Major Pulmonary Surgery in Patients with Compromised Lung Function

Introduction: The risk stratification of lung resection is fundamentally based on the results of pulmonary function tests. In patients considered to be at risk, major surgery is generally denied, opting for potentially less curative therapies. Objective: To evaluate the postoperative outcomes of major lung surgery in a group of patients deemed high risk. Methods: We performed a retrospective review of clinical records of all patients submitted to lobectomy, bilobectomy or pneumonectomy in a 3-year period in a reference Thoracic Surgery Unit. The patients were then divided in two groups: group A composed of patients with normal preoperative pulmonary function and group B which included patients with impaired lung function, defined as FEV1 and/or DLCO ≤60%. Results: A total of 234 patients were included, 181 (77.4%) in group A and 53 (22.6%) in group B. In group B, patients had more smoking habits, were more often associated with chronic obstructive pulmonary disease and were also more frequently submitted to thoracotomy. When surgery was motivated by primary lung cancer this group had a more advanced clinical stage of the disease. In the postoperative period, these patients had longer hospital stay, longer chest drainage time and greater need for oxygen therapy at home, however, no statistically significant difference was noted in morbidity or mortality. Conclusions: Major thoracic surgery can be safely performed in selected patients considered to be high risk for resection by pulmonary function tests. A potentially curative surgery should not be denied based on respiratory function tests alone.info:eu-repo/semantics/publishedVersio

Association of HCV with diabetes mellitus: an Egyptian case-control study

<p>Abstract</p> <p>Background</p> <p>The highest Hepatitis C Virus (HCV) prevalence in the world occurs in Egypt. Several studies from different parts of the world have found that 13% to 33% of patients with chronic HCV have associated diabetes, mostly type II Diabetes Mellitus (DM). In Egypt the prevalence of DM is 25.4% among HCV patients. Therefore, it is important to identify the magnitude of the problem of diabetes in order to optimize the treatment of chronic hepatitis C.</p> <p>Methods</p> <p>The objective of this case-control study was to evaluate the prevalence of DM and other extrahepatic (EH) manifestations among patients with different HCV morbidity stages including asymptomatic, chronic hepatic and cirrhotic patients. In this study, 289 HCV patients older than 18 were selected as cases. Also, 289 healthy controls were included. Laboratory investigations including Liver Function tests (LFT) and blood glucose level were done. Also serological assays including cryoglobulin profile, rheumatoid factor, antinuclear antibody, HCV-PCR were performed.</p> <p>Results</p> <p>Out of 289 HCV cases, 40 (13.84%) were diabetic. Out of 289 healthy controls, 12 (4.15%) were diabetic. It was found that the diabetic HCV group mean age was [48.1 (± 9.2)]. Males and urbanians represented 72.5% and 85% respectively. Lower level of education was manifested in 52.5% and 87.5% were married. In the nondiabetic HCV group mean age was [40.7 (± 10.4)]. Males and urbanians represented 71.5% and 655% respectively. secondary and higher level of education was attained in 55.4% and 76.7% were married. Comparing between the diabetic HCV group and the non diabetic HCV group, age, residence and alcohol drinking were the only significant factors affecting the incidence of diabetes between the two groups. There was no significant difference regarding sonar findings although cirrhosis was more prevalent among diabetic HCV cases and the fibrosis score was higher in diabetic HCV patients than among the non diabetic HCV cases.</p> <p>Conclusion</p> <p>The diabetic patients in the HCV group were older, more likely to have a history of alcohol drinking than the non diabetic HCV cases. Age and alcohol drinking are factors that could potentially contribute to the development of type 2 diabetes. Logistic regression analyses showed that age and residence in urban regions were the predictive variables that could be associated with the presence of diabetes. Alcohol consumption was not a significant predictive factor.</p

On generalized surrogate duality in mixed-integer nonlinear programming

The most important ingredient for solving mixed-integer nonlinear programs (MINLPs) to global -optimality with spatial branch and bound is a tight, computationally tractable relaxation. Due to both theoretical and practical considerations, relaxations of MINLPs are usually required to be convex. Nonetheless, current optimization solvers can often successfully handle a moderate presence of nonconvexities, which opens the door for the use of potentially tighter nonconvex relaxations. In this work, we exploit this fact and make use of a nonconvex relaxation obtained via aggregation of constraints: a surrogate relaxation. These relaxations were actively studied for linear integer programs in the 70s and 80s, but they have been scarcely considered since. We revisit these relaxations in an MINLP setting and show the computational benefits and challenges they can have. Additionally, we study a generalization of such relaxation that allows for multiple aggregations simultaneously and present the first algorithm that is capable of computing the best set of aggregations. We propose a multitude of computational enhancements for improving its practical performance and evaluate the algorithm’s ability to generate strong dual bounds through extensive computational experiments

Sintomas vestibulares em crianças com queixa de dificuldades escolares Vestibular symptoms in children with complaints of school difficulties

OBJETIVO: Estudar os sintomas vestibulares em crianças com queixas de dificuldades escolares. MÉTODOS: Foram estudadas 88 crianças entre sete e 12 anos, que freqüentavam escolas públicas da cidade de Piracicaba no período de 2004 a 2006. Os procedimentos utilizados foram: a anamnese; exame otorrinolaringológico; exame audiológico e questionário dirigido utilizado como instrumento de coleta de dados. RESULTADOS: Das crianças avaliadas 51% não relataram dificuldades escolares e 49% referiram ter dificuldades escolares. A queixa referida mais comum foi a de vertigem (22,7%), e os sintomas referidos mais comuns no ambiente escolar foram de ansiedade (95,5%) e cefaléia (53,4%), as dificuldades escolares mais citadas foram a de ler (56,8%) e a de copiar (43,2%). CONCLUSÕES: A queixa de tontura e as dificuldades em ler e copiar apresentaram relação estatisticamente significante nas crianças com queixas de dificuldades escolares.<br>PURPOSE: To study vestibular symptoms in children with complaints of school difficulties. METHODS: Eighty-eight children between seven and 12 years old were studied. The subjects attended public schools from Piracicaba - SP (Brazil) during the period from 2004 to 2006. The procedures included: anamnesis, otorhinolaryngological examination, audiological examination, and a directed questionnaire used as an instrument for data gathering. RESULTS: From the evaluated children, 51% had no complaints of school difficulties, and 49% reported school difficulties. The most common complaint reported was vertigo (22.7%), and the most common symptoms reported in school environment were anxiety (95.5%) and chronic headache (53.4%). The most cited school difficulties were reading (56.8%) and copying (43.2%). CONCLUSIONS: Vertigo complaints and reading and copying difficulties presented a statistically significant relation in children with complaints of school difficulties