The impact of adding platelet-rich plasma during fat graft myringoplasty for managing medium-sized tympanic membrane perforations: A prospective randomized case-control study.

PURPOSE: This study aimed to evaluate the effect of adding platelet-rich plasma (PRP) during FGM to close medium-sized TM perforations. METHODS: This prospective randomized case-control study was conducted from February 2017 to March 2022. We included 320 patients with a medium-sized TM perforation with inactive mucosal otitis media. Transcanal FGM managed all patients under general or local anesthesia according to the patient preference. According to PRP, patients were divided into two groups: the first with PRP (170 patients) and the other without PRP (150 patients). We evaluated the closure rate of both groups one month, six months, and one year after the surgery. Also, we assessed the audiological performance before and one year after the operation for the patients with a successful closure. RESULTS: The closure rate was 87.6 % in the first group and 72.7 % in the second group, with a statistically significant difference between both groups as the P-value, was 0.001. Successful closure of the ABG to <10 dB occurred in 95.3 % of group A and 90.8 % of group B without a statistically significant difference between both groups (P-value = 0.163). CONCLUSIONS: This prospective comparative study on a relatively large number of patients revealed that FGM effectively closed medium-sized TM perforations. It also significantly improved postoperative audiological performance in both groups. Adding PRP during the FGM enhanced the closure success and the healing process without recorded complications. We recommend using the PRP in the routine FGM for closing medium-sized TM perforations.

Radar/INS Integration and Map Matching for Land Vehicle Navigation in Urban Environments.

Autonomous navigation requires multi-sensor fusion to achieve a high level of accuracy in different environments. Global navigation satellite system (GNSS) receivers are the main components in most navigation systems. However, GNSS signals are subject to blockage and multipath effects in challenging areas, e.g., tunnels, underground parking, and downtown or urban areas. Therefore, different sensors, such as inertial navigation systems (INSs) and radar, can be used to compensate for GNSS signal deterioration and to meet continuity requirements. In this paper, a novel algorithm was applied to improve land vehicle navigation in GNSS-challenging environments through radar/INS integration and map matching. Four radar units were utilized in this work. Two units were used to estimate the vehicle's forward velocity, and the four units were used together to estimate the vehicle's position. The integrated solution was estimated in two steps. First, the radar solution was fused with an INS through an extended Kalman filter (EKF). Second, map matching was used to correct the radar/INS integrated position using OpenStreetMap (OSM). The developed algorithm was evaluated using real data collected in Calgary's urban area and downtown Toronto. The results show the efficiency of the proposed method, which had a horizontal position RMS error percentage of less than 1% of the distance traveled for three minutes of a simulated GNSS outage.

The Implementation of Precise Point Positioning (PPP): A Comprehensive Review.

High-precision positioning from Global Navigation Satellite Systems (GNSS) has garnered increased interest due to growing demand in various applications, like autonomous car navigation and precision agriculture. Precise Point Positioning (PPP) offers a distinct advantage over differential techniques by enabling precise position determination of a GNSS rover receiver through the use of external corrections sourced from either the Internet or dedicated correction satellites. However, PPP's implementation has been challenging due to the need to mitigate numerous GNSS error sources, many of which are eliminated in differential techniques such as Real-Time Kinematics (RTK) or overlooked in Standard Point Positioning (SPP). This paper extensively reviews PPP's error sources, such as ionospheric delays, tropospheric delays, satellite orbit and clock errors, phase and code biases, and site displacement effects. Additionally, this article examines various PPP models and correction sources that can be employed to address these errors. A detailed discussion is provided on implementing the standard dual-frequency (DF)-PPP to achieve centimeter- or millimeter-level positioning accuracy. This paper includes experimental examples of PPP implementation results using static data from the International GNSS Service (IGS) station network and a kinematic road test based on the actual trajectory to showcase DF-PPP development for practical applications. By providing a fusion of theoretical insights with practical demonstrations, this comprehensive review offers readers a pragmatic perspective on the evolving field of Precise Point Positioning.

A novel radiological method to evaluate the posterior tympanotomy depth for cochlear implantation: our experience in 257 patients.

PURPOSE: This study aimed to validate our novel proposed radiological evaluation of the posterior tympanotomy (PT) depth. This dimension represents the bone of the facial recess needed to be drilled to get access into the middle ear during cochlear implantation. METHODS: It was a retrospective observational study that included 257 patients who underwent cochlear implantation from July 2018 to April 2021 in tertiary referral institutions. Two physicians evaluated the preoperative HRCT to measure the PT depth in the oblique para-sagittal cut. On the other hand, two other physicians evaluated the unedited surgical videos to judge the PT depth and classified it into an ordinary PT or deep PT. Then, the preoperative radiological measurements were correlated with the intraoperative findings. RESULTS: The radiological PT depth ranged from 2.5 to 5.4 mm with a mean of 3.91 ± 0.886. Sixty-six patients had ordinary PT, and 191 patients had deep PT. Spearman's correlation coefficient revealed a strong correlation between the preoperative radiological PT depth measurements and the intraoperative PT depth judgments (p value < 0.0001). CONCLUSIONS: We created a novel radiological method to measure the posterior tympanotomy depth. This method was valid, reproducible, and reliable in the preoperative radiological evaluation of the PT depth with high sensitivity (91.71%), specificity (90.62%), and accuracy (91.44%). We also found a significant impact of the PT depth on the PT difficulty during cochlear implantation.

Anterior part middle turbinoplasty in endoscopic sinus surgery: a randomized controlled study.

OBJECTIVE: Resection of middle turbinate in the setting of endoscopic sinus surgery is a controversial procedure. Our aim is to assess the impact of the anterior part middle turbinoplasty on the outcome of endoscopic sinus surgery, incidence of synechia between the middle turbinate and the lateral nasal wall, intra- and post-operative accessibility to the paranasal sinuses. METHODS: Single blinded randomized controlled study of 120 patients with chronic rhinosinusitis without polyps, they were allocated into two groups, we performed anterior part middle turbinoplasty in the group one "60 patients", and we preserved the middle turbinate in the group two "60 patients". We assessed the patients pre-operatively by Sino-nasal outcome Test (SNOT-22), intra-operatively by Likert scale score for the sinuses accessibility. At least 6 months post-operatively, we assessed the patients by SNOT-22, and Likert scale score for sinus accessibility. RESULTS: During and after surgery, the Likert scale score in the group one showed statistically significant better sinuses accessibility than in the group two. We noticed synechia between the MT and the lateral nasal wall in 9.2% and 18.2% of the operated sides in group one and group two, respectively. SNOT-22 and its smell item improved significantly in both groups with no statistically significant differences between them. No major complications were reported. CONCLUSION: Anterior part middle turbinoplasty is a safe and effective technique during endoscopic sinus surgery to improve the intra- and post-operative sinus accessibility, and decrease the incidence of post-operative synechia, with no adverse effect on olfaction or bleeding.

Correction: Elsheikh et al. Low-Cost Real-Time PPP/INS Integration for Automated Land Vehicles. Sensors 2019, 19, 4896.

The authors wish to make the following corrections in the original paper [...].

Building power-ful health systems: the impacts of electrification on health outcomes in LMICs.

Critical disparities threaten health care in developing countries and hinder progress towards global development commitments. Almost a billion people and thousands of public services are not yet connected to electricity - a majority in sub-Saharan Africa. In economically fragile settings, clinics and health services struggle to gain and maintain their access to the most basic energy infrastructure. Less than 30% of health facilities in LMICs report access to reliable energy sources, truncating health outcomes and endangering patients in critical conditions. While 'universal health coverage' and 'sustainable energy for all' are two distinct SDGs with their respective targets, this review challenges their disconnect and inspects their interdependence in LMICs. To evaluate the impact of electrification on healthcare facilities in LMICs, this systematic review analysed relevant publications up to March 2021, using MEDLINE, Embase, Scopus, CENTRAL, clinicaltrials.gov and CINAHL. Outcomes captured were in accordance with the WHO HHFA modules. A total of 5083 studies were identified, 12 fulfilled the inclusion criteria of this review - most were from Africa, with the exception of two studies from India and one from Fiji. Electrification was associated with improvements in the quality of antenatal care services, vaccination rates, emergency capabilities and primary health services; with many facilities reporting high-quality, reliable and continuous oxygen supplies, refrigeration and enhanced medical supply chains. Renewable energy sources were considered in six of the included studies, most highlighting their suitability for rural health facilities. Notably, solar-powered oxygen delivery systems reduced childhood mortality and length of hospital stay. Unavailable and unreliable electricity is a bottleneck to health service delivery in LMICs. Electrification was associated with increased service availability, readiness and quality of care - especially for women, children and those under critical care. This study indicates that stable and clean electrification allows new heights in achieving SDG 3 and SDG7 in LMICs.

Telemedicine in Orthopedic Surgery: A Systematic Review of Current Evidence.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has triggered transformative changes in how clinicians interact with patients. There has been a shift toward virtual consultations. The evidence to support this change in practice is unclear. The aim of this study was to systematically review the evidence base for virtual consultations for orthopedics. Materials and Methods: Two independent reviewers performed a literature search based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, utilizing the MEDLINE, EMBASE, and Scopus databases. Only studies reporting outcomes following the use of telemedicine for diagnosis, consultation, rehabilitation, and follow-up were included. Outcomes analyzed were: (1) patient and clinician satisfaction, (2) clinical outcome measures, and (3) cost analysis of traditional versus teleconsultation. Results: A total of 41 studies were included. Fifteen studies compared clinical outcomes of telemedicine against a matched traditional cohort. Of these 15 studies, 2 demonstrated noninferiority, 9 showed no statistically significant difference, and 4 found telemedicine to be superior. Eleven studies recorded patient reported outcomes, which demonstrated high patient satisfaction. Nine studies reported decreased costs when telemedicine was compared to traditional care. The remaining six studies had varied aims and methodologies that didn't fit well with any of these subheadings. Discussion: While the available evidence is limited, the studies assessed here show that telemedicine can deliver high quality health care with good clinical outcomes and high patient satisfaction in a cost-effective manner. Our team thinks what this has highlighted is that communication technology is advancing rapidly and that we as a community of surgeons need to be able to adapt rapidly and adopt innovative technology to continue to improve patient experience and outcomes.

Mean macular intercapillary area in eyes with diabetic macular oedema after anti-vascular endothelial growth factor therapy and its association with treatment response.

BACKGROUND: To evaluate the changes in the mean macular intercapillary area (ICA) from sequential enface optical coherence tomography angiography (OCTA) images following intravitreal anti-vascular endothelial growth factor (VEGF) therapy in initially treatment-naïve eyes with diabetic macular oedema (DME). METHODS: In this multicentre retrospective study, 6 × 6 and 3 × 3 mm customised, total retinal projection enface OCTA images were collected and processed for quantitative assessment of ICA by a customised MATLAB software. Measurements were done in concentric regions centred on the fovea-with the exclusion of foveal avascular zone (FAZ)-in 0.5 mm diameter increments as well as within the intervening rings. RESULTS: In this study, 6 × 6 mm OCTA images from 46 eyes of 29 patients, and 3 × 3 mm OCTA images from 23 eyes of 15 patients were included. There was no significant change in mean ICA after treatment in either scan size or in any measurement regions (all p > 0.05). Multivariate analysis revealed that baseline BCVA was significantly correlated with the visual outcome (p = 0.039). Additionally, after correction for age, baseline central retinal thickness (CRT), baseline BCVA, and retinopathy severity, mean ICA in the 1.5 mm circle was found to be a significant predictor of post treatment CRT, (p = 0.006). CONCLUSIONS: Absence of significant change in mean ICA after a minimum of three intravitreal anti-VEGF injections, may indicate that, in the short term, anti-VEGF injections neither impair nor improve macular perfusion in DME. Baseline BCVA was found to be a robust predictor of functional outcome, while inner mean ICA was a significant predictor for macular thickness outcomes.

[Diagnosis of Obsessive Compulsive Disorder in Refugees: Are We Asking The Right Questions?] / Diagnosestellung von Zwangsstörungen bei geflüchteten Patienten. Stellen wir die richtigen Fragen?

Obsessive Compulsive Disorder (OCD) is a severe and disabling clinical condition that usually arises in late adolescence or early adulthood and, if left untreated, has a chronic course. The concept of OCD has considerably varied across history and cultures. Among refugees from arab cultures; religious and contamination obsessions were found to be the commonest kind of obsessive thoughts. This makes diagnosing OCD even more challenging due to associated shame and guilt which delays help-seeking behavior. The use of culturally sensitive diagnostic instruments is important to correctly identify obsessive compulsive symptoms in refugee populations. We propose adapting the Zohar-Fineberg Obsessive Compulsive Screen (ZF-OCS) in its Arabic version to address religious and contamination obsessions safely and explicitly.

Low-Cost Real-Time PPP/INS Integration for Automated Land Vehicles.

The last decade has witnessed a growing demand for precise positioning in many applications including car navigation. Navigating automated land vehicles requires at least sub-meter level positioning accuracy with the lowest possible cost. The Global Navigation Satellite System (GNSS) Single-Frequency Precise Point Positioning (SF-PPP) is capable of achieving sub-meter level accuracy in benign GNSS conditions using low-cost GNSS receivers. However, SF-PPP alone cannot be employed for land vehicles due to frequent signal degradation and blockage. In this paper, real-time SF-PPP is integrated with a low-cost consumer-grade Inertial Navigation System (INS) to provide a continuous and precise navigation solution. The PPP accuracy and the applied estimation algorithm contributed to reducing the effects of INS errors. The system was evaluated through two road tests which included open-sky, suburban, momentary outages, and complete GNSS outage conditions. The results showed that the developed PPP/INS system maintained horizontal sub-meter Root Mean Square (RMS) accuracy in open-sky and suburban environments. Moreover, the PPP/INS system could provide a continuous real-time positioning solution within the lane the vehicle is moving in. This lane-level accuracy was preserved even when passing under bridges and overpasses on the road. The developed PPP/INS system is expected to benefit low-cost precise land vehicle navigation applications including level 2 of vehicle automation which comprises services such as lane departure warning and lane-keeping assistance.

Double random phase encoding for cancelable face and iris recognition.

Most modern security systems depend on biometrics. Unfortunately, these systems have suffered from hacking trials. If the biometric databases have been hacked and stolen, the biometrics saved in these databases will be lost forever. Thus, there is a desperate need to develop new cancelable biometric systems. The basic concept of cancelable biometrics is to use another version of the original biometric template created through a one-way transform or an encryption scheme to keep the original biometrics safe and away from utilization in the system. In this paper, the optical double random phase encoding (DRPE) algorithm is utilized for cancelable face and iris recognition systems. In the proposed cancelable face recognition scheme, the scale invariant feature transform is used for feature extraction from the face images. The extracted feature map is encrypted with the DRPE algorithm. The proposed cancelable iris recognition system depends on the utilization of two iris images for the same person and features are extracted from both images. The features extracted from one of the iris images are encrypted with the DRPE algorithm, provided that the second phase mask used in the DRPE is generated from the other iris image features. This trend guarantees some sort of feature fusion between the two iris images into a single cancelable iris code and increases user privacy. Simulation results show good performance of the two proposed cancelable biometric schemes even in the presence of noise, especially with the proposed cancelable face recognition scheme.

Accelerating matchmaking of novel dysmorphology syndromes through clinical and genomic characterization of a large cohort.

PURPOSE: Dysmorphology syndromes are among the most common referrals to clinical genetics specialists. Inability to match the dysmorphology pattern to a known syndrome can pose a major diagnostic challenge. With an aim to accelerate the establishment of new syndromes and their genetic etiology, we describe our experience with multiplex consanguineous families that appeared to represent novel autosomal recessive dysmorphology syndromes at the time of evaluation. METHODS: Combined autozygome/exome analysis of multiplex consanguineous families with apparently novel dysmorphology syndromes. RESULTS: Consistent with the apparent novelty of the phenotypes, our analysis revealed a strong candidate variant in genes that were novel at the time of the analysis in the majority of cases, and 10 of these genes are published here for the first time as novel candidates (CDK9, NEK9, ZNF668, TTC28, MBL2, CADPS, CACNA1H, HYAL2, CTU2, and C3ORF17). A significant minority of the phenotypes (6/31, 19%), however, were caused by genes known to cause Mendelian phenotypes, thus expanding the phenotypic spectrum of the diseases linked to these genes. The conspicuous inheritance pattern and the highly specific phenotypes appear to have contributed to the high yield (90%) of plausible molecular diagnoses in our study cohort. CONCLUSION: Reporting detailed clinical and genomic analysis of a large series of apparently novel dysmorphology syndromes will likely lead to a trend to accelerate the establishment of novel syndromes and their underlying genes through open exchange of data for the benefit of patients, their families, health-care providers, and the research community.Genet Med 18 7, 686-695.

The impact of the bladder wall thickness on the outcome of the medical treatment using alpha-blocker of BPH patients with LUTS.

OBJECTIVES: To evaluate whether the outcome of medical treatment with α 1 receptor blocker in Benign prostatic hyperplasia (BPH) patients with lower urinary tract symptoms (LUTS) is affected by the bladder wall thickness (BWT) Methods: A total of 125 male BPH patients with LUTS were enrolled. All patients were assessed using The International Prostatic Symptom Score (IPSS), prostate specific antigen (PSA), prostate volume, uroflowmetry, post voiding residual (PVR). BWT was measured by Trans-abdominal ultrasound, and patients were divided into two groups group 1 (patients with BWT <5 mm) and group 2 (patients with BWT ≥5 mm). The patients were reassessed after 2 months of treatment with α 1 receptor blocker (alfuzosin 10 mg). Clinical parameters were analyzed and compared between groups. RESULTS: There were significant difference between both groups as regard IPSS, voiding symptoms, and storage symptoms (p = 0.005), (p = 0.010) and (p = 0.041) respectively. After medication, there were improvements in the total IPSS, voiding symptoms, storage symptoms, Qmax, PVR and Qol in both groups and these improvements were more effectively in (group 1) than (group 2) with statistically significant differences (p < 0.05). CONCLUSION: BWT has positive correlation with the total IPSS, voiding symptoms subscores and storage symptoms subscores. The response to medical treatment is found statistically less in patients with BWT greater than 5 mm.

Vaginal pessary: a culprit for intraperitoneal bladder perforation.

Vaginal pessaries are widely considered to be a safe and effective non-surgical management option for women with pelvic organ prolapse. Complications may occur, and are more frequent with improper care and certain device designs and materials. It is imperative to provide information to patients about potential complications. We present the case of a woman in her 70s who presented to the Emergency Department with increasing groin and abdominal pain following a vaginal pessary insertion 2 days prior for grade 3 vaginal vault prolapse. On presentation, her abdomen was markedly distended with guarding. Laboratory investigations showed a significant acute kidney injury with a metabolic acidosis. An initial non-contrast CT showed fluid and inflammatory changes surrounding the bladder, and bladder perforation was suspected. A subsequent CT cystogram showed extravasation of contrast from the bladder into the peritoneal cavity, in keeping with an intraperitoneal bladder rupture. The patient underwent an emergency bladder repair in theatre.

Influence of climate change on emerging pathogens and human immunity.

Global warming can be defined as the detectable increase in average global temperature in the last ten years regarding frequency and intensity. Climate change represents a long-term detectable climatic variability. The climatic system of the earth is disrupted because of the continuous production of greenhouse gases, which raises the risk of the emergence and re-emergence of human pathogens. In this review, we aimed to present the different mechanisms of climate change that increase human/pathogen exposure, introduce the recent concept of disaster microbiology, and discuss the effects of climate change on zoonoses as well as the effects of climate change on antibiotic resistance and human health.

Does Gender Affect the Outcomes of Myocardial Revascularization for Left-Main Coronary Artery Disease?

Currently, gender is not considered in the choice of the revascularization strategy for patients with unprotected left main coronary artery (ULMCA) disease. This study analyzed the effect of gender on the outcomes of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) in patients with ULMCA disease. Females who had PCI (n = 328) were compared with females who had CABG (n = 132) and PCI in males (n = 894) was compared with CABG (n = 784). Females with CABG had higher overall hospital mortality and major adverse cardiovascular events (MACE) than females with PCI. Male patients with CABG had higher MACE; however, mortality did not differ between males with CABG vs PCI. In female patients, follow-up mortality was significantly higher in CABG patients, and target lesion revascularization was higher in patients with PCI. Male patients had no difference in mortality and MACE between groups; however, MI was higher with CABG, and congestive heart failure was higher with PCI. In conclusion, women with ULMCA disease treated with PCI could have better survival with lower MACE compared with CABG. These differences were not evident in males treated with either CABG or PCI. PCI could be the preferred revascularization strategy in women with ULMCA disease.

Defensive medicine practices as a result of malpractice claims and workplace physical violence: a cross-sectional study from Egypt.

Defensive medicine refers to practices motivated mainly by legal rather than medical purposes. Increased healthcare costs, overutilization of medical services, and potential harm to patients from unnecessary procedures are among its drawbacks. We performed this study to assess the prevalence of defensive medicine practices in Egypt and their associations with experiencing malpractice claims and workplace physical violence. We investigated 1797 physicians (68.1% male), with an average age of 36.8 ± 9.1 years, practicing in Egypt between January 14th and February 23rd, 2023. SPSS was used for statistical analysis. The majority reported engaging in defensive medicine practices. Specifically, 89.6% acknowledged avoiding high-risk procedures, 87.8% refrained from treating high-risk patients, 86.8% admitted to making unnecessary referrals, 84.9% acknowledged ordering unnecessary tests, 61.4% reported performing unnecessary procedures, and 56.4% disclosed prescribing unnecessary medications. Obstetricians and surgeons exhibited the highest rates of defensive medicine. Using linear regression analysis adjusted for age and sex, malpractice claims and workplace physical violence were associated with defensive medicine score (zero-100): ßs (95% CIs) = 5.05 (3.10, 6.99) and 5.60 (3.50, 7.71), respectively, (p values < 0.001). In conclusion, defensive medicine is deeply ingrained in the clinical routines of Egyptian physicians. Establishing a comprehensive national medical liability framework is required.

Patient-performed at-home surgical drain removal is safe and feasible following hernia repair and abdominal wall reconstruction.

BACKGROUND: Traditionally, surgical drains are considered a relative contraindication to telemedicine-based postoperative care. We sought to assess the safety, feasibility, and outcomes of an at-home patient-performed surgical drain removal pilot program. METHODS: A prospective cohort study among patients who were discharged with surgical drains was performed. Patients discharged with drains were given the option for in-clinic, provider-performed removal, or at-home, patient-performed drain removal. Patient demographics, health characteristics, perioperative metrics, and operative outcomes were compared and analyzed. RESULTS: A total of 68 encounters with drain removal were included (at-home: 28%, n = 19; in-clinic: 72%, n = 49), with both groups having similar demographics, except for age (median age of telemedicine-based at-home: 50 vs in-clinic: 62 years, p = 0.03). Patients who opted into at-home, patient-performed drain removal were more likely to have drain removal occur earlier (9 vs 13 days for in-clinic, p < 0.001). In-clinic removal resulted in increased encounters with surgical nursing staff and increased travel time, with no significant difference in complication burden. CONCLUSIONS: Patient-performed at-home drain removal is safe and allows for more timely drain removal.