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Patients with Clostridium difficile infection and prior appendectomy may be prone to worse outcomes

World Journal of Gastrointestinal Surgery 2021年第11期13卷 1436-1447页

作者： Danial Haris Shaikh Harish Patel Rezwan Munshi Haozhe Sun Shehriyar Mehershahi Ahmed Baiomi Ahmed Alemam usman pirzada Iqra Nawaz Kamrun Naher Siddarth Hanumanthu Suresh Nayudu Division of Gastroenterology Department of MedicineBronxCare Health SystemBronxNY 10457United States Department of Medicine Nassau University Medical CenterNew YorkNY 11554United States Department of Medicine BronxCare Health SystemBronxNY 10457United States

BACKGROUND Clostridium difficile infection(CDI)occurs due to a dysbiosis in the colon.The appendix is considered a‘safe house’for gut microbiota and may help repopulate gut flora of patients with CDI.AIM To study the impact of prior appendectomy on the severity and outcomes of CDI.METHODS We retrospectively reviewed data of 1580 patients with CDI,admitted to our hospital between 2008 to 2018.Patients were grouped based on the presence or absence of the appendix.The primary aim was to(1)assess all-cause mortality and(2)the severity of CDI.Severity was defined as per the Infectious Diseases Society of America criteria.Logistic regression,and propensity score analysis using inverse probability of treatment weights(IPTW)was performed.RESULTS Of the 1580 patients,12.5%had a history of appendectomy.There was no statistical difference in mortality between patients with a prior appendectomy or without(13.7%vs 14%,P=0.877).However,a history of appendectomy affected the severity of CDI[odds ratio(OR)=1.32,95%confidence interval:1.01-1.75].On IPTW,this association remained significant(OR=1.59,P<0.05).On multivariable toxic megacolon(OR=5.37,P<0.05)and colectomy(OR=2.77,P<0.05).CONCLUSION Prior appendectomy may affect the severity of CDI,development of toxic megacolon and the eventual need for colectomy.Since treatment of CDI is governed by its severity,stronger antibiotic regimens or earlier use of fecal microbiota transplant may be a viable option for patients with prior appendectomy.

关键词： Appendectomy Clostridium difficile Toxic megacolon Colectomy Gut microbiome

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Hepatitis in slaughterhouse workers

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World Journal of Hepatology 2019年第1期11卷 37-49页

作者： Hassan Tariq Muhammad Umar Kamal Jasbir Makker Sara Azam usman Ali pirzada Vaniza Mehak Kishore Kumar Harish Patel Department of Medicine BronxCare Health System Division of Gastroenterology Department of Medicine BronxCare Health System

Slaughterhouse workers(SHW) are at increased risk of hepatitis which can occur due to different organisms and should be investigated for viral, bacterial, and parasitic organisms. Slaughter house personnel including butchers are at a higher risk of infections from cuts and blood-letting, with the possible risk of the transmission of blood-borne pathogens to their colleagues. The objective of this review is to evaluate the common etiologies of hepatitis in SHW which will assist in the assessment of these patients presenting with transaminitis. Types of Microorganisms causing hepatitis with their reservoirs, routes of transmission,laboratory diagnosis, clinical features, treatment options and preventive strategies are included in this review. Proper investigation and awareness is of utmost importance as it causes significant financial constraints derived from workers health cost and from livestock production losses when the disease is confirmed. The work up is essential because infected workers might be a source of infections to other colleagues, family and the consumers.

关键词： Hepatitis Slaughterhouse workers Liver infections Transaminitis Occupational safety Abattoir

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