Many patients develop a variety of bowel dysfunction after sphincter preserving surgeries (SPS) for rectal cancer. The bowel dysfunction usually manifests in the form of low anterior resection syndrome (LARS), which has a negative impact on the patients’ quality of life. This study reviewed the LARS after SPS, its mechanism, risk factors, diagnosis, prevention, and treatment based on previously published studies. Adequate history taking, physical examination of the patients, using validated questionnaires and other diagnostic tools are important for assessment of LARS severity. Treatment of LARS should be tailored to each patient. Multimodal therapy is usually needed for patients with major LARS with acceptable results. The treatment includes conservative management in the form of medical, pelvic floor rehabilitation and transanal irrigation and invasive procedures including neuromodulation. If this treatment failed, fecal diversion may be needed. In conclusion, Initial meticulous dissection with preservation of nerves and creation of a neorectal reservoir during anastomosis and proper Kegel exercise of the anal sphincter can minimize the occurrence of LARS. Pre-treatment counseling is an essential step for patients who have risk factors for developing LARS.

The clinical, biochemical, and neuroradiologic findings and clinical follow-up of seven patients with glutaric aciduria type II are reported. Three phenotypes of the disease are encountered: neonatal-onset form with congenital anomalies (two patients) or without congenital anomalies (three patients) and late-onset form (two patients). The neonatal-onset form presents as an overwhelming illness, with severe hypoglycemia and metabolic acidosis leading to rapid death. Frequently it is associated with perinatal energy deprivation, a neonate with low birth weight and prematurity. The late-onset form presents with intermittent episodes of vomiting, hypoglycemia, and acidosis especially after meals rich in fat and/or proteins. All parents are consanguineous and have a first- or second-degree relationship. Initially, in the two phenotypes with neonatal onset and during crisis in the late-onset phenotype, routine laboratory evaluation showed severe metabolic acidosis, with an increased anion gap, hypoglycemia without ketonuria, and disturbed liver function tests. In the majority of patients with neonatal-onset forms, the kidneys, liver, and at times the spleen are enlarged with an increased echogenic pattern; however, no hepatic or renal cysts are detected. Cardiomegaly is observed in most patients. The diagnosis can be easily and rapidly reached through tandem mass spectrometry study of the blood and can further be confirmed by gas chromatography/mass spectrometry analysis of the urine organic acids. In this report, the magnetic resonance imaging/computed tomography brain studies showed brain atrophy, white matter disease, and in one patient, fluid-filled cavities in the periventricular area and putamina. Fluorine-18-labeled 2-fluoro-2-deoxyglucose positron emission tomographic (FDG PET) brain studies in two patients with late-onset disease showed slightly decreased activity in the cerebral cortex in one and in the caudate nuclei in the other. Brain FDG PET scan and magnetic resonance spectroscopy were normal in one patient with neonatal-onset disease. All patients were treated with a diet low in fat and protein, oral riboflavin, and carnitine. The results were promising for the late-onset disease. Intravenous carnitine gave rewarding results in one patient with neonatal-onset disease.

In a patient with ESRD receiving intermittent hemodialysis, a ceftolozane-tazobactam loading dose of 1.5 g i.v. followed by a maintenance dosage of 300 mg every 8 hours appeared to be safe and effective in the treatment of nosocomial pneumonia caused by MDR .

Pyroglutamic aciduria (5-oxoprolinuria) is a rare autosomal recessive disorder caused by either glutathione synthetase deficiency (GSSD) or 5-oxoprolinase deficiency. GSSD results in low glutathione levels in erythrocytes and may present with hemolytic anemia alone or together with pyroglutamic aciduria, metabolic acidosis, and CNS damage. Five patients with pyroglutamic aciduria were studied. All presented with hemolytic anemia and metabolic acidosis. Two (brothers) also had Fanconi nephropathy, which is not seen in pyroglutamic aciduria. Molecular analyses of the GSS gene was performed in 3 patients. RT-PCR and heteroduplex analysis identified a homozygous deletion in 1 patient and a homozygous mutation in 2 others (brothers with Fanconi nephropathy). Sequencing of glutathione synthetase (GSS) cDNA from the first patient showed a 141-bp deletion corresponding to the entire exon 4, whilst the corresponding genomic DNA showed a G491 --> A homozygous splice site mutation. Sequencing of GSS cDNA from the Fanconi nephropathy patients showed a C847 --> T [ARG283 --> CYS] mutation in exon 9.

Several studies have been conducted in the Kingdom of Saudi Arabia to evaluate clinical manifestations, risk factors and epidemiological data in order to emphasize the need for educating the general public and to help in implementing community-based programs for preventing diseases. [1][2][3][4][5] The Hepatology Section of the Department of Pediatrics, King Faisal Specialist Hospital and Research Centre (KFSH&RC) is a national tertiary care referral center for pediatric liver diseases. We felt that most parents were unaware of various aspects of liver diseases, including symptoms, causes, diagnosis and the treatment modalities available.A survey was conducted among randomly chosen parents in the outpatient department and pediatric wards to assess and document the magnitude of this problem. The results suggest that except for the well-educated parents, the majority are unaware of the significance of the problems related to liver diseases among children. MethodsA questionnaire was distributed to 500 randomly selected parents who brought their children to the Outpatient Clinic or to the pediatric ward at KFSH&RC, over a six-month period between September 1995 and February 1996. The following were excluded from the survey: 1) parents of children with liver disease; 2) parents whose child had been admitted to the pediatric floor in the hospital for more than 24 hours; and 3) parents with a relative in the medical profession. After a brief introduction, a single trained interviewer explained the purpose of the survey. The parents completed the questionnaire written in Arabic by themselves. Parents who were illiterate were helped by the interviewer to fill in the questionnaire. The interviewer explained to the parents that the survey was strictly confidential. The different parameters included in the questionnaire are shown in Table 1.The frequencies of all category variables were calculated, and a table showing the association between the education level and different answers was created. Difference in means of continuous variables were tested for significance by Student's t-test. The P-value of <0.05 was used to indicate statistically significant differences. For small frequencies, Fisher's exact test was used. ResultsOf the parents taking part in the survey, 210 (42%) were below 30 years of age, 222 (44.4%) were between 30 and 40 years of age, and 68 (13.6%) were over 40 years. The number of fathers interviewed was 262 (52.4%) and mothers 238 (47.6%). Of the number interviewed, 89 (17.8%) were illiterate (education level 1), 66 (13.2%) had primary school education (level 2), 120 (24%) had intermediary school (level 3), 95 (19%) had secondary school certification (level 4), and finally 130 (26%) had university, or a higher education (level 5).The response to all categories of questions asked is listed in Table 1. The majority of parents (over 50%) had no knowledge about the location of the liver in the abdomen, symptoms and causes of liver diseases, infectivity of liver diseases, relationship of the disease to inher...

Our findings help to optimize management of post-thyroidectomy hypocalcemia by assisting in the early identification of those who are not at risk of hypocalcaemia and by guiding early effective management of those at risk. This may reduce complications and medical cost.

ObjectivesThe risk of recurrent Clostridium difficile infections (RCDIs) is high when treated with standard antibiotics therapy (SAT) alone. It is suggested that the addition of faecal microbiota transplantation (FMT) or bezlotoxumab after SAT reduces the risk of RCDI. In the absence of head-to-head randomised controlled trials (RCTs), this review attempts to compare the efficacy and safety of bezlotoxumab with FMT in reducing the risk of RCDI in hospitalised patients.DesignA systematic review and Bayesian network meta-analysis.Data sourceA comprehensive search from inception to 30 February 2019 was conducted in four databases (Medline/PubMed, Embase, Scopus, ClinicalTrials.gov).Eligibility criteriaRCTs reporting the resolution of diarrhoea associated with RCDI without relapse for at least 60 days after the end of treatments as the primary outcome.Data extraction and synthesisWe extracted author, year of publication, study design and binomial data that represented the resolution of diarrhoea or adverse events of monoclonal antibodies and FMT infusion. Random-effects models were used for resolution rate of RCDI and adverse events. The Cochrane Risk of Bias tool was used to assess the quality of included RCTs.ResultsOut of 1003 articles identified, seven RCTs involving 3043 patients contributed to the review. No difference was reported between single or multiple infusions of FMT and bezlotoxumab in resolving RCDI, (OR 1.53, 95% credible interval (CrI) 0.39 to 5.16) and (OR 2.86, 95% CrI 1.29 to 6.57), respectively. Patients treated with SAT alone or bezlotoxumab with SAT showed significantly lower rates of diarrhoea than FMT (OR 0, 95% CrI 0 to 0.09) and (OR 0, 95% CrI 0 to 0.19), respectively. There was no difference in terms of other adverse events.ConclusionsThis is the first network meta-analysis that has compared the recently Food and Drug Administration-approved monoclonal antibody bezlotoxumab with FMT for resolving RCDI. The quality of the included RCTs was variable. The findings of this study suggested no difference between single or multiple infusions of FMT and bezlotoxumab. However, FMT was associated with a higher rate of non-serious diarrhoea as opposed to SAT used alone or in combination with bezlotoxumab.

Patient: Male, 58Final Diagnosis: Vertebral osteomyelitisSymptoms: Back painMedication: DalbavancinClinical Procedure: —Specialty: Infectious DiseaseObjective:Unusual clinical courseBackground:Native vertebral osteomyelitis (NVO) is a common form of hematogenous osteomyelitis, with Staphylococcus aureus (S. aureus) being the most commonly isolated organism. Dalbavancin is approved by the US Food and Drug Administration (FDA) for the treatment of acute bacterial skin and skin structure infections (ABSSSI) and has a sufficiently promising pharmacokinetic and pharmacodynamic profile to be considered for the treatment of vertebral osteomyelitis. We describe here what is probably the first reported case of using multiple weekly dalbavancin to treat a complicated methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and vertebral osteomyelitis.Case Report:A 58-year-old man with a long history of recurrent MRSA bacteremia, who failed multiple courses of vancomycin and daptomycin, presented with recurrent MRSA bacteremia complicated by diskitis and osteomyelitis of the lumbar vertebrae. The patient was treated with dalbavancin 1000 mg intravenously weekly for two weeks followed by 500 mg weekly for six additional weeks. He improved clinically, his back pain resolved, and C-reactive protein (CRP) decreased to normal. Three months after the last dose of dalbavancin therapy, he underwent angiography for peripheral artery diseases, after which he developed a fever, mild leukocytosis, an elevated CRP, and the repeat blood cultures were positive for MRSA. No apparent adverse events were observed during dalbavancin therapy.Conclusions:In this case, multiple weekly dalbavancin infusions appeared to be safe in the treatment of vertebral osteomyelitis caused by MRSA, but did not seem to prevent infection recurrence. However, reinfection with a new strain from the angiography catheter insertion is highly likely. Clinical studies are needed to further assess the safety and effectiveness of multiple weekly dalbavancin dosing in the management of vertebral osteomyelitis.