Single Dose Versus 72-Hour Course of Ceftriazone for Antibiotic Prophylaxis in Preventing Post-Caesarean Wound Infection: A Randomized Control Trial.

Background: Single dose antibiotic prophylaxis has been established as the standard for prevention of post-caesarean wound infection in most developed centers across the world. However, this is not the case in most developing countries including Nigeria where various multiple dose regimens are still being used due to paucity of locally generated evidence, and anecdotal suggestions of a higher risk of infectious morbidity in our environment. Objectives: This study was aimed to determine whether there was a significant difference in the incidence of post-caesarean section wound infection between a single dose and a 72-hour course of intravenous ceftriazone for antibiotic prophylaxis in selected patients undergoing both elective and emergency caesarean section. Materials and Methods: A randomized controlled trial was carried out among 170 consenting parturients scheduled for elective or emergency caesarean section who met a set out selection criteria, between January and June 2016. They were divided randomly into two equal groups, A and B, of 85 each using the Windows WINPEPI software version 11.65 (Copyright J.H. Abrahamson, 22 Aug 2016) for randomization. Group A patients received a single dose of 1 g, whereas Group B patients were given a 72-hour course (1 g daily) of intravenous ceftriazone. The primary outcome measure was the incidence of clinical wound infection. The secondary outcome measures were the incidences of clinical endometritis and febrile morbidity. Data were collected using a structured proforma and analyzed using Statistical Package for Social Sciences version 21. Results: The overall incidence of wound infection was 11.2%; Group A had 11.8%, and Group B had 10.6%. Endometritis was 20.6%; Group A had 20% and Group B had 21.2%. Febrile morbidity was 4.1%; Group A had 3.5% and Group B had 4.7%. There was no statistically significant difference in the incidence of wound infection (relative risk [RR] = 1.113; 95% confidence interval [CI] = 0.433, 2.927; P = 0.808), endometritis (RR = 0.943; 95% CI = 0.442, 1.953; P = 0.850), and febrile morbidity (RR = 0.745, 95% CI = 0.161, 3.415; P = 0.700) between the two groups. Group A showed similar risk of developing wound infection compared to Group B (P > 0.05). Conclusion: There was no significant difference in post-caesarean wound infection and other infectious morbidity between patients that received a single dose, and those that received a 72-hour course of ceftriazone for antibiotic prophylaxis. This suggests that single dose antibiotic prophylaxis with ceftriazone is similar to multiple dose regimens in efficacy with likely cost-effective advantage.

Imipenem Resistance in Gram-Negative Bacteria in the Central Pediatric Teaching Hospital in Baghdad, Iraq.

Antimicrobial resistance (AMR) is a serious challenge for infectious disease prevention and treatment, according to the World Health Organization. It is a worldwide problem caused primarily by inappropriate and insufficient therapy, misuse of antimicrobials without physician supervision, unnecessary hospital readmissions, and other factors. AMR has several consequences, including increased medical costs and mortality. The present study aimed to evaluate imipenem resistance in gram-negative bacteria in Central Pediatric Teaching Hospital in Baghdad, Iraq, and determine this bacteria resistance in different samples. Initially, a total of 100 different samples were collected from child patients from October 1, 2020, to August 31, 2021. Each isolate was identified using VITEK 2 automated microbiology system. The recorded data showed that the isolated organisms resistant to imipenem included Klebsiella pneumonia (n=21), Pseudomonas aeruginosa (n=19), and Acinetobacter baumannii (n=16). In the current study, Klebsiella pneumonia was the most common pathogen in males (n=57) compared to female (n=43), followed by Pseudomonas aeruginosa and Acinetobacter baumannii, particularly in the age range of 1 day- 3 years. Depending on the sample type, Klebsiella pneumonia, the most imipenem-resistant bacteria, was found more in the urine of patients with urinary tract infections. Pseudomonas aeruginosa was equally found in blood, urine, wound swab, and sputum samples. In comparison to other samples, Acinetobacter baumannii was found in greater numbers in the blood and in an equal number in urine and cerebrospinal.

Safety, feasibility, acceptability and effects of a behaviour-change intervention to change physical activity behaviour among people with multiple sclerosis: Results from the iStep-MS randomised controlled trial.

BACKGROUND: There is limited information regarding the safety, feasibility and acceptability of behaviour-change interventions to increase physical activity (PA) and reduce sedentary behaviour among people with multiple sclerosis (MS). Prior to evaluating efficacy, it is important to identify problems with feasibility and acceptability, which may undermine effectiveness. OBJECTIVE: To examine the safety, feasibility and acceptability of a behaviour-change intervention to increase PA and reduce sedentary behaviour among people with MS. METHODS: Sixty people received a 3-month intervention or usual care. Fatigue, pain and adverse events (AEs) were assessed. Feasibility and acceptability were explored through focus groups with physiotherapists and interviews with participants. Fidelity to intervention content, delivery skills, programme receipt and programme task were assessed. RESULTS: There was no difference in AE rate between groups (p = 0.965). Fatigue and pain were not higher in the intervention group at 3 or 9 months. Therapists reported the intervention was feasible to deliver and fidelity was acceptable. Twenty-nine participants (97%) attended at least 75% of sessions. Participants found the intervention acceptable but suggested some amendments were required to intervention components. CONCLUSIONS: The intervention was safe, feasible and acceptable. Although modifications are required to intervention components, the intervention warrants further evaluation in a future trial.

Infantile spasms: A prognostic evaluation.

BACKGROUND: Few papers address the comprehensive prognosis in infantile spasms and look into the seizure profile and psychomotor outcome. OBJECTIVE: We aimed to follow up children with infantile spasms to study: a) the etiology, demographics, semiology, electroencephalogram (EEG), and radiological pattern; b) seizure control, psychomotor development, and EEG resolution with treatment; c) the effects of various factors on the control of spasms, resolution of EEG changes, and psychomotor development at 3-year follow-up. MATERIALS AND METHODS: Fifty newly diagnosed cases with a 1-12 month age of onset and who had hypsarrhythmia in their EEG were recruited and 43 were followed up for 3 years. RESULTS: Of the children followed up, 51% were seizure-free and 37% had a normal EEG at the 3-year follow-up. Autistic features were seen in 74% of the children. Only 22.7% among the seizure-free (11.6% of the total) children had normal vision and hearing, speech with narration, writing skills, gross and fine motor development, and no autism or hyperactivity. On multivariate analysis, two factors could predict bad seizure outcome - the occurrence of other seizures in addition to infantile spasms and no response to 28 days of adrenocorticotropic hormone (ACTH). No predictor could be identified for abnormal psychomotor development. DISCUSSION AND CONCLUSION: In our study, we could demonstrate two factors that predict seizure freedom. The cognitive outcome and seizure control in this group of children are comparable to the existing literature. However, the cognitive outcome revealed by our study and the survey of the literature are discouraging.

The early electroclinical manifestations of infantile spasms: A video EEG study.

PURPOSE: Infantile spasms are described as flexor extensor and mixed; but more features of their semiology and ictal electroencephalography (EEG) changes are sparse in the literature. The purpose of the study was to describe the clinical and ictal video-EEG characteristics of consecutive cases with infantile spasms and to try to find an association with the etiology. MATERIALS AND METHODS: The clinical phenomenology and EEG characteristics on video-EEG were analyzed in 16 babies with infantile spasms. RESULTS: A total of 869 spasms were reviewed. Nine (56.3%) showed focal seizures at least once during the recording and 1 (6.3%) had multifocal myoclonus in addition to the spasms. The duration of the cluster and interval between spasms was totally variable in all patients. Lateralizing phenomena were present in at least some of the spasms in all patients. Unilateral manual automatism in the form of holding the pinna was noted in three patients following the spasm. The ictal EEG activity in the majority (75%) was the slow wave. Four (25%) showed fast generalized spindle-like ictal discharges. Spikes, spike and wave activity, or electrodecremental pattern alone during the ictus was seen in none. On bivariate analysis, no factor noted on the video EEG had association with the etiology. CONCLUSION: Infantile spasms could be associated with focal and other seizures, has unique, non-uniform and variable semiology from patient to patient. The ictal EEG manifestation in the majority (75%) of our patients was the slow wave transient with 25% showing generalized fast spindle-like activity.

Objective structured clinical examination vs traditional clinical examination: An evaluation of students' perception and preference in a Nigerian medical school.

BACKGROUND: Method of testing clinical competence of medical students in this setting has been controversial. This report evaluates the perceptions and preferences of 5(th) and 6(th) year medical students about traditional clinical examination (TCE) and objective structured clinical examination (OSCE). MATERIALS AND METHODS: A cross-sectional study using a structured questionnaire, administered to 156 students, who had been previously exposed to TCE and OSCE. RESULTS: There were 110 (70.5%) males and 46 (29.5%) females, with median age group of 26-30 years. One hundred and thirty-one respondents (84%) felt TCE is more difficult and 20 (12.8%) felt OSCE was more difficult. One hundred and forty-two (91%) felt OSCE was easier to pass, 8 (5.1%) felt TCE was easier to pass and 6 (3.8%) were undecided. Majority of the 5(th) and 6(th) year students (95.5% and 100%, respectively) preferred OSCE for assessment. In relation to validity and reliability of OSCE, 124 (79.5%) of all the students felt it provides a true measure of essential clinical skills, 130 (83.3%) felt its scores are standardised, 143 (91.7%) felt it is a practical and useful experience and 135 (86.5%) felt students' personality, ethnicity and gender will not affect OSCE scores. Overall, there were no significant differences in preference and perceptions between 5(th) and 6(th) year students and between males and females. CONCLUSION: Students preferred OSCE as method of assessing clinical competence and considered it a more valid and reliable method of examination.

Community-level distribution of misoprostol to prevent postpartum hemorrhage at home births in northern Nigeria.

In Nigeria, most deaths due to postpartum hemorrhage (PPH) occur in the absence of skilled birth attendants. A study using community mobilization and the training of community drug keepers to increase access to misoprostol for PPH prevention was conducted in five communities around Zaria in Kaduna State, Nigeria. Community-oriented resource persons (CORPs) and traditional birth attendants (TBAs) recruited and counseled pregnant women on bleeding after delivery, the importance of delivery at a health facility, and the role of misoprostol. Drug keepers stored and dispensed misoprostol during a woman's third trimester of pregnancy. TBAs and CORPs enrolled 1,875 women from January through December 2009. These results are based on 1,577 completed postpartum interviews. Almost all women delivered at home (95%) and skilled attendance at delivery was low (7%). The availability of misoprostol protected 83% of women who delivered at home against PPH who otherwise would not have been protected. Policymakers working in similar contexts should consider utilizing commuity-level distribution models to reach women with this life-saving intervention.

Atrioventricular Nodal Re-entrant Tachycardia Ablation: Unusual Function of Slow Pathway.

Slow pathway (SP) ablation is an acceptable, standard method for atrioventricular nodal re-entrant tachycardia (AVNRT) ablation. The exact role of SP in the human heart and the possible negative implications of SP ablation are unknown. The current case report describes an unusual, brief, functional heart block, following radiofrequency ablation of the SP. Our findings highlight the peculiar property of the SP in maintaining conduction over an atrioventricular (AV) node, in circumstances of extreme autonomic imbalance. SP can be ablated without major conduction problems for AVNRT. Careful pre-ablation evaluation of the AV conduction pattern may assist in predicting occurrences of this type of heart block.

Unusual survival time of primary cardiac sarcoma of the right ventricle.

Primary cardiac sarcomas are rare tumors with unfavorable prognosis. We report a 69-year-old male with a right ventricular mass diagnosed as primary malignant cardiac sarcoma with unexpected long survival of 16.5 months.

Hepatoprotective effect of morin on ethanol-induced hepatotoxicity in rats.

Morin is a flavonoid that exists in nature and is the major component of traditional medicinal herbs. Here we evaluated morin for its hepatoprotective effect against chronic ethanol-induced biochemical changes in male Wistar rats. Ethanol administration (7.9 g/kg bwt) for 60 days induced hepatic and renal damage by increasing oxidative stress and decreasing antioxidant levels. The status of lipid peroxidation (thiobarbituric reactive substances (TBARS) and hydroperoxides (HP)), antioxidant (vitamin C, vitamin E, GSH), serum hepatic markers (AST, ALT, ALP, GGT, bilirubin), and renal markers (urea, creatinine) were assessed as biochemical endpoints to determine the hepatic protective effect of morin. Oral administration of morin (100 mg/kg b.w) to alcohol-intoxicated rats for 30 days showed significant decreases in lipid peroxidation and restoration of antioxidant, hepatic, and renal markers to normal. Histopathologic observations of liver were also in correlation with biochemical parameters. The results indicate that morin might be beneficial in ameliorating alcohol-induced oxidative damage in rat liver.

Automatic implantable cardioverter defibrillator for the treatment of ventricular fibrillation following coronary artery spasm: a case report.

Coronary artery spasm is an infrequently recognized condition that causes Prinzmetal's angina and specific electrocardiographic changes. A 50-year-old man who suffered a spontaneously aborted acute inferior myocardial infarction is presented. He underwent cardiac catheterization, which initially showed a normal coronary artery. The coronary angiogram was repeated shortly after a second presentation of acute coronary syndrome and ventricular fibrillation. Coronary spasm of very proximal right coronary artery was present, which was reversed completely with intracoronary nitroglycerin. The spasm segment was first stented. Subsequently, an automatic implantable cardioverter defibrillator was inserted because of the uncertainty of future spasm recurrence. The patient was discharged with oral isosorbide dinitrate and Amlodipine. In further follow-up, the patient had two separate shocks within 4 months of implantation. Ventricular fibrillation was the trigger for the shock therapy in both occasions.

Pathogenesis of pleural infection.

The pleura responds to the presence of infecting organisms with a vigorous inflammatory response associated with an exudation of white blood cells and proteins. The development and outcome of pleural infections is a function of a balance between the virulence of the invading microorganism and the immune reaction involving professional immune cells as well as the pleural mesothelial cells. Most commonly, pleural infection occurs after invasion through the lung parenchyma and a breach in the viscera pleura resulting in the formation of a parapneumonic process. Upon infection, the microorganisms are recognized by the pleural mesothelial cell, which remains the first line of defence. Pleural responses to infection include those of innate immunity as well as adaptive or acquired immunity. Innate and acquired immune responses are closely linked. In this review, we discuss the different virulence factors that allow microorganisms to infect the pleura and the role of the pleural mesothelial cells in bridging the innate and acquired immune responses.