Isolated Abdominal Wall Actinomycosis Associated with an Intrauterine Contraceptive Device: A Case Report and Review of the Relevant Literature

Isolated abdominal wall actinomycosis in the presence of an intrauterine contraceptive device (IUCD) is extremely rare and only six such cases have been reported in the literature. We report a case where clinical and radiological examinations revealed a pseudotumor within the anterior abdominal wall. After being lost to follow-up, the patient presented two years later with the enlargement of the mass. The mass including the affected anterior abdominal wall was completely excised. The diagnosis of actinomycosis was established postoperatively by histopathological examination. Further questioning concerning her gynecological history revealed long-term use of the same IUCD. Surgical excision of the actinomycotic pseudotumour and removal of the IUCD followed by antibiotic therapy resulted in the full recovery of the patient

Unusual Suspect After Spinal Anesthesia: Herpetic Encephalitis

Herpes simplex virus (HSV) is the most common cause of acute, sporadic viral encephalitis. Usually occurs with the activation of the latent virus. Sudden onset fever and especially temporal lobe involvement are typical clinical features of HSV encephalitis. In this article, we aimed to present a case of herpetic encephalitis, which is an unusual factor in meningitis after spinal anesthesia. Severe headache and convulsion developed at postoperatively. Body temperature of the patient was 38.3 °C and neck stiffness developed. The patient was diagnosed with herpes encephalitis by clinical, laboratory and cranial magnetic resonance, and acyclovir treatment was started immediately. The patient was discharged home with recovery on the 14th day. Loss of consciousness and convulsions with fever seen at the postoperative period after spinal anesthesia, may not always be due to bacterial meningitis but sometimes due to HSV-associated acute herpetic meningoencephalitis. Rapid diagnosis and treatment is life-saving

Investigation of antioxidant and anticonvulsant activity of Hypericum triquetrifolium Turra

Epilepsy is a state characterized by sudden, recurrent epileptic seizures that are not initiated by an identifiable event. There are various studies has been shown that Hypericum species may be used for their anticonvulsant potentials. Besides, the relationship between anticonvulsant activity and antioxidant effect has already been shown in the literature. In the current study, H. triquetrifolium was investigated for the first time for its potential antioxidant and anticonvulsant potential using in vitro and in vivo test models. H. triquetrifolium extracts were tested with DPPH assay, FRAP assay, copper (II) ion reducing antioxidant capacity assay, and acetylcholinesterase inhibitory activity assay to understand their antioxidant potential. Especially, methanolic extract of H. triquetrifolium was shown the highest antioxidant activity. Moreover, a pentylenetetrazole (PTZ, 80 mg/kg, i.p.)-induced seizure model was conducted to analyze the anticonvulsant activities of H. triquetrifolium extracts in mice. In addition, this study revealed that H. triquetrifolium decreased the ratio of severe seizures and increased the mean onsite of mortality and survival rate in a dose-dependent manner. It is thought that the anticonvulsant effect may be either related to the antioxidant potential of H. triquetrifolium or its interference in the GABAergic system

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

Laparoscopic Floppy Nissen Fundoplication: 16 Years of Experience from the Historical Clinic of Rudolph Nissen

Background/Aims: Since its original description in 1956 by Rudolph Nissen, minor changes were made in technical details of Nissen fundoplication. After the introduction of laparoscopic fundoplication, in order to reduce the rate of complications, some technical modifications led to the development of "floppy" Nissen fundoplication

Single-Port Laparoscopic Floppy Nissen Fundoplication: A Novel Technique with the Aid of the Cerrahpasa Retractor

With the advent of single-port laparoscopy, the spectrum of abdominal surgeries performed is widening. The retraction of the left lobe of the liver in the upper gastrointestinal procedures is a critical maneuver with its added possible complications. In our study, we used the Cerrahpasa retractor (R) (trademark pending by E. Eyuboglu and T. Ipek) for the retraction of the left liver in 22 patients with a different concept other than using the suturing or silk lace techniques described in previous studies. In our technique, the potential of tearing the liver or other anatomical structures is minimal. We believe that, with the aid of our Cerrahpasa retractor, the problem of liver retraction is being solved by a simple and safe technique

A Centralized Detection of Sinkhole Attacks Based on Energy Level of the Nodes on Cluster-Based Wireless Sensor Networks

Wireless Sensor Networks is consist of thousands of small and low-cost devices, which communicate over wireless medium. Due to locating in harsh environment and having limited resources, WSN is prone to various attacks. One of the most dangerous attacks threatening WSN is the sinkhole attack. In this paper, sinkhole attack is modelled on a cluster-based WSN, and a centralized detection algorithm based on the remaining energies of the nodes is proposed. The simulations were run for different values of energy thresholds and various numbers of nodes. The performance of the system was investigated over total energy consumption in the system, the number of packets arrived at base station and true detection rate of the sinkhole node(s). The results showed that the proposed method is energy-efficient and detects the malicious nodes with a 100% accuracy for all number of nodes