Background: Diabetic foot ulcers (DFU) are one of the major complications of diabetes. Despite proper insulin treatment and a strict diabetic diet, 15% of diabetic population develop non-healing ulcers which leads to amputation of the lower limb. Wound dressings represent a part of the management of diabetic foot ulceration. Normal saline (0.9%) wound dressings have been a useful adjunct in the treatment of open wounds. Topical insulin dressing improves wound healing by regulating oxidative and inflammatory responses. PRP dressing has emerged as an adjunctive and newer method for treating DFUs. Hence, the present study was undertaken to compare the effect of topical insulin, platelet-rich plasma (PRP), and normal saline dressing in healing of DFU. Aims and Objectives: The aim of the study was to study the comparison between topical application of insulin versus PRP versus regular normal saline dressing in healing of DFU. Materials and Methods: It is a duration based prospective comparative study including 60 patients divided equally into normal saline dressing group, topical insulin dressing group and PRP dressing group after they fulfilled all the inclusion and exclusion criteria and after obtaining the proper informed and written consent from relatives/patients. Ulcers at days 0, 7 and 14 in terms of size, depth and percentage reduction in area of wound were analyzed. Results: The mean ulcer size at day 14 in normal saline was 4.19±0.95, in Insulin 2.64±0.83 while 2.08±0.47 in PRP group. The mean ulcer depth at day 14 in normal saline was 5.35±1.18, in insulin 4.30±1.38 while 2.35±1.42 (mm) in PRP group, percentage reduction of mean ulcer size in normal saline was 27.02±4.46, in insulin 50.31±7.53 and 63.80±5.75% in PRP group. Conclusion: PRP appears to be a promising agent in terms of faster wound healing, more significant reduction in the size of DFU as compared to topical insulin and other conventional dressings.

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties.Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations.IJCRI publishes Review Articles, Case Series, Case Reports, Case in Images, Clinical Images and Letters to Editor. Website: www.ijcasereportsandimages.comA forgotten double-J stent with missing shaft and unusual large stone formation at its both the J end: A case report Rajesh Kumar Maurya, Vikash Katiar, Vijay Kannaujiya ABSTRACT Introduction: Use of ureteric stents is accepted standard practice in the management of ureteric obstruction, 'forgotten' indwelling stents can cause encrustation, pyelonephritis, recurrent obstruction, and stent migration and breakage. A stent register should be maintained to check follow-up of such patient to prevent this urological travesty. Case Report: We are reporting a case of encrustation and unusual large stones formation at both the J end of a forgotten double-J stent in a 35-year-old female presented in our outpatient department for complaints of left flank and lower abdominal pain, burning and increased frequency of micturition for four months. Conclusion:Indwelling stents can result in complications such as encrustation, pyelonephritis, recurrent obstruction, and stent migration and breakage so their use should be done with caution.

Background: Despite advancements in modern surgery and postoperative care, disruption of gastrointestinal anastomosis remains the most dreaded complication, even in experienced surgical hands. The cause of leakage is multifactorial consisting of a complete spectrum of pre, intra and postoperative factors. Search for an ideal gastrointestinal anastomosis still remains an unquenched thirst. Study Design: Prospective, hospital based, time bound observational study. Methods: After ethical clearance, 288 consenting adult patients who underwent gastrointestinal anastomosis were observed for risk factors, presentation and outcome of leakage and evaluated using appropriate statistical tools. Results: An overall gastrointestinal anastomotic leak rate of 15.28% with peak incidence at 41-50 years (19.51%) was seen. Peritonitis (p=0.0009, OR=2.9611), COPD (p=0.0181, OR=2.7306), low serum albumin concentration (p=0.0028, OR=3.1442), ASA status of ≥III (p=0.0001, OR=4.0281) and a perioperative blood transfusion requirement of ≥2 units (p=0.0028, OR=3.1442) were the most signicant risk factors associated with leakage. Obstruction (p=0.0160, OR=2.2310), malignancy (p=0.0149, OR=2.6961), steroid therapy (p=0.0176, OR=2.2741), chemoradiation (p=0.0400, OR=2.4889), diabetes (p=0.0427, OR=2.2689), undernutrition (p= 0.0308, OR= 2.1099), anaemia (p=0.0325, OR=2.0183) and sepsis (p=0.0187, OR=2.2702) also showed clear risk augmentation. Risk of leakage was increased with a surgical duration of >4 hours (p=0.0078, OR=2.5610), when anastomosis was done as an emergency procedure (p=0.0427, OR=2.6571) or by a surgeon with expertise of ≤5 years (p=0.0338, OR=2.7733). Neither the level, type, technique of anastomosis; nor the usage of surgical staplers had an impact on leakage. Preoperative bowel preparation and creation of a proximal stoma also had minimal effect on leakage rates; though, the infectious complications that follow were greatly reduced. The most common presentation of anastomotic leak was a suspicious drain output with a mean time of 7.59± 2(2.48) postoperative days; resulting in a prolongation of hospitalization by more than ten days (p<0.0001), along with an increased mortality rate (p<0.0001). Conclusions: Accurately predicting anastomotic leakage still requires more evidence-based information. Even with good risk stratication, many causative factors may not be amenable to immediate correction in the pre-operative period. In such cases, the patient must be considered as a candidate for an enterostomy to help tide the crisis over.