One-stage lingual augmented urethroplasty in repair of distal penile hypospadias

AbstractObjectivesTo evaluate the outcome of augmentation of shallow urethral plate by lingual graft in repair of distal penile hypospadias.Patients and methodsBetween June 2008 and May 2011, the procedure was performed on 23 patients with mean age 2.3 years (range 1–3). All patients had distal penile hypospadias; 11 sub coronal and 12 coronal. The urethral plate was less than 8mm in all patients and 3 of them had history of previous hypospadias surgery. All procedures were carried out under general anesthesia using 4× magnifying loupe. After penile degloving and dorsal incision of the urethral plate, the lingual graft was harvested and sutured to the edges of the incised urethral plate from the hypospadias opening to the tip of the penis. The neourethra was closed and an intervening flap was fixed over the neourethra as a barrier against fistula formation.ResultsSuccess rate was 87% as 20/23 patients were cured without any permanent complication throughout the follow up period. None of patients suffered meatal stenosis or required regular urethral dilatation. Three patients developed urethrocutaneous fistula, of which two closed spontaneously and one required surgical repair 6 months later. Two patients had failed procedures and delayed re-intervention was performed due to complete loss of the graft in one of them and repair disruption following infection in the other. Two patients had post-operative pain in the graft harvesting site which disappeared within days.ConclusionThe one-stage lingual augmented urethral plate urethroplasty offers promising outcomes for repair of distal penile hypospadias with narrow urethral plate

A novel nomadic people optimizer-based energy-efficient routing for WBAN

In response to user demand for wearable devices, several WBAN deployments now call for effective communication processes for remote data monitoring in real time. Using sensor networks, intelligent wearable devices have exchanged data that has benefited in the evaluation of possible security hazards. If smart wearables in sensor networks use an excessive amount of power during data transmission, both network lifetime and data transmission performance may suffer. Despite the network's effective data transmission, smart wearable patches include data that has been combined from several sources utilizing common aggregators. Data analysis requires careful network lifespan control throughout the aggregation phase. By using the Nomadic People Optimizer-based Energy-Efficient Routing (NPO-EER) approach, which effectively allows smart wearable patches by minimizing data aggregation time and eliminating routing loops, the network lifetime has been preserved in this research. The obtained findings showed that the NPO method had a great solution. Estimated Aggregation time, Energy consumption, Delay, and throughput have all been shown to be accurate indicators of the system's performance

Pancreaticobiliary Malignancies in the Emergency Room: Management of Acute Complications and Oncological Emergencies

Background Management of pancreaticobiliary (PB) malignancies remains a clinical challenge. In this review, we focus on the management of oncological emergencies in PB malignancies and the potential complication of associated therapeutic interventions. Methods Biobliographic review of current evidence on the management of oncological emergencies, their potential complications, as well as synthesis of recommendations was performed. The pathogenesis, frequency, related symptoms as well as appropriate investigations are presented. Results The oncologic emergencies in PB patients were summarised in six categories: (1) hematological (including febrile neutropaenia, thrombocytopenia, coagulopathies), (2) gastrointestinal (gastric outlet and biliary obstruction, gastrointestinal bleeding), (3) thromboembolic events, (4) ascites, (5) metabolic disorders and (6) neurologic complications. The pathogenesis, frequency, related symptoms as well as appropriate investigations are also presented. Conclusion Patients with PB malignancies are at increased risk of a wide variation of medical emergencies. Clinical knowledge, early recognition and collaboration with the relevant specialties are critical to manage these complications effectively, tailoring overall management around the actual prognosis and individuals’ expectations

Home exposure to Arabian incense (bakhour) and asthma symptoms in children: a community survey in two regions in Oman

<p>Abstract</p> <p>Background</p> <p>Incense burning has been reported to adversely affect respiratory health. The aim of this study was to explore whether exposure to bakhour contributes to the prevalence of asthma and/or triggers its symptoms in Omani children by comparing two Omani regions with different prevalence of asthma.</p> <p>Methods</p> <p>A randomly selected sample of 10 years old schoolchildren were surveyed using an Arabic version of ISAAC Phase II questionnaires with the addition of questions concerning the use and effect of Arabian incense on asthma symptoms. Current asthma was defined as positive response to wheeze in the past 12 months or positive response to "ever had asthma" together with a positive response to exercise wheeze or night cough in the past 12 months. Simple and multivariable logistic regression analyses were performed to estimate the effect of bakhour exposure and other variables on current asthma diagnosis and parents' response to the question: "Does exposure to bakhour affect your child breathing?"</p> <p>Results</p> <p>Of the 2441 surveyed children, 15.4% had current asthma. Bakhour use more than twice a week was three times more likely to affect child breathing compared to no bakhour use (adjusted OR 3.01; 95% CI 2.23–4.08) and this effect was 2.55 times higher in asthmatics (adjusted OR 2.55; 95% CI 1.97–3.31) compared to non-asthmatics. In addition, bakhour caused worsening of wheeze in 38% of the asthmatics, making it the fourth most common trigger factor after dust (49.2%), weather (47.6%) and respiratory tract infections (42.2%). However, there was no significant association between bakhour use and the prevalence of current asthma (adjusted OR 0.87; 95% CI 0.63–1.20).</p> <p>Conclusion</p> <p>Arabian incense burning is a common trigger of wheezing among asthmatic children in Oman. However, it is not associated with the prevalence asthma.</p

Ubiquitous robust communications for emergency response using multi-operator heterogeneous networks

A number of disasters in various places of the planet have caused an extensive loss of lives, severe damages to properties and the environment, as well as a tremendous shock to the survivors. For relief and mitigation operations, emergency responders are immediately dispatched to the disaster areas. Ubiquitous and robust communications during the emergency response operations are of paramount importance. Nevertheless, various reports have highlighted that after many devastating events, the current technologies used, failed to support the mission critical communications, resulting in further loss of lives. Inefficiencies of the current communications used for emergency response include lack of technology inter-operability between different jurisdictions, and high vulnerability due to their centralized infrastructure. In this article, we propose a flexible network architecture that provides a common networking platform for heterogeneous multi-operator networks, for interoperation in case of emergencies. A wireless mesh network is the main part of the proposed architecture and this provides a back-up network in case of emergencies. We first describe the shortcomings and limitations of the current technologies, and then we address issues related to the applications and functionalities a future emergency response network should support. Furthermore, we describe the necessary requirements for a flexible, secure, robust, and QoS-aware emergency response multi-operator architecture, and then we suggest several schemes that can be adopted by our proposed architecture to meet those requirements. In addition, we suggest several methods for the re-tasking of communication means owned by independent individuals to provide support during emergencies. In order to investigate the feasibility of multimedia transmission over a wireless mesh network, we measured the performance of a video streaming application in a real wireless metropolitan multi-radio mesh network, showing that the mesh network can meet the requirements for high quality video transmissions

Hemoglobin E syndromes in Pakistani population

<p>Abstract</p> <p>Background</p> <p>Hemoglobin E is an important hemoglobin variant with a worldwide distribution. A number of hemoglobinopathies have been reported from Pakistan. However a comprehensive description of hemoglobin E syndromes for the country was never made. This study aimed to describe various hemoglobin E disorders based on hematological parameters and chromatography. The sub-aim was to characterize hemoglobin E at molecular level.</p> <p>Methods</p> <p>This was a hospital based study conducted prospectively for a period of one year extending from January 1 to December 31, 2008. EDTA blood samples were analyzed for completed blood counts and hemoglobin variants through automated hematology analyzer and Bio-Rad beta thalassaemia short program respectively. Six samples were randomly selected to characterize HbE at molecular level through RFLP-PCR utilizing <it>Mnl</it>I restriction enzyme.</p> <p>Results</p> <p>During the study period, 11403 chromatograms were analyzed and Hb E was detected in 41 (or 0.36%) samples. Different hemoglobin E syndromes identified were HbEA (n = 20 or 49%), HbE/β-thalassemia (n = 14 or 34%), HbEE (n = 6 or 15%) and HbE/HbS (n = 1 or 2%). Compound heterozygosity for HbE and beta thalassaemia was found to be the most severely affected phenotype. RFLP-PCR utilizing <it>Mnl</it>I successfully characterized HbE at molecular level in six randomly selected samples.</p> <p>Conclusions</p> <p>Various HbE phenotypes are prevalent in Pakistan with HbEA and HbE/β thalassaemia representing the most common syndromes. Chromatography cannot only successfully identify hemoglobin E but also assist in further characterization into its phenotype including compound heterozygosity. Definitive diagnosis of HbE can easily be achieved through RFLP-PCR.</p

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

A dual-population multi operators harmony search algorithm for dynamic optimization problems

Dynamic optimization problems (DOPs) have been widely researched in recent years. This is due to its numerous practical applications in real-life conditions. To solve DOPs, the optimizer should be able to track the changes and simultaneously seek for global optima in the search space. This paper proposes a dual population multi operators harmony search algorithm for DOPs to deal with changes in the problem landscape. The main difference between the proposed algorithm and other techniques are twofold: dual population for exploring and exploiting the search space, and the use of multi operators at different points of the search. Extensive experiments were conducted on the Moving Peaks Benchmark (MPB) and six dynamic test functions proposed in the IEEE Congress on Evolutionary Computation (CEC 2009) were used to evaluate the performance of the proposed algorithm. Empirical results indicate the superiority of the proposed algorithm when compared to state-of-the-art algorithms from the literature