\\n\\n
More than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\\n\\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\\n\\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\\n\\nAdditionally, each book published by IntechOpen contains original content and research findings.
\\n\\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\\n\\n\\n\\n
\\n"}]',published:!0,mainMedia:null},components:[{type:"htmlEditorComponent",content:'
Simba Information has released its Open Access Book Publishing 2020 - 2024 report and has again identified IntechOpen as the world’s largest Open Access book publisher by title count.
\n\nSimba Information is a leading provider for market intelligence and forecasts in the media and publishing industry. The report, published every year, provides an overview and financial outlook for the global professional e-book publishing market.
\n\nIntechOpen, De Gruyter, and Frontiers are the largest OA book publishers by title count, with IntechOpen coming in at first place with 5,101 OA books published, a good 1,782 titles ahead of the nearest competitor.
\n\nSince the first Open Access Book Publishing report published in 2016, IntechOpen has held the top stop each year.
\n\n\n\nMore than half of the publishers listed alongside IntechOpen (18 out of 30) are Social Science and Humanities publishers. IntechOpen is an exception to this as a leader in not only Open Access content but Open Access content across all scientific disciplines, including Physical Sciences, Engineering and Technology, Health Sciences, Life Science, and Social Sciences and Humanities.
\n\nOur breakdown of titles published demonstrates this with 47% PET, 31% HS, 18% LS, and 4% SSH books published.
\n\n“Even though ItechOpen has shown the potential of sci-tech books using an OA approach,” other publishers “have shown little interest in OA books.”
\n\nAdditionally, each book published by IntechOpen contains original content and research findings.
\n\nWe are honored to be among such prestigious publishers and we hope to continue to spearhead that growth in our quest to promote Open Access as a true pioneer in OA book publishing.
\n\n\n\n
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Quite often, the functional requirements of a component are conflicting. For the engineer, this occurrence makes most materials in their natural form deficient. For instance, a part may require both hardness and ductility to function properly in a given working environment. It is more or less impossible to find such material existing naturally. This type of situation has led engineers to explore different production techniques that produce the desired conflicting properties [1]. At times, two different materials may be combined, with each having one of the required properties. The combined materials could be metal and metal, metal and non-metal or non-metal and non-metal, and during merging, they may be in the same state or otherwise. The new material reflects the properties of the different materials that are combined. Several techniques have been established and used to improve the properties of aluminium and its alloys. The concept behind these methods is modification of the material’s microstructure, which ultimately alters the properties of the material [2].
\nThe light weight and high corrosion resistance of aluminium make it significant in its applications; however, there are restrictions on aluminium applications, due to its soft and brittle nature [3]. Thus, to optimally exploit its natural attributes in automotive, aerospace and defence sectors requires a high strength-to-weight ratio. Processes have been developed to strengthen and harden this metal. The primary method of strengthening aluminium is alloying, which is the addition of a calculated amount of selected elements to aluminium. Aluminium alloy is a metallic substance and consists of approximately 90–96% aluminium and another or more elements, most commonly silicon (Si), copper (Cu), magnesium (Mg), zinc (Zn) and manganese (Mn) [4]. However, commercially available aluminium alloys have about 0.1–0.4% iron (Fe) by mass, which gives the alloys special qualities. While the iron content could be seen as an unwanted impurity, it depends on the fed raw materials and the electrolytic reduction process. There are other alloy elements that provide special properties, and are usually applied in smaller amount (less than 0.1% by mass), and include elements such as bismuth (Bi), chromium (Cr), boron (B), lead (Pb), zirconium (Zr), nickel (Ni) and titanium (Ti) [5]. The most important and commonly used alloying element of aluminium is Si. Silicon addition to aluminium improves the fluidity of the Al-Si alloy, feeding, hot tear resistance, tensile strength and hardness.
\nHowever, alloying has not completely satisfied material engineers’ quest to meet the trends of Al-Si alloys functional requirements, due to as-cast mechanical properties limitations. Cast alloys of Al-Si produced by conventional processes of melting, pouring and solidification, without post-process is called as-cast alloys. Studies have shown that the microstructure of as-cast alloys under the conventional solidification conditions consists of coarse flakes of Si that promote brittleness within these alloys [6, 7]. The primary Si in the form of a plate in Al-17%Si is shown is Figure 1. Consequently, material engineers and scientists have developed several processes to enhance Al-Si alloys mechanical and physical properties. The properties of a material are defined by the characteristics of its microstructure. In the case of Al-Si alloys, microstructures can be modified either chemically or mechanically. In a chemical modification, certain elements are added in trace levels to the matrix depending on the needed property. This chapter, therefore, discusses Al-Si alloys modification concept, Al-Si modification methods and their applications.
\nPrimary Si in the form of a plate in Al-20%Si [8].
Generally, modification and refinement processes are used for improving mechanical properties of alloys by altering the alloy’s Si morphology and distribution. There are several modification and refinement techniques that can be used and these techniques can be categorised into three:
\nChemical modification and refinement processes; addition of a calculated amount of nucleation agents
Mechanical modification and refinement processes; ultrasonic, squeeze, stirring, centrifugal and vibration methods
Thermal modification process; superheating, quench and cooling
The addition of trace levels of certain additive (modifier) to a molten Al-Si to alter its structure is called modification. Modification reduces the size of eutectic Si particles to enhance the cast\'s mechanical properties such as ductility and strength. The addition of a modifier such as Sr transforms the Al-Si cast to fine and globular/fibrous morphology. Chemically stimulated modification produces a fine flake-like or fibrous structure. Many elements have been discovered to produce a fibrous eutectic Si structure such as Na, Sr, K, Ce and Ca. These following elements, Sb, As, and Se have been found also to produce a refined flake-like structure. These three elements Sr, Na, and Sb are the most effective modifiers in trace levels of additions and widely used in the foundry industry. The strongest modifiers known are Na and Sr. Other modifying elements are K, Rb, Ba, La, Yb, As and Cd, as presented in Table 1.
\nElements | \nMorphology of eutectic Si | \n
---|---|
No addition | \n― | \n
Sodium, Na | \nFibrous | \n
Calcium, Ca | \nFibrous | \n
Strontium, Sr | \nFibrous | \n
Potassium, K | \nFibrous | \n
Barium, Ba | \nFibrous | \n
Cerium, Ce | \nFibrous | \n
Rubidium, Rb | \nFibrous | \n
Europium, Eu | \nFibrous | \n
Antimony, Sb | \nLamellar (or a fine version of acicular) | \n
Ytterbium, Yb | \nLamellar (or a fine version of acicular) | \n
Arsenic, As | \nLamellar (or a fine version of acicular) | \n
Selenium, Se | \nLamellar (or a fine version of acicular) | \n
Cadmium, Cd | \nLamellar (or a fine version of acicular) | \n
All rare earth metals and misch metals except Eu including Laa, Cea, Pra, Nd, Sm, Gd, Tb, Dy, Ho, Er, Tm, Yba and Lu | \nLamellar (or a fine version of acicular) | \n
The first commercially modifier applied to Al-Si alloys was Na. It is required in trace levels, usually <0.007%Na, to make the full modification. Advantages of Na-modification include: its effective use for many years; small amount required for modification; short residence time (the time it takes to remove inclusions); minimal surface agitation; and reduced offensive fumes. However, there are several drawbacks: it has about 10–50% volatility recoveries; limitation due to the danger in handling caused by its rapid reaction with moisture; formation of thick oxide skin that hinders fluidity, which may cause entraining in casting; it makes surface appearance of casting scaling; Na attacks mould coatings; and over modification challenges.
\nModification of Al-Si microstructure is performed by the addition of a minute quantity of ternary element such as Na to Al-Si. The use of addition of a trace level alkaline earth metals or alkali metals to AI-Si alloys to alter their structures began several years ago. This alteration enhances the mechanical properties; raise the ultimate tensile strength (UTS) and increases the ductility. The influence of Na on tensile strength and elongation is shown in Figure 2. Describing this morphological alteration, conventionally, there are two versions of explaining the principle of Na-modification [12, 13]: (i) based on Na influence on Si growth and; (ii) based on Na influence nucleation of the Si phase. However, Day and Hellawell identified three various modes of eutectic nucleation and growth in Al-Si alloys that are composition and solidification conditions depended. These modes are [13]:
\nNucleation at or near to the wall and front growth facing the thermal gradient
Nucleation of eutectic on primary dendrites
Heterogeneous nucleation of eutectic on nucleant particles in the interdendritic liquid
Sodium effect on tensile strength [14].
The growth model seems to have the widest acceptance, due to the appearance of Si interconnectivity in both unmodified and modified structures. Consequently, the continuous nucleation of Si has been contested. However, two limitations were observed in the growth model. In a Na-modified casting, a significant change of the microstructure was noted, while little spacing changed and fibrous Si form are produced in the directionally grown specimens. Again, it was noted that Na addition has little influence on the equilibrium liquidus temperature, but there is a huge change in the plateau temperature produced during the thermal investigation of a cast alloy [13]. Enhancement of capacity of Si to branch by Na, in the growth models, has been advocated and this reduces spacing and total undercooling, at a specified growth velocity.
\nConversely, Flood and Hunt concluded in their work that nucleation and Si growth are both affected by the addition of Na to Al-Si cast alloys. In the Na-modified casting, two effects were reported that [15]:
\nSodium presence transforms the Si growth morphology from the plate-like form to the fibrous form.
If the temperature rise in the liquid is small, Na stops nucleation from happening ahead of the eutectic growth front. The lack of nucleation primarily accounts for the finer structure and larger undercooling of modified castings or ingots.
Trace of phosphorous is often found in Al-Si alloys, which causes the formation of a granular structure and aluminium phosphite (AlPO3). Aluminium phosphite accelerates primary Si crystallisation that appears in the microstructure in the form of polyhedral platelets. In Na-modification, Na reacts with phosphorus to form sodium phosphite (Na3O3P). The solid solution phase in the form of dendrites crystallises out first before the Si phase.
\nSignificant change is observed in Si morphology and particle spacing when 0.01 wt.%Na was added. This process transforms solidifying alloy into highly refined Al-Si eutectic and also, reduces temperatures and moves the eutectic point to a higher Si content. The broken line in Figure 3 shows the modified Al-Si alloy phase diagram.
\nModified Al-Si alloy phase diagram [16].
Addition of Na modifies the eutectic Si growth to an irregular fibrous form instead of the usual coarse flakes. The composition of Al-Si alloy at the new eutectic point due to the Na-modification is hypoeutectic instead of hypereutectic, which results in the formation of primary α-Al instead of Si. Figure 4 shows micrograph of Al-13%wtSi and Al-13%wtSi-0.01%Na respectively. Addition of small of the quantity of 0.01%Na as an impurity to Al-Si alloy modifies its microstructure and improves its properties.
\nMicrograph of [16] (a) Al-13%Si; (b) Al-13%Si-0.01%Na, where 1 = α-Al dendrite; 2 = primary Si; 3 = Eutectic Si; 4 = α-Al; and 5 = fibrous eutectic Si.
Wessén, Andersson and Granath investigated Na-modification effect on the mechanical properties of a secondary alloy, Al-6%Si-2.5%Cu, produced from rheocasting, applied to thick wall components production [17]. The study revealed noteworthy alterations in the microstructure of the Na-modified; individual Si lamellar could not be identified, while the average size of Si lamellar of the unmodified alloy was 100 μm. The reduction of the quantity of Na from 4.3×10−5 wt.% to 3×10−5 wt.% did not show a significant change in the structure and shows that a trace level of Na can substantially transform eutectic. The energy disperse X-ray spectroscopy (EDX) analysis shows intermetallic phases Al2Cu and Al15(Fe, Mn)3Si2 and these are shown in the SEM image in Figure 5.
\nSEM image showing main intermetallic phases in microstructure [17].
Modification by Sr and Na has the similar result of fibrous eutectic Si structure. However, Na is much more volatile than Sr, as is often considered as a semi-permanent modifier. This property and its easy application, coupled with other metallurgical advantages have increased the use of Sr as a modifier in recent years. Other advantages are [18–29]: about 80–90% recovery rate; addition melt easily; wide effective concentration range; last long in the melt during holding times; less delicate to over-modification; produces smooth appearance castings; found in suitable master alloy form; and it does not react with refractories; it has no environmental challenges. In a well Sr-modified hypoeutectic casting microstructure, the estimated average area of the fibrous eutectic Si particle is 3.8 ± 0.6 μm2 and the aspect ratio is about 1.58 ± 0.29. The impact of Sr concentration on strengths is shown in Figure 6.
\nImpact of Sr concentration on strengths of: (a) AA601 cast alloy; and (b) AA401 alloys [20].
There are challenges that are associated with Sr-modification such as the promotion of gas levels in the melt and the cost is comparatively high. Nevertheless, these challenges can be overcome by easier melt treatment practice and other casting quality enhancement processes. Over modification causes the mechanical properties of the alloy to revert to that of a typical unmodified alloy, Figure 7 shows the microstructures of, unmodified, modified and over modified alloys.
\nEutectic microstructures of fully solidified Al-Si alloys: (a) unmodified commercial purity; (b) unmodified high purity; (c) Sr modified commercial purity;(d) Sr modified high purity [21]; over Sr-modification of AA601 alloy: (e) >0.03%Sr formation of Al4SrSi2 phase; (f) >0.09%Sr formation of coarse of the eutectic Si [22]; SEM images of etched microstructures of the Al-Si eutectic [23], (g) unmodified Al-Si alloy; (h) Sr-modified Al-Si alloy.
The transformation of eutectic Si morphology in Al–Si casting alloys from coarse plate-like to fine fibrous networks can be achieved by trace addition of Sr the alloy. To further explain the process of Sr-modification, Timpel et al investigated the distribution of Sr in two ways [24]: in nanometre resolution by transmission electron microscopy (TEM) and in atomic resolution by atom probe tomography (APT). The two methods showed that within the eutectic Si phase, there is Sr co-segregation with Al and Si. Two kinds of segregations, type I and type II, were identified:
\nType I segregation is a nanometre-thin rod-like, accountable for the formation of numerous twins in a Si crystal and facilitate its development in various crystallographic directions.
Type II segregations are more stretched structures that impede the growth of a Si crystal and regulate its branching.
This study agrees with earlier studies of modification mechanisms, which hinged the modification on growth restriction of eutectic Si phase and impurity induced twinning [11, 25]. Figure 8 shows the optical micrographs of Al–10%Si–0.1Fe alloy for unmodified alloy and 200 ppm Sr-modified alloy.
\nOptical micrographs of Al–10%Si–0.1Fe alloy [24]: (a) and (b) unmodified alloy; (c) and (d) alloy modified by 200 ppm Sr.
Atom probe tomography analysis and TEM images of Al and Si interface are presented in Figures 9 and 10 respectively. The ATP data set does not contain crystallographic information. Therefore, TEM is used to obtain such information with a spotlight on the structural and compositional characteristics of the eutectic Si phase.
\nAPT analysis of eutectic Al–Si interface of Al–10%Si–0.1%Fe alloy of 200 ppm Sr-modified; (a) iso-density surface; (b) representation of 0.17 Sr atoms/nm3 in both co-segregations; (c) concentrations of Al, Si and Sr in proxigram, which depend on the distance to the Si/Sr–Al–Si co-segregation interface in (a) and (b) [24].
TEM images of eutectic Al–Sr interface of Al–10%Si–0.1%Fe alloy of 200 ppm Sr-modified. (a) Visible internal boundary of eutectic Si phase, along a {1 1 1} plane; (b) bright field scanning transmission electron microscopy (BF-STEM) image of the enlarged rectangular mark; (c) high angle annular dark field (HAADF) image of the enlarged rectangular mark; (d) and (e) energy disperse X-ray spectroscopy (EDX) mapping of Sr and Al [24].
In another study, hypoeutectic Al-Si alloys containing two levels of Fe (0.5 and 1.1 wt.%) and modifier (Sr) in the range of 30–500 ppm, were investigated. Significant reduction in the number of eutectic grains and the formation of polygonal-shaped Al2Si2Sr intermetallic were observed in excess addition (100 ppm) of Sr. TEM examination showed that the Al2Si2Sr phase is bounded by the P-rich particles, and this infers poisoning or deactivation of nuclei for the Al-Si eutectic. The poisoning is due to the formation of Al2Si2Sr phase about the particles. Further reduction in the number of eutectic Al-Si nucleation actions was recorded at 1.1 wt.% Fe due to the formation of pre-eutectic, β-Al5FeSi platelets.
\nThere is the difference in the nucleation temperatures between unmodified and Sr-modified Al-10%Si alloys. In the Sr-modified alloy, the eutectic-nucleation temperature is depressed with minimum occurrence before recalescence and growth temperature. Figure 11 shows unmodified and Sr-modified Al-10%Si alloys of low Fe (0.5 wt.%) and high Fe (1.1 wt.%) cooling curves recorded during solidification, respectively. Considering the curves, Ta is α-Al nucleation temperature; Tb is β-Al5FeSi nucleation temperature; and TN is Al-Si eutectic nucleation temperature.
\nCooling curves during solidification of Al-10Si alloys in the unmodified and Sr-modified conditions containing (a) low Fe (0.5 wt.%); (b) high Fe (1.1 wt.%) [18].
Addition of Sb produces a refined flake-like eutectic structure, unlike Sr or Na-modified alloys, which result in a fibrous structure. Sb remains a permanent constituent of the alloy, unlike Sr and Na, which fade away with time. Because of this, the supplier adds it to the foundry ingot. The ultimate tensile strength of unheated treated alloy, AlSi6Cu4, was improved from 5 to 10% by increasing the addition of Sb from 1000 to 2500 ppm to the alloy respectively [26]. The Sb-modification decreases the size of grain but increases the number. The maximum size of unmodified Al-Si alloy grain is about 220 μm. The size of the eutectic grain is reduced from 156 μm (0 ppm Sb) to 84 μm (1000 ppm Sb) by Sb-modification. Antimony, Sb, is widely used in Japan and Europe and commonly called permanent modifier. Its addition to molten Al-Si alloy is straightforward, as it does not require any special set up, and once it is added, it becomes a permanent part of the alloy. The use of Sb as a modifier has merits such as insensitive to re-gassing; it does not fade; and is appropriate for components that are susceptible to porosity formation. However, Sb-modification has the following drawbacks: Sb reacts and reduces the effectiveness of Sr and Na; Sb may react with hydrogen dissolved in the metal and forms a stabile gas, a toxic material; may cause the slower solidifying regions of casting poor mechanical properties; and Sb is least effective, as lowest level of transformation is achieved compared to Sr and Na [20, 27].
\nDespite many years of application, Na and Sr modification and its influence on the gas content of Al-Si alloy melts are still being contested by researchers. Several studies declare that Sr-modification has no effect on the alloy’s hydrogen content [28, 29]. The measured hydrogen content in a melt after 0.03% Sr addition, using Al-90% Sr master alloy, to a non-degassed A356 melt at 710°C, is shown in Figure 12. Others claim that Sr-modification levels addition above 0.10–0.12% causes gas porosity [30–32]. Porosity formation in alloys during solidification is a major challenge for casting industry due to its negative effect on total elongation and fatigue performance. Jahromi et al. reported that 0.013% Sr and 0.1% Sb were found to be the optimum additions to modified A356 alloy to fibrous structure in a sand casting. More porosity developed in Sr-modified than Sb-modified [29]. Denton and Spittle reported that hydrogen content of Al-Si alloys increased significantly in the addition of Sr to Al-Si melts, at elevated temperatures [33].
\nEffect of addition of 0.03% Sr to a non-degassed A356 melt at 710°C [22].
Coarse columnar grain structures are developed by Al-Si cast alloys under normal casting conditions. But these structures can be transformed into fine grain structures and uniform distribution in the alloy by mechanical modification and through rapid cooling. Rapid cooling results in a fine dendritic structure in the alloy [34, 35]. Large dendritic structure is due to undercooling during solidification. Rate of cooling affects the size of critical nuclei, and subsequently, the effective number of nuclei that will ultimately produce fine-grained structures.
\nCooling rate can be expressed by this relation:
\nwhere d—secondary dendrite arms spacing, SDAS, (μm); C and n—are constants; and v—cooling rate (°K/s).
\nThe local solidification times (tf) can be calculated in terms of SDAS measurements through the following expression [36]:
\nwhere Γsl—Gibbs-Thomson coefficient; Dl—diffusion coefficient in liquid; ml—liquidus curve slope; k0—coefficient of partition; Ceut and C0—are the eutectic composition and the initial alloy concentration respectively.
\nThe removal of superheat and latent heat from a liquid at a cooling rate of 102–106 K/s to form solid is called rapid solidification. To accomplish this, there are certain conditions that must be satisfied [37]. There should be impressive:
\nHigh undercooling before solidification occurs
High solidification front speed during continuous solidification
Rapid cooling during solidification
Duwez and his team at the California Institute of Technology developed an innovative method in 1960 to increase solid solubility and to yield metastable crystalline in some simple binary eutectic alloy structures [38]. A similar process was performed earlier by a Russian researcher, Salli, in 1958 [7]. In their modification technique, a gun was applied to deposit a small droplet of molten metal, at high velocity, on a freezing surface. This resulted in the formation of an irregular solidified splat of metal. The estimated cooling rate range of the process reported was 105 to 106 K/s as against the conventional cooling rate of 102 K/s or less. Other metal rapid quenching systems, with varied solidification effects, have been introduced since the development of fast cooling by Duwez. However, the common principal aims of these systems are to: increase solid solubility limits; decrease grain size; create metastable crystalline phases; form metallic glasses; and increase chemical homogeneity. Recent studies have shown that rapid cooling systems such as atomisation, melt spinning and splat quenching are effective in the modification of Si phase in Al-Si alloys. In an investigative study, the microstructure and mechanical properties of A356 alloy prepared from a copper mould cooled by a phase-transition medium [34]. The study reported that a cooling rate of 102 K/s was obtained using this method and this method was described as a fast-cooling technology. The study indicated that:
\nVariation in the quantity of cooling medium controlled the cooling rate to a certain extent.
The primary and SDAS were better refined by this technology compared to the use of conventional casting technique
Increase in cooling rate decreases SDAS while strength and microhardness increase correspondingly.
The studies essentially focused on: characterisation of rapidly solidified Al-Si alloys microstructure; and the determination of retained-Si amount in α-Al by X-ray diffraction methods, which depends on lattice parameter.
\nThere are several quenching fluids (quenchants) used in the quenching of high strength Al-Si alloys. There is no an ideal all-purpose quenchant, their applications depend on some factors such as composition, cast thickness, etc. Quenchants that are commonly used for different aluminium alloys are water spray, cold water immersion, hot water immersion, air blast, still air, glycols/polymers, fast quenching oil, liquid nitrogen and brine solutions [39]. Water is the most common quenchant, with the advantages of being cheap, readily available and providing the fast cooling rate needed to produce the required properties. Furthermore, the temperature of water can be altered to produce a wide range of quenching characteristics. Boiling water is used in many aluminium alloys quenching operations due to sufficient cooling rate. Colder water or polymers may be used in the case of premium property requirements, such as in A357 and A201 castings alloys [40].
\nIn 2014, Abdulazeez et al. observed that microhardness of Al-Si-Mg alloys is affected by quenchants differently [41]. Water quenching was said to give higher microhardness compared to polymers. This was attributed to faster cooling rate, restraining elements from solid solution (α-Al) diffusion and grain boundary precipitation by water. The generally acceptable water quenching temperatures ranges for various aluminium alloys are presented in Table 2.
\nType | \nAlloy/temper | \nWater temperature (°C)\n | \n|||
---|---|---|---|---|---|
21–32 | \n54–65.6 | \n60–71 | \n65.6–100 | \n||
Casting | \nC355 | \n\n | ✓ | \n\n | \n |
A356 | \n\n | ✓ | \n\n | \n | |
AA356 premium | \n✓ | \n✓ | \n\n | \n | |
AA357 premium | \n✓ | \n\n | \n | \n | |
AA201 | \n✓ | \n\n | \n | \n |
Normal water quenching temperatures for some aluminium casting alloys.
In the heat treatment sequence, quenching is the next vital process, and its purposes are as follows: to suppress precipitation; to preserve the maximum amount of hardening elements precipitates in solution to develop a supersaturated solid solution at low temperatures; and to confine several vacancies [42]. Quench rate limit is 4°C/s, above this, the yield strength increases slowly. To maximise vacancy confinement concentration and minimise part deformation after quenching, optimal quenching rate is required. A slow quenching rate reduces residual distortion and stresses in parts, but it causes harmful effects such as precipitation during quenching; reduction in grain boundaries; increase tendencies for corrosion; localised over-ageing and leads to a response to ageing treatment reduction. Optimal cooling rate should be established, and the optimum combination of ductility and strength depends on rapid cooling.
\nModification of Al-Si alloy can as well be achieved through the use of mechanical techniques, such as centrifuge, sonic and ultrasonic vibration, squeezing, etc. These mechanical means have been identified to cause grain refinement, density increase, shrinkage, degassing, change size, shape and distribution of the second phase [43, 44]. Refinement is produced through some mechanical means of breaking up newly developed dendrites, as in case of semisolid-metal (SSM) casting technique. The size, distribution and morphology of α-Al particles govern die filling, and subsequently, control the ability to produce thin wall castings.
\nRefinement of primary austenite structure was achieved by Chernov in 1868 by applying vibration during solidification [45]. Since then, several other researchers have investigated and applied the beneficial effects of vibration energy to treat many alloys of aluminium, zinc, brass, etc. during solidification [46, 47]. Vibration influences the structure of a solidifying alloy by suppressing the growth of columnar and the formation of equiaxed grains. The effect of vibration on unmodified and Na-modified alloy has been reported. A schematic of a mould mounted on the vibrator or shaker is shown in Figure 13.
\nSchematic of mould assembly mounted on the vibrator.
These beneficial effects include nucleation promotion, which reduces as-cast grain size; decreases shrinkage porosities; and stimulates the formation of a more homogeneous metal structure with cracking susceptibility decrease. Therefore, due to vibration, alterations occur to the morphologies and dispersion of eutectic and dendritic phases in the microstructure. Pillar’s study revealed that eutectic Si of unmodified Al-Si alloys was modified by vibration at a frequency of 12 Hz and amplitude of 10 mm [48]. Contrarily, it was found that vibration coarsened the eutectic Si in Na-modified Al-Si alloys and this was attributed to fine eutectic Si agglomeration. Abu-Dheir et al. observed that at constant frequency of 100 Hz and varying amplitude resulted in different degree of breakup of the dendrites and eutectic Si phase [49]. Micrographs of Al-12.5% Si castings of without vibration and with vibration at 100 Hz are shown in Figure 14.
\nMicrographs of Al-12.5% Si castings (a) casting without vibration; (b) with vibration at 100 Hz and 18 μm; (c) with vibration at 100 Hz and 149 μm; (d) with vibration at 100 Hz and 199 μm [49].
It was seen in the optical micrographs that degree of fragmentation is a function of the amplitude, which shows proportionality. However, the study indicated that there is a limit of amplitude above which the size of fragmented dendrites and eutectic Si start to form coarse flakes due to agglomeration. The microstructural characteristics of Al–12.5% Si casting without and with vibration at constant frequency (100 Hz) and varying amplitude are presented in Table 3.
\nCasting condition | \nLamellar spacing (μm) | \nSi flake length (μm) | \nNotes | \n
---|---|---|---|
No vibration | \n2.5 | \n27 | \nSi cuboids, large dendrites | \n
18 μm | \n2 | \n15 | \nBroken dendrites | \n
49 μm | \n2.77 | \n31 | \nRefined broken dendrites | \n
149 μm | \nN/A | \nN/A | \nFibrous Si observed | \n
199 μm | \n1.5 | \n10.5 | \nCoarse Si flakes | \n
Microstructural characteristics of Al–12.5% Si casting without and with vibration at constant frequency (100 Hz) and varying amplitude [49].
There are different methods of applying vibration. Electromagnetic vibration is one of the non-contact methods used to generate vibration in the solidifying alloy. The vibration is produced by using an orthogonal static magnet and alternating electric fields [50]. It was observed that the collapse of the cavities created by this method was accountable for the refinement of the microstructure for Al–7% Si and Al–17% Si [51].
\nCentrifugal casting technique (CCT) is a casting production process that involves rotation of a mould during pouring and solidification of the casting. The schematic in Figure 15 shows the forms and the major components of a centrifugal casting machine [52].
\nClassification of centrifugal casting methods [52]. (a) horizontal true centrifugal casting process; (b) horizontal inclined centrifugal casting process; (c) vertical true centrifugal casting process; (d) semi vertical centrifugal casting process; (e) vertical inclined centrifugal casting process.
The attributes of material depend not only on the composition chemistry but also on the morphologies and distribution of the microstructural features present in the microstructure. These microstructural features include the primary and eutectic Si phases, α-Al dendritic and intermetallics. Low solidification rate results in large flakes of Si, large dendritic cells and large inter-dendrite arm spacing of α-aluminium dendrites. Centrifugal casting process increases cooling rate and consequently, produces small dendritic cells, small inter-dendrite arm spacing and small flakes of Si. Alloys of Al-Si by CCT are morphologically transformed from acicular to fibrous [52]. Micrographs of A390-5%Mg alloy as-cast fabricated by gravity casting and CCT are shown in Figure 16.
\nMicrographs of A390-5%Mg alloy as-cast (a) by gravity casting and (b) by CCT.
Speed of rotation is a parameter that controls the rate at which centrifugal casting process affects cooling. Some studies have reported that mould rotational speed range of 1200–1500 RPM as the optimum [53] and other relevant processing parameters are pre-heating and pouring temperatures [52]. The effect of CCT on casting can be classified into three: centrifugal pressure, inherent vibration of the process and fluid dynamics.
\nComponents made of materials in their natural forms often do not satisfactorily meet functional requirements, due to harsh and extreme working environments. Scientists and engineers have continuously modified these natural occurring materials, using different production processes, to suit their harsh working environments. Material’s mechanical, physical and chemical properties depend on the size, morphology and dispersion of the constituents of the microstructure of the material. Aluminium is one of such natural materials that have evolved into several alloys and composites. The mechanical properties of aluminium-based alloys and composites have further been improved by microstructural alteration processes, termed as modification processes. These modification techniques can be classified into three:
\nChemical modification processes; addition of a calculated amount of nucleation agents
Mechanical modification processes; ultrasonic, squeeze, stirring, centrifugal, and vibration methods
Thermal modification process; superheating, quench and cooling
Chemical modification, which is the addition of trace levels of certain elements, such as Na, Sr and Sb, into aluminium alloys, is most effective. However, optimal modification occurs when thermal modification process is combined with chemical or mechanical process.
\nSinusitis is swelling or an inflammation of the tissue lining of the sinuses. Sinuses are hollow cavities anatomically located within the cheekbone, around the eyes and behind the nose. Physiologically sinuses are filled with air and contain mucous which helps in moisten, warm and filter the inhaled air. Pathophysiologically, when the sinuses get blocked by the mucous, viruses and bacteria can grow and cause infection in sinuses [1].
There are basis four types of sinusitis or rhino sinusitis.
Sudden onset with cold-like symptoms (runny and stuffy nose, fever, facial pain). It may last for 2–4 weeks.
It is usually the continuation of acute sinusitis which may last up to 12 weeks.
It happens several times per year. Four or more episodes of acute sinusitis for 7 days in 1 year of period.
Persistent symptoms of sinusitis for 12 weeks or longer [1].
Sinusitis is the inflammation of facial sinuses. Different factors may contribute in sinusitis. Sinusitis may develop by the combination of environmental and host factors. Acute sinusitis is more common in occurrence as compared to chronic sinusitis. High prevalence of sinusitis is in the Midwest, south and among women. Sinusitis more often affects children younger than 15 years of age and adults 25–64 years of age. Common cause of sinusitis is viruses and mostly they are self-limiting. About 90% of the population who get cold also have viral sinusitis. Not only patients suffering with cold have sinusitis elements but atopic patients may also develop sinusitis. Risk factors causing sinusitis are viruses, bacteria, fungi, allergens, irritants (dander, polluted air, smoke, dust mites) [2].
Other risk factors for sinusitis may involve: anatomic defects such as septal deviations, polyps, conchae bullosa, other trauma and fractures involving the sinuses or the facial area surrounding them. Rhinitis medicamentosa, toxic rhinitis, nasal cocaine abuse, barotrauma, foreign bodies. Patients with nasogastric or nasotracheal tubes. Body positioning, intensive care unit (ICU) patients due to prolonged supine positioning that compromises muco-ciliary clearance. Impaired mucous transport from diseases such as cystic fibrosis, ciliary dyskinesia. Immunodeficiency from chemotherapy, HIV, diabetes mellitus, etc. Prolonged oxygen use due to drying of mucosal lining [3].
Histopathology is the examination of pathological condition of tissues. Histopathology of respiratory track reveals incidents 1% of viruses, 3% Streptococcus pneumoniae, 6% anaerobes, 2% Streptococcus pyogenes, 2% Moraxella, 21% Haemophilus influenza 21%, anaerobes and 4% Staphylococcus aureus. In case of chronic sinusitis 20% S. aureus, 20%, 4% S. pneumoniae, 3% anaerobes, 16% multiple organisms. About 2–7% are fungal incidences in which most common is Aspergillus seen in immunocompromised patients [4].
There are four sinuses in the facial area around the nose i.e. frontal sinus, maxillary sinus, sphenoid sinus and ethmoid sinus. Most commonly sinusitis develops by the attack of viruses on the upper respiratory track followed by edema and inflammation of nasal lining. This inflammation leads to thick mucus production that obstructs the paranasal sinuses due to which immunity is disturbed and bacterial infection appear at once. Allergic rhinitis may proceed in to sinusitis due to ostial obstruction. Cilia get immobilized due to heavy nasal mucous discharge which further block the drainage. That give the opportunity to the bacteria to enter into sinuses by coughing or by nose blowing. Bacterial sinusitis develop after the viral attack on the upper respiratory track, symptoms of sino nasal disease may get worse in 5 days or become persistent in 10 days [5].
Major symptoms shown by sinusitis patients are pain or pressure on face, nasal obstruction, hyposmia, nasal and post nasal purulence, facial congestion and fullness, fever. Minor symptoms of sino nasal disease include malaise, headache, cough, dental pain, headache, halitosis, otalgia, fatigue [6, 7].
Physical examination is performed after the topical decongestant.
Physical examination include looking for the facial swelling, looking for the periorbital edema, post nasal drip, cervical adenopathy and pharyngitis.
Anterior rhinoscopy shows mucous crusting, obstructive polyps, mucosal edema, frank purulence and other anatomical defects.
Press the forehead and cheeks for deep tenderness.
Transillumination of the sinuses are also performed.
Five important predicators of sinusitis include 1. Abnormal sinus transillumination, 2. Maxillary dental pain, 3. Colored nasal discharge, 4. Poor response to nasal decongestants and anti-histamines, 5. Mucopurulent seen on examination.
Overall examination of the patient is more valid then to observe single parameter to confirm the sinusitis [8].
For the acute sinusitis no laboratory tests are recommended in emergency departments because for the acute sinusitis diagnosis is clinically. For the diagnosis of maxillary, frontal, sphenoid sinusitis plain sinus X-ray is most accurate. In contrast plain X-ray is not suitable for the evaluation of ostiomeatal complex or anterior ethmoid cells, which are the originating cell for sino nasal diseases. Positive lab test on plain films for sinusitis shows air-fluid levels, mucosal thickening of 6 mm or even more, sinus opacity. The choice of diagnostic test for sinusitis is the coronal CT at a thickness of 3–4 mm. Clinical findings of CT are sinus wall displacement, air-fluid levels, sinus opacification, 4 mm or more mucosal thickening. For the chronic bacterial and fungal sinusitis choice of diagnostic test is culture and biopsy [9].
Most of the time rhinitis or upper respiratory tract infection are mistakenly diagnose as sinusitis. Maxillary toothache can also be mistaken as pain appeared in maxillary sinusitis. Besides this vascular headache, tension headache, epidural abscesses, brain abscesses, subdural empyema, meningitis and foreign bodies are also madly mistaken as sinusitis [10].
Sinusitis may spread to the soft tissues of eye orbits, face and bones. Due to the malignancy periorbital cellulitis, facial cellulitis, blindness and orbital abscess may develop. Sinusitis can breach into the brain and cause intra cranial disorders such as meningitis, epidural or subdural empyema and cavernous sinus thrombosis [11].
Treatment for sinusitis include, nasal wash, decongestants, humidification, nasal sprays, corticosteroids, antibiotics and nasal surgery [12].
Saline nasal wash are in the form of nasal sprays or nasal solutions, which are intended to rinse away allergens and irritants and also to reduce drainage [13].
Topical as well as systemic nasal decongestants can be used such as pseudoephedrine. Caution should be taken in using decongestants. Oxymetazoline should not be used for more than 3 days as it causes rebound congestion. Oral decongestants should be used with special care in hypertensive patients [14].
Nasal corticosteroids help in reduction and treatment of inflammation. Nasal corticosteroid sprays include beclomethasone, fluticasone, budesonide, mometasone, and triamcinolone. Topical nasal sprays effectively treat mucosal edema but they are more effective in chronic sinusitis [15].
These corticosteroids are used in severe inflammation especially if patient is suffering from nasal polyps. Oral corticosteroids have serious side effects when used for long term so, it should be used only to treat severe symptoms [16].
Antibiotics are given in case of bacterial sinusitis. In case of bacterial infection amoxicillin or amoxicillin-clavulanate for 10–14 days is the first line treatment. Trimethoprim-sulfamethoxazole is effective for some population but there is high rate of resistance. If symptoms do not resolve in 7 days then broader spectrum agents are used such as augmentin, axetil, cefuroxime, second or third generation cephalosporins, fluoroquinolones and clindamycin. For anaerobic bacterial infection metronidazole can also add in the therapy [17].
If patient is sensitize to the aspirin and may develop sinusitis then under medical supervision gradually larger doses are given to patient to increase the tolerance of aspirin.
Patients who are sensitive to allergens and these allergens may contribute to sinusitis. Immunotherapy is suggested to those individuals. Which help to reduce the body reaction against specific allergens.
If the medications are not effective in treatment of sinusitis then endoscopic sinus surgery would be an option. In this surgery endoscope is used to explore sinuses. Depending upon the obstruction source different instruments might be used to remove mucous or to scrap polyps [18].
Atopy is the development of allergic hypersensitive reactions or IgE-mediated reactions. Atopic patients may develop genetic allergic diseases such as asthma, rhinitis, and atopic dermatitis. Atopy usually associated with the inhaled or food allergens. Topical corticosteroids are the major steroids used for atopy over 40 years. Among steroids hydrocortisone is the first to be used.
Acute atopic attack is treated by medium to high strength topical steroid for upto 2 weeks. These steroids should not be used for face and neck area because of side effects. Ointment should be apply within 5 min of twice daily bathing. Patients may also suffer from side effects such as atrophy, hypopigmentation, thinning of skin. Generally more potent steroids have more side effects.
The use of systematic steroid is under controversy for acute atopy. Most of the prescribers do not prescribe systematic steroids for acute atopy. For severe cases oral prednisone at usual dose of 20 mg/day for 7 days are used. But after discontinuation of the medicine, disease relapses quickly [19].
Patients with acute sinusitis are treated effectively as outpatient with better prediction of disease. Whereas, severe sinusitis of sphenoid and frontal area associated with air and fluid accumulation require I/V injection of antibiotics and keep under care in hospital. High mortality and morbidity rates are associated with fungal sinusitis. Immunocompromised patients should also get hospitalized [20].
Acute sinusitis often begins with the symptoms of common cold. These symptoms may fade away in less than 4 weeks but if symptoms persist for more than 12 weeks despite of proper medical treatment then acute sinusitis is converted into chronic sinusitis. In chronic sinusitis airways get severely inflamed with either bacterial or viral infection, which leads to the development of asthma. Which is known as sinusitis related asthma [21, 22].
Asthma is a chronic disorder that involves airflow obstruction, an underlying inflammation and bronchial hyper responsiveness. Asthma is complicated disorder that not only involves larger airways but also small airways. Sino nasal disorders are most commonly diagnosed with the asthma. For centuries the continuous existence of these pathological conditions has been known. However the link between upper airways and lower airways has been not clearly understood. Rhinitis and sinusitis are two wide spectrum disorders agonizing the upper airways which are closely related to asthma [23].
Allergic rhinitis and sinusitis are one of the risk factor for asthma. Inherited differences in asthma prevalence, asthma attacks, constructive and appropriate asthma management, thorough education and regular visit to medical health care of patients with asthma associated with sinusitis and rhinitis may lead to effectively control of asthma and also reduce the risk factor for more prevalence.
Clinical trials on the sino nasal pathological conditions has been conducted and it was reported that sinusitis and allergic rhinitis of childhood was severely associated with asthma among them 42% of the patients had asthma with sinusitis whereas 12.9% of the patients only suffered with asthma. Before the age of 7 years if sinusitis is present then it would subsequently lead to asthma. If the sinusitis or allergic rhinitis occurred at the age of seven then the chances of developing asthma increases three fold. The term “The Allergic March” is used to show the progression of the disease from the nose and sinuses to the airways of the lungs [24].
The progression of sino nasal allergic march may proceed before the development of sinusitis. In children and infants atopic eczema may leads to sinusitis and subsequently to asthma. Comparatively in infants with non-atopic eczema, no sinusitis would develop. This confirms that eczema is risk factor for the development of sinusitis and asthma as well. Which further strengthen the concept of an “Allergic March” that sinusitis, allergic rhinitis and asthma are different diseases but still the progressively enhance by allergy [25]. The effect of the first line treatment for eczema on the progression and development of sinusitis is still unknown in patients with sino nasal disorder. Clinical trials have shown that smoking increased three folds the risk of asthma in patients already having sinusitis. Recent publications have shown that obesity is also one of the risk factor for asthma however obesity is not involved in sino nasal disorders as both obesity related asthma and sinusitis related asthma follows different pathway and mechanism [26].
These clinical trials and studies verify that the sinusitis and allergic rhinitis are contributing factors in asthma progression. If sinusitis can be intervene than the development of asthma can be prevented. Another important environmental factor that is smoking elevate asthma can be controlled by quitting tobacco [27] (Figure 1).
Risk factors for the development of sinusitis and rhinitis which leads toward asthma.
Sino nasal disease may appear differently in asthmatics then that of general population. Literature survey showed that the patients showing nasal symptoms and undergo to examine the clinical feature of lower airway disease then it is found that most of the patients suffering with the chronic sinusitis and allergic rhinitis along with asthma as compared to non-allergic rhinitis. Asthmatic patients associated with sinusitis progress to nasal polyps and are in much complications of sino nasal disease comparing to non-asthmatics. Sinusitis related asthmatics have more severe and persistent disease and they need multiple of surgeries as well [28].
Studies revealed that sinusitis may develop asthma progressively but there is a difference in between sinusitis related asthma and general population. This is strongly supported by data.
In asthmatics upper air way disease appear differently as compared to general population.
Inflammation in upper and lower air ways in both population would be alike.
Increasing severity in the upper air ways going parallel to the severity in lower air ways [29, 30].
In asthmatic patients the inflammation in nose and sinuses shows there is disease in the lungs. For instance if patient having nasal polyposis inflammation its clinical identification feature shows antibody IgE production and eosinophilic inflammation. Common inflammatory mediators are release from upper and lower air ways, due to which it is difficult to assess pathways that cause Sino nasal inflammation in asthmatics and non-asthmatics [31]. Further clinical studies have performed in which gene expression of patient with sinus mucosa polyposis and aspirin sensitive asthma was compared with chronic sinusitis and no difference in gene expression was found. Further clinical studies on gene assays that is based on testing of lower air way helps us to understand how sinusitis is different in asthma patient than non-asthmatics [26].
From the literature review it is noted that increase in severity of sino nasal disease goes parallel with the lower airways. Recent publication shows that patients having severe sinusitis have severe asthma series. This study suggests that sinusitis, rhinitis and asthma all are common progression of a single systematic disease [32]. Which ids further confirm by more clinical research in which severity in inflammation of lungs is same as in sinuses, nose and systematic inflammation which is measured by circulating eosinophilia, hence the severity in sinusitis or sino nasal disease is parallel to asthma and also same implies that lymphocyte and eosinophil are characteristic feature of upper and lower air way inflammation if upper air way go worse than lower air way also get affected in same way [33] (Figure 2).
Physiological relation between upper and lower air way: Inflammation in upper air way (nose, sinuses) develop with parallel to lower air way (lungs) in asthmatic patients.
Sino nasal disorders may increase the risk of lower air way (lungs) diseases which can be seen from the clinical studies. It has been shown that children suffering from allergic asthma and allergic rhinitis due to the dust mites, in that patients there was increased exhalation of nitric oxide was found [34]. Studies have also shown that in patients with allergic asthma allergens can develop the release of eosinophils from bone marrow which shows that sinusitis, rhinitis and asthma could be separate diseases but affected by single systematic disease [35].
Sino nasal disorders are linked with asthma is supported by the clinical research studies i.e. non asthmatic patients with allergic rhinitis have inflammation and abnormalities in lower airway. This is further supported by the fact that allergic rhinitis have an increase prevalence for the hyper bronchial activity. Another study showed that sinusitis and allergic rhinitis are associated with impaired lung functions which are significantly related to duration and exposure of sino nasal disorder to the risk factors. These findings suggest that patients with sinusitis and allergic rhinitis may have subclinical abnormalities of their intra thoracic airways and may be at risk of developing the clinical disease of asthma [36, 37] (Figure 3).
Progressive gradation of sino nasal disease.
Asthma control appears worse in individuals having sino nasal disorder. Recent cross sectional, retrospective and prospective studies between the asthma symptoms and sinusitis symptoms have performed. These studies suggested that severity in sino nasal disorders increase the severity of asthma symptoms [36].
Important parameters for the treatment outcome include 1. Early treatment of the patient suffering with sino nasal disease to prevent asthma. 2. Treatment regimen should be as effective as to treat asthma symptoms along with sinusitis and rhinitis [38].
Clinical trials are performed on 147 children treated with specific subcutaneous immunotherapy for rhinoconjuctivitis, showed that most of the children do not progress to asthma. Recently study was published in which patients treated with antihistamine and nasal corticosteroids for the treatment of allergic rhinitis and airflow obstruction investigated by FEF25–75. It was shown that air flow obstruction was treated with in 3 months [39]. Over the decades there has been much interest in finding out and establishing treatment for the sino nasal disorder which may affect the asthma. However studies were performed among which prospective study was disappointing and retrospective study was suggested that by treating sinusitis and rhinitis asthma can be prevented from progression [40, 41]. From the previous trials it was believed that by treating nasal diseases lower air way abnormalities can be controlled which can decrease systemic eosinophilic inflammation. But in the recent trials it was seen that treatment of rhinitis do not affect the lower air way inflammation in any way which was investigated by measuring exhaled (nitric oxide) NO [42]. In these double blinded systemic controlled trials almost 40 children were subjected to treat with nasal steroids along with placebo. The results of the trials suggested that sino nasal inflammation and systemic inflammation was treated, which were investigated by counting eosinophilic cationic protein but unfortunately there was no effect on lower air way inflammation (measured by exhaled by NO). These randomized trials were contraindicated with the previous trials which were carried on the adults. According to previous trials on adults lower air way inflammation was affected by measuring exhaled NO which was decreased by treating with nasal steroids. These results suggested that the effect of nasal treatment to control asthma or lower air way inflammation may vary in different patients sub groups. Not only this but also, studies have suggested that surgical treatment of nasal disease may also help in managing asthma outbreak. Despite of these clinical trials still there is a need to determine how well sino nasal treatment can help in reduction of asthma. Investigation of the patients who may have benefit from the treatment of nasal disease [42, 43].
Headache is a symptom produced by the nervous system in response to disturbance or any threat. Hence it is the physiologically protective symptom of nervous system. About 90% are the life time incidents of the headache [44]. Headache may be primary or secondary as well, depending upon the underlying cause of the pain. When no definite pathological cause is identified then the headache is considered as primary headache syndrome. The most common primary headache disorders are migraine, tension type headache, cluster headache and probable migraine. When the cause of headache can be definable under pathological conditions, this type of headache is known as secondary headache. Causes of secondary headache include neoplastic, immunologic, metabolic, infectious, traumatic, inflammatory, endocrinologic and sinusitis [45]. Patients visited to the otolaryngologist because of their chronic headache, it is difficult to diagnose depending on the patients’ presentation whether the headache is because of sinusitis or may be the other reason. Endoscopic techniques have been well developed for the diagnosis of underlying diseases and their associated symptoms. Sinus headaches are headache in which individual may feel pain and pressure around his eyes, cheeks and forehead. Due to differential diagnosis sometimes migraine and tension headaches may mistakenly consider as sinus headache [46, 47].
Sinus headaches are mostly associated with other chronic secondary headaches. It may cause pain and pressure around facial area and in sinuses and progress the sino nasal disorders. Sinus headaches are not related with the sinus infections therefore they should not be treated with antibiotics. Sinus headaches may affect any individual but they are more prone to those patients who have family history or even previous history of migraine or primary headache disorders. It also affects those patients who have sinusitis and they also suffered with headaches related with hormonal changes [48].
Symptoms of sinus headache exclusive of causes may include pressure, pain and tension around eyes cheeks and forehead, stuffy filled nose, fatigue, fever, pain may worsen upon bending forward or even lie down and pain sensations in upper jaw and teeth [49].
Headache is pathological disorder of nervous system and it is difficult to diagnose the exact cause of headache. After physical examination medical practitioner may perform imaging diagnostic test to find out the real cause of headache. Imaging tests include:
Cross sectional images of brain, spinal cord and sinuses are obtained by X-ray which rotates around the body and displayed on the computer.
Cross sectional images of the brain and sinuses are made with magnetic field and radio waves.
These tests are used to diagnose the headache. If sinuses are stuffy filled and inflamed than the sinusitis is the definite cause of headache [50].
Precautions help in reducing the severity and attacks of headache. Healthy life style changes may prevent from headache other than using medications.
Regular aerobic exercise helps in reduction of tension and prevention of headache. Aerobic exercises include swimming, cycling and walking. Before starting intense exercise one should warm up his body because sudden exercise also initiate headache. One of the causes of headache is obesity, in that case obese patients need to exercise daily in order to reduce headache [51].
If any odor, taste, food and even caffeine, tobacco triggered headache in the past so, one should avoid trigger factors and establish healthy daily routine with regular sleep of at least 8 h, try to reduce stress and take healthy diet.
Women who are taking medications such as birth control pills and hormonal replacement therapy have episodes of headache and estrogen seems to make it worse. Ask your doctor to reduce the dose or to prescribe alternate therapy [52].
Most of the time migraine and chronic headaches are assumed as sinusitis headache. These type of headaches are treated with prescribed medicine on regular basis or to take medicine in order to prevent onset of headache.
Chronic headaches can be treated with over the counter pain relievers such as acetaminophen, naproxen and ibuprofen.
Triptans are most effective in treating migraine headaches. Triptans include sumatriptan, almotriptan, frovatriptan, naratriptan and eletriptan. They are available in form of nasal sprays, tablets and injections. Triptans effect by constricting blood vessels and block the pain pathways in the brain.
Ergots containing active constituent ergotamine. It is available in combination with caffeine. Ergotamine is most effective for the pain which lasts more than 72 h but it is less effective than triptans. Migraine related nausea and vomiting may get worse because of ergotamine. Overuse of ergotamine also leads to headache. Dihydroergotamine is comparatively more effective than ergotamine and have fewer side effects [53].
Headaches are mostly associated with nausea and vomiting especially in case of migraine. Anti-emetic medications such as metoclopramide, chlorpromazine and prochlorpromazine are given in combination with other medication to prevent nausea and vomiting.
Sinusitis related headaches and migraine are mostly confused with each other in term of diagnosis because signs and symptoms of both ailments are overlapped each other. In both type of headaches, condition become worse when individual bend forward. However in migraine there are also nasal disorders such nasal congestion, stuffy filled nose with watery discharge and facial pressure. Due to these symptoms migraine is mistakenly taken as sinusitis related headache by 90% of the patients. Whereas in case of sinus headache there is no nausea and vomiting which is usually common in migraine. Duration of sinus related headache is from 7 days or even longer however, migraine may last from hours to 1 or 2 days [56, 57].
Sinusitis is a nasal disorder featured by inflammation of mucosal epithelium of sinuses. Clinical studies have published and trials have been conducted which shows that the sinusitis and rhinitis are the two crucial disorders associated with asthmatics. Sinusitis and asthma follows the same inflammatory pathways and temporal sequence of disease which confirms that their progression is manifested by common nasal disorder. Early prevention and treatment of sinusitis is of great interest I order to prevent the progression of sinusitis into asthma. Sinus headache is also one of the symptoms of the sinusitis. Ninety percent life time incidents of headache are reported. Migraine is some time mistakenly taken as sinus headache. Before treating headache it should be diagnosed clearly whether the cause of headache is primary or secondary. After knowing the sinogenic headache, treatment strategies must be followed. Most of the time sinus related headaches are associated with acute or chronic sinusitis.
I am thank full to the Faculty of Pharmacy, University of Lahore, for being helpful. My deepest gratitude to Nasir Mahmood Pro Rector Academics, UOL for his great support.
No financial support and no other potential conflict of interest.
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She performed research in perioperative autotransfusion and obtained the degree of PhD in 1993 publishing Peri-operative autotransfusion by means of a blood cell separator.\nBlood transfusion had her special interest being the president of the Haemovigilance Chamber TRIP and performing several tasks in local and national blood bank and anticoagulant-blood transfusion guidelines committees. Currently, she is working as an associate professor and up till recently was the dean at the Albert Schweitzer Hospital Dordrecht. She performed (inter)national tasks as vice-president of the Concilium Anaesthesia and related committees. \nShe performed research in several fields, with over 100 publications in (inter)national journals and numerous papers on scientific conferences. \nShe received several awards and is a member of Honour of the Dutch Society of Anaesthesia.",institutionString:null,institution:{name:"Albert Schweitzer Hospital",country:{name:"Gabon"}}},{id:"83089",title:"Prof.",name:"Aaron",middleName:null,surname:"Ojule",slug:"aaron-ojule",fullName:"Aaron Ojule",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Port Harcourt",country:{name:"Nigeria"}}},{id:"295748",title:"Mr.",name:"Abayomi",middleName:null,surname:"Modupe",slug:"abayomi-modupe",fullName:"Abayomi Modupe",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/no_image.jpg",biography:null,institutionString:null,institution:{name:"Landmark University",country:{name:"Nigeria"}}},{id:"94191",title:"Prof.",name:"Abbas",middleName:null,surname:"Moustafa",slug:"abbas-moustafa",fullName:"Abbas Moustafa",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/94191/images/96_n.jpg",biography:"Prof. Moustafa got his doctoral degree in earthquake engineering and structural safety from Indian Institute of Science in 2002. He is currently an associate professor at Department of Civil Engineering, Minia University, Egypt and the chairman of Department of Civil Engineering, High Institute of Engineering and Technology, Giza, Egypt. He is also a consultant engineer and head of structural group at Hamza Associates, Giza, Egypt. Dr. Moustafa was a senior research associate at Vanderbilt University and a JSPS fellow at Kyoto and Nagasaki Universities. He has more than 40 research papers published in international journals and conferences. He acts as an editorial board member and a reviewer for several regional and international journals. His research interest includes earthquake engineering, seismic design, nonlinear dynamics, random vibration, structural reliability, structural health monitoring and uncertainty modeling.",institutionString:null,institution:{name:"Minia University",country:{name:"Egypt"}}},{id:"84562",title:"Dr.",name:"Abbyssinia",middleName:null,surname:"Mushunje",slug:"abbyssinia-mushunje",fullName:"Abbyssinia Mushunje",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"University of Fort Hare",country:{name:"South Africa"}}},{id:"202206",title:"Associate Prof.",name:"Abd Elmoniem",middleName:"Ahmed",surname:"Elzain",slug:"abd-elmoniem-elzain",fullName:"Abd Elmoniem Elzain",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Kassala University",country:{name:"Sudan"}}},{id:"98127",title:"Dr.",name:"Abdallah",middleName:null,surname:"Handoura",slug:"abdallah-handoura",fullName:"Abdallah Handoura",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"École Supérieure des Télécommunications",country:{name:"Morocco"}}},{id:"91404",title:"Prof.",name:"Abdecharif",middleName:null,surname:"Boumaza",slug:"abdecharif-boumaza",fullName:"Abdecharif Boumaza",position:null,profilePictureURL:"//cdnintech.com/web/frontend/www/assets/author.svg",biography:null,institutionString:null,institution:{name:"Abbès Laghrour University of Khenchela",country:{name:"Algeria"}}},{id:"105795",title:"Prof.",name:"Abdel Ghani",middleName:null,surname:"Aissaoui",slug:"abdel-ghani-aissaoui",fullName:"Abdel Ghani Aissaoui",position:null,profilePictureURL:"https://mts.intechopen.com/storage/users/105795/images/system/105795.jpeg",biography:"Abdel Ghani AISSAOUI is a Full Professor of electrical engineering at University of Bechar (ALGERIA). 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El-Hemaly\nProfessor OB/GYN & Urogynecology\nFaculty of medicine, Al-Azhar University \nPersonal Information: \nMarried with two children\nWife: Professor Laila A. Moussa MD.\nSons: Mohamad A. M. El-Hemaly Jr. MD. Died March 25-2007\nMostafa A. M. El-Hemaly, Computer Scientist working at Microsoft Seatle, USA. \nQualifications: \n1.\tM.B.-Bch Cairo Univ. June 1963. \n2.\tDiploma Ob./Gyn. Cairo Univ. April 1966. \n3.\tDiploma Surgery Cairo Univ. Oct. 1966. \n4.\tMRCOG London Feb. 1975. \n5.\tF.R.C.S. Glasgow June 1976. \n6.\tPopulation Study Johns Hopkins 1981. \n7.\tGyn. Oncology Johns Hopkins 1983. \n8.\tAdvanced Laparoscopic Surgery, with Prof. Paulson, Alexandria, Virginia USA 1993. \nSocieties & Associations: \n1.\t Member of the Royal College of Ob./Gyn. London. \n2.\tFellow of the Royal College of Surgeons Glasgow UK. \n3.\tMember of the advisory board on urogyn. FIGO. \n4.\tMember of the New York Academy of Sciences. \n5.\tMember of the American Association for the Advancement of Science. \n6.\tFeatured in �Who is Who in the World� from the 16th edition to the 20th edition. \n7.\tFeatured in �Who is Who in Science and Engineering� in the 7th edition. \n8.\tMember of the Egyptian Fertility & Sterility Society. \n9.\tMember of the Egyptian Society of Ob./Gyn. \n10.\tMember of the Egyptian Society of Urogyn. \n\nScientific Publications & Communications:\n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Asim Kurjak, Ahmad G. Serour, Laila A. S. Mousa, Amr M. Zaied, Khalid Z. El Sheikha. \nImaging the Internal Urethral Sphincter and the Vagina in Normal Women and Women Suffering from Stress Urinary Incontinence and Vaginal Prolapse. Gynaecologia Et Perinatologia, Vol18, No 4; 169-286 October-December 2009.\n2- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nFecal Incontinence, A Novel Concept: The Role of the internal Anal sphincter (IAS) in defecation and fecal incontinence. Gynaecologia Et Perinatologia, Vol19, No 2; 79-85 April -June 2010.\n3- Abdel Karim M. El Hemaly*, Laila A. S. Mousa Ibrahim M. Kandil, Fatma S. El Sokkary, Ahmad G. Serour, Hossam Hussein.\nSurgical Treatment of Stress Urinary Incontinence, Fecal Incontinence and Vaginal Prolapse By A Novel Operation \n"Urethro-Ano-Vaginoplasty"\n Gynaecologia Et Perinatologia, Vol19, No 3; 129-188 July-September 2010.\n4- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n5- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n6- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n7-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n8-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n9-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n10-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n11-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n12- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n13-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n14- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n15-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n\n16-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n17- Abdel Karim M. El Hemaly. Nocturnal Enureses: An Update on the pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecology/?page=/ENHLIDH/PUBD/FEATURES/\nPresentations/ Nocturnal_Enuresis/nocturnal_enuresis\n\n18-Maternal Mortality in Egypt, a cry for help and attention. The Second International Conference of the African Society of Organization & Gestosis, 1998, 3rd Annual International Conference of Ob/Gyn Department � Sohag Faculty of Medicine University. Feb. 11-13. Luxor, Egypt. \n19-Postmenopausal Osteprosis. The 2nd annual conference of Health Insurance Organization on Family Planning and its role in primary health care. Zagaziz, Egypt, February 26-27, 1997, Center of Complementary Services for Maternity and childhood care. \n20-Laparoscopic Assisted vaginal hysterectomy. 10th International Annual Congress Modern Trends in Reproductive Techniques 23-24 March 1995. Alexandria, Egypt. \n21-Immunological Studies in Pre-eclamptic Toxaemia. Proceedings of 10th Annual Ain Shams Medical Congress. Cairo, Egypt, March 6-10, 1987. \n22-Socio-demographic factorse affecting acceptability of the long-acting contraceptive injections in a rural Egyptian community. Journal of Biosocial Science 29:305, 1987. \n23-Plasma fibronectin levels hypertension during pregnancy. The Journal of the Egypt. Soc. of Ob./Gyn. 13:1, 17-21, Jan. 1987. \n24-Effect of smoking on pregnancy. Journal of Egypt. Soc. of Ob./Gyn. 12:3, 111-121, Sept 1986. \n25-Socio-demographic aspects of nausea and vomiting in early pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 35-42, Sept. 1986. \n26-Effect of intrapartum oxygen inhalation on maternofetal blood gases and pH. Journal of the Egypt. Soc. of Ob./Gyn. 12:3, 57-64, Sept. 1986. \n27-The effect of severe pre-eclampsia on serum transaminases. The Egypt. J. Med. Sci. 7(2): 479-485, 1986. \n28-A study of placental immunoreceptors in pre-eclampsia. The Egypt. J. Med. Sci. 7(2): 211-216, 1986. \n29-Serum human placental lactogen (hpl) in normal, toxaemic and diabetic pregnant women, during pregnancy and its relation to the outcome of pregnancy. Journal of the Egypt. Soc. of Ob./Gyn. 12:2, 11-23, May 1986. \n30-Pregnancy specific B1 Glycoprotein and free estriol in the serum of normal, toxaemic and diabetic pregnant women during pregnancy and after delivery. Journal of the Egypt. Soc. of Ob./Gyn. 12:1, 63-70, Jan. 1986. Also was accepted and presented at Xith World Congress of Gynecology and Obstetrics, Berlin (West), September 15-20, 1985. \n31-Pregnancy and labor in women over the age of forty years. Accepted and presented at Al-Azhar International Medical Conference, Cairo 28-31 Dec. 1985. \n32-Effect of Copper T intra-uterine device on cervico-vaginal flora. Int. J. Gynaecol. Obstet. 23:2, 153-156, April 1985. \n33-Factors affecting the occurrence of post-Caesarean section febrile morbidity. Population Sciences, 6, 139-149, 1985. \n34-Pre-eclamptic toxaemia and its relation to H.L.A. system. Population Sciences, 6, 131-139, 1985. \n35-The menstrual pattern and occurrence of pregnancy one year after discontinuation of Depo-medroxy progesterone acetate as a postpartum contraceptive. Population Sciences, 6, 105-111, 1985. \n36-The menstrual pattern and side effects of Depo-medroxy progesterone acetate as postpartum contraceptive. Population Sciences, 6, 97-105, 1985. \n37-Actinomyces in the vaginas of women with and without intrauterine contraceptive devices. Population Sciences, 6, 77-85, 1985. \n38-Comparative efficacy of ibuprofen and etamsylate in the treatment of I.U.D. menorrhagia. Population Sciences, 6, 63-77, 1985. \n39-Changes in cervical mucus copper and zinc in women using I.U.D.�s. Population Sciences, 6, 35-41, 1985. \n40-Histochemical study of the endometrium of infertile women. Egypt. J. Histol. 8(1) 63-66, 1985. \n41-Genital flora in pre- and post-menopausal women. Egypt. J. Med. Sci. 4(2), 165-172, 1983. \n42-Evaluation of the vaginal rugae and thickness in 8 different groups. Journal of the Egypt. Soc. of Ob./Gyn. 9:2, 101-114, May 1983. \n43-The effect of menopausal status and conjugated oestrogen therapy on serum cholesterol, triglycerides and electrophoretic lipoprotein patterns. Al-Azhar Medical Journal, 12:2, 113-119, April 1983. \n44-Laparoscopic ventrosuspension: A New Technique. Int. J. Gynaecol. Obstet., 20, 129-31, 1982. \n45-The laparoscope: A useful diagnostic tool in general surgery. Al-Azhar Medical Journal, 11:4, 397-401, Oct. 1982. \n46-The value of the laparoscope in the diagnosis of polycystic ovary. Al-Azhar Medical Journal, 11:2, 153-159, April 1982. \n47-An anaesthetic approach to the management of eclampsia. Ain Shams Medical Journal, accepted for publication 1981. \n48-Laparoscopy on patients with previous lower abdominal surgery. Fertility management edited by E. Osman and M. Wahba 1981. \n49-Heart diseases with pregnancy. Population Sciences, 11, 121-130, 1981. \n50-A study of the biosocial factors affecting perinatal mortality in an Egyptian maternity hospital. Population Sciences, 6, 71-90, 1981. \n51-Pregnancy Wastage. Journal of the Egypt. Soc. of Ob./Gyn. 11:3, 57-67, Sept. 1980. \n52-Analysis of maternal deaths in Egyptian maternity hospitals. Population Sciences, 1, 59-65, 1979. \nArticles published on OBGYN.net: \n1- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Laila A. S. Mousa and Mohamad A.K.M.El Hemaly.\nUrethro-vaginoplasty, an innovated operation for the treatment of: Stress Urinary Incontinence (SUI), Detursor Overactivity (DO), Mixed Urinary Incontinence and Anterior Vaginal Wall Descent. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/ urethro-vaginoplasty_01\n\n2- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamed M. Radwan.\n Urethro-raphy a new technique for surgical management of Stress Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/\nnew-tech-urethro\n\n3- Abdel Karim M. El Hemaly, Ibrahim M Kandil, Mohamad A. Rizk, Nabil Abdel Maksoud H., Mohamad M. Radwan, Khalid Z. El Shieka, Mohamad A. K. M. El Hemaly, and Ahmad T. El Saban.\nUrethro-raphy The New Operation for the treatment of stress urinary incontinence, SUI, detrusor instability, DI, and mixed-type of urinary incontinence; short and long term results. \nhttp://www.obgyn.net/urogyn/urogyn.asp?page=urogyn/articles/\nurethroraphy-09280\n\n4-Abdel Karim M. El Hemaly, Ibrahim M Kandil, and Bahaa E. El Mohamady. Menopause, and Voiding troubles. \nhttp://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly03/el-hemaly03-ss\n\n5-El Hemaly AKMA, Mousa L.A. Micturition and Urinary\tContinence. Int J Gynecol Obstet 1996; 42: 291-2. \n\n6-Abdel Karim M. El Hemaly.\n Urinary incontinence in gynecology, a review article.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/abs-urinary_incotinence_gyn_ehemaly \n\n7-El Hemaly AKMA. Nocturnal Enuresis: Pathogenesis and Treatment. \nInt Urogynecol J Pelvic Floor Dysfunct 1998;9: 129-31.\n \n8-El Hemaly AKMA, Mousa L.A.E. Stress Urinary Incontinence, a New Concept. Eur J Obstet Gynecol Reprod Biol 1996; 68: 129-35. \n\n9- El Hemaly AKMA, Kandil I. M. Stress Urinary Incontinence SUI facts and fiction. Is SUI a puzzle?! http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly/el-hemaly-ss\n\n10-Abdel Karim El Hemaly, Nabil Abdel Maksoud, Laila A. Mousa, Ibrahim M. Kandil, Asem Anwar, M.A.K El Hemaly and Bahaa E. El Mohamady. \nEvidence based Facts on the Pathogenesis and Management of SUI. http://www.obgyn.net/displayppt.asp?page=/English/pubs/features/presentations/El-Hemaly02/el-hemaly02-ss\n\n11- Abdel Karim M. El Hemaly*, Ibrahim M. Kandil, Mohamad A. Rizk and Mohamad A.K.M.El Hemaly.\n Urethro-plasty, a Novel Operation based on a New Concept, for the Treatment of Stress Urinary Incontinence, S.U.I., Detrusor Instability, D.I., and Mixed-type of Urinary Incontinence.\nhttp://www.obgyn.net/urogyn/urogyn.asp?page=/urogyn/articles/urethro-plasty_01\n\n12-Ibrahim M. Kandil, Abdel Karim M. El Hemaly, Mohamad M. Radwan: Ultrasonic Assessment of the Internal Urethral Sphincter in Stress Urinary Incontinence. The Internet Journal of Gynecology and Obstetrics. 2003. Volume 2 Number 1. \n\n13-Abdel Karim M. El Hemaly. Nocturnal Enureses: A Novel Concept on its pathogenesis and Treatment.\nhttp://www.obgyn.net/urogynecolgy/?page=articles/nocturnal_enuresis\n\n14- Abdel Karim M. El Hemaly. 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