Effect of Obesity on Dural Puncture Epidural Analgesic Onset in Parturients Scheduled for Normal Vaginal Delivery

Background: Obese parturients are at higher risk for epidural analgesic failure, so the dural puncture epidural (DPE) technique may have particular advantage in this population. DPE has been suggested to improve the efficacy of labor epidural analgesia, potentially by facilitating the translocation of medication from the epidural to intrathecal space.   Objective: We designed this prospective interventional study to explore the influence of obesity on DPE technique regarding labor analgesia onset and quality.   Methods: Design: A prospective interventional study.   Patients: 64 parturients were consented to receive a DPE labor analgesia. Parturients were assigned according to pregestational body mass index groups into normal weight and obese groups. After successful placement of the epidural catheter and puncturing the dura, analgesic regimen was initiated.   Main outcome measure: The primary outcome was median time to onset of sensory block assessed by Kaplan-Meier analysis.   Results: Using Kaplan-Meier curve, we found median time to onset of sensory block 6 min in obese parturients compared with 13 min in non obese. Difference between both groups was statistically significant (Logrank Chi-squared = 56.663, df = 1, p < 0.0001). Incidence rate ratio (95% CI) = 21.0 (9.51, 46.5). No asymmetrical block was noticed in both groups, but a higher incidence of perineal dose supplementation and postoperative nausea were observed in obese group Conclusion: DPE offers a favorable risk–benefit ratio for management of neuraxial analgesia in obese parturient. Further studies comparing different volume, concentration, method of application of DPE local anesthetic are needed

Quality of life and glycemic control in adolescents with type 1 diabetes and the impact of an education intervention

Mostafa A Abolfotouh1,*, Mofida M Kamal2,*, Mohamed D El-Bourgy2,*, Sherine G Mohamed2,*1King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, Kingdom of Saudi Arabia; 2Department of Health Administration and Behavioral Sciences, High Institute of Public Health, Alexandria University, Alexandria, Egypt; *All authors contributed equally to this workObjective: To assess quality of life (QoL) and glycemic control in adolescents with type 1 diabetes and to investigate the impact of an educational program.Methods: A quasiexperimental study with nonrandomized experimental and control groups was conducted in which a total of 503 adolescents with type 1 diabetes completed a questionnaire using the Diabetes Quality of Life Instrument for Youth. Adolescents were then assigned to experimental and control groups. The experimental group was subjected to four 120-minute sessions of an educational program over a period of 4 months. Extracted medical chart data included the duration of diabetes, insulin dosage, and most recent hemoglobin A1c levels. Analysis of covariance was used to detect the impact of intervention.Results: The overall mean QoL score (%) was 76.51 ± 9.79, with good QoL in 38% of all adolescents. Poorer QoL was significantly associated with older age (P < 0.001), more hospital admissions in the last 6 months (P = 0.006), higher levels of depression (P < 0.001), poor self-esteem (P < 0.001), and poor self-efficacy (P < 0.001). There was significant deterioration in all domains of QoL in the experimental group after intervention. However, this deterioration was significantly less severe than in the control group. Between-group effects on total knowledge, adherence to exercise, glucose monitoring, treatment, self-efficacy, family contribution to management, glycemic control, and satisfaction with life were significantly in favor of the experimental group.Conclusion: Education intervention for adolescents with type 1 diabetes could be a safeguard against possible deterioration in QoL and glycemic control over time.Keywords: adolescents, diabetes, QoL, glycemic, intervention&nbsp

Starlike and convex functions of complex order involving generalized multiplier transformations

summary:We investigate the starlike, convex and close-to-convex functions of complex order involving generalized multiplier transformations by means of the Hadamard product

Effect of aluminum content on structure, transport and mechanical properties of Sn-Zn eutectic lead free solder alloy rapidly solidified from melt.

The greatest advantage of Sn-Zn eutectic is its low melting point (198 oC) which is close to the melting point. of Sn-Pb eutectic solder (183 oC), as well as its low price per mass unit compared with Sn-Ag and Sn-Ag-Cu solders. In this paper, the effect of 0.0, 1.0, 2.0, 3.0, 4.0, and 5.0 wt. % Al as ternary additions on melting temperature, microstructure, microhardness and mechanical properties of the Sn-9Zn lead-free solders were investigated. It is shown that the alloying additions of Al at 4 wt. % to the Sn-Zn binary system lead to lower of the melting point to 195.72 ?C. From x-ray diffraction analysis, an aluminium phase, designated ?-Al is detected for 4 and 5 wt. % Al compositions. The formation of an aluminium phase causes a pronounced increase in the electrical resistivity and microhardness. The ternary Sn-9Zn-2 wt.%Al exhibits micro hardness superior to Sn-9Zn binary alloy. The better Vickers hardness and melting points of the ternary alloy is attributed to solid solution effect, grain size refinement and precipitation of Al and Zn in the Sn matrix. The Sn-9%Zn-4%Al alloy is a lead-free solder designed for possible drop-in replacement of Pb-Sn solders

CAFFEINEAS A PROMISING ANTIFBROTIC AGENT AGAINST CCL4-INDUCED LIVER FIBROSIS

Objective: Hepatic fibrosis is a wound-healing process in the liver with chronic injury and is characterized by an excess production and deposition of extracellular matrix (ECM) components. Our aim is to investigate the hepatoprotective effects of caffeine against CCL4-induced liver fibrosis in rats and to be compared with the reference standard N-acetylcysteine (NAC).Methods: Rats were divided into 5 groups (n=8), the 1st group served as normal control, the 2nd group received corn oil, the 3rd group is a fibrosis control and the remaining two groups received in addition to CCL4, NAC (150 mg/kg/day) as a reference treatment and caffeine (15 mg/kg/day). At the end of experimental period the following parameters were measured, specific fibrosis biomarkers [hepatic transforming growth factor β1(TGF-β1) and hepatic hydroxyproline (HYP)], liver function biomarkers [serum alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin and albumin], lipid profile [serum triglycerides, total cholesterol, low density lipoprotein cholesterol (LDL-Ch) and high density lipoprotein cholesterol (HDL-Ch)], inflammatory biomarkers [serum tumor necrosis factor alpha (TNF-α), hepatic myeloperoxidase (MPO)], oxidative stress biomarkers [hepatic malondialdehyde (MDA), glutathione (GSH) and catalase (CAT)], relative liver body weight and liver histopathological study.Results: Caffeine significantly improved all the aforementioned biochemical parameters and liver sections obtained from this group showed prominent histopathological improvement.Conclusion: Caffeine hepatoprotective effects may be due to modulation of the fibrous scar formation, Improvement of liver function, Anti-inflammatory and antioxidant potentials

Some properties for certain class of analytic functions defined by convolution

In this paper, we introduce a new class H_{T}(f,g;\alpha ,k) of analytic functions in the open unit disc U={z\in \mathbb{C}: left\vert z \right\vert <1} defined by convolution. The object of the present paper is to determine coefficient estimates, extreme points, distortion theorems, partial sums and integral means for functions belonging to the class H_{T}(f,g;\alpha ,k). We also obtain several results for the neighborhood of functions belonging to this class

Post-transplant anemia in pediatric patients and its impact on patient and graft survival: single center experience

Introduction: Post-transplantation anemia (PTA)occurs frequently, with prevalence rates between 20and 60% depending on the criteria used for defininganemia.Aim of the work: We aimed to assess the prevalenceof anemia after 6 months of transplantation inpediatric renal transplant patients under differentprotocols of immunosuppression, and to determinethe impact of anemia upon long-term patient andgraft survival.Patients and methods: Based on the data of 108renal transplants performed in our center, patientswere categorized after 6 months according to theirhemoglobin (Hb) levels into two groups. The firstgroup with Hb more than 11gm/dl (group I, 29cases) and the second group with Hb lessthan11gm/dl (group II, 79cases). We compared thetwo groups regarding post transplant complications(rejection episodes, hypertension, diabetes mellitus,infections, hepatic dysfunction, and patient andgraft survival.Results: we found no significant difference betweenthe two groups regarding rejection episodes.However, the percentage of cases with chronicallograft nephropathy was significantly higher in the anemic group. The survivors with functioning graftswere significantly higher in cases with normal Hb.Moreover, living cases with graft failure weresignificantly higher in anemic group. Graft survivalrate was better in the non anemic group. However,no difference in patient survival was detected. Also,we found no difference between the two groupsregarding post-transplant complications.Conclusions: From this study, we can conclude thatthe prevalence of post-transplant anemia is highpediatric renal transplant patients especially thosereceiving CNI and MMF, and it was associated withpoorer graft outcome but no effect on patientsurvival

Microwave Assisted Synthesis Of Binary Metallic Oxides For Catalysis Applications

Herein, versatile, and reproducible method to prepare binary metal oxides via microwave assisted synthesis. Catalysts are substances that basically speeds up chemical reactions. Ideally, bonds are formed between the catalysts and the reactants. Also, catalysts permit formation of products from the reactants. These formed products, splits off the catalyst without affecting or changing it. Catalytic kinetics studies the correlate chemical reaction rate with some properties of reactants and/or products for instance, temperature, concentration and pressure. The aim of the project is to prepare pure and bi-metal iron-based catalyst by co-precipitation method and to characterize the prepared sample using X-ray diffraction. Metal oxides nanoparticles is a field of interest in catalysis, such that these oxides are used to oxidize carbon monoxide. The samples were prepared through co-precipitation method in laboratory scale. The metals used was copper, iron and cobalt. After preparing pure sample of each metal a mix of two metals were introduced in different ratios. The samples were characterized via X-ray diffraction (XRD) and then the results were compared to exist data introduced from others research, the prepared samples XRD was having a great matching with the data retrieved from internet and we found that the metal could exist in two form of oxides and even could exist as pure metal. Each peak in the XRD figure could indicate one or more phase of the metal

Placental pouch closure: a novel, safe and effective surgical procedure for conservative management of placenta accreta

Background: Placenta accreta spectrum (PAS) has become a global problem secondary to the high rate of cesarean delivery (CD). The current study presents an effective surgical procedure (placental pouch closure) for uterine preservation in patients with PAS. Methods: We applied this procedure in sixty cases at a tertiary university hospital between September 2017 and January 2019. We included women who were diagnosed as PAS based on preoperative ultrasound and Doppler evaluation, and who had the desire for uterine preservation. Results: The procedure was successful in almost all cases; the uterus was conserved 98.33 % of participants, with no associated severe maternal morbidities or mortality. In all cases, no additional surgical procedures were needed. The mean blood loss was 1263 ml, and the mean number of units of blood required for transfusion was 2.31 units. Conclusion: Identifying and meticulously closing the placental pouch is a novel surgical procedure for conservative management of PAS. In well-selected cases with the availability of facilities and expertise, the technique could have a place as a safe and effective surgical technique in women presenting with placenta accreta who desire uterine preservation. Trial registration number: NCT03241849. Registered on August 8, 201