Fournier Gangrene: Case Report & Litarature Review

Introduction: Necrotizing fasciitis of the perineal and vaginal region is a symptom of Fournier's gangrene, which is caused by a synergistic polymicrobic infection. The clinical presentation varies depending on the original aetiology, ranging from anorectal or vaginal pain with limited evidence of cutaneous necrosis to a rapidly spreading necrosis of the skin and soft tissue, to systemic sepsis without any obvious signs or symptoms. Case history: A 65-year-old male who was admitted in hospital with the chief complaint of Scrotal enlargement, discomfort, hyperemia, pruritus, crepitus, and fever. There may also be a foul-smelling discharge. Symptoms usually appear during a two- to seven-day period. Soft-tissue gas may be present before clinical crepitus is detected. The patient with Fournier gangrene frequently seems poorly on physical examination, with prodromal signs of fever and lethargy lasting 2-7 days. Edema of the overlaying skin is usually present, as is acute pain and tenderness in the genitalia; pruritus may also be present.Skin may show evidence of trauma, surgery, insect or human bites or injection sites, In Respiratory system, B/L Air entry present. In cardiovascular system, S1 and S2 sound heard and Patient get conscious and well oriented to time, place, and person. Then, as quickly as possible, treatment was began; he did not improve after treatment, and treatment would continue till the conclusion of my care. Conclusion: We focus on professional management and superior nursing care in this study so that we may provide the complete treatment that Fournier Gangrene requires while also effectively managing the complex case. After a full recovery, the patient's comprehensive health care team collaborates to help the patient regain his or her previous level of independence and happiness.

Emergency amputation necessitated within 24 hours by a human bite: a case report

We herein review and analyze the diagnosis, treatment, and outcome of a severe infection caused by a human bite. A 68-year-old man was bitten on the forearm by a 3-year-old child. Rapid progression of infection, severe local and systemic poisoning, and diverse clinical manifestations were observed at presentation. Based on the medical history, physical signs, imaging examinations (X-ray films, color Doppler ultrasound, and computed tomography), laboratory examinations, and multidisciplinary consultation, the patient was diagnosed with gas gangrene or gas gangrene-like changes. Twenty-four hours after the injury, an emergency amputation was performed (open amputation with wound closure after 1 week). After the operation, the patient was sent to the intensive care unit for isolation and further anti-infection and anti-shock treatments. His condition gradually improved after treatment and he was discharged without further complications. Bacteriological and pathological examinations indicated Aeromonas hydrophila infection leading to extensive necrotizing fasciitis of the limb and severe systemic poisoning. In addition, pre-existing myelodysplastic syndrome progressing to acute myeloid leukemia was identified as a possible predisposing factor. Human bites can cause serious infections requiring timely treatment, particularly in patients with predisposing comorbidities.

Human bite wounds as a portal of entry for infective endocarditis and purulent pericarditis: a very rare association

Human bites are an infrequent cause of emergency department visits and hospital admissions. There are rarely published cases of complicated infection, such as infective endocarditis. We present a rare case of a patient with acute infective endocarditis in a healthy native valve and purulent pericarditis from a human bite. A 40-year-old man with obesity suffered deep human bites by an adult woman, with two deep lesions in the anterior thorax and one superficial lesion in the upper abdomen and admitted in intensive care unit with septic shock and a persistent aortic murmur. Echocardiography described evidence of vegetation, perforation and severe regurgitation of aortic valve. Scanner described moderate pericardial effusion. Cardiac surgery was performed, with evidence of purulent pericardial effusion after pericardiotomy, and subsequently aortic valve replacement with a 25 mm bioprosthesis. The patient showed positive progress.

Amblyomma sculptum Salivary Protease Inhibitors as Potential Anti-Tick Vaccines

Amblyomma sculptum is the main tick associated with human bites in Brazil and the main vector of Rickettsia rickettsii, the causative agent of the most severe form of Brazilian spotted fever. Molecules produced in the salivary glands are directly related to feeding success and vector competence. In the present study, we identified sequences of A. sculptum salivary proteins that may be involved in hematophagy and selected three proteins that underwent functional characterization and evaluation as vaccine antigens. Among the three proteins selected, one contained a Kunitz_bovine pancreatic trypsin inhibitor domain (named AsKunitz) and the other two belonged to the 8.9 kDa and basic tail families of tick salivary proteins (named As8.9kDa and AsBasicTail). Expression of the messenger RNA (mRNA) encoding all three proteins was detected in the larvae, nymphs, and females at basal levels in unfed ticks and the expression levels increased after the start of feeding. Recombinant proteins rAs8.9kDa and rAsBasicTail inhibited the enzymatic activity of factor Xa, thrombin, and trypsin, whereas rAsKunitz inhibited only thrombin activity. All three recombinant proteins inhibited the hemolysis of both the classical and alternative pathways; this is the first description of tick members of the Kunitz and 8.9kDa families being inhibitors of the classical complement pathway. Mice immunization with recombinant proteins caused efficacies against A. sculptum females from 59.4% with rAsBasicTail immunization to more than 85% by immunization with rAsKunitz and rAs8.9kDa. The mortality of nymphs fed on immunized mice reached 70–100%. Therefore, all three proteins are potential antigens with the possibility of becoming a new tool in the control of A. sculptum.

The Diversity of Potential Malaria and Dengue Mosquito Vector from Bangsring Village Wongsorejo District Banyuwangi East Java

Bangsring village in Wongsorejo regency has been reported as malaria endemic area in Banyuwangi since 2011. Understanding the diversity and behavior of mosquito vector in this area will be very impotant in developing vector control program. The masquitoes were collected by landing collection outside and inside house by human bites, we also observed the area around cattle cage. During observation periods, a total 633 masquitos were collected consist of 44% malaria potential vector (Anopheles spp.) 19% Dengue fever (DF) potential vector (Aedes spp.) and 36% were not belong to both of them. Out of total collected Anopheles spp. mosquitoes about 65% were indentified as An. vagus, 25% were An. indevinitus, 8% were An. vagus (limosus), and only 2% as well as 0,04 % were An. supictus and An. kochi. Meanwhile we found 19% of Aedes sp. were Ae. aegypti and 81% were Ae. albopictus. This study showed that the dominan potential malaria’s vector is An. Vagus and the dominan DF vector is Ae. albopictus. Mostly colleted Anopheles sp. were exophagic and zoophilic with the highest activities between 06.00-08.00 pm. This was in contras to Aedes sp. where mosfly found endophilic and it has 2 hightime of activities Aedes sp. between 06.00- 07.00 AM and 05.00-06.00 PM. Keywords: Dengue, Malaria, diversity, Anopheles, Aedes.

CRIMES SOLVED THROUGH BITE MARKS

The study is part of the area of ​​legal or forensic dentistry, which is a branch of Dentistry, specialized in helping the Judiciary Branch through the identification of marks and injuries caused by the dental arch, which is unique to each human being. The theme chosen for the research is relevant, as I identify with the subject and expand my professional knowledge. Aiming at the article, the description through a brief literature review, historical approach and the contribution of the Odontolegist's work in Post-Mortem. The realization of this work was based on research, such as: monographs, scientific articles and some research sites, such as Google. In its development, I show some cases where we have evidence and samples of human bites, their description and identification. It is concluded that the process of analysis of the Dentist is essential in the examinations of the body of crime and also in the knowledge of bite marks, charred bodies and all other elements that involve the oral cavity. This qualified professional works in favor of legal truth.