Bossenholm3562

Antibacterial resistance (ABR) is a major global health security threat, with a disproportionate burden on lower-and middle-income countries (LMICs). It is not understood how 'One Health', where human health is co-dependent on animal health and the environment, might impact the burden of ABR in LMICs. Thailand's 2017 "National Strategic Plan on Antimicrobial Resistance" (NSP-AMR) aims to reduce AMR morbidity by 50% through 20% reductions in human and 30% in animal antibacterial use (ABU). There is a need to understand the implications of such a plan within a One Health perspective.

A model of ABU, gut colonisation with extended-spectrum beta-lactamase (ESBL)-producing bacteria and transmission was calibrated using estimates of the prevalence of ESBL-producing bacteria in Thailand. This model was used to project the reduction in human ABR over 20 years (2020-2040) for each One Health driver, including individual transmission rates between humans, animals and the environment, and to estimate the long-term impact of the NSP-AMR intervention.

The model predicts that human ABU was the most important factor in reducing the colonisation of humans with resistant bacteria (maximum 65.7-99.7% reduction). The NSP-AMR is projected to reduce human colonisation by 6.0-18.8%, with more ambitious targets (30% reductions in human ABU) increasing this to 8.5-24.9%.

Our model provides a simple framework to explain the mechanisms underpinning ABR, suggesting that future interventions targeting the simultaneous reduction of transmission and ABU would help to control ABR more effectively in Thailand.

Our model provides a simple framework to explain the mechanisms underpinning ABR, suggesting that future interventions targeting the simultaneous reduction of transmission and ABU would help to control ABR more effectively in Thailand.Trapezoid dislocation is infrequent, and palmar trapezoid dislocation is even more rare. This uncommon injury is associated with high-energy trauma and is often combined with other distracting injuries that may lead to misdiagnosis or delayed diagnosis. We present a case of isolated palmar dislocation of the trapezoid in a 49-year-old man with major trauma following a motor vehicle accident. We identified the dislocation by radiograph and performed open reduction and internal fixation (ORIF) after primary management of his major trauma. The patient recovered with satisfactory hand and wrist function. We share our experience and review the pitfalls in diagnosis and treatment for this rare injury.We present an unusual case of a young male with a penetrating neck injury (PNI) due to a work-related injury. A metallic foreign body traversed from entry at surgical Zone 2 to Zone 1 in the neck and resulted in a transection of the left thyrocervical trunk at the origin with the left subclavian artery. Computed Tomographic Angiography (CTA) of the aortic arch and major branch vessels demonstrated haemorrhage anterior to the left subclavian artery and left thyrocervical trunk. We describe some of the diagnostic and operative challenges which may occur in these rare and life-threatening injuries. We have also reviewed some of the recent key literature on this topic and have collated the recommendations of the review. In recent years, there has been a movement away from selective "zone-based" mandatory surgical exploration for Zone 2 injuries, as well as invasive and time-consuming investigations (such as digital subtraction angiography, contrast oesophageal swallow and bronchoscopy) for Zone 1 and 3 injuries due to the high number of negative surgical procedures and investigations. We demonstrate there is now an evidence-based algorithm which demonstrates that a "no zone" approach to the management of these patients is safe and effective. This requires an initial physical examination looking for the presence or absence of "hard", "soft" or "no" physical signs in these patients, and then deciding on subsequent management which would include immediate surgery, CTA of the aortic arch and branches (and subsequent surgical or other management) or observation only. Our aim in describing this case it to highlight that there is now good evidence-based guidance for the safe and effective management of patients with this infrequent but potentially fatal injury.Vascular injury caused by spinal screw displacement is a rare complication of spinal fusion surgery. Here, we report a case with no perforation of the aortic wall, which we treated by means of simultaneous thoracic endovascular aorta repair (TEVAR) and screw removal. An 82-year-old female underwent corrective spinal fixation. Postoperatively, a screw became displaced from the vertebrae and contacted the outer membrane of the descending aorta. To prevent rupture of the aorta, we performed stent graft placement from the right common femoral aorta. We left a flexion-resistant catheter in the left arm and moved the patient into an abdominal position with the left arm extended upward to enable immediate insertion of a guidewire and occlusion balloon if necessary. Then we removed the displaced screw with a drill. This safe and effective method can prevent possible aortic injuries secondary to displaced spinal screws. The key to our method is the simultaneous performance of TEVAR and screw removal, made possible through patient repositioning.

We report what is, to the best of our knowledge, the first case of pediatric trans-olecranon fracture dislocation of the elbow associated with a radial head fracture and with a medial collateral ligament disruption.

A 7-year-old girl presented to the emergency department after a fell on his right elbow while playful activity at home. The elbow X-ray showed acute trans-olecranon fracture dislocation of the elbow associated with a radial head fracture. A pre-operative 3D TC scans confirmed and clarified the injury pattern. However, stress radiographs performed in the operating room under anesthesia revealed an associated severe valgus instability caused by medial collateral ligament disruption. The olecranon fracture was fixed with two crossing 1.5mm K-wires and the angulated radial neck fracture was fixed with a retrograde 1.5mm K-wire by S.E.R.I. technique.

Although trans-olecranon fracture dislocation of the elbow is well recognized and clearly described in adults, it is uncommon in children. A pre-operative 3D TC scans are recommended to enable a more accurate diagnosis and surgical planning. Ferrostatin-1 supplier Medial collateral ligament has a central role in elbow stability and is very important to repair it during surgery.

Although trans-olecranon fracture dislocation of the elbow is well recognized and clearly described in adults, it is uncommon in children. A pre-operative 3D TC scans are recommended to enable a more accurate diagnosis and surgical planning. Medial collateral ligament has a central role in elbow stability and is very important to repair it during surgery.Facial injections with cosmetic fillers can lead to local artery occlusion. The bilateral nasolabial folds of a 39-year-old woman were injected with hyaluronic acid at another hospital. After the righthand injection, the patient immediately felt pain that ran from the right nasolabial fold to the nasal alar. The injecting doctor suspected embolism due to intravascular misinjection and immediately injected hyaluronidase and vasodilator subcutaneously and intravenously, respectively. Five days later, the patient presented at our hospital with extensive endovascular embolization-related signs along with some oral mucosa, the skin of the right nasolabial fold, right nasal alar, and right mouth corner exhibited necrosis. We diagnosed secondary peripheral embolus, and we used the treatment, namely, subcutaneously flooding/immersing the embolization site in the peripheral blood vessels with 2000 units of hyaluronidase.The objective of this retrospective cohort study was to review the use of neoadjuvant chemotherapy followed by interval cytoreductive surgery in patients presenting with advanced, unresectable endometrial cancer at two large cancer centers. Patients with advanced endometrial cancer treated with neoadjuvant chemotherapy between 2008 and 2015 were identified from an institutional database. Clinical and surgical variables were analyzed and time to recurrence and death was calculated and compared between surgical groups. Thirty-three patients were identified (mean age 64.8 (range 42-86 years)). Overall, 28% of patients had endometrioid histology, 48% serous, 4% clear cell, 4% carcinosarcoma, 12% mixed and 4% other. Ineligibility for primary surgery was due to unresectable disease (85%), comorbidities (6%) and unknown reasons (9%). All patients received neoadjuvant chemotherapy with 91% of patients receiving carboplatin and paclitaxel. link2 On reimaging, 12% of patients had progressed, 76% had a partial response and 3% had a complete response to chemotherapy. 76% of patients underwent interval surgery, with cytoreduction to no visible residual disease achieved in 52%. Overall, 91% of patients recurred and 85% died during follow-up. link3 Patients undergoing surgery after chemotherapy had significantly longer progression-free survival (11.53 vs. 4.99 months, p = 0.0096) and overall survival (24.13 vs. 7.04 months, p = 0.0042) when compared to patients who did not have surgery. Neoadjuvant chemotherapy is a feasible treatment option to allow for interval cytoreductive surgery in patients with advanced endometrial cancer not amenable to primary debulking. Patients who undergo surgery after chemotherapy have significantly improved progression free and overall survival.Gastroparesis is a syndrome of delayed gastric emptying associated with nausea, vomiting, and postprandial fullness. Despite multiple etiologies, diabetes is one of the principal causes of gastroparesis. This case report examines a 57 year-old woman with poorly controlled diabetes type II (HbA1c 8.3%) complicated by diabetic nephropathy who was readmitted for gastroparesis after two days following uncomplicated robotic surgical staging for endometrial cancer. Prior to the procedure, the patient had received carbohydrate loading in accordance with our center's enhanced recovery pathway; this resulted in severe acute hyperglycemia, a recognized cause of gastroparesis in women with diabetes. During her readmission, she improved with bowel rest and optimization of glycemic control. This case suggests that routine pre-operative carbohydrate loading should be used with caution in poorly controlled diabetic patients.Due to the lack of therapeutics and vaccines, diagnostics of COVID-19 emerges as one of the primary tools for controlling the spread of SARS-COV-2. Here we aim to develop a theoretical model to study the detection process of SARS-COV-2 in lateral flow device (LFD), which can achieve rapid antigen diagnostic tests. The LFD is modeled as the adhesion of a spherical nanoparticle (NP) coated with ligands on the surface, mimicking the SARS-COV-2, on an infinite substrate distributed with receptors under a simple shear flow. The adhesive behaviors of NPs in the LFD are governed by the ligand-receptor binding (LRB) and local hydrodynamics. Through energy balance analysis, three types of motion are predicted (i) firm-adhesion (FA); (ii) adhesive-rolling (AR); and (iii) free-rolling (FR), which correspond to LRB-dominated, LRB-hydrodynamics-competed, and hydrodynamics-dominated regimes, respectively. The transitions of FA-to-AR and AR-to-FR are found to be triggered by overcoming LRB barrier and saturation of LRB torque, respectively.