Detection of Cardiac Disarrhythmia with Patients Post-Haemodialysis in Dialysis Center of General Kirkuk Hospital

Background : Cardiovascular disease (CVD) is a most common complication and  cause of death in patients with end stage renal disease (ESRD). Arrhythmias are complications that are frequently observed in patients attending to hemodialysis varies between 17 to 76%. Increased QT intervals dispersion is predisposing to ventricular arrhythmias and sudden cardiac death.Objective : The main objective of the study is to detect the cardiac disarrhythmia with patients at post-hemodialysis  and  to assess the effect of hemodialysis (HD) on corrected QT (QTc) intervals and their dispersions (QTd) in chronic hemodialyzed patients.Methods: A descriptive study a purposive (non-probability) sample of (60) patients were undergoing hemodialysis was carried out at Kirkuk general hospital/ dialysis center, from December 2013 to 28 March  2014.  The study sample consisted of 60 patients undergoing hemodialysis (61.7% males and 38.3% females), whose mean age was 66.79±13.16 years. All of them underwent  electrocardiograms  performed after one dialysis session. On a second phase, ECG was performed pre –post  hemodialysis .12-leads standard ECG were recorded using a Mortara instrument 1246, (USA) electrocardiograph at paper speed of 25 mm/s and 10 mm/mV, and a blood specimen was drawn to measure plasma electrolytes pre –post a single hemodialysis session. Results were tested for normality and expressed as mean ± SD,. Comparisons were made using t test or Mann-Whitney test (electrolyte values).Results :Post-dialysis arrhythmia showed 20(33.3%) of participants are suffer from Sinus bradycardia and 15 (25%) of them are suffer from irregularity with possible premature atrial  contraction. The mean of pre and post dialysis R-R intervals was (780.11±90.75 ms pre-HD vs. 811.16±81.45 post-HD, respectively (p>0.05). The mean of corrected QT cmax intervals increased significantly from 383.11±11.95 msec pre-HD vs. 422.16±18.70  msec post-HD, (p<0.05). The mean of QTc dispersion increases from 47.56±9.85 ms pre-HD to 59.25±11.93 ms post-HD (p<0.05) respectively. The changes in serum potassium and calcium levels were related with QT interval prolongation. a statistical  high  significant difference of  serum Changes ( (Potassium, Calcium, and Urea) at pre-post hemodialysis  with mean± SD (5.09±0.70 vs 3.96±0.54 , 7.34±0.90 vs 7.72±0.60 , 59.88±9.50 vs 21.97±4.81 ) respectively .Conclusions: This study showed that QTcmax and QT dispersion, markers of risk for arrhythmias and sudden death, are elevated in hemodialysis patients, and rise pos-dialysis.QTc interval and dispersion increase in HD patients. Keywords: Chronic renal disease, Hemodialysis, QT interval, Arrhythmi

THE PRACTICE AND PERCEPTION OF HOSPITAL PHARMACISTS TOWARDS ERRORS IN DISPENSING MEDICINES AND THEIR POSSIBLE CAUSES IN OMDURMAN MILITARY HOSPITAL, SUDAN

Introduction: Hospital pharmacies dispensing errors are common and investigating them for identifying factors involved in it and developing strategies to minimize their occurrence. Errors can arise at any stage during the dispensing process. Dispensing errors were identified by checking the prescribed drug against the dispensed medication. Materials and Methods: A cross sectional study involving 100 pharmacists who were administered a survey research designed to assess pharmacists' attitudes, factors associated with DEs and involvement in DE, conducted between 1st January 2019 and 1st February 2019 at Omdurman Military Hospital (OMH) Pharmacies. A data analyzed by Statistical Package for Social Sciences software version 21. Results: 55% from the pharmacists in the study have poor attitude toward dispensing errors. The most common factors influencing dispensing errors as stated by participants were lack of therapeutic training (stated by 81%), 62% from the participants stated that workload and time pressure are causes of dispensing errors in area of factors associated with the work environment. 48% from the pharmacists in the study committing dispensing errors, 41.7% from them committed dispensing errors once while 23% committed fourth or more. Conclusion: With the multiplicity of risk factors in our environment, there is urgent need to reinforce the training of pharmacists and the provision of resource materials and enabling work environment aimed at minimizing medication errors.                                  Peer Review History: Received: 8 September 2020; Revised: 7 October; Accepted: 20 October, Available online: 15 November 2020 Academic Editor: Dr. Tamer Elhabibi, Suez Canal University, Egypt, [email protected] UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file:                Reviewer's Comments: Average Peer review marks at initial stage: 5.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewer(s) detail: Prof. Dr. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, [email protected]   Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, [email protected] Similar Articles: AWARENESS OF PHARMACISTS TOWARDS ASPARTAME SIDE EFFECTS IN KHARTOUM CITY, SUDA

The effects of a combined psychotherapy and physiotherapy group treatment program for survivors of torture incarcerated in an adult prison in Kurdistan, Iraq: A pilot study

Introduction: Survivors of torture have high rates of mental health problems and can experience a sequela of physical effects with the most common being persistent pain. Similar to survivors of torture, persons that are incarcerated have high rates of mental health problems, persistent pain and pain-related disability.The purpose of this study is to assess the effect of an interdisciplinary group treatment approach, involving psychotherapy and physiotherapy, with survivors of torture whom are incarcerated in a prison in Kurdistan, Iraq. Methods: A parallel group study design was used to compare a treatment group (n=11) and a wait-list control group (n=16). The treatment group participated in an interdisciplinary treatment service for a total of 10 weekly group sessions for each discipline.The primary outcome measures were symptoms of nociplastic pain, anxiety, depression, and PTSD. Secondary outcome measures evaluated physical functioning, sleep quality, and general self-efficacy. Results: A statistically significant reduction in outcome measure scores was seen in all symptoms measured immediately post-treatment. Discussion and Conclusion: These findings suggest that a culturally and contextually appropriate interdisciplinary group treatment intervention for survivors of torture in a prison could be effective for short-term reductions in symptoms of anxiety, depression, PTSD, persistent pain, and function. The study has limitations including a small sample size, lack of long-term outcome measures, and an inability to isolate effect of each component of care. The study does demonstrate the feasibility of implementing research that follows international research standards and practices within under-researched settings and post-conflict areas

Percutaneous Transpedicular Fixation: Technical tips and Pitfalls of Sextant and Pathfinder Systems

Study DesignThe efficacy of the operative techniques, possible benefits as well as pitfalls and limitations of the techniques are discussed. Potential drawbacks are also detected.PurposeThis study aims to report indications, techniques, and our experience with the use of the Sextant and PathFinder percutaneous transpedicular screw fixation systems.Overview of LiteraturePercutaneous pedicle screw insertion is a novel technique. Successful percutaneous placement of pedicle screws requires surgical skill and experience because of lack of anatomic surface landmarks. Fluoroscopy-guided percutaneous placement of pedicle screws is effective. Many systems are now available.MethodsWe conducted a prospective operative and postoperative analysis of 40 patients with absolute indication for thoracic or lumbar instability between January 2009 and June 2013. All procedures were performed with the Sextant (group A) and PathFinder (group B) systems under fluoroscopic guidance. Operative techniques are discussed and the results compared.ResultsPercutaneous transpedicular screw fixation minimizes the morbidity associated with open techniques without compromising the quality of fixation. A total of 190 screws were inserted. There was no additional morbidity. Postoperative computed tomography images and plain X-rays were analyzed. Reduction of visual analog scale scores of back pain was evident.ConclusionsFluoroscopy-guided percutaneous pedicular screws are feasible and can be safely done. Current systems allow multi-segmental fixation with significantly less difficulties. The described techniques have acceptable intra- and postoperative complication rates, and overall sufficient pain control with early mobilization of patients

LINEARNO PROGRAMIRANJE KAO ALAT ZA PROJEKTIRANJE SIROVINSKE SMJESE U TVORNICI CEMENTA

This study uses linear programming to develop a methodology for selecting the best raw material mix in an ASCOM cement plant in Egypt. In cement factories, this type adheres to Egyptian chemical composition criteria for raw feed (e.g. 82.5% calcium carbonate, 14.08% silica, 2.5% alumina and 0.92% iron oxide). Furthermore, the model is bound by industry-specific characteristics (e.g. lime saturation factor, silica modulus, alumina modulus and loss of ignition). The results reveal that the model is able to accurately reproduce the mixing of high-quality feed with varying constituent percentages. It is also capable of determining the combining limitations of each ingredient. Furthermore, it demonstrates optimality for additive sourcing short-term planning and capping limestone quality to meet changeable component combinations. Additionally, improving the raw mix reduces limestone feed quality from 51 to 50.6%, resulting in the inclusion of extra limestone reserves.Studija prikazuje metodu linearnoga programiranja uporabljenu sa svrhom odabira najbolje sirovinske smjese u tvornici cementa ASCOM (Egipat). Takva smjesa poštuje egipatske standarde kemijskoga sastava sirovine (npr. 82,5 % kalcijeva karbonata, 14,08 % silikata, 2,5 % aluminijeva oksida, 0,92 % željeznoga oksida). Također, model je uvjetovan industrijskim standardima (npr. faktorom zasićenja vapnom, silikatnim i aluminatnim modulom te gubitkom (oksida) žarenjem). Modelom se mogla točno izračunati visokokvalitetna mješavina različitih (postotnih) komponenti te je dokazan kao optimalan za brz izračun raznih aditiva i postizanje najveće kvalitete vapnenačke sirovine uz doziranje ostalih komponenti. Time je udjel vapnenca bilo moguće smanjiti na 50,6 – 51 %, što je otvorilo put eksploataciji dodatnih rezervi te sirovine

A genetic algorithm for shortest path with real constraints in computer networks

The shortest path problem has many different versions. In this manuscript, we proposed a muti-constrained optimization method to find the shortest path in a computer network. In general, a genetic algorithm is one of the common heuristic algorithms. In this paper, we employed the genetic algorithm to find the solution of the shortest path multi-constrained problem. The proposed algorithm finds the best route for network packets with minimum total cost, delay, and hop count constrained with limited bandwidth. The new algorithm was implemented on four different capacity networks with random network parameters, the results showed that the shortest path under constraints can be found in a reasonable time. The experimental results showed that the algorithm always found the shortest path with minimal constraints

Fistules perilymphatiques post-traumatiques

Introduction : La fistule péri-lymphatique (FPL) post-traumatique réalise une communication anormale entre le compartiment liquidien périlymphatique et l’oreille moyenne. Son diagnostic est souvent difficile du fait du tableau clinique parfois incomplet. L’imagerie est indispensable afin d’étayer le diagnostic. Le traitement repose sur la chirurgie.Matériel et méthodes : Il s’agit d’une étude rétrospective à propos de 13 patients colligés sur une période de 13 ans (1996-2008). Un examen ORL complet, une audiométrie et une imagerie (tomodensitométrie des rochers) ont été réalisés dans tous les cas. Tous les patients ont bénéficié d’un traitement médical et ont été opérés sous anesthésie générale. Le contrôle ultérieur était clinique, audiométrique et radiologique avec un recul moyen de 22 mois.Résultats : L’âge moyen était de 29 ans (20-47 ans) et le sex-ratio 3,33. Les signes fonctionnels étaient essentiellement représentés par l’hypoacousie dans 12 cas (92,3%), les vertiges dans 11 cas (84,6%) et les acouphènes dans 4 cas (30,8%). L’écoulement d’un liquide eau de roche par l’oreille a été rapporté par 2 patients (15,4%). L’examen clinique trouvait un nystagmus spontané battant du côté controlatéral au traumatisme chez un seul patient, et un signe de la fistule positif chez 2 patients (15,4%). A l’audiométrie, 9 patients (69,3%) avaient une surdité de perception ou mixte dont 6 cas de cophose. Une surdité de transmission a été objectivée dans 3 cas. Un patient avait une audition subnormale. La TDM des rochers a montré une fracture extra-labyrinthique dans 5 cas (38,5%) et une fracture trans-labyrinthique ou mixte dans 6 cas (46,2%). Un pneumolabyrinthe a été constaté chez 5 patients (38,5%). Une exploration chirurgicale a été indiquée chez tous les patients. En per-opératoire, une FPL a été mise en évidence dans tous les cas. Le siège de la fistule était au niveau du promontoire et/ou au niveau des fenêtres. Un colmatage de la fistule a été réalisé dans tous les cas. Les matériaux utilisés étaient essentiellement de l’aponévrose temporale superficielle, du périchondre tragal et de la graisse. En post-opératoire, les vertiges se sont améliorés chez 9 patients parmi les 11 vertigineux (81,8%). L’audition était améliorée chez 2 patients parmi les 9 ayant une surdité de perception ou mixte (18,2%).Conclusion : La fistule périlymphatique post-traumatique est de diagnostic difficile. Celui-ci est étayé par un faisceau d’arguments cliniques et paracliniques et n’est confirmé qu’en per-opératoire. L’indication d’une exploration chirurgicale et son délai dépendent essentiellement de la symptomatologie clinique et de son évolution dans le temps.Mots-clés : fistule périlymphatique, traumatisme, vertige, surdité, tomodensitométrie, chirurgieIntroduction: Post-traumatic perilymphatic fistula (PLF) realises an abnormal communication between the perilymphatic fluid compartment and the middle ear. Its diagnosis is often difficult because the clinical presentation is sometimes incomplete. Imaging is essential in order to support the diagnosis. Treatment is based on surgery.Materials and Methods: We carry a retrospective study about 13 patients collected over a period of 13 years (1996-2008). A complete ENT examination, audiometry and imaging (petrous CT scan) were performed in all cases. All patients received medical treatment and were operated under general anaesthesia. Subsequent control was clinical, radiological and audiometric with a mean period of 22 months.Results: Mean age was 29 years (20-47 years) and sex ratio 3.33. Symptoms were mainly hearing loss in 12 cases (92.3%), vertigo in 11 cases (84.6%) and tinnitus in 4 cases (30.8%). Flow of liquid from the ear was reported by 2 patients (15.4%). Clinical examination showed spontaneous nystagmus beating to the contralateral side of the trauma in one patient, and a positive sign of the fistula in 2 patients (15.4%). At audiometry, 9 patients (69.3%) had sensorineural or mixed deafness, of which 6 cases of cophosis. Transmission deafness was found in 3 cases. One patient had a subnormal hearing. Petrous CT scan showed extra-labyrinthic fracture in 5 cases (38.5%) and trans-labyrinthic or mixed fracture in 6 cases (46.2%). A pneumolabyrinth was found in 5 patients (38.5%). Surgical exploration was indicated in all patients. PLF was found in all cases. The localization of the fistula was at the promontory and / or at the windows. Blockage of the fistula was achieved in all cases. Materials used were essentially superficial temporal fascia, tragal perichondrium and fat. Postoperatively, vertigo improved in 9 patients among 11 (81.8%). Hearing was improved in 2 patients among the 9 having sensorineural or mixed deafness (18.2%).Conclusion: Post-traumatic perilymphatic fistula trauma is difficult to diagnose. This is supported by a beam of clinical and paraclinical arguments, and is confirmed intraoperatively. The indication for surgical exploration and its delay depend mainly on clinical symptomatology and its evolution over time.Keywords: perilymphatic fistula, trauma, vertigo, deafness, CT scan, surger