Background Scrub typhus, an important cause of acute fever in Asia, is caused by Orientia tsutsugamushi, an obligate intracellular bacterium. Antibiotics currently used to treat scrub typhus include tetracyclines, chloramphenicol, macrolides, and rifampicin. Objectives To assess and compare the effects of different antibiotic regimens for treatment of scrub typhus. Search methods We searched the following databases up to 8 January 2018: the Cochrane Infectious Diseases Group specialized trials register; CENTRAL, in the Cochrane Library (2018, Issue 1); MEDLINE; Embase; LILACS; and the meta Register of Controlled Trials ( m RCT). We checked references and contacted study authors for additional data. We applied no language or date restrictions. Selection criteria Randomized controlled trials (RCTs) or quasi‐RCTs comparing antibiotic regimens in people with the diagnosis of scrub typhus based on clinical symptoms and compatible laboratory tests (excluding the Weil‐Felix test). Data collection and analysis For this update, two review authors re‐extracted all data and assessed the certainty of evidence. We meta‐analysed data to calculate risk ratios (RRs) for dichotomous outcomes when appropriate, and elsewhere tabulated data to facilitate narrative analysis. Main results We included six RCTs and one quasi‐RCT with 548 participants; they took place in the Asia‐Pacific region: Korea (three trials), Malaysia (one trial), and Thailand (three trials). Only one trial included children younger than 15 years (N = 57). We judged five trials to be at high risk of performance and detection bias owing to inadequate blinding. Trials were heterogenous in terms of dosing of interventions and outcome measures. Across trials, treatment failure rates were low. Two trials compared doxycycline to tetracycline. For treatment failure, the difference between doxycycline and tetracycline is uncertain (very low‐certainty evidence). Doxycycline compared to tetracycline may make little or no difference in resolution of fever within 48 hours (risk ratio (RR) 1.14, 95% confidence interval (CI) 0.90 to 1.44, 55 participants; one trial; low‐certainty evidence) and in time to defervescence (116 participants; one trial; low‐certainty evidence). We were unable to extract data for other outcomes. Three trials compared doxycycline versus macrolides. For most outcomes, including treatment failure, resolution of fever within 48 hours, time to defervescence, and serious adverse events, we are uncertain whether study results show a difference between doxycycline and macrolides (very low‐certainty evidence). Macrolides compared to doxycycline may make little or no difference in the proportion of patients with resolution of fever within five days (RR 1.05, 95% CI 0.99 to 1.10; 185 participants; ...

Traumatic brain injury is a major problem worldwide. Our objective is to synthesize available evidence in the literature concerning the effectiveness of neuroprotective drugs (cerebrolysin, citicoline, and piracetam) on Glasgow outcome score (GOS), cognitive performance, and survival in traumatic brain injury patients. Comprehensive search of electronic databases, search engines, and conferences proceedings; hand search journals; searching reference lists of relevant articles, theses, and local publications; and contact of authors for incomplete data were performed. Studies included patients in all age groups regardless of severity of trauma. There was no publication date restriction. Two reviewers independently extracted data from each study. Fixed effect or random effects model selection depends on results of statistical tests for heterogeneity. The literature search yielded 13 studies. Patients treated with cerebrolysin (n = 112) had favorable GOS three times more than controls (OR 3.019; 95 % CI 1.76 to 5.16; p = 0.003*). The odds of cognition improvement in the treatment group was 3.4 times more than controls (OR 3.4; 95 % CI 1.82 to 5.21; p < 0.001*). Survival of cerebrolysin-treated patients did not differ from controls (103 patients; OR = 2.81; 95 % CI 0.905 to 8.76). Citicoline did not improve GOS (1355 patients; OR 0.96; 95 % CI 0.830 to 1.129; p = 0.676), cognitive performance (4 studies; 1291 patients; OR 1.35; 95 % CI 0.58 to 3.16; p = 0.478), and survival (1037 patients; OR = 1.38; 95 % CI 0.855 to 2.239). One study showed a positive effect of piracetam on cognition. Further research with high validity is needed to reach a solid conclusion about the use of neuroprotective drugs in cases of brain injury.

Education is inversely associated with total cancer mortality, and the association was stronger in men. Different patterns and trends in tobacco smoking in men and women account for at least most of the gender differences.

Superficial incisional surgical site infection (SSI) is a common postoperative complication in surgical patients. The aim of this study was to assess the predictive power of an assessment scale for identifying patients at risk of superficial incisional SSI. A cross-sectional survey was conducted at the Department of Surgery at the Medical Research Institute Hospital, Alexandria University. A sample of 150 adult patients aged from 18 to 65 years, who undergoing general surgeries that had clean sutured surgical wounds, was randomly selected. Forty-six patients (30.7%) had SSI. The total score can significantly discriminate between positive and negative superficial incisional SSI patients with diagnostic accuracy of AUC (SE) = 0.66 (0.048). Each score more than the cutoff point (11.5) will increase the risk of surgical site infection development by 2.5 times (OR (95% CI) = 2.5 (1.26-3.1)). The developed assessment scale can discriminate between patients who are at risk of superficial incisional SSI and those who are not. It can be used as a preliminary screening tool for subsequent investigation for the presence of infection.

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