回顾性分析颅内肿瘤患者术后感染危险因素

目的:了解神经外科颅内肿瘤切除患者术后相关感染（HAI）的发生情况及其危险因素,为制定干预措施提供理论依据。方法:收集 2017 年1月至2018年12月1 049例颅脑手术患者的临床资料,根据术后是否发生颅内感染将患者分为感染组 91例和非感染组958例。对两组患者进行临床资料的单因素和多因素logistic回归分析。结果:颅内肿瘤患者术后医院感染率为8.67%。两组在年龄、性别、职业、文化程度、民族、药物过敏、切口等级等方面比较差异无统计学意义（P＞0.05）,麻醉方式、手术等级、转科情况、住院天数和住院费用两方面比较差异有统计学意义（P＜0.05）;经过logistic多因素回归分析显示麻醉方式、住院天数是颅内肿瘤手术患者术后医院感染的独立危险因素,其OR及95％CI分别为5.173（2.738～9.774）、1.132（1.079～1.189）。结论:颅脑手术患者中HAI发生率较高,应根据危险因素采取有效预防和控制措施,以降低HAI的发生率。     

Direct observation of physician counseling on dietary habits and exercise: patient, physician, and office correlates

BACKGROUND: This study documented the frequency and correlates of directly observed physicians' counseling on dietary habits and exercise in private medical practices. METHODS: Trained medical students observed physician, office, and patient characteristics in 4344 patient visits in 38 nonmetropolitan primary care physician offices. RESULTS: Counseling rates ranged from 0% in some offices to 55% in others. Physicians counseled patients on dietary habits in 25% of visits and exercise in 20% of visits. Physicians counseled new patients 30% more often than established ones (P < 0.05). Dietary counseling was associated with having dietary and exercise brochures in the office (P < 0.05). When counseling occurred, physicians (rather than patients) initiated both dietary and exercise counseling 61% of the time. Counseling for dietary habits was associated with counseling for exercise (P < 0.05); some physicians may be more likely to give preventive counseling. Counseling was not associated with physicians' age, years in practice, or number of patients per week. CONCLUSION: Physician counseled patients in 20-25% of visits, and this was not affected by physician characteristics. Results suggest that physician counseling protocols and other office prompts should be developed and promoted. Strategies targeting both physician and the health care system may improve the consistency of physician preventive counseling practices.     

Surgical site infection rate and associated risk factors in elective general surgery at a public sector medical university in Pakistan

This prospective study aimed to determine the surgical site infection (SSI) rate and associated risk factors was carried in a general surgical ward at Liaquat University Hospital Jamshoro. A total of 460 patients requiring elective general surgery from July 2005 to June 2006 were included in this study. All four surgical wound categories were included. Primary closure was employed in all cases. Patients were followed up to 30th day postoperatively. All cases were evaluated for postoperative fever, redness, swelling of wound margins and collection of pus. Cultures were taken from all the cases with any of the above finding. Mean +/- SD age of the patients was 38.8 +/- 17.4 years with male to female ratio of 1.5:1. The overall rate of surgical site infection was 13.0%. The rate of wound infection was 5.3% in clean operations, 12.4% in clean-contaminated, 36.3% in contaminated and 40% in dirt-infected cases. Age, use of surgical drain, duration of operation and wound class were significant risk factors for increased surgical site infection (P < 0.05). Postoperative hospital stay was double in cases who had surgical site infection. Sex, haemoglobin level and diabetes were not statistically significant risk factors (P > 0.05). In conclusion, surgical site infection causes considerable morbidity and economic burden. The routine reporting of SSI rates stratified by potential risk factors associated with increased risk of infection is highly recommended.     

Clinical features of culture-proven Mycoplasma pneumoniae infections at King Abdulaziz University Hospital, Jeddah, Saudi Arabia

Objective  

This retrospective chart review describes the epidemiology and clinical features of 40 patients with culture-proven Mycoplasma pneumoniae infections at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.     

Imported tropical diseases

Imported tropical diseases are among the top three leading causes for morbidity and may affect up to 8% of returning travelers. Because the spectrum of dermatological manifestations seen in travelers is broad, it can be challenging for physicians to recognize and treat such conditions in a timely and efficient manner. Therefore, the present review highlights common imported tropical diseases with a focus on treatment regimens. Specifically, cutaneous larva migrans, myiasis, swimmer's itch, mycetoma, Chagas disease, and leishmaniasis are discussed. As awareness increases among travelers, immigrants, and health care providers regarding imported tropical diseases, early intervention and proper diagnosis can ensue, thus reducing morbidity and mortality in affected individuals.     

Small bowel obstruction at a Filshie clip applicator port site

Laparoscopic Filshie clip sterilisation remains a common method of permanent female contraception. Worldwide, approximately 190 million couples use tubal occlusion (United Nations world population monitoring. United Nations, 2002). Trocar site incisional hernia has been reported as a complication of laparoscopic surgery where a 10-mm port was employed (Tonouchi et al. Arch Surg 139(11):1248–1256, 2004). It is common practice to repair port sites of 10 mm or more to prevent herniation. Port sites of 5 mm are not routinely repaired by most surgeons because it is thought that such iatrogenic fascial defects are not large enough to predispose to hernia (Reardon et al. J Laparoendosc Adv Surg Tech A 9(6):523–525, 1999). We report a rare case of early Filshie clip applicator port site intestinal obstruction following laparoscopic sterilisation. The mechanism of hernia formation and a preventive strategy are discussed.     

Root formation by tooth germs following extraction of prematurely erupted upper first premolars. Case report

A case is described of a seven year-old boy in whom root formation continued following the premature extraction of both maxillary first premolars.     

Expression of HER-2 in MCF-7 breast cancer cells modulates anti-apoptotic proteins Survivin and Bcl-2 via the extracellular signal-related kinase (ERK) and phosphoinositide-3 kinase (PI3K) signalling pathways

Background  

The oncoprotein HER-2 is over-expressed and/or has undergone gene amplification in between 20 to 30% of breast and ovarian cancers. HER-2 amplified breast cancer is associated with a poor prognosis and increased resistance to chemo- and hormonal therapy. Data supporting the transforming potential of HER-2 are irrefutable but the mechanism by which HER-2 contributes to this process is complex and a unified model of HER2-induced increased cell proliferation and survival has not emerged.