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AIM: This was a prospective double-blinded randomized comparative study. Several authors have reported the efficacy of platelets derivatives for spinal union. However, the use of PRP and PRF for bone fusion with TLIF has not been fully explored. METHODS: Standard open TLIF surgery was performed on 80 patients, randomized in three groups, TLIF and local bone were used in 40 patients (control group) and TLIF, local bone, and PRP were used in 20 patients (PRP group) and PRF was used in 20 patients (PRF group). Radiological parameters were assessed by X-ray after 3 months post-operative to evaluate the position of the screws and cage migration and by CT scans at 6 months and 12 months postoperatively. Patients, surgeons, and post-surgical analysis were blinded. RESULTS: VAS scores for lower back pain and leg pain were statistically significant between the three groups preoperatively. The VAS scores of back pain improved after 12 months and were statistically significant (p < 0.001) and the VAS score of leg pain improved compared with preoperatively in the three groups during the 6- and 12-month follow-up postoperatively, however, the three groups, VAS scores for leg pain were not significantly different. After 1-year follow-up, significantly more patients achieved definite fusion, when implanted platelets derivatives compared with the control group, but with no significance regarding fusion rates. CONCLUSION: We advocated using platelet derivative as a fusion enhancer modality which is cost and time saving. It appears to be a complementary step that ensures better outcome for the patients.

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.

Background: Breast cancer related lymphedema represents a major complication of breast cancer treatment, impacting the quality of life of breast cancer survivors. Patients with lymphedema need to conduct lifelong self care activities to control the progression of swelling, manage lymphedema-associated symptom burden, and minimize long term negative outcomes. Aim: This study aimed to assess knowledge and self care practices of women with breast cancer related lymphedema. Study design: A descriptive study design was utilized to conduct this study. Setting: This study was conducted in the outpatient breast clinic at Oncology Center and Nuclear Medicine, affiliated to Ain Shams University Hospitals. Subjects: A purposive sample of 50 women newly diagnosed with breast cancer related lymphedema, post mastectomy, and treated with radiotherapy. Data collection tools: A structured interview questionnaire for women with breast cancer related lymphedema, and self care practices questionnaire. Results: The mean age of the studied women was 47.71±7.16, and about one fifth of them had satisfactory level of total knowledge regarding breast cancer related lymphedema, also; the minority of them had adequate level of total lymphedema self care practices. Moreover there is statistically significant difference between the self care practices of the studied women and their educational level. Conclusion: The majority of the studied women had unsatisfactory knowledge regarding breast cancer related lymphedema, and almost of them had inadequate lymphedema self care practices. Recommendations: Educational programs about lymphedema and risk reduction methods after the breast surgery are strongly needed. Also, continuous in service educational programs should be held for all the health care team working in breast cancer units. In addition, further researches are recommended to assess barriers to self care among patients with breast cancer related lymphedema.

Background: Subcutaneous enoxaparin administration often causes problems such as pain; bruise and hematoma at the injection sites. In terms of these problems, cold application has been found to have various therapeutic benefits as relieve pain by produce localized anesthetic effect and controls bleeding by causing vasoconstriction. Aim of the study: To investigate the effect of cold application on local problems among patients receiving subcutaneous enoxaparin. Design: Self controlled trial design was utilized. Setting: The study was carried out in general surgery department, orthopedic surgery department, and chest Intensive Care Unit at Beni-seuf University Hospital. Study subjects: A purposive sample of 60 patients was included in the study. Data collection tools: Data were obtained through Patient assessment tool, Bruising Category Scale, Visual Analogue Scale for pain and Hematoma Formation Scale. Results: All studied patients had pain and more than half developed bruise at injection site when they received enoxaparin without cold application but more than three quarter of studied patients had pain and less than one quarter developed bruise when they received injection with cold application. Meanwhile, the majority of the studied patient did not develop hematoma whether cold applied at injection site or not. Conclusion: The pre-injection cold application at enoxaparin injection site was effective in reducing the occurrence of pain and bruising. Moreover, there was statistically significant relation between the patients’ pain intensity, the size of bruising and their demographic characteristics; age and gender. Recommendations: Cold application should be included in standard protocol for the administration of SC enoxaparin and providing on-going and regular in-service educational programs about it for nurses.

Background: The rise of Primary Percutaneous Coronary Intervention (PPCI) procedure as an option for treating Coronary Artery Diseases demands addressing a variety of concerns in the recovery period and afterward including fasting the Ramadan month in the countries with the prevailing Muslim population. Therefore this study aims to assess the ability and the safety of fasting among patients who underwent PPCI within two specified periods.Method: This study was a prospective observational study with a sample size of 200 consecutive patients that have been divided into two groups based on the duration of their last PCI for an attack of Acute Myocardial Infarction (AMI). The patients were admitted to the Causality Department of the Surgical Specialty Hospital-Cardiac Center, Erbil/Iraq. The studied data have been analyzed using the Statistical Package for Social Science version 25 (SPSS), and a P-value of ≤0.05 was considered statistically significant.Results: The proportion of fasting and non-fasting patients showed a significant association with the duration of their last PCI procedure with a P-value of 0.001 as 14% in Group I (patients with less than 6 weeks duration post-PCI) successfully fasted the month while it was 54% in Group II (Patients with more than 6 weeks duration post PCI). Among our findings, there were significant associations with P-values of 0.001 between post-PCI symptoms and Ramadan fasting. In regards to NYHA classifications assessment, Group I had a higher proportion of patients classified as Class III and Class IV compared to Group II with a significant P-value of 0.001 with proportions of class III classification in Group I of 14.3% among fasting, 17.1% among non-fasting, and 58.3% among those who could not continue their fasting while in Group II, the proportions showed 3.7% among fasting, 6.7% among non-fasting, and 0% among those who could not continue their fasting.Conclusion: We discourage fasting among patients who have undergone Percutaneous Coronary Intervention within the first 6 weeks, as well as patients who have NYHA class III and above as they are highly liable for deterioration and can not continue their fasting.

Context: Hepatocellular carcinoma (HCC) is considered one of the most challenging tumors with high incidence, prevalence, and mortality rates. Radiofrequency Ablation (RFA) is one of the emerging therapeutic modalities used for the minimally invasive treatment in the management of early-stage HCC. Aim: This study aimed to assess the effect of self-care guidelines on quality of life for patients with Hepatocellular Carcinoma undergoing Radio Frequency Ablation. Methods: A quasi-experimental design was used to achieve the aim of this study. This study was conducted at the Interventional Radiology Unit, affiliated to Ain Shams University Hospital, on a purposive sample of 50 patients with hepatocellular carcinoma; 25 randomly allocated to the study group, and 25 allocated to the control group. A structured interview questionnaire for patients with hepatocellular carcinoma undergoing radiofrequency ablation was used to collect the study data. It comprises three parts: Sociodemographic characteristic, assessment of patients' medical health, and knowledge about HCC and RFA. The second tool was the quality of life of cancer survivors questionnaire (pre /posttest), and finally, a patient-reported self-care practices assessment checklist (pre /posttests). Results: There were statistically significant differences between the study and control groups regarding their total knowledge about hepatocellular carcinoma and radiofrequency ablation therapy pre and post-implementation of self-care guidelines. There were highly statistically significant differences between both groups regarding the total quality of life, pre and post-implementation of self-care guidelines. In addition, there were highly statistically significant differences regarding total self-care practice, pre, and post-implementation of self-care guidelines. A positive correlation was revealed between total knowledge with total self-care practice and total quality of life (pre/posttest). Also, a significant correlation was revealed between the total quality of life and self-care practices post self-care guidelines implementation at (p

Background: Intensive Care Unit Acquired Muscle Weakness (ICU-AW) is one of the most important complications occurs in the ICU. ICU-AW is a multifactorial syndrome characterized by generalized muscle weakness. Critical care nurses (CCNs) have an important role in the prevention of ICU-AW through increase mobility and applying of range of motion. Design: A descriptive exploratory design was utilized to achieve aim of this study. Aim: This study aimed to assess factors contributing to acquired muscle weakness among critical ill patients. Setting: the study was carried out in intensive care units of Beni–Suef University Hospital. Subjects: A Purposive sample of seventy five patients admitted in the previous mentioned setting. Tools of data collection were consisted of Patient assessment tool, muscle strength scale and indicators to incidence of ICU-AW and factors contributing to ICU-AW assessment tool. Results: revealed that more than half of the studied patients had ICU-AW. The majority of studied patients who had muscle weakness were older than the Non ICU-AW patients. Application of positioning and range of motion exercises were not done in the ICU-AW patients. Administration of corticosteroid and incidence of malnutrition was higher in the ICU-AW patients than the Non ICU-AW patients. There were no statistically significant relation between incidence of ICU-AW and gender, admission medical diagnosis, administration of parenteral nutrition and application of positioning and walking exercises. Conclusion: More than half of studied patients developed ICU-AW. The contributing factors of ICU-AW are patient age, WBCs level, not applying range of motion and chair sitting exercise to ICU patients, administration of corticosteroid and malnutrition. Recommendations: Further researches are recommended to study extensively the effect of nutritional status on incidence of ICU-AW. Also, examine the incidence of ICU-AW in sedated and unconscious patients.

Background: Non-Hodgkin's lymphoma patients undergoing chemotherapy have symptoms that continue to place a significant burden and preventing them from living normally. This requires non-hodgkin's lymphoma patients to engage in a range of self-management actions. The aim of this study was to assess the effect of self-management guidelines on chemotherapy associated symptoms among non-Hodgkin lymphoma patients. Design: A quasi experimental design. Setting: the study was conducted at the hematology unit in Ain Shams University Hospital. Subjects: A purposive sample of 76 adult patients. Data collection tools: Three tools were used in this study, structured interview questionnaire for the non-hodgkin's lymphoma patients undergoing chemotherapy, self-care practices questionnaire, and symptoms experience tools. Results: Regarding total level knowledge, 28.9% of the studied patients had satisfactory level of total knowledge pre implementation of self-management guidelines which improved to 65.8% with a highly significant difference post implementation of self-management guidelines (P≤ 0.001). While 26.3% of the studied patients had satisfactory level of total self-care practices pre implementation of self-management guidelines which improved to 57.9% with a highly significant difference post implementation of self-management guidelines (P≤ 0.001). There was a significant improvement on patients` symptoms experience post implementation of self management guidelines. Conclusion: The implementation of self-management guidelines for patients with non-Hodgkin's lymphoma undergoing chemotherapy has a statistically significant positive effect on their knowledge, self-care practice and associated symptoms which support the stated hypothesis. Recommendation: This study recommends the importance of developing tailored self-management programs for fatigue, nausea, vomiting and oral mucositis to understand and promote chemotherapy associated symptoms self-management in patients with non-hodgkin's lymphoma disease.

Background: Hospital acquired anemia (HAA) is one of the most common intensive care unit (ICU) acquired complications that associated with poor outcomes, increase morbidity and mortality for critically ill patients. Factors contribute to its development include profound loss of RBCs or insufficient RBCs production. Aim of the study: to assess factors contributing to HAA among critical ill patients. Design: A descriptive exploratory design was utilized. Setting: The study was carried in Beni –Suief university hospital inside the critical care units which include; general ICU, cardio care unit (CCU) and chest ICU. Study subjects: purposive sample of 75newly admitted adult critically ill patients to the above mentioned sitting was included in the study. Data collection tools: Data were obtained through patients assessment tool, factors contributing to HAA and indicators of HAA tool. Results: reveals that, nearly one third of studied patients their age were more than or equal fifty years. As regard to gender, the results revealed that, more than half of them were males, nearly one third of anemic patients had HAA in the 5th day from admission to hospital. As well more than three quarter of anemic patients were under feeding and more than one third of them had sepsis, in addition to mean amount of blood loss for anemic patients exceed amount of blood loss for non anemic patients. Conclusion: More than half of studied patients developed HAA during their ICU stay. Even, non-anemic patients were subjected to a decline in their Hb level. As well as, there were statistically significant relation between nutrition deficiency, sepsis, blood loss in ICU and drugs increase RBCs loss factors and occurrence of HAA. Also there were insignificant relation between demographic characteristic of studied patients, their diagnosis on admission to hospital, hemodilution, drugs affect RBCs production and occurrence of HAA. Recommendations: Designing in-service training and educational program for nurses about blood conversation strategies especially prevention of blood loss associated invasive procedure and phlebotomy practice.

Objectives:Patients with impaired renal functions have a variable risk of morbidity and mortality in cardiovascular surgery. Poor outcome was reported among patients who underwent valve surgery. Current study is presumed to compare the early outcomes of patients having different degrees of impaired renal functions and undergoing mitral valve replacement surgery. Methods:135 patients were admitted into the three highly specialized centers in Cairo and Ismailia–Egypt between Dec.2018 and Jan.2020 Preoperative, intraoperative and early post-operative data were recorded. Impairment may present as one of these strata: early reversible (G1-2 included strata 1 & 2 kidney disease patients), moderate G3-4 included strata 3 & 4 kidney disease patients) or advanced irreversible renal damage. (The 5th stratum or G5-KD included end stage renal disease patients undergoing 4-hour hemodialysis sessions, three times a week, with bicarbonate dialysate). We correlated outcome among each stratum with cardiac and renal functions in that stratum. Results:The more is the impairment of renal functions at any peri- operative stage, the longer is the need for prolonged mechanical ventilation and the longer is the hospital stay. We found that levels of serum creatinine were significantly increased postoperatively Also, the more is the reversibility of the renal impairment, even by renal dialysis, the much better is the outcome (P=.0019). We also found insignificant difference between different strata of irreversible renal impairment in the early outcome of the prosthetic mitral valve replacement surgery. The early reversible damage can be repaired peri-operatively. Conclusions:Prosthetic mitral valve replacement among patients with different degrees of impaired renal functions is not only feasible but also it does not seem to add any more deterioration into renal function. Prolonged mechanical ventilation and hospital stay are the only drawbacks of irreversibly impaired renal damage by dialysis or renal transplant.

Background Ischemic heart disease (IHD) is a common cause of death, which encourages us to improve continuously the techniques adopted for coronary artery bypass grafting (CABG). Still the most commonly used graft is saphenous vein harvested by different techniques. Methods This prospective randomized study included 60 patients with IHD in need of CABG classified into two equal groups: group A (saphenous vein harvesting with conventional technique) and group B (saphenous vein harvesting with lens assisted bridging technique [LABT]). We compared the two groups in terms of preoperative, intraoperative and postoperative data then we statistically analysed the findings. Results Our study showed that LABT had significantly less pain, less infection, more cosmetic, less hospital stay with more patient satisfaction and without any additional costs. Conclusions Our study showed that lens assisted bridging vein harvesting was a good substitute for conventional technique.

Introduction: Cerebrovascular Background: Critical care nurses are expertly trained to care for critically ill patients; however, many critical care nurses feel inadequately prepared to provide end of life care to patients in the intensive care unit. The nurses attribute this to lack of support and training on end-of-life care. The study aim was to assess effect of self-learning package (SLP) on critical care nurses' performance regarding care for end of life patient. Methods, Design: To achieve this aim a quasi-experimental design was utilized. Subjects and setting: A convenient sample of 60 nurses was selected from surgical, medical and neurological ICU of Ain-Shams university hospitals. Study results: Regarding demographic characteristics. This study revealed that, 58.3% of the studied subjects were less than 30 years, 83.3% were female, 75.0% were diploma nurses, 46.7% of them had ten or more years of experience, and 81.7% had no training related to end of life care. Regarding knowledge and practice 15.0% & 23.3% respectively of the study subjects had satisfactory knowledge and practice related to care for end of life patient in pre phase, 80.0% & 81.7 % respectively in post implementation of self-learning package and 60.0% &45% had a satisfactory knowledge and practice in follow up phase. While regarding attitude, positive attitude was 5%, 80% and 55% respectively in pre, post and follow up phases Conclusion: The current study concluded that there was highly statistically significant increase of total score of nurses' knowledge, practice and total score of nurse’s attitude pre/post, pre/follow up and post/ follow up phases of SLP implementation. there was statistically significant positive effect for SLP on nurses' knowledge, practice and attitude. Recommendations; conduction of further researches in end of life care to enrich, improve, & update nurse's knowledge, practice and attitude. Periodic in-services education program regarding end of life care and self-learning package to be performed for patients are recommended.

Scientific knowledge has advanced to enable the development of inhaled insulin. It is a form of diabetes medication administered via the pulmonary system that studies have shown to be efficacious in the treatment of both type 1 and type 2 diabetes. Inhaled insulin is a new, safe means to deliver insulin that may increase patient compliance with insulin therapy, helping them to achieve optimal glycemic control and possibly reducing their risk of developing cardiovascular complications. However, diabetes is a chronic illness requiring lifetime intervention. Empowering patients with the knowledge of the diabetes disease process may give them the confidence to be more autonomous in managing their diabetes. HIIP gives nurse practitioners a new option that may improve their patients’ acceptance of insulin therapy, and improve glycemic control.

Context: Exercise interventions are the cornerstone of cardiac rehabilitation. The exercise program consists of respiratory physiotherapy, neck and shoulder exercises, walking, and cycling. The purpose is preventing respiratory complications, neck and shoulder pain, and increasing the physical functional level. Aim: of this study is to evaluate the effect of applying nursing exercise protocol on hemodynamics and functional capacity among post-cardiac surgery patients. Methods: Quasi-experimental research design utilized in the current study. A purposive sample including 60 male and female patients, classified equally into two equal groups; study group (n= 30) and control group (n= 30), collected through 14 months. This study carried out in the inpatient cardiac surgery department and the outpatient cardiac clinic of Cardiothoracic Surgery Hospital at New Minia City. Four tools utilized in collecting data; named Health Assessment Record; Six Minute Walk Distance Test; Modified Medical Research Council Scale (MMRC) for measuring dyspnea; and Nursing Educational Protocol Checklist. Results: Current study findings displayed an improvement of total distance walked among study group compared to control group, it also showed highly statistically significant differences between both groups related to total distance walked after 12th-week post-discharge documented by p-value (0.000). Conclusion: The current study findings concluded that the nursing educational protocol in the form of deep breathing, incentive spirometer; coughing and early ambulation induces a significant improvement in hemodynamic variables and six minute walk distance recommending that hospitals should implement nursing educational protocol as a routine hospital policy among all cardiac surgical patients in all age groups.

Aim of The study to assess the mothers’ knowledge about breast Feeding, bottle Feeding and weaning of their Infants. This study was carried out in all MCH centers at Minia city. Descriptive research design was used to meet the aim of study. A convenient sample included 1000 mothers who were attending MCH centers.A structured interview sheet was developed by the researcher based on review of relevant literature. It included 2 parts: Part I; included sociodemographic characteristics of the mother and child, Part II; included items related to mothers’ knowledge about breast feeding, bottle feeding, and weaning. There were highly statistical significant differences between total knowledge of mother about breast feeding and all her socio-demographic characteristics. There was a positive relationship between maternal education and increased knowledge about infant feeding. Conclusion of this study illustrated that there is a relationship between knowledge of mother about breast feeding, bottle feeding ,and weaning and her socio-demographic characteristics and that there is a relationship between the education of mother with her knowledge about pattern of breast feeding, bottle feeding, and weaning and that there is a relationship between the occupation of mother and knowledge about exclusive breast feeding, duration of exclusive breast feeding. The study recommended that there is a dire need to arrange for health education program sessions for mothers with main emphasis on importance of colostrum’s feeding, exclusive breast feeding & suitable age of starting and complete weaning.

Background and objective: The goal of this study was to determine the association of complete left bundle branch block (LBBB), site , severity & risk factors of coronary artery disease (CAD). Complete Left bundle branch block increases the risk of cardiac mortality, and prognosis is primarily determined by the underlying CAD. Because the presence of complete LBBB makes the noninvasive identification of CAD less informative, patients with complete LBBB often are referred for coronary angiography to assess the presence and severity of CAD. Methods: A total of 150 consecutive patients with complete LBBB admitted to the coronary care unit were enrolled from the age of 27 to 81 years with the mean age of 59.32 ± 10.5. Male 84 (56%), Female (44%). History, basal investigations echocardiography and virology screen were performed. Coronary angiography has been done for all patients for different reasons of presentation. Results: Critical CAD 70 (46.7%), Left ventricular systolic dysfunction (LVSD) 50 (33.3%). Hypertension found in 83 (55.3%), diabetes mellitus (DM) in 44 (30%), DM& left ventricular systolic dysfunction(LVSD) were more associated with critical CAD. Conclusion: In our study complete LBBB was more common among hypertensive patients. In DM patients was associated with severe CAD. With Left anterior descending artery being the most common artery involved.

Background: The Western-style diet is characterised by the high intake of energy- -dense foods. Consumption of either high-fructose diet or saturated fat resulted in the development of metabolic syndrome. Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome. Many researchers studied the effect of high-fat diet (HFD), high-fructose diet (HFruD) and high-fructose high-fat diet (HFHF) on the liver. The missing data are the comparison effect of these groups i.e. are effects of the HFHF diet on the liver more pronounced? So, this study was designed to compare the metabolic and histopathological effect of the HFD, HFruD, and HFHF on the liver. The proposed underlying mechanisms involved in these changes were also studied. Materials and methods: Twenty four rats were divided into four groups: con- trol, HFD, HFruD, and HFHF. Food was offered for 6 weeks. Biochemical, light microscopic, immunohistochemical (Inducible nitric oxide synthase [iNOS] and alpha-smooth muscle actin [ α -SMA]), real-time polymerase chain reaction (gene expression of TNF- α , interleukin-6, Bax, BCL-2, and caspase 3), histomorphometric analysis and oxidative/antioxidative markers (thiobarbituric acid reactive substances [TBARS], malondialdehyde [MDA]/glutathione [GSH] and superoxide dismutase [SOD]) were done. Results: The HFD, HFruD and HFHF groups developed a cluster of liver disorders; steatosis, necrosis, inflammation, apoptosis, ballooning degeneration and cytopla- smic vacuolations. Internal metabolic impairments include elevated serum levels of glucose, triglycerides, low density lipoprotein and decreased serum levels of high density lipoprotein and albumin. The immunoreaction of the α -SMA and iNOS was strong in these groups. The oxidant markers (MDA and TBARS) were elevated, while the antioxidant markers (SOD and GSH) were decreased. The area per cent of collagen, inflammatory markers, caspase 3 and Bax were elevated, while the BCL-2/Bax ratio was decreased. The decrease in PAS, antioxidant markers and the elevation of the α -SMA, iNOS, inflammatory and oxidant markers were obvious in the HFHF when compared to that of the other groups. Conclusions: High-fat diet, HFruD, and HFHF developed morphologic hepatic changes ranging from steatosis to necrosis and inflammation, besides the deve- lopment of internal metabolic impairments. The chief factors of hepatic injury were fat accumulation in the hepatocytes, oxidative stress and highly elevated iNOS. Compared to the other groups, HFHF’s effect was more prominent.