Pregnancy outcome in rheumatic mitral stenosis patients with and without surgical correction: a prospective cohort study

Background: The aim of the current study is to assess the maternal and fetal outcomes of pregnant females with and without surgically corrected mitral stenosis (MS).Methods: A cross sectional study was carried out at Assiut Women's Health Hospital, Egypt between February 2016 and December 2016. All pregnant women diagnosed with rheumatic heart disease attending the antenatal care clinic were enrolled in the study. They were divided into two groups according to previous surgical correction of MS or not. All women were followed up during pregnancy till the end of puerperium. The primary outcome of the study was the difference in the rate of maternal cardiac complications during pregnancy between both groups.Results: The study included 48 patients (39%) with surgically corrected MS and 75 patients (61%) with uncorrected MS. All cardiac complications were significantly higher in the uncorrected MS group (p <0.05). No difference between both groups in the mode of delivery (p=0.52). Postpartum hemorrhage is more common with the corrected MS group than the uncorrected group (25% vs. 9.3% respectively, p=0.003), while the need for postpartum admission to ICU was significantly higher in the uncorrected group (p=0.006). The mean birth weight was higher in the corrected MS group (p=0.000). The percentage of stillbirths and the rate of admission to PCU was higher in the uncorrected MS group (p=0.003).Conclusions: Surgical correction of MS significantly improves the maternal and fetal outcomes of rheumatic heart pregnant females with MS

Comparison between two different regimens of anticoagulants for pregnant women with prosthetic heart valves

Background: The current study aims to assess the maternal and fetal outcomes of pregnant females with prosthetic heart valves receiving oral anticoagulants only versus the sequential regimen of heparin and OA throughout pregnancy.Methods: An observational was carried out at Assiut Women's Health Hospital, Egypt between February and December 2016. All pregnant women with prosthetic heart valves attending the emergency department during the study period were enrolled in the study. All included patients were classified into two groups; women who receive low molecular weight heparin (LMWH) during the first trimester then shift to warfarin till 36 weeks of gestation then continue on LMWH till delivery (Group I) and those who continue the all period of pregnancy on warfarin (Group II). The primary outcome of the study was the difference in the rate of maternal cardiac complications during labor between both groups.Results: The study included 72 patients have prosthetic valve replacement and on anticoagulants. Twenty-one were on oral anticoagulant; warfarin (Group II) and 51 pregnant women were on sequential regimen. Both groups were comparable in their basic and clinical data on admission. No difference between both groups in the mode of delivery (p=0.52), postpartum hemorrhage (0.09), sub rectal hematomas (p=0.08), the need for postpartum admission to ICU (p=0.93) and the duration of hospital stay (p=0.47). Additionally, no statistical significant difference between both groups as regard the mean birth weight (p=0.97), Apgar score (p=0.62), fetal sex (p=0.92) and congenital anomalies (p=0.08).Conclusions: The use of sequential LMWH and oral anticoagulants appears to be a safe option for those women although there is no difference in maternal and fetal outcomes with the use of continuous oral anticoagulants throughout the pregnancy

INVESTIGATION OF THE EFFECT OF THE WAKE GENERATED BY ROTOR BLADES ON THE FLOW THROUGH STATOR PASSAGE FOR LOW PRESSURE TURBINE

The effects of incoming wakes of upstream rotor on the flow field in a low pressure turbine cascade are investigated. The flow field is studied numerically with and without inlet wake. The rotor effect is represented by moving bars that produce passing wakes at the entrance of the stator. The flow field is analyzed numerically by solving the steady and unsteady forms of the two-dimensional compressible Reynolds-averaged Navier-Stokes equations. Steady flow is performed without wake while the unsteady flow is performed with periodic inlet wake for Reynolds number of order 105. A k- turbulence model is used to obtain the eddy viscosity. The Cartesian velocity components and pressure on a collocated (non-staggered) grid are used as dependent variables in the momentum equations, which discretized by finite volume method, body fitted coordinates are used to represent the complex blade geometry accurately, and grid generation technique based on elliptic partial differential equations is employed. SIMPLE algorithm is used to adjust the velocity field to satisfy the conservation of mass. The results show that the wake passing produces unsteady pressure field in the direction of the rotor traverse. The comparison with the experimental data is acceptable and there is similar trend between the prediction and experimental data, except at the separation flow region due to the limitation of the turbulence model

The relationship between vitamin D level and severity and control of bronchial asthma among adult Sudanese patients

Background: The aim of this study was to assess the relationship between vitamin D level and severity and control of bronchial asthma among adult Sudanese patients at Alshaab Teaching Hospital.Methods: This prospective cross-sectional study, conducted at Alshaab Teaching Hospital, Khartoum Sudan in the period from June to August 2015. Eighty-six asthmatic patients participated in the study after taking their consent. Demographic data were collected using structured questionnaire, the clinical parameters of asthma severity and control were measured according to the criteria of Global Strategy for Asthma Management and Prevention 2014 of the Global Initiative for Asthma (GINA). Airway limitation was assessed using Peak Flow Meter. Three ml of blood was taken from each patient to measure vitamin D (25(OH)D) using enzyme-linked immunosorbent assay (ELISA) and data were analyzed using the statistical package for social science (SPSS) version 20.Results: Normal serum 25(OH)D (30-50ng/ml) was found in only 2.3% of patients. The mean serum 25(OH)D level in patients with controlled asthma was 25.82±17.27ng/ml while in patients with uncontrolled asthma it was16.48±7.14ng/ml. (P value = 0.005). The mean serum 25(OH)D level in patients with severe asthma was 16.15±6.9ng/ml (P value = 0.151).Conclusions: There was a positive correlation between vitamin D level and bronchial asthma control and a negative correlation with bronchial asthma severity among the study group

Omega 3 (n−3) fatty acids down-regulate nuclear factor-kappa B (NF-κB) gene and blood cell adhesion molecule expression in patients with homozygous sickle cell disease

Chronic inflammation and reduced blood levels of omega-3 fatty acids (n − 3) are known characteristics of sickle cell disease (SCD).The anti-inflammatory properties of n − 3 fatty acids are well recognized. Omega-3 treated (n = 24), hydroxyurea (HU) treated (n = 18), and n − 3 untreated (n = 21) homozygous SCD patients (HbSS) and healthy (HbAA) controls (n = 25) matched for age (5–16 years), gender and socioeconomic status were studied. According to age (5–10) or (11–16) years, two or three capsules containing 277.8 mg docosahexaenoic (DHA) and 39.0 mg eicosapentaenoic (EPA) or high oleic acid placebo (41%) were assigned to n − 3 treated and n − 3 untreated groups, respectively. Hydroxyurea treated group was on dosage more than 20 mg/kg/day. The effect of supplementation on systemic and blood cell markers of inflammation was investigated. The n − 3 treated group had higher levels of DHA and EPA (p < 0.001) and lower white blood cell count and monocyte integrin (p < 0.05) compared with the n − 3 untreated. No difference was detected between the two groups regarding C-reactive protein, granulocytes integrin and selectin, plasma tumour necrosis factor-α and interleukin-10. The n − 3 treated group had lowered nuclear factor-kappa B (NF-κB) gene expression compared to n − 3 untreated and HU treated groups (p < 0.05). This study provides evidence that supplementation with n − 3 fatty acids may ameliorate inflammation and blood cell adhesion in patients with SCD

A reliable route repairing scheme for internet of vehicles

Recently, Internet of Vehicles (IoVs) has been recognised as a key solution for vehicular communications. Connected vehicles and infrastructure' roadside units have been shaping the underlying architecture of IoVs technology, where the conventional routing protocols cannot facilitate reliable and efficient communication for dynamic IoVs topologies. Hence, this technology is highly susceptible to frequent network fragmentations, thus exposing communication channels to regular failure problems. This paper, thus, introduces a novel routing repair strategy, referred as Reliable Route Repairing Strategy (RRRS) to tackle routing failure problems. Repairing the operation of channel communications is prioritised according to a stability degree of the connected vehicles. The RRRS features are combined with the traditional AOMDV protocol, and a comparison study has been conducted to compare the AOMDV, the RRRS-AOMDV and the HM-AOMDV protocols. The simulation results demonstrate that the RRRS-AOMDV achieves better performance, about 30% to 45% in terms of packets overhead and latency

Molecular Screening of <i>VAX1</i> Gene Polymorphisms Uncovered the Genetic Heterogeneity of Non-Syndromic Orofacial Cleft in Saudi Arabian Patients

Objective: Nonsyndromic orofacial cleft (NSOFC) including cleft lip with or without cleft palate (CL±P) and cleft palate (CP) are multifactorial developmental disorders with both genetic and environmental etiological factors. In this study we investigated the association between CL±P and CP, and two polymorphisms previously determined using genome-wide association studies, as well as the association between consanguinity and CL±P and CP. Methods: DNA was extracted from saliva specimens from 171 triads consisting of affected individuals and their parents, as well as 189 control triads (matched for age, gender, and location) that were recruited from 11 referral hospitals in Saudi Arabia. Two polymorphisms, rs4752028 and rs7078160, located in the VAX1 gene were genotyped using real-time polymerase chain reaction. A transmission disequilibrium test was carried out using the Family-Based Association Test and PLINK (genetic tool-set) to measure the parent-of-origin effect. Results: Significant differences were found between affected individuals and the control group. In the case of the rs4752028 risk allele in cleft, the phenotypes were: CL±P (fathers: odds ratio [OR] 2.16 [95% CI 1.38–3.4]; mothers: OR 2.39 [95% CI 1.53–3.71]; and infants: OR 2.77 [95% CI 1.77–4.34]) and CP (fathers: OR 2.24 [95% CI 1.15–4.36] and infants: OR 2.43 [95% CI 1.25–4.7]). For CL±P and the rs7078160 risk allele, the phenotypes were: (fathers: OR 1.7 [95% CI 1.05–2.86]; mothers: OR 2.43 [95% CI 1.49–3.97]; and infants: OR 2.34 [95% CI 1.44–3.81]). In terms of consanguinity, we found significant association between consanguinity and the rs4752028 polymorphism minor allele among CL±P compared with controls (p = 0.001). Conclusion: This is the first study to find a relationship between these two loci on 10q25 (rs4752028 and rs7078160) and NSOFC in a population with high levels of consanguinity

Measurement of proton electromagnetic form factors in e+e−→ppˉe^+e^- \to p\bar{p} in the energy region 2.00-3.08 GeV

The process of $e^+e^- \rightarrow p\bar{p}$ is studied at 22 center-of-mass energy points ($\sqrt{s}$) from 2.00 to 3.08 GeV, exploiting 688.5~pb$^{-1}$ of data collected with the BESIII detector operating at the BEPCII collider. The Born cross section~($\sigma_{p\bar{p}}$) of $e^+e^- \rightarrow p\bar{p}$ is measured with the energy-scan technique and it is found to be consistent with previously published data, but with much improved accuracy. In addition, the electromagnetic form-factor ratio ($|G_{E}/G_{M}|$) and the value of the effective ($|G_{\rm{eff}}|$), electric ($|G_E|$) and magnetic ($|G_M|$) form factors are measured by studying the helicity angle of the proton at 16 center-of-mass energy points. $|G_{E}/G_{M}|$ and $|G_M|$ are determined with high accuracy, providing uncertainties comparable to data in the space-like region, and $|G_E|$ is measured for the first time. We reach unprecedented accuracy, and precision results in the time-like region provide information to improve our understanding of the proton inner structure and to test theoretical models which depend on non-perturbative Quantum Chromodynamics

Observation of Ds+→pnˉD^+_s\rightarrow p\bar{n} and confirmation of its large branching fraction

The baryonic decay $D^+_s\rightarrow p\bar{n}$ is observed, and the corresponding branching fraction is measured to be $(1.21\pm0.10\pm0.05)\times10^{-3}$, where the first uncertainty is statistical and second systematic. The data sample used in this analysis was collected with the BESIII detector operating at the BEPCII $e^+e^-$ double-ring collider with a center-of-mass energy of 4.178~GeV and an integrated luminosity of 3.19~fb$^{-1}$. The result confirms the previous measurement by the CLEO Collaboration and is of greatly improved precision, which may deepen our understanding of the dynamical enhancement of the W-annihilation topology in the charmed meson decays

Observation and study of the decay J/ψ→ϕηη′J/\psi\rightarrow\phi\eta\eta'

We report the observation and study of the decay $J/\psi\rightarrow\phi\eta\eta'$ using $1.3\times{10^9}$ $J/\psi$ events collected with the BESIII detector. Its branching fraction, including all possible intermediate states, is measured to be $(2.32\pm0.06\pm0.16)\times{10^{-4}}$. We also report evidence for a structure, denoted as $X$, in the $\phi\eta'$ mass spectrum in the $2.0-2.1$ GeV/$c^2$ region. Using two decay modes of the $\eta'$ meson ($\gamma\pi^+\pi^-$ and $\eta\pi^+\pi^-$), a simultaneous fit to the $\phi\eta'$ mass spectra is performed. Assuming the quantum numbers of the $X$ to be $J^P = 1^-$, its significance is found to be 4.4$\sigma$, with a mass and width of $(2002.1 \pm 27.5 \pm 21.4)$ MeV/$c^2$ and $(129 \pm 17 \pm 9)$ MeV, respectively, and a product branching fraction $\mathcal{B}(J/\psi\rightarrow\eta{}X)\times{}\mathcal{B}(X\rightarrow\phi\eta')=(9.8 \pm 1.2 \pm 1.7)\times10^{-5}$. Alternatively, assuming $J^P = 1^+$, the significance is 3.8$\sigma$, with a mass and width of $(2062.8 \pm 13.1 \pm 7.2)$ MeV/$c^2$ and $(177 \pm 36 \pm 35)$ MeV, respectively, and a product branching fraction $\mathcal{B}(J/\psi\rightarrow\eta{}X)\times{}\mathcal{B}(X\rightarrow\phi\eta')=(9.6 \pm 1.4 \pm 2.0)\times10^{-5}$. The angular distribution of $J/\psi\rightarrow\eta{}X$ is studied and the two $J^P$ assumptions of the $X$ cannot be clearly distinguished due to the limited statistics. In all measurements the first uncertainties are statistical and the second systematic.Comment: 10 pages, 6 figures and 4 table