Diabetic foot ulcer (DFU) is a major complication of diabetes with high morbidity and mortality rates. The pathogenesis of DFUs is governed by a complex milieu of environmental and host factors. The empirical treatment is initially based on wound severity since culturing and profiling the antibiotic sensitivity of wound-associated microbes is time-consuming. Hence, a thorough and rapid analysis of the microbial landscape is a major requirement toward devising evidence-based interventions. Toward this, 122 wound (100 diabetic and 22 nondiabetic) samples were sampled for their bacterial community structure using both culture-based and next-generation 16S rRNA-based metagenomics approach. Both the approaches showed that the Gram-negative microbes were more abundant in the wound microbiome. The core microbiome consisted of bacterial genera, including Alcaligenes, Pseudomonas, Burkholderia, and Corynebacterium in decreasing order of average relative abundance. Despite the heterogenous nature and extensive sharing of microbes, an inherent community structure was apparent, as revealed by a cluster analysis based on Euclidean distances. Facultative anaerobes (26.5%) were predominant in Wagner grade 5, while strict anaerobes were abundant in Wagner grade 1 (26%). A nonmetric dimensional scaling analysis could not clearly discriminate samples based on HbA1c levels. Sequencing approach revealed the presence of major culturable species even in samples with no bacterial growth in culture-based approach. Our study indicates that (i) the composition of core microbial community varies with wound severity, (ii) polymicrobial species distribution is individual specific, and (iii) antibiotic susceptibility varies with individuals. Our study suggests the need to evolve better-personalized care for better wound management therapies. IMPORTANCE Chronic nonhealing diabetic foot ulcers (DFUs) are a serious complication of diabetes and are further exacerbated by bacterial colonization. The microbial burden in the wound of each individual displays diverse morphological and physiological characteristics with unique patterns of host-pathogen interactions, antibiotic resistance, and virulence. Treatment involves empirical decisions until definitive results on the causative wound pathogens and their antibiotic susceptibility profiles are available. Hence, there is a need for rapid and accurate detection of these polymicrobial communities for effective wound management. Deciphering microbial communities will aid clinicians to tailor their treatment specifically to the microbes prevalent in the DFU at the time of assessment. This may reduce DFUs associated morbidity and mortality while impeding the rise of multidrug-resistant microbes.

Castleman's disease is a clinic-pathological entity of unknown etiology with non-neoplastic lymph node hyperplasia. It is extremely rare and can be found in patients of all age groups. It can present as localized with local signs and symptoms or disseminated disease which includes a wide range of systemic problems. Our patient is a 15-year-old adolescent female with nonspecific features of abdominal pain, vomiting. Blood and Imaging studies were inconclusive and the diagnosis of Castleman's diseases was confirmed by histopathology. Here, we discuss the importance of considering Castleman's diseases as a differential diagnosis for a case of acute abdomen.

A 67-year-old male was referred with three days old symptoms of diffuse generalized pain abdomen with distension, but no vomiting. He had obstipation and also gave a history of occasional right upper quadrant pain, in the past. Clinical examination revealed small bowel obstruction and abdominal radiographs showed dilated small bowel loops with air fl uid levels (Fig. 1). As patient had not responded to conservative management of 3 days, he was subjected to an emergency laparotomy.At laparotomy, the small bowel was distended more than the large bowel. A hard object was felt at the ileocecal junction. An enterotomy revealed a large gall stone at this site. Seventeen stones were recovered from this enterotomy site (Fig. 2). On proximal examination, a cholecystoduodenal fi stula was found, for which a cholecystectomy with closure of the cholecystoduodenal fi stula was executed and the patient had an uneventful postoperative recovery. The patient has been followed up for seven months now with no postoperative complications.Gallstone ileus is a rare complication of cholecystolithiasis especially in the elderly age group, requiring emergency surgery. It is an uncommon cause of intestinal obstruction, accounting for 1-4% of mechanical small bowel obstructions and usually results from luminal impaction of one or more gallstones [1]. Of late, there have been more and more cases reported, likely as a result of a high index of suspicion and improved diagnostic imaging techniques. It is associated with a high mortality because of the advanced age of the patients, a delayed diagnosis and signifi cant concomitant medical illnesses [2]. The clinical symptoms and signs of gallstone ileus are mostly nonspecifi c, contributing to delay in diagnosis. Signs of a cholecystoduodenal fi stula are often absent on conventional radiological and ultrasonic methods, though a few show pneumobilia [3]. For several IMAGES IN SURGERY

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