Non-antibiotic treatment of uncomplicated acute diverticulitis is applicable and safe in our environment. A prospective multicenter study

INTRODUCTION

acute diverticulitis is one of the most frequent underlying causes behind individuals attending the Emergency Room with abdominal pain. The most widespread therapy for acute uncomplicated diverticulitis includes outpatient treatment with antibiotics; however, several publications indicate that patients can also be successfully treated without antibiotics. The results of the implementation of this more recent protocol in two hospitals in Madrid are presented.

METHODS

an observational prospective study was performed. Participants were patients diagnosed with uncomplicated acute diverticulitis at two hospitals in Madrid, Hospital Universitario de Torrejón and Hospital Universitario Puerta de Hierro Majadahonda, between December 2018 and August 2021, treated on an outpatient basis without antibiotic therapy. The study group was compared with a control group, composed of patients diagnosed with uncomplicated acute diverticulitis and treated with outpatient antibiotic therapy at Hospital Universitario Puerta de Hierro between March 2015 and March 2018.

RESULTS

three hundred and sixty-one patients were included, 182 in the study group and 179 in the control group. Diverticulitis was persistent in 19 patients (10.4 %) in the study group, who were not treated with antibiotics, and in five patients (2.8 %) in the control group, treated with outpatient antibiotic therapy (p = 0.004). Recurrences occurred in 23 patients (12.6 %) in the study group, and in 53 patients (29.6 %) in the control group (p < 0.0001). The analysis of the complications found no significant differences between both groups (p = 0.109). No urgent surgical intervention or mortality was recorded in the study group.

CONCLUSIONS

in our environment, symptomatic non-antibiotic treatment of uncomplicated acute diverticulitis cases is safe, without showing a higher rate of complications. Although, there seems to be a worse initial symptom control.

Efficacy of amoxicillin/clavulanic acid after surgical drainage of perianal abscess in the prevention of the development of anal fistula (PERIQxA study): study protocol for a multicenter randomized, double-blind clinical trial

BACKGROUND

Anorectal fistula, which is a relatively common pathology, is the chronic manifestation of the acute perirectal process that forms an anal abscess. The development of a fistula after incision and drainage of an anal abscess is seen in approximately 26-37%. Its treatment is a relevant topic, and the role of the use of antibiotic therapy in its prevention remains controversial, after the publication of several studies with contradictory results and several methodological limitations. Our hypothesis is that the combination of amoxicillin and clavulanic acid will reduce the incidence of anal fistula.

METHOD

The aim of this study is to evaluate the efficacy of antibiotherapy after surgical drainage of perianal abscess in the development of perianal fistula. The PERIQxA study is a multicenter, randomized, double-blind controlled trial. The study has been designed to include 286 adult patients who will be randomly (1:1) assigned to either the experimental (amoxicillin/clavulanic acid 875/125 mg TDS for 7 days) or the control arm (placebo). The primary outcome measure is the percentage of patients that develop perianal fistula after surgery and during follow-up (6 months).

DISCUSSION

This clinical trial is designed to evaluate the efficacy and safety of amoxicillin/clavulanic in the prevention of perianal fistula. The results of this study are expected to contribute to stablish the potential role of antibiotherapy in the therapeutics for anal abscess.

TRIAL REGISTRATION

EudraCT Number: 2021-003376-14. Registered on November 26, 2021.

Diverticulitis in immunodeficient patients: our experience in the management of high-risk patients

INTRODUCTION

acute diverticulitis is a very prevalent disease. The need for a more aggressive management in immunodeficient patients has not been established. We present the results of our unit with immunodeficient patients diagnosed with acute diverticulitis and their follow-up.

OBJECTIVES

to assess the possibility that a conservative management in this group is as valid as in the immunocompetent population.

METHODS

a retrospective analysis study was performed in our hospital. Forty immunodeficient patients (transplant, corticoid treatment, dialysis, oncologic, HIV patients) diagnosed with acute diverticulitis were analyzed. The patients were managed with a surgical or non-surgical treatment according to their status on admission. The main analyzed items were the severity of the acute episode and the need for surgical treatment compared to the cause of immunodeficiency. Other studied variables included follow-up results and recurrences.

RESULTS

thirty-two of the 40 patients studied received a non-surgical treatment during the acute episode, eight required emergency surgery (seven had a Hartmann procedure and one underwent a colon resection and anastomosis). Transplant patients and those between 40 and 50 years old proved to be higher risk groups. Three patients subsequently required elective surgery due to complications. Twenty-four patients had uneventful recoveries.

CONCLUSIONS

the frequency of complicated acute diverticulitis is higher in immunodeficient patients than that of the general population. Non-surgical treatment seems to be as safe as in immunocompetent patients. Younger and transplanted patients were higher risk groups for severe acute diverticulitis that required a more aggressive management initially.

New method to assess the long-term role of wind energy generation in reduction of CO2 emissions - Case study of the European Union

Most existing works using a displacement estimation method to estimate the CO₂ emissions abated by wind energy are based on the current operating principles of the power system. They consider a fixed displacement emission factor since wind energy is assumed to replace high-carbon generation. This method may be unsuitable in the long run when the energy mix of most countries becomes more decarbonised. Consequently, wind energy would replace those technologies becoming increasingly predominant in the future, i.e. lower polluting fossil fuels such as natural gas and even other less competitive low-carbon technologies. In order to consider this effect, this paper proposes a new method that estimates a range of potential CO₂ emissions abated by wind energy based on two dynamic displacement emission factors, which are periodically updated according to the evolution of the future energy mix. Such factors represent an upper and a lower limit of CO₂ emissions avoided. The method is validated in the case study of the European Union over the period 2015-2050. The results show that the annual displacement emission factor by wind energy may vary from about 422 to 741 t CO₂/GWh in 2015 to around 222-515 t CO₂/GWh in 2050. The total CO₂ abatement ranges from about 6600 to 13100 Mt CO₂ in the period 2015-2050.

Acute appendicitis after a colonic endoscopic submucosal resection

We present a case of acute appendicitis as a complication after an Endoscopic Submucosal Resection of a colonic polyp.

Decrease of ruminal methane production in Rusitec fermenters through the addition of plant material from rhubarb (Rheum spp.) and alder buckthorn (Frangula alnus)

Roots of rhubarb (Rheum spp.) and bark of alder buckthorn (Frangula alnus) were tested as feed additives for decreasing ruminal methane production released from anaerobic fermentation of a forage-based diet in a rumen-simulating fermenter (Rusitec). Sixteen fermentation units (vessels) were set up for the experiment lasting 19 d. Treated vessels were supplied with 1g/d of rhubarb or alder buckthorn (4 vessels per plant species); another 4 vessels received 12 microM sodium monensin (positive control), and the remaining 4 vessels were controls (no additive). Upon termination of the experimental period, batch cultures were inoculated with the liquid contents of the vessels for examining in vitro fermentation kinetics of cellulose, starch, barley straw, and the same substrate used in the Rusitec cultures. Monensin induced changes in fermentation in agreement with those reported in the literature, and inocula from those cultures decreased the fermentation rate and total gas produced in the gas kinetics study. Rhubarb decreased methane production, associated with limited changes in the profile of volatile fatty acids throughout the duration of the study, whereas digestibility and total volatile fatty acids production were not affected. Rhubarb inocula did not affect gas production kinetics except for cellulose. Alder buckthorn decreased only methane concentration in fermentation gas, and this effect was not always significant. The use of rhubarb (milled rhizomes of Rheum spp.) in the diets of ruminants may effectively modulate ruminal fermentation by abating methane production, thus potentially involving productive and environmental benefits.