This study is a systematic review and meta-analysis of studies using nucleic acid-based techniques to detect Mycobacterium avium paratuberculosis (MAP) in patients with Crohn's disease (CD) compared with controls. Database searches were conducted and risk difference estimates were calculated using meta-analysis. Fifty-eight studies were reviewed, 47 of which were included in the analysis. The pooled estimate of risk difference from all studies was 0.23 (95% confidence interval [CI], 0.14-0.32) using a random effects model. Similarly, MAP was detected more frequently from patients with CD compared with those with ulcerative colitis (risk difference 0.19, 95% CI, 0.10-0.28). Year of study, assay type, and inclusion of children explained some but not all of the observed heterogeneity. The data confirms the observation that MAP is detected more frequently among CD patients compared with controls. However, the pathogenic role of this bacterium in the gut remains uncertain. Our analysis demonstrates that there is an association between MAP and CD, across many sites, by many investigators, and controlling for a number of factors; however, this association remains controversial and inconclusive. Future studies should determine whether there is a pathogenic role.

Background:The provision of quality health care is one of the priorities of every government. The quality of such care is however, limited by the human and technical resources available. The varying types of thyroidectomy for Goitres are often done under general anaesthesia, unless, there is a contraindication such as, cardiopulmonary instability. Recently, there is increasing evidence that thyroidectomy could be done under local anaesthesia with or without anxiolytics or opioid analgesia augmentation. This study reports on our experience of performing thyroidectomy under infi ltrative local anaesthesia.Objectives: To evaluate the safety of performing thyroidectomy under infi ltrative local anaesthesia and compare the post-operative outcome with that done under general anaesthesia.Patients and methods: This is a descriptive case series of 59 patients that underwent thyroidectomy under fi eld block with 1% Lignocaine with Adrenaline 1:200,0000 dilutions. Dose was standardised for all patients at 4mg/kg under monitored anaesthesia. The period under study covered from October 2017-October 2019. The patients' characteristics analysed were Biodata, clinical diagnosis, patients' weight, type of surgery, duration of surgery and complications. Results:The study population were 59 patients, 88.1% were females, 11.9% were males with female -male ratio of 8:1. The mean age was 42.03(+_3.5), simple multinodular goitre was the most common subtype 47.5%, toxic multinodular goitre 39%, diffuse simple goitre and diffuse toxic goitre 5.1% each. Malignant goitre 3.4% and all are papillary carcinomas. 54,2% off all the goitres are WHO grade 3. The mean duration of surgery is 40minutes and the average duration of hospital stay is 24-48hours. There were 6 complications. 1(1.7%) sub-cutaneous haematoma, 1(1.7%) post-operative hypocalcaemia, 2(3.4%) keloidal scar and 2(3.4%) surgical site infections. Conclusion:Thyroidectomy under infi ltrative local anaesthesia is safe if done by a trained surgeon, in a poor resource health facility.Limitation: Patient's preference for general anaesthesia and short-necked, obese patients.

No abstract

Sepsis remains an intractable problem in the critically ill and is associated with considerable morbidity and mortality. Antibiotics have proved valuable and lifesaving in the management of this group of patients. However, antibiotic use is not without undesirable side effects, ranging from adverse drug interactions to increased toxicity and the development of resistance. The contribution of antibiotics to multiorgan failure within the intensive care unit setting is frequently overlooked. We review the role of this important group of agents in the context of multiple organ failure and proffer strategies for minimising adverse events associated with their use.

No abstract