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Article
Cardiac Troponins as Prognostic Markers in Acute Heart Failure

Author: Muataz Fawzi Hussein
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2010 Volume: 9 Issue: 2 Pages: 214-220
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Cardiac troponins provide diagnostic and prognostic information in acute coronary syndromes, but their role in acute decompensated heart failure is unclear.OBJECTIVE:Describe the association between elevated cardiac troponin levels and adverse events in patients hospitalized with acute decompensated heart failure.METHODS:Troponin was measured at the time of admission in 340 patients who were hospitalized to Baghdad Teaching Hospital for acute decompensated heart failure between October 2007 and October 2008. A positive troponin test was defined as a cardiac troponin I level of 0.5 ng/mL or higher.RESULTS:Overall, 30 patients (8.8%) were positive for troponin. Patients who were positive for troponin had lower systolic blood pressure on admission [138±30 vs. 144±30 mmHg, P value 0.01], a lower left ventricular ejection fraction [mean 33±15 % vs. 38±16%, P value 0.002] and higher in-hospital mortality [3 patients (10%) vs 8 patients (2.58%), P value 0.001] than those who were negative for troponin. The adjusted odds ratio for death in the group of patients with a positive troponin test was 2.45 (95% confidence interval [CI], 2.14 to 2.79; P<0.001) by the Wald test).CONCLUSION:In patients with acute decompensated heart failure, a positive cardiac troponin test is associated with higher in-hospital mortality, independently of other predictive variables


Article
Assessment of Congestive Heart Failure Patients Knowledge and Compliance in Kirkuk
تقييم معارف والتزام مرضى عجز القلب الإحتقاني في مدينة كركوك

Author: Abid Salih Kumait
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2014 Volume: 4 Issue: 2 Pages: 196-206
Publisher: University of Kufa جامعة الكوفة

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Abstract

Background: Heart failure is an increasing cause of morbidity and mortality, especially in people aged above 65 years .Year after year, heart failure (HF) affects and kills an increasingly large number of people , the nurses educating of Heart Failure patients about diagnosis and treatment of their diseases have fewer hospital re-admissions and a better quality of lifeAim of the study:- In order to assessment patients knowledge and compliance with congestive heart failure in Kirkuk city . as well as to find out the relationship between patients knowledge and some as age and gender , residence , educational level .Methodology A descriptive study of a quantitative design was conducted in Kirkuk hospitals( Kirkuk general hospital, Azadi teaching hospital and Dakuk hospital) throughout the period from 1st of June 2012 to 31st of July 2013 . A non-probability (purposive) sample of (75) patients who admitted to Cardiac care units and ward of internal medicine at ( Kirkuk general hospital, Azadi teaching hospital and Dakuk hospital) . In order to collect the study information, a questionnaire was constructed. The questionnaire which contain of ( 54) items .Demographic data include ( 9 ) items , knowledge of the Patients include (36) items , practice of the Patients include (9) items . 3-likert scale option was used in the rating scale as: (3) for yes , (2 ) for uncertain ,and ( 1 ) for no . Content validity was determined by presenting the questionnaire to a panel of (10) experts Frequencies and percentage were used to describe and to analyze the data the present study and inferential statistical data analysis (chi-square).Results The findings of the study indicate that a high percentage 56% of patients was from four age group (51-and more) years. Its also appears that more than half (61%) of patients was male. With regard to their educational level, a high percentage (37%) from less than secondary school. The data indicate that (60%) were married. It had been noted that the majority of patients (70%) were retired. As for address, it is obvious that a high percentage (62%) of the patients were from the city. The data indicates that the most of these patients (72%) were had chronic diseases. The data analysis revealed that a high percentage (72%) of the patients were use medications. Its also appears that (53%) were no smoking. Conclusions : A socio demographic characteristic tends to have clearly effect on the knowledge of the patients and nursing staff , also the study concluded high percentage from patients have poor knowledge and practice about disease , while nurses staff have poor knowledge and need to update about congestive heart failure .Recommendation According to the results of the study, the study recommended the following items, concentrates should be on the health education for our society who may be had risk factors to heart diseases, more studies conducting about heart disease.

خلفية البحث :- يعتبر مرض عجز القلب لاحتقاني من الأمراض التي ترتبط بالدرجة الأساس بالعمر و يصيب في الغالب الأشخاص الذين تتجاوز اعمارهم٦٠ سنة. ويسبب في موت الكثير من الناس .وتعليم المرضى من قبل الملاك التمريضي حول تشخيص وعلاج عجز القلب ألاحتقاني يقلل من تكرار دخول المريض الى المستشفى مما يساعد في تحسين نوعية حياة المرضى الهدف :تهدف الدراسة الحالية هو تقييم معارف والتزام المرضى المصابين بعجز القلب ألاحتقاني في مدينة كركوك بالإضافة إلى إيجاد العلاقة بين معارف والتزام المرضى مع بعض الخصائص الديموغرافية مثل العمر، الجنس, المستوى التعليمي والسكن..المنهجية : أجريت الدراسة الوصفية في ثلاث مستشفيات داخل مدينة كركوك (مستشفى أزادي التعليمي و مستشفى كركوك العام و مستشفى داقوق العام) للمدة من١ حزيران ٢٠١2 و لغاية ٣١ تموز ٢٠١3 ولتحقيق أهداف الدراسة اختيرت عينة غرضية غير احتمالية مكونة من (٧٥) مريضا مشخصين بعجز القلب الإحتقاني من الراقدين في ردهات الباطنية و وحدات الإنعاش القلبي في مستشفى أزادي التعليمي و مستشفى كركوك العام و مستشفى داقوق العام في محافظة كركوك .ولغرض جمع المعلومات صممت استمارة استبيان تتكون من (54) فقرة .واستخدم مقياس يتألف من ثلاث مستويات للإجابة : الرقم (3) نعم, والرقم (2) غير متأكد , والرقم (1) يعني كلا . وتم تحديد مصداقية المحتوى من خلال عرض الاستبيان على (8) خبراء وشملت الاستبانة على الخصائص الديموغرافية (6) فقرة ؛ ومعارف المرضى (36 فقرة ) والتزام المرضى ( 9 فقرة) وبطريقة ألمقابلة الشخصية مع عينة البحث جمعت المعلومات وباستخدام التحليل الوصفي ( التوزيع التكراري, النسبة المئوية ) كذلك التحليل ألاستنتاجي (مربع كاي) .النتائج: من خلال تحليل البيانات تبين أن ( ٥٦%) من المرضى هم من الفئة ( أكثر من٥١سنة) و(٦١%) كانوا من الذكور، و( ٣٧%) من المرضى مستواهم الدراسي دون الدراسة الثانوية و كان ( ٦٠% ) من المتزوجين و( ٧٠%) منهم متقاعدين ، و(٧٢%) من المرضى يعانون من إمراض مزمنة و كذلك (٧٢%) من المرضى يتعاطون الأدوية ونسبة ( ٥٣% ) منهم غير مدخنين. الاستنتاجات : أظهرت الدراسة أن غالبية المرضى كانت معارفهم ضعيفة حول المرض والتزامهم كان ضعيفا لتقليل أعباء المرض عليهم ضعيفة .التوصيات: أوصت الدراسة بزيادة الثقافة الصحية للمجتمع وإجراء دراسات أخرى حول أمراض القلب


Article
B-Natriuretic Peptide Level as a Predictor for the Severity of LV Dysfunction

Author: Tharwet H. Nasser
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2007 Volume: 49 Issue: 4 Pages: 438-448
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: B -Natriuretic peptide is a neurohormone normally synthesized in ventricular heart muscle and known to be released in situations when left ventricular wall stress increases, it has a variety of physiological functions on its own, that are thought to be compensatory. Objective: The aim of this study was to apply B-natriuretic peptide (BNP) as a biomarker and to correlate its levels with the severity of heart failure using certain selected parameters as indicators of cardiac function. Patients and Methods Forty Six (46) patients with provisional diagnosis of heart failure were chosen for this work, thirty six (36) males and ten (10) Females, their age ranged between 33 and 80 Years. All underwent complete physical examination and ECG tracing together with ECHO/DOPPLER examination for heart failure. Eleven (11) healthy Subjects were chosen as control group for purpose of comparison.The patients were divided into groups, according to Age , Gender, BMI, whether they had the following selected associated diseases: (IHD, hypertension, and diabetes mellitus), smoking habit, Drugs intake, cardiac chambers dilatation including (LV in systole and diastole, RV, and LA), EF%, FS%, degree of diastolic impairment, LV Segmental wall motion abnormalities. Five ml (5ml) specimen of venous blood were aspirated from each patient, and also the control group for estimation of BNP level, using ELIZA technique. Results There was a significant difference in mean serum BNP levels between cases of congestive heart failure and control group. Considering the subject as a positive for heart failure if his BNP level was ≥ 375pmol/l, at this cutoff value there will be a sensitivity of 80.4% and specificity of 100%. Also the study showed highest values of mean BNP in those patients having restrictive pattern of diastolic dysfunction. Conclusion: BNP was used as a biomarker for the first time in Iraq to diagnose congestive heart failure. The role of BNP as a guide to determine the severity of heart failure and the efficacy of treatment was promising, so BNP fulfill most of the criteria in patients with suspected heart failure. At this point it was found that the mean of the right ventricular dimensions were significantly higher in the group with highest BNP quartile compared to lowest quartile BNP group, probably reflecting more severe form of impaired cardiac function and heart failure, a finding which has not been mentioned in any earlier studies in the same field.


Article
Prognostic Significance of Serum Albumin Levels in Patients with Systolic Heart Failure

Author: Muataz Fawzi Hussein
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 3 Pages: 411-417
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Hypoalbuminemia is considered as poor prognostic factor in patients with certain chronic diseases, such as cancer and end-stage renal failure. Low serum albumin is common in patients with heart failure; nevertheless, the relationship between serum albumin and heart failure prognosis has not been well verified.OBJECTIVE:To elucidate the effect of serum albumin level on prognosis of patients with systolic heart failure.METHODS:This study included 250 patients with systolic heart failure who were admitted to Baghdad teaching hospital between February 2008 and April 2010. Patients were divided into groups based on presence of hypoalbuminemia (≤3.4 g/dL).RESULTS:The mean age of patients was 55 ± 14 years and the mean left ventricular ejection fraction [LVEF] was 28 ± 11 %). The mean serum albumin was 3.9 ± 0.7 g/dL; 27.2 % of patients had hypoalbuminemia. Patients with and without low serum albumin levels were similar in age, cause of heart failure, and ejection fraction. Patients with hypoalbuminemia had higher New York Heart Association (NYHA) class, higher serum urea, creatinine and C-reactive protein levels but lower levels of sodium, hemoglobin, and cholesterol. In patients with body mass index (BMI) < 25 kg/m2, 26% had hypoalbuminemia compared to 20% in those with BMI ≥25 kg/m2 (P ≤ 0.01). One-year survival was 64.71% in patients with and 85.72% in those without hypoalbuminemia (P < 0.001). Risk-adjusted hazard ratio for 1-year mortality was 1.9 (1.5-2.4).CONCLUSION:Hypoalbuminemia is common in patients with heart failure and is independently associated with increased mortality.


Article
Left Ventricular Remodeling Patterns in Chronic Heart Failure

Author: Muataz Fawzi Hussein
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2012 Volume: 11 Issue: 4 Pages: 551-556
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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ABSTRACT:BACKGROUND:Patients with heart failure show a wide spectrum of changes in left ventricular volume, mass, and function.OBJECTIVE:The aims of this study were to define the patterns of left ventricular structural and functional remodeling and consider their clinical implications in patients with chronic heart failure.PATIENTS AND METHODS:Two-dimensional echocardiograms were obtained for patients with chronic heart failure in Baghdad teaching hospital during the period from February 2009 to February 2011 and were used to calculate left ventricular volume, mass, geometry, and ejection fraction. Inclusion required the diagnosis of heart failure in symptomatic patients on medical therapy. Measures of left ventricular size or function were not used as inclusion or exclusion criteria.RESULTS:Two hundred and eighty (280) patients were included in this study of whom 154 were males and 126 were females. The mean age of patients was 58 ± 17 years. Plots of ejection fraction against left ventricular end-diastolic volume showing an inverse curvilinear relation allowed a description of 4 remodeling patterns. Pattern A (n = 58) was defined as normal end-diastolic volume (<91 ml/m2) and normal ejection fraction (>50%); 67.24% of these patients showed left ventricular hypertrophy or concentric remodeling. Pattern B (n = 58) was defined as normal end-diastolic volume and depressed ejection fraction; hypertrophy or concentric remodeling was present in 65.51%. Pattern C (n = 153) was defined as increased end-diastolic volume and depressed ejection fraction; eccentric hypertrophy was present in 94.77%. Pattern D (n = 11) was defined as increased end-diastolic volume and normal ejection fraction; eccentric hypertrophy was present in 81.81%.CONCLUSION:These patterns of remodeling encompass a wide spectrum of geometric changes with different clinical and pathophysiologic features and possibly different management strategies.


Article
EVALUATION OF IN VITRO PRODUCTION OF CYTOKINES BY MONOCYTES/MACROPHAGES IN PATIENTS WITH HEART FAILURE
الانتاج التلقائي للسيتوكينات الاتهاب من الخلايا الوحيدة / البالعة عند مرضى قصور القلب

Authors: IVANO-FRANK --- LIUBOMYR GLUSHKO --- SERGIY FEDOROV
Journal: Duhok Medical Journal مجلة دهوك الطبية ISSN: ISSN: 20717334 (online)/ ISSN: 20717326 (Print) Year: 2014 Volume: 8 Issue: 2 Pages: 78-84
Publisher: University of Dohuk جامعة دهوك

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ABSTRACTAbstract Recent studies showed an important role of inflammation in heart failure (HF).Monocytes/macrophages are main cells in immune response. The aim was to investigate spontaneous cytokines production by monocytes/ macrophages in patient with ischemic heart failure.Methods Ninety six patients with HF of ischemic genesis were observed. The spontaneous production of interleukin 1 (IL-1 ), interleukin 6 (IL-6), and interleukin 10 (IL-10) by monocytes/macrophages in vitro was detected by ELISA method.Results The in vitro spontaneous production of pro inflammatory cytokines IL-1 and IL-6 by monocytes/ macrophages in patients with HF was significant higher and antiinflammatory IL-10 was lower than in control group. The progression of HF caused toincrease of spontaneous production by monocytes/ macrophages of IL-1 and IL-6 but decrease of IL-10.Conclusion The monocytes/macrophages in patients with ischemic HF are in condition of chronic activation which manifests of overproduction of pro inflammatory cytokines and poor secretion of anti-inflammatory IL-10.

خلفية وأهداف البحث: لقد أظهرت الد ا رسات ألاخيرة دو ا ر هاما للألتهاب في قصور القلب. وان الخلايا الوحيدة / البالعة هي الخلايا الرئيسية في الاستجابة المناعية. هو البحث عن الانتاج التلقائي للسيتوكينات من الخلايا البالعة عند مرضى قصور القلب الناتج عن نقص التروية.طرق البحث: تم معاينة ٩٦ مريضا يعاني من قصور في القلب سببه نقص التروية وتم الكشف عن الانتاج التلقائيمن الخلايا الوحيدة في المختبر بواسطة فحص الانزيم المرتبط المناعي ,(IL-10) ,(IL-6),(IL-1b) للأنترلوكين .(ELISA) من الخلايا الوحيدة (IL- و( 6 (IL-1b) النتائج: لقد أظهرت النتائج في المختبر أن الانتاج التلقائي للسيتوكينات الالتهابية كان أقل مما كانت عليه في المجموعة (IL- /البالعة عند مرضى قصور القلب كان أعلى، ومضادات الالتهاب ( 10 IL-) ولكن ادى لنقصان (IL- و( 6 (IL-1b) القياسية. وأن تفاقم قصور القلب أدى لزيادة أنتاج الخلايا الوحيدة / البالعة .(10 الاستنتاج: أنه عند مرضى قصور القلب الناتج عن نقص التروية ,الخلايا الوحيدة /البالعة هي في حالة تنشيط مزمن الذي .(IL- كشف عن زيادة أنتاج السايتوكينات الالتهابية ونقص أف ا رز مضادات الالتهاب ( 10


Article
Left Ventricle Remodeling for Patients with Heart Failure and its Influence on Cardiac Performance

Author: Durra A. Ahmed درة علي احمد
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2013 Volume: 55 Issue: 2 Pages: 125-130
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Many cardiac diseases can cause cardiac hypertrophy developed by the established cardiac overload, such as long term of uncontrolled hypertension, valvuler disease or congenital anomaly and many more causes. If the cause of hypertrophy persists for long time it will generate heart failure, as a result changes in size, shape and function of the heart which refer as remodeling. Objective: To investigate the types of remodeling in patients with heart failure, and study its relation with cardiac performance.Patients and methods: The study included fifty normal individuals and fifty patients, only those patients who developed hypertrophy and failure were chosen. The study has included the measurements of many cardiac parameters obtained by the echocardiography examination. The measurements have included: Left ventricle internal diameter at diastole (LVIDd), Left ventricle internal diameter at systole ( LVIDs), Peak velocity of early transmitral flow (E), Peak velocity of late transmitral flow (A), Isovolumetric contraction time (ICT), Isovolumetric relaxation time (IRT), Ejection time (ET), Ejection fraction (EF%), myocardial performance Index (MPI), Left ventricle mass index (LVMI ), Posterior wall thickness at diastole ( PWTd), Relative wall thickness ( RWT) and Interventricular septum thickness at diastole (IVSTd).Results: results of remodeling have shown nine patients expressed concentric hypertrophy, thirty seven patients have shown eccentric hypertrophy and only four patients were similar to normal. Many other changes were observed these are an exaggerated ratio of (E/A) goes up to four, an increase in the (LV) volume appeared on its dimension at systole for patients (54.63%), a reduced cardiac output for patients and insignificant small change in relative wall thickness (RWT. (Conclusion: In conclusion long term cardiac overload can induce hypertrophy, after a period of time heart failure may ensue. This can influence the shape and size of the heart together with a reduction in its performance.Keywords: Heart Failure, Cardiac remodeling & left ventricular performance.

الخلفية:- الكثير من إمراض القلب يمكن ان تؤدي الى تضخم في عضلة القلب, هذا التضخم ناجم عن زيادة الاجهاد على العضلة القلبية مثال ذلك:ضغط الدم الغيرمسيطر عليه لمدة طويلة, امراض صمامات القلب أو التشوهات الولادية للقلب باللاضافه الى اسباب اخرى كثيرة, اما اذا استمر سبب الاجهاد لمدة طويلة سوف يسبب عجزفي القلب. في البحث الحالي حاولنا استقصاء التغيرات الحاصلة في عضلة القلب نتيجة التضخم وعجز القلب.خطة البحث:-تضمنت الدراسة (50 مريضا") و50(شخصا" صحي). تم اختيار المرضى فقط الذين تبين لديهم تضخم بالقلب مع عجز في القلب. كذلك تضمنت الدراسة قياسات عديده الى عوامل تشخيصية لعضلة القلب من خلال قياسات اخذت بجهاز صدى القلب((echocardography.أخذت القياسات بصورة رئيسية للتغيرات التي اصابت حجم البطين الايسر ومن ثم تمت قياسات المتغيرات الاخرى او التي لها علاقة )بتضخم القلب و(LV Remodeling وهذه العوامل تتعلق بقصور عمل القلب الانقباضي والانبساطي. لقد تضمنت القياسات:-(LVIDd, LVIDs, E/A, IVRT, IVCT, ET, EF%, PWTd, IVSTd, VTI, LVOT, IMP, LVMI, SV, CO, RWT).النتائج:-أظهرت النتائج أن (9) لديهم (Concentric hypertrophy) و(37) لديهم (Eccentric hypertrophy)و (4) فقط كانت نتائجهم ضمن الطبيعي ((Normal geometry. حتى وصلت الى (4) وزيادة الحجم الانقباضي للبطين الايسر E/A تغيرات كثيرة اخرى شملت زيادة مبالغه مع نقصان في كمية ضخ الدم للجسم مع تغير في عرض الجدار النسبي للبطين الايسرRWT)). الزيادة في التثخن في البطين الايسر (Concentric remodeling) يمكن ان يكون قد تسبب في كثرة الجهد على عضلة القلب بينما الجلطة القلبية والتليف الحاصل من جرائها قد يعطي (Eccentric hypertrophy) .كذلك اظهرت النتائج قلة في قيمة سرعه الدم خلال الصمام الاكليلي كذلك انقباض الاذين الايسر ( (Aربما تسببت عدم كفائة الاذين الايسر كذلك نقصان في قيمة (LVIDd/LVIDs) بسبب نقصان في تقلص LVIDs)) كذلك (RWT) وزيادة في ((LVMI هذا علاوة على عوامل كثيرة اخرى والتي تعطي تغيرات اقل وضوحا".الاستنتاج:- يمكن الاستنتاج إلى إن الإجهاد المستمر لمدة طويلة من الممكن ان يولد التضخم, وبعد وقت اخر يولد عجز القلب. وهذا ممكن ان يؤثر على:-1-شكل وحجم القلب.2-E F%.3-CO.


Article
Nurse's Knowledge about Modifiable and Non-Modifiable Risk Factors of Heart Failure Patient in Erbil Teaching Hospitals
معارف الممرضين للعوامل الخطرة القابلة للتغير وغيرالقابلة للتغيرلحدوث عجز القلب في مستشفيات اربيل التعليمية

Author: Yousif Mohammed Younis
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2014 Volume: 4 Issue: 3 Pages: 204-214
Publisher: University of Kufa جامعة الكوفة

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Abstract

Background: The changes in cardiac function are associated with heart failure which result in a decrease of cardiac output. This results form a decline in stroke volume that is due to systolic dysfunction, diastolic dysfunction or a combination of the two. Nurses can play a role in prevention of heart failure disease by being knowledgeable of the risk factors associated with disease and also, the nurse may be a teacher-motivator for the patient. The aim of the study is to find out the association between nurse's knowledge about modifiable and non-modifiable risk factors of heart failure.Methods: A non probability purposive sample was 20 of February, 2014 to 20 of April 2014, 64 subjects, were selected in medical wards and coronary care units in both Hawler and Rizgary Teaching Hospitals. The study instrument contained of two parts. Part one included socio-demographic characteristics and part two was observational check list which contained 21 items for nurse's knowledge about modifiable and non-modifiable risk factors of heart failure patient. Data was analysis by the statistical package for science service (SPSS version 17) was used for data entering and analysis such as S= significant (<0.05), very highly significant (<0.000) and non-significant (>0.05), Percentage, frequency and Chi-square test were used to interpretation. Results: According to the results, that majority of the sample (67.2%) were within age group 23-32 years old. Male were more than female, the majority 83.8% of them were married and 75% of them graduates from nursing institute. Most of them had 1-7 years of experiences. The study shows very highly significance association of gender and highly significances association of marital status, levels of education and years of experiences in medical ward and coronary care unit. Conclusion:According to the results, the majority of the samples were within young age group, male more than female, the majority of them were graduated from nursing institution. Concerning statistical association between age group and nurse's knowledge about heart failure risks shows non-significant, while shows very highly significant within gender and highly significant between nurse's knowledge with their marital status, levels of education and years of experiences in medical ward and coronary care unit.Recommendation: Training session, continuous education and work shop by world health organization should be conduct for nurses at coronary care unit and medical ward to provide best nursing care for heart failure patient. Further study should be done to find out the gap between nursing practices and theory topics

خلفية البحث : ترتبط التغيرات بوظيفة القلب للمصابين بعجزالقلب مما يؤدي إلى انخفاض النتاج القلبي. هذه النتائج تشكل تراجعا في حجم المخ التي هي نتيجة لوجود خلل في الضغط الانقباضي او الانبساطي أو للحالتين معا. يمكن أن يلعب الممرض دورا في الوقاية من مرض عجز القلب عندما يكون على دراية بعوامل الخطورة المرتبطة بالمرض وايضا قد يكون الممرض معلما ومحفزا للمريض. وتهدف الدراسة الحالية من ايجاد العلاقة بين معارف الممرض المتعلقة بعوامل الخطورةالقابلة وغير القابلة للتغيرلحدوث عجز في القلب.المنهجية: تم اختيار عينة غير غرضيةللفترة من 20من شهر شباط 2014 إلى 20 من شهر نيسان عام 2014و تم اختيار 64 ممرض وممرضة العاملين في الردهات الباطنية والعناية القلبية في مستشفيات اربيل التعليمية في كل من مستشفى هولير ومستشفى رزكاري وشملت اداة الدراسة من جزأين.الاول شمل الخصائص الاجتماعية والديموغرافية والجزء الثاني شمل على الملاحظة و التي تضمنت 21 فقرة حول معارفالممرضين للعوامل القابلة للتغير وغير القابلة للتغير لحدوث عجز القلب.فقد تم استخدام الوسائل الإحصائية (برنامج SPSSالاصدار 17) للبيانات الداخلة وتحليل مثل=Sهام(<0.05)، =VHSذو أهمية عالية جدا (<0.000) و=NSغير هام (> 0.05)، النسبة المؤية، والتردد و تم استخدام اختبار مربع للتفسير.النتائج: ان غالبية العينات (67.2٪) كانت ضمن الفئة العمرية 23-32 سنة:وان الذكور كانوا أكثر من الإناث، وكانت الأغلبية 83.8٪ منهم متزوج و 75٪ منهم من خريجي معاهد التمريض. وكان لديهم خبرة من 1-7 سنوات. واظهرت الدراسة وجود علاقة عالية جدا بين الجنسين والحالة الزوجية ومستويات التعليم وسنوات الخبرة.الاستنتاج: وفقا للنتائج، كانت الغالبية العظمى من العينات في غضون الفئة العمرية من الشباب، الذكور أكثر من الإناث، وقد تخرج معظمهم من من معاهد التمريض. بخصوص التحليلات الاحصائية بين الفئات العمرية ومعارف الممرضين حول مخاطر عجز القلب يظهر غير هامة، في حين يظهر هامة للغاية داخل الجنسين وهامة للغاية بين معارف الممرضين مع حالتهم الزوجية، ومستويات التعليم، وسنوات الخبرة في الأجنحةالطبية و وحدة العناية التاجية .التوصيات:دورة التدريب والتعليم المستمر و ورشة عمل من قبل منظمة الصحة العالمية ينبغي أن يزيد معلوماتالممرضين في وحدة العناية التاجية والأجنحة الطبية لتقديم أفضل الرعايات التمريضية لمريض عجز القلب. وينبغي أن يتم إجراء مزيد من الدراسات لمعرفة الفجوة بين الممارسات التمريضية و المواضيع النظرية.


Article
Cardiac Resynchronization Therapy in Patients with advanced

Author: Arshad Fuad
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2014 Volume: 13 Issue: 2 Pages: 28-35
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Evidence suggests that Cardiac Resynchronization Therapy(CRT) is useful in patients with advanced heart failure (HF) & wide QRScomplexes despite optimal medical therapyObjective: To demonstrate the beneficial effect of CRT in improving thehemodynamic profile of patients with advanced HF despite optimal medicaltherapy.Methods: This prospective study enrolled 22 patients with advanced heartfailure (HF) who were selected from those patients who attend Ibn Al‐Bitarcenter for cardiac surgery during the period from September 2010 to April2011. All patients were subjected to thorough history taking and physicalexamination and have been investigated to assess their eligibility toCRT.ECG and Echocardiography {assessing LV systolic & diastolic functions,septal to posterior wall motion delay (SPWMD), left ventricular volumes, leftventricle ejection fraction (LVEF) (by biplane Simpson’s method) and mitralregurgitation (MR)} had been done to all patients before and 1 day after CRTdevice implantation. Tei index calculated before and after CRT, comparingresponders and non‐responders.Results: Sixteen patients (72.7%) are matching the definition of theresponders. The responders have a decrease in QRS width (by 14.63%), LVend‐diastolic diameter (by 6.35%), Tei index (by 14.85%), LV end‐systolicvolume (16.61%), and SPWMD (by 41.72%) with increase in EF (by 22.86%) incomparison to the non‐responder.Also responders patients had highermean initial Tei index (1.040) in comparison to non‐responders whose theirmean initial Tei index was (0.9616).Conclusions: CRT has been shown to improve the functional status in amajority of patients with drug –refractory Heart failure (ischemic, or dilatedcardiomyopathy), and Wide QRS complex & resulted in decrease rate ofhospitalization in responders.


Article
Prevalence of iron deficiency among patients with chronic heart failure attending Rizgary and Hawler teaching hospitals in Erbil City
انتشار نقص الحديد بين المرضى الذين يعانون من قصور القلب المزمن و الذين يراجعون مستشفيات رزكاري و اربيل التعليمية في مدينة أربيل

Authors: Kawa Muhamedamin Hasan --- Hawree Ibrahim Othman
Journal: Zanco Journal of Medical Sciences مجلة زانكو للعلوم الطبية ISSN: 19955588/19955596 Year: 2018 Volume: 22 Issue: 3 Pages: 355-366
Publisher: Hawler Medical Univeristy جامعة هولير الطبية

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Abstract

Background and objectives: Iron deficiency is an emerging problem in patients with chronic heart failure and could be a potential therapeutic target. This study aimed to determine the prevalence, severity, and type of iron deficiency among patients with chronic heart failure.Methods: This study was conducted in Rizgary and Hawler teaching hospitals in Erbil from April 2015 to January 2016. A total of 60 patients with heart failure for more than six months with an ejection fraction less than 55% were enrolled. These patients were evaluated for iron status and hematological indices.Results: The prevalence of iron deficiency was 76.7% with 52 %of them having severe iron deficiency. Absolute iron deficiency was detected in 41% of patients. The prevalence of anemia was 41.7%. There was a significant difference between those with chronic heart failure with iron deficiency and those with no iron deficiency in the hemoglobin (P = 0.001), mean cell volume (P = 0.001), mean corpuscular hemoglobin (P = 0.002), serum iron (P <0.001) and transferrin saturation (P <0.001).Conclusion: Iron deficiency is common in chronic heart failure. It is the most common cause of anemia in such patients. Serum ferritin alone was not a reliable marker of iron deficiency in such patients.

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