Assessment of the Cognitive function in the epileptic patients and effect of anti epileptic drugs

This study is a prospective study that aimed to evaluate cognitive function in newly diagnosed epileptic patients before and 3 months after taking an antiepileptic drug by doing Wechsler IQ for patients before and 3 months after treatment and for their parents . the study included 40 patients. Divided into 4 groups  (each containing 10 patients ) and subjected to one of the following AEDs  for  3  months : 1. group A : receiving Carbamazepine (Tegretol)  in a dose of 10-20 mg/kg/day,2. group B receiving Na valproate (Depakine) in a dose of 20-40 mg/kg/day,3. group C : receiving Lamotrigine (Lamictal)  in a dose of 3-5 mg/kg/day,4. group D : receiving Topiramate in a dose of 3-6 mg/kg/day.Taking into consideration other factors that may be of Significance in affecting cognitive functions as seizure frequency ,age at onset of seizures and EEG abnormality. The results of the study were as following:1-There are statistically significant differences between IQs before and after treatment in the 4 groups. 2-there is +ve correlation between IQs before and after ttt in all groups.3- there is -ve correlation between IQs after ttt and frequency of seizures in group (B).4- There is +ve correlation between IQs of parents and patients? IQs before ttt in all groups.5-there is +ve correlation between IQs after ttt and parents' IQs  in all group,From these results we can conclude that  heredity is the main factor responsible for most of the decline in cognitive functions seen in epileptic patients after  treatment with AEDs and other factors as   seizure frequency, age at onset of seizures and EEG  abnormalities may also  play  a role,  By comparing the four groups we found that the impairment in cognitive function is mainly related to the impairment in cognitive function already present in those patients before the start of treatment. which were correlated and inherited in all groups. Keywords: Epilepsy,Cognition,Antiepileptic drug

Safety and efficacy of implantable phakic contact lens versus implantable collamer lens in myopia correction

Background: Phakic intraocular lenses (pIOLs) have proven to be excellent substitutes for excimer laser keratorefractive surgery in certain situations. We aimed to assess the efficacy and safety of two pIOLs, the implantable collamer lens (ICL V4c) versus the implantable phakic contact lens (IPCL V2), for myopic correction. Methods: In this prospective randomized clinical trial, we allocated eligible eyes with myopia > - 6 diopters into IPCL or ICL implantation groups, each including 100 eyes of 100 individuals. Preoperative and postoperative assessments at 3, 6, and 12 months included measurements of the spherical equivalent (SE), uncorrected distance visual acuity (UCDVA), best-corrected distance visual acuity (BCDVA), intraocular pressure (IOP), maximum keratometry (K1), minimum keratometry (K2), mean keratometry (Kmean), anterior chamber depth (ACD), anterior chamber angle (ACA), and endothelial cell density (ECD). Results: The groups had comparable demographic characteristics and baseline visual and anatomical values (all P > 0.05). The UCDVA, BCDVA, and SE of the two groups were comparable at baseline and at all postoperative follow-up examinations (all P > 0.05). Both groups experienced significant improvements in UCDVA, BCDVA, and SE at three months postoperatively (all P = 0.001), and measurements remained stable for up to 12 months. Keratometry readings were comparable between the groups over the follow-up period and remained unchanged at all visits (all P > 0.05). The ACA in the ICL group was significantly decreased at three months postoperatively (P = 0.001) and then widened significantly at 6 and 12 months (both P = 0.001). In the IPCL group, the postoperative ACA was significantly decreased at three months (P = 0.001) and was comparable to that in the ICL group (P > 0.01). However, at the 6- and 12-month postoperative visits, the ACA was significantly narrower in the IPCL group than in the ICL group (both P = 0.001). The ACD in both groups was decreased at three months postoperatively (both P = 0.001) and remained stable until the end of the study. The ECD remained comparable between the groups at all postoperative visits (all P > 0.05). We did not observe a significant ECD reduction in either group at any postoperative follow-up visit (all P > 0.05). We encountered no serious complications in either group. Conclusions: ICL and IPCL had comparable safety and efficacy outcomes in terms of anterior chamber morphometrics, visual and refractive results, and corneal parameters. Further multicenter randomized clinical trials with longer follow-up periods, larger sample sizes, and measurement of additional anterior chamber and corneal morphometrics, vault, and other vision parameters are needed to verify these findings

Longitudinal changes in peri-papillary retinal nerve fiber layer thickness in patients with unilateral branch retinal vein occlusion

Background: Associations between retinal venous occlusion (RVO), elevated intraocular pressure, and glaucoma have been reported. Further investigations into structural alterations in the fellow eyes of individuals with unilateral RVO have revealed that the peripapillary retinal nerve fiber layer is thinner than in healthy eyes, suggesting that there may be systemic risk factors common to both RVO and glaucoma. We aimed to evaluate changes in peripapillary retinal nerve fiber layer thickness (pRNFLT) among individuals with unilateral branch retinal vein occlusion (BRVO). Methods: This prospective observational study recruited 30 individuals (60 eyes) with newly diagnosed unilateral BRVO and macular edema, and a control group of 30 healthy individuals (30 eyes) with no abnormalities on fundus examination or concurrent systemic comorbidities. After baseline measurements, the participants were reassessed at 6, 12, and 24 months by measuring global and sectoral pRNFLT using spectral-domain optical coherence tomography. Results: The mean age and sex distributions were comparable between the patient and control groups (both P > 0.05). When compared to fellow eyes, global and sectoral pRNFLT in eyes with BRVO were significantly higher at baseline (all P < 0.05). Over time, pRNFLT decreased dramatically, and by the conclusion of the two-year follow-up, there was a significant reduction from baseline in the affected eyes (all P < 0.05). Likewise, affected eyes experienced a significant improvement in best-corrected distance visual acuity and central macular thickness over the two-year follow-up (both P Less than or equal to 0.001). Comparing the global and all-sector pRNFLT of fellow eyes in the patient group with those of normal eyes in the control group, there were no significant differences at any visit, except in the temporal sector, which revealed a significant reduction in pRNFLT at 24 months in the fellow eyes of patients with unilateral BRVO (P = 0.02).   Conclusions: Patients with unilateral BRVO experienced a significant reduction in pRNFLT in the affected eyes and, to a lesser extent, in the fellow eyes, compared with that of the control arm, suggesting that they are prone to retinal nerve fiber layer damage. The reduction in pRNFLT in the normal fellow eyes of patients with BRVO may be attributed to age or concurrent systemic comorbidities. Further studies with long follow-up periods are required to shed light on the etiology of functional and structural changes in both the retinal nerve fiber layer and ganglion cell complex in the normal and affected eyes of patients with unilateral BRVO

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

A review of the effects of colour and light on non-image function in humans

This paper reviews current knowledge on non-image-forming aspects of vision. Developments in the last 20 years have included the discovery of a fifth class of human visual pigment (melanopsin), in addition to the three classes of photopsin to be found in the cones and rhodopsin in the rods in the human retina. Melanopsin is found in a small number of retinal ganglion cells which then, in addition to receiving input from rods and cones, are intrinsically photosensitive. These retinal ganglion cells send their input primarily to the hypothalamus, where they help to regulate the circadian system (daily rhythms of sleep patterns, body temperature, heart rate, etc.). The discovery of the anatomical basis of non-image-forming vision has led to a great deal of research into the effects of light on sleep, depression and mood, retinal photodamage and well-being, amongst other factors. Given that recent technological innovations in LED lighting now give us greater control over environmental lighting, it is timely to review the non-visual effects of light in humans in order to inform lighting design in the future

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

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

On the Security of Spectrum Sharing and the Privacy of Data Retrieval

In the era of big data, large volumes of data are collected, communicated, processed, stored, and retrieved to enable a wealth of new applications in all facets of everyday life. The fine-grained collection of information and ever-increasing reliance on computing and networking systems comes with grave security and privacy risks at every stage of the data lifecycle. At the system level, such risks include data exposure, denial-of-service, and reduced network performance, to name a few. At the user level, security and privacy risks include the leakage of sensitive personal information to unauthorized parties, digital identity theft, user tracking, loss of financial assets, and others. In this dissertation, we focus on the security of two stages of the data lifecycle. In the first part, we study the implications of allowing multiple wireless technologies to coexist in unlicensed bands. In the second part, we study the potential leakage of sensitive information when users retrieve stored data from public databases. The unprecedented increase in the demand for wireless services has led to a severe shortage in radio spectrum resources. The regulatory solution for the scarcity of the available resources is to allow the coexistence of competing wireless technologies in common bands (e.g., the coexistence of Wi-Fi/Zigbee and LTE/Wi-Fi). This shared spectrum paradigm introduces novel challenges for the secure, efficient, and fair resource access. Many of these challenges arise from the heterogeneity of the coexisting systems, the system scale, and the lack of explicit coordination mechanisms between them. In this dissertation, we study the LTE/Wi-Fi coexistence in unlicensed bands as an example of heterogeneous coexistence. We develop methods that ensure fair and efficient coexistence. In the first objective, we consider the problem of fair coexistence between LTE and Wi-Fi systems in the unlicensed 5 GHz U-NII bands. We develop implicit sensing techniques that can accurately estimate the operational parameters of LTE transmissions under various topological scenarios and {\em without decoding.} These techniques apply correlation-based signal detection to infer the required information. The estimated parameters are vital in evaluating the behavior of coexistent terminals. Our techniques are validated through experiments on a USRP testbed. In the second objective, we focus on the misbehavior opportunities due to the heterogeneity in the channel access mechanism and the lack of a common control plane. We define selfish misbehavior strategies for the LTE that yield an unfair share of the spectrum resources. Such strategies are based on manipulating the operational parameters of the LTE-LAA standard. Prior methods for detecting misbehavior in homogeneous settings are not applicable in a spectrum sharing scenario because the devices of one system cannot decode the transmissions of another. We further apply a statistical inference framework for determining deviations of the LTE behavior from the coexistence etiquette. By characterizing the detection and false alarm probabilities, we show that our framework yields high detection accuracy at a very low false alarm rate. Although our methods focus on detecting misbehavior of the LTE system, they can be generalized to other coexistence scenarios. We further exploit the quick change detection framework to provide a method that detects any change in LTE behavior immediately after it happens. This method enables the Wi-Fi system not only to detect any LTE misbehavior but also to identify the exact misbehavior strategy adopted by the LTE. We further propose response strategies for the Wi-Fi system that equalize the channel access opportunities. These include a reflection strategy in which the Wi-Fi mimics the LTE misbehavior and a fair response strategy in which the Wi-Fi selects parameters that restore fairness. We study mechanisms for improving the coexistence efficiency in the third objective. We first study conserving energy when the wireless channel is occupied. In a Wi-Fi only system, the network allocation vector (NAV) included in the header of IEEE 802.11 frames advertises the duration of an imminent transmission. Nearby Wi-Fi terminals decode the frame header and transition to sleep mode to conserve energy. However, when heterogeneous systems coexist (e.g., LTE and Wi-Fi), frames that belong to other systems are not decodable. This leads to continuous channel sensing even when the channel is to be occupied for a long duration. We design two implicit mechanisms to play the role of the NAV. Our mechanisms predict the duration of an imminent LTE transmission by predicting the frame's traffic class. The prediction is based on the elapsed idle slots between successive transmissions and the transmission history. We show that our methods achieve significant energy savings without stifling transmission opportunities. Second, we investigate how the traffic class selection affects the delay for completing the transmission of a fixed number of bits. We develop an analytical framework that characterizes the average delay under Wi-Fi/LTE coexistence. Our framework allows us to optimize the class selection for a Wi-Fi or LTE station based on the traffic class selected by the surrounding stations and minimize the average delay. We show that operating at a high priority class does not always minimize delay. Under certain contention and class selection conditions, a low priority class reduces the collision probability while increasing the airtime once the channel is captured. This leads to a lower overall delay. In the second part of the dissertation, we study the process of privately retrieving data from one or more public databases, known as private information retrieval (PIR). Information-theoretic formulations of the PIR problem have been investigated under a variety of scenarios. Symmetric private information retrieval (SPIR) is a variant where a user is able to privately retrieve one out of $K$ messages from $N$ non-colluding replicated databases without learning anything about the remaining $K-1$ messages. However, the goal of perfect privacy can be too taxing for certain applications. We investigate if the information-theoretic capacity of SPIR (equivalently, the inverse of the minimum download cost) can be increased by relaxing both user and DB privacy definitions. Such relaxation is relevant in applications where privacy can be traded for communication efficiency. In the fourth objective, we introduce and investigate the Asymmetric Leaky PIR (AL-PIR) model with different privacy leakage budgets in each direction. For user privacy leakage, we bound the probability ratios between all possible realizations of database queries by a function of a non-negative constant $\epsilon$. For database privacy, we bound the mutual information between the undesired messages, the queries, and the answers, by a function of a non-negative constant $\delta$. We propose a general AL-PIR scheme that achieves an upper bound on the optimal download cost for arbitrary $\epsilon$ and $\delta$. Second, we obtain an information-theoretic lower bound on the download cost. The gap analysis between the two bounds shows that our AL-PIR scheme is optimal when $\epsilon =0$, i.e., under perfect user privacy and it is optimal within a maximum multiplicative gap for any $\epsilon>0$ and $\delta>0$. Finally, we study the Latent-variable PIR (LV-PIR) in the fifth objective. In LV-PIR, a user wishes to retrieve one out of $K$ messages (indexed by $\theta$) without revealing any information about a sensitive \textit{latent} attribute (modeled by a latent variable $S$ correlated with $\theta$). We characterize the capacity (equivalently, the optimal download cost) of LV-PIR as a function of the distribution $P_{S|\theta}$. We present a converse proof that yields a lower bound on the optimal download cost and a matching achievable scheme. The optimal scheme, however, involves an exhaustive search over subset queries and over all messages, which can be computationally prohibitive for large databases. We further present two low-complexity, albeit sub-optimal, schemes that outperform the conventional PIR solution

A novel technique of harmonic tissue dissection reduces seroma formation after modified radical mastectomy compared to conventional electrocautery: a single-blind randomized controlled trial

Abstract Background Seroma is the most frequent postoperative complication following breast cancer surgery. Our aim was to evaluate the effect of the harmonic focus scalpel versus electrocautery in reducing seroma formation post-mastectomy and axillary clearance. Methods A prospective randomized controlled trial study was conducted at the Department of Surgery of Suez Canal University Hospital from April 26th 2014 to 30th June 2016. Seventy-two women, in whom a mastectomy and axillary clearance for breast cancer were performed, were randomly allocated to either harmonic dissection (n = 36) or electrocautery (n = 36). Results The mean operative time was significantly longer for harmonic dissection compared with electrocautery (2.63 ± 0.41 vs. 1.75 ± 0.26 h; p < 0.0001). In addition, a significantly smaller amount of intraoperative blood loss (69.4 ± 25.1 vs. 255.5 ± 41.6 ml; p = 0.002) and total drainage volume (1277.8 ± 172.5 ml vs. 3300 ± 167.5 ml; p = 0.002) were found in the harmonic group. Moreover, there was a significant reduction in the time of drain removal (10.9 ± 1.12 vs. 15.9 ± 1.44; p = 0.001) and the incidence of seroma formation after drain removal [8.3% vs 33.3%; p = 0.003] in the harmonic group compared with those in the electrocautery group. Conclusion Harmonic dissection technique leads to significant decreases in intraoperative blood loss, total drainage volume and postoperative seroma in terms of shorter drain duration with a minimal increase in the operative time and better quality of life. Here, we recommend the use of the harmonic dissection technique in mastectomy and axillary clearance

An optimization model for the design of a sustainable municipal solid waste management system

Solid waste management is critical to sustainable, healthy, and eco-friendly cities and societies. In developing countries, only a small percentage of municipal solid waste is disposed safely, while the majority remains in the streets or disposed in open landfills. Most countries seek to establish effective and efficient solid waste management system (SWMS) that can handle and dispose of the daily generated waste at minimum cost and in a sustainable manner. Those systems usually consist of waste sources, waste collection stations, landfills, incinerators, and recycling plants, in addition to the transportation system that integrates the different sub-systems. The problem facing decisionmakers while designing or reconfiguring a SWMS is to determine the optimal supply chain network design for such systems in a way that ensures the treatment and disposal of all daily generated waste at the lowest cost. In this context, this paper aims to develop a generic optimization model suitable for application in SWMS optimization in developing countries. A new mixed-integer linear programming (MILP) model is formulated for a SWMS configuration that integrates waste generation sources, collection/transfer stations, recycling plants, incinerators, and landfills. The proposed MILP model is formulated to determine the optimal number and locations of the different facilities, and the optimal flow of waste in the system that minimizes the net daily cost incurred in the system. The model has been applied in a case study on the SWMS in Fayoum Governorate, Egypt. The main contribution of this research refers both to the theoretical development of a generic MILP model that can be applied to optimally design the SWMS in developing countries, and to its operational counterpart, as per the design solutions provided in the SWMS of Fayoum Governorate (Egypt)