Has the significance of incidental findings on unenhanced computed tomography for urolithiasis been overestimated? A retrospective review of over 800 patients

Objectives: To evaluate the detection of clinically unsuspected pathologies using 64-slice multidetector computed tomography (CT) of the abdomen in patients with flank pain. The presence of significant incidental findings (those warranting immediate management) was also correlated with that of urolithiasis, to assess potential changes of management.PATIENTS AND Methods: The study included 899 patients undergoing CT in a 6-month period between June and December 2008. Patients who were referred from outside, with no medical record in the hospital where the study was conducted, and those who were lost to follow-up, were excluded. All of the CT examinations were reported after a radiology resident and a consultant radiologist with \u3e4years of experience evaluated the CT. Genitourinary and extra-genitourinary findings were assessed and divided into clinically significant or not.Results: The overall incidence of additional and incidental findings was 14%. Besides urolithiasis and obstruction there were 34 (28%) genitourinary findings and 87 (72%) extra-genitourinary findings; most of the former were insignificant. Of the extra-genitourinary findings, significant diagnoses were documented in 34 cases.CONCLUSIONS: Abdominal multidetector CT detects more incidental findings which are clinically significant

Time series subsidence evaluation using NSBAS InSAR: a case study of twin megacities (Rawalpindi and Islamabad) in Pakistan

Ground deformation associated with natural and anthropogenic activities can be damaging for infrastructure and can cause enormous economic loss, particularly in developing countries which lack measuring instruments. Remote sensing techniques like interferometric synthetic aperture radar (InSAR) can thus play an important role in investigating deformation and mitigating geohazards. Rawalpindi and Islamabad are twin cities in Pakistan with a population of approximately 5.4 million, along with important government and private entities of national and international interest. In this study, we evaluate rapid paced subsidence in this area using a modified small baseline subset technique with Sentinel-1A imagery acquired between 2015 and 2022. Our results show that approximately 50 mm/year subsidence occurs in the older city of Rawalpindi, the most populated zone. We observed that subsidence in the area is controlled by the buried splays of the Main Boundary Thrust, one of the most destructive active faults in the recent past. We suggest that such rapid subsidence is most probably due to aggressive subsurface water extraction. It has been found that, despite provision of alternate water supplies by the district government, a very alarming number of tube wells are being operated in the area to extract ground water. Over 2017–2021, field data showed that near-surface aquifers up to 50–60 m deep are exhausted, and most of the tube wells are currently extracting water from depths of approximately 150–160 m. The dropping water level is proportional to the increasing number of tube wells. Lying downstream of tributaries originating from the Margalla and Murree hills, this area has a good monsoon season, and its topography supports recharge of the aquifers. However, rapid subsidence indicates a deficit between water extraction and recharge, partly due to the limitations inherent in shale and the low porosity near the surface lithology exposed in the area. Other factors amplifying the impacts are fast urbanization, uncontrolled population growth, and non-cultivation of precipitation in the area

Graphene oxide incorporated polyether sulfone nanocomposite antifouling ultrafiltration membranes with enhanced hydrophilicity

In this study, the polyether sulfone (PES) based membranes containing various concentrations of graphene oxide (GO), polyvinylpyrrolidone (PVP), and polyethylene glycol (PEG) were synthesized via the phase immersion method. This study aims to evaluate the effect of GO addition on the structural properties and performance of the membranes. The membranes were analyzed by x-ray diffraction (XRD), scanning electron microscopy (SEM), and Fourier transforms infrared spectroscopy (FTIR). The FTIR-ATR spectra indicated the presence of hydroxyl and carboxylic acid groups on the surface of GO-incorporated membranes, which improved their dispersion in the polymeric matrix and hydrophilicity. The SEM analysis of the GO-containing PES membranes confirmed the formation of a well-defined finger-like porous structure presenting adequate water flux (95 l.m(-2).h(-1)) and salt rejection (72%) compared to the pristine PES membranes (46 l.m(-2).h(-1) and similar to 35%, respectively). In addition, the significantly large wettability and considerably improved antibacterial characteristic (against S. aureus and E. coli strains) of the GO-PES membranes are considered impressive features.National University of Sciences and Technology (NUST) Research Directorate; HEC; NRPU [6020]6020; Higher Education Commission, Pakistan, HEC; National University of Sciences and Technology, NUS

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

A paradigm shift in imaging for renal colic - Is it time to say good bye to an old trusted friend?

Objectives: To study the changing pattern in the use of intravenous urogram (IVU) and non-contrast enhanced CT (CTKUB) for evaluation of flank pain at a single centre. Methods: All Patients who underwent either an IVU or CTKUB at a single, tertiary care center from January 2002 to December 2007 were retrospectively identified from the radiology database. Study samples were-divided into two groups: Pediatric (14 years or less) and Adult (greater than 14 years). For each group, overall trends as well as trends across referral setting and gender were explored by plotting line graphs using SPSS version 15. Results: During the study period a total of 11245 uro-radiological examinations were performed using either IVU (43.7%, n=4915) or CTKUB (56.3%, n=6330). A remarkable majority of procedures (95.5%, n=10741) was performed in adult Patients. Overall, the respective proportions of IVU and CTKUB were 87.9% (n=43) and 12.1% (n=61) in the pediatric group whereas 41.6% (n=4472) and 58.4% (n=6269) in adults. Majority in both groups were ambulatory Patients (Pediatrics 83.7%, Adults 76.7%). During 2002-20007, the yearly proportion of CTKUB increased from 27% to 80% in adults and from 3% to 27% in children. Conclusions: There is major shift in the choice of imaging in adults from IVU to CTKUB during years 2002-2007. In pediatric Patients, IVU referrals still comprise the greater proportion of uro-radiological exams

Enhanced anti-tumor efficacy of paclitaxel with PEGylated lipidic nanocapsules in presence of curcumin and poloxamer: In vitro and in vivo studies

International audienceCancer chemotherapeutic drug containing PEGylated lipidic nanocapsules (D-LNCs) were formulated by the controlled addition of organic phase (combined solution of paclitaxel and curcumin in a mixture of oleic acid and MPEG2000-DSPE (90:2.5 molar ratio) in acetone) to the aqueous phase (consist of Poloxamer 407 as emulsifying agents and glycerol as a co-solvent) at a temperature of 55-60°C followed by evaporation of organic solvent. The obtained pre-colloidal dispersion of D-LNCs was processed through high pressure homogenization to get more uniformly and nano-sized particles. Effect of concentration of emulsifying agent and process variables of high pressure homogenization (pressure and number of cycles) on average particle size and entrapment efficiency was further investigated by constructing Box-Behnken experimental design to achieve the optimum manufacturing process. D-LNCs were characterized by dynamic light scattering, scanning and transmission electron microscopy, Fourier transform infrared spectroscopy, and differential scanning calorimetry. In vitro release studies showed a sustained release pattern of drug from the PEGylated D-LNCs, whereas in vivo pharmacokinetic studies after a single-dose intravenous (i.v.) administration of paclitaxel (15mg/kg) in Ehrlich ascites tumor (EAT)-bearing female Swiss albino mice showed a prolonged circulation time and slower elimination of paclitaxel from D-LNCs as compared with marketed formulation (Paclitec®). From the plasma concentration vs. time profile, i.v. bioavailability (AUC0-∞) of paclitaxel from D-LNCs was found to be increased approximately 2.91-fold (P<0.001) as compared to Paclitec®. In vitro cell viability assay against MCF-7 and MCF-7/ADR cell lines, in vivo biodistribution studies and tumor inhibition study in EAT-bearing mice, all together prove its significantly improved potency towards cancer therapy

Nano Matrix Soft Confectionary for Oral Supplementation of Vitamin D: Stability and Sensory Analysis

Vitamin D deficiency distresses nearly 50% of the population globally and multiple studies have highlighted the association of Vitamin D with a number of clinical manifestations, including musculoskeletal, cardiovascular, cerebrovascular, and neurological disorders. In the current study, vitamin D oil-in-water (O/W) nanoemulsions were developed and incorporated in edible gummies to enhance bioavailability, stability, and patient compliance. The spontaneous emulsification method was employed to produce a nano-emulsion using corn oil with tween 20 and lecithin as emulsifiers. Optimization was carried out using pseudo-ternary phase diagrams and the average particle size and polydispersity index (PDI) of the optimized nanoemulsion were found to be 118.6 &plusmn; 4.3 nm and 0.11 &plusmn; 0.30, respectively. HPLC stability analysis demonstrated that the nano-emulsion prevented the degradation and it retained more than 97% of active vitamin D over 15 days compared to 94.5% in oil solution. Similar results were obtained over further storage analysis. Vitamin D gummies based on emulsion-based gelled matrices were then developed using gelatin as hydrocolloid and varying quantities of corn oil. Texture analysis revealed that gummies formulated with 10% corn oil had the optimum hardness of 3095.6 &plusmn; 201.7 g on the first day which remained consistent on day 45 with similar values of 3594.4 &plusmn; 210.6 g. Sensory evaluation by 19 judges using the nine-point hedonic scale highlighted that the taste and overall acceptance of formulated gummies did not change significantly (p &gt; 0.05) over 45 days storage. This study suggested that nanoemulsions consistently prevent the environmental degradation of vitamin D, already known to offer protection in GI by providing sustained intestinal release and enhancing overall bioavailability. Soft chewable matrices were easy to chew and swallow, and they provided greater patient compliance