Prognostic indicators of morbidity and mortality in non diabetic soft tissue infections

INTRODUCTION: Soft tissue skin infections (SSTI’s) were first described in the Hippocratic era. The principles of management, including early diagnosis with prompt and repeated surgical debridement, aggressive resuscitation and physiological support, broad spectrum antimicrobial drugs, and nutritional support, have been well documented. Despite this well accepted management approach, the mortality rate remains between 16 – 34% in most major published series. Due to the lack of defined criteria to determine the type of treatment that has to be given for patients at the time of admission, most patients undergo multiple surgical procedures which increases the morbidity and mortality. AIM OF THE STUDY: The primary objective of this analysis is to create a simple clinical score to aid in the prediction of morbidity defined by the number of days of hospital stay or limb loss and mortality in patients with SSTIs at the time of first assessment. The scoring system may further be used to predict limb loss at first assessment, thereby reducing multiple surgeries for the same patient. METHODS: A retrospective review of 200 consecutive patients with necrotizing soft tissue infections, treated at Rajiv Gandhi Government General Hospital during a 1-year period, was conducted. Using a model for logistic regression analysis, characteristics of each patient and his/her clinical course were tested for impact on outcome. The variables which were found to independently alter the outcome were used to establish a scoring system. This was then applied to a prospective pool of 50 patients admitted over 6 months in the same hospital. RESULTS: The scoring system decreased the number of surgeries undergone by each patient significantly. The scoring system also reduced the number of days of hospital stay per patients, though not significantly. The use of the scoring system did not alter the mortality in any way. CONCLUSION: Skin and soft tissue infections of the limbs have a high mortality and morbidity especially if necrosis is present. The morbidity is in the form of prolonged hospital stay and limb loss. Further detailed studies are required to produce repeated significant results, which is essential for the scoring system to be applied as an established protocol

Effect of Chronic Alcoholism and Smoking in Male Reproductive Function

The effect of chronic alcoholism, chronic smoking and chronic alcoholism with smoking on pituitary, testicular hormones and semen pertaining to male reproductive functions were studied in human beings. The male population who were included in the study were categorized into four groups: Group I. Control (non alcoholics and non smokers), Group II. Alcoholics, Group III. Smokers and Group IV. Alcoholics with smoking. The Questionnaire specially prepared for this study were carefully analyzed. Subjects falling under the age group of 20 to 50 years, married, who are free from chronic diseases were selected. Based on the questionnaire, the inclusion and exclusion criteria were fixed and the eligible subjects were included in the present study. All the investigations planned in the study were done before alcohol deaddiction treatment. Alcohol and smoking are two different pleasure-seeking habits. Initially people start these for fun but slowly most of the people become addicted to these habits. Controls and smokers were selected from 6000 people registered in Health registry. About 1700 de-addiction center alcoholic persons were screened and selected for alcoholics and alcoholics with smoking groups. In all the subjects, haematological parameters such as haemoglobin, total WBC count, differential WBC count, platelet count, total RBC count, MCV, MCH, MCHC, PCV were estimated. Biochemical parameters such as glucose, creatinine, total bilirubin, total protein, albumin, globulin, albumin / globulin ratio, SGPT, alkaline phosphatase, gamma GT, cholesterol, triglycerides, HDLcholesterol, LDL – cholesterol, VLDL-cholesterol and phospholipids were estimated in blood. Functions of liver and kidneys, lipid profile, glucose and haematological parameters were found statistically normal. Along with above results clinical examination was carried out by a physician showed that all the subjects were free from diseases. The inclusion criteria such as age limit, volume of alcohol consumption, duration of alcohol consumed in a week, number of years of consumption of alcohol in a row and number of cigarettes smoked in a day, libido, potency and fertility status data were tabulated and statistically analyzed. Fertility hormones FSH, LH, testosterone, progesterone, estradiol and prolactin were estimated in blood. Volume of semen, sperm count, sperm motility (sperm rapid progressive motility, slow or sluggish motility, non progressive motility and immotility), viability (alive sperm and dead sperm) and sperm morphology (normal morphology, head defective morphology, neck defective morphology and tail defective morphology) were analysed. The semen viscosity, pH, color, appearance and fructose were also analysed. The testosterone and progesterone levels in the blood were found to be significantly decreased in alcoholics and alcoholics with smoking. The levels of FSH, LH, and estrodiol in the blood were significantly increased in alcoholics and alcoholics with smoking. Prolactin level in the blood was not significantly altered in alcoholics and alcoholics with smoking. Smoking alone did not alter the levels of the above hormones in blood. The volume of semen, sperm count, motility, viability and morphology were decreased in alcoholics and alcoholics with smoki ng. In smokers, the volume of semen and the morphology of sperm were not affected, but the sperm count, motility and viability were decreased. Seminal pH, viscosity, appearance, color and fructose were found to be normal in all the groups studied. In the present study, on alcoholics, the testicular hormonal and seminal impairments were observed. Alcohol affected both testicular Leydig cells and seminiferous tubule functions. In Leydig cells, alcohol decreased the synthesis of testosterone, progesterone hormones and increased the synthesis of estradiol, which might be by way of altering the functions of steroidogenesis enzymes. Because of the suppression of testosterone, the pituitary feedback regulation was affected and by the compensatory mechanism, the pituitary LH was increased. At seminiferous tubular level, the toxicity of alcohol might acted on Sertoli cells, germ cells, accessory sex organs and decreased the process of spermatogenesis and spermiogenesis, which might have led to decreased semen volume, sperm count, motility, viability and morphology. This variation was due to decreased testosterone level in blood and the entry of alcohol directly to seminiferous tubules. Due to the loss of seminiferous tubular function, the pituitary FSH level was increased. This elevated FSH levels in alcoholics demonstrated that the alcohol was having direct toxic effects at seminiferous tubule Sertoli cells and germ cells. The increased level of estradiol revealed that the metabolic clearance (aromatization) rate of testosterone was accelerated in alcoholics. Along with low sperm count, decreased testosterone level and increased estradiol level in blood, alcohol decreased the libido, potency and led to male infertility. In the present study, chronic cigarette smoking, did not produce any alteration in the levels of testosterone, progesterone, estradiol, FSH, LH and prolactin in the blood. Smoking reduced the semen quality to a certain extent. Smoking might have acted on germ cells and accessory sex organs directly and decreased the process of spermatogenesis, spermiogenesis and led to decreased total sperm concentration, viability and motility. The semen volume and morphology of the sperm were not affected by smoking. An unaltered levels of testosterone in smokers suggested that the smoking acted only at seminiferous tubules and it was not at Leydig cells. Chronic smoking was having a definite toxic effect on male reproduction by altering the sperm count, motility, and viability. Because of this, male infertility was possible to a certain limit. Sexual functions, libido and potency were not affected much by smoking alone because testosterone, the male reproductive hormone was not affected. In this study, it is found that chronic alcoholism together with chronic smoking increased the severity of the reproductive illnesses compared to alcoholism or smoking alone. Due to the toxicity of alcohol together with smoke on the steroidogenesis pathway, the synthesis of testosterone and progesterone decreased and estradiol was found to be elevated significantly. The toxicity of alcohol together with smoking acted at the level of testicular Leydig cell steroidogenic enzymes, StAR protein, autocrine and paracrine regulations and decreased the progesterone and testosterone levels in blood. Elevated levels of FSH and LH were noted in alcoholics with smoking. These elevations were due to the decreased negative feedback regulations on pituitary. The toxicity of alcohol together with smoking acted at seminiferous tubular Sertoli cells, germ cells and accessory sex organs, decreased the semen quality severely along with decreased testosterone. Semen sperm count was significantly suppressed, the progressive motile sperms were significantly reduced, sluggish motile, non-progressive motile and immotile sperms were significantly increased in alcoholics with smoking. In the viability study, alcoholics with smoking have a significant negative effect on alive sperms. Dead sperms were found to be significantly increased. Morphology of sperms was significantly altered by alcohol with smoking. Percentage of normal sperm morphology decreased and abnormal forms like defective head, neck and tail were increased in alcoholics with smoking. In the libido and potency study, smoking did not alter the libido and potency significantly. Alcohol and alcohol with smoking decreased the libido and potency significantly. This may be due to the decreased level of testosterone in blood. In the fertility status, smoking had less effect, followed by alcohol, which was having more effect and alcohol together with smoking the effect was very severe. Decreased blood testosterone and seminal parameters, decreased libido and potency might be the reason for the decreased fertility in alcoholics and alcoholics with smoking. In smokers the decreased sperm quality alone decreased the male fertility to a certain extent. It is concluded that cigarette smoking decreased the male reproductive function in unique direction by acting at testicular germ cells, accessory sex organs and decreased the semen quality alone. Alcohol has decreased the reproductive function bidirectionally, one by acting at testicular Leydig cells, decreasing the male reproductive hormone testosterone and the other by acting at seminiferous tubular Sertoli cells, germ cells and accessory sex organs and decreasing the semen quality. Consumption of alcohol and smoking together have severely suppressed the male reproductive function by further decreasing testosterone and semen quality. Therefore, by reviewing the effects of alcohol, smoking and alcohol with smoking, it is concluded that smoking has less toxic effect by impairing only the semen quality and alcohol abuse is having more toxic effect than smoking is evidenced by decrease in blood testosterone level and semen quality. Alcohol together with smoking the toxicity on male reproductive function is increased further. All the possible toxic actions of alcohol and smoke are at testicular level than at the central pituitary level. Further to know about the molecular mechanisms involved in the present study of decreased levels of testosterone, progesterone, increased levels of LH, FSH, estradiol in blood, decreased semen quality in alcoholics and alcoholics with smoking and the decreased semen quality alone in smokers, additional molecular level study needs to be carried out. To know the status of restoration of testosterone, progesterone, estradiol, LH, FSH levels in blood and the quality of semen in alcoholics, smokers and alcoholics with smoking, a further study on the withdrawal of the habits of chronic alcoholism, chronic smoking and chronic alcoholism with smoking can be carried out. This research has proved beyond doubt that chronic alcohol consumption and chronic smoking have a detrimental effect on the male reproductive hormones and also on the quality of semen, which, in turn, will make people impotent and sterile. Hence, men are advised to refrain from these addictions if they want to procreate and also to lead a normal sexual life

Improving Healthy Living Youth Development Program Outreach in Extension: Lessons Learned from the 4-H Health Rocks! Program

This article discusses a qualitative evaluation of the Florida 4-H Health Rocks! program aimed at youth alcohol, tobacco, and other drug use prevention. A questionnaire was distributed to Extension professionals across Florida to gain insight into the strengths and barriers they faced with programming. Programmatic strengths included targeting a significant issue, using experiential activities, building life skills, and emphasizing youth-adult partnerships. Major programmatic barriers included time constraints, unsuccessful recruitment of volunteers, and an inability to fulfill implementation requirements. Specific recommendations are proposed to Extension professionals in order to improve overall Extension programming

Correlation between maternal and neonatal blood vitamin D levels and its effect on the newborn anthropometry

Background: Vitamin D deficiency during pregnancy has important implications for the new born and infant. In India, there were few data about the prevalence of hypovitaminosis D in pregnancy and in new-born and its correlation. Hence, this study aim was to determine vitamin D deficiency in pregnant women and their new-borns and to assess the correlation between maternal and new born serum levels of the vitamin D3 and also to study its effect on the newborn anthropometry.Methods: This cross-sectional, hospital based study was conducted with 54 consecutive women in labour presenting with a singleton term pregnancy at a large tertiary centre in Tamilnadu, India. Data were recorded on a special form and 25-hydroxy vitamin D3 was assessed before delivery in mothers and after delivery in their infant’s umbilical cord blood.Results: The mean vitamin D levels were 20.21 ng/mL for the participants and 20.07 ng/mL for the newborns. Vitamin D severe deficiency was noted in 3 (6%), deficiency 31 (57%), insufficiency 12 (22%) and sufficiency in 8 (15%) of 54 participants whereas severe deficiency, insufficiency and sufficiency respectively, were noted in 4 (7%), 30 (56%), 11 (20%) and 9 (17%) of the newborns. Maternal vitamin D level significantly associated with socioeconomic status, term of delivery and type of delivery respectively were p=0.000, p=0.000 and p=0.038 whereas age (p=0.081), BMI (p=0.085) and parity (p=0.038) was not significant at p <0.05 level by chi-square analysis. Similarly, the new born characteristics of birth weight (p=0.000), birth length (p=0.016), head and chest circumference (p=0.001, p=0.000) exists significant association at p<0.05 level by analysis of variance (ANOVA) method and also there was a strong positive correlation between the vitamin D levels in maternal and cord blood (r=0.898; P <0.05).Conclusions: There was a high prevalence of vitamin D deficiency in the south Indian pregnant women and their newborns. Vitamin D deficiency increased the risk of low birth weight neonate and it also had an effect on the length of the baby, head circumference and chest circumference. This public health problem needs urgent attention

Association between placental vitamin D receptor expression and cord blood vitamin D level and its effect on the birth weight of newborns

Background: Vitamin D deficiency during pregnancy affects fetal growth and development. The present study explored the association between vitamin D levels in cord blood and placental vitamin D receptor expression.Methods: A total of 54 subjects with live-born singleton deliveries were included in SRM Medical College Hospital and Research Centre, Kattankulathur, India. Cord blood and placenta was obtained at the time of delivery.      Results: The mean newborn vitamin D level was 20.07 ng/mL (13-27.50). The mean of relative vitamin D receptor (VDR) expression was 1.45Ct (range 0.10-2.6). Mean comparison of cord serum 25(OH) D3 and VDR revealed significant at p<0.05 by student’s t-test. The newborn anthropometric measurement of head circumference 31.44±3.99 cm, Chest circumference 28.88±4.30 cm, Body length 45.52±8.05 cm, Birth weight 2660.61±353.27 g had significant association with mean VDR expression at p <0.05 level by student t-test analysis. Further, Pearson correlation coefficient also revealed strong positive correlation of placental VDR and cord serum vitamin D (r=0.853, p <0.05).Conclusions: The present study indicates that there was a high prevalence of vitamin D deficiency in the south Indian newborns and the study suggested that VDR had crucial role in maternal to fetal nutrient transfer mechanism. Vitamin D status in cord blood is associated with the birth weight of newborns. Hence, Vitamin D levels during gestation may affect fetal growth and development

Anatomical Venous Variants in Children with Cerebral Sinovenous Thrombosis

Background and Purpose - Literature is sparse on the frequency and significance of anatomical venous variants (AVVs) in pediatric cerebral sinovenous thrombosis (CSVT). Methods - We retrospectively reviewed children with CSVT and controls undergoing computed tomography/magnetic resonance venography from January 2008 to 2014. Clinical features examined included raised intracranial pressure, risk factors, and treatment. Radiological features examined included CSVT location, presence and type of AVVs, hemorrhagic venous infarction, and venous collateralization. Clinical outcome was measured by the pediatric stroke outcome measure and radiological outcome by thrombus recanalization. Results - Fifty-one children with CSVT were identified. Twenty-two (43%) had AVVs at presentation. Nineteen (86%) had hypoplasia/absence of major dural sinus, 5 (23%) had persistent fetal structures, 3 (14%) had duplications/fenestrations, and 1 (5%) had disconnected superficial and deep venous systems. Controls had a slightly higher but nonsignificant prevalence 26 (51%) of AVVs. No significant clinical and radiological differences were observed between children with CSVT and AVVs compared with those with typical venous anatomy. Conclusions - AVVs are seen in many children with and without CSVT and do not seem to alter the presentation or clinical course. The influence of these variations on the brain\u27s ability to tolerate venous congestion because of thrombosis merits further study

The 4-H Health Rocks! Program in Florida: Outcomes on Youth Tobacco, Alcohol, and Other Substance Abuse Prevention

Youth tobacco, alcohol, and other substance abuse is a serious concern in the State of Florida, as well as across the nation. 4-H Health Rocks! is a positive youth development prevention program that utilizes experiential learning methods and youth-adult partnerships. The program and supporting curriculum were designed to foster personal and social skills to better equip adolescents to overcome pressures to participate in substance use. The purpose of this article is to describe the implementation of Health Rocks! in Florida and program evaluation including its impact on participants’ drug knowledge, drug beliefs and attitudes, and drug resistance skills. Program evaluation indicates that 4-H Health Rocks! resulted in statistically significant improvement in each of these categories for hundreds of youth reached in 2009-2012. The importance of program components in preventing and influencing adolescent substance abuse are discussed

A 1HNMR-Based Metabonomics Study of Postmenopausal Osteoporosis and Intervention Effects of Er-Xian Decoction in Ovariectomized Rats

A metabonomics method using 1H nuclear magnetic resonance spectroscopy (1HNMR) was applied to obtain a systematic view of the development and progression of postmenopausal osteoporosis. Using partial least squares discriminant analysis (PLS-DA), 26 and 34 characteristic resonances were found respectively in urine and plasma of ovariectomized rats (Variable importance, VIP value ≥1.0), and the significant altered metabolites identified in the plasma and urine were 10 and 9, respectively. Changes in these metabolites were related to the pathways of lipid, energy and amino acid metabolism, some of which involved the oxidative system. The described method was also used to analyze the therapeutic effects of Er-Xian Decoction (EXD), a traditional Chinese medicine widely used in the clinical treatment of osteoporosis in China. The results showed that EXD administration could provide satisfactory effects on osteoporosis through partially regulating the perturbed pathways of lipid, energy and amino acid metabolism and improving the anti-oxidative ability

The effect of cigarette smoking, alcohol consumption and fruit and vegetable consumption on IVF outcomes: A review and presentation of original data

Background - Lifestyle factors including cigarette smoking, alcohol consumption and nutritional habits impact on health, wellness, and the risk of chronic diseases. In the areas of in-vitro fertilization (IVF) and pregnancy, lifestyle factors influence oocyte production, fertilization rates, pregnancy and pregnancy loss, while chronic, low-grade oxidative stress may underlie poor outcomes for some IVF cases. Methods - Here, we review the current literature and present some original, previously unpublished data, obtained from couples attending the PIVET Medical Centre in Western Australia. Results - During the study, 80 % of females and 70 % of male partners completed a 1-week diary documenting their smoking, alcohol and fruit and vegetable intake. The subsequent clinical outcomes of their IVF treatment such as quantity of oocytes collected, fertilization rates, pregnancy and pregnancy loss were submitted to multiple regression analysis, in order to investigate the relationship between patients, treatment and the recorded lifestyle factors. Of significance, it was found that male smoking caused an increased risk of pregnancy loss (p = 0.029), while female smoking caused an adverse effect on ovarian reserve. Both alcohol consumption (β = 0.074, p < 0.001) and fruit and vegetable consumption (β = 0.034, p < 0.001) had positive effects on fertilization. Conclusion - Based on our results and the current literature, there is an important impact of lifestyle factors on IVF clinical outcomes. Currently, there are conflicting results regarding other lifestyle factors such as nutritional habits and alcohol consumption, but it is apparent that chronic oxidative stress induced by lifestyle factors and poor nutritional habits associate with a lower rate of IVF success