Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

The Distribution of Hepatitis C Virus Genotypes of Patients with Chronic Hepatitis C Infection in the Eskisehir Region of Turkey

Aim:Chronic Hepatitis C is a serious disease than can result in long-term health problems. It is known that different genotypes in HCV infections account for differences in disease courses and treatment responses. Our study aimed to determine the HCV genotype distribution of patients with chronic hepatitis C infection. Material and Method: This study investigated the anti-HCV, HCV RNA viral loads, and HCV genotypes of 203 patients who were followedup in Eskisehir Osmangazi University Medical Faculty from 2009-2014. Anti-HCV was tested by microparticle ELISA (Abbott AxSYM System HCV 3.0). HCVRNA viral loads were determined by Artus HCV RG PCR kit (QIAGEN) on a Rotor-Gene 6000 (Corbett Research) instrument between 2009-2011, and by Cobas TaqMan 48 (Roche) between 2011-2014 by Real Time PCR. Genotyping of HCV RNA positive patients was performed by HCV genotype Pyrosequencing test and PCR based assay Abbott Real Time Genotype II (USA). Results: The distribution of HCV genotypes was as follows: In 151 (74.4%) patients genotype 1; in 36 genotype 1b (17.7%), in 5 type 1a (2.4%), in 3 genotype 2(1.4%); in 4 genotype 3(1.9%); and in 4 genotype 4(1.9%). HCV viral loads were between 1.25x10(3)-8.35x10(7). In 191 (94.0%) patients, anti-HCV was positive and in 12 (6.0%), anti-HCV was negative. Discussion: The most common HCV genotype in the Eskisehir region was genotype 1, and the most common subtype in this group was genotype 1b. Treatment protocols should be reevaluated by taking into consideration that sustained viral response in these patients might be weak. In Turkey, approximately 90% of HCV infections are of type 1 (most are type 1b), although types 2, 3, and 4 HCV infections are also seen

Evaluation of the Size and Area of the Corpus Callosum with the Osiris Method in Alzheimer's Disease

Background/Objective: Significant corpus callosum (CC) atrophy has been demonstrated in patients with Alzheimer's disease (AD). The aim of this study is to evaluate the size and the area of the CC with the Osiris method. The correlation between the CC measurements and Mini-Mental Status Examination (MMSE) scores in AD patients was also investigated. Methods: The results of the topographic measurements included the cross-sectional area of entire CC, body, rostral portion of the genu and splenium from a midsagittal magnetic resonance imaging section. The results of the topographic measurements of CC on MRI with the Osiris method were compared between AD (n = 29) and control subjects (n = 27). Results: In AD patients the mean value of the splenium was 9.2 +/- 1.5 mm, the width of the CC body was 3.9 +/- 8 0.2 mm, the rostral portion of the genu was 7.9 +/- 0.2 mm, and the total CC area was 47.2 +/- 0.9 mm(2). In the control group the mean values were 12.2 +/- 2.1 mm, 5.9 +/- 0.2 mm, 11.2 +/- 0.2 mm and 56.1 +/- 0.6 mm(2), respectively. Significant reduction was detected in the splenium, the CC body and the rostral part of the genu and CC area in AD patients. The MMSE score was 18.9 +/- 4.5 in the AD patients and 29.1 +/- 0.9 in the control subjects. A significant positive correlation between the MMSE scores and each CC measurement was seen in the AD patients. Conclusion: The results of this study suggest that callosal atrophy in AD may suggest the severity of the disease. The Osiris method for CC measurements may be used as an easy and reliable technique to assess the severity of the disease. Copyright (C) 2009 S. Karger AG, Base

The neuroprotective effect of acute moderate alcohol consumption on caspase-3 mediated neuroapoptosis in traumatic brain injury: The role of lysosomal cathepsin L and nitric oxide

Our aim in this study was to investigate the effect of moderate acute alcohol administration on cysteine protease mediated neuronal apoptosis and nitric oxide production in the traumatic brain injury. A total of 29 adult Sprague-Dawley male rats weighing 250-300 g were used. The rats were allocated into four groups. The first group was the control (sham-operated) group in which only a craniotomy was performed, the others were alcohol, trauma and trauma + alcohol groups. Caspase-3 enzyme activity in the trauma group increased significantly in comparison with the control group. The alcohol given group showed a decreased caspase-3 enzyme activity compared to the trauma group. The level of caspase-3 enzyme activity in the alcohol + trauma group decreased in comparison to the trauma group. SF/EEL ratio of cathepsin-L enzyme activity in the trauma group was significantly higher than in the control group. Our results indicate that moderate alcohol consumption may have protective effects on apoptotic cell death after traumatic brain injury. Protective effects of moderate ethanol consumption might be related to inhibition of lysosomal protease release and nitric oxide production. Published by Elsevier B.V

Comparison of Methods Used for the Diagnosis of Epstein-Barr Virus Infections in Children

The accurate diagnosis of Epstein-Barr virus (EBV) infections is important, as many other infectious agents or diseases can cause similar symptoms. In this study, sera of pediatric patients who were suspected to have an EBV infection, were sent to Eskisehir Osmangazi University Faculty of Medicine, Department of Clinical Microbiology, and investigated by IFA, ELISA, immunoblotting and Real-time PCR. The performances of these tests were compared with IFA. The rates of agreement between ELISA and IFA were found as 100% for seronegative, 100% for acute primary infection, 22.2% for late primary infection, 92.1% for past infection. The rates of agreement between immunoblotting and IFA were found as 80.8% for seronegative, 68.8% for acute primary infection, 55.6% for late primary infection, 86.6% for past infection. The sensitivity of immunoblotting for anti-VCA IgM was identical with ELISA, and higher for anti-VCA IgG, anti-EBNA IgG, anti-EA antibodies, while the specificity of immunoblotting for these antibodies were found to be lower. The sensitivity and specificity of Real-time PCR for detection of viremia in acute primary infection were found as 56.25% (9/16) and 97.89% (139/142), respectively. The diagnostic methods should be chosen by evaluating the demographic characteristics of patients and laboratory conditions together

Assessment of atrial electromechanical delay and P wave dispersion in patients with chronic obstructive pulmonary disease

Objective: Chronic obstructive pulmonary disease (COPD) is associated with atrial fibrillation (AF) and reduced forced expiratory volume (FEV1) is an independent predictor for new onset AF. The aims of this study were (1) to analyze the atrial electromechanical delay (AEMD) and P wave dispersion which are two predictors of AF development in patients with COPD and without any cardiovascular disease, and (2) to assess the relationship of those with pulmonary functions as quantified by FEV1 measurements