Recurrent pregnancy loss at gynecology and obstetrical hospital in Duhok Province

Background: Recurrent pregnancy loss is physically and emotionally harmful for mothers. This study aimed to find out the prevalence and associated factors of recurrent pregnancy loss (RPL) in pregnant women in Duhok province.Methods: In this retrospective study, the medical records of the patients who had pregnancy loss and registered in Duhok Maternity Hospital were reviewed for the period of January - December 2019. Accordingly, 300 women aged 18 years and older with pregnancy loss were included in this study.Results: The prevalence of EPL was 16.3%. The study found that patients with RPL were statistically older compared to those patients without RPL, (39.27 vs. 33.24 years; P<0.001), respectively. Besides, the RPL group had a significantly higher percentage of family history of pregnancy loss (12.24% vs. 1.20%; P<0.001). The patients with RPL had significantly higher prevalence of Chlamydia trachomatis (14.29% vs. 3.59%; P=0.002), cervical incompetence (8.16% vs. 0.80%; P=0.002), structural abnormalities of uterus (14.29% vs. 4.8%; P=0.012), and polycystic ovary syndrome (PCOS) (40.82% vs. 11.95%; P<0.001). There was no significant association of RPL with smoking (P=0.261).Conclusions: This study revealed a high prevalence of RPL in patients with pregnancy loss. Also, the study showed that the patients in the RPL group were significantly older and had a higher prevalence of medical illnesses; including chlamydia trachomatis, cervical incompetence, structural anomalies of the uterus, and polycystic ovarian syndrome

Design and Development of Low Cost Certified Green Building for Non Residential Existing Building (NREB)

The Green Building Index (GBI) is one of rating tool which are provides a prospect for building developers and owners for designing and constructing a green and sustainable buildings. The proposed low cost GBI buildings provide many advantages such as energy savings, water savings, a healthier indoor environment, and better connectivity to public transport. Besides, adoption of recycling and greenery for the projects and can reduce the impact on the environment. However, the implementation to certify as Green Building Index has a lot of concerns such as cost constraint, know how constraints and etc. Therefore, in this paper, the design and development of low cost certified green building by fulfilling the Green Building Index (GBI) is proposed in order to ease the development of green building to have better life for human and environment in this world in term of energy efficiency performances

Relevant Problem of a Hydraulic Jump at Diyala Weir and the Proposed Remedy

This study aims to analyze the Diyala weir problems and compares it with the safe limit and proposes the treatment for these problems. One of the most influencing problems in the site of weir was the formation of the hydraulic jump, it was found that the scour occurs due to the position of the hydraulic jump and the sequence depth of the jump is higher than the tail water depth. Some treatment procedures are suggested, these treatments cover this problem by presenting a suitable stilling basin as well as recommended to use a low weir at end of basin to produce a back water curve that should be increase the stage of tail water and ensuring the stability of a hydraulic jump

Reusing of Treated Wastewater by Membrane Bioreactorin Irrigation

Membrane Bio Reactor(MBR) methods is considered as one of the most advanced used technology in waste water treatment. The aim of this technology is to obtain high quality treated waste water. This study conducted to investigate the ability of using of sewage water from zaafrania city for irrigation and their effect on corn growth and some of soil chemical properties which include electrical conductivity and soil pH in extract soil paste and the micro nutrient content in soil and plant which include Fe, Mn, Zn, Cu, Cd, Pb. Three levels of wastewater were used 0, 50, 100% in two stages, the three levels of wastewater ( without soil fertilization ) were used in the first stage, where 21.8 Kg P/D +80 N Kg/D was added to the soil as fertilizer in the control 0% treatment and 10.9Kg P/D +40 Kg N/D were added to 50 and 100% levels in the second stage. Corn seeds were planted in 10kg plastic pots in Completely Randomized Block Design in three replicates. The results refer to a high significant increase in plant height, fresh and dry weight for all treatments in comparison with control treatment. The low add level of wastewater 50%+ half of fertilizer recommendation gives a significant increase of plant height and fresh and dray weight. The results showed a high increased of electrical conductivity for 50, 100% wastewater added levels for both stages compared with control treatment. The high add level 100% gives high significant increase of electrical conductivity compared with the low level of the wastewater. Whereas the values of soil PH were close to the neutral for all treatment. The result showed a significant increase in micro nutrients content (which include Fe, Mn, Zn, Cu, Cd, Pb) in soil and plant for all treatment compared with control treatment, this increased was continues with the increase of additional level of wastewater. However all the micro nutrient was within the allowed natural limits and not reached the toxic limits in soil and plant

Study protocol on Enhanced Primary Healthcare (EnPHC) interventions: a quasi-experimental controlled study on diabetes and hypertension management in primary healthcare clinics

Aim: This paper describes the study protocol, which aims to evaluate the effectiveness of a multifaceted intervention package called ‘Enhanced Primary Healthcare’ (EnPHC) on the process of care and intermediate clinical outcomes among patients with Type 2 diabetes mellitus (T2DM) and hypertension. Other outcome measures include patients’ experience and healthcare providers’ job satisfaction. Background: In 2014, almost two-thirds of Malaysia’s adult population aged 18 years or older had T2DM, hypertension or hypercholesterolaemia. An analysis of health system performance from 2016 to 2018 revealed that the control and management of diabetes and hypertension in Malaysia was suboptimal with almost half of the patients not diagnosed and just one-quarter of patients with diabetes appropriately treated. EnPHC framework aims to improve diagnosis and effective management of T2DM, hypertension or hypercholesterolaemia and their risk factors by increasing prevention, optimising management and improving surveillance of diagnosed patients. Methods: This is a quasi-experimental controlled study which involves 20 intervention and 20 control clinics in two different states in Malaysia, namely Johor and Selangor. The clinics in the two states were matched and randomly allocated to ‘intervention’ and ‘control’ arms. The EnPHC framework targets different levels from community to primary healthcare clinics and integrated referral networks. Data are collected via a retrospective chart review (RCR), patient exit survey, healthcare provider survey and an intervention checklist. The data collected are entered into tablet computers which have installed in them an offline survey application. Interrupted time series and difference-in-differences (DiD) analyses will be conducted to report outcomes

Identifying associations between diabetes and acute respiratory distress syndrome in patients with acute hypoxemic respiratory failure: an analysis of the LUNG SAFE database

Background: Diabetes mellitus is a common co-existing disease in the critically ill. Diabetes mellitus may reduce the risk of acute respiratory distress syndrome (ARDS), but data from previous studies are conflicting. The objective of this study was to evaluate associations between pre-existing diabetes mellitus and ARDS in critically ill patients with acute hypoxemic respiratory failure (AHRF). Methods: An ancillary analysis of a global, multi-centre prospective observational study (LUNG SAFE) was undertaken. LUNG SAFE evaluated all patients admitted to an intensive care unit (ICU) over a 4-week period, that required mechanical ventilation and met AHRF criteria. Patients who had their AHRF fully explained by cardiac failure were excluded. Important clinical characteristics were included in a stepwise selection approach (forward and backward selection combined with a significance level of 0.05) to identify a set of independent variables associated with having ARDS at any time, developing ARDS (defined as ARDS occurring after day 2 from meeting AHRF criteria) and with hospital mortality. Furthermore, propensity score analysis was undertaken to account for the differences in baseline characteristics between patients with and without diabetes mellitus, and the association between diabetes mellitus and outcomes of interest was assessed on matched samples. Results: Of the 4107 patients with AHRF included in this study, 3022 (73.6%) patients fulfilled ARDS criteria at admission or developed ARDS during their ICU stay. Diabetes mellitus was a pre-existing co-morbidity in 913 patients (22.2% of patients with AHRF). In multivariable analysis, there was no association between diabetes mellitus and having ARDS (OR 0.93 (0.78-1.11); p = 0.39), developing ARDS late (OR 0.79 (0.54-1.15); p = 0.22), or hospital mortality in patients with ARDS (1.15 (0.93-1.42); p = 0.19). In a matched sample of patients, there was no association between diabetes mellitus and outcomes of interest. Conclusions: In a large, global observational study of patients with AHRF, no association was found between diabetes mellitus and having ARDS, developing ARDS, or outcomes from ARDS. Trial registration: NCT02010073. Registered on 12 December 2013

Spontaneous Breathing in Early Acute Respiratory Distress Syndrome: Insights From the Large Observational Study to UNderstand the Global Impact of Severe Acute Respiratory FailurE Study

OBJECTIVES: To describe the characteristics and outcomes of patients with acute respiratory distress syndrome with or without spontaneous breathing and to investigate whether the effects of spontaneous breathing on outcome depend on acute respiratory distress syndrome severity. DESIGN: Planned secondary analysis of a prospective, observational, multicentre cohort study. SETTING: International sample of 459 ICUs from 50 countries. PATIENTS: Patients with acute respiratory distress syndrome and at least 2 days of invasive mechanical ventilation and available data for the mode of mechanical ventilation and respiratory rate for the 2 first days. INTERVENTIONS: Analysis of patients with and without spontaneous breathing, defined by the mode of mechanical ventilation and by actual respiratory rate compared with set respiratory rate during the first 48 hours of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: Spontaneous breathing was present in 67% of patients with mild acute respiratory distress syndrome, 58% of patients with moderate acute respiratory distress syndrome, and 46% of patients with severe acute respiratory distress syndrome. Patients with spontaneous breathing were older and had lower acute respiratory distress syndrome severity, Sequential Organ Failure Assessment scores, ICU and hospital mortality, and were less likely to be diagnosed with acute respiratory distress syndrome by clinicians. In adjusted analysis, spontaneous breathing during the first 2 days was not associated with an effect on ICU or hospital mortality (33% vs 37%; odds ratio, 1.18 [0.92-1.51]; p = 0.19 and 37% vs 41%; odds ratio, 1.18 [0.93-1.50]; p = 0.196, respectively ). Spontaneous breathing was associated with increased ventilator-free days (13 [0-22] vs 8 [0-20]; p = 0.014) and shorter duration of ICU stay (11 [6-20] vs 12 [7-22]; p = 0.04). CONCLUSIONS: Spontaneous breathing is common in patients with acute respiratory distress syndrome during the first 48 hours of mechanical ventilation. Spontaneous breathing is not associated with worse outcomes and may hasten liberation from the ventilator and from ICU. Although these results support the use of spontaneous breathing in patients with acute respiratory distress syndrome independent of acute respiratory distress syndrome severity, the use of controlled ventilation indicates a bias toward use in patients with higher disease severity. In addition, because the lack of reliable data on inspiratory effort in our study, prospective studies incorporating the magnitude of inspiratory effort and adjusting for all potential severity confounders are required

Epidemiology and patterns of tracheostomy practice in patients with acute respiratory distress syndrome in ICUs across 50 countries

Background: To better understand the epidemiology and patterns of tracheostomy practice for patients with acute respiratory distress syndrome (ARDS), we investigated the current usage of tracheostomy in patients with ARDS recruited into the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG-SAFE) study. Methods: This is a secondary analysis of LUNG-SAFE, an international, multicenter, prospective cohort study of patients receiving invasive or noninvasive ventilation in 50 countries spanning 5 continents. The study was carried out over 4 weeks consecutively in the winter of 2014, and 459 ICUs participated. We evaluated the clinical characteristics, management and outcomes of patients that received tracheostomy, in the cohort of patients that developed ARDS on day 1-2 of acute hypoxemic respiratory failure, and in a subsequent propensity-matched cohort. Results: Of the 2377 patients with ARDS that fulfilled the inclusion criteria, 309 (13.0%) underwent tracheostomy during their ICU stay. Patients from high-income European countries (n = 198/1263) more frequently underwent tracheostomy compared to patients from non-European high-income countries (n = 63/649) or patients from middle-income countries (n = 48/465). Only 86/309 (27.8%) underwent tracheostomy on or before day 7, while the median timing of tracheostomy was 14 (Q1-Q3, 7-21) days after onset of ARDS. In the subsample matched by propensity score, ICU and hospital stay were longer in patients with tracheostomy. While patients with tracheostomy had the highest survival probability, there was no difference in 60-day or 90-day mortality in either the patient subgroup that survived for at least 5 days in ICU, or in the propensity-matched subsample. Conclusions: Most patients that receive tracheostomy do so after the first week of critical illness. Tracheostomy may prolong patient survival but does not reduce 60-day or 90-day mortality. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013