Introduction: Infected diabetic foot ulcers may lead to serious complications if not recognised in the early stage. Diagnosis of infection is particularly challenging at that stage; thus, a sensitive inflammatory biomarker may be helpful. We aimed to evaluate the role of procalcitonin (PCT) as an early biomarker for infected diabetic foot ulcers (IDFU). Materials and method: This cross-sectional study was conducted at Klinik Rawatan Keluarga (KRK), Orthopedic clinic and wards in Hospital Universiti Sains Malaysia (USM) from May 2020 to December 2020. A total of 264 participants were recruited and divided into three groups: 50 diabetic patients with no ulcers (control), 107 patients with non-infected diabetic foot ulcers (NIDFU), and 107 patients with infected diabetic foot ulcers (IDFU). The level of PCT was taken for all patients. Total white count (TWC) and Creactive protein (CRP) were taken only for IDFU patients. Diagnosis of infection was based on the Infectious Disease Society of America-International Working Group of Diabetic Foot (IDSA-IMWGDF), and the severity of infection was graded according to the Wagner Classification. Results: The level of PCT was higher in IDFU than in NIDFU and diabetic patient, with a median (IQR) of 0.355 (0.63) ng/mL, 0.077 (0.15) ng/mL and 0.028 (0.02) ng/mL, respectively. PCT and CRP showed moderate positive correlations in IDFU patients (p<0.001). The sensitivity and specificity were 63.6% and 83.2%, respectively, at the best cut-off at 0.25 ng/mL. Conclusion: PCT is a valuable biomarker for the diagnosis of infection; however, it adds little value in the early diagnosis of IDFU in view of its low sensitivity.

Comparison between Surgeon Administered Intraoperative Transverse Abdominis Plane Block with Wound Site Local Anesthetic Infiltration in Patients Undergoing Open Appendicectomy: A Prospective Double-Blinded Randomised Control Trial Transversus abdominis plane (TAP) block is a defined technique for managing postoperative pain. In particular, the use of surgeon-administered TAP blocks needs more comprehensive research. Therefore, our objective was to record the pain relief needed in patients who underwent surgical administered TAP blocks followed with an open appendectomy in comparison to those who received local anaesthetic infiltration at the wound site. Additionally, we aimed to assess the time until the first postoperative analgesic application and compare tramadol requirements in the postoperative period for these two groups. We conducted a controlled, prospective, randomised, double-blind study involving patients who underwent open appendicectomy at Hospital Sultanah Aminah Johor Bahru from April 2017 to October 2017. Of 61 patients, 31 were in the intervention group, and 30 were in the control group. Both groups of patients received a dose of 10cc of 0.25% levobupivacaine. Patients in the intervention group experienced a longer interval before requiring their first rescue analgesia (2.6 hours versus 1.17 hours; p=0.02, SD=1.66-2.97). The total tramadol dose needed over the first 24 hours in the intervention group was slightly lower at 115.8mg compared to the control group, which used 136.7mg (p=0.32, sd=72.42-89.96). Notably, patients in the intervention group also had a significantly shorter hospital stay (1.39 versus 1.68 days, p=0.02). It was worth noting that none of our patients experienced any adverse events during the study. Considering our study's effectiveness and safety profile, we recommended the routine use of surgeon-administered TAP blocks in open appendicectomy. This approach not only enhanced patient postoperative analgesia but also reduced the duration of hospitalisation.