Network science algorithms for mobile networks.

Network Science is one of the important and emerging fields in computer science and engineering that focuses on the study and analysis of different types of networks. The goal of this dissertation is to design and develop network science algorithms that can be used to study and analyze mobile networks. This can provide essential information and knowledge that can help mobile networks service providers to enhance the quality of the mobile services. We focus in this dissertation on the design and analysis of different network science techniques that can be used to analyze the dynamics of mobile networks. These techniques include evolutionary clustering, classification, discovery of maximal cliques, and evolutionary centrality algorithms. We proposed evolutionary clustering and evolutionary centrality algorithms that can be used to dynamically discover clusters and central nodes in mobile networks. Overall, the experimental results show that the proposed evolutionary algorithms are robust to short-term variations but reflects long-term trends and can be used effectively to analyze the dynamics of mobile networks

Ultrafast-track extubation after pediatric cardiac surgery; benefits and safety

Background: Ultrafast-track extubation after cardiac surgery my facilitate rapid recovery. However, the overall risk-benefit is still debatable. The objective of this study was to report the effect of ultrafast-track extubation in pediatric patients undergoing cardiac surgery. Methods: This is a retrospective study that included 260 patients who had surgery for congenital heart diseases between 2015 and 2019. Patients were divided into two groups. Group A included patients who had ultrafast-track extubation protocol (n = 140), and group B was the conventional anesthesia group (n = 120). Results: The mean age was 3.68 ± 2.1 and 3.8 ± 1.6 years for groups A and B, respectively (p= 0.08). The total operative time was higher in group A (326± 18.15 vs. 274.6±28.1 minutes;  p 0.001), and the degree of pulmonary hypertension were higher in group B (p= 0.02). The rate of ventilator-related complications was higher in group B (P = 0.02). There was a significant reduction in mean length of intensive care unit stay between the ultrafast-track extubation and the conventional groups (65.3 ± 33.7 and 81.6±70.2 hours, respectively; p= 0.001). The total hospital stay was significantly reduced in group A (6.7 ± 2.7 vs. o 7.43±2.65 days for group  A and B, respectively, p= 0.03). Conclusions: The application of ultrafast-track extubation protocol could lead to a reduction in the ventilator-related complications, the length of intensive care unit and hospital stays without increasing postoperative complications

Short Term Outcome of Plasma Pleurodesis in Post Pulmonary Resections Persistent Air Leak

Background: Air leak is the most common morbidity after pulmonary resection surgery. It may result in prolonged duration with chest tubes with their annoying chest pain, prolonged hospital stay time with increased financial costs, pneumonia, empyema, and patient dissatisfaction. Our objective was to evaluate the efficacy of plasma pleurodesis for stoppage of air leak after lung resection, in comparison to conservative measures. Methods: This prospective single-blinded randomized study included 60 patients randomly divided into two groups: Group A: included 30 patients who received intrapleural fresh frozen plasma.  One bag of FFP, contains 250 ml of plasma, matched for the ABO group was installed through the apical chest tube into the pleural cavity. Group B: a control group of 30 patients who did not receive any sclerosing agent. They were managed with under-water seal and observation. Results: This study showed that the stoppage of air leak in group A was faster “which stopped in 9-10 days” in comparison to control group B “24-25 days”, (P-value <0.001). There was a significant difference between groups A and B regarding the hospital stay, which was in 9-10 days in group A in comparison to group B “26-28 days (P-value <0.001). Conclusion: Intrapleural fresh frozen plasma appears to be a valuable option to stop persistent air leaks post pulmonary resections. It’s a cheap, available, and safe agent. It reduced hospital stay, costs and morbidities

Modified Single-Patch Technique Versus Two-Patch Technique in Infants with Complete Atrioventricular Septal Defect

Background: There are many techniques in repairing complete atrioventricular septal defect including: double patch technique, classic single patch technique and modified single patch technique. It's still debated which of these techniques is superior to the other one, our objective was to contrast the outcomes following surgery between the modified single patch and double patch techniques for repair of complete atrioventricular septal defect. Methods: This study includes 100 infants who underwent complete atrioventricular septal defect repair. Individuals were split into patients repaired with modified single patch as group A (n= 50), and patients repaired with double patch as group B (n= 50). Results: Group B showed significantly higher Cardiopulmonary bypass time (110 ±12 vs. 88 ±8 min, P < 0.001) Aortic cross clamp time (81 ±7 vs. 61 ±5 min, P < 0.001), ICU stay (10 ±1 vs. 9 ±1 day, P < 0.001), hospital stay (17 ±2 vs. 15 ±1 day, P < 0.001), and drainage amount (310 ±98 vs. 194 ±80, P < 0.001). No changes observed among groups of the study in other operative or postoperative statistics. Conclusion: Modified single-patch repair and two-patch repair did not yield significantly different results in the total correction of atrioventricular septal defects

The Preoperative Use of Levosimendan in Patients undergoing Coronary Artery Bypass Surgery with Low Ejection Fraction

Background: Levosimendan is a calcium sensitizer with positive inotropic, vasodilatory, and cardioprotective actions. Levosimendan infusion time may affect the outcomes. Our objective was to evaluate its efficacy and safety when used before coronary artery bypass grafting (CABG) in patients with low ejection fraction. Methods: This prospective observational study included 150 CABG patients with ejection fraction ≤ 40% divided into two groups. In the Levosimendan group (n= 75), it was given preoperatively, and in the conventional group (n= 75), myocardial support was used if indicated. Results: Operative time (344±28.7 vs. 421.4±34.5 min) and cardiopulmonary bypass time (97±17.4 vs. 127.4±24.5) were significantly shorter in the Levosimendan group (P˂ 0.001, for both). Failure to wean from bypass (13 (17.3%) vs. 23 (30.7%), P=0.06) and the need for intra-aortic balloon pump (6 (8%) vs. 14 (18.7%), P= 0.06) were non significantly lower in the Levosimendan group. The mechanical ventilation duration (12±3.3 vs. 19.6±4.7 h, P= 0.04) and ICU stay (3.8±1.2 vs. 5.3±1.4 days, P ˂ 0.001) were lower with levosimendan. Mortality was non-significantly lower in the Levosimendan group (10 (13.3%) vs. 18 (24%), P= 0.09). There were no differences in atrial and ventricular arrhythmias between groups. Conclusion: The preoperative use of levosimendan could improve the outcomes in patients undergoing CABG with low ejection fraction. Levosimendan complication profile was comparable to the conventional approac

Comparative Study Between Custodiol® versus Cold Blood Cardioplegia for Myocardial Protection in Double Valve Replacement Surgery

Background: Several cardioplegic solutions are available for myocardial preservation. The superiority of intracellular over extracellular cardioplegia is still debated. Our study aimed to compare the results of Custodiol® and blood Cardioplegia for myocardial protection in double valve replacement surgery. Methods: This is a prospective study that included 301 patients. We grouped the patient into; Group A (n= 135) had Custodiol® cardioplegia, and Group B (n= 166) had cold blood cardioplegia. We included patients who had double valve surgery and excluded redo, emergency procedures, and patients who had concomitant coronary artery bypass grafting. Results: Patients in Group A were significantly younger (43 ±9 vs. 47 ±10, P<0.001). There were 72 females (53.3%) in Group A and 71 (43.4%) in Group B (P= 0.09). The total bypass time was higher in group B (217± 40 vs. 179± 35 min, P< 0.001). The cross-clamp time was comparable between groups (90± 31 vs. 85± 29 min, P= 0.15). The duration of mechanical ventilation (7 ± 1 vs. 12 ± 2 h, P< 0.001), ICU stay (3± 0.7 vs. 4± 0.9, P< 0.001) and hospital stay (8± 1 vs. 13± 3, P< 0.001) were shorter in Group A. Postoperative wound seroma (5 (26.6%) vs. 60 (36.1%), P< 0.001) and mortality (2 (1.5%) vs. 11 (6.6%), p= 0.042) were lower in Group A. Conclusion: Custodiol cardioplegia could be safe during double valve surgery. A larger randomized trial is required to confirm our findings

Negative pressure wound therapy versus conventional therapy for the treatment of post-coronary artery bypass graft mediastinitis

Background: Various treatments, such as negative pressure wound therapy or traditional therapy, can be employed to manage postoperative mediastinitis. The superiority of one approach over the other is still a subject of discussion. Our purpose was to compare the results of negative pressure wound therapy and conventional therapy for treating postcoronary artery bypass graft mediastinitis. Methods: This study included 50 individuals with mediastinitis after coronary artery bypass grafting. Patients were divided into Groups A and B according to whether the wound was treated with negative pressure wound therapy (n= 25) or conventional therapy (n= 25), respectively. Results: The studied groups were comparable concerning age (P = 0.5), sex (P = 0.395), and body mass index (P = 0.556). No significant differences were detected among the studied groups concerning diabetes mellitus (P = 0.733), chronic obstructive pulmonary disease (P = 0.564), previous myocardial infarction (P = 0.370), isolated or combined surgery (P = 0.508), left main stenosis (P = 0.569), or emergency surgery (P = 0.508). Group A exhibited a significantly shorter hospital stay (26 ±4 days) than Group B (37 ±6) (P < 0.001). In contrast, no significant differences were observed among the studied groups concerning ventilation hours (P = 0.913) or ICU stay (P = 0.524). Group A demonstrated significantly lower reinfection than Group B (24% vs. 52%, respectively; P = 0.041). No significant differences were noted concerning reoperation for bleeding (P = 1.0) or mortality (P = 0.1). Group A demonstrated a significantly lower mean cost than Group B (110±23 vs. 140 ±37, respectively; P = <0.001). Conclusion: Negative pressure wound therapy for postcoronary artery bypass graft mediastinitis could be more effective than the conventional treatment methods

On-Pump versus Off-Pump Coronary Artery Bypass Grafting in The Surgical Management of High-Risk Patients, A Clinical Randomized Study

Background: Surgical treatment modalities of coronary artery diseases (CAD) include on-pump or off-pump coronary artery bypass grafting (CABG). CABG performed on the beating heart can avoid complications that might occur on cardiopulmonary bypass. Our objective was to compare the effectiveness of on-pump versus off-pump CABG in high-risk patients stratified according to the EuroSCORE scoring system.  Methods: This randomized clinical study included 80 high-risk patients who underwent CABG and assigned into two groups; each contains 40 patients. Patients with valvular affection, ischemic ventricular septal defect or left ventricle and aortic aneurysms, and/or those exhibiting significant neurological pathology were excluded from the study. Study outcomes were blood loss, length of ICU and hospital stay, inotropic use, re-exploration rate, and operative mortality. Results: The study showed significant higher use of inotropic drugs intra and post-operatively (57.5% vs 40%, p = 0.021), more low cardiac output (12.5% vs 2.5%, p = 0.031), lower blood loss (337±67 vs 498±68 ml, p = 0.01), lower blood transfusion (1.1±0.2 vs 1.2±0.4 unit, p = 0.024), more prolonged ICU stay (4.0±1.6 vs 3.0±0.9 day, p = 0.001) and the higher re-exploration rate (17.5% vs 7.5%, p = 0.035) in the on-pump group. Hospital stay (8.7±2 vs 8.1±1, p = 0.121) and early mortality (7.5% vs 2.5%, p = 0.451) did not differ significantly between the two groups. Conclusion: Management of coronary artery disease is still challenging, and there is still a place for off-pump CABG in CAD in high-risk patients due to its advantages in the early complications while has the same total hospital stay when compared with on-pump CABG

Effect of Body Mass Index on Morbidity and Mortality in Patients Undergoing Coronary Artery Bypass Grafting

Background: Obesity affects cardiovascular morbidity and mortality, and it increases the risk of coronary artery disease. Despite that, several cardiac surgery risk stratification scores do not consider the effect of obesity on the outcomes. The objective of this research is to study the impact of body mass index (BMI) on morbidity and mortality after coronary artery bypass grafting (CABG) in Egyptian patients. Methods: This prospective cohort study included 200 patients who underwent CABG for atherosclerotic coronary artery disease. Patients were divided into two groups, group A: patients with BMI ≥ 25 Kg/m2 and group B: patients with BMI < 25 Kg/m2. The mean age in group A was 56± 4.95 years vs. 54± 5.5 years in group B (p= 0.102). Male patients presented 58% of the population in group A vs 74% in group B (p= 0.017). 60% of patients were hypertensive in group A compared to 63% in group B (p= 0.66) and 62%, and 48% were diabetics in group A and B respectively (p= 0.04). Results: Postoperatively, there was a significant increase in wound infection (40% vs 8%; p< 0.001), chest infection (47% vs. 10% p< 0.001), surgical re-exploration (28% vs. 1%; p< 0.001), prolonged ICU stays (5.3 ± 2.88 vs. 3.93 ± 1.71 days; p< 0.001), ward stay (11.28 ±8.9 vs. 5.48 ± 2.45 days; p< 0.001), mediastinitis (34% vs. 6%; p< 0.001), the occurrence of sternal wound sinus within 8 months (26% vs. 7%; p< 0.001), in group A more compared to group B. There was no difference in ejection fraction (54.2 ±7.38 vs. 54.7 ± 9.1%; p= 0.69) and mortality (4% vs. 2%; p= 0.68) between groups. Conclusions: BMI 25 Kg/m2 or higher is associated with increased infectious complications and prolonged stay after CABG; however, it did not affect mortality. Optimizing body weight is recommended before elective surgery

The Effect of Learning Package on Knowledge and Practice of Women's Regarding Osteoporosis in Port Said City, Egypt.

Osteoporosis is a major and growing public health problem in both sexes but particularly in women which associated with fragility fractures at the hip, spine, and wrist. Hip fracture contributes to both morbidity and mortality in the elderly. Approximately 1.6 million hip fractures occur each year worldwide, the incidence is set to increase to 6.3 million by 2050. It is a systemic skeletal disorder, characterized by reduction of bone mass, deterioration of bone structure, increasing bone fragility, and increasing fracture risk. It is a major cause of fractures in elderly, resulting in pain, disability, costly rehabilitation, poor quality of life, and premature death .Data survey from the Egyptian national nutrition institute to determine bone mass density (BMD) among the elderly in 2001 and, among adolescents and adults in 2004 revealed that (16.7%) of 1190 Egyptian menopausal females had lumbar osteoporosis. Aim: The present research was designed to assess effect of learning package on knowledge and practice of women's regarding osteoporosis in Port Said City .This intervention study was at the gynecological and obstetric clinic at Port Said general hospital. Study sample composed of 129 women. Tools: Data were collect using interview questionnaire sheet contains 4 main parts based on literature review & modificated tool to assess knowledge and practice of women's regarding osteoporosis in Port Said City. Results: The study found that the majority of studied women have poor knowledge regarding osteoporosis. Also, revealed a highly statistically significant difference between pre and post program in relation to knowledge about calcium p- value (0.003) and total knowledge score p- value (0.002).and there was  statistically difference between pre and post program in relation to walk more than 10 min in sun daily and practice physical exercise p- value =(0.021 and 0.0007) respectively. And there was statistically difference between pre and post program in relation to walk more than 10 min in sun daily and practice physical exercise p- value =(0.021 and 0.0007) respectively Conclusion: The present study concluded that the family needs to improve their knowledge and practice regarding prevention osteoporosis Recommendations: It is recommended to design and implement educational trials to change and improve women lifestyle to prevent osteoporosis. Also long-term effects of such educational programs should be assessed. Women should also be aware of their risks factors for developing osteoporosis. Keywords: learning package, knowledge, practice, women, osteoporosi