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https://www.readbyqxmd.com/read/29766136/can-necrotizing-soft-tissue-infection-be-reliably-diagnosed-in-the-emergency-department
#1
Sharon M Henry, Kimberly A Davis, Jonathan J Morrison, Thomas M Scalea
Necrotizing soft tissue infections (NSTIs) are associated with a high mortality and require prompt recognition and treatment, consisting of aggressive surgical debridement and critical care support. Diagnosis is a key step, which is generally made in the operating room (OR), but the decision to debride requires guidance. This is frequently made on clinical grounds, but NSTI can be occult in presentation and several other infective processes can mimic NSTI. It is unknown whether the various scoring systems described in the literature can enable clinicians to reliably diagnose NSTI in the emergency department, rather than the OR...
2018: Trauma surgery & acute care open
https://www.readbyqxmd.com/read/29672405/necrotizing-soft-tissue-infection-diagnostic-accuracy-of-physical-examination-imaging-and-lrinec-score-a-systematic-review-and-meta-analysis
#2
Shannon M Fernando, Alexandre Tran, Wei Cheng, Bram Rochwerg, Kwadwo Kyeremanteng, Andrew J E Seely, Kenji Inaba, Jeffrey J Perry
OBJECTIVE: We sought to summarize accuracy of physical examination, imaging, and Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score in diagnosis of necrotizing soft tissue infection (NSTI) in adults with a soft tissue infection clinically concerning for NSTI. SUMMARY OF BACKGROUND DATA: NSTI is a life-threatening diagnosis. Delay to diagnosis and surgical management is associated with increased mortality. METHODS: We searched 6 databases from inception through November 2017...
April 18, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29671865/diabetes-and-necrotizing-soft-tissue-infections-a-prospective-observational-cohort-study-statistical-analysis-plan
#3
A Rosén, P Arnell, M B Madsen, B G Nedrebø, A Norrby-Teglund, O Hyldegaard, V M Dos Santos, F Bergey, E Saccenti, S Skrede
BACKGROUND: Necrotizing soft tissue infections (NSTIs) are rare but carry a high morbidity and mortality. The multicenter INFECT project aims to improve the understanding of the pathogenesis, clinical characteristics, diagnosis, and prognosis of NSTIs. This article describes the study outline and statistical analyses that will be used. METHODS: Within the framework of INFECT project, patients with NSTI at 5 Scandinavian hospitals are enrolled in a prospective observational cohort study...
April 19, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/29613958/the-impact-of-age-on-the-innate-immune-response-and-outcomes-after-severe-sepsis-septic-shock-in-trauma-and-surgical-intensive-care-unit-patients
#4
Scott C Brakenridge, Philip A Efron, Julie A Stortz, Teczan Ozrazgat-Baslanti, Gabriela Ghita, Zhongkai Wang, Azra Bihorac, Alicia M Mohr, Babette A Brumback, Lyle L Moldawer, Frederick A Moore
INTRODUCTION: Advancing age is a strong risk factor for adverse outcomes across multiple disease processes. However, septic surgical and trauma patients are unique in they incur two or more inflammatory insults. The effects of advanced age on sepsis pathophysiology and outcomes remain unclear. METHODS: We performed a single center, prospective observational cohort study of Surgical ICU patients with severe sepsis/septic shock. Peripheral blood was collected for genomic, cytokine and biomarker analysis at 0...
April 2, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29485428/optimal-timing-of-initial-debridement-for-necrotizing-soft-tissue-infection-a-practice-management-guideline-from-the-eastern-association-for-the-surgery-of-trauma
#5
Rondi B Gelbard, Paula Ferrada, D Dante Yeh, Brian Williams, Michele Loor, James Yon, Caleb Mentzer, Kosar Khwaja, Mansoor Khan, Anirudh Kohli, Eileen M Bulger, Bryce R H Robinson
BACKGROUND: Necrotizing soft tissue infections (NSTI) are rare, life-threatening, soft-tissue infections characterized by rapidly spreading inflammation and necrosis of the skin, subcutaneous fat, and fascia. While it is widely accepted that delay in surgical debridement contributes to increased mortality, there are currently no practice management guidelines regarding the optimal timing of surgical management of this condition. Although debridement within 24 hours of diagnosis is generally recommended, the time ranges from 3 hours to 36 hours in the existing literature...
February 27, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29482646/correcting-for-16s-rrna-gene-copy-numbers-in-microbiome-surveys-remains-an-unsolved-problem
#6
Stilianos Louca, Michael Doebeli, Laura Wegener Parfrey
The 16S ribosomal RNA gene is the most widely used marker gene in microbial ecology. Counts of 16S sequence variants, often in PCR amplicons, are used to estimate proportions of bacterial and archaeal taxa in microbial communities. Because different organisms contain different 16S gene copy numbers (GCNs), sequence variant counts are biased towards clades with greater GCNs. Several tools have recently been developed for predicting GCNs using phylogenetic methods and based on sequenced genomes, in order to correct for these biases...
February 26, 2018: Microbiome
https://www.readbyqxmd.com/read/29417246/necrotizing-soft-tissue-infections-at-a-tertiary-referral-hospital-in-rwanda-epidemiology-and-risk-factors-for-mortality
#7
Christophe Mpirimbanyi, Jennifer Rickard, Charles Furaha, Faustin Ntirenganya
BACKGROUND: Necrotizing soft tissue infections (NSTI) are emergency surgical conditions with severe physiologic and metabolic derangement. These infections are associated with increased rates of mortality and morbidity worldwide, particularly in developing countries if not diagnosed and treated early. METHODS: This prospective, observational cohort study includes all patients aged 12 and above who presented at Department of Surgery, University Teaching Hospital of Kigali from April 2016 to January 2017 with NSTI...
February 7, 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/29281190/hyperbaric-oxygen-therapy-as-an-adjuvant-to-source-control-in-necrotizing-soft-tissue-infections
#8
António Pedro Pinto Ferreira, Sérgio Santos Vide, Tiago David Fonseca Fernandes, Pedro Miguel Barata de Silva Coelho, Óscar Ferraz Camacho
INTRODUCTION: Necrotizing soft tissue infections (NSTI) are rare but potentially lethal disorders, and adequate management is time- and resource-demanding. This study aims to assess whether variations in the treatment modalities - surgery, hyperbaric oxygen (HBO₂) therapy and negative pressure wound therapy - had an impact on the length to definitive source control in NSTI patients who underwent HBO₂. METHODS: This is a retrospective study of all NSTI patients treated with hyperbaric oxygen therapy between March 2007 and May 2015 at Unidade Local de Saúde de Matosinhos (ULSM) Hyperbaric Unit...
November 2017: Undersea & Hyperbaric Medicine: Journal of the Undersea and Hyperbaric Medical Society, Inc
https://www.readbyqxmd.com/read/29248883/necrotising-soft-tissue-infection-without-systemic-toxicity-in-a-patient-with-rheumatoid-arthritis-treated-with-tocilizumab
#9
Saki Manabe, Hidetaka Yanagi, Hideki Ozawa, Atsushi Takagi
A Japanese woman aged 76 years with rheumatoid arthritis treated with prednisolone and tocilizumab presented with a 2-day history of redness and pain in her right thigh. She was hospitalised with a primary diagnosis of cellulitis and antimicrobial therapy was initiated. She had been stable until the fourth day of admission, when the swelling of her right thigh rapidly worsened and demonstrated purpura; she was subsequently unable to walk because of the pain. A diagnosis of necrotising soft tissue infection (NSTI) was made and extensive debridement was performed...
December 15, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29211657/open-to-air-is-a-viable-option-for-initial-wound-care-in-necrotizing-soft-tissue-infection-that-allows-early-detection-of-recurrence-without-need-for-painful-dressing-changes-or-return-to-operating-room
#10
Derek Yang, April Davies, Bailey Burge, Phillip Watkins, Sharmila Dissanaike
BACKGROUND: The standard treatment of necrotizing soft tissue infection (NSTI) includes extensive surgical debridement. Care of these debridements is challenging because of the size of the wound and associated pain. A potential solution is to leave the wounds open-to-air in the period after the initial debridement, allowing for regular inspection at bedside while reducing pain associated with frequent dressing changes. We evaluated the feasibility of this approach from a pain control standpoint...
January 2018: Surgical Infections
https://www.readbyqxmd.com/read/29180205/effect-of-transfer-status-on-outcomes-for-necrotizing-soft-tissue-infections
#11
Angela M Ingraham, Hee Soo Jung, Amy E Liepert, Charles Warner-Hillard, Caprice C Greenberg, John E Scarborough
BACKGROUND: Whether patients with necrotizing soft tissue infections (NSTI) who presented to under-resourced hospitals are best served by immediate debridement or expedited transfer is unknown. We examined whether interhospital transfer status impacts outcomes of patients requiring emergency debridement for NSTI. METHODS AND MATERIALS: We conducted a retrospective review studying patients with an operative diagnosis of necrotizing fasciitis, Fournier's gangrene, or gas gangrene in the 2010-2015 American College of Surgeons National Surgical Quality Improvement Program Participant Use Data Files...
December 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/29124012/necrotizing-soft-tissue-infection-of-the-thigh-associated-with-retroperitoneal-abscess-in-a-patient-with-locally-advanced-ascending-colon-cancer-a-case-report
#12
Shotaro Harada, Takaharu Kato, Shinichiro Okada, Kensuke Nakatani, Risa Matsumoto, Kazuhiro Nishida, Hiroyasu Komuro, Ai Yokoyama, Chikara Takase, Toshiyuki Suganuma
Necrotizing soft tissue infection (NSTI) is a rare but rapidly progressing soft-tissue infection. Few reports of NSTI caused by colon cancer have been published. We present a rare case of NSTI of the thigh associated the retroperitoneal spread of ascending colon cancer. A 64-year-old man had noticed right hip pain since 3 months before admission, he felt pain in the right thigh which was reddening, and he had difficulty in walking. He was referred to Yokosuka general hospital Uwamachi. Anterolateral aspect of his right thigh was reddening and swelling...
2017: IDCases
https://www.readbyqxmd.com/read/28982834/how-biomarkers-reflect-the-prognosis-and-treatment-of-necrotising-soft-tissue-infections-and-the-effects-of-hyperbaric-oxygen-therapy-the-protocol-of-the-prospective-cohort-protreat-study-conducted-at-a-tertiary-hospital-in-copenhagen-denmark
#13
Peter Polzik, Pär I Johansson, Ole Hyldegaard
INTRODUCTION: Not enough is known regarding the prognosis and treatment of necrotising soft tissue infections (NSTIs). Mortality has been shown to be 25%-35%, with survivors coping with amputations and prolonged rehabilitation. This study will evaluate soluble urokinase-type plasminogen activator receptor (suPAR) as a possible prognostic marker of NSTI severity and mortality, as well as whether hyperbaric oxygen therapy (HBOT) can modulate markers of endothelial damage during NSTI. We hypothesise that in patients with NSTI, suPAR can provide prognostic risk assessment on hospital admission and that HBOT can reduce the endothelial damage that these patients are exposed to...
October 5, 2017: BMJ Open
https://www.readbyqxmd.com/read/28892969/fistulating-richter-s-hernia-of-groin-with-necrotizing-soft-tissue-infection-a-lethal-combination
#14
Shibojit Talukder, Ashish Gupta, Basant Narayan Singh, Lileswar Kaman, P Abhinaya Reddy
Strangulation of groin hernia can result in significant morbidity and mortality. Spontaneous external fistulation following strangulation is rare and typically occurs with Richter's hernia. Spreading Necrotizing Soft Tissue Infection (NSTI) secondary to Enterocutaneous Fistula (ECF) is an ominous sign, further worsening its prognosis. Early diagnosis and prompt surgical treatment is crucial to improve outcome. Herewith the authors are presenting a case of neglected inguinal hernia. It was complicated with ECF formation and rapidly spreading NSTI of flank...
July 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28863028/associations-of-plasma-nitrite-l-arginine-and-asymmetric-dimethylarginine-with-morbidity-and-mortality-in-patients-with-necrotizing-soft-tissue-infections
#15
Marco Bo Hansen, Lars Simon Rasmussen, Peter Garred, Katrine Pilely, Anna Mygind Wahl, Anders Perner, Martin Bruun Madsen, Elise Røge Hedegaard, Ulf Simonsen, Ole Hyldegaard
BACKGROUND: The nitric oxide system could play an important role in the pathophysiology related to necrotizing soft tissue infection (NSTI). Accordingly, we investigated the association between plasma nitrite level at admission and the presence of septic shock in patients with NSTI. We also evaluated the association between nitrite, asymmetric dimethylarginine (ADMA), L-arginine, L-arginine/ADMA-ratio and outcome. METHODS: We analyzed plasma from 141 NSTI patients taken upon hospital admission...
August 31, 2017: Shock
https://www.readbyqxmd.com/read/28814893/presentation-and-outcomes-of-necrotizing-soft-tissue-infections
#16
Kuan-Chin Jean Chen, Michelle Klingel, Shelley McLeod, Sean Mindra, Victor K Ng
BACKGROUND: Necrotizing soft tissue infections (NSTIs) are aggressive infections associated with significant morbidity, including amputation and organ failure, and high mortality. The rapid progression and significant risk of morbidity and mortality associated with NSTIs makes quick diagnosis and treatment critical. The objective of this study was to determine the presentation of patients diagnosed with NSTIs and their in-hospital outcomes. METHODS: This was a retrospective review of adult (>17 years) patients with a discharge diagnosis of necrotizing fasciitis at London Health Sciences Centre (annual census 125,000) over a 5-year period (April 2008-March 2013)...
2017: International Journal of General Medicine
https://www.readbyqxmd.com/read/28762168/the-role-of-computed-tomography-in-the-diagnosis-of-necrotizing-soft-tissue-infections
#17
Myriam Martinez, Thomas Peponis, Aglaia Hage, Daniel D Yeh, Haytham M A Kaafarani, Peter J Fagenholz, David R King, Marc A de Moya, George C Velmahos
BACKGROUND: The exact role of IV contrast-enhanced computed tomography (CT) in the diagnosis of necrotizing soft tissue infections (NSTIs) has not yet been established. We aimed to explore the role of CT in patients with clinical suspicion of NSTI and assess its sensitivity and specificity for NSTI. METHODS: The medical records of patients admitted between 2009 and 2016, who received IV contrast-enhanced CT to rule out NSTI, were reviewed. CT was considered positive in case of: (a) gas in soft tissues, (b) multiple fluid collections, (c) absence or heterogeneity of tissue enhancement by the IV contrast, and (d) significant inflammatory changes under the fascia...
January 2018: World Journal of Surgery
https://www.readbyqxmd.com/read/28673381/biomarkers-of-necrotising-soft-tissue-infections-aspects-of-the-innate-immune-response
#18
Marco Bo Hansen
Necrotising soft tissue infection (NSTI) is a life-threatening and rapidly progressing bacterial infection involving one or more layers of the soft tissue compartments causing necrosis. The amputation and mortality rates remain high despite increased focus on the patients. Timely treatment, including surgical intervention, reduces the risk of severe disability and death. However, the lack of pathognomonic signs impedes early diagnosis and treatment. Moreover, the rarity of the disease makes it difficult to conduct large prospective studies, thus prospective research is almost non-existent in this group of patients...
July 2017: Danish Medical Journal
https://www.readbyqxmd.com/read/28641951/necrotizing-fasciitis-attended-in-the-emergency-department-in-a-tertiary-hospital-evaluation-of-the-lrinec-scale
#19
J R Ballesteros-Betancourt, R García-Tarriño, J Ríos-Guillermo, J M Rodriguez-Roiz, P Camacho, A Zumbado-Dijeres, A Domingo-Trepat, M Llusá-Pérez, A Combalia-Aleu, S García-Ramiro, A Soriano-Viladomiu
AIM: To describe mortality and complications of patients seen in the emergency room, diagnosed with necrotizing soft tissue infection (NSTI) and the correlation of such complications with the Laboratory Risk Indicator for Necrotizing fasciitis scale (LRINEC). METHODS: Retrospective observational study including patients with a diagnosis of NSTI in the emergency room of a tertiary hospital over 7 years. The results are shown as median, interquartile range and absolute range for quantitative variables...
July 2017: Revista Española de Cirugía Ortopédica y Traumatología
https://www.readbyqxmd.com/read/28628390/influence-of-screw-surface-treatment-on-retention-of-implant-supported-fixed-partial-dentures
#20
Marcos Boaventura de Moura, Renata Borges Rodrigues, Leandro Moreira Pinto, Cleudmar Amaral de Araújo, Veridiana Resende Novais, Paulo Cézar Simamoto Júnior
The aim of this study was to assess the effect of a diamond-like carbon (DLC) coating on the removal torque of prefabricated implant screws after cyclic loading. Four groups with two crowns supported by two implants (n = 5) were obtained according to splinted and nonsplinted prosthesis, using titanium or DLC screws (splinted crowns with titanium screw [STi], splinted crowns with DLC screw [SC], nonsplinted crowns and titanium screw [NSTi], and nonsplinted crowns and DLC screw [NSC]). The prosthetic screws were tightened at 32 Ncm and retightened, and the specimens were submitted to 106 mechanical cycles (4 Hz/98 N)...
August 2017: Journal of Oral Implantology
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