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Annals of Medicine and Surgery (2012) Oct 2022Breast abscess in newborns is an exceedingly rare pyogenic inflammation that usually starts as mastitis neonatorum. Although mastitis can respond to antibiotic therapy...
BACKGROUND
Breast abscess in newborns is an exceedingly rare pyogenic inflammation that usually starts as mastitis neonatorum. Although mastitis can respond to antibiotic therapy in the initial stages, once advanced into a purulent collection, decompression may be indicated either in the form of needle aspiration or even surgical drainage. We present two newborns with breast abscesses managed surgically with successful outcomes.
CASE PRESENTATION
Case 1: A 13-day-old boy presented with swelling and redness over the left breast for a day. Local examination revealed a warm, indurated swelling with redness and fluctuation. Needle aspiration confirmed pus. Intravenous (IV) antibiotics were started right away followed by pus drainage, the culture of which yielded Methicillin-Sensitive (MSSA). Regular wound care subsequently resulted in complete recovery.Case 2: A 15-day-old boy presented with swelling, redness and milky discharge from the right breast for two days. The swelling was erythematous, tender and indurated but not cystic or fluctuant. Ultrasonogram was suggestive of an abscess. Once again, IV antibiotics were administered followed by drainage. Pus yielded MSSA. Following regular wound dressings, satisfactory healing was achieved.
CONCLUSION
Neonatal mastitis and breast abscess are uncommon. Early recognition followed by appropriate antibiotic therapy and drainage of the abscess is the mainstay of treatment.
PubMed: 36268300
DOI: 10.1016/j.amsu.2022.104774 -
Skin Health and Disease Feb 2024Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition with recurrent nodules and abscesses that culminate in purulent discharge and scarring. It has...
BACKGROUND
Hidradenitis Suppurativa (HS) is a chronic inflammatory skin condition with recurrent nodules and abscesses that culminate in purulent discharge and scarring. It has significant physical, psychological and financial impact.
OBJECTIVES
This study plans to analyse patient costs associated with HS. Direct costs include prescription items. Indirect or out-of-pocket costs include dressings, analgesia, and healthcare-related travel costs. This study will also assess disease impact on quality-of-life (QOL).
METHODS
Patients with HS diagnosis attending dermatology OPD at our public tertiary centre were invited to participate. Ethical approval was secured, and informed consent was obtained. Participants completed an anonymous survey which was analysed to identify costs associated with HS as well as demographics and QOL impact.
RESULTS
A total of 25 patients completed the survey; median age was 29% and 80% were female. Median time from HS onset to diagnosis was 2 years, with 24% waiting >10 years to be diagnosed. In the past 3 months, 20% spent >€200 in both categories; prescription and non-prescription items. In the non-prescription category, 36% of patients reported expenditure >€100 in the past 3 months. Dressings were the most common out-of-pocket expense (in 15/25 patients), followed by analgesia and protective clothing. Attendance at medical appointments cost 24% of patients €50-€200. Four participants reported difficulty accessing HS treatments due to associated costs. Mean number of absence days from work/education as result of HS was 8.7 in the past 3 months. Two patients reported being on disability allowance, and two on unemployment benefit as result of their skin disorder. In the QOL question; 96% reported disease impact on QOL, and 11 participants reported that it affected their life 'very much'.
CONCLUSIONS
HS is a chronic inflammatory skin condition with significant financial burden alongside the well-analysed biopsychosocial disease impact. Financial burden can be divided into direct prescription costs and indirect costs such as non-prescription items, protective clothing and travel costs which we have explored in this study. Further research is needed in this area to identify and optimise both the financial and QOL implications of HS in acute flares and chronic disease management.
PubMed: 38312251
DOI: 10.1002/ski2.306 -
Indian Journal of Otolaryngology and... Nov 2019Odontogenic etiology accounts for 10-12% of cases of maxillary sinusitis. Although uncommon, direct spread of dental infections into the maxillary sinus is possible due...
Odontogenic etiology accounts for 10-12% of cases of maxillary sinusitis. Although uncommon, direct spread of dental infections into the maxillary sinus is possible due to the close relationship of the maxillary posterior teeth to the maxillary sinus. An odontogenic infection is a polymicrobial aerobic-anaerobic infection, with anaerobes out numbering the aerobes. Diagnosis requires a thorough dental and clinical evaluation, including radiographs. Management of sinus disease of odontogenic origin often requires medical treatment with appropriate antibiotics, surgical drainage when indicated, and treatment to remove the offending dental etiology. A 35-year-old, non-smoking woman visited our clinic, with a history of 6 months of facial pain, purulent nose discharge, and a foul taste in her mouth. The patient was otherwise healthy. Nasal endoscopy showed purulent discharge coming from the left middle meatus with a congested nasal mucosa and with a past history of dental treatments. CT PNS showed fractured free floating and an impacted foreign body through the premolar tooth and a right maxillary polyp with evidence of similar dental procedure done bilaterally. Functional endoscopic sinus surgery with extraction of the affected tooth and closure of oroantral fistula was done. The association between an odontogenic condition and maxillary sinusitis requires a thorough dental examination of patients with sinusitis. Concomitant management of the dental origin and the associated sinusitis will ensure complete resolution of the infection and may prevent recurrences and complications. A combination of a medical and surgical approach is generally required for the treatment of odontogenic sinusitis. An endoscopic shaver-assisted approach to is a reliable, minimally invasive method associated with less morbidity and lower incidence of complications.
PubMed: 31763250
DOI: 10.1007/s12070-017-1167-5 -
Journal of Family Medicine and Primary... Aug 2022Overuse of antibiotics is considered a major public health problem on a global level and leads to existence and spread of antibiotic-resistant bacterial strains in all...
BACKGROUND
Overuse of antibiotics is considered a major public health problem on a global level and leads to existence and spread of antibiotic-resistant bacterial strains in all settings.
OBJECTIVES
To explore the knowledge, attitude, and practice of primary healthcare physicians regarding antibiotic use.
METHODS
A cross-sectional study was conducted at a random sample of primary healthcare centers (PHCCs), belonging to Ministry of Health, in the city of Jeddah, Saudi Arabia. All primary healthcare physicians working at chosen PHCCs were recruited. A self-administered questionnaire was used for data collection. It includes five sections; socio-demographic characteristics of physicians, 11 statements to assess knowledge about antibiotic use, 6 statements to assess attitude toward antibiotic use, 6 statements concerning practice of antibiotic prescription, and 12 statements about factors influencing antibiotic prescription.
RESULTS
The study included 163 primary care physicians. The age of 58.9% ranged between 31 and 40 years. Approximately two-thirds of them were females (64.4%), and majority were Saudi nationals (98.8%). History of attending training . The median (Interquartile range) of knowledge score percentage was 63.64 (45.45-81.82). It was abnormally distributed (p-value of Shapiro-Wilk test was 0.001). Physicians who reported previous attendance of courses in antibiotic use and resistance were more knowledgeable regarding antibiotics use and resistance compared to those who did not attend such courses (Mean ranks were 91.04 and 73.70, respectively (p = 0.018)). Most of the physicians agreed that taking antibiotics as prescribed minimize its side effects (81.6%), and taking antibiotics without rationale indication increase its side effects (81%). Male physicians were more likely than females to agree that use of antibiotics in case of viral infection prevents secondary bacterial infection (27.6% versus 10.5%), < 0.001. Majority of the participants would increase antibiotic prescription in cases of purulent discharge (83.5%) and to prevent complications (71.1%).
CONCLUSION
Knowledge and practice of primary healthcare physicians in Jeddah city regarding antibiotics use and resistance needs improvement. However their attitude toward them was acceptable. Improvement of their knowledge and continuous monitoring of their practice in this regard are warranted.
PubMed: 36352954
DOI: 10.4103/jfmpc.jfmpc_60_22 -
Diagnostics (Basel, Switzerland) Nov 2023A patient in her early 20s presented with constant and progressive lower abdominal and back pain, mainly on the right side of the abdomen, purulent vaginal discharge and...
A patient in her early 20s presented with constant and progressive lower abdominal and back pain, mainly on the right side of the abdomen, purulent vaginal discharge and pyrexia. A radiological assessment revealed a possible tubo-ovarian abscess and the incidental diagnosis of ipsilateral renal agenesis. The patient was treated for pelvic inflammatory disease (PID); however, after antibiotic administration and since the symptoms did not resolve, an abdominal MRI was requested, which revealed uterus didelphys with two cervices, an obstructed haemivagina and evidence of haematocolpos. The diagnosis of Obstructed Hemi-Vagina with Ipsilateral Renal Agenesis (OHVIRA) syndrome was confirmed, and the patient underwent the excision of the vaginal septum, the drainage of the haematopyocolpos and the laparoscopic drainage of the tubo-ovarian abscess. She achieved a good recovery.
PubMed: 37958273
DOI: 10.3390/diagnostics13213377 -
The Israel Medical Association Journal... May 2020Buried bumper syndrome (BBS) mostly occurs as a late complication after percutaneous endoscopic gastrostomy (PEG) insertion; however, early BBS has been rarely reported,... (Review)
Review
BACKGROUND
Buried bumper syndrome (BBS) mostly occurs as a late complication after percutaneous endoscopic gastrostomy (PEG) insertion; however, early BBS has been rarely reported, and the treatment of this condition is still unclear.
OBJECTIVES
To evaluate the Seldinger technique for treatment of early BBS after PEG insertion.
METHODS
We report two cases of early BBS in two consecutive patients who underwent PEG insertion to maintain oral intake. The first patient was an 83-year-old woman showing Alzheimer type dementia, while the other one was a 76-year-old man who presented with maxillary cancer and treated with radiotherapy followed by left maxillectomy. Post-surgery, he developed progressive difficulty of swallowing due to mouth deformation and treatment related nerve toxicity. The first patient presented with fever and purulent discharge from the gastrostomy insertion site, without ability to rotate or slide the tube through the stoma 10 days after the PEG insertion. The man was admitted to the hospital 5 days following PEG insertion due to a fever of 38°C and peritubal swelling with purulent discharge. In addition, the tube could not rotate or slide through the stoma.
RESULTS
Buried bumper syndrome was demonstrated by computed tomography scan. Gastroscopy and gastrostomy tube replacement was performed successfully according to the Seldinger technique (replacement over guidewire) in both cases. Correct intragastric tube positioning was demonstrated radiographically before resuming tube feeding. The two patients were discharged in good physical condition several days later.
CONCLUSIONS
External replacement over guide wire should be considered in such cases.
Topics: Aged; Aged, 80 and over; Device Removal; Enteral Nutrition; Female; Gastrostomy; Humans; Male; Point-of-Care Systems; Postoperative Complications; Retreatment; Time Factors
PubMed: 32378825
DOI: No ID Found -
Cureus Nov 2021Pyoderma gangrenosum (PG) is a rare, reactive, non-infectious inflammatory dermatosis. It typically presents with extensive cutaneous ulcerations. A 20-year-old lady...
Pyoderma gangrenosum (PG) is a rare, reactive, non-infectious inflammatory dermatosis. It typically presents with extensive cutaneous ulcerations. A 20-year-old lady presented with a painful, progressive, non-healing ulcer with purulent discharge on the right upper thigh. Debridement of the ulcer was done, and pus was sent for culture and sensitivity. Despite regular wound care, the ulcer was progressing in size with persistent pain. The ulcer exhibited the phenomenon of pathergy. The pus was sterile on examination, and the histopathology showed extensive neutrophilic infiltration. A history of similar non-healing ulcers in a family member pointed toward the diagnosis of this rare condition. Treatment of pyoderma gangrenosum started in conjunction with the dermatology department. After appropriate wound care with systemic steroids and immunomodulators, the ulcer healed by secondary intention. PG is a diagnosis of exclusion. A high level of suspicion of an uncommonly presenting ulcer would lead to early diagnosis and appropriate treatment. Early diagnosis and treatment with corticosteroids and immunosuppressants can heal the lesion early by minimizing pathergy.
PubMed: 34900493
DOI: 10.7759/cureus.19324 -
Open Veterinary Journal 2022Trypanosomiasis is a zoonotic parasitic disease endemic in Iraq but with limited information about its occurrence in cats.
BACKGROUND
Trypanosomiasis is a zoonotic parasitic disease endemic in Iraq but with limited information about its occurrence in cats.
AIM
This study was designed to detect spp. in cats using microscopic examination by Giemsa stain and conventional polymerase chain reaction (PCR) technique in Mosul, Iraq.
METHODS
A total of 120 blood samples from cats were microscopically examined using Giemsa stain. Only 35 positive blood samples were examined by the conventional PCR technique. Hematological changes were also reported.
RESULTS
The infection rate of spp was 34.2% (41 out of 120). Results of conventional PCR technique for the positive 35 blood samples indicated 31.4% as spp. and 20% . This study showed that the infection in younger cats was significantly more than in older cats, with significant differences between females and males. Affected cats suffered from fever, dullness, pale mucous membranes, emaciation, muco-purulent ocular discharge, anorexia, incoordination, and anemia. Results of the blood picture indicated increase in total leukocyte count and decrease in hemoglobin concentration, packed cell volume, and total red blood cells.
CONCLUSION
spp. and infection in Mosul of Iraq is reported for the first time in cats, and younger cats were more affected than older cats.
Topics: Male; Female; Cats; Animals; Iraq; Azure Stains; Trypanosomiasis; Trypanosoma; Anemia; Cat Diseases
PubMed: 36589397
DOI: 10.5455/OVJ.2022.v12.i5.13 -
The Pan African Medical Journal 2019Mycetoma is a chronic inflammatory process during which exogenous fungal or actinomycosic agents produce grains. The infection involves the skin, the subcutaneous...
Mycetoma is a chronic inflammatory process during which exogenous fungal or actinomycosic agents produce grains. The infection involves the skin, the subcutaneous tissues, the muscles and the bones. We report the case of a 39-year old woman, a teacher, living in Brazzaville, who had regularly resided in the village. She presented with a painless suppurative mass in the left thigh that had been treated with bandages over the past 4 years. The patient didn't have fever. Her general condition was good. Physical examination showed poly-lobed, firm tumor mass in the posterior surface of the left thigh, measuring 11cm in diameter on the major axis, with ulcerations discharging purulent serosity. There was no satellite adenopathy. The remainder of the physical examination was normal. Bacteriological analysis showed sterile serosity. Skin biopsy revealed alteration of the connective tissue and the presence of small foci of grains, typical of Actinomadura pelletieri. CRP level was 48mg/L; blood count, blood glucose, blood lipids and LDH were normal. Standard radiography of the affected thigh was normal. The diagnosis of actinomycosic mycetoma was retained. Patient's outcome, after a 12-month treatment with cotrimoxazole, was marked by the epidermization of the ulcers and the persistence of the tumor mass, justifying secondary surgical resection.
PubMed: 32153703
DOI: 10.11604/pamj.2019.34.163.20300 -
American Journal of Ophthalmology Case... Sep 2022This report describes a case of conjunctival chronic lymphocytic leukemia (CLL) in a 73 year-old female with a prior history of CLL thought to be in remission who...
PURPOSE
This report describes a case of conjunctival chronic lymphocytic leukemia (CLL) in a 73 year-old female with a prior history of CLL thought to be in remission who presented with bilateral chronic conjunctivitis.
OBSERVATION
Examination revealed bilateral conjunctival injection, mildly purulent discharge, and the presence of large follicle-like lesions involving the bilateral superior and inferior palpebral conjunctiva. Conjunctival cultures grew Corynebacterium species. The patient was treated with topical antibiotics and steroids which improved the conjunctival injection and discharge, but the follicle-like lesions persisted. A conjunctival biopsy was performed and was consistent with the diagnosis of chronic lymphocytic leukemia. Fundoscopic exam did not demonstrate posterior uveal or retinal involvement. She was referred to her oncologist for further evaluation and management. Marked clinical improvement was noted after starting treatment with ibrutinib.
CONCLUSIONS AND IMPORTANCE
This case demonstrates a rare ocular manifestation of the most common form of leukemia. It happened to present with common, nonspecific symptoms of eye redness, discharge, and follicular reaction consistent with a bilateral chronic conjunctivitis. Clinical appearance and symptoms improved with topical steroids and eventually resolved with systemic bruton kinase inhibitor therapy.
PubMed: 35959475
DOI: 10.1016/j.ajoc.2022.101670