Jejunojejunal intussusception caused by an inflammatory fibroid polyp. Case report and review of the literature

Inflammatory fibroid polyps (IFPs) are rare benign submucosal growth of the gastrointestinal tract. The exact pathogenesis is still not well known. Clinical symptoms are variable. Physical exam and laboratory tests are helpful in establishing the diagnosis ; however, microscopic examination of the resected lesions is required to confirm the diagnosis of IFPs. Surgical resection of the lesion remains the primary therapy. Jejunojejunal intussusception secondary to IFPs in particular has only rarely been reported. We have reviewed all documented cases and added a new one to the literature. In this paper, we examine pertinent pathologic, epidemiologic, clinical, diagnostic, and therapeutic characteristics of this clinical entity.     

Evaluation of food security and anti-hunger public policies in Brazil, 1995-2002: 4--National School Nutrition Program

This study evaluated the Brazilian National School Nutrition Program from a structure-process-results perspective. The methodology involved document research and a case study in 45 counties and 73 schools in the State of Bahia, including program manager interviews and household questionnaires involving 3,367 children (7-14 years of age). Relating to program structure, the study analyzed the evolution of normative instruments and some infrastructure aspects. Managers reported problems with the installations for preparing and distributing meals in 28% of the counties. Decentralization to the county (municipal) level was present in 93% of cases and to the school level in about 20%; however, nearly 70% of the schools received the food supplies directly. Although Social Control Councils were created, members were not always chosen democratically. Acceptability of the meals was good, as expected considering the widespread poverty in the target population. Overall program coverage was high (95%), but 77% of schoolchildren in the interior and 39% in the capital city did not receive meals every day. So far, irregular school meal distribution has frustrated the program's aspirations to become a universal social policy and ensure a basic right for children.     

Topical Metronidazole can Reduce Pain after Surgery and Pain on Defecation in Postoperative Hemorrhoidectomy

Background Topical metronidazole (10 percent) has been previously demonstrated to decrease postoperative pain after hemorrhoidectomy. The aim of this study was to evaluate the effect of topical metronidazole (10 percent) in reducing postoperative and after-defecation pain of hemorrhoidectomy. Materials and Methods A double-blind, randomized trial was conducted to compare posthemorrhoidectomy pain with use of topical metronidazole (10 percent) vs. placebo carrier, applied to surgical site. Forty-seven patients were randomly allocated to receive metronidazole (n = 25) or placebo (n = 22). Pain was assessed using a visual analog scale preoperatively and on postoperative hours 6 and 12 and at days 1, 2, 7, and 14. The use of narcotic, additional analgesics, and complications were recorded. (Pain scores were calculated and compared with baseline values and control group (t test, SPSS ver.10). Results Patients in the topical metronidazole group had significantly less postoperative pain than those in the placebo group up to day 14 (P ≤ 0.04). There was no significant difference in narcotic analgesic requirements between groups, except on hour 12 (P < 0.05). In the metronidazole group, after-defecation pain was ranked significantly lower at day 2 (P = 0.016) and patients required fewer additional analgesics postoperatively on days 2 and 7 (P ≤ 0.04). Conclusion These finding indicate that topical 10 percent metronidazole significantly reduce posthemorrhoidectomy discomfort, and postoperative defecation pain is reduced compared with that of the placebo control group. Support: A grant of vice-chancellor for research of Mazandaran University of Medical Sciences     

Split-dose menthol-enhanced PEG vs PEG-ascorbic acid for colonoscopy preparation

AIM:To compare the efficacy and palatability of 4L polyethylene glycol electrolyte(PEG)plus sugar-free menthol candy(PEG+M)vs reduced-volume 2 L ascorbic acid-supplemented PEG(Asc PEG).METHODS:In a randomized controlled trial setting,ambulatory patients scheduled for elective colonoscopy were prospectively enrolled.Patients were randomized to receive either PEG+M or Asc PEG,both splitdosed with minimal dietary restriction.Palatability was assessed on a linear scale of 1 to 5(1=disgusting;5=tasty).Quality of preparation was scored by assignment-blinded endoscopists using the modified Aronchick and Ottawa scales.The main outcomes were the palatability and efficacy of the preparation.Secondary outcomes included patient willingness to retake the same preparation again in the future and completion of the prescribed preparation.RESULTS:Overall,200 patients were enrolled(100patients per arm).PEG+M was more palatable than Asc PEG(76%vs 62%,P=0.03).Completing the preparation was not different between study groups(91%PEG+M vs 86%Asc PEG,P=0.38)but more patients were willing to retake PEG+M(54%vs 40%respectively,P=0.047).There was no significant difference between PEG+M vs Asc PEG in adequate cleansing on both the modified Aronchick(82%vs77%,P=0.31)and the Ottawa scale(85%vs 74%,P=0.054).However,PEG+M was superior in the left colon on the Ottawa subsegmental score(score0-2:94%for PEG+M vs 81%for Asc PEG,P=0.005)and received significantly more excellent ratings than Asc PEG on the modified Aronchick scale(61%vs 43%,P=0.009).Both preparations performed less well in afternoon vs morning examinations(inadequate:29%vs 15.2%,P=0.02).CONCLUSION:4 L PEG plus menthol has better palatability and acceptability than 2 L ascorbic acidPEG and is associated with a higher rate of excellentpreparations;Clinicaltrial.gov identifier:NCT01788709.     

Efficacy and safety of lacosamide as an adjunctive therapy for refractory focal epilepsy in paediatric patients: a retrospective single‐centre study

Aim. Lacosamide is an antiepileptic drug approved for the treatment of focal epilepsy in adult patients. The aim of this observational study was to review our centre's experience with lacosamide and to characterize its effectiveness and tolerability as an adjunctive antiepileptic drug in a retrospective cohort of children with refractory focal epilepsy. Methods. We retrospectively reviewed the medical records of 22 patients who received lacosamide from November 2009 to April 2014 at the CHU Ste‐Justine, University of Montreal. Treatment responders were defined as children with a ≥50% reduction in seizure frequency compared to baseline, and this was determined three months after the initiation of treatment and at the last follow‐up visit. Results. We included 14 boys and eight girls with a mean age of 12.9 years (SD: 5.2; range: 5.2–20.7 years) at the initiation of treatment. The average length of follow‐up was 11.9 months. Patients had previously received an average of 7.5 antiepileptic drugs. The mean number of concomitant antiepileptic drugs was 2.3. The mean initial and maintenance doses were 2.9 and 8.4 mg/kg/d, respectively. Thirteen (59%) and ten (45%) patients were responders after three months of treatment and at the last follow‐up visit, respectively. One became seizure‐free. Adverse effects were reported in 11 patients and none were severe. Responders and non‐responders were identical with respect to all studied parameters except gender, with the proportion of responders being greater in girls than in boys (75% vs 29%; p=0.035). Conclusion. Our study adds evidence that lacosamide appears to be a safe and effective adjunctive therapy for children with refractory focal epilepsy.     

Benign recurrent intrahepatic cholestasis with secondary renal impairment treated with extracorporeal albumin dialysis

Benign recurrent intrahepatic cholestasis (BRIC) is a rare autosomal recessive condition characterized by intermittent episodes of pruritis and jaundice that may last days to months. Treatment is often ineffective and symptoms, particularly pruritis, can be severe. Extracorporeal albumin dialysis (molecular adsorbent recycling system, MARS) is a novel treatment which removes albumin bound toxins including bilirubin and bile salts. We describe a case of a 34-year-old man with BRIC and secondary renal impairment who, having failed standard medical therapy, was treated with MARS. The treatment immediately improved his symptoms, renal and liver function tests and appeared to terminate the episode of cholestasis. We conclude that MARS is a safe and effective treatment for BRIC with associated renal impairment.     

Effect of grinding and polishing on roughness and strength of zirconia

Statement of problem

The clinical applications of high-translucency monolithic zirconia restorations have increased. Chairside and laboratory adjustments of these restorations are inevitable, which may lead to increased roughness and reduced strength. The influence of grinding and polishing on high-translucency zirconia has not been investigated.

Implementation research evidence uptake and use for policy-making

A major obstacle to the progress of the Millennium Development Goals has been the inability of health systems in many low- and middle-income countries to effectively implement evidence-informed interventions. This article discusses the relationships between implementation research and knowledge translation and identifies the role of implementation research in the design and execution of evidence-informed policy. After a discussion of the benefits and synergies needed to translate implementation research into action, the article discusses how implementation research can be used along the entire continuum of the use of evidence to inform policy. It provides specific examples of the use of implementation research in national level programmes by looking at the scale up of zinc for the treatment of childhood diarrhoea in Bangladesh and the scaling up of malaria treatment in Burkina Faso. A number of tested strategies to support the transfer of implementation research results into policy-making are provided to help meet the standards that are increasingly expected from evidence-informed policy-making practices.