Hiatal hernia

61 years old known case of bronchial asthma, chronic pancreatitis, presented with postprandial epigastric cramping abdominal pain and vomiting for one month no history of trauma. Initial evaluation revealed paraesophageal hernia. EGD finding is grade II esophagitis with nodular mucosa and superficial ulceration, Distal part of the funds, body and the Antrum were rolled back into thoracic cavity. Abdominal computed tomography (CT) showed undulating diaphragm and large complex hiatal hernia. The cardia is above the diaphragm. The entire stomach is in the chest, paraesophageal, right and left to esophagus. The patient is symptomatic and surgery done for him.Pan African Medical Journal 2016; 2

Chlorhexidine versus Povidone-Iodine for the prevention of ‎Surgical Site ‎Infections: A review.‎

BackgroundSurgical Site Infections (SSIs) are the third most frequently reported health care-associated ‎infection‎ and it remain a major clinical problem despite improvements in prevention, as they ‎are associated with ‎significant mortality and morbidity. Prevention strategies for SSIs are based ‎on reducing the risk of infection by bacteria, So many antiseptic agents are ‎used, the most ‎common one are Chlorhexidine and Povidone-Iodine.‎AimsTo discuss the ‎findings of RCTs that compare Chlorhexidine versus Povidone-Iodine in the prevention of ‎Surgical ‎Site ‎Infections (SSIs).‎Methods This systematic review was carried out, including PubMed, Google Scholar, and EBSCO that ‎examining randomized trials of Chlorhexidine and Povidone-Iodine to summarize the major ‎RCT that compare Chlorhexidine versus Povidone-Iodine in the prevention of Surgical Site ‎Infections (SSIs).‎Results The review included six randomized studies that compare between Chlorhexidine and Povidone-‎Iodine for the prevention of SSIs. The findings showed that many studies prefer using ‎Chlorhexidine over Povidine-Iodine to reduce SSIs, few studies prefer using PVI as antiseptic ‎and other studies reported that there is no significant difference between both. ConclusionMajority of results prefer using Chlorhexidine than Povidone-Iodine‎ as antiseptics but ‎there were few findings prefer ‎PVI and other studies reported that there was no significant ‎difference between using them as ‎antiseptics.

Systolic Blood Pressure Variability When Transitioning From Intravenous to Enteral Antihypertensive Agents in Patients With Hemorrhagic Strokes

Background/ObjectiveSystolic blood pressure variability (SBPV) in patients with intracranial hemorrhage (ICH) and subarachnoid hemorrhage (SAH) is associated with an increased risk of acute kidney injury (AKI) and mortality. SBPV is a strong predictor of poor functional outcomes in patients with ICH. Intravenous (IV) antihypertensive agents are commonly used to achieve sustained target blood pressure goals; however, this is not a feasible long-term option. The transition from IV to enteral antihypertensives is not yet well established in patients with ICH and SAH. This study aimed to assess the effect of the number of antihypertensive agents and overlap time during the transition period from IV to enteral route on SBPV in patients with ICH and SAH.MethodsThis retrospective single-center study was conducted at a tertiary teaching hospital in Riyadh, Saudi Arabia. Data were extracted from electronic medical records after obtaining Institutional Review Board approval. Patients were included if they were &amp;gt;18 years old, admitted with spontaneous ICH or SAH, and received continuous infusion antihypertensives prior to transitioning to the enteral route. The major outcome was the effect of the number of antihypertensive agents and overlap time on SBPV during the transition process. Minor outcomes included the effect of the number of antihypertensive agents and overlap time on heart rate variability and the incidence of AKI on day 7.ResultsAfter the screening, we included 102 patients. Based on our regression model, the number of enteral antihypertensive agents upon transitioning from IV to enteral antihypertensive therapy had no effect on SBPV in the intensive care unit (ICU) among our patients (p-value = 0.274). However, the prolonged overlap was associated with reduced SBPV in the ICU (p-value = 0.012). No differences were observed between the groups in heart rate variation or AKI rate.ConclusionsIn patients with ICH and SAH, prolonged overlap of enteral antihypertensive agents to overlap with intravenous antihypertensive therapy may result in lower SBPV. This finding needs to be confirmed on a larger scale with more robust study designs for patients with ICH and SAH.</jats:sec

SYSTEMATIC REVIEW OF THE PREVALENCE OF ANXIETY AND DEPRESSION DISORDERS AMONG PATIENTS WITH INFLAMMATORY BOWEL DISEASE

Background: Mental health is an important but often disregarded part of inflammatory bowel disease (IBD) patient care, with difficulties defining effective medications and psychological health services. Anxiety and sadness are the most frequent psychosocial problems among IBD patients. The rising frequency of these mental problems calls for mental screening of all IBD patients at the initial appointment. Objective: A growing number of research on anxiety and depression in IBD have been undertaken nevertheless, there is no clear consensus on the prevalence of anxiety and depression in this group. The goal of this systematic review was to consolidate current data on the prevalence of depression and anxiety disorders in individuals with IBD. Methods: Authors began with recognizing the important examination proof that spots light on the prevalence of anxiety and depression among IBD patients. We led electronic writing look in the accompanying data sets: Ovid Medline (2010 to present), Ovid Medline Daily Update, Ovid Medline in process and other non-filed references, Ovid Embase (2010 to present), The Cochrane Library (latest issue) and Web of Science. Just examinations in English language will be incorporated. The precise selection was acted in close collaboration with a clinical examination curator. Results: There were 10 articles found, with a total of 26097 participants. The pooled prevalence estimate for anxiety disorders was 20.3%, and 13.3% for depression. When compared to those in remission, IBD patients in active illness showed a 75.6% greater prevalence of anxiety. Depressive symptoms were more common in Crohns disease than in UC (P0.001), and more common in active illness than in IBD patients in remission (P= 0.004). Conclusion: Results from this systematic review indicate that patients with IBD have about a 20.3% prevalence rate of anxiety and a 13.3% prevalence rate of depression

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population