Insulinoma-Induced Hypoglycemia in a Patient with Insulinoma after Gastrojejunostomy for Prepyloric Ulcer

Hyperinsulinism due to dumping syndrome following gastric surgery is an uncommon condition. It is specified with hypoglycemic attacks. However, linking symptoms to dumping syndrome in each patient to whom gastric surgery was performed leads to inappropriate diagnosis and therapy. Insulinoma and other causes that give rise to hyperinsulinemia should not be ignored and these diagnoses should be excluded. In this paper, 71-year-old male patient who was followed up for 2 years with a false conclusion of dumping syndrome and operated on due to insulinoma diagnosed at endoscopic ultrasonography is presented in the light of the literature

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Antibiotic Resistance Profile of Acinetobacter Strains Isolated from Patients in the Intensive Care Unit: A Surveillance Study of Four Years

Introduction: Acinetobacter species can cause health care-associated infections in patients who are treated in intensive care units of hospitals. The aim of this study was to determine the antibiotic resistance rates of Acinetobacter species that induce health care-associated infections among intensive care unit patients in a state hospital during the period 2008-2011. Materials and Methods: Clinical samples obtained from intensive care unit patients were cultured by regular methods. The identification and antibiotic susceptibility tests were performed using the BD Phoenix 100 system, BD Phoenix NMIC/ID-82 Id+ADT (Becton Dickinson, Belgium). Results: During the study period a total of 320 Acinetobacter strains were isolated. Colistin and tigecycline were found to be the most effective antimicrobial agent against Acinetobacter species. When the resistance rates were compared between 2008 and 2011, significant increases were observed for imipenem, meropenem, ceftazidime, trimethoprim-sulfamethoxazole, and ampicillin- sulbactam; a significant decrease was observed for tobramycin. No statistically significant changes were observed for amikacin, cefepime, ceftriaxone, piperacillin-tazobactam, and gentamicin. Conclusion: High antibiotic resistance rates of Acinetobacter species induce health care- associated infections in intensive care unit patients. It is important to undertake bacteriologic surveillance in hospitals to ascertain the common microorganisms and their antibiotic resistance rates

Insulinoma-Induced Hypoglycemia in a Patient with Insulinoma after Gastrojejunostomy for Prepyloric Ulcer

Hyperinsulinism due to dumping syndrome following gastric surgery is an uncommon condition. It is specified with hypoglycemic attacks. However, linking symptoms to dumping syndrome in each patient to whom gastric surgery was performed leads to inappropriate diagnosis and therapy. Insulinoma and other causes that give rise to hyperinsulinemia should not be ignored and these diagnoses should be excluded. In this paper, 71-year-old male patient who was followed up for 2 years with a false conclusion of dumping syndrome and operated on due to insulinoma diagnosed at endoscopic ultrasonography is presented in the light of the literature

Volume of intensive care unit patients in the emergency department: Clinical experience in a training and research hospital

There is an increasing tendency for critically ill patients to present to emergency departments (EDs). In this study, it was aimed to assess patients who presented to the ED and admitted to the intensive care unit (ICU) and to identify waiting times in the ED. This retrospective study was conducted by reviewing data from 4904 patients (aged >18 years) who presented to the ED for whom the decision was made for hospitalization in the ICU between January 1st, 2016, and December 31st, 2017. Waiting time in the ED, demographic data, and length of ICU stay were reviewed for 3572 patients who were admitted to ICUs from the ED. The total number of patients who presented to the ED between January 1st, 2016, and December 31st, 2017 was 200,603. Among these patients, the ICU admission rate was 2.4%. Of 4904 patients who presented to the ED and the decision was made for ICU admission, 1332 patients were transferred to other facilities. When these patients were excluded, the ICU admission rate was found as 1.8% in our facility. When time to ICU admission from the ED was assessed, it was found that the shortest time recorded for admission from the ED to the burns unit was 48 minutes. The second shortest waiting time (148 min) was seen in patients admitted to the coronary intensive care unit. The mean waiting time of ICU patients in the ED was 282 min. The increase in the patients who have been decided to hospitalization in the ICU in the ED remains an important problem that should be managed in the ED crowd. Long waiting times for ICU patients in the ED make the already existing crowd more complicated. [Med-Science 2020; 9(1.000): 49-53

Investigation of the Effects of Probiotic Bacteria on Bacterial Translocation that Developed During Diagnostic Laparoscopy: An Experimental Study

WOS: 000311330900014PubMed: 23188579Probiotics which are non-pathogenic live microorganisms ingested along with food or as dietary supplements, are thought to be beneficial to the host by supporting the microbial balance in digestive system. Various studies suggest that the effects of probiotics on the intestinal mucosa and immunity are protective against bacterial translocation. We aimed to investigate bacterial translocation related to the amount of CO2 insufflation given during laparoscopy and the effect of probiotic bacteria in an experimental peritonitis model. In this study 60 Wistar rats were used in six groups consisting of 10 rats. Group 1, 3 and 5 consisted of the rats that were fed without probiotics, while the rats in Group 2, 4, and 6 were fed with water containing 5 x 10(8) cfu/ml probiotic bacteria complex (Bifidobacterium lactis, Lactobacillus bulgaricus, Streptococcus thermophilus) for 15 days. To generate experimental peritonitis, 2 x 10(7) cfu/ml Escherichia coli ATCC 25922 was inoculated intraperitoneally to all of the rats. Thereafter, laparoscopy was applied in all groups. Application in Group 1 and Group 2 was without CO2; Group 3 and Group 4 with 14 mmHg CO2 insufflation, and Group 5 and Group 6 with 20 mmHg CO2 insufflation. Blood samples were taken in 2nd, 4th, and 6th hours. Mesenteric lymph node, liver and spleen samples were taken at 6th hour when the rats were sacrified and then these were evaluated microbiologically with qualitative and quantitative methods. Bacterial translocation and bacteremia were found in the rats that were undergone experimental peritonitis during laparoscopy. All positive tissue and blood cultures yielded E.coli. The highest level of bacterial translocation was found to be in mesenteric lymph nodes (in 3/10, 6/10 and 10/10 in groups 1, 3 and 5 fed without probiotics, respectively; in 2/10, 3/10 and 4/10 in groups 2, 4 and 6 fed with probiotics, respectively). The bacterial translocation rates were found to be related to the increased CO2 insufflation. It was found that probiotic bacteria were more effective for decreasing bacterial translocation rates and bacteremia in the groups that were given high CO2 pressure during laparoscopy. It was also found that these results were correlated with bacterial translocation per gram of tissue. As an example, the quantitative bacterial growth values detected in mesenteric lymph node were 5.4 +/- 2.9 x 10(3), 10.6 +/- 3.3 x 10(3) and 21.5 +/- 12.4 x 10(3) cfu/g in groups 1, 3 and 5, fed without probiotics, respectively; and 2.0 +/- 1.3 x 10(3), 3.8 +/- 1.9 x 10(3) and 9.0 +/- 3.1 x 10(3) cfu/g in groups 2, 4 and 6, fed with probiotics, respectively. Our data emphasized that probiotic bacteria may be used as prophylactic agents for the prevention of bacterial translocation during laparoscopy, however comprehensive and clinical studies are needed to support these experimental results

The Association of PRKRAP1 Pseudogene with Acute Lymphoblastic Leukemia Risk

Objective: Acute Lymphoblastic Leukemia (ALL) consists of excessive proliferation of lymphoblasts. The frequency of Human Leukocyte Antigen (HLA)-DR53 (DRB4) homozygosity and allele was found to be higher in male childhood ALL cases. The aim of this study was to identify the HLA-DR53 allele frequency; interferon-inducing double chain ribonucleic acid binding protein kinase A pseudogene 1 (PRKRAP1) positivity; rs2395185 allele and genotype frequencies in ALL patients. Materials and Methods: Sixty ALL patients and 40 healthy controls were studied. HLA’s were analyzed using the PCR-SSP. The PRKRAP1 positivity have been identified by PCR and rs2395185 genotypes were determined by TaqMan assay using real-time PCR. Results: PRKRAP1 positivity was shown to be specific to HLA-DRB4 haplotype in the whole group. We observed that HLA-DRB1*04, DRB1*07 alleles were higher in male patients (43.5%, 25.0%) compared with female patients (25.0%, 21.4%). The prevalence of rs2395185 T allele, HLA-DRB4 allele and HLA-DRB4 homozygous in childhood ALL patients were significantly higher in males compared with the females (p:0.044, p:0.007, p:0.045, respectively). Conclusion: The molecular mechanism of PRKRAP1 pseudogenesis, which we have confirmed to be specific for HLA-DRB4 (DR53) haplotypes, in a newly identified specific transcription map can be investigated and its relationship with ALL can be determined

Investigation of Intestinal Parasites and Level of Hygiene Knowledge of School Students

Amaç: Bu çalışmada, bağırsak parazitlerinin prevalansı ile bazı hijyen alışkanlıkları ve sosyo-demografik özelliklerinin ilişkisinin araştırılması amaçlanmıştır.Yöntemler: Çalışmanın ilk yılı parazitoz prevalansı ve anketlerle hijyen bilgi düzeyleri ölçülmüş, ikinci yıl kontrol ve müdahale grubu belirlenmiştir. Müdahale gruplarına eğitim verilmiştir. Üçüncü yıl bu kontrol ve müdahale gruplarında parazitoz ve hijyen konusundaki gelişme araştırılmış, sonuçlar karşılaştırılmıştır. İlk olarak, toplam 826 çocuğa ulaşılmış ancak öğrencilere ait 523 dışkı örneği ve 540 selofan bant örneği incelenebilmiştir. Dışkı örneklerine direk bakı, %0,85'lik NaCl, formol-eter konsantrasyon işlemi sonrasında lugol, kinyoun asit-fast ve trikrom boyama yöntemleri uygulanmıştır. Bulgular: İncelenen örneklerde 87 (% 16,1) Enterobius vermicularis, 79 (% 15,1) Giardia intestinalis, 73 (% 13,9) patojen olmayan çeşitli parazitler, 1 (% 0,19) Ascaris lumbricoides, 1 (% 0,19) Hymenolepis nana, saptanmıştır. Bulunan sonuçlar anket cevapları ile birlikte analiz edilmiştir. Dışkılama sonrası ellerini yıkamayan çocuklarda G. intestinalis yüksek oranda pozitif saptanmıştır. Ayrıca anne-baba eğitim durumu, ailenin gelir düzeyi ve baba mesleği ile bağırsak parazitleri varlığının ilişkili olduğu bulunmuştur. Üçüncü aşamada müdahale grubunda 68 (45,6%), kontrol grubunda 81 (54,4%) toplam 149 çocuk incelenmiştir. Eğitim sonrası müdahale grubunda giardiyazis ve enterobiazis olgu sayılarında belirgin azalma görülmüştür. Sonuç: Paraziter hastalıkların bu bölgede önemli bir halk sağlığı sorunu olduğu görülmüştür. Hijyen konusunda yapılacak eğitimlerin paraziter hastalıkları önlemesi açısından faydalı olacağı düşünülmüştürObjective: In this study, the prevalence of intestinal parasites and its relationship with some hygiene habits and socio-demographic characteristics of students in Yığılca were investigated. Methods: This study was conducted in three parts. Firstly, the prevalence of parasitic diseases was measured, and questionnaires about the level of knowledge of hygiene were administered. Secondly, control and intervention groups were determined. Lastly, some education and training courses were organized and provided to the intervention group, including parents and children, about the prevention of parasitic diseases and habits of cleaning. Results: In this study, 540 cellophane tapes and 523 stool samples were studied. Among the samples analyzed, 87 (16.1%) with Enterobius vermicularis, 79 (15.1%) with Giardia intestinalis, 73 (13.9%) with various non-pathogenic parasites, 1 (0.19%) with Ascaris lumbricoides, and 1 (0.19%) with Hymenolepis nana were found. G. intestinalis was highly positive among the children who do not wash their hands after defecation. Also, some intestinal parasites were found to be related to the socio-demographic characteristics of families; parental education, family income, and father's profession were found to be associated with the presence of intestinal parasites. After training, the intervention group showed a significant decrease in the number of giardiasis and enterobiasis cases. Conclusion: Education on hygiene will prevent parasitic diseases from an early ag