ABSTRACT
Background: A number of foot ulcer classification systems have been devised in an attempt to categorize ulcers more effectively and allow effective comparison of the outcome of routine management. DUSS (Diabetic Ulcer Severity Score) is one of the latest wound based system of classification, which needs to be validated. Aims and Objectives: Our aim was validation of this diabetic ulcer severity score (DUSS), with patients outcome including healing and amputation. Methods: Total of 100 Diabetic patients attending surgical outpatient clinic or admitted into the hospital (BMCRI) with diabetic foot ulcers from September 2014 to September 2016 were included in the study. Necessary data was collected .DUSS score was calculated for each patient and analysis was done using SPSS package version16. Results: Most common age group affected with Diabetic foot was between 41 -60 years. Males were commonly affected by Diabetic foot ulcers accounting to 68% .Most commonly ulcers were of DUSS Score of 2 followed by Score 3. Overall 50 (50.0%) of 100 people had amputations in our study. Major Amputation was done for 25% of patients. Minor Amputation was done in 25% of patients in our study. The probability of healing with score 0 was 95%,91.6% with score 1,85.7% with score 2,52% with score 3, and 28.5% with score 4. Conclusion: DUSS scoring system provides an easy diagnostic tool for predicting probability of healing or amputation .This is a very simple and easy scoring system which needs no advanced investigation tool and can be easily followed even in busy OPDs.
ABSTRACT
Background: Penetrating abdominal trauma is a commonly encountered emergency surgical condition. Though it is less common compared to blunt abdominal trauma, it is more dramatic due to the nature of the causative modes of injury involved. Mandatory laparotomy, which was earlier advocated for these cases, has gradually been replaced by conservative management in carefully selected cases thereby avoiding the unnecessary complications associated with laparotomy. Aims and objectives: To study the efficacy of conservative management in cases of penetrating abdominal trauma thereby obviating the need for unnecessary laparotomy. Methods: It was a prospective study conducted in a tertiary hospital, involving 64 patients, over a 2 year period. All patients underwent a CT scan to identify their injuries following a clinical examination and patients were managed conservatively or underwent laparotomy based on the CT findings.Results: Of the 64 patients 53 were managed conservatively making it a success rate of 82.81%. Only 2 patients who had a negative CT scan needed a subsequent laparotomy making it a very reliable investigation in these patients. Conclusion: Conservative management for penetrating abdominal trauma patients is effective in the majority of cases and hence can be advocated in the initial management plan of these cases supplemented by serial assessment of physical symptoms and signs, unless laparotomy is considered necessary based on their initial CT or physical examination findings.
ABSTRACT
Background: Necrotizing pancreatitis is one of the severe complications associated with acute pancreatitis. Serum creatinine has recently emerged as a reliable predictor of this severe complication associated with acute pancreatitis. Aims and objectives: The aim of this study is to evaluate the sensitivity and specificity of this simple biochemical marker in predicting the likelihood of developing pancreatic necrosis in any case of acute pancreatitis. Methods: A prospective study was carried out in Victoria Hospital, Bangalore over a period of two years and a total of 200 patients who presented with features suggestive of acute pancreatitis and further confirmed by computerized tomographic evaluation carried out within 96 hours of admission. Serum creatinine levels were documented at the time of admission, 24hrs and 48hrs after admission to notice if an elevation in serum creatinine corresponded with the development of pancreatic necrosis. Results: Out of the 200 test subjects, 26 (13%) patients developed pancreatic necrosis, which was confirmed by a contrast enhanced CT scan performed within 96 hours of admission into our centre. The sensitivity of serum creatinine alone in predicting the development of necrotizing pancreatitis was found to range between 75%-83% and the specificity varied between 71%-79% in our study. The positive predictive value ranges between 11%-23% with a negative predictive value ranging between 98%-99%. Conclusion: Serum creatinine though not highly sensitive is more specific and hence is a valuable simple and inexpensive biochemical parameter for predicting the development of pancreatic necrosis in cases of acute pancreatitis.
ABSTRACT
Background: Hypocalcaemia is one of the acute and most feared complication following thyroidectomy. Depending upon the extent of parathyroid damage, post-operative hypocalcaemia may be temporary or permanent requiring lifelong calcium supplements. Aims and objectives: This study aims to prospectively study and analyse the demographics and possible causes of hypocalcaemia post thyroidectomy.Methods: This is a prospective study of 150 patients undergoing thyroidectomy surgery from January 2015 to December 2015 in Victoria hospital, Bangalore medical college and research institute, Bangalore. Patients demographics, intra operative and pathological aspects were correlated to our hypocalcaemic findings.Results: Out of 150 patients, 18 patients developed temporary hypocalcaemia (12%), none of them developed permanent hypocalcaemia. Mean age of patients developing hypocalcaemia was 45.16 years. 15 (83.33%) of them were females and 3 (16.66%) were male. Hypocalcaemia was found in 9% in multinodular goitre (9 out of 99 patients), 20% in papillary carcinoma (3 out of 15 patients) and 40 % in follicular neoplasm (6 out of 15 patients). Near total thyroidectomy was the procedure in 105(70%) patients, 3 from them (2.86%) developed hypocalcaemia and the other 15 out of 45 cases (30%) were after total thyroidectomy. Mean duration of surgery was 101 mins. Average no of parathyroid glands identified was 2. Conclusion: Risk factor for development of hypocalcaemia is multifactorial. The recommended surgical strategy is meticulous dissection and preservation of at least one parathyroid gland and their blood supply to prevent permanent hypocalcaemia.