Management Of Appendiceal Mass

Background: The management of appendiceal mass is surrounded with controversy. Traditional management has been conservative, with interval appendicectomy performed weeks after the mass had resolved. This remains the most common approach at many centers in the world. Recently, an increasing number of studies have challenged this approach. This article reviews some of the controversial issues in the management of appendix mass, assesses current practice and suggests an appropriate approach for the management of appendix mass. Methods: A Medline, Pubmed and Cochrane database search were used to find such key words and combinations of: appendix, appendiceal, appendicular, interval, appendectomy, appendicectomy, mass, abscess, phlegmon, and appendicitis. Results were saved and managed by Reference manager 11. All articles were cross-referenced by the authors. Results: A conservative management is still a highly acceptable approach for appendix mass. This should be followed with interval appendicectomy especially in patients with persistent right iliac fossa pain. Conclusion: We recommend initially conservative approach to the management of appendiceal mass especially in our environment.Contexte: La prise en charge du plastron appendiculaire est entoure de controverses. Le traitement usuel a toujours \ue9t\ue9 conservateur avec l\u2019appendicectomie r\ue9alis\ue9e plusieurs semaines apr\ue8s la fonte de la masse. C\u2019est l\u2019attitude la plus commune dans la plupart des centres \ue0 travers le monde. R\ue9cemment, un nombre croissant d'\ue9tudes ont conteste cette approche. Cet article passe en revue certaines controverses dans la prise en charge du plastron appendiculaire, pr\ue9sente les pratiques actuelles, et sugg\ue8re une approche appropri\ue9e de la prise en charge du plastron appendiculaire. M\ue9thode: Une recherche dans les bases documentaires Medline, Pubmed et Cochrane ont \ue9t\ue9 faites par la recherche et la combinaison des mots cl\ue9s que sont: appendice, appendiculaire, intervalle, appendicectomie, masse, abc\ue8s, phlegmon et appendicite. Les r\ue9sultats ont \ue9t\ue9 sauvegardes et traites a l\u2019aide de R\ue9f\ue9rence Manager 11. Tous les articles ont \ue9t\ue9 recoupes par les auteurs. R\ue9sultats: Un traitement conservateur est encore une approche tr\ue8s acceptable pour le plastron appendiculaire. Cela devrait \ueatre suivi \ue0 distance par une appendicectomie particuli\ue8rement chez les patients ayant une douleur persistante de la fosse iliaque droite. Conclusion: Nous recommandons initialement une approche conservatrice pour la prise en charge du plastron appendiculaire particuli\ue8rement dans notre contexte

Using a Hybrid Lecture and Small Group Standardized Patient Case to Teach the Inclusive Sexual History and Transgender Patient Care

Background: Previous negative experiences with the medical community often leave transgender people reluctant to seek needed medical treatment and preventive care. Inadequate training in transgender healthcare during all stages of medical education promotes the disparities experienced by this community. Undergraduate medical education is uniquely positioned to address these disparities by better preparing future physicians to provide inclusive care to transgender patients; however, curricular coverage of these topics remains inadequate. Methods: The second-year clinical skills course at the Herbert Wertheim College of Medicine includes a hybrid workshop consisting of a one-hour lecture about the components of an inclusive sexual history, followed by a 1.5 hour, faculty-facilitated small group session during which students interview a standardized patient playing the role of a transgender man with abdominal pain. During the session, students were provided with an optional, anonymous pre- and post-intervention survey assessing the impact of this workshop. Results: After the session, there was a statistically significant increase in students’ knowledge of the Create your own automated PDFs with JotForm PDF Editor 1 components of an inclusive sexual history, in the number of students who felt that their medical training had effectively prepared them to provide medical care for transgender patients, and in those who reported feeling comfortable gathering a sexual history from a transgender patient. Students overall reported a high level of satisfaction with the session and the standardized patient case. Conclusions: Our findings suggest that the hybrid-learning format of the sexual history workshop effectively improved students’ knowledge and confidence regarding transgender healthcare and sexual history taking. Although our case was acted by well-coached cis-gender standardized patients without the lived experiences of being transgender, students still reported that it provided a realistic opportunity to explore the nuances of transgender healthcare. While we demonstrated value in using cis-gender standardized patients, future directions of this project will explore the recruitment of transgender standardized patients.https://jdc.jefferson.edu/sexandgenderhealth/1027/thumbnail.jp

Influence of Sulphuric Acid on the Compressive Strength of Ternary Blended Geopolymer Mortar

The deteriorating effect of acid media on cement based constructions has become a worrying problem all over the world. These media generally occur as solutions in various branches of the industry, acid rains and mists, and acid ground-waters. A very popular form of acid attack on concrete that is usually referred to as biogenic sulphuric acid attack also occurs in both industrial and urban sewer systems. The emergence of new cementitious materials, like geopolymer cements, during the past decades necessitates detailed experimental work and research activities to investigate their durability in aggressive acid environments. The study therefore explored the development of alkali-activated CPA-SHA-MK ternary blended geopolymer mortar (GPM) using sodium silicate (Na2Si3) and sodium hydroxide (NAOH) solutions with 9M constant concentration as alkaline activators under both the aggressive and ambient-temperature curing media. The mass ratio of sodium silicate to sodium hydroxide (NS: NH) and as well as the binder to fine aggregate were fixed at 2.5 and 0.8 respectively. The durability of the ternary blended geopolymer mortar was examined through acid resistance test using 50 mm cubes after 28, 56 and 90 days of curing. The results revealed that the setting time prolonged as the replacement levels of RHA-MK increased at a decrease in the replacement levels of CPA. The results also showed that both the PCM and GPM samples studied suffered mass and strength losses in the acid solution and the loss increases at an increase in the hydration periods. The strength losses were observed to be higher in PCM mix (12.19 N/mm2 at 90 days) as compared to the GPMs (6.67 N/mm2 at 90 days) while the mix incorporated 50% CPA, 33% MK and 17% RHA (C50M33R17) was observed to be better compared to other mixes in durability behaviour. The study therefore recommends C50M33R17 mix proportion for good durability performance.&nbsp

Effects of Kenaf Fibre on Fresh Properties of Fibrous Concrete

As a result of global quest for sustainable materials to achieve a bio based economy and low carbon foot print environment, the use of fibre to produce fibrous concrete composite has continuously received significant research attention. While several researches have been conducted on metallic and synthetic fibrous concretes, they exhibit several unavoidable drawbacks and bio fibrous concrete has proven to be a better alternative. Therefore, the effect of fibre volume fraction and fibre length on fresh properties of concrete was investigated. The bio fibrous concrete mix was made of six different fibre volume fractions (0.25%, 0.5%, 0.75%, 1%, 1.5% and 2%) and corresponding three different fibre lengths of 25 mm, 50 mm and 75 mm. A concrete mix proportion of grade 30 N/mm2 at 28 days target strength was prepared. A total of 19 different concrete mixes comprising of one PC mix was the control for the experiment, and 18 different mixes of Kenaf bio fibrous concrete composite (KBFCC) at varying fibre volume fraction (vf) and fibre length (lf) were tested. These mixes were tested for workability (slump, compacting factor and Vebe test) and fresh density. The slump and Vebe time for KBFCCs were 5–100 mm and 3–79 seconds respectively. The slump and Vebe time for PC were 120 mm and 3 seconds respectively. A significant drop from 0.951 to 0.809 for fibre length of 25 mm, 0.947 to 0.799 for fibre length of 50 mm and 0.931 to 0.793 for fibre length of 75 mm was observed for the compacting factor value. Though, KBFCC with fibre content below 1% was workable in spite of its low slump, its high Vebe time and low compacting factor. For fibre volume of 1% and above, the workability of concrete decreased and became very stiff with balling effect. It was seen that fresh density of PC concrete (2358 kg/m3) was higher compared to those of KBFCC (2105-2339 kg/m3), however, both values were lower than 2400 kg/m3 threshold specified by the BS code of practice. The study therefore recommended that fibre contents lesser than 1% and 50 mm length can be used in order to have good fresh properties performance

Boko Haram and the Recurring Bomb Attacks in Nigeria: Attempt to Impose Religious Ideology through Terrorism?

Attempt to forcefully impose religious ideology and or belief on Nigeria’s secular society is not new. The leader of the Maitatsine sectarian group attempted it in 1981 and eventually led to large scale uprisings. Since the early 1980s and 2012, Nigeria has witnessed other uncountable religious related crises. Beginning from 2009, the country once again, has been stormed by large scale and unimaginable bomb attacks by the Boko Haram movement. Although Boko Haram can be compared in terms of philosophy and objectives to the Maitatsine sectarian group, its organisational planning, armed resistance, and modus operandi is Taliban and attacks executed by the groups so far the most ferocious and devastating. To arrest terrorism related offences, the Nigerian National Assembly on 17th February, 2011 passed a bill on Anti-Terrorism. Even with the Bill in place, and the invitation to negotiate by President Goodluck Ebele Jonathan, Boko Haram attacks which initially was confined to North-Eastern Nigeria, like cancer has infected the North-Central and is spreading to Southern Nigeria. Given the inherent unsettled political and economic environment, the menace caused by Boko Haram attacks has cashed in to compound an already chaotic situation. A fall-out of the Boko Haram saga for example, is the re-awakening of the acrimonious call for a Sovereign National Conference- by implication; the so called ‘One Nigeria’ is being questioned. On the basis of this background, for the motives and intention of Boko haram, it can no longer be ignored, trivialised or abandoned. Apparently, the dynamics of terrorism in the context of Boko Haram attacks in Nigeria remains insufficiently explored. This article aims to narrow such a gap by analysing the concept of terrorism in light of the philosophy and objectives, spectrum of strategies, dimensions and networking of Boko Haram movement in Nigeria.Key words: Boko Haram; Bomb Attack; Ideology; Nigeria; Religion; Terrorism.Résumé: La Tentative d’imposer par la force l’idéologie religieuse ou de conviction et sur la société laïque du Nigeria n’est pas nouvelle. Le leader du groupe sectaire Maitatsine il a tenté en 1981 et a finalement conduit à des soulèvements de grande envergure. Depuis le début des années 1980 et 2012, le Nigeria a connu d’autres crises innombrables religieuses liées. A partir de 2009, le pays encore une fois, a été pris d’assaut par grande échelle et attentats à la bombe inimaginables par le mouvement Boko Haram. Bien que Boko Haram peut être comparé en termes de philosophie et les objectifs pour le groupe Maitatsine sectaire, sa planification organisationnelle, la résistance armée, et le modus operandi est talibans et les attaques exécutées par les groupes de loin la plus féroce et dévastatrice. Pour arrêter infractions liées au terrorisme, l’Assemblée nationale nigériane le 17 Février, 2011 a adopté un projet de loi sur la lutte contre le terrorisme. Même avec le projet de loi en place, et l’invitation à négocier par le président Goodluck Jonathan Ebele, Boko Haram attaques qui, initialement, a été confinée au nordest du Nigeria, comme le cancer a infecté le Centre-Nord et se propage vers le sud du Nigeria. Compte tenu de la inhérente environnement politique instable et économique, la menace causée par les attaques Boko Haram a encaissé à aggraver une situation déjà chaotique. Une chute-de la saga Boko Haram par exemple, est le réveil de l’appel acrimonieuse pour une conférence nationale souveraine par l’implication, la soi-disant «Un Nigeria est remise en question. Sur la base de ce contexte, pour les motifs et l’intention de Boko haram, il ne peut plus être ignoré, banalisé ou abandonnés. Apparemment, la dynamique du terrorisme dans le contexte des attaques Boko Haram au Nigeria reste insuffisamment exploré. Cet article vise à combler une telle lacune, en analysant le concept de terrorisme à la lumière de la philosophie et les objectifs, le spectre de stratégies, les dimensions et mise en réseau des Boko Haram mouvement au Nigeria.Mots clés: Boko Haram; Attentat à la bombe; L’idéologie; Le Nigeria; La religion; Le terrorisme

Dog Ecology and Management in Niger State, Nigeria: A Basic Tool for Rabies Control

Aims: To examine the dog ecology and management as it relates to the control of rabies in Niger State, Nigeria. Study Design: Questionnaire based survey. Place and Duration of Study: Structured questionnaires on dog ecology and management were administered in Niger State of Nigeria between January and March 2012. Methodology: Structured questionnaires on dog ecology and management comprising of 4 sections, were administered to 300 adult participants between the ages of 18-70 years using systematic randomization; 237 questionnaires were returned. Descriptive statistics using the SAS statistical package were employed to analyze the data. Results: Results indicated that there was a population ratio of 1:5.4 dogs to humans and 1:1.9 female to male dog ratio with an estimated 732,476 dog population in Niger State. Most of the dogs (58.6%) in the state were kept for security reasons and that majority of the dogs strayed at night (52.4%) and evenings (23.8%) into homes across the state. About 52% of dogs were not confined and responsibility for dogs in terms of welfare, mostly (61.5%) lied on everybody in the family and 61% of dogs were fed on family left overs. About 30.4% of dogs were never vaccinated and 31% of the respondents (or their family members) have been inflicted with a dog bite, but only 28.1% of cases received post-exposure prophylaxis (PEP). For those humans that were bitten, about 13.8% resulted in death. Conclusion: Due to free roaming and irregular vaccination of dogs in the state; there is bound to be increased dog bite cases/rabies spread. This study concludes that dogs were not catered for as expected in the state and that employment of dog ecological studies before any rabies control programmes, will explore necessary data for planning the programme in Niger State of Nigeria. Improvement and employment of dog ecological studies across states for rabies control programmes in Nigeria and W/Africa is hereby recommended

Hybridized zoonotic schistosoma infections result in hybridized morbidity profiles: a clinical morbidity study amongst co-infected human populations of Senegal

Hybridization of infectious agents is a major emerging public and veterinary health concern at the interface of evolution, epidemiology, and control. Whilst evidence of the extent of hybridization amongst parasites is increasing, their impact on morbidity remains largely unknown. This may be predicted to be particularly pertinent where parasites of animals with contrasting pathogenicity viably hybridize with human parasites. Recent research has revealed that viable zoonotic hybrids between human urogenital Schistosoma haematobium with intestinal Schistosoma species of livestock, notably Schistosoma bovis, can be highly prevalent across Africa and beyond. Examining human populations in Senegal, we found increased hepatic but decreased urogenital morbidity, and reduced improvement following treatment with praziquantel, in those infected with zoonotic hybrids compared to non-hybrids. Our results have implications for effective monitoring and evaluation of control programmes, and demonstrate for the first time the potential impact of parasite hybridizations on host morbidity

Estimation of changes in the force of infection for intestinal and urogenital schistosomiasis in countries with Schistosomiasis Control Initiative-assisted programmes

The last decade has seen an expansion of national schistosomiasis control programmes in Africa based on large-scale preventative chemotherapy. In many areas this has resulted in considerable reductions in infection and morbidity levels in treated individuals. In this paper, we quantify changes in the force of infection (FOI), defined here as the per (human) host parasite establishment rate, to ascertain the impact on transmission of some of these programmes under the umbrella of the Schistosomiasis Control Initiative (SCI)

The Schistosomiasis Control Initiative (SCI): rationale, development and implementation from 2002-2008

Schistosomiasis remains one of the most prevalent parasitic diseases in developing countries. After malaria, schistosomiasis is the most important tropical disease in terms of human morbidity with significant economic and public health consequences. Although schistosomiasis has recently attracted increased focus and funding for control, it has been estimated that less than 20% of the funding needed to control the disease in Africa is currently available. In this article the following issues are discussed: the rationale, development and objectives of the Schistosomiasis Control Initiative (SCI)-supported programmes; the management approaches followed to achieve implementation by each country; mapping, monitoring and evaluation activities with quantifiable impact of control programmes; monitoring for any potential drug resistance; and finally exit strategies within each country. The results have demonstrated that morbidity due to schistosomiasis has been reduced by the control programmes. While challenges remain, the case for the control of schistosomiasis has been strengthened by research by SCI teams and the principle that a national programme using ‘preventive chemotherapy' can be successfully implemented in sub-Saharan Africa, whenever the resources are available. SCI and partners are now actively striving to raise further funds to expand the coverage of integrated control of neglected tropical diseases (NTDs) in sub-Saharan Afric

Concurrent breast stroma sarcoma and breast carcinoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Breast cancer is one of the most important health problems in the world and affects a great number of women over the entire globe. This group of tumors rarely presents as bilateral disease and, when it does happen, normally occurs within the same histological type. We report a rare case of concurrent bilateral breast cancer with two different histology types, a breast carcinoma and a breast sarcoma, in a 42-year-old woman referred to our hospital.</p> <p>Case presentation</p> <p>A 42-year-old Caucasian woman admitted to our institute in August 1999, presented with a nodule in the left breast of 3.0 × 2.5 cm, and, in the right breast, one of 1.0 cm, suspected of malignancy and with a clinically negative armpit. Biopsies had revealed invasive mammary carcinoma (right breast) and sarcoma (left breast). She was submitted to bilateral modified radical mastectomy. A histological study showed an invasive mammary carcinoma degree II lobular pleomorphic type with invasion of seven of the 19 excised axillary nodes in the right breast and, in the left breast, a sarcoma of the mammary stroma, for which the immunohistochemistry study was negative for epithelial biomarkers and positive for vimentin. Later, she was submitted for chemotherapy (six cycles of 75 mg/m²5-fluorouracil, epirubicin and cyclophosphamide) followed by radiotherapy of the thoracic wall and axillary nodes on the left. Hormone receptors were positive in the tumor of the right breast, and tamoxifen, 20 mg, was prescribed on a daily basis (five years) followed by letrozole, 2.5 mg, also daily (five years). She presented no sign of negative evolution in the last consultation.</p> <p>Conclusion</p> <p>The risk of development of bilateral breast cancer is about 1% each year within a similar histological type, but it is higher in tumors with lobular histology. In this case, the patient presented, simultaneously, two histologically distinct tumors, thus evidencing a rare situation.</p