Robotics in neurosurgery: A literature review

Robotic surgery has been the forte of minimally invasive stereo-tactic procedures for some decades now. Ongoing advancements and evolutionary developments require substantial evidence to build the consensus about its efficacy in the field of neurosurgery. Main obstacle in obtaining successful results in neurosurgery is fine neural structures and other anatomical limitations. Currently, human rationalisation and robotic precision works in symbiosis to provide improved results. We reviewed the current data about recent interventions. Robots are capable of providing virtual data, superior spatial resolution and geometric accuracy, superior dexterity, faster manoeuvring and non-fatigability with steady motion. Robotic surgery also allows simulation of virtual procedures which turn out to be of great succour for young apprentice surgeons to practise their surgical skills in a safe environment. It also allows senior professionals to rehearse difficult cases before involving into considerable risky procedures

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Breast cancer management pathways during the COVID-19 pandemic: outcomes from the UK ‘Alert Level 4’ phase of the B-MaP-C study

Abstract: Background: The B-MaP-C study aimed to determine alterations to breast cancer (BC) management during the peak transmission period of the UK COVID-19 pandemic and the potential impact of these treatment decisions. Methods: This was a national cohort study of patients with early BC undergoing multidisciplinary team (MDT)-guided treatment recommendations during the pandemic, designated ‘standard’ or ‘COVID-altered’, in the preoperative, operative and post-operative setting. Findings: Of 3776 patients (from 64 UK units) in the study, 2246 (59%) had ‘COVID-altered’ management. ‘Bridging’ endocrine therapy was used (n = 951) where theatre capacity was reduced. There was increasing access to COVID-19 low-risk theatres during the study period (59%). In line with national guidance, immediate breast reconstruction was avoided (n = 299). Where adjuvant chemotherapy was omitted (n = 81), the median benefit was only 3% (IQR 2–9%) using ‘NHS Predict’. There was the rapid adoption of new evidence-based hypofractionated radiotherapy (n = 781, from 46 units). Only 14 patients (1%) tested positive for SARS-CoV-2 during their treatment journey. Conclusions: The majority of ‘COVID-altered’ management decisions were largely in line with pre-COVID evidence-based guidelines, implying that breast cancer survival outcomes are unlikely to be negatively impacted by the pandemic. However, in this study, the potential impact of delays to BC presentation or diagnosis remains unknown

Morphoanatomical study of some species from fabaceae family in Iraq

The current study dealt with comparative morphological and anatomical study of different species of Leguminosae family in Iraq. The study included seven species : Albizia lebbeck Benth. , Alhagi maurorum Medik. , Cassia sopheral Roxb. , Leucaena leucocephala Lam. , Medicago sativa Boiss., Trifolium repens Boiss, Vicia tenuifolia Roth. .The morpho-anatomical study is very important to distinguish between them. Samples of the study were collected from different areas in Iraq during flowering period between 2021-2022. In the present research, cuticular and epidermal anatomical features were described, in addition to the anatomical features of stems, leaves and petiole. Results showed that some of the morphological and anatomical characters of studied parts have good taxonomic value to distinguish between above studied species. Epidermis characters have taxonomic significance , espeically the nature of anticilinal walls and types of stomatal complexes , while dimensions of stem cells and the rates of the length of stomata were limited taxonomic importance . The general shapes of cross – sections of stem showed great taxonomic significance for isolation species , as well as cortex thickness .

Neonatal Mortality Rates at Al-Sadar City 2015 – 2019

Neonatal mortality is an index for newborn care and maternal health care. It is a useful indicator for obstetrical and neonatal healthcare services quality and availability. It is influenced by environmental, economic and social factors. Therefore, it is a measure of socio-economic status and health system. The study was a cross sectional one. It was conducted at Al Resafa side in Baghdad city. The requested data were reviewed from medical records (sex, cause of death, etc.). Chi-square was used to show the impact of dependent variables (death causes) on the independent variables (sex, and type of neonatal death). P value < 0.05 was considered statistically significant. The results showed number of neonatal deaths per 1000 livebirths ranged from 19.30-19.08 per 1000 livebirths between 2015 - 2019 respectively. Males had the highest neonatal deaths through studied years (54.8%, 54.5%, 56.4%, 57.2%, and 59 respectively). Prematurity (487, 32.1%), and respiratory distress syndrome (387, 25.5%) were significantly the common causes of early neonatal deaths. Sepsis (216, 30.1%), and respiratory distress syndrome (149, 20.8%) were significantly the main late neonatal deaths causes (kh 2= 429.582, p value = 0.001). Both males and females mainly died from prematurity (340, 285; 27%, 29.2% respectively). The distribution of causes of neonatal death were significantly varied between sexes (kh2= 20.782, p value= 0.001). In conclusions, neonatal mortality rate is high in the studied period. Two thirds of neonatal death occurred early

The Effect of the Annealing on the Properties of ZnO/Cu/ZnO Multilayer Structures

AbstractStudy of ZnO / Cu / ZnO multilayer film stack using Cu film as a sandwich layer, in order to improve the overall performance of the transparent conductive film, structural, electrical and optical properties. ZnO / Cu / ZnO multilayer films prepared at room temperature by a DC and RF magnetron sputtering technique. The results showed that ZnO / Cu / ZnO multilayer film has good crystalline properties. With an increasing Cu layer thickness, a visible light transmittance of the multilayer film is reduced, while the electrical performance improved significantly. In the Cu layer thickness of 20nm, ZnO / Cu / ZnO multilayer film optoelectronic integrated for optimal performanc

Sigmoid volvulus: a rare but unique complication of enteric fever

We present a case of sigmoid volvulus in a young male patient with culture-proven Salmonella Typhi in the blood which was sensitive to Meropenem and Azithromycin only, presented with fever, vomiting, loose stools, hematochezia, abdominal distention and tenderness with no signs of perforation on erect chest x-ray. Further, radiological imaging showed signs of sigmoid volvulus. An urgent colonic decompression with untwisting of the mesentery was performed. In our case, it can be said that sigmoid volvulus was developed as a complication of multiple drug-resistant strains of Salmonella Typhi. The resistance is acquired by alteration in the genome sequence. Currently, it is important to control such an unknown outbreak of multiple drug-resistant strains of Salmonella Typhi as it is a serious health care issue of disease control and prevention in Pakistan

Management Strategies to Mitigate N2O Emissions in Agriculture

The concentration of greenhouse gases (GHGs) in the atmosphere has been increasing since the beginning of the industrial revolution. Nitrous oxide (N2O) is one of the mightiest GHGs, and agriculture is one of the main sources of N2O emissions. In this paper, we reviewed the mechanisms triggering N2O emissions and the role of agricultural practices in their mitigation. The amount of N2O produced from the soil through the combined processes of nitrification and denitrification is profoundly influenced by temperature, moisture, carbon, nitrogen and oxygen contents. These factors can be manipulated to a significant extent through field management practices, influencing N2O emission. The relationships between N2O occurrence and factors regulating it are an important premise for devising mitigation strategies. Here, we evaluated various options in the literature and found that N2O emissions can be effectively reduced by intervening on time and through the method of N supply (30–40%, with peaks up to 80%), tillage and irrigation practices (both in non-univocal way), use of amendments, such as biochar and lime (up to 80%), use of slow-release fertilizers and/or nitrification inhibitors (up to 50%), plant treatment with arbuscular mycorrhizal fungi (up to 75%), appropriate crop rotations and schemes (up to 50%), and integrated nutrient management (in a non-univocal way). In conclusion, acting on N supply (fertilizer type, dose, time, method, etc.) is the most straightforward way to achieve significant N2O reductions without compromising crop yields. However, tuning the rest of crop management (tillage, irrigation, rotation, etc.) to principles of good agricultural practices is also advisable, as it can fetch significant N2O abatement vs. the risk of unexpected rise, which can be incurred by unwary management

Human candidate gene polymorphisms and risk of severe malaria in children in Kilifi, Kenya: a case-control association study

Background: Human genetic factors are important determinants of malaria risk. We investigated associations between multiple candidate polymorphisms—many related to the structure or function of red blood cells—and risk for severe Plasmodium falciparum malaria and its specific phenotypes, including cerebral malaria, severe malaria anaemia, and respiratory distress. Methods: We did a case-control study in Kilifi County, Kenya. We recruited as cases children presenting with severe malaria to the high-dependency ward of Kilifi County Hospital. We included as controls infants born in the local community between Aug 1, 2006, and Sept 30, 2010, who were part of a genetics study. We tested for associations between a range of candidate malaria-protective genes and risk for severe malaria and its specific phenotypes. We used a permutation approach to account for multiple comparisons between polymorphisms and severe malaria. We judged p values less than 0·005 significant for the primary analysis of the association between candidate genes and severe malaria. Findings: Between June 11, 1995, and June 12, 2008, 2244 children with severe malaria were recruited to the study, and 3949 infants were included as controls. Overall, 263 (12%) of 2244 children with severe malaria died in hospital, including 196 (16%) of 1233 with cerebral malaria. We investigated 121 polymorphisms in 70 candidate severe malaria-associated genes. We found significant associations between risk for severe malaria overall and polymorphisms in 15 genes or locations, of which most were related to red blood cells: ABO, ATP2B4, ARL14, CD40LG, FREM3, INPP4B, G6PD, HBA (both HBA1 and HBA2), HBB, IL10, LPHN2 (also known as ADGRL2), LOC727982, RPS6KL1, CAND1, and GNAS. Combined, these genetic associations accounted for 5·2% of the variance in risk for developing severe malaria among individuals in the general population. We confirmed established associations between severe malaria and sickle-cell trait (odds ratio [OR] 0·15, 95% CI 0·11–0·20; p=2·61 × 10−58), blood group O (0·74, 0·66–0·82; p=6·26 × 10−8), and –α3·7-thalassaemia (0·83, 0·76–0·90; p=2·06 × 10−6). We also found strong associations between overall risk of severe malaria and polymorphisms in both ATP2B4 (OR 0·76, 95% CI 0·63–0·92; p=0·001) and FREM3 (0·64, 0·53–0·79; p=3·18 × 10−14). The association with FREM3 could be accounted for by linkage disequilibrium with a complex structural mutation within the glycophorin gene region (comprising GYPA, GYPB, and GYPE) that encodes for the rare Dantu blood group antigen. Heterozygosity for Dantu was associated with risk for severe malaria (OR 0·57, 95% CI 0·49–0·68; p=3·22 × 10−11), as was homozygosity (0·26, 0·11–0·62; p=0·002). Interpretation: Both ATP2B4 and the Dantu blood group antigen are associated with the structure and function of red blood cells. ATP2B4 codes for plasma membrane calcium-transporting ATPase 4 (the major calcium pump on red blood cells) and the glycophorins are ligands for parasites to invade red blood cells. Future work should aim at uncovering the mechanisms by which these polymorphisms can result in severe malaria protection and investigate the implications of these associations for wider health. Funding: Wellcome Trust, UK Medical Research Council, European Union, and Foundation for the National Institutes of Health as part of the Bill & Melinda Gates Grand Challenges in Global Health Initiative