Diagnosis of abdominal tuberculosis:Experience from 11 cases and review of the literature

AIM:To analyze the experience within our hospital and toreview the literature so as to establish the best means ofdiagnosis of abdominal tuberculosis.METHODS:The records of 11 patients (4 males,7 females,mean age 39 years,range 18-65 years) diagnosed withabdominal tuberculosis in Harran University Hospitalbetween January 1996 and October 2003 were analyzedretrospectively and the literature was reviewed.RESULTS:Ascites was present in all cases.Other commonfindings were weight loss (81%),weakness (81%),abdominalmass (72%),abdominal pain (72%),abdominal distension(63%),anorexia (45%) and night sweat (36%).The averagehemoglobin was 8.2 g/dL and the average FAR was 50 mm/h(range 30-125).Elevated levels of cancer antigen CA-125were determined in four patients.Abdominal ultrasoundshowed abnormalities in all cases:ascites in all,tuboovarianmass in five,omental thickening in 3,and enlarged lymphnodes (mesenteric,para-aortic) in 2.CT scans showed ascitesin all,pelvic mass in 5,retroperitoneal lymphadenopathyin 4,mesenteric stranding in 4,omental stranding in 3,bowel wall thickening in 2 and mesenteric lymphadenopathyin 2.Only one patient had a chest radiograph suggestive ofa new TB lesion.Two had a positive family history ofpulmonary TB.None had acid-fast bacilli (AFB) in the sputumand the tuberculin test was positive in only two.Laparotomywas performed in 6 cases,laparoscopy in 4 and ultrasound-guided fine needle aspiration in 2.In those patientssubjected to operation,the findings were multiple diffuseinvolvement of the visceral and parietal peritoneum,white‘miliary nodules’or plaques,enlarged lymph nodes,ascites,‘violin string’fibrinous strands,and omental thickening.Biopsy specimens showed granulomas,while ascitic fluidshowed numerous lymphocytes.Both were negative foracid-fast bacilli by staining.PCR of ascitic fluid was positivefor Mycobactenum tuberculosis ( M.tuberculosis) in all cases.CONCLUSION:Abdominal TB should be considered in allcases with ascites.Our experience suggests that PCR ofascitic fluid obtained by ultrasound-guided fine needleaspiration is a reliable method for its diagnosis and shouldat least be attempted before surgical intervention.     

Functional outcomes after transanal ileal pouch–anal anastomosis for ulcerative colitis: narrative review of the current literature

Techniques in Coloproctology - The transanal approach to ileal pouch–anal anastomosis (Ta-IPAA) for ulcerative colitis was introduced in 2015 and has since been shown to be a safe and...     

Identifying the Most Sensitive and Specific Sign and Symptom Combinations for Cholera: Results from an Analysis of Laboratory-Based Surveillance Data from Haiti, 2012–2013

Since October 2010, over 700,000 cholera cases have been reported in Haiti. We used data from laboratory-based surveillance for diarrhea in Haiti to evaluate the sensitivity, specificity, and positive (PPV) and negative predictive values (NPV) of the cholera case definitions recommended by the World Health Organization (WHO). From April 2012 to May 2013, we tested 1,878 samples from hospitalized patients with acute watery diarrhea; 1,178 (62.7%) yielded Vibrio cholerae O1. The sensitivity and specificity of the WHO case definition for cholera in an epidemic setting were 91.3% and 43.1%, respectively, and the PPV and NPV were 72.8% and 74.8%, respectively. The WHO case definition for cholera in an area where cholera is not known to be present had lower sensitivity (63.1%) and NPV (55.1%) but higher specificity (74.2%) and PPV (80.0%). When laboratory diagnostic testing is not immediately available, clinicians can evaluate signs and symptoms to more accurately identify cholera patients.     

Who pays for the drinking? Characteristics of the extent and distribution of social harms from others’ drinking

AIMS: To explore the extent and distribution of experienced negative consequences from other people's drinking and to explore what characterizes the victims of these harms. DESIGN, PARTICIPANTS AND MEASUREMENTS: Cross-sectional survey in a national sample of adults. Net sample comprised 2170 respondents. Negative consequences from others' drinking during the past 12 months were assessed by seven items. RESULTS: The more severe types of consequences (being physically hurt or property damage) were reported less often (by 3.1% and 4.8%, respectively) than the least severe type of consequence (being kept awake at night by drunk people, reported by 21.2%), thus leaving the four other types of consequences (being harassed in public places, being harassed in private parties, being scolded at and being afraid of drunk people in public areas) somewhere in between. The extent to which the respondents had been subject to social harm from others' drinking displayed a very skewed distribution. The majority reported not to have experienced any such harms, whereas a small proportion had been harmed repeatedly and in various ways. Multivariate analyses showed that social harms from others' drinking were most often reported by younger persons, women, those with high education level, those who reported a higher annual alcohol intake, more frequent episodes of intoxication and more frequent visits to public drinking places. The impact of intoxication frequency on victimization from alcohol-related social harms was stronger for women than for men. Similar individual characteristics were also associated with victimization from physical harm and victimization in the public sphere. CONCLUSIONS: Relatively minor harms from others' drinking are experienced quite frequently. The social victims of others' drinking tend to drink heavily themselves, yet in contrast to what characterizes social consequences of own drinking, we find that the burden of social harms from others' drinking is to a larger extent carried by women than by men.     

Diagnosis of abdominal tuberculosis： Experience from 11 cases and review of the literature

AIM: To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis.METHODS: The records of 11 patients (4 males, 7 females,mean age 39 years, range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed.RESULTS: Ascites was present in all cases. Other common findings were weight loss (81%), weakness (81%), abdominal mass (72%), abdominal pain (72%), abdominal distension (63%), anorexia (45%) and night sweat (36%). The average hemoglobin was 8.2 g/dL and the average ESR was 50 mm/h (range 30-125). Elevated levels of cancer antigen CA-125 were determined in four patients. Abdominal ultrasound showed abnormalities in all cases: ascites in all, tuboovarian mass in five, omental thickening in 3, and enlarged lymph nodes (mesenteric, para-aortic) in 2. CT scans showed ascites in all, pelvic mass in 5, retroperitoneal lymphadenopathy in 4, mesenteric stranding in 4, omental stranding in 3,bowel wall thickening in 2 and mesenteric lymphadenopathy in 2. Only one patient had a chest radiograph suggestive of a new TB lesion. Two had a positive family history of pulmonary TB. None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two. Laparotomy was performed in 6 cases, laparoscopy in 4 and ultrasoundguided fine needle aspiration in 2. In those patients subjected to operation, the findings were multiple diffuse involvement of the visceral and parietal peritoneum, white‘miliary nodules‘ or plaques, enlarged lymph nodes, ascites,‘violin string‘ fibrinous strands, and omental thickening.Biopsy specimens showed granulomas, while ascitic fluid showed numerous lymphocytes. Both were negative for acid-fast bacilli by staining. PCR of ascitic fluid was positive for Mycobacterium tuberculosis ( M. tuberculosis) in all cases.CONCLUSION: Abdominal TB should be considered in all cases with ascites. Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention.     

Should the initiation of antiarrhythmic therapy for atrial fibrillation occur in the hospital or out of the hospital?: a review of the literature

BACKGROUND: Initiation of antiarrhythmic therapy for atrial fibrillation is a key step in the treatment of this disorder. Much controversy remains as to the risks and benefits of initiating therapy as an inpatient versus an outpatient. OBJECTIVE: To explore the various issues of debate and to determine the importance and validity of these various issues when it comes to the evaluation of patients for in- versus out-of-hospital initiation of antiarrhythmic therapy for atrial fibrillation. METHODS: A MEDLINE search of English language journal articles since 1966 and a hand search of bibliographies included in pertinent retrieved articles was undertaken. Articles used included review articles, retrospective studies, and meta-analyses. RESULTS: The literature is full of articles for and against outpatient initiation of antiarrhythmic therapy. One side feels that the risks of antiarrhythmic therapy initiation are serious enough in all patients and easy enough to reverse or ameliorate if the patient is in the safety of the monitored hospital setting. The other side argues that these complications are infrequent enough except in certain commonly identifiable patients, that not all need hospitalization during antiarrhythmic initiation. The issues at the heart of the dispute include: the presence or absence of underlying heart disease; the period of monitoring after initiation of therapy; the choice of antiarrhythmic agent used; and even the seriousness and prevalence of the arrhythmia which can be induced. CONCLUSIONS: The issue of in versus out-of-hospital initiation of antiarrhythmic therapy for atrial fibrillation remains a widely disputed topic. Many factors come under consideration when this topic is studied. At present, we recommend that patients with significant structural heart disease, conduction disease, and/or QT prolongation be strongly considered for in-hospital initiation of antiarrhythmic medications. Further prospective studies are necessary to assess the magnitude of the difference of initiating antiarrhythmic therapy as an inpatient versus as an outpatient.