Efficacy of topical recombinant epidermal growth factor as compared to Povidone Iodine on chronic diabeic foot ulcers

Background: Diabetic foot ulcer is a common surgical complication in patient of diabetes mellitus. It is the most frequent reason for hospitalization for patients with diabetes. Still the ideal material for dressing is not known.  This study has been conducted to compare the efficacy of topical application of Povidone- Iodine with recombinant epidermal growth factor in  chronic diabetic foot ulcers of size 5 to 10 cm2. Methods: Diabetic foot ulcers which were non-healing for more than 3 months were  randomized into two groups of 30 each. Clinical examination of the ulcer and limb was  done. Ischemic ulcers, ulcers with gangrene or associated osteomyelitis were excluded. One group  had received Povidone iodine  (Betadine 10% solution) soaked dressing while other group was dressed with  Recombinant Epidermal Growth Factor gel (Eugraf 150 mcg gel) dressing  twice weekly for 12 weeks. At the end of twelve weeks ulcers were assessed for healing. Results:There were total 60 cases from Jan 2014 till Dec 2014. Age range from 45 to 70 yrs (mean age 55 yrs). There were 45 males and 15 females (M: F:  3:1).  The ulcers were developed  most commonly in foot in 48 patients ( 80%) followed by  in lower leg around ankle in 06 patients ( 10%)  and in 10 % of cases involved foot and leg both.  Six (20%) patients on Povidone- Iodine dressing group showed complete wound healing while 23 (76%) patients on recombinant epidermal growth factor dressing group showed complete wound healing. Dressing with recombinant epidermal growth factor is the more effective than Povidone iodine dressing (P<. 001). Average healing time for complete healing for completely healed ulcers was 11 weeks in  Povidone-Iodine Dressing and 8 weeks in Recombinant epidermal growth factor  dressing group. Conclusion: Recombinant epidermal growth factor dressing is the significantly effective dressing in comparison to Povidone-Iodine in diabetic foot  non healing ulcers of size 5 to 10 cm in size. Average time of complete healing of diabetic foot  non healing ulcers is less with topical application of Recombinant epidermal growth factor  soaked dressing as compared to Povidone – Iodine dressings

Septic complications in perforation peritonitis: microflora and search for therapia sterilisans Magna

Objective: This study was conducted to determine the etiology, anatomical site of perforation and the suitable empirical antibiotic in our region which decreases the bacterial load effectively and to decrease the morbidity associated with infectious complications in patients with peritonitis secondary to gut perforation. Methods: This study was a prospective study conducted for a period of one year. Patients who were fulfilled the inclusion criteria with peritonitis due to gut perforations and operated in our institute were included in this study. Data regarding patient demography, associated co-morbidities and relevant history were recorded. Duration of hospitalization, wound infection, wound dehiscence, anastomotic leak, re do surgeries and number of patients died after surgery were documented. Antimicrobial susceptibility testing was done by Kirby-Bauer disk diffusion method. Antibiotics were changed as per clinical progress of the patient and as per culture and sensitivity report. Results: Perforations were mostly ileal (38%) followed by duodenal (29%).Common etiology being peptic ulcer disease (38.7%) and typhoid fever (22.5%). Peptic ulcer perforations were managed by Graham patch omentopexy in 24 (38.6 %) cases, small bowel perforations by only stoma in 18 (29 %), primary repair 6 (9.6 %) cases and resection and anastomosis done in 8 (12.9%) who presented with multiple small bowel perforation. Appendicectomy was done in 6 (9.6%) cases.Sensitivity to Cefaperazone was about 66 % in E. Coli isolates while 75% for Ceftazidime while for Klebsiella 60% and 80% resperctively. Meropenam was sensitive in all the isolates of Staphyloccus, Streptococcus, Pseudomonas and Proteus while cefaperazone was sensitive only in 50 % of the cases. Piperacillin + Tazobactum were sensitive in all the isolates of Stryptococcus, Pseudomonas and Proteus. The sensitivity of Amoxicillin+ Clavulinic acid, Ceftriaxone, Aminoglycosides and Fluoroquinolones were very low. Conclusion: Most common organisms cultured from peritoneal fluid were E. coli and Klebsiella. Piperacillin + Tazobactum and Carbepenam were sensitive in most of the isolates and might be started in patients with perforation peritonitis as a empirical antibiotic therap