Herniated gravid uterus through an infra-umbilical laparotomy scar: a case report

Herniation of a gravid uterus through the abdominal wall is a rare and potentially serious condition due to its antecedent complications. Management is determined by gestational age. Simultaneous hernioplasty with cesarean section is considered safe. Clinical awareness of this complication will prevent delay in its diagnosis and treatment. Delay in recognition of this condition can lead to incarceration and subsequent strangulation of the gravid uterus. Strangulation at or near term appears to be a genuine indication for early hospitalization and elective cesarean section, possibly combined with hernia repair. Here we report the case of a middle aged woman who presented with abdominal pain at 28 weeks of gestation with an unusual bulge of her abdomen. The lower abdominal bulge turned out to be her gravid uterus herniated through the anterior abdominal wall. Cesarean delivery with herniorrhaphy was done for the large abdominal defect

Silencing the nosocomial pathogen Serratia marcescens by glyceryl trinitrate

Background: Quorum sensing is a cell-to-cell communication system in bacteria that controls the production of virulence factors. Serratia marcescens is a causative agent of hospital-acquired infections that shows high resistance to antibiotics. This makes the treatment of these infections difficult. Quorum sensing regulates the production of virulence factors of S. marcescens such as prodigiosin, protease, swimming and swarming motilities and formation of biofilms. Inhibition of quorum sensing may be an alternative to antibiotic treatment to avoid emergence of resistance.Objectives: Testing the ability of glyceryl trinitrate to inhibit quorum sensing and virulence factors of Serratia marcescens.Methods: The inhibiting activities of sub-inhibitory concentration of glyceryl trinitrate against the quorum-sensing regulated violacein pigment in Chromobacterium violaceum CV026 was performed to evaluate the anti-quorum sensing effect of glyceryl trinitrate. The anti-virulence activity was assessed against prodigiosin, protease, biofilm formation in addition to swimming and swarming motilities.Results: Glyceryl trinitrate at at a concentration of 0.25 mg/ml produced significant inhibitory effects against violacein (67.01%), prodigiosin (82.67%), protease, swimming (36.72%) and swarming (79.31%) motilities and biofilm formation (87.83%).Conclusion: Glyceryl trinitrate is a quorum sensing and virulence inhibitor that may be useful in treatment of nosocomial infections caused by Serratia marcescens.Keywords: Serratia marcescens, quorum sensing, virulence, glyceryl trinitrate

Compensating Chromatic Dispersion and Phase Noise using Parallel AFB-MBPS For FBMC-OQAM Optical Communication System

Filter Bank Multi-Carrier Offset-QAM (FBMC-OQAM) is one of the hottest topics in research for 5G multi-carrier methods because of its high efficiency in the spectrum, minimal leakage in the side lobes, zero cyclic prefix (CP), and multiphase filter design. Large-scale subcarrier configurations in optical fiber networks need the use of FBMC-OQAM. Chromatic dispersion is critical in optical fiber transmission because it causes different spectral waves (color beams) to travel at different rates. Laser phase noise, which arises when the phase of the laser output drifts with time, is a major barrier that lowers throughput in fiber-optic communication systems. This deterioration may be closely related among channels that share lasers in multichannel fiber-optic systems using methods like wavelength-division multiplexing with frequency combs or space-division multiplexing. In this research, we use parallel Analysis Filter Bank (AFB) equalizers in the receiver part of the FBMC OQAM Optical Communication system to compensate for chromatic dispersion (CD) and phase noise (PN). Following the equalization of CD compensation, the phase of the carriers in the received signal is tracked and compensated using Modified Blind Phase Search (MBPS). The CD and PN compensation techniques are simulated and analyzed numerically and graphically to determine their efficacy. To evaluate the FBMC\u27s efficiency across various equalizers, 16-OQAM is taken into account. Bit Error Rate (BER), Optical Signal-to-Noise Ratio (OSNR), Q-Factor, and Mean Square Error (MSE) were the primary metrics we utilized to evaluate performance. Single-tap equalizer, multi-tap equalizer (N=3), ISDF equalizer with suggested Parallel Analysis Filter Banks (AFBs) (K=3), and MBPS were all set aside for comparison. When compared to other forms of Nonlinear compensation (NLC), the CD and PN tolerance attained by Parallel AFB equalization with MBPS is the greatest

Undiagnosed asymptomatic second trimester broad ligament ectopic pregnancy: a case report and mini-review

Pregnancy in the broad ligament is a retro-peritoneal abdominal pregnancy. It is a rare form in which the gestational tissue gets implanted between the layers of the broad ligament. Due to its rarity, the diagnosis is infrequently established before surgical intervention. A twenty-five year old nulliparous woman presented for routine antenatal care in the second trimester (±17 weeks). Routine ultrasound revealed an empty uterus with a large pelviabdominal mass. This picture suggested and undiagnosed extra-uterine pregnancy. A right broad ligament ectopic pregnancy was diagnosed at exploratory laparotomy, excision of pregnancy and right salpingectomy was performed. Postoperative course was uneventful and serum hCG was undetectable at the fourth week after surgery. Information about this rare form of ectopic pregnancy is observational and mainly comes from reported cases. A high index of suspicion is needed for early diagnosis and intervention

Undiagnosed asymptomatic second trimester broad ligament ectopic pregnancy: a case report and mini-review

Pregnancy in the broad ligament is a retro-peritoneal abdominal pregnancy. It is a rare form in which the gestational tissue gets implanted between the layers of the broad ligament. Due to its rarity, the diagnosis is infrequently established before surgical intervention. A twenty-five year old nulliparous woman presented for routine antenatal care in the second trimester (±17 weeks). Routine ultrasound revealed an empty uterus with a large pelviabdominal mass. This picture suggested and undiagnosed extra-uterine pregnancy. A right broad ligament ectopic pregnancy was diagnosed at exploratory laparotomy, excision of pregnancy and right salpingectomy was performed. Postoperative course was uneventful and serum hCG was undetectable at the fourth week after surgery. Information about this rare form of ectopic pregnancy is observational and mainly comes from reported cases. A high index of suspicion is needed for early diagnosis and intervention

Intrauterine Misoprostol versus intravenous Oxytocin infusion during cesarean delivery to reduce intraoperative and postoperative blood loss: a randomised clinical trial

Background: The objective of the present study was to compare the efficacy of intrauterine misoprostol with intravenous oxytocin infusion in reducing blood loss during and after cesarean section (CS).Methods: An open, randomized, clinical trial, registered (ClinicalTrials.gov ID: NCT03148574) conducted between July 1, 2017 and April 1, 2018. The study included 240 pregnant females that were recruited at term (37-40 weeks) gestation scheduled for either elective or emergency CS. Eligible participants were randomly allocated into two equal groups: Group A: patients who receive intravenous infusion of 10 I.U diluted to 500ml of normal saline for 30 minute after delivery. Group B: patients received 400μg misoprostol intrauterine just after cord clamping and delivery of the placenta. Primary outcome measure was assessment of amount of intraoperative and postoperative blood loss.Results: The intraoperative and 2h postoperative blood loss in the misoprostol group was higher than oxytocin group (p<0.001). Hemoglobin level decreased significantly among both groups, manifested by the highly significant p value in comparison of pre and postoperative Hb level in the two groups (p<0.001). However, the blood loss in the misoprostol group was higher than oxytocin group (p=0.004). There was a statistical significant differences between both groups as regards the need for additional uterotonic drug (66% in misoprostol group vs 5% in oxytocin group, P<0.001). Shivering and pyrexia were more in common in the misoprostol group while vomiting, headache and giddiness were significantly higher among oxytocin group.Conclusions: Administration of misoprostol 400mcg through intrauterine route appears to be less effective than intravenous oxytocin infusion in reducing blood loss during and after CS

Undiagnosed endometrial abnormalities in women with normal hysterosalpingography scheduled for IVF: prospective evaluation of three-dimensional transvaginal ultrasound versus office hysteroscopy

Objectives: To compare the diagnostic accuracy of three-dimensional transvaginal ultrasound (3D-US) to office hysteroscopy (OH) in the screening of uterine cavity with normal hysterosalpingography (HSG) findings for subtle endometrial abnormalities before in vitro-fertilization (IVF). Methods: A prospective cohort cost-modeling study was carried out in a University hospital. We included 120 infertile women with a normal uterine cavity on HSG scheduled for IVF. All cases were evaluated by 3D-US, and the results were compared with OH findings. Results: OH revealed cavitary endometrial lesions (CLs) in thirty-four women (28.3%). Endometrial polyps were the most common detected lesions (16, 47.1%). 3D-US had 88.2% sensitivity, 96.5% specificity, 90.9% positive predictive value, 95.4% negative predictive value, and 94.2% overall accuracy for CLs. The overall agreement between 3D-US and OH was near-perfect (κ=0.86, 95% CI=0.75-0.96). Irregular menstrual bleeds and prior endometrial procedures were significant predictors for CLs (aOR=24.96, 95% CI=2.71–230.04, P=0.005, aOR=9.16, 95% CI=2.13–39.3, P=0.002, respectively). A selective screening strategy discerning OH to women with these predictors and/or women with abnormal 2D-US would have an NPV of 92.8 % with substantial cost benefits. Conclusions: In the pre-IVF work up, 3D-US, a non-invasive imaging modality, seems to be nearly comparable to OH. Office hysteroscopy screening prioritizing women with abnormal 2D-US, irregular menstrual periods and/or prior endometrial traumatization could yield a satisfactory cost-effective approach for identifying endometrial lesions