Childhood Diarrhoea in the Eastern Mediterranean Region with Special Emphasis on Non-Typhoidal Salmonella at the Human–Food Interface

Diarrhoeal disease is still one of the most challenging issues for health in many countries across the Eastern Mediterranean region (EMR), with infectious diarrhoea being an important cause of morbidity and mortality, especially in children under five years of age. However, the understanding of the aetiological spectrum and the burden of enteric pathogens involved in diarrhoeal disease in the EMR is incomplete. Non-typhoidal Salmonella (NTS), the focus of this review, is one of the most frequently reported bacterial aetiologies in diarrhoeal disease in the EMR. Strains of NTS with resistance to antimicrobial drugs are increasingly reported in both developed and developing countries. In the EMR, it is now widely accepted that many such resistant strains are zoonotic in origin and acquire their resistance in the food-animal host before onward transmission to humans through the food chain. Here, we review epidemiological and microbiological aspects of diarrhoeal diseases among children in the EMR, with emphasis on the implication and burden of NTS. We collate evidence from studies across the EMR on the zoonotic exposure and antimicrobial resistance in NTS at the interface between human and foods of animal origin. This review adds to our understanding of the global epidemiology of Salmonella with emphasis on the current situation in the EMR.

Biomarkers in routine diagnosis of pleural effusions

Background: Pleural fluid biochemical analysis is the first step in pleural effusion (PE) diagnostics. Our purpose was to analyse the utility of the biomarkers used at our clinic in the routine diagnosis of PE.Methods: We retrospectively reviewed the PE levels of proteins, lactate dehydrogenase (LDH), alpha amylase (AA), pH and glucose in 433 patients who were treated at the University Clinic Golnik in a one-year period and compared these values with the final identified aetiology of the effusions.Results: The majority of the effusions were determined to be a consequence of malignancy (n = 154) or infection (n = 108). In 94 cases the aetiology of the effusions was heart failure and in 54 cases other diseases, while 23 effusions remained aetiologically undetermined. Considering Light’s criteria, the vast majority of the effusions were correctly classified as exudates or transudates (97.1 %). Comparing paramalignant and malignant effusions, we detected significantly lower values of pleural fluid LDH (p < 0.0005) and proteins (p < 0.0005), and higher pH (p < 0.0005) values in the paramalignant effusions.Conclusion: We have found that pleural LDH and proteins are the most helpful biochemical parameters in our routine diagnosis of pleural effusions and helped us to correctly narrow the aetiological spectrum. Furthermore, significantly higher pleural LDH and protein values and a pH below 7.32 additionally facilitated distinguishing between malignant and paramalignant effusions. Parameters such as glucose and AA are useful in selected cases and have a limited role in routine diagnostics.

Clinical and aetiological spectrum of spontaneous pneumothorax in adults in Sub-Himalayan: a prospective study at tertiary care institute

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">The spontaneous pneumothorax has been classified as major cause of morbidity and mortality among respiratory diseases. The objectives of the study were to determine the incidence and aetiology of spontaneous pneumothorax and to assess the clinical profile of affected patients admitted in our institute</span>.</p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">A hospital based prospective study was conducted in year 2011-12 in the Department of Medicine, IGMC Shimla (H.P.) India. During study period the total admissions were 7335 out of which 30 patients were diagnosed as spontaneous pneumothorax and treated as cases under study. The data was collected on proforma includes demographic profile, probable cause, clinical and outcome indicators of Spontaneous Pneumothorax, master chart framed and analysed into frequency percentage. </span><span lang="EN-IN"> </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Incidence of spontaneous pneumothorax was found to be 408.99/yr/100000 admissions in the department of medicine. Incidence of primary spontaneous pneumothorax was 81.79/yr/100000 admissions. Incidence of secondary spontaneous pneumothorax was 327.19/yr/100000 admissions. Majority of the patients of primary spontaneous pneumothorax were of the 20-29yrs age group. Higher proportions of cases were from male gender (93.33%). Secondary pneumothorax patients were mostly of 50 to 59 years age group. The predominant aetiology for secondary spontaneous pneumothorax was COPD (36.66%) followed by Pulmonary tuberculosis (33.33%)</span>.</p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">Spontaneous pneumothorax was more common in men. The predominant aetiology for secondary spontaneous pneumothorax was COPD (36.66%) followed by pulmonary tuberculosis (33.33%). </span></p><p class="abstract"> </p>

Urinary incontinence principles

Urinary incontinence (UI) is a highly prevalent and bothersome problem that affects men and women of all ages. The aetiological spectrum of UI is wide, encompassing dysfunctions of the lower urinary tract, its neural control, the pelvic floor as well as other factors such as the side effects of pharmacotherapy. Although not life-threatening, UI frequently impacts upon the quality of life, psychological and emotional well-being of affected individuals. Additionally, UI imposes a tremendous economic burden on both the individual and the wider society in costs of nursing care, treatments, and lost productivity. The purpose of this chapter is to provide a broad overview of the epidemiology, aetiopathophysiology of UI, and to discuss the approach to the assessment, investigation, and initial management of the patient presenting with UI.