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Participation in research is important in producing doctors with an understanding of evidence-based medicine. Though a mandatory part in post-graduate medical course, research has largely been invisible from the under graduation medical course in India. Very few research opportunities are available at under graduate level. The reason behind this is lack of encouragement, lack of basic infrastructure, facilities and structured mentorship programs, no extra incentives to researchers and the long journey to get academic acclaim. Another additional aspect is of lack of writing skills for biomedical publication. Additional incentives to students as well faculty members are required to foster the research environment in India.

Objective: To evaluate the relationship between preoperative A1C and clinical outcomes in individuals with diabetes mellitus undergoing noncardiac surgery., Research Design and Methods: Data were obtained from the National Surgical Quality Improvement Program database and the Research Patient Data Registry of the Brigham and Women's Hospital. Patients admitted to the hospital for ≥1 day after undergoing noncardiac surgery from 2005 to 2010 were included in the study., Results: Of 1,775 patients with diabetes, 622 patients (35%) had an A1C value available within 3 months before surgery. After excluding same-day surgeries, patients with diabetes were divided into four groups (A1C ≤6.5% [N = 109]; >6.5-8% [N = 202]; >8-10% [N = 91]; >10% [N = 47]) and compared with age-, sex-, and BMI-matched nondiabetic control subjects (N = 888). Individuals with A1C values between 6.5 and 8% had a hospital length of stay (LOS) similar to the matched control group (P = 0.5). However, in individuals with A1C values ≤6.5 or >8%, the hospital LOS was significantly longer compared with the control group (P < 0.05). Multivariate regression analysis demonstrated that a higher A1C value was associated with increased hospital LOS after adjustments for age, sex, BMI, race, type of surgery, Charlson Comorbidity Index, smoking status, and glucose level on the day of surgery (P = 0.02). There were too few events to meaningfully evaluate for death, infections, or readmission rate., Conclusions: Our study suggests that chronic hyperglycemia (A1C >8%) is associated with poor surgical outcomes (longer hospital LOS). Providing a preoperative intervention to improve glycemic control in individuals with A1C values >8% may improve surgical outcomes, but prospective studies are needed.

We report three cases of an unusual aggressive type of Mycobacterium marinum infection of the hand which had been a nightmare both for us and the patient. These were the patients in which even after repeated thorough surgical debridement and appropriate (drug sensitive) medical treatment over a period had resulted in amputation or devastation of the soft tissues so extensively that almost only the neurovascular bundle, bone and the skin were the only structures left (cosmetic fingers - no function) at the last debridement after which the infection has not recurred. By presenting this article we want to stress on certain points pertaining to diagnosis, management, varied presentation and of course the dreadful complications of deep-seated M. marinum infection.

The metabolic syndrome, as described by Reaven, is a combination of obesity, insulin resistance, hypertension, hypertriglyceridemia, low HDL cholesterol, and hyperinsulinemia. The syndrome was recognized as a very high pro-atherogenic risk causing coronary heart disease. More recently, other features like an elevated plasma PAI -1 and CRP have been added to the syndrome. In view of the recent data demonstrating that insulin exerts an anti-inflammatory effect while macronutrients exert a pro-inflammatory effect, we are in a better position to explain not only why an insulin resistant state like the metabolic syndrome is pro-inflammatory but also to explain how it develops. This review discusses the relevance of these recent observations and puts into perspective the pathogenesis of various features of the metabolic syndrome and also predicts some features which may get incorporated into it in the future.