A Clinical Analysis of Acute Small Bowel Obstruction – A Review of Sixty-four Patients in a Tertiary Hospital

Background: Acute small bowel obstruction (SBO) is an ever increasing clinical problem. Successful management depends on comprehensive knowledge of the aetiology and patho-physiology of SBO, familiarity with imaging methods, good clinical judgment, and sound technical skills. Aim of the Study: To study the incidence, clinical features, and operative findings of small bowel obstruction in a Tertiary Hospital of Kerala. Materials and Methods: Aprospective cross-sectional analytical study was conducted in the Department of General Surgery, Medical College, Kerala, including 64 patients. Inclusion criteria: (1) Patients aged between 18 and 87 years were included in the study. (2) Patients with complaints of vomiting, pain in the abdomen, fever, and abdominal distension were included. (3) Patients who had hernia with recent onset of irreducibility, pain, vomiting, and constipation were included in the study. Exclusion criteria: (1) Patients who were aged below 18 and above 80 years were excluded from the study. (2) Patients with signs and symptoms of subacute intestinal obstruction (IO) and paralytic ileus were excluded from the study. The following data were collected: Adetailed record of the patient’s history, physical examination, and necessary investigations such as baseline, X-ray abdomen erect and supine in all cases, and ultrasound abdomen was recorded based on the requirement for each case. The pro forma was used to record the age, sex, and symptom duration, past surgical and medical history of all patients. All patients were subjected to surgery as their clinical presentation was of acute nature. The patients were stabilized from shock, fluid-electrolyte imbalances, and nasogastric aspiration before taking them to the operation theater. All the patients were followed postoperatively for 2–4 months from the time of discharge. The events of post-operative period and complications were noted and tabulated. All the data were analyzed using standard statistical methods. Observations and Results: A total of 64 patients presenting with acute IO were included in the study. Among the 64 patients, there were 49 male (76.56%) and 15 female (23.43%) with a male to female ratio of 3.26:1. The mean age of the patients was 49.36 ± 3.14 years. The youngest patient was aged 19 years and the eldest one was 76 years. It was observed that pain in the abdomen accounted for the most common symptom with 60/64 patients presenting with the symptom, followed by abdominal distension 49/64 (76.56%), vomiting in 43/64 (66.15%), and absent bowel sounds in 28/64 (43.75%) of the patients. Among the causes for small bowel obstruction (50/64), intussusceptions were noted in 13/64 (20.31%), volvulus in 10/64 (15.62%), adhesions in 8/64 (12.50%), hernia in 7/64 (10.93%), appendicitis in 6/64 (9.37%), and intestinal tuberculosis in 6/64 (9.37%) of the patients. Among the large bowel obstructions, volvulus was noted in 7/64 (10.93%), intussusceptions in 4/64 (06.25%), and large bowel tumor in 3/64 (4.68%) of the patients. Paralytic ileus was noted in 10/64 (15.62%) of the patients. Conclusions: Acute IO is a common surgical emergency requiring timely intervention to reduce morbidity and mortality. Acute IO is more common in small bowel when compared to large bowel. Males are more commonly affected than females. The clinical presentation varies on the level of obstruction and hence the incidence of symptoms varies from study to study. Intussusceptions, volvulus, herniae, and adhesions account for more than 50% of the causes of IO. Laparotomy was the most common means of IO management, while bowel resection and anastomosis were the most common intraoperative procedure. Early recognition and timely intervention are important to prevent the bowel going for gangrenous changes. Mortality increases with the delay in the institution of surgical or medical treatment.

Employers' Perceptions of Intimate Partner Violence among a Diverse Workforce

OBJECTIVES: Intimate partner violence (IPV) is a significant global public health concern, affecting 5.3 million US individuals annually. An estimated 1 in 3 women globally are abused by an intimate partner in their lifetime, and the effects carry over into the workplace. This article examines employers' perceptions of IPV in the workplace, targeting supervisors of Latina employees. METHODS: Fourteen employers and supervisors of small service-sector companies in Oregon were interviewed using semi-structured interviews. Interpretive description was used to identify themes. These qualitative interviews preceded and helped to formulate a larger workplace intervention study. RESULTS: The following themes were found and are detailed: (1) factors associated with recognizing IPV in the workplace, (2) effects of IPV on the work environment and (3) supervisors' responses to IPV-active vs. passive involvement. Also, supervisors' suggestions for addressing IPV in the workplace are summarized. CONCLUSION: These findings demonstrate the need for more IPV-related resources in the workplace to be available to supervisors as well as survivors and their coworkers. The needs of supervisors and workplaces vary by site, demonstrating the need for tailored interventions, and culturally appropriate workplace interventions are needed for Latinas and other racially and ethnically diverse populations.

[Utilization of particulate and immuno-modulating adjuvants for enhancement of immune response against tumors antigenic markers]

Regards to the weak immunigenicity of tumor cells as well as recombinant antigenic markers [like BLP25], adjuvants are needed for enhancement of immune response and it's skewing toward cellular immunity. In this research poly [lactide-co-glycolide] [PLGA] microspheres were used as delivery system for a recombinant mucin named mucin 1 [MUCl, BLP25] as a recombinant antigenic cancer marker, and CpG-ODN was used for enhancement of immune response and its biasing toward cellular immunity. PLGA microspheres encapsulated with BLP25 and CpG-ODN were prepared using a w/o/w emulsion method. Encapsulation of BLP25 was determined by a HPLC method and spectrophotometry at 260 nm was used for quantification of encapsulated CpG-ODN. In vivo immunization studies were performed by SC injections of 20 micro g BLP25 and 4 micro g CpG-ODN in mice [4 animal per group]. Group I] Mice immunized with microspheres co-encapsulated with BLP25 and CpG; Group II] Mice immunized with microspheres encapsulated with BLP25 mixed with CpG solution; Group III] Mice immunized with microspheres encapsulated with BLP25. For evaluation of specify of immune response, T lymphocytes separated from different groups of mice were incubated with different antigens [T Cell Proliferation Assay]. IFN-gamma and IL-4 cytokines were assayed by a sandwich ELISA method. T lymphocytes separated from group I, showed high proliferation [stimulation index = 25] and high levels of IFN-y interferon [11200+/-172 pg/ml] which were significantly higher than other two groups [P<0.0001]. Co-encapsulation and co-delivery of MUCl and CpG-ODN produced high cellular [Thl] immunity responses [high levels of IFN-gamma and no IL-4], indicating the high adjuvanticity potential of CpG-ODN for immunization against cancer markers. Importance of co-encapsulation of antigen and adjuvant in the same delivery system for better adjuvant effect was also approved

Avaliaçäo do nimesulide suspensäo oral versus diclofenaco resinato em infecçöes das vias aéreas superiores na pediatria / Evaluation of nimesulid oral suspension versus diclofenac resinate in upper respiratory tract infections in the pediatrics

Num estudo aberto e comparativo 60 crianças portadoras de infecçöes de vias aéreas superiores foram avaliadas. As crianças foram alocadas aleatoriamente em dois grupos de tratamento, um recebendo nimesulide suspensäo oral (5mg/Kg/peso em duas tomadas diárias), e outro recebendo diclofenaco resinato na dose de 1 gota/Kg/peso três vezes ao dia, durante sete dias. Em ambos os grupos os resultados terapêuticos foram similares. No que se refere à tolerabilidade, nenhum efeito colateral foi observado no grupo nimesulide, enquanto que no grupo diclofenaco duas crianças apresentaram reaçöes adversas (2 drop-outs). Quanto à palatabilidade, melhores resultados foram relatados no grupo nimesulide, onde 83,3% das crianças consideraram a palatabilidade boa, contra 66% no grupo diclofenaco

Distúrbio transitório da conduçäo atrioventricular: uma causa potencial de morte súbita na miocardite por varicela; relato de caso / Transient atrioventricular conduction disorder: a potential cause of sudden death in myocarditis due to varicella: a case report

Os autores apresentam o caso de uma paciente de 4 anos de idade, hospitalizada com insuficiência cardíaca grave associada a varicela. Durante a internaçäo houve aparecimento de distúrbio de conduçäo atrioventricular transitória. Apesar da melhroa clínica inicial a paciente faleceu devido a uma broncopneumonia e a necrópsia demonstrou lesöes miocárdicas compatíveis com miocardite aguda

Miocardiopatia hipertrófica fatal no recém-nascido: relato de caso / Fatal hypertrophic myocardiopathy in newborn infants: a case report

Os autores apresentam o caso de uma paciente de 6 semanas de vida, hospitalizada por apresentar insuficiência cardíaca grave e alteraçöes eletrocardiográficas sugestivas de infarto agudo do miocárdio de parede ântero-lateral. Apesar da melhora clínica com terapêutica convencional, a paciente morreu subitamente 30 horas após a admissäo provavelmente devido a uma arritmia. A necrópsia evidenciou uma miocardiopatia hipertrófica grave associada à comunicaçäo interatrial

Reavaliaçäo da eficácia da ampicilina em pneumonia / Re-evaluation of ampicillin's efficacy in pneumonia

Foram estudados 31 pacientes portadores de pneumonia lobar, tratados com ampicilina 1,0g quatro vezes ao dia, na forma de comprimidos, por 10 dias, analisando-se a eficácia e a tolerabilidade da droga. As avaliaçöes clínicas foram realizadas no início do tratamento e diariamente por 10 dias, verificando-se porcentagem de cura de 96,77%. Houve melhora estatisticamente significante para a maioria dos sintomas e sinais a partir do 3§ dia de tratamento. O autor discute a importância da etiologia e do diagnóstico no tratamento da pneumonia lobar