Efficacy of oral celecoxib and hyoscine butyl-bromide versus placebo during copper intrauterine device placement in women delivered only by elective cesarean section: a randomized controlled study

Objective: To compare the efficacy and tolerability of celecoxib to hyoscine butyl bromide (HBB) and placebo in reducing pain scores during placement of copper intrauterine devices (IUD) in parous women who have undergone elective cesarean section and who have had no previous vaginal deliveries. Methods: We conducted a randomized, double-blind, placebo-controlled trial at a tertiary University hospital from April 2018 to September 2018. The study included women who had never delivered vaginally and who desired copper IUD insertion. We randomized the study participants in a 1:1:1 ratio to celecoxib, HBB or placebo groups. They took the tablets orally two hours before IUD insertion. The study outcomes were the self-reported pain measurements, using a 10-cm Visual Analogue Scale (VAS), taken during tenaculum placement, sound insertion, IUD insertion and five minutes post-insertion, as well as an ease of insertion score. Results: The study included 105 women (n=35 in each group). The baseline characteristics were similar among all groups. The mean pain score in the celecoxib group was lower during IUD insertion than placebo (1.97 vs 4.34, p<0.001). Moreover, the ease of insertion score was significantly better with celecoxib [1.56 vs. 3.03, p< 0.001] than with placebo. Similarly, Women in the HBB group were more likely to report lower pain scores during IUD insertion (2.91 vs 4.34, p<0.001) and lower ease of insertion score [1.43 vs. 3.03, p< 0.001]. Conclusions: The use of celecoxib and HBB may both reduce the pain associated with copper IUD insertion among women with no previous vaginal delivery. However, celecoxib is better tolerated with fewer side effect

Warthin-like papillary thyroid carcinoma: a case report and comprehensive review of the literature

BackgroundPapillary Thyroid Carcinoma (PTC) is the most frequent endocrine malignancy with a variety of histological presentations. Warthin-like Papillary Thyroid Carcinoma (WLPTC) is an uncommon neoplasm that is recognized as a distinct subtype of PTC in the WHO classification of thyroid tumors. In this report, we present a novel case of WLPTC in a female patient and provide an in-depth review of the available literature on its clinical, pathological, and therapeutic characteristics.Case presentationA 27-year-old female patient was referred for neck swelling. Ultrasound showed two suspicious thyroid nodules leading to a thyroidectomy. She was diagnosed with intermediate-risk bifocal foci of classic PTC and WLPTC, arising from a background of chronic lymphocytic thyroiditis (CLT). This pT1b(m) N1b M0 malignancy was treated with adjuvant isotopic ablation and suppressive thyroxine therapy. The 1-year outcomes were favorable.Literature reviewIt covered articles published from 1995 to 2022, by searching PubMed and Google Scholar using specific terms. Out of 148 articles reviewed by two authors, 25 relevant articles were selected, including 13 case reports and 12 case series. The study included 150 cases of WLPTC. Data related to clinical presentation, imaging, histological features, management, and outcomes, were extracted. The mean age of diagnosis was 39 years, with a female predominance. The most common clinical presentation was neck swelling. Thyroid autoimmunity was positive in 71.6% of patients. Lymph node metastases were present in 28% of cases, with no reported distant metastases. Overall, the outcomes were favorable.ConclusionWLPTC shares similar clinical and radiological presentations as classic PTC. The hallmark histological features of WLPTC are papillae lined with oncocytic tumor cells with papillary nuclear changes and lymphoid stroma. WLPTC is almost constantly associated with CLT. The management of WLPTC aligns with that of classic PTC with comparable stage and risk category, often resulting in favorable outcomes

Nodular diagnosis for ecological engineering of the symbiotic nitrogen fixation with legumes

As a major contributor to the reduced nitrogen pool in the biosphere, symbiotic nitrogen fixation by legumes plays a critical role in a sustainable production system. However this legume contribution varies with the physico-chemical and biological conditions of the nodulated-root rhizosphere. In order to assess the abiotic and biotic constrains that might limit this symbiosis at the agroecosystem level, a nodular diagnosis is proposed with common bean as a model grain-legume, and a major source of plant proteins for world human nutrition. The engineering of the legume symbiosis is addressed by participatory assessment of bean recombinant inbred lines contrasting for their efficiency in use of phosphorous for symbiotic nitrogen fixation. With this methodology, in field-sites chosen with farmers of an area of cereal-cropping in the Mediterranean basin, a large spatial and temporal variation in the legume nodulation was found. Soil P availability was a major limiting factor of the rhizobial symbiosis. In order to relate the field measurements with progress in functional genomics of the symbiosis, in situ RT-PCR on nodule sections has been implemented showing that the phytase gene is expressed in the cortex with significantly higher number of transcripts in P-efficient RILs. It is concluded that various tools and indicators are available for developing the ecological engineering of the rhizobial symbiosis, in particular for its beneficial contribution to the bio-geochemical cycle of N, and also P and C

Epidemiology of surgery associated acute kidney injury (EPIS-AKI): a prospective international observational multi-center clinical study

Purpose: The incidence, patient features, risk factors and outcomes of surgery-associated postoperative acute kidney injury (PO-AKI) across different countries and health care systems is unclear. Methods: We conducted an international prospective, observational, multi-center study in 30 countries in patients undergoing major surgery (&gt; 2-h duration and postoperative intensive care unit (ICU) or high dependency unit admission). The primary endpoint was the occurrence of PO-AKI within 72&nbsp;h of surgery defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Secondary endpoints included PO-AKI severity and duration, use of renal replacement therapy (RRT), mortality, and ICU and hospital length of stay. Results: We studied 10,568 patients and 1945 (18.4%) developed PO-AKI (1236 (63.5%) KDIGO stage 1500 (25.7%) KDIGO stage 2209 (10.7%) KDIGO stage 3). In 33.8% PO-AKI was persistent, and 170/1945 (8.7%) of patients with PO-AKI received RRT in the ICU. Patients with PO-AKI had greater ICU (6.3% vs. 0.7%) and hospital (8.6% vs. 1.4%) mortality, and longer ICU (median 2 (Q1-Q3, 1-3) days vs. 3 (Q1-Q3, 1-6) days) and hospital length of stay (median 14 (Q1-Q3, 9-24) days vs. 10 (Q1-Q3, 7-17) days). Risk factors for PO-AKI included older age, comorbidities (hypertension, diabetes, chronic kidney disease), type, duration and urgency of surgery as well as intraoperative vasopressors, and aminoglycosides administration. Conclusion: In a comprehensive multinational study, approximately one in five patients develop PO-AKI after major surgery. Increasing severity of PO-AKI is associated with a progressive increase in adverse outcomes. Our findings indicate that PO-AKI represents a significant burden for health care worldwide

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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

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

The Journal Of Turkestan Provınce And The Rıse Of Uzbek Lıterary

Bu çalışmada, Çarlık Rusyasının Türkistan'da yayılma siyasetinin bir aracı olarak 1870-1917 yılları arasında, Taşkent'te yayınlandığı Türkistan Vilayetinin Gazeti adlı süreli yayını esas alarak Rusların bölgede uyguladığı dil politikasının sonuçlarını değerlendirmek ve 20. yüzyılın başında gerçekleşen Özbek Türkçesine geçiş sürecinde değişen dil özelliklerini bu gazete metinlerinden tespit edilecek somut örneklerle belgelendirmek amaçlanmıştır. Çalışma,1870-1917 yılları arasında Türkistan Vilayetinin Gazetinde yayınlanan dil, kültür ve tarih konulu makaleleri kapsamaktadır. Yaklaşık 47 yıl, düzenli olarak yayınlanan bu gazetenin bütün sayılarına ulaşmak ve bunları incelemek bu tez çalışmasının boyutunu aşacağından imkan dahilinde ulaşabildiğimiz 250 gazete nüshası ve 413 makale arasından farklı yılları örneklendirmesi ve içerik olarak incelenen konuya ışık tutması göz önünde bulundurularak tarama yöntemiyle seçilen toplam 31 makalenin transkripsiyonu yapılmış ve dil özellikleri incelenmiştir. Kavramsal Çerçeve-İnceleme- Metin başlıklı üç ana bölümden oluşan çalışmamızın Kavramsal Çerçeve bölümünde Türkistan konulu tarih kaynakları, Türkistan'da Gazetecilik Türkistan Vilayetinin Gazeti hakkında yazılmış kaynaklar ve Çağatay Türkçesi, Özbek Türkçesi ile ilgili gramer kaynakları taranmış ve tezimizin kuramsal temeli oluşturulmuştur. Metin bölümünde Arap alfabesinden transkripsiyonu yapılan gazete makaleleri tarih sırasına göre sunulmuştur. İnceleme bölümünde ise Çağatay Türkçesi'nden Özbek Türkçesi'ne geçiş sürecinde görülen dil özellikleri, ele alınan metinlerden tespit edilen örneklerle açıklanmıştır. Ayrıca Rusların bu gazete vasıtasıyla oluşturmayı ve yaygınlaştırmayı amaçladığı Sart dili nin özellikleri de bu yolla tespit edilmeye çalışılmıştır. Sonuçta, Rusların bütün çabalarına rağmen Türkistan Vilayeti Gazetinin geniş bir halk kitlesine ulaşamadığı ve bu nedenle fazla etkili olamadığı tespit edilmiştir. Ancak yine de içerik bakımından bu gazetede yayınlanan makalelerin yerli halkın Rus kültürüne ve diline yakınlaşmasında önemli rol oynadığı gerçeği yadsınamaz. Rusların bu gazete aracılığıyla oluşturmaya ve benimsetmeye çalıştığı Sart dilinin özelliklerine ilişkin tespit edilen sonuçlar önemlidir. Bu çalışmanın Türkistan'da yayınlanan ilk gazeteyi tanıtmasıyla ve Özbek Türkçesi'ne geçiş dönemine ilişkin içerdiği bilgilerle bu alanda kendisinden sonra yapılacak olan çalışmalara kaynaklık edeceği düşünülmektedir.The aim of this study is to reveal the outcome of the language policy which Russians carried out between 1870 and 1917 with respect to the periodical Journal of the province of Turkestan published in Tashkent as a means of the expansion policy of tsardom of Russia to Turkestan and to certify the language characteristics which changed during the transition period into Uzbek Turkish in the beginning of the 20th century with the concrete examples established from these report.In this descriptive study the articles on language, culture and history that were published in Journal of the province of Turkestan are included. Since it was not possible to reach and research all the issues of the newspaper published through 47 years, 31 articles were transcripted through scanning method among 250 copies and 413 articles. Language areas were analysed in terms of the characteristics of Chagatay Turks and Uzbek Turks. The study mainly consists of three main parts such as research, text and analysis. The introduction stage covers the historical resources on Turkestan, the resources written about Journalism in Turkestan and Journal of the Province of Turkestan as well as scanning grammar resources about Chagatay Turkish and Uzbek Turkish. Hence the oritical basis of the thesis was formed. In the text part, the articles transcripted from the Arabic alphabet were presented in accordance with the date order. The language characteristics seen in the transition period from the Chagatay Turkish into Uzbek Turkish were illustrated with the help of the examples obtained from these texts in the analysis part. Accordingly the characteristics of Sart Language which Russians aimed to form and generalise are tried to be detected. As a result, it was determined that the Journal of the province of Turkestan was not able to reach a large mass of people and as a result of this it was not effective. However it can not be denied that the articles published in that newspaper played an important role in locals' getting familiar to the Russian culture and language. The characteristics of sart langauge which Russians tried to form and impose by means of the newspaper are among the astonishing outcomes. The study is thought to be a resource for the forthcoming studies by introducing the first newspaper ever published in Turkestan with the information about the transition period of Uzbek Turkish