Structured Reporting of Superficial Soft Tissue Masses on Ultrasonography: A Closed-Loop Clinical Audit From a Tertiary Care Hospital in Pakistan.

Background Among all the modalities of diagnostic radiology, ultrasonography is considered the least invasive one. However, this benefit usually comes at the cost of its subjective evaluation since it is purely a dynamic diagnostic modality. Thus, instead of ultrasonography, most clinicians usually rely on the report written by the radiologist. Objective The objective of this study is to evaluate the clinical practices of ultrasound reporting of superficial soft tissue masses. Materials and methods A closed-loop retrospective and prospective study was conducted at the Department of Radiology and Medical Imaging, Jinnah Hospital, Lahore between December 2023 and March 2024. In the pre-intervention phase, a randomly collected sample of 100 ultrasound reports documenting superficial soft tissue masses were included in the study and judged against standard criteria set by the Royal College of Radiologists (RCR). The intervention phase included regular presentations, identification of problems, and designing of preformed reporting forms. Post-intervention assessments were based on the judgment of 100 ultrasound reports in each cycle twice. Intervention and post-intervention assessments were done twice to correct the ongoing practices. Results During the pre-intervention phase, the ultrasound reports issued by the department of study showed only 41.5% compliance with the RCR structured reporting guidelines. However, after the first and second post-intervention phases, this percentage increased up to 98.3%. Overall, we observed a compliance difference of 56.5% between the pre-intervention and second post-intervention phases. Conclusion Integration of methods, such as briefing the residents on RCR guidelines, displaying parameters, and making structured report templates available, can greatly increase adherence to RCR guidelines for structured ultrasonography reporting. It also greatly enhances the comprehensiveness and reliability of ultrasonography reports for clinicians. Clinical audits should be routinely practiced in the settings of radiology.

Sustainable hydrogen production via microalgae: Technological advancements, economic indicators, environmental aspects, challenges, and policy implications.

Hydrogen has emerged as an alternative energy source to meet the increasing global energy demand, depleting fossil fuels and environmental issues resulting from fossil fuel consumption. Microalgae-based biomass is gaining attention as a potential source of hydrogen production due to its green energy carrier properties, high energy content, and carbon-free combustion. This review examines the hydrogen production process from microalgae, including the microalgae cultivation technological process for biomass production, and the three main routes of biomass-to-hydrogen production: thermochemical conversion, photo biological conversion, and electrochemical conversion. The current progress of technological options in the three main routes is presented, with the various strains of microalgae and operating conditions of the processes. Furthermore, the economic and environmental perspectives of biomass-to-hydrogen from microalgae are evaluated, and critical operational parameters are used to assess the feasibility of scaling up biohydrogen production for commercial industrial-scale applications. The key finding is the thermochemical conversion process is the most feasible process for biohydrogen production, compared to the pyrolysis process. In the photobiological and electrochemical process, pure hydrogen can be achieved, but further process development is required to enhance the production yield. In addition, the high production cost is the main challenge in biohydrogen production. The cost of biohydrogen production for direct bio photolysis it cost around $7.24 kg-1; for indirect bio photolysis it costs around $7.54 kg-1 and for fermentation, it costs around $7.61 kg-1. Therefore, comprehensive studies and efforts are required to make biohydrogen production from microalgae applications more economical in the future.

Comparison of Postoperative Complications of Open Versus Laparoscopic Cholecystectomy According to the Modified Clavien-Dindo Classification System.

BACKGROUND: Though laparoscopic cholecystectomy has become a gold standard management technique for gallbladder diseases, an open approach can also be used for patients having complicated gallbladder disease. Post-cholecystectomy complications are well-documented in existing English scientific literature but are not well understood according to the grade of intervention required to treat those complications. OBJECTIVE: To compare the postoperative complications of laparoscopic versus open cholecystectomy according to the modified Clavien-Dindo classification (MCDC) system. MATERIALS AND METHODS:  A retrospective study was conducted at the Department of General Surgery, Unit - III, Lahore General Hospital, Lahore, comprising the data of patients operated between July 01, 2021, and December 31, 2021, after departmental approval # SU-III/73/LGH, dated April 1, 2022. Patients with the definitive diagnosis of acute cholecystitis, chronic cholecystitis, cholelithiasis, and cholecysto-duodenal fistula were included, while cases of choledocholithiasis and, gall bladder carcinoma were excluded from this study. Eighty patients met the inclusion criteria, with 40 patients in each group of open and laparoscopic cholecystectomy. Information for the data set of age, gender, history of surgical procedure, immediate and late outcome, length of surgery, and MCDC grade were collected. Low-grade complications were Grade I and Grade II, while Grades III to V were high-grade. RESULTS: The mean age of included patients was 42.52 ± 8.76 and 40.025 ± 8.12 years, in the open and laparoscopic group, with 80% and 90% female preponderance, respectively. Grade I and Grade II complications occurred in both groups of patients, with Grade III only in patients who underwent open cholecystectomy. None of the patients from each group developed Grade IV or Grade V complications. Among 40 patients who underwent laparoscopic cholecystectomy, 35% of the patients developed low-grade complications, whereas 40% of the patients developed low-grade complications after open cholecystectomy, with respiratory complications being the most common. High-grade complications after open cholecystectomy were found among 2.5% of patients, whereas no patients developed high-grade complications following the laparoscopic approach. CONCLUSION: Patients who underwent laparoscopic cholecystectomy are less prone to develop complications than patients undergoing open cholecystectomy, hence requiring low-grade interventions of surgical and non-surgical types. MCDC is a valuable tool for assessing surgical complications and can help improve patient outcomes by providing a standardized method for reporting and comparing complication rates.

Significance of Histopathology of Appendectomy Specimens: Analysis From a Teaching Hospital of Pakistan.

Background Histopathology of a tissue specimen plays a crucial role in formulating the final diagnosis of any disease. It confirms whether the histopathological findings are in correspondence with the clinical diagnosis and thus suggests an optimal management plan. Standard surgical practices guide that every human tissue specimen must undergo postoperative tissue analysis unless indicated otherwise. Objective To determine the significance of histopathology in determining the final diagnosis of appendectomy specimens. Materials and methods This retrospective clinical study conducted in May 2022 included 100 patients operated for appendectomy from January 1, 2021, to December 31, 2021, in the emergency room of the Department of General Surgery, Unit-III, Lahore General Hospital, Lahore. Data were retrieved from patients' records and the picture archiving and communication system (PACS). A Google Forms-based pro forma (Google, Mountain View, CA) was generated to include the demographic details, clinical manifestations, and histopathology reports of the patients. Descriptive analysis was completed using a Microsoft Excel spreadsheet (Microsoft Corporation, Redmond, WA). Results Fifty-two patients were females out of the total 100. The mean age at presentation was 23.02 ± 12.02 years. Of the samples, 54% were not sent for histopathology. Among the remaining ones, 27% of cases were proven to be acute appendicitis. Alvarado score was 7-10 in 50% of patients. Other lesions proven by histopathology were appendiceal phlegmon (4%), perforated appendix (4%), mucocele (1%), carcinoid tumor (1%), tuberculosis (1%), and adenocarcinoma (1%). Conclusions Histopathological analysis is the gold standard for the tissue diagnosis of a disease. The high percentage of the samples not sent for histopathology is alarming since the appendix is not only a site for inflammatory pathologies but for neoplastic lesions as well. This practice depicts that the incidence of non-inflammatory pathologies is being ignored by healthcare professionals and there is a dire need to emphasize the significance of acquiring histopathology reports for the specimens of appendectomy in all circumstances.

Membrane-assisted natural gas liquids recovery: Process systems engineering aspects, challenges, and prospects.

Membrane-based natural gas liquid (NGL) recovery processes are still far from their large-scale applications owing to communication gaps among academic researchers and industry practitioners. A comprehensive process systems engineering (PSE) assessment of membrane-based NGL recovery processes is required to determine their commercial suitability. This PSE-based review presents the technical and economic aspects of standalone and integrated membrane processes. Literature review shows that polymeric membranes (e.g., cellulose acetate) are primarily evaluated in NGL recovery processes despite their low separation efficiencies. So far, multiple multistage membrane models with standalone and integrated designs have been suggested by analyzing different configurations to improve separation efficiency. In standalone processes, cellulose acetate membrane modules with high selectivity ratio can improve methane recovery by up to 100%. Absorption or cryogenic integrated processes exhibit high methane recovery (up to 99%) but demonstrate high energy consumption. The integrated absorption-membrane process is more capital cost intensive (i.e., 0.41 m$) than the cryogenic-membrane process (0.39 m$). Furthermore, in this review, the key challenges encountered by membrane processes and related issues are identified to improve their commercial viability by capitalizing on their maximum potential benefits. The major challenges associated with membrane processes constitute the lack of rigorous multistage membrane models and inflexibility in product purity and recovery. The policy implications and future directions suggest that owing to the growing demand for NGLs, membranes that can sustain varying natural gas compositions and conditions may be required. This PSE assessment will help process engineers and policymakers to improve natural gas supply chain economics.

Motor Training Using Mental Workload (MWL) With an Assistive Soft Exoskeleton System: A Functional Near-Infrared Spectroscopy (fNIRS) Study for Brain-Machine Interface (BMI).

Mental workload is a neuroergonomic human factor, which is widely used in planning a system's safety and areas like brain-machine interface (BMI), neurofeedback, and assistive technologies. Robotic prosthetics methodologies are employed for assisting hemiplegic patients in performing routine activities. Assistive technologies' design and operation are required to have an easy interface with the brain with fewer protocols, in an attempt to optimize mobility and autonomy. The possible answer to these design questions may lie in neuroergonomics coupled with BMI systems. In this study, two human factors are addressed: designing a lightweight wearable robotic exoskeleton hand that is used to assist the potential stroke patients with an integrated portable brain interface using mental workload (MWL) signals acquired with portable functional near-infrared spectroscopy (fNIRS) system. The system may generate command signals for operating a wearable robotic exoskeleton hand using two-state MWL signals. The fNIRS system is used to record optical signals in the form of change in concentration of oxy and deoxygenated hemoglobin (HbO and HbR) from the pre-frontal cortex (PFC) region of the brain. Fifteen participants participated in this study and were given hand-grasping tasks. Two-state MWL signals acquired from the PFC region of the participant's brain are segregated using machine learning classifier-support vector machines (SVM) to utilize in operating a robotic exoskeleton hand. The maximum classification accuracy is 91.31%, using a combination of mean-slope features with an average information transfer rate (ITR) of 1.43. These results show the feasibility of a two-state MWL (fNIRS-based) robotic exoskeleton hand (BMI system) for hemiplegic patients assisting in the physical grasping tasks.