Production Of Pus Research Articles

Characterization of the microorganisms of human pus samples- a tertiary care hospital based study

The term "pyogenic infection" describes an infectious agent-induced localized inflammation and pus production caused by a buildup of dead leukocytes. 120 patients' specimens were gathered and grown on blood agar and MacCokey agar. Biochemical tests were used to identify colonies grown in these conditions, and subsequently their antibiotic susceptibility was examined. When combined with the patient's medical history, these data showed how common pyogenic infections were in BIHS General hospital, Dhaka. Within 86.67% of the Positive pyogenic infection were due to bacterial agents, with Staphylococcus aureus (23.07%), Escherichia coli (15.39%), Klebsiella (15.39%), Proteus (15.39%), Pseudomonas (7.69%), Enterococci (7.69%), Citrobacter (7.69%), Enterobacter (7.69%) being the major pathogens. Female was predominant than male which was 72 (60%) cases and 48 (40%) cases respectively. The most common age group for both the male and female groups was 40–60 years old, with 16 (13.33%) and 64 (53.33%) instances, respectively. In conclusion, Staphylococcus aureus is the most often isolated bacterium following aerobic culture of pus. Nonetheless, there are fewer gram-positive cocci than gram-negative bacilli.

Non-Isocyanate Polyurethane Synthesis by Polycondensation of Alkylene and Arylene Bis(fluoroalkyl) Bis(carbonate)s with Diamines

Abstract Alkylene and arylene bis(fluoroalkyl) bis(carbonate)s (BFBCs) were quantitatively synthesized through base-catalyzed fluoroalkyl carbonate esterification of diols with bis(fluoroalkyl) carbonates (BFCs). Non-isocyanate polyurethane (NIPU) synthesis was then achieved without a catalyst through polycondensation reactions of BFBCs and a series of diamines in solvent or solvent-free conditions. Compared with the previously reported synthetic methods of NIPUs, this method has the distinct advantage of synthesizing a wide variety of NIPUs including new and commercially available conventional PUs. This method allows the arbitrary synthesis of NIPUs with commonly available diols and diamines used in the industrial production of PUs by the conventional isocyanate method, or with original synthetic ones. Furthermore, when using a solvent, the polycondensation occurred below 100 °C to give a colorless PU having an average molecular weight of over 10000. Transparent films with the characteristic high elasticity of PU could be obtained from a proper combination of BFBC and diamine, one as the hard segment and the other as the soft segment. Then, a novel fluorinated PU was successfully synthesized from a fluoroalkylene BFBC and a diamine. The present new reaction will be a practically available production method of functional NIPUs.

Successful Intrapericardial Fibrinolysis on Acute Recurrent Purulent Pericarditis with Impending Cardiac Tamponade during Pandemic Situation: A Rare Case Report

Introduction: Acute recurrent purulent pericarditis is an uncommon pericardium infection that can be life-threatening due to pus production, leading to cardiac tamponade. Case presentation: We report a 36-year-old man referring to our hospital with impending cardiac tamponade who needed urgent pericardiocentesis. The patient's complaints were worsening dyspnea and palpitations in the last two days. The patient had been hospitalized for the same complaint and had pericardiocentesis due to cardiac tamponade approximately three weeks earlier. Physical exam, ECG, and CXR suggest impending cardiac tamponade. Echocardiography indicated massive right and left pericardial effusion and right atrial collapse. The Covid-19 screening test was positive; however, RT-PCR revealed a negative result. The patient was diagnosed with recurrent acute purulent pericarditis with impending cardiac tamponade requiring urgent pericardiocentesis. After the procedure, 1.5 million units of intrapericardial fibrinolytic were administered to patients. His improved hemodynamic and clinical symptoms indicate a successful procedure. Conclusion: This case highlights the challenges of managing an acute recurrent purulent pericarditis patient due to Staphylococcus A. infection in the current pandemic era, including distinguishing it from other contagious diseases due to nonspecific dyspnea, limited therapeutic options, and the effectiveness of intrapericardial fibrinolytic in improving the overall patient conditions, and reducing the mortality rate.

Unconstrained one-stage total knee arthroplasty PS design in patient with secondary osteoarthritis due to granulomatous infection with medial femoral condyle defect: A case report.

Introduction and importanceGranulomatous Mycobacterium Tuberculosis Infection Causes Secondary Knee Osteoarthritis is still a point of contention in terms of therapy, whether it is done early in the first stage or later in the second stage of knee surgery. Early Total Knee Arthroplasty as a therapy for secondary knee osteoarthritis induced by Granulomatous mycobacterium tuberculosis infection is still performed rarely.Case presentationA case of left pain and swollen knee in males for 8 months. Because of pain and reduced knee range of motion, the patient now has an antalgic gait, which make him difficult to do daily activities. Treatment with medications and physiotherapy failed. Radiographs revealed juxta-articular osteoporosis, peripherally distributed osseous erosions, joint space narrowing, and a bony defect in the medial femoral condyle. This case was successfully treated using Unconstrained Knee Arthroplasty PS Design.Clinical discussionCase selection for granulomatous infection case is key element to determine whether a single TKA procedure can be used to treat knee pain problems as a result of secondary osteoarthritis.ConclusionThis case shows secondary knee osteoarthritis caused by Granulomatous Mycobacterium Tuberculosis Infection without pyogenic pus production might allow for early one-stage total knee arthroplasty. Three months following surgery, the patient's knee was stable and painless, with good wound healing and no signs of infection.

English

BACKGROUND Active mucosal chronic otitis media (COM) is a disease of the middle ear cleft associated with inflammation and production of pus. The incidence is high in developing countries. It affects all age groups and both genders. If not properly treated, it can lead to complications. The bacterial isolates and their sensitivity pattern vary from place to place and also over time. Early identification of the microorganisms and their antibiotic sensitivity patterns helps in proper selection of antibiotics and quick recovery in COM patients. METHODS Fifty patients with active mucosal COM were selected for the study. The study was conducted over a period of one year. Ear swab from the deep external auditory canal was collected under strict aseptic precautions from these patients before starting antibiotic treatment. Microorganisms were identified by gram staining, growth on different agar plates, and various biochemical tests. Antibiotic sensitivity was done by the Kirby-Bauer method. RESULTS Majority of the patients were in the age group of 21 - 40 years (42 %) with female preponderance (62 %). All patients had a central perforation in the tympanic membrane (100 %). Bacterial growth was seen in 44 samples (88 %). Two samples (4 %) showed fungal growth. Four samples (8 %) showed no growth even after 48 hours of incubation. Single bacterium was isolated in 41 cases (82 %) whereas 3 samples (6 %) showed more than one bacterial growth. The predominant bacteria were Pseudomonas aeruginosa (50 %) followed by Staphylococcus aureus. The other isolates were coagulase negative staphylococci, enterococci, enterobacter, acinetobacter, and E coli. Pseudomonas showed maximum sensitivity to amikacin, imipenem and piperacillin / tazobactam (100 %). The most effective antibiotics for staphylococcus was vancomycin and linezolid. CONCLUSIONS The most common bacteria isolated in active mucosal COM were pseudomonas followed by Staphylococcus aureus. The most effective antibiotics for pseudomonas was amikacin, imipenem and piperacillin / tazobactam. Staphylococcus showed maximum sensitivity to vancomycin and linezolid. KEYWORDS Chronic Otitis Media (COM), Active Mucosal, Ear Swab, Bacteriology, Sensitivity

Late Eyelid Reconstruction of Necrotizing Fasciitis

Necrotizing fasciitis (NF) is a devastating severe infection. NF involving periorbital tissue is rarely found. We reported a 42-year-old woman with eyelid edema surrounded by necrotic tissue and pus production for about a week. LRINEC score was 6. Widespread local excision and debridement were urgently performed. Reconstruction performed two weeks after the onset. The rotational flap is taken from her forehead to prompt good skin remodeling and vascularization. A part of the flap slipped underneath the temporal skin. The flap was perfectly grown, and the eyelid function recovered. NF is a rare severe infection and rarely involves the periorbital area. Early recognition is critical. LRINEC score could be used, and urgent debridement is needed. Late skin flap could be a choice to cover the debrided skin and give a good aesthetic yet functional eyelid.

Antibiotic Sensitivity Pattern of Pathogens Isolated from Pus Culture- A Tertiary Care Hospital Based Study

Background: Microbial pathogens cause human skin and soft tissue infections (SSTI) and surgical site infections (SSI) after surgical procedures. These can result in the production of pus, yellowish fluid comprising of dead WBCs and cellular debris. The microorganisms responsible for pus production vary greatly in relation to their spectrum of prevalence in different hospital and also in their antibiotic sensitivity. Further, the antibiotic sensitivity also changes because of the emergence of resistant strains. It is therefore, important that the common bacterial pathogens causing infection in a particular hospital and their sensitivity should be known. This will help in the choice of prophylactic antibiotic and in initiating the empirical antibiotic prescription for the infected cases before the culture sensitivity report is made available which takes about 2-3 days.
 Objective: To identify the spectrum of aerobic bacteria which are responsible for SSTI and SSI and their antibiotic sensitivity pattern.
 Method: This cross sectional hospital based study was conducted in Nepalgunj Medical College and Teaching Hospital (NGMCTH), Kohalpur from January 2019 to November 2019. These pus swabs were obtained from the Department of Surgery and Department of Gynaecology & Obstretics. Samples were cultured in the Microbiology laboratory of NGMCTH, Kohalpur. Identification and characterization of isolates were performed on the basis of Gram staining and cultural characteristics. Antibiotic sensitivity test was performed in vitro by Bauer-Kirby method. Collected data were statistically analyzed using SPSS 20.0 and Microsoft Excel 2015.
 Results: During the study period, a total number of 311 pus swabs were obtained among which only 164 (52.73%) pus swab showed bacterial growth. Out of 164 pus swabs, 150 pus swabs yielded monomicrobial growth (150 bacterial isolates) and 14 pus swabs yielded polymicrobial growth (33 bacterial isolates). Gram Negative Bacteria (60.1%) was more prevalent than Gram Positive Bacteria (39.9%). Combined together, the most common isolate was S. aureus (36.1%) followed by E.coli (24.0%), Klebsiella (14.2%), Enterobacter (11.5%), Pseudomonas (9.8%), S. pyogenes (3.3%) and Proteus (1.1%). S. aureus was highly sensitive to Doxycycline (90.6%), Chloramphenicol (81.5%), Amikacin (79.5%) and Ceftraixone (72.7%). S. pyogenes showed 100% sensitivity to Cefexime, Amikacin, Chloramphenicol, Azithromycin and 80% sensitivity to Doxycycline. Similarly, most common gram negative isolate E.coli showed higher sensitivity to Chloramphenicol(71.4%) and Amikacin (66.7%) , Klebsiella showed higher sensitivity to Doxycycline(92.3%), Gentamicin(87.5%) and Amikacin (81.0%), Enterobacter showed higher sensitivity to Amikacin(90.9%) and Pseudomonas was highly sensitive to Chloramphenicol (71.4%) and Amikacin (66.7%). Piperacillin, Amikacin, Gentamicin, Ofloxacin and Ceftriaxone showed 100% sensitivity to Proteus spp. Amoxyclav, Cefepime and Cefexime (except in S. pyogenes) showed least sensitivity in both gram negative and gram positive bacterial isolates.
 Conclusion: In our study, the most common isolate wasS. aureus. Amikacin, as a single drug was found to be effective for empirical therapy of both gram negative and gram positive bacteria whereas Doxycycline and Amikacin was found effective in gram positive isolates. Amoxyclav and Cefepimewas commonly resistant in all bacterial isolates.

Differences Exudates After Irrigation With Measured Pressure on Diabetic Ulcers

Diabetic ulcer is a further complication of the presence of diabetic ulcers that are not handled properly. Gangren ulcers are very difficult to cure. One of them is the characteristic of gangrene wounds that have a hollow (hard) that is very difficult to do cleansing. In addition, the types of bacteria that are in gangrene are anaerobic bacteria that are difficult to treat with antibiotics. The number of bacteria will also be proportional to the number of production of pus. One of the most possible actions is to irrigate the wound tunnel so that the wound is clean and anaerobic bacteria are reduced. The modern wound irrigation device, which is one of the developments of existing irrigation devices, is expected to be able to reach gangrenous wound tunnels with a modified form of output. This study aimed to determine the effect of modification of the output of the modern wound irrigation device (MWID) on the number of bacteria in diabetic gangrenous ulcer sufferers. The method used in this study was quasi-experimental without a control group. The intervention group was given wound irrigation using a modified MWID tool. The instrument was used to determine exudate production using the observation sheet Leg Ulcer Measurement Tool (LUMT). The results of the analysis by the Mc Nemar test showed that p value 0.67 (p value> 0.05) means that there is no difference in the amount of exudate production with modification of the MWID output. Further research is needed regarding the effect of irrigation angle on the number of bacteria in diabetic ulcers.

Surgical outcome in chronic otitis media with cholesteatoma

<p class="abstract"><strong>Background:</strong> Cholesteatoma is synonymous with active squamous type of disease where there is retraction of pars flaccida or tensa that has retained squamous epithelial debris and is associated with inflammation and the production of pus. This pathology can only be eradicated by meticulous surgery. Our study compares the surgical outcome of intact canal wall vs. canal wall down surgeries done for cholesteatoma.</p><p class="abstract"><strong>Methods:</strong> Prospective study on 42 patients who underwent surgery for cholesteatoma between December 2010 and March 2013 at VIMS, Bellary. </p><p class="abstract"><strong>Results:</strong> The net improvement in ABG in ICW mastoidectomy was 16.03 (±7.5) dB and that in CWD mastoidectomy was 11.39(±7.4) dB with a significant p value of 0.04 as determined by the independent ‘t’ test. The residual disease rate for ICW mastoidectomy was determined as 12% whereas recurrence rate was nil. CWD mastoidectomy had no residual or recurrent disease in the 6-month follow-up period. Postoperative complications were noted in 15% of the study population.</p><p class="ETDBodyText"><strong>Conclusions:</strong> The ICW and CWD surgeries have their own advantages and disadvantages and when performed meticulously both serve the purpose of rendering the patient a safe ear. The ICW procedure leaves behind an anatomically near normal ear and when quality of life concerns needs to be addressed this should be the procedure of choice, with advancement in technology and availability of angled endoscopes which have marched well into otology. The CWD procedure should be reserved to cases presenting with complications and in patients who are more likely to be lost to follow-up.</p>

Bacteriological Profiles of Pus with Antimicrobial Sensitivity Pattern at a Teaching Hospital in Dhaka City

Background: The human skin and soft tissue infections (SSTIs) caused by microbial pathogens during or after trauma, burn injuries, and surgical procedures result in the production of pus, a white to yellow fluid comprised of dead WBCs, cellular debris, and necrotic tissues.Objective: The purpose of the present study was to see the frequency and distribution of bacteria isolated from pus and sensitivity pattern.Methodology: This retrospective study was conducted in the Department of Microbiology at Shaheed Suhrawardy Medical College, Dhaka from January 2016 to December 2016 for a period of one (01) year. The pus samples were collected from the patients who were visited in outpatient department and were admitted at IPD in Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka with skin and soft tissue infection. Bacteria were detected by culture and biochemical test and antibiotic susceptibility test done by disc diffusion method.Result: A total number of 212 patients presented with wound infection or pus were recruited for this study. Among 212 patients majority were in the age group of 20 to 40 years which was 89(42.0%) cases. Interestingly male was predominant than female which was 119(56.1%) cases and 93(43.9%) cases respectively. aerobic culture was positive in majority cases which were 131(61.8%) cases.Conclusion: In conclusion the most common isolated bacteria after aerobic culture of pus is the Staphylococcus aureus. However the gram positive cocci is less in number than gram negative bacilli.Bangladesh Journal of Infectious Diseases 2018;5(1):10-14

Ossicular Involvement and Types of Pathology in Chronic Otitis Media Squamous Active Disease

Background: Chronic otitis media (COM) squamous type is commonly as­sociated with cholesteatoma. In COM squamous type with active disease, there is retraction of pars flaccida or pars tensa with retention of squamous epithelial debris and is associated with inflammation and production of pus. It is potentially dangerous because it can cause resorption of bone, leading to ossicular erosion and destruction of bony plates of middle ear. The objective of this study is to determine the effect of chronic otitis media squamous type on the ossicular chain as well as to observe the types of pathology in this disease.
 Methods and materials: Fifty cases of chronic otitis media squa­mous type who underwent surgical management were included. The status of ossicular chain was evaluated intraoperatively. The type of pathology in­volving middle ear was also studied. Cases admitted for revision surgery were excluded from the study.
 Results: Of the total fifty cases, ossicular changes were observed in forty eight cases and in two cases all ossicles were intact. Long process of incus is the most frequently involved ossicle. The most common pathology was found to be mixed type (52%).
 Conclusion: The conclusion of this study is that ossicular chain is commonly involved in chronic otitis media squamous type and mixed pathology consisting of cholesteatoma and granulation tissue is the most frequent pathology.

A bioluminescent Pseudomonas aeruginosa wound model reveals increased mortality of type 1 diabetic mice to biofilm infection.

To examine how bacterial biofilms, as contributing factors in the delayed closure of chronic wounds in patients with diabetes, affect the healing process. We used daily microscopic imaging and the IVIS Spectrum in vivo imaging system to monitor biofilm infections of bioluminescent Pseudomonas aeruginosa and evaluate healing in non-diabetic and streptozotocin-induced diabetic mice. Our studies determined that diabetes alone did not affect the rate of healing of full-depth murine back wounds compared with non-diabetic mice. The application of mature biofilms to the wounds significantly decreased the rate of healing compared with non-infected wounds for both non-diabetic as well as diabetic mice. Diabetic mice were also more severely affected by biofilms displaying elevated pus production, higher mortality rates and statistically significant increase in wound depth, granulation/fibrosis and biofilm presence. Introduction of a mutant Pseudomonas aeruginosa capable of producing high concentrations of cyclic di-GMP did not result in increased persistence in either diabetic or non-diabetic animals compared with the wild type strain. Understanding the interplay between diabetes and biofilms may lead to novel treatments and better clinical management of chronic wounds.

Aktivitas Penyembuhan Luka Sediaan Topikal Ekstrak Bawang Merah (Allium cepa) terhadap Luka Sayat Kulit Mencit (Mus Musculus) (THE ACTIVITY OF TOPICAL EXTRACT OF ONIONS (ALLIUM CEPA) ON WOUND HEALING PROCESS IN MICE (MUS MUSCULUS))

Wound healing is a physiological response of the body to restore continuity, structure and function ofthe injured tissue. Onion is one of the plants that are empirically used by the community to heal wounds.The purpose of this study was to observe the effect of topical extract of onions (Allium cepa) on woundhealing process in mice (Mus musculus) strain BalbC. This study used the posttest-only control groupdesign with completely randomized design (CRD). The samples were 12 male mice with weight ranged of22-32 g divided into four treatments; i.e.: Vaseline, topical extract of onion 5%, topical extract of onion30% and topical extract of onion 55% with 3 replications. Wound healing evaluated macroscopically toobserve hyperemia, wound contraction, granulation, crusting and pus production; and microscopically bycounting the number of fibroblasts on day 10. Hyperemia, granulation, crusting and pus production wereanalyzed descriptively. Wound contraction and the number of fibroblasts were analyzed using ANOVA(p<0.05) and followed with Duncan’s test (p<0,05). Descriptive observations obtained hyperemia lasteduntil day 3, granulation in wounds used topical extract of onion 30% and 55% were faster than the other,crusting lasted until day 6 and the production of pus was not found in any treatment. Statistical testresults showed that topical extract of onion 55% significantly affected wound contraction and topicalextract of onion 30% and 55% significantly affected maturation, which characterized by the decreasednumber of fibroblasts. The results of this study showed that topical extract of onion had significant effect(p<0.05) on wound healing and the effect was in line with the increased concentration of the onion extract.

Epidural abscess imitating recurrent pilonidal sinus: a case report

Pilonidal sinus or pilonidal cyst is a common benign disease, affecting mostly young working men. We present the first case of an epidural abscess imitating pilonidal sinus. A 33-year old male, suffering from previously undiagnosed and untreated diabetes mellitus (DM), presented to our emergency department (ER), one month after open surgical treatment of pilonidal sinus, due to weakness and fever. After re-operation of the pilonidal cyst and due to post-operative pus production and continuation of fever a computer tomogr aphy (CT )scan was performed revealing an epidural abscess extending from the thoracic vertebrae 12 (T-12) to the sacrococcygeal area. At that point he underwent new surgery for drainage of the epidural abscess. The patient received intravenous antimicrobial treatment and was discharged on the 23rd postoperative day without signs or symptoms of infection. At follow up for a whole year no signs of recurrence have been observed.

An Important Role for N-Acylethanolamine Acid Amidase in the Complete Freunds Adjuvant Rat Model of Arthritis

The endogenous lipid amides, palmitoylethanolamide (PEA) and oleoylethanolamide (OEA), exert marked antinociceptive and anti-inflammatory effects in animal models by engaging nuclear peroxisome proliferator-activated receptor-α. PEA and OEA are produced by macrophages and other host-defense cells and are deactivated by the cysteine amidase, N-acylethanolamine acid amidase (NAAA), which is highly expressed in macrophages and B-lymphocytes. In the present study, we examined whether a) NAAA might be involved in the inflammatory reaction triggered by injection of complete Freund's adjuvant (CFA) into the rat paw and b) administration of 4-cyclohexylbutyl-N-[(S)-2-oxoazetidin-3-yl]-carbamate (ARN726), a novel systemically active NAAA inhibitor, attenuates such reaction. Injection of CFA into the paw produced local edema and heat hyperalgesia, which were accompanied by decreased PEA and OEA content (assessed by liquid chromatography/mass spectrometry) and increased NAAA levels (assessed by Western blot and ex vivo enzyme activity measurements) in paw tissue. Administration of undec-10-ynyl-N-[(3S)-2-oxoazetidin-3-yl] carbamate (ARN14686), a NAAA-preferring activity-based probe, revealed that NAAA was catalytically active in CFA-treated paws. Administration of ARN726 reduced NAAA activity and restored PEA and OEA levels in inflamed tissues, and significantly decreased CFA-induced inflammatory symptoms, including pus production and myeloperoxidase activity. The results confirm the usefulness of ARN726 as a probe to investigate the functions of NAAA in health and disease and suggest that this enzyme may provide a new molecular target for the treatment of arthritis.

The Bolognese surgeon Giuseppe Ruggi: how and why the aseptic surgery was introduced in Bologna in the middle half of the XIX century

BackgroundThe first reliable statistic data about perioperatory mortality were published in 1841 by the French Joseph-Francois Malgaigne (1806–1863): he referred to a mean mortality of 60% for amputations and this bad result was to be attributed mainly to hospital acquired diseases. The idea of “hospital acquired disease” although vague, included five infective nosologic entities, which at that time were diagnosed more frequently: erysipelas, tetan, pyemia, septicemia, and gangrene. Nonetheless, the suppuration with pus production was considered from most of the surgeons and doctors of that time as a necessary and unavoidable step in the process of wound healing. During the end of the eighteenth century, hospitals of the main European cities were transforming into aggregations of several wards, where the high concentration of patients created poor sanitary conditions and a consistent increase of perioperatory mortality. In 1865, Lister applied his first antiseptic dressing on the surface of an exposed fracture. These experimental attempts lead to an effective reduction of wound infections respect to the dressing with strings used previously. DiscussionLister's innovations in the field of wound treatment were based on two brand new concepts: germs causing rot were ubiquitarious and the wound infection was not a normal step in the process of wound healing. The concept of antisepsis was hardly accepted in the European surgical world: “Of all countries, Italy is the most indifferent and uninterested in experimenting this method, which has been so favorably judged from the greatest surgical societies in Germany”. This quotation from the young surgeon Giuseppe Ruggi (1844–1925) from Bologna comes from his article where he presented his first experiences on aseptic medications started the previous year in the Surgical Department of Maggiore Hospital in Bologna. In his report, Ruggi described the adopted technique and suggested that the medication should be extended to all the surgical patients of the hospital:“… this is needed to totally remove from the hospital all those elements of infection which grow in the wounds dressed with the old method”. The experimentation of this new dressing for the few treated cases was rigorous and concerned both the sterilization of surgical tools with the fenic acid (5%) and the shaving of the skin. Ruggi also observed that there was no correlation between the seriousness of the wound and its extension or way of healing: when “simple” cases that “should heal without complication” showed fever he often realized that “it was often due to a medication performed without following the rules for an accurate disinfection and dressing”. Ruggi thought that the fever was connected to “reabsorption of pyrogenic substances, which can be removed cleaning and disinfecting the wound” in cases of wounds not accurately dressed and rarely medicated. Frequent postoperative medications of the wound were able to eliminate the fever within 2 h. Ruggi's attitude toward the fine reasoning lead him to introduce the concept of immunodeficiency related to physical deterioration: “… patients treated for surgical disease may sometimes suffer from complications of medical conditions, which initially escape the most accurate investigations… The surgical operation could, in some cases, hold the balance of power”. ConclusionsThe obtained results, published in 1879, appear extremely interesting. As he wrote in 1898, for the presentation of his case record of more than 1000 laparotomies, he had started “… operating as a young surgeon without any tutor, helped only by his mind and what he could deduce from publications existing at the moment …”.

The proboscis of eye-frequenting and piercing Lepidoptera (Insecta)

The external structures of the proboscis are investigated in eye-frequenting species of Noctuidae, Geometridae and Pyralidae by means of scanning electron microscopy. They are compared with non-eye-frequenting representatives of these families. In Noctuidae, highly specialized fruit-piercing, skin-piercing blood-sucking, and sweat-feeding representatives have been included. All hemi- and eulachryphagous species have a soft proboscis tip which is characterized by few sensilla and strongly elongated, dentate plates of the dorsal galeal linkage. The latter structures leave broad gaps between them that lead into the food canal at the tip. This arrangement permits the uptake of fluid suspensions such as lachrymal fluid, wound exudates and pus. The modified dorsal galeal linkage is regarded as an adaptation for this highly derived feeding habit. The rough surface of the proboscis is likely to cause irritation and possible mechanical damage to the conjunctiva and cornea which results in an increased lachrymal flow and production of pus. In contrast to fruit-piercing and skin-piercing Noctuidae, there are no erectile structures on the proboscis of eye-frequenting species.—The comparison with related non-eye-frequenting species demonstrates that the particular morphology of the proboscis tip in lachryphagous moths evolved convergently in different families of Leipdoptera.

Comportamiento experimental del Sporothrix schenckii y la Leishmania mexicana en el hamster

The macroscopic description of the pathogenic process of Sporothrix schenckii and Leishmania mexicana spp in hamsters inoculated subcutaneously in the nose provided bases for the differentiation of the behavior of these two microorganisms in a model frequently utilized for their study. Sequential observations over 150 days demonstrated that infections caused by these pathogens results initially in edema and erythema followed by loss of hair, necrosis and ulceration. The pus production was a characteristic presented only by S. schenckii. These clinical signs were observed earlier in sporotrichosis than in L. mexicana infection. Differences in the mean day of appearance were statistically significant. The lesions produced by S. schenckii and L. mexicana in this experimental model share clinical signs, but their incubated period and relative frequency allow us to differentiate them. The circumstances of inoculation such as strain, dose of inoculum, place and route of inoculation are related to the experimental behavior of them.

Treatment of chronic respiratory infections.

When a respiratory infection has persisted for more than a few months, one can regard it as chronic, although most chronic chest infections have been present years, not months , when patients are seen. Chronic respiratory infections lasting for years are invariably bronchial. Apparent chronic infections persisting for months and accompanied by radiological opacification in the lungs need to have tuberculosis, malignancy. foreign body etc. eliminated as possible under lying causes. Treatment of chronic respiratory infections is not easy and it is wise to follow an initial programme of investigation to establish the nature of the disorder and the bacterial pathogens involved. The types of problems are listed in table I. When acute bronchitis continues, it can be called persistent bronchitis. The disorder chronic bronchitis , characterised by continuous mucus expectoration, may be accompanied by intermittent or chronic infection, as indicated by purulence of the sputum. Patients with these conditions may have a superadded asthmatic component. Bronchiectasis usually involves persistent cough and purulent sputum , although, of course, continuous pus production does not necessarily mean bronchiectasis. There may be a superadded hypersensitivity (asthmatic) component , as in, for example, allergic aspergillosis, or there may be a deficiencystate associated, such as a low serum IgG or IgA level. Many persons with such chronic suppurative disease of the lower respiratory tract also have chronic sinusitis . An acute lung abscess can be colonised by bacteria capable of causing continuing infection and thus a situation akin to bronchiectasis can develop. Children with cystic fibrosis are usually known an(J are under the care directly or indirectly of an interested paediatrician. Nevertheless, they may present for the first time at an age beyond early childhood and one should be ever watchful.

Experimental and clinical studies on the deodorant, Flagyl (Metronidazole)

Subctaneous injection of suspension of odoriferous pus collected from the lesion of experimental Vincent's disease induced on a guinea pig was made in depilated back of another guinea pig weighing from 250 to 350 grams. The water solutions of Flagyl were injected subctaneously to the other portion on the back of the guinea pig, 10, 5 and 2.5mgs a day for 7 days respectively. The Flagyl group had a less production of pus and did not remain spirochaete or odour in the pus.Clinical trial:Clinical examination was made in 50 adults who were pointed out halitosis by means of double blind method. They were given 400mgs of either Flagyl or placebo tablets once a day for 5 days. Unexpectancy, disappearance of halitosis was not experienced only in the Flagyl group. The consideration of these results was discussed.