Fournier’s gangrene which is a rapidly progressive, fulminant polymicrobial synergistic infection of the perineum and genitals is now changing its pattern. Both genders can be affected and the mortality is still high (around10%). The clinical presentation in many patients in early stage may not be prominent. Thus rapid and accurate diagnosis is must for prompt treatment. Extensive surgical debridement and broad spectrum intravenous antibiotic remains the mainstay of treatment in order to reduce the morbidity and mortality.
“Love is like the human appendix. You take it for granted while it's there, but when it's suddenly gone you're forced to endure horrible pain that can only be alleviated through drugs.”
― Reverend Jen,
Femoral hernia is the third common hernia after inguinal and incisional hernias. The swelling in femoral hernia is below and lateral to pubic tubercle. It is more common in females. Strangulation is very common in this hernia.
An anorectal abscess is a collection of pus in the anal or rectal region.
It may be caused by infection of an anal fissure, sexually transmitted infections or blocked anal glands.
An anorectal abscess is a collection of pus that builds up in the rectum and anus.
With prompt treatment, client with this condition usually recover very well.
Complications tend occur when treatment is delayed.
“Love is like the human appendix. You take it for granted while it's there, but when it's suddenly gone you're forced to endure horrible pain that can only be alleviated through drugs.”
― Reverend Jen,
Femoral hernia is the third common hernia after inguinal and incisional hernias. The swelling in femoral hernia is below and lateral to pubic tubercle. It is more common in females. Strangulation is very common in this hernia.
An anorectal abscess is a collection of pus in the anal or rectal region.
It may be caused by infection of an anal fissure, sexually transmitted infections or blocked anal glands.
An anorectal abscess is a collection of pus that builds up in the rectum and anus.
With prompt treatment, client with this condition usually recover very well.
Complications tend occur when treatment is delayed.
Management of Fournier’s Gangrene in a Low Resource Settingasclepiuspdfs
external genitalia and perineum. Although the condition is rare in absolute terms, over 1726 cases have been reported in English literature, with a male/female ratio of 10:1. There have been 502 cases from Africa, which ranks second to the USA/Canada. At present, there is only one published literature on the management of FG in Liberia. Objective: This study highlig hts the late presentation and the challenges in the management of FG at the John F. Kennedy Medical Center. Methodology: This is a retrospective study of 30 patients with FG who were admitted and managed by our division of urology, from January 2018 to May 2019. The patient’s records were retrieved and reviewed for age, sex, onset of disease, sites of the disease, management, duration of stay, and outcome. The frequency and percentage of various parameters were displayed in tables.
SPORADIC OUTBREAK CASES OF DIPHTHERIA: A THREE YEARS’ STUDY IN A TERTIARY CAR...Earthjournal Publisher
SPORADIC OUTBREAK CASES OF DIPHTHERIA: A THREE YEARS’ STUDY IN A TERTIARY CARE CENTRE OF NORTHEAST INDIA.
Daiji Gogoi Mohan, Mayuri Gogoi,Naba Kumar Hazarika
IRO INTERNATIONAL JOURNAL OF MEDICAL AND APPLIED SCIENCES 2018, 1(1):1-5.
—In the Indian sub-continent, first isolation of the chikungunya virus was done in Kolkata during 1963. During 2006 reports of large scale outbreaks in several parts of India have confirmed the re-emergence of this virus in the country. Since the incidence of this disease is increasing. So a retrospective analysis of laboratory confirmed chikungunya patients admitted to pediatric ward was done to study biochemical profile of chikungunya fever in children. Total 51 children were laboratory confirmed for chickungunya, 36 of them had isolated chikungunya infection. Male/female ratio of isolated chikungunya was 2.6:1. Fever was invariably present, associated constitutional symptoms consisted of skin rash, vomiting, diarrhea, pain abdomen, cough, corrhyza, myalgia and bleeding manifestations. The most characteristic feature of the infections in infants was skin manifestations in form of symmetrical superficial vesiculobullous lesions & maculopapular erythematous rash. Nine patients (25%) had neurological manifestations. Joint pain was present in only three patients but none had arthritis. Most common hematological abnormality revealed thrombocytopenia in 39% cases. There was mild to moderate elevation of liver enzymes in 13 patients (36%). Average length of hospital stay was 5.1 days. Thirty four patients recovered completely & two left against medical advise. It is concluded from this study that skin manifestations and neurological manifestations are common in younger age group apart from other constitutional symptoms. Arthralgia and chronic polyarthritis is rare in this age group as found in adults.
People Living with Human Immunodeficiency Virus in Hadhramout: Clinical Prese...asclepiuspdfs
The objective of the study was to determine the clinical features and outcome of patients living with human immunodeficiency virus (HIV) in Hadhramout and nearby governorates. Materials and Methods: This descriptive study was conducted in the antiretroviral therapy (ART) site at Ibn-Sina General Hospital, Mukalla, Hadhramout governorate. All 145 patients were enrolled in HIV treatment and care program from December 2008 to the end of December 2016 with confirmed HIV test. Data included all personal data, clinical staging, drugs taken, and outcomes. Patients were grouped according to the decades to five groups, ≤15 years, 16–30 years, 31–50 years, 51–70 years, and >70 years. Cases classify according to the antiretroviral drugs to ART group and Pre-ART group. The relevant data parameters were analyzed using SPSS statistical software version 21 and Excel 10. Results: A total of 145 cases, most adults (97.9%), males and females were104 (71.7%) and 41 (28.3%), respectively. Mean age was 36.46 years and 30–50 years the most affected age group (55.2%). Clinical Stages 3 and 4 were the common presentation in 73.8%, and most cases were from Mukalla city. Of the total cases, 74.5% were on ART 53.1 of them improved, pulmonary tuberculosis was found in 4 cases, and death cases were (18.5%), mostly due to late presentation and non-adherence, and mostly occurred in early 6 months of starting the ART. 37 patients were in a pre-treatment group (21.6%), where the mortality rate is 35.1%, mainly due to loss of follow-up. Conclusions: Most cases were adult males, young age and have had late presentation, where mortality is higher in the pre-treatment group due to loss of follow-up and in early 6 months of treatment.
For DH Theory III, students must give a presentation on a specific module in the class. The purpose of these presentations is to inform students on how treat patients in a dental setting who may be compromised by a certain medical condition. I was tasked with presenting on sexually transmitted diseases, as well as on chronic kidney disease and dialysis. This is the presentation that I modified on sexually transmitted diseases.
A Case of Postmenopausal Pyometra Caused By Endometrial Tuberculosisiosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Travel-related infectious diseases on the rise
International travel has an important role in the transmission of emerging and re-emerging infectious diseases across geographical areas.
Since 1980, the world has been threatened by different waves of emerging disease epidemics.
In the twenty-first century, these diseases have become an increasing global concern because of their health and economic impacts in both developed and resource-constrained countries.
It is difficult to stop the occurrence of new pathogens in the future due to the interconnection among humans, animals, and the environment.
As many as 43%–79% of travelers to low- and middle-income countries become ill with a travel-related health problem.
Although most of these illnesses are mild, some travelers become sick enough to seek care from a health care provider.
HIV ITS PREVENTION AND CONTROL is a presentation that aim to introduce HIV(Human immunodeficiency Virus),its pathogenesis, clinical manifestation, diagnosis, treatment, prevention and control
To Assess the Effectiveness of Structure Teaching Programme on Knowledge Rega...ijtsrd
A Pre experimental study one group pre test and post test design was selected for the study, which was conducted on 60 GNM first year nursing students of Integral Institute Of Nursing Sciences and Research, Lucknow U.P. through Random sampling technique. Data was collected through using a self structured knowledge questionnaire. Researcher introduced her and explained the purpose of study to the sample. Written informed Consent was taken from each sample. Pretest was administered to the group followed by structured teaching programme which took about 45 minutes. Post test was taken after one week of administration of structured teaching programme. Mr. Aarif Mohammad | Mr. Sabeehuddin "To Assess the Effectiveness of Structure Teaching Programme on Knowledge Regarding Prevention of Urinary Tract Infection Among the G.N.M. 1st Year Student in Integral Institute of Nursing Sciences & Research, Lucknow U.P." Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-8 | Issue-1 , February 2024, URL: https://www.ijtsrd.com/papers/ijtsrd63501.pdf Paper Url: https://www.ijtsrd.com/medicine/nursing/63501/to-assess-the-effectiveness-of-structure-teaching-programme-on-knowledge-regarding-prevention-of-urinary-tract-infection-among-the-gnm-1st-year-student-in-integral-institute-of-nursing-sciences-and-research-lucknow-up/mr-aarif-mohammad
Clinical analysis of 228 patients with pulmonary fungal diseases iWilheminaRossi174
Clinical analysis of 228 patients with pulmonary fungal diseases in China
Abstract
Background: Due to the lack of specific clinical manifestations and imaging features, the diagnosis of pulmonary fungal diseases is difficult. This study aims to investigate the clinical features of pulmonary fungal diseases.
Methods: We retrospectively analyzed the demographics, types of fungus,radiological characteristics,underlying diseases, the usage of steroid and immunosuppresants, laboratory tests of 228patients with pulmonary fungal disease diagnosed by pathological examination or laboratory culture from October 2011 to July 2018in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology.
Results: A total of 228 patients, had a median age of 49years, which included 130 (57%) males and 98(43%) females. The most common fungal species identified were aspergillus (39.5 %), cryptococcus (18.4%), and mucormycosis (3.5 %).The main imaging findings were nodules or mass in 144 patients (63.2%), cavitation in 57 patients (25%),consolidation shadows or ground glass infiltrates in 15 patients (6.6%), and reverse halo sign in 12 patients (5.3%). The main infection sites were right upper lobe (26.8%), right lower lobe (21.5%) and the bronchus infection were 18 (7.9%) persons. For the underlying diseases, the prevalence of diseases was pulmonary tuberculosis (17.5%), bronchiectasis (16.2%), diabetes mellitus (9.2%) and the previous thoracic malignancy (6.6%) was common. The number of patients using steroid was 50% and the number of patients using immunosuppressant was 7%.
Conclusions: The imaging findings and the underlying diseases of patients should be taken into account when making diagnosis of pulmonary funga1disease for the purpo se to speculate the probable fungal pathogen and choose the most appropriate diagnostic tool.
Keywords:Pulmonary fungal disease; pathogen; imaging manifestation; Underlying disease; Clinical analysis; Chinese
(pneumomycosis; pulmonary mycosis?)invasive mould infection (IMI)Invasive fungal infections (IFIs),invasive aspergillosis
invasive mold disease, invasive aspergillosis, diabetes mellitus.
1. INTRODUCTION
In environment, the fungi produce small spores that are routinely inhaled and rapidly cleared from the normal host. However after long standing inhalation makes people more vulnerable to get effected .Moreover pulmonary fungal diseases are an opportunistic infection that predominantly attacks immunocompromised just as immunocompetent patients, however extensive utilization of gluccocorticoids and chemotherapeutics utilizes in patients make the pulmonary fungal disease no longer an uncommon occurrence. The complex underlying conditions such as pulmonary tuberculosis, bronchectasis, COPD and diabetes mellitus in the patients of pulmonary fungal disease and the non-specific nature of pathogen can confound identification and lead to under diagnosis. Due to its vague nature the dia ...
Fournier’s Gangrene in a 9 Yrs. Old Patient; A Rare Presentation in Paediatri...semualkaira
Necrotizing fasciitis of the perineum and external genitalia is a
life-threatening infective gangrene, primarily seen in adults but
relatively rare in children. We present a nine-year-old male child
with spinal bifida and double incontence who was admitted at our
hospital due to gangrenous right hemi-scrotal ulcer extending to
the right thigh. It was proceeded with painful swollen hemi-scrotum 2wks prior to admission. We treated him aggressively with
broad spectrum antibiotics and early surgical debridement. Being
paraplegic with double incontinence hence spending most of the
time dressed with diapers we therefore think of poor hygiene and
the diaper rash as the etiological factors. Early surgical debridement with appropriate antibiotics and aggressive supportive care
usually gave good results.
Similar to FOURNIER’S GANGRENE: REVIEW OF 57 CASES IN TERTIARY INSTITUTION (20)
KNOWLEDGE AND PRACTICES AMONG SURGEONS REGARDING CROSS INFECTION CONTROL PROC...Anil Haripriya
The study revealed good knowledge of infection control procedures but there were problems in practices of
sterilization. Most of them did not separate the needle from the syringe prior to disposal therefore needle
prick injuries were common. So more intensive and regular training programs to surgeons must be included
in the plans of quality control in all hospital and regular inspection from the ministry of health guarantees
good infection control practices
knowledge of health care professionals regarding medico-legal aspects and its...Anil Haripriya
knowledgeable about medical legal aspects and informed consent but when it came to actual objectives of consumer protection act and methods of filing cases their knowledge was satisfactory. So, medical health professionals need to update their understanding on consumer protection act and its amendments to be on a legally safer side.
EVALUATION OF ABSORBABLE AND NON-ABSORBABLE SUTURES IN A COHORT STUDYAnil Haripriya
Suturing has been used all the way through the ages to assist healing of human tissues by wound closure. Earlier, animal fibers were used as thread and the needles were fashioned from animal bone or bits of metal. Nowadays, sterilized sutures have mostly replaced these materials but the essential principles remain the same.[13]
our study and experiences we thus conclude that the stapler haemorrhoidopexy is simple and safe procedure. It is a minimally invasive procedure and it is less associated with post-operative pain bleeding and prolapse. It can be done as the day care surgery.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Hot Selling Organic intermediates
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
FOURNIER’S GANGRENE: REVIEW OF 57 CASES IN TERTIARY INSTITUTION
1. DOI: 10.18410/jebmh/2015/837
ORIGINAL ARTICLE
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 38/Sept. 21, 2015 Page 6068
FOURNIER’S GANGRENE: REVIEW OF 57 CASES IN TERTIARY
INSTITUTION
Pradeep Soni1
, Anil Haripriya2
, Santosh Uddesh3
HOW TO CITE THIS ARTICLE:
Pradeep Soni, Anil Haripriya, Santosh Uddesh. “Fournier’s Gangrene: Review of 57 Cases in Tertiary
Institution”. Journal of Evidence based Medicine and Healthcare; Volume 2, Issue 38, September 21, 2015;
Page: 6068-6072, DOI: 10.18410/jebmh/2015/837
ABSTRACT: INTRODUCTION: Fournier's gangrene is a rapidly spreading polymicrobial
necrotising fascitis affecting the perineum, perianal and genital regions but remarkably sparing
the testicle, bladder and rectum due to their separate blood supply which is directly from the
aorta. The purpose of this study is to share our experience in the management of Fournier's
gangrene. MATERIAL & METHODS: We had retrospectively analysed the medical records of 57
patients admitted with Fournier's gangrene between January 2012 to January 2015 in
Chhattisgarh institute of medical sciences. Data extracted from these includes patient's age, sex,
hospital stay, Premorbid diseases, morbidity, mortality, laboratory investigations and treatment
carried out. RESULTS: 57 patients were admitted and managed for Fournier's gangrene during
the study period. All the patients were male and mean age was 41 years (05-76). 6 patients died,
mortality was 10.52%. The shortest hospital stay was 5 days and longest was 44 days.
Polymicrobial synergistic infection was common in most of the cases (77.19%). CONCLUSION:
Fournier's gangrene is a life threatening disease and world-wide in its distribution. It is a rapidly
progressive, fulminant polymicrobial synergistic infection of the perineum and genitals, now
changing its pattern. Extensive debridement and broad spectrum intravenous antibiotics remain
mainstay of treatment.
KEYWORDS: Fournier’s gangrene, Necrotizing fasciitis, Synergistic infection.
INTRODUCTION: Fournier's gangrene is the sudden onset of fulminant gangrene of the
external genitalia and perineum. It was first reported by Baurienne in 1764,(1)
and then described
by Jean Alfred Fournier a French dermatologist and venereologist, in1883, in a series of five cases
with no apparent cause.(2)
Fournier's gangrene is a rapidly spreading necrotising gangrene affecting the perineum,
perianal and genital regions but remarkably sparing the testicle, bladder and rectum due to their
separate blood supply. It is a polymicrobial synergistic infection caused by the aerobic, anaerobic,
gram positive and negative bacteria, yeast and sometimes mycobacteria. It can progress to a
fulminant soft tissue infection rapidly spreading along the facial planes, causing necrosis of the
skin, subcutaneous tissue and fascia and subsequently septicaemia. Rising incidence is due to
increasing elderly population, prevalence of diabetes mellitus, immunosuppressive therapy and
multi drug resistant pathogens. Although, it is thought to be uncommon, but usually presents as
a surgical emergency, with high morbidity and prolonged hospital stay with a huge financial
burden on the patient and relatives. However the mortality rate is decreasing now due to newer
antibiotics and public awareness towards early treatment.
2. DOI: 10.18410/jebmh/2015/837
ORIGINAL ARTICLE
J of Evidence Based Med & Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 38/Sept. 21, 2015 Page 6069
Fournier's gangrene commonly affects men but does not spare women who constitutes
about 10% and also affects children. It occurs commonly among those in their 5th and 6th
decade. Predisposing factors include diabetes mellitus, local trauma, urine leakage, perirectal or
perineal surgery, extension of per urethral, anal infection anorectal abscess, genitourinary
infection, alcoholism, immunosuppressive and renal or hepatic diseases.(3)
Low socioeconomic
level has also been reported to be a predisposing factor.(4)
The aim of our study is to report our experience with the management of Fournier's
gangrene.
MATERIALS & METHODS: All patients who were diagnosed and managed for Fournier's
gangrene in Chhattisgarh institute of medical sciences from January 2012 to January 2015 were
included in this study. Their medical records were retrospectively studied for the age, sex,
predisposing factors, duration of hospital stay and outcome of treatment. The diagnosis was
made from history and physical examination. The data collected was analysed.
Descriptive statistics was used for data analysis. Mean summation, percentage and
frequency distribution were used where applicable.
RESULTS: A total of 57 patients were admitted and managed for Fournier's gangrene during the
study period. All the patients were male and mean age was 41 years range 5-76 year. (Table
1).All patients presented late to the hospital. The earliest presented two days after
commencement of the symptoms. Most of them had fever, pain and discharge of sero-purulent
material from the site. They also had swelling, redness, tenderness and black dermal necrosis of
the skin. Diagnosis was made on clinical ground. All were treated with broad spectrum
intravenous antibiotics initially than according to their culture sensitivity reports. They all had
crystalloid infusion, aggressive repetitive wound debridement, analgesics, antibiotics, and tetanus
prophylaxis. Five of patients had blood transfused. Serial debridement under antibiotics coverage
was done in all cases. In majority of cases (35 cases) secondary suturing was done. Skin grafting
had done in four patients. Out of 57 patients, 6 patients died (10.52%) mortality, 51(89.47%)
patients survived. The shortest hospital stay was 5 days and longest was 44 days. Predisposing
conditions were identified in only 19 patients (33.33%). 15 were diabetic, one HIV positive, 3Hbs
Ag positive. Majority of them were of low socioeconomic status.
Demographic
Variables
No. of Cases Percentage
(A) Gender
Male 57 100%
Female - -
Total 57
(B) Age group
0-20year 02 3.5%
21-30 year 10 17.54%
31-40 year 11 19.29%
3. DOI: 10.18410/jebmh/2015/837
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41-50 year 16 28.07%
51-60 year 8 14.03%
61-70 year 6 10.52%
71-80 year 4 7.01%
Total 57
Table 1: Demographic characteristic of cases
Duration No. of Cases Percentage
5-10 days 9 15.70%
11-20 days 15 26.31%
21-30 days 16 28.07%
31-40 days 12 21.05%
41-50 days 5 08.77%
Table 2: Distribution of cases according to duration of hospital stay
Result No. of Cases Percentage
Cured 51 89.47%
Death 6 10.53%
Table 3: Outcome of treatment
MICROBIOLOGY: A variety of organism had been cultured from necrotic tissue or pus during
surgery or at the time of admission. Only one organism was identified in 13 patients (22.80%),
while culture results revealed polymicrobial infection in 44 patients (77.19%) (Table-4) The most
commonly isolated organisms from wound were Escherichia coli in32 patients (56.14%),
Staphylococcus aureus 26 (45.61%), bacteroides fragilis in 18 patients (31.57%), klebsiella
in16patients (28.07%), Proteus mirabilis in 16 patients (28.07%), Enterococcus spp in 14 patients
(24.56%) and Pseudomonas in 8 (14.03%) (Table-5).
Organism No. of Cases Percentage
(A) Single 13 22.80%
(B) Polymicrobial 44 77.19%
Table 4: Distribution of cases according to Organism cultured
Micro Organism No. of Cases Percentage
E. coli 32 56.14%
Staphylococcus aureus 26 45.61%
Bacteroides fragilis 18 31.57%
Klebsiella 16 28.07%
4. DOI: 10.18410/jebmh/2015/837
ORIGINAL ARTICLE
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Proteus mirabilis 16 28.07%
Enterococcus spp. 14 24.56%
Psudomonas aeruginosa 8 14.03%
Table 5: Bacteriology according to Culture Report
DISCUSSION: Fournier’s gangrene is truly a life threatening disease and surgical emergency
too. Any genders can be affected and the mortality is high. Though, disease is commoner in older
age group, but no age is exempted.[5,6]
In our study, oldest patient was a 76 year old while the
youngest was 5 year. Majority of the cases belong to the age group 41-50 years. The age
distribution is in keeping with the report from other studies.
Various organisms both aerobes and anaerobes have been identified as agents that acts
synergistically in causing the disease. Meleny, in his article described it in relation to
streptococcus infection,[7]
while Cullen associated it with bacteria acting in synergism.[8]
Polymicrobial organisms were identified in most of the reports[9,10,11,12]
In our study single
organism was identified in 13cases (22.80%), poly microbial organisms were identified in 44cases
(77.19%). The most common organism was Escherichia coli in 32cases (56.14%) staphylococcus
aureus, Klebseilla pneumonia, Pseudomonas aeruginosa, Proteus mirabilis and streptococcus. This
is similar with results of other reports.[13,14]
We also believe that synergism of these different
micro-organism might be responsible for the fulminant infection. Co-morbid conditions like
hypertention Diabetes, Alcoholism and immunocompromised status, Chronic liver disease,
uraemia usually carry higher rate of mortality. In spite of advancement in management, mortality
rates are still high. In some series, it ranges from 14-45%.[11,12,15]
However, in this study mortality
rate was (10.52%). Rapid and accurate diagnosis is a key component for successful treatment.
Fluid, hemodynamic and nutritional support, use of appropriate broad-spectrum antibiotics, and
prompt and repeated surgical intervention are the cornerstones of treatment.
CONCLUSION: Fournier’s gangrene which is a rapidly progressive, fulminant polymicrobial
synergistic infection of the perineum and genitals is now changing its pattern. Both genders can
be affected and the mortality is still high (around10%). The clinical presentation in many patients
in early stage may not be prominent. Thus rapid and accurate diagnosis is must for prompt
treatment. Extensive surgical debridement and broad spectrum intravenous antibiotic remains the
mainstay of treatment in order to reduce the morbidity and mortality.
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5. DOI: 10.18410/jebmh/2015/837
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NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. Pradeep Soni,
Shivam Nursing Home,
Ashok Nagar,
Seepat Road,
Bilaspur-495001,
Chhattisgarh.
E-mail: dr.psoni1304@gmail.com
Date of Submission: 09/09/2015.
Date of Peer Review: 10/09/2015.
Date of Acceptance: 14/09/2015.
Date of Publishing: 19/09/2015.
AUTHORS:
1. Pradeep Soni
2. Anil Haripriya
3. Santosh Uddesh
PARTICULARS OF CONTRIBUTORS:
1. Associate Professor, Department of
General Surgery, Chhattisgarh Institute
of Medical Sciences, Bilaspur,
Chhattisgarh.
2. Assistant Professor, Department of
General Surgery, Chhattisgarh Institute
of Medical Sciences, Bilaspur,
Chhattisgarh.
3. Associate Professor, Department of
General Surgery, Chhattisgarh Institute
of Medical Sciences, Bilaspur,
Chhattisgarh.