Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial

Background Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. Methods In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. Findings Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18–45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference −1·4%, 95% CI −7·0 to 4·3; hazard ratio 0·96, 0·68–1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3–4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). Interpretation Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia

COMPARISON BETWEEN TRANSVERSE ABDOMINIS PLANE BLOCK VERSUS TRADITIONAL PARENTERAL ANALGESIA IN LOWER ABDOMINAL SURGERIES

BACKGROUND A revolution in the management of acute postoperative pain has occurred during the past three decades. The transverse abdominis plane block is a peripheral nerve block used to provide analgesia to anterior and lateral abdominal wall. By introducing local anaesthetic to transverse abdominis plane via the triangle of Petit, it is possible to block the sensory nerves of the anterior abdominal wall before they leave this plane and pierce the musculature to innervate the entire anterior abdominal wall. TAP block provides excellent pain relief especially in lower abdominal surgeries. MATERIALS AND METHODS An observational study is carried out in sixty patients who underwent lower abdominal surgeries and who were given TAP block or traditional parenteral analgesia, 30 in each group. All patients in the study group were scheduled for postoperative pain monitoring using numerical rating scale at specific times 2/6/12/24 hours postoperatively. RESULTS Considering socioeconomic data, there was no significant difference between the two groups with regard to age, sex and weight (p>0.05). Among clinical variables, the test and control group were comparable with respect to ASA physical status and haemodynamic parameters (p>0.05). There was significant difference in the pain scores of the 2 groups at 2, 6 and 12 hours, but at 24 hours, the pain scores were not significant. CONCLUSION We conclude that TAP block is an effective method of providing postoperative analgesia in patients who undergo lower abdominal surgeries and we recommend the same for all patients undergoing lower abdominal surgeries

Computational Intelligence in Otorhinolaryngology

There have been major advancements in the field of artificial intelligence (AI) in the last few decades and its use in otorhinolaryngology has seen promising results. In machine learning, which is a subset of AI, computers learn from historical data to gather insights and they make diagnoses about new input data, based on the information it has learned. The objective of this study was to provide a comprehensive review of current applications, future possibilities, and limitations of AI, with respect to the specialty of otorhinolaryngology. A search of the literature was performed using PubMed and Medline search engines. Search terms related to AI or machine learning in otorhinolaryngology were identified and queried to select recent and relevant articles. AI has implications in various areas of otorhinolaryngology such as automatically diagnosing hearing loss, improving performance of hearing aids, restoring speech in paralyzed individuals, predicting speech and language outcomes in cochlear implant candidates, diagnosing various otology conditions using otoscopic images, training in otological surgeries using virtual reality simulator, classifying and quantifying opacification in computed tomography images of paranasal sinuses, distinguishing various laryngeal pathologies based on laryngoscopic images, automatically segmenting anatomical structures to accelerate radiotherapy planning, and assisting pathologist in reporting of thyroid cytopathology. The results of various studies show that machine learning might be used by general practitioners, in remote areas where specialist care is not readily available and as a supportive diagnostic tool in otorhinolaryngology setups, for better diagnosis and faster decision-making

Ectopic meningioma presenting as a neck mass: case report and review of literature

Abstract Background Ectopic meningiomas are rare neoplasms that occur entirely outside the intracranial and intraspinal cavities and account for only 1–2% of all meningiomas. These tumors have been reported at various sites, however they are predominantly observed in the head and neck region. Here, we detail a case of an adult diagnosed with ectopic meningioma of the neck. Case presentation A 26-year-old woman underwent evaluation for a neck swelling associated with difficult in swallowing. Clinical examination revealed a firm, non-tender and non-pulsatile swelling in the right side of neck. On imaging, a soft tissue mass lesion was seen involving the right supra-hyoid neck, centered at the right carotid space/retro-styloid parapharyngeal space. She underwent maximal safe resection of the tumor and a consensus was reached regarding the diagnosis of ectopic meningioma based on the histopathological, clinical and radiological findings. Relevant literature is reviewed. Conclusions The diagnosis of ectopic meningioma may pose difficulties due to their occurrence in uncommon sites. The primary approach to treatment entails the surgical removal of the neoplasm, and a multidisciplinary strategy is pivotal for achieving the best possible clinical outcomes for patients with this rare entity