Laparoscopic-assisted Appendectomy in Children with Uncomplicated Appendicitis

Background: Acute appendicitis is one of the common surgical emergencies in the pediatric population. In 1990, laparoscopic-assisted  appendectomy was used in children for the first time. In this study, we present our initial experience with laparoscopic-assisted appendectomy in children, using two trocar sites, and assess it for safety and outcome. Methods: 76 cases with acute appendicitis underwent laparoscopic-assisted appendectomy at Salmaniya Medical Complex (SMC), Kingdom of Bahrain, between January 2012 and December 2015. These cases were reviewed prospectively. Results: 76 patients between 5 and 12 years underwent laparoscopic-assisted appendectomy at SMC. Operative time ranged from 25 to 45 min  (mean 33.93 min). Postoperative hospitalization ranged from 2 to 5 days (mean 2.88 days). One patient developed wound infection which  subsequently subsided with conservative treatment. One case was converted to open appendectomy, but without any intraoperative complications. All patients were followed up for 2 weeks, 1 month, and 3 months postoperatively. Conclusion: Laparoscopic-assisted appendectomy in children is a safe alternative to the open technique. The operative time in this technique and the length of hospitalization are both less and shorter than the open counterpart. No major intra-operative or postoperative complications were documented. Recovery was excellent. Keywords: Appendicitis, Laparoscopic-assisted appendectomy, Open appendectom

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

The outcome of PDA ligation by mini-thoracotomy in premature neonates: A single hospital experience

Background: Various thoracotomy practices have been employed for occlusion of patent ductus arteriosus (PDA) which are not amenable to medical management. We report our preliminary experience of using a mini-thoracotomy approach in small premature infants and determining survival outcomes in relation to factors such as gender, birth weight, age, and type of ventilation used intraoperatively.  Methods: Between January 2004 and December 2012, 52 consecutive premature infants with an echocardiographic diagnosis of isolated PDA, which are not amenable to medical treatment, were included. Those with chromosomal abnormalities, major cardiac congenital anomalies aside from septal defects, and infants who did not receive mechanical ventilation in the first week of life were excluded. The median gestational age was 28 weeks and the median gestational weight at surgery was 705g. The median PDA size was 3.8mm, ranging from 1.6 to 5mm. Twenty-nine patients were given non-selective ventilation and twenty-three were anesthetized using selective right-lung ventilation using a 2-F balloon catheter for arterial embolectomy. A left lateral mini-thoracotomy was performed in all infants and PDA closure achieved by double ligation using zero silk sutures. Results: The median operative time and mean length of hospital stay were 45 minutes and 90 days, respectively. No major hemorrhage requiring blood transfusion occurred during the surgery. The survival rate until hospital discharge was 88.5%. There were no mortalities associated with the surgery itself. Six (11.5%) neonates died postoperatively because of prematurity (p-value=1.000). Pneumonia and atelectasis were among the few complications encountered post ligation. An interesting association was recognized between ventilation and surgical complications; that is neonates who underwent selective right ventilation did not experience any of the complications mentioned above in comparison to those who were put under non-selective ventilation (p-value &lt;0.001). Conclusion: Closure of PDA by double ligation via a left mini-thoracotomy in small premature infants proved to be safe and effective in providing pediatric surgeons adequate exposure within confined and delicate anatomic spaces. No mortalities or major complications were encountered.</jats:p

Nonablative Laser Skin Resurfacing of Fine and Coarse Wrinkles – Two Study Cases

The use of the Nd+ and Er+: YAG lasers is still under development for cutaneous resurfacing. Cooling the epidermis induces laser heating under invasive epidermal layer regime. Injuring the dermis can treat skin defects and improve its quality. Various therapeutic options have been utilized to treat aging signs. Laser resurfacing has proven effectiveness and popularity due to its shorter recovery time and high success rate. Non-invasive Nd: YAG laser and 2940nm Er: YAG laser pulses were employed to provide deep dermal laser heating and induce elastin and collagen regeneration. Two subjects of skin-tone 2 were laser treated in the present study. Photographs were taken before the treatment and after the last session. The 1064nm Nd: YAG and 2940nm lasers treatment results were followed up in treating fine and coarse wrinkles. The patients were given four sessions every other week. The laser energy was calculated at all interfaces between the layers of the skin in order to find out the exact laser fluence, and then the temperature rise at the targeted tissue. The 1064nm Nd: YAG laser was benefited more by younger subject while the 2940nm was better for older case

Laparoscopic-assisted Appendectomy in Children with Uncomplicated Appendicitis

Background: Acute appendicitis is one of the common surgical emergencies in the pediatric population. In 1990, laparoscopic-assisted  appendectomy was used in children for the first time. In this study, we present our initial experience with laparoscopic-assisted appendectomy in children, using two trocar sites, and assess it for safety and outcome.&#x0D; Methods: 76 cases with acute appendicitis underwent laparoscopic-assisted appendectomy at Salmaniya Medical Complex (SMC), Kingdom of Bahrain, between January 2012 and December 2015. These cases were reviewed prospectively.&#x0D; Results: 76 patients between 5 and 12 years underwent laparoscopic-assisted appendectomy at SMC. Operative time ranged from 25 to 45 min  (mean 33.93 min). Postoperative hospitalization ranged from 2 to 5 days (mean 2.88 days). One patient developed wound infection which  subsequently subsided with conservative treatment. One case was converted to open appendectomy, but without any intraoperative complications. All patients were followed up for 2 weeks, 1 month, and 3 months postoperatively.&#x0D; Conclusion: Laparoscopic-assisted appendectomy in children is a safe alternative to the open technique. The operative time in this technique and the length of hospitalization are both less and shorter than the open counterpart. No major intra-operative or postoperative complications were documented. Recovery was excellent.&#x0D; Keywords: Appendicitis, Laparoscopic-assisted appendectomy, Open appendectomy </jats:p

Knowledge and Perceptions of the COVID-19 Pandemic in the Kingdom of Bahrain: A Descriptive Study

This study aims to explore the public’s knowledge and perceptions towards COVID-19 and its preventive measures in the Kingdom of Bahrain. This is in order to aid the authorities in improving information dissemination and help control the spread of the virus and in time eliminate it. Data was collected from 613 Bahrain residents who were asked to complete online survey questions about their perceptions, knowledge, and thoughts toward the virus. The dataset was then analyzed using SPSS 23. Based on the analysis, several interesting findings were uncovered. For example, while about 70% of the respondents said they trusted the governments’ reaction to contain the coronavirus and showed knowledge about COVID-19 measures undertaken in the government, nearly 32% of the respondents thought that the virus is a part of an international con-spiracy. Our results show the persistent fragmented opinions of the public toward the pandemic, which calls for additional education and health communication efforts directed toward them in order to combat misinformation and succeed in the battle to fight the pandemic.</p

Pre-calculated relevant Nd: YAG laser parameters for optimized varicose veins treatment

Abstract Full clearance of enlarged veins, without side effects, had always been the ultimate dream of patients. Varicose veins’ treatment protocols were not very decisive and mostly associated with some side effects. The aim of this work is to demystify the exact dose of laser parameters; namely fluence and pulse duration, to successfully treat enlarged blood vessels in face, legs and arms without side effects. This necessitated the calculation of exact temperature rise of the targeted tissue before laser irradiation. The pre-calculated laser parameters required, for successful treatment, without side effects were tested to achieve optimum clinical results; using 1064nm pulsed Nd: YAG lasers for all skin photo types. For this work, two values of spot size (5mm and 3mm), variable pulse duration (15-30 ms), variable fluences (110-190 J/cm2) and variable skin cooling temperature (3-18 °C) were used. Pre and post-cooling were found necessary to ensure positive results and minimal discomfort.</jats:p

Joint Optimization Scheme of User Association and Channel Allocation in 6G HetNets

The sixth-generation (6G) wireless cellular network integrates several wireless bands and modes with the objectives of improving quality of service (QoS) and increasing network connectivity. The 6G environment includes asymmetrical heterogeneous networks (HetNets) with the intention of making effective use of the available frequencies. However, selecting a suitable gNB and a communication channel that works for users in the network is an enormous challenge in 6G HetNets. This paper investigates a joint user association (UA) and channel allocation (CA) problem in two-tier HetNets by considering the downlink scenario to improve QoS. Our study presents an innovative scheme for user association and channel allocation, wherein the user can be connected to either the macro base station (MBS) or a possible small base station (SBS) in a direct or relay-assisted link. Furthermore, the proposed scheme identifies the optimal channel to be allocated to each user so that the overall network QoS can be maximized. A symmetric matching game-based user association is proposed to find the optimal association for users. Moreover, a modified auction game is applied to allocate the optimal channel by considering the quota of each gNB. Regarding connection probability, throughput, energy efficiency (EE), and spectrum efficiency (SE), the simulation results show that the proposed approach performs well over the state-of-the-art techniques