1
|
Zubair R, Azam AM, Fatima M, Azam MM, Shah AM, Rehman Khan MA, Yaqoob Ú. Fournier's gangrene in a female: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241243276. [PMID: 38577558 PMCID: PMC10993664 DOI: 10.1177/2050313x241243276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 03/14/2024] [Indexed: 04/06/2024] Open
Abstract
Fournier's gangrene is characterized by an acute necrotic infection. The infection can occur in all parts of the body including the scrotum, penis, or perineum, and is a rare condition that is primarily reported in men and seldom in women. Existing literature suggests that it might be underreported, possibly leading to overlooked cases. Risk factors include diabetes, chronic illness, and trauma. This case involves a 52-year-old female with a 10-year medical history of diabetes mellitus, multiple healed skin lesions all over the body, and dermatitis. The presentation was a perianal swelling, which progressed into an extensive necrotizing soft tissue infection of the perineum, making a diagnosis of Fournier's gangrene. She underwent wide local debridement and was managed with antibiotics in a timely manner. The patient's clinical course and subsequent follow-up were uneventful. Uncontrolled diabetes and dermatitis significantly increase the risk of Fournier's gangrene; therefore, it should be suspected in women with such comorbid conditions. This case highlights the need for increased awareness and vigilance regarding this condition among women.
Collapse
Affiliation(s)
- Rabbia Zubair
- Department of Surgery, Hamdard University Hospital, Karachi, Pakistan
| | | | - Munqabat Fatima
- Department of Surgery, Hamdard University Hospital, Karachi, Pakistan
| | | | | | | | - Úzair Yaqoob
- Department of Surgery, Hamdard University Hospital, Karachi, Pakistan
| |
Collapse
|
3
|
Vellaichamy G, Kohli I, Zubair R, Yin C, Braunberger T, Nahhas AF, Nicholson C, Mohammad TF, Isedeh P, Lyons AB, Nartker N, Al-Jamal M, Matsui M, Karaman-Jurukovska N, Zhou L, Lim HW, Mi QS, Hamzavi IH. An in vivo model of postinflammatory hyperpigmentation and erythema: clinical, colorimetric and molecular characteristics. Br J Dermatol 2021; 186:508-519. [PMID: 34625951 DOI: 10.1111/bjd.20804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Postinflammatory hyperpigmentation (PIH) is a common, acquired pigmentary disorder of the skin associated with significant quality-of-life impairment, especially in individuals with skin of colour. Current treatment for PIH is limited, largely due to a poor understanding of disease pathogenesis and the lack of a representative disease model. OBJECTIVES This study is intended to further develop, update and validate our previously designed in vivo model of acne-induced PIH/postinflammatory erythema (PIE) using different concentrations of trichloroacetic acid (TCA), a medium-depth chemical peel. METHODS Twenty-nine patients with skin types II-VI and clinician-confirmed presence of two or more truncal acne pustules and PIH/PIE were included. On the basis of Investigator's Global Assessment (IGA), clinical polarized photography (CPP), colorimetry and Skindex, we experimentally determined an optimum TCA concentration and assessed our model's ability to exhibit a dose-response relationship between degree of inciting insult and severity of resulting pigmentation. We also performed differential microRNA profiling and pathway analysis to explore the potential of microRNAs as molecular adjuncts to our model. RESULTS Application of TCA 30% produced lesions indistinguishable from acne-induced PIH and PIE lesions on the basis of colorimetry data without causing epidermal necrosis. Application of progressively increasing TCA doses from 20% to 30% resulted in concentration-dependent increases in CPP, IGA and colorimetry scores at all timepoints during the study. miRNA-31 and miRNA-23b may play a role in PIH pathogenesis, although further validation is required. CONCLUSIONS Our TCA-based in vivo model, using TCA concentrations between 20% and 30% with an optimum of 30%, enables the quantitative assessment of the pigmentary response to varying degrees of cutaneous inflammation in a fashion that mirrors natural acne-induced PIH and PIE.
Collapse
Affiliation(s)
- G Vellaichamy
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - I Kohli
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - R Zubair
- Broward Health Medical Center, Fort Lauderdale, FL, USA
| | - C Yin
- Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - T Braunberger
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - A F Nahhas
- Department of Dermatology, Beaumont Hospital, Farmington Hills, MI, USA
| | - C Nicholson
- Department of Dermatology, Wayne State University, Dearborn, MI, USA
| | - T F Mohammad
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - P Isedeh
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - A B Lyons
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - N Nartker
- Department of Dermatology, Wayne State University, Dearborn, MI, USA
| | - M Al-Jamal
- Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - M Matsui
- Department of Dermatology and Division of Environmental Sciences, School of Public Health, Columbia University, New York, NY, USA
| | | | - L Zhou
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - H W Lim
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - Q-S Mi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Center for Cutaneous Biology and Immunology Research, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Immunology Research Program, Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - I H Hamzavi
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
4
|
Lyons AB, Narla S, Kohli I, Zubair R, Nahhas AF, Braunberger TL, Joseph MK, Nicholson CL, Jacobsen G, Hamzavi IH. Assessment of Inter-rater Reliability of Clinical Hidradenitis Suppurativa Outcome Measures Using Ultrasonography. Clin Exp Dermatol 2021; 47:319-324. [PMID: 34388853 DOI: 10.1111/ced.14889] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hidradenitis suppurativa (HS) staging and severity is typically based upon physical examination findings which can result in misclassification of severity based on subclinical disease activity and significant variation between healthcare providers. Ultrasound (US) is an objective tool to help evaluate subclinical disease and more accurately classify severity of disease. The objective of this study was to evaluate inter-rater reliability in HS disease severity assessment using clinical and US techniques. METHODS Twenty subjects underwent clinical evaluation of HS using clinical outcome measures including Hurley, Sartorius, HS Physician Global Assessment (HS-PGA), and Hidradenitis Suppurativa Clinical Response (HiSCR) independently by two physicians. US was subsequently performed, and clinical assessments were repeated. Intra-class correlation coefficients (ICC) were obtained to evaluate inter-rater agreement of each outcome measure before and after US. RESULTS Pre- to post-US improvement in ICC was seen with the Sartorius, HiSCR nodule and abscess count, and HiSCR draining fistula count. The scores went from having "good" rater agreement for Sartorius and HiSCR nodule and abscess count and "poor" rater agreement for HiSCR draining fistula count to "excellent" rater agreement amongst these scores. CONCLUSIONS US improved inter-rater agreement and should be used in conjunction with physical examination findings to evaluate disease severity to ensure uniform staging.
Collapse
Affiliation(s)
- A B Lyons
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - S Narla
- Department of Dermatology, St. Lukes Hospital, Easton, PA, USA
| | - I Kohli
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA.,Department of Physics & Astronomy, Wayne State University, Detroit, MI, USA
| | - R Zubair
- Department of Dermatology, Broward Hospital, Ft. Lauderdale, FL, USA
| | - A F Nahhas
- Department of Dermatology, Beaumont Health-Farmington Hills, Farmington Hills, MI, USA
| | - T L Braunberger
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - M K Joseph
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
| | - C L Nicholson
- Department of Dermatology, Wayne State University, Detroit, MI, USA
| | - G Jacobsen
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI, USA
| | - I H Hamzavi
- Multicultural Center, Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| |
Collapse
|
5
|
Zubair R, Mirza M, Iftikhar J, Saeed N. Frequency of incidental fatty liver on ultrasound and its association with diabetes mellitus and hypertension. Pak J Med Sci 2018; 34:1137-1141. [PMID: 30344564 PMCID: PMC6191815 DOI: 10.12669/pjms.345.15102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To see the frequency of incidental fatty liver on ultrasound and its association with diabetes mellitus and hypertension. Methods: A cross sectional study was conducted from January 2016 to June 2016 in the department of Surgery and Radiology at Hamdard University Hospital. Patients of both genders and all ages were selected by non purposive convenience sampling. Critically ill, trauma cases and all those patients who had a history of chronic liver disease, alcohol intake and expected pregnancy were excluded. Blood pressure and random blood sugar were recorded. Results: Six hundred patients were included in the study with mean age of 44.65±18.8 years. 240 patients (40%) had incidental finding of fatty liver on ultrasound. Out of 240 with fatty liver patients 117 were males (48.8%) and 123 were females (51.3%). Total 141 patients were diagnosed with hypertension, out of which 81(57.44%, p< 0.001) had fatty liver on ultrasound. Diabetes mellitus was diagnosed in 84 patients, in which 57 patients (67.8%, p<0.001) had fatty liver. Conclusion: Fatty liver is a frequently found incidental finding on ultrasound. There is a significant association of fatty liver with diabetes mellitus and hypertension.
Collapse
Affiliation(s)
- Rabbia Zubair
- Dr. Rabbia Zubair, FCPS. Assistant Professor. Department of Surgery, Hamdard University Hospital, Karachi, Pakistan
| | - Masoom Mirza
- Dr. Masoom Mirza, FRCS. Professor and Head of Surgery Department. Department of Surgery, Hamdard University Hospital, Karachi, Pakistan
| | - Javeria Iftikhar
- Dr. Javeria Iftikhar, FCPS. Senior Registrar. Department of Surgery, Hamdard University Hospital, Karachi, Pakistan
| | - Nida Saeed
- Dr. Nida Saeed, FCPS. Senior Registrar, Department of Endocrine Surgery, Jinnah Post Graduate Medical Centre, Karachi, Pakistan
| |
Collapse
|