Dorsal Phalloplasty to Preserve Penis Length after Penile Prosthesis Implantation

Objectives: Following penile prosthesis implantation (PPI), patients may complain of a decrease in visible penis length. A dorsal phalloplasty defines the penopubic junction by tacking pubic skin to the pubis, revealing the base of the penis. This study aimed to evaluate the efficacy of a dorsal phalloplasty in increasing the visible penis length following PPI. Methods: An inflatable penile prosthesis was implanted in 13 patients with severe erectile dysfunction (ED) at the Kamal Shaeer Hospital, Cairo, Egypt, from January 2013 to May 2014. During the surgery, nonabsorbable tacking sutures were used to pin the pubic skin to the pubis through the same penoscrotal incision. Intraoperative penis length was measured before and after the dorsal phalloplasty. Overall patient satisfaction was measured on a 5-point rating scale and patients were requested to subjectively compare their postoperative penis length with memories of their penis length before the onset of ED. Results: Intraoperatively, the dorsal phalloplasty increased the visible length of the erect penis by an average of 25.6%. The average length before and after tacking was 10.2 ± 2.9 cm and 13.7 ± 2.8 cm, respectively (P <0.002). Postoperatively, seven patients (53.8%) reported a longer penis, five patients (38.5%) reported no change in length and one patient (7.7%) reported a slightly shorter penis. The mean overall patient satisfaction score was 4.9 ± 0.3. None of the patients developed postoperative complications. Conclusion: A dorsal phalloplasty during PPI is an effective method of increasing visible penis length, therefore minimising the impression of a shorter penis after implantation

Remission of Grave\u27s disease after oral anti-thyroid drug treatment

OBJECTIVE: To evaluate remission rate of anti-thyroid drug treatment in patients with Grave\u27s disease, and to study the factors associated with remission. STUDY DESIGN: A cross sectional study. ,p\u3ePLACE AND DURATION OF STUDY: The Endocrine Department of the Aga Khan University Hospital, Karachi from 1999 to 2000. METHODOLOGY: Seventy four patients of Grave\u27s disease were recruited who were prescribed medical treatment. Grave\u27s disease was diagnosed in the presence of clinical and biochemical hyperthyroidism along with anti-microsomal (AMA) and anti-thyroglobulin antibodies (ATA) and thyroid scan. These patients were prescribed oral anti-thyroid drugs using titration regime and followed at 3, 6, 12 and 18 months. Patients were categorized into two groups: remission group and treatment failure group and results were compared using a chi-square test, t-test and logistic regression model with significance at p \u3c 0.05. RESULTS: A majority of the patients were females (62.6%, n=46). During the follow-up period of 18 months, 41.9% patients went into remission. Univariate analysis showed that the initial free T4 level was significantly different (p \u3c 0.05) in patients in remission and treatment failure groups. Multivariate analysis showed only initial free T4 level was a significant predictor of outcome. Positive AMA patients (n=27) had higher treatment failure (odds ratio: 2.55: 95%, CI 0.69 - 9:31), although the difference was not statistically significant (p = 0.13). CONCLUSION: Remission rates with oral anti-thyroid agents is markedly high. Patients should be offered alternate treatment options to those who do not enter remission during a period of 12-18 months of treatment, those who develop relapse, and those who have aggressive disease on initial presentation

A review on Precoding Techniques For mm-Wave Massive MIMO Wireless Systems

The growing demands for high data rate wireless connectivity shed lights on the fact that appropriate spectrum regions need to be investigated so that the expected future needs will be satisfied. With this in mind, the research community has shown considerable interest in millimeter-wave (mm-wave) communication. Generally, hybrid transceivers combining the analog phase shifter and the RF chains with digital signal processing (DSP) systems are used for MIMO communication in the fifth generation (5G) wireless networks. This paper presents a survey for different precoding or beamforming techniques that have been proposed in the literature. These beamforming techniques are mainly classified based on their hardware structure into analog and digital beamforming. To reduce the hardware complexity and power consumption, the hybrid precoding techniques that combine analog and digital beamforming can be implemented for mm-wave massive MIMO wireless systems. The performance of the most common hybrid precoding algorithms has been investigated in this paper

Can frozen-section analysis of ureteric margins at the time of radical cystectomy predict upper tract recurrence?

Objective: To summarise the currently available literature and analyse available results of the outcome of intraoperative frozen-section analysis (FSA) on upper urinary tract recurrence (UUTR) after radical cystectomy (RC). Materials and methods: A systematic review of the literature was performed according to the Cochrane Reviews guidelines and in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Articles discussing ureteric FSA with RC were identified. Results: The literature search yielded 21 studies, on which the present analysis was done. The studies were published between 1997 and 2019. There were 10 010 patients with an age range between 51 and 95 years. Involvement of the ureteric margins was noted in 2–9% at RC. The sensitivity and specificity of FSA were ~75% and 99%, respectively. Adverse pathology on FSA and on permanent section, prostatic urothelial carcinoma involving the stroma but not prostatic duct, and ureteric involvement on permanent section were all more likely to develop UUTR. Neither evidence of ureteric involvement nor ureteric margin status on permanent section were significant predictors of overall survival. Conclusion: Routine FSA is mandatory for a tumour-free uretero–enteric anastomosis and is predictive of UUTR. To lower the UUTR, FSA is not necessary if the ureters are resected at the level where they cross the common iliac vessels. FSA is indicated whenever the surgeon encounters findings suspicious of malignancy, e.g. ureteric obstruction, periureteric fibrosis, diffuse carcinoma in situ, induration or frank tumour infiltration of the distal ureter is discovered unexpectedly during surgery, and prostatic urethral involvement. Abbreviations CIS: carcinoma in situ; FSA: frozen-section analysis; HR: hazard ratio; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RC: radical cystectomy; (UT)UC: (upper tract) urothelial carcinoma; UUT(R): upper urinary tract (recurrence)

A rare presentation of acute flaccid myelitis in covid-19 patient: a case report

SARS-CoV-2 virus enters human cells via ACE-2 receptors and causes multiple organs dysfunction. These ACE-2 receptors are in cells surface of human lung, liver, heart, kidney and blood vessels. The expression of ACE2 receptors in cortical neurons, glial cells and spinal cord cells create nervous system susceptible to SARS-CoV-2 attack and may be a source of different neurological deficits including myelitis in COVID-19 patients

Salvage of Hemodialysis Catheter in Staphylococcal Bacteremia: Case Series, Revisiting the Literature, and the Role of the Pharmacist

Catheter-related blood stream infections comprise a major concern in hemodialysis patients, leading to increased mortality, morbidity, and cost of treatment. Prompt appropriate systemic antibiotics treatment, which includes administration of appropriate systemic antibiotics and, frequently, catheter removal and replacement, is warranted. However, in hemodialysis patients, repeated catheter insertions may cause central vein stenosis and thrombosis which limits the future availability of hemodialysis access. Lock solutions containing antibiotics and anticoagulants, instilled directly into the catheter lumen after each dialysis, have been successfully utilized for catheter salvage but higher rates of recurrence and complications were observed in infections resulting from staphylococcal species. We report several cases of catheter salvage using antibiotic lock solution in staphylococcal bacteremia with the purpose of stimulating the interest in randomized clinical trials. Evaluating the risk and benefits of catheter salvage in this patient subset in light of optimized systemic antibiotic dosing, improved lock solution use, and multidisciplinary involvement, balanced with the critical need to prevent unnecessary vascular trauma, is of great importance

Teledentistry: Limitation and Challenges

Dentistry is the top listed most risky jobs in this pandemic Covid 19 situation, as dentist contain close face-to-face contact with the patients which increase the potential transmission of the (SARS)-CoV-2 virus from human to human through direct contact via oro-pharyngeal droplets and indirect contacts with fomites where dental professionals are highly vulnerable to get infected from the coronavirus. Thus, dental practice has mostly been suspended during this period. Teledentistry introduces a novel solution to resume dental practice by providing dental treatment, guidance, and education through teleconsultation, telediagnosis and telemonitoring through Information Technology (IT) instead of direct contact with patients. But there are some major challenges like lack of government initiatives, compensation strategy, legal issues, technical base, co-ordination among doctors, along with patients’ co-operation and limitations in telediagnosis. This technical note highlighted these limitations and challenges to make a concern to the dentist as at least teledentistry can accompaniment the existing threaten dental system during this living pandemic

Bridging vs Non-Bridging with Warfarin Peri-Procedural Management: Cost and Cost-Effectiveness Analyses

The warfarin peri-procedural management in Qatar is predominantly based on bridging (63%), compared to non-bridging. This study sought to perform a first-time cost analysis of current warfarin peri-procedural management practices, including a cost-effectiveness analysis (CEA) of predominant bridging vs predominant non-bridging practices. From the hospital perspective, a one-year decision-analytic model followed the cost and success consequences of the peri-procedural warfarin in a hypothetical cohort of 10,000 atrial fibrillation patients. Success was defined as survival with no adverse events. Outcome measures were the cost and success consequences of the 63% bridging (vs not-bridging) practice in the study setting, ie, Hamad Medical Corporation, Qatar, and the incremental cost-effectiveness ratio (ICER, cost/success) of the warfarin therapy when predominantly bridging based vs when predominantly non-bridging based. The model was based on Monte Carlo simulation, and sensitivity analyses were performed to confirm the robustness of the study conclusions. As per 63% bridging practices, the mean overall cost of peri-procedural warfarin management per patient was USD 3,260 (QAR 11,900), associated with an overall success rate of 0.752. Based on the CEA, predominant bridging was dominant (lower cost, higher effect) over the predominant non-bridging practice in 62.2% of simulated cases, with a cost-saving of up to USD 2,001 (QAR 7,303) at an average of USD 272 (QAR 993) and was cost-effective in 36.9% of cases. Being between cost-saving and cost-effective, compared to predominant non-bridging practices, the predominant use of bridging with warfarin seems to be a favorable strategy in atrial fibrillation patients

Exploiting visual cues for safe and flexible cyber-physical production systems

Human workers are envisioned to work alongside robots and other intelligent factory modules, and fulfill supervision tasks in future smart factories. Technological developments, during the last few years, in the field of smart factory automation have introduced the concept of cyber-physical systems, which further expanded to cyber-physical production systems. In this context, the role of collaborative robots is significant and depends largely on the advanced capabilities of collision detection, impedance control, and learning new tasks based on artificial intelligence. The system components, collaborative robots, and humans need to communicate for collective decision-making. This requires processing of shared information keeping in consideration the available knowledge, reasoning, and flexible systems that are resilient to the real-time dynamic changes on the industry floor as well as within the communication and computer network infrastructure. This article presents an ontology-based approach to solve industrial scenarios for safety applications in cyber-physical production systems. A case study of an industrial scenario is presented to validate the approach in which visual cues are used to detect and react to dynamic changes in real time. Multiple scenarios are tested for simultaneous detection and prioritization to enhance the learning surface of the intelligent production system with the goal to automate safety-based decisions