Endoscopic removal of a toothpick perforating the sigmoid colon and causing chronic abdominal pain: a case report

Toothpick ingestion is implicated in gut injuries which may cause severe complications, mimicking diseases causing acute abdomen. However, toothpick ingestion-related perforation may also cause mild, non-specific gastrointestinal symptoms without significant findings or major complications. We describe a young male with chronic postprandial lower abdominal pain caused by a toothpick impaction at the rectosigmoid junction after inadvertent ingestion. The foreign body was detected and successfully removed during flexible sigmoidoscopy. Perforation due to foreign body ingestion must be considered in the differential diagnosis in patients presenting with unexplained symptoms and findings, even when they do not recall any foreign body ingestion

Socioeconomic Crisis and Incidence of Acute Myocardial Infarction in Messinia, Greece

In the last 5 years Greece is facing the worst socioeconomic crisis since the end of the Second World War. The purpose of the current study was to gather all the incident cases of acute myocardial infarction (AMI) that were hospitalized in the General Hospital of Kalamata during the last 10 years. Our results suggest that the prolonged financial crisis may have led to a higher incidence of AMI in the population of Messinia, Greece

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Optimization of the signal to noise ratio in localized in vivo magnetic resonance spectroscopy, and of the accuracy of the simultaneous quantitative determination of the hepatic fat infiltration and iron concentration

The doctoral thesis comprises two main research topics. The first one involved the optimization of the signal to noise ratio (per unit time), in localized in vivo magnetic resonance spectroscopy, for SVS (single voxel spectroscopy) spectroscopic techniques. The second one was about the simultaneous quantitative specification of the fat infiltration and the iron concentration of the liver. Furthermore, a model was developed, along with the appropriate signal equation, treating the water protons and the fat protons as distinct entities. This was compared statistically with other methods most commonly used for the determination of these parameters (fat infiltration and hepatic iron concentration).Στο πρώτο ερευνητικό κομμάτι, διερευνήθηκε η βελτιστοποίηση του λόγου σήματος προς θόρυβο στην εντοπισμένη in vivo μαγνητική φασματοσκοπία πρωτονίων, σε φασματοσκοπικές τεχνικές τύπου SVS (single voxel spectroscopy). Στην δεύτερη ερευνητική συνιστώσα της διατριβής, διερευνήθηκε το ζήτημα του ταυτόχρονου ποσοτικού προσδιορισμού της λιπώδους διήθησης και της εναπόθεσης σιδήρου στο ήπαρ, αναπτύχθηκε ένα περιγραφικό μοντέλο με την αντίστοιχη εξίσωση σήματος, θεωρώντας ξεχωριστά τα πρωτόνια του νερού και του λίπους και συγκρίθηκε στατιστικά με άλλες συχνά χρησιμοποιούμενες μεθόδους προσδιορισμού των ίδιων παραμέτρων

Robotics-enabled roadwork maintenance and upgrading

Closing, this chapter presents recent research efforts and results on a Robotics-enabled Roadwork Maintenance and Upgrading approach and tools. This includes the implementation of a road infrastructure blueprint developed including advanced engineering solutions for interconnecting and facilitating seamless transitions between different transportation modes in the event of severe disruptions affecting one mode of transportation

A novel role for natural science collections in European contaminant monitoring

International audienceIntegration of the world’s natural history collections can provide a resource for decision-maker

Correction to: Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

International audienceIn this article, the name of the GLORIA-AF investigator Anastasios Kollias was given incorrectly as Athanasios Kollias in the Acknowledgements. The original article has been corrected

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II-III (November 2011-December 2014 for Phase II, and January 2014-December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22-0.25] and 0.66 [0.61-0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67-1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76-0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH