Patterns of Otorhinolaryngological Disorders in Subjects with Diabetes

Objective: To find out the prevalence of otorhinolaryngological disorders in patients with diabetes mellitus who presented to Ear, Nose and Throat (ENT) clinic at Al-Noor specialist hospital, Makkah, Saudi Arabia. Materials & Methods: This observational retrospective study was carried out over a period of one year, from July 15, 2004 to July 20, 2005 by the collaboration of ENT Department and Health Research Center of Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Patients’ information was collected such as the demography, types and durations of diabetes, types of diabetic treatments, and fi nal ENT diagnosis. Subjects’ random blood sugar and hemoglobin A1c (HbA1c) levels were collected on the fi rst visit to the ENT-Outpatient Department. Results: One hundred patients met the inclusion criteria; with mean age of 51.5 years (age range 14-86 years). Thirty-nine percent of the patients were at the age of 45-54 years old. Males (52%) slightly out-numbered the females. Majority had diabetes mellitus type 2 and 78% patients had high HbA1c levels indicating poor glycemic controls. The most common ENT disorder was rhinitis (19%), followed by sensorineural hearing loss (12%) and malignant otitis externa (8%). Conclusion: The most common ENT disorder in patients with diabetes mellitus type 2 was rhinitis, followed by sensorineural hearing loss. Majority of these patients had poor glycemic control, hence can explain the predominance of certain disorders over others

Hybrid deposition additive manufacturing: novel volume distribution, thermo-mechanical characterization, and image analysis

(c) The Author/sCAUL read and publish agreement 2022The structural integrity of additive manufacturing structures is a pronounced challenge considering the voids and weak layer-to-layer adhesion. One of the potential ways is hybrid deposition manufacturing (HDM) that includes fused filament fabrication (FFF) with the conventional filling process, also known as “HDM composites". HDM is a potential technique for improving structural stability by replacing the thermoplastic void structure with a voidless epoxy. However, the literature lacks investigation of FFF/epoxy HDM-based composites regarding optimal volume distribution, effects of brittle and ductile FFF materials, and fractographic analysis. This research presents the effects of range of volume distributions (10–90%) between FFF and epoxy system for tensile, flexure, and compressive characterization. Volume distribution in tensile and flexure samples is achieved using printable wall thickness, slot width, and maximum width. For compression, the printable wall thickness, slot diameter, and external diameter are considered. Polylactic acid and acrylonitrile butadiene styrene are used to analyze the brittle and ductile FFF structures. The research reports novel application of image analysis during mechanical characterization using high-quality camera and fractographic analysis using scanning electron microscopy (SEM). The results present surprising high tensile strain (0.038 mm/mm) and compressive strength (64.5 MPa) for lower FDM-percentages (10%, 20%) that are explained using in situ image analysis, SEM, stress–strain simulations, and dynamic mechanical analysis (DMA). In this regard, the proposed work holds novelty to apply DMA for HDM. The optimal volume distributions of 70% and 80% alongside fractographic mechanisms for lower percentages (10%, 20%) can potentially contribute to structural applications and future material-based innovations for HDM.fals

Sustainable energy generation from plastic waste: An in-depth review of diesel engine application

Plastic consumption has increased significantly over the previous few decades and it is one of the most significant sources of waste in many countries. Recycling and energy recovery methods are just two methods for dealing with plastic waste. As a result, the process of converting waste plastic into energy and its application in the diesel engine was reviewed in the present study. The pyrolysis process could be utilized to use plastic waste efficiently. The waste plastic is converted to liquid oil, gas, and solid by using this process. This article reviewed the application of plastic pyrolysis oil (PPO) in diesel engines regarding its properties and effects on the fuel's performance, combustion, and emission parameters. PPO typically has a lower sulfur concentration than standard diesel fuel. Plastic pyrolysis oil (PPO) improves cylinder pressure, brake power, and brake thermal efficiency while lowering fuel consumption when blended with diesel. Emissions can also vary depending on combustion characteristics, fuel quality, and engine technology. The literature on emission assessments yields conflicting results regarding nitrogen oxides and hydrocarbon emissions from PPO. However, because of the higher oxygen concentration, carbon monoxide (CO) and particulate matter (PM) often decrease. Finally, the study recommended a 10%− 90% mix of PPO-diesel as an alternative fuel for the engine with no modifications; this concentration may be increased by adding additives/nanoparticles in the fuel or modifying the engine

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Higher ethical objective (Maqasid al-Shari'ah) augmented framework for Islamic banks : assessing the ethical performance and exploring its determinants.

This study utilises higher objectives postulated in Islamic moral economy or the maqasid al-Shari’ah theoretical framework’s novel approach in evaluating the ethical, social, environmental and financial performance of Islamic banks. Maqasid al-Shari’ah is interpreted as achieving social good as a consequence in addition to well-being and, hence, it goes beyond traditional (voluntary) social responsibility. This study also explores the major determinants that affect maqasid performance as expressed through disclosure analysis. By expanding the traditional maqasid al-Shari’ah,, we develop a comprehensive evaluation framework in the form of a maqasid index, which is subjected to a rigorous disclosure analysis. Furthermore, in identifying the main determinants of the maqasid disclosure performance, panel data analysis is used by including several key variables alongside political and socio-economic environment, ownership structures, and corporate and Shari’ah governance-related factors. The sample includes 33 full-fledged Islamic banks from 12 countries for the period of 2008–2016. The findings show that although during the nine-year period the disclosure of maqasid performance of the sampled Islamic banks has improved, this is still short of ‘best practices’. Through panel data analysis, this study finds that the Muslim population indicator, CEO duality, Shari’ah governance, and leverage variables positively impact the disclosure of maqasid performance. However, the effect of GDP, financial development and human development index of the country, its political and civil rights, institutional ownership, and a higher share of independent directors have an overall negative impact on the maqasid performance. The findings reported in this study identify complex and multi-faceted relations between external market realities, corporate and Shari’ah governance mechanisms, and maqasid performance

Multiplicity and Diversity of Plasmodium vivax Infections in a Highly Endemic Region in Papua New Guinea

Plasmodium vivax is highly endemic in the lowlands of Papua New Guinea and accounts for a large proportion of the malaria cases in children less than 5 years of age. We collected 2117 blood samples at 2-monthly intervals from a cohort of 268 children aged 1 to 4.5 years and estimated the diversity and multiplicity of P. vivax infection. All P. vivax clones were genotyped using the merozoite surface protein 1 F3 fragment (msp1F3) and the microsatellite MS16 as molecular markers. High diversity was observed with msp1F3 (HE = 88.1%) and MS16 (HE = 97.8%). Of the 1162 P. vivax positive samples, 74% harbored multi-clone infections with a mean multiplicity of 2.7 (IQR = 1–3). The multiplicity of P. vivax infection increased slightly with age (P = 0.02), with the strongest increase in very young children. Intensified efforts to control malaria can benefit from knowledge of the diversity and MOI both for assessing the endemic situation and monitoring the effects of interventions

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

Pooled analysis of who surgical safety checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89⋅6 per cent) compared with that in countries with a middle (753 of 1242, 60⋅6 per cent; odds ratio (OR) 0⋅17, 95 per cent c.i. 0⋅14 to 0⋅21, P &lt; 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P &lt; 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P &lt; 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P &lt; 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; P &lt; 0⋅001). The greatest absolute benefit was seen for emergency surgery in low-and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries