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Background: Medical care may become worse during holidays and weekends, probably, due to decrease in the number of physicians, other health staff, or medical resources, in addition to increase in the number of patients admitted at this period. This may explain the negative impacts on the outcome of patients admitted to the hospital at weekends and holidays. Aim of study: It is to shed light on the impact of holidays and weekends on the death rates among admissions in the main hospital in the governorate of Misan governorate. Patients and methods: In this cross-sectional stud, records of all patients admitted to the Al-Sadder teaching hospital in Misan, from the first January 2015 to end December 2015 were reviewed with particular concern of, site and day of admission to the hospital, day of death, and the number of dead individuals, among admissions during holidays and other week days. Results: A total of 34983 patients admitted to the hospital during one year, (25.4%) of them were admitted on the weekends and public holidays. Among patients in the hospital wards other than labor room & ICU, there was a statistically significant increase in death rate among admissions on the weekends and holidays compared to that on other week days, (3.5% versus 1.9%, P value > 0.0001).All-cause death, in the hospital as a whole, was found to be significantly higher on weekends and holidays than that on the other weekdays. (4.3% versus 2.6% P value > 0.0001). Conclusion: weekends and holidays have a negative impact on the outcome of hospital admissions as reflected by higher death rates compared to that on the other week days.

يهدف البحث لدراسة وتحليل دور السياسة المالية في تصحيح المسار التنموي في الاقتصاد العراقي، عبر التطرق لأدوات السياسة المالية خلال المدة (2010-2021)، من أجل الإجابة على تساؤل هو: ما هو دور السياسة المالية في تصحيح المسار التنموي العراقي؟ وما هي الرؤية التوجيهية لتصحيح اختلالات هذا الدور؟ حيث إن للسياسة المالية مكانة في توجيه اقتصاديات البلدان نحو تنمية اقتصادتها، وخاصة العراق الذي يسعى لتحقيق تطورات تنموية في اقتصاده. ليتوصل البحث إلى عدد من الاستنتاجات كانت أهمها: بأنه بالرغم من التوجهات الاصلاحية للسياسة المالية العراقية، لكنها عبارة عن أهداف واجراءات توضع في خطط تنموية لا يتم تنفيذها فعلياً عند اعداد الموازنات المالية للحكومة، ولم ترى تأثير فعلي على المسار الاقتصادي العراقي وتنميته. حيث بالرغم من إن بعض الأعوام شهدت تراجع في معدلات نمو الناتج المحلي الإجمالي في العراق إلا أن السياسة المالية في العراق لم تواكب مسار تراجع النمو الاقتصادي، حيث كان على هذه السياسة أن تتجه نحو الإنفاق الاستثماري لتعيد تنشيط الاقتصاد العراقي، التي بقت معدلاته من النفقات العامة منخفضة نسبياً خلال مدة البحث.

يهدف هذا البحث إلى التمييز بين الاستدلالات الطبيعية والاستدلالات الصورية. ثم سيركز الجانب التطبيقي على جرد الوسائل الاستدلالية المنذورة لبناء حجاج قرآني قادرٍ على إثارة العقول وحملها على الاقتناع. كما تهدف الدراسة إلى اختبار فاعلية بعض القواعد الاستلزامية التي يقترحها منطق اللغة. والوقوف على مدى نجاعة هذه القواعد في استيعاب الاستدلال الطبيعي بمساراته المتشعبة. ويقع هذا البحث ضمن الدراسات اللسانية المنطقية، الساعية إلى إقامة منطق طبيعي تتوافر فيه الأدوات اللازمة لتعقب الاستدلالات القائمة في اللغة الطبيعية. فإذا كان المنطق البرهاني يختص بضبط وتقنين الاستدلالات الصورية، فإن المنطق الطبيعي يستفيد من النظرية البرهانية، ويقتبس بعض تقنياتها لوضع قواعد قادرة على رصد حركية الاستدلالات الطبيعية، وتقييم فاعليتها. وينطلق من فرضيتين أساسيتين: الأولى ترتبط بالمنهج، ونتصور من خلالها أن الجمع بين الدراستين اللسانية والمنطقية، يوفر للدارس المفاتيح المناسبة لضبط الاستدلالات الحجاجية التي تزخر بها الخطابات الطبيعية. أما الفرضية الثانية، فهي مرتبطة بالمتن، ونعتقد في هذا الجانب أن الخطاب القرآني ينفرد ببناء حجاجي خاص يراعي المدارك المتفاوتة والطبائع والمتباينة. وهذه الخاصية القرآنية هي التي تجعل "الآية الواحدة" كفيلة -حسبما نفترض- باستخلاص أهم أصول المنطق الطبيعي.

Abstract Background Assessment of the interatrial septum (IAS) has become an attractive area of interest for a variety of important interventional procedures. Newer imaging modalities like multi-slice computed tomography (MSCT) and cardiac MRI (CMR) can provide higher resolution and wider field of view than echocardiography. Moreover, high-field (3-Tesla) CMR can even enhance spatial and temporal resolution. The characteristics of the interatrial septum were retrospectively studied in 371 consecutive subjects (201 men, 31–73 years old) in whom MSCT was performed primarily for non-invasive evaluation of the coronary arteries. All subjects underwent both MSCT and MRI scans within 0–30 day’s interval. A 3D volume covering the whole heart was acquired across the heart with and without contrast enhancement. Also, patients underwent cardiac MSCT examinations using 64-row MSCT scanners. Results The mean scan time of MSCT was 10.4 ± 2.8 s and 9.7 ± 2.9 min for CMR. The mean length of IAS by CMR and CT was 39.65 ± 4.6 mm and 39.28 ± 4.7 mm, respectively. The mean maximal thickness of IAS by CMR and CT was 3.1 ± 0.97 mm and 3.15 ± 0.95 mm, respectively. The mean thickness of fossa ovalis by CMR and CT was 1.04 ± 0.36 mm and 1.04 ± 0.44 mm, respectively. The mean length of fossa ovalis by CMR and CT was 12.8 ± 3.7 mm and 12.8 ± 3.5 mm, respectively. Finally, the mean angle of IAS by CMR and CT was identical (155 ± 9.2°). Measurements of various morphological features of IAS showed no statistically significant difference between CMR and CT, with an excellent correlation and close relationship regarding IAS length, maximal IAS thickness, fossa ovalis thickness, fossa ovalis length, and IAS angle (r = 0.98, 0.98, 0.95, 0.96, and 0.92, respectively). Conclusion Whole-heart 3D acquisition at 3-T MRI using a free-breathing technique provides a valuable non-invasive imaging tool for excellent assessment of the interatrial septum—as compared to MSCT—that may have significant clinical implication for diagnostic purposes and therapeutic interventional procedures, as it may facilitate planning, improve outcome, and shorten its duration.

This study evaluated the adherence to prescribed cardiovascular therapy medications among cardiovascular disease patients attending clinics in Misan, Amara, Iraq. Mixed methods were used to assess medication adherence comprising the Arabic version of the eight-item Morisky Medication Adherence Scale (MMAS-8) and determination of drug concentrations in patient dried blood spot (DBS) samples by liquid chromatography-high resolution mass spectrometry. Three hundred and three Iraqi patients (median age 53 years, 50.5% female) who had been taking one or more of the nine commonly prescribed cardiovascular medications (amlodipine, atenolol, atorvastatin, bisoprolol, diltiazem, lisinopril, losartan, simvastatin and valsartan) for at least six months were enrolled. For each patient MMAS-8 scores were determined alongside drug concentrations in their dried blood spot samples. Results from the standardized questionnaire showed that adherence was 81.8% in comparison with 50.8% obtained using the laboratory-based microsample analysis. The agreement between the indirect (MMAS-8) and direct (DBS analysis) assessment approaches to assessing medication adherence showed significantly poor agreement (kappa = 0.28, P = 0.001). The indirect and direct assessment approaches showed no significant correlation between nonadherence to prescribed cardiovascular pharmacotherapy and age and gender, but were significantly associated with the number of medications in the patient's treatment regimen (MMAS-8: Odds Ratio (OR) 1.947, 95% CI, P = 0.001; DBS analysis: OR 2.164, 95% CI, P = 0.001). The MMAS-8 results highlighted reasons for nonadherence to prescribed cardiovascular pharmacotherapy in this patient population whilst the objective DBS analysis approach gave valuable information about nonadherence to each medication in the patient's treatment regimen. DBS sampling, due its minimally invasive nature, convenience and ease of transport is a useful alternative matrix to monitor adherence objectively in Iraq to cardiovascular pharmacotherapy. This information combined with MMAS-8 can provide clinicians with an evidence-based novel approach to implement intervention strategies to optimise and personalise cardiovascular pharmacotherapy in the Iraqi population and thereby improve patient health outcomes.

The study evaluated the non-adherence to selected cardiovascular medications, atenolol, atorvastatin, bisoprolol, diltiazem, lisinopril, simvastatin and valsartan in Iraqi patients by applying a standardized Morisky questionnaire (8-MMAS) and by measuring therapeutic drug concentrations in dried blood spots (DBS) analyzed by liquid chromatography - high resolution mass spectrometry (LC-HRMS). Sixty-nine patients, on continued use of one or more of the selected drugs, were evaluated. The questionnaire showed that 21.7% of participants were non-adherent whereas DBS analysis showed that 49.3% were non-adherent to their medications. No significant correlation between medication non-adherence and gender was detected, but adherence was negatively correlated with the number of medications in the regimen. The 8-items questionnaire was unable to differentiate non-adherence to multiple medications in the prescribed pharmacotherapy regimens. DBS is an alternative to conventional methods to monitor non-adherence objectively. Agreement between the two approaches was weak (Kappa =0.269, p-value 0.05).

Background: As tuberculosis (TB) is still endemic disease in Iraq, efforts in detection, diagnosis, treatment, and prevention are of utmost importance to decrease the prevalence and negative impacts of this disease on people. In this study we aim to find out the extent of contribution of the private health sector in, Missan governorate to the detection of cases of tuberculosis and referring them to the Chest and Respiratory Disease Clinic in Missan for further management. Collaboration between the private and public health sectors is crucial for early detection, treatment, and cure of tuberculosis and consequently decrease in its prevalence and transmission to other people. Patients and methods: Records of patients managed by the Chest and Respiratory Disease Clinic in Missan, for the period between 2012-2014 were reviewed. The above mentioned clinic deals with all cases any different types of tuberculosis. All cases, and of different types of tuberculosis, were enrolled in the study. Particular concern to the source of referral of these cases was considered. Other parameters such as, type of tuberculosis, whether it is newly or previously diagnosed, and the results of the sputum test for acid-fast bacilli. (AFB) were considered. Results: 752 patients with tuberculosis were diagnosed and managed by the Chest and Respiratory Disease Clinic in Missan for the period between 2012-2014, considerable number of these patients (44.4%) was detected and referred to the TB Center by the physicians in the private health sector. Private health sector had more contribution to detection of extrapulmonary tuberculosis than the public health centers. Conclusion: The private health sector in Missan governorate has an important role in detection of cases, mostly newly diagnosed cases, of tuberculosis. So collaboration between governmental health faculties and private health sector is essential for effective detection and management of cases of tuberculosis to decrease its prevalence and negative impacts on the public health.

Introduction Prolonged stays in the intensive care unit (ICU) are known to increase the risk of adverse outcomes following severe conditions. This study focuses on the factors affecting ICU length of stay, particularly in Urology and Nephrology patients who require intensive monitoring and specialized care, and their impact on patient outcomes. Methods A descriptive cross-sectional study was conducted with a sample size of 45 patients. Data was collected using a validated closed-ended questionnaire and analyzed with IBM SPSS Statistics for Windows, Version 23.0 (Released 2015; IBM Corp., Armonk, New York, United States). Results The study found positive associations between prolonged ICU stay and several factors, including elevated total bilirubin levels, deranged creatinine, urea, sodium, and calcium levels, as well as abnormal C-reactive protein levels. Higher bilirubin levels and positive blood and culture results were linked to extended ICU stays. Additionally, the use of contrast CT and MRI was associated with longer ICU durations. Conversely, broad-spectrum antibiotics showed a negative association with ICU stay length, while transfusion of blood products was positively associated with longer stays. Conclusion Understanding these factors can help improve the management of ICU patients and enhance outcomes in future cases., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Begum Akhtar Rukhsana Memorial Trust Safari Hospital Ethics Committee, Rawalpindi, Pakistan issued approval BIHS/Adm/CME/24/12. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Afzal et al.)

We present a case of a young man with a new-onset supraventricular arrhythmia accompanied by polyuria and natriuresis with subsequent renal salt-wasting causing hypovolemic hyponatremia. Resolution of the electrolyte imbalance occurred only after successful atrial flutter ablation., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: There is no guidance surrounding postoperative venous thromboembolism (VTE) prophylaxis using pharmacological agents (chemoprophylaxis) in patients undergoing skull base surgery. The aim of this study was to compare VTE and intracranial haematoma rates after skull base surgery in patients treated with/without chemoprophylaxis., Methods: Review of prospective quaternary centre database including adults undergoing first-time skull base surgery (2009-2020). VTE was defined as deep vein thrombosis (DVT) and pulmonary embolism (PE) within 6 months of surgery. Multivariate logistic regression was used to determine factors predictive of postoperative intracranial haematoma/VTE. Propensity score matching (PSM) was used in group comparisons., Results: One thousand five hundred fifty-one patients were included with a median age of 52 years (range 16-89 years) and female predominance (62%). Postoperative chemoprophylaxis was used in 81% of patients at a median of 1 day postoperatively. There were 12 VTE events (1.2%), and the use of chemoprophylaxis did not negate the risk of VTE entirely (p > 0.99) and was highest on/after postoperative day 6 (9/12 VTE events). There were 18 intracranial haematomas (0.8%), and after PSM, chemoprophylaxis did not significantly increase the risk of an intracranial haematoma (p > 0.99). Patients administered chemoprophylaxis from postoperative days 1 and 2 had similar rates of intracranial haematomas (p = 0.60) and VTE (p = 0.60), affirmed in PSM., Conclusion: Postoperative chemoprophylaxis represents a relatively safe strategy in patients undergoing skull base surgery. We advocate a personalised approach to chemoprophylaxis and recommend it on postoperative days 1 or 2 when indicated., (© 2024. Crown.)

Sjogren's syndrome is an autoimmune disease associated with xerostomia and xerophthalmia. The association of Sjogren's with hyponatremia has rarely been reported and has been attributed to syndrome of inappropriate antidiuretic hormone secretion. Here, we report a case of polydipsia secondary to xerostomia as a cause of chronic hyponatremia in the setting of Sjogren's syndrome. Analysis of the patient's medical record, including medication reconciliation and dietary habits, revealed several underlying causes of her recurrent hyponatremia. A thorough review of the patient's clinical history and good bedside examination may reduce prolonged hospitalizations and improve the quality of life of a hyponatremic population of patients who are predominantly elderly., Competing Interests: The authors have stated that they have no conflicts of interest., (© 2023 The Author(s). Published by S. Karger AG, Basel.)

The aim of this study was to explore the potential of default mode network (DMN) functional connectivity for predicting the success of smoking cessation in patients with tobacco dependence in the context of a real-time function al MRI (RT-fMRI) neurofeedback (NF) supported therapy.Fifty-four tobacco-dependent patients underwent three RT-fMRI-NF sessions including resting-state functional connectivity (RSFC) runs over a period of 4 weeks during professionally assisted smoking cessation. Patients were randomized into two groups that performed either active NF of an addiction-related brain region or sham NF. After preprocessing, the RSFC baseline data were statistically evaluated using seed-based ROI (SBA) approaches taking into account the smoking status of patients after 3 months (abstinence/relapse).The results of the real study group showed a widespread functional connectivity in the relapse subgroup (n = 10) exceeding the DMN template and mainly low correlations and anticorrelations in the within-seed analysis. In contrast, the connectivity pattern of the abstinence subgroup (n = 8) primarily contained the core DMN in the seed-to-whole-brain analysis and a left lateralized correlation pattern in the within-seed analysis. Calculated Multi-Subject Dictionary Learning (MSDL) matrices showed anticorrelations between DMN regions and salience regions in the abstinence group. Concerning the sham group, results of the relapse subgroup (n = 4) and the abstinence subgroup (n = 6) showed similar trends only in the within-seed analysis.In the setting of a RT-fMRI-NF-assisted therapy, a widespread intrinsic DMN connectivity and a low negative coupling between the DMN and the salience network (SN) in patients with tobacco dependency during early withdrawal may be useful as an early indicator of later therapy nonresponse.

One of the most prominent symptoms in addiction disorders is the strong desire to consume a particular substance or to show a certain behavior (craving). The strong association between craving and the probability of relapse emphasizes the importance of craving in the therapeutic process. Former studies have demonstrated that neuromodulation using real-time fMRI (rtfMRI) neurofeedback (NF) can be used as a treatment modality in patients with tobacco use disorder. The aim of the present project was to determine whether it is possible to predict the outcome of NF training plus group psychotherapy at the beginning of the treatment. For that purpose, neuronal responses during the first rtfMRI NF session of patients who remained abstinent for at least 3 months were compared to those of patients with relapse. All patients were included in a certified smoke-free course and took part in three NF sessions. During the rtfMRI NF sessions tobacco-associated and neutral pictures were presented. Subjects were instructed to reduce their neuronal responses during the presentation of smoking cues in an individualized region of interest for craving [anterior cingulate cortex (ACC), insula or dorsolateral prefrontal cortex]. Patients were stratified to different groups [abstinence ( N = 10) vs. relapse ( N = 12)] according to their individual smoking status 3 months after the rtfMRI NF training. A direct comparison of BOLD responses during the first NF-session of patients who had remained abstinent over 3 months after the NF training and patients who had relapsed after 3 months showed that patients of the relapse group demonstrated enhanced BOLD responses, especially in the ACC, the supplementary motor area as well as dorsolateral prefrontal areas, compared to abstinent patients. These results suggest that there is a probability of estimating a successful withdrawal in patients with tobacco use disorder by analyzing the first rtfMRI NF session: a pronounced reduction of frontal responses during NF training in patients might be the functional correlate of better therapeutic success. The results of the first NF sessions could be useful as predictor whether a patient will be able to achieve success after the behavioral group therapy and NF training in quitting smoking or not.