High Horn's index score predicts poor outcomes in patients with Clostridium difficile infection.

Several variables have been proposed to predict the prognosis of patients with Clostridium difficile infection (CDI), but a clinically useful tool to stratify resource utilization has not been determined. Horn's index, a severity score based on underlying clinical illness, reliably predicts patients at high risk of CDI. The purpose of this study was to assess the use of Horn's index to stratify patients with CDI at high risk of poor clinical and economic outcomes. Hospitalized patients diagnosed with CDI were followed prospectively for three months. Horn's index scores were calculated for each patient on the day of the positive toxin test for C. difficile, and used to stratify differences in outcome variables (length of hospital stay, mortality and hospital costs). Eighty-five CDI patients (50% male, 64% Caucasian) were recruited. Discharge mortality was 0% for patients with Horn's index scores of 1 or 2, 5% for those with a score of 3, and 50% for those with a score of 4 (P < 0.001). Three-month mortality was 0%, 5%, 17% and 60% for patients with Horn's index scores of 1, 2, 3 and 4, respectively (P = 0.0004). Median three-month hospital costs were $8,585, $12,670, $29,077 and $68,708 for patients with Horn's index scores of 1, 2, 3 and 4, respectively (P < 0.001). Patients with Horn's index scores of 3 or 4 had a significantly longer hospital stay [mean 33.4 (standard deviation, SD 33.3) days] than patients with scores of 1 or 2 [mean 15.1 (SD 16.2) days, P = 0.001]. This study found Horn's index to be a simple and useful method for identifying CDI patients at high risk of poor clinical and economic outcomes.

Decreasing the cancer burden in developing countries: concerns and recommendations.

Although the close of the 20th century witnessed advances in cancer detection and treatment, cancer morbidity and mortality rates steadily increase across the globe within the 21st century. The majority of this cancer burden can be found in underdeveloped and developing countries. A growing concern can be seen regarding this issue, with the research community as well as governmental and non-governmental organizations considering efforts that need to be developed and implemented. In this article, we propose several strategies to reduce cancer burden in developing countries that involve not only governmental and non-governmental organizations in such developing countries but also the research community. Such measures may prove helpful in gaining a better understanding of cancer burden and assist in clinical decision making and the design of prevention strategies for developing countries.

Left-sided gall bladder: Report of two cases.

Left-sided gall bladder without situs inversus viscerum is a rare albeit recognized clinical entity. We report our experience of two cases of left-sided gall bladder in two women aged 36 and 48 who underwent laparoscopic cholecystectomy for chronic calculous cholecystitis. Left-sided gall bladder may provide an unusual surprise to the surgeons during laparoscopy as routine pre-operative studies may not always detect the anomaly. Awareness of the unpredictable confluence of the cystic duct into the common bile duct (CBD) and selective use of intraoperative cholangiography aid in the safe laparoscopic management of this unusual entity.

Optical internal urethrotomy as the treatment of choice for primary stricture of the urethra.

Seventy-five patients with primary urethral strictures were treated by optical urethrotomy with catheter drainage for 7 days. Good results were obtained in 66% of cases, which were all post-traumatic in nature; 34% had to undergo further procedures such as dilatation or repeat internal urethrotomy.