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

Uterine sparing approaches in management of placenta accreta: a summarized review

Placenta accreta is a potentially life-threatening obstetric condition that required multidisciplinary approach to management. Placenta accreta occurs in complete absence of the decidua basalis. Women with previous cesarean section delivery or placenta previa are known to be at greater risk of placenta accreta. A previous study reported that 24%& 67% increase in the incidence of placenta accreta in women 1 versus 3 or more previous cesarean deliveries respectively. Antenatal diagnosis of placental invasion has the potential to improve maternal and fetal outcomes. In practice, incomplete non-separation of the placenta at delivery leads to massive obstetric hemorrhage resulting in maternal morbidities such as massive blood transfusion, DIC, injury to the bladder and intestines and the need for hysterectomy. Sonographic examination with gray scale and color doppler imaging is the recommended first line modality for diagnosis of morbidly adherent placenta. Techniques developed for conservative management are techniques developed to preserve uterus and future fertility which is crucially linked to societal status and self-esteem

Laparoscopic and bacteriologic evidence of bacterial vaginosis in unexplained infertility

Background: Aim of current study was to estimate the prevalence of Bacterial Vaginosis (BV) among women with Unexplained Infertility (UI) and to describe laparoscopic appearances in positive cases.Methods: Design: Prospective randomized comparative diagnostic trial. Setting: Tertiary care referral facility and University hospital. Patients: One hundred and fifty women divided into UI study group A (120 cases) and a control group B (30 cases). Intervention(s): Vaginal and endouterine swabs form two subgroups of the UI group (60 cases each) and vaginal swabs from control group (30 cases). All swabs were tested using Amsel's criteria then cultured. Thereafter, UI group (60 cases) was subjected to diagnostic laparoscopy. Main outcome measure(s):  the prevalence of BV among women with UI and laparoscopic findings among positive cases.Results: In the study group, the number of positive cases of BV confirmed by culture was 51 cases (42.5%) while it was diagnosed in three cases (10%) in group B (P = 0.0001). In group A, BV was diagnosed in 24 and 27 infertile cases with periods of infertility less than and more than 3 years respectively and in 39 patients (32.5%) with recurrent vaginitis without statistically significant difference. There was an insignificant difference in diagnosis of BV whether the site of sample was the posterior fornix of the vagina or the endometrial cavity. Positive laparoscopic findings were reported in 77 patients (64.2%). The most common laparoscopic abnormalities were hyperemic uterus and chronic salpingitis.   Conclusions: BV is frequently implicated in female infertility and it is probably an underestimated cause of UI. There is no extra benefit from using culture instead of Amsel’s criteria for the diagnosis of BV.  No difference in the site of sample taking in diagnosis of BV from posterior vaginal fornix or endometrial cavity.  Laparoscopy is very beneficial in explaining the effect of BV on the upper genital tract

Longitudinal changes in peri-papillary retinal nerve fiber layer thickness in patients with unilateral branch retinal vein occlusion

Background: Associations between retinal venous occlusion (RVO), elevated intraocular pressure, and glaucoma have been reported. Further investigations into structural alterations in the fellow eyes of individuals with unilateral RVO have revealed that the peripapillary retinal nerve fiber layer is thinner than in healthy eyes, suggesting that there may be systemic risk factors common to both RVO and glaucoma. We aimed to evaluate changes in peripapillary retinal nerve fiber layer thickness (pRNFLT) among individuals with unilateral branch retinal vein occlusion (BRVO). Methods: This prospective observational study recruited 30 individuals (60 eyes) with newly diagnosed unilateral BRVO and macular edema, and a control group of 30 healthy individuals (30 eyes) with no abnormalities on fundus examination or concurrent systemic comorbidities. After baseline measurements, the participants were reassessed at 6, 12, and 24 months by measuring global and sectoral pRNFLT using spectral-domain optical coherence tomography. Results: The mean age and sex distributions were comparable between the patient and control groups (both P &gt; 0.05). When compared to fellow eyes, global and sectoral pRNFLT in eyes with BRVO were significantly higher at baseline (all P &lt; 0.05). Over time, pRNFLT decreased dramatically, and by the conclusion of the two-year follow-up, there was a significant reduction from baseline in the affected eyes (all P &lt; 0.05). Likewise, affected eyes experienced a significant improvement in best-corrected distance visual acuity and central macular thickness over the two-year follow-up (both P Less than or equal to 0.001). Comparing the global and all-sector pRNFLT of fellow eyes in the patient group with those of normal eyes in the control group, there were no significant differences at any visit, except in the temporal sector, which revealed a significant reduction in pRNFLT at 24 months in the fellow eyes of patients with unilateral BRVO (P = 0.02).&nbsp;&nbsp; Conclusions: Patients with unilateral BRVO experienced a significant reduction in pRNFLT in the affected eyes and, to a lesser extent, in the fellow eyes, compared with that of the control arm, suggesting that they are prone to retinal nerve fiber layer damage. The reduction in pRNFLT in the normal fellow eyes of patients with BRVO may be attributed to age or concurrent systemic comorbidities. Further studies with long follow-up periods are required to shed light on the etiology of functional and structural changes in both the retinal nerve fiber layer and ganglion cell complex in the normal and affected eyes of patients with unilateral BRVO

Mean centering of ratio spectra and successive derivative ratio spectrophotometric methods for determination of isopropamide iodide, trifluoperazine hydrochloride and trifluoperazine oxidative degradate

Two sensitive, selective and precise stability indicating methods for the determination of isopropamide iodide (ISO), trifluoperazine hydrochloride (TPZ) and trifluoperazine oxidative degradate (DEG) were developed and validated. Method A is a successive derivative ratio spectrophotometric one, which depends on the successive derivative of ratio spectra in two steps using 0.1 N HCl as a solvent and measuring TPZ at 250.4 and 257.2 nm, ISO at 223 and 228 nm and DEG at 210.6, 213 and 270.2 nm. Method B is mean centering of ratio spectra which depends on using the mean centered ratio spectra in two successive steps and measuring the mean centered values of the second ratio spectra at 322, 355 and 339 nm for TPZ, ISO and DEG, respectively. Factors affecting the developed methods were studied and optimized, moreover, they have been validated as per ICH guidelines and the results demonstrated that the suggested methods are reliable, reproducible and suitable for routine use with short analysis time. Statistical analysis of the two developed methods with the reported one using F- and Student’s t-test showed no significant difference regarding accuracy and precision

Split source inverter: Topology and switching modulation improvements—A review

Single-stage DC-AC converters with boost capabilities are highly required in power conversion processes compared to two-stage converters due to a reduced number of components, weight, size, cost, and complexity. The literature has reported several types of single-stage converters, each has its advantages and drawbacks. In order to satisfy the rising demand for these applications, new single-stage converter topologies are increasingly proposed. Recently Split Source Inverter (SSI) has been presented due to its ease of operation, and less stress. In addition, it has lesser passive components and the same switching states as the Voltage Source Inverter (VSI), this paper aims to comprehensively classify and review conventional and modified topologies of SSI, where the operation, the charging and discharging states, merits, and demerits are mentioned

Long term behavior of rubberized concrete under static and dynamic loads

Eco-friendly recycled tire-derived rubberized concrete is an environmentally conscious alternative employed in civil engineering for diverse purposes, enhancing the characteristics of concrete. In this paper, the research focuses on examining the drying shrinkage, creep, impact, and post-impact and creep behavior of concrete incorporating rubber. Four groups of cylindrical samples, each with a diameter of 150 mm and a length of 300 mm, were subjected to a consistent load corresponding to 0.25 of the bearing load capacity determined through compression tests on identical concrete mixtures. The testing spanned a year, during which measurements were taken for total strain, dependent strain, creep, and shrinkage. The concrete mixtures were formulated with crumb rubber in place of fine aggregate sand, with varying percentages (0%, 10%, 20%, and 30%). To emphasize distinctions in outcomes across mixtures with different crumb rubber proportions, tests for compression, indirect tension, flexural strength, and impact resistance were carried out at intervals of 28 days, three months, six months, and one year. The examination and contrast of the four combinations demonstrated notable effects on both concrete creep and impact energy due to the addition of rubber particles. Despite this, shrinkage showed minimal influence. In general, there was a decrease in the compressive strength of rubberized concrete. The concrete compressive strength decreased by 25–35%, 45–50%, and 55–65% for rubberized concrete incorporating 10%, 20%, and 30% crumb rubber, respectively. Furthermore, it was observed that creep negatively affects the impact resistance of non-rubberized concrete. Nevertheless, including rubber helps mitigate the effect of creep on the impact resistance, resulting in a reduction ranging from 6% to 12% across rubber percentages from 10% to 30%

Tramadol Induced Adrenal Insufficiency: Histological, Immunohistochemical, Ultrastructural, and Biochemical Genetic Experimental Study

Tramadol is a synthetic, centrally acting analgesic. It is the most consumed narcotic drug that is prescribed in the world. Tramadol abuse has dramatically increased in Egypt. Long term use of tramadol can induce endocrinopathy. So, the aim of this study was to analyze the adrenal insufficiency induced by long term use of tramadol in experimental animals and also to assess its withdrawal effects through histopathological and biochemical genetic study. Forty male albino rats were used in this study. The rats were divided into 4 groups (control group, tramadol-treated group, and withdrawal groups). Tramadol was given to albino rats at a dose of 80 mg/kg body weight for 3 months and after withdrawal periods (7–15 days) rats were sacrificed. Long term use of tramadol induced severe histopathological changes in adrenal glands. Tramadol decreased the levels of serum cortisol and DHEAS hormones. In addition, it increased the level of adrenal MDA and decreased the genetic expression of glutathione peroxidase and thioredoxin reductase in adrenal gland tissues. All these changes started to return to normal after withdrawal of tramadol. Thus, it was confirmed that long term use of tramadol can induce severe adrenal insufficiency