An Extensive Warfarin-Induced Jejunal Hematoma

The most common adverse event associated with oral anticoagulation (OAC) is bleeding in general that is seen in 5 to 48% of patients and gastrointestinal bleeding (GIB) in particular which occurs in 2–4% of patients. Intramural hematoma (IMH) is a rare variant of GIB, occurring in 1 in every 2500 patients and is treated with OACs. IMHs are rarely fatal and the current data suggest conservative medical therapy and clinical follow-up for management of IMHs. GIB and intestinal IMH is becoming a more common clinical problem because of increasing number of patients taking OACs. This report describes a 91-year-old woman who was presented with abdominal discomfort for 2 days. The patient had been under anticoagulant therapy with warfarin because of atrial fibrillation. She was found to have an inappropriately prolonged international normalized ratio level of 8.1. IMH was confirmed with abdominal ultrasound and computed tomography (CT) scan. The patient was treated conservatively with fluid resuscitation, nasogastric decompression, bowel rest and reversal of anticoagulation. Follow-up CT scans, approximately one month after medical treatment, demonstrated complete resolution of the IMH. Intestinal IMH should be considered in the differential diagnosis of acute abdomen in any anti-coagulated patient with abdominal complaints

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 < 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

Pretest Setup Installation of the METU-DBL Project to Perform Space Radiation Tests

Satellites and spacecrafts are exposed to space radiation environment during their mission. This environment consists of cosmic rays, solar particles and trapped particles. Cosmic rays are coming fromthe outside of our solar system. Solar particles are produced by the Sun. These particles can be trapped around the Earth's magnetic field lines when they approach the Earth's atmosphere. These particles can affect performance and robustness of electronic components or materials used in space and such effects can be classified as Total Ionising Dose (TID), Single Event Effect (SEE) and Displacement Damage (DD). To ensure the performance of innovative components or materials that will be used in space, they must be tested before they are launched to space. Currently, only TID tests can be realized in Turkey but others cannot be performed yet

Preliminary Test Setup of the Metu Defocusing Beam Line, an Irradiation Test Facility in Turkey

METU-Defocusing Beam Line (METU-DBL) Project has been started in August 2015 and aims to construct a beam line at Turkish Atomic Energy Authority Sarayköy Nuclear Education and Research Center Proton Accelerator Facility to perform Single Event Effect (SEE) tests for the first time in Turkey. The METU-DBL is 8m-long and has quadrupole magnets to enlarge the beam size and collimators to reduce the flux. When complete the METU-DBL will provide a beam that is suitable according to ESA ESCC No. 25100 Single Event Effects Test Method and Guidelines standard. The METU-DBL beam size is 15.40cm x 21.55cm and the flux will be variable between 10⁵ p/cm²/s and 10¹⁰ p/cm²/s. The METU-DBL will serve space, particle, nuclear and medical physics communities starting from 2018 with performing irradiation tests. A preliminary test setup is being constructed towards first tests in March 2017. The beam size will be 6cm x 8cm and the flux will be 1.4x10⁹ p/cm²/s for preliminary test setup. The METU-DBL project construction status for the preliminary test setup is presented in this poster