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Background and Purpose: It is still a matter of debate whether delayed primary closure (DPC) of dirty abdominal incisions reduces surgical site infections (SSIs) compared with primary closure (PC). Our objective was to determine whether DPC of dirty abdominal incisions reduces SSIs., Method: A controlled randomized study was conducted at an academic tertiary care 1,500-bed university hospital in Western India involving 81 consecutive patients with dirty abdominal incisions. Only 77 patients (DPC = 37, PC = 40) were evaluable because of the deaths of four patients. A total of 52 patients had peptic or typhoid perforations, whereas the rest had appendicular perforations/abscesses, penetrating or blunt abdominal injuries with gastrointestinal perforation, or intra-peritoneal abscesses. Patients were randomized to have their surgical incisions (skin and subcutaneous tissue) either closed primarily (PC) or left open with saline-soaked gauze dressings for DPC on the 3(rd) postoperative day or later if the incision conditions were inappropriate for closure. The main outcome measure was the incidence of postoperative SSI., Results: In the entire series, SSI developed after incision closure in 23% of the patients. Infections were significantly more common in the PC group (42.5% vs. 2.7% for DPC; p = 0.0000375). There also were significantly more cases of abdominal dehiscence in the PC group (DPC 1 [2.7%] vs. PC 10 [25%]; p = 0.005). The mean complete incision healing (CIH) time and length of hospital stay (LOS) were longer after PC (18.52 days) than DPC (13.86 days), resulting in a significant difference in the end point of healing and LOS (p = 0.0207). Short-term cosmetic results for PC incisions were significantly inferior to those for DPC (p = 0.03349)., Conclusions: Delayed primary closure is a sound incision management technique that should be utilized for dirty abdominal incisions. It significantly lowers the rate of superficial SSI as well as fascial dehiscence and reduces the mean CIH time and hospitalization. The short-term cosmetic appearance is superior.

Introduction: Hepatic hydatid disease can be successfully treated by a variety of modalities., Case Presentation: We report a case of a 60 year old male with giant hepatic hydatid disease who presented with a huge cystic mass in the upper abdomen. Diagnosis was confirmed by serology, ultrasonography and CT scan. The patient was treated successfully by open minimally invasive surgery with minimum breaching of the peritoneal cavity using a laparoscopic trocar to evacuate the cyst., Conclusion: The use of a laparoscopic trocar through a small abdominal incision in selected patients with hepatic hydatid disease with subfascial extension can be a safe, minimally-invasive option of treatment.

The present study was conducted to find the prevalence of Extended spectrum b Lactamase (ESBL) producing strains of Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. Coli) in different clinical samples received at the Department of Microbiology, Medical College Baroda. A total of 187 clinical isolates (106 of K. pneumoniae and 81 of E. Coli) were tested for resistance to any one of the three Third generation cephalosporins (3GC) namely cefotaxime, ceftazidime and ceftriaxone. 100 isolates (57 of K. pneumoniae and 43 of E. Coli) were found to be resistant to at least one of the 3GC tested. These were then tested for ESBL production by Double Disc Diffusion Synergy Test (DDST) using Ceftriaxone, Ceftazidime, and Cefotaxime along with Augmentin as well as by the MIC reduction test. ESBL was detected in 53 isolates (33 K. pneumoniae and 20 E. coli). Using the interpretative guidelines of the NCCLS, 24% to 27% of the ESBL isolates would have been reported to be susceptible to the 3GC by routine antimicrobial susceptibility methods. DDST was found to be a useful, simple and cost effective test for the detection of ESBL producing strains.

Mycetoma due to Madurella grisea has not been previously reported from Gujarat. We report a case in whom identification of the strain was made through the structure and texture of grains, morphology in Sabouraud's dextrose agar and histopathology.

There has been an increase in disease caused by Non Tuberculous Mycobacteria (NTM) since the early 1980s. Though ubiquitous in environment, they may act as clinically important pathogens in various conditions. More importantly they are resistant to the conventional anti-tuberculous therapy (ATT) and respond to antibiotics such as quinolones and aminoglycosides and need an aggressive surgical intervention. Missing these atypical mycobacteria may lead to unnecessary administration of ATT and hence delay in proper management of the case. We report a case of spinal tuberculosis due to a Non Tuberculous Mycobacteria, M. fortuitum (Rapid grower). Relevant literature is also reviewed.