Neuroendocrine tumor of the appendix inside an incarcerated Amyand’s hernia

AbstractAmyand’s hernia is a rare type of hernia where the vermiform appendix is within an inguinal hernia sac. Tumors of the appendix are quite uncommon. The coincidence of an Amyand’s hernia with neuroendocrine tumor of the appendix, as in our case, is even more rarely reported.We report the case of an 81-year-old male who presented with an incarcerated right inguinal hernia. After resuscitation, the clinical diagnosis was confirmed by computed tomography. It showed an incarcerated right inguinal hernia which contained the distal ileum, cecum, thickened appendix, as well as a small amount of fluid. Subsequently, the patient was prepared for emergency surgery. During the operation, the hernia sac was found and opened. The appendix was swollen. Therefore, appendectomy was performed. The inguinal defect was repaired using the Modified Bassini Technique. The patient had an uneventful postoperative recovery and surprisingly the histopathology of the appendix revealed a 1.5cm well-differentiated low grade neuroendocrine tumor (carcinoid) of the appendix tip.An incidental finding of neuroendocrine tumor of the appendix in a patient with s hernia is extremely rare. A high index of suspicion is the key to diagnose such a coincidence in order to safely and optimally treat such a condition

Spontaneous Rupture of Intra Cranial Dermoid Cyst: A Case Report

Intracranial dermoid cysts are benign, slow growing, congenital lesions that comprise less than 1% of all intracranial lesions. They are usually asymptomatic unless they get ruptured, either spontaneously or after head injury. We present a case of a ruptured intracranial dermoid cyst, at sellar/suprasellar region, in a middle aged male with multiple known comorbids. He presented in Accident and Emergency Department with severe headache, behavioral changes and vomiting. Radiological investigation were carried out showing ruptured intracranial dermoid cyst with dissemination of its contents into the ventricles and the sub arachnoid space causing hydrocephalus

Impact of tobacco smoking on oral microbiota – a case-control study.

Oral microbiota is a vital part of human microbiota, including bacterial, protozoa, viral and fungal species. Beneficial microbes form biofilms to form a first-line defense against harmful microorganisms. Tobacco smoking is considered a major environmental factor affecting the orodental microbiota. Smokers harbor more pathogenic microbes than non-smokers. In fact, cigarette smoking exposes the oral cavity to a large number of toxicants, perturbing the oral microbial ecology through various mechanisms. In Saudi Arabia, research on the impact of tobacco smoking on oral microbiota is still lacking. Therefore, this case-control study is an important addition to the literature in terms of tobacco use and its effects on oral microbiota and oral hygiene. 130 men were recruited for this study, including 65 smokers and 65 non-smokers. The following parameters were recorded for all 130 participants – age, weight, height and education. The aim of this study was to investigate and compare the effect of tobacco smoking on the oral microbiome of smokers and non-smokers. The majority of the smokers were young adults between the ages of 21 and 30 inclusive (n=27). The results show that excessive microorganism growth was seen in smokers to a greater degree than non-smokers (38.5% of smokers vs. 8.8% of non-smokers). Not surprisingly, a significant majority (85.3%) of non-smokers had moderate microorganism growth compared to only 53.8% of smokers. cigarette smoking facilitates excessive growth of oral microorganisms, predisposing smokers to various periodontal diseases. In fact, smoking perturbs the balance of oral microbiota, producing a viable environment for microbes to cause diseases. Further large scale prospective studies are required to determine the exact mechanism that causes tobacco to affect oral microbiota

CAUSES AND MANAGEMENT OF VIRAL EYE INFECTION

Introduction: The eye is a fascinating organ for several reasons. It is not only have a composite structure, however it is considered an immune-privileged organ. The anatomy of the eye is composed of the anterior and posterior parts, the line of division is posterior to the lens. The anterior chamber lies within the anterior segment and is an immuneprivileged anatomical location, this is due to the fact that the T-cell response in this area is suppressed This protects the eye from potentially destructive immune attacks however it also makes defence against infectious agents challenging, particularly where T-cell responses are critical for immunological defence. Viruses could get into the eye by direct inoculation, or through haematogenous or neuronal spread. The diagnoses of viral eye infections are usually clinical one, helped by taking a thorough history and performing ophthalmic examination. But in challenging cases the lab tests are essential. In this review, we will discuss the most recent evidence regarding Causes and management of viral eye infection Aim of work: In this review, we will discuss the most recent evidence regarding Causes and management of viral eye infection Methodology: We did a systematic search for Causes and management of viral eye infection using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles. Conclusions: A wide range of of viruses can affect the eye and cause viral eye infections, either as a primary infection or reactivation. Some affect the eye directly while the others indirectly but may still manifest with eye disease. One virus may affect several parts of the eye, while different viruses may cause the same eye disease. This could complicate the clinical diagnosis of viral eye disease, but the lab tests like PCR and antibody tests could assist in challenging cases where there may be diagnostic dilemma. The HIV epidemic has had an huge impact on ophthalmology clinics, this is because the virus can cause different eye diseases, and the associated decrease in cell-mediated immunity makes the person highly susceptible to opportunistic viral eye infections, sometimes with severe morbidity. There could be other viruses that may affect the eye that we did not discuss. Key words: Causes, management, viral eye infection

Impact of tobacco smoking on oral microbiota – a case-control study.

Oral microbiota is a vital part of human microbiota, including bacterial, protozoa, viral and fungal species. Beneficial microbes form biofilms to form a first-line defense against harmful microorganisms. Tobacco smoking is considered a major environmental factor affecting the orodental microbiota. Smokers harbor more pathogenic microbes than non-smokers. In fact, cigarette smoking exposes the oral cavity to a large number of toxicants, perturbing the oral microbial ecology through various mechanisms. In Saudi Arabia, research on the impact of tobacco smoking on oral microbiota is still lacking. Therefore, this case-control study is an important addition to the literature in terms of tobacco use and its effects on oral microbiota and oral hygiene. 130 men were recruited for this study, including 65 smokers and 65 non-smokers. The following parameters were recorded for all 130 participants – age, weight, height and education. The aim of this study was to investigate and compare the effect of tobacco smoking on the oral microbiome of smokers and non-smokers. The majority of the smokers were young adults between the ages of 21 and 30 inclusive (n=27). The results show that excessive microorganism growth was seen in smokers to a greater degree than non-smokers (38.5% of smokers vs. 8.8% of non-smokers). Not surprisingly, a significant majority (85.3%) of non-smokers had moderate microorganism growth compared to only 53.8% of smokers. cigarette smoking facilitates excessive growth of oral microorganisms, predisposing smokers to various periodontal diseases. In fact, smoking perturbs the balance of oral microbiota, producing a viable environment for microbes to cause diseases. Further large scale prospective studies are required to determine the exact mechanism that causes tobacco to affect oral microbiota

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Efficacy of tranexamic acid administration in traumatic brain injury patients: A review

BackgroundAnti-fibrinolytic medications decrease traumatic intracranial haemorrhage (ICH). Tranexamic acid (TXA) is an anti-fibrinolytic, which recently has shown effectiveness in management of traumatic haemorrhage‎.AimsTo summarize the randomized control trials (RCTs) that evaluate the efficacy of tranexamic acid administration in traumatic brain ‎injury (TBI) patients‎.‎Methods An electronic literature review, including PubMed, Google Scholar, and EBSCO that examining RCTs, observational, and experimental studies which study the efficacy of TXA administration in (TBI) patients.ResultsThe current review included 7 randomized studies reported the efficacy of TXA in management of TBI. TXA limit secondary brain injury by preventing the expansion of ICH. Administration of TXA exhibited a tendency to decrease head trauma-related mortality.ConclusionTXA significantly lower the risk of ICU expansion m and prevent brain injury related deaths

Oral semaglutide adequate glycaemia control with safe cardiovascular ‎profile

BackgroundType 2 diabetes is a chronic and progressive disease that ‎associated with series complication such as major adverse ‎cardiovascular events. Adequate glycaemic control proven ‎to reduce this risk. Orally administered semaglutide ‎promising medication in managing patient with type 2 ‎diabetes.‎AimsTo assess the cardiovascular safety and efficacy of semaglutide, a recently approved glucagon-like peptide 1 receptor agonist (GLP-1 RA) for type 2 diabetes.Methods Pub Med, ‎Google Scholar, and EBSCO ‎ databases were ‎systematically search for relevant articles. The terms‎ diabetes‎, Glucagon-like peptide, semaglutide‎ were used. Out of hundred twenty-two records, only ‎four fulfilled ‎the inclusion criteria.Results Four placebo-controlled studies with oral semaglutide ‎were included. Single study concern about the cardiovascular safety of oral semaglutide ‎and showed that, ‎compared with placebo, semaglutide ‎ was not associated ‎with increased in the cardiovascular events. On the other ‎hand, the remaining trials shown that, semaglutide ‎ can ‎effectively control the blood glucose as evident by ‎reduction in HA1c.ConclusionOral semaglutide can effectively and safely lower blood glucose without increase in the major adverse ‎cardiovascular events‎‎ (MACE).

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication