ObjectivesTo investigate the prevalence of nasal methicillin-resistant Staphylococcus aureus (MRSA) colonization among adults with atopic dermatitis and explore its association with disease severity.MethodsThis cross-sectional study included 100 adults (≥18 years) with dermatologist-confirmed atopic dermatitis who attended dermatology outpatient clinics in Kuwait. Patients with nonatopic eczema, major systemic illnesses, or skin malignancy were excluded. Disease severity was assessed using the validated Investigator's Global Assessment for Atopic Dermatitis. Nasal swabs were collected, and S. aureus isolates were identified using culture, Gram staining, and catalase and coagulase tests, followed by confirmation using the VITEK® 2 system. Methicillin resistance (mecA) and selected staphylococcal virulence genes, including the classical (sea, seb, sec, sed, and see) and nonclassical staphylococcal enterotoxins (seg, seh, and sei), Panton-Valentine leukocidin (pvl), and toxic shock syndrome toxin-1 (tsst-1) were determined using polymerase chain reaction. Antimicrobial susceptibility profiles were assessed using the Clinical and Laboratory Standards Institute disk diffusion method.ResultsS. aureus colonization is a key feature of atopic dermatitis and is closely associated with disease activity. This study investigated the prevalence of nasal MRSA colonization among adults with atopic dermatitis and examined its association with disease severity and virulence gene carriage. Overall, 53% of patients were colonized with S. aureus, of whom 71.7% carried MRSA. MRSA colonization was significantly associated with older age and greater disease severity. Virulence gene analysis in MRSA isolates revealed higher frequency of seg and sei, whereas the presence of sea and tsst-1 were significantly associated with more severe atopic dermatitis.ConclusionsAdults with atopic dermatitis showed a high prevalence of nasal MRSA colonization. The predominance of enterotoxin gene cluster genes and the association of sea and tsst-1 with greater disease severity highlight the potential clinical importance of nasal MRSA as a reservoir of virulent strains in atopic dermatitis.
Hemorrhoidectomy is one of the most common surgical interventions to remove the third and fourth degrees of prolapse hemorrhoid. We carried out this systematic review and meta-analysis of the randomized controlled trials (RCTs) to comprehensively evaluate the efficacy of harmonic scalpel (HS) versus bipolar diathermy (BD) methods in terms of decreasing intraoperative and postoperative morbidities among patients undergoing hemorrhoidectomy. Suitable citations were found utilizing digital medical sources, including the CENTRAL, Web of Science, PubMed, Scopus, and Google Scholar, from inception until December 2022. Only RCTs that matched the inclusion requirements were selected. We used the updated Cochrane risk of bias (ROB) tool (version 2) to assess the quality of the involved citations. The Review Manager (version 5.4 for Windows) was used to perform the pooled analysis. Data were pooled and reported as mean difference (MD) or risk ratio (RR) with a 95% confidence interval (CI) in random-effects models. Overall, there was no significant difference between HS and BD in terms of decreasing intraoperative morbidities like operative time, intraoperative blood loss, mean duration of hospital stay, and mean duration of first bowel movement (P>0.05). Similarly, the rate of postoperative complications like pain, bleeding, urinary retention, anal stenosis, flatus incontinence, and wound edema; was similar in both groups with no significant difference (P>0.05). In conclusion, our pooled analysis revealed there was no substantial difference between HS and BD in terms of intraoperative and postoperative endpoints. Additional RCTs with larger sample sizes are needed to consolidate the power and quality of the presented evidence.