Traumatic Optic Neuropathy and Central Retinal Artery Occlusion Following Blunt Ocular Trauma

We present a case as a rare sign of traumatic optic neuropathy and central retinal artery occlusion following blunt ocular trauma. A 10-year-old child suffered complete loss of the vision of one eye following a blunt ocular injury. He sustained an occlusion of the central retinal artery and traumatic optic neurupathy of the affected eye. Isolated cases of central retinal vessel occlusions and traumatic optic neurapathy following ocular blunt trauma are rare conditions. Clinicians to be aware of the potential for blunt ocular trauma to cause optic nerve damage and retinal vessel occlusions

Is Cyclic Exercise Performed before Tibial Fixation Effective on Grafts during Anterior Cruciate Ligament Reconstruction?

Objectives: The necessity of cyclic exercise to pre-stretch the autograft before tibial fixation during ACL reconstruction is unknown. In this study, we evaluated whether there was a statistically significant difference between the results of patients whounderwent cyclic exercise by way of physical examinations, knee joint stability tests, and functional evaluation tests, comparedwith the patients who underwent ACL reconstructions with or without cyclic exercise.Methods: Between March 2016 and May 2018, 59 patients with at least eight months’ follow-up of an ACL reconstruction wereidentified. Thirty patients (Group 1) who underwent cyclic exercise before tibial fixation and 29 patients (Group 2) who did notundergo cyclic exercise were evaluated and compared.Results: The mean age of the patients in Group 1 and Group 2 was 25.9 (range, 18-36) years and 25.2 (range, 18-35) years, respectively. The mean follow-up period in Group 1 was 14.6 (range, 8-22) months and 13.5 months in Group 2 (range, 8-21 months).The mean Lysholm scores of Group 1 and 2 were 95.1 (range, 83-100) and 87.1 (range, 78-100), respectively. The modified Cincinnati scores of Groups 1 and 2 were 28.7 (range, 24-30) and 26.2 (range, 21-30). The mean IKDC subjective knee evaluation scoresin Groups 1 and 2 were 91.9 (range, 83-100) and 86.7 (range, 75-100). The mean thigh atrophy was 1.5 cm in Group 1 and 2.5 cm inGroup 2. In Group 1, 23 patients jumped 85% of the distance compared with the intact side in the single-legged hop test, and 12patients in Group 2 were able to hop this distance successfully.Group 1 had statistically significantly better results in Lysholm activity scores, modified Cincinnati scores, IKDC subjective kneeassessment scores, two-time IKDC activity scale results, comparison of thigh diameters, and single-legged hop tests (p<0.05). Nosignificant difference was found in other examinations and tests.Conclusion: Cyclic exercise during the operation had a positive effect on functional scores. We believe that cyclic exercise shouldbe added to the operative procedur

THE EFFECT OF CHRONIC KIDNEY DISEASE IN PATIENTS WITH SPONTANEOUS SPONDYLODISCITIS

Objective: Spontaneous spondylodiscitis is a rare but serious infectious disease of the vertebral column that can lead to permanent neurological deficits. We investigated the differences during follow-up of this pathology, which is more common in patients undergoing hemodialysis (HD) treatment for chronic kidney disease (CKD), compared with the general population. Materials and Methods: The data of patients who were treated for spontaneous spondylodiscitis between 2016-2021 at the Başkent University Department of Neurosurgery were used retrospectively. The patients were divided into 2 groups according to the diagnosis of CKD. Demographic data of the patients, biochemical values at the time of diagnosis (C-reactive protein, sedimentation, leukocyte, lymphocyte), microbiological and pathological examination results, and treatment method (surgical, medical) applied after diagnosis was obtained from the medical records. The effects of CKD presence and treatment methods on patient survival were investigated. Results: Of the 49 patients included in the study, 57.1% were female and the mean age was 66 years. Twenty-four of the patients were chronic HD patients. The microbiological examination of the samples taken determined that the causative pathogen could be produced in the cultures of 21 (42.8%) patients. According to the results of the pathological examination, signs of infection were detected in 24 (48.9%) patients. It was determined that 27 of the patients were operated. There was a central venous catheter in 20 of the patients. There was no statistically significant difference in survival between the groups that were operated on for instability and those that were not operated on. However, chronic renal failure and the presence of central venous catheters increased mortality statistically significantly. Conclusion: In the presence of back pain in chronic HD patients, spondylodiscitis should be suspected and diagnosed at an early stage, even if there is no fever or high infection parameters. Finally, great emphasis on disinfection procedures and aseptic techniques in patients with central venous catheters protected from these serious infectious complications

Amyloid Goiter Associated with Amyloidosis Secondary to Rheumatoid Arthritis

Amyloidosis refers to a variety of conditions in which amyloid proteins are abnormally deposited in organs and/or tissues. The most common forms of systemic amyloidosis are primary amyloidosis (PA) of light chains and secondary amyloidosis (SA) caused by chronic inflammatory diseases such as rheumatoid arthritis (RA). Although involvement of the thyroid gland by amyloid is a relatively common phenomenon, clinically significant enlargement of the thyroid owing to amyloid deposition is a rare occurrence. In SA, the deposition of amyloid associated (AA) protein is associated with atrophy of thyroid follicles. The clinical picture of these patients is characterized by rapid, painless thyroid gland enlargement which may be associated with dysphagia, dyspnea, or hoarseness. Thyroid function is not impaired in most cases. Although amyloid goitre secondary to systemic amyloidosis due to chronic inflammatory diseases is relatively common, specifically related to RA is much more uncommon one and it is reported less in the literature. In this report, A 52-old-year female patient with amyloid goiter associated with amyloidosis secondary to rheumatoid arthritis is presented

Kâğıt geri dönüşümünde enzim ve ultrasonik enerji kullanımı

Medeniyetin kurulmasında, bilgi depolama ve aktarımında tartısmasız bir yeri olan kâğıt, günümüzde artık çok çesitli amaçlar için hayatın her kademesinde yer almakta, giderek tüketimi inanılmaz boyutlara ulasmaktadır. Kâğıt sektöründe hammadde problemine çözüm için, sürdürülebilir ormancılık çalısmalarından daha ziyade, sürdürülebilir geri dönüsüm teknolojilerini gelistirmek gerekmektedir. Bu anlamda atık sınıfına giren kâğıtın, lifler dısında bulunan bütün bilesenlerini en ekonomik ve çevreci metotlarla ayırmak son derece önemlidir. Bu çalısmada, toner baskılı ofis kâğıtlarının mürekkep ve kirliliklerinden arındırılmasında enzim ve ultrasonik enerji kullanımı konusunda elde edilen bazı sonuçlar tartısılmıs ve geri dönüsüm açısından kâğıt sektörü çevresel açıdan irdelenmistir.Paper has undeniable key roles in establishing civilization, archiving and transferring knowledge. Paper is in all parts of daily life for different purposes today and its consumption is getting at unbelievable level. For solving the problems related to insufficient raw materials, the sustainable recycling technologies should be developed rather than concentrating on sustainable forestry practices. In this sense, extracting all materials from waste papers with economical and environmentally friendly methods are extremely important. In this study, some results obtained from an experimental study carried out on the deinking of toner printed office papers with the help of enzymes and ultrasonic energy were discussed and paper industry was examined in respect to recycling and environment

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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely