FREQUENCY OF COMMON FACTORS INFLUENCING THE GRAFT UPTAKE IN MYRINGOPLASTY AMONG THE TERTIARY CARE HOSPITAL KPK

Introduction: Tympanoplasty refers to any operation involving reconstruction of the tympanic membrane and /or the ossicular chain. Myringoplasty is a tympanoplasty without ossicular reconstruction. Over the years many methods have been used for closing perforations. Myringoplasty was introduced by Berthold in 1878 but the modern era began only in 1950s with the work of Wullstein and Zoellner. The study aims to analyse the common factors which are predictive of success of myringoplasty in adult patients and to construct and validate a prognostic index that could be used as tool to predict the success of myringoplasty in adults. Objectives: To determine the frequency of common factors influencing the graft uptake in myringoplasty. Materials and Method: In this study, a total sample size was 376, using 4.08% proportion of fourth degree perineal tear, 95% confidence level and 2% margin of error under WHO software for sample size determination. Moreover, consecutive non probability sampling technique was used. Results: The mean age was 40 years with standard deviation of ± 2.63. Sixty two percent of the patients were male while thirty eight percent patients were female. The success rate of myringoplasty was 90% while the failure rate was 15(10%) patients in which 4(25%) patients had medium perforation, 5(33%) patients had large perforation while 6(42%) patients had subtotal perforation. Regarding the causes of perforation among 15(10%) patients, 13(85%) patients had infection while only 2 patients had trauma. Conclusion: The study concludes that infection (85%) was the most common cause of perforation followed by trauma (15%) in the graft uptake in myringoplasty.

Аналитическое решение задачи синтеза трехзвенного ступенчатого чебышевского СВЧ-фильтра

The problem of synthesis of the three–link stepped Chebyshev's microwave filter is reduced to two independent fourth degree equations, including a single link wave impedance as unknown. The solution of Descartes – Euler is applied to these equations. It is proved, that in case of wave impedances of extreme links are equal, the problem of the filter synthesis has two solutions. Identical phase–frequency responses correspond to these solutions. It is proved, that for every one of links a product of the wave impedances, relating to these solutions, is equal to a square of the wave impedance of transmission line, including filter.

Assessment of Safety of Vaginal Repair of Pelvic Organ Prolapse in Elderly at Birat Medical College Teaching Hospital, Nepal

Background: Pelvic organ prolapse in elder women causes sufficient morbidity and decreased quality of life. Despite age related comorbidities and decreased physiological capabilities, elder women with pelvic organ prolapse may be benefitted by surgical repair via vaginal route.The purpose of this study is to evaluate the safety of vaginal repair of pelvic organ prolapse in women of age 60 years or older. Materials and Methods: This hospital based analytical study was carried out in Birat Medical College Teaching Hospital from September 2020 to September 2021. Fifty-four patients aged 60 years or older with third and fourth degree pelvic organ prolapse were recruited for the study. Necessary information was obtained by self-structured questionnaire and entered into Microsoft Excel. Data was analyzed by SPSS version 22. Results: Fifty-four women with third or fourth degree prolapse with cystocele and rectocele underwent vaginal hysterectomy with anterior colporrhaphy with posterior colpoperineorrhaphy. No organ injury occurred during operation. There was no mortality or severe intraoperative or postoperative complications. Conclusion: Vaginal hysterectomy with pelvic floor repair for pelvic organ prolapse in women of 60 years or older is safe.

Anal endosonographic assessment of the accuracy of clinical diagnosis of obstetric anal sphincter injury

Introduction and hypothesis Obstetric anal sphincter injuries (OASIS) are a common cause of maternal morbidity with an overall incidence in the UK of 2.9% (range 0–8%). They can cause a range of physical symptoms and psychological distress. This study aims to assess the accuracy of clinical diagnosis of OASIS using endoanal ultrasound (EAUS) and the correlation between confirmed injury and change to anorectal physiology squeeze pressure and the incidence of bowel symptoms. Methods and materials Retrospective study of prospectively collected data from 1135 women who attended the Third- and Fourth-Degree Tears Clinic at our institution, 12 weeks post-delivery, between June 2008 and October 2019. Results OASIS was confirmed in 876 (78.8%) women and 236 (21.3%) had no injury. Of the women who underwent anorectal physiology, 45.6% had a mean maximal resting pressure below the normal range and 68.8% had a mean incremental squeeze pressure below normal. Women with confirmed OASIS had significantly lower pressures (p < 0.001) than those without a confirmed sphincter injury. Three hundred ninety-three (34.8%) women reported bowel symptoms, with those with endosonographic evidence of injury more likely to develop flatus incontinence. Conclusion Of the women in this study with a suspected OASIS, 21.2% could be reassured that they did not have an injury. This information is useful for women considering future mode of delivery. Those with confirmed injury are more likely to complain of flatus incontinence and have reduced anal sphincter pressures.

Direito à Não Discriminação e à Verdade Biológica dos Nascidos por PMA em Portugal e no Brasil

This study discusses issues related to Medically Assisted Procreation, particularly about heterologous artificial insemination – using genetic material from third parties – and “replacement pregnancy” in Portugal and Brazil. Therefore, it addresses the right to “biological truth” for those born by PMA and non-discrimination in the use of genetic material, focusing on respect for the dignity of the human person. It is questioned how advances in science in this area can lead, in the case of PMA, to the choice of “perfect” embryos, and we start from the hypothesis that this leads to “genetic eugenics.” Methodologically, this is an exploratory bibliographical review. According to the Portuguese standard, the PMA has as beneficiaries the hetero couple, the single woman and women who are married or in a de facto union who can even have a “shared pregnancy”, but the “replacement pregnancy” is only done exceptionally and is not donor secrecy allowed. In Brazil, if it is free and with the help of relatives up to the fourth degree, regardless of the peer’s sexual orientation and maintaining the confidentiality of the donor, the “replacement pregnancy” is guaranteed to everyone.

Episiotomy: Evolution of a Common Obstetric Practice at a Public Hospital

Objective This study aimed to evaluate the rate and impact of episiotomy on maternal and newborn outcomes before and after restricted use of episiotomy. Study Design This population-based observational study used an obstetric database of all deliveries since 1990 that has been maintained with quality checks. Inclusion criteria were vaginal deliveries at ≥37 weeks. Exclusion criteria included fetal malformations, multifetal gestations, or fetal deaths known on arrival to Labor and Delivery. The primary outcomes of interest were episiotomy, perineal lacerations, and newborn outcomes. To evaluate the impact of restrictive episiotomy, data from 1990 to 1997 (35% overall episiotomy rate) were compared with data from 2010 to 2017 (2.5% overall episiotomy rate). Univariable analysis of maternal and infant outcomes were performed comparing the two-time epochs with the Pearson's Chi-squared test. Results Overall, 268,415 women met inclusion criteria and 49,089 (18.2%) had an episiotomy. The rate of episiotomy decreased from 37% of deliveries in 1990 to 2% in 2017. A total of 82,082 deliveries occurred in the 1990 to 1997 epoch and 57,183 in 2010 to 2017. Indicated use of episiotomy was associated with a significant decrease in third and fourth degree lacerations. Immediate newborn condition (5-minute Apgar's score ≤3 and umbilical artery pH <7.1) and neonatal outcomes (intraventricular hemorrhage [IVH] grade 3/4, positive culture sepsis, neonatal seizures, and neonatal demise) were not significantly different. Conclusion Selective, indicated use of episiotomy compared with routine was associated with lower rates of third/fourth-degree lacerations with no change in neonatal outcomes. The common obstetric practice of routinely performing episiotomy, presumably to prevent perineal trauma, proved untrue when analyzed over almost three decades. Key Points

Revealing changes in the technical parameters of the teat cup liners of milking machines during testing and production conditions

To implement effective cow milking, it is necessary to take into account the peculiarities of the milk flow process, the milking machine's adaptability to perform the given technological functions. The aim of research is to establish changes in the design and technological parameters and physical and mechanical properties of teat cup liner of milking machines during its testing and in production conditions. The results obtained will make it possible to make a rational choice of rubber, ensure an efficient milking process during its service life. It is found that the tensile strength of silicone teat cup liner at the beginning of operation was 1.6 times higher than that of a rubber compound, and after 6 months. operation – 1.7 times. With respect to the relative elongation, this difference was 1.4 times, and after operating time – 1.3 times. Studies have proven that rubber during operation changes its physical and mechanical properties: the length of the active part increased by 3.1 mm; wall thickness – 0.2 mm. It is found that the most intensively elastic properties of teat cup liner changed during the first 10–20 days. After 10 days, the closing vacuum increased by 16.6 % compared to the initial one, and after 20 days by 23.3 %, which amounted to 8.57 and 9.06 kPa, respectively. Up to 420 hours of operation, the clamping vacuum reached 11.3 kPa, which is 5.8 % lower than the requirements for toughening teat cup liner for rejection. In general, over the period of experiments, the average value of the vacuum of closing the opposite walls of teat cup liner increased from 7.35 to 12.43 kPa, which is 3.6 % higher than the norm (12 kPa). As a result of experimental studies, the regularity of the rubber tension force depending on the operating time in the form of a fourth degree polynomial is obtained. It is found that after 150 hours of operation, the tensile force of teat cup liner decreased by 21 %

Morphological variability of Douglas fir (Pseudotsuga menziesii (Mirb.) Franco) cones in the context of seed extraction

In the paper generating curves given by fourth-degree polynomials were used to model the shape of Douglas fir (Pseudotsuga menziesii (Mirb.) Franco) cones from the Polish Forest Districts of Kołaczyce (one batch) and Opole (two batches), and to calculate the surface area and volume of individual cones. However, it was not possible to construct generalized equations for the surface area and volume of Douglas fir cones due to the high variability of empirical coefficients. The surface area and volume of the cones were also calculated from their length and diameter based on formulas for a cylinder and a barrel corrected by constants k1 and k2. The mean surface area of closed Douglas fir cones determined for the first, second, and third batch using the generating function was 4,348.4 mm2, 3,857.0 mm2, and 2,844.7 mm2, and the volume was 27,212.4 mm3, 21,012.9 mm3, and 12,844.4 mm3, respectively. The corresponding values calculated from the geometric formulas for solids were 4,332.0 mm2, 3,838.0 mm2, and 2,862.9 mm2 for the surface area and 27,366.0 mm3, 20,648.9 mm3, and 13,375.3 mm3 for the volume. The evaporation area of open cones was found to be five times greater than that of closed cones, with the difference being statistically significant. The outer and inner surfaces of scales taken from the middle segment of Douglas fir cones were photographed using a Quanta 200 scanning microscope (FEIC). The characteristic elements of scale morphology were evaluated by means of MultiScan Base software package. The outer and inner surfaces of Douglas fir scales were found to differ in some important ways, similarly as it has been reported in the literature for the Scots pine, silver fir, European larch, and black alder. The outer surface of scales is formed by thick-walled cells with marked protrusions, while the inner surface reveals cells with thin, frayed walls in the region adjacent to the seeds and wings. Knowledge of the geometry of Douglas fir cones and the morphology of their scales may be helpful in optimizing seed extraction parameters for those cones. Key words: seed extraction, model, shape curve, surface area, volume, scanning electron microscope

Prospective assessment of vacuum deliveries from midpelvic station in a tertiary care university hospital: Frequency, failure rates, labor characteristics and maternal and neonatal complications

Background Midpelvic vacuum extractions are controversial due to reports of increased risk of maternal and perinatal morbidity and high failure rates. Prospective studies of attempted midpelvic vacuum outcomes are scarce. Our main aims were to assess frequency, failure rates, labor characteristics, maternal and neonatal complications of attempted midpelvic vacuum deliveries, and to compare labor characteristics and complications between successful and failed midpelvic vacuum deliveries. Study design Clinical data were obtained prospectively from all attempted vacuum deliveries (n = 891) over a one-year period with a total of 6903 births (overall cesarean section rate 18.2% (n = 1258). Student’s t-test, Mann-Whitney U-test or Chi-square test for group differences were used as appropriate. Odds ratios and 95% confidence intervals are given as indicated. The uni- and multivariable analysis were conducted both as a complete case analysis and with a multiple imputation approach. A p-value of <0.05 was considered statistically significant. Results Attempted vacuum extractions from midpelvic station constituted 36.7% (n = 319) of all attempted vacuum extractions (12.9% (n = 891) of all births). Of these 319 midpelvic vacuum extractions, 11.3% (n = 36) failed and final delivery mode was cesarean section in 86.1% (n = 31) and forceps in the remaining 13.9% (n = 5). Successful completion of midpelvic vacuum by 3 pulls or fewer was achieved in 67.1%. There were 3.9% third-degree and no fourth-degree perineal tears. Cup detachments were associated with a significantly increased failure rate (adjusted OR 6.13, 95% CI 2.41–15.56, p< 0.001). Conclusion In our study, attempted midpelvic vacuum deliveries had relatively low failure rate, the majority was successfully completed within three pulls and they proved safe to perform as reflected by a low rate of third-degree perineal tears. We provide data for nuanced counseling of women on vacuum extraction as a second stage delivery option in comparable obstetric management settings with relatively high vacuum delivery rates and low cesarean section rates.