RESUMO
To find out the frequency, causes and role of conservative treatment in early stage ingrown toe nail. Descriptive, observational, case series study. This study was conducted at the Department of Surgery, Ghulam Muhammad Mahar Medical College [GMC] ,Teaching Hospital, Sukkur from March 2011 to February 2012. Detailed history and physical examination especially local examination of the affected toe was made in OPD, to stage the disease. Only patients with early stage [Stage-I] ingrown toe nail were included in this study. Patients in advanced stages [stages-II and III], with history of diabetes, trauma, vascular diseases and all recurrent cases, which were operated upon in past excluded from this study. The patients were treated conservatively by advising for good foot hygiene and cutting the nails properly. Selected patients required wicking technique. This procedure was taught to patients so that they could do it once or twice daily at their homes. Patients were kept on antibiotics where required and simple pain killers. The patients were advised to visit the OPD regularly at defined time. 86 patients participated in this study, 54 [62.7%] were males and 32 [37.2%] were females with male: female ratio of 1.68: 1. Age ranged from 17-66 years, majority of patients were in between 21 to 40 years of age [44.1%] with mean age of 36 years. In majority of patients the right big toe was affected [n=56, 65.1%], in 22 [25.5%] left big toe and in 08 patients [09.3%] there was bilateral involvement of both big toes. Lateral nail fold was affected more [n=38, 44.1%] than medial fold [n=12, 13.9%]. In 36 [41.8%] patients both nail folds were affected. Various causative factors were identified with most important was improper nail trimming [n= 17, 19.7%] followed by tight fitting shoes [n=14, 16.2%] and idiopathic [n=02, 2.3%]. Majority of the patients [n=52, 60.4%] were only required antibiotic, pain killer and advice on foot care while 34 [39.5%] patients were advised for wicking. In our study, the success rate of conservative treatment remained 92.85% [n=65] at one year follow up. Ingrown toe nail is quite common condition. In early stage, it can be safely treated by conservative methods, if applied properly, which avoid disfigurement and train the patients to care for their own toes
RESUMO
To analyze clinical and laboratory parameters in patients with Fournier's gangrene [FG] and to assess factors that determine mortality. A retrospective review of 82 patients with FG from January 2007 to December 2011 was made. They were divided into two groups: those who survived [survivors] and those who did not [non survivors]. We analyzed clinical and laboratory data. The mortality rate remained 36.6% [30/82 patients]. Increased heart and respiratory rates, elevated serum creatinine, pre-existing kidney disease, and higher extent of affected body surface were associated with higher mortality. Severe sepsis on admission and hypotension < 90 mm Hg] were also predictive for higher mortality. The median FG severity index [FGSI] score was higher in non survivors [22 vs 12, p < 0.0001]. Besides standard clinical and laboratory parameters included in the FGSI calculation, higher extent of affected body surface area and presence of hypotension on admission were positively associated with mortality. Early clinical identification and prompt aggressive treatment are essential for reducing mortality and morbidity in patients