The reported impact of non-communicable disease investment cases in 13 countries.

Non-communicable diseases (NCDs) are a leading health and development challenge worldwide. Since 2015, WHO and the United Nations Development Programme have provided support to governments to develop national NCD investment cases to describe the socioeconomic dimensions of NCDs. To assess the impact of the investment cases, semistructured interviews and a structured process for gathering written feedback were conducted between July and October 2022 with key informants in 13 countries who had developed a national NCD investment case between 2015 and 2020. Investment cases describe: (1) the social and economic costs of NCDs, including their distribution and projections over time; (2) priority areas for scaled up action; (3) the cost and returns from investing in WHO-recommended measures to prevent and manage NCDs; and (4) the political dimensions of NCD responses. While no country had implemented all the recommendations set out in their investment case reports, actions and policy changes attributable to the investment cases were identified, across (1) governance; (2) financing; and (3) health service access and delivery. The pathways of these changes included: (1) stronger collaboration across government ministries and partners; (2) advocacy for NCD prevention and control; (3) grounding efforts in nationally owned data and evidence; (4) developing mutually embraced 'language' across health and finance; and (5) elevating the priority accorded to NCDs, by framing action as an investment rather than a cost. The assessment also identified barriers to progress on the investment case implementation, including the influence of some private sector entities on sectors other than health, the impact of the COVID-19 pandemic, and changes in senior political and technical government officials. The results suggest that national NCD investment cases can significantly contribute to catalysing the prevention and control of NCDs through strengthening governance, financing, and health service access and delivery.

Compressed and Expanded Lattices - Barriers to Spin-State Switching in Mn3+ Complexes.

We report the structural and magnetic properties of two new Mn3+ complex cations in the spin crossover (SCO) [Mn(R-sal2323)]+ series, in lattices with seven different counterions in each case. We investigate the effect on the Mn3+ spin state of appending electron-withdrawing and electron-donating groups on the phenolate donors of the ligand. This was achieved by substitution of the ortho and para positions on the phenolate donors with nitro and methoxy substituents in both possible geometric isomeric forms. Using this design paradigm, the [MnL1]+ (a) and [MnL2]+ (b) complex cations were prepared by complexation of Mn3+ to the hexadentate Schiff base ligands with 3-nitro-5-methoxy-phenolate or 3-methoxy-5-nitro-phenolate substituents, respectively. A clear trend emerges with adoption of the spin triplet form in complexes 1a-7a, with the 3-nitro-5-methoxy-phenolate donors, and spin triplet, spin quintet and thermal SCO in complexes 1b-7b with the 3-methoxy-5-nitro-phenolate ligand isomer. The outcomes are discussed in terms of geometric and steric factors in the 14 new compounds and by a wider analysis of electronic choices of Mn3+ with related ligands by comparison of bond length and angular distortion data of previously reported analogues in the [Mn(R-sal2323)]+ family. The structural and magnetic data published to date suggest a barrier to switching may exist for high spin forms of Mn3+ in those complexes with the longest bond lengths and highest distortion parameters. A barrier to switching from low spin to high spin is less clear but may operate in the seven [Mn(3-NO2-5-OMe-sal2323)]+ complexes 1a-7a reported here which were all low spin in the solid state at room temperature.

Informed consent process for emergency surgery: A scoping review of stakeholders' perspectives, challenges, ethical concepts, and policies.

Background: A scoping review of literature about the informed consent process for emergency surgery from the perspectives of the patients, next of kin, emergency staff, and available guiding policies. Objectives: To provide an overview of the informed consent process for emergency surgery; the challenges that arise from the perspectives of the patients, emergency staff, and next of kin; policies that guide informed consent for emergency surgery; and to identify any knowledge gaps that could guide further inquiry in this area. Methods: We searched Google Scholar, PubMed/MEDLINE databases as well as Sheridan Libraries and Welch Medical Library from 1990 to 2021. We included journal articles published in English and excluded non-peer-reviewed journal articles, unpublished manuscripts, and conference abstracts. The themes explored were emergency surgery consent, ethical and theoretical concepts, stakeholders' perceptions, challenges, and policies on emergency surgery. Articles were reviewed by three independent reviewers for relevance. Results: Of the 65 articles retrieved, 18 articles were included. Of the 18 articles reviewed, 5 addressed emergency informed consent, 9 stakeholders' perspectives, 7 the challenges of emergency informed consent, 3 ethical and theoretical concepts of emergency informed consent, and 3 articles addressed policies of emergency surgery informed consent. Conclusion: There is poor satisfaction in the informed consent process in emergency surgery. Impaired capacity to consent and limited time are a challenge. Policies recommend that informed consent should not delay life-saving emergency care and patient's best interests must be upheld.

Effects of online brain training on self-reported mental health symptoms for generally healthy adults during the Covid-19 pandemic.

BACKGROUND: The cognitive training Strategic Memory Advanced Reasoning Training (SMART) has been shown to improve symptoms of depression, anxiety, and stress when completed using in-person delivery, but mental health outcomes have not yet been studied for online delivery of SMART. METHODS: Data was analyzed from 145 generally healthy adults participating in the BrainHealth Project pilot study who had access to 12 weeks of online self-paced SMART and self-reported mental health symptoms on the Depression Anxiety Stress Scale (DASS-21) pre- and post-training. We utilized linear models to examine the change in self-reported symptoms of depression, anxiety, and stress following the 12-week training period and to explore the influence of age, gender, and education on changes in symptomatology. Data from 44 participants who completed a follow-up DASS-21 6 months after completing SMART was used to explore the lasting impact of the training. RESULTS: Improvements in depression, anxiety, and stress symptoms were observed following online SMART, evidenced by a significant decrease in self-reported symptoms on the DASS-21. Improvement in self-reported mental health symptomatology was maintained or continued to improve 6-month post-training. No significant effect of gender was observed, but findings motivate additional exploration of the effects of education and age. CONCLUSION: Online SMART should be considered a low-cost, high-impact approach for supporting public mental health for generally healthy adults.

Validation of a vision-screening tool for use by nurses and other non-eye care health practitioners on stroke survivors.

Purpose: To validate a vision-screening tool for use by nurses and other non-eye care health practitioners (NECHP) to aid identification of visual deficits and ocular conditions in stroke survivors.Material and Methods: Stroke survivors were recruited from two metropolitan Sydney public hospitals who had no access to on-site eye care professionals. Those admitted for 3 days and who were able to provide clear responses were randomly allocated into two groups. All were assessed by a NECHP using a purposely designed bedside vision-screening tool to assess their visual function. In Group 1, the orthoptist repeated the assessment with the same vision-screening tool, in Group 2 they performed a comprehensive orthoptic assessment. Levels of agreement and sensitivity and specificity for key outcomes were assessed.Findings: Levels of agreement for most items analyzed for Group 1 reached 80%. Comparison of the screening tool to a comprehensive orthoptist assessment (Group 2), demonstrated high (88.57-91.12%) sensitivity and specificity for detecting pre-existing and acquired visual problems.Conclusion: The vision-screening tool is a valid instrument for use by NECHP, for the detection of vision defects in stroke survivors. Improved detection of eye conditions may facilitate timely identification and management of visual conditions in stroke survivors, potentially improving patient care and rehabilitation outcomes.

Split-thickness skin grafting in the management of cutaneous sequelae of intramuscular pentazocine injections: a novel approach.

INTRODUCTION: Pentazocine, a synthetic opioid with partial agonist and antagonist activity administered by parenteral injection, was used clinically in the 1970s. Dermatologic complications at injection sites were reported soon after its introduction. These complications are thought to be underreported. Many well-documented cases describe the development of fibrosis and calcinosis at the site of parenteral pentazocine injections, but few reports document management or successful treatment of the long-term sequelae of these manifestations. CASE REPORT: The successful use of STSG for the treatment of chronic nonhealing ulcers secondary to pentazocine-induced cutaneous fibrosis in a 78-year-old male is presented. In the early 1970s, he was started on 3-times-daily intramuscular pentazocine injections to treat pain secondary to ulcerative colitis. He injected himself in the proximal thighs and buttocks for a period of approximately 10 years. He gradually developed severe soft tissue calcifications of both buttocks and anterior thighs. In the mid-to-late 1980s, the pentazocine injections were discontinued. The diffuse sclerosis and disfiguring fibrosis remained. CONCLUSIONS: This case underscores the lasting effects of pentazocine-induced cutaneous sclerosis and fibrosis, with cutaneous complications manifesting in this patient even decades after use. It also highlights the novel use of STSG as a treatment strategy for these cutaneous complications.

Estimating the Relationship Between Perceived Stigma and Victimization of People With Mental Illness.

Over the past two decades, we have substantially increased our understanding of violence committed by individuals with mental illness, while comparatively less is known about the victimization experiences of this population. What has been established in the literature is that individuals with mental illness are more likely to experience victimization than the general public, and certain risk factors influence the likelihood of victimization. What remains unexplored is the possibility that a person with mental illness' perception that mental illness is stigmatized may be significantly associated with victimization experiences. Thus, the purpose of the current study is to examine whether stigma and victimization are associated, and in what direction. In other words, does perceived stigma lead to victimization? Or does victimization lead to perceived stigma? To assess these research questions, data from the Community Outcomes of Assisted Outpatient Treatment study are used, which is a longitudinal study of individuals with serious mental illness (n = 184). A variety of methods are employed to assess the association between victimization and perceived stigma including logistic and ordinary least squares regression models. Results from the logistic regression model indicate that perceived stigma is associated with an increase in the odds that a person with mental illness will experience victimization at later follow-ups. Results from the ordinary least squares regression analysis, however, show that victimization at baseline does not predict perceived stigma at later times. Implications regarding future research and clinical practice are discussed.

Are we Truly "Safer-At-Home"? A Test of Contextual Effects on Mental Health and Drug Overdose Incidents During the COVID-19 Pandemic.

This study examined whether the social restrictions stemming from COVID-19 impacted the locations of mental health and drug overdose incidents, while controlling for immediate and community contextual indices. Addresses for mental health/overdose calls to law enforcement or emergency medical services between January 1, 2018 and August 13, 2020 were collected from one police department in the Midwestern United States. Businesses and previous victimization/offending were joined with parcels (level-1; N = 20,019), whereas local services and socioeconomic indicators were joined with block groups (level-2; N = 32), to allow for a multi-level (HLM7) examination of context on mental health/overdose incidents. Event Rate Ratios (ERR) revealed the greatest contextual effects took place following social distancing mandates. Findings highlight the importance of allocating to areas with the highest likelihood of reporting incidents and suggest that parcels with a history of sex offenses, drug offenses, and prior mental health calls may benefit the greatest from preventative resources.

Hydrothermal Alteration of the Ocean Crust and Patterns in Mineralization With Depth as Measured by Micro-Imaging Infrared Spectroscopy.

Processes for formation, cooling, and altering Earth's ocean crust are not yet completely understood due to challenges in access and sampling. Here, we use contiguous micro-imaging infrared spectroscopy to develop complete-core maps of mineral occurrence and investigate spatial patterns in the hydrothermal alteration of 1.2 km of oceanic crust recovered from Oman Drilling Project Holes GT1A, GT2A, and GT3A drilled in the Samail Ophiolite, Oman. The imaging spectrometer shortwave infrared sensor measured reflectance of light at wavelengths 1.0-2.6 µm at 250-260 µm/pixel, resulting in >1 billion independent measurements. We map distributions of nine key primary and secondary minerals/mineral groups-clinopyroxene, amphibole, calcite, chlorite, epidote, gypsum, kaolinite/montmorillonite, prehnite, and zeolite-and find differences in their spatial occurrences and pervasiveness. Accuracy of spectral mapping of occurrence is 68%-100%, established using X-ray diffraction measurements from the core description. The sheeted dikes and gabbros of upper oceanic crust Hole GT3A show more pervasive alteration and alteration dominated by chlorite, amphibole, and epidote. The foliated/layered gabbros of GT2A from intermediate crustal depths have similarly widespread chlorite but more zeolite and little amphibole and epidote. The layered gabbros of the lower oceanic crust (GT1A) have remnant pyroxene and 2X less chlorite, but alteration is extensive within and surrounding major fault zones with widespread occurrences of amphibole. The results indicate greater distribution of higher temperature alteration minerals in the upper oceanic crust relative to deeper gabbros and highlight the importance of fault zones in hydrothermal convection in the lower ocean crust.

A Call for Low- and Middle-Income Countries to Commit to the Elimination of Cervical Cancer.

The World Health Organization has called for the global elimination of cervical cancer. While high income countries have made significant progress, the incidence and mortality due to cervical cancer is unacceptably high in low and middle income countries (LMIC). Jamaica is an upper middle income country with cervical cancer incidence and mortality of 21.6/100,000 and 13.6/100,000 person years respectively compared to 14.9/100,000 and 7.6/100,000 person years in Latin America and the Caribbean. Jamaica's pathway to reducing the burden of cervical cancer highlights challenges and opportunities for other LMIC. High prevalence of HPV infection (54% women attending primary care clinics), low levels of cervical cancer screening (<50% women 15 to 54 years old screened in the last 3 years) and suboptimal uptake of HPV vaccination (approximately 30%) are persistent barriers to achieving this goal. Lessons learned from the response to the human immunodeficiency virus (HIV) epidemic confirm the need for serious political commitment by global and national leaders, meaningful engagement of stakeholders and innovative strategies to improve uptake of HPV vaccination and cervical cancer screening. Commitment of technical and financial resources are critical for establishing robust cancer registries and strengthening monitoring and evaluation systems in LMIC.

Global guideline for the diagnosis and management of rare yeast infections: an initiative of the ECMM in cooperation with ISHAM and ASM.

Uncommon, or rare, yeast infections are on the rise given increasing numbers of patients who are immunocompromised or seriously ill. The major pathogens include those of the genera Geotrichum, Saprochaete, Magnusiomyces, and Trichosporon (ie, basidiomycetes) and Kodamaea, Malassezia, Pseudozyma (ie, now Moesziomyces or Dirkmeia), Rhodotorula, Saccharomyces, and Sporobolomyces (ie, ascomycetes). A considered approach to the complex, multidisciplinary management of infections that are caused by these pathogens is essential to optimising patient outcomes; however, management guidelines are either region-specific or require updating. In alignment with the One World-One Guideline initiative to incorporate regional differences, experts from diverse geographical regions analysed publications describing the epidemiology and management of the previously mentioned rare yeasts. This guideline summarises the consensus recommendations with regards to the diagnostic and therapeutic options for patients with these rare yeast infections, with the intent of providing practical assistance in clinical decision making. Because there is less clinical experience of patients with rare yeast infections and studies on these patients were not randomised, nor were groups compared, most recommendations are not robust in their validation but represent insights by use of expert opinions and in-vitro susceptibility results. In this Review, we report the key features of the epidemiology, diagnosis, antifungal susceptibility, and treatment outcomes of patients with Geotrichum, Saprochaete, Magnusiomyces, and Trichosporon spp infections.

Coping With COVID-19: Health Risk Communication and Vulnerable Groups.

OBJECTIVES: This study sought to identify coronavirus disease 2019 (COVID-19) risk communication materials distributed in Jamaica to mitigate the effects of the disease outbreak. It also sought to explore the effects of health risk communication on vulnerable groups in the context of the pandemic. METHODS: A qualitative study was conducted, including a content analysis of health risk communications and in-depth interviews with 35 purposively selected elderly, physically disabled, persons with mental health disorders, representatives of government agencies, advocacy and service groups, and caregivers of the vulnerable. Axial coding was applied to data from the interviews, and all data were analyzed using the constant comparison technique. RESULTS: Twelve of the 141 COVID-19 risk communication messages directly targeted the vulnerable. All participants were aware of the relevant risk communication and largely complied. Barriers to messaging awareness and compliance included inappropriate message medium for the deaf and blind, rural location, lack of Internet service or digital devices, limited technology skills, and limited connection to agencies that serve the vulnerable. CONCLUSION: The vulnerable are at increased risk in times of crisis. Accessibility of targeted information was inadequate for universal access to health information and support for vulnerable persons regardless of location and vulnerability.

The Prediction of Repeated Violence Among Individuals With Serious Mental Disorders: Situational Versus Dispositional Factors.

The question we attempt to answer in this study is why some individuals with serious mental illness engage in repeated violence, while others do not. There appear to be two perspectives that may explain repeated violence: one that emphasizes situational factors and one that emphasizes dispositional factors. Situational factors are those that are constantly changing within one's life, whereas dispositional factors are those that remain relatively stable over time. Therefore, dispositional factors would theoretically put individuals with serious mental illness at stable risk for repeated violence because these factors remain relatively stable over time. In fact, perhaps individuals with mental illness repeatedly engage in violence because they have a dispositional trait (like impulsivity, for example) that puts them at stable risk for repeated violence. Conversely, situational factors would theoretically explain why individuals do not engage in repeated violence because they are transient and constantly changing. Therefore, perhaps one desists from violence because some situational factors changed in that individual's life. Using data from the MacArthur Violence Risk Assessment Study (i.e., MacRisk), a longitudinal study of people with serious mental illness, repeated violence was evaluated across waves. A multilevel logistic regression model was employed. Results indicate that both situational and dispositional factors are significantly associated with repeated violence. Specifically, situational factors such as marital status, drug use, perceived stress, and time away from the psychiatric hospital and dispositional factors such as personality traits including agreeableness, conscientiousness, openness, and extraversion are all significantly associated with repeated violence. These findings have important policy implications regarding criminal justice intervention and clinical practice.

Mental Illness and its Link to Illegal Street Market Activity: Prevalence, Risk Factors, and How They Compare to Violence.

Given the focus on research assessing violence among people with mental illness, other forms of deviance such as illegal street market offending have been relatively ignored. As such, the prevalence and risk factors for illegal street market offending among those with mental disorders is unknown. Utilizing the MacArthur Risk Assessment Study, the prevalence of illegal street market offending among this population is assessed along with the risk factors for engaging in this type of behavior. These factors are investigated for their generality in predicting violent offending to see if there are unique risk factors associated with illegal street market offending. Results indicate that factors related to money, factors related to substance usage, and general factors related to offending are significantly associated with illegal street market offending. Theoretical implications and future research are discussed.

Does Preoperative Ostomy Education Decrease Anxiety in the New Ostomy Patient? A Quantitative Comparison Cohort Study.

PURPOSE: The purpose of this study was to determine if patients undergoing presurgical ostomy education and routine postoperative education experienced less postsurgical anxiety than patients undergoing routine preoperative education. DESIGN: Quantitative, prospective, comparison cohort study. SUBJECTS AND SETTING: The sample comprised 30 participants divided into 2 groups; one group received preoperative ostomy education and stoma site marking, along with postoperative ostomy education, while the other received only postoperative ostomy education. Each group had an equal number of males (n = 11) and females (n = 4). The mean age for the groups was 65.27 (SD = 9.97) and 61.87 (SD = 17.56) years, respectively; this difference was not statistically significant (P > .05). The intervention group included 9 patients who underwent colostomy, 4 who underwent ileostomy, and 2 who underwent urostomy. The comparison group comprised 10 patients with colostomies, 4 with ileostomies, and 1 with a urostomy. The study setting was a 385-bed tertiary hospital in Northern California. Data collection occurred from November 2, 2018, to February 22, 2019. METHODS: Postoperative anxiety levels were evaluated in both groups during their postoperative ostomy education session. Anxiety level was measured using the anxiety domain of the Hospital Anxiety and Depression Survey (HADS), which was administered during their postoperative educational session. Analysis of variance was used to compare the difference between the HADS anxiety domain scores between the groups. RESULTS: Patients who received preoperative ostomy education had statistically significant lower postsurgical anxiety scores than patients who had standard education (P < .001). CONCLUSIONS: Study findings suggest that preoperative ostomy education, when offered in addition to routine preoperative education, significantly lowers anxiety when compared to patients managed by routine preoperative education alone.

Forced treadmill running reduces systemic inflammation yet worsens upper limb discomfort in a rat model of work-related musculoskeletal disorders.

BACKGROUND: Musculoskeletal disorders can result from prolonged repetitive and/or forceful movements. Performance of an upper extremity high repetition high force task increases serum pro-inflammatory cytokines and upper extremity sensorimotor declines in a rat model of work-related musculoskeletal disorders. Since one of the most efficacious treatments for musculoskeletal pain is exercise, this study investigated the effectiveness of treadmill running in preventing these responses. METHODS: Twenty-nine young adult female Sprague-Dawley rats were used. Nineteen were trained for 5 weeks to pull a lever bar at high force (15 min/day). Thirteen went on to perform a high repetition high force reaching and lever-pulling task for 10 weeks (10-wk HRHF; 2 h/day, 3 days/wk). From this group, five were randomly selected to undergo forced treadmill running exercise (TM) during the last 6 weeks of task performance (10-wk HRHF+TM, 1 h/day, 5 days/wk). Results were compared to 10 control rats and 6 rats that underwent 6 weeks of treadmill running following training only (TR-then-TM). Voluntary task and reflexive sensorimotor behavioral outcomes were assessed. Serum was assayed for inflammatory cytokines and corticosterone, reach limb median nerves for CD68+ macrophages and extraneural thickening, and reach limb flexor digitorum muscles and tendons for pathological changes. RESULTS: 10-wk HRHF rats had higher serum levels of IL-1α, IL-1ß and TNFα, than control rats. In the 10-wk HRHF+TM group, IL-1ß and TNFα were lower, whereas IL-10 and corticosterone were higher, compared to 10-wk HRHF only rats. Unexpectedly, several voluntary task performance outcomes (grasp force, reach success, and participation) worsened in rats that underwent treadmill running, compared to untreated 10-wk HRHF rats. Examination of forelimb tissues revealed lower cellularity within the flexor digitorum epitendon but higher numbers of CD68+ macrophages within and extraneural fibrosis around median nerves in 10-wk HRHF+TM than 10-wk HRHF rats. CONCLUSIONS: Treadmill running was associated with lower systemic inflammation and moderate tendinosis, yet higher median nerve inflammation/fibrosis and worse task performance and sensorimotor behaviors. Continued loading of the injured tissues in addition to stress-related factors associated with forced running/exercise likely contributed to our findings.

The link between self-esteem and social relationships: A meta-analysis of longitudinal studies.

Theorists have long assumed that people's self-esteem and social relationships influence each other. However, the empirical evidence has been inconsistent, creating substantial uncertainty about whether relationships are in fact an influential factor in self-esteem development and vice versa. This meta-analysis synthesizes the available longitudinal data on the prospective effect of social relationships on self-esteem (48 samples including 46,231 participants) and the prospective effect of self-esteem on social relationships (35 samples including 21,995 participants). All effects controlled for prior levels of the outcomes. Results showed that relationships and self-esteem reciprocally predict each other over time with similar effect sizes (ß = .08 in both directions). Moderator analyses suggested that the effects held across sample characteristics such as mean age, gender, ethnicity, and time lag between assessments, except for the self-esteem effect on relationships, which was moderated by type of relationship partner (stronger for general relationships than for specific partners) and relationship reporter (stronger for self-reported than for informant-reported relationship characteristics). The findings support assumptions of classic and contemporary theories on the influence of social relationships on self-esteem and on the consequences of self-esteem for the relationship domain. In sum, the findings suggest that the link between people's social relationships and their level of self-esteem is truly reciprocal in all developmental stages across the life span, reflecting a positive feedback loop between the constructs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Are current mental health assessment formats consistent with contemporary thinking and practice?

Conducting and documenting a mental health assessment is considered a central activity from a clinical and organizational perspective. In recent years, thinking and practice in mental health service delivery has changed considerably to embrace principles of recovery, trauma-informed care, and strengths-based approaches. The aim of the present study was to determine the degree to which these concepts are reflected in the content of assessment formats across mental health services in Australia and New Zealand. Copies of mental health assessments used in each state and territory in Australia, and three District Health Boards in New Zealand were obtained. Assessment formats were compared for similarities and differences, and to determine whether concepts of recovery, trauma-informed care, and strengths-based approaches were incorporated. The assessment formats analysed (n = 11) contained many traditional features targeted at identifying harms, problems, risks, and pathology. Some attempts to redress this discrepancy were evident. Overall, assessment formats did not adequately voice the individual's perspective or promote a truly comprehensive assessment through an exploration of individual strengths, skills and abilities, past successes, and future hopes. Assessment formats across Australia and New Zealand are not currently aligned with contemporary thinking and practice in mental health care. Given the heavy influence that mental health assessment has on clinical decision making in particular, a reappraisal of the focus and content of formats used is urgently required.

Stage IV colorectal cancer presenting after necrotizing soft tissue infection.

Necrotizing soft tissue infections (NSTIs) are highly aggressive and may be lethal if untreated. Polymicrobial infections of the groin and lower limb have been documented secondary to invasive colorectal cancer (CRC). We present a case of CRC diagnosed more than 4 years after the development of NSTI. There are documented cases of NSTIs concomitant with a preexisting CRC. In this case, however, the patient's initial presentation was an NSTI followed by later diagnosis of CRC. A previously treated NSTI that is not healing appropriately may be an early indicator for CRC.