Background: Diabetes is considered as one of the most important and rapidly evolving non-communicable disease which requires top priority around the world. 10-25% of diabetics develop foot infections [DFI’s] during the course of their disease period ranging from simple calluses to major Osteomyelitis. 3 Microbial infections of the diabetic foot ulcers are difficult to manage because of multiple factors associated in response including overall glycaemic control, associated complications like vascular disease and neuropathy. The present study was done to assess the microbial flora according to Wagner’s classification for diabetic foot disease. To isolate, identify the aerobic bacterial pathogens and their drug sensitivity pattern with reference to ESBL productionMethods: A prospective study was conducted at a tertiary care hospital by department of general surgery among Diabetics presenting with diabetic foot infections. All the enrolled cases were classified based on Wagner’s classification and socio demographic data was noted. Specimens from the ulcer were collected and processed for isolation, identification of pathogens based on standard CLSI guidelines. The antibiotic sensitivity of the isolates was done and ESBL production was demonstrated by standard guidelines.Results: 346 cases were enrolled in study and grade-3 Wagner’s ulcers were predominant. Males were predominant, 46-55 years age group was common with mean age of 55.3±1.4 years. Peripheral arterial disease was more common than peripheral neuropathy and both were found significantly associated with development of ulcers. Methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa were most common isolates. MRSA exhibited maximum sensitivity to vancomycin, clindamycin and linezolid. Gram negative isolates exhibited maximum sensitivity to meropenems, piperacillin-tazobactam. The prevalence of ESBL producers in the study was 16.24%.Conclusions: DFI are a serious concern in uncontrolled diabetics and require proper management. Outcome of the infection depends upon the grading of the ulcer as per Wagner’s classification and also the nature of the infection either polymicrobial or with a single organism. Our study highlights and suggests that prospective multicentre studies are required to assess the appropriate antibiotic regimen in diabetic foot ulcers and proper management of antibiotics must be implemented to decrease the incidence and development of multi drug resistant organisms.

Background: Acute appendicitis remains as one of the most common surgical entity requiring early intervention. Delay in management results in complications and misdiagnosis results in negative appendectomy. Hence there is always a need to develop a well-designed protocol for diagnosis and to reduce negative appendectomy. Alvarado score for diagnosis of acute appendicitis is an easy, affordable and diagnostic which has been evaluated early with variable reports. In cases with equivocal score, additional tools like sonography may provide a reliable result in accurate diagnosis of acute appendicitis. Objective of the study was to determine the diagnostic accuracy of Alvarado score and ultrasonography in diagnosis of acute appendicitis. To determine the sensitivity, specificity and predictive values of ultrasonography in cases operated with histopathological correlation.Methods: A prospective observational study was conducted at our hospital by department of general surgery for a period of six months. All suspected cases of appendicitis were scored by Alvarado score and cases with>5 were performed additional USG for further evaluation. All the cases of appendicitis that underwent surgery were further confirmed by histopathological correlation with USG and clinical Alvarado score.Results: A total of 200 cases were enrolled with male predominance (57.5%) and mean age of study group was 34.26±8.64 years and male to female ratio of 1.3:1.69% of cases presented with Alvarado score of 7 and above, while 21% of cases with 5-6. Migratory pain in RIF was the commonest symptom and tenderness RIF was the most common sign.160 cases (80%) were operated totally with 75% cases lap appendectomy and 25% cases by open appendectomy. USG was performed on 160 cases and 146 were positive and 14 were negative whereas histopathologically 142 cases were confirmed as Acute appendicitis. The sensitivity, specificity, PPV and NPV of USG is 97.18%, 55.56%, 94.52% and 71.43%. The accuracy of USG is 92.5.Conclusions: Acute appendicitis is first and foremost a clinical diagnosis with scoring systems and imaging being necessary adjuncts in equivocal cases. USG is an easily available tool in diagnosis of acute appendicitis. Application of USG as adjunct tool to Alvarado scoring improves the diagnostic accuracy.