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Diabetic foot ulcer (DFU) is a major cause of lower limb amputations. Many treatment recommendations have been proposed. This study was conducted to evaluate the effectiveness of topical sucralfate when combined with mupirocin ointment, in the treatment of diabetic foot ulcer in comparison to topical mupirocin alone, in terms of healing rates. This open-labeled randomized study was conducted on 108 patients to evaluate the effectiveness of topical sucralfate and mupirocin combination, compared to topical mupirocin alone. The patients were administered the same parenteral antibiotic, and wounds were subjected to daily dressing. The healing rates (determined by the percentage reduction in wound area) in the two groups were calculated. The mean healing rates in both groups were expressed in percentage and compared using the Student's t-test. A total of 108 patients were included in the study. Male-to-female ratio was 3:1. The incidence of diabetic foot was the highest (50.9%) in the age group of 50-59 years. The mean age of the study population was 51 years. The incidence of diabetic foot ulcers was highest in the months of July-August (42%). A total of 71.2% patients had random blood sugar levels between 150-200 mg/dL, and 72.2% patients had diabetes for five to 10 years. The mean±standard deviation (SD) of the healing rates in the sucralfate and mupirocin combination group and the control group were 16.2±7.3% and 14.5±6.6%, respectively. Comparison of the means by Student's t-test failed to show a statistical difference in healing rates between the two groups (p=0.201). We concluded that the addition of topical sucralfate does not show any obvious benefits in terms of healing rates in diabetic foot ulcers as compared to mupirocin alone.

Mucinous cystadenoma of appendix is a rare clinical entity with very few reported cases in the literature. Consensus on optimal surgical management has not been reached. We report the case of a 65-year-old female patient who presented with fistula over the right iliac fossa. Computed tomography (CT) of the abdomen suggested abscess of the parietal wall. Upon exploration, a mass was found to be arising from the tip of the retroperitoneal appendix and the retroperitoneum was studded with mucoid material. Appendectomy was carried out and final histopathology revealed mucinous cystadenoma with no evidence of malignancy. The patient was discharged uneventfully. The unusual presentation of this disease, as retroperitoneal psuedomyxoma without any intraperitoneal pathology, prompted us to report this case.

Background Ileal perforations represent one of the most common surgical emergencies in India, associated with significant morbidity and mortality rates. The causes of these perforations include infections such as tuberculosis and enteric fever, as well as malignancy and trauma. Management options encompass ileostomy, resection with anastomosis, and primary closure. Objective The objective of this study is to evaluate the clinical profile, etiology, management strategies, and complications associated with ileal perforation. Methodology A total of 70 patients with ileal perforation were included in the study. The proportions of various etiological factors, surgical interventions, and their associated complications were analyzed. The study aimed to determine whether ileostomy leads to fewer complications compared to primary repair. Results Ileal perforation is more prevalent in males than in females, with an incidence ratio of 2.68:1, predominantly affecting individuals in their 30s. Antituberculosis treatment does not consistently protect against perforation. Delays in presentation are linked to a higher likelihood of developing pyoperitoneum, increased chances of stoma creation (with a mean delay of 2.50 days in the closure group compared to 4.98 days in the ileostomy group), and greater mortality. Closure was performed in 18 patients (25.7%), while 52 patients (74.3%) underwent stoma creation. The duration of surgery was longer in the closure group (2.889 hours) than in the ileostomy group (2.635 hours) and also greater in the mortality group (three hours) compared to the non-mortality group (2.64 hours). The mean number of perforations was 1.59 ± 0.970, with 1.33 ± 0.840 in the closure group and 1.67 ± 1.004 in the ileostomy group. A higher number of perforations is associated with an increased likelihood of stoma creation. The most common cause of perforation was nonspecific, accounting for 40% of cases. The most frequently encountered complication was wound infection, occurring in 42.9% of patients. The mean duration of hospital stay was shorter in the ileostomy group (9.50 ± 5.500 days) than in the closure group (17.22 ± 19.219 days). Death occurred in 18.6% of cases, with higher rates observed in males (8:5), patients with delayed presentation, and elderly patients. A significant p-value was found in relation to leaks and fecal fistulas. Conclusions No significant difference was observed in complications associated with the various surgical procedures performed. However, a delay in presentation is linked to a higher rate of complications and increased mortality.

Background Anastomotic leakage after gastrointestinal surgery is a significant postoperative complication that leads to increased morbidity and mortality. C-reactive protein (CRP) has been used previously as a predictive marker of anastomotic leakage in gastrointestinal surgeries. Its short half-life makes it a reliable marker for postoperative complications, rapidly returning to normal values as the patient recovers. We conducted this study to evaluate the predictive accuracy of serum CRP levels in predicting anastomotic leaks in patients undergoing gastrointestinal repair surgeries. Methods Ninety-six gastrointestinal surgeries involving anastomoses and primary repairs were included in the study. CRP was taken serially from postoperative days (POD) 1 to 7. Patients were divided into two groups based on postoperative outcomes: leakage and non-leakage. The receiver operating characteristic (ROC) curve of CRP levels with leak and mortality was plotted to find a threshold value for leak and mortality. Results Out of 96 patients included in the study, Group B (non-leakage) consisted of 78 patients (81.3%), while Group A (leakage) comprised 18 patients (18.7%). ROC analysis identified a CRP cutoff of 127 mg/L on POD 5, with high sensitivity (80%) and high specificity (80%) indicating a high likelihood of leakage above this threshold. Conclusion This study underscores the importance of monitoring CRP levels in the postoperative period, particularly on POD 5, as a non-invasive and cost-effective tool for the early detection of anastomotic leaks.

BackgroundRituximab, a monoclonal antibody targeting B lymphocytes, effectively sustains remission in steroid-dependent nephrotic syndrome (SDNS). We studied its effects on lymphocyte subsets and urinary CD80 excretion (uCD80) in patients with SDNS.MethodsBlood and urine samples were collected from 18 SDNS patients before rituximab, and after 1 month and 1 year or at first relapse. T and B lymphocytes and uCD80 were determined by flow cytometry and ELISA, respectively.ResultsTreatment was associated with reduction in counts of Th17, Th2, and memory T cells, and increased T-regulatory (Treg) cells. The Th17/Treg ratio declined from baseline (median 0.6) to 1 month (0.2, P = 0.006) and increased during relapse (0.3, P = 0.016). Ratios of Th1/Th2 cells at baseline, 1 month after rituximab, and during relapse were 7.7, 14.0 (P = 0.0102), and 8.7, respectively. uCD80 decreased 1 month following rituximab (45.5 vs. 23.0 ng/g creatinine; P = 0.0039). B lymphocytes recovered earlier in relapsers (60.0 vs.183.0 days; P < 0.001). Memory B cells were higher during relapse than remission (29.7 vs.18.0 cells/µL; P = 0.029).ConclusionRituximab-induced sustained remission and B-cell depletion was associated with reduced numbers of Th17 and Th2 lymphocytes, and increased Treg cells; these changes reversed during relapses. Recovery of B cells and memory B cells predicted the occurrence of a relapse.