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[en] Objectives: To see the effect of intra operative antegrade flexible nephroscopy during Percutaneous nephrolithotomy on stone free rate. Methods: We retrospectively reviewed electronic medical records of patients who underwent percutaneous nephrolithotomy from 2010 to 2017 for renal stones >2cm. Patients found eligible were divided in, Group-I who did not have intraoperative Flexible nephroscopy and Group-II who had flexible nephroscopy during percutaneous nephrolithotomy. All procedures were done by senior consultants. Variables like Mean age, side, stone size, skin to stone distance and Hounsfield unit were compared. Outcomes like Stone free rate, hospital stay and operative time were compared between the groups. Results: The study included 248 patients, consisting 85 (34.3%) females and 163 (65.7%) males. Mean age ± SD was 45.8±13.8 years. Both group were similar in characteristics like mean age, stone size, skin to stone distance and Hounsfield units. The overall stone free rate was 71%. It was not significantly different between the groups, 76% in Group-II vs. 67% in Group-I. However stone free rate markedly improved with flexible nephroscopy in patients with staghorn calculi. Mean operative time and hospital stay were similar between the groups. Conclusions: Intraoperative flexible nephroscopy during percutaneous nephrolithotomy significantly increases stone free rate in patients with staghorn stones. (author)
[en] Objective: To identify utility of chest computed tomography severity score (CT-SS) as an additional tool to COVID-19 pneumonia imaging classification in assessing severity of COVID-19. Study Design: Descriptive analytical study Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, (AFIRI) Rawalpindi, from April 2020 to June 2020. Methodology: Five hundred suspected COVID-19 cases referred for high resolution computed tomography – chest were included in the study. Cases were categorised by radiological findings using COVID-19 pneumonia imaging classification, proposed in the radiological society of North America expert consensus statement on reporting chest CT findings related to COVID-19. CT-SS was calculated for all scans. Patients were clinically classified according to disease severity as per ‘Diagnosis And Treatment Program of Pneumonia of New Coronavirus Infection’ recommended by China's National Health Commission. The relationships between radiological findings, CT-SS, and clinical severity were explored. Results: Based on the radiological findings, 298 cases were graded as typical, 34 as indeterminate, 15 as atypical, and 153 as negative for pneumonia. The apical and posterior basal segments of lower lobes were most commonly involved. The CT-SS showed higher values in patients of severe group as compared to those in moderate group (p < 0.05). CT-SS threshold for recognising severe COVID-19 was 18.5 (area under curve, 0.960), with 84.3% sensitivity and 92.5% specificity. Conclusion: In coherence with COVID-19 pneumonia imaging classification, CT-SS may provide a comprehensive and objective assessment of COVID-19 severity. (author)
[en] Microbial formulations prepared from entomopathogenic fungi emerging as the effective alternate of chemical pesticides against different crop pests. They cause lethal infections and regulate insects and mites population in nature by epizootics and considered as primary candidates for mycoinsecticides. In this study, we evaluated five species of entomopathogenic fungi such as Beauveria bassiana, Metarhizium anisopliae, Isaria farinosa, Paecilomyces lilacinus and Verticillium lecanii against Phenacoccus solenopsis on okra crop. Three concentrations calculated on the basis of previous study (LD50, ten times higher and ten times lower than LD50) of each fungal biocontrol agent were applied to okra plants infested with mealybugs. In the pot experiment, the higher dose of M. anisopliae (7.063×108) and B. bassiana (1.37×108) followed by P. lilacinus (6.615×107) were highly effective in controlling the pest population, they brought 83.7, 80 and 78.7% reduction, respectively. Second most effective treatments were a higher dose of V. lecanii (1.69×107) and a medium dose of P. lilacinus (6.615×106), brought 69.4 and 53% reduction in mealybugs. Among all entomopathogenic fungi, I. farinosa was the least effective; its lower, medium and higher doses caused only 20.7, 48.5 and 51.6% reduction, respectively. In field trial, higher doses of all biocontrol agents were more effective than their medium and lower doses. Whereas, maximum yield was recorded in the higher (7.063×108) and medium dose of (7.063×107) of M. anisopliae followed by a higher (1.37×108) and medium (1.37×107) dose of B. bassiana. This study provides new opportunities for effective and eco-friendly control measures of mealybugs. (author)
[en] To determine the sonographic characteristics of borderline tumors (BoTs) and cystadenofibromas (CAFs). Preoperative sonograms from consecutive patients who had at least one primary epithelial tumor in the adnexa were retrospectively collected. All tumors were described using the International Ovarian Tumor Analysis terminology. Ultrasound variables were tested using multinomial logistic regression after univariate analysis. A total of 650 patients were included in this study. Of these, 110 had a CAF, 128 had a BoT, 249 had a cystadenoma (CAD), and 163 had a cystadenocarcinoma (CAC). Nearly half of CAFs and more than half of BoTs and CACs appeared to be unilocular and multilocular solid on the ultrasound images, while CADs were predominantly uni- or multilocular (p < 0.001). Overall, shadowing was identified in 82/650 cases. Sixty-five of 110 (59.1%) CAFs exhibited an acoustic shadow, compared with only 4/249 (1.6%) in CADs, 7/128 (5.5%) in BoTs, and 6/163 (3.7%) in CACs (p < 0.001). Furthermore, 112/650 cases demonstrated microcystic pattern (MCP). Sixty-eight of 128 (53.1%) BoTs exhibited MCP, compared with only 5/249 (2.0%) in CADs, 19/163 (11.7%) in CACs, and 20/110 (18.2%) in CAFs (p < 0.001). Logistic regression analysis revealed that shadowing is an independent predictor of CAFs, while MCP is an independent predictor of BoTs. Sonographic findings for CAFs and BoTs were complex and partly overlapped with those for CACs. However, proper recognition and utilization of shadowing or MCP may help to correctly discriminate CAFs and BoTs.
[en] The yellow tortrix, Acleris fimbriana Merick (Lepidoptera: Tortricidae), is a serious pest on fruit trees in North China. Under laboratory conditions (temperature 25 ± 1ºC, 80 ± 5% relative humidity, photoperiod 14L:10D), the effect of the 4 host plants Armeniaca vulgaris (apricot), Malus pumila (apple), Prunus salicina (plum), and Amygdalus persica (peach) on the growth, development, survival, reproduction, and life table parameters of A. fimbriana were studied. Different host plants had significant effects on the growth, development, and reproduction of A. fimbriana. The overall developmental duration was the longest on apple (60.71 d) and peach (60.78 d) and shortest on apricot (54.55 ± 3.56 d). The cumulative survival rate was highest on apricot (64.58%) and plum (60.44%) and lowest on peach (44.50%). The average number of eggs produced was highest on apricot (175.58 eggs) and plum (178.43 eggs). Life table parameter results showed that the net reproductive rate, intrinsic growth rate, and finite growth rate were highest on apricot (101.75, 0.0892, and 1.0933, respectively) and plum (97.75, 0.0832, and 1.0867, respectively). Mean generation time was the longest on apple (58.41 d) and peach (58.45 d). Population doubling time was shortest on apricot (7.77 d) and plum (8.33 d). Of the 4 hosts, apricot and peach are more suitable for A. fimbriana growth, development, and reproduction. The results of this study provide an important basis for forecasting and integrated management of A. fimbriana. (author)
[en] Objective: A comparison of the initial stability of narrow- and standard-diameter implants (SDIs) placed in Type-I and Type-IV bone-blocks is not yet reported. The aim was to evaluate in-vitro the influence of implant diameter on the initial stability of narrow- and standard-diameter implants (SDIs) placed in simulated Type-I and Type-IV bone-blocks. Methods: The present experimental in-vitro study was performed between July and September 2020 at the Specialist Dental Practice, Riyadh, Saudi Arabia. Narrow- and standard-diameter implants were placed 3-mm apart in simulated soft (Type-IV) and dense (Type-I) bone blocks by a trained and calibrated investigator. In groups A (Type-IV bone blocks) and B (Type-I bone blocks), implants were inserted using an insertion-torque and drilling-speed of 15-30 Ncm and 1000-1500 rpm, respectively with the implant collar at the crest of simulated bone blocks. In all samples, initial-stability was recorded using resonance frequency analysis (RFA). Sample-size estimation was done and group-comparisons were carried out. A P-value of 0.01 or less reflected statistical significance. Results: In Groups-A and -B, 44 (22 NDIs and 22 SDIs) and 44 (22 NDIs and 22 SDIs) were placed. In group-A, the mean RFA values for NDIs and SDIs were 68.5 ± 3.5 and 69.1 ± 2.4, respectively. In Group-B, the mean RFA values for NDIs and SDIs were 78.06 ± 9.6 and 75.3 ± 5.2. RFA values among NDIs and SDIs in groups A and B were similar. Conclusion: The NDIs and SDIs show comparable initial-stability when positioned in simulated Type-I and Type-IV bone blocks. (author)
[en] Objective: To compare endonasal and external septoplasty for type 2 caudal septal deviations in terms of operative time, aesthetic and functional outcome. Study Design: Descriptive Analysis. Place and Duration of Study: ENT Department, Mayo Hospital/ K.E.M.U, Lahore, from October 2019 to October 2020. Methodology: Record of patients operated for septal deviations in 2019 were retrospectively reviewed. All patients, diagnosed with type 2 caudal septal deviations, were included; while those with marked inferior turbinate hypertrophy, deviated nasal septum after trauma, and those who could not be followed-up, were excluded. Twenty-eight patients, operated by external approach, were placed in group A; and 32 patients, who had endonasal surgery, were placed in group B. Functional outcome was assessed by nasal obstruction symptom evaluation (NOSE) scale; and cosmetic deformity was assessed by visual analog scale (VAS) pre- and postoperatively at six months. Operative time was measured for both the groups. Results: Sixty patients were included. Mean preoperative NOSE scale score for group A was 67.36 ± 8.07 and postoperative was 15.82 ± 3.62 (p<0.001). Mean preoperative NOSE score for group B was 69.40 ± 5.80 and postoperative it was 18.00 ± 3.75 (p<0.001). Mean VAS score for group A preoperative and postoperative was 18.93 ± 7.86 and 76.07 ± 6.85 (p<0.001), respectively. Mean VAS score for group B preoperative and postoperative was 19.69 ± 7.82 and 71.56 ± 8.84, respectively (p<0.001). Mean operative time for group B was 52.25 ± 3.37 minutes, and for group A 115.00 ± 9.91 minutes (p<0.001). The difference in preoperative and postoperative NOSE and VAS scores compared for both groups revealed p-value of 0.952 and 0.044, respectively. Conclusion: Extracorporeal septoplasty resulted in better aesthetic outcome; though endonasal septoplasty had shorter operative time. Both surgical techniques resulted in good functional outcome. (author)
[en] Objective: To evaluate the accuracy of ultrasound findings as compared to operative findings and positive predictive value of ultrasonography in the diagnosis of acute appendicitis. Study Design: Cross sectional study. Place and Duration of Study: Pak Field Hospital – 7 (Level III) United Nations African Union Mission in Darfur (UNAMID) Darfur, Sudan, from Mar 2015 to Mar 2016. Methodology: All patients presenting with clinically suspected acute appendicitis (Alvarado’s score >4) were referred for right lower quadrant sonography. Three point scale was used to grade sonographic findings ranging from grade 1 to grade 3. Fifty One patients with persistent symptoms and/or positive sonographic findings were operated. Operative findings were also graded on a 3 point scale. Subsequently, sonographic and operative findings were compared. Surgical findings were considered gold standard to assess diagnostic accuracy of sonography. Results: Out of 51 patients 46 (90.2%) were males and 5 (9.8%) were females. Mean age of the patients was 32.3 ± 7.3 years. Among the study subjects, 15 (29.4%) patients were from Nigeria followed by 12 (23.5%) from Pakistan, 7 (13.7%) from Egypt and 17 (33.5%) from other countries. The sonographic findings were detected positive for acute appendicitis in 40 (78.4%) and negative in 11 (21.6%) out of 51. All Fifty-one patients underwent surgery. The surgical findings were positive for appendicitis in 43 patients (84.3%). Four patients with negative sonographic findings did have acute appendicitis according to surgical findings. The positive predictive value was 90.9%. There was good agreement between sonographic findings and surgical findings, which was statistically significant. (κw=0.70 [95% CI, 0.49–0.91]). Conclusion: In our study, sonography has a high PPV and NPV. Sonography should be considered as a primary screening tool in the algorithm of evaluation of acute appendicitis. (author)
[en] Since 2016, certified prostate cancer centres have been able to participate in the Prostate Cancer Outcomes (PCO) study. The aim of this study is to compare outcomes across centres after local treatment for prostate cancer. The study originated from a support group initiative and is jointly carried out by the German Cancer Society (Deutsche Krebsgesellschaft), the certification institute OnkoZert, patient support groups and the participating centres. So far, centres have been more successful at recruiting patients undergoing surgery than those receiving radiotherapy as the definitive treatment. This means that conclusions for the latter group of patients are almost impossible. It is important to us that all types of treatment are equally well represented in the study; thus, we encourage radiation therapists to participate in the PCO study.
[en] Background: About 80% of tympanic membrane tears consequential of middle ear infections or trauma restore spontaneously. Myringoplasty is the procedure to fix the perforation which fails to heal. It is of two types; overlay and underlay techniques. In former technique graft is placed lateral to the fibrous sheet of the tympanic membrane while in underlay technique the graft is placed medial to the tympanic membrane remnant. The published success rates of underlay and overlay myringoplasty varied. This study was conducted to evaluate the effectiveness of graft uptake by underlay and overlay technique in patients undergoing myringoplasty. Methods: This randomized control trial including 80 patients was carried out at Otorhinolaryngology department of Combined Military Hospital, Rawalpindi from April 2016 to September 2017. Patients going through myringoplasty for tympanic perforations were randomly allocated into two groups. Group-A underwent underlay while Group-B underwent overlay myringoplasty. Results: The age of the patients ranged from 20 to 40 years with a mean of 29.58±5.92 years with a male to female ratio of 1.2:1. Hearing improvement was significantly higher (97.5% vs. 77.5%) in patients undergoing underlay versus overlay myringoplasty. The frequency of effectiveness in terms of graft uptake was significantly higher in patients undergoing underlay (95.0% vs. 57.5%) as compared to overlay myringoplasty. Conclusion: The underlay procedure is more effective in terms of graft uptake and lesser complications as compared to overlay myringoplasty. (author)