Abstract: The aim of this study is the review of the management practices of sickle cell disease patients during pregnancy, as well as the maternal and neonatal outcome at Ampang Hospital, Selangor. The study consisted of a review of pregnant patients with sickle cell disease under follow up at the Hematology Clinic, Ampang Hospital over the last seven years to assess their management and maternal-fetal outcome. The results of the review show that Ampang Hospital is considered the public hematology centre for sickle cell disease and had successfully managed three pregnancies throughout the last seven years. Patients’ presentations, managements and maternal-fetal outcome were compared and reviewed for academic improvements. All three patients were seen very early in their pregnancy and had been given a regime of folic acid, antibiotics and thrombo-prophylactic drugs. Close monitoring of maternal and fetal well being was done by the hematologists and obstetricians. Among the patients, there were multiple admissions during the pregnancy for either a painful sickle cell bone crisis, haemolysis following an infection and anemia requiring phenotype- matched blood and exchange transfusions. Broad spectrum antibiotics coverage during and infection, hydration, pain management and venous-thrombolism prophylaxis were mandatory. The pregnancies managed to reach near term in the third trimester but all required emergency caesarean section for obstetric indications. All pregnancies resulted in live births with good fetal outcome. During post partum all were nursed closely in the high dependency units for further complications and were discharged well. Post partum follow up and contraception counseling was comprehensively given for future pregnancies. Sickle cell disease is uncommonly seen in the East, especially in the South East Asian region, yet more cases are seen in the current decade due to improved medical expertise and advance medical laboratory technologies. Pregnancy itself is a risk factor for sickle cell patients as increased thrombosis event and risk of infections can lead to multiple crisis, haemolysis, anemia and vaso-occlusive complications including eclampsia, cerebrovasular accidents and acute bone pain. Patients mostly require multiple blood product transfusions thus phenotype-matched blood is required to reduce the risk of alloimmunozation. Emphasizing the risks and complications in preconception counseling and establishing an ultimate pregnancy plan would probably reduce the risk of morbidity and mortality to the mother and unborn child. Early management for risk of infection, thromboembolic events and adequate hydration is mandatory. A holistic approach involving multidisciplinary team care between the hematologist, obstetricians, anesthetist, neonatologist and close nursing care for both mother and baby would ensure the best outcome. In conclusion, sickle cell disease by itself is a high risk medical condition and pregnancy would further amplify the risk. Thus, close monitoring with combine multidisciplinary care, counseling and educating the patients are crucial in achieving the safe outcome.
Abstract: Adequate analgesia following caesarean section
decreases morbidity, hastens ambulation, improves patient outcome
and facilitates care of the newborn. Intrathecal magnesium, an
NMDA antagonist, has been shown to prolong analgesia without
significant side effects in healthy parturients. The aim of this study
was to evaluate the onset and duration of sensory and motor block,
hemodynamic effect, postoperative analgesia, and adverse effects of
magnesium or fentanyl given intrathecally with hyperbaric 0.5%
bupivacaine in patients with mild preeclampsia undergoing caesarean
section. Sixty women with mild preeclampsia undergoing elective
caesarean section were included in a prospective, double blind,
controlled trial. Patients were randomly assigned to receive spinal
anesthesia with 2 mL 0.5% hyperbaric bupivacaine with 12.5 μg
fentanyl (group F) or 0.1 ml of 50% magnesium sulphate (50 mg)
(group M) with 0.15ml preservative free distilled water. Onset,
duration and recovery of sensory and motor block, time to maximum
sensory block, duration of spinal anaesthesia and postoperative
analgesic requirements were studied. Statistical comparison was
carried out using the Chi-square or Fisher’s exact tests and
Independent Student’s t-test where appropriate. The onset of both
sensory and motor block was slower in the magnesium group. The
duration of spinal anaesthesia (246 vs. 284) and motor block (186.3
vs. 210) were significantly longer in the magnesium group. Total
analgesic top up requirement was less in group M. Hemodynamic
parameters were similar in both the groups. Intrathecal magnesium
caused minimal side effects. Since Fentanyl and other opioid
congeners are not available throughout the country easily,
magnesium with its easy availability and less side effect profile can
be a cost effective alternative to fentanyl in managing pregnancy
induced hypertension (PIH) patients given along with Bupivacaine
intrathecally in caesarean section.
Abstract: This study was conducted to examine the possible role of serum Gamma-glutamyltransferase (GGT) and Lactate dehydrogenase (LDH) in the prediction of severity of preeclampsia. The study group comprised of 40 preeclamptic cases (22 with mild and 18 with severe) and 40 healthy normotensive pregnant controls. Serum samples of all the cases were assayed for GGT and LDH. Demographic, hemodynamic and laboratory data as well as serum GGT and LDH levels were compared among the three groups.
The results indicated that severe preeclamptic cases had significantly increased levels of serum GGT and LDH. The symptoms in severe preeclamptic women were significantly increased in patients with GGT > 70 IU/L and LDH >800 IU/L. Elevated levels of serum GGT and LDH can be used as biochemical markers which reflects the severity of preeclampsia and useful for the management of preeclampsia to decrease maternal and fetal morbidity and mortality.
Abstract: In most industrial compounds are used trapezoidal metal sheets like a roof decks. These trapezoidal metal sheets are exposed by concentrated loads, usually by service loads arise from installation of air distribution, sanitary distribution, sprinkler system or wiring installation. In objects of public facilities (like shopping centre, tennis hall, etc.) they can be used for hanging advertising posters etc, too. These systems work as “building kit”. These anchoring systems are represented by clamps in shape of “V”.
This paper is occupy with recapitulation of installation systems available in trade with focus on load-bearing capacity specified by producer and on possible methods, how exactly define load bearing capacity of trapezoidal sheet loaded by concentrated load. The load bearing capacity was verified at experimental samples to determine real behavior of trapezoidal metal sheets exposed to concentrated loads.
Abstract: This work presents a methodology for the design and
manufacture of propellers oriented to the experimental verification of
theoretical results based on the combined model. The design process
begins by using algorithms in Matlab which output data contain the
coordinates of the points that define the blade airfoils, in this case the
NACA 6512 airfoil was used. The modeling for the propeller blade
was made in NX7, through the imported files in Matlab and with the
help of surfaces. Later, the hub and the clamps were also modeled.
Finally, NX 7 also made possible to create post-processed files to the
required machine. It is possible to find the block of numbers with G
& M codes about the type of driver on the machine. The file
extension is .ptp. These files made possible to manufacture the blade,
and the hub of the propeller.
Abstract: To investigates the effect of fiberglass clamping
process improvement on drape simulation prediction. This has
great effect on the mould and the fiber during manufacturing
process. This also, improves the fiber strain, the quality of the
fiber orientation in the area of folding and wrinkles formation
during the press-forming process. Drape simulation software
tool was used to digitalize the process, noting the formation
problems on the contour sensitive part. This was compared
with the real life clamping processes using single and double
frame set-ups to observe the effects. Also, restrains are
introduced by using clips, and the G-clamps with predetermine
revolution to; restrain the fabric deformation during the
forming process.The incorporation of clamping and fabric
restrain deformation improved on the prediction of the
simulation tool. Therefore, for effective forming process,
incorporation of clamping process into the drape simulation
process will assist in the development of fiberglass application
in manufacturing process.
Abstract: This work deals with the design of the robotic assembly
system for the roller clamps. The task is characterized by high speed,
high yield and safety engagement. This paper describes the design of
different parts of an automated high speed machine to assemble the
parts of roller clamps. The roller clamp robotic assembly system
performs various processes in the assembly line which include clamp
body and roller feeding, inserting the roller into the clamp body, and
dividing the rejected clamp and successfully assembled clamp into
their own tray. The electrical/electronics design of the machine is
discussed. The target is to design a cost effective, minimum
maintenance and high speed machine for the industry applications.
Abstract: Sharing the manufacturing facility through remote
operation and monitoring of a machining process is challenge for
effective use the production facility. Several automation tools in term
of hardware and software are necessary for successfully remote
operation of a machine. This paper presents a prototype of workpiece
holding attachment for remote operation of milling process by self
configuration the workpiece setup. The prototype is designed with
mechanism to reorient the work surface into machining spindle
direction with high positioning accuracy. Variety of parts geometry
is hold by attachment to perform single setup machining. Pin type
with array pattern additionally clamps the workpiece surface from
two opposite directions for increasing the machining rigidity.
Optimum pins configuration for conforming the workpiece geometry
with minimum deformation is determined through hybrid algorithms,
Genetic Algorithms (GA) and Particle Swarm Optimization (PSO).
Prototype with intelligent optimization technique enables to hold
several variety of workpiece geometry which is suitable for
machining low of repetitive production in remote operation.