Causes and treatment outcome of mechanical bowel

obstruction in north eastern Nigeria.

Abstract
BACKGROUND: Mechanical bowel obstruction is one of the commonest surgical
emergencies in the tropics. There has been a recent change in its commonest aetiology
from external abdominal hernias to adhesions however data on the subject from this
environment are lacking.
OBJECTIVES: To establish the aetiological factors, clinical presentation, treatment
methods and outcome of mechanical bowel obstruction (MBO) in Maiduguri.
METHODS: A retrospective review of all cases of MBO that presented to the surgical
services of the University of Maiduguri Teaching Hospital (UMTH) between Jan 1994 and
March 2004 was under taken.
RESULTS: There were 372 patients ranging between ages five days and 90 years with a
male: female ratio of 2.4:1. The mean age was 34.5 years. Patients below 10 years and
those between the third and fifth decades accounted for 227(60%) of the cases. Abdominal
pain 330 (88.7%), vomiting 316 (84.8%), and constipation 293 (78.8%) were the main
symptoms while tenderness and abdominal masses were common signs. Obstructed
external hernias, 131 (35.0%) were the commonest cause of MBO; with indirect inguinal
hernia 105, (80.1%) accounting for most hernias. Intraperitoneal adhesions 99, accounted
for 26.61% of cases. Other causes in descending order were intussusception 80 (21.5%),
malignant colonic obstruction 34 (9.14%) and sigmoid volvulus 11 (2.95%). There were no
cases of MBO due to Ascaris worms. Adhesiolysis and bowel resection were the
commonest operative procedures performed. Common postoperative complications
included wound infection 57 (15.3%) and pneumonia 35 (9.4%). There were 34 deaths;
giving a mortality rate of 9.14%.

CONCLUSION: Strangulated external hernias remain the main cause of MBO though its
incidence appears to be falling. The pattern of MBO seems to be affected by changing
attitude to and availability of elective operations for external abdominal hernias.

http://europepmc.org/abstract/med/19025024
Etiology and treatment of community-acquired pneumonia
in ambulatory children
ABSTRACT:

Objectives. To determine the etiology of community-acquired pneumonia in ambulatory children and

to compare responses to treatment with azithromycin, amoxicillin-clavulanate or erythromycin estolate.
Methods. Ambulatory patients with pneumonia were identified at the Children's Medical Center of
Dallas, TX. Children age 6 months to 16 years with radiographic and clinical evidence of pneumonia were
enrolled and randomized to receive either azithromycin suspension for 5 days or a 10-day course of
amoxicillin-clavulanate for those <5 years or erythromycin estolate suspension for those 5 years. Blood
culture was obtained in all patients and we obtained nasopharyngeal and pharyngeal swabs for culture and
polymerase chain reaction (PCR) testing for Chlamydia pneumoniae and Mycoplasma pneumoniae and
nasopharyngeal swabs for viral direct fluorescent antibody and culture. Acute and convalescent serum
specimens were tested for antibodies to C. pneumoniae, M. pneumoniae and Streptococcus
pneumoniae. Patients were evaluated 10 to 37 days later when repeat specimens for serology, PCR and
culture were obtained. For comparative purposes healthy children attending the well-child clinic had
nasopharyngeal and pharyngeal swabs obtained for PCR and culture for C. pneumoniae and M.
pneumoniae.
Results. Between February, 1996, and December, 1997, we enrolled 174 patients, 168 of whom fulfilled
protocol criteria for evaluation. There were 55% males and 63% were <5 years of age. All blood cultures
were sterile and there was no correlation between the white blood cell and differential counts and etiology
of pneumonia. Etiologic agents were identified in 73 (43%) of 168 patients. Infection was attributed to M.
pneumoniae in 7% (12 of 168), C. pneumoniae in 6% (10 of 168), S. pneumoniae in 27% (35 of 129) and
viruses in 20% (31 of 157). None of the swab specimens from 75 healthy control children was positive
for C. pneumoniae or M. pneumoniae. Clinical response to therapy was similar for the three antibiotic
regimens evaluated, including those with infection attributed to bacterial agents.

Conclusion. Although a possible microbial etiology was identified in 43% of the evaluable patients,
clinical findings and results of blood cultures, chest radiographs and white blood cell and differential
counts did not distinguish patients with a defined etiology from those without a known cause for
pneumonia. There were no differences in the clinical responses of patients to the antimicrobial regimens
studied.

http://journals.lww.com/pidj/Abstract/1999/02000/Etiology_and_treatment_of_community_acquire
d.4.aspx
 Kabanata XVII
Ang mga Kadayaan

Buod
Sinalubong ni Mr. Leeds ang mga panauhin sa kanyang perya. Bago nagsimula ang palabas, nagsiyasat si Ben Zayk upang
Makita ang salamin sa kanyang inaasahang matagpuan, ngunit wala siyang nakita.

Pumasok si Mr. Leeds sa isang pinto at may dalang kahong kahoy sa kanyang pagbabalik. Ipinaliwanag niya na ito ay
natagpuan naiya sa isang libingang nasa-piramid ni Khufu, isang Paraon ng Ehipto. Ang kahon ay may lamang abo at
kapirasong papiro na kinasusulatan ng dalawang salita. Sa pamamagitan ngpagbigkas ngunang salita ang abo ay
nabubuhay at nakakausapang isang ulo at pagbanggit ng ikalawang salita ito ay babalik sa dating kinalalagyan nito.

Bumigkas ng isang salita si Mr. Leeds, lumabas ang isang ulo at sinsbi nitong siya si Imuthis. Siya ay umuwi sa sariling
bayan pagkatapos ng pag-aaral at mahabang paglalakbay. Sa kanyang pagdaraan sa Babilonia ay nabati niya ang isang
lihim na hindi ang tunay na Sumerdis ang namamahala doon kundi si Gautama, isang magnanakaw ng kapangyarihan at
namamahala sa tulong ng pandaraya. Sa katakutang isumbong siya kay Cambises ay binalak ang ikakasawi ni Imuthus sa
tulong ng mga saserdoteng Taga-Ehipto na siyang nakapangyayari noon sa kanilang bayan. Siya ayumibig sa isang anak
ng pari at naging kaagaw niya rito ang pari sa Abidos. Nagpanukala ang pari ng kaguluhan at siya ang sinangkalan.
Isinakdal siya at napiit, tumakas at napatay. Ayon sa ulo siya ay nabuhay muli upang ihayag ang gayong kataksilan. Titig
na titig kay Padre Salvi ang espinghe habang nagsasalita ito. Dahil sa takot hinimatay ang prayle.

Kinabukasan nagpalabas ng utos ang gobernador na nagbabawal sa palabas ngunit wala na si Mr. Leeds, nagtungo ito sa
Hongkong dala ang kanyang lihim.

Mga Tanong at Sagot

1.Bakit hinimatay si Padre Salvi?

Sagot

Dahil sa takot sa tinawag na ulo.

2. Kanino inahalintulad ang buhay ni Imuthis?

Sagot

Kay Ibbara.

3. Ano ang ipinahihiwatig ng naging reaksyon ni Padre Salvi pagkatapos ng salaysay ni Imuthis?

Sagot

Ito ay nagpapakilala ng pagtanggap ng mga prayle sa kanilang kasamaan at pagpakasal.