Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. Several studies have tried to identify the risk ...factors for PAS disorders. The ideal management for PAS disorders is a matter of debate. The study objectives were to evaluate the incidence and risk factors of PAS disorders and to compare different management strategies at a tertiary referral hospital, Minia, Egypt.
This prospective study included 102 women diagnosed with PAS disorders admitted to Minia Maternity university hospital, Egypt between January 2017 to August 2018. These cases were categorized into three groups according to the used approach for management: Group (A), (n = 38) underwent cesarean hysterectomy, group (B), (n = 48) underwent cesarean section (CS) with cervical inversion and ligation of both uterine arteries and group (C), (n = 16): the placenta was left in place.
The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4 ± 4.2 years, 60% of them had a parity ≥3 and 82% of them had ≥2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had higher mean hospital stay duration. Group A was associated with significantly higher complication rate.
The incidence of PAS disorders was 0.91%. Maternal age > 32 years, previous C.S. (≥ 2), multiparity (≥ 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation appears to be a safe alternative to hysterectomy in patients with focal placenta accreta and low parity desiring future fertility. Patients with diffuse placenta accreta keen to preserve the uterus could be offered the option of leaving the placenta aiming at conservative management after proper counseling.
Registered 28th October 2015, ClinicalTrials.gov NCT02590484 .
The subject of heat transfer enhancement has significant interest to develop the compact heat exchangers in order to obtain a high efficiency, low cost, light weight, and size as small as possible. ...Therefore, energy cost and environmental considerations are going on to encourage attempts to invent better performance over the existence designs. Streamwise vortices can be generated using small flow manipulators or protrusions such as wings and winglets configurations. Single-pair, single row, or two dimensional array of vortex generators (VGs) can be punched, mounted, attached or embedded in the boundary layer of flow channel. VGs generate longitudinal and transverse vortices, while longitudinal vortices are more efficient for heat transfer enhancement than transverse vortices. A dramatic augmentation in thermal performance of the thermal system can be achieved but pressure drop penalty is existed. Several parameters have been overviewed in this paper, which have pronounced effect on the convective heat transfer coefficient and pressure drop penalty. These parameters are: attack angle of VG, geometry of VG, standard and novel types of VG, spacing between the VG tips, number of pairs of VGs in the flow direction, rectangular or circular array arrangement of VGs, common-flow upper (CFU) or common-flow down (CFD) configuration of VG, pointing up (PU) or pointing down (PD) arrangement of VG with flow direction, Re number, channel aspect ratio, number of tubes of fin-tube heat exchanges (HE), circular or oval tubes of fin-tube HE, and location of VG respect to the tube of HE or from leading edge of the channel. This paper gives an overview about the early studies done in order to improve the performance of thermal systems with minimal pressure losses to derive systems with less negative impact on the environment and high level of energy economic. This study also provides an outlook for future work using nanofluids with vortex generators.
This article is also summarizes the recent experimental and numerical developments on the thermal conductivity measurements of nanofluids, thermal conductivity enhancement, convection and conduction heat transfer, some applications, main problems and suggestions for future works.
Doxorubicin (DOXO) is an antineoplastic drug that is used extensively in managing multiple cancer types. However, DOXO-induced cardiotoxicity is a limiting factor for its widespread use and ...considerably affects patients' quality of life. Farnesol (FSN) is a sesquiterpene with antioxidant, anti-inflammatory, and anti-tumor properties. Thus, the current study explored the cardioprotective effect of FSN against DOXO-induced cardiotoxicity. In this study, male Wistar rats were randomly divided into five groups (
= 7) and treated for 14 days. Group I (Control): normal saline, p.o. daily for 14 days; Group II (TOXIC): DOXO 2.4 mg/kg, i.p, thrice weekly for 14 days; Group III: FSN 100 mg/kg, p.o. daily for 14 days + DOXO similar to Group II; Group IV: FSN 200 mg/kg, p.o. daily for 14 days + DOXO similar to Group II; Group V (Standard): nifedipine 10 mg/kg, p.o. daily for 14 days + DOXO similar to Group II. At the end of the study, animals were weighed, blood was collected, and heart-weight was measured. The cardiac tissue was used to estimate biochemical markers and for histopathological studies. The observed results revealed that the FSN-treated group rats showed decrease in heart weight and heart weight/body weight ratio, reversed the oxidative stress, cardiac-specific injury markers, proinflammatory and proapoptotic markers and histopathological aberrations towards normal, and showed cardioprotection. In summary, the FSN reduces cardiac injuries caused by DOXO via its antioxidant, anti-inflammatory, and anti-apoptotic potential. However, more detailed mechanism-based studies are needed to bring this drug into clinical use.
There is growing interest in Mindfulness-based Stress Reduction (MBSR) program to combat mental distress in medical students. In Saudi Arabia, literature is insufficient about MBSR and its ...effectiveness. This study aims to measure the effectiveness of MBSR in improving mindful state, stress, anxiety, and depression in medical students. Also, the study explores the association between the attendance rate of MBSR sessions and its effectiveness. Lastly, the study examines gender differences in response to MBSR. This is a stratified randomized controlled study of 84 medical students from two medical schools in Riyadh, Saudi Arabia. They were recruited voluntarily from November 2018 to April 2021, and allocated to MBSR and waitlist groups using a stratified randomization method based on gender. MBSR group received eight weeks of sessions through audiovisual materials. An online survey utilizing validated questionnaires assessing stress, mindfulness, anxiety, and depression was used to evaluate both groups pre-program (time 0), post-program (time 1), and three months later (time 2). Seventy-one participants completed the post-test (time 1). There were no differences between study groups at time 0 and 1. However, in 41 subjects who completed the follow-up test (time 2), the anxiety dropped significantly in MBSR group (mean difference (MD), -3.935; 95% CI, -7.580 to -0.290). Furthermore, attending more MBSR sessions was inversely correlated with depression (r, -0.556; P, 0.002), and anxiety (r, -0.630; P, 0.000). Compared to their baseline, males in MBSR group improved in stress (MD, 3.08; 95% CI, 0.30 to 5.86), anxiety (MD, 4.91; 95% CI, 3.32 to 6.50), and mindfulness (MD, -0.58; 95% CI, -1.01 to -0.15), while females improved in stress (MD, 2.64; 95% CI, 0.02 to 5.26). Despite the study being interrupted by the stressful COVID-19 outbreak, the findings suggest that MBSR improved psychological outcomes when participants commit to the program.
The objective of this investigation was to develop nanoemulsion formulations of Eucalyptus essential oil (EEO) and to evaluate its wound healing effects in comparison with standard gentamycin in rat ...model. Various nanoemulsionns of EEO were prepared using aqueous phase titration method and the zones of nanoemulsion were identified by the construction of phase diagrams. EEO nanoemulsions were investigated in terms of physical stability, self-nanoemulsification efficiency and physicochemical characterization. Optimized nanoemulsion of EEO was selected for wound healing study, collagen estimation and histopathological evaluation in rats in comparison with pure EEO and standard gentamycin. Optimized nanoemulsion presented significant would healing activity in rats as compared with pure EEO upon oral administration. The wound healing activity of optimized nanoemulsion was comparable with standard gentamycin. Optimized EEO nanoemulsion also presented significant enhancement in collagen content as compared with pure EEO and negative control. However, the collagen contents of optimized nanoemulsion treated animals were comparable with standard gentamycin-treated animals. Histopathological studies of optimized nanoemulsion treated rats showed no signs of inflammatory cells which suggested the safety and non-toxicity of EEO nanoemulsion. This study suggested the potential of nanoemulsion in enhancing the wound healing activity of EEO upon oral administration.
The organic cation transporter 2 (OCT2) belongs to the SLC22 family, while the multidrug and toxin extrusion 1 and 2-K (MATE1/MATE2-K) belong to the SLC47 family, are localized to the basolateral and ...apical membrane of human renal proximal tubular epithelial cells, respectively. They are polyspecific transporters that enable the transit of structurally diversified drugs with overlapping selectivity across plasma membranes. OCT2 and MATE1/2-K are critically involved in renal secretion, pharmacokinetics (PK), and toxicity of cationic drugs. Drug–drug interactions (DDIs) at OCT2 and/or MATE1/2-K have been shown to result in clinical impacts on PK, therapeutic efficacy and are probably involved in the renal accumulation of drugs. Sites of OCT2 and MATE1/2-K expression and function play an essential role in the pharmacokinetics and toxicity of drugs, such as cisplatin. Thus, knowing the sites (basolateral vs. apical) of the interaction of two drugs at transporters is essential to understanding whether this interaction helps prevent or enhance drug-induced nephrotoxicity. In this work, an overview of OCT2 and MATE1/2-K is presented. Primary structure, membrane location, functional properties, and clinical impact of OCT2 and MATE1/2-K are presented. In addition, clinical aspects of DDIs in OCT2 and MATE1/2-K and their involvement in drug nephrotoxicity are compiled.
The sudden increase in patients with severe COVID-19 has obliged doctors to make admissions to intensive care units (ICUs) in health care practices where capacity is exceeded by the demand. To help ...with difficult triage decisions, we proposed an integration system Xtreme Gradient Boosting (XGBoost) classifier and Analytic Hierarchy Process (AHP) to assist health authorities in identifying patients’ priorities to be admitted into ICUs according to the findings of the biological laboratory investigation for patients with COVID-19. The Xtreme Gradient Boosting (XGBoost) classifier was used to decide whether or not they should admit patients into ICUs, before applying them to an AHP for admissions’ priority ranking for ICUs. The 38 commonly used clinical variables were considered and their contributions were determined by the Shapley’s Additive explanations (SHAP) approach. In this research, five types of classifier algorithms were compared: Support Vector Machine (SVM), Decision Tree (DT), K-Nearest Neighborhood (KNN), Random Forest (RF), and Artificial Neural Network (ANN), to evaluate the XGBoost performance, while the AHP system compared its results with a committee formed from experienced clinicians. The proposed (XGBoost) classifier achieved a high prediction accuracy as it could discriminate between patients with COVID-19 who need ICU admission and those who do not with accuracy, sensitivity, and specificity rates of 97%, 96%, and 96% respectively, while the AHP system results were close to experienced clinicians’ decisions for determining the priority of patients that need to be admitted to the ICU. Eventually, medical sectors can use the suggested framework to classify patients with COVID-19 who require ICU admission and prioritize them based on integrated AHP methodologies.
The aim was to evaluate the adaptation of CAD/CAM occlusal veneer with different cement space settings using micro CT scan. Three groups of IPS e.max-CAD lithium disilicate occlusal veneers with ...different cement space settings (30, 40, and 50 µm) were produced. A circle with 20 different diameters was centered at the center of the same image position of every scanned specimen using micro CT scan to measure four different locations Occlusal (OCG), axial (AXG), Marginal (MAG), and absolute marginal discrepancy values (AMD). Kruskal-Wallis test revealed that there were no statistical differences between (OCG), (AXG), and (AMD) tested groups (p>0.05), and statistical differences between (MAG) group and other two groups (p<0.05). An increase in the digital cement space significantly improved the marginal fit of IPS e.max-CAD occlusal veneer.
A novel derivative of ciprofloxacin (Cpx) was synthesized and characterized using various analytical techniques, including FT-IR spectroscopy, UV-Vis spectroscopy, TEM and SEM analysis, 1H NMR, 13C ...NMR, and HPLC analysis. The newly prepared Cpx derivative (Cpx-Drv) exhibited significantly enhanced antibacterial properties compared to Cpx itself. In particular, Cpx-Drv demonstrated a 51% increase in antibacterial activity against S. aureus and a 30% improvement against B. subtilis. It displayed potent inhibitory effects on topoisomerases II (DNA gyrase and topoisomerase IV) as potential molecular targets, with IC50 values of 6.754 and 1.913 µg/mL, respectively, in contrast to Cpx, which had IC50 values of 2.125 and 0.821 µg/mL, respectively. Docking studies further supported these findings, showing that Cpx-Drv exhibited stronger binding interactions with the gyrase enzyme (PDB ID: 2XCT) compared to the parent Cpx, with binding affinities of −10.3349 and −7.7506 kcal/mole, respectively.
The main obstacle of using geopolymer as a construction repair material is its slow strength development rate, which is the most significant attribute of an early-age opening for traffic and ...striking-off formwork. Geopolymer technology has recently attracted huge interest as an alternative to traditional cementitious materials with low environmental impact. Thus, this study investigates the feasibility of developing an ultra-high performance geopolymer concrete (UHPGC) with the aim of achieving high early-age strength. For this purpose, UHPGC mixtures activated with different potassium hydroxide molarities and aluminosilicate material types were developed and examined being cured with different curing temperatures. The early strength and durability of the UHPGC after 8 and 24 h were investigated. Experimental results revealed that the optimal mix design of UHPGC corresponds to a KOH molarity of 16 M and a 30% silica fume content. Furthermore, former mixture cured at 100 °C gave superior 8 and 24 h early strength values of 79 and 134 MPa, respectively. Moreover, a superior interaction of slag, silica fume, and activator solution at early age for UHPGC is revealed by the microstructural characteristics examined by a field emission scanning electron microscope (FESEM) with energy dispersive X-ray spectroscopy (EDS), Fourier transform infrared spectroscopy analysis, and thermogravimetric (TGA) techniques. It was also found that the compressive strength results and the results of the microstructure analysis are well coincided. The experimental results obtained in this study emphasize the feasibility of using developed UHPGC as an eco-friendly quick repair materials The development of one-part UHPGC as a quick, cost-effective, and high-strength product for all construction repair maintenance will lead to huge improvements in the structural capacity and durability of structural components.
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