Clinical presentation and bacteriological profile of diabetic foot in Eastern Bihar, India

Background: Diabetes is a worldwide problem. A majority of diabetic patients develop foot ulcers in one point of time or other during the course of their illness. Chronic wound, especially non-healing types are the most common surgical conditions. The etiopathogenesis of diabetic foot lesions are multi-factorial like diabetic neuropathies, vasculopathy, poor control of diabetes and bacterial infection. The aim of the present study was to study various modes of presentation and microbiological profile in management of diabetic foot.Methods: 100 diagnosed cases of diabetic foot were studied over a period of three years in the department of General Surgery at Katihar Medical College with emphasis on clinical features and microbiological picture of diabetic foot and its complications.Results: Males are more prone to surgical complications three times than females because of more outdoor activities. It is more prevalent in age group 51-60 years (36%). In the present study, cases presenting with ulcer were maximum (52%) followed by cellulitis (20%), cases presenting with gangrene of toe or foot was minimum (12%). Staphylococcus Aureus was found in majority of cases of septic lesions on culture of pus (41%). Other organisms isolated were Pseudomonas, Klebsiella, E.Coli, Proteus etc.Conclusions: Diabetic foot has varied presentation. The prevalence of diabetes mellitus and its surgical complications can be attributed to poor patient knowledge, education and awareness of the disease. Patient education for care of feet such as pairing of nails, wearing proper footwear and prompt reporting to doctor in case of early lesions is essential.

Nondifferentiable multiobjective programming problem under strongly K-Gf-pseudoinvexity assumptions

[EN] In this paper we consider the introduction of the concept of (strongly) K-G(f)-pseudoinvex functions which enable to study a pair of nondifferentiable K-G- Mond-Weir type symmetric multiobjective programming model under such assumptions.Dubey, R.; Mishra, LN.; Sánchez Ruiz, LM.; Sarwe, DU. (2020). Nondifferentiable multiobjective programming problem under strongly K-Gf-pseudoinvexity assumptions. Mathematics. 8(5):1-11. https://doi.org/10.3390/math8050738S11185Antczak, T. (2007). New optimality conditions and duality results of type in differentiable mathematical programming. Nonlinear Analysis: Theory, Methods & Applications, 66(7), 1617-1632. doi:10.1016/j.na.2006.02.013Antczak, T. (2008). On G-invex multiobjective programming. Part I. Optimality. Journal of Global Optimization, 43(1), 97-109. doi:10.1007/s10898-008-9299-5Ferrara, M., & Viorica-Stefanescu, M. (2008). Optimality conditions and duality in multiobjective programming with invexity. YUJOR, 18(2), 153-165. doi:10.2298/yjor0802153fChen, X. (2004). Higher-order symmetric duality in nondifferentiable multiobjective programming problems. Journal of Mathematical Analysis and Applications, 290(2), 423-435. doi:10.1016/j.jmaa.2003.10.004Long, X. (2013). Sufficiency and duality for nonsmooth multiobjective programming problems involving generalized univex functions. Journal of Systems Science and Complexity, 26(6), 1002-1018. doi:10.1007/s11424-013-1089-6Dubey, R., Mishra, L. N., & Sánchez Ruiz, L. M. (2019). Nondifferentiable G-Mond–Weir Type Multiobjective Symmetric Fractional Problem and Their Duality Theorems under Generalized Assumptions. Symmetry, 11(11), 1348. doi:10.3390/sym11111348Pitea, A., & Postolache, M. (2011). Duality theorems for a new class of multitime multiobjective variational problems. Journal of Global Optimization, 54(1), 47-58. doi:10.1007/s10898-011-9740-zPitea, A., & Antczak, T. (2014). Proper efficiency and duality for a new class of nonconvex multitime multiobjective variational problems. Journal of Inequalities and Applications, 2014(1). doi:10.1186/1029-242x-2014-333Dubey, R., Deepmala, & Narayan Mishra, V. (2020). Higher-order symmetric duality in nondifferentiable multiobjective fractional programming problem over cone contraints. Statistics, Optimization & Information Computing, 8(1), 187-205. doi:10.19139/soic-2310-5070-60

Comparative evaluation of fentanyl versus nalbuphine for attenuation of hemodynamic changes during airway stimulation

Background: Airway stimulation predictably leads to variable hemodynamic changes which can be modified by opioid premedication. The present study was aimed to compare the clinical efficacy of fentanyl with nalbuphine on hemodynamic changes during airway stimulation.Methods: Sixty adult patients of ASA physical status I and II of either gender, were randomized into two groups of 30 patients each to receive either fentanyl 2µg/kg, Group I or nalbuphine 0.2mg/kg, Group II, 10min before induction with propofol. Direct laryngoscopy and intubation was facilitated with vecuronium bromide. Heart rate, blood pressure and ECG were recorded at baseline, after giving study drug, at intubation and then after at 1st, 2nd, 3rd, 5th, 10th and 15th minutes after intubation and noted as primary variable. Any adverse effects and complications were recorded as secondary end points.Results: After premedication, the fall in heart rate was comparable between the groups. The fall in mean blood pressure showed statistically significant difference between the groups. After induction, there was further decrease in heart rate and blood pressure with statistically significant difference. After laryngoscopy and intubation, the increase in mean heart rate and blood pressure occurred immediately in patients of nalbuphine group and persisted up to 1to 2min while this increase persisted up to 5 to 7min in fentanyl group. The differences in hemodynamic changes between the groups were statistically significant.Conclusions: Nalbuphine (0.2mg/kg) could effectively attenuate the hemodynamic changes during airway stimulation when compared to fentanyl (2µg/kg), when given 10 minutes before induction

Prosthetic Vascular Graft Infection: A Multi-Center Review of Surgical Management

A multi-center retrospective review of major prosthetic graft infection outcomes was undertaken to determine graft preservation and limb salvage rates. The management of infected prosthetic vascular grafts continues to be controversial. The purpose of this study was to review the surgical management of major extracavitary prosthetic vascular graft infections and to correlate the outcomes on the basis of bacteriology and grade. The change in patient population seen by vascular surgeons and the recent emergence of more virulent bacterial strains should influence surgical management. Bacteriology and severity of infection based on grade must play a greater role in the selection criteria for graft salvage. Despite advancement in the understanding of these interactions and the emergence of new management algorithms, we are continuing to operate without a uniform standard in managing this difficult and rapidly evolving clinical problem