"Introduction: About 15% of diabetic patients get affected with a complex and heterogeneous disorder with diabetic foot syndrome (DFS) once in a lifetime.
Objectives: To record the pattern of pathogenic infectious agents across various levels of fasting blood glucose (FBS) levels and hemoglobin A1c (HbA1c) in type 2 diabetic foot ulcer patients to determine the better predictor among culture growth and FBS levels.
Materials and methods: This is a cross-sectional study at a tertiary healthcare center for the duration of 2 months. Pus from the diabetic foot infection was sent to the microbiology laboratory and processed immediately. Microorganism identification and antibiotic susceptibility testing were carried out as per the standard procedures. At the same time, FBS by spectrophotometric method and HbA1c values [Bio-Rad DIO HbA1c analyzer, by high-performance liquid chromatography (HPLC) method] of all the patients involved in the study were recorded.
Results: Maximum patients (81%) had FBS of >126 mg/dL and 58% had HbA1c of ≥10. Gram-negative bacilli (GNB) were 80% and gram-positive cocci (GPC) were 20%. With FBS of <100 mg/dL, culture revealed 50% of Klebsiella spp and 50% of Proteus spp. In FBS of 100–126 mg/dL, P. aeruginosa (50%) was common. In ≥126 mg/dL, along with GNB, GPC was also detected.
Conclusion: Fasting blood glucose (FBS) and HbA1c values can be of great help in predicting the organism associated with diabetic foot infections and starting the bacteria-targeted antibiotic therapy to reduce further complications."

Background and aims: Midazolam and dexmedetomidine have been routinely used for intravenous sedation in ophthalmic surgeries. Dexmedetomidine is an alpha-2 agonist that provides sedation and analgesia without respiratory depression. It has also been shown to reduce intraocular pressure (IOP) in ophthalmic surgeries done under regional anesthesia. Midazolam has been used alone or in combination with opioids or propofol with variable results. This study aimed to compare the efficacy of single low-doses of midazolam and dexmedetomidine for reducing blood pressure (BP) in patients undergoing ophthalmic surgeries under local anesthesia. Methods: In a prospective blinded study, 50 patients undergoing cataract surgery under local anesthesia whose on table BP was >150/90 mm Hg were randomly divided to receive either dexmedetomidine 0.4 μg/kg or midazolam 20 μg/kg single dose. Reduction in BP, heart rate (HR), sedation level, decrease in IOP, and any delay in discharge were assessed. Results: There was a significant drop in HR after 10 minutes in the dexmedetomidine group compared to the midazolam group (p < 0.05). Systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were comparable in both groups. But eight patients in the midazolam group required a second dose of the study drug for the control of BP, which was clinically significant. Also, patients who received dexmedetomidine had a significant fall in IOP compared to those who received midazolam (p < 0.00001). The sedation score was 2 in all patients and there was no delay in discharge from the recovery room. Conclusion: Small single dose of dexmedetomidine of 0.4 μg/kg in patients undergoing short duration cataract surgery under regional anesthesia, provides adequate control of BP without causing undue sedation, respiratory depression, and without any delay in discharge compared to 20 μg/kg midazolam.

"Introduction: Coronavirus 2019 (COVID-19), pandemic has increased mental illnesses. Vaccination was the preferred method of protection and there is sparse knowledge regarding the impact of vaccination on mental health status. Awareness, availability, and accessibility to healthcare vary between urban and rural settings.
Aim: This study compared the adherence to COVID-appropriate behavior, psychiatric illnesses, and quality of life (QOL) among post-vaccinated individuals in urban and rural populations.
Materials and methods: A comparative cross-sectional study was done on 606 vaccinated individuals of both urban and rural Bengaluru. Data was collected through a self-structured questionnaire which incorporated a sociodemographic profile, depression anxiety, and stress scale (DASS-21), and QOL and was analyzed using Statistical Package for Social Sciences (SPSS) version 23.
Results: In both urban and rural population, majority followed COVID-appropriate behaviors. It was found that anxiety was significantly high in the rural, whereas QOL was low in both urban and rural areas. Individuals with high scores on depression, anxiety, and stress (DAS) were found to have a negative correlation with QOL.
Conclusion: In addition to vaccination, adhering to COVID-appropriate behavior is necessary to eradicate the disease. Appropriate mental health care should be provided even in the rural setting to address COVID-related anxiety and depression."

"Introduction: Forward-lying sigmoid sinus and injury during cortical mastoidectomy are complications every otologist bears in mind while operating. Pseudomonas infection of the middle ear cleft is difficult to eradicate. Following coronavirus disease 2019 (COVID-19), there is a hypercoagulable state which surgeons have to take into account while caring for affected individuals. Here is a case with all three problems, necessitating prolonged treatment.
Case description: We report the clinical course and management of a teenage child who developed unilateral near-complete thrombosis of the internal jugular vein (IJV), jugular bulb, and partial thrombosis of distal sigmoid sinus—with a short segment thrombus—following myringoplasty and attempted cortical mastoidectomy. She developed a severe throbbing headache postoperatively (post-op). Imaging showed hypoplastic transverse and sigmoid sinus on the opposite side, aberrant anterior, and laterally placed sigmoid sinus on the operated side. Although the child had no history of upper respiratory tract infection/COVID-19 infection preoperatively, post-op measured COVID-19 antibody levels were elevated. The patient was treated with intravenous and oral anticoagulants, and antibiotics, leading to a complete resolution of symptoms.
Conclusion: In the COVID-19 era, seemingly common problems may be amplified and more difficult to manage. In this report, we illustrate a problem which may be faced by the otologist—to raise awareness and improve clinical care."

"Background: This case report demonstrates the acute onset of diplopia due to isolated abducens nerve palsy secondary to uncontrolled diabetes, presenting as ophthalmoplegia.
Case description: A 55-year-old female with a history of type 2 diabetes mellitus (DM) and hypertension presented with sudden onset binocular horizontal diplopia in the past 15 days, which was greater at a distance and worsened on looking toward the right. Ophthalmological examination was unremarkable except for right eye abduction limitation on lateral gaze. Blood investigations revealed glycated hemoglobin (HbA1c)—11.8, fasting blood sugar (FBS)—271, postprandial blood sugar (PPBS)–385, and the rest of the reports were unremarkable. Fundoscopic examination of eyes was normal. Magnetic resonance imaging (MRI) brain and orbit were also normal. A diagnosis of isolated sixth nerve palsy (ISNP) secondary to uncontrolled diabetes was made. Subsequently, the patient was put on oral hypoglycemia agents, insulin, aspirin, and dark goggles with alternate eye occlusion therapy. Over the course of 4 days of hospital stay, the patient noticed a 20% improvement in her symptoms.
Conclusion: It is important to consider sixth nerve palsy in poorly controlled diabetic patients presenting with diplopia with normal neurological findings."

Posterior reversible encephalopathy syndrome (PRES) is a rare condition in which some parts of the brain are affected by tissue edema. The highly elevated blood pressure (BP) by itself may result in PRES. We also find underlying disease conditions with high BP presenting as PRES. The features of PRES are headache, altered vision, and seizures. Patients with this disorder may develop neurological symptoms like confusion or paresis of the upper and lower limbs or, at times, both. The causes of PRES have severely elevated BP, infections, preeclampsia, certain drugs, or autoimmune diseases. Imaging studies help in the diagnosis of PRES. Magnetic resonance imaging (MRI) brain scan may show gyral hyper-intensity in the posterior aspect of the bilateral parietal lobes without diffusion restriction. Treatment of PRES includes treatment of the etiology and the underlying complications. Here we present a case of PRES in a postpartum female patient of day 10.