Acquired Rectourethral and Rectovaginal Fistulas in Children: A Systematic Review

Background: Acquired rectourethral (RUF) or rectovaginal fistulas (RVF) in children are rare conditions in pediatric surgery. Prior literature are retrospective studies and based on a small number of patients. The managements and outcomes vary widely across different studies. No standard or recommended management has been universally adopted. The goal was to systematically summarize different causes, provide an overlook of current clinical trend and to derive recommendation from the literature regarding the etiology, managements, and outcomes of pediatric acquired RUF and RVF.Methods: PubMed, Embase, Cochrane databases were searched using terms: rectourethral fistula, recto-urethral fistula, urethrorectal fistula, urethro-rectal fistula, rectovaginal fistula. All studies were retrospective, in English, and included patients under the age of 18 years. Any series with congenital cases, adult (>18 years), <2 fistula cases less and obstetric related causes were excluded. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline was followed.Results: Of the 531 records identified, 26 articles with 163 patients (63 RUF and 100RVF) were fully analyzed. Most RUF resulted from trauma, most RVF were from infection of HIV. About 92 patients underwent 1 of 3 categories of definitive repair, including transanal (4.3%), trans-sphincteric (48.9%), and transperineal (30.4%). Tissue interposition flaps were used in 37.6% patients, while temporary fecal diversions were used in 63.9% patients. Fistula was successfully closed in 50.3% patients (98.4% RUF and 20% RVF). 89.1 and 79.7 % of surgical repair patients had optimal fecal and urinary functions, respectively. In the inflammatory bowel disease and HIV infection related RVF patient group, the closure rate was prohibitive poor.Conclusions: Most RVF are a sign of systematic diseases like HIV-infection or IBD and are associated with poor general conditions. While conservative treatment is recommended, stable patients can benefit from surgery. Further investigation is recommended if RVF are encountered without trauma or surgical history. RUF are likely to result from trauma or surgery, and transperineal or trans-sphincter approach can lead to closure and optimal function results. Fecal diversion and/or urinary diversion are helpful in some cases, while interposition technique may not be necessary. An objective scoring system for long-term follow-up and reporting consensus is needed to address treatment inconsistence.

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Prevalence of large vessel occlusion in patients presenting with acute ischemic stroke: a 10-year systematic review of the literature

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2018-014239 ◽

2018 ◽

Vol 11 (3) ◽

pp. 241-245 ◽

Cited By ~ 22

Author(s):

Nikita Lakomkin ◽

Mandip Dhamoon ◽

Kirsten Carroll ◽

Inder Paul Singh ◽

Stanley Tuhrim ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Large Vessel ◽

Large Vessel Occlusion ◽

Review Of The Literature ◽

Qualitative Synthesis ◽

Vessel Occlusion ◽

Number Of Patients ◽

Meta Analyses

BackgroundAccurate assessment of the prevalence of large vessel occlusion (LVO) in patients presenting with acute ischemic stroke (AIS) is critical for optimal resource allocation in neurovascular intervention.ObjectiveTo perform a systematic review of the literature in order to identify the proportion of patients with AIS presenting with LVO on image analysis.MethodsA systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in order to identify studies reporting LVO rates for patients presenting with AIS. Studies that included patients younger than 18 years, were non-clinical, or did not report LVO rates in the context of a consecutive AIS series were excluded. Characteristics regarding presentation, diagnosis, and LVO classification were recorded for each paper.ResultsSixteen studies, spanning a total of 11 763 patients assessed for stroke, were included in the qualitative synthesis. The majority (10/16) of articles reported LVO rates exceeding 30% in patients presenting with AIS. There was substantial variability in the LVO definitions used, with nine unique classification schemes among the 16 studies. The mean prevalence of LVO was 31.1% across all studies, and 29.3% when weighted by the number of patients included in each study.ConclusionsDespite the wide variability in LVO classification, the majority of studies in the last 10 years report a high prevalence of LVO in patients presenting with AIS. These rates of LVO may have implications for the volume of patients with AIS who may benefit from endovascular therapy.

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Sexually transmitted infections among HIV positive patients: a five year retrospective study

International Journal of Research in Dermatology ◽

10.18203/issn.2455-4529.intjresdermatol20184724 ◽

2019 ◽

Vol 5 (1) ◽

pp. 23

Author(s):

N. Saravanan ◽

Murugan Swamiappan ◽

Rajkumar Kannan ◽

G. Arul Raja

Keyword(s):

Hiv Infection ◽

Sexually Transmitted Infections ◽

Tamil Nadu ◽

Clinical Manifestations ◽

Hiv And Aids ◽

People Living With Hiv ◽

Hiv Patients ◽

Sexually Transmitted ◽

Number Of Patients ◽

Clinical Records

Background: Sexually transmitted infections (STIs) are the most well established risk factors for the spread of HIV infection. STIs act as cofactors and facilitators for HIV transmission. The effects of HIV infection on immunity can increase susceptibility to other STIs. The aims and objectives of the study were to determine the prevalence of co-infection of sexually transmitted infections among people living with HIV and AIDS.Methods: A retrospective chart review of the data collected from the clinical records of all HIV patients who had attended the STI clinic of Chengalpattu Medical College, Chengalpattu, Tamil Nadu during the five years period, from January 2013 to December 2017, was carried out. Demographic data, clinical manifestations, co-infection of STIs among HIV patients, laboratory investigations and treatment were collected. The data collected were computed and analyzed statistically.Results: During the study period of 5 years from 2013 to 2017 the total number of patients attended the STI clinic were 10825, among that males were 4534 (41.88%) and females were 6291 (58.12%). STIs/RTIs were seen in 2560 (23.65%) cases among the total number of patients attended. HIV was found to be positive in 294 cases, in that 168 (57.15%) were males and 126 (42.85%) were females. In male HIV patients, 51 (30.36%) had co-infection with other STIs/RTIs. In female HIV patients, 57 (45.24) % had co-infection with other STIs/RTIs. Viral STIs was the common co-infection seen in males and vaginal cervical discharge was common in females.Conclusions: STI/RTI co-infection, both symptomatic and asymptomatic are common among PLHIV. Hence they should be regularly counselled regarding the significance of periodic screening for STI/RTIs avoidance of high risk sexual behaviour.

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The structure of acute chemical poisoning in patients with HIV infection in the emergency hospital

Научно-практический журнал «Наркология» ◽

10.25557/1682-8313.2018.01.3-13 ◽

2018 ◽

pp. 3-13

Author(s):

М.М. Поцхверия ◽

М.В. Белова ◽

С.А. Солонин ◽

М.А. Годков

Keyword(s):

Hiv Infection ◽

Virus Transmission ◽

Pairwise Comparison ◽

Simple Random Sampling ◽

Immunoblot Analysis ◽

Acute Poisoning ◽

Economic Problem ◽

High Risk Group ◽

Emergency Hospital ◽

Number Of Patients

Употребление психоактивных веществ (ПАВ) с немедицинскими целями является огромной медико-социальной, экономической проблемой, и становится наиболее частой причиной инфицирования ВИЧ. Наркозависимые лица представляют особо уязвимую группу для заражения. Цель исследования: изучить структуру веществ, вызвавших острые отравления у ВИЧ-инфицированных пациентов, госпитализированных в стационар скорой медицинской помощи. Пациенты и методы исследования: ретроспективно проанализированы структура острых отравлений химической этиологии (ООХЭ) и результаты освидетельствования на ВИЧ-инфекцию 19 061 пациента, госпитализированных (простая случайная выборка) в отделение лечения острых отравлений НИИ СП им. Н.В. Склифосовского (ОЛОО НИИ СП) в 2013-2016 гг. Диагноз ООХЭ верифицирован методом хромато-масс-спектрометрии. Диагностику ВИЧ-инфекции осуществляли с использованием иммуноферментного анализа и иммуноблотинга. Для попарного сравнения распределения частот выявляемости ВИЧ у лиц ООХЭ использовали точный тест Фишера. Различия оценивали как статистически значимые при p<0,05. Результаты исследования. Выявляемость ВИЧ-инфекции у пациентов с ООХЭ варьировала от 5,7 до 7,7%. Среди пациентов с ВИЧ подавляющее большинство обращений было связано с отравлениями опиатами, лекарственными средствами и различными смесями ПАВ. За три года количество пациентов с ВИЧ и передозировками опиатов сократилось в 2,3 раза (p<0,0001). Значительно чаще стали встречаться отравления психодислептиками, смесями ПАВ и веществами немедицинского назначения. Среди ВИЧ-инфицированных значительную долю составляли лица с отравлениями несколькими видами наркотических и/или лекарственных веществ. При этом снизились доли отравлений опиатами в сочетании с метадоном и психофармакологическими средствами. У пациентов с ВИЧ обнаружен высокий удельный вес интоксикации этанолом и его суррогатами. Выводы. Динамика выявляемости ВИЧ-инфекции у пациентов с ООХЭ свидетельствует о высокой поражённости этой категории лиц. Причины увеличения частоты обнаружения ВИЧ-инфекции могут быть связаны с изменением ассортимента принимаемых ПАВ и путей передачи вируса. Пациенты ОЛОО являются группой высокого риска распространения ВИЧ-инфекции и могут рассматриваться как фокусная группа, отражающая общие тенденции в потреблении наркотических и ПАВ в г. Москве. The use of psychoactive substances (PS) with non-medical purposes is a huge medical, social and economic problem. It becomes the most frequent cause of HIV infection. Drug addict individuals are vulnerable group for HIV. Aim: study the structure of substances that caused acute poisoning in HIV-infected patients hospitalized in an emergency hospital. The object and methods: it has been retrospectively analyzed the structure of acute poisoning of chemical etiology (APCE) and prevalence of HIV infection among 19061 patients hospitalized (simple random sampling) at N.V. Sklifosovsky’s Research Institute for Emergency Medicine department of acute poisoning treatment (DAPT) in 2013-2016 years. The diagnosis of APCE was verified by chromatography-mass spectrometry. Diagnosis of HIV infection was carried out using immunoassay and immunoblot analysis. Fisher’s exact test was used for a pairwise comparison of the prevalence HIV in individuals with APCE. Differences were assessed as statistically significant at p <0.05. Results. The prevalence of HIV infection in patients with APCE ranged from 5.7 to 7.7%. Among the patients with HIV the vast majority of cases were associated with poisoning with opiates, drugs and various PS mixtures. For the period from 2013 to 2016 the number of patients with HIV infection and opiate overdoses decreased by 2.3 times (p <0.0001). More common became poisoning with psychotomimetic substance, PS mixtures and non-medical substances. Among HIV infected patients significant share were people poisoned several types of drugs and/or medicines. At the same time, the share of poisoning with opiates decreased in combination with methadone and psychopharmacological medicines. In patients with HIV were detected a high proportion of ethanol and its surrogates’ intoxication. Conclusions. The prevalence of HIV infection in patients with APSE indicates of the high affection of this category persons. The reasons of increasing the prevalence of HIV infection can be associated with a change in PS consumption assortment and the ways of virus transmission. Patients with APSE are a high risk group for HIV spreading and can be considered as a focus group reflecting general trends in the drug consumption in Moscow.

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Medical Adjuvant Therapy in Reducing Thrombosis With Arteriovenous Grafts and Fistulae Use: A Meta-Analysis of Randomized Controlled Trials

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/10760296211063882 ◽

2021 ◽

Vol 27 ◽

pp. 107602962110638

Author(s):

Kaleem Ullah ◽

Maham Bashir ◽

Noor Ul Ain ◽

Azza Sarfraz ◽

Zouina Sarfraz ◽

...

Keyword(s):

Adjuvant Therapy ◽

Adjuvant Treatment ◽

Meta Analysis ◽

Controlled Trials ◽

Graft Thrombosis ◽

Av Fistula ◽

Number Of Patients ◽

Long Term Follow Up ◽

Stage Renal Disease ◽

End Stage

Hemodialysis is required for patients with end-stage renal disease (ESRD) that require arteriovenous (AV) grafts or fistulas for vascular access. These access points are prone to thrombosis. To determine the effect of medical adjuvant therapy on AV graft/fistula patency among patients with ESRD on hemodialysis. Adhering to the PRISMA 2020 statement, a systematic search was conducted until August 20, 2021, with keywords including arteriovenous graft, fistula, patency, thrombosis, hemodialysis, adjuvant treatment. The following databases were searched: PubMed, Scopus, Web of Science, CINAHL Plus, and Cochrane. A random-effects model was employed using Review Manager 5.4 for data analysis. The meta-analysis pooled in 1985 participants with 1000 (50.4%) in the medical adjuvant treatment group. At a snapshot, medical adjuvant therapy reduced the risk for graft thrombosis (RR = 0.64, P = .02). Notable medications included aspirin for graft thrombosis (RR = 0.36, P = .006) and ticlopidine for fistula thrombosis (RR = 0.53, P = .01). Certain antiplatelet therapies (aspirin and ticlopidine) reduced the number of patients with AV fistula/graft thrombosis among patients with high heterogeneity among the trials. Other therapies (fish oil, sulfinpyrazone, clopidogrel, and aspirin/dipyridamole) did not demonstrate significant improvement but may be promising once concrete evidence is available. Potential benefits of anti-platelet therapies may be explored to maintain the potency of AV grafts/fistulas through well-designed placebo-controlled trials and long-term follow-up.

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HIV INFECTION AMONG PATIENTS WITH TUBERCULOSIS IN MOSCOW

Epidemiology and Infectious Diseases (Russian Journal) ◽

10.18821/1560-9529-2018-23-4-178-185 ◽

2018 ◽

Vol 23 (4) ◽

pp. 178-185

Author(s):

Mikhail Valerevich Sinitsyn ◽

S. E. Borisov ◽

E. M. Belilovskiy ◽

E. M. Bogorodskaya

Keyword(s):

Comparative Analysis ◽

Hiv Infection ◽

Monitoring System ◽

Drug Users ◽

Significant Contribution ◽

Age Group ◽

Tuberculosis Patients ◽

Number Of Patients ◽

The Impact ◽

Epidemiological Situation

The study is devoted to the evaluation of the impact of the spread of HIV infection on the epidemiological indicators of tuberculosis in a megacity. Based on information from the registers of the tuberculosis monitoring system in Moscow for 2014-2015. A comparative analysis of indicators for patients with tuberculosis was conducted with the presence and absence of co-infected HIV infection. The results showed that among patients with tuberculosis combined with HIV infection, patients from the city’s permanent population, from the age group of 31-40 years old, non-working, injecting drug users are much more likely than other TB patients. The number of tuberculosis patients who died of HIV infection, in comparison with the number of patients who died from tuberculosis, accounted for more than a third of the total number of tuberculosis-related deaths. Thus, when assessing the epidemiological situation of tuberculosis, it is necessary to take into account the significant contribution of HIV infection to the values of the main indicators and their dynamics.

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Policing Practices and Risk of HIV Infection Among People Who Inject Drugs

Epidemiologic Reviews ◽

10.1093/epirev/mxaa010 ◽

2020 ◽

Cited By ~ 1

Author(s):

Pieter Baker ◽

Leo Beletsky ◽

Liliana Avalos ◽

Christopher Venegas ◽

Carlos Rivera ◽

...

Keyword(s):

Hiv Infection ◽

Risk Behaviors ◽

Hiv Risk ◽

People Who Inject Drugs ◽

Methadone Maintenance ◽

The United States ◽

Knowledge Generation ◽

Physical Assault ◽

Drug Law ◽

Meta Analyses

Abstract Drug-law enforcement constitutes a structural determinant of health among people who inject drugs (PWID). Street encounters between police and PWID (e.g., syringe confiscation, physical assault) have been associated with health harms, but these relationships have not been systematically assessed. We conducted a systematic literature review to evaluate the contribution of policing to risk of human immunodeficiency virus (HIV) infection among PWID. We screened MEDLINE, sociological databases, and gray literature for studies published from 1981 to November 2018 that included estimates of HIV infection/risk behaviors and street policing encounters. We extracted and summarized quantitative findings from all eligible studies. We screened 8,201 abstracts, reviewed 175 full-text articles, and included 27 eligible analyses from 9 countries (Canada, China, India, Malaysia, Mexico, Russia, Thailand, Ukraine, and the United States). Heterogeneity in variable and endpoint selection precluded meta-analyses. In 5 (19%) studies, HIV infection among PWID was significantly associated with syringe confiscation, reluctance to buy/carry syringes for fear of police, rushed injection due to a police presence, fear of arrest, being arrested for planted drugs, and physical abuse. Twenty-one (78%) studies identified policing practices to be associated with HIV risk behaviors related to injection drug use (e.g., syringe-sharing, using a “shooting gallery”). In 9 (33%) studies, policing was associated with PWID avoidance of harm reduction services, including syringe exchange, methadone maintenance, and safe consumption facilities. Evidence suggests that policing shapes HIV risk among PWID, but lower-income settings are underrepresented. Curbing injection-related HIV risk necessitates additional structural interventions. Methodological harmonization could facilitate knowledge generation on the role of police as a determinant of population health.

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Improved Biochemical Parameters in Patients Who Undergo Early Resection in Isolated Ileocaecal Crohn’s Disease

Surgery Research and Practice ◽

10.1155/2017/4396573 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

Mirzafaraz Saeed ◽

Hari Hullur ◽

Amro Salem ◽

Abbas Ali ◽

Yousif Sahib ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Surgical Resection ◽

Complete Blood Count ◽

Long Term Results ◽

Number Of Patients ◽

Long Term Follow Up ◽

One Year

Introduction. The aim of this study is to evaluate the outcome of introduction of early surgery in the course of isolated ileocecal Crohn’s disease, where there is no absolute indication of surgery. Methods. Observational study involving patients with isolated ileocecal Crohn’s disease who underwent early surgical resection (within one year of the presentation of the hospital). A complete blood count, ESR, and CRP were done and compared between the preoperative value, 1st postoperative visit (3-4 weeks), and last follow-up visit. Statistical analysis was done using Analysis of Variance (ANOVA) to compare the different figures. Results. There was a statistically significant increase in the hemoglobin levels between preoperative, postoperative, and long-term follow-up and a significant decrease in leukocyte count between the pre- and postoperative values (F=19.8, p<0.001 and F=8.9, p=0.002, resp.). Similarly, the ESR and CRP values were decreased significantly at long-term follow-up (F=8.5, p=0.019 and F=8.3, p=0.013, resp.). Conclusion. Early surgical resection in isolated ileocaecal Crohn’s disease achieved significant biochemical improvements. These successful results in this small number of patients indicate that early surgical intervention may provide better outcomes. These initial results encourage larger and comparative studies of long-term results versus long-term use of biological agents.

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Revision Surgery for Chronic Otitis Media: A Learning Experience

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949810700606 ◽

1998 ◽

Vol 107 (6) ◽

pp. 486-491 ◽

Cited By ~ 36

Author(s):

Jan E. Veldman ◽

W. Weibel Braunius

Keyword(s):

Otitis Media ◽

Revision Surgery ◽

Learning Experience ◽

Chronic Otitis Media ◽

Canal Wall ◽

Long Term Follow Up ◽

Surgical History ◽

History Of ◽

Canal Wall Down ◽

Residual Air

The objective of this study was to evaluate, during a long-term follow-up period, the results of revision surgery for chronic otitis media with or without cholesteatoma. Intact canal wall and canal wall down procedures were performed. The surgical history of every patient was assessed before the operation. A dry, relatively safe, and disease-free ear was created in 90% of the reoperated ears (N = 389). The recurrence rate of cholesteatoma was 5% for the total group. Reperforations of the tympanic membrane occurred in 10%, and persistent or recurrent otorrhea was present in 10% of cases. The functional hearing results were quite satisfactory. A residual air-bone gap of ≤30 dB was reached in 70.3% of the cases after revision tympanoplasty only (N = 41). Revision mastoidectomy with revision tympanoplasty as a one-stage procedure led subsequently, in 76% of intact canal wall procedures (N = 113) and 55% of canal wall down procedures (N = 98), to a residual air-bone gap of ≤30 dB.

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A Bayesian Network Meta-analysis of Add-on Drug Therapies Specific for Pulmonary Arterial Hypertension

Annals of Pharmacotherapy ◽

10.1177/1060028019888760 ◽

2019 ◽

Vol 54 (5) ◽

pp. 423-433 ◽

Cited By ~ 1

Author(s):

Maja Petrovič ◽

Igor Locatelli

Keyword(s):

Pulmonary Arterial Hypertension ◽

Combination Therapy ◽

Arterial Hypertension ◽

Meta Analysis ◽

Phosphodiesterase Type 5 Inhibitors ◽

Number Of Patients ◽

All Cause Mortality ◽

Pulmonary Arterial ◽

Meta Analyses ◽

Better Than

Background: Recently published meta-analyses did not discriminate between drug agents used for initial and sequential combination therapy. Objective: To assess the comparative efficacy of drugs specific for the treatment of pulmonary arterial hypertension (PAH) as add-on therapies based on 6-minute walk distance (6MWD), all-cause mortality, and discontinuation due to adverse events (AEs). Methods: EMBASE, PubMed, Cochrane Library, and ClinicalTrials.gov were searched until December 9, 2018, for the randomized, placebo-controlled clinical trials (RCTs) conducted on primarily adult patients diagnosed with PAH. Data extracted from applicable RCTs were as follows: for 6MWD mean change from baseline, the total number of patients, and the number of patients with events, per treatment. Network meta-analysis (NMA) was conducted in a Bayesian framework. Results: A total of 16 RCTs were eligible for analysis, with 4112 patients. Add-on therapy with tadalafil or inhaled treprostinil performed better than endothelin receptor antagonists alone [27 m; 95% credible interval (CrI): (11, 43); and 19 m; 95% CrI: (10, 27); respectively]. Add-on therapy with macitentan or bosentan performed better than phosphodiesterase type 5 inhibitors alone [26 m; 95% CrI: (6.4, 45); and 22 m; 95% CrI: (5.1, 38); respectively]. Differences in all-cause mortality and discontinuation due to AEs were nonsignificant. Conclusion and Relevance: Our NMA evaluated efficacy and safety of add-on therapies in patients with PAH. None of the previous meta-analyses evaluated RCTs focusing solely on patients pretreated with another PAH-specific drug therapy. Our results support guideline recommendations on combination therapy in PAH patients and add the quantitative perspective on which sequential therapy demonstrated the greatest effect size.

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Subtotal Pancreatectomy for Cancer: Closure of the Pancreatic Remnant With Staplers

HPB Surgery ◽

10.1155/1990/73475 ◽

1990 ◽

Vol 2 (1) ◽

pp. 29-39 ◽

Cited By ~ 9

Author(s):

Bo Ahrén ◽

Karl-G. Tranberg ◽

Åke Andrén-Sandberg ◽

Stig Bengmark

Keyword(s):

Fatal Outcome ◽

Endocrine Function ◽

Periampullary Cancer ◽

Gastric Stasis ◽

Subtotal Pancreatectomy ◽

Pancreatic Remnant ◽

Number Of Patients ◽

Long Term Follow Up ◽

Pancreatic Endocrine Function

This paper presents a 2-year series of 26 consecutive pancreatectomies for periampullary cancer where the pancreatic tail was closed with a stapler in order to avoid complications related to a pancreatico-digestive anastomosis. The follow-up period was 14 months or more. Seven patients developed operative complications. Pancreatic fistulas developed in 3 patients. The fistulas closed spontaneously in 2 of the patients after 2-4 months, lntraabdominal abscesses developed in 4 patients and required surgical drainage. In 1 of these patients, the abscess eroded a large vessel with a fatal outcome resulting in an operative mortality rate of 3.8%. A transient postoperative gastric stasis was observed in seven patients. Postoperative hospital median stay was 27 days (range 10–83 days). Eighteeen patients have died after 4–30 months in recurrent disease and seven patients are alive after a follow-up period of 15–29 months. Pancreatic endocrine function seemed well preserved; diabetes mellitus has developed in only one patient. In conclusion, it appears that subtotal pancreatectomy with closure of the pancreatic remnant with staples gives a low morbidity and mortality. Although the conclusion should be tempered by the small number of patients, the results justify continued evaluation of this technique with long-term follow-up.

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