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Infect Dis (Lond) 2019 Apr 15:1-8. Epub 2019 Apr 15.

c Department of Clinical Medicine , Aarhus University , Aarhus , Denmark.

Background: Necrotizing soft tissue infection (NSTI) is a rare and potentially life-threatening disease. Rapid surgical intervention, antibiotics and intensive care are the mainstay of treatment. Hyperbaric oxygen therapy (HBOT) is used as adjuvant therapy in some centres but there is a lack of research-based evidence of efficacy. Read More

Expert Opin Drug Saf 2019 Apr 1:1-17. Epub 2019 Apr 1.

a Division of Clinical Pharmacology , Center for Interdisciplinary Research on Medicines (CIRM), Liège University , Liège , Belgium.

Introduction: Sodium-glucose cotransporter type 2 inhibitors (SGLT2is) are recommended after metformin for a large spectrum of patients with type 2 diabetes, because of a favorable benefit/risk profile despite a variety of adverse events. Areas covered: This narrative review discusses the safety profile of SGLT2is: initial concerns (cardiovascular safety, acute renal failure, hypoglycemia, urinary and genital infections, volume depletion, bladder cancer), further concerns (euglycemic ketoacidosis, bone fractures) and more recent concerns (lower limb amputation, Fournier's gangrene). Expert opinion: Overall, the safety profile of SGLT2is is good. Read More

Radiol Clin North Am 2019 May 14;57(3):635-648. Epub 2019 Feb 14.

Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St Louis, MO 63110, USA.

Ultrasound is the imaging modality of choice to evaluate the scrotum because of its high resolution, Doppler capabilities, availability, and lack of ionizing radiation. Acute urologic emergencies diagnosed with ultrasound include testicular torsion, testicular rupture, and Fournier gangrene. The radiologist's knowledge of sonographic features of vascular, infectious, traumatic, and benign and malignant processes that occur in the scrotum coupled with the patient's presenting symptoms, age, and physical examination allows for the correct diagnosis of a wide spectrum of scrotal pathology. Read More

Urology 2019 Mar 14. Epub 2019 Mar 14.

Department of Plastic Reconstructive and Aesthetic Surgery, Erciyes University School of Medicine Gevher Nesibe Hospital, 38030 Melikgazi, Kayseri. Electronic address:

Objective: To reconstruct the defect secondary to Fournier's gangrene, which is an infection localized in the perineum and the lower abdominal region, characterized by large tissue loss following debridement. A large tissue loss caused by Fournier's gangrene brings with repair problems. The primary goal is to achieve cosmetically and functionally successful results. Read More

Int Braz J Urol 2019 Jan-Feb;45(1):201-202

Faculdade de Medicina da Universidade Estadual de Ciências da Saúde de Alagoas (UNCISAL), Maceió, AL, Brasil.

GMS Interdiscip Plast Reconstr Surg DGPW 2019 4;8:Doc02. Epub 2019 Feb 4.

Department of Plastic Surgery and Burn Unit, King Fahad Military Medical Complex, Dammam, Saudi Arabia.

To share our experience with the management of Fournier gangrene (FG) using the bagging technique of the testes, and to highlight the importance of implementing a multidisciplinary approach in managing FG. A 58-year-old male with type 2 diabetes mellitus (DM) was brought to the emergency department (ED) with necrotizing fasciitis involving the genitalia; he was managed in the ED with Intravenous (IV) fluid resuscitation and IV antibiotics. The surgical team was consulted and multiple debridement procedures were done. Read More

Urol Int 2019 Feb 21:1-8. Epub 2019 Feb 21.

Department of General Surgery, Seth G S Medical College and KEM Hospital, Mumbai, India.

Objective: To identify factors that dictate morbidity and mortality in patients with Fournier's Gangrene and validate the Fournier gangrene severity index (FGSI).

Materials And Methods: We prospectively studied 50 patients with FG from January 2016 to December 2016 pertaining to their presenting signs, intraoperative findings, and postoperative wound management and outcome. We also checked the power of the FGSI to predict the outcome of the patients in terms of mortality. Read More

Clin Nurse Spec 2019 Mar/Apr;33(2):E6

Clin Nurse Spec 2019 Mar/Apr;33(2):63-65

Author Affiliation: Nurse Researcher, Premier Health-Miami Valley Hospital, Dayton, Ohio.

Wounds 2019 Jan;31(1):E1-E4

Christus Trinity Mother Frances Hospitals, Tyler, TX.

Introduction: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) cleanses wounds with cyclic delivery, dwell, and removal of topical solutions to solubilize infectious materials and wound debris.

Objective: In this 2-patient case study, the authors report their experiences using NPWTi-d on 2 critically ill patients requiring management of large, complex wounds.

Materials And Methods: In both cases, normal saline was instilled with 10- to 20-minute dwell times, followed by 2 hours of negative pressure wound therapy (NPWT) at -125 mm Hg. Read More

J Diabetes 2019 May 5;11(5):348-350. Epub 2019 Feb 5.

Department of Endocrinology, Ankara Training and Research Hospital, Ankara, Turkey.

BMJ Case Rep 2018 12 7;11(1). Epub 2018 Dec 7.

Department of Hematology and Oncology, Boston Medical Center, Boston, Massachusetts, USA.

We present a case of an unusual presentation of acute promyelocytic leukaemia (APML), which presented with Fournier gangrene (FG). A 38-year-old man presented with malaise, groin swelling, anal bleeding, fever and was found to have FG. Initial workup revealed pancytopaenia, borderline low fibrinogen, prolonged international normalized ratio (INR), which raised the suspicion for leukaemia. Read More

Ann Surg Treat Res 2018 Dec 26;95(6):324-332. Epub 2018 Nov 26.

Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea.

Purpose: We present our experience involving the management of this disease, identifying prognostic factors affecting treatment outcomes.

Methods: The patients treated for Fournier gangrene at our institution were retrospectively reviewed. Data collected included demographics, extent of soft tissue necrosis, predisposing factors, etiological factors, laboratory values, and treatment outcomes. Read More

Plast Reconstr Surg 2019 02;143(2):444e

Department of Plastic and Reconstructive Surgery, Yuzuncu Yil University Faculty of Medicine, Van 65040, Turkey,

Plast Reconstr Surg 2019 02;143(2):443e-444e

Department of Hematology, Ufuk University Faculty of Medicine Department of Internal Medicine, University of Health Sciences, Kecioren Training and Research Hospital, Ankara, Turkey.

Surg Infect (Larchmt) 2019 Jan 7;20(1):78-82. Epub 2018 Nov 7.

Faculty of Medicine, Department of General Surgery, Kirikkale University , Kirikkale, Turkey .

Background: The objective of this study was to determine the clinical and laboratory features affecting mortality in Fournier gangrene.

Patients And Methods: This retrospective case control study was designed to evaluate patients treated for Fournier gangrene in our center between 2010 and 2018. Those patients were divided into two groups: discharged patients (group 1) and deceased patients (group 2). Read More

Cent European J Urol 2018 22;71(3):360-365. Epub 2018 Sep 22.

University Medicine Greifswald, Department of Haematotology/Oncology, Greifswald, Germany.

Introduction: To compare earlier and later patient groups with Fournier's gangrene, specifically with the incidence of rising antibiotic resistance rates in mind. Primary endpoints were to compare therapy, outcomes, and resistance rates.

Material And Methods: A multicentric, retrospective, multi-national study was performed. Read More

Urol Int 2018 16;101(4):467-471. Epub 2018 Oct 16.

Department of Urology and Kidney Transplantation, Martin Luther University, Halle, Germany.

Introduction: Hyperbaric oxygenation (HBO), in addition to anti-infective and surgical therapy, seems to be a key treatment point for Fournier's gangrene. The aim of this study was to investigate the influence of HBO therapy on the outcome and prognosis of Fournier's gangrene.

Patients And Methods: In the present multicenter, retrospective observational study, we evaluated the data of approximately 62 patients diagnosed with Fournier's gangrene between 2007 and 2017. Read More

Wounds 2018 Oct;30(10):290-299

Wright State University, Boonshoft School of Medicine, Division of Plastic Surgery, Dayton, OH.

Introduction: Fournier's gangrene (FG) remains a forbidding necrotizing soft tissue infection (NSTI) that necessitates early recognition, prompt surgical excision, and goal-directed antibiotic therapy. Traditionally, surgical management has included wide radical excision for sepsis control, but this management often leaves large, morbid wounds that require complex wound coverage, prolonged hospitalizations, and/or delayed healing.

Objective: The purpose of this case series is to report the outcomes of FG using a surrogate approach of concurrent debridement of spared skin and soft tissue, negative pressure wound therapy (NPWT), and serial delayed primary closure (DPC). Read More

BMC Surg 2018 Sep 24;18(1):77. Epub 2018 Sep 24.

Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, Army Medical University, Xinqiao Road, Sha Ping Ba District, Chongqing, 400037, People's Republic of China.

Background: Perineum necrotizing fasciitis, also known as Fournier gangrene (FG), is a rare but highly mortal infectious necrotizing fasciitis with or without involvement of the underlying muscle. Evidence exists that negative pressure wound therapy (NPWT) combined with a split thickness skin graft (STSG) can help to heal wounds with FG. However, when the wound spreads to the anal area, it can easily be contaminated by faeces, causing a more extensive wounds; thus, faecal diversion is considered. Read More

Forensic Sci Med Pathol 2019 03 19;15(1):155-158. Epub 2018 Sep 19.

Department of Forensic Medicine, Cliniques St-Luc, Université catholique de Louvain, Brussels, Belgium.

Fournier gangrene is a rare fulminant necrotizing infection of the skin and soft tissue of the perineum that may result in rapid death. We describe the autopsy case of a 70-year-old female with uncontrolled diabetes mellitus who was found unexpectedly dead in her house where she lived with her dog. Examination of the body revelaed a deep necrotic ulceration of the perineum with exposure of the underlying deep muscles that was initially misinterpreted by police officers as post mortem animal predation. Read More

BMJ Case Rep 2018 Sep 19;2018. Epub 2018 Sep 19.

Department of Urology, King George's Medical University, Lucknow, Uttar Pradesh, India.

Ann Dermatol Venereol 2018 Nov 11;145(11):671-675. Epub 2018 Sep 11.

Clinique de dermatologie, hôpital Civil de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.

Background: Subcutaneous glatiramer acetate, commercialized under the name of Copaxone, is licensed for the treatment of relapsing multiple sclerosis. Its major adverse effects are skin reactions at the injection site. Nicolau syndrome is a rare but serious iatrogenic accident. Read More

Cleve Clin J Med 2018 Sep;85(9):664-665

Department of General Internal Medicine, Aso Iizuka Hospital, Fukuoka, Japan.

Pak J Med Sci 2018 Jul-Aug;34(4):1027-1029

Mehmet Oguz Sahin, M.D. Department of Urology, Manisa State Hospital, Manisa, Turkey.

Fournier's gangrene (FG) is a life-threatening, rapidly progressing acute necrotizing fasciitis of perianal, genitourinary and perineal areas. The most common isolated pathogens are , and in tissue and abscess cultures. However we present the first Rhizobium radiobacter FG in this case. Read More

Intern Med J 2018 09;48(9):1157-1160

Sydney, New South Wales, Australia.

Perineal gangrene (synergistic gangrene), an age-old severe infectious disorder, was more completely described by Dr Robert Robertson (1742-1829) in 1777, providing much needed data on the clinical features well before Dr Jean Alfred Fournier's (1832-1914) account in 1883. Robertson's historically overlooked and detailed narrative is presented with implications, in part, refuting some conclusions made by Fournier 100 years later. Read More

Urol J 2018 Aug 26. Epub 2018 Aug 26.

Department of female urology, Shahid Hasheminejad Hospital, Iran university of medical sciences, Tehran, Iran.

In this article we present two-year-old male patient who had history of Fournier gangrene of scrotum. Extensive perineal and scrotal debridement with suprapubic cystostomy tube insertion had been done for him in the emergency setting One year later his parents brought him back for scrotal reconstruction. A novel technique by using rotational perineal flap was used. Read More

ANZ J Surg 2019 Apr 2;89(4):350-352. Epub 2018 Sep 2.

Urology Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.

Background: Fournier's gangrene (FG) is a necrotizing fasciitis involving the perineum, external genitalia or perianal area. A rare condition with a historically high mortality rate (20-40%), our objective was to provide an up to date mortality rate for patients treated with multimodal therapy in a tertiary referral centre.

Methods: A retrospective review of a prospective database of FG patients treated at our tertiary referral centre was conducted. Read More

AJR Am J Roentgenol 2018 Nov 7;211(5):1051-1057. Epub 2018 Aug 7.

1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St. Louis, MO 63110.

Objective: The objective of our study was to delineate CT findings and anatomic areas of involvement of surgically proven Fournier gangrene (FG) and determine interobserver reliability.

Materials And Methods: This study was a single-center retrospective study of patients with FG who underwent CT before surgical débridement of FG during a 9-year period. Thirty-eight patients with FG, 17 male and 21 female patients, underwent preoperative CT. Read More

Cir Cir 2018 ;86(4):327-331

Departamento de Urología, Hospital General de México Dr. Eduardo Liceaga, Ciudad de México, México.

Antecedentes: La gangrena de Fournier (GF) es una fascitis necrotizante que pone en peligro la vida del paciente. El objetivo de este trabajo fue determinar la etiología y el impacto del agente aislado en el cultivo de la herida y de orina.

Método: Se llevó a cabo un análisis retrospectivo de una cohorte de 66 pacientes con GF de origen urogenital. Read More

Wounds 2018 Jul;30(7):E73-E76

Medical faculty, University in Ljubljana, Ljubljana, Slovenia.

Introduction: Fournier's gangrene is a rare but severe form of necrotizing fasciitis, primarily affecting the perianal, genital, and perineal regions. It is a rapidly progressive disease and can be potentially fatal; therefore, it should be treated as an emergency.

Case Report: Presented herein is the case of a 30-year-old man, without significant medical history, who presented to general surgery with complaints of swelling and pain in the gluteal area. Read More

Am J Emerg Med 2018 Sep 30;36(9):1719.e1-1719.e2. Epub 2018 May 30.

Cleveland Clinic Akron General, Department of Emergency Medicine, Akron, OH, United States; Northeastern Ohio Medical University, Rootstown, OH, United States. Electronic address:

Fournier's gangrene (FG) is a very serious and life threatening emergency. FG is a polymicrobial subset of necrotizing fasciitis affecting the genital region. Most cases have a perianal or colorectal focus; less often the gangrene originates from the urogenital tract or is preceded by trauma or a surgical procedure. Read More

Rev Bras Ortop 2018 Jul-Aug;53(4):493-498. Epub 2018 Jun 10.

Serviço de Ortopedia e Traumatologia, Grupo do Ombro e Cotovelo, Hospital Manoel Victorino, Salvador, BA, Brazil.

Fournier's gangrene is a rare, high-mortality infection that affects the subcutaneous tissue with rapidly progressive necrosis. The objective is to report a case of Fournier's gangrene involving the region of the shoulder girdle after closed fracture of the clavicle, and to discuss this unusual evolution. The patient underwent a series of surgical procedures and was followed up on an outpatient basis for 12 months, at which point she was discharged. Read More

Radiol Bras 2018 May-Jun;51(3):193-199

MD, PhD, Radiologist and Coordinator of the Imaging Department of the Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.

Emergencies involving the inguinal region and scrotum are common and can be caused by a plethora of different causes. In most cases, such conditions have nonspecific symptoms and are quite painful. Some inguinoscrotal conditions have high complication rates. Read More

World J Emerg Surg 2018 22;13:25. Epub 2018 Jun 22.

1Department of Urology, University Hospital Basel, Spitalstr. 21, 4031 Basel, Switzerland.

Background: Fournier's gangrene (FG) is a life-threatening infection of the genital, perineal, and perianal regions with a morbidity range between 3 and 67%. Our aim is to report our experience in treatment of FG and to assess whether three different scoring systems can accurately predict mortality and morbidity in FG patients.

Methods: All patients that were treated for FG at the Department of Urology of the University Hospital Basel between June 2012 and March 2017 were included and assessed retrospectively by chart review. Read More

Plast Reconstr Surg 2018 07;142(1):68e-75e

Van, Turkey From the Department of Plastic, Reconstructive, and Aesthetic Surgery and the Department of Anesthesiology and Reanimation, Yuzuncu Yil University Faculty of Medicine.

Background: The authors studied the alterations in mean platelet volume, neutrophil-to-lymphocyte ratio, and red blood cell distribution width values together with the platelet count in hospitalized patients diagnosed with Fournier gangrene to determine their association with disease prognosis.

Methods: Records of patients diagnosed with Fournier gangrene were analyzed retrospectively.

Results: Seventy-four patients (49 men and 25 women) with a mean age of 57. Read More

Urol Int 2018 27;101(1):91-97. Epub 2018 Jun 27.

Background: Fornier gangrene is an extremely rare disease of the genitals. This disease is a result of the urogenital tract, anorectal area, and genital skin infections, appearing usually in immunocompromised patients with diabetes, obesity, and malignant neoplasms. The basic treatment of Fournier gangrene includes an emergency surgical intervention combined with antibiotic therapy and detoxification. Read More

Dermatol Online J 2018 Apr 15;24(4). Epub 2018 Apr 15.

Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.

Many cases of superinfected hidradenitis suppurativa (HS) involve multiple species of bacteria, but gas-producing infections are rare and can complicate the clinical picture. Additionally, recognizing squamous cell carcinoma (SCC) as a complication of longstanding HS is imperative. Herein, we present a unique case of a severe emphysematous HS that was initially mistaken for Fournier gangrene and eventually diagnosed as superinfected SCC. Read More

Surg Infect (Larchmt) 2018 Jul 12;19(5):467-472. Epub 2018 Jun 12.

2 Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine , Houston, Texas.

Background: Fournier's gangrene is a necrotizing soft-tissue infection (NSTI) that often originates from a break in bowel integrity and affects the perineum, anus, or genitalia. Although the pathogenesis is similar, NSTI caused by a break in bowel integrity less commonly presents as infection of other sites.

Objective: To characterize NSTIs originating from bowel perforation and presenting as infection of the abdominal wall, flank, or thigh but that largely spare the perineum, anus, and genitalia. Read More

Pan Afr Med J 2018 24;29:70. Epub 2018 Jan 24.

Service de Chirurgie Générale, Hôpital Habib Bougatfa de Bizerte, Tunisie.

Fournier gangrene is a rare and severe necrotizing fasciitis. It is burdened with high morbi-mortality, requiring early and massive medical and surgical management. Initial treatment is based on patient's resuscitation associated with surgical debridement. Read More

Med Gas Res 2018 Jan-Mar;8(1):29-33. Epub 2018 Apr 18.

Department of Physiology and Biophysics, Stony Brook University School of Medicine, Stony Brook, NY, USA.

Hyperbaric oxygen therapy (HBOT) is a medical technique which delivers oxygen at ambient pressures to increase the amount of dissolved oxygen in the blood and oxygen distribution to tissues. There are several beneficial properties of HBOT concomitant with elevated oxygen distribution in tissue including anti-inflammation, angiogenesis through vascular endothelial growth factor proliferation, augmented fibroblast activity through fibroblast growth factor proliferation, tissue and wound repair, enhancement of lymphocyte and macrophage activity, increased male testosterone secretion, and bactericidal activity. Given its renown in treating conditions such as decompression sickness and carbon monoxide poisoning, HBOT is making gradual strides for use in genitourinary medicine due to its low risk and likeliness to achieve favorable results. Read More

Georgian Med News 2018 Apr(277):57-60

Institute of Nephrology, Department of Internal Medicine, Struga, Macedonia.

The presented case reports on 54-years old patient with T2 Diabetes mellitus who, due to hypoglycemic episodes on Insulin therapy, was treated with oral anti-hyperglycemic medications. Patient was on hemodialysis due to the stage 5 chronic kidney failure and had various comorbid conditions: arterial hypertension, history of acute myocardial infarction, dilative cardiomyopathy, amaurosis and peripheral neuropathy. Besides his complicated medical history, patient developed an early stage of Fournier's gangrene. Read More

Zhonghua Nan Ke Xue 2017 Mar;23(3):237-242

Department of Urology, Research Institute of Field Surgery, Daping Hospital, The Third Military Medical University, Chongqing 400042, China .

Objective: To search for an optimal strategy for the treatment of penile and scrotal gangrene by analyzing the clinical effect of vacuum sealing drainage (VSD) as an adjuvant treatment on this disease.

Methods: We retrospectively analyzed the clinical data about 4 cases of penile and scrotal gangrene treated by VSD as an adjuvant treatment from January 2015 to June 2016. The 4 patients all underwent early extensive and radical debridement of gangrene of the scrotum and penis and received intravenous injection of two broad-spectrum antibiotics, followed by VSD for wound drainage and irrigation. Read More

Saudi Med J 2018 Apr;39(4):415-418

Department of Accident and Trauma, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.

Fournier gangrene is a rapidly progressive necrotizing fasciitis of the perianal and genitourinary area. Although typically affects men, we present here a rare disease founding in a pregnant woman. An obese 36-year-old female patient in her third trimester of pregnancy presented with a history of perianal pain and swelling. Read More

ANZ J Surg 2018 Apr;88(4):386-387

Department of General Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.

BMC Nephrol 2018 03 27;19(1):72. Epub 2018 Mar 27.

Department of Nephrology, Kameda Medical Center, Chiba, Japan.

Background: Vancomycin is the first-line antibiotic for methicillin-resistant Staphylococcus aureus and coagulase-negative strains. The risk of vancomycin-induced acute kidney injury increases with plasma vancomycin levels. Vancomycin-induced acute kidney injury is histologically characterized by acute interstitial nephritis and/or acute tubular necrosis. Read More

Oxf Med Case Reports 2018 Feb 26;2018(2):omx101. Epub 2018 Feb 26.

Department of Radiation Oncology, Bank of Cyprus Oncology Center, Nicosia, Cyprus.

We herein present a case of a 24-year-old patient with a cT4N+ rectal cancer who developed Fournier's gangrene (FG) 1 week after the completion of preoperative chemoradiotherapy. The patient was promptly referred to the surgical department where she was treated with antibiotics and repeated surgical debridement. FG is a rare and life-threatening situation that needs to be managed aggressively with no delay. Read More

Oxf Med Case Reports 2018 Feb 9;2018(2):omx094. Epub 2018 Feb 9.

Department of Emergency Medicine, Beaumont Hospital, Teaching Hospital of Michigan State University, Farmington Hills, MI, USA.

Fournier's gangrene, a rare polymicrobial infection that affects the genitals and perineum, can present as an insidious onset to a rapid and fulminant course. Early recognition, diagnosis, initiation of broad-spectrum antibiotics and prompt surgical treatment remain the foundation of management. If treatment is not initiated aggressively, the patient will likely rapidly deteriorate, leading to organ failure and death. Read More

Plast Reconstr Surg Glob Open 2018 Jan 25;6(1):e1650. Epub 2018 Jan 25.

Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Surgery, Faculty of Medicine, Collage of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; and Center for Stem Cell Research, Kaohsiung Medical University, Kaohsiung, Taiwan.

Background: The use of negative-pressure wound therapy (NPWT) for Fournier gangrene management is well documented; however, it is difficult to fixate GranuFoam dressings and maintain an airtight seal over the perineum area. We developed a simple method to facilitate GranuFoam fixation and improve airtight sealing.

Methods: The Fournier's gangrene severity index (FGSI) score less than 9 was collected in from January 2015 to October 2016. Read More