The shock index is a good tool to identify patients with the potential for short-term adverse outcomes when they present with UGIB. It performs as well as other risk-scoring tools for GI bleeding and has the potential for serial use during hospitalization to identify changes in the clinical course.

No abstract

Background: Gentamicin has been increasingly used instead of cephalosporins for surgical prophylaxis in an attempt to reduce the rate of "Clostridium difficile" infection. There are limited data regarding nephrotoxicity related to gentamicin in these patients. Methods:We have conducted a systematic review and meta-analysis to evaluate the risk of acute kidney injury (AKI) in gentamicin-containing surgical prophylactic regimens, compared to regimens without gentamicin, in several types of surgery. Electronic searches were performed using PubMed and Embase, including terms for "AKI, gentamicin, and surgical prophylaxis" with and without MeSH/EMTREE functions. Statistical analysis was then performed using a random-effect model; risk ratios (RR), risk differences (RD) and heterogeneity (I 2 ) were calculated. Funnel plot was used for assessment of publication bias.Results: Eleven studies with fifteen cohorts with 18,354 patients were included in the analysis. Subgroup analysis was performed according to surgery type. We have found that antibiotic prophylaxis with gentamicin containing regimen has significant risk for developing postoperative AKI in orthopedic surgery (RR 2.99; 95% CI: 1.84, 4.88). The results were inconclusive in other types of surgery. Funnel plot indicates potential publication bias.Conclusions: Gentamicin-induced AKI is significant in patients undergoing orthopedic surgery.Physicians should consider risks and benefits of using this regimen in individual patients.

Primary non-Hodgkin lymphomas in the esophagus are rare. Tracheoesophageal fistulas mainly arise from solid esophageal carcinoma or mediastinal malignancies. Our patient presented with cough, dysphagia and weight loss, and upon initial computed tomography imaging and esophagogastroduodenoscopy, a malignant mass in the middle third of esophagus with tracheoesophageal fistula was found. The location of the mass and presence of malignant tracheoesophageal fistula were strongly suggestive of squamous cell carcinoma. However, tumor biopsy revealed diffuse large B-cell lymphoma. This case report details a rare incident of a primary diffuse large B-cell lymphoma presented as tracheoesophageal fistula and reviews previous literature.

A literature search was performed through May 2017. Studies that compared the risk of developing Clostridium difficile infection (CDI) and/or the clinical outcomes of CDI in patients who received statin treatment versus those who did not receive statins were included. Ten observational studies with 37,109 patients were included. Compared to no treatment, statins reduced the risk of CDI development (odds ratio [OR] ¼ 0.66, 95% confidence interval [CI], 0.44-0.99). However, among patients who developed CDI, the use of statins did not significantly reduce recurrent CDI risk (OR ¼ 0.69, 95% CI, 0.28-1.71) or 30-day mortality (OR ¼ 0.77, 95% CI, 0.51-1.14). In conclusion, our study demonstrates a significant association between statin use and a reduced risk of CDI development. However, the findings of our study suggest no significant associations between statin use and improvement in clinical outcomes of CDI. These findings might impact the clinical management and primary prevention of CDI. KEYWORDS Clostridium difficile diarrhea; Clostridium; infectious diarrhea; meta-analysis; nosocomial diarrhea; statins C lostridium difficile is one of the most common pathogens in infectious nosocomial diarrhea. 1 Many studies in the last decade have reported an increasing number of C. difficile infections (CDIs). 2,3 The reported case fatality rates of CDIs are 6% to 30% and have been rising recently. 4,5 The infection increases not only patient mortality but also health care expenditures and length of hospital stay. 2,[6][7][8] Some drugs, such as antibiotics or proton pump inhibitors, can increase the risk for these infections. 9 Recent observational studies also suggest an effect of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) on the risk of CDI development. To investigate this association further, we performed a meta-analysis to determine the risk and clinical outcomes of CDI in patients who receive statin therapy and in patients not on statin therapy.

No abstract

No abstract

No abstract