Neobična etiologija infarkta miokarda tipa 2: pregled temeljen na prikazu slučaja

Organophosphate pesticide (OP) poisoning is quite common and can cause cardiovascular complications and even direct myocardial injury. However, no guideline has included an acute poisoning as a potential cause for a type 2 myocardial infarction (MI) so far. Here we present a case of a 61-year-old woman brought by ambulance to emergency department one hour after accidental ingestion of an unknown quantity of a solution she used against flea infestation. The patient presented with dizziness, myosis, excessive sweating, hypersalivation, sphincteric incontinence, muscle fasciculation, tremor of the extremities, pale skin, alcoholic and pesticide breath odour. Even though we had no guidelines to fall back on, we successfully treated the patient with low-molecular-weight heparin, antiplatelets, statin, diltiazem, antidote therapy, and supportive care. Physicians should be aware that OP poisoning can induce type 2 MI as a complication within a few hours since exposure, and emergency management should always include close cardiac monitoring.Otrovanje organofosfatnim pesticidima prilično je često i može dovesti do komplikacija sa srcem i krvožiljem, a ponekad i izravno oštetiti srčani mišić. Do sada, međutim, nije zabilježen slučaj infarkta miokarda tipa 2. U ovom je radu prikazan slučaj otrovanja 61-godišnjakinje koja je primljena u odjel hitne pomoći jedan sat nakon slučajnoga gutanja nepoznate količine otopine koju je upotrebljavala za suzbijanje biljnih uši. Bolesnica je primljena sa znakovima i simptomima ošamućenosti, mioze, prekomjernoga znojenja, hipersalivacije, urinarne inkontinencije, mišićne fascikulacije, drhtavice u udovima, bljedilom te dahom koji je mirisao na alkohol i pesticide. Premda nije bilo smjernica za liječenje u takvom slučaju, primjena heparina niske molekulske mase, antitrombotika, statina, diltiazema, antidota i potpornoga liječenja dovela je do povoljnog ishoda. Svrha je ovoga prikaza ukazati liječnicima da otrovanje organofosfatima može uzrokovati infarkt miokarda tipa 2, koji se javlja kao komplikacija unutar nekoliko sati od otrovanja, tako da obrada u odjelu hitne pomoći svakako treba obuhvatiti i strogi nadzor srčane funkcije

Breast cancer detection based on simplified deep learning technique with histopathological image using BreaKHis database

Presented here are the results of an investigation conducted to determine the effectiveness of deep learning (DL)-based systems utilizing the power of transfer learning for detecting breast cancer in histopathological images. It is shown that DL models that are not specifically developed for breast cancer detection can be trained using transfer learning to effectively detect breast cancer in histopathological images. The outcome of the analysis enables the selection of the best DL architecture for detecting cancer with high accuracy. This should facilitate pathologists to achieve early diagnoses of breast cancer and administer appropriate treatment to the patient. The experimental work here used the BreaKHis database consisting of 7909 histopathological pictures from 82 clinical breast cancer patients. The strategy presented for DL training uses various image processing techniques for extracting various feature patterns. This is followed by applying transfer learning techniques in the deep convolutional networks like ResNet, ResNeXt, SENet, Dual Path Net, DenseNet, NASNet, and Wide ResNet. Comparison with recent literature shows that ResNext-50, ResNext-101, DPN131, DenseNet-169 and NASNet-A provide an accuracy of 99.8%, 99.5%, 99.675%, 99.725%, and 99.4%, respectively, and outperform previous studies

Charming and bewitching : considering the Harry Potter series

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Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

Addictive and wonderful : the experience of reading the Harry Potter series

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Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Type 1 Diabetes Mellitus and Bariatric Surgery: A Systematic Review and Meta-Analysis

Type 1 diabetes mellitus (T1DM) has a rising global prevalence. Although it is vastly outnumbered by type 2 diabetes mellitus rates, it remains a persistent worldwide source of morbidity and mortality. Increasingly, its sufferers are afflicted by obesity and its complications. The objective of the study is to quantify the effects of bariatric surgery on T1DM by appraising the primary outcomes of glycosylated haemoglobin (HbA1c), insulin requirements and body mass index (BMI). Secondary outcomes included blood pressure, triglycerides and cholesterol biochemistry. A systematic review of studies reporting pre-operative and post-operative outcomes in T1DM patients undergoing bariatric surgery was done. Data were meta-analysed using random effects modelling. Subgroup analysis and quality scoring were assessed. Bariatric surgery in obese T1DM patients is associated with a significant reduction in insulin requirement (-48.95 units, 95 % CI of -56.27, -41.62), insulin requirement per kilogramme (-0.391, 95 % CI of -0.51, -0.27), HbA1c (-0.933, 95 % CI of -1.604, -0.262) and BMI (-11.04 kg/m(2), 95 % CI of -13.49, -8.59). Surgery is also associated with a statistically significant reduction in systolic and diastolic blood pressure and a significant beneficial rise in HDL. Heterogeneity in these results was high, and study quality was low overall. Bariatric surgery in obese T1DM patients is associated with a significant improvement in insulin requirement and a significant though modest effect on HbA1c. These early results require further substantiation with future studies focusing on higher levels of evidence. This may offer a deeper understanding of diabetogenesis and can contribute to better selection and stratification of diabetic patients for metabolic surgery and future metabolic treatment strategies

Key issues in North-western Mediterranean dry grassland restoration

International audienceDry grasslands of the North‐western Mediterranean Basin are semi‐natural species‐rich ecosystems, composed of many annual species and some structuring perennial species. As these grasslands have been used as rangelands for centuries, human management (grazing; fire regimes) is one of their main ecological and evolutionary drivers, along with the Mediterranean climate. Despite EU conservation policy, damage to such grasslands still occurs and efficient ecological restoration is needed. This paper reviews restoration constraints, effective techniques, and research perspectives for restoring them in the light of their ecological characteristics. Major restoration constraints specifically include i) a poor contribution of the internal (seed bank) and external (seed rain) species pools, and ii) low establishment. The latter may be the result of the low seed quantity or quality of perennial species, stochastic or extended droughts, high soil nutrient content that may lead to competition (e.g. between weed and target species), inappropriate grazing management or fire regimes leading to shrub encroachment, or the death of target species seedlings in early stages of restoration. Successful restoration techniques include seeding, transplanting, hay transfer and timely soil transfer, all of which have to be adapted to regional plant phenology and to local Mediterranean climate. They must be combined with appropriate grazing or fire management. Their success may depend on years with particular rainfall amounts or patterns or on particular target plant species. We discuss research perspectives contributing to a better understanding of seed dispersal, seedling recruitment and soil processes and suggesting the benefits of using ecosystem engineer species

Intraoperative transfusion practices in Europe

Transfusion of allogeneic blood influences outcome after surgery. Despite widespread availability of transfusion guidelines, transfusion practices might vary among physicians, departments, hospitals and countries. Our aim was to determine the amount of packed red blood cells (pRBC) and blood products transfused intraoperatively, and to describe factors determining transfusion throughout Europe. We did a prospective observational cohort study enrolling 5803 patients in 126 European centres that received at least one pRBC unit intraoperatively, during a continuous three month period in 2013. The overall intraoperative transfusion rate was 1.8%; 59% of transfusions were at least partially initiated as a result of a physiological transfusion trigger- mostly because of hypotension (55.4%) and/or tachycardia (30.7%). Haemoglobin (Hb)- based transfusion trigger alone initiated only 8.5% of transfusions. The Hb concentration [mean (sd)] just before transfusion was 8.1 (1.7) g dl and increased to 9.8 (1.8) g dl after transfusion. The mean number of intraoperatively transfused pRBC units was 2.5 (2.7) units (median 2). Although European Society of Anaesthesiology transfusion guidelines are moderately implemented in Europe with respect to Hb threshold for transfusion (7-9 g dl), there is still an urgent need for further educational efforts that focus on the number of pRBC units to be transfused at this threshold