Using algae in Li-ion batteries: A sustainable pathway toward greener energy storage.

This paper reviews and analyzes the innovations and advances in using algae and their derivatives in different parts of Li-ion batteries. Applications in Li-ion battery anodes, electrolytes, binders, and separators were discussed. Algae provides a sustainable feedstock for different materials that can be used in Li-ion batteries, such as carbonaceous material, biosilica, biopolymers, and other materials that have unique micro- and nano-structures that act as biotemplates for composites structure design. Natural materials and biotemplates provided by algae have various advantages, such as electrochemical and thermal stability, porosity that allows higher storage capacity, nontoxicity, and other properties discussed in the paper. Results reveal that despite algae and its derivatives being a promising renewable feedstock for different applications in Li-ion batteries, more research is yet to be performed to evaluate its feasibility of being used in the industry.

A critical insight on nanofluids for heat transfer enhancement.

There are numerous reports and publications in reputable scientific and engineering journals that attribute substantial enhancement in heat transfer capabilities for heat exchangers once they employ nanofluids as working fluids. By definition, a nanofluid is a working fluid that has a small volume fraction (5% or less) of a solid particle with dimensions in the nanoscale. The addition of this solid material has a reported significant impact on convective heat transfer in heat exchangers. This work investigates the significance of the reported enhancements in many recent related publications. Observations on these publications' geographical origins, fundamental heat transfer calculations, experimental setups and lack of potential applications are critically made. Heat transfer calculations based on methodologies outlined in random selection of available papers were conducted along with a statistical analysis show paradoxically inconsistent conclusion as well as an apparent lack of complete comprehension of convective heat transfer mechanism. In some of the surveyed literature for example, heat transfer coefficient enhancements were reported to be up to 27% and 48%, whereas the recalculations presented in this work restrain proclaimed enactments to ~ 3.5% and - 4% (no enhancement), respectively. This work aims at allowing a healthy scientific debate on whether nanofluids are the sole answer to enhancing convective heat transfer in heat exchangers. The quantity of literature that confirms the latter statement have an undeniable critical mass, but this volition could be stemming from and heading to the wrong direction. Finally, the challenges imposed by the physical nature of nanoparticles, as well as economic limitations caused by the high price of conventional nanoparticles such as gold (80$/g), diamond (35$/g), and silver (6$/g) that hinder their commercialization, are presented.

A passive isolation of sensor faults from un-stealthy attacks in uncertain nonlinear systems.

In this paper, a novel nonlinear observer-based approach is established to cast light on the problem of isolating sensor faults from un-stealthy attacks for Lipschitz affine nonlinear systems subjected to unknown uncertainties and disturbances. A structure consisting of a multi-line transmission mechanism, a random number generator (RNG), and Dedicated Observer Scheme is developed to make the abnormal behaviors distinguishable. A group of two interlinked nonlinear Luenberger-Like observers is designed in nonlinear coordinates to detect abnormal behaviors. Two banks of detection observers and an incidence matrix are introduced to make the final decisions. Adaptive threshold techniques are exploited to guarantee the robustness against the model uncertainties and disturbances. Compared with the existing results, the proposed approach isolates the abnormal behaviors without the need for any redundant hardware components. Finally, the performance of the proposed approach is evaluated on a continuous stirred tank reactor (CSTR).

Clinical and epidemiological characteristics of the first 150 patients with COVID-19 in Lebanon: a prospective descriptive study.

Background: Clinical features of confirmed COVID-19 cases cover a wide spectrum. Aims: To study the clinical, radiological and virological features of the first 150 patients with COVID-19 in Lebanon. Methods: Our university hospital was designated as the primary COVID-19 care centre in Lebanon. Between 21 February 2020, the date of the first confirmed case of COVID-19 in Lebanon, and 3 April 2020, our team treated 150 patients diagnosed with COVID-19. In this prospective descriptive study, we present our experience in treating these patients, specifically the diagnostic criteria, outcome, and demographic, clinical, radiological and biological characteristics. Results: Ninety-five (63.33%) of the patients were male and 55 (36.67%) were female. Most patients (58%) were aged > 50 years, and 8 (5.33%) were healthcare workers. Diagnosis was based on reverse transcription polymerase chain reaction, and patients were classified as mild, moderate or critical. Fifteen (10%) patients had a critical presentation and fever was the most prominent symptom at presentation. One hundred and thirty-eight (92%) patients underwent radiological evaluation. The most common laboratory findings were lymphocytopenia (34.38%), followed by neutropenia (28.13%), but leukocytosis was not prevalent (1.56%). Old age and comorbidity were significant indicators in patient risk stratification. Chest computed tomography was an invaluable method of diagnosis and management. Our radiological findings were consistent with the published literature. Conclusion: Our study underlines the variable presentation of COVID-19, the difference in severity, and the diverse methods of diagnosis. This suggests the need for a tailored approach, taking into consideration the wide spectrum of presentation.

A case report of reconstruction of ocular and complete upper eyelid avulsion with severe facial soft tissue injuries using anterolateral thigh free flap.

INTRODUCTION AND IMPORTANCE: Ocular injury is second mostly caused by motor vehicle accident (MVA) and often leads to severe ocular injury even to visual loss and various aesthetic problems. The outcome is determined by the magnitude of the initial damage and treatment availability. Treating ocular and facial injury due to MVA is challenging given the scope of the damage and may result in various outcomes. CASE PRESENTATION: This case presented a 22-years old woman with a history of car accident assessed with total upper eyelid avulsion with corneal perforation and involvement of multiple facial fractures on the left side. The visual function is irreparable due to the extensive corneal defect from exposure and secondary infection, and possible optic nerve damage. CLINICAL DISCUSSION: This case presented a complete upper eyelid avulsion with severe facial tissue injury. Therefore, the reconstructive procedure main objectives are to maintain appropriate prosthetic position and to improve cosmetic function. This case used anterolateral thigh free flap as the reconstructive surgery method because it is convenient for large defects and the donor scar is not visible. After completing the surgery and several follow-up procedures, the patient recovered without any significant complications. CONCLUSION: Despite visual loss due to the extent damage of the eye, it is important to restore the facial damages. Visual function is as crucial as cosmetic function in determining the patient's quality of life.

The impacts of different heating systems on the environment: A review.

This paper presents a review of the environmental impacts of most heating systems drawing together published literature on the subject, not previously available. Here, a comparison between the different systems such as coal, wood, oil, natural gas, heat pump, geothermal and solar energy is provided in terms of their environmental impact. The most important parameters considered are the emission rate and toxicity. This places the coal-fired system as the worst among all heating systems regarding the impacts on the environment. On the other hand, renewable energy sources are the most preferred sources decreasing total emissions and air pollution. In order to make a comparison between the different systems, the emissions that must be taken into consideration are CO, CO2, NOx, SO2, PMs, N2O, CH4, volatile organic compounds, polycyclic aromatic hydrocarbons and aldehydes.

Second-trimester acute fatty liver disease of pregnancy: A brief review of the literature and a case report.

Acute fatty liver disease of pregnancy (AFLP) is a rare life-threatening medical emergency unique to pregnancy. It is characterized by progressive microvesicular fatty infiltration of maternal hepatocytes, but the exact etiology has yet to be elucidated. AFLP typically manifests in late third trimester or immediately postpartum and seldom during second trimester. Prompt delivery, irrespective of gestational age or severity, is crucial for arresting the insult and permitting recovery. We hereby report a 21-year-old Lebanese second-gravid woman at 20 weeks' gestation diagnosed with AFLP depending on clinical features and compatible laboratory studies (score of 8 on Swansea criteria), in spite of early occurrence. A review and analysis of early AFLP (second trimester) compared to late (third trimester) was also presented. AFLP appearing during second trimester is as serious as the disease manifesting in late third trimester, with similar diagnostic difficulties, less association with hypertension, but with greater hesitation of obstetricians to affect prompt delivery and higher adverse perinatal outcome due to added effect of premature delivery in second trimester.

Isolated Tubal Torsion: A Rare Cause of Acute Pelvic/Abdominal Pain among Adolescent Females.

Tubal torsion usually occurs as a part of adnexal torsion that affects an ovary and the adjacent tube; however, isolated tubal torsion is an extremely rare condition. Usually, it presents as acute pelvic/abdominal pain but could also exhibit milder intermittent pain alternating with periods of relief (subacute). This condition has seldom been diagnosed preoperative and commonly results in tubal damage due to delayed management. We hereby, report the findings of two cases managed recently at our center. In both cases, the diagnosis was delayed 2-3 days and was only made intraoperative when the tubes could not be salvaged due to extensive necrosis. The extent of tubal damage is predominantly dependent on the duration of vascular insult; hence, the urgency for affecting early diagnosis and intervention to restore blood supply and preserve tubal integrity and function. We advocate the liberal and early use of laparoscopy in patients presenting with subacute unexplained pelvic/abdominal pain.

New Concept of Power Generation Using TEGs: Thermal Modeling, Parametric Analysis, and Case Study.

In this manuscript, an innovative concept of producing power from a thermoelectric generator (TEG) is evaluated. This concept takes advantage of using the exhaust airflow of all-air heating, ventilating, and air-conditioning (HVAC) systems, and sun irradiation. For the first step, a parametric analysis of power generation from TEGs for different practical configurations is performed. Based on the results of the parametric analysis, recommendations associated with practical applications are presented. Therefore, a one-dimensional steady-state solution for the heat diffusion equation is considered with various boundary conditions (representing applied configurations). It is revealed that the most promising configuration corresponds to the TEG module exposed to a hot fluid at one face and a cold fluid at the other face. Then, based on the parametric analysis, the innovative concept is recognized and analyzed using appropriate thermal modeling. It is shown that for solar radiation of 2000 W/m2 and a space cooling load of 20 kW, a 40 × 40 cm2 flat plate is capable of generating 3.8 W of electrical power. Finally, an economic study shows that this system saves about $6 monthly with a 3-year payback period at 2000 W/m2 solar radiation. Environmentally, the system is also capable of reducing about 1 ton of CO2 emissions yearly.

A review on maintenance strategies for PV systems.

PV (PhotoVoltaic) systems gained popularity in being eco-friendly power supplies, reducing toxic gas emissions for energy production. Unfortunately it's been seen that efficiency reduction and output deficit are two common scenarios for PV systems when confronted with faulty events: this fact creates the crucially important need of knowing types of different possible faults and be able to detect them according to their ways of striking, timing and density of their leftovers. What comes after is fixing the damages, by preventing them from happening repeatedly and stop them from reaching the surface. Since knowing the fault without correcting it is counterproductive, maintenance strategies can reduce competencies of the system, accelerate operation time, and compensate the system in a way that prevents lowering in efficiency and consequently financial losses. This paper aims to present different schemes used in fault intervention categorized by preventive, corrective, predictive and urgent case faults maintenance methods with corresponding effects on environment. A critical comparison between different strategies is presented as well as an economical assessment of the maintenance costs and energy production increase. Each type is individually clarified to reveal what area of PV faults types it can withstand. With a recommendation on maintenance choice, an informative reference for researchers in the field is established to optimally maintain a sustainable PV system.

How safe is high-order repeat cesarean delivery? An 8-year single-center experience in Lebanon.

AIM: To quantify the impact of the number of prior cesarean deliveries (CD) on operative complications and preterm birth. Then to investigate the presence of a threshold, beyond which complications tend to be disproportionately dangerous. METHODS: This was a retrospective cohort observational study, where data corresponding to all CD done at our service, during an 8-year period, were collected and analyzed. In total, 1840 CD were performed. Patients were divided into five categories that corresponded to the number of CD. Primary outcome was the composite adverse maternal outcome, while preterm birth and individual complications were secondary outcomes. RESULTS: The composite adverse maternal outcome, preterm birth, as well as all individual complications related to CD, except for placental abruption, showed a significant rise in frequency that paralleled the increase in the number of CD. Furthermore, this increase tended to be continuous as the number of CD increased, with an evident surge after the fourth. CONCLUSION: In our population, increasing number of prior CD was a risk factor for a parallel increase in the rate of composite adverse maternal outcome, preterm birth and almost all intraoperative complications attributable to CD. Decreasing exposure to such surgeries by limiting family size to four offspring should be considered seriously in patient counseling.

Uterine body placenta accreta spectrum: A detailed literature review.

Placenta accreta spectrum (PAS) is a major obstetrical problem whose incidence is rising. Current guidelines recommend screening of all women with placenta previa and risk factors for PAS between 20 and 24 weeks. Risk factors, diagnosis, and management of previa PAS are well established, but an apparently normal location of the placenta does not exclude PAS. Literature data are scarce on uterine body PAS, which carries a high risk of maternal and neonatal adverse outcome, but is still easily missed on prenatal ultrasound. We conducted a comprehensive review to identify possible risk factors, clinical presentations, and diagnostic modalities of uterine PAS. A total of 133 cases were found during a 70-year period (1949-2019). The vast majority of them presented with signs of uterine rupture, even prior to the viability threshold of 24 weeks (up to 45%). Major risk factors included previous cesarean delivery, uterine curettage, uterine surgery, Asherman's syndrome, manual removal of the placenta, endometritis, high parity, young maternal age, in vitro fertilization, radiotherapy, uterine artery embolization, and uterine leiomyoma. Diagnosis was pre-symptomatic in only 3% of cases. Future studies should differentiate between previa PAS and uterine body PAS.

Characteristics of fetal and maternal heart rate tracings during labor: A prospective observational study.

BACKGROUND: Fetal well-being is assured during labor and delivery with the employment of electronic fetal heart monitoring (EFHM). In uncommon instances, maternal heart rate (MHR) instead of fetal heart rate (FHR) can be the source of signals on monitors (signal ambiguity) leading to erroneous interpretation and management. Information about MHR characteristics are comparatively inadequate. We aim to analyze and compare MHR and FHR characteristics during the first and second stages of labor. METHODS: A prospective cohort study was conducted in a single tertiary care center during a one year period. Fifty one healthy full term women with singleton pregnancies during labor were enrolled. Uterine contractions, MHR and FHR were recorded simultaneously during both stages of labor by monitors designed for twin gestation. RESULTS: When compared to FHR, MHR had significantly lower baseline rate during 1st and 2nd stages (p < 0.0001). It demonstrated also more marked beat-to-beat variability during both stages (p < 0.0001). MHR showed significantly more accelerations (p = 0.03 and p = 0.008) and less decelerations (p < 0.0001 and p = 0.021) during 1st and 2nd stages respectively. CONCLUSIONS: All characteristic parameters and patterns produced by FHR could be mimicked by MHR as well, though, at different frequencies. Understanding EFHM patterns suspected to be MHR artefacts and the employment of modern monitors that simultaneously obtain and display FHR and MHR can unmask ambiguity and avert related misinterpretation problems. Similar studies should be conducted in high-risk groups where the potential for fetal hypoxia/acidosis is increased.

Transposition of Cardinal Ligaments for Stages II-III Uterine Prolapse: A Minimally Invasive Procedure.

Uterine and other pelvic organ prolapse (POP) are becoming more frequently encountered due to increased life expectancy among menopausal women. Traditionally, most surgical procedures included hysterectomy as an integral part of the management. POP might, however, though less commonly, affect women not willing to accept hysterectomy, especially young females who did not complete their family. For these patients, uterine prolapse could be managed by a number of uterine-sparing surgical procedures that are performed through either abdominal or vaginal route according to patient's condition, surgeon's choice, and skills. Most of these operations, however, are usually lengthy, invasive, need good experience, and sometimes special accessories and instruments. We performed anterior transposition of the cardinal ligaments on two patients with POP quantification Stages II-III uterine prolapse without amputating the cervix. Both patients were interviewed at 6, 12, and 18-month intervals and reported no undue pain or dyspareunia with complete satisfaction regarding self-assessment of gynecologic anatomy. Furthermore, examination by the lead author revealed satisfactory anatomic correction. We recommend this simple, easy, and minimally invasive vaginal procedure to fellow gynecologists for repair of mild degrees of uterine prolapse in women declining hysterectomy or amputation of the cervix.

HELLP Syndrome, Thrombotic Thrombocytopenic Purpura or Both: Appraising the Complex Association and Proposing a Stepwise Practical Plan for Differential Diagnosis.

Both thrombocytopenia and microangiopathic hemolytic anemia (TMA) are seen in thrombotic thrombocytopenic purpura (TTP) and HELLP syndrome among other disorders during pregnancy. Although both share backgrounds of endothelial injury and microvascular thrombi and some clinical features, yet, they have different etiologies and courses. In late pregnancy, differentiating between these two pathologies can be extremely difficult due to the immense overlap in clinical and laboratory manifestations and this becomes only possible with the use of specific markers as ADAMTS-13, when available. Hereby, we describe three cases that may exemplify the complex association between PE/HELLP syndrome and TTP. The first case presented with PE/HELLP syndrome and deteriorated postpartum to improve on plasmapheresis. The second case was a known TTP patient who developed superimposed PE/HELLP at 27 weeks gestation which necessitated emergent delivery. The third was a case of preeclampsia that progressed to HELLP syndrome on day 2 postpartum but 3 days later was complicated by TTP. HELLP syndrome and TTP can co-exist, but can also complicate one another. In the absence of instantaneous results of ADAMTS-13 and when diagnosis with clinical judgement alone cannot be done with certainty, a short trial-plasmapheresis could be attempted with close observation of the immediate response. This stepwise approach might prove to be a valuable tool when integrated in the usual workup of clinical and laboratory evaluation both before and after delivery.

A multicentric prospective study evaluating the safety and efficacy of Kii® Fios® First Entry Trocar in laparoscopic bariatric surgery.

INTRODUCTION: Laparoscopic surgery has evolved as an important field of surgery due to its clear benefits when compared to open laparotomy surgery. However, specific complications of laparoscopic surgery have been reported, of which the majority are complications associated with first entry to the abdominal cavity. The emergence of bariatric surgery, combined with the special considerations of the abdominal wall and cavity of obese patients, leads to seeking new modalities of access to the abdominal cavity in this specific population.Kii Fios First Entry Bladeless Trocar (Applied) is a new device that may allow surgeons to facilitate the creation of pneumoperitoneum. This prospective multicenter nonrandomized trial aims to evaluate the safety and efficacy of Kii Fios First Entry Bladeless Trocar in laparoscopic bariatric surgery. METHODS: In the period between December 2013 and June 2014, 588 patients were included by 18 surgeons from several French hospitals to undergo laparoscopic surgery using Kii Fios First Entry Trocar as a first-entry trocar. The surgeons filled out a questionnaire assessing the safety and efficacy of the trocar for every patient. RESULTS: There were no mortality and no major complications. However, 11 cases (1.87%) of minor complications (liver and greater omentum injuries) were reported. The surgeons reported successful entry in less than 1 min for 70.58% of the cases. CONCLUSIONS: Kii Fios First Entry Trocar (Applied) is a safe and efficient method to establish first entry in laparoscopic bariatric surgery when all the recommendations are followed and respected.

Short-term neonatal outcome in singleton, late preterm deliveries: a three-year experience at a single Lebanese center.

BACKGROUND: There has been a decrease in the mean gestational age at delivery worldwide mostly due to an increase in deliveries occurring at late preterm period (LPP) with a concomitant rise in the rate of morbidities among newborns delivered at this period. OBJECTIVES: To report the frequency of common short-term neonatal morbidities in infants born at LPP (between 34(0/7) and 36(6/7) weeks' gestation) and to compare these frequencies with those of full-term infants born at our institution. MATERIALS & METHODS: A descriptive cohort study (2008-2010) at Makassed General Hospital. All deliveries occurring at LPP constituted the study group (n = 361), while births at or beyond 37 weeks' gestation were considered as controls (n = 2814). RESULTS: The average rate of deliveries in LPP was 11.4% for the entire study period. The rate of Neonatal Intensive Care Unit admissions, respiratory morbidities, sepsis, jaundice, hypothermia, hypoglycemia and overall neonatal morbidity were all significantly higher in LPP infants when compared to those at term (p-value < 0.013). CONCLUSION: In our cohort of Lebanese newborns delivered at LPP, significantly higher morbidities were encountered when compared to full-term newborns. Every possible effort should be exerted to avoid elective deliveries during LPP in order to curb the incidence of neonatal morbidities.

Duodenal duplication cyst in a 52-year-old man: A challenging diagnosis and management.

INTRODUCTION: Duodenal duplication is a rare congenital malformation. Although more frequent in childhood, it may rarely be observed in adulthood. Pre-operative diagnosis can be difficult. PRESENTATION OF CASE: We report the case of a 52-year-old man with a duodenal duplication cyst, who was misdiagnosed even after a primary surgery. Definitive treatment needed an extensive diagnostic workup and a second delicate operation. DISCUSSION: This article discusses the incidence of duodenal duplications, their types, their clinical presentations, the radiologic and diagnostic features along with different therapeutic options. CONCLUSION: Duodenal duplication should always be one of the differential diagnoses proposed when approaching upper abdominal cystic formations.