Diabetic foot infection and surgical treatment in a secondary health care centre in Malaysia.

INTRODUCTION: Diabetic foot infection is often associated with high morbidity, disability and poor quality of life. This study focuses on the demography, the number of repetitive surgery and length of stay in hospital of patients with diabetic foot infection. METHOD: This is a retrospective observational study. Patients who were admitted to the Orthopaedic ward of Hospital Segamat (HS), Johor, Malaysia from January 2016 to December 2018 and required surgical intervention were included in the study. Data was collected from the computer system of HS and medical notes of patients. RESULTS: 35.6% of the total orthopaedic emergency surgeries performed were for patients with diabetic foot infection, 25% of the surgical procedures performed were major amputations of lower limb and 40% of the patients with diabetic foot infection required more than one surgical operation. DISCUSSION: The demographics of the patients is consistent with the demographics of Malaysia where majority of them are Malays followed by Chinese, Indians and others. Despite being only 10% of total admission to the department, this group of patients contributed to 35.6% of the total emergency surgeries performed. The amputation rate in the centre is comparable to the other local studies. The average length of stay in hospital was found to be shorter compared to overseas due to different rehabilitation protocols.

Necrotising fasciitis caused by aeromonas sobria: Not just a simple catfish sting.

Necrotising fasciitis is a life-threatening infection of the soft tissue which can be caused by different microorganisms, but infection caused by Aeromonas spp. or Vibrio spp. is frequently associated with higher mortality rate. Necrotising fasciitis progresses rapidly and often need aggressive surgical intervention. We present a rare case of necrotising fasciitis cause by Aeromonas sobria which mortality was successfully prevented by swift diagnosis and aggressive surgery.

Somatosensory evoked potentials as a predictor for functional recovery of the upper limb in patients with stroke.

BACKGROUND: Predicting motor recovery in the arm of patients with stroke is generally based on clinical examination. However, neurophysiologic measures may also have a predictive value. OBJECTIVE: We sought to assess the value of somatosensory evoked potentials (SSEPs) in predicting motor recovery of the upper limb and to determine whether any of the SSEPs components can predict the severity of the deficit so that it can document the size of the stroke (lacunar or large-vessel stroke). METHOD: In all, 22 patients who had had a first-ever stroke and presented with obvious motor deficit of the arm were examined in terms of 3 clinical variables (motor performance, muscle tone, and overall disability) and for SSEPs. Clinical (Medical Research Council [MRC] scale and Barthel index scores) and neurophysiologic examinations were done at entry to the study (first week poststroke) and 3 months after stroke. RESULTS: Significantly low mean MRC scale score was found at first week versus after 3 months of stroke and in patients with large-vessel as compared with lacunar stroke both at first week and after 3 months. The mean Barthel index score was significantly higher after 3 months than at first week, whereas it was significantly lower in large-vessel as compared with lacunar stroke both at first week and after 3 months of stroke. Significantly prolonged N(20) latency, low peak-to-peak amplitude (PPA), and low amplitude ratio were found in patients with stroke as compared with control subjects. None of the neurophysiologic parameters were different in the patients with stroke between first week and third month. The MRC score and PPA were correlated well with the outcome MRC and Barthel index scores after 3 months. N(20) latency correlates with the outcome MRC score but not with the outcome Barthel index score. Interestingly, the N(20) latency was significantly different in lacunar from large-vessel stroke. CONCLUSION: The muscle power (MRC score) is the main outcome predictor in patients with stroke. PPA is the main SSEPs component with high prognostic value in stroke. The SSEPs N(20) latency can predict (even roughly) the size of cerebral infarction (whether lacunar or large-vessel stroke).

A point survey of periurban and urban malaria in Karachi.

A point survey of malaria in Karachi revealed a concentration of malaria cases in the periurban perimeter and marginal areas where immigrating groups, including Afghan refugees and Biharis from Bangladesh are concentrated. Populations of Anopheles stephensi, Karachi's main vector, were low, and were feeding chiefly on buffaloes which are also concentrated along the periurban perimeter. Maintenance of malaria transmission in periurban zones may depend on immigration of susceptibles, bovid hosts which help maintain zoophilic vector populations, and mosquito breeding sites in water tanks or buffalo hoofprints. The vector's switch to man-biting behaviour may occur either due to a 'spillover' effect from buffalo corrals to surrounding houses, or when buffaloes become less available for biting. Four types of chromosome inversions were found in the Karachi An. stephensi; as this species is not a vector in similar habitats in Lahore and Pondicherry where such inversions are not prevalent, it is likely that its status as a vector is related to chromosomal polymorphism influencing behaviour.