Microbial Community Distribution and Core Microbiome in Successive Wound Grades of Individuals with Diabetic Foot Ulcers.

Diabetic foot ulcer (DFU) is a major complication of diabetes with high morbidity and mortality rates. The pathogenesis of DFUs is governed by a complex milieu of environmental and host factors. The empirical treatment is initially based on wound severity since culturing and profiling the antibiotic sensitivity of wound-associated microbes is time-consuming. Hence, a thorough and rapid analysis of the microbial landscape is a major requirement toward devising evidence-based interventions. Toward this, 122 wound (100 diabetic and 22 nondiabetic) samples were sampled for their bacterial community structure using both culture-based and next-generation 16S rRNA-based metagenomics approach. Both the approaches showed that the Gram-negative microbes were more abundant in the wound microbiome. The core microbiome consisted of bacterial genera, including Alcaligenes, Pseudomonas, Burkholderia, and Corynebacterium in decreasing order of average relative abundance. Despite the heterogenous nature and extensive sharing of microbes, an inherent community structure was apparent, as revealed by a cluster analysis based on Euclidean distances. Facultative anaerobes (26.5%) were predominant in Wagner grade 5, while strict anaerobes were abundant in Wagner grade 1 (26%). A nonmetric dimensional scaling analysis could not clearly discriminate samples based on HbA1c levels. Sequencing approach revealed the presence of major culturable species even in samples with no bacterial growth in culture-based approach. Our study indicates that (i) the composition of core microbial community varies with wound severity, (ii) polymicrobial species distribution is individual specific, and (iii) antibiotic susceptibility varies with individuals. Our study suggests the need to evolve better-personalized care for better wound management therapies.IMPORTANCE Chronic nonhealing diabetic foot ulcers (DFUs) are a serious complication of diabetes and are further exacerbated by bacterial colonization. The microbial burden in the wound of each individual displays diverse morphological and physiological characteristics with unique patterns of host-pathogen interactions, antibiotic resistance, and virulence. Treatment involves empirical decisions until definitive results on the causative wound pathogens and their antibiotic susceptibility profiles are available. Hence, there is a need for rapid and accurate detection of these polymicrobial communities for effective wound management. Deciphering microbial communities will aid clinicians to tailor their treatment specifically to the microbes prevalent in the DFU at the time of assessment. This may reduce DFUs associated morbidity and mortality while impeding the rise of multidrug-resistant microbes.

Evaluation of efficacy of thermographic breast imaging in breast cancer: A pilot study.

BACKGROUND: Thermographic imaging is a non-invasive and radiation free imaging modality that measures the infrared radiation released by the body. Recently, there is a renewed interest regarding the scope of thermal imaging for breast cancer. OBJECTIVE: To evaluate the efficacy of thermographic breast imaging in detecting breast cancer. METHODS: A Prospective observational study was carried out from January 2014 to December 2014 at Kasturba Hospital, Manipal, India. Patients in whom breast cancer was confirmed on FNAC or biopsy, were included in the study and further evaluated with thermographic imaging of the breast. RESULTS: 65 patients with FNAC or biopsy proven breast carcinoma were included in the study. Using thermographic imaging, malignancy was accurately detected in 60 patients (92.31%). Mammography was able to detect malignancy in 62 out of the 65 patients (95.38%). Thermography was able to detect malignancy in all 3 cases in which conventional mammography missed it. CONCLUSION: Thermography may have a role in detection of breast cancer. However, it is too early to recommend thermographic imaging as a standard imaging modality for breast cancer. Larger studies are required to evaluate the usefulness of thermography in diagnosis and/or screening of breast cancer.