Prospective observational study on antibiotic-associated bloody diarrhea: report of 21 cases with a long-term follow-up from Turkey

WOS: 000303826200012PubMed ID: 22433794Objective Antibiotic-associated hemorrhagic colitis is a distinct form of antibiotic-associated bloody diarrhea (AABD) in which Clostridium difficile is absent. Although the cause is not exactly known, reports have suggested the role of Klebsiella oxytoca and/or C. difficile. Materials and Methods Between 2001 and 2006, stool samples of 21 consecutive patients with AABD were cultured for common enteric pathogens and K. oxytoca, and were tested for the presence of parasites and C. difficile toxin A + B within the first 24 h of their initial admission and a colonoscopy was performed when available. The patients were followed up prospectively by telephone interviews. Results The occurrence of symptoms ranged between 6 h and 14 days following the first dose of the antibiotic responsible and the duration of the AABD ranged between 6 h and 21 days. The antibiotic responsible was oral ampicillin/sulbactam in 18 (85%) cases. C. difficile toxin A + B production by enzyme-linked immunosorbent assay and K. oxytoca growth in stool cultures were detected in six (29%) and 11 (51%) of 21 patients, respectively. Endoscopic morphology and histology in a limited number of patients revealed no more than a nonspecific inflammation and acute colitis, respectively. Conclusion This study confirms that antibiotic-associated hemorrhagic colitis, as a distinct entity in relation to K. oxytoca, is seen in half of the patients with AABD. Most of the cases are seen within a week following the antibiotic use. Almost all of the patients did not develop any flares during the long-term antibiotic-free follow-up. In some of the patients with AABD, there was coexistence of K. oxytoca with C. difficile toxin A + B. Eur J Gastroenterol Hepatol 24: 688-69

Yoğun Bakım Hastalarında Akut Böbrek Hasarı ve Mortalite İlişkisinin Belirlenmesinde RIFLE, AKIN ve KDIGO Kriterlerinin Yeri

Amaç: Akut böbrek hasarının (ABH) daha kesin biçimde tanımlanması ve takip sürecinin daha iyi yönetilmesi amacıyla çok sayıda sınıflama gündeme gelmiştir. Bunlar arasında en yaygın kabul görenler risk, injury, failure, loss, and end stage (RIFLE), acut kidney injury network (AKIN) ve kidney disease: Improving global outcomes (KDIGO) sınıflamaları olmuştur. Bu çalışmada, yoğun bakımda izlenen ve ABH tanısı alan hastalarda RIFLE, AKIN ve KDIGO kriterlerine göre ABH şiddeti ile mortalite arasındaki ilişkinin saptanması amaçlanmıştır. Gereç ve Yöntem: Dahiliye yoğun bakım ünitesinde izlenen 1.491 hastaya ait veriler retrospektif olarak incelendi ve ABH saptanan hastalar çalışmaya dahil edildi. Tüm hastalar için RIFLE, AKIN ve KDIGO kriterlerine kullanılarak ABH şiddeti belirlendi. Bulgular: Çalışmaya 155 hasta dahil edildi. RIFLE kriterlerine göre risk, hasar, yetmezlik evrelerinde yer alan hasta oranları sırasıyla; %14,8, %40,0, %45,2; AKIN kriterlerine göre evre 1, evre 2 ve evre 3’te yer alan hasta oranları sırasıyla; %45,6, %30,6, %23,8; KDIGO kriterlerine göre evre 1, evre 2 ve evre 3’te yer alan hasta oranları sırasıyla; %18,7, %21,7, %54,1 idi. AKIN ve RIFLE kriterlerine göre belirlenen ABH evreleri arasında mortalite oranları açısından farklılık saptanmazken, KDIGO evre 3’te yer alan hastalarda evre 1 ve evre 2 ABH gruplarına göre mortalite daha yüksek saptandı. Sonuç: Her üç tanı ve evreleme sistemi de ABH etiyolojisini dikkate almamaktadır. Bu nedenle mortalite ve ABH şiddeti arasındaki ilişkiyi doğru yansıtmamaları söz konusu olabilir. Bununla birlikte, kendisinden önce kullanılan evreleme sistemlerindeki eksikliklerden doğan ihtiyaçla ortaya çıkan KDIGO evreleme sistemi bu açıdan daha geçerli görünmektedir

A Child with Acute Appendicitis Secondary to Blunt Abdominal Trauma: A Case Report and Review of the Literature

We present a child with abdominal pain and vomiting after blunt abdominal trauma (BAT). He had tenderness, guarding and rebound on the bilateral lower quadrant of the abdomen. He had no abrasion on the abdominal skin surface. He had marked leukocytosis and increased C-reactive protein level. Contrast-enhanced abdominal computed tomography revealed inflamed appendicitis. He was operated by pediatric surgeons and, an perforated appendix was illustrated on pathological examination. BAT and acute appendicitis (AA) are independently very frequent issues. In pediatric emergency departments, BAT and AA are very frequent issues, however, coexistence of these two condition in the same patient is rare. This case report and review of the literature showed that occurrence of AA after BAT should be considered by emergency physicians

Point-of-Care Ultrasound as a Diagnostic Tool for Nutcracker Syndrome in Pediatric Emergency Department

Abdominal pain is one of the most common causes of admission to pediatric emergency department. Point-of care ultrasonography combined with appropriate history and physical examination provides rapid and accurate management of abdominal pain in emergency setting. Here, we report a 15-year-old girl with abdominal pain who was diagnosed with Nutcracker syndrome by the guidance of point-of-care ultrasound findings

Does Providing Clinical Care for Trauma Patients have a Positive Effect on Physicians’ Perspective on Child Passenger Safety?

Introduction: Motor vehicle crashes are the most common cause of the mortality in the pediatric population. Preventive strategies are the best approach to reduce mortality and morbidity due to motor vehicle crashes. Since parents mostly refer to them for guidance, doctors should have a high level of knowledge and awareness to increase the usage of car safety seats. We thought that providing care for trauma patients could have a positive effect on the physicians’ awareness and knowledge level. Based on this, we aimed to assess the awareness and knowledge of pediatricians and emergency physicians and trauma doctors. Methods: An electronic survey consisting of 23 questions was prepared. Demographic features, awareness and knowledge level of the physicians were assessed on three sections. Five suggestions in the guideline of the American Academy of Pediatrics were used to assess physicians’ knowledge level. The respondents were grouped as those providing clinical care for trauma patients and those do not. Results: The questionnaires were sent to 641 physicians and 323 who completed the questionnaire were included in the study. One hundred and fourteen (35.3%) of the respondents were providing clinical care for trauma patients. One hundred ninety (59.2%) respondents had children. Majority of the physicians had a satisfactory level of knowledge about car safety seat (CSS). The number of respondents reported having adequate self-awareness was found statistically significantly higher in the groups of doctors who have children and provide clinical care for trauma patients (p0.05). Interestingly, the knowledge level in physicians who had children was statistically significantly lower than in those with no children (p<0.01). Conclusion: Our survey revealed that physicians who provide clinical care for trauma patients think they have a high level of knowledge about CSS. Unfortunately, their knowledge level was low as other physicians in the study group

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Antonio Negri ve Michael Hardt Düşüncesinde İmparatorluk Çokluk ve Biopolitik Üretim Kavramları Üzerine

This study focuses on the ideas of Antonio Negri and Michael Hardt, the most influential thinkers of recent period, about the concepts of the Empire, Multitude and Biopolitical production. These concepts being at the center of contemporary political discussions problematise the ideaitonal foundations of the idea of Empire evaluated as a new form of sovereignty, the economic transformation in the contemporary capitalism and the new form of subjectivity in this age. To Negri and Hardt, Empire is seen as a logic of network operating at global level and a new logic of sovereignty and governance going beyond the political boundaries of nation states as form of sovereignty. In this regard, multitude is evaluated as a collective and joint social subject against the power and command forms of empire. As for biopolitical production, it is defined as the production of life in which feelings, symbols, communication and cooperation go beyond the understanding that centers the production of tangible goods within the capitalist production and work organization. These three concepts draw an important framework in terms of understanding the economic, political transformation of the contemporary world. In this study, it was aimed at interpreting the nature of global changes brought forward by the Negri and Hardt thought within the boundaries of these three concepts

On the concepts of the empire, multitude and biopolitical production in the thought of Antonio Negri And Michael Hardt

Bu çalışma son dönemin önemli düşünürlerinden Antonio Negri ve Michael Hardt’ın İmparatorluk, Çokluk ve Biopolitik üretim kavramlarına odaklanmaktadır. Çağdaş siyasal tartışmaların merkezindeki bu kavramlar yeni bir egemenlik biçimi olarak ele alınan İmparatorluk fikrinin düşünsel temellerini olduğu kadar çağdaş kapitalizmdeki ekonomik dönüşümü ve bu çağın yeni öznellik biçimini de tartışmaya açmaktadır. Negri ve Hardt’a göre İmparatorluk küresel uzamda işleyen bir ağ mantığı, egemenlik biçimi olarak ulus devletlerin siyasal sınırlarını aşan yeni bir egemenlik ve yönetimsel mantık olarak görülmektedir. Çokluk ise imparatorluğun iktidar ve komuta biçimlerine karşı kolektif ve müşterek bir toplumsal özne olarak ele alınmaktadır. Biopolitik üretim ise kapitalist üretimdeki maddi malların üretimini merkeze alan iş ve çalışma örgütlenmesini aşan duyguların, sembollerin, simgelerin, iletişimin ve işbirliğinin merkezinde olduğu hayatın üretimi olarak tarif edilmektedir. Bu üç kavram çağdaş dünyanın ekonomik, siyasal dönüşümünü anlamak açısından önemli bir çerçeve çizmektedir. Bu çalışma da üç kavramın sınırları dahilinde Negri ve Hardt düşüncesinin tartışmaya açtığı küresel değişimlerin doğasını anlamayı hedeflemektedir.This study focuses on the ideas of Antonio Negri and Michael Hardt, the most influential thinkers of recent period, about the concepts of the Empire, Multitude and Biopolitical production. These concepts being at the center of contemporary political discussions problematise the ideaitonal foundations of the idea of Empire evaluated as a new form of sovereignty, the economic transformation in the contemporary capitalism and the new form of subjectivity in this age. To Negri and Hardt, Empire is seen as a logic of network operating at global level and a new logic of sovereignty and governance going beyond the political boundaries of nation states as form of sovereignty. In this regard, multitude is evaluated as a collective and joint social subject against the power and command forms of empire. As for biopolitical production, it is defined as the production of life in which feelings, symbols, communication and cooperation go beyond the understanding that centers the production of tangible goods within the capitalist production and work organization. These three concepts draw an important framework in terms of understanding the economic, political transformation of the contemporary world. In this study, it was aimed at interpreting the nature of global changes brought forward by the Negri and Hardt thought within the boundaries of these three concepts

The Consecutive Substitution Method for Boundary Value Problems (BVPs) with Retarded Argument

In this study, we applied an approximate solution method for solving the boundary value problems (BVPs) with retarded argument. The method is the consecutive substitution method. The consecutive substitution method was applied and an approximate solution was obtained. The numerical solution and the analytical solution are compared in the table. The solutions were found to be compatible