Diabetic foot ulcer and its surgical management

Background: Almost 80% population of diabetic foot are from low to middle income countries like India, a country with second largest number of diabetic populations. Prevalence of diabetes mellitus in India is 9.3%. Lower extremity diseases, including peripheral neuropathy, peripheral arterial disease, and foot ulceration, is twice common in diabetic subjects. the most feared consequence of diabetic foot ulcer is limb amputation, which is seen 10 to 30 times more often in person with diabetes. The objective of this study concentrates on surgical management of diabetic foot ulcer.Methods: This is an observational prospective study of 100 cases for evaluation of diabetic foot ulcer and its surgical management at P.D.U. Hospital, Rajkot from January 2017 to November 2018.Results: The average age of presentation is 55.70 year. The male to female ratio was 1.27:1. Most of the patients are from lower middle class and upper lower class according to modified kuppuswamy socioeconomic classification. Most of the patients have duration of diabetes more than 5 years.  Most common microorganism grown from culture was Staphylococcus aureus. This study has higher rate of amputations of 74% due to late presentation and neglected disease due to peripheral neuropathy causes decreased pain sensation. There was no mortality in this study.Conclusions: Management of diabetic foot ulcer is by multimodal approach with conservative and surgical approaches. Preventive measures, early diagnosis and timely surgical intervention prevents limb amputations in diabetic foot ulcer

Triple mesh technique in repair of recurrent lumbar incisional hernia

Lumbar hernias occur infrequently and can be congenital, primary (inferior or Petit type, and superior or Grynfeltt type), post-traumatic, or incisional. They are bounded by the 12th rib, the iliac crest, the erector spinae, and the external oblique muscle. Most postoperative incisional hernias occur in nephrectomy or aortic aneurysm repair incisions for which various surgical method in context of meshplasty are available. In this case 60 yr. male hypertensive patient presented to the outpatient clinic of institute with recurrent left side lumbar incisional hernia, patient was previously operated for left side nephrolithiasis 15 years back and onlay meshplasty 2 years back for incisional hernia. The patient was operated under high risk for recurrent incisional hernia repair by triple layered meshplasties in the same sitting. Lumbar incisional hernias are often diffuse with fascial defects that are usually hard to appreciate. Computed tomography scan is the diagnostic modality of choice with adjuvant clinical findings, which allows differentiating them from abdominal wall musculature denervation atrophy complicating flank incisions. Repairing these hernias is difficult due to the surrounding structures for which our surgical approach included a triple mesh repair consisting of underlay, inlay and onlay meshplasty thereby anticipating further such incidences of incisional hernia

An Efficient and Scalable Synthesis of <i>tert</i>-Butyl (3a<i>R</i>,6a<i>S</i>)‑5-Oxohexa­hydrocyclo­ penta­[<i>c</i>]­pyrrole-2(1<i>H</i>)‑carboxylate: A Pharmacologically Important Intermediate

Hexahydro­cyclo­penta­pyrrolone derivatives constitute an important class of bicycles, and it represents an essential pharmacophore for diversified pharmacological activities. A highly efficient process for the synthesis of <i>tert</i>-butyl­(3a<i>R</i>,6a<i>S</i>)-5-oxohexa­hydro­cyclo­penta­[<i>c</i>]­pyrrole-2­(1<i>H</i>)-carboxylate <b>1</b> has been developed. The improved process involves transformation of isoindole <b>4</b> to diacid <b>5</b>, using an inexpensive KMnO₄ mediated oxidative cleavage as a key step. The developed process was cost-effective, high yielding, kilogram scalable, and commercially viable for synthesis of <b>1</b>