C-reactive protein as a screening test for gestational diabetes mellitus in first-trimester of pregnancy: a prospective cohort study

Background: The current study aims to determine if increased inflammation identified by increased C-reactive protein (CRP) level is associated with the subsequent development of gestational diabetes mellitus (GDM).Methods: A prospective cohort study conducted at a tertiary University Hospital included 496 booking for their antenatal care visit between 10-12 weeks of gestation. They were tested for presence of CRP in blood. All women without a history of antenatal type 1 or type 2 diabetes undergo routine GDM screening with the 50-g oral glucose-loading test (GLT) between 24 and 28 weeks 'gestation. Women whose 1-h post-loading plasma glucose level >7.8 mmol/l (>140 mg/dl) undergo a diagnostic, fasting, 100-g, 3-h oral glucose tolerance test (OGTT) within 1-2 weeks following the GLT.Results: Among these 496 women, a total of 27 women (5.4%) were diagnosed as GDM and 10 women (2.0%) were diagnosed as IGT at week 24-28. The CRP was positive and higher in the GDM diagnosed group (p=0.000) compared to those who did not develop GDM. CRP was positively correlated with diagnosis of GDM (r=0.438, p=0.012).Conclusions: There is an association between first-trimester inflammation, marked by increased CRP levels and subsequent risk of GDM

Prevalence of cesarean section on demand in Assiut Governorate, Egypt

Background: The current study aims to evaluate the prevalence of CS on demand in Women's health hospital, Assiut University and Abnob Central Hospital in Assiut Governorate, Egypt.Methods: A cross sectional study conducted in Assiut Women Health Hospital and Abnob central hospital from January 2017 to December 2017. The total number of cesarean section done was 180 cases and the number of CS on demand was 64 (35.6%). The demographic data were collected by one of the study investigators. Women were asked about the causes of requesting CS before surgery.Results: The study group was 64 women with age ranging from 18-40 years old, 40 primipara and 24 multipara. Of those 24 women, 21 of them previously delivered vaginally and only 3 women delivered by emergency CS. Twenty- six women had a history of previous abortion. Fear of pain was the main cause for CS on demand in the whole study participants (57.8%). In primipara, the main cause for requesting CS is fear of pain in 62.5% of participants followed by fear on the baby in 45 % of women. On the other hand, in multipara, the main cause for CS on demand was bad history of previous experience (60%) followed by fear of pain in 50% of cases. There was statistical significant difference between both groups in only two causes; fear of pelvic floor injuries (50% in multipara vs. 20% in primipara, p=0.02) and bad history of previous experience (60% in multipara vs. 0% in primipara, p=0.001). Other causes were not statistically different.Conclusions: The incidence of cesarean sections performed on request without medical indications is rising. The reasons for this are not only for perceived medical benefit, but also due to social, cultural, and psychological factors

Integrating the Principles of Lean Management into the Design Process of Green Tall Buildings

Tall buildings have become a sign of Economic and technological development in advanced countries, resolving different issues coming from the significant increase in the urban dwellers and land price. This type of buildings is characterized by its high levels of energy consumption and design complexity. The design process of tall buildings involves many professionals from several disciplines, requiring an efficient management to coordinate and interpret the interrelations between these various disciplines in the design stage taking into consideration the global awareness of energy consumption and the urgent need to reduce the quantity of energy used by this type of buildings. Lean process tools and methods have been adapted to the design management process in the AEC industry - known as Lean Design management (LDM) - to improve the context of design and overcome its deficiencies with minimum wastage with a greener comprehensive view of the whole project. Applying lean design management tools to the design process of tall buildings will help in overcoming the challenges coming from the complex design process of tall buildings. Thus, the objective of this paper is to set preliminary guidelines for the integration of the lean design management concept with the design process management of green tall buildings, through a literature review. More than 200 research paper -ranging from 2010 till present mostly indexed in Scopus database- including the aim of the study were selected for review. Research found a number of preliminary guidelines for optimizing the design process of green tall buildings through the adaptation of the lean design management concept. This research is meant to be the first phase of the study to assess the application of lean principles to the design process of tall buildings through practical analysis of case studies that will be carried out in further studies

Integrating the Principles of Lean Management into the Design Process of Green Tall Buildings

Tall buildings have become a sign of Economic and technological development in advanced countries, resolving different issues coming from the significant increase in the urban dwellers and land price. This type of buildings is characterized by its high levels of energy consumption and design complexity. The design process of tall buildings involves many professionals from several disciplines, requiring an efficient management to coordinate and interpret the interrelations between these various disciplines in the design stage taking into consideration the global awareness of energy consumption and the urgent need to reduce the quantity of energy used by this type of buildings. Lean process tools and methods have been adapted to the design management process in the AEC industry - known as Lean Design management (LDM) - to improve the context of design and overcome its deficiencies with minimum wastage with a greener comprehensive view of the whole project. Applying lean design management tools to the design process of tall buildings will help in overcoming the challenges coming from the complex design process of tall buildings. Thus, the objective of this paper is to set preliminary guidelines for the integration of the lean design management concept with the design process management of green tall buildings, through a literature review. More than 200 research paper -ranging from 2010 till present mostly indexed in Scopus database- including the aim of the study were selected for review. Research found a number of preliminary guidelines for optimizing the design process of green tall buildings through the adaptation of the lean design management concept. This research is meant to be the first phase of the study to assess the application of lean principles to the design process of tall buildings through practical analysis of case studies that will be carried out in further studies

Formulation, evaluation and optimization of miconazole nitrate tablet prepared by foam granulation technique

The aim of our study was to utilize novel foam granulation technique in formulation of miconazole nitrate; a model hydrophobic drug as oral disintegrating tablets "ODT" particularly to enhance its bioavailability. Foam granulation technique has additional advantages over the other traditional granulation technique since; it enhances the granulation process and produce acceptable tablets. Fractional factorial design was used to investigate the effect of formulation and processing variables on the prepared miconazole ODT. The prepared granules were evaluated by measuring their density, flowability, granules size and shape, and granules wetting time. The quality attributes of the prepared tablets; drug content, tablet thickness, uniformity of weight, tablet tensile strength, friability, disintegration, and dissolution were also evaluated. The results indicated that, the prepared granules showed acceptable characteristics and is significantly affected by the disintegrant type, urea concentration, and the lubricant type. The quality attributes of the tablets were not affected by the processing parameters. From the prepared formulas; F20, F19, F12, and F20 displayed 18, 35, 35, and 40 seconds disintegration time respectively and the percent of dissolution after 15 minutes ranged from 94.4-100%. These results ascertained that foam granulation technique fulfill the requirement in preparation of miconazole ODT. Key words: miconazole nitrate, foam granulation, oral disintegrating tablet

Evaluation of hepatitis B vaccine responsiveness in ‎hemodialysis and peritoneal dialysis patients

Background: Hepatitis B Virus (HBV) infection is considered as a major cause of liver ‎cirrhosis and hepatocellular carcinoma. Patients with End Stage Renal Disease (ESRD) are a risk group for HBV infection. The vaccine of hepatitis B has ‎been recommended for prevention of HBV infection in ESRD patient ‎especially on renal replacement therapy.  Methods: Eighty seven patients with ESRD on peritoneal ‎dialysis and hemodialysis requiring primary hepatitis B vaccination were ‎enrolled in the study. Each of them received 40 µg of recombinant hepatitis B ‎vaccine in a four-dose schedule. Antibody response was determined by the ‎levels of antibodies to the hepatitis B surface antigen (anti-HBs) after last ‎doses of the vaccination schedule.  Results: We observed three response patterns to the ‎immunizations in all patients after vaccination, the nonresponders (24.7%) ‎never reached the minimum protective titer of 10 mIU/mL, the poor responders (18.5%) had titers between 10 and 100 mIU/mL, and the good responders (56.8%) had antibody titers above 100 mIU/mL. Despite a reduction in anti-‎HBs over time, the good responders did not become unprotected during the ‎observation period, especially those participants who had titers above 1000 ‎mIU/mL after the initial immunization.  Conclusions: We concluded that the immune ‎response of the HBV vaccine was reduced in the HD and PD patients, which ‎need yearly re-evaluation of seroconversion with booster doses of HBV ‎vaccination if needed‎.

Gonadal infection: a risk factor for the development of adolescent varicocele

Objective: The aim of this study was to determine whether a relationship between previous gonadal infections and adolescent varicocele occurrence exists.Patients and methods: All adolescents who presented with varicocele at Tanta Urology Department during the period from January 2006 to March 2011 were included in this study. Patients were evaluated for age, clinical presentation, previous history of epididymitis or epididymoorchitis, laterality, and grading of varicocele. Examination of testicular consistency and ultrasound measurement of testicular volume were carried out for all patients to define those with testicular atrophy.Results: Sixty-three boys were included in this study. The mean patients’ age was 15.6 years (range: 10–18, SD; 1.6 years). Twenty-nine (44.4%) boys had signs of testicular atrophy (testes are soft in consistency with ultrasounddetected volume smaller than that normal for age) either unilateral or bilateral. About 28.6% of patients (18 boys) had a history of epididymitis or epididymo-orchitis either associated with mumps or of unknown etiology. Of those patients, six boys had previous history of single attack, 10 boys had two attacks, and two boys had more than two attacks of epididymo-orchitis. A significant positive correlation was seen between the incidence of epididymo-orchitis attacks and the grade of varicocele (rs=0.63, 95% confidence interval: 0.21–0.85, P<0.05). Patients with past history of epididymo-orchitis were significantly more liable (4.1 times) of developing testicular atrophy as compared with those without a history of epididymo-orchitis (95% confidence interval: 1.517–11.097, P<0.05).Conclusion: History of epididymo-orchitis is significantly a potential risk factor for the development of adolescent varicocele with subsequently higher risk for testicular atrophy. We advise routine ultrasonographic examinations in patients with previous history of epididymo-orchitis both for possible early detection of varicocele and to avoid testicular atrophy in this cohort of patients. However, more studies on a larger scale are still warranted.Keywords: adolescent varicocele, epididymo-orchitis, testicular atroph

The Safety and Efficacy of Cervical Laminectomy and Fusion versus Cervical Laminoplasty Surgery in Degenerative Cervical Myelopathy: A Prospective Randomized Trial

BACKGROUND: There is a lack of evidence of whether degenerative cervical myelopathy (DCM) is best treated through cervical laminoplasty (CLP) or cervical laminectomy with lateral mass fusion due to the lack of prospective randomized studies that are well designed. We conducted the largest prospective randomized trial to date to determine the comparative effectiveness and safety of both approaches. METHODS: In this prospective, randomized trial, we randomly assigned patients who had symptoms or signs of DCM to undergo either cervical laminectomy and lateral mass fixation (CLF) or CLP. The primary outcome measures were the change in the Visual Analog Scale (VAS), neck disability index, modified Japanese Orthopedic Association (mJOA) score, and Nurick’s myelopathy grading 1 year after surgery. The secondary outcome measures were the intraoperative, post-operative complications, hospital stay, C2-7 Cobb’s angle, and Odom’s criteria. The follow-up period was at least 1 year. RESULTS: A total of 30 patients (mean age, 54.5 ± 5.5 years, 70% of men) underwent prospective randomization. There was a significantly greater improvement in neck pain (VAS) in the CLF group at 1 year (p < 0.05). The improvement in the mJOA and Nurick’s myelopathy grading showed insignificant improvement between both groups. Furthermore, there was no significant difference in the patient’s post-operative satisfaction (Odom’s criteria). The mean operative time was significantly longer in the CLF group (p < 0.001), with no significant difference in the post-operative complications, however, there was a higher rate of C5 palsy, dural tear and infection in the CLF, and a higher rate of instrumentation failure in the CLP. The mean hospital stay was significantly longer in the posterior group (p < 0.05). Finally, there was a significant better improvement in the C2-7 Cobb’s angle at 1 year in the CLF group (p < 0.05). CONCLUSION: Among patients with multilevel DCM, the CLF approach was significantly better regarding the post-operative pain and Cobb’s angle while the CLP was significantly better in terms of shorter hospital stay and operative time

Učinak zamjene obroka od pšeničnih mekinja obrokom sa sjemenkama kima na nesenje, kvalitetu jaja i masnokiselinski profil u kokoši nesilica

The objective of the present study was to investigate the effect of substituting wheat bran (WB) with cumin seed meal (CSM) on laying performance, egg quality characteristics and egg-yolk fatty acids profile in laying hens. A total of 180 Bovans hens at 55 weeks of age were divided randomly into three treatments. The CSM was incorporated into a standard corn- and soybean meal-based diet by replacing 0, 50, and 100% of WB [i.e., 100% WB (control), 50% WB+50% CSM and 100% CSM] from 55 to 61 weeks of age. Body weight was measured at the beginning and end of the experiment. Feed intake, hen-day egg production and egg weight were recorded daily. At 61 weeks of age, 30 eggs were taken at random from each treatment group to determine the egg quality characteristics. Replacing 100% of WB by CSM did not affect body weight, however, hen-day egg production, egg weight and egg mass significantly increased, while feed conversion ratio significantly decreased (P<0.05). Haugh unit, shell thickness and yolk color significantly increased by CSM substitution in comparison with 100% WB. Plasma concentrations of total cholesterol, triglycerides, LDL-cholesterol and glutamic oxalacetic transaminase (GOT) significantly decreased by replacing WB with CSM, while, plasma HDL-cholesterol significantly increased. Furthermore, the liver malondialdehyde (MDA) concentration significantly decreased, while vitamin E, linoleic acid and alpha-linolenic acid significantly increased (P<0.05) due to CSM inclusion. Therefore, it could be concluded that substitution of WB with CSM could improve laying performance and egg quality characteristics, and reduce lipid peroxidation in laying hens.Cilj ovoga rada bio je istražiti učinak zamjene obroka s pšeničnim mekinjama (WB) obrokom sa sjemenkama kima (CSM) na nesenje, kvalitetu jaja te profil masnih kiselina u žumanjku jajeta kokoši nesilica. Ukupno je 180 Bovans kokoši u dobi od 55 tjedana slučajnim odabirom podijeljeno u tri pokusne skupine, u kojima su sjemenke kima dodane u standardni obrok s kukuruzom i sojom zamjenjujući 0, 50 i 100 % pšeničnih mekinja. Tako je kontrolna skupina hranjena obrocima sa 100 % pšeničnih mekinja, druga skupina s 50 % obroka s pšeničnim mekinjama i 50 % obroka sa sjemenkama kima, a treća skupina obrokom koji je sadržavao 100 % sjemenki kima. Pokusno razdoblje je trajalo od 55. do 61. tjedna starosti nesilica. Tjelesna je masa mjerena na početku i na kraju pokusa. Unos hrane, dnevna proizvodnja jaja i njihova masa bilježili su se svaki dan. U dobi od 61 tjedna iz svake je skupine slučajnim odabirom uzeto 30 jaja kako bi se odredila njihova kvaliteta. zamjenjujući 100 % obrok od pšeničnih mekinja sjemenke kima nisu utjecale na tjelesnu masu, no ipak su dnevna proizvodnja, težina i masa jaja znakovito porasle, dok se stopa konverzije hrane znakovito smanjila (P<0,05). Haugh-ova jedinica, debljina ljuske i boja žumanjka znakovito su porasle u skupinama u kojima su pšenične mekinje zamijenjene sjemenkama kima u odnosu na kontrolnu skupinu. Ukupni kolesterol, trigliceridi, LDL-kolesterol i glutaminska oksalooctena transaminaza (GOT) znakovito su sniženi u skupinama u kojima su pšenične mekinje zamijenjene sjemenkama kima, dok je HDL-kolesterol znakovito povišen. nadalje, koncentracija malondialdehida (MDA) u jetri znakovito je snižena, dok su vitamin E, linolna i alfa-linolna kiselina znakovito porasli (P<0,05) uslijed dodanih sjemenki kima. Može se zaključiti da zamjena obroka s pšeničnim mekinjama obrokom sa sjemenkama kima može poboljšati nesenje i kvalitetu jaja te smanjiti lipidnu peroksidaciju u kokoši nesilica