Arcot Rekha

A multicenter trial of the efficacy and safety of tigecycline versus imipenem/cilastatin in patients with complicated intra-abdominal infections [Study ID Numbers: 3074A1-301-WW; ClinicalTrials.gov Identifier: NCT00081744]

BackgroundComplicated intra-abdominal infections (cIAI) remain challenging to treat because of their polymicrobial etiology including multi-drug resistant bacteria. The efficacy and safety of tigecycline, an expanded broad-spectrum glycylcycline antibiotic, was compared with imipenem/cilastatin (IMI/CIS) in patients with cIAI.MethodsA prospective, double-blind, multinational trial was conducted in which patients with cIAI randomly received intravenous (IV) tigecycline (100 mg initial dose, then 50 mg every 12 hours [q12h]) or IV IMI/CIS (500/500 mg q6h or adjusted for renal dysfunction) for 5 to14 days. Clinical response at the test-of-cure (TOC) visit (14–35 days after therapy) for microbiologically evaluable (ME) and microbiological modified intent-to-treat (m-mITT) populations were the co-primary efficacy endpoint populations.ResultsA total of 825 patients received ≥ 1 dose of study drug. The primary diagnoses for the ME group were complicated appendicitis (59%), and intestinal (8.8%) and gastric/duodenal perforations (4.6%). For the ME group, clinical cure rates at TOC were 80.6% (199/247) for tigecycline versus 82.4% (210/255) for IMI/CIS (95% CI -8.4, 5.1 for non-inferiority tigecycline versus IMI/CIS). Corresponding clinical cure rates within the m-mITT population were 73.5% (227/309) for tigecycline versus 78.2% (244/312) for IMI/CIS (95% CI -11.0, 2.5). Nausea (31.0% tigecycline, 24.8% IMI/CIS [P = 0.052]), vomiting (25.7% tigecycline, 19.4% IMI/CIS [P = 0.037]), and diarrhea (21.3% tigecycline, 18.9% IMI/CIS [P = 0.435]) were the most frequently reported adverse events.ConclusionThis study demonstrates that tigecycline is as efficacious as imipenem/cilastatin in the treatment of patients with cIAI.

Keloids - a frustrating hurdle in wound healing.

A balance between collagen formation and degradation is essential for normal wound healing. Inadequate wound healing results in wound breakdown, and exaggeration results in hypertrophic scars and keloids. We look at the aetiological factors, the biochemical alterations and the treatment modalities for keloids, in this clinical challenge.

Sciatic Nerve Schwannoma

Schwannomas are benign tumors of the nerve sheath, commonly seen in the vestibular nerve. Although they are common in the head and neck areas, their occurrence in extra-cranial locations is rare. We report a case of a sciatic nerve schwannoma and review the literature.

Von recklinghausen neurofibromatosis-pachydermatocele causing lower limb gigantism: a case report.

Gigantism of the lower limb can occur because of plexiform neurofibromas. This condition is seen with café au lait patches and multiple neurofibromatosis in this case of von Recklinghausen neurofibromatosis. We report our patient and review literature of this uncommon condition.

Transoral endoscopic thyroidectomy: A case report.

Highlights • Endoscopic thyroidectomies aim to provide patients with minimal or no scars.• Transoral endoscopic thyroidectomy is based on the principles of natural orifice translumenal endoscopic surgery (NOTES).• Involves minimal dissection and is truly scar-free.• Transoral endoscopic thyroidectomy has proven to be a feasible procedure.• It provides easy access to the thyroid gland with aesthetically pleasing results.

A retrospective study of necrotising fasciitis.

Necrotising fasciitis (NF) is an unusual though well-described soft tissue infection of the deeper tissues resulting in a progressive synergistic bacterial gangrene. In a small retrospective study in a single center, an association was observed between NF and diabetes, age, peripheral arterial disease, and high mortality.

Fusarium solani in the Post-transplant Patient: An Unusual Fungus

The incidence of fungal infections in post-transplant patients ranges from 2% to 50%, and more uncommon pathogens are being isolated. Earlier, the fungi seen were candida, aspergillus, and cryptococcus; and of late, histoplasma, coccidiodomycoses, and dematiaceous fungi are seen. In this article, a patient with invasive fusariosis is presented, and literature of this uncommon fungus is reviewed.

Civilian Gas Gangrene: A Clinical Challenge:

Gas gangrene due to clostridia infections is commonly seen in war injuries and is much less commonly seen in civilian life. When such problems do occur, they present a challenge to the surgeon due to the associated high morbidity and mortality associated. A case is presented where a patient developed gas gangrene in a limb consequent to trauma that had been treated surgically. It is vital to make a correct diagnosis at the earliest to limit disease progression and to avoid complications.

Malignant Melanoma and Filariasis: A Coexistence or an Association?

Malignancy has been reported with chronic lymphedema, especially lymphangiosarcoma. The authors report on a patient with lymphedema due to filariasis, presenting with an ulcerated pigmented lesion that was malignant melanoma. A literature search revealed no previous report of such lesions existing together.

Understanding the processus vaginalis: the abdomino scrotal hydrocoele

El conocimiento de la embriologia y el descenso de los testiculos es esencial para todos los clinicos. El hidrocele congenito, aunque es una anomalia embriologica se puede presentar en la edad adulta. Un hidrocele abdomino-escrotal debe ser considerado cuando una masa en la parte inferior del abdomen co existe con un hidrocele testicular.