The impact of electronic prescribing systems on clinical pharmacy practice

This review explores the impact of electronic prescribing (e-prescribing) systems on clinical pharmacy practice, highlighting the potential benefits and challenges associated with their use. Medication errors, a significant concern within healthcare settings, have been shown to decrease with the adoption of e-prescribing, offering a promising tool to enhance patient safety and reduce adverse drug events. However, the transition from traditional handwritten prescriptions to electronic methods introduces new challenges, including the emergence of new types of errors, such as incorrect drug selection, and potential increases in mortality rates, as observed in pediatric patient. Furthermore, it discusses the limited exploration of e-prescribing in primary care and community pharmacy settings, areas that require further investigation to fully understand the benefits and burdens of e-prescribing use. By examining barriers related to person, tasks, environment, tools and technologies, and organizational factors, this review emphasizes the importance of considering various aspects that influence the efficacy and safety of e-prescribing systems. The findings suggest a critical need for incorporating human factors principles in the design and evaluation of these systems to ensure they effectively support clinical pharmacy practice and enhance patient care.

Hemovigilance: knowledge, attitude and practice among postgraduates and interns of a tertiary care hospital

Background: Adverse reactions due to transfusion of blood and blood products should be reported for the betterment of patients health and to minimize such effects in the future. A Program was initiated to report and reduce incidence of adverse reactions to blood products which is hemovigilance program of India. Aim was to evaluate the knowledge, attitude and practice of haemovigilance among postgraduates and interns. Methods: This was a cross-sectional questionnaire-based study conducted among 159 participants of a tertiary care hospital for a period of 1 month. Results: Results obtained were analysed using descriptive and qualitative statistics. About 83.6% of the participants were aware about the concept of Haemovigilance. Only 23 out of the 159 had reported transfusion reactions in the past but the attitude towards this concept was satisfactory. Conclusions: Overall the participants had a less satisfactory overview of this concept and hence educational interventions can aid in serving the purpose.

Mirizzi syndrome-differential diagnosis with cholangiocarcinoma: case report

Mirizzi syndrome is a rare complication of gallstone disease and poses a diagnostic challenge for general surgeons due to its clinical presentation, which resembles other pathological entities such as cholangiocarcinoma. We present a clinical case of a 68-year-old female patient with symptoms of jaundice and right upper quadrant pain. During the patient's diagnostic workup, altered liver function tests were documented, highlighting obstructive pattern hyperbilirubinemia, elevated tumor marker CA 19.9, and suspicion of biliary tract tumor based on imaging studies. However, surgical and pathological confirmation revealed Mirizzi syndrome. This case emphasizes the importance of considering differential diagnoses in patients presenting with obstructive jaundice to provide timely and appropriate treatment.

Evaluation of minimum inhibitory concentration of methanol extract of cacao seeds on growth of Streptococcus mutans bacteria by microdilution method

Background: Indonesia is famous for its medicinal plants. Cocoa bean (Theobroma cacao L.) is a plant widely used as a traditional medicine alternative to cure diseases. Cocoa beans contain alkaloids, flavonoids, saponins and tannins which are antibacterial and have potential as antioxidants. Various dental and oral diseases that occur are caused by bacteria, one of which is Streptococcus mutans which causes dental caries. Bacteria that play an important role in the occurrence of dental caries is Streptococcus mutans. Dental caries can be prevented by chemically and mechanically maintaining oral hygiene using antiseptics that have antibacterial properties. This study aimed to test the minimum inhibitory concentration of methanol extract of cocoa seeds on the growth of Streptococcus mutans with the microdilution method. Methods: The research method is the microdilution method with concentrations of 0.753%, 1.563%, 3.125%, 6.25%, 12.5%, 25%, 50%, 100%. Streptococcus mutans bacteria were obtained from the University of Indonesia's veterinary laboratory. Results: The results showed that the minimum inhibitory concentration of methanol extract of cocoa beans on the growth of Streptococcus mutans was at a concentration of 1.563%. Conclusions: In conclusion, the methanol extract of cocoa beans has an inhibitory effect on Streptococcus mutans bacteria and there is a minimum inhibitory concentration at a concentration of 1.563%. It is recommended to continue to toothpaste medication and do preclinical trials.

The Beneficial Effects of Photobiomodulation to Reduce Intraocular Pressure in Primary Open-Angle Glaucoma

Purpose: The aim of this trail was to study the efficacy of photobiomodulation (PBM) treatment to reduce the intraocular pressure in subjects with primary open angle glaucoma disease.Methods: Twenty eyes suffering from open angle glaucoma with high IOP level were selected, examined and treated with Thera-RED light diode system. The subjects were divided into two groups (n=10); treated and placebo group respectively; this system provide two lights (red at 660n.m continue and Near IR light micro-pulsed at 850 n.m), the patients received two series of treatment (ten per month within three months between every series of sessions) over five months and follow up taking ocular pressure measurements after every diode delivery session.Results: A significant decrease in IOP has been observed from the first month of the treatment compared to the placebo group (from 22.6mmHg before treatment to 15 mmHg after the tenth session) this amelioration has been also remarked during the second session of treatment (fifth month) to attempt 14.2 mmHg. Conclusion: Thera-RED light diode system treatment shows a significant decrease of IOP and remained to be stable under 14.2 mmHg in all the follow up, which confirm that photobiomodulation help in reducing the intraocular pressure in glaucomatous patients .

Investigating the Effect of Physical Activity and Exercise on Serum Leptin Levels

Leptin is derived from the Greek word leptose, which means thinness, and was discovered in 1994 by isolating the obesity gene. This substance is a protein hormone with a helical structure similar to cytokines, which is mainly synthesized and released by the subcutaneous fat cells in a constant pulsating manner with a peak secretion near midnight. A key factor in controlling energy and metabolism, which has an impact on body weight, is leptin. Leptin, which is produced by the obesity gene, has been the subject of extensive investigation in recent times. Researchers have reported contradictory findings about the effect of physical activity in different situations on the regulation of leptin secretion from adipose tissue sources. This review article is focused on conflicting studies and the effect of different intensities of physical activity on leptin and leptin's response to intense activity and training periods. This study reviews research that has examined the effect of various types of exercise on leptin in the form of a literature review. Recent reports on the effect of physical activity and exercise on leptin concentrations are conflicting. Some researchers have determined that exercise can reduce leptin concentration, depending on the duration of physical activity and calories consumed. While some researchers have not reported any change in leptin concentration. The present review indicates that physical activity longer than 60 minutes with substantial energy expenditure (>800 kcal) of exercise is required to observe reductions in plasma leptin concentrations in non-athletes.

Knowledge and attitude of materiovigilance among doctors in a tertiary care teaching hospital: A cross-sectional survey

Background: Post marketing surveillance of medical devices has to be done to avoid injuries and it is highly required to evaluate and ascertain the risks and benefits associated with the medical devices. Aims and Objectives: The aim of the study was to assess the knowledge and attitude about materiovigilance among doctors working in a tertiary care hospital. Materials and Methods: A cross-sectional study involving faculty and postgraduate residents of a tertiary care hospital using questionnaire which had 12 questions pertaining to attitude and knowledge of materiovigilance. Results: The survey questionnaire was sent to 300 health-care professionals among them, 259 respondents completely answered the questions. There were 96 teaching faculty, 163 were postgraduates residents. The average response rate was 86.3%. There was no statistical significant difference seen between the two groups (P = 0.85). Conclusion: More workshops and training programs need to be conducted to create awareness and reporting of adverse reactions due to medical instruments.

Psychometric properties of the Child Development Assessment Questionnaire (QAD-PIPAS) for use in population studies involving Brazilian children aged 0-59 months

Abstract Objective: To analyze the psychometric properties of the Child Development Assessment Questionnaire (QAD-PIPAS). Methods: This methodological study was comprised of two axes. The first one aimed to analyze the instrument's construct validity (discriminant and concurrent validity) and internal consistency, and the second one examined test-retest reliability, involving two different samples and procedures. For construct validity and internal consistency, the sample was recruited in Embu das Artes-SP, Brasilia-DF and Recife-PE during the immunization campaign in 2017, involving caregivers of 2005 children under 60 months of age (1295 under 36 and 710 from 37 to 59 months). For the test-retest analysis the sample consisted of 30 children aged 0-59 months old that attended daycare centers in Embu das Artes-SP in 2018. Results: Multivariate analyses of construct validity showed that the QAD-PIPAS was able to identify the association between the outcome (suspected child development delays) and expected risk and protective factors based on Nurturing Care Framework (OMS/UNICEF). A significant positive correlation was achieved between the scores of the QAD-PIPAS and CREDI in six of the eight age groups analyzed, with the most significant correlations being in the age groups from 25 to 30 and 31-36 months. Acceptable internal consistencies were identified in all age groups, with better performance above 36 months of age (Cronbach's alpha between 0.61 to 0.80). We also found an adequate test-retest reliability (global Kappa 0.81). Conclusion: The QAD-PIPAS showed evidence of construct validity and reliability to be used in population studies involving children aged 0-59 months during multi-vaccination campaigns in Brazil.

Morphological assessment of vascular anastomoses performed using high frequency electric welding / Evaluación morfológica de anastomosis vasculares realizada mediante soldadura eléctrica de alta frecuencia

SUMMARY: The studies of the properties of vascular structures and tissues during electric welding, in particular direct morphological changes in the blood vessel walls in the areas of welding processes, are of interest. Perforating veins, femoral veins, abdominal aorta, vena cava and porcine perforating veins of the limbs were used in this study. We performed end-to-end electric welding of the aorta, venous end-to-side electric welding, vein end-to-artery side arterial and venous welding, venous end-to-end electric welding, as well as arterial and venous lumen sealing.The results of histological studies showed the formation of a coagulated acellular protein matrix, represented by unorganized denatured protein fibrous structures. In the area of vascular tissue coagulation, lacunes were formed as a result of water evaporation from the biological tissue. In the perifocal area of the welded junction, cell reduction occurred without necrosis or charring. The data obtained confirm the safety of high frequency electric welding of the main vessels and the prospectfor clinical use of the studied techniques.

RESUMEN: Los estudios de las propiedades de las estructuras y tejidos vasculares durante la soldadura eléctrica son relevantes, en particular los cambios morfológicos directos en las paredes de los vasos sanguíneos en las áreas de los procesos de soldadura. En este estudio se utilizaron venas perforantes, venas femorales, parte abdominal de la aorta, vena cava y venas perforantes porcinas de los miembros. Realizamos soldadura eléctrica de extremo a extremo de la parte abdominal de la aorta, soldadura eléctrica de extremo a lado venosa, soldadura arterial y venosa de extremo a arteria del lado venoso, soldadura eléctrica de extremo a extremo venoso, así como lumen arterial y venoso. Los resultados de los estudios histológicos mostraron la formación de una matriz de proteína acelular coagulada, representada por estructuras fibrosas de proteínas desnaturalizadas no organizadas. Se formaron lagunas como resultado de la evaporación del agua del tejido biológico en el área de la coagulación del tejido vascular, En el área perifocal de la unión soldada, la reducción celular ocurrió sin necrosis ni carbonización. Los datos obtenidos confirman la seguridad de la soldadura eléctrica de alta frecuencia de los vasos principales y la perspectiva de uso clínico de estas técnicas.

Diagnosis and treatment of HEp-2 cells contaminated with mycoplasma / Diagnóstico e tratamento de células HEp-2 contaminadas por micoplasma

Abstract Contamination of primary and cell cultures by mycoplasmas is one of the main economic and biological pitfalls in basic research, diagnosis and manufacture of biotechnological products. It is a common issue which may be difficult to conduct surveillance on. Mycoplasma presence may affect several physiological parameters of the cell, besides being considered an important source of inaccurate and/or non-reproducible scientific results. Each cell type presents characteristical symptoms, mainly morphological, that indicate a contamination by mycoplasma. HEp-2 cells originate from carcinoma of the larynx and are, therefore, part of the respiratory tract, which is one of mycoplasma habitats. Despite the importance these cells in several biological research (evaluation of cell proliferation and migration, apoptosis, antiviral and antitumor compounds), the alterations induced by mycoplasma contamination in HEp-2 cells have not yet been described. Here, we describe the progressive morphological alterations in culture of HEp-2 cells infected with mycoplasma, as well as the-diagnosis of the infection and its treatment. Mycoplasma contamination described within this work led to cytoplasm elongation, cell-to-cell spacing, thin plasma membrane projections, cytoplasmic vacuoles, fusion with neighboring cells, and, finally, cell death. Contamination was detected by fluorescence imaging (DAPI) and PCR reactions. The cultures were treated with BM-Cyclin antibiotic to eliminate contamination. The data presented here will be of relevance to researchers whose investigations involve cell culture, especially respiratory and HEp-2 cells.

Resumo A contaminação de culturas primárias e celulares por micoplasmas é uma das principais armadilhas econômicas e biológicas da pesquisa básica, diagnóstico e fabricação de produtos biotecnológicos. Trata-se de uma contaminação rotineira, mas de difícil acompanhamento. A presença de micoplasma pode afetar vários parâmetros fisiológicos da célula, além de ser considerada uma importante fonte de resultados científicos imprecisos e/ou não reprodutíveis. Cada tipo de célula apresenta sintomas característicos, principalmente morfológicos, que indicam uma contaminação por micoplasma. As células HEp-2 são originárias do carcinoma da laringe e, portanto, fazem parte do trato respiratório, um dos habitats do micoplasma. Apesar da importância destas células em diversas pesquisas biológicas (avaliação da proliferação e migração celular, apoptose, compostos antivirais e antitumorais), as alterações decorrentes da contaminação por micoplasma nestas células ainda não foi descrita. Aqui, descrevemos as alterações morfológicas progressivas na cultura de células HEp-2 infectadas por micoplasma, bem como o diagnóstico da infecção e seu tratamento. A contaminação por micoplasma descrita neste trabalho resultou em alongamento citoplasmático, espaçamento entre células, projeções delgadas da membrana plasmática, vacúolos citoplasmáticos, fusão de células vizinhas e, finalmente, morte celular. A contaminação foi detectada por imagens de fluorescência (DAPI) e reações de PCR. As culturas foram tratadas com antibiótico BM-Cyclin para eliminar a contaminação. Os dados aqui apresentados serão de relevância para pesquisadores cujas investigações envolvem cultura celular, principalmente células respiratórias e HEp-2.

Five-Class Classification of Cervical Pap Smear Images: A Study of CNN-Error-Correcting SVM Models / 대한의료정보학회지

Objectives@#Different complex strategies of fusing handcrafted descriptors and features from convolutional neural network (CNN) models have been studied, mainly for two-class Papanicolaou (Pap) smear image classification. This paper explores a simplified system using combined binary coding for a five-class version of this problem. @*Methods@#This system extracted features from transfer learning of AlexNet, VGG19, and ResNet50 networks before reducing this problem into multiple binary sub-problems using error-correcting coding. The learners were trained using the support vector machine (SVM) method. The outputs of these classifiers were combined and compared to the true class codes for the final prediction. @*Results@#Despite the superior performance of VGG19-SVM, with mean ± standard deviation accuracy and sensitivity of 80.68% ± 2.00% and 80.86% ± 0.45%, respectively, this model required a long training time. There were also false-negative cases using both the VGGNet-SVM and ResNet-SVM models. AlexNet-SVM was more efficient in terms of running speed and prediction consistency. Our findings also showed good diagnostic ability, with an area under the curve of approximately 0.95. Further investigation also showed good agreement between our research outcomes and that of the state-of-the-art methods, with specificity ranging from 93% to 100%. @*Conclusions@#We believe that the AlexNet-SVM model can be conveniently applied for clinical use. Further research could include the implementation of an optimization algorithm for hyperparameter tuning, as well as an appropriate selection of experimental design to improve the efficiency of Pap smear image classification.

The Allure of Abdominal Scarification (`UDE`) among the Esan Tribe in South-South Nigeria – A Prospective Analysis

Background:The practice of inflicting cuts (incisions) on the anterior abdominal wall to treat splenomegaly of various causes is a very common one in some parts of Edo State, Nigeria. Such incisions may result in several complications including sepsis (especially inchildren who are the major targets); massive blood loss leading to symptomatic anemia that may require blood transfusions or lead to death and massive keloidal growth as sequelae in some of the patients. This practice is a long-termpractice of the Esan people of the central part of Edo State Nigeria. This study aims to identify the factors that continue to make this practice attractive to members of the community, the common complications encountered, and how to develop an advocacy tool for health education and promote the health-seeking behavior of the populace.Methods:This was a prospective community based cross-sectional descriptive study that was conducted in all the 5 Esan speaking local government areas of Edo State where this practice is very common. The study was done between January 2017 and June 2018. Participants were interviewed using a structured questionnaire by previously trained researchers, after pretesting and validation. The questionnaire was administered on 700 adults, however, 500 were returned. The data obtained were summarized as frequencies and percentages.Results:The majority of the participants were middle-aged. Ninty-five percent (95%) of respondents were aware of the practice of abdominal scarification and 80% of them think itis effective. It was mainly carried out by herbalists in 95% of the respondents. Half of the respondents were unaware of any complications associated with the procedure. Conclusion:Abdominal scarification is a common practice among the Esan people of south-south Nigeria. They believe it's effective, affordable, and risk-free. This is despite the availability of effective alternatives in orthodox medicine. There is, therefore, a need for advocacy and health education considering the dangers and complications associated with the practice

Prevalence of Rubella IgG Antibodies among Pregnant Women in Rivers State, Nigeria

Aim: Rubella virus is the cause of the communicable viral infection that can affect the foetus causing foetal loss or congenital rubella syndrome. Plasma samples from 180 pregnant women attending tertiary hospitals in River State, Nigeria were examined randomly to evaluate the prevalence of rubella virus (RubV) IgG antibodies.Study Design:Cross-sectional study.Place and Duration of Study:University of Port Harcourt Teaching Hospital (UPTH) and Braithwaite Memorial Specialist Hospital (BMSH) now Rivers State University Teaching Hospital (RSUTH) between September 2015 and August 2017 Methods: The sample of this study was composed of 180 pregnant women. ELISA was used to detect the RubV IgG antibodies andprevalence was correlated with sociodemographic factors.Results: The study result revered that 155(86.1%) were positive for RubV IgG while 25(13.9%) were negative for RubV IgG. Of the 90 samples examined from BMSH, 71(78.9%) were IgG-positive. From UPTH,84(93.3%) were positive for RubV IgG. The highest (100%) seropositivity for RubV IgG was found in age groups 39-43 years. No RubV IgG was recorded in age groups 44-48 years. Women in their third trimester had the highest prevalence of RubV IgG antibodies (94.7%). Those with secondary education had the highest prevalence of RubV IgG (93.4%). Vaccinated pregnant women had the highest prevalence (87.4%). Among the variables evaluated, education (p=0.023), occupation (p=0.040), marital status (p=0.001) and vaccination history (p=0.005) were the main correlates in this study.Conclusions: This study has shown evidence of immunity among expectant mothers in this study (86.1%) with 13.9% being vulnerable to rubella virus infection. Completion of adequate rubellavaccination along intensified surveillance of the vulnerable population remains the keystone for the control of congenital rubella syndrome in Nigeria

Death from Neglected Pituitary Adenoma: A Case Report

We present a case of a patient who presented with pituitary macroadenoma complicated with hydochephalus.He presented late to the referral hospital in a comatose state and died a few hours later.He was a 33-year-old,male who gave a history of highly accelerated symptoms lasting 1 week.Neurosurgical consultation as well as investigations with CT scan or MRI were not availed the patient,which could have been life saving. Autopsy findings were of a pituitary macroadenoma and signs of hydrocephalus and raised intracranial pressure which proved fatal

Genital Tract Tuberculosis in a 42-year Female Masquerading as Ovarian Malignancy

Female genital tuberculosis is one the known causes of infertility in the tropics. The symptom complex arediverse and it is one of the known causes of pyrexia of unknown origin. Instances of mimicry of ovarian cancer with raised CA125, have been reported. We present a case report in a 42-year-old woman with abdominal pain and progressive abdominal pain of 3 weeks durations, who had confounding symptom of raised CA125, forcing a presumptive diagnosis of ovarian cancer.She had exploratory total abdominal hysterectomy (TAH). The surgical findings and histopathological diagnosis were suggestive of tuberculosis, for which she is undergoing treatment and showing remarkable improvement

The Pattern of Cancer Cases in the Rest of Cross River State Not Covered by the Calabar Cancer Registry between 2004 and 2013

Aims:This study aims to find out the prevalence of cancer in the different age groups in the restof Cross River state not covered by the Calabar cancer registry.Study Design:Descriptive retrospective study involving a trend analysis of the cancers incident in the University of Calabar Teaching Hospital, and persons from the rest of Cross River State not covered by the Calabar cancer registry. Such cases as occurred between 1st of January 2004 to December 31st, 2013 were included.Place and Duration of Study:The Department of Pathology, University of Calabar Teaching hospital; between April and May 2019.Methodology:A trend analysis of cancer cases from the rest of Cross River State outside the range of the Calabar cancer registry over the period was studied.Results:Nine hundred and forty-one (941) cases of cancer were seen outside Calabar in Cross River State, within January 2004 and December 2013. Mean age was 49.18 ± 18.9years, ranging Original ResearchArticle from 1 to 100 years, and female: male ratio was 1: 0.97. The commonest age range cancer occurred is 40 to 64 years overall, 40 to 64 years in males and 40 to 64 years in females. The commonest cancers sites were breast cancer (21.9%), prostate (21.3%), lymphohematopoietic (9.2%). The commonest cancers in males were prostate (43.1), lymphohematopoietic (12.9%), soft tissue (11.4%). In females' breast 41.1% and cervix, 15.9% were the dominant sites. Cancer in the 0 to 17 age range was remarkably similar and was dominated by lymphohematopoietic sites, soft tissue, eye and urinary system. Cancer in the older ages 65 years and above is overwhelmingly dominated by prostate 60% followed by breast 18%.Conclusion:Cancer in the rest of Cross River State is dominated by breast, prostate and cervical sites. This is like the GLOBOCAN estimates for Nigeria.

Cancer in Cross River State

Aims:To determine the prevalence of cancer in the rest of Cross River State not covered by the population-based cancer registry which is limited to the capital city of Calabar.Study Design:Descriptive retrospective study involving a trend analysis of cancers from the rest of Cross River State not covered by the Calabar cancer registry. Cancers incident in the Pathology and Haematology departments of the University of Calabar Teaching hospital are included in the study.Place and Duration of Study:Pathology and Haematology departments of the University of Calabar Teaching hospital. Data was assessed between April to May 2019.Methodology:An institution-based trend analysis of cancers originating from the rest of Cross River State, out of population-based cancer registry’s coverage was carried out. Such cases incident in the Pathology and Hematology Departments of the University of Calabar Teaching Hospital were included. Cancer data from 1stJanuary 2004 to 31stDecember 2013 was accessed from the archives of both departments. Data extraction was carried out though filling of a check list and these were fed into IBM statistical package for social sciences SPSS version 21 for analysis.

Prevalence of Benign Breast Lesions, Epithelial Proliferations with or without Atypia in Calabar-A Retrospective Review

Aims:The aim of this study is to find out the prevalence of benign breast lesions and proliferative lesions which are associated with increase risk of breast cancer.This is aimed at influencing the hospital policy on mammographic screening.Study Design:Descriptive retrospective study involving a trend analysis of benign breast lesion, proliferative analysed in the surgical pathology unit of the University of CalabarTeaching Hospital between 1st of January 2012 to October 31st 2014.Place and Duration of Study:Pathology Department of the University of Calabar Teaching Hospital.The study was carried out between March and April 2019.Methodology:Descriptive retrospective study of trend analysis of benign and proliferative breast lesions over the period with literature review Results:Two hundred and seventeen 217 patients consisting of seven males and two hundred and ten females with a female: Male ratio of 1:0.04. Mean age was 26.4 ± 10.0 years, ranging from 10 to 70 years, with 21-30 (94, 43.5%),as the predominant age and less than 21 years (70, 32.4%) as the second common age group.Seventy four percent of (74%) of the breast lesions were benign non proliferative lesions while 26% were proliferative breast lesions.Of the proliferative lesions, five or 8.9% of the proliferative or 2.33% of the lesions were atypical ductal hyperplasia’s which have a high risk of progression to cancer.Conclusion:Proliferative breast lesions and the premalignant lesions of the breast are not commonly reported in Calabar. An upscale of population screening and mammographic services may improve their yield which will help prevent some invasive breast cancers

Fournier's gangrene: outcome analysis and prognostic factors

Background: Fournier's gangrene is an infective necrotising fasciitis of the external genitalia and perineum associated with significant morbidity and mortality. The factors associated with non survival have been described but are not universally accepted. The identification of prognostic factors remains critical to improve outcomes.Objectives: To determine the hospital based mortality and factors associated with non-survival among subjects with a clinical diagnosis of Fournier's gangrene. Methods: A prospective hospital based observational study on 51patients with a clinical diagnosis of Fournier's gangrene over a 2-year period. A comparison was made between survivors and non-survivors to establish prognostic factors associated with non survival.Results: The disease related hospital mortality was 27% (14/51). The mean age of the 51, all male patients was 47 years. An older age was significantly associated with non-survival (p=0.02). The presence of renal dysfunction (p=0.001), severe sepsis (p=0.000), delay in surgical debridment (p=0.04), urogenital source of infection (p=0.01), a body surface area involvement of greater than 5% (p=0.006), abdominal wall involvement (p=0.02) on admission were significant factors associated with mortality. The presence of either HIV infection or diabetes mellitus was not a prognostic indicator of mortality. The clinical and biochemical parameters on admission associated with non survival were a high respiratory rate (p=0.03), a low hemoglobin(p=0.0001), an elevated blood urea nitrogen (p=0.005) and creatinine (p=0.01). Multivariate logistic regression analysis did not show any independent factors associated with non survival.Conclusion: Fournier's gangrene remains a fatal condition with a hospital mortality of 27%. Prognostic factors for non survival include an advanced age, a urogenital source of infection, abdominal involvement, severe sepsis and renal dysfunction

Dermatite alérgica à picada de Culicoides em muar: relato de caso / Allergic dermatitis due to bite of Culicoides in muar: case report

A dermatite alérgica à picada de ectoparasitos é uma enfermidade alergoparasitária bastante comum entre animais domésticos, sendo relatada principalmente em pequenos ruminantes e em animais de companhia. Contudo, a doença é pouco diagnosticada na clínica de equídeos devido a similaridades nosológicas com outras dermatopatias. Objetivou-se, com este relato de caso, descrever a síndrome clínica, o plano diagnóstico e a conduta terapêutica de um muar acometido por essa enfermidade. Atendeu-se, no Hospital Veterinário da Universidade Federal Rural do Pernambuco, uma mula de oito anos de idade, que apresentava lesões cutâneas pápulo-crostosas e pruriginosas com evolução clínica de dois anos. Em três situações anteriores, a doença havia sido tratada como dermatite fúngica por outros médicos veterinários. Para o diagnóstico, foram solicitados exame citopatológico e parasitológico de pele, cultivo bacteriológico e fúngico, análise histopatológica e hemograma. Os exames demonstraram uma dermatite superficial perivascular eosinofílica crônica, sendo indicada a terapia tópica com dimetilsufóxido, sulfadiazina, ureia e vitamina A. O protocolo terapêutico mostrou-se satisfatório, permitindo completa remissão do quadro clínico. Este trabalho relatou achados clínicos e patológicos da dermatite alérgica à picada de Culicoides spp. em muar, além de alertar sobre a importância de exames complementares para a realização do diagnóstico diferencial e para o direcionamento terapêutico adequado.(AU)

Allergic dermatitis to ectoparasite bites is a common parasitic disease among domestic animals, being reported mainly in small ruminants and companion animals. However, the disease is poorly diagnosed in equine clinics due to nosological similarities with other skin diseases. The aim of this case report was to describe the clinical syndrome, the diagnostic plan and the therapeutic management of a mule affected by this disease. An 8-year-old mule was observed at Universidade Federal Rural de Pernambuco, presenting papular-crusted and pruritic cutaneous lesions with clinical evolution of two years. In three previous situations, the disease had been treated as fungal dermatitis by other veterinarians. For the diagnosis, cytopathological and parasitological examination of the skin, bacteriological and fungal culture, histopathological analysis and blood count were performed. The exams showed a chronic eosinophilic perivascular superficial dermatitis. A topical therapy with dimethyl sulfoxide, sulfadiazine, urea, and vitamin A was indicated. The therapeutic protocol was satisfactory, allowing complete remission of the clinical condition. This work reported clinical and pathological findings of allergic dermatitis to the bites of Culicoides spp. in muar, in addition to alerting about the importance of complementary examinations for the accomplishment of the differential diagnosis and adequate therapeutic orientation.(AU)