IS BACTERIOLOGY A CONTRIBUTING FACTOR IN UNSALVAGEABLE NATURE OF DIABETIC FOOT INFECTIONS?–A STUDY IN A DISTRICT HOSPITAL IN MALAYSIA

Objective: The objective is to study bacterial pathogens isolated in diabetic foot infection (DFI) and their sensitivity pattern to antibiotics commonly used in the management of DFI in the salvageable and unsalvageable groups of patients in a district hospital.Methods: 122 patients with diabetic limb infections treated at the Orthopedic Department of Hospital Sultan Abdul Halim, Sungai Petani, Kedah State in Malaysia. Clinically, limb infections were classified as salvageable and unsalvageable infections. Salvageable-mild, superficial/deep, localized ulcer with no systemic derangements necessitating conservative treatment or surgical procedures with minor amputations of limb (toe/ray amputation). Unsalvageable-deep seated extensive or spreading ulcers threatening the integrity of limb with or without toxic symptoms or metabolic derangement and could result in major limb amputation. A standard questionnaire was used to collect demographic, clinical and microbiological details of patients in both groups. Co-morbid illnesses, type/severity of limb infection during presentation and results of routine blood investigations were recorded. Details of nature of each specimen, species of isolate pathogen and sensitivity pattern to antibiotic of each clinical isolates were recorded.Results: 62 and 60 patients respectively belonged to the salvageable and unsalvageable groups. Only 11.66% presented with evidence of toxemia in the unsalvageable group. ESBL was the commonest nosocomial organisms. Percentage of organism sensitivity was most to vancomycin, ceftazidime, and gentamicin.Conclusion: All severe infections do not present with toxemia in diabetic patients. Gram-negative organisms were predominant in both groups although Staphylococcal organisms were the single largest group in the unsalvageable group. 3rd generation antibiotics are more useful in its control.Â

Pneumocephalus Following Combined Spinal Epidural Anaesthesia for Total Knee Arthroplasty: A Case Report

The authors describe a case of pneumocephalus following epidural anaesthesia for total knee arthroplasty. Multiple attempts in locating the epidural space for the anaesthesia and the use of loss of resistance to air (LORA) technique were identified as the source of air entry. Supportive management was given including high flow oxygenation therapy and spontaneous reabsorption of air was noted five days after surgery. The presence of pneumocephalus should be kept in mind if patient develops neurological complications postoperatively following epidural anaesthesia

Efeito de um programa de condicionamento físico no broncoespasmo induzido pelo exercício em mulheres obesas Effect of a physical fitness program on the exercise-induced bronchospasm in obese women

O broncoespasmo induzido pelo exercício físico (BIE) é uma síndrome clínica caracterizada pelo estreitamento brônquico e ocorre mais frequentemente em indivíduos obesos. OBJETIVO: Avaliar o possível efeito de um programa de condicionamento físico em relação ao BIE em mulheres obesas. MÉTODOS: Trinta e duas mulheres foram divididas em três grupos: grupo A (obesidade ou sobrepeso + treinamento físico), grupo B (obesidade ou sobrepeso) e grupo C (controle). Foi aplicado um teste de caminhada de seis minutos antes e após um período de 12 semanas. O BIE foi verificado por meio de um monitor de pico de fluxo expiratório após a aplicação do teste de caminhada. Durante essas 12 semanas, para o grupo A um programa de atividade física foi conduzido três vezes por semana e cada sessão de 60 minutos foi composta por 10 minutos de alongamento, seguidos por 30 de exercícios aeróbios (50% da frequência cardíaca de reserva como intensidade), 15 de exercícios de força de baixa intensidade e cinco de relaxamento e alongamento. RESULTADOS: O programa de treinamento físico causou aumento significativo no pico de fluxo expiratório mínimo após o teste de esforço (pré: 379 ± 16l/min; pós: 405 ± 12l/min; p < 0,05) e reduziu em 50% (33% para 17%) a proporção de mulheres que apresentou BIE (p < 0,05). CONCLUSÃO: O programa de condicionamento físico de 12 semanas foi capaz de melhorar a função respiratória de mulheres obesas.<br>Exercise-induced bronchospasm (EIB) is a syndrome characterized by reduced bronchial lumen and happens more often in obese subjects. OBJECTIVE: To evaluate the possible effect of an exercise training program on EIB in obese women. METHODS: 32 women were divided in three groups: group A (obesity + exercise training), group B (obesity) and group C (control). A six-minute walking test was applied before and after 12 weeks. EIB was measured through a monitor of peak of expiratory flow used after the application of the walking test. During the12 weeks, an exercise training program was delivered to group A, three times a week, 60 minutes a day. Each exercise session consisted of 10 minutes of stretching exercises, followed by 30 minutes of aerobic exercise (50% of reserve heart rate as intensity), 15' of low-intensity strength training and 5' of stretching and relaxing exercises. RESULTS: Exercise training significantly increased minimum peak of expiratory flow after the walking test (before: 379±16 l/min; after: 405±12 l/min; p<0.05) and reduced in 50% (33% to 17%) the proportion of women who presented EIB (p<0.05). CONCLUSION: The 12-week exercise training increased the respiratory function of obese women