Amoxycillin/Clavulanic acid monotherapy in complicated paediatric appendicitis: Good enough?

BACKGROUND: Antibiotic choice for complicated appendicitis should be based on both microbiological effectiveness as well as ease of administration and cost especially in lower resourced settings. Data is limited on comparative morbidity outcomes for antibiotics with similar microbiological spectrum of activity. Incidence and morbidity of surgical site infection after appendectomy for complicated appendicitis was assessed after protocol change from triple antibiotic (ampicillin, gentamycin, and metronidazole) regimen to single agent (amoxycillin/clavulanic acid). METHODS: Surgical site infection (SSI) rate, relook surgery rate and length of hospital stay were retrospectively compared in patients treated for acute appendicitis preceding (2014, 2015; "triple-therapy, TT") and following (2017, 2018; "single agent, SA") antibiotic protocol change. RESULTS: The rate of complicated appendicitis was similar between groups; 72.6% in TT and 66% in SA (p = 0.239). Significantly, SSI occurred in 22.7% of the SA group compared to 13.3% in TT group (OR 1.920, 95% CI 1.000-3.689, p = 0.048). Use of laparoscopy increased from 31% in TT to 89% in SA, but with subgroup analysis this was not associated with increased SSI (17.3% in open and 20.6% in laparoscopic; OR 0.841, 95% CI 0.409-1.728, p = 0.637). Relook rate (OR 1.444, 95% CI 0.595-3.507, p = 0.093) length of hospital stay (U = 6859, z = -1.163, p = 0.245), and ICU admission (U = 7683, z = 0.634 p = 0.522) were equivocal. Neither group had mortalities. CONCLUSIONS: Despite increased SSI with SA, overall morbidity relating to ICU admission, relook rate and length of hospital stay was similar in both groups. More prospective research is required to confirm equivalent overall morbidity and that single agent therapy is more cost-effective with acceptable clinical outcomes.

Return to Ballet Progression for Dancers After Hip Arthroscopy for Instability or Femoroacetabular Impingement Syndrome.

ABSTRACT: Ballet dancers may be predisposed to hip injuries because of the unique demands placed on the hips during dance training and performance. Hip arthroscopy can be used to address several of these symptomatic disorders, including hip instability and femoroacetabular impingement syndrome (FAIS). After hip arthroscopy, ballet dancers undergo a rehabilitation program to allow for healing, range of motion restoration, and progressive strengthening. Once patients complete the standard postoperative therapy program, a paucity of information is available to guide dancers back to the advanced hip movements involved in ballet. Therefore, the purpose of this clinical commentary is to present a stepwise rehabilitation protocol with return to ballet progression for dancers undergoing hip arthroscopy for instability or FAIS. Particular emphasis is placed on movement-specific exercises for ballet performers, and objective clinical metrics, to guide return to dance progression.

Noise exposure enhances auditory cortex responses related to hyperacusis behavior.

Hyperacusis, a marked intolerance to normal environmental sound, is a common symptom in patients with tinnitus, Williams syndrome, autism, and other neurologic diseases. It has been suggested that an imbalance of excitation and inhibition in the central auditory system (CAS) may play an important role in hyperacusis. Recent studies found that noise exposure, one of the most common causes of hearing loss and tinnitus, can increase the auditory cortex (AC) response, presumably by increasing the gain of the AC. However, it is not clear whether the increased cortical response will affect sound sensitivity and induce hyperacusis. In this experiment, we studied the effects of noise exposure (narrow band noise, 12 kHz, 120 dB SPL, 1 hour) on the physiological response of the inferior colliculus (IC) and the AC, and the behavioral sound reaction in conscious Sprague Dawley rats. Noise exposure induced a decrease of sound evoked potential in the IC. However, significant increases of AC response including sound evoked potentials and the spike firing rates of AC neurons were recorded right after the noise exposure. These results suggest that noise exposure induces hyperexcitability of AC presumably by increasing the post-synaptic response of AC neurons. The behavioral consequence of the noise exposure on sound perception was measured by the amplitude of the acoustic startle response before and after noise exposure in a separate group of rats. Although noise exposure caused a moderate hearing loss, the acoustic startle amplitude at the super-threshold level was significantly increased. These results suggest that noise exposure can cause exaggerated the sound reaction which may be related with the enhanced responsiveness of the AC neurons. This phenomenon may be related with noise induced hyperacusis.This article is part of a Special Issue entitled: Tinnitus Neuroscience.

Motor and locomotor responses to systemic amphetamine in three lines of selectively bred Long-Evans rats.

The goal of the study was to measure spontaneous and amphetamine-induced motor and locomotor activity in three selectively bred lines of male Long-Evans rats. The number of 50 kHz ultrasonic vocalizations (USVs) emitted in response to heterospecific play with human hand ("tickling") had been measured daily in these lines of rats from 21 to 24 days of age, as a criterion for dividing them into high vocalizing line, low vocalizing line, and random breeding and testing lines. This study sought to determine whether selection of rats based on their affective social-vocalizations also had effects on their locomotor performance and sensitivity to amphetamine. In this study adult animals from the 25th generation (with no further selection) were tested. The results showed that rats, which were selectively bred to emit high numbers of 50 kHz vocalizations, also exhibited elevated levels of spontaneous locomotor activity. After systemic injection of d-amphetamine (1.5mg/kg), the level of motor and locomotor activity significantly increased further in all the lines as compared to saline controls. The horizontal and vertical activities and the distance covered by rats of the high line, both at the baseline and after amphetamine challenge, were significantly higher than those of the low line animals in absolute scores but not as proportion of relevant saline controls. Since appetitive 50 kHz USVs and locomotor activity are both dependent on the activity of the dopamine system, it is concluded that selection of rats based on the expression of their positive emotional state is also selecting other features than vocalization, namely locomotor behavior. This may help explain why these animals are relatively resistant to depressogenic manipulations.