Albendazole is Not Effective for Primary Treatment of Hepatic Hydatid Cysts

Introduction In current practice, minimal invazive interventions such as percutaneous drainage and laparoscopic surgery in adjunct treatment with benzimidazoles have been gaining acceptance in treatment of hydatid cystic disease with minimal morbidity and mortality. In this prospective study, the efficacy and validity of primary medical therapy in the treatment of hydatid cystic disease has been investigated. Patients and methods Sixty-five patients with hepatic cystic disease were treated with albendazole alone between January 2004 and June 2007. All of the patients were administrated albendazole as 10 mg kg⁻¹ day⁻¹ divided into two equal doses for 6 months with ultrasonography (USG), serological tests, full-blood cell count and hepatic function tests performed in 2 months intervals in the course of treatment. Results Fifty of the patients were female and 15 were male with a mean age of 47.0 ± 16.9 (17–80). A total number of 106 cysts were present in 65 patients. Mean cystic diameter was 5.5 ± 3.6 (1–16). In 41 of the patients, cysts were solitary and in remaining 24 patients cysts were multiple. Mean follow-up period was 28.3 ± 8.6 (12–42) months. The overall success rate of albendazole therapy was 18 % (12/65) in the study. Conclusion Albendazole therapy for hepatic hydatidosis is not effective in the vast majority of patients and, therefore, should not be used as the primary therapy for patients who are surgical candidates.     

Turkish general practitioners and complementary/alternative medicine

BACKGROUND: Complementary and alternative medicine (CAM) is in the spotlight of society. However, what is the position of physicians at this point? OBJECTIVES: To determine general practitioners' (GP) knowledge, attitudes, and approaches to CAM. METHODS: All GPs (n=521) practicing in Bursa Province, Turkey were surveyed by a questionnaire. RESULTS: Responses from 49% of GPs were analyzed. Altogether, most of our physicians (96.5%) had not received any education about CAM, wanted to learn more (74.4%), and their knowledge levels were low (60.8%). About half of them (51%) believed in the efficiency of CAM, whereas 38.0% did not. GPs desire more information about herbal medicine and acupuncture. Only 29% of GPs were using some type of CAM for themselves. CONCLUSIONS: GPs are aware of the subject's importance and want to learn more about CAM and improve their knowledge. It would be reasonable to provide training possibilities for GPs, primarily for the CAM types highly used by the population and most requested by the physicians.     

Comparative associations of baseline frailty status and age with postoperative mortality and duration of hospital stay following metastatic brain tumor resection

Metastatic brain tumors are the most common intracranial neoplasms diagnosed in the United States. Although baseline frailty status has been validated as a robust predictor of morbidity and mortality across various surgical disciplines, evidence within cranial neurosurgical oncology is limited. Adult metastatic brain tumor patients treated with resection were identified in the National Inpatient Sample during the period of 2015–2018. Frailty was quantified using the 11-point modified frailty index (mFI-11) and its association with clinical endpoints was evaluated through complex samples multivariable logistic regression and receiver operating characteristic (ROC) curve analyses. Among 13,650 metastatic brain tumor patients identified (mean age 62.8 years), 26.8% (n?=?3665) were robust (mFI?=?0), 31.4% (n?=?4660) were pre-frail (mFI?=?1), 23.2% (n?=?3165) were frail (mFI?=?2), and 15.8% (n?=?2160) were severely frail (mFI?≥?3). On univariable assessment, these cohorts stratified by increasing frailty were significantly associated with postoperative complications (13.6%, 15.9%, 23.9%, 26.4%; p?<?0.001), mortality (1.2%, 1.4%, 2.7%, 3.2%; p?=?0.028), and extended length of stay (eLOS) (15.7%, 22.5%, 28.9%, 37.7%; p?<?0.001). Following multivariable logistic regression analysis, frailty (by mFI-11) was independently associated with postoperative mortality (aOR 1.34, 95% CI 1.08, 1.65) and eLOS (aOR 1.26, 95% CI 1.17, 1.37), while increasing age was not associated with these endpoints. ROC curve analysis demonstrated superior discrimination of frailty (by mFI-11) in comparison with age for both mortality (AUC 0.61 vs. 0.58) and eLOS (AUC 0.61 vs. 0.53). Further statistical assessment through propensity score adjustment and decision tree analysis confirmed and extended the findings of the primary analytical models. Frailty may be a more robust predictor of postoperative outcomes in comparison with age following metastatic brain tumor resection.

     

Migrated endoclip and stone formation after cholecystectomy： A new danger of acute pancreatitis

Endoclip migration into the common bile duct following laparoscopic cholecystectomy (LC) is an extremely rare complication. Migrated endoclip into the common bile duct can cause obstruction,serve as a nidus for stone formation,and cause cholangitis. We report a case of obstructive jaundice and acute biliary pancreatitis due to choledocholithiasis caused by a migrated endoclip 6 mo after LC. The patient underwent early endoscopic retrog-rade cholangiopancreatography (ERCP) with endoscopic sphincterotomy and stone extraction.     

Incidence and precipitating factors of delirium after coronary artery bypass grafting

OBJECTIVE: To analyze large contemporary patient population, undergoing on-pump coronary artery bypass grafting at our institution, and identify the prevalence and precipitating factors of delirium development. DESIGN: Baseline demographics, operative data and postoperative outcomes of 1367 consecutive patients were recorded prospectively and analysed using multivariate logistic regression analysis, to determine independent predictors of postoperative delirium development. RESULTS: Delirium was detected in 42 (3.07%) patients. Eight factors: age more than 65 years, peripheral vascular disease, Euroscore>/=5, preoperative IABP support, postoperative blood product usage and postoperative low cardiac output syndrome were independently predicting delirium development after coronary artery bypass procedures. Postoperative delirium was associated with significantly higher mortality rate (16.6% vs. 3.9%, p=0.013), prolonged mechanical ventilation time (9.2+/-3.1 vs. 5.05+/-7.6, p=0.04) and increased length of intensive care unit stay (6.8+/-4.9 vs. 2.0+/-2.7 days, p=0.001). CONCLUSIONS: Delirium is a dangerous complication, prolonging intensive care unit stay and postoperative mortality. Factors associated with delirium development are advanced age, peripheral vascular disease, diminished cardiac function and blood product usage.     

The effect of octreotide on pancreatic damage in TNBS-induced colitis

Inflammatory bowel disease, a chronic condition of the intestine, is associated with numerous extraintestinal manifestations, including pancreatitis. This study investigated the effect of octreotide administration on oxidative damage in a rat model of colitis induced by 2,4,6-trini-trobenzene sulfonic (TNBS) acid. Colonic and pancreatic malondialdehyde and glutathione levels are indicators of oxidative damage, and TNBS-induced colitis significantly increased the colonic and pancreatic malondialdehyde levels and decreased glutathione levels. Octreotide treatment was associated with decreased malondialdehyde levels and increased glutathione levels in the colonic and pancreatic tissue. The colonic mucosal structure was preserved and pancreatic inflammation decreased in rats treated with octreotide. Octreotide also significantly decreased nuclear factor-kB expression by immunohisto-chemistry in the colonic and pancreatic tissue compared with TNBS-induced colitis group. Octreotide appears to have protective effects against TNBS-induced colonic and pancreatic damage. These results imply the reduction in mucosal damage owing to the anti-inflammatory and antioxidant effects of octreotide.     

Prevalence and Importance of Amebic Infestation in Patients with Ulcerative Colitis in Two Regions in Turkey

We investigated the prevalence of amebiasis in patients with ulcerative colitis residing in two geographical regions with different socioeconomic status and climatic conditions, and its effect on the age of onset, duration, localization, and activity of disease. Ninety patients from a high socioeconomic location (group I) and 28 cases from a low socioeconomic location (group II) were enrolled. Median age at disease onset was significantly higher in group I compared with in group II. Prevalence of amebiasis in group I was significantly lower than in group II. A considerably number of patients with amebiasis in group I had a history of travel to the cities with a lower socioeconomic level, mainly located in the east of Turkey. There was a strong relationship between presence of amebiasis and history of travel to eastern parts of Turkey among residents from the northwestern part of Turkey. Median age and age at time of diagnosis were significantly lower in patients with amebiasis compared with those without infection. In patients with mild disease activity, prevalence of amebiasis was significantly lower compared with those with moderate or severe disease activity. In conclusion, prevalence of amebiasis was markedly higher in the southeast compared to the northwest of Turkey. Travel to regions with low socioeconomic status may be considered a risk factor for amebiasis in patients with ulcerative colitis. Amebiasis enhances disease activity in ulcerative colitis.     

Serum levels of Zn in children with different degress of nutritional deficiency

The importance of Zinc (Zn) as a necessary oligoclement for human nutrition begins in the first three decades of life. At the moment, the role that Zn plays in the infantile nutrition is very well-known, acquiring a special connotation in children with proteic-energetics malnutrition (PEM). In this study the daily ingestion and the serum measuremets of Zn were determined in 64 undernourished children (light, mild and severe) and in 25 eutrophic children with ages between 1 to 5 years, belonging to families of the strata IV and V according to the Graffar scale corrected by age. The results of the serum values of Zn were for the light undernourished of 39.73 +/- 14.97 microg/dL (30.38 microg/dL-44.56 microg/dL), for the mild undernourished of 35.07 +/- 28.13 microg/dL (27.76 microg/dL-65.80 microg/dL) and for the severe undernourished of 15.48 +/- 10.44 microg/dL (5.57 microg/dL-28.56 microg/dL), which were diminished in relation with the control group, 76.71 +/- 33.29 microg/dL (45.75 microg/dL - 78.27 microg/dL) with p < 0.0001. Equally, there were significant differences (p < 0.001) among the group of severe undernourished with the light undernourished and normal subjects. In relation with the daily ingestion of Zn, a statistically significant difference was observed only (p < 0.001) in the severe undernourished, 1.87 +/- 0.54 mg/día (1.20 mg/día-2.87 mg/día) when comparing them with the light undernourished, 5.48 +/- 0.98 mg/día (3.50 mg/día-7.87 mg/día), the mild undernourished, 4.99 +/- 1.24 mg/día (4.10 mg/día-11.42 mg/día) ) and the normal subjects, 6.22 +/- 0.98 mg/día (4.8 mg/día-8.02 mg/día). There was a positive correlation between ingestion and seric values of Zn when the 3 undernourished groups were studied. These results allow to conclude that both the seric values of Zn and its ingestion show modifications in relation with the degree of nutritional deficiency.     

Comparative study of nanohydroxyapatite microspheres for medical applications

This study concerns the preparation, physical, and in vitro characterization of two different types of hydroxyapatite (HA) microspheres, which are intended to be used as drug-delivery systems and bone-regeneration matrices. Hydroxyapatite nanoparticles (HA-1 and HA-2) were prepared using the chemical precipitation synthesis with H(3)PO(4), Ca(OH)(2), and a surfactant, SDS (sodium dodecyl sulfate), as starting reagents. The HA powders were dispersed in a sodium alginate solution, and spherical particles were obtained by droplet extrusion coupled with ionotropic gelation in the presence of Ca(2+). These were subsequently sintered to produce HA-1 and HA-2 microspheres with a uniform size and interconnected microporosity. Both powders and microspheres were characterized using FTIR and X-ray diffraction. Moreover, SEM and mercury intrusion porosimetry were used to analyze the microspheres, and TEM was used to analyze the powders. Results showed that pure HA and mixtures of HA/beta-TCP in the nanometer range and needlelike shape were obtained for HA-1 and HA-2 powders, respectively. Neutral Red, scanning electron microscopy and confocal microscopy were used to evaluate the behavior of osteoblastic-like MG-63 cells cultured on HA microspheres surfaces for 7 days. Results showed that good adhesion and proliferation of osteoblasts on the HA microspheres surface. Cells built bridges between adjacent microspheres, forming microspheres-cells clusters in both types of materials.