Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Attitudes and practices of healthcare workers regarding of medical waste management in hospitals of Al-Najaf Governorate

Background: Iraq suffers from many pollutants in its environment. One of these pollutants is medical waste (MW) from hospitals, which is considered the second most dangerous waste after radioactive waste and needs to be properly managed by trained healthcare workers. Aims: This study aimed to assess the attitudes and practices of healthcare workers on medical waste management (MWM) and determine the relationship between socio-demographic characteristics of healthcare worker with their attitudes and practices. Instruments and methods: A descriptive; cross sectional study conducted at the government hospitals of Al-Najaf governorate, Iraq. The study include 443 participants (93 medical staff, 310 paramedical staff, and 40 housekeeping staff) collected through period from 2nd January until 31th March 2022 using a structured questionnaire depends on the National Guide to Infection Control in the Iraqi Health Institution and the previous studies. Findings: The study was conducted on 443 participants with the mean ± SD of their ages was 29.18 ±7.68 years. The age group 20-29 years had the highest percentage (69.1%), female were represented (58.9%) of the studied sample compared to (41.1%) male. The highest percentage of the studied sample had Baccalaureate certification (44%) and period of experience (1-5) years (62.98%)

Focused-Based Multifractal Analysis of the Wake in a Wind Turbine Array Utilizing Proper Orthogonal Decomposition

Hot-wire anemometry measurements have been performed in a 3×3 wind turbine array to study the multifractality of the turbulent kinetic energy dissipation. A multifractal spectrum and Hurst exponents are determined at nine locations downstream of the hub height, bottom and top tips. Higher multifractality is found at 0.5D and 1D downstream of the bottom tip and hub height. The second order of the Hurst exponent and combination factor shows the ability to predict the flow state in terms of its development. Snapshot proper orthogonal decomposition (POD) is used to identify the coherent and incoherent structures and to reconstruct the stochastic velocity signal using a specific number of the POD eigenfunctions. The accumulation of the turbulence kinetic energy in the top tip location exhibits fast convergence compared with the bottom tip and hub height. The dissipation of the large and small scales is determined using the reconstructed stochastic velocities. The higher multifractality is shown in the dissipation of the large scale compared with small scale dissipation showing consistency with the behavior of the original signals. Multifractality of turbulent kinetic energy dissipation in the wind farm is examined and the effect of the reconstructed flow field via proper orthogonal decomposition on the multifractality behavior is investigated. Findings are relevant in wind energy as multifractal parameters identify the variation between the near- and far-wake regions

Does body mass index affect restoration of femoral offset, leg length and cup positioning after total hip arthroplasty? : A prospective cohort study

Background: In obese patients, total hip arthroplasty (THA) can be technically demanding with increased perioperative risks. The aim of this prospective cohort study is to evaluate the effect of body mass index (BMI) on radiological restoration of femoral offset (FO) and leg length as well as acetabular cup positioning. Methods: In this prospective study, patients with unilateral primary osteoarthritis (OA) treated with THA between September 2010 and December 2013 were considered for inclusion. The perioperative plain radiographs were standardised and used to measure the preoperative degree of hip osteoarthritis, postoperative FO, leg length discrepancy (LLD), acetabular component inclination and anteversion. Results: We included 213 patients (74.5% of those considered for inclusion) with a mean BMI of 27.7 (SD 4.5) in the final analysis. The postoperative FO was improper in 55% and the LLD in 15%, while the cup inclination and anteversion were improper in 13 and 23% of patients respectively. A multivariable logistic regression model identified BMI as the only factor that affected LLD. Increased BMI increased the risk of LLD (OR 1.14, 95% CI 1.04 to 1.25). No other factors included in the model affected any of the primary or secondary outcomes. Conclusion: Increased BMI showed a negative effect on restoration of post-THA leg length but not on restoration of FO or positioning of the acetabular cup. Age, gender, OA duration or radiological severity and surgeon’s experience showed no relation to post-THA restoration of FO, leg length or cup positioning

العدد الاول المجلد السادس.doc

Abstract This study was applied on fifty patients having urinary bladder cancer, proved by histopathological study for the biopsy taken from the bladder by cystoscopy performed under general anesthesia. In this study the type of cancer was transitional cell carcinoma of urinary bladder of different stages. In this study changes in malondieldehyde as biomarker of lipid peroxidationhave been studied the result revealed significant elevation in patient groups compared with control, and glutathione level (GSH) which considered as antioxidant defenses mechanism are significantly reduced in patients groups in comparison to control groups. The changes in level of trace elements copper and zinc are study in this work, the result revealed increase level of copper and reduced level of zinc in patients groups in comparism with control group