Search

Abstract Background Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P

المخلص: أهداف البحث: كان الهدف من هذه الدراسة هو تقييم ممارسات مكافحة العدوى لممارسي طب الأسنان العامين في باكستان، كما أبلغوا ذاتيا من قبلهم. طرق البحث: تمت دعوة ما مجموعه 619 ممارسا عاما لطب الأسنان للمشاركة في هذه الدراسة عبر استبيان إلكتروني تم توزيعه في مجموعات واتساب المختلفة. يتكون الاستبيان من ستة عشر سؤالا تتعلق بتدابير مكافحة العدوى المختلفة التي أوصت بها الجمعية الأوروبية لطب لب الأسنان. تضمنت الأسئلة موضوعات مثل استخدام السد المطاطي أو طرق العزل الأخرى، واختيار أجهزة ري القناة والحلول المضادة للبكتيريا، والممارسات المتعلقة بنظافة اليدين واستخدام قفازات الفحص. كما تم جمع المعلومات الديموغرافية. تم تحليل البيانات باستخدام الحزمة الإحصائية للعلوم الاجتماعية، وتم الإبلاغ عن الإحصاء الوصفي كنسب مئوية وترددات. النتائج: من بين 619 ممارسا عاما لطب الأسنان، استجاب 350، مما أدى إلى معدل استجابة قدره 56.5٪. عمل حوالي 43.7٪ من ممارسي طب الأسنان العام في أجهزة طب الأسنان الخاصة. كانت غالبية المستجيبين من الإناث (64٪)، وتخرجن بعد عام 2010 (81.1٪)، وتنتمي إلى الفئة العمرية من 24 إلى 34 عاما (78.9٪). استخدم حوالي 72.3٪ من ممارسي طب الأسنان العام لفائف القطن، واستخدم 17.4٪ فقط السد المطاطي بشكل روتيني لعزل لب الأسنان. 89٪ لم يقوموا بتطهير مكان الجراحة. أفاد حوالي 80٪ من ممارسي طب الأسنان العام باستخدام تركيزات مختلفة من ناضور الصوديوم الهايبوكلورايت أثناء استخدام أجهزة قناة الجذر، بينما أفاد 0.9٪ أنهم لا يستخدمون أي جهاز ري أثناء إجراءات علاج لب الأسنان. أفاد 61.7٪ من ممارسي طب الأسنان العام أنهم يستخدمون دائما الأدوية داخل القناة أثناء العلاج اللبي متعدد الزيارات، وأعلن 82.5٪ من هؤلاء أنهم يستخدمون كالسيوم هيدروكسيد. أفاد جميع المستجيبين باستخدام قفازات اليد أثناء العلاج اللبي. الاستنتاجات: أشارت النتائج إلى أن ممارسي طب الأسنان العام كانوا يميلون إلى اتباع معايير جودة معينة في علاج جذور الأسنان على النحو الموصى به من قبل الجمعية الأوروبية لطب لب الأسنان، ولكن التطبيق العام لجميع المبادئ التوجيهية لم يكن مرضيا تماما ويتطلب التحسين. Abstract: Objective: This study was aimed at evaluating the self-reported endodontic infection control practices of general dental practitioners in Pakistan. Methods: An e-questionnaire was sent to 619 general dental practitioners in several WhatsApp groups. Sixteen questions associated with various infection control measures recommended by the ESE were asked, including the use of various isolation methods/rubber dams, the selection of canal irrigants and anti-bacterial solutions, and practices regarding hand hygiene and use of examination gloves. The e-questionnaire also included questions associated with demographics. Data analysis was conducted in SPSS-24. Descriptive statistics were documented as percentages and frequencies. Results: Of 619 GDPs, 350 responded (56.5% response rate), of whom 43.7% worked in private dental practices. The majority were women (64%), had graduated after 2010 (81.1%), and were 24–34 years of age (78.9%). A total of 72.3% of GDPs used cotton rolls, and 17.4% routinely used rubber dams for endodontic isolation; 89% did not disinfect the operative field; 80% reported using different concentrations of NaOCl during root canal instrumentation; and 0.9% reported not using any irrigant during endodontic procedures. A total of 61.7% reported always using intra-canal medication during multi visit endodontic treatment, among whom 82.5% reported using Ca(OH)2. Finally, 100% of respondents reported using gloves during endodontic treatment. Conclusion: The results indicated that the GDPs tended to follow some of the endodontics quality standards recommended by the ESE, but the overall implementation of all guidelines requires improvement.

Integrating wind power with energy storage technologies is crucial for frequency regulation in modern power systems, ensuring the reliable and cost-effective operation of power systems while promoting the widespread adoption of renewable energy sources. Power systems are changing rapidly, with increased renewable energy integration and evolving system architectures. These transformations bring forth challenges like low inertia and unpredictable behavior of generation and load components. As a result, frequency regulation (FR) becomes increasingly important to ensure grid stability. Energy Storage Systems (ESS) with their adaptable capabilities offer valuable solutions to enhance the adaptability and controllability of power systems, especially within wind farms. This research provides an updated analysis of critical frequency stability challenges, examines state-of-the-art control techniques, and investigates the barriers that hinder wind power integration. Moreover, it introduces emerging ESS technologies and explores their potential applications in supporting wind power integration. Furthermore, this paper offers suggestions and future research directions for scientists exploring the utilization of storage technologies in frequency regulation within power systems characterized by significant penetration of wind power.

Introduction The extensive resources needed to train surgeons and maintain skill levels in low-income and middle-income countries (LMICs) are limited and confined to urban settings. Surgical education of remote/rural doctors is, therefore, paramount. Virtual reality (VR) has the potential to disseminate surgical knowledge and skill development at low costs. This study presents the outcomes of the first VR-enhanced surgical training course, ‘Global Virtual Reality in Medicine and Surgery’, developed through UK-Ugandan collaborations.Methods A mixed-method approach (survey and semistructured interviews) evaluated the clinical impact and barriers of VR-enhanced training. Course content focused on essential skills relevant to Uganda (general surgery, obstetrics, trauma); delivered through: (1) hands-on cadaveric training in Brighton (scholarships for LMIC doctors) filmed in 360°; (2) virtual training in Kampala (live-stream via low-cost headsets combined with smartphones) and (3) remote virtual training (live-stream via smartphone/laptop/headset).Results High numbers of scholarship applicants (n=130); registrants (Kampala n=80; remote n=1680); and attendees (Kampala n=79; remote n=556, 25 countries), demonstrates widespread appetite for VR-enhanced surgical education. Qualitative analysis identified three key themes: clinical education and skill development limitations in East Africa; the potential of VR to address some of these via 360° visualisation enabling a ‘knowing as seeing’ mechanism; unresolved challenges regarding accessibility and acceptability.Conclusion Outcomes from our first global VR-enhanced essential surgical training course demonstrating dissemination of surgical skills resources in an LMIC context where such opportunities are scarce. The benefits identified included environmental improvements, cross-cultural knowledge sharing, scalability and connectivity. Our process of programme design demonstrates that collaboration across high-income and LMICs is vital to provide locally relevant training. Our data add to growing evidence of extended reality technologies transforming surgery, although several barriers remain. We have successfully demonstrated that VR can be used to upscale postgraduate surgical education, affirming its potential in healthcare capacity building throughout Africa, Europe and beyond.

This study is devoted to the preparation of barium doped bismuth ferrites by sol–gel auto combustion method using different concentrations of barium nitrates Bi1-xBaxFeO3 (x = 0, 0.10, 0.20, 0.30). The Electrical, structural properties, and crystallite size of all samples had been studied. The electrical properties, of the samples, showed compromising results to use in electrical applications. The X-ray diffraction analysis of the samples showed the rhombohedra shape of the samples. The crystallite size were measured and noted to be 24 nm with the enhancement of Ba concentration. The electrical conductivity and resistivity are measured by the mean of two probe methods and results showed an increase in conductivity with the addition of barium. The activation energy were also calculated and recorded to be a 2.07 eV. The magnetic susceptibility of all samples was measured and the response was enhanced by the increase of the Ba concentration. SEM study revealed the morphology of the all prepared samples. The nanoparticles have average particle sizes of 15 and 75 nm, were observed by using image software. The FTIR analysis of all samples resulted the transmittance and the functional group of the all samples.

Abstract Background Severe complicated intra-abdominal sepsis (SCIAS) has an increasing incidence with mortality rates over 80% in some settings. Mortality typically results from disruption of the gastrointestinal tract, progressive and self-perpetuating bio-mediator generation, systemic inflammation, and multiple organ failure. A further therapeutic option may be open abdomen (OA) management with negative peritoneal pressure therapy (NPPT) to remove inflammatory ascites and attenuate the systemic damage from SCIAS, although there are definite risks of leaving the abdomen open whenever it might possibly be closed. This potential therapeutic paradigm is the rationale being assessed in the Closed Or Open after Laparotomy (COOL trial) ( https://clinicaltrials.gov/ct2/show/NCT03163095 ). Initially, the COOL trial received Industry sponsorship; however, this funding mandated the use of a specific trademarked and expensive NPPT device in half of the patients allocated to the intervention (open) arm. In August 2022, the 3 M/Acelity Corporation without consultation but within the terms of the contract canceled the financial support of the trial. Although creating financial difficulty, there is now no restriction on specific NPPT devices and removing a cost-prohibitive intervention creates an opportunity to expand the COOL trial to a truly global basis. This document describes the evolution of the COOL trial, with a focus on future opportunities for global growth of the study. Methods The COOL trial is the largest prospective randomized controlled trial examining the random allocation of SCIAS patients intra-operatively to either formal closure of the fascia or the use of the OA with an application of an NPPT dressing. Patients are eligible if they have free uncontained intraperitoneal contamination and physiologic derangements exemplified by septic shock OR severely adverse predicted clinical outcomes. The primary outcome is intended to definitively inform global practice by conclusively evaluating 90-day survival. Initial recruitment has been lower than hoped but satisfactory, and the COOL steering committee and trial investigators intend with increased global support to continue enrollment until recruitment ensures a definitive answer. Discussion OA is mandated in many cases of SCIAS such as the risk of abdominal compartment syndrome associated with closure, or a planned second look as for example part of “damage control”; however, improved source control (locally and systemically) is the most uncertain indication for an OA. The COOL trial seeks to expand potential sites and proceed with the evaluation of NPPT agnostic to device, to properly examine the hypothesis that this treatment attenuates systemic damage and improves survival. This approach will not affect internal validity and should improve the external validity of any observed results of the intervention. Trial registration: National Institutes of Health ( https://clinicaltrials.gov/ct2/show/NCT03163095 ).

Maize is the second staple food and a major cereal crop in Pakistan, but its actual yield is 25-30% less than the potential because of high soil bulk densities. Three exotic maize varieties (Baber, Pioneer-30P45, and Syngenta-6621) were evaluated under the three different soil bulk densities of 1.00 - 1.30, 1.30 - 1.60, and 1.60- 1.90 g.cm-3. Nine treatments were replicated three times, making 27 pots experiments under complete randomized design were tested. Results showed that bulk density significantly (α < 0.05) affected all the parameters of the crops except the number of days to emergence. The fewest number of days to emergence (8.4), tasseling (60.9), silking (66.9), maturity (91.9), leaves per plant (6.3), as well as the lowest shoot thickness (0.49 cm) were obtained under the 1.00 - 1.30 g.cm-3 density. This density also produced the tallest plants (174.7 cm), highest stover (5938.7 kg ha-1), grain yields (1551 kg ha-1), and harvest index (21.9 %). Conversely, most days to emergence, tasseling, silking, and maturity occurred at the bulk density of 1.60 - 1.90 g.cm-3, which also produced the shortest plants and the lowest grain stover and grain yields as well as the harvest index. It was concluded that increasing bulk density levels increase the number of days to tasseling, silking, maturity, and leaves per plant and shoot thickness. Syngenta 6621 was found late in maturity among the hybrids but produced superior stover and grain yields.

Investigating the effects of climate and land-use changes on surface runoff is critical for water resources management. The majority of studies focused on projected climate change effects on surface runoff, while neglecting future land-use change. Therefore, the main aim of this article is to discriminate the impacts of projected climate and land-use changes on surface runoff using the Soil and Water Assessment Tool (SWAT) through the lens of the Upper Indus Basin, Pakistan. Future scenarios of the land-use and climate changes are predicted using cellular automata artificial neural network and four bias-corrected general circulation models, respectively. The historical record (2000–2013) was divided into the calibration period (2000–2008) and the validation period (2009–2013). The simulated results demonstrated that the SWAT model performed well. The results obtained from 2000 to 2013 show that climate change (61.61%) has a higher influence on river runoff than land-use change (38.39%). Both climate and land-use changes are predicted to increase future runoff depth in this basin. The influence of climate change (12.76–25.92%) is greater than land-use change (0.37–1.1%). Global weather data has good applicability for simulating hydrological responses in the region where conventional gauges are unavailable. The study discusses that both climate and land-use changes impact runoff depth and concludes with some suggestions for water resources managers to bring water environment sustainability. HIGHLIGHTS The SWAT model was used to isolate the climate and land-use change impacts on streamflow.; The general circulation model was used to assess climate change impacts on streamflow.; The CA-ANN model was used to predict future land use.; Multiple climate and land-use scenarios were set to isolate climate and land-use change impacts on streamflow.; Climate change effects overweigh the land-use change effects on streamflow.;

Two-dimensional computed tomography scans no longer offer the level of detail that many surgeons desire for more accurate and precise surgical intervention. Computed tomography image reconstruction into three dimensional (3D) virtual models with interactive capability is providing an enhanced understanding of the patient’s anatomy and pathology allowing the surgeon to create tailored intraoperative plans, minimizing complications and maximizing the intended therapeutic outcome. In this case report we demonstrate the use of 3D image reconstruction software in the management of a 36-year-old female with metastatic breast cancer affecting the chest wall.

Abstract Trauma accounts for a third of the deaths in Western countries, exceeded only by cardiovascular disease and cancer. The high risk of massive bleeding, which depends not only on the type of fractures, but also on the severity of any associated parenchymal injuries, makes pelvic fractures one of the most life-threatening skeletal injuries, with a high mortality rate. Therefore, pelvic trauma represents an important condition to correctly and early recognize, manage, and treat. For this reason, a multidisciplinary approach involving trauma surgeons, orthopedic surgeons, emergency room physicians and interventional radiologists is needed to promptly manage the resuscitation of pelvic trauma patients and ensure the best outcomes, both in terms of time and costs. Over the years, the role of interventional radiology in the management of patient bleeding due to pelvic trauma has been increasing. However, the current guidelines on the management of these patients do not adequately reflect or address the varied nature of injuries faced by the interventional radiologist. In fact, in the therapeutic algorithm of these patients, after the word “ANGIO”, there are no reports on the different possibilities that an interventional radiologist has to face during the procedure. Furthermore, variations exist in the techniques and materials for performing angioembolization in bleeding patients with pelvic trauma. Due to these differences, the outcomes differ among different published series. This article has the aim to review the recent literature on optimal imaging assessment and management of pelvic trauma, defining the role of the interventional radiologist within the multidisciplinary team, suggesting the introduction of common and unequivocal terminology in every step of the angiographic procedure. Moreover, according to these suggestions, the present paper tries to expand the previously drafted algorithm exploring the role of the interventional radiologist in pelvic trauma, especially given the multidisciplinary setting.

Abstract Background Aim of this study was to clarify the best laparoscopic subtotal cholecystectomy (LSTC) technique for finalizing a difficult cholecystectomy. Patients and methods A review was performed (1987–2021) searching "difficulty cholecystectomy" AND/OR "subtotal cholecystectomy". The LSTC techniques considered were as follows: type A, leaving posterior wall attached to the liver and the remainder of the gallbladder stump open; type B, like type A but with the stump closed; type C, resection of both the anterior and posterior gallbladder walls and the stump closed; type D, like type C but with the stump open. Morbidity (including mortality) was analysed with Dindo–Clavien classification. Results Nineteen articles were included. Of the 13,340 patients screened, 678 (8.2%) had cholecystectomy finalized by LSTC: 346 patients (51.0%) had type A LSTC, 134 patients (19.8%) had type B LSTC, 198 patients (29.2%) had type C LSTC, and 198 patients (0%) had type D LSTC. Bile leakage was found in 83 patients (12.2%), and recorded in 58 patients (69.9%) treated by type A. Twenty-three patients (3.4%) developed a subhepatic collection, 19 of whom (82.6%) were treated by type A. Other complications were reported in 72 patients (10.6%). The Dindo–Clavien classification was four for grade I, 27 for grade II, 126 for grade IIIa, 18 for grade IIIb, zero for grade IV and three for grade V. Conclusion In the case of LSTC, closure of the gallbladder stump represents the best method to avoid complications. Careful exploration of the gallbladder stump is mandatory, washing the abdominal cavity and leaving drainage.

Photocatalysis is a promising technology for the degradation of recalcitrant organic pollutants in water. In this study, superparamagnetic zinc ferrite nanoparticles (ZnFe2O4) were synthesized and characterized using scanning electron microscopy, X-ray diffraction, energy dispersive X-ray and Fourier transform infrared spectroscopy. The synthesized nanoparticles (NPs) of ZnFe2O4 were observed to have a photosensitive nature and showed characteristic visible-light-induced activation that was used for the photocatalytic degradation of a textile dye, Remazol brilliant violet 5R (RBV-5R). The effect of different operational parameters such as pH, H2O2, catalyst dosage, concentration of RBV-5R and the reusability of ZnFe2O4 as well as scavengers were investigated under visible irradiation. The almost complete degradation (99.9%) of RBV-5R was observed at pH 10, 0.1 g of ZnFe2O4 and 6 mM of H2O2 in 30 min. The photocatalytic degradation of RBV-5R followed pseudo-first-order kinetics. The mineralization was calculated from total organic carbon (TOC) that was represented by 82% TOC removal in 30 min. The results revealed that visible-light-induced ZnFe2O4 photocatalysis may be a promising technology for the elimination of toxic organic dyes, such as RBV-5R, from water resources.

Hydrogen peroxide acts as a byproduct of oxidative metabolism, and oxidative stress caused by its excess amount, causes different types of cancer. Thus, fast and cost-friendly analytical methods need to be developed for H2O2. Ionic liquid (IL)-coated cobalt (Co)-doped cerium oxide (CeO2)/activated carbon (C) nanocomposite has been used to assess the peroxidase-like activity for the colorimetric detection of H2O2. Both activated C and IL have a synergistic effect on the electrical conductivity of the nanocomposites to catalyze the oxidation of 3,3′,5,5′-tetramethylbenzidine (TMB). The Co-doped CeO2/activated C nanocomposite has been synthesized by the co-precipitation method and characterized by UV–Vis spectrophotometry, FTIR, SEM, EDX, Raman spectroscopy, and XRD. The prepared nanocomposite was functionalized with IL to avoid agglomeration. H2O2 concentration, incubation time, pH, TMB concentration, and quantity of the capped nanocomposite were tuned. The proposed sensing probe gave a limit of detection of 1.3 × 10−8 M, a limit of quantification of 1.4 × 10−8 M, and an R2 of 0.999. The sensor gave a colorimetric response within 2 min at pH 6 at room temperature. The co-existing species did not show any interference during the sensing probe. The proposed sensor showed high sensitivity and selectivity and was used to detect H2O2 in cancer patients’ urine samples.

Silicone breast implant ruptures have been widely reported in the literature. Granuloma formation is a known complication of such ruptures with reported sites including the axillae, limbs, chest wall muscles, and internal organs, such as the lungs and the liver. To the best of our knowledge, there are no reported cases of a silicone granuloma causing osteomyelitis of the sternum and multiple ribs in the absence of infection. We therefore report on the case of an 81-year-old patient who presented with an anterior chest wall discharging sinus tract on the background of a ruptured silicone breast implant. We raise awareness about the potentially devastating complications resulting from a ruptured silicone implant with relevance to cardiothoracic practice.

In this study, activated carbon derived from Monotheca buxifolia waste seeds was used for the adsorptive removal of a number of selected azo dyes such as Eriochrome Black T (EBT), Remazol brilliant blue (RBB), Remazol yellow (RY) and Remazol brilliant orange (RBO) from an aqueous solution by changing the initial dye concentration, adsorbent dosage, solution pH, contact time and temperature. A Fourier transform infrared spectroscopic analysis of the activated carbon showed the existence of hydroxyls, methyl, methylene, carbonyls, alkane and alkenes groups while the scanning electron microscopic image displayed the gradual formation of cavities and open pores on the surface. The results showed that as the amount of the adsorbent and the shaking time were increased, the removal percentage of the dye increased accordingly. Higher adsorption percentages were observed at a lower dye concentration and temperature in an acidic media at a pH range (1-5). The investigated data were evaluated with the Langmuir and Freundlich adsorption models. The maximum adsorption capacities obtained from the Langmuir model were 112.36, 96.34, 97.65 and 90.91 mg/g for EBT, RBB, RY and RBO, respectively. The results indicated that the electrostatic interaction was the main cause of the adsorption of these anionic azo dyes on the surface of the activated carbon.

Background Penetrating gluteal injuries (PGIs) are an increasingly common presentation to major trauma centers (MTCs) in the UK and especially in London. PGIs can be associated with mortality and significant morbidity. There is a paucity of consistent guidance on how best to investigate and manage these patients.Methods A retrospective cohort study was performed by interrogating prospectively collected patient records for PGI presenting to a level 1 MTC in London between 2017 and 2019.Results There were 125 presentations with PGI, accounting for 6.86% of all penetrating injuries. Of these, 95.2% (119) were male, with a median age of 21 (IQR 18–29), and 20.80% (26) were under 18. Compared with the 3 years prior to this study, the number of PGI increased by 87%. The absolute risk (AR) of injury to a significant structure was 27.20%; the most frequently injured structure was a blood vessel (17.60%), followed by the rectum (4.80%) and the urethra (1.60%). The AR by anatomic quadrant of injury was highest in the lower inner quadrant (56%) and lowest in the upper outer quadrant (14%). CT scanning had an overall sensitivity of 50% and specificity of 92.38% in identifying rectal injury.Discussion The anatomic quadrant of injury can be helpful in stratifying risk of rectal and urethral injuries when assessing a patient in the emergency department. Given the low sensitivity in identifying rectal injury on initial CT, this data supports assesing any patients considered at high risk of rectal injury with an examination under general anesthetic with or without rigid sigmoidoscopy . The pathway has created a clear tool that optimizes investigation and treatment, minimizing the likelihood of missed injury or unnecessary use of resources. It therefore represents a potential pathway other centers receiving a similar trauma burden could consider adopting.Level of evidence 2b.

Background: Cancer treatments have gradually evolved into targeted molecular therapies characterized by a unique mechanism of action instead of non-specific cytotoxic chemotherapies. However, they have unique safety concerns. For instance, endocrinopathies, which are defined as unfavorable metabolic alterations including thyroid disorders, hyperglycemia, dyslipidemia, and adrenal insufficiency necessitate additional monitoring. The aim of this study was to assess the prevalence of monitoring errors and develop strategies for monitoring cancer patients who receive targeted therapies. Method: A retrospective chart review was used to assess the prevalence of monitoring errors of endocrinopathies among cancer patients who received targeted therapies over one year. All of the adult cancer patients diagnosed with a solid tumor who received targeted therapies were included. The primary outcome was to determine the prevalence of monitoring errors of endocrinopathies. The secondary outcomes were to assess the incidences of endocrinopathies and referral practice to endocrinology services. Results: A total of 128 adult patients with solid tumors were involved. The primary outcome revealed a total of 148 monitoring errors of endocrinopathies. Monitoring errors of the lipid profile and thyroid functions were the most common error types in 94% and 92.6% of the patients treated with novel targeted therapies, respectively. Subsequently, 57% of the monitoring errors in the blood glucose measures were identified. Targeted therapies caused 63 events of endocrinopathies, hyperglycemia in 32% of the patients, thyroid disorders in 15.6% of them and dyslipidemia in 1.5% of the patients. Conclusion: Our study showed a high prevalence of monitoring errors among the cancer patients who received targeted therapies which led to endocrinopathies. It emphasizes the importance of adhering to monitoring strategies and following up on the appropriate referral process.

In patients undergoing emergent operation for trauma, surgeons must decide whether to perform a definitive or damage control (DC) procedure. DC surgery (abbreviated initial surgery followed by planned reoperation after a period of resuscitation in the intensive care unit) has been suggested to most benefit patients more likely to succumb from the “vicious cycle” of hypothermia, acidosis, and coagulopathy and/or postoperative abdominal compartment syndrome (ACS) than the failure to complete organ repairs. However, there currently exists no unbiased evidence to support that DC surgery benefits injured patients. Further, the procedure is associated with substantial morbidity, long lengths of intensive care unit and hospital stay, increased healthcare resource utilization, and possibly a reduced quality of life among survivors. Therefore, it is important to ensure that DC laparotomy is only utilized in situations where the expected procedural benefits are expected to outweigh the expected procedural harms. In this manuscript, we review the comparative effectiveness and safety of DC surgery when used for different procedural indications. We also review recent studies suggesting variation in use of DC surgery between trauma centers and the potential harms associated with overuse of the procedure. We also review published consensus indications for the appropriate use of DC surgery and specific abdominal, pelvic, and vascular DC interventions in civilian trauma patients. We conclude by providing recommendations as to how the above list of published appropriateness indications may be used to guide medical and surgical education, quality improvement, and surgical practice.

Hydrogen peroxide (H2O2) is a byproduct of oxidative metabolism, acts as a signaling molecule, and can induce protein and DNA damage by oxidative stress. Ionic liquid-coated lignin stabilized silver nanoparticles (LAgNPs) have been used for the colorimetric detection of H2O2. Both ionic liquid and lignin moieties have a synergistic effect on the conductivity of silver nanoparticles to display intrinsic peroxidase-like activity with the enhanced potential to catalyze the oxidation of substrate 3,3′,5,5′-tetramethylbenzidine (TMB). LAgNPs have been synthesized by the green synthesis method and the prepared nanoparticles have been characterized by different techniques such as FTIR, EDX, TGA, SEM, and XRD. 1-H-3-methylimidazolium acetate (ionic liquid) was prepared and used for tuning of AgNPs. By using ionic liquid capped LAgNPs the colorimetric detection of H2O2 was done with the assistance of TMB solution and results were analyzed by UV–Vis spectrophotometer. Different parameters such as (amount of capping agent and TMB, pH, H2O2 concentration, and time) were optimized to get the best results of the proposed sensor. The H2O2 biosensor exhibited a linear response in the range of 1 × 10−9–3.6 × 10−7 M, with a detection limit of 1.379 × 10−8 M and a quantification limit of 4.59 × 10−8 M, and R2 of 0.999. The sensor gave a short response time of 5 min for colorimetric detection of H2O2 at pH 7.5 and room temperature. For the detection of hydrogen peroxide, the proposed sensor showed good sensitivity and selectivity and was successfully employed for the detection of H2O2 in the blood serum samples of hypertension patients.

Objective: The purpose of this in vitro study was to investigate variations in the root canal morphology of mesiobuccal root of maxillary first permanent molars in local population of Rawalpindi and Islamabad. Study Design: Descriptive cross sectional study. Place and Duration of Study: The study was conducted from 1 January to 30th June 2017 at Islamic International Dental Hospital (IIDH), Riphah International University, Pakistan. Materials and Methods: Mesiobuccal root of eighty two maxillary first permanent molar teeth collected from Islamabad and Rawalpindi were analyzed using the Clearing Technique. Convenience sampling technique was used. Data was analyzed by using SPSS version 24. Descriptive statistics were used. Frequency and percentages were calculated for types of canal configuration. Results: The frequency of a single canal orifices in the mesiobuccal root of maxillary first molar was 48.7% (type I, III, V and others), that with two canal orifices was 50% (type II, IV, VI and others), whereas with three canal orifices was 1.23% . Conclusion: According to the results of this study, a second canal is common occurrence in local population of Rawalpindi and Islamabad. The distribution of canal configurations of our population differs from other populations suggesting ethnic/racial divergence.

Wind power forecasting plays a key role in the design and maintenance of wind power generation which can directly help to enhance environment resilience. Offshore wind power forecasting has become more challenging due to their operation in a harsh and multi-faceted environment. In this paper, the data generated from offshore wind turbines are used for power forecasting purposes. First, fragmented data is filtered and Deep Auto-Encoding is used to select high dimensional features. Second, a mixture of the CNN and LSTM models is used to train prominent wind features and further improve forecasting accuracy. Finally, the CNN-LSTM deep learning hybrid model is fine-tuned with various parameters for reliable forecasting of wind energy on three different offshore Windfarms. A state-of-the-art comparison against existing models is presented based on root mean square error (RMSE) and mean absolute error (MAE) respectively. The forecasting analyses indicate that the proposed CNN-LSTM strategy is quite successful for offshore wind turbines by retaining the lowest RMSE and MAE along with high forecasting accuracy. The experimental findings will be helpful to design environment resilient energy transition pathways.

ABSTRACT Introduction: extremity tourniquet (TQ) use has increased in the civilian setting; the beneficial results observed in the military has influenced acceptance by EMS and bystanders. This review aimed to analyze extremity TQ types used in the civilian setting, injury site, indications, and complications. Methods: a systematic review was conducted based on original articles published in PubMed, Embase, and Cochrane following PRISMA guidelines from 2010 to 2019. Data extraction focused on extremity TQ use for hemorrhage control in the civilian setting, demographic data, study type and duration, mechanism of injury, indications for use, injury site, TQ type, TQ time, and complications. Results: of the 1384 articles identified, 14 were selected for review with a total of 3912 civilian victims with extremity hemorrhage and 3522 extremity TQ placements analyzed. The majority of TQs were applied to male (79%) patients, with blunt or penetrating trauma. Among the indications for TQ use were hemorrhagic shock, suspicion of vascular injuries, continued bleeding, and partial or complete traumatic amputations. Upper extremity application was the most common TQ application site (56%), nearly all applied to a single extremity (99%), and only 0,6% required both upper and lower extremity applications. 80% of the applied TQs were commercial devices, and 20% improvised. Conclusions: TQ use in the civilian setting is associated with trauma-related injuries. Most are single-site TQs applied for the most part to male adults with upper extremity injury. Commercial TQs are more commonly employed, time in an urban setting is under 1 hour, with few complications described.

Non-compressible torso hemorrhage (NCTH) (i.e. bleeding from anatomical locations not amenable to control by direct pressure or tourniquet application) is a leading cause of potentially preventable death after injury. In select trauma patients with infra-diaphragmatic NCTH-related hemorrhagic shock or traumatic circulatory arrest, occlusion of the aorta proximal to the site of hemorrhage may sustain or restore spontaneous circulation. While the traditional method of achieving proximal aortic occlusion included Emergency Department thoracotomy (EDT) with descending thoracic aortic cross-clamping, resuscitative endovascular balloon occlusion of the aorta (REBOA) affords a less invasive option when thoracotomy is not required for other indications. In this article, we review the innovation, pathophysiologic effects, indications for, and technique of EDT and partial, intermittent, and complete REBOA in injured patients, including recommended methods for reversing aortic occlusion. We also discuss advantages and disadvantages of each of these methods of proximal aortic occlusion and review studies comparing their effectiveness and safety for managing post-injury NCTH. We conclude by providing recommendations as to when each of these methods may be best, when indicated, to manage injured patients with NCTH.

Sternal osteomyelitis is a morbid and challenging condition, which can rarely occur after trauma, with no established consensus over best therapeutic options. In this case, a 47-year-old man with history of intravenous drug use presented 11 weeks after a minor blunt chest trauma with a severe necrotizing osteomyelitis involving sternum, muscles, fascia and subcutaneous tissue and positive blood cultures for Methicillin Sensitive Staphylococcus aureus. Alongside tailored antibiotic therapy, extensive surgical debridement was performed, leaving a full thickness 3 × 4 cm sternal defect and a large skin defect. After 4 weeks of antibiotics and Vacuum-Assisted-Closure pump, a novel reconstruction technique was utilized, with full collaborations of thoracic surgeons, orthopaedic surgeons and plastic surgeons. An autologous tricortical iliac crest bone graft was harvested and shaped to fit the full-thickness sternal defect, while two titanium sigmoid-shaped clavicle plates were used for internal fixation of the autograft. The large skin defect was covered with a pedicled myocutaneous latissimus dorsi flap. Integrity and stability of the chest wall was fully restored, and infection was completely eradicated. No complications occurred and the patient was well at the 18 months follow-up. To the best of our knowledge, this is the first report on autologous iliac crest bone graft in the treatment of sternal osteomyelitis. In this case, it proved to be a viable therapeutic option, providing good long-term clinical and cosmetic results.

Intrauterine devices (IUDs) are the most common form of contraceptive used worldwide. The imaging features of IUDs and their potential complications are crucial to recognize in order to determine adequate positioning and ultimately function of the IUD. Herein, we report a rare case of a copper IUD embedded in the left fallopian tube that required surgical removal. Only a few such cases have been reported in the literature to date. Keywords: IUD, Fallopian tube, Copper IUD, Embedment

Herein, we report the synthesis of magnetic nanoparticle (MNP)-reduced graphene oxide (rGO) and polymethylmethacrylate (PMMA) composite (MNPs/rGO/PMMA) as adsorbent via an in situ fabrication strategy and, in turn, the application for adsorptive removal and recovery of Cr(VI) from tannery wastewater. The composite material was characterized via XRD, FTIR and SEM analyses. Under batch mode experiments, the composite achieved maximum adsorption of the Cr(VI) ion (99.53 ± 1.4%, i.e., 1636.49 mg of Cr(VI)/150 mg of adsorbent) at pH 2, adsorbent dose of 150 mg/10 mL of solution and 30 min of contact time. The adsorption process was endothermic, feasible and spontaneous and followed a pseudo-2nd order kinetic model. The Cr ions were completely desorbed (99.32 ± 2%) from the composite using 30 mL of NaOH solution (2M); hence, the composite exhibited high efficiency for five consecutive cycles without prominent loss in activity. The adsorbent was washed with distilled water and diluted HCl (0.1M), then dried under vacuum at 60 °C for reuse. The XRD analysis confirmed the synthesis and incorporation of magnetic iron oxide at 2θ of 30.38°, 35.5°, 43.22° and 57.36°, respectively, and graphene oxide (GO) at 25.5°. The FTIR analysids revealed that the composite retained the configurations of the individual components, whereas the SEM analysis indicated that the magnetic Fe3O4–NPs (MNPs) dispersed on the surface of the PMMA/rGO sheets. To anticipate the behavior of breakthrough, the Thomas and Yoon–Nelson models were applied to fixed-bed column data, which indicated good agreement with the experimental data. This study evaluates useful reference information for designing a cost-effective and easy-to-use adsorbent for the efficient removal of Cr(VI) from wastewater. Therefore, it can be envisioned as an alternative approach for a variety of unexplored industrial-level operations.

Background Financial, clinical, and psychological considerations have made same-day surgery an attractive option for a variety of procedures. This article aimed to analyse the postoperative results of same-day primary unilateral cleft nasolabial repair. Methods This study was performed from 2011 to 2014. Unilateral cleft lip patients fulfilling the inclusion criteria were preoperatively classified as mild, moderate, and severe. All patients underwent same-day surgery and were discharged after satisfying the appropriate clinical criteria, receiving thorough counselling, and the establishment of a means of communication by phone. Postoperative outcomes were assessed and stratified according to preoperative severity and the type of repair. Results A total of 423 primary unilateral cleft lip patients were included. Fisher's anatomical subunit approximation technique was the most common procedure, followed by Noordhoff's technique. The postoperative outcome was good in 89.8% of cases, fair in 9.9% of cases, and poor in 0.2% of cases. The complication rate was 1.18% (n=5), and no instances of mortality were observed. The average hospital stay was 7.5 hours, leading to a cost reduction of 19% in comparison with patients who stayed overnight for observation. Conclusions Mild unilateral cleft lip was the most common deformity for which Fisher's anatomical subunit approximation technique was performed in most of the cases, with satisfactory postoperative outcomes. Refinements in the cleft rhinoplasty techniques over the course of the study improved the results regarding cleft nasal symmetry. Single-day primary unilateral cleft cheiloplasty was found to be a cost-effective procedure that did not pose an additional risk of complications.

Subcutaneous emphysema of the scalp is a process often attributed to secondary factors such as trauma, infection, or a myriad of iatrogenic etiologies. Here, we are presenting a case report of an adult patient with spontaneous subcutaneous emphysema of the scalp following a hair coloring/treatment. We performed an extensive review of literature on this topic, however, could not find a single case with similar presentation of subcutaneous emphysema. This case demonstrates an unreported etiology for this diagnosis and is thus being reported for its uniqueness and to raise clinical awareness.

Wind power forecasting plays a vital role in renewable energy production. Accurately forecasting wind energy is a significant challenge due to the uncertain and complex behavior of wind signals. For this purpose, accurate prediction methods are required. This paper presents a new hybrid approach of principal component analysis (PCA) and deep learning to uncover the hidden patterns from wind data and to forecast accurate wind power. PCA is applied to wind data to extract the hidden features from wind data and to identify meaningful information. It is also used to remove high correlation among the values. Further, an optimized deep learning algorithm with a TensorFlow framework is used to accurately forecast wind power from significant features. Finally, the deep learning algorithm is fine-tuned with learning error rate, optimizer function, dropout layer, activation and loss function. The algorithm uses a neural network and intelligent algorithm to predict the wind signals. The proposed idea is applied to three different datasets (hourly, monthly, yearly) gathered from the National Renewable Energy Laboratory (NREL) transforming energy database. The forecasting results show that the proposed research can accurately predict wind power using a span ranging from hours to years. A comparison is made with popular state of the art algorithms and it is demonstrated that the proposed research yields better predictions results.

Biodiesel production is a field of outstanding prospects due to the renewable nature of its feedstock and little to no overall CO2 emissions to the environment. Data-based soft sensors are used in realizing stable and efficient operation of biodiesel production. However, the conventional data-based soft sensors cannot grasp the effect of process uncertainty on the process outcomes. In this study, a framework of data-based soft sensors was developed using ensemble learning method, i.e., boosting, for prediction of composition, quantity, and quality of product, i.e., fatty acid methyl esters (FAME), in biodiesel production process from vegetable oil. The ensemble learning method was integrated with the polynomial chaos expansion (PCE) method to quantify the effect of uncertainties in process variables on the target outcomes. The proposed modeling framework is highly accurate in prediction of the target outcomes and quantification of the effect of process uncertainty.

Objectives: To analyse the demographics, mechanism, nature, anatomical distribution, management and complications in trauma patients presenting to the plastic surgery unit. Study Design: Descriptive cross-sectional study. Setting: This study was conducted in the Plastic and Reconstructive Surgery Unit, Hayatabad Medical Complex, Peshawar, from 1 st January 2009 to 30 th April 2012. Materials and Methods: All trauma patients referred from emergency department and other departments irrespective of age and gender were enrolled in the study, excluding acute burns and trauma sequelae patients. The details were obtained from the data sheets of the patients. All the data were analysed and projected in the form of tables and figures. Results: A total of 1034 patients including 855 (82.7%) males and 179 (17.3%) females presented with plastic surgical trauma, with age ranging from 1 to 86 years, with a mean age of 20.84 ± 15.469 SD. The upper limb was affected in 492 (47.6%) patients, followed by head and neck in 273 (26.4%) cases. Road traffic accidents (RTAs) were the main cause of trauma, affecting 340 (32.9%) patients. Wound excision and closure was performed in 473 (45.7%) patients, followed by skin grafting and flap coverage in 232 (22.4%) and 132 (13.2%) patients, respectively. Postoperative complications were observed in 45 (4.35%) patients. Conclusion: Males in their young age mainly presented with plastic surgical trauma with RTA as the main mechanism and laceration as the most common type of these injuries. The upper limb was the most commonly affected region. The frequency of different types of surgical procedures and postoperative complications observed are comparable with international literature except for the microvascular surgery which is not performed in our centre. Regular audit of the plastic surgical trauma should be conducted in all plastic surgical units to both improve trauma care and reaffirm the role of Plastic Surgery in the new age trauma.

Objectives: To determine the frequency of different types of cleft lip and palate, geographical distribution and its association with consanguinity, family history and other syndromes in the Northern Pakistani population. Study design: Descriptive cross-sectional study. Settings: This study was performed in Plastic and Reconstructive units of Hayat Medical Complex Peshawar Pakistan, Aman Hospital Peshawar Pakistan and Abasin Hospital Peshawar, Pakistan from November 2010 to December 2011. Material and Methods: All the patients, irrespective of their gender, presenting with cleft lip/palate deformities were included in the study. Previously operated cases and those who did not agree with the study protocol were excluded from the study. The data were collected through questionnaires as well as history and physical examination. The data were organized and analyzed through Statistical Package for Social Sciences version 17 (SPSS 17). The results were expressed in the form of tables and figures. Results: A total of 159 patients of cleft lip and cleft palate deformities were included in the study, having a mean age of 3.5+6.59 years and containing 59.1% males and 40.9% females with a ratio of 1.4:1. A cleft lip with palate, cleft palate and cleft lip were found in 51.6%, 31.4% and 17% of cases, respectively. Left-sided clefts were most common in the cleft lip with palate and the isolated cleft lip deformity. A cleft lip with palate was a male dominant variety (62.8% of cases), while in the cleft palate variety, the dominant gender was female. In 61.6% of cases, the parent had a consanguineous relationship. In 21.4% of cases, family history was positive for the cleft lip/palate. Other congenital anomalies were associated in 10.7% of cases. Conclusion: Cleft deformities of the lip and palate affect the male population more than females with cleft lips, in association with a cleft palate being the most common anomaly. Females are mainly affected by an isolated cleft palate. The high prevalence of these deformities in consanguineous marriages emphasizes educating people. The lower number of patients from distant distracts of Northern Pakistan calls for the attention of the health department. [Arch Clin Exp Surg 2012; 1(2.000): 63-70]

Background/Aim: The aim of the study was to compare laparoscopic and open appendectomy (OA) in terms of primary outcome measures. Study design: A randomized controlled trial. Place and duration of the study: Khyber Teaching Hospital, Peshawar, Pakistan, February 2008 to December 2009. Patients and Methods: A total of 160 patients were divided into two groups, A and B. Group A patients were subjected to laparoscopic appendectomy (LA), whereas Group B patients were subjected to OA. Data regarding age, gender, and primary outcome measures, such as hospital stay, operative duration, and postoperative complication, were recorded and analyzed. Percentages were calculated for categorical data, whereas numerical data were represented as mean ± SD. Chi-square test and t test were used to compare categorical and numerical variables, respectively. Probability ≤ 0.05 (P ≤ 0.05) was considered significant. Results: After randomization, 72 patients in group A and 75 patients in group B were analyzed. The mean age of patients in groups A and B was 23.09 ± 8.51 and 23.12 ± 10.42 years, respectively, (P = 0.981). The mean hospital stay was 1.52 ± 0.76 days in group A and 1.70 ± 1.06 days in group B (P = 0.294). The mean operative duration in group A and B were 47.54 ± 12.82 min and 31.36 ± 11.43 min, respectively (P < 0.001). Pain (overall level) was significantly less in group A compared with group B (P = 0.004). The two groups were comparable in terms of other postoperative complications, such as hematoma (P = 0.87), paralytic ileus (P = 0.086), urinary retention (P = 0.504), and wound infection (P = 0.134). Conclusion: LA is an equivalent procedure and not superior to OA in terms of primary outcome measures.

Dry band formation on the surface of outdoor insulators is one of the main reasons leading to flashover and power outages. In this paper, a dynamic arc model is proposed for single and multiple dry bands configuration to predict the critical flashover voltage for silicone rubber outdoor insulators. An arc is modelled as a time dependent impedance consisting of a Resistor Inductor Capacitor (RLC) circuit. The effect of dry band location and existence of multiple dry bands on critical flashover voltage is investigated. To validate the proposed model, experiments were conducted in a climate chamber under controlled environmental conditions on rectangular silicone rubber sheets polluted using improved solid layer method based on IEC 60,507. Tests were conducted at different dry band configurations and pollution severity levels. A good correlation was found between experimental results and simulation results. This model can provide a good foundation for the development of mathematical models for station post insulators having multiple dry and clean bands and can be used in the design and selection of outdoor insulators for polluted conditions.

The effect of alfalfa seed flour supplementation on the quality characteristics of refined wheat flour-based biscuits was studied. The proximate composition of refined wheat flour and alfalfa seed flour was determined. Refined wheat flour contained 12.43% moisture, 11.52% crude protein, 1.61% crude fat, 0.71% crude fiber, 1.43% ash and 70.83% nitrogen free extract, while alfalfa seed flour contained 5.79%, 29.49%, 12.71%, 5.53%, 4.80% and 41.73% moisture, crude protein, crude fat, crude fiber, ash and nitrogen free extract correspondingly. Alfalfa seed flour at 5%, 10%, 15% and 20% supplementation levels was incorporated in refined wheat flour to produce composite flour. The biscuits prepared were subjected to quality evaluation. Physical analysis of biscuits disclosed that supplementation of alfalfa seed flour decreased the width from 47.25 to 42 mm and the spread factor from 62.7 to 53.12, while it increased the thickness from 7.53 to 8.10 mm. Supplementation of refined wheat flour–based biscuits with alfalfa seed flour at different inclusion levels significantly (p < 0.05) increased the crude protein content from 10.19% to 15.30%, the crude fiber content from 0.73% to 1.62%, the crude fat content from 17.46% to 21.59% and the ash content from 1.37% to 1.92%, whereas it decreased the moisture content from 3.57% to 3.26% and the nitrogen free extract from 66.90% to 59.32%. The effect of supplementation on the mineral contents of biscuits was also significant (p < 0.05). Potassium, magnesium, calcium, iron and zinc contents increased from 105.30, 14.65, 43.91, 3.74 and 0.94 to 145.00, 26.64, 79.60, 7.93 and 1.60 mg/100 g, respectively. Sensory evaluation revealed that the quality score of biscuits in terms of color, taste, texture and overall acceptability decreased with increased supplementation. The present research work confirmed that a maximum of 10% alfalfa seed flour supplementation in refined wheat flour could produce acceptable biscuits with an appropriate nutritional profile.

ABSTRACT A case of multiple liver abscesses in a patient with situs inversus totalis is presented. Initially the patient was treated conservatively and remained symptom free for 4 days of hospital stay. On a follow up visit after 1 week the patient had high grade spiking fever and ultrasonography showed expanding multiple abscesses. The patient was restarted on intravenous antibiotics which resolved the disease. Keywords: This article may be cited as: Situs Inversus Viscerum, Situs Inversus Totalis, Liver Abscess, Kartagener’s Syndrome, Situs Solitus,DNAH11, Mirror Image Mufti TS, Khan M, Alam MB, Mufti SE . Situs inversus totalis with liver abscess. KUST Med J 2009; 1 (1): 21-23