Crimean-Congo hemorrhagic fever: epidemiological trends and controversies in treatment

Crimean-Congo hemorrhagic fever (CCHF) virus has the widest geographic range of all tick-borne viruses and is endemic in more than 30 countries in Eurasia and Africa. Over the past decade, new foci have emerged or re-emerged in the Balkans and neighboring areas. Here we discuss the factors influencing CCHF incidence and focus on the main issue of the use of ribavirin for treating this infection. Given the dynamics of CCHF emergence in the past decade, development of new anti-viral drugs and a vaccine is urgently needed to treat and prevent this acute, life-threatening disease

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

GEOCHEMICAL CHARACTERISTICS OF THE RECENT SEDIMENTS FROM THE SEA OF MARMARA

Six box-cores, one boomerang core and one hundred sixty-six surface sediment samples recovered in the Sea of Marmara were analyzed in an attempt to establish the main controls on distribution and origin of trace metals within the oxic to suboxic basin of this sea

DISTRIBUTION OF SURFICIAL SHELF SEDIMENTS IN THE NORTHEASTERN AND SOUTHWESTERN PARTS OF THE SEA OF MARMARA - STRAIT AND CANYON REGIMES OF THE DARDANELLES AND BOSPORUS

Surficial sediment samples collected from the northeastern and southwestern shelf regions of the Sea of Marmara, together with data available from other sources, indicate marked variations in sediment compositions resulting from differences in topographical, hydrological and biological conditions. In the strait channels of the Dardanelles and Bosporus, where strong undercurrents prevail, the floor was covered mostly by coarse-grained sediments (rich in sand and gravel). However, in areas of relatively low energy conditions, sediments contained appreciable amounts of mud, with a tendency towards an increase in the amount of clay towards the open sea. The effects of the strong undercurrents on the bedforms was also apparent in the southern Strait of Bosporus where sidescan sonar surveys revealed the presence of asymmetrical sand ripples. Although terrigenous mud is the principal sediment type in the two canyons (Dardanelles and South Bosporus), the sediments, in particular on the floor of South Bosporus Canyon, show a distinct contrast between the inner N-S and outer E-W trending parts: along its axis, where depths are greatest, the outer part of the canyon appears to contain much more coarse sediment (in part derived from the benthic communities) than the inner canyon. In general, both the topography-related current regimes and the biological activities in the study areas mostly determine the types and modes of sediment distribution. Among the biogenic components, the calcareous corraline algae Rhodophycae (chiefly Lithothamnium calcareum and L.fruticolusum) and the molusc families Galeommatacae and Cerithiospidae are associated with the prevailing Mediterranean undercurrents, especially in the shallower waters of the junction of the Sea of Marmara and Strait of Bosporus. The relatively abundant mollusc species Mytilus galloprovincialis and Modiolus barbatus and the Trochidae in the Strait of Bosporus are largely affected by Black Sea waters. The wide range of carbonate concentrations in the sediments generally reflects the relative abundances of biogenic admixtures in the samples. High carbonate percentages in the sediments are usually associated with low mud contents, and vice versa. Interestingly, the organic carbon contents of the sediments generally increase with proximity to the Black Sea, suggesting influxes of appreciable amounts of organic matter from the Black Sea

ORGANIC-CARBON DISTRIBUTION IN THE SURFACE SEDIMENTS OF THE SEA-OF-MARMARA AND ITS CONTROL BY THE INFLOWS FROM ADJACENT WATER MASSES

The organic carbon contents and textural composition of a total of 166 surficial sediment samples (from 10 to 1226 m water depths) together with data on primary productivity rates and dissolved oxygen concentrations have been studied to investigate the main controls on the distribution of organic carbon buried within the modern sediments across the Sea of Marmara

concrete against seawater attack

The aim of this research work is to investigate the seawater resistance of the concrete incorporating ground blast furnace slag (GBS) and ground basaltic pumice (GBP) each separately or both together. The variable investigated in this study is the level of fine aggregate replacement by GBS and GBP. Compressive strength measured on 150 mm cubes was used to assess the changes in the mechanical properties of concrete specimens exposed to seawater attack for 3 years.Differential scanning calorimeter was used to evaluate the microstructure of the specimens under seawater attack. The effects of exposure were determined by direct measurement of the mass loss of steel bars, embedded in the mortar after 1, 2 and 3 years. The abrasion of concrete was also determined according to mass loss of specimens.The test results showed that the presence of GBS and GBP had a beneficial effect on the compressive strength loss due to seawater attack and abrasion value. The results create perspectives of forecasting the durability of concrete depending on the types and amount of additives. Furthermore, specimen CSP80 was found to have higher seawater attack resistance than that of the reference concrete. This improvement can be explained partly by the decrease in the permeability of the specimen and partly by the seawater resistance of the additives. Additionally, the corrosion percentage obtained in the reference specimen was higher than all other specimens. (C) 2007 Elsevier Ltd. All rights reserved

slag and ground basaltic pumice

In this research work, an attempt has been made to find the suitability of the ground blast-furnace slag (GBS) and ground basaltic pumice (GBP) as a possible substitute for conventional crushed fine aggregate. The main purpose of this investigation is to determine the hydro-abrasive erosion (HAE) characteristics of concrete with GBS and GBP as fine aggregates.The results create perspectives of forecasting HAE of concrete structures depending on the types and amount of additives. It was found that the HAE characteristics of concrete had improved when some of the fine aggregates were replaced by GBS and GBP. As the amount of these additives increased, the mass loss of the concrete incorporating GBS + GBP decreased. This improvement can be explained partly by the decrease in the permeability and partly by the HAE resistance of the additives. In addition to these results, the HAE of concrete was strongly influenced by its compressive strength. Furthermore, the increase in the percentage of additives increased the chloride penetration depths, sharply. The results of this investigation suggest that a joint incorporation of GBS and GBP could conveniently be used to improve its HAE characteristics of concrete. (C) 2008 Elsevier Ltd. All rights reserved