Immediate results of surgical treatment of high and intermediate risk pulmonary embolism in elderly and senile patients

The aim of the study: is to analyze the immediate results of surgical treatment of high-and intermediate-risk PE in a group of elderly and senile patients. Material and methods. The study included 43 patients operated on for high-and intermediate-risk pulmonary embolism between 2008 and 2019. In the general group of patients, the number of women prevailed and amounted to 67.4%. The average age was 65.4 ± 4.23 years old. The Miller index in the general group was 29.1 ± 1.42. The Geneva Index was 8.4 ± 1.12. The average pressure in the pulmonary artery at the time of operation was 54 ± 1.4 mm Hg, and the peak pressure was 68 ± 3.43 mm Hg. Results. 5 patients died at the hospital stage. Thus, the hospital survival rate of patients was 88.4%. Among nonlethal complications, cardiovascular and respiratory failure prevailed. According to the statement, the calculated pressure gradient in the pulmonary artery was 29.0 ± 3.1 mm Hg. Conclusion. Surgical treatment is a highly eff ective and reliable method of treatment in the group of older patients.

Process intensification in Desalination operation in mesoscale systems

Development of desalination technologies has been identified as vital to fulfilling future water demand. Directional solvent extraction is one of the promising membrane-less seawater desalination method. Membrane based desalination technologies incur a higher cost and are subjected to fouling after certain period of time of operation and needs regular maintenance and monitoring. It is believed that, overcoming these drawbacks is possible by working in the millimeter scale through the incorporation of pulsatile flow and air damper. This work presents a theoretical approach designed for a certain nominal length of an air damper, placed on the top of the extraction column, with the flow in the desalination unit being semi pulsatile combined with secondary pulsation generated due to air suspension during solvent extraction applied for desalination operation. Henceforth a theoretical approach based on the above stated parameters, it is found theoretically that with increase in flow pulsation amplitude and frequency the extracted salt concentration in solvent increases. The application of infra red radiation in preheating section with the help of a infrared heating device is the crucial part of DSE process, cooling is planned to achieve via a heat exchanger or atmospheric cooling. The total exergy and energy calculations will be conducted to see the energy requirement for the process. It is planned to calculate the salt separation efficiency of sea water (on the basis of WHO guidelines) to fresh water, alongwith flow rate and processing time.

Assessment of the influence of the Viriva granite quarry on the condition of the surface and ground waters within the Vyry village

Analyzed the results of their own research to assess the impact of the Vyrovsky granite quarry on the state of surface and ground waters within the village of Vyry, Sarny district, Rivne region of Ukraine. Research methods: hydrogeological, sanitary-chemical, analytical. It has been established that the technological process of extracting granite and producing construction crushed stone does not involve the use of a large amount of water. Pit water is used as process water without additional intake of surface or groundwater. The main problems during the exploitation of the car, which are found on the enterprises, are connected with water. The stench is overwhelmed by the surging of ground and surface waters and the need for input for the safety of normal minds of their exploitation. Significant watering of the area's surface is due to the abundance of atmospheric precipitation, relatively flat relief, the presence of a small thickness of sedimentary rocks covering the crystalline massifs. So, the chemical and biological pollution of the river. The extraction by quarry waters does not occur, since the results of laboratory studies of the quarry water did not show its contamination. In general, the Vyrovsky granite quarry does not affect the volume of the river flow. Alignment, for a long time of operation of the Vyrovsky granite quarry, the groundwater levels of the aquifer have already been established and currently remain relatively stable. Further development of the open pit area will not affect the lowering of the groundwater level within the village. Vyry. Decrease in water levels in wells and wells within the village. Vyry in recent years (2015-2020) is associated with climatic changes, which led to a decrease in precipitation, an increase in temperature and evaporation and, as a consequence, a very low water content in rivers practically throughout Ukraine.

Influence of Contamination of Gear Oils in Relation to Time of Operation on Their Lubricity

The quality and reliability of consumables, including gear oils, results in the failure-free operation of the transmission components in heavy trucks. It is known that oil viscosity is essential for all lubricated tribopairs for wear and friction reduction in all vehicles with a gearbox. Viscosity may be influenced by the contamination that wear products can impart on the oil. Oil contamination can also affect lubrication efficiency in the boundary friction conditions in gearboxes where slips occur (including bevel and hypoid gearboxes). The present research focused on this issue. An obvious hypothesis was adopted, where it was theorized that exploiting the contaminants that are present in gear oil may affect how the lubricating properties of gear oils deteriorate. Laboratory tests were performed on contaminants that are commonly found in gear oil using the Parker Laser CM20. The study was designed to identify a number of different solid particles that are present in oil. At the second stage, friction tests were conducted for a friction couple “ball-on-disc” in an oil bath at 90 °C on a CSM microtribometer. The quantitative contamination of the gear oils that contained solid particles and the curves representing the friction coefficients of fresh oils with a history of exploitation were compared. The test results were statistically analysed. Exploitation was shown to have a significant impact on the contamination of gear oils. It was revealed that the contamination and the mileage had no effect on the tested oils.

P-OGC90 Hiatus Hernia post oesophagectomy for oesophageal cancer: incidence & outcomes

Background The development of a hiatus hernia following oesophagectomy is a well-documented occurrence. The aim of this study is to examine the incidence of hiatus hernia formation, the symptoms patient present with and differences between open and laparoscopic/minimally invasive surgery. Methods A dataset containing data on all patients from an upper GI regional tertiary referral centre were analysed. All subsequent patients who underwent oesophagectomy between Nov 2014 and Nov 2020 were included. Results A total of 268 patients underwent oesophagectomy over this time, of whom 81.0% (n = 217/268) were male and the median age was 68 years old (62-73 years). The median BMI at the time of operation was 27.6Kg/m2 (IQR 24.6-30.7Kg/m2). Over a median follow up of 12 months (IQR 5-21), 4.5% (n = 12/268) developed a hiatus hernia. Amongst these 12, the most common organ in the hernia was the transverse colon (66.7%, n = 8/12) and the small bowel (n = 3). The most reported symptoms in those with a hiatus hernia were respiratory symptoms (cough/breathlessness: n = 5), reflux (n = 3), vomiting (n = 3) and chest pain (n = 3). There was no correlation between BMI and the occurrence of a hiatus hernia (p = 0.145) nor were there differences across males and females in terms of hiatus hernia rates (p = 0.845). In patients who had prophylactic repair of the diaphragm (n = 126/268, 47.0%) the rate of hernia repair was no different (4.8%) compared with those who did not have a prophylactic diaphragmatic repair with sutures (4.2%, p = 0.832). There was however a correlation between the volume of intraoperative blood loss and the occurrence of a hiatus hernia, with increasing blood loss correlating with a higher likelihood of hernia occurrence (r = 0.295, p = 0.037). Conclusions Hiatus hernia is a relatively common occurrence after oesophageal cancer surgery, with most patients suffering from chest symptoms, pain, and reflux. Intra-operative blood loss may influence the chances of developing a hiatus hernia. Prophylactic measures such as reinforcing the diaphragm or hiatus with sutures, do not appear to affect hernia rates.

The effect of acetate Ringer’s solution versus lactate Ringer’s solution on acid base physiology in infants with biliary atresia

Background The choice of the perioperative crystalloid is a key component of the fluid management and must take into account the liver function and the appearing metabolic disorders to avoid increase the liver extra metabolism. The aim of this study is to analyze the effect of acetate Ringer’s solution or lactate Ringer’s solution in biliary atresia patients. Methods We included 68 infant patients aged between 21 ~ 65 d, ASA physical status II or III, who underwent elective Kasai hepatoportoenterostomy, received either AR and LR for intravenous fluid resuscitation according to their group allocation. Lactate concentration, serum electrolytes and pH were noteded before skin incision (T1), end of surgery (T2) and postoperative 12 h. We also recorded the time of operation, stay of hospital, loss of blood and urinary, total volume of infusion of crystalloid. Results Lactate level was significantly higher in Group LR than in Group AR patients at T2 (0.76 ± 0.13 versus 0.57 ± 0.22, P = 0.03). Compared with T3, sodium and chlorine were significantly higher in two groups at T2 (145.2 ± 3.1 versus 143.4 ± 3.4 and 104.6 ± 3.7 versus 105.2 ± 2.1). No significant differences were noted in potassium, HCO3− and calcium. There was no statistically significant difference in pH. No glycopenia was recorded in two groups. No significant difference was noted in administration of vasoactive drug (0.7% versus 1%). Conclusions Resuscitation with AR and LR was associated with similar clinical improvement in infants with biliary atresia. Use of AR reduced the level of lactate comparison with LR.

Functional outcome of judet’s quadriceptoplasty in posttraumatic stiff knees.

Objective: To evaluate functional outcomes of Judet’s Quadriceptoplasty in posttraumatic stiff knees according to Judet’s criteria and Hospital for special surgery score of knee. Study Design: Retrospective Cohort Study. Setting: Ghurki Trust Teaching Hospital, Lahore, Pakistan. Period: January 2015 to June 2017. Material & Methods: 74 patients 61 males and 13 femal with stiff knees underwent Judet’s Quadriceptoplasty and followed by 12 weeks of aggressive rehabilitation and followed by aggressive rehabilitation for 12 weeks. Range of motion was measured with goniometer at last follow up. Outcomes were measured in terms of Judet’s criteria and Hospital for special surgery score of the knee. Results: Mean age at time of operation was 33.70±10.66 years. According to Judet’s criteria 68.9% (51) patients have excellent range of motion, 21.6% (16) have Good, 6.8% (5) patients have fair, 2.7% (2) have poor outcome. According to Hospital for special surgery score of the knee (HSS) mean score was 86.68±5.92 (60-96). There were 83.8% (62), 13.5% (10) and 2.7% (2) cases in excellent, good and fair group respectively. Blood loss was minimum 250ml max 650ml mean 443ml. Conclusion: Judet’s quadriceptoplasty for knee extension contracture is a useful procedure to increase the range of motion of stiff knees.

The In-hospital Outcome of Ventricular Septal Defect Closure and Predictor of Morbidity and Mortality at Tertiary Level Cardiac Center

Background and Aims: Factors responsible for complications and outcomes of surgical closure of ventricular septal defect differ between different cardiac centers globally. In this study, we tried to evaluate outcomes and predictors of morbidity and mortality of surgical closure of VSD in a single center. Methods: The retrospective cohort study was conducted in Shahid Gangalal National Heart Centre from 14th April 2018 to 13th April 2020. It included consecutive series of patients undergoing ventricular septal defect closure as a primary surgery Results: Out of a total 166 patients, males were 100 (60%). Adverse complications occurred on 36 (21%) with mortality of 6 (3.6%). The age ranged from 4 months to 35 years. The weight <10 kgs at the time of operation had significant post-operative prolong ventilation duration (more than 6 hours) with a p value of 0.012; significant prolong ICU stays (>2 days) with a p value of <0.001; significant prolong hospital stay (> 7 days) with a p value of <0.001. The longer CPB time was associated with significantly prolonged ventilation duration (p value 0.001); significant longer ICU stay (p value 0.02). The age <1 year at the time of operation had significant prolonged ICU stay; significantly prolonged hospital stays (p value of 0.033). Severe pulmonary artery hypertension (PAH) and weight up to 10 kgs at the time of operation demonstrated a trend towards association with mortality. Conclusion: Surgical VSD closure can be done with acceptable level of mortality and morbidity in our context.

The Inclusion of Women and Young People in Brazilian Solidary Cooperatives: a Proposal for an Inde

This article presents the elaboration and the results of the “Inclusive Development Index for Solidary Cooperatives” (IDICS in Portuguese). The Index measures the inclusion of young people and women in 30 cooperatives of family farming in Minas Gerais, Brazil. Its elaboration took place through a participatory process with the cooperatives’ members and managers. IDICS consists of 2 sub-indexes of 18 variables each: The Women's Inclusion Index (IIM) and the Youth Inclusion Index (IIJ). The collection of data was done through structured questionnaires, applied remotely to the cooperatives. The results suggest a strong heterogeneity among the cooperatives, and the results are related to the size, time of operation of the cooperative and the region of location. Most cooperatives lack progress with regard to their inclusion processes. Therefore, the Index can be a useful tool for planning and identifying good practices.

Effectiveness and success rates of endoscopic third ventriculostomy in patients under 2 years old

Objective: Endoscopic third ventriculostomy (ETV) stands out as an important option in the treatment of hydrocephalus without shunts. Endoscopic third ventriculostomy (ETV) has become more popular due to recent technical developments in endoscopic systems. But the urge of the physician, to provide a shuntfree survival for his patients, leads to performing the procedure in a unsuitable group of patients. Compared with shunt surgery, ETV presents a more physiological solution for the treatment of hydrocephalus. ETV is accepted as the first-line treatment method in many centers in appropriate cases in the treatment of obstructive hydrocephalus. The aim of this study is to examine the results of patients under the age of two underwent endoscopic third ventriculostomy. Methods: 79 patients who underwent ETV between 2011 and 2020 in our clinic and who were under 2 years of age at the time of operation were retrospectively analyzed. Results: 45 of 79 patients were male babies and 34 were female babies. The average age of the patients is 7 months (1 day - 22 months). In 39 (49.3%) patients, there was no need for repeat surgery in their follow-up after ETV. ETV procedure was repeated in 5 (6.3%) patients, and ventriluloperitoneal shunt (VPS) surgery was performed in 2 (2.5%) patients. In 13 patients, ventriculoperitoneal shunt was applied from the anterior and presented with shunt dysfunction. VPS surgery was not performed again after ETV in 3 (23%) of 13 patients after ETV. Conclusions: ETV can also be applied to patients younger than two years of age, and this treatment can give patients the chance to live a life independent of shunt.