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Patients infected with COVID-19 virus, show a highly variable symptomatology which can include central nervous system (CNS) dysfunction. One of the most disabling CNS manifestations is persistent severe encephalopathy seen for weeks after the resolution of the acute viral pneumonia and associated acute systemic illnesses. The precise pathophysiology of this persistent Post COVID Encephalopathy is unknown but may involve direct viral invasion of microvascular endothelium, microvascular thrombosis, toxic neuronal effects of inflammatory products, vasoactive pathology at arteriolar level or leptomeningeal inflammation. Currently, there are no established specific treatments for Post COVID -19 encephalopathy. We present a case series of three patients that underwent Therapeutic Plasma Exchange (TPE) with salinized albumin that suggests a positive therapeutic effect. We believe that the results warrant further evaluation for the role of TPE with a prospective randomized trial in persistent Post COVID -19 encephalopathy syndrome.

Background: There is variation in the reported incidence of levator avulsion (LA). Objective: Explore incidence of LA by mode of birth, imaging modality, timing of diagnosis and laterality of avulsion. Search strategy: We searched MEDLINE, EMBASE, CINAHL, AMED and MIDIRS with no language restriction from inception to April 2019. Study eligibility criteria: A study was included if LA was assessed by an imaging modality after the first vaginal birth or if only delivered by caesarean section. Case series and reports were not included. Data collection and analysis: RevMan v5.3 was used for the meta-analyses and SW SAS and STATISTICA packages for type and timing of imaging analyses. . Results: We included 37 primary non-randomized studies from 17 countries and involving 5594 women. Incidence of LA was 1%, 15%, 21%, 38.5% and 52% following caesarean, spontaneous, vacuum, spatula and forceps births respectively, with no differences by imaging modality. OR of LA following spontaneous birth vs. caesarean was 10.69. While the OR for LA following vacuum and forceps compared to the spontaneous birth were 1.66 and 6.32 respectively. LA was more likely to occur on the right side following spontaneous birth (p = 0.02) and unilaterally vs. bilaterally following spontaneous (P < .0001) and vacuum-assisted births (P = 0.0103) only. Incidence was higher if assessment was performed in the first 4 weeks postpartum. Conclusions: Forceps significantly increases incidence and severity of LA. Ultrasound and MRI are comparable diagnostic tools but early postpartum imaging may lead to over diagnosis of LA.

Episiotomy should be cut at certain internationally set criteria to minimize risk of obstetric anal sphincter injuries (OASIS) and anal incontinence. The aim of this study was to assess the accuracy of cutting right mediolateral episiotomy (RMLE). An institution-based prospective cohort study was undertaken in a Palestinian maternity unit from February 1, to December 31, 2016. Women having vaginal birth at gestational weeks ≥24 or birthweight ≥1000 g and with intended RMLE were eligible (n=240). Transparent plastic films were used to trace sutured episiotomy in relation to the midline within 24-hour postpartum. These were used to measure incisions’ distance from midline, and suture angles were used to classify the incisions into RMLE, lateral, and midline episiotomy groups. Clinical characteristics and association with OASIS were compared between episiotomy groups. A subanalysis by profession (midwife or trainee doctor) was done. Less than 30% were RMLE of which 59% had a suture angle of

Perineal pain and dyspareunia are experienced by women undergoing a vaginal birth that can have short and longer term physical and psychological morbidities. This review aimed to determine the incidence of perineal pain and dyspareunia following spontaneous vaginal birth (SVB) with intact perineum, first and second-degree perineal trauma or episiotomy. Searches of MEDLINE, EMBASE, CINAHL, AMED and MIDIRS (inception – December 2017) were undertaken with selection criteria of any study evaluating the effect of intact perineum, first- or second-degree perineal trauma on perineal pain or dyspareunia in women with SVB. Eighteen studies (8 RCTs and 10 NRSs) were included. Fourteen and 12 studies were undertaken to assess perineal pain and dyspareunia after SVB, respectively. Meta-analysis of 16 studies (3133 women) demonstrated that women at 2 days postpartum experienced nearly the same incidence of perineal pain whether perineal trauma existed or not. At 4–10 days postpartum there was a significant reduction in the incidence of perineal pain for both presence and absence of any perineal trauma. Episiotomy was associated with the highest rate of perineal pain. The incidence of dyspareunia was high at resumption of sexual intercourse following SVB with an intact perineum. At 12 months, women still experienced dyspareunia whether perineal trauma existed or not. Women experience perineal pain and dyspareunia regardless of the presence or absence of perineal trauma after SVB; nonetheless, the reported incidence is higher if perineal trauma occurred.

The efficiency of cysteine as a non-toxic corrosion inhibitor for copper metal in 0.6 M NaCl and 1.0 M HCl has been investigated by electrochemical studies. Potentiodynamic polarization measurements and electrochemical impedance spectroscopy “EIS” were used to study the effect of cysteine on the corrosion inhibition of copper. Inhibition efficiency of about 84% could be achieved in chloride solutions. The presence of Cu 2+ ions increases the inhibition efficiency to 90%. Potentiodynamic polarization measurements showed that the presence of cysteine in acidic and neutral chloride solutions affects mainly the cathodic process and decreases the corrosion current to a great extent and shifts the corrosion potential towards more negative values. The experimental impedance data were analyzed according to a proposed equivalent circuit model for the electrode/electrolyte interface. Results obtained from potentiodynamic polarization and impedance measurements are in good agreement. Adsorption of cysteine on the surface of Cu, in neutral and acidic chloride solutions, follows the Langmuir adsorption isotherm. The adsorption free energy of cysteine on Cu (∼−25 kJ mol −1 ) reveals a strong physical adsorption of the inhibitor on the metal surface.

The electrochemical behavior of Cu–Ni alloys in acidic chloride medium was investigated. Commercial Cu–Ni alloys were investigated using potentiodynamic techniques, complemented by electrochemical impedance spectroscopy. The influence of alloy composition, chloride ion concentration and immersion time on the electrochemical response of the alloys was analyzed. Results of present investigations with pure metals (Cu and Ni) are also considered in this paper for the sake of comparison. Potentiodynamic measurements reveal that the increase in nickel content decreases the corrosion rate of the alloy and when the nickel content exceeds 30%, an increase in the corrosion rate was recorded. Also, the corrosion current density increases with increasing the concentration of chloride ions up to 0.6 M. The experimental impedance data were fitted to an equivalent circuit model representing the electrode/electrolyte interface. The relevance of the proposed model to the corrosion/passivation phenomena occurring at the electrode/solution interface was discussed.

The corrosion inhibition of Cu–Ni alloys was investigated in aqueous chloride solutions using amino acids as environmentally safe materials. The corrosion rate was calculated in absence and presence of the corrosion inhibitor using polarization and impedance techniques. The inhibition efficiency of the different amino acids was also calculated. The experimental results have shown that a simple amino acid like glycine can be used as efficient corrosion inhibitor for the Cu–Ni alloys in neutral chloride solutions. An inhibition efficiency of about 85% could be achieved at very low concentrations of the amino acid (0.1 mM). For low Ni content alloy (Cu–5Ni), 2.0 mM cysteine shows a remarkable high (∼96%) corrosion inhibition efficiency. The experimental impedance data were fitted to theoretical data according to a proposed equivalent circuit model for the electrode/electrolyte interface, and the mechanism of the corrosion inhibition process was suggested. Different adsorption isotherms were tested and the corrosion inhibition process was found to depend on the adsorption of the amino acid molecules and/or the deposition of corrosion products on the alloy surface. The adsorption free energy of cysteine on Cu–5Ni (−37.81 kJ mol−1) reveals a strong physical adsorption of the inhibitor on the alloy surface.

The effect of systematic increase of Ni content on the electrochemical behavior of the Cu–Ni alloys in neutral chloride solutions was investigated. The pitting corrosion behavior of Cu–Ni alloys with different Ni contents, namely, 5, 10, 30 and 65 mass% Ni, in a stagnant 0.6 mol dm−3 NaCl solution of pH 7.0 was studied. The effect of chloride ion concentration on the electrochemical behavior of these alloys was also investigated. The results show that the increase in nickel content decreases the corrosion rate of the alloys in the neutral chloride solution. The increase of chloride concentration up to 0.3 mol dm−3 increases the corrosion rate. At higher concentrations ([Cl−] > 0.3 mol dm−3) the corrosion rate decreases due to the hydrolysis of Cu(I) chloride to form the passive Cu(I) oxide film. The breakdown potential depends on the chloride ion concentration and the nickel content of the alloy. For these investigations conventional electrochemical techniques and electrochemical impedance spectroscopy (EIS) were used. The impedance measurements have shown that the increase of the Ni content and the immersion time of the alloys in the chloride solution increase the corrosion resistance of the alloys. The experimental impedance data were fitted to theoretical values according to a proposed equivalent circuit model.

Amorphous manganese-rich (67/80 at.%) Mn/Ta/Cr alloy films were prepared by DC magnetron sputtering method. The corrosion behavior and stability of the Mn/Ta/Cr alloy films were examined in chloride-free and -containing 1 M H2SO4. AC and DC electrochemical techniques in combination with XPS analysis were used. Mn/Ta/Cr alloys exhibited very high corrosion resistance and stability up to transpassive dissolution region of chromium. The high corrosion resistance of Mn/Ta/Cr sputtered films is based on the formation of double oxyhydroxide passive film composed mainly of chromium and tantalum. The partial substitution of tantalum with chromium improves the corrosion resistance of the sputter-deposited alloys via accelerating the preferential dissolution of manganese and stabilizing alloy/passive film interface. A change in the passive film structure was observed when the alloys were anodically polarized at potentials higher than 0.6 V (SCE). # 2002 Elsevier Science Ltd. All rights reserved.

A 43-year-old man was admitted to the emergency department after a cardiac arrest of unknown etiology. The patient's medical history was unremarkable except for surgery to remove a mediastinal lipoma two years earlier. In the intensive care unit, he was observed to have a mass bulging from the left chest wall. Echocardiography showed cardiac herniation through the chest wall, which was confirmed by thoracic computed tomographic scan.

A 75-year-old patient was admitted to the operating room for an emergency laparotomy for leaking abdominal aortic aneurysm. A pulmonary artery catheter (PAC) was inserted through the right internal jugular vein but it was impossible to advance the catheter lip into the pulmonary artery. We tried to withdraw the catheter but this was also impossible. A postoperative chest radiograph revealed a catheter knot in the right atrium. We succeeded in removing the PAC through a 14-French sheath introducer placed in the femoral vein via fluoroscopy.