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This article reports a case of Colovesical fistula presenting with epididymitis. A 61-year-old male with a history of obstructive sleep apnea and diverticulitis, was presented to the emergency room on December 19, 2017, with severe dysuria, polyuria, fever and chills. The Patient was treated for sepsis probably due to acute cystitis and discharged from the hospital on oral antibiotics. Ultrasound done during the hospitalization showed a 6 mm no obstructing right midpole calculus. Renal ultrasound was otherwise normal. Urine grew E coli. Patient came to establish care with PCP on January 9, 2018 and he was tachycardia in the office considering his abdomen was tender and any male patient rate to have E coli in that significant quantity I decided to do CT scan of the abdomen and pelvis and that subsequently revealed patient having Colovesical fistula and patient was septic again admitted to the emergency room. Treated with IV antibiotics Foley catheter was placed and patient discharged subsequently patient ended up having elective sigmoid colectomy Foley catheter was left in place for 3 days subsequently was taken out patient came for follow-up after 6 months without signs of any UTI.

Background: Hepatitis B is a major cause of liver disease worldwide, can cause acute and chronic disease, ranking as a substantial cause of cirrhosis and hepatocellular carcinoma. A vaccine against hepatitis B available since 1982, Hepatitis B runs more serious in children due to its chronic behaviour in more than 85%of affected ones.

Patient and method: An observational retrospective cohort study, since 1st August/2015 to 1st February/2016. The patients were gathered from the gastroenterology and liver disease clinic/Child Welfare Teaching Hospital in Baghdad. Among 71 patients with chronic hepatitis B regularly followed up, a total of 32 patients on lamivudine therapy were selected for this study, the patients files were evaluated retrospectively and then followed up during their scheduled visits every 3-6 months. All patients underwent detailed history and physical examination, sent for full blood picture, liver function tests, viral panel and abdominal ultrasound.

Results: Mean ages of patients were 7.8 ± 3.87 years ranging from 2 to 14 years, male were predominating with 71.9:28.1 ratio. The majority of patients with leukemia 31% on chemotherapy and 38% finished chemotherapy, 9% thalassemia, 6% haemophilia and others accident 17%; viral load show significant decrement in Lamivudine receiving patients on chemotherapy with p value <0.001, While in those patients who were not on chemotherapy p value was 0.001. In Lamivudine receiving patients who were on chemotherapy (n=10): 20% and 40% patients with undetectable viral load (HBV DNA –ve) after 6 months and 1 year respectively had significant P value at border line 0.048; and 10%, 30% with seroconversion (HBeAb) after 3 months, 6 months respectively; and 80% normalization of ALT over I year period. While Lamivudine receiving patients with chronic HBV not on chemotherapy (n=22) : had undetectable viral load significant P value 0.026 over I year period; and there are only 9 of 22 had HBeAg +ve, 4 of 9 with seroconversion (HBeAb) after 6 months; while influence on ALT show 81.8% normalization over I year period.

Conclusion: Lamivudine therapy is an effective drug and had a significant effect on children with chronic hepatitis B, This effect was clear on HBV-DNA disappearance, and ALT normalization, HBeAg seroconversion, this was very clear on both groups of children immune compromised and immune competent. It is recommended for all children with chronic hepatitis B who are on chemotherapy to prevent reactivation of the virus.

Steven Johnson syndrome (SJS) is a life-threatening illness usually associated with usage of medicines, which causes drug interactions. SJS seems to be one of the lethal drug reactions. Herbal medications are also responsible for these syndromes; many medications have been reported to cause SJS. Even though only few cases are described in the literature. It has important impact on the public health in view of its high morbidity and mortality. It is a severe hypersensitive reaction which belongs to type IV hypersensitive reaction. SJS are considered to resemble erythema multiforme with mucosal involvement. It mainly affects oral mucosal cavity. A drug named Ginkgo biloba was prescribed to the patient affected with vitiligo and also treated with allopathic medications for fever and headache. It caused an herbal drug interaction which eventually induced Steven-johnson syndrome. The patient has clinical manifestations such as fever, maculopapular rashes over anterior part of chest and ulceration all over mouth and lips. The patient was treated with rational antibiotic regimen and corticosteroids along with the withdrawal of herbal medications. Pharmacists have a vital role in evaluating a case study of patients and result superiority conclusion of the patient with an advice to withdrawal the medication and to monitor the interactions which was caused by the medications and their symptoms. This helps to improve the condition of the patient for better quality of life.

The use of Mucuna flagellipes in recent time has been on the increase as a result of its speculated therapeutic effect. Owing to the fact that there are no detailed reports on Mucuna flagellipes or any report on its effect on anxiety and fear, this work is therefore intended to investigate the possible effects of this herb on anxiety and fear in Swiss white mice, using the elevated plus maze as experimental apparatus. Twenty CD-1 mice were divided into two groups (1-2, n=10). Group 1 (Control) was administered normal fed while group 2 was the treated group. Data were analyzed using statistical tools (one way ANOVA and Student t-test). Results revealed anxiety like behavior treated mices when compared to the control. However, administration of the Ibie Leave (Mucuna flagellipes) reduced anxiety related behavior in mice. In summary, it is therefore a strong consideration that Mucuna flagellipes (Ibie leaf) contains compounds and other constituents which could be responsible for the anxiolytic properties and effects which the leaf had on the mice thereby reducing fear and anxiety related behavior.

The use of Mucuna flagellipes in recent time has been on the increase as a result of its speculated therapeutic effect. Owing to the fact that there are no detailed reports on Mucuna flagellipes or any report on its effect on anxiety and fear, this work is therefore intended to investigate the possible effects of this herb on anxiety and fear in Swiss white mice, using the elevated plus maze as experimental apparatus. Twenty CD-1 mice were divided into two groups (1-2, n=10). Group 1 (Control) was administered normal fed while group 2 was the treated group. Data were analyzed using statistical tools (one way ANOVA and Student t-test). Results revealed anxiety like behavior treated mices when compared to the control. However, administration of the Ibie Leave (Mucuna flagellipes) reduced anxiety related behavior in mice. In summary, it is therefore a strong consideration that Mucuna flagellipes (Ibie leaf) contains compounds and other constituents which could be responsible for the anxiolytic properties and effects which the leaf had on the mice thereby reducing fear and anxiety related behavior.

Background: Respiratory distress is one of interesting presentation of elective caesarean deliveries, the presence of labor before elective caesarean delivery decrease the risk of respiratory distress adverse respiratory problem in neonate delivered before 39 weeks of gestation are increased.

Aim: To evaluate the association between gestational age at delivery and neonatal respiratory outcomes after elective caesarean delivery between 37 and 41 completed weeks.

Patients and methods: Descriptive study with prospectively collected data from Baghdad teaching hospital/ medical city at neonatal care unit. All infants of gestational age from 37 to 41 completed weeks, with uncomplicated pregnancy, of which 1407 were born by elective caesarean delivery compared to 1304, delivered by spontaneous vaginal delivery between 1st of September 2015 and 31st of January 2016. The neonates delivered by elective caesarean delivery were stratified into five groups according to the gestational age. Data including maternal age, indication of elective caesarean delivery birth weight, gender, respiratory outcomes (transient tachypnea of the newborn (transient tachypnea of the newborn), Respiratory distress syndrome pneumothorax) and also included others measures oxygen therapy, assisted ventilation, length of hospital stay and neonatal death.

Results: There were 1407 neonates delivered by elective caesarean delivery compared with 1304 by spontaneous vaginal delivery of overall 118 neonate were admitted to the Neonatal care unit with Respiratory distress and receiving oxygen therapy or assisted ventilation. Early neonatal Respiratory distress risk was significantly higher in neonate delivered by elective caesarean delivery 108/1407 (7.7%) compared with spontaneous vaginal delivery 10/1304 (0.7%) (Eleven folds higher, odd ratio was 11.12 (5.61 to 22.04), p<0.0001). Respiratory distress risk decreased with each increment week of gestation from 37 weeks to 40 weeks, odd ratio 3.57 (1.69-7.53) for 37 weeks about four folds higher than 39 weeks, odd ratio 1.2 (0.52-2.76) for 38 weeks more than one fold higher than 39 weeks. Male newborns delivered by elective caesarean delivery more at risk of developing Respiratory distress than female. Requirement of assisted ventilation increased significantly with earlier week of gestation (p=0.004). The rate of Respiratory distress such as (transient tachypnea of the newborn, Respiratory distress syndrome and pneumothorax) increased with earlier gestational age for both group (elective caesarean delivery, and spontaneous vaginal delivery). The hospitalization days, also decreased with increased gestational age.

Conclusions: Term neonates delivered by elective caesarean section are at increased risk for developing Respiratory distress compared vaginal delivery. The neonatal Respiratory distress decreased if elective caesarean delivery performed after 39 gestational weeks.

Objective: Laparoscopic-assisted total gastrectomy (LATG) is the most commonly used method for laparoscopic treatment of gastric upper gastric cancer. However, because of the difficulties of total laparoscopic reconstruction, especially in vivo esophageal jejunum anastomosis is not easy to complete, resulting in a large number of complete laparoscopic total gastrectomy (TLTG), but it is worth to explore the complete laparoscopy the clinical value of total gastrectomy. This study from the perspective of evidence-based medicine TLTG treatment of gastric cancer in the safety and feasibility of the recent and effective.

Methods: A comparative study of the efficacy of TLTG and LATG in the treatment of upper gastric cancer was published in 2017. Meta-analysis was performed using RenMan 5.3 software.

Results: A total of 912 patients with gastric cancer were enrolled in this study. Among them, 425 LATG patients and 487 TLTG patients were all Asian populations. The results of meta-analysis showed that there was no significant difference in TLTG between operation time, proximal margin, lymph node dissection, postoperative complications and the most important complication of the anastomotic fistula compared with LATG (MD=-65.91, 95% CI: -114.18 ~
-1.7.65, P<0.05), but the length of incision was shorter (P<0.05), but the length of incision was shorter (MD=-4.91, 95 (MD=-1.07, 95% CI: -1.88 ~ -0.26, P<0.05), the time of premature feeding was earlier (MD=-1.07, 95% CI: -1.88 ~ -0.26, P<0.05) (MD=-1.55, 95% CI: -2.70 ~ -0.40, P<0.05). The postoperative hospital stay was shorter (MD=-1.55, 95% CI: -2.70 ~ -0.40, P<0.05).

Conclusion: TLTG is safe and feasible in the treatment of upper gastric cancer in Asian population, and has the advantages of quick recovery after incision.