Efficient graphene-based circularly polarized MIMO antenna for THz applications.

In this paper, a graphene-based (MIMO) antenna is designed and examined. Two unique properties of the proposed terahertz (THz) MIMO antenna are (1) circular polarization is achieved through an asymmetrical cross slot, etched over the graphene patch; and (2) a bidirectional radiation pattern is achieved through oppositely oriented identical antenna ports. Mutual coupling between the antenna ports is less than -35dB. Due to the inclusion of the pattern diversity concept, a low value of envelope correlation coefficient is achieved. The proposed THz radiator operates over the frequency range of 4.67-4.87 THz, along with a 3 dB axial ratio between 4.76 and 4.81 THz. This type of antenna is widely employable for biomedical applications.

Risk factors for postoperative voiding dysfunction following surgery for pelvic organ prolapse.

OBJECTIVE: Short-term postoperative voiding dysfunction (POVD) is common in women undergoing surgery for pelvic organ prolapse. It results in increased catheter burden for patients and health services, and catheter-associated urinary tract infections (CAUTIs), thereby escalating the overall cost of treatment. Our aim was to determine the risk factors for voiding dysfunction following surgery for POP in our unit. STUDY DESIGN: A retrospective case-control study conducted in a tertiary center in the U.K. The study cohort included all women who underwent surgery for pelvic organ prolapse between March 2017 and March 2019 and had a failed trial without catheter (TWOC). The control group comprised consecutive women on the surgical database who passed TWOC. Relevant data, including demographic details, past medical history, intraoperative and postoperative factors, were collected. We used the Chi-square test to calculate the statistical significance and multiple logistic regression analysis using SPSS software to identify the risk factors. RESULTS: 286 surgeries were performed. After exclusion, 43 patients were included in each group. Baseline demographics were similar in both groups. The incidence of POVD was 15%, and none of our patients had long-term voiding problems. Logistic regression analysis identified five risk factors - advanced pelvic organ prolapse (OR = 2.654, p = 0.029), comorbidities (OR = 4.583, p = 0.019), preoperative anticholinergics and/or antidepressants (OR = 4.440, p = 0.004), sacrospinous hysteropexy/colpopexy (OR = 2.613, p = 0.041) and postoperative opioid use (OR = 3.529, p = 0.004). CONCLUSION: We identified five risk factors to recognize the women who would benefit from advanced counseling and management plan following surgery for pelvic organ prolapse.

Sinapic Acid Alleviates Oxidative Stress and Neuro-Inflammatory Changes in Sporadic Model of Alzheimer's Disease in Rats.

The role of oxidative stress, neuro-inflammation and cholinergic dysfunction is already established in the development of Alzheimer's disease (AD). Sinapic acid (SA), a hydroxylcinnamic acid derivative, has shown neuro-protective effects. The current study evaluates the neuro-protective potential of SA in intracerebroventricular streptozotocin (ICV-STZ) induced cognitive impairment in rats. Male Wistar rats were bilaterally injected with ICV-STZ. SA was administered intragastrically once daily for three weeks. Rats were divided into sham, ICV-STZ, STZ + SA (10 mg/kg), STZ + SA (20 mg/kg) and SA per se (20 mg/kg). Behavioral tests were assessed on day 0 and 21 days after STZ. Later, rats were sacrificed for biochemical parameters, pro-inflammatory cytokines, choline acetyltransferase (ChAT) expression and neuronal loss in the CA1 region of the hippocampus. The results showed that SA 20 mg/kg significantly (p < 0.05) improved cognitive impairment as assessed by Morris water maze and passive avoidance tests. SA 20 mg/kg reinstated the altered levels of GSH, MDA, TNF-α and IL-1ß in the cortex and hippocampus. STZ-induced decreased expression of ChAT and neuronal loss were also significantly (p < 0.05) improved with SA. Our results showed that SA exhibits neuro-protection against ICV-STZ induced oxidative stress, neuro-inflammation, cholinergic dysfunction and neuronal loss, suggesting its potential in improving learning and memory in patients of AD.

Management of urethral caruncle - A systematic review of the current literature.

Urethral caruncle is a benign fleshy outgrowth at the urethral meatus that occurs mainly at posterior lip of urethra and is most commonly seen in postmenopausal women. They are typically asymptomatic and are mostly reported as incidental findings during pelvic examination. When symptomatic, they commonly present with bleeding, haematuria, pain, dysuria or a lump. Despite being a recognised condition in medicine for more than two centuries, urethral caruncle is still a very poorly understood condition and the current literature is largely deficient to guide the general practitioners and gynaecologists in the appropriate management of the condition. The aim of the paper is to systematically review the current literature on the management options available for urethral caruncle and highlight the need for high quality research to develop better management strategies for this condition. We searched the following electronic databases from 1946 until January 2019: MEDLINE, EMBASE, COCHRANE and WEB OF SCIENCE. The search identified a total of 41 articles on the treatment of the condition in pre- and postmenopausal women, out of which only eight studies were relevant for our review. Most of these studies were retrospective case series or small cohort studies, mainly on the surgical treatment of the lesion. We found no systematic studies in the current literature on the conservative management of urethral caruncles. The most common method of surgical treatment encountered in these studies was simple excision. In conclusion, the current literature is largely deficient to guide us in the appropriate management of this common condition and there is need for more robust studies to develop evidence based management of this distressing condition that can guide the general practitioners and gynaecologists.

The impact of pelvic floor multidisciplinary team on patient management: the experience of a tertiary unit.

PURPOSE: Pelvic floor dysfunction is a common and heterogenous condition with numerous clinical manifestations, making the optimal management challenging. The traditional single-specialty approach may fail to address its complex nature. Currently, there are no published data on the impact of joint pelvic floor multidisciplinary team (MDT) meetings on patient management. PATIENTS AND METHODS: This study represents a retrospective analysis of prospectively collected data on female patients discussed at a joint pelvic floor MDT over a 12-month period in a tertiary referral center. RESULTS: One hundred fifty-two cases were included with a median age of 55 years (range 18-83) and a BMI of 32 kg/m2 (range 17-58). Lower urinary tract dysfunction was the predominant symptom in 75% (114/152). The pelvic organ prolapse symptom of a vaginal bulge was present in 11% (17/152). All cases of vaginal prolapse were accompanied by either urinary incontinence, 59% (10/17), or obstructive defecation, 41% (7/17). Fecal incontinence was recorded in 10% (15/152). Mesh-related complications were reported in 3% (4/152). The MDT recommended a change in the initial management plan in 20% (31/152) of cases, of whom 80% (25/31) were patients with complex urinary incontinence. The MDT agreed a change in the primary care team in 16% (25/152) of cases. CONCLUSION: There is an increasing regulatory requirement for patients with pelvic floor dysfunction to be discussed in an MDT setting. Findings demonstrate that joint pelvic floor MDT meetings are feasible and contribute to a change in the management of complex patients.

Role of Acute Illness Observation Scale (AIOS) in managing severe childhood pneumonia.

OBJECTIVE: In the perspective of integrated management of childhood illness (IMCI) strategy and recent evidence favoring use of oral antibiotics in severe pneumonia, a generic illness severity index--Acute Illness Observation Scale (AIOS)--was prospectively validated in children with severe pneumonia in a civil hospital in remote hilly region. METHODS: AIOS was used in quantifying overall severity of illness for eighty-nine consecutive children (age, 2-59 months) hospitalized with community-acquired severe pneumonia. A detailed clinimetric evaluation of scale was carried out and logistic regression analyses predicted the following outcomes: 1) mode of initial antimicrobial therapy (oral vs. parenteral); and 2) need for intravenous fluids at admission. RESULTS: Majority of children (80.9%) with severe pneumonia scored abnormally (AIOS score> 10) at initial evaluation. Children with abnormal AIOS scores (>10) had significantly greater severity of respiratory distress and higher incidence of radiological pneumonia. Outcome measures i.e. time to defervescence and length of hospital stay were also positively and significantly correlated with the scores. The six-item scale had good internal consistency (Cronbach's alpha 0.81); and its factor analysis yielded a single latent factor explaining 54% of variance in illness severity at admission. Furthermore, logistic regression analyses revealed an independent predictive ability of AIOS in aiding clinician to decide the mode of initial antimicrobial therapy (oral or parenteral), as well as need for intravenous fluids. CONCLUSION: Authors study indicates the clinimetric validity of AIOS in managing, Severe childhood pneumonia and suggests its role in further enriching IMCI strategy.

Severe pneumonia in a remote hilly area: integrated management of childhood illness.

OBJECTIVE: This study aims to profile children with severe pneumonia in the perspective of Integrated Management of Childhood Illness (IMCI) strategy in a resource-constrained environment. METHODS: 115 consecutive children, aged 2 months to 10 yr, hospitalized with severe pneumonia were prospectively evaluated between May 1997 and June 1998 at a civil hospital in the northern hilly state of India. RESULTS: All children had tachypnea and lower chest wall indrawing. Grunting was observed in 39.7%, inability to drink in 16.5%, and cyanosis in 1.7% cases. Radiological investigation was carried out only in 90 children that included abnormal chest radiographs (CXRs) in 76.6% cases. Feeding malpractices, vaccination inconsistencies, exposure hazards to smoking, micronutrient as well as macronutrient deficiencies, treatment from unqualified practitioners, inconsequential involvement of health care workers, predominant burden on mothers in the care of sick children, failure to recognize signs and symptoms of pneumonia by parents at home, lack of oxygen facilities, problems of accessibility and less faith on primary health care services were widely prevalent bottlenecks for effective implementation of 3 components of IMCI. CONCLUSION: Our study offers practical insights that can be useful in customizing IMCI to needs of children with pneumonia in a resource-constrained environment.