Surgical site infections after abdominal surgery: incidence and risk factors. A prospective cohort study.

BACKGROUND: Abdominal surgeries have high rates of surgical site infections (SSIs), contributing to increased morbidity and mortality and costs for hospitalization. The aim of this study was to determine the SSI incidence rates and risk factors after abdominal surgeries. METHODS: This prospective cohort study included all patients undergoing abdominal surgeries between 2005 and 2007 in the Western Galilee Medical Center in Nahariya, Israel. SSI incidence rates were calculated per 100 operations. Odds ratios (ORs) were estimated for each risk factor using univariate and multivariate analyses by logistic regression models. RESULTS: Among 302 patients in the study cohort, the total SSI incidence rate was 22.2%. The univariate analysis defined 13 variables significantly associated with SSI: age > 60 years, lower functional status, diabetes mellitus, congestive heart failure, immunocompromising underlying disease, treatment with chemotherapy and other immunosuppressive medications, impaired immune system open cholecystectomy, laparotomy, an American Society of Anesthesiologists (ASA) score > 2, drain insertion, and 'dirty wound' classification. In multivariate regression analysis, treatment with immunosuppressive medications (OR = 2.5, 95% confidence interval (CI) = 1.099-143.443), open cholecystectomy (OR = 2.25, 95% CI = 2.242-40.109), and dirty wound classification (OR = 2.179, 95% CI = 3.80-20.551) were significantly associated with SSI. CONCLUSIONS: The significant risk factors defined should be addressed preoperatively to decrease the risk for SSI. Wound surveillance in the post-discharge period is necessary for correct estimation of SSI rates.

The role of empirical albendazole treatment in idiopathic hypereosinophilia - a case series.

Hypereosinophilia is usually defined as a blood eosinophil count >1500/µL. A broad variety of conditions are associated with hypereosinophilia. The present report describes three cases of hypereosinophilia, in which a thorough history, physical examination, laboratory and imaging investigations were unable to detect any abnormalities. Albendazole was empirically administered in all three cases, with complete normalization of eosinophil counts thereafter. Empirical treatment with albendazole for patients presenting with hypereosinophilia should be strongly considered.

L'hyperéosinophilie est généralement définie comme une numération d'éosinophiles sanguins supérieure à 1 500/µL. Diverses affections s'y associent. Le présent rapport en décrit trois cas, dans lesquels des antécédents approfondis, un examen physique et des examens de laboratoire et d'imagerie n'ont pas décelé d'anomalies. L'albendazole a été administré de manière empirique dans les trois cas, et la numération d'éosinophiles s'est entièrement normalisée. Il faudrait envisager un traitement empirique à l'albendazole chez les patients présentant une hyperéosinophilie.

Microangiopathic Anemia of Acute Brucellosis - is it a True TTP?

Thrombotic thrombocytopenic purpura (TTP) is a severe disease, potentially fatal, if not diagnosed and treated promptly. TTP is clinically characterized by the pentad of thrombocytopenia, Coombs-negative hemolytic anemia, fever, renal abnormalities and neurological disturbances. Advances in recent years have delineated the molecular mechanisms of acquired and hereditary TTP.Many infectious organisms have been reported to be associated with TTP, especially mycoplasma, but few cases of Brucella infection associated with thrombotic microangiopathy have been reported.We describe a young woman who presented with TTP after acute infection with both Brucella melitensis and Brucella abortus. The patient completely recovered following aggressive therapy with plasmapharesis, high-dose corticosteroids and appropriate antimicrobial therapy.Since measurement of ADAMTS13 activity and neutralizing antibodies is now available, and none of the reported cases of brucellosis with thrombotic microangiopathy (including the present report) were tested, for better understanding of this rare association, we recommend this work-up in future cases.

Olive oil consumption and non-alcoholic fatty liver disease.

The clinical implications of non-alcoholic fatty liver diseases (NAFLD) derive from their potential to progress to fibrosis and cirrhosis. Inappropriate dietary fat intake, excessive intake of soft drinks, insulin resistance and increased oxidative stress results in increased free fatty acid delivery to the liver and increased hepatic triglyceride (TG) accumulation. An olive oil-rich diet decreases accumulation of TGs in the liver, improves postprandial TGs, glucose and glucagon-like peptide-1 responses in insulin-resistant subjects, and upregulates glucose transporter-2 expression in the liver. The principal mechanisms include: decreased nuclear factor-kappaB activation, decreased low-density lipoprotein oxidation, and improved insulin resistance by reduced production of inflammatory cytokines (tumor necrosis factor, interleukin-6) and improvement of jun N-terminal kinase-mediated phosphorylation of insulin receptor substrate-1. The beneficial effect of the Mediterranean diet is derived from monounsaturated fatty acids, mainly from olive oil. In this review, we describe the dietary sources of the monounsaturated fatty acids, the composition of olive oil, dietary fats and their relationship to insulin resistance and postprandial lipid and glucose responses in non-alcoholic steatohepatitis, clinical and experimental studies that assess the relationship between olive oil and NAFLD, and the mechanism by which olive oil ameliorates fatty liver, and we discuss future perspectives.

Streptococcus pneumonia endocarditis associated with gastrointestinal malignancy.

Particular systemic infections have been found to be associated with concurrent malignancies sufficiently commonly as to warrant search for malignancy in patients with such infections. The current study adds Streptococcus pneumonia endocarditis to the list of relevant infections.

Suicidal attempts admitted to a general hospital in the Western Galilee: an inter-ethnic comparison study.

BACKGROUND: Deliberate self-harm is a relatively frequent cause of consultation in the emergency room of general hospitals. Despite its importance, few epidemiological studies of self-injury in Israel have been carried out, and of these, they mostly covered selected population groups. OBJECTIVES: To provide epidemiological data on self-harm in patients examined in the emergency room of a general hospital in the Western Galilee, with special emphasis on differential sociodemographic and clinical characteristics of the Arab and Jewish subjects. METHODS: Demographic, clinical, and self-harm characteristics were extracted from hospital files for people aged 18 years and older admitted to the general hospital in Nahariya, Western Galilee, over a 24-month period (January 1996 to December 1997) following a suicidal attempt. Chi-square statistics, two-tailed t-tests, and logistic regression analyses were used to test the significance of inter-ethnic differences in risk factors. RESULTS: The overall incidence rate of suicidal attempts was 16.7 per 100,000 population of Northern District in 1996 (Arabs, 24.4 and Jews, 11.0); or 37.6 per 10,000 admissions (Arabs, 44.2 and Jews, 30.3). Among the Jewish male subjects, attempts rose markedly after the age of 40, while among their Arab counterparts the age distribution was even throughout all age groups. Among Jewish females, admissions for self-harm rose gradually with age, while among the Arab women there was a peak at the 20-29 year age group. Both ethnic groups differed significantly in their sociodemographic and clinical profiles, but they shared common characteristics with regard to the attempt. CONCLUSIONS: Our findings suggest differential ethnic patterns of risk factors for self-harm. Further in-depth investigation of deliberate self-harm is warranted to better explore these factors.

Salmonella paratyphi endocarditis.

Endocarditis is a rare complication of salmonellosis. The most frequently observed species is Salmonella typhi. Endocarditis caused by Salmonella paratyphi is extremely rare with only three previous cases documented in the medical literature. We report a case of endocarditis caused by Salmonella paratyphi in an otherwise healthy young patient, with full recovery after appropriate antibiotic treatment.

An unusual cause of pleural effusion.

Primary effusion lymphoma (PEL) is a unique clinicopathological entity associated with human herpesvirus-8 (HHV-8) infection, occurring almost exclusively in human immunodeficiency virus (HIV)-infected individuals. We report a rare case of HHV-8-negative PEL in an HIV-negative elderly patient who presented with pleural effusion. The patient was treated with CHOP and Rituximab. As opposed to the general poor outcome of this disease, our patient achieved complete remission and is still without signs of disease 11 months after the last treatment.

Bone marrow fibrosis and caseating granulomas associated with intravesicular BCG treatment.

Intravesicular instillation of bacille Calmette-Guérin (BCG), an attenuated variant of the virulent strain of Mycobacterium bovis, has been extensively used as the treatment of choice for bladder cancer since first approved in 1976. Adverse effects of treatment are rare and mostly local, with systemic reactions complicating up to 5% of patients. The majority of serious side effects have occurred in immunocompromised patients. Even more rare is bone marrow involvement. Only two previous cases are reported in the medical English literature; in these cases, the granulomas were non-caseating. We describe a patient who developed fever and pancytopenia associated with mycobacterial infection after intravesicular instillation of BCG. Caseating granulomas were seen in the bone marrow biopsy and, later, bone marrow fibrosis developed gradually, in spite of successful treatment with antimycobacterial agents.

A rare lung manifestation with rapidly progressive glomerulonephritis (RPGN).

In this unusual case, we report the history of a patient who was hospitalized with pulmonary manifestations presenting as broncholitis obliterance organizing pneumonia (BOOP) associated with ANCA-negative pauci-immune glomerulonephritis. Other known causes for the occurrence of BOOP were excluded. Immediate diagnosis and treatment with a combination of steroids and cytotoxic therapy resulted in a complete remission and prevented eventual dialysis.

Intravenous immunoglobulin for treatment of toxic epidermal necrolysis.

We report three female patients suffering from toxic epidermal necrolysis, with 30% to 70% epidermal detachment. Alleged causative agents were dipyrone, dibenzazepine, and allopurinol. All patients were treated by intravenous immunoglobulins (IVIG) and survived without further complications, although poor prognostic factors such as concomitant diabetes, large areas of epidermal detachment, and pancytopenia were present. We report these cases with emphasis on the concept that prompt diagnosis, withdrawal of causative drugs, and immediate treatment are imperative for the favorable outcome of the disease. Our patients can be added to the list of those patients who were successfully treated by IVIG, as indicated in this review of the literature.

Genotypic differences of Candida albicans and C. dubliniensis isolates related to ethnic/racial differences within the same geographic area.

Candida albicans and C. dubliniensis genotype differences among Israeli ethnic groups were assessed. Isolates from Jews (51), Arabs (35) and Druze (25) were genotyped. The distributions among ethnic groups were not different, however they differed (p = 0.002) from global populations. Therefore, C. albicans and C. dubliniensis genotype distribution differences in Israel are related to changes in all ethnic groups.