Ultrasound-Assisted Focused Open Necrosectomy in the Treatment of Necrotizing Pancreatitis

Publisher Copyright: © 2015, JOP. J Pancreas (Online). All rights reserved.Introduction The surgical treatment of necrotizing pancreatitis includes percutaneous drainage of acute necrotic collections and sequestrectomy in the late phase of the disease. The aim of the study was to compare the conventional open necrosectomy (CON) approach with the alternative focused open necrosectomy (FON) approach in patients with infected necrosis and progression of sepsis. Methods Patients with acute necrotizing pancreatitis were included in the study prospectively from January 2004 to July 2014. All patients had been admitted with the first or a new episode of disease. Symptomatic large fluid collections were drained percutaneously. The step-up approach was used in patients with several distant localizations of infected necrosis. The methods were analysed by comparing the individual severity according to the ASA, APACHE II and SOFA scores, infection rate, postoperative complication rate and mortality. Results A total of 31 patients were included in the FON group and 39 in the CON group. The incidence of infection was similar in groups. More ASA III comorbid conditions, a higher APACHE II score, a more frequent need for renal replacement therapy was observed in the CON group. The postoperative complication rate was in the range of 32% to 44%; mortality reached 6.5% in the FON group and 12.8% in the CON group. Conclusions Comorbid conditions, organ failure, and infection are the main risk factors in patients with necrotizing pancreatitis. The step-up approach and perioperative ultrasonography navigation improves the clinical outcome and reduces the extent of invasive surgical intervention in patients unsuited to other minimally invasive procedures.publishersversionPeer reviewe

UEG Young Talent Group : What do we do?

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Higher CTX-M, TEM, and SHV extended-spectrum beta-lactamase plasmid gene combination frequency in ESBL producing Klebsiella pneumoniae compared with ESBL producing Escherichia coli

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Risk Factors that Determine Less Favourable Hospitalisation Course and Outcome in Patients with ESBL Producing Enterobacteriaceae Infection : Preliminary Results

Publisher Copyright: © 2016 by Vita Skuja. Copyright: Copyright 2016 Elsevier B.V., All rights reserved.Hospitalisation course and outcome for patients with extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae infection is less favourable due to extensive antibacterial resistance. This study was conducted to identify possible risk factors that could influence the hospitalisation course and outcome in these patients. The study protocol included demographic, clinical, hospitalisation, bacteriological and plasmid genetic data. The preliminary study results showed that hospitalisation course and outcome was less favourable for internal medicine profile patients with ESBL producing bacteria, TEM gene presence in the bacterial plasmid genome, patient age < 65 years and patients with infectious and musculoskeletal diseases. The study includes preliminary data only and further studies should be carried out to verify the suggested risk factors.publishersversionPeer reviewe

Inflammatory Bowel Disease Activity in Previously Hospitalised Patients with Extended Spectrum Beta-lactamase Producing Enterobacteriaceae Presence in the Gut. Doctoral Thesis

Promocijas darbs izstrādāts Rīgas Stradiņa universitātē, Rīgā, Latvijā. Aizstāvēšana: 2020. gada 2. jūnijā plkst. 15.00 tiešsaistē Zoom platformā.Ievads. Paplašināta spektra beta-laktamāzes (ESBL) producējošās Enterobacteriaceae dzimtas baktērijas (ESBL-E) ir visbiežāk sastopamie multi-rezistentie mikroorganismi (MRM) iekaisīgo zarnu slimību (IZS) pacientu zarnu traktā. Iepriekš hospitalizētiem IZS pacientiem ir lielāka iespēja atkārtoti nonākt kontaktā ar medicīnas sistēmu un veicināt tālāku ESBL-E izplatību, ja tās konstatētas pacientu zarnu traktā. Ņemot vērā, ka Enterobacteriaceae dzimtas baktēriju palielināts īpatsvars zarnu mikrobiotas sastāvā tiek saistīts ar IZS – čūlainā kolīta (ČK) un Krona slimības (KS) – attīstību, ESBL-E esamības gadījumā IZS pacientu zarnu traktā varētu tikt novērota lielāka IZS klīniskā aktivitāte. Mērķis. Pētījuma mērķis bija noteikt atšķirības IZS klīniskajā aktivitātē iepriekš hospitalizētiem ČK un KS pacientiem ar un bez ESBL-E pacientu zarnu traktā. Pētījuma pamatā ir hipotēze, ka iepriekš hospitalizētiem IZS pacientiem ar ESBL-E zarnu traktā ir vērojama augstāka IZS klīniskā aktivitāte. Materiāli un metodes. Šķērsgriezuma pētījums, kas veikts divos terciārās medicīnas centros Rīgā, Latvijā, laika posmā no 2015. līdz 2017. gadam, iekļaujot iepriekš hospitalizētu ČK un KS pacientu slimības klīniskās aktivitātes rādītājus un informāciju par ESBL-E šo pacientu zarnu traktā. ČK un KS pacienti analizēti atsevišķi, jo atšķirīgi ir principi un punktu sistēmas, pēc kurām nosaka IZS klīnisko aktivitāti. ČK klīniskā aktivitāte un izplatība novērtēta pēc pilnās un daļējās Mayo score punktu sistēms, adaptētā Truelove and Witt’s indeksa un Montreālas klasifikācijas, savukārt KS klīniskā aktivitāte un izplatība novērtēta pēc Krona slimības aktivitātes indeksa (CDAI), Harvey-Bradshaw indeksa (HBI) un Montreālas klasifikācijas atbilstoši Eiropas Krona un Kolīta organizācijas (ECCO) vadlīnijām. No pacientiem tika iegūts rektālās iztriepes biomateriāls, no kura izolētas ESBL-E un noteikti baktēriju ESBL produkciju noteicošie plazmīdu gēni (blaCTX-M, blaTEM un blaSHV) atbilstoši Eiropas Antibakteriālās jutības noteikšanas komisijas (EUCAST) vadlīnijām. ČK un KS klīniskās aktivitātes rādītāji salīdzināti gadījumos ar un bez ESBL-E iepriekš hospitalizēto IZS pacientu zarnu traktā. Rezultāti. Pētījumā analizēti 177 iepriekš hospitalizēti IZS pacienti – 122 (69%) ČK un 55 (31%) KS pacienti. ESBL-E šo pacientu zarnu traktā konstatētas 19 (11%) gadījumos – 13 (11%) ČK un 6 (11%) KS pacientiem. E. coli bija visbiežāk konstatētā ESBL-E, kas visbiežāk saturēja blaCTX-M baktēriju plazmīdu gēnu gan ČK, gan KS gadījumā. Iepriekš hospitalizētiem gan ČK, gan KS pacientiem ar ESBL-E zarnu traktā, salīdzinot ar pacientiem bez ESBL-E zarnu traktā, tika konstatēta lielāka slimības klīniskā aktivitāte pēc pilnās Mayo score punktu sistēmas (Mdn = 5, IQR = 6 vs. Mdn = 3, IQR = 2 punkti; p = 0,016), adaptētā Truelove and Witt’s indeksa (mērena vs. viegla slimība; p < 0,0001) un Montreālas klasifikācijas (vidēji smaga slimība vs. klīniskā remisija; p = 0,001) ČK pacientiem un CDAI (vidēji smaga slimība vs. remisija; p = 0,028; Mdn = 219, IQR = 281,71 vs. Mdn = 103,99, IQR = 119,01 punkti; p = 0,023) un HBI (mērena slimība vs. remisija; p = 0,008; Mdn = 7, IQR = 8 vs. Mdn = 3, IQR = 5 punkti; p = 0,01) KS pacientiem. ČK pacientiem ar ESBL-E zarnu traktā tika konstatēta plašāka slimības izplatība (ekstensīvs kolīts (E3) vs. proktīts (E1); p = 0,042) resnajā zarnā. Secinājumi. Augstāka IZS klīniskā slimības aktivitāte tika konstatēta iepriekš hospitalizētiem ČK un KS pacientiem, kuru zarnu traktā konstatētas ESBL-E. Nepieciešami turpmāki pētījumi, lai noteiktu ESBL-E saistību ar IZS klīnisko aktivitāti

Iekaisīgo zarnu slimību aktivitāte iepriekš hospitalizētiem pacientiem ar paplašināta spektra beta-laktamāzes producējošām Enterobacteriaceae dzimtas baktērijām zarnu traktā. Promocijas darba kopsavilkums

The Doctoral thesis has been developed in: Rīga Stradiņš University, Riga, Latvia. Defence: online on 2 June 2020 at 15.00 using the Zoom platform.Background. Extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (ESBL-E) are the most commonly found multi-drug resistant bacteria in the gut of inflammatory bowel disease (IBD) patients. Previously hospitalized IBD patients are more likely to repeatedly come into contact with the medical system and promote further spread of ESBL-E if they are found in the patient’s gut. Considering that increased proportion of Enterobacteriaceae in the gut microbiota is associated with the development of IBD – ulcerative colitis (UC) and Crohn’s disease (CD), a higher IBD clinical disease activity could be observed in case of ESBL-E presence in the gut. Aim and objectives. The aim of the study was to determine the differences in IBD clinical disease activity in previously hospitalized UC and CD patients with and without ESBLE presence in their gut. The study is based on the hypothesis that higher clinical disease activity is observed in previously hospitalized IBD patients with ESBL-E in their gut. Materials and methods. A cross-sectional study was carried out in two tertiary medical centers in Riga, Latvia betrween 2015 and 2017. Thes study incluced information on IBD clinical disease activity in previously hospitalized UC and CD patients and information about presence of ESBL-E in their gut. UC and CD pacients were analysed seperately, beacuse of the differences in the principles of determening the clinical disease activity and differences in the clinical scores between the two diseases. UC clincial disease activity and extent was evaluated according to the full and partial Mayo score, adapted Truelove and Witt’s index and Montreal classification and CD clinical disease activity and extent was evaluated according to Crohn’s disease activity index (CDAI), Harvey-Bradshaw index (HBI) and Montreal classification, according to the European Crohn’s and Colitis Oraganisation (ECCO) guidelines. Rectal swabs with fecal biomaterial were collected from the patients, ESBL-E were isolated, and bacterial plasmid genes responsible for ESBL production (blaCTX-M, blaTEM and blaSHV) were detected, according to the European Committee on Antibicrobial Susceptibility Testing (EUCAST) guidelines. Clinical disease activity in previously hospitalised UC and CD patients was compared in cases with and without ESBL-E presence in patient’s gut. Results. A total of 177 previously hospitalised IBD patients – 122 (69%) UC and 55 (31%) CD patients were analysed in the study. ESBL-E presence in previously hospitalised IBD patient’s gut was found in 19 (11%) cases – 13 (11%) UC and 6 (11%) CD cases. E. coli, was the most frequently found ESBL producing strain, most frequently containing blaCTX-M bacterial plasmid gene in both previously hospitalised UC and CD patients. Previoulsy hospitalised UC and CD patients with ESBL-E presence in their gut had more severe IBD clinical disease activity compared to patients without ESBL-E presence in their gut, according to full Mayo score (Mdn = 5, IQR = 6 vs. Mdn = 3, IQR = 2 points; p = 0.016), adapted Truelove and Witt’s index (moderate vs. mild disease; p < 0.0001) and Montreal classification (moderate disease vs. clinical remission; p = 0.001) in UC patients and CDAI (moderate disease vs. remission; p = 0.028; Mdn = 219, IQR = 281.71 vs. Mdn = 103.99, IQR = 119.01 points; p = 0.023) and HBI (moderate disease vs. remission; p = 0.008; Mdn = 7, IQR = 8 vs. Mdn = 3, IQR = 5 points; p = 0.01) in CD patients. Previously hospitalised UC patients with ESBL-E presence in their gut, comparing to patients without ESBL-E presence in their gut had more extensive disease according to the Montreal classification (extensive (E3) vs. protctitis (E1); p = 0.042). Conclusions. Higher IBD clinical disease activity was observed in previously hospitalised UC and CD patients with ESBL-E presence in their gut. Further studies are needed to examine the association between ESBL-E presence in the gut and IBD activity

Young GI Societies in Europe: 2019 update

Abstract Background: One of the aims of the Young Talent Group (YTG) is to make United European Gastroenterology (UEG) more attractive to young fellows interested in gastroenterology (GI), and to actively involve them in UEG activities and the activities of their respective national societies. In 2017, we conducted a survey among the Friends of the UEG YTG with the aim of identifying the state of organization and needs of Young GI Sections (YGISs) throughout Europe, highlighting areas for further development and improvement. Aims: The aim of the current web-based survey was to assess the progress of YGISs over 1 year, and persisting hurdles in forming and running a YGIS. Results: Overall, 38 of 42 Friends answered the survey (91%). The number of YGISs has increased significantly from 12 in 2017 to 25 in 2019. Young gastroenterologists remained supported, but not influenced, by national societies. Results of the survey suggest that a lack of dedicated and motivated fellows has replaced a lack of funding as the most prevalent hurdle in forming these types of sections. Conclusion: Our survey shows that the development of YGISs has improved markedly within the last 2 years. However, several limitations, like underrepresentation in subcommittees of national societies, remain and need to be addressed in order to involve young gastroenterologists in their respective national societies and within UEG, to pave the way for future research, education and excellent quality of care, and reduce health inequalities across Europe