present cross sectional study was carried out by the Department of Pharmacology, MSDS Medical College, Fatehgarh among the undergraduate students currently studying in a rural medical school from western Uttar Pradesh. A 25 item self administered questionnaire was administered to the students in the classrooms just after completion of classes. Time allocated for the completion of the questionnaire was 30 minutes. After compilation of collected data, analysis was done using Statistical Package for Social Sciences, version 21 (IBM, Chicago, USA). Results: Data of 256 study subjects was analyzed. Overall prevalence of self medication among study subjects was found to be 71.5% (87.6% among males and 50.5% among females). 82.5% had trust in allopathic medicine system. 81.5% students learnt self medication from doctors prescriptions provided during their prior illness. Regarding categories of drugs commonly self-prescribed, they commonly used antipyretics (81.4%), anti-tussives (72.1%) and analgesics (68.9%). ‘Illness too trivial for consultation’ was the most common (71%) reason for self-medication cited by them. Almost 69% of them were aware of possible adverse effects. 7.7% of them even experienced the side effects of self-medication. Conclusion: The study highlighted growing trend of self-medication among medical students. Policies prohibiting the supply of medicines without a valid prescription should be enforced strictly. A robust monitoring system among the physicians and pharmacists is need of an hour.

Bilateral Pheochromocytoma: An anesthetic challenge.

Pheochromocytoma is a rare catecholamine secreting neuroendocrine tumor. It is bilateral in 10% of cases. A 24 year lady with bileteral Pheochromocytoma operated for resection under epidural with general anesthesia. Diagnosis was confirmed with 24 hour urinary VMA levels, USG, CT scan and MIBG scan. Tumor resection was incomplete on left side so patient underwent reexploration. Preoperative BP controlled with Phenoxybenzamine and Prazocine. Intra-operative BP fluctuations managed with sodium nitropruside and esmolol. Post operative hypotension was tackled with higher doses of Dopamine and Noradrenline due to down regulation of adrenergic receptors. Patient was discharged on oral steroids after 3 weeks.

Anatomic variations in the origin of the left circumflex coronary artery with angiography in Northern Indian population.

Introduction: Knowledge of the normal and variant anatomy and anomalies of coronary circulation is definitely a crucial component in the management of heart diseases. Complex cardiac surgical repairs demand enhanced understanding of the basic anatomy to improve the operative Outcomes Material and methods: The present study was planned by Department of Anatomy and was executed in collaboration with Department of Internal Medicine and Cardiology during 2010 to 2014 at a tertiary care teaching hospital located in western Uttar Pradesh. The angiographic data of 5,532 patients who underwent coronary angiography were considered for anomalous origin of the left circumflex coronary artery (LCx). Results: The incidence of anomalous origin of the LCx was found to be 0.36%. The LCx arose from the left coronary sinus of valsalva (there was separate orifice for the LCx and the left anterior descending coronary artery) in 45.0% patients, from the right coronary sinus of valsalva, (there was a separate orifice for the LCx and the right coronary artery) in 25.0% patients, from the proximal part of right coronary artery in 30.0% patients. Conclusion: On the basis of findings of the current study it can be concluded that, the anomalous origin of the LCx may not be benign all the time. In case where ischemia does not resolve accurately after successful treatment of a coronary stenosis, anomalous coronary arteries must be considered.

A comparative study of different modalities of treatment of liver abscess.

Objective: To compare the effectiveness of conservative medical treatment versus minimal invasive surgical techniques like percutaneous catheter drainage (PCD) and percutaneous needle aspiration (PNA) in the management of liver abscess. Material and methods: All patients with liver abscess who were admitted in Surgery from October 2013 to June 2014 were included in this study and were exposed to four different treatment modalities. The patients were first treated with combination of medicine (Option-A). If they failed to respond to this treatment then they were subjected to ultrasound guided aspiration (Option -B). If Option - B failed they were exposed to pig tail catheter placement (Option -C). Final option was surgical drainage (Option - D) if it was rupture liver abscess and if the patient presented with co morbid conditions like septicaemia and peritonitis.PNA was repeated every third day if the cavity size had not declined to 50% of the original for up to three times. Persistence of cavity or of clinical symptoms was considered failure of treatment. Results: Out of 51 patients, 14 patients responded to drug therapy alone. 34 patients required ultrasound guided aspiration and Pig tail catheter placement and 3 patients required open surgical drainage. A combination of drug therapy and ultrasound guided needle aspiration was effective for majority of 83% patients Duration of hospital stay was similar in the two groups. Conclusion: Minimal surgical interventions like PCD and PNA are better than conservative treatment for the management of liver abscesses of size >5 cm, in terms of duration to attain clinical relief and duration for which parenteral antibiotics are needed. Pyogenic liver abscess are less common than amoebic liver abscess. Right lobe of the liver is most commonly involved in both types of abscesses. Radio-imaging techniques like ultrasonography (US) and computerized tomography (CT) are the modalities of choice for investigation purposes. Treatment modalities of these abscesses, first emphasizes on medical treatment, but if it is unsuccessful then only the surgical intervention should be taken up. Laparotomy and Drainage or Laparoscopic Drainage remains the standard of care for ruptured liver abscess.

Comparison of the effi cacy of sitagliptin with pioglitazone on dexamethasone-induced hepatic steatosis, dyslipidemia, and hyperglycemia in albino rats.

Background: Sitagliptin is a dipeptidyl peptidase type 4 inhibitor. This study was done to assess the insulin-sensitizing effect of sitagliptin on Wistar albino rats by means of surrogate measures. Methods: There were four groups of six rats each. First group received dexamethasone alone in a dose of 8 mg/kg intraperitoneally for 6 days to induce metabolic changes and considered as dexamethasone control. Second group received sitagliptin 100 mg/kg orally 6 days before dexamethasone and 6 days during dexamethasone administration. Third group received pioglitazone 45 mg/kg orally 6 days before dexamethasone and 6 days during dexamethasone administration. Fourth group did not receive any medication and was considered as normal control. Fasting blood sugar, lipid profi le, blood sugar 2 hrs after glucose load (postprandial blood sugar), liver weight, liver volume, and histopathological analysis were done. Results: The effects of sitagliptin were compared with that of pioglitazone. Dexamethasone caused hepatomegaly, dyslipidemia, and hyperglycemia. Both pioglitazone and sitagliptin signifi cantly reduced hepatomegaly, dyslipidemia, and hyperglycemia (p<0.01). Reduction of blood sugar levels after glucose load was signifi cant with pioglitazone in comparison to sitagliptin (p<0.01). Conclusions: Sitagliptin has comparable effi cacy to pioglitazone in dexamethasoneinduced hepatomegaly, dyslipidemia, and fasting hyperglycemia

Histopathological diagnosis of gastrointestinal malignancies - A retrospective study.

Objective: Worldwide gastrointestinal malignancies are a leading cause of both mortality and morbidity with marked epidemiological differences in various geographic and ethnic populations. The objective of current study was to study the prevalence, age and sex distribution and to analyze variations in histopathological lesions of gastrointestinal malignancies. Method: The entire specimens were fixed overnight in 10% formalin, processed using automatic tissue processor and stained with routine Haematoxylin and Eosin stain. Results and conclusion: Total 98 cases of gastrointestinal malignancies were analyzed; out of these, total 61 were male patients while 37 were female patients with overall male to female ratio of 1.65:1. The commonest affected age group was 46-60 years with more than 50% cases of gastrointestinal malignancies in this age group. The youngest patient was 14 years of age while the oldest was 92 years old. Adenocarcinoma was the commonest histopathological diagnosis with 70 cases followed by 15 cases of squamous cell carcinoma. We also found cases of malignant gastrointestinal stromal tumour, non-Hodgkin’s lymphoma, carcinoid tumour and malignant melanoma at different anatomical location of gastrointestinal tract.

Electrophoresis pattern in clinically and hematologically suspected cases of haemoglobinopathies.

Objective: Haemoglobinopathies are a group of disorders with structural or quantitative variation in normal hemoglobin structure. There are various identified haemoglobinopathies worldwide, among these sickle cell disease and beta thalassemia are prevalent in Gujarat. Both of them are associated with marked morbidity and mortality.Method: Hemoglobin electrophoresis is a low cost method helpful in early diagnosis of many of these haemoglobinopathies. In current retrospective study- 33 cases of clinically and hematological suspected cases of haemoglobinopathies were subjected for hemoglobin electrophoresis on agarose gel at pH 8.6. Result and conclusion: Out of 33 suspected cases 13 cases of thalassemia major, 10 cases of sickle cell anemia and 7 cases of sickle cell trait were diagnosed with varying degree of clinical and hematological findings.

Unresponsive cutaneous leishmaniasis and HIV co-infection: Report of three cases.

Cutaneous leishmaniasis (CL) is a vector borne disease caused by various species of Leishmania parasite. CL is endemic in the Thar desert of Rajasthan state and Himachal Pradesh in India. Immune suppression caused by human immunodeficiency virus (HIV) infection is associated with atypical clinical presentation of CL which responds poorly to the standard treatment and causes frequent relapses. We are reporting three cases of localized and disseminated CL due to Leishmania tropica which failed to respond to conventional intralesional/intramuscular sodium stibogluconate (SSG) injections. Initially, we did not think of HIV infection because CL is endemic in this region. When patients did not respond to SSG injections, we performed enzyme-linked immunosorbent assay (ELISA) tests for HIV and they turned out to be HIV positive. Our report showed that CL is emerging as an opportunistic infection associated with HIV/AIDS and may be the first manifestation in HIV positive patients in an endemic area.