Ultrasound guided tube drainage of perinephric abscess: Experience of 70 cases.

Objective: To determine the efficacy of ultrasound guided tube drainage of Perinephric abscess. Study Design: Observational study. Setting: Surgical Unit-II and Urology Ward Ghulam Muhammad Mahar Medical College Teaching Hospital Sukkur & Mustafia Hospital Sukkur. Period: February 2016 to January 2020. Material & Methods: 70 cases with Perinephric abscess underwent ultrasound guided tube drainage. Diagnosis was established by history, clinical examination, investigations like ultrasound & CT scan. Patients with emphysematous kidney & chronic sinus formation and with small abscess were excluded from the study. Patients were followed up for 4 weeks for complete regression of abscess cavity on ultrasound. Results: Out of 70 Patients 61.4% were male and 35% were female. 58.5% of the patients had right sided Perinephric abscess. Majority of the patients(42.8%) belonged to age group 41-50 years. 31.4% of the patients were diabetic. Clinically 95.7% of the patients reported with fever and 88.5% with flank pain. Ultrasound guided tube drainage was successful in 65(92.8%) while in 5(7.1%) patients it failed and open drainage was performed. Conclusion: Ultrasound guided tube drainage is an effective way to treat Perinephric abscess with very few minor complications as compared to open drainage.

Urban mosquitoes and filamentous green algae: their biomonitoring role in heavy metal pollution in open drainage channels in Nairobi industrial area, Kenya

Background Industrial wastewater is a human health hazard upon exposure. Aquatic organisms in contaminated wastewater may accumulate the toxic elements with time. Human population living in informal settlements in Nairobi industrial area risk exposure to such toxic elements. Biomonitoring using aquatic organisms in open drainage channels can be key in metal exposure assessment. Levels of Mercury (Hg), Lead (Pb), Chromium (Cr), Cadmium (Cd), Thallium (Tl), and Nickel (Ni) were established in samples of wastewater, filamentous green algae (Spirogyra) and mosquitoes obtained from open drainage channels in Nairobi industrial area, Kenya. Results Pb, Cr, & Ni levels ranged from 3.08 to 15.31 µg/l while Tl, Hg, & Cd ranged from 0.05 to 0.12 µg/l in wastewater. The Pb, Cr, Ni, & Cd levels were above WHO, Kenya & US EPA limits for wastewater but Hg was not. Pb, Cr, Tl, & Ni levels in assorted field mosquitoes were 1.3–2.4 times higher than in assorted laboratory-reared mosquitoes. Hg & Cd concentrations in laboratory-reared mosquitoes (0.26 mg/kg & 1.8 mg/kg respectively) were higher than in field mosquitoes (0.048 mg/kg & 0.12 mg/kg respectively). The levels of Pb, Cr, & Ni were distinctively higher in field mosquito samples than in wastewater samples from the same site. Pb, Cr, Ni, Cd & Hg levels in green filamentous Spirogyra algae were 110.62, 29.75, 14.45, 0.44, & 0.057 mg/kg respectively. Correlation for Pb & Hg (r (2) = 0.957; P < 0.05); Cd & Cr (r (2) = 0.985; P < 0.05) in algae samples was noted. The metal concentrations in the samples analyzed were highest in filamentous green algae and least in wastewater. Conclusion Wastewater, mosquitoes, and filamentous green algae from open drainage channels and immediate vicinity, in Nairobi industrial area (Kenya) contained Hg, Pb, Cr, Cd, Tl, and Ni. Mosquitoes in urban areas and filamentous green algae in open drainage channels can play a role of metal biomonitoring in wastewater. The potential of urban mosquitoes transferring heavy metals to human population from the contaminated wastewater should be investigated.

Bilateral iliopsoas abscess presenting with abdominal wall cellulitis and left-sided empyema thoracis: a rare presentation

Iliopsoas abscess is common in immunocompromised patients and rarely presents with empyema thoracis. We present a 26-year-old male with no comorbidities who presented with a 3-day history of abdominal pain, fever and dyspnoea. There was no history of tuberculosis or recent contact with a tuberculous patient. On examination, the patient had facial dysmorphism and abdominal wall cellulitis extending bilaterally from flank to the inguinoscrotal region. Chest X-ray showed a left pleural effusion. Ultrasonography and contrast-enhanced CT also showed bilateral iliopsoas abscess with a left massive pleural empyema. The patient underwent bilateral abscess open drainage, thoracostomy for left empyema thoracis and intravenous antibiotic therapy. The patient had an uneventful course postoperatively and was discharged.

Power-Assisted High Definition Liposuction in Male Patients With or Without VASER: Comparison of Seroma Formation

In power-assisted high definition liposuction (PA-HDL), large areas of the body surface are treated, followed by superficial aspiration along definition lines between muscle groups. Both factors can contribute to seroma formation. The purpose of this study was to evaluate if the use of vibration amplification of sound energy at resonance (VASER) prior to PA-HDL would increase the frequency of seroma formation. In this retrospective study, 164 male patients underwent PA-HDL with (n = 82) or without VASER (n = 82). No drains were used. Lymphatic drainage was performed in all patients. Seroma formation was determined by physical examination 1 and 2 weeks postoperatively. The incidence of seroma was 11% (n = 9) in the group with VASER treatment prior to PA-HDL, and 4.9% (n = 4) in the group without previous VASER use. The difference was statistically not significant ( P > .05). The most frequent area of seroma formation was at the lower part of the linea semilunaris. PA-HDL has an increased risk of seroma formation, which in our series was mainly located at the lower part of the linea semilunaris. VASER treatment prior to PA-HDL showed a tendency to further increase the risk of seroma formation in an open drainage—no-drains technique, albeit the difference was not statistically significant.

Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis. A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management. Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician’s clinical judgment. Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve. The growing body of evidence on ‘high-risk’ children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets. Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis. Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155

PSOAS ABSCESS – THE CHANGING TRENDS

Introduction: Psoas abscess (IPA) is an abscess collection in the retroperitoneal space tracking along the psoas major muscle. The microbial etiology of Psoas abscess is variable and depends on the geographical area. This study attempts to evaluate the microbial etiology, its implication in deciding the management modalities, and outcomes in patients with Psoas abscess from a tertiary care center in South India. Materials and Methods: This was a retrospective study done in a tertiary care center in Southern India. Results: A total of 47 patients were enrolled in the study, with causative organism identified in 40 (85.15%) patients. In 17 patients (36.17%), it was found to be tuberculous origin; and of nontuberculous origin in 23 patients (48.93%). No causative organism could not be isolated in 7 patients (14.89%). While 33 patients were treated with percutaneous drainage (70.12%), open drainage was done in 14 patients (29.78%) and 1 patient died (2.12%). Conclusion: The most common causative organism of psoas abscess is found to be of nontuberculous origin and PCD was found to be better modality of treatment. Empirical administration of anti-tuberculous drugs needs further evaluation. Key words: psoas, retroperitoneal, retrospective, tuberculous, drainage, empirical

Microbiological profile and treatment outcome of emphysematous pyelonephritis: experience from two teaching hospitals of Bangladesh

Background: Emphysematous pyelonephritis (EPN) is a rare severe necrotizing infection of the renal parenchyma, collecting system and/or perirenal tissues. Patients with diabetes mellitus, renal stones and renal tract obstruction are at risk for development of EPN. Escherichia coli is the most common aetiological agent and treatment is aimed at infection control and interventions in appropriate cases. This study aimed to identify the aetiological agents responsible for EPN and the outcome of such cases. Methods: This observational study was done in BIRDEM General Hospital and Bangabandhu Sheikh Mujib Medical University over a period of three years (2011-2013). Twenty adult EPN cases were included in this study. Results: The mean age of the study participants was 59.2 years with female predominance (80%). Risk factors included diabetes mellitus (90%), renal stones (5%) and kidney transplant recipient (5%). Fever, loin pain and dysuria were common. Six patients had class 1 EPN, seven had class 2 disease, five had class 3 and two patients had class 4 EPN. Aetiological agents were cultured in 19 cases; E. coli in 12 (68%), Klebsiella in three (16%), Pseudomonus in two (11%) and Proteus and Enterococcus, one each (5% each). Carbapenems appeared as the most sensitive antibiotic. Along with antibiotic, half of the patients required interventions; percutaneous drainage in two, open drainage in two and six patients required nephrectomy. Regarding outcome, five patients died, 10 patients recovered completely and five patients recovered with residual renal dysfunction. Conclusion: E. coli was the most common causative agent in present EPN cohort. Outcome was poor. With improved management strategy, combining nephrologists, intervention radiologists and urologists – all together, a good outcome is expected. Birdem Med J 2021; 11(2): 108-111

Design of Drainage System Coal Mine at PT. Tebo Agung International Site Project, Semambu Village, Sumay District, Tebo Regency, Jambi

Tebo Agung Internasional Ltd is one of the companies in coal mining that employs the open-pit mining method. This sort of method will create a large basin that can accumulate water inside the mining pit. The drainage system is applied at the Pit-1 Site Semambu is mine-dewatering carried out by draining the water into the sump so that it can be pumped out of the mining area and prevent the runoff from coming inside through an open drainage system (ditch). The result of data analysis demonstrated that referring to the daily rainfall in 2010 – 2019 through the distribution of Log Person Type III, the maximum rainfall being planned was 508.019 mm/day within the return period of 5 years. The intensity of rainfall at the research site was 82.5 mm/hour having a rain duration averagely of 3.1 hours/day. Pit-1 Site Semambu had a catchment area around 469,317.15 m2 and a water discharge totally 61,238.81 m3/day derived from rainwater discharge of 48,530.48 m3/day and runoff water discharge 12,708.33 m3/day, whereas the capacity of the temporary accommodating pond (Sump) was 39,539.55 m3. The pump at the research site could not be operated anymore (broken). Accordingly, the recommendation that can be given to the company is changing the broken pumps with 4 units of multi fall 420 pumps having operating speed 1,300 rpm and actual discharge yielded by the pump 871.64 m3/hour. The pump worked for 14 hours/day and the total water discharge that could be produced was 12,202.96 m3/day. Open channel (ditch) at Pit-1 Site Semambu was the only one with accommodated discharge 1.27 m3/second. Thus, the recommendation that could be delivered to optimally prevent the runoff water coming into the mining area is by adding 2 ditches having the capacities of 0.90 m3/second and 0.75 m3/second which have been adjusted to the planned water discharge.

Influence of territory slope and drainage systems on the value of fire risk during transportation of flammable liquids by road transport

В работе осуществлена оценка величины потенциального риска при перевозке пожароопасных грузов автомобильным транспортом с учетом возможного стекания горючей жидкости по уклонам. Проведено сравнение величины пожарного риска для случаев открытых и закрытых дренажных канав. It is not possible to calculate the fire risk that takes into account slopes on roads within the existing methodology for determining the calculated fire risk values at production facilities. The article suggests the elaboration of methodology considering the above-mentioned factors. The paper provides comparative assessment of the fire risk when transporting gasoline by automobile tanks with a capacity of 28 m, both considering one of the factors (road slope, the presence of drainage ditches) and without it. It is shown that these factors can have a significant impact on the fire risk value for objects near which there is an accident with a fire of vehicles with significant amount of flammable liquid. The potential risk increases approaching the lowest point of the road section. At the same time, depending on the total length of the section with a slope, this value may be an order higher than the fire risk in the areas located above. Technical measures such as drainage ditches can significantly affect the fire risk value. When open drainage ditches are installed, the risk of fire escalation increases when the burning liquid flows down. When installing closed drainage ditches, the risk of escalation due to the spread of fire is minimized and is possible mainly in the locations of drainage ditch hatches. At the same time, such technical solution increases the potential risk in the area of liquid discharge to the terrain.