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In this paper, geostatistical analysis of digital image processing data efficiently contributed to the preliminary site investigation and geotechnical mapping of Wadi Fayidah, Saudi Arabia. 3D modeling, clustering, and chart pattern changes were used to analyze the spectral electromagnetic energy reflected values in red, green, and blue (RGB) ranges on false color composite Landsat-7 images. Therefore, from upstream to downstream, a series of measurements were carried out on a 70km dendritic drainage pattern at 78 stations. Wadi Fayidah was found to have a dominant structural lineament of 56° to 84°. Furthermore, as a preliminary engineering geology mapping, Wadi Fayidah has 9 lithofacies that may differ in engineering geological properties.

A fast effective inversion algorithm is proposed herein to interpret gravitational responses caused by mineralized/ore sources (sphere, vertical and horizontal cylinders). The algorithm relies on local wavenumber and correlation imaging techniques. The correlation factor (R) between the local wavenumber of observed gravitational field and that of computed field was calculated, and the maximum Rmax was considered to correspond to the best true model (parameters). The proposed algorithm was applied to two theoretical examples, including an example contaminated with regional background and another multisource example. Besides, the proposed approach was used on three different real field cases for mining/ore investigation from Canada and Cuba. From the results obtained from the theoretical and real examples and by comparing the results with drilling and literature information, it was concluded that the method is effective, is applicable even for more than one source, is accurate, and does not necessitate any prior knowledge of the source shape.

The Bat optimizing algorithm (BOA) is one of the metaheuristic algorithms and applied here to interpret self-potential (SP) data. The BOA is depending upon a bat echolocation behavior for global optimization, which the global optimum solution reached at the suggested minimum value of the objective function. The best interpretive source parameters for the subsurface structures occurred at the minimal the objective function value (global best solution). The BOA is applied to 2D SP anomaly data to estimate the characteristic source parameters (i.e., the depth to center, amplitude coefficient, origin location, geometric shape factor, and polarization and inclination angle of the causative buried structure). The BOA can be applied to single and multiple source structures in the restricted class of simple geometric shapes, which these bodies help in the validation of the subsurface ore and mineral targets. The stability and efficiency of the proposed BOA have been examined by several synthetic examples. In addition, three different real field examples from Germany and Indonesia have been successfully applied to ore and mineral investigation and geological structure studies. In general, the achieved results are in good agreement with the available borehole data and results mentioned in the literature.

Rapid imaging technique, so-called “R-parameter”, utilized for interpreting a gravity anomaly profile. The R-parameter based on calculating the correlation factor between the analytic signal of the real anomaly and the analytic signal of the forward anomaly of assumed buried source denoted by simple geometric shapes. The model parameters (amplitude, origin, depth, and shape factor) picked at the maximum value of the R-parameter. The technique has been proved on noise free and noisy numerical example, numerical example showing the impact of interfering sources. Furthermore, the introduced technique has been successfully applied to visualize a salt dome gravity anomaly profile, USA. The obtained results are in good agreement with those reported in the published studies and that with that obtained from drilling.

Metaheuristic algorithms are increasingly being utilized as a global optimal method in the inversion and modeling of magnetic data. We proposed the Bat Algorithm Optimization (BAO) technique that is based on bat echolocation performance to find the global optimum solution. The best-estimated source parameters that correspond to the objective function minimum value are obtained after achieving the global optimum (best) solution. The suggested BAO technique does not require any prior knowledge; rather, it is a global search method that provides an effective tool for scanning the space of data to appraise sources parameters. The BAO technique is applied to magnetic data in the class of dipping and vertical dikes along 2D profiles to estimate the dimensional source parameters that include the depth to top, origin location, amplitude coefficient, index angle of magnetization, and width of the dipping dikes. The BAO technique has been used for single and multiple dikes structures. The accuracy and stability of the BAO technique are achieved on different synthetic examples of free and noisy data for single and multiple cases. Furthermore, the presented BAO technique was effectively utilized in three field examples from China and Egypt for iron ore deposits and metavolcanics basalt rock investigations. Overall, the BAO technique recovered inversion outcomes are in good agreement with borehole, geology, and published literature results.

A new imaging method has been developed for elucidating the observed magnetic data gauged along profile. The method is based on the calculation of the correlation factor (the R-parameter) between the analytic signal of the measured magnetic anomaly and the analytic signal of the calculated response of some geometrically simple interpretive models in the confined category of sheets, cylinders, and spheres. The characteristic parameters (amplitude coefficient, depth, location, approximative shape of the buried structure, and effective angle of magnetization) of the interpretive model correspond to the maximum R-parameter value. The scheme has been verified on a number of noise-free synthetic examples and recovered the actual model parameters. Prior to applying the developed scheme to real-field examples, the accuracy of it has been carefully investigated on synthetic examples which are contaminated with realistic noise levels, interference effects, and regional field. Finally, the method has been successfully applied to three real-field data examples from the USA, Senegal, and Egypt for mineral exploration, and it is found that the obtained results are in good concordance with those obtained from drilling and/or the published literature.

We have developed an algorithm to obtain the model parameters for two co-axial structures from self-potential data. The method uses the first numerical horizontal derivatives calculated from the observed self-potential anomaly employing filters of sequential window lengths (s-values) so as to gauge the model constraints for the shallow and deep structures. In addition, this algorithm uses a standard inversion method for solving a non-linear equation based on the lowest root-mean-square (RMS) error of the estimated model parameters. The body constraints are the depth, polarization angle and electric dipole moment of each structure. Our approach models the self-potential dataset as an aggregation of spheres, horizontal cylinders, and vertical cylinders. These simple bodies are used to approximate, without a priori expectations, the furthermost plausible position and/or area of intersection. In other words, the bodies are used to estimate the true values of the source parameters for the two-co-axial bodies at different s-values. Minimizing the RMS error has the advantage of optimizing all model factors. The proposed technique is tested using a numerical model with and without noise and on self-potential field data acquired at a site in Germany. In all cases, the assessed body parameters are reasonable approximations of the known values.

Background Various adjuvants were added to intrathecal anaesthetics to improve quality of the block and postoperative analgesia. We hypothesized that intrathecal dexmedetomidine and magnesium sulphate (MgSO4 ) may add similar effects. Our objectives were to compare their effects as adjuvants to intrathecal bupivacaine on postoperative analgesia, stress hormones, sedative properties and the neonatal outcome after caesarean section. Methods A randomized double-blind controlled study; 90 parturients were divided into three groups. All patients received intrathecal hyperbaric bupivacaine 12.5 mg. NaCl 0.9% was added to intrathecal block in group C, 5 μg dexmedetomidine in the group D and 50 mg MgSO4 in group M. Visual analogue scale (VAS) score, stress hormones were assessed within the first 12 postoperative hours, sensory block, and neonatal outcome were also assessed. Results VAS scores were significantly lower in groups D and M. Onset of postoperative pain was significantly prolonged in group D. Time to peak sensory level was shorter in group D. Sedation score was significantly higher in group D only after 30 min of intrathecal block. Although stress hormones increased in all groups during intraoperative and postoperative periods, their levels were significantly lower in group D compared to other groups. No differences were noted regarding neonatal outcomes. Conclusion Intrathecal dexmedetomidine is superior to intrathecal MgSO4 during caesarean section with regard to duration of analgesia, pain severity and stress hormone levels. Dexmedetomidine has a rapid onset and longer duration of sensory block compared to MgSO4 . No significant adverse effects to the parturients or newborns.

The near-surface groundwater aquifer that threatened the Great Pyramids of Giza, Egypt, was investigated using integrated geophysical surveys. A total of 10 electrical resistivity imaging, 26 shallow seismic refraction, and 19 ground-penetrating radar surveys were conducted in the Giza Plateau. Collected data for each method were evaluated by state-of-the art processing and modeling techniques. A three-layer model depicts the subsurface layers and better delineates the groundwater aquifer and water table elevation. The resistivity of the aquifer layer and seismic velocity vary between 40 and 80 Ωm and between 1500 and 2500 m s−1, respectively. The average water table elevation is about +15 m, which is safe for the Great Sphinx, but it is still subjected to potential hazards from the Nazlet El-Samman suburb where the water table elevation reaches 17 m. A shallower water table at the Valley Temple and the tomb of Queen Khentkawes, with a low topographic relief, represents severe hazards. It can be concluded that a perched groundwater table is detected in the elevated topography to the west and southwest that might be due to runoff and capillary seepage.

Background Studying the impact of chronic kidney disease on neurocognitive functions is a critical element for providing optimal care to these children who might suffer from its detrimental consequence on their psychosocial life. Aim The aim of the study was to assess the cognitive functions in adolescents with end-stage renal disease (ESRD) under regular hemodialysis compared with healthy controls. Patients and methods We studied 40 adolescents – 20 patients with ESRD on regular dialysis and 20 controls closely matched with the patient in terms of their age, sex, and educational level. Patients were recruited from the pediatric dialysis unit, Menoufia University hospitals, with dialysis durations ranging from 0.5 to 8.5 years with mean 3.25±2.28 years. They were assessed using Raven’s Progressive Matrices tests (for fluid intelligence), and a computerized battery composed of Spatial Span (visual–spatial working memory task), Tower of London task (measuring planning and problem-solving ability), and the Go/No Go task (a task assessing response inhibition, set shifting, and attention). We, furthermore, assessed disease-related variables impacting the cognitive functions of the patients. Results The average age of the patients was 14.4±3.315 years, and that of the controls was 13.7±1.46 years. The fluid IQ for the patients was significantly lower than the controls (P Conclusion Our findings provide evidence that the fluid intelligence and cognitive function of adolescents with ESRD on dialysis fall within the low average on most tasks. Furthermore, hypertension and anemia potentially place children with ESRD at an increased risk for neurocognitive deficits, which consequently places them at risk for poor long-term educational and occupational outcomes.

Background The nasal soft tissue envelope affects the final rhinoplasty result, and can limit the expected improvement. Currently, no dependable and objective test exists to measure the thickness of the nasal skin and underlying soft tissue. Objectives This paper presents a simple, yet reliable method to determine the thickness of the soft tissue envelope. An algorithm is presented for treatment of the dermis and/or soft tissue apart from surgery of the underlying osseocartilaginous structures. Methods Seventy-five patients presenting for primary rhinoplasty underwent visual and ultrasound assessment of their nasal soft tissue envelope. At preoperative evaluation, the Obagi "skin pinch test" was used to assess the thickness of the nasolabial fold and whether or not the skin was oily. Patients were classified based on the pinch thickness. At time of surgery prior to injection of local anesthesia, ultrasonic assessment was done at the nasolabial fold, keystone junction, supratip, and tip to measure the thickness of the nasal dermis and underlying soft tissue. Results Patients determined to have thin, normal, and thick skin by the "skin pinch test" were found to have a nasolabial fold dermal thickness with an average of 0.7 mm (0.4-1.2 mm), 1.1 mm (0.8-1.8 mm), and 1.4 mm (0.7-2.0 mm). Patients determined to have thin, normal, and thick skin were found to have a dermal thickness at the keystone junction with an average of 0.3 mm (0.2-0.4 mm), 0.5 mm (0.3-1.1 mm), and 0.9 mm (0.6-1.2 mm), respectively. This difference in thickness also translated to the supratip and tip areas measured. However, all areas were also affected by the oiliness of the skin. Soft tissue thickness (SMAS and muscle) underlying the dermis was variable. Patients of non-Caucasian background were more likely to have a thicker soft tissue layer. Conclusions The "skin pinch test" is an easy and reliable way for the surgeon to evaluate the thickness of the nasal soft tissue envelope. The rhinoplasty surgeon can make decisions pre- and postoperatively to treat patients with difficult soft tissue envelopes. LEVEL OF EVIDENCE 4.

Introduction Laparoscopic surgery is a common daily performed procedure. It has the advantages of small incision, better cosmetic aspects, less postoperative pain, and rapid recovery to daily activities. Pneumoperitoneum and increased intraabdominal pressure can induce many pathophysiologic disturbances, requiring the anesthesiologist to be well alert during the operation for necessary management. Patients and methods This is a prospective, observational clinical study. A total of 60 consecutive patients scheduled for gynecological laparoscopic surgery were recruited from the Gynecological and Obstetrics Department. Selected patients were divided into two groups according to the duration in Trendelenburg positioning: group I ( 1 h). A preoperative anesthetic assessment was carried out, and a standardized general anesthesia technique and monitoring were followed for all patients of the two groups. Pneumoperitoneum was generated by the insufflation of gas (CO2) into the peritoneal cavity. Results On the evaluation of the effect of prolonged pneumoperitoneum and position of patents on intraoperative hemodynamics, mean arterial blood pressure was significantly decreased (in group II) at time M3 (average mean blood pressure during Trendelenburg position till recovery). Heart rate also significantly decreased (in group II) at time heart rate 3 (average heart rate during Trendelenburg position till recovery). Intraabdominal pressure significantly decreased in group II at time intraabdominal pressure 4 (average time during positioning), and pulmonary function test parameters were significantly decreased after recovery. Conclusion Prolonged laparoscopic gynecological surgery can markedly affect intraoperative hemodynamics and postoperative respiratory function.

This paper describes a fast imaging technique, the so-called here the “R-parameter imaging technique”, for the interpretation of gravity data measured along profile. The technique calculates the R-parameter (a statistical parameter called the correlation coefficient) between the analytic signal of the measured gravity field and that of the synthetic response of an assumed interpretive model in the restricted class of spheres and cylinders. The characteristic source parameters (depth, shape, origin point of the gravity profile, and amplitude factor) of the model correspond to the maximum R-parameter value. The method has been verified on noise free numerical examples. Following that, the accuracy of the method has been carefully assessed on both noisy numerical examples and numerical examples with interference effects. Finally, the technique has been successfully applied to five field data examples from Canada, Sweden and Cuba for mineral exploration, and it is found that the obtained results are in good agreement with those reported in the published literature.

The hazards of ground water rise threatened the most famous and well preserved archaeological sites of the Great Giza Pyramids and Sphinx area investigated using non-destructive geophysical techniques. Ground Penetrating Radar and (GPR) and Electrical Resistivity Sounding and Tomography (VES and ERT) surveys conducted in the study area to characterize the ground water aquifer and determination of the water table level. The water table elevation determined at different archaeological locations within the study area. The average water table depth is about 15 meters, which is safe for the Sphinx status. Water table of the surrounding area reached about 17 m due to different sources of leakage.

Geophysical studies were performed along selected locations across the Pyramids Plateau to investigate the groundwater table and the near aquifer, which harmfully affected the existed monuments of the Giza Pyramids and Sphinx. Electrical Resistivity Imaging (ERI), Shallow Seismic Refraction (SSR) and Ground Penetrating Radar (GPR) techniques were carried out along selected profiles in the plateau. Ten ERI, twenty six SSR and nineteen GPR profiles were performed at the sites. The ERI survey shows that, the groundwater table is at elevations varying from 13 to 18 m above the sea level (asl) and low resistivity values near the surface at the Great Sphinx. ERI profiles, which were applied southeast of the Middle Pyramid (Khafre), show high resistivity values near the surface, and water table is located at elevations ranging from 22 to 40 m asl, while the ERI profiles conducted south of Menkaure, show almost high resistivity near the surface. The groundwater table is located at elevations ranging between 45 and 58 m asl. The aquifer layer shows electrical resistivities ranging between 10 and 50 Ohm.m. The considerable high change in the groundwater table is due to the rapid increases of topography from the Great Sphinx towards the Small Pyramids (Menkaure), where this part looks-like a scarp. The SSR Survey is transmitted to know the different velocities and types of the layers, which can help in knowing the saturated layers in the area. The GPR Survey is performed to delineate the water table, which gives good matching with the ERI results.

Background Shivering was found to be a common side effect with spinal anesthesia. It was observed in about 55% of patients with neuraxial anesthesia. It results in increased oxygen consumption and pain which usually interfere with patient’s monitoring. Objectives This study was designed to show the effect of intrathecal injection of magnesium sulfate to control shivering during spinal anesthesia for cesarean section. Study Design This study was a prospective randomized controlled double-blind study using a computer-generated randomization scheme. Methods 84 Women were randomly allocated into 2 groups: Magnesium sulfate group (M); patients received intrathecal 2 ml of 0.5% heavy bupivacaine (10 mg) plus 25 mg MgSO4. Placebo group (P); patients received intrathecal 2 ml of 0.5% heavy bupivicaine (10 mg) plus 0.5 ml normal saline. Vital signs, temperature, shiverig score, sensory level, motor block, and any complications were recorded. Results Shivering score revealed a statistically significant difference between both study groups throughout the whole intraoperative and postoperative periods with lower shivering incidence in the M group. There was a statistically significant difference between both groups regarding temperature readings during the first 30 minutes postoperatively. Intraoperative sensory level block was statistically significant different only 30 minutes after drugs injection. No serious complications were recorded in both groups. Conclusion We concluded that intrathecal Magnesium sulfate is safe and can decrease the incidence and intensity of shivering during cesarean section under spinal anesthesia, without having any serious side effects.

Aim: To estimate the effect of 0.9% saline during bipolar resectoscopy and 1.5% glycine during monopolar resectoscopy on hemodynamic, biochemical and hematological parameters. Material & Methods: A prospective randomized study in a tertiary care university hospital and comprising of 155 patients scheduled for hysteroscopic myomectomy. They were subjected to bipolar resectoscopic myomectomy utilizing 0.9% saline in group A, and monopolar resectoscopic myomectomy utilizing 1.5% glycine in group B. Perioperative measurements of hemodynamic, hematological, and biochemical changes in all cases were reported. Likewise, intrauterine pressure throughout the different procedures was recorded. Main outcome measures: intraoperative difference with regards to fluid volume and subsequent systemic changes specially osmolarity. Results: A significant increase of central venous pressure, end diastolic volume, end diastolic index, stroke volume, stroke index, cardiac output, cardiac index, postoperative prothrombin time and postoperative partial thromboplastin time in both groups with positive correlations between the absorbed fluid volume and these measurements in both groups. Moreover, there was a significant decrease in systemic vascular resistance, postoperative hemoglobin concentration, postoperative hematocrit value ratio, postoperative platelet count and postoperative prothrombin concentration in both groups and there were negative correlations between the absorptive fluid volume and these measurements in both groups. There were significant decrease in serum sodium concentration and postoperative serum osmolarity in glycine group (B) with negative correlations between the absorptive fluid volume and both serum sodium concentration and serum osmolarity in glycine group (B). Conclusions: The use of bipolar resectoscope utilizing 0.9% saline as a distention media is not associated with hyponatremia or hyposmolarity unlike monopolar resectoscope utilizing 1.5% glycine distending media in cases with submucous myoma of considerable size.

Objective To record circulatory volume changes, hyponatraemia, decrease in plasma osmotic pressure, changes in blood picture and coagulation profile in correlation with the size of myoma during hysteroscopic myomectomy. Design A cross-sectional prospective comparative study. Setting Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt. Subjects Fifty patients undergoing hysteroscopic myomectomy where a balanced general anaesthetic technique was used. Interventions Patients were divided into two groups according to the size of the submucous myoma. Group A included 25 patients having small submucous myomas (3 cm or less). Group B included those having larger myomas (more than 3 cm). Hysteroscopic myomectomy was done using glycine 1.5% as an irrigating solution for all cases. Haemodynamic measurements included pulse, mean arterial blood pressure and central venous pressure (CVP). Cardiodynamic measurements using non-invasive thoracic electrical bioimpedence (TEB) included cardiac output (CO), cardiac index (CI), stroke volume (SV), stroke index (SI), end diastolic volume (EDV), end diastolic index (EDI), ejection fraction (EF), peak flow (PF), peak flow index (PFI) and systemic vascular resistance (SVR), arterial blood gases (PaO2, PaCO2), oxygen saturation by pulse oximeter and end tidal CO2 by capnogram. Serum sodium and potassium concentration, blood osmolarity, prothrombin time (PT), prothrombin concentration (PC), partial thromboplastine time (PTT), haemoglobin concentration (HB), haematocrite value (HCT) and platelet count (PLT) were also measured. Absorbed fluid volume and intrauterine pressure (IUP) were also measured. Main outcome measures Changes in haemodynamics, caerdiodynamics, blood gases and haematological measurements as measured preoperatively and every 15 min for 75 min. Results The trial showed statistically significant variations regarding haematological and biochemical variables, but it was not associated with clinical signs of hyponatraemia. No signs of cardiac overload or cerebral confusion in both groups. Group B was associated with significant hyponatraemia, increased CVP, hypo-osmolarity, increased PT and PTT, and increased most of the cardiodynamic parameters. Conclusions Hysteroscopic myomectomy, despite being the most risky hysteroscopic procedure, can be safely performed in most cases following the safety precautions. Intraoperative fluid absorption, especially with large myomas, is the trigger of some systemic changes. The procedure should be performed by an experienced hysteroscopist using a quick technique with the least possible glycine volume and minimal intrauterine pressure to achieve the goal of a safe out-patient minimal access surgery.

Introduction: There is a great deal of concern when it comes to resurfacing the skin of patients who have recently taken or are taking isotretinoin. Much of the concern arises from reports of abnormal and keloidal scarring postdermabrasion, Argon laser, and pulsed dye laser. This study was designed to retrospectively evaluate the complication rate of patients undergoing chemical resurfacing within 2 years of taking isotretinoin and to see if timing of the medication and depth of peel correlated. Materials and Methods: This is a retrospective chart review of 91 patients (14 men, 77 women) who had 123 peels documented. Patients were assigned to 1 of the following 4 groups based on the timing of isotretinoin use to the chemical peel: prepeel, perioperative, pre- and postpeel, and postoperative. Complications, isotretinoin dose, patient age and race, peel depth, and presence of keloids before surgery were recorded. Results: A total of 123 peels were documented in 91 patients: 51 prepeel, 13 perioperative, 22 pre- and postpeel, and 37 postoperative. The complications recorded were prolonged erythema (0.8%), atrophic scarring (0.8%), altered texture (0.8%), delayed healing (3.25%), and hypertrophic scarring (2.44%). Delayed healing was observed only in patients taking isotretinoin before or at the time of surgery. Two of 3 patients who developed hypertrophic scarring had taken isotretinoin during the postoperative stage. Discussion: Although previous case reports suggest a correlation between isotretinoin use and abnormal or keloidal scarring after dermabrasion, Argon laser, and pulsed dye laser, the occurrence of hypertrophic scarring remained low in the chemical-peel group of patients. We suggest avoiding isotretinoin for 3 months preoperatively and delaying postoperative use of isotretinoin until dermal regeneration is complete (3 months). Further studies are needed to determine if the use of refrigerants in dermabrasion and the heat generated by lasers cause temperature alterations that predispose to scarring in patients taking isotretinoin.

Background. Trichloroacetic acid (TCA) peels are popular, well known, and widely utilized to correct a variety of skin problems. Different methods exist, ranging from the use of plain TCA to augmented or modified TCA at concentrations ranging from 30% to 50%. However, peel results vary depending upon the physician skill level, patient selection, and patient management. Objectives. The purpose of this article is to fill the gap for a peel that is deeper than superficial exfoliative procedures yet lighter than a medium-depth peel, to simplify and standardize the TCA peel, to define depth properly based on intraoperative clinical signs, to implement a color guide that facilitates even application of TCA and avoids skip areas, and to identify and minimize variables that may contribute to inconsistent outcomes. Methods. A coating system for TCA application is created by selecting a specific TCA concentration (15% or 20%), TCA volume (4 or 6 ml, respectively), and a standardized body surface area to be peeled (5%), taking into consideration skin thickness and fragility. Multiple coats of TCA are applied to reach the desired endpoints: papillary dermis (light Blue Peel) or the immediate upper reticular dermis (light/medium Blue Peel). Clinical signs guide the depth achieved (frost quality, even blue, pink sign, epidermal sliding) and correlate retrospectively with healing time (7–10 days). Results. The TCA Blue Peel was found to be a simple and consistent treatment approach for problems related to the epidermis, papillary dermis, and immediate upper reticular dermis. An unexpected benefit was the appearance of skin tightening and a reduction of skin laxity in many cases. This suggests that the papillary dermis and the immediate upper reticular dermis play a significant role in skin tightness. Conclusion. A simple coating system for achieving depth-controlled TCA peels is presented with correlation to intraoperative clinical signs. This method makes it easier to peel skin of all racial backgrounds, including nonfacial skin. This is especially useful for many patients previously excluded from having procedures that penetrate beneath the papillary dermis. Commonly encountered variables in chemical peels are presented which may affect outcome.

Objectives To record the severity of pain following operative laparoscopic surgery and to assess the effectiveness of either intraperitoneal infusion of bupivacaine or intravenous tramadol for postoperative pain relief. Design A prospective randomized study. Setting Gynaecologic Endoscopy Unit, Assiut University Hospital, Assiut, Egypt. Subjects 90 patients undergoing day case laparoscopic surgery where a standard anaesthetic technique was used. Interventions Patients were randomly allocated to one of three groups according to the analgesia provided in the postoperative period. Group B received intraperitoneal bupivacaine (20 ml, 0.25%) through the laparoscopic cannula and another 5 ml which was injected around the incision sites. Group T received intravenous tramadol hydrochloride slowly in a dose of 2 mg/kg, after the end of the procedure and group P received placebo saline, 20 ml intraperitoneally and 5 ml at the incision sites, and a placebo saline 2-ml intravenous injection. Main outcome measures Each patient recorded the site of pain, and its severity using a 4-point verbal rating scale (0 = no pain to 3 = severe pain), at 30, 60, 120 and 240 min postoperatively. We also recorded the maximum pain score, the need for fentanyl and the time to first analgesia in minutes. The suitability for same- or next-day discharge was also assessed in all patients. Results The trial showed a statistically significant reduction in pain scores up to 4 h postoperatively in groups T and B compared with group P (P

Introduction Maternal near-miss (MNM) is one of the related concepts to maternal mortality. MNM is a special category of survivors, whose stories provide unique insights and valuable information on maternal mortality. Measuring MNM beside maternal mortality and identifying its causes is essential, and should be calculated regularly for the purpose of planning, monitoring, and evaluation of provided maternal healthcare. Objectives The objectives of the study were to determine the magnitude and to identify the patterns of MNM among cases admitted to Women's Health Hospital, Assiut University, Egypt. Methodology This paper is a part of a larger case–control prospective study; however, for this analysis, we are presenting only the findings of the MNM cases. (The full profile of the cases and controls was presented in another paper.) The study was conducted at Women's Health Hospital, Assiut University and included 342 MNM cases by total coverage of all eligible cases who met the criteria of MNM identification published in WHO bulletin (2011) throughout the 12 months' period of the study. A checklist was used to collect data from the hospital records of eligible respondents. Results During the 12 months' period of the study, there were 17 503 deliveries and 16 972 live births. The maternal mortality ratio was 276 per 100 000 live births and the MNM incidence ratio was 20 per 1000 live births. This means that there was one maternal death for every seven cases of MNM. The mean age of MNM cases was 28.4 ± 8.5, whereas the mean gestational age of MNM was 35.66 ± 8.6 weeks. The main direct obstetric causes of MNM were hypertensive disorders of pregnancy (49.8%), obstetric hemorrhage (38.3%) and dystocia (32.5%). On the other hand, cardiovascular disorder was the most prevalent nonobstetric cause among MNM cases (48.8%). The peak frequency of the cases occurred during the summer season. Conclusions and recommendations MNM and maternal mortality are alarmingly high. Hypertensive disorders of pregnancy and obstetric hemorrhage were the two main direct obstetric causes of near misses that require strict and quick management protocols.

Objective To describe a simplified laparoscopic approach to cervical cerclage in the early second trimester. Design A case study. Setting Gynaecological Endoscopy Unit, Assiut University Hospital, Assiut, Egypt. Subject A 31-year-old-patient, para 5, gravida 11, with a history of eight cervical cerclage operations performed using Shirodkar and McDonald techniques. Interventions A laparoscopic abdominal cerclage procedure was carried out by fixation of a Mersilene tape into the cervical isthmus at the 12 o’clock position. The stitch was advanced at each side and passed underneath the round ligament after freeing of the bladder. The stitch was tightened posteriorly after appropriate visualization using a fan-shaped retractor. Main outcome measures Continuation of the pregnancy after 36 weeks. Results The patient delivered a healthy 3150-g female baby at 37 weeks by repeat Caesarean section and the stitch was left in place. Conclusions Laparoscopic abdominal cerclage in the early second trimester is technically feasible without deleterious effects on the mother or the fetus. Randomized studies are required to compare the cost-effectiveness, fetal and maternal safety, feasibility and success of laparoscopic vs. open abdominal cerclage.

The soaps of alkaline earth's and transition elements and closed ‘d’ orbitals were prepared by the double decomposition method by the reaction between metallic salts and sodium palmitate. The thermal stability of these soaps was studied in order to throw the light on their suitability for using as catalysts or lubricants. The soaps of alkaline earth's were found to be more stable than transition and ‘d’ closed shell soaps.Se han preparado jabones de tierras alcalinas y elementos de transición y orbitales “d” completos por el método de la descomposición doble mediante la reacción entre sales metálicas y palmitato sódico. La estabilidad térmica de estos jabones se estudio con el fin de arrojar luz sobre su idoneidad para su uso como catalizadores o lubricantes. Se encontró que los jabones de las tierras alcalinas son más estables que los de transición y que los jabones con la capa “d” completa.

Current treatments to correct and reverse diseased or aged skin yield widely divergent results. Judging the outcome of such treatments is done in an arbitrary and subjective fashion that is often limited to a patient's feedback or the physician's opinion. This makes it difficult for inter-physician or physician-patient agreement as to the degree of improvement achieved. In an age where skin rejuvenation is being widely practiced, a tremendous void needs to be filled by a system that appropriately evaluates and scores treatment outcomes. Such a system will help physicians communicate better in lectures, help them to better assess the results of various treatment modalities, and facilitate patient-doctor communication. The objective of this paper is to present a standardized scoring system against which skin rejuvenation results can be judged. This system is based on a model of healthy skin that can be defined by practical criteria against which patients can be judged pre- and post-skin rejuvenation procedures. A gold standard for healthy skin (baby skin) is established from a clinical, functional, and histologic perspective. Each patient's skin is compared with the healthy skin model and graded before and after treatment by implementing our scoring system which encompasses objective and subjective criteria. Objective criteria include the following skin characteristics: smoothness, firmness, even coloration, normal texture, and absence of any clinically evident disease. Subjective criteria include proper hydration and normal tolerance, and are not considered in the final scoring. Grading of each element in the scoring system [minimal (1), average (2), maximal (3)], and subsequently the final score [excellent (12 to 15), average (7 to 11), poor (

Currently, no documentation correlates histological changes with clinical signs of depth of the trichloroacetic acid peel. Obagi identified clinical signs of depth of injury following topical trichloroacetic acid application, employing prepeel conditioning and a method for slowing trichloroacetic acid action. A three-part study of 20 patients was undertaken to determine whether Obagi's visual and palpatory signs of depth correlated histologically with depth of peel. Also analyzed were physiological mechanisms associated with these signs. Patients were pretreated and biopsy specimens were harvested before and after modified trichloroacetic acid peeling. The results largely confirmed the validity of Obagi's observations regarding the method of trichloroacetic acid peel described. These clinical signs are verified by histology and correlated with some findings by electron microscopy. Differentiation of papillary from upper reticular dermal penetration is particularly useful. Physiological explanations for the phenomena observed are proposed. The specificity and safety of peels may be improved with these criteria.

The procedures for the preparation of the rinderpest hyperimmune sera in rabbits were studied by comparing the sera from rabbits immunised by three different schedules of inoculations. The best sera for use in immunodiffusion tests were obtained from rabbits inoculated first with rinderpest hyperimmune serum and lapinised virus, and then with lapinised virus mixed with oil adjuvant twice at weekly intervals. Those rabbits which received additional one or two intravenous inoculations with lapinised virus yielded satisfactory sera for use in the diagnosis of rinderpest by immunodiffusion technique.

A countercurrent extraction-isoelectric precipitation procedure for the preparation of protein isolates from defatted sunflower seed meal is described. Using 0.04M NaOH and a solvent:meal ratio of 20:1, as much as 95% of meal nitrogen was extracted. Precipitation at pH 4.0 resulted in an isolate containing 88.4% of the meal protein. Using 0.1% sodium sulphite with the alkaline solution in the countercurrent extraction resulted in a white, bland and highly pure protein isolate. Isolated sunflower seed protein is limiting in the amino acid lysine, while other essential amino acids are present in amounts which meet the dietary requirements of chicks and human adults.