Short-course versus long-course antibiotic therapy for complicated appendicitis: A meta-analysis

OBJECTIVE@#To compare the efficacy of short-course versus longcourse antibiotic therapy among patients undergoing appendectomy for complicated appendicitis.@*METHODS@#The authors conducted an electronic search of PubMed, Cochrane Library, and EBSCOHost for studies from 2000 to January, 2000 to September, 2018 comparing short-course versus long-course antibiotic therapy in adults undergoing appendectomy for complicated appendicitis. The outcomes considered were the incidence of superficial surgical site infection and intra-abdominal abscess, and duration of hospital stay. Meta-analysis was performed using Review Manager software.@*RESULTS@#A total of 360 patients in two studies were analyzed. Superficial surgical site infection was identified in 5 out of 123 patients in the short-course antibiotic group (4%), and 5 out of 237 patients in the long-course antibiotic group (2.1%) (95% CI 0.38, 5.51, p=0.58). There was a decrease in the incidence of intra-abdominal abscess in the short-course antibiotic group (6.5%), but the difference was not statistically significant (95% CI 0.32, 1.77, p=0.52). The duration of hospital stay was significantly less in the short-course antibiotic group (3.95 days) compared to the long-course antibiotic group (4.6 days) (95% CI -0.66, -0.21; p<0.001). @*CONCLUSION@#No difference between the <5-day and ≥5-day antibiotic course in terms of surgical site infection and intra-abdominal abscess was detected. However, the hospital stay of the <5-day group was shorter.

Antibiotics versus no antibiotic therapy for uncomplicated sigmoid diverticulitis: A meta-analysis / The Health Sciences Journal

INTRODUCTION@#Antibiotics have been used customarily in the treatment of uncomplicated diverticulitis since their introduction and have become the standard of care. The aim of this study is to compare the effectiveness of antibiotic therapy versus no antibiotic therapy in the treatment of uncomplicated sigmoid diverticulitis.@*METHODS@#An electronic search for randomized controlled trials comparing antibiotics versus no antibiotic therapy for uncomplicated diverticulitis was conducted. The outcomes considered were associated morbidity (abscess formation and sigmoid perforation); need for sigmoid colon resection, and recurrence of diverticulitis. The included studies were evaluated for risk of bias. Meta-analysis with Forest plot was performed using Review Manager Version 5.3.@*RESULTS@#Two trials, consisting of 1,151 subjects, were included in the meta-analysis. There was no difference in the risk of sigmoid perforation (RR 1.02, 95% CI 0.30, 3.49). Abscess formation and incidence of sigmoid resection were lower in the antibiotics groups (RR 2.24, 95% CI 0.51, 9.95 and RR 1.59, 95% CI 0.75, 3.36, respectively) but the differences were not significant. There was no difference in the recurrence of diverticulitis (RR 1.05, 95% CI 0.74, 1.78) between the two groups.@*CONCLUSION@#There is no definite advantage in giving antibiotics to patients with uncomplicated diverticulitis. Not giving antibiotics may be an acceptable treatment option for patients with acute uncomplicated sigmoid diverticulitis.

The Measurement Of Quality Of Life Among Population Within The Crowd: A Case Study Among Malaysian Pilgrims In Makkah

Hajj and ‘Umrah pilgrimage are a huge congregation performed by Muslims in Makkah, Saudi Arabia. The pilgrimage causes overcrowding and congestion that can lead to a high risk of health problems, especially when pilgrims have health problems. The purpose of this study is to assess the reliability of EQ-5D as a measuring tool to capture the health status of the pilgrims. Data collection was done during Ramadhan’s ‘Umrah in 2014. In this cross-sectional study, a total of 300 self-administered questionnaires attached with the EQ-5D-5L questions were distributed to Malaysian ‘Umrah pilgrims in Makkah and willing to participate in the study. The outcomes from the questionnaires and EQ-5D-5L were systematically analysed by using the SPSS software. The response rate was 64%, involved female (53%) and male (47%) respondents with the mean age of 55 years old. Hypertension (21.5%) and diabetes (16.2%) were the commonest underlying health problems suffered by the respondents in this study. Based on the EQ-5D outcomes, 53.3% of the respondents had no problem in their movement. However, the mean of EQ-VAS (visual analogue scale) presented 83 out of 100 scaling point, which means they might have problems in their health status. In addition, this study revealed, respondents with underlying illnesses had difficulty in some dimensions in EQ-5D. Hypertension was identified as the commonest underlying disease amongst the pilgrims. A contradicted outcome from the objective and subjective measuring scales of EQ-5D and EQ-VAS respectively; presented its sensitivity of EuroQol as a measuring tool for the quality of life among pilgrims living within such congestion

The Fundamental Of Hajj Demand For Health Care Services Within Congestion In Makkah

The large population of human congestion in Makkah during Hajj would promote contagious diseases. Thus, the pilgrims require health care services that are efficient, effective, and high quality. The aim of this study is to determine the type of health-related problems among Malaysian pilgrims and to identify the health care services required by them during Hajj in Makkah. A cross-sectional study was conducted in which involved 379 Malaysian pilgrims in 2013/14234H. The survey was conducted after the pilgrims completed their Hajj ritual. A total of 400 sets of questionnaires were distributed at Abraj Janadriyah Hotel, which was occupied by more than 3000 Malaysian pilgrims. The response rate for this survey was 93%. Male respondents were constituted of 49.6% and female respondents were 50.4% with the mean age 52 years old. The underlying disease among Malaysian pilgrims during Hajj was respiratory disease (77.5%). The demands for health personnel (36.1%) and quality medication (34.7%) are among the important healthcare services required by the Malaysian pilgrims in Makkah. Respiratory disease is a common disease experienced by Malaysian pilgrims in Makkah. A certain types of services such as health personnel and quality medicine are strongly demanded by the Malaysian pilgrims to overcome their health problem during Hajj. This research provides a fundamental input to the health care providers, and also benefited the Hajj management authority to improve the quality of hajj management in future

Oclusão percutânea da fenestração no pós-operatório tardio da cirurgia de Fontan / Percutaneous occlusion of Fontan fenestrations in the late postoperative period

Introdução: A fenestração na cirurgia de Fontan (CF) melhora o resultado imediato no pós-operatório, por descompressão do circuito venoso-pulmonar e aumento do débito cardíaco, a despeito da dessaturação arterial de oxigênio e do risco de embolia paradoxal. Geralmente as fenestrações são ocluídas percutaneamente no seguimento a médio prazo. Este estudo teve como objetivo relatar a experiência institucional na oclusão percutânea da fenestração. Métodos: Estudo descritivo longitudinal, observacional, retrospectivo, de uma coorte não-consecutiva de pacientes. O procedimento foi realizado sob anestesia geral com a ajuda de ecocardiograma transesofágico. O teste de oclusão da fenestração com cateter Bermann angiográfico foi realizado antes da intervenção. Diferentes técnicas e dispositivos foram empregados para a oclusão da fenestração. Resultados: Entre abril de 2004 e dezembro de 2010, 12 pacientes (média de idade, 103,1 ± 88,6 meses; peso, 29,9 ± 12,7 kg) submetidos a CF (10 tubos extracardíacos, 2 túneis intra-atriais) foram tratados 44,1 ± 26,7 meses após a CF. Um paciente não tolerou o teste de oclusão com o balão, sendo contraindicado o procedimento. As próteses utilizadas foram: HelexTM (4 pacientes), AmplatzerTM (2 pacientes), Cardia AtriaseptTM (2 pacientes), FigullaTM (1 paciente), CeraTM (1 paciente), e 1 stent coberto Cheatham-PlatinumTM. Após a oclusão da fenestração, a saturação de oxigênio aumentou significativamente (82,1 ± 6,5% para 95,2 ± 3,2%), sem aumento significativo da pressão venosa central (12,4 ± 2,6 mmHg para 14,5 ± 2,3 mmHg) nem queda do débito cardíaco. Após o procedimento foi observado shunt residual imediato em 5 pacientes, que desapareceu antes da alta. Conclusões: A oclusão percutânea das fenestrações após CF pode ser realizada com várias opções de próteses e técnicas, sendo um procedimento seguro e efetivo e que resulta em normalização dos níveis de saturação.

BACKGROUND: Surgical fenestrations improve the early postoperative outcomes of the Fontan operation (FO) as a result of reduced systemic venous congestion and increased cardiac output, in spite of mild systemic desaturation and risk of paradoxical embolization. Generally, these fenestrations are occluded in the midterm follow-up. This study was aimed at reporting our experience with the percutaneous occlusion of Fontan fenestrations. METHODS: Longitudinal descriptive, observational, retrospective study of a non-consecutive cohort of patients. The procedure was performed under general anesthesia with the guidance of the transesophageal echocardiogram. A fenestration occlusion test was performed prior to the intervention using a Bermann angiographic catheter. Different techniques and devices were used to occlude fenestrations. RESULTS: From April 2004 to December 2010, 12 patients (mean age 103.1 ± 88.6 months; weight 29.9 ± 12.7 kg) undergoing FO (10 extracardiac conduits, 2 intra-atrial tunnels) were treated 44.1 ± 26.7 months after the operation. One patient failed the balloon occlusion test and the procedure was contraindicated. The following devices were used: HelexTM (4 patients), AmplatzerTM (2 patients), Cardia AtriaseptTM (2 patients), FigullaTM (1 patient), CeraTM (1 patient) and 1 covered Cheatham-PlatinumTM stent. After fenestration closure there was a significant increase in oxygen saturation (82.1 ± 6.5% to 95.2 ± 3.2%), without a significant increase in central venous pressures (12.4 ± 2.6 mmHg to 14.5 ± 2.3 mmHg) or reduction of cardiac output. Immediate residual shunt was observed in 5 patients, which disappeared before discharge. CONCLUSIONS: Percutaneous occlusion of Fontan fenestrations can be performed safely and effectively using a variety of techniques and devices resulting in normalization of systemic saturation levels.

Opsoclonus-Myoclonus in children

Opsoclonus-myoclonus [OPMS] is a rare neurological syndrome of children and adults. Association with neuroblastoma occurs in 20-50% of all cases. We have recently encountered an infant with this syndrome and detailed work up revealed her to have an underlying neuroblastoma. Etiology and pathogenesis of this syndrome have been reviewed, it is important for general paediatricians to recognise this entity in order to initiate investigations and possible treatment

Comparison study of the management of severe primary postpartum haemorrhagia at Ahmed Maher teaching hospital during the year of 1996

The management of severe primary postpartum hemorrhage needs a very will trained senior doctors. It found that B-Lynch surgical technique is useful and a simple suture, but it needs more study to evaluate is value and safety

Study of the maternal mortality in Egypt and at Ahmed Maher teaching hospital

Maternal mortality and morbidity is higher in Egypt than other countries in the world and in the area covered by Ahmed Maher Teaching Hospital is still high. The aim of this study is to discover the main factors of maternal mortality and trying to reduce the incidence of these factors especially the avoidable one

Colposcopy in the diagnosis of human papillomavirus associated lesions of the cervix

The aim of this study was to determine the prevalence of HPV among 1419 patients underwent hybridization tests. Diagnosis of HPV infection of the cervix was done by colposcopy, microscopic examination of cytological smear and /or histological section and hybridization techniques. It was evident from the results that each of the different techniques e.g. colposcopy and cytology gave only a partial view on the presence or absence of HPV-DNA and the associated morphological anomalies. Thus, the different analysis techniques were rather complementary than competing

Multiple sclerosis: a review of existing therapy and future prospects

Multiple sclerosis [MS] is an incurable neurological illness that frequently causes chronic disability. Neurologists broach the diagnosis with dread. "I'll end up in a wheel chair" is the anguished cry of the newly diagnosed and mostly young patients. The past decade has improved our understanding of the immunopathogenesis of MS enormously. This has led to a plethora of clinical trials and the resultant emergence of several new drugs in various stages of development. In 1993, Food and Drug Administration [FDA] approved Betaseron for the treatment of MS. Todate, this is the only drug approved by the FDA, specifically for the treatment of MS. However, it would not be too long before several other drugs are approved, leaving the neurologist bewildered having gone from a state of practically little to offer to a state of several options to choose from. This review discusses the status of current and future therapy in the treatment of MS. Multiple sclerosis [MS] is the most common demyelinating disease of the human central nervous system [CNS]. Medline includes over 13000 articles on MS since 1966 that exclude book chapters and other references. MS typically affects the youth and women more than men, between the ages of twenty and forty. Clinically, the illness is characterized into a relapsing-remitting [RR] or chronic progressive [CP] stage although more precisely defined stages exist for research purposes. It tends to follow a highly unpredictable course leading to chronic and sometimes devastating disability. More recently, follow up data suggested that the disease may fall into a pattern after several years. Despite decades of hectic research and better understanding of immunological mechanisms involving human CNS disease, the cause of MS remains unknown. However, it is widely believed that MS is the result of an autoimmune disorder in a genetically susceptible individual, mediated by autoreactive T cells that migrate into the CNS and initiate the inflammatory demyelinating lesion[2]-4. Regardless of the plausibility of this theory and without going into details, several aspects of immune mediated pathology of MS remain unexplained. This is an attempt to review the status of current therapy and future prospects in the treatment of MS

Control of hypertension during labour and obstetric operation by using nifedipine and its effect on maternal cerebral circulation

Nifedipine is an effective drug in the management and the control of primary and secondary hypertension and hypertensive crisis during the gynecological and obstetric operation and it also reduces the mean blood flow velocity of the middle cerebral artery

The eosinophils in parasitic infections

Local and peripheal eosinophilia is a common feature of many helminth infections that present large, non-phagocytable surfaces to the inmune system. The effect of the eosinophils on these organisms has been studied in the last 18 years using schistosoma mansoni, trichinella spiralis, and other helminths as models. The early infection causes a nonspecific inflammation rich in macrophages, lymphocytes and neutrophils that sets the stage for a subsequent inmune response. The predominant effector elements of the inmune response are anaphylactic antibodies, mast cells, and eosinophils. Mast cell products attract eosinophils and concentrate antibodies and complement-covered parasites by their Fc and/or C3c receptors and release oxygen radicals and/or preformed proteins on the helmith surface. The radicals alter molecules of the parasite and the proteins disrupt its tegument or cuticle. Occasionally, they may harm host cells. Eosinophils also phagocytize and harm extracellular trypanosoma cruzi and may play a role in the damage to the host heart tissue. The eosinophil response is regulated by eosinophilopoietic factors (interleukines [IL] 3 and 5, and granulocyte macrophage colony-stimulating factor) eosinophilotactic factors (C5a from complement, eosinophil chemotactic factor of anaphylaxis [ECF-A], histamine, platelet stimulating factor, and other ECFs from mast cells and basophils, and ECF from parasites), and eosinophiloactivating factors (IL-5 from Th2 lymphocytes, tumor necrosis factor from macrophages, antibodies, and complement components). Other phagocytic cells (macrophages and neutrophils) also exhibit important anti-helminthic activities

Ectopic pregnancy a clinical study of 44 cases at England and 32 cased at Ahmed Maher hospital

Ectopic pregnancy is an acute potentially fatal gynecological emergency, and needs a correct, firm diagnosis and quick action. The incidence of ectopic pregnancy at Medway is slightly higher than the incidence in the United Kingdom. But like incidence at Ahmed Maher Hospital, is very low in comparison with the United Kingdom, Medway incidence, Baltimore [U.S.A.] and Jamaica in West Indies. There was no difference in the etiological factors, symptoms, signs and diagnosis of ectopic pregnancy between the patients in the Medway, Ahmed Maher Hospital area and other areas

effect of hepatitis B surface antigen in carrier mothers on immunoglobulin E concentration of the newly born

Viral hepatitis is a worldwide major public health problem and transmission of hepatitis B virus from the mother to the infant occurs when the mother is a chronic hepatitis B surface antigen carrier or had acute hepatitis B during pregnancy [Sacher al., 1985]. This study included 2 groups of parturient women at term pregnancy. The first group included 15 women with positive HBsAg and the second group included 30 women negative for HBsAg as a control group. The IgE concentration in the sera of the neonates of the study group ranged from 1.8 to 36 with a mean of 9.7 +/- 8.79 Iu/ml. While the concentration in the control group ranged from 4 to 106 with a mean of 20.0 +/- 20.05 Iu/ml. The levels were significantly lower in the study group than in the control group. This might have a correlation with the future occurrence of allergy later on in life