Recurrent Episodes Of Infection Research Articles

The effect of adenoidectomy on occlusal development and nasal cavity volume in children with recurrent middle ear infection

ObjectivesThe aim of the study was to examine the effect of adenoidectomy on occlusal/dentoalveolar development and nasal cavity volume in children who underwent tympanostomy tube insertion with or without adenoidectomy due to recurrent episodes of middle ear infection. MethodsThis prospective controlled study consisted of two randomly allocated treatment groups of children, younger than 2 years, who had underwent more than 3–5 events of middle ear infection during the last 6 months or 4–6 events during the last year. At the mean age of 17 months tympanostomy tube placement without adenoidectomy (Group I, n=63) tympanostomy tube placement with adenoidectomy (Group II, n=74) was performed. At the age of 5 years 41 children of the original Group I (14 females, 27 males, mean age 5.2 yrs, SD 0.17) and 59 children of the original Group II (17 females, 42 males, mean age 5.2 yrs, SD 0.18) participated in the re-examination, which included clinical orthodontic examination defining morphological and functional craniofacial status and occlusal bite index to measure upper dental arch dimensions. Acoustic rhinometry and anterior rhinomanometry was made by otorhinolaryngologist at the same day. ResultsNo statistically significant differences were found between the groups in the frequencies of morphological or functional characteristics or upper dental arch measurements or in the minimal cross-sectional areas or inspiratory nasal airway resistance measurements. ConclusionCombining adenoidectomy with tympanostomy tube insertion in the treatment of recurrent middle ear infection at an early age (under the age of 2 years) does not seem to make any difference in occlusal development in primary dentition at the age of 5 years as compared to tympanostomy tube insertion only. Since adenoid size was not evaluated, the findings do not allow interpretation that hypertrophic adenoids should not be removed in children with continuous mouth breathing or sleep disordered breathing.

Open and Endoscopic Management of Fourth Branchial Pouch Sinus – Our Experience

Introduction Acute suppurative neck infections associated with third or fourth branchial arch fistulas are frequently recurrent. Third and fourth branchial arch anomalies are much less common and usually present with recurrent left thyroid lobe abscesses. Objectives The authors present their experience in treating such cases that were observed exclusively in children. Methods The study involved performing a retrospective review of five cases in PSG Institute of Medical Sciences & Research. All cases were evaluated radiologically and with Direct Rigid hypopharyngoscopy. Definitive surgery was performed, including hemithyroidectomy. Results The patients consisted of five children, two boys and three girls. All of them presented with recurrent episodes of neck infection. Investigations performed included computed tomography (CT) fistulography, rigid hypopharyngoscopy and ultrasound, which were useful in preoperatively delineating pyriform sinus fistulous tract. All patients underwent neck exploration with excision of the fistulous tract and hemithyroidectomy. Upon follow-up, all patients are asymptomatic. Conclusions Recurrent neck abscesses in a child should alert the clinician to the possibility of a fourth branchial arch anomaly; therefore, children with this condition require a complete evaluation so the anomaly can be ruled out.

Anatomy and Physiology of the Urinary Tract: Relation to Host Defense and Microbial Infection.

The urinary tract exits to a body surface area that is densely populated by a wide range of microbes. Yet, under most normal circumstances, it is typically considered sterile, i.e., devoid of microbes, a stark contrast to the gastrointestinal and upper respiratory tracts where many commensal and pathogenic microbes call home. Not surprisingly, infection of the urinary tract over a healthy person's lifetime is relatively infrequent, occurring once or twice or not at all for most people. For those who do experience an initial infection, the great majority (70% to 80%) thankfully do not go on to suffer from multiple episodes. This is a far cry from the upper respiratory tract infections, which can afflict an otherwise healthy individual countless times. The fact that urinary tract infections are hard to elicit in experimental animals except with inoculum 3-5 orders of magnitude greater than the colony counts that define an acute urinary infection in humans (105 cfu/ml), also speaks to the robustness of the urinary tract defense. How can the urinary tract be so effective in fending off harmful microbes despite its orifice in a close vicinity to that of the microbe-laden gastrointestinal tract? While a complete picture is still evolving, the general consensus is that the anatomical and physiological integrity of the urinary tract is of paramount importance in maintaining a healthy urinary tract. When this integrity is breached, however, the urinary tract can be at a heightened risk or even recurrent episodes of microbial infections. In fact, recurrent urinary tract infections are a significant cause of morbidity and time lost from work and a major challenge to manage clinically. Additionally, infections of the upper urinary tract often require hospitalization and prolonged antibiotic therapy. In this chapter, we provide an overview of the basic anatomy and physiology of the urinary tract with an emphasis on their specific roles in host defense. We also highlight the important structural and functional abnormalities that predispose the urinary tract to microbial infections.

Obstructive Uropathy Caused by Chronic Constipation

We herein report a case regarding a 90-year-old woman with a history of recurrent episodes of urinary tract infections presenting with fever. Urinalysis revealed bacteria and white blood cells. Computed tomography showed dilated and fecally loaded rectum and colon with signs of obstructive uropathy. The patient was treated for urinary tract infection and constipation. Her bowel habits were controlled with lubiprostone, and she was discharged in good medical condition. This case highlights the importance of considering fecal impaction as a cause of urinary tract obstruction or infection.

Primary Hyperoxaluria Diagnosed Based on Bone Marrow Biopsy in Pancytopenic Adult with End Stage Renal Disease.

Inborn errors of metabolism cause increase of metabolites in serum and their deposition in various organs including bone marrow. Primary hyperoxaluria (PH) is a rare inborn error in the pathway of glyoxylate metabolism which causes excessive oxalate production. The disease is characterized by widespread deposition of calcium oxalate (oxalosis) in multiple organs. Urinary tract including renal parenchyma is the initial site of deposition followed by extrarenal organs such as bone marrow. This case report introduces a 54-year-old woman with end stage renal disease presenting with debilitating fatigue and pancytopenia. The remarkable point in her past medical history was recurrent episodes of nephrolithiasis, urolithiasis, and urinary tract infection since the age of 5 years and resultant end stage renal disease in adulthood in the absence of appropriate medical evaluation and treatment. She had an unsuccessful renal transplantation with transplant failure. The patient underwent bone marrow biopsy for evaluation of pancytopenia. Microscopic study of bone marrow biopsy led to the diagnosis of primary hyperoxaluria.

B cell subtypes' kinetics over a 6 monthxs period in CVID patients submitted to influenza and H1N1 immunization

Background Common Variable Immunodeficiency (CVID) is characterized by hypogammaglobulinaemia and impaired specific antibody production, resulting in increased susceptibility to infections, mainly of the respiratory tract. In an attempt to minimize the recurrent episodes of infections, some studies have recommended immunization with inactivated pathogens or subunits, however, experience with vaccine administration in immunodeficient patients is limited.

Viral load, CMV-specific T-cell immune response and cytomegalovirus disease in solid organ transplant recipients at higher risk for cytomegalovirus infection during preemptive therapy.

Despite advances in prevention, cytomegalovirus (CMV) recurrence is an important challenge in high-risk organ recipients. The present study prospectively evaluates the impact of CMV-specific T-cell immune response and secondary prophylaxis on the risk of recurrence in a cohort of CMV high-risk organ recipients and whether it is possible to determine a safe standardized viral load value below which CMV disease is unlikely. Thirty-nine recipients were included. Thirty-six had primary infections, and 88.9% recurred. Rate and duration of recurrent CMV infection was similar in patients with and without secondary prophylaxis: 57.9% vs. 53.6%, P=0.770 and 16 vs. 15days, P=0.786, respectively. The only factor independently associated with no episodes of CMV recurrence was the acquisition of CMV-specific T-cell immune response (OR: 0.151, 95% CI: 0.028-0.815; P=0.028). Cytomegalovirus diseases (N=5) occurred in patients with CMV viral load above 1500IU/ml who did not follow the planned monitorization schedule. Our observations suggest that episodes of recurrent CMV infection are common after preemptive therapy despite secondary prophylaxis and that CMV-specific T-cell immune response is associated with a decreased risk of recurrent infections. Preemptive therapy may be safe in patients at high risk for CMV infection with strict close monitoring of the CMV viral load.

Single Nucleotide Polymorphisms of the tcdC Gene and Presence of the Binary Toxin Gene Predict Recurrent Episodes of Clostridium difficile Infection

To identify Clostridium difficile genotypes, which are associated with recurrent C difficile infection (RCDI). Reliable bacterial genetic factors predicting RCDI are currently lacking. Inpatients and outpatients 18 years or older treated at our institution for C difficile infection (CDI) of any severity were consecutively enrolled. CDI was defined as symptoms of colitis with a positive PCR stool test. Each bacterial isolate was studied for virulence factors: tcdC mutations, including single nucleotide polymorphisms (SNPs) via PCR, the presence of genes for toxins A, B and binary toxin using restriction fragment length polymorphism, and identification of ribotype by PCR. χ tests, t tests, and logistic and linear regression were used to determine which virulence factors predicted RCDI and the need for hospital admission, with corrections made for multiple statistical comparisons. Seventy-three patients (male: 52%; mean age: 66 ± 15 years) were studied. Binary toxin gene (P = 0.03) was associated with at least 1 episode of RCDI, as was the presence of SNPs C184T (P = 0.006) and A117T (P = 0.003). The presence of the binary toxin gene with either of these tcdC SNPs increased RCDI by 80% (P = 0.0002) but did not predict the need for hospital admission. None of the other virulence factors, including ribotype 027, were predictive of RCDI. The presence of the binary toxin gene and tcdC SNPs C184T and A117T strongly predict RCDI. The presence of both tcdC SNPs and the binary toxin gene significantly increased the risk of RCDI, which might warrant longer antibiotic courses to eradicate the infection.

MP8-01 CAN WE TREAT FEMALE RECURRENT URINARY TRACT INFECTION WITHOUT URINE CULTURE? COMPARATIVE ANALYSIS OF BACTERIOLOGY AND SUSCEPTIBILITY PROFILE

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder1 Apr 2014MP8-01 CAN WE TREAT FEMALE RECURRENT URINARY TRACT INFECTION WITHOUT URINE CULTURE? COMPARATIVE ANALYSIS OF BACTERIOLOGY AND SUSCEPTIBILITY PROFILE Marcelo Hisano, Homero Bruschini, Antonio Carlos Nicodemo, Marcos Lucon, Cristiano Mendes Gomes, Fabio Baracat, Jose Alaor de Figueiredo, and Miguel Srougi Marcelo HisanoMarcelo Hisano More articles by this author , Homero BruschiniHomero Bruschini More articles by this author , Antonio Carlos NicodemoAntonio Carlos Nicodemo More articles by this author , Marcos LuconMarcos Lucon More articles by this author , Cristiano Mendes GomesCristiano Mendes Gomes More articles by this author , Fabio BaracatFabio Baracat More articles by this author , Jose Alaor de FigueiredoJose Alaor de Figueiredo More articles by this author , and Miguel SrougiMiguel Srougi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.344AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES First uncomplicated cystitis episode (UTI) in women can be managed without urine culture. However, for recurrent uncomplicated urinary tract infection (rUTI) episodes, it is mandatory. In this study, we analyzed the bacteriology and the profile of antimicrobials susceptibility to determine if there are any reliable options to treat cystitis episode of patients with rUTI without urine culture. METHODS Between January/2007 and December/2012, we retrospectively reviewed data of 493 female patients with diagnosis of UTI and rUTI. Patients were divided in two groups: 1- patients with UTI; and 2- rUTI. Bacteriology of urine culture and susceptibility tests for nalidixic acid (NA), amoxicillin/clavulanate (AC), ampicillin (AMP), cefoxitin (CEF), ciprofloxacin(CIPR), gentamicin (GEN), levofloxacin (LEV), norfloxacin (NOR), nitrofurantoin (NITRO) and TMP-SMX were performed and compared between groups. Statistical analysis was performed with X2 or Fisher's exact test with significance of p<0.05. RESULTS Of all patients, 420 had sufficient data for analysis. Group 1 had 233 patients (55.5%), with a mean age of 39.5 years-old (y-o); group 2 had 187 patients (44.5%) and mean age of 48.6 y-o. Bacteriology of both groups was the same (table 1). Comparing groups 1 and 2, we identified a susceptibility decrease for the following antimicrobials: NA (87.7% x 65.9%); AMP (53% x 40.1%); CIPR (92.2% x 71.3%); LEV (93.1% x 72.7%); NOR (91% x 77.3%); and TMP-SMX (69% x 57.8%), all with p<0.05. No significant changes in susceptibility were found for: AC (96.0% x 90.8%); CEF (96.4% x 92.8%); GEN (96.5% x 93%); and NITRO (92% x 92.6%). Data were summarized in table 2. CONCLUSIONS Although the bacteriology was similar in groups, the antimicrobial susceptibility had differences. Actually, as nitrofurantoin and amoxicillin/clavulanate resistances were not affected by rUTI, they can be the practical choice to treat new episodes of cystitis in these patients, precluding urinary culture, since their susceptibilities rates are > 90%. Table 1. Bacteriology Group 1 Group 2 p Escherichia coli 76.4% 74.3% 0.63 Enterococcus faecalis 5.2% 8% 0.23 Staphylococcus saprophyticus 8.2% 5.9% 0.37 Proteus mirabilis 4.3% 4.3% 0.99 Klebsiella pneumoniae 3.4% 4.3% 0.65 Streptococcus agalactiae 3.5% 3.0% 0.81 Other species 6.4% 8.0% 0.53 Table 2. Antimicrobial Group 1 Group 1 Group 2 Group 2 p Susceptible(%) Resistant(%) Susceptible(%) Resistant(%) Nalidixic acid 87.7 12.3 65.9 34.1 < 0.001 Amoxicillin/clavulanate 96 4 90.8 9.2 0.07 Ampicillin 53 47 40.1 59.9 0.02 Cefoxitin 96.4 3.6 92.8 7.2 0.24 Ciprofloxacin 92.2 7.8 71.3 28.7 < 0.001 Gentamicin 96.5 3.5 93 7 0.13 Levofloxacin 93.1 6.9 72.7 27.3 < 0.001 Norfloxacin 91 9 77.3 22.7 0.03 Nitrofurantoin 92 8 92.6 7.4 0.86 TMP-SMX 69 31 57.8 42.2 0.04 © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e74-e75 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Marcelo Hisano More articles by this author Homero Bruschini More articles by this author Antonio Carlos Nicodemo More articles by this author Marcos Lucon More articles by this author Cristiano Mendes Gomes More articles by this author Fabio Baracat More articles by this author Jose Alaor de Figueiredo More articles by this author Miguel Srougi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Day-care centers: Sites of viral contact

RésuméLa répétition des épisodes infectieux chez les nourrissons placés précocement en collectivités est une évidence. Leur tropisme sur la sphère respiratoire et l’appareil digestif l’est également. Leur probable retentissement au long cours est difficile à évaluer par la rareté des études prospectives. Le risque infectieux est lié en partie au type de structure de garde, ce risque est important dans les premiers mois de fréquentation et conditionne les récidives ultérieures. Les liens de causalité entre infection virale et asthme sont complexes. Les infections virales augmentent le risque d’asthme mais le statut asthmatique augmente aussi le risque de réponses sévères à une infection virale. Alors que les infections acquises dans cet environnement sont majoritairement virales, leur répétition conduit à une utilisation excessive des antibiotiques d’où une pression de sélection microbienne et un retentissement sur le microbiome digestif voire respiratoire.

Complicated rectovaginal fistula secondary to Bartholin's cyst infection

Rectovaginal fistula formation secondary to Bartholin's cyst is a very rare complication, and to date only three cases were reported in the literature. We report a case of a 32-year-old woman who suffered recurrent episodes of Bartholin's cyst infection with subsequent abscess formation that resulted in rectovaginal fistula formation. We treated her initially with transperineal repair; however, the fistulous tract recurred a month later. A laparoscopic colostomy and transperineal repair using biological graft was then performed, with excellent results. The patient underwent reversal of colostomy after 2 months, and remained asymptomatic upon follow-up 12 months later.

Primary ciliary dyskinesia complicated with diffuse panbronchiolitis: a case report and literature review

BackgroundFifty percent of patients with primary ciliary dyskinesia (PCD) have situs inversus. Diffuse panbronchiolitis (DPB) might be one of the characteristic features of the lung in PCD.MethodsWe reported a case of PCD without situs inversus, yet complicated with DPB, and did literature review.ResultsA 34-year-old nonsmoking Chinese woman with 6-year primary infertility suffered from recurrent episodes of respiratory tract infections since childhood. Lung auscultation revealed end-inspiratory coarse crackles. Pulmonary function tests demonstrated mild obstructive ventilation functional impairment. Lung biopsy showed respiratory bronchiolitis. Nasal mucosa cilia showed the absence of both outer and inner dynein arms of the microtubules. Saccharin test was positive. Chest images showed bronchiectasis and bronchiolitis but no situs inversus. Paranasal sinus computed tomography (CT) showed maxillary sinusitis and ethmoid sinusitis. A culture of bronchoalveolar lavage fluid was positive for Pseudomonas aeruginosa. Her conditions improved in clinical symptoms and CT images after 2 months of treatment with azithromycin. Literature review revealed that very rare patients were diagnosed as PCD complicated with diffuse DPB, and all of them had situs inversus.ConclusionsThe association of DPB might be one of the characteristic features of the lung in PCD. Further studies on the concurrence of these two diseases are suggested so as to elucidate the mechanism of both.Please cite this paper as: Chen W, Shao C, Song Y and Bai C. Primary ciliary dyskinesia complicated with diffuse panbronchiolitis: a case report and literature review. Clin Respir J 2014; 8: 425–430.

Symptomatic calyceal diverticulum: A case report

Calyceal diverticula are rare and unusual lesions in children. We report a case of symptomatic lesion in a 13-year-old male child presenting with pain and recurrent episodes of infection.

A rare case of ataxia telangiectasia with intracranial tumor

Ataxia telangiectasia is a rare autosomal recessive multisystem disorder results in neurodegeneration, variable immunological abnormality that leads to recurrent sinopulmonary infection, febrile episodes, progressive cerebellar ataxia, ocular, and cutaneous telangiectasias. We report a case of 3-year-old Indian boy with recurrent episodes of fever and sinopulmonary infection and repeated hospitalization, rapidly progressive neurological symptoms. On clinical examination no ophthalmological or dermatological lesion was detected. On laboratory and immunological investigation polymorphonuclear leukocytosis with mild normocytic hypochromic anemia, IgA level of 39 mg/dl, alphafetoprotein level of 35 IU/L and normal interictal EEG was noted. Nerve conduction studies (NCS) was suggestive of wide spread early demyelinating polyradiculopathy. MRI shows a suprasellar tumor. The patient was diagnosed to be Ataxia telangiectasia (AT) according to diagnostic criteria of Ataxia-Telangiectasia Clinical Center. Patient was treated with pulse methyl prednisolone and IVIG. Further CD4/CD8 count, IgG subfraction estimation, leucocyte phagocytic activity and mutation analysis of ATM gene should be done to confirm the diagnosis.

Familial pyoderma gangrenosum in association with common variable immunodeficiency

Funding sources: none. Conflicts of interest: none declared. Dear Editor, Pyoderma gangrenosum (PG) is a rare skin disease characterized by noninfective, painful, necrotizing ulcerations. PG is extremely rare in the paediatric population; 4% of patients are infants and children.1 The occurrence of PG in a familial pattern is extremely rare. As far as we could ascertain, only three reports of familial predisposition in PG have been published previously in the English literature.2 3 4 The aetiopathogenesis of PG is still unclear. Its association with a variety of immunological disorders suggests an underlying defective immune system.5 6 However, to date, no cases of PG have been described in the context of common variable immunodeficiency (CVID). We report familial PG in two siblings with CVID, which we believe to be the first documentation of this kind. Patient 1, a 9‐year‐old boy born to nonconsanguineous parents, presented with painful ulcers that had appeared 2 months before. He had a history of recurrent episodes of lower respiratory tract infection since the age of 3 years leading to bronchiectasis. On clinical examination, the child was febrile, underweight and had multiple ulcers with undermined, violaceous margins and indurated bases on his neck, scalp, upper and lower extremities, groin and buttocks. The oral mucosa was particularly affected, presenting pustular exophytic lesions with an erythematous halo and friable membrane that easily disintegrated leading to exulcerated and vegetating lesions of the labial mucosa (Fig. 1). The rest of the clinical examination was unremarkable. Laboratory investigations revealed an elevated level of inflammatory markers. Cultures for bacteria and fungi from skin lesions and blood were repeatedly negative. A skin biopsy specimen revealed an ulcerated epidermis with a massive neutrophilic infiltrate in the upper and lower dermis. Based on the clinical and histological features, the diagnosis of PG was made and the patient was treated with oral prednisone 1 mg kg−1 daily, which induced a great improvement in his lesions and complete resolution in 4 weeks. The steroids were slowly tapered with no recurrence 1 year after the diagnosis. CVID was diagnosed when screening investigations revealed low IgG and IgM levels (IgG 5 g L−1, normal range 6·13–15·12; IgM 0·4 g L−1, normal range 0·7–2·84), absent response to polysaccharide and protein antigens, a reverse CD4:CD8 ratio, with normal complement levels and nitroblue tetrazolium test functional assays. The percentage of total B cells was within the lower normal range (5% of circulating lymphocytes) but with a reduced number of memory B cells identified by the surface marker CD27 (2% of B cells, normal range 6·5–29·2%).

Short-term outcome following concurrent surgical treatment of ureteral ectopia and intrapelvic urinary bladder in nine neutered bitches

Congenital ureteral ectopia is an abnormality in which one or both ureters terminate at a position other than the urinary bladder trigone. This condition is the most frequent reason for...

Complex Genitourinary Duplication Affecting Neurourologic and Urodynamic Findings: Report of a Case and Review of the Literature

BackgroundComplete duplication of the bladder and urethra is a rare congenital anomaly and usually occurs in association with other organ anomalies. We report a case of complete bladder duplication associated with multiple non-genitourinary anomalies. CaseA 10-year-old girl presented with urinary incontinence and recurrent episodes of febrile urinary tract infections. Simultaneous right and left bladder urodynamic study was performed and revealed bilateral decreased bladder compliance associated with hyperreflexia. The patient underwent reconstructive surgery with combination of the 2 bladders and closure of the right incompetent bladder neck. Summary and conclusionManagement of bladder duplication is directed towards creating an unobstructed urinary tract, preventing infections, and achieving urinary continence. Neurourologic and urodynamic assessment is of utmost importance especially when concomitant spinal anomaly exists. Furthermore, these patients should be observed lifelong as alteration in bladder function may occur.

Clinical and Microbiological Characteristics of Perianal Infections in Adult Patients with Acute Leukemia

BackgroundPerianal infection is a common problem for patients with acute leukemia. However, neutropenia and bleeding tendency are relatively contraindicated to surgical intervention. The epidemiology, microbiology, clinical manifestations and outcomes of perianal infection in leukemic patients are also rarely discussed.MethodThe medical records of 1102 adult patients with acute leukemia at a tertiary medical center in Taiwan between 2001 and 2010 were retrospectively reviewed and analyzed.ResultThe prevalence of perianal infection was 6.7% (74 of 1102) in adult patients with acute leukemia. Twenty-three (31%) of the 74 patients had recurrent episodes of perianal infections. Patients with acute myeloid leukemia had higher recurrent rates than acute lymphoblastic leukemia patients (p = 0.028). More than half (n = 61, 53%) of the perianal infections were caused by gram-negative bacilli, followed by gram-positive cocci (n = 36, 31%), anaerobes (n = 18, 15%) and Candida (n = 1, 1%) from pus culture. Eighteen patients experienced bacteremia (n = 24) or candidemia (n = 1). Overall 41 (68%) of 60 patients had polymicrobial infection. Escherichia coli (25%) was the most common micro-organism isolated, followed by Enterococcus species (22%), Klebsiella pneumoniae (13%), and Bacteroides species (11%). Twenty-five (34%) of 74 patients received surgical intervention. Acute leukemia patients with surgically managed anal fistulas tended to have fewer recurrences (p = 0.067). Four (5%) patients died within 30 days after diagnosis of perianal infection. Univariate analysis of 30-day survival revealed the elderly (≧ 65 years) (p = 0.015) and patients with shock (p<0.001) had worse outcome. Multivariate analysis showed septic shock to be the independent predictive factor of 30-day crude mortality of perianal infections (p = 0.016).ConclusionPerianal infections were common and had high recurrence rate in adult patients with acute leukemia. Empirical broad-spectrum antibiotics with anaerobic coverage should be considered. Shock independently predicted 30-day crude mortality. Surgical intervention for perianal infection remains challenging in patients with acute leukemia.

Medicine's Metaphysics

AbstractThe scenario could not have been more grim. Mrs. Carr had been fitted with a breathing tube for surgery, but the doctors were unable to wean her from the ventilator due to recurrent episodes of life‐threatening infection. She could not eat because of the ventilator, so she received nutrition through a tube in her stomach. At some point, her kidneys shut down and she started dialysis treatments. Between recurrent infection and dialysis, her blood pressure bottomed out, and the medical team frequently jump‐started her heart with intravenous adrenaline‐type medications. Without aggressive support of her lungs, kidneys, nutrition, and cardiovascular system, Mrs. Carr would be dead. “What is going on here?” Anna wondered aloud. “Is this life?”Philosopher and physician Jeffrey Bishop might argue that this is not life. Rather, medicine has created a body in perpetual motion. Contemporary medicine, he contends, has redefined human life as human function; doctors simply replace the broken or dead parts of the human machine with other machines—a ventilator for the lungs, dialysis for the kidneys, and so forth—and the body stays in motion indefinitely. Bishop argues that the discipline of medicine needs to reexamine its metaphysical assumptions—its current approach is detrimental to human flourishing. Should a metaphysics of efficient causation be replaced with a more expansive metaphysics of final causes?

RANDOMIZED CONTROLLED TRIAL ON THE EFFECT OF VRISHA GHRITA IN CHILDHOOD ASTHMA MANAGEMENT

An interventional randomized controlled trial was conducted to evaluate the efficacy of Vrisha Ghrita on Tamaka Swasa (with special reference to bronchial Asthma) with plain Ghrita as control in children aged up to 12 years. Vrisha Ghrita was giv en internally in a divided dos e of 5 - 15ml twice daily along with honey according to the age for a period of 3 months during attack free int ervals. The idea behind trial was to improve the immunological compliance of the child and to conquer recurrent asthma. A total number of 26 children attending OPD (Out patient department) section of the hospital participated in the study. Analysis of the data was done using clinical parameters, routine hematolog y wi th AEC (Absolute Eosinophil Count) , selected immunoglobulin assay, lung function tests, measures of morbidity and asthma and quality of life questionnaire. The assessment reported that effects of Vrisha Ghrita were significant in combating the clinical man ifestations of Tamaka Swasa ( p <0.01), reducing morbidity episodes, school absenteeism, number of unsc heduled visits to doctors (all p <0.01). All these point suggests that the trial drug is highly effective in controlling recurrent episodes of asthma and re spiratory tract infections. However, the results were statistically not significant with respect to h a ematology, immunoglobulin assay and pulmonary function tests. Risks of side effects were minimal in both the groups. The stud y was effective in curtailing the conventionally used bronchodilators and antibiotic therapies in children. Keyw ords: Efficacy Trial, Asthma, Tamaka Swasa , Vrisha Ghrita , Ayurvedic medicine.