To evaluate the diagnostic accuracy of ultrasound and in the diagnosis of Placenta accreta spectrum (PAS).
Screening of MEDLINE, CENTRAL, other bases from inception to February 2022 using the ...keywords related to placenta accreta, increta, percreta, morbidly adherent placenta, and preoperative ultrasound diagnosis.
All available studies- whether were prospective or retrospective- including cohort, case control and cross sectional that involved prenatal diagnosis of PAS using 2D or 3D ultrasound with subsequent pathological confirmation postnatal were included. Fifty-four studies included 5307 women fulfilled the inclusion criteria, PAS was confirmed in 2025 of them.
Extracted data included settings of the study, study type, sample size, participants characteristics and their inclusion and exclusion criteria, Type and site of placenta previa, Type and timing of imaging technique (2D, and 3D), severity of PAS, sensitivity and specificity of individual ultrasound criteria and overall sensitivity and specificity.
The overall sensitivity was 0.8703, specificity was 0.8634 with -0.2348 negative correlation between them. The estimate of Odd ratio, negative likelihood ratio and positive likelihood ratio were 34.225, 0.155 and 4.990 respectively. The overall estimates of loss of retroplacental clear zone sensitivity and specificity were 0.820 and 0.898 respectively with 0.129 negative correlation. The overall estimates of myometrial thinning, loss of retroplacental clear zone, the presence of bridging vessels, placental lacunae, bladder wall interruption, exophytic mass, and uterovesical hypervascularity sensitivities were 0.763, 0.780, 0.659, 0.785, 0.455, 0.218 and 0.513 while specificities were 0.890, 0.884, 0.928, 0.809, 0.975, 0.865 and 0.994 respectively.
The accuracy of ultrasound in diagnosis of PAS among women with low lying or placenta previa with previous cesarean section scars is high and recommended in all suspected cases.
Number CRD42021267501.
Gerf Neoproterozoic ophiolitic rocks in the Southern Eastern Desert of Egypt represent the largest ophiolite nappe in the Arabian-Nubian Shield and have been preserved as part of the N-S striking ...Allaqi-Heiani suture zone. Landsat-8 OLI/TIRS, ASTER and Sentinel-1B data successfully discriminate the Gerf ophiolitic section and the structural framework of the study area. This study has applied spectral transform approaches, consisting of principal component analysis (PCA), band ratio (BR) and minimum noise fraction (MNF) for lithological and structural mapping. NW-SE and N-S structural trends are dominant and control the distribution of talc‑carbonates and ophicarbonates. The mantle section comprises dominantly harzburgites with subordinate dunites and is rarely cut by dike-like bodies of clinopyroxenites; these peridotites have been partially to completely converted to serpentinites and related rocks. The primary Gerf peridotites are low in TiO2 (0.01 wt%), Al2O3 (0.50 wt%), and CaO (0.44 wt%) content on average, but are rich in Ni (up to 2758 ppm) and Cr (2906 ppm) relative to primitive mantle, suggesting their highly refractory residual nature after high degrees of partial melting, similar to forearc peridotites. This is confirmed by chemistry of their relic primary minerals, namely olivine (Fo: 91–93.7; NiO: 0.28–0.43 wt%), chromian spinel (Cr# 0.75 on average), orthopyroxene (Mg#: 0.92–0.93) and clinopyroxene (Mg#: 0.89–0.90). Gerf serpentinized peridotites also show ranges of oxygen fugacity (Δlog ƒO2, FMQ + 0.2 – FMQ + 1.4) and equilibrium temperature (770–900 °C), consistent with those of forearc peridotites. Bulk-rock analyses of ultramafic rocks and in-situ analyses of their pyroxenes reveal enrichment of fluid mobile elements (FME: e.g., B, Cs, Pb, Sr) relative to high-field strength elements (e.g., Nb, Zr, Ti, Ta), indicating intense metasomatism of Gerf peridotites by slab-derived fluids. The Gerf peridotites have been subjected to intense CO2 input from the subducted slab to form carbonate-rich rocks beneath the arc-forearc region. Carbonates (mainly magnesite) replace serpentine minerals and their formation synchronizes with the transition from lizardite to antigorite at temperatures, ~250° to ~350 °C. The CO2-rich fluids increase the Au content because of alteration and break down of Au-bearing sulphides, and this process formed Au mineralization in carbonate-rich rocks. The maximum amount of CO2 expulsion from the subducted slab increases with increasing mantle depth, and structural trends as ophicarbonates are abundant in thick parts of the ophiolite sequence in the Gerf area that was highly dissected by NW-SE, N-S and E-W striking faults. This confirms that structures control on distribution of the ophiocarbonate rocks in Gerf ophiolite. Calculated parental melts in equilibrium with Gerf peridotite spinels have boninitic affinities, suggesting their generation during the forearc stage, but parental melts of Gerf clinopyroxenite veins resemble N-MORB-like melts, indicating melt metasomatism of sub-arc mantle by impregnated mafic melts during early subduction initiation. Clinopyroxenite veins crystallized from MOR-like melts as a result of interaction between these melts and depleted peridotites in the sub-arc mantle.
•Remote sensing, band ratios, principal component analysis, and mineral indices used to extract shear zones controlled on ophicarbonates.•Mineral chemistry and whole-rock chemistry of Neoproterozoic serpentinites and ophicarbonates.•Carbonation of sub-arc oceanic mantle, extent of carbonation and source of CO2-rich fluids in the mantle wedge.•Evidence and nature of mantle metasomatism at convergent margins and the effect of carbonation on mineralogical and bulk-rock compositions.•Petrogenesis and geodynamic evolution of Gerf ophiolite as part of Allaqi-Heiani suture zone.
Objective
To assess the value of intrauterine PRP to improve IVF outcome in women with previous implantation failure.
Methods
Screening of Pubmed, Web of Science, and other databases from inception ...to August 2022 using the keywords related to “platelet-rich plasma” OR “PRP” AND “IVF” “implantation failure.” Twenty-nine studies (3308 participants) were included in our analysis, 13 were RCTs, 6 were prospective cohorts, 4 were prospective single arm, and 6 were retrospective analyses. Extracted data included settings of the study, study type, sample size, participants’ characteristics, route, volume, timing of PRP administration, and outcome parameters.
Results
Implantation rate was reported in 6 RCTs (886 participants) and 4 non-RCTs (732 participants). The odds ratio (OR) effect estimate was 2.62 and 2.06, with 95% CI of 1.83, 3.76, and 1.03–4.11, respectively. Endometrial thickness was compared in 4 RCTs (307 participants) and 9 non-RCTs (675 participants), which showed a mean difference of 0.93 and 1.16, with 0.59–1.27 and 0.68–1.65 95% CI, respectively.
Conclusion
PRP administration improves implantation, clinical pregnancy, chemical pregnancy, ongoing pregnancy, live birth rates, and endometrial thickness in women with previous implantation failure.
Hyperuricemia was linked to diabetes mellitus, metabolic syndrome, and oxidative stress, and could be induced by higher fructose consumption through altering energy status in liver. l‐Carnitine is an ...antioxidant, affecting mitochondria and cellular energetics; however, little is known about its effects in hyperuricemic states. This study investigated metabolic and hepatic effects of hyperuricemia and fructose feeding, and demonstrated the role of l‐Carnitine in such states. Fifty adult male Wistar rats were randomly divided into control, untreated hyperuricemic, fructose‐supplemented hyperuricemic, l‐Carnitine‐treated hyperuricemic, and l‐Carnitine‐treated fructose‐supplemented hyperuricemic groups. The separated plasma was used for determination of the glycemic control, lipid profile, liver function tests, uric acid level, and oxidative stress markers. Atherogenic index, HOMA‐IR, and body mass index (BMI) were calculated. Left liver lobe and left kidney specimen from all groups were used for histopathological studies. Hyperuricemic rats exhibited significantly hypoalbuminemia, dyslipidemia, insulin resistance, and oxidative stress compared to the controls. Fructose‐supplemented hyperuricemic group showed obesity and more deleterious effects, as well as, steatosis, and renal tubular damage compared to the hyperuricemic rats. Concomitant l‐Carnitine treatment with hyperuricemia improved such effects, despite causing adiposity. While combined l‐Carnitine treatment and fructose supplementation in hyperuricemia limited the aggressive hyperuricemic picture of fructose supplementation. It is concluded that hyperuricemia has detrimental metabolic and hepatic effects. Artificial fructose supplementation worsened such effects, while l‐Carnitine was efficient in ameliorating these hyperuricemia and/or excess fructose‐induced hyperuricemia effects, through its anti‐inflammatory, antisteatotic, and antioxidant properties.
Hyperuricemia has detrimental metabolic and hepatic effects. Artificial fructose supplementation worsened such effects, while l‐Carnitine was efficient in ameliorating these hyperuricemia and/or excess fructose‐induced hyperuricemia effects, through its anti‐inflammatory, antisteatotic, and antioxidant properties.
Anticancer agents featuring hybrid molecules can improve effectiveness and diminish drug resistance. The current study aimed to introduce newly synthesized heterocyclic steroids of promising ...anticancer effects loaded in polyethylene glycol (PEG)•based nanoparticles form. Several heterocyclic steroids (1-9) were synthesized via multicomponent reactions (MCRs) and confirmed via the analytical and spectral data. Compounds 1, 2, 3, 4, 5, 6, 7 and 9, were investigated individually in their free and PEG based nano-size hybrid forms as anticancer agents against three human cell lines: hepatocellular carcinoma cells (HepG2); breast cancer cells (MCF-7); and colon cancer cells (HCT116). The neutral red supravital dye uptake assay was employed. Compound 6 in its PEG based nano-size form exhibited the best cytotoxic effects against HepG2 and HCT116 cell lines, with IC
50
values of 2.44 µmol/l and 2.59 µmol/l, respectively. In addition, it demonstrated a low IC
50
value against MCF-7 (3.46µmol/l) cells. This study introduced promising anticancer agents acting through conversion into PEG-based nanoparticles.
Colloid cysts are benign intracranial lesions, typically located in the anterior portion of the third ventricle near the interventricular foramina of Monro. The cysts usually consist of an epithelial ...lining filled with viscous gelatinous material of various components. Colloid cysts are generally asymptomatic, but once symptomatic, they can present in a variety of ways, including headaches, vomiting, visual and memory problems, and vertigo. Colloid cysts present classically on imaging as a well-delineated hyperattenuating lesion on unenhanced radiological modalities. Herein, we report a case of a patient who presented with hydrocephalus caused by a sizeable colloid cyst which demonstrated atypical imaging findings in the form of hypodensity on CT and hyperintensity on T2WI, making them difficult to identify and easy to miss. Although this atypical imaging appearance is uncommon with yet unknown true incidence, it is prudent to be aware of it because early management of colloid cysts has a favorable outcome, in contrast to untreated cysts that are associated with higher rates of morbidity and mortality. Additionally, we provide a comprehensive, evidence-based review of the medical entity of intracranial colloid cysts with highlights of current postulated pathological theories and management algorithms.
Background
Hydrosalpinx is considered one of the obstacles that could hinder the success of IVF techniques due to the toxic effect of the hydrosalpinx fluid pouring into the uterine cavity. Tubal ...disconnection by either hysteroscopic or laparoscopic approaches is considered the standard in the operative management of hydrosalpinx prior to IVF cycles. The aim of the current study was to compare the success rate of hysteroscopic tubal occlusion using electro-coagulation with laparoscopic tubal disconnection in cases of hydrosalpinx prior to in vitro fertilization (IVF).
Methods
A total of 108 women with unilateral or bilateral hydrosalpinx, who were candidates for tubal occlusion before IVF, were equally randomized into two groups. Group A (
n
= 54) underwent hysteroscopic tubal occlusion using the roller-ball electro-coagulation of the interstitial part of the tube and the uterine cornual area, and group B (
n
= 54) underwent laparoscopic tubal disconnection using bipolar coagulation and a proximal tubal cut. Operative time, complications, postoperative pain measured by the visual analogue score (VAS score), and postoperative hospital stay were recorded for both groups. The success rate of tubal occlusion was assessed 1 month later using a post-menstrual hysterosalpingogram (HSG).
Results
Laparoscopic tubal disconnection was more successful than the hysteroscopic approach regarding tubal occlusion rate (96.15% vs. 86.67% respectively,
p
= 0.044). The operative time and postoperative pain VAS scores in the hysteroscopy group (3.65 ± 1.03 min and 1.81 ± 1.35, respectively) were significantly lower than that in the laparoscopy group (17.48 ± 4.70 min and 4.06 ± 1.65, respectively) with
p
< 0.001.
Conclusion
Although laparoscopic tubal disconnection is more successful, the hysteroscopic approach is an alternative which has its own limitations that can be assessed by hysterosalpingogram, especially when laparoscopy is contraindicated, technically difficult, or refused by the patient.
Trial registration
It was first registered at ClinicalTrials.gov on 30/07/2019 with registration number
NCT04037813
.
One of the drawbacks of the Ordinary Portland cement industry is its vast carbon dioxide emission quantities causing environmental and health problems. These problems can be faced by reducing the ...production of OPC by introducing alternative and supplementary cementitious materials. The present study aims to use mafic rock powder from the ophiolitic meta-gabbroic rock sequences as an alternative substitute for cement and its effect on the fresh and hardened properties of cement composite pastes. The main objective of this study is to track the pozzolanic activity of these alternative materials through physico-mechanical properties, mineralogy, microstructure, and heat of hydration. The studied mafic rock was thoroughly analyzed using a polarized light microscope, XRD, XRF, SEM, DTA/TG, and FTIR, in addition to physical properties. Seven mixes of cement paste composites using up to 30% mafic rock powder were prepared. Several hydration and attack regimes were involved, starting with tap water hydration for up to 28 days, followed by adverse attack conditions such as seawater and sulfate attack media for up to 3 months. The kinetics of hydration, mineralogical, and morphological investigations of the prepared composites were followed over different hydration and attack periods. An improvement in the physico-mechanical properties with notable progress up to 10% replacement was observed. The durability results of all mixes exhibited an outstanding enhancement regarding resistance to strength loss compared with the reference mix. The novelty of the current research is the recording of a significant effect of a minute addition of studied mafic rock powder on the hydration kinetics and the hydration products. Utilizing mafic rock powder up to 10% was recommended in producing different low costs cement-based materials. The partial replacement of cement by mafic rock powder up to 10% decreased the energy needed to produce a ton of binder by 13.75%.
•No pozzolanic activity for mafic rock, even though it passed the strength activity index (SAI).•A slight decrease in mix water, while a remarkable prolongation in setting times with addition.•An improvement in physico-mechanical properties with a notable advance up to 10% addition.•An outstanding resistance against seawater and sulfate attack was noticed with replacement.•A reduction in energy consumed for blended cement production by 13.75% at 10% addition.
Background: Postpartum hemorrhage is the leading cause of maternal mortality worldwide.
Aim: To compare the incidence of postpartum hemorrhage in women eligible for elective cesarean section (CS) ...delivery when using intrauterine misoprostol added to oxytocin versus oxytocin alone.
Design, Setting, Participants: This parallel randomized controlled trial study was conducted in two institutions in Egypt (Kasralainy and Aljazeerah hospital) 0.300 women eligible for elective CS delivery were enrolled in the study.
Interventions: Before randomization, all women received the same preparations. After randomization; in the study group (N = 150), intrauterine misoprostol was used after placental delivery. In the control group (N = 150), the routine oxytocin alone was used.
Results: Both groups were comparable (p-value >.05) with regard to the age, BMI, and gestational age as well as hemoglobin and hematocrit levels. The incidence of postpartum hemorrhage was significantly lower (p = .018) in the study group (1.33%) than the control group (6.67%). The absolute risk reduction was 5.3% (CI 95%: 0.8-10.6%) with a relative risk of 0.20 (CI 95%: 0.05-0.90) and number needed to treat (NNT) 19 (CI 95%: 125-9). Moreover, the needs for a blood transfusion, extra uterotonics or additional interventions were significantly lower in the study group than in the control group (p < .05). All the three parameters of blood loss ie the mean blood loss, and the mean reductions of hemoglobin and hematocrit levels were significantly (p-value <.05) lower in the study group (mean and SD) (442.59 and 151.33 mL,0.46 and 0.3 g/dL, and 0.84 and 0.56%), respectively than in the control group (591.01 and 287.97 mL,1.2 and 1.39 g/dL, and 3.47 and 3.52%), respectively. Adverse events were comparable between groups; these were fever, nausea, and vomiting and shivering.
Conclusion: Intrauterine misoprostol (400 mg) when added to oxytocin is safe and effective in decreasing the incidence of postpartum hemorrhage (PPH) and reducing the amount of postpartum blood loss in case of elective CS delivery.
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