Awareness about Necrotizing Fasciitis among South Indian Population Type of manuscript:Original ResearchRunning Title:Awareness about Necrotizing Fasciitis P.Keshaav KrishnaaUndergraduate Student Saveetha Dental College, Saveetha University,ChennaiA.Jothi PriyaAssistant professor Department of PhysiologySaveetha Dental College, Saveetha University, ChennaiCorresponding Author:A.Jothi PriyaAssistant ProfessorDepartment of Physiology Saveetha Dental College, Saveetha University,ChennaiEmail: [email protected] number:8939360922Word Count:1828Abstract:Aim: To assess the knowledge about Necrotising Fasciitis among the South Indian population.Materials and Methods:The survey was conducted through an online basis. The survey consisted of questions which would educate the participant on the condition and also grasp on how much information they already posses. The initial question would rely on their present knowledge and the next question would be to educate the person on the same. The survey was circulated among the student population primarily in the health care field. The study was designed such that there would be no overlap of information between concurrent questions. A total of 80 responses was obtained from the surveyed population and was analysed.Results:The study results reveal that majority of the South Indian population are unaware about the condition called necrotising Fasciitis and are also not aware about the modalities of management of the particular disease.Conclusion:The awareness about the particular disease should be enhanced and more awareness programs should be conducted to improve the knowledge that persists about the disease.Key Words: Necrotising Fasciitis, nec fas, Awareness, Indian, disease Introduction:Necrotizing fasciitis is any necrotizing soft tissue infection spreading along fascial planes with or without overlying cellulitis.1 It has also been described as a rapidly progressing necrotizing process accompanied by severe systemic toxicity.2 Necrotizing fasciitis has been historically reported from almost all parts of the world and is now understood to be caused by either a single organism or more frequently by a variety of microbes — both aerobic and anaerobic.3,4. The first clear description was offered by Joseph Jones in 1971 5. The source of infection is variable but may usually occur after a trauma or postoperatively.3,6,7,8 Frequently no history of trauma may be elicited in patients with necrotising Fasciitis .2 Seemingly very insignificant and most easily forgotten trauma, including minor lacerations of the skin, abrasions, or insect bites in various environments can initiate the process.8 Insignificant trauma in a marine environment where insects are not present leading to necrotizing fasciitis has been reported by Pessa.9. Thus necrotising Fasciitis cannot be attributed to a particular source.Similar to several infectious diseases, three factors mainly interact to produce an infection the factors which interact to form the infection include factors related to the bacteria,factors related to the patient, and factors relating to the environment that brings them together — in this case, the nature of the injury may also play a role.Patient factors associated with infection include impaired immunity, obesity and chronic diseases such as diabetes.Many patients report a preceding breach in the skin, through things such as surgery, accidental wounds, or intravenous drug use.Some types of infections are associated with particular settings.For instance, injuries occurring in marine environments, such as coral cuts, can be associated with particular types of bacteria that live in watery settings (such as Vibrio or Aeromonas).Unfortunately, early necrotising fasciitis is easily missed. This is because the symptoms — fever, pain, swelling and tenderness at the affected site — may be non-specific or confused with a mild, superficial infection.The hallmark of necrotising fasciitis is pain far more severe than expected for what might otherwise look like a minor infection. Occasionally, some bacteria produce gas and this can be felt as “crackling” under the skin.The infection can spread quickly — over minutes to hours — and deaths have been described within 24 hours in otherwise healthy people.The important treatment that is available for infections such as necrotising fasciitis or myositis is surgery to relive the symptoms or to remove the dead tissue and as much of the bacterial burden as possible. A combination of various antibiotics is usually used for the treatment of the disease . A range of various different bacteria may be implicated and each requires different set of antibiotics. Some antibiotics may also help to switch off the toxins produced by the bacteria.There is some interest in a lot of other secondary treatments, though these should be considered as a last option and only after getting the patient to surgery, supporting failing organ systems and quickly administering the correct antibiotics for treatment .Hyperbaric oxygen delivered in specialised compression chambers is often used as treatment, for instance it aims to preserve living tissue and help the immune system combat infection present in the body. However, there is very little good evidence that this helps.Similarly, intravenous immunoglobulin is a serum protein pooled from blood donors that may “mop up” toxin.It is sometimes given for some types of necrotising fasciitis, although the evidence that it helps is also conflicting.Although the disease is a very cruel disease only very little knowledge is available about the disease among the population. Information on conditions such as this are very essential and thus the public must know about the implications of the particular disease. This would help a well educated person to take well thought out decisions in the case of a medical proxy etc.Materials and Methods:The survey was conducted through an online basis. The survey consisted of questions which would educate the participant on the condition and also grasp on how much information they already posses. The initial question would rely on their present knowledge and the next question would be to educate the person on the same. The survey was circulated among the student population primarily in the health care field. The study was designed such that there would be no overlap of information between concurrent questions There were 82 responses which were obtained as part of the study. The results that were obtained through the survey was later analysed to obtain an updated knowledge on the same.Results:The responses that were obtained from the study were verified and was analysed to obtain the results from the given survey. Chart 1 Chart 2 Chart 3 Chart 4Chart 1 describes the knowledge among the surveyed population about the disease of necrotising Fasciitis. Only 28.7% of the Population were even aware about the disease called necrotising Fasciitis. This is alarming as the majority of the population are unaware about the disease and hence they do not know about the safety methods and precautions to be taken as part of the disease management. Chart 2 describes the source of knowledge among the people who said that they were aware about the disease in the South Indian population. A bulk of the population, 32.5% of the people have heard of the term only through word of mouth and not through any credible sources. This chart brings to notice that camps have to be conducted to educate people about the prevailing condition and how they can help themselves in such conditions.Chart 3 describes the need for proper patient hygiene and anti septic environment for patients in need. 65% of the surveyed population has agreed that patient hygiene and sepsis are absolute requirements for patients with nec fas and also for any patients for that matter. This question was framed as part of the survey to emphasise the need for sepsis and proper patient hygiene. These two factors play a role not only in the disease in question but also in many other diseases.Chart 4 provides the data about the outcome of the population that was presently surveyed. Once they took the survey 83.8% of the population was very interested about the disease and wanted some additional information on the same. Thus this research created awareness among the South Indian population which was surveyed.Discussion:The present study emphasises on spreading awareness about necrotising Fasciitis in the South Indian population. The surveyed population consisted of majority of Females in comparison to males. The survey revealed that a considerable majority of the population are not aware about the condition called necrotising Fasciitis and hence the population has to be educated to bring awareness among the population.There are various factors that affect the results of the study. They include the geographic location in which the survey was conducted and the lifestyle of the people that was surveyed.There are various methods of management of necrotising Fasciitis. It includes surgical methods which is the most preferred choice of treatment. 10-14There are various other modalities that are available for the management of necrotising Fasciitis. Some modalities Of management includes oxygen therapy 15, But certain authors disagree with the concept of using a hyperbaric chamber for the management of Necrotising Fasciitis 16. Certain comparative studies are also available for the management of necrotising Fasciitis in various aspects 17. Other methods of Management of necrotising Fasciitis includes the use of antibiotic administration. 18References:1. Ahrenholz DH. Necrotising soft-tissue infections. Surg Clin North Am. 1988;68:199–214. PubMed2. Janeviscus RV, Hann S, Butt MD. Necrotising fasciitis. Surg Gynecol Obstet. 1982;154:97–102. PubMed3. Giuliano A, Lewis F, Jr, Hadley K, Blaisdell FW. Bacteriology of necrotising faciitis. Am J Surg. 1977;134:52–7. PubMed4. Changchien CH, Chen YY, Chen SW, Chen WL, Tsay JG, Chu C. Retrospective study of necrotizing fasciitis and characterization of its associated Methicillin- resistant Staphylococcus aureus in Taiwan. BMC Infect Dis. 2011;11:297. PMC free article PubMed5. Meleney FL. Hemolytic streptococcus gangrene. Arch Surg. 1924;9:317–64.6. Wilson B. Necrotising fasciitis. Am Surg. 1952;18:416–31. PubMed7. Lancerotto L, Tocco I, Salmaso R, Vindigni V, Bassetto F. Necrotising fasciitis: Classification, diagnosis, and management. J Trauma Acute Care Surg. 2012;72:560–6. PubMed8.. Rea WJ, Wyrick WJ. Necrotising fasciitis. Ann Surg. 1970;172:957–64. PMC free article PubMed9. 8. Pessa ME, Howard RJ. Necrotising fasciitis. Surg Gynecol Obstet. 1985;161:357–61. PubMed10. Bilton B, Zibari B, McMillan R, Al E. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study. Am Surg. 1998;64:397–40011. Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009;208(2):279–28812. Simonsen E, Orman E, van Hatch B, et al. Cellulitis incidence in a defined population. Epidemiol Infect. 2006;134(2):293–29913. Busti AJ, Hooper JS, Amaya CJ, Kazi S. Effects of perioperative antiinflammatory and immunomodulating therapy on surgical wound healing. Pharmacotherapy. 2005;25(11):1566–159114. Bilton B, Zibari B, McMillan R, Al E. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study. Am Surg. 1998;64:397–40015. Riseman J, Zamboni W, Curtis A. Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery. 1990;108:84716. George ME, Rueth NM, Skarda DE, Chipman JG, Quickel RR, Beilman GJ. Hyperbaric oxygen does not improve outcome in patients with necrotizing soft tissue infection. Surg Infect. 2009;10:21–2817. Knighton DR, Halliday B, Hunt TK. Oxygen as an antibiotic. A comparison of the effects of inspired oxygen concentration and antibiotic administration on in vivo bacterial clearance. Arch Surg. 1986;121(2):191–195.18. Takei S, Arora Y, Walker S. Intravenous immunoglobulin contains specific antibodies inhibitory to activation of T-cells by staphylococcal toxin superantigens. J Clin Invest. 1993;91:602–607
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