Necrotising fasciitis due to Absidia corymbifera in wounds dressed with non sterile bandages

We present three cases of Absidia corymbifera necrotising fasciitis presenting to our centre within 1 month of each other. All patients had wound dressings with non sterile crepe bandages at peripheral centres. One patient was lost to follow-up, another improved on timely antifungal therapy, while the last patient succumbed to disseminated infection. We propose that traumatic and deep wounds be dressed with sterile roller bandages to prevent outbreaks of wound zygomycosis.     

Haematological and some biochemical changes in experimental fowl typhoid infection in broiler chickens

A study was conducted to evaluate the effect of Salmonella Gallinarum (9, 12) infection on broiler chicks infected through oral and intraperitoneal routes. One hundred and ten broiler chicks (1 week of age) were divided into three groups: group CR (30 chicks) were kept uninfected and served as control group, group OR (40 chicks) were inoculated orally with Salmonella Gallinarum (10⁹ organisms/ml) and group IP (40 chicks) were infected intraperitoneally with Salmonella Gallinarum (10⁹ organisms/ml). Three birds from each group (including those that die) were sacrificed at 3, 5, 7, 14, 21, 28, 35 and 42 days post infection (DPI). Clinical signs were noticed as early as 12 h after intraperitoneal infection and on 3 DPI after oral infection. Higher mortality of 47.50% was observed in intraperitoneally infected chicks as compared to 22.50% in orally infected birds. Decreased body weight and reduced feed intake were observed in chicks in both the infected groups; however, the effects were more marked in chicks infected intraperitoneally. Mean values of haemoglobin, packed cell volume and total erythrocyte count were significantly lower (P?<?0.05) in both orally infected as well as intraperitoneally infected chicks. Leucocytosis observed in both the infected groups was due to increase in the number of heterophils and lymphocytes. Significant decrease (P?<?0.05) in serum total protein and serum albumin was observed in intraperitoneally infected birds only. However, the values of aspartate transaminase and alanine transaminase were increased significantly (P?<?0.05) in both the orally infected and intraperitoneally infected birds.     

Evaluation of antibiotic use in Pediatric Intensive Care Unit of a developing country

Background:Pediatric Intensive Care Unit (PICU) patients are often prescribed antibiotics with a low threshold in comparison to patients elsewhere. Irrational antibiotics use can lead to rapid emergence of drug resistance, so surveillance of their use is important.Objectives:To evaluate the use of antibiotics in relation to bacteriological findings in PICU of a Tertiary Hospital.Methods:Retrospective review of medical records of all children (age 1 month–16 years) admitted in our closed multidisciplinary-cardiothoracic PICU from January to June 2013 was performed, after approval from Ethical Review Committee. For each antibiotic, indication (prophylactic, empiric, therapeutic) and duration of use were recorded. All diagnoses of infections were recorded according to diagnostic criteria of IPSCC 2005. Results are presented as frequency and percentages and median with inter quartile range using SPSS version 19.Results:All of the total 240 patients admitted in PICU during the study period received antibiotics: 43% (n = 104) prophylactically, 42% (n = 102) empirically, and 15% (n = 15) therapeutically. Median number of antibiotic use per patient in PICU was 3, with range of 1–7. 25% received 1 antibiotic, 23% received 2 antibiotics, 29% received 3 antibiotics, and rest received ≥4 antibiotics. Most commonly used antibiotics were cefazolin, meropenem, vancomycin and ceftriaxone, and most frequently used combination was meropenem and vancomycin. In majority of the cases, (70%) empiric antibiotic combinations were stopped in 72 h.Conclusion:This is the first report of antibiotics use in PICU from our country, which shows that antibiotics are prescribed universally in our PICU. Strategies to assess the need for antibiotic use are needed.     

Drug-induced systemic lupus erythematosus associated with etanercept therapy

Specific antagonists of tumour necrosis factor (TNF)-alpha have rapidly gained popularity for the treatment of rheumatoid arthritis. The monoclonal antibody against TNF-alpha, infliximab, has been associated with induction of systemic lupus erythematosus (SLE); however, there have been no published reports of drug-induced SLE associated with the soluble TNF-alpha receptor etanercept. We describe four female patients who developed signs and symptoms of SLE during treatment with etanercept; in two SLE was unambiguous. On diagnosis of SLE, etanercept was discontinued and the SLE-related symptoms promptly resolved. Etanercept should be considered in the list of agents associated with drug-induced SLE.     

El Niño and health

El Ni?o Southern Oscillation (ENSO) is a climate event that originates in the Pacific Ocean but has wide-ranging consequences for weather around the world, and is especially associated with droughts and floods. The irregular occurrence of El Ni?o and La Ni?a events has implications for public health. On a global scale, the human effect of natural disasters increases during El Ni?o. The effect of ENSO on cholera risk in Bangladesh, and malaria epidemics in parts of South Asia and South America has been well established. The strongest evidence for an association between ENSO and disease is provided by time-series analysis with data series that include more than one event. Evidence for ENSO's effect on other mosquito-borne and rodent-borne diseases is weaker than that for malaria and cholera. Health planners are used to dealing with spatial risk concepts but have little experience with temporal risk management. ENSO and seasonal climate forecasts might offer the opportunity to target scarce resources for epidemic control and disaster preparedness.     

Effects of common footwear on joint loading in osteoarthritis of the knee

Objective

Elevated joint loads during walking have been associated with the severity and progression of osteoarthritis (OA) of the knee. Footwear may have the potential to alter these loads. This study compares the effects of several common shoe types on knee loading in subjects with OA of the knee.

Methods

Thirty‐one subjects (10 men, 21 women) with radiographic and symptomatic knee OA underwent gait analyses using an optoelectronic camera system and multicomponent force plate. In each case, gait was evaluated during barefoot walking and while wearing 4 different shoe types: 1) clogs, 2) stability shoes, 3) flat walking shoes, and 4) flip‐flops. Peak knee loads were compared between the different footwear conditions.

Results

Overall, the clogs and stability shoes resulted in a significantly higher (～15% higher) peak knee adduction moment (mean ± SD 3.1 ± 0.7 and 3.0 ± 0.7 divided by body weight [BW] × height [H] multiplied by 100, respectively; P < 0.05) compared with that of flat walking shoes (mean ± SD 2.8 ± 0.7 %BW × H), flip‐flops (mean ± SD 2.7 ± 0.8 %BW × H), and barefoot walking (mean ± SD 2.7 ± 0.7 %BW × H). There were no statistically significant differences in knee loads with the flat walking shoes and flip‐flops compared with barefoot walking.

Conclusion

These data confirm that footwear may have significant effects on knee loads during walking in subjects with OA of the knee. Flexibility and heel height may be important differentiating characteristics of shoes that affect knee loads. In light of the strong relationship between knee loading and OA, the design and biomechanical effects of modern footwear should be more closely evaluated in terms of their effects on the disease.