Hepatobiliary Manifestations of Inflammatory Bowel Disease

Hepatobiliary manifestations occur quite frequently in patients suffering from chronic ulcerative colitis and Crohn's disease and carry with them considerable morbidity and mortality. Although the true incidence is difficult to determine, clinically, significant hepatobiliary disease occurs in 5%–10% of patients. At the present moment, the aetiology and pathogenesis of inflammatory bowel disease and its systemic manifestations remains speculative. For those hepatobiliary manifestations that respond to therapy of the underlying bowel disease, medical and/or surgical therapy must be aggressively pursued. More urgent research is required towards understanding the underlying cause(s) of the primary bowel disease and its systemic manifestations in order to improve the overall management of this condition

Laparoscopic surgery for achalasia and other primary esophageal motility disorders (PEMD)-indications, preoperative investigations and patient's selection

Primary esophageal motility disorders (PEMD) including achalasia cardia are relatively rare disorders and diagnosed with relative accuracy using high-resolution manometry applying the new Chicago Classification v3.0. The role of additional investigations such endoscopy and barium swallow play a vital role in the diagnosis of achalasia, however their inclusion in diagnosing other PEMD is of no value as the esophagus is anatomically normal. Surgical treatment in the form of Heller myotomy and partial fundoplication is considered the gold standard for achalasia but there is uncertainty regarding the surgical treatment of other PEMD even when the patient experiences obstructive symptoms of dysphagia due to unpredictable outcome. It is therefore imperative that the patient selection and preoperative counseling should take the lead role in these patients before embarking on the surgical treatment. In recent days Heller myotomy has been challenged by a newer endoscopic technique of peroral endoscopic myotomy for achalasia treatment. However, the long-term results are still not available and caution is required. This review scrutinizes both the new and old literature regarding the diagnostic features, preoperative investigations, indications and patient's selection for the laparoscopic treatment of achalasia and other PEMD. It also aims to provide argument for and against various aspects of Heller myotomy in combination with antireflux procedures. It is hoped that further refinement of Chicago Classification may subgroup some of these PEMD and therefore provide clarity regarding the ones requiring definite surgical treatment for the improvement of their symptoms in long term

Laparoscopic common bile duct exploration: The past, the present, and the future

BACKGROUND: The advent of laparoscopic cholecystectomy (LC) has created a dilemma for treating patients with known or suspected choledocholithiasis, With rapid technologic growth and experience in laparoscopic skills, many surgeons are now routinely performing laparoscopic common bile duct exploration (LCBDE) and questioning the wisdom of preoperative endoscopic retrograde cholangiography (ERC) with or without endoscopic sphincterotomy. The purpose of this article is to review the current literature on the subject of LCBDE and critically evaluate the clinical results of this emerging technology

Burden of culture confirmed enteric fever cases in Karachi, Pakistan: Surveillance for enteric fever in Asia project (SEAP), 2016-2019

Background: The Surveillance for Enteric Fever in Asia Project (SEAP) is a multicenter, multicountry study conducted in Pakistan, Nepal, and Bangladesh. The objectives of the study were to characterize disease incidence among patients with enteric fever. We report the burden of enteric fever at selected sites of Karachi, Pakistan.Methods: During September 2016 to September 2019, prospective surveillance was conducted at inpatient, outpatient, surgical departments, and laboratory networks of Aga Khan University Hospital, Kharadar General Hospital, and surgery units of National Institute of Child Health and Jinnah Postgraduate Medical Centre. Socio-demographic, clinical, and laboratory data were obtained from all suspected or confirmed enteric fever cases.Results: Overall, 22% (2230/10 094) of patients enrolled were culture-positive for enteric fever. 94% (2093/2230) of isolates were Salmonella Typhi and 6% (137/2230) were S. Paratyphi. 15% of isolates multi-drug resistant (MDR) to first-line antibiotics and 60% were extensively drug-resistant (XDR), resistant to first-line antibiotics, fluoroquinolones and third generation cephalosporin.Conclusion: Enteric fever cases have increased during the last 3 years with large proportion of drug resistant S. Typhi cases. However, the burden of paratyphoid is still relatively low. Strengthening the existing surveillance system for enteric fever and antimicrobial resistance at the national level is recommended in Pakistan to inform prevention measures. While typhoid vaccination can significantly decrease the burden of typhoid and may also impact antimicrobial resistance, water, sanitation, and hygiene improvement is highly recommended to prevent the spread of enteric fever

Burden of Culture Confirmed Enteric Fever Cases in Karachi, Pakistan: Surveillance For Enteric Fever in Asia Project (SEAP), 2016-2019

Background: The Surveillance for Enteric Fever in Asia Project (SEAP) is a multicenter, multicountry study conducted in Pakistan, Nepal, and Bangladesh. The objectives of the study were to characterize disease incidence among patients with enteric fever. We report the burden of enteric fever at selected sites of Karachi, Pakistan. Methods: During September 2016 to September 2019, prospective surveillance was conducted at inpatient, outpatient, surgical departments, and laboratory networks of Aga Khan University Hospital, Kharadar General Hospital, and surgery units of National Institute of Child Health and Jinnah Postgraduate Medical Centre. Socio-demographic, clinical, and laboratory data were obtained from all suspected or confirmed enteric fever cases. Results: Overall, 22% (2230/10†094) of patients enrolled were culture-positive for enteric fever. 94% (2093/2230) of isolates were Salmonella Typhi and 6% (137/2230) were S. Paratyphi. 15% of isolates multi-drug resistant (MDR) to first-line antibiotics and 60% were extensively drug-resistant (XDR), resistant to first-line antibiotics, fluoroquinolones and third generation cephalosporin. Conclusion: Enteric fever cases have increased during the last 3 years with large proportion of drug resistant S. Typhi cases. However, the burden of paratyphoid is still relatively low. Strengthening the existing surveillance system for enteric fever and antimicrobial resistance at the national level is recommended in Pakistan to inform prevention measures. While typhoid vaccination can significantly decrease the burden of typhoid and may also impact antimicrobial resistance, water, sanitation, and hygiene improvement is highly recommended to prevent the spread of enteric fever

Nutrient acquisition and yield response of Barley exposed to salt stress under different levels of potassium nutrition

A greenhouse experiment was carried out in 2002 at Jordan University of Science and Technology, Agricultural Experiment Station to examine the effect of potassium fertilization on the response of barley ( Hordeum vullgare L. ) to different soil salinity levels. Five levels of potassium (0, 0.2, 0.4, 0.6, and 0.8 g K per pot as KCl) and two salt levels (0.75 and 13 ds/m) were investigated in a split plot design with four replications. Soil salinity affected growth and yield component parameters in most of the cases. However, potassium application alleviated the stress condition and significantly (p < 0.05) improved dry matter yield and yield components in barley. The highest dry matter yield (19.63 g/ pot) of barley grown on the very saline soil was obtained in response to the highest potassium level (0.8 g K/ pot). Number of kernels per spike, number of tillers per plant, weight of kernels per spike and total top (shoot) dry weight were all significantly influenced by the main effects and their interaction. The content of nitrogen and Potassium in barley shoot was also increased due to potassium application. In general, the result of this experiment indicated that application of potassium to barley grown on saline soil medium could bring about improvements in yield and yield component parameters, which would otherwise suffer badly

Prevalence and risk factors of hepatitis B and C virus infections in an impoverished urban community in Dhaka, Bangladesh

Viral hepatitis is a serious global public health problem affecting billions of people globally, and both hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are rapidly spreading in the developing countries including Bangladesh due to the lack of health education, poverty, illiteracy and lack of hepatitis B vaccination. Also there is lack of information on their prevalence among the general population. So, a population-based serological survey was conducted in Dhaka to determine the prevalence and risk factors of HBV and HCV infections

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN