Resilience is essential for medical students to navigate the challenges of their education and future careers. Defined as the ability to adapt well in the face of adversity, resilience can be learned and is critical for maintaining mental health. Medical educators play a pivotal role in fostering resilience by integrating it into both formal and informal curricula, including the hidden curriculum, which can significantly influence students’ coping strategies. Research highlights the importance of resilience training in reducing depression and anxiety among students, underscoring its necessity as a core component of medical education. This essay presents the Systematic Assessment for Resilience (SAR) framework, which provides a comprehensive approach to promoting resilience through four key constructs: self-control, management, engagement, and growth. Practical strategies for each construct are discussed, including assessment mapping, time management, and the use of formative assessments to enhance students’ preparedness and self-control. Engagement is fostered through collaborative assessments, open book exams, and regular formative feedback, while growth is encouraged via self-reflection and faculty development. Implementing the SAR framework has shown positive outcomes, with students reporting reduced anxiety and improved performance. However, further exploration and institutional support are needed to fully integrate these strategies into medical education. The SAR framework offers a feasible and effective method for cultivating resilience, contributing to students’ mental well-being and equipping them to face future challenges in their medical careers. Continued refinement and broader institutional adoption will be crucial to sustaining the impact of resilience training in medical education.

BACKGROUND:Artificial intelligence (AI) is transforming health profession education (HPE) through personalized learning technologies. HPE students must also learn about AI to understand its impact on healthcare delivery. We examined HPE students' AI-related knowledge and attitudes, and perceived challenges in integrating AI in HPE. METHODS:This cross-sectional included medical, nursing, physiotherapy, and clinical nutrition students from four public universities in Jordan, the Kingdom of Saudi Arabia (KSA), the United Arab Emirates (UAE), and Egypt. Data were collected between February and October 2023 via an online survey that covered five main domains: benefits of AI in healthcare, negative impact on patient trust, negative impact on the future of healthcare professionals, inclusion of AI in HPE curricula, and challenges hindering integration of AI in HPE. RESULTS:Of 642 participants, 66.4% reported low AI knowledge levels. The UAE had the largest proportion of students with low knowledge (72.7%). The majority (54.4%) of participants had learned about AI outside their curriculum, mainly through social media (66%). Overall, 51.2% expressed positive attitudes toward AI, with Egypt showing the largest proportion of positive attitudes (59.1%). Although most participants viewed AI in healthcare positively (91%), significant variations were observed in other domains. The majority (77.6%) supported integrating AI in HPE, especially in Egypt (82.3%). A perceived negative impact of AI on patient trust was expressed by 43.5% of participants, particularly in Egypt (54.7%). Only 18.1% of participants were concerned about the impact of AI on future healthcare professionals, with the largest proportion from Egypt (33.0%). Some participants (34.4%) perceived AI integration as challenging, notably in the UAE (47.6%). Common barriers included lack of expert training (53%), awareness (50%), and interest in AI (41%). CONCLUSION:This study clarified key considerations when integrating AI in HPE. Enhancing students' awareness and fostering innovation in an AI-driven medical landscape are crucial for effectively incorporating AI in HPE curricula.

Background Medical students face significant psychological stress, impacting their academic performance and well-being. The Systematic Assessment for Resilience (SAR) framework is designed to enhance resilience and mitigate stress among medical students, addressing the need for interventions within the assessment system in medical education. The aim of this study was to evaluate the implementation of SAR framework on medical students' resilience, anxiety, depression, burnout, and academic stress. Methods This study employed a quasi-experimental design with pre- and post-testing. It involved the training of course coordinators in implementing the SAR framework and its integration into the daily learning activities. Fourth-year medical students were assessed before and after the intervention using standardized measures of resilience, anxiety, depression, burnout, and academic stress. Data were analyzed using quantitative methods and thematic analysis for qualitative feedback. Results Post-intervention, students demonstrated a significant increase in resilience scores (p < 0.001) and a notable decrease in measures of anxiety, depression, and academic stress (p < 0.001). The burnout types were also statistically different (p < 0.001) except client-related burnout (p > 0.05). Qualitative feedback of the course coordinators highlighted an improved learning environment, increased coping strategies, and a more supportive academic culture. Conclusion The SAR framework significantly contributes to enhancing medical students' resilience and reducing psychological distress. Its implementation suggests a promising approach to fostering a supportive educational environment that not only addresses the psychological challenges faced by medical students but also enhances their academic performance and overall well-being. Further research is warranted to explore the long-term impacts of SAR across different medical education contexts.

The CYP2C19 gene is frequently included in different pharmacogenomic panels tested in clinical practice, due to its involvement in the metabolism of a myriad of frequently prescribed medications. Accordingly, CYP2C19 genotyping can promote precise therapeutic decisions and avoid the occurrence of significant drug-drug-gene interactions in the clinical setting. A comprehensive examination of the role of the CYP2C19 gene in real-world medical settings is presented in this review. This review summarizes the most recent information on how genetic variants in CYP2C19 affect drug metabolism and therapeutic outcomes. It goes into the wide range of CYP2C19 phenotypes, with different degrees of metabolizing activity, and their implications for customized medication response through a review of the literature. The review also analyzes the clinical significance of CYP2C19 in several medical specialties, including cardiology, psychiatry, and gastro-enterology clinics, and illuminates how it affects pharmacological efficacy, safety, and adverse effects. Finally, CYP2C19-supported clinical decision-making is outlined, highlighting the possibility of improving therapeutic outcomes and achieving more affordable treatment options, a step towards optimizing healthcare provision through precision medicine.

COVID-19 exhibits diverse and systemic clinical symptoms, much like systemic autoimmune diseases, and there are notable similarities in the immune responses seen in both conditions. There are rare reports of ulcerative colitis and autoimmune hepatitis triggered by COVID-19 infection. Reported herein is a case of a previously healthy patient who was diagnosed with chronic colitis resembling ulcerative colitis, autoimmune pancreatitis, and suspected immune-mediated hepatitis (AIH-like hepatitis) 2 months after a COVID-19 infection. A 33-year-old COVID-19-vaccinated male, presented with abdominal pain, nausea, and vomiting for 2 days. He also had bloody diarrhea that persisted for 2 months after recovering from a COVID-19 infection. A diagnosis of acute pancreatitis was confirmed by markedly elevated serum amylase and lipase and a CT scan of the abdomen. Colonoscopy and histopathology findings also confirmed a diagnosis of chronic colitis resembling ulcerative colitis (Mayo Endoscopy Subscore 3). Marked improvement in bloody diarrhea was observed within 72 h of treatment with IV prednisolone. MRI of the abdomen performed due to an unresolved clinical picture of pancreatitis revealed a bulky pancreas showing delayed diffuse homogenous enhancement, findings possibly consistent with autoimmune pancreatitis. Investigation for elevated liver transaminases showed high titers of antinuclear antibodies and anti-smooth muscle (anti-actin) antibodies while viral hepatitis markers were negative. The patient had already been started on steroid therapy before the lab results were available, with rapid normalization of liver enzymes following treatment. A liver biopsy was not performed. The patient is currently on mesalazine 4 gr/day, and azathioprine 100 mg/day - oral steroids had been tapered and discontinued. Seven months after the initial diagnosis, the patient remains symptom-free. A high level of suspicion for autoimmune disorders is required when assessing patients with a history of COVID-19 infection, although diagnostic pathways remain the same, with generally good response and remission rates to conventional treatment.

Objective: Granulomatous mastitis is an infrequent, benign, inflammatory disease of the breast that mostly affects young women of reproductive age. The main objective of this review was to clarify the latest terminology and to provide an update on the diagnosis and management.Materials and Methods: A total of 792 granulomatous mastitis-related articles published in the English literature from 1965 to 2022 were reviewed.Results: The management of this benign but daunting condition remains controversial, and there is no worldwide consensus regarding the best systematic treatment protocol. Good judgment is required to ensure optimal diagnosis and treatment. Conclusion: This narrative review deals with the latest developments in the diagnosis, etiopathogenesis, and modern treat-ment of the disease.

Liver biopsy is required to make a diagnosis of autoimmune hepatitis. During the COVID-19 pandemic there have been calls to commence empirical treatment in patients with suspected disease who have characteristic clinical, biochemical and immunological features. It is suggested to modify the current simplified autoimmune hepatitis scoring system to include two additional criteria - No history of drug-induced liver injury-associated medications and response to immunosuppressive treatment - that if fulfilled, could be considered as an alternative to a histological confirmation.

A 61-year-old man presented with dysphagia, weight loss and shortness of breath. On examination, he had reduced lung sounds on the right, and obvious neck vein distention. Chest X-ray raised a suspicion of lung tumor with possible superior vena cava syndrome. Subsequent CT scan of chest confirmed the presence of markedly dilated and tortuous esophagus (sigmoid megaesophagus) extending to the right hemithorax and pressing on the trachea. The patient was referred for surgery.

Up to 25% of patients with ulcerative colitis (UC) require a colectomy at some point in their lives. However, there is a high cumulative risk for complications of ileostomas and ileal or anal pouches after proctocolectomy such as retraction, stenosis, parastomal hernia or prolapse. During pregnancy, there is limited practical experience on how to manage severe complications of ileostomas. During the 24th week of pregnancy, a 28-year-old woman who had undergone restorative proctocolectomy 5 years prior developed an acute ileus. Endoscopy and magnetic resonance tomography (Fig. 1) revealed an inflammatory stricture of the afferent intestinal loop near the ileal stoma. The corresponding histomorphology was interpreted as pouchitis. Providing a rapid release of the intestinal obstruction, a long-tube decompression (outer diameter 16 Fr) was inserted by an endoscope immediately relieving the ileus. As a stable and ultimate solution was required for the remaining pregnancy, we bridged the ileal stricture by a self-expanding stent. Ensuring proper inner positioning through ultrasound, a covered stent with a length of 100 mm and an internal diameter of 28 mm was placed using an upper endoscope in the ileostoma. The optimal position bridging the stricture was fixed by mucosal seams (Fig. 2). To avoid pressure necrosis, the stent was replaced after 6 weeks and lasted until delivery. Stenting of the ileal stricture over a 3-month period prevented successful surgical therapy and preterm delivery so that the woman could give birth to a mature healthy child (39th week of pregnancy). The postpartum course was unremarkable showing no recurrence of intestinal obstruction. The so far uncommon stenting of the ileal stricture provided a rapid, safe and durable solution avoiding radiation exposure. Our single patient experience suggests that this easy and effective method expands the limited therapeutic options in pregnant women preventing maternal as well as fetal and neonatal sequelae.

Congenital hepatic fibrosis is part of many different malformation syndromes, of which oculo-encephalo-hepato-renal syndrome is the most common. These syndromes largely overlap, and so accurate classification of individual patients may be difficult. We present herein three syndromic siblings who were products of a consanguineous marriage. We investigated in detail at least six organ systems in these patients, namely the liver, brain, eye, kidneys, skeleton, and gonads. The common features observed in these three cases were congenital hepatic fibrosis, retinitis pigmentosa, truncal obesity, rotatory nystagmus, mental retardation, advanced myopia, and high-arched palate. The clinical dysmorphology in these patients was distinct and lacked the major features of the known syndromes associated with congenital hepatic fibrosis. Although some features of these presented cases are similar to those found in Bardet-Biedl syndrome (BBS), the absence of some major criteria of BBS (polydactyly, renal abnormality, and hypogonadism) suggests that this may be a new syndrome. All three patients remain under follow-up in the departments of Gastroenterology, Ophthalmology, and Neurology at Hacettepe University.

It is with great interest that we read the article by Valats et al1Valats J.C. Funakoshi N. Bauret P. et al.Covered self-expandable biliary stents for the treatment of bleeding after ERCP.Gastrointest Endosc. 2013; 78: 183-187Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar on the successful management of post-ERCP bleeding with the use of covered self-expandable biliary stents, and we would like to take this opportunity to share our experience with a modified approach in a patient with severe bleeding after ERCP.Recently, a 52-year-old man was referred to our clinic for further evaluation of obstructive jaundice and weight loss. US examination of the abdomen revealed a 3 × 3 cm mass in the hilus of the liver; the margins could not be distinguished from the gallbladder. On subsequent ERCP, deep cannulation of the common bile duct (CBD) was achieved after a precut sphincterotomy, and the cholangiographic images revealed a stricture in the mid-CBD with dilatation of the proximal biliary tree, which prompted placement of a 10F 10-cm plastic biliary stent. Although the ERCP procedure was otherwise uneventful, the patient experienced melena 12 hours later and required 10 units of packed erythrocytes within 36 hours to maintain a hemoglobin concentration of more than 10 g/dL. Two attempts at hemostasis with use of a duodenoscope failed because the source of the bleeding could not be accurately located, owing to the massive bleeding and to large coagulum covering the duodenal lumen completely. However, endoscopic evidence was highly suggestive of either sphincterotomy bleeding or hemobilia from the identified tumor.The patient was consequently referred for percutaneous transhepatic cholangiography, during which a 10 mm × 80 mm covered self-expandable metallic stent (SEMS) (Wallflex; Boston Scientific, MA) was placed next to the plastic stent, with its distal end slightly protruding into the duodenum through the ampulla of Vater. An external-internal drainage catheter was also placed before conclusion of the procedure (Fig. 1A). This was followed by conventional angiographic evaluation, which confirmed that bleeding was brought under control with no apparent extravasation of injected contrast dye (Fig. 1B). No other bleeding episode was observed during 3 weeks of follow-up.Although successful control of post-ERCP bleeding with endoscopic SEMS placement has been previously reported in the form of case series,2Shah J.N. Marson F. Binmoeller K.F. Temporary self-expandable metal stent placement for treatment of postsphincterotomy bleeding.Gastrointest Endosc. 2010; 72: 1274-1278Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar, 3Itoi T. Yasuda I. Doi S. et al.Endoscopic hemostasis using covered metallic stent placement for uncontrolled postendoscopic sphincterotomy bleeding.Endoscopy. 2011; 43: 369-372Crossref PubMed Scopus (63) Google Scholar Valats et al1Valats J.C. Funakoshi N. Bauret P. et al.Covered self-expandable biliary stents for the treatment of bleeding after ERCP.Gastrointest Endosc. 2013; 78: 183-187Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar underlined the efficacy of this method in controlling hemobilia where the CBD rather than the sphincterotomy was the source of bleeding. Our case demonstrates that percutaneous placement of a SEMS is a viable alternative to the endoscopic approach for the management of bleeding from the CBD or postsphincterotomy bleeding, especially in cases in which endoscopic hemostasisis unachievable because of excessive hemorrhage or inaccessibility to the source of bleeding when conventional hemostatic techniques are used. It is with great interest that we read the article by Valats et al1Valats J.C. Funakoshi N. Bauret P. et al.Covered self-expandable biliary stents for the treatment of bleeding after ERCP.Gastrointest Endosc. 2013; 78: 183-187Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar on the successful management of post-ERCP bleeding with the use of covered self-expandable biliary stents, and we would like to take this opportunity to share our experience with a modified approach in a patient with severe bleeding after ERCP. Recently, a 52-year-old man was referred to our clinic for further evaluation of obstructive jaundice and weight loss. US examination of the abdomen revealed a 3 × 3 cm mass in the hilus of the liver; the margins could not be distinguished from the gallbladder. On subsequent ERCP, deep cannulation of the common bile duct (CBD) was achieved after a precut sphincterotomy, and the cholangiographic images revealed a stricture in the mid-CBD with dilatation of the proximal biliary tree, which prompted placement of a 10F 10-cm plastic biliary stent. Although the ERCP procedure was otherwise uneventful, the patient experienced melena 12 hours later and required 10 units of packed erythrocytes within 36 hours to maintain a hemoglobin concentration of more than 10 g/dL. Two attempts at hemostasis with use of a duodenoscope failed because the source of the bleeding could not be accurately located, owing to the massive bleeding and to large coagulum covering the duodenal lumen completely. However, endoscopic evidence was highly suggestive of either sphincterotomy bleeding or hemobilia from the identified tumor. The patient was consequently referred for percutaneous transhepatic cholangiography, during which a 10 mm × 80 mm covered self-expandable metallic stent (SEMS) (Wallflex; Boston Scientific, MA) was placed next to the plastic stent, with its distal end slightly protruding into the duodenum through the ampulla of Vater. An external-internal drainage catheter was also placed before conclusion of the procedure (Fig. 1A). This was followed by conventional angiographic evaluation, which confirmed that bleeding was brought under control with no apparent extravasation of injected contrast dye (Fig. 1B). No other bleeding episode was observed during 3 weeks of follow-up. Although successful control of post-ERCP bleeding with endoscopic SEMS placement has been previously reported in the form of case series,2Shah J.N. Marson F. Binmoeller K.F. Temporary self-expandable metal stent placement for treatment of postsphincterotomy bleeding.Gastrointest Endosc. 2010; 72: 1274-1278Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar, 3Itoi T. Yasuda I. Doi S. et al.Endoscopic hemostasis using covered metallic stent placement for uncontrolled postendoscopic sphincterotomy bleeding.Endoscopy. 2011; 43: 369-372Crossref PubMed Scopus (63) Google Scholar Valats et al1Valats J.C. Funakoshi N. Bauret P. et al.Covered self-expandable biliary stents for the treatment of bleeding after ERCP.Gastrointest Endosc. 2013; 78: 183-187Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar underlined the efficacy of this method in controlling hemobilia where the CBD rather than the sphincterotomy was the source of bleeding. Our case demonstrates that percutaneous placement of a SEMS is a viable alternative to the endoscopic approach for the management of bleeding from the CBD or postsphincterotomy bleeding, especially in cases in which endoscopic hemostasisis unachievable because of excessive hemorrhage or inaccessibility to the source of bleeding when conventional hemostatic techniques are used. Covered self-expandable biliary stents for the treatment of bleeding after ERCPGastrointestinal EndoscopyVol. 78Issue 1PreviewBleeding is a recognized adverse event of ERCP, especially when sphincterotomy is performed, and may occur after 2% to 9% of procedures.1 Post-ERCP bleeding may either cease spontaneously or necessitate the use of endoscopic hemostatic techniques, such as epinephrine injection,2 balloon tamponade, electrocoagulation,3,4 argon plasma coagulation,5 or hemoclip placement.6 Most often, bleeding originates from the edges of the sphincterotomy site; however, bleeding may also be consecutive to common bile duct (CBD) wall trauma. Full-Text PDF

OBJECTIVE Hashimoto's thyroiditis (HT) may affect metabolic parameters and increase predisposition to obesity. In this study, we aimed to assess the relationships among serum ghrelin concentrations, metabolic parameters, and thyroid autoimmunity in euthyroid HT patients. METHODS The study included 48 euthyroid HT patients and 41 age- and sex-matched healthy controls. We assessed serum ghrelin, free triiodothyronine (T3), free thyroxine (T4), thyroid-stimulating hormone (TSH), thyroid peroxidase antibody (anti-TPO), thyroglobulin antibody (anti-Tg), fasting blood glucose (FBG), insulin, lipid levels, and homeostasis model assessment insulin resistance (HOMA-IR) in all subjects. RESULTS Sex distribution, mean age, and body mass index (BMI) were similar in HT patients and controls (female/male, 42/6 vs. 33/8, 46.8 ± 14.7 vs. 45 ± 12.5 years, 28.5 ± 6.1 vs. 28.4 ± 4.9 kg/m2, respectively; P>.05 for all). The mean waist circumference (WC) of the HT group was significantly higher than that of the control group (100.6 ± 14.6 vs. 93.2 ± 13.2 cm, P = .015). While FBG, low-density lipoprotein cholesterol (LDL-C), and triglyceride levels in the HT group were significantly higher than in the control group, insulin levels and HOMA-IR were similar. Ghrelin levels were lower in HT patients compared to controls (416.9 ± 224.4 and 689.9 ± 191.6 pg/mL, respectively; P<.001). Ghrelin levels were similar in patients with low and high anti-TPO titers. Negative correlations were observed between ghrelin levels and BMI, WC, and anti-TPO levels. Regression analysis revealed that HT was the most important predictor of ghrelin levels. CONCLUSION Euthyroid HT is associated with a decrease in plasma ghrelin levels. Altered body fat distribution and increased anti-TPO levels do not seem to be directly involved in lower ghrelin levels in euthyroid HT patients.

We read with great interest the report by Fiocca et al1Fiocca F. Salvatori F.M. Fanelli F. et al.Complete transection of the main bile duct: minimally invasive treatment with an endoscopic-radiologic rendezvous.Gastrointest Endosc. 2011; 74: 1393-1398Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar in which the authors described a rendezvous technique for the management of complete transection of the main bile duct. Their account aided us in implementing a modified technique in a 54-year-old woman who had undergone open cholecystectomy for symptomatic cholelithiasis in February 2012, which resulted in major injury to the common hepatic duct. ERCP revealed contrast leakage in the proximal common bile duct (CBD) with no opacification of the intrahepatic bile ducts, findings that raised a suspicion of complete transection of the CBD (Fig. 1). All attempts at advancing a guidewire proximally failed, with the guidewire constantly passing into the intra-abdominal space. A nasobiliary drain was inserted in the intra-abdominal space to drain the contrast material. On a subsequent percutaneous transhepatic cholangiogram, both right and left intrahepatic bile ducts were visualized, with contrast medium leaking into the intra-abdominal space without passing into the CBD (Fig. 2). Several attempts at advancing the guidewire into the CBD via the percutaneous access failed, with the guidewire repeatedly passing intra-abdominally. As described by Fiocca et al in their report, a snare was slowly introduced endoscopically through the papilla and was opened within the intra-abdominal space (Fig. 3). A guidewire introduced via the percutaneous access into the same intra-abdominal space was then “caught” by closing the snare in what could be described as a “lasso” technique. The guidewire was pulled into the duodenum and eventually all the way to the patient’s mouth to provide through-and-through access. This was followed by a 6-mm balloon dilation of the stricture and placement of an internal-external biliary drainage catheter. One month later, the drainage catheter was removed, and biliary plastic stents were inserted.Figure 2Right and left intrahepatic ducts were visualized on a subsequent PTC with no passage of contrast medium into the CBD. Leakage of contrast medium was observed at a level close to the confluence (black arrows).View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Guidewire is inserted via the percutaneous access into the intraabdominal space where it is caught by the snare advanced endoscopically.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Complete transection of the CBD is one of the most frequently encountered biliary injuries, the management of which may be extremely challenging. Such injuries are mostly not amenable to endscopic intervention. The technique described by Fiocca et al offers a minimally invasive alternative, involving insertion of the snare loop into the subhepatic space via percutaneous access with 100% technical success. Our case demonstrates that similar success may be achieved if the snare is advanced endoscopically via the papilla while a guidewire is inserted via the percutaneous access. Complete transection of the main bile duct: minimally invasive treatment with an endoscopic-radiologic rendezvousGastrointestinal EndoscopyVol. 74Issue 6PreviewComplete transection of the common bile duct (CBD) is a dramatic and often extremely difficult-to-repair event after surgery. Abdominal biliary fluid collection or jaundice is the initial symptom, and ERCP is the determinant for diagnosis. Full-Text PDF

ObjectiveWe aimed to determine the risk factors of methicillin-resistant Staphylococcus aureus (MRSA) colonization, and the impact of colonization on MRSA infection to evaluate the necessity of MRSA survey program in intensive care units (ICUs) in Turkey.MethodsThe patients hospitalized in medical and neurosurgical ICUs longer than 24 hr were included into the study. To determine anterior nares MRSA colonization, swabs were taken from each patient in the first 48 hr, and followed by once a week till discharge from ICUs.ResultsDuring the one-year follow-up period, the number of the hospitalized patients who spent more than 24 hr in ICUs was 195 of 372 and 85 of 619 in medical and neurosurgical ICUs, respectively. Totally, 23 out of 280 patients (14 from medical ICU, 9 from neurosurgical ICU) were colonized with MRSA, and 11 out of 23 colonized patients were accepted as ICU-acquired infection. The duration of ICU hospitalization in patients with ICU-acquired MRSA colonization was found to be longer than the noncolonized patients (18 days vs. 8 days, P value < 0.001). The presence of gastrostomy and femoral catheter were determined as risk factors for ICU-acquired MRSA colonization. The percentages of MRSA infection in patients with and without MRSA colonized were 8.6% and 1.1%, respectively (P value: 0.009).ConclusionThe presence of gastrostomy and femoral catheter, and the duration of ICU hospitalization were found to be related with ICU-acquired MRSA colonization. Also, MRSA nares colonization increased the rates of both MRSA infection and ICU hospitalization.

Ozseker, Burak; Shorbagi, Ali; Efe, Cumali; Haznedaroglu, Ibrahim C.; Bayraktar, Yusuf Author Information

Abdominal tuberculosis is a rare infectious disease that can involve the peritoneum and lead to portal vein thrombosis and mimic peritoneal carcinomatosis. We report on a 43-year-old male patient with fatigue and progressive weight loss for two years. Ascites was the only pathologic finding in his physical examination and laboratory findings revealed only a mild anaemia with Ca-125 elevation. The ascitic fluid Adenosine deaminase (ADA) level was also elevated. Computed tomography revealed splenomegaly, a mesenteric mass measuring 3.5 cm and intra-abdominal lymphadenopathies at the hepatic hilum. Oesophagogastroduodenoscopy (EGD) revealed oesophageal varices which was also consistent with portal hypertension. Diagnostic laparotomy and biopsies obtained from the omentum and the lymph nodes revealed acid-fast staining tuberculosis bacilli.

A 20 year-old man presented to our clinic for evaluation of iron deficiency anemia (IDA). He complained of fatigue, weight loss, intermittent abdominal pain and diarrhea. Upper and lower gastrointestinal endoscopic examinations were normal whereas serological markers for Celiac disease were also negative. Evaluation with capsule endoscopy revealed the presence of a tapeworm identified as belonging to the genus Taenia in the proximal third of the small bowel (Figure 1) and healing ulcers (Figure 2) which were also attributed to the parasite. No other lesion that could explain the anemia were found in this patient and he was started on iron replacement therapy with a course of niclosamide. During the follow up, his symptoms were resolved and hemoglobin turned normal levels. Although anemia is not considered a classical finding of infestation with Taenia spp., there are two reports of patients with unexplained refractory IDA in whom treatment of the infestation resulted in resolution of symptoms. The absence of any other lesion to which the anemia could be attributed led us to conclude that the tapeworm was responsible for the IDA in our patient in more ways than one (loss of appetite, interference with nutrient absorption and mucosal ulceration). The patient will of course be followed-up closely with regard to clinical response to treatment. According to international guidelines for the management of obscure gastrointestinal bleeding (including unexplained iron deficiency anemia), capsule endoscopy is indicated after negative upper and lower endoscopic studies. On the other hand, helminths are a recognized cause of anemia, particularly in developing countries where infestation is endemic. Unless patients confess to passing active or passive proglottids in the stool, arriving at a diagnosis may be challenging. In the event of unexplained IDA, empirical anti-helminthic treatment may be warranted for patients living in endemic areas before endeavoring on expensive and perhaps unnecessary investigations. Contributed by