Evaluating the Perception and Awareness of Patients Regarding Ovarian Cysts in Peshawar, Pakistan

Purpose: To evaluate patients’ perception regarding ovarian cyst as well as their awareness of the symptoms and health management of the disease.Methods: A quantitative research approach was used to conduct this study. Patients were selected from the Gynecology wards, Hayatabad Medical Complex, Peshawar and a questionnaire was designed to evaluate the patients’ knowledge and awareness.Results: When women were asked if they had prior knowledge about the ovarian cyst, 37 (58.7 %) responded that they were first told by the  physician during their visit to the clinic or hospital while the patients  responded, “Still don’t know” are 22 (34.9 %). With respect to educational level of the patients, they seemed to be less aware of the disease. Their perception regarding the disease is that they had a “water filled” balloon or tumor.Conclusion: Prior to discharge of an ovarian cyst patient from the hospital, she should be counseled on the disease and successful treatment outcomes. Counseling of the patients may result in compliance with therapy, good quality of life and lower economic burden.Keywords: Ovarian cyst, Menstrual cycle, Awareness, Perception, Treatment outcome

Antimicrobial activity analysis of extracts of Acacia modesta, Artimisia absinthium, Nigella sativa and Saussurea lappa against Gram positive and Gram negative microorganisms

Antimicrobial activity of extracts of certain herbs including Acacia modesta (leaf and stem), Artimisia absinthium (leaf and stem), Nigella sativa (seeds) and i (root) was evaluated against three Gram positive and two Gram negative microorganisms. The Gram positive organisms included Bacillus subtalis (ATCC 6633), Entereococcus faecalis (ATCC 14506) and Staphylococcus aureus (ATCC 6538) and the Gram negative organisms included Pseudomonas aeruginosa (ATCC 27853) and Salmonella typhi (ATCC 14028). Methanolic, hot water and cold water extracts of these plants were taken for antibacterial assay through Discs agar diffusion technique using commercial filter paper discs applied on inoculated Muellar Hinton agar plates. The objective of this study was to explore the curative powers of these herbs that exist in nature as a tool to counter disease causing agents. The maximum zone of inhibition of 18 mm of methanolic extract of N. sativa was observed against B. subtalis and S. aureus. Similarly, the maximum zone of inhibition of 18 mm of cold water extract of N. sativa against S. aureus and methanolic extract of Saussurea lappa against S. aureus and Pseudomonas aeruginosa was also observed. The antibacterial action was compared with the effect of ceftriaxone, ceftriaxone sodium, cefuroxine, ciprofloxacin, gentamycine, levofloxacin, metronidazole and tranexamic acid that were used as standered drugs. Based on the results obtained in this study, it may be concluded that plant extracts of A. modesta, A. absinthium, N. sativa and Saussurea lappa have a stronger and broader spectrum of antimicrobial activity against a number of food borne bacteria.Key words: Herbs, methanolic extract, Acacia modesta, Bacillus subtalis, gentamycine, gram negative, gram positive

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

On the fixed point theory of soft metric spaces

[EN] The aim of this paper is to show that a soft metric induces a compatible metric on the collection of all soft points of the absolute soft set, when the set of parameters is a finite set. We then show that soft metric extensions of several important fixed point theorems for metric spaces can be directly deduced from comparable existing results. We also present some examples to validate and illustrate our approach.Salvador Romaguera thanks the support of Ministry of Economy and Competitiveness of Spain, Grant MTM2012-37894-C02-01.Abbas, M.; Murtaza, G.; Romaguera Bonilla, S. (2016). On the fixed point theory of soft metric spaces. Fixed Point Theory and Applications. 2016(17):1-11. https://doi.org/10.1186/s13663-016-0502-yS111201617Zadeh, LA: Fuzzy sets. Inf. Control 8, 103-112 (1965)Molodtsov, D: Soft set theory - first results. Comput. Math. Appl. 37, 19-31 (1999)Aktaş, H, Çağman, N: Soft sets and soft groups. Inf. 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Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

An example of the “Statistics” page in the SeeDP system.

From the “Statistics” page, the prediction performance and distribution of each AI model (gastric/colorectal) can be checked. Moreover, the pathologist can review the applicable WSIs by selecting the cells within the “AI Distribution” table, which allows the pathologist to selectively review the cases that meet desired conditions from the “Statistics” page, similar to the “Test Results” page. Abbreviations: AI (artificial intelligence), SeeDP (Seegene Medical Foundation’s AI-assisted Digital Pathology Total Solution), WSI (whole slide image). (DOCX)</p

S4 Table -

S4.1 Table. Ternary classifier AI model performance. S4.2 Table. Binary classification AI model performance. (ZIP)</p

Distribution of the classification by AI prediction of gastric biopsy WSIs.

Distribution of the classification by AI prediction of gastric biopsy WSIs.</p