Incidence of fistula subsequent to anal abscesses

A prospective study about the incidence of fistula subsequent to perianal abscesses , the study included 216 patients admitted to AL-kindy general hospital from 2018 to 2020, all of them male persons. All the abscesses were managed by incision & drainage only 11 without prodding or exploration of anorectal area. The patients studied were classified into 3 groups to the incidence of occurrence of perianal abscesses: Croup 1 : patient with no pervious episode of anorectal sepsis, in those the incidence of fistula was 30.5 % Group II : Patient with only one previous episode of anorectal sepsis, in those the incidence of fistula was 72.2 % . Group III : Patients who did not get proper surgical treatment & the abscess opened spontaneously & all of them had simple perianal abscess, in those the incidence of fistula was 100 % . The study showed there is no need for rectal exploration in each & every case of anorectal sepsis at first encounter because only 30.5% of those patient will develop fistula , In addition to the risk to operate on such inflamed area & the anorectal exploration should be kept for patient seen for the second or third time with recurrence of anorectal or persistent anorectal fistula following incision & drainage.

Cellulitis Is Associated with Severe Breast Cancer-Related Lymphedema: An Observational Study of Tissue Composition

Cellulitis is a common complication in Breast Cancer-Related Lymphedema (BCRL). The excess amount of fat and lean mass in BCRL is a vital factor in patient stratification, prognosis, and treatments. However, it is not known whether cellulitis is associated with the excess fat and lean mass in BCRL. Therefore, this prospective observational study was designed to fundamentally understand the heterogonous biocomposition of BCRL. For this study, we consecutively enrolled 206 patients with unilateral BCRL between January 2019 and February 2020. All patients underwent Dual-Energy X-Ray Absorptiometry scans, bioimpedance spectroscopy, indocyanine green lymphangiography comprehensive history of potential risk factors, and a clinical exam. Multivariate linear and beta regression models were used to determine the strength of association and margins effect. Sixty-nine patients (33%) had at least one previous episode of cellulitis. Notably, a previous episode of cellulitis was associated with 20 percentage points more excess fat and 10 percentage points more excess lean mass compared to patients without cellulitis (p < 0.05). Moreover, each 1 increase in the patients BMI was associated with a 0.03 unit increase in the fat mass proportion of the lymphedema arm. Cellulitis was associated with more excess fat and lean arm mass in BCRL. In addition, patients BMI affect the proportion of fat mass in the arm.

Decompression sickness after a highly conservative dive in a diver with known persistent foramen ovale: Case report

A diver returned to diving, 15 months after an episode of neuro-spinal decompression sickness (DCS) with relapse, after which she had been found to have a moderate to large provoked shunt across a persistent (patent) foramen ovale (PFO), which was not closed. She performed a single highly conservative dive in line with the recommendations contained in the 2015 position statement on PFO and diving published jointly by the South Pacific Underwater Medicine Society and the United Kingdom Sports Diving Medical Committee. An accidental Valsalva manoeuvre shortly after surfacing may have provoked initial symptoms which later progressed to DCS. Her symptoms and signs were milder but closely mirrored her previous episode of DCS and she required multiple hyperbaric oxygen treatments over several days, with residua on discharge. Although guidance in the joint statement was mostly followed, the outcome from this case indicates that there may be a subgroup of divers with an unclosed PFO, who have had a previous episode of serious DCS, who may not be safe to dive, even within conservative limits.

DOES THE DROP IN PORTAL PRESSURE AFTER ESOPHAGOGASTRIC DEVASCULARIZATION AND SPLENECTOMY INFLUENCE THE VARIATION OF VARICEAL CALIBERS AND THE REBLEEDING RATES IN SCHISTOSOMIASIS IN LATE FOLLOW-UP?

ABSTRACT Background: The treatment of choice for patients with schistosomiasis with previous episode of varices is bleeding esophagogastric devascularization and splenectomy (EGDS) in association with postoperative endoscopic therapy. However, studies have shown varices recurrence especially after long-term follow-up. Aim: To assess the impact on behavior of esophageal varices and bleeding recurrence after post-operative endoscopic treatment of patients submitted to EGDS. Methods: Thirty-six patients submitted to EGDS were followed for more than five years. They were divided into two groups, according to the portal pressure drop, more or less than 30%, and compared with the behavior of esophageal varices and the rate of bleeding recurrence. Results: A significant reduction on the early and late post-operative varices caliber when compared the pre-operative data was observed despite an increase in diameter during follow-up that was controlled by endoscopic therapy. Conclusion: The drop in portal pressure did not significantly influence the variation of variceal calibers when comparing pre-operative and early or late post-operative diameters. The comparison between the portal pressure drop and the rebleeding rates was also not significant.

Ponytail headache (external-traction headache): prevalence, characteristics and relationship with migraine

IntroductionDespite its frequent occurrence, external-traction headache (previously named as “ponytail headache”) is scarcely documented in the literature.ObjectiveIn the present study we set out to estimate the prevalence of ponytail headache and its relationship with migraine.MethodsOne hundred and thirty women (27.7±11.1 years of age), 108 of them reported a previous history of primary headache [81/130 (62.3%) migraine or probable migraine and 27/130 (20.8%) non-migraine headache; 22/130 (16.9%) did not report any previous episode of headache], were requested to wear a ponytail for 60 minutes, removing it only in case of pain. When pain occurred, it was recorded for the latency between the placement of the ponytail and the onset of the pain, its duration and characteristics. The women also filled out a questionnaire on previous headache episodes.ResultsDuring the 60 minute-period, 52/130 (40%) women had ponytail headache elicited by the experiment. There was a higher prevalence of ponytail headache in those who reported previous episodes of primary headache [48/108 (44.4%)], compared to those who did not [4/22 (18.2%)] (p=0.022). The migraineurs had more ponytail headache than non-migraneurs [39/81 (48.2%) versus 9/27 (33.3%), p=0.180] with a positive history of primary headache and they also had more than those without [4/22 (18.2%)] (p=0.012). The group of women with migraine also presented more ponytail-induced headache than non-migraineurs combined with the groupof individuals without a previous history of headache [13/49 (26.5%), OR 2.57, 95%CI 1.19-5.55; p=0.015]. Migraine-like episodes were trigged in 3/52 (5.8%) by the experiment, all three migraineurs. The latency time for the beginning of ponytail headache during the experiment was 21.5 ± 15.4 min and the duration was 76.0±159.3 min.ConclusionThe prevalence of ponytail headache in our study was 40% and was statistically higher in migraineurs.

Prevalence and risk factors for back pain in sports: a systematic review with meta-analysis

ObjectivesWe aimed to determine the prevalence of low back pain (LBP) in sport, and what risk factors were associated with LBP in athletes.DesignSystematic review with meta-analysis.Data sourcesLiterature searches from database inception to June 2019 in Medline, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Scopus, supplemented by grey literature searching.Eligibility criteriaStudies evaluating prevalence of LBP in adult athletes across all sports.ResultsEighty-six studies were included (30 732, range 20–5958, participants), of which 45 were of ‘high’ quality. Definitions of LBP varied widely, and in 17 studies, no definition was provided. High-quality studies were pooled and the mean point prevalence across six studies was 42%; range 18%–80% (95% CI 27% to 58%, I2=97%). Lifetime prevalence across 13 studies was 63%; range 36%–88% (95% CI 51% to 74%, I2=99%). Twelve-month LBP prevalence from 22 studies was 51%; range 12%–94% (95% CI 41% to 61%, I2=98%). Comparison across sports was limited by participant numbers, study quality and methodologies, and varying LBP definitions. Risk factors for LBP included history of a previous episode with a pooled OR of 3.5; range 1.6–4.0 (95% CI 1.9 to 6.4). Statistically significant associations were reported for high training volume, periods of load increase and years of exposure to the sport.ConclusionLBP in sport is common but estimates vary. Current evidence is insufficient to identify which sports are at highest risk. A previous episode of LBP, high training volume, periods of load increase and years of exposure are common risk factors.

Systemic septic emboli in tricuspid endocarditis due to an atrial communication with a right-to-left shunt

We present the case of a patient admitted to hospital in septic shock. He had a history of tricuspid valve infective endocarditis (IE) 6 months prior and regularly injected intravenous drugs. A bedside echo on arrival confirmed vegetations on his tricuspid valve, torrential tricuspid regurgitation and signs of significantly raised right-sided pressures. The admission chest radiograph showed consolidative changes in the lungs, suggestive of septic pulmonary emboli. He was commenced on antibiotics and treated in the high-dependency unit. He subsequently developed an acutely ischaemic right foot and nasal tip. Suspicions were raised of a paradoxical septic embolus through a right-to-left shunt, subsequently confirmed on bubble echo which showed passage of agitated saline between the atria. This was not apparent clinically or on echocardiogram during his previous episode of tricuspid valve IE, raising the possibility of the development of an acquired inter-atrial communication since his previous episode.

Factors associated with disabling low back pain among nursing personnel at a medical centre in Japan: a comparative cross-sectional survey

ObjectivesLow back pain (LBP) is a common cause of disability among nursing personnel. Although many studies regarding the risk factors for LBP among nursing staff have focused on the physical load at work, multidimensional assessments of risk factors are essential to identify appropriate preventive strategies. We aimed to investigate the association of multidimensional factors (individual, physical, psychological and occupational) with disabling LBP among nursing personnel in Japan.DesignObservational study with comparative cross-sectional design.SettingData were collected using the self-administered questionnaire at a tertiary medical centre.ParticipantsAfter excluding participants with missing variables, 718 nursing personnel were included in the analysis.Outcome measuresA self-administered questionnaire assessed individual characteristics, rotating night shift data, severity of LBP, previous episode of LBP, sleep problem, kinesiophobia (Tampa Scale for Kinesiophobia), depressive condition (K6), physical flexibility and frequency of lifting at work. A logistic regression model was used to evaluate the factors associated with disabling LBP (LBP interfering with work) among nursing personnel.ResultsOf all participants, 110 (15.3%) reported having disabling LBP. The multivariable logistic regression analysis after adjustment for several confounding factors showed that kinesiophobia (highest tertile, adjusted OR (aOR): 6.13, 95% CI : 3.34 to 11.27), previous episode of LBP (aOR: 4.31, 95% CI: 1.50 to 12.41) and insomnia (aOR: 1.66, 95% CI: 1.05 to 2.62) were significantly associated with disabling LBP.ConclusionsThe present study indicated that kinesiophobia, a previous episode of LBP, and sleep problems were associated with disabling LBP among nursing personnel. In the future, workplace interventions considering assessments of these factors may reduce the incidence of disabling LBP in nursing staff, although further prospective studies are needed.

A search for OB stars in the field of the galactic OB association Bochum 7

Aims. We plan to identify the members of the Bochum 7 association by performing simultaneous astrometric and spectrophotometric analyses, and estimate its distance and evolutionary stage. Methods. We used our own visual spectroscopic and UBV photometric data of a 30′ × 30′ region centered at = 8h44m47.2s, = −45°58′55.5″. This information enabled us to estimate the spectral classification and distance of all stars present in the region. The proper motion was analyzed with data of the UCAC 5 catalog and was used to identify the members of this association. We added JHK data from 2MASS and IRAS catalogs to check for the presence of infrared (IR) excess stars. Results. We found that Bochum 7 is an OB association with at least 27 identified stellar members (l = 265°.12, b = − 2°) at a distance of ≃5640 pc. Its proper motion is μαcos δ = −4.92 ± 0.08 mas yr−1, μδ = 3.26 ± 0.08 mas yr−1. We derived an average heliocentric radial velocity of ~35 km s−1 and were able to confirm the binary nature of the (ALS 1135) system and detect four new binary star candidates. Analysis of data for massive Bo 7 star candidates points towards a young age (≤ 3 × 106 years old) for the association, although the presence of a previous episode of star formation remains to be analyzed.