Surgical management of Diabetic foot ulcers: A Tanzanian university teaching hospital experience

\ud \ud Diabetic foot ulcers (DFUs) pose a therapeutic challenge to surgeons, especially in developing countries where health care resources are limited and the vast majority of patients present to health facilities late with advanced foot ulcers. A prospective descriptive study was done at Bugando Medical Centre from February 2008 to January 2010 to describe our experience in the surgical management of DFUs in our local environment and compare with what is known in the literature. Of the total 4238 diabetic patients seen at BMC during the period under study, 136 (3.2%) patients had DFUs. Males outnumbered females by the ratio of 1.2:1. Their mean age was 54.32 years (ranged 21-72years). Thirty-eight (27.9%) patients were newly diagnosed diabetic patients. The majority of patients (95.5%) had type 2 diabetes mellitus. The mean duration of diabetes was 8.2 years while the duration of DFUs was 18.34 weeks. Fourteen (10.3%) patients had previous history of foot ulcers and six (4.4%) patients had previous amputations. The forefoot was commonly affected in 60.3% of cases. Neuropathic ulcers were the most common type of DFUs in 57.4% of cases. Wagner's stage 4 and 5 ulcers were the most prevalent at 29.4% and 23.5% respectively. The majority of patients (72.1%) were treated surgically. Lower limb amputation was the most common surgical procedure performed in 56.7% of cases. The complication rate was (33.5%) and surgical site infection was the most common complication (18.8%). Bacterial profile revealed polymicrobial pattern and Staphylococcus aureus was the most frequent microorganism isolated. All the microorganisms isolated showed high resistance to commonly used antibiotics except for Meropenem and imipenem, which were 100% sensitive each respectively. The mean hospital stay was 36.24 ± 12.62 days (ranged 18-128 days). Mortality rate was 13.2%. Diabetic foot ulceration constitutes a major source of morbidity and mortality among patients with diabetes mellitus at Bugando Medical Centre and is the leading cause of non-traumatic lower limb amputation. A multidisciplinary team approach targeting at good glycaemic control, education on foot care and appropriate footware, control of infection and early surgical intervention is required in order to reduce the morbidity and mortality associated with DFUs. Due to polymicrobial infection and antibiotic resistance, surgical intervention must be concerned

Major limb amputations in El Obeid Hospital, Western Sudan

Objectives: To study the causes and pattern of major limb amputations in El Obeid Hospital, Western Sudan. Patients and methods: The records of 50 major limb amputations performed in patients admitted to the University Surgical Unit at El Obeid Teaching Hospital, Western Sudan in two years were retrospectively studied. Results: 72% of the victims were males. The mean age was 51 years ± SD 34.5. 36% of the amputations were emergency procedures. Sepsis, trauma and vascular causes accounted for 40%, 32% and 16% respectively. The upper limb amputations were due to crushed missile injuries, lacerated wounds of animal bites and gangrenous limbs after post-fracture tight splintage by traditional bone setters. Conclusions: The study showed that 96% of the causes were potentially preventable, and that establishment of a Prothetic-Orthotic Centre is needed in this part of the country. Keywords: Limb amputationsSudan Journal of Medical Sciences Vol. 2 (4) 2007: pp. 237-24

cute Appendicits: Still a Missed Diagnosis in El Obeid, Western Sudan

Patients and Methods: One hundred and one patients with appendicitis were admitted to the emergency wards of the University Surgical Unit in El Obeid Teaching Hospital, Western Sudan during the period from July 2005 to June 2006. There were 64 males and 37 females. Results: The mean age was 20.8 years ± S.D. 12.8. 34 patients had appendicular mass, four patients had appendicular abscess and five patients had generalized peritonitis presenting with acute abdomen. Out of the 58 patients admitted as acute appendicitis, 15 patients were found to have perforated appendices at operation and the rest inflamed oedematous appendices, with a negative appendicectomy rate of zero per cent. Conclusion: These findings reflect the poor awareness about acute appendicitis and its seriousness in this area. It is the problem of late diagnosis rather than late presentation as all patients were misdiagnosed and put under treatment for other medical conditions before being admitted to the surgical wards Sudan Joural of Medical Studies Vol. 2 (1) 2007: pp. 7-

A Novel Theoretical Study of Elastic and Electronic Properties of M₂CdC (M = Zr, Hf, and Ta) MAX Phases

In this study, we have investigated the structural, electronic, and elastic properties of the M₂CdC (M = Ta, Zr, and Hf) MAX phases, using the first-principle methods based on the density functional theory. The calculated formation energies revealed that these compounds are thermodynamically stable in the hexagonal MAX phase. The stability is confirmed by the elastic constants and the conditions of mechanical stability criterion. Also, we have determined the bulk and shear modules of the Young modulus and the Poisson coefficient. The band structures indicate that the three materials are electrically conductive. The chemical bond in M₂CdC is covalent-ionic in nature with the presence of metallic character. For the density of states the hybridization peak between M d and C p occurs in the lower energy range. We have found that there is no gap for these materials due to the existence of a maximum peak of DOS around Fermi level

Half‐metallic ferromagnetic properties of Cr‐ and V‐doped AlP semiconductors

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