Fracture of an osteochondroma treated successfully with total excision: two case reports

Fracture of an osteochondroma is a rare complication. We report two cases of fractured osteochondroma in two children that were treated successfully with total excision

Ocjena apsorpcije, djelotvornosti protiv bakterije Escherichia coli i citotoksičnosti krutih lipidnih nanočestica s moksifloksacinom

Moxifloxacin (MOX) is an important antibiotic commonly used in the treatment of recurrent Escherichia coli (E. coli) infections. The aim of this study was to investigate its antibacterial efficiency when used with solid lipid nanoparticles (SNLs) and nanostructured lipid carriers (NLCs) as delivery vehicles. For this purpose we designed two SLNs (SLN1 and SLN2) and two NLCs (NLC1 and NLC2) of different characteristics (particle size, size distribution, zeta potential, and encapsulation efficiency) and loaded them with MOX to determine its release, antibacterial activity against E. coli, and their cytotoxicity to the RAW 264.7 monocyte/macrophage-like cell line in vitro. With bacterial uptake of 57.29 %, SLN1 turned out to be significantly more effective than MOX given as standard solution, whereas SLN2, NLC1, and NLC2 formulations with respective bacterial uptakes of 50.74 %, 39.26 %, and 32.79 %, showed similar activity to standard MOX. Cytotoxicity testing did not reveal significant toxicity of nanoparticles, whether MOX-free or MOX-loaded, against RAW 264.7 cells. Our findings may show the way for a development of effective lipid carriers that reduce side effects and increase antibacterial treatment efficacy in view of the growing antibiotic resistance.Moksifloksacin je važan antibiotik koji se često rabi za liječenje rekurentne infekcije bakterijom Escherichia coli (E. coli). Cilj je ovog istraživanja bio ocijeniti njegovu djelotvornost u formulaciji s krutim lipidnim nanočesticama (engl. solid lipid nanoparticles, krat. SNL) i nanostrukturiranim lipidnim nosačima (engl. nanostructured lipid carriers, krat. NLC) kao njegovim vehikulima. U tu smo svrhu osmislili dva SLN-a (SLN1 I SLN2) te dva NLC-a (NLC1 i NLC2) različitih svojstava (veličine čestice, raspodjele veličina, zeta potencijala i sposobnosti enkapsulacije) te ih obogatili moksifloksacinom kako bismo utvrdili njegovo otpuštanje, djelovanje protiv E. coli i citotoksičnost za makrofagnu staničnu liniju RAW 264.7 in vitro. S bakterijskom apsorpcijom od 57,29 %, SLN1 se pokazao značajno djelotvornijim vehikulom moksifloksacina od njegove standardne formulacije (otopine), a formulacije s SLN2, NLC1 odnosno NLC2 s odgovarajućim apsorpcijama od 50,74 %, 39,26 % odnosno 32,79 % iskazale su djelotvornost sličnu onoj standardnog antibiotika. Test citotoksičnosti nije pokazao značajnu toksičnost nanočestica bez obzira na to jesu li sadržavale moksifloksacin ili nisu. Naši rezultati upućuju na mogući smjer razvoja djelotvornih lipidnih nosača kojima bi se mogle smanjiti nuspojave i povećati antibakterijska djelotvornost liječenja s obzirom na sve veću bakterijsku rezistentnost

Phytocontact dermatitis due to Ranunculus arvensis mimicking burn injury: report of three cases and literature review

Ranunculus arvensis (corn buttercup) is a plant species of the genus Ranunculus that is frequently used in the Far East to treat rheumatic diseases and several dermatological disorders. In Turkey, the plant is seen in the eastern and southeastern Anatolian highlands, which are underdeveloped areas of the country. Herein, we report three patients who used Ranunculus arvensis for the treatment of arthralgia and osteoarthritis. A distinctive phytodermatitis developed on the right thumb in one patient (48-year-old male), on the anterior aspect of both knees in another patient (70-year-old female) and all around both knees in a third (59-year-old female). The patients were treated with topical antibiotics and daily wound dressing, and none of them experienced any complications. Ranunculus arvensis was confirmed as the cause of the phytodermatitis in the three cases. Poultices of plants applied to the skin demonstrate beneficial effects on many dermatological and rheumatic diseases; however, they have several adverse effects that should not be ignored. In this study, we also present a review of 25 cases reported in the literature

Design and Additive Manufacturing of a Medical Face Shield for Healthcare Workers Battling Coronavirus (COVID-19)

During the coronavirus disease-19 pandemic, the demand for specific medical equipment such as personal protective equipment has rapidly exceeded the available supply around the world. Specifically, simple medical equipment such as medical gloves, aprons, goggles, surgery masks, and medical face shields have become highly in demand in the health-care sector in the face of this rapidly developing pandemic. This difficult period strengthens the social solidarity to an extent parallel to the escalation of this pandemic. Education and government institutions, commercial and noncommercial organizations and individual homemakers have produced specific medical equipment by means of additive manufacturing (AM) technology, which is the fastest way to create a product, providing their support for urgent demands within the health-care services. Medical face shields have become a popular item to produce, and many design variations and prototypes have been forthcoming. Although AM technology can be used to produce several types of noncommercial equipment, this rapid manufacturing approach is limited by its longer production time as compared to conventional serial/mass production and the high demand. However, most of the individual designer/maker-based face shields are designed with little appreciation of clinical needs and nonergonomic. They also lack of professional product design and are not designed according to AM (Design for AM [DfAM]) principles. Consequently, the production time of up to 4 – 5 h for some products of these designs is needed. Therefore, a lighter, more ergonomic, single frame medical face shield without extra components to assemble would be useful, especially for individual designers/makers and noncommercial producers to increase productivity in a shorter timeframe. In this study, a medical face shield that is competitively lighter, relatively more ergonomic, easy to use, and can be assembled without extra components (such as elastic bands, softening materials, and clips) was designed. The face shield was produced by AM with a relatively shorter production time. Subsequently, finite element analysis-based structural design verification was performed, and a three-dimensional (3D) prototype was produced by an original equipment manufacturer 3D printer (Fused Deposition Modeling). This study demonstrated that an original face shield design with <10 g material usage per single frame was produced in under 45 min of fabrication time. This research also provides a useful product DfAM of simple medical equipment such as face shields through advanced engineering design, simulation, and AM applications as an essential approach to battling coronavirus-like viral pandemics

Porous metal-organic Cu II complex of L-Arginine; synthesis, characterization, hydrogen storage properties and molecular simulation calculations

Cu II -arginine coordination compound was synthesized and characterized by using DSC, DTA, EA, FT-IR, XRD, SEM and EDX analysis techniques and then the hydrogen storage properties were investigated. Hydrogen storage performance of synthesized compound was determined both experimental and theoretically by using Materials Studio which is one of the Molecular simulation software and adsorption measurement equipment. It is found out that the arginine compound uptakes approximately 1.2 wt. % experimentally and 0.8 wt. % theoretically hydrogen in 77K and 100 bars pressure. Also the surface characteristics was calculated and also the possible cites which could uptake hydrogen in a single lattice cell were determined. At the end of this research, in addition to drug and other applications of L-arginine, it is proved that could be used as a part of adsorbent for hydrogen storage application

Effect of Coronal Fracture Angle on the Stability of Screw Fixation in Medial Malleolar Fractures:A Finite Element Analysis

Malleolar screw fixation is the most widely used treatment method for medial malleolar (MM) fractures. Here, although buttress plate fixation is advocated for vertical MM fractures, the angular discrimination between oblique and vertical MM fractures is still not fully understood. The purpose of this study is to test the adequacy of screw fixation in MM fractures with different angles and determination of a ‘critical fracture angle’ to guide surgeons in the decision-making for screw fixation for MM fractures by utilizing an advanced engineering simulation approach. In addition to loading of the healthy tibia structure, various cases of the MM fracture double screw fixation (14 simulation scenarios in total with fracture angles between 30° and 90°, in 5° increments) were considered in this research and their static loading conditions just after fixation operation were simulated through nonlinear (geometric and contact nonlinearity) finite element analysis (FEA). Patient-specific computed tomography scan data, parametric three-dimensional solid modelling and finite element method (FEM) based engineering codes were employed in order to simulate the fixation scenarios. Visual and numerical outputs for the deformation and stress distributions, separation and sliding behaviours of the MM fracture fragments of various screw fixations were clearly exhibited through FEA results. Minimum and maximum separation distances (gap) of 3.75 and 150.34 µm between fracture fragments at fracture angles of 30° and 90° were calculated respectively against minimum and maximum sliding distances of 25.87 and 41.37 µm between fracture fragments at fracture angles of 90° and 35°, respectively. The FEA results revealed that while the separation distance was increasing, the sliding distance was decreasing and there were no distinct differences in sliding distances in the scenarios from fracture angles of 30°–90°. The limitations and errors in a FEA study are inevitable, however, it was interpreted that the FEA scenarios were setup in this study by utilizing acceptable assumptions providing logical outputs under pre-defined boundary conditions. Finally, the fracture healing threshold for separation and/or sliding distance between fracture fragments was assigned as 100 µm by referring to previous literature and it was concluded that the screws fixed perpendicular to the fracture in a MM fracture with more than 70° angle with the tibial plafond results in a significant articular separation (>100 µm) during single-leg stand. Below this critical angle of 70°, two screws provide sufficient fixation

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication