ObjectiveTo assess the prediction of stone clearance and complications of percutaneous nephrolithotomy (PCNL) using the ‘STONE’ nephrolithometry score, assessing stone size, tract length (skin-to-stone distance), degree of obstruction, number of calyces involved and stone essence (density).Patients and methodsThis was a prospective study of patients undergoing single-tract PCNL while prone, conducted at a university hospital. All patients had non-contrast-enhanced computed tomography within 3 weeks of the procedure. Only patients with a unilateral procedure and radio-opaque stones were included. The five variables of the STONE nephrolithometry score were calculated before the procedure. The stone-free rates were assessed with a plain abdominal film at 4 weeks and complications were graded using the modified Clavien system.ResultsIn all, 107 patients were included in the final analysis. Overall, 80% of patients were rendered stone-free. Among the individual variables, a larger stone (P = 0.002) and the involvement of multiple calyces (P = 0.04) were associated with residual stones, while tract length (skin-to-stone distance), stone density and presence of hydronephrosis were not. Patients who were rendered stone-free had a statistically significant lower overall STONE score than those with residual stones, at 7.24 vs. 8.14 (P = 0.02). The score also correlated with operative duration, which was significantly longer with a higher STONE score (P = 0.03). The complication rate was 18% and most complications were Clavien grade 2, with bleeding requiring a blood transfusion (11 patients) being the commonest. There were no deaths within 30 days of surgery, but there was no correlation between the STONE score and complications.ConclusionThe STONE nephrolithometry score is a simple and easy to apply system for predicting complexity in stone clearance with PCNL.

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Background and Aims:Propofol, the most commonly used intravenous (IV) anesthetic agent is associated with hypotension on induction of anesthesia. Different methods have been used to prevent hypotension but with variable results. The objective of this study was to evaluate efficacy of equipotent doses of phenylpehrine and ephedrine in preventing the hypotensive response to the induction dose of propofol.Material and Methods:One hundred thirty five adult patients were randomised to one of the study groups: propofol-saline (PS), propofol-phenylephrine (PP) or propofol-ephedrine (PE) by adding study drugs to propofol. Anesthesia was induced with a mixture of propofol and the study drug. Patients were manually mask-ventilated for 5 min using 40% oxygen in nitrous oxide and isoflurane at 1%. A baseline mean arterial pressure (MAP) was recorded prior to induction of anesthesia. Systolic, diastolic and mean blood pressure and heart rate were recorded every minute for up to 5 min after induction. Hypotension was defined as a 20% decrease from the baseline MAP.Results:There were no significant demographic differences between the groups. Overall incidence of hypotension in this study was 38.5% (52/135). Rate of hypotension was significantly higher in group PS than group PP (60% vs. 24.4% P = 0.001) and group PE (60% vs. 31.1% P = 0.005). In contrast, a significant difference in rate of hypotension was not observed between groups PP and group PE.Conclusion:In equipotent doses, phenylephrine is as good as ephedrine in preventing the hypotensive response to an induction dose of propofol.

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Helicoverpa armigera H. is a polyphagous notorious pest of a number of economic crops including tomato. In tomato, it can reduce its yield as high as 70% due to fruit boring. Although some predators and parasitoids have been recorded in the field for their natural control, their manipulation to a successful crop management is still awaited. To overcome this pest, insecticides play a significant role in its effective crop management program globally. Tomato is an absolutely perishable commodity and needs the specified period required between the application, of conventional pesticides of organophosphate group, and consumption which can hardly be afforded. Therefore, nine insecticides from the new chemistries, which were relatively safer to human and environment, i.e. Coragen (chlorantraniliprole), steward (indoxacarb), Belt (flubendamide), Delegate (spintoram), Volium Flexy (chlorantraniliprole + thiamethaxim), Fipronil (grafter), Proclaim (emamectin benzoate), Pirate (chlofenapyr) and Lufenuron (lufenuron), were tested on tomato crop heavily infested by this pest in the farmers field in districts Lodhran and Bahawalpur (Pakistan) in the month of April 2014. The mortality was compared after 4, 7 and 10 days and treatments were compared with control as well with one another. The average maximum % mortality, i.e. 89.36 and 85.09 of the pest, was observed with Volium Flexy, and Delegate also worked well even after 7 and 10 days. Similarly, the results on the basis of damaged fruits and percent loss of yield pointed out that Chlorantraniliprole, Flubendiamide and Indoxacarb had resulted better as compared with others, although the difference was statistically non significant. These new chemistry pesticides are suggested to be used at tomato crop against Helicoverpa armigera which are best fitted in the IPM program for the control of the pest.

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Enterprise Risk Management (ERM)is an integrated risk management approach, which considers risks in the context of business strategy and manages them with a portfolio perspective through well defined risk responsibilities and strong risk monitoring processes. The purpose of this study is to examine the impact of ERM on firm value for 130 firms operating in the manufacturing industry and listed in Borsa Istanbul. For this purpose, we utilized panel regression models on financial data collected in the period 2008-2013. The dependent variable is Tobin's Q, which is used as a proxy of firm value. The independent variable is ERM implementation, whereas the control variables are firm size, leverage ratios and profitability ratios. We tested the hypothesis that there is a relationship between ERM and firm value. Our findings suggest that there seems to be no statistically significant relationship between firm value and ERM. We also employed a survey to explore how firms implement ERM and to obtain information about motivation behind adoption of ERM, challenges of ERM implementation and effects of ERM adoption.