Intensive Care Management of an Adult Patient With Rare Chilaiditi Syndrome Presenting as Abdominal Breathing: A Case Report.

Chilaiditi syndrome (CS) is an uncommon case of the asymptomatic radiographic finding of an intestinal loop between the liver and the diaphragm. The most crucial phases in the diagnosis process are a thorough physical examination and precise imaging, particularly in challenging disorders such as CS. The presence of free air under the right hemidiaphragm in this syndrome, the diagnosis of which is based on radiographic imaging, might direct the start of treatment without the need for surgical intervention. An 86-year-old man, with asthma and chronic obstructive pulmonary disease (COPD) was checked out in our hospital's emergency department (ED) after experiencing nausea and vomiting. Having abdominal breathing while the patient was in an internal medicine department owing to a urinary tract infection (UTI) and acute kidney injury (AKI), he was moved to the intensive care unit (ICU). The patient was treated with respiratory physiotherapy, inhaler bronchodilator treatment, antibiotic therapy, enema, and laxatives. Medical imaging is the primary diagnostic tool for CS, guided by the symptoms. In patients like this elderly patient who was taken to ICU from internal medicine due to acute respiratory failure and abdominal breathing, when free air is detected in the subdiaphragmatic region, control should be provided with computed tomography (CT), and non-invasive mechanical ventilation should be applied.

What is the effect of percutaneous cholesistostomy in patients with acute cholecystitis? when is the right time for the procedure?

BACKGROUND: Acute cholecystitis (AC) is one of the most common emergency diseases in surgical practice. Although the gold standard treatment is laparoscopic cholecystectomy, percutaneous cholecystostomy (PC) is performed in some patients due to age, comorbidity, and delays in admission. We aimed to investigate the effect of timing on the clinical process of patients undergoing PC. METHODS: Patients who underwent PC between February 2017 and December 2021 were included in the study. Those who un-derwent PC in the first 72 h were determined as the early PC group, and those who underwent PC after 72 h were determined as the late PC group. Demographic information of the patients, clinical information before drainage, biochemical values of the first 3 days, length of hospital stay, morbidity and mortality in the early and late period after drainage, and elective cholecystectomy information were recorded. These data were compared between the two groups. RESULTS: One hundred and twenty-two patients were included in the study. Early PC was performed in 98 patients (80.3%) and late PC was performed in 24 patients (19.7%). The median follow-up period was 26.6 months (min: 0.25-max: 67) in the early PC group and 26.4 months (min: 0.6-max: 66) in the late PC group (P=0.408). There was no statistically significant difference in mean age, distribu-tion of males and women, concomitant disease, Charlson Comorbidity Index, hepatopancreatobiliary pathology (HPBP), endoscopic retrograde cholangiopancreatography in history and grade (TG18) compared to Tokyo classification (P>0.05). There was no difference between the biochemical parameters (P>0.05). In our study, the median length of hospital stay was 6 (min: 2-max: 36) days in the early PC group, and the median was 9 days (min: 5-max: 20) in the late PC group (P<0.001). A total of 25 patients developed HPBP after PC, 16 of which were AC. There was no statistically significant difference between the early and late PC groups in terms of HPBP develop-ment after PC (P=0.576). There was no statistically significant difference between the early and late PC group in terms of the rate of surgery and type of operation (emergency/elective, open/laparoscopic/conversion, total/subtotal, duration) (P>0.05). CONCLUSION: Discussions about the right timing are ongoing. In our study, we found that patients who underwent early PC had shorter hospital stays. There was no difference between the early and late groups in terms of patient characteristics and severity of AC. PC procedure in AC should be based on algorithms determined by objective data instead of patient-based indications with ran-domized controlled trials.

Comparison of percutaneous gallbladder aspiration with percutaneous cholecystostomy in acute cholecystostomy patients. Can gall bladder aspiration alone be sufficient?

BACKGROUND: The aim of this study is to compare the efficacy and complication rates of percutaneous gallbladder aspiration (PA) and percutaneous cholecystostomy (PC) in the management of AC and present the experiences of a single third-line center. METHODS: The results of 159 patients with AC who admitted to our hospital between 2015 and 2020, that underwent PA and PC procedures, because they did not respond to conservative treatment and LC could not be performed, were retrospectively analyzed. Clinical and laboratory data before and 3 days after PC and PA procedure, technical success, complications, response to treatment, duration of hospital stay, and reverse transcriptase-polymerase chain reaction (RT-PCR) test results were recorded. RESULTS: Out of 159 patients, 22 (8 men 14 women) underwent PA procedure and 137 (57 men 80 women) underwent PC. No significant difference was detected between the PA and PC groups in terms of clinical recovery (P: 0.532) and duration of hospital stay (P: 0.138) in 72 h. The technical success of both procedures was 100%. While 20 out of 22 patients with PA were having a noticable recovery, only one was treated with twice PA procedures and a complete recovery was observed (4.5%). Complication rates were low in both groups and were statistically insignificant (P: 1.00). CONCLUSION: In this pandemic period, PA and PC procedures are effective, reliable, and successful treatment method that can be applied at the bedside for critical patients with AC who are not compatible with surgery, which are safe for health workers and low-risk minimal invasive procedures for patients. In uncomplicated AC patients, PA should be performed, and if there is no response to treatment, PC should be reserved as a salvage procedure. The PC procedure should be performed in patients with AC who have developed complications and are not suitable for surgery.

Are the thorax Computed Tomography findings of ICU patients diagnosed with COVID-19 pneumonia related to the duration of hospital stay and mortality?

INTRODUCTION: Quantitative thorax Computed Tomography (CT) is used to determine the severity of COVID-19 pneumonia. With a new approach, quantitative thoracic CT is to contribute to the triage of patients with severe COVID-19 pneumonia in the ICU and to evaluate its relation with mortality by taking into account the vaccination status. METHODS: Fifty-six patients who had a diagnosis of COVID-19 pneumonia confirmed in the adult ICU were evaluated retrospectively. To evaluate the degree of parenchymal involvement, the quantitative CT "craniocaudal diameter of the thorax/craniocaudal largest lesion diameter (CCDT/CCDL)" ratio and semi-quantitative total CT severity scores (TCTSS) (0:0%; 1:1-25%; 2:26-50%; 3:51-75% and 4:76-100%) were calculated. Both methods were analyzed with comparative ROC curves for predicting mortality. The effects of vaccines on thorax CT findings and laboratory parameters were also investigated. RESULTS: The sensitivities and specificities were found to be 72.5%, 75.61%, and 80%, 73.33% when CCDT/CCDL and TCTSS cutoff value was taken <1.4, and >9, respectively, to predict mortality in COVID-19 pneumonia (Area Under the Curve = AUC = 0.797 and 0.752). Both methods predicted mortality well and no statistical differences were detected between them (p = 0.3618). In vaccinated patients, CRP was higher (p = 0.045), and LDH and ferritin were lower (p = 0.049, p = 0.004). The number of lobes involved was lower in the vaccinated group (p = 0.001). CONCLUSIONS: The quantitative CT score (CCDT/CCDL) may play as important a role as TCTSS in diagnosing COVID-19 pneumonia, determining the severity of the disease, and predicting the related mortality. COVID-19 vaccines may affect laboratory parameters and cause less pneumonia on thoracic CT than in unvaccinated individuals.

Incidentally Detected Gastrointestinal Wall Thickness on Abdominal Computed Tomography; What Does it Mean for Endoscopy?

BACKGROUND: The clinical significance of gastrointestinal wall thickening (GWT) on abdominal computed tomography (CT) is not certain, yet. Despite the need for clinical guidelines describing the importance and evaluation of GWT on a CT scan, there have been few studies evaluating these incidental imaging abnormalities. The aim of this study is to endoscopically evaluate certain etiologies that cause incidental GWT found on CT. METHODS: This retrospective cohort study was carried out with patients who had incidentally detected GWT on a CT scan at the Kanuni Sultan Süleyman Training and Research Hospital between February 2016 and December 2018. RESULTS: A total of 129 patients (62 males and 67 females; mean age 57.5 years, range: 26-87 years) were included in the study. Abnormalities observed during endoscopy at the exact site of the GWT noted on a CT image were found in 114 patients (99%): upper endoscopy revealed malignancy in 33 (29%), gastritis in 63 (52%), hiatal hernia in 19 (16%), a gastric ulcer in 7 (6%), and alkaline gastritis in 3 (2%). Colonoscopy revealed malignancy in 4 (33%), benign polyps in 5 (35%), colonic ulcer in 2 (16%), and 2 patients (16%) had normal findings. Malignancy was detected more frequently in the cardioesophageal region compared with the antrum (P=0.020). CONCLUSION: In this study, detection of GWT on CT often indicated pathologies which were subsequently confirmed endoscopically. Pathological findings were detected in 83% of these patients, with approximately 30% determined to be malignant. Endoscopic evaluation is recommended when GWT is reported on a CT scan.

Coexistence of Juvenile Systemic Lupus Erythematosus and Juvenile Spondyloarthropathy: A Case Report and Review of the Literature.

Sacroiliitis has been scarcely reported in patients with systemic lupus erythematosus (SLE). In this article, we presented a pediatric case with coexis- tence of juvenile SLE and juvenile spondyloarthropathy (SpA) and discussed the clinical and laboratory findings by the literature review. A 16-year- old female patient with a diagnosis of SLE was referred to our outpatient clinic with inflammatory low-back pain for two months. Sacroiliac magnetic resonance imaging confirmed the presence of bilateral active sacroiliitis. She was finally diagnosed with juvenile SpA. She achieved remission with subcutaneous methotrexate and non-steroid anti-inflammatory drugs. To the best of our knowledge, this is the first pediatric case with SLE and SpA. This case provides further implication about atypical presentation of a well-known disorder.

Chemical compositions and antioxidant properties of essential oils from nine species of Turkish plants obtained by supercritical carbon dioxide extraction and steam distillation.

Chemical compositions and antioxidant activities of essential oils from nine different species of Turkish plants, namely Melissa officinalis L., Rosmarinus officinalis L., Cuminum cyminum L., Piper nigrum L., Lavandula stoechas spp., Foeniculum vulgare, Pimpinella anisum L., Thymus serpyllum and Liquidamber orientalis Mill., were studied. Essential oils were obtained by supercritical carbon dioxide (SCCO2) extraction and steam distillation, and were analyzed by gas chromatography-mass spectrometry. The antioxidant activities of SCCO2 extraction and steam distillation extracts were tested by means of the 1,1-diphenyl-2-picrylhydrazyl (DPPH) assay. Essential oils extracted by SCCO2 and steam distillation showed different compositions in different species. In the DPPH assay, R. officinalis, C. cyminum, P. anisum, T. serpyllum and L. orientalis essential oils obtained by SCCO2 extraction showed higher antioxidant activity than steam distillation extracts, with radical scavenging activities ranging from 87.1 +/- 0.23% to 92.0 +/- 0.34% compared with the butylated hydroxytoluene positive control (91.4 +/- 0.21%).

Extraction of lycopene from tomato skin with supercritical carbon dioxide: effect of operating conditions and solubility analysis.

Supercritical carbon dioxide (SCCO2) extraction of lycopene from waste tomato skins was investigated. The experiments were carried out at pressures and temperatures ranging from 20 to 50 MPa and 313 to 373 K, respectively, without any modifiers. The flow rate of CO2 was maintained at 2.5 mL/min for 330 min extraction time. Solvent flow rate effect was examined for CO2 flow rates from 1.5 to 4.5 mL/min. The extracts were analyzed by high-performance liquid chromatography and UV-visible spectroscopy. The results showed that with optimized operating conditions, the maximum yield of lycopene (1.18 mg of lycopene/g of sample) was obtained at 40 MPa, 373 K, and 2.5 mL of CO2/min. Chromatographic analysis indicated that lycopene was extracted from tomato skin with negligible degradation at the optimum conditions and the amount extracted represented more than 94% of the total carotenoid content of the sample. The solubility of lycopene was modeled by use of the Chrastil equation.