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Endoscopic follow-up of patients resected for ileal Crohn's disease have shown that, in the absence of treatment, the post-operative recurrence rate is 70-90% within one year of the operation and 83-100% within 3 years. Post-operative recurrence requires further operation in approximately half the patients in a 10-year period of follow-up. Therapeutic strategies aimed to prevent recurrence are, therefore, needed. Evidence supporting the administration of drugs early after surgery are listed below. Evidence from morphological and immunological studies: minimal mucosal lesions have been found using scanning electron microscopy in unaffected specimens of ileum and colon from 2/3 of patients resected for Crohn's disease. An increased production of TNF alpha, IL-1 beta, IL-6 and phospholipase A2 has also been found in the unaffected mucosa of patients with Crohn's disease providing evidence for a sustained immune stimulation in Crohn's disease even in the absence of patent inflammation. These inflammatory mediators are inhibited "in vitro" by aminosalicylates and, therefore, their use early after surgery is justified. Evidence from randomised controlled trials: several randomised controlled clinical trials have shown that aminosalicylates are able to prevent post-operative recurrence. In particular, an Italian study demonstrated that the cumulative proportion of endoscopic recurrence at 36 months was significantly lower in patients treated with Asacol compared to controls (0.57 +/- 0.12 vs 0.83 +/- 0.07, p = 0.003). A less frequent occurrence of severe complications and reoperations was also observed in the Asacol group. A North American study confirmed these results at 3 years' follow-up using Salofalk. Additional evidence for effectiveness of aminosalicylates in the prevention of post-operative recurrence was provided by two more studies in which Pentasa was used. Further evidence in favour of 5-ASA treatment comes from a recent metanalysis which showed that 5-ASA is effective as maintenance treatment in Crohn's disease, in particular in patients with resection. Metronidazole and fish-oil have also been found to be useful in the prevention of post-operative recurrence in isolated reports but need further investigation. Finally, cigarette smoking and end-to-end anastomosis are considered to be associated with an increased risk of recurrence. Overall, these data suggest that to stop smoking, avoiding end-to-end anastomosis and early administration of admino-salicylates after surgery should be recommended for all patients resected for Crohn's disease.
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Strong acid inhibition using esomeprazole increases cure rates with triple therapy and 10-day treatments are more effective than 7-day ones. The combination of amoxicillin plus metronidazole at full doses, and using a physiologically-correct schedule three times a day, and has been shown to overcome metronidazole resistance and to achieve good eradication rates.
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Multiple brain abscesses are serious neurological problems with high mortality and disabling morbidity. The frequency is rising as a result of AIDS and the increasing number of immunocompromised patients.
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The activities of DU-6859a, ciprofloxacin, levofloxacin, sparfloxacin, piperacillin, piperacillin-tazobactam, imipenem, clindamycin, and metronidazole against 11 anaerobes were tested by the broth microdilution and time-kill methods. DU-6859a was the most active drug tested (broth microdilution MICs, 0.06 to 0.5 microg/ml), followed by imipenem (MICs, 0.002 to 4.0 microg/ml). Broth macrodilution MICs were within 3 (but usually 1) dilutions of the broth microdilution MICs. All compounds were bactericidal at the MIC after 48 h; after 24 h, 90% killing was shown for all strains when the compounds were used at four times the MIC. DU-6859a at < or = 0.5 microg/ml was bactericidal after 48 h.
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In this prospective, serial and cross-sectional study, H. pylori cultures were successfully obtained from 371 and 950 patients (never receiving eradication) during 2009-2010 and 2013-2014, respectively. Resistance to amoxicillin, clarithromycin, metronidazole, levofloxacin, tetracycline, and rifampicin was determined by Epsilometer test.
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A total of 5968 adult inpatients with hospital-onset CDI between January 1, 2002, and June 30, 2006.
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Statistical analysis was done with the help of Chi square test.
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The loss of fluid and electrolytes from a high-output ileostomy (>1200 ml/day) can quickly result in dehydration and if not properly managed may cause acute renal failure. The management of a high-output ileostomy is based upon three principles: correction of electrolyte disturbance and fluid balance, pharmacological reduction of ileostomy output, and treatment of any underlying identifiable cause. There is an increasing body of evidence to suggest that Clostridium difficile may behave pathologically in the small intestine producing a spectrum of enteritis that mirrors the well-recognised colonic disease manifestation. Clinically this can range from high-output ileostomy to fulminant enteritis. This report describes two cases of high-output ileostomy associated with enteric C difficile infection and proposes that the management algorithm of a high-output ileostomy should include exclusion of small bowel C difficile.
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Bacterial vaginosis, AV and AVF are associated with PTB, especially LM and severe PTB between 25 and 35 weeks. The absence of lactobacilli (AVF), partial BV and M. hominis, but not full BV, were associated with an increased risk of preterm delivery after 24 weeks+ 6 days. As metronidazole effectively treats full BV, but is ineffective against other forms of AVF, the present data may help to explain why its use to prevent PTB has not been successful in most studies.
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We report a case of a 22-year-old female university student who was admitted to the University Hospital of the West Indies, Jamaica with a presumptive diagnosis of pseudomembranous colitis PMC. She presented with a 5-day history of diarrhoea following clindamycin treatment for coverage of a tooth extraction due to a dental abscess. Her clinical condition deteriorated and progressed from diarrhoea to toxic megacolon, bowel perforation and Gram-negative sepsis. Clostridium difficile NAP12/ribotype 087 was isolated from her stool while blood cultures grew Klebsiella pneumoniae. Despite initial treatment intervention with empiric therapy of metronidazole and antibiotic clearance of Klebsiella pneumoniae from the blood, the patient died within 10 days of hospital admission.
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Our conclusion is that antibiotic treatment in the patients with acute appendicitis is quite effective, and these patients may not need surgery. The patients managed conservatively with antibiotics alone experience less pain and require less analgesia but have high recurrent rate.
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On a observé une augmentation de l’incidence d’infections par le Clostridium difficile chez les enfants hospitalisés des États-Unis. Le présent document de principes, qui s’adresse aux cliniciens qui s’occupent de nourrissons et d’enfants de la collectivité et en établissement, contient un résumé de l’information pertinente sur le rôle du C difficile dans la diarrhée infantile et propose des recommandations sur le diagnostic, la prévention et le traitement. On y traite des différences importantes des facteurs de risque et de la maladie entre les adultes et les enfants, de même que des thérapies émergentes. On ne connaît toujours pas la relation entre l’âge et la gravité de la maladie chez les enfants ayant une souche de C difficile nouvellement émergente et plus résistante aux fluoroquinolones (nord-américain type 1 en champ pulsé [NAP1]). On y souligne l’importance de la gestion des antimicrobiens à titre de stratégie préventive. Le présent document de principes remplace celui qui a été publié par la Société canadienne de pédiatrie sur le C difficile en 2000.