Treatment options in painful chronic pancreatitis: a systematic review

Background

Longlasting and unbearable pain is the most common and striking symptom of chronic pancreatitis. Accordingly, pain relief and improvement in patients'' quality of life are the primary goals in the treatment of this disease. This systematic review aims to summarize the available data on treatment options.

Methods

A systematic search of MEDLINE/PubMed and the Cochrane Library was performed according to the PRISMA statement for reporting systematic reviews and meta-analysis. The search was limited to randomized controlled trials and meta-analyses. Reference lists were then hand-searched for additional relevant titles. The results obtained were examined individually by two independent investigators for further selection and data extraction.

Results

A total of 416 abstracts were reviewed, of which 367 were excluded because they were obviously irrelevant or represented overlapping studies. Consequently, 49 full-text articles were systematically reviewed.

Conclusions

First-line medical options include the provision of pain medication, adjunctive agents and pancreatic enzymes, and abstinence from alcohol and tobacco. If medical treatment fails, endoscopic treatment offers pain relief in the majority of patients in the short term. However, current data suggest that surgical treatment seems to be superior to endoscopic intervention because it is significantly more effective and, especially, lasts longer.     

Multicenter evaluation of AYC.2.2 agar for the isolation of mycobacteria from clinical samples

PurposeThe aim of this multicenter study is to evaluate AYC.2.2 agar for the isolation of mycobacteria from clinical samples.MethodsTotally 5559 media were tested in 7 centers. AYC.2.2 agar media for the study were prepared by C1 and sent to other centers under appropriate conditions. Other media except AYC.2.2 agar were purchased commercially.The media were subjected to routine laboratory operations in the center where they were sent. After the samples received for routine processing (in all centers, samples were processed with the same method (NALC-NaOH)), they were cultivated on routine media and AYC.2.2 agar afterward.ResultsC1: Average growth time was determined as 12.74±3.74 days with MGIT 960 system; 24.42±4.75 days with LJ and 24.37±4.96 days with AYC.2.2 agar. C2: Average growth time was determined as 18.25±9.32 days with TK-Medium, 28.73±7.44 days with LJ, and 31.72±6.35 days with AYC.2.2 agar. C3: Average growth time was determined as 20.48±7.24 days with Ogawa medium, 20.74±7.12 days with LJ, and 20.26±7.43 days with AYC.2.2 agar. C4: Average growth time was determined as 15.27±6.37 days with MGIT 960 system, 22.14±9.1 days with LJ, and 22±8.45 days with AYC.2.2 agar. C5: Average growth time was determined as 13±4.24 days with MGIT 960 system, 32.16±6.23 days with LJ, and 33±5.73 days with AYC.2.2 agar. C6: Average growth time was determined as 9±3.11 days with MGIT 960 system, 18.68±5.32 days with LJ, and 18.34±4.63 days AYC.2.2 agar. C7: Average growth time was determined as 14.74±7.65 with MGIT 960 system, 26.01±8.21 days with LJ, and 26.24±7.88 days with AYC.2.2 agar.ConclusionsIn conclusion, similar results were obtained with LJ and Ogawa media and AYC.2.2 agar. Furthermore, more studies should be conducted for isolation of M. tuberculosis and performing antibiotic susceptibility tests using AYC.2.2 agar before it can be used as a routine media in the laboratories.     

The role of N terminal pro-brain natriuretic peptide in the evaluation of left ventricular diastolic dysfunction: correlation with echocardiographic indexes in hypertensive patients

The utility of N-Terminal pro Brain Natriuretic Peptide (NT-proBNP) and Brain Natriuretic Peptide (BNP) for detecting left ventricular (LV) diastolic dysfunction in hypertensive patients without heart failure symptoms is unclear. In this study, we investigated the relation between NT-proBNP plasma levels and LV diastolic dysfunction in hypertensive patients without systolic dysfunction. Method: We studied 40 ambulatory patients (26 women, mean age 52 ± 5) with controlled hypertension. LV diastolic function was assessed with conventional Doppler, by means of mitral inflow and with tissue Doppler echocardiography by means of mitral annulus. The ratio of early diastolic transmitral E wave velocities to tissue Doppler mitral annulus early diastolic E' wave velocities (E/E′), was used to detect LV filling pressures. Patients were divided in three groups according to E/E′ ratios < 10 (group I), E/E′ ratios 'between' 10 and 15 (group II) and E/E′ ratios > 15 (group III). Plasma concentrations of NT-proBNP were measured by electro chemiluminescence's immunoassay. Results: The NT-proBNP blood levels were positively correlated significantly with E/E′ ratio (r = 0.80, P < 0.0001). Patients with elevated LV end diastolic pressure (LVEDP), defined as E/E′ > 15 (n = 8) had highest NT-proBNP (203 ± 75 pg/ml) levels. E/E′ 10 to 15 group (n = 16) had a mean NT-proBNP level of 71 ± 26 pg/ml, and those with E/E′ < 10 (n = 16) had 39 ± 20 pg/ml. A NT-proBNP value of 119 pg/ml had a sensitivity of 87%, a specificity of 100% for predicting E/E′ > 15. Conclusion: The assessment of the blood concentration of NT-proBNP is of potential value for identification of those patients with hypertension to detect early cardiovascular changes, especially LV diastolic dysfunction.     

A prospective comparative study of the relationship between different types of ring and microbial hand colonization among pediatric intensive care unit nurses

Objectives

The aim of the study is to assess the effect of ring wearing and ring types on hand contamination and efficacy of alcohol-based hand disinfection among nurses working in intensive care settings.

Methods

Hand cultures were obtained from 84 nurses providing direct patient care in intensive care units of a pediatric hospital. Colony counts were compared depending on ring wearing and the type of ring worn. Twenty-eight nurses were asked to a wear plain wedding ring, 28 to wear rings with stones and 28 not to wear any rings, starting 15 days before and continuing throughout the study. Cultures were obtained by using sterile gloves containing phosphate-buffered-saline solution (PBS) after an alcohol-based hand disinfectant was used and bacteria were identified with standard laboratory tests.

Results

The nurses wearing rings had more Gram-positive, Gram-negative and total bacterial colonization on their hands than the nurses without rings despite using an alcohol-based rub (p = 0.001). When comparing the two groups with rings (plain wedding rings and rings with stones), colony counts of Gram-positive, Gram-negative and total bacteria did not differ (p > 0.05).

Conclusions

Ring wearing increases the bacterial colonization of hands and alcohol-based hand disinfection might not significantly reduce contamination of the ring-wearing hands. The type of ring did not cause any significant difference on the bacterial load. Wearing rings could increase the frequency of transmission of potential nosocomial pathogens.     

Fasting insulin levels independently associated with coronary heart disease in non-diabetic Turkish men and women

BACKGROUND: Levels of plasma insulin have been recognized as a weak risk indicator for coronary or cardiovascular risk in the general population with ethnic background and gender modifying this relationship. We assessed whether insulin concentrations are associated with or would serve as a marker of prevalent coronary heart disease risk in a cross-sectional study of a population having low cholesterol levels (just under 5 mmol/l) but higher prevalence of components of the metabolic syndrome. METHODS: In 688 participants of the Turkish Adult Risk Factor Survey in 2001, plasma insulin values as well as other risk variables were evaluated, and coronary heart disease was diagnosed based on clinical findings and Minnesota coding of resting electrocardiograms. Nearly equal numbers of men and women (>30 years of age) constituted the population sample from the two largest regions of Turkey. Concentrations of insulin were determined by the chemiluminescent immunometric method. RESULTS: Geometric mean value was 50 pmol/l (interquartile range 37-68 pmol/l), without revealing a significant difference in genders. Fasting insulin was correlated in both genders with many variables, notably those involving central obesity, triglycerides, blood pressure, physical inactivity and, inversely, with high-density lipoprotein (HDL)-cholesterol. In a regression model, waist circumference and body mass index were strongly associated with log insulin, after controlling for age and presence of coronary heart disease. The age- and obesity-adjusted odds ratio for coronary heart disease in the highest as opposed to the lowest quartile was 2-fold in both genders (P<0.05). Even after adjustment for dyslipidemia, blood pressure, glucose intolerance, physical activity and smoking status, an over 2-fold increased coronary heart disease risk still persisted with regard to hyperinsulinemia (>or=10 mU/l, 69.5 pmol/l). When C-reactive protein which was correlated with fasting insulin only in women, was added to the model, the impact of hyperinsulinemia on coronary heart disease risk remained unchanged. CONCLUSION: Hyperinsulinemia (i) may provide information on the coronary heart disease likelihood over and above that provided by the other risk factors, including HDL-cholesterol, and (ii) may contribute, within the frame of insulin resistance, to the coronary heart disease risk independently of the classical risk factors.     

Proteolytic Mediators in Gestational Diabetes Mellitus and Gingivitis

Background: This study evaluates levels of matrix metalloproteinase (MMP)‐8, MMP‐9, and tissue inhibitor of MP‐1 (TIMP‐1) in biofluids of women with gestational diabetes mellitus (GDM) and systemically healthy counterparts with different statuses of periodontal health. Methods: Seventy‐one women with GDM and gingivitis (Gg), 30 women with GDM and healthy periodontium (Gh), 28 systemically and periodontally healthy women (Hh), and 37 systemically healthy women with gingivitis (Hg) were evaluated. MMP‐8, MMP‐9, and TIMP‐1 levels were determined in gingival crevicular fluid (GCF), saliva, and serum by immunofluorometric and enzyme‐linked immunosorbent assays. Full‐mouth clinical periodontal parameters were recorded. Results: GCF and serum MMP‐8 concentrations, serum MMP‐9 concentrations, and serum MMP‐8/MMP‐1 and MMP‐9/MMP‐1 molar ratios were significantly higher in Gg compared with Hg group (P <0.05). Serum MMP‐8 levels and salivary TIMP‐1 levels were higher in Gh compared with Hg group (P <0.05) whereas salivary MMP‐8/TIMP‐1 molar ratio was lower in Gh compared with Hg group (P <0.05). Elevated concentrations of GCF MMP‐8 and MMP‐9 were found in Gg compared with Gh group (P <0.05). Significant correlations were found between local levels of biomarkers and clinical periodontal parameters in only GDM group. Conclusion: GDM may modulate both local and circulating levels of MMP‐8 especially when associated with gingivitis.