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Background Preeclampsia is a hypertensive disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Osteoprotegerin (OPG), a glycoprotein involved in vascular homeostasis, has emerged as a potential biomarker for disease severity. This study aimed to evaluate serum OPG levels in pregnant women with and without late-onset preeclampsia and to assess its correlation with disease severity and clinical outcomes. Methods This case–control study was conducted at Ain Shams University Maternity Hospital between August 2022 and January 2024. Ninety pregnant women with gestational age ≥ 34 weeks were enrolled and equally divided into three groups: normotensive controls ( n  = 30), mild late-onset preeclampsia ( n  = 30), and severe late-onset preeclampsia ( n  = 30). Clinical assessments, laboratory investigations, and serum OPG levels (measured by ELISA) were compared among groups. Correlation, multivariate regression, and receiver operating characteristic (ROC) curve analyses were performed. Results Serum OPG levels were significantly higher in women with late-onset preeclampsia, particularly in the severe group ( p  < 0.0001). Elevated OPG levels were strongly correlated with adverse perinatal outcomes, including fetal growth restriction, preterm delivery, NICU admission, and cesarean delivery. Multivariate regression analysis demonstrated that OPG levels were independently associated with preeclampsia severity and adverse perinatal outcomes. ROC analysis showed excellent diagnostic performance of OPG in identifying severe late-onset preeclampsia (AUC = 0.976), with sensitivity and specificity of 93.3%. Conclusion Serum OPG levels are significantly elevated in late-onset preeclampsia and correlate closely with disease severity and adverse maternal and fetal outcomes. OPG shows promise as a clinical biomarker for identifying severe late-onset preeclampsia, although its utility in mild disease appears limited.

ObjectivesOne particularly effective method of long-acting, reversible, and reasonably priced contraception for spacing out pregnancies is the intrauterine device (IUD), especially in areas with poor access to medical facilities. Alongside contraceptive implants, IUDs are known to offer high satisfaction rates among users. For postpartum contraception, IUD insertion immediately after placental delivery, following either vaginal or abdominal delivery, is considered feasible. Additionally, insertion within 48 hours of delivery is also a viable option. To compare the post-placental insertion (PPIUD) of an IUD among women who had a cesarean birth against those who planned for interval IUD installation 6 weeks postpartum in terms of expulsion rate and patient compliance.Materials and MethodsThis randomized controlled trial involved 97 patients who were recruited from an outpatient clinic and received the intervention of IUD insertion. It was carried out at the Tertiary Care Hospital’s Obstetrics and Gynecology Department at Ain Shams University Maternity Hospital from July 2022 to March 2024.ResultsThere were no statistically significant difference between the studied groups regarding age, body mass index, parity and history of previous IUD use. None of the cases in either group experienced failed insertion or perforation during insertion. Pelvic pain, dyspareunia and abnormal bleeding in month-6 follow-up were significantly less frequent in PPIUD group. None of the cases in either group experienced perforation, pelvic inflammatory disease or pregnancy in month-6 follow-up. IUD removal, expulsion and failure by month-6 were nonsignificantly more frequent in PPIUD group. Also, there were no statistically significant difference between the study groups regarding baseline and month-6 hemoglobin. Hemoglobin significantly less reduced in PPIUD. Patient satisfaction in month-6 was significantly higher in PPIUD group.ConclusionPPIUD of the IUD following cesarean delivery is a safe, simple, efficient, and practical method of contraception that can replace delayed IUD insertion because of its immediate and sustained contraceptive benefit, patient comfort, convenience, and lower incidence of side effects. As such, it qualifies for popularization as a first-line contraceptive agent in eligible patients.

Background The impact of early diagnosis of fetal cardiac abnormalities on the postnatal outcome has been controversial in literature. We aimed to evaluate the role of fetal echocardiography (FE) as a diagnostic tool for early detection and proper management of fetal cardiac abnormalities, study the indications of referral and detect the perinatal outcome in our institution. Results This is a cross-sectional observational and descriptive study that included one hundred and one singleton pregnant women (101 fetuses) who were referred for FE over a period of one year. Indications for referral and perinatal risk factors were documented. FE and postnatal transthoracic echocardiography were done. Fetal cardiac abnormalities were detected in 46.5% of cases. Congenital heart defects (CHDs) in 34.6%, fetal arrythmias in 9.9%, cardiomyopathy in 2.9% and cardiac mass (Rhabdomyoma) in 1% (combined structural and rhythm abnormalities were observed in two fetuses). Of the CHDs, complex heart lesions were diagnosed in 57.1%, common atrioventricular canal in 28.6% and conotrunchal anomalies in 14.3%. Of the ten cases with fetal arrythmias, five fetuses had tachyarrhythmias, four had ectopics and one fetus had congenital heart block in association with maternal lupus. The indications for referral were abnormal obstetric ultrasound (52.5%), maternal medical illnesses (23.8%), multiple neonatal deaths (13.9%) and positive family history of CHD (10.9%). The number of fetuses with cardiac abnormalities was significantly higher than those without cardiac abnormalities in mothers not exposed to perinatal risk factors ( p  = 0.009) and was statistically lower in mothers exposed to perinatal risk factors ( p  = 0.005). FE showed 100% accuracy in diagnosing complex lesions, common atrio-ventricular canals, cono-truncal anomalies, cardiac masses and fetal arrhythmias. It missed two cases of tiny muscular ventricular septal defects and one case of aortic coarctation. Cases of fetal supraventricular tachycardia were successfully treated in-utero. Conclusions CHDs exist in fetuses with no underlying perinatal risk factors. FE can accurately diagnose most of the cardiac anomalies though few errors remain challenging (aortic coarctation). It also offers a good chance for successful early life-saving management of some types of fetal arrhythmia.

For almost eight decades, U.S. sports leagues have disclosed information about athletes’ health with the stated goal of protecting the integrity of sports from bettingrelated manipulations. The leagues’ treatment of such information, however, has been inconsistent: When professional athletes miss games due to physical injuries, leagues usually disclose such injuries in great specificity. By contrast, when players miss a game due to mental health issues, their absence is simply attributed to “personal reasons.” This Article documents this disparity and situates it within existing regulatory frameworks in the areas of privacy law, disability law, and sports betting regulation. The Article’s main argument is that this practice cannot be justified on either factual or normative grounds. On the factual side, we review medical research showing that a stark dichotomy between “physical” and “mental” health is incompatible with the modern recognition that the body and the mind are interrelated systems. On the normative side, we argue that treating mental health issues as “personal reasons” may exacerbate the preexisting stigma surrounding mental health, may imply that mental health issues are not “real,” and may obscure the sports leagues’ responsibility for such issues. To address these problems, this Article proposes several alternative methods of disclosing health status, taking into account the importance of preserving athletes’ autonomy in regard to their mental health reporting. We conclude by discussing how the implications of this analysis may extend beyond the sports arena.

Background Variceal hemorrhage from the rupture of esophageal varices is accompanied by a substantial mortality rate. So, newly diagnosed cirrhotic patients are recommended to perform screening esophago-gastroduodenoscopy (EGD) for identifying varices. The primary objective of the present research was to ascertain the most precise biochemical and ultrasonographic variables that have the potential to non-invasively forewarn the occurrence of varices in cirrhotic patients. The study evaluated different parameters such as aspartate aminotransferase-to-platelet ratio index (APRI), platelet count/splenic diameter (PC/SD), portal vein velocity (PVV), and splenic and hepatic stiffness in prediction of EV. Methods This is a cross-sectional study that was conducted on 100 cirrhotic patients based on clinical, laboratory, and radiological assessments. All patients were subjected to thorough clinical examinations; laboratory tests were conducted to assess liver function and calculate Child–Pugh score and non-invasive tests for detecting esophageal varices such as APRI, PC/SD, Doppler ultrasonography for assessment of PV Doppler, and hepatic and splenic elastography. All patients got an endoscopic assessment in order to examine and classify the esophageal varices. Results Based on the current study, we found that predictors for EV among the studied patients were the following: PC/SD ratio with odds ratio (OR) was 2.20, PVV with OR was 4.68, liver stiffness with OR was 1.99, and splenic stiffness with OR was 3.55. With ROC curve analysis, PVV has the best overall accuracy (85.4%) for prediction of EV with an area under the curve of 0.79 at cutoff point < 7.09 (cm/s) followed by splenic stiffness that has 82.6% overall accuracy with an area under the curve of 0.71 at cutoff point > 62.22 kPa. Conclusion PVV and splenic stiffness measurement hold potential as non-invasive markers for predicting the presence of esophageal varices in individuals with liver cirrhosis. Moreover, these markers can also aid in predicting the occurrence of advanced esophageal varices.

Modern digital communication systems target satisfying multiple standards and different operating scenarios. Applications include read channels of data storage systems, PCIe links, FPGA I/Os, and multi-standard radios. This stimulates the research on reconfigurable analog-to-digital converters (ADCs) to serve as a key building block at the front-end of such systems. Conventional reconfigurable designs suffer from poor figure-of-merit (FoM) scaling with different resolutions, which reduces their flexibility. The limited efficiency of these techniques is attributed to the fact that they fix the ADC architecture for all configurations, whereas the optimum architecture depends on the target resolution. This dissertation introduces an architecture reconfigurable ADC that efficiently covers a wide range of resolutions by configuring the ADC to the proper architecture for each resolution. This leads to a reconfigurable ADC nearly as efficient as dedicated designs in both area and power. Device matching is the heart of precision analog design. Basically, well matched devices come at the expense of larger die, parasitic capacitance and power consumption. Instead of only sizing the devices to achieve the desired accuracy, the intrinsic accuracy of an area efficient converter is designed worse than its resolution. Before or during chip usage, self-calibration automatically detects and corrects for elements mismatches and leads to reduced silicon area and improved yield. This dissertation investigates the efficiency of using body voltage trimming calibration for data converters. The tradeoffs of this technique are studied in details. Suggested methods have been presented to extend the use of bulk voltage trimming beyond technology limitations with minimal area and power overhead and no special technology requirements. The study shows that best results are achieved when mixing bulk trimming with other calibration techniques. Two prototype chips are implemented in 65-nm CMOS to verify the results of this study. The first chip is a 2.5-10GS/s reconfigurable flash ADC. The ADC can be configured to work as a 3-bit, a 4-bit, or a 5-bit ADC with worst case integral nonlinearity (INL) and differential nonlinearity (DNL) of 0.48LSB and 0.35LSB respectively. The ADC achieves a figure-of-merit of 0.46pJ/conv-step and the active area is 0.13mm2. The second chip is a 1.5-4GS/s \"architecture\" reconfigurable ADC. The ADC covers resolution range from 3b to 7b, and achieves a figure-of-merit of 0.46pJ/conv-step at 7-bit and the active area is 0.15mm2.

Many recent studies have investigated the role of either Chloroquine (CQ) or Hydroxychloroquine (HCQ) alone or in combination with azithromycin (AZM) in the management of the emerging coronavirus. This systematic review and meta-analysis of either published or preprint observational studies or randomized control trials (RCT) aimed to assess mortality rate, duration of hospital stay, need for mechanical ventilation (MV), virologic cure rate (VQR), time to a negative viral polymerase chain reaction (PCR), radiological progression, experiencing drug side effects, and clinical worsening. A search of the online database through June 2020 was performed and examined the reference lists of pertinent articles for in-vivo studies only. Pooled relative risks (RRs), standard mean differences of 95% confidence intervals (CIs) were calculated with the random-effects model. Mortality was not different between the standard care (SC) and HCQ groups (RR = 0.99, 95% CI 0.61–1.59, I 2  = 82%), meta-regression analysis proved that mortality was significantly different across the studies from different countries. However, mortality among the HCQ + AZM was significantly higher than among the SC (RR = 1.8, 95% CI 1.19–2.27, I 2  = 70%). The duration of hospital stay in days was shorter in the SC in comparison with the HCQ group (standard mean difference = 0.57, 95% CI 0.20–0.94, I 2  = 92%), or the HCQ + AZM (standard mean difference = 0.77, 95% CI 0.46–1.08, I 2  = 81). Overall VQR, and that at days 4, 10, and 14 among patients exposed to HCQ did not differ significantly from the SC [(RR = 0.92, 95% CI 0.69–1.23, I 2  = 67%), (RR = 1.11, 95% CI 0.26–4.69, I 2  = 85%), (RR = 1.21, 95% CI 0.70–2.01, I 2  = 95%), and (RR = 0.98, 95% CI 0.76–1.27, I 2  = 85% )] respectively. Exposure to HCQ + AZM did not improve the VQR as well (RR = 3.23, 95% CI 0.70–14.97, I 2  = 58%). The need for MV was not significantly different between the SC and HCQ (RR = 1.5, 95% CI 0.78–2.89, I 2  = 81%), or HCQ + AZM (RR = 1.27, 95% CI 0.7–2.13, I 2  = 88%). Side effects were more reported in the HCQ group than in the SC (RR = 3.14, 95% CI 1.58–6.24, I 2  = 0). Radiological improvement and clinical worsening were not statistically different between HCQ and SC [(RR = 1.11, 95% CI 0.74–1.65, I 2  = 45%) and (RR = 1.28, 95% CI 0.33–4.99), I 2  = 54%] respectively. Despite the scarcity of published data of good quality, the effectiveness and safety of either HCQ alone or in combination with AZM in treating COVID-19 cannot be assured. Future high-quality RCTs need to be carried out. PROSPERO registration : CRD42020192084.

Post-weld heat treatment (PWHT) and solid-state thermomechanical treatment (TMT) via friction stir processing (FSP) have been shown to enhance the mechanical properties of aluminum alloys. The current work investigates the effects of PWHT and TMT on the microstructure and mechanical performance of AA6082-T6 welded butt joints welded using the MIG process. The 5 mm thick AA 6082-T6 plates were joined in butt configuration using MIG welding with ER 5356 filler wire, 120 A current, 0.3 mm/s weld speed, and argon shielding gas at 15 L/min flow rate. PWHT was performed on the MIG welds per the T6 temper procedure. TMT was implemented via FSP using a pinless tool rotating at 800 rpm and traversing speed at 200 mm/min with a 3° tilt angle. Microstructural analysis, hardness mapping, tensile testing, and fracture surface evaluation were utilized to characterize the as-welded, PWHT, and TMT samples. The results demonstrate that both PWHT and TMT significantly refine and homogenize the microstructures of the welded joints. However, the TMT samples displayed superior hardness and tensile strength compared to the as-welded and PWHT conditions. The TMT-processed welds achieved approximately 99% joint efficiency versus only 69% and 85% for the as-welded and PWHT samples. In summary, PWHT and especially TMT via FSP are effective at enhancing the mechanical properties of MIG welded AA6082-T6.

This study investigated the effect of a hemispherical friction stir welding (FSW) tool on the heat generation and mechanical properties of dissimilar butt welded AA5083 and AA7075 alloys. FSW was performed on the dissimilar aluminum alloys AA5083-H111 and AA7075-T6 using welding speeds of 25, 50, and 75 mm/min. The tool rotation rate was kept constant at 500 rpm. An analytical model was developed to calculate heat generation and temperature distribution during the FSW process utilizing a hemispherical tool. The experimental results were compared to the calculated data. The latter confirms the accuracy of the analytical model, demonstrating a high degree of agreement. Sound FSW dissimilar joints were achieved at welding speeds of 50 and 25 mm/min. Meanwhile, joints created at a welding speed of 75 mm/min exhibited a tunnel-like defect, which can be attributed to the minimal heat generated at this particular welding speed. At a lower welding speed of 25 mm/min, a higher tensile strength of the dissimilar FSWed joints AA5083 and AA7075 was achieved with a joint efficiency of over 97%.