"Progressive Necrotizing Diseases; Management:Titrated Dosage Anti-Histaminics Role."
Journal Title: IOSR Journal of Pharmacy (IOSRPHR) - Year 2017, Vol 7, Issue 11
Abstract
ABSTRACT: Introduction- Amongst Various Skin & Soft Tissue Infection(SSTI),Progressive Necrotizing Disease(PND): Infections, Cellulititis, Fascitis(NF) & Sometimes Myositis, Is Not Uncommon Clinical Entity, Characterized By Extensive, Rapidly Progressive Soft-Tissue Necrosis That Usually Involves The Subcutaneous Tissue And Muscular Fascia, But Can Also Affect The Skin And Muscle, Has Vivid Spectrum Of Epidemiolgical, Aetio-Pathogenesis, Clinical Manifestations Of Varying Severity & Differing Treatment Seeking TimePeriod. NF Poses A Serious Surgical Challenge Not Only Because Of Its Rapid And Progressive Nature, But Also Because Of Its Attributing High Morbidity And Mortality. Materials & Method- Present Multi-Centric Study, Comprising About 500 Patients Presenting With Variable Stages Of Disease, Performed At, Plains Of North India Haryana, Adjoinig Rajasthan & Hilly Region Of Uttarakhand, During Last More Than A Decade Duration. Management Methodology-Management Of Pre-Existing & Or Precipitating Co-Morbidities - Diabetes, HTN, Deranged Renal Function, C-Reactive Protiens, HB%, Serum Protiens, Electrolytes, Minerals, Blood Gas Chemistry Alterations, Hepatic Dysfunction, Different Stages Of Progressive Toxicaemia, Septicaemia Due To Ensuing ‘PF Shock Syndrome’, Time Of Seeking Medical Attention & Standard Of Appropriate Care, Are Important Determinants For OverAll Result Out Come, In Regards To Mortality & Morbidity Aspects. Results-Early (Immediately/Within 2-4 Days Of Disease Onset), Medical Opinion Seeking Patients, Managed With, Described Medical Therapy Including Anti-Allergic Drug, For 3-5-7 Days, With Careful Monitoring & As Needed Immediate Follow Up Advise, Were Completely Relieved, In About 75% Of The Cases, (i.e Disease Process Cessation Control, In Clinical Stage -1(Early) & Upto Initial Clinical Stage- 2, In Early Reporting Category Patients). Remaining About 25% Patients, Not Completely Controlled By Described Treatment Protocol & Late Presentations Of 1-2 Weeks Disease Onset With Progressive Disease Of Varying Manifestations, Responded To Management-Medical, Surgical, Supportive & Could Be Discharged Within 1-2 Weeks Of Hospital Stay. About 5-10% Patients-Late Presentations Of Severe Progressive Disease,Without Previous Treatment & Or Not Proper Inadequate Management, In Different Stages Of Septicaemia, Deteriorating G.C, Co-Existing Controlled/ Uncontrolled Co-Morbidities, Were Advised Referral To Higher Specialized Centres For Immunotherapy, Hyper-Baric Oxygen Therapy Etc. After Preliminary Management & Supportive Measures With Ensured Safe, Secure Transport, Otherwise, Continued Management At The Same Centre, With Prognosis Explained Treatment Risk Consent, Recorded Increased Morbidity And About 1-2% Mortality. Conclusion- In Clinical Stage -1(Early) & Upto Initial Clinical Stage-2(Intermediate), Reporting Early To Clinician Category Patients,(i.e Clinically Evident Acute Inflammatory Response Phase – Usually, Initial 3-5-7 Days After Disease Process Onset, In All Types), Inclusion Of Meticulously Titrated Dosage Duration Schedule Of Anti-Allergic Medication Therapy, In Administered Medications, With Properly Instituted Supportive Measures, Controlled Necrotizing Soft-Tissue Disease Process Severity, Conversion To Next Clinico-Pathological Strata Of Disease (Infections-CellulitisFascitis-Myositis & Others.), Associated Complications, Sequelae Of The Disease Process, Safely, With Better Result Out Comes Of Subsequent Management & Decreased Morbidity, Mortality.
Authors and Affiliations
Dr. (Prof. ) Anil K. Sahni
Keywords
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