A rare case of pituitary macroadenoma with synchronous suprasellar meningioma.: Case report, surgical strategy and review of literature

Synchronous tumours can be found all along the entire neuraxis, however, some lesions are far less likely to coexist. One of these extremely rare associations is between GH-pituitary adenomas and suprasellar meningiomas. A wide spectrum of transcranial and transsphenoidal approaches were described in the literature for either sellar, suprasellar and parasellar lesions, but no agreement has been reached for the cases of simultaneous occurring lesions. We present a rare case of a woman with GH-secreting pituitary adenoma and concomitant suprasellar meningioma. The strategy chosen was sequential transsphenoidal surgeries. However, after the first surgery, the remaining tumour mass did not mobilize as expected due to gravity, hence we decided to perform a transcranial subfrontal unilateral approach. Surprisingly, the second surgery revealed a different histopathological result. Association of a GH-pituitary adenoma and suprasellar meningioma is very rare, only 17 cases being reported in the relevant literature so far.  Different authors prefer different strategies, ranging from only transsphenoidal to simultaneous transsphenoidal and transcranial approaches, but no general consensus was established. In conclusion, the existence of synchronous tumours of the sellar region should be taken into account when imaging studies reveal an intracranial mass developing both sellar and suprasellar. The surgical strategy should be tailored to every specific patient and experience of the neurosurgeon

Presentation, management and outcomes of pituitary adenomas: A 10-year experience from a single tertiary neurosurgery centre

Introduction: One of the most frequently encountered intracranial tumours are the pituitary adenomas, these accounting for 5% to 20%. Therapeutic strategies vary largely, from medical therapy to complex neurosurgical procedures. The transsphenoidal approach can solve most of the lesions of the pituitary area, as long as the invasion of the adjacent structures is not significant. The transcranial approach is indicated in tumours with extensive invasion Materials and methods: We performed a retrospective study in the Bagdasar-Arseni Emergency Hospital Neurosurgery that aimed to analyze the demographics, signs and symptoms, therapeutic strategy, surgical approach, complications, and histopathology, from 2010 to 2019. Results: The total number of hospitalization records, including the follow-up hospitalization and/or second surgery hospitalization, was of 1107. Furthermore, there were 704 unique patients. The most common signs and symptoms encountered for the first admission were headache (245 – 34.56%), optic chiasm deficits (153 – 21.58%), acromegaly (85 – 11.99%). However, the majority of patients (507 – 71.51%) presented with some sort of hormonal imbalance or diabetes insipidus. On the one hand, a number of 325 (45.84%) patients had non-surgical treatment. On the other hand, a total of 384 (54.16%) surgeries for pituitary tumours were performed in this period. Discussion: In our study, the patients who underwent surgery benefited from either microsurgical transsphenoidal or transcranial surgeries. Even if the transsphenoidal approach was used far more, there was a greater relapse proportion in these patients. Transcranial surgery, even if followed by a far less proportion of relapse surgery, carried with it the burden of more days spent in hospital (most of the time twice as much as for the transsphenoidal patients). Conclusion: Both transsphenoidal and transcranial approaches have advantages and disadvantages, thus the best strategy would be to tailor each surgery to each patient, keeping an open mind to all available approaches

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

Software tool for passive real-time measurement of QoS parameters

The paper presents the designing of a software tool for real-time measurement of the following quality of service parameters: one-way delay, average one-way delay, IP packet delay variation and average IP packet delay variation. The solution is an improved version of OreNETa (One-way delay REaltime NETwork Analyzer), by optimizing the traffic between the meter and the analyzer. When a new flow is detected, the meter assemblies a flow descriptor and sends it to the analyzer. Following the flow recording, it will announce the meter to send a shorter message, called header, for all the packets belonging to the newly registered flow

Software tool for passive real-time measurement of QoS parameters

The paper presents the designing of a software tool for real-time measurement of the following quality of service parameters: one-way delay, average one-way delay, IP packet delay variation and average IP packet delay variation. The solution is an improved version of OreNETa (One-way delay REaltime NETwork Analyzer), by optimizing the traffic between the meter and the analyzer. When a new flow is detected, the meter assemblies a flow descriptor and sends it to the analyzer. Following the flow recording, it will announce the meter to send a shorter message, called header, for all the packets belonging to the newly registered flow.Postprint (published version

Software tool for passive real-time measurement of QoS parameters

The paper presents the designing of a software tool for real-time measurement of the following quality of service parameters: one-way delay, average one-way delay, IP packet delay variation and average IP packet delay variation. The solution is an improved version of OreNETa (One-way delay REaltime NETwork Analyzer), by optimizing the traffic between the meter and the analyzer. When a new flow is detected, the meter assemblies a flow descriptor and sends it to the analyzer. Following the flow recording, it will announce the meter to send a shorter message, called header, for all the packets belonging to the newly registered flow

The Impact of the COVID-19 Pandemic on Dentistry and Dental Education: A Narrative Review

Dentists and dental staff have an increased risk of airborne infection with pathogens such as SARS-CoV-2 since they are exposed to high levels of droplets and aerosols produced during specific dental procedures. Hence, new guidelines such as patient screening and temperature control, air purification, space, surface and hand sanitizing and the use of protective equipment and physical barriers have been successfully implemented. In addition, the use of teledentistry has expanded considerably in pediatric dentistry, orthodontics, oral medicine and periodontics in order to address oral and dental health issues during the COVID-19 pandemic while minimizing virus transmission. Thus, teleconsultation, telediagnosis, teletriage, teletreatment and telemonitoring have emerged as valuable tools not only in the delivery of care, but also in the academic and research training of dental health professionals. This narrative review summarizes the current literature on the impact of the pandemic on dental care, dental staff and dental education, with an emphasis on how newly emerging protocols and technologies can be successfully utilized as integral parts of various branches of the dental practice and their future implications without compromising patient care

Thermal Evaluation of an Innovative Type of Unglazed Solar Collector for Air Preheating

International audiencePerforated solar walls pre-heat the fresh air introduced in the building when the air is forced to pass through this solar heated perforated facade. The heat transfer between the fluid and the metal is intensified depending especially on the flow's characteristics. An experimental campaign on an innovative solar collector was performed in the laboratory of Building Services from Technical University of Civil Engineering Bucharest. The solar collector with lobed perforations was analyzed and the results indicated that the system can attain a high thermal performance, but only for a certain range of airflow rate

Cercetari multidimensionale in stiintele umaniste/ Multidimensional Research in Human Science (Romanian Version)

Summary: Liberalism and Diversity: Costel DUMBRAVA Corneliu Coposu and PNTCD: Cristina COSTANDACHE Models of Universe: Antonio SANDU You Are on the Internet, That Means You Exist: Ionut SOCOL No. pg. 169, B5 JIS formatCorneliu Coposu and PNTCD, Internet,Liberalism and Diversity