Background: Transradial compared to classic transfemoral coronary intervention has been shown to have similar efficacy rates, while being more cost-effective and most importantly safer due to fewer access site complications. Furthermore, patient comfort is increased and outpatient treatment may be feasible..Objectives: To start trans-radial intervention program and the initial learning curve for fellows and the catheterization –laboratory nursing staff. To test how could it be applicable and comfortable for our patientsMethods: This prospective study was performed in Ibn-Albitar hospital for cardiac surgery over a period of 6 months from the 1st of August 2012 till the 1st of February 2013. Every patient referred for percutenuos coronary intervention whether on scheduled or on an emergency basis was considered initially for trans-radial approach for intervention unless they are excluded. Allen test was required ensuring adequate ullnar collateral supply. Sledinger technique was used for radial artery puncture and a special radial sheath was introduced. Intervention was performed through the same catheter and equipments that are used for femoral approach.. medication given according to center protocol, the relevant data collected and patients immediately ambulated unless they receive sedation.Results: A total of 126 patients were referred for intervention during the study period, 20 cases were excluded for various reasons , 6caese were crossed over to femoral approach and the other 100 cases the procedure completed transradially. The mean age of the patients was 57 ± 8 years. Of these 72% were males ,with different risk factors . Most cases presented with chronic stable angiana (87%). Access site was right radial artery in 87% of patients while left radial approach used in 13% of patients. In 72% of cases single guiding catheter was used, in 21% of cases 2 guiding catheter were used and more than 2 types of guiding catheter were used in 7% of cases. In most session of intervention single artery was treated (78%) , 2 vessel intervention in 21%, 3 vessel in one case..Lesions treated were different types 26%,36%,38% A,B and C respectively. The success in obtaining radial access was 97.7% ,while angiographic procedural success rate was 96%. Mean total procedure time was ( 43+/-23min ), mean fluoroscopy time (13+/-8 min )and the average amount of contrast used was (178+/-80ml). with no major complication apart from 3% small heamatom and 6% radial loss. Around 80% of patients preferred TRI approach.Conclusion: Radial artery approach for percutenuos coronary interventions has high procedural success rate and associated with low risk of access site complications and no significant increase of procedural and fluoroscopy time. It is comfortable approach for most patients especially female and obese. Early ambulation with no risk of bleeding and reduction of the duration of hospital stay are in favor of TRI approach.
This literary review addresses the status of the most famous Israeli writer, Amos Oz, through the analysis of relevant articles that highlight various aspects of his literary and political orientations, reflecting his ideological and social background. Oz's literature encompasses a mix of political orientations that many critics view as extreme, while others see them as moderate stances indicative of the author's awareness. And these are what strengthened his literary status in modern Hebrew literature.These trends emphasized the contribution of Oz's works to shaping Israeli cultural consciousness and reflect the challenges facing identity in multiple contexts. He was an advocate for equality between Palestinians and Israelis and
... Show MoreAbstract ABSTRACT:BACKGROUND: Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed orthopedic procedures. Technical factors especially correct tunnel placement play major role in its success. However its failure rate is still high (10%), and impingement of the graft on the posterior cruciate ligament (PCL) and the medial wall of the lateral femoral condyle is an important cause of failure. Wallplasty is a technique used to prevent graft impingement, but there is no consensus on its routine use.OBJECTIVE:Is to compare between the postoperative knee functional outcome and stability of arthroscopic ACLR performed with wallplasty versus those performed without wallplasty.PATIENTS AND METHODS: A prospective exp
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Pluripotent stem cells (PSC) possess unlimited proliferation, self-renewal, and a differentiation capacity spanning all germ layers. Appropriate culture conditions are important for the maintenance of self-renewal, pluripotency, proliferation, differentiation, and epigenetic states. Oxygen concentrations vary across different human tissues depending on precise cell location and proximity to vascularisation. The bulk of PSC culture-based research is performed in a physiologically hyperoxic, air oxygen (21% O2) environment, with numerous reports now detailing the impact of a physiologic normoxia (physoxia), low oxygen culture in the maintenance of stemness, survival, morphology, proliferation, differentiation potential, and epigenetic
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Many behavioral researchers pointed out the importance of relaxation techniques in the treatment of different psychological disorders where find the importance of these techniques in reducing anxiety and stress and the resulted of behaviors and habits, with the development of these techniques are being used to gain public health, whether mental health or physical or mentality, and one of these techniques is music therapy that reduces tension and anxiety and operates a state of relaxation, which is used in the treatment of patients of dental clinic.
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... Show MoreForest fires continue to rise during the dry season and they are difficult to stop. In this case, high temperatures in the dry season can cause an increase in drought index that could potentially burn the forest every time. Thus, the government should conduct surveillance throughout the dry season. Continuous surveillance without the focus on a particular time becomes ineffective and inefficient because of preventive measures carried out without the knowledge of potential fire risk. Based on the Keetch-Byram Drought Index (KBDI), formulation of Drought Factor is used just for calculating the drought today based on current weather conditions, and yesterday's drought index. However, to find out the factors of drought a day after, the data
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Suggestive ambiguity is a strategy of defense and maneuvering as it provides the speaker both protection and function. To put it differently, it helps the speaker to say whatever he likes and at the same time gives his opponents and friends the interpretation they desire. This is possible due to the flexibility of the linguistic expressions that the speaker uses. To be more clear, the context of situation, peoples' background and world knowledge interact with the significance of the linguistic expressions reaching an allusive situation where two interpretations, positive and negative, are available to the addressees. Such situation enables the addressers to implicate different ideas or messages, accusations, inciting violence, etc. The pres
... Show MorePublic-private partnership (PPP) has been used over the past 20-30 years by governments in developed countries to meet the public demand for infrastructural services. In Iraq, the PPP concept is comparatively new to the Government of Iraq (GoI), where the government has historically taken most of the responsibility for providing public services. There are few PPP projects in Iraq. However, the number is increasing. Recently the Iraqi market has experienced a number of attempts of PPP in different sectors, especially after the new investment law in 2006. The aim of this paper is to evaluate the investment environment in Iraq and to indicate the main factors affecting PPP in particular for infrastructure projects. Some literature review and
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