BACKGROUND: An incarcerated hernia is a part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia. An increase in morbidity and mortality occurs after intestinal resections from strangulated hernias. This study aims to examine the markers that may be effective in determining the risk of small bowel resection due to incarcerated hernias. In particular, we aimed to investigate the effect s of blood lactate levels in determining this risk. METHODS:A cross-sectional retrospective study was designed. Patients, whose preoperative diagnosis were reported as incarcerated hernia and had essential information, were included in this study. They were divided into two groups according to whether they had resection or not. Age, gender, hernia type, hernia side, resection material, blood lactate level (BLL), white blood cell (WBC), neutrophil count (NE), lymphocyte count (LY), neutrophil/lymphocyte ratio (NLR), platelet count (PLT), lactate dehydrogenase (LDH), radiologic bowel obstruction sign and comorbidities were evaluated. RESULTS:Sixty-seven patients were included in this study. It was observed that 16 (23.9%) of these patients underwent small intestinal resection, 16 (23.9%) had an omentum resection, while no resection was performed on 35 (52.2%) patients. There was a statistically significant difference regarding radiologically intestinal obstruction (p=0.001), hernia type (p=0.005), BLL (p<0.001), WBC, NLR and LDH values (p<0.05). In incarcerated hernia patients with a lactate value ≥1.46 mg/dL, sensitivity was observed to be 84.0% and specificity 86.0% (p<0.001). CONCLUSION:In patients with a preliminary diagnosis of an incarcerated hernia, the risk of possible small bowel resection is the most important point in deciding for an operation. The presence of an intestinal obstruction in radiological examinations, and particularly the high levels of WBC, NLR, LDH and BLL, may indicate a necessity for possible small bowel resection. Concerning the risk associated with small bowel resection, blood lactate levels ≥1.46 mg/dL may be alerting.

Çukurova is an endemic region for malaria, and Adana is the largest city in the region. We believe that surveillance studies conducted without any interruption may prevent malaria from becoming a reemerging problem in this region.

ÖzetAmaç: Bu çalışmada medikal yoğun bakım ünitelerinde ventilatörle ilişkili pnömoni (VİP) gelişmesine etki eden risk faktörlerinin saptanması amaçlanmıştır. Yöntemler: 16 yaş ve üzeri, 48 saatten fazla mekanik ventilatöre bağlı kalan, ilk yatışta akciğer infeksiyonu olmayan hastalar çalışmaya alındı. İstatistiksel analizler için STATA 9.0 ® (College Station, TX, USA) bilgisayar programı kullanıldı. Sonuçlardan p değeri <0.05 olanlar anlamlı kabul edildi. Bulgular: 142 hasta çalışmaya alındı. Hastaların 64 (%45.1)'ünde VİP gelişti. 1000 ventilasyon günü için VİP hızı 23.3 idi. Çalışmada intübasyon ve mekanik ventilasyon süresinin uzaması (p<0.001), hastanede (p<0.001) ve yoğun bakımda yatışın uzaması (p<0.001), APACHE II skorunun yüksekliği (p<0.001), kan transfüzyonu (p<0.001), enteral beslenme (p=0.025), üriner infeksiyon (p<0.001), yara infeksiyonu (p=0.045), en az bir bölgede infeksiyon varlığı (p<0.001), kronik obstrüktif akciğer hastalığı (KOAH) (p=0.003), diabetes mellitus (DM) (p<0.001), önceki antibiyotik kullanımı (p=0.003), trakeostomi açılması (p=0.003) ve santral kateter varlığı (p<0.001) VİP gelişmesi için risk faktörü olarak saptandı. Lojistik regresyon analizinde intübasyon süresinin uzaması (p=0.015), APACHE II skorunun yüksekliği (p=0.001), kan transfüzyonu (p=0.015), KOAH (p=0.036), DM (p=0.019) ve santral kateter varlığı (p<0.001) bağımsız risk faktörleri olarak tespit edildi. Sonuçlar: VİP için tanımlanmış risk faktörlerinin bilinip, VİP'in önlenmesi için etkin infeksiyon kontrol programlarının uygulanması, her ünitede sürveyans sonuçlarının düzenli olarak değerlendirilmesi ve uygun tedbirlerin alınması gerekir. Klimik Dergisi 2010; 23(3): 83-8.Anahtar Sözcükler: Ventilatörle ilişkili pnömoni, yoğun bakım ünitesi, risk faktörleri. AbstractObjective: The aim of this study was to investigate risk factors for ventilator-associated pneumonia (VAP) which developed in patients admitted to medical intensive care units. Methods: Patients who were 16 years old and above, dependent on a mechanical ventilator for more than 48 hours and without pulmonary infection on fi rst admission were included in the study. STATA 9.0 ® (College Station, TX, USA) was employed for statistical analyses and p<0.05 was regarded as the signifi cant value. Results: This study included 142 patients and 64 (45.1%) developed VAP. The incidence of VAP was 23.3 cases per 1000 ventilator-days. Univariate analysis showed that duration of mechanical ventilation (p<0.001), length of intensive care unit (p<0.001) and hospital stay (p<0.001), the APACHE II score (p<0.001), blood transfusion (p<0.001), enteral feeding (p=0.025), urinary infection (p<0.001), wound infection (p=0.045), presence of at least one region of infection (p<0.001), chronic obstructive pulmonary disease (p=0.003), diabetes mellitus (p<0.001), prior antibiotics (p=0.003), tracheotomy (p=0.003) and presence of central catheter (p<0.001) were associated with the development of VAP. Logistic regression analysis showed a relationship between VAP and duration of mecha...

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Background Non-alcoholic fatty liver disease (NAFLD) has a high prevalence among patients undergoing laparoscopic sleeve gastrectomy (LSG). Although liver biopsy is the gold standard for assessing histopathologic changes in the liver, it is an invasive procedure. The objective of this study was to evaluate the effect of sleeve gastrectomy on liver enzymes, fibrosis and steatosis scores; ultrasonographic findings; biochemical parameters; and anthropometric measurements in morbidly obese patients with NAFLD. Methods Ninety-seven obese patients who underwent LSG were included in this study. Sex, age, body mass index (BMI), comorbidities, liver enzymes, ultrasonographic findings and laboratory parameters to calculate fibrosis and steatosis scores were collected before surgery and after 1 year of follow-up. Results A total of 88.7% of patients had liver steatosis at the pre-surgical ultrasonographic evaluation and this ratio decreased to 46.4% 1 year after surgery. Alanine aminotransferase (ALT), homeostatic model assessment of insulin resistance index (HOMA-IR), aspartate aminotransferase-to-platelet ratio index (APRI) and liver fat score (LFS) were significantly higher in patients with steatosis grade III vs. others. There were improvements in high-density lipoprotein (HDL), triglycerides (TG), glycated hemoglobin (HbA1c), glucose, insulin, BMI, liver enzymes and all NAFLD-related fibrosis and steatosis scores. Conclusions HOMA-IR, ALT, LFS and APRI scores can be used for follow-up procedures in morbidly obese patients with NAFLD who underwent LSG.