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One of the deadliest diseases, heart disease, claims millions of lives every year worldwide. The biomedical data collected by health service providers (HSPs) contain private information about the patient and are subject to general privacy concerns, and the sharing of the data is restricted under global privacy laws. Furthermore, the sharing and collection of biomedical data have a significant network communication cost and lead to delayed heart disease prediction. To address the training latency, communication cost, and single point of failure, we propose a hybrid framework at the client end of HSP consisting of modified artificial bee colony optimization with support vector machine (MABC-SVM) for optimal feature selection and classification of heart disease. For the HSP server, we proposed federated matched averaging to overcome privacy issues in this paper. We tested and evaluated our proposed technique and compared it with the standard federated learning techniques on the combined cardiovascular disease dataset. Our experimental results show that the proposed hybrid technique improves the prediction accuracy by 1.5%, achieves 1.6% lesser classification error, and utilizes 17.7% lesser rounds to reach the maximum accuracy.

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Abstract Objective: To compare the recurrence rate and chronic pain in hernia patients undergoing laparoscopic or robotic transabdominal preperitoneal fixation with and without mesh. Method: The prospective comparative study was conducted at Surgical Units 4 and 5 of the Civil Hospital, Karachi, from August 1, 2017, to July 1, 2018, and comprised hernia patients undergoing laparoscopic or robotic transabdominal preperitoneal fixation who were randomised into fixation Group A and non-fixation Group B. Postoperative visual analogue scale score was calculated at the time of discharge. At 1-year follow-up, recurrence rate and chronic pain were assessed. Data was analysed using SPSS 23. Result: Of the 98 patients, there were 49(50%) in each of the two groups. Of the total, there were 97(99%) males. The overall mean age was 44.52±14.51 years. The differences in visual analogue scale scores at the time of discharge and the mean discharge from the hospital in terms of days were statistically significant (p<0.005). At 1-year follow-up, there was recurrence in 1(1.02%) case and that was in Group A (p>0.05). Chronic pain between the groups was not significant (p>0.05). Conclusion: There was no significant difference in terms of recurrence and chronic pain between mesh and non-mesh fixation. Key Words: TAPP, Transabdominal preperitoneal, Laparoscopic TAPP, Robotic TAPP, Mesh fixation, Tacker fixation. Continuous...

Objective: To evaluate whether or not prior laparoscopic training improves performance during robotic surgery utilising DaVinci robotic skills simulator. Methods: The cross-sectional study was conducted at the Civil Hospital, Karachi, from May 4 to November 11, 2018, and comprised first year residents in Group A with no laparoscopic skills and fourth year residents doing laparoscopic cholecystectomy independently and surgical faculty members in Group B who had laparoscopic skills. Both the groups had no previous exposure to robotic surgery and skills simulator. There were 4 exercises which were repeated three times by each participant. Scoring was done using the the DaVinci robotic skills simulator software. Data was analysed using SPSS 22. Results: Of the 30 surgeons, there were 15(50%) in Group A with a mean age of 26±0.56 years, and 15(50%) in Group B with a mean age of 32 years± 9.16 (p<0.001). The overall mean age was 32±9.16 years (range: 25-52 years). There were 19(63.3) females in the sample compared to 11(36.6%) males. Mean scores of Ring walk 2, Peg board 2, and Suture sponge 3 were better in Group A, while mean score of Matchboard 2 was better in Group although B (p>0.05). Group B fared better in the individual scoring of Suture sponge 2 (p>0.05). Conclusion: Laparoscopic skills apparently did not confer any benefit while performing exercises on the DaVinci skills simulator. Key Words: DaVinci Si, DaVinci skills simulator, dVSSS, Robotic surgery curriculum, Robotic surgery simulation. Continuous...

Background: Biliary strictures(BS) possess challenging diagnosis, requiring a multidisciplinary approach. In gastrointestinal clinical practice, the occurrence of biliary strictures is quite common. Multiple diagnostic techniques are used to examine BS in which endoscopic management is considered comparatively effective and non-invasive intervention. Objective: The study aimed to observe the impact of the endoscopic management of unresectable malignant biliary strictures on the patients' quality of life (QoL). Methodology: This cross-sectional study was conducted at the Surgical Ward IV Civil Hospital Karachi, Pakistan. A total of 80 patients with diagnosed unresectable malignant stricture, aged between 18 to 70 years, those with disease duration of more than eight weeks and life expectancy > 1 month were included in the study. In addition to the baseline characteristics along with the pre and post-treatment quality of life was assessed, and the mean values were compared statistically using SPSS version 19.0. Results: The mean total score of QoL improved from 71.47 ± 0.88 at baseline to 84.12 ± 1.93 after 30 days of endoscopic management of unresectable malignant biliary strictures. Conclusion: There was a significant improvement in the patient's QoL after 30 days of endoscopic management of unresectable biliary stricture.

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