Short Term Outcome of Plasma Pleurodesis in Post Pulmonary Resections Persistent Air Leak

Background: Air leak is the most common morbidity after pulmonary resection surgery. It may result in prolonged duration with chest tubes with their annoying chest pain, prolonged hospital stay time with increased financial costs, pneumonia, empyema, and patient dissatisfaction. Our objective was to evaluate the efficacy of plasma pleurodesis for stoppage of air leak after lung resection, in comparison to conservative measures. Methods: This prospective single-blinded randomized study included 60 patients randomly divided into two groups: Group A: included 30 patients who received intrapleural fresh frozen plasma.  One bag of FFP, contains 250 ml of plasma, matched for the ABO group was installed through the apical chest tube into the pleural cavity. Group B: a control group of 30 patients who did not receive any sclerosing agent. They were managed with under-water seal and observation. Results: This study showed that the stoppage of air leak in group A was faster “which stopped in 9-10 days” in comparison to control group B “24-25 days”, (P-value <0.001). There was a significant difference between groups A and B regarding the hospital stay, which was in 9-10 days in group A in comparison to group B “26-28 days (P-value <0.001). Conclusion: Intrapleural fresh frozen plasma appears to be a valuable option to stop persistent air leaks post pulmonary resections. It’s a cheap, available, and safe agent. It reduced hospital stay, costs and morbidities

Managing the Risk of Wellbore Instability Using Geomechanical Modeling and Wellbore Stability Analysis for Muzhil Shale Formation in Gulf of Suez, Egypt

Wellbore instability constitutes potential risks during wellbore drilling operation; these risks may cause complicated states, and in some cases, can lead to costly operational issues. In this study we present the best solution by predicting and quantifying wellbore instability in Muzhil field, Gulf of Suez, using a 1-DMechanical Earth Model (1DMEM) built with well logs, pressure measurements, and drilling events reports. Firstly we created 1DMEM by calculating the pore pressure, vertical stress, rock strength, rock elastic parameters, and horizontal stresses. Mohr Coulomb, Modified Lade and Mogi Coulomb failure criteria determined the well deformation possibility. Lastly 1-DMEM can be used to conduct a comprehensive geo-mechanical wellbore stability analysis for the trouble zones of Muzhil Formation. 1-DMEM results showed that the best azimuth for Vertical and slightly inclined Wells will be (40º–60º) clockwise from the North, i.e. parallel to SHmin (NE40SW). The wellbore stability analysis showed that the vertical and low deviated wellbore (less than 40º) is safe and more stable than the horizontal and high deviated wellbore and unsuitable Mud Weight (MW) is a major cause of the wellbore instability. The optimal solution to wellbore instability is to follow the optimum wellbore path and use safe MW. The optimum MW in shale formation ranges from (13.5-15) ppg. The results contribute in development plan of the wellbores nearby the studied area and reducing nonproductive time and cost

Modified Single-Patch Technique Versus Two-Patch Technique in Infants with Complete Atrioventricular Septal Defect

Background: There are many techniques in repairing complete atrioventricular septal defect including: double patch technique, classic single patch technique and modified single patch technique. It's still debated which of these techniques is superior to the other one, our objective was to contrast the outcomes following surgery between the modified single patch and double patch techniques for repair of complete atrioventricular septal defect. Methods: This study includes 100 infants who underwent complete atrioventricular septal defect repair. Individuals were split into patients repaired with modified single patch as group A (n= 50), and patients repaired with double patch as group B (n= 50). Results: Group B showed significantly higher Cardiopulmonary bypass time (110 ±12 vs. 88 ±8 min, P < 0.001) Aortic cross clamp time (81 ±7 vs. 61 ±5 min, P < 0.001), ICU stay (10 ±1 vs. 9 ±1 day, P < 0.001), hospital stay (17 ±2 vs. 15 ±1 day, P < 0.001), and drainage amount (310 ±98 vs. 194 ±80, P < 0.001). No changes observed among groups of the study in other operative or postoperative statistics. Conclusion: Modified single-patch repair and two-patch repair did not yield significantly different results in the total correction of atrioventricular septal defects

The Preoperative Use of Levosimendan in Patients undergoing Coronary Artery Bypass Surgery with Low Ejection Fraction

Background: Levosimendan is a calcium sensitizer with positive inotropic, vasodilatory, and cardioprotective actions. Levosimendan infusion time may affect the outcomes. Our objective was to evaluate its efficacy and safety when used before coronary artery bypass grafting (CABG) in patients with low ejection fraction. Methods: This prospective observational study included 150 CABG patients with ejection fraction ≤ 40% divided into two groups. In the Levosimendan group (n= 75), it was given preoperatively, and in the conventional group (n= 75), myocardial support was used if indicated. Results: Operative time (344±28.7 vs. 421.4±34.5 min) and cardiopulmonary bypass time (97±17.4 vs. 127.4±24.5) were significantly shorter in the Levosimendan group (P˂ 0.001, for both). Failure to wean from bypass (13 (17.3%) vs. 23 (30.7%), P=0.06) and the need for intra-aortic balloon pump (6 (8%) vs. 14 (18.7%), P= 0.06) were non significantly lower in the Levosimendan group. The mechanical ventilation duration (12±3.3 vs. 19.6±4.7 h, P= 0.04) and ICU stay (3.8±1.2 vs. 5.3±1.4 days, P ˂ 0.001) were lower with levosimendan. Mortality was non-significantly lower in the Levosimendan group (10 (13.3%) vs. 18 (24%), P= 0.09). There were no differences in atrial and ventricular arrhythmias between groups. Conclusion: The preoperative use of levosimendan could improve the outcomes in patients undergoing CABG with low ejection fraction. Levosimendan complication profile was comparable to the conventional approac

African vulture optimizer algorithm based vector control induction motor drive system

This study describes a new optimization approach for three-phase induction motor speed drive to minimize the integral square error for speed controller and improve the dynamic speed performance. The new proposed algorithm, African vulture optimizer algorithm (AVOA) optimizes internal controller parameters of a fuzzy like proportional differential (PD) speed controller. The AVOA is notable for its ease of implementation, minimal number of design parameters, high convergence speed, and low computing burden. This study compares fuzzy-like PD speed controllers optimized with AVOA to adaptive fuzzy logic speed regulators, fuzzy-like PD optimized with genetic algorithm (GA), and proportional integral (PI) speed regulators optimized with AVOA to provide speed control for an induction motor drive system. The drive system is simulated using MATLAB/Simulink and laboratory prototype is implemented using DSP-DS1104 board. The results demonstrate that the suggested fuzzy-like PD speed controller optimized with AVOA, with a speed steady state error performance of 0.5% compared to the adaptive fuzzy logic speed regulator’s 0.7%, is the optimum alternative for speed controller. The results clarify the effectiveness of the controllers based on fuzzy like PD speed controller optimized with AVOA for each performance index as it provides lower overshoot, lowers rising time, and high dynamic response

Orogenic Gold in Transpression and Transtension Zones: Field and Remote Sensing Studies of the Barramiya–Mueilha Sector, Egypt

Multi-sensor satellite imagery data promote fast, cost-efficient regional geological mapping that constantly forms a criterion for successful gold exploration programs in harsh and inaccessible regions. The Barramiya–Mueilha sector in the Central Eastern Desert of Egypt contains several occurrences of shear/fault-associated gold-bearing quartz veins with consistently simple mineralogy and narrow hydrothermal alteration haloes. Gold-quartz veins and zones of carbonate alteration and listvenitization are widespread along the ENE–WSW Barramiya–Um Salatit and Dungash–Mueilha shear belts. These belts are characterized by heterogeneous shear fabrics and asymmetrical or overturned folds. Sentinel-1, Phased Array type L-band Synthetic Aperture Radar (PALSAR), Advanced Space borne Thermal Emission and Reflection Radiometer (ASTER), and Sentinel-2 are used herein to explicate the regional structural control of gold mineralization in the Barramiya–Mueilha sector. Feature-oriented Principal Components Selection (FPCS) applied to polarized backscatter ratio images of Sentinel-1 and PALSAR datasets show appreciable capability in tracing along the strike of regional structures and identification of potential dilation loci. The principal component analysis (PCA), band combination and band ratioing techniques are applied to the multispectral ASTER and Sentinel-2 datasets for lithological and hydrothermal alteration mapping. Ophiolites, island arc rocks, and Fe-oxides/hydroxides (ferrugination) and carbonate alteration zones are discriminated by using the PCA technique. Results of the band ratioing technique showed gossan, carbonate, and hydroxyl mineral assemblages in ductile shear zones, whereas irregular ferrugination zones are locally identified in the brittle shear zones. Gold occurrences are confined to major zones of fold superimposition and transpression along flexural planes in the foliated ophiolite-island arc belts. In the granitoid-gabbroid terranes, gold-quartz veins are rather controlled by fault and brittle shear zones. The uneven distribution of gold occurrences coupled with the variable recrystallization of the auriferous quartz veins suggests multistage gold mineralization in the area. Analysis of the host structures assessed by the remote sensing results denotes vein formation spanning the time–space from early transpression to late orogen collapse during the protracted tectonic evolution of the belt

The optimal sequence of radiotherapy and chemotherapy in adjuvant treatment of breast cancer

<p>Abstract</p> <p>Background</p> <p>The optimal time sequences for chemotherapy and radiation therapy after breast surgery for patients with breast cancer remains unknown. Most of published studies were done for early breast cancer patients. However, in Egypt advanced stages were the common presentation. This retrospective analysis aimed to assess the optimum sequence for our population.</p> <p>Methods</p> <p>267 eligible patients planned to receive adjuvant chemotherapy [FAC] and radiotherapy. Majority of patients (87.6%) underwent modified radical mastectomy while, 12.4% had conservative surgery.</p> <p>We divided the patients into 3 groups according to the sequence of chemotherapy and radiotherapy. Sixty-seven patients (25.1%) received postoperative radiotherapy before chemotherapy [group A]. One hundred and fifty patients (56.2%) were treated in a sandwich scheme (group B), which means that 3 chemotherapy cycles were given prior to radiotherapy followed by 3 further chemotherapy cycles. A group of 50 patients (18.7%) was treated sequentially (group C), which means that radiotherapy was supplied after finishing the last chemotherapy cycle. Patients' characteristics are balanced between different groups.</p> <p>Results</p> <p>Disease free survival was estimated at 2.5 years, and it was 83.5%, 82.3% and 80% for patient receiving radiation before chemotherapy [group A], sandwich [group B] and after finishing chemotherapy [group C] respectively (p > 0.5). Grade 2 pneumonitis, which necessitates treatment with steroid, was detected in 3.4% of our patients, while grade 2 radiation dermatitis was 17.6%. There are no clinical significant differences between different groups regarded pulmonary or skin toxicities.</p> <p>Conclusion</p> <p>Regarding disease free survival and treatment toxicities, in our study, we did not find any significant difference between the different radiotherapy and chemotherapy sequences.</p