Structural, radiation shielding, thermal and dynamic mechanical analysis for waste rubber/EPDM rubber composite loaded with Fe2O3 for green environment.

Increasing waste rubber recycling produces a specious range of products for many valuable applications. Waste Rubber/EPDM composite with different concentrations was prepared. Infrared spectroscopy (FTIR) is used to identify the chemical composition. A water absorption test, Dynamic mechanical analysis (DMA), and Thermal Gravimetric Analysis (TGA) were performed. The (75/25) WR/EPDM rubber composite exhibited the best behavior with the highest mechanical performance. Fe2O3 was added to (75/25) WR/EPDM rubber composite. Water absorption, FTIR, TGA, and DMA were investigated. The composite performance was improved with increasing Fe2O3 content. The linear attenuation coefficients (µ) were also measured as a function of the concentrations of Fe2O3 for γ-ray energy 662 keV by using 137Cs point source; the radiation shielding can be denoted by numbers of parameters like mass attenuation coefficient (µm), half value layer (HVL), Tenth value layer TVL and radiation protection efficiency (RPE%), radiation protection efficiency increased as Fe2O3 increased.

Theoretical study of the Tetraaminelithium and Tetraaminesodium molecules complexed with H-, Li- and Na- anions: static and dynamic NLO parameters.

CONTEXT: This work focuses on the study of six molecules composed of the TetraAmineLithium (TALi+) and TetraAmineSodium (TANa+) structures linked with the anions H-, Li- and Na-. The NLO results obtained by these calculations showed significant values of static first hyperpolarizabilities (ßtot) ranging from 8.74 * 10-30 to 691.99 * 10-30 esu. The two molecules TALi-Li and TALi-Na gave the highest values of static ßtot equal to 563.20 and 691.99 * 10-30 esu respectively and static second hyperpolarizabilities (γav) of 680.02 and 779.05 * 10-35 esu. The highest dynamic first hyperpolarizabilities (ß||) values are around 1474080.00 * 10-30 esu and 6,145,080.00 * 10-30 esu at 720 nm lasers and which are attributed to the two molecules TANa-Li and TANa-Na respectively. Four molecules have push-pull behavior where the anions are donor groups, the Li+-NH3 and Na+-NH3 groups are acceptor groups and a bridge composed by the three remaining NH3 ligands. The maximum wavelengths (λmax) in vacuum and in the presence of solvents for all molecules are in the range 240 to 870 nm. METHOD: The software used in this study is Gaussian 16. The optimizations of the molecules were calculated by B3LYP-D3/6-31 + + G(d,p). The static first hyperpolarizability (ßtot) was calculated by different functionals: CAM-B3LYP, LC-wPBE, LC-BLYP, M11, wB97X, HSEh1PBE and M06-2X and the MP2 method, the basis-set used is 6-31 + + G(d,p). Other calculations of static ßtot were carried out by the CAM-B3LYP functional combined with several basis-sets: 6-31G(d,p), 6-31 + + G(d,p), cc-pVDZ, AUG-cc- pVDZ, 6-311G(d,p), 6-311 + + G(d,p), cc-pVTZ and AUG-cc-pVTZ. The calculations of the first (ß||) and second (γ||) hyperpolarizabilities in second harmonic generation (SHG) were calculated by CAM-B3LYP/6-31 + + G(d,p). The delocalization energies (E(2)) were determined by the NBO approach and calculated by the same functional and basis-set cited before. The solvation Gibbs energies (ΔGsolv) were calculated using the implicit SMD model. Maximum wavelengths (λmax) and oscillator strengths ([Formula: see text]) were calculated by TD-CAM-B3LYP/6-31 + + G(d,p) in the presence of the implicit CPCM model.

Characteristics of new pyrrolic derivatives and their oligomers using DFT and TD-DFT calculations.

CONTEXT: This article is based on the study of pyrrolic derivatives and their oligomers. Knowing that, pyrrolic derivatives are widely studied on an industrial scale. The aim of this work is to find pyrrolic derivatives having the same physicochemical characteristics such as the pyrrolic edifice. Six derivatives were studied by substituting the hydrogens in the ß position of the pyrroles with the following radicals: -CHO, -Cl, -CN, -NO, and -OH. The study was carried out theoretically using ab initio and density functional of theory (DFT) methods. In the first step, molecules of four units were taken into consideration in order to make the comparison between them. This comparison showed that the majority of molecules exhibited high intramolecular charge transfer (ICT) compared to the molecule composed of four pyrrolic units (OP4), and also exhibited strong nucleophilic and electrophilic characteristics. Natural bond orbital (NBO) analysis has shown continuous ICT mechanisms for certain molecules. The studied derivatives showed good solvation in several solvents compared to OP4. The molecules substituted by the radicals -CHO, -CN, -OH, and -NO generated several peaks in the excited states, which is the opposite case for the other molecules with a single peak. The effects of chain elongation revealed exponential equations generated by the two parameters energy gaps (ΔEH-L) and maximum wavelengths (λmax) as a function of the number of units (n). These equations were used to predict the maximum and minimum values of the above parameters for more elongated oligomers. METHOD: The software used to make the calculations is Gaussian 16. All geometries were calculated by B3LYP functional and 6-31++G(d,p) basis set. The electronic parameters ΔEH-L were calculated by the following functionals: B3LYP, CAM-B3LYP, LC-wPBE, LC-BLYP, wB97X, M062X, M06HF, and M11 in addition to the second-order Møller-Plesset method (MP2) while always keeping the basis set mentioned before. An effect of basis set variation was studied by the optimal functional in combination with the following basis sets: 6-31G(d,p), 6-31++G(d,p), cc-pVDZ, AUG-cc-pVDZ, 6-311G(d,p), 6-311++G(d,p), cc-pVTZ, and AUG-cc-pVTZ. The NBO study was carried out with the M06HF/6-31++G(d,p) functional using the NBO method. The solvation parameters were calculated by M06HF/6-31++G(d,p) in the presence of the implicit solvation model Solvation Model based on Density (SMD). The excited states were calculated by M06HF/6-31++G(d,p) by the implicit solvation model Conductor Polarizable Continuum Model (CPCM).

Response of Canola productivity to integration between mineral nitrogen with yeast extract under poor fertility sandy soil condition.

Canola is one of the important oil crops and is considered the most promising oil source and adapts to reclaimed soil conditions. The current study aimed to evaluate the influence of yeast extract (YE) integrated with nitrogen (N) rates and treatments were arranged as follows: Control (without F0), 95 kg N ha-1 (F1), 120 kg N ha-1 (F2), 142 kg N ha-1 (F3), 95 kg N ha-1 + YE (F4), 120 kg N ha-1 + YE (F5) and 142 kg N ha-1 + YE (F6) on physico-chemical properties, yield and its components for three Canola genotypes i.e. AD201 (G1), Topaz and SemuDNK 234/84 under the sandy soil. In this work, Results reveal that increasing rates of Nitrogen fertilization from 95 kg N ha-1 to 142 kg N ha-1 have a great effect on physicochemical properties yield and its components. The result proved that 142 kg N ha-1 with yeast treatment was the best treatment for three Canola genotypes. Also, the result showed that seed yield was positively correlated with Chl. a/b ratio, plant height, number of branches/plant, number of pods/plant, and number of seeds/pod, and a strong negative correlation was detected between seed oil percentage when the amount of nitrogen fertilization applied without or with yeast extract is increased.

Isolation of Genetically Diverse H5N8 Avian Influenza Viruses in Poultry in Egypt, 2019-2021.

The global spread of avian influenza virus (AIV) of clade 2.3.4.4b since 2016 has caused severe losses in wild birds and poultry and has posed a risk for the infection of mammals including humans. The vaccination of poultry has been used to limit the spread of the virus and mitigate its socioeconomic impact. Here, we describe H5N8 epidemics in chickens, turkeys and ducks from different localities in Egypt from 2019 to 2021. About 41.7% (n = 88/211) flocks were tested positive by RT-qPCR for H5N8 viruses with prevalence rates of 45.1% (n = 65/144) and 34.3% (n = 23/67) in vaccinated and non-vaccinated flocks, respectively. A sequence analysis of the hemagglutinin and neuraminidase genes indicated not only the multiple introduction events of H5N8 viruses in Egypt but also the establishment of endemic viruses in commercial poultry in 2020/2021. The recent H5N8 viruses in poultry in Egypt are genetically distinct from the majority of licensed vaccines used in the field. Together, our findings indicate that poultry in Egypt is an endemic center for clade 2.3.4.4b in the Middle East. The efficiency of current vaccines should be regularly evaluated and updated to fully protect poultry flocks in Egypt against H5N8 viruses.

Maximizing land utilization efficiency and competitive indices of roselle and cluster bean plants by intercropping pattern and foliar spray with lithovit.

To maximize the land utilization efficiency of Hibiscus sabdariffa L. (roselle) and Cyamopsis tetragonoloba, Taub (cluster bean), this experiment was executed successfully at Experimental Farm, Fac. Agric., Zagazig Univ., Egypt during 2018 and 2019 at summer season. Intercropping pattern treatments as main plots (sole planting of each component as control, 1: 2, 1: 3 and 2: 3 of roselle: cluster bean as row ratio, respectively), lithovit as sub-plots (CO2 nano-material) at various rates (0.0, 2.0, 4.0 and 6.0 g/l) as well as their interaction effects were estimated. In addition, from calculating competitive indices, it was clear that, the highest land equivalent ratio (abbreviated as LER), area time equivalent ratio (abbreviated as ATER), land utilization efficiency percentage (abbreviated as LUE%) and relative crowding coefficient (abbreviated as RCC) values 1.24 and 1.12, 1.16 and 1.03, 120.57% and 108.06% as well as 0.82 and 0.41 were achieved by the treatment of intercropping pattern of 1 row of roselle alternating with 3 rows of cluster bean during the 1st and 2nd seasons, respectively. The highest values in this concern were achieved with 1: 3 planting pattern combined with 0.0 lithovit rate in the first seasonas well as 1: 2 planting pattern combined with 6.0 g/l lithovit rate in the second one. Also, the highest values of competitive ratio for roselle (Crr) were achieved by combination between 4.0 g/l lithovit rate under 1: 3 pattern, in contrary, the highest values of competitive ratio for cluster bean (Crc) were recorded by combination between 1: 2 pattern with 2.0 g/l lithovit rate in first season. Regardless of the planting patterns combined with different lithovit rates, aggressivity, based on the results, therewas a positive sign for roselle and a negative sign for the intercropped cluster bean, indicating that roselle was dominant, while, cluster bean was dominated.

Theoretical study by DFT of organometallic complexes based on metallocenes active in NLO.

This study is based on the valuation of a few model molecules. The objective of this research is focused on linear optical (LO) and nonlinear optical (NLO) enhancement of five organometallic molecules based on different metallocenes. These molecules were subjected to several calculations by different long-range functionals CAM-B3LYP, LC-BLYP, LC-wPBE, wB97X, M11, and the following three Minnesota functionals: M06-2X and M08-HX in comparison with the MP2 approach. Hence, the CAM-B3LYP functional gave the closest NLO values to the MP2 method. Second, molecule 3A based on nickelocene recorded the highest static (ßtot) value which is 76.46 Χ 10-30 esu and 4803.4 Χ 10-30 esu under the laser wavelength λ = 532 nm. Third, intramolecular charge transfers (ICTs) of the molecules studied are all directed in both directions (donor to acceptor and vice versa). Finally, the specific solvent for molecules 2A and 3A is acetonitrile, and the maximum wavelengths obtained for the isolated or solvated molecule are all located in the near UV; the corresponding interval is between 250 and 395 nm. Graphical abstract.

Alogliptin: a novel approach against cyclophosphamide-induced hepatic injury via modulating SIRT1/FoxO1 pathway.

Cyclophosphamide (CP) is one of the most potent alkylating agents and is widely used in the treatment of numerous neoplastic conditions, autoimmune diseases and following organ transplantation. Due to its ability to induce oxidative stress and subsequent apoptosis, CP is affiliated with many adverse effects with special emphasis on the highly prevalent hepatotoxicity. Dipeptidyl peptidase 4 (DDP-IV) inhibitors are being rediscovered for new biological effects due to their ability to target multiple pathways, among which is the phosphoinositide 3-kinase (PI3K) and protein kinase B (Akt) axis. This could offer protection to multiple organs against reactive oxygen species (ROS) through modulating sirtuin 1 (SIRT1) expression and, in turn, inactivation of forkhead box transcription factor of the O class 1 (FoxO1), thus inhibiting apoptosis. Accordingly, the current study aimed to investigate the potential therapeutic benefit of alogliptin (Alo), a DPP-IV inhibitor, against CP-induced hepatotoxicity through enhancing PI3K/Akt/SIRT1 pathway. Forty male Wistar rats were randomly divided into four groups. The CP-treated group received a single dose of CP (200 mg/kg; i.p.). The Alo-treated group received Alo (20 mg/kg; p.o.) for 7 days with single CP injection on Day 2. Alo successfully reduced hepatic injury as witnessed through decreased liver function enzymes, increased phospho (p)-PI3K, p-Akt, superoxide dismutase (SOD) levels, SIRT1 expression, p-FoxO1 and anti-apoptotic B-cell lymphoma 2 (Bcl-2). This resulted in decreased apoptosis, as witnessed through decreased caspase-3 levels and improved histopathological picture. In conclusion, the current study succeeded to elaborate, for the first time, the promising impact of Alo in ameliorating chemotherapy-induced liver injury.

Histopathological patterns of primary malignant ovarian neoplasms in different age groups in Almadinah Almunawwarah region, KSA.

OBJECTIVES: In the literature, the epidemiological pattern of ovarian neoplasms in different age groups in the Almadinah Almunawwarah region in KSA has not been completely elucidated. Moreover, an unusually frequent diagnosis of adult granulosa cell tumour (AGCT) has been observed in patients in Almadinah Almunawwarah, KSA. This study aimed to describe the pattern of ovarian neoplasms in different age groups in the Almadinah Almunawwarah region with particular emphasis on AGCT. METHODS: Histopathological records of all ovarian specimens diagnosed from 2011 January to 2016 December were collected from the Maternity and Children Hospital in Almaadinah Almunawwarah, KSA. Hematoxylin and eosin (HE)-stained microscopic slides of serous and mucinous epithelial borderline neoplasms and of malignant epithelial, sex cord-stromal and germ line neoplasms were identified and examined. The tissue sections from the AGCT were stained immunohistochemically with BRCA-1 antibody. RESULTS: A total of 301 ovarian specimens were obtained. Of the specimens, 217 (72%) were neoplastic and 84 (28%) were non-neoplastic. In total, 135 (63%) of the neoplastic specimens were benign, 16 (7%) were borderline tumours, and 66 (30%) were malignant tumours. Moreover, 41 (62%) of the malignant tumours were surface epithelial carcinomas, 17 (26%) were sex cord-stromal tumours, and 8 (12%) were germ cell tumours. The incidence of AGCT was unusually high, which accounts for 26% (16/66) of all malignant ovarian neoplasms. Altered BRCA-1 expression was observed in only two specimens. CONCLUSION: In this study, malignant ovarian neoplasms accounted for 30% of all neoplastic ovarian specimens, and the incidence of AGCT was remarkable. Such tumours did not show a significantly altered expression of BRCA-1. Further studies must be conducted to explore the underlying molecular causes of this condition.

Sunflower Oil and Nannochloropsis oculata Microalgae as Sources of Unsaturated Fatty Acids for Mitigation of Methane Production and Enhancing Diets' Nutritive Value.

The objective of this assay was to investigate the effect of adding sunflower oil, Nannochloropsis oculata microalgae and their mixture at 0, 1, 2, 3, 4, and 5% to three total mixed rations (TMRs) with different concentrate:forage ratios (40C:60F, 50C:50F, and 60C:40F) on in vitro gas production (GP), methane (CH4) production, and nutrient degradability. Asymptotic GP, GP rate, CH4 concentration/g acid detergent fiber (ADF), dry matter (DM) degradability (DMD), short chain fatty acids (SCFAs), and ruminal bacteria population increased, but neutral detergent fiber (NDF) degradability (NDFD), ADF degradability (ADFD), and protozoa count decreased with increasing concentrate level in the TMR. Methane production/g DM and NDF was higher for 50C:50F TMR. Sunflower oil reduced asymptotic GP, lag time, CH4 production/g ADF, ammonia-N (NH3-N), and SCFA. Compared to the control treatments, additives decreased GP rate, while sunflower oil/N. oculata mixture increased DMD and NDFD. All additives at 5% increased GP rate and lag time and decreased CH4 production/g DM, ADF, and NDF, ruminal NH3-N, and protozoa count. All additives at 2% increased DMD, NDFD and ADFD, SCFA, and bacteria population. Supplementation of TMR, containing different concentrate:forage ratios, with sunflower oil, N. oculata, and sunflower oil/N. oculata mixture at different doses modified in vitro GP, CH4 production, and nutrient degradability.

SUTURE VERSUS FIBRIN GLUE MICRONEURAL ANASTOMOSIS OF THE FEMORAL NERVE IN SPRAGUE DEWLY RAT MODEL. A COMPARATIVE EXPERIMENTAL ASSESSMENT OF THE CLINICAL, HISTOLOGICAL AND STATISTICAL FEATURES.

INTRODUCTION: Peripheral nerve injury is a frequently encountered clinical problem that leads to functional losses at the long-term. Although microsurgical repair has been introduced to clinical practice in peripheral nerve injuries, unsatisfactory outcomes regarding functional recovery in target organ cause an increasing interest on studies about nerve injury and biology of the recovery in nerve injuries1. MATERIAL AND METHODS: Sciatic nerves of seventy adult Sprague Dewly rats were transected and primary anastomosis was performed. Rats were then divided into three groups: Control group, while 30 rats were repaired with sutures, and the remaining 30 were repaired with fibrin glue. After 30 days the rats were sacrified and the sciatic nerves were investigated histologically with morphometrical and statistical analyses. RESULTS: In microsurgical nerve repair, suture placement has been thought to cause hindrance to the sprouting axons and compress the blood supply to the fascicles, thereby impairing the regeneration of the transected nerve ends after repair, with possible neuroma formation. On the other hand, fibrin glue is a simple, effective technique, less time consuming than suturing. Another advantage of this suture-free technique is that it avoids injuring the axon with needles, and the lack of foreign bodies minimizes the inflammatory reaction. CONCLUSION: We recommend using fibrin glue as it demonstrates less inflammatory reaction, less scar tissue formation, it is less time consuming and provides better outcomes.

Molecular Profiling of Breast Carcinoma in Almadinah, KSA: Immunophenotyping and Clinicopathological Correlation.

PURPOSE: To subtype breast cancer (BC) in Saudi women according to the recent molecular classification and to correlate these subtypes with available clinicopathological parameters. MATERIALS AND METHODS: Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor (Her2/neu) immunostaining was semi-quantitatively assessed to define molecular subtypes of luminal A and B, HER-2 and triple negative (basal- like) in BC paraffin embedded sections from 115 Saudi female patients diagnosed between 2005 to 2015 at the Department of Pathology, King Fahd Hospital, Almadinah, Saudi Arabia. RESULTS: The most common subtypes were luminal A (47%), followed by luminal B (27.8%) and basal like subtypes (18.3%), whereas HER-2 was the least common subtype (6.9%). Luminal A was predominantly found in the old age group, with low tumor grade (p< 0.001) and small tumor size, whereas HER-2 and basal-like subtypes were significantly associated with young age, high tumor grade, lymph node metastasis and lymphovascular invasion (p< 0.03, 0.004, 0.05 and 0.04 respectively). All subtypes showed advanced clinical stage at the time of presentation. CONCLUSIONS: Molecular subtypes of Saudi BC patients in Almadinah region are consistent with most of the worldwide subtyping. The biological behaviour of each molecular subtype could be expected based on its characteristic clinicopathological features. Along with other prognostic indicators, molecular subtyping would be helpful in predicting prognosis and management of our BC patients. We recommend screening and early diagnosis of BC in our population.

Primary versus secondary ureteroscopy for pediatric ureteral stones.

OBJECTIVE: To evaluate the outcome of primary versus secondary ureteroscopy for pediatric ureteral stones. PATIENTS AND METHODS: A retrospective chart review study that included 66 children aged less than 12 years, who were subdivided into two groups: Group A, which included 42 children who had undergone primary ureteroscopy without pre-stenting; and Group B, which included 24 children who had undergone ureteroscopy after ureteric stenting. Kidneys, ureters and bladder radiographs were done on the first postoperative day to assess the degree of stone clearance and stent position. RESULTS: Age, gender, stone location and stone size were not significantly different between both groups. In Group A, 31 (73.8%) children required ureteric dilation, 13 (31%) had a tight ureter that failed to respond to dilation, 25 (59.5%) displayed complete stone clearance, and of these, 13 (52%) needed postoperative stenting. One child experienced ureteric injury during stone disintegration and was stented for two weeks. Children in Group B experienced a 95.8% complete stone clearance rate, with no ureteric injury reported; postoperative stenting was performed in three (12.5%) children.. CONCLUSION: Secondary ureteroscopy is preferable over primary ureteroscopy in pediatric populations because of a significantly lower need for ureteric dilation, shorter procedure time and better stone clearance rate..

Chronic renal failure complications and management in kidney transplanted and nontransplanted patients.

BACKGROUND: Our purpose was to compare the management of chronic kidney disease (CKD) according to Kidney Disease Quality Initiative (K/DOQI) recommendations in kidney transplanted patients (T) and nontransplanted ones (NT). METHODS: Data concerning CKD complications were collected retrospectively. Patients seen in consultations in our department from May 2009 to June 2010 were selected if they had at least 6 months of follow-up, CKD stage 4 or 5, and no exclusion criteria namely hospitalization, active cancer, or infection in the 3 months before data collection. RESULTS: Fifty-eight T were compared with 85 NT matched by CKD stage (4-5). Anemia within K/DOQI target was better controlled among NT (51.2% versus 41.3%); however, ferritin levels within K/DOQI target were higher (80% T versus 51.7% NT). Average arterial blood pressure was similar in both groups but 51.7% of T were in K/DOQI target versus 41% of NT. Dyslipidemia within cholesterol K/DOQI target was better controlled in 60% (NT) versus 35% NT with 63.5% versus 38% NT within low-density lipoprotein K/DOQI targets. Phosphorus level was better controlled among T; parathyroid was better controlled in among 65% NT versus 50% T within the target level. CONCLUSION: Most complications of CKD were better managed among NT.

Impact of short term use of interdialytic 60% ethanol lock solution on tunneled silicone catheter dysfunction.

INTRODUCTION: Ethanol lock (EL) is used to reduce catheter infections, but its impact on dialysis catheter dysfunction has not been studied. METHODS: We analyzed the rate of dialysis silicone catheter dysfunction after an interdialytic 60% EL in an open prospective controlled non crossover cohort study, with each patient being his or her own control. The study was divided into three consecutive 2-week periods: the pre- and post-intervention periods, in which interdialytic standard locks (SL) were used, and the intervention period, in which one EL was instilled during the first week, and two consecutively in the second week. We analyzed the rate of catheter dysfunction (exchange, use of fibrinolytic, reversing the lines, difficulty in instilling or withdrawing fluid) after EL or SL. RESULTS: In 30 patients, 90 EL were instilled. The rate of catheter dysfunction increased during the EL period (2 - 13%, p < 0.001), and between the two consecutive dialysis sessions before and after EL (p < 0.05). It decreased between the two consecutive dialysis sessions after EL and the following dialysis session after an SL (p < 0.05). No catheter was removed. The urea reduction ratio did not differ in dialysis after an SL and after an EL (0.77 vs. 0.73, p = 0.17). CONCLUSION: Short term EL is associated with a transient increase in catheter dysfunction, without resulting in catheter removal or decreasing dialysis efficiency.

Changes in nasal aesthetics following nasal bone manipulation.

Nasal bone fractures are the commonest type of bony facial injury causing aesthetic deformity. The aim of this study was to identify the effect of nasal trauma and fracture manipulation on the aesthetic proportions of the nose, by comparing pre- and post-treatment nasal aesthetics. Thirty-two patients (26 men and 6 women) underwent aesthetic assessment prior to treatment of the injury by closed nasal manipulation, 7 to 10 days after the initial injury. Standard facial aesthetic photographic assessments were performed prior to and following manipulation. Assessment involved measurement of standard nasal aesthetic parameters. In the nasal trauma cohort, the main anomalies in nasal aesthetics were nasal deviation and differences in the nasal aesthetic profile. Nasal fracture manipulation successfully reduced deviation from an average of 35 degrees pre-manipulation to an average of 9 degrees post-manipulation.

Ensuring financial access to emergency obstetric care: three years of experience with Obstetric Risk Insurance in Nouakchott, Mauritania.

INTRODUCTION: The high cost of emergency obstetric care (EmOC) is a catastrophic health expenditure for households, causing delay in seeking and providing care in poor countries. METHODS: In Nouakchott, the Ministry of Health instituted Obstetric Risk Insurance to allow obstetric risk sharing among all pregnant women on a voluntary basis. The fixed premium (US$21.60) entitles women to an obstetric package including EmOC and hospital care as well as post-natal care. The poorest are enrolled at no charge, addressing the problem of equity. RESULTS: 95% of pregnant women in the catchment area (48.3% of the city's deliveries) enrolled. Utilization rates increased over the 3-year period of implementation causing quality of care to decline. Basic and comprehensive EmOC are now provided 24/7. The program has generated US$382,320 in revenues, more than twice as much as current user fees. All recurrent costs other than salaries are covered. CONCLUSION: This innovative sustainable financing scheme guarantees access to obstetric care to all women at an affordable cost.

Endoscopic control of the sphenopalatine artery for epistaxis: long-term results.

The aim of this study was to prospectively evaluate post-operative cessation of bleeding and late recurrence of epistaxis in a cohort of patients treated by endoscopic ligation of the sphenopalatine artery. Participants comprised patients undergoing sphenopalatine artery ligation for posterior epistaxis at three east Scotland hospitals. Main outcome measures were recurrence of epistaxis in the immediate post-operative period and at long-term follow up (minimum nine months). Forty-three patients (30 men and 13 women) underwent 45 procedures; two patients underwent bilateral ligation. Two patients suffered recurrence as in-patients. Two patients experienced subsequent epistaxis requiring medical treatment. Two further patients suffered minor late epistaxis not requiring treatment. Success in preventing significant recurrence was 93 per cent. All recurrences requiring intervention occurred within one month of surgery. None of the patients in this series reported nasal complications. We found sphenopalatine artery ligation to be an effective means of achieving long-term control of posterior epistaxis.

Continence after radical prostatectomy with bladder neck preservation.

PURPOSE: Bladder neck preservation during radical prostatectomy has been advocated for improving urinary continence. We evaluate bladder neck preservation looking at continence rates, surgical cancer control and bladder neck contracture. MATERIALS AND METHODS: A total of 40 patients underwent retropubic radical prostatectomy for clinically localized carcinoma of the prostate. The prostatic urethra was dissected in continuity with the bladder away from the lumen of the prostate, which allows for a true urethra-to-urethra anastomosis. RESULTS: Continence was noted immediately in 26 patients, within 2 weeks in 9 and within 6 weeks in 3. Only 2 patients required pads 3 months postoperatively. Microscopic positive surgical margins were noted in 2 of 40 patients. In 1 patient the urethral margins were not involved with carcinoma. In the other patient the urethra was not the sole positive margin and microscopic positive margins were noted elsewhere. Early results of cancer control were good. CONCLUSIONS: Early follow-up of this technique of radical retropubic prostatectomy suggest that preservation of the continence mechanism at the level of the bladder neck and prostatic urethra results in significantly improved postoperative urinary continence without adversely affecting cancer control.

Prospective evaluation of the value of direct referral hearing aid clinic in management of young patients with bilateral hearing loss.

The purpose of this study was to evaluate the value and effectiveness of a direct referral hearing aid clinic (DRHAC) in providing appropriate hearing aids to young patients aged 18-60 years while at the same time identifying patients with significant ear disease who need an otologist's opinion. The patients were referred to a tertiary referral hearing assessment clinic. A total of 137 patients (18-60 years) met the criteria to be included in the study to be assessed in the clinic by both an audiometrician and an otologist. The main outcome measures were hearing evaluation and audiometrician's management. Of them, 114 patients attended the research clinic (83%), 23 patients (17%) did not attend the clinic and 57 patients (51%) did not need any treatment or further investigation as their hearing was normal or near normal. Thirty patients (27%) were given hearing aids. Twenty-five patients (22%) failed the audiometrician assessment and were referred to the otologist. Only 13 (18%) of the 25 patients referred for an otological opinion actually required further investigations, medical or surgical treatment. DRHAC is as viable a system in the younger as in the elderly population.