EFFICACY AND SAFETY OF ACETAMINOPHEN COMPARED TO TRAMADOL AFTER LAPAROSCOPIC CHOLECYSTECTOMY

Abstract Background: Laparoscopic cholecystectomy become widely popular because of its less postoperative pain produced compared to conventional cholecystectomy. The use of opioids postoperatively to reduce pain may be harmful and produce some adverse effects .Tramadol is a centrally acting opioid which is effective for postoperative analgesic pain but produce undesirable adverse effects the patients do not tolerate it so that intravenous acetaminophen could be helpful to optimize postoperative analgesia by reducing the requirement for opioids and their adverse effects.Method: A prospective randomized clinical trial was carried out on 27 adults undergoing elective laparoscopic cholecystectomy were randomly assigned to two groups in this study (13patients) to receive intravenously 1000mg acetaminophen and (14 patients) to receive intramuscularly tramadol 100mg postoperatively; visual analog scale (VAS) was utilized to asses pain severity and efficacy of analgesic agents. Pain scores were assessed at 0,2,4,6,8,10 and 12h after surgery the incidence of adverse effects was also assessed.Results: Over a period of 12hours, visual analog scale (VAS) scores were significantly lower in each group at each time interval compared to zero time; there is a non significant difference in pain score between the different groups; the incidence of adverse effects like nausea and vomiting was significant in tramadol group compared to acetaminophen group.Conclusion: Postoperative intravenous acetaminophen infusion of 1000mg is useful for reducing pain scores after elective laparoscopic cholecystectomy; it is effective and safe analgesic with less adverse effects compared to tramadol.  Key words: laparoscopic cholecystectomy, Acetaminophen, Tramadol, Postoperative analgesia.  Â

Cerebral venous thrombosis: a descriptive multicenter study of patients in Pakistan and Middle East

Background and Purpose: The natural history, causative factors, and outcomes of patients with cerebral venous thrombosis from Asia and Middle East have not been well described. This descriptive multicenter study describes the results for cerebral venous thrombosis patients in South Asia and the Middle East. Methods: The retrospective and prospective data of patients with radiologically confirmed cerebral venous thrombosis were collected from 4 centers located in Pakistan and United Arab Emirates. The demographic, clinical, radiological, and outcome data were recorded and analyzed. Primary outcome was death or dependency (modified Rankin score \u3e2) at the time of hospital discharge. Results: This study included 109 patients with cerebral venous thrombosis; the presenting features most commonly being observed were headache (81%), focal motor deficits (45%), seizures (39%), and mental status changes (37%). Important predisposing factors included systemic and central nervous system infection (18%), postpartum state (17%), hyperhomocystinemia (9%), genetic thrombophilia (5%), and oral contraceptive pill use (3%). Ninety-six (67%) patients received therapeutic anticoagulation. Seven patients died and 43 had poor outcome at discharge. Focal motor deficits (OR, 2.93; 95% CI, 1.2–7.5; P=0.018) and hemorrhagic infarctions (OR, 2.81; 95% CI, 1.04–7.85; P=0.041) were independent predictors of unfavorable outcome at discharge. Hemorrhagic infarction was the most significant factor of long-term unfavorable outcome (OR, 5.87; 95% CI, 1.49–23.02; P=0.011). Conclusions: Infections and postpartum state were the most common predisposing factors for cerebral venous thrombosis in this cohort. Most patients (67%) were treated with anticoagulation therapy. Almost 50% of patients were dead or disabled at discharge

Combined DFT, SCAPS-1D, and wxAMPS frameworks for design optimization of efficient Cs2BiAgI6-based perovskite solar cells with different charge transport layers

In this study, combined DFT, SCAPS-1D, and wxAMPS frameworks are used to investigate the optimized designs of Cs2BiAgI6 double perovskite-based solar cells. The first-principle calculation is employed to investigate the structural stability, optical responses, and electronic contribution of the constituent elements in Cs2BiAgI6 absorber material, where SCAPS-1D and wxAMPS simulators are used to scrutinize different configurations of Cs2BiAgI6 solar cells. Here, PCBM, ZnO, TiO2, C60, IGZO, SnO2, WS2, and CeO2 are used as ETL, and Cu2O, CuSCN, CuSbS2, NiO, P3HT, PEDOT: PSS, Spiro-MeOTAD, CuI, CuO, V2O5, CBTS, CFTS are used as HTL, and Au is used as a back contact. About ninety-six combinations of Cs2BiAgI6-based solar cell structures are investigated, in which eight sets of solar cell structures are identified as the most efficient structures. Besides, holistic investigation on the effect of different factors such as the thickness of different layers, series and shunt resistances, temperature, capacitance, Mott-Schottky and generation-recombination rates, and J-V (current-voltage density) and QE (quantum efficiency) characteristics is performed. The results show CBTS as the best HTL for Cs2BiAgI6 with all eight ETLs used in this work, resulting in a power conversion efficiency (PCE) of 19.99%, 21.55%, 21.59%, 17.47%, 20.42%, 21.52%, 14.44%, 21.43% with PCBM, TiO2, ZnO, C60, IGZO, SnO2, CeO2, WS2, respectively. The proposed strategy may pave the way for further design optimization of lead-free double perovskite solar cells.Comment: 36 pages, 14 figures, 6 table

Framework for evaluating update propagation techniques in large scale data grid

This paper introduces a framework for evaluating update propagation techniques in large scale Data Grid. The framework qualitatively compares the update propagation techniques using an analytical model based network queuing model. To achieve accuracy, the framework takes into account, the computing element, storage element capacity in additional to the arrival rate, and the computational complexity moreover it consider the heterogeneity of the grid environment and the heterogeneity of the jobs. The framework can predict the utilization, response time, update propagation response time of the update propagation techniques

Empirical determination of charm quark energy loss and its consequences for azimuthal anisotropy

We propose an empirical model to determine the form of energy loss of charm quarks due to multiple scatterings in quark gluon plasma by demanding a good description of production of D mesons and non-photonic electrons in relativistic collision of heavy nuclei at RHIC and LHC energies. Best results are obtained when we approximate the momentum loss per collision $\Delta p_T \propto \alpha \, p_T$, where $\alpha$ is a constant depending on the centrality and the centre of mass energy. Comparing our results with those obtained earlier for drag coefficients estimated using Langevin equation for heavy quarks we find that up to half of the energy loss of charm quarks at top RHIC energy could be due to collisions while that at LHC energy at 2760 GeV/A the collisional energy loss could be about one third of the total. Estimates are obtained for azimuthal anisotropy in momentum spectra of heavy mesons, due to this energy loss. We further suggest that energy loss of charm quarks may lead to an enhanced production of D-mesons and single electrons at low $p_T$ in AA collisions.Comment: 11 pages, 3 figures, Typographical errors corrected, Key-words and PACS indices added, sequence of figures corrected, references added in section 3, discussions expande

Cloud of Things and fog computing in Iraq: Potential applications and sustainability

This paper depicts the principles of Cloud of Things and fog computing and discusses its possible uses in Iraq with sustainability measures. The capacity of cloud computing to supply elastic, as-needed computer resources has garnered widespread interest worldwide. However, fog computing and a Cloud of Things enhance the Internet of Things by relocating computation to devices on the network's periphery. This study looks at how the Cloud of Things and fog computing are used now in Iraq, the obstacles, and the future uses of these technologies in various fields. To fully reap the benefits of the Cloud of Things and fog computing in Iraq, the study also emphasizes the significance of infrastructure development, policy design, cybersecurity, and other measures. This study will discuss the use of questionnaires in research. There are two distinct components to this. The first section includes questions regarding the respondents' affiliations, including their roles, departments, organization sizes, and ministries. The rest of the study's factors are discussed with inquiries in line with issues of cyber security, privacy, sustainability, cost of implementation, feasibility, trust, IT infrastructure, and government support. The survey's final open-ended inquiry will help us to compile a wide range of perspectives on what kinds of Cloud of Things and fog computing services based on the Iraqi government's needs

Operative management and outcomes in patients with myxomas: A single-center experience

BackgroundCardiac myxoma is a rare cardiac tumor that may be asymptomatic or can cause embolization or intracardiac obstruction, leading to heart failure, sudden cardiac death, and arrhythmia. This study aims to report an 11-year experience of a single center in the management of cardiac myxoma.MethodThis study is a single-center retrospective case series. Eighty cases of cardiac myxoma were collected in Ibn Albitar's specialized center for cardiac surgery. Transthoracic echocardiography was used to make the preoperative diagnosis in all patients. The surgeries were undertaken through the standard approach of a median sternotomy. All four cardiac chambers were thoroughly explored for additional myxomas. The major objective of the operations was complete tumor resection.ResultThe mean age of the patients was 46.3 years. Females (67.5%) were predominant over males (32.5%). Shortness of breath was the most common symptom (86.25%). The left atrium was the most affected site (83.75%), followed by the right atrium (13.75%). Coronary artery bypass grafting was required as the secondary or associated intervention in 19 (23.75%) cases. The recurrence rate was 11.25%, with a mortality rate of 3.75%.ConclusionRecurrence and tumor embolism are risks of surgical intervention for myxoma. Good preparation using transthoracic echocardiography as a diagnostic tool and standard median sternotomy to complete resection of the tumors can decrease the rate of recurrence, embolism, and even mortality

Presentation and outcome of Middle East respiratory syndrome in Saudi intensive care unit patients.

BACKGROUND: Middle East respiratory syndrome coronavirus infection is associated with high mortality rates but limited clinical data have been reported. We describe the clinical features and outcomes of patients admitted to an intensive care unit (ICU) with Middle East respiratory syndrome coronavirus (MERS-CoV) infection. METHODS: Retrospective analysis of data from all adult (>18 years old) patients admitted to our 20-bed mixed ICU with Middle East respiratory syndrome coronavirus infection between October 1, 2012 and May 31, 2014. Diagnosis was confirmed in all patients using real-time reverse transcription polymerase chain reaction on respiratory samples. RESULTS: During the observation period, 31 patients were admitted with MERS-CoV infection (mean age 59 ± 20 years, 22 [71 %] males). Cough and tachypnea were reported in all patients; 22 (77.4 %) patients had bilateral pulmonary infiltrates. Invasive mechanical ventilation was applied in 27 (87.1 %) and vasopressor therapy in 25 (80.6 %) patients during the intensive care unit stay. Twenty-three (74.2 %) patients died in the ICU. Nonsurvivors were older, had greater APACHE II and SOFA scores on admission, and were more likely to have received invasive mechanical ventilation and vasopressor therapy. After adjustment for the severity of illness and the degree of organ dysfunction, the need for vasopressors was an independent risk factor for death in the ICU (odds ratio = 18.33, 95 % confidence interval: 1.11-302.1, P = 0.04). CONCLUSIONS: MERS-CoV infection requiring admission to the ICU is associated with high morbidity and mortality. The need for vasopressor therapy is the main risk factor for death in these patients

Studies of di-jet survival and surface emission bias in Au+Au collisions via angular correlations with respect to back-to-back leading hadrons

We report first results from an analysis based on a new multi-hadron correlation technique, exploring jet-medium interactions and di-jet surface emission bias at RHIC. Pairs of back-to-back high transverse momentum hadrons are used for triggers to study associated hadron distributions. In contrast with two- and three-particle correlations with a single trigger with similar kinematic selections, the associated hadron distribution of both trigger sides reveals no modification in either relative pseudo-rapidity or relative azimuthal angle from d+Au to central Au+Au collisions. We determine associated hadron yields and spectra as well as production rates for such correlated back-to-back triggers to gain additional insights on medium properties.Comment: By the STAR Collaboration. 6 pages, 2 figure