A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in Epidemiology and Biostatistics , Johannesburg, 2013 / Previous studies have found prematurity to be consistently associated with necrotising enterocolitis (NEC). At Chris Hani Baragwanath Academic Hospital (CHBAH) in 1994, prematurity, antepartum haemorrhage and positive blood culture at birth were associated with NEC. This study looked at the maternal and neonatal factors that are associated with NEC at CHBAH during the era of human immunodeficiency virus (HIV) infection.

published_or_final_version / Surgery / Doctoral / Doctor of Philosophy

Thesis (Ph. D.)--University of Hong Kong, 2009. / Includes bibliographical references (p. 234-252) Also available in print.

Idelalisib is an oral, phosphatidylinositol 3-kinase delta (PI3Kδ) inhibitor, approved by FDA since July 2014 for the treatment of relapsed follicular B-cell non-Hodgkin lymphoma. Data from three phases of the study involving idelalisib demonstrate diarrhea (47%) to be the common adverse effect. The other side effects are pyrexia (28%), fatigue (30%), nausea (29%), cough (29%), pneumonia (25%), abdominal pain (26%) and rash (21%). The characteristic histological findings of idelalisib colitis include intraepithelial lymphocytosis, neutrophilic cryptitis and epithelial cell apoptosis within the crypts. Histological findings help differentiate among other causes of diarrhea and entero-colitis. We present a female patient with recurrent follicular lymphoma treated with idelalisib and presented with diarrhea. She was found to have entero-colitis and was treated successfully with drug discontinuation and prednisone.

OBJETIVO: Conocer la prevalencia y características clínicas de Enterocolitis Necrosante en recién nacidos pretermino menores de 1500g en UCIN del Hospital Nacional Sergio Bernales de Noviembre 2013 – Noviembre 2015. MATERIAL Y METODOS: Se realizó un estudio de tipo observacional, descriptivo, retrospectivo en la UCIN del Hospital Nacional Sergio E. Bernales, donde se encontraron 11 recién nacidos vivos prematuros y con un peso menor de 1500 gr que cumplieron con los criterios de inclusión. Se revisó el libro de los registros de ingresos en el servicio de UCI de neonatología, el instrumento utilizado fue la ficha de recolección de datos. Finalmente, se realizó un análisis descriptivo utilizando el paquete estadístico SPSS (Statistical Package for the Social Sciences) versión 23. RESULTADOS: Durante el periodo de estudio ingresaron 716 recién nacidos a la UCI neonatal en el Hospital Sergio E. Bernales , donde 389 eran prematuros, de los cuales solo 106 tenían muy bajo peso al nacer y de estos solo 11 (10,38%) presentaron Enterocolitis Necrosante , se observó que el 54,55%(6) fueron de sexo femenino y 45,45 % (5) masculinos, en cuanto al peso se encontró 63,64% (7) con muy bajo peso y 36,36% (4) extremo bajo peso. El 9,9% era prematuros extremos, 18,18 % muy prematuros y el 72,73 % de moderado prematuros, no hubieron casos de prematuros cerca a término ( 35 -36 ss) . El apgar al primer minuto de vida fue de 72,73 % con apgar entre 7 a 10 y 9,09 % un apgar de 0-3. El apgar a los 5 minutos fue de un 9,09% con depresión moderada y un 90,91% con un apgar normal. El 100% curso con sepsis, 72,7 % con enfermedad de membrana hialina, 18,1% ictericia del prematuro y asfixia junto a Taquipnea transitoria del RN ambos con un porcentaje de 9,09%. CONCLUSIÓN: Se encontró que la prevalencia de enterocolitis Necrosante es similar a lo descrito en la literatura además de presentarse con mayor frecuencia en recién nacidos prematuros

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / OBJECTIVE: An estimated 20-30% of patients with primary Clostridium difficile infection (CDI) develop recurrent CDI (rCDI) within 2 weeks of completion of therapy. While the actual mechanism of recurrence remains unknown, a variety of risk factors have been suggested and studied. The aim of this systematic review and meta-analysis was to evaluate current evidence on the risk factors for rCDI. DESIGN: We searched MEDLINE and 5 other databases for subject headings and text related to rCDI. All studies investigating risk factors of rCDI in a multivariate model were eligible. Information on study design, patient population, and assessed risk factors were collected. Data were combined using a random-effects model and pooled relative risk ratios (RRs) were calculated. RESULTS: A total of 33 studies (n=18,530) met the inclusion criteria. The most frequent independent risk factors associated with rCDI were age≥65 years (risk ratio [RR], 1.63; 95% confidence interval [CI], 1.24-2.14; P=.0005), additional antibiotics during follow-up (RR, 1.76; 95% CI, 1.52-2.05; P<.00001), use of proton-pump inhibitors (PPIs) (RR, 1.58; 95% CI, 1.13-2.21; P=.008), and renal insufficiency (RR, 1.59; 95% CI, 1.14-2.23; P=.007). The risk was also greater in patients previously on fluoroquinolones (RR, 1.42; 95% CI, 1.28-1.57; P<.00001). CONCLUSIONS: Multiple risk factors are associated with the development of rCDI. Identification of modifiable risk factors and judicious use of antibiotics and PPI can play an important role in the prevention of rCDI.

Necrotizing enterocolitis (NEC), a severe inflammatory disorder of the gastrointestinal tract with high morbidity and mortality, affects primarily preterm infants. The diagnosis represents a challenging task, and no biomarker has been found to aid early diagnosis with high accuracy. Microdialysis has been widely used to detect metabolites of anaerobic metabolism, enabling a local and early detection of ischemia. This thesis aims to evaluate the possibility of detecting intestinal ischemic stress in experimental and clinical  NEC, by use of rectal intraluminal microdialysis. Intraluminal rectal microdialysis was performed on rats subjected to total intestinal ischemia. Metabolites of ischemia were detectable in both ileum and rectum, with raised glycerol concentrations and lactate/pyruvate ratios. Elevated concentrations of glycerol correlated to increasing intestinal histopathological injury. Experimental early NEC was induced in newborn rat pups, by hypoxia/re-oxygenation treatment. Development of NEC was confirmed by histopathology. Elevated glycerol concentrations were detected by rectal microdialysis. The genetic alterations following experimental NEC in rat pups were studied with microarray. Immunohistochemistry staining was performed for tight junction proteins claudin-1 and claudin-8. Several genes were altered in experimental NEC, mainly genes regulating tight junctions and cell adhesion. Immunohistochemistry revealed reduced expression of claudin-1. A prospective study was conducted on preterm infants with a gestational age of less than 28 weeks. The infants were admitted to a neonatal intensive care unit, and observed during a 4-week period. Rectal microdialysis was performed twice a week, and blood was drawn for analysis of I-FABP. A total of 15 infants were included in the study, whereof four infants developed NEC, and 11 served as controls. Rectal glycerol and I-FABP displayed high concentrations, which varied considerably during the observation periods, both in NEC and controls. No differences in either glycerol or I-FABP concentrations were seen in the NEC-group vs. the controls. In conclusion, rectal microdialysis can detect metabolites of intestinal ischemia, both in experimental and clinical NEC. Rectal microdialysis is safe and could provide a valuable non-invasive aid to detect hypoxia-induced intestinal damage or ischemic stress in extremely preterm infants. In this study however, it was not possible to predict the development of clinical NEC using microdialysis or I-FABP.

The purpose of this review of literature is to understand the current state of the science and to make recommendations for practice and research in regards to the gastrointestinal condition affecting premature infants, necrotizing enterocolitis (NEC). Emphasis is placed on reviewing the literature to identify prevention strategies nurses can use to reduce the incidence, morbidity and mortality of NEC. The introduction will focus on discussing the problem of NEC including its risk factors, pathophysiology, and disease presentation. The findings sections will focus on the most promising and researched areas of intervention. The discussion section will focus on how this knowledge can be translated into practice and what nurses can do about it. The research will be conducted through nursing databases with conceptual primary sources that will further expand upon the selected studies on this topic.

No description available.

published_or_final_version / Biological Sciences / Doctoral / Doctor of Philosophy