A probabilistic early fault detection model for a feedback machining system with multiple types of spares.

This paper studies corrective and preventive maintenance to provide a quality control policy. The corrective maintenance, depending on the time, of a feedback machining system model with a finite source and standbys is presented. Moreover, the system has a known number of servers to repair the damaged units, and it contains an inspector to ensure the maintenance quality of the repaired units. The exact value of the probability of n units in the system will be obtained by using an efficient algorithm that depends on the Laplace transformation. To promote the concept of preventive maintenance, we use this probability to get the probability of early fault detection as a function of time and in the steady state. The applicability of this model is discussed for different system capacities.

Postbariatric Abdominal Contouring: Technical Approach and Quality of Life.

BACKGROUND: Abdominal contouring is a common procedure after bariatric surgery, but few studies on its outcomes have been conducted. The authors measured surgical and functional outcomes after postbariatric abdominal contouring and their effects on quality of life. METHODS: Thirty patients, male and female, of different age groups, underwent postbariatric abdominal contouring using traditional abdominoplasty, fleur-de-lis abdominoplasty, or belt lipectomy. The technical approach was decided according to each patient's presentation regarding the amount and extent of skin redundancy. All patients were given a booklet containing simplified questionnaires to assess quality of life and appearance to fill out both before and 6 months after the procedure. Data were collected face-to-face at the outpatient clinic during follow-up, by e-mail, or by messaging. RESULTS: The authors performed traditional abdominoplasty (seven cases), fleur-de-lis abdominoplasty (eight cases), or belt lipectomy (15 cases). Surgical outcomes (operative time, resection weight, blood transfusion, postoperative hemoglobin level, postoperative albumin level, hospital stay, drain period, and complications) were influenced significantly by the procedure type ( p ≤ 0.01). Health-related quality-of-life and appearance scale scores changed significantly from the precontouring stage to the postcontouring stage. This significant change in functional outcome was not correlated to the technical approach. CONCLUSION: Abdominal contouring surgery improves quality of life after bariatric surgery irrespective of the procedure type. . CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Outcome comparison between thoracodorsal artery perforator flap and muscle-sparing latissimus dorsi flap in axillary reconstruction after hidradenitis suppurativa excision.

BACKGROUND: Thoracodorsal artery perforator (TDAP) flap and muscle-sparing latissimus dorsi (MSLD) flap have been frequently used for axillary coverage after hidradenitis suppurativa (HS) excision. However, none showed superiority to others. This study compared both flaps to define the ideal option, highlighting flap outcomes and functional and aesthetic results. METHODS: A retrospective study was conducted to compare both flaps that were used for axillary reconstruction in nine patients with bilateral HS Hurley stage III between 2017 and 2020. Eight TDAP and 10 MSLD flaps underwent functional evaluation using shoulder abduction angle (SA); the Disabilities of the Arm, Shoulder, and Hand (DASH) score; visual analog scale (VAS) for pain; and the Dermatology Life Quality Index (DLQI) questionnaires. Aesthetic assessment included the Scar Cosmesis Assessment and Rating (SCAR) scale and arm-chest interval. RESULTS: The mean operating time was 194.4 ± 51.58 and 128.5 ± 31.45 min for TDAP and MSLD (p = .009), respectively. Flap complications were significantly higher in the TDAP group (p = .034). There was no significant difference between both groups regarding SA; DASH, DLQI, VAS, and SCAR scale (p > .05). The mean arm-chest interval was significantly longer in the MSLD than in the TDAP group by 6.9 mm (p = .001). CONCLUSIONS: TDAP and MSLD are comparable versatile flaps to eradicate axillary HS with higher TDAP flap complications. Although the TDAP flap is less bulky than the MSLD flap, the MSLD flap shortens the harvesting time without a significant difference in functional outcomes and scar results.

Developing a detection model for a COVID-19 infected person based on a probabilistic dynamical system.

This paper presents a novel model to detect the COVID-19 infected person from a Markovian feedback persons in a limited department capacity. The persons arrive one by one to the department and the balking and the retention of reneged person approaches are considered. There exists one server presents the service to these persons according to first-come, first-served (FCFS) discipline. An efficient and novel algorithm is presented to get the exact value of the probability of n persons in the department at any time interval. This algorithm depends on the Laplace transform to solve a probabilistic dynamical system of differential equations. By considering the exponential detection function and if the probability of the infected person in the department is equal to the probability of each one, then this algorithm is useful to obtain the detection probability of the infected one. Under steady state, the detection probability of the infected person is described. The usefulness of this model is illustrated for different capacities by using a numerical example to describe the behavior of probabilities of the persons in the department, the detection probabilities of the infected person as functions in time, and the mean time to detection.

Detection of an appropriate pharmaceutical company to get a suitable vaccine against COVID-19 with minimum cost under the quality control process.

Some international pharmaceutical companies have succeeded in producing vaccines against COVID-19. Countries all over the world have aimed to obtain these vaccines with minimum cost. We consider a set of K-independent Markovian waiting lists. Each list contains a set of countries, where each one of them has an exponential service time and a Poisson arrival process. These companies differ in some characteristics such as the vaccine production cost and the speed of the required quantity delivery. We present a new detection model that helps in providing an appropriate decision to choose a suitable company. Moreover, the concept of balking and the retention of reneged countries is taken into consideration under the quality control process of each waiting list. Under steady state, we face an interesting and difficult discrete stochastic optimization problem. Its solution gives an optimal distribution of the searching effort, which is bounded by a known probability distribution. A simulation study has been derived to get the minimum value of the paid cost random values. The highest service rate, the total expected profit of each queuing system, and the optimum performance measures, which depend on this cost, have been obtained to show the effectiveness of this model.

Assessment of lacrimal glands in thyroid eye disease with diffusion-weighted magnetic resonance imaging.

PURPOSE: To assess the lacrimal glands in patients with thyroid eye disease with diffusion-weighted magnetic resonance (MR) imaging. MATERIAL AND METHODS: This study was carried out on 44 consecutive patients (17 males, 27 females, with mean age 36 years) with thyroid eye disease and 20 age- and sex-matched volunteers. They underwent diffusion-weighted MR imaging of the orbit. The apparent diffusion coefficient (ADC) values of the lacrimal glands were calculated and correlated with the clinical activity score (CAS). RESULTS: The mean ADC of lacrimal glands in thyroid eye disease (1.73 × 10-3 mm2/s) was significantly higher (p = 0.001) than that of volunteers (1.52 × 10-3 mm2/s). The cutoff ADC value of lacrimal gland used for differentiation of thyroid eye disease from volunteers was 1.62 × 10-3 mm2/s with an area under the curve value of 0.95 and an accuracy of 96%. There was significant difference (p = 0.03) in the ADC of the lacrimal glands in patients with active (n = 24) and inactive (n = 20) disease. The cutoff ADC value of the lacrimal gland used to suspect active disease was 1.76 × 10-3 mm2/s with an area under the curve value of 0.80 and an accuracy of 82%. There was positive correlation between the ADC value of the lacrimal glands and CAS (r = 0.73, p = 0.001). CONCLUSIONS: The ADC of the lacrimal glands is a non-invasive imaging parameter that can be used for diagnosis of thyroid eye disease and to predict the active form of the disease.

Psychiatric Disorders and Quality of Life in Egyptian Patients with Chronic Immune Thrombocytopenic Purpura: A Single Center Study.

The impact of chronic immune thrombocytopenic purpura (ITP) on the psychological health and quality of life is evident among children and adolescents. We aimed to describe psychological disorders and assess quality of life in children with chronic ITP and compared their results with their healthy peers. A cross-sectional comparative study was carried out in a tertiary care university-affiliated hospital during a period from November, 2015 till April, 2018. We enrolled 119 children with chronic ITP and compared with 220 healthy peers. Relevant demographic and clinical data were collected and statistically analyzed. Quality of life for both patients and control groups was measured using pediatric quality of life inventory version 4 (Arabic one). Also psychiatric evaluation of both groups was done using Arabic version of Mini-International Neuropsychiatric Interview for Children (Mini-KID). Majority of patients (90.7%) exhibited mucocutaneous bleeding. Most of patients (61.3%) did not need any definitive treatment for chronic ITP while 38.6% received second line therapy. About one-third of the patients needed rescue medications to control active bleeding. The scores of all sub-scales of Peds QL 4.0 were significantly decreased among patients group when compared to their healthy peers (P < 0.001). General anxiety disorder and oppositional defiant disorders were the commonest psychiatric disorders among children with chronic ITP. Quality of life in children with chronic ITP is markedly impaired with occurrence of a variable spectrum of psychiatric disorders among the studied patients.

Performance of apparent diffusion coefficient of medial and lateral rectus muscles in Graves' orbitopathy.

Objective The purpose of this study was to determine the performance of the apparent diffusion coefficient in the detection of involvement of the medial and lateral rectus muscles in patients with Graves' orbitopathy. Methods and materials This prospective study was conducted on 33 consecutive patients (16 males, 17 females with a mean age of 36 years) with Graves' orbitopathy and 18 age- and sex-matched volunteers. The patients and volunteers underwent diffusion-weighted magnetic resonance imaging of the orbit in the axial plane using echo-planar imaging. The apparent diffusion coefficient of the medial and lateral rectus muscles was calculated. Results The medial rectus muscle was more affected than the lateral rectus muscle. The mean apparent diffusion coefficient value of the medial and lateral rectus muscles was 1.81 ± 0.19 and 1.72 ± 0.07 × 10-3 mm2/s in patients with Graves' orbitopathy and 1.59 ± 0.06 and 1.51 ± 0.06 × 10-3 mm2/s in volunteers, respectively. There was a significant difference in apparent diffusion coefficient values of the medial and lateral rectus muscles between patients with Graves' orbitopathy and volunteers ( p = 0.001). The classification performance as measured with area under the receiver operator characteristic curve was 0.89 (95% confidence interval: 0.732-0.904). The best performing threshold of the apparent diffusion coefficient value of the medial rectus muscle was 1.69 × 10-3 mm2/s and associated efficiency was 86%, sensitivity was 97%, and specificity was 97%. Conclusion We concluded that the apparent diffusion coefficient of the medial rectus muscle can be used for diagnosis of Graves' orbitopathy.

MTHFR gene polymorphism and age of onset of schizophrenia and bipolar disorder.

OBJECTIVE: Several studies with contradictory results from different cultures about association of methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism in schizophrenia and bipolar disorders. Little is known about this association in Arab culture and Egypt. So the present study aimed to assess the association of MTHFR C677T polymorphism in bipolar disorder (BD) and schizophrenia in comparison to control group. The association between MTHFR C677T polymorphism and the age at onset in schizophrenia or BD was also studied. METHODS: Polymerase chain reaction and restriction fragment length polymorphism (PCR-RFLP) were used to examine the genotype and allele frequencies of MTHFR C677T polymorphism in 149 healthy subjects and 134 bipolar and 103 schizophrenia patients. RESULTS: In BD and schizophrenia, there was a higher prevalence of MTHFR C677T polymorphism than healthy subjects. Earlier age at onset was found in patients with BD, carrying one copy of the T allele or CT genotypes but not in patients with schizophrenia. CONCLUSION: The present findings suggest that the MTHFR C677T polymorphisms are likely to be associated with the risk of developing BD and schizophrenia and influence the age at onset of BD but not the age at onset of schizophrenia.

Disruptive behavior in Down syndrome children: a cross-sectional comparative study.

BACKGROUND AND OBJECTIVES: Down syndrome (DS) is associated with intellectual disability, and patients with DS show significant psychopathology. The objectives of this study were to estimate the prevalence of disruptive behavior in DS patients compared to their siblings, and to find any association between the disruptive behavior and the degree of intelligence. DESIGN AND SETTINGS: This is a cross-sectional comparative study done in Mansoura University Children's Hospital during the period March 1, 2012-February 28, 2013. SUBJECTS AND METHODS: In this study, 100 cases of DS and an equal number of their brothers/sisters were enrolled in the study. The Arabic version of Vineland Adaptive Behavior Scale was used for assessing social and mental intelligence quotient (IQ). The Arabic version of Mini International Neuropsychiatric Interview for Children (MINI-KID) and disruptive behavior disorder (DBD) rating scale were used for assessing disruptive behavior disorders. RESULTS: Both social and mental IQs were significantly higher in non-DS than in DS cases. The prevalence of different variants of attention deficit/hyperactive disorder (ADHD)-impulsive, inattentive, and combined types-was significantly lower in non-DS than in DS cases; however, there was no statistical difference between both groups as regards oppositional defiant disorder and conduct disorder (CD). Also among DS cases, impulsive and combined types varied significantly with the degree of their IQ. CONCLUSION: ADHD was more common among DS patients with a special impact of IQ on the type of psychiatric illness. We recommend psychiatric assessment for DS patients as a part of multidisciplinary management.

WITHDRAWN:C677T Methylenetetrahydrofolate reductase gene polymorphism in schizophrenia and bipolar disorder.

Ahead of Print article withdrawn by publisher.

Predictors of anxiety and depression in Egyptian thalassemic patients: a single center study.

Thalassemic patients are vulnerable to emotional and behavioral problems. Each patient age group exhibits problems unique to that stage of development, and although up to 80 % of thalassemic patients are likely to have psychological disorders, e.g., anxiety and depression, predictors of these disorders remain poorly understood. The present study was designed to assess the prevalence of anxiety and depression in a sample of Egyptian thalassemic patients and to identify predictors of these psychiatric disorders. A case-control study was conducted in 218 thalassemic patients, with 244 healthy subjects as a control. All patients and control subjects were subjected to thorough evaluation of medical history and clinical examination, and examined by a psychiatrist using the clinician version of the structured clinical interview for DSM-IV (SCID-CV), hospital anxiety and depression scale and Coopersmith self-esteem inventory. Abnormal and borderline anxieties were reported by 36.7 and 20.6 % of thalassemic patients, respectively, while abnormal and borderline depressions were reported by 32.1 and 16.1 % of patients, respectively. Hospitalization, low self-esteem, diabetes mellitus and heart failure were independent predictors of anxiety. The independent predictors of depression were heart failure, hospitalization, diabetes mellitus, short stature and delayed puberty. Thalassemic patients were more vulnerable to anxiety and depression, indicating that screening and management for such psychiatric disorders should be considered in treating all such patients.

Predictors of postpartum depression in a sample of Egyptian women.

INTRODUCTION: Postpartum depression (PPD) represents a considerable health problem affecting women and their families. The aims of this study were to: (a) compare female patients with PPD to normal controls with regard to some biopsychosocial variables, (b) correlate between the severity of PPD and some clinical and biological variables, and (c) to predict some risk factors for PPD. METHOD: Sixty female patients with PPD were compared with 60 healthy postpartum females (control group). Patient and controls were subjected to: (1) a complete psychiatric and obstetric examination, (2) psychometric studies using the Edinburgh Postnatal Depression Scale, Fahmy and El-Sherbini's Social Classification Scale for Egyptian socioeconomic classification and Horowitz et al's Impact of Event Scale, (3) quantities of thyroid hormone (T3), cortisol hormone, and estrogen were assessed. RESULTS: There were high statistical differences between PPD females and controls as regard psychosocial stressors, level of (estradiol, thyroxin [T3], and cortisol), marital status, residence, parity, method of delivery, complicated puerperium, positive history of premenstrual tension syndrome and baby variables (eg, unwelcomed, with a negative attitude of parents toward the baby, underweight, female, artificially feeding, unhealthy baby). While there were moderate statistical differences in attitude toward spouse and social support and mild statistical difference in socioeconomic status between them. Severity of depression is positively highly correlated with onset of depression, psychosocial stress, levels of T3 and cortisol. However, severity of depression is negatively high when correlated with socioeconomic status. Stepwise linear regression indicated that PPD was significantly predicted by social support, socioeconomic status, feeding of baby, and prior psychiatric problems. CONCLUSION: Many factors may lead to development of PPD. These factors include some psychosocial, socioeconomic, obstetric, and hormonal variables. Early detection of these factors could help in prediction of the development of PPD.

Psychiatric morbidity among Egyptian breast cancer patients and their partners and its impact on surgical decision-making.

INTRODUCTION: Psychiatric morbidities, especially cases of anxiety and depression, are prevalent among breast cancer patients and their partners. PATIENTS AND METHODS: Fifty-four early diagnosed breast cancer patients and their partners were compared with 50 healthy couples to assess psychiatric morbidity and the impact of various factors upon patients' surgical choice. RESULTS: It was found that 18.5%, 22.2%, and 3.7% of husbands had generalized anxiety disorder, major depressive disorder, and panic disorder, respectively. It was also found that 38.8%, 29.6%, and 9.2% of the patients had major depressive disorder, generalized anxiety disorder, and panic disorder, respectively. Depression and anxiety scores were high in both partners in love-based, well-adjusted marriages, within the middle socioeconomic class, and among educated couples. Among the well-known factors related to surgical treatment choice (age, parity, tumor size, pathology, grade, lymph node status), only age and psychological morbidity (in the patients and their partners) had a significant impact on treatment choice. CONCLUSION: Patients of middle socioeconomic class, the well educated, and those in love-based marriages had a higher likelihood of suffering different types of psychological morbidities and were more likely to choose breast conservation or reconstruction than mastectomy.