VAAFT PROCEDURE (Video-assisted Anal Fistula Treatment) versus open method in the treatment of high fistula in ano

Background: A common acquired anorectal condition is anal fistula. The treatment approaches that have been employed have been linked to erratic outcomes and sometimes life-threatening consequences. Video-assisted anal fistula treatment (VAAFT), a minimally invasive method, was introduced for adult patients in 2011. Objective: To know the efficacy of the VAAFT procedure in treating high anal fistulas and to compare it to open methods in the Basrah province. Methods: The present study was performed on 200 patients with high fistulas in ano in Basrah province. We divided the patients into 2 groups: Group A: treated by the VAAFT technique and Group B: treated by open fistulotomy Results: The patients treated with VAFFT revealed no occurrence of the following postoperative complication: Infection, incontinence, recurrence, anal stenosis, and bleeding. There was lower incidence of pain, short time for wound healing, rapid return to work, and more patient satisfaction compared with open fistulotomy Conclusion: An innovative method for managing ano fistula is VAAFT. Compared with traditional methods, it has a lot of benefits. It is day case surgeryno open wound.no damage to anal sphincter and no risk of incontinence, it is more affordable.it allow for clear identification of internal office, whole tract and its associated branches and cavity. The instrument can be used for multiple patients after good sterilization and disinfection. (AU)

COVID-19 herd immunity v. learning to live with the virus

Mutations of SARS-CoV-2 have been associated with increased transmissibility and occasionally reduced sensitivity to neutralising antibody activity induced by past ancestry virus infection or current COVID-19 vaccines. Nevertheless, COVID-19 vaccines have consistently demonstrated high efficacy and effectiveness against COVID-19 severe disease, hospitalisation and death, including disease caused by designated variants of concern. In contrast, COVID-19 vaccines are more heterogeneous in reducing the risk of infection and mild COVID19, and are modestly effective in interrupting virus transmission. Ongoing mutations of SARS-CoV-2 resulting in increased transmissibility and relative evasion of neutralising antibody activity induced by past virus infection or COVID-19 vaccines are likely. The duration of protection induced by COVID-19 vaccines is modelled to be relatively short in protecting against infection and mild COVID-19, but is likely to be 2 - 3 years against severe disease. Current experience from the UK and Israel demonstrates that even with high levels of COVID19 vaccine coverage (>85% of the adult population), resurgences with new variants of concern remain a strong probability. Nevertheless, such resurgences are not mirrored by high rates of hospitalisation and death compared with what was experienced in relatively COVID-19 vaccine-naive populations. Even though COVID-19 vaccines are unlikely to result in a herd immunity state, their ability to protect against severe COVID-19 and death could allow for a return to normalcy once a large enough proportion of the adult population in a country has been vaccinated

Children caught in the long shadow of COVID-19

Despite the more transmissible delta variant being associated with higher rates of COVID-19 in unvaccinated adolescents, children have remained relatively spared from severe disease. Nevertheless, children are indirectly affected by the COVID-19 pandemic, which threatens to have far-reaching consequences. The effect of disruptions of seasonal patterns of circulation of respiratory pathogens on future immunity against such pathogens, childhood immunization programmes, and HIV and tuberculosis treatment programmes poses a threat to the future wellbeing of children. Furthermore, the economic devastation caused by the pandemic, including an increase in unemployment, gives rise to numerous challenges, such as food insecurity, which is likely to worsen childhood nutritional status. Also, COVID-19 has ongoing effects on the mental wellbeing of children, driven in part by the interruption of schooling and other opportunities to socialize. An increase in psychological illnesses has manifested in children consequent to the stresses of the pandemic, lockdowns, caregiver deaths. In this article, we highlight the indirect effects of COVID-19 on children, and suggest solutions to mitigate against the long-term sequelae. A focused health, nutrition, education and child protection response is required from government and healthcare practitioners to safeguard the health and wellbeing of South African children.

COVID-19 antibody testing: from hype to immunological reality

The potential role for serological tests in the current COVID-19 pandemic has generated very considerable recent interest across many sectors worldwide, inter alia pathologists seeking additional weapons for their armoury of diagnostic tests; epidemiologists seeking tools to gain seroprevalence data that will inform improved models of the spread of disease; research scientists seeking tools to study the natural history of COVID-19 disease; vaccine developers seeking tools to assess vaccine efficacy in clinical trials; and companies and governments seeking tools to aid return-to-work decision-making. However, much of the local debate to date has centred on questions surrounding whether regulatory approval processes are limiting access to serological tests, and has not paused to consider the intrinsically limiting impact of underlying fundamental biology and immunology on where and how different COVID-19 serological tests can usefully be deployed in the response to the current pandemic. We review, from an immunological perspective, recent experimental evidence on the time-dependency of adaptive immune responses following SARS-CoV-2 infection and the impact of this on the sensitivity and specificity of COVID-19 antibody tests made at different time points post infection. We interpret this scientific evidence in terms of mooted clinical applications for current COVID-19 antibody tests in identifying acute infections, in confirming recent or past infections at the individual and population level, and in detecting re-infection and protective immunity. We conclude with guidance on where current COVID-19 antibody tests can make a genuine impact in the pandemic

Etiological Evaluation of Non-resolving Pneumonia: Our Experience in a Tertiary Care Center of Telangana

Introduction: Non-resolving or slowly resolving pneumonia is not uncommon, affecting 10–20% of patients admitted withcommunity-acquired pneumonia (CAP). Non-resolving pneumonia is a challenging clinical problem. Incidence of non-resolvingpneumonia was found to be 10–15% among hospitalized patients with CAP and of them 6% developed progressive pneumonia.This study aims to evaluate the patients of non-resolving or slowly resolving pneumonias to establish the cause of it.Methodology: It is a prospective, observational study taken up by the Department of Pulmonary Medicine of SVS MedicalCollege and Hospital, Mahabubnagar, Telangana. All the enrolled cases of non-resolving or slowly resolving pneumonia whichsatisfy the inclusive criteria were taken into the study from June 2017 to December 2018. A total of 28 patients were satisfyingthe inclusion criteria and were further studied for evaluating the causative factors. The study was started after taking the approvalof the Institutional Ethics Committee, SVS Medical College and Hospital, Mahabubnagar, Telangana.Observation and Results: The mean age of the patients was 48.2 years. Of 28 patients, 18 (64.2%) were male and 10 (35.7%)were female with a male:female ratio – 1.8:1. Fever (81%) and cough (86%) were the most common symptoms. Smoking wasthe most common comorbidity noted (60.7%) followed by alcoholism (46.6%), diabetes (39.28%), hypertension (25%), andchronic obstructive pulmonary disease (21.4%). The most common cause of non-resolution of pneumonia in this study wastuberculosis 11 (39.28%) followed by bacterial pneumonias 9 (32.1%) which were caused by drug-resistant organisms. Othercauses were malignancy 6 (21.4%), foreign body 1 (3.57%), and fungal pneumonia 1 (3.57%).

Gastroesophageal reflux disease among pilgrims during the Hajj period [1438 Hegira]: prevalence and impact on the quality of life

Background: Gastroesophageal reflux disease [GERD] is a chronic motility disorder resulting in reflux of stomach contents in to the esophagus. It has a prevalence rate of 10-20% in the western world. In the Gulf region, the prevalence of GERD is not yet well characterized. Annually, millions of Muslims gather from across the world embark on a religious pilgrimage to Mecca in Saudi Arabia. They represent a population with various socio-demographic characteristics, life styles, dietary habits and social life stresses that might affect the prevalence of this chronic disorder

Objective: the aim of this study was to determine the prevalence and impact of GERD on the pilgrims in Mecca region during the Hajj period in the year 1438 Hegira

Methods: participants were asked to fill a self-administered questionnaire, GERD questionnaire [GERDQ] and GERD-HRQL were used for making the diagnosis of GERD and to assess its impact on the patient's quality of life

Results: the prevalence of GERD among the study population was 29.0%, with a statistically significant association with age and nationality. Neither smoking nor the presence of other diseases showed statistically significant relationship with the presence of GERD [p>0.05]. GERD-HRQL scale showed a statistically higher median in GERD patients compared to healthy subjects. Moreover, 58 participants [52.73%] showed poor quality of life compared to 52 participants [47.27%] who expressed good quality

Conclusion: this study showed a prevalence rate of GERD among pilgrims in Mecca region to be 29.0%, which has an impact on their daily life activities. These data indicate a need for a comprehensive approach to GERD management in the health-care system

Pneumococcal conjugate vaccines and hospitalization of children for pneumonia: a time-series analysis, South Africa, 2006­2014

Objective To assess the impact of immunization with pneumococcal conjugate vaccines on all-cause pneumonia hospitalizations among children in Soweto, South Africa. Methods We used data collected at the Chris Hani Baragwanath Hospital in Soweto between 2006 and 2014 ­ i.e. before and after April 2009, when a pneumococcal conjugate vaccine was first included in South Africa's routine immunization programme. Using a Bayesian generalized seasonal autoregressive moving-average model and the data collected in 2006­2008, we estimated the numbers of children that would have been hospitalized for pneumonia between 2010 and 2014 if no pneumococcal conjugate vaccines had been used. These estimates were then compared with the corresponding numbers of hospitalizations observed. Findings Between 2006 and 2014, 26 778 children younger than five years ­ including 3388 known to be infected with human immunodeficiency virus (HIV) ­ were admitted to the study hospital for pneumonia. We estimated that, for the children known to be infected with HIV and for the other children, pneumococcal conjugate vaccines reduced the numbers of hospitalizations for pneumonia in 2014 by 33% (50% credible interval, CrI: 6 to 52) and 39% (50% CrI: 24 to 50), respectively. In the study hospital in 2012­2014, as a result of immunizations with these vaccines, there were an estimated 3100 fewer pneumonia hospitalizations of children younger than five years. Conclusion. In our study hospital, following the introduction of pneumococcal conjugate vaccines into the national immunization programme, there were significant reductions in pneumonia hospitalizations among children

Prognostic indicators in patients with relapsing remitting multiple sclerosis

Background: Multiple sclerosis inflammation demyelinating disease of the central nervous system affecting nearly 2 million people worldwide. Multiple sclerosis typically begins in early adulthood and has a variable prognosis

Objective: To determine the factors that affects the prognosis in Iraqi patients with relapsing remitting multiple sclerosis

Patients and Methods: This study includes fifty patients with relapsing remitting MS and was conducted from March 2007 to July 2008in Baghdad Teaching Hospital MS clinic. A study protocol sheet was done and filled from the patient's database in the MS clinic. The Prognostic indicators of residual disabillity depends on the [EDSS]

Results: The mean age for the study sample was 45-58 years, with 27 male and 23 female. High percentage of patients represented as monosymptomatic [70%], most of symptoms was spinal [48%]. The mean value for relapses was 2.3 with maximum number of 6. The study shows that there is no significant effect of gender as a prognostic indicators on the residual disabillity of patient with relapsing remitting multiple sclerosis. There is significant correlation between the age at CDMS and the EDSS in the first visit [SDSSI]

Conclusion: we concluded that the older age at onset, pyramidal and sphincteric involvement at the beginning of the illness and more relapses in the first 2 years of the illness all are associated with poor prognosis.

Understanding trainees' perception concerning the educational process in general practice, does it help?

Trainees' skills and the teaching process can be improved by consideration of candidates' views. To find out the trainees' perception and views about the features and teaching methods of the Family Practice Training Program [FPSTP] in Kuwait to upgrade its standard. The study design is cross sectional descriptive one. Data were collected from fifty seven trainees and twenty seven newly graduated doctors from FPSTP in Kuwait. The questionnaire included, in addition to personal characteristic, two sections. The first one was used to explore their views about different teaching methods. The second one included questions related to specific aspects of the program. The response rate was 93.3%. Most of the trainees received tutorials [76.2%] and case discussions [72.6%]. About half of them [54.8%] had joint consultations. More than half of them [63.1%] think that joint consultation sessions are useful. Video consultation analysis was viewed beneficial by about half of them [57.1%]. The majority of the participants think that communicative skills improved by case discussion [91.7%] and observed consultation [89.3%], and they find it easy to discuss clinical problems with trainers [82.1%]. Most of the graduated doctors [74.4%] think that Clinical Audit is useful for the training program, while less than half of the trainees [49.1%] believe in this, with a significant difference. [P = 0.03] between the two groups of participants. Feedback from trainees is essential in order to measure their level of satisfaction with teaching methods and for improvement of the educational process for family practitioners

[Induction of specific T-cell response following in vivo treatment of dendritic cells by 1,25-dihydroxycholecalciferol]

Dendritic cells [DCs], as the managers of the immune response, have a crucial role in forming the direction and nature of the immune response. Some compounds such as 1,25-dihydroxycholecalciferol affect the function of DCs and can be used to shift the immune functions toward favorite directions. The aim of this study was to investigate the in vivo effects of 1, 25- dihydroxycholecalciferol on DCs surface markers, their potential to induce specific T-cell responses and the cytokines profile. 1, 25-dihidroxycholecolciferol was regularly injected intraperitoneal into C57BL/6 mice. DCs were separated from the spleens of calciferol treated and non-treated mice using magnetic beads. The expression of DCs surface markers was investigated by flow cytometric analysis. The separated cells were pulsed by myelin oligodendrocyte glycoprotein [MOG] and injected subcutaneously into front footpads of syngeneic mice. After five days, the lymphocytes from regional lymph nodes were separated and used for the lymphocyte transformation test [LTT] and determination of the interferon gamma/interleukin 4 [IFN gamma/IL-4] ratio by ELISA technique. Statistical analysis of the obtained results showed reduced expression of maturation markers and co-stimulatory molecules by cholecalciferol treated DCs. The specific T-cell stimulation potential of treated DCs as well as the induced IFN gamma/IL-4 ratio was also down-regulated compared to non-treated cells [p value<0.05]. It seems that 1,25-dihydroxycholecolciferol can regulate the DCs function and maturation state in vivo. The T-cell stimulation rate and Th1/Th2 cytokines ratio also changes following interaction with cholecalciferol treated DCs

Evaluation of quality characteristics for three types of local produced Yoghurt [Zabady]

To evaluate quality of three types of Yoghurt [A,B,C], chemical, organoleptic microbiological tests were conducted, after 24 hours, a week and 2 weeks of the production and during storage at 5°C +/- 2°C. The results showed that the quality characteristics of the three types of Yoghurt were confirmed to the Yemeni standards [No: 66 for Yoghurt] in the total titrable acidity, total solids, fat, solids not fat,flavour, taste texture and total coliform bacteria, during the period of storage. The [C] type was significantly better [P<0.05] in flavour than the other two types [A,B] after 24 hours from the production and storage at 5°C +/- 2°C. The [C] type was mathematically better in most of the quality characteristics under investigation

Diagnosis and Management of Community-Acquired Pneumonia in Childhood - South African Thoracic Society Guidelines

Background: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality in South African children. The incidence; severity and spectrum of childhood pneumonia have changed owing to the HIV epidemic. Increasing emergence of antimicrobial resistance necessitates a rational approach to the use of antibiotics in pneumonia management. Objective: To develop guidelines for the diagnosis; management and prevention of CAP in South African children. Methods: The Paediatric Assembly of the South African Thoracic Society established five expert subgroups to address: (i) epidemiology and aetiology; (ii) diagnosis; (iii) antibiotic treatment; (iv) supportive therapy; and (v) prevention of CAP. Each subgroup developed a position paper based on the available published evidence; in the absence of evidence; expert opinion was accepted. After peer review and revision; the position papers were synthesised into an overall guideline which was further reviewed and revised. Recommendations: Recommendations based on epidemiological factors include a diagnostic approach; investigations; supportive therapy; appropriate antibiotic treatment and preventive strategies. Specific recommendations for HIV-infected children are provided. Validation: These guidelines are based on the available evidence supplemented by the consensus opinion of South African experts in aediatrics; paediatric pulmonology; radiology; infectious diseases and microbiology. Published international guidelines have also been consulted

Introduction of the Pneumococcal Conjugate Vaccine into the South African Public Immunisation Programme: Dawn of a New Era?

Streptococcus pneumoniae is a leading vaccine-preventable cause of childhood death with an estimated 716;000 deaths occurring annually. Recent advances have seen the development of vaccines targeted against S. pneumoniae that are immunogenic and efficacious in very young children. These pneumococcal conjugate vaccines have now been evaluated in developed and industrialising countries with consistent efficacy against invasive pneumococcal disease at least due to the serotypes included in the vaccine. The vaccine has also been efficacious in preventing radiographically confirmed pneumonia; but has had less effect on pneumococcal acute otitis media. The introduction of the vaccine into the USA has been greatly successful and exceeds its expectations based upon the vaccine efficacy trials. In addition to preventing a greater than expected burden of invasive disease and pneumonia than anticipated in vaccinated children; the vaccine has also been associated with marked reduction in pneumococcal disease among unvaccinated members of the population; referred to as `indirect protection'. The introduction of the vaccine into the immunisation programme of industrialising countries; such as in South Africa; require robust surveillance to evaluate the effectiveness of the vaccine in such settings where the epidemiology of pneumococcal diseases differs to that in developed countries

[Desmoid tumors of the limbs in the child. About 6 cases]

[Invasive fibroma of the limbs in childhood] Six cases of invasive fibromata have been observed in children of various age. The symptoms are described and were found seldom to be typical. Treatment should always be surgical. Recurrence is frequent despite extensive resection

Inhabitual case of sciatica in a child: presacral hydatid cyst

Hydatid cyst involving the pelvis in children is extremely rare. We report a case of an 11-year old boy with sciatic pain. Ultrasonography and computerised tomography scan showed a presacral cyst mass extending into the intervertebral foramen at the S1 level. The intraoperative findings and histologic examination indicated the diagnosis of a solitary hydatid cyst. After surgical enucleation, there was no envidence of recurrence on long-term follow-up