Iris Publishers-Open access World Journal of Gynecology & Womens Health| Ureteral Stenosis after Uterine Suspension Using TVM (Transvaginal Mesh)

Authored by Jier Zen Chang

Introduction

We report a rare case of ureteral stenosis after sacrospinous suspension. A 64-year-old post-menopausal female, G2P2, complained of a heavy sensation and the feeling of sitting on a ball, especially in the afternoon. Tracing back her previous surgical history, she had undergone a cesarean section and subtotal hysterectomy due to myoma with severe adhesion. A pelvic examination revealed total prolapse of the vaginal cervix with stage III cystocele. A urodynamic study revealed bladder outlet obstruction, and a pad test was 13g after restoring the vaginal cervix. Therefore, after explaining the risks and complications of surgery, Pelvic organ prolapse (POP) surgery including sacrospinous suspension (Upholds), mid-urethral sling surgery (Solyx) and anterior compartment repair was performed. Ten days after surgery, she returned to our hospital due to left costovertebral angle pain plus knocking tenderness. CT showed hydronephrosis without urolithiasis, and antegrade pyelography also showed ureteral stenosis in the lower third (Figure 1). After several attempts at stent insertion had failed, a urologist suggested re-implanting the ureter. The postoperative course was uneventful. Intravenous pyelography was performed 4 months after this surgery, and showed a patent left ureter.

POP is a disabling and chronic condition that affects roughly 20% of women of all ages both physically and psychologically [1]. Pelvic organs can protrude outside the body through the vagina due to weakness in the pelvic floor, and most women with POP also suffer from at least one other pelvic floor disorder such as incontinence. POP increase nationwide, namely, anterior, posterior and middle compartments prolapse. Many different kits have been developed in recent years for reconstructive surgery, among which synthetic material augmentation plays a major role but also results in complications such as dyspareunia and vaginal discomfort.

Surgical mesh can be used for urogynecological procedures, including repair of POP and stress urinary incontinence (SUI). It is implanted to reinforce the weakened vaginal wall for POP repair or support the mid-urethra for the repair of SUI [2]. The most frequent complications include erosion through vaginal epithelium, infection, pain, urinary problems, and recurrence of prolapse and/ or incontinence [3]. There have also been reports of bowel, bladder, and blood vessel perforation during insertion [4]. In some cases, vaginal scarring and mesh erosion have been reported to lead to a significant decrease in patient quality of life due to discomfort and pain, including dyspareunia [5]. POP surgery will be required for patients with total prolapse of the uterus or vault, and we suggest inserting a double j before surgery in order to prevent ureter kicking subsequent to hydronephrosis. In addition, once the operation has been completed, attempts should be made to loosen the tightness of the mesh around the hanging area with palpitation under a cystoscope to allow the operators to recheck the flow of urine from bilateral ureters. It is mandatory to inform the patients of the risk of such surgery.

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Iris Publishers-Open access World Journal of Gynecology & Womens Health| An Established Technology Gets a New Application: Reimplantation of Autologous Ovarian Tissue to Treat Menopausal Symptoms

Authored by BM Petrikovsky

Introduction

In 1954 and 1956, Deanesly [1] and Green, et al. [2] were one of the first to experiment with the freezing and thawing of animal ovarian tissue. In the first half of the 20th century, the art of tissue cryopreservation was at its infancy with glycerol being the only cryoprotectant available [3]. Glycerol is a poor cryoprotectant and, therefore, early research showed very limited success [4]. Additional cryoprotectants became available during the 1990s leading to successful ovarian tissue cryopreservation, transplantation, and resumption of fertility studies in animals and humans [3,5,6].
In 1983, Trounson and Mohr [7] reported what appeared to be the first ever pregnancy in a human following preservation and transfer of an [8] cell embryo. This was followed by the report of the first human live birth after ovarian cryopreservation and transfer with more cases to follow [8,9]. Sonmezer and Oktay [10] performed a metanalysis, which included 21 studies on oocyte cryopreservation. They found that the mean oocyte survival rate after thaw, mean fertilization rate, and mean pregnancy rate per cryopreserved/thawed oocyte was 47%, 52.5%, and 1.52%, respectively.10 In a recent interview, Oktay, et al. [11] cited the first report of resumption of ovarian endocrine function following orthotopic transplantation of frozen banked ovarian tissue.

Summary

The preservation and autologous transplantation of endocrine glandular tissue is not limited to the ovaries. In 1977, Wells, et al. [12] introduced reimplantation of autologous cryopreserved parathyroid tissue as a treatment modality of hypoparathyroidism. Wagner, et al. [13] simplified the methods of parathyroid gland cryopreservation and storage. For cryopreservation, the parathyroid tissues were cut into cubes of 1 mm in length. The time between parathyroidectomy and replantation of cryopreserved tissue was 5 months on average (range, 0.5 to 15 months). Follow up examinations in 25 patients were performed 6 months to 120 months (median: 40 months) postoperatively. In all patients, the autografts functioned well and most of the patients did not require any additional medication [13].

Despite technical difficulties with cryopreservation at that time, pioneering research in parathyroid autotransplantation was performed in the 70s by Alveryd, et al. [14] and Wells, et al. [15,16], Alveryd, et al. [14] described six patients with primary parathyroid hyperplasia who had parathyroid autografts. In 1976, Wells, et al.15 reported an additional four patients with primary parathyroid hyperplasia who were treated by total parathyroidectomy and auto transplantation of parathyroid tissue inserted into the forearm muscle. All of these patients remained norm calcemic at 9 and 13 months, respectively. Good graft function was documented further by detection of a higher concentration of parathyroid hormone in the patients’ blood. Hormonal activity of auto transplants, if excessive, can be adjusted by removing some transplanted tissue [15]. Additional implantation can be carried out if the amount of tissue initially implanted had been insufficient or if the transplanted parathyroid tissue failed to survive. In the rat model, parathyroid isografts functioned normally after cryopreservation for up to 9-12 months [16]. Wells, et al. [15] grafted autologous parathyroid tissue, frozen for six weeks, into a patient who had had a total parathyroidectomy for renal osteodystrophy. The graft was still functioning 18 months after the procedure.

Research on oocyte and ovarian tissue cryopreservation has gained momentum in recent years [17]. Oktay, et al. [18] reported their experience with auto transplantation of ovarian tissue in cancer patients to alleviate premature menopause and preserve fertility.Inspired by the success in parathyroid tissue auto transplantation and recent advances in ovarian tissue cryopreservation technology, we propose to apply this technique to treat menopausal symptoms.19 We established an ovarian tissue cryopreservation bank in 2000 in collaboration with Professor E. Zharov (Russian Federation) with the goal to collect and preserve ovarian tissue retrieved with the patient’s consent during indicated obstetrical or gynecological procedures (cesarean section-15, minilaparotomies and tubal ligation – 12, gynecological surgeries for benign conditions – 22). Since our computer-assisted search failed to find an ovarian tissue bank with similar goals, we used the experience of the ovarian transplantation program in Denmark for the purpose of preserving ovarian tissue to combat infertility. The ovarian transplantation program started in Denmark in 2000 (800 women have had their ovarian tissue frozen) [19]. For this study, the researchers studied the outcomes of women who had received transplantation between 2003 and June 2014. The functional life span of the grafts varied between one and ten years; grafted tissue robustly restored ovarian function.

In 2000, we initiated a research protocol at Nassau University Medical Center (Petrikovsky BM, Ansari AH, Beers PG, et al. which stated as follows:
After obtaining approval from the Institutional Review Board, patients, ages 40 and under, will be included in this study. Normal ovarian function in these cases is to be established prior to ovarian sampling, using such methods as; hormonal assay, pelvic ultrasonography and endometrial sampling. Opportunistic ovarian biopsy will be performed by means of laparoscopy or laparotomy. Ovarian cortex will then be separated from its stroma and divided into several pieces. Each piece will be placed in a special cryovial container and filled with a special cryoprotectant solution (dimethyl sulfoxide, human serum albumin factor V). The cryovials are then transferred to a special aluminum case and lowered into a liquid nitrogen tank where it is stored until such time that it is used for autologous transplantation. To assess potential structural alterations, it is the further aim of this study to examine a portion of the ovarian tissue by means of TEM, prior to and after freeze thawing. Whenever, clinically indicated, the specimen will be thawed and reimplanted, subcutaneously, in a cosmetically acceptable body site. The function of the transplanted ovarian tissue will be assessed clinically by re-evaluation of symptomatology, as well as such techniques as bone density analysis, ultrasonography, and hormonal assay.”

None of the patients experienced complications directly related to opportunistic ovarian sampling. Now, 20 years later, histological assessment of preserved ovarian strips (15 samples) demonstrated ovarian tissue adequate for reimplantation, 6 samples contained visible icicles and were judged unfit for transplantation.

Conclusion

• Ovarian autotransplantation may be considered for treating menopausal symptoms in carefully selected and motivated patients.
• Opportunistic ovarian sampling is not associated with additional complications.
• The majority of preserved specimen appear fit for transplantation based on their histological appearance.

• Long-term outcomes of ovarian autotransplantation to treat and/or prevent menopause symptoms, remain unclear.

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Iris Publishers-Open access Online Journal of Dentistry & Oral Health| The Association of Elevated Serum IgE and Xerostomia with Recurrent Aphthous Stomatitis

Authored by Hassan Abdulwahab Al Shamahy

Abstract

Background and objectives: Recurrent Aphthous Stomatitis (RAS) is one of the most common oral mucosal diseases. This study aimed to determine the prevalence of RAS, the association of Immunoglobulin E with RAS and potential risk factors of RAS in patients at dental clinics of Sana’a universities in Sana’a city, Yemen.
Subjects and methods: A cross-sectional study was conducted from January to December 2017 and includes 2164 patients. The patients interviewed and examined by dentists and 72 were clinically diagnosed to have RAS. The patients with RAS responded to a questionnaire that included demographic background, Qat chewing habits, smoking habits, history and course of RAS episodes. They were also subjected to laboratory tests, including determination of serum IgE levels and xerostomia.
Results: The crude prevalence of RAS was 3.3%; female prevalence was 3.8% slightly higher than 2.4% of the male. There was a higher rate of RAS in age group 16-25 years (12.3%) and age group 26-35 years (9.3%) with OR=7 times and 4.1 times respectively (p<0.001). While lower rates of RAS were occurred in children under 15 years (0.41%) and older age (0.4%), (<0.001). The Mean±SD of IgE level for major RAS patients was 233±15.3IU/ml; while for minor was 127±17.3IU/ml. There was association between elevated IgE, Xerostomia, smoking habit, and chewing Qat and occurrence of major RAS (OR=6.4, 3.3, 26.8, and 7.1 respectively).

Conclusion: Elevated IgE levels and xerostomia may be considered as part of the RAS patient’s work‐up. Further research is needed to identify biological mechanisms that account for the observed associations.

Introduction

Recurrent Aphthous Stomatitis (RAS), or Recurrent oral ulceration (ROU), is one of the most common oral mucosal diseases. It is the most common recurring idiopathic intra oral ulcerative disease in different parts of the world [1,2]. The prevalence of RAS in the general population ranges between 5 and 25%. Such significant differences have been reported depending on the origin of the examined groups and populations as well as on the studies’ design and methodology [3-6]. Aphthae are located on nonkeratinized mucosa; the ulcers have well circumscribed margins, erythematous haloes and yellow or grey floors. They appear first in childhood or adolescence and heal naturally within 7-14 days [7]. Aphthae are painful and interfere with daily oral behavior such as eating, speaking and swallowing [8]. The etiology of RAS lesions is unknown, but several local, systemic, immunologic, genetic, allergic, nutritional and microbial factors have been proposed as causative agents [9,10]. An association has also been proposed between RAS and psychological stress and anxiety [11-13]. Allergy has been suspected as a cause of RAS, and hypersensitivity to certain foo substances, oral microbes such as Streptococcus sanguis, and microbial heat-shock proteins have been suggested as possible causative factors [10]. Elevated IgE is pathogenesis of many allergic diseases and has role as a potential biomarker in atherosclerosis, pulmonary hypertension, ischemic reperfusion injury, male infertility, nociception, anxiety, Alzheimer’s disease, auto-immune diseases, obesity and diabetes [14]. Moreover, Almoznino, et al [15] found elevated serum IgE in RAS and associations with RAS characteristics. Lack of epidemiological research on the topic in our country Yemen has encouraged us to conduct a populationbased study to assess its prevalence, the association of elevated Immunoglobulin E, Xerostomia and potential risk factors of RAS in patients at dental clinics of Sana’a universities in Sana’a city, Yemen.

Subjects and Methods

A cross-sectional study was conducted at dental clinics of Sana’a University and University of Science and Technology in Sana’a city, Yemen, during the period from January to December 2017. The study includes 2164 patients attending clinics in the time of the study. The patients interviewed and examined by dentists and 72 were clinically diagnosed to have RAS (minor or major). The patients with RAS responded to a questionnaire that included demographic background, Qat chewing habits, smoking habits, history and course of RAS episodes. They were also subjected to laboratory tests, including determination of serum IgE levels and xerostomia [16].

Inclusion criteria

All patients of Recurrent Aphthous Stomatitis (infected more than two times) of any age and both sex. Recurrent Aphthous Stomatitis was diagnosed by dentists. Xerostomia was diagnosed according to references [16].

Exclusion criteria

Any patient having allergy (Hypersensitivity I) according to questionnaire.

Methods

Serum samples were collected from RAS patients and tested for the IgE level by determines quantitative total immunoglobulin E by the electro-chemiluminescence immunoassay “ECLIA” on cobas e 411 immunoassay analyzers (Roche diagnostic).

Data analysis

Analysis of the data was performed by using SPSS (Version 21) and the quantitative data with normal distribution was expressed as mean and standard deviation (SD). Odds ratio and 95% CI were used to determine the association of RAS with Qat chewing habits, smoking habits, age, sex, elevated IgE and xerostomia. Chisquare (χ2) test was used for categorical variables and fisher exact used if any cell < 5 to determine the p ≤ 0.05 that was considered statistically significant.

Ethical approval

Ethical approval was obtained from the Medical Research & Ethics Committee of the Faculty of Medicine & Health Sciences at Sana’a University. All data, including patient identification and clinical outcomes, were kept confidential.

Results

(Table 1) shows the frequency of minor and major RAS among our patients. 53 (73.6%) patients were suffering from minor RAS and 19 (26.4%) were suffering from major RAS. The crude prevalence of RAS in the current study was 3.3%; female prevalence was 3.8% slightly higher than 2.4% of male prevalence. There was no significant association of RAS with patient’s sex. When age groups were considered, a higher rate of RAS (12.3%) was occurred in age group 16-25 years with significant associated OR equal to 7 times, 95%CI =4.3-11.3 (p<0.001). The second-high rate of RAS was 9.3% for age group 26-35 years with significant associated OR equal to 4.1 times, 95%CI =2.5-6.8 (p<0.001). While lower rates of RAS were occurred in children under 15 years (0.41%) and older age groups as ≥46 years (0.4%, <0.001) (Table 2). The Mean±SD of IgE level for major RAS patients was 233±15.3IU/ml; and ranged from 55-377IU/ml, while for minor RAS the Mean±SD of IgE level was 127±17.3IU/ml; and ranged from 9-288IU/ml (p<0.001) (Table 3). The total rate of elevated IgE was 41.6%; in major RAS was 73.7% with significant associated OR equal to 6.4 times, 95%CI =1.9-21 (p<0.001) comparing with 30.2% for minor RAS without associated OR (Table 4). The total rate of Xerostomia among RAS patients was 45.8%; and it was 79% among major RAS patients (OR= 3.3 times, 95%CI =1.0-11.4, p=0.04) comparing with 52.8% for minor RAS (Table 5). There was significant association between major RAS and smoking habit (OR=26.8 times, 95%CI =6.7- 106, p<0.001). Also, there was significant association between major RAS and chewing Qat. (OR=7.1 times, 95%CI =2.1- 23, p<0.001).

Discussion

Recurrent Aphthous stomatitis includes periodic painful oral ulcers at breaks of a few months to a few days. RAS is common disorder and observed worldwide, seldom associated with systemic disease. In the current study 72 RAS patients have been diagnosed and classified to the 2 types of RAS in which 53 patients 73.6% were Minor RAS and 19 patients 26.4% were Major RAS. These results were roughly similar to studies carried out by Boldo, [17] and Tarakji, et al [18] where the rate of Minor RAS was 85% and Major was 15%. RAS remains the most common ulcerative disease of the oral mucosa [9]. The point crude prevalence of RAS in the current study during the study period was 3.3%; the female prevalence was 3.8% slightly higher than 2.4% of male prevalence. Our result is lower than that reported from Tur¬key [19], the prevalence was 22.8% (11,360 respondents); from Iran [20], 25.2% (10,291 respondents); and from Jordan [21], 37.3% (2,175 respondents). Also our result is lowered than that reported in the general population in different parts of the world in which RAS ranges between 5 and 25 %. [3- 6]. In this study, the female prevalence of RAS was 3.8% slightly higher than 2.4% of male prevalence with non significant variation. Our result is agreed with a study carried by Edgar, et al [22] in which they found equal rates in both males and females. However, this result disagreed with a study carried by Naikoo, et al [23] in which female RAS rate was higher than that of male rate. In the current study, when age groups were considered, a higher rate of RAS (12.3%) was occurred in age group 16-25 years with significant associated OR=7 times, 95%CI =4.3-11.3 (p<0.001) and 9.3% in age group 26-35 years (OR=4.1 times, 95%CI =2.5-6.8 (p<0.001). While lower rates of RAS were occurred in children under 15 years (0.41%) and older age groups as ≥46 years (0.4%, <0.001). Our study results were consistent with the several studies worldwide [11, 24].


One of basic aim of our study was to investigate association between elevated serum IgE levels and RAS episodes. There was statistically significant elevated serum levels IgE in RAS. The elevated levels were more common in patients with major RAS (more frequent recurrences and more severity of lesions). Scully, et al [25] in their study observed higher levels of IgE and IgD in patients of RAS than in normal controls or patients with other 14 ulcerative conditions. Also our result is agreed with studies carried by Almoznino, et al [15]; and Naikoo, et al [23] in which elevated IgE was associated with RAS. The total rate of Xerostomia among RAS patients was 45.8%; and it was 79% among major RAS patients with significant associated OR= 3.3 times, 95%CI =1.0- 11.4, p=0.04) (Table 6). This result is in agreement with others studies that reported a significant association between Xerostomia and RAS [26,27]. This result can be explained by the fact that almost all of potential factors of RAS occur combine with another symptom which is mouth dryness (Xerostomia), which might be having a role in RAS occurrence. Also the atopic background of the condition has been suggested [3,15]. In the current study, there was significant association between major RAS and smoking habit (OR=26.8 times, 95%CI =6.7- 106, p<0.001). This result is different from that reported by Ciçek, et al [19], Davatchi, et al [20], Darwazeh and Pillai [21], Axéll and Henricsson [28] and Grady, et al [29] in Turkey, Iran, Jordan, Sweden and USA in which smoking is associated with protective effect towards RAS. In the current study, there was significant association between major RAS and chewing Qat (OR=7.1 times, 95%CI =2.1- 23, p<0.001). Our study is the first study that reported Qat chewing as risk factor of major RAS.

Conclusion

In conclusion high prevalence of RAS in Yemeni young adults, with association with smoking and Qat chewing habits. Also, elevated IgE levels and xerostomia may be considered as part of the RAS patient’s work‐up. Further research is needed to identify biological mechanisms that account for the observed associations.

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Iris Publishers-Open access Journal of Ophthalmology & Vision Research | Could Netarsudil be the promising treatment of Glaucoma?

Authored by Mina Abdelmseih

Editorial

Glaucoma is a group of chronic optic neuropathies characterized by degenerative changes in the optic nerve and visual field loss [1]. Intraocular pressure is considered the major risk factor for the progression of glaucomatous optic neuropathy involving the death of retinal ganglion cells and their axons [2].
However, glaucoma pathogenesis is not fully understood, the degeneration of retinal ganglion cells is related to increased intraocular pressure level. The intraocular pressure is determined by the balance between the ciliary body’s secretion of aqueous humor and its drainage through two independent pathways: the trabecular meshwork and uveoscleral pathway. There is increased resistance to aqueous outflow through the trabecular meshwork in patients with open-angle glaucoma. In contrast, in patients with angle-closure glaucoma, access to the drainage pathways is typically obstructed by iris [3].
Netarsudil ophthalmic solution 0.02% [Rhopressa®] is a Rhoassociated protein kinase (ROCK) inhibitor that primarily reduces intraocular pressure (IOP) by increasing the outflow of aqueous humor through the trabecular meshwork pathway. It is recently approved for the reduction of elevated IOP in patients with openangle glaucoma or ocular hypertension in the United States. The recommended dosage is once daily in the evening one drop in the affected eye(s). For this indication, there are ongoing researches: Phase III development in the EU, and Phase II development in Japan [4].
In three phases III trials of patients with elevated IOP, in patients with a baseline IOP less than 25 mmHg, the ocular hypotensive efficacy of once-daily 0.02% met the non-inferiority criteria for twice-daily timolol 0.5% over 3 months. The most common side effects are mild conjunctival hyperemia without increasing the severity with the continued dose, subconjunctival hemorrhages and cornea verticillata. Also, serious or systemic side effects related to treatment are uncommon probably due to a lack of systemic exposure [5].
According to a study by Kazemi A, McLaren JW, and Kopczynski which is designed to evaluate the effect of netarsudil 0.02 % on aqueous humor dynamics (AHD) parameters. In this doublemasked study, 11 healthy volunteers received topical netarsudil ophthalmic solution 0.02% once a day for 7 days (morning dosage).
The difference between netarsudil and placebo eyes in diurnal outflow change was 0.08μL / min / mmHg (P < 0.001). Diurnal episcleral venous pressure (EVP) decreased in netarsudil-treated eyes from 7.9±1.2mmHg to 7.2 ± 1.8 (-10 percent; P= 0.01). Diurnal EVP was not significantly different between netarsudil and placebotreated eyes. Once a day, netarsudil ophthalmic solution 0.02 % reduced IOP by increasing trabecular outflow and reducing EVP. This suggests a combination of mechanisms that affect both the proximal and distal outflow pathways [6].

The development of Rho kinase inhibitors for the reduction of IOP in patients with glaucoma and ocular hypertension is a triumph of medical research. Rho kinase inhibitors agents are thought to be very effective alone or in combination with other glaucoma medications. Netarsudil has neuroprotective and antifibrotic properties and enhances ocular blood flow. Therefore, it may be considered a revolutionary medication in the medical and surgical treatment of glaucoma [7].

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Iris Publishers-Open access Journal of Ophthalmology & Vision Research| Double Femtosecond Laser Created Incomplete Flaps After Repeated Docking

Authored by Amr Mounir

Abstract

Purpose: To report a case of femtosecond laser flap complication in the form two incomplete flaps after repeated separate docking procedures.
Methods: a 28-year-old female complaining of bilateral defective vision due to high myopia in right eye and subjected to right Femtosecond laser for flap creation for laser-assisted in situ keratomileusis (Lasik). After suction release we found that the created flap was decentered with flap edge near the pupil which will interfere with excimer laser ablation. So, the decision was to postpone the surgery. Another trial for Femtosecond laser flap creation with the same parameters of the previous trial with the same flap depth 90um. During flap lifting the flap was found to be divided into 2 parts, one peripheral crescent the other is incomplete circular flap. Both parts were lifted with underlying wide ablation zone. After excimer laser treatment, both parts were repositioned to their respective places. Contact lens was applied at the end of the procedure.
Result: After 2 months of follow up complete healing of the flap has occurred with satisfactory refractive result.
Conclusion: Flap decentration and incomplete flaps can occur with femtosecond laser flap creation. More notable conclusion is that femto flap edge healing is not so tight as thought before.
Keywords: Femtosecond laser; Docking; Incomplete flaps

Introduction

Femtosecond laser-assisted in situ keratomileusis (Femto- LASIK) is the latest successful innovation in refractive surgery because of its superior outcome, long-term stable results, and reduced complications compared to other procedures [1]. The first phase of LASIK procedure, the creation of a corneal flap, is the most critical step of LASIK and it affects the visual outcome of the whole procedure [2]. Conventional mechanical microkeratome was used to make flaps that were thinner in the center compared to periphery which could lead to buttonhole perforations. This flap-related complication has been dramatically overcome by femtosecond laser that creates corneal flaps with uniform thickness.
In this case report study, we report a case of flap complication of Femtosecond laser created flaps.

Case report

A 28 years old lady complaining of bilateral defective vision due to high myopia seeking refractive surgery. The uncorrected visual acuity (UCVA) in the right eye (RE) was 1.2LogMAR corrected to 0.18 by a refraction of -7.50Ds –1.00Dc x12, while the UCVA in the left eye (LE) was 1.2LogMAR corrected to 0.3 by a refraction of -6.50 Ds -1.50Dc x196. Corneal topography was done for both eyes by Sirius Scheimpflug Analyzer (CSO, Florence, Italy) and the patient was diagnosed as normal and thinnest pachymetry was 530μm in Right eye and 535μm in Left eye with normal topographical map and no risk factors in both eyes.
After counseling with the patient, the decision was to do bilateral Femtosecond laser for thin (90μm) flap creation We calculated the possibility of correcting the whole refractive error taking into account that the residual stromal bed would be 300μm. We also chose creating the flap with femtolaser to allow a regular ultrathin flap (90μm) leaving more stromal bed for the correction. As each diopter needs 13 μm of the bed. This would allow us to correct in RE and in LE.
Before the surgery, topical anesthetic 0.4% Benoxinate hydrochloride was instilled into the operated eyes. The corneal flap was cut with femtosecond laser by IntraLase (iFS, Abbott) the aimed flap thickness was 90 μm in both eyes. Femtosecond laser parameters for the corneal flap creation included bed energy level of 0.85μJ, a side-cut energy level of 0.95μJ with superior hinge orientation, flap diameter 9.00 mm, side cut angle 90 degree and hinge angle 90 degree. In the right eye, docking procedure started by placing the suction ring between the eyelids, the suction ring was positioned over the cornea, relatively concentric to the limbus, and then vacuum was initiated. Integrated joystick was used for docking with the interface’s disposable lens. Femtosecond Laser had been initiated to create the flap.
After suction release we found that the created flap was decentered with flap edge near the pupil edge which will interfere with excimer laser ablation (6mm ablation zone) safety. If we had proceeded with ablation it would have compromised the nearby epithelium concentric to the decentered flap leading to severe treatment decentration and would have affected healing and increased the incidence of epithelial ingrowth. So, the decision was to postpone the surgery and not try to dissect the flap from the bed to allow good flap healing and a therapeutic contact lens was applied for 24 hours.

We followed up the patient for 3 months to ensure complete flap healing which is expected with femtosecond laser a second trial for Femtosecond laser flap creation was decided in the same parameters of the previous trial with the same flap depth 90 um to save more residual stromal bed. We were convinced that complete flap edge healing has occurred by after this duration especially we didn’t try to lift the flap. This time we made sure that the cornea was totally centralized before Femtosecond Laser had been initiated. The second created flap was central with its edge away from the pupil to the extent that allow excimer laser ablation on lifting the flap, we found it to be divided into 2 parts, one peripheral crescent the other is incomplete circular flap. (Figure 1a, b) Both parts of the flap were attached to the superior hinge at a point. Going through with ablation this time as the flap was centered other parts were lifted meticulously. The excimer laser treatment was started immediately thereafter using the VISX S4IR. Both parts had been repositioned to their respective place with contact therapeutic contact lens application with regular ring of illumination. (Figure 1c, d, e, f). The second eye was treated in the second session by femtosecond laser with excimer laser ablation with same parameters and passed uneventful (Figure 1).
Postoperative medications included topical antibiotics eye drops (0.3% Gatifloxacin 5 times/day for one week), Topical steroid eye drops (1% Prednisolone acetate 5 times/day for one week), Lubricant eye drops and systemic non-steroidal anti-inflammatory drugs.

The patient’s follow up was for 2 months. Complete healing of the flap has occurred (Figure 2) with normal postoperative Corneal topography (Figure 3). The uncorrected visual acuity in the right eye was 0.3_Log (satisfactory to the patient especially in near vision) corrected to 0.18 by a residual refraction of -0.75Ds -0.50Dc axis 105. The corneal surface was regular as well. The uncorrected visual acuity in the left eye was 0.3 with refraction of -0.50Ds -0.50Dc axis 105.

Discussion

The technological progress of flap creation has emerged from mechanical manually guided microkeratomes to automated microkeratomes, single-use microkeratomes, and most recently to femtosecond (FS) laser technology [4, 5].
FS laser photo disrupts tissue at a preset depth and produces micro cavitation bubbles consisting of water and carbon dioxide. The bubbles expansion separates the corneal lamellae and flap creation [6]. Preliminary studies with the IntraLase FS laser have demonstrated lower rates of flap related complications in such as free flaps, irregular flaps, micro perforations, decentered flaps, epithelial defects, and abrasions [7-9].
In our case, although, the flap was created by femtosecond laser incomplete flaps had occurred due to repeated docking and femtosecond laser emission. In the first trial for flap creation by femtosecond laser, the flap wasn’t centralized enough to allow sufficient ablation zone, so surgery was postponed and repeated again thereafter.
In a study of [10] they compare Laser in situ keratomileusis flap complications using mechanical microkeratome versus femtosecond laser, severe flap decentration had occurred in both groups with more liability in microkeratome group but with difference from our management that photorefractive keratectomy (PRK) was done for all cases of severe flap decentration.
Flap decentration in our case can be explained by minor movement of the patient’s cornea with minimal tilting during femtosecond laser ablation leading to decentered created flap [11,12]. showed that flap adhesion strength in LASIK flaps made with a femtosecond laser was higher compared with a microkeratome due to good stromal wound healing to the extent that strong femto flap adhesion could be a disadvantage for patients of LASIK enhancement as this increase in flap edge healing interfere with re-lifting of the flap [13].
The second flap was created at the same depth of the first one (90um) because we expect complete flap healing as mentioned before especially no trial for decentered flap lifting had been done, also we were in need to create this thin flap to leave enough residual stromal bed adequate to treat as much as possible of the myopic error.
The second femtosecond laser ablation with the same depth created another flap encircling the previous decentered one and with the same bed.

We expected that decentered flap edge healing was complete; however, during flap lifting we found it did not heal completely leading to flap cleavage into two parts. In conclusion, flap decentration and incomplete flaps can occur with femtosecond laser flap creation. More notable conclusion is that femto flap edge healing is not so tight as thought before.

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Iris Publishers- Open access Journal of Nutrition & Food Science | Extrusion Cooking using Fruits Peels, Whole Cereals and Grains

Authored by Jose Luis Ramirez Ascheri

Abstract

New equipment, new accessories, better processing techniques in the area of food extrusion, coupled with the possibility of exploring much more raw materials available. In this way, processing whole grains, using agro-industry by-products, is becoming more and more feasible, with beneficial results of value added. As a result, products of better quality from a nutritional point of view, with sensory quality and lower cost possibilities, as well as serving groups that need gluten-free food.
Keywords:Extrusion cooking; Products development; Parameters processing; Quality criteria; Foods; Nutrition values

Introduction

Several treatises describe thermoplastic extrusion as an important technology in food product development. Mainly for the possibility of using several ingredients, either alone or in formulations. Recently we have gained high market values products with greater health. In this context, the use of grains and whole grains is an important market in the preparation of breakfast foods, or special foods for children or the elderly, which contain significant nutritional values: antioxidants, fibers, vitamins and, possibly, better protein and free gluten [1].

Production Alternatives

Through the extrusion, it is possible to obtain products of better nutritional quality. Thus, we can mention sorghum, if we consider, the different existing varieties [2], there are those that have high antioxidants levels, these, in turn, can be prepared and used in the elaboration of foods such as morning cereals, porridge, pregelatinized flours for use as an input in other food preparations, among other alternatives. On the other hand, in order to provide a product to improve fiber intake, day-to-day, extrusion tests were performed using mixtures of passion fruit peel flour to rice flour [3] in order to obtain a pre-cooked flour, easy to prepare, in the form of a porridge or be ingested with milk or juices. In this way, to take advantage of this natural resource and that can be used to improve the digestive system, which also suggests possibilities of use in people with diabetes or mainly pre-diabetics [4,5].
An interesting industrial coproduct, in the manufacture of analogs of jabuticaba wine (Plinia cauliflora), corresponds to peel. This material, already analyzed by several researchers, rich in antioxidants that after dehydration, in the form of flour, could be used, in mixtures with cereals, like rice, in the preparation of precooked mixed flour of fast preparation. Although the heat treatment during food extrusion can generate some loss of the natural antioxidants, there is always a surplus that can be harnessed [6,7].
To attend populations of extreme food need, as in nutritional campaigns in countries with populations of extreme poverty, a mixed flour, of low cost, was elaborated using corn grits and whole soybean meal flour in various proportions (soybean/maize: 40/60, 50/50, 60/40). These flours have nutritional properties ranging from 25-30% protein, good biological value, and caloric, lipid content compatible with the needs for these groups. The flour result has a good degree of solubility when required in the use of a preparation of beverages, or porridges, soups, etc. All this with ease preparation, only adding water is cold or hot according to the required objective [8,9].
Although the production of the Andean pseudocereals (Chenopodium quinoa willd, Amaranthus spp) is limited by their small production area in the Andes of Peru and Bolivia, they have very high nutrient values. In this sense, breakfast cereals are already available using these grains. The advantage, in this case, is that these grains can be processed in their integral form. Only depending on its quality, the proper handling of the extrusion parameters [10], to guarantee the least possible loss of its essential amino acids.
On the other hand, the use of green fruits, as in the case of certain varieties of banana, can be used as functional ingredients. Thus [11] prepare banana flakes with and without peel and processed by extrusion to study their characteristics: gelatinization, resistant starch, dietary fiber, and functional properties, such as pasting properties, concluded that the product has a high content of nondigestible carbohydrates, which indicates its potential in diabetic patients or in need of a diet to reduce body weight.
It is important to emphasize that, due to this technology, food thermoplastic extrusion allows the elaboration of several convenience products, and it offers finished products for immediate use, in which they can be mixed with a variety of ingredients, including enrichment with sources of minerals, amino acids, bioactive, provided that the appropriate tools are used during the elaboration so as not to diminish their bioavailability.

Conclusion

With the possibility of having different forms of control in the extrusion system, new accessories, excellent pre-conditioners, different shapes and configurations of the extrusion system, handling of raw materials, proper grinding, makes possible better conditions for use of raw materials, or with high fiber content. This will be the reason to make available to the consumer market better products in both sensory and nutritional quality. Still with the possibilities of a better price and for those in need of products high in fiber and gluten-free.

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Iris Publishers- Open access Journal of Nutrition & Food Science | Fruits and Vegetables, The Best Alternative to Hospital

Authored by  Michael Uchenna

Opinion

Nutrition can be explained in different ways depending on the context at which one wants to use it for. Nevertheless, it can be said to be the study of nutrients and its roles to the body. According to the above definition, it directs to knowing the nutrients needed by the body and their roles when taken. As it is, there are six (6) nutrients in which the body needs which equally correspond with the six classes of food; protein, carbohydrates, fat and oil, vitamins, mineral salt and water.
All the food nutrients are mostly found in fruits and vegetables. Fruits such as watermelon and guava contain Vitamin A with other nutrients that helps in keeping the body healthy. Also, vegetables like carrots, tomatoes, bell peppers, pumpkin, broccoli, chard, lettuce, etc. all contains Vitamin C, K, etc. which also helps in keeping the body healthy.
Less I forget, fruits and vegetables are body building and energy giving food. People need to get leave of fries and prepackaged foods and go for fruits and vegetables as they help prevent a whole lot of diseases that people suffer from often. They help you control both sugar and weight lost. A diet rich in fruits and vegetables can as well lower the risk of heart disease. Vegetables like broccoli, green cabbage and fruits like lemon, orange, etc. can help to boost cardiovascular health. Vegetable like tomato that contains lycopene according to health professionals helps to reduce the possibility of suffering from cancer. This is because, lycopene acts as a layer of cancer fighting agent in the body.
The fiber content of fruits and vegetables also helps in smooth running of the digestive system. Intake of fruits and veggies that is of high fiber content helps to prevent constipation when enough water is also taken. After going through the aforementioned health benefits of fruits and vegetables, you would understand that you do not have to go to the hospital and pay a doctor to prescribe drugs for you when you have the best drugs and medicine at your own door step.

Most Africans now believe in modernization transferring it to both drugs forgetting the veggies that we were known for. The world needs to understand that farmers and their products are the best and most needed in the world. When you pay a farmer today for fruits and vegetables, you have equally paid for the huge amount you would have spent in the hospital tomorrow. Let us know that FRUITS AND VEGETABLES are our homemade hospital.

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Iris Publishers-Open access Journal of Textile Science & Fashion Technology| Improvement of Efficiency and Productivity Through Machine Balancing in a Sewing Line

Authored by Champa Saha

Abstract

 This study investigates and demonstrates the application of computer simulation for the design of a manufacturing process for t-shirt production in a virtual-reality environment. The focal constraint against the higher productivity is the difference in individual capacity which is the mode of improper line balancing and bottle check process. This study is based on an effective layout model where to hit upon the bottleneck process through benchmark capacity and led us to use balancing process using two separate concept of manufacturing processes- modular line and traditional system both together. The research shows that this balanced layout model has increased the efficiency by 9 % and labor productivity by 6 %/\

Introduction

The ready-made garment (RMG) sector is the life-blood of Bangladesh economy achieving higher export growth every year. The sector is now the largest contributor not only to overseas trade but also to the national economy. Today’s business climate for clothing manufacturers requires low inventory and quick response systems that turn out a wide variety of products to meet customers demand [1]. It is especially in the Apparel industry that managers are trying to develop their current systems or looking for new production techniques in order to keep pace with the rapid charges in the fashion industry. Therefore, to develop a new system, good observations needed. However, to observe real manufacturing systems is very expensive and sometimes cumbersome [2]. The rapid rate at which the whole process takes place, the interaction between workers and the different transition times between workers make it increasingly more difficult for a human being to make correct decisions regarding how fast each operator should work in order to continue the process, while at the same time keeping productivity high and throughput at an acceptable level [3]. Construction of a quality garment requires a great deal of knowhow, a lot of coordination and schedule management. Clothing manufacturing consists of a variety of product categories materials and styling. dealing with constantly changing styles and consumer demands is so difficult. Furthermore, to adapt automation for the clothing system is also so hard because, beside the complex structure also it is labor intensive. There-fore, garment production needs properly rationalized manufacturing technology, management and planning [4]. In garment production, until garment components are gathered into a finished garment, they are assembled through a subassembly process. The production process includes a set of workstations, at each of which a specific task is carried out in a restricted sequence, with hundreds of employees and thousands of bundles of sub-assemblies producing different styles simultaneously [5].

The joining together of components, known as the sewing process, which is the most labor-intensive part of garment manufacturing, makes the structure complex as some works has a priority before being assembled [6]. Furthermore, since sewing process is labor intensive; apart from material costs, the cost structure of the sewing process is also important. Therefore, this process is of critical importance and needs to be planned more carefully [7]. As a consequence, good line balancing with small stocks in the sewing line has to be drawn up to increase the efficiency and quality of production. An assembly line is defined as a set of distinct tasks which is assigned to a set of workstations linked together by a transport mechanism under detailed assembling sequences specifying how the assembling process flows from one station to another. In assembly line balancing, allocation of jobs to ma-chines is based on the objective of minimizing the workflow among the operators, reducing the throughput time as well as the work in progress and thus increasing productivity. Sharing a job of work between several people is called division of labor. Division of labor should be balanced equally by ensuring the time spent at each station approximately the same. Each individual step in the assembly of product has to be analyzed carefully and allocated to stations in a balanced way never the available workstations. Each operator then carries out operations properly and the work flow is synchronized. In a detailed work flow, synchronized link includes short distances between stations, low volume of work in process, precise o planning of production times and predictable production quantity [8]. Overall, the important criteria in garment production is whether assembly work will be finished on time for delivery, how machines and employees are being utilized, whether any station in the assembly line is lagging behind the schedule and how the assembly line is doing overall [9,10]. To achieve this approach, work-time study, assembly line balancing and simulation can be applied to apparel production line to find alternative solutions to increase the efficiency of the sewing line [11]. Factories in Srilanka and India operate at 80% - 90% of efficiency, whereas in Bangladesh according to some experts, productivity is between 35- 55% of efficiency with very few exceptions. For the RMG sector in Bangladesh productivity alone can make a difference between life and death [12].

Productivity

In simple words, productivity is the relationship between output and input. The output in garments factories can be pieces of finished garments. The output of sections or departments within the garment factories could be, meters of the fabric inspected in fabric inspection section cut components in cutting room, number of garments ironed in the ironing section and so on. The examples of input are – man hours, machine hours, and meters of fabric consumed, or electricity consumed [13].

Clarification

In simple words, productivity is concerned with the efficient utilization of resources (inputs) in producing goods. This expression may also be called ‘productive efficiency.
Factor Productivity (Labor)=Output/Input(Labor)

Line balancing

The Line Balancing is to design a smooth production flowed by allotting processes to workers so as to allow each worker to complete the allotted workload within an even time. Line balancing is an effective tool to improve the throughput of assembly lines and work cells while reducing manpower requirements and costs. Assembly Line Balancing, or simply Line Balancing (LB) is the problem of as-signing operations to workstations along an assembly line, in such a way that the assignment be optimal in some sense. Ever since Henry Ford’s introduction of assembly lines, LB has been an optimization problem of significant industrial importance, the efficiency difference between an optimal and a sub-optimal assignment can yield economies (or waste) reaching millions of dollars per year. It is a system where we meet the production expectations and we can find the same amount of work in process in every operation at any point in the day.

Reasons for machine balancing

Purpose of balancing a line is to reduce operator’s idle time or maximize operator utilization. In a balanced line work will flow smoothly and no time will be lost in waiting for work. A time of line setting select operators for the operation matching operator skill history and skill required. Following this method, we will select highly skilled operators for higher work content operations. Once line is set conduct capacity study at a regular interval. We have to use pitch diagram method to find bottlenecks inside the line. We have to think how we will minimize WIP level at bottleneck operations.
• Keeping inventory costs low results in higher net income.
• Keeping normal inventory levels lets the operator work all day long giving him/her the opportunity to earn more money by increasing his/her efficiency.
• Keeping the line balanced lets the supervisors improve other areas because they can use their time better.
• Balanced production keeps prices low which turns into repeat sales.
• Balanced production means better production planning.

Materials and Methods

Required tools and materials

Different materials and methods are mainly used based on the work Experiments. Here, the following materials and tools are used to complete the testing and evaluation of this work:
• Stop Watch
• Spread Sheet
• Calculator
• Paper and Pencils

Equations

Data analysis and calculation

Before balancing line: Table 1 shows that the target per hour for the line calculating total 37 manpower worked on that line for 600 minutes with a S.A.M value of 8.90. We have standardized the Bench mark target of 200 pieces of garment at 80% efficiency. Observation before balancing the line has been reflected as labor and machine productivity is 30 and 50, line efficiency is 44%.

Figure 1 shows that Variation in each process capacity per hour compare to bench mark target per hour Plotting process wise capacity in a line graph shows the variation of each process from the bench mark target as the upper capacity is 490 pieces per hour where the lower capacity is only 115 pieces per hour compare to the bench mark target of 200 pieces. This shows the imbalance situation in the line and bottle neck condition throughout the process of the whole garment making as lots of WIP stations in the line.


Bottleneck processes: From Table 2 we have identified some variations in process capacity from the bench mark target and the lower capacity from the bench mark target is the bottleneck process as production flow would stuck on the bottleneck point. Comparing total capacity of each process to the 80 % bench mark target, we have identified the bottleneck processes named make and join care label, back neck elastic tape joint, match sleeve pair and sleeve and body, sleeve hem, churi hem raw edge cut, security tack and thread cut body tum. Total production has been blocked in these seven work stations and large work in process (WIP) has been stuck in these bottleneck processes.

Balancing processes: Balancing method is very essential to make the production flow almost smoother compare to the previous layout. Considering working distance, type of machines and efficiency, workers who have extra time to work after completing their works, have been shared their work to complete the bottleneck processes. Previously identified seven bottleneck processes have been plotted (Table 3). Make and join care label and Back neck elastic tape joint both have been made by lock stitch machine and these have been shared by two lock stitch machine processes. Operator minutes per hour in her first process, no.7 Neck rib make width, have been worked for 50 minutes per hour in the first process, capacity 217 pieces and then have been worked in the process no.6 make and join care label for last 10 minutes to make additional 30 pieces for overall capacity of 208 pieces on process no.6. Similarly Process no.13.B back neck elastic top have been worked for 35 minutes and rest 25 minutes have been worked on process no.12 to make total capacity of 216 pieces which was originally 153 pieces shown in Table 4. Process no.14, 25, 20 and 22 have been similarly worked on the process no.16, 23, 24 and 27 for the capacity of 195, 198, 153 and 199 pieces per hour. Process no.24 churi hem raw edge cut have been suggested an extra floater to use after being shared worked from process no.20.

Proposed layout: Research has been customary through this model which indicates that the processes are almost balanced from previous layout through the combination of balancing and bottleneck processes. The blue arrow on the center table indicates the production flow through the process no, as semi zigzag combination and green arrow shows the sharing of works in between balancing and bottleneck processes.
First column on both side of center table shows the machine type and then followed by process no. process name, S.A.M value, and previous capacity and after balance capacity. After first process front and back match, bundle of garments have been come to process no.2 shoulder joint, then the bundle have been passed diagonally to process no.4 shoulder top and in between the processes, one helper has been worked in process no.3 shoulder cut mark which is shown in fig 3.1.The working bundle then has been passed to process no.6 and so on. From process no.6 to 7 and process no.23 to 25, work has been flowed vertically not diagonally because of balancing out the bottleneck processes of no.6 and 23 as diagonal flow would have create the long distance and much time to balance, For balancing 6 possible stations, we have used the short possible distance, similar machines (process 6, 7, 12, 13.B, 22, 27) have been utilized in lock stitch machines, process 23 and 25 have been utilized in flat lock machines and process 14 and 16 are service operators.

Results and Discussions

Changing from traditional layout to balanced layout model, there are considerable improvements have moved toward us. Among the three operators who were replaced to another line, have been used in the lock stitch and flat lock machines and machine productivity for these less used machines has been increased from 50 to 60 where for the total worker of 32 instead of 37, labor productivity has been increased to 36 from 30.
In a day we have boost up the production up to 1145 and with manpower of 32, line efficiency has been improved from 44 % to 53 % (as shown in Table 2). In the improved layout, target has been decreased at each efficiency level. At 80 % efficiency, target is now 173 pieces per hour.

From Figure 2, it shows the less variation of each process from the bench mark target as the upper capacity is 260 (previous one was 490) pieces per hour where the lower capacity is only 153 (previous one was 115) pieces per hour compare to the benchmark target of 200 pieces which shows that the variation in each process has been decreased from the previous one and reflects much better balanced production flow in the line. For Process no.24 churi hem raw edge cut, an extra floater has been suggested to utilize (Table 5).

Conclusion

Maximum outputs have been increased to 1280 pieces a day which was previously recorded to 1184 pieces a day. Before balancing the line 5664 pieces of garments have been produced for 6 days where 6880 pieces have been produced for 6 days after balancing the line. We have saved one day lead time for that style of 12000 pieces and almost 600 minutes of labor work value time. We have replaced 3 operators and 2 helpers into different lines and relatively saved 5 workers work time of 3000 minutes from that line and almost $130.

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Iris Publishers-Open access Journal of Textile Science & Fashion Technology| Quality Assurance in the Ready-Made Garment Industry

Authored by Taher Rajab Kaddar

Introduction

Quality is a set of characteristics of an entity showing its ability to meet specific or anticipated requirements [1]. TQM is a management approach that focuses on quality and depends on the participation of all its members and aims to achieve long-term success by satisfying the customer and achieving benefits for all members of the organization and society.
• The expression of all individuals (means concerned individuals in all sections at all levels of organizational structure).
• The strong leadership of senior management, as well as the training and rehabilitation of all members of the organization, are essential to the success of this approach.
• The concept of quality in TQM means achieving all management objectives.
• The concept of “benefits to society” is intended to meet the needs of society as needed.
• Total quality management or any parts thereof are sometimes called Total Quality.

International Quality Management Systems

The global quality management systems are numerous and vary from state to state and from company to company. However, quality management systems have become widely used within and outside the country where they were born and have been globally recognized for their efficiency and effectiveness in improving and developing institutions such as TQM. Including the adoption of a global quality management system by international organizations such as ISO 9000.
The following are some of these systems in the hope of helping companies in the modernization and development to build a quality management system in them, to adopt their work on scientific grounds far from improvisation and adventure is not guaranteed results [2].

What to do before Applying a Quality Management System?

Prior to the introduction of any quality management system in the organization at all levels of senior and middle management and employees, the workplace must be cleaned, organized and arranged in order to identify and identify difficulties and problems and to implement effective implementation procedures to address them and take measures to prevent their recurrence. Hence the importance of the application of the five S (5S) (or so-called Kaizen) [3] i.e. The five steps in Japan to improve work and productivity. As an important and necessary step to create an appropriate working environment for the implementation of international quality management systems.
The 5S is a modern idea that originated in Japan as a result of the need for Japanese companies to excel in international markets. The five S is aimed at continuous improvement through organizing, arranging and maintaining the workplace, Discipline and doing business well in the company. The five S is derived from five Japanese words beginning with letter S: seiri, seiton, seiso, seiketsu, and shitsuke.

Quality Control and Monitoring of Production in the Garment Industry

The garment industry has evolved over the ages and is closely related to fashion. Fashion has shown many forms of culture, customs and traditions. Studies of the development of the garment industry have shown that they are an integral part of customs.
Fashion is constantly changing, and it does not only indicate clothing, but also the person as a whole with who surrounds him and what surrounds him.
In the fashion world, there is a short-term trend that lasts only for a few weeks and is limited to specific social groups such as youth, artists, students, etc. These trends may take an exaggerated form.

Where do we Control and Monitor the Quality of Ready-Made Garments?

Quality control and control in the garment industry goes through multiple stages. It extends to all phases of production and operations in the company, securing physical and human resources and procurement through inspection and verification of the quality of materials, warehouses, raw materials, production lines, inspection, final testing, Disinfected or disposed of.
It is difficult to limit all the processes related to quality control in the clothing industry within this article and we will refer to some of the basic joints of the control and control operations, stressing that in each laboratory there are specialties different from another laboratory [4].

Importance of Clothing, Fashion and Clothing Industry

Since ancient times, clothing, in addition to its importance and its basic function in protecting human beings from the changing factors of nature (cold, free, stress ...) has been important for several considerations. In all cases, attention to quality has been accompanied by, The following cases:

The importance of clothing and fashion in society

Throughout history, pride in the past and the modern, clothing has a social, national and religious significance And physiological and psychological, and here we can distinguish two dates that have an important meaning in this context in 2500 BC, clothing depicted human life in the caves, and since 4000 BC began the first discoveries of the first clothing in the Mediterranean.

Social importance of clothing

Clothing, as we have said, has not only been a function of human rights; it has begun to play a role in distinguishing members of society from one another. For example, it has distinguished individuals like the magicians, princes, princesses and aristocrats from the general public. It was easy to identify which layer belonged to someone who wore or worn.
For this reason, it is no wonder that there are rules and guidelines that specify which clothes to wear, when, where and for which occasion ... and if someone wears negligible clothes, this may lead to a feeling of distrust.

National importance of clothing

In many countries, citizens insist on distinguishing them from others. Take, for example, the location of the Gulf region, the Europeans or some segments of society within a single country, and the athletes who participate in the Olympic Games, where their clothing symbolizes the way of life in this country.

Religious importance of clothing

Clothing was and continues to be of major importance. The clergy in most religions wear clothing that distinguishes them from the rest of the general population on the one hand and distinguishes them from the clergy of other religions.
The information indicates that the primitive tribes of South America wore dresses during worship, while walking naked at other times. On occasions, priests wear special clothing.

Physiological importance of clothing

Clothing has evolved throughout the ages. It is used to protect against heat, cold, fire, water and environmental conditions that are close to and harmful to humans. Take, for example, astronauts or motorcyclists, firefighters and others. Clothing plays a role in leaving the psychological impact on others and in the psyche of the person who wears it. Clothes and fashion are a special form of selfexpression, do not you also try to focus on the impression you want to leave in the hearts of others through what you wear?

The sexual importance of clothing

At the global level, clothes are worn without shame, unlike those who wear them to indicate their commitment to their own customs and traditions. Sometimes clothes are used to entice someone, of both sexes to gain attention.
And the fact that the curiosity of man is an incentive for people to invent new ways and methods to wear clothes and stripping them and so remains the influence of seduction clothes alive.

Fashion and its role in the clothing industry

Fashion designers emphasize that the frequent appearance and concealment of body parts makes fashion a good and vivid condition.
The fashion of men was followed by similar models, clothes that emphasized the strength and texture of men, the beauty of the shoulders or the soft or ordinary appearance (placing or leaving a small padding on the shoulders), focusing on the waist, buttocks, back or Thighs.
Fashion has played an important role in expressing the economic status of societies throughout the ages. Fashion researchers have shown that over the past 60 years there has been a relationship between the economic situation and the length of the skirt in women.
The life of the fashion cycle alternates between short for about four years and longer phases spanning a whole century.
It has become known to all those interested in fashion today that the centers of women’s fashion are Paris, Rome, Florence, Scandinavia and America recently. The current men’s fashion centers are Rome, Paris and London.
The campaign to establish international fashion fashions and fashion shows began to show the latest innovations and inventions in this field.
We find that quality control and control in the basic stages: raw materials, spinning, weaving is a difficult task to give a variety of high-quality products that keep pace with the rapid change in fashion as well as the control and quality control in the industry itself. To meet the aspiration and the global outlook and increasing.
It should be noted that a very important point for textile engineers and workers in this sector to be within the event and not outside. Within the playing field and not outside.
The colors of the season for textiles and others are determined two years ago, and the raw materials for the clothing industry are determined by one and a half years ago.
The world is moving with the capacity of the textile industry at the international level. Are we present or absent? We have to think carefully about whether we want to develop the textile industry, whether we are mixing it with this land and moving quickly and with high quality to keep up with the demands of the coming fashion and fill the need of the wide range of people at their diversity, at the right price and with an open mind.

Quality Control in the Clothing Industry

The process of quality control in the ready-made garment industry includes many operations, which we are not explaining here, but rather, most importantly, arranged according to the sequence of operations [5].

Quality control of raw materials and assistance

• Quality control of fabrics.
• Quality control sewing thread.
Quality control needle sewing.
• Quality control accessories.
• Quality control of adhesive fillings.
• Quality control lining.

Quality control design

• Monitoring the elements of customer needs and satisfaction.
• Monitoring the elements of the specifications of the raw materials, the product and the service requirements.
• Monitoring the elements of the operational specifications and service requirements.

Quality control during the process of individual/cloth

Quality control in the preparation phase of the model

Quality control in the shearing process

Quality control in the sewing process

Inspection procedures on the quality of operations: There are three elements of quality on the production line in the sewing room are the worker and the head of the line and quality monitor, all of them have an important role in ensuring quality in the manufacture of ready-made garments.

Quality control of ironing and packaging

Quality control of packing and storage

Due to the importance of clothing and fashion in the daily life of all mankind and quality assurance in the ready-made garment industry there is a constant need to develop and improve quality control and control methods in this important sector of human activities.

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