Pleural space infections after image-guided percutaneous drainage of infected intraabdominal fluid collections: a retrospective single institution analysis

BACKGROUND: Percutaneous drainage of infected intraabdominal fluid collections is preferred over surgical drainage due to lower morbidity and costs. However, it can be a challenging procedure and catheter insertion carries the potential to contaminate the pleural space from the abdomen. This retrospective analysis demonstrates the clinical and radiographic correlation between percutaneous drainage of infected intraabdominal collections and the development of iatrogenic pleural space infections. METHODS: A retrospective single institution analysis of 550 consecutive percutaneous drainage procedures for intraabdominal fluid collections was performed over 24 months. Patient charts and imaging were reviewed with regard to pleural space infections that were attributed to percutaneous drain placements. Institutional review board approval was obtained for conduct of the study. RESULTS: 6/550 (1.1%) patients developed iatrogenic pleural space infections after percutaneous drainage of intraabdominal fluid collections. All 6 patients presented with respiratory symptoms and required pleural space drainage (either by needle aspiration or chest tube placement), 2 received intrapleural fibrinolytic therapy and 1 patient had to undergo surgical drainage. Pleural effusion cultures revealed same bacteria in both intraabdominal and pleural fluid in 3 (50%) cases. A video with a dynamic radiographic sequence demonstrating the contamination of the pleural space from percutaneous drainage of an infected intraabdominal collection is included. CONCLUSIONS: Iatrogenic pleural space infections after percutaneous drainage of intraabdominal fluid collections occur at a low incidence, but the pleural empyema can be progressive requiring prompt chest tube drainage, intrapleural fibrinolytic therapy or even surgery. Expertise in intraabdominal drain placements, awareness and early recognition of this complication is critical to minimize incidence, morbidity and mortality in these patients. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12893-015-0030-4) contains supplementary material, which is available to authorized users

Kulturelle Vielfalt in Lehrwerken des Deutschen und des Finnischen als Zweitsprache

In der Masterarbeit wird die Behandlung der kulturellen Vielfalt in den Lehrwerken für Deutsch und Finnisch als Zweitsprache, Wo ist Paula? Kursbuch 1 und Kielikarhu 1 untersucht. Ziel ist zu verstehen, wie Minderheitskulturen und -gruppen in diesen Lernmaterialien sowohl durch Texte als auch durch Bilder dargestellt werden. Die Methodologie der Studie basiert auf einer Lehrwerkanalyse, die Textanalyse und vergleichende Analysemethoden kombiniert. Dies ermöglicht eine tiefe Untersuchung der Struktur, Themen und kulturellen Elemente der Bücher. In der Definition des Begriffs kulturelle Vielfalt wird ein breiter Ansatz gewählt, der alle Kulturen umfasst, die nicht ausschließlich auf die finnische oder deutsche Kultur beschränkt sind. Es ist wichtig zu beachten, dass die Analyse sich nur auf schriftliches Material konzentriert und Audioaufnahmen so wie andere Multimediaelemente außer Acht lässt. Dies kann die Vollständigkeit der Analyse einschränken, insbesondere wenn man mögliche Akzente und Betonungen berücksichtigt, die nicht bewertet werden können. Zusammenfassend lässt sich sagen, dass in beiden Lehrwerken verschiedene Kulturen vorgestellt werden, aber ihre Darstellung ist nicht immer tiefgreifend oder umfassend. Dies kann zu vereinfachten Vorstellungen und zur Verstärkung von Stereotypen führen. Da sowohl Finnland als auch Deutschland multikulturelle Länder sind, ist es wichtig, dass Schulmaterialien diese Vielfalt widerspiegeln. Lehrwerke sollten ein vielfältiges und realistisches Bild verschiedener Kulturen bieten, und Schüler:innen sollten die Möglichkeit haben, über ihre eigenen kulturellen Erfahrungen zu sprechen und sie mit anderen zu teilen. Dies hilft, Gemeinschaft und Verständnis zwischen verschiedenen Kulturen aufzubauen

DIGLOSIA DALAM TUTURAN REMAJA DI DESA AYUHULALO KECAMATAN TILAMUTA KABUPATEN BOALEMO

Penelitian ini bertujuan untuk mendeskripsikan situasi penggunaan bahasa oleh remaja di Desa Ayuhulalo melalui permasalahan tentang 1) bagaimana bentuk diglosia dalam tuturan remaja di Desa Ayuhulalo, dan 2) faktor apa saja yang menyebabkan terjadinya diglosia dalam tuturan remaja di Desa Ayuhulalo. Tujuan penelitian yakni, 1) mendeskripsikan bentuk diglosia dalam tuturan remaja di Desa Ayuhulalo dan 2) mendeskripsikan faktor penyebab terjadinya diglosia dalam tuturan remaja di Desa Ayuhulalo. Penelitian ini menggunakan metode kualitatif dengan teknik pengumpulan data yang digunakan yakni, teknik simak, teknik catat, teknik wawancara, dan teknik dokumentasi. Analisis data dilakukan dengan urutan pereduksian data, penyajian data, dan penarikan simpulan. Berdasarkan hasil penelitian dapat disimpulkan bahwa bentuk diglosia dalam tuturan remaja di Desa Ayuhulalo terdapat 2 bentuk yang sering digunakan yakni (1) diglosia dalam ragam tinggi mencakup Bahasa Indonesia dan Dialek Melayu Manado dan (2) diglosia dalam ragam rendah mencakup Bahasa Gorontalo dan Dialek Melayu Manado. Faktor penyebab terjadinya diglosia dalam tuturan remaja yang ditemukan dalam penelitian ini meliputi (1) faktor fungsi, (2)faktor prestise, (3) faktor pemerolehan, (4) faktor stabilita

Total leucocytes in human semen of normal and pathologic origin

Total Leucocytes were counted by using O-touJidine, in one hundred and thirty nine semen samples of normal and pathological origin.The values of alI the samples had fallen almost in the same range. However significant difference in mean value was 8een in oLigoasthenozoospermia (p < 0.05)

Correlation between serum ferritin and glycaemic control in patients of type 2 diabetes mellitus: a case control study

Background: Diabetes Mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both. Ferritin is a ubiquitous intracellular protein complex that reflectes the iron stores of the body. Many cross-sectional studies indicate that increased body iron stores have been associated with the development of glucose intolerance, type 2 diabetes, metabolic syndrome. This study was carried out to find out the relationship between serum ferritin and type 2 diabetes and to see the influence of body iron stores on HbA1c and blood glucose.Methods: This study includes 50 patients suffering from type 2 diabetes and compared with controls at Sir T hospital, Bhavnagar. S. ferritin, Fasting Blood Sugar (FBS), Post Prandial Blood Sugar (PPBS) and HbA1c were measured.Results: Serum ferritin was significantly higher (p<0.0001) in the patients suffering from type 2 diabetes and the correlation between serum ferritin and HbA1c was positive. Patients with type 2 diabetes with increased level of serum ferritin had poor glycemic control reflected by increased levels of HBA1c (r=0.701, p<0.0001)Conclusions: There is a positive association between elevated iron stores measured by serum ferritin levels and type 2 diabetes mellitus. Ferritin levels also correlated FBS, PP2BS and HbA1c.

Developing a Cancer Survivorship Curriculum for Family Medicine Residents: A Needs Assessment

With the increasing survival of cancer patients, primary care residents must be familiar with the late effects of cancer treatment and be able to offer appropriate survivorship care in partnership with cancer care specialists. To address these paired public health and educational needs, an interdisciplinary group at our institution is developing, implementing, and evaluating an online cancer survivorship curriculum for primary care residents. In the development phase of our survivorship curriculum we administered an online needs assessment survey questionnaire and conducted a focus group interview with the family medicine residents at our institution. Residents indicated that they rarely utilized survivorship care plans or explicitly negotiated a program of shared patient care with the patient’s cancer specialists. Less than satisfactory elements of cancer survivorship education were identified. Cancer survivorship care is common in family medicine residency care and opportunities exist to improve education, care, and collaboration

Gastrointestinal stromal tumor (GIST) recurrence following surgery: review of the clinical utility of imatinib treatment

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. Surgery with complete removal of the tumor is the primary treatment for resectable GIST and the only chance of cure. However, recurrence after surgery is common. The 2 main prognostic factors are the mitotic activity and the size of the tumor. Tumor rupture is also a risk factor for postoperative recurrence, and extra care should be taken while manipulating this soft and friable tumor. Imatinib mesylate (IM, Gleevec®, Novartis, Basel, Switzerland) is a tyrosine kinase inhibitor and was first studied in the palliative setting for metastatic GIST patients in the year 2000. It is now the cornerstone of metastatic GIST treatment. IM also plays an important role as an adjuvant treatment for resectable GIST and has been shown to increase the recurrence-free survival in phase III studies. However, some points remain to be clarified. Notably, the ideal duration of adjuvant IM after surgery is still unclear. It is also difficult to determine the exact place of surgery in metastatic or recurrent GIST patients in the IM era. A multidisciplinary approach is, therefore, mandatory to offer GIST patients the best treatment available

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks