Assessment of Mortality and Causes after Re-bleed In Patients Having Endoscopy for Upper Gastrointestinal Bleeding

Introduction: Acute Upper gastrointestinal bleeding (AUGIB), with prevalence of 36 to 172/100,000 natives per year, is a common medical emergency. Mortality rate after UGIB ranges from 4–14% while re-bleeding is evident in 10–30% of these patients. Despite advances in treatment modalities of UGIB, the in-hospital mortality rate remains high and it is commonly due to re-bleeding. However, the causes and frequency of mortality among patients with re-bleeding are not well known in Pakistan. Objective: To determine the frequency and causes of in-hospital mortality after re-bleeding among patients undergoing endoscopy for upper gastrointestinal bleeding. Methodology:  A descriptive cross-sectional study was done in Military hospital Rawalpindi from December 2014 to June 2015. A total 150 patients aged between 18 to 65 years who presented with upper gastrointestinal bleeding (UGIB) and underwent upper GI endoscopy and re-bleed were included through purposive sampling. Structured questionnaire used to record data. The patients were observed for mortality and causes after re-bleeding in the hospital for about 5 days. Patients who died, the cause of the death was assessed by 2 senior consultant physicians. SPSS version 21 was used for data entry and analysis. Variables like mortality were presented as percentage and frequencies. Effect modifiers like age and gender were controlled by stratification. Results:  The mean age of patients (n=150) was 43.97±12.28 years. Among total cases, 97 (64.7%) were males and 53 (35.7%) were females. The in-hospital mortality rate was 20% (n=30), re-bleed was cause in 12 (40%) while in 18 (60%) cause was other than re-bleed (cardiac, multi-organ failure, neurological, pulmonary, and advanced malignancy). Mortality in male patients was higher (n=18, 60.0%) as compared to female patients (n=12, 40.0%). The highest mortality (n=22, 73.3%) was observed in age group ˃43 years. The association of in-hospital mortality was statistically significant (p value = 0.02) by age but not by gender. Conclusion: In-hospital mortality after UGIB is 20 %, frequent cause is other than the re-bleed. Male above aged 43 are more vulnerable. Management of UGIB should also focus on optimization of non-re-bleeding causes and other co-morbid related deaths instead of merely maintaining homeostasis and blood transfusions.   Keywords: Re-bleeding, Mortality, Acute Upper Gastrointestinal Bleeding, Upper GI Endoscopy

Factors affecting wool quality and quantity in sheep

There are varieties of factors which can affect wool (macro and micro elements of wool) in sheep directly or indirectly. Genetic and environmental factors are major factors influencing wool quality and quantity. There are some bacterial, viral, fungal and espically parasitic diseases which also affect the wool. Other factors are exogenous chemicals, hormones, weather and photo period. In the present study, existing knowledge on the factors affecting wool were reviewed but there are gaps to conduct research on fundamental aspects of wool growth, which could have relevance to other areas of biology.Keywords: Wool quality, staple length, ultra high-sulphur proteins, fleec

Endourological Management of Urolithiasis in Donor Kidneys prior to Renal Transplant

Background. We present our centres successful endourological methodology of ex vivo ureteroscopy (EVFUS) in the management of these kidneys prior to renal transplantation. Patient and Methods. A retrospective analysis was performed of all living donors (n = 157) identified to have asymptomatic incidental renal calculi from January 2004 until December 2008. The incidence of asymptomatic renal calculi was 3.2% (n = 5). Donors were subdivided into 2 groups depending on whether theydonated the kidney with the renal calculus (Group 1) versus the opposite calculus-free kidney (Group 2). Results. All donors in Group 1 underwent a left laparoscopic donor nephrectomy. The calculi were extracted in all 3 cases using a 7.5 Fr flexible ureteroscope either prior to transplant (n = 2) or on revascularization (n = 1). There were no urological complications in either group. At a mean followup at 64 months there was no recurrent calculi formation in the recipient in Group 1. However, 1 recipient formed a calculus in group 2 at a follow up of 72 months. Conclusions. Renal calculi can be successfully retrieved during living-related transplantation at the time of transplant itself using EVUS. This is technically feasible and is associated with no compromise in ureteral integrity or renal allograft function

The results of 2013 survey to evaluate Laparoscopic and Partial nephrectomy practice in the United Kingdom

This article is an editorial, and it doesn't include an abstract. Full text of this article is available in HTML and PDF.Cite this article as: Vasdev N, Mafeld S, Fuge O, Lane T, Boustead G, Adshead JM, Soomro NA. The results of 2013 survey to evaluate laparoscopic and partial nephrectomy practice in the United Kingdom. Int J Cancer Ther Oncol 2014; 2(2):02022.DOI: http://dx.doi.org/10.14319/ijcto.0202.

Challenges of early renal cancer detection: symptom patterns and incidental diagnosis rate in a multicentre prospective UK cohort of patients presenting with suspected renal cancer.

OBJECTIVES: To describe the frequency and nature of symptoms in patients presenting with suspected renal cell carcinoma (RCC) and examine their reliability in achieving early diagnosis. DESIGN: Multicentre prospective observational cohort study. SETTING AND PARTICIPANTS: Eleven UK centres recruiting patients presenting with suspected newly diagnosed RCC. Symptoms reported by patients were recorded and reviewed. Comprehensive clinico-pathological and outcome data were also collected. OUTCOMES: Type and frequency of reported symptoms, incidental diagnosis rate, metastasis-free survival and cancer-specific survival. RESULTS: Of 706 patients recruited between 2011 and 2014, 608 patients with a confirmed RCC formed the primary study population. The majority (60%) of patients were diagnosed incidentally. 87% of patients with stage Ia and 36% with stage III or IV disease presented incidentally. Visible haematuria was reported in 23% of patients and was commonly associated with advanced disease (49% had stage III or IV disease). Symptomatic presentation was associated with poorer outcomes, likely reflecting the presence of higher stage disease. Symptom patterns among the 54 patients subsequently found to have a benign renal mass were similar to those with a confirmed RCC. CONCLUSIONS: Raising public awareness of RCC-related symptoms as a strategy to improve early detection rates is limited by the fact that related symptoms are relatively uncommon and often associated with advanced disease. Greater attention must be paid to the feasibility of screening strategies and the identification of circulating diagnostic biomarkers

Challenges of early renal cancer detection: symptom patterns and incidental diagnosis rate in a multicentre prospective UK cohort of patients presenting with suspected renal cancer

Objectives: To describe the frequency and nature of symptoms in patients presenting with suspected renal cell carcinoma (RCC) and examine their reliability in achieving early diagnosis. Design: Multicentre prospective observational cohort study. Setting and participants: Eleven UK centres recruiting patients presenting with suspected newly diagnosed RCC. Symptoms reported by patients were recorded and reviewed. Comprehensive clinico-pathological and outcome data were also collected. Outcomes: Type and frequency of reported symptoms, incidental diagnosis rate, metastasis-free survival and cancer-specific survival. Results: Of 706 patients recruited between 2011 and 2014, 608 patients with a confirmed RCC formed the primary study population. The majority (60%) of patients were diagnosed incidentally. 87% of patients with stage Ia and 36% with stage III or IV disease presented incidentally. Visible haematuria was reported in 23% of patients and was commonly associated with advanced disease (49% had stage III or IV disease). Symptomatic presentation was associated with poorer outcomes, likely reflecting the presence of higher stage disease. Symptom patterns among the 54 patients subsequently found to have a benign renal mass were similar to those with a confirmed RCC. Conclusions: Raising public awareness of RCC-related symptoms as a strategy to improve early detection rates is limited by the fact that related symptoms are relatively uncommon and often associated with advanced disease. Greater attention must be paid to the feasibility of screening strategies and the identification of circulating diagnostic biomarkers

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial

Background: Tranexamic acid reduces surgical bleeding and reduces death due to bleeding in patients with trauma. Meta-analyses of small trials show that tranexamic acid might decrease deaths from gastrointestinal bleeding. We aimed to assess the effects of tranexamic acid in patients with gastrointestinal bleeding. Methods: We did an international, multicentre, randomised, placebo-controlled trial in 164 hospitals in 15 countries. Patients were enrolled if the responsible clinician was uncertain whether to use tranexamic acid, were aged above the minimum age considered an adult in their country (either aged 16 years and older or aged 18 years and older), and had significant (defined as at risk of bleeding to death) upper or lower gastrointestinal bleeding. Patients were randomly assigned by selection of a numbered treatment pack from a box containing eight packs that were identical apart from the pack number. Patients received either a loading dose of 1 g tranexamic acid, which was added to 100 mL infusion bag of 0·9% sodium chloride and infused by slow intravenous injection over 10 min, followed by a maintenance dose of 3 g tranexamic acid added to 1 L of any isotonic intravenous solution and infused at 125 mg/h for 24 h, or placebo (sodium chloride 0·9%). Patients, caregivers, and those assessing outcomes were masked to allocation. The primary outcome was death due to bleeding within 5 days of randomisation; analysis excluded patients who received neither dose of the allocated treatment and those for whom outcome data on death were unavailable. This trial was registered with Current Controlled Trials, ISRCTN11225767, and ClinicalTrials.gov, NCT01658124. Findings: Between July 4, 2013, and June 21, 2019, we randomly allocated 12 009 patients to receive tranexamic acid (5994, 49·9%) or matching placebo (6015, 50·1%), of whom 11 952 (99·5%) received the first dose of the allocated treatment. Death due to bleeding within 5 days of randomisation occurred in 222 (4%) of 5956 patients in the tranexamic acid group and in 226 (4%) of 5981 patients in the placebo group (risk ratio [RR] 0·99, 95% CI 0·82–1·18). Arterial thromboembolic events (myocardial infarction or stroke) were similar in the tranexamic acid group and placebo group (42 [0·7%] of 5952 vs 46 [0·8%] of 5977; 0·92; 0·60 to 1·39). Venous thromboembolic events (deep vein thrombosis or pulmonary embolism) were higher in tranexamic acid group than in the placebo group (48 [0·8%] of 5952 vs 26 [0·4%] of 5977; RR 1·85; 95% CI 1·15 to 2·98). Interpretation: We found that tranexamic acid did not reduce death from gastrointestinal bleeding. On the basis of our results, tranexamic acid should not be used for the treatment of gastrointestinal bleeding outside the context of a randomised trial

Wireshark window authentication based packet captureing scheme to pervent DDoS related security issues in cloud network nodes

DoS (Denial of Service) attack forces a cloud network node to handle few unauthorized access that employ unwanted computing cycle. As a result, the cloud node response is slow as usual and resource on cloud network becomes unavailable. Some Dos attacks are Ping of Death, Teardrop, Snork, Locking authentication, SYN flooding, Operating System Attacks etc. The most vulnerable incident happen when the adversary is committed DDoS (Distributed Denial of Service) attack with comprised cloud network. In this paper, the prevention techniques for DDoS (Distributed Denial of Service) attack in cloud nodes were discussed, a dynamic window scheme in cloud nodes to determine a message verification to resolve unnecessary packet processing was proposed

Incidental metastatic endocrine tumor diagnosed at laparoscopic radical prostatectomy and bilateral lymph node dissection

The introduction and expansion of laparoscopic and robotic radical retropubic prostatectomy (LRRP and RRRP) for organ-confined prostate cancer have led to an increase in pelvic lymphadenectomy specimens. Extended lymph node dissection (eLND) involves removing nodes over the obturator fossa, external ileac vessels as well as the internal iliac and increases the number of nodes examined. This has the potential to increase incidental nonprostatic nodal pathology identified in prostatectomy specimens. For the first time in the current literature we report the incidental diagnosis of a metastatic small bowel endocrine tumor in a 69-year-old gentleman, made at the time of LRRP and bilateral lymph node dissection. This report suggests that the benefit of an extended lymph node dissection is not only to prostate cancer control and staging, but also to the possibility of diagnosing potentially treatable incidental disease. It is a possibility that both pathologists and urologists alike should be aware of