Abdominal tuberculosis and its protean manifestations still create a worldwide diagnostic challenge for clinicians and remain an important concern in the developing world. Crohn's disease, which is being increasingly recognized in countries where intestinal tuberculosis is prevalent, needs to be differentiated as the two diseases resemble each other in their clinical presentation, and in their radiological, endoscopic, and histological findings. New diagnostic modalities and scoring systems have facilitated the differentiation of Crohn's disease from intestinal tuberculosis with good accuracy. Randomized trials have shown 6 months of therapy to be equivalent to longer durations of treatment for patients with abdominal tuberculosis.
Laparoscopic cholecystectomy has become one of the most commonly performed abdominal surgeries worldwide. Several anatomic variations and congenital malformations in the gallbladder and biliary anatomy have been described. We reported the case of a middle-aged woman who presented with jaundice and abdominal pain. Her laboratory investigations revealed an elevated bilirubin level (mainly the direct component). The patient showed an improvement in the clinical and laboratory parameters after conservative management. Then, the patient was prepared for a laparoscopic cholecystectomy which revealed a duplication of the gallbladder with two distinct cystic ducts draining independently to the common bile duct. The procedure was completed uneventfully. This type of gallbladder duplication is among the least common types. The case highlights the importance of having a meticulous intraoperative evaluation of the biliary anatomy to avoid potential complications and injuries.
Oseltamivir delivers modest clinical advantages to children with influenza when started within 48 hours of symptom beginning. Nevertheless, effectiveness and safety stay controversial. We conducted the current meta-analysis using a comprehensive search of EMBASE, MEDLINE, PubMed, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials till 15 February 2018 for randomized controlled trials of oseltamivir therapy in children. Four studies met the search criteria. Overall, oseltamivir treatment significantly reduced the duration of illness in the ITTI population (RMST difference, -18.2 hours; 95% CI, −32.2 to −0.6 hours). In trials that enrolled patients without asthma, the difference was larger (RMST difference −26.7 hours; 95% CI, −49.8 to −6.1 hours).Risk of otitis media was 34% lower in the ITTI population. Vomiting was the only adverse event with a significantly higher risk in the treatment group. Regardless of considerable heterogeneity in pediatric trials, we found that treatment with oseltamivir treatment started within 24 hours of symptom onset provides substantial benefits to children with influenza infection and lowered the risk of developing otitis media.
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