Is quadratus lumborum block combined with low dose-spinal anesthesia an effective alternative to general anesthesia in patients undergoing percutaneous nephrolithotomy?

Background: General anesthesia in high-risk patients has many complications and needs long preoperative preparations and postoperative intensive care unit (ICU). Therefore the present study aimed to evaluate the efficacy of combined low-dose spinal anesthesia with quadratus lumborum block (QLB) as an alternative to general anesthesia for patients undergoing percutaneous nephrolithotomy. Patients and methods: A prospective study was conducted at the urology department of Al-Azhar University Hospitals in Cairo, Egypt, from January 2021 to January 2022. The study included 60 patients of ASA ll-lll scheduled for percutaneous nephrolithotomy. All patients received low-dose spinal anesthesia (5 mg bupivacaine) and QLB (QL1-QL2-QL3) approaches. The primary observation parameter was the efficacy of this technique as an alternative to general anesthesia. The secondary parameters measured were evaluation of need for intraoperative narcotics, postoperative pain score (VAS), and patients satisfaction as assessed using a 5-point Likert Scale. Results: None of the patients was given general anesthesia, and intraoperative sedation was given to nineteen patients (32.2%). No hemodynamic changes were observed in all patients. There was a significant correlation between the use of intraoperative sedation and stone site, intraoperative blood loss, and hospital stay. Pain intensity on VAS at rest and movement was low until the 24th postoperative hour. Patient satisfaction score was 3, 4, and 5 in 1 (1.7%), 4 (6.7%), and 55 (91.6%) patients, respectively. Conclusions: Combined low-dose spinal anesthesia with quadratus lumborum block is an effective alternative to general anesthesia in patients undergoing PCNL procedures with good postoperative analgesia. Patients with lower calyceal punctures have a lower incidence of intraoperative sedation requirements

The Extended Inverse Weibull Distribution: Properties and Applications

This paper proposes the new three-parameter type I half-logistic inverse Weibull (TIHLIW) distribution which generalizes the inverse Weibull model. The density function of the TIHLIW can be expressed as a linear combination of the inverse Weibull densities. Some mathematical quantities of the proposed TIHLIW model are derived. Four estimation methods, namely, the maximum likelihood, least squares, weighted least squares, and Cramér–von Mises methods, are utilized to estimate the TIHLIW parameters. Simulation results are presented to assess the performance of the proposed estimation methods. The importance of the TIHLIW model is studied via a real data application

Bayesian Analysis of Dynamic Cumulative Residual Entropy for Lindley Distribution

Dynamic cumulative residual (DCR) entropy is a valuable randomness metric that may be used in survival analysis. The Bayesian estimator of the DCR Rényi entropy (DCRRéE) for the Lindley distribution using the gamma prior is discussed in this article. Using a number of selective loss functions, the Bayesian estimator and the Bayesian credible interval are calculated. In order to compare the theoretical results, a Monte Carlo simulation experiment is proposed. Generally, we note that for a small true value of the DCRRéE, the Bayesian estimates under the linear exponential loss function are favorable compared to the others based on this simulation study. Furthermore, for large true values of the DCRRéE, the Bayesian estimate under the precautionary loss function is more suitable than the others. The Bayesian estimates of the DCRRéE work well when increasing the sample size. Real-world data is evaluated for further clarification, allowing the theoretical results to be validated

Classical and Bayesian estimation for the extended odd Weibull power Lomax model with applications

A new continuous distribution called the extended odd Weibull power Lomax (ExOW-POLO) distribution is introduced and studied. Numerous reliability and statistical features are derived. Additionally studied are point estimates using maximum likelihood, maximum product space, least square, weighted least square, and Bayesian estimation techniques. The mean square error and bias of the maximum likelihood and Bayesian parameter estimators are computed using simulation approaches, such as Markov chain Monte Carlo. Two intraocular pressure (IOP) real datasets were conducted between January 2015 and February 2018 on 49 patients (84 eyes) under the age of two who presented with primary congenital glaucoma to the Paediatric Ophthalmology Unit of the Mansoura Ophthalmic Center of Mansoura University in Egypt have been fitted the ExOW-POLO distribution. Comparing the properties of the proposed distribution’s fitting of the data to recognized extensions of the Lomax distribution. The analysis revealed that the most well-known extensions of Lomax distribution were made by the ExOW-POLO distribution outfit. In addition, the correlation measures and independent sample test for the two IOP real datasets are introduced with (A) Levene’s test for equality of variances for the two cases and (B) the t-test for equality of means. For Levene’s test for equality of variances: the null hypothesis is that equal variances are assumed and the alternative hypothesis is that equal variances are not assumed

Inverse power Ramos–Louzada distribution with various classical estimation methods and modeling to engineering data

This work uses the inverse-power transformation to create the inverse power Ramos–Louzada distribution (IPRLD), a novel two-parameter version of the Ramos–Louzada distribution. The failure rate of the new distribution can be represented by a reverse bathtub shape, a rising shape, or a decreasing shape, making it appropriate for a range of real data. Asymmetrical and unimodal densities can be produced via the IPRLD. Its mathematical characteristics are computed in some cases. The novel proposed model’s structural characteristics are derived. To estimate the model parameters, several estimating strategies are explored, including ten classical methods. Simulation results with their partial and total ranks are used to evaluate the ranking and behavior of various approaches. Finally, two real-world datasets are used to experimentally show the suggested distribution’s adaptability. The analysis of the data reveals that the introduced distribution offers a better fit than some significant rival distributions, including the inverse Ramos–Louzada, inverse power Burr Hatke, inverse Nakagami-M, inverse log-logistic, inverse weighted Lindley, inverse Lindley, and Ramos–Louzada

A New Sine Family of Generalized Distributions: Statistical Inference with Applications

In this article, we extensively study a family of distributions using the trigonometric function. We add an extra parameter to the sine transformation family and name it the alpha-sine-G family of distributions. Some important functional forms and properties of the family are provided in a general form. A specific sub-model alpha-sine Weibull of this family is also introduced using the Weibull distribution as a parent distribution and studied deeply. The statistical properties of this new distribution are investigated and intended parameters are estimated using the maximum likelihood, maximum product of spacings, least square, weighted least square, and minimum distance methods. For further justification of these estimates, a simulation experiment is carried out. Two real data sets are analyzed to show the suggested model’s application. The suggested model performed well compares to some existing models considered in the study

Use of K-Y Jelly on Throat Packs for Postoperative Sore Throat after Nasal Surgery: A Randomized Controlled Trial

Introduction Postoperative sore throat (POST) is a fairly common side effect of general anesthesia. The K-Y jelly is a well-known lubricant used in many medical procedures

Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)