BACKGROUND-Diabetic foot is a wound failing to heal after 4 weeks of onset which can result from trauma, peripheral arterial disease and/or sensory neuropathy affecting the feet in diabetes mellitus. METHODS- With that background we aim to predict the functionality of a relatively new score called DIAFORA in the North Indian population, by studying parameters like neuropathy, presence of foot deformity, peripheral arterial disease, multiple ulcers, infection, gangrene, bone involvement along with blood sugar levels and culture results. We classified patients with diabetic foot into 3 risk groups- low risk, medium risk and high risk to predict lower limb amputation. RESULTS-With a 41:8 male-female ratio, our study subject’s mean age was 55.38+/- 11 years. Examining patients 90 days post enrollment in our study, 70% of the 30 cases in the high risk group required amputation, 40% of the 5 cases in medium risk groups underwent amputation whereas amputation was redundant in all 15 cases belonging to the low risk group. According to our study, the DIAFORA score has a sensitivity of 91.3% and specificity of 66.7%. CONCLUSION- With a prevalence of approximately 15% diabetic foot in India, this study is a paradigm to predict the amputation in high risk patients. Along with stringent blood sugar control we recommend utilization of DIAFORA score in regular clinical practice by clinicians to predict and prevent amputation in Diabetics and hence improve their quality of life.

Primary Splenic lymphoma is a rare type of Non Hodgkin’s lymphoma of the spleen with or without splenic hilar lymph nodes with preservation of other organ systems. In this case, we encountered a patient who presented with fever of unknown origin since 25 days and was diagnosed with Primary splenic lymphoma based on a tru cut biopsy which was then confirmed by immunohistochemistry. Patient was treated with Chemotherapy alone and showed no recurrence after 6 months of follow up. The aim of reporting this case is to have a high index of suspicion for rare malignancies like PSL in cases of FUO. Contrary to the current guidelines, use of trucut biopsy can be used as a promising investigation to diagnose PSL and treatment with chemotherapy with R-CHOP regimen alone prevented recurrence of the tumour. Investigations like PET-CT which have 100% accuracy in diagnosing PSL can reduce the number of operative procedures like splenectomy used for its diagnosis and treatment.

Persistent uncontrolled hyperglycaemia in Diabetes Mellitus causes permanent structural and functional damage to tissues, which leads to micro and macro vascular complications causing increased mortality and morbidity. Magnesium and Calcium are required for Insulin secretion, Iron is essential for cell functioning and zinc forms the structure of insulin. 90 subjects were enlisted in the study after obtaining written informed consent and divided into 3 groups of pre-diabetic, diabetic and diabetic with micro and macro vascular complication. A brief history with relevant clinical examinations using monofilament test and ophthalmoscopic examination were done to evaluate for diabetic neuropathy and retinopathy respectively. Blood samples for serum zinc, calcium, magnesium and iron were collected and analysed with respect to age, gender and duration since diabetes was diagnosed. With increase in duration of diabetes and HbA1c, serum zinc, iron, and magnesium levels decreased, while calcium levels increased. Till date very few studies have been conducted to study micronutrients deficiency in pre-diabetics. Detection of micronutrients deficiency early in the course of diabetes, may delay the development of complications with their supplementation. Hence, this study is being done to study micronutrients in diabetics and pre-diabetic patients.