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Personalised Warfarin Dosing in Children Post-cardiac Surgery
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Abstract<p>Warfarin dosing is challenging due to a multitude of factors affecting its pharmacokinetics (PK) and pharmacodynamics (PD). A novel personalised dosing algorithm predicated on a warfarin PK/PD model and incorporating CYP2C9 and VKORC1 genotype information has been developed for children. The present prospective, observational study aimed to compare the model with conventional weight-based dosing. The study involved two groups of children post-cardiac surgery: Group 1 were warfarin naïve, in whom loading and maintenance doses were estimated using the model over a 6-month duration and compared to historical case-matched controls. Group 2 were already established on maintenance therapy and randomised into a crossover study comparing the model with conventional maintenance dosing, over a 12-month period. Five patients enrolled in Group 1. Compared to the control group, the median time to achieve the first therapeutic INR was longer (5 vs. 2 days), to stable anticoagulation was shorter (29.0 vs. 96.5 days), to over-anticoagulation was longer (15.0 vs. 4.0 days). In addition, median percentage of INRs within the target range (%ITR) and percentage of time in therapeutic range (%TTR) was higher; 70% versus 47.4% and 83.4% versus 62.3%, respectively. Group 2 included 26 patients. No significant differences in INR control were found between model and conventional dosing phases; mean %ITR was 68.82% versus 67.9% (<italic>p</italic> = 0.84) and mean %TTR was 85.47% versus 80.2% (<italic>p</italic> = 0.09), respectively. The results suggest model-based dosing can improve anticoagulation control, particularly when initiating and stabilising warfarin dosing. Larger studies are needed to confirm these findings.</p>
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Publication Date
Fri Jun 30 2023
Journal Name
Iraqi National Journal Of Nursing Specialties
Effectiveness of Cardiac Rehabilitation Instructional Program on Health-related Quality of Life for Patients Undergone Coronary Artery Bypass Graft Surgery
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Objective(s): evaluation of effectiveness of cardiac rehabilitation instructional program on health-related quality of life and to find out the relationship between health-related quality of life and patient’s socio-demographic and clinical characteristics. 

Methodology: A descriptive study design was carried out from 8th August, 2022 to 10th January, 2023.

A non-probability purposive sample of (50) patients undergone coronary artery bypass graft surgery at Iraqi center for heart diseases using pre-experimental design. The data were collected by direct interview with sample using questionnaire composed of three parts: part (1) Socio-demographic and clinical ch

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Publication Date
Wed Jan 05 2022
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Early complications associated with obesity following coronary artery bypass graft surgery: Obesity and post-CABG morbidity
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Background: One of the major health concerns and possible risk factors in open heart surgery is the increasing prevalence of obesity among patients.

Methodology: Over a period of sixteen months (February 2017 to June 2018), 246 patients underwent coronary artery bypass graft surgery (CABG) in Slemani Cardiac Hospital (SCH). The patients were divided according to the WHO classification into two groups: The obese (BMI ≥ 30) and the non-obese  (BMI < 30) and were compared in regard to the rate of occurrence of early postoperative complications.

Objective: To evaluate the impact of obesity [body mass i

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Publication Date
Sat Jul 01 2017
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Prevalence, risk factors and association of renal artery stenosis with coronary artery disease in patients undergoing coronary angiography in Ibn-Al Bitar center for cardiac surgery
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Background:-Atherosclerosis is a systemic disease that often affects multiple vascular distributions in a single patient. The increased prevalence of renal artery stenosis in association with coronary artery disease has been well documented.
Objectives:-To examine in detail the prevalence of renal artery stenosis in patients undergoing cardiac catheterization for suspected coronary artery disease.
Patients &methods:-Between April 2010 and February 2011, two hundred patients underwent coronary and renal angiography at the same session in Ibn Al-bitar Hospital for Cardiac Surgery. Clinical and procedural data for patients undergoing renal angiography were prospectively collected and entered into database specially designed for th

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Publication Date
Sun Jan 03 2016
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Complication Following percutaneous coronary intervention via the femoral artery Experience in lraqi center for the Heart Disease and lbn Al-Bitar Hospital for cardiac surgery.
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Background: Vascular complications have been recognized as an important factor in morbidity after diagnostic and percutaneous coronary interventions.
Objectives: This study sought to evaluate vascular complications after diagnostic coronary angiography and percutaneous coronary intervention (PCI) from the common femoral artery.
Patients and methods: This prospective cohort study was carried out over a year period, from February 2008 till January 2009, at the Iraqi Center for the Heart Disease and Ibn Al-Bitar Hospital for Cardiac Surgery. A total number of 2400 patients underwent 3600 procedures, diagnostic coronary angiography (2196) and PCI(1404) via their common femoral arteries were included in this study.
Result: A total 40

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Publication Date
Tue Dec 01 2020
Journal Name
Al-khwarizmi Engineering Journal
Studying the Radial and Tangential Velocity Components of the Epithelization Healing Post Photorefractive Keratectomy Surgery of the Human Eye
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Photorefractive keratectomy (PRK) is the refractive technique that began with a physical scraping of the epithelial layer of cornea subsequent by laser treatment. Post this procedure to about 48 hours the removed epithelial layer regenerated to protect the eye again. The regeneration process (called re-epithelization) started from the limbus of the cornea toward the central part of it. The re-epithelization mechanism consists of a change in cell density (mitosis) and cell concentration (migration) with a velocity in two directions: radial and tangential. In the present study, an estimation for both radial (responsible for the overlapped layers toward the outward direction of the cornea) and tangential comp

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Publication Date
Thu Jun 25 2020
Journal Name
Iraqi Journal Of Pharmaceutical Sciences ( P-issn 1683 - 3597 E-issn 2521 - 3512)
Comparing the Efficacy of Paracetamol, Diclofenac, and Ketorolac on Post-Appendectomy Outcomes in Children and Adolescents
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Abstract

urgent surgical intervention and appendectomy until now represent standard treatment for uncomplicated cases of appendicitis. Nausea, vomiting and pain after surgery are the most frequent issues facing patients and affecting patient quality of life and responsible for many cases of readmission after surgery. Ketorolac and diclofenac represent the most commonly prescribed non-steroidal anti-inflammatory used in postoperative setting and they cause many side effects as gastrointestinal, kidney and cardiac adverse effect in addition to increased risk of bleeding. Paracetamol is currently among the most frequently prescribed medication worldwide and it can be used safely for all age groups. This study aimed

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Publication Date
Thu Jan 02 2014
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Surgery In Infective Endocarditis
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Background: Early surgery during the active phase of infective endocarditis was considered to carry high morbidity and mortality due to technical difficulties on an inflamed tissues.

Objectives: Is to focus a light on the increasing indications for surgery during the active phase of infective endocarditis which lead to significant drop in the hospital mortality.  

Patients and Methods: Eighteen patients with bacterial endocarditis and valvular dysfunction were admitted to Iraqi center for heart diseases during the period from January 2008 –April 2013. All of them were fully investigated and adequately prepared for open heart surgery.

Result:

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Publication Date
Thu Jan 02 2014
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Surgery in Varicose Veins
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Background: Varicose veins are common in Iraq. Increasing incidence is associated with available jobs of bodyguards, barbers and computer workers.

Objectives: To highlight the frequency, presentation, methods of accurate diagnosis and surgical procedures which are commonly used by Vascular Surgeons in Medical City Teaching Complex, Al-Shaheed Ghazi Al-Hariri Subspecialties hospital and to compare this study with other international studies.

Patients and methods:  This is a retrospective study of hundred patients with varicose veins, who were admitted and surgically treated at Al-Shaheed Ghazi Al-Hariri subspecialties hospital during one year period (1st of July 2010

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Publication Date
Thu Sep 12 2019
Journal Name
Al-kindy College Medical Journal
Minimal sternotomy surgery in comparison to standard sternotomy in the coronary bypass Surgery
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Background Median sternotomy is the gold standard incision for most cardiac operations. However, with the advent of minimal invasive surgery, a new approach emerged in cardiac surgery named mini-sternotomy and has been successfully used to perform a variety of operations.

 The aim of this paper is to present our experience of using mini-sternotomy to harvest the left internal mammary artery (LIMA) for off-pump revascularization of the left anterior descending artery (LAD)

 Methodology Over a 2-year period (October 2012-October 2014), 100 patients underwent coronary artery bypass grafting (CABG) via conventional median sternotomy (CMS) (n=80) and mini-sternotomy (MS) (n=20). The

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Publication Date
Sun Oct 02 2016
Journal Name
Journal Of The Faculty Of Medicine Baghdad
Glycemic control in children and adolescents with type 1 diabetes mellitus in post conflict Iraq: a primary report
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Background: Type 1 diabetes mellitus (T1DM) is a common disease in childhood. A linear relation between glycemic control (HbA1c < 7) and onset or progression of complication was detected. Only few individuals achieve glycemic control.
Objective: To estimate the glycemic control among diabetic children attending tertiary center.
Methods: All diabetic children registered in the diabetic consultancy clinic in Children Welfare Teaching hospital (298) were included in the study. Case records were reviewed and information on demography, weight and height, age at diagnosis and HbA1c was requested.
Results: Out of the total, 23.8% diabetic children had glycemic control. Glycemic control was decreasing with age (p=0.001), significantl

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