Rapid emergence of colistin resistance and its impact on fatality among healthcare-associated infections.

This article describes the emergence of resistance and predictors of fatality for 1556 cases of healthcare-associated Gram-negative bloodstream infection in 2014 and 2015. The colistin resistance rate in Klebsiella pneumoniae was 16.1%, compared with 6% in 2013. In total, 660 (42.4%) cases were fatal. The highest fatality rate was among patients with Acinetobacter baumannii bacteraemia (58%), followed by Pseudomonas aeruginosa (45%), Klebsiella pneumoniae (41%), Enterobacter cloacae (32%) and Escherichia coli (28%). On multi-variate analysis, the minimum inhibitory concentrations for carbapenems [odds ratio (OR) 1.02, 95% confidence interval (CI) 1.01-1.04; P = 0.002] and colistin (OR 1.1, 95% CI 1.03-1.17; P = 0.001) were found to be significantly associated with fatality.

The effect of smoking on neutrophil/lymphocyte and platelet/lymphocyte ratio and platelet indices: a retrospective study.

OBJECTIVE: Smoking commonly leads to death. Although the neutrophil/lymphocyte Ratio, platelet/lymphocyte ratio and platelet indices have been shown to be important for the diagnosis, prognosis and severity of some diseases, the smoking status of patients in these studies has not been well defined. In this study, we compared ratios derived from complete blood count and platelet indices to smoking status and length in smokers and non-smokers. PATIENTS AND METHODS: The data of healthy males and females aged between 18-60 years who presented to our institute for a routine check-up were collected, and subjects were divided in two groups - smokers and non-smokers. The presence of medical history or laboratory results which could affect inflammatory response, formed our exclusion criteria. All complete blood count results were noted and persons' smoking habits were calculated as pack/years. RESULTS: White blood cell, neutrophil, basophil and eosinophil counts; mean corpuscular volume, red cell distribution width and neutrophil/lymphocyte ratio were significantly higher in smokers when compared to non-smokers (p<0.05). When smokers were grouped according to smoking habits; positive linear correlations were detected between pack/year and Neutrophil/lymphocyte ratio and also pack/year and plateletcrit in smokers (p<0.05). CONCLUSIONS: Neutrophil/lymphocyte ratio increases in correlation with pack/year while platelet/lymphocyte ratio is not affected and platelet distribution width is increased in smokers. If smokers are not excluded from studies evaluating neutrophil/lymphocyte ratio and platelet distribution width, the relationship between smoking status as well as pack/year must be determined and reported.

How obesity affects the neutrophil/lymphocyte and platelet/lymphocyte ratio, systemic immune-inflammatory index and platelet indices: a retrospective study.

OBJECTIVE: Obesity is an important preventable cause of death and is a major risk factor for cardiovascular diseases as well as skeletal system diseases and malignancies. In many studies, complete blood count (CBC) and ratios derived from its results - such as the neutrophil/lymphocyte ratio, platelet/lymphocyte ratio and systemic immune inflammatory index have been associated with some diseases and their surveys. In these studies, the body mass index (BMI) and state of obesity of patients and the possible effects of these factors on CBC have not been defined. In this study, our aim was to evaluate the effect of BMI and smoking on CBC and ratios derived from CBC. PATIENTS AND METHODS: In this cross-sectional, retrospective study; the data of male and female patients aged between 18-65 years who presented for a routine check-up or obesity was collected and subjects were grouped as normal weight, overweight, obese and morbidly obese accordingly BMI. Persons' smoking habits were calculated as pack/years. All complete blood count results were noted. Smoking status and BMI groups were compared to CBC findings and ratios derived from these findings. RESULTS: After exclusion, 223 participants' data (104 female and 119 male) was included in the study. BMI was found to have a statistically significant positive linear correlation with lymphocyte number, PDW, SII and RDW (p < 0.05), and an extremely significant positive linear correlation (p < 0.01) was found between BMI and WBC, neutrophil count, PCT and platelet count. When BMI was not considered and 135 smokers were compared to 88 non-smokers, leukocytes and neutrophil counts were found to be higher in smokers (p < 0.05). CONCLUSIONS: Our study has found that WBC, neutrophil count, lymphocyte count, platelet count, PCT, PDW and SII are significantly affected by BMI status. Future studies that use these parameters and indices must take the participants' BMI and smoking status into account.

Anal canal pressure in anal fissure before and after internal sphincterotomy.

PURPOSE: To assess whether the anal canal pressure is increased in patients with a chronic anal fissure and to examine the effects of internal anal sphincterotomy (IASy) on this pressure. MATERIALS AND METHOD: Anorectal manometry was performed in 28 patients in whom an anal fissure had been diagnosed by means of physical examination and anuscopy. After IASy the manometric measurement was repeated on the 15th postoperative day and compared with the value obtained in twelve healthy volunteers. RESULTS: In patients with chronic anal fissure, the mean maximal resting pressure (MRP) was found to be 112.38 +/- 8.35 cm H2O pre-operatively and 66.23 +/- 8.44 cm H2O postoperatively, with a significant drop after IASy (p < 0.001). The MRP value was found as 75.16 +/- 10.22 cm H2O in the control group. The pre-operative MRP values in patient group was found to be higher than in the control group (p < 0.001). CONCLUSIONS: In patients with chronic anal fissure, the anal canal MRP pressures decreased significantly following IASy and complete clinical recovery was attained.

The outcome of gallbladder perforation during laparoscopic cholecystectomy.

PURPOSE: Laparoscopic cholecystectomy (LC) has become the standard treatment for symptomatic cholelithiasis. The perforation of gallbladder, bile and stone spillage, trauma to bile duct are the most common complications of LC. This study was carried out to assess the outcome of gallbladder perforation (GBP) during LC. MATERIAL AND METHODS: Between 1991 and 2001, intraoperative GBP occurred in 48 patients during LC among 336 patients who were operated on for acute cholecystitis in 14, and for chronic cholecystitis in 322. RESULTS: Perforation was observed in 48 patients (14%). Perforation occurred during traction and grasping in 36 patients (75%), dissection of gallbladder in 8 patients (16%), and removal of the gallbladder in 4 patients (8%). Bile spillage occurred in 40 patients (83%) while bile and stone spillage was present in 8 patients (16%). During the follow-up period, a patient was diagnosed with a subhepatic abscess on the 15th postoperative day and percutaneous drainage was performed. CONCLUSIONS: During LC careful attention must be taken in order to prevent perforation, and the procedure must be performed by experienced surgeons with adequate instrumentations. If perforation occurs, extensive prompt retrieval of the bile and stone spillage must be done along with abundant irrigation. In case of inadequate aspiration and irrigation, the patients must be closely followed.

Bezoar: an uncommon cause of intestinal obstruction.

Bezoars or undigested food concretions in the gastrointestinal tract are mostly due to ingestion of a stringent immature fruits following gastric surgery and can lead to the serious complication of acute small bowel obstructions. We are reporting a case of complete jejunal obstruction in a 60 year old female, 15 years following bilateral vagotomy and gastrojejunostomy for pyloric obstruction. Important clinical and pathological features are emphasised to increase the awareness of this rather uncommon cause of intestinal obstruction.