Maternal IVIG Administration in Rhesus Alloimmunized Pregnancies: A Systematic Review

Background: Rhesus (Rh) alloimmunization occurs when an Rh negative mother is exposed to red blood cells (RBC) from an Rh positive fetus. The mother develops antibodies in the current pregnancy that attack Rh positive fetus in subsequent pregnancy, causing hemolytic disease of the fetus and newborn (HDFN). RhD is the most common antigen to result in fetal anemia requiring intrauterine transfusions (IUT). Although the traditional method of management and highly effective, IUTs carry significant risk particularly when performed early in gestation, potentially resulting in procedure-related fetal deaths. Intravenous immunoglobulin (IVIG) therapy may postpone or even replace invasive intrauterine treatment in fetuses of mothers with severe alloimmunization in previous pregnancies. Objective: To evaluate whether maternal administration of IVIG in high-risk Rhesus alloimmunized pregnancies is effective in delaying the need for IUTs as well as delaying the onset of severe fetal anemia and thus in diminishing its clinical consequences. Study design: A systematic literature search was conducted for maternal intravenous immunoglobulin administration in pregnancies with Rh isoimmunization in the following databases: Medline, Embase and Cochrane Library from 1946 to 2 February 2023. Inclusion criteria was studies done during pregnancy in which IVIG was administered to the mother in Rh alloimmunized pregnancies/fetal anemia. All non-english papers, animal papers, systematic reviews, editorials and studies in which IVIG was administered to non-pregnant patients were excluded. Data was extracted from these full texts and analyzed for inclusion based on the quantity of usable data and patient information. Extracted data included maternal antibody type and titer, number of maternal IVIG administrations, number of IUTs, and fetal Hb levels prior to first IUT and at delivery. Time interval (weeks) between IVIG and first IUT was also included in the extracted data along with gestational age at delivery. Individual patient data extraction was done for studies that provided data. Results: 16 studies were included in data analysis. Analysis of extracted data is ongoing

Fog attenuation penalty analysis in terrestrial optical wireless communication-modified duo-binary return-to-zero system with various receiver pointing errors

In metropolitan communication infrastructures a revolutionary technique is emerge known as terrestrial optical wireless communication (OWC), which makes a high-rise building connection is possible. Even with this solution, there are many other problems like the influence of haze and fog in the propagation channel which obstruct and scatter OWC propagation light and consequently led to a big attenuation, due to propagate in temporal, angular and spatial of the light signal. Not to mention the minimum visibility that discourages the implementation of the pointing errors (PE) and tracking system. This present work aims to analyze the interrelation between multiple scattering (dense fog, heavy fog, light fog, heavy haze and light haze) and receiver PE under modified duo-binary return-to-zero (MDRZ) system. We found that PE caused by beam swag is the main controlling factor and industriously minimize the link margin, signal-to-noise ratio (SNR), and raise the bit error rate (BER) when there is an increasing the turbulence strength and the track length. We recommended to guarantee transmitter– receiver alignment by installing a variable field of view (FOV) receiver (a tracking system) to overcome the scattering impact of the fog that make render urban laser communication effective in the presence of PE

Prenatal Predictors of Survival, Pulmonary Hypertension, and ECMO in Isolated CDH Undergoing Expectant Management, A Systematic Review and Meta-analysis

Background and Hypothesis: Congenital diaphragmatic hernia (CDH) is a severe developmental defect affecting 1-4 per 10,000 births, characterized by left/right-sided defect, or mixed with herniation of abdominal contents into thorax, with resultant lung hypoplasia and persistent pulmonary hypertension (PHTN). The study investigates prenatal predictors of survival to hospital discharge, PHTN and the need for ECMO in fetuses with isolated CDH undergoing prenatal expectant management. Project Methods: We performed a systematic literature review on prenatal diagnostic tests in fetuses with isolated CDH undergoing expectant management. Primary outcomes included survival-to-hospital discharge, persistent PHTN within 28 days, and ECMO need. Newcastle Ottawa Scale assessed quality of studies. Meta-analysis performed when two or more studies reported on the same test. Subgroup analysis performed according to CDH side. Results: 161 full-text articles between 2000-2022 were assed for eligibility; 48 met inclusion criteria. 45 reported on survival, 12 on ECMO need, 8 on PHTN; quality of studies was moderate. Studies included were retrospective (81%) or prospective (19%) regarding fetuses undergoing expectant management (77%), or mixed tracheal occlusion and expectant management (20%). Most studies included mixed (41%) or left-sided (47%) CDH. Survival predicted by TFLV, o/e-TFLV, o/e-TFLV <30%, LiTR, o/e-LHR, o/e-LHR <25%, percentage herniated liver, MSA, stomach position in mid-chest, and liver up. ECMO need predicted by o/e-TFLV, o/e-LHR, and PPLV. These results were confirmed through subgroup analysis of only left-sided lesions. PHTN was predicted by presence of intrathoracic liver (OR-1.96, 95%CI 1.14,3.37, I2-0%); this was not significant after left-sided subgroup analysis. Conclusion and Potential Impact: In fetuses with CDH, FLV and presence/percentage of intrathoracic liver predict survival. FLV measurements predict ECMO need. Presence of intrathoracic liver may predict persistent PHTN; further studies are needed. Accurate prognostication of CDH severity would aid patient triage, resource mobilization, and identification of high-risk CDH infants in need of advanced treatment including ECMO or identification of candidates for fetal intervention procedures

A PRACTICAL INTRUSION DETECTION APPROACH FOR ARP SPOOFING AND MITM IN LOCAL AREA NETWORKS

In modern network environments, the increasing sophistication of cyberattacks poses significant risks, particularly through Address Resolution Protocol (ARP) spoofing and Man-in-the-Middle (MITM) attacks, which exploit vulnerabilities in local area networks. Existing tools often focus on detection or protection at the client side, leaving network-wide detection and response largely unaddressed. This paper presents a novel intrusion detection tool specifically designed to identify ARP spoofing and MITM attacks in real-time within local area networks. The system leverages Python and Scapy for low-level packet analysis and Flask for an intuitive web-based dashboard. Key features include network monitoring, attack detection through ARP table comparisons, logging capabilities, and attack attribution by identifying malicious IP addresses. The tool was tested in a controlled lab environment, demonstrating high accuracy in detecting ARP spoofing attempts, even in complex network scenarios. The findings underscore the tool\u27s potential as a foundational step toward developing comprehensive mitigation solutions for securing local networks. Future work aims to integrate automated mitigation strategies and expand the system\u27s applicability to larger network infrastructures

Image Compression-Based Discrete Wavelet Transform Combined with Zooming-out Algorithm

Image compression is one of the most important processes in image processing. It has numerous applications and plays a significant role in increasing transmission efficiency by reducing image size to just a few bytes, enabling the transmission of images without compromising their quality. The present study's proposed method focuses on reducing the size of an image through a compression technique. This technique involves extracting the essential information from the original image, which is represented by the low-frequency coefficients obtained through the discrete wavelet transform (DWT). By discarding the high-frequency coefficients, it can effectively preserve only the important details while significantly reducing the image size. In our approach, we employ the bi-cubic zoom-out method to resize the low-frequency coefficients, resulting in a high compression ratio.  Finally, these high-frequency data are reduced by the Minimize-Final-Data method to produce compressed data (a stream of bits). Importantly, this zoomed-out image does not affect the overall image quality. We compared this proposed algorithm with both JPEG and JPEG2000 based on image quality and compression ratio. When applied to the Lena image, the proposed method achieved a PSNR of 40 dB and a compression size of 13.8 KB. However, when compared to the JPEG2000 method, the PSNR increased to 41.1 dB while maintaining a smaller compression size of 13.3 KB

Prevalence and Risk Factors of Gestational Diabetes in Twin Pregnancies: Population Based Study

Objective: To assess the prevalence and risk factors of gestational diabetes (GDM) in twin compared with singleton pregnancies. Methods: Population-based study using CDC birth data from 2016-2020. Higher order pregnancies and pre-pregnancy diabetes were excluded. A Chi-square test of independence was performed to identify significant factors associated with GDM in twin versus singleton pregnancies and within each group independently. Multivariable regression analyses were performed first to assess risk factors that are significantly associated with GDM in twins and second to assess the risk of GDM in twin compared with singletons, adjusted for the significant risk factors. P value<0.01 was considered statistically significant Results: Total of 18,173,365 singleton and 611,043 twin pregnancies were included during the study period. Following the regression model, maternal age≥30 years, nulliparous, IVF, chronic hypertension, Hispanic and Non-Hispanic (NH) Asian, foreign-born, overweight and obesity class I/II/II remained significantly associated with GDM in twins. However, maternal age<25 years, NH Black, and W.I.C program reduced that risk. Factors that more than doubled the risk in twins were maternal age≥40 years (OR 2.06 (1.97 – 2.14), P<0.001), NH Asian (OR 2.12 (2.04 – 2.20), P<0.001), and obesity class I, II, and III (OR: 2.22 (2.16 – 2.29), P<0.001, OR:3.01 (2.92 – 3.11), P<0.001, OR: 3.80 (3.67 – 3.93), p<0.001, respectively). Following adjustment for all the significant risk factors, twin pregnancy remained significantly associated with increasing the risk of GDM in twin compared to singleton pregnancies (OR 1.22 (1.21 – 1.23), P<0.001). Conclusion: Of the significant risk factors, maternal age≥40 years, NH Asian, and obesity class I, II, and III more than doubled the risk of GDM in twins. Regardless of maternal demographics, obstetric history, and endocrine factors, twin pregnancy remained significantly associated with GDM compared to singleton pregnancies. These factors can be used in risk prediction models to better counsel and manage twin pregnancies

EVALUATION OF THE PHYTOCHEMICAL COMPOSITION, ANTIOXIDANT PROPERTIES, AND IN VIVO ANTIHYPERGLYCEMIC EFFECT OF COCCINIA GRANDIS LEAF EXTRACT IN MICE

Background: Diabetes mellitus (DM) is a disease described as a high level of blood glucose level and caused by Insulin Deficiency called (Type I). Abnormal metabolism of carbohydrates in connection with insufficient insulin production is called Type II (insulin resistance). As synthetic drugs are generated for the management of different types of DM in injectable and oral dosage forms undesired side effects are being recorded. Objective: The research side moves nowadays to the safer chemical components with hypoglycemic effects. Using natural remedies, particularly those derived from medicinal plants, to treat diabetes has emerged as a promising alternative treatment.Methods: This study investigated the phytochemicals constituents, and anti-hyperglycemic and anti-oxidant activities of Coccinia grandis leaves extract. Where the leaves of Coccinia grandis were collected and the extract containing ethanol was made. The initial phytochemical screening concerning the plant powder was done using standard procedures. Sixteen mice were divided into four groups, group (1) received normal saline, group (2) received standard oral hypoglycemic agent (glimepiride), group (3) received Glucose 50%, and group (4) received ethanolic extract. Extract doses were calculated according to the mice's body weight. Results: Antioxidant activity for the plant extract was found to be (62 ± 0.03 %) The Anti-hyperglycemic effect was determined by calculating the reduction in glucose levels as a function of time. Conclusion: The outcomes showed that the pharmacological impact of C. grandis’s extract reduces the blood glucose levels than the normal metabolic process and when compared to the standard oral hypoglycemic agent.                      Peer Review History: Received 2 February 2024;   Revised 11 March 2024; Accepted 23 April; Available online 15 May 2024 Academic Editor: Dr. Gehan Fawzy Abdel Raoof Kandeel, Pharmacognosy Department, National Research Centre, Dokki, 12622,  Giza, Egypt, [email protected]  Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Ahmad Najib, Universitas Muslim Indonesia, Makassar, Indonesia, [email protected] Prof. Ali Gamal Ahmed Al-kaf, Sana'a university, Yemen, [email protected]

Inflammatory mediators in saliva and gingival fluid of children with congenital heart defect

Objectives (a) To compare levels of pro- and anti-inflammatory mediators in saliva and gingival crevicular fluid (GCF) in children with and without congenital heart defects (CHD cases and controls) and to test whether a systemic component exists in CHD cases by controlling for gingivitis and plaque scores. (b) To correlate the levels of pro- and anti-inflammatory mediators in GCF and saliva with plaque bacterial composition among CHD cases and controls. Materials and Methods Whole un-stimulated saliva and GCF samples were collected (60 CHD cases, 60 controls [Sudan]) and were analysed for levels of prostaglandin E2 (PGE2), interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α), interleukin-1ra (IL-1ra) and interleukin-10 (IL-10) levels. These levels were correlated with the previously reported levels of four red complex bacteria. Results Significantly elevated levels of PGE2 and IL-1β in GCF and IL-1β and TNF-α in saliva were detected among CHD cases compared with controls. General linear model (GLM) analyses revealed that PGE2 and IL-1β levels remained significantly higher in GCF and saliva samples, respectively, among CHD cases after controlling for gingivitis and plaque score, whereas TNF-α and IL-10 levels were significantly lower in their GCF samples. Additionally, IL-1β level was significantly positively correlated to the counts of the four red complex species in their GCF. Conclusion In addition to higher levels of some pro-inflammatory mediators in saliva and GCF corresponding to more gingivitis in CHD cases, also a systemic inflammatory component exists and is reflected in these two oral fluids.publishedVersio

Late Antenatal Corticosteroid Treatment in Twin Pregnancies and Neonatal Outcomes: A Systematic Review and Meta-Analysis

Objective: To examine the impact of administering late-preterm corticosteroids on neonatal outcomes in twin pregnancies.&nbsp; Study Design: A systematic review of the literature was conducted in four electronic databases between 2000-2024. Studies reporting on neonatal outcomes in twin pregnancies at risk of preterm birth receiving corticosteroid treatment for fetal lung maturity at the gestational age (GA) of 34 weeks and 0 days to 36 weeks and 6 days were included. Studies involving participants with specific conditions (twin-to-twin transfusion syndrome and intrauterine fetal demise of one fetus) were excluded. The primary outcome was incidence of respiratory distress syndrome (RDS). Secondary outcomes included need for mechanical ventilation, continuous positive airway pressure (CPAP), and neonatal hypoglycemia. Comparison groups included those receiving steroids vs those not. The random effect model was used to generate weighted mean differences (MD) and odds ratio (OR) along with their 95% confidence intervals (CI). Heterogeneity was assessed using the I2 value.&nbsp;&nbsp; Results: 267 abstracts were screened of which 15 full-texts were fully reviewed. A total of three studies were included in the final analysis which comprised 489 twin pregnancies receiving steroids and 2807 pregnancies not receiving steroids. There were no differences in obstetric characteristics between groups, including maternal age, body mass index, preeclampsia, diabetes, and type of twin chorionicity. GA at delivery was significantly earlier in the steroids group (MD -0.91, 95% CI -1.50 to -0.32). For neonatal outcomes, there were no significant differences in incidence of RDS and need for mechanical ventilation between groups. There were higher chances for CPAP use (OR 2.69, 95% CI, 1.47 to 4.92) and neonatal hypoglycemia (OR 2.05, 95% CI, 1.18 to 3.56) in the steroids group.&nbsp; Conclusion: This study found that antenatal corticosteroid treatment during the late-preterm period in twin pregnancies was not associated with a reduced risk of neonatal respiratory complications.&nbsp

Oral-health-related background factors and dental service utilisation among Sudanese children with and without a congenital heart defects

Background: Sudanese children with congenital heart defects (CHDs) were found to have poorer oral health than those without CHDs. The aims of this study were to: describe the patterns of oral-health-related background factors in children with and without CHD and explore any differences, and to evaluate the effects of background factors on caries and gingivitis prevalence and dental services utilisation. Methods: In this analytical cross-sectional study, caregivers of children aged 3–12 years with (CHD cases n = 111) and without CHDs (Controls n = 182), underwent face-to-face interviews using a structured questionnaire. The questionnaire items covered several oral health background factors (independent variables) including: child’s health status, oral hygiene practices, dental services utilization, mother’s level of education, and caregiver’s perception and awareness of their child’s oral health. The relationship between these factors and occurrence of ‘caries’ and ‘gingivitis’ as well as ‘child’s dental services utilisation’ (dependent variables) were explored using multiple adjusted and hierarchal logistic regression analyses. Results: Compared with controls, CHD cases had lower frequencies of brushing and use of fluoridated toothpaste, and their caregivers were less knowledgeable about caries. Among CHD cases, the variables (brushing and fluoridated toothpaste use) had significant impacts on caries prevalence (odd ratio (OR) =5.6, 95% confidence interval (CI): 1.4–22.8 and OR = 0.3, 95% CI: 0.1–0.8 for infrequent compared to frequent ones, respectively) as well as the mother’s level of education (OR = 2.6, 95% CI: 1.0–6.4). When differences in background factors were controlled for, the adjusted ORs for caries and gingivitis prevalence in CHD cases compared with controls were 1.8, (95% CI: 1.1–3.2) and 5.3 (95% CI: 2.9–9.4), respectively. Among CHD cases, the child’s age (8–12 years: OR = 11.9, 95% CI: 1.9–71.6), and the mother’s level of education (lower education: OR = 0.2, 95% CI: 0.03–0.9) were significantly associated with the child’s dental services utilisation. Conclusions: Lower frequencies of brushing and use of fluoride tooth paste were reported among CHD cases, and brushing had the predominant significant impact on caries prevalence. The child’s age and the mother’s level of education were the main factors affecting the child’s (CHD cases) dental services utilisation.publishedVersio