A normalization model for repeated letters in social media hate speech text based on rules and spelling correction.

As social media booms, abusive online practices such as hate speech have unfortunately increased as well. As letters are often repeated in words used to construct social media messages, these types of words should be eliminated or reduced in number to enhance the efficacy of hate speech detection. Although multiple models have attempted to normalize out-of-vocabulary (OOV) words with repeated letters, they often fail to determine whether the in-vocabulary (IV) replacement words are correct or incorrect. Therefore, this study developed an improved model for normalizing OOV words with repeated letters by replacing them with correct in-vocabulary (IV) replacement words. The improved normalization model is an unsupervised method that does not require the use of a special dictionary or annotated data. It combines rule-based patterns of words with repeated letters and the SymSpell spelling correction algorithm to remove repeated letters within the words by multiple rules regarding the position of repeated letters in a word, be it at the beginning, middle, or end of the word and the repetition pattern. Two hate speech datasets were then used to assess performance. The proposed normalization model was able to decrease the percentage of OOV words to 8%. Its F1 score was also 9% and 13% higher than the models proposed by two extant studies. Therefore, the proposed normalization model performed better than the benchmark studies in replacing OOV words with the correct IV replacement and improved the performance of the detection model. As such, suitable rule-based patterns can be combined with spelling correction to develop a text normalization model to correctly replace words with repeated letters, which would, in turn, improve hate speech detection in texts.

Fabrication and characterization of NiCu/GO and NiCu/rGO nanocomposites for fuel cell application.

This study investigated the electrochemical behavior of NiCu, NiCu/GO, and NiCu/rGO nanocomposites designed by combining a modified Hummers' method and hydrothermal technique. The prepared nanocomposites are tested as electrocatalysts in direct alcohol oxidation fuel cells (DAFCs) to identify the role of GO and rGO as catalyst supports for the enhancement of the NiCu composite performance. The production of the NiCu/GO and NiCu/rGO composites was demonstrated by FTIR spectroscopy, EDX, and SEM analyses. In DAFCs experiments, NiCu/rGO has better catalytic activity than pure NiCu and NiCu/GO composites, whereas the use of rGO and GO as supports enhances the performance of NiCu by 468.2% and 377.7% in methanol and 255.6% and 105.9% in ethanol, respectively. The higher performance was caused by the increased density of active dots and the combined electronic effects in the designed catalysts. The stabilities of the catalysts and charge carriers' dynamics are studied using chronoamperometry and electrochemical impedance spectroscopy.

The impact of environmentally friendly supramolecular coordination polymers as carbon steel corrosion inhibitors in HCl solution: synthesis and characterization.

Two 3D-supramolecular coordination polymers (SCP1 & SCP2) have been synthesized and characterized by physicochemical and spectroscopic methods. In a solution of 1.0 M HCl, SCPs were used to prevent corrosion of carbon steel (CS). The inhibition productivity (%η) rises as the synthetic inhibitor dose rises, and the opposite is true as the temperature rises. The study was carried out using chemical (mass loss, ML) and electrochemical ( potentiodynamic polarization, PDP and electrochemical impedance microscopy, EIS) techniques, which showed %η reached to 93.1% and 92.5% for SCP1 & SCP2, respectively at 21 × 10-6 M, 25 °C. For the polarization results, SCPs behave as mixed-type inhibitors. With increasing doses of SCPs, the charge transfer resistance grew and the double layer's capacitance lowered. The creation of a monolayer on the surface of CS was demonstrated by the finding that the adsorption of SCPs on its surface followed the Henry adsorption isotherm. The parameters of thermodynamics were computed and explained. The physical adsorption of SCPs on the surface of CS is shown by the lowering values of free energy (∆Goads < - 20 kJ mol-1) and increasing the activation energy (E*a) values in presence of SCP1 & SCP2 than in their absence. Atomic force microscope (AFM) and scanning electron microscopy (SEM) demonstrated the development of a protective thin film of SCPs precipitated on the surface of CS. There is a strong matching between results obtained from experimental and theoretical studies. Results from each approach that was used were consistent.

Sensing of heavy metal Pb2+ ions in water utilizing the photonic structure of highly controlled hexagonal TiON/TiO2 nanotubes.

The detection of heavy metals in water, especially Pb2+ ions, is important due to their severe hazardous effects. To address this issue, a highly controlled hexagonal TiON/TiO2 heterostructure has been synthesized in this study. The fabrication process involved the utilization of atomic layer deposition and direct current sputtering techniques to deposit TiO2 and TiON layers onto a porous Al2O3 membrane used as a template. The resulting heterostructure exhibits a well-ordered hollow tube structure with a diameter of 345 nm and a length of 1.2 µm. The electrochemical sensing of Pb2+ ions in water is carried out using a cyclic voltammetry technique under both light and dark conditions. The concentration range for the Pb2+ ions ranges from 10-5 to 10-1 M. The sensitivity values obtained for the sensor are 1.0 × 10-6 in dark conditions and 1.0 × 10-4 in light conditions. The remarkable enhancement in sensitivity under light illumination can be attributed to the increased activity and electron transfer facilitated by the presence of light. The sensor demonstrates excellent reproducibility, highlighting its reliability and consistency. These findings suggest that the proposed sensor holds great promise for the detection of Pb2+ ions in water, thereby facilitating environmental monitoring, water quality assessment, and safety regulation across various industries. Furthermore, the eco-friendly and straightforward preparation techniques employed in its fabrication provide a significant advantage for practical and scalable implementation.

Angular surface plasmon resonance-based sensor with a silver nanocomposite layer for effective water pollution detection.

For sensing various samples of polluted water and various sodium chloride concentrations using an angular surface plasmon resonance (ASPR), we have introduced a conventional structure and a hybrid heterostructure in the current research. The suggested structures are composed of silver metal, dielectric layers, silver nanocomposite, and a sensing medium. The reflectance spectra of all structures in the visible region were obtained through the utilization of the transfer matrix method by using the angular interrogation method depending on the Kretschmann configuration. Through our findings, five substrate parameters have been optimized to attain the utmost level of sensitivity across all structures: the thickness of Ag-metal, the type and thickness of dielectric materials, the host material type and the volume fraction of nanoparticles for the nanocomposite layer. In this regard, the suggested sensor provides excellent performance with a sensitivity of 448.1°[Formula: see text], signal-to-noise ratio of 0.787, sensor resolution of 0.284°, and figure of merit of 78.766 RIU-1. Therefore, we believe that the introduced design of our ASPR sensor presents a good candidate for an accurate and efficient detection of low concentrations of contaminated water and sodium chloride as well.

Monitoring and simulation of the fuel irradiation behavior in nuclear reactors based on phononic crystal structure.

We have presented in the current work a novel idea for simulating the irradiation behaviors of the nuclear fuel pellets in nuclear reactors by using a one-dimensional defective phononic crystal (1D-DPnC) design was presented. The transmission spectra of the incident mechanical waves were considered basic data for expressing the characteristics of different nuclear fuel-pellets. Herein, the density, sound speed, and Young's modulus of the fuel-pellets represent the key parameters that are influenced by the irradiation behaviors of these pallets. Mixed plutonium-uranium oxide (MOX) nuclear fuel is considered the main fuel in the present study. In addition, a comparison is performed for this fuel with other types of nuclear fuels. Moreover, the mechanical properties of these MOX-pellets are dependent on the porosity, the ratio of oxygen-to-metal (O/M), and the plutonium (Pu-content). The theoretical treatments depend on the transfers matrix method to compute the transmission spectra through the 1D-DPnC. The numerical findings provided that the MOX-pellet has the highest performance compared to other fuel pellets and with sensitivity equal to 59.388 × 103 Hz s/m. It was also reported that the effects of the percentage of the O/M and Pu- content in MOX had a minor effect in a comparison with the impact of porosity. The theoretical simulation agreed extremely with the experimental data reported for these nuclear fuels. Because of the close relationship between sound speed and density, this sensor can be utilized to monitor the porosity, O/M, Pu-content, and density of fuel-pellets as a quick and non-destructive evaluation technique in a nuclear fuel fabrication laboratory. This article has proven theoretically that MOX fuel produced from nuclear waste of uranium dioxide and plutonium dioxide gives excellent results compared to other types of nuclear fuels, and this agrees with experimental researches. Thus, it may contribute in preserving the environment from nuclear waste, and this can be considered a novel kind of purification of environmental pollution treatment.

Mechanical properties and durability of cobalt free steel alloy as a developed radioactive waste capsule.

In this work, Cobalt-free alloys are prepared as a capsule in which radioactive waste is placed for disposal, and this is a preventive measure to rid the environment of radioactive waste and bury it deep in the earth in a capsule. So, the buildup factor was measured for 1-5-10-40 MFP. The mechanical properties (hardness and toughness) of the processed samples were studied. The hardness was calculated by the Vickers hardness test additionally; the tolerance process was carried out using concentrated chloride acid for 30 days and NaCl 3.5% for 30 days for the studied samples. In this work the resulted developed alloys are resistant to stainless steel 316 L and therefore the alloys are a suitable material in the nuclear field as a container for burying and disposing of waste.

A doped-polymer based porous silicon photonic crystal sensor for the detection of gamma-ray radiation.

In this research, a theoretical investigation of the one-dimensional defective photonic crystals is considered for the detection of gamma-ray radiation. Each unit cell of the considered one-dimensional photonic crystals (1D PhCs) is composed of two layers designed from porous silicon infiltrated by poly-vinyl alcohol polymer doped with crystal violet (CV) and carbol fuchsine (CF) dyes (doped-polymer) with different porosity. In addition, a single layer of doped-polymer is included in the middle of the designed 1D PhCs to stimulate the localization of a distinct resonant wavelength through the photonic band gap. In particular, the appearance of this resonant mode represents the backbone of our study towards the detection of γ-ray radiation with doses from 0 to 70 Gy. The Bruggeman's effective medium equation, the fitted experimental data to the refractive index of the doped-polymer, and the Transfers Matrix Method (TMM) serve as the mainstay of our theoretical treatment. The numerical findings provide significant contributions to some of the governing parameters such as the thicknesses of the considered materials on the performance of the presented sensor, the effect of incidence angle and the porosity of the considered materials on the resonance wavelength. In this regard, at optimum values of these parameters the sensitivity, quality factor, signal-to-noise ratio, detection limit, sensor resolution, and figure of merit that are obtained are 205.7906 nm RIU-1, 9380.483, 49.315, 2.05 × 10-5 RIU, 3.27 × 10-5, and 2429.31 RIU-1, respectively. Therefore, we believe that the suggested design could be of significant interest in many industrial, medical, and scientific applications.

Improving the Polarity of Text through word2vec Embedding for Primary Classical Arabic Sentiment Analysis.

Over the past decade, Sentiment analysis has attracted significant researcher attention. Despite a huge number of studies in this field, Sentiment analysis of authors' books (classical Arabic) with extracting the embedding features has not yet been done. The recent feature extraction of Arabic text depends on the frequency of the words within the corpus without extracting the relation between these words. This paper aims to create a new classical Arabic dataset CASAD from many art books by collecting sentences from several stories with human-expert labeling. Additionally, the feature extraction of those datasets is created by word embedding techniques equivalent to Word2vec that are able to extract the deep relation which means features of the formal Arabic language. These features are evaluated by several types of machine learning for classical Arabic, for example, support vector machines (SVM), Logistic Regression (LR), Naive Bayes (NB) K-Nearest Neighbors (KNN), Latent Dirichlet Allocation (LDA) and Classification And Regression Trees (CART). Moreover, statistical methods such as validation and reliability are applied to evaluate this dataset's label. Finally, our experiments evaluated the classification rate of the feature-extraction matrices in two and three classes using six machine-learning algorithms for tenfold cross-validation that showed that the Logistic Regression with Word2Vec approach is the most accurate in predicting topic-polarity occurrence.

Point-of-care ultrasound use in emergencies: what every anaesthetist should know.

Point-of-care ultrasound has been embraced by anaesthetists as an invaluable tool for rapid diagnosis of haemodynamic instability, to ensure procedural safety and monitor response to treatments. Increasingly available, affordable and portable, with emerging evidence of improved patient outcomes, point-of-care ultrasound has become a valuable tool in the emergency setting. This state-of-the-art review describes the feasibility of point-of-care ultrasound practice, training and maintenance of competence. It also describes the many uses of point-of-care ultrasound for the anaesthetist and describes the most salient point-of-care ultrasound views for anaesthetic emergencies including: undifferentiated shock; hypoxemia; and trauma. Procedural safety is also discussed in addition to relevant important governance aspects. Cardiac function should be assessed using the parasternal long axis, parasternal short basal/mid-papillary/apical, apical four chamber and subcostal four chamber views, and should include a visual estimation of global left ventricular ejection fraction. Other cardiovascular conditions that can be identified using point-of-care ultrasound include: pericardial effusion; cardiac tamponade; and pulmonary embolism. Pulmonary emergency conditions that can be diagnosed using point-of-care ultrasound include pneumothorax; pleural effusion; and interstitial syndrome. The extended focused assessment with sonography for trauma examination may of value in patients who are hypotensive in order to identify intra-abdominal haemorrhage, pneumothoraces and haemothoraces.

Aizoon extract as an eco-friendly corrosion inhibitor for stainless steel 430 in HCl solution.

Aizoon extract is used as an eco-friendly anti-corrosive material for stainless steel 430 (SS430) in a 2 M hydrochloric acid solution. Many strategies were utilized to estimate the mitigation efficacy such as mass reduction (MR), electrochemical impedance spectroscopy (EIS), and potentiodynamic polarization (PDP). The inhibition percentage (%I) increases by increasing the concentration of Aizoon and reaches 95.8% at 300 ppm and 298 K, while it lowers by raising the temperature, reaching 85.6% at 318 K. Tafel curves demonstrated that Aizoon extract is a mixed type inhibitor with an excellent ability to inhibit the cathodic reaction. Adsorption of the Aizoon extract on an SS430 surface is regulated by the Langmuir adsorption model. The value is is -20.9 kJ mol-1 at 298 K indicating that the adsorption is of mixed type affecting both cathodic and anodic reactions. Thermodynamic factors for adsorption and activation processes were estimated and discussed. The adsorption of Aizoon extract on the SS430 surface was tested utilizing Fourier transform infrared spectroscopy (FTIR) and scanning electron microscope (SEM) techniques. The Nyquist curves confirmed that Aizoon extract prohibits the disintegration of SS430 in an acid medium without changing the dissolution reaction mechanism. The theoretical calculations showed that Aizoon extract is considered as an excellent corrosion inhibitor. The experimental data were supported by theoretical evaluations.

Adsorption of the Xanthan Gum Polymer and Sodium Dodecylbenzenesulfonate Surfactant in Sandstone Reservoirs: Experimental and Density Function Theory Studies.

Chemical flooding using a polymer and/or surfactant has been widely applied in oilfields worldwide for enhanced oil recovery. Chemical adsorption in reservoirs has a significant effect on the rock permeability and wettability and hence can affect the overall oil production. In this work, two chemicals, namely, the xanthan gum (XG) biopolymer and sodium dodecylbenzenesulfonate (SDBS) anionic surfactant, were used individually as displacement fluids. The amount of chemical adsorption on the rock surface and the residual resistance factor (permeability reduction) were calculated throughout the flooding experiments using an unconsolidated sandstone (SS) pack model. The effects of the injected chemicals' concentration and reservoir salinity on adsorption capacity have been examined. Additionally, the effect of the addition of nanosilica particles (NSPs) to the injected fluid on the rock adsorption was also investigated. The results showed that the amount of XG and SDBS adsorption on the rock surface increased, albeit to a different extent, by increasing the chemical concentration at the applied salinities (0, 3.5, 5, and 10%) of the displacement fluids. Also, the permeability reduction increased with the increase in XG and SDBS concentrations; however, permeability reduction due to SDBS flooding was lower than that of XG in SS. The use of NSPs as a coinjectant to the XG and SDBS displacement fluids increased the adsorption on the SS rock. A plausible mechanism for the adsorption of the XG/NSP and SDBS/NSP blends on the SS surface was proposed. A density function theory calculation was employed to establish a relation between the adsorptivity of NSPs on SDBS and XG and the total energy and dipole moment of the molecules.

The impact of car seat giveaways on compliance among newborns in Saudi Arabia.

OBJECTIVES: Road traffic injuries are a leading cause of morbidity and mortality among children in Saudi Arabia. Previous literature suggests that poor compliance to traffic safety measures is exacerbating the burden of childhood injuries. Although car seats have been found to reduce injuries among children, their compliance remains poor nationally. The aim of this study was to evaluate whether providing free car seats for newborns is associated with the compliance of car seat use 3 months after hospital discharge. METHODS: This study was conducted in three regions of the country following a national public health campaign aimed to improve traffic safety. In November 2020, five hundred car seats were given to mothers at the time of discharge. Three months later, parents were contacted to evaluate the prevalence of compliance. In addition to estimating the prevalence of car seat use at 3 months, the analysis assessed predictors of use using a multiple logistic regression model. RESULTS: Of the 486 initial participants, 375 (77%) responded. According to the parents, 76% of children still use the car seat 3 months after hospital discharge. The age of the parents and the number of family members were significant predictors of car seat use. Smaller families (≤4 members) were 2.2 (95% confidence interval: 1.36-3.82) times more likely to comply with the car seat law 3 months after discharge than larger families. Most of the respondents (70.5%) strongly agree that child restraint systems are an essential device while driving with children. CONCLUSIONS: We found that providing free car seats for newborn children is associated with uptake of improved traffic safety, but compliance remains lower than in developed countries. Further studies are needed to facilitate improving child seat safety among large families. As the country strives to invest in reducing traffic injuries, similar initiatives may facilitate adopting safety measures among parents, which may reduce preventable injuries and improve population health.

Incidence, risk factors and management of post cesarean section surgical site infection (SSI) in a tertiary hospital in Egypt: a five year retrospective study.

BACKGROUND: Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3-20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. METHODS: This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. RESULTS: The incidence of SSI post-cesarean section was 5.34%. Significant risk factors for SSI were; chorioamnionitis (adjusted odds ratio (AOR) 4.51; 95% CI =3.12-6.18), premature rupture of membranes (PROM) (AOR 3.99; 95% CI =3.11-4.74), blood loss of > 1000 ml (AOR 2.21; 95% CI =1.62-3.09), emergency CS (AOR 2.16; 95% CI =1.61-2.51), duration of CS of > 1 h (AOR 2.12; 95% CI =1.67-2.79), no antenatal care (ANC) visits (AOR 2.05; 95% CI =1.66-2.37), duration of labor of ≥24 h (AOR 1.45; 95% CI =1.06-2.01), diabetes mellitus (DM) (AOR 1.37; 95% CI =1.02-2.1 3), obesity (AOR 1.34; 95% CI =0.95-1.84), high parity (AOR 1.27; 95% CI = 1.03-1.88), hypertension (AOR 1.19; 95% CI = 0.92-2.11) and gestational age of < 37 wks (AOR 1.12; 95% CI = 0.94-1.66). The mortality rate due to SSI was 1.33%. CONCLUSIONS: The obtained incidence of SSI post CS in our study is relatively lower than other previous studies from developing countries. The development of SSI is associated with many factors rather than one factor. Management of SSI is maninly medical but surgical approach may be needed in some cases. REGISTRATION: Local ethical committee (Registration number: MOBGYN0040).

Dental trauma characteristics in the primary dentition in Greifswald, Germany: a comparison before and after German unification.

BACKGROUND: The data on the distribution and pattern of dental trauma in the primary dentition are very rare. AIM: To investigate primary dental trauma patterns in relation to gender, age, time and cause for a recent paediatric cohort and to compare this with a historic one before German unification. METHODS: This retrospective study compared the patterns of dental trauma injuries at the trauma centre at Greifswald University/Germany for a recent paediatric cohort (2014-16, 103 children) with a historic one (1974-1989, n = 120). The data contained details on etiology, injury types and treatment delivered for 450 injured teeth (247 historic, 203 recent). RESULTS: In both cohorts, the occurrence was more common in males than females (63%/55%, resp.) with an age peak from 2 to 6 years. Maxillary incisors were most affected (89.6%/88.6%, resp.) and periodontal ligament injuries dominated (77.8%/90.3%, resp.). Almost half of the injuries occurred at home (46.6%), mostly due to falling (48.5%) or during playing (37.8%) in the recent paediatric cohort which provided better forensic data due to insurance issues and potential concern about child abuse. Advice and follow up was the most common approach in the recent paediatric cohort (76%). CONCLUSION: Even after 30 years and a change in the health care system due to German unification, the patterns of dental traumatic injuries in the primary dentition were similar.

A ten year analysis of maternal deaths in a tertiary hospital using the three delays model.

BACKGROUND: Reducing maternal mortality ratios (MMRs) remain an important public health issue in Egypt. The three delays model distinguished three phases of delay to be associated with maternal mortality: 1) first phase delay is delay in deciding to seek care; 2) second phase delay is delay in reaching health facilities; and 3) third phase delay is delay in receiving care in health facilities. Increased health services' coverage is thought to be associated with a paradigm shift from first and second phase delays to third phase delay as main factor contributing to MMR. This study aims to examine the contribution of the three delays in relation to maternal deaths. METHODS: During a 10 year period (2008-2017) 207 maternal deaths were identified in a tertiary hospital in Minia governorate, Egypt. Data were obtained through reviewing medical records and verbal autopsy for each case. Then data analysis was done in the context of the three delays model. RESULTS: From 2008 to 2017 MMR in this hospital was 186/100.000 live births. Most frequent causes of maternal mortality were postpartum hemorrhage, hypertensive disorders of pregnancy and sepsis. Third phase delay occurred in 184 deaths (88.9%), second phase delay was observed in 104 deaths (50%), always together with other phases of delay. First phase delay alone was observed in 13 deaths (6.3%) and in 82 deaths (40%) with other phases of delay. One fifth of the women had experienced all three phases of delay together. Major causes of third phase delay were delayed referral from district hospitals, non-availability of skilled staff, lack of blood transfusion facilities and shortage of drugs. CONCLUSIONS: There is a paradigm shift from first and second phases of delay to the third phase of delay as a major contributor to maternal mortality. Reduction of maternal mortality can be achieved through improving logistics, infrastructure and health care providers' training. TRIAL REGISTRATION: This study is a retrospective study registered locally and approved by the ethical committee of the Department of Obstetrics and Gynaecology, Minia University Hospital on 1/4/2016 (Registration number: MUEOB0002).

Multidimensional model to assess the readiness of Kuwait to implement evidence-based child maltreatment prevention programs at a national level.

OBJECTIVE: To assess the readiness to implement child maltreatment (CM) prevention programs at a national level. STUDY DESIGN: This is a cross-sectional study. METHODS: This study was completed alongside similar studies undertaken by the rest of the Gulf Cooperation Council (GCC) countries and led by Kingdom of Saudi Arabia (KSA). The study will allow further understanding of possible obstacles that may be encountered while implementing a nationwide prevention program. The 10-dimensional model of readiness had been developed by the World Health Organization (WHO) in collaboration with five countries (Brazil, The Former Yugoslav Republic of Macedonia, Malaysia, Saudi Arabia, and South Africa) through a five-stage process. Stakeholders and decision makers were invited to participate. Scores for each dimension were compared with those for the rest of the GCC countries. RESULTS: The overall score of Kuwait was 39.17 out of 100. This was below the mean average score for the GCC countries (47.83). Out of the 10 dimensions, key informants scored the highest on legislation, mandates and policies (6.61). The lowest score was reported on attitudes towards CM prevention (1.94). Informal social resources (5.72) ranked the highest as compared to the rest of the GCC countries. CONCLUSIONS: The readiness of Kuwait is weak on several dimensions and needs to be strengthened. Despite that, the country is moderately ready to implement large-scale evidence-based CM prevention programs because it is strong in the infrastructure of knowledge, legislation, mandates, and policies and informal social resources.

Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. TRIAL REGISTRATION: Registered 28th October 2015, ClinicalTrials.gov NCT02590484 .

Intra-abdominal infection (IAI) following cesarean section: a retrospective study in a tertiary referral hospital in Egypt.

BACKGROUND: The incidence of post cesarean intra-abdominal infection (IAI) and the independent risk factors associated with it were retrospectively studied at a tertiary referral hospital in Egypt. METHODS: The study targeted the period between January 2014 and December 2017 (4 years) at Minia University Hospital for Obstetrics and Gynecology (a tertiary referral hospital), Minia Governorate, Egypt. All cases that developed IAI following cesarean section (CS) during the study period were included (408 cases, which served as the case group); in addition, 1300 cases that underwent CS during the study period and were not complicated by IAI or surgical site Infection (SSI) were randomly chosen from the records (control group). The records of cases and controls were compared and bivariate analysis and multivariate logistic regression were used to identify risk factors for IAI. RESULTS: During the studied period, there were 35,500 deliveries in the hospital, and 14200 cases (40%) of these were by cesarean section, producing a rate of 40%. The incidence of IAI post CS was 2.87%, and the mortality rate was 1.2% (due to septicemia). The most identifiable risk factors for IAI were chorioamnionitis (AOR 9.54; 95% CI =6.15-16.2; p ≤ 0.001) and premature rupture of membranes (PROM) (AOR 7.54; 95% CI =5.69-10.24; p ≤ 0.001). Risk factors also included: prolonged duration of CS >  1 h (AOR 3.42; 95% CI =2.45-5.23; p = 0.005), no antenatal care (ANC) visits (AOR 3.14; 95% CI =2.14-4.26; p = 0.003), blood loss > 1000 ml (AOR 2.86; 95% CI =2.04-3.92; p = 0.011), emergency CS (AOR 2.24; 95% CI =1.78-3.29; p = 0.016), prolonged labor ≥24 h. (AOR 1.76; 95% CI =1.26-2.27; p = 0.034) and diabetes mellitus (AOR 1.68; 95% CI =1.11-2.39; p = 0.021). CONCLUSIONS: The incidence of IAI post CS in our hospital was 2.87%. Identification of predictors and risk factors for IAI is an important preventive measure.

Management of bleeding from morbidly adherent placenta during elective repeat caesarean section: retrospective -record -based study.

BACKGROUND: Controlling massive haemorrhage from morbidly adherent placenta (MAP) at caesarean section is a major surgical challenge to obstetricians. This study compares different intra-operative interventions to control haemorrhage from morbidly adherent placenta and its impact on maternal morbidity. METHODS: Retrospective analysis was done for baseline characteristics, intra-operative and postoperative complications of 125 patients with morbidly adherent placenta who had elective CS at 35-38 weeks gestation in the period from 01/2012 to 01/2017. The included patients were categorized into three groups according to intra-operative interventions they had for controlling bleeding; Group A (n = 42) had only balloon tamponade, Group B (n = 40) had balloon tamponade and bilateral uterine artery ligation, in Group C (n = 43) all cases were managed by bilateral uterine artery ligation and inverting the cervix into the uterine cavity and suturing the anterior and/or the posterior cervical lips into the anterior and/or posterior walls of the lower uterine segment using the cervix as a natural tamponade. RESULTS: There were no differences of baseline characteristics of patients in all groups. Group C had significantly better outcomes as compared with groups A and B; less total blood loss (Group C 2869.5 ml vs Group B 4580 ml, Group A 4812 ml, P <  0.001), less requirement of blood transfusion more than 4 units (Group C 4/43, Group B 10/40,Group A 12/42, P <  0.02), significant reduction in prolonged hospital stay over 10 days (Group C 2/43, Group B 9/40,Group A 14/42, P < 0.001) and lower risk of coagulopathy (Group C 4/43, B 8/40, A 9/42), visceral injuries (Group C 4/43 vs B 8/40, A 10/42,P < 0.01) and need for hysterectomy (Group C 4/43 vs B 11/40, A 13/42,P < 0.001). CONCLUSION: A combination bilateral uterine artery ligation and using the cervix as a natural tamponade are very effective and simple methods in controlling bleeding resulting from separated placenta accreta. TRIAL REGISTRATION: The findings are part of the research project registered in ClinicalTrials.gov NCT02590484 . Registered 28 October 2015.