Management of Fournier’s Gangrene; A Randomized Controlled Trial at High Volume Center Comparing the Efficacy of Honey and Eusol Dressing in Wound Healing

OBJECTIVE: To assess the effectiveness of honey dressing in Fournier’s Gangrene against conventional Edinburgh University solution of lime (EUSOL) dressing. METHODOLOGY: This was a prospective experimental study conducted in Liaquat National Medical College and Hospital Karachi for duration of 5 and half years. Total 44 patients having gangrene and no co morbid conditions were included in this study. Patients who had co-morbid conditions like deranged coagulation profile and CVA, who were not willing to participate or loss to follow up were excluded from the study. After getting baseline blood workup (i.e. CBC, S. Creatinine, S. Electrolytes, Urine D/R, C/S and Diabetic workup) done and taking consent, the patients were immediately shifted to operation theatre, the incision and drainage was performed, and the necrotic tissues were debrided. Pus cultures were sent, and patients were started on routine intravenous antibiotics (3rd generation Cephalosporin and metronidazole). A Dressing of wound was done randomly by honey in Group A and by Eusol in Group B. Patients were discharged after wound was completely healed. The data were obtained and analyzed by using SPSS version 20. Mann-Whitney U-test and chi-square test was applied to find out the significance. RESUTS: The patients in Group A got slough cleared in4.82±0.96 days, on average requiring 3.22±0.75 number of debridement’s, complete wound healing and duration of hospital stay being 9.54±0.74 days. The patients in Group B got slough cleared in 8±0.87 days, requiring 5.32±0.72 number of debridement’s, complete wound healing and duration of hospital stay 13.68±1.09 days.There was a significant difference in slough clearance, number of debridement’s required, time taken for complete wound healing and hospital stay between Group A and Group B (P-value <0.001). CONCLUSION: This study predicted that honey is very valuable in the management of Fournier’s gangrene as it ensured early clearance of slough, required lesser number of debridement’s, had early wound healing and had relatively shorter duration of stay in hospital than those treated with conventional EUSOL as dressing material

Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BackgroundDisorders affecting the nervous system are diverse and include neurodevelopmental disorders, late-life neurodegeneration, and newly emergent conditions, such as cognitive impairment following COVID-19. Previous publications from the Global Burden of Disease, Injuries, and Risk Factor Study estimated the burden of 15 neurological conditions in 2015 and 2016, but these analyses did not include neurodevelopmental disorders, as defined by the International Classification of Diseases (ICD)-11, or a subset of cases of congenital, neonatal, and infectious conditions that cause neurological damage. Here, we estimate nervous system health loss caused by 37 unique conditions and their associated risk factors globally, regionally, and nationally from 1990 to 2021.MethodsWe estimated mortality, prevalence, years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs), with corresponding 95% uncertainty intervals (UIs), by age and sex in 204 countries and territories, from 1990 to 2021. We included morbidity and deaths due to neurological conditions, for which health loss is directly due to damage to the CNS or peripheral nervous system. We also isolated neurological health loss from conditions for which nervous system morbidity is a consequence, but not the primary feature, including a subset of congenital conditions (ie, chromosomal anomalies and congenital birth defects), neonatal conditions (ie, jaundice, preterm birth, and sepsis), infectious diseases (ie, COVID-19, cystic echinococcosis, malaria, syphilis, and Zika virus disease), and diabetic neuropathy. By conducting a sequela-level analysis of the health outcomes for these conditions, only cases where nervous system damage occurred were included, and YLDs were recalculated to isolate the non-fatal burden directly attributable to nervous system health loss. A comorbidity correction was used to calculate total prevalence of all conditions that affect the nervous system combined.FindingsGlobally, the 37 conditions affecting the nervous system were collectively ranked as the leading group cause of DALYs in 2021 (443 million, 95% UI 378–521), affecting 3·40 billion (3·20–3·62) individuals (43·1%, 40·5–45·9 of the global population); global DALY counts attributed to these conditions increased by 18·2% (8·7–26·7) between 1990 and 2021. Age-standardised rates of deaths per 100 000 people attributed to these conditions decreased from 1990 to 2021 by 33·6% (27·6–38·8), and age-standardised rates of DALYs attributed to these conditions decreased by 27·0% (21·5–32·4). Age-standardised prevalence was almost stable, with a change of 1·5% (0·7–2·4). The ten conditions with the highest age-standardised DALYs in 2021 were stroke, neonatal encephalopathy, migraine, Alzheimer's disease and other dementias, diabetic neuropathy, meningitis, epilepsy, neurological complications due to preterm birth, autism spectrum disorder, and nervous system cancer.InterpretationAs the leading cause of overall disease burden in the world, with increasing global DALY counts, effective prevention, treatment, and rehabilitation strategies for disorders affecting the nervous system are needed

Confocal microwave imaging and artifact removal algorithms for the early detection of breast cancer

Microwave imaging is an emerging imaging modality for the early detection of breast cancer. Early-time artifact removal and imaging algorithm are the two most important signal processing components of any Confocal Microwave Imaging (CMI) system. The artifact removal algorithm reduces the large undesired early-time reflections from the breast skin that could potentially mask the tumour response. The imaging algorithm generates images of the breast such that the tumour is a strong scatterer and clutter due to healthy breast tissues is suppressed. In this thesis, artifact removal and imaging algorithms have been investigated. Several artifact removal algorithms for CMI along with an algorithm adapted from the Ground Penetrating Radar (GPR) have been evaluated in terms of their ability to reduce the artifact, while preserving the tumour response. The results from a comparative study have led to the development of a novel hybrid artifact removal algorithm that combines the best features of two existing artifact removal algorithms. The Hybrid Artifact Removal (HAR) algorithm has been shown to effectively reduce the early-time artifact while preserving the tumour response in 3D numerical breast phantoms. The HAR algorithm is then extended to a multistatic data acquisition approach. The proposed Multistatic Artifact Removal (MAR) algorithm has been shown to reduce the early-time artifact in selective multistatic signals, which improves the overall imaging quality compared to monostatic-only imaging. Since different CMI prototypes use different scan configurations, the HAR algorithm, along with the Neighbourhood-based Skin Subtraction (NSS) algorithm, have been applied to the most common scan configurations used in CMI prototypes. Both algorithms have been shown to successfully reduce artifacts and produce similar quality images across all scan configurations examined. The NSS algorithm demonstrated better artifact suppression than the HAR. However, the HAR algorithm demonstrated better tumour response preservation particularly in experimental breast phantoms that were scanned with the patient-specific scan configuration of the second-generation TSAR prototype. Finally, a variety of imaging algorithms have been compared across patient data obtained from a small-scale patient study at the University of Calgary. The Delay Multiply and Sum (DMAS) imaging algorithm has been shown to provide the best quality images, with correct detection and localisation of breast lesions in most cases

ARTIFACT REMOVAL ALGORITHMS FOR MICROWAVE IMAGING OF THE BREAST

One of the most promising alternative imaging modalities for breast cancer detection involved the use of microwave radar systems. A critical component of any radar-based imaging system for breast cancer detection is the early-stage artifact removal algorithm. Many existing artifact removal algorithms are based on simplifying assumptions about the degree of commonality in the artifact across all channels. However, several real-world clinical scenarios could result in greater variation in the early-stage artifact, making the artifact removal process much more difficult. In this study, a range of existing artifact removal algorithms, coupled with algorithms adapted from Ground Penetrating Radar applications, are compared across a range of appropriate performance metrics

Microwave bone imaging: A preliminary investigation on numerical bone phantoms for bone health monitoring

Microwave tomography (MWT) can be used as an alternative modality for monitoring human bone health. Studies have found a significant dielectric contrast between healthy and diseased human trabecular bones. A set of diverse bone phantoms were developed based on single-pole Debye parameters of osteoporotic and osteoarthritis human trabecular bones. The bone phantoms were designed as a two-layered circular structure, where the outer layer mimics the dielectric properties of the cortical bone and the inner layer mimics the dielectric properties of the trabecular bone. The electromagnetic (EM) inverse scattering problem was solved using a distorted Born iterative method (DBIM). A compressed sensing-based linear inversion approach referred to as iterative method with adaptive thresholding for compressed sensing (IMATCS) has been employed for solving the underdetermined set of linear equations at each DBIM iteration. To overcome the challenges posed by the ill-posedness of the EM inverse scattering problem, the L2-based regularization approach was adopted in the amalgamation of the IMATCS approach. The simulation results showed that osteoporotic and osteoarthritis bones can be differentiated based on the reconstructed dielectric properties even for low values of the signal-to-noise ratio. These results show that the adopted approach can be used to monitor bone health based on the reconstructed dielectric propertiesThe research leading to these results has received funding from the European Research Council under the European Union’s Horizon 2020 Programme (H2020)/ERC grant agreement n.637780.peer-reviewe

Microwave bone imaging: A preliminary investigation on numerical bone phantoms for bone health monitoring

Microwave tomography (MWT) can be used as an alternative modality for monitoring human bone health. Studies have found a significant dielectric contrast between healthy and diseased human trabecular bones. A set of diverse bone phantoms were developed based on single-pole Debye parameters of osteoporotic and osteoarthritis human trabecular bones. The bone phantoms were designed as a two-layered circular structure, where the outer layer mimics the dielectric properties of the cortical bone and the inner layer mimics the dielectric properties of the trabecular bone. The electromagnetic (EM) inverse scattering problem was solved using a distorted Born iterative method (DBIM). A compressed sensing-based linear inversion approach referred to as iterative method with adaptive thresholding for compressed sensing (IMATCS) has been employed for solving the underdetermined set of linear equations at each DBIM iteration. To overcome the challenges posed by the ill-posedness of the EM inverse scattering problem, the L2-based regularization approach was adopted in the amalgamation of the IMATCS approach. The simulation results showed that osteoporotic and osteoarthritis bones can be differentiated based on the reconstructed dielectric properties even for low values of the signal-to-noise ratio. These results show that the adopted approach can be used to monitor bone health based on the reconstructed dielectric propertiesThe research leading to these results has received funding from the European Research Council under the European Union’s Horizon 2020 Programme (H2020)/ERC grant agreement n.637780.peer-reviewe