Knowledge and Attitude of Pregnant Women towards Antenatal Exercise in Erbil City

Background and objective: Antenatal exercises provide many health benefits not only to pregnant mothers but also to the fetuses. In the absence of medical or obstetrical complications, pregnant women are encouraged to continue and maintain active lifestyles during their pregnancies. The objective of this study is to assess knowledge and attitude of pregnant women towards antenatal exercises. Methods: A descriptive cross-sectional study was conducted to assess mother's knowledge and attitudes regarding exercise during pregnancy. The convenience sample of the study included 100 pregnant women. The study was conducted in Najdi Heydari Health Care Center in Erbil City / Kurdistan region / Iraq from December 2016 to Feb, 2017. Data were collected by interview with the pregnant women. A questionnaire was constructed to collect the data by researchers. A statistical package for social science (SPSS, version20) was used for data analysis the data. All statistical procedures were tested on a probability of P-value was ≤ 0.05 significant. Results: The majority of the study sample had poor overall knowledge regarding antenatal exercises (93%), Interest in attending antenatal exercise classes 80%, the barrier to attend antenatal exercise 79% during pregnancy. There was very highly significant relationship between the pregnant women’s educational level and overall knowledge regarding exercise during pregnancy. Conclusion: The knowledge of women about exercise during pregnancy was less than average and women do not believe in the positive effect of exercises during pregnancy. The main reason for poor knowledge was inadequate antenatal exercise education. It is recommended that the apply antenatal exercise education teaching program is important to in-crease pregnant women’s knowledge regarding to exercise during pregnancy and change their believe regarding antenatal exercises

Impact of Personality Trait of Emotional Stability on Oral Parafunctional Habits

OBJECTIVES To find the impact of emotional stability on oral parafunctional habits. METHODOLOGY A Cross-sectional descriptive study was conducted at the College of Dentistry, Sharif Medical and Dental College, Lahore, over five months, from July to November 2021. Data was collected using a medical questionnaire and a ten-item personality inventory scale (TIPI). The medical questionnaire comprised two sections with 11 items. The first section had six demographic statements, including age, gender, marital status, occupation, educational level and medical condition. The second section consisted of a pre-validated parafunctional habits questionnaire. RESULTSThere was a non-significant difference in the scores of the personality trait of emotional stability across categories of oral parafunctional habits of nail-biting (p=0.093), tooth grinding (p=0.192), tooth clenching (p=0.055), biting on hard objects (p=0.17) and chewing gum (p=0.116). CONCLUSION Emotional stability was most prevalent in individuals who denied having the habit of nail-biting, teeth grinding, tooth clenching and biting hard objects but neither agreed nor disagreed with having the habit of chewing gum

PESTE DES PETITS RUMINANTS: AN OVERVIEW AND A CASE REPORT FROM PAKISTAN

Peste des petits ruminants (PPR) is an acute or subacute viral disease of goats and sheep characterized by fever, necrotic stomatitis, gastroenteritis, pneumonia, and sometimes death. The virus also affects several wild small ruminant species. Cattle, buffalo, and pigs are only sub clinically infected. People are not at risk. The disease is of heavy economic significance in small ruminant industry and ranks among the top ten diseases affecting small ruminants. Isolation and quarantine measures, slaughtering of positive animals, proper disposal of infected materials, proper disinfection of utensils and other items of flock are crucial for control of PPR. PPR leads to heavy economic setbacks to the farmers. With the aims and objectives to flourish small ruminant farming and maximizing profit, a few key points should be rigorously adopted

A green nutraceutical study of antioxidants extraction in Cleome brachycarpa - an ethnomedicinal plant

In the present study, an indigenous medical plant ‘Cleome brachycarpa’ was comparatively investigated for its antioxidant extraction for first time; using the soxhlet (traditional), microwave-assisted, and ultrasound-assisted (green) extraction methods with seven different solvents. The microwave-assisted extraction with methanol as solvent recovered the phytochemicals two-folds higher than the other methods with extraction efficiency of 370.57 ± 0.49 μg/ mg and correspondingly extracted the polyphenols: Phenolics (74.17 ± 0.61 μg GAE/mg DW), Flavonoids (65.46 ± 0.40 μg QE/mg DW), and Tannins (55.97 ± 0.85 μg CE/mg DW). The antioxidant capacity in relation with polyphenols was determined for Free radical scavenging activity and total antioxidant potential. The DPPH radical scavenging percentage of methanolic green extract of Cleome brachycarpa was found to be 81.37 ± 0.28 with IC50 of 0.30 mg/mL that matched up to the DPPH scavenging potential of Trolox. Furthermore, the ferric reducing potential was high up to 15.30 ± 0.30 μg GAE/mg DW. The correlation of antioxidant capacity with polyphenols was highly significant (p < 0.05). The green nutraceutical study has validated the ethnomedicinal importance of Cleome brachycarpa which is related to its high polyphenolic content. The findings highlight Cleome brachycarpa as a potential candidate for research and isolation of medicinal polyphenols

Understanding the role of metal supported on TiO2 in photoreforming of oxygenates

To achieve net-zero targets regarding GHG emissions by 2050, the identification of sustainable energy vectors is critical. In this context, photoreforming presents a potential candidate for recycling and transforming widely available biomass-derived wastes into clean hydrogen fuel, such as crude glycerol from biodiesel and a potential future H2 production opportunity from bioethanol. Many years of work has proved that TiO2 is an excellent material for photoreforming of organics due to its stability, availability, and environmentally friendly characteristics as compared to other semiconductors. However, photoreforming faces several obstacles, including the comparatively low hydrogen generation under Sun-equivalent light sources and the need of expensive noble metals. Efforts have been made in several directions, such as extending light absorption by TiO2 to the visible range, reducing the recombination rate of charge carriers, and preventing back reactions. To overcome these challenges, many methods have been proposed, such as controlling the phase and morphology of TiO2 nanoparticles, decoration with various metal co-catalysts, doping with metal and non-metal ions, plasmonic enhancement, and preparation of composite systems. Although each approach has its own merits, metal loading has proven to be the most effective among them all. This review provides a deep insight into the underlying role of metal towards the enhancement of TiO2 catalytic activity, focusing on the findings of recent published work. We discuss in detail the effect of various metals on TiO2 electronic structure, preparation methods, role in light absorption (surface Plasmon resonance) and chemical changes during various photoreforming steps. Following this we extend our discussion to dye sensitized systems and catalyst testing benchmarking. At the end of the review, we provide possible future research directions to enhance the photocatalytic activity of TiO2 based photocatalysts for photoreforming

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone