Advance age is a risk factor for an anastomotic leak. An anastomotic leak, a mucin-secreting tumor, and lower rectal growth predispose patients to develop anastomotic strictures.
Religion and its practices have been duly implicated in treating not only problems related to medical health, rather, intervening and preventing such problems as well. In the present article, the authors have reviewed significance of the Islamic prayers (Salah/Namaaz) in healthcare in general and mental health in particular. The nature, procedures, practices and the benefits of Salah have been comprehensively described and discussed. In addition, an attempt to combine yoga and its practices with Salah has been made for intervening and preventing the problems of mental health as an expeditious tool. In upshot, the clinicians in the field of mental health care have been suggested to incorporate these two viewpoints in their intervention program, at least, for the Muslim patients for a more desirable outcome.
In selected cases of adenocarcinoma of the GE junction, laparoscopic esophagogastrectomy offers as good as or better results than open operation in our institution with extensive advance endoscopic and open experience. This study shows that laparoscopic esophagogastrectomy has potential to meet oncologic criteria of clearance and provide the benefits of minimally invasive surgery as well.
Aim:The present study was conducted to evaluate the antidiarrheal effect of ethanolic extract of Holarrhena antidysenterica (Family - Apocynaceae) seeds against induced diarrhea in Wistar albino rats.Materials and Methods:The extract was evaluated for castor oil and Escherichia coli induced diarrhea. Extract was given at 100, 200, 400 mg/kg body wt. orally in both protocols. Standard antidiarrheal Loperamide was used at 5 mg/kg body wt. orally in castor oil induced protocol, while standard antibiotic Gentamicin at 8 mg/kg body wt. intraperitoneally was used in E. coli induced diarrhea. In castor oil induced protocol, the percentage inhibition of defecation was calculated for each group, whereas in E. coli induced protocol, change in fecal consistency, and body weight was recorded for each individual rat for 3 days.Results:The severity of castor oil induced diarrhea was reduced significantly (p<0.05) with H. antidysenterica seeds extract at 200 and 400 mg/kg body wt. which showed equivalent effectiveness like that of Loperamide treated groups. Similarly in E. coli induced diarrhea protocol, the mean change in body weight was significantly (p<0.05) higher in positive control, whereas no significant variation was observed in negative control, Gentamicin treated and H. antidysenterica treated group at 200 mg/kg and 400 mg/kg body wt., respectively.Conclusion:The study concluded that ethanolic extract of H. antidysenterica seeds effectively controlled diarrhea and decreased the severity of clinical signs of castor oil and E. coli induced diarrhea in Wistar rats.
Surgery in patients with the mentioned risk factors remains debatable and should be approached cautiously. Larger multi-institutional and meta-analytic studies are required to study and statistically establish the factors which might be associated with poor outcome in these patients. An algorithm which may be used in the management of traumatic intracerebellar haematoma patients is proposed.
Background This study was conducted to evaluate the microbiological profile of bacterial isolates in febrile neutropenia in a pediatric oncology unit, thereby, reviewing the use of restricted antibiotics and need for aggressive medical treatment accordingly. Methods A prospective observational study was conducted in a paediatric haemat-oncology division of a tertiary care teaching hospital in southern India from September 2014 to August 2016. One hundred and thirty children with febrile neutropenia were enrolled in the study. Blood cultures were performed using automated system. Cultures from other sites were obtained if needed, based on the clinical profile. Standard antibiotic susceptibility testing was done. Statistical analysis was done using SPSS. Results One hundred and thirty children were enrolled for the study. Two hundred and fifty episodes of febrile neutropenia were studied. Three hundred and eighty four cultures were sent and 92 (24%) cultures were positive. There were 48 (52.2%) Gram negative isolates followed by 33 (35.8%) Gram positive isolates, six (6.5%) fungal isolates and five (5.5%) poly-microbial cultures. Lactose fermenting Gram negative bacilli (20 isolates, 31.5%) were the most frequently isolated in the Gram negative group, with Escherichia coli being the most common organism (19 isolates, 20.6%). Amongst the Gram positive coagulase negative staphylococcus was the most common (twenty seven isolates, 29%). Escherichia coli and Non lactose fermenting gram negative bacteria (NFGNB) had only 36, 25% sensitivity to ceftazidime, respectively. Most Gram negative bacilli were found to have better sensitivity to amikacin (mean: 57%). There was a higher prevalence of extended spectrum beta lactamase producing organisms. Pan drug resistance, Extreme drug resistance and Multi drug resistance was found in three, twenty and thirteen Gram negative isolates respectively.Escherichia coli and Klebsiella were often drug resistant. Significantly higher mortality was associated with Gram negative isolates (eight deaths out of the thirteen deaths, 61.5%). Conclusions Our results show the importance of surveillance, monitoring resistance frequencies and identifying risk factors specific to each region. Given that significant mortality is attributed to drug resistant Gram negative bacilli, early initiation of appropriate antibiotics to cover for drug resistance is required while formulating empirical antibiotic policies for febrile neutropenia in the oncology units in the developing world.
Multiple osseous lesions in children are rare and suggest the possibilities of Langerhans cell histiocytosis (LCH), malignancies, enchondromatosis, multifocal osteomyelitis, and tuberculosis [1]. We present a 12-year-old boy with fever for 7 months and pain in the lower back and left hip joint for 5 months, with multiple sclerotic, lytic, and mixed osseous lesions in the axial and appendicular skeleton (see Figure 1). He had received antitubercular treatment for 5 months for suspected tuberculosis of the spine, with no clinical improvement. Aspirin and methotrexate prescribed for suspected juvenile rheumatoid arthritis had provided no relief of symptoms. He had no history of recurrent infections. His HIV was negative by ELISA and his serum immunoglobulin levels were normal. There was no palpable lymphadenopathy or organomegaly. Bone marrow examination was normal. Computed tomography (CT) showed enlarged mediastinal (largest 2.8 × 2 cm) and abdominal lymph nodes (largest 2.7 × 1.3 cm), sclerotic and lytic lesions of 5th rib, sternum, and various vertebrae. Endoscopic fine needle aspiration cytology (FNAC) of mediastinal lymph nodes, CT-guided FNA-biopsy of the 5th rib, and paravertebral mass as well as a laparoscopic biopsy of mesenteric and iliac lymph nodes were done in a staged manner, but all showed reactive changes. Finally, a bone biopsy from an occipital mass lesion, which appeared 3 weeks later, was suggestive of mixed-cellularity Hodgkin lymphoma (HL) (see Figure 2) with immunohistochemistry positive for CD30, CD15, and EBV. He was started on ABVD chemotherapy for stage IV-B HL. Fever, limp, and bone pain subsided dramatically after 2 weeks of chemotherapy. In view of residual disease after four ABVD cycles on positron emission tomography-CT scan, he received further four BEACOPP cycles. He has been disease free for 30 months. Multifocal Osseous Lesions in a Child FIGURE 1 Chest X-ray (postero-anterior view) showing a right hilar and upper mediastinal lymphadenopathy with a lytic lesion at the posterior end of (A) the right 5th rib. (B) Anterior and (C) posterior views of 99m Tc methylene diphosphonate ( 99m Tc MDP) bone scan showing increased osteoblastic activity in the skull, multiple ribs and vertebrae, bilateral pelvic bones, and the proximal appendicular skeleton. Copyright C Informa Healthcare USA, Inc.
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