Microbiology of diabetic foot infections in three district hospital in Malaysia and comparison with South East Asian Countries

@#Introduction: Diabetic foot infection, a complication that is associated with lower-limb amputation, incurs a huge economic burden to the hospital and health care system of Malaysia. The bacteriological profile of pathogens in diabetic foot infections in Malaysia has been sparsely studied. We investigated the microbiology of diabetic foot infections in patients admitted to the district hospitals on the east coast of Malaysia. Methods: A retrospective analysis was conducted in three district hospitals (Hospital Kuala Lipis, Hospital Bentong and Hospital Raub) in Malaysia from 1st of January 2016 to 31st December 2016. The clinical specimens were cultured using Clinical and Laboratory Standards Institute (CLSI) guidelines. Antibiotic sensitivity testing to different antibiotics was carried out using the disc diffusion method. Result: A total of 188 pathogens were isolated from 173 patients, with an average of 1.09 pathogens per lesion. Majority of the pathogens isolated were gram negative pathogens (73.4%). The most commonly isolated pathogens were Staphylococcus aureus (17.5%). This was followed by Klebsiella spp. (17%), Pseudomonas spp. (15.4%) and Proteus spp. (13.8%). Gram positive pathogens were sensitive to most of the antibiotics tested except penicillin and fusidic acid. Gram negative pathogens were sensitive to all antibiotics tested except ampicillin and amoxicillin/clavulanic acid. Amikacin provide coverage for all gram negative pathogens in DFI. Conclusion: For the management of patient with infection in diabetic foot, the choice of antibiotic therapy depends on the sensitivity of the pathogens, the severity of the infection, the patient’s allergies history, toxicity and excretion of the antibiotics.

Cervical vertebral fracture: A report of two cases of “Near-Miss” C6 fractures

ervical spine injury is commonly associated with road-traffic accidents. The true incidence of cervical spine injuries is unknown due to under-reporting of such injuries. Cervical spine injury is associated with high morbidity and mortality if it is missed. With the advancement of imaging modalities, the number of missed cervical injuries has reduced. Nevertheless, some clinicians are dependent solely on imaging tools to rule out cervical spine injury in a trauma victim. We report two cases of “near miss” C6 fracture to highlight the importance of a detailed clinical history and clinical examination with imaging as an adjunct to rule out cervical injury.

Management of a failed femoral plate in an obese patient: A case report

Femoral nailing is the overall “gold standard” in treating femoral shaft fractures. However, plate osteosynthesis at the femoral shaft is still being done in selected patients. We report a case of right femoral implant failure after a broad limited contact dynamic compression plate (LC-DCP) insertion and its subsequent management using our minimally invasive technique. Our technique is biologically compliant as well as cosmetically friendly. We converted a loadbearing implant into a load-sharing implant in view that obesity is a significant predictive factor of non-union in a femoral fracture treated with locking plate. The patient subsequently recovered well with no complication.

Marjolin’s ulcer: A case report of chronic leg ulcer leading to squamous cell carcinoma

34 1 Department of Orthopaedic, Hospital Kuala Lipis, 27200 Kuala Lipis, Pahang, MALAYSIA 2 Department of Surgery, Hospital Kuala Lipis, 27200 Kuala Lipis, Pahang, MALAYSIA 3 Department of Pathology, Hospital Tengku Ampuan Afzan, 25300 Kuantan, Pahang, MALAYSIA 4 Department of Radiology, Hospital Kemaman, 24000 Kemaman, Terengganu, MALAYSIA Marjolin’s ulcer: A case report of chronic leg ulcer leading to squamous cell carcinoma Ren Yi Kow 1 , Dhiauddin Hai Ismail 2 , Jamaluddin Shafie 1 , Ruben Jaya Kumar 1 , Nor Hafliza Md Salleh 3 , Chooi Leng Low 4 Case Report IeJSME 2016 10(3): 34-36 Introduction Marjolin’s ulcer is a malignant cutaneous ulcer that undergoes transformation from a previously traumatized or chronically inflammed skin. 1 Causes leading to ulcerations can be burn injury, trauma, chronic osteomyelitis and varicose ulcers. 2 It is named after a French surgeon, Jean Nicolas Marjolin, who first described the condition in patients who developed malignant ulcers from burn scars. 3 We report a case of a chronic non-healing foot ulcer that has become a Marjolin’s ulcer after 12 years

Giant Cell Tumour of the Distal Ulna: A Rare Presentation

Giant-cell tumour (GCT) of bone, a primary yet locally aggressive benign tumour, commonly affects patients between the ages of 20 and 40 years, with the peak incidence occurring in the third decade. Women are affected slightly more than men. The distal end of the ulna is an extremely uncommon site for primary bone tumours in general and giant cell tumours in particular. Wide resection of the distal ulna is the recommended treatment for GCT in such locations. Radio-ulna convergence and dorsal displacement of the ulna stump are known complications following ulna resection proximal to the insertion of the pronator quadratus. This leads to reduction in grip power and forearm rotatory motion. Stabilization of the ulna stump with extensor carpi ulnaris (ECU) tendon after wide resection of the tumour has been described in the literature. We report a case of GCT of distal end of ulna treated with wide resection and stabilization with ECU tendon.