The microbial flora in the bypassed biliopancreatic intestinal segment was studied after obesity surgery. This procedure causes less diarrhea than jejunoileal bypass and appears to avoid extraintestinal complications. This report concerns type and quantity of bacteria colonizing the biliopancreatic segment and changes occurring after oral metronidazole treatment. Twelve specimens were aspirated in 10 patients via catheter inserted percutaneously during surgery. The specimens were plated immediately on selective and nonselective media under aerobic and anaerobic conditions. Essentially equal numbers of aerobes and anaerobes were recovered from the biliopancreatic segment with average counts of 10(4) cfu/mL and median counts of 10(5) cfu/mL. Four patients had counts of 10(7) cfu/mL. The most common aerobes were E. coli, Klebsiella, Gram-positive cocci, and Candida; among anaerobes, Clostridium and the Bacteroides fragilis group were most common. In three patients treated with metronidazole because of diarrhea, anaerobes were eliminated and diarrhea cleared.

Background: Peritonitis is defined as inflammation of the serosal membrane that lines the abdominal cavity and the organs contained therein. Peritonitis is often caused by the introduction of infection into the otherwise sterile peritoneal environment through the perforation of the bowel, such as the ruptured appendix or colonic diverticulum. The disease may also be caused by the introduction of a chemically irritating material, such as gastric acid from a perforated ulcer. Peritonitis secondary to perforation of the gastrointestinal tract, a common occurrence in this country, requires emergency surgical intervention and is associated with significant morbidity and mortality rates.Methods: This was a comparative prospective cohort study in which 150 patients presenting with symptoms peritonitis secondary to hollow viscus perforation in general surgery department, Sri Venktaeshwara Medical College, Tiruapti from March 2017 to November 2018 were taken for the study.Results: Jabalpur prognostic scoring system has a slightly higher area under the curve of 96% when compared with the Mannheims peritonitis index score with 95%. So this shows that the Jabalpur prognostic scoring system has slightly greater indices than, that of Mannheims peritonitis index scoring system in predicting the prognosis of perforative peritonitis.Conclusions: In patients with perforation peritonitis, Jabalpur prognostic scoring system is an easy and reliable predictor in evaluating prognosis. In developing countries like India, where in resources are limited, Jabalpur prognostic scoring system will greatly help in predicting prognosis in patients with perforarion peritonitis. Because of its cost effectiveness, availability and ease of use, it is recommended as a part in the holistic approach of treatment of perforation peritonitis.

Background: Acute pancreatitis is a common condition associated with morbidity and mortality. The incidence of acute pancreatitis (AP) has been increasing worldwide. Recent advances in diagnostic and therapeutic management in acute pancreatitis (AP) remarkably decreased the mortality rate. Assessing severity of acute pancreatitis at an early stage will further decrease the mortality rate and will help to initiate appropriate treatment as early as possible to prevent mortality. Many clinical, laboratory, and radiological factors and scoring systems are used to predict severity and prognosis of AP, but none is ideal. In low resource setting, costly laboratory tests are not readily available.  Platelet to lymphocyte ratio (PLR) is an easily derivable, cost effective and applicable blood test. Platelet to lymphocyte ratio (PLR) is a relatively novel inflammatory marker and can predict severity in various diseases. In this study, we evaluated the value of PLR as prognostic factor in acute pancreatitis (AP).Methods: This prospective study was conducted on 256 patients admitted to S.V.R.R.G.G. Hospital, with the diagnosis of acute pancreatitis, from April 2017 to September 2018. Patients with Acute Pancreatitis were divided into tertiles based on the values of PLR at admission, a PLR of less than 150 as 1st tertile, a PLR of 150-300 as 2nd tertile and a PLR of more than 300 as 3rd tertile. The outcomes assessed were intensive care unit (ICU) admission, length of stay (LOS) in the hospital and death.Results: According to PLR tertiles, patients in the 3rd tertile (PLR>300) had significantly more ICU admissions, 59 (71%) and longer average Length of Hospital Stay (LOS) of survivors,18+/-5 days and higher mortality, 24 (28.9%), compared with those in the 1st tertile (PLR<150).Conclusions: PLR is an easily derivable, cost effective prognostic factor which can predict the outcome of acute pancreatitis. In this study, we established that high PLR value is associated with very bad prognosis and poor outcome or death in Acute pancreatitis.

BACKGROUND Diabetic foot is the most common and most feared complication of diabetes and is more significant than nephropathy, retinopathy, heart attack, and stroke combined. Diabetes-associated problems are the second common cause of lowerlimb amputations in India. Foot disorders like ulcerations, infection, Gangrene are the leading causes of hospitalization in patients with diabetes mellitus in India.1 METHODS A prospective study, carried out on 100 diabetic patients with foot ulcers over a period of one year from April 2019 to March 2020 at Sri Venkateswara Medical College hospital. The extent of foot infection was assessed based on Wagner’s classification and were studied based on the culture and sensitivity obtained and the efficacy of the antibiotic used. RESULTS The data analysis of 100 patients has given the following results. 70 % (70 patients) of them were culture positive, and 30 % (30 patients) were culture negative. Culture positive patients were divided into two groups with 35 patients each. Group A started on empirical therapy, Group B on sensitive antibiotic therapy. Repeat swab taken on day 7 from the previously culture-positive patients (70 patients), it was found that 30 out of 35 patients of group-A (empirical therapy) were still culture positive with a similar or newer organism, only 5 patients were culture negative, whereas in 35 patients of Group-B (sensitive antibiotic therapy) only 5 patients were culture positive with a similar or newer organism, remaining 30 patients were culture negative. Sensitive antibiotic therapy was found to be effective than empirical therapy in treatment of diabetic foot ulcers. CONCLUSIONS Culture and sensitivity from the wounds play a critical role in prescribing appropriate antibiotic at the time of admission itself rather than starting the empirical treatment. KEYWORDS Diabetic Foot, Culture and Sensitivity, Empirical Antibiotic Therapy

BACKGROUND Intestinal obstruction can be defined as the partial or complete blockage of either the small intestine or large intestine or both, causing failure of intestinal contents to pass beyond the point of obstruction. Subacute intestinal obstruction implies incomplete obstruction. It is characterized by continuous passage of flatus and /or feces beyond 6 -12 hours of the onset of symptoms. We wanted to study the conservative management of subacute intestinal obstruction and its outcome. METHODS Data was collected from patients presenting to outpatient Department of General Surgery, SVRRGGH, Tirupati and emergency with the features of subacute intestinal obstruction during the period of March 2019 to April 2020 were included in the study. RESULTS The incidence is high in patients of age group 41-50 years with Male: Female ratio is 2.1:1. The most common presenting symptom is pain abdomen (92 %), followed by vomiting (84 %). In our study, exaggerated bowel sounds (60 %) are the most common physical finding. The most common cause of obstruction is Postoperative adhesions (36 %), followed by obstructed hernias (22 %). Out of 50 cases, 72 % of cases were managed successfully by conservative management. In the patients who were managed conservatively, most of them are due to postoperative adhesions. In the patients who underwent emergency surgical intervention, 50 % of cases operated on the 2nd day of admission. Most commonly done Surgery include Adhesiolysis (28.6 %), Herniorrhaphy (28.6 %) and Resection and anastomosis (21.5 %). CONCLUSIONS Our study showed that conservative management is successful in about 72 % of patients with subacute intestinal obstruction. Not all the patients attending the emergency ward with features of intestinal obstruction need emergency surgical intervention. Conservative management can be tried in selective cases in patients with SAIO, thereby reducing the rate of negative laparotomies and morbidity and mortality. KEYWORDS Sub-Acute, Intestinal, Obstruction Conservative, Outcome