Navigating through the maze of caesarean myomectomy: generating evidence

Management of myomas during pregnancy and labor is a contested subject so far. Currently no recommended national or international guidelines are in place resulting in conflicted opinion and management variation across the globe. Many obstetricians still discourage its practice due to fear of uncontrolled haemorrhage which may lead to unwanted hysterectomy in a reproductive age. However, some researchers have challenged the conventional perspective and argue that caesarean myomectomy (CM) is a safe procedure. The aim of this study is to examine all aspects of CM with an evaluative lens and to weigh its risk-benefit ratio.  For this purpose, we conducted a literature review of studies, including those from low-resource countries indexed in scientific databases like PubMed, Google Scholar and Scopus. Most recent articles that reported benefits, complications and different techniques to safely perform caesarean myomectomy with proven benefit for the patient were examined thoroughly so that solid evidence on pros and cons of caesarean myomectomy could be generated. There is a dire need to conduct large sample size studies or randomized controlled trials for the risk-benefit evaluation of CM and to produce evidence-based clinical conclusion

A methodology for flexibility analysis of pipeline systems

Pipeline systems serve a crucial role in an effective transport of fluids to the designated location for medium to long span of distances. Owing to its paramount economic significance, pipeline design field have undergone extensive development over the past few years for enhancing the optimization and transport efficiency. This research paper attempts to propose a methodology for flexibility analysis of pipeline systems through employing contemporary computational tools and practices. A methodical procedure is developed, which involves modeling of the selected pipeline system in CAESAR II followed by the insertion of pipe supports and restraints. The specific location and selection of the inserted supports is based on the results derived from the displacement, stress, reaction, and nozzle analysis of the concerned pipeline system. Emphasis is laid on the compliance of the design features to the leading code of pipeline transportation systems for liquid and slurries, ASME B31.4. The discussed procedure and approach can be successfully adjusted for the analysis of various other types of pipeline system configuration. In addition to the provision of systematic flow in analysis, the method also improves efficient time-saving practices in the pipeline stress analysis

Unfeasible body mass index and its association with low haemoglobin concentration: a correlation study among undergraduate medical students

Background: Low hemoglobin concentration and unfeasible body mass index adversely affect the health of people, consequently increasing morbidity and mortality among them. Hemoglobin concentration among individuals is associated with their body mass index. The prevalence of iron deficiency anemia is higher among underweight and overweight/obese people compared to those with normal BMI. Thus, the present study aimed to determine the correlation between hemoglobin concentration and BMI of undergraduate medical students.Methods: A cross-sectional study was carried out among 210 undergraduate medical students. Body mass index was calculated and hemoglobin estimation was done by Sahli's hemoglobinometer. Correlation between hemoglobin concentration and body mass index of subjects was assessed by Pearson’s correlation coefficient.Results: Underweight students had lowest mean hemoglobin concentration and the mean hemoglobin concentrations increased significantly (p<0.001) with increase in the BMI of subjects. A highly significant positive correlation (r=0.307, p<0.001) between BMI and hemoglobin concentration was observed. Further, significant positive correlation was observed among males (r=0.268, p=0.013), students with normal BMI (r=0.283, p=0.003) and overweight students (r=0.415, p=0.035) only.Conclusions: Hemoglobin concentration and BMI show a positive correlation, however this correlation tends to become negative in obese individuals. As both low hemoglobin concentration and unfeasible body mass index have detrimental effects on the health, diligent screening and management of both is essential for better outcome

Dry Matter Degradation Kinetics of Selected Tropical Forage in Nili-Ravi Buffalo and Cholistani Cows at Heifer and Lactating Stages Using NorFor in Situ Standards

Current methods of ruminant ration formulation in Pakistan use foreign-based nutrient availability values. These values may not be optimal for all geographic areas, as variation in environment, agronomic factors, animal species, and diet characteristics may not be considered. The aim of present study was to establish a database of the chemical composition and dry matter degradation parameters of tropical forage commonly fed to ruminants in Pakistan and South Asian countries using Nili-Ravi buffalo and Cholistani cattle at heifer and lactating stages. Six cereal grain and four legume species were grown in 3 locations under standard agronomic conditions and sampled at booting and at 50% flowering stage for cereal and legumes, respectively. Dried and milled feeds were analyzed for chemical composition and in situ dry matter degradation parameters using 1 g samples in bags placed in the rumen of 2 Nili-Ravi buffalo heifers, 2 lactating Nili-Ravi buffaloes, 2 Cholistani heifers, and 2 lactating Cholistani cows. The forage family (cereal vs. legumes), species, and geographic location of growth significantly influenced (P 0.05). Legume-by-heifer interactions significantly increased (P < 0.05), and legume-by-lactating cow interaction tended (P = 0.065), to increase the rate of degradation (Kd). The selected forages were degraded to a similar extent independent of animal species or developmental stage, and legumes are degraded at higher rates and to a greater extent than are cereals. A moderately significant relationship between Kd and effective dry matter degradability (DMD) suggests that Kd could be the single most important predictor of forage degradability in the rumen

Analyzing Sedimentary Rocks to Evaluate Paleo Dimensions and Flow Dynamics of Permian Barakar River of Rajmahal Gondwana Sub-Basin of Eastern India

The cross strata and planar strata of sedimentary rocks are used in estimating paleo dimensions and flow dynamics of Permian Barakar River of eastern India. Quantitative estimates indicate that mean bed form became thinner i.e., from 1.363 m to 0.928 m to 34.21 m–23.33 m, as the Barakar River flowed with flow velocity of between 90 cm/sec and 157 cm/sec from Fox Ridge situated to the south on a steeper slope which becomes gentler downstream. The friction factor (0.036) is on higher side indicating low flow resistance while bed shear stresses remain competent, even during low paleo-discharges to transport coarse-pebble bed. Rouse number, Z, is decreased from Brahmini (3.38) to Hurra (1.71) implying predominant bed-load in upstream and local transition to mixed load in the downstream. Bed load formed 17.74 to 15.62 percent in upstream and reduced to 10.14–7.94 percent in downstream suggesting bed load channel for the former and mixed load channel for the latter corroborating estimated Rouse Number (Z) values. The trunk Barakar River on an average was about 2260 km long, 817 m wide and 13.63 m deep with channel belt width in between 6310 and 2205 m. The river channel sinuosity was in place of sinuosity 1.361 in the south-southwest part and progressively became more sinuous in the northern and northeastern part of the basin (1.728) with maximum sinuosity of 1.955. The catchment area of the Barakar River lies between 10,700 to 422,600 km2 and paleo-discharge between 22,070–4510 m3/sec with the maximum 66,000 m3/sec and whose mean annual flood was in the range of 170,600–42,260 m3/sec. These parameters suggest that initially multi-thread and broad Barakar River became narrow and single thread in downstream and had its outlet in the northeast (Sikkim, Assam and Bangladesh) towards the Tethys Ocean during Permian times

Surgical Management of Soft Tissue Sarcoma

Background: To study the management patternof soft tissue sarcomas in a tertiary care settingMethods: In this descriptive study patients whowere operated for soft tissue masses were included.Intra-operative findings, procedure details andpostoperative orders were recorded. Postoperativechemo-radiotherapy records were reviewed andrecorded. Depth of the tumour was grouped asdeeper or superficial than 5 cm. The follow uprecords were accessed from the outpatientdepartment and any surgical complications wererecorded up to three years.Staging was done usingclinical and radiological criteria taking into accountthe histological grade,tumour size , depth, locallymph node invasion and metastasis.Surgicalprocedure for removal of STS are wide local excision(WLE), intralesional excision (IE) or tumordebulking, marginal excision (ME) and radicalexcision (RE).Results: Sixty eight patients with mean age of 43.0± 17.258 SD were diagnosed as cases of soft tissuesarcomas. Male to female ratio was 3.25:1.The mostcommon histopathological variety was malignantfibrous histiocytoma (35.3%) , followed byRhabdomyosarcoma(30%). Most common involvedsite was lower limbs (35.3%).Wide local excision wasperformed in majority (82.4%) . Most commonpostop complication was wound infection (10.3%)Conclusion: Clinicians must be agile about thenature of these tumours and their referral to aspecialist surgeon for further management. Promptdiagnosis, accurate investigations and earlyintervention will benefit the patients and help usunderstand this disease entity

Experimental Study on the Structural Behavior of Cast in-situ Hollow Core Concrete Slabs

An experimental work has been carried out to study the flexural behavior of cast in-situ hollow core reinforced concrete (HCRC) slabs constructed by using easy, cost effective and implementable techniques in field. The precast elements made of different easily available affordable material i.e. concrete, polyvinyl chloride (PVC) and plaster of paris having voided cross- sections of circular, rectangular and triangular shapes were incorporated in one direction during pouring of concrete with minimum flexural reinforcement to construct HCRC slabs. A total of 14 slab specimens including 02 specimens per specification were tested with third point loading for the assessment of flexural behavior as per ASTM standards C78/C78M. The flexural behavior of HCRC slabs with polyvinyl and plaster of paris elements having hollow cross-sections was comparable with the control solid slabs, however, HCRC slab with concrete pipes showed 7 to 8 percent reduction in flexural strength with 19 to 20 percent reduction in self-weight. All the tested specimens performed well in shear as no shear failure was observed. This study reveals that HCRC slabs with locally available material having hollow cross section elements can be used for the construction of cast in-situ monolithic construction of one-way slabs with ordinary construction techniques. Doi: 10.28991/cej-2020-03091597 Full Text: PD