Prevention of vesicoureteral reflux in neonatal patients with intravesical ureterocele using holmium-laser.

AIM: To evaluate the effectiveness of laser fenestration of intravesical ureterocele in prevention of vesicoureteral reflux. MATERIAL AND METHODS: The result of intravesical ureterocele holmium laser fenestration (LF) was retrospectively analyzed in 29 neonatal patients (mean age 8.1 days, range 3-28) in comparison with 38 neonates (mean age 9.6 days, range 5-28) treated with electrosurgical incision (ES). Patients' records were reviewed for preoperative findings, endoscopic procedure description and postoperative outcomes. RESULTS: Vesicoureteral reflux (VUR) was found in two patients (5.6%) in LF and in 25 patients (65.8%) in ES group after six months (P=0.000). The patients with VUR in LF group had reflux grade III. In ES group six patients (15.8%) had reflux grade III, ten (26.3%) grade IV and nine (23.7%) grade V. DISCUSSION: In our study we found that de novo VUR is several times more common in patients treated with electrosurgical incision. This is the main difference between two described endoscopic procedures. Although this is a relatively new surgical technique, and other authors had similar results, which implies the importance of laser fenestration in the prevention of VUR in neonates with ureterocele. CONCLUSION: The occurrence of VUR is significantly lower in neonatal patients treated with holmium-laser fenestration, compared to standard electrosurgical incision, although both techniques are highly effective in relieving the obstruction. Since the use of this technique reduces the incidence of VUR, the need for subsequent surgery is lower in patients treated with holmium-laser. KEY WORDS: Laser Reflux Prevention, Ureterocele.

Types, sources, socioeconomic impacts, and control strategies of environmental noise: a review.

Noise exposure has reached an alarming degree over the years because of rapid growth in the industry, transportation, and urbanization. Therefore, it is a dire need to provide awareness of the sources and mitigation strategies of noise, and to highlight the health, and socio-economic impacts of noise. A few research studies have documented this emerging issue; however, there is no comprehensive document describing all types of noise, their impacts on living organisms, and control strategies. This review article summarizes the sources of noise; their effects on industrial workers, citizens, and animals; and the value of property in noisy areas. The plethora of literature is showing an increased level of noise in various cities of the world, which have various health consequences such as high blood pressure, insomnia, nausea, heart attack, exhaustion, dizziness, headache, and triggered hearing loss. Apart from humans, noise also affects animal habitat, preying, and reproduction ability; increases heart rate and hearing loss to even death and loss in property value; and impairs the hospital environment. Finally, we have discussed the possible strategies to mitigate the noise problem, policy statements, and regulations to be followed, with future research directions based on the identified research gaps.

Urban noise assessment and its nonauditory health effects on the residents of Chiniot and Jhang, Punjab, Pakistan.

Elevated noise level is an emerging global problem. Therefore, the present work is conducted that can improve, increase, and integrate the already known issue in literature with new information coming from an emerging country such as Pakistan. The objectives of this study were (i) to assess the urban noise levels and traffic density of Chiniot and Jhang and (ii) to determine nonauditory health effects of noise levels on the residents of both cities. Noise levels were examined from 181 locations (103 from Jhang and 78 from Chiniot) and categorized into hospitals, educational, religious and recreational, residential, industrial areas, and traffic intersections. A-weighted noise level measurements were taken using an integrated sound level meter which recorded short-term road traffic noise continuously for 15 min at each location (LAeq15). The urban noise data showed 82% of the sites in Jhang (LAmax = 103 dB) and 95% in Chiniot (LAmax = 120 dB) exceeded the noise limits set by the National Environment Quality Standard of Pakistan (NEQS-Pak) and World Health Organization (WHO). Moreover, higher intensity of noise levels (LAeq15 ≥ 100 dB) was recorded in Chiniot (17 sites) than in Jhang (1 site). Regression analysis showed a relatively strong relationship of traffic density with noise at Chiniot (R2 = 0.48) compared to Jhang (R2 = 0.31). However, spatial variability of noise with traffic density was observed in both cities. Survey study revealed that all the respondents in Jhang and Chiniot suffered from many noise-related health problems such as annoyance (53 and 51%), depression (45 and 47%), dizziness (61 and 65%), headache (67 and 64%), hypertension (71 and 56%), hearing loss (53 and 56%), physiological stress (65 and 65%), sleeplessness (81 and 84%), and tinnitus (70 and 62%) due to noise, respectively. We conclude that noise levels are higher in Chiniot primarily due to high road traffic and secondarily due to high population density. It is recommended that vehicle maintenance and family and urban planning could be effective measures to reduce urban noise levels.

Surface water quality assessment of Skardu springs using Water Quality Index.

Natural springs which originate from hilly areas of Skardu in Pakistan make their route downward and are utilized by the public as they passes from residential areas. Due to weathering processes in mountainous regions, these springs can be the source of various trace elements and pollutants. Keeping in mind the same concept, ten mostly used freshwater springs were selected to evaluate their drinking water quality in the Skardu region. Three samples of water from each spring (start/mouth, 100 m away from the mouth, and 200 m away from mouth) were collected and analyzed for water quality via Water Quality Index (WQI). The main parameters of spring water were recorded in the laboratory as electrical conductivity (EC), total dissolved solids (TDS), residual sodium carbonate (RSC), and sodium adsorption ratio (SAR), and secondary parameters, i.e., Kelley's ratio (KR), permeability index (PI), and WQI, were derived. Besides these parameters, heavy metal pollutants (Cd, Cr, Mn, and Cu) were also determined from the water samples. The results showed that the assessed parameters TDS, SSP, KR, and PI were found within the safer limits of drinking water as prescribed by the Pak-EPA and WHO. However, among trace elements, only Cd (0.03 mg L-1) was found above the permissible limits of 0.01 mg L-1 as given by the GOP-EPA (2008) and WHO (1996) at Shigri Bala spring 200 m away. Similarly, at 2 ft from the mouth of Chumig S1 spring, its concentrations were recorded 0.03 mg L-1, and at Benazir Chowk spring (100 m away), it was found 0.02 mg L-1. In general, the Water WQI demonstrates that springs have good water quality. Our findings are useful for the environmental protection managers and citizens of the Skardu concerned with the water quality of the springs.

Latissimus dorsi free flap phalloplasty: a systematic review.

A phalloplasty is a complex genital reconstruction procedure of creating a neophallus. Several techniques to create a neophallus are described, based on different vascularized flaps, and each of them has its advantages and drawbacks. The aim of this study is to present musculocutaneous latissimus dorsi (MLD) flap as a viable option for total phalloplasty, with an interest in clinical outcomes and complications. A comprehensive literature review of all available reports about MLD flap phalloplasty was made. The following keywords were used on PubMed: latissimus dorsi musculocutaneous/myocutaneous free flap and phalloplasty. Research criteria revealed five articles and the results of 182 patients were analyzed. A total number of the patients, indications, operative technique, follow-up period, postoperative results, and complications were presented. In conclusion, MLD free flap presents a good choice for phalloplasty providing sufficient amount of tissue for safe implantation of penile prosthesis and successful penetrative sexual intercourse. The erogenous sensitivity is preserved with clitoris or glans penis incorporated into the base of the neophallus, and voiding in a standing position is achievable after urethral reconstruction. The main drawback is the lack of tactile sensation of the neophallus and the significant advantage is a well-concealed donor site.

Assessment of safety aspect and probiotic potential of autochthonous Enterococcus faecium strains isolated from spontaneous fermented sausage.

OBJECTIVE: The objectives of this research project were isolation, identification, and evaluation of the safety aspect and probiotics properties of 21 Enterococcus faecium strains isolated from sausages originated from southeastern Serbia. RESULTS: Analyzed E. faecium isolates showed tolerance to simulated gastrointestinal conditions. All the examined isolates grew well on media with 0.1% and 0.2% of phenol. None of the tested isolates were histamine-producers, while the synthesis of tyramine was observed for E. faecium sk8-1 and sk8-17. Full resistance to antibiotics was not observed for any examined isolate of E. faecium (penicillin, amoxicillin, and ofloxacin showed the effect on all tested isolates). An inhibition zone against examined pathogens was exhibited by all strains, with the largest inhibition zone against Pseudomonas spp., Proteus spp. and E. coli (12-30 mm/MIC values ranged from 0.5 to 12 mg mL-1). CONCLUSION: The results indicated that E. faecium isolates from spontaneously fermented sausage showed a potential for further investigation and possible application as probiotics.

Assessment of noise pollution and its effects on human health in industrial hub of Pakistan.

Faisalabad is one of the major industrial cities of Pakistan, which may cause noise pollution to the local residents due to the development of robust industrial and transport systems. This study aimed at (i) mapping the noise pollution levels at various locations of Faisalabad city; (ii) comparing noise pollution levels in the morning, the afternoon, and the evening for each source; and (iii) assessing nonauditory effects of noise on human health. Two industries and 43 famous/busy locations of Faisalabad Sadar were selected to study noise pollution by using the sound level meter for the period of 24 h. A questionnaire-based survey was carried out near the sampling points to get a public perception about the health impacts of noise pollution. The measured equivalent sound pressure levels (SPLeq) were higher than the permissible limits at all the sampling locations during morning, afternoon, and evening hours. The maximum sound pressure level (SPLmax) was 102 dB inside the production unit in the afternoon at Mian Muhammad Siddiq Textile Loom industry. The average SPL was found at State Bank road (102 dB), Children's Hospital (101 dB), Jhang Bazar (100 dB) in the afternoon and at Punjab Medical College in the evening (97 dB). Based on the survey, 94% of respondents reported headache, 76% sleeplessness, 74% hypertension, 74% physiological stress, 64% elevated blood pressure levels, and 60% dizziness due to noise. Noise pollution is higher than the standard limits and causes auditory as well as nonauditory effects on humans. The vehicles and industrial machinery should be maintained, and sound proofing and protection equipment should be provided to the workforce in order to protect them from extreme noise levels.

Ureterocele fenestration with holmium laser in neonates.

AIM: To evaluate the effectiveness of holmium-laser fenestration of intravesical ureteroceles in neonatal period. MATERIAL AND METHOD: We retrospectively analyzed the results of the holmium-laser puncture in ten neonates with intravesical ureterocele, between September 2013 and September 2016. Laser probe was placed through the cystoscope to the lowest and medial portion of the ureterocele, near the bladder floor. Few punctures (4 to 8) were made, until ureterocele has been collapsed. RESULTS: Mean duration of general anesthesia was 16 minutes (range, 10-24) and duration of hospitalization was 1-3 days (mean, 1.3 days). There weren't complications regarding endoscopic treatment. There was the need for retreatment in one (10%) patient. Obstruction was found in one (10%) patient on ultrasound after one month. After three months there was no obstruction on ultrasound in any patient. In patients in whom VCUG was performed, vesicoureteral reflux was not found three months after the surgery. DISCUSSION: The relief of the obstruction, prevention of the vesicoureteral reflux and the urinary tract infection are the reasons for the immediate treatment in the neonatal period. In that way, the preservation of renal function is enabled. The reason for laser fenestration was better endoscopic control of the extensibility of the ablation. The moment of ureterocele collapsing can be visualized directly. CONCLUSIONS: Holmium-laser fenestration is a minimally invasive, highly effective and safe kind of treatment for ureterocele in neonatal period with minimal complication rate. Further clinical studies with a greater number of patients will offer more reliable information regarding this procedure. KEY WORDS: Fenestration, Holmium-laser, Neonates, Ureterocele.

Laser-puncture Versus Electrosurgery-incision of the Ureterocele in Neonatal Patients.

PURPOSE: To compare the holmium-laser puncture and electrosurgery-incision in neonates with intravesical ureterocele. MATERIALS AND METHODS: We retrospectively analyzed the results of laser-puncture of ureterocele (LP group) in 12 patients (mean age 9.8 days, range 4-28) and electrosurgery-incision in 20 patients (ES group) (mean age 10.2 days, range 6-28), treated at our institution. Patients had their records reviewed for preoperative findings, endoscopic procedure description, and postoperative outcomes. RESULTS: There was the need for retreatment in one (8.3%) patient in LP group and in four (20%) patients in ES group (P = .626). Duration of general anesthesia in LP and ES groups was 16 (range, 10-24) minutes and 15 (range, 10-20) minutes, respectively (P = .355). There was no statistically significant difference in terms of hospitalization (LF group one day, ES group 1.35 days) (P = .286). Complications were not found in LP group. There were two (10%) patients with pyelonephritis after the treatment in ES group (P = .516). After one month, obstruction was observed on ultarsound examination in one (8.3%) and two (10%) patients, respectively. After three months, obstructionwas not found in any patient in both groups. After six months, vesicoureteral reflux was found in one (8.3%) patient after laser-puncture of the ureterocele and in 13 (65%) patients after electrosurgery-incision (P = .003). CONCLUSION: Both laser-puncture and electrosurgery-incision endoscopic techniques are highly effective in relieving the obstruction. There is no significant difference regarding hospitalization, need for retreatment and the occurrence of complications. The incidence of de novo vesicoureteral reflux is significantly lower in patients treated with holmium-laser, as well as the need for upper pole partial nephrectomy.

Laser lithotripsy in the treatment of renal stones in children. A single-center experience.

AIM: To evaluate the effectiveness and safety of laser lithotripsy in the treatment of renal stones in children in a single center. MATERIAL AND METHODS: We retrospectively analysed patients (n=36) who were treated with laser nephrolithotripsy (LL group) between 2011 and 2014. We compared those results with results of pneumatic nephrolithotripsy in patients (n=32) who were treated from 2007 to 2011 (PL group). The patients were evaluated in respect of gender, age, stone location, stone size, complications and stone-free rate. RESULTS: The duration of anesthesia, the need for retreatment, the mean hospitalization and the occurrence of minor complications (perirenal haematoma, urinoma, minimal ureteral perforation) were significantly lower in LL group (p < 0.05). We found statistically significant difference in stone-free rate between two groups - stone-free rate was significantly higher in LL group (LL: 94.4% vs. PL: 62.5%) (p < 0.05). DISCUSSION: Analyzing the stone-free rate after lithotripsy and the occurrence of complications, it is shown that the laser lithotripsy is more efficient than pneumatic lithotripsy and that endoscopic procedure proved safer, in terms of complications. Majority of the studies showed different successful rate after laser lithotripsy for stones located in the kidney. In particular cases, there is the need for ureteral orifice dilatation and ureteral stent insertion. CONCLUSIONS: Laser endoscopic lithotripsy is minimally invasive, effective and safe surgical procedure for the treatment of renal stones in children with minimal complication rate. The effectiveness is partially limited to stones in lower pole calices of the kidney. KEY WORDS: Laser lithotripsy, Urolithiasis, Ureterorenoscopy.

Sources of organochlorine pesticides in air in an urban Mediterranean environment: volatilisation from soil.

Organochlorine pesticide (OCP) cycling was studied in the area of Banja Luka, Bosnia and Herzegovina, over 3 days in summer with high temporal (4 h-means) and spatial (3 sites distanced 3-6 km) resolutions. Elevated levels of DDX compounds (i.e. o,p'- and p,p'-isomers of DDT, DDE and DDD, 44-74 pg m(-3) at the urban sites and 27 pg m(-3) as a background level), HCH (α-, ß- and γ-isomers, 52-70 vs. 147 pg m(-3)), HCB (34-48 vs. <0.1 pg m(-3)) and pentachlorobenzene (6.8-9.9 vs. 6.0 pg m(-3)) were found. The variation of OCP levels at the two urban sites was not in phase, except for most DDX compounds. This was related to background levels, which for HCH were higher than in the urban area. Vertical profiles between samples collected from 1.1 and 2.3 m (part of the time 0.6 and 2.3 m) above a soil, which was only moderately contaminated by OCPs (0.12 ng g(-1) HCH, 0.11 ng g(-1) DDX, 0.44 ng g(-1) HCB) were analysed. Volatilisation from the ground caused negative vertical concentration gradients of HCH isomers (day and night), but not for HCB (except for 1 day-time sample) and DDX compounds (except p,p'-DDD, day-time, sporadically). The concentration in air and the vertical concentration gradient of the HCH isomers varied with air temperature (day-time maxima), while the variation of the HCB concentration was inversely related to air temperature and was determined by mixing (night-time maxima). α- and ß-HCH were volatilised from soil throughout the three days, even during periods of cooling. Fugacity calculations, based on the absorption in soil organic matter as the process determining retention in soil, underestimated the volatilisation of ß-HCH and p,p'-DDD. It is concluded that the representativeness of point measurements of OCPs in urban areas is limited by the spatial variability of soil contamination.

Quantification of sources of PCBs to the atmosphere in urban areas: a comparison of cities in North America, Western Europe and former Yugoslavia.

We present estimated emission source strengths of seven polychlorinated biphenyl (PCB) congeners for Banja Luka, a city that was affected by the civil war in Bosnia and Hercegovina (former Yugoslavia) in the 1990s. These emission estimates are compared to PCB emission rates estimated for the cities of Zurich, Switzerland, and Chicago, USA using an approach that combines multimedia mass balance modeling and measurement data. Our modeled per-capita emission estimates for Banja Luka are lower by a factor of ten than those for Zurich and Chicago, which are similar. This indicates that the sources of PCB emissions in Banja Luka are likely to be weaker than in the Western European and North American cities which show relatively high PCB emissions. Our emission rates from the three cities agree within a factor of ten with emission estimates from a global PCB emission inventory derived from production and usage estimates and emission factors.