A 58-year-old male clerk working in a Bank at Gujarat, presented to our hospital on 14 th December 2013 with swelling of the forearm and discolouration of the skin. He had a fall while playing cricket with his son and sustained superficial bruises along left wrist and forearm 5 days before. He had received some medicines from general practitioner. He had no history of any chronic illnesses like diabetes mellitus or tuberculosis. Patient was well oriented at the time of presentation. Local examination revealed swelling involving left hand and half of left forearm. Blackish discolouration with serosanguineous discharge was present on dorsal aspect of fingers, wrist of left hand.Patient was admitted to ward with suspected clinical diagnosis of necrotizing fasciitis. Debridement of the tissue was undertaken on day one [Table/ Fig-1
DisCussionNecrotizing fasciitis (NF) is an aggressive and life-threatening infection of skin and soft tissue characterized by widespread fascial necrosis which can lead to gross morbidity and mortality upto 73% if left untreated [1][2][3]. NF is usually caused by a mixture of aerobic and anaerobic organisms, typically including group A streptococcus, Enterobacteriaceae, anaerobes, and S. aureus. Although skin and soft tissue infections caused by MRSA is becoming common globally over the past few years, monomicrobial MRSA necrotizing fasciitis reports are sparse in literature [4,5].Hohendorff B et al., has reported a case of fall at home on left hand leading to fulminant NF of the hand from group A β-haemolytic streptococcus, requiring an lifesaving amputation [6]. Similarly Dias L et al., reported a case of NF of the thumb following minor injury to the left thumb, requiring ICU admission and surgical debridement Keywords: Amputation, Daptomycin, Monomicrobial Necrotizing fasciitis (NF) is an aggressive and life-threatening infection of skin and soft tissue characterized by widespread fascial necrosis, leads to gross morbidity and mortality if left untreated. Although MRSA has become a common isolate associated with skin and soft tissue infections globally over the past few years, monomicrobial MRSA NF has been reported only in a few studies. Our case represents the development of NF followed by trivial trauma salvaged with daptomycin and amputation of the affected limb.Prompt diagnosis and surgical management with empiric MRSA cover in areas where community acquired MRSA (CA-MRSA) is endemic for suspected cases of necrotizing fasciitis can prevent the dreaded consequences.[
Hypertension is attributed to be one of the major risk factors in the pathophysiology of ischemic heart disease, stroke, heart failure and renal dysfunction. Angiotensin receptor blockers (ARBs) are one of the first line drugs recommended for clinical use in hypertension by JNC 8. Azilsartan is the recent addition to this family of ARBs and is perceived as one of the potent antihypertensive drugs today. Azilsartan was developed by replacing the tetrazole ring in candesartan with a 5 member oxo-oxadiazole ring. In India Azisartan was recently approved by DCGI in December 2016 for use in hypertension. In various randomized, double blind clinical studies Azilsartan was found to be to be superior in terms of clinical efficacy over other ARBs like Candesartan, Olmesartan and Valsartan and angiotensin converting enzyme inhibitor like Ramipril. In terms of safety profile Azilsartan appears to be equivalent to the currently available ARBs. Azilsartan due to its superior efficacy and comparative safety profile appear to be a new addition to the armamentarium in the treatment of hypertension.
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