ABSTRACT
L'infection du pied chez le diabetique entraine une morbidite importante avec un risque d'amputation. Elle necessite une prise en charge multidisciplinaire. Les cocci a Gram positif; notamment S. aureus; dominent la microbiologie des infections du pied diabetique. Cependant; les cocci a Gram negatif et les anaerobies sont plus frequents en cas d'ulcerations chroniques ou d'antibiotherapie prealable. Les infections du pied diabetique doivent etre cliniquement diagnostiquees devant la presence de signes generaux et locaux d'inflammation. Des prelevements microbiologiques correctement obtenus doivent etre adresses pour culture avant toute antibiotherapie. Les biopsies; les curetages d'ulcere et les aspirations seront privilegies. Les infections doivent etre classes pour juger le risque fonctionnel et le degre d'urgence de la prise en charge. L'antibiotherapie empirique sera debutee sur la base de la severite clinique et de la presomption microbiologique. Elle sera evaluee par la suite en fonction de la reponse clinique et des resultats de l'antibiogramme. Dans les formes moderees; une antibiotherapie couvrant les cocci a Gram positif peut s'averer suffisante. Dans les formes severes; la voie parenterale sera privilegiee surtout en presence d'osteite. Cependant; certains antibiotiques ayant une biodisponibilite orale elevee peuvent etre prescrits meme en cas d'osteite. L'antibiotherapie sera poursuivie jusqu'a la disparition des signes d'infection sans exiger une cicatrisation complete des ulcerations. Le recours a la chirurgie doit etre toujours discute surtout devant un abces profond; une extension aux structures osteo-articulaires; la presence d'une necrose ou d'une gangrene ou en ca de fasciite necrosante
Subject(s)
Anti-Bacterial Agents/therapeutic use , Diabetic Foot , Diabetic Foot/diagnosis , Diabetic Foot/drug therapy , Diabetic Foot/microbiologyABSTRACT
PURPOSE: Lacerations requiring formal wound closure compose a significant number of all childhood injuries presenting to the emergency department. The problem with conventional suture technique are that suture removal is quite cumbersome, especially in children. Unwanted soft tissue damage can result in the process of suture removal, which calls for sedation, stressful for both medical personnel and child. The purpose of this study is to introduce the convenient suture technique for pediatric facial lacerations. METHODS: Children under the age of four, presenting to the emergency department with facial lacerations were enrolled in the study. From March 2008 to June 2009, 63 patients (41 males and 22 females) with an average age of 1.4 years were treated with our convenient suture technique using utilized a loop suspended above a double, flat tie. Clean, tension free wounds were treated with our technique, wounds with significant skin defect and concomitant fractures were excluded. RESULTS: The Patients were followed-up in 1, 3 and 5 days postoperatively. On the third hospital visit, suture removal was done by simply cutting the loop suspended above the wound margin and gently pulling the thread with forceps. There were no significant differences in the rates of infection and dehiscence compared with conventional suture technique. CONCLUSION: The use of our technique was to be simple with similar operative time compared with conventional suture technique. Removal of suture materials were easy without unwanted injuries to the surrounding tissue which resulted in less discomfort for the patient and greater parental satisfaction, minimized the complications. It can be considered as a viable alternative in the repair of pediatric facial lacerations.
Subject(s)
Child , Humans , Male , Emergencies , Lacerations , Operative Time , Parents , Skin , Surgical Instruments , Suture Techniques , SuturesABSTRACT
BACKGROUND: Antipsychotic drugs are widely used for the treatment of psychosis, especially schizophrenia. Their long-term use can result at times in serious side-effects such as Tardive Dyskinesia (TD). Since over 80% of schizophrenia sufferers (lifetime prevalence 1%) receive long-term antipsychotic drug treatment, the extent of the problem is potentially large. Increasing age is the most consistently demonstrated risk factor for TD. AIMS: To assess effect of different clinical factors and demographic variables in India and Israel and sib pair concordance of Tardive Dyskinesia (TD) in India. SETTINGS AND DESIGN: The study was conducted simultaneously among Indian and Israeli subjects: ascertainment was family-based in India and hospital-based in Israel. METHODS AND MATERIAL: In India the instruments used were: Diagnostic Interview for Genetic Studies (DIGS), Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and Simpson Angus Scale (SAS). The last three instruments were also used in Israel. STATISTICAL ANALYSIS: Regression analysis and Pearson's correlation. RESULTS AND CONCLUSIONS: TD symptoms were present in 40.4% of 151 Israeli subjects and 28.7% of 334 Indian subjects. While age at onset and total scores on PANSS were significant predictors of TD in both the samples, lower scores on the Global Assessment of Functioning Scale (GAF), diagnostic sub-group and male gender were significant predictors among Indians. There was no concordance of TD symptoms among 33 affected sib-pairs from India.