Similarities and Differences Between Gerontal and Young Patients with Acute Pancreatitis: Evaluation of Clinical Characteristics and Outcomes

Background:

Acute pancreatitis is an abrupt inflammatory disease of the exocrine pancreas and it can occur in different severities. It is becoming more common and more mortal in the gerontal population. The aim of our study was to explore the similarities and differences between young and gerontal patients with acute pancreatitis, with a special emphasis on patients over 80 years of age.

Methods:

Medical records of patients (n = 1150) with acute pancreatitis were analyzed retrospectively. Several scoring systems including Bedside index for severity in acute pancreatitis, Ranson’s score, Harmless acute pancreatitis score, Acute Physiology and Chronic Health Evaluation, Balthazar Grade, Glasgow score, and Japanese severity score were applied at admission. Patients were divided into 3 groups; group I, young group (n = 706), if they were aged <65 years; group II, older group (n = 338), if they were aged ≥65 years to <80 years; group III, octogenarian group (n = 106), if they were aged ≥ 0 years.

Results:

In total, 1150 patients with acute pancreatitis were analyzed. Octogenarian group (n = 42, 39.6%) showed a more severe acute pancreatitis compared to patients in group I (n = 15, 2.1%) and II (n = 50, 14.8%, P < .001). Complications were more common in patients in group III (P < .001). Mortality rate was higher in patients in group III (n = 53, 50%) compared to group I (n = 8, 1.1%) and group II (n = 53, 15.7%) (P < .001).

Conclusion:

Gerontal patients with acute pancreatitis tend to have more severe disease and systemic and local complications. Mortality rates were higher in older patients compared to younger patients.

Fear of hypoglycemia in adults with diabetes mellitus switching to treatment with IDegAsp co-formulation to examine real-world setting: an observational study (The HATICE study)

OBJECTIVES

To evaluate the clinical results of insulin degludec/aspart (IDEgAsp) therapy and its effect on the fear of hypoglycemia.

METHODS

A prospective observational study has been conducted through surveys of 36 patients using insulin because of type 2 diabetes mellitus who initiated treatment with IDegAsp switching from other insulins. Patients, 18-75 years old, were recruited to the study, consecutively. Participants' age, gender, height, weight, body mass index (BMI), daily insulin dose, glycated hemoglobin (HbA1c), hypoglycemia rate, hypoglycemia fear survey (HFS) were recorded at the beginning of the study. By the end of 12th month, data was re-measured and compared with each other.

RESULTS

HbA1c was declined by mean of -1.59% (95% CI -1.06 to -2.12, p<0.001). There was also a significant decrease in mean, daily insulin dose, weight and BMI values of patients via IDegAsp. While there was an increase in the amount of dipeptidyl peptidase 4-inhibitors (DPP4-i) and sodium-glucose co-transporter 2-inhibitors (SGLT2-i), there was a decrease in daily injection frequency. There was also a significant decrease in the median values of monthly hypoglycemia rate (from 2.0 to 1.0, p<0.001) and the entire HFS scores (HFS-T: from 1.09 to 0.73, p<0.001; HFS-B: from 0.83 to 0.60, p<0.001; HFS-W: from 1.33 to 0.88, p<0.001). There was a strong positive correlation between ΔHFS-B and daily injection frequency (Rho: 0.398; P: 0.016).

CONCLUSIONS

IDegAsp co-formulation, combined with DPP4-i and/or SGLT2-i, can provide usefulness in terms of rates of hypoglycemia, reduced HbA1c, less injection administration, and decreased the fear of hypoglycemia in diabetics.

Preoperative platelettolymphocyte ratio as a prognostic factor in geriatric patients with proximal femoral fractures

INTRODUCTION

The aim of this study was to investigate whether the platelet to lymphocyte ratio is a prognostic factor in geriatric patients who underwent surgery for proximal femoral fractures.

MATERIALS AND METHODS

Clinical and laboratory data of 288 patients who underwent surgery for proximal femoral fracture were analysed. The patients were divided into six groups on the basis of sex (male and female) and survival duration after the operation (death within the first 6 months, death between the 6 and 12 months, survival for more than 12 months). Pre-operative platelet/lymphocyte ratios of these groups were compared.

RESULTS

Of 288 patients, 187 were female and 101 were male. There was no significant difference between the groups with regard to age (p = 0.123 female groups) (p = 0.207 male groups). Although the preoperative platelet to lymphocyte ratio was higher in patients who died within 12 months than in those who survived beyond that, this platelet/lymphocyte ratio was statistically significant in females who died in the first 6 months (p = 0.038).

CONCLUSION

A high preoperative platelet to lymphocyte ratio may be associated with high risk of mortality in patients who were operated for proximal femoral fracture.

[Neuraxial anesthesia after local anesthesia for management of percutaneous vertebroplasty complication during vertebroplasty]

Percutaneous vertebroplasty is a relatively safe, simple and commonly performed interventional procedure for the management of vertebral compression fractures. However, serious complications are rarely reported in the procedure. Those are pulmonary embolism, severe infection, paraplegia and an occurrence of a new fracture in an adjacent vertebra after vertebroplasty. Acute complications are generally associated with the procedure. We present the case of neuraxial anesthesia, developed after local anesthesia with 8mL of 2% prilocaine, in a 68-year-old woman who underwent percutaneous vertebroplasty after an osteoporotic collapsed fracture in the L₁ vertebra due to trauma. To our knowledge, this is the first case in the literature.

Obesity-related cardiovascular behavior in children

OBJECTIVE

Obesity is a chronic metabolic disorder and may associate with cardiovascular geometrical, structural and functional changes. The aim of this study is to assess the relationship between body mass index (BMI), body surface area (BSA) and arterial-ventricular elasticity (Ea and Ees respectively) and cardiovascular coupling and myocardial wall stress and fiber stress in obese children.

PATIENTS AND METHODS

Sixty non-obese healthy children with BMI <85th percentile aged 6-17 years and 65 age and sex-matched children with BMI of ≥95th percentile, were included in the study. Beside cardiac systolic and diastolic functions, left verntricular (LV) systolic and diastolic dimensions and volumes (LVDs, LVDd, LVVs, LVVd respectively), LV mass (LVM), LV end-systolic pressure (LVESP), meridional end-systolic wall stress (ESWm), myocardial fiber stress (MFS), Midwall Shortening Fraction (SFmid), heart rate corrected circumferential fiber shortening (VCFc), predicted mid wall fiber shortening for a measured fiber stress (mid wall VCFc), right ventricular (RV) and LV work index (RVWI, LVWI), LV relative wall thickness (LVRWT), arterial elastance (Ea), LV end-systolic elastance (Ees) and end-systolic pressure volume relationship (ESPVR) were calculated.

RESULTS

LVDs and LVDd, LV mass (LVM), ESWSm, MFS, SF mid, Midwall VCFc and LVWI found to be significantly (p<0.001) higher, while Ea, Ees, ejection fraction (EF), fractional shortening (FS), VCFc-ESWS, RVWI, ESWSm/LVVs, LV end-systolic pressure (Pes)/LVVs and LVM/LVVd values were significantly (p<0.001) lower among obese group. By increasing age and BMI the Ea and Ees, ESWSm/LVVS and RVWI decrease; while LVDd, LVVd and stroke volume (SV) values increase. There was a reverse-relation between BMI percentiles and EF and FS.

Panton-Valentine leukocidin positive Staphylococcus aureus infection in childhood: a case report

Staphylococcus aureus is a common cause of musculoskeletal infections. Panton-Valentine leukocidin (PVL) is an exotoxin produced by S. aureus and is an important virulence factor. PVL-positive S. aureus infections have been associated with soft tissue infections and necrotizing pneumonia. In this case report, the clinical course of a 13-year-old boy who was admitted with right hip pain and fever, diagnosed with a gluteal abscess and incidentally discovered multiple cavitary pulmonary lesions, and had a methicillin susceptible and PVL-producing S. aureus (MSSA) extracted from the abscess culture is presented. The related literature is also reviewed.

Does level of antenatal care affect birthweight? Study of a Central Anatolian Region

PURPOSE OF INVESTIGATION

The objective of this research was to measure the impact of the level and quality of antenatal care (ANC) on the birthweight (BW) of hospital-born infants.

MATERIALS AND METHODS

This study was cross-sectional research. This study was conducted at the maternity hospital and a private hospital in the center of the province of Yozgat, Turkey. Women (N=788) were included in the research who had a singleton live delivery at hospitals.

RESULTS

It was found that adequate receipt of ANC was significant, although had little affect on BW; the number of ANC visits or whether ANC was adequate was not found to be significant. BW increased depending on primarily the mother's gestational age (GA) and then her age, height, and weight gained during pregnancy (p < 0.05).

CONCLUSIONS

It is GA that impacts BW primarily. It is recommended that necessary interventions be made to minimize the factors leading to preterm births.

Neuraxial anesthesia after local anesthesia for management of percutaneous vertebroplasty complication during vertebroplasty

Percutaneous vertebroplasty is a relatively safe, simple and commonly performed interventional procedure for the management of vertebral compression fractures. However, serious complications are rarely reported in the procedure. Those are pulmonary embolism, severe infection, paraplegia and an occurrence of a new fracture in an adjacent vertebra after vertebroplasty. Acute complications are generally associated with the procedure. We present the case of neuraxial anesthesia, developed after local anesthesia with 8mL of 2% prilocaine, in a 68-year-old woman who underwent percutaneous vertebroplasty after an osteoporotic collapsed fracture in the L₁ vertebra due to trauma. To our knowledge, this is the first case in the literature.

Supercharged dorsoulnar island flap: a case report and review of the literature

Complicated hand and wrist defects require durable and pliable tissues which are offered by flaps, instead of skin grafts. Various dorsoulnar flap options have been used in the regional flap armamentarium of the upper limb. Poor venous drainage may be a considerable handicap when moderate to large skin paddle dorsoulnar flaps are used. In the present case, we aimed to reduce the risk of necrosis by supercharging the dorsoulnar island flap. The current literature regarding dorsoulnar island flap has also been reviewed with focus on this flap. This technique has successfully been used for a complex wrist defect in a 48-year-old man. Postoperative follow up was one year. The flap survived completely with perfect hand function. We think this modification can prevent possible venous stress in the pedicled and free dorsoulnar flaps by obtaining extraveneous drainage. The method is simple, does not need sophisticated microsurgical procedure and longer operative time.

What are the predictors of scapula fractures in high-impact blunt trauma patients and why do we miss them in the emergency department?

AIM

To find out the predictors of scapula fractures in high-impact blunt trauma patients and the predictors of missing them in the emergency department (ED).

METHODS

This is a retrospective descriptive review of patients treated at a single hospital over a 3.5-year period. The study included 1,039 high-impact blunt trauma patients of any age. The patients were divided into two groups: patients with scapula fractures (the patient group) and others (the control group). The patient group was re-assessed into two subgroups: patients with and without missed scapula fractures. Logistic regression analysis was used to assess the predictors of a scapular fracture in the ED.

RESULTS

The incidence of scapula fractures was 4%. The Injury Severity Scores (ISS) of the scapula fracture group were significantly higher than those of the control group (P < 0.0001). Patients with scapula fractures were significantly older (P < 0.001). Patients with scapular body fractures stayed for significantly longer in the intensive care unit (ICU) (P = 0.039) and their mean Abbreviated Injury Scale (AIS)face score was higher (P = 0.04) compared to scapular fractures without body parts. Scapula fractures were missed in 35.7% of patients. All bilateral scapula fractures were missed. Computerized tomography showing shoulder region or scapula was obtained in 26.7% of missed injuries.

CONCLUSION

After matching for ISS, the mortality of patients with scapula fracture was significantly higher than the control group. We observed that fractures in the glenoid and scapular neck occurred higher than in the body region. We found that the seniority of the ED doctor, consultation ratio for orthopedics in ED, and the existence of brain contusion were important parameters for missing scapula fractures in ED.

Mutation spectrum of fumarylacetoacetase gene and clinical aspects of tyrosinemia type I disease

Tyrosinemia type I (OMIM 276700) is a rare, autosomal recessive disorder caused by a deficiency in the fumarylacetoacetate hydrolase (FAH) enzyme. This study examined the spectrum of FAH gene mutation in 32 patients with tyrosinemia type I. In addition, clinical and biochemical findings were evaluated to establish a genotype-phenotype relationship in the patients. Mutation screening was performed using a 50K custom-designed resequencing microarray chip (TR_06_01r520489, Affymetrix) and sequencing analysis. Of the 12 different mutations found, 6 are categorized as novel. Three of the mutations-IVS6-1G>A, D233V, and IVS3-3C>G-are the most common in Turkish patients, comprising 25%, 17.1%, and 12.5% of mutant alleles, respectively.Clinical evaluations suggest that the spectrum of symptoms observed in the patients with very early and early disease were of the more nonspecific form, whereas the patients with late-presenting disease had more of the distinctive form over the course of the disease. This study adds support to the notion that the D233V mutation is specific to the Turkish population.