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Search Results: 1 - 10 of 461471 matches for " Hesham A. Elsharkawy "
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Anesthetic Management of Direct Laryngoscopy and Dilatation of Subglottic Stenosis in a Patient with Severe Myasthenia Gravis
Hesham A. Elsharkawy,Ursula Galway
Case Reports in Anesthesiology , 2012, DOI: 10.1155/2012/217561
Abstract: We describe the anesthetic management of a patient with severe myasthenia gravis and tracheal stenosis; the patient was scheduled for direct laryngoscopy and dilatation. The combination of myasthenia gravis and tracheal obstruction presents several difficulties for anesthetic management. The airway is shared; therefore, any complications are also shared by the anesthesiologist and bronchoscopists. The potential for respiratory compromise in patients undergoing the two procedures requires that anesthesiologists be familiar with the underlying disease state, as well as the interaction of anesthetic and nonanesthetic drugs in a case involving myasthenia gravis. We reviewed the literature and report our experience in this case. There is no strong evidence for choosing one approach to general anesthesia over another for bronchoscopy. Careful preoperative planning and experience in airway management and jet ventilation are crucial to prevent an adverse outcome and obtain favorable results.
Anesthetic Management of Direct Laryngoscopy and Dilatation of Subglottic Stenosis in a Patient with Severe Myasthenia Gravis
Hesham A. Elsharkawy,Ursula Galway
Case Reports in Anesthesiology , 2012, DOI: 10.1155/2012/217561
Abstract: We describe the anesthetic management of a patient with severe myasthenia gravis and tracheal stenosis; the patient was scheduled for direct laryngoscopy and dilatation. The combination of myasthenia gravis and tracheal obstruction presents several difficulties for anesthetic management. The airway is shared; therefore, any complications are also shared by the anesthesiologist and bronchoscopists. The potential for respiratory compromise in patients undergoing the two procedures requires that anesthesiologists be familiar with the underlying disease state, as well as the interaction of anesthetic and nonanesthetic drugs in a case involving myasthenia gravis. We reviewed the literature and report our experience in this case. There is no strong evidence for choosing one approach to general anesthesia over another for bronchoscopy. Careful preoperative planning and experience in airway management and jet ventilation are crucial to prevent an adverse outcome and obtain favorable results. 1. Introduction We present the anesthetic management of a patient with severe myasthenia gravis (MG) and tracheal stenosis she was scheduled for direct laryngoscopy and dilatation. Institutional review board (IRB) approval is not required by our institution for single case reports; therefore, written patient permission was not obtained. The combination of myasthenia gravis and tracheal stenosis presents several challenges for the anesthesiologist. Therefore, preoperative evaluation of the MG patient should include a review of the severity of the patient’s disease and the treatment regimen. The case should therefore be reviewed with the surgeon before formulating the anesthesia plan. Specific attention should be paid to voluntary and respiratory muscle strength. The patient’s ability to protect and maintain a patent airway postoperatively may be compromised if any bulbar involvement exists preoperatively. Respiratory muscle strength can be quantified by pulmonary function tests. Finally, it is critical to evaluate the severity of the subglottic stenosis and the difficulty of the intubation. 2. Case Presentation The patient was a 24-year-old female with a past medical history of myasthenia gravis (MG) and asthma. Her history included nine days of orotracheal intubation for myasthenia exacerbation. She needed five plasma phoresis exchanges and high doses of corticosteroids and azathioprine. Afterwards, the patient was discharged home in stable condition. At home, the MG was treated with oral pyridostigmine 60?mg, 3?times per day; prednisone 20?mg daily in the morning; oral
Caesarean Delivery Complicated by Unintentional Subdural Block and Conversion Disorder
Hesham Elsharkawy,Ashish K. Khanna,Sabri Barsoum
Case Reports in Medicine , 2013, DOI: 10.1155/2013/751648
Abstract: Combined spinal epidural (CSE) can provide excellent labor analgesia. Subdural block is also a potential but rare complication of attempted epidural placement during a CSE procedure, which may present as a block that is usually patchy in nature, with a component of sensory and/or motor deficit and a variable duration of action. In addition, a conversion disorder or a functional neurological disorder has been described with epidural and spinal anesthesia in obstetric patients. In this clinical report, we describe a 33-year-old G4P3 at 40 weeks gestation that received an unintentional subdural block as part of her labor analgesia and after an uneventful caesarean delivery presented with a conversion disorder. The rarity of the association between a subdural block and a conversion disorder complicated by the fact that the neurological deficit produced by the subdural block and that produced by a conversion disorder are similar in distribution made the clinical presentation and diagnosis a challenge for the obstetric anesthesia team. A functional neurological disorder of this nature complicating a subdural block in an obstetric anesthesia clinical practice has not been described so far. 1. Introduction Combined spinal epidural (CSE) can provide excellent labor analgesia. Complications of this procedure are uncommon, but they may include bleeding, infection, failed block, and nerve root injury [1]. Subdural block is also a potential but rare complication of attempted epidural placement during a CSE procedure, which may present as a block that is usually patchy in nature, with a component of sensory and/or motor deficit and a variable duration of action. In addition, the literature is rampant with reports of a conversion disorder or a functional neurological disorder in conjunction with epidural and spinal anesthesia in obstetric patients [2, 3]. However, this type of conversion disorder complicating a subdural block has not been described so far. In this report, we describe a patient who had a conversion disorder after undergoing a caesarean delivery following an unintentional subdural injection. The rarity of the association between a subdural block and a conversion disorder complicated by the fact that the neurological deficit produced by the subdural block and that produced by a conversion disorder are similar in distribution made the clinical presentation and diagnosis a challenge for the obstetric anesthesia team. 2. Case Description A 33-year-old G4P3 at 40 weeks gestation presented to the labor and delivery unit in active labor. Her past medical
Cement Kiln Dust Chemical Stabilization of Expansive Soil Exposed at El-Kawther Quarter, Sohag Region, Egypt  [PDF]
Hesham A. H. Ismaiel
International Journal of Geosciences (IJG) , 2013, DOI: 10.4236/ijg.2013.410139
Abstract:

This work dealt with a chemical stabilization of an expansive high plastic soil of Pliocene deposits exposed at El-Kawther quarter using cement kiln dust (CKD) and cement kiln dust with lime (L) to reduce their swelling and improve their geotechnical properties. Several specimens of the studied expansive soil were collected from El-Kawther quarter. Chemical analysis of the used cement kiln dust and the lime was conducted. Microstructural changes were examined using scanning electron microscope (SEM) before and after chemical treatment of the studied soil. Geotechnical properties including plasticity, compaction parameters, unconfined compressive strength (qu), ultrasonic velocities and free swelling of the studied soil were measured before and after the treatment. An optimum content of the cement kiln dust was 16% (CKD). The optimum content of the cement kiln dust with the lime was 14% (CKD) with 3% (L) according to pH-test. The results showed that the addition of cement kiln dust and cement kiln dust with lime led to a decrease in maximum dry density and an increase in optimum water content. Unconfined compressive strength values were increased using cement kiln dust and cement kiln dust with lime at 7 days curing time. Ultrasonic longitudinal (Vp) and shear (Vs) velocities values were also increased by addition of the cement kiln dust and the cement kiln dust with lime at 7 days curing time. Increment of the curing time from 7 to 28 days led to an increase in both unconfined compressive strength and ultrasonic velocities values. Free swelling percent of the studied soil was reduced from 80.0% to 0.0% after the treatment.

Geotechnical Investigations of Sub-Grade Soils at the Connector Road, New Tiba City, Luxor, Egypt  [PDF]
Hesham A. H. Ismaiel
Open Journal of Geology (OJG) , 2018, DOI: 10.4236/ojg.2018.812069
Abstract: The presented study dealt with geotechnical investigations on the sub-grade soils along the connector road between the electrical transformer station and the industrial city, New Tiba city, Luxor, to classify these soils and to examine their geotechnical behavior and their proportionality for constructing the road at the study area. One of the most important aims of this work was to determine the problematic sub-grade soils and to recommend the suitable reclamation. To achieve these goals sixty disturbed samples from six mechanical wash drilling boreholes and three undisturbed samples from three open pits were collected. The studied soils were belonged to Quaternary age. Gradation parameters (coefficient of uniformity, Cu and coefficient of concavity, Cc), plasticity, California bearing ratio (CBR), proctor density and free swelling percent of the studied soils were measured. PH-value, dissolved chloride, dissolved sulfate, calcium carbonate, total carbonate, and total dissolved salts were determined. The results pointed that the studied Quaternary soils along the study road were mainly composed of gravels, sands and clayey sands. The studied gravels were classified as poorly graded gravels (GP) according to Unified Soil Classification System (USCS) and as A-1-b according to American Association of State Highway and Transportation Official (AASHTO). The studied sands were classified as well graded sands (SW) according to USCS and as A-1-a according to AASHTO. The results showed also that the sub-grades at boreholes no. 1, 3, 4, 5, and 6 were excellent to good and the sub-grade at boreholes no. 2 was fair to poor. Free swelling percent of the studied clayey sand soils was ranging from 30% to 80% and they were classified as low to medium grade expansive soil. Replacement and/or chemical stabilization (using lime and/or cement kiln dust) of the problematic clayey sands soils were suggested to reduce their swelling and to prevent the possible heave.
Geotechnical Investigations and Estimation of Earthquakes Factors at an Industrial Qift City, Qena, Egypt  [PDF]
Hesham A. H. Ismaiel
Journal of Geoscience and Environment Protection (GEP) , 2018, DOI: 10.4236/gep.2018.612010
Abstract: The present work dealt with the estimation of geotechnical parameters and earthquakes factors of poultry feed factory project constructing at an industrial Qift city, Qena, Egypt. The geotechnical parameters were including gradation parameters, shear velocity (Vs), shear parameters (frictional angle and cohesion), and allowable bearing capacity. The earthquakes factors were including soil coefficient (S), limits of constant value for elastic response spectrum (TB and TC), and specified value for begin of the constant displacement spectrum (TD). The present study was interested also in an estimation of design ground acceleration (ag). To achieve these objectives, five mechanical wash boreholes were conducted at ten meter depth. Fifty disturbed samples were collected. Geotechnical laboratory tests were carried out like grain size analyses, direct shear box, and shear velocity (Vs). Standard penetration test (SPT) as geotechnical field test was conducted. The results showed that the studied soils were classified as well graded and poorly graded sands (SP and SW) according to the unified soil classification system (USCS). The earthquakes factors including S, TB, TC, and TD were 1.80, 0.10, 0.30, and 1.20 respectively. The ag-value of the studied area was 0.10. According to Egyptian code for vibration and dynamic load foundations, the studied project area was classified as low potential seismic. According to Egyptian code for shallow foundation, the allowable bearing capacity of the studied sands ranging from 1.5 to 3 kg/cm2 at shallow foundation width must be not less than one meter. Shallow foundations like isolated footing or structural mat were recommended.
The Impact of Traffic Emission on Air Quality in an Urban Environment  [PDF]
Hesham A. Al-Jeelani
Journal of Environmental Protection (JEP) , 2013, DOI: 10.4236/jep.2013.42025
Abstract:

Study of the impact of traffic emissions on air quality around the Haram Mosque in Makkah, Saudi Arabia, was conducted experimentally, numerically and statistically. Experimental study was performed to measure existing air quality. Numerical study was done to model the extent of air movement and pollutant dispersion within and around the Haram area. Statistical study was conducted to determine correlation coefficients, auto-correlation and time lags of each pollutant. Pollutant measurements were carried out using an air quality mobile laboratory at three sites. Numerical calculations were made using an ISC-AERMOD dispersion model. Concentrations of traffic emissions including nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), ozone (O3) and airborne particulate material under 10 μm diameter (PM10) are presented and analyzed. The calculated concentrations are validated by comparing with observed values at the three sites. The results indicate good agreement between calculated concentrations and observed values, which demonstrate satisfactory model performance. Results show that the Haram area is experiencing high concentrations of dust. High buildings around the Haram Mosque act as flow obstacles. Mean pollutant dispersion was toward the south and southeast during January and June. Highest mean concentrations were observed in January and June.

Diurnal and Seasonal Variations of Surface Ozone and Its Precursors in the Atmosphere of Yanbu, Saudi Arabia  [PDF]
Hesham A. Al-Jeelani
Journal of Environmental Protection (JEP) , 2014, DOI: 10.4236/jep.2014.55044
Abstract:

Surface ozone (O3) and its precursor’s gases (nitrogen monoxide (NO), nitrogen dioxide (NO2), nitrogen oxides (NOx), carbon monoxide (CO), methane (CH4) and non-methane hydrocarbons (NMHCs), and sulfur dioxide (SO2) were measured in Yanbu, Saudi Arabia from January 2004-December 2004. The annual average concentrations of O3, NO, NO2, NOx, SO2, CO, CH4, TNMHCs and THC were 22.51 ppb, 15.58 ppb, 17.25 ppb, 23.84 ppb, 6.66 ppb, 165.13 ppb, 3.44 ppm, 0.56 ppm and 3.88 ppm, respectively. The SO2/NOx and SO2/NO2 concentration ratios during the period of study indicate that the mobile emissions are the predominant sources in yanbu. The diurnal cycles of O3 concentrations revealed highest levels in the daytime and lowest levels in night time. The diurnal variations of NO, NO2, NOx, SO2, CO, NMHCs

Quality Characteristics of Gamma Irradiated Beefburger Formulated with Partial Replacement of Beef Fat with Olive Oil and Wheat Bran Fibers  [PDF]
Karema A. Mahmoud, Hesham M. Badr
Food and Nutrition Sciences (FNS) , 2011, DOI: 10.4236/fns.2011.26091
Abstract: Five beefburger formulations were prepared with substituting beef fat with olive oil and levels of wheat bran and irradiated at doses of 0 and 3 kGy, then samples were refrigerated stored and their quality characteristics were investigated. The results indicated that replacement of beef fat with olive oil and ascending levels of wheat bran in burger batter significantly decreased their contents of total lipids and saturated fatty acids, while increased their contents of dietary fibers, unsaturated fatty acids and the ratios of unsaturated and polyunsaturated fatty acids to the saturated ones. Moreover, significant improvements were observed in the cooking yield and moisture and fat retention of samples, proportionally to the added wheat bran, and both raw and cooked burger samples showed a high sensory acceptability. Irradiation of samples effectively inactivated Staphylococcus aureus, Salmonella and enterobacteriaceae and significantly reduced the counts of mesophilic and psychrophilic bacteria as well as molds and yeasts without any adverse effects on the quality characteristics of samples. Thus, reducing beef fat levels with the addition of olive oil and wheat bran produced a highly acceptable beefburger products with improved nutritional content as well as improved cooking and binding properties, while irradiation improved their microbiological quality.
Electrochemical Deposition and Optimization of Thermoelectric Nanostructured Bismuth Telluride Thick Films  [PDF]
Hesham M. A. Soliman, Abdel-Hady B. Kashyout
Engineering (ENG) , 2011, DOI: 10.4236/eng.2011.36079
Abstract: Bismuth telluride thick films are suitable for thermoelectric (TE) devices covering large areas and operating at small-to-moderate temperature differences (20 - 200 K). High efficiency and high coefficient of performance (COP) are expected to be achieved by using thick films in some cooling applications. Bismuth telluride thick films fabrication have been achieved with Galvanostatic and Potentionstatic deposition. Stoichiometric bismuth telluride thick film was obtained by Galvanostatic deposition at current density of 3.1 mAcm-2. Bismuth telluride films with average growth rate of 10 µmh-1 and different composition were obtained. Effects of current density and composition of electrolyte in Galvanostatic deposition were studied. The current density affected the film compactness, where films deposited at lower current density were more compact than those deposited at higher current density. The morphology of the films did not depend on the current density, but chemical composition was observed when different composition of electrolyte was used. Effects of distance between electrodes, composition of electrolyte solution, and stirring in Potentionstatic deposition were studied. The shorter the distance between electrodes, the higher the electric field, thus the higher current density was applied and the deposited film was less compact. The current density increased more rapidly with stirring during electrodeposition which leads to less compact film. Through this study, films electrode-posited from solution containing 0.013 M Bi(NO3)3.5 H2O, 0.01 M TeO2 and 1 M HNO3 at 3.1 mA cm-2 for 6 hours without stirring and with interelectrode distance of 4.5 cm were free-standing with average film thickness of 60 µm and optimum film composition of Bi2Te3. The crystallite size of the later films was found to be around 4.3 nm using Scherrer’s equation from XRD patterns. Also, negative Seebeck coefficient for the same samples was revealed with an average value of -82 μV.K-1.
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