Patrick Harnarayan

The economic impact of hospitalization for diabetic foot infections in a Caribbean nation.

CONTEXT Foot infection is the most common complication of diabetes mellitus in the Caribbean. Diabetic foot infections place a heavy burden on health care resources in the Caribbean. OBJECTIVE To evaluate the treatment-related costs for diabetic foot infections in a Caribbean nation. METHODS We identified all patients with diabetic foot infections in a 730-bed hospital serving a catchment population of approximately 400,000 persons from June 1, 2011 through July 31, 2012. The following data were collected: details of infection, antibiotic usage, investigations performed, number of physician consultations, details of operative treatment, and duration of hospitalization. Total charges were tallied to determine the final cost for inhospital treatment of diabetic foot infections. RESULTS There were 446 patients hospitalized with diabetic foot infections, yielding approximately 0.75% annual risk for patients with diabetes to develop foot infections. The mean duration of hospitalization was 22.5 days. Sixteen patients (3.6%) were treated conservatively without an operative procedure and 430 (96.4%) required some form of operative intervention. There were 885 debridements, 193 minor amputations and 60 major amputations, 7102 wound dressings, 2763 wound cultures, and 27,015 glucometer measurements. When the hospital charges were tallied, a total of US

Epidemiology of diabetic foot infections in an eastern Caribbean population: a prospective study.

13,922,178 (mean, US

Brachial Artery Injury Accompanying Closed Elbow Dislocations

31,216) were spent to treat diabetic foot infections in these 446 patients during 1 year at this hospital. CONCLUSIONS Each year, the government of Trinidad and Tobago spends US

Successful penile replantation using loupe magnification.

85 million, or 0.4% of their gross domestic product, solely to treat patients hospitalized for diabetic foot infections. With this level of national expenditure and the anticipated increase in the prevalence of diabetes, it is necessary to revive the call for investment in preventive public health strategies.

The largest and neglected giant phyllodes tumor of the breast-A case report and literature review.

INTRODUCTION This study evaluates the epidemiology of diabetic foot infections in an Eastern Caribbean nation in order to direct public health preventive measures. METHODS We prospectively identified all patients with diabetic foot infections who were admitted to tertiary care hospitals across Trinidad and Tobago from July 2011 to June 2012. A questionnaire was used to collect data on demographics, patient knowledge, avoidance of risk factors for chronic diseases (a proxy to unhealthy lifestyles), and glycosylated hemoglobin measurements on admission as an index of blood glucose control. The data were analyzed with statistical software. RESULTS There were 446 patients with diabetic foot infections (mean age = 56.9 years, standard deviation = 12.4 years). Most patients had Type 2 diabetes (93.3%) and were of Indo-Trinidadian (49.1%) or Afro-Trinidadian (41.7%) descent. There were preexisting complications of diabetes in 82.9% of patients with Type 2 diabetes: foot infections requiring hospitalization (70.2%), ischemic heart disease (32.5%), renal impairment (13.7%), and retinopathy (22.1%). Despite most patients claiming compliance with treatment, 75% had glycosylated hemoglobin levels above 7.1% at presentation, and 49.3% continued unhealthy lifestyles. Despite the high prevalence of diabetic complications at admission, and despite 70% having had previous hospitalization for treatment of foot infections, only 57.4% of patients reported ever being counseled or taught about foot care by medical personnel. CONCLUSIONS There is room for improvement in public health strategies to prevent diabetic foot complications in this setting. Such strategies should focus on patient education with emphasis on lifestyle modification and compliance with medical therapy.

adverse events in diabetic foot infections: a case control study comparing early versus delayed medical treatment after home remedies

Highlights • Brachial artery injuries after closed shoulder dislocations are uncommon.• A high index of suspicion should be maintained in order to make the diagnosis early.• Exploration with excision of the injured segment and reverse vein interposition grafting is the treatment of choice in these cases.

Axillary Artery Injury Accompanying Humeral Neck Fracture

Traumatic penile amputation is a rare condition requiring urgent surgical consultation with almost immediate surgical intervention. Although seen in both paediatric and adult populations, the majority are seen in the latter age group. These injuries are penetrating in nature, usually occur with the organ flaccid and most are self-inflicted by mentally unstable patients. Currently replantation involves meticulous microsurgery to reduce skin, urethra and graft loss, but these complications may still occur. Non-microsurgical techniques have been utilised with good post-operative outcomes. This report describes penile replantation in a 24-year old mentally challenged patient using 4.5× loupe-magnification to restore a functional, fully erectile penis without tissue loss and a 20-year problem free follow-up.

Acute pancreatitis due to hypertriglyceridemia-a case series of West Indians of Asian Indian ancestry

Highlights • The Finding of a giant phyllodes tumor is very rare.• The diagnosis should be entertained in all patients presenting with progressive enlargement of breast lump.• Emphasis should be given in early diagnosis and treatment to decrease morbidity and mortality.• Core needle biopsy is key method of preoperative diagnosis of phyllodes tumour Emphasis should be given on proper health education on breast cancer and its management.• Patient needs to be well educated about the negative consequences of alternative or delayed treatment.

Brachial Artery Reconstruction in Trauma Using Reversed Arm Vein from the Injured Upper Limb

Background The aim of conventional medical therapy in diabetic foot infections is to control infection, thereby reducing amputation rates, infectious morbidity, and death. Any delay incurred during a trial of home remedies could allow an infection to progress unchecked, increasing the risk of these adverse outcomes. This study sought to determine the effects of delayed operative interventions and amputations in these patients. Methods A questionnaire study targeting all consecutive patients admitted with diabetic foot infection was carried out over 1 year. Two groups were defined, ie, a medical therapy group comprising patients who sought medical attention after detecting their infection and a home remedy group comprising those who voluntarily chose to delay medical therapy in favor of home remedies. The patients were followed throughout their hospital admissions. We recorded the duration of hospitalization and number of operative debridements and amputations performed. Results There were 695 patients with diabetic foot infections, comprising 382 in the medical therapy group and 313 in the home remedy group. Many were previously hospitalized for foot infections in the medical therapy (78%) and home remedy (74.8%) groups. The trial of home remedies lasted for a mean duration of 8.9 days. The home remedy group had a longer duration of hospitalization (16.3 versus 8.5 days; P<0.001), more operative debridements (99.7% versus 94.5%; P<0.001), and more debridements per patient (2.85 versus 2.45; P<0.001). Additionally, in the home remedy group, there was an estimated increase in expenditure of US

Preoperative Digital Carotid Compression as a Predictor of the Need for Shunting During Carotid Endarterectomy

10,821.72 US per patient and a trend toward more major amputations (9.3% versus 5.2%; P=0.073). Conclusion There are negative outcomes when patients delay conventional medical therapy in favour of home remedies to treat diabetic foot infections. These treatments need not be mutually exclusive. We encourage persons with diabetes who wish to try home remedies to seek medical advice in addition as a part of holistic care.