Outcome of Acute Peritonitis Related To Cause and Duration Of Presentation

Objective: To determine the outcome of acute cause-related peritonitis correlated with the duration of inflammation within 24, 24-48, and after 48 hours of hospital admission. Methodology: This quasi experimental study was conducted at Surgical Ward #3, Jinnah Postgraduate Medical Centre from September 2019 to March 2021. Patients over 12 years old were included in this study. The duration, cause, and outcomes of peritonitis were noted. All complications were recorded and treated accordingly. Results: 136 patients between the ages of 13 to 80 years old were included, 104 were males (76.8%) and 32 females (23.18%). 37 patients (28.2%) were aged 13–20 years, 61 (44.2%) were aged 21–40, 33 (23.91%) were aged 41–60, and 5 (3.6%) were aged over 60 years. Mortality showed 2 patients (1.47%) expired in 24–48 hours, and 6 (4.4%) in 48 hours.  The cause of peritonitis included typhoid ileal perforation (41%), duodenal perforation (33%), ruptured appendix (28%), intestinal tuberculous (14%), gangrenous gut (7%), tumour perforation (6%), liver abscess (3%), and gastric perforation and rectal tear (1%). Notably, 2.4% of patients with typhoid peritonitis, 3.0% with duodenal perforation, 3.5% with ruptured appendix, 14.2% with tuberculous intestine, 33.3% with tumour perforation, and 100% with liver abscess perforation passed. Paralytic ileus (8%) and burst abdomen (8%), were the most common complications. Conclusion: Typhoid ileal perforation was the major cause of peritonitis, and paralytic ileus and burst abdomen were the most common complications contributing to the mortality rate

A Deep Learning Based Approach for Grading of Diabetic Retinopathy Using Large Fundus Image Dataset

Diabetic Retinopathy affects one-third of all diabetic patients and may cause vision impairment. It has four stages of progression, i.e., mild non-proliferative, moderate non-proliferative, severe non-proliferative and proliferative Diabetic Retinopathy. The disease has no noticeable symptoms at early stages and may lead to chronic destruction, thus causing permanent blindness if not detected at an early stage. The proposed research provides deep learning frameworks for autonomous detection of Diabetic Retinopathy at an early stage using fundus images. The first framework consists of cascaded neural networks, spanned in three layers where each layer classifies data into two classes, one is the desired stage and the other output is passed to another classifier until the input image is classified as one of the stages. The second framework takes normalized, HSV and RGB fundus images as input to three Convolutional Neural Networks, and the resultant probabilistic vectors are averaged together to obtain the final output of the input image. Third framework used the Long Short Term Memory Module in CNN to emphasize the network in remembering information over a long time span. Proposed frameworks were tested and compared on the large-scale Kaggle fundus image dataset EYEPAC. The evaluations have shown that the second framework outperformed others and achieved an accuracy of 78.06% and 83.78% without and with augmentation, respectively

Enhanced OER performance by varying Al-WO3 electrocatalyst thickness: Process optimization

Oxygen evolution reactions (OER) are highly significant and play a critical role in the advancement of fuel cells, electrolyzers, chemicals, and solar energy conversion devices. The challenge in the quest is attributed to the absence of an efficient electrocatalyst assembly that functions optimally. A simple method of electrodeposition of Al:WO3 on a fluorinated tin oxide (FTO) electrode was used to investigate the OER in this study. The electrodepositions were achieved by employing a three-electrode cell at various scan rates ranging from 10 to 100 mV/s. During this investigation, the influence of the scan rate on electrocatalyst loadings and the impact of electrocatalyst layer thickness on the OER were examined. The electrodepositions of Al:WO3@FTO were analyzed using a range of optical, chemical, and physical techniques such as SEM, XRD, FT-IR, Raman spectroscopy, EDX, EDS mapping, and electrochemical tests. The FTIR and Raman analysis confirmed the synthesis of AL:WO3 while the peaks detected at angles 38.7° and 43° by XRD with planes (111) and (200), served as a distinctive characteristic for identifying aluminum (Al). The peaks observed at angles of 27.8°, 30.7°, 33°, 50.45°, and 58° correspond to WO3 material. The characterization techniques also confirmed that the synthesized material is highly crystalline in nature. The OER potential using Al:WO3@FTO electrodes with different electrocatalyst thicknesses, ranging from 8 nm to 31 nm was investigated by studying various electrochemical techniques such as CV, LSV, CPE, Tafel slope, HP2P splitting, EIS, TOF, short and long-term electrode stability, and double layer capacitance. The linear regression coefficient (R2) was also calculated to measure the relationship between the electrocatalyst's thickness and each electrochemical test. The findings indicated that increasing the scan rates resulted in thinner and denser electrodepositions on the FTO substrate as the thinnest film was formed at 100 mV/s. An inverse relationship between electrocatalyst layer thickness and OER activity was observed. The electrode with the thinnest and most compact electrocatalyst layer, specifically ED Al:WO3@FTO08, exhibited the lowest onset potential of 1.48 V and a maximum current of 84 mA/cm2 at 1.76 V. It also demonstrated superior reaction kinetics, as evidenced by its lower Tafel slope value of 49 mV/dec, which is the lowest among all the electrodes that were prepared. In particular, the electrode with a thin and compact electrocatalyst layer worked better in OER operations than the other five electrodes that had higher amounts of Al:WO3

Prophylactic biological mesh reinforcement versus standard closure of stoma site (ROCSS): a multicentre, randomised controlled trial

Background: Closure of an abdominal stoma, a common elective operation, is associated with frequent complications; one of the commonest and impactful is incisional hernia formation. We aimed to investigate whether biological mesh (collagen tissue matrix) can safely reduce the incidence of incisional hernias at the stoma closure site. Methods: In this randomised controlled trial (ROCSS) done in 37 hospitals across three European countries (35 UK, one Denmark, one Netherlands), patients aged 18 years or older undergoing elective ileostomy or colostomy closure were randomly assigned using a computer-based algorithm in a 1:1 ratio to either biological mesh reinforcement or closure with sutures alone (control). Training in the novel technique was standardised across hospitals. Patients and outcome assessors were masked to treatment allocation. The primary outcome measure was occurrence of clinically detectable hernia 2 years after randomisation (intention to treat). A sample size of 790 patients was required to identify a 40% reduction (25% to 15%), with 90% power (15% drop-out rate). This study is registered with ClinicalTrials.gov, NCT02238964. Findings: Between Nov 28, 2012, and Nov 11, 2015, of 1286 screened patients, 790 were randomly assigned. 394 (50%) patients were randomly assigned to mesh closure and 396 (50%) to standard closure. In the mesh group, 373 (95%) of 394 patients successfully received mesh and in the control group, three patients received mesh. The clinically detectable hernia rate, the primary outcome, at 2 years was 12% (39 of 323) in the mesh group and 20% (64 of 327) in the control group (adjusted relative risk [RR] 0·62, 95% CI 0·43–0·90; p=0·012). In 455 patients for whom 1 year postoperative CT scans were available, there was a lower radiologically defined hernia rate in mesh versus control groups (20 [9%] of 229 vs 47 [21%] of 226, adjusted RR 0·42, 95% CI 0·26–0·69; p<0·001). There was also a reduction in symptomatic hernia (16%, 52 of 329 vs 19%, 64 of 331; adjusted relative risk 0·83, 0·60–1·16; p=0·29) and surgical reintervention (12%, 42 of 344 vs 16%, 54 of 346: adjusted relative risk 0·78, 0·54–1·13; p=0·19) at 2 years, but this result did not reach statistical significance. No significant differences were seen in wound infection rate, seroma rate, quality of life, pain scores, or serious adverse events. Interpretation: Reinforcement of the abdominal wall with a biological mesh at the time of stoma closure reduced clinically detectable incisional hernia within 24 months of surgery and with an acceptable safety profile. The results of this study support the use of biological mesh in stoma closure site reinforcement to reduce the early formation of incisional hernias. Funding: National Institute for Health Research Research for Patient Benefit and Allergan