Use of garenoxacin: a new generation antibiotic for surgical infections.

Background: The management of skin and skin structure infections (SSSI) still continues to be global challenge. USFDA has given strong recommendation for adequate empirical antibiotic coverage to avoid further complication of the wounds. Wound complications, especially in the diabetic population, patients with low immunity remains a big challenge though other factors like site of the wound, age of the patients also play an important role. Methods: A retrospective observational study was conducted to analyze clinical utility of garenoxacin for surgical prophylaxis. A total of 100 patients, 30 patients with diabetic foot and 70 patients with post-surgical intraabdominal wounds who were prescribed garenoxacin 2×200 mg as stat dose prophylactically. Swab culture from the wound slough and drain tube samples were sent for culture/sensitivity on day 0, day 5, and day 7. Wound healing was evaluated by estimating slough discharge, size of the wound, vascularity, and overall healing. They were categorized as treatment failure group, when sough/drain-discharge reduction was ≤50%, improved if sough/drain-discharge reduction was 50-75% and cure when sough/drain-discharge reduction was 75-100%. Results: The healthy granulation tissue was observed post 7 days therapy of garenoxacin 2×200 mg in diabetic foot ulcer (DFU) patients when administered empirically before surgical debridement. In patients with post-operative infectious intraabdominal wounds, the most common isolated organisms were Enterococcus, Acinetobacter and Klebsiella. Post garenoxacin therapy used as switch therapy empirically for 5 days resulted in 100% sterile culture. While evaluating slough/draindischarge in DFU patients, 84% patients showed cure and 16% showed improvement at the end of day 7 and in patients with post-operative infectious intra-abdominal wounds cure was observed in 86% patients showed cure and 14% patient showed improvement. No side effects were reported during the study. Conclusions: Administration of garenoxacin used as empirical therapy for surgical prophylaxis and as switch therapy in patients with DFU s and post-surgical infectious wounds for the period of 5-7 days has been found effective indicating its wide spectrum of action.

Newborn care at peripheral health care facilities.

Primary health centres, sub-district hospitals (first referral units) and district hospitals constitute the backbone of the health services in the country. These facilities are expected to cater to the care of the newborn infants who are delivered there, as well as those brought from the community with sickness. This paper, based on a survey in Orissa, and studies in a district hospital in Himachal Pradesh and a sub-district hospital in Haryana, is an attempt to piece together the present status of neonatal care at these facilities. In Orissa, the district and sub-district hospitals cater to a median of 100 and 30 deliveries per month, respectively. Most of the deliveries at these facilities are conducted by the nurses and not the physicians. Neonates are generally kept in the facility only for a day. Hardly any deliveries take place at primary health centres. Cesarean deliveries are mostly confined to the district hospitals. The commonest diagnosis of neonates admitted in the district and sub-district facilities is sepsis (septicemia pneumonia, skin infections, diarrhea and meningitis). Primary health centres seldom admit a sick neonate. It is reassuring to note that the outcome of sick neonates admitted at a functional district or sub-district hospital manned by a pediatrician is highly rewarding with low mortality rates.

Fungal colonization in gastric ulcers.

Until now studies on fungal colonization of gastric ulcers were retrospective involving small series of patients. This prospective study of 50 patients with gastric ulcers (25 benign and 25 malignant) revealed colonization by Candida in 17 (34%) cases. There was no significant difference in colonization between benign and malignant ulcers. Follow up revealed no difference in healing of ulcers with or without fungal colonization.

Penicillium species causing onychomycosis.

Onychomycosis caused by mould infection is rare. A 40 year old male patient presented with dystrophic finger nails and multiple, erythematous lesions with slightly raised borders and scaling all over the body. The patient was a known diabetic. He did not respond to griseofulvin. Samples from nails and skin scales were cultured. From the nails, Penicillium species and from the skin scales. Trichophyton rubrum were isolated. Ketoconazole therapy (200 mg twice daily x 4 mths) led to complete cure with negative cultures and normalization of nails.

Disposable polyethylene wiremesh capsules for histopathological tissue processing.

An attempt was made to find a suitable alternative material for tissue carriers other than gauze and stainless steel capsules. Since polyethylene (high density) wire mesh is resistant to all acids, alkalis and inorganic chemicals and has no known solvent at room temperature, it is a suitable alternative disposable material for histopathological tissue processing purposes.

Glycemic control and its relationship to diabetic foot ulcers.

Glucosylhaemoglobin (HbA1) was estimated in 60 diabetic patients, 30 with foot ulceration and 30 without foot lesions. Peripheral neuropathy and vascular disease were commonly found in the ulcer' group. The mean HbA1 level in diabetics without ulcers was 9.77 +/- 2.34, while the corresponding level in diabetics with ulcers was 14.14 +/- 3.63. The difference in values is statistically highly significant (p less than 0.001) suggesting that foot ulcers are more likely to occur in poorly controlled diabetic patients.

Bacteriology of diabetic foot ulcers.

Seventy five diabetic foot ulcers were cultured using optimal aerobic and anaerobic microbiologic techniques. There were a total of 223 isolates (162 aerobes and 61 anaerobes) representing an average of 2.97 bacterial species per specimen. Mixed organisms were the most common isolates. Staphylococcus aureus was the commonest isolate being recovered in 60% of cases. Anaerobic organisms were isolated in 46 patients (61.33%) and the most frequent anaerobe isolated was Bacteroides fragilis. The other organisms predominantly isolated were Proteus, Klebsiella, Pseudomonas, Peptoccus and Clostridia. Antibiogram showed discouraging pattern with commonly used antibiotics. Metronidazole and gentamicin were the most effective antimicrobial agents against anaerobic and aerobic organisms respectively. Appreciation of the causative organisms in diabetic foot and their antibiotic sensitivity is essential for institution of appropriate antibiotic therapy.

Clinico-pathological profile of lymphomas in south India: a prospective rural referral hospital study of 103 cases.

A prospective clinical and histopathological study of 103 patients with lymphomas is reported. Of these, 72 (69.9%) had non-Hodgkin's lymphoma (NHL) and 31 (30.1%) had Hodgkin's lymphoma (HL). The median age at presentation was 34 and 43 years for Hodgkin's and non-Hodgkin's lymphoma respectively, which is lower than that seen in the West. Fever and superficial lymphadenopathy were the commonest presenting features and 'B' symptoms were present in over 60% of both groups. Seventy-five per cent of NHL and 64.5% of HL presented in stages III and IV of the disease.

Aetiology of diabetic foot ulceration.

A prospective study of 150 diabetic patients was undertaken with the aim of determining the factors associated with the development of foot ulcerations. Seventy five patients had foot ulceration and 75 had no foot lesions. Peripheral (78.7%) and autonomic (38.7%) neuropathy were more commonly found in the "ulcer" group, as were vascular insufficiency (49.3%) and hyperlipidaemia (60%). Renal failure (9.3%) and ketoacidosis (20%) were also commoner in patients with foot ulceration. Most, if not all, of the aetiological factors are related to prolonged uncontrolled hyperglycaemia.

Morbidity and mortality of acute myocardial infarction in and around Aligarh.

A 6-year retrospective study of 341 cases of acute myocardial infarction admitted to JN Medical College Hospital, Aligarh in respect of the incidence, complications and mortality in relation to age, sex, religion, smoking habit occupation and risk factors was made. The incidence was found to be 9 per 1000 hospital admissions. Maximum number of cases was in the age group of 51-60 years and male to female ratio was 7:1. There was no significant difference in incidence and mortality between Hindus and Muslims of both sexes. Highest incidence was noted among sedentary workers and smokers. Hypercholesterolaemia was found in only 17.01% cases, the rest having normal serum cholesterol levels. Hypertension and diabetes mellitus were associated in 24.05% and 12.32% cases respectively. Cardiac complications were noted in 43.4% of patients, the commonest being cardiac failure. Overall in-hospital mortality was observed to be 11.41% of which 79.49% had cardiac complications. Diabetics had significantly (p less than 0.05) higher mortality rate (21.43%) as compared to non-diabetics. Smokers had higher mortality rate compared to non-smokers (p less than 0.01). Although those with hypertension and with hypercholesterolaemia had higher mortality, the results were not statistically significant. The average day of expiry after acute myocardial infarction was 3.82 days during hospital stay.