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Background: The rate of multiple cesarean sections is persistently on the rise because of cultural demands for large families, and multiple cesarean sections are an important cause of maternal morbidity and mortality.Objectives: This study was designed to detect the complications associated with higher order compared to lower order cesarean sections.Materials and methods: The hospitals record of women who had a cesarean section performed after three or more previous cesarean sections, and those who had a cesarean section for the second time over 2 years reviewed. Women with ≥3 cesarean sections admitted for elective cesarean section after 38 weeks' gestation, and those with ≥3 cesarean sections admitted in labor for emergency cesarean section were included in group 1. Women with history of previous one lower segment cesarean section (LSCS), who refused trial of labor and women with one LSCS who had an emergency cesarean section after failed trial of labor (TOL) were included in group 2. Antenatal, intraoperative, and postoperative data were reviewed. Statistical analysis done using SPSS version 20 (Chicago, Illinois, USA), to detect the complications associated with higher order compared to lower order cesarean sections. Primary outcome measures; complications associated with higher order compared to lower order cesarean sections. Secondary outcome measures; intraoperative, and postoperative complications.Results: Four hundred and fifty (450) women undergoing repeat cesarean section studied; 32.2% (145/450) had ≥3 previous cesarean sections (group 1), and 67.8% (305/450) had previous one cesarean section (group 2). In group 1, 77.2% (112/145) had previous three cesarean sections, 12.4% (18/145) had previous four cesarean sections, 9% (13/145) had previous five cesarean sections, and 1.4% (2/145) had previous six cesarean sections. The proportion of unbooked admission, and emergency cesarean sections were significantly high in group 2 compared to group 1 (11.1% (34/305) and 73.1% (223/305) versus 4.83% (7/145) and 40.7% (59/145); respectively) (p<.05, 95% CI; 0.1-0.2) and p<.01, 95% CI; 0.4-11.4; respectively. The risk of dense omental adhesions, and bladder injuries were significantly high in group 1 compared to group 2 (4.14% (6/145) and 1.38% (2/145) versus 0.66% (2/305) and 0% (0/305); respectively), (p=.01 (95% CI; 0.6-1.6) and p=.01 (95% CI; 0.5-5.5); respectively). Logistic regression analysis showed that the bladder injury was 5 times more (odds ratio 5.0 (95% CI; 0.035-711.8)) and the blood transfusion was 4.7 times more (odds ratio 4.7 (95% CI; 0.147-151.5)) in women with >3 repeat cesarean sections compared to women with previous one cesarean section (insignificant difference p=.52 and .38; respectively).Conclusion: The risk of dense omental adhesions and bladder injury was significantly high in women with previous ≥3 cesarean sections compared to women with previous one cesarean section. Logistic regression analysis showed that the bladder injury was five times more and the blood transfusion was 4.7 times more in women with >3 repeat cesarean sections compared to women with previous one cesarean section (insignificant difference). [ABSTRACT FROM AUTHOR]

The bactericidal efficiency of silver nanoparticles (AgNP) was evaluated against bacteria isolated from surface and ground water samples in Egypt. The AgNP were synthesized by typical one-step synthesis protocol, and were characterized using transmission electron microscopy and atomic absorption spectrophotometer. The bactericidal efficiency of AgNP was evaluated by its application in three concentrations i.e., 0.1, 0.05 and 0.01 ppm to water sample, and allowed to interact with bacteria for different duration e.g., 5 min 15 min, 30 min, 1 h and 2 h. Then, the bactericidal efficiency of AgNPs was determined by comparing the counted bacteria before and after the treatments. Higher mean values of total bacterial count (TBC), total coliform count (TCC), and total streptococcal count (TFS) were detected in surface water than in ground water. Also, the results showed that TBC, TCC and TFS exceeded permissible limits. Application of AgNP at different concentration, the number of bacteria in TBC was significantly reduced in all AgNP-exposed samples as compared to the control group (p<0.05). The highest concentration of AgNP exhibited highest bactericidal efficiency in TBC, where, after two hours, 0.1, 0.05 and 0.01 mg/L AgNP was found to be sufficient to inhibit 91.85, 89.14 and 74.92%, and 92.33, 85.23 and 53.17% in TBC of surface and ground water, respectively. Moreover, the inhibition efficiency of the highest concentration (0.1 ppm) against TCC reached to 98.10 and 99.88% in surface water and 95.54 and 99.20% in ground water after 1 h and 2 h, respectively. Similar results were found against TFS count. The AgNPs were found to be effective against bacteria of water origin. [ABSTRACT FROM AUTHOR]