Introduction-The risk of diabetes mellitus is increasing worldwide, and is particularly high in Indigenous Australians. Complicated foot infection is one of the most common sequelae of diabetes. We describe the incidence and associations of Indigenous and non-Indigenous inpatients with diabetic foot infections at Royal Darwin Hospital.Methods-All adult Royal Darwin Hospital inpatients with diabetic foot infections were enrolled prospectively from September 2012 to November 2013. Incidence, demographics, microbiology, management and clinical outcomes were analysed by Indigenous status, and association with methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa.Results-There were 245 separate hospital admissions in 177 patients with an incidence of 79 admissions per 100,000 person years. Patients occupied a mean of 19.4 hospital beds each day. Compared to the non-Indigenous population, Indigenous patients had a greater incidence of admission (Rate Ratio (RR) = 5.1, [95%CI = 3.8, 7.0]), were younger (mean difference of 11.1 years; p < 0.001), and more likely to undergo major and minor amputations (RR = 4.1 [95%CI = 1.6, 10.7], and 6.2 [95%CI = 3.5, 11.1] respectively). Non-multiresistant methicillin resistant S. Conclusions-This study highlights a rising burden of diabetic foot infections in the Top End of Australia, with a four-fold increase in bed days since 2002 and an overrepresentation in the Indigenous population. Europe PMC Funders Group

EDITORIAL COMMENT: We accepted this case for publication to remind readers that a broad ligament haematoma can occur after a normal vaginal delivery and can cuuse continued huemorrhage requiring radical and diflcult surgery. The case also illustrates that conservative management of broad ligament haemtoma may be contruindicuted. As stated by the author, broad ligament haematomas most commonly w e ussociated with a diflcult delivery, usually mid-forceps delivery, and usually can be treuted conservatively although the patient requires resuscitation with blood rrctnsfir.sion and intruvenous therapy for the paralytic ileus that is open associated. An indwelling urinary cutheter is usually also necessary. A paravaginal haematoma when it occurs obove the level of the levator ani muscle attachment to the lower one third of vuginu will present into the upper vagina and broad ligament and not into the vulvu. It i s unother cause of postpartum collapse without visible blood loss and m y be c~verlooked if u vucrginal examination is not pelformed.Broad ligament haematoma is an uncommon maternal injury in obstetrics. There is sparse information concerning its aetiology and surgical pathology when there is no cervical laceration or extraperitoneal (incomplete) uterine rupture. Some standard teaching promotes conservative management of this condition (1). Others recognize the condition as a tragic and often fatal catastrophe for which early intervention is imperative ( 2 ) and that the haematoma which forms immediately after delivery usually is associated with significant occult trauma such as high cervical lacerations, incomplete uterine rupture or broad ligament vessel damage and is usually the result of arterial bleeding (3). This paper describes the management and experience gained in a case of acute broad ligament haematoma which occurred shortly after a normal vaginal delivery. CASE REPORTAfter a normal antenatal course, the 34-year-old para 7 gravida 9 presented in spontaneous labour which progressed rapidly, with a first stage duration of 3.5 hours, a second stage of 5 minutes and the third stage of 7 minutes with an intact perineum and a total blood loss of 150 mL. Two hours postpartum, the patient collapsed in acute shock with no external or 1. Senior Obstetrician and Gynaecologist. 2. Vascular Surgeon. 3. Intensivist. clinically evident internal bleeding and resuscitation was commenced. Forty minutes later an indwelling urinary catheter was inserted and a speculum examination confirmed no laceration of the vagina and cervix. Bimanual pelvic examination, which included a manual exploration of the uterus, revealed no abnormality of the uterine cavity but a central suprapubic mass anterior to the lower uterus was palpated and the diagnosis of broad ligament haematoma was made. The patient was observed and 3 hours postpartum there was no vaginal bleeding but marked haematuria commenced and the firmly contracted uterine fundus was deviated to the left of the umbilicus by a tender boggy mass arising from the suprapubic reg...