Imaging of ischemia, obstruction and infection in the abdomen

Intestinal ischemia is a serious condition that continues to be associated with mortalities in excess of 70%. Intestinal obstruction and gastrointestinal tract sepsis are common conditions, accounting for a large proportion of patients admitted to emergency departments with acute abdominal symptoms. This article discusses the imaging methods and key findings of these entities in the emergency radiology department. The article includes imaging examples, diagnostic options, protocol selections, diagnostic criteria, and differential diagnoses

Incidence and Risk Factors of Neutropenic Enterocolitis after Myelosuppressive Chemotherapy

Background Neutropenic enterocolitis (NE) is a serious complication in patients receiving intensive chemotherapy for the treatment of onco-haematological diseases. Yet, the relative incidence of the disease and its risk factors among patients treated with different regimen is not well defined. Methods The development of NE was analysed in 1223 neutropenic episodes from 692 onco-hematological patients receiving chemotherapy at the isolation Unit of CHUV who signed an informed consent (Swissethics 2017-01975). NE was defined by the presence abdominal signs and symptoms during neutropenic fever together with bowel wall thickening >4mm in any bowel segment by computed tomography or ultrasound. The incidence of NE and risk factors known at hospitalization baseline were analysed by using uni- and multivariate regression models according to the chemotherapy regimen, including those used for the induction of acute myeloblastic (AML) or lymphoblastic (ALL) leukemia and autologous hematopoietic cell transplantation (HCT). Results. A total of 72 episodes of radiologically-proven NE (5.9%) occurred; the percentage of NE was 16.3% for AML induction (e.g. HOVON based protocol), 5.6% for autologous HCT using the BEAM protocol, 4.8% for ALL induction, 2.9% for AML salvage (e.g. CLAG or FLAG +/- idarubicin), 1.9% for autologous HCT using a non-BEAM protocol (e.g. melphalan) and 1.9% for the other types of chemotherapy (Figure 1). In the HCT population, the single independent risk factor for NE was the BEAM versus non-BEAM protocol (Odd ratio [OR]=3.40, 95% confidence interval [CI] 1.14-10.1, P=0.03). In AML patients, independent risk factors for NE included induction versus salvage chemotherapy (OR=3.87, CI 1.31-11.4, P=0.01), chemotherapy with amsacrine (OR=2.94, CI 1.40-6.21, P=0.005) and triple intrathecal chemotherapy (OR=2.03, CI 1.01-4.08, P=0.048). Conclusions. Susceptibility to NE is strongly influenced by the type of chemotherapy. Patients receiving salvage therapy for AML have a surprisingly low rate of NE, possibly due to the concomitant use of G-CSF or an immunomodulaor effect of fludarabine or cladribine. Intrathecal chemotherapy has probably not a direct effect on NE but reflect the patients with high-risk AML quickly neutropenic or presenting a leukemic digestive infiltration

Gastrointestinal Infection in South African Children under the Age of 5 years:A Mini Review

Objective. To estimate gastroenteritis disease and its etiological agents in children under the age of 5 years living in South Africa. Methods. A mini literature review of pertinent articles published in ScienceDirect, PubMed, GoogleScholar, and Scopus was conducted using search terms: “Gastroenteritis in children,” “Gastroenteritis in the world,” Gastroenteritis in South Africa,” “Prevalence of gastroenteritis,” “Epidemiological surveillance of gastroenteritis in the world,” and “Causes of gastroenteritis”. Results. A total of 174 published articles were included in this mini review. In the last 20 years, the mortality rate resulting from diarrhea in children under the age of 5 years has declined and this is influenced by improved hygiene practices, awareness programs, an improved water and sanitation supply, and the availability of vaccines. More modern genomic amplification techniques were used to re-analyze stool specimens collected from children in eight low-resource settings in Asia, South America, and Africa reported improved sensitivity of pathogen detection to about 65%, that viruses were the main etiological agents in patients with diarrhea aged from 0 to 11 months but that Shigella, followed by sapovirus and enterotoxigenic Escherichia coli had a high incidence in children aged 12–24 months. In addition, co-infections were noted in nearly 10% of diarrhea cases, with rotavirus and Shigella being the main co-infecting agents together with adenovirus, enteropathogenic E. coli, Clostridium jejuni, or Clostridium coli. Conclusions. This mini review outlines the epidemiology and trends relating to parasitic, viral, and bacterial agents responsible for gastroenteritis in children in South Africa. An increase in sequence-independent diagnostic approaches will improve the identification of pathogens to resolve undiagnosed cases of gastroenteritis. Emerging state and national surveillance systems should focus on improving the identification of gastrointestinal pathogens in children and the development of further vaccines against gastrointestinal pathogens

Macaque models of human infectious disease.

Macaques have served as models for more than 70 human infectious diseases of diverse etiologies, including a multitude of agents-bacteria, viruses, fungi, parasites, prions. The remarkable diversity of human infectious diseases that have been modeled in the macaque includes global, childhood, and tropical diseases as well as newly emergent, sexually transmitted, oncogenic, degenerative neurologic, potential bioterrorism, and miscellaneous other diseases. Historically, macaques played a major role in establishing the etiology of yellow fever, polio, and prion diseases. With rare exceptions (Chagas disease, bartonellosis), all of the infectious diseases in this review are of Old World origin. Perhaps most surprising is the large number of tropical (16), newly emergent (7), and bioterrorism diseases (9) that have been modeled in macaques. Many of these human diseases (e.g., AIDS, hepatitis E, bartonellosis) are a consequence of zoonotic infection. However, infectious agents of certain diseases, including measles and tuberculosis, can sometimes go both ways, and thus several human pathogens are threats to nonhuman primates including macaques. Through experimental studies in macaques, researchers have gained insight into pathogenic mechanisms and novel treatment and vaccine approaches for many human infectious diseases, most notably acquired immunodeficiency syndrome (AIDS), which is caused by infection with human immunodeficiency virus (HIV). Other infectious agents for which macaques have been a uniquely valuable resource for biomedical research, and particularly vaccinology, include influenza virus, paramyxoviruses, flaviviruses, arenaviruses, hepatitis E virus, papillomavirus, smallpox virus, Mycobacteria, Bacillus anthracis, Helicobacter pylori, Yersinia pestis, and Plasmodium species. This review summarizes the extensive past and present research on macaque models of human infectious disease

Invasive Infections Associated with the Use of Probiotics in Children: A Systematic Review.

Although the effectiveness of probiotics has only been proven in specific conditions, their use in children is massively widespread because of their perception as harmless products. Recent evidence raises concerns about probiotics' safety, especially but not only in the paediatric population due to severe opportunistic infections after their use. This review aimed at summarising available case reports on invasive infections related to probiotics' use in children. For this purpose, we assessed three electronic databases to identify papers describing paediatric patients with documented probiotic-derived invasive infections, with no language restrictions. A total of 49 case reports from 1995 to June 2021 were identified. The infections were caused by Lactobacillus spp. (35%), Saccharomyces spp. (29%), Bifidobacterium spp. (31%), Bacillus clausii (4%), and Escherichia coli (2%). Most (80%) patients were younger than 2 years old and sepsis was the most observed condition (69.4%). All the patients except one had at least one condition facilitating the development of invasive infection, with prematurity (55%) and intravenous catheter use (51%) being the most frequent. Three (6%) children died. Given the large use of probiotics, further studies aiming at evaluating the real incidence of probiotic-associated systemic infections are warranted

Evaluation of Validity of Scoring Systems in Diagnosing Acute Appendicitis in South Indian Population

BACKGROUND: Acute appendicitis is one of the most common surgical emergencies worldwide, the diagnosis of which is still a challenging job for the surgeon. Both delayed diagnosis resulting in perforation (20%) and negative appendectomy (2-30%) have their own complications. Hence there is need for an accurate preoperative diagnosis. Even though CT has a high sensitivity and specificity in diagnosing appendicitis, the cost, availability and time delay become its limitations. Several scoring systems using clinical, laboratory data have been designed to diagnose acute appendicitis. An ideal scoring system would increase the accuracy of decision making and at the same time reduces the need of potentially harmful and expensive imaging. The scoring system must recognize patients in need of urgent surgery without delay and on the other hand, must avoid the unnecessary risks and cost of negative appendectomy. More than 10 such systems have been developed since the beginning of 1980s. In our study we consider 4 such scoring systems. The aim of our study is to assess and compare the diagnostic accuracy of these scoring systems on South Indian population and to study their role in diagnosing a case of acute appendicitis. AIMS & OBJECTIVES: 1. To assess the diagnostic value of different scoring systems in acute appendicitis and their role in improving accuracy. 2. To identify the most reliable scoring system for South Indian population. METHODOLOGY: This is a prospective and observational study. Patients admitted in Rajiv Gandhi Government General Hospital with the right iliac fossa pain suspicious of acute appendicitis are included in the study. Detailed clinical history is taken and physical examination is done for each patient. All patients underwent laboratory investigations such as complete blood count, blood urea, serum creatinine and electrolytes, urine routine, C-reactive protein and imaging tests like Chest X ray, Abdomen X ray erect, Ultrasound abdomen and pelvis. Using the above data, the probability of acute appendicitis is calculated using the Alvarado, Tzanaki, RIPASA and AIR scores. Patients will be taken up for emergency/elective appendicectomy based on the surgeon’s clinical judgement. The intraoperative findings will be noted. Intraoperatively normal appearing appendix and presence of other diagnosis will be excluded from the study. Following surgery, the histopathological reports of the patients will be collected. The various preoperative scores and the HPE reports will be correlated to calculate the Sensitivity, Specificity, PPV, NPV, diagnostic accuracy and negative appendicectomy rates. This will prove the validity of scoring systems in the diagnosis of acute appendicitis and provides the most reliable system applicable in South Indian population. RESULTS: The following results are obtained. 1. Out of 100 patients, majority belong to the age group 20 – 30 years with a female sex predominance. 2. Majority of the patients in the study have Alvarado scores of 7 and above, Tzanaki scores of 10 and above, RIPASA scores of 8.5 and above and AIR scores of 9 and above. 3. Sensitivity and Specificity of various scores are as follows: ALVARADO - SENSITIVITY - 84.61% ; SPECIFICITY - 82.35%, TZANAKI - SENSITIVITY - 100% ; SPECIFICITY - 23.5%, RIPASA - SENSITIVITY - 97.5% ; SPECIFICITY - 64.7%, AIR – SENSITIVITY - 87.9% ; SPECIFICITY - 82.35%. 4. Positive and Negative predictive value of various scores are as follows: ALVARADO - PPV : 96.25% ; NPV - 70%, TZANAKI - PPV - 86.45% ; NPV - 100%, RIPASA - PPV - 93.1 % ; NPV - 84.6%, AIR - PPV - 96.05% ; NPV - 58.33%. 5. In 17 patients, appendix is not inflamed intraoperatively and among these only 4 have no histopathological evidence of inflammation. CONCLUSION: 1. From the study on validation of diagnostic accuracy of scoring systems for acute appendicitis, the scoring system which has high positive predictive value and high negative predictive value is considered best to diagnose as well as to rule out acute appendicitis based on the clinical scoring system. 2. It is the Alvarado score which is still considered best in terms of statistical equivalents and it is better than Appendicitis Inflammatory Response Score. 3. Tzanaki Score is the most easy to use score in emergency situations and low scores almost excludes acute appendicitis

The Pathology of Equine Gastrointestinal Disease

To initiate the study a comprehensive review was made of the available literature relating to the equine gastrointestinal tract. This is presented in the literature review. It includes papers and texts concerning the anatomy and function of the equine gastrointestinal tract as well as causes of clinical disease and pathological lesions. A total of 213 horses, ponies and donkeys underwent a full post mortem examination by Glasgow University Veterinary School Department of Veterinary Pathology in the the 5 year period 1987-1991 inclusive. The majority were mixed breed pleasure animals rather than pedigree competition horses. These findings are presented in Part I, the Necropsy Series. The lesions recorded were considered, on the basis of appearance and clinical history, to be either principal or incidental and were then grouped by the system in which they were found. Lesions were identified in all anatomical systems. The gastrointestinal system was found to be by far and away the most frequently affected by both principal lesions, ie those considered to have resulted in the animal's death or humane destruction, and incidental lesions with no reported history of associated clinical disease. The Necropsy Series identified 92 animals with one or more lesions of the gastrointestinal system which were studied in more detail. These findings are presented in Part II, the Gastrointestinal Series. Here the general groupings used in the Necropsy Series were broken down by location and the actual lesion identified. In addition, other factors such as possible seasonal incidence and any concurrent, contributory lesions were also studied. Grass sickness was the most frequently identified significant primary condition and parasitism featured heavily as a cause of incidental lesions. The Gastrointestinal Series in turn revealed a group of 20 animals with clinical evidence of malabsorption and a chronic enteropathy which were studied in depth. Histopathological examination of multiple tissues from these cases allowed them to be divided into 2 groups, one of recognised conditions where a definitive diagnosis was made and one where only a morphological diagnosis was made. This series is presented in Part III, the Enteropathy Series. The recognised conditions identified by the Enteropathy Series were alimentary lymphosarcoma, equine granulomatous enteritis, equine eosinophilic enteritis, cyathostomiasis, Phenylbutazone toxicity and coccidiosis. However, these 6 conditions only accounted for 11 of the 20 animals. Eight of the remaining 9 animals had gastrointestinal lesions which differed significantly from those previously described in the equine literature. These were the animals where only a morphological diagnosis was made. The remaining case had clinical evidence of malabsorption in the form of an abnormal oral glucose tolerance test result but apparently no significant gross or microscopic lesions of the gastrointestinal tract, just extremely abnormal dentition. The Enteropathy Series revealed that the recognised equine inflammatory bowel diseases do occur in the UK and are not restricted to Standardbreds and Thoroughbreds as the available literature would suggest