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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.

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.

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]

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]