Multi-level optimal energy management strategy for a grid tied microgrid considering uncertainty in weather conditions and load.

Microgrids require efficient energy management systems to optimize the operation of microgrid sources and achieve economic efficiency. Bi-level energy management model is proposed in this paper to minimize the operational cost of a grid-tied microgrid under load variations and uncertainties in renewable sources while satisfying the various technical constraints. The first level is day ahead scheduling of generation units based on day ahead forecasting of renewable energy sources and load demand. In this paper, a recent meta-heuristic algorithm called Coronavirus Herd Immunity Optimizer (CHIO) is used to solve the problem of day-ahead scheduling of batteries, which is a complex constrained non-linear optimization problem, while the Lagrange multiplier method is used to determine the set-point of the Diesel Generator (DG). The second level of the proposed EMS is rescheduling and updating the set-points of sources in real-time according to the actual solar irradiance, wind speed, load, and grid tariff. In this paper, a novel real-time strategy is proposed to keep the economic operation during real-time under uncertainties. The obtained results show that the CHIO-based bi-level EMS demonstrates an optimal economic operation for a grid-connected microgrid in real-time when there are uncertainties in weather, utility tariffs, and load forecasts.

A Prospective Interventional Study on LigaSureTM Haemorrhoidectomy as a Daycare Procedure.

OBJECTIVE: This study was designed as a prospective and interventional study that evaluated LigaSure™ haemorrhoidectomies with regional anaesthesia as a daycare procedure. METHODS: Patients with third- and fourth-degree haemorrhoids were recruited from the clinic from January 2018 to December 2019. The procedure was performed as a day case under regional anaesthesia. Using a LigaSureTM device, excisional haemorrhoidectomies (Milligan-Morgan haemorrhoidectomy) were performed without sutures or an anal sponge. We evaluated wound bleeding, pain and urinary retention per daycare protocols. RESULTS: A total of 264 patients were enrolled. There were 153 males (57.9%) with a median age of 30 years old (range 16 years old-80 years old). A total of 142 patients (54%) had third-degree haemorrhoids, while the rest had fourth-degree haemorrhoids. The median operating time was 8 min (range 4 min-17 min) and minimal blood loss was observed. During follow-up, the complications were one case (0.3%) had anal stenosis, one case (0.3%) had minimal bleeding and one case (0.3%) had urine retention. Upon discharge, four patients (1.5%) required additional analgesia and another four (1.5%) developed post-spinal headaches. No incontinence was encountered. CONCLUSION: LigaSure™ excisional haemorrhoidectomy is a safe and effective daycare procedure with acceptable re-admission and complication rates.

The Perils of Haemorrhoids Treatment

@#Treating problematic haemorrhoids has taken a long turmoil route. Its peak incidence is among 45 to 65 years of age group. Typically, problematic haemorrhoids present in multi-symptoms forms like a prolapsed lump, painless bleeding, discomfort, soiling, or itchiness. Many theories were postulated in the pathophysiology of symptomatic haemorrhoids. The sliding and engorged of anal cushion with hypervascularity is the most popular. This is an updated review of published English-language literature regarding the treatment of haemorrhoids. The treatment includes medical therapy, office procedures, and surgical operations. Merits and demerits of the different modalities of treatment of haemorrhoids are presented. The best treatment options are difficult to ascertain. It should be tailored to individualize treatment according to their presentation and severity. Up till recently, the excisional haemorrhoidectomies are considered the standard procedure for haemorrhoid treatment. These techniques produce significant post-operative pain to the patient, which hinders them from normal daily activity. Recent advancement in surgical intervention has focused on minimising severity of pain and enhances recovery.

The management of otitis externa in UK general practice.

Acute otitis externa is common and provides a heavy workload for general practitioners. We aim to determine the first-line treatment used by general practitioners in the management of otitis externa and subsequent second-line treatment in a hospital ENT clinic. In addition, this study aims to ascertain whether local and national guidelines are being followed appropriately. A prospective observational study on the management of otitis externa in consecutive patients referred to an ENT emergency clinic was undertaken. Data were collected and analysed on symptoms, initial management by general practitioners, findings and treatment in the ENT clinic. A total of 106 patients were studied. The mean duration of symptoms before presentation to clinic was 13 days; 42% of patients received no treatment by their GP prior to referral to the ENT emergency clinic. Only 14% of patients received topical antibiotics alone, whilst 44% received oral antibiotics, either alone or in conjunction with topical antibiotics by their GP. Of the 106 patients, 86% received topical antibiotics in the ENT emergency clinic and oral antibiotics were reserved for those presenting with complicated acute otitis externa. Topical antibiotics are associated with a decrease in disease persistence, whilst oral antibiotics are associated with an increase. However, general practitioners are prescribing oral antibiotics more often than required. There are few regional guidelines and no explicit national guidelines on the management of acute otitis externa for GPs to refer to. We suggest the implementation of national guidelines to aid clinical practice.

Surgeons' Evaluation of Colorectal Cancer Resections Against Standard HPE Protocol-Auditing the Surgeons.

The survival of Colorectal Cancer patients is very much dependent on complete tumor resection and multimodality adjuvant treatment. However, the main determinants for management plan of these patients rely heavily on accurate staging through histopathological examination (HPE). A reliable standard HPE protocol will be a significant impact in determining best surgical outcome. We evaluate surgeons' intra-operative judgment and the quality of resected specimens in the treatment of colorectal cancers. To quantify the quality of surgery by applying standard HPE protocol in colorectal cancer specimens and to assess the use of new format for pathological reporting in Colorectal Cancer using a formulated standard proforma. We perform a prospective observation of all colorectal cancer patients who underwent surgical resection over 8 month duration. Surgeons are required to make self-assessment about completion of tumor excision and possible lymph nodes or adjacent organ involvement while all pathologists followed standard reporting protocol for examination of the specimens. We evaluate the accuracy of surgeons judgment against HPE. The study involved 44 colorectal cancers comprising of 23 male and 21 female patients. The majority of these patients were Malay (50%) followed by Chinese (43%) and Indian (7%). The main presenting symptoms were bleeding (32%), intestinal obstruction (29%) and perforation (7%). Sixteen (36%) patients underwent emergency surgery.Rectal tumor was the commonest (53%) followed by sigmoid colon (22.7%). Neoadjuvant Chemoradiation were given to 8 patients and complete pathological response was observed in 1 (12.5%) of these. The final TNM classification for staging were; stage I (22.7%), stage IIa (18.2%), stage IIb (11.4%), stage IIIa (2.3%), stage IIIb (25%), stage IIIc (13.6%) and stage IV (6.8%).The commonest surgery performed was anterior resection with mesorectal excision (43.2%). Ten patients (22.7%) had laparoscopic surgery with 3 (30%) patients converted to open surgery. The surgeons claimed to have performed a curative resection with complete excision and clear margin in 40 (90%) patients. Of these, only 1 (2.5%) patient had a positive resection margin. Meanwhile, the surgeons reported involvement of resection margins in 4 cases but this was disputed by the HPE in all 4 cases. Lymph nodes involvement was detected intra-operatively in 13 (29.5%) of the cases and all were proven positive for metastases through HPE. On the other hand, of the remaining 31 patients who were reported as no obvious lymphadenopathy by the surgeons, lymph nodes positvity was found in 7 (22.5%) cases. Using standard HPE reporting protocol brings suitable evaluation of surgery in colorectal cancer treatment. Although surgeons' judgment is fairly accurate in predicting margin clearance and complete specimen excision, complete mesocolic and mesorectal excision is of utmost importance since lymph nodes metastatic involvement may not be obvious at surgery.

Bilateral Psoas Abscess and Extensive Soft Tissue Involvement Due to Late Presentation of Pott's Disease of the Spine.

Pott's disease of the spine with psoas abscess is currently rare form of Extra- pulmonary tuberculosis (TB) in the developed countries, however it is still seen in areas where TB is endemic. We describe a rare case if not the first (according to our knowledge) of bilateral ruptured psoas abscess with extensive tissue necrosis and pelvic organs exposure with limited neurological deficit presented late in young girl. In this case Pott's disease was associated with extensive tissue necrosis exposing pubic bones, urinary bladder and psoas muscle.

Currarino's triad: Intraoperative ultrasound image-guided surgery.

This is a report on the use of transperineal intraoperative ultrasound imaging in a case of Currarino's triad for the first time in the literature.

Human islet graft function in NOD-SCID mice predicts clinical response in islet transplant recipients.

The purpose of this study was to evaluate the utility of nondiabetic immune-deficient NOD-SCID mouse model in assessing the functional capacity of isolated human islets. We transplanted 2000 islet equivalents obtained from six preparations used for human islet transplantation in three patients under the kidney capsule of groups of 10 mice. Human (Hu) C-peptide and insulin levels were determined following intraperitoneal (i.p.) glucose challenge at days 0, 7, 14, 21, 30, 60, 90, and 120. The Hu C-peptide level >1.5 ng/mL was the threshold for islet function in this model. The first patient did not achieve insulin independence and had minimal (0.5 ng/mL) fasting C-peptide levels that mirrored the low C-peptide levels observed in the mice. After the first infusion, the insulin requirements were reduced by 50% in the second patient. She became insulin free 10 days after her second infusion with a C-peptide level of 3.0 ng/mL, which corresponded to the peak C-peptide level (3.9 ng/mL) observed in the mice. By 150 days' posttransplant, the decline in C-peptide level paralleled the decline observed in mice. Within 2 weeks after the first transplant, insulin dose was reduced by 75% in the third patient, which corresponded to the robust C-peptide production in mice (7.3 ng/mL). Both patient and mice had a delay in islet function following the second infusion. She remained with a C-peptide level of 1.8 ng/mL and insulin free until suffering a rejection episode 3 months later. We observed that human islet graft function in NOD-SCID mice correlated with clinical response in islet transplant recipients.

Inappropriate antidiuresis and hyponatremia with suppressible vasopressin in Guillain-Barré syndrome.

Studies in which plasma osmolality was altered acutely by oral water loading and hypertonic sodium chloride infusion were performed to further identify the mechanisms involved in the pathogenesis of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) in a patient with Guillain-Barré syndrome. Although resetting of the osmotic threshold for vasopressin release was demonstrated in these studies, this does not seem to have been a primary factor in the development of SIADH in this patient. Downward resetting of the osmotic threshold by sustained hypoosmolality has been previously demonstrated, and it is possible that this may account for the initially low osmotic threshold identified by our studies. These studies suggest that inappropriate antidiuresis, as shown by the absence of a diuretic response to low threshold suppression of the plasma arginine vasopressin concentration was due either to a vasopressin-independent mechanism or to markedly increased renal tubular sensitivity to vasopressin.

[Invasive amebiasis]. / Invazív amoebiasis.

There has only a small number of invasive amoebiasis cases occurred in Hungary up to now. Introducing two of our cases we would like to call attention on these cases coming mainly from tropical countries or having been just transiently there invasive amoebiasis should also be considered. Modern diagnostic imaging technics are of importance in differential diagnosis in showing antibodies against amoebas (!) because amoebas frequently cannot be directly shown from the patients in the invasive stage. Both ulcerous amoebic colitis and amoebic liver abscesses can be treated with drugs affecting amoebas in deep tissues (metronidazole, emetine, and its derivates, etc.).

Studies on skin and urinary mucopolysaccharides in malnourished/vitamin A deficient children.

In protein-calorie malnourished children, with or without associated vitamin A deficiency, skin content of acid mucopolysaccharides (MPS) and urinary excretion of MPS and amino sugars were studied. MPS content of skin in both malnourished groups was increased 3-6-fold. This increase was essentially in the non-sulphated component. In normal skin, non-sulphate MPS accounted for 68% of the MPS content, whereas in the malnourished group with vitamin A deficiency it constituted 93%. Urinary excretion of MPS (24h) was significantly reduced by 50-70% in malnourished groups. This returned to normal levels in the malnourished/vitamin A deficient group when vitamin A injections were administered. Excretion of amino sugars (24 h) in the malnourished groups was also decreased by 50-70%. In normal children 55% of the total amino sugars was dialysable whereas in the malnourished it was increased to 60%. The excretion of protein-bound and dialysable amino sugars was increased to normal level only in the group given supplements of vitamin A in addition of protein and calories.

Urinary excretion of arylsulfatases in malnourished/vitamin A deficient children.

Serum vitamin A (retinol) levels were generally low in all malnourished children (6-15 microgram/100 ml) compared with control children (50 microgram/100 ml). A significant increase in vitamin A after appropriate therapy was observed in all malnourished groups. Dietary supplements of proteins and calories even without extra vitamin A supplements increased serum vitamin A levels in cases of kwashiorkor indicating active mobilization of liver vitamin A. Total urinary arylsulfatase A activity excreted in 24-h or within 8-h in the morning (6 a.m. to 2 p.m.) was significantly reduced in cases of malnutrition with or without mild vitamin A deficiency symptoms. The excretion of arylsulfatase B was not altered. In cases of severe vitamin A deficiency coupled with malnutrition increased excretion of both arylsulfatases A and B was evident. These results on urinary arylsulfatases excretory pattern have been obtained either in samples collected for 24-h or specifically for 8-h (morning) and it is suggested that this test on urinary arylsulfatases may prove useful for detection of acute vitamin A deficiency with malnutrition in field studies. A ratio of arylsulfatases A/B of 2.0 or less seems to indicate mild malnutrition, the normal ratio being 3.4. Furthermore a low ratio coupled with increased excretion of both arylsulfatases A and B may be considered specific for acute vitamin A deficiency.