Value of Oxygenation Index in Selecting Neonates for Thoracoscopic Repair of Congenital Diaphragmatic Hernia

Introduction: The major obstacles for routine application of thoracoscopic repair for congenital diaphragmatic hernia (CHH) in neonates include intraoperative hypercarbia, acidosis and conversion to open surgery. Therefore, strict preoperative selection criteria should be followed for successful primary thoracoscopic repair of the diaphragm and achievement of minimal conversion rate. Materials and Methods: A prospective study was conducted from April 2016 to March 2018, where all neonates confirmed to have CDH were assessed by a specialized anaesthesia team for the possibility of undergoing thoracoscopic repair. In order to assess the severity of persistent pulmonary hypertension (PPH), oxygenation index (OI) was used and babies who had OI <5 were considered to have mild pulmonary hypertension; and consequently underwent thoracoscopic repair. Results: Twenty nine CDH cases met the selection criteria; hence, they underwent thoracoscopic repair. Primary diaphragmatic repair was successfully performed thoracoscopically in all neonates without perioperative complication. Conversion to open repair occurred in 3 cases, with causes related to surgical factors. Recurrence was discovered in 1 case only. Conclusion: While choosing candidates for thoracoscopic CDH repair in neonates, OI is a reliable indicator as it clarifies neonates who have good preoperative pulmonary functio

Neonatal Auditory Screening is a Necessity in The Neonatal Intensive Care Unit: Single Center Study

Background: Hearing impairment early in life interferes with normal healthy psychosocial, linguistic and educational development. Neonatal morbidities might be complicated by increased hearing impairment. Aim of the Work: To study the frequency of hearing loss among neonates with morbidities necessitating admission to neonatal intensive care units. Materials and Methods: This cross-sectional study involved screening of 250 neonate on day of discharge from Neonatal Intensive Care Unit (NICU), Children Hospital, Cairo University Hospitals, Egypt during 2020 using evoked otoacoustic emission (EOAE). Automated auditory brain stem response (AABR) was used as a confirmatory test for those who failed EOAE. Results: among the 250 neonates, 70 (28%) failed the screening by EOAE, and hearing loss was confirmed by AABR among 35(14%). Morbidity risk factors that contributed to hearing impairment was prematurity (p = 0.001), low birth weight (p = 0.003), low APGAR score at 1 and 5 minutes (p = 0.004), long NICU stay duration (p = 0.001), complications of pregnancy and delivery (p = 0.001 and p = 0.006 respectively), hypoxic ischemic encephalopathy (p = 0.001), intracranial hemorrhage (p = 0.001), meningitis (p = 0.003), mechanical ventilation for more than 5 days (p = 0.005), ototoxic drug use (p = 0.007) and hyperbilirubinemia at level of exchange transfusion (p = 0.001). Conclusion: EOAE and confirmatory AABR non- invasively and objectively detected 14% hearing loss among neonates admitted to NICU. Implementation of screening for hearing impairment among those with morbidity risk factors is a necessity to allow prompt diagnosis and early management of hearing loss

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Utilizing shallow seismic reflection for mitigating seismic and geo-environmental hazards in the development project of Gabal Ataqa Area, Cairo–Suez District, Egypt

Abstract Nowadays, development projects are becoming so rapid in many developing countries worldwide. The study of interest focuses on Cairo–Suez District, which represents the most important location in Egypt for major infrastructure projects and urbanization expansion. Consequently, it is very important to reduce the hazards surrounding this area from natural disasters, so all information that supports geo-environmental hazards assessment is importantly needed. The Gabal Ataqa area has socioeconomic importance as it is considered the industrial zone in the national project for developing the northern part of the Gulf of Suez. The situation of Gabal Ataqa area for being rich with numerous geological structures, and its socioeconomic importance calls the need for the delineation of the subsurface structural features in this area using the appropriate method. The geological framework has recognized all Quaternary faults in the Gabal Ataqa area as they are exposed to the surface, at the same time, no seismic reflection data has been acquired in the Gabal Ataqa area. Accordingly, the shallow seismic reflection method is applied in the Gabal Ataqa area to detect the Quaternary faults that are not exposed to the surface and also to detect any subsurface features that may cause construction problems, such as water-wet sands, sabkhas, and limestone cavities. Three lines of 2D seismic profiles are acquired in the study area. After applying seismic data processing and interpretation, two Quaternary faults have been recognized in the first and third lines. The location of the first seismic line has been chosen to be between two historic earthquake events, increasing the probability that the sources causing these two events will be located on the newly recognized quaternary fault. A dim spot has been recognized in the second seismic line at a depth of 50 m, which may indicate the presence of a groundwater aquifer or wet sandstone layer. Based on these results, changing the industrial zone place to another side to be away from the area of the three seismic lines is highly recommended

Efficient Artificial Neural Network for Smart Grid Stability Prediction

According to the stability process of smart grids, which starts by gathering information of consumers, and then evaluating this information based on specifications of a power supply, and finally, information of a price is sent to the consumers as a report about the utilization. From this perspective, this process is too much time consuming, thus it should predict a smart grid stability via artificial intelligence (e.g., neural networks). Recent advances in the accuracy of neural network have effective solutions to solving the smart grid stability prediction issues, but it remains necessary to develop high performance neural networks that give higher accuracy. In this paper, an artificial neural network (ANN) is proposed to predict a smart grid stability for Decentral Smart Grid Control (DSGC) systems. This neural network is applied to a dataset aggregated from simulations of grid stability, executed on a four-node network with star topology, and engaged in two classes of grid stability–stable and unstable. Keras framework is used to train the proposed neural network, and a hyperparameter tuning method is utilized to achieve high accuracy. Receiver operating characteristic (ROC) curves and confusion matrices are experimentally utilized to evaluate the performance of the proposed neural network. The neural network provides high performance, with a testing loss rate of 0.0619, and a testing accuracy of 97.36%. The weighted average recall, precision, and F1-score for the proposed neural network are 98.02%, 98.03%, and 98.02%, respectively, while the area under the ROC curves (AUCs) is 100%. This neural network with the utilized dataset indeed provides an accurate and quick approach of predicting grid stability to analyze DSGC systems

Cost Minimizations and Performance Enhancements of Power Systems Using Spherical Prune Differential Evolution Algorithm Including Modal Analysis

A novel application of the spherical prune differential evolution algorithm (SpDEA) to solve optimal power flow (OPF) problems in electric power systems is presented. The SpDEA has several merits, such as its high convergence speed, low number of parameters to be designed, and low computational procedures. Four objectives, complete with their relevant operating constraints, are adopted to be optimized simultaneously. Various case studies of multiple objective scenarios are demonstrated under MATLAB environment. Static voltage stability index of lowest/weak bus using modal analysis is incorporated. The results generated by the SpDEA are investigated and compared to standard multi-objective differential evolution (MODE) to prove their viability. The best answer is chosen carefully among trade-off Pareto points by using the technique of fuzzy Pareto solution. Two power system networks such as IEEE 30-bus and 118-bus systems as large-scale optimization problems with 129 design control variables are utilized to point out the effectiveness of the SpDEA. The realized results among many independent runs indicate the robustness of the SpDEA-based approach on OPF methodology in optimizing the defined objectives simultaneously