Detection of alcoholic liver disease

INTRODUCTIONAlcohol has been used in society over centuries and all over the world for its mood-lifting properties and taste. It is probably ,however ,the commonest drug of abuse world-wide and unfortunately causes considerable morbidity, mortality and social disruption .In 1990 the cost tl the USA was more than $ 100 billion and 100 000 lives.The relationship between alcohol and mankind is well documented from the earliest tines .

Prospective Evaluation of Outcomes of Mechanical Devices in Women with Symptomatic Pelvic Organ Prolapse in Ogbomoso, South-Western Nigeria

Background: Symptomatic pelvic organ prolapse (POP) impacts the sufferers’ quality of life negatively. There is a preference for a mechanical device in certain conditions though the definitive management of POP is surgical. Objectives: We conducted the study to evaluate the outcome of management of POP using mechanical devices. Methods: It was a prospective study. It took place in the gynecology unit of the Bowen University Teaching Hospital Ogbomoso between May 2014 and April 2019. We followed up with eligible patients who opted for pessary use for a median duration of 18 months (Range 12 - 84 months). We excluded those who refuse to participate in the study. Results: Of the 127 patients with symptomatic POP, seventy-five (59.1%) opted for the use of mechanical devices, and 70 successfully retained them four weeks after insertion. We lost Six (9.2%) patients to follow up. Of the 64 women included in the analysis, 16 (25%) discontinued use at some point after four weeks, whereas 36 (56.3%) used the pessary successfully throughout the follow-up period. Overall, 12.1% of the women experienced minor complications (6.9% pain or discomfort, 3.2% excoriation or bleeding, and 2.0% dis-impaction or constipation). After cessation of pessary use, 12 (25%) of the 48 women chose surgery, and 10 (20.8%) chose no further treatment. Conclusion: This study concluded that pessary use for pelvic organ prolapse is safe in low resource settings. Therefore, it is justifiable to offer pessaries in the initial management of uterovaginal prolapse to all patients who opt for conservative management and those awaiting surgery.

腹腔镜下子宫内膜异位症切除术主要并发症的多中心前瞻性研究

Objective: To clarify the rate of major intra-operative and post-operative complications experienced during excisional surgery for endometriosis. Design: Prospective multi-centre observational study set in two University teaching hospitals and three private hospitals in Sydney, Australia. All consecutive subjects undergoing laparoscopic excisional surgery for minimal to severe endometriosis were recruited (790 subjects). Complications were recorded intra-opera- tively or post-operatively on a secure computerised patient database. Major intra-and post-operative complications i.e. inadvertent visceral or vascular injury or other complications directly related to surgery that either significantly prolonged the operating time, delayed discharge or necessitated re-admission. Results: Seven hundred and ninety subjects were recruited over a 3-year period. Seven major complications were experienced (8.8/1000); four bowel injuries, one cystotomy, one ureteric transection, and one major vascular injury. All visceral or vascular injuries were diagnosed prior to completion of the surgery. No significant longterm sequelae were experienced. Conclusion: The incidence of major complications in this study of 8.8/1000 compares favourably with other similar reports. In view of the potential symptom relief obtained, the authors continue to believe the benefits of such surgery significantly outweigh the risks of subsequent operative-related morbidity.

Screening for early-onset neonatal sepsis on the Kaiser Permanente sepsis risk calculator could reduce neonatal antibiotic usage by two-thirds

Importance:Effective screening strategies for early-onset neonatal sepsis(EONS)have the potential to reduce high volume parenteral antibiotics(PAb)usage in neonates.Objective:To compare management decisions for EONS,between CG149 National Institute for Health and Care Excellence(NICE)guidelines and those projected through the virtual application of the Kaiser Permanente sepsis risk calculator(SRC)in a level 2 neonatal unit at a district general hospital(DGH).Methods:Hospital records were reviewed for maternal and neonatal risk factors for EONS,neonatal clinical examination findings,and microbial culture results for all neonates born at≥34 weeks’gestation between February and July 2019,who were(1)managed according to CG149-NICE guidelines or(2)received PAb within 72 h following birth at a DGH in Winchester,UK.SRC projections were obtained using its virtual risk estimator.Results:Sixty infants received PAb within the first 72 h of birth during the study period.Of these,19(31.7%)met SRC criteria for antibiotics;20(33.3%)met the criteria for enhanced observations and none had culture-proven sepsis.Based on SRC projections,neonates with’’≥1 NICE clinical indicator and≥1 risk factor’were most likely to have a sepsis risk score(SRS)>3.Birth below 37 weeks’gestation(risk ratio[RR]=2.31,95%confidence interval[CI]:1.02–5.22)and prolonged rupture of membranes(RR=3.14,95%CI:1.16–8.48)increased the risk of an SRS>3.Interpretation:Screening for EONS on the SRC could potentially reduce PAb usage by 68%in term and near-term neonates in level 2 neonatal units.