C) Anti-tuberculosis drug-inducEd hepatitis

WV Senaratne, MJ Pinidiyapathirage, G Perera, A Wickremasinghe

Ceylon Medical Journal Vol. 51(1), 2006, pp. 9-14

Background Most drugs can be metabolized with no hepatic damage; however, new adverse reactions to anti-tuberculosis agents are occurring each year.

Objective To assess the incidence of anti-tuberculosis drug-induced hepatitis (AIH) in Sri Lankan patients, and to determine risk factors of AIH.

Design A prospective study.

Setting Chest Hospital, Welisara (Sri Lanka), from April 2001 to April 2002.

Patients 783 patients with a confirmed diagnosis of tuberculosis (TB).

Methods Treatment with rifampicin was started in all cases. AIH was diagnosed when patients had elevated serum bilirubin.

Results Of all enrolled patients, 74 (9.5%) developed AIH, the majority (58%) developing AIH within the first 2 weeks of the intensive phase of treatment. AIH was more common among patients over 60 years, who developed pulmonary TB, and in patients weighing 33-55 kg. Age, weight and rifampicin overdosage were significant predictors of AIH.

Conclusions The incidence of AIH in Sri Lanka is 9.5% in treated patients. AIH was associated with age, low body weight and rifampicin overdosage.

• Sri Lankan – Шри-Ланка

• adverse reactions – побочные реакции

D) Making the Diagnosis of Acute Appendicitis: Do More Preoperative ct Scans Mean Fewer Negative Appendectomies? a 10-year Study

Courtney A. Coursey, Rendon C. Nelson, Mayur B. Patel, Courtney Cochran

Radiology, February 2010, Vol. 254, pp. 460-468

Purpose To determine the frequency of preoperative computed tomography (CT) in the evaluation of patients suspected of having appendicitis at one institution during the past 10 years and to determine whether changes in CT utilization were associated with changes in the negative appendectomy rate.

Design A surgical database search.

Materials and Methods 925 patients (526 men and 399 women [mean age - 38 years (range 18–95 years]) who underwent urgent appendectomy between January 1998 and September 2007. CT, pathology, and surgery reports were reviewed. By using logistic regression, changes in the proportion of patients undergoing CT and in the proportion of patients undergoing each year appendectomy in which the appendix was healthy were evaluated. Subgroup analyses based on patient age (≤ 45 years or > 45 years) and sex also were performed.

Results Prior to urgent appendectomy, 18.5% of patients underwent preoperative CT in 1998 compared with 93.2% of patients in 2007. The negative appendectomy rate for women 45 years of age and younger decreased from 42.9% in 1998% to 7.1% in 2007. However, the timing of the decrease in negative appendectomy rates for women 45 years and younger could not be proved to be associated with the increase in CT use.

Conclusion Rising utilization of preoperative CT and advances in technology coincided with a decrease in the negative appendectomy rate for women 45 years and younger but not in men of any age or women older than 45 years.

• negative appendectomy – отрицательная аппендэктомия (удаление здорового червеобразного отростка)

• timing – синхронизация, согласование по времени, хронометраж