Fatal craniocervical necrotizing fasciitis in an immunocompetent patient: A case report and literature review

Background. Craniocervical necrotizing fasciitis (CCNF) is a rapidly progressive, severe bacterial infection of the superficial fascial planes of the head and neck. Group A beta–hemolytic Streptococcus, staphylococcus aureus, and obligate anaerobic bacteria are common pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CCNF. Recently the lay press has referred to necrotizing fasciitis in several articles about “flesh eating” bacteria, which have resulted in several deaths. Methods. We report the first case of a fatality in an otherwise immunocompetent patient. The patient was a 66-year-old black man with no identifiable source of infection and no history or evidence of immunocompromising disorders. Results. Despite aggressive surgical debridement and broad-spectrum antibiotic coverage, he died 30 hours after admission from multisystem organ failure secondary to overwhelming sepsis. Conclusion. Treatment consists of early recognition of CCNF combined with aggressive surgical debridement and drainage of the involved necrotic fascia and tissue along with broad-spectrum intravenous antibiotic coverage. Although 11 other fatal cases of CCNF have been previously reported, all had an underlying medical problem which created an immunocompromised state, usually diabetes mellitus or chronic alcoholism. We present a case report and literature review along with a discussion of the related anatomy. © 1995 Jons Wiley & Sons, Inc.     

WSJM, a simple chemically defined medium for growth of Neisseria gonorrhoeae

The growth requirements of 135 clinical isolates of Neisseria gonorrhoeae and six American Type Culture Collection reference strains were examined by using a simple chemically defined medium known as Wong-Shockley-Johnston medium, WSJM. The simple liquid medium supported growth of gonococci from an inoculum of 2 X 10(6) colony-forming units ml-1 and yielded 10(10) colony-forming units ml-1 in 10 h in the absence of CO2. Scale-up experiments with the complete medium yielded 5 to 10 g, wet weight, of cells per liter. The complete medium was stable upon storage at 5 degrees C and after lyophilization.     

Statistical considerations for crosssectional data relating to tracheal reconstruction over time

Complementary statistical analyses are performed on data concerning tracheal reconstruction in rats. The principal response criterion is vessel area as defined by the area of a graft onto the trachea covered by blood vessels. Postoperatively, this vessel area changes in a nonlinear fashion over time. Starting at 0% immediately postoperation, the vessel area increases to a peak and then sharply decreases to a certain level at which it remains. A total of 64 independently observed cross-sectional pairs (postop day, vessel area) are distributed among four treated groups. Analysis consists of two-way analysis of variance and piecewise linear regression under the usual assumptions of normality and variance homogeneity. Other analyses that relax these assumptions are also considered; treatment differences are established by nonparametric tests, and a quasi-likelihood analysis of the piecewise linear regression model is applied under the assumption of a binomial-like variance function. The resulting fit of the normal-theory-based piecewise linear model is compared to that of a nonlinear model whose shape is that of a gamma function integrand.     

Fetal Electrocardiogram Extraction and Analysis Using Adaptive Noise Cancellation and Wavelet Transformation Techniques

Birth defect-related demise is mainly due to congenital heart defects. In the earlier stage of pregnancy, fetus problem can be identified by finding information about the fetus to avoid stillbirths. The gold standard used to monitor the health status of the fetus is by Cardiotachography(CTG), cannot be used for long durations and continuous monitoring. There is a need for continuous and long duration monitoring of fetal ECG signals to study the progressive health status of the fetus using portable devices. The non-invasive method of electrocardiogram recording is one of the best method used to diagnose fetal cardiac problem rather than the invasive methods.The monitoring of the fECG requires development of a miniaturized hardware and a efficient signal processing algorithms to extract the fECG embedded in the mother ECG. The paper discusses a prototype hardware developed to monitor and record the raw mother ECG signal containing the fECG and a signal processing algorithm to extract the fetal Electro Cardiogram signal. We have proposed two methods of signal processing, first is based on the Least Mean Square (LMS) Adaptive Noise Cancellation technique and the other method is based on the Wavelet Transformation technique. A prototype hardware was designed and developed to acquire the raw ECG signal containing the mother and fetal ECG and the signal processing techniques were used to eliminate the noises and extract the fetal ECG and the fetal Heart Rate Variability was studied. Both the methods were evaluated with the signal acquired from a fetal ECG simulator, from the Physionet database and that acquired from the subject. Both the methods are evaluated by finding heart rate and its variability, amplitude spectrum and mean value of extracted fetal ECG. Also the accuracy, sensitivity and positive predictive value are also determined for fetal QRS detection technique. In this paper adaptive filtering technique uses Sign-sign LMS algorithm and wavelet techniques with Daubechies wavelet, employed along with de noising techniques for the extraction of fetal Electrocardiogram.Both the methods are having good sensitivity and accuracy. In adaptive method the sensitivity is 96.83, accuracy 89.87, wavelet sensitivity is 95.97 and accuracy is 88.5. Additionally, time domain parameters from the plot of heart rate variability of mother and fetus are analyzed.     

Deviations from Hardy-Weinberg Frequencies Caused by Assortative Mating in Hybrid Populations

The conventional formulas for genotype frequencies in a hybrid population H produced by interbreeding from ancestral populations P₁ and P₂ involve only one hybrid parameter M, equal to the fraction of alleles derived from P₂. For the one-parameter model to be accurate, all individuals of H must have probabilities for alleles determined by one and the same M. When H contains subpopulations that have different values of M, the correct genotype frequencies can be predicted by use of two parameters: (i) M_H, the average of M for all individuals of H and (ii) eta_H, defined like the eta devised by C. A. B. Smith for testing the Hardy-Weinberg Law and computed with a formula like G. R. Price's eta, which involves assortative mating covariance—in this case for the M values of the parents of H. If parents of H have equal average M values for males and females, and mate at random, eta_H vanishes. For perfect assortative mating, eta_H is the variance of M for H. As for Smith's eta, eta_H provides a test of fit of prediction to observed that is sensitive to signs of deviations. Using eta_H with T. E. Reed's data for Gm in Oakland, California Negroes, his one-parameter fit (“good” by his chi-square test) is significantly rejected (P = 0.04). A simultaneous good fit of Reed's Gm data and his Duffy data results (chi-square, 1 df = 0.88, P > 0.30) from the use of previously published values of 0.23 and 0.047 for M_H and eta_H. It is concluded that Reed's conclusion that these values were in error is itself in error, as is also his view that differences between M values from different genes and deviations from frequencies expected within genes are not likely to give significant information about variance of M.     

Acute severe asthma

Acute exacerbations of asthma are very common reasons for a presentation to emergency departments. This paper focuses on defining the high‐risk group, consideration of the concept of phenotypes of acute asthma, the assessment of severe and life‐threatening exacerbations and an emphasis on the management of the more severe end of the exacerbation severity. A number of evidence‐based guidelines exist throughout the world and are all slightly different. This reflects the poor evidence base for some of those recommendations. Thus, a large variation of treatment drugs, doses and regimen are used and clearly not standardised. This paper aims to present a summary of the best evidence and discuss some of these controversies. The most important aspect of treating an exacerbation of acute asthma is to review regularly and assess response to treatment. Severe and life‐threatening episodes should be treated with early use of intravenous treatment in a stepwise manner following the local guidelines. Non‐invasive ventilation and high flow nasal cannulae delivery of oxygen in the emergency department are evolving modalities, but evidence for their use is currently limited.