Peripartum hysterectomy for cesarean section with morbidly adherent placenta: case series of 25 patients

Background: The current paper reports the outcome of case series of patients presented with placenta accreta confirmed histopathologicaly after management by peripartum hysterectomy.Methods: The study was set in Women’s Health Hospital, Assiut University, Egypt. This was a case series of 25 women presented with placenta accreta between May 2017 and April 2018. We included all pregnant women with placenta previa as diagnosed by ultrasound with suspicion of abnormal placentation by Doppler, confirmed intra-operatively undergoing either emergent or elective CS. All cases were performed by an expert team of obstetricians and anesthetists. Cesarean delivery was done under general anesthesia through pfannensteil incision. The primary outcome was the estimated intra-operative blood loss through assessment of amount of blood in the suction by ml, difference between the weight of surgical drapes and towels before and after operation.Results: Pre-operative Hb was 10.64±1.01 gm/dL and there was significant decline in the postoperative Hb reaching 8.36±1.21 gm/dL (p<0.001). The mean drop in Hb was 2.28±1.43gm/dL. Estimated intra-operative blood loss was 974.4±398.05 ml in the towels and 847.6±362.56 ml in the suction apparatus. The total blood loss was 1822±653.73 ml. The mean number of units of whole blood transfused was 2160.0±825.6 ml and fresh frozen plasma was 1010.0±349.7 ml. Regarding intra-operative complications, bladder injury was the most common one in 14 cases (56%), followed by ureteric injury in two cases (8%). Postoperative ICU admission was in 6 cases (24%) and the mean duration of hospital stay 12.44 ± 4.07 days. No cases of maternal mortality.Conclusions: In conclusion, peripartum hysterectomy is considered life-saving surgery in patients with placenta accreta

CNC Machining Path Planning Optimization for Circular Hole Patterns via a Hybrid Ant Colony Optimization Approach

Abstract This paper presents a path-planning optimization study for a Computer Numerical Control (CNC) machining center tasked with machining jobs involving a large number of holes to drill that are mostly arranged in concentric circular patterns. Benefits of this research may contribute to shortening the machining time in certain components used in heat exchangers, boilers, condensers, trammel screens and food separators. Optimization of tool travel distance and machining cost are typically overlooked aspects when generating tool paths and CNC codes from commercially available CAD software packages. Tool path travel distance minimization can be modelled Travelling Salesman Problem (TSP). Optimization algorithms have been heavily applied in the literature to the TSP with varying levels of success. Ant Colony Optimization (ACO) is one of the most prominent approaches that mimics the natural behavior of ant colonies. The research in this paper proposes a hybrid ACO that has a biasing mechanic designed to take advantage of the geometric hole-pattern arrangement, as well as a local search. Simulation examples show the proposed approach exhibiting superior performance compared to the classic ACO approach, a genetic algorithm (GA) approach, as well as the simple spiral path generated via commercial CAD software. The proposed approach is then applied to the drilling path planning of a two-thousand-hole food-industry separator plate

The impact of adding fetal MRI to sonographically diagnosed intrauterine ventriculomegaly: a prospective cohort study

Objective: Intrauterine fetal ventriculomegaly (IVM) is one of the most commonly detected fetal anomalies. Prenatal diagnosis in IVM is considered a challenge with a significant impact on management. The current study aims to evaluate the added value of performing fetal MRI to sonographically diagnosed IVM. Methods: A prospective cohort study was conducted at a tertiary University Hospital in the period between January 2017 and March 2019. We included pregnant women with a single fetus sonographically diagnosed IVM (symmetrical or asymmetrical). First, a basic obstetric sonographic examination was done, followed by a detailed (2D/3D) fetal CNS anomaly scan for the detection of other associated anomalies. A fetal MRI brain scan was performed for all cases. Results: Sixty women were included in the study. Of the 60 fetuses with IVM, additional findings were seen on MRI in 14 cases (23%), and most of these findings were identified in fetuses with severe IVM (about 50%). No additional abnormalities were identified in fetuses of less than 24 weeks gestation. Callosal and septum pellucidum lesions (29%), along with posterior fossa abnormalities (28%) and cortical malformations (21%) accounted for the most common additional significant fetal MRI findings. Fetal MRI sensitivity, specificity, and positive and negative predictive values in correlation with those of prenatal ultrasound turned out to be notably higher, approaching nearly 100 %. Conclusions: Fetal MRI for sonographically diagnosed moderate or severe IVM is recommended to guide clinical management

Effectiveness of microwave technique in early detection of breast abnormalities

In this paper, a breast phantom of CIRS Model 010A contains various known masses and sizes is studied. A measurement of S11 signals is taken at few locations on a breast surface using an open-ended coaxial probe. The obtained signals permit the extraction of the dielectric property of the masses. The result has shown that the smallest size detected through this probe is approximately 0.20 mm, small enough to be detected at early stage breast abnormality growth. This method undoubtedly recognizes the presence and location of possible abnormalities such as benign and malignant tissues. Although the model does not contain malignant tissues, this study demonstrates the viability of detecting small breast tumors using this approach. Index Terms - Breast abnormalities, dielectric properties, microwave technique, open-ended coaxial probe

A Closer Look at Precision Hard Turning of AISI4340: Multi-Objective Optimization for Simultaneous Low Surface Roughness and High Productivity

This article reports an extended investigation into the precision hard turning of AISI 4340 alloy steel when machined by two different types of inserts: wiper nose and conventional round nose. It provides a closer look at previously published work and aims at determining the optimal process parameters for simultaneously minimizing surface roughness and maximizing productivity. In the mathematical models developed by the authors, surface roughness at different cutting speeds, depths of cut and feed rates is treated as the objective function. Three robust multi-objective techniques, (1) multi-objective genetic algorithm (MOGA), (2) multi-objective Pareto search algorithm (MOPSA) and (3) multi-objective emperor penguin colony algorithm (MOEPCA), were used to determine the optimal turning parameters when either the wiper or the conventional insert is used, and the results were experimentally validated. To investigate the practicality of the optimization algorithms, two turning scenarios were used. These were the machining of the combustion chamber of a gun barrel, first with an average roughness (Ra) of 0.4 µm and then with 0.8 µm, under conditions of high productivity. In terms of the simultaneous achievement of both high surface quality and productivity in precision hard turning of AISI 4340 alloy steel, this work illustrates that MOPSA provides the best optimal solution for the wiper insert case, and MOEPCA results are the best for the conventional insert. Furthermore, the results extracted from Pareto front plots show that the wiper insert is capable of successfully meeting both the requirements of Ra values of 0.4 µm and 0.8 µm and high productivity. However, the conventional insert could not meet the 0.4 µm Ra requirement; the recorded global minimum was Ra = 0.454 µm, which reveals the superiority of the wiper compared to the conventional insert

Menopause Anxiety and Depression; How Food Can Help?

BACKGROUND: Anxiety and depression are reported as two major frequent and chief complaints among peri-menopausal women in several societies. AIM: The objective of the study was to study the effect of using two dietary supplements to beat depression and anxiety associated with menopause. SUBJECTS AND METHODS: Sixty-six volunteers’ menopausal women participated on the study for 8 weeks, 35 subjects consumed daily cookies prepared mainly from soya flour and flaxseed, and 31 females consumed daily a blend composed mainly of raw unroasted peanut and raw sesame. Follow-up was performed with menopause rating scale, anxiety score, depression score, and biochemical parameters. RESULTS: Soya cookies were rich in plant-based protein and total phenols while blend was a good source of unsaturated fatty acid. Blend consumers showed significant percentage reduction in beck anxiety score and beck depression score after intervention, more than cookies consumers group. The anthropometrics parameters were statistical significant changed on both groups, more on the group who consumed the soya cookies. Soya cookies demonstrated an anti-inflammatory effect, while blend had an antioxidant and anti-inflammatory effects as was shown on the serum assay of interleukin-6 and malondialdehyde as an inflammatory marker and an antioxidant marker, respectively. CONCLUSION: From the results, it can be concluded that the supplementation of products enriched with unsaturated fatty acid was more beneficial to slow down the psychological menopause symptoms than natural estrogen rich product consumption

Drinking Water Quality I: Effects on Broiler Chicks Performance During Summer Season

Abstract: This experiment was carried out to examine the effects of different sources of water on broiler chick&apos;s performance during summer season. Samples of water were taken from different sources (commercial, Nile and well). Physical, chemical and bacteriological analysis of samples revealed that, levels of salinity, hardness, and alkalinity, Ca, Mg, Na and K in the well water were higher than those in the Nile and commercial water. Higher levels of sulphate and chloride were found in the commercial water. Total bacterial count was higher in the Nile water than in the commercial and well water. Water and feed consumption, water/feed consumption ratio, weight gain, feed conversion ratio, final live body weight and mortality rate of broiler chicks were not significantly (P&gt; 0.05) affected by the different sources of water. Commercial water when given to broiler chicks during summer season resulted in significantly higher (P&lt; 0.01) level of plasma potassium and inorganic phosphorous concentrations compared to well water. Nile and well water increased (P&lt; 0.01) calcium concentration of plasma when offered to broiler chicks than did commercial water. Sodium and magnesium concentrations of plasma were not significantly (P&gt; 0.05) affected by different treatments

Effect of dexamethasone on reducing pain and gastrointestinal symptoms associated with cesarean section: a systematic review and meta-analysis

Background: Dexamethasone has analgesic and antiemetic actions that have been documented in the literature. Therefore, we performed a systematic review and meta-analysis to investigate its overall effectiveness in reducing a variety of negative outcomes after cesarean section. Objectives: To investigate the efficacy and safety of dexamethasone for reducing pain associated with cesarean section, nausea, vomiting, pruritus, postoperative need for analgesia, postoperative antiemetic requests and headache. Methods: We searched PubMed, Cochrane CENTRAL, SCOPUS, and Web of Science for relevant clinical trials. We then performed a systematic review and meta-analysis, including only randomized, placebo-controlled clinical trials. Our main population target was women undergoing elective cesarean delivery. The intervention under consideration was dexamethasone administered both by intravenous (IV) or subcutaneous (SC) over a variety of doses. The comparator was a placebo. Our main outcomes included: (1) perceptions as indicated by pain scores, (2) occurrence of nausea and (3) occurrence of vomiting. Secondary outcomes included: (4) occurrence of pruritus, (5) need for postoperative analgesia, (6) need for postoperative antiemetic drugs and (7) occurrence of headache. We assessed the quality of included studies using the risk of bias tool described in Cochrane\u27s handbook for systematic reviews of interventions. Results: We found that dexamethasone seemed to significantly reduce scores for pain at rest (p<0.001), as well as occurrence of nausea (p<0.001) and vomiting (p<0.001). The drug also showed significant reduction of negative symptoms in other secondary outcomes, including need for postoperative analgesia (p<0.001) and postoperative antiemetic drugs (p<0.001). However, the drug showed no significant effect in reducing headache and pruritus or in improving pain at movement scores. Conclusion: Dexamethasone appears to decrease perception of pain at rest and protects against nausea and vomiting. However, it does not seem effective against headaches or pruritus