Meckel’s diverticulum: a rare cause of intestinal perforation in a preterm newborn

Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. It is usually encountered as an incidental finding at operation or autopsy. Symptomatic cases usually present during infancy with intestinal obstruction, intestinal hemorrhage, diverticulitis, or perforation. We report on a preterm newborn who developed abdominal distension at 17 h of age and pneumoperitoneum at 30 h. At laparotomy, a  narrow-based MD with a small  perforation at the tip was encountered. Segmental resection of the ileum,  including the MD, and end-to-end anastomosis was performed. A review on perforated MD from the English medical literature is also presented. Perforated MD, although rare, should be included in the differential diagnosis of neonatal gastrointestinal perforations and acute abdomen.Keywords: acute abdomen, gastrointestinal perforation, perforated Meckel’s diverticulum, preterm newbor

Prevalence of Urinary Incontinence and Probable Risk Factors in a Sample of Kurdish Women

Objectives: The most common manifestation of pelvic floor dysfunction is urinary incontinence (UI) which affects 15–50% of adult women depending on the age and risk factors of the population studied. The aim of this study was to determine the probable risk factors associated with UI; the characteristics of women with UI; describe the types of UI, and determine its prevalence. Methods: A cross-sectional study was conducted between February and August 2011, in the Maternity Teaching Hospital of the Erbil Governorate, Kurdistan Region, northern Iraq. It included 1,107 women who were accompanying patients admitted to the hospital. A questionnaire designed by the researchers was used for data collection. A chi-square test was used to test the significance of the association between UI and different risk factors. Binary logistic regression was used, considering UI as the dependent variable. Results: The overall prevalence of UI was 51.7%. The prevalence of stress, urgency, and mixed UI was 5.4%, 13.3% and 33%, respectively. There was a significant positive association between UI and menopause, multiparity, diabetes mellitus (DM), chronic cough, constipation, and a history of gynaecological surgery, while a significant negative association was detected between UI and a history of delivery by both vaginal delivery and Caesarean section. Conclusion: A high prevalence of UI was detected in the studied sample, and the most probable risk factors were multiparity, menopausal status, constipation, chronic cough, and DM

Prevalence and Risk Factors of Episiotomy and Perineal Tear in the Maternity Teaching Hospital of Erbil City, Iraq

Background and Objectives: During childbirth, women are at risk for experiencing perineal trauma to the genitalia resulting in a tear of the perineum or the surgical process of an episiotomy. Knowing the prevalence and the risk factors associated with perineal trauma may help in the reduction of episiotomy and prevention of occurrence of tear. The aim of the study was to find out the prevalence and risk factors associated with perineal trauma among women ages 15-48. Methods: A cross-sectional study was conducted in the Maternity Teaching Hospital of Erbil, Kurdistan region, Iraq. All records of mothers (n = 1500) who had been admitted to the delivery room for vaginal delivery during the month of May (2015) were reviewed. Chi-square test of association and binary logistic regression were used to interpret the data. Results: The overall rates of episiotomy, tear, their combined presence, and an intact perineum were: 47.8%, 7.2%, 26.1% and 18.9%, respectively. Incidence of having an episiotomy, tear, or combination of both, were significantly associated with women of young ages and women who were primigravida parity. There was a statistically significant association between high birth weight and the occurrence of perineal trauma. There was no association between perineal trauma and residency (urban/rural), occupation, gender of baby and time of delivery. Binary logistic regression analysis showed that having an episiotomy increased the risk of a tear by more than 30%. Conclusions: The prevalence of episiotomy was found to be 73.9% which is much higher compared to the World Health Organization recommendation which is 10%. Perineal trauma were associated with factors such as age, parity, and birth weight. Episiotomy is a risk factor for a vaginal tear. We recommend further research to inform the development and implementation of restrictive episiotomy policies to reduce and prevent occurrences of perineal trauma

Specific Cellular Immune Response and Cytokine Patterns in Patients Coinfected with Hepatitis C Virus and Schistosoma mansoni

Patients coinfected with hepatitis C virus (HCV) and Schistosoma mansoni show high incidence of viral persistence and accelerated fibrosis. To determine whether immunological mechanisms are responsible for this alteration in the natural history of HCV, the HCV-specific peripheral CD4+ T cell responses and cytokines were analyzed in patients with chronic hepatitis C monoinfection, S. mansoni monoinfection, or HCV and S. mansoni coinfection. An HCV-specific CD4+ proliferative response to at least 1 HCV antigen was detected in 73.3% of patients infected with HCV, compared with 8.6% of patients coinfected with HCV and S. mansoni. Stimulation with HCV antigens produced a type 1 cytokine profile in patients infected with HCV alone, compared with a type 2 predominance in patients coinfected with HCV and S. mansoni. In contrast, there was no difference in response to schistosomal antigens in patients infected with S. mansoni alone, compared with those coinfected with HCV and S. mansoni. These findings suggest that the inability to generate an HCV-specific CD4+/Th1 T cell response plays a role in the persistence and severity of HCV infection in patients with S. mansoni coinfectio

Incidence of adverse drug events in public and private hospitals in Riyadh, Saudi Arabia: the (ADESA) prospective cohort study

Objectives: To determine the incidence of adverse drug events (ADEs) and assess their severity and preventability in four Saudi hospitals. Design: Prospective cohort study. Setting: The study included patients admitted to medical, surgical and intensive care units (ICUs) of four hospitals in Saudi Arabia. These hospitals include a 900-bed tertiary teaching hospital, a 400-bed private hospital, a 1400-bed large government hospital and a 350-bed small government hospital. Participants: All patients (≥12 years) admitted to the study units over 4 months. Primary and secondary outcome measures Incidents were collected by pharmacists and reviewed by independent clinicians. Reviewers classified the identified incidents as ADEs, potential ADEs (PADEs) or medication errors and then determined their severity and preventability. Results: We followed 4041 patients from admission to discharge. Of these, 3985 patients had complete data for analysis. The mean±SD age of patients in the analysed cohort was 43.4±19.0 years. A total of 1676 ADEs were identified by pharmacists during the medical chart review. Clinician reviewers accepted 1531 (91.4%) of the incidents identified by the pharmacists (245 ADEs, 677 PADEs and 609 medication errors with low risk of causing harm). The incidence of ADEs was 6.1 (95% CI 5.4 to 6.9) per 100 admissions and 7.9 (95% CI 6.9 to 8.9) per 1000 patient-days. The occurrence of ADEs was most common in ICUs (149 (60.8%)) followed by medical (67 (27.3%)) and surgical (29 (11.8%)) units. In terms of severity, 129 (52.7%) of the ADEs were significant, 91 (37.1%) were serious, 22 (9%) were life-threatening and three (1.2%) were fatal. Conclusions: We found that ADEs were common in Saudi hospitals, especially in ICUs, causing significant morbidity and mortality. Future studies should focus on investigating the root causes of ADEs at the prescribing stage, and development and testing of interventions to minimise harm from medications

A service-based system for malnutrition prevention and self-management

Malnutrition is considered one of the root causes for the occurrence of other diseases. It is particularly common in the ageing population, where it requires more efficient handling and management to enable longer home independent living. However, to achieve this, a number of related challenges need to be overcome, especially those related to management of health and disease let alone other social and logistical barriers. This paper presents the design of a distributed system that enables homecare management in the context of self-feeding and malnutrition prevention through balanced nutritional intake. The design employs a service-based system that incorporates a number of services including monitoring of activities, nutritional reasoning for assessing feeding habits, diet recommendation for food planning, and marketplace invocation for automating food shopping to meet dietary requirements. The solution is deployed in a small pilot in 12 elder adult houses that, in early results, demonstrates its holistic user-centred scalable approach for malnutrition self-management

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Effects of antiplatelet therapy after stroke due to intracerebral haemorrhage (RESTART): a randomised, open-label trial

Background: Antiplatelet therapy reduces the risk of major vascular events for people with occlusive vascular disease, although it might increase the risk of intracranial haemorrhage. Patients surviving the commonest subtype of intracranial haemorrhage, intracerebral haemorrhage, are at risk of both haemorrhagic and occlusive vascular events, but whether antiplatelet therapy can be used safely is unclear. We aimed to estimate the relative and absolute effects of antiplatelet therapy on recurrent intracerebral haemorrhage and whether this risk might exceed any reduction of occlusive vascular events. Methods: The REstart or STop Antithrombotics Randomised Trial (RESTART) was a prospective, randomised, open-label, blinded endpoint, parallel-group trial at 122 hospitals in the UK. We recruited adults (≥18 years) who were taking antithrombotic (antiplatelet or anticoagulant) therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage, discontinued antithrombotic therapy, and survived for 24 h. Computerised randomisation incorporating minimisation allocated participants (1:1) to start or avoid antiplatelet therapy. We followed participants for the primary outcome (recurrent symptomatic intracerebral haemorrhage) for up to 5 years. We analysed data from all randomised participants using Cox proportional hazards regression, adjusted for minimisation covariates. This trial is registered with ISRCTN (number ISRCTN71907627). Findings: Between May 22, 2013, and May 31, 2018, 537 participants were recruited a median of 76 days (IQR 29–146) after intracerebral haemorrhage onset: 268 were assigned to start and 269 (one withdrew) to avoid antiplatelet therapy. Participants were followed for a median of 2·0 years (IQR [1·0– 3·0]; completeness 99·3%). 12 (4%) of 268 participants allocated to antiplatelet therapy had recurrence of intracerebral haemorrhage compared with 23 (9%) of 268 participants allocated to avoid antiplatelet therapy (adjusted hazard ratio 0·51 [95% CI 0·25–1·03]; p=0·060). 18 (7%) participants allocated to antiplatelet therapy experienced major haemorrhagic events compared with 25 (9%) participants allocated to avoid antiplatelet therapy (0·71 [0·39–1·30]; p=0·27), and 39 [15%] participants allocated to antiplatelet therapy had major occlusive vascular events compared with 38 [14%] allocated to avoid antiplatelet therapy (1·02 [0·65–1·60]; p=0·92). Interpretation: These results exclude all but a very modest increase in the risk of recurrent intracerebral haemorrhage with antiplatelet therapy for patients on antithrombotic therapy for the prevention of occlusive vascular disease when they developed intracerebral haemorrhage. The risk of recurrent intracerebral haemorrhage is probably too small to exceed the established benefits of antiplatelet therapy for secondary prevention