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Background: Complications associated with ventriculoperitoneal shunt insertion constitute a significant cause of morbidity and mortality among hydrocephalus patients. Despite this, VP shunt placement has remained the mainstay of treatment for hydrocephalus. The aim of this study is to evaluate the complications of VP shunt surgery in our environment and to identify the risk factors associated with it. Methodology: Patients who had VP shunt surgery over a period of two years (Jan 2015–December 2016) were evaluated retrospectively by reviewing their hospital records. The patients’ demography, aetiology and clinical presentation of the hydrocephalus, and complications were analysed using SPSS version 26.0. Results were presented in tables and figures. Results: A total of 69 patients who had VP shunt over the study period had complete medical records available for review. Their age ranged between 2days and 68years with a male to female ratio of 1.8:1. Overall complication rate was 30.4%. Shunt malfunction (11.5%) and shunt infection (7.2%) were the commonest complications recorded. Late presentation was the most important risk factor for shunt complications. Conclusion: The rate of shunt complications seen in this study compares fairly with studies in other parts of the world.

Background: Laryngopharyngeal reflux disease (LPRD) is a condition with nonspecific symptoms and most of times patients present late with advanced disease which may predispose to malignancy. The magnitude and clinical characteristics of this condition are not well known among patients attending Otorhinolaryngology services in Tanzania. Materials and methods: This was a hospital based descriptive cross sectional study, conducted in the wards and clinics of Otorhinolaryngology department of Muhimbili National Hospital. Patients with symptoms of Laryngopharyngeal reflux disease were included in the study. Data was collected using questionnaires and clinical examination forms, were processed and analysed by using SPSS. Results presented in frequency tables, cross tabulations and figures. Results: This study recruited 256 participants among them males were 131(51.2%).The mean age was (41.38 ± 13.94) years. Prevalence of Laryngopharyngeal reflux disease was 18.4% without gender predilection. The commonest symptoms were globus sensation, hoarseness of voice and excessive urge to clear the throat with 95.7%, 88.1% and 83.0% respectively while the most observed signs were thick endolaryngeal mucus, Vocal cord oedema and partial ventricular obliteration with 90.9%, 88.6% and 72.7% respectively. Lying down less than two hours after meal and spices foods consumption were the leading risk factors. Hypertension and Diabetes Mellitus type 2 were the most prevalent co morbid conditions associated with Laryngopharyngeal reflux disease. Conclusion: The prevalence of Laryngopharyngeal reflux disease is high among patients attending Otorhinolaryngology services at Muhimbili national hospital. All patients with Laryngopharyngeal reflux disease related symptoms should get thorough evaluation for early diagnosis and treatment.

This paper presents the findings of an investigation into the compressive and flexural strength of various cement mortars containing very high levels of Class F fly ash (HVFA). A total of twelve cement mortar mixtures with constant water/powder ratios, cement, sand, and Air-Entraining Admixtures (AEA) were subjected to 20, 30, 40, 50, 60, and 70% partial replacement of cement content with Fly Ash (HVFA) class F. The results of the tests show that the compressive and flexural strength decreased slowly as the fly ash content increased to up to 40%, but the strength values began to decrease dramatically with the addition of a higher amount of fly ash. According to the results, the best percentage of cement replacement with fly ash in mortar is 40%. It has 24% less compressive strength and 13% less flexural strength than 20% FA mortar. In general, the air-entraining admixture has no negative effect on the properties of the cement mortars. The measured properties of the hardened mortar are very satisfying.

Background: The gold standard in assessing asthma control is the Global Initiative for Asthma (GINA) criteria. And because of the difficulties of access to pulmonary functions tests, The ACT has the added advantage that it does not require lung function assessment. Objectives: The aim of this study is to assess asthma control through ACT score and GINA guideline, and to determine if the ACT can be as useful as the GINA-guidelines criteria in assessing asthma control in Iraq. Patient and method: Cross sectional study with comparing ACT vs. GINA guideline in control of asthma level. This study was conducted at Respiratory consultation unit of the Iraqi National center of early detection of Cancer, Baghdad-Iraq, The study was conducted during the period from 1stNovember 2012 to 1stJuly 2013. A total of 71 adult asthmatic patients who were attended to the respiratory consultant unit were asked to participate and were enrolled in this study regardless their age or gender. Their asthma diagnosed and proved clinically by a combination of history, clinical finding In addition objective measurements using spirometry(FEV1) measured by the reversibility test which is defined as(an increment of>12% or 200 ml of FEV1 after 20 minutes of administration of inhaled short acting B2-agonist). Result: There were 71 patients enrolled in this study, of them 66 (92.96%) had an ACT score of ≤ 19 ((26) (39.4%) are male),(40)(60.6%) are female ,and 5 patients (7.04%) had an ACT score of > 19 (only(1) (20.0%) is male and and(4)(80.0%) are female. It had been found the number of male is( 27)and(26)(39.4%) out of them had an ACT19 and number of female is(44),(40)(60.6%)out of them had ACT19. No significant differences had been found in between those patients with ≤19 ACT score vs. those with > 19, regarding the age and gender, in both comparison P>0.05 it had been found that good agreement present between ACT and GINA, 92.9%.ACT agreed the GINA in (37 patients with uncontrolled asthma, 24 patients with partially controlled and 5 patients with controlled). Conclusion: ACT can serve as an alternative diagnostic tool in assessing asthma control even without an aid of a spirometer or a peak flow meter. An ACT score of more than 19 can classify patient as controlled asthmatic while an ACT score < 19 can classify the patient as uncontrolled and partially controlled asthmatics.

ABSTRACT Fifty patients with electrocardiographic (ECG) evidence of left Bundle Branch Block (LBBB) and fifty control group with no significant electrocardiographic findings were studied over the period from October 2004 to July 2005 for evidence of Coronary Artery Disease (CAD) and Left Ventricular (LV) dysfunction. Both groups underwent cardiac catheterization and CAD considered present if there was 70% and more lumen diameter stenosis except for Left Main Coronary Artery (LMCA) was 50% and more. LV function was assessed visually and the function was considered normal or abnormal. The CAD was found in 37/50 (74%) of patients with LBBB, it was significantly (P

Background: Lung cancer is the leading cause of cancer deaths and its incidence is rising. The determination of histopathology and stage of primary lung carcinoma is crucial to develop appropriate treatment approach that affects morbidity and mortality. Fiber optic bronchoscope techniques for early detection of lung cancer are a promising tool as they might allow visualizing changes of early lung cancer and also permitting sampling for histological confirmation. Objective: This study was intended to compare the fiber optic bronchoscopy findings and their anatomical locations with the histopathology types in patients with lung cancer. Patient and Methods: A cross section study was conducted during the period from 1st February 2012 to the 31th of July 2013, 49 patients with clinical and radiological findings suggesting primary lung cancer and diagnose later by bronchoscope samples as cases of primary lung cancer chosen for analysis of their bronchoscope findings, at Baghdad teaching hospital / respiratory clinic. Results: Patients with squamous carcinoma (31%) had (67%) visible mass and (13%) presented invisibly as external compression. Patients with adenocarcinoma (41%) had (40%) visible mass and (35%) presented invisibly as external compression while normal bronchoscope was seen in (30%) of those patients so that adenocarcinoma mostly invisible. Patients with small cell carcinoma (28%) had (50%) visible mass and (21%) presented invisibly as external compression.The location of finding in (27%) of the patients with squam. ous carcinoma was in the right main bronchus and (20%) in right upper lobe bronchus while the carina affected in (47%). Patients with adenocarcinoma have vocal cord affected in (25%) and left upper lobe bronchus lesion in (25%). Conclusion: There was no relationship between the fiber optic bronchoscope findings and their anatomical locations with the histological types of lung.

Background: Chronic obstructive pulmonary disease (COPD) is a preventable disease with some significant extra pulmonary effects that may contribute to the severity in individual patients.. The systemic manifestations of COPD include a number of endocrine disorders , such as those involving the pituitary, the thyroid , the gonads, the adrenals and the pancreas. The mechanisms by which COPD alters endocrine function are incompletely understood but likely involve hypoxemia , hypercapnia , systemic inflammation and glucocorticoid administration. Objective: To evaluate the relationship between pulmonary function tests and thyroid gland function in patient with chronic obstructive pulmonary disease (COPD). Subjects and Methods: Cross sectional study was done in Baghdad teaching hospital from April 2012 to October 2012 in respiratory outpatient. Thirty eight patients were included in the study (36 male and 2 females) who had stable COPD , thyroid function tests and FEV1% were done to all of them. Patients were classified into four groups according to GOLD criteria: mild COPD ( > 80) FEV1% , moderate (80 – 50)%, severe ( 50 – 30)% and very severe < 30%. Results: one patient has decreased level of TSH , one patient has decreased T3 hormone and one patient has increased free T3 hormone level, all other patient had normal thyroid hormones levels. The results of study showed no significant changes in thyroid hormones concentrations with COPD and its severity. Conclusion: We found no significant changes in thyroid hormones in patients with COPD, and any changes that occur in TFT in these patients are may be due to other causes than COPD.

Background: Pulmonary tuberculosis is a chronic infectious disease which affects nutritional status of the patients. The presence of poor nutritional status in pulmonary tuberculosis patients has been one of the most important determining factor in recommending adjuvant nutrient therapy to prevent oxidative stress and further complication. Objective: This study was designed to assess the nutritional status and body mass index of pulmonary tuberculosis patients. Patients and methods: During the period 1st of June 2010 to 30th of May 2011, a prospective study was done on 60 patients with active pulmonary tuberculosis and 60 controls. Levels of total protein (TP), albumin (ALB.), triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC), and body mass index (BMI) were measured. Results: The mean levels of TP (59.5 ± 0.8g/dl), ALB (23.4 ± 1.8g/dl), TC (138.7 ± 4.9mg/dl), HDLC (32.2 ± 4.0mg/dl), LDLC (86.5 ± 1.3mg/dl) and TG (62.4 ± 1.3mg/dl) were significantly lower while the level of globulin (36.2 ± 1.2g/dl) was significantly higher in pulmonary tuberculosis patients when compared with controls (TP=81.2 ± 4.5g/dl; ALB= 50.0 ± 4.0g/dl; TC = 213.5 ± 26.8mg/dl; HDLC = 57.4 ± 8.5mg/dl; LDLC = 161.1 ± 28.3mg/dl; TG= 148.5 ± 37.1mg/dl; globulin = 31.4 ± 1.7g/dl respectively). (P

Background: Arm span is the closest physiologic measurement to standing height. Increased arm span to standing height ratio, which indicates a possible loss of height, due to aging, often results from osteoporosis-related vertebral collapse or other causes. This has possible consequences on lung functions. Objective: To evaluate the effects of aging related loss of height to severity of dyspnea. Method: Patients visited pulmonary function test laboratoryat Baghdad teaching hospital outpatient clinic department from first of November 2009 to thirty first of December 2010 for preoperative assessment were recruited to participate in our study. All recruited subjects were evaluated with a clinical history and physical examination followed by measurements of arm span, standing height, weight, forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Patients 40 years old of age and older were included .Patients with chronic disabilities (cardiac, respiratory or systemic diseases) were excluded. Patients were classified according to their gender and Medical Research Council severity of dyspnea. Results: one hundred thirty one subjects aged 40 years and older were recruited for this study. Arm span to height ratio was significantly negatively correlated with FEV1/FVC ratio, FVC, and positively correlated with severity of dyspnea. Conclusion:There is a significant association between increased arm span to height ratio with increased severity of dyspnea. The role of arm span measurements in assessment of pulmonary function tests in older patients and the association between loss of height and dyspnea deserves further evaluation.

Background: Chronic cough is often the key symptom not only of chronic pulmonary diseases but for other important extrapulmonary pathologies, in particular upper airway and gastrointestinal diseases. Objective: This study was designed to determine the etiology of chronic cough and the usefulness of the available diagnostic tests in reaching its causes. Methods: One hundred patients presenting with chronic cough at Baghdad Teaching Hospital Outpatient Clinic were enrolled in this study. The patients underwent a full clinical interview, physical examination with indicated diagnostic test(s) (such as chest x ray, bronchoscope, PFT, GIT study, sinus X ray or CT). Results: An etiology of chronic cough was determined in 93% of the patients. Post nasal drip is the leading cause of chronic cough reported in 31% of the patient, while asthma gastroesophageal reflux disease, and chronic bronchitis seen in (26, 20, and 6 % respectively). The diagnosis of chronic cough can be reached by comprehensive history, proper physical examination, and chest X ray findings in 66 % patients, further more sophisticated and invasive tests like: PFT, upper GIT study , expectorated sputum examination (AFB, Gram staining, cytology), fibrooptic bronchoscope, and full ENT evaluation including sinuses X ray or sinuses CT scanning, are need in the rest. Conclusion: The etiology of chronic cough can often be diagnosed safely with a simple initial evaluation (history, physical examination and chest X-ray). Postnasal drip, asthma and gastroesophageal reflux disease account for the etiology in more than three quarter of the patients.

Back ground: The use of Montelukast in mild and moderate asthma has been studied ,allergic rhinitis or rhinitis and asthma are strongly inter related, Montelukast has been used in both conditions, whether treating rhinitis will improve asthma control ,a point which has been stressed recently. Objectives: To evaluate the effect of Montelukast in mild and moderate asthma according to Global INitiative For Asthma guidelines ( GINA),and to compare its use in asthma alone and in asthma which is associated with persistant rhinitis symptoms. Patients and methods: Seventy patients who fulfill the criteria of mild and moderate asthma according to Global INitiative For Asthma guidelines had been recruited from the consultation clinic of the respiratory diseases in Baghdad Teaching Hospital from the 111st.July 2009 to 31st. December 2010,patients were divided in to 2 groups : Group – 1 patients with asthma only which was subdivided into 2 sub groups: 1-a on salbutamol inhaler on need and 1-b on beclomethasone inhaler 800Mgm/day in addition to salbutamol inhaler on need. Group- 2 patients with asthma and rhinitis which was sub divided in to subgroups: 2-a on salbutamol inhaler on need and 2-b on beclomethasone 800Mgmlday in addition to salbutamol inhaler on need. Evaluation of day and night time symptoms, records of rhinitis symptoms and measurement of FEV1(Forced Expiratory Volume in 1st. second) and FEF 25-75%(Forced Expiratory Flow)were done to all patients . Montelukast 10 mg/ day was given to all patients for 4 weeks,and reevaluation for day , night time symptoms , rhinitis symptoms and measurement of FEV1 and FEF 25-75% were done . Results: There was a significant statiscal improvement in day , night time symptoms , FEV1 , FEF 25-75% and rhinitis symptoms after Montelukast treatment than before treatment ( p value < 0.05), Montelukast use in asthma alone as compared to its use in asthma which was associated with rhinitis did not show a significant statiscal improvement in outcome response in day,night symptoms and in percentage of change in FEV1 and FEF25-75% (p value>0.05) . Conclusion: Montelukast improved day , night time symptoms , FEV1 , FEF 25-75% in mild and moderate asthma ,it also improved rhinitis symptoms but Montelukast use in asthma alone as compared to its use in asthma which was associated with rhinitis did not show a significant statiscal imrovement in asthma control regarding day,night time symptoms,FEV1 and FEF25-75% values .

Background: The critically ill patient is at risk of developing intensive care acquired infection, with the lungs being especially vulnerable. Ventilator associated pneumonia (VAP) occurring after two days of mechanical ventilation and it is the most nosocomial infection seen in the intensive care unit .The establishment of an accurate diagnosis of ventilator associated pneumonia remains problematic and yet there is still no accepted "gold standard" for the diagnosis. Patients& Methods: This is a cross section study for 328 patients admitted to intensive care unit at medical city teaching hospital. Full history, physical examination and investigation were done after 48 hours of admission according to clinical pulmonary infection score using clinical criteria (body temperature, WBC count, oxygenation, chest radiography and tracheal aspiration).Arterial blood gases were taken for all patients. Results: 40 patients developed ventilation associated pneumonia out of 328 patients (12.19%) treated intensive care unit. Most patients who developed pneumonia were at extreme of age and there was no association between the disease and gender. The presence of risk factors like invasive mechanical ventilation (97.5%) nasogastric intubation (90%), tracheostomy (75%), post-operative (30%),insertion of urinary catheter (75%) unconscious patients (57.5%) and vomiting (27.5%) were found as an important risk factors .Gram negative bacteria was the most frequently observed especially pseudomonas aeruginosa (40%) klebsiella (15%).. Conclusion: ventilator associated pneumonia is an important cause of mortality. The clinical pulmonary infection score was found to be the reliable method for diagnosis of ventilator associated pneumonia. There is general agreement that rapid initiation of appropriate antimicrobial therapy will improve the outcome.

Background: Chronic obstructive pulmonary disease (COPD) is a common disease and it accounts for over 10% of all hospital medical admission. Cigarette smoking is the most important risk factor. Pulmonary arterial hypertension (PHT) is a common complication of COPD and the increase in pulmonary artery pressure is often mild to moderate. The presence of pulmonary arterial pressure and its severity is readily and reliably determined by transthoracic echocardiography in majority of COPD patients. Patients and Methods: This study included 55 patients with mean age 65.6 ±8.2 years .The mean duration of symptoms was 18 ±10 months. 32 patients (58%) were current smoker, 18 patients (33%) were exsmoker and 5 patients (9%) were non smoker. The mean intensity of smoking for smoker was 49.5 ± 22.2 pack- years. For all patients, history, clinical examination, ECG, CXR, and routine blood tests were done. For all patients pulmonary function tests were done and patients were classified according to GOLD criteria into 4 stages. Echocardiography was done for all patients; ventricular and atrial dimensions were taken, and using Doppler technique to detect tricuspid and pulmonary regurgitation, estimation of pulmonary artery systolic and/or diastolic pressure using special formulas was undertaken. Results: Tricuspid regurgitation (TR) jet was found in 70.9% of patients with COPD. Increased pulmonary artery systolic pressure was found in 51% of patients with TR (36% of total patients) and increased pulmonary vascular resistance was found in 48.7% of patients with TR (34.5% of total patients). There were significant associations between echo findings of increasing RV size, TR, increased pulmonary arterial pressure and pulmonary vascular resistance with decrease in FEV1, FEV1/VC and oxygen saturation. There was no significant association with decrease in vital capacity. Conclusions: There is a high prevalence of pulmonary arterial hypertension with increasing severity of chronic obstructive pulmonary disease.

Background: The importance of essential trace elements plays a major role in medicine mainly cardiovascular diseases. Methods: The study involved 305 patients with either myocardial infarction ( MI ) , angina pectoris ( AP ) or hypertension ( HT ) for evaluation of these trace elements level ( Se & Cr ) as compared with 100 control subjects in Ibin Al Bitar hospital for cardiac surgery between July 2003 and May 2005 by using Atomic Absorption Spectrophotometer ( AAS ) done in the laboratories of ministry of Sciences and Technology in Baghdad. Result: The total numbers of patients enrolled in this study were 305 patients, Ml contributes to 70 patients, 55 male and 25 female with mean age of 60 ± 20 and 58 ± 19 years respectively. Unstable angina contribute to 105 patient in which 70 of them were male with mean age of 63 ± 20 years and 35 female with mean age of 60 ± 19 years and 120 hypertensive patient in which male contribute to 90 with mean age of 64 ± 19 years and the other 30 were female with mean age of 48 ± 13 years, those 305 patients were compared with 100 normotensive control subject in which 65 of them were male with mean age of 56 ± 20 years and the remaining 35 were female with mean age of 46 ± 13 years. The analysis of results show that the level of Se and Cr were significantly lower in both sexes in patient with MI, AP and HT as compared with control, and the concentrations of Se were even much lower in acute MI as compared with AP. Conclusion: The concentrations of trace elements Se and Cr were significantly lower in patients having MI, AP and HT as compared with controlled normotensive persons, besides the concentration of Se was much lower in MI as compared with cases of AP.

Back ground : Coronary artery diseases are not uncommon in the presence of right bundle branch block. Aim : The aim of this study is to assess the findings of coronary angiography in patients with chest pain and right bundle branch block. Methods : The study involved review of case sheets and coronary angiography of one hundred patients, who underwent coronary angiography due to chest pain suspected to have coronary artery diseases (CAD) , fifty patients of them had right bundle branch block (RBBB) , the other fifty did not have RBBB , those 100 patients were presented to Ibin Al Bitar hospital for cardiac surgery from January 2004 to June 2006. History, clinical examinations, electrocardiogram (ECG) , ECG exercise tests (EET) echocardiogram (ECHO) and coronary angiography had been performed. Results : Mean age of patients was 53± 10.6 years, 84% were male , hypertension, diabetes mellitus, and smoking as risk factors were present as 30%, 32% and 48% respectively. 58% of patients presented with chronic stable angina (CSA) while 42% with acute coronary syndrome (ACS), ECHO showed that left ventricular dysfunction (LVD) was present in 34%, EET was positive in 11 of the 23 patients (47.8%) who were able to perform EET. Normal coronary angiography found in 20% of patients and there were no significant difference in coronary angiographic findings between patients with and without RBBB. Conclusion : RBBB of indeterminate age has no significant impact on clinical and haemodynamic characteristics of CAD patients and it may be incidental finding.

Background : Left main coronary artery (LMCA) disease represents important and serious portion of coronary artery disease(CAD). Aim: The aim of this study is to estimate the incidence of LMCA disease among patients with CAD undergoing coronary artery angiography and to evaluate clinical characteristics of patients with LMCA disease. Methods: The study involved review of clinical notes and coronary angiography of 1020 patients with CAD in Ibin Al Bitar hospital for cardiac surgery between April and September 2004.This review included evaluation of electrocardiogram (ECG), echocardiogram(ECHO), ECG exercise test (EET) and coronary angiography. Results: Among 56 patients proved to have left main coronary artery (LMCA) disease,40 patients had complete data available which were studied. Mean age of patients with LMCA disease was 60 ± 8.07 years, 82% of them were males, 62% were smokers, 40% were diabetics and 55% were hypertensive. In this group 62.5% of patients with LMCA disease presented as acute coronary syndrome (ACS) and 37.5% as chronic stable angina (CSA),normal left ventricular (LV) function was found in 75% of patients and 40% have normal electrocardiogram (ECG). Patients with LMCA disease who have distal involvement represent 75%,15% have diffusely diseased LMCA, right coronary artery (RCA) was involved in 80% of patients and those with RCA involvement were more commonly presented with ACS (78%), while those without RCA involvement presented more as CSA. Those patients who underwent ECG exercise test had poor functional Capacity, with mean exercise duration of 3.7 ± 2.3 minutes and mean metabolic equivalents (METs) of 4.5 ± 2.46. The tests were positive in 76.9% of patients inconclusive in the rest but no negative tests were recorded. No significant differences were observed between those patients with ACS and those with CSA in regard to patients' characteristics. Conclusion: LMCA disease is not uncommon among those with CAD, it occurs in patients with multiple cardiovascular risk factors. Patients with LMCA disease usually have poor functional capacity and their ETTs are commonly positive and of high risk score. Involvements of right coronary artery (RCA) in addition to LMCA render the patients more unstable.

Poor adherence to diabetes medications, particularly insulin, is still a concern. This study aimed to assess insulin refill adherence among diabetes patients attending public health clinics in Perlis before and during the COVID-19 pandemic. The underlying factors associated with insulin refill adherence were also investigated. This cross-sectional study was conducted among type 2 diabetes mellitus patients with insulin therapy from five primary health clinics in Perlis. Simple random sampling method was used to select participants from the Pharmacy Information System (PhIS) database. Adherence to insulin refill was measured by medication possession ratio before and during the COVID-19 pandemic. A general linear model was used to identify factors associated with adherence to insulin refills. A total of 426 patients were included in this study. Patients in this study were mostly Malay (94.3%) and female (63.1%). The insulin refill adherence was significantly poorer during the COVID-19 pandemic (mean=59.24, SD=28.97) than before the pandemic (mean=68.31, SD=31.27) (p<0.001). Only total daily insulin dose (adjusted β = -0.129; p=0.012) and not having hypertension (adjusted β = -7.359; p=0.043) were significantly associated with insulin refill adherence. This study highlighted that overall insulin refill adherence among patients in public health clinics in Perlis was still low, especially during the COVID-19 pandemic. Special attention should be given to patients using high total daily insulin doses and having no hypertension to improve adherence. [ABSTRACT FROM AUTHOR]

Farah Abdullahi Ismail,1 Yasir Khalif Ali,1 Ahmed Mohamed Ali,2 Ibrahim Mohamed Hirsi,1 Naima Abukar Ali,1 Mohamed Mukhtar Kassim,1 Farah Ali Ahmed,1 Mohamed Nur Ali1 1Pediatric Department of Mogadishu-Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia; 2Department of Infectious Diseases and Clinical Microbiology, Mogadishu-Somalia Turkey Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, SomaliaCorrespondence: Farah Abdullahi Ismail; Ahmed Mohamed Ali, Email Farahbucul96@gmail.com; ahmedorey22@gmail.comAbstract: Congenital rubella syndrome (CRS) is a serious condition with a high rate of morbidity. It is currently a rare disorder, especially in developed countries, because of universal vaccination campaigns. However, it remains a public health concern in developing countries. Here, we report a case of congenital rubella syndrome in a mother who did not receive any prenatal care or had a known history of vaccination. He is a term male infant, and the infant’s positive rubella IgM confirmed the diagnosis. The baby had a bilateral cataract, convulsions, Patent ductus arteriosus (PDA)-related cardiomegaly, and bilateral hearing loss. The only known preventive measure for congenital rubella syndrome is vaccination.Keywords: congenital rubella syndrome, vaccine, prenatal care

In the last century, global awareness of the environmental repercussions associated with petroleum-based polymer composites has surged. This realization urged extensive scientific research directed towards plant-based biomass, particularly nanocellulose, as a reinforcing element in polymer matrices. Global market value of nanocellulose is expected to increase considerably by 2025, to a forecast USD 783 million. Despite nanocellulose’s performance benefits, its poor compatibility with hydrophobic polymer matrices poses challenges, limiting thermal stability and impeding widespread commercialization at higher processing temperatures. To overcome these issues, chemical modification or functionalization emerges as a promising solution to enhance nanocellulose-based polymer nanocomposites’ thermal stability. The abundance of hydroxyl groups on nanocellulose enables specific chemical modifications, such as grafting functional molecules or forming covalent/ionic bonds with the polymer matrix. The aim of this study is to validate that integrating chemically functionalized nanocellulose into various polymer matrices, including thermoset, thermoplastic, and bio-polymer, enhances the thermal stability of resulting polymer nanocomposites, supported by thermogravimetric analysis (TGA). The study also explores six additional factors influencing TGA in nanocomposites, providing a comprehensive understanding of elements impacting the thermal properties of these materials.

Purpose: To investigate whether the rate of Anti‐Osteoporosis Medication (AOM) dispensing was related to prevalence of risk factors and hip fracture incidence in the local population. Methods: The Open Prescribing database was used to analyse dispensed AOM at the level of Clinical Commissioning Groups (CCGs) in England. Male Healthy Life Expectancy (MHLE), Female Healthy Life Expectancy (FHLE), the prevalence of smoking and active adults, the incidence of hip fracture and of alcohol related hospital admissions, and local dispensing of a comparator drug (atorvastatin) were considered as predictor variables. Linear and multilinear regression were performed. Using atorvastatin as a comparator, AOM dispensing was compared after the start of the Covid‐19 pandemic with the same quarter the previous year. Results: Rates of AOM per 1000 people aged over 65 years in a CCG area varied between 379.2 and 1129.1, with a mean of 670.3. Population risk factors were individually related to the amount of AOM dispensed in an area. Collectively, local activity levels in adults (p = 0.042) and local hip fracture incidence (p = 0.003) were significantly negatively correlated with rates of AOM dispensed. Rates of alendronate dispensing fell significantly at the start of the Covid‐19 pandemic (p < 0.001), whilst atorvastatin dispensing rates significantly increased (p < 0.001). Conclusion: Lower rates of AOM dispensing were seen in areas with a higher proportion of active adults and higher incidence of hip fracture. Multidisciplinary services should be developed to address this care gap with consideration given to local population risk factors. Community pharmacists are ideally placed to play a vital role in osteoporosis management. [ABSTRACT FROM AUTHOR]

Reduction in cell size in an ultra-dense network faces the challenge of increase in frequency of handovers and signaling overhead (mobility management) as well as inter-cell interference. Such frequent handovers leads to increased packet loss and blocking rate if the handover latency is very high, which have adverse effect on connectivity and performance. However, most existing schemes have the common characteristics of increasing spectral and energy efficiency due to increase in the number of micro cell on a network, thus decreases the general network performance. In this study, an improved scheme was developed for fixed mobility management pattern (FMP). A comparison module was established and an identifier algorithm that uses the user equipment international mobile equipment identity (IMEI) as a decisive component of its cell selection camping process was designed. Network simulator (NS-3) was used to study the impact of macro cell and inter site distance (ISD) on user throughput and battery life usage using mobility pattern of 3km/h, with A3 event based measurement for ISD 50, 150, 300, 500, and 1000 respectively. The performance evaluation metrics used are; reference signal received power (RSRP), flow monitor and handover time. The FMP results were compared with micro cell performance in an ultra-dense network. The RSRP result from FMP was higher than that of micro cell at ISD 50 and 150 respectively (-71.36, -73.97 and 83.77, 85.13). The handover time for FMP was higher than that of micro cell except for ISD 50 which was 50s and 51s respectively. The flow monitor of FMP showed a packet loss ratio of 0.0001 compare to 0.21 of micro cell. The battery life usage shows that FMP used 5943±8.7mw compare to micro cell which used 1680.2±15.7 mw. These results showed that FMP is efficient in managing the frequency of handover and battery life consumption for better connectivity and performance. [ABSTRACT FROM AUTHOR]

13 An increase in regressor I x i SB I t i sb is represented as HT ht and a decrease is represented as HT ht . Moreover, unlike the vector autoregressive (VAR) model, the NARDL allows including a mix of endogenous and exogenous variables and captures the positive and negative changes in the regressors, where HT ht and HT ht are the partial positive (+) and partial negative (-) ([25]). [Extracted from the article]

INTRODUCTION: Experiential avoidance is a key psychological process variable that measures the level of neglect or avoidance of unpleasant personal psychological experiences. It is highly correlated with the psychological flexibility construct, and both of these are important components in Acceptance and Commitment Therapy (ACT). Acceptance and Action Questionnaire-II (AAQ-II) has been used to measure both constructs and the Malay version of AAQ-II has been translated and validated in the clinical sample. Hence, this study aimed to assess the psychometric properties of the Malay version of AAQ-II in a non-clinical sample. MATERIALS AND METHOD: The participants were recruited from 3 campuses of Universiti Malaysia Sabah namely UMSLabuan International Campus (UMSKAL), Sandakan campus, and the main campus in Kota Kinabalu. Convenience sampling was employed and the snowball method was used to recruit participants. All participants answered online questionnaires, which consist of sociodemographic information as well as the Malay version of AAQ-II, Mindfulness Awareness and Attention Scale (MAAS), General Health Questionnaire-12 (GHQ-12), and Balanced Index of Psychological Mindedness (BIPM). Both classical test theory and Rasch measurement theory were used to check the reliability and validity. RESULTS: There were 370 participants in this study. Malay version of AAQ-II demonstrated good psychometric properties with Cronbach’s alpha of 0.932, parallel reliability of 0.844, and satisfactory Rasch analysis. Exploratory factor analysis supported a one-factor model with 7-items. AAQ-II scores were positively correlated with depressive and anxiety scores, and lower levels of mindfulness and psychological mindedness, supporting the concurrent and convergent validity. CONCLUSION: Malay version of the AAQ-II has adequate reliability and validity in assessing psychological inflexibility in the non-clinical sample and hence could be a useful psychological instrument in assessing COVID-19 mental health effect. [ABSTRACT FROM AUTHOR]