Intestinal pseudo-obstruction in patients with systemic lupus erythematosus: A real diagnostic challenge

Intestinal pseudo-obstruction secondary to systemic lupus erythematosus (SLE) is a rare syndrome described in recent decades. There are slightly over 30 published cases in the English language literature, primarily associated with renal and hematological disease activity. Its presentation and evolution are a diagnostic challenge for the clinician. We present four cases of intestinal pseudo-obstruction due to lupus in young Mexican females. One patient had a previous diagnosis of SLE and all presented with a urinary tract infection of varying degrees of severity during their evolution. We consider that recognition of the disease is of vital importance because it allows for establishing appropriate management, leading to a better prognosis and avoiding unnecessary surgery and complications.     

Ultrasound of the paediatric urogenital tract

Pathology in the urinary tract is one of the most frequent queries when children are referred for an ultrasound examination. Comprehensive ultrasound examinations can answer most clinical questions of the urogenital tract with minimal patient preparation and without the use of ionising radiation. Therefore, optimised imaging protocols should be available in all radiology departments where children are examined. This review suggests a preferred imaging protocol for urogenital imaging in children and gives an overview of the different structures of the urogenital tract, the normal age-related sonographic anatomy, and gives examples of the most commonly encountered diseases of the urogenital system in children.     

加味四妙勇安汤联合前列地尔注射液治疗下肢动脉闭塞90例临床研究

目的:观察加味四妙勇安汤联合前列地尔注射液治疗下肢动脉闭塞疗效。方法:将90例下肢动脉闭塞症患者随机分为治疗组和对照组,各45例。治疗组给予加味四妙勇安汤联合前列地尔注射液治疗,加味四妙勇安汤每日1剂,水煎服,连用3周;对照组给予前列地尔注射液治疗。其它情况处理,两组同样对待。前列地尔注射液2 m L+生理盐水10 m L缓慢静注,连续治疗两周为1个疗程,每20天1个疗程,共治疗4个疗程,其他治疗两组相同。观察两组患者治疗结束后临床疗效、血浆血脂及两组病人治疗前后症状变化。结果:治疗组患者总有效率为97.8%,高于对照组的88.9%,比较两组患者的总有效率,经检验后得出差异有统计学意义(χ2=4.94,P=0.026)。两组患者治疗结束后的总胆固醇、低密度脂蛋白均较治疗前有所降低,而高密度脂蛋白较治疗前则有所升高,与对照组相比差异具有统计学意义(P<0.05)。两组患者的ABI值也较治疗前有所升高,但治疗组ABI升高值明显大于对照组,差异具有统计学意义(P<0.03)。两组患者症状体征积分比较,差异具有统计学意义(P<0.001)。结论:加味四妙勇安汤联合前列地尔注射液治疗下肢动脉闭塞症临床疗效肯定,可能通过降低患者的血浆血脂而起作用。     

Treatment of Urinary Tract Infections and Antibiotic Stewardship

Urinary tract infections affect >30% of people around the world. Empirical treatments are currently used for several infections, but appropriate criteria for the rational use of antibiotics should be focused to prevent bacterial resistance phenomena and the increased risk of difficult to-treat infections. Relevant information concerning risk factors and different levels of severity as well as appropriate microbiological interpretation of pathogens have been included and discussed. Moreover, the optimal clinical approach to asymptomatic bacteriuria and recurrent infection episodes has been evaluated, with appropriate suggestions for antibiotic treatment. The prevalence of antibiotic resistance is worsening, probably because of the increasing number of multidrug-resistant bacterial strains and the indiscriminate use of broad-spectrum antibiotics and empirical treatments, inducing increased treatment costs and hospitalizations. Antibiotic stewardship should be introduced in clinical practice to avoid the risk of infection episodes in which the urologist cannot risk systemic inflammatory response syndrome or sepsis. For these reasons, adequate indications for the rational use of antibiotic treatment have been described and discussed, including when and how empirical treatments should be used in current clinical practice.Patient summaryThe prevalence of antibiotic resistance is worsening likely because of the increasing number of multidrug-resistant bacterial strains and the indiscriminate use of broad-spectrum antibiotics. Antibiotic stewardship should be introduced in clinical practice to avoid the risk of infection episodes in which the urologist cannot risk systemic inflammatory response syndrome or sepsis.     

Maternal self-efficacy,postpartum depression,and their relationship with functional status in Iranian mothers

ABSTRACT

Readiness to care for family, infant, and self are important during the postpartum period. The objective of this study was to determine the relationships of self-efficacy and postpartum depressive symptoms with functional status in randomly sampled Iranian mothers (n = 437). The study was cross-sectional and conducted in 2015. The mean (SD) of the total functional status score was 2.3 (0.2) out of a possible score of 1–4. The maximum and minimum scores in infant care were 4.0 and 2.2 and, in social and community activity, levels were 3.5 and 1.0, respectively. Significant inverse correlations were observed between postpartum depressive symptoms and total scores for functional status, self-care, and levels of social and community activity. A significant positive relationship was observed between self-efficacy and functional status and all of its subscales. In the multivariate linear regression model, postpartum depressive symptoms, nulliparity, and low income were significantly negatively related with functional status; maternal self-efficacy, having a spouse aged 26–35 years, high school diploma, lower educational level, and the spouse’s job (shopkeeper) were significantly positively correlated with functional status. Early diagnosis and treatment of depressive symptoms and promotion of maternal self-efficacy may improve overall functional status of mothers in the postpartum.     

Association between depressive symptoms,CD4 count and HIV viral suppression among HIV-HCV co-infected people

Depressive symptoms are associated with poor HIV viral control and immune recovery among people living with HIV. However, no prior studies assessed this association exclusively among people co-infected with HIV-hepatitis C virus (HCV). While people with HIV only and those with HIV-HCV co-infection share many characteristics, co-infected people may become more susceptible to the effects of depressive symptoms on health outcomes. We assessed this association exclusively among people co-infected with HIV-HCV in Canada using data from the Food Security &; HIV-HCV Sub-Study (FS Sub-Study) of the Canadian Co-Infection Cohort (CCC). Stabilized inverse probability weighted marginal structural model was used to account for potential time-varying confounders. A total of 725 participants were enrolled between 2012 and 2015. At baseline, 52% of participants reported depressive symptoms, 75% had undetectable HIV viral load, and median CD4 count was 466 (IQR 300–665). People experiencing depressive symptoms had 1.32 times (95% CI: 1.07, 1.63) the risk of having detectable HIV viral load, but had comparable CD4 count to people who did not experience depressive symptoms (fold change of CD4?=?0.96, 95% CI: 0.91, 1.03). Presence of depressive symptoms is a risk factor for incomplete short-term HIV viral suppression among people co-infected with HIV-HCV. Therefore, depressive symptoms screening and related counseling may improve HIV related health outcomes and reduce HIV transmission.     

An association between diet,metabolic syndrome and lower urinary tract symptoms

Diet is a key factor in the aetiology of many diseases, including metabolic syndrome and lower urinary tract disorders. Metabolic syndrome is a growing and increasingly expensive health problem in both the developed and the developing world, with an associated rise in morbidity and mortality. On the other hand, lower urinary tract symptoms affect millions of individuals worldwide, lowering their quality of life. Associations have been established between both conditions in existing literature and the various components of the metabolic syndrome have been linked with the onset and aggravation of symptoms in various forms of LUTS. This current review explores the relationships between these in detail, focusing on their inter-relationships particularly vis-a-vis dietary macronutrient and micronutrient intake.