MHD mixed convection of hybrid nanofluid in a wavy porous cavity employing local thermal non-equilibrium condition.

The current study treats the magnetic field impacts on the mixed convection flow within an undulating cavity filled by hybrid nanofluids and porous media. The local thermal non-equilibrium condition below the implications of heat generation and thermal radiation is conducted. The corrugated vertical walls of an involved cavity have [Formula: see text] and the plane walls are adiabatic. The heated part is put in the bottom wall and the left-top walls have lid velocities. The controlling dimensionless equations are numerically solved by the finite volume method through the SIMPLE technique. The varied parameters are scaled as a partial heat length (B: 0.2 to 0.8), heat generation/absorption coefficient (Q: - 2 to 2), thermal radiation parameter (Rd: 0-5), Hartmann number (Ha: 0-50), the porosity parameter (ε: 0.4-0.9), inter-phase heat transfer coefficient (H*: 0-5000), the volume fraction of a hybrid nanofluid (ϕ: 0-0.1), modified conductivity ratio (kr: 0.01-100), Darcy parameter [Formula: see text], and the position of a heat source (D: 0.3-0.7). The major findings reveal that the length and position of the heater are effective in improving the nanofluid movements and heat transfer within a wavy cavity. The isotherms of a solid part are significantly altered by the variations on [Formula: see text], [Formula: see text], [Formula: see text] and [Formula: see text]. Increasing the heat generation/absorption coefficient and thermal radiation parameter is improving the isotherms of a solid phase. Expanding in the porous parameter [Formula: see text] enhances the heat transfer of the fluid/solid phases.

The Success Rate of Ultrasound-Guided Sacroiliac Joint Steroid Injections in Sacroiliitis: Are We Getting Better?

BACKGROUND: The sacroiliac joint is one of the most common sources of low back pain; however, it is difficult to place the needle accurately inside the joint space without image guidance. Improvement of ultrasound technology may lead to a high success rate for intra-articular drug deposition. OBJECTIVE: Assessment of the success rate of ultrasound-guided intra-articular sacroiliac joint injection. DESIGN: Prospective observational study. METHODOLOGY: Ultrasound-guided injections were performed on 34 patients suffering from sacroiliitis. After injection of the drug solution and withdrawal of the needle, an anteroposterior fluoroscopy image was obtained and recorded for the injected joint to detect whether it was predominantly intra-articular or peri-articular. Clinical outcome using a numeric pain rating scale as well as limitation of physical functioning measured by the Oswestry Disability Index (ODI) were determined. RESULTS: Thirty-three injections (84.6%) were intra-articular, while 6 injections (15.4%) were peri-articular, as confirmed by fluoroscopy, with no statistical difference regarding clinical outcome between them. The baseline mean pain score decreased from 7.21 to 1.92 1 month after injection, and the mean ODI scores improved from 61.41% to 17.13%. Intervention was well tolerated, and 91.2% of patients were satisfied or mostly satisfied. CONCLUSION: Ultrasonography provides a high success rate of intra-articular sacroiliac joint injection as confirmed by fluoroscopy. No significant difference in clinical outcome between intra-articular and peri-articular injection was found.

Perioperative Calcium, Magnesium, and Phosphorus Levels in Live Donors For Liver Transplant.

OBJECTIVES: The increased number of liver transplants in Egypt has increased the focus on perioperative complications in live donors. An important but not yet well-investigated complication is electrolyte disturbances, which are common in such patients, need intervention, and affect the outcome. We retrospectively analyzed data of perioperative calcium, magnesium, and phosphorus levels in live liver donors at our center. MATERIALS AND METHODS: We collected perioperative laboratory results from 44 living donors for liver transplant who were at our center from February 2009 to August 2013. We analyzed results of perioperative calcium, magnesium, and phosphorus levels before transplant, on the day of transplant (defined as day 0), and at 1 and 2 days after the surgical procedure. RESULTS: Mean serum calcium level was 2.31 mmol/L before transplant, 1.97 mmol/L on day 0, and 1.99 mmol/L on day 1, and 2.05 mmol/L on day 2 after transplant. Serum calcium level was significantly reduced at day 0 and on postoperative days 1 and 2 (P < .0001). Mean magnesium level was 0.8 mmol/L before transplant, 0.58 mmol/L on day 0, and 0.83 mmol/L on day 1, and 0.79 mmol/L on day 2 after the surgical procedure. The day 0 level was significantly reduced versus before transplant (P < .0001). Mean phosphorus level was 1.23 mmol/L before transplant, 1.11 mmol/L on day 0, and 0.97 mmol/L on day 1, and 0.76 mmol/L on day 2 after transplant, with significant declines on day 0 and on postoperative days 1 and 2 (P < .0001). CONCLUSIONS: Living liver donors showed significantly decreased levels of calcium and phosphorus on day 0 and on postoperative days 1 and 2, whereas magnesium level was significantly decreased on day 0 only.

Nonopioid versus opioid based general anesthesia technique for bariatric surgery: A randomized double-blind study.

OBJECTIVE: The objective of this study was to evaluate the efficacy and safety of giving general anesthesia without the use of any opioids either systemic or intraperitoneal in bariatric surgery. METHODS: Prospective randomized controlled trial. Obese patients (body mass index >50 Kg/m(2)) undergoing laparoscopic sleeve gastrectomies were recruited and provided an informed signed consent. Patients were randomized using a computer generated randomization table to receive either opioid or non-opioid based anesthesia. The patient and the investigator scoring patient outcome after surgery were blinded to the anesthetic protocol. Primary outcomes were hemodynamics in the form of "heart rate, systolic, diastolic, and mean arterial blood pressure" on induction and ½ hourly thereafter. Pain monitoring through visual analog scale (VAS) 30 min after recovery, hourly for 2 h and every 4 h for 24 h was also recorded. Pain monitoring through VAS and post-operative nausea and vomiting 30 min after recovery were also recorded and finally patient satisfaction and acute pain nurse satisfaction. RESULTS: There was no difference in background characteristics in both groups. There were no statistically significant differences in different outcomes as heart rate, mean blood pressure, O2 saturation in different timings between groups at any of the determined eight time points but pain score and nurse satisfaction showed a trend to better performance with non-opioid treatment. CONCLUSION: Nonopioid based general anesthesia for Bariatric surgery is as effective as opioid one. There is no need to use opioids for such surgery especially that there was a trend to less pain in non-opioid anesthesia.

A novel intubation technique in bilateral cleft palate pediatric patients: hard gum shield-aided intubation.

BACKGROUND: Cleft palate anesthesia is challenging due to difficult airway. Left paraglossal intubation moves resting point of laryngoscope laterally but associated with narrower laryngoscopic view and possible trauma, and we invented the use of hard gum shield as a bridge over defective palate to facilitate intubation with possible wider window and defective tissue protection. METHODS: Eighty bilateral cleft palate children, ASA physical status I-II aged 9 months to 6 years scheduled for plastic surgery had general anesthesia, were involved in prospective, controlled, randomized study, and were randomly divided by closed envelope method into two groups: group I (40 patients): intubated by hard gum shield-aided intubation and group II (40 patients): intubated by left paraglossal intubation. Both techniques compared as regards (i) intubation time; (ii) Cormack and Lehane score; (iii) need for external laryngeal manipulation; (iv) easiness of intubation: easy, modest, or difficult intubation; and (v) complications: desaturation and failed intubation. RESULTS: Intubation time was shorter in group I (28.47 ± 3.78 vs. 37.63 ± 6.64 s, P = 0.001). Cormack and Lehane score was better in group I (P = 0.003). Need for external laryngeal manipulation was less in group I (P = 0.015). Easiness of intubation was better in group I (P = 0.022). No difference was found in complications between groups. CONCLUSION: Hard gum shield-aided intubation facilitated intubation more than left paraglossal in bilateral cleft palate children with shorter intubation time, better glottic view, easier intubation, less need for laryngeal manipulation than left paraglossal intubation with no difference in complications.