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Pediatric Surgery International Mar 2024The purpose of this study was to review a 5-year operative experience of transanal fistula repair for the treatment of rectovestibular fistula with a normal anus in...
PURPOSE
The purpose of this study was to review a 5-year operative experience of transanal fistula repair for the treatment of rectovestibular fistula with a normal anus in female children.
METHODS
In this study, we conducted a retrospective review of children diagnosed with rectovestibular fistula with normal anus who underwent transanal fistula repair in the department of General Surgery, Children's Hospital of Chongqing Medical University. Clinical data were retrospectively analyzed.
RESULTS
A total of 56 female children were included in the study. The patients' ages ranged from 1 year 10 months to 15 years 11 months, with an average age of 5 years 1 month. These children had a clear history of gas or loose stool leakage through the vestibular area, with or without a history of vestibular infection. All patients had a normal anus and underwent transanal fistula repair. Follow-up was conducted through telephone or outpatient visits for a duration of 10 months to 5 years (average follow-up duration 19 months). Three patients experienced minimal secretion from the external orifice of the vestibular fistula within two weeks after the operation, but were successfully treated with sitting bath therapy without any relapse. Another three cases had a recurrence of the fistula, and two of them underwent transanal fistula repair at our center again, resulting in a successful cure after reoperation. The remaining case has not yet undergone reoperation. In the long-term follow-up, all the children had satisfactory anal appearance, with no fecal incontinence, anorectal stenosis, or fistula infection.
CONCLUSION
Transanal fistula repair is a simple, safe, and effective surgical method to treat female children with rectovestibular fistula with a normal anus.
Topics: Child; Child, Preschool; Female; Humans; Infant; Anal Canal; Plastic Surgery Procedures; Rectal Fistula; Rectovaginal Fistula; Retrospective Studies; Treatment Outcome; Adolescent
PubMed: 38456957
DOI: 10.1007/s00383-024-05658-4 -
The Journal of Infection Apr 2024Many sexual health services are overwhelmed and cannot cater for all the individuals who present with sexually transmitted infections (STIs). Digital health software...
INTRODUCTION
Many sexual health services are overwhelmed and cannot cater for all the individuals who present with sexually transmitted infections (STIs). Digital health software that separates STIs from non-STIs could improve the efficiency of clinical services. We developed and evaluated a machine learning model that predicts whether patients have an STI based on their clinical features.
METHODS
We manually extracted 25 demographic features and clinical features from 1315 clinical records in the electronic health record system at Melbourne Sexual Health Center. We examined 16 machine learning models to predict a binary outcome of an STI or a non-STI diagnosis. We evaluated the models' performance with the area under the ROC curve (AUC), accuracy and F1-scores.
RESULTS
Our study included 1315 consultations, of which 36.8% (484/1315) were diagnosed with STIs and 63.2% (831/1315) had non-STI conditions. The study population predominantly consisted of heterosexual men (49.5%, 651/1315), followed by gay, bisexual and other men who have sex with men (GBMSM) (25.7%), women (21.6%) and unknown gender (3.2%). The median age was 31 years (intra-quartile range (IQR) 26-39). The top 5 performing models were CatBoost (AUC 0.912), Random Forest (AUC 0.917), LightGBM (AUC 0.907), Gradient Boosting (AUC 0.905) and XGBoost (AUC 0.900). The best model, CatBoost, achieved an accuracy of 0.837, sensitivity of 0.776, specificity of 0.831, precision of 0.782 and F1-score of 0.778. The key important features were lesion duration, type of skin lesions, age, gender, history of skin disorders, number of lesions, dysuria duration, anorectal pain and itchiness.
CONCLUSIONS
Our best model demonstrates a reasonable performance in distinguishing STIs from non-STIs. However, to be clinically useful, more detailed information such as clinical images, may be required to reach sufficient accuracy.
Topics: Male; Humans; Female; Adult; Homosexuality, Male; Sexual and Gender Minorities; Sexually Transmitted Diseases; Sexual Behavior; Heterosexuality; HIV Infections
PubMed: 38452934
DOI: 10.1016/j.jinf.2024.106128 -
Scandinavian Journal of Immunology Mar 2024Acute-on-chronic liver failure (ACLF) is a progressive disease that is associated with rapid worsening of clinical symptoms and high mortality. A multicentre prospective... (Review)
Review
Acute-on-chronic liver failure (ACLF) is a progressive disease that is associated with rapid worsening of clinical symptoms and high mortality. A multicentre prospective study from China demonstrated that patients with hepatitis B virus-related ACLF (HBV-ACLF) exhibited worse clinical characteristics and higher mortality rates compared to non-HBV-ACLF patients. Immune dysregulation is closely linked to the potential mechanisms of initiation and progression of ACLF. Innate immune response, which is represented by monocytes/macrophages, is up-regulated across ACLF development. This suggests that monocytes/macrophages play an essential role in maintaining the immune homeostasis of ACLF. Information that has been published in recent years shows that the immune status and function of monocytes/macrophages vary in ACLF precipitated by different chronic liver diseases. Monocytes/macrophages have an immune activation effect in hepatitis B-precipitated-ACLF, but they exhibit an immune suppression in cirrhosis-precipitated-ACLF. Therefore, this review aims to explain whether this difference affects the clinical outcome in HBV-ACLF patients as well as the mechanisms involved. We summarize the novel findings that highlight the dynamic polarization phenotype and functional status of hepatic macrophages from the stage of HBV infection to ACLF development. Moreover, we discuss how different HBV-related liver disease tissue microenvironments affect the phenotype and function of hepatic macrophages. In summary, increasing developments in understanding the differences in immune phenotype and functional status of hepatic macrophages in ACLF patients will provide new perspectives towards the effective restoration of ACLF immune homeostasis.
Topics: Humans; Hepatitis B virus; Acute-On-Chronic Liver Failure; Prospective Studies; Hepatitis B; Macrophages
PubMed: 38441398
DOI: 10.1111/sji.13349 -
Journal of Clinical Virology : the... Apr 2024Anorectal and oropharyngeal exposures are implicated in sexual transmission of mpox, but authorized assays in the United States are only validated with cutaneous lesion...
Anorectal and oropharyngeal exposures are implicated in sexual transmission of mpox, but authorized assays in the United States are only validated with cutaneous lesion swabs. Diagnostic assays for anorectal and oropharyngeal swabs are needed to address potential future outbreaks. The Cepheid Xpert® Mpox is the first point-of-care assay to receive FDA emergency use authorization in the United States and would be a valuable tool for evaluating these sample types. Our exploratory study demonstrates 100 % positive agreement with our in-house PCR assay for natural positive anorectal and oropharyngeal specimens and 92 % sensitivity with low-positive spiked specimens. The Xpert® assay detected viral DNA in specimens not detected by our reference PCR assay from four participants with mpox DNA at other sites, suggesting it may be more sensitive at low viral loads. In conclusion, the validation of the Xpert® for oropharyngeal and anorectal sample types can be rapidly achieved if clinical need returns and prospective samples become available.
Topics: Humans; United States; Prospective Studies; Mpox (monkeypox); Sensitivity and Specificity; Specimen Handling; Polymerase Chain Reaction
PubMed: 38430669
DOI: 10.1016/j.jcv.2024.105659 -
Complicated anorectal sepsis: Validation of scoring system for predicting anorectal sepsis severity.Medicine Mar 2024Anorectal sepsis is a common and potentially serious medical condition characterized by infection and inflammation of the anal canal and surrounding tissues. However,...
Anorectal sepsis is a common and potentially serious medical condition characterized by infection and inflammation of the anal canal and surrounding tissues. However, the lack of standardized and comprehensive scoring systems specifically tailored for predicting the severity of anorectal sepsis poses challenges in clinical practice. This study aimed to develop and validate a scoring system for predicting the severity of anorectal sepsis by incorporating relevant patient factors. A retrospective cohort study was conducted at Mansoura University Hospital, a tertiary care center, over a period of 5 years. The study population consisted of 330 patients diagnosed with anorectal sepsis during the study period. A scoring system was developed using multiple variables, with each variable assigned a specific score based on its clinical significance and weight in predicting disease severity. The developed scoring system's predictive performance was evaluated using receiver operating characteristic (ROC) analysis, calculating the area under the ROC curve to assess discriminative ability. Descriptive statistics were used to summarize the demographic and clinical characteristics of the study population. Chi-square tests or t tests were performed to assess differences between non-severe and severe anal sepsis groups. The scoring system consisted of 12 variables, with a maximum total score of 18. The logistic regression analysis revealed significant associations between localized swelling, presentation within 72 hours, multiple drainage sessions, and severe anorectal sepsis. The ROC analysis showed an area under the curve of 0.85, indicating good discriminative ability of the scoring system. The scoring system was developed and validated in a single center, which may limit its generalizability to other settings. The scoring system demonstrated good predictive performance and can be a valuable tool for clinicians in assessing disease severity, guiding treatment decisions, and identifying high-risk patients.
Topics: Humans; Retrospective Studies; Sepsis; APACHE; ROC Curve; Inflammation; Prognosis
PubMed: 38428871
DOI: 10.1097/MD.0000000000037377 -
Euro Surveillance : Bulletin Europeen... Feb 2024BackgroundEpidemiology of (NG) infection remains inadequately understood.AimWe aimed to characterise NG epidemiology in Europe.MethodsWe used Cochrane and PRISMA...
BackgroundEpidemiology of (NG) infection remains inadequately understood.AimWe aimed to characterise NG epidemiology in Europe.MethodsWe used Cochrane and PRISMA guidelines to systematically review, report, synthesise and analyse NG prevalence data from 1949 to 30 September 2021. Random-effects meta-analyses estimated pooled prevalence. Meta-regression analyses investigated associations and sources of heterogeneity.ResultsThe 844 included publications yielded 1,573 prevalence measures. Pooled prevalence of current urogenital infection was 1.0% (95% CI: 0.7-1.2%) among general populations, 3.2% (95% CI: 1.8-4.8%) among female sex workers, 4.9% (95% CI: 4.2-5.6%) among sexually transmitted infection clinic attendees and 12.1% (95% CI: 8.8-15.8%) among symptomatic men. Among men who have sex with men, pooled prevalence was 0.9% (95% CI: 0.5-1.4%), 5.6% (95% CI: 3.6-8.1%), and 3.8% (95% CI: 2.5-5.4%), respectively, for current urogenital, anorectal or oropharyngeal infection. Current urogenital, anorectal or oropharyngeal infection was 1.45-fold (95% CI: 1.19-1.77%), 2.75-fold (95% CI: 1.89-4.02%) and 2.64-fold (95% CI: 1.77-3.93%) higher among men than women. Current urogenital infection declined 0.97-fold (95% CI: 0.96-0.98%) yearly, but anorectal and oropharyngeal infection increased (1.02-fold; 95% CI: 1.01-1.04% and 1.02-fold; 95% CI: 1.00-1.04%), respectively.Conclusions epidemiology in Europe has distinct and contrasting epidemiologies for vaginal sex transmission in heterosexual sex networks vs anal and oral sex transmission in MSM sexual networks. Increased transmission may facilitate drug-resistant strain emergence. Europe is far from achieving the World Health Organization target of 90% incidence reduction by 2030.
Topics: Female; Humans; Male; Gonorrhea; Homosexuality, Male; Neisseria gonorrhoeae; Prevalence; Sex Workers; Sexual and Gender Minorities; World Health Organization
PubMed: 38426239
DOI: 10.2807/1560-7917.ES.2024.29.9.2300226 -
BMC Infectious Diseases Feb 2024Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections have increased globally. Asymptomatic infections represent a significant risk of long-term...
Clinic-based evaluation of the dual Xpert CT/NG assay on the GeneXpert System for screening for extragenital chlamydial and gonococcal infections amongst men who have sex with men.
BACKGROUND
Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections have increased globally. Asymptomatic infections represent a significant risk of long-term complications. Men who have sex with men (MSM) are disproportionally affected, underscoring the need to offer screening programmes to this population. CT/NG Point of Care Testing (POCT) constitutes a strategic tool to improve the continuum of STI care, however extensive real-life evaluations amongst at risk populations are lacking. The aim of this study is to estimate the GeneXpert CT/NG assay performance and usability for CT and NG at genital and extragenital sites for screening amongst MSM.
METHODS
This study was a multi-site sexual health clinic-based evaluation (Italy, Malta and Peru) with consecutive enrolment. A first void urine sample (divided in two aliquots), two oropharyngeal and two anorectal swabs were collected for each study participant. One specimen set (one for each anatomical site) was tested with the dual index test (Cepheid) at the clinics by the healthcare staff, the other set with FDA/CE approved Nucleic Acid Amplification Tests (NAATs) at the laboratory. Clinical sites and reference laboratories participated in an internal and external quality control programme. Sensitivity, specificity, positive and negative likelihood ratios, positive and negative predictive values for each anatomical site were estimated using a meta-analytic approach.
RESULTS
One thousand seven hundred two MSM were recruited across all clinical sites for a total of 5049 biological specimens. NG and CT were respectively detected in 274 and 287 of samples. Overall, the NG POCT sensitivity and specificity was 91.43% and 99.75% in urine (LR + 372.80, LR- 0.09), 89.68% and 99.55% in rectal specimens (LR + 197.30, LR- 0.10) and 75.87% and 98.77% at the pharynx respectively (LR + 61.94, LR- 0.24). The CT component of the POCT sensitivity was 84.82% and specificity 99.63% in urine (LR + 228.68, LR- 0.15), 78.07% and 99.19% respectively on rectal site (LR + 96.23, LR-0.22), 67.79% and 99.88% respectively at pharyngeal site (LR + 554.89, LR- 0.32). 95.95% of MSM reported to be willing to wait for POCT results and no provider reported difficulties in terms of performance or interpretation of the results of the Xpert CT/NG.
CONCLUSION
Rapid turnaround time, ease of use and high acceptability make the Xpert CT/NG testing system a strategic tool for increasing testing frequency, reaching those not yet tested and offering the possibility of immediate treatment if needed. The assay showed good negative likelihood ratios and confirms its use to rule out CT/NG infections. Sensitivity varied across sites and pathogens. Periodic staff training at the testing sites should be mandatory.
Topics: Male; Humans; Homosexuality, Male; Neisseria gonorrhoeae; Chlamydia Infections; Sexual and Gender Minorities; Gonorrhea; Chlamydia trachomatis; Nucleic Acid Amplification Techniques; Tomography, X-Ray Computed
PubMed: 38418963
DOI: 10.1186/s12879-024-09042-4 -
Health Science Reports Feb 2024Perianal fistula is a prevalent anorectal condition originating from an infectious crypt extending to the external opening. Multiple surgical methods exist for treating...
BACKGROUND AND AIMS
Perianal fistula is a prevalent anorectal condition originating from an infectious crypt extending to the external opening. Multiple surgical methods exist for treating perianal fistulas; however, selecting the appropriate options is still controversial. Our study aims to evaluate seton replacement versus other surgical methods in treating perianal fistula.
METHODS
This study recruited 72 patients presenting with perianal discharge and diagnosed with perianal fistula through intra-sphincteric, trans-sphincteric, and supra-sphincteric examinations at Imam Reza and Besat Hospitals from July 2022 up to March 2023. Regarding case-control design, patients were divided into two groups: the first group ( = 36) underwent seton insertion, while the control group ( = 36) received alternative surgical methods. Follow-up was conducted for 1 month post-discharge, with monthly visits for 6 months. Patients were evaluated for fistula tract healing, seton loosening, and daily secretion rate (based on infected pads) during each visit. Finally, the two groups were compared in terms of improvement rates.
RESULTS
In the seton group, approximately 94.4% of patients showed improvement. However, the difference between the groups was insignificant ( = 0.494). Seton replacement was performed in 52% of patients, with the majority requiring replacement twice (61%). Improvement rates were highest among cases with two seton replacements, although the difference was not statistically significant ( = 0.073). Following seton replacement, the most common treatment methods were endoanal flap and fistulotomy, with observed improvement in 10 cases for each procedure.
CONCLUSION
This study highlights that draining seton remains a primary choice for intermediate treatment due to its satisfactory improvement rate and lower requirement for replacement, especially up to two times.
PubMed: 38410496
DOI: 10.1002/hsr2.1911 -
Journal of Pediatric Surgery Feb 2024Urinary tract drainage is necessary to facilitate the maneuver in laparoscopic-assisted anorectoplasty (LAARP). Male patients with Anorectal malformations (ARM) are...
BACKGROUND
Urinary tract drainage is necessary to facilitate the maneuver in laparoscopic-assisted anorectoplasty (LAARP). Male patients with Anorectal malformations (ARM) are often encounter difficult catheterization during surgery.
OBJECTIVE
We pioneered the urinary catheterization through the urachus in ARM patients and evaluated the efficacy.
METHOD
Fourteen ARM patients undergoing urinary catheterization through urachus between September 2015 and September 2023 were reviewed.
RESULTS
The median age at the time of surgery was 0.06 months. Nine neonatal patients underwent the one-stage LAARP, while five patients underwent staged procedure. Four ARM patients with rectoprostatic fistula, while ten with rectobulbar fistula. All patients successfully underwent transurachal catheterization. No incidents of catheter blockage, accidental removal, or urinary tract infection symptoms were detected during hospitalization.
CONCLUSIONS
Transurachal catheterization is a safe, effective, and cosmetic procedure for ARM patients with difficulty urethral catheterization.
LEVEL OF EVIDENCE
IV.
PubMed: 38403490
DOI: 10.1016/j.jpedsurg.2024.01.038 -
Medicina (Kaunas, Lithuania) Feb 2024-This report illuminates the distinctive features of a successfully managed Retzius space infection arising from a complex perirectal abscess. It adds novel insights to...
-This report illuminates the distinctive features of a successfully managed Retzius space infection arising from a complex perirectal abscess. It adds novel insights to the scientific literature by addressing the rarity of such occurrences, highlighting the diagnostic complexities associated with extraperitoneal spread, and underscoring the crucial role of a nuanced understanding of anatomy in navigating clinical scenarios involving anorectal abscesses. -A 68-year-old male presented with dizziness and diffuse lower abdominal pain, accompanied by intermittent perianal pain for one month. Regardless of an initial misdiagnosis as hemorrhoids, the patient presented sepsis status with fever, hypotension, and tachycardia upon admission. Clinical examinations, including a digital rectal examination, laboratory findings, and imaging studies, revealed a substantial perianal abscess extending into the space of Retzius. Primary Diagnoses, Interventions, and Outcomes-The primary diagnosis involved a heterogeneous fluid-filled perianal abscess extending into the Retzius space, confirmed by abdominal contrast-enhanced computed tomography (CT). Immediate initiation of broad-spectrum antibiotics and subsequent incision and drainage in the 8 o'clock region was performed. Post-operatively, the patient experienced rectal bleeding, necessitating suturing ligation. A follow-up CT scan revealed an extraperitoneal abscess around the bladder, leading to CT-guided drainage and identification of microbial pathogens. Antibiotic treatment with piperacillin-tazobactam was administered. With two weeks of antibiotics and post-operative care, the patient's symptoms improved, and he was discharged with no signs of recurrence or complications. -This case report emphasizes the importance of early consideration and identification of extraperitoneal abscesses for timely intervention. The complexity of anatomical planes in extraperitoneal spaces poses diagnostic challenges, necessitating a strategic treatment. The successful management of this case underscores the significance of a multidisciplinary approach, including prompt diagnosis, appropriate antibiotic therapy, and timely surgical interventions, ultimately contributing to improved outcomes in cases involving complex anorectal abscesses.
Topics: Male; Humans; Aged; Abscess; Drainage; Rectum; Tomography, X-Ray Computed; Anti-Bacterial Agents
PubMed: 38399580
DOI: 10.3390/medicina60020293