Maternal mortality: a tertiary care hospital experience in Upper Egypt

Background: Maternal mortality is one of the major challenges which face the developing countries throughout the world. The aim of the study is to assess the causes of maternal mortality at Women Health Hospital, Assiut University, Egypt, and to identify the avoidable ones.Methods: Data were collected from records of patients who presented to and/or delivered at Women Health Hospital between 2009 and 2014. Only cases of maternal mortality were included in this study. In our study, we found 213 maternal deaths at our hospital between 2009 and 2014.Results: The maternal mortality ratio decreased progressively from 2009 to 2014 (228 and 89 per 100000 live birth respectively). Moreover, we found that the indirect causes of maternal mortality accounted for 24.9 % of all mortalities. As regards the direct causes of maternal mortality, preeclampsia remained the primary cause and represented 27.7 % of the avoidable causes. The second most frequent cause of direct maternal mortality was postpartum hemorrhage (PPH), which represented 26.8 %.Conclusions: Preeclampsia and PPH, as well as their complications are the leading causes of death in one of the biggest tertiary care university hospitals in Egypt. However, there are other important avoidable predisposing factors that should be dealt with including lack of patient education, delayed transfer from other hospitals, and substandard practice

Acute Fatty Liver of Pregnancy; 10 Years’ Experience in a Large Tertiary Center in Egypt

Objective:To provide a description for the demographics, clinical presentation, maternal and perinatal outcome in patients with acute fatty liver of pregnancy (AFLP) admitted in Assiut Woman’s Health Center, Egypt.Materials and Methods:This was a retrospective study over a period of 10 years included all women who were admitted in Assiut Woman’s Health Center with the diagnosis of AFLP. Data were collected from the records of patients; their symptoms, laboratory findings, clinical course, maternal and perinatal outcome were reviewed.Results:Thirty-two women with AFLP were identified. Twenty-nine of them were diagnosed in the antepartum period, and three cases were diagnosed after delivery. There were 27 cases of maternal deaths (84.7%). Persistent nausea and vomiting was the most common initial presentation (68.8%). Moderate rise of liver transaminases was the only constant laboratory finding in all cases. Conclusions:AFLP is a medical and obstetrical emergency. In Egypt, the disease still has a high mortality rate. Lack of awareness of many health care providers about the nature of this mysterious disease is a contributing factor. Early recognition and treatment can improve both maternal and fetal survival

Sustainable approach of solid waste management of small urban area: case for Habiganj municipality in Bangladesh

Existing solid waste management system of Habibganj municipality (pourashava) of Bangladesh was studied. A total of 234 households were surveyed. Solid waste generation rate was found to be 0.36 kg/cap/day. Household waste disposal was one of the main problems across the city. Among the different options of waste disposal, 21.4% and 23.9% respondents generally threw their wastes into nearby ponds and drains, respectively. About 14.5% of the sampled households discarded their wastes in their respective compound and only 12% households used bins supplied by the municipality. About 10.7% households disposed their garbage on the roadside. Lack of awareness, lack of dustbins, and improper maintenance of drainage system and lack of drainage facilities were the main reasons of the current inadequacy of the management system as reported by 183 (78%) respondents. The results indicate that for a 200 MT capacity composting plant, safe distance will be about 800 m from the disposal site in terms of odorous impact, while 500 m for health impact. In this study, a sustainable management system of solid waste disposal is suggested for the Habibganj municipal area

Mobile encounters:bus 5A as a cross-cultural meeting place

The paper explores modes of encounters in the everyday practice of bus travel. Particularly, it addresses cross-cultural encounters located in the tension between familiarity and difference, between inclusion and exclusion. The paper is located in contemporary thoughts, approaching public transport not only as a moving device but also as a social arena. Furthermore, the bus is simultaneously perceived as a public space, at once composite, contradictory and heterogeneous, and as a meeting place involving ‘Throwntogetherness’. The encounters analysed are bodily, emotional charged and outspoken meetings between passengers, with the socio-materiality of the bus and drivers as co-riders and gatekeepers

Human embryonic stem cell-derived neurons establish region-specific, long-range projections in the adult brain

While the availability of pluripotent stem cells has opened new prospects for generating neural donor cells for nervous system repair, their capability to integrate with adult brain tissue in a structurally relevant way is still largely unresolved. We addressed the potential of human embryonic stem cell-derived long-term self-renewing neuroepithelial stem cells (lt-NES cells) to establish axonal projections after transplantation into the adult rodent brain. Transgenic and species-specific markers were used to trace the innervation pattern established by transplants in the hippocampus and motor cortex. In vitro, lt-NES cells formed a complex axonal network within several weeks after the initiation of differentiation and expressed a composition of surface receptors known to be instrumental in axonal growth and pathfinding. In vivo, these donor cells adopted projection patterns closely mimicking endogenous projections in two different regions of the adult rodent brain. Hippocampal grafts placed in the dentate gyrus projected to both the ipsilateral and contralateral pyramidal cell layers, while axons of donor neurons placed in the motor cortex extended via the external and internal capsule into the cervical spinal cord and via the corpus callosum into the contralateral cortex. Interestingly, acquisition of these region-specific projection profiles was not correlated with the adoption of a regional phenotype. Upon reaching their destination, human axons established ultrastructural correlates of synaptic connections with host neurons. Together, these data indicate that neurons derived from human pluripotent stem cells are endowed with a remarkable potential to establish orthotopic long-range projections in the adult mammalian brain

A new estimate of carbon for Bangladesh forest ecosystems with their spatial distribution and REDD+ implications

In tropical developing countries, reducing emissions from deforestation and forest degradation (REDD+) is becoming an important mechanism for conserving forests and protecting biodiversity. A key prerequisite for any successful REDD+ project, however, is obtaining baseline estimates of carbon in forest ecosystems. Using available published data, we provide here a new and more reliable estimate of carbon in Bangladesh forest ecosystems, along with their geo-spatial distribution. Our study reveals great variability in carbon density in different forests and higher carbon stock in the mangrove ecosystems, followed by in hill forests and in inland Sal (Shorea robusta) forests in the country. Due to its coverage, degraded nature, and diverse stakeholder engagement, the hill forests of Bangladesh can be used to obtain maximum REDD+ benefits. Further research on carbon and biodiversity in under-represented forest ecosystems using a commonly accepted protocol is essential for the establishment of successful REDD+ projects and for the protection of the country’s degraded forests and for addressing declining levels of biodiversity

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Left Main Coronary Artery Revascularization in Patients with Impaired Renal Function: Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting

Introduction: The evidence about the optimal revascularization strategy in patients with left main coronary artery (LMCA) disease and impaired renal function is limited. Thus, we aimed to compare the outcomes of LMCA disease revascularization (percutaneous coronary intervention [PCI] vs. coronary artery bypass grafting [CABG]) in patients with and without impaired renal function. Methods: This retrospective cohort study included 2,138 patients recruited from 14 centers between 2015 and 2,019. We compared patients with impaired renal function who had PCI (n= 316) to those who had CABG (n = 121) and compared patients with normal renal function who had PCI (n = 906) to those who had CABG (n = 795). The study outcomes were in-hospital and follow-up major adverse cardiovascular and cerebrovascular events (MACCE). Results: Multivariable logistic regression analysis showed that the risk of in-hospital MACCE was significantly higher in CABG compared to PCI in patients with impaired renal function (odds ratio [OR]: 8.13 [95% CI: 4.19–15.76], p &lt; 0.001) and normal renal function (OR: 2.59 [95% CI: 1.79–3.73]; p &lt; 0.001). There were no differences in follow-up MACCE between CABG and PCI in patients with impaired renal function (HR: 1.14 [95% CI: 0.71–1.81], p = 0.585) and normal renal function (HR: 1.12 [0.90–1.39], p = 0.312). Conclusions: PCI could have an advantage over CABG in revascularization of LMCA disease in patients with impaired renal function regarding in-hospital MACCE. The follow-up MACCE was comparable between PCI and CABG in patients with impaired and normal renal function