COMPARISON OF NONSTEROIDAL ANTI-INFLAMMATORY OF COX-1 AND COX-2 REGARDING SIDE EFFECTS IN THE ASTROINTESTINAL TRACT

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat symptoms caused by rheumatoid arthritis due to their ability to inhibit prostaglandin synthesis by inhibiting cyclooxygenase (COX). The side effects of NSAIDs are also associated with inhibiting prostaglandin production. Consequently, their application is problematic. NSAID selective COX-2 inhibitors give minor gastrointestinal complications. Our study aims to compare nonsteroidal anti-inflammatory inhibitors of COX-1 and COX-2 regarding side effects in the gastrointestinal tract of patients with rheumatoid arthritis.Keywords:  Nonsteroidal anti-infammatory drugs, rheumatoid arthtritis, COX-2, gastrointestinal tract, PPIs

Morgagni hernia presenting in a 68‐year‐old patient treated for pneumonia

Key Clinical Message We report an unusual case of an advanced congenital diaphragmatic hernia (Morgagni type) in an elderly patient, which was initially diagnosed and treated for pneumonia. Surgical repair through laparotomy is the method of choice in acute and complicated cases such as our patient. She was successfully treated surgically. Abstract Morgagni hernia represents a congenital form of diaphragmatic hernia that due to its frequent complications is regularly diagnosed during late infancy or early adulthood. Described some centuries before, its pathogenesis is still a matter of controversy. Nevertheless, authors converge into the option of surgical repair that, as a rule, ensures a definite resolution of symptoms. We describe the case of a female patient aged 68 years old, which was being treated for pneumonia. Due to persistent vomiting, malaise, and lack of improvement, she underwent imaging procedures that initially suspected and thereafter confirmed the presence of a huge intrathoracic right Morgagni hernia, needing surgery

Pneumoretroperitoneum, pneumomediastinum, and neck emphysema due to rectal diverticulosis

Abstract Intestinal diverticulosis is a chronic disorder that might present with acute symptoms, due to colonic perforation. Pneumoperitoneum and air bubbles spreading in different anatomical locations can be seen. These complications need careful consideration and, when appropriate, surgery, for an otherwise chronic condition that can be successfully treated through conservative measures

Antibiotic therapy in acute pancreatitis: From global overuse to evidence based recommendations

Background & objectives: Unwarranted administration of antibiotics in acute pancreatitis presents a global challenge. The clinical reasoning behind the misuse is poorly understood. Our aim was to investigate current clinical practices and develop recommendations that guide clinicians in prescribing antibiotic treatment in acute pancreatitis. Methods Four methods were used. 1) Systematic data collection was performed to summarize current evidence; 2) a retrospective questionnaire was developed to understand the current global clinical practice; 3) five years of prospectively collected data were analysed to identify the clinical parameters used by medical teams in the decision making process, and finally; 4) the UpToDate Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was applied to provide evidence based recommendations for healthcare professionals. Results The systematic literature search revealed no consensus on the start of AB therapy in patients with no bacterial culture test. Retrospective data collection on 9728 patients from 22 countries indicated a wide range (31–82%) of antibiotic use frequency in AP. Analysis of 56 variables from 962 patients showed that clinicians initiate antibiotic therapy based on increased WBC and/or elevated CRP, lipase and amylase levels. The above mentioned four laboratory parameters showed no association with infection in the early phase of acute pancreatitis. Instead, procalcitonin levels proved to be a better biomarker of early infection. Patients with suspected infection because of fever had no benefit from antibiotic therapy. Conclusions The authors formulated four consensus statements to urge reduction of unjustified antibiotic treatment in acute pancreatitis and to use procalcitonin rather than WBC or CRP as biomarkers to guide decision-making