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Introduction: The introduction of the functional lumen imaging probe (FLIP) has provided objective, real-time feedback on the geometric variations with each component of a hiatal hernia repair (HHR). The utility of this technology in altering intraoperative decision-making has been scarcely reported. Herein, we report a single-center series of intraoperative FLIP during HHR. Methods: A retrospective review of electronic medical records between 2020 and 2022 was conducted and all patients undergoing non-recurrent HHR with FLIP were queried. Patient and hernia characteristics, intraoperative FLIP values and changes in decision-making, as well as early post-operative outcomes were reported. Both diameter and distensibility index (DI) were measured at 40 ml and 50 ml balloon inflation after hiatal dissection, after hiatal closure, and after fundoplication when indicated. Results: Thirty-three patients met inclusion criteria. Mean age was 62 ± 14 years and mean BMI was 28 ± 6 kg/m2. The majority (53%) were type I hiatal hernias. The largest drop in DI occurred after hiatal closure, with minimal change seen after fundoplication (mean DI of 4.3 ± 2. after completion of HH dissection, vs 2.7 ± 1.2 after hiatal closure and 2.3 ± 1 after fundoplication when performed). In 13 (39%) of cases, FLIP values directly impacted intraoperative decision-making. Fundoplication was deferred in 4/13 (31%) patients, the wrap was loosened in 2/13 (15%); the type of fundoplication was altered to achieve adequate anti-reflux values in 2/13 (15%) patients, and in 1/13 (3%) the wrap was tightened. Conclusion: FLIP measurements can be used intraoperatively to guide decision-making and alter management plan based on objective values. Long-term outcomes and further prospective studies are required to better delineate the value of this technology. [ABSTRACT FROM AUTHOR]

Background/Aim: Postoperative cognitive dysfunction (POCD) is an important problem that is encountered perioperatively and has a complex pathophysiology. Diabetes mellitus (DM) can cause adverse effects on cognitive functions, such as memory dysfunctions, psychomotor retardation, slower information processing, impairment of complex motor functions, deterioration of verbal rationality, and attention deficit. We assume that DM will have a triggering effect on POCD. Mild cognitive dysfunction caused by diabetes mellitus may increase the risk of POCD. For this purpose, we aimed to investigate the effect of type 2 DM on early POCD. Methods: Fifty literate patients who ranked 1-2 on the American Society of Anesthesiologists (ASA) scale were included in our prospective case-control study. They ranged in age from 35 to 70. All were scheduled for elective laparoscopic cholecystectomy at the İstanbul Training and Research Hospital. Patients were divided into two groups: the diabetes mellitus group and the control group. The DM group consisted of 25 patients who had been diagnosed with type 2 DM and had been on regular oral antidiabetic medication or insulin for at least five years. To examine the patients neuropsychologically, the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) Test were conducted one day before the surgery. The MMSE and MoCA were repeated at the 4th and 24th hours postoperatively. The patients were monitored to record their depth of anesthesia, peak heart rate, mean arterial pressure, oxygen saturation, end-tidal carbon dioxide value, and expiratory sevoflurane concentration prior to perioperative intubation and every five minutes after intubation until the end of the operation. The state of postoperative pain and total analgesic dose used for the patients were also recorded. Results: Demographic data in both groups were similar in terms of age, gender, body mass index, and duration of surgery (P > 0.05 for each). Perioperative depth of anesthesia, hemodynamic data, and postoperative pain scores were similar in both groups (P > 0.05 for each). While there was initially no significant difference between the groups in terms of preoperative cognitive function, compared with the control group, the DM group had significantly lower values of MMSE and MoCA at the postoperative 4th (P = 0.014 and P = 0.014) and 24th hour (P = 0.026 and P = 0.01). Conclusion: Our study shows that the early postoperative cognitive functions of diabetic patients are affected more than non-diabetic patients in laparoscopic surgery. MMSE and MoCA tests are appropriate for screening type 2 diabetic patients. Thus, complications can be prevented in diabetic surgical patients by detecting cognitive dysfunction in the early stages, so that appropriate treatment can be initiated. [ABSTRACT FROM AUTHOR]

Background/Purpose: Most community-acquired urinary tract infections (UTIs) are usually treated empirically. The knowledge of antibiotic resistance patterns of the microorganisms causing UTI is essential for defining the empirical treatment. Objective: The aim of the present study is to determine the distribution of bacterial strains isolated from lower UTIs and their resistance patterns against commonly used antimicrobial agents and treatment results in female patients. Subjects and Methods: This is a retrospective analysis of medical case records of 90 female patients with lower UTI for a period of 4 years from January 2013 to December 2016 in a tertiary care hospital in the Trakya region of Turkey. Results: The most common causative agent was Escherichia coli (66.6% of cases) followed by Klebsiella pneumoniae (16.6%). Fosfomycin was the most active agent against E. coli (resistant isolates: 5.5%), followed by nitrofurantoin (resistant isolates: 7.4%). Extended-spectrum beta-lactamases (ESBLs) production was observed in 29 (32.2%) isolates (22 in E. coli, 6 in K. pneumoniae, and 1 in Enterobacter spp.). The antimicrobial resistance rates among ESBL-producing E. coli isolates for trimethoprim-sulfamethoxazole, ciprofloxacin, fosfomycin, and nitrofurantoin were 77.7%, 72.7%, 13.6%, and 18.2%, respectively (P < 0.05). The estimated microbiological eradication rates for nitrofurantoin and fosfomycin were 89.7% and 83.8%, respectively. Conclusions: The results of the present study indicate that nitrofurantoin and fosfomycin may be considered for empirical therapy of lower UTIs in Trakya region of Turkey. [ABSTRACT FROM AUTHOR]

Objective: Acute kidney injury (AKI) is an important clinical entity that is known to increase mortality in patients with sepsis. Erythrocyte maturation and proliferation are inhibited by pro-inflammatory cytokines; these cytokines exert effects on red cell distribution width (RDW) well. Based on this knowledge; our aim in this study was to evaluate the impact of RDW on acute kidney injury in patients with sepsis. Methods: 120 patients diagnosed with sepsis and admitted to intesive care unit (ICU) and treated between 2009-2013 were retrospectively evaluated. Patients were divided into two groups as follows: group 1 (RDW≥16.8) and group 2 (RDW<16.8). Multiple logistic regression analysis was used to determine the association between RDW and AKI and mortality. Results: There was a statistically significant relationship between AKI and RDW (p<0.001, OR=11.52) but there were no statistically significant relationship between AKI and sex, age, serum lactate levels as well as SOFA score. Also, there were statistically significant relationship between mortality and RDW (p=0.044, OR=5), serum lactate levels (p=0.030) and SOFA score (p<0.001). RDW was found associated with both AKI and mortality. Conclusions: Results suggest that RDW is an important parameter for predicting development of AKI and mortality in ICU patients with sepsis. [ABSTRACT FROM AUTHOR]

Antiphospholipid syndrome (APS) is an autoimmune disease characterised by arterial and/or venous thrombosis and/or recurrent pregnancy loss in the presence of antiphospholipid (APL) antibodies. It is evaluated as APS when it develops associated with other systemic autoimmune diseases or primary APS if there is no concomitant disorder. In this study, we present a case of a 16-year-old male patient with primary APS. The patient was admitted with presumptive diagnosis of pneumonia, but multiple pulmonary thromboembolism (PTE) was observed on computerized tomography (CT) pulmonary angiography. APL antibodies positivity and thrombocytopenia developed in our patient. The patient was evaluated as primary APS since another etiology that could explain PTE was not found. Primary APS is a rare disease in children along with adolescents, compared with APS associated with other systemic autoimmune diseases. We present here a young male patient with primary APS and PTE to contribute to the literature. The patient initially had pneumonia but later developed PTE and thrombocytopenia. [ABSTRACT FROM AUTHOR]

Objectives: It has been reported that increased sempathic nerve system activity due to infalammatory stress and it cause disturbance of heart rate variability (HRV) in rheumatoid arthritis (RA). In this study, it was assessed cardiac sempatovagal activity by noninvasive parameters such as HRV in patients with RA. Materials and methods: 49 patients with RA and age-matched 28 healthy subjects as control group were enrolled to this study. Clinical and laboratory parameters of all subjects were assessed and 24-hour electrocardiographic Holter monitoring were performed to all of them. Results: Minimum, maximum and mean heart rate were significantly higher while mean RR interval were significantly lower in patients with RA when compared with controls. In addition, among time domain HRV parameters, SDNN, SDANN ve triangular index were significantly lower in patients with RA (p<0.05, p<0.01, p<0.01, respectively). In correlation analysis, it was not found a significant association between HRV parameters and age, sex, duration and activity of disease, inflammatory markers, supraventricular or ventricular extrasystole (VES). There were only significant negative associations between VES and pNN50, SDANN and RMSDD. But, there was no independent correlation between these parameters. Conclusion: Non-invasive parameters such as HRV may have a modest role in assessment of cardiovascular risk and prediction of sudden cardiac death risk, in addition to the traditional risk factors, in patients with RA. However, to reach to the more accurate decision, there are need to carry out larger and long term studies which include different patients groups. [ABSTRACT FROM AUTHOR]

Objective: Cardiac involvement occurs due to the disease itself and secondary to the used drugs, and commonly develops silent in rheumatoid arthritis (RA). In this study, it was investigated the presence of cardiac involvement by non-invasive electrophysiological parameters Materials and Methods: 49 patients with RA and age-matched 28 healthy subjects as control group were enrolled to this study. Clinical and laboratory parameters of all subjects were assessed and 24-hour electrocardiographic Holter monitoring were performed. Results: Minimum, maximum and mean heart rate were significantly higher (p<0.05, p<0.01, p<0.01, respectively), while maximum QT interval were significantly lower in patients with RA compared to controls (p<0.05). P wave parameters (P maximum, P minimum and P dispersion) were similar both groups. In correlation analysis, there was only significant negative association between erythrocyte sedimentation rate and corrected QT dispersion (r=0.317, p<0.05). However, it was not found any association between P wave and QT parameters and other anyone of clinical or laboratory parameters. Conclusion: There is modest role of non-invasive parameters such as QT dispersion in assessment of cardiovascular risk and prediction of sudden cardiac dead risk in addition to the traditional risk factors in patients with RA. However, prospective, larger and long term studies which include different patient groups are needed to obtain more accurate conclusions. [ABSTRACT FROM AUTHOR]