Amyand’s Hernia Complicated With Acute Appendicitis in a Severe Morbidity Obesity Patient

INTRODUCTION: An Amyand’s hernia is a heterogeneous clinical condition defined by the presence of the vermiform appendix within an inguinal hernia sac, which may or may not contain other abdominal contents or pathologic inflammatory changes. Herein we present an exceptionally rare case of an Amyand’s hernia containing a suppurative appendix and omentum on a morbidity obesity patient , in order to improve our understanding of this disease, avoid misdiagnosis and share experience in the treatment. PRESENTATION OF CASE: A 46-year-old morbidity obesity male presented to our Emergency Department complained an acute onset abdominal pain near the right groin and the McBurney point with nausea and fever. The patient was initially diagnosed as acute appendicitis according to the laboratory tests and the clinical presentation. However, after a right groin hernia contained an inflamed appendix showed by the computed tomography scan, the final diagnosis of Amyand’s hernia was supported. Surgical treatment was then performed, and a right groin hernia was found to contain a suppurative appendix and omentum, intraoperatively. An appendectomy was performed, but the hernia was not repaired simultaneously considering the morbidity risks and surgically technical difficulty brought with the severe morbidity obesity. CONCLUSION: With an estimated incidence of only 1%, Amyand’s hernias are rare emergency case, lacking a clear evidence-based management scheme. Moreover, they can contain a diverse range of pathologic features and presentations that can complicate diagnosis and treatment. There is a paucity of reports describing the management of an Amyand’s hernia with appendicitis on morbidity obesity patients. In our case, we shared our surgical experience and the management of Amyand’s hernia on morbidity obesity patient should be tailored to individual’s condition.

Effect of bariatric surgery on circulating and urinary mitochondrial DNA copy numbers in obesity with or without diabetes

IntroductionRecent studies have suggested that extracellular circulating and urinary mitochondrial DNA (mtDNA) are associated with mitochondrial dysfunction in obesity and type 2 diabetes mellitus (T2DM). However, the changes to cell-free serum and urinary mtDNA after bariatric surgery in patients with obesity with T2DM have not been investigated to date.Research design and methodsWe prospectively recruited patients with obesity (n=18), and with obesity and T2DM (n=14) who underwent bariatric surgery, along with healthy volunteers (HV) as a control group (n=22). Serum and urinary mitochondrial nicotinamide adenine dinucleotide dehydrogenase subunit-1 (mtND-1) and cytochrome-c oxidase 3 (mtCOX-3) copy numbers were measured using quantitative PCR (qPCR). The mtDNA copy numbers of patients with obesity (with and without T2DM) were followed up 6 months after surgery.ResultsThe copy numbers of urinary mtND-1 and mtCOX-3 in patients with obesity, with or without T2DM, were higher than those in the HVs. Moreover, urinary mtCOX-3 copy number increased in patients with obesity with T2DM compared with patients with obesity without T2DM (p=0.018). Meanwhile, serum mtCOX-3 copy numbers in HV were higher in both obesity patient groups (p=0.040). Bariatric surgery reduced urinary mtND-1 and mtCOX-3 copy numbers, as well as serum mtCOX-3 copy numbers only in patients with obesity with T2DM.ConclusionThese results suggest that T2DM induces greater kidney mitochondrial dysfunction in patients with obesity, which can be effectively restored with bariatric surgery.

Proteinuria Pasien Diabetes Melitus dan Obesitas Poli Penyakit Dalam RS Ibnu Sina Makassar

Background: The prevalence of diabetes mellitus in the world has increased which is certainly accompanied by a rapid increase in the incidence of its chronic complications like kidney disorders. Insulin resistance, the patophysiology of diabetes mellitus, also associated with obesity, which both are the main risk factors for cardiovascular events. Obesity also known as a risk factor for kidney disease that proved by the presence of proteinuria in obesity patients. Objective: To determine the correlation of obesity with occurrence of proteinuria in patients with type 2 DM in internal medicine polyclinic Ibnu Sina Hospital Makassar. Method: A cross sectional study on 32 type 2 DM patients at Ibnu Sina Hospital as measured by body weight, height and waist circumference. Urinalysis examination is also performed at that time. Results: In this study, there were 4 patients (12,5%) patients with proteinuria (+), 1 patient (3.1%) with proteinuria (++), 2 patients (6.3%) with proteinuria (+++) and 1 patient (3.1%) with proteinuria (++++). According to BMI, we found that 17 patients (53.1%) were overweight, 5 patients (15.6%) were class 1 obesity, no class 2 obesity patient, and 1 patients (3.1%) were class 3 obesity. In Waist circumference examination we found that in normal waist circumference group there is 1 patient that did not has proteinuria while in the abnormal waist circumference group, 8 patients out of 31 patients have proteinuria. After doing statistical analysis to assess the correlation of obesity with proteinuria obtained p value> 0.05. Similarly, the correlation analysis waist circumference with proteinuria obtained p value> 0.05. Conclusion: There is no correlation between obesity and proteinuria as well as waist circumference and proteinuria correlation in type 2 DM patients.