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Scientific Study Various methods of Interior Fixation for Treatment of Lisfranc Joint Damage.
tandard of care as an adjunct to postoperative analgesia for patients who undergo outpatient ARCR. LEVEL OF EVIDENCE Level III, retrospective, comparative therapeutic trial. BACKGROUND Several studies in the Arab region have recognized the rate of nosocomial infections caused by Pseudomonas aeruginosa which produce β-lactamase and identified their emergence and prevalence in the region. This article seeks to review molecular studies on these β-lactamase producing Pseudomonas aeruginosa during the period 2010 to 2018 in several countries of the Arab region in order to analyze the trend of rising prevalence of disease causing drug resistant Pseudomonas aeruginosa in the Arab region. METHODS The data available from selected clinical studies during the period 2010 to 2018 on β-lactamase producing P. aeruginosa in the Arab region obtained from reliable scientific databases was analyzed and evaluated. RESULTS Significant changes have been found in resistance of Pseudomonas aeruginosa towards certain antibiotics of the β-lactam class. There is an increasing trend in the occurrence of resistance genes in β-lactamase producing P. aeruginosa. CONCLUSION This review shows that there is increasing prevalence of β-lactamase producing P. aeruginosa in some countries in the Arab region. This is a major cause of concern as this implies that more and more instances of multidrug resistance are emerging in this area. This leads to an overall negative impact on the health concerns and amounts to increasing difficulty in combating disease. It is recommended that awareness about antibiotic use and abuse be made a priority and measures of curbing unchecked use of prescription antibiotics be put into place. Effective screening methods to detect cases of resistance at their onset may be developed. OBJECTIVE The purpose of this study was to isolate the active antibacterial compounds from Bilberry (Vaccinium myrtillus L.) against periodontopathic bacteria. METHODS The acetone soluble fraction of Bilberry was extracted from the oil layer by oil/water separation. The extract was then purified by a silica gel open column chromatography. The minimum inhibitory concentration (MIC) of the total extract or purified fractions against bacteria was measured at each step. RESULTS The MIC of the total extract against Porphyromonas gingivalis was 500 μg/mL. DTNB The fraction exhibiting antibacterial activity against P. gingivalis was called NU4-TDC, and its MICs against P. gingivalis, Fusobacterium nucleatum, and Prevotella intermedia were 26.0 ± 7.8 μg/mL, 59.0 ± 10.4 μg/mL, and 45.1 ± 16.5 μg/mL, respectively. The MIC against Streptococcus mutans was >62.5 μg/mL. CONCLUSION Bilberry contains antibacterial components against periodontopathic bacteria, such as P. gingivalis, F. nucleatum, and P. intermedia. V.BACKGROUND & AIMS Although single-operator cholangioscopy (SOC)-guided lithotripsy and large balloon sphincteroplasty (LBS)-based techniques are effective rescue measures, the ideal approach to management of difficult bile duct stones is unclear. We conducted a randomized trial to compare the effectiveness of SOC-guided lithotripsy and LBS-based approaches for endoscopic management of difficult bile duct stones. METHODS Patients with difficult bile duct stones who failed retrieval using balloon or basket were randomly assigned to groups that received SOC-guided laser lithotripsy (SOC-LL, n=33) or LBS (n=33), from June 2016 through August 2018. When assigned treatment was unsuccessful, patients underwent mechanical lithotripsy before crossing over to the other group. The main outcome was treatment success, defined as ability to clear the duct in 1 session. Secondary outcomes were adverse events and treatment costs. RESULTS A higher proportion of patients in the SOC-LL group had treatment success (93.9%) than in the LBS group (72.7%) (P=.021). On multiple logistic regression analysis, treatment success was significantly associated with use of SOC-LL (odds ratio [OR], 8.7; 95% CI, 1.3-59.3; P=.026), stone to extrahepatic bile duct ratio of 1 or less (OR, 28.8; 95% CI, 1.2-687.6; P=.038), and lack of a tapered bile duct (OR, 26.9; 95% CI, 1.3-558.2; P=.034). There was no significant difference between groups in adverse events (9.1% in the SOC-LL group vs 3.0% in the LBS group, P=.61) or overall treatment cost ($16,684 in the SOC-LL group vs $10,626 in the LBS group; P=.097). CONCLUSIONS In a randomized trial of patients with difficult bile stones that cannot be cleared by standard maneuvers, SOC-guided lithotripsy leads to duct clearance in a significantly higher proportion of patients than LBS-particularly when stone size exceeds the diameter of the extrahepatic bile duct. Adjunct lithotripsy might be required in patients with tapered distal bile duct, because LBS alone is less likely to be successful. BACKGROUND & AIMS Patient satisfaction is an important, but largely overlooked, component of management of functional gastrointestinal disorders. We aimed to identify demographic, clinical, psychosocial, and health-care use factors associated with satisfaction of patients with irritable bowel syndrome (IBS). METHODS We collected data from consecutive patients at an outpatient gastroenterology clinic of a tertiary care center from 2017 through 2019; the patients completed an electronic symptom survey at their initial visit and 3-6 months later. Patients were included in the study if they met Rome IV criteria for IBS with no organic cause for their symptoms. Patient satisfaction was measured using the irritable bowel syndrome satisfaction with care scale. We collected demographic, clinical, psychosocial, and healthcare use information from survey responses and review of medical records. RESULTS Of the 137 patients who completed the study, most were satisfied a great deal (34.9%) or completely (18.6%), whereas 6.2% were not satisfied at all and 14.7% were a little satisfied. Among the 5 satisfaction subscales, the highest proportion of patients were satisfied with connection with their provider (93.4%). The subscale benefits of the visit had the lowest satisfaction rate (70.8%). Factors associated with overall satisfaction scores in the 3-6 months after initial consultation included decreased severity of IBS, higher number of follow-up gastroenterology visits, higher number of diagnostic tests during the follow-up period, and higher number of recommendations made at initial visit. Additionally, lower depression score at initial visit associated with higher satisfaction after 3-6 months. CONCLUSIONS Based on a survey of 137 patients with IBS, factors associated with satisfaction 3-6 months after establishing care with a gastroenterologist include reduced IBS severity, lower depression score at initial visit, higher number of recommendations, and higher number of follow-up gastroenterology visits.
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