Triglyceride-Glucose Index is a Reliable Predictor of Metabolic Disorder in Gallstones

Objective: The risk of gallstones is increased in fatty liver, overweight, and metabolic syndrome. The hyperinsulinemic-euglycemic clamp method is considered the best method for insulin resistance (IR); but it is a time consuming and expensive procedure. As an alternative strategy, in this study, we would like to demonstrate the triglyceride-glucose (TyG) index as the predictor of the development of gallstone disease associated with metabolic disorders. Methods: The TyG was investigated in our study with 1484 patients between the ages of 18-75 who underwent follow-up and/or cholecystectomy due to gallstones. The serum fasting blood glucose and triglyceride levels of the patients were measured in the biochemistry laboratory of our hospital. The bile ducts and gallstones of all patients were evaluated with the Philips Affiniti 50 (The Philips Affiniti 50 Ultrasound; Philips North America Corporation 3000 Minuteman Road M/S 109 Andover, MA 01810, USA) ultrasonography device used by radiologists in the radiology clinic of our hospital. The data obtained were evaluated in SPSS, and p<0.05 was considered significant. Results: Our study includes 1484 (980 female, 504 male) patients. The plasma glucose (124.6±24.5 mg/dL), triglyceride (198.3±36.8 mg/dL), insulin (16.5±5.6 uIU/mL), and Homeostasis Model Assessment of IR 4 level (8±1.2), were at statistically and significantly higher levels in the patients than in the control group (p=0.001). It was found that the basal TyG was associated with the primary endpoint incidence of gallstones at significant levels. The TyG was related with hazard ratio 1.65 as a continuous variable in univariate analysis (95% confidence interval 1.15-1.98; p<0.001). Conclusion: High TyG scores were associated with gallstone disease, and it can be used as an identifying marker for screening people who have gallstone disease and as an indication for therapeutic precautions

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Predictive Contribution of Neutrophil/Lymphocyte Ratio in Diagnosis of Brucellosis

Here we wanted to investigate predictive value of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in the diagnosis of brucellosis. Thirty-two brucellosis patients diagnosed with positive serum agglutination test and thirty-two randomized healthy subjects were enrolled in this study retrospectively. Result with ROC analyzes the baseline NLR and hemoglobin values were found to be significantly associated with brucellosis (P=0.01, P=0.01, resp.). Herein we demonstrated for the first time that NLR values were significantly associated with brucellosis. This situation can help clinicians during diagnosis of brucellosis

Thyroid Homeostasis After Bariatric Surgery in Obese Cases

Onmez, Attila/0000-0002-7188-7388WOS: 000490203600001PubMed: 31617112Background The aim of this study was to determine changes in thyroid hormones and morphology with weight loss after bariatric surgery in obese patients. Methods This prospective study was performed in our endocrinology and surgery clinic. Pre- and post-bariatric surgery thyroid function tests and thyroid ultrasonography parameters were compared. Results Four hundred seventy-two patients were included in the study. Mean weight loss after surgery was 30.7 +/- 5.1 kg. TSH levels decreased statistically significantly parallel with weight loss and decreased BMI (p = 0.025) after bariatric surgery. However, no statistically significant change was observed in fT4 or fT3 levels (p > 0.05). A significant increase in thyroid parenchyma echogenicity, correlated with weight loss and time elapsed since surgery, was detected at ultrasonography (US) grayscale histogram analysis compared with muscle echogenicity (p = 0.032). An increase in echogenicity was even detected in patients with isoechoic thyroid parenchyma before surgery. Fasting insulin and HOMA-IR levels decreased after surgery (p = 0.010 and p = 0.001, respectively). Patients were divided into three groups based on weight loss. In group 3, preoperative TSH of 4.1 +/- 0.7 decreased to 1.6 +/- 0.7 postoperatively (p = 0.001), while preoperative HOMA-IR of 4.9 +/- 1.9 decreased to 2.4 +/- 0.8 postoperatively (p = 0.001). Conclusions Obesity causes thyroid hormone resistance through a mechanism similar to insulin resistance and leads to an increase in TSH similar to hyperinsulinemia. Our findings show that echogenicity at thyroid US increases in line with weight loss following bariatric surgery

Drug-Induced Liver Injury by Glatiramer Acetate Used for Treatment of Multiple Sclerosis

Glatiramer acetate (GA, Copaxone) is an approved drug for the treatment of relapsing–remitting multiple sclerosis. Most common side effects observed with GA are local injection site reactions, which can include pain, swelling, or redness. However, systemic adverse event such as hepatotoxicity related to GA is rarely seen. In this report, we present a case of GA-induced toxic hepatitis associated with cholestatic and hepatocellular damage

Epicardial Adipose Tissue Thickness in Patients With Subclinical Hypothyroidism and the Relationship Thereof With Visceral Adipose Tissue Thickness

BACKGROUND: Subclinical hypothyroidism (SH) is associated with cardiovascular metabolic syndromes, especially dislipidemia and abdominal obesity. Visceral abdominal adipose tissue (VAAT) and epicardial adipose tissue (EAT) have the same ontogenic origin and produce many proinflammatory and proatherogenic cytokines. We evaluated EAT and VAAT thickness in patients with SH. METHODS: Forty-one patients with SH and 35 controls were included in the study. Demographical and anthropometric features of both patients and controls were recorded. Thyroid and metabolic parameters were measured. EAT was measured using 2D-transthoracic echocardiography. RESULTS: The age and gender distributions were similar in the two groups (P = 0.998 and P = 0.121, respectively). Body mass index (BMI), fat mass, waist circumference (WC), hip circumference (HC), the WC/HC ratio, and the thicknesses of VAAT and abdominal subcutaneous adipose tissue were higher in the case group than the control group (all P values < 0.01). However, both groups had similar EAT thickness (P = 0.532), which was positively correlated with BMI, fat mass, WC, HC, VAAT thickness, abdominal subcutaneous adipose tissue thickness, and serum triglyceride (TG) level (all P values < 0.01). We found no correlation between EAT thickness and thyroid-stimulating hormone (TSH) level, free thyroxine (FT4) level, or low-density lipoprotein-cholesterol (LDL-C) level, and anti-TPO level (all P values > 0.05). We found no difference between the two groups in fasting plasma glucose (FPG) level (P = 0.780), but the levels of LDL-C and TG differed significantly (P = 0.002 and P = 0.026, respectively). The serum TSH level was higher and the FT4 level was lower in the case than the control group (both P values <0.01). CONCLUSION: Increased abdominal adipose tissue thickness in patients with SH is associated with atherosclerosis. To detemine the risk of atherosclerosis in such patients, EAT measurements are valuable; such assessment is simple to perform