Ectopic pregnancy is a leading cause of maternal mortality in the first trimester. It may occur in different anatomic locations with fallopian tube being the most frequent. Cesarean-scar ectopic pregnancy is one of the rarest ectopic pregnancies. We report the case of a 44-year-old woman, gravida 5 para 4, who attended the antenatal clinic after her pregnancy was confirmed by positive urine testing. She underwent transvaginal ultrasound examination which identified the gestational sac with fetal pole and cardiac activity located in the anterior part of the lower uterine segment with empty uterine cavity. Magnetic resonance imaging (MRI) scan had confirmed the diagnosis of cesarean scar ectopic pregnancy. After through discussion on the management options, the patient was treated with intra-gestational sac injection of methotrexate. Four days after the procedure, she developed profuse vaginal bleeding and her hemoglobin showed a drop of 4.9 g/dL. She underwent emergency laparotomy with excision of the ectopic pregnancy. The patient tolerated the procedure well without complications. The serum β-human chorionic gonadotropin level was undetectable on the 35 th day after the methotrexate injection. Caesarean scar pregnancy is an unusual form of ectopic pregnancy. However, clinicians should have a high index of suspicion for this condition as it may result in serious complications, unless promptly managed. MRI is recommended particularly when transvaginal ultrasound scan is inconclusive.
Sclerosing encapsulating peritonitis (SEP) is a rare clinical condition characterized by the formation of a thick, fibrous membrane encasing the intestines, which may lead to intestinal obstruction. The pathogenesis is not completely understood, but various risk factors are well established. However, there are only few reported cases of SEP associated with peritoneal carcinomatosis. Herein, we report a case of a 69-year-old male patient who presented clinically with acute intestinal obstruction 2 years after undergoing a resection procedure for gastric cancer. An abdominal computed tomography revealed findings typical of SEP. Consequently, the patient underwent exploratory laparoscopy, which confirmed the diagnosis of SEP and established the etiology as peritoneal metastases. The patient was managed conservatively, and his symptoms showed some improvement. The patient was at an advanced stage of the disease, and thus remained on palliative care and passed away 1 month later. Although very rare, physicians should consider SEP in their differential diagnoses of intestinal obstruction in patients, particularly in those with a history of intra-abdominal malignancies.
The construction industry has one of the highest work accident rates in the world when compared to other industrial undertakings, particularly tunneling construction. Risk events are often interrelated. The occurrence of a technical risk usually carries a cost and scheduled consequences. Schedule risks typically impact cost escalation and project overhead. Some projects are primarily schedule-driven; other projects are primarily cost or qualitydriven. The objective of this study is to perform a comprehensive investigation about hazards and risks in the construction process of tunnels by carrying out a state-of-the-art study on the most critical risks in tunnel construction projects. The methodology used was a systematic review of all available literature in the previous studies. As a result of the review, as ix-group risk categorization was developed, which includes risks associated with confined spaces, ventilation &air monitoring, fires, physical &chemical hazards, electricity, personnel safety& emergency plans. According to the output of this study, managing hazards and risks will aid managers and engineers in attaining their goals, achieving safety management, reducing, and controlling accidents and injuries in tunnel construction sites. This will result in a safer workplace, more worker awareness, and a reduction in project schedules and costs.
Many Egyptian cities are influenced by environmental stress from air pollution, noise, traffic jams, and the scarcity of green spaces. Green roofs represent one of the ways to achieve sustainability as a result of the environmental, social and economic benefits they provide. The research aims to identify the most important roles that green roof technology can provide and to identify the challenges it faces in the Egyptian market. This research deals with the study of the awareness of Egyptian professionals in the various fields of the built environment with green roof technology, its capabilities and difficulties. The research concludes with a set of recommendations aimed at trying to overcome these difficulties in order to maximize the use of green roof technology.
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