Effectiveness of Chest Physiotherapy in Infants Hospitalized with Acute Bronchiolitis: A Multicenter, Randomized, Controlled Trial

Vincent Gajdos and colleagues report results of a randomized trial conducted among hospitalized infants with bronchiolitis. They show that a physiotherapy technique (increased exhalation and assisted cough) commonly used in France does not reduce time to recovery in this population

Acute abdominal pain and appendicitis in north east Thailand

In a survey of emergency admissions to hospital in rural Thailand, acute appendicitis was the commonest cause of acute abdominal pain. Estimates of the incidence of appendicitis, in two series comprising a total of 356 patients, at 3.2 and 3.7 per 10,000 population per year, were relatively high compared with reports from other warm climate countries. In comparison with 1825 cases in studies sponsored by the Organisation Mondiale de Gastroenterologie (OMGE), Thai patients with acute appendicitis were older, presented late and experienced more complications than those in 14 other countries. In Khon Kaen only 2-3% of the cases were children aged 0-9 years, compared with 9-26% in the OMGE series. In patients admitted to hospital with acute abdominal pain in Thailand, acute appendicitis was diagnosed more often than non-specific abdominal pain. The converse was true in OMGE series. This may reflect the longer distances travelled to hospital by many patients and delays between onset of symptoms and admission to hospital. Acute appendicitis was the commonest definitive diagnosis in both series. This survey indicates that relatively high rates of acute appendicitis may occur in populations eating traditional diets. The results are consistent with the recently described hypothesis of an infective aetiology and increases in appendicitis rates may be expected in people born since the introduction of improvements in environmental sanitation. Further studies are needed to examine trends in the incidence of appendicitis in populations eating traditional diets with both high and low fibre content and to investigate the significance of changing social and environmental factors.link_to_subscribed_fulltex

Culpability for Violence in the Congo: Lessons from the Crisis of 1960–1965

During Congo’s emergence from colonization in the mid-twentieth century, coups, political assassinations, and ethnic massacres took place that exacerbated inequality and insecurity in the region then and ever since. Some Western literature has essentialized these events, implying that they were a product of African people’s innate disorganization, divisiveness, leftism, and violence. Many of the writings keep to surface appearances rather than probing behind-the-scenes causalities. Evidence from archives, images, memoirs, and interviews, however, reveals a counterintuitive complexity in both the representation and perpetration of the direct and structural violence of the Congo crisis. Very different cultures, financing, technology, and interactions were characteristic of the western state agents who sponsored, organized, took part in, and often wrote about the coups and killings in Congo as opposed to the African functionaries with whom and against whom they worked. This chapter illustrates some of the evidence for these complex and contrasting patterns, offers alternative explanations, and outlines some lessons to be learned from the crisis