Foul-smelling Discharge Research Articles

Preoperative vaginal cleansing with chlorhexidine solution in preventing post-cesarean section infections in a low resource setting: A randomized controlled trial.

Infection is one of the most common causes of maternal morbidities and mortality and has been reported to be responsible for about 15% of maternal deaths. Any woman is at risk of infection during childbirth, but women undergoing cesarean section are at higher risk. Improvement in surgical procedures with asepsis and the use of antibiotics have helped reduce postoperative infectious morbidities. However, ascending infection from the lower to the upper genital tract is a common but often neglected source of infection. Cleaning the vagina with chlorhexidine antiseptic solution before cesarean section can be a cheap and affordable source of infection control. This study is aimed at evaluating the efficacy of preoperative vaginal cleansing using 1.0% chlorhexidine in the reduction of post-cesarean section infectious morbidities. This prospective randomized control trial was conducted among 322 pregnant women who underwent an emergency cesarean section at Alex Ekwueme Federal University Teaching Hospital, Abakaliki (AE-FUTHA). The women were randomized into two groups. The interventional group received vaginal cleansing with three standard gauzes soaked in 30mL 1.0% chlorhexidine gluconate solution preoperatively in addition to surgical skin cleaning with chlorhexidine-alcohol. The women in the control group only had surgical skin cleaning with chlorhexidine-alcohol. All the women received pre- and postoperative antibiotics. The primary outcomes were endometritis and wound infections. Infectious morbidity was significantly reduced from 36.8% in the control group to 12.0% in the intervention group (P=.001). Endometritis occurred significantly less frequently in the intervention group than the control group (respectively 6.6% compared with 27.6%: relative risk [RR] 0.29, 95% confidence interval [CI] 0.16-0.53; P<.05). Foul-smelling vaginal discharge was significantly more common in the control group than in the intervention group (11.8% vs 1.3%, respectively) but the CI was wide (RR 8.5, 95% CI 1.30-64.55; P<.001). Fever and wound infection were more common in the control group (5.9% vs 3.3% and 9.2% vs 5.3%) but the difference was not significant. The hospital stay was significantly shorter among the intervention group (5.54±1.04days compared with 6.01±1.55days, P<0.05). The most common microbial isolate implicated in endocervical colonization was Staphylococcus aureus followed by Klebsiella species. Vaginal cleansing with 1.0% chlorhexidine gluconate solution before emergency cesarean section appears to be effective in reducing rates of post-cesarean section infectious morbidity in the study area. We recommend its use among women undergoing cesarean section to help reduce the contribution of infections to a poor obstetrics outcome.

The Awareness Status of Pregnant Women about Obstetric Danger Signs

Giriş: Obstetrik tehlike belirtilerini erken fark eden gebeler, sağlık kuruluşuna daha hızlı başvurarak hem kendilerinin hem de fetüsün hayatının kurtarılmasına katkıda bulunurlar. Amaç: Araştırma, gebe kadınların obstetrik tehlike belirtileri hakkındaki farkındalıklarını ve bununla ilişkili faktörleri belirlemek amacıyla yapılmıştır. Yöntem: Kesitsel türdeki çalışmanın verileri, Nisan- Eylül 2018 tarihleri arasında anket formu ile toplanmıştır. Örneklem, ikinci basamak bir hastaneye başvuran 350 gebeden oluşmaktadır. Veriler, SPSS 21.0 istatistik programı kullanılarak tanımlayıcı istatistikler ve ki-kare analizi ile değerlendirilmiştir. Bulgular: Yaş ortalaması 29.57 ± 4.7 olan gebelerin %59.7’si multigravidadır. Gebelerin “tehlike belirtisidir” biçiminde işaretlediği ilk 10 belirti; kasılma ya da bayılma nöbeti geçirme (%88.6), bilinç/şuur kaybı (%88.3), üreme organlarından kan gelmesi/kanama (%86.9), tansiyonun yükselmesi (%82.3), ateşin yükselmesi (%81.1), üreme organlarında yara, uçuk, siğil, kaşıntı ya da kötü kokulu akıntı olması (%78.3), bebek harekelerinin eskiye oranla azalması (%78), nefes darlığı çekilmesi/morarma (%75.7), idrar yaparken ağrı ya da yanma (%71.1) ve görmede değişiklik (%69.4) idi. Gebelerin sosyodemografik ve obstetrik özellikleri ile incelenen konuda eğitim alma durumları, “tehlike belirtisi” olarak nitelendirdikleri bazı semptomlarla ilişkilidir. Sonuç: Gebelerin, antenatal bakım alma oranları yeterlidir. Obstetrik tehlike belirtileri konusundaki farkındalıkları istendik düzeyde değildir ve bazı alanlarda eğitime ihtiyaçları vardır. Yapılacak eğitimlerde, gebelerin sosyo-demografik ve obstetrik özellikleri göz önünde bulundurulmalıdır.

Knowledge, Attitude, and Practice on Cervical Cancer and Screening Among Women in India: A Review.

Background:Cervical Cancer is the second most common cancer among women in the world leading to 90% deaths in low and middle income countries. About 96,922 new Cervical Cancer cases are diagnosed annually in India.Objective:To study the knowledge, attitude and practice on Cervical Cancer and screening among women in India.Materials and Methods:Health sciences electronic databases PubMed and Google Scholar were searched for studies published between 2012 to March 2020. Keywords used for the search were (“Cervical Cancer screening”), (“knowledge”),(“attitude”), (“practice”) AND (“India”). 19 articles were included in the review based on the eligibility criteria. Statistical software SPSS-V.23 was used for the statistical application.Results:7688 women were included in the study. Age of study participants ranged from 12-65 years. Overall knowledge on Cervical Cancer among women was 40.22%. Knowledge of risk factors and signs and symptoms was fairly adequate among the women. 32.68% of women knew that early age of marriage was a risk factor for Cervical Cancer followed by 23.01% women who mentioned that early age of initiation of sexual activity was a common risk factor for Cervical Cancer. Inter menstrual bleeding and foul smelling discharge was the most common sign and symptom reported in 30.75% and 28.86% women respectively. Knowledge, attitude and practice regarding Cervical Cancer screening was seen in 20.31%, 43.64% and 13.22% of women respectively.Conclusion:Effective information, education and communication strategies are required to improve the level of awareness of women on Cervical Cancer.

Nasal foreign bodies in children – our experiences at a tertiary care teaching hospital in Eastern India

BackgroundChildren with nasal foreign body (FB) often come to clinician for its removal. These children often present with foul-smelling nasal discharge, nasal obstruction, nasal mucosal irritation, and epistaxis. In most cases, unilateral nasal FB is easily removed but occasionally may lead to life-threatening situation.ObjectivesTo study the details of the nasal FBs including treatment in children at a tertiary care teaching hospital of Eastern India.Patients and methodsThis retrospective study was done between June 2015 and July 2020 and included children attending the otorhinolaryngology clinic and emergency unit for nasal FB. Patient details such as age, sex, symptoms, type of FB, techniques of removal, and complications are analyzed.ResultsA total of 318 children with FB were included in this study. The mean age of the participants was 4.23 ± 1.8 years (range, 0–16 years); the male to female ratio was 1.6: 1 (male predominance). Most FB cases were owing to organic substances such as vegetables (30.81%), and nonorganic FB were paper piece, plastic piece, foam, metallic nuts, and button battery cell. The commonest clinical presentation among participating children was unilateral foul-smelling nasal discharge. Complications included epistaxis, rhinosinusitis, rhinolith, and perforation of the nasal septum.ConclusionFBs in the nasal cavities are a common accidental medical problem, especially in pediatric age. These nasal FBs are often harmless but may cause complications in some cases if neglected or overlooked without removing it in time. However, the best treatment remains the prevention.

Tumor recurrence in a previous abdominal incision site in a patient with endometrial adenocarcinoma: A case report

Endometrial cancer is frequently diagnosed at an early stage and exhibits a good prognosis. However, 10%–15% of tumors recur usually within 3 years. Common sites of recurrence are the vaginal vault and pelvis. Only a number of case reports exist for tumor recurrence in a previous incision site. We present a case of a 71-year-old Filipino woman, a diagnosed case of Endometrial Adenocarcinoma Stage III A, FIGO Grade 1, who underwent surgical management, chemotherapy, and radiation therapy 9 years prior, presenting with an abdominal mass at the inferior aspect of the previous surgical scar with the foul-smelling discharge of 1-year duration. Physical examination revealed a 6 cm × 4 cm, friable, movable, nontender abdominal mass, with associated edema of the mons pubis. Surgical resection showed that the mass was confined to the abdominal wall, with no extension beneath the fascia and no evidence of tumor in the pelvic and abdominal cavity. Histological examination revealed a moderately differentiated adenocarcinoma in the abdominal wall, confirming tumor recurrence in an atypical location, probably arising from the previous incision site.

UNSAFE TYPE OF CHRONIC OTITIS MEDIA, HOW PREVALENT IT IS?

Objective: To determine the frequency of unsafe type of chronic otitis media (COM) in patients with chronic ear discharge. Materials and Methods: A cross sectional study was conducted in August 2019 to May 2020 at ENT department, Khyber Teaching Hospital, Peshawar. All patients with more than 3 months history of ear discharge were included in the study. Unsafe COM was defined as persistent foul-smelling ear discharge for at least 3 months with attic or marginal perforation of the pars tensa, suspicious of cholesteatoma and granulation tissues on otoscopy/ otoendoscopy and/ or hearing loss of more than 30 dB on pure tone audiometry. Spss Version 22 was usecd for analysis. Results: Out of total 312 participants, age distribution showed 224 (72%) participants between 18-30 years, while 88(28%) between 31-60 years. Among 312 patients most of the participants 194 (62%) participants were male as compare to female 118 (38%) participants were female. Duration of symptoms showed 46 (15%) with duration of symptoms ≤6 months, 266 (85%) patients had duration of symptoms &gt; 6 months. Mean duration of symptoms was 6 months with SD ± 4.212. Unsafe type COM was found in 44 (14%) participants and 268 (86%) patients did not have unsafe type COM. Conclusion: The frequency of unsafe type of COM is 14% among patients presenting with chronic ear discharge.

Unexpected nasal foreign body

Foreign body in the nose is a common complaint in the paediatric age group and the most prevalent site of foreign body insertion compared to the ear and throat. Typical presentation involves foul-smelling unilateral nasal discharge. However, some cases are asymptomatic with no witnesses, and only discovered by medical practitioners during routine examinations. The diagnosis in this scenario becomes more challenging when another nasal pathology is present. We describe the case of a 6-year-old girl with underlying extensive infantile haemangioma of the face, tongue, neck and chest, who came for a routine follow-up, without any nasal complaints. However, the examination revealed right nasal crusting with bluish discoloration and hypertrophy of the right inferior turbinate, which was initially thought of as extension of the patient’s haemangioma. A foreign body in the right nasal cavity was noted by the girl’s parent on the next day after nasal douching, and was successfully removed in the clinical setting.

Isolated cortical vein thrombosis complicating orbital cellulitis

Background: Orbital cellulitis is characterized by the infective inflammation of orbital structures, usually posterior to the orbital septum. Extension of infection from the paranasal sinuses is the most common etiology for orbital cellulitis. Intracranial complications of orbital cellulitis include meningitis, subdural empyema, brain abscess, and cavernous sinus thrombosis.&#x0D; Case presentation: A 33-year-old man presented with acute onset of foul-smelling mucopurulent nasal discharge and swelling of the left eye followed by altered sensorium. On examination of the left eye, chemosis, eyelid edema, and proptosis were present. Computed tomography (CT) of the brain revealed non-axial left proptosis with inflammatory reticulation in the intra- and extraconal fat alongside sinusitis. Magnetic resonance imaging of the brain confirmed the CT findings and additionally showed meningitis and subdural empyema along the left frontoparietal convexity with parenchymal signal changes, suggesting venous infarction in the left frontal lobe. Susceptibility weighted imaging (SWI) confirmed thrombus in the frontal polar vein on the left side, suggesting septic isolated septic cortical venous thrombosis (ICVT) as a complication of orbital cellulitis. Cerebrospinal fluid showed polymorphonuclear cell pleocytosis with elevated protein and lowered sugar. Blood and conjunctival swab cultures were negative. He was subsequently treated with intravenous broad-spectrum antibiotics and antifungals to which he responded and was discharged in stable condition.&#x0D; Conclusions: Our case highlights the presentation of septic ICVT complicating orbital cellulitis and paranasal sinusitis. It also underscores the higher sensitivity of SWI as a crucial tool in diagnosing ICVT. Appropriate and prompt medical treatment in orbital cellulitis can prevent further complications.

Small cell neuroendocrine carcinoma coexisting with adenocarcinoma of the uterine cervix - a rare entity

Squamous cell carcinoma and adenocarcinoma are the most common histological types of cervical cancer. The co-existence of two histological types is rare. Here we report a case of a 65-year-old woman with a complaint of postmenopausal bleeding and a history of foul-smelling discharge per vagina for 8 months. On examination cervix flared up with growth, bled on touch, parametrium was involved and adherent anteriorly with bladder &amp; posteriorly with the rectum. Cervical biopsy revealed small cell carcinoma coexisting with Adenocarcinoma. Later it was confirmed by immunohistochemistry.&#x0D;

Chronic rhinosinusitis due to cyano-acrylic glue after endoscopic transsphenoidal pituitary surgery

BackgroundTo reduce the risk of cerebrospinal fluid leak, clinicians utilize a filling material placed in the sella followed by floor reconstruction with various materials, including glue sealing. Cyano-acrylic glue Glubran®2 glue is commercially available and is generally used as embolizing agent and for the prevention of cerebrospinal fluid leakage.Case DescriptionA 25-year-old woman underwent endoscopic endonasal transsphenoidal surgery for pituitary adenoma. After tumor resection, sellar floor reconstruction was performed by mucosal graft and Glubran®2 glue. The early post-operative period was uneventful. However, 2 months after surgery, the patient complained of headache, facial pain and greenish foul-smelling nasal discharge with solid particles dripping from the nose. Medical treatment was unsuccessful. Brain MRI showed inflammation and thickening of the sphenoidal and para-sphenoidal mucosa. The patient underwent endoscopic endonasal surgery and a solid glass-like mass surrounded by inflamed infected mucosa was seen in the inferior and lateral aspects of the sphenoid sinus. Efforts were made to erupt and de-crust the solid mass until total resection was achieved. Early post-operative period was uneventful, and a course of antibiotics was continued until total disappearance of the discharge.ConclusionTo the best of our knowledge, this is the first case reporting of acrylic glue (Glubran®2)-related sinusitis. Surgeon should be aware about similar side effects for the glue material that would complicate the surgery.

Haematoma vulvae et vaginae и Morbus maculosus Werlhofii

On October 12, 1891, a 22-year-old patient S. J. was admitted to the city hospital in Warsaw, who safely gave birth 12 days ago to a healthy girl, with signs of severe acute anemia and a colossal enlargement and swelling of the right large lip and pubic integument. The bladder is swollen and full of urine. With great difficulty, it was possible to find the opening of the urethra for catheterization through the mass of voluminous blood tumor. A foul-smelling discharge, yellowish in color, follows from the vagina. T - 40 C. Diagnosis Endometritis puerpuralis et haematoma vulvae et vaginae post partum.

ABNORMAL FINDING OF PAP SMEAR AMONG WOMEN HOSPITAL VISITORS IN CITY OF MOSUL, IRAQ

Objective: The research aims to test the use of the Pap smear screening system to identify precancerous lesions among women in City of Mosul, Iraq. Methods: This prospective study was carried out over 1 year at the Department of Obstetrics and Gynaecology in Mosul Teaching Hospital, city of Mosul, Iraq. We screened 100 sexually active women who were more than 21 years of age. Women with different complaints, including vaginal discharge, blood‑mixed discharge, foul-smelling discharge, postcoital bleeding, intermenstrual bleeding, postmenopausal bleeding, abdominal pain, infertility, and secondary amenorrhea, were included in this study. The glass slides had been sent for cytopathological review to the pathology department. The laboratory results have been reported by the new Bethesda Cervical Cytology Reporting System 2014. The device divided the lesions narrowly into certain negative ones for intraepithelial neoplasia and with epithelial cell abnormalities (ECA) that involve squamous and glandular cells. Upon pap smear, the patient was treated accordingly. Results: The study had enrolled a total of 100 cases. All of these patients had an abnormal Pap smear finding that fell according to TBS-2014 criteria in the category of Epithelial Cell abnormality. We interviewed all patients in Detail by proforma. The data reported were statistically analyzed and were collected following observations and tests. Among the study subject, the most common abnormal findings (68.9%) were negative findings. Inflammatory constitute (15.4), and Atypical squamous cells of undetermined significance (7%) followed by LSIL (5.9) and HSIL (2.9). Conclusion: Pap smear is an effective method for screening for Cervical Lesions Precancerous and cancerous. Nevertheless, a cervical biopsy must be performed which Is gold standard if any epithelial defects are found to be confirmed in cervical cytology.

ROLE OF HIGH-RESOLUTION COMPUTED TOMOGRAPHY TEMPORAL BONE IN THE EVALUATION OF UNSAFE CHRONIC SUPPURATIVE OTITIS MEDIA

Background: Unsafe or atticoantral chronic suppurative otitis media (CSOM) is characterized by scanty, purulent, and foul-smelling discharge with attic or marginal tympanic membrane perforation. This can be associated with serious complications. Objective: The objective of the study was to evaluate the pre-operative high-resolution computed tomography (HRCT) temporal bone findings in unsafe CSOM and to determine its usefulness in patients undergoing surgery. Materials and Methods: In this prospective study, 50 random patients with clinically diagnosed as unsafe CSOM from the ENT Department were subjected to HRCT temporal bone in the Department of Radiodiagnosis, Sriram Chandra Bhanj Medical College, Cuttack. The radiological findings were compared with the intraoperative findings. Results: The study results show a good correlation between the pre-operative (HRCT) and intraoperative findings. Cholesteatoma was seen in 35 cases. Ossicle erosion was seen in 40 cases with incus being the most commonly eroded ossicle, followed by scutum erosion (25 cases), mastoid cortex erosion (10 cases), sinus plate erosion (8 cases), tegmen erosion (6 cases), lateral semicircular canal erosion (4 cases), and facial canal erosion (5 cases). Among the extracranial complications (32 cases), mastoiditis was the most common complication and among the intracranial complications (3 cases), epidural abscess was most commonly seen. Conclusion: HRCT temporal bone helps in depicting the site, extent of the disease, bony erosions, and complications associated with the disease proving to be very helpful in surgical planning. Hence, it is necessary to preoperatively evaluate every case of unsafe CSOM with HRCT.

Knowledge of obstetric danger signs among Saudi Arabian women

BackgroundIn the Middle East, tremendous efforts have been made to promote both maternal and child health. However, there is little information in the literature about maternal knowledge of obstetric danger signs. Thus, this study aims to investigate Saudi Arabian women’s knowledge of obstetric danger signs and their determinant factors.MethodsA community-based, cross-sectional survey was conducted in primary health care centers (PHCCs) in Riyadh City. A proportionate random sample of women who have delivered during the past 2 years was selected from the PHCCs. Data were then collected through structured interviews; the questionnaire was developed based on the literature review.ResultsA random sample of 1397 women were included in the final analysis of this study. During pregnancy, 21.1% of the participants reported that they knew about swollen hands or faces. During labor, 23.1% of the participants reported that they knew about prolonged labor (> 12 h). At postpartum, 26.3% of the participants reported that they knew about foul-smelling vaginal discharge. In this study, women in the northern region of Riyadh who visited government hospitals had significantly higher odds of knowing at least one obstetric danger sign. A statistically significant difference was found between the participants’ knowledge of at least one obstetric danger sign and her 11–15 times of antenatal care visit.ConclusionsA dedicated health education guide, and a kingdom-wide maternal and child health preventive care promotion program could improve the health and wellbeing of expectant mothers. In these programs, it is essential to focus on birth preparedness, with danger signs recognition, and the integrate health-related data for the whole kingdom.

Penile necrosis due to calciphylaxis in peritoneal dyalisis patient: a case report

Introduction: Calciphylaxis (or calcific uremic arteriolopathy) is a life-threatening condition that affects 1–4% of patients with end-stage renal disease (ESRD). Penile necrosis is one of the complications of calciphylaxis that occur in ESRD patients undergone haemodialysis. Although rarely happen, this condition is potentially life-threatening and usually has a poor prognosis. It is associated with diabetes mellitus (DM), cholesterol embolism. The treatment varies, from surgical to conservative, and is usually depends on patient’s general condition.Case presentation: A 41-years-old male, known to have ESRD and underwent hemodialysis for 1 year in 2014, but has been switched to peritoneal dialysis ever since, presented with complaints of severe pain, purulent and progressive necrosis of glans penis within the last two months, and history of long-term DM and hypertension. Physical examination showed that the patient was alert, with blood pressure of 141/80 mmHg, pulse rate of 88 bpm, respiration rate of 20 times per minute, and temperature of 36.8ºC. A yellow purulent tissue was noticed over the glans penis, foul-smelling discharge was observed from urethra and undersurface of penile lesion. Laboratory examination showed elevated calcium level of 7.3 mg/dL. Ultrasound revealed multiple calcifications at the base of penis, hypoechoic lesion, nearly circular, irregular border, likely sac with thin wall, attached to the gland penis, and filled with exudate. Doppler confirmation showed avascular area. The patient was treated with partial penectomy, debridement, and antibiotic.Conclusion: Calciphylaxis in peritoneal dialysis patients as reported in this case was rarely found. Although the treatment is still debatable, however, we decided to impose surgical approach in this patient along with antibiotics. Despite its poor prognosis, the patient in this case showed improvement after the procedure.

Ascaris lumbrocoides in the Right Maxillary Sinus-a rare case

Introduction: Sinusitis is fairly a common condition in an Otolaryngology clinic.However sinusitis due to Ascaris lumbrocoides obstructing the maxillary ostium is a very rare case.&#x0D; Objective: To report a very rare case of round worm in the Right Maxillary sinus.&#x0D; Case report: A nine year old girl presented with right nasal blockage and dull aching pain over the right maxilla and foul smelling discharge from the right nostril for a week duration. Examination revealed a cord like structure in the right nostril which was very painful on manipulation. Examination under generl anesthesia revealed a 15 cm long dead Ascaris lumbrocoides in the right nostril emerging from the right maxillary sinus obstructing its ostium. After removal of the round worm, patient and the immediate family members were treated with Albendazole.&#x0D; Conclusion: In rare occasions, particularly in underdeveloped countries, clinicains should be midful that round worms can be a cause of sinusitis.&#x0D; J Dhaka Medical College, Vol. 28, No.1, April, 2019, Page 126-128

Wound Healing Efficacy of Re Cell Heal in a Diabetic Foot Infection Patient Diagnosed with Gas Gangrene – A Case Report

Gas gangrene is a rapidly progressive and bacterial infection that produces tissue gas in gangrene. The condition may result from ischemia, infection, or trauma or a combination of these processes. A 72-year-old woman with a 10 years history of type-2 diabetes mellitus (NIDDM) presented to the emergency department with a one-week history of left foot painful, swelling, redness, fever and foul-smelling discharge from wound. Wound infection of the left foot worsening progressing to gas gangrene that remains unhealed after a week to one month. She was diagnosed with Clostridium perfringens and Clostridial myonecrosis. The foot X-ray showed a 13 X 8.5 X 1.75 cm and is surrounded by callus under the 1st to 5th metatarsal heads (Figure 3a &amp; 3b). Computed tomography (CT) scan showed moderate air suggesting deep tissue infection, with multiple tiny gas bubbles within under the first metatarsal heads, concerning for gas gangrene. The patient was treated with Poly Herbal Formulation (PHF), Re Cell Heal 500 mg Capsule (PRANATHI HERBALS; License No. T-2265/Ayur/; Letter No 2884/ DA/2018) (p.o) twice a day, in addition to the (Topical) Wound Check Ointment (Letter No 4964/DA/2018) accompanied with debriment over a five (5) months, foot healed without amputation improved therapeutic outcomes, reduce fatalities caused by gas gangrene. Re Cell Heal helps to provide relief in the symptoms like swelling and pain in tissues. Recent scientific evidences and trials conducted on Re Cell Heal is a traditional and alternative medicine in wound therapy, gas gangrene and diabetic related foot problems holds good promise in the future safety without any side effects.

Unnoticed impacted foreign body ear presenting as chronic suppurative otitis media with postaural fistula: a rare case

&lt;p class="abstract"&gt;Foreign body ear, especially in the external auditory canal are common in adults and children. Most common age group presenting with foreign body is 2 to 10 years. Most common foreign bodies are seeds insects, paper, chalk pieces etc. Most common complications of foreign body ear are pain, bleeding, foul smelling discharge, otitis externa and irritation of ear. There are chances of external auditory canal laceration, bleeding, infection, perforation of tympanic membrane, dislodgement of foreign body towards inner region during the time of removal. This is a case of unnoticed impacted foreign body presented as chronic suppurative otitis media with postaural fistula, found on table broomstick foreign body which was removed using canaloplasty and further managed with tympanoplasty and cortical mastoidectomy.&lt;/p&gt;

Massive epistaxis secondary to an impacted rhinolith in mentally disabled patient

&lt;p class="abstract"&gt;Foreign body nose commonly seen in paediatric age group. In mentally disable patient this may occur and become asymptomatic for many years. We reported mentally disable patient presented with massive epistaxis and history of multiple episodes of foul-smelling discharge from his right nose for the past 20 years. After epistaxis resolved during nasal endoscopy noted impacted rhinolith foreign body in between the septum and the right middle turbinate. Rhinolith successful removed using bent tip of Jobson-Horne probe in otorhinolaryngology, head and neck clinic.&lt;/p&gt;

CASE REPORT ON FOURNIER'S GANGRENE

Fournier's Gangrene is a rare condition marked by fluminent polymicrobial necrotising fascitis which involves scrotum and penis, or both with occasional extensions upto the an abdominal wall. Pre disposing factors includes Diabetes mellitus,Immuno compromised patients, Alcoholism, Tobacco, Chemotherapy, Radiography etc. Fournier's Gangrene occurs at any age and it effects mostly in men but also effects women too. We present a case of Fournier's Gangrene - A 40 years old male patient was admitted in emergency department with the complaints of pain over the Testicular region, Itching, Ulcerative over the scrotal region with foul smell & pus discharge and fever. This symptoms have started five day prior to the presentation but symptoms are rapidly progressive in nature since 24 hours of admission. His past medical history reveals that he has Diabetes mellitus type-1 and on medication. He had undergone surgery of hydrocelectomy one month back.The management steps Includes Resustation , Broad spectrum Antibiotics, Surgical debredment and skin grafting. As the patient is known diabetes the chances of infection is more. So early presentation, diagnosis and treatment plays a major role in preventing further complications. In order to do this, we have to provide awareness about the disease among the people.