Seroprevalence of Toxocara at Tra Vinh University Hospital in Vietnam.

OBJECTIVE: The study aims to assess the seroprevalence of Toxocariasis and its associated risk factors among individuals attending the outpatient department at Tra Vinh University Hospital, Vietnam, in 2022. SUBJECTS AND METHODS: A cross-sectional survey was conducted among outpatients of Tra Vinh University Hospital. Toxocariasis diagnosis was based on the Enzyme-Linked Immunosorbent Assay (ELISA) performed at the hospital's laboratory department. We assessed the seroprevalence of Toxocariasis and evaluated associated risk factors, including demographics and certain behaviors. RESULTS: Of the 249 participants surveyed, 165 tested positive for Toxocariasis, yielding a seroprevalence of 66.3% (95% CI: 60.4-72.1). Multivariate analysis revealed that age groups up to 30 and 30-60 years had higher odds of Toxocariasis infection, with adjusted odds ratios (aOR) of 2.52 (95% CI: 1.04-6.11) and 3.21 (95% CI: 1.44-7.15) respectively. Additionally, individuals residing in rural areas and those in contact with dogs or cats had increased risks, with aORs of 2.21 (95% CI: 1.21-4.01) and 2.04 (95% CI: 1.10-3.79), respectively. Notably, hand washing before eating emerged as a protective factor against Toxocariasis, presenting an aOR of 0.38 (95% CI: 0.19-0.76). CONCLUSIONS: Our findings underscore a significant seroprevalence (66.3%) of Toxocara spp. among outpatients at Tra Vinh University Hospital. Proactive measures, including hand hygiene before meals and after pet interactions, are advocated. There is a pronounced need for community-level epidemiological surveillance for human Toxocariasis.

Effect of Sevoflurane and Isoflurane on Post-Anaesthesia Cognitive Dysfunction in Normal and Type II Diabetic Rats.

Both animal and human studies have documented cognitive and behavioural impairment after exposure to inhalational anaesthetics. Therefore, the current study was designed to demonstrate if the anaesthetics isoflurane and Sevoflurane can result in postoperative cognition dysfunction in normal and diabetic rats. Sixty male Wister rats aged 12 weeks were divided into 6 groups (n=10); group C (standard control), group CD (diabetic control), group S (sevoflurane anaesthesia), group I (isoflurane anaesthesia), group SD (diabetic sevoflurane anaesthesia) group ID (diabetic isoflurane anaesthesia). Animals were anaesthetized with either 2. 5% sevoflurane or 1.5% isoflurane, respectively, for 2h. 1 week later, animals were undergone cognitive tests in (a Morris water maze, T maze and open field arena), the animals were sacrificed, and hippocampus homogenates were studied for caspase 3 activity by western blot assay. Induction of type II diabetes in CD, SD and ID groups was carried out by feeding on a high-fat diet for 8 weeks before the start of the experiment. During the fourth week, Type II diabetes was induced in the experimental group by a single IP injection of 30 mg/kg STZ. Control (normal and diabetic) rats showed no change in long-term/reference memory, non-spatial working memory, exploratory activity or caspase 3 expression in the hippocampus homogenate. Anaesthesia with isoflurane in normoglycemic rats resulted in a significant decline in long-term/reference memory and non-spatial working memory, while exploratory activity and caspase 3 expressions in hippocampus homogenate showed no change to normal control rats. Both isoflurane and Sevoflurane in diabetic rats demonstrated a decline in long-term/reference memory, non-spatial working memory, exploratory activity and caspase 3 expression in hippocampus homogenate compared with normal control rats. Diabetes revealed significant post-anaesthesia cognitive dysfunction after anaesthesia with Sevoflurane or isoflurane in all the studied domains compared to standard control or diabetic control.

Arthroscopic medial meniscus trimming or repair under nerve blocks: Which nerves should be blocked?

BACKGROUND: This study aimed to determine the role of the sciatic and obturator nerve blocks (in addition to femoral block) in providing painless arthroscopic medial meniscus trimming/repair. MATERIALS AND METHODS: One hundred and twenty patients with medial meniscus tear, who had been scheduled to knee arthroscopy, were planned to be included in this controlled prospective double-blind study. The patients were randomly allocated into three equal groups; FSO, FS, and FO. The femoral, sciatic, and obturator nerves were blocked in FSO groups. The femoral and sciatic nerves were blocked in FS group, while the femoral and obturator nerves were blocked in FO group. Intraoperative pain and its causative surgical maneuver were recorded. RESULTS: All the patients (n = 7, 100%) in FO group had intraoperative pain. The research was terminated in this group but completed in FS and FSO groups (40 patients each). During valgus positioning of the knee for surgical management of the medial meniscus tear, the patients in FS group experienced pain more frequently than those in FSO group (P = 0.005). CONCLUSION: Adding a sciatic nerve block to the femoral nerve block is important for painless knee arthroscopy. Further adding of an obturator nerve block may be needed when a valgus knee position is required to manage the medial meniscus tear.

Ropivacaine in ultrasound-guided femoral nerve block: what is the minimal effective anaesthetic concentration (EC90)?

The objective of this study was to estimate the minimal effective anaesthetic concentrations of ropivacaine required to block the femoral nerve in 90% of patients. Forty-five patients who had knee surgery received ultrasound-guided femoral nerve block using 15 ml ropivacaine. The ropivacaine concentration given to a patient relied on the efficacy of the block in the previous patient, using the biased-coin design up-down sequential method. In the event of successful block, the next patient was randomly assigned to receive either the same ropivacaine concentration or a concentration 0.02% w/v less. In the event of a failed block, the next patient received a concentration 0.02% w/v higher. Successful block was defined as complete sensory and motor block before surgery together with pain-free surgery. The minimal effective ropivacaine concentration was estimated to be 0.167% w/v (95% CI 0.14-0.184%). Perineural injection of 15 ml ropivacaine 0.167% w/v under ultrasound guidance can provide successful femoral nerve block in 90% of patients.

Lidocaine use in ultrasound-guided femoral nerve block: what is the minimum effective anaesthetic concentration (MEAC90)?

BACKGROUND: This study aimed to estimate the minimum effective anaesthetic concentrations of lidocaine required to block the femoral nerve under ultrasound (US) guidance in 90% (MEAC90) of patients. METHODS: A minimum of 45 patients who had undergone knee arthroscopy were included in this observational study. All the patients received US-guided sciatic, obturator, and femoral nerve blocks. The femoral nerve block was performed using 15 ml of lidocaine. The lidocaine concentration given to a patient was determined by the response of the previous patient (a biased-coin design up-down sequential method). If a patient had a negative response, the lidocaine concentration was increased by 0.1% w/v in the next patient. If a patient had a positive response, the next patient was randomized to receive the same lidocaine concentration (with a probability of 0.89) or to receive a concentration 0.1% w/v less (with a probability of 0.11). A positive response was defined as complete sensory and motor block. The patients' responses were analysed to calculate the mean MEAC90. RESULTS: Fifty-two patients were required to complete the study; 45 had a positive response and seven had a negative response. The mean MEAC90 was estimated to be 0.93% w/v [95% confidence interval (CI), 0.8-1.03%]. Lidocaine 0.93% w/v was estimated to produce a successful block in 89% (95% CI, 78-100%) of patients. CONCLUSIONS: Perineural injection of 15 ml of lidocaine 0.93% w/v under US guidance could provide successful femoral nerve block in 90% of patients.

Long-term outcomes of isolated liver transplantation for short bowel syndrome and intestinal failure-associated liver disease.

BACKGROUND AND AIM: A select group of children with short bowel syndrome (SBS) and intestinal failure-associated liver disease (IFALD) fulfill the criteria for isolated liver transplantation (iLTx). Long-term results in this group of patients have not been reported. METHODS: A retrospective study of the medical records of 8 survivors of 14 children who underwent iLTx for SBS and IFALD from 1998 to 2005, managed by a multidisciplinary intestinal rehabilitation team at our institution. RESULTS: Median follow-up is 107.5 months (range 89-153 months). Five of 8 children were weaned from parenteral nutrition (PN) to enteral nutrition (EN) in a median of 10 months after iLTx (range 3-32 months). Three of 5 children were subsequently weaned from EN to full oral feeding in 13, 24, and 53 months after stopping PN, whereas the remaining 2 are still receiving EN 118 and 74 months after stopping PN. These 5 children maintain their weight median z scores with a median increase of 1.59 (range 1.24-1.79) compared with the pretransplant z score, whereas the height z scores show fluctuations through the years with a median change of 0.12 (range -0.29 to 0.36). The other 3 of 8 children developed progressive intestinal failure; 2 underwent isolated small bowel transplantation 112 and 84 months after iLTx and the third is receiving PN. CONCLUSIONS: Children with SBS and IFALD who have the potential for adaptation in the residual bowel can undergo iLTx, but it is a treatment option to be exercised with extreme caution. These children need close follow-up with an experienced multidisciplinary team to monitor nutritional outcomes and may need consideration for transplant or nontransplant surgery in the long term.

Trauma epidemiology and outcome in a developing country: perspectives from a university teaching hospital in Beirut.

This study aims at evaluating trauma care at the American University of Beirut Medical Centre (AUB-MC) and comparing it to the norms established by the Major Trauma Outcome Study (MTOS). From January 2001 until January 2003, data necessary to calculate probability of survival using the Trauma Injury Severity Score methodology were collected. M, W, Z, Ws and Zs statistics were calculated to compare outcome at AUB-MC to the MTOS dataset. A total of 873 patients were included in the study. W statistics was calculated at 0.35 with Z score for the overall sample of 0.081 indicating that there was no statistically significant difference in survival between this group and the MTOS group. In a developing country a hospital achieves trauma outcomes similar to the MTOS dataset. Further studies looking at trauma care in Lebanon as a whole are needed.

Five-year surveillance of acute flaccid paralysis in Malaysia.

OBJECTIVE: The nation-wide surveillance for acute flaccid paralysis (AFP) was implemented in Malaysia in 1995 and further intensified in 1996 as part of the World Health Organization's (WHO) certification process for polio eradication in the Western Pacific Region. Clinical data on AFP cases during a 5-year surveillance period from 1997 to 2001 were compiled and analysed. RESULTS: Based on 517 cases of AFP reported during this 5-year period, the overall rate of AFP was 1.2 per 100 000 children below 15 years old. The major clinical diagnosis associated with AFP were Guillain-Barre syndrome (30.2%), central nervous system infection (16.2%), transverse myelitis (10.6%) non-polio enterovirus infection (6.2%), and hypokalaemic paralysis (5.2%). This unusual pattern with an excess of CNS infection and non-polio enterovirus infection was attributed to the outbreak of enterovirus 71 infection nation-wide in 1997. According to the WHO virological classification, there was no case of poliomyelitis due to wild poliovirus. Three cases were 'polio compatible', there were no cases of vaccine-associated paralytic polio (VAPP), while 62 cases (12.0%) were merely classified as 'non-polio AFP'. CONCLUSION: Overall, these data suggest the absence of circulation of wild poliovirus in Malaysia from 1997 to 2001. The pattern of AFP in this study is different from other published reports.

Detection of Vibrio cholerae 01 from aquatic environment in Sarawak.

The detection of Vibrio cholerae 01 from the aquatic environment of Daro and Bintulu in Sarawak was carried out following an outbreak of cholera. Conventional culture methods and detection of ctx gene by polymerase chain reaction technique were carried out on 80 water samples. Only one sample was positive by culture methods while 8 were positive by PCR. DNA finger printing by pulsed-field gel electrophoresis showed that the clinical isolates in Daro and Bintulu were genetically identical while the environmental isolate was closely related. Recovery of Vibrio cholerae by culture method is poor and newer methods of detection should be developed.

The treatment of pulled elbow: a prospective randomized study.

To evaluate the effectiveness in decreasing recurrence of cast application after manual reduction of pulled elbow. Sixty-four children with pulled elbow were randomized into two treatment groups: Group A underwent manipulative reduction followed by splinting the elbow in a flexed and supinated position for 2 days; group B underwent manipulative reduction only. Both groups were examined 2, 5, and 10 days later. None of the 33 patients in group A had a pulled elbow at follow-up. Four (13%) of 31 patients in group B had a pulled elbow 2-5 days later. Immobilizing the elbow for 2 days after manipulative reduction improves the success of treatment of a pulled elbow.

Laparoscopic inguinal hernia repair.

Open hernia repair is associated with significant postoperative pain and disability resulting in delayed return to full activity. Laparoscopic hernia repair has been advocated as the procedure that combines the benefit of tension-free repair with the preservation of the basic anatomy of the inguinal area. We present our experience with 803 laparoscopic hernia repairs in 517 patients over a period of 66 months (August 92 to February 98). The effects of the learning curve and the refinement of the technique had their impact on earlier results and complications. However, with more experience we found that the laparoscopic preperitoneal approach is safe and efficacious. There was no mortality. Most patients (85%) were discharged home within 24 h of the procedure and returned to full activity within 10 days. Patient satisfaction was excellent. The complication rate decreased and operative time was reduced with experience. This procedure is clearly indicated in patients who have recurrent or bilateral hernias. It is associated with shorter convalescence and a quick return to work.

Bupivacaine local injection in anorectal surgery.

A retrospective study of 46 patients who received bupivacaine local injections after hemorrhoidectomy were compared to a matching group of 46 patients of similar age and sex distribution who underwent the same operation. Pain medications requirement on the same day of operation and on subsequent days were measured and found to be the same in both groups. The incidence of urinary retention was equal in both groups. However, the group receiving bupivacaine had a shorter hospital stay. In this respect, local injection of bupivacaine after hemorrhoidectomy may have a role in making patients more comfortable and shortening hospital stay.

Cathodic stripping voltammetry of the anticancer agent 5-fluorouracil and determination in urine.

Cathodic stripping voltammetry was used to determine 5-fluorouracil (5-FU) in the presence of traces of Cu(II). It was found that the addition of 5 x 10(-9) mol dm(-3) Cu(II) to the measurement cell greatly enhanced the peak current of the adsorbed molecule. Different parameters were tested to optimize the conditions for the determination of 5-FU. The adsorbed form is reduced irreversibly. It was observed that by controlling the deposition potential, the technique could be directed to the determination of Cu(II) or the drug. The linear range was from 5 x 10(-9) to 6 x 10(-8) mol dm(-3) for 5-FU and from 6 x 10(-9) to 5 x 10(-8) mol dm(-3) for Cu(II). Detection limits of 4.6 x 10(-10) and 5 x 10(-10) mol dm(-3) were obtained for 5-FU and Cu(II), respectively. The method was applied to urine and molecules or ions which may interfere were studied.

Straight pin aspiration in young women.

Straight pins are used extensively for securing facial scarves in women and girls in the Middle East. Accidental aspiration often results in the pin lodging in the segmental bronchus with the sharp end pointing cephalad. Flexible bronchoscopy is superior to rigid bronchoscopy in retrieving these pins. We report on five cases successfully treated by fiberoptic bronchoscopy under general anesthesia.

Surgical therapy for pulmonary hydatidosis.

Surgical treatment of pulmonary hydatidosis varies from one country to another. Whereas some reports describe marsupialization of the residual cavity others favor capitonnage (imbrication) to decrease complications and hospital stay. Post operative complications and hospital stay were compared in a retrospective study of 53 patients treated surgically at the American University Hospital over a period of 10 years. Forty eight cysts were treated by evacuation after chemical sterilization. Fifteen were marsupialized and 33 were imbricated. Five were excised with lung parenchyma, 5 were delivered intact and one cyst was treated by lobectomy. There was no postoperative mortality. There was no statistical difference in the hospital stay or the complication rate between the marsupialized and imbricated cases. Both imbrication and marsupialization are equally effective methods of treatment of pulmonary hydatid cysts. Anatomic resection is rarely required.

Survey of availability of iodine-enriched salt in Sarawak.

Three hundred and forty five salt samples were randomly taken from 106 sources where iodised salts were supplied or put for sale in all areas gazetted as endemic goitre areas in Sarawak. The samples were analysed for the presence of iodine. In areas in Sibu, Sarikei and Kapit Divisions, 53-70% of salt put for sale were iodised while in the other 6 Divisions, it was less than 27%. As iodisation of salt is an interventive measure in addressing the goitre problem in the State, regular monitoring of iodisation facilities and iodine content of iodised salt in the affected areas is important to ensure the effectiveness of the programme.

Successful delayed repair of a complete transection of the right mainstem bronchus in a five-year-old girl: case report.

Bronchial transection of a main bronchus is usually recognized and repaired immediately after injury. Delayed repair is uncommon, especially in pediatric patients. We report a case of delayed repair of a transected right mainstem bronchus in a 5-year-old girl, 3 years after the initial injury. The transected lung re-expanded immediately and showed continued growth 3 years later.