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Hunt TJ, Powlan FJ, Renfro KN, Polmear M, Macias RA, Dunn JC, Wells ME. Common Finger Injuries: Treatment Guidelines for Emergency and Primary Care Providers. Mil Med 2024; 189:988-994. [PMID: 36734106 DOI: 10.1093/milmed/usad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/10/2022] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Finger and hand injuries are among the most common musculoskeletal conditions presenting to emergency departments and primary care providers. Many rural and community hospitals may not have immediate access to an orthopedic surgeon on-site. Furthermore, military treatment facilities, both within the continental United States and in austere deployment environments, face similar challenges. Therefore, knowing how to treat basic finger and hand injuries is paramount for patient care. MATERIALS AND METHODS The Armed Forces Health Surveillance Branch operates the Defense Medical Surveillance System, a database that serves as the central repository of medical surveillance data for the armed forces. The Defense Medical Surveillance System was queried for ICD-10 codes associated with finger injuries from 2015 to 2019 among active duty service members across the major branches of the military. RESULTS The most commonly reported finger injuries were open wounds to fingers without damage to nails, metacarpal fractures, phalanx fractures, and finger subluxation/dislocation. Emergency departments were the most commonly reported treatment facility type accounting for 35% of initial finger injuries, followed by 32.2% at orthopedic surgery clinics, 22.2% at family medicine clinics, and 10.8% at urgent care centers. CONCLUSIONS Finger injuries are common in the military setting and presenting directly to an orthopedic surgeon does not appear the norm. Fingertip injuries, fractures within the hand, and finger dislocations can often be managed without the need for a subspecialist. By following simple guidelines with attention to "red flags," primary care providers can manage most of these injuries with short-term follow-up with orthopedics.
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Affiliation(s)
- Tyler J Hunt
- Jack Hughston Memorial Hospital, Phenix City, AL 36867, USA
| | - Franklin J Powlan
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Texas Tech University Health Sciences Center of El Paso, El Paso, TX 79905, USA
| | - Kayleigh N Renfro
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Texas Tech University Health Sciences Center of El Paso, El Paso, TX 79905, USA
| | - Michael Polmear
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Texas Tech University Health Sciences Center of El Paso, El Paso, TX 79905, USA
| | - Reuben A Macias
- Blanchfield Army Community Hospital, Fort Campbell, KY 42223, USA
| | - John C Dunn
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Matthew E Wells
- William Beaumont Army Medical Center, Fort Bliss, TX 79918, USA
- Texas Tech University Health Sciences Center of El Paso, El Paso, TX 79905, USA
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Hattori Y, Kawaguchi Y, Joyo Y, Okamoto H, Murakami H, Waguri-Nagaya Y. Reverse Posterior Interosseous Artery Flap for Human Bite Injury to the Hand. Case Rep Orthop 2024; 2024:5392926. [PMID: 38410683 PMCID: PMC10896647 DOI: 10.1155/2024/5392926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/27/2024] [Accepted: 02/05/2024] [Indexed: 02/28/2024] Open
Abstract
Bite injuries frequently occur on human hands. Human bite injuries to the hand may lead to an infection because of limited soft tissue protection and wound contamination. However, no studies have reported severe bite injuries on hands treated by flaps. We report a case of an 80-year-old woman diagnosed with a major neurocognitive disorder. The patient accidentally had a self-bite injury accompanied with an open metacarpal fracture. Debridement and fixation of the first metacarpal fracture were performed. Afterward, skin necrosis occurred gradually on the dorsum of the hand. Therefore, a reverse posterior interosseous artery (PIA) flap was used, and the postoperative course was uneventful. Given the high risk of infection, human bite injuries, particularly hand bites, should be treated immediately. Delayed treatment for such injuries may lead to extensive soft tissue defects requiring reconstruction with flaps.
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Affiliation(s)
- Yusuke Hattori
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
- Department of Orthopedic Surgery, Nagoya City University East Medical Center, 1 Wakamizu, Chikusa-ku, Nagoya, Aichi 464-8457, Japan
| | - Yohei Kawaguchi
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Yuji Joyo
- Department of Orthopedic Surgery, Nagoya City University East Medical Center, 1 Wakamizu, Chikusa-ku, Nagoya, Aichi 464-8457, Japan
| | - Hideki Okamoto
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Hideki Murakami
- Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan
| | - Yuko Waguri-Nagaya
- Department of Orthopedic Surgery, Nagoya City University East Medical Center, 1 Wakamizu, Chikusa-ku, Nagoya, Aichi 464-8457, Japan
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Rhodes IJ, Mwangi MW, Romeo DJ, Rhodes WR, Rohde C. Management of Human Bites in a Rural Kenyan Setting: A Plastic Surgeon's 8-Year Experience. Ann Plast Surg 2024; 92:86-91. [PMID: 37962161 DOI: 10.1097/sap.0000000000003730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
INTRODUCTION The treatment of human bites is a common issue facing healthcare practitioners in the developing countries of Sub-Saharan Africa where it has been noted as a growing public health concern. Generally, the desired outcomes from surgical management are healing, function, and aesthetics. We share our 8-year experience at Kapsowar Hospital in Kenya with the presentation, management, and outcome of human bites. We are uniquely situated to do so given the prevalence of human biting in our community and the full-time presence of a plastic surgeon at our institution. To the best of our knowledge, this study is the first to present human bite surgical management by a plastic surgeon certified by the American Board of Surgery working full-time on the African continent. METHODS A retrospective chart review was conducted on all patients who presented to the operating theater at Kapsowar Hospital with a human bite between 2013-2021. After identification of eligible patients, charts were reviewed assessing parameters including age, gender, timing from injury to presentation at hospital, localization of bite, severity of facial wounds using Lackmann's classification, surgical procedure(s), postoperative complications, surgical revisions, antibiotics administered, and circumstance of incident. Data were analyzed using SPSS 29.0.0.0. RESULTS Forty-four patients were identified. Seventeen (38.6%) were female and 27 (61.4%) were male. Thirty-one patients had facial bites and 13 patients had bites to other parts of the body. Of facial bites, 70.3% resulted in amputation of the affected part while 29.7% were lacerations. Using Lackmann's classification for facial bite severity, IIIA bites (complete avulsion) were most common for both males (9) and females (7). Females comprised 68.4% of total lip bite victims. Bites to the extremity were associated with late presentation and infection. We report a salvage rate of 85.7% for infected digits. CONCLUSIONS Compared with most other studies on human bites, our patient population presents with a higher rate of avulsive lip injuries, most commonly among women. Our postoperative infection rate is lower than many others reported in the literature. Satisfactory cosmetic outcome with low risk of infection can be achieved by following well-established principles of wound healing and tension-free closure.
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Affiliation(s)
- Isaiah J Rhodes
- From the Columbia University Vagelos College of Physicians and Surgeons, New York City, NY
| | - Mark W Mwangi
- Plastic and Reconstructive Surgery Department, Kapsowar Hospital, Kapsowar, Kenya
| | - Dominic J Romeo
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - W R Rhodes
- Plastic and Reconstructive Surgery Department, Kapsowar Hospital, Kapsowar, Kenya
| | - Christine Rohde
- From the Columbia University Vagelos College of Physicians and Surgeons, New York City, NY
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4
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Atthakomol P, Thachooprakorn N, Phinyo P, Manosroi W. Open fractures of the hand: a new classification based on risk score to predict infection requiring re-debridement. J Hand Surg Eur Vol 2023; 48:1214-1220. [PMID: 37440189 DOI: 10.1177/17531934231187553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
We developed a classification for open hand fractures based on risk score to predict the risk of infection requiring re-debridement. A total of 846 retrospectively included patients underwent multivariable analysis with backward elimination to derive the predictive risk score from independent predictors. The incidence of infection requiring re-debridement was 4%. Independent predictors include diabetes mellitus or immunocompromised condition, injuries from a bite, fractures with comminution/bone loss, neurovascular injuries and inadequate soft tissue coverage. The area under the receiver operating characteristic curve of the prediction score was 0.79. The new classification system for open hand fractures divides patients into three groups: low-risk open fractures (Type I, score <1); moderate-risk open fractures (Type II, score 1 to 2.5); and high-risk open fractures (Type III, score >2.5), based on the risk of infection requiring re-debridement. Re-debridement and delayed primary closure are suggested for type III open fractures.Level of evidence: III.
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Affiliation(s)
- Pichitchai Atthakomol
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nitipong Thachooprakorn
- Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Phichayut Phinyo
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worapaka Manosroi
- Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Rocha JLFDN, Leão CCA, Canedo LR, Macedo LFRD, Rosa SC, Macedo JLSD. Epidemiological Profile of Victim Patients of Facial Canine and Human Bites in a Public Hospital. J Craniofac Surg 2023:00001665-990000000-01181. [PMID: 37948634 DOI: 10.1097/scs.0000000000009818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/26/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Bites are among the most common types of trauma to which humans are exposed. The possibility of disfiguring lesions and the transmission of infectious diseases with high morbidity make this trauma a public health problem. METHOD This was a retrospective, descriptive study that analyzed the medical records of patients treated at the Emergency Unit of the Plastic Surgery Service of the Asa Norte Regional Hospital from March 2019 to March 2020. The variables analyzed included age, sex, origin, time interval from aggression to hospital care, aggressor agent, wound site, lesion characteristics, and treatment. RESULTS A total of 103 patients with a mean age of 25 years were evaluated. Most patients were male (57.3%), and 73.8% were from the Federal District. The most common type of treatment was direct suturing in 77.7% of cases, followed by local flaps (15.5%) or grafts (4.9%). There were no deaths or infections reported. CONCLUSION The predominant profile of a facial bite victim is a young male adult living in the Federal District, bitten by a canine and treated with direct sutures. Adequate treatment for animal bites should include prevention of infection, such as rabies and tetanus, as well as primary wound closure for achieving a better prognosis and satisfactory esthetics for the patient.
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Affiliation(s)
| | | | - Lucas Ribeiro Canedo
- Asa Norte Regional Hospital, Plastic Surgery Service
- Graduate Program in Health Sciences, Foundation for Teaching and Research in Health Sciences
| | | | - Simone Corrêa Rosa
- Asa Norte Regional Hospital, Plastic Surgery Service
- Medical School of the Catholic University of Brasília, Brasília, DF, Brazil
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Singh K, Aggarwal K. Human Bites Over Nose: Management and Reconstruction. Arch Plast Surg 2023; 50:171-176. [PMID: 36999144 PMCID: PMC10049811 DOI: 10.1055/s-0042-1760406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 10/27/2022] [Indexed: 03/30/2023] Open
Abstract
Background
Human bite wounds in emergency department need evaluation in regard of reconstruction. These are due to occlusive bite injuries over face. Most commonly, human bites over face involve ear and nose, and may lead to avulsion injury. Defects over nose can be reconstructed immediately after debridement or delayed till the wound heals and scar becomes supple. Thorough wash and lavage with broad- spectrum antibiotic cover has utmost importance in preventing cartilage infection.
Methods
We report 20 cases of human bite injuries over nose who presented to us in emergency department between 2018 and 2020. At the time of presentation the wound was assessed for closure. If not possible, patient was planned for delayed reconstruction after 3 months. In case delayed reconstruction was planned, the skin and nasal mucosa were approximated at first presentation. The patients underwent paramedian forehead flap after recreation of defect with conchal cartilage graft. Second stage of flap detachment and insetting was done after 3 weeks. After three weeks of second stage, third stage of flap thinning was done. Patients were followed for 3-6 months and subjective satisfaction was noted.
Results
Nineteen patients underwent delayed staged reconstruction with paramedian forehead flap and one underwent primary wound closure. The flap survival was 100%. The patient satisfaction was excellent in most cases.
Conclusion
We recommend delayed reconstruction for human bite nasal injuries. For reconstruction, paramedian forehead flap with conchal cartilage graft, if required, provides excellent reconstructive option with good contour and color match and minimal donor site scar.
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Affiliation(s)
- Kuldeep Singh
- Department of Burns and Plastic Surgery, Pt. Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India
| | - Krittika Aggarwal
- Department of Burns and Plastic Surgery, Lok Nayak Hospital, Delhi, India
- Address for correspondence Krittika Aggarwal, MS, Mch Department of Burns and Plastic Surgery, Lok Nayak HospitalDelhiIndia
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Muacevic A, Adler JR. Packing a Punch: Fight Bite Induced Septic Joint. Cureus 2022; 14:e30765. [PMID: 36447727 PMCID: PMC9701090 DOI: 10.7759/cureus.30765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 01/25/2023] Open
Abstract
'Fight bites' constitute a considerable number of accidental human bite injuries. Where the mechanism involves a closed fist contacting another person's teeth, the subsequent injury tends to involve the metacarpophalangeal joint region. These injuries are unique for their seemingly benign appearance on initial presentation. Their presence can easily be missed if the treating physician does not seek investigative history and a high index of suspicion. If improperly managed, fight bites may be associated with the introduction of bacteria that may invade deeper tissues, causing potential debilitation from progressive infection. Our case discusses a 33-year-old female who presented three weeks after an altercation where a fight bite occurred but was not treated with antibiotics on discharge. Her clinical presentation matched a flexor sheath infection, which was revealed after investigation to be a consequence of a septic metacarpophalangeal joint that had also progressed to involve the underlying bones. The case outlines the dangers of improper assessment and management of fight bite injuries and reviews best practices surrounding the recognition, assessment, and treatment of these patients in the Emergency Department.
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Alshahrani MS, Alfaraj D, AlHumaid J, Alshahrani K, Alsubaie A, Almulhim N, Althawadi D, Alam S, Alzahrani M, Alwosibai H, Alshahrani A, Makhdom R, Alkhadra F, Al-faraj S, Al-Qahtani S, AlSulaibikh A, Jumaan MA, Asonto LP, Alahmadi S, Alghamdi M, Al-Mulhim M. Prevalence, Causes, and Adverse Clinical Impact of Delayed Presentation of Non-COVID-19-Related Emergencies during the COVID-19 Pandemic: Findings from a Multicenter Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9818. [PMID: 36011457 PMCID: PMC9408350 DOI: 10.3390/ijerph19169818] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 06/15/2023]
Abstract
Objective: The coronavirus disease (COVID-19) pandemic has disrupted healthcare systems worldwide, resulting in decreased and delayed hospital visits of patients with non-COVID-19-related acute emergencies. We evaluated the impact of the COVID-19 pandemic on the presentation and outcomes of patients with non-COVID-19-related medical and surgical emergencies. Method: All non-COVID-19-related patients hospitalized through emergency departments in three tertiary care hospitals in Saudi Arabia and Bahrain in June and July 2020 were enrolled and categorized into delayed and non-delayed groups (presentation ≥/=24 or <24 h after onset of symptom). Primary outcome was the prevalence and cause of delayed presentation; secondary outcomes included comparative 28-day clinical outcomes (i.e., 28-day mortality, intensive care unit (ICU) admission, invasive mechanical ventilation, and acute surgical interventions). Mean, median, and IQR were used to calculate the primary outcomes and inferential statistics including chi-square/Fisher exact test, t-test where appropriate were used for comparisons. Stepwise multivariate regression analysis was performed to identify the factors associated with delay in seeking medical attention. Results: In total, 24,129 patients visited emergency departments during the study period, compared to 48,734 patients in the year 2019. Of the 256 hospitalized patients with non-COVID-19-related diagnoses, 134 (52%) had delayed presentation. Fear of COVID-19 and curfew-related restrictions represented 46 (34%) and 25 (19%) of the reasons for delay. The 28-day mortality rates were significantly higher among delayed patients vs. non-delayed patients (n = 14, 10.4% vs. n = 3, 2.5%, OR: 4.628 (CI: 1.296−16.520), p = 0.038). Conclusion: More than half of hospitalized patients with non-COVID-19-related diagnoses had delayed presentation to the ED where mortality was found to be significantly higher in this group. Fear of COVID-19 and curfew restrictions were the main reasons for delaying hospital visit.
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Affiliation(s)
- Mohammed S. Alshahrani
- Emergency Medicine and Intensive Care Departments, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Dunya Alfaraj
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Jehan AlHumaid
- Preventive Dental Sciences Department, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Khalid Alshahrani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Aisha Alsubaie
- Department of Emergency, King Hamad University Hospital, Road 2835, Busaiteen P.O. Box 24343, Bahrain
| | - Nasser Almulhim
- Emergency Department, King Fahad Hospital (KFU), Hofuf 36277, Saudi Arabia
| | - Dana Althawadi
- Department of Emergency, King Hamad University Hospital, Road 2835, Busaiteen P.O. Box 24343, Bahrain
| | - Salah Alam
- Department of Emergency, King Hamad University Hospital, Road 2835, Busaiteen P.O. Box 24343, Bahrain
| | - Malak Alzahrani
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Hassan Alwosibai
- Emergency Department, King Fahad Hospital (KFU), Hofuf 36277, Saudi Arabia
| | - Abdullah Alshahrani
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Rawan Makhdom
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Faisal Alkhadra
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Sukayna Al-faraj
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Saad Al-Qahtani
- Department of Orthopedic Surgery, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Amal AlSulaibikh
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Mohammed Al Jumaan
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Laila Perlas Asonto
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Sarah Alahmadi
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Mohannad Alghamdi
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
| | - Mohammed Al-Mulhim
- Department of Emergency Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam 31441, Saudi Arabia
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Ismail K, Hughes I, Moloney S, Grimwood K. Streptococcus anginosus group infections in hospitalised children and young people. J Paediatr Child Health 2022; 58:809-814. [PMID: 34854155 DOI: 10.1111/jpc.15840] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/22/2021] [Accepted: 11/21/2021] [Indexed: 11/29/2022]
Abstract
AIM The Streptococcus anginosus group (SAG) comprises three bacterial species colonising the mouth and gastrointestinal and genitourinary tracts and capable of serious pyogenic infections. Although well-described in adults, studies in children are limited. Here, we characterise paediatric SAG infections from a single Australian centre. METHODS Hospitalised patients aged ≤18 years with positive SAG cultures from January 2009 to December 2019 were identified from Pathology Queensland's Gold Coast Laboratory database and their medical records were reviewed. RESULTS Two-hundred children (62% male), median age 12 years (interquartile range 6-16), with positive SAG cultures were identified. Overall, 90% received intravenous antibiotics, 89% underwent surgical drainage, 23% were readmitted and 15% required additional surgery. The most common sites were the abdomen (39%), soft tissues (36%) and head and neck regions (21%). Since 2011, Pathology Queensland reported SAG at the species level (n = 133). Of these, S. anginosus was the most prevalent (39%), then S. constellatus (34%) and S. intermedius (27%). Compared with the other two species, S. intermedius was most commonly associated with head and neck infections (relative risk (RR) = 2.2, 95% confidence interval (CI) 1.4-3.5), while S. constellatus (RR = 1.7, 95% CI 1.2-2.4) and S. anginosus (RR = 1.5, 95% CI 1.0-2.0) were each associated with a higher risk of intra-abdominal infection than S. intermedius. Since February 2015, the number of children admitted with SAG-associated intra-abdominal infection per 1000 hospitalisations increased by 29% annually compared with an annual decline of 8% in previous years. CONCLUSIONS SAG infections occur at various anatomical sites. Despite antibiotics and surgical management, almost one-quarter are re-hospitalised for further treatment.
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Affiliation(s)
- Khairul Ismail
- Department of Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Ian Hughes
- Office of Research Governance and Development, Gold Coast Health, Gold Coast, Queensland, Australia
| | - Susan Moloney
- Department of Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia
| | - Keith Grimwood
- Department of Paediatrics, Gold Coast Health, Gold Coast, Queensland, Australia.,School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.,Department of Infectious Diseases, Gold Coast Health, Gold Coast, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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10
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Biting the hand that feeds you: Management of human and animal bites. Injury 2022; 53:227-236. [PMID: 34838260 DOI: 10.1016/j.injury.2021.11.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bites from animal and humans represent a very small proportion of all the patients presenting to emergency departments, However, they require prompt medical and surgical intervention in order to minimise the risk of infection, that may lead to limb and life-threatening complications. In this review article we synthesise the existing literature for treatment of human and animal bites and offer practical considerations when managing bite injuries.
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11
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Oyonarte Gómez M, Del Castillo Gordillo C, Rojas Romero M, Loo Urbina K. Human bite wounds as a portal of entry for infective endocarditis and purulent pericarditis: a very rare association. BMJ Case Rep 2021; 14:14/4/e241264. [PMID: 33837032 PMCID: PMC8042996 DOI: 10.1136/bcr-2020-241264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
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.
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Affiliation(s)
| | - Cesar Del Castillo Gordillo
- Cardiovascular Center, Hospital Clinico San Borja Arriaran, Santiago, Chile .,Cardiovascular Center, Hospital DIPRECA, Santiago, Chile
| | - Manuel Rojas Romero
- Cardiovascular Center, Hospital Clinico San Borja Arriaran, Santiago, Chile.,Intermal Medicine and cardiology, Hospital Provincial del Huasco, Vallenar, Chile
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Abstract
Animal and human bite injuries are a public health burden. Dog bites outnumber cat bites, but cat bites pose the greatest risk for infection. Skin and soft tissue infections are the most frequent infectious manifestations resulting from bite injury, although invasive infection may occur through direct inoculation or dissemination through the bloodstream. Although contemporary, well-designed trials are needed to inform clinical practice, preemptive antibiotic therapy after a bite injury is warranted for injuries posing high risk for infection and for patients at risk of developing severe infection; antibiotics should target aerobic and anaerobic microbes that comprise the oral and skin flora.
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Affiliation(s)
- Sarah E Greene
- Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8116, St Louis, MO 63110, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8116, St Louis, MO 63110, USA.
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Aloua R, Kerdoud O, Kaouani A, Iro S, Slimani F. Restorative management of human bite injuries to the face: Case series. Ann Med Surg (Lond) 2021; 62:249-252. [PMID: 33537139 PMCID: PMC7840440 DOI: 10.1016/j.amsu.2021.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/25/2022] Open
Abstract
Facial skin wounds are common problems seen and treated by emergency centers around the world. Among all wounds, cat and dog bites are frequently seen. Human bite injuries are both deceptive and difficult in their presentation and management. The injuries have a disfiguration effect with possible psychological impact on the patient. The aim of this paper is to compare experience with human bites of the face in our surgical unit, with other similar trials in term of reasons for the circumstances of injuries, age, and sex of the patients, site of injury, pan-time between consultation and treatment, incidence of infection and surgical management. Data in terms of age, gender distribution, circumstances of injury, location of injuries, evolution of surgical management and complications were recorded. We report here a series of 10 cases of human bite wounds to the face, admitted to our department, and treated with different reconstruction procedures.
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Affiliation(s)
- Rachid Aloua
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Ouassime Kerdoud
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Amine Kaouani
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Salissou Iro
- Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
| | - Faiçal Slimani
- Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, B.P 5696, Casablanca, Morocco.,Oral and Maxillofacial Surgery Department, CHU Ibn Rochd, B.P 2698, Casablanca, Morocco
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Kondo Y. Construction of a Mutant in Prevotella melaninogenica Using the Conjugation Transfer Method with Escherichia coli. Methods Mol Biol 2021; 2210:33-41. [PMID: 32815125 DOI: 10.1007/978-1-0716-0939-2_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Prevotella melaninogenica is a bacterium that is resident in the oral cavity and upper respiratory tract and is associated with periodontal disease and aspiration pneumonia. Prevotella mutants are difficult to produce and only few reports have been reported. We examined several methods and many strains and succeeded in producing mutants in Prevotella melaninogenica GAI 07411. In this chapter, we will describe how to create a mutation of a target gene by carrying out conjugation transfer using Escherichia coli S17-1 as a donor and introducing a plasmid into P. melaninogenica.
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Affiliation(s)
- Yoshio Kondo
- Department of Pediatric Dentistry, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
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15
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Tannahill VJ, Giavitto A, Munroe GA. Medial pterygoid myositis in a Thoroughbred gelding. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- V. J. Tannahill
- University of Bristol School of Veterinary Sciences Langford, Bristol UK
| | - A. Giavitto
- University of Bristol School of Veterinary Sciences Langford, Bristol UK
| | - G. A. Munroe
- Flanders Veterinary Services Cowrig Cottage Greenlaw, Duns UK
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Clarós P, Końska N, Clarós A. Facial human bites. Vision on STMMs in Africa. Otolaryngol Pol 2020; 74:31-35. [PMID: 34550092 DOI: 10.5604/01.3001.0014.1045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Objectives:</b> Human bites of the face are a frequent and serious health issue as they often compromise patients function and aesthetics as well as lead to further complications. The aim of the study is to review human bites of the face referred to our team during 112 short-term medical missions (STMMs) in Sub-Saharan Africa over the past 20 years and to discuss the epidemiology, appearance, management and outcome, including the most common complications. <br><b>Methods:</b> A retrospective medical documentation review was carried out examining all human bites of the face operated by our team during 112 STMMs from 2000 to 2019 in different countries of Sub-Saharan Africa. <br><b>Results:</b> Out of about 5500 patients medical charts 51 patients were selected due to history of human bite. Patients' age range was 15-65 years, female to male ratio was 1, 55:1, the most often involved parts were: lips, ear and nose. Various surgical procedures were carried out including local flaps and free grafts. Infection and graft necrosis were the most common reported complication (n = 4; 9.3%). <br><b>Conclusion:</b> Human bites injuries are a serious health problem in some African populations because of their frequency and possible severity. The treatment is particularly challenging due to their potential to cause local infections, the risk they pose for transmission of systemic diseases as well as their demanding surgical management.
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Affiliation(s)
- Pedro Clarós
- Clarós Otorhinolaryngology Clinic, ENT and Facial Plastic Surgery, Barcelona, Spain
| | - Natalia Końska
- Department of Otorhinolaryngology, Stefan Zeromski Specialist Hospital, Cracow, Poland and Scholarship in Clarós Clinic, Barcelona, Spain
| | - Andrés Clarós
- Clarós Otorhinolaryngology Clinic, ENT and Facial Plastic Surgery, Barcelona, Spain
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Sendi P, Kaempfen A, Uçkay I, Meier R. Bone and joint infections of the hand. Clin Microbiol Infect 2020; 26:848-856. [PMID: 31917233 DOI: 10.1016/j.cmi.2019.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/10/2019] [Accepted: 12/14/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Little guidance is currently available for standardized diagnostic protocols and therapeutic recommendations for bone and joint infections (BJIs) of the hand. OBJECTIVES To summarize the available data in the scientific English-language literature on the diagnosis and treatment of native BJIs of the hand. To illustrate these concepts from a narrative point of view in areas where there is lack of evidence. SOURCES We performed a systematic PubMed and Internet search of studies that investigated hand BJIs in adult patients. CONTENT Few studies have systematically investigated and validated diagnostic concepts, classifications or surgical treatment protocols. Most concepts derive from traditional intra-institutional experience, expert opinions and extrapolations from infections in large joints and long bones. Similarly, there is no uniformly accepted infection definition of BJIs of the hand. The best-documented literature is available for microbiological findings and antibiotic treatment duration in uncomplicated native joint arthritis of the fingers. Retrospective studies and one prospective randomized trial suggest that post-surgical targeted antibiotic therapy of 2 weeks results in a microbiological cure rate of ≥88%. IMPLICATIONS Studies on diagnostic workup and infection definition and classification are urgently needed to compare inter-institutional outcome results and generate guidelines for the best patient care. For uncomplicated pyogenic arthritis of native joints, current evidence suggests that a 2-week course of antibiotic therapy following surgery cures the infection.
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Affiliation(s)
- P Sendi
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, University of Basel, Switzerland; Institute of Infectious Diseases, University of Bern, Bern, Switzerland.
| | - A Kaempfen
- Clinic for Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Switzerland
| | - I Uçkay
- Infectiology, Balgrist University Hospital, Zürich, Switzerland
| | - R Meier
- Department of Plastic and Hand Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Bhaumik S, Kirubakaran R, Chaudhuri S. Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite. Cochrane Database Syst Rev 2019; 12:CD011822. [PMID: 31805611 PMCID: PMC6894945 DOI: 10.1002/14651858.cd011822.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Mammalian bites are a common presentation in emergency and primary healthcare facilities across the world. The World Health Organization recommends postponing the suturing of a bite wound but this has not been evaluated through a systematic review. OBJECTIVES To assess the effects of primary closure compared with delayed closure or no closure for mammalian bite wounds. SEARCH METHODS In July 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included randomised controlled trials which compared primary closure with delayed or no closure for traumatic wounds due to mammalian bite. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles, abstracts and full-text publications, applied the inclusion criteria, and extracted data. We pooled data using a random-effects model, as appropriate. We used the Cochrane 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We found three trials (878 participants) that compared primary closure with no closure for dog bites and one trial (120 participants) that compared primary closure with delayed closure. No other mammalian bite studies were identified. The trials were from the UK (one trial), Greece (one trial) and China (two trials). Overall, participants from both sexes and all age groups were represented. We are uncertain whether primary closure improves the proportion of wounds which are infection-free compared with no closure, as the certainty of evidence for this outcome was judged to be very low (risk ratio (RR) 1.01, 95% confidence interval (CI) 0.97 to 1.05; 2 studies, 782 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. There is no clinically important difference in cosmesis (acceptable physical/cosmetic appearance) of dog bite wounds when primary closure is compared with no closure (mean difference (MD) -1.31, 95% CI -2.03 to -0.59; 1 study, 182 participants). The certainty of evidence for this outcome was judged to be moderate (we downgraded our assessment by one level for imprecision). We are uncertain whether primary closure improves the proportion of dog bite wounds that are infection-free compared with delayed closure, as the evidence for this outcome was judged to be very low (RR 0.98, 95% CI 0.90 to 1.07; 1 study, 120 participants; I2 = 0%). We downgraded the evidence by one level for high risk of bias and two levels for imprecision. None of the four trials reported any adverse outcomes such as death or rabies but they were, in any case, unlikely to have been large enough to have satisfactory power to provide precise estimates for these. Important outcomes like time to complete wound healing, proportion of wounds healed, and length of hospital stay were not evaluated. AUTHORS' CONCLUSIONS All the studies we identified concerned dog bites. There is no high-certainty evidence to support or refute existing recommendations concerning primary closure for dog bites. The potential benefits and harms of primary closure compared with delayed or no closure for mammalian bites remain uncertain and more robust trials are needed.
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Affiliation(s)
- Soumyadeep Bhaumik
- The George Institute for Global Health311‐312, Third Floor, Elegance TowerPlot No. 8, Jasola District CentreNew DelhiIndia110025
| | - Richard Kirubakaran
- Christian Medical CollegeCochrane South Asia, Prof. BV Moses Centre for Evidence‐Informed Healthcare and Health PolicyCarman Block II FloorCMC Campus, BagayamVelloreIndia632002
| | - Sirshendu Chaudhuri
- Christian Medical CollegeWellcome Trust Research Laboratory, Division of Gastrointestinal SciencesIda Scudder RoadVelloreTamil NaduIndiaPIN 632004
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Beltrán Guzmán I, Gil Cuesta J, Trelles M, Jaweed O, Cherestal S, van Loenhout JAF, Guha-Sapir D. Delays in arrival and treatment in emergency departments: Women, children and non-trauma consultations the most at risk in humanitarian settings. PLoS One 2019; 14:e0213362. [PMID: 30835777 PMCID: PMC6400395 DOI: 10.1371/journal.pone.0213362] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/20/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Delays in arrival and treatment at health facilities lead to negative health outcomes. Individual and external factors could be associated with these delays. This study aimed to assess common factors associated with arrival and treatment delays in the emergency departments (ED) of three hospitals in humanitarian settings. METHODOLOGY This was a cross-sectional study based on routine data collected from three MSF-supported hospitals in Afghanistan, Haiti and Sierra Leone. We calculated the proportion of consultations with delay in arrival (>24 hours) and in treatment (based on target time according to triage categories). We used a multinomial logistic regression model (MLR) to analyse the association between age, sex, hospital and diagnosis (trauma and non-trauma) with these delays. RESULTS We included 95,025 consultations. Males represented 65.2%, Delay in arrival was present in 27.8% of cases and delay in treatment in 27.2%. The MLR showed higher risk of delay in arrival for females (OR 1.2, 95% CI 1.2-1.3), children <5 (OR 1.4, 95% CI 1.4-1.5), patients attending to Gondama (OR 30.0, 95% CI 25.6-35.3) and non-trauma cases (OR 4.7, 95% CI 4.4-4.8). A higher risk of delay in treatment was observed for females (OR 1.1, 95% CI 1.0-1.1), children <5 (OR 2.0, 95% CI 1.9-2.1), patients attending to Martissant (OR 14.6, 95% CI 13.9-15.4) and non-trauma cases (OR 1.6, 95% CI 1.5-1.7). CONCLUSIONS Women, children <5 and non-trauma cases suffered most from delays. These delays could relate to educational and cultural barriers, and severity perception of the disease. Treatment delay could be due to insufficient resources with consequent overcrowding, and severity perception from medical staff for non-trauma patients. Extended community outreach, health promotion and support to community health workers could improve emergency care in humanitarian settings.
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Affiliation(s)
- Isabel Beltrán Guzmán
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
- Operational Centre Geneva, Médecins Sans Frontières, Geneva, Switzerland
| | - Julita Gil Cuesta
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - Miguel Trelles
- Operational Centre Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - Omar Jaweed
- Mission Afghanistan, Médecins Sans Frontières, Kunduz, Afghanistan
| | - Sophia Cherestal
- Mission Haiti, Operational Centre Brussels, Médecins Sans Frontières, Port-au-Prince, Haiti
| | - Joris Adriaan Frank van Loenhout
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters, Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
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20
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Smith HR, Conyard C, Loveridge J, Gunnarsson R. Predicting Amputation and Multiple Debridements in Tooth Knuckle Injuries. J Hand Surg Asian Pac Vol 2019; 24:6-12. [PMID: 30760142 DOI: 10.1142/s2424835519500024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Tooth knuckle injuries can be expensive to treat and may necessitate amputation in some cases. Several limitations exist in the literature regarding our knowledge around the factors predicting amputation and the need for multiple debridements in treating this injury. METHODS A historic cohort study of 321 patients treated for tooth knuckle injuries was undertaken. Twenty-one demographic, clinical and laboratory variables were collected. Two outcome measurements were collected - the need for amputation and the need for more than one surgical debridement. A multivariate logistic regression was performed to determine the relationship between the predictor variables and the outcome measurements. RESULTS Of the 321 patients examined, 1.6% required amputations and 25% required multiple debridements. Osteomyelitis was found to be a major predictor for amputation in these patients (OR = 35). Delayed presentation (OR = 1.1) and diabetes (OR = 2.6) were found to significantly increase the risk of requiring multiple debridements. CONCLUSIONS Our models were able to predict what patients were at the greatest risk for amputation and multiple debridement. Reducing rates of osteomyelitis and delays in presentation may help reduce the incidence of amputation and reoperation in this injury.
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Affiliation(s)
- H R Smith
- * College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - C Conyard
- † Department of Orthopaedics, Cairns Hospital, Cairns, QLD, Australia
| | - J Loveridge
- † Department of Orthopaedics, Cairns Hospital, Cairns, QLD, Australia
| | - R Gunnarsson
- * College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.,‡ Research and Development Center Södra Älvsborg, Närhälsan, Primary Health Care, Västra Götaland, Sweden.,§ Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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21
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Fournier's Gangrene of the Penis following a Human Bite Wound. Case Rep Urol 2018; 2018:9798607. [PMID: 30498616 PMCID: PMC6222233 DOI: 10.1155/2018/9798607] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/09/2018] [Indexed: 01/22/2023] Open
Abstract
Fournier's gangrene isolated to the penis is exceedingly rare. It is an urologic emergency that requires emergent parenteral antibiotics as well as aggressive irrigation and debridement. While human bite wounds can be overlooked as a serious cause of injury and infection, they can result in highly dangerous, polymicrobial infections in affected patients. Here, we report a case of penile Fournier's gangrene caused by a human bite wound managed with broad spectrum antibiotics, irrigation and debridement, penile reconstruction, and skin grafting with successful preservation of a normal penile structure and function.
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22
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Spiegelhauer MR, Andersen PF, Frandsen TH, Nordestgaard RLM, Andersen LP. Leclercia adecarboxylata: a case report and literature review of 74 cases demonstrating its pathogenicity in immunocompromised patients. Infect Dis (Lond) 2018; 51:179-188. [PMID: 30488747 DOI: 10.1080/23744235.2018.1536830] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Leclercia adecarboxylata is a Gram-negative bacterium belonging to the family Enterobacteriaceae. It has been described as an emerging human pathogen with the potential to cause severe infection in immunocompromised patients. The aim of this study was to describe a clinical case of infection with L. adecarboxylata and give a review of previous reports on infection. We report the presence of L. adecarboxylata in a patient initially admitted to our hospital for a lung transplant. She had diarrhoea, urinary tract infection and pneumonia caused by L. adecarboxylata. The isolate was resistant to trimethoprim-sulfamethoxazole and susceptible to 15 other antibiotics tested. The literature search for previous reports of infection with L. adecarboxylata resulted in 61 publications describing 74 cases. Bacteremia and wound infections were most often described, and only a few cases were fatal. L. adecarboxylata was most often found as a monomicrobial infection in immunocompromised patients, and as part of a polymicrobial infection in immunocompetent patients. The previously described isolates showed a high susceptibility to antibiotics, and treatment was efficient in most cases. Due to similarities in metabolic products, L. adecarboxylata might have been mistaken as Escherichia spp., but with new identification methods such as MALDI-TOF MS, it is possible to obtain a certain identification.
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Affiliation(s)
- Malene Roed Spiegelhauer
- a Department of Clinical Microbiology , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | - Peter Fruergaard Andersen
- b Department of Cardiothoracic Surgery , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | - Tove Havnhøj Frandsen
- a Department of Clinical Microbiology , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
| | | | - Leif Percival Andersen
- a Department of Clinical Microbiology , Copenhagen University Hospital (Rigshospitalet) , Copenhagen , Denmark
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Schultz J, Schröttner P, Leupold S, Dragu A, Sußmann S, Haase M, Fitze G. Conservative treatment of fingertip injuries in children - first experiences with a novel silicone finger cap that enables woundfluid analysis. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2018; 7:Doc05. [PMID: 30430061 PMCID: PMC6218674 DOI: 10.3205/iprs000125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction: Human fingertips are able to regenerate soft tissue and skin after amputation injuries with excellent cosmetic and functional results when treated with semiocclusive dressings. Despite bacterial colonizations, proceeding infections are not reported with this management. The underlying mechanisms for this form of regenerative healing as well as for the resilience to infections are not known. Due to the lack of mechanical protection, the leakage of maloderous woundfluid and the sometimes challenging application, conventional film dressings have their problems, especially in treating young children. We therefore treated selected patients with a novel silicone finger cap with an integrated wound fluid reservoir that enables atraumatic routine wound fluid aspiration. Methods: We report on 34 patients in between 1 and 13 years with traumatic fingertip amputations primarily treated with occlusive dressings. 12 patients were treated with a novel silicone finger cap. We summarized clinical data for each patient. This included photographs and microbiological results from wound fluid analyses, whenever available. Results: The results of both, conventional film dressing and silicone finger cap treatment, were excellent with no hypersensitivity and no restrictions in sensibility and motility. Even larger pulp defects were rearranged in a round shape and good soft tissue coverage of the distal phalanx was achieved. Nail deformities were not observed. We detected a wide spectrum of both aerobic and anaerobic bacteria in the wound fluids but infections were not observed. Epithelialization times did not differ significantly and no severe complications were seen in all primarily conservatively treated patients. Conclusion: This study provides preliminary data demonstrating that the treatment with the silicone finger cap leads to excellent clinical results in wound healing. Interestingly, the wounds were colonized with a wide range of bacteria including species that may cause wound infections. However, we saw no proceeding inflammation and the regeneration was undisturbed. In the future, the efficacy of this new management should be evaluated in randomized, controlled clinical trials to confirm the results under standard conditions and get more insight into the role of the wound microbiome as well as other factors that may promote regeneration. The aspirable Reservoir of the finger cap will enable easy atraumatic sampling of wound fluids both for diagnostic and for research purposes as well as possibly allowing direct administration of pro-regenerative drugs in the future.
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Affiliation(s)
- Jurek Schultz
- Pediatric Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Percy Schröttner
- Institute of Medical Microbiology and Hygiene, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Susann Leupold
- Pediatric Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Adrian Dragu
- Department of Plastic and Hand Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Silvana Sußmann
- Pediatric Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Michael Haase
- Pediatric Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Guido Fitze
- Pediatric Surgery, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
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[Surgical treatment of bites]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2018; 30:321-341. [PMID: 30209521 DOI: 10.1007/s00064-018-0563-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/21/2018] [Accepted: 06/07/2018] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Thorough and profound debridement for acute bite injuries while sparing nerves, vessels and tendons. INDICATIONS Acute traumatic and late presented bite injuries. CONTRAINDICATIONS General contraindication for anesthesia or surgery. SURGICAL TECHNIQUE Extensive flabellate local anesthesia/general anesthesia, wound irrigation using 0.9% NaCl or antiseptic solutions, removal of avital tissues, wound debridement, wound edge excision, anew extensive irrigation, drainage if necessary, wound closure where applicable (except older or punctual deep injuries), bandage, elastic wrapping and immobilization. If necessary, plastic surgery with coverage of remaining defects. POSTOPERATIVE MANAGEMENT Immobilization with initially daily wound evaluation, removal of drainage/loop on postoperative day 2; if necessary, antibiotic therapy with amoxicillin and clavulanic acid in high-risk wounds (e.g., puncture wounds, joint or bone involvement, extensive soft tissue squeezing), suture removal on day 10-12 after surgery. RESULTS Of 142 bite injuries that were treated and retrospectively evaluated, 46% were caused by dogs and 32% by cats. Patients were on average 44 years old; 55% of all dog bites affected women, but 67% of all cat bites. In 48% of the cases, general anesthesia was necessary. The postoperative infection rate was 6.3%.
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25
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Kondo Y, Sato K, Nagano K, Nishiguchi M, Hoshino T, Fujiwara T, Nakayama K. Involvement of PorK, a component of the type IX secretion system, in Prevotella melaninogenica pathogenicity. Microbiol Immunol 2018; 62:554-566. [PMID: 30028034 DOI: 10.1111/1348-0421.12638] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/09/2018] [Accepted: 07/13/2018] [Indexed: 12/27/2022]
Abstract
Prevotella melaninogenica is a gram-negative anaerobic commensal bacterium that resides in the human oral cavity and is isolated as a pathogen of suppurative diseases both inside and outside the mouth. However, little is known about the pathogenic factors of P. melaninogenica. The periodontal pathogens Porphyromonas gingivalis and Tanerella forsythia secrete virulence factors such as protease and bacterial cell surface proteins via a type IX secretion system (T9SS) that are involved in pathogenicity. P. melaninogenica also possesses all known orthologs of T9SS. In this study, a P. melaninogenica GAI 07411 mutant deficient in the orthologue of the T9SS-encoding gene, porK, was constructed. Hemagglutination and biofilm formation were decreased in the porK mutant. Furthermore, following growth on skim milk-containing medium, the diameters of the halos surrounding the porK mutant were smaller than those of the wild-type strain, suggesting a decrease in secretion of proteases outside the bacterium. To investigate this in detail, culture supernatants of wild-type and porK mutant strains were purified and compared by two-dimensional electrophoresis. In the mutant strain, fewer spots were detected, indicating fewer secreted proteins. In infection experiments, the mortality rate of mice inoculated with the porK mutant strain was significantly lower than in the wild-type strain. These results suggest that P. melaninogenica secretes potent virulence factors via the T9SS that contribute to its pathogenic ability.
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Affiliation(s)
- Yoshio Kondo
- Department of Pediatric Dentistry, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan
| | - Keiko Sato
- Department of Microbiology and Oral Infection, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan
| | - Keiji Nagano
- Department of Microbiology, School of Dentistry, Aichi Gakuin University 1-100 Kusumoto-cho, Chikusa-ku, Nagoya, Aichi 464-8650, Japan
| | - Miyuki Nishiguchi
- Department of Pediatric Dentistry, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan
| | - Tomonori Hoshino
- Department of Pediatric Dentistry, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan
| | - Taku Fujiwara
- Department of Pediatric Dentistry, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan
| | - Koji Nakayama
- Department of Microbiology and Oral Infection, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki 852-8588, Japan
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Performance of MALDI-TOF MS for identification of oral Prevotella species. Anaerobe 2017; 47:89-93. [DOI: 10.1016/j.anaerobe.2017.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/17/2017] [Accepted: 04/20/2017] [Indexed: 01/26/2023]
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Abstract
Mammalian bites, typically from dogs, cats, or humans, are a common presentation in EDs and family practice settings, and patients present with varying degrees of complexity. Injuries can range from local to systemic, including aggressive bacterial infections and permanent limb impairment. Using a systematic approach to initial wound assessment, followed by appropriate diagnostic testing and treatment, is critical to improved long-term patient outcomes.
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Kalchbrenner K. Managing Common Bite Wounds and Their Complications in the United States. PHYSICIAN ASSISTANT CLINICS 2017. [DOI: 10.1016/j.cpha.2016.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Septic arthritis is a rheumatologic emergency that may lead to disability or death. Prompt evacuation of the joint, either by arthrocentesis at the bedside, open or arthroscopic drainage in the operating room, or imaging-guided drainage in the radiology suite, is mandatory. Methicillin-resistant Staphylococcus aureus (MRSA) has become a major cause of septic arthritis in the United States. MRSA joint infection seems to be associated with worse outcomes. Antibiotic courses of 3 to 4 weeks in duration are usually adequate for uncomplicated bacterial arthritis. Treatment duration should be extended to 6 weeks if there is imaging evidence of accompanying osteomyelitis.
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Affiliation(s)
- John J Ross
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, PBB-B420, Boston, MA 02115, USA.
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Patrozou E. Management of Human Bites. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00219-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sikka N, Robinson H, Little C, Pourmand A. ED approach to electrical toothbrush associated hand injury, a unique case of non-oropharyngeal injury. Am J Emerg Med 2016; 35:667.e3-667.e5. [PMID: 27839840 DOI: 10.1016/j.ajem.2016.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 11/01/2016] [Indexed: 01/29/2023] Open
Abstract
Puncture wounds are common injuries treated in the emergency department (ED). Prior studies have shown that toothbrushes are common reservoirs for oral flora, especially in regions near the head of the toothbrush near the bristles. ED providers must be aware of the danger associated with bacterial contamination of the associated wound and should be familiar with different pathogens and options for treatment. We present a unique case of a 30-year-old male with non-intraoral injury who presented to the ED after puncturing his left palm with the metal post of an electric toothbrush.
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Affiliation(s)
- Neal Sikka
- Department of Emergency Medicine, George Washington University, Washington, DC, United States.
| | - Hannah Robinson
- Department of Emergency Medicine, George Washington University, Washington, DC, United States
| | - Chimere Little
- Department of Emergency Medicine, George Washington University, Washington, DC, United States
| | - Ali Pourmand
- Department of Emergency Medicine, George Washington University, Washington, DC, United States
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Abstract
BACKGROUND Animal bites are a major public health problem, it is estimated that 2% of the population is bitten each year. Most bites are by dogs and the risk factors include young children, men, certain breeds of dogs and untrained dogs. The risk of infection after bites differs between animal species and depends on the animal teeth and oral flora. CONCLUSIONS Animal bites are still a major cause of morbidity in patients of all ages and have caused several preventable childhood deaths. These wounds often become infected. If the wound requires it, early surgical evaluation must be performed. The use of antibiotics is only recommended for high risk bite wounds.
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Honnorat E, Seng P, Savini H, Pinelli PO, Simon F, Stein A. Prosthetic joint infection caused by Pasteurella multocida: a case series and review of literature. BMC Infect Dis 2016; 16:435. [PMID: 27544345 PMCID: PMC4992566 DOI: 10.1186/s12879-016-1763-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 08/07/2016] [Indexed: 12/19/2022] Open
Abstract
Background Pasteurella multocida is a well-recognized zoonotic agent following dog or cat bites or scratches. Nevertheless, prosthetic joint infection caused by P. multocida are rarely reported. Method We report here a series of six cases of prosthetic joint infection caused by P. multocida managed at a referral centre for the treatment of bone and joint infection in southern France. We also reviewed the 26 cases reported in literature. Results The mean age of our cases was 74 years [±8.2, range 63–85]. In majority of our cases (5 cases) were associated with knee prostheses and one case with a hip prosthesis. Most of cases occurred after cat or dog scratches or licks or contact. Diagnoses of prosthetic joint infection caused by P. multocida were made by positive cultures of surgical biopsies or needle aspiration. Mean time delay between prosthetic joint implantation and infection onset was 7.6 years (±5.12 years, range 2–17). Local inflammation, which occurred in all six cases, was the most frequent clinical symptom, followed by pain in five cases, fever and swollen joints in four cases, and a fistula with purulent discharge inside the wound in two cases. The mean time of antibiotic therapy was 8 months. Surgical treatment with prosthesis removal was performed in three cases. Six of our cases were in remission without apparent relapse at 3 years after end of treatment. Conclusion Prosthetic joint infections caused by P. multocida usually occur after animal scratches or bites, but can occasionally occur after a short animal lick. These infections are usually resulting from a contiguous infection and localized in the knee. An early antibiotic therapy after surgical debridement could avoid prosthetic withdrawal, notably in elderly patients. Patients with prosthetic joints should be warned that animals are potential sources of serious infection and urgent medical advice should be sought if they are bitten or scratched.
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Affiliation(s)
- Estelle Honnorat
- Centre de Référence des Infections Ostéo-Articulaires (CRIOA), Interrégional Sud-Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147, boulevard Baille, Marseille, France.,Service des Maladies Infectieuses, Hôpital de la Conception, 147, boulevard Baille, 13005, Marseille, France
| | - Piseth Seng
- Centre de Référence des Infections Ostéo-Articulaires (CRIOA), Interrégional Sud-Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147, boulevard Baille, Marseille, France. .,Service des Maladies Infectieuses, Hôpital de la Conception, 147, boulevard Baille, 13005, Marseille, France. .,Aix Marseille Univ, INSERM 1095, CNRS 7278, IRD 198, URMITE, Marseille, France.
| | - Hélène Savini
- Service de Pathologie Infectieuse et Tropicale, Hôpital Instruction des Armées Laveran, 13013, Marseille, France
| | - Pierre-Olivier Pinelli
- Centre de Référence des Infections Ostéo-Articulaires (CRIOA), Interrégional Sud-Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147, boulevard Baille, Marseille, France
| | - Fabrice Simon
- Service de Pathologie Infectieuse et Tropicale, Hôpital Instruction des Armées Laveran, 13013, Marseille, France
| | - Andreas Stein
- Centre de Référence des Infections Ostéo-Articulaires (CRIOA), Interrégional Sud-Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147, boulevard Baille, Marseille, France.,Service des Maladies Infectieuses, Hôpital de la Conception, 147, boulevard Baille, 13005, Marseille, France.,Aix Marseille Univ, INSERM 1095, CNRS 7278, IRD 198, URMITE, Marseille, France
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Kilian M. Clenched fist injury complicated by septic arthritis and osteomyelitis treated with negative pressure wound therapy: One case report. Chin J Traumatol 2016; 19:176-8. [PMID: 27321301 PMCID: PMC4908226 DOI: 10.1016/j.cjtee.2015.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
We reported a 30 years old man who suffered a bite wound of the right hand in a fight. Two days after the injury, he was admitted in emergency because of stab wound above the head of the third metacarpal bone. He presented the swelling, redness, pain and fever. Primary revision confirmed only partial lesion of the extensor apparatus. During the following days, we recorded a deterioration of local findings and magnetic resonance imaging revealed osteomyelitis and septic arthritis of the thirdmetacarpophalangeal joint. The wound was then revised several times using negative pressure wound therapy in combination with intravenous antibiotics. After resolution of clinical and laboratory findings, the wound was finally closed by delayed primary suture. Clenched fist injury is a medical emergency that requires immediate surgical revision. We treated clenched fist injury with the development of septic arthritis and osteomyelitis with negative pressure wound therapy and obtained good outcomes.
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Animal Inflicted Maxillofacial Injuries: Treatment Modalities and Our Experience. J Maxillofac Oral Surg 2016; 16:356-364. [PMID: 28717295 DOI: 10.1007/s12663-016-0918-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 04/27/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Animal inflicted injuries to the face and neck are becoming much more common as people lavish affection on pets. Injuries caused by animal attacks to the face can cause complex injuries to soft and hard tissues, presented as perforations, lacerations, crushes, avulsion or fractures. An uncountable number of bacteria and virus can be found in such injuries, with a potential pathological effect to humans, regarding infections. Although the infection rate is low due to excellent blood supply to face, the injuries have disfiguring effect with possible psychological repercussion to the patients. The treatment of animal inflicted injuries must address the soft tissue defect, neurovascular injuries, and bone injuries as well as prevention of post treatment infection. Primary wound repair is the treatment of choice for most clinically uninfected bite wound where as delayed closure should be reserved for wounds at high risk of infection or already infected wounds and tissue defect may require local flap or micro-vascular re-implantations. MATERIAL AND METHODS In this article, we have elicited up to date considerations regarding the management of animal inflicted injuries to the face based on literature search and exemplified by multiple case reports. CONCLUSION For bite injuries on face, immediate primary wound repair after meticulous wound debridement and irrigation with sufficient volume added by antibiotic prophylaxis gives good cosmetic results with minimum risk of infection. Depending upon type of attack and age of victims, psychiatric or social counseling may also be required.
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Abstract
The HACEK group of bacteria - Haemophilus parainfluenzae, Aggregatibacter spp. (A. actinomycetemcomitans, A. aphrophilus, A. paraphrophilus, and A. segnis), Cardiobacterium spp. (C. hominis, C. valvarum), Eikenella corrodens, and Kingella spp. (K. kingae, K. denitrificans) - are fastidious gram-negative bacteria, part of the normal microbiota of oral and upper respiratory tract in humans. Although their pathogenicity is limited, they are responsible for 1-3% of all infective endocarditis. HACEK endocarditis mostly affect patients with underlying heart disease or prosthetic valves, and are characterized by an insidious course, with a mean diagnosis delay of 1 month (Haemophilus spp.) to 3 months (Aggregatibacter and Cardiobacterium spp.). The advent of continuously monitored blood culture systems with enriched media has erased the need for extended incubation for the diagnosis of HACEK endocarditis. Medical treatment relies on third-generation cephalosporin, with a favorable outcome in 80-90% of cases, with or without cardiac surgery.
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Affiliation(s)
- Matthieu Revest
- a Infectious Diseases and Intensive Care Unit , Pontchaillou University Hospital , Rennes , France
| | - Gérald Egmann
- b Department of Emergency Medicine, SAMU 97.3 , Centre Hospitalier Andrée Rosemon , Cayenne , French Guiana
| | - Vincent Cattoir
- c Bacteriology, Pontchaillou University Hospital , Rennes , France
| | - Pierre Tattevin
- a Infectious Diseases and Intensive Care Unit , Pontchaillou University Hospital , Rennes , France
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Abstract
Lower genitourinary tract trauma comprises a substantial portion of the trauma burden in the USA. Some key trends and findings are described. Mortality is relatively high in patients with bladder trauma due to associated injuries. Urethral injuries should be suspected in patients presenting with the triad of blood at the urethral meatus, suprapubic fullness indicative of a full bladder, and urinary retention. Urethral injury is common in penetrating penile trauma, and stab wounds to the penis are more likely to involve the urethra than gunshot wounds. Penile fracture is largely a clinical diagnosis and suspicion of fracture requires urgent surgical exploration. Zipper injuries are the most common cause of presentation to the emergency department for penile trauma in adults. Toilet seat injuries are the leading cause of penile pediatric trauma presenting to the emergency department. In the setting of testicular trauma, rates of testicular salvage are excellent when exploration is prompt. Trauma in the form of animal or human bites requires treatment with broad-spectrum antibiotics in addition to repair of the injury. Military trauma has seen an increase in explosive injuries to the lower urinary tracts due to evolution of warfare tactics. Increasing awareness of presentation and context of lower genitourinary tract trauma can reduce delay of diagnosis and morbidity associated with such injuries.
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Affiliation(s)
- David Bayne
- Department of Urology, University of California, San Francisco, CA, USA
| | - Uwais Zaid
- Department of Urology, University of California, San Francisco, CA, USA
| | - Amjad Alwaal
- Department of Urology, University of California, San Francisco, CA, USA
| | - Catherine Harris
- Department of Urology, University of California, San Francisco, CA, USA
| | - Jack McAninch
- Department of Urology, University of California, San Francisco, CA, USA
| | - Benjamin Breyer
- Department of Urology, University of California, San Francisco, CA, USA
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Mahida N, Anthony L, Martin N, Gupta A, Andrewartha F. Human bite leading to fatal Neisseria meningitidis septicaemia and pericarditis. JMM Case Rep 2015. [DOI: 10.1099/jmmcr.0.000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Nikunj Mahida
- Department of Clinical Microbiology, Nottingham University Hospitals, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Laura Anthony
- Department of Rheumatology and General Medicine, Nottingham University Hospitals, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Nicola Martin
- Department of Rheumatology and General Medicine, Nottingham University Hospitals, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Anindya Gupta
- Department of Rheumatology and General Medicine, Nottingham University Hospitals, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
| | - Fiona Andrewartha
- Department of Clinical Microbiology, Nottingham University Hospitals, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK
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Bhaumik S, Kirubakaran R, Chaudhuri S. Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite. Hippokratia 2015. [DOI: 10.1002/14651858.cd011822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Richard Kirubakaran
- Christian Medical College; South Asian Cochrane Network & Center, Prof. BV Moses Center for Evidence-Informed Health Care and Health Policy; Carman Block II Floor CMC Campus, Bagayam Vellore Tamil Nadu India 632002
| | - Sirshendu Chaudhuri
- Christian Medical College, Vellore; CHAD; CHAD Hospital, Bagayam Vellore Tamil Nadu India 632002
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40
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Kang H. Animal bite injuries and vaccination. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.3.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hyunggoo Kang
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, Korea
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41
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Bedside Ultrasound in the Diagnosis of Complex Hand Infections: A Case Series. J Emerg Med 2015; 48:63-8. [DOI: 10.1016/j.jemermed.2014.09.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 07/09/2014] [Accepted: 09/02/2014] [Indexed: 11/19/2022]
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Abstract
The hand is the most common site for bite injuries. Because of specific characteristics of hand anatomy, bite mechanics, and organisms found in human and animal saliva, even small wounds can lead to aggressive infections. Failure to recognize and treat hand bites can result in significant morbidity. Human and animal bites most commonly lead to polymicrobial bacterial infections with a mixture of aerobic and anaerobic organisms. Pasteurella species are commonly found in dog and cat bite wounds, and Eikenella is characteristic of human wounds. Staphylococcus, Streptococcus, and anaerobic bacterial species are common to all mammals. Although public health measures in developed countries have been highly effective at reducing rabies transmission, dog bites remain the most common source of rabies infection worldwide. Human bites can transmit HIV, hepatitis B, or hepatitis C, especially when contaminated blood is exposed to an open wound. Appropriate management of any mammal bite requires recognition, early wound cleansing, evaluation of injured structures, and infection prophylaxis. Structural repair is performed as indicated by the severity and contamination of the injury, and wounds may require delayed closure. Wound infections typically require débridement, empiric antibiotics, and delayed repair or reconstruction.
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Abstract
Traumatic injuries to the extremities are common in athletic competitions. The practitioner providing coverage of sporting events must be prepared to diagnose and provide initial treatment of these injuries. A thorough history and physical examination should result in a provisional diagnosis. Many injuries will require subsequent radiographs or orthopedic consultation. Limb threatening emergencies are rare but must be promptly recognized and referred to a hospital. Early treatment can protect athletes from further injury and may hasten their return to competition. Some athletes with extremity trauma can return to the contest, but this decision must be made on an individual basis.
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Affiliation(s)
- Daniel C Wascher
- Department of Orthopaedics and Rehabilitation, University of New Mexico, MSC 10 5600, 1 University of New Mexico, Albuquerque, NM, 87131-0001, USA,
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Diaz EC, Kimball D, Gong EM. Acute Scrotal Pain in Pediatric Emergency Medicine: Assessment, Diagnosis, Management, and Treatment. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2014. [DOI: 10.1016/j.cpem.2014.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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45
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Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue
Infections: 2014 Update by the Infectious Diseases Society of America. Clin Infect Dis 2014; 59:147-59. [DOI: 10.1093/cid/ciu296] [Citation(s) in RCA: 1187] [Impact Index Per Article: 118.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.
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Affiliation(s)
- Dennis L. Stevens
- Division of Infectious Diseases, Department of Veterans Affairs, Boise, Idaho
| | - Alan L. Bisno
- Medical Service, Miami Veterans Affairs Health Care System, Florida
| | | | | | - Ellie J. C. Goldstein
- University of California, Los Angeles, School of Medicine, and R. M. Alden Research Laboratory, Santa Monica, California
| | | | - Jan V. Hirschmann
- Medical Service, Puget Sound Veterans Affairs Medical Center, Seattle, Washington
| | - Sheldon L. Kaplan
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | | | - James C. Wade
- Geisinger Health System, Geisinger Cancer Institute, Danville, Pennsylvania
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46
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Human Bite Injuries. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e3182a01f7f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Jha S, Khan WS, Siddiqui NA. Mammalian bite injuries to the hand and their management. Open Orthop J 2014; 8:194-8. [PMID: 25067974 PMCID: PMC4110393 DOI: 10.2174/1874325001408010194] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 03/23/2014] [Accepted: 03/27/2014] [Indexed: 11/22/2022] Open
Abstract
Bite wounds are a common form of hand injury with the potential to lead to severe local and systemic sequelae and permanent functional impairment. Mammalian bite wounds may be caused by a variety of animal class and species; injuries resulting from dogs, cats and humans are the most widely discussed and reported in the literature. Bite wounds may be contaminated with aggressive pathogens and the anatomical vulnerability of structures within the hand means that without early recognition and treatment with irrigation and antibiotics, alongside a low index of suspicion for deep structural involvement requiring formal surgical exploration and washout, the consequences of such injuries can be disastrous. We review the literature and discuss the epidemiology, pathophysiology and microbiology relating to these injuries, as well as clinical aspects including signs, symptoms, and management.
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Affiliation(s)
- Shilpa Jha
- Department of Trauma & Orthopaedics, Kingston Hospital NHS Trust, Kingston, London, UK
| | - Wasim S Khan
- University College London Institute of Orthopaedics and Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - Nashat A Siddiqui
- Department of Trauma & Orthopaedics, Kingston Hospital NHS Trust, Kingston, London, UK
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Malahias M, Jordan D, Hughes O, Khan WS, Hindocha S. Bite injuries to the hand: microbiology, virology and management. Open Orthop J 2014; 8:157-61. [PMID: 25067969 PMCID: PMC4110396 DOI: 10.2174/1874325001408010157] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Revised: 04/05/2014] [Accepted: 04/10/2014] [Indexed: 11/22/2022] Open
Abstract
Bites to the human hand, be it from a pet, a stray animal or even a fellow human, may often have dire consequences for the person suffering the insult. Bites by mammals are a common problem and they account for up to 1% of all visits to hospital emergency rooms, in the UK. Clenched fist injuries to the mouth ('fight bite') are notorious for being the worst human bites. Bite injuries of the hand and their related infections must be monitored vigilantly and managed proactively, by experts in this field of surgery. In this review article we discuss the associated microbiology and virology of these injuries as well as their management.
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Affiliation(s)
- M. Malahias
- Plastic Surgery Department, Good Hope Hospital, West Midlands, B75 7RR, UK
| | - D. Jordan
- Plastic Surgery Department, Whiston Hospital, Liverpool, L35 5DR, UK
| | - O. Hughes
- Plastic Surgery Department, Whiston Hospital, Liverpool, L35 5DR, UK
| | - Wasim S. Khan
- University College London Institute of Orthopaedics & Musculoskeletal Sciences, Royal National Orthopaedic Hospital, Stanmore, London, HA7 4LP, UK
| | - S. Hindocha
- Plastic Surgery Department, Whiston Hospital, Liverpool, L35 5DR, UK
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49
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Maxillofacial injuries due to animal bites. J Maxillofac Oral Surg 2013; 14:142-53. [PMID: 26028828 DOI: 10.1007/s12663-013-0593-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 09/23/2013] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Animal bites are a significant public health problem, with the majority of bites coming from dogs, cats and humans. These may present as punctures, abrasions, tears, or avulsions. The force and relative bluntness of the teeth also increases the possibility of a crush injury with devitalized tissue .The clinical presentation and appropriate treatment of infected bite wounds vary according to the animal and causative organisms. These wounds have always been considered complex injuries contaminated with a unique polymicrobial inoculum. MATERIALS This article reviews animal bite wound incidence, bacteriology, risk factors for complications, evaluation components, recommended treatment and prevention based on advanced PUBMED search of the English language literature from the years 1970 to present. CONCLUSION As the bite wounds are frequently located on the face, an oral and maxillofacial surgeon needs to be familiar with the treatment of animal bites, pitfalls in management and to educate patients on ways to avoid future bite injuries. The management of animal bites is an evidence poor area and most recommendations are based on small case series, microbiological data and expert opinion. The main controversies include whether wounds should or should not undergo primary closure and the use of prophylactic antimicrobials.
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50
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Galé Ansó I, Bergua Martinez A, Caudevilla Lafuente P, Ciria Calavia L. Infección por Eikenella corrodens tras mordedura humana. An Pediatr (Barc) 2013; 78:414-5. [DOI: 10.1016/j.anpedi.2012.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 08/06/2012] [Accepted: 09/25/2012] [Indexed: 10/27/2022] Open
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