The diagnostic value of serum hepcidin in acute appendicitis.

BACKGROUND: Acute appendicitis (AA) is the primary cause of acute abdomen in patients presenting to the emergency department with abdominal pain. Limited studies have explored the relationship between serum hepcidin levels and AA. This study aimed to measure serum hepcidin levels in patients undergoing surgery with a preliminary diagnosis of AA and to assess whether these levels can serve as a biochemical marker for diagnosing AA. METHODS: This study included patients aged 18 or older who presented to the emergency department between April 2018 and May 2019 and underwent surgery with a diagnosis of AA. The cohort comprised 94 patients with surgical pathology results compatible with AA (Group A), 16 patients with results not compatible with AA (Group B), and 42 healthy controls. Serum hepcidin levels were measured from venous blood samples. RESULTS: Mean hepcidin levels were 1750±285 pg/mL in Group A, 1349±381 pg/mL in Group B, and 1066±225 pg/mL in the control group. Statistically significant differences in serum hepcidin levels were observed between Group A and the control group (p<0.05). CONCLUSION: Hepcidin levels were significantly higher in patients with AA compared to both the control group and patients with surgically confirmed non-AA pathology. Therefore, hepcidin may serve as a useful adjunct in diagnosing acute appendicitis.

The diagnostic value of serum urokinase-type plasminogen activator receptor in acute appendicitis.

BACKGROUND: To measure serum uPAR levels in patients operated with a preliminary diagnosis of acute appendicitis (AA) and to investigate whether these parameters can be used as a biochemical marker in the diagnosis of AA. METHODS: Patients aged 18 or over, presenting to the emergency department between May and December 2018 and operated with a diagnosis of AA were enrolled. This study included 84 patients with surgical pathology results compatible with AA (Group A), 26 patients with surgical pathology results were not compatible with AA (Group B) and 55 healthy control groups. Serum uPAR levels were measured from venous blood samples taken at admission. RESULTS: Mean uPAR levels were 4.53±3.47 ng/mL in the Group A, 1.13±1.63 ng/mL in the Group B and 0.80±1.21 ng/mL in the control group. Serum uPAR levels differed statistically significantly from Group A in Group B and the control group, (p<0.05). CONCLUSION: uPAR was found to be significantly higher in the AA patients compared to the control group and patients with surgically determined non-AA pathologies. uPAR can be used as an aid in the diagnosis of acute appendicitis.

Comparison of the effects of continuous versus intermittent enteral feeding on plasma leptin and ghrelin levels in Intensive Care Units / Comparação do efeito da alimentação enteral contínua com o efeito da alimentação intermitente nos níveis plasmáticos de leptina e grelina em Unidades de Terapia Intensiva

ABSTRACT Objective: The aim of this prospective randomized trial is to verify whether there is an association between the methods of administration of enteral nutrition and the leptin and ghrelin hormones, which have a major role in the regulation of energy metabolism. Methods: This study enrolled 38 enteral-fed patients aged 18 to 85 in the Intensive Care Unit. The patients were prospectively randomized to receive either continuous infusion (n=19) or intermittent feeding (n=18) of enteral nutrition. In addition to routine biochemical assays, blood samples were taken from the patients for leptin and ghrelin analyses on the 1th, 7th, and 14th days of enteral nutrition. Results: There was no statistically significant difference between the groups regarding descriptive statistics and categorical variables such as underlying diseases, complications, steroid use and others (p>0.05). The decrease in the number of white blood cells and in creatinine and C-reactive protein levels over time were statistically significant (p=0.010, p=0.026, p<0.001 respectively). There was no statistically significant difference between the groups with respect to leptin and ghrelin levels (p=0.982 and p=0.054). Leptin levels did not change over time; however, the ghrelin levels of both groups were significantly higher on the 7th and 14th days than on the first day of analysis (p=0.003). Conclusion: This study revealed that both continuous and intermittent enteral nutrition feeding regimens were well tolerated in Intensive Care Unit patients showing minor complications. The method of administration of enteral nutrition alone did not affect the leptin and ghrelin levels. Randomized controlled large cohort trials are needed to to compare intermittent and continuous enteral nutrition to determine which one is more adaptable to diurnal patterns of secretion metabolic hormones.

RESUMO Objetivo: Este ensaio aleatório prospectivo tem por objetivo verificar se existe uma associação entre o programa de administração de nutrição enteral e os hormonios leptina e grelina, os quais funcionam no metabolismo energético. Métodos: Este estudo incluiu 38 pacientes de Unidades de Terapia Intensiva, com idades entre os 18 e os 85 anos, que receberam nutrição enteral. Os pacientes foram escolhidos aleatoriamente para receberem nutrição enteral utilizando infusão contínua (n=19) ou intermitente (n=18). Além de exames bioquímicos de rotina, foram colhidas amostras de sangue dos pacientes para análises dos níveis de leptina e grelina no 1º, 7º e 14º dias de nutrição enteral. Resultados: Não houve diferença estatística significante entre os grupos em relação a dados descritivos e variáveis categóricas tais como doenças subjacentes, complicações, utilização de esteroides e outros (p>0,05). A diminuição no número de leucócitos e nos níveis de creatinina e proteína C-reativa com o tempo foi estatisticamente significativa (p=0,010, p=0,026, p<0,001, respetivamente). Não existiu diferença com significância estatística entre os grupos em relação aos níveis de leptina e grelina (p=0,982 e p=0,054). Embora os níveis de leptina não mudaram com o tempo, os níveis de grelina de ambos os grupos foram significativamente superiores no 7° e 14° dias quando comparados aos verificados na análise do primeiro dia (p=0,003). Conclusão: Este estudo revelou que os programas de nutrição enteral contínua e intermitente foram bem tolerados com pequenas complicações apresentadas pelos pacientes em Unidades de Terapia Intensiva. O padrão de administração de nutrição enteral por si só não afetou os níveis de leptina e grelina. Estudos controlados aleatórios em coortes maiores são necessários para verificar qual programa de administração de nutrição enteral, intermitente ou a contínuo, é mais adaptável ao padrão de secreção diurno de hormônios metabólicos.

The histopathologic effects of L-carnitine in Sodium Taurocholate Induced Severe Pancreatitis Model.

OBJECTIVE: To evaluate the histopathologic effects of L-carnitine (LC) in an experimental severe pancreatitis (SP) model induced with sodium taurocholate (STC). SUMMARY OF BACKGROUND DATA: LC is an amino acid-like molecule that plays an active role in transporting fatty acids and producing Acetyl CoA in mitochondrial matrix for ß-oxidation to provide energy which is needed for metabolism. It has ameliorative effects on cell injury demonstrated in many studies. The present study focuses on evaluating histopathologic effects of LC in an experimental SP model. METHODS: This experimental study in rats was conducted at the Experimental Animal Research Laboratory of the Faculty of Medicine of Inonu University, Malatya, Turkey. Thirty-two Spraque-dawley male rats were divided into 4 groups in a randomized fashion: control (C) group, L-carnitine (LC) group, pancreatitis (P) group, pancreatitis and L-carnitine (P+LC) group. Pancreatitis was induced by a retrograde pancreatic duct injection of 4% sodium taurocholate and L-carnitine was administered 200 mg/kg/day in treatment group. Rats were euthanized with cardiac puncture under anesthesia at 48th hour of the experiment for biochemical and histopathological examination. RESULTS: In (P+LC) group, the histopathological findings of the pancreatitis were markedly reduced. Acinar cell degeneration was rarely seen. Interlobular and intralobular inflammation and edema was generally mild. The pancreatic damage score of (P+LC) group was significantly lower than that of the (P) group (p<0.05). CONCLUSION: This study revealed that l-carnitine has a significant histopathologic protective effect on acinar cell degeneration in STC-induced SP model in rats.

Comparison of 3D imaging and 2D imaging for performance time of laparoscopic cholecystectomy.

OBJECTIVE: The aim of this study is to evaluate the effect of the Viking 3-dimensional (3D) system on performance time of laparoscopic cholecystectomy. METHODS: Twenty-two patients were included in the study. The groups were standardized using a multiparameters filter (MPF) depending on preoperative ultrasonography and perioperative exploration findings. The 11 patients operated with the Viking 3D system (group A) were compared with 11 patients operated with the Olympus 2D/HD system (group B). RESULTS: The mean performance time was 20.63 ± 5.66 and 30.0 ± 6.03 minutes in the group A (3D) and group B (2D), respectively (P<0.01). CONCLUSIONS: The 3D imaging systems may cause a significant reduction in the performance time of laparoscopic cholecystectomy.

Recurrent acute pancreatitis due to a hydatid cyst of the pancreatic head: a case report and review of the literature.

CONTEXT: Primary pancreatic hydatid disease is rare and there have only been a few cases of recurrent acute pancreatitis due to a hydatid cyst of the pancreas. CASE REPORT: We describe a case of recurrent acute pancreatitis in which the definitive diagnosis of hydatid cyst of the pancreatic head was only made during a repeat operation and the patient subsequently underwent total pericystectomy. CONCLUSION: A hydatid cyst of the pancreas is an extremely rare condition but it may be a causative factor for recurrent acute pancreatitis, especially in endemic areas. In this case, pericystectomy might be the procedure of choice in order to release the pressure.