BACKGROUND: To predict testicular involvement in patients diagnosed with Fournier\'s gangrene (FG) using the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score and the site other than lower limb (SIARI) score.
METHODS: The medical records of 51 patients operated for FG in our clinic between December 2012 and April 2022 were evaluated retrospectively in this study. Patients\' demographics, and laboratory test results were compared with the testisticular involvement status. Patients with testisticular involvement (n = 10) were compared with patients without testicular involvement (n = 41). The SIARI score at initial admission was analysed using logistic regression analyses for its performance in predicting testicular involvement with FG. Receiver operating characteristics (ROC) curves and the area under the receiver operating characteristic curve (AUROC) were used to evaluate its discriminating ability.
RESULTS: The SIARI score had modest performance for diagnosing testicular involvement in FG patients, with ROC analysis showing an AUROC value of 0.83 (p < 0.001). With a SIARI cut-off score of ≥ 3, the sensitivity was 90% and the specificity was 68%. For a SIARI cut-off score of ≥ 5, the sensitivity was 40% and the specificity was 97%.
CONCLUSIONS: The ability of the SIARI score to discriminate FG with testicular involvement is modest. The SIARI score should be employed cautiously as a routine diagnostic tool for the prediction of testicular involvement in FG at the initial admission. More research is needed to develop a better understanding of the relationship between the SIARI score and testicular involvement in FG.

BACKGROUND: Fournier\'s Gangrene Scoring Index (FGSI), Simplified FGSI (SFGSI), Uludag FGSI (UFGSI), Laboratory Risk Indicator for Necrotizing (LRINEC), Neutrophil-Lymphocyte ratio (NLR), and Platelet-lymphocyte ratio (PLR) have been devised to assess the risk of mortality in Fournier\'s Gangrene (FG) patients. However, the effectiveness of these indicators in predicting mortality at the time of admission remains uncertain. The aim of this study is to assess the prognostic efficacy of FG\'s various indicators on in-hospital mortality.
METHODS: This study analyzed 123 patients from Dr. Soetomo General Hospital\'s emergency department in Indonesia from 2014 to 2020. Data included demographics, wound cultures, and parameters like FGSI, UFGSI, SFGSI, NLR, PLR, and LRINEC. In-hospital mortality status was also recorded. The data was subjected to comparative, sensitivity, specificity and regression analyses.
RESULTS: In our study of 123 patients, the median age was 52, with a mortality rate of 17.9%. The majority of patients were male (91.1%) and the most common location was scrotal (54.5%). Non-survivors had a shorter median stay (6.5 days) compared to survivors (14 days). Diabetes was the most prevalent comorbidity (61.8%). The highest sensitivity and specificity were found in FGSI and UFGSI indicators. Multivariate logistic regression identified LoS and FGSI as independent predictors of mortality.
CONCLUSIONS: FGSI and UFGSI, upon admission, demonstrated the highest sensitivity and specificity, with hospital stay duration and FGSI as key mortality determinants.

BACKGROUND: The aggressive nature of Fournier gangrene and the associated health issues can result in a more complex clinical course and potentially a longer hospital stay. This study aimed to assess factors that affect the length of hospital stay (LHS) and its relation to the outcome of Fournier gangrene patients.
METHODS: A retrospective study was performed at King Abdulaziz University Hospital (KAUH), Saudi Arabia, on patients diagnosed with Fournier gangrene between 2017 and 2023. Data about length of hospital stay (LHS), age, BMI, clinical and surgical data and outcome was obtained.
RESULTS: The mean age of the studied patients was 59.23 ± 11.19 years, the mean body mass index (BMI) was 26.69 ± 7.99 kg/m2, and the mean duration of symptoms was 10.27 ± 9.16 days. The most common presenting symptoms were swelling or induration (64%), 88% had comorbidities with diabetes mellitus (DM) (84%), and 76% had uncontrolled DM. of patients, 24% had a poly-microbial infection, with E. coli being the most common (52%). The mean length of hospital stay (LHS) was 54.56 ± 54.57 days, and 24% of patients had an LHS of more than 50 days. Longer LHS (> 50 days) was associated with patients who did not receive a compatible initial antibiotic, whereas shorter LHS was associated with patients who received Impenem or a combination of vancomycin and meropenem as alternative antibiotics following incompatibility. Reconstruction patients had significantly longer LHS and a higher mean temperature. However, none of the studied variables were found to be predictors of long LHS in the multivariate regression analysis.
CONCLUSIONS: Knowledge of the values that predict LHS allows for patient-centered treatment and may be useful in predicting more radical treatments or the need for additional treatment in high-risk patients. Future multicenter prospective studies with larger sample sizes are needed to assess the needed variables and predictors of long LHS.

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BACKGROUND: Fournier\'s gangrene (FG) is a destructive necrotizing infection with a generally poor prognosis. This study aims to share our experience in handling FG patients in a resource-limited setting and identify prognostic factors for FG mortality.
METHODS: A retrospective study of thirty-six patients diagnosed with FG and treated at our teaching hospital between Jun 2010 to Oct 2022 was conducted. Laboratory and nonlaboratory data and patients\' outcomes were gathered. A univariate analysis was computed for identifying prognostic factors for FG mortality.
RESULTS: The main age was 68.30 ± 5.61years and most (69.4%) were older than 65 years. The overall survival was 63.9% and the mortality rate was 36.1%. Univariate analysis showed that advanced age (p = 0.02), delayed in hospital presentation (p = 0.024), involvement of larger area (p = 0.001), a history of diabetes mellitus (p < 0.006), end-stage renal disease (p = 0.018), heart failure (p = 0.005), cerebrovascular accident (p = 0.003), liver cirrhosis (p = 0.001), presence of multiple comorbidities (p = 0.001), septic conditions at admission (p = 0.048), need for mechanical ventilation (p = 0.001), hypoalbuminemia (p < 0.001), and elevated blood urea nitrogen (p = 0.002) were found to be risk factors for mortality in patients with FG.
CONCLUSIONS: Fournier\'s gangrene is a fulminant condition with a high mortality rate, especially in resource-limited settings. In this study, the mortality rate was 36.1%. Advanced age, delayed in hospital presentation, involvement of larger area, a history of diabetes mellitus, end-stage renal disease, heart failure, cerebrovascular accident, liver cirrhosis, presence of multiple comorbidities, septic conditions at admission, need for mechanical ventilation, hypoalbuminemia, and elevated blood urea nitrogen were associated with FG mortality.

Sodium-glucose cotransporter-2 inhibitors (SGLT-2is) are indicated in patients with or without type 2 diabetes mellitus atherosclerotic cardiovascular disease, chronic kidney disease, or heart failure. Postmarket surveillance data have identified many safety signals which warrants further investigation. We aimed to compare the safety of SGLT-2i and glucagon-like peptide-1 receptor agonists (GLP-1RA). Using the Veterans Health Administration nationwide database, patients with type 2 diabetes mellitus who were newly initiated on a SGLT-2i or GLP-1RA between April 1, 2013 and September 1, 2020 were identified. The primary outcome was the incidence of any amputation, below-knee amputation (BKA), all clinical fractures, hip fracture, Fournier gangrene, acute pancreatitis, diabetic ketoacidosis (DKA), serious urinary tract infections (UTIs), and venous thromboembolism (VTE). All outcomes were compared between the treatment groups. Cox proportional hazard models were used to estimate adjusted hazard ratios (aHRs) for the comparative analysis. A total of 70,694 propensity-matched new users of SGLT-2i and GLP-1RA were identified. The use of SGLT-2 inhibitors, compared with GLP-1RA, was not associated with an increased rate of any amputation (aHR 1.02, 95% confidence interval [CI] 0.82 to 1.27), BKA (aHR 1.05, 95% CI 0.84 to 1.32), all clinical fractures (aHR 0.94, 95% CI 0.86 to 1.03), hip fractures (aHR 0.82, 95% CI 0.50 to 1.32), DKA (aHR 1.66, 95% CI 0.97 to 2.85), VTE (aHR 1.02, 95% CI 0.80 to 1.30), acute pancreatitis (aHR 1.02, 95% CI 0.80 to 1.30), and Fournier gangrene (aHR 0.92 95% CI 0.61 to 1.38). Lower rates of serious UTIs were observed in the SGLT-2i group than in the GLP-1RA group (aHR 0.74, 95% CI 0.64 to 0.84). This real-world study found that SGLT-2i use compared with GLP-1RA did not increase the rate of amputation, BKA, clinical fractures, hip fracture, Fournier gangrene, acute pancreatitis, DKA, serious UTIs, and VTE in veteran patients.

BACKGROUND: Fournier\'s gangrene (FG) is a rapidly progressive necrotizing infection that affects the perineal and abdominal regions and is known for its high mortality rate. This study aims to present the practical experience of managing FG patients and identify factors that may affect their clinical outcomes.
METHODS: A retrospective study was conducted from April 2009 to December 2020 at General Military Hospital in Sana\'a, Yemen including 26 patients who were diagnosed with FG and treated on. Data on demographic characteristics, time to admission, surgical intervention, and treatment outcomes were collected. Univariate analysis was performed to determine factors that affect patient outcomes.
RESULTS: The mean age of the patients was 65.77 ± 5.04 years, and 65.4% of them were over the age of 65. Most patients (57.7%) presented after five days of experiencing symptoms, and 65.4% were in septic conditions. Of the patients, 17 (65.4%) survived, and the total mortality rate was 34.6%. Univariate analysis showed that delayed presentation (p = 0.001), a history of diabetes mellitus (p < 0.001), end-stage renal disease (p < 0.001), heart failure (p < 0.001), cerebrovascular accident (p = 0.032), liver cirrhosis (p < 001), presence of multiple comorbidities (p < 001), involvement of lager area (p < 001), septic conditions (p = 0.009), advanced age (p = 0.018), and intensive care unit admission (p = 0.002) were found to be risk factors for mortality in patients with FG.
CONCLUSIONS: FG is a potentially life-threatening medical condition, even with aggressive and specialized treatment. Our study revealed a mortality rate of 34.6%. Factors such as older age, the presence of multiple comorbidities, septic conditions, the abdominal spread of the disease, intensive care unit admission, and delayed presentation contribute to higher mortality rates.

Background and Aim: Value of colostomy in management of Fournier gangrene (FG) is a debatable issue. Almost all relevant studies are retrospective and included heterogeneous patients\' groups. The present prospective study aimed to evaluate the role of colostomy in management of FG affecting the perianal region in 2 well-matched FG groups. Patients and Methods: The present prospective comparative study included 30 patients with FG associated with extensive involvement of the perianal region. They comprised 15 patients subjected to colostomy and other 15 patients who refused to perform the procedure. Colostomy was performed after the first debridement. Outcome parameters in the present study included time to wound healing, length of hospital stay, and inhospital mortality. Results: Comparison between the studied groups regarding the preoperative characteristics revealed no statistically significant differences. Postoperatively, patients in the colostomy group had significantly fewer number of debridements (1.3 ± 0.5 vs 2.7 ± 1.2, P < .001), shorter hospital stay (9.5 ± 3.3 vs 29.9 ± 6.2 days, P < .001), and significantly shorter time to wound healing (16.5 ± 3.9 vs 42.9 ± 6.9 days, P < .001). Also, patients in the colostomy group had significantly lower rate of wound dehiscence, wound infection, and flap ischemia. However, the difference wasn\'t statistically significant. Conclusions: Aggressive treatment of FG aided by colostomy after first debridement would result in better clinical outcome.
Historique et objectif: L’intérêt de la colostomie pour prendre en charge la maladie de Fournier (MF) n’est pas consensuel. Presque toutes les études pertinentes sont rétrospectives et portent sur des groupes de patients hétérogènes. La présente étude prospective visait à évaluer le rôle de la colostomie pour prendre en charge la MG qui touche la région périanale dans deux groupes bien appariés de patients atteints de la MF. Patients et méthodologie: La présente étude comparative prospective portait sur 30 patients atteints de la MF associés à une atteinte importante de la région périanale. Elle était composée de 15 patients soumis à une colostomie et à 15 patients qui avaient refusé l’intervention. La colostomie a été effectuée après le premier débridement. Le temps jusqu’à la guérison de la plaie, la durée du séjour hospitalier et la mortalité en milieu hospitalier étaient les résultats primaires de la présente étude. Résultats: La comparaison des caractéristiques préopératoires des groupes à l’étude n’a révélé aucunes différences statistiquement significatives. Après l’opération, les patients du groupe ayant subi une colostomie présentaient beaucoup moins de débridements (1,3 ± 0,5 par rapport à 2,7 ± 1,2, p<0,001) et avaient été hospitalisés moins longtemps (9,5 ± 3,3 par rapport à 29,9 ± 6,2 jours, p <0,001) et leur plaie avait guéri plus vite (16,5 ± 3,9 par rapport à 42,9 ± 6,9 jours, p <0,001). De plus, les patients qui faisaient partie du groupe ayant subi une colostomie présentaient un taux beaucoup plus bas de déhiscences ou d’infections de la plaie et d’ischémies du lambeau. Cependant, cette différence n’était pas statistiquement significative. Conclusions: Un traitement énergique de la MF assisté par colostomie après le premier débridement de meilleurs résultats cliniques.

As indications for sodium-glucose co-transporter-2 inhibitors (SGLT2i) are expanding, a growing number of older adults have become candidates for treatment. We studied the safety profile of SGLT2i among older adults.
A retrospective, pharmacovigilance study of the FDA\'s global database of safety reports. To assess reporting of pre-specified adverse events following SGLT2i among adults (< 75 years) and older adults (≥ 75), we performed a disproportionality analysis using the sex-adjusted reporting odds ratio (adj.ROR).
We identified safety reports of 129,795 patients who received non-insulin anti-diabetic drugs (NIAD), including 24,253 who were treated with SGLT2i (median age 60 [IQR: 51-68] years, 2,339 [9.6%] aged ≥ 75 years). Compared to other NIAD, SGLT2i were significantly associated with amputations (adj.ROR = 355.1 [95%CI: 258.8 - 487.3] vs adj.ROR = 250.2 [79.3 - 789.5]), Fournier gangrene (adj.ROR = 45.0 [34.5 - 58.8] vs adj.ROR = 88.0 [27.0 - 286.6]), diabetic ketoacidosis (adj.ROR = 32.3 [30.0 - 34.8] vs adj.ROR = 23.3 [19.2 - 28.3]), genitourinary infections (adj.ROR = 10.3 [9.4 - 11.2] vs adj.ROR = 8.6 [7.2 - 10.3]), nocturia (adj.ROR = 5.5 [3.7 - 8.2] vs adj.ROR = 6.7 [2.8 - 15.7]), dehydration (adj.ROR = 2.5 [2.3 - 2.8] vs adj.ROR = 2.6 [2.1 - 3.3]), and fractures (adj.ROR = 1.7 [1.4 - 2.1] vs adj.ROR = 1.5 [1.02 - 2.1]) in both adults and older adults, respectively. None of these safety signals was significantly greater in older adults (Pinteraction threshold of 0.05). Acute kidney injury was associated with SGLT2i in adults (adj.ROR = 1.97 [1.85 - 2.09]) but not in older adults (adj.ROR = 0.71 [0.59 - 0.84]). Falls, hypotension, and syncope were not associated with SGLT2i among either adults or older adults.
In this global post-marketing study, none of the adverse events was reported more frequently among older adults. Our findings provide reassurance regarding SGLT2i treatment in older adults, although careful monitoring is warranted.

BACKGROUND Fournier\'s gangrene (FG) is a potentially fatal necrotizing infection. Due to the rapid progression of the disease, the fatality rate remains high despite advances in therapy. This 10-year observational study from a single tertiary referral center in Indonesia aimed to identify the risk factors for in-hospital mortality from 145 male patients diagnosed with FG. MATERIAL AND METHODS This retrospective cohort study was conducted at one of Indonesia\'s largest tertiary referral hospitals. The risk factors of in-hospital mortality were analysed using data collected through hospital medical records. All patients diagnosed with FG from January 2012 until December 2021 were included. Outcome measured was sociodemographic factors, comorbidities, laboratory findings, length of stay, culture results, and disease outcome. The microbiological culture was performed on FG lesions isolates. The statistical analysis was conducted using SPSS version 26.0. RESULTS The analysis included 145 male patients with a median age of 52 (IQR, 43-61) years. Of them, 38 (26.20%) patients died. There were more patients with diabetes mellitus (DM) in non-survivor groups compared to survivor groups (76.3% vs 57%, p=0.035). On multivariate analysis, DM and Clostridium perfringens infection were found to be independent factors of in-hospital mortality [adjusted odds ratio (aOR)2.583, 95% confidence interval (CI)=1.061-6.289, aOR 5.982,95% CI=1.241-28.828, respectively]. CONCLUSIONS The mortality rate for FG was considerably high. DM and Clostridium perfringens infection were shown to be independent risk factors for mortality among men.