Effect of Perioperative Instructions on Postoperative Discomforts and Satisfaction Level among Patients Undergoing Thyroidectomy

Context: Thyroidectomy is a type of surgery directed to remove all or part of the thyroid gland. Documented complications after thyroidectomy are rare, but their consequences can often be life-threatening. Patients who receive perioperative instructions about what to expect after the operation often have better coping with postoperative discomforts minimize post-surgical complications and reduce the duration of hospitalization. It also improves patient safety and reduces the anxiety induced by the intervention. In addition to this, it elevates the patient's satisfaction level. So, perioperative instructions are essential. Aim: The present study aims to determine the effect of perioperative instructions on postoperative discomforts and satisfaction levels among patients undergoing thyroidectomy. The study hypothesized that postoperative patients who receive the perioperative instructions exhibit fewer discomforts and more satisfaction than those who do not.Methods: The study utilizes a quasi-experimental (study/control group) design. It was conducted at the Head and Neck Surgical Department of Alexandria Main University Hospital. A convenience sample included 70 adult patients were selected from the setting mentioned above who have enrolled in either study or control groups of 35 patients for each. Three tools were used for data collection. A structured interview questionnaire aimed to assess the socio-demographic characteristics and clinical data of the study subjects. Discomfort assessment scale to rate the patient's level of discomfort against six common postoperative problems. Perioperative instructions patients’ satisfaction questionnaire developed to determine the patients′ satisfaction level regarding perioperative instructions. Results: There were statistically significant differences among the study and control groups in the first, second, and third weeks regarding total discomfort score level, where t=3.606, p=<0.001; t=3.049, p=<0.001; t=21.213, p=<0.001respectively. The studied patients had a higher level of satisfaction compared to those in the control group with statistically significant differences regarding overall scores of satisfaction, and with preoperative instruction, postoperative instruction, and psychological preparation, where t=48.382, p=<0.001; t=6.023, p=<0.001; t=27.997, p=<0.001; t=32.939, p=<0.001respectively. Conclusion: The study hypotheses were accepted as postoperative patients who receive perioperative instructions exhibit less discomfort and a more satisfying level than those who do not. The perioperative instructions should be applied to the care of patients undergoing thyroidectomy to decrease patients' discomfort and increase their satisfaction level

study of Islamic values of architecture and interior design of the mosque between heritage and contemporary

The mosque is the center of spiritual and scientific radiation and the starting point of the call for the religion of the righteous God. Since the Prophet of God laid the stone of his foundation. The architecture of the mosque is the memory of the nation and its cultural history, in which the hearts of Muslims are united to worship God alone and have no partner. In its framework, there is a focus on morals and data that determine the behavior of Muslims religiously, morally and socially. It is from this point of view that the construction of mosques has been taken into account, taking into account the importance of architecture that reflects Islamic civilization. This led to the development of the building of the mosque to meet the requirements and needs of the era, the appearance of the mosque which contains the school and the center of the memorization of the Quran and the hospital as a result of meeting the requirements of the era. The spread of Islam in the West played its part in producing a distinct architecture for the contemporary mosque.Also emerged in the contemporary period new directions and patterns in the architecture and interior design of mosques, which differ from the traditional mosques, whose model was influenced by a set of Islamic contents and values that contributed to its final crystallization, which is the source of Islamic architecture, hence the problem of research in asking several questions, including: Has contemporary architecture been able to maintain the achievement of Islamic contents and values for the construction of mosques?, the research aims to discover contemporary trends and the extent to which they achieve Islamic values affecting architecture and design. The research concluded that our Islamic religion did not reject development, but on the contrary it was a grainy and Islamic architecture was a model of flexibility and the assimilation of many different civilizations and cultures

Structure of New Solitary Solutions for The Schwarzian Korteweg De Vries Equation And (2+1)-Ablowitz-Kaup-Newell-Segur Equation

In this research, we introduce and represent the modified Khater method on two basic models in the optical fiber. These two models describe the dynamics of the wave movement in the optical fiber.  It is a new modification of new recent method which developed by Mostafa M. A. Khater in 2017. We implement this new modified technique on Schwarzian Korteweg de Vries equation and (2+1)-Ablowitz-Kaup-Newell-Segur equation. This modification of Khater method produces more closed solutions than many other methods. Schwarzian Korteweg de Vries (SKdV) equation has a closed relationship with (2+1)-Ablowitz- Kaup-Newell-Segur equation. Schwarzian Korteweg de Vries equation prescribes the location in a micro-segment of space and motion of the isolated waves in varied fields which localized in a tiny portion of space. It is a great and basic system in fluid mechanics, nonlinear optics, plasma physics, and quantum field theory

The effect of betaine on broilers infected experimentally with Clostridium perfringens

This study was investigated the effect of betaine on blood biochemical parameters, histopathological picture and intestinal integrity in broiler chickens challenged with C.perfringens . A total of 120, one- day-old broiler chicks (Rose chickens) were randomly assigned to one of three treatments: 1) negative control (NC), 2) infected group (IG) and 3) treated group (TG), which were dosed with 1.0 ml betaine/L drinking water, from day one until the conclusion of the end of experiment. At 14 days of age, both the infected and treated groups were orally inoculated with 1×104 sporulated oocysts of mixed Eimeria species. Five days later, the same groups were orally challenged with a toxigenic strain of C. perfringens by inoculating each bird with 2 ml of broth culture (1×108 CFU) per bird. Betaine decreased the severity of necrotic enteritis in (TG) by decreasing the severity of brown diarrhea resulting in a significant (P< 0.05) reduction in the total count of C. perfringens (CFU/g) in the cecum in comparison to the infected and control groups. Betaine supplementation improves blood parameters. Additionally, betaine treatment diminishes pathological lesions in comparison to the infected group

Quantum Heat Flow Model for Heat Flow in Some Nanotubes

Using Schrodinger equation in a fractional medium a useful expression for heat flow through Nano tubes has been found. Fortunately, this equation resembles &nbsp;that obtained by Moran Wang etal, and Hai- Dong Wang teal.&nbsp;&nbsp; the ordinary thermal conductivity is constant. The effective thermal conductivity temperature dependent resembles that obtained for carbon Nano tubes and Boron Nitride Nano tubes. It is also finite at low temperature which also conforms with experimental data for carbon and Boron. Since Nano materials are described by quantum lows, this new model is thus more suitable for Nano tubes, as for as it is derived using quantum laws

Alveolar Cleft Reconstruction Using Different Grafting Techniques

BACKGROUND: Cleft lip and palate CLP is a frequent congenital malformation that manifests in several varieties including unilateral or bilateral anomalies due to either genetic or acquired causes. Alveolar cleft graft ACG remains controversial as regard timing, grafting materials and surgical techniques. The primary goal of alveolar cleft grafting in ACG patients is to provide an intact bony ridge at the cleft site to allow maxillary continuity for teeth eruption, proper orthodontic treatment for dental arch alignment, oronasal fistula closure and providing alar support for nasal symmetry. AIM: This study aims to compare different grafting techniques to treat the alveolar cleft defect. METHODS: This study included 24 cases divided into three groups of patients: Group A was treated with autogenous iliac crest bone; Group B was treated with nano calcium hydroxyapatite with collagen membrane and Group C was treated with tissue engineering method using bone marrow stem cells extract and PRF membrane. RESULTS: According to clinical and radiographic examination measuring bone density in the CT preoperatively compared to six months postoperatively. Group C with bone marrow stem cells extract showed superior results among all followed by group B, while group A with autogenous iliac crest showed resorption in some cases and gave the least values, in addition to its drawbacks as regard donor site affection with pain &amp; scar formation. CONCLUSION: Bone substitutes as Nano calcium hydroxyapatite and bone marrow stem cells extract showed to be reliable methods for bone grafting than autogenous iliac crest

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Detecting All Non-Dominated Points for Multi-Objective Multi-Index Transportation Problems

Multi-dimensional transportation problems denoted as multi-index are considered as the extension of classical transportation problems and are appropriate practical modeling for solving real–world problems with multiple supply, multiple demand, as well as different modes of transportation demands or delivering different kinds of commodities. This paper presents a method for detecting the complete nondominated set (efficient solutions) of multi-objective four-index transportation problems. The proposed approach implements weighted sum method to convert multi-objective four-index transportation problem into a single objective four-index transportation problem, that can then be decomposed into a set of two-index transportation sub-problems. For each two-index sub-problem, parametric analysis was investigated to determine the range of the weights values that keep the efficient solution unchanged, which enable the decision maker to detect the set of all nondominated solutions for the original multi-objective multi-index transportation problem, and also to find the stability set of the first kind for each efficient solution. Finally, an illustrative example is presented to illustrate the efficiency and robustness of the proposed approach. The results demonstrate the effectiveness and robustness for the proposed approach to detect the set of all nondominated solutions

Neutrophil-lymphocyte and platelet-lymphocyte ratios in rheumatoid arthritis patients: Relation to disease activity

Aim of the work: To assess the neutrophil–lymphocyte ratio (NLR) and platelet–lymphocyte ratio (PLR) in rheumatoid arthritis (RA) patients and compare between active cases and those in remission. Patients and methods: The study included 50 RA patients and 20 matched control. Patients were enrolled into 2 equally divided groups; group A (active) with a disease activity score (DAS-28) ≥2.6 and group B (remission) <2.6. Laboratory investigations included the calculation of the NLR and PLR for all subjects. Results: The mean age of patients was 40.7 ± 10.1 years and the mean of disease duration was 5.9 ± 3.4 years. The DAS-28 was 3.9 ± 0.9 in active patients and 2.1 ± 0.3 in those in remission (p = .001). NLR was 2.8 ± 2.1 in the patients and 2.1 ± 0.59 in the control (p = .15). PLR was 1.7 ± 0.9 in the patients and 1.27 ± 0.46 in the control (p = .09). Active patients had an NLR of 3.27 ± 2.81 and PLR of 1.8 ± 1.2 while they were 2.3 ± 0.84 and PLR 1.5 ± 0.59 in patients in remission (p = .05 and p = .18 respectively). There was a significant difference regarding NLR and PLR between active patients and control (2.1 ± 0.59 and 1.27 ± 0.46; p = .03 and p = .04 respectively). In active patients, the NLR and PLR significantly correlated with the patients age (p = .02 and p = .006) and with the DAS-28 (p = .001 and p = .03 respectively). Conclusion: NLR and PLR are 2 emerging inflammatory biomarkers which could be used to evaluate disease activity in active RA patients. A larger scale longitudinal study is recommended to confirm the present results and further demonstrate the relation to medications received and disease outcome. Keywords: Rheumatoid arthritis, DAS-28, Neutrophil-lymphocyte ratio, Platelet-lymphocyte rati