Superficial and Deep Skin Preparation with Povidone-Iodine for Ventriculoperitoneal Shunt Surgery : A Technical Note

OBJECTIVE: Ventriculoperitoneal (VP) shunt surgery is a common and effective treatment for hydrocephalus and cerebrospinal fluid disorders. Infection remains a major cause of morbidity and mortality after a VP shunt. There is evidence that a deep skin flora microbiome may have a role to play in post-operative infections. In this technical note, we present a skin preparation technique that addresses the issue of the skin flora beyond the initial incision. METHODS: The patient is initially prepped, as standard, with. a single layer of 2% CHG+70% isopropyl alcohol. The novel stage is the ‘double incision’ whereby an initial superficial incision receives a further application of povidone-iodine prior to completing the full depth incision. RESULTS: Of the 84 shunts inserted using the double-incision method (September 2015 to September 2016), only one developed a shunt infection. CONCLUSION: The double incision approach to skin preparation is a unique operative stage in VP shunt surgery that may have a role to play in reducing acute shunt infection.

Superficial and Deep Skin Preparation with Povidone-Iodine for Ventriculoperitoneal Shunt Surgery : A Technical Note

OBJECTIVE: Ventriculoperitoneal (VP) shunt surgery is a common and effective treatment for hydrocephalus and cerebrospinal fluid disorders. Infection remains a major cause of morbidity and mortality after a VP shunt. There is evidence that a deep skin flora microbiome may have a role to play in post-operative infections. In this technical note, we present a skin preparation technique that addresses the issue of the skin flora beyond the initial incision.METHODS: The patient is initially prepped, as standard, with. a single layer of 2% CHG+70% isopropyl alcohol. The novel stage is the ‘double incision’ whereby an initial superficial incision receives a further application of povidone-iodine prior to completing the full depth incision.RESULTS: Of the 84 shunts inserted using the double-incision method (September 2015 to September 2016), only one developed a shunt infection.CONCLUSION: The double incision approach to skin preparation is a unique operative stage in VP shunt surgery that may have a role to play in reducing acute shunt infection.

The Pattern of sexual assault in people presenting to a gynaecological unit of a tertiary hospital in South-West Nigeria

Context: Sexual assault is a crime of violence that incorporates unwanted sexual behaviour, such as sexual coercion, uninvited kissing, fondling, touching and ultimately, rape. Individuals prone to sexual abuse are usually the young, poor, and vulnerable members of society, who are often subject to other forms of social vices, such as domestic violence. Aims: To ascertain the pattern of sexual assault in people presenting to a large gynaecological unit of a tertiary referral centre, in Nigeria. Settings and Design: Methods and Material: The study is a descriptive cross-sectional study that was undertaken over a 2-year period from January 2011 to December 2012. Statistical analysis used: SPSS. Results: The prevalence of sexual assault in this study was 1.64%. The majority (90.3%) of victims were single. At least a third (n=35) had secondary education. 62.65% of the patients delayed presentation until after 24hours, (n=52). The commonest reason for delay in presentation was of fear or embarrassment in 51.80% (n=43). The commonest place of assault was at the assailant's home in 33.7% (n=28). Many cases of assault occurred at night. 63.65% of the victims wanted suspects to be prosecuted (n=53). 67.46% of the victims expressed the desire to take legal action (n=56). Only 51.80% of the respondents (n=43) were aware of a route of seeking re-dress. Conclusions: Victims of sexual assault delay their presentation to health facilities because of fear and embarrassment. A significant percentage of the victims do not know how to obtain medical help

Big toe metastases as first clinical sign of occult bronchogenic carcinoma

Metastasis to bone is a common manifestation of malignant tumours. However, metastasis to the bones of the foot is exceedingly rare. It usually arise from genitourinary tract and colon, with the tarsal bones accounting for half of all metastases. We report a rare case of pain and destruction of the distal phalanx of great toe, initially suspected as osteomyelitis, which on biopsy proved to be metastases from a clinically silent bronchogenic carcinoma

Primary carcinoid tumour of the testis

A left radical orchidectomy was performed on a 32-year-old man presenting with a testicular mass. Histology revealed a tumour comprising of cells with monotonous nuclei and granular cytoplasm arranged in an insular pattern. Immunohistochemical expression for NSE, synaptophysin and chromogranin A were positive. No teratomatous elements were seen. Postoperatively, a staging CT and an octreotide scan were normal. Urinary 5-HIAA levels were not elevated. Based on these investigations the tumour was diagnosed as a pure primary carcinoid tumour of the testis. The patient has been followed up for 3 years with no evidence of recurrence

Lepidopterismo por Hylesia nigricans ( Mariposa negra ). Investigacion y accion preventiva en Buenos Aires / Lepidopterism due to the butterfly Hylesia nigricans. Preventive research-intervention in Buenos Aires

En el barrio El Pato,municipio de Berazategui, provincia de Buenos Aires, se realizó una investigación-acción preventiva contra la “mariposa negra” Hilesia nigricans, luego del aumento de consultas espontâneas por dematitis inespecífica. La incidência, durante el verano del año 2001, se estimo mediante una encuesta semiestructurada. En noviembre de 2002, se roció con Bacillus thuringiensis el arbolado público, evaluándose su efecto insecticida en campo y en laboratorio. El impacto se estimó mediante una encuesta pos-intervención en marzo de 2002. La distribución por edad, signos clínicos, persistência (11 días) y estacionalidad de los casos ( enero-febrero) fue consistente con dermatitis por H . nigricans. La mortalidad de larvas a las 96 horas del rociado fue del 100%. Las tasas de incidencia de dermatitis antes y después de la intervención fueron de 10.3% y 1.8% respectivamente. La acción coordinada de agentes nacionales, provinciales y locales permitió identificar el problema, diseñar investigaciones operacionales, y aplicar una estratégia de control preventivo, transferible por sus mismos efectores a la comunidad.

Hemorragia de vías digestivas altas / Acute upper gastrointestinal bleeding

La hemorragia aguda de vías digestivas altas es una de las emergencias más frecuentes en los servicios de urgencias. Su mortalidad promedio es del 10 por ciento. La etiología más común continúa siendo la úlcera péptica, representando casi la mitad de los casos. La restauración del volumen intravascular y la estabilización de la presión arterial son la primera prioridad del manejo más que identificar la causa del sangrado. En un 70-80 por ciento de los casos el sangrado se detiene espontáneamente. La endoscopia debe realizarse luego de la reanimación inicial y lograda la estabilidad, en diversas técnicas de hemostasis endoscópica. Respecto al tratamiento farmacológico, no hay datos convincentes para soportar el uso de antagonistas de receptores IL. Aunque algunos resultados son contradictorios, los inhibidores de la bomba de protones han demostrado su utilidad, sin embargo un beneficio claro en la mortalidad no se ha demostrado. Los beta-bloqueadores disminuyen la tasa de resangrado por várices esofágicas. Los pacientes con resangrado después de una fase inicial de estabilización requieren una nueva endoscopia para confirmarlo y tratarlo, en caso fallido deben ser llevados a cirugía. Se revisan los aspectos relacionados al diagnóstico, pronóstico y tratamiento, este último según grados de evidencia y se propone un algoritmo de diagnóstico y toma de decisiones

Association studies between -1185A/G von Willebrand factor gene polymorphism and coronary artery disease

High levels of von Willebrand factor (vWF) have been associated with cardiovascular disease. The A allele of the -1185A/G polymorphism in the 5'-regulatory region of the vWF gene was associated with the highest plasma vWF levels in a normal population. To examine the association between -1185A/G polymorphism and coronary artery disease (CAD), 173 Brazilian Caucasian subjects submitted to coronary angiography were studied. Of these, 57 (33 percent) had normal coronary arteries (control group) and 116 (67 percent) had CAD (patient group). Plasma vWF levels were higher in patients (145 U/dl) than in controls (130 U/dl), but the differences were significant only for O blood group subjects. Polymerase chain reaction amplification of the 864-bp vWF promoter region followed by AccII restriction digestion was used to identify the -1185A/G genotypes. The -1185A allele frequency was 43.1 percent in patients and 44.7 percent in controls. Allele and genotype frequencies were not significantly different between patients and controls. No association was observed between the -1185A/G genotypes and plasma vWF levels in patients or controls. These results suggest that -1185A/G polymorphism is not an independent risk factor for CAD

Epilepsy: a general practice perspective / Epilepsia: una perspectiva de practica general

La presente publicacion contiene los siguientes temas: definicion de la epilepsia; epidemiologia, cuidados primarios, clasificacion de la enfermedad, etiologia, diagnostico diferencial, farmacoterapia, aspectos sociales de la enfermedad y su prognosis.