Obstetric complications and neonatal outcome of grandmultiparity: A comparative study

Background: The aim of the current study was to determine the prevalence of grand multiparity and the associated risks factors.  Methods: Four hundred thirty grand mutliparas (parity 5 or more) were compared with multiparous population (parity 2-4) with regard to maternal age, gestational age, mode of delivery, fetal and maternal outcomes and inter-current medical and obstetrical problems.Results: There were significant association between grand multiparity and adverse pregnancy outcomes such as cesarean delivery (OR=2.699, CI=2.072-3.515, P <0.001), fetal macrosomia (OR=1.675; 95% CI=1.004-2.796, P = 0.048), diabetes mellitus (OR=1.634, 95%CI=1.076-2.481, P = 0.021), and pregnancy induced hypertension (OR=1.838, 95% CI=1.054-3.204, P = 0.032). No significant associations were seen in placenta abruption, placenta previa, preterm labor, postpartum hemorrhage and the frequency of admission to neonatal intensive care unit. No prenatal or maternal mortality was reported in this study.Conclusions: Grand multiparity remains a major obstetrics problem. It is associated with many medical and obstetrical complications. In communities where large family is desirable it is important to address the value of family planning and conduction of meticulous antenatal care

Mitigation and control of electric fields on spacers' surfaces in gas insulated systems

Research in the area of gas insulated systems' (GIS) reliability is still attracting a considerable attention from the electric utilities and the scientific community in many countries. Solid insulating spacers in GIS represent the weakest points in these systems, and several troubles and systems' outages have been reported allover the world due to their failure. So it is essential to determine the electric field distribution along their surfaces and hence evaluate the degree of their reliability. Several researchers evaluated the electric field distribution on the spacers' surfaces in gas insulated systems and studied the effects of their dimensions and its relative permittivity on the electric field stress distribution. The outcome of these investigations is that the electric field stresses intensify around the triple junction and they are the main reason to initiate breakdown in gas insulated systems. Due to the previously mentioned spacers' troubles, they should be precisely designed to realize more or less uniform field distribution along their surfaces. The spacer's profile is considered the main variable, which controls the field distribution and hence field uniformity can be achieved by adopting the appropriate profile. This paper uses the artificial neural network technique "ANN" to optimize the electric field on the spacer's surface, and introduces a novel method based on replacing the spacer's material with a constant permittivity by another one having a functionally graded permittivity to optimize and control the electric field along its surface. The use of the ANN enabled the authors to design a spacer with a pre-selected almost uniform field along its surface. The error between the target field and the evaluated one is ± 5%. Also the use of FGM reduced the electric field near the triple junction at the enclosure to les than 50% in some cases

Sudden cardiac arrest and coexisting mitral valve prolapse: a case report and literature review

The aetiology of sudden cardiac arrest can often be identified to underlying cardiac pathology. Mitral valve prolapse is a relatively common valvular pathology with symptoms manifesting with increasing severity of mitral regurgitation (MR). It is unusual for severe MR to be present without symptoms, and there is growing evidence that this subset of patients may be at increased risk of sudden cardiac arrest or death. The difficulty lies in identifying those patients at risk and applying measures that are appropriate to halting progression to cardiac arrest. This article examines the association of mitral valve prolapse with cardiac arrests, the underlying pathophysiological process and the strategies for identifying those at risk

Evaluation of Postoperative Pain following Sonic and Ultrasonic Root Canal Irrigation Activation protocols in Patients with Non-vital Teeth Associated with Apical Periodontitis (Randomized Clinical Trial)

Objectives Evaluate the degree of postoperative pain in patients with necrotic teeth with symptomatic apical periodontitis in mandibular first molar teeth at 6, 12, 24, 48 and 72 hrs time interval after using different irrigation activation techniques in single-visit endodontic treatment. Methods Seventy-eight patients diagnosed with necrotic mandibular first molar with symptomatic apical periodontitis were randomly allocated into 1 of 3 separate groups (n=26); Navitip group (control), EndoUltra group, or Eddy group. After a single visit root canal treatment and a specific method of agitation, depending on each group, the patients were given a questionnaire on which the patient would mark the degree of pain in a scale from 0 to 10 at 6, 12, 24, 48, 72 hours and 7 days post-obturation. Data were statistically analyzed with a significance level of P ≤ 0.05. Results EndoUltra ultrasonic agitation and Eddy sonic agitation as a final irrigation protocol showed significantly lower pain values than the control group, but there was no significant difference in pain values between the experimental groups. Conclusion There was significantly less pain associated with EndoUltra ultrasonic and Eddy sonic agitation compared to Navitip irrigatio

Novel Urinary Biomarkers and Chronic Kidney Disease After Coronary Angiography: A Prospective Case-Controlled Study

BACKGROUND: Novel urinary biomarkers may have potential for early detection of acute kidney injury. AIM: The aim of the study was to test two urinary biomarkers: Kidney injury molecule-1(KIM-1) and liver-type fatty acid binding protein (L-FABP) as markers of kidney injury following coronary angiography. METHODS: This is a prospective non-randomized controlled trial, performed in two large teaching hospitals. Patients were recruited from the catheter lab or form nephrology outpatient clinics. In group (A), 100 patients with AKI on top of CKD after coronary angiography and Group B: Thirty-one patients with stable CKD as a control. KIM-1 and L-FABP were measured at base line and after 3 months. RESULTS: In group (A), 100 patients who had acute on top of CKD after coronary angiography, stage progression occurred in 15 patients in group (A) compared to two patients in group (B) (p = 0.28). The median change in eGFR after 3 months was not statistically significant between both groups (p = 0.8). Median baseline urinary liver-type fatty acid binding protein was higher in Group A compared to Group B (3.7 μg/g vs. 1.82μg/g). The change in L-FABP from baseline to 3 months was significant between both groups (p &lt; 0.001). The median urinary concentrations of KIM-1 and L-FABP were higher at the end of the follow-up compared to base line values in both groups, (p &lt; 0.000). CONCLUSION: Urinary L-FABP correlates with kidney function decline in patients with acute on top of CKD after coronary angiography. Urinary levels of KIM-1 and L-FABP at 3 months increase significantly compared to baseline in patients with progressive CKD

Effect of Bone Marrow-derived Mesenchymal Stem Cells and Umbilical Cord Blood-CD34+ cells on Experimental Rat liver Fibrosis

Background and Objective: Liver disease is one of the major causes of death in many countries. Hence, the development of effective therapies for liver fibrosis is a major aim of medical research. So this study was designed to investigate the therapeutical role of mesenchymal stem cells (MSCs) and hematopoietic stem cells (HSCs) transplantation in the experimental rat liver fibrosis. Design and Method: Bone marrow-derived MSCs were isolated from femoral and tibial bones of male albino rats, then were grown and propagated in culture for 2 weeks and were characterized morphologically and by detection of CD29 by real time-PCR. Human umbilical cord blood cells were obtained after full-term caesarean delivery from healthy donors after written informed consent. Low-density mononuclear cells were separated over Ficoll- Paque (Gibco-Invitrogen, Grand Island, NY), and then CD34+ HSC was isolated using a magnetic cell sorter (MiniMACS; Miltenyi Biotec, Bergisch Gladbach, Germany). The cells were then infused intraperitoneally in rats that received CCl4 injection to induce liver fibrosis. Rats were divided into 4 groups: control, CCl4, CCl4 plus MSC, and CCl4 plus CD34+. Liver tissue was examined histopathologically for all groups. The expression of collagen I and metalloproteinase-2 genes as a marker of liver fibrosis was measured by real time RT- PCR. Results: The results of the present study showed that both MSCs and CD34+ have a significant antifibrotic effect as evidenced by the significant decrease in liver collagen gene expression as well as the decrease in MMP-2 (p < 0.05) compared to the CCl4 group

Impact of Nursing Educational Program on Reducing or Preventing Postoperative Complications for Patients after Intracranial Surgery

Intracranial surgery means any surgery performed inside the skull to treat problems in thebrain and surrounding structures. Aim: Evaluate the impact of nursing educational program on reducing or preventing postoperative complications for patients after intracranial surgery. Subjects and methods: Sixty adult patients had intracranial surgery (burr hole, craniotomy and craniectomy) were included in this study. Their age ranged from18-65 years old, fully conscious after operation. Patients divided into two groups; control group (30 patients who received routine care) and study group (30 patients who received nursing educational program). Three tools were used for data collection; tool I patient assessment sheet, tool II nursing educational program after intracranial surgery and tool III patient evaluation sheet. Results: A good improvement in total knowledge scores of study group patients after application of nursing educational program. Significant reduction and/or prevention of systemic and neurosurgical postoperative complications for study group patients after application of nursing educational program. Conclusion:Improving patients` knowledge in study group had a favorable effect in reducing or preventing systemic and neurosurgical postoperative complications than in control group. Recommendation: Establishment of health care educational center in neurosurgery department to educate patients about their conditions. Keywords: Nursing educational program– Intracranial surgery– Postoperative complications

Application of the Methylated Markers (Spectrin Beta and DEAD-Box Protein) for Definitive Differentiation Between Fresh and Aged Semen by evaluating Their Role in Identifying Semen From Mixed Body Fluids

Background: Semen identification is assumed a crucial proof of sexual assault. Moreover, body fluids at the crime scene of a human being, such as blood, semen, and saliva, are often mixed.Methods: Hence, in our study, we aimed to use methylation analysis targeting DNA epigenetic markers Spectrin beta chain (B_SPTB_03) and DEAD-box protein (DDX4) to differentiate between fresh semen (less than 4 hours) and aged semen (after 24 hours) as well as to differentiate between semen alone and semen mixed with other body fluids (blood and saliva) in the fresh and dried state.Results: Our findings showed statistically significant differences in the methylation patterns of the SPTB and DDX4 loci to distinguish semen from mixed body fluids in fresh and old samples. We were able to obtain two novel cutoff values to differentiate between fresh and aged semen, which are (52.25) with the SPTB marker and (70.75) with the DDX4 marker. Conclusion: It is concluded that the methylation approach based on the epigenetic markers of Spectrin beta chain and DEAD-box protein (B_SPTB_03 and DDX4) successfully identified fresh from aged semen and semen-derived alleles from mixed stains, hence it is recommended to be employed in forensic practice

Role of IL-28B polymorphisms in virologic response to combined pegylated interferon and ribavirin therapy in genotype 4 chronic HCV infected patients with and without cirrhosis

Background: Chronic hepatitis C virus (HCV) represents one of the common causes of chronic liver disease worldwide with Egypt having the highest prevalence, namely genotype 4. The rs12979860 CC genotype of the interleukin 28B (IL28B) polymorphisms is associated with high rates of sustained virological response to pegylated interferon and ribavirin in HCV genotype-1 patients. Data on other genotypes are more limited.Objective: We aim to evaluate the predictive power of the rs12979860 IL28B single nucleotide  polymorphisms for treatment response at 3 and 6 months in chronic HCV genotype 4 Egyptian patients in relation to other predictors.Patients and methods: The study included 60 chronic HCV Egyptian patients receiving pegylated interferon and ribavirin therapy. Patients were classified into 2 groups; 30 patients with compensated cirrhosis, and 30 patients without cirrhosis. We analyzed selected pretreatment factors such as age, sex, HCV viral load, anti-schistosomal antibodies, insulin resistance, alpha fetoprotein, low and high density lipoproteins and single nucleotide polymorphisms of IL28B and tried to find out which of them influence sustained virological response.Results: In univariate analysis, CC genotype showed a significant association with sustained virological response at 6 months among the cirrhotic patients (81.8% responders had the CC genotype, 58.3% had the CT/TT genotype) (p= 0.009). While in multivariate analysis, the presenceKEYWORDS: HCV; IL28B; Polymorphism; Interferon; Schistosomiasis; Respons

Comparison of Operative vs Non-operative Management of Ankle Fractures in Diabetic Patients: Prospective Randomized Trial

This study investigates the outcomes and complications associated with the management of ankle fractures in diabetic patients. A total of 44 diabetic patients with ankle fractures were enrolled, and they were randomly assigned to either conservative or operative treatment groups. The study evaluated demographic characteristics, diagnosis, complications, functional outcomes, and correlation with HbA1c and ankle brachial index. The results revealed a 29.5% complication rate among the patients, including superficial infections, Charcot neuroarthropathy, arthritic changes, loss of reduction leading to ankle fusion, and stiffness. Functional outcome scores (AOFAS and SF36) did not significantly differ between the conservative and operative groups. Correlation analysis showed a significant negative relationship between HbA1c levels and functional scores in the conservative group. Ankle brachial index demonstrated a negative correlation with the SF36 score in the conservative treatment group. The study emphasizes the importance of diabetic control and vascular assessment in guiding treatment decisions for diabetic ankle fractures