Background: Treatment for pilonidal disease using minimally invasive methods is a reliable and successful alternative to conventional surgery, with quicker recovery, better cosmetic outcomes, and better pain management. The primary goals of this study are to assess the early outcomes of endoscopic pilonidal sinus treatment and to demonstrate the surgical approach and its adaptations. Materials and Methods: Our study was conducted on 30 patients with pilonidal sinus disease as a prospective cohort study for endoscopic treatment of the pilonidal sinus, from October 2021 to October 2022, in our surgical department at Theodor Bilharz Research Institute (TBRI). Surgical outcomes of sinus healing, pain, and discharge were reviewed in the outpatient clinic, and patient satisfaction levels were assessed through a standardized phone interview. Results: There were 24 males and 6 females, with a median age of 21.87±1.85 years (ranging from 16 to 57 years). The mean operative time was 44.17 (35-55) ±1.26 min. During the follow-up period of 24 weeks, wound closure was seen after a median of 4 weeks. Wounds were closed in 72% of patients after one month and 93% of patients after two months. 2 patients had to be re-operated due to failure: one had persistence of discharge, and the other had recurrence after 3 months. The satisfaction rate was 93.3%. Conclusions: Endoscopic pilonidal sinus treatment is a minimally invasive and cosmetically favorable procedure. To find out if it reduces recovery time and the long-term recurrence rate, a larger sample size and a longer follow-up are needed.
RCT on Base tie in laparoscopic appendecomy (Journal Club).pptxadnanhabib31
This is ppt made on a study based on Randomised controlled trial on the tie of appendix base in laparoscopic appendectomy by hem-o-lok,endoloop or stapler.This study showed that hem-o-lok clips are better and cheaper as compared to others.
This study evaluated the experiences and outcomes of 150 patients who underwent single incision laparoscopic cholecystectomy (SILC) between 2009-2011. Two different techniques were used for the single incision procedure. The median operative time was 29 minutes. Patients were discharged after a median hospital stay of 1.33 days. Five patients developed superficial wound infections. Port site hernias developed in 5 patients within 6 months of surgery. No other major complications occurred. The study concluded that SILC is a safe procedure that can be performed successfully with conventional laparoscopic instruments and may provide advantages of reduced postoperative pain and improved cosmetic outcomes compared to traditional laparoscopic cholecystectomy.
This study investigated the clinical efficacy and safety of uniportal video-assisted thoracoscopic bronchial sleeve lobectomy (BSL) in 5 patients with central lung cancer. The results found that the BSL procedure was successfully completed in all 5 patients without severe complications. Key findings included an average operation time of 254 minutes, average blood loss of 116 ml, average hospital stay of 9.2 days, and no postoperative recurrence or metastasis during follow-up periods ranging from 3-19 months. The study concluded that uniportal video-assisted thoracoscopic BSL is a safe and minimally invasive treatment for central lung cancer.
Endoscopic suturing appears to be an effective rescue therapy for bleeding peptic ulcers when initial endoscopic hemostasis fails or bleeding recurs. In this study of 10 patients:
- All patients had recurrent or high-risk bleeding from peptic ulcers despite prior endoscopic therapy.
- Endoscopic suturing achieved immediate hemostasis in all cases with no early or delayed rebleeding.
- The procedure took on average 13 minutes with an average of 1.5 sutures placed and was technically successful in all cases without adverse events.
This study compared outcomes of patients undergoing either laser ablation (PiLaT technique) or Limberg flap (LF) surgery for primary pilonidal sinus. 200 patients were randomized to each group. Results showed PiLaT had significantly shorter surgery time, less post-op pain, earlier return to daily activities, higher patient satisfaction, and no recurrences at 2-month follow-up compared to LF surgery. The authors conclude PiLaT is an effective treatment that may be preferred over LF due to benefits of less pain/tissue loss.
Cold Snare Polypectomy for Large Sessile Colonic Polyps: A Single-Center Expe...ENDONOTICIAS
This study retrospectively analyzed outcomes of using cold snare polypectomy (CSP) to remove large (≥10 mm) sessile colon polyps in 30 patients. CSP was found to be feasible for large polyps, with no adverse events and a 20% residual polyp rate on follow-up colonoscopy. While limited by its retrospective design, this study suggests CSP may safely and effectively remove large polyps. Further prospective research is needed to determine optimal CSP techniques and compare efficacy to standard polypectomy.
Pilonidal sinus disease is a soft tissue infection. It presents either acutely with abscess or the chronic form of sinus formation. The disease affects multiple body regions but the commonest is the sacrococcygeal region. There are different treatment strategies ranging from simple incision and
drainage of an abscess to complex constructive procedures.
Endoscopic techniques have been widely adopted in sinus and skull base surgery replacing the traditional intracranial/extracranial approaches. However, one of the most common complication is an iatrogenic Cerebrospinal Fluid (CSF) leak, which places the patient at risk for meningitis, pneumocephalus and brain herniation. The instant intraoperative CSF leak diagnosis and consequent repair is crucial to avoid these complications. Traditionally, intrathecal fl uorescein injection was utilized to aid in the diagnosis. However, this technique is not FDA approved and encompasses major drawbacks (seizure, lower extremity paresis, cranial nerve palsies and patient discomfort).The purpose of this case series is to introduce a new diagnostic paradigm using topical fl uorescein strips “FLUORETS”. It has shown promising prospects due to its safety, accuracy and sensitivity in identifying CSF leaks.
RCT on Base tie in laparoscopic appendecomy (Journal Club).pptxadnanhabib31
This is ppt made on a study based on Randomised controlled trial on the tie of appendix base in laparoscopic appendectomy by hem-o-lok,endoloop or stapler.This study showed that hem-o-lok clips are better and cheaper as compared to others.
This study evaluated the experiences and outcomes of 150 patients who underwent single incision laparoscopic cholecystectomy (SILC) between 2009-2011. Two different techniques were used for the single incision procedure. The median operative time was 29 minutes. Patients were discharged after a median hospital stay of 1.33 days. Five patients developed superficial wound infections. Port site hernias developed in 5 patients within 6 months of surgery. No other major complications occurred. The study concluded that SILC is a safe procedure that can be performed successfully with conventional laparoscopic instruments and may provide advantages of reduced postoperative pain and improved cosmetic outcomes compared to traditional laparoscopic cholecystectomy.
This study investigated the clinical efficacy and safety of uniportal video-assisted thoracoscopic bronchial sleeve lobectomy (BSL) in 5 patients with central lung cancer. The results found that the BSL procedure was successfully completed in all 5 patients without severe complications. Key findings included an average operation time of 254 minutes, average blood loss of 116 ml, average hospital stay of 9.2 days, and no postoperative recurrence or metastasis during follow-up periods ranging from 3-19 months. The study concluded that uniportal video-assisted thoracoscopic BSL is a safe and minimally invasive treatment for central lung cancer.
Endoscopic suturing appears to be an effective rescue therapy for bleeding peptic ulcers when initial endoscopic hemostasis fails or bleeding recurs. In this study of 10 patients:
- All patients had recurrent or high-risk bleeding from peptic ulcers despite prior endoscopic therapy.
- Endoscopic suturing achieved immediate hemostasis in all cases with no early or delayed rebleeding.
- The procedure took on average 13 minutes with an average of 1.5 sutures placed and was technically successful in all cases without adverse events.
This study compared outcomes of patients undergoing either laser ablation (PiLaT technique) or Limberg flap (LF) surgery for primary pilonidal sinus. 200 patients were randomized to each group. Results showed PiLaT had significantly shorter surgery time, less post-op pain, earlier return to daily activities, higher patient satisfaction, and no recurrences at 2-month follow-up compared to LF surgery. The authors conclude PiLaT is an effective treatment that may be preferred over LF due to benefits of less pain/tissue loss.
Cold Snare Polypectomy for Large Sessile Colonic Polyps: A Single-Center Expe...ENDONOTICIAS
This study retrospectively analyzed outcomes of using cold snare polypectomy (CSP) to remove large (≥10 mm) sessile colon polyps in 30 patients. CSP was found to be feasible for large polyps, with no adverse events and a 20% residual polyp rate on follow-up colonoscopy. While limited by its retrospective design, this study suggests CSP may safely and effectively remove large polyps. Further prospective research is needed to determine optimal CSP techniques and compare efficacy to standard polypectomy.
Pilonidal sinus disease is a soft tissue infection. It presents either acutely with abscess or the chronic form of sinus formation. The disease affects multiple body regions but the commonest is the sacrococcygeal region. There are different treatment strategies ranging from simple incision and
drainage of an abscess to complex constructive procedures.
Endoscopic techniques have been widely adopted in sinus and skull base surgery replacing the traditional intracranial/extracranial approaches. However, one of the most common complication is an iatrogenic Cerebrospinal Fluid (CSF) leak, which places the patient at risk for meningitis, pneumocephalus and brain herniation. The instant intraoperative CSF leak diagnosis and consequent repair is crucial to avoid these complications. Traditionally, intrathecal fl uorescein injection was utilized to aid in the diagnosis. However, this technique is not FDA approved and encompasses major drawbacks (seizure, lower extremity paresis, cranial nerve palsies and patient discomfort).The purpose of this case series is to introduce a new diagnostic paradigm using topical fl uorescein strips “FLUORETS”. It has shown promising prospects due to its safety, accuracy and sensitivity in identifying CSF leaks.
This study compared the frequency of post-operative adhesions in 62 patients undergoing endoscopic sinus surgery who received either an intranasal silastic splint plus anterior nasal packing (Group A) or anterior nasal packing alone (Group B). The frequency of post-operative adhesions was significantly lower in Group A (0%) compared to Group B (16.1%). Across age, gender, and symptom duration subgroups, adhesion rates remained significantly lower in patients receiving silastic splints. The study concludes that silastic splints are effective in reducing post-operative adhesions after endoscopic sinus surgery.
This study evaluated the efficacy of laparoscopically assisted high ligation of patent processus vaginalis in 40 children aged 6 months to 7 years. The laparoscopic procedure detected unsuspected contralateral hernias in 28.1% of cases, without increasing operative time. All procedures were completed without complications. The mean operative time was 25 minutes for unilateral hernias and 35 minutes for bilateral cases. The mean post-operative hospital stay was 4 hours. One recurrence occurred among 57 hernias repaired over an average 18-month follow-up. Laparoscopic repair was found to be a safe and effective procedure for detecting and repairing hernias in children.
This document summarizes developments in direct visual internal urethrotomy (DVIU) for treating urethral strictures. It discusses techniques for DVIU, factors that influence outcomes, and the long-term efficacy of DVIU. While initial studies reported high success rates of around 80%, more recent long-term studies have found much lower success rates of only around 8-30%. Recurrence rates are higher for longer strictures, greater spongiofibrosis, distal strictures, and when DVIU is repeated for recurrent strictures. Overall, DVIU has relatively poor long-term outcomes for treating urethral strictures.
1) The document describes a study of 31 patients who underwent a trans-umbilical laparoscopy assisted appendicectomy (TULAA) procedure between November 2011 and October 2012 at a hospital in South Africa.
2) TULAA involves using laparoscopy to mobilize the appendix and deliver it through an incision at the umbilicus, then completing the appendicectomy via an open technique.
3) The results showed that TULAA was an effective approach in selected cases, taking advantage of laparoscopy's visualization benefits while using the familiar open technique. It also avoided the use of some costly disposable equipment required for standard laparoscopy.
our study and experiences we thus conclude that the stapler haemorrhoidopexy is simple and safe procedure. It is a minimally invasive procedure and it is less associated with post-operative pain bleeding and prolapse. It can be done as the day care surgery.
LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN ADULTS. (STUDY OF 50 CASES)KETAN VAGHOLKAR
Background: Appendicectomy is one of the common procedures performed by a general surgeon. However,
the advent of laparoscopic appendicectomy has reduced the number of open appendicectomies performed. Therefore
there is a need to study the advantages of the laparoscopic approach over the traditional open approach. Aims: The
study aimed to compare laparoscopic appendicectomy with open appendicectomy based on various intraoperative and
postoperative parameters Materials and methods: 50 patients undergoing interval appendicectomy were randomised
into two groups. Group A comprised 25 patients who underwent laparoscopic appendicectomy and group B comprised
25 patients who underwent open appendicectomy. Results: Confirmation of diagnosis and evaluation of intraoperative
findings was easier in group A patients. In addition, early commencement of feeds with early bowel movements, reduced
need for postoperative analgesia due to less pain, lesser complications and shorter duration of hospital stay was observed
in group A patients. Conclusion: Laparoscopic appendicectomy has better outcomes rendering it a preferable procedure
for appendicectomy.
Negative pressure wound therapy (NPWT), also known as vacuum-assisted closure (VAC) therapy, uses controlled suction to promote wound healing. The study explored using VAC therapy to control orthopedic infections. Patients underwent surgical debridement and VAC application for 5-7 days. Early results showed formation of new granulation tissue and improved healing with continuous therapy at 120 mmHg using standard large pore foam sponges over necrotic soft tissue for 7 days. Further research is still needed to determine the optimal duration of therapy and effects of different dressing types under NPWT.
Journal Club on Autologous blood injection for the treatment of recurrent tmj...Dr Bhavik Miyani
The document summarizes a journal club presentation on a study evaluating the effectiveness of autologous blood injection for the treatment of recurrent mandibular dislocation. The study included 11 patients with recurrent dislocation who underwent injection of their own blood into the temporomandibular joint. After a follow up period ranging from 24 to 35 months, 8 of the 11 patients (72.7%) did not experience further dislocation episodes. Autologous blood injection was found to be a simple, minimally invasive procedure for treating recurrent mandibular dislocation. However, more research with larger sample sizes and longer follow up periods is still needed.
A Prospective comparative study of Local anaesthesia & Spinal anaesthesia for...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
EPSiT study copy Pilonidal sinussss.pptxcsxbbk85tx
This journal article presents the results of a prospective study evaluating endoscopic pilonidal sinus treatment (EPSiT) on 77 patients over 2 years. EPSiT uses a fistuloscope to ablate the sinus cavity and tracts endoscopically under local anesthesia. The study found EPSiT resulted in a 92% healing rate with low postoperative pain and quick recovery time, returning to work in 6 days on average. Recurrence rate was low at 8%. EPSiT provides promising minimally invasive results for pilonidal sinus treatment with short healing times, low complications and high patient satisfaction compared to open surgical techniques.
Mahendra Azad et al. GAINT ODONTOGENIC KERATOCYST OF MANDIBLE OPERATED UNDER LOCAL ANESTHESIA- A CASE REPORT. JOURNAL OF DENTAL HEALTH & RESEARCH (VOL. 1, ISSUE 2, JUL - DEC 2020): 24-2
This document summarizes information on parastomal hernias (PSH), including:
- PSH incidence varies widely depending on stoma type but can be as high as 48% for end colostomies.
- Risk factors include smoking, obesity, diabetes, and conditions that increase intra-abdominal pressure.
- Mesh repair results in significantly lower recurrence rates than simple fascial repair, with rates under 20% for mesh.
- Prophylactic mesh placement during primary stoma formation may reduce PSH incidence without increasing complications, though existing RCTs have poor quality. Further research is still needed to determine optimal techniques.
endoscopic third ventriculostomy and care.pptxAnujaSebastian
This document provides information about endoscopic third ventriculostomy (ETV), including definitions, background, indications, positioning, procedure details, endoscopic views, required equipment, prognosis, complications, and a journal discussion on outcomes from 50 ETV cases. It describes ETV as a surgical procedure that creates an opening in the floor of the third ventricle using an endoscope to drain cerebrospinal fluid and bypass obstructions. The procedure involves burr hole placement, endoscope insertion, identification of anatomical structures, and puncture or dilation of the intermammillary membrane. Potential complications include hemorrhage, neural injury, hematomas and infections. A retrospective study found an 88% success rate for ETV
Pleurodese em derrames pleurais malignosFlávia Salame
- The study evaluated the effectiveness and safety of outpatient talc pleurodesis in patients with recurrent malignant pleural effusions and low performance status (KPS ≤70).
- 64 patients underwent pleural catheter placement, with 52 patients subsequently receiving talc pleurodesis. No complications occurred during catheter placement or pleurodesis.
- Pleurodesis resulted in complete or partial symptomatic improvement in nearly all patients. The recurrence rate 30 days after pleurodesis was 13.9%. Complications included catheter obstruction and empyema in a small number of patients.
Transgastric and transvaginal endoscopic cholecystectomy procedures were performed in 27 patients between 2007-2008. The procedures were performed using hybrid NOTES techniques, with laparoscopic assistance. Both transgastric and transvaginal routes were utilized to access the peritoneal cavity. The authors present their initial experience with these novel natural orifice techniques for cholecystectomy in humans.
Overlapping MAF is a modification of the original MAF technique used in the management of high anal fistulas. This simple modification showed to improve the success rate in 10% more than the original technique.
A comparative study of fine needle aspiration cytology, trucut biopsy and his...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
USING STRUCTURAL EQUATION MODELING ON FOREIGN DIRECT INVESTMENT OF INDIAN ECO...indexPub
Purpose: Foreign direct investment (FDI) altogether influences the beneficiary country's financial development, making it more stable, high-quality, and healthy, according to this empirical study based on the present stage of economic development. Thus, every country encountering financial globalization is attempting to lay out a serious business climate to increment worldwide speculation. Design/Methodology/Approach: the main objective of this study is based on Institutional quality or Evidence and I selected 5 factors Institutional Metrics like Voice and Accountability, Civil liberties, Women in parliament, Corruption perceptions, Political rights from DPIIT website (Secondary Data) for the period 2018-2023. Static analysis methods such as the Unit Root Test, the ARDL Approach, and SEM are being used. Originality/Value: The experts in this study used OLS (Least Squares) regression: Foreign direct investment (FDI) streams were the focal point of the exploration. The impact of institutional qualities on unfamiliar direct speculation streams has been explored utilizing the customary least square methodology. Findings: Institutional metrics of government efficacy and corruption have shown a shortrun link with foreign direct investment (FDI) flows, according to the research, which used the ARDL model to find that these indicators had positive coefficient values. As far as institutional markers like law and order, administrative quality, and voice and responsibility, the review found that political stability had a long-term association with foreign direct investment flows (7.4578 > 4.16), placing it above the upper peasant table.
SUSTAINABLE INVESTING UNVEILED: THE ROLE OF BOND RATINGS IN GUIDING GREEN BON...indexPub
The increasing urgency to address climate change has propelled sustainable investing into the spotlight, with green bonds emerging as a pivotal instrument for mobilizing the capital required for environmental projects. This study delves into the critical role that bond ratings play in guiding investments in green bonds, shedding light on how these ratings influence investor confidence and the allocation of funds towards sustainable initiatives. By employing a mixed-methods approach, combining quantitative analysis of green bond performance with qualitative interviews from industry experts, this research offers a comprehensive overview of the interplay between bond ratings and green bond investments. The findings suggest that higher bond ratings, often indicative of lower risk and better sustainability credentials, significantly impact the attractiveness of green bonds to investors. Additionally, the study examines the evolution of rating criteria to encompass environmental, social, and governance (ESG) factors, highlighting the shift towards more holistic assessments of investment risk and potential. This research contributes to the broader discourse on sustainable finance by providing insights into the mechanisms through which bond ratings can facilitate more informed and impactful green bond investments.
AN EXPLONATORY ANALYSIS OF HR ANALYTICS MODEL OVER BIG DATA PROCESS IMPACT ON...indexPub
By generating pertinent indicators, Human Resource Analytics (HRA) can provide HR personnel with a broader perspective on their contribution to the organization's financial objectives. There is a scarcity of research, however, regarding the impact of HRA on business outcomes, specifically in the context of organisations based in India and Vietnam. Within this particular framework, the current study investigates the impact of HRA big data capabilities on business outcomes. The study also investigates the discrepancy between the actual and perceived levels of big data expertise possessed by human resources analysts in Indian and Vietnamese organisations. The current study constructs a conceptual framework in order to examine the hypotheses formulated for assessing the interconnections between the variables being investigated. Utilising the Capability, Motivation, and Opportunity (CMO) framework, it accomplishes this. The data were collected using a quantitative approach, which entailed integrating the various components of HRA expertise and assessing their influence on business outcomes through the utilisation of big data. A systematic questionnaire was developed and distributed to 230 human resources professionals employed by various organisations located in Ho Chi Minh City, Vietnam, and Hyderabad, India. In addition to HR administrators, users of HRAs comprised the participants. A variety of statistical methods were applied to the data to assess the disparity between HRA's anticipated and realised big data capabilities, as well as the impact of HRA on business outcomes. It appears, based on the data that offering incentives and opportunities to employees with HR analytical skills could result in enhanced performance for the organisation. Research has demonstrated that providing opportunities and incentives to skilled employees is crucial for encouraging the development of their analytical abilities. Possessing these types of analytical abilities significantly influences the outcomes of an organisation.
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This study compared the frequency of post-operative adhesions in 62 patients undergoing endoscopic sinus surgery who received either an intranasal silastic splint plus anterior nasal packing (Group A) or anterior nasal packing alone (Group B). The frequency of post-operative adhesions was significantly lower in Group A (0%) compared to Group B (16.1%). Across age, gender, and symptom duration subgroups, adhesion rates remained significantly lower in patients receiving silastic splints. The study concludes that silastic splints are effective in reducing post-operative adhesions after endoscopic sinus surgery.
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1) The document describes a study of 31 patients who underwent a trans-umbilical laparoscopy assisted appendicectomy (TULAA) procedure between November 2011 and October 2012 at a hospital in South Africa.
2) TULAA involves using laparoscopy to mobilize the appendix and deliver it through an incision at the umbilicus, then completing the appendicectomy via an open technique.
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LAPAROSCOPIC VERSUS OPEN APPENDICECTOMY IN ADULTS. (STUDY OF 50 CASES)KETAN VAGHOLKAR
Background: Appendicectomy is one of the common procedures performed by a general surgeon. However,
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study aimed to compare laparoscopic appendicectomy with open appendicectomy based on various intraoperative and
postoperative parameters Materials and methods: 50 patients undergoing interval appendicectomy were randomised
into two groups. Group A comprised 25 patients who underwent laparoscopic appendicectomy and group B comprised
25 patients who underwent open appendicectomy. Results: Confirmation of diagnosis and evaluation of intraoperative
findings was easier in group A patients. In addition, early commencement of feeds with early bowel movements, reduced
need for postoperative analgesia due to less pain, lesser complications and shorter duration of hospital stay was observed
in group A patients. Conclusion: Laparoscopic appendicectomy has better outcomes rendering it a preferable procedure
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Negative pressure wound therapy (NPWT), also known as vacuum-assisted closure (VAC) therapy, uses controlled suction to promote wound healing. The study explored using VAC therapy to control orthopedic infections. Patients underwent surgical debridement and VAC application for 5-7 days. Early results showed formation of new granulation tissue and improved healing with continuous therapy at 120 mmHg using standard large pore foam sponges over necrotic soft tissue for 7 days. Further research is still needed to determine the optimal duration of therapy and effects of different dressing types under NPWT.
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This journal article presents the results of a prospective study evaluating endoscopic pilonidal sinus treatment (EPSiT) on 77 patients over 2 years. EPSiT uses a fistuloscope to ablate the sinus cavity and tracts endoscopically under local anesthesia. The study found EPSiT resulted in a 92% healing rate with low postoperative pain and quick recovery time, returning to work in 6 days on average. Recurrence rate was low at 8%. EPSiT provides promising minimally invasive results for pilonidal sinus treatment with short healing times, low complications and high patient satisfaction compared to open surgical techniques.
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- PSH incidence varies widely depending on stoma type but can be as high as 48% for end colostomies.
- Risk factors include smoking, obesity, diabetes, and conditions that increase intra-abdominal pressure.
- Mesh repair results in significantly lower recurrence rates than simple fascial repair, with rates under 20% for mesh.
- Prophylactic mesh placement during primary stoma formation may reduce PSH incidence without increasing complications, though existing RCTs have poor quality. Further research is still needed to determine optimal techniques.
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The increasing urgency to address climate change has propelled sustainable investing into the spotlight, with green bonds emerging as a pivotal instrument for mobilizing the capital required for environmental projects. This study delves into the critical role that bond ratings play in guiding investments in green bonds, shedding light on how these ratings influence investor confidence and the allocation of funds towards sustainable initiatives. By employing a mixed-methods approach, combining quantitative analysis of green bond performance with qualitative interviews from industry experts, this research offers a comprehensive overview of the interplay between bond ratings and green bond investments. The findings suggest that higher bond ratings, often indicative of lower risk and better sustainability credentials, significantly impact the attractiveness of green bonds to investors. Additionally, the study examines the evolution of rating criteria to encompass environmental, social, and governance (ESG) factors, highlighting the shift towards more holistic assessments of investment risk and potential. This research contributes to the broader discourse on sustainable finance by providing insights into the mechanisms through which bond ratings can facilitate more informed and impactful green bond investments.
AN EXPLONATORY ANALYSIS OF HR ANALYTICS MODEL OVER BIG DATA PROCESS IMPACT ON...indexPub
By generating pertinent indicators, Human Resource Analytics (HRA) can provide HR personnel with a broader perspective on their contribution to the organization's financial objectives. There is a scarcity of research, however, regarding the impact of HRA on business outcomes, specifically in the context of organisations based in India and Vietnam. Within this particular framework, the current study investigates the impact of HRA big data capabilities on business outcomes. The study also investigates the discrepancy between the actual and perceived levels of big data expertise possessed by human resources analysts in Indian and Vietnamese organisations. The current study constructs a conceptual framework in order to examine the hypotheses formulated for assessing the interconnections between the variables being investigated. Utilising the Capability, Motivation, and Opportunity (CMO) framework, it accomplishes this. The data were collected using a quantitative approach, which entailed integrating the various components of HRA expertise and assessing their influence on business outcomes through the utilisation of big data. A systematic questionnaire was developed and distributed to 230 human resources professionals employed by various organisations located in Ho Chi Minh City, Vietnam, and Hyderabad, India. In addition to HR administrators, users of HRAs comprised the participants. A variety of statistical methods were applied to the data to assess the disparity between HRA's anticipated and realised big data capabilities, as well as the impact of HRA on business outcomes. It appears, based on the data that offering incentives and opportunities to employees with HR analytical skills could result in enhanced performance for the organisation. Research has demonstrated that providing opportunities and incentives to skilled employees is crucial for encouraging the development of their analytical abilities. Possessing these types of analytical abilities significantly influences the outcomes of an organisation.
EVOLUTION OF EXPECTATION VIOLATIONS THEORY (EVT) FROM FACE-TO FACE COMMUNICAT...indexPub
The promotion carried out by Holywings in the religious community is a promotional strategy that carries a big risk considering that the majority of Indonesian people are Muslims where liquor is an unlawful item. This was considered a violation and sparked various reactions in society. In the digital era, data sourced from social media is important data to understand the response of the Indonesian people to the violation of the Holywings issue. The research method used is explorative because marketing communication research based on social media data is still new. The research method is descriptive and quantitative by describing variables such as user volume, reach, conversation trends, top tweets, sentiments, influencers, and communication networks between social media users. The research sample uses the period from 23 June 2022 to 30 June 2022. The results of this research indicate that the issue of the Holywings violation is viral compared to other issues. The scope of the issue of violations at Café Holywings spreads throughout Indonesia and is dominant in DKI Jakarta Province. Even though Bali is the biggest branch of Café Holywings, there was very little reaction to the violation of Café Holywings. This is following the theory of expectation violations that the size of the violation reaction on social media is highly dependent on individual characteristics, context, and reaction.
ANTECEDENT OF ORGANIZATIONAL PERFORMANCE IN PT “XXX” PHARMA, TBKindexPub
The objective of this study is to investigate the influence of information technology capability on knowledge management capability, the influence of information technology capability on organisational performance, the influence of knowledge management capability on organisational performance, and the indirect impact of information technology capability on organisational performance through knowledge management capability in PT. "XXX" Pharma, Tbk. The research is based on the understanding of the interconnectedness between information technology cap. The present study utilised a quantitative approach, employing both explanatory and survey methodologies. The process of data collection involved the distribution of a questionnaire to a sample of 44 respondents, which was selected using the purposive random sampling technique. The data processing was performed using route analysis, utilising the IBM Predictive Analytic Software (PASW) version 24. The empirical evidence suggests a statistically significant and positive correlation between the capability of information technology and the capability of knowledge management. Additionally, there is a positive and significant impact of information technology capability on organisational performance. Furthermore, knowledge management capability is found to have a positive and significant effect on organisational performance. Lastly, it is observed that information technology capability positively and significantly influences organisational performance through its impact on knowledge management capability.
UNRAVELLING THE MENTAL HEALTH LANDSCAPE: EXPLORING DEPRESSION AND ASSOCIATED ...indexPub
Introduction: The prevalence of depression and its correlates in Bangladeshi rural university students have been rarely investigated. We draw a literature review, a cross-sectional study and analysis of the rural students’ depression natures and mechanisms that influence their academic performance and health and well-being. Methods: A cross-sectional research was conducted during the period august 2019 to January 2020 in a university. We employed Beck Depression Inventory scale to collect data from 200 undergraduate and graduate students. Data were analysed using chi-square association test and ordinal logistic regression. Results: We discovered that mild to severe depression affected 60% of rural students [mild (16%), borderline (10%), moderate (12%), severe (11.5%), and extreme (10.5%)]. Family expectations, smoking, bad academic achievement, inability to enroll in a particular program, and inadequate household finances were significant risk factors for depression. When it comes to depression, male students scored noticeably higher than female pupils. The decreased depression was linked to both strong household economics and intellectual achievement. Conclusions: The intricate interactions among the risk factors influence the character and processes of depression in rural students.
IMPACT OF PERFORMANCE MANAGEMENT ON SUCCESSION PLANNINGindexPub
Motivation: HR in an organization faces various challenges in business environment, such as Building Capabilities, Improving Productivity, Building Performance Culture, Talent Management, Succession Planning for Key Leadership and Critical Roles, Developing Accountability and Ownership, Human Capital Management and transforming HR function into developmental Role from the legacy driven HR, etc. Succession Planning is the process of identifying and developing individuals, who have potential to hold the key leadership position in an Organization, whereas Performance Management includes assessing and improving upon the performance of an employee to meet the organizational goals. There are several Management Practices, which are adopted widely in Industry to make a successful Succession Planning. Workforce and Talent Management is one of them. The health of an organization majorly depends on the proper placement of people, which is a combined outcome of Talent Identification, Talent Development and Talent Retention. Performance Management plays a vital role in Talent Identification. It also has an impact on Talent Development and Talent Retention. The key idea of succession planning suggests that the right person to be placed at the right position at the right time. Succession planning is becoming a challenge these days in the corporate world. Organizations are often not found prepared with their successors to occupy the key positions as and when required. The positions are either kept vacant for a substantial period or more than one role is assigned to a single person. Identifying the right talent for the key positions from outside the organization and recruiting them is a much more difficult task at the eleventh hour. This has a significant impact on organizational health and in turn to organizational sustainability. Organizations must last longer than people. Role of organization continues even when the people move out. Employees must superannuate after attaining a certain age. Also, organizations must have a contingency plan for sudden vacancy arises out of attrition, health hazards and death of employee. Succession planning is the strategy to ensure that a suitable person is made available during exigencies. Employees are developed for taking on higher responsibilities and for the new roles that may emerge in future. The placement of Key Leadership positions can be executed either by inviting the talent from outside or developing the talent in-house. The latter is always in demand keeping in view the core values of the organization and the impact on loyalty and organizational culture in a long run. It is preferable to develop the in-house talent pool to reduce dependency on recruitment of experienced people from outside for the critical roles. It brings the talent acquisition cost low and contributes as a motivating factor for the team as well. The acceptability of a person placed at Top / Key Leadership Positions is high when these are occupied
EXTERNAL BEHAVIOURAL FACTORS IMPACT ON INVESTMENT DECISIONS OF INDIVIDUAL INV...indexPub
The study collects data from a sample of individual investors and analyses their responses to recent financial events, changes in market trends, and economic forecasts. By examining factors such as demographic profiles, financial literacy, risk tolerance, and market perceptions, the research aims to identify significant predictors of investment decisions in this demographic. The findings suggest that investors are predominantly influenced by financial news, peer influence, past investment performance, and the economic stability of the region. This study contributes to the field by highlighting the localized factors impacting investment choices and providing insights for financial advisors and investment firms to tailor their strategies according to investor needs and regional specifics.
GLOBAL RESEARCH TREND AND FUTURISTIC RESEARCH DIRECTION VISUALIZATION OF WORK...indexPub
Purpose – The purpose of this research is to undertake a bibliometric analysis of working capital management. The study examines papers from time period 1974-2023and performed performance analysis, co-citation analysis, bibliographic coupling and scientific mapping. Design/methodology/approach – The study examines 174 articles retrieved from the Scopus database using bibliometric analysis, performance analysis and thematic clustering. The study looked at the scientific productivity of papers, prolific authors, most influencing papers, institutions and nations, keyword co-occurrence, thematic mapping, co-citations and authorship and country collaborations. VOSviewer was as a tool in the research to conduct the performance analysis and thematic clustering.The watchword "Working Capital Management" was used to include only English-language articles. Findings – The most productive year was 2022 with 26 publications. Martínez and García- are the most protuberant authors with 708 citations. The findings of the study shows that the most influential institutions are ‘The Department of Management and Finance, Faculty of Economy andBusiness and Department of Management and Finance, Faculty of Economics and Business, The University of Murcia, Spain with 381 & 297 citations. Among,thecountry analysis,Spain with 744 citations stands first of all other nations for publication on Working Capital Management. Kärri is the most productive author with 7 documents. Country-wise analysis reveals that the United States is the most productive country for Working Capital Management research with 40 documents.The authors also identified seven thematic clusters of Working Capital Management. Research limitations/implications – It informs and directs researchers on the current state of study in the field of Working Capital Management.The present study has quite a few implications forSmall & Medium enterprise managers, entrepreneurs, financial managers, academicians and scholars. It also outlines future research directions in this field.Present study provides an inclusive acquaintance about the working capital management till date. Originality/value – This is the first study which provides the performance analysis and scientific mapping of the all published documents on working capital management between the time periods 1974-2023
A SOCIAL CAPITAL APPROACH TO ENTREPRENEURIAL ECOSYSTEM AND INNOVATION: CASE S...indexPub
Despite being recognised as drivers of innovative development, Micro, Small, and Medium-Sized Enterprises (MSMEs) frequently confront resource limitations. Therefore, enhancing the ecosystem is contingent on the entrepreneurs’ social capital, which is crucial for the success of MSMEs. This study applies the social capital approach to analyse the entrepreneurial ecosystem enrichment and its impact on the innovation process of cosmetics MSMEs. The qualitative case study of six cosmetic manufacturing MSMEs explores that social capital is a multifaceted asset to MSMEs. Through an in-depth thematic analysis of three dimensions of social capital (structural, relational, and cognitive), this study states that the innovation process is supported by the synergistic transformation of one dimension of social capital into another. Entrepreneurs sharing the common norms, rules, and language enrich their cognitive as well as relational aspects of ecosystem. The study suggests that as network ties, trust, and norms collectively influence innovation in firms, hence, social capital needs to be studied with its contextualization in the ecosystem.
ASSESSING HRM EFFECTIVENESS AND PERFORMANCE ENHANCEMENT MEASURES IN THE BANKI...indexPub
This study employs an exploratory and quantitative research approach to systematically investigate the impact of Human Resource Management (HRM) practices on Organizational Performance within the Indian Banking sector. The research approach combines exploratory research, aimed at gaining insights into HRM practices, with a quantitative approach using a purposive sampling technique. Data is collected through a questionnaire from employees in both public (SBI) and private banks (HDFC Bank) who work in HR departments or are involved in HR activities. The Likert scale is utilized in the questionnaire to measure participant perceptions of HRM practices. The study utilizes two statistical tools: Neural Network and Exploratory Factor Analysis (EFA). The findings of the study highlight the significance of promotion and transfer policies, considered paramount in influencing organizational performance in both public and private banks. Additionally, the study underscores the importance of training and development initiatives in enhancing employee skills and competencies. Clear and effective communication within HR policies is identified as pivotal in improving organizational performance. Lastly, aligning HRM practices with sector-specific goals is recognized as a significant contributor to improved employee satisfaction and overall performance in the banking sector. The findings offer guidance for HR practitioners and policymakers in optimizing HRM practices to achieve better organizational performance.
CORRELATION BETWEEN EMPATHY AND FRIENDSHIP QUALITY AMONG HIGH SCHOOL STUDENTS...indexPub
In this research were used two questionnaires Empathy Formative questionnaire and Friendship Quality Scale. The aim of this study is to see the relationship between empathy and friendship quality among adolescent, to find out if there are gender differences in empathy and friendship quality, and to see if there are any differences between younger and older students on examined variables. This research was done with 65 high school students. Age of the students were 15 to 17 years old. Results show that there is a correlation between empathy and friendship quality. The results of t test show that there are not significant differences between females and males on variable empathy. Girls and boys have significant difference in friendship quality in Kosovo. There are no significant differences between older students and younger students in the level of empathy and also there are no significant differences between older students and younger students in the level of friendship quality.
LEVELS OF DEPRESSION AND SELF-ESTEEM IN STUDENTSindexPub
Introduction: among the most worrying problems in recent years are low self-esteem, family and friends problems, anxiety, stress, and depression, which are taking on alarming proportions in students and young people in general. Purpose: the study is a prediction, which focuses on analyzing and evaluating students' self-esteem and level of depression. Methodology: the population is 332 students (13-15 years old) in high schools in the Gjakova region. The study describes the analysis, classification, and evaluation of the collected data by doing the analysis and real examination of the findings. Results: in terms of gender there is no significant difference in self-esteem, while in depression there is a significant difference. The level of depression is higher in women (11.9) than in men (9.5). Economic status shows that students with employed fathers have lower depression (6.77) compared to those with unemployed fathers (10.80). Conclusions: The level of depression and self-esteem and parental reflection affect students. A link has been found between economic status and emotional problems and student behavior. To prevent it, the psychological service in schools should function, and together with families and the community should be as close as possible to the problems of students.
THE IMPACT OF SOCIAL FACTORS ON INDIVIDUALS DIAGNOSED WITH SCHIZOPHRENIAindexPub
The society with diverse structural and ideological influences, assumes its role in relation to behavior, attitude, belief and relations. The impact can be seen in every society globally, however the western nations have adjusted their social policies to suit these transformations, whereas nations in developing phase have failed to establish suitable systems. In Kosovo, the allocation of funds for mental health services remains insufficient, even though mental health disorders account for 12.3% of overall illnesses and 30.8% of work incapacities! The objective of this study is to examine the impact of society on the decline and recovery of individuals with schizophrenia. The study employs both qualitative and quantitative methods to provide a descriptive-analytical. A study was conducted in four municipalities of Kosovo, using individuals with schizophrenia from psychiatric institutions as subjects along with their caregivers/family members . The research found that social factors greatly contribute to the worsening of schizophrenia patients' condition. The presence of schizophrenia is evident through a higher likelihood of having a low level of education, high unemployment rates, and engaging in harmful behaviors like tobacco and alcohol use, as well as physical inactivity. Significant correlations have been observed in the subscales of positive and negative symptoms using the Self-Report PNS-Q questionnaires. It is crucial for individuals with schizophrenia to have a carefully designed strategy in place, developed in partnership with professionals from various relevant fields such as social protection, psychiatric medical services, education, and social integration plans.
RETURN ON EQUITY (ROE) AS MEDIATION OF BANK'S CAPITAL ADEQUATION RATIO (CAR)indexPub
Banks need to maintain their performance and the level of Capital Adequasi Ratio (CAR). This study wants to see the variables that affect the Capital Adequasi Ratio (CAR) and see ROE as a variable that mediates the Capital Adequasi Ratio (CAR) at Bank Rakyat Indonesia (BRI). The research method used multiple regression analysis, t-test, Anova test and Coefficient of Determination and the research period for 14 years from 2009 to 2022, by using SPSS Software version 26. The conclusion of the study, only the BOPO variable has a significant effect on the Capital Adequasi Ratio (CAR) and the ROE variable as a variable that can mediate the CAR variable at Bank Rakyat Indonesia (BRI). Keywords: Capital Adequasi Ratio, Bank Financial Ratio.
INNOVATIVE DESIGN FOR KIDS MASTERY IMPROVEMENT OF LANGUAGE FEATURES IN A STORYindexPub
One of the hardest things for people learning English as a third language is still reading and writing. Because they are still not good enough at language features, they often make big mistakes and assumptions that aren't true. To make learning more fun and useful, visual symbols were made for seven different kinds of language traits. It looks at the Vipicoll form a lot. Visual Symbols media, Picture and picture, and the Collaborative approach are all creatively put together in Vipicoll. This research used Reeve's design method. Research develops Vipicoll learning model, employing interviews, literature reviews, and questionnaires for iterative improvement and validation. Researchers identify problems, create Vipicoll, iteratively refine through trials, forming an effective English Language Education model. Study assesses individual English thinking development, emphasizing interpretive framework, relation, function, and unique visual symbols. From this research, it was found that using Vipicoll really helps improve kids' mastery of language features, especially those in a story. This is proven by the fact that after implementation, kids' correct answers when asked directly by their teachers and their written test answers increased greatly even though many direct answers and test answers used to be wrong and they often didn't understand.
CARDIOVASCULAR DISEASE DETECTION USING MACHINE LEARNING AND RISK CLASSIFICATI...indexPub
The global prevalence of heart disease indicates a major public health issue. It causes shortness of breath, weakness, and swollen ankles. Early heart disease diagnosis is difficult with current approaches. Hence, a better heart disease detection tool is needed. Treatment requires more than just diagnosis. Risk classification is critical for accurate diagnosis and treatment. In this analysis, a novel cardiovascular disease (CVD) detection paradigm using machine learning (ML) and risk classification based on a weighted fuzzy system is proposed. The system is developed based on ML algorithms such as artificial neural network (ANN) and Long Short-Term Memory (LSTM) and uses standard feature selection techniques knowns as Principal Component Analysis (PCA). Furthermore, the cross-validation method has been used for learning the best practices of model assessment and for hyperparameter tuning. The accuracy-based performance measuring metrics are used for the assessment of the performances of the classifiers. Finally, the outcomes revealed that the proposed model achieved an accuracy of 94.01% which is higher than another conventional model developed in this domain. Additionally, the proposed system can easily be implemented in healthcare for the identification of heart disease.
ANALYSIS OF FLOW CHARACTERISTICS OF THE BLOOD THROUGH CURVED ARTERY WITH MIL...indexPub
Narrowing of the arteries caused by atherosclerosis reduces blood flow to the heart, which results shows ischemia, angina pectoris, cerebral strokes, and other coronary artery disease signs and symptoms. Curvature is seen in blood vessels at various locations. The stenotic surface provides an additional curvature and the point of maximum shear which varies with the cross-section. A cylindrical form of the Navier-Stokes equations in polar coordinate system have been extended to include dynamic curvature along the axial direction. The blood flow behavior of taking different values of blood parameters like viscosity, the radius of the artery, and the thickness of the stenosis has been studied with and without curvature by using an extended blood flow model with dynamic curvature. Moreover, the aspects of blood flow, such as dynamic curvature velocity profile, volumetric flow rate, pressure drop, and shear stress, have been studied in relation to blood flow around curved arteries with stenosis, variations in the radii of the artery, thickness of the stenosis, and viscosity. The information may reveal that by increasing the values of curvature, viscosity, and thickness of stenosis, velocity, and volumetric flow rate can be quickly reduced. Increasing the curvature, viscosity, and thickness of stenosis also results in an increase in shear stress and a pressure drop. The presence of curved stenotic arteries has a significant impact on the flow parameters, and it is crucial to know about these dynamics in order to study the cardiovascular system.
ANALYSIS OF STUDENT ACADEMIC PERFORMANCE USING MACHINE LEARNING ALGORITHMS:– ...indexPub
Student academic performance is the great value of institutes, universities and colleges. All colleges majorly focus on the career development of students. The academic performance of students plays a vital role in the establishment of a bright career. On the basis of better academic performance, the placement of the students will be better and the same will be reflected in the form of better admission and future. Machine learning can be deployed for the prediction of student performance. Various algorithms are playing an important role in the prediction of the accuracy of various machine learning models. These articles discuss various algorithms that can be helpful to deploy for predicting student academic performance. The article discusses various methods, predictive features and the accuracy of machine learning algorithms. The primary factors used for predicting students performance are academic institution, sessional marks, semester progress, family occupation, methods and algorithms. The accuracy level of various machine learning algorithms is discussed in this article.
IMPLEMENTATION OF COMPUTER TECHNOLOGY IN BLENDED LEARNING MODELS: EFFECTS ON ...indexPub
This study was conducted to identify the influence of computer technology in blended learning on the achievement in the Principles of Accounting subject through of self-directed learning. The research also assessed the relationship of the elements of blended learning on student achievement. Despite the encouragement by the Ministry of Education for the use of Computer Technology In Education, there is a lack of research on a measurable and testable model of the influence of computer technology. In reality, various aspects such as schools, teachers, content, and technology exist to provide and utilize computer technology through learning in Malaysia. A quantitative study using a correlational design was conducted on 400 Form Four students in secondary schools in the Southern Zone of Malaysia, namely in the states of Johor, Melaka, and Negeri Sembilan, to identify the influence of computer technology in blended learning on achievement. Data were collected using adapted and modified questionnaires from previous studies. Descriptive data analysis was performed using SPSS version 28, while inferential analysis was conducted using the Smart PLS analysis technique. Smart PLS version 4.0 software was utilized to test the mediator relationships in the study. The results of the study showed high minimum scores for blended learning through computer technology and self-directed learning, as well as achievement. The influence of blended learning elements also had a significant relationship with student achievement in the Principles of Accounting subject. This study is expected to contribute to the effectiveness of blended learning through information technology on the achievement in the Principles of Accounting subject by enhancing self- directed learning among students. The development of this conceptual model is hoped to serve as a guide for policymakers, the Ministry of Education, teachers, students, and other stakeholders in ensuring that blended learning practices can be implemented more effectively. Furthermore, it is hoped that the achievement and interest in the Principles of Accounting subject can be improved by applying computer technology in learning.
Hiranandani Hospital in Powai, Mumbai, is a premier healthcare institution that has been serving the community with exceptional medical care since its establishment. As a part of the renowned Hiranandani Group, the hospital is committed to delivering world-class healthcare services across a wide range of specialties, including kidney transplantation. With its state-of-the-art facilities, advanced medical technology, and a team of highly skilled healthcare professionals, Hiranandani Hospital has earned a reputation as a trusted name in the healthcare industry. The hospital's patient-centric approach, coupled with its focus on innovation and excellence, ensures that patients receive the highest standard of care in a compassionate and supportive environment.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
One health condition that is becoming more common day by day is diabetes.
According to research conducted by the National Family Health Survey of India, diabetic cases show a projection which might increase to 10.4% by 2030.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
ENDOSCOPIC TREATMENT OF PILONIDAL SINUS IN EGYPTIAN PATIENTS
1. Hunan Daxue Xuebao/Journal of Hunan University Natural Sciences
ISSN:1674-2974 | CN 43-1061 / N
DOI: 10.5281/zenodo.10152961
Vol: 60 | Issue: 11 | 2023
Nov 2023 | 15
ENDOSCOPIC TREATMENT OF PILONIDAL SINUS IN EGYPTIAN PATIENTS
MOHAMED A.ELASHRY*
Researcher, Department of Surgery, Theodor Bilharz Research Institute, Giza, Egypt.
*Corresponding Author Email: ashry2020hana@gmail.com, m.elashry@tbri.gov.eg
M EMAD ESMAT
Professor, Department of Surgery, Theodor Bilharz Research Institute, Giza, Egypt.
Email: emadesmat2000@yahoo.com
MOHAMED S HEDAYA
Professor, Department of Surgery, Theodor Bilharz Research Institute, Giza, Egypt.
Email: hedayams@gmail.com
Abstract
Background: Treatment for pilonidal disease using minimally invasive methods is a reliable and
successful alternative to conventional surgery, with quicker recovery, better cosmetic outcomes, and
better pain management. The primary goals of this study are to assess the early outcomes of
endoscopic pilonidal sinus treatment and to demonstrate the surgical approach and its adaptations.
Materials and Methods: Our study was conducted on 30 patients with pilonidal sinus disease as a
prospective cohort study for endoscopic treatment of the pilonidal sinus, from October 2021 to October
2022, in our surgical department at Theodor Bilharz Research Institute (TBRI). Surgical outcomes of
sinus healing, pain, and discharge were reviewed in the outpatient clinic, and patient satisfaction levels
were assessed through a standardized phone interview. Results: There were 24 males and 6 females,
with a median age of 21.87±1.85 years (ranging from 16 to 57 years). The mean operative time was
44.17 (35-55) ±1.26 min. During the follow-up period of 24 weeks, wound closure was seen after a
median of 4 weeks. Wounds were closed in 72% of patients after one month and 93% of patients after
two months. 2 patients had to be re-operated due to failure: one had persistence of discharge, and the
other had recurrence after 3 months. The satisfaction rate was 93.3%. Conclusions: Endoscopic
pilonidal sinus treatment is a minimally invasive and cosmetically favorable procedure. To find out if it
reduces recovery time and the long-term recurrence rate, a larger sample size and a longer follow-up
are needed.
Keywords: Pilonidal Sinus, Endoscopy, and Treatment.
INTRODUCTION
Pilonidal sinus (PS) is a frequent sacrococcygeal health issue that primarily affects young males (1). It
is linked to obesity, sedentary jobs, local irritation, and hirsutism (2). Several ideas were created to
support the idea that the disease is congenital, however, in the last 50 years, it has been claimed that
the disorder is acquired (3) due to the blocking of hair or hair follicles in the natal cleft (4). The
symptoms might range from asymptomatic pits to pain, reddening of the skin, discharge of pus or
blood from a skin orifice, a foul odor, an acute abscess, and a chronic cyst (5).
Pilonidal illness incidence peaks between the ages of 16 and 20 and continues to be high until the age
of 25, at which point it starts to rapidly diminish (6). Regarding economics and human resources, it
has raised serious concerns (7).
2. Hunan Daxue Xuebao/Journal of Hunan University Natural Sciences
ISSN:1674-2974 | CN 43-1061 / N
DOI: 10.5281/zenodo.10152961
Vol: 60 | Issue: 11 | 2023
Nov 2023 | 16
Pilonidal sinus treatment aims to offer a good likelihood of cure with a low recurrence rate, prevent
hospitalisation and general anaesthesia, and cause the patient the least amount of discomfort,
complications, and time away from work (8).
There have been numerous therapies recommended for the pilonidal sinus during the past 25 years,
but no agreement has developed, and there have been few studies comparing the relative expenses,
discomfort, and time off work associated with various treatments (9). There is still a significant
opportunity for improvement given the number of recorded recurrences and the variety of surgical
alternatives, which point to the fact that the perfect surgical treatment is still being sought after (10).
The best surgical method would eliminate the cyst and remove and clean the sinus tract or tracts,
resulting in thorough and long-lasting healing and pleasing aesthetic outcomes (11). The treatment
for PS involves open excision and healing by secondary intention; however, the literature reports that
this method has a poor postoperative quality of life and necessitates frequent clinical surveillance
(12). In contrast, PS excision with primary closure employing a variety of methods, primarily midline
closure or flap-based surgeries, appears to be the gold standard. These surgical techniques produce
varying results, as well as varying healing durations and consequences. For the treatment of PS,
various minimally invasive procedures have been developed, including radiosurgery, fibrin glue
injection, and more recently, endoscopy (13). Meinero et al. devised a special fistuloscope with the
potential to remove the sinus cavity and sinus tracts while viewing them directly through an operating
channel, and they suggested using this method (14), also using a hysteroscopy and the video-assisted
anal fistula therapy (VAAFT) technique, both of which produced outstanding results (15). It is
established that alternative, more complex techniques of pilonidal sinus surgery have a high
recurrence and morbidity rate (16).
Aim of work
In this study, we sought to document our experience treating the pilonidal sinus endoscopically using
this method, with healing rate as the primary outcome and hospitalization, morbidity, healing
duration, return to work, and satisfaction rate as secondary endpoints.
MATERIALS AND METHODS
A prospective cohort study was conducted on 30 candidates for pilonidal sinus from October 2021 to
October 2022 in the Theodor Bilharz Research Institute. Demographic data (age, sex, and BMI) were
documented. All patients are candidates for endoscopic treatment of PNS.
Patients under the age of 16 and those with acute pilonidal abscess were excluded from the study,
but those with symptomatic chronic or recurrent PNS were included sequentially.
Ethical approval
The study's protocol was approved by the TBRI institutional review board under Federal Wide
Assurance (FWA 00010609), and the work was carried out in accordance with the World Medical
Association's Code of Ethics for Human Experiments (Declaration of Helsinki) and its later
amendments (GCP guidelines) or comparable ethical standards.
Examination and diagnosis
All cases are diagnosed by taking the patient's medical history, performing an examination. All patients
underwent routine laboratory tests according to their ASA anaesthesia score (complete blood picture,
coagulation profile, random blood sugar, renal, and liver function tests). Patients were informed about
the procedures and signed consent forms before surgery.
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Operation protocol
All patients underwent a day surgery procedure under local anaesthesia and sedation while prone,
with the buttocks separated by two large plasters. All patients are instructed to remove surrounding
hairs by shaving or using depilatory cream (at least an area 10 cm in diameter). A single dose of
antibiotic prophylaxis (Ceftriaxone 1 g) was administered 30 minutes before surgery. Informed
consent was obtained from all patients before the surgical procedure.
The surgical technique of endoscopic treatment of the pilonidal sinus is performed with a fistuloscope
(sinoscope) manufactured by Karl Storz (Southbridge, Massachusetts, USA). In the kit (Figure 1), the
fistuloscope has an 8° angle eyepiece and is equipped with an optical channel 14 cm long with a
handle, an operative channel, and an irrigation channel. The latter channel is connected to a 5000-mL
bag containing a solution of glycine and 1% mannitol. If the external orifice is too small, it is enlarged
with a scalpel or diathermy to allow introduction of the fistuloscope. In our procedure, we use 2
openings, one for the fistuloscope and the other for extraction of hairs if present in the pilonidal cavity,
curettage with a spoon, and diathermy. (Figure 2).
The procedure begins from the first opening with a diagnostic step, which is necessary to characterise
the anatomy of the tracts, followed by the operative step from the second opening to achieve
intraluminal destruction and the removal of waste material (Figure 3). During the diagnostic phase,
the fistuloscope (sinoscopy) is introduced through the external opening into the sinus cavity. Hair and
all fistula tracts or abscess cavities clearly appear on the screen (Fig. 3). By making slow up-and-down
and side-to-side movements, the infected area can be clearly delineated. The progression of the
fistuloscope is easy, even through long and angled secondary tracts. In the operative phase, all hair
debris was removed by mosquito forceps (Figure 3), then all the granulation tissue was destroyed and
removed by a brush or curettage spoon. A diathermy electrode was then introduced, and the cavity
and fistula’s track were ablated. The continuous lavage of the washing solution allows full elimination
of debris and blood. Lastly, the opening of the endoscope was closed with prolene suture, but the
second opening was left for repeated dressing.
Postoperative Discharge and Follow-up
Patients were encouraged to mobilize immediately after surgery, with the goal of discharge within 4
hours after treatment. After discharge, patients were instructed to irrigate the cavity through the
external opening with 5 mL of saline solution twice a day and to keep the surrounding area clean and
dry. All patients were asked to report daily the pain experienced on the visual analogue scale (VAS 0–
10), as well as to take a 1 g paracetamol tablet if necessary. Severe pain was represented by a VAS
score greater than 7. After surgery, patients were seen in the outpatient clinic at 1, 2, and 4 weeks
and then routinely every 6 months. During the follow-up, patients were monitored for healing, pain,
complications, recurrence, and satisfaction (satisfied or not satisfied). Healing of the PS was defined
as complete wound healing with closure of all external openings during the first 60 postoperative
days. The presence of an external opening or secretion after 2 months was considered wound
persistence, and recurrence was defined as the return of symptoms 90 days after complete healing.
Statistical analysis
Study population in prospective Cohort a total of patients 30, two tail, effect size dz = 0.69 a err prob
= 0.5 power (1- β err prob ) = 0.9 Total sample size = 30
The data was computerized and statistically analyzed was performed using (IBM SPSS version 25).
Descriptive statistics will be presented in tables. The results are reported as counts and percentages
for categorical variables, as the means ±SEM (range) for continuous normally distributed variables.
The difference between the two values will be analyzed using a two-tailed unpaired t test. Significance
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levels were assessed at p value ˂0.05. The work will be reported in line with the TBRI criteria
(strengthening the reporting of Cohort studied in surgery).
Figure 1: the endoscope used in our procedure
Figure 2: shows the openings used during the procedure
Figure 3: shows hairs and granulation tissue inside pilonidal cavity
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RESULTS
The patients’ characteristics are shown in Table 1. From October 2021 through October 2022, we
enrolled 30 consecutive patients: 24 males and 6 females, median age 21 (range, 16–57) years. There
were follow-ups at 1, 2, 4, and 6 weeks. Twenty seven patients had a primary sacrococcygeal pilonidal
sinus, and three had a recurrent pilonidal sinus. The mean operative time was 44.17 (35–55) ±1.26
min. The average hospital stay was 8 hours, with a range of 6–10 hours. All patients were discharged
as planned after the end of the procedure. No patients required admission for an overnight stay or
emergency room readmission after the discharge. According to the VAS score, at 1 week after surgery,
24 patients (80%) reported a VAS between 1 and 3, and 4 (13.33%) reported a score between 4 and
6, while only 2 patients (6.66%) reported a score between 7 and 10. The average time off work and
return to daily activities (mean ±SD) was 5.62±2.55 days. During the follow-up period of 24 weeks,
wound closure was seen after a median of 4 weeks. Wounds were closed in 72% of patients after one
month and 93% of patients after two months. Four patients experienced more bloody discharge after
surgery and required unplanned outpatient visits. The overall healing rate was 92%. We reported 2
failures (6.66%): 1 patient reported incomplete healing (persistence), and 1 reported recurrence. The
satisfaction rate was 93.3% (Table 2).
Table 1: patient characteristics
Characteristic Value
Patients enrolled 30
Male/female 24/6
Age (years) 21.87±1.85
Presentation, n (%)
De novo
Recurrent
27 (90.0%)
3 (10.0%)
Mean operative time, min (range) 44.17 (35-55)±1.26
Number of external openings; n (%) 1
2
≥3
16 (53.3)
11 (36.67)
3 (10.0)
Discharge, n (%)
No
Yes
22 (73.3%)
8 (28.7%)
Mean operative time, min (range) 44.17 (35-55)±1.26
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Table 2: intraoperative and post-operative charctaristics.
1-3 vas score ***p<0.001 significant decrease than 4-6 and 7-10; 4-6 was score **p<0.01 significant
decrease than 7-10.
DISCUSSION
A safe and successful substitute for traditional surgery for the treatment of pilonidal disease is
minimally invasive endoscopic procedures (17). Our study's objectives are to describe the surgical
procedure and its adjustments while assessing the early outcomes of endoscopic pilonidal sinus
treatment in Egyptian patients.
Our study shows that 93.3% of the patients achieved complete long-term healing, a quick return to
normal daily activities, a short time off work, and high patient satisfaction after endoscopic treatment
of the pilonidal sinus. Under direct vision, the endoscopic technique allows for the removal of the
infected area, hair, and hair follicles, as well as the vision of fistula tracts, side tracts, or any abscess
cavities. This is in line with a study conducted on 42 patients by Foti, N., et al., who state that patient
satisfaction, time off work, and failure rate were similar to those of excisional surgery (18).
In our study, the aesthetic result appears to be good, and the procedure is well tolerated with a
prompt return to work. There is no need for painful dressings, and healing occurs within 2–4 weeks.
This is consistent with a study done on 32 patients by Gallo Gaetano et al., who report no painful
repeated dressings with excellent aesthetic results (19).
All patients were discharged within 4 hours. In the first postoperative week, we found a mean VAS
score of 1.79±0.19, and that 2 patients needed painkillers for 4 weeks (7.5 %). This is similar to what
Emile et al. reported, which stated that the mean VAS score was 1.35±0.8 (20).
Our follow-up for this endoscopic technique of the pilonidal sinus showed 2 cases of recurrence, one
with persistence of discharge and the other with recurrence after 3 months. The failure rate was
higher in recurrent disease and when lateral openings were present. This is in line with a prospective
international multicenter study done by Meinero P, et al., who concludes that recurrence is more
common with recurrent cases and multiple openings (21).
Characteristic Value
Sinus openings
One
Two
More than two
19 (63.33%)
8 (26.66%)
3 (10.0%)
Removed hair 30 (100%)
No hair 0
VAS score (1 week after surgery) (%)
1–3 n=24
4–6 n=4
7–10 n = 2
1.79±0.19***
5.25±0.25**
7.5±0.50
Post-operative Infection None
Wound closure 28 (93.3%)
Recurrence 2 (6.7%)
Time off work (day) (mean ±SD) 5.62±2.55
satisfaction
satisfied
Not satisfied
28 (93.3%)
2 (6.7%)
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In our study, operative costs in endoscopic treatment of the pinonidal sinus were significantly higher
compared to open surgery, but hospital costs were significantly higher for open surgery than for
endoscopic surgery due to the increased hospital stay. In open surgery, the benefits from the delay in
returning to normal activity, both at work and at home, are greater, increasing the daily losses per
person in our government. But in endoscopic surgery, based on the lower rate of relapse, the lower
average length of stay, the shorter duration of sick leave, and the duration of the work sick leave
period, this endoscopic technique would provide more financial benefits. Milone et al., reported lower
costs for control visits and dressing on one side, and for time off work on the other (22).
CONCLUSIONS
Endoscopic treatment of the pilonidal sinus is associated with a short hospital stay, a low level of pain,
limited painkiller usage, fast recovery, a return to work, optimal cosmetic results, and high patient
satisfaction. The favorable postoperative outcomes suggest that surgeons should be familiar with this
technique.
Acknowledgment
General: Not applicable
Funding statement
No funding received.
Author information
Affiliations
Department of Surgery, Theodor Bilharz Research Institute, Giza, Egypt
Mohamed A. Elashry*, Emad Esmat, and Mohamed S Hedaya
Corresponding author
Correspondence to Mohamed A. Elashry.
Conflicts of interest
Authors declared that they have no competing interests
Availability of the data and materials
All relevant data analyzed during this study are presented in tabular form in this published article. The original
datasets used during the current study are available from the corresponding author on reasonable request
Informed consent statement was obtained from all the participants in the study.
Authors' contribution
Mohamed Elashry, M Emad Esmat sharing in design of the study. Mohamed Elashry, and Mohamed S Hedaya
were involved data analysis, interpretation and manuscript writing and Mohamed Elashry collected the data
from medical records. All authors shared in reviewing and approval of the final manuscripts.
Consent for publication
Not applicable
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