Acute Appendicitis Secondary to Intestinal Schistosomiasis

Schistosomiasis, a chronic parasitic disease is caused by a blood fluke (Schistosoma). 200 million people are infected worldwide, 85% in sub-Saharan Africa. In Kenya coastal region and irrigation schemes are endemic. Mwea irrigation scheme is endemic with 47% prevalence. Close proximity of Kagio area to the irrigation scheme offers labor opportunities to the population including school children posing a transmission threat. This study investigated Schistosoma mansoni infections among school children aged 8-15 years. Kagio and Kang’aru schools (Kagio area) and Kandongu (Mwea irrigation scheme) were selected. 322 pupils were tested for the presence of S. mansoni eggs by direct wet smears and Karto Katz. 263 questionnaires were administered to pupils from Kagio and Kang’aru schools. Data was analysed using Chi square and t-test statistics. Results showed that 7.2% of pupils from Kagio area had Schistosoma mansoni compared to 22% sampled from Mwea irrigation scheme. Mean number of eggs was 56 epg and 104 epg for the pupils who had light infection and those with moderate infection respectively. No pupils had heavy infestation. Pupils from Kagio area who worked in the farms in Mwea irrigation scheme were more prone to infection. 7.9% of those infected worked in rice paddies compared to 4% of infected pupils who did not. There was a significant relationship between labor migration and occurrence of Schistosoma mansoni infection among school children in Kagio area (x 2 =1.267; df=1; P=0.2604). There was no significant difference in infection rates between pupils from Kagio and Mwea areas (t=5.33, cl=95%, df=1, P=0.118). Schistosoma mansoni was present in both endemic and non-endemic areas. Labor migration was a significant transmission risk factor. The results indicate a need for the policymakers to institute programs that are designed to eliminate or minimize child labor migration from non-endemic to endemic areas as a way of preventing spread of Schistosoma mansoni, regular testing and treatment of the entire population and extend control interventions to neighboring non endemic area.

Background: Injuries, disorders, and deformities of the hands and upper extremities cause significant morbidity worldwide, but in sub-Saharan Africa, the burden of disease and the availability of appropriate care remain unknown. We sought to characterize disease burden and barriers to care for hand and upper extremity conditions across sub-Saharan Africa, examining differences in burden and access by geographic region and national income level. Methods: From 6 June 2020 through 17 March 2021, we surveyed providers of musculoskeletal care in sub-Saharan Africa regarding the provision of care and the most common acute and chronic hand or upper extremity conditions encountered by respondents. Surveys were distributed through professional networks across sub-Saharan Africa. We categorized responses by each respondent’s national income level and geographic region. Then, we examined how frequently various challenges to accessing healthcare, as well as how frequently acute or chronic conditions, were reported. Additionally, we analyzed how these data varied by income level and geographic region. Results: We received 193 responses from 39 countries in sub-Saharan Africa. Eighty-eight per cent of respondents reported that general orthopaedic surgeons and orthopaedic traumatologists primarily manage upper extremity conditions. A lack of adequate and timely diagnosis was reported by 142 respondents (74%); late referral for treatment was reported by 149 (77%); and inadequate physical therapy, occupational therapy, and rehabilitation was reported by 149 respondents (77%). The most commonly reported acute conditions were adult and paediatric radius/ulna fractures/dislocations, adult metacarpal/phalangeal fractures/dislocations, soft-tissue injuries (including burns), and paediatric elbow fractures/dislocations. The most commonly reported chronic conditions were tendinitis/tenosynovitis, chronic infections/osteomyelitis, neuropathies, posttraumatic stiff hand, and radius/ulna malunion/nonunion. Neglected trauma (including chronic elbow injuries and burn contractures) was frequently reported, especially in low-income countries. Conclusions: Trauma care should be strengthened through training of general orthopaedic surgeons in hand and upper extremity surgery throughout sub-Saharan Africa. Especially in low-income countries, particular training emphasis should be placed on the management of malunion/nonunion, osteomyelitis, acute and chronic elbow injuries, and burn contractures. These findings should inform the development of core competencies in hand surgery for providers managing musculoskeletal conditions in sub-Saharan Africa, as well as guide capacity-building activities on the continent.

Potentially preventable hospitalizations for acute and chronic conditions in Alaska, 2010-2012.

Acute perforated appendicitis is associated with increased post-operative morbidity and mortality. Avoiding delays in surgery in these patients may play a role in reducing observed morbidity. To analyze the clinico-pathological profile and outcomes in a cohort of patients undergoing emergency appendicectomies for suspected acute appendicitis and to determine factors influencing the risk of perforated appendicitis in order to aid better identification of such patients and develop protocols for improved management of this subset of patients. A retrospective analysis of patients undergoing emergency appendicectomies following presentation with acute appendicitis to the Modbury hospital, South Australia from March 2007 to April 2011 was conducted. Statistical analyses were performed in SAS 9.2. 506 patients underwent emergency appendectomy for acute appendicitis which included equal number of male and female patients with a median age of 25 years. Perforated appendicitis was found in 102 (20%) patients. Post-operative morbidity was significantly higher in patients with perforated appendicitis (28.4% vs 4.7%; P<0.0001). Male sex, patients older than 60 years, along with raised neutrophil counts and C-reactive protein levels were found to be significantly associated with the risk of perforation (P<0.05). Acute perforated appendicitis is associated with high morbidity. The increased risk of perforation in males and elderly patients appears unrelated to delays in presentation, diagnosis, or surgery. Patients with clinically diagnosed acute appendicitis and an elevation in neutrophil count and CRP level must be considered candidates for early surgery as they are likely to have an appendicular perforation.

To investigate potential differences in the availability of medicines for chronic and acute conditions in low- and middle-income countries. Data on the availability of 30 commonly-surveyed medicines - 15 for acute and 15 for chronic conditions - were obtained from facility-based surveys conducted in 40 developing countries. Results were aggregated by World Bank country income group and World Health Organization region. The availability of medicines for both acute and chronic conditions was suboptimal across countries, particularly in the public sector. Generic medicines for chronic conditions were significantly less available than generic medicines for acute conditions in both the public sector (36.0% availability versus 53.5%; P = 0.001) and the private sector (54.7% versus 66.2%; P = 0.007). Antiasthmatics, antiepileptics and antidepressants, followed by antihypertensives, were the drivers of the observed differences. An inverse association was found between country income level and the availability gap between groups of medicines, particularly in the public sector. In low- and lower-middle income countries, drugs for acute conditions were 33.9% and 12.9% more available, respectively, in the public sector than medicines for chronic conditions. Differences in availability were smaller in the private sector than in the public sector in all country income groups. Current disease patterns do not explain the significant gaps observed in the availability of medicines for chronic and acute conditions. Measures are needed to better respond to the epidemiological transition towards chronic conditions in developing countries alongside current efforts to scale up treatment for communicable diseases.

Acute appendicitis after closed abdominal trauma: A case report

Background: Female patients during reproductive age had a high rate of gynecological conditions, such as ovarian cysts, ovarian torsion, uterine fibroids, or endometriosis, that occur and misdiagnosed with acute or chronic appendicitis; these disorders can be without identifiable pathologies and discovered accidentally during appendectomy. Objectives: The aim of this article is to study the most common gynecological conditions that are accidentally encountered in female patients presented with acute appendicitis. Materials and Methods: A cross-sectional study was done on 97 female patients who were admitted to the hospital for open and laparoscopic appendectomy during the period of January–April 2021. Results: The study included 97 patients, 71 (73%) were of the age group 20–49 years, 35 of them had incidental gynecological findings, and the rest 62 were having true acute appendicitis, ovarian cyst, and ectopic pregnancy which were the most common findings (16, 5) cases, respectively. Conclusion: Surgical gynecological conditions in female patients with appendectomy are commonly encountered, and the most common diagnoses were ovarian cysts.

Acute appendicitis, one of the most frequent emergencies in general surgery, has been repeatingly investigated with regard to specific aspects such as medical history, clinical symptoms, the perioperative management and follow up. The aim of the study was to investigate relevant and combined determinants for the perioperative management of acute appendicitis a systematic clinical prospective unicenter observational study was conducted. A representative patient cohort was studied (n=9,991; middle Europe) to reflect daily surgical practice through a time period of 27 years divided into 3 separate periods and the frequency of specific categories (e.g., characteristics of the medical history, clinical and intraoperative findings as well as complications), their correlation and relative risk factors for the disease as well as prognosis. 1. The wound abscess rate was 10.9%. Perforation, surgical intervention in time, acute, gangrenous and chronic appendicitis, age, accompanying diseases such as obesity, arterial hypertension, diabetes mellitus, sex, and missing pathological finding intraoperatively had a significant impact on the postoperative development of a wound abscess. 2. The longer the specific appendicitis-associated medical history was, the more frequent a perforated appendicitis occurred, greater the appendectomy (AE) rate in a non-inflamed appendix and higher the rate of required second interventions. 3. The average hospital stay was 11 days. 4. There was a significantly decreased percentage of patients with no pathological finding intraoperatively at the appendix vermiformis (p<0.001), who underwent AE, in particular, through the last investigation period from 1997 to 2000 onto only 6.8% (1974-1985, 15.5%; 1986-1996, 10.3%). 5. The mortality was 0.6%, with no significant difference comparing male and female patients (p=1), the three investigation periods (p=0.077), or the patients with AE in non-inflamed appendix (0.4%) and AE in acute appendicitis (0.6%; p=0.515). The study showed a positive, partially significant quality improvement within the presenting clinic with regard to a decreased rate of AE in non-inflamed appendix, wound abscess rate and, in particular, to mortality. Despite this, there is a trendy increase of the perforation rate in the investigated cohort. Quality control remains indispensable for the assessment of the disease´s surgical treatment. A further significant improval of this control might be achieved by multicenter studies and multifactorial evaluations.

The number of the passenger using air travel keeps increasing every year. Inconsistency with an increasing number of passengers without medical conditions, the number of passengers with acute or chronic medical conditions increases inevitably. The attitude of commercial aircrafts providing passenger transportation during air travel is associated with altered internal cab pressure, humidity rate, partial oxygen pressure when compared with sea level pressure and medium. Alterations in the internal cab during a flight are usually well tolerated by healthy passengers, however might harm passengers with acute or chronic medical conditions. Around 65 % of health conditions emerging during flights are related to pre-existing medical conditions. Passengers with medical conditions are not fully aware of the potential influences of flight on their acute or chronic conditions. However, treatment options are substantially limited in case of an emergent medical condition during flights. Evaluation and clearance of patients with medical conditions before the flight by physicians experienced in-flight medicine is the key step for elimination or minimizing risks during the flight. Particularly patients with a history of recent hospitalization, injury, surgery, unstable conditions related to chronic health conditions, acute conditions, need for oxygen support, need for stretcher should be thoroughly evaluated before the flight. The present review aimed to investigate preflight medical screening of patients with medical conditions and their risks associated with air travel.

Rubefacients containing salicylates cause irritation of the skin and are believed to relieve various musculoskeletal pains. They are available on prescription, and are common components in over-the-counter remedies. This is an update of a review of rubefacients for acute and chronic pain, originally published in 2009, which found limited evidence for efficacy. To assess the efficacy and safety of topically applied salicylates in acute and chronic musculoskeletal pain in adults. We searched CENTRAL, MEDLINE, and EMBASE, from inception to 22 August 2014, together with the Oxford Pain Relief Database, two clinical trial registries, and the reference lists of included studies and relevant reviews. Randomised, double-blind, placebo- or active-controlled clinical trials of topical rubefacients containing salicylates to treat musculoskeletal pain in adults, with at least 10 participants per treatment arm, and reporting outcomes at close to 7 (minimum 3, maximum 10) days for acute conditions and 14 (minimum 7) days or longer for chronic conditions. Two review authors independently assessed trials for inclusion and risk of bias, and extracted data. We calculated risk ratio (RR) and number needed to treat to benefit or harm (NNT or NNH) with 95% confidence intervals (CI) using a fixed-effect model. We analysed acute and chronic conditions separately. New searches for this update identified one new study that satisfied our inclusion criteria, although it contributed information only for withdrawals. Six placebo- and one active-controlled studies (560 and 137 participants, respectively) in acute pain, and seven placebo- and three active-controlled studies (489 and 182 participants, respectively) in chronic pain were included in the review. All studies were potentially at risk of bias, and there were substantial differences between studies in terms of the participants (for example the level of baseline pain), the treatments (different salicylates combined with various other potentially active ingredients), and the methods (for example the outcomes reported). Not all of the studies contributed usable information for all of the outcomes sought.For the primary outcome of clinical success at seven days in acute conditions (mostly sprains, strains, and acute low back pain), the RR was 1.9 (95% CI 1.5 to 2.5) and the NNT was 3.2 (2.4 to 4.9) for salicylates compared with placebo, but this result was not robust (very low quality evidence). Using a random-effects model for analysis the RR was 2.7 (1.05 to 7.0). For the same outcome in chronic conditions (mostly osteoarthritis, bursitis, and chronic back pain), the RR was 1.6 (1.2 to 2.0) and the NNT was 6.2 (4.0 to 13) (very low quality evidence). This result was not substantially changed using a random-effects model for analysis. In both categories there were a number of factors might have influenced the results but sensitivity analysis was limited because of the small number of studies and participants.For both acute and chronic painful conditions any evidence of efficacy came from the older, smaller studies, while the larger, more recent studies showed no effect.Adverse events were more common with salicylate than with placebo but most of the events occurred in only two studies. There was no difference when these studies were removed from the analysis (very low quality evidence). Local adverse events (at the application site) were again more common with salicylate but were nearly all in one study (in which salicylate was combined with another irritant). There was no difference when this study was removed (very low quality evidence).There were insufficient data to draw conclusions against active controls. The evidence does not support the use of topical rubefacients containing salicylates for acute injuries or chronic conditions. They seem to be relatively well tolerated in the short-term, based on limited data. The amount and quality of the available data mean that uncertainty remains about the effects of salicylate-containing rubefacients.

The diagnosis and treatment of parasitic diseases has undergone major changes because of increased awareness and technological advances that now allow for more rapid and accurate diagnosis of parasitic diseases. These advances are critically important for the continuing diagnosis of these infections as there has been a steady decline in the quantity and quality of laboratory technicians who are expert in the classical techniques of examining stool and blood smears for parasites. The majority of laboratories have an increased reliance on nonclassical parasitological techniques for the accurate diagnosis of these infections. Dr. Ndao from McGill University has given an overview of many of these newer diagnostic methods. Malaria is a major pathogen in most of the world, and Drs Murray and Bennett from the US Army provide a timely review of the current status of rapid diagnosis of malaria using nontraditional methods. These rapid techniques have been a great advance since, in many laboratories; there are now few individuals that are expert in examining smears. In addition, these rapid techniques can be used by field workers and military personnel. These new methods make the diagnosis more rapid and accurate leading to a more rapid institution of appropriate treatment. Amebiasis continues to be an important cause of morbidity and mortality worldwide. Drs. Singh, Haupt, and Petri, in their review provide an update on the rapid diagnosis of Entamoeba histolytica. Diseases caused by Microsporidia are found in both immune-competent and immune-compromised hosts such as those with HIV/AIDS. The diagnosis is often difficult to make. In their article, Drs. Ghosh and Weiss review the state of molecular diagnostics for microsporidian infections. Human infections caused by free-living amoebas have not received sufficient attention in literature despite the fact that they may cause disabilities and death. Dr. Marciano-Cabral's group has reviewed the current state of the diagnosis of these important organisms. The review by Vannier and Krause provides an excellent update on the status of the diagnosis and treatment of babesiosis. Importantly, this infection still poses a threat not only from natural infection via the bite of a tick but also through blood transfusion. New diagnostic techniques have been developed for metazoan as well as protozoan infections. Neurocysticercosis has received increasing attention as a cause of seizures worldwide. There has also been an awareness of this disease because of the immigration of individuals from endemic areas to non-endemic areas of the world. Drs. Coyle and Tanowitz provide a review of the diagnostic and therapeutic options for management of this infection. Another helmintic disease of humans with complex management issues is that caused by Echinococcus and this is reviewed by Siracusano and colleagues. The articles by Dr. Baccchi and Dr. de Souza deal with the chemotherapy of trypanosomiasis, both African and American. Drs. Hochman and Kim explore the recent data on the HIV-malaria interaction. Since both HIV and malaria coexist in sub-saharan Africa, this review is timely. Dr. Petersen examines canine leishmaniasis and it implications for human disease. This year 2009 marks the 100th anniversary of the discovery of Chagas disease. This disease caused by the parasite Trypanosoma cruzi continues to be an important cause of cardiomyopathic heart disease in endemic areas of Latin America and is being increasingly recognized in non-endemic areas such as North America and Europe. The article by Dr. Gupta et al. from the Garg group in the University of Texas has offered a unique insight into the role of oxidative stress in the pathogenesis of chagasic cardiomyopathy. Adipose tissue is the largest endocrine organ in the body and its role in infection has only recently been appreciated. The laboratory group at the Albert Einstein College of Medicine offers a review of the role of adipose tissue in the pathogenesis of Chagas diseases, providing a new perspective on this overlooked facet of pathogen host interaction. There has been little success in changing the chronic manifestations of Chagas Disease by using antiparasitic therapy. A new approach to this problem is discussed in the article by Dr. Campos de Carvalho et al. who provide data suggesting that stem cell therapy may be useful in the treatment of the cardiomyopathy caused by T. cruzi infection. We have obtained articles on a range of topics which highlight many of the new issues in the field of parasitological diagnosis and treatment. It is our belief that this collection of articles provides an important summary of these issues and will be of use to both clinicians and researchers working on parasitic diseases. Herbert B. Tanowitz Louis M. Weiss

Data on physical health and mortality in the US, centered near the 1980 Census year, are presented, focusing on sex differentials in mortality followed by sex differentials in health. The discussion covers possible explanations for these sex differentials and the apparent contradiction of why there is excess female morbidity but excess male mortality. In 1980, the estimated life expectancy at birth was 70.0 years for men and 77.5 years for women. Age-adjusted death rates in the US were 777 deaths/100,000 for men and 433 deaths/100,000 for women, yielding a sex ratio of 1.79. Thus, in 1980, men had nearly an 80% higher age-adjusted death rate than women. Further, for every 100,000 people, 200 more men than women died. The age-adjusted figure was 345. In the US in 1980 the age-adjusted mortality rate for each of the 12 leading causes of death was higher for men than women. The sex mortality ratios demonstrate that relative to women, men had higher mortality rates particularly between the ages of 15-34. The sex ratio of life expectation increases with age. A women over age 60 in 1980 could expect to live nearly 30% longer than a man her age. Accidents are the main contributor to the sex differential at young ages; heart disease is the primary contributor at older ages. Regardless of how health interviews word the questions, women consistently report worse health status than men. In interview data, females tend to have more acute conditions per year than males -- about 17% more in 1980, and with a similar excess in other years. The female excess appears for infective and parasitic diseases, respiratory conditions, digestive system conditions, and "all other acute conditions." The last group includes problems due to pregnancy and childbirth, yet, even when these are removed, female rates for "all other acute conditions" exceed male rates. Only for injuries do males have higher rates than females. The available data suggest that women have greater morbidity than men. After early childhood, females have both higher rates of acute conditions and more restricted activity per condition. Females are more likely to have a chronic condition, to have more doctor and dentist visits, and to use more drugs. These relationships remain even after pregnancy-related events are removed. Yet, men have higher prevalence for many "killer" chronic conditions, higher prevalence rates of heart disease at younger ages, and higher injury rates at all ages. Sex differences in 4 areas provide possible explanations as to why women tend to have poorer health but men tend to have shorter lives: inherited risks; acquired risks; illness and prevention orientations; and health and death reporting behavior.

Rubefacients (containing salicylates or nicotinamides) cause irritation of the skin, and are believed to relieve various musculoskeletal pains. They are available on prescription, and are common components in over-the-counter remedies. A non-Cochrane review in 2004 found limited evidence for efficacy. To review current evidence for efficacy and safety of topically applied rubefacients in acute and chronic painful musculoskeletal conditions in adults. Cochrane CENTRAL, MEDLINE, EMBASE, the Oxford Pain Relief Database, and reference lists of articles were searched; last search December 2008. Randomised, double blind, placebo or active controlled clinical trials of topical rubefacient for musculoskeletal pain in adults, with at least 10 participants per treatment arm, and reporting outcomes at close to 7 (minimum 3, maximum 10) days for acute conditions and 14 (minimum 7) days or longer for chronic conditions. Two review authors independently assessed trials for inclusion and quality, and extracted data. Relative benefit or risk and number needed to treat to benefit or harm (NNT or NNH) were calculated with 95% confidence intervals (CI). Acute and chronic conditions were analysed separately. Six placebo and one active controlled studies (560 and 137 participants) in acute pain, and seven placebo and two active controlled studies (489 and 90 participants) in chronic pain were included. All used topical salicylates. The evidence in acute conditions was not robust; using only better quality, valid studies, there was no difference between topical rubefacient and topical control, though overall, including lower quality studies, the NNT for clinical success compared with placebo was 3.2 (95% CI: 2.4 to 4.9). In chronic conditions the NNT was 6.2 (95% CI: 4.0 to 13) compared with topical placebo. Adverse events and withdrawals occurred more often with rubefacients than placebo, but analyses were sensitive to inclusion of individual studies, so not robust. There were insufficient data to draw conclusions against active controls. The evidence does not support the use of topical rubefacients containing salicylates for acute injuries, and suggests that in chronic conditions their efficacy compares poorly with topical non-steroidal antiinflammatory drugs (NSAIDs). Topical salicylates seem to be relatively well tolerated in the short-term, based on limited data. There is no evidence at all for topical rubefacients with other components.

Timing and Causes of Common Pediatric Readmissions

(i) To estimate the numbers of deaths and person-years of life lost (PYLL) due to high-risk alcohol consumption in Australia during 1997, using current estimates of consumption. (ii) To compare the number of deaths and PYLL due to acute conditions associated with bouts of intoxication and chronic conditions associated with long-term misuse of alcohol. All Australian deaths during 1997 related to conditions considered to be partially or wholly caused by high-risk alcohol consumption were extracted from the Australian Bureau of Statistics Mortality Datafile and adjusted by alcohol aetiologic fractions calculated for Australia in 1997. A life-table method was used to estimate the PYLL for deaths from alcohol-caused conditions. Numbers of all deaths and PYLL due to chronic and acute alcohol-related conditions. Of the 3290 estimated alcohol-caused deaths in 1997, chronic conditions (eg, alcoholic liver cirrhosis and alcohol dependence) accounted for 42%, acute conditions (eg, alcohol-related road injuries and assaults) for 28% and mixed (chronic and acute) for 30%. Of the 62914 estimated potential life years lost, acute conditions were responsible for 46%, chronic for 33% and mixed for 21%. The average number of years of life lost through deaths from acute conditions was more than twice that from chronic conditions, because the former mostly involved younger people. In view of the societal burdens imposed by premature deaths, more effective public health strategies are needed to reduce the harm associated with occasional high-risk drinking (as well as sustained high-risk drinking), especially among young people.