Comparative Study Between Antegrade Flexible Ureteroscopy and Reterograde Intrarenal Surgery in the Management of Impacted Upper Ureteric Stones 1.5 cm or Larger

OBJECTIVE: To prospectively investigate the safety and efficacy of antegrade flexible ureteroscopy (FURS) with the following criteria (supine, ultrasonic guided puncture through lower calyx with 14 fr tract, tubeless) versus retrograde intrarenal surgery (RIRS) in the management of large impacted upper ureteric stones ≥ 1.5 cm. PATIENTS AND METHODS: This study recruited 61 patients with single large impacted upper ureteric stone of ≥ 1.5 cm. The patients were randomly allocated to two groups. Group A, included 31 patients who treated by antegrade FURS, all patients were put in supine modified galadako Valdivia position and the renal access is reached by ultrasonic guided puncture through the lower calyx with dilatation upto 14 fr to insert ureteric access sheath and all cases were tubless with JJ stent insertion. Group B, included 30 patients who were treated by RIRS with JJ stent insertion. Stone fragmentation was done by holmium laser in both group. RESULTS: Group A was significantly associated with higher proportion of SFR (90.3%) compared to Group B (70%) (p = 0.046). Group B was significantly associated with shorter operative time and fluoroscopy time in comparison with Group A (p \u3c 0.001). No significant differences were found between studied groups regarding bleeding (p = 0.238). Urosepsis showed significantly higher proportion associated with retrograde approach when compared to antegrade approach (p = 0.024). CONCLUSION: This study showed that antegrade FURS is safe and more effective than RIRS for the management of large impacted upper ureteric stones ≥ 1.5 cm

Help Me Evacuate! A Smart Adaptable Evacuation System With Congestion Prediction Capabilities

Emergency evacuation planning is a vital problem that affects building occupants’ safety. The commonly used static evacuation plans rely on static signs disregarding crowd density changes. Such static plans often lead to congestion at emergency exits; since many occupants tend to avoid following exit signs as they feel safer following the crowds exiting the building or following other paths familiar to them. This paper proposes a smart and adaptable evacuation system that predicts congestion and adapts accordingly to minimize evacuation time. We introduce a simulation model that mimics occupants’ movement in different building layouts. The proposed system performs Monte Carlo simulations to forecast possible congestion locations and guide occupants away from them. Guiding directions are displayed and updated to consider dynamic environment changes. We evaluated our approach compared to a greedy evacuation method that relies on static exit signs, showing a significant evacuation time improvement of 21% achieved on average by our approach

Modeling COVID-19 effects on SDGs using system dynamics in Egypt

AbstractThe coronavirus disease 2019 (COVID-19) poses a significant threat to achieving the Sustainable Development Goals (SDGs). To address this challenge, a thorough examination of the pandemic’s influence on four SDGs in Egypt is presented in a system dynamic model. The addressed goals are related to no poverty (SDG 1), zero hunger (SDG 2), decent work and economic growth (SDG 8), and climate action (SDG 13). The model is simulated over 35 years extending from 2015 to 2050. Furthermore, a web-based interactive learning environment is developed to analyze the interdependencies among public health activities and study the impacts of possible intervention countermeasures or prevention policies. Indicators including poverty line, food insecurity, gross domestic product (GDP) growth rate, and greenhouse gas (GHG) emissions are evaluated to track Egypt’s performance in relation to SDGs 1, 2, 8, and 13. According to the simulation model, the poverty line will continue to decline until it reaches around 16% by 2050. According to the significant governmental efforts to follow its vision of 2030, Egypt can achieve a decreasing percentage of food insecurity, reaching 3% in 2030, and this percentage will continue to decrease until it reaches full sufficiency by 2050. The GDP growth rate will rise every year until it reaches 13.71% in 2050. With respect to climate, GHG emissions are predicted to fall to roughly 97 Mt CO2-equivalents by 2050. This approach revitalizes debates about the achievement of SDGs amid the crisis and acts as a powerful tool that aids decision-makers in identifying leverage points to avoid the long-term negative repercussions of the crisis on the economy, people, and environment.</jats:p

Modeling COVID-19 Effects on Sustainable Development Goals in Egypt Using System Dynamics

Abstract The coronavirus disease 2019 (COVID-19) poses a significant threat to achieving the Sustainable Development Goals (SDGs). To address this challenge, a thorough examination of the pandemic’s influence on four SDGs in Egypt is presented in a system dynamic model. The addressed goals are related to no poverty (SDG 1), zero hunger (SDG 2), good health and well-being (SDG 3), decent work and economic growth (SDG 8), and climate action (SDG 13). The model is simulated over 35 years extending from 2015 to 2050. Furthermore, a web-based interactive learning environment is developed to analyze the interdependencies among public health activities and study the impacts of possible intervention countermeasures or prevention policies. This approach revitalizes debates about the achievement of SDGs amid the crisis and acts as a powerful tool that aids decision-makers in identifying leverage points to avoid the long-term negative repercussions of the crisis on the economy, people, and environment.</jats:p

Using Virtual Reality Pablo Gaming in the Post-Operative Rehabilitation of Breast Cancer Patients: Randomized Controlled Trial

Background/Objectives: Surgical treatment of breast cancer may lead to physical and psychological side effects. Exercises, especially those aided by virtual reality (VR), can improve both physical and psychological dysfunctions. To explore the effects of exercises using VR through Pablo games Technology on the function, grip strength, wrist ROM, fatigue, pain, activities of daily living (ADLs), and anxiety among post-operative breast cancer females. Methods: Forty post-operative breast cancer females participated in the current study: nineteen in the control group (CG), who received a standard treatment consisting of upper limb exercises plus intermittent compression therapy, and twenty-one participants assigned to the Pablo group (PG), who received the standard treatment plus additional training using the Pablo game training system. The intervention period was eight weeks long. The outcome measures were function, grip strength, wrist ROM, fatigue, pain, activities of daily living, and anxiety. Data were obtained at the baseline, after eight weeks, and at two months follow-up. Results: There were statistically significant declines in pain and fatigue, while there were statistically significant improvements in ADLs, grip strength, function, and ROM post-intervention and at two months follow-up in both groups (p &lt; 0.001). Between-group comparisons demonstrated a statistically significant decrease in pain, anxiety, and fatigue and statistically significant improvements in function, ADLs, grip strength, and ROM in favor of the PG post-treatment and at the follow-up (p &lt; 0.001). Conclusions: Adding VR using the Pablo game training system to the standard rehabilitation of post-surgical breast cancer patients can further improve their function, hand grip, wrist ROM, fatigue, pain, and ADLs

Impact of low-level laser therapy on upper limb lymphoedema secondary to breast cancer: a systematic review and meta-analysis

Introduction This review analysed the efficiency of low-level laser therapy in treating breast cancer-related lymphedema (BCRL) in women. Material and methods Databases such as Scopus, PEDro, PubMed, Cochrane, and Web of Science were searched for RCTs using low-level laser therapy (LLLT) or photo-bio modulation therapy (PBMT) on BCRL published between 2010 and August 2023. Primary outcomes were arm circumference, volume, and hand grip strength, while secondary outcomes were pain, shoulder mobility, and quality of life. Results Eleven RCTs with a total of 379 patients were analysed, and 8 studies were included for meta-analysis. We found no significant difference between laser-treated and control groups in any of the trials in terms of arm circumference, arm volume, grip strength, and quality of life post-intervention, and a significant difference between the groups in terms of pain intensity and shoulder mobility. Conclusions This review revealed that low-level laser therapy (photobiostimulation) was successful in reducing arm circumference, volume, and pain, as well as enhancing grip strength, life quality, and mobility. However, the meta-analysis did not show any improvement except in pain and shoulder mobility. Further trials are required to assess the long- and short-term efficacy of LLLT in managing lymphoedema secondary to breast cancer