Background: Numerous topical agents are used for chronic diabetic foot ulcer (DFU) care and healing. In most of the hospitals in India povidone iodine is used topically for DFU dressing, however few other agents are more efficacious; the present study was aimed to compare the effect of povidone iodine and normal saline dressing in healing of DFU.Methods: A total of 50 patients (25 patients in each arm of povidone Iodine and Saline dressing group) with complaints of chronic DFU attending surgery outpatient department of Rajarajeswari Medical College and Hospital were considered in this prospective comparative study from July 2017 to December 2018. Dressings were done on daily basis for a period of 6 weeks, and the results were compared on 2nd, 4th and 6th week, using reduction in surface area of chronic DFU as parameter of healing process.Results: The mean surface area of wound in povidone iodine group was: baseline- 12.2 sq.cm, 2nd week- 11.7 sq.cm, 4th week- 10.6 sq.cm, 6th week- 9.8 sq.cm; While in saline group was: baseline- 13.3 sq.cm, 2nd week- 11.6 sq.cm, 4th week- 10.8 sq.cm, 6th week- 9.6 sq.cm. After 6 weeks, the mean reduction in surface area of wound is more in the saline dressing group compared with the povidone iodine dressing group and the results are statistically significant at a p<0.05.Conclusions: Saline dressing is more effective than povidone iodine dressing in achieving complete healing, reducing wound surface area, and increasing comfort in subjects with chronic DFU.

Background: Acute anal fissure (AAF) heals spontaneously with conservative line of treatment. Chronic anal fissure (CAF) needs either traditional surgical lateral sphicterotomy or chemical sphincterotomy with topical agents. The present study aims at the effectiveness of topical diltiazem (DTZ) cream over topical glyceryl trinitrate (GTN) ointment in the treatment of chronic anal fissure.Methods: A total of 100 patients with CAF were included in this comparative prospective study conducted in Rajarajeswari Medical College and Hospital Bengaluru from July 2017 to December 2018. Eligible patients were randomly assigned to one of the two treatment groups of 50 patients each and were advised to apply 2% DTZ cream or 0.2% GTN ointment by fingertip to the anal verge twice daily for 8 weeks. The results were analysed and compared on two weekly intervals to know the effectiveness of treatment. P value of <0.05 is considered to be significant.Results: Complete healing of the fissure occurred in 80% of the patients in DTZ group against 76% in the GTN group by the end of 6 weeks (p>0.05, statistically not significant). Mild headache was experienced by 14% of the patients in the DTZ group, while 46% of the cases in the GTN group reported about the same (p<0.05 statistically significant).Conclusions: Topical 2% DTZ appeared to be well tolerated and effective preferred first-line method of chemical sphincterotomy with less side effects for chronic anal fissure.

Rectal foreign bodies represent a unique and challenging field of surgical management which includes a careful history, physical examination and a high index of suspicion for complications. Foreign bodies are rarely seen in lower GI or rectum, inserted either accidently or for sexual satisfaction or to inflict harm. We have 3 case scenarios of unusual foreign body in rectum with varied clinical presentation, findings and three different methods of management/extraction done in our Institution. Patients present with common complaints of rectal or abdominal pain, constipation or obstipation, bright red blood per rectum, or incontinence. Initial step is to assess for peritonitis which is suggestive a perforation with intraperitoneal contamination and requires emergency exploratory. Erect Xray abdomen can reveal the presence of free air and the location of the object relative to the pelvic floor. A careful digital rectal examination is the most informative component of the evaluation process. Impacted foreign bodies may result in complications like intestinal obstruction, perforation of gut and peritonitis. Rectal foreign body is a diagnostic and management dilemma due to the delayed presentation owing to associated social stigma. Patients require a detailed examination and radiographic evaluation with resuscitation. Surgical intervention should be planned based on hemodynamic stability and presence/absence of perforation. Patient has to be referred to the psychiatrist for his perversion disorder, which is also mandatory for preventing recurrences.