Efficacy and safety of endoscopic retrograde cholangiopancreatography in the very elderly by using a combination of intravenous midazolam, ketamine and pethidine

Aim The number of therapeutic endoscopic procedures in elderly individuals keeps increasing and this population has a high risk of adverse events related to sedation and general anesthesia. However, there is a paucity on data about the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) in this population. Methods In total, 417 consecutive ERCP procedures were performed in 362 patients between September 2018 and January 2020. Of these, 59 patients (74 sessions) were aged >= 80 years (Group A) and 173 patients (193 procedures) were aged <= 65 years (Group B). We analyzed the prospectively collected data of patient- and procedure-related variables. Results The procedure time was significantly longer in Group A (P < 0.05). The prevalence of comorbidities, use of anticoagulants and American Society of Anesthesiologists (ASA) physical status classification levels were significantly higher in Group A (P < 0.05). The incidence of periampullary diverticula, malignancy, rate of difficult cannulation, mean number of stones, use of biliary stents and stent dysfunction was also significantly higher in Group A (P < 0.05). The medication doses used were significantly higher and emergence symptoms were significantly more frequent in Group B (P < 0.05). The rates of bleeding, pancreatitis, perforation, cholangitis, hypoxia, hypotension and the length of hospital stay did not significantly differ between the two groups. The overall success rate of the procedure was comparable in the two groups (P = 0.874). Conclusions ERCP can be safely performed in elderly patients using a combination of midazolam and ketamine without propofol. The incidence of complications is comparable with that observed in younger patients. Geriatr Gerontol Int center dot center dot; center dot center dot: center dot center dot-center dot center dot Geriatr Gerontol Int 2021; center dot center dot: center dot center dot-center dot center dot.WOS:0006873533000012-s2.0-85113207943PubMed: 3442703

Efficacy of Epinephrine Injection in Preventing Post-ERCP Pancreatitis

Background: Rectal indomethacin or a topical spray of epinephrine to the papilla of Vater has each shown efficacy alone in the prevention of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP). We supposed that a submucosal epinephrine injection would be more effective and longer acting than a topical epinephrine spray and therefore would further reduce the incidence of PEP. Patients and Methods: A retrospective analysis was conducted of 412 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) between January 2017 and December 2019. These patients were divided into 2 groups: the indomethacin group and the indomethacin plus the submucosal epinephrine injection group. The incidence rates and severity of PEP, post-ERCP hyperamylasemia, other outcomes, and any other adverse events were compared between the groups. Results: Baseline demographic and clinical characteristics and procedure-related parameters were similar between the 2 groups. The incidence of PEP was 0.4% in the epinephrine group compared with 5.1% in the indomethacin group (P <0.001). Post-ERCP hyperamylasemia occurred in 24.6% of patients in the indomethacin group, whereas 7.6% of patients in the epinephrine group developed this condition; the difference was significant (P <0.001). Postsphincterotomy bleeding occurred in 5 patients, all of whom were in the indomethacin group (P < 0.001). Other adverse events, including arrhythmias, acute coronary events, stroke, or hypertension were not significantly different between the 2 groups. Conclusion: Addition of a submucosal epinephrine injection in conjunction with rectal indomethacin significantly reduced the incidence of PEP, post-ERCP hyperamylasemia, and post-sphincterotomy bleeding.WOS:0006477597000162-s2.0-8510368338

The role of anti-mullerian hormone for determining the ovarian reserve of IVF patients

WOS: 000399405200003Purpose: The puspose of this study was to find the level of effectiveness and reliability of AMH (anti-mullerian hormone) in indicating the over reserve of IVF patients in comparison with other reserve indicators used. Materials and Methods: The study included 89 infertile couples ages between 18 and 45. Basal serum FSH, LH, E2, prolactin, fT3, fT4 and TSH, AMH levels of female patients were measured in the 3rd day of menstruation. Ovary volume and AFC(antral follicle count) were determined through transvaginal ultrasound. In our study, all patients were subjected to long protocol with GnRH agonist. Oocyte numbers equal to or higher than 4 were included in the " good response" group and oocyte numbers lower than 4 were included in the "poor response" group. Afterwards, the results obtained were statistically compared with other parameters used for determination of ovarian reserve. Results. Significant differences were present between two groups in terms of age, serum FSH, AMH levels, hCG day E2 levels, number of antral follicles, hCG day follicle numbers and mature oocyte numbers. When the cutoff value for AMH was taken to be 0,24 ng/ml, sensitivity and specifity were determined to be 82.1% and 72.7% respectively. Conclusion: There is a strong relationship between serum AMH level and the ovarian response of the patients. Besides, AMH levels were determined to be in relation with the pregnancy rate

A surveillance study of antimicrobial resistance of Gram-negative bacteria isolated from intensive care units in eight hospitals in Turkey

This study was carried out with the participation of eight hospitals in Turkey to determine the frequency of Gram-negative bacteria isolated in intensive care units (ICU) and to compare their resistance rates to selected antibiotics. Aerobic Gram-negative bacteria isolated from ICUs during 1996 were studied. Antibiotic susceptibilities to imipenem, ceftazidime, ceftazidime-clavulanate, ceftriaxone, cefotaxime, cefepime, cefodizime, cefuroxime, piperacillin/tazobactam, amoxycillin-clavulanate, gentamicin, amikacin and ciprofloxacin were determined by Etest. A total of 748 isolates were obtained from 547 patients. The majority of organisms were isolated from the respiratory (38.8%) and urinary tracts (30.9%). Pseudomonas spp. were the most frequently isolated Gram-negative species (26.8%), followed by Klebsiella spp. (26.2%). Escherichia coli, Acinetobacter spp. and Enterobacter spp. were the other commonly isolated organisms. High resistance rates were observed for all antibiotics studied. Imipenem appeared to be the most active agent against the majority of isolates. Although resistance rates exceeded 50%, ciprofloxacin, cefepime and amikacin were found to be relatively effective. Extended-spectrum beta-lactamase (ESBL) production appeared to be a major mechanism of resistance to beta-lactam antibiotics. In contrast to ceftazidime-clavulanate, piperacillin/tazobactam showed poor activity against organisms thought to produce ESBL, suggesting the presence of an enzyme resistant to tazobactam action. This study has yielded high rates of resistance in aerobic Gram-negative isolates from ICUs in Turkey. High resistance rates to all the other antibacterials studied leave imipenem as the only reliable agent for the empirical treatment of ICU infections in Turkey

Determination of changes in heavy metal accumulation depending on plant species, plant organism, and traffic density in some landscape plants

The level of pollution has reached the dimensions that threaten human health, with the rapid urbanization and the increase of energy consumption especially in developing countries. Every year in the world, millions of people lose their lives because of air pollution. Heavy metals have a separate precaution in pollutants, especially in terms of human health, because they can remain intact in nature for long periods of time, they tend to bioaccumulate and some are toxic or carcinogenic even at low concentrations. Therefore, monitoring of heavy metal pollution and determination of risky areas is very important. Biomonitors are the most commonly used methods for monitoring heavy metal pollution. However, determining which plants and organelles are more suitable for monitoring the metal is essential in order to ensure that the monitoring is reliable. In this study, it was aimed to determine the variations of the concentration of Ni, Pb, and Cd elements depending on the traffic density in leaves, seeds, and branches of Ailanthus altissima, Biota orientalis, Platanus orientalis, and Pyracantha coccinea which are grown in areas with heavy, low dense, and non-traffic areas. As a result of the study, it was determined that concentrations of Ni, Pb, and Cd increased depending on traffic density. According to the results obtained, it was determined that seeds and branches of Biota orientalis were the most suitable species and organelles to determine Ni pollution. The leaves of Ailanthus altissima are very suitable for monitoring the pollution of Pb and Cd. © 2018, Springer Nature B.V

What is the optimal dwell time for maximizing ultrafiltration with icodextrin exchange in automated peritoneal dialysis patients?

Background: Icodextrin is increasingly being used in automated peritoneal dialysis (APD) for the tong dwell exchange to maintain adequate ultrafiltration (UF). However, the UF reported in the literature varies with different dwelt times: from 200 to 500 mL with 12 - 15 hour dwells. In order to maximize UF, it is important to know the relationship between dwell time and UF when using icodextrin in APD patients. With this knowledge, decisions can be made with respect to dwelt period, and adjustments to the dialysis prescription can be made accordingly