Recurrence of Scaphoid Stress Fracture: A Case Report

Background Scaphoid stress fractures are rare and typically present in young, elite male athletes. Due to the infrequency in which these injuries are encountered, the optimum management is not established. Case Description We present the case of a 20-year-old male gymnast with bilateral stress fractures of the scaphoid waist. Following conservative treatment, clinical and radiological signs of union were seen bilaterally. Eight months after return to normal activities, a unilateral recurrence of the stress fracture occurred. This was successfully treated with internal fixation and bone grafting. Literature Review Scaphoid stress fractures are most frequently seen in gymnasts but also occur in participants of other sports involving repetitive loading of an extended wrist. This action conveys force predominantly through the waist of the scaphoid. Most case studies have reported high union rates, whether treated operatively or conservatively, and the patients returned to high-level sport with no further problems. Stress fracture recurrence has been reported in other bones such as the metatarsal and tibia but never before in the scaphoid. Our case is unusual in that the patient suffered ongoing problems due to a recurrence of the scaphoid stress fracture after returning to normal activities. Clinical Relevance Clinicians should be aware that scaphoid stress fracture recurrence can occur, counsel patients accordingly, and remain vigilant after apparent union. We would recommend early fixation to allow a quicker return to function and prevention of recurrence.

Prevalence of Helicobacter Pylori Serologically in Patients Who Presented With Dyspeptic Symptoms to Orotta Medical Surgical National Referral Hospital

Background: Optimum management of dyspepsia in primary care is a debatable subject. Testing and treatment for Helicobacter pylori has become widely accepted as the approach of choice for patients with chronic dyspepsia but no alarming features. We evaluated prevalence of H. pylori among outpatients with dyspepsia and serologic investigations for it in tertiary hospital Orotta Medical Surgical National Referral Hospital (OMSNRH) retrospectively.Methods: A retrospectively collected data of H. pylori status among dyspeptic patients from Out Patient Department (OPD) and laboratory of OMSNRH, who had undergone serologic test for the infection, of the year 2012 was reviewed for the period from February 2013 to May 2013.Results: The prevalence of dyspepsia visited OMSNRH was 6.08%, with female predominance, from a total visit of 30,035. Of all 1844 dyspeptic patients from the OPD, 20.93% were positive, 48.05% were negative and 31.02% were untested for H. pylori. From a total of 4136 of the laboratory results, the prevalence of H. pylori was 31%. In adults (>14 years), it was 34% and pediatric (<15 years), prevalence was 12.5%. Male sex preference was observed among the adults in this study (37.7% vs. 31.7%, P=0.034). Conclusion: The prevalence of dyspepsia was 6.08% and the prevalence of H. pylori serologically in this study was 34% in adults and 12.5% in pediatric age group.

Development Wells Optimum Management Technique Coping with Production Curtailment for Stacked Oilfields Consisting of Multiple Complex Reservoirs

Affected by the Covid-19 pandemic and low oil prices, OPEC members were forced to curtail production. The H oilfield in Iraq commenced production curtailment in early March 2020 and then oil production gradually decreased. By the end of 2020, production was less than one-third of the rate before curtailment. There are multiple sets of oil-bearing formations in the H Oilfield vertically. The developed oil reservoirs have a total of more than three hundreds development wells. The reservoir types are diverse, the relationship among multiphase fluids is complex, and the development methods are different. The reduction of the daily production will inevitably require a comprehensive strategy adjustment to cope with the new situation. Any intentional or unintentional shut-in has a price. Therefore, the key is how to reasonably control the production in many oil reservoirs and re-adjust the oil reservoir development plan at the minimum cost while meeting the overall changing production restriction target for each oil reservoir. In this study, the author established a simple and fast process for judging open and closed wells through years of experience in reservoir dynamic analysis and field management. Step 1: Wells are classified according to production characteristics. For pre-selected wells, some wells with unique functions that need to be opened and those that need to be closed for objective reasons should be excluded. Step 2: Conduct single well cost analysis with reference to production status. Respectively evaluate the performance of the production well under the state of opening and closing. Step 3: Establish the model with economic indicators as the objective function. According to different goals, the model established is slightly different. Step 4: Optimize the best solution based on actual needs. Solve the optimal solution under the target and optimize the number of reasonably configured wells in each reservoir. Through this process, combined with historical and current actual production conditions, different types of oil wells in all reservoirs are classified. Their priorities of reopening are evaluated to meet the needs of other production restriction targets and ensure the smooth transition of oilfield development.

Optimizing the Financial Management of Electronic Companies using Goal Programming Model

The swift development and transformation of emerging technologies such as augmented reality, robotics, biometrics and 3D printing place varying degree of pressure to the electronic industry to play a trailblazing role in making the world a smarter place of living. The concept of smart city increases the demand for the upgrades and sophistication of electronic components. Shorter product life cycles of personal and commercial electronic products also keep the electronic companies in a never-ending loop for huge investments in materials, equipment and expertise. Electronic companies in Malaysia are still facing financial stress in their operations. Therefore, this paper aims to optimize the financial management of listed electronic companies, namely D&O, GTRONIC, UNISEM and VITROX with asset, liability, equity, earning, profit and optimum management item as the objectives using goal programming model. The benchmarks of all the goals are obtained by comparing the maximum and minimum values of the optimal values of these companies. The results of this study show that the goal programming model is able to generate the optimal solution for each company. Besides liability and earnings, all the goals have been attained by these companies upon analysis using goal programming. Possible refinement values particularly for liabilities for all the companies have been generated from this model to provide insights for these companies to benchmark for risk alleviation and strategic decision making.

Rheumatologic aspects of the COVID-19 pandemic: a practical resource for physicians in Kuwait and the Gulf region based on recommendations by the Kuwait Association of Rheumatology (KAR)

: The Kuwait Association of Rheumatology members met three times in April 2020 to quickly address and support the local practitioners treating rheumatic disease in Kuwait and the Gulf region during the COVID-19 pandemic. As patients with rheumatic and musculoskeletal disease (RMD) may need modifications to their therapy during the COVID-19 pandemic, we voted online for general guidance that local practitioners needed. In this review, we have addressed the vulnerability of rheumatic patients and issues surrounding their optimum management. We base our recommendations on a synthesis of national/international guidelines and expert consensus among KAR members in the context of the Kuwaiti healthcare system caring for the patient population with RMD. The most recent reports from the World Health Organization, the Center for Disease Control, the National Institutes of Health – National Medical Library, and the COVID-19 educational website of the United Kingdom National Health Service have been incorporated. We discuss the management of RMD in various clinical scenarios: screening protocols in an infusion clinic, medication protocols for stable patients and care for suspected or confirmed COVID infection and whether they are stable, in a disease flare or newly diagnosed. Besides, we also outline the conditions for the hospital admission. This guidance is for the specialist and non-specialist readership and should be regarded as interim as the virus is relatively new and we rely on experience and necessity more than evidence collection. The guidance presented should be supplemented with recent scientific evidence wherever applicable.

Optimum Management of Leaf Removal and Lateral Branch Fruit Set in Winter-Planted Cultivation of Paprika

This study was carried out to balance the production and consumption of assimilates according to crop conditions as a basis to reduce the waste of assimilation through leaf and fruit control. There were four treatments: one fruit and two leaves (F1L2); two fruits and two leaves (F2L2); two fruits and three leaves (F2L3); and two fruits and four leaves (F2L4). This study showed that, as the number of leaves increased in Periods 1 and 2, the stem diameter and average weight decreased, with F1L2 having the highest stem diameter and average weight, although its numbers of leaves and fruits were the fewest. In the summer, Period 3, F1L2 production was the lowest due to increased rates of flower drop and fruit drop. In Period 4, when ambient temperature and light levels were decreased, the number of fruits was increased. However, the production was decreased. F1L2 and F2L4 showed significant decreases in production. Although F1L2 showed the highest average weight, it had a low production due to a decrease in the number of fruits. F2L4 showed weak generative growth due to an imbalance in growth over the summer. After reaching the last stage of development, the number of leaves showed the highest average weight and production in F2L4.

543 Improving the Management of Acute Ureteric Colic in A Multi-Centre District General Hospital: A Closed-Loop Audit

Introduction The British Association of Urological Surgeons (BAUS) released guidance in 2018 regarding the optimum management of acute ureteric colic: a condition which can present as a surgical emergency. Our aim was to review the current practice at our hospital in diagnosing and managing acute ureteric colic and ultimately, implement sustainable change to address any areas of limitations. Method The following data was retrospectively collected for of all patients admitted with acute ureteric colic: investigations performed, medications administered, details of surgical intervention and follow-up. 1st Cycle: March 2017 to February 2018. Intervention: Teaching sessions delivered to staff (including doctors and nurses) in the A&E and urology department. 2nd Cycle: January 2019 to December 2019. Results 268 patients presented to A&E with ureteric colic – 18% increase from previous year. On admission: 60.4% of patients had serum calcium checked, 97.7% had a CT KUB performed within 24 hours and 67.2% were given NSAIDs; this is a 20.4%, 0.4% and 5.2% increase from the previous year, respectively. Only 31.3% of patients had an acute surgical intervention. The average wait time for clinic follow-up was reduced to 41 days following departmental education, but only 26.4% of patients were seen within the BAUS advised 4-week timeframe. Conclusions Re-audit showed distinct improvement in the management of acute ureteric colic. Thus, departmental education strategies have had a positive impact. It is recommended that the reservation of one daily elective theatre slot for an emergency operation and a computerised clinic booking system will further optimise our management in line with BAUS guidance.

833 CLINICAL PATHWAY DEVELOPMENT AND IMPLEMENTATION FOR THE MANAGEMENT OF CHYLE LEAK FOLLOWING OESOPHAGECTOMY: THE OXFORD EXPERIENCE

Thoracic chyle leakage is a major and frequently encountered complication following oesophagectomy. The incidence of chyle leakage depends on the definition used and been reported to be as high as 20% among patients undergoing oesophagectomy. The sequalae can be severe and include hypovolemia, electrolyte disturbance, malnutrition, immune suppression, and increased mortality, thereby making prompt diagnosis and optimum management essential. Nevertheless, controversy remains surrounding the nature and timing of interventions. Methods Retrospective audit was performed of 227 consecutive patients undergoing oesophagectomy between October 2014 and April 2018 at the Oxford Oesophagogastric Centre. Following pathway implementation, data are being prospectively collected along with surveys of the experience and satisfaction of stakeholders. Results Chyle leak was treated in 29 (12.8%) post-operative patients. Females were over twice as likely to be treated for chyle leak (OR 2.31, P = 0.042), while age and length of operation showed no association. Chyle leak was associated with a failure to complete the ERAS pathway (P = 0.005), an increased length of stay (P = 0.0001) with the median length of stay being 4 days greater among the chyle leak group, and increased rates of readmission (P = 0.032). Conclusion Our data highlight the significant morbidity associated with thoracic chyle leakage. Upon review of best available evidence, a clinical pathway was developed for the early diagnosis and standardised management of chyle leak (Figure 1). The goal of the pathway is that patients achieve predetermined outcome within a specified time frame. Here we present our development and experience of the Oxford Oesophagogastric Chyle Leak Pathway and describe the particular challenges and interim outcomes of its implementation.

Understanding Oilfield Scale Deposition and Inhibition Mechanisms for Optimum Management: A Review

Oilfield scales are crystalline minerals made up of Na, K, Mg, Ca, Ba, Sr, Fe, Cl from produced water that can precipitate out in the reservoir, well, pipelines and process during the production and transportation of oil and gas. These precipitates can deposit as a result of thermodynamic and/or chemical changes and pose costly flow assurance issues to the oil industry. Several factors have been identified to be responsible including temperature, pressure, ionic strength, pH, evaporation, bicarbonate anion, super-saturation and contact time and water chemistry. Attempts to solve this problem in the past have focused mainly on the use of chemical inhibitors and the most accepted mechanism of scale inhibition is squeeze injection method. While adsorption and retention of scale inhibitors on rock formations needs more research, there had been improvement to better ways of ensuring adsorption and precipitation through nanotechnology including the use of nano-carbon enhanced squeeze treatment (NCEST). The uses of these conventional inhibitors have been found to be toxic to the flora and fauna in biotic communities during water disposal. In order to reduce the environmental burden caused by these conventional solutions and still manage the problem effectively, greener solutions have been proposed. This review x-rays the mechanisms of scale precipitation and deposition, evaluate the solutions that have been provided in literature based on efficiency, economics and environmental impact and propose guidelines to field operators in selecting optimum solutions.