A Case of Gallstones Causing Pelvic Pain.

INTRODUCTION: Assessing abdominal pain, particularly in women of reproductive age, requires thorough history taking, clinical examination, and investigations to obtain an accurate diagnosis. Both surgical and gynecological causes need to be considered, particularly previous relevant surgical history. Presentation of case. We report a case of pelvic pain secondary to multiple gallstones found within the pelvic cavity postlaparoscopic cholecystectomy. Thorough investigations have been conducted without any obvious cause found. The pain was debilitating and largely affecting the patient's quality of life. Therefore, decision to perform diagnostic laparoscopy and gallstones was found all over pelvic cavity and retrieved. Her pain resolved post operatively. CONCLUSIONS: Gallbladder perforation and stone spillage are the most common complications of laparoscopic cholecystectomy that arise during the removal and dissection of gallbladder and can cause significant morbidity if not managed early, especially retrieval of the stones intraoperatively. Therefore, patient with history of previous cholecystectomy with stone spillage presenting with undifferentiated abdominal pain and early diagnostic laparoscopy should be considered.

Reducing surgical site infections post-caesarean section in an Australian hospital, using a bundled care approach.

BACKGROUND: The past 20 years have seen increasing Caesarean section (CS) rates in Australia. Increasing antenatal morbidity means that post-CS surgical site infection (SSI) is an issue impacting Australian women, mostly low-socioeconomic and regional communities. Recent trends supporting development of evidence-based bundled approaches to SSI reduction, have not proved efficacy nor supported bundle implementation. AIMS: This pilot study aimed to develop, implement and assess an evidence-based Caesarean Infection Prevention ("CIP") bundled intervention to reduce post-CS SSI rates in a high risk population. METHODS: The study was a pre-post-intervention study, including women undergoing CS at one referral hospital between December 1st 2016 and December 31st 2018. A 12 month retrospective pre-intervention review identified women who developed a post-CS SSI. A comprehensive literature review informed the development of the intervention, which was implemented in December 2017. Data was collected for the subsequent 12 months on women undergoing CS. RESULTS: A total of 710 procedures were monitored with 346 and 364 women in the pre and post-intervention groups respectively. Demographic and comorbidity variables remained consistent over time. Post-CS SSI rates significantly reduced post-intervention (5.5% vs. 1.6%, p = 0.007), the greatest benefit in class II and III obese patients (12.2% vs. 2.5%, p = 0.019). Higher hypertension rates (24% vs. 9%, p = 0.01) and lower maternal mean age (27 vs. 30, p = 0.01) were seen in patients with SSI. CONCLUSION: The "CIP" bundle effectively reduced post-CS SSIs in a high risk population. Our findings substantiate the need for development and evaluation of multifaceted, evidenced-based interventions to reduce post-CS SSIs. TRIAL REGISTRATION: Retrospectively registered. TRIAL REGISTRATION: ACTRN12619001001189, July 2019.

[Prevalence of sexually transmitted diseases (STD) in HIV positive women in southern Israel].

BACKGROUND: Co-infection of HIV and other sexualLy transmitted diseases (STDs) is common. The Centers for Disease Control and Prevention (CDC) recommends routine yearly screening for STDs in HIV carriers. There is only scarce data on the prevalence of STD in HIV positive individuals in Israel and no current recommendations on this issue are available. OBJECTIVES: To evaluate the prevalence of STDs, in HIV positive females attending the HIV Clinic at the Soroka University Medical Center in Beer Sheva and to compare prevalence and risk factors for STDs between HIV female carriers of Ethiopian and non-Ethiopian origin. METHODS: Eighty five HIV-positive women were enrolled in the study. Demographic data and sexual behavior were obtained and medical records were reviewed. Cervical swabs for Neisseria gonorrhoeae, Herpes simplex 1 and 2, Ureaplasma urealyticum and Mycoplasma hominis and serum samples for hepatitis B, C and syphilis were obtained. RESULTS: Thirty two of the study participants (37.6%) had at least one STD and in eleven cases (12.9%) two or more STDs were found. Ureaplasma urealyticum was the most frequent pathogen (29.4%). Prevalence for Mycoplasma hominis, HSV1 and 2, Neisseria gonorrhoeae, syphilis and HBV was low. Despite significant differences in sexual behavior between women of Ethiopian and non-Ethiopian origin there were no differences in the prevalence of STDs in the two groups. HCV was significantly more prevalent in women of non-Ethiopian origin, due to high use of intravenous drugs in this group. There was no correlation between CD4 levels and the prevalence of STDs in both groups. DISCUSSION AND CONCLUSION: A relatively low prevalence of STDs among female HIV carriers was found, despite low condom use. The exclusion of males in this study may have contributed to this. The most frequent pathogen found in this study was asymptomatic Ureaplasma urealyticum (29.4%). As this pathogen may cause premature delivery and fetal death it seems important to routinely screen HIV-positive fertile women for its presence. A nationwide multicenter study of HIV-positive females and males is needed in order to establish the prevalence of STDs in this population in Israel and to recommend a screening policy.

The prevalence of human papillomavirus and cervical cytology abnormalities in women infected with human immunodeficiency virus in southern Israel.

BACKGROUND: Concomitant human immunodeficiency virus (HIV) and human papillomavirus (HPV) infection increases both HPV persistence and the risk of invasive cervical cancer. An estimation of HPV prevalence among HIV-positive women in Israel would contribute to improving care for this population and preventing morbidity and mortality related to cervical cancer. OBJECTIVES: To determine the prevalence of HPV infection and cervical cytology abnormalities, and to assess the possible influence of HIV infection on HPV carriage in HIV-positive women attending the Infectious Disease Clinic at Soroka University Medical Center. METHODS: The study population included 84 HIV-seropositive women. They were examined by a gynecologist and screened for HPV genotyping, and Pap smears were obtained for cervical cytology. Demographic, behavioral, and HIV infection variables were also recorded and analyzed. RESULTS: Forty-nine (58.3%) of the study participants were HPV-positive; 34 of them had oncogenic genotypes. Young age (< 16 years) at first sexual intercourse was the only variable significantly associated with HPV infection (P < 0.05). Abnormal cervical cytology was present in 17 women (20.3%); 21 women were referred to colposcopy, which was abnormal in 9 (10.7%). CONCLUSIONS: The prevalence of HPV carriage among HIV-positive woman in our study was slightly higher than published elsewhere. The prevalence of pathological cervical cytology was much higher than in the general population. An extremely high prevalence of pathological colposcopies requiring further treatment was found. Screening for HPV and premalignant changes in the uterine cervix is highly recommended in the HIV-seropositive population. We suggest that colposcopy be considered part of the routine workup in HIV-seropositive woman.

Antepartum fetal death following a yellow scorpion sting.

Scorpion envenomation in pregnant victims has been scarcely studied. We would like to suggest an association between yellow scorpion sting during the third trimester of pregnancy and adverse fetal outcome. The particular deleterious mechanism of scorpion venom has not been elucidated yet.

Childhood obesity and attention deficit/hyperactivity disorder: a newly described comorbidity in obese hospitalized children.

OBJECTIVE: The current study described a subgroup of children presenting with obesity and comorbid attention deficit/hyperactivity disorder (AD/HD) and assessed a possible casual relationship. METHOD: School-aged children hospitalized for obesity (body mass index [BMI] >85%) in a tertiary referral center underwent extensive evaluations and were prospectively assessed for comorbid AD/HD. RESULTS: During a 4-year period, 32 obese school-aged children were hospitalized and 26 were included in the current study. We found that over one half (57.7%) suffered from comorbid AD/HD. DISCUSSION: AD/HD shows a high comorbidity among obese hospitalized children. The characteristic difficulty in regulation found in AD/HD may be a risk factor for the development of abnormal eating behaviors leading to obesity. We suggest that obese children should be screened routinely for AD/HD.