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There was significant relationship between decision basis and actual gestational age at birth anxiety vitamins cheap doxepin 25mg online, as well as between maternal age and medical and surgical complications (P-value<0 kitten anxiety symptoms order 25mg doxepin visa. Conclusion: Neonates born after elective cesarean delivery in Al-Hillah city have significantly higher rates of respiratory morbidity and longer length of hospital stay anxiety symptoms at bedtime doxepin 75mg low price, with increased risk of certain medical and surgical complications anxiety disorder nos doxepin 10 mg amex. The unexpected medical complications are inversely related to gestational age at which elective cesarean section is timed. Introduction Child delivery in Babylon is associated with a multitude of physical, emotional, social, physiological, ethnocultural, and psychological dimensions. Planned sections are done before delivery commences, as compared to emergency sections, which are undertaken before or after labour has commenced[3]. The reasonable gestational age for scheduled sections has become a matter of heated debate among professionals dealing with maternal and child health care [4]. Over nearly a half century, maternal and child health care professionals have defined "term pregnancy" based on the assumption that fetal maturity is completed at the end of 37th week[5]. However, it recently became clear that neonatal respiratory complications are reduced when increasing the gestational age to 39 weeks. There is evidence that babies born by planned C-section at 37 weeks have more occurrences of certain compilations that those at 39 weeks[6]. Therefore, experts recommend that elective C-section be conducted from 39 weeks onwards to achieve fetal maturity[7]. Although pregnancy is a physiological process, its end is a painful experience for mothers and associated with fear, dread and anxiety[8]. C-section was introduced primarily to reduce the risks maternal child complications. Unfortunately there is a false assumption nowadays that scheduled C-section provides a safe and healthier means of escaping vaginal delivery pain. That is why it is estimated that more than half of women voluntarily choose C-section as the preferred mode of delivering their babies[10]. In North America notably the United States of America, C-section accounted for 26. In addition, in Latin America this rate is also quite high reaching up to 40%[12]. According to regional health records and statistics, the prevalence of C-section in Iraq is up to three times higher than the international rate[13]. Although scheduled operations should be decided when the health of the mother or baby are compromised; this mode of delivery has become a way of avoiding distress of labor pain, due to a common notion that its less painful, safer, and healthier than vaginal delivery[14]. Aim of the Study Identify the unexpected medical and surgical conditions of newborns by elective cesarean delivery in Al-Hillah city, and assess the association between the actual gestational age at birth and decision by which elective caesarean sections were done as influenced by local sociodemographic factors and perceptions; that resulted in those conditions. Patients and Methods this is a cross-sectional study conducted in AlHilla General Teaching Hospital from the beginning of March 2018 until the end on August 2018, and included a total of 150 neonates born via elective cesarean section who had unexpected medical and surgical conditions following the procedure, who were born at various gestational ages. Excluded cases were those who did not develop unexpected outcomes, as well as those born via emergency C-section or normal vaginal delivery. Table 1: Distribution of unexpected medical complication of pregnant women who underwent elective caesarean section. Surgical complication Pneumothorax Intestinal obstruction Tracheo eosophageal fistula Others (injury) Total Number 10 15 5 20 50 Percentage(%) 20. Table 3: Association between variables and timing of caesarean section Variables Decision Clinically Ultrasound Total 20(19. Overall, they assumed that vaginal delivery was less risky than C­section as it eliminates maternal child adverse outcomes[16]. The highest percentage of unexpected medical complications of pregnant women who underwent elective C-section was respiratory compromise in 23. This study is in line with international studies that indicate lung complications are the commonest cause of neonatal morbidity following elective C-sections[17]. These are in part attributed to the absence of hormonal and physiological cascade of changes associated with birth which are vital for lung function Medico-legal Update, January-March 2020, Vol. Term neonatal respiratory distress syndrome is also associated with higher need for oxygen and assisted pulmonary ventilation, lengthy hospital stays and higher mortality than other causes of respiratory morbidity in term counterparts[19]. Infants delivered by planned C-sections in Babylon have an increased risk of adverse respiratory morbidity. These complications are similar to international studies and surpassed other medical conditions. As shown by this current research paper elective C-section can elicit some unexpected negative outcomes in neonates.

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On the other hand anxiety home remedies doxepin 75 mg mastercard, learners with low levels of self-esteem tend to anxiety quizlet 75 mg doxepin otc be characterized by the feeling and perceptions of powerlessness anxiety symptoms everyday buy 10mg doxepin with visa, helplessness anxiety 4th 9904 generic doxepin 75 mg online, and even ineptness. When faced by different tasks and challenges in their personal lives, the group with low self-esteem is highly susceptible to stress where they can perceive a normal challenge to be insuperable the findings from the present study align from the findings from a study by Fahran & Khan (2015) that identified that individuals with lower levels as compared to the average level of selfesteem portrayed lack of confidence and self-assurance. The study by Fahran & Khan (2015) emphasized that the lack of assertiveness is negative for these individuals, especially if they are nursing students. Such negativity is linked to contributing to the students accepting tasks that are beyond their capabilities. Due to the lack of the necessary skills and competencies required to complete these tasks, the students are more likely to demonstrate increased stress levels. Several aspects can be linked with the behavior of individuals with lower levels of self-esteem. These factors include challenges with alcohol usage, poor time management, study behavior and even reflecting self-defeating practices. Such a decline in self-esteem is linked with the growth in the cognitive ability of these individuals which makes them increasingly sensitive to social issues. The lowered self-esteem is also attributed to the widening gap between the real identity and the ideal selves. The gap between the two identities has been identified to be wider among the adolescent girls compared to the boys. These findings have also been contradicted by other studies that identify the female adolescents and having a more positive perception of themselves compared to the male adolescents and also those that identify no difference between the self-esteem levels across different genders. Recommendations, it is important to raise awareness of faculty members about the alarming level of stress among students to help them find new ways of supporting their students. Teach and encourage students to use more effective stress management strategies to minimize the risk of academic stress. Ethical Clearance: All experimental protocols were approved under the College of Nursing, University of Kerbala, Kerbala City, Iraq and all experiments were carried out in accordance with approved guidelines. Self-esteem: Moderator or mediator between perceived stress and expectancy of success? Relationships between academic stress, social support, optimism-pessimism and self-esteem in college students. Gender differences in coping with positive and negative experiences, Indiana University. The association between stress, selfesteem and depressive symptoms in adolescents. The association between stress and emotional states in adolescents: the role of gender and self-esteem. The cortisol response to awakening in relation to different challenge tests and a 12-hour cortisol rhythm. The relationship between educational stress, stress coping, self-esteem, social support, and health status among nursing students in Turkey: A structural equation modeling approach. Social support, self-esteem, and stress as predictors of adjustment to university among first-year undergraduates. A total of 70 cases studied from 16th of February 2018 to 20th of June 2018 for hemoglobin variant analysis at the teaching labrotarioes of Al- Hussseini Teaching hospital which were studied for patterns of hemoglobinopathies. Out of total 70 patients screened for patterns of hemoglobinopathies the result of the study revealed that 48 Patients which represent(68. Key Words: Hemoglobinopathies, Hb electrophoresis, Hemoglobin Variants, retention time, hemoglobin A2. Phone: +9647727472664 structure of hemoglobin in healthy individual consisted of tetramers of 4 globin chains of polypeptide, every one of them connected to haem protein. The predominant hemoglobin in normal adults is HbA (forming about 97%) and it has 2 and 2 chains. A remaining part of hemoglobin consists of approximately 2-3% HbA2 which has two and two chains, and a few portion of hemoglobin of fewer than 1% represents HbF, which has two and two chains. In the neonatal period, the major haemoglobin is HbF (approximately 8090%), with a variable amount of HbA (approximately 10-20%). The switch from chain synthesis (which is the predominant form of hemoglobin in the fetus and neonate) to chain synthesis (which predominates in children and adults), together with the production of chains, is usually finished by about one year from time of baby delivery.

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Nearly half (45%) of the allergic reactions seen in our outpatient unit were related to anxiety disorder treatment order doxepin 75 mg visa the use of docetaxel anxiety chat room cheap 75 mg doxepin with amex, and the percentage of reactions to anxiety 9 year old buy doxepin 10mg low price docetaxel was 26% anxiety symptoms forums buy 25 mg doxepin mastercard. In our study, nearly 80% of the patients developed this reaction during the first docetaxel infusion, within the first 1-5 min of infusion. In our unit, the percentage of the reaction against paclitaxel was 10 %, consistent with the range of 8-45% that has been reported [15]. The incidence of any grade reaction to platinum compounds has been reported to be 12-20% [9,10,16,17]. In our unit, platinum agents (carboplatin, oxaliplatin and cisplatin) produced an overall reaction rate of 29. A study reported that the incidence of any type of reaction to carboplatin was 12% [17]. In the same study, 27% of the patients who received 7 or more cycles with carboplatin developed reactions, compared to approximately 1% in those who received less than 7 cycles [17]. Furthermore, in this study, a direct relationship was found between the number of platinum therapy cycles and the occurrence of hypersensitivity reactions. In the literature, 50% of patients who developed an infusion reaction against platinum agents went on to develop reactions to repeated drug administrations, despite premedication [20,22-24]. Cross-allergy exists between cisplatin and carboplatin, but its incidence is not known [26]. Therefore, if a platinum compound will be re-used, desensitization is recommended [27-29]. Due to the increasing use of carboplatin as both a first- and second-line therapy for ovarian cancer, the incidence of allergic reactions also increased. In this study, the majority of reactions were mild to moderate and the rate of severe reactions was 6. Although there are more case reports about oxaliplatin allergy, a study published in 2006 showed that 15% of 108 patients showed an allergic response. When oxaliplatin was readministered to 14 patients who developed reactions, recurrent development of the allergy was seen [20]. In a subsequent large-scale study, 308 of 1224 patients (25%) developed oxaliplatin allergy. The percentage of grade 1-2 reactions was 23%, while the percentage of grade 3-4 was 37% [9,16,20,21]. Three patients (30% of the reacting ones) could not continue therapy due to a grade 3-4 reaction after the 4th and 5th cycles. While infusion reactions to monoclonal antibodies are typically seen within the first 30 to 120 min after initiation of infusion, the majority of reactions occur during the first and second infusion [11]. With rituximab, more than 50% of the reactions were seen during the first infusion. The incidence of reaction during the first infusion of trastuzumab is 20-40% [30,31], with 0. The incidence and severity of adverse reactions to trastuzumab is lower than that caused by rituximab [32]. Other patients with grade 1-2 Acute infusion reactions 266 reactions could continue to use the drug safely. The incidence of infusion reactions due to the administration of cetuximab varies by geographic region. While two studies conducted in Europe showed an incidence of grade 3-4 reactions as 2. Consequently, although severe reactions are rare, the incidence of mild to moderate reactions against taxanes, platinum compounds, and monoclonal antibodies is quite high. Clinical symptoms do not vary widely among the agents, though the onset time of symptoms does vary. While reactions against platinum agents was accounted for type 1 anaphylactic reactions, in contrast, reactions against taxanes and monoclonal antibodies during the first infusion and in the following minutes suggests the presence of different mechanisms. While mild-moderate reactions (grade 1-2) tend to present with fever, skin rash, flushing, tremor, itching, and dyspnea, severe reactions (grade 3-4) tend to present with serious hives, bronchospasm, wheezing, zonesthesia, and voice alterations. Mild-moderate reactions can be controlled by temporary discontinuation of treatment and administration of symptomatic supportive therapy. Although the same drug can be continued after complete resolution of the symptoms, subsequent administrations should include premedication, decrease of the infusion rate, and/or a desensitization protocol. In severe reactions, the infusion should be discontinued and supportive therapy should be initiated.

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This approach anxiety symptoms get xanax doxepin 25mg sale, however social anxiety symptoms yahoo order 10mg doxepin mastercard, has been shown to anxiety symptoms unreal generic doxepin 75 mg without a prescription miss disabilities that are least publicly evident10 anxiety symptoms burning skin cheap doxepin 75mg fast delivery. Such as cognitive and hearing disabilities and to include children from outside the population of interest11. Howeverinformation on the validity of singlephase survey data on disabilities in children islacking, especially in developing countries. In addition, instruments that have been used to survey childhood disabilities in developed countries are unlikely to be cross-culturallyvalid in developing countries12. The above considerations led to the development of a twophase methodology forsurveying childhood disabilities in populations where professional resources are future researchextremely limited. This paper describes the methodology, presents data on its reliability and validity across culture, discusses its uses and limitations, and identifies areas forHandicapping disabilities in both developing and developedcountries are important public health issues13. Basic data on their frequencies, underlying risk factorsand associations are necessaryin order to plan healthprograms and to provide social services for them. Screening in community surveys is a good strategy for providing a quick insight for this problem among children14. Many community surveys have been conducted for handicapped children in various parts of the world. In which a population-based study has applied the tenquestions tool to estimate the prevalence of handicapping disabilities among children up to 9 years of age and describe the epidemiological pattern of disabilities in the eastern part of the city. The study was part of the training led survey for male medical students in the Medical College. In countries with reasonably well-developed services for children with disabilities, administrative data and registries provide a useful source of population-based information on childhood disabilities. Material and Method Study setting and population A Population based cross-sectional study carried out in Basra cityfrom October 2016 to February 2017. Interviews at the selected houses wereconducted primarily by gathering the basic sociodemographic information of the family from the head of the family,usually the father. Variables included in this part were family income, number of family members, age of thechild, ages of parents, occupation of parents, educational level of parents, history of disabilities in either parents families and consanguinity between parents. The tenquestions tool with their probes was explained to thehead of the household to detect any disabled member ofthe family in the age 9 or below. Houses with nochildren at the required age were skipped and replacedby the next one fulfilling the research criteria. Thedetailed questionnaire was filled for any child with apositive answer on one or more of the disability questions. The study sample and data collection Total 1734 sampleswere collected to study the prevalence rate of childhood disabilities in Basra center from November 2016 to March 2017. The percentage of under nine years children from the total population is about 11. The high percentage (52%) of the studied families had three disabled child while the lowest percentage (6. Characteristics of order of birth of disable child among their sibling in the family Order 1 2 3 4 5 Total No. Table 3: Age frequencies of all children and the disabled group Disabled group Age 1year> 1­2 2- 6 6Total No 1 8 23 41 73 % 1. Characteristics of number of disable children in the family Number of children 1 2 3 Total No. Frequency of various types of disabling conditions in Basra city Condition Speech Motor Mental Fits Learning difficulty Hearing Vision Emotional problem Chronic or hereditary Previously diagnosed 23 12 9 7 6 7 4 3 2 Newly identified 3 2 3 1 2 1 1 1 1 Conditions have not been totaled due to multiple disabilities in some cases. Causes of disabilities as perceived by parents Suspected cause of disability Hereditary causes Non hereditary illnesses Accidental/traumatic causes Other causes Unknown cause No 37 10 4 2 20 % 50. Accurate determination of the prevalence is hindered by a group of inherent problems in these countries including under reporting, late identification, poor registration and lack of infrastructure for their monitoring and service provision. To overcome these shortcomings, a variety of methods were tried in order to identify disabilities at the community level.

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Materials/Methods: 99 consecutive patients with head and neck cancers were treated with radiation therapy (+/chemotherapy) at our institution anxiety 5 see 4 feel order 75 mg doxepin otc. Conclusion: Our study demonstrates that despite weight loss of head and neck cancer patients anxiety 6 year old discount 25 mg doxepin with amex, there was no significant correlation with setup inaccuracy anxiety 2 days before menses buy 75mg doxepin. Increasing stage was found to anxiety symptoms depression buy cheap doxepin 10mg line be predictive of an increase in percent weight change. This study suggests that most patients undergoing head and neck radiation therapy will have a reliable set-up when properly immobilized despite weight loss. Radiation Oncologists providing these treatments may not have peer-to-peer collaboration available. This abstract will demonstrate feasibility in performing peer review within multiple non-affiliated organizations using a cloud-based platform to increase quality and safety. Materials/Methods: the oncology system stores patient specific clinical and dosimetric data for electronic brachytherapy and was utilized for multi-fraction treatment across several facilities. The oncology platform is used to facilitate workflow management and documentation in a process structured environment. Mandatory fields throughout the care path allow consistent data to maximize comprehensive peer reviews. The cloud-based infrastructure permitted quick access to pertinent chart details across multiple nonaffiliated locations to streamline the peer review method. Evaluation elements specific to surface electronic brachytherapy were determined at onset. These included a variety of specifications regarding clinical presentation, diagnosis including pathology, informed consent, radiation prescription including dose fractionation scheme, treatment delivery parameters and presence of appropriate clinical documentation. An independent Radiation Oncologist was chosen to review 2 patient charts per month at each location during the validation process between July-December 2014. Pathologic histology presented with Basal Cell, Squamous Cell, Carcinoma in Situ, and Basosquamous in anatomic locations throughout the face, trunk, and scalp (63%, 31%, and 6%, respectively. A dose prescription was present in 100% of patient charts which varied between 500cGy, 400cGy, and 450cGy per fraction (84%, 13%, and 3% respectively). These were prescribed at depths of 2, 3, and 4 mm with 55% most commonly prescribed at 2 mm. Additional data fields such as lesion size, cone size, and cutout type assisted in determining appropriateness of treatment parameters. Conclusion: A cloud-based management platform enables a single Radiation Oncologist to remotely complete peer reviews effectively across multiple non-affiliated locations. The concept of utilizing data systems to complete peer review for surface electronic brachytherapy is feasible and should be introduced in the broader oncology community for data capture and predictive analytics to improve patient care. In the remaining fifteen patients, we defined palliation as relief of the presenting symptom(s) or tumor response by clinical exam or imaging. The Spearman rho test was used to examine the correlation between various clinical factors and palliative response. The most common histology was squamous cell carcinoma (66%), followed by adenocarcinoma of the lung metastatic to the head and neck (13%), non-anaplastic thyroid carcinoma (7%), mucosal melanoma (7%), and adenocarcinoma (7%). The most common presenting symptoms were visual changes (16%), dysphagia/odynophagia (16%), pain (12%), and/or epistaxis (12%). The minimal toxicity profile in these heavily pre-irradiated patients is encouraging and warrants further study. We collected information on demographic, pathologic, and treatment-related variables from medical records. Loco-regional and distant recurrences were assessed using follow-up imaging and exam findings. We examined the association of variables collected with clinical outcomes using Kaplan and Meier methods and Cox proportional hazards models. Sensitivity and specificity for detection of hemodynamically relevant coronary artery lesions were 71. Since quantitative T1 and T2 values are dependent on magnetic field strength and temperature there is a need for evaluation of quantitative values with regard to magnetic field strength and tissue temperatures. The quantitative values were related to temperature and correlated with autopsy and histology findings.