Introduction and importance
The impact of Covid-19 pandemic on the incidence and pattern of Mucormycosis (the black fungus), has increased sharply and is featured as an epidemic within a pandemic. The majority of cases were detected at late stages, which decreases the chances of survival.
Case presentation
The authors present a case of an immunocompetent male patient diagnosed with left orbital apex syndrome post covid-19 infection, which necessitated orbital exenteration. He was later hospitalized in a quarantine facility and an area of skin breakdown on his left cheek was noted and surgical debridement performed. Later, He presented to our institution with left hemifacial skin loss, exposing the underlying diseased bone. A multidisciplinary team examined the patient clinically and radiographically, reaching a primitive diagnosis of secondary cutaneous Mucormycosis due to rhino-orbital Mucormycosis, with no cavernous sinus thrombosis nor cranial extension. Radical surgical and medical treatments were given and he had an uneventful recovery. Unfortunately, he died 5 days after the reconstructive surgery with Anterolateral Thigh (ALT) flap.
Clinical discussion
The dual effect of both (covid-19) and its' associated Mucormycosis, predispose patients to increased risk of pressure injuries including Medical device related pressure injuries. Survivors of Mucormycosis are high-risk patients, and planning their reconstruction by free flaps is challenging. However, delayed reconstruction is always recommended.
Conclusion
Early diagnosis and management of covid-19 associated Mucormycosis should be prioritized. Moreover, surgical debridement of necrotic tissues should not be delayed due to an unavailable or negative histopathology.
HighlightsThe mode of entry of the foreign body was unique as well as the force required to impale and break a knife blade in bone.The authors present a minimally invasive technique for dealing with this type of injury and highlight its challenges.This case report emphasis the need for baseline radiology in cases of traumatology especially those with vague history.The patient was examined by multiple physicians who did not detect the foreign body which could raise medico-legal issues.
Highlights
This case report contributes to the growing pool of reports concerning human papillomavirus (HPV) associated oral cancers.
There is a paucity of information in the literature regarding the malignant transformation of oral squamous cell papilloma (SCP).
The authors present a unique case of virus-associated cancer highlighting its progress and implications.
Immunocompromised patients and the elderly are at higher risk of malignancy and require closer observation.
ABSTRACT… Haemorrhoids are one of the most common anorectal disorders. Internal haemorrhoids are symptomatic anal cushions and characteristically lie in the 3, 7 and 11 o'clock position whereas external haemorrhoids relate to venous channels of the inferior haemorrhoidal plexus. Objectives: To compare the outcome of haemorrhoidectomy using harmonic scalpel versus conventional closed haemorrhoidectomy. Study Design: Randomized control trial. In Group A, (70 patients) conventional haemorrhoidectomy was performed by the Ferguson Technique (closed technique) whereas in Group B, (70 patients) suture less closed haemorrhoidectomy was performed by using the harmonic scalpel. Results: The mean age of the patients in group A was 43.3±8.2 years and in group B was 42.3±7.3 years. The mean time for surgery in group A was 23.8±4.2 minutes and in group B was 8.5±3.6 minutes. The mean pain score in group A was 5.3±1.8 VAS and in group B was 3.9±1.9 VAS. In group A, less than 1 day postoperative hospital stay was in 62 (88.6%) patients and in group B, it was in 66 (94.3%) patients. Conclusions: It is concluded from this study that haemorrhoidectomy by harmonic scalpel results in decrease in operation time and less postoperative pain although there is not much significant difference in less than 1 day hospital stay as compared to the conventional closed haemorrhidectomy technique.
Key words:Haemorrhoidectomy, operating time, pain score, hospital stay, harmonic scalpel haemorrhoidectomy. Article Citation: Nasim A, Baig M, Saad R. Haemorrhoidectomy; outcome using harmonic scalpel versus conventional closed haemorrhoidectomy. Professional Med J 2017;24(1):69-74.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.