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Background: Appendicitis is a common disease with a lifespan risk of approximately 8%. The full range of specific causes for the disease remains elusive, but an aberrant microbiota have been identified as a potential risk factor., Aim: To investigate if use of antibiotics in a paediatric population increases the risk of appendicitis in childhood and adolescence METHODS: We conducted a cohort study from 1 January 1995 to 31 December 2014. A total of 1 385 707 children (0-19 years of age) including 7 406 397 antibiotic prescriptions and 11 861 cases of appendicitis were included. Primary outcome was appendicitis requiring appendectomy according to previous use of antibiotics. Appendicitis and appendectomy were identified from nationwide hospital records, and exposure to antibiotics was identified from nationwide prescription register. Rate ratios (RRs) with 95% confidence intervals were estimated from Poisson and logistic regression models., Results: Children who received at least one course of antibiotics were at increased risk of developing appendicitis compared to unexposed children (adjusted RR 1.72 [95% confidence interval 1.61-1.85]), mean age of developing appendicitis was 9.8 years (SD 4.1 years). The RR of appendicitis increased by 1.04 (1.04-1.04) per antibiotic course. A higher risk of appendicitis was observed in children exposed to antibiotics within the first 6 months of life (RR 1.46 [1.36-1.56]) and children exposed to broad-spectrum antibiotics (RR 1.33 [1.27-1.39]). After adjustment for number of antibiotic courses, the association between early age of antibiotic exposure and risk of appendicitis and the association between exposure to broad-spectrum antibiotics and the risk of appendicitis both disappeared., Conclusion: Children who receive antibiotics are at increased and dose-dependent risk of appendicitis. The underlying mechanisms merit further investigation., (© 2020 John Wiley & Sons Ltd.)

Introduction: Several studies have suggested that supine posture during pill ingestion prolongs oesophageal transit time. Whether ingesting prasugrel in an upright position leads to reduced platelet reactivity during percutaneous coronary intervention remains unclear., Methods: A total of 20 people were randomly assigned to ingest 60 mg of prasugrel in either the supine or upright position. Platelet reactivity was analysed using the point-of-care assay VerifyNow., Results: In the upright position, the velocity of platelet inhibition was highest between 20 and 40 min. (Δ = 101.9 P2Y12 reaction units (PRU)). In the supine position, the highest value was seen between 40 and 60 min. (Δ = 56.85 PRU). Time to reach the cut-off for reducing peri- and post-operative risk of thrombosis showed a mean difference of 8 min. in favour of the upright group., Conclusions: A trend towards faster reduction of platelet reactivity was seen when ingesting prasugrel in the upright position compared with the supine position., Funding: This work was supported by Oda and Hans Svenningsens Foundation (grant number: BOF-10109). The foundation had no part in the collection, analysis or interpretation of data, or in the writing of the report or the decision to submit the work for publication., Trial Registration: This trial was registered with clinicaltrials.gov (NCT01365741)., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)

Introduction: Recent studies have described the benefits of performing bowel resections for benign and malignant diseases as a total laparoscopic procedure with intra-corporeal anastomosis. We describe our preliminary experience with total laparoscopic surgery for benign lower gastrointestinal diseases., Methods: All patients (n = 32) who had received elective bowel surgery with intra-corporeal anastomosis for benign diseases between November 2013 and August 2015 were included in this retrospective study., Results: A total of 15 patients (47%) had a primary anastomosis, 17 patients (53%) had a stoma reversal. The median length of stay was five days (range: 3-16). Surgical complications requiring re-operation were present in five patients (Clavien-Dindo grade IIIb) of whom two presented with anastomotic leaks (6%; 95% confidence interval: 2-20%). No post-operative medical complications according to the Clavien-Dindo Classification were seen. The median duration of surgery was 127 min. (range: 61-211 min.). No deaths occurred., Conclusion: A total laparoscopic approach to benign lower gastrointestinal diseases with intra-corporeal ana-stomosis was feasible., Funding: none., Trial Registration: The trial is registered with the Danish Data Protection Agency., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)