Ultrafast photochemistry and electron-diffraction spectra in n → (3s) Rydberg excited cyclobutanone resolved at the multireference perturbative level

We study the ultrafast time evolution of cyclobutanone excited to the singlet n → Rydberg state through non-adiabatic surface-hopping simulationsperformed at extended multi-state complete active space second-order perturbation (XMS-CASPT2) level of theory. These dynamics predict relaxation to the ground-state with a timescale of 822 ± 45 fs with minimal involvement of the triplets. The major relaxation path to the ground-state involves a three-state degeneracy region and leads to a variety of fragmented photoproducts. We simulate the resulting time-resolved electron-diffraction spectra, which track the relaxation of the excited state and the formation of various photoproducts in the ground state.

Effect of 3 Days of Oral Azithromycin on Young Children With Acute Diarrhea in Low-Resource Settings: A Randomized Clinical Trial

Importance

World Health Organization (WHO) guidelines do not recommend routine antibiotic use for children with acute watery diarrhea. However, recent studies suggest that a significant proportion of such episodes have a bacterial cause and are associated with mortality and growth impairment, especially among children at high risk of diarrhea-associated mortality. Expanding antibiotic use among dehydrated or undernourished children may reduce diarrhea-associated mortality and improve growth.

Objective

To determine whether the addition of azithromycin to standard case management of acute nonbloody watery diarrhea for children aged 2 to 23 months who are dehydrated or undernourished could reduce mortality and improve linear growth.

Design, Setting, and Participants

The Antibiotics for Children with Diarrhea (ABCD) trial was a multicountry, randomized, double-blind, clinical trial among 8266 high-risk children aged 2 to 23 months presenting with acute nonbloody diarrhea. Participants were recruited between July 1, 2017, and July 10, 2019, from 36 outpatient hospital departments or community health centers in a mixture of urban and rural settings in Bangladesh, India, Kenya, Malawi, Mali, Pakistan, and Tanzania. Each participant was followed up for 180 days. Primary analysis included all randomized participants by intention to treat.

Interventions

Enrolled children were randomly assigned to receive either oral azithromycin, 10 mg/kg, or placebo once daily for 3 days in addition to standard WHO case management protocols for the management of acute watery diarrhea.

Main Outcomes and Measures

Primary outcomes included all-cause mortality up to 180 days after enrollment and linear growth faltering 90 days after enrollment.

Results

A total of 8266 children (4463 boys [54.0%]; mean [SD] age, 11.6 [5.3] months) were randomized. A total of 20 of 4133 children in the azithromycin group (0.5%) and 28 of 4135 children in the placebo group (0.7%) died (relative risk, 0.72; 95% CI, 0.40-1.27). The mean (SD) change in length-for-age z scores 90 days after enrollment was -0.16 (0.59) in the azithromycin group and -0.19 (0.60) in the placebo group (risk difference, 0.03; 95% CI, 0.01-0.06). Overall mortality was much lower than anticipated, and the trial was stopped for futility at the prespecified interim analysis.

Conclusions and Relevance

The study did not detect a survival benefit for children from the addition of azithromycin to standard WHO case management of acute watery diarrhea in low-resource settings. There was a small reduction in linear growth faltering in the azithromycin group, although the magnitude of this effect was not likely to be clinically significant. In low-resource settings, expansion of antibiotic use is not warranted. Adherence to current WHO case management protocols for watery diarrhea remains appropriate and should be encouraged.

Trial Registration

ClinicalTrials.gov Identifier: NCT03130114.

Clinical profile and early outcome of arteriovenous fistula creation for haemodialysis: Integrated activity in a general surgery unit

Introduction: A functioning arteriovenous fistula (AVF) is essential for maintenance hemodialysis (HD) in a patient with chronic renal failure. This study explores the creation of AVF as an integral activity in a general surgical unit by a general surgeon.Methods: This is a hospital based cross sectional study done at Patan Hospital patients who underwent creation of AVF from January 2015 to June 2015 were included in the study. Patient demographic and clinical data were documented. Outcome and complications of AVF surgery were obtained over a 6 months period from the time of vascular access creation.Results: Thirty-seven patients were operated in the study period with a mean age of 35.44 years and M: F ratio of 2.7:1. There were 3 immediate and 3 delayed failure with 81.81% (n=27) patency rate at 6 months follow up. The maturation time was 3-7weeks (mean +/- SD of 4.83 +/- 1.053). Complication occurred in 4 patients, namely arm edema (n=3) and haematoma (n=1).Conclusion: The creation of AVF for HD performed in a general surgery unit is a safe procedure with satisfactory outcome and acceptable level of complications. Journal of Society of Surgeons of Nepal, 2015; 18 (2), Page: 2-5 

Clinical profile and early outcome of arteriovenous fistula creation for Haemodialysis: Integrated activity in a general surgery unit

<p><strong>Introduction: </strong>A functioning arteriovenous fistula (AVF) is essential for maintenance hemodialysis (HD) in a patient with chronic renal failure. This study explores the creation of AVF as an integral activity in a general surgical unit by a general surgeon.</p><p><strong>Methods: </strong>This is a hospital based cross sectional study done at Patan Hospital patients who underwent creation of AVF from January 2015 to June 2015 were included in the study. Patient demographic and clinical data were documented. Outcome and complications of AVF surgery were obtained over a 6 months period from the time of vascular access creation.</p><p><strong>Results: </strong>Thirty-seven patients were operated in the study period with a mean age of 35.44 years and M: F ratio of 2.7:1. There were 3 immediate and 3 delayed failure with 81.81% (n=27) patency rate at 6 months follow up. The maturation time was 3-7weeks (mean +/- SD of 4.83 +/- 1.053). Complication occurred in 4 patients, namely arm edema (n=3) and haematoma (n=1).</p><p><strong>Conclusion: </strong>The creation of AVF for HD performed in a general surgery unit is a safe procedure with satisfactory outcome and acceptable level of complications.</p>

The microbiological and clinical characteristics of invasive salmonella in gallbladders from cholecystectomy patients in kathmandu, Nepal

Gallbladder carriage of invasive Salmonella is considered fundamental in sustaining typhoid fever transmission. Bile and tissue was obtained from 1,377 individuals undergoing cholecystectomy in Kathmandu to investigate the prevalence, characteristics and relevance of invasive Salmonella in the gallbladder in an endemic area. Twenty percent of bile samples contained a Gram-negative organism, with Salmonella Typhi and Salmonella Paratyphi A isolated from 24 and 22 individuals, respectively. Gallbladders that contained Salmonella were more likely to show evidence of acute inflammation with extensive neutrophil infiltrate than those without Salmonella, corresponding with higher neutrophil and lower lymphocyte counts in the blood of Salmonella positive individuals. Antimicrobial resistance in the invasive Salmonella isolates was limited, indicating that gallbladder colonization is unlikely to be driven by antimicrobial resistance. The overall role of invasive Salmonella carriage in the gallbladder is not understood; here we show that 3.5% of individuals undergoing cholecystectomy in this setting have a high concentration of antimicrobial sensitive, invasive Salmonella in their bile. We predict that such individuals will become increasingly important if current transmission mechanisms are disturbed; prospectively identifying these individuals is, therefore, paramount for rapid local and regional elimination.

Is prophylactic placement of drains necessary after subtotal gastrectomy?

AIM: To determine the evidence-based values of prophylactic drainage in gastric cancer surgery.

METHODS: One hundred and eight patients, who underwent subtotal gastrectomy with D1 or D2 lymph node dissection for gastric cancer between January 2001 and December 2005, were divided into drain group or no-drain group. Surgical outcome and post-operative complications within four weeks were compared between the two groups.

RESULTS: No significant differences were observed between the drain group and no-drain group in terms of operating time (171 ± 42 min vs 156 ± 39 min), number of post-operative days until passage of flatus (3.7 ± 0.5 d vs 3.5 ± 1.0 d), number of post-operative days until initiation of soft diet (4.9 ± 0.7 d vs 4.8 ± 0.8 d), length of post-operative hospital stay (9.3 ± 2.2 d vs 8.4 ± 2.4 d), mortality rate (5.4% vs 3.8%), and overall post-operative complication rate (21.4% vs 19.2%).

CONCLUSION: Prophylactic drainage placement is not necessary after subtotal gastrectomy for gastric cancer since it does not offer additional benefits for the patients.

Facial nerve neurinoma presenting as middle cranial fossa and cerebellopontine angle mass: a case report

Facial nerve neurinomas are rare. The tumours arising from the geniculate ganglion may grow anteriorly and superiorly and present as a mass in the middle cranial fossa. Only a few cases of facial nerve neurinomas presenting as middle cranial fossa mass have so far been reported. These tumours present with either long standing or intermittent facial palsy along with cerebellopontine angle syndrome.