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We present a 31-year-old man who, after a Conus textile sting acquired in New Caledonia, developed a cutaneous abscess on a buttock. The abscess was accompanied by pain, paraesthesia, general malaise, and fever. Complete remission was achieved by sodium hypochlorite packs and oral amoxicillin/clavulanic acid, metronidazole, and tramadol.
Four randomized controlled trials of medical therapy in adult patients with pouchitis were identified: two placebo controlled trials in active chronic pouchitis; one maintenance of remission trial comparing two active agents in chronic pouchitis; and one placebo-controlled maintenance of remission trial for chronic pouchitis. A single patient "n-of-1" trial for active chronic pouchitis was excluded.
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Two authors independently screened studies for eligibility, extracted data and assessed study quality. Methodological quality was assessed using the Cochrane risk of bias tool. The overall quality of the evidence supporting the outcomes was evaluated using the GRADE criteria. The primary outcome was the proportion of patients with clinical improvement or remission of pouchitis in patients with acute or chronic pouchitis, or the proportion of patients with no episodes of pouchitis after IPAA. The proportion of patients who developed at least one adverse event was a secondary outcome. We calculated the risk ratio (RR) and corresponding 95% confidence interval (CI) for each dichotomous outcome.
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Amebiasis remains a major public health issue in most of the world. Amebic liver abscess is the most common extraintestinal manifestation. A complication such as venous obstruction associated with amebiais is rare. We report a thrombosis in hepatic veins associated with amebic hepatic abscess in a traveler.
The quality of the studies was generally poor.
H and E is taken as the gold standard according to CDC. Urease test is a better screening procedure than culture. H pylori resistance to metronidazole in our zone was highest. This is due to general and extensive use of metronidazole for other infectious diseases. Our study suggests need for a systematic approach to determine antibiogram of the strains before considering the drug regimens.
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The authors report on 20 immunocompetent patients with brain abscess after 12 cases of middle ear, seven tooth and a single frontal sinus infection. The clinical aspects, hematochemical and microbiological data, the role of imaging diagnostics (CT, MR) and the type of treatment are analysed. Neurosurgery was performed on 17 patients (85%), eight of whom subsequently underwent evacuation of the primary source of infection (four mastoidectomies, two timpanoplasties, two tooth extractions). Mastoidectomy was eventually carried out on one of the three patients who did not undergo neurosurgery. Microbiological diagnosis was possible in nine patients through culture examination: Proteus mirabilis in three cases, Peptostreptococcus sp. in two, Micrococcus varians, Proteus vulgaris, Streptococcus sanguis and Streptococcus viridans not typed in single cases. The pus was sterile in eight patients (47.1% of those operated). An association of two antimicrobial agents was used in 18 patients, while in two cases monotherapy was preferred, based on the isolated bacteria. Treatment lasted on average 38 days. The most frequently used therapy regimen (75%) was the association of a beta-lactam drug with chloramphenicol or metronidazole. Therapy was successful in 19/20 patients; one patient died. There was no significant difference in prognostic terms with regard to sex, age, duration of symptoms prior to diagnosis, clinical picture at onset, number and size of abscesses or type of treatment. Recognising the first clinical signs and symptoms (headache, fever, alterations in consciousness, focal neurological deficit, epileptic seizures) is extremely important for prompt diagnosis of brain abscess.
The impact of antibiotic prophylaxis on fecal carriage of ESBL-/AmpC-/carbapenemase-producing Enterobacteriaceae (CPE) was investigated. Patients admitted for elective surgery or diagnostic procedure in a Department of Surgical Gastroenterology (SG) (n= 450) and Orthopedic Surgery (OS) (n= 300) provided a fecal swab at admission and responded to a questionnaire on possible exposures. SG patients received gentamicin/penicillin G (±metronidazole); OS patients received cefuroxime. Two days after surgery a second swab was taken. From SG patients, 6% of first swabs and 9% of second swabs were positive for ESBL-/AmpC-producers. A similar carriage rate was observed in OS patients (6% and 8%, respectively). No CPE were detected. Escherichia coli was the predominant species and blaCTX-M-15 (29% and 22%) and blaCTX-M-14 (11% and 17%) were the most prevalent ESBL genotypes among SG and OS patients. Two different prophylactic antibiotic regimens had no impact on carriage rates. Previous hospitalization and antimicrobial treatment were associated with carriage for SG patients.
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A double-blind, randomized trial was conducted to compare posthemorrhoidectomy pain with use of topical metronidazole (10 percent) vs. placebo carrier, applied to surgical site. Forty-seven patients were randomly allocated to receive metronidazole (n=25) or placebo (n=22). Pain was assessed using a visual analog scale preoperatively and on postoperative hours 6 and 12 and at days 1, 2, 7, and 14. The use of narcotic, additional analgesics, and complications were recorded. (Pain scores were calculated and compared with baseline values and control group (t test, SPSS ver.10).