Early outcome of pediatric pyeloplasty in kidneys with split renal function less than 10%: A prospective study of 25 cases

Objectives: To detect the outcome of pyeloplasty in kidneys with split renal function (SRF) less than 10% in the pediatric age group.Subjects and methods: We prospectively analyzed the data from 25 cases of ureteropelvic junction obstruction (UPJO) candidate for pyeloplasty with SRF less than 10%. Abdominopelvic ultrasonography and diuretic renogram using technetium-99 m diethylenetriamine Penta acetic acid (DTPA) were done in all cases. We studied the improvement in pelvic anteroposterior diameter (APD) postoperatively. We compared pre and postoperative SRF after six months and one year.Results: The median age was 24 months (3 months–11 years), male to female 2:1. The median preoperative SRF was 5% (range: 0%–10%) and the median APD of the renal pelvis was 3 cm (range: 2.2–5). There was significant improvement of median APD 0.8 cm (range: 0.5–1.9) (P value <0.05). There was a significant postoperative improvement in the median SRF (P-value <0.05) as the median SRF after 6 months and 1 year were 21% and 20%, respectively but there was no significant difference between SRF at six months and one year (P value 0.174).Conclusion: Pyeloplasty provides high rates of functional success even in very poorly functioning kidneys with SRF ≤10% by DTPA renogram in pediatric age group

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Flower pollination algorithm to solve combined economic and emission dispatch problems

Economic Load Dispatch (ELD) is the process of allocating the required load between the available generation units such that the cost of operation is minimized. The ELD problem is formulated as a nonlinear constrained optimization problem with both equality and inequality constraints. The dual-objective Combined Economic Emission Dispatch (CEED) problem is considering the environmental impacts that accumulated from emission of gaseous pollutants of fossil-fuelled power plants. In this paper, an implementation of Flower Pollination Algorithm (FPA) to solve ELD and CEED problems in power systems is discussed. Results obtained by the proposed FPA are compared with other optimization algorithms for various power systems. The results introduced in this paper show that the proposed FPA outlasts other techniques even for large scale power system considering valve point effect in terms of total cost and computational time

Flower pollination algorithm to solve combined economic and emission dispatch problems

Economic Load Dispatch (ELD) is the process of allocating the required load between the available generation units such that the cost of operation is minimized. The ELD problem is formulated as a nonlinear constrained optimization problem with both equality and inequality constraints. The dual-objective Combined Economic Emission Dispatch (CEED) problem is considering the environmental impacts that accumulated from emission of gaseous pollutants of fossil-fuelled power plants. In this paper, an implementation of Flower Pollination Algorithm (FPA) to solve ELD and CEED problems in power systems is discussed. Results obtained by the proposed FPA are compared with other optimization algorithms for various power systems. The results introduced in this paper show that the proposed FPA outlasts other techniques even for large scale power system considering valve point effect in terms of total cost and computational time

Preliminary study of the efficacy of the combination of tamsulosin and trospium as a medical expulsive therapy for distal ureteric stones

Objectives: To evaluate and compare the efficacy of tamsulosin (0.4 mg, once/day) and combinations of it with trospium (20 mg, twice/day) in the treatment of single small lower ureteral stones. Patients and methods: A total of 126 patients presenting to urology outpatient clinics from July 2012 to May 2015, with a single 5–10 mm sized lower ureteral stone were randomly classified into two treatment groups. Patients in group A (n = 62) received an oral dose of 0.4 mg tamsulosin once daily and 20 mg trospium chloride twice daily. Patients in group B (n = 64) received 0.4 mg tamsulosin once daily and placebo twice daily. The spontaneous passage of stones, the stone expulsion time, and adverse effects were evaluated. Results: There were no significant differences in baseline characteristic of the patients in both groups. Stone expulsion was observed in 47 patients (75.8%), and 58 (90.62%) in groups A and B respectively. The average time to expulsion was 11.65 ± 5.32 days in group A and 17.35 ± 6.21 days in group B. The spontaneous stone passage rate through the ureter was significantly higher and the stone expulsion time was faster in groups A than in group B (p < 0.05). The adverse effects observed in both groups were comparable and were mild. Conclusions: The combination of 0.4 mg tamsulosin and 40 mg trospium as MET for single lower ureteral stones <10 mm is safe and more effective than 0.4 mg tamsulosin as a mono-therapy

Annealing effects on the structural, electrical and optical properties of ZnO thin films prepared by thermal evaporation technique

Zinc oxide (ZnO) thin films have been prepared on glass substrates at room temperature by thermal evaporation technique using ZnO powders and then are annealed at different temperatures ranging from 200 °C to 500 °C for 2 h in air. The effect of the annealing temperature (Tr) on the structural, optical and electrical properties of the ZnO thin films was studied. Experimental results show that annealing temperature has an important role in the changes observed in the structural, optical and electrical properties of the ZnO thin films. The XRD measurements confirm that the thin films grown by this technique have good crystalline hexagonal wurtzite structures. The optical transmittance spectra show transmittance higher about ∼90% within the visible wavelength region. Hence, the values of the gap are found to be between 3.13 and 3.25 eV. The resistivity values of the films have changed between 2.10−3 and 4.10−2 Ω cm with annealing temperature

Diagnostic performance of Multislice Computed Tomography in evaluation of coronary artery bypass grafts in diabetic and non-diabetic patients

We sought to evaluate the diagnostic accuracy of noninvasive dual-source multi-slice computed tomography (MSCT) angiography in the assessment of graft patency and degree of stenosis in patients after coronary artery bypass grafting (CABG). Background: Assessment of bypass grafts body and their anastomotic sites by invasive coronary angiography have a risk of potentially life-threatening complications and often require extra procedure time, contrast load, and radiation exposure. Methods: 64-dual-source MSCT was performed to 51 (49 men, mean age 58.6 ± 8 years, range from 38 to 76) post-CABG symptomatic patients. Control of heart rate was done with oral beta blockers, sublingual nitrates was given 2-3 min before the scan. Mean interval between CABG surgery and MSCT was 73.41 ± 65.84 (range 3 to 252) months. Mean heart rate during scanning was 62.5 ± 13.2 (range 52–72) beats/min. Ninety-four percent of patients had both arterial and venous grafts. A total of 142 graft body and 142 anastomotic sites were analyzed. Two grafts body and 4 anastomotic sites were excluded because they were non-evaluable by MSCT. A semi-quantitative assessment of the graft stenosis severity was done according to the recommendation of the Society of Cardiovascular Computed Tomography (SCCT) A significant stenosis was defined as equal to or >70%, moderate stenosis 40–69% and mild <40% lumen diameter reduction. A reference standard invasive coronary angiography was done according to conventional technique through standard trans-femoral approach and was evaluated by an observer blinded to the MSCT results. Results: The diagnostic accuracy of MSCT for the detection or exclusion of significant stenosis in grafts body and their anastomotic sites was 99.28%, sensitivity, specificity, positive and negative predictive values were 97.75%, 100%, 100%, 98.95%. The diagnostic accuracy for detection of degree of graft stenosis (mild, moderate, severe or occluded) was 97.18%. Conclusion: Noninvasive MSCT angiography is an excellent tool for evaluating patency or degree of stenosis of bypass grafts body and their anastomotic sites in post-CABG patients

Forgotten ureteral stents: Risk factors, complications and management

Objectives: To assess complications of neglected stents, risk factors for the occurrence of complications, and management options and outcomes. Subjects and methods: A prospective study including patients presenting to our center with neglected polyurethane ureteral stents (indwelling for more than 6 months in the period from February 2012 to September 2015). We noted the complications of neglected stents (urinary tract infections (UTI), urinary obstruction, elevated creatinine, encrustations and stent fragmentation), management challenges (need for complex endo-urologic or open procedures). We evaluated potential risk factors for these complications (duration of stenting, lack of urinary acidification, cause of stent placement). Results: The study included 68 patients with mean age 49.3 ± 12.6 years 80.9% were males. Mean stenting duration 17.3 ± 12.7 months. A total of 29% of patients received urine acidifier while the stent was indwelling, 92% were stone formers, 60% presented with UTI and 25% presented with elevated creatinine. Preoperative non-contrast spiral CT abdomen and pelvis showed encrustations on the stent in 23.5% of patients and fragmented stent in 13%. The stent was removed by cystoscopy only as an outpatient procedure in 26 (38.3%) cases (7 of them with encrustation) while 42 (61.7%) cases needed more than simple cystoscopy. Management challenges included need for complex endourological interventions (URS, PCNL, cystolithotripsy or even open surgery). Lack of urinary acidification was a significant risk factor for UTI and stent fragmentation (P-value = 0.038 and 0.006, respectively). Stone former patients needed complex interventions (P = 0.046). UTIs were more likely with longer duration of stenting (P = 0.027). Conclusion: Forgotten ureteral stents are associated with significant complications. Urinary acidification is protective against complications. Patients with stones are more liable to forgotten stents complications. Keywords: Ureteral stents, Infection, Encrustations, Urinary acidificatio