Background
Obesity is a complex and multifactorial disease whose incidence has increased, making it a serious public health issue. Laparoscopic sleeve gastrectomy (LSG) is one of the most common ...surgical procedures that is chosen for bariatric surgery. Decreasing postoperative pain in these patients which will increase patients’ compliance and quality of life will lead to better surgical results. This study aims to compare the effectiveness of trocar site infiltration versus bilateral subcostal transversus abdominis plane block (TAP) in controlling postoperative pain in patients.
Methods
Forty-five consecutive patients who have undergone LSG in xxx General Surgery Department have been enrolled in the study. Patients were divided into two groups according to the surgeon’s choice. The first group underwent TAP block, while the second group underwent trocar site infiltration. Patients’ pain was recorded via visual analogue scale (VAS) in postoperative periods.
Results
Twenty-nine female (69%) and 13 (31%) male patients were included in the study. Median age was 41 (18–58) and median BMI was 48 (41.1–68). When the VAS values were compared, in the TAPB group, 6th hour resting and coughing pain was statistically significantly less. Other VAS values measured while resting, coughing, and post-mobilization did not show significant differences. There were no significant differences between the groups’ tramadol use.
Conclusions
After LSG, TAP block and trocar site infiltration yield similar pain control. Due to the faster application and fewer side effects, we concluded that trocar site infiltration should be the intervention of choice in controlling postoperative pain in LSG.
Acute bacterial rhinosinusitis is a common childhood infection and a frequent complication of viral infections or allergic inflammations of the upper respiratory tract. Untreated cases may have ...serious complications as meningitis, orbital cellulitis, epidural and brain abscesses (1,2). Brain abscesses rarely seen pediatric infections with high mortality and morbidity rates, are mostly observed secondary to extrasinus spread of rhinosinusitis and acute otitis media, hematogenous spread and penetrating trauma (3). The most common predisposing factors are immunodeficiencies, cyanotic heart and hematologic diseases. A 16-year-old boy was admitted to the emergency service due to seizure. It was learned from his history that he was admitted to the hospital 10 days ago due to headache and high fever. With the diagnosis of acute sinusitis, azithromycin and ornidazole treatment was started, but there was no improvement in his complaints.. On physical examination, clouding of consciousness and postnasal purulent discharge were detected. Remarkable laboratory test results: WBC: 22.500/mm3; platelets 156.000/mm3, C-reactive protein 226 mg/L. Brain tomography revealed a 4-cm suspicious abscess or mass lesion in the right frontal region of the brain compatible with right frontal and ethmoid sinusitis. Upon consultation with pediatric neurology and neurosurgery departments, cranial MRI and MR spectrometry were performed which revealed a lesion compatible with a 4- cm brain abscess, brain edema , shift, and acute sinusitis in the right frontal region. Treatment with cefotaxime, vancomycin and metroinidazole was started for acute sinusitis, and hypertonic sodium infusion and leveteresitam treatment for brain edema. Surgical drainage of the abscess > 2 cm was performed by neurosurgery. Gram staining and culture of the abscess material were unremarkable. Upon evaluation by pediatric immunology, cardiology and hematology departments, immunodeficiency, cyanotic heart disease and hematologic disease were not detected. The lesion was evaluated as inappropriately treated brain abscess secondary to acute sinusitis. In the 2nd week of treatment, edema surrounding the abscess, shift and pressure regressed, but the the abscess did not shrink, so the treatment with meropenem, vancomycin and metroinidazole was initiated. Antiedema therapy was discontinued, and antibiotherapy was maintained for 9 weeks until the abscess size was < 2 cm. When the abscess shrinked below 1 cm in the control cranial images he was discharged with follow-up recommendations. Acute bacterial sinusitis is one of the common, and clinically diagnosed infectious diseases of childhood. And current guidelines recommend amoxicillin, amoxicillin-clavulanic acid and cephalosporins (ie.cefdinir) as the first-line treatment. Considering the high drug resistance in our country, macrolides are not the first choice in patients without a history of penicillin allergy (2). If not treated appropriately, serious cranial complications preventable with timely appropriate antibiotherapy may develop. Brain abscesses are rare but mortal infectious diseases in childhood. The most common cause is the extrasinus spread of infections such as acute rhinosinusitis (3). Combination of medical and surgical treatment is usually recommended for abscesses > 2 cm. For abscesses < 2 cm and inoperable multiple abscesses only medical treatment is an option. Although the duration of treatment depends on the size, location, causative agent and treatment response, medical treatment is recommended for approximately 6-12 weeks until the abscess is < 2 cm (4)
Abstract
Introduction
Acute gastroenteritis is one of the most common causes of hospital admission in children. Treatment regimens differ depending on the pathogen. In our study, we aimed to evaluate ...the epidemiological and clinical features of pediatric patients whose gastrointestinal agents were detected by multiplex PCR.
Materials and Methods
The study included 131 pediatric patients who were followed up at Eskişehir Osmangazi University, Pediatric Department between January 2018 and December 2021.Gastrointestinal pathogens were detected in stool samples by multiplex PCR. The epidemiological and clinical features were reviewed retrospectively.
Results
A total of 203 gastrointestinal pathogens were detected from the stool samples of 131 cases. Of these cases, 56% were male and 44% were female. The mean age was 66 (2–204) months. The most common symptoms were diarrhea, fever, vomiting and abdominal pain. The pathogen detection rate was 69% by multiplex PCR. A single pathogen was detected in 85 (65%) cases and multiple pathogens were detected in 46 (35%) cases. The most common pathogens were enteropathogenic Escherichia coli (EPEC, 23%), Clostridium difficile (21%), norovirus (17%), rotavirus (15%), salmonella (12%) and enterotoxigenic E. coli (ETEC, 11%). Stool culture was positive in 16 (12%) cases and microscopic examination positive in 17 (13%) cases. Probiotic treatment was given to 119 (92%) cases and antimicrobial treatment (metroinidazole, ceftriaxone, azithromycin and oral vancomycin) to 34 (26%) cases. Of the cases, 56 (42%) had chronic disease, 40 (30%) had a history of previous antibiotic use and 17 (13%) had a history of hospitalization in the intensive care unit.
Conclusion
The sensitivity of the multiplex PCR in the detection of acute gastroenteritis agents is higher than stool microscopy, stool culture and stool antigen tests. However, due to the inability to distinguish between colonization, carrier state and pathogenicity, it should be evaluated together with other diagnostic tests and clinical findings in order to determine whether the determined agent is pathogenic or not and in the regulation of antimicrobial therapy.
The aim was to evaluate the epidemiological, clinical, laboratory, and radiologic data of children with SARS-CoV-2 positivity by polymerase chain reaction (PCR) together with treatment strategies and ...clinical outcomes and to evaluate cases of multisystem inflammatory syndrome in children (MIS-C) in this population.
This was a multicenter retrospective observational cohort study performed in the pediatric emergency departments of 19 tertiary hospitals. From March 11, 2020, to May 31, 2021, children who were diagnosed with confirmed nasopharyngeal/tracheal specimen SARS-CoV-2 PCR positivity or positivity for serum-specific antibodies against SARS-CoV-2 were included. Demographics, presence of chronic illness, symptoms, history of contact with SARS-CoV-2 PCR-positive individuals, laboratory and radiologic investigations, clinical severity, hospital admissions, and prognosis were recorded.
A total of 8886 cases were included. While 8799 (99.0%) cases resulted in a diagnosis of SARS-CoV-2 with PCR positivity, 87 (1.0%) patients were diagnosed with MIS-C. Among SARS-CoV-2 PCR-positive patients, 51.0% were male and 8.5% had chronic illnesses. The median age was 11.6 years (IQR: 5.0–15.4) and 737 (8.4%) patients were aged <1 year. Of the patients, 15.5% were asymptomatic. The most common symptoms were fever (48.5%) and cough (30.7%) for all age groups. There was a decrease in the rate of fever as age increased (p < 0.001); the most common age group for this symptom was <1 year with the rate of 69.6%. There was known contact with a SARS-CoV-2 PCR-positive individual in 67.3% of the cases, with household contacts in 71.3% of those cases. In terms of clinical severity, 83 (0.9%) patients were in the severe-critical group. There was hospital admission in 1269 (14.4%) cases, with 106 (1.2%) of those patients being admitted to the pediatric intensive care unit (PICU). Among patients with MIS-C, 60.9% were male and the median age was 6.4 years (IQR: 3.9–10.4). Twelve (13.7%) patients presented with shock. There was hospital admission in 89.7% of these cases, with 29.9% of the patients with MIS-C being admitted to the PICU.
Most SARS-CoV-2 PCR-positive patients presented with a mild clinical course. Although rare, MIS-C emerges as a serious consequence with frequent PICU admission. Further understanding of the characteristics of COVID-19 disease could provide insights and guide the development of therapeutic strategies for target groups.
Material and Methods: Twenty-five children who were followed up in Eskişehir Osmangazi University Faculty of Medicine Hospital between December 2022 and February 2023 with the diagnoses of pulmonary ...effusion/empyema, bacteremia, mastoiditis, and toxic shock syndrome were included in the study. ...during the same time interval before the pandemic i.e. between December 2019 and February 2020, only five cases of invasive bacterial infections were seen, including three cases with pleural effusions and two cases with mastoiditis. ...we decided to conduct this study so as to evaluate the clinical and epidemiological features, laboratory and radiologic findings of these pediatric cases of invasive bacterial infection. Materials and Methods After the pandemic, we found an increase in the incidence rates of invasive bacterial infections in our clinic, especially between December 2022 and February 2023. ...twenty-five children who were followed up at Eskişehir Osmangazi University Faculty of Medicine Hospital between December 2022 and February 2023 with the diagnoses of pulmonary effusion/empyema, bacteremia, mastoiditis, and toxic shock syndrome were included in the study. According to Light's criteria, all of these eleven pleural fluid samples were exudate and nine of them were empyema.
Giriş: Hidatik kist, ekinokokal sestodların neden olduǧu yaygın zoonotik bir hastalıktır. Hidatik kistlerin tanısı klinik, seroloji ve radyolojik bulgulara dayanır. Medikai ve cerrahi tedavi ...seçenekleri mevcuttur. Bu çalışmada pediyatrik hidatik kist olgularının klinik, epidemiyolojik özelliklerini, laboratuvar ve radyografik bulgularını deǧerlendirmeyi amaçladık. Gereç ve Yöntemler: 2012-2022 yılları arasında hastanemizde takip edilen 84 pediyatrik kist hidatikolgusu çalışmaya dahil edildi. Olguların epidemiyolojik ve klinik özellikleri deǧerlendirildi. Bulgular: Seksen dört hastanın 50 (%59.5)'si erkekti ve yaş ortalaması 137 aydı. Hastaların 48 (%57.1 )'i kırsal kesimdendi ve 38 (%45.2)'inin hayvan teması vardı, indirekt hemaglütinasyon testi olguların %54.8'inde pozitifti ve %48.8'inde eozinofili vardı. Hastaların %41.7'sinde akciǧer kisti, %32.1'inde karaciǧer kisti, %23.8'inde akciǧer ve karaciǧer kisti saptandı. Hastaların %71.4'üne cerrahi ve albendazol tedavisi, %25'ine sadece medikai tedavi ve bir olguya PAIR uygulandı. Akciǧer kisti olan hastalarda rüptür riski daha yüksek bulunurken, karaciǧer kisti olan hastalarda İHA pozitifliǧi daha yüksekti. Sonuç: Hidatik kist tüm dünya için bir halk saǧlıǧı sorunu olmaya devam etmektedir. Toplumun eǧitimi, bulaşmayı ve yayılımı önleyici tedbirlerin alınması, kist hidatikten en önemli korunma yöntemidir. Standart bir tedavi rejimi olmamakla birlikte cerrahi veya medikai tedavi kararında kistin boyutu, yeri ve sayısı önemlidir.
We present an adolescent with syphilis secondary thrombosis extending from the bilateral renal veins to the inferior vena cava. A 16-year-old male patient presented to the emergency department with ...severe abdominal and back pain for 12 hours. Abdominal ultrasonography was performed for the differential diagnosis of acute abdomen, and the radiologist reported chronic thrombus occluded the inferior vena cava, the main iliac veins on both sides, and the proximal part of the external iliac veins, starting at the level of the renal veins. It was learned from his clinical history that he had fever every two to three days for about a month. The case, who learned that she had sexual intercourse with a sex worker about two years ago, was screened for sexually transmitted diseases and the western blot test was positive for syphilis. Warfarin was started on the 5th day of heparin treatment and recanalization was observed in the control Doppler USG at the fourth week.
Bilateral renal venlerden vena cava inferiora uzanan sifilize sekonder trombozu olan bir ergeni sunuyoruz. On altı yaşında erkek hasta, on iki saattir şiddetli karın ve sırt ağrısı ile acil servise başvurdu. Akut karın ayırıcı tanısı için karın ultrasonografisi yapıldı ve radyolog renal venler seviyesinden başlayarak, vena cava inferior, her iki taraftaki ana iliak venler ve eksternal iliyak venlerin proksimal kısmını tıkayan kronik trombüs bildirdi. Klinik öyküsünden yaklaşık bir aydır iki-üç günde bir ateşi olduğu öğrenildi. Yaklaşık iki yıl önce seks işçisi ile cinsel ilişkiye girdiği öğrenilen olgu cinsel yolla bulaşan hastalıklar açısından tarandı ve western blot testi sifiliz için pozitif sonuçlandı. Heparin tedavisinin 5. gününde varfarin başlandı ve dördüncü haftada kontrol doppler USG'de rekanalizasyon izlendi.
Objective: The aim of this study was to evaluate the efficacy of combined treatment with anti-tumor necrosis factor (TNF) agents, and setons for perianal fistulas in Crohn’s disease.Patients and ...Methods: Study included 27 consecutive patients with perianal fistulizing Crohn’s disease, requiring seton drainage and anti-TNF therapy in our center from January 2013 to November 2014. All patients underwent a standardized pelvic magnetic resonance imaging (MRI) examination. Patient characteristics, follow up time, findings of pelvic MRI, colonoscopy and examination under anesthesia findings were recorded. Response to treatment was evaluated at the end of the follow up.Results: The median follow-up after treatment was 17 months (6-32). The fistula was complex in 24 (89%) of the 27 patients. Colonoscopy revealed ileitis in 16 (59.3%) patients and active proctitis in 9 (33.3%) patients. Perianal abscess was observed in12 (44.4%) patients. Complete response was obtained in 17 (63%) patients. Only 3 (11.1%) patients experienced recurrence abscess during the study period. We could not find any factor, which were associated with complete response.Conclusion: Complete response was achieved in 63% of the patients, with perianal fistula formation associated with Crohn’s disease, with combined seton drainage and anti-TNF therapy.Keywords: Crohn’s disease, Perianal fistula, Setons, Infliximab
Celiac disease (CD) is an immune-mediated enteropathy characterized by lifelong gluten intolerance. Interleukin-15 (IL- 15) is a proinflammatory cytokine that is considered a key component in the ...immune reaction triggered by gluten. Our aim of this study was to evaluate the influence of IL-15 gene polymorphisms on CD development and clinical presentation.
The study was enrolled-with 90 CD patients (49 female/41 male, median years of age 11), their 38 siblings (20 female/18 male, median years of age 8), and 99 healthy controls (66 female/33 male, median years of age 13). Their demographic findings, symptoms, and signs histopathological grade, Human Leukocyte Antigen (HLA) types were recorded. IL-15 gene polymorphisms rs2857261, rs10519613, and rs1057972 were analyzed through PCR.
There was a significantly higher frequency of GG genotype in rs2857972 polymorphisms and TT genotype in rs1057972 polymorphisms in celiac families compared to controls 41% vs. 23% (P = .0008), 36% vs. 11% (P = .001), respectively. Without considering their HLA status, there was not any difference between celiacs and healthy siblings. However, when stratified according to their HLADQ2 status, rs2857972 GG polymorphism was 1.5 times prominent in celiacs than siblings at homozygous state, whereas rs1057972 TT genotype was found to be 2.5 times prominent in celiac siblings at heterozygous state. There was no association between these polymorphisms and clinical presentation.
rs2857972 GG and rs1057972 TT variants of IL 15 are more prominent in celiac families than controls. However, the impact of IL-15 gene polymorphism on CD development is dependent on HLADQ2 status.
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